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lki^M@
Gift
Dr. John Adams.
y&r^^.^^'f^^'yy^
COPTRIOHT, 1880,
■T
F. A. DAVIS.
COPTRIOHT, 189S. 1895. 1898,
BT
THE F. A. DAVIS COMPANV.
COPTRIGHT. 1901, 1906,
BT
F. A. DAVIS COMPANV.
tBagUUrtd at SUHomfi' Ilftll, London. Eng.]
Fhilwlelphit, Pa., II. S. A.:
Preu of F. A. Dkrii Companj,
19t4-16 Cfafrrjr Stntt.
• -Sr' ^
THE MANY PUPILS
WHO HAVE ATTENDED HIS LECTURES DURING THE PAST THIRTY-
ONE YEARS AND ARE NOW PURSUING THEIR PROFESSION
IN THE UNITED STATES OF AMERICA AND IN
MANY FOREIGN COUNTRIES
THIS VOLUME,
ILLUSTRATING AN ALL-IMPORTANT AND PRACTICAL
DEPARTMENT OF MEDICINE, PHARMACY,
AND DENTISTRY,
IS
RESPECTFULLY INSCRIBED BY THEIR TEACHER,
The Author.
PREFACE TO THE SIXTH EDITION.
The coincidence afforded by the exhaustion of a vety large edition
of this work, and the publication of a new revision of the United States
Pharmacopceia, has afforded the author an opportunity of making
many additions to the text, which he believes will make it fairly, if
not fully, representative of the present state of therapeutics. The
numerous pharmacopoeial alterations in nomenclature and in the
strength of official preparations, and also the many new titles which
have been added, have necessitated a thorough revision of every page,
particularly in order to make the second part correspond with the
present standards, both of the United States Pharmacopoeia and the
British Pharmacopoeia. Among the notable changes from the last
edition are the following : Part I is entirely added, having been taken
from the limited Students' Edition, thoroughly revised, and completed
by adding a comparative table, giving the changes in the strength of
preparations and relative dosage, in the present Pharmacopoeia and
the one which preceded it. Among the new therapeutic agents will be
observed a consideration of the Roentgen-Ray and the Pinsen Light,
or Actinotherapy, Serumtherapy, Animal Extracts, Vibrotherapy,
Hydrotherapy, etc., etc. Every part has been carefully revised, and,
when possible, condensed, so that, notwithstanding the large addition
of new material, the work has been really increased only by about one
himdred pages altogether. The features of the work which have met
with approval by readers, have been retained. In preparing the present
edition, the author has kept in view, as heretofore, the needs of the
medical student, as well as the physician, and he hopes that it will be
found no less useful to those who consult it than the former editions
which it supersedes. He will be very much gratified, if it will be
deemed, at least in some measure, contributory to the progress of
scientific medicine, and the establishment of rational therapeutics in
this country.
J. V. S.
98104
TABLE OP CONTENTS.
PART I.
Phabmagoloqt.
pAaa
General Considerations Concerning Remedies and Systems of Therapeutics 1
Pharmacology and the Pharmacopoeia 4
IkUteria Hedica 5
Pharmacy 14
Classes of Remedies and Preparations 16
Pharmaceutical Processes 29
Preseription-writing and Formula 43
Poisons and Antidotes 66
General Therapeuticd 70
PART ir.
The Matebxa Medica, ob Phabmageutical Tiiebafeutic Agents, ob Dbuos.
Official Remedies, or Drugs Contained in the United States and British Phar-
macopceias 85 to 926
PART III.
NON-PHABMACAL REMEDIES AND EXPEDIENTS.
EJecfricity in Medicine — ^Electrotherapeutics 927
Physiological Effects of Currents of Electricity 960
Methods of Elactrodiagnosis in Various Nervous Affections 961
Clinical Electrotherapeutics 965
Electrical Foresis 970
Electricity in the Treatment of Paralysis 976
Electrodiagnosis in Paralysis 973
Electricity in Gynecology — the Apostoli Method 981
Application of Electricity in Dermatology 091
Removal of Superfluous Hair — Hypertrichosis • 992
Removal of Foreign Bodies from the Eye with the Electromagnet. . . .- 993
Electricity in Nose and Throat Diseases 994
Electrical Illumination in Medicine and Surgery 998
Kinesltherapy ; Mechanotherapy; Massotherapeutics ; Massage and Rest-cure. . .1000
Technique of Maasotherapeutics and Mechanotherapy 1001
Physiological Effects of Mechanotherapy * 1003
Therapeutic Applications of Mechanotherapy 1006
Massage in General Medical Practice 1009
Synergists with Massage 1014
Contra-indications to Massage 1016
How to Prescribe Massage 1017
Vibrotherapy 1019
Pneumotherapy and Pneumatic Differentiation 1021
Oxygen 1026
Preparation of Oxygen 1026
Physiological Effects of Oxygen 1027
Therapeutic Applications of Oxygen 1027
Apparatus ana Technique of Administration 1030
Ozone 1031
Physiological Effects of Ozone 1032
(vii)
VIU TABLE OF CONTENTS.
Ozone in Medicine
Nitrogen and Nitrogen Monoxide (Nitrous Oxide) ,
Pneumatic Differentiation and Treatment by Inhalation
Medicated Vapors — Atomization — Inhalation
Formul® for Inhalation
Hydrotherapy and Balneotherapy
Physiological Effects of Water
Clinical Applications of Water in the Treatment of Disease
Hydrotherapy in Nervous Diseases
Mineral Springs
Physiological Effects of Mineral Springs
Climatotherapy and Climatology
Climatotnerapy
Choice of Climate for the Treatment or Prevention of Disease
Diet in Disease
Formulae for Special Foods
Predigestion of Food
Psychotherapy ; Hypnotism and Suggestion
Hypnotism
Hypnotism in General Practice
Metalloscopy and Metallo therapy
Heat and Cold as Therapeutic Agents
Heat as a Remedy
Physiological Effects of Hot AppUcations
Therapeutical Applications of Heat.
Physiological Effects of Hot Applications
Therapeutical Applications of Heat
Effects of Abstraction Qf Heat by Cold Applications
Therapeutics of Cold
Light and Darkness
Physiological Effects of Light
Therapeutical Deductions Concerning Light
The Roentgen Rays in Medicine
Radium '
Music
Physiological Effects of Music
Therapeutic Applications
Various Therapeutic Methods More or Less Mechanical and Local in tli
Effects
Acupuncture
Antiseptics
Aquapuncture
Aspiration
Bandaging
Baunscheidtism
Blood-letting and Transfusion
Hypoderraoc lysis
Entcroclysis ; Irrigation of the Bowels, Injectionct, Clysters, and Enematf
Formulse for Enema ta
Rectal Alimentation and Intestinal Inhnustion ,
Setons and Issues
Suspension in Diseases of Spinal Cord and Nerve-stretching in Nerve
Disorders
Nerve-stretching
Formulary for Hypodermic I'se
General Index.
Clinical Index.
PART I.
GEJHEIEAL CONSIDEEATIOITS GOKCEEirma EEHESIES AND
SYSTEMS OF THEILAPEXJTIGS.
Therapeutics, or the treatment of disease, makes frequent use of cer^
tain agents, which are known collectively as remedies. In point of fact,
every preventive, reparative, or restorative means which is, or can be made,
available for the relief of the sick is a remedium, or remedial agent, in a
comprehensive sense of the term. It follows from this that remedies are of
many kinds and of varjing importance ; indeed, they are almost as ntunerouB
and diverse as the causes of disease themselves. The principal olaases of rem-
edies, however, are comparatively few, and these may now be taken up
systematically for consideration. A very important class is composed of
remedial measures which seek to prevent disease, or, if it be already present,
to shield the patient from the effects of unsanitary influences and ftius place
him imder more favorable conditions for recovery than those under which
the sickness originated; such are known as prophylactio, or hygienic,
remedies. They presuppose, on the part of the medical attendant, an
acquaintance with th^ physiological laws of the human body, and of the
effects of food, clothing, climate, occupation, habits, etc., upon its func-
tions, and the skill to apply this knowledge to the individual case. Among
prominent hygienic remedies are dieting, bathing, ventilation, change erf
residence or of occupation, due regulation of habits, . and especially regu-
lated exercises, including gj'mnastics and maSsage. These are sanitary,
prophyl&ctic, or hygienic, agents when employed to preserve health and pre-
vent disease; they become sanatory, or curatiTe, measures when utilized in
conjunction with appropriate medical remedies, as they constantly are, in
the treatment of the sick. In the latter case they are also included under
the comprehensive term regimen. It is now considered of as great, or even
greater, importance to regulate properly the ventilation and temperature of
the sick-room, to direct the bathing and food of the patient, and to decide
whether he shall have rest or exercise, in most instances, than it is to frame
a prescription nicely adjusted to the state of the case, although the latter
15 by no means to be slighted. Light, heat and cold, magnetism, and
electricity are also capable of powerfully influencing the bodily functions,
and, when wisely directed, may produce positive sanatory, or curative, effects.
These imponderable remedies, or forces, as they have been called, are receiv-
ing much attention at the present day. As a result of the profound and
painstaking investigations of many scientists and the careful observations
of expert clinicians, the medical practitioner is now, indeed, for the first
time,, in a position to satisfactorily apply these remedial agents and to
record the results of his studies in exact and scientific terms. Mechanical
remedies include various surgical measures, such as acupressure, acu-
puncture, aspiration, bandaging, blood-letting, etc. ; also the various forme
of gymnastics known under the name of Swedish movements, the move-
(1)
PHARMACOLOOy AXD (UCNEU-VL TUERAPEL'TICS.
mcni cure, passive motion, etc. Laetj but l>y no means the kast it
among remedies which, at. least, are parti)' iiKieluuiical, is massag'e,
attention has been already called as a hygienic agent, and to w
coneideratinn will be given hereafter in a Bpcuial section, under Ki
apy. Finally, there is a class of remedies which are considered of
portance. and are so commonly n&cd in the ircatiiieiit of every con
disease, that they iire popularly termed ''nu'dicine:;"; these proj
drugs, or pharmaceutical remedies. Formerly thoy were divi<
chemical agents and drugs proper, or Galenicals; bnt this distinc
lost its force, since it has been shown that herbs, or "simples," c
medicinal elTecte to **active principles," which are chemical in thai
and which may he isolated and administered separately in order to
the characteristic physiological and therapeutical efTects of tlie dr
Therapcatics (©fpaTt^^a, treatment) considers the apphcation
dial agents to tlie treatment of disease, and the proper care of
Other medical studies are only the foundation, ihcrajieutics is th
structure. As Follicrgill has well said, *Mho ultimate aim of all mc
search is t)ie treatment and prevention of disease." For conveniei
divided into surgical and medical therapeutics. Many systems of t
tics have been formulated in times before the present application
scientific methiHls to the study of the action nf drugs and the investi]
pathological nnd clinical problems, and so-ealled ^'schools of medit
tice"' have been foinidcd thenx)n, which havi' rvow heconie obsolete an
forgotten. Having at length a sound foundation of accumulated la
and experience upon which to rest our practice, we are, at the prea
prepared to base a system of rational therapeutics upon the demo
and established effects of drugs in healtby and diseased conditic
upon onr knowledge of the nature and conrse of morbid processe
human body. The only scientific system possible is one which (1) ei
to remove morbific causes, or render them inoperative; ("2) seeks t
the ravages of disease, or to correct abnormal physiological action; (
to ameliorate the condition of the patient by relieving prominent syj
such as pain, fever, sleeplessness, loss of appetite, etc., and (4) plii
under conditions most favorable to recovery. Symptomatic tr«
which seeks merely to remove symptoms, without investigating theii
is obviously unsatisfactory and imscientific, but occasionally is resi
in an emergency when such s^ymptoms are urgent. Empirical tr
was the only kind of treatment possible before the mode of action
effects of medicines were vmdcrstood; it merely directi^d that certai
cines should be taken for the reason that in apparently similar co:
their, administration had been followed by good results. Owing
fallacious character of the teachings of experience, as pointed out 1
pocrates in his celebrated aphorism, it results that pure, blind em|
abounds in fallacy, and, as a rule of practice, is the poorest s^-stem c
nioTit to follow. Where the knowledge obtained at the bedside, h
IB aided by sufficient acquaintance with the physiological action oi
already referred to, we have mod(»m *'T?ational Medicine." which ali
the patient nil the assistance which science and experience combil
provide towanl hastening and completing his recovery. It is an enlij
empiricism* which is not based on fixed law, bnt is progressively im;
in proportion with advances in other departments of science. Any )
GENERAL CONSIDERATIONS. 3
of medicine assuming tp rest upon a foundation less broad than this, or on
a system which is fixed and stationary, by its own terms separates itself
from scientific medicine, and makes its followers a medical sect, or "school."
In the course of centuries many such schools have been brought to light,
and, after a brief period, have been outgrown and forgotten. Such a fate
is the natural destiny of any restricted system, based upon dogma. The
system of medicine which is studied as a department of natural science,
and which is imrestricted by any hypothesis, or supposed law of cure, in its
application of remedies to the trealznent of disease, will undoubtedly vary
somewhat in its results, according to the individual skill of its practitioners,
the scientific attainments of the time, and the peculiarities of patients ; but
when statistics are correctly compiled from sufficiently large groups of cases
it must be more successful than any restricted system whi(3i has been or can
ever be brought in competition with it. In order to avoid misapprehension,
it may be proper at the outset to e^lain that in the present treatise this
system of scientific, or so-called "regumr," medicine, will be followed. Scien-
tific, or regular, medicine is quite distinct from any school or sect in medi-
cine, and is equally separate from so-called "allopathy*' or "allopathic prac-
tice." As every educated physician knows, there is a radical difference
between "an allopathic doctor" and "a regular practitioner," inasmuch as one
is sectarian and the other non-sectarian. In point of fact, at the present day
there are no allopathic physicians and, of course, no "allopathic" examining
boards, and all followers of scientific medicine should resent the application
of such a sectarian title to designate the regular practice of medicine.
At the same time that we discard restrictions as to therapeutics and
claim the right to employ whatever remedial means experiment and obser-
vation lead us to believe will benefit our patients, it should not be forgotten
that the knowledge at our command is derived from various sources, and if
we are willing to acknowledge the indebtedness of modern medicine even to
native tribes for many useful remedies, we should not be above admitting
the fact that useful lessons may also be occasionally learned from followers
of exclusive schools of medicine, or so-called irregular physicians. "Every
judicious physician," said Dunglison, "must be an eclectic," in the sense
that he selects from every source the best means of controlling disease. In
the ordinary restricted sense, an eclectic is one who confines himself to
vegetable drugs, or, in other words, is a botanic physician, and in this sense
it has been appropriated by a sect of physicians who were formerly known
as Thomsonians, from the name of the founder. In the ranks of regular
medicine, also, there are specialists in therapeutics, some confining their
practice to massage or gymnastics, others to electricity, others again to
bathing, or hydropathy. . The qualified physician or general practitioner
appreciates the value of all the various agencies that are used in treating
the sick, and assigns to each its proper place in his therapeutics, directing
his treatment not against disease, but to the improvement of the health of
3>atients who are, for the time, in a diseased, or abnormal, condition.
A complete cyclopsedia of therapeutic agents should include in its con-
sideration every remedial measure which the best educated and most skillful
physicians employ in treating the sick, giving to each its proper place and
value. As there are separate treatises upon hygiene, dietetics, massage,
balneology, and electrotherapeutics, and the importance of these subjects
warrants their separate treatment, modem text-books of therapeutics are
PHARMACOLOGY AKD OENEUAL THEKAPEl'TlCfl.
usually restricted to treatment solely liy pharmaceutical remedieSjl
Nevertheless, the author hfls given tlun eonaJderation to the other
remetlial agencies, sudi as electrotherapeutics, bytlrolherupeulies
therapy, metalloTherapy, balneology, elimatolog}', and liypuotiBm
which, in the third part of this work, will he found under theii
titles. '
PHAEMACOLOGY AND THE PHARMACOPEIA.
1
Pharmacolo^ ((papuaxov^ *J iiRMlicniiient ; ajul Xoyoc. a trej
broadly speaking, the science of drutrs. One of its branches is ]
oognosy, or the study of their nutural history, their physical and c
characters, tests for purity, etc. Another is Pharmacy, which co
the various methods of conipouuding iind dispensing ilrugs in theii
combinations for the treatment "^f disease. The place wliere m
are dispenscil is also cnlleti a |ihnnnacy. Some aulliors have rcstrit
term '^iihanuacolog}''' to Ihe results obtained from the study of thi
ological a*:tiou of drugs, but this is moru u]>pr«)priately named Ph.
dynamics.
The Materia Mcdica, or collection of ])harinaeologiciil remedies,
divided into crudr drugs and pn^parations. The latter nuiy be DC
conling to established formula*, both olficial and Tion-of!icial, or th
be extemporaneously eonipoiuuh'd, and dispensed, according to thi
tions furnished by a physician. The latter are known as "magistral'
rations; they are comjM>iiiided according to tlic formula contained
prcftcription, of M-hich more will be said pa'scntly. Official P
are those recognized by the Phannacop*eia, The formuhe and di]
for compounding '"'official" preparations are established by the at
of the pharmaef.>poeia. Since this authority does not extend beyc
geograpiiiejil limits of the country to which it belongs, it follo\
England. Franco, Germany, Sweden, and other countries, as well
T'nitcd Sbdes. have pharmaco])icirts of their own, Remedies belonj
each aro distinguished by initials indicating their source; thus TJ.
means T'nited States Phannacnpfria : B. 1\. British Phnrmacopreia;
French PharmacopuMa, or Codex I^IcdieamentariuB; 6. P., German
maeopo?ia; 8. P., Swedish Pluirmacop^cia. In the usual and mod'
ceptation of the term, a phannacopcEia is a medical hook, issued by aid
containing a list of recognized drugs, with drscrif>tions and physica
acters, tests for purity and medicinal activity, and forundic for a<
prcjiarations. The necessity of lia\ ing sonu^ slandard to dcHm- the chf
ffstablisli the purity, and regulate the strength o'f medicinal pn-pnrat
universally conceded. Those countries which do not possess a pha
pteia of their own usually adopt the French Co<lo\', or the British,
United States PharniacopiT'ia. Unfortunately, it may happen that fi
aration will have the same title, hut differ considerably in strength
fercnt p]ianimcopa*ias, such as the tincture of hclladonnn-h'nvcs anc
cially the extract of nconitc. which is a source of error in copying fo
from English, Frencli, or ({ernuin sources, since some preparations ;
United States PharmacopnMa are considerably etronger than the corrfl
ing foreign preparations.
MATERIA MEDICA. O
The Phaimacopceia of the TTxiited States is not issued directly by
authority of the government, as in other countries, although it is adopted
in the medical departments of the army, navy, and marine-hospital service,
and it has been recognized as the final authority upon the purity and prep-
aration of medicinal agents in recent Acts of Congress, It is compiled
as a purely voluntary undertaking by the physicians and pharmacists, in
accordance with the following arrangement: Every ten years repre-
sentatives from medical societies and colleges, pharmaceutical societies and
colleges, and delegates from the Army, Navy, and United States Marine-
Hospital Service, meet in Washington, forming the National Convention
for the Bevision of the Pharmacopoeia. After organization and the disposal
of business, which may come before it, a standing committee on revision is
appointed, which, having received instructions from the convention, pro-
i'pi^s to prepare and publish an edition of the United States Pharmacopoeia.
The first issue was in 1820, and the eighth revision was that of 1905. This
went into effect September Ist of that year and has displaced the former
editions. Important changes have been made in the strength of some
preparations, and a number of new titles have been introduced. It is incum-
bent upon both physicians and pharmacists to follow the present Pharma-
copoeia in prescribing and dispensing drugs, especially in those States in
which it has been adopted as the -legal standard. Many new remedies
had been brought to the notice of the profession since the previous revision,
some of which have come extensively into use and possess decided merit,
others are ephemeral and will soon sink into well-deserved neglect. Owing
to the present degree of activity in therapeutics, it is impossible that the
pharmacopoeia should include all the medicinal agents used by physicians
in the treatment of disease, especially those more recently introduced.
Therefore, a considerable number of unofficial drugs are in use, some of
which will eventually prove their right to be recognized and become official,
while many others will never be able to make good their claim. Proprietary
remedies, or preparations made by secret formulae, are sold very largely to
the public* and are sometimes prescribed by physicians, who appear to be
unmindful of the fact that the Code of Ethics denounces this as a repre-
hensible practice. The prescribing of preparations of unknown composition
is opposed to the best interests both of scientific medicine and of the public.
KATEEIA MEDICA.
The Materia Medioa consists of official and non-official drugs and their
preparations. It has several branches. Pharmacognosy investigates the
p.liysical characters of drugs in order to establish their identity. Medical
botany establishes their place in the vejjjetable kingdom and their botanical
grouping or relationship. Plant-chemistry determines the constituents of
the drug and isolates the so-called active principles; it also teaches the
chemical antidotes. In the United States Pharmacopoeia all remedies are
arranged under their Latin titles alphabetically, and, owing to its conven-
ience, the same plan has been adopted in the present work. A large number
of unofficial, or extra-pharmacopopial, drugs are also considered. It is
possible to adopt also a natural method of classification of drugs or an
6
PHARMACOLOGY AND GEXERAI. TUEHAPEDTICS.
artificial arrangement into classes according to the physiological i
peutical effects. A scheme of the latter kind appears at the concl
this section. The following list comprises most of the drugs in use, i
according to their natural alfmities and chemical characters: —
Inoboanio Materia ilEDicA.
G»orp T. — yott-metals.
Hydrogen. Chlorine (chlorinated lime or cl
Oxygen (ozone, hydrogen dioxide). soda).
Sulphur (hydrogen sulphide). Iodine (hydriodic acid, the iodidea,
Oaroon (charcwvl). Nitrogen (nitrii' acid, etc).
Bromine (liydrobronvic acid). PliosphorviH (pliuwphoric add).
Group U. — Metala (u) r/f the AJkaOcs and Atkalhw Earths.
Monml Mt'iaJs. — Potaasium, Sodium, Lilhium, Ammonium,
Dyad MctaU. — Calcium, Strontium, Barium, Aluminum, Magnesiuni, 2
per, Cadmium, Silver, Mercury.
(hj The Heavy Metals.
Triad MetaU. — Thallium, Iridium, Gallium.
Tetrad Metals.— heeid, Tin.
Fi'titad Metfjh. — PhoRphorus, Arsenic, Biftniut.h, Antimony.
Besad .1/f//;/*.— Chromium, Tungsten, Molybdenum.
Heptad Metals. — Manganese.
Vnclassified Metals.— Iron, Nickel, Cobalt, Platinnm, r^old.
Organic Materia Medica.
Grocp T. — Carbon Compounds.
(a J ALIPHATIC, OB TATTY SERIES.
Flydrociirbona.
Benzinum.
Petrolatum.
Acetone.
Alcohol (ethylic, raetbylic,
amylic).
Aldehydes (ethylaldehyde,
paraldehyde, and for-
maldehyde).
Carbolic nt id, or Phtiiol.
Creosotum.
Guaiacol.
Resorcinol.
MethylthioiiiniE hydro-
eld oridum.
Pyrocatechin.
Ether.
Ethereal oil.
Ethylohloride.
Amyl nitrite.
Acetic ether.
Glycerylis nitrns.
Ethyl-bromide and iodide.
Chloral-hydrate.
Bromfll-hydrate.
(b) ABO^LATIC SEBIBS.
Salicylic acid.
Naphthnlenum.
Ttctanaphthol.
Cbinolin.
Kairin.
Antipyrina (phenas^onum).
Phenylis salicylas.
Ethyl carbamate.
Methylis aalicylaa.
Chloroform.
Chloralformamiduni.
Iodoform.
lodoL
Sulphonmetlianum.
Hexamethylenamtna
Sulphonethylmcthan
Acetanilidtim.
Acetphenetidinuui.
Benzol.
Creaol.
Toluol.
Benzoic add.
Pvridina.
Group U.— Vegetable Materia Medica,
SUBKnVGDO&t I.— PHANEROGAM.^.
1 CIJ^.«6 I. — KXOGE.Vfl.
DIVISION I. — A?rOI08PEBiC«.
SUBCLASfi I. — TUALAJtflFLOlLB.
yaturnl Order. Namr. Synonym.
Banunculaces. Ranunculus, Crow-foot, buttercup,
Aconitum, Monk's-hood.
^^^^^^^^ ^^H
MATERIA MEDICA.
yatural Order,
yame.
Synonym.
Ranunculacea [continued).
Staphisagria,
Stavesacre.
■r i_
Delphinium,
I^irkapur.
Pulsatilla,
Meadow-anemone.
Cimiciluga,
Black cohosh.
Podophyllum,
Hydrastis,
May-apple.
Golden seaL
MtgnolUooB.
Magnolia,
Ehcium,
Magnolia.
Star -anise.
Menispennacea.
Menispermum^
Calumba,
Canadian moon-seed.
Columbo.
Pareira.
Pareira,
Picrotoxinum,
Cocculus Indicus.
BerberidacMB.
Caulophyllum,
Blue cohosh.
Poppy.
Bloodroot.
Celandine.
Papaveracefie.
Papavcr,
Sanguinaria,
Chelidonium,
Crucifene.
Sinapis,
Armoracia,
Mustard.
Horse-radish.
Violaccffi.
Viola,
Pansy,
Linee.
Linum,
Flaxseed.
Geraniacece.
Geranium,
Crane's-bilL
PolTgalefie.
Senega,
Senega.
Krameria,
Rhatany.
Saptndacess.
Guarana,
Paullinia.
EiythroiylacefiB.
Krythroxylon,
Coca.
MalTteen
Gossypium,
Cotton.
AIth»a,
Marshmallow.
Anrantiacee.
Aurantium,
Orange.
Limones,
Lemons.
SterenliaceflB.
Theobroma,
Cacao.
Sterculia,
Kola.
TenistroemiaceflB.
Camellia,
Tea.
GnttiferflD.
Cambogia,
Gamboge.
CaneUa4!ee.
Canella,
CaneUa.
Vitaces.
Uvae passae.
Raisins.
Vina,
Wines.
ZTgophylle©.
Guaiacum,
Guaiac.
M^iilMk
Azedarach,
Pride of China.
Botaeen. Rutese.
Ruta,
Rue.
Cusparia,
Angostura-bark.
•
Bergamum,
Bergamot.
IHosmca.
Buchu,
Buchu,
Xanthoxy'.e«e. Xanthoxylum,
Prickiy ash.
Pilocarpus,
Jaborandi.
SimarnbcM.
Quassia,
Quassia.
suBCZiAee ii. — caltciflors:.
yatural Order.
yame.
Synonym,
Bhamnacee.
Rharanus purshiana,
Cascara sagrada.
Rhamnus frangula.
Buckthorn
Celafitrineffi.
Kuonymus,
Wahoo.
Aquifoliaceae.
Prinos,
Alder.
Anacardiete.
Mastiche,
Mastic.
Rhus glabra,
Sumach.
Rhus toxicodendron,
Poison-ivy.
Borseracen.
Myrrha,
Myrrh.
LegnmhioMBi Papilionaceje. Glycyrrhiza,
Licorice.
Scoparius,
Broom.
Tragacantha,
Tragacanth.
PHAUMACOLOGY AND OENEttAL THEHAPEUTICS.
Natural Order.
Name.
Stfnonjfm.
Leguminoste.
Fapilionaces
Santftlum,
Saunders.
(continued).
Kino,
Kino.
Balsamura Peruvianum,
Balsam of Peru.
Balftanium Tolutanum,
Balaam of Tolu.
Abrua,
Jequirity.
Physostigma,
Calabar bean.
Htematoxylon,
logwood.
Krameria,
Rhatany.
ChrvBarobinum,
Chrysarobin.
Ceesalpinae.
Senna,
Senna.
Cassia,
Purging cassia.
Tamarindus,
Tamarind.
Copaiba,
Copaiba.
Piscidia,
Jamaica dogwood.
Mimosese.
Acacia,
Gum arabic.
ErythrophlfiBum,
Sassy-bark.
Indigo,
Indigo.
Rosaceaa.
Pomese.
Cydonium,
Quince.
Rubns,
Blackberry.
''>ryadeeB.
Rubus idceus.
Raspbern'.
Aosese.
Rosa,
Rose.
Cuaso,
Kousso.
Quillaja,
Soap- bark.
Amygdalece.
Amygdala dulcis.
Sweet almond.
Amygdala amara,
Bitter almond.
.
Prunua,
Prune.
Prunus Virginiana.
Wild cherry.
T^urocerasus.
Cherry-laurel.
Papayaceee.
Passiflorse.
Carica papaya.
Papaw.
Myrtaceee.
Caryophyllus,
• Cloves.
Pimenta,
Allspice.
Chekan,
Cheken,
Myrtus,
Myrtle.
Cajuput,
Cajeput.
E^ucaJyptiis,
Blue gum.
Oranatum,
Pomegranate.
Cucurbitacese
.
Colocynth,
Bitter cuctimber.
Klaterinm,
Squirting cucumbei
Ppno,
Pumpkin.
[mne
"Rrvonia,
Bryony ,
Umbellifer».
Carapylosper
- Coniiim.
Hemlock.
.
; 'Orthoaperma
>. Asafostida,
Asafetida.
Galbanum,
Galbanum.
Ammoniacum,
Ammoniac.
T^opnicuhim,
Fennel.
Anisum.
Anise.
Anethuni,
Dill.
(^arum.
Caraway.
Sumbnl.
Musk -root.
Coelospermee.
Coriandrum,
Coriander,
srncLASs in.— corolltflor^.
Natural Order.
Name,
Spnonfw
Caprifoliaceee.
Sambucus,
Klder.
Cornaceffi.
Cornus,
DogAvood.
Rubiacee.
C^inoboneiP.
Cinchona,
Cinchona bark.
CoffefiB.
Coffea.
Coffee.
Gambir,
Gambir.
Enuragoga. Ipecacuanha,
Ipecac.
MATERIA MEDICA.
Natural Order,
Valemnett.
Capzifoliaceee.
Composite.
Lobeliacece.
Ericacese.
Sapotacee.
StyracoB,
Oleteeae.
I»guuace«.
ApocTnaceee.
Asclepladee.
Oentkztee.
Conrolrulacen.
Chenopodiacefls.
Solanacee.
^Tophu]ariac«.
Labia ts.
Pedaliacett.
Name.
^'aleriaIl,
Viburnum, ,
Pyrethrum,
Absinthium,
Tanacetum,
Saotonica,
Anthemis,
Matricaria,
Eupatorium,
Taraxacum,
lActuca,
Arnica,
Calendula,
Grindelia,
Inula,
Lappa,
XiObelia,
Uva ursi,
Chimaphila,
Gaultheria,
Gutta-percha,
Benzoin,
Olivee oleum^
Manna,
Xux vomica,
Ignatia,
Gelsemium,
Spigelia,
Apocynum,
Aspido sperm n,
8trophanthus,
Asclepias,
Hemidesmus,
Condurango^
Gentian,
Chlretta.,
Scammony,
Jalap,
Chenopodium,
Scopola.
Capsicum,
itelladonmt.
Hyoscyamus,
Stramoniiun,
Tobacco,
IMgitalia,
Ijq)tandra,
Kosmarinus,
Lavandula,
Mentha piperita,
Mentha viridis.
Thymus.
Hedeoma,
Marrubium,
Melissa,
Origanum,
Salvia,
Scutellaria,
Sesami oleum,
Hynonym,
Valerian.
Black haw.
Pellitory.
Wormwood.
Tansy.
Santonica.
Chamomile.
German chamomile.
Thoroughwort.
Dandelion.
Lettuce.
Leopard*a-bane.
Marigold.
Grindelia.
£:ecampane.
Burdock.
Indian tobacco.
Bearberry.
Pipsiasewa.
Wintergreen.
Gutta-percha.
Benzoin.
Olive-oil.
Manna.
Nux vomica.
Bean of St. Ignatius
Yellow jasmine.
Vink root.
Canadian hemp.
Quebracho.
Strophanthus.
Pleurisy-root.
Indian sarsaparilla.
Condurango.
Yellow gentian.
Chirata.
Scammony.
Jalap.
American worm-seed.
Scopola.
Red pepper.
Deadly-nightshade.
Henbane.
Jamestown weed.
Tobacco.
Fox-glove.
Culver's physic.
Rosemary.
Lavender.
Peppermint.
Spearmint.
Thyme.
Pennyroyal.
Horehound.
Balm.
Wild marjoram.
Sage.
Skull-cap.
Benne oil.
10
PHABMACOLOGY AXD GENERAL THERAPEUTICS.
Natural Order,
Polygonace®.
Phytolacca cesB.
Myristicacese.
LaurineflB.
AristolocbUceflB.
Santalacese.
Thymelaceee.
EuphorbiacbsB.
FiperacesB.
Salicaceee.
Juglandaceea.
Hamamelacen,
CupuUfena.
UrticaceflB.
Ulmett.
Moren.
Artocatpen.
Cannabmeo.
SUBCLASS IV. — APETAL^.
yame.
Kheum,
Rumex,
Phytolacca,
Myristica,
Macis,
Omnaraomum,
Camphora,
Sassafras,
Goto,
^rpentaria,
Asamm,
Santali oleum,
Mezereum,
Elastica,
Cascarilla,
Stillingia,
Tiglii oleum,
Ricinus (oleum),
Eamala,
Piper,
Cubeba,
Matico,
Salix,
Juglans,
Hamametis,
Styrax,
Quercus,
Castanea,
nmuB,
Mortis,
Ficus,
Cannabis Indica,
Cannabis Americana,
Humultis,
Synonyn,
Rhubarb.
Yellow dock.
Poke.
Nutmeg.
Mace.
Cinnamon.
Camphor.
Sassafras.
Coto.
Snake-root.
Canada snake-root.
Sandal-wood oil.
Mezereum.
India rubber.
Sweet wood.
Queen's root.
Croton oil.
Castor-oil.
Rottlera.
Pepper.
Cubebs.
Matico.
Willow.
Butternut.
Witch-hazel.
Storax.
Oak.
Chestnut.
Elm.
Mulberry.
Kg.
Indian hemp.
American hemp.
Hops.
DIVISION II. — QYMNOSPKBM^.
yatural Order,
Coniferse.
Natural Order.
Smilaceffi.
LiliacesB.
Melanthacese.
Otchidece.
ScitamlnesB.
yame,
Pinus sylvestris,
Abies excelsa,
Abies balsamea
Pinus palustris.
Thuja occidentaJis,
Jumperus communis,
Juniperus oxycedrus,
Jimiperus sabina,
Serenoa serrulata,
CLASS II. — ENDOOEN8.
Xamt:
Sarsaparilla.
Allium,
Scilla,
Aloe,
Veratrum viride,
Colchicum,
Sabadilla,
Vanilla,
Cypripedium,
Zingiber,
Synonym,
Scotch fir.
Spruce fir.
^Isam fir.
Turpentine pine.
Arbor vitae.
Juniper oil.
Cade oil,
Savin.
Saw-palraetto.
Synonym.
Sarsaparilla,
Garlic.
Squill.
Aloes.
Green hellebore.
Meadow- saffron .
Cevadilla.
Vanilla.
Ladies'-slipper.
Ginger.
MATERIA MEDICA.
11
yatural Order,
Name.
Synonym,
SeiUminese (continued).
Cardamomunif
Cardamom.
Irides.
Iris,
Blue flag.
Crocus,
Saffron.
Falmacem.
Areca,
Betel-nut.
Aroidee.
Calamus,
Sweet flag.
GraminefiB.
Farina tritid.
Wheat-flour.
Avens farina.
Oatmeal.
Amylum,
Starch.
Triticum,
Couch-grass.
Hordeum,
Barley.
MaJtum,
Barley-malt.
SUBKINQDOM U. — CBYPTOOAlld.
yatural Order.
Name.
Synonym.
nUces.
Aflpidium,
Male fern.
Liehenes.
Cetraria,
Iceland moss.
Litmus,
litmus.
Pongl.
Ergota,
Brgot of rye.
UstUago,
Corn-smut.
Alga.
ChondruB,
Irish moss.
Group III.— AnimoZ Kingdom.
Cla$8.
Order.
Name.
8ynonym.
yUmaaii$L
Rodentia.
Castoreum,
Castor.
Rtuninantia.
Moschus,
Musk.
Serum antidiphtlieriticum,
Diphtheria antitoxin.
Glandules suprarenaSes
siccfB,
Dried ftuprarenid glands.
Glandulffl thyroidea aicctB,
Dried thyroid gUmda.
■'
Sevum.
Suet (mutton-suet).
'
Adeps lans.
Wool-fat (purified).
Gelatinum,
Gelatin.
Carbo animalis.
Bone-charcoaL
Fel boTis,
Ox-gall.
PachydennaU. Adeps,
Lard.
Pepainum,
Pepsin.
Pancreatinum,
Pancreatin.
Cetacea.
Spermaceti,
SpermacetL
%g (of domestic fowl)
Ares,
GalliiUB.
Ovum,
Pisces,
Sturiones.
Tdeoetei
(gadidsB),
Ichthyoeolla,
Isinglass.
f
Morrhuffi oleum.
Codliver-oil.
Iiuecta,
Hymenoptera^ Mel,
Honey.
Cera,
Wax.
HemSptera.
Coccus,
Cochineal.
Coleoptem.
Cantharis,
Spanish fly.
Hrimhitlie%
Annelida.
Sanguisuga, or hirudo.
Leech.
In the above comprehensive scheme^ which is essentially that of
Lauder Braton's "Pharmacology," remedies are arranged with reference
to their natural afiSnities, and in this classification relaHonships are mani-
fested which ordinarily might be unnoticed by the student. It will be
observed that drugs are derived from various sources, and vary greatly in
their properties, physical and chemical. They all agree in one attribute,
however, which is of influencing bodily functions in such a maimer as to
12
FHABUACOLOOY AND GENERAL THEBAPEDT1C8,
make them useful in the treatment of diseased conditions. The nature of
these effects and the manner of their manifestations it will be the purpose
of the following pages to show, especially in Part II, where drugs are dis-
cussed individually and in detail.
SCIBKTIFIC SyNOXYMS OF NeW EeMEDIES.'
3Iost of the remedies of recent introduction bear names which give little
or no clue either to their chemical composition or therapeutical properties.
In preparing the following list of synonyms an effort has been made to give
the correct chemical designation of the drug named, as well as the brand,
or trade, name adopted by the manufacturers, and it is hoped that the list
will prove useful to those who have calls for such remedies under their
chemical titles.
Scientifie .Vnme. Trade Yamr.
Acetamidosalol Salophen
Acetphenetidine Phenacetin
Acetphenone Hypnone
Acetylaalicylic acid Aspirin
Acetylsalicylic acid Acftyaal
Acetylaalicylic acid Xaxa
Acetyltannin Tannigen
AcetyUalol Spiroforin or Vesipyrin
Albumin iodoform lodoformogen
Aluminum carbonate Alchol
Aluminum naphtholsulphonate. .Alumnol
Amidopyrine Pyramidon
Amylene hydrochloride Stovaine
Ammonium ichthyolsuJ-
phonate Ichthyol, Thiolin
Ammonium ichthyolaul-
phonate Ichthosan
Ammonium ichthyolsulphonate . .Thigenol
Amylum formaldehyde Amyloform
AnUpyrine acetybalieylate. . . , . Acopyrin
Anhydromethylene sodium
citrate Citarin'
Amylene chloral Dormiol
Antipyrine, caffeine citrate. . . .Migrainin
Antipyrine-ferric chloride Ferri pyrin
Antipyrine-ferric chloride Ferropyrin
Apomorphinbrommethylate .. .Euporphin
Arffentum (See Silver.)
Atropin methylnitrate Eumydrin
Benzolylacetyl peroxide Acetozone
BenzoBUlphinide Saccharin
Benzoyl guaiacol Bcnzozol
Benzylmorphine hydrochloride. .Peronine
Beta-eucaine mandelate Euphthalminc
Biiimuth albuminate Bismuthose
Biftmiith cinchonidindiiodide ...Ervthrol
Bismuth dithiosalicylate Thioform
Bifimuth fluorbromphonyl . , .- Fluotal
Bismuth oxiodogallate '. Airol
Bismuth bctanaphtholate Orphol
ftcienfific Xame. Trade Yamr.
Bismuth methylene digallate Bismal
Bismuth subgallate Dermatol
Bismuth chrysophanat^ Dermol
Bismuth cinnamylate Hetof orm
Bismuth bilactomonotannate ..Lactanine
Bismuth pyrogallol Helcoaol
Bismuth phosphate Bisol
Brominized oil ". Bromipin
Bornyl valerate Hysterol
Butipyrine Trigemine
Codeine brommethylate Eucodeine
( 'alcium beta naphtholsulphonate . Asaprol
Copper nucleinate Cuprol
Casein sodium Nutrose
Chloral ethylcarbonate ....... .Uralium
Chloralformamide Chloralamido
Cotamine hydrochloride ytypticin
Cotamin phthallate Styptol
Creosote carbonate Creosotal
Oeosote carbonate Ciba
Creosote salicylate Salocreol
JMacetyl morphine Heroin
Didymium salicylate Dymal
Diethylbarbituric acid Veronal
Diethylmaionylurea Veronal
Diomidophenol hydrochloride Amidol
Diiodomethyl salicylate Sanoform
Dioxybenzol-hexa-
methvlenamine Hetralin
EUagic" acid , Gallogen
Ethyl carbamate Urethane
Ethylene |)eriodide Diiodoform
Elixir chloreethanal alcoholate. . .Somnos
Ethylmorphine hydrochloride Dionin
Ethyl salicylate Sal-etliyl
Ethylidene diethylether Acetal
Kthyl rhioridc Kelene
Epineplirin hydrate Adrin
Ferralbumin Ferratin
(ielatin formaldehyde Glutol
^ From the Rejwrt of the Committee on New Remedies of the Xew York State
Pharmaceutical Association for 1900. Amcnran Dntffgist, 1906, pnge 36.
MATERIA MEDICA.
13
Hcientific Name. Trade A'ame.
Gelatoee silver Albargin
Guiiacol albuminate Histosan
Guaiacol cacfxlylate Cacodyliacol
Guaiacol benzoate Benzosol
Guaiacol carbonate Duotal
Guaiacol cinnamate Styracol
Guaiacol salicylate Guaiacol-salol
Guaiacol valerate Geosot
Hexamethylenamine-anhydro-
methyleiie citrate Helmitol
Hexamethylenamine Aminoform
Hexamethylenamine Urapurgol
Hexamethylenamine. . . .
Ammonio-formaldehyde
Hexamethylenamine Cyatamine
Hexamethylenamine Cystogen
Hexamethylenamine Formtn
Hexameth-vlpnamine Uritone "
Hexamethylenamine Urotropine
Hggamrethylenamine-BalicylaAe. ,
Saliforniiu
Hexamethylenamine-ethylbromide. .
Bromalin or Bromoformin
Hexamethylenamine- tannin Tannopin
Hexamethylenamine-quinate. Chinotropin
Hexamethylenamine-quinate Chinoformin
Hydrargyrum colloidale Hyrgol
Iron nucleinate Ferratogen
Ichthyol albuminate Ichthalbin
Ichthyol formaldehyde Ichthyoform
Iron paranucleinate Triferrin
lodochloroxychinolin Viofonn
Iodized oil lodipin
Isobutylorthocresol-iodide ... .Europhene
Lactylparaphenetidin Lactopnenin
Lithium quinate Urosine
Lithium benzoate Uristamine
Limonin Citarin
Menthol valerate Validol
Methylacetanilide Exalgin
Methylene bromtannin Bromotan
Methylene dicotoine Fortoine
Methvlene-ditannin Tannoform
Methylmorphine Codeine
Metbylthionine hydrochloride
Methylene blue
Mercury, colloidal Hyrgol
Mercury nucleinate Mercurol
Mercuric ethylenediamine
iiulphate .Sublamine
Methylzanthin sodium
acetate Theocine-sodium acetate
Methylenehippuric acid Hippol
MoDorhloral-antipyrine Hypnal
Xaphthalol .Betol
Xaphthol salicylate Betnl
Xaphthopalol /. Betol
Scientific Name. Trade Name.
Nicotine salicylate .Eudermol
Piperazine quinate Sidonal
Faramidophenol hydrochloride ..Rodinal
PvTocatecnindimetnyl-ether Veratrol
Phenylurethane Euphorin
Fhenetidine citrate Citrophen
Potassium-creosote
sulphonate Sulphosote
Potassium-guaiacol sulphonate. ..Thioeol
Potassium-guaiacol
sulphonate Kasucolum
Potassium ortho-oxy-
chinolinsnlphonate Chinosol
Pyrogallol monoacetate Eugallol
Pyrogallol triacetate LenigaJlol
Kesorcin monoacetate Buresol
Quinine guaiacol blaulphonate. .Guaiquin
Quinine ethyl carbonate Euquinine
Quinine ethyl carbonate. .... .Aristochln
Quinic acid anhydride Sidonal, new
Quinine-phenetidine ethyl
carbonate Chinaphenin
Silver citrate Itrol
Silver citrate Antiseptic Cred6
Silver, cot loidal CoUargol
Silver ichthyolsulphonate ... .Ichthargan
Silver lactate Actol
Silver proteinate Protargol
Silver proteinate Novargan
Silver protalbin Largin
Sodium acid oleate Eunatrol
Sapocarbol Lysol
Sodium oxycyanocinnamate ...Zymphene
Sodium lygosinate Lygosine
Sapocresol Creoline
Sodium perborate Euzone
Sodium pyrocatechin
monoacetate Guaiacetin
Sapof ormal Lysoform
Succinic peroxide Alphozone
Sulphonethylmethane Trional
Sulphonmethane Sulphonal
Tannin albuminate Tannalbin
Tetraiodopyrrol lodol
Theobromine sodium acetate ...Agurine
Theobromine sodium
salicylate Fibrolysin
Thyminic acid Solurol
Theobromine sodium salicylate. .Diuretin
Thymol carbonate Thymotal
Thymol iodide Aristol
Thymol iodide Annidalin
Thymol iodide Thymotol
Tribromphenolbismuth Xeroform
Urea salicylate Ursal
Zinc phenolsulphonate. .
Zinc sulphocarbolate
14
PUABALACOLOOY AND GEKEIUL THERAPEUTICS.
PHARMACY.
Pharmaceutical Nomenclature and Classification. — In evurv 8c
is necesary to ruHow some system of naming the objects under co,
tion, and if this be done carefully it is a great assistance to its sti
avoids much conftision. ConimoD names, being used by persoi
possess but slight knowledge of the enhject, are likely to be frequeni
applied and are not sutiiciently distinctive. For instance, nitre ma
sodium carbonate or sodium nitrate, as well as potassium nitrate, v
the proper chemical title. Milk-weed designates any common plant
a milkj'^ juice, whereas the name Asclepias tuberosa always serves to i
a species of asclepias, without confusion or error. Sciextific nai
therefore not adopted witli the object of making the study of a subje
difficult to the beginner, but really with the view of making its c
hension more easy after he has mastered the details of its techniq
nomenclature. It is absolutely necessary for the student of materia
to have a knowledge of botanical and chemical terms. In the consid
of drugs in the present work, every ollloifil drug appears under the titl
Latin chemical or botanical name, with the letters U. S. P. nr B. P.
the common name or synonym is also given. In the case of plants t
botanical name and natural order are usually stated, following tlie
States Pharmacopoeia. The scientific, or botanical, title is gh,
Latin so as to avoid mistakes, as this is the name by which it wc
recognized all over the world, and by which it may easily be idei
whereas, the same common name may be applied to plants of di
species having very different physiological actions and medicinal effect
common language the English name of the remedy is to be used,
prescriptions the Latin pharmacopceial name shoiild always be emj
Further remarks u}>on prescription-writing will be found at the end ■
section. It is to be understood that throughout these pages the
U. S. P. after the name of a drug, preparation, or formula indicate tl
that it is recognized by the United States Pharmacopncia. and is
wherever this authority is acknowledged. B, P. similarly indicates tt
remedy or preparation is official in the last edition (1898) of the 1
Pharmacopoeia.
The nomenclature of the United States Pharmacopoeia ia based
the following rules adopted by the Convention of 1800, through its
mittee on Revision, which have also been followed in the more
edition.
"In the choice of titles of official articles the principle governs tha
vonience, established custom, and consideration of safety against mi
tlirough similarity or changes in names, should outAveigh purely theoi
considerations or scientific preciseness. In tlie designation of chemical
pounds (oxides, salts, etc.), put the hasylous or metallic component
viz.: sodium chloride, silver nitrate, lithium bromide, lead oxide, et<
stead of writing chloride of sodium, nitrate of silver, bromide of lit!
oxide of lead, etc. In the case of the salts of iron and mercury this d
FHARKACY. 16
inTolves also the use of the respective terms in ous and tc (ferrous and
ferric, mercurous and mercuric) which greatly help to distinguish salts
heretofore frequently confounded. As a matter of precaution, however, the
distinguishing adjectives, 'corrosive,' 'mild,' ^yellow,' 'red,' etc., have been
left in the titles of the respective mercury compounds; for instance, 'Corro-
sive Mercuric Chloride,' 'Mild Mercurous Chloride,' etc. In the case of
complex iron preparations such as the so-called scide salts (Ferri et Am-
monii Citras, Ferri et Ammonii Tartras, etc.), which are not true chemical
salts, yet all of which contain the iron in a ferric condition, the word- iron
was left unchanged, to avoid the impression that they are definite, double
salts." These changes in nomenclature were retained in the Eighth Be-
vision. In addition a few synthetic remedies were introduced, such as anti-
pyrine, sulphonal, phenacetin, and formin^ under their (condensed) chemical
titles- Also a few organic remedies were made official.
Pharmacentical Classes of Bemedies.
ACIDA — ^ACIDS.
Two degrees of relative concentration are usually recognized, and in
one case (acetic acid) there are three. The dilute acids are all of uniform
lO-per-cent. strength, — one-tenth acid and nine-tenths water, — except di-
lute nitrohydrochloric, which contains only 7 per cent., and dilute acetic,
6 per cent, while the aromatic sulphuric acid contains 20 per cent, of the
official acid, and dilute hydrocyanic acid contains only 2 per cent, of abso-
lute hydrocyanic acid. The official Acids are : —
1. IxroBOAinc.
fa) Liquid Aiid9:-~ (a) Liquid Adda (continued).'^
Addmn hydrobromicum dilutum. AoSdum nitrohydrochloricum dilutum.
Aeidum hydrocliloricuin. Acidum phosphoricutn.
Acidum hydrochloricuro dilutum. Acidum phoAphoricum dilutum.
Acidum hydriodicum dilutum. Acidum Bulphuricum.
Acidum hypophoapfaorosum. Acidum sulphuricum dilutum.
Acidum hypophoaphorosura dilutum. Acidum sulphuricum aromaticum.
Acidum nitricum. Acidum sulphurosum.
Aeidum nitricum dilutum.
Acidum nitrohydrochloricum.
(h) Solid Acid:—
Acidum boricum.
2. Oboanic.
(aj Liquid Adda:— (h) Solid Adds:—
Acidum aceticuiu glaciale. Acidum bemsoicum.
Addum aceticum. Acidum camphoricum.
Acidum aceticum dilutum. Acidum citricum.
Acidum hydrocyanicum dilutum. Acidum gallicum.
Acidum lacticum. Acidum salicylicum.
Acidum oleicnm. Acidum stearicum.
Acidum tannicum.
Acidum tartaricum.
Acidum trichloraceticum.
^^V 16 PUABMACOLOOY AND
GEXEIUL TIIKRAPEUT1C3.
^^^^^H The ofticial Alkaloids are : —
^^^^^^H Aconitina.
Morpliinfle aeetas.
^^^^^^H Apomurpliime hydrochtoritiunir
Morphiuoe hydroehloridunu
^^^^^^H
\lniphimp siilphaa.
^^^^^^ Atropinn^ sulphas.
Peiletieniiffi tannas.
^^^^H CalFeina.
Physoati^minoj siilioylng.
^^^H citrRUi.
Pliyfto^itipmime sulphas.
^^^H Caffeina citrula elKu'vettceiiH.
I*iloettrpime hydrochlnridun
^^^H Cinohoninic stilphafi.
IMloi'iirpiiui? niti-us.
^^^1 Cocama.
Quinina. i
^^^H Cooaiiim hydrouliloridum.
Quiuimc hUulphas. '
^^^H Codeina.
On in imp hyrlrobTomidum.
^^^H Codeini? phnnpUas.
Qnininn? hydrnebloridiim.
^^^H rodoiiifp *^ii]p1iA4.
Qurninio finlieyln^.
^^^^H Coli-hk-ina.
QuininiP BulphaB,
^^^^H Homntroptnip hydrnbroniidum.
Scopolnminr* hydinbramidu]
i^^^H ITyilraAtinip.
Sparteinflp sulpha-^.
^^^^H Hydraj*tininffi hydrnrhloridiim.
Strychnina.
^^^H H^'osoinie hydri^brnmithini.
Stri-elinime nitras.
^^^^B Hyospynminn^ )iydrn1>ronitduTn,
Str;vehnimB sulphas.
^^^^1 HvoAryATnin«e siilpliaa.
Veratrina.
^^^^^^ Morphina.
^^^^^^
Pri
Nt'IPI.Efl.
^^^^1 Cbry^flrobmum.
Piperiinim.
^^^H Elateriniim.
Salifinum.
^^^^^^^ Gljoyrrlii/.innni niiinioniatum.
Santoninum.
^^^^V
^^^^^^ 1. EXPOESfiED
OR
Fixed Ott-s.
^^^B Oti?um adfpip.
Oleum nlivR*.
^^^^1 OUnini nmyf2dfll(c cxpreasum.
Olf'Tim ricini.
^^^^f Otonm ;ro?6ypii oominH.
Oleum tbeoliromatis.
^^^1 Oleiim lini.
Oleum tijrlii.
^^^^^^ Oleum morrhiue.
^^^^^^ 2. DiSTIIXKD OR V^OIJiTILE OlT,a.
^^^H Oleiun amy^dalee aiuarfie.
Oletim beileomra.
^^^^1 Oleum anisi.
Ofpinu iiiniperi.
Oleum lavHudulfp florum.
^^^^1 Oleum aiinintii cortiels.
^^^H Oleum botiOns volatile.
Oleum limonis.
^^^H Oleum
Oleum iiienthiE piperiteo.
^^^H Oleitm eHJupuU.
Oleum mprulire viridia.
^^^H Oleum
Oleum myri>tie*p.
^^^H Oleum I'liryophylli.
Oli'um piris liquiilne.
^^^H Oleum eheuopodii.
Oleuru pimentnp.
^^^^H Oleum finnnmoii]!.
Oleum rnsm.
^^^^1 Oleum onpaibm.
Oleum rosmarini.
^^^^^ Olpum eorinndri.
Oleum sabinnp.
^^^^B Oleitm eiihehfp.
Oleum »antaJi.
^^^^1 Oleum erifTcrontia.
Oleum sassufras.
^^^^B Oleum
Oteiim ftinapis vidfttilp.
^^^^1 OTeum ftpnieuli.
Oleum tereWntbiuro.
^^^H Oleum gaultherirr.
■
Oleum terebiutbinoR reettfica
Oleum <hymi.
PHARMACY.
17
Pharmacopceial Pbeparations.
The U. S. Pharmacopoeia presents thirty-six classes of official prepara-
tions:—
Latin.
EnglUh.
1. Acetum.
[Gen.
sing.
, i Nom.
pi.,
a
Vinegar.
2. Aqua.
u
M
w
tt
H
w
1 Water (aromatic).
3. Cataplaama.
I "
*«
atia
.<
(.
ata ]
Poultice.
4. Ceratum.
[ "
tt
i
u
1*
a
1 Cerate.
3. Ch&rta.
[ "
tt
fp
tt
tt
<B
1 Paper.
6. CoUodium.
1 •(
M
i
u
It
a
1 Co lodion.
7. Confecto.
u
tt
i
it
tt
a
1 Confection.
8. Decoctum.
not declinable
> Decoction.
9. Elixir.
G^n.
sing.
. i Nom.
pl.,
a
I Elixir (cordial).
10. Bmplastrum.
1 it
11
i
tt
It
a
1 Plaater.
11. Emulflom.
r •<
fi
i
u
tt
a
1 Emulsion.
12. Eztraetum.
ti
tt
i
It
tt
a
Extract
13. Fluidertractum.
tt
tt
i
tt
tt
a
Fluid Extract.
14. Gljceritum.
1*
tt
i
It
It
a
Glycerite.
15. Infnsnm.
' U
tl
i
tt
It
a
' Infusion.
16. Linimentum.
\ u
tt
i
t*
tl
a
) TJniment.
17. Liquor.
*•
tt
oris
tt
tt
ores
Solutiop.
18. Massa.
(.'
*t
at
tt
i*
a?
Pill-mass.
19. Mel.
tt
tt
lis
tt
U
Hia
Honey.
> Mixture.
20. Mistunu
tt
tt
m
tt
11
<e
21. Mttdlago. 1
tt
It
inia
tt
*l
ines]
Mudlage.
Oleate.
32. Oleatum.
tt
ft
i
It
tt
a
23. Oleoresina. i
tt
ft
tF.
tl
tt
(B )
Oleoresin.
24. Pflula.
M
tt
<r
*t
tl
« ]
Pill.
25. PulviB.
((
tt
eHs
n
M
eres
► Powder.
26. Bmina.
U
it
Of
II
tt
m
Reain.
27. Sermn.
tl
tt
i
11
tl
tt ]
Serum.
28. Spiritus
u
tt
U9
a
It
ua ]
Spirit
29. Suppoeitorium.
u
tt
i
tt
tt
a
Sui^ository.
30. Pympns. '
tt
tl
i
It
tt
i )
Syrup.
31. Tinctura.
H
tl
m
tt
tl
*B ]
Tincture.
32. Tinctura herbanim i
tt
tt
<r
tt
It
<B )
Tincture of irea\
reoentium.
herbs.
3.r Trituratio.
tt
tl
onin
Gen
U
one*
Trituration.
34. TrocliMctis.
it
ft
i
a
tl
i ]
Troche (lozenge).
35. UnfnientTiin.
tt
«f
i
It
tt
ff )
Ointment
36. Vinum. {
tt
tt
i
u
M
« )
vnnt.
Aoeta, or Yinegars (2). — Liquid preparations made with dilute acetic
acid. Strength, 10 per cent.
Acetum opii. Acetum scillfie.
Aqiue, or Aromatic Waters (IS). — Watery solutions of volatile sub-
:?tance8, formerly prepared by distillation, now commonly made by adding
the volatile or essential oil to distilled water, with magnesia and filtering.
They are generally used as flavoring agents, and the dose is indefinite, ex*
cept ammonia, chlorine, and creosote waters. Aqua is potable water in
its purest attainable form.
Aqua aurantii florum fortior.
Aqua camphone.
Aqua chloroformL
Aqua cinnamomi.
Aqua creosoti.
Aqua foeniculL
Aqua destillata.
Aqua anunonise.
Aqua ammonis fortior.
Aqua amygdalae amans.
Aqua anisi.
Aqua aurantii flormn.
Aqua hamamididis.
Aqua hydrogenii dioxidi.
Aqua menthee piperiteOb
Aqua mentbsB viridis.
Aqua rosse. ,
Aqua Tosse fortior.
18
iniAUAlACOUXiY AM) OENEItAL TIIKlLVI'ErTlCS.
Cataplasmata, or Poultices (1).^ — Moist, eeiui-Holid inixture^
consistency for oxtornal application. J
CataphimiiH knolini. 1
Cerata, or Cerates (6). — Fatty mixttires containing wax, so ai
them firnuT ihini ordinarv ointment?.
Oratum.
Ceratum eamphortr.
Oinititiii t»iU3uiritli!4. C'eriitiiiii rosino;.
Chartee, <»r Medicated Paper* (1). — l^apers^ of (lotinitc sizt^
with drugs. ■
Charta sjnapis. 4
Gollodia* or Collodions (4). — Tiiquid jircparationH r>f collndioi
CuncHlimn. PoUtKliiini fle^■^(^.
<'oUnrliuni caiitliarulat iiiii. CoUocUuni stypticui
ConicctioncB, or Confections (2). — Soft, solid preparations in
a paste with sugar.
Confectio mwe. Conf«*ti« HMina*.
Decocta, or Decoctions. — Liquid prnpHrations of vc;j;ctabl*
obtained bv iioiliu): witli wntcr. A dtvixtion is din'ctcd Id b*.* imi
rule, by placing' tin' drup in n Hiiitiiblr* vcbhoI, with a cfivcr, and
lOOO parts of cold water for each oO nf substance used, covering it \»
boiling for fifteen minutes. When emd, it is pai^sed thmiigli the t
adding enough cold water to bring up the product to 1000 partj
strength of decoct ifuis of energetic or powerful drugs should l>e t^
proscribed by the physician. In tlic I'. S. Pharmacopoeia there
otUcial decoctions; tlie British l*hai'iiuUH)pteia hatf ihre**: Decoctu:
conipositum. D. gninati radicis. and D. haunatoxyli.
£lixiria« or Elixirs (3). — The pnpubirily of this class of reinedie
to their coniparati\i'ly ]>Icawint taste and U* \]w faet that they conta
hoi and sugar.
Elixir adjnvans.
Elixir flroimiticiiin.
Elixir f**ni. tpiitHf pt strych-
Tiinir phi*sp)iatum.
Emplastra, or Plasters (7). — Solid MibstaiKcs rendered t^oft a
hcsive liy heat, f^** ns to be sjircad upon leather or muslin, of any
size or phape, for apidieatiou to the surface of the body tn ^vliich the
is intended to adhere. Oiu* is an exception fo the giMicral ruli; tliat ]
are to be applit'd with heilt: the eiuplastnnn ichthyocoll^, or isi
plaster (miirt-plastcr) (I'. S. P., IHflO), is rendered adhesive by nn
Kmplftstnmi rtrlhnp«inim.
Rmplji'^tniin iKUadonnBC.
Emplastnini oapsi<'i.
Enip'a«tnim hydrarjpyri.
Eraplrtstriim opii.
KinplaKtriim plimihi.
Emuha, or Emulsions (3). — Tluok liquid iireparations contain
insoluble suhi^tance (generally an oil or a rcsin) suspended in u
mcnstnainu hv tht* addition of a viscid material.
Eraulsum oici morrhum. EmuUum olei ninrrloia.* cum KmiiUum oici tf^relni
ll,^|i^Jpil('^|«llillml.
PHABMACY,
19
Eztracta, or £xtraoti (28). — Preparations of a solid or semisolid con-
sistency, containing the active principles or constituents of drugs, obtained
usually by evaporation of alcoholic or watery solutions, the strength being
from twice to four times that of the official agent from which they are
made. They often contain glycerin, to keep them in a condition to readily
make into pills. Assayed extracts contain a definite proportion of the
active ingredient, determined by chemical analysis. Alcoholic extracts,
aqueous extracts, acetic extracts, and ethereal extracts are made with the
aid of dilute alcohol, water, acetic acid, or ether. Many so-called active
principles, such as leptandrin, macrotin, hydrastin," etc., tised by botanic
physicians, are simply alcoholic extracts, or impure resins, precipitated from
strong tinctures by the addition of water.
Extractum opiu
Extractum pnysostigmatis.
Extractum quassise.
Extractum rhamni pursh-
ianffi.
Extractum rheL
Extractum ftcopoln.
Extractum stramonii.
Extractum siimbul.
Extractum taraxaci.
Extractum aloSs. Extractum euonymi.
Extractum bMladonnee foil- Extractum gentiause.
omm. Extractum glycyrrhuae.
Extractum cannabis Indicee. Hlxtractum glycyrrbizie
Extractum dmicifugffi. purum.
Extractum colcbici cormi. I'^xtractum hiematoxyli.
Extractum co^ocynthidis. Extractum byoecyami.
Extractum colocynthidis Extractum kramerise.
compositum. Extractum leptandrse.
Extractum digitalis. Extractum malti.
Extractum ergotce. Extractum nucis vomica.
Flnidextracta, or Fluid Eztracti (86). — Liquid preparations repre-
Ht^ntative of organic drugs, usually alcoholic, hydro-alcoholic, or acetic acid,
and are equivalent to strong tinctures. The rule followed, with a few excep-
tions, is to have these preparations of definite strength, as related to the
crude drug, so that one tiiousand cubic centimetres of the fluid extract
represents the active principle of one thousand grammes of the drug. The
dose, therefore, is the same, as the rule, in minims as that of the dry, pow-
dered drug in grains.
Fluidextractum
Fluldextract um
Muidextr actum
Fluidextractum
Fluidextractum
Fl u idex tra c t um
Fluidextractum
Fluidextractum
Fluidextractum
Fluidex t ract u ra
FluWextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractimi
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
aconiti
apocyni.
aromaticum.
aurantii amari.
belladonnse radicis
berberidis.
buchu.
calami.
calumbee.
cannabis Indicie.
capsici.
cbimaphile.
chiratse.
cimicifugsp.
cinchonse.
cocee.
colchici peminis.
conii.
convallar.'ffi.
cubebffi.
cypripedii.
digitalis.
ergotffi.
enodiotyi.
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractimi
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
eucalypti.
euonymi,
eupatorii.
frangulee.
gelflemii.
gentians.
geranii.
glycyrrhizae.
granati.
grindclia.
guaranse.
hamamelidia foliorum.
Hydrastis.
hyoscyami. ^
ipecaeuanhie.
kramerite.
lappee.
leptandre.
lobeliee.
lupuUni.
matico.
mezereL
nucis vomicte.
pareire.
20
PHARMACOLOGY AND GENEILAL TiiERAPErTlCS,
Fluidextractum
Flttjdeslractum
Fluidextractum
Fluidextractiuri
Fluidextractum
lluidextractum
Fluidextractiiitt
Fluidextractum
Fluidextractum
maticuiD.
Fluidextntetum
Fluidextractum
Huidextractum
Fluidextractum
Fluidextmctura
I'luidextractuin
Flui<lextractum
Fluidextractum
Fluidextractum
Phytolacca'.
pilociiriji.
podt^phylli.
prunt Virginianre.
qua^sise.
qucnuK.
tiUilJuje.
nmniui purshianic
rhanini purHliiaiui*
aio-
rhei.
rhoia glabne.
rosce. ■
rubi,
sabince.
Baiiguinarifle.
sarsaparillse.
KarHaparillR* compositutu.
Bcillce.
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextructum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextructum
Fluidextractum
Fluidextractum
Fluidextractum
Fluidextractum
Fl uid ex t rac t um
Fluidextractum
Fluidextructum
FluidfXtracUKii
Fluidextractum
Fluidextracttm;
scopolce.
9cutctlariu!*J
senega?,
scrpeutaria?.
apigelite.
atavisa^ia.
stillln).Ma?.
Htrumonii.
suiubul.
tjirnxaci.
tritici.
uvae ursi.
valerJHiise.
veratri.
viburni opuli.
viburni prunifo
xanthoxyli.
ziriftibi'vi-^.
Glycerita, Qlycerites (6). — In tiicse proparations, the veliicle t
cal substances is glycerin, a liquid abtaineJ by ilie decomposition of \
or animal fats, or fixed oil?, and containing not less than 95 per cent,
lute glycerol, a triatomic aIenho[.
Glyceritum.
GlyctTitum acidi tannici
(Jlyreritura amyli.
Strtcliniiim |jimt*phnlum.
Glyceritum ferri, qutninee et
Btrychninie phospliatum.
Infusa, or Infusions (3). — These are usually made by ponring
water upon regetable druga and letting them stand for half an he
covered ves*el in a warm place, and Repariiting the infusion by
ing. When the strenjrth is not otherwise directed by the p
copccia or by the prescrijvtion of u physician, thev are to be niadt
cent, strengtn. The infusions of cinchona (U. S. f ., 1890), and of
VirjEriniana are best made with cold water, hy percolation. The olfic
lire not made according to the decimal system.
Tnfusum digitalis (I'/i per cent).
InfuMum pruni VirginianHj (4 por
cont.).
Infusnm seniife compositum (6 p4
Linimenta, or Liniments (8). — Preparations, oily or alcoholic, o
containing medicinal t?ubstances, and intended for external applica
tlje surface of the hodv, with friction.
Liniment iini ammonije.
Liniinentura bellpdonnre.
Linimentum oaJcis.
Uninicntiim cnrnplnirw.
Linimentwm cholorfonni.
Lioimentum Baponis.
liinimcntum .«apnnift
Linimentuin terebint
Liquores, or Solutions (25). — Liquid preparations of non-volatile
generally cliemicnls. which are wholly solul*le in the menstnuim emph
Liquor acidi arscnoei.
Li<]iior nmmonii acctatis.
Liquor antisepticus.
Ijtpior arseni et hydrar-
f^-T\ iodidi.
Tjipior cnlcis.
Ijquor chlori compositus.
Liquor crefiolis compoi^ituB
Liquor ffrri t'li!oridi.
Liquor ferri et nminoTiii
acctati'*.
Liquor ft^rri '^ulwulplmtii*.
Lifjuor ferri ter&uJphiLtifl.
Liquor InrinnMchvdi.
Liquor hydrargyri nitralis.
Liquor iodi compositua.
Liquor ma^esii citr
Liquor pinmhi Rubac
Liquor plunibi sulmo
diluttiR.
Liquor potassii hydr
Liquor potn^ifiii nrsei
Liquor ]K>ta:^sii citra
Liquor fio<iii hydroxi'
A
PHAEMACY. 21
liqaor sodie ehlorinatse. Liquor Bodii phosphAtiB liquor zinci chloridi.
liquor sodii arseiiatis. compositua.
MassflB, or Kasses (2). — These are soft, solid mixtures of proper con-
sistency to be made into pills.
Massa ferri carbonatis. Massa hydrargyri.
M^lita, or Honejs (3). — Liquid preparations consisting of honey, or
honey as a basis.
Mel. Mel depuratum. Mel rosce.
Kisturse, or Mixtures (4). — Preparations consisting of a liquid used
as a vehicle, and containing an agent not soluble in the menstruum em-
ployed.
Mi-^tuia crctse. Mistura gljcyrrbizee com- Mistura rhei et sod«e.
Mistura ferri compoeita. poeita.
Mucili^^es, or Hucilages (4) . — These are rather dense, viscid prepa-
rations of gum, or mucilaginous substances, dissolved in water. They are
used for suspending insoluble powders or emulsifying oily substances,
Miifila^ acaciae. Mucilago sassafraa medulle. Mucilage ulmi.
Mucilago tragacanthffi.
Oleata, or Oleates (5). — The official oleatcs are made by dissolving
medicinal bases in oleic acid, and are in the form of a soft solid or oint-
ment Some of the non-official oleates are in the form of dry powder. The
official oleates are : —
Oleatum atropinse. Oleatum hydrargyri. Oleatum veratrinse.
Oleatnm cocainse. Oleatum quininee.
Oleoresiiue, or Okoresins (6). — These are liquid preparations obtained
by dissolving oily and resiilous matters out of vegetable drugs by means
of acetone (except ginger, which is extracted with alcohol). Oleo-
rta»ins differ from fluid extracts in composition and in strength, being the
most concentrated liquid preparations of drugs that are produced. The
\ield of oleoresin naturally varies, according to the quality of the crude
dru^, this class of remedies not bearing a uniform relation (of gramme to
cubic centimetre), as fluid extracts are required to do.
Oleoreaina eapsici. Oleoreaina cubebae. Oleoresina piperis.
(Heorcaina capaici. Oleoresina lupulini. Oleoreeina zingiberia.
Pilnlse, or Pills (14). — Small spherical masses of medicinal sub-
stances intended to be swallowed whole; two of the official forms are
coated with Tolu (pilulae ferri iodidi and pilulse phosphori) ; the rest are
simply treated with dusting-powder. It is the rule among manufacturers
also to supply a full line of pills coated with gelatine or with sugar, in order
to preserve and render them more pleasant to swallow. Sometimes a coat-
ing of keratin is used where it is desired the pills should not be dissolved
until reaching the intestinal tract.
Pilulae aloSs. Pilulae alo^s et mastiches. Pilulffi aaafoetidae.
Fflulaf aloSa et ferri. PiUilee alo&a et myrrhse. Pilules catharticae compos-
itae.
PHAKAL\COLOOY AND GENERAL THEIUrEUTICH.
Pihilue cathartjeffi yegeta- Pilultp laxativie compoflitee. Pilulie podophylU;
bilea. Pilulte opii. doniw*, vi capsic
Pilulfle ferri cnrbonatis. Piliilu^ phosphori. Pilula? rhei coiupo
Pilulfe ferri iodidi. I
Pulveres, or Powders (9). — iJrugs in a dry, finely-divided fo
erally compound**^ or mixed.
Pulvis a<?etanilidi compos- PuJvis glyoyrrhizce com- Pulvis jalapre coin
itus. po«iituN. l^lvu iiiorphiiis
Pulvis ammaticus. Pulvis i])ecacna:ibeD ct itus.
Pulvia cretflB eompositus. npii. Pulvia rhei compoe
PulviH cffervesceoa cuiij-
pOHltUH.
i
Eesinse, or B-esins (4). — Solid preparation? of vetjetablc ori
tained by e.xtnictiug witli ulcoliol and procipitating with wate^. Ql
tilling the volatile oil from an oleoresin. iHl
Resina (from turpentine), Resinn jnlnpfe. R««ina scammomi
Ke»ina j>odo[ihylli.
Sera, or Serums, am tiuids sfparatrd from tlie coagidated liln
horse, which has been immunized against certain forms of infection
one is official at present.
Serum antidiphtheritioum.
Spiritus, or Spirits (20). — Solutions of vohitile or aromatic sub
in which alcohtd is used as the menstrnviin.
Spiritus oetheris.
Spiritus ffitheris enmpoa-
itus.
Spiritus eetheris nitrosi.
Spiritus (vmmonise.
Spiritus ammoTiiip aromat-
icus.
Spirilti'i amygdnln? ftmarae.
Spiritus niiisi.
Spiritus fltirnntii eomposi-
tus,
Spiritus tamphorre,
SpirituB chlnroformi.
Spiritus cinnamnmi.
Spiritu.-* frumcnti.
Spiritus ujiiiUhjfriie.
Spiritus ;;lyrprvlis i
Spiritus junii>cri.
Bpiritus juniperi coi
tUB.
SpiritUH lavan'lulre.
Spiritus inonMtfp ])ip
Spiritus nicnlhrp vir;
Spiritu*) viui {r^Uifi.
Suppositoria, or Suppositories (1). — Only one formula for suppo;
ifl now oflicial, hut they arc directrtl to be made cxtempnnineon&ly
oorporatinp the mediciuiil suhstanccs with eaeno-hutter (oI(*ijm th*X)[jro
and shapinur them wiili a mold into small, conical masses, wei^hi)
gramme each, imlof^n ntherwit^o directed. They are intended to he ii
into the rectum iitiil other cavities of the body, where they melt and
the medicament to conn* into contnct with an absorI)in;r surface. Sr
tories of soap »ind fflycerin are Inrirtdy used as hixtitives to empty the
bowel. Simihir prepjiratinns of cacao-bntter or gelatin, for the uret
nose, are cnlied l)uginana, or bougies.
Suppositoria glyrnrini.
Sympi, or Syrups (29). — These popular preparations are stronj
tions of sugar in water, containing ttaroring and medicinal suhsi
They are usually made with the aid of heat, for convenience; but,
PHARMACY.
2Z
heat would be injurious, they are directed to be made by stirring and filter-
ing, or by percolation.
Syrupurt.
Synipuii acacis.
Syrupus acidi citrici.
^yrupus acidi hydriodioi.
Syrupus amygdsuee.
Synipua aurantii.
Syrupus aurantii florum.
Synipus calcii lactophoB-
phatus.
Syrupus calcis.
Syrupus ferri idodidi.
Syrupus ferri, quininse, et
strychinffi phoAphatum.
Syrupus hypophosphitum.
Syrupus hypophosphitum
compoaitus.
Syrupus ipeoacuanbs.
Syrupus kramerifle.
ISyrupua lactucarii.
Syrupus picis liquidae.
Syrupus pruni \irginianse.
Syrupus rhei.
Syrupus rhei aromatieus.
Syrupus rosfe.
Syrupus rubi.
Syrupus sarsaparilUe com*
positus.
Syrupus scillse.
Syrupus sciUse compositus.
Syrupus senegse.
Syrupus sennse.
Syrupus tolutanus.
Syrupus zingiberis.
Tinctursey or TinotureB (63). — Liquid preparations of vegetable drugs,
as the rule, diifering from spirits in not containing volatile substances. To
this, tinctune iodi, lavanduhe compositor, and moschi are exceptions.
Tinctunk aconjti.
Tinctura einnamomi.
Tinctura moschi.
"nnctura aJo^.
Tinctura colchici seminis.
Tinctura myrrhae.
Tinctura aloi^ et myrrhcp.
Tinctura digitalis.
Tinctura nucia vomicee.
Tinctura aniicse.
Tinctura ferri chloridi.
Tinctura opii.
Tinctura asafstidse.
Tinctura gallae.
Tinctura opii camphorata.
Tinctura aurantii amari.
Tinctura gambir composita.Tinctura opii deodorati.
Tinctura aurantii dulcis.
Tinctura gelsemii.
Tinctura physostigmatis.
Tinctura belladonnas folio-
Tinctura gentianip compos-
Tinctura pyrethri.
rum.
ita.
Tinctura quassim.
Tinctura benroini.
Tinctura giiaiaoi.
Tinctura quillajae.
■nnctura bcnzoini compos-
Tinctura guaiaci ammoni-
Tinctura rhei.
ita.
ata.
Tinctura rhei aroniatica.
Tinctura calendulse.
Tinctura hydrastis.
Tinctura sanguinariae.
Tinctura calumbn.
Tinctura hVoscyami.
Tinctura scillae.
TinctuiH cannabis IndicfP.
Tinctura iodi.
Tinctura serpentariee.
Tinctura cantharidis.
Tinctura ipecacuanha et
Tinctura stramonii.
Tinctura capsici.
opii.
Tinctura strophanthi.
Tinctura carda'momi.
Tinctura kino.
Tinctura tolutana.
Tinctura cardamomi com-
Tinctura kramerise.
Tinctura Valerianae.
posita.
Tinctura lactucarii.
Tinctura valerians} ammo?
Tinctura cimicifugee.
Tinctura lavandulte com-
niata.
Tinctura cinchoxue.
posita.
Tinctura vaniMae.
Tinctura cinchonse compos-
Tinctura limonis corticia.
Tinctura veratri.
ita.
Tinctura lobeliw.
Tinctura zingiberis.
Tinctune Herbarum Kecentium, or Tinctures of Fresh Herbs, are
«lirected by the Phannacopa?ia to be made of 50 parts of the fresh herb,
macerated in 100 parts of alcohol for two weeks, and then iiltering the
product. No special formulae are given.
Triturationes, or Triturations (1). — This is a newly-recognized class
of preparations, which represent one-tenth of the strength of the crude drug,
to every 10 parts of which 90 of sugar of milk are added, and the mixture
thoroughly incorporated by trituration. The only official representative is
Trituratio elaterini.
Trochiti, or Troches (9). — Small, flattened, disk-like, solid masses,
usually called lozenges. The basis is generally gum and sugar, or fruit-
PHAUMACOLOOY A}iD GEXKIUL THEILVPELTICS.
^aste, making a mass wliich can be slowly dissolved in the mot
medicating the mucous membrane of the mouth and ihi-oat.
Trochisci acidi tRnnict Ttochisci glycyrrhiza? et Trochisci potassii (
Trochisci ammonii chloridi. opii. Troriiisoi santonini
Trochisci cubebaa. Trochisci kraTnericc. TrocUiaci sodU hiei
Xrochiftoi ;:ainbir.
P Unguenta, or "Ung^uents (24). — Soft, fatty preparations, m^
the temperature of the body, and suitable for inunction and the adl
tion of remedies by external application and frictian.
Unguentuni.
Ungiiontuni acidi borici.
Unjcpicntiiin acidi tjiiinici.
Unguontuin iiqiue roste.
Ungueiitum iH'lIadonniE.
Unguentum chrj'aarobini.
UngueBtura diachylon.
UngueJituni gallffi.
Un^enttim hydrargyri.
Unguentiiin hydrarg-yri dilutiim,
UngUPiitum hydrariHTi ammonia li.
UngueiiLiim liydrarjryri nilratis.
Unguentum hydrargj'ri oxidi fli
Ln^uontum hydrurgyri oxidi n
Ingiientum tidi.
l'n;riipntuin indnfnrmi.
Ungupntum ]thenoU*. \
Ungurntinn piris lit^uidee. >
Unguentuiii pniassi iodidi.
Unguertniii slrfimonii.
Unguentum Bulphurin.
Unguentum. vuiutrimc.
Unguentum zinci oxidi.
Ungwcntiun zinci stearalia.
Vina, or Wines (10). — Alcoholic preparations in which strongc
wine is tho menstruum generally employed.
Vinum album.
Vinum antimonii.
Vinum cocse.
Vinum colchici seminis.
Vinum ergotfp.
Vinum ferri.
Vinum ferri citratis.
Vinum ipc<^acuanhflB
Vinum opii.
Vinum rubrnm.
Impouxant Chaxoes IX THE KiiiiiTH Revisiox of the
Phakmacopceta.
iUpou the succeeding few pages will be found, arranged in a con
form for reference, tallies showing tlie comparative etrengtli of fh
infportant pharmaoopreial suhstaneee and preparations as given in t
ceding and the j-truscut revision : —
PHARMACY.
25
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PHAKitACOLOOY AND GENEBAL THERAPEUTICS.
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pharmagt. 29
Pharmaceutical Processes^ or Pharmacy Proper.
Pharmacy is that department of medical science which is devoted to
the collection, identification, manipulation, compounding, and dispensing
of dmgs. It comprises the various articles and preparations composing
the Materia Medica, official and non-official; guards against adulteration
and substitution; analyzes the composition and determines the standard
proportion of active constituents, besides providing eligible and efficient
preparations and indicating the proper procedures in Ming prescriptions
secundum artem. A knowledge of at least the rudiments of pharmacy is
absolutely necessary to the practicing phy&ician. It is a great misfortune
that so many students are permitted to graduate from our medical schools
with such an imperfect acquaintance with practical pharmacy as they ordi-
narily possess. A very little carelessness or ignorance on the part of the
prescriber may cause serious mistakes to be made.
[In practical pharmacy, a number of preparations known as favorite
prescriptions or popular remedies, like Squibb's Cholera Mixture, Lafayette
Mixture, etc., being in frequent demand, are usually kept on hand in the
shops. Some of these, like Brown Mixture, Compound Licorice Ijozenges,
and Basham's Mixture, have been admitted to the pharmacopoeia. Others
are less often prescribed, but the pharmacist is expected to have a for-
mula at hand so as to prepare the remedy extemporaneously. Such a col-
lection is known as the "Extra Pharmacopoeia," or simply as a Formulary.
Some years ago the American Pharmaceutical Association appointed a
committee to collect the formulaB for such unofficial preparations and to
select the best of each class, so as to form a National Formulary. This was
done, and the result of the committee's work was fully approved by the
American Pharmaceutical Association. The work was issued for the pur-
pose of obtaining uniformity in unofficial compounds, and to publish for-
mulae which represent some proprietary preparations. A "Physicians'
Manual of the National Formulary" is published in Chicago, by C. S. Hall-
berg, at a trifling cost. Every physician will And it useful to have at hand
for reference the United States Pharmacopoeia, or a good Dispensatory,
and ako the National Formulary of the American Pharmaceutical Asso-
ciation.]
The principal operations of pharmacy are : —
1. Weighing and Measuring.
2. Determination of Specific Gravity and Temperature.
3. Operations Requiring the Use of Heat.
4. Operations Chiefly Mechanical.
5. Pharmaceutical Testing and Analysis.
6. Extemporaneous Preparations.
1, Weighing and Meaiuring. — Solids are usually weighed and liquids
measured ; the denser liquids, however, are often, for the sake of accuracy,
dispensed by weight, and all liquids might be. Owing, however, to the
variation in bulk of liquids, and the necessity of making corrections for
specific gravity and temperature, this plan is not employed in prescribing,
although parts by weight have been adopted in our pharmacopoeia, which
in the last edition has largely followed out the metric system. Scales, or
balances, of various kinds and varying degrees of accuracy, are employed
30 * , PHAKMACOLOGY AXD GEKERAL THERAPEUTICS.
in weighing, and care should he taken that scales used in compounding pre*
seriptions are reliable and sufficiently sensitive for the purpose for which
they are used-
Weight is the measure or expression of the attraction of gravitation
for a given mass of matter at the earth's surface, being dependent prin-
cipally upon its bulk, density, and physical condition- The comparative
bulk of bodies is expressed in terms of dimension or measurement. Stand-
ards of weight and measure are established by law in all civilized countries.
Those in use in the United States have been adopted by Act of Congress
of June 14, 1836, when the Secretary of the Treasury was directed to fur-
nish each State in the Union with a complete set of revised standards based
upon those of Great Britain. In 1864 the use of what is known as the
metric system was legalized in Great Britain, but was not marlc compulsory ;
and in 1866 the United States pursued the same course. It was finally intro-
duced into the Pharmacopceia in the last two revisions. The measures in
common use in handling drugs and compounding prescriptions are as fol-
lows: Troy and Avoirdupois weights for ascertaining the relative pon-
derosity of bodies ; Wine, or Imperial, measure for quantity of liquids, and
the Metric System for both solids and liquids.
Troy, or apothecaries', weight is iised for compounding or dispensing
drugs; avoirdupois is the standard for commercial purposes, and is used
in bu\-ing and selling drugs in quantity.
Troy, or Apothecaries', Weight.
20 grains (symbol gr.) equal I f^oruple (symbol 3 ) .
60 grains, or 3 scruples equal 1 draobm (symbol 3).
4S0 grains, or 8 drachms equal 1 ounee (symbol 51-
.57fiO grains, or 12 ounces equal 1 pound (symbol lb Troy).
Avoirdupois Weight.
437*-^ grains equal 1 ounce (symbol oz.)-
7000 grains, or 16 ounces equal 1 pound ( >ymbo) lb Av.>.
The British Pharmacopoeia is peculiar in u?ing in its formulae Avoir-
dupois weight. As will be noticed above, denominations may be repre-
sented by symbols. In Troy or Apothecaries' weight, gr. (Lat. granum)
stands for grain or grains; 9 (Lat- scrupulum) stands for scruple or
KTuplt.'s; 3 (Lat. drachma) for drachm or drachms, and % (Lat. uncia) for
ounce or ounce?. In prescriptions, as well as in dispenping. tho::e s^-mbols
are commonly employi-d ; they will be referred to again under the section on
"Prescription-writing.'*
Fluids, as aln-ady stated, may be dispensed by weight; but they are
usually measured and sold by quantity.
Apothecaries' Measure,
*50 minims (^vmhol m) equal 1 tluidrarhm (symbol f3).
4S0 minims, or 8 fluidraohnw equal 1 Hiiid ounce (*s>-mbol fj).
70sO minim-', or 10 fluidounces equal 1 pint (syinlwl 0».
61440 minims, or 8 pints equal 1 galUm (symbol C).
An Imperial pint contain? t^venty fluidounces: tliere nre eight such
pints in the Imperial gallon. The latter will contain ten pounds of distilled
PHAKMACY. 31
vater (at 60° F.). The Imperial fluidounce weighs 437.5 grains, which is
less by 18.2 grains than the IJnited States Pharmacopoeia's ounce of water.
This should be remembered in copying prescriptions from English medical
publications.
The Metric System of weights and measures is growing in favor, and
is employed by nearly all European pharmacopoeias, and also by that of
the United States. The unit of this system is the metre, which is the
ten-millionth part of one-fourth of a meridian, or one forty-millionth of
the polar circumference of the earth. This has been found to be a little
more than the English yard (3 feet, 3Vs inches), 39.37 inches. From
this unit of length the unit of capacity is derived ; a thousandth part of
a cubic metre is a litre, which contains a little more than two pints (S^/^o
pints) ; it is represented by a cube whose height is one-tenth of a metre.
The unit of weight is obtained by weighing a quantity of distilled water re-
quired to fill a cube whose sides measure one one-hundredth of a metre;
this is called a gramme, and it is equivalent to 15.432 grains. By a
px'stem of prefixes the quantities are readily expressed by multiplication or
division; thus, myria = 10,000 times, kilo = 1000 times, hecto = 100 times,
deka=^ 10 times; whereas deci means Vi^, centi ^/,oo, and milli Viooo- This
will be readily understood by referring to the following table, in which the
relative values of different denominations in the metric and English systems
are approximately given : —
Measures of Length.
Vi9» metre =1 millimetre (mm.), or Vm inch.
Vw metre = 1 centimetre (em.), or Vio inch.
Vrt metre ==1 decimetre (dm.), or 3 "/„ inches.
1 metre =1 ketbe (M.) , or 39.37 inches.
10 metres ^1 Dekametre (Dm.), or 32.81 feet.
100 metres ^1 Hectometre (Hm.) , or 328.09 feet.
1000 metres =1 Kilometre (Km.)» or 3280.9 feet.
10000 metres =1 Myriametre (Mm.), or 32,809 feet, or 6«4 miles.
Mextsures of Capacity.
\'vm litre. . . . =r 1 cubic centimetre (c.cm.), or millilitre (ml.) := 16 minims
Vi« litre. . . . = 1 centilitre
Vi» litre ^1 decilitre
1 LITRE ( L. ) = 2 Vio pints
10 litres* . . . = 1 Dekalitre
lOO litres . . . = 1 Hectolitre
1000 litres . . . = 1 Kilolitre
10000 litres . . . = 1 Myrialitre
Measures of Weight.
Vio» fijamme, or 1 milligramme (mg.) equal to */« grain.
Vm gramme, or 1 centigramme (eg.) equal to V« grain.
V« gramme, or 1 decigramme (dg.) equal to 1.5 grains.
1 gramme (Gm.) equal to 15.432 grains,
10 grammes, or 1 Dekagramme (Dg.) equal to 154.32 grains.
100 grammes, or 1 Hectogramme (Hg.) equal to 3.52 oz. Av.
1000 grammes, or 1 Kilogramme (Kg.) equal to 2.2 n»s Av.
(cl.)
r=
2.705 fS.
(dl.)
=
3.381
«.
(0)
:=
33.815 f5.
• (Dl.)
=
2.641
gallons.
(HI.)
=r
26.410
gallons.
(Kl.)
_.
264.19
gallons
(Ml.)
=
2541.9
gallons
PUAUMACOLOGY A\*D OENEHAL THEUAPEUTICS.
Relation of Metric Weights and Mmsurcs to Apothecaries* Weight.
^ MMstircs.
1 f^'ain equals
1 scruple equnU
I dracbm equaU
1 ounce equals
1 rninim equals
1 dracbm equBU
1 ounce cquuls
1 pint equals
1 gallon et|Uol3
0.0047805 gramme.
1.295 grammes.
3.SS7 grammes.
31.103 grammes.
O.OfilinS cubic centimetre (weighing 0.816
or 0.05 grain.)
3.0I»7 cubic centimetres.
20.57 oubie rentimotres.
473.11 cubic centimetres.
3785.0 cubic rentjmetrea.
Ju ordinary use, in prescription-writing, the followiug table
found to be nearly correct, and can be easily memorized: —
mj equaU |00 ccm.
f3| equal B 4j e.cra,
f3ij equals 7 50 c.cm.
fjss equals 15j com.
f3j eq\ial.s 30] e.cm.
gr. j equals {065 gram)
3j equals 4 I grami
3ij equals. , 8 | grami
J^s cquuN 1.1 .> grami
Sj lm|UjiIh 31 1 1 grami
The use of a decimal lino ;:rcally reduces the jxissibility of m
in reading such prescriptions. As U.Uti (drug) is lefis than 1 grain,
4.0 and 32.0 (vehicle) are more than the fluidruchm or ounce, then
danger of giving a stronger dose than was intended by using this 8
C.cm. (cubic centimetres), used for Gni. (fjramnies), caust^s an error oJ
5-per-cent. excess.
A teaspoonful is usually 4 to 5 c.cm.; a taLlespoonfiil, lo.O c.cm.
domestic measurements of this kind are so irrcguhir and unreliable
best to have the patient take his medicine from a properly graduatec
or a standard spoon.
Ordinary expressions of M*eight or measure, tl^erefore, may be ap
matcly reduced to metric tenns by the following rule: Multiply gra
G, and the result will be ecnligrammoe ; multiply drachms by 4, or t
by 32, and the result will bo grammes. Id the same manner, by di'
centigrammes by 0, we oI>tain jrrnins; or grammes by 4 or 32, and the
will bo the number of draobms or ounces, as the onse may be.
Liquids are usually measured, when compounding prescriptioi
convenient glass vessel:*, whicli, on account of having their capacity c
ated by marks blown or engraved upon them, are known as grad
They are usually smsilh'r nt the bottom, having a conical slmpe, oi
may be lyliuilrical. The indications of capacity may be according i
ordinary a[)oihecaries' liquid m<*)isnre or to the metric system. I
quantities arc measured in tinned-iron or copper measuroSj where the ]
is not corrosive; for liquids which cannot be measured in metallic V«
glass or porcelain can be used. Small quantities are measured by ra
or by drops. The onlv accurate method of regulating the dosage of
quantities is by using a 8mall instrument known as a minim-pipette,
is simply a glass tube, with a slightly contracted extremity, so that r
deliver its contents not too rapidly. Upon tlie side the tube has gr
tions engraved upon it. A rubber rap may be applied to the uppc
tremity, by which fluid may be drawn into the tube when its point is p
under the surface. The desired amount may then be expelled by
pressing the cap or bulb, and tlie amount is indicated by the gradual
PHAOaiAOY.
33
thit pipette ifi long enough the rubber bulb can be disj^ensed with and
■^ aovln Applied to produce suction, tlie liquid afterward being retained
Ij plaeitig the forefinger over its upper end^ by which also the flow may be
i^pkted. A little experience vrith this instrument will enable the operator
tB tZBBftfer small i|uantitiea of liquid from one receptacle to another with
WMMlmlili accuracy and rapidity. A good way to keep the pipette ready
far (ue aad clean is to use a p>erforaled cork, passiug the pipette through
it into a bottle containing alcohol or water. When water or any fluid
Mable of wetting the glass is used the fluid will creep up the sides of the
ttie by capillary attraction, and the outer edge of the fluid will therefore
te hi^ier than the remainder of the surface. In reading the measure it
icanomary to take tlie level of the centre of the liquid, or a plane shghtly
it, in order to be accurate.
In cpite of the fact that every one knows that a drop is not a unit of
fttre, and that the size and weight of drops of liquid vary according
to tanpezatore, speciflc gravity, and even the shape of the bottle from
vioelk tbej oome, and that the drops of some liquids are much larger than
i^ — for instance, the drop of deodorized tincture of opium being nearly
Large as that of Uxe ordinary tincture, — physicians constantly
pnaeribe active medicines by drops when they mean minims, if they mean
earthing at all definite. This uncertainty with regard to drops is shown
%j the following table,' where evei-y attempt to maintain uniformity was
opii 90 drops in 3.70 ccm. or 69 minima.
b^Ub , . .08 " " "
■4»ticam .108
«rt)oIicUTn : ...in
hTdrocyanicum t»
UcUcuni in
phoftphoricum dil 50 " " "
flulpburicum aromat 140 " " " "
vulphuricuin dil 00
fortior 17«
140
ite%taiiit» 00
i-V)
rMvnm purif 2.V)
uim 12i
!«&d«KC belUdonnte radiois....
cotcbici nulicift.
addi
. . . . 15rt
.100
- 07
57
• rg. iodidi 59
lljdru: luli? 131
lodi oomp, .03
qnor potAJsa: . . ^ 02
potAMii aneuitih .57
' la Mtridii lao
riemi ... "7
tigm I'M
oltlomfomti . 150
05
.. 75
.102
*rill«
comp.
A tabltf prtrpATiM by tho Uit«> Mr. Stephen U TallHit. The preparnUoiu
lo arr of tbe revi«ion of 1S70.
34 PHARMACOLOGY AND OEXEEAL THBBAPEUTICS.
Syrupus senegse 106 drops in 3.70 c.cm. or 60 minima.
Tinctura acomta 146 ' *
Tinctura belladonnse 137 "
Tinctura digitalis 128 "
Tinctura ferri chloridi 160 "
Tinctura iodi 148
Tinctura nucis vomicfie 140 **
Tinctura opii 130 "
Tinctura opii camph 130 **
Tinctura opii deodorat 110 "
Tinctura veratri viridU 145 "
Vini colchici radicia , 107 "
Vini colchici seminia Ill "
Vini opU 100
Scientific accuracy in prescribing and in dispensing medicines can
only be obtained by carefully measuring or weighing the agent in gradu-
ates, or scales, of standard accuracy. Where a fraction of a grain, drop, or
minim of some powerful remedy is ordered, the division can be made more
evenly by diflfusing the remedy in a larger quantity of some menstruum
in which it is soluble, like alcohol, ether, water, or by mixing it with some
inert powder, like gum arable. Thus, the one one-hundred-and-twentieth of
a grain of atropine may be obtained by dissolving one grain in 480 mininoB
of water, of which four minims would represent the desired quantity.
Croton-oil and similar agents can be dissolved in alcohol or diffused through
some inert powder, like milk-sugar, and thus be accurately divided into paiis
smaller than the minim or drop.
Most pharmacistB are supplied with a full set of metric weights and
measures, and can compound prescriptions in accordaiice therewith; but
there are practical objections and diMculties that stand in the way of the
general adoption of the French system which will prevent its general use
in preficription-writing for many years, or until they are overcome, as
pointed out by Prof. Oscar Oldberg. At the same time those physicians
who have been trained according to the metric system may find it easier
for themselves to continue to employ it in prescription-writing; they owe
it to their patients, however, to see that the prescriptions are sent to a
pharmacist sufficiently versed in the system not only to avoid making mis-
takes himself, but also to qualify him to detect any errors that may have
been accidentally made by the physician. The maximum dosage of drues,
according to the usual metrology, is usually known to a drug-clerk, but ne
may not be as familiar with the doses according to the metric system,
and therefore the chances of mistakes in compounding are greatly in-
creased. Bottles are now provided by the manufacturers, which contain
definite quantities, according to decimal system, in cubic centimetres or
millilitres; and pipettes and graduates, marked in metric equivalents, are
for sale in all establishments for the sale of scientific apparatus,
2. Determinatipn of Temperature and Specific Qravity. — In some phar-
maceutical operations it is necessary to take into consideration the tem-
perature or relative degree of heat, both of the room in which the work is
going on and of the object manipulated. For instance, the laboratory or
room may be below zero or above 90 degrees ; it usually is about 65 degrees,
or between this and 70 degrees, and, where no temperature is specified, it is
supposed to be at this point. When it differs much, either above or below,
it should be noted, especially when taking the specific gravity of fluids.
The instruments employed in measuring degrees of heat are called
PHARMACY.
35
t^amom«i* ■ ' do not indicate absolute heat, but only its relative in-
Inatj. T: re boat would be re<:iuired to raise a gallon than an ounce
«f w«tf?r 1 degrt^, and yet the thermometer would register the same in each
cam. The quantity of heat is calculated in another way, — according to the
isvs of physics. Thermometers used to indicate the degree of beat are
I VBtHy made of gl&s&, pure mercury being preferred aa the index because
i it erpuidfl uniformly between the freezing-point of water and ita boiling-
' pQZ&t. On account of the contraction of the glass, old thermometers gen-
oallj read too high. Where the temperature is important, the thermometer
■aj be compared with a standard, and its variations noted and allowed for.
Tkononseters should be three years old before being graduated, in order
to ailow for the shrinkage of the glass, which usually reaches its limit in
.lUi time^
ThermometerB in this country are usually marked according to Faliren-
Efa exhale, which commences at 32 degrees below the n^eltiug-point of
divides the intervening space between tliis and the boiling-point
ST into 212 equal gradations, making 180 degrees between the point
ii vhich ice melts and water boils; the degrees above and below these ex-
toflnaa are established by experiment. This form of thermometer is gcn-
odlj emploTed in this country for laboratory work, and is given the second
p2aDr bv the U. S. Pharmacopoeia, In Reaumur's thermometer, which is
sa lase to some extent on the continent of Europe, the freezing-point is 0
AttiLia and the boiling-point 80 degrees. The Centrigrade, or the ther-
■wncTrr nf Cehius, is principally used for scientific work all over the world,
mti kaa b«an adopted in the U. S. Pharmacopoeia (1890). The melting-
pot of ice la zero and the boiling-point of water is 100 degrees, the inter-
vcainir *p«ce being equally divided into degrees Centigrade. The reading
m Fursnbeit degrees may be converted into Centigrade by a simple rule.
in mind that the former begins 32 degrees below freezing, which
»ero o£ the other, and that the space in the former occupying 180
only covers 100 degn*es of the latter, we have the following: —
To ooBvert Fahrenheit de£n*ees into Centigrade, subtract 32> multiply
ly l4iO, anH divide bv ISO, — the result will be degrees Centigrade.
To convert Centigrade degrees into those of Fahrenheit, multiply bv
itD. diride by 100, and add 32.
Am both scales are in use in clinical medicine, it is necessary for the
ftt to familiarize himself with this calculation and remember the rules.
JUl thermometers are not equally sensitive; while some reach their
reading in one minute, others require three or four minutes, or
«pr -- "* -ip to the proper degree.
I 'ir Gravity of any substanne is an expression of the relative
Stit ':.uiti(y of the subst^mcc as compared with an equal bulk of
He* ii a temperature of 60° F. and under ordinary conditions
V atlBoapb>*nc presj^ure ns indicated by the barometer. It may be ascer-
Qaikt^ ^inTl!v in the cai»e of a liquid by placing it in a lx)ttle which, when
fi]. point with distilled water, would contain just 1000
0auj> "i ^'" ,..;:. r, and weighing it accurately; in this way, by subtracting
ife wiirfat of ii»e V>oltli\ we jret the weight of a quantity of liquid which
flEKtiT filla the pp«<*e that 1000 grains of water would. The result is the
" ^frarilT or the liquid. .\n easier, though less direct, method is to
tperiflcHtrnyiiy heads, which are small, balloon-ehaped, glass globes, of
36 PHARMACOLOGY AND GENERAL THERAPEUTICS.
different sizes and weights, so adjusted that they have different degrees of
buoyancy. Figures are scratched upon each one, showing the specific
gravity of the medium in which it swims indifferently, neither floating nor
sinking. These are known as Levi's beads, and are used in cases where a
liquid is to be evaporated until it attains a given specific gravity. They
are hydrometers having only one specific gravity. An improvement on
this, which is in general use, is the mercurial hydrometer, of which two are
used, — one for liquids heavier than water and one for liquids lighter than
water. The form in general use is that of Baum6, which consists of a closed
glass tube,' loaded at the lower end with mercury or shot, and having an
expansion, just above the weight, containing air, which causes it to float in
an upright position. The original scale of Baum6 has been superseded by
the specific-gravity scale, which is engraved upon the stem of the instru-
ment. Hydrometers are usually floated in cylindrical glass jars, the instru-
ment sinlang to a certain depth in liquids to be tested; the degree marked
upon the scale cut by the surface of the fluid indicates the specific gravity
at the ordinary temperature (60 degrees). Alcoholmeters, elaeometers, and
lactometers are used for alcohol, oils, and milk, respectively. The uri-
nometer, used in testing urine, is a specific-gravity hydrometer. The best
form for this purpose is that manufactured by Dr. E. R. Squibb, of New
York, which is remarkably accurate, as it is graded at 77° (F-)? which is
nearer the usual room-temperature than is 60* (F.).
3. Heat is indispensable in pharmaceutical operations. Any of the
.ordinary sources of heat may be utilized, but it is found more convenient'
to use alcohol or illuminating-gas for the majority of the purposes to which
heat is essential. The ingenuity of inventors has supplied us with small
lamps or stoves, burning alcohol or petroleum, which are most convenient
and cleanly. A Bunsen gas-burner, or one of its many modifications, is
now an indispensable adjimct to the pharmaceutical laboratory.
The following are lie principal procedures requiring heat : —
(a) High Temperatures. — Ignition, or burning. Fusion, or melting.
Calcination, or driving off volatile substances by heat. Deflagration, or
burning with the aid of oxygen or some substance, like nitre or potassium
chlorate, capable of yielding oxygen. Carbonization, or heating organic
substances without exposure to air; the volatile substances escape, and the
residue is of a dark color, like charcoal. Torrefaction, or roasting. In-
cineration, or reduction to cinders by consuming all the carbon. Sublima-
tion, or separation of a volatile solid substance from another not volatile
by heat.
(&) Temperatures Less Iligh. — Among these are the water-bath;
steam-bath ; glycerin-, oil-, or sand- bath. In the water-bath it is not possi-
ble to raise the temperature higher than 212* F., but addition of salt in-
creases the density and raises the boiling-point to 227** F. By using steam
under pressure the temperature may be still further increased 100 degrees.
Vaporization and evaporation are employed to separate volatile substances
from fixed bodies. *^^hen vaporization is used to separate a volatile liquid
from a less volatile liquid it is called evaporation. When the object sought
is the volatile liquid it is called distillation. When it is used to separate
a volatile liquid from a solid it is called desiccation, exsiccation, or grana-
lation. When it is used to separate a volatile solid from another body it is
called sublimation.'*
FHAHMACT.
»r
Mmny of the znoet useful classes of preparations are made with the aid
of iDOderate degree of intensity. Irtfttsions are liquid preparations
Ur treating regetable substances with either hot or cold water, but
h Hie former. The preparation must not be boiled. Cold water ie
^akctod as a menstruum when tlie drug contains some volatile substance
whkh msT be ilLssipated by heat, such as in prunus Virginiana. The gen-
«ml direct'' -n by ll»e pharmacopeia are to take 5 parte of the sub-
tfaace and _ water q. s. to make 100 parts. 'Tut the substance into
asoitebJe Te*aei provided with a cover, pour upon it the boiling water, cover
tbe TTMol tightly, and let it stand for half nn hour. Then strain, and pass
okMijeh water tJirough Uie strainer to make the infusion wei«:h 100 parts."
three official solutions this system is not followed. The infusion of
Ui« is only I'/a P^r ceni,^ that of wild cherry is 4, and the compound
^contains 6 per cent, of senna and 12 each of manna and
ium. The stren^h of energetic or powerful substances
spedalTv prescribed by the physician.
Heeoctians require not only boiling water, but boiling vegetable eub-
with water. The general oOlicial formula for an ordinary decoction,
th^ fftrencrih of which is not directed by the physician nor specified by the
pbannacoparut, is bai^d upon the same proportion of ingredients as the
laltUMio, hut the process differs. Put the substance into a suitable vessel
|iwidc>d with a cover, pour upon it 100 parts of cold water, cover it well,
Md boil for fifte^ minutes; then let it cool to about 40** C. (104° F,),
opHJBi^ strnin the ejtpressed liquid, and pass enough cold water tlirough
dM fiiail>er to make tlie product weigh 100 part.'?. Of the two ofticial
dnoctiona, that of cetraria conbiins 5 per cent. ; that of sarsaparilla comp.
iflfttains 10 of sarsaparilla* with 2 each of sassafras, guaiac, and licorice-
fMt, and aIso 1 of mezereum.
In making extracts, the heat of the water-bath is utilized in erap-
maiing tl" ^ t to a pihdar consistency. Heat is also employed in
M^'ng Oil -. cerates, suppositories, solutions, in spreading plasters,
•mI a rariety f*i tithr-r pharmaceutical manipulations,
4. Bone operationi are chiefly mechanical; among these are commi-
sstkm, •olntioD. separation of fluids and solids, filtration, clarification, de-
^^|terstion, pwvipitation, cri-stallization. granulation, dialysis, extraction,
^^^Krffluon, percolation, maceration, separation of immiscible fluids, decan-
^RIBoo, luid siphonage.
r Gomminntion is the process of breaking a solid into small pieces. In
nf herbs, the agent may be broken up by cutting, slicing, or
or, if it be s\ilhciently dry, it may be ground in a mill or mortar,
m It wody bt rasjjwl or grated. When it is reduced to fragments by being
Alii«*rfri«f to a Bucccssion of blows, the process is called contusion. Drugs
Mt^ -illy cut or sliced and then contused, preparatory to making phar-
preparations, such as infusions, decoctions, or tinctures. For
ititir^i the mortar and pestle are generally used, but larger quanti-
I in a drug-mill. Different degrees of fineness of powder may
ing regulated by the fineness of the meshes of sieves through
vtidi it w to Im* passed to separate it from the coarser particles and maJce
it tanfonxu When nnluced to a very minute subdivision it is siiid to be
tmpmlnahU*-, JMx*nu8e the substance bas lost its chamcter of hardness, and is
^ sd liiarht t'^ th*^ touch. Very fine powder passes through a sieve having
38 PHARMACOLOGY AND GENEEAL THERAPEUTICS.
eighty or more meshes to the linear inch, and is known as No. 80 powder ;
fine powder passes through a sieve of sixty meshes to the inch and is called
No. 60 ; moderately fine powder passes through one having fifty meshes to
the inch, — No. 50 powder ; moderately coarse powder passes through a sieve
of forty meshes to the inch, — No. 40 powder; and coarse powder is only
required to pass through a sieve having twenty meshes to the linear inch,
— No. 20 powder. These are the five different degrees of fineness and
names to distinguish them adopted by the United States Pharmacopoeia.
For very fine powders bolting cloth is used, which gives a product as smooth
as flour. Levigation is the term applied to a process for reducing solids to
a powdered state by adding some Hquid in which they are not soluble, the
paste thus formed being rubbed up in a shallow mortar or on a glass slab
with another piece of glass somewhat bell-shaped, with a solid, flat base,
which is known as a muller. When a porphyry slab and muller are used
the process is termed porphyrization. Another method is to use an excesa
of liquid, in which the fine, insoluble powder is suspended, and then de-
canting the portion of the liquid containing the lighter particles, which is
set aside; the fine powder subsequently subsides to the bottom of the re-
ceiver, and the supernatant liquid may then be poured off and the powder
dried. This is known as elutriation ; a good illustration is the preparation
known as prepared chalk, which is made in this way. By a modification of
the latter process the semiliquid, pasty mass, containing the elutriated
powder, may be placed in a funnel-rfiaped receptocle fastened in a wooden
frame, having a short leg near its middle, and a handle.
The material having been placed in the receptacle, the apparatus is
held in the hand, and the leg tepped slightly upon a teble of chalk or
other porous substance; the shock of impact causes a small portion to
become detached from the rest and to fall in the form of small, conical
masses or troches, which, with a little practice, may be made nearly uni-
form in size. Pastils (Fastilla) are small masses of this kind, which are
usually made with aromatic substances and used for fumigation. Sub-
stances refractory to pulverization, like gold-leaf, may be pulverized by rub-
bing them into a paste with honey or potassium sulphate, afterward removing
the foreign element by washing with water. Camphor is pulverized by the
addition of a few drops of alcohol or chloroform, although it may be obtained
from the spirit by the addition of water, and elutriation or filtration, and
afterward removing the alcohol or water by evaporation, Metellic tin ia
granulated by agitating melted (fused) tin with chalk-powder, the latter
being subsequently removed by washing or by chemical solution with an
acid. Phosphorus may be pulverized by heating it in the presence of water
until melted and keeping it agiteted until cooled- Calomel, calcined mag-
nesia, and sulphur may be sublimed, and by introducing steam an excep-
tionally fine product is obtained. A coarse powder is produced by evaporat-
ing a solution to point of concentration and continuing the evaporation,
while stirring the liquid, until all the fluid is evaporated. This process is
known as granulation. Granular effervescent salts are made by thoroughly
mixing the perfectly dry material and moistening the mixture with strong
alcohol. The pasty mass is pressed through a sieve, and the granules quickly
dried in a hot chamber and packed in hermetically-sealed bottles to exclude
the moisture of the air. Pulverization is sometimes preceded by ezncoation,
by which water of crystallization is driven off; this is usually required for
• PHARMACY. 39
salts like alum and sulphate of iron, which contain a large proportion of
water of crystallization. Some metals, like zinc, are granidated by melting
them and pouring them in a fine stream into water. Pepsin and similar
adhesive substances are reduced to a powdered state by being dissolved and
painted on glass plates, from which, after drying, they are scraped off in fine
Bcalea. If a finer powder is needed, a cold mortar, perfectly dry and washed
with alcohol, is used. The operation is facilitated by combining some rather
hard solid with the powder, — like milk-sugar.
Solution is the process whereby a solid or gaseous substance is made
to lose its physical identity by the power of some liquid known as a solvent
or menstruum. When the liquid has dissolved some, and will take up no
more of the substance, it is called a saturated solution. A simple solution
is one which contains the original substance chemically unaltered and will
yield it again by evaporation. A chemical solution is one in which some
chemical action takes place, and the evaporation of the liquid will yield a
body having different chemical properties from the original substance.
Solution is favored by agitation and usually by the application of heat.
Rapid solution is accompanied by change of temperature and abstraction
of heat from surroxmding bodies, so that the process may be used as a cool-
ing agency. Freezing mixtures are made in this way. On the contrary,
where chemical change occurs, there is apt to be a rise of temperature.
A decimal solntioii contains one part of the substance in ten of the
mehstmum; a 1-per-cent. solution is a centesimal solution. The principal
solvents employed in pharmacy are the following: —
Water, preferably chemically pure, or recently distilled, water (as
ordinary spring- or river- water contains more or less earthy and organic
matter, in solution or suspension) is used in making liquors, medicated
waters, infusions, decoctions, solutions, syrups, etc. Alcohol is used very
^rgcly, and is next in importance to water. As it has antiseptic qualities,
solutions with alcohol are not so liable to fermentation, as watery prepara-
tions are. Moreover, alcohol is a solvent for many substances that are insolu-
ble in the former menstruum, such as resins, volatile or fixed oils, alkaloids,
glucosides, etc., while gum, albumin, and starch are not affected by it. This
affords an opportunity of dissolving out the medicinal qualities or prin-
ciples, and leaving the inert, woody, and starchy matters. In some of the
manipulations dilute alcohol is directed, which contains one-half water, or,
more correctly, according to the pharmacopoeia, it contains about "41 per
cent, by weight, or about 48.6 per cent, by volume, of absolute ethyl-alco-
hol, and about 59 per cent., by weight, of water." Alcohol is the basis of
the spirits, elixirs, tinctures, medicated wines, and many of the fluid ex-
tracts of the pharmacopoeia. Ether, benzol, chloroform, carbon disulphide,
acetone, acids, and oils are all recognized as solvents in appropriate cases.
Solids may be separated from liquids, or solutions containing them, by
filtration, precipitation, decantation, eiphonage, evaporation, and crystal-
lization. Dialysis is a process by which a crystallizable substance in solu-
tion may be separated from non-crystallizable (colloid) substances. Grsr
ham, in 1861, brought out this very useful process, which depends upon the
diffasability of certain solutions through porous partitions. The usual form
is a circular frame, like a sieve, in which the wire meshes are replaced by
a diaphragm of parchment or parchment-paper (made by inunersing un-
sized white paper in a cold mixture of two measures of sulphuric acid and
40
PHARMACOLOGY AXD GEyEBAL THERAPEDTIGS.
one of water). The dialyzer is floated upon the Burfaee of wator ir
receptacle, and the mijcture to be separated is placed within it. j
suspended in a glass jar would answer the sanie purpose. This
used to separate alkaloids from organic mixtures, especially for
of quantitative testing, crystalloid substances passing out thn
diaJyzer, leaving colloid substances behind. It is particidarly 8
to toxicological investigations.
When the object in view is to separate active principles from
constituents of drugs, a liquid is employed, termed a meusiiuurn,
the desired principles are soluble. Tlie principal modes of extrac
ployed by pharmacy, at present, are maceration and expression, pei
digestion, infusion, and decoction. Maceration requires the drug
a coarse powder, contused or properly comminuted. The usual n
to place the powder and menatninm in a ]arge bottle, tintil the sob
stituents are all taken up: a process which may be facilitated by o<
shaking during a week or more. This was formerly the process e
in making tinctures, and is still followed by the German Pharm
In this country it is now superseded by the process of percolation,
much more expeditious, and, when properly done, equally etlectiv
eolation, or displacetnont, is the process by which a powder pacl
coiiical or cylindricnl receiver known as a percolator is exhausted of i
principles or medicinal qualities by the descent through it of a
fiolvent. Lixiviation is the name applied to this process when the &\
is first incinerated, as in the process of extracting lye from wood-ash
U. S. Phamuieopnaia gives specific directions for percolation, ■«
largely used in making tinctures and fluid extracts, as follows: '*The
of percolation, or displacement, directed in this phannacopoMa, con
subjecting a substance, or mixture of substances, in powder, co
in a vessel called a pen'olator, to the solvent action of successive por
a certain menstruum in such a manner that the liquid, as it travel
powder in its descent to the receiver, shall he charged witli the solul
tion of it, and pass from the percolator free from insoluble matter.
''When the process is successfully conducted tiie first portion
liquid, or percolate, passing through tlie percolator will be nearly sa
with the soluble constituents of tlie substance treated; and if the q
of menstruum be sufficient for its exhaustion, tlie last portion of tl
colate will be nearly free from color, odor, and t^iste, other than those
menstruum itself.
*'The percolator most suitable for the qtnintities contemplated 1
pliarmacoptpia should be nearly cylindrical, or slightly conical, with
nel-shnped termination at the smnller end. The neck of this fimi
should be rather short, and should gradually and repidarly become na
toward the orifice, so that a perforated cork, bearing a short glass tub
be tightly weilged into it from within until the end of the cork is flus!
the outer erlge of the orifice. The glass tube, which must not project
the inner surface of the cork, should extend from 3 to 4 cm. 1
the outer surface of the cork, nnd should hp provided with a closely-
rubber tube, at least one-fourth lonsrer than the percolator itself, and t
in another short glass tube, whereby the rubber tube may be so sub|
that its orifice shall be above the surface of the menstruum in thej
lator, a nihber band holding it in position.
PHABMACY. 41
**The size of the percolator selected should be in proportion to the
quantity of drug extracted. When properly packed in the percolator, the
drug should not occupy more than two-thirds of its height.
"The percolator is prepared for percolation by gently pressing a small
tuft of cotton into the neck above the cork, a thin layer of clean and dry
sand then being poured upon the surface of the cotton to hold it in place.
'*The powdered substance to be percolated (which must be uniformly
of the fineness directed in the formula, and should be perfectly air-dry be-
fore being weighed) is put into a baain, the specified quantity of menstruum
is poured cm, and it is thoroughly stirred with a spatula, or other suitable
instrument, until it appears uniformly moistened. The moist powder is
then passed through a coarse sieve — No. 40 powders, and those which are
fiaer, requiring a No. 20 sieve, while No. 30 powders require a No. 15 sieve
for ttiis purpose. Powders of a less degree of fineness usually do not require
this additional treatment after moistening. The moist powder is now
tranaferred to a sheet of thick paper, and &e whole quantity poured from
this into the percolator. It is then shaken down lightly and allowed to
remain in that condition for a period varying from fifteen minutes to sev-
eral hours, unless otherwise directed, after which the powder is pressed, by
the aid of a plunger of suitable dimensions, more or less firmly, in propor-
tion to the character of the powdered substance and the alcoholic strength
of the menstruum, strongly-alcoholic menstrua, as a rule, permitting finer
packing of the powder than the weaker. The percolator is now placed in
position for percolation, and, the rubber tube having been fastened at a
suitable height, the surface of the powder is covered by an accurately-fitting
disk of filtenng-paper, or other suitable material, and a sufficient quantity
of the menstruum poured on through a funnel reaching nearly to the sur-
face of the paper. If these conditions are accurately observed, the men-
Btraum will penetrate the powder equally until it has passed into the rubber
tube and has reached, in this, a height corresponding to its level in the
percolator, which is now closely covered to prevent evaporation. The appa-
ratus is then allowed to stand at rest for the time specified in the formula.
'*To begin percolation, the rubber tube is lowered and its glass end
introduced into the neck of a bottle previously marked for the quantity of
hquid to be percolated, if the percolate is to be measured, or of a tared
bottle if the percolate is to be weighed; and, by raising or lowering this
receiver, the rapidity of percolation may be increased or decreased as may
be desirable, care being taken, however, that the rate of percolation, unless
the quantity of material be largely in excess of the pharmacopoeial quan-
tities, shall not exceed the limit of 10 to 30 drops in a minute. A layer of
menstruum fiiust constantly be maintained above the powder, so as to pre-
vent the access of air to its interstices, until all ^as been added, or the
requisite quantity of percolate has been obtained. This is conveniently
accomplished, if the space above the powder will admit of it, by inverting
a bottle containing the entire quantity of menstruum over the percolator
in such a manner that its mouth may dip beneath the surface of the liquid,
the bottle being of such shape that its shoulder will serve as a cover for the
percolator.
"When the dregs of a tincture, or of a similar preparation, are to be
subjected to percolation, after maceration with all or with the greater por-
tion of tiie menstruum, the liquid should be drained off as completely as
42
PHARMACOLOGY AXD GENERAL THERAPEUTICS.
possible, tlie solid portion packed in a percolator, as before descri
the liquid poured on, until all has passed from the surface, whe
diately a sufficient quantity of the original menstruum should bi
on to displace the absorbed liquid, until the required quantity ]
obtained.
"Authority ia given to employ, in the case of fluid extracts,
may be applicable, the process of repercolation without change of tl
menstruum."'
Fractional percolation is the same process applied to two si
portions of the powder, the result being identical with repercolati<
Expression is the process of forcibly separating liquids from so
is a very ancient method, the best-known form bein^ the wine- (
prees. After macerating a cnide dnig for tlie desired len^rth of t
full amount of tincture is obtained by decantation and expression.
Precipitation is the process of separating solid particles from a
by the action of physical or chemical means. If the precipitate is <
specific gravity than the liquid it will float iipon its surface; if, as
is the case, it is of higher specific gravity it will sink to the botton
receptacle. Precipit^^tes may be curdy, granular, flocculent, gel
crystalline, amorphous, etc. A magma is a thick, more or less te:
precipitate. Substances containing albumin arc precipitated by hea
precipitates silver salts; but the most frequent mctlmd of precipit
by chemical action. This is resorted to (1) for the purpose of obtainj
stances in the form of a powder, (2) as a means of purification, (3) J
ing chemicals, and (4) to isolate chemicals. In nssuming the crv
form some salts take up considerable water, which is known as w
crystallization ; the amount varies in different salts, but it is impoi
bear this in mind with some salts like sulphate of iron or alum,
water should he expelled by heat before making them into pills or p
Such salts are liable to deliquesce and become moist or liquid by abi
more moisture from the air, or in a dry atmosphere they may eS
from loss of water.
5. Pharmaceutical testing and analysis is the method followed ii
taining the presence of certain constituents and determining the pro]
if present. The methods followed are not difTorent from those empk
organic chemistry and in the laboratory. The pharmacopana sup]
list of standard reagents for the purpose of applying the tests prescri
the text. As the processes of analysis are not peculiar to pharmac
space will not be taken here to consider them in detail. In practical
macv the microscope is indispensable for the recognition of dru^
adulterants and for the examination of ervptalline deposits aftd sedi
6, The preparation^ of extemporaneous formolse is not different ii
ciple from tlie official, except that some extemporaneous preparation
be ordered which have no relation to tlio pharmacopceia. For ins
some preparations of the English, German, or other phnrmncopceii
occasionally prescribed, or fnrmida^ which are original with the phyt
Unoflicial articles, or now remedies, are also often included in the ma^
prescription, but care should be taken that this is not done to exces
^ PharmacopcEia of the United States of .\raerica, 7t!i DeepnniBl Re*
PRESCRIPTION-WRITING AND FORMULA. 43
is by no means creditable to a physician to be constantly trying much-
vaunted new remedies or proprietary preparations, and neglecting to use
the older remedies of established reputation and of standard composition,
which have received the sanction of the pharmacopoeia. The art of pre-
scribing will now be taken up for consideration.
PBESCBIPTIOH- W BITIEQ ASB TOBXJTLM,
In the progress of the science of medicine it has been found necessary,
owing to the accumulation of knowledge, to institute special departments
of study, as well as specialties in practice. It having become inexpedient
for a physician to collect his own herbs in the fields, to make his own prep-
arations, and to dispense his own prescriptions, these duties have been dele-
gated and entrusted to the trained pharmacist and his assistants, who have
special qualifications for the task, to which they devote their whole time and
attention. This division of lahor is to the advantage of scientific medicine,
as the practitioner of medicine is relieved of routine work and has more
leisure to devote to the study of pathology, diagnosis, and therapeutics.
The Prescription. — ^The physician usually writes his directions, regard-
ing the medicines which the patient is to take, according to a general form,
the writing being called "the prescription^' {prcBScribo, prcBscriptum, prce-
scripiio, in Latin, — something written for, or ordered; in French, ordour
nance). As a prescription furnishes very tangible evidence of the attain-
ments of a physician, and, being preserved on the prescription-file of the
pharmacist as a matter of record, may confront him in the courts of justice,
it is of considerable importance that students should be well drilled in pre-
scription-writing before graduating, so that they may be spared mortifica-
tion and possibly the loss of reputation, caused by blunders or carelessly-
written formulae, to say nothing of the risk to the patient.
The first point to be settled, in composing a prescription, is to deter-
mine the therapeutic indication and to decide upon the drug to be employed,
and in what form it shall be given, — ^whether solid or liquid, and whether
alone or combined with other remedies. Following this is the question of
dosage and the number of doses and length of time during which the
remedy is to be given, which determines the quantity to be ordered in the
prescription. The body of the prescription, or the formula, may have the
quantities written according to the metric system, but, sb pharmacists and
physicians ar^ more familiar with apothecaries* weights and measures, it is
better — for present purposes, at least — ^to follow the prevailing method, as
a matter of precaution, and to prevent mistakes. It has been found that,
hy adopting a certain form in writing prescriptions, the work of compound-
ing and dispensing is made easier and more certain, and the task of transla-
tion facilitated. In framing a prescription, certain principles should be
kept in mind, in order that the product shall be creditable and accomplish
the purpose for which it was written. The tendency of the day is toward
simplicity, the elegant pharmaceutical preparations at our command having
removed tiie necessity of the resort to polypharmacy, as it is called, when
a large number of agents are combined in one prescription. As remedies
44
PHARMACOLOGY AND GBNEUAL THERAPEUTICS.
are modified in tlieir action by association with otliers, it is oft
tageoiis to make such a combination, and knowledge and expe:
sometimes displayed to a marked advautage in onglnating such coi
mida?. Instances of tliis will be abundantly given in tJae sectio
to the consiflenition of drugs. It used to be the rule that a pr
should contain four parts, — (1) the base, (2) the adjuvant, (3)
gent, and {■!) the vehicle; the dose of the first having been decided
quantities of the otiier iugredieuta were made to correspond with
to make the desired quantity of the medicine to be taken at a d
preparations of the j}harmacopceia, as a rule, may be prescribes
addition, except with water, or some other convenient diluent, wht
istered.
The first rule in prescribing should be to make a judicious
of the active remedy or remedies to constitute the basis of tlie pre
always taking a single remedy, unless a distinct advantage can I
by using others in conjunction witli it. In this connection, it t
noted that some drugs can be given in larger doses when thus c
whereas others must have their doses reduced. As a general ru
agents are from the same therapeutical class they mutually enha
other's effects, and must he given in smaller doses than when giv(
when they belong to ditferent classes, and especially when they
dilTerent organs, the dose can often be largely increased with ac
Having settled upon the mnin remedy and its associate, and the
desired to he given, the question of eligibility comes up, in decidi
the special pharmaceutical form to be employed. There are freque
resentatives of the drug in question in several pharmaceutical c
some in solid form, others liquid, — each having, or supposed to ha
special application or advantage in certain cases, and offering i
opportunities for combination. It may be a matter of indiJTcren<
form or prepn ration of the remedy is chosen, but the probabilities
it is not; and that some are better suited than others. Thus, som
preparations of iron are astringent, i>thers acid; others contain aU
are combined with tonics and alteratives; one combination is ei
diuretic, anotlier is used as styptic, and rarely given internally; on«
only as an antidote for arsenical poisoning, nnd so on.
Having decided upon the principal therapeutic agent, if we (
to give it alone, that will complete the prescription formula, and ■
only to add the directions to tlie pharmacist and to the patient (t>
directions being simply what is desired to be copied upon the labe
medicine-bottle or packiige). If we wish to combine our remedies,
lowing objects may govern our selection: First, an addition may I
of some agent which will assist the action of the main ingredient,
or more may be selected which mutually aid each other. This aid
chemical in character, as where dilute sulphuric acid is added to
sulphate to help in its solution, or hydrnchlnnc ncid is added to a d
mixture containing pepsin; or it may be physiolo^cal, and iiitendet
upon some associated organ, so as to make the effect of the remed
favorable; or thirdly, to prevent some incidental, disagreeable resul
example of the former is w^here resin-bearing purgatives, or chol
agents, and a sedative like boUndnnna or hyoseyamus are introduced
purgative pill; an example of Ihe latter is wliere hydrohromic acid h
d
PRESCRIPTION-WBITING AND FORMULA. 45
to a cinchona preparation to prevent noises in the ears, or where carmina-
tives are combined with a cathartic remedy, or the unpleasant effects of mor-
phine are prevented by combining with it a small proportion of atropine.
The object, not infrequently, may be purely pharmaceutical, as where a dry
powder, as an excipient, is added in making pills. The third object of ad-
ministering remedies in combination is to obtain as pleasant, or at least as
unobjectionable, a form as possible.
When a remedy is exhibited in a form that the patient is utterly un-
able to swallow it, or is so repulsive that each dose causes nausea or vomiting,
no matter how cbrrect the prescription may be from the therapeutic stand-
point, the patient will pronounce it a failure, and will probably relieve his
feelings by uttering maledictions upon the doctor. On the other hand, if
the remedy be attractive in appearance and pleasant to the taste, it will be
regarded as a signal success, even though of less therapeutical activity. An
agent is sometimes given merely for the mental and moral effect, without
having any medicinal action directly. Such a combination is called a
pltoebo, because it is administered simply to please the patient. Although
placebos are rarely resorted to, patients should always be well treated, and
with a little care much can be done toward making preparations pleasant.
In choosing a physician, the voice of the patient would, in the majority of
cases, be given, without hesitation, in favor of the prescriber who orders
pleasant medicine, over him who has a special reputation for giving in-
tolerably nasty ones. The young physician can get a hint from fiiis which
may greatly contribute to his success in after-life. Hence, a practical ac-
quaintance with the expedients which modem elegant pharmacy offers, for
overcoming the objectionable character of remedies, is of the highest serv-
ice, has no mean intrinsic value from a financial point of view. A few
suggestions for prescribing may be given here. Solid medicines may be given
in compressed pills, coated with chocolate, in pills sugar- or gelatin- coated,
in hard or soft capsules, or in suppositories. Powdeza can be given in cachets
de pain, gelatin capsules, or suspended in a dense syrup or other vehicle
(such as stewed fruit or currant-jelly). Soluble or flmd agents, if unpleas-
ant, are more difficult to hide, but they may be given in combination with
aromatic or orange elixir, some fruit-syrup or in aromatic water. Many illtis-
trations will appear, and formulae will be given of good forms of combina-
tion, in the discussion of individual drugs under each head. A proper un-
derstanding and appreciation of this principle of combination will not only
make the remedies more effective, but the patient will be lees likely to for-
get to take his medicine, and thus will co-operate with the physician rather
than oppose him in every possible way. This is seen to the best advantage in
the management of sick children, where the remedies must be palatable or the
struggles of the child to escape a nauseous dose may cause the attendant to
give up in despair and conclude that the excitement may do the child more
harm than the medicine will do him good.
In combining our remedies the question of incompatibility demands
consideration. Bemedies may be (1) pharmaceutieally incompatible, (2)
chemically incompatible, or (3) physiologically incompatible. Agents are
pharmaceutieally incompatible when the proposed combination is either
impracticable or extremely undesirable. Thus, the addition of water to a
tincture of a resin-bearing drug precipitates the resin, or oleoresin, which
floats upon the surface, thus spoiling the appearance of the preparation, and
46
PHARMACOLOGY AND GEXEIUVL THERAPEUTICS.
possibly permitting too large a quantity of the active principle to
with the first doses from the bottle. As a rule, such tinctures si
be combined with sohitions, aroinatie waters, or infusions, Prepa]
vegetable drugs coutainiu<? tannic or gallic acid sliould not be j
with iron, as this combination produces an unsightly mixture, and
is precipitated in au insoluble form. A survey of the Materia Mt
afford niany instances of the ineligibility of particular remedies L
forms of combination. Volatile and corrosive substances, or hy
bodies* should not be given with powders; bulky dru^s ghould not
to pills. In alkaloids of great ]>hysiological activity, such as stl
delphinine, or aconitine, the pill-form should not be resorted to on
of tlie danger of unequal mechanical division, and, in solution, it s
seen to that nothing be added that would render them in.=olubIe.
tlie combinations, inexpedient from a pharmaceutical standpoint
follows : —
(a) Form Explosive Compounds. — Chlorate of potassium and t
gallic acid. Bromide and alcohol. Nitrate of silver iiud creo
vegetable extracts containing glucose. Iodine and pohitions of aj
Chromic acid and glycerin. Chloride of lime with sulphur. Spirit '
ether with certain fluid extracts. Calcium or sodium hypophosphi
dry powders, or when triturated alone.
(b) Form UnsighiJy or UndesirahJe Mixtures. — Chloral with s
containing alcohol. Vegetable tinctures containing oils and resi:
water. Spirit of nitrons ether with potassium iodide, iron snlpliate,
of g^aiac, antip}T*in, mucilage, tannic and gallic acids. Compound i
of gentian with infusion of wild cherry nr of cinchona. Copaiba i
with watery preparations (unless suspended by acacia or other emu
agent). Acids with ftmmoniated glycrrhizin.
Chemical incompatibility ia caused by chemical decomposition n
production of a compound (srU) having characters and reaction d
from its com|X)ncnt3. It should be avoided, as the rule, except wh
prcssly intended liy the prescriber. A knowledge of chemistry will g€
put the physician upon his guard, but there are special illustrations,
must be home in mird. where the combination is particularly unde
and, when ordered in a prescription, will defeat the object of the tre
and bring discredit upon tbe attendnnt. The general rules of chemi
compatibility are iisually stated ns follows: —
As a rule, a remedy is not to be ordered in combination with it
dotes and chemical tests, cspecifilly if the latter depend upon the fori
of an insoluble precipitate or a corrosive nr poisonous salt. Thus, nil
re usually precipitated by mercurials and other metals, and may
royed by compounds containing free chlorine, cnustir alkalies, or
sinm pcrmangannte. Tannic and gallic acids usually precipitate thi
loids in a nearly insoluble form. The alkalies usually cause precip
when added to solutions of metallic salts. Qlucosides are decomjm
free acids or by emulsions.
Special incompatibilities will be studied in connection with ind
dmgs. Among those that are most likely to give trouble are prepa:
containing corrosive chloride of mercury, silver nitrate, solutions of
and iodides, arsenic, lead, quinine, strychnine, and tannic acid, and/
rule, such combinations should be avoided and the agents given bj'
PKESCKIPTION-WHITINQ AND FOBMUI^. .47
selves or simply in some vehicle. Care should be taken in mixing powerful
oxidizing agents with easily-combustible bodies. Among the former are
chromic. acid, concentrated nitric or nitrohydrochloric acid, potassium chlor-
ate or permanganate. Some of the latter are oils, alcohol, ether, glycerin,
sulphur, and phosphorus. Mixtures of chromic acid and glycerin or alcohol,
88 already stated, are explosive ; so is silver nitrate with a vegetable extract,
or glucose. Compressed tablets of potassium chlorate sometimes explode
from slight friction.
Incompatibilities of Some New Bemedies. ^ — I^e task of avoiding in-
compatibilities in the dispensing of the newer remedies of synthetic origin
has become correspondingly diflBcult with their increasing number.
A favorite method nowadays with some physicians is to prescribe a
large variety of drugs in wafers. Many remedies, however, are unsuitable
for dispensing in wafers, because they attract moisture and soften the wafers.
Among these are sodium bromide, calcium chloride, strontium chloride,
chloral, the glycerophosphates, piperazine, and the dry vegetable extracts
from drugs obtained by desiccation in vacuo. Iodides should not be pre-
scribed in wafers, as they decompose or change color.
Some of the pharmaceutical incompatibilities are due to the fact that
the mixture of some solids produces a liquid. Thus, camphor mixed with
naphthol makes a liquid, while antipyrine and sodium salicylate give rise
to a semi-liquid, pasty mass. Antipyrine gives also an oily liquid with
chloral, betanaphthol, salol, resorcin, phenol, pyrogallol, thymol, and ure-
thane.
Aeetaoilide is incompatible with chloral, thymol, reaorcin, and menth<^.
Betanaphthol should not be mixed with antipyrine, camphor, menthol, phenol,
and urethane.
Camphor should not be dispensed with betanaphthol^ chloral, exalgine, menthol,
phenol, pyrogallol, resorcin, salol, thymol, and urethane.
Camphor mono^omide is incompatible with chloral, phenol, salol, and thymol.
Chloral is incompatible with acetanilide, camphor, camphor bromide, exalgine,
menthol, methacetiDe, phenaeetin, phenol, salol, thjTnol, and urethane.
Exalgine is incompatible with chloral, naphthol, menthol, phenol, pyrogallol,
resorcin, salol, thymol, and salicylic acid.
Menthol cannot be mixed with naphthol, chloral, phenol, pyrogallol, resorcin,
salol, thymol, and urethane.
Sodium salicylate should not be dispensed with antipyrine and phenoL
Phenaeetin is incompatible with naphthol, chloral, and phenol. Phenol decom-
poses antipyrine, naphthol, camphor monobroraide, camphor, chloral, ex-
algine, menthol, methacetine, sodiimfi salicylate, pyrogallol, resorcin, salol,
thymol, and urethane.
Pyrogallol is incompatible with antipyrine, camphor, exalgine, menthol, and
phenol.
Reaorcin forma new compounds with acetanilide, camphor raonobromide, ex-
algine, naphthol, menthol, methacetine, phenol, and urethane.
Salol reacts with antipyrine, camphor, camphor bromide, chloral, exalgine,
phenaeetin, pyrogallol, and thymol.
Thymol ia incompatible with acetanilide, antipyrine, camphor, chloral, exalgine,
menthol, phenol, salol, and urethrane.
Urethane should not be dispensed with antipyrine, naphthol, camphor, chloral,
exalgine, phenol, pyrogallol, reaorcin, 'salicylic acid, salol, or thymol.
>Frmn the Report of the Committee on New Remedies of the New York State
rhaTmaceutical Association for 1906. American Druggist, 1906, p. 37.
48
PIURilACOLOGY AND GEKERAL THEILiPEDTICS.
Great care should be taken in preparing mixtures of syrups c<
cia with certain phenol derivatives and synthetics. Incorapatib:
pt to occur as the result of the presence of an oxidizing ferment oi
in tlie gum, in virtue of which chemical changes take place, eitlier
in a precipitation or a change of color. Witness, for example, the :
combination which occurs in an article by Tanzi, quoted in Repe
Th i'. rape utique : — Jk
l»j'ranudou 0120 Gm.
Sodium bromide 0 25 Cim.
Syrup of gum ucocia 130j Gm.
9
This mixture at once turns a bluish-violet, then violet, then p
after a few hours becomes yellow.
Syrup of acacia gives a blue color with guaianira resin; a pi
turning black with phenol; a violet color, and later a blue precipit
niphanaphthol; a gra3aBh white opacity with betanaphthol ; a y<
brown color and a garnet precipitate with pyrocatechin ; a white pr
with vanillin; and a deposit of white crystals of oxy-morphine wi
phine hydrochhiride. Syrup of acacia is also incompatible with
adrenalin, synip of tar, and the liquid preparations of aloes.
Physiological incompatibility is based upon the physiologica
of drugs, the rule being that drugs having dissimilar effects upon
organs should not be combined in one prescription, especially wl
principal action of the drugs is antagonistic. Inasmuch as the el
individual remedies are not restricted to one orgim or set of orga
as it never happens that t^vo dnigs will be found exactly opposed
other throughout tlioir whole ran^e of action^ considerable latitude
respect is permitted in prescribing. Jn fact, there is sometimes an
tage in modifying the activity of a drug by one which is antagonisti
instance, morphine and atropine are opposed in their effects, and y
pine is very frequently added to an opiate to diminish the disii^
effects, — headache, nausea, and constipation, — and heighten the i
and anodyne qualities. Illustrations of such incompatibility are lai
be found under the antidotes to the toxic efTects of drugs, a remed;
considered incompatible with its p]iysiological antagonists, as the
rule. Some prominent illustrations are the following: —
Acetanilidc: Alcoholt ammonia, CAffeine, cardiac stimulants.
Aconite: Alcohol, ammonia, atropine, amyl nitrite, dij^talis, stropi
itrychnine.
Agaricus albua: OpiTim, strychnine, pilocarpine.
A^ftricus uuiscftrius: Atropine, digitalis, stimulants.
Alcohol: Ammonium, acetato, digitalis, strj-ehnine, catTeine, liyosoyara
Atropine: Acouitinc, chloral-hydrate, hydrocyiinic acid, jaborandi, mu
morphine, pfayaostigmine (escrine).
Caffeine : Opium.
ClilorHl-hydrfite: Ammonium salts, atropine, alcohol, many alkaloids.
Chloroform: Amyl nitrite, ammonia, digitalis, strychnine.
Digitalis: Aconit(s muKcarine, saponin.
Gelsetniimi: Opium, atropine, strychnine.
Hydrocyanic noid: Atropine, hyo&cynmine.
Morphine: Atropine, caffeine, nicotine, physostigmine,
Miiscnrine (see AKarieus muscarius).
Opium: Atropine, gclaemium, veratnim viride, potassium i>erman;,'Qnat
PKESCBIPTION-WEITING AND FORMULA. 49
PhTBostigmine: Atropine, chloral-hydrate, morphine.
Saponin : Digitalis, strophanthus.
Strychnine: Amyl nitrite, chloral, potassium bromide, chloroform, etc,
Veratnim viride: Opium.
The risks of incompatibility in prescribing can be entirely avoided if
due precaution is taken. Whenever a new or unfamiliar combination is
ordered, the careful prescriber will, if possible, supervise the preparation of
the prescription, and examine the completed product. If an insoluble
precipitate be formed, it 'should be at once investigated and its character
determined. Very often a skilled pharmacist will be able to detect an in-
compatibility in a prescription, owing to his practical acquaintance with the
combining of drugs, and in this way point out the fact that such an unin-
tentional incompatibility may exist, and thus show his willingness to work
with the physician. It is expected by the general comm\mity that a phy-
sician should be able to recognize a remedy or preparation by its physical
characters alone. In order to do this it will be necessary for him to cultivate
a close acquaintance with drugs and the results of combinations which he
wishes to order, so that he may pronounce a verdict upon a preparation and
decide whether or not it is properly compounded. If he has not such tech-
nical knowledge, he should make it his business to acquire it in a laboratory
or a pharmacy.
Form and LanipDUige of the Prescription. — For many- reasons formulae
are usually written in the Latin language. However, if any physician
choose to write his prescriptions entirely in English he is at liberty to do
so; but the demands of accuracy require that he write the official English
titles without abbreviation. Such titles as muriate of ammonia, balsam of
copaiba, saltpetre or nitre, brown mixture, spirit of turpentine, etc., may be
used in conversation, but in prescriptions the correct titles should be given;
either ammonii chloridum or ammonium chloride; copaiba (not balsam);
potanii nitras or potassium nitrate ; mistura glyoyrrliizec oomposita or com-
ponnd licorice mixture ; oleum terebinthine reotiflcatum or rectified oil of
turpentine, and so on. Many popular titles are very objectionable; thus,
oidic acid is sometimes called essential salt of lemons or salt of sorrel, lead
ac-etate is called sugar of lead, while an attempt to trace the vulgar names
of plants leads to endless confusion. Sometimes preparations of different
strength may be indicated; thus, prussic acid may mean concentrated acid
or the official 2-per-cent. dilute acid ; oil of almonds may mean oil of sweet
almonds or oil of bitter almonds, which differ very much in their properties
and effects. The only safe rule, therefore, in writing prescriptions, is to
IcDow exactly what is intended to be ordered and to legibly write the scien-
tific name and quantity of the article desired, and if this is done, the lan-
guage may be left to the choice of the prescriber. As a rule, it will be found
that physicians who are competent to do so prefer to write in Latin, and
those who cannot write them correctly in the language of the pharmacopceia
cannot write them correctly in English either.
As to the status of a prescription, although really a communication
from a physician to the pharmacist, directing the preparation of the remedy,
bv tacit consent of all parties it is generally admitted to be the property of
the patient, who haa ihe privilege of having it repeated or refilled at his
pleasure. When thie prescription is marked *'not to be repeated," the patient
i« understood to assume all the responsibility of an injury which he may
50
PHARMACOLOGY AXD GENERAL THERAPEUTICS.
experience from disobedience to the physician's directions, the
pharmacist generally satisfying his conscience by calling atteutio
fact that the physician did not desire the remedy to l>e continued,
chiring that the entire responsibility must rest with the patient, b
the prescription just the same. In this way the alcohol habit, tl:
habit, the chloral habit, the cocaine habit, the antip\Tin or bronu
are fostered by the resources of modem pharmacy, which preset
agents in the form of cordials and otht^r attractive preparations;
physicians hesitate to pro:=cribe them, for foar of the eonsoi]uences oi
patients acquainted with these seductive preparatiuns. as there is pr
no restriction on their sah\ It is only ju.-^t to add that there are mt
orablc pharmacists to whom the above remarks do not apply, and
deavor to co-<ipernte with the physician and who practice pharmt
special department of the practice of ineflieine.
Besides the formula, the complete prescription contains insi
to the pharmacist conceniing the combining or compounding of tl
cine and direct ions t-o the patient as to the dose of, find the manner e
of taking, th*? proparation. Finally the document must bo signed an
and, as a matter of precaution, it is advisable to write upon it the ]
name and address, so that, if the pharmacist should make a mistak
liver the wrong medicine, he will be able to trace it at once. Thii
a safeguard against error in administration where more than one pi
mider treatment in a family or institution. Many physicians reqi
formula to be copied upon the label, a plan that is often very useful.
Proceeding to the actual framing of prescriptions, assuming i
ledge of tlie Materia Medica and pharmacopoeia 1 titles BufScient to
the prescriber to determine what remedy he wishes to give and its
he writes, as legibly as possible, upon a piece of paper, the formula
has in his mind, making the csit^e endings agree with the rf'quirement
situation. For instance, aa the first word is *'Recipe," the iniperati'V
of the verb "take" requiring the accusative case, it follows that th<
which follow referring to quantity should be considered as in the ac<
case. Thus, **RecijH\ 1 G. or 8 e.cm.." means: "Take one gramme i
cubic centimetres" of any desired agent. The latter, however, \? to b€
in the genitive case whenever the quantity is expressed; thus, "B
ealcis, 15 c.cm./' means: "Take Irt e.cm. of lime water/' On thi
liand, when the quantity is not given in any denomination of we
volume, the subject itself being directly taken, the latter is put
accusative case; thus: —
'B Vitpllum ovi,
Aqun? cinnnmomi.
.q. s. ad 30 c.vm, or J
means: "Take the yelk of an Qgg. and enough cinnamon-water (wj
cinnamon) to maJce thirty c.cm, or one iluidouncr'," the letters q. s. st
for qjtntifum stifpciai. or "as much as may be required to make i
amoimt specified." If the case-endings are known » the proper case
be ascertained by trying to insert the word "of"; where this can h
the word following it should be written in the genitive case; thus, in
of cinnamon, or syrup of orange, tlie words cinnamon and orang
always he in the genitive ease. To students unfamiliar with Lati
difficulties in the way of o:irrect writing of prescriptions may seem
••• •
FaESCBIPTION-WBITING AND FORMULA. 51
moontable; but they will disappear after a little attention and practice-
One of the best ways of learning the genitive case of pharmacopoeial nouns
is to study the list of fluid extracts or tinctures in which the remedial agent
is in the genitive (fluid extract or tincture of — ), Familiarity with the
names of the Materia iledica will supply the needed information in the
majority of drugs regarding the case-endings.
The general form of the prescription is : —
T^ (for recipe, or take)
B<ui$. of A (in the genitive case), a certain quantity (in the accusative case).
Adjuvant, of B (in the genitive case), a certain quantity (in the accusative caae).
Corriffcnt. of C (in the genitive case), a certain quantity (in the accusative case).
rfMcie. of D (in the genitive case), a certain quantity (in the accusative case).
Pharmaceutical DirecHons. Let such or such preparation be made.
Directions for the Patient. Write (upon the label) the specific directions for dosage,
time of taking, alone or with any vehicle, etc.
Siffnature. Physician's name.
Date.
Same and Address of Patient. For Mr. So-and-HO.
It is not at all necessary that the classical arrangement of base, ad-
juvant, and so on, should always be observed, but it seexna natural to write
the most important agent first, and follow this with any agent or agents
which we desire to combine with it, and, finally, a menstruum or vehicle if
any be needed. For illustration, suppose it is desirable to give a patient an
expectorant cough mixture. In order to render the secretions more liquid
we may use potassium iodide, or a vegetable substance, like ipecacuanha,
and, perhaps, may decide to combine them. Associated with them we may
give ammonium chloride, which acts beneficially upon the bronchial mucous
membrane, causing the development of more healthy epithelium. Finally,
a suitable menstruum would make the mixture more palatable. We next
decide upon the quantity for each dose, and the prescription now appears
in this form: —
20 Gm. or gr. iij.
75 Gm. or gr. xij.
12 c.cm. or mij.
50 c.cm. or f3ij.
Recim
Potassii iodidi
Amxnonii chloridi
Floidextracti ipecacuanhee
Syrupi sarsaparillse compositi q. s. ad
MiBoe et fiat mistura.
Or (in English form) : —
Take
of iodide of potassium twenty centigrammes, or three grains
of ammonium Chloride. . , seventy-five centigrammes, or twelve grains.
of ttuid extract of ipecac twelve centigrammes, or two minims.
of rompound syrup of sarsa-
parilla enough to make 7.50 cubic centimeteres, or two drachms.
Mix. Let a mixture be made.
Having settled that a dessertspoonful (7.50 c.cm., or 2 drachms) will
be a sufficient dose to give, we decide upon the number of doses to be or-
(iered. If twenty be the niunber selected, the entire prescription will then
equal twenty times this quantity, or 150 c.cm., and, when completed, will
fom a mixture, with directions like the following : —
52
PHARMACOLOGY AND GENERAL THERAPEUTICS.
Gm.
or 3j.
5 Gm.
or 3iv.
50 c.cm.
or msh
c.cm.
or f3v.
Potaasu iodidi 4
Ammonii chloridi 16 (
Huidextracti ipecacuanhee 21
Syrupi sarsaparilUe compositi q. s. ad 150
Misce et fiat mistura.
Signa: Take a dessertspoonful every four hours for cough, as directed by
Phila,, Sept. 30. 1900. Dr. X.
For Mr. A.
Another illustration may be taken: —
n
Base. Quininse sulphatis 3
Adjuvant. Acidi sulphurici diluti 4
Corrigent. TincturK cardamomi compositae
Vehicle, Elixir aromatic! 90
Sig.: Take a teaspoouful with water after meals,
July 20, 1900.
Gm. or gr. xlviij.
com. or ^j.
com. or fSvij.
c.cm. or fS"j*
I>H. A.
For Mrs. O.
The principal object of the addition of the sulphuric acid is to increase
the activity of the quinine by changing it into the more soluble bisulphate.
The compoimd tincture of cardamom makes the mixture more acceptable
to the stomach, and increases the tonic effect, in which the alcohol, both of
the tincture and the elixir, will participate. Where the latter is objection-
able, the syrup of the red orange may be substituted for the elixir.
There is no essential difference, as regards their form, between pre-
scriptions for internal remedies and those for topical or local use; for in-
stance, we may write as follows ; —
B Olei tiglii 41 c.cm. or f3j.
Olei amygdales expreasi 7|50 c.cm. or fSij.
M. Sig. : For external use. Apply with a earners-hair pencil, once daily, over
a space aa large as a silver dollar, as directed. Dr. B.
U Acidi ^lUci 41 Gm. or 3j.
Glyeerini 30] c.cm. or fSj.
H. ft. solutio.
Sig. : Apply, night and morning, to the throat as directed. Dr. C.
B Potassi chloratis 81 Gm. or 3ij.
Glyeerini 30 ccm. or fSj.
Extract! geranii fluidi 15 ccm. or f3tv.
Aquce roses q. s. ad 180( ccm. or fjvj.
M. et ft. mistura.
Sig. : Use as a gargle several times daily, diluting with water if necessary.
Db. D.
Time and Interval in Eelation to Dosage. — In addition to the question
of dosage and the proper form in which to administer remedies, the problem
of the frequency of giving the dose must be decided ; and the time of the
day, the relation to meal-time, all come up for settlement. The old and
pT(?v:iilin;:r tlii>^« tinioii ^]aih^ or ter in die, method of ordering medicine to
be tdkcTi am^r from ilie natural division of time and the custom of eating
ft morning, noon, aiiil evening meal. Remedies affecting the stomach
jtlv nir iisTiflUy ffiven when the organ is empty, — that is, before meals, —
Je iigf^t)tivt> agotit^?, to assist the assimilation of food, would properly be
DiaistfTed dnriDg tlv? period of digestion. Systemic remedies, in a sim-
annor. nro- lic^t fiiven a short time after meale, so as to mix with the
ADHIKISTRATIOX OF BEMEDIES. 53
food and be absorbed with it and so enter the circulation. Laxative pills
may be taken after the principal meal of the day (dinner-pills), or, if they
contain cathartics of a slowly-acting character, they are best given upon
retiring at night, so that in case they cause griping it will not give so much
pain or inconvenience as if it occurred during the day. On the other hand,
salines, such as Rochelle or Epsom salts, or natural purgative waters con-
taining them, are more efficient when taken early in the morning, when the
stomach and intestinal tract are not occupied in digesting food, and are
thus more directly affected. It is sometimes of importance that the bowels
should be moved just before retiring at night ; for instance, where there are
haemorrhoids, it is found that they are liable to come down during the act
of defecation, and afterward to cause pain and irritation during the time
the patient is in the erect posture. In such a case a laxative, such as com-
pound licorice powder, or rhubarb, may be given at an hour in the after-
noon which a little experience will determine so as to bring about the desired
result Xarcotic and sedative remedies are more effective if given just
before the patient is accustomed to sleep : just as bitter tonics intended to
excite the appetite should be given a little before the times appointed for
the meals. Remedies may be given for a temporary purpose, as where alum
and molasses, or an ipecac mixture, is ordered for croup, or preparations
ordered for headache, or cough, which are to be discontinued as the symp-
toms are relieved or the object of the treatment is accomplished. In treat-
■ ing a patient for tape-worm it is considered advisable to have the intestinal
tract nearly empty, and the action of the remedy is greatly assisted by a
preliminary purging to carry off the mucus which is thrown out as a result
of the irritation caused by the parasite. For the administration of a purga-
tive or the removal of a tape-worm the medicine is frequently taken on
Saturday night, so as to enable the patient to rest the following day in case
of overaction of the drug. When it is desired to evacuate the stomach by
an emetic, it is advisable that some warm water or gruel shall be swallowed,
60 as to moderately distend the organ and give the muscles something to
contract upon. On the other hand, when vomiting is not desirable, as
when ipecac is administered for dysentery and it is not intended to be
rejected by the stomach, the patient should abstain from drinking water
before or after taking the medicine. Seasons and locality have some effects
upon dosage ; in hot weather the system usually does not bear strong medi-
cation as well as in winter-time. In some localities, where malaria is rife,
antiperiodics must be given in larger doses, and are required in almost
every disease. The numerous modifying elements that arise from circum-
stance and place, or the condition of particular organs, will receive due
attention in another part of this work.
The Model of AdministratioiL, from a pharmaceutical standpoint, have
already been referred to, but a few words remain to be said from the thera-
peutical or physiological point of view. Remedies produce systemic effects
because they enter the blood and become a part of the circulating fluid, or
they may occasionally produce an impression upon the peripheral nerves,
and thus produce local or remote effects, owing to reflex action. It must
alw be admitted that disturbances of function, similar to those produced
by medicines, may be produced by emotion or mental states. In certain
^m sensitive subjects, usually hysterical, it has been found, in Charcot's
flinic, that the effects can be apparentlv obtained by "suggestion," without
54
PHARitACOLOGY AND GENTRAL THERAPEUTICS.
administration of the remedy. This is very similnr in princip!
metnllotherapy of Rurq nnd to the traclothcrapy of Perkins. Th
just adverted to will he further discussed in the chapter upon **H
and Allied StatoB." For the pn-sent we are concerned with the act
iolofrical action of remedif^, which may enter the cireiilation (1
mouth and stomach, (2) by the rectum, (3) by the bladder or va^
by the &kin, (v>) by the brftnt-ho-pulnionary mucous membrane, an<
the veins or capillaries u[nm p[ranulating surfaces.
1. The mouth being the natural channel for the introduction
or sustenance, it seems the most convenient route for tlie admin
of medicines, and ie adopted, as a rule. Nature has placed sentii
in the form of the pistatory nen^es and papilke, and innumerable ex
have been resorted to in order to enable badly-tasting remedies to pi
out exciting repugiinnce or nausea. Patients differ «rreatly with r
to their ability to take medicines. Some can take castor-oil w^ith
otluTS enjoy asafcetida as a condiment to their food; some are so i
that they are nauseated even by the idea of taking medicine of aj
The latter often tax the resources of the pharmacist and physicia
some more suitnble channel is found for introducing the remed
abBorption of medicines is largely by means of the capillaries or sma
but the lymphntics or lactoals also participate. After entering th
tlie l>?nl"•[lie^ are carried by it into the Ciij«illaries of the central
system and the various orgnns of the body. After remaining in the
for a greater or lest^ length of time, nnd exerting certain charai
effr-cts upon the functions of the several organs, these a,gentfi ma;
enter the circulation, and be excreted from the system by the emuE
As a nile. tlte remedy acts as an excitant or stimulant to the organ Ir
it is separated from the blood. They are subsequently to be found
vnrious secretions and exerefione, either in their original form o
derivative of it. The iibj^orption of insoluble substances is depender
their being transformed into soluble form ; this may be done by tl
gastric juice or the alkaline intestinal juice. In some cases of ingea
corrosive poisons the individunl may perish from shock, or from sp
the glottis; but, as the rule, there is sufficient time for absorption
poison from the alimentary cnnal before death occurs. When a toxit
has been swallowed it is important to evacuate the stomach and int
at once, so as to prevent tlie continued absorpliojj nf the poison.
2. Remedies may be introduced by enema, — otherwise called inj
lavement, or clyster. In this instance the mucous membrane of the i
takes the place of tlie lining membrane of the str>maclK There can
question with regard to the absorption <tf rumodies by the bowel, si
con be so readily demonstrated. Thus, suppositories of opium produ
usual systemic effects of this drug; quinine, intitiduced into the n
stops intermittent fever; nutritive enemnta support life for monthi
so on. Injections of starch, with laudanum, are especially useful in p
affections of the rectum or the other pelvic organs, and clieck secret
diarrho-a or dysentery. When an enema is to be retained it should l
more than from 1 to 4 ounces, according to eircumstartcea; as a lav
or clyster, as large an nnioimt as can bt* borne by the patient without
ing actual pain may be given, — thus, from 2 to 4 pints may be inJ€
an adult, from one-eighth to one-fourth this quantity for a child.
ADMIKISTRAXIONT OF REMEDIES. 55
2 ounces for an infant. The instrument used for this purpose is called a
syringe. It may be the classical form, with a piston and receiver, the latter
b«ing furnished with a tube, through which the fluid is forced when the
piston is forced down. The. best are made out of hard rubber ; those made
of pewter or glass are very inferior. In addition to these, \^e have the soft-
rubber tube, terminating in a tube of metal or of hard rubber ; in the course
of this tube there is a rubber bulb, which, expanding after compression,
exercises suction, and, by alternate compression and expansion, forces fluids
along the tube. This is a great improvement over the old style, as it is easily
operated and can be used as a self-injecting apparatus. The fountain-
syringe is simply a rubber bag or receiver, of adequate capacity, terminating
in a tube, through which the water flows by force of gravity, when the
reservoir is elevated. A pneumatic syringe is also made, in which the solu-
tion is placed and is afterward forced through the tube by pumping air into
the bottle, reversing the aspirator of Dieulafoy. The ordinary injertion used
for evacuating the bowel consists of warm water containing some Castile soap
in solution. In addition to this, we may add 30 to 60 c.cm. of castor-oil or
a teaspoonful or more of oil of turpentine, in order to make the injection
more stimulating. Glycerin may be used for the same purpose, from 4 to
16 c.cm. (1 to 4 drachms) being generally sufficient to evacuate the lower
bowel. When gaseous enemata are administered, the gas diffuses rapidly
into the blood, and is excreted by the lungs. It was thought that the intro-
duction of sulphuretted hydrogen in this way might benefit tubercular
lesions in the lungs (Bergeon^s method) ; but it has not been found to be
of much service, clinically. Anesthesia for surgical operations may be pro-
duced by the injection of the vapor of ether into the bowel ; but this metiiod
is not devoid of danger and has not met with much favor.
3. The bladder or vagina may be used for the administration of reme-
dies; but, nsually, agents here applied are only intended to act locally. A
weak solution of silver nitrate, or of some sedative antiseptic, — ^boric acid or
carbolic acid, — ^is sometimes resorted to, with excellent effect, in cases of
inflammation ; but remedies are rarely, if ever, introduced by either of these
channelB into the system.
4. The ikin, or general surface, may be utilized in several ways for the
introduction of medicines. In the first place, the agent may be simply ap-
plied to the surface and kept in contact with the skin, — the enepidermio
method. Friction may be called to our assistance to force the agent through
the skin, — ^the epid«rmio method. The cuticle may be removed by a blister
or other means, and the agent applied directly to the derma, — the endermio
method. Eemedies may be introduced beneath the skin and thrown into
the areolar tissue, — ^the hypodermic method. With regard to the first three
bnt little need be said. There are in use a large variety of lotions and lini-
ments, some of which are active coimter-irritants, which are used principally
for a local effect. At the same time, remedies can be thus made to produce
a systemic effect, as where mercurials are applied by inunction ; or quinine
is used in the same way. Occasionally, medicines applied to the surface
for a local effect may produce a general one, as where a belladonna ointment
or plaster produces dilated pupils, or croton-oil causes a general eruption.
Similarly, remedies injected under the skin will produce sj'steraic effects.
The last-named, or hypodermic, method will require a more extended notice.
By the subcutaneous or hypodermic method, remedies in a state of
56
PHARMACOLOOT AND OKNERAl THERAPEUTICS.
solution arc introduced by means of a ?mail syring'c, amied with
needle, which is made to perforato the skin. This plan was first bi
the notico of the profession by Dr. ^Vlexandcr Wood, of Edinbu:
being adopted, soon acquired a remarkable popularity. It has sorat
advantages over ordinary methods, in that it admits of greater pre
dosage, sinee the entire dose rapidly outers the circulation; where
by the moutli, some may escape absorptioTi, It produces prompt ef.
infhu^nce being observed in from five to fifteen niiniiiesi, wbieli mal
valuable in the ease of pain. It eonibines a local with a peueral e
according to Dr. Wood, the injection should be administered as ne*
site of pain as possible. It is clean, it is convenient, and it is ehea|:
the patient has it given to him. On the other hand, if an overdose
dentally administered the poisoning must be met by physiological a
since it cannot be withdrawn from the circiiktion after being injec
_the needle be not strictly sterilized, or aseptic, it may communicate
ad instances have been known of pyaemia and tetanus following
" the h)iiodeniiie needle. The greatest objection of all is that, by
some patients acrniire the morphine liabit, they are apt to become in
with the little instrument and the effects of the punctures, and soon
confirme<l morphinomiiniacs. It is the latter consideration part
which lias induced physicians to use the hypodermic needle with in»
caution, and to refrain from its use whenever the remedy can be g
the stomach.
The hypodermic syringe is iisually made of glass, of 1.30 c.(
twenty minims) caj>acity, the gradations being engraved upon the b
the piston-rod. The needles may be of steel or platinum ; it the form
may be gohl-plated. Various modifications have been made in the e
shape, but the form used by Pr. Kobert Koch, of Berlin, has an adv
from an antiseptic stand-point, in that it is free from a piston and p
The fluid is sucked up by aspiration, l)y means of a rubber ball atta
the end of the syringe, and, by compression of the hall, is again fore
The nf^edle is fittctl upon the glass barrel by ji earefullv ground frietio]
and llie whole iiistnnnent can readily be taken apart and washed wit
septic solutions or treated with hot water. Tlie construction of the i
is readily understood from the foregoing, but a more extended degc
can be found in the 2ledical Bulkiin of February, 1891, by those esf
interested in the Koch treatment. Tliere are numerons makes of hypo
t:yringes in the market, and tliosse are to be ])referr*Hl wliicli can moBt :
lie made aseptic and luive the smallest needles. Bartholow, who has
much attention U^ thie method, reconnnends a silver-plated instrumer
ing a fiat side to the piston-rod, upon which is marked the quantity o
tion contained in the barrel. He makes the proper suggestion that,
using such an instrument, it should be carefully tested with a sta
minim-glass, in order to see that it is properly graduated. For conve
of steriijzution, hypodermic syringes may now be obtained made entii
glass. Tlypodcrmic syringes of larger size are also supplied for the s
administration nf diphtheria antitoxin. The instrument must he kef
gically clean : the lu'cdles pliould l)e small and sharp, and tlie s^Tinf
quently washed with antise])tic solution, in order to keep the packi
the piston in good order and ]>rcvent it fmm bccnminir dry. As rep
solution, it should be chemically pure and made with great accura
ADMINISTKATION OF REMEDIES.
57
not too concentrated. It should be fresh, because a fungus often develops in
the course of a few days (penicillium) , which destroys the alkaloid. "Where
the synnge is not frequently used it is better to rely upon extemporaneously
prepared solutions made with recently-boiled water, and powders, compressed
tablets, or triturates containing the desired quantity. Distilled water that
is not fresh is not so good as recently-boiled water for making the solutions.
Chloroform-water, orange-flower water, peppermint-water, or carbolic-acid
solutions will keep for a comparatively long time without spoiling.
In administering a hypodermic injection, a part of the skin free from
superficial veins should be selected and the surface washed with soap and
irater and made surgically clean. The previously-sterilized needle is intro-
duced in a plane nearly parallel with the surface of the surrounding skin.
If, when the needle is in position, the piston be pulled out slightly and
blood is seen to flow into the syringe, the needle should be withdrawn and
another spot selected. Profound narcotism (possibly fatal coma) might re-
sult from the injection of morphine directly into the circulation by puncture
of a vein. The place being selected, — generally in the outer aspect of the
arm or forearm, or on the back, — ^the skin is pinched up into a fold between
the forefinger and thumb of the operator's left hand. The needle is then
introduced lengthwise into the fold, which is slightly elevated aa the desired
amount is injected; the needle is withdrawn from the little wound by a
twisting motion, and the puncture rubbed gently with the finger. A small
tomor or swelling is caused by the injection, which is dispersed into the
cellular tissue by rubbing. No further attention to the puncture is neces-
sary, although, if it be painful, the next day it may be washed with carbolized
water (1 to 128), as a local sedative as well as antiseptic, or a lead-water-
and-laudanum compress be applied. The following are frequently employed
for hypodermic medication : —
AIcoW , Dose,
.Ether "
Ammonise (aqua) "
Apomorphina hydrochloridum ... "
Araenicnm ( Fowler's Solution ) . . "
Aeidum carbolicum ( liq. phenol. ) . "
Amyli nitris "
Atropime sulphas "
Atropine et morphiiuB sulphas . . " ^
Caffeine citraa '*
B Caffeinse citratis 6|36 Gm. or gr. xcvj.
Glycerini,
Aquie aa 15| c.cm. or f^ss.
M. Twelve centigramTnes are contained in 0.6 cubic centimetres (ten minims
contain two grains}.
60 to
2
20 to
4
60 to
2
004
12 to
01 to
20 to
0005 to
0004 to
0004 to
065 to
ccm.
or mx-xxx.
ccm.
or mxx-lx.
c.cm.
or wx-xxx.
Om.
or gr. V,..
30 c.cm.
or ffiii-v.
13 Gm.
orgr.V.-ij.
30 c.cm.
or miii-v.
0008 Gm.
orgr.V«-V«.
0005 Gm.
or gr. Vi«.-Vw atropine.
021 Gm.
or gr. V,.-Vi morphine.
13 Gm.
or gr. i-SJ.
Cocaime hydrochloras Dose, |016 to |065 Gm.
B Cocainae hydrochloridi |75 Gm.
or gr. V.-j.
Aque aurantii florum 15|
M. Twenty minims contain one grain.
or gr. XI J.
c.cm. or f3iv.
Curare Dose, |003 to |021 Gra. or gr. Vi»
Coniinae hydrobromldum , " 10015 to ' (?m. or nr. V„.
Chloroformum puriflcatum " 130 to 1| c.cm. or *wv-xv.
or Spiritus chloroformi '* 1|20 to 2|60 c.cm. or «ixx-xl.
v..
58
PHARMACOLOGY AND OENEUAL THERAPEITICB.
\m to
l! tim.
or pr-
001
Gm.
or gr.
0004 to
001 Gni.
or gr.
13 to
20 Gm.
or gr.
Chloral Doae, |G5
Colchioina,
UulxfieiinaQ sulpbun, or hydrobroraas
Ergota ;
ft Fluidcxtracti prpotte.
Glycerini,
Aqua; ua 30 c.ciu. or f5j-
M. Sig.: Ufte 1.20 to 2.0 c.cm. (or twenty to thirty minima) by injectio
Hyoeoina Dose, |0000 Gm. or
IJ Hyoseinie hydrobromidi 1012 Gm. or
Glycerini 1(20 c.cm, or
Aquas q. 8. ad 6[20 c.cm, or
M. Sig.: 0.30 com. (or live mioims) contains 0.0006 Gm. (or Vim grain)
HyoBcyamintc Dose, jOOOO Gm. or
R Ilyoecyaiiiina' sulphat |03 Gm. or
Aquce chloroforraj SOj c.cm. or
M. Sig.: 0.(K) c.cm. (or ten minims) constitute a dose (0.0008 Gm.^ or gr.
Hydrargyrum (aee article "Hydrargyrum" in Part II).
MorphiniB suJphfVfi ' Dose, jOl to \03 Gni. org
H Morphirm^ Huii)hiit |60 Gm. or g
Phenulia liquefacti 120 Gm. or j
Aquse 30| com. or f]
H. Sig.: 0.60 c.cm. (or ten minims) equal 0.01 Gm. (or gr. Vc)* Powders
siUes may aUo be used.
ft Morphina; Bulphntis 25[ CJm.* or (
K. et divide in chnrtit- vt'l cappellai no. x.viv. Each contain 0.01 Gm. (or |
To be used for making an extemporaneous solution.
Quininic hydrobromidum Dose, |06o to |05 Gm. or ^
H Quiniiice hydrobromidi 1|60 Gm. or g
AqiiflB deatlltatiE 30| com. or i
M. Sig.: 0.60 c.cm, (or ten minims) contains O.OGd Gm. (or one grain) of q
ft QuininjB aulphnvinatis 81 Gm. or o
Aquee chlorofortni 15] c.cm. or £
M. Sig.: O.lin I'.cm. (or ten minims) contniris 0.32 Gm. [or five grains).
The quininip biniuriata cHrbainidata, the double chloride of quinine luid i
soluble in an equal part of water, and is very siutable lor b)-podorni
Scopolamine (same as Hyoscine).
Strychninffi Dose, |001 Gm. orgr.
ft StrychiiintB aulphatis |015 Gm. or gr.
Acid, acetic, dil., q. s. ad solve.
Aquaj creosoti q. s. ad 15j c.cm. or f3i'
M. Sig.: 1.20 c.cm. (or twenty minims) contains 0.001 Gra. {or gr. V**) of a
nine.
"Many other instances of elijrible forms for the administration of (
iiypodermicallv will bo found, in tlio following pages, specially ment;
umh.-v flip (lniL!:s oonoenied.
Parenchymatous injection is a form of hypodennic injection in v
the solution is thrown deeply into the tissues instead of merely "undei
akin. It is eraploved in eases of ncuiralgia to deposit the remedies
ADMINISTRATION OF REMEDIES. 59
in contact with the affected nerve. Bartliolow formerly used chloroform
in this way, with marked benefit in cases of sciatica. Bichloride of mercury
hns been injected into the lung-tissue in the treatment of acute and chronic
pneumonitis. Liquefied phenol, or tincture of iodine, has been injected into
the cavity of the tunica vaginalis testis in the treatment of hydrocele ; and
acetic acid and ergot have been thrown into the substance of various new
growths. Ether has caused the disappearance of sebaceous tumors when
injected into their interior, and parenchymatous injections of cocaine are
u:=ed as a local anaesthetic for small surgical operations. Insoluble prepara-
tions of mercury, like grey oil and calomel, are much used in France, in the
treatment of syphilis. The injection is made into the gluteal muscles, and
is very slowly absorbed.
5. By inhalation, remedies may be introduced, through the route of
bronchial mnconi membrane, into the blood. Although rarely employed,
except for producing surgical anaesthesia, this method promises, in the
future, to play a more important part in therapeutics. The remedies may
be in the gaseous form, as where oxygen or nitrous oxide is administered;
they may be in a vapor, and inhaled with steam ; or made into a spray with
the atomizer, and thus inhaled; or they may be used in fumes, as where
tar or asthma pastilles are burnt, or sulphur or mercury vaporized. Con-
cerning the extravagant hopes that have lately been raised (especially in
the tr^tment of pulmonary consumption) of the bactericidal effects of in-
halations, the results have not been very favorable. When the smaller bron-
chial tubes and air-cells and their walls are filled with bacteria the only
antiseptic that can reach them is the opsonin contained in the blood and more
particularly that contained in the healthy white blood-cell. At the same
time salicylic acid and other agents are capable of being introduced into
the bronchial tubes, and, by liquefying and favoring the expulsion of the
secretions and making them less septic, they are capable of affording much
relief to the patient and retarding the progress of the disease, if not hasten-
ing the cure. Hay fever is much relieved by applications of cocaine and
iiJialations of weak solutions of quinine ; a similar treatment may sometimes
be devised for acute and chronic pulmonary affections. For the production
of a fine spray by mechanical action, instruments known as atomizers are
used. Hand-atomizers consist of bulbs, which, by compression, deliver a
blast of air throxigh a tube past a capillary orifice in another tube, the latter
being partially immersed in water or other desired solution. The blast of
air produces a partial vacuum, and the fluid ascends the tube until, escaping
by drops, it is blown into fine spray at right angles to the extremity of the
tube. This is a very convenient instrument for small quantities of medicated
?olutionfi. When the quantity is larger the hand would become tired, and
steam may be resorted to, or we may use compressed air by means of an air-
pump. Some very neat and even ornamental forms of the latter have been de-
vised by ingenious instrument-makers, and they may now be met with in the
offices of all physicians who pay special attention to treatment of diseases of
the throat or lungs.
6. The intraTenons administration of medicine is the most direct
method at our command of obtaining prompt physiological effects from our
remedies. The transfusion of blood is an ancient therapeutic device, and
it naturally suggested the employment of remedies in the same manner.
In the collapse of cholera, intravenous saline injections have saved numerous
60
PIIABMACOLOGY AN'D OEXEHAL TIIEHAPECTICS.
lives that were apparently in a hopeless condition. The luniiul^
by Hayera is : — ■
Sodium flulplmle 261 Gm. or f
Sodium chloride 6|30 Gm. or (
Sodium hydrate 1| Gm. or j
Wattir nO| c.cm. or t
This should be filtered and brought to the temperature of the bloo'
surface, or not more than 100° F. Of such a solution as much aa !
have been used at one i^peration, but, as a rule, 1 quart will be qu:
cient. It is important to inject the fluid slowly, so as to imitate the
blood-current. Holutiong of sodium ]>bo5;plmte and cldoride (specific
filiout 1050) have nho been employeil ^ith success. The late Dr
employed the !attt*r sohitiou in tJio Irontment of diabetic coma with
able iniprovemcnt after 2i^ ounces (imperial) had been thus used.
of collapse froui ha-niorrha^^', milk litis been emiilnyed by a number o
tors, with gratifying ret^ults. Hal ford, of Australia, has fihown tha
a wound from a venomous snake, the intravenous injection of aqua an
fortior (1 part) with aqua destillata {2 parts) is well home and i
system in Bustainin^ itself under the effects of the poison, altliough
not i>e directly autidotal, as was at first supposed. J. T. Eskrid^e u
diluted aqua ainnmnii^' fortior, injected into the rein of the arm. ^
bad consequences and with ret-overy of the patient, who had been aspli
with hydrogen sulphide. It is also ijf service in tln*oiid)Osi8 of the
nary artery, chloroform asphy.xia, hydrocyanic poisoning^, etc. The
of admitting: air into the vein is not very great and its evil consei
have been jL'^reatly exaggerated; however, it may readily be averted
little care. It is hardly necessary' to add that the huicet, and, in fact
the instruments slmuld be fiur^cally dean, and that every antisept
caution should be scrupulously observed.
Transfusion of blood has been performed many times, and i
modifications of inslnnneuts have been invented to accomplish it
trouble is that, when the emergency arises, the instruments are not a(
except in a large general hospital, and the practitioner must exten
a transfusion apparatus out of n 4- or G-ounce syrin^je and a rubbi
^laas tubes. Immediate transfusion is where the blond lV>ws from the i
blood-vessel into the recipient's, through a tube which had been pre^
filled with an antiseptic solution. A Bvrin^e may be introduced, so
measure the amount of Idood, as in the instrument of ^lartin, of 1
Tlie instrument of Aveling, of London, is simply a rul^ber tube with s
ous enlargement in the middle. The capacity of tbe bulb is 2 dn
Silver cannulas are placed at tJie ends of the tube, which is nl>out ]
inches in length. Each cannula is guarded by a stop-cock, and the en
beveled or rounded, so as to facilitate the insertion, Tlie modu of ope
is to carefully cleanse the apparatus by immersion in warm, recently
water. The air is entirely expelled, and a warm saline solution used tc
pletely fill the tube. The veins of the donor and recipient being select
generally in front of the elbow, — tiie incision is made with a scalpel
tube inserted into each, and held in place by the fingers of an assists
preference to a ligature. Now, the stop-cocks being turned, the ti
ADMINISTRATION OF REMEDIES. 61
pinched on the side toward the donor, and the fluid is forced onward; the
efferent tube is then pinched, and the bulb allowed to slowly refill, when it
is again emptied and again refilled, until the proper quantity of blood (6 to
8 ounces usually) has been delivered. The apparatus is then withdrawn, a
ligature placed upon the veins, and a proper dressing applied.
In mediate transfniion the blood is drawn into a warm bowl, beaten
or whipped with sterilized straw to remove the fibrin and prevent sub-
sequent clotting; then the blood is taken up into a previously warmed
s}Tinge and slowly injected, through a cannula, into the vein, the median
basilic generally being chosen for the purpose. In this way repeated charges
may be slowly and gently delivered, but, as Bartholow taught, from 4 to 8
ounces of blood will usually be sufficient to strengthen the heart and avert
threatened collapse. The use of lambs* blood was advocated by Gesellius
and others, but the transfusion was generally followed by a rigor and sweat-
ing, which greatly prostrated the patient, and it is no longer practiced.
Transfusion has been performed in phthisis and other chronic diseases
without benefit. It is of greatest service in acute emergencies, such as severe
bemorrhage (traumatic or posl-partum), htematemesia, intestinal haemor-
rhage, epistaxis, etc. In the hsemorrhagic diathesis it has been successfully
used by Dr. Buchser, of New York, but it has failed in simple ansBmia, In
acute poisoning by phosphorus, or carbonic oxide, transfusion has been re-
sorted to successfully by a number of clinicians. A modification of this
method has been proposed by Albanese and Hueter in arterial transfniion.
In this method an artery of one of the extremities is selected and divided
(generally the radial or posterior tibial being taken), and the blood is in-
jected just as in mediate transfusion. The advantage sought for is the pre-
vention of clotting and the danger of embolism, and that there is less danger
of the introduction of air. Where a large quantity is to be injected, it might
be better to employ this expedient, so as to avoid any danger of suddenly
overwhelming a weak heart. The effects following the transfnsioiL of milk
have been found to be very much the same as those from the use of blood,
except that albuminuria is more apt to follow. When milk is used it should
be taken directly from the cow or goat, and after being carefully strained,
without being allowed to cool, it should be gradually introduced into the
circulation by means of the syringe and cannula. The results, in some cases,
of the treatment after hsemmorrhage have been to warrant further trial. At
the same time, the report of those who have gone over the entire subject
critically is that nothing can be a complete substitute for human blood
for the purpose of transfusion. The later plan of injecting a quantity of
blood into a large serous sac like the peritoneum, as recommended by Pon-
fick, has found few followers, and, whereas some good results have been
reported, others have occuired in which death resulted from peritonitis.
The introduction of large quantities of water or of normal salt solution
into the peritoneal cavity or under the skin has been followed by excellent
results in the collapse of cholera and after haemorrhage. It will be con-
Fidered fully under the title "Hypodermoclysis."
Medicines may be applied topically to wounds and granulating surfaces,
or injected into suppurating cavities. The fact that such agents may be
absort>ed and produce systemic poisoning should lead us to be careful in
applying carbolic acid, corrosive sublimate, or other active antiseptics which
have powerful toxic effects upon the human organism. By what is called
62
PHABMACOLOGY AND CENEEAL THERAPEUTICS.
galvanic cataphoresis medical solutions may be made to pass thro
akin, and directly into tlie tissues and the blood (see Electrothera]
Idiosyncrasy : Individual Peculiaxitiefl Aff ectingr the Dosage <
of Administration of Drugs. — Pereonal peculiarities on the part
patient, as regacds the etl'ects of remedies, often cause serious em
ment to the prescriber. They are usually attributed to idiosyncre
this is merely a term wherewith to hide our iterance of the rea
One of the puzzles of experimental therapeutics is the occasional i
in the action of remedial agenta in dilTerent species of animals, — ejj,,
arc very slightly affected by opium and are not injured by a quantit;
would be fatal in man; a deer can eat tobacco, or a rabbit belladonnf
without producing toxic effects. Something of a similar character
among palimts. It is simply impossible to ana'stheti/.o some patier
ether, and we are obliged, in such cases, to resort to chloroform whc]
gical operation is required. There is also a great difference with re
susceptibility to the effects of alcohol; gome persrins are easily overc
it, and quickly rendered helplesa and unconscious; others can tal
large amounts, and, while showing its physiological effects by inebrii
not discommoded by it to the extent of losing control of themselves,
times we encounter indivndunJs who arc rendered very uncomforti
calomel, even a small do^^e bringing on neuralgia or gouty pains in the
others require quite large doses to prodnce any effects at alL Cincho
its alkaloids (quinine, cinciionine, quinidine, etc.) sometimes cause d
ance of digestion and eruptions upon the skin, even purpura lisemorr
cases of the latter having been reported by Dr. Woodbury.^ The obj
to taking quinine sometimes encountered, however, are probably i
ignorantly confounding it with other agents, such as mercury, Soi
tients cannot take colchicum at all; others can use it in large dose
good results. Opiun\ and its alkaloids, uiorpliino especially, are oft€
ductive of unpleasant consequences; and, iusteEid of soothing a patie]
producing sle^^p, they occasion excitement, restlessness, headache, irr,
of the skin (followed by vomiting and prostration), or an eruption
bling urticaria or erythema. In the same way, potassium iodide, b
small doses, occasions severe coryza in some patients, while in oti
vesicular or bullous eruption appears, resembling varicella or variola,
pectod progtration and sMnptoms of poisoning have occasionally fa
the adminislrntion of ordinary doses of chh>r;i]-hydrate, tlie cases ten
ing fatally, in ppite of everything that could be done. This occurs s
quontly from chloroform that its use as an ana?stlioti<' has been aban
by many surgeons, or employed only with great caution. Iodoform
surgical dressing, even, may cause poisoning in C('rtain susceptible pe
The new aromatic compounds — antipyrin, acetanilide, sulphonal, etc.—
sionally excite a peculiar tniin of toxic effects, for which, as yet, no exj
tion, except idiosyncrasy, has been given. On the other linnd, it is some
necessary to give large doses of quinine, opiu7n, calomel, chloral, or ]
sium iodide, in order to produce a desired, or positive, theTHpeutic r
When such unpleasant effects forbid the enq)loyment of a remedy, it be<
necessary to resort to a substitute, or succedaneum, as it is called, "
' Phitadeli»f>i<i Mt'fUcal Times, Sept, 18. 1880.
ADKINISTBATION OK REMKDZE8.
03
tberapeatic offectB without the objectionable features of the former
From all tt l>o<?n said in the pnvediug pages, the explanation is
maSy jntvo of ; -n why the dose of a drug cannot be stated with the
mmm defiiuteiKfi& aa iti? specific gravity, for instance. While we can say that
qnandtr is a customary* or usual dose, and that a larger quantity
maximnni dose, which, under ordinary circumstances, it is not well
ni the same time we may find patients who cannot take even the
nr doee without great discomfort, and others who actually require
^cOanrdmATily lar^e doses before obtaining Ihe anticipated therapeutic re-
Tbe Committee on Revision has introduced the average or medium
ic dosi*« into the Pharmacopceia ; but has very wisely avoided the
of majimum dosage. It is customary, when a very large dose is
tfjpolated in a prescription, for the pharmacist to ascertain from the phii'si-
daft if the dose was intended, or was due to a mistake, owing to haste or to
Aammption while writing it. Physicians can save delay, in a case where
a hrigr «lf*e*is intentional, by underlining it or putting a star after it, to
^^f^>tr that notice has already been taken by the author of the prescription,
^ it i- ' esjyiry to call it to his attention again.
Frc g for Children. — If the doses for adults are subject to such
factvaboo Aud uncertainty, it is evident that any calculation by mathemat-
mi formala of the dose for a child at any given age, based upon the adult
idae, mast be unreliable. Several such schemes have been proposed. Thus.
Dr. Toon^s plan was to diminish the dose in the proportion of a fraction
ahoie numfTator is a figure representing: the cliild*s age and the denominator
&ea^ of the child increased by 12. The rule would therefore be: Multiply
ikr wait do«e by a figure corresponding to the years of a child's age and
^nitby the ago plus twelve. Thus, if a child's age is G years and the adult
itm 80 grains, we have the follon-ing formula : —
^-
20 X
«+l2
or J = (>§ grains.
fact that the development of children depends upon other factors than
ia anffictent to show the fallacy of this scheme, especially if we remem-
that *'•; ' "' ' !. like adult.*, are very susceptible to medicines. A
■iDevhat I ^1 plan than the preceding is based upon the weight
rf die ^iHiL whith ia taken as the numerator of a fraction whose denom-
aator ia 140, which is arbitrarily taken as tlie average adult weight. Inas-
wmth aa many circumstances besides the age and weight of an individual
^1 > ♦^«« »?oo*tion of dosage, and as this ia even more evident in prescribing
fcr n tJian among adults, we cannot advocate any such mathematical
fconoj-^ ^'lining the dose for children. Caution should be obsen^ed
■ ma "tics to very young children; a single drop of laudanum
llP <3iv Ifath of an infant, while, on the other hand, they may bear,
«il^3Qt . relativelv large dopes of belladonna, conium, arsenic, and
^ acmrr. Ptyalism should never be intentionally set up in children by
m -migwiVr nae of mcrcnr>', because it may be followed by inflammation
^ «foni;hin^^ of the li}>s and che«'k and other serious lesions. In writing
« af*s«iption f^r a child it is sometimes of advantage for the pharmacist
% fcflovr the fact, which may be indicated by addressing it *'for baby," or
*^ Willie or Mary," or simply "for Mr. Blank's child."
'
^^^ 64 PHARMACOLOGY AXD OEXERAL THEIUPEUTICS, T
^^^ In concluding this
jart of tlie work, the following table vinlLJ
^1 useful ill reading and w
riting prescriptions: —
1
^^f Latin Terms and Phrases Employed in Pbescriptioxs.
H WORD OB PBBXeS.
USttAX COKTRACTIOW.
BNOLISB EQiriV/
H A or Ab (prep, with abla-
A or Ab
From or Out of. _
To or Up to. 1
^H Ad (with aooutiative)
Ad
■ Adde
Add
Ad(L
■ Ad dime vices
Ad 2 vie.
In t\vo takings or 6
^H Ad tei'tiam vioein
Ad 3 Vic.
At three tatcings Of
^H Ad libitum
Ad Ub.
At pleasure.
^m Absent e k'bre
Abs. feb.
Fever being absent.
^H Adstitnto febre
Ad. leb.
Fever being present
^H Adtiibcndus
Adhib.
To be adminiatercd.
^M Ad move
Admov.
Apply.
^H AUiiuot
Aliquot
Several.
^H Alt(.>rnis lioria
Alt. Iioris
Every second hour.
^H Alvo ndKtricta
Alv. adHtrict.
The boweU being b
^1 Ana
lU or aft.
Of each.
^M Ante cibuni
Ante cib.
Before food.
^H Aqua astricta
Aq. ostr.
Ice.
^M Aqua bullifna
Aq. bull.
Boiling water.
^H Aqua dostillnta
Aq. dest.
Distilled water.
^1 Aqua ex Ilimiine
Aq. ex flum.
River water.
^M Aqu:i ffTvena
Aq. ferv.
Rot water.
^H Aquu Huvinlia
Aq. Huv,
River water.
^H Aqun fuiitts!i or foutana
Aq. font.
Spring water.
^m Aquii pluviuliii
Aq. phiv.
Rain water.
^B Aqua pura
A.|. pur.
Pure water.
^M l^eue
Bene
Well.
^M His in die
Bis die or* Bisind.
Twice daily.
^^^_ Biiii^da
Boug.
A long auppositorj-o
^^H Bulliat
Bull.
Let it boil
^^V Capiat
Cap.
Take.
^V Cauto
Caute
Cautiously.
■ abua
Cib.
Food or Sleal-lirne.
^m Cochleare ma^muin
Coch. mag.
A tablcspoonful.
^H Cotrhl«>nre modiiim
Coch. med.
A dcBsertspoonful.
^H Cocl!li?ar*> pmn'um
Coch. imrv.
A teanpoonful.
^M Cola nr L'olftiir
Col. or Colet
Strain.
^1 Cullyrtuin
Collyr.
An eyo-waish.
^M Colorotnr
Colore t.
lA't it be ci^lored.
^m Compositu.s
Co. or Comp.
Compound.
^m Pongiua
Cong.
A gallon.
^H Continnantur rpmetlia
Cont. rem.
Continue the medici
1
^M Co<)uc. Co<|UAntur
Coq.
Boil
^B Craft, Crarttinus
Crast.
To-morrow.
^B Crfls marc »umendus
Cms mane buhl
Take to-morrow mo
r
H Cujufl
F^J-- ...
Of wbichj of any.
^H C*iijuft lihet
Cuj. lib.
Of nnv you plpflae.
^1 ('urn (with ablative)
Cum
With. '
■ CHathus
C. or Cjrath.
A glass.
^M C>'nthus vinnn'uH
C. vin.
A winc-gln.^s.
^M Ik*bitA «|>i8Mtiii]i)
Deb. spiM,
Proper consistence.
^m OectibituB
Decub,
Lying down (or A h
e
^H De dii- in ilifm
Of d. in (li.
From day to day.
^m Diobus altoniiH
Dicb. alt.
Hvery second ilay.
1
^m Tiivhwi* tertins
Dieb. tert.
Every third day.
I
^M Dilue, Dilutus
Dil.
Dilute, diluted.
1
LATIN TERMS AND PHRASES IN PRESCRIPTIONS.
65
WORD OB PBBABE.
USUAL CONTBACTION.
Dimidius
Divide
Divktatnr in partes
squales
Donee alrus soluta fuerit !
DosiB '
Drachma
Durante dolore
Eadem I
Ejufidein
tor Ex
Fac or flat
Fac pilulaa duodecim
Femu*
Fiant chartulie duoderim
Fiant pilulsp duodecim
Fiat emplastrum '
Oargarisma '
(iradatim |
Gntta, Guttse i
Guttatim
Haustus
Horft decubitus '
Hor& somni I
Horse uniua spatio i
Idem
in dies
Infrico
Infusa
Intime
Jus
Liflimentum
Lotio
Maoero
Magnus
Mane
ifane prime
Mcdica men turn
Mica nanis
Minimum
Miaee
Mitte
Mitte decem tales
Modicus
Mode ■ prsescripto
Mollis
Morbus
More dictu
More BoHto
Ke tradas sine nummo
Noete maneque
Xomen proprium
^OB repetatur
Ortarios
Onmi horft (or Omnia horia)
Omnibus aJtemis horis
Omai bihoris
Omni quadrante hone
Omni mane vel nocte
Optimns
Partes nqualea
Pamilus
Dim.
Div.
Div. in par. seq.
Done alv. sol. ft.
D.
Dr. or 3
Dur. dolor.
Ead.
Ejusd.
E.
F. or ft.
F. pil. xij.
Ferv.
Ft. chart, xij.
Ft. pil. xij.
Ft. empl.
Garff.
Grad.
Gtt.
Guttat.
Hau»t.
Hor. Deeub.
Hor. Bom.
Hor. 1 spat.
Id.
Ind.
Infr.
Inf.
Int.
Jus.
Lin.
Lot.
Mac.
Mag.
Mane
Man. prim.
Med.
Mic. pan.
M. or Min.
M.
Mitt.
Mitt. X tal.
Mod.
Mod. prssc.
Moll.
Morb.
Mor. diet.
Mor. Rol.
Ne tr. 8. num.
Noct maneq.
Nom. prop.
Non . repetat.
O., Oct.
Omn. hor.
Om. alt. hor.
Om. bih.
Om. V« h.
Om. mane vel noc.
Opt.
P. eeq.
Parv.
I ENOUSH EQUIVALBNT.
One half.
Divide.
Let it be' divided into equal
' portions.
I Until bowels are open.
' Dose.
I A drachm. r
During pain.
The same.
Of the same.
Out of, from.
Make, or let be made.
Make 12 pills.
Hot.
Let 12 papers be made.
Let 12 pills be made.
I Let a plaster be made.
' A gargle.
By degrees.
I Drop or Drops.
By drops.
' Draught or Potion.
Bed-hour.
I Hour of sleeping.
i One hour's time.
The same.
I Daily.
I To rub in.
Let it infuse or steep.
Thoroughly.
I A broth (juice).
; A liniment.
I A lotion.
! To macerate.
■ Large.
I In the morning.
I First thing in the morning.
A medicine.
Crumb of bread.
A minim.
I Mix.
Send.
' Send 10 such.
I Moderate- sized.
I In the manner written.
Soft.
A sickness.
In the manner directed.
As accustomed.
Collect on delivery.
Night and morning.
The proper name.
Let it not be repeated.
A pint.
Every hour.
Every second hour.
Every two hours.
Every fifteen minutes.
Every morning or night.
Best.
Equal parts.
Small.
66
PHARMACOLOGY AND OENEaAL THEKAPEUTICS.
WOBO OB PHBABB.
USUAL CONTBACTION.
ENGLISH EQUIVALENT.
PeniciUum camelinum
Penicil cam.
Camel-hair penciL
Through or By.
pier (accusative case)
Per
Phiala priiu agitata
P. p. a.
The bottle being first shaken.
Post (accusative)
Post
After.
Pro (ablaUve)
Pro
For or According to.
Pro ratione aetas
Pro rat. eet.
According to patient's age.
Pto re nata
P. r. n.
As occasion arises.
Quantum libet
Q. lib.
As much as pleases.
Quantum sufficiat
Q. suff.
As much as suffices.
Quftque hoTd
Qq. hor.
Every hour.
Quoque
Quoq. or Q.
Also.
Quotidie
Quotid.
Daily.
Recipe
5
Take.
Redactus in pulverem
Red. in pulv.
Powdered.
Kepetatur
Repetat.
To be repeated.
Scrupulum
Scrap, or 3
A scruple (20 grains).
Secundum artem
Sec. a.
According to art.
Semi or Semisse
Ss.
A half.
Semihora
Semih.
Half an hour.
Sesqui
Sesqui.
One and a half.
Signa
SiR.
Write.
Simul
Simul
Toflrether.
Sine
Sin.
Without.
Singnlorum
Sing.
Of each.
Si opus sit
Si op. sit
If need exists.
Solve
Solv.
Dissolve.
Statim
Stat.
Immediately.
Stct or Stent
St.
Let it (or them) stand.
Subinde
Subind.
Frequently.
Succus
Sue.
Juice.
Sumat talem
Sum. tal.
Take one such.
Sume
Sum.
Take.
Talis
Tal.
Of such.
Tere
Tere
Rub.
Ter in die
T. i. d.
Thrice daily.
Tritura
Trit.
Triturate or Grind.
Tussis
Tus.
Cough.
Ultimus Prsscriptus
Ult. preesc.
The last ordered.
rt dictum
Vt diet.
As directed.
Vel
Vel
Or.
Verus ,
Ver.
Genuine.
Vesper I
Vesp.
The evening.
Vitellus
Vitel.
Yelk of an egg.
FOISOirS AND AiniDOTES.
A general formula for administration in cases of poiiioning by an un-
known agent is sometimes useful as a sort of universal antidote. Dr! Murrell
recommends the following combination : —
B Liquor ferri sulphatis (ad <iaturandum) .• 100
Aquce 800
Magnesise 88
Carbonis animalis purificatee •. 40
The iron solution is to be kept separate fmm the mixture of calcined
magnesia and animal charcoal until wanted, and then the ingredients should
be put in a bottle and well shaken together. The solution should be drunk
POISON'S AXD ANTIDOTES.
67
nue tne uuoiiible ingredients are in a state of suspension. A wineglassful
«A do«e, frequcDtlj repeated.
The foUoiring table is placed here for convenience of reference; for
tethrr details of treatment the reader is referred^ to t]ie paragraphs relating
to taxk eflects and antidotes under the individual titles in the section de-
■Mh-H to drugs.
Poisons.
1
TApors Afid ga«e«:
oXMie (CO).
dIoKide (CO.),
Treatment,
DifTusible stimulants, hot ale<^>hnUo drinks, hot coffee,
i»timulatiiigeiitrnuita,hypodefniic injections of atro-
pine, digitalij^ or nitroglycerin.
Magnesia, chalk, dilute solutions of alkaline carbo-
nates (soap, tooth powder). l>emulcents: milk,
albumin, oils.. (For hydrocyanic acid the treatment
U the same oa for oyauidc of potassium.)
Vmeffar, dilute acids, lemon- juice. Demulcent*:
milk and oil, flour and water, etc. Opium, mor-
phine, and atrupine to relieve symptoms.
I Finely divided animal charcoal, tannic acid, coffee.
Pre^h «ir, oxygen initiations, artificial respuration.
Intravenous injcctiona of ammonia. Transfusion
of blood.
r DifTuAiblp Mimulaiit^, trtnnic aoid. coffoe or tea in-
J fusion, alcohol, smnionia. Hypodermic injections
I of dij^tnlis, strophanthuR. ntropine, or amyl ni-
I trite. Hot pack. Faradization.
\ Coffe**, ammonium aretale, strichnine, stimulating
\ enemutn. mtheterization, stomach-pump.
f Artificial respiration, inhiilntion of nmmonia or amyl
\ nitrite, faradization, inversion of the body.
f Tannic acid, albumin, milk, and demulcents, with
\ hypodermic injections of morphine and atropine.
For farth- ' ■ ^^>alk»n concerning poisons and their nntidote» the reader will
I tb« UkIi' img* in Part II. He also will find Dr. Murrell's little book,
10 ]>o In Ca3<; of Poisoning," very convenient for reference.
68
Apomorphine.
Areenic.
Atropine.
(Belladonna).
Belladonna.
Brucine.
Calabar bean.
( Physostigmine) .
Cannabis Indica.
Cantharides.
Carbolic acid.
Chloral.
Cinchona
(Quinine,
Cinchonine,
Quinidine, etc.)*
Codeine.
Colchicum.
Conium.
Copper.
Corrosive sublimate.
Croton-oil.
Curare.
Cyanide of potassium.
(Hydrocyanic acid).
PHABMAGOLOQY AND GENERAL XHERAFECTICS.
f Chloroform mixture; digitalis hypodermically. Dilu-
\ ents and stimulants.
' Freshly-precipitated hydrated sesquioxide of iron,
ferric hydrate in a moist and pulpy state (a table-
spoonful to each grain of poison), or hydrated oxide
of iron with magnesia, or dialyzed iron. Animal
charcoal, magnesia levis, with opium to r^eve
pain and vomiting or diarrhoea. Demulcents.
Fixed alkalies. Caffeine, or fresh infusion of coffee
or tea, artificial respiration. Morphine, cautiou&ly
given, physostigmine, muscarine, and pilocarpine
are physiological antidotes.
•| (See atropine.)
i Same as for strychnine.
( Stimulants, fixed alkalies, atropine hypodermically,
\ artificial respiration.
< Atropine.
{
Opium, demulcent drinks, saline cathartics. Avoid
oils and fats.
r Soluble sulphates, saccharated lime, stimulants and
\ anodynes. Alcohol. Glycerin.
/ Hot infusion of tea or coffee, strychnine hypoder-
\ mically, warmth and exercise.
r Tannic-acid and astringent infusions: iodine forms in-
•I soluble compounds with the alkaloids. Morphine
I. and atropine hypodermically.
< (See opium.)
-j Opium, stimulants, astringents.
I Alkalies, astringents, strychnine hypodermically.
< Morphine, albumin, demulcents.
-[ Albiunin, atropine, and morphine.
j Opium, stimulants, astringents.
j Strychnine and atropine, oxygen inhalations, artificial
\ respiration.
f Artificial respiration, ammonia inhalations. Cold
-j affusions to the spine, transfusion of blood. Ether
( hypodermically.
POISONS AND ANTIDOTES.
69
DigiUlia.
Lead salts.
Lobelia.
Mercunald.
Muscarine
(Mushrooms).
Xitrit«s : —
Sodium,
Nitroglycerin.
Opium
f Morphine,
Codeine) .
Phosphorus.
Picrotoxin.
Pilocarpine.
Savin.
Silver nitrate
(Lunar caustic).
Snake-venom.
Sirv'^hnine.
T(»bacco.
Turpentine, oil of.
Veratrine,
Zinc salts.
i Opium, nitroglycerin solution.
( Atropine, strophanthus, hot alcoholic stimulants,
\ hypodermic injections of ether.
i Magnesium sulphate, opium, potassium iodide. Baths.
i Morphine, strychnine, strophahthus, stimulants.
( (See also corrosive sublimate.) Albumin, demulcent
drinks, opium or belladonna.
timulants and cathartic agents
micaliy, with morphine, if needed.
< Stimulants and cathartic agents, atropine hypoder-
Stimulants, digitalis, atropine, artificial respiration,
hot and cold douches, ergot.
IKmetics or stomach-pump, coffee, exercise, friction
or flagellation, caffeine by the rectum, atropine
hypodermically, faradization, artificial respiration,
warmth, permanganate of potassium.
f Old oil of turpentine; sulphate of copper. Avoid oils
X and fats. Transfusion of blood.
•j Chloral, bromide^, morphine.
i Atropine and morphine hypodermically, stimulants.
■j Soluble sulphates, demulcents, anodynes.
f Table-salt, chlorides, demulcents, potassium iodide.
Ligature of limb, with application oi cuppmg glass
or caustic alkali. Ammonia inhalation, stimulants.
Artificial respiration. Heat to surface. Solution
of potassium permanganate injected into the
wounds. Digitalis or ammonia hypodermically.
( Chloral, potassium bromide, chloroform by inhalation.
/ Strophanthus. hot applications, and cardiac stimu-
alkalies, tannin, alcoholic stimuUints.
trophanthus. hot applications, an
X lants; strychnine hypodermically,
-j Magnesium sulphate, demulcents, opium.
{Diffusible stimulants, caffeine; rest in recumbent
posture.
{Spdium carbonate and demulcents; anodynes if
needed.
70
PHARMACOLOGY AND GENERAL THEBAPEDT1C8.
GENEBAL THEEAPEUTICS^
Therapeutics is the application of knowledge to the treatn
the sick. It comprises in its widest scope everything relating to t.
vention, cure, or alleviation of disease. The special pharniaceutical
employed in the treatment of sickness in the human subject, taken
aggregate, constitute the Materia Medica. Among these are many im
elements and their compoujids; but by far the larger proportion ii
up of orgiiuic sub?taiu't'9, espeeially certain veua'table structures,
crude drugs and their derivatives form the principal part of the ^
classes of official pharmaceutical preparations. A smaller portion :
plied by animal bodies, such as the organic extracts, antitoxins, di|
ferments, etc.
The drugs and preparations which constitute the United States
macopceia are, in this country, spoken of as official. All other re
are unofiBcial. In the following pages the remedies of the British PI
copceia are also systematically considered, but these are only official
the British standard authority govema. The official remedies repre
select class of therapeutic agents, the value of which has been estat
by careful investigation and clinical experience. The results of the
lent work of the Committee on Revision of the United States Pharmac
deser\^e high appreciation.
The Materia Medica does not represent the sum-total of the reai
of modern medicine. In addition to his knowledge of the action of
the physician must understand the value of hygienic measures, whic
greatly to the comfort of the patient and facilitate his recovery,
human body is an assemblage of organs designed collectively as a
paratus for the transformation and evolution of energy. The activ
the vital forces gives the living body recuperative power which, when
erly directed, tends to restore disturbed functions to their normal i
tions. A knowledge of physiology often enables the physician to anti*
Nature's methods and to place the patient under circumstances most :
able for his recovery.
Modern therapeutics is not based upon mere theory, but upon a i
tific foundation of physiologic experiment and clinical experience,
maeology is afHliated with the other natural sciences, and its facts, i
are determined by true scientific methods, are capable of demonstrati
the laboratory and clinically. They also agree with the general expei
of mankind. In his early struggles for existence man learned by ace
the medicinal qualities of mineral springs and some vegetable substc
In the course of centxiries the elTecU of these drugs became tlioroi
established by experience, and their application to bodily disorders
better defined. It ip to be not<?d that these actions of drugs upor
human body and its functions are elementary facts and are essential <
acters of the substances in question. They are supported by the
character of evidence as the statement that sugar tastes sweet or qu:
bitter. Tlicy are true bincheniical phenomena or physiologip reactions.
The influence of the mind upon the body, especially during the
of strong emotions or of subconscious attention, is fully recognized
pathologists and clinical observers, as a cause of disordered function,
as aphonia^ paralysis of sensation or motion, and various neuroses. It
GKXaUL TnERAPBrTICS AND CLASSIFICATION' OF HEMEDIES.
71
kca wbown by experience that, frequently, such eases may be cured by
f^ggvtion, or br simply acting on the mind of the patient. The practical
to be learned is that the mind is a powerful factor in causing or
miy^nf^ 'listurbances of the bod)*, and, on the other hand, is a very
• t in thernpoutic<. The oinincnt Dr, Rusli appreciated this
• ligfc lie always, when giving a remedy to a patient, took particu-
kretr* ^-i**- ui»on the iiulividuarsj mind ihe etfet-is whirh he expected
Id Calk -^ _.^ --imimBtration. This practice is now followed by many, who
iR ockiioTledged to be the most successful exponents of modem medical
It hss often been observed that among patients of highly developed
«siw» organization the adniiniPtration of s<'»me almost inert remedy, or
eitn the nee of some mysterious agent (such as Perkins's tractors, Hay-
fVth'ft imitation tractors, the iron ring for rheumatism, the horse-chestnut
m potato carried in the pocket for other disorders, amber necklaces for
tH^ ete.) may be followed by apparently m&rvelous results. The eminent
Amentmn &argeon, Joseph Pancoast, in lecturing to his class, pointed out
tet fame patients suffered discomfort or disease, without having any bodily
lacr' -; --' he insisted upon the clinical fact that, whether a man be
9tk or in his mind, he is sick, and appropriate treatment should
W Adxmiujtcrcdy physics for the bodily sick; psycho-therapy for the mentally
Tbcre can be no success in therapeutics without recognizing the im-
of the psychical factor in disease. Sometimes a sudden mental
win restore speech to an aphonic patient, or it may be expectant
-'one that accomplishes the result. Sir Humphry Davy reported
m . :\js case of a paralytic patient, who remarked, after experiencing
the Eoei seneation of having a clinical thermometer placed under hia
that he felt better. I'pon repeating the procedure daily he steadily
and fully recovered at the end of a fortni;?ht witliout any other
t.* Patients of neurotic ancestry, without being actually insane,
haTe dehision?, or morbid fears, about their health. In such cases,
m called the moral treatment is of the highest importance. In order
to obtain the best results in therapeutics, it is essential that the physician
^alJ oae every prop<'r means to secure the confidence and co-operation of
tka patient. Expectant attention is aoknowleged to be a powerful thera-
' a ' "^' '-^tion undoubtedly has a strong influence, and is a
ir ■ I be reckoned with.
Diaea^^ «» frvq\ienily causcKl or maintained by certain states of the
^li|^* These may be provisionally divided into three classes. 1. Those
^^^■kich there is a diminution or absence of certain principles in the blood
^Pln are necessarj* for cell-development and metabolism. Thus, a peculiar
^CivWd condition (cachexia stnimipriva) has been observed to follow re-
r^avsl, or destmction by disease, of the thyroid gland, apparently because
Aa kh>od is deprived of some important constituent or internal secretion
aUdi this gland elaborates and which is necessary to health. This con-
>nft Connecl(*d with the Hi«lory and Practice of Medicine and
^^^. . ^ JciKr])h Pettigrew, Philndelphia, 1844.
I from on «ddre*« on "Our Thcrnpeutics," delivered bv the author
^^f, ■ .\t9! Menliral Society. Journal of th^ American Urdica) AnnoHation,
ins a, 1H?|P.
78
PHAHMACOLOGV AND GENEIUL THERAPEUTICS.
dition has been bIiowq to be amenable to treatment by means of
extract obtained from the organs of sheep. When we treat anaem
iron, rickets with lime-salts, scurvy with lemon-juice, or neurasthen
hypophosphites. this principle is followed of supplying to the blood
proximate priiiriplis wliicli arc needed for healtliy inetaboliBm. Sii
we may siipfiiy ?ome suliPtuucv which tlie lilfHtd need:? to enabi
resist infection or throw off the consequences of infection. Thui
toxin is used in diphtheria and similar bodies in er3'sipelas, tetanus, t
fever, pla^e, pneumonia, tuberculosis, cholera, and yellow fever. 2.
is another claes of cases in which certain elements normally present
blood are in such excess as to cause symptoms of disorder. Tn di
for example, there is an excess of glucose in the blood, and the n
manifested in glycosuria. In gout and litha-mirt, we have evidence of
of uric acid, or of other compounds of the xanthin group. In jauudic
is biliary }dg[nont in tlie t ireiiliitinLT fluid. The oliji^et el Ireatni
such cases is to diminish the quantity of the pathogenic element by t
istering drugs which reduL-e produrtidn and auginrnt excretion, thus ]
the patient in a condition a|)]tniachiug the noruial. 3. In a third
there are present in the blood substances which are not among its or
constituents and which cause disturbance of cell-action (alcohol, nii
muscarine, metallic poisons, etc.). There is a large class of substan
bacterial origin which cause symptoms of disease when introduce*
the blood. In addition to the group of infections diseases, which are
lar instances, there are also toxins absorbed fi-i>m the alimentary tra(
productive of symptoms, the origin of which is often overlooked,
eczema may be produced in this manner. A case has been reporl
which, after the removal of a Fallopian tube, which was distended witi
a lupus of the face underwent a spontaneous cure. Albuminuria it
wise occasionally due to toxins. In all these instances it is seen that
the active cause of the disease is recognized and removed the symptom
disappear. How drugs may be utilized in bringing about this result i
be the object of therapeutics to show, as vriU he made manifest in th
lowing sections on tlic uses of drugs.
TlIEIlAPEUTIC T'LASStFICATION OF EeMEDIES.
Classification has been found as difficult in Materia ilcdica as in
other bnnicii of natural science. It is impossible to mark out. with e:
tudc, definite linuts to the action of drugs on account of the fact that
often simidtimeously influence different organs ami functions. If. fron
point of view, a medicine Ije described as a diuretic, fnini ani'thcr s
point it might I>e no less jireperly jtlaoed among the carthiirtics or diajdior
When we seek to understand the mechanism of its aeti(»n and its intli
upon the composition of the urine, we must also study its effect upoi
central nervous system, the cardiac nerves and ganglia, the heart-mi
and tlic muscular coat of the arterial pystcm. The orgaiLs couccrne
sanguification may likewise be affected, and this result is evidenced hi
changed projHiriion of the urinarv constituents. If a drug specially
press(^s the chief nerve-centres, its range of rniluence must extend moi
less powerfully and direetly to every important organ. It need not,
OBXC&AI. TlCClUPElTlCd AND CLASSIFICATIOX Of R£M:KD1K^.
^tore, meKtn stmn^ that no elassiiicatiou of remedies has received imiversal
sspfdfft. In »J(*5*^^riliing iht- [irciMi-rtiei? and applicfltiona of drug3, the alplia-
fctfbiwi arrui^einent i« here adopted, as it is the moet simple and it facilitates
Dillervnt methods of classification of the articles of the Materia Medica
employed for different purposes. Thus, a botanical basis may be
or tlni^s and preparations may be arranged according to their
and pharmaceutical relations; or remedies may be classified ac-
cording' to their most prominent physiological or therapeutical effects. It
BfacTsllT Teccpnized that drugs affect function because they contain cer-
tUB prQXimate principles, or extractives, by virtue of which they produce
dwir pbjmoloincai action and iheir therapeutical powers. A cinchona-tree
vtadi fe prown in a botanical garden, and on this account contains no
■BBUkr ■ ark. will have no medicinal value, and preparations of such
lark tri. ■. no thorapeulit' i^ffect, except it may bo through mental im-
■WMiim^> upon the patient who thinks that he has taken an antiperiodic.
la pac«inir. it may ble nientionc<] that one of the great sourtrs of fallacy in
dsaical therayjeutics exists in the varying quality of drugs and the conse-
fmut uncrrtainty as to their effects. This may be obviated to a large
dteot bj n£ing precautions to obtain only the best quality of drugs and
Ife vmtf what are called etandardized preparations, in which the proportion
^ tile active principle is ascertained and guaranteed to be uniform.
It ift only proper to state that the therapeutical classification is ncces-
mw^x- -.iiU- ,» general one, and many exceptions can be taken. Especially
<1 that it is not to be inferred that this classification is ex-
Mc, ati>j iuat, because the principal action of a remedy under ordinary
»tanees is sm-h as to warrant its being placed under a special head-
, it might not also be entitled to a place under another heading. This
Ity arises from the multiple action of drugs, and that they often
aet opon Mveral organs :simidtaneously. Thus a drug, like quinine, may
ta an antiaeptic and it may also be a stimulant, or an antiperiodic. As an
abdentnl effect it may act as a depressant or cause certain eruptions on
tfe ckin. Th<^ oil of turpentine is an antiseptic and a stimulant to the di-
fcstiTe or^ns and the heart, it is also a diuretic; but it is capable in some
ciMs of cauainK toxic symptoms and general inflammation of the skin, or
dSB^nrr atid nephritia. even from small doses. With reference to this
feenliar ility of individuals to the action of drugs, called
fv oiL« i-y. no satisfactory' explanation can be given.
opici! id of acting as a narcotic as it generally does, sometimes
> aa a 51.: :: morphine in some individuals causes wakefulness and
Liting and annoying itching of the skin. Cannabis Indica may cause
SDfitaa and ncn'nus excitement instead of soothing the nervous system.
haoAie eaa»e» alcuhol acts like a narcotic poison, in others it produces acute
'•ration of the actions of dnigs in the next section
»▼ »i 1 be referred to. Enough have been mentioned here
that classification of drugs according to their effects
IS only tentative and suggestive at the best, and is
;t to many <orn.»ctions as applied to individual cases. The therapeu-
..irirj- aw ]ir. of the incidental effects of drugs, is constantly on the alert
inent when they are manifested.
- i...i. |)ft divided into classes (after Garrod): —
76
PHARMACOLOGY AND GENERAL THEBAPEUTICS.
The alkallfs coniliinr* with and neutralize acids. Tiieivft
■usoful in overcoming hyfJtnacidity of the fitomacli, whether due to
fcssive production of hvdrocldoric acid or to fermentative chang
the proiliutioii of fatly acids. Thov ]>rojiiiite the gecretiou of acid,
sti'ain tliat of alkaline, fluids. Hence, when administered imn
before a nual. an alkali e.xcites a flow of gastric jiiiee, and, in t\
promotes digestion and h ger^-iceable in dyspepsia. On the othc
given immediately after a meal, such a ivmedy, by neutralizing
trie juice, corrects hyperacidity and relieves the symptonis of indi
it may, however, embarrass digestion and favor fermentation.
readily he understood, therefore, how the prolonjjed nso of alkalies
]>opsia at length diporders appetite an<l aggravates the condition fo
they were originally prescribed. A dilute alkaline solutiou chrcki*
charge of acute eczema, which posseBses the j^nme reaction : it all
itching and smarting of this disease, nr the Iturning pain of superfieii
and scalds. Para-tithe^in, whether deiiendent u]M>n L'nn:?titutional *
or excited by local causes, is often anu-nnble to the intluence of an
lotion. The same pre])aration is beneficial by neutralizing acid so
from the bowel, vaginn. or the ^kin, and obviating their elTccts. Pr
administration of an alkaline remedy may lie injurious and give rise
elation iiml <iehility from the a<*eelerated disiiitcgralion of nitrogenoii
These remedies aid in the resolutiou of inlhnnmatory exudations.
A diminished alkalinity of the blooil in rheumatism and gout ia
caused by the pivsenee. respectively, of laetic or uric acid, with ot
crementitious substances, in excessive (pmntity. The alkalies are
tageiuia in tliese diseases, ctmibintng witli the jieitl and facilitating i*
ination. The siime result takes place in the urine. The reaction
fluid being rendered alkaline, uric aeid is disstdved rir forms solubi
biniitionSj irritatiim of the urinary tract is rjuicted, and the precipitu
the uric acid in the kidney or Idadder is preventtnl. Alkalies are usefi
ft uric-acid calculus is ]>resent. They luay be able to dissolve a sm
soft stone. At all events, they ]jrevent further dc])osit nnd ndieve 1
extent the irritation, which tlie foreign body and acid urine have i-»ccfi
Alkaline remeilics consist of: potassium hydrate, potassium ca:
nnd bicarbonate, sodium liydrate, sodium carbonate and bicarbonate, 1
carbonate, calcined magnesia and n^agnesiuin carbonate, lime-wate
eipilated calcium carbonate, and prepared thalk. The combinati
potassium, sodium, Mid lithium witli the vegetable iicids do not act a
lies in the stomaeh, luit. being convert<:*d into carbonates in tlie bloo^
alkalinize the urine as they esca])e from the svrstem. Finally, an nlki
as n chemical antidote in |)oisnning by an aeid.
Acids. — When given after meals, these supjdy tlic arid medium in
pepsin is ctTicient, They, therefore, improve the appetite and digestic
are useful in digestive disorders. They promote secretion and allay
and nausea. Administered before a meal. i»y reducing the secretion (
by the peptic glands, and by ]ireventing fermentation, they check
acidity of the stomach. Tlic niinerfil acidic possess astringent pro]
and are of service in lessening hfcmorrhagep. morbid secreti<*ns. an
charges. They are, likewise, usually antisc]>tic: they disinfect the a
tary canal and restrain deleterious feritH'ntnti«m of its contents. Is
centrated form thev act as esclmrntics.
G£N£RAL THSRAPEUTICS AND CLASSIFICATION OF REMEDIES. 75
Irritants are applied to the skin in order to produce nervous and vas-
cular reaction. According to the degree of their action, they are classed as
nibefaeients, or those which simply redden the surface; epispastici (or
Teneantt), those which occasion blisters; and pmtulanti, which excite suffi-
cient inflammation to form pus. The rubefacients most in use are mustard,
capsicum, arnica, turpentine, chloroform, ether, and iodine. Among ves-
icants are ammonia, cantharides, euphorbium, mezereum, and iodine. The
principal pustidants are tartar emetic, croton-oil, and silver nitrate. The
prolonged application of a rubefacient often gives rise to a blister.
Escharotict or canstici destroy tissues and lead to the formation of a
slough. The principal escharotics are : liquefied phenol, glacial acetic acid,
chromic acid, strong mineral acids, caustic potash, caustic soda, and the
galvanocautery or actual cautery.
Local sedatiTes diminish nervous and vascular excitement in the part
to which they are applied. They consequently relieve local inflammation and
pain. Among agents of this group are bismuth, acetate of lead, aconite,
cocaine, opium, belladonna, etc.
Bmnlcents are bland substances used to protect, mechanically, the gas-
tro-intestinal tube from contact with irritant poisons, to allay inflammation
of the same canal, of the respiratory or genito-urinary passages. Many of
them possess some nutritive value. This class embraces acacia, flaxseed, elm,
m&rshmallow, Iceland and Irish moss, starch, gelatin, olive*oil, etc.
Emollients axe applied to the external surface. They resemble de-
mulcents in being of a bland, soothing character, protect the surface from
friction and from air, relieve tension, and diminish pain. Among emollient
Hibstances are : lard, olive-oil, spermaceti, glycerin, starch, cacao-butter, etc.
Local Astringents and Styptics. — The astringents and acids, which are
useful in checking haemorrhages and morbid discharges when administered
internally, usually have the same effect when locally applied.
Antiparasitics. — The term antiparasitic, or parasitieide, is generally
restricted to agents which have the jxjwer of destroying the animal and
Tp^etable parasUes which may infest the exterior of the body. The prin-
cipal antiparasitic remedies are: sulphur, iodine, salts of mercury, lique-
fied phenol, and boric acid.
ttsmatinicB are given internally to influence favorably the composi-
tion of the blood. ITseless, or even deleterious in health, such a drug
tends to improve, in ceriain diseased states, the quality of the blood, and,
consequently, the nutrition of the entire organism. D^truction of its cor-
puscular elements and drain of its albumin indicate that the nutrient fluid-
tissue urgently requires increased and appropriate pabulum. Remedies be-
longing to this class are, or contain, normal constituents of the body, and
are necessary to the maintenance of structure and the performance of func-
tion. Prominent among the ha»matinics are preparations of iron, manganese,
codliver-oil, other animal and vegetable oils, and a good diet.
Alkalies. — When alkalies, in concentrated form, are brought into con-
tact with animal tisues, they enter into chemical combination with the
ongen present, and thus give rise to an active necrosis, or destructive in-
flammation. Alkalies are, likewise, solvents of albumin. These physical
and chemical properties render the caustic alkalies useful in producing pow-
erful counter-irritation. Their escharotic effects have been made use of in
chronic synovitis, myelitis, and meningitis, and in the destruction of mor-
bid tissue, whether of neoplastic or inflammatory origin.
78
PHARMACOLOGY AND GENEIIAL THERAPEUTICS.
Alteratives counteract the effects of various forms of toxemia,
of chronic malaria, sypliilis, scrofula, tuherculosis, carcinoma, and
mineral poisoning.
The principal agents of this clafs are : gold and sodium ohlorid
arations of arsenic, propnrntions of mercury, preparations of iodin
form, iodol, potassium chlorate, antimony, inexerouni, sulphur, su
colchicum, guaiacum, sanfruinaria, xanthoxylum, calcium chloride, st
sarsaparilla, codliver-oil, and phosphorus.
Exhilaranta determine an active cerebral cirouktinn and stimu
functions of cerebral centres; but if administered for loo long a ■
in excessive quantities, a depresing effect is produced. The effect n;
higher is reflected to the lower centres, the heart strengthened, the :
tion deepened, and muscular vigor promoted. Substances belonging
class support the system under prolonged and unusual strain, and ai
useful in the trentmciit of mental nlienation. Among exhilarants
ranked the prepnrationj? of belladonna, hyoscyamus and stramoniun
tea. coffee, tlie primary action of ether, and alcohol.
Hypnotics and Anodyiies. — Hypnotics cause sleep, anod^-nes alia
Sound sleep obliterates the perception of pain; the relief of pain,
other liand, permits sleep. A close rehitionsliip exists, therefore, h
these remedies. An hvpnotie will often abolish pain, while an anody
frequently overcome wakefulness. In some suhstatices, however, Ih
notic, and in others the anodyne, influence is more conspicuous.
sleeplessn(*ss depends upon anxiety, mental excitement, or prolonged
lectual effort, the treatnumt differs from tliat to be adopted when int
is due to pain. Hy]>noties act chiefly by influencing the circulation tl
the brain, nnodnies by their effect upon sensory centres.
The chief romedies belonging to this class are : opium, chloral-h;
ehloralamid: potnssiuui, sodium, and ammonium bromides, acetone, a
paraldehyde, ethvl carbamate, sutphonelhylmetliane. and sulphonm€
'AnBEsthctics. — Agents of this class abolisli consciousness and sen
bv inhibiting the functions of the liigher cerebral centres. When th*
fluence is continue<l. the sensory and motor centres of the spinal coi
of the medulla oldojigata are, in turn, affected. The first result of
inhalation is a stage of intellectual, emotional, and motorial exeit4
This is succeeded by a stage of narcosis. Anaesthetics destmy life by'
ysia of the centres situated in the medulla oblongata. Thev are em]
for the purpose of relaxing spasm and producing a condition of x
sciou8ne?s, during wliioh suririea) oi^erations may be painles<lv perfo
The chief memhrrs of this group are: ether, chloroform, ethyl-brc
ethyl chloride, anil nitrous oxide.
Spinal Stimulants. — Agents belonging to this chips, when givi
medicinal doses, exalt the functions of the cord, invigorate the aetii
the heart and lungs, and promote secretion and nutrition, by influe
gastric motion and peristalsis.
These remedies are useful in atonic dyspepsia, atouy of the bo\i
bladder, cardiac weakmess, emphysema, neuralgia, spinal neurasthenia, ]
ysis, and phthisis.
The principal members of this group are: nux vomica and its re
dpecies, ignatia. and alcohol and camphor in small doses.
Spinal Sedatives. — These are substJinces which have the properl
OSXC&AL TUUUPEUTICS AXD CLASSIFICATIOX Of tlKUi;DIKS.
79
the fnnctions of the spinal cord. They may act directly upon the
lis or proiiace tlieir effect by an influence on the circulation through
te eord. Ejiceseive doses cause paralysis. Spinal sedatives are valuable in
of irritation, or congestive excitement, of the cord. The chief
beloQ^ng to the gfoup are; potassium bromide, sodium bromide,
petsemiucu. oonium, hydhx-yanic acid, potassium nitrate, physostig-
\ ■■* aAiirA'late, and tobacco. ^lagnesiiun sulphate, when injected into
ypouil Ci>rd. \s a powerful sedative.
Aatispaflxnodios. — Antispaf^modic 'drugs allay irregular action of the
tr - involuntary muscles by a calmative influence upon nerve-cen-
i!>* of use in many disorders characterized by nervous excite-
K At) ^i>asm. 8uch as hysteria, colic, asthma, and intc^stinal
T' . /al antispasmodic remedies are: ammoniated valerian,
CAmphor, musk, castor, and ether.
. — Tonics improve appetite, digestion, assimilation, and secre-
ana,. «trra^tben the circulator}* apparatus, improve the composition of the
kked, invigorate the muscular system, and promote the nutrition of nerve-
and fibres. The most powerful members of this class also possess
IKhdlir • - Tonics are useful in the treatment of digestive dis-
in li* 1 conditions of tlie nervous system and nutrition in gen-
«ai« and in •li^^aiics characterized by periodicity. The former variety
: gentian, calumba. chirata, serpentaria, and eucal\'ptus. The prep-
of iron and manganese act as tonics when the quality of the blood
impairv-d. Certain mineral salts, as zinc oxide, silver oxide, and zinc sul-
•^ exert a similar influence in nervous affections, as chorea and epilepsy.
Ywrnlf r Stimulants. — Memliers of this class stren^hcn the action of
^ baart an*l blood-vessels. Tbey are, therefore, advantageously employed
^wmtkeati' ions of the central organ of tJie circulation, in transuda-
ih« dor Xr. lams. and in liaMuorrhage. Chief among vascular stimu-
latsar '1, preparations of ammonium, caffeine, convallaria, digitalis,
tfTopha: ind scoparius.
Vascular Sedatives. — Tbese remedies render the heart's action more
^rm aad Irt* forcible. They moderate cardiac excitement, and are of service
« ftArrile and intlnmmiitory affections of n sthenic t>'po. Examples of this
1^^ - iite, veratrum, gelsemium, antimony, muscarine, jnlocarpine,
^ . :c acid.
fitalagosaea. — Sialagogues excite the secretion of saliva, either by an
sinsTiT lAcnl eilect, with a reflex stimulation of the salivary glands, or by a
^- 'iienoe upon the glands during their elimination. Examples of
^ ;, . .... . varifty are: capsicum, mustard, ginger, pellitory, and mezereum;
V the lattrr: preparations of iodine and mercury, pilocarpus, muscarine,
phTao^tisiTia,
^tiaialiea check salivar>' secretion. Tliis is the action of belladonna,
and pot lilorate.
letiea. — cause vomiting, either by irritating the terminal
of th- nerves or by exciting the nervous centre which pre-
ihr .; MU'sis, Rem«Mli»*s which act by direct irritation aro;
copper sulphate, zinc sulphate, and mercuric substilphate.
•--^nj t-r -»r-iomic L*melic8 are; aiwmorphine, ipecacuanha, tobacco, and
«rlar emetic.
Aati-einetiea allar irritability of the gastric nerves or the vomiting oen*
78 rHAHMACOLOGy AND GEVEUAL THERAPEC
Alteratives counteract the effects of various forms of toxEBuiia,
of chronic malaria, eyphilis, scrofula, tuberculosis, carcinoma, and
mineral poisoning.
The priiieifjiil agents of tliis class are : gold and sodium chlorid
arations of arsenic, proparntions of mercury, preparations of iodin
form, iodol, potassium elilorate. antimony, niezereum. sulphur, su
colrhicum, guaiacum, sanniiiri^i'i'i. xantlmxyluiu, calcium chloride, at
sarsjipfirilla, cotiliver-oil, and phosphonis.
Ezhilarants determine an active een-brnl circulation and stimu
functions of eeix'bral centres; but if administered for too long a '
in excessive quantitie?. a depresing effect is produced. The effect m
higher is reflected to the lower eentreta, the heart ehvngtliened. the
tion dee])encd. and muscular vigor promoted. Substances hojonging
class support the system under prolonged and unusual strain, and ai
useful in the treatment of mental alienation. Among e.xhilnrnnts
ranked tlie preyxiration? of hr"lladi>nna, hv^^Rcyamus and stramoniun
tea, cofTee, the jirimnry action of '4her. and alcohol.
Hypnotics and Anodynes. — Hypnotics cause sleep, anodynes alia
Sound sleep obi iterates the perception of pain; the relief of pain,
otlier hand, permits sleep, A chise rehitioufhip exists, therefore, fc
these remedies. An h\7inotic will often abolish pain, while an nnody
frequently overcome wakefulness. Tu some substances, liowever. th
notic, and in others the anodyne, influence is more conspicuous.
sleeplessness depends upon anxiety, mental excitement, or prolonged
lectiial eiTort. the treatment differs from that to be adopted when ini
is due to pain. Hypnotics act chiefly by influencing the circulation tl
the brain, anodynes by their effect upon sensory centres.
The chief remedies belonging to this class are: opium, chloral-h;
chloralamid : ])otnssiunu sodium, and ammonium hromi4les, acetone, a
paraldehyrle. ethyl Ciirbamate, sulphonctliylmethane. and sulphonmt
'Ansesthetics. — Agents of this class niKilish consciousness and sei
by inhibiting the functions of the higher cerebral centres. Wlicn tb
fluence is continued^ the sensory and motor centres of the spinal coi
of the medulla oblongata are. in turn, alTe<:*ted. The first result oi
inhalation is a stage of intellectual, emoliomil. and motorial exciti
This is succeeded by a stage of narcosis. Anaesthetics destroy life by
yais of the centres situated in the medulla oblongata. Thev are era]
for the purpose nf relaxing spasm and i>roducing a condition of x
sciousness, during which surgical o]nTations may be painlessly perfo
The chief memlnTs of this grou]> are: ether, chloroform, cthyl-brc
ethyl chloride, ami nitrous oxide.
Spinal Stimulants. — Agents belonging to this class, when giv»
medicinal doses, exalt the functions of t!ie cord, invigorate the aeti
the heart and lungs, and promote secretion and nutrition, by influe
gastric motion and peristalsis.
These remedies are useful in atonic dyspepsia, atony of the hmi
bladder, cardiac weakness, emphysema, neuralgia, sj>inal neurasthenia, ]
ysis, and phthisis.
The principal meml»er-i of this group are: nux vomica and its r€
rfpecies, ignatia. nnd alcolml and camphor in small doses.
Spinal Sedatives. — These are substances which have the propen
GEXERAL THEaAPEDTICS AND CLASSIFICATION OF REMEDIES. 79
reducing the functions of the spinal cord. They may act directly upon the
nerve-cells or produce their effect by an influence on the circulation through
the cord. Excessive doses cause paralysis. Spinal sedatives are valuable in
conditions of irritation, or congestive excitement, of the cord. The chief
remedies belonging to the gfoup are : potassium bromide, sodium bromide,
lohelia, ^Isemium, conium, hydrocyanic acid, potassium nitrate, physostig-
mine salicylate, and tobacco. Magnesiimi sulphate, when injected into
the spinal cord, is a powerful sedative.
Antispasmodics. — ^Antispasmodic drugs allay irregular action of the
voluntary- or involuntary muscles by a cahnative influence upon nerve-cen-
tres. They are of use in many disorders characterized by nervous excite-
ment and muscular spasm, such as hysteria, colic, asthma, and intestinal
colic. The principal antispasmodic remedies are: ammoniated valerian,
asafetida, camphor, musk, castor, and ether.
TonicB. — Tonics improve appetite, digestion, assimilation, and secre-
tion, strengthen the circidatory apparatus, improve the composition of the
blood, invigorate the muscular system, and promote the nutrition of nerve-
centres and fibres. The most powerful members of this class also possess
antiperiodic virtues. Tonics are useful in the treatment of digestive dis-
orders, in depressed conditions of the nervous system and nutrition in gen-
eral, and in diseases characterized by periodicity. The former variety
includes : gentian, calumba, chirata, serpentaria, and eucalyptus. The prep-
arations of iron and manganese act as tonics when the quality of the blood
1$ impaired. Certain mineral salts, as zinc oxide, silver oxide, and zinc sul-
phate, exert a similar influence in nervous affections, as chorea and epilepsy.
Vascular Stimulants. — ^IVIembers of this class strengthen the action of
the heart and blood-vessels. They are, therefore, advantageously employed
in weakened conditions of the central organ of the circulation, in transuda-
tion due to blood-stasis, and in haemorrhage. Chief among vascular stimu-
lants are : alcohol, preparations of ammonium, caffeine, convallaria, digitalis,
^rophanthus, and scoparius.
Vascular Sedatives. — ^These remedies render the heart's action more
«Iow and less forcible. They moderate cardiac excitement, and are of service
in febrile and inflammatory affections of a sthenic type. Examples of this
class are : aconite, veratrum, gelsemium, antimony, muscarine, pilocarpine,
and hydrocyanic acid.
Sialagogues. — Sialagogues excite the secretion of saliva, either by an
irritant local effect, with a reflex stimulation of the salivary glands, or by a
specific influence upon the glands during their elimination. Examples of
the former variety are : capsicum, mustard, ginger, pellitory, and mezereum ;
of the latter : preparations of iodine and mercury, pilocarpus, muscarine,
and physosti^rma.
Antisialics check salivary secretion. This is the action of belladonna,
opium, and potassium chlorate.
Emetict. — Emetics cause vomiting, either by irritating the terminal
filaments of the gastric nerves or by exciting the nervous centre which pre-
sides over the act of emesis. Eeraedies which act by direct irritation are :
alum, mustard, copper sulphate, zinc sulphate, and mercuric subsulphate.
General or systemic emetics are: apomorphine, ipecacuanha, tobacco, and
tartar emetic.
Anti-emetics allay irritability of the gastric nerves or the vomiting cen-
80
PHARMACOLOOY AXD OENERAL THERAPECTIC8.
tre. Bismuth, cerium oxalate, creosote, carbolic acid, chloroform
caloiDol, an*l silver nitrate soothe gastric irritatiou. Opium, hydi
acid, bromides, and chloral-hydrate quiet the excitement of this nerv(
Purgatives jtrodiice evacuation of the intestinal canal by im
secretion, or transiidfltion, along the tract and l)y excitin^^ perigtalti
mentfl. According to the intensity of their action, pur^mtives or ca
are subdivided into several varieties' 1. Laxiitivc^ cause fiiight inc:
secretion and perisitalis, resulting in softened jitools. Among laxat
ranked nmnna, sulphur, figs, prunes, olive-oil, rhnnwuis purshiani
eyamus, sfiap, etc. 2. Simple purgiitivi-s. or purgatives ]iniper, are ii
cidedly stimulant, and oecnsion seiniliquid motion*. Belonging to thi
are: senna, aloes, rhubarb, castor-oil, and calomel. '^. Drastic cathai
strongly irritant to the intestinal mucous menihrsnc. and occasi-
transudiiti'Hi from its ves?;t'l? and uhnost fluid stools. The nclifm of
ie often accompanied by eonsitleral^lc j:ripiug ])ain. Exampb^-s of drasi
jalap, colocvnth, ganibog*^, scanniiony, elateriuni. podophylhnn, and
oil. Excessive doses of simple purgatives have a very similar eifi
Hydragogue purgatives remove abundant serum from the intestinal
vessels and protluce large, watery motions. Ebiti^'rium, cream of
and croton-oil are ilhistrations. An analogous action is exerted I;
ous salt^ of the alkalies and alkaline earths. Large iloses «^f the
cathartics have t}ie effect of bydrngognes. Tlie principal saline pin
are Radium sidi)biite» miiErnesiuin sulpliate, magnesium citrate, |>o'
tartrate and hitartrate. and potassium and sodium tartrate. 5. Cho
purgatives stirnukte. either directly or iiidi redly, the liver, cause
creased flow of bile, tpiieken the peristnltie movements, and produce
ish, liquid evacuations. Among the cholagogueii! are included some i
mercury, aloes. euon\Tnin. iridin, rliuhnrb. le])tandra, and podophyllu
Anthelmintics cau^o destruction or expulsion of intestinal
Those agents which destroy are termed vernneides; those wliich ex
kno^vn as vermifuge remedies. Tape-wonns are killed or removed by
of aspidiiuu. kiimabi, kous?o, poniegnniate (or pr'llr-tierine), pumpki
turpentine, ami chloroform. Remedies which act against round-won
santonin, spigLdia. chenopodium. nnd nzedarach. Seat-worms are dei
by enemata containing tahle-salt. tannic acid, quflssia. eucalyptol. et<
Stomachics-. — Stomachics stimulate the gnstric muc-ous membra
crease fl])petite, promote the secn^tion of giistric juire. and assist di^
Carminatix'cs restrain abnormal fermentatinn and dispel intestinal
Among stomachics are: cnpsieum, piper, cardamom, cloves, mustar
ginger.
Hepatic Stimulant*. — These are medicines which excite the li
incrciised fiiiictional activity. Thev occasion an nngmcnted format
bile, and thus promote the normal elaboration of nitrogenous aliment
increased quantity of bile i? not always accompanied by a eorrpspond:
crease in the ehanicteristic bile-salts.
The [>riiici[>al substances which increase production ipf bile are:
hvdroehloric acid. ij>ecacnanhn, sodium ple^spbate. mennmic eh
aloes, podophylHn, rhubarb, colocvnth. enrmymin. iridiu. etc. The qr
of virea is inerensed by nmmoniimi chloride, arsenic, nntimony, pbosB
and iron. The glyeo^rnnic function is stimulated by nitrohydrochJorw
amy! nitrite, and sodinm bicarbonate.
Hepatic Depressants. — Agents belonging to this class reduce!
GENERAL THERAPBUTICS AND CLASSIFICATION OF REMEDIES. 81
tional activity of the liver, diminishing the formation of bile, urea, and
plycopen. Those which lessen the secretion of bile are : opium, lead acetate,
alcohol, and quinine. The amount of urea is decreased by opium, alcohol,
quinine, and colchicum. Glycogenesis is diminished by opium, phosphorus,
Arsenic, and antimony.
Expectorants. — Expectorant remedies modify the character of the bron-
chial secretions and facilitate their expulsion. Small or nauseating doses of
«^metic substances increase and liquefy the secretions of the mucous mem-
branes. Larger dos&s by causing vomiting, mechanically aid the expulsion
of mucus from the air-passages. The terra "stimulating expectorants" is
pven to a group of drugs eliminated by the bronchial mucous membrane,
which they stimulate, and the secretion of which they at the same time alter
and improve. Certain substances, when dissolved in the mouth, aid ex-
pectoration by a stimulating influence upon the cilia of the trachea and
bronchi. These are called ciliary excitants. The nauseating expectorants
are: antimony, ipecacuanha, apomorphine, lobelia, pilocarpus, etc. Among
the stimulating expectorants are : ammonium chloride, balsams of Peru and
Tolu, senega, squill, sulphur, and terpin hydrate. Ciliary excitants are:
ammonium chloride, potassium and sodium chlorate, gum acacia, etc.
Pulmonary sedativea relieve cough by allajing irritability of the re-
spirator}' centre, or the terminal fibres of the nerves distributed to the bron-
chi and lungs. Examples of this class are : opium, belladonna, stramonium,
hjoscyamua, hydrocyanic acid, etc.
Anliydrotics check excessive sweating; among them are atropine or
belladonna, camphoric acid, mineral acids, especially aromatic sulphuric
acid, also agaricin and adrenalin.
Diaphoretics increase perspiration by stimulating the sudoriparous
fflands in the course of their removal, as sulphur, guaiacum, sarsaparilla,
-^rpentaria, mezereum, and camphor. Other agents produce the same effect
bv causing relaxation of the cutaneous capillaries. In this subdivision are
found the nauseants and emetics, as tartar emetic, ipecacuanha, lobelia, and
Dover's powder, as well as opium, ether, and alcohol. A third group of
rpmedies excites diaphoropia by an influence upon the sweat-centres, as pilo-
carpus, veratrum, and salts of potassium.
Diuretics. — The quantity of urine excreted is increased by remedies
which raise general or local arterial tension, and by those which stimulate
the secreting* cells of the kidney. The free ingestion of water assists the
action of diuretic drugs, and is mechanically serviceable by irrigating the
rf-nal tubules. Among the stimulant diuretics are found cantharides, co-
paiba, cubeb, turpentine, colchicum, squill, broom, juniper, potassium ace-
tate, and calomel. The principal agents which act by elevating blood-pres-
snre are: digitalis, belladonna, nux vomica, and alcohol.
Lithontriptics. — This name has been given to a class of remedies which
increase the flow of urine, and at the same time, by modifying its chemical
reaction, dissolve and prevent the deposition in the urinary passages of uric,
phosphoric, or oxalic acid, or insoluble salts of those acids. If precipitation
ha3 taken place, they are given with a view to dissolve or remove gravel or
calculi. Potassium carbonate, bicarbonate, and citrate, and lithium carbon-
ate and citrate are the principal solvents for uric acid. The agents which
are given for the purpose of acting upon phosphoric calculi are : benzoic acid,
ammonium benzoate, and diluted nitric acid.
PHARMACOLOGY AND GENER.VL THERAPEUTICS.
Hemostatics. — Apentg for checking pulmonflrv haemorrhage, oi
ing excessive menstrual flow, or bipinorrhnge from the uterus at oth<
than the monthly periods are frequently (iemanded. They may ac
tlirough the nervous systtnn, as when atropine is injected hypodei
or oil of erigeron administered, or they may act throuirh contractioi
muscular fibres^, aa when ergot or stypticin is given. Cold causes vaa
constriction, ai* when ice is applied to lia?morrhoids, or introduced i
vagina or rectum.
Ecbolici. — These remedies, also known as oxytocics, stimulate t\
nant womb to contraction. They may thus lead to abortion, if pren:
giveOj hut, administered during labor, are often of valuable assist)
invigorating the organ. It is sunuisod thnt eobolioB may act either 1:
ing direct irritation of the muscular structure of the womb, or exciti
traction through an influence upon the uterine centre in the core
principal acholics are: ergot, cotton-root bark, nstilago, quinine, ant
Emmenagog^ues. — Emmeniigogucs excite the menstrual ilux eil
a direct stimulant elTcct upon the uterus or indirectly by improvi
quality of the blood and nutrition in general. Small doses of ecbolit
dies are usually emmenagogue. Direct cmmenagognes are: ergot,
cantharis, rue, myrrh, etc. Indirect emmi^nagogues are: preparat
iron and uianganeso, nux vomica, codliver-oii, etc.
Aphrodisiacs (*xcite the sexual appetite and the genital functions
object they accoujplish by stimnlntion. either direct or reflex, of tl
tres which govern the genital organs. Whatever promotes uutritior
indirectly to invigorate the sexual apparatus. The oliief aphrodisiac
are; cantbari?, phosphorus, nicohol, camphor, and cannabis Indica.
Anaphrodisiacs diminish st*xunl desire and power. They allay
bility of the genital centres and diminish irritation or hypera?mia
generative organs. Among anaphrodisiacs arc iiirhided potassium, s
or ammonium bromide; potassium iodide: krge doses of camp!
opium : tobncco, gelsemium, etc. Whatever depresses general systemi*
has likewise an indirect anaphrodisiae effect.
Mydriatics produce dilatation of the pupil by stimulation of th
organs of the sympathetic, with contraction of the radiating fibres
iris as a n-sult. and by pfiralysis nf the third nerve, causing relaxation
circular filtres. The principal n^ydriatics are: atropine, eocainC; ho:
pine, daturine, duboisinc. and hyoscyaraine.
Myotics cause the pupil to contract by stiraiilating the circular
of the iris. Eserine, or physostigmine, thus acts when locally applied,
used by ophthalmologists for this purpose. Other drugs which contri
pupil, though not administered for that purpose, are opium, pilocarpn
muscarine.
Antiseptics net upon pathogenetic micro-organisms, prevent
growth and multiplication, and thus protect the system against irtft
Tlie most valuable nntiseptics are: raerouric chloride and iodide, ci
acid, creosote, salicylic acid, chlorine, naphthol, quinine, thymol, snlpl
acid, iodine, iodoform, resorcin, etc.
Disinfectants are used for the purpose of destro^nng the organic
of disease, as they may exist in the atmosphere, clothing, water, pathol
discharges, etc. Substances whicli accomplish this purpose are: Fort
hyde, sulphurous-acid gas, chlorine, bromine, zinc chloride, mercuridl
ride, etc. A high degree of heat is also disinfectant.
GBNEEAL THBEAPEUTICS AND CLASS IFICATIOX OF REMEDIES. 83
BoH^. — ^By the dosage of a remedy is meant the definite quantity of
the agent required to produce a desired therapeutical result. Naturally a
considerable margin exists, owing to different degrees of vigor in patients,
and to the amount of impression we desire to make upon the bodily func-
tions. It is evident, then, that, even among patients of the same age, some
will require larger doses than others in order to produce a particular effect.
Thus arises the distinction between the minimum and maximum doses, the
former being the smallest dose capable of physiological or therapeutical
effect, the latter being the largest dose which it is considered safe to give.
The toxic dose rapidly develops the physiological action of the drug in a high
degree, giving rise to the characteristic symptoms of poisonous action of the
remedy. Broken or fractional doses are merely doses much smaller than
those usually given, and intended to develop the physiological effects by
degrees, being the reverse of toxic doses in the sense that they singly pro-
duce no marked disturbance, and are within perfectly safe limits. In the
following pages reference may be found to a full or single dose, the inter-
rapted dose, and the continued dose. The full dose is the maximum amount
which the patient will require to produce the physiological action of the
remedy, and it is usually not intended to be repeated. For instance, an
ounce of magnesium sulphate, or several cathartic pills, may be ordered to
accomplish a certain therapeutical result, and, this being obtained, there is no
need to give any more. Where the symptoms tend to recur, as where purga-
tive remedies are required in chronic constipation, or amyl nitrite for angina
pectoris, it becomes necessary to repeat the administration of the remedy
from time to time, the system having opportunity to recover fully from the
effects of one dose before another is administered. The intermpted dose
\s generally smaller than the full dose, although exceptionally it occurs that
by the frequent repetition of a remedy the system becomes accustomed to
it, and larger doses are required to produce the same effect. The continued
doie is where each succeeding dose is given before the effects of the
preceding have passed away, so that when the intervals are short a cumu-
lative action of the remedy is seen. The latter obviously depends upon
the rate of elimination of the agent ; some drugs, like alcohol or ether, are
excreted very quickly, and exert a cumulative action only when the intervals
are very short; others, like arsenic, mercury, and digitalis, are excreted
slowly, and may show a cumulative effect after awhile, even when only one
or two doses are given daily. The alternating administration of drugs by
rotation, as a practical principle of treatment, is designed to overcome the
tendency to toleration of drugs by the system. Rotation has been advocated
bj Ewart* on these grounds: 1. Some drugs — and these are chiefly the
mmnlants and the sedatives — ^lose more and more of their effect the longer
they are continued. 2. Other drugs, being slowly eliminated or distinctly
(Emulative, acquire through prolonged administration an increased activity,
uid in some instances a modifled, and sometimes a dangerous, action.
3. The most active dose, in the case of any stimulant or sedative, and in that
'if many tonics, is (putting aside summation of doses or of their effects) the
f-ret dose. These considerations led Ewart to the adoption of a principle
»hich may be regarded as novel, that of a systematic "rotation of drugs,"
»hiph, not unlike the farmer's "rotation of crops," rests as well as fertilizes.
^British Medical Journal Oct. 1, 1898, p. 938.
84
PHARMACOLOGY AND GENERAL THERAPErXICS.
Without advocating an excessive poiypliarmacy, it appeare ovidei
patients may ofton be placed with advuntngG under the joint influence
eral dnifjs; l)iit in winie cases they will derivo moyt l>cnefit from
qneiit renewal (thanks to intervening hrenks) of the first impression
had buen prodinvd by eaeli drug. An Jiltematins rotation- — daily, t
or of any other i>eri()d — of tlic (lru<.'s to be administered would work
game di reel ion.
Systemic. Specific, and Analeptic Eemedies. — A systemic remedy
vrhieh is not desi^ied to espoeially atTeet the organs by Avhieh it cnt<
cirenlation, nor those by which it is finally excreted : it is given with
of bringing about some change in the general sidids or fluids of the
80 as to affect nutrition, and, as a rule, does tliis through some effect
the nervous system. Remedies designed to affeet special organs, 6t
the liver, kidneys, heart, genitorurinary tract, or alimentary canal, an
or organic remedies. Remedies are also divided into inorganic and oi
in relation to their nature and origin, as they belong to the mineral kil
or to the animal or vegetable kingdom. A specific remedy is one Imvii
p<iwer to stop tlu^ course of a particular disease and act as an antidote
effects. Tlicre are no ''sure cures'' in nsedicine. ami no true spcvifics.
the manifestations of malaria are so uniformlv contridled by cinchona,
ilis by mercurv, rheumatism by salicylic ncid, and gout by colchicum
these remedies are considered as approaching the cliaraeter of sp€
although they sometimcB fail, and often must be couibined with other
dies in order to produce tlie best results. Analeptic remedies are
whicli build up the system: they are tonics and restoratives; tliey 8tin
the. nutritive functions, and sorue of them, such as codliver-oil, act as
A rrmedy is sumetinies said, technically, to he ^'indicated" whe
symptoms sli^w that tlie function of some part of the l»ody is disord
and our knowledge of the physiologicul action and clinical effects t
remedy indicates to us the j>rohability tliat its administration would pr
a favorable result; thus, an emetic would be indicated in narcotic poia
or in croup, a purgative would ho indicated in f?ecnl impaction of the b
or in cerebral congestion ; the sponge-hnth and antipyretics are indicai
fever. It is not meant that tliere is any mvsterions relation existing he'
certain diseases and particulsir remedies in the sense that nature is c
out for a certain drug, and that no utluT would he scrviceidile, or tlia
patient would necessarily <Iic if the medical att(mdnnt failed to discer
indication or to decipher the cabalistic inseri[>tion bv which nature tea
skill.
Diseases arise from ennaea ; the object of treatment is (1) to re
the cause of disorder, if possible, and if not (2) to obviate its effects fc
moval of tlio patient to more sanatory surroundings, or placing him i
improved physical condition, and better able to resist the further pro
of the disea.se: {'A) to make the pnlicTit comfortable: (4) to avert any
tendency which may arise: rtnd (Ti) to do everything jjossible to haste;
recovery. This is rationni medicine: it is also seientitic medicine be<
based upon exact knowledge of the effects of drugs and other remedial ap
From various sources an immense* fund of information has been colli
and classified. The application of this knowledge to individual cases of
ease constitjites the art of medicine, or practical tberapeutics.
PART n.
PHABMACEUnCAL THEEAPEUTIC AOEKTS, OB BBTTGS.
In this section will be considered, systematically and in alphabetical
order, the remedial agents or drugs in present use in the treatment of dis-
ease. All of the drugs and preparations made o£&cial by the United States
and British Pharmacopceias receive notice and consideration in proportion to
their importance. Some of the most valuable of the new remedies which
are coming largely into use by the profession have also been introduced,
these being distinguished from the omcial agents by the absence after them
of the letters U. S. P. or B. P.
Each drug will be considered individually and from three different
points of view: (1) the botanical or chemical definition and physical char-
acters of the remedy, with the strength and dosage of its various prepara-
tions; (2) its physiological actions, including toxicology and antidotes, with
special effects, if any, upon individual organs and tissues; and (3) the thera-
peutical indications, with illxistrative formulae, comments, and suggestions
as to eligible forms of administration, or cautions concerning its use. This
arrangement is the one which has been found by experience to be the most
convenient to facilitate reference and study.
ABBXJS. — Jequirity, Wild Licorice, or Abrus precatorius (Leguminosffi) ,
Pharmacology and Toxicology. — Abrus is a native of India, but grows
f^I^ewhere in the tropics. The part used in medicine is the seed, or bean.
These are small, nearly round, of a bright-red color, with a black spot at the
hilum. The poisonous constituents are a globulin, and an albumose, the
action of which closely resembles that of toxins of bacterial origin. These
bodies, of similar chemical composition, are both extremely toxic, and their
systemic effects have been likened to those produced by the venom of the
snake. The temperature is lowered and the blood remains fluid after death
(Martin and Wolfenden). The seeds do not contain an alkaloid. The
root contains glycyrrhizin (15 per cent.) and an acrid resin (8 per cent.).
The leaves contain 10 per cent, of glycyrrhizin.
Therapy. — The infusion is made by triturating three seeds in a mortar
with an ounce of cold water, to which is added an ounce of hot water.
When cold, the solution is filtered; the resulting filtrate, containing the
globulin and albumose, if introduced into the eye, is highly irritating,
and sets up a purulent inflammation. It has accordingly been success-
fully used in ophthalmological practice in the treatment of granular lids,
or trachoma. It is applied three times the first day and repeated on the
wrond and third days, if necessary. This powerful application should
be made with care, since Dr. T. E. Murrell describes three cases of strict-
ure of the nasal duct that had resulted from its careless use or too frequent
application. Hypodermic injections produce local gangrene.
The cases in which jequirity is apt to prove most serviceable are the
later stages of trachoma or the fibrous state of the conjunctiva following
trachoma. Good results also follow its cautious use in vascular keratitis
produced by a burn. The powdered drug may be applied by means of a
(85)
86
PHARMACEDTICAL THERAPEUTIC AGENTS OR DHUGS.
camers-hair brush to the everted lid, a very small quantity being u
first, in order to avoid an excessive reaction. Jequirity has been en
in chronic buppurative otitis, and also in chronic metritis. So
should be recently made, as they rapidly undergo decomposition.
Abrus is not used internally. Injection of the infusion in
circulatinn nf tlie Imver aiiiuials causes death by cardiac depressior
consists of the leaves ai
4
ABSINTHIUlil,— European Wormwood:
of Artemisia A1**inihiu!n (Cf^mpositje).
Preparations. — Worniwoud has du oflicial preparations.
Pharmacology. — An herb, bitter and aromatic to the taste, indi,
to Europe, but naturalized in this country, and common along waysid
contains theglucosideAbsinthinand a very bitter resin; the fomierof
is soluble in water, alcoliol, and ether. Wormwood also contains an
volatile oil, more in the dried plant than in the fresh state. The oil c
largely of Thujone, or absintholf with a blue coloring principle. A li
flavored with aromatics, called Absinthe, is used to a large extent as
toxicant in France^ where its pernicious effects have attracted the att
of sanitarians. The constant use of absinthe produces profound dis
of the nervous system, epileptiform convulsions, and renders the sul
physical wreck. These effects are similar to those produced by the v
oil of wormwood upon the lower animals^ in which it acts as a depres
nervous energy, followed by stupor, clonic muscular spasms, and fatal
According to the experiments ol Cadeac and Albin Meunier upon an
the oil of wormwood, in email and large doses, possesses decided anti
properties. The oil is frequently adiiltcratt/d with oil of turpentine.
Toxicology. — Poisonous elTects may be counteracted by cold affu
followed by friction of the skin and sinapisms, with careful administ
of ammonia by inhalation^ or by the mouth, or by injection under the sit
into a vein. Evacuation of the contents of the stomach should be obt
by stimulating emetics; or, if these fail, by the stomach-pump. The
ment of abBinthism calls for hygienic and restorative measures, partici
nerve-tonics, in addition to the usual treatment of alcoholism. The i
absinthe as a stimulant should bo discouraged on account of the gTa\
terioration, moral and physical, which it produces.
Therapy. — Wormwood has been used medicinally in the form c
fusion (4 to S Gm. to 473 c.cm., or m-ij to Oj), b wincglassful beiuj
dose, as a tonic or as an anthelmintic, for children. The infusion is
wise employed as an enema for the destruction of thread-worms.
Hiccough due to flatulent distension may be checked by the adn
tration of a few drops of the volatile oil. The dose of the powdered I
is 1.30 to 3.00 Gm. (or gr. xx-xl), or, of the oil, O.OC to 0.18 c.cm. {or m
It is a domestic remedy for flatulent dyspepsia and weak digestion,
ternally, it has been used as a stimulant application to indolent vi
According to Dr. J, L. Corning, the volatile oil of wormwood is a vali
local aniesthetic, and may be aerviceably applied for the purpose of relic
rlietimatic pains. A wine slightly tinctured with wormwood, know
Vermouth, is sometimes given to increase appetite and hasten convalesce
Absinthin has been employed recently as a bitter tonic in doses of 0.015
(or gr. V4 before meal's. Tlio Gorman Pharmacopoeia recogni
extract and a tincture of absinthium.
ACACIA, 87
ACACIA (TJ. S. P.).— Aoacia (Gum Arabic, Oum Senegal). The dried^
gummy exudation from Acacia Senegal, Willdenow, or from other species
of Abrus (LeguminossB).
ACACIiE 0I7MUI (B. P.). — Gtun Aoacia. A gummy exudation from
the stem and branches of Acacia Senegal and of other species of Acacia.
Preparations.
Synipus Acaciee (U. S. P.)- — Syrup of Acacia (acacia, 100 parts, with sugar, 800,
and distilled water to make 1000 parts). Dose, 2 to 7.5 c.cm. (or f5.s8-ij ).
Pulvis Cretee Compositus (U. S. P.)- — Compound Chalk Powder (prepared chalk,
30; acacia, 20; sugar, 50). For making chalk mixture. Dose, 1.67 to 4 Gm. (or
gr. rt-3j).
Mueilago Acacise (U. S. P., B. P.). — Mucilage of Acacia (U. S. P. contains 34
parts, with lime-water 33, and plain water enough to make 100 parts by weight).
Dose, 2 to 7.5 c.cm. (or fSes-ij).
These are the only official preparations of acacia, and are simply used as vehicles.
The density of the solution of gum arable enables it to be used io suspend insoluble
powders or oils; in the latter case the resulting mixture form^ an emulsion.
Pharmacology. — Gum arabic comes in white, or nearly colorless, trans-
lucent, irregular lumps, which are brittle, odorless, and almost tasteless. Its
solution is valued for its adhesive qualities. Acacia also possesses some nu-
tritive properties, and in the East it is eaten as food. It is soluble in water,
but insoluble in alcohol. It has a faint odor and a mucilaginous, insipid
taste. Acacia consists of a peculiar principle called arabin, or arabio add,
united with calcium, potassium, and magnesium. Arabin is described as an
amorphous, glassy, and transparent substance when dry and of a milk-white
color when moist. The solutions of acacia readily undergo acetous fer-
mentation, unless some antiseptic is added to preserve them. As a rule, they
should be freshly made.
Therapy. — In bowel disorders and fevers, a thin mucilage, flavored with
lemon and sweetened, makes a nourishing, bland drink which relieves thirst.
Irritation in the throat is relieved by ^m-arabic troches. Coryza is relieved
by a snuff of acacia and bismuth subnitrate, to which a little morphine may
be added, as in Fender's snufE: —
B Morphinee sulphatis .^ 32 Gm. or gr. v.
Pulveris acaciffl '. 8 Gm. or 3ij,
Bismuthi subnitratis 23 32 Gm. or 3vj.
M. et ft pulria.
Sig.: A few grains to be snuffed into the nostrils, aa directed.
For sore nipples, a good combination is as follows: —
B Pulveris Bcacifie 15 6 Gm. or 3iv.
Pulveris Bodli boratis 4 Gm. or 3j.
Pulveris camphors 32 Gm. or gr, v.
Pulveris marantee 8 Gm. or Sij.
M. Sig.: Vusi over the surface.
Another serviceable application, in some diseases of the skin, is: —
B Pulveris acacisQ 12
Pulveris rind oleatis 2
Adipis laniB hydrosi 15
Gm. or 3iij,
Gm. or 588.
5 Gm. or Jbb.
M. Sig.: Ointment for sore nipples, intertrigo, or acute dermatitis.
88
PHAUMACEtTTICAL THERAPEUTIC AGENTS OR DBUCIS.
Powdered gum arable may be used to check bleeding from leect
The mucilage acts as a protective to slight bums and excoriations.
The emulsion may likewise be employed as a demulcent vehicle in
chitis, and in irritation of the genito-urinary passages.
Gum arable is chiefly employed for pharmaceutical purposes,
preparation of emulsions, pills, etc.
ACETANILIDUM (U. S. P., B, P.).— Acetanilide, or Phenyl-acefc
Acetanilide {B. P,). Also known bv trade name of Antifebrin.
Dose, O.OG to 0.30 Gm. (or gr. j-V). B. P., 0.0G6 to 0.2 Gm. (or gr.
Preparation.
Puh-is Acotanilidi CompoKitua (U. S. P.). — Compound Aevianilide I
(Acetauilidcs 70; caffeine, 10; and sodium biourbonnt^, 20 jmrts.) Dose, 0.10
Urn. (or gr. ij-x).
Fbarmacology. — Acetanilide is an acetal derivwtive of auiliue. ]
white powder, of neutral reaction, slightly pungent, without odor, sL
soluble in water and freely soluble in ether and in alcoholic solutions,
not chanced by acids or alkaliep.
Physiological Action. — In ordinary dose, the action of acetauill
mnch less marked upon a person m health than when fever is prese
its most evident action is to reduce temperature, possibly by conv*
oxyfaEPmoglobin into inetha'iiinglobin in the red blond-ooqnt^c*le and "
fering with oxidation. Tlie efTect does not depend upon swoating-, sij
occurs wlien no per5]iiration is produced. Acetanilide, which at firs
introduced as nn an ti pyretic, h;is been fouiul to fn>?;sess renuirkiihlo
gesic power. It is the chief constituent of popular headache rerai
to take the place of which the eniiipound acetanilide powder was*!
duced into the pharmaeopann. When a toxic quantity has been ahs
the patient becomes prostrated, the lips and finger-nails are dark eo]
the pulse rapid and compressible, and the skin pale and moist; the
linity of the blood is lessened, many red corpuscles destroyed, hiemog
is liberated and eventually appears in the urine, which becomes dark b
in color. Tlie quantity of unc acid and urea in the urine is incre
Peptonuria may be produced. The drug is eliminated by the kid:
Large doses cause diastolic arrest of the heart, preceded by tremors,
YulsionE, depressed temperature, coma, and motor and sensory paralyeifl,
smaller doses, the action of the skin and kidneys is increased; the b;
pressure is at first elevated, but snon falls, and the hearths action deore
In some cases, however, whether owing to ])eculiar susceptibility, or
purity in the drujr. symfilonis of poisoning — cyanosis and collapse —
resnlted even from small doses. Vomiting or profuse sweating have
followed moderate doses of acetanilide. Toxic s}Tnptoms are espec
apt to occur when acototoluld is present as a contamination. Tht
effects of the drug must be couuteraeted by use of external \
vifforoiis alcoholic stinmlatioUj together with the hypodcrnne use
ether, atropine, and stryrhTiine. in ordnr to support the respira
and rirculatinn. Tn patients siTpTerinar with fattv or dilated h«
acetanilide shonld be used with great caution, if at all. Owing
its action upon the blood-cclls, it should not be used repeatedly or in
doses, in the low fevers. Tlie prolonged adni^riistration of acetanilide g
ACETANILIDUM. 89
rise to congestion of the liver, spleen, and kidneys. In animals poisoned
by acetanilide the heart, liver, kidneys, and other organs have heen found
af ecied by fatty degeneration. When used as a dusting-powder, combined
with an equal quantity of starch or zinc stearate, in the treatment of inter-
trigo of infants, it has caused death from absorption of the drug, in several
cases (Journal of ih^ American Medical Association, Feb. 1, 1896, p. 239).
Ilierapy. — Acetanilide possesses antiseptic properties and may be ad-
TEQtageously used as a local remedy. It is an efficacious local application
to chwicroids and ulcerated chancres, used as a dusting-powder. In the form
of an ointment containing 1.30 Gm. (or gr. xx) to 31 Gm. (or gj) it is of
service in obstinate and irritable ulcers, erysipelas, eczema, herpes, urticaria,
and other diseases associated with considerable irritation. Combined with a
mercurial it exercises a beneficial influence upon the lesions of psoriasis. A
gargle, containing 0.25 Gm. (or gr. iv) of acetanilide to 30 c.cm. (or fgj) of
water, may be beneficially employed in pharyngitis. Finely-powdered ace-
tanilide and boric acid constitute an excellent dressing to bums, scalds, and
small lacerated wounds. In many cases it has been found to prevent the
production of pus. It has a beneficial influence upon ulcers and has been
applied with success to mucous patches.
Given in fever (0.20 Gm., or gr. iij, or less) every hour, it usually is
followed by prompt reduction of the temperature to the normal. It is also
antispasmodic, and has been used in small doses in epilepsy, asthma, and
whooping-cough. In whooping-cough it is given in the dose of 0.03 to 0.32
Gm, (or gr. ss-v), according to the age and condition of the child. Improve-
ment has taken place in chorea, also, in consequence of its administration.
For the relief of pain it has been employed in nervous affections, and relieves
attacks of facial neuralgia, locomotor ataxia, sciatica, etc., in doses of 0.06
to 0.30 Gm. (or gr. i-v). In migraine, or neuralgic headache, it is also an
efficient remedy. Acetanilide is highly esteemed in the treatment of dsy-
menorrhoea, especially of yoxmg girls. In doses of 0.20 to 0.32 Gm. (or gr.
iii-v) thrice daily it is of value in relieving seasickness. Acetanilide may be
used with lupulin for the affections just named: —
9 Acetanilid.,
Lapulini aa 6{50 Gm. or gr. c.
M. et ft. eftpsuIsB no. xx.
Sig.: One or two capaulea every two or three hours.
It may be employed with camphor, as —
IJ CamphoTsa 3126 Gm, or gr. 1.
Acetanilid 6|60 Gm. or gr. c.
Olei tbeobromatis, q.s.
K. et ft snppositoria no. z.
Sig. : Insert one into the bowel every two or three hours, for the relief of neu-
nlgia.
In tratunatic tetanus, doses of 0.25 to 0.38 Gm. (or gr. iv-vj) of ace-
tanilide every third or fourth hour, in conjunction with hypodermic injec-
tions of carbolic acid, have been used with success.
A combination of value in the treatment of neuralgia, headaches, mus-
cular and acute articular rheumatism, dysmenorrhcea, influenza, and various
febrile affections is thus given by Dr. W. Blair Stewart: —
90
PHARMAOEUTICAL THBRAPEUTIO AGENTS OH DRUGS.
^ Acetanilid.,
Quininte bisulplmt aa [DOS Gm. or gr. J.
CocflinJE hy*irochloridi |(M)4 Gra. or gr. Vh
The ingredients are compressed into the form of a tablet triturff
one tablot can he administered every three or four lumr'i. according
effect and the nature of the case.
Acetiinilidc is said to be of vnhie in the treatment of olistuiatt^ vol
especially when due to nervous distiirbance or extreme irritability
stomach. It has also been employed with success in order to relie
vomiting which follows surgical operations or the use of an aniestheti
Dr. llollopeter recommends, in simple fevers of children, the foL
combination: —
R Aoetanilid 1
Hydrarg. clilor. mitis
Sodii bicArb
Sacch. lact 1
M, et ft. chart, no. xij.
Sig.: One every two nours until three are taken.
20 Gm. or gr. t
065 Gm. or gr. j.
76 Gm. or gr. i
Gm. or gr. i
ACETOKUM (U. S. P. ) .— Pyroacetic Spirit, or Ether (C^n.O o
COCII,).
Dose, 1 to 1.3 com. (or mxv-xx). dissolved in spirit of nitrous et
Acetone is a liquid containing not les^s than \^9 per cent, by i
of absolute acetone (dimcthylketone). It should bo kept in well-
vessels in a cool place, rf>mote from lights or ftro.
TheiEpy. — P>Toacetic spirit has a peiufiar ethereal, faintly min
odor, and a punj^i^nt, sweetish taste. It has been used as an antip;
or febrifutTP, und jis a sedative for cough, espeeifilly in puliiiouiiry
culosis. It has nlso been used to relieve flatulence and pain in colic, a
ing diarrhaM or dysentery. It checks vomiting. Wlieu iuludi'd. it ha8
ana?sthetic olTecL but caiipos bronchial irritation. It is n miUl hypnoti
analgesic, and has l»cen used in rheumatism and gout. Acetone is i
Btiluent of the urine in diabetes, and occasionally in that of healthy
viduals whih; nn a pr"tr*id diet.
ACETPHENETIDIN (TJ. S. P.).— (See Phenacetine. )
ACIDUM ACETICTJM (U. S. P., B. P.).— Acetic Acid, composed
per cent., by weisjht. of absolute acetic acid, U. S. P.; 33 parts of hyd:
acetate, Pi. P.
ACIDTJM ACETICUM GIACIALE (U. S. P., B. P.).— Glacial i
Acid, nearly or ipiito absolute acetic acid (contains 99 per cent, of C,T1
Preparalions.
Acidum AcetKuin Dilntum (U. S. P., B. P.). — Diluted Acetic Acid contains
cent., by weight, of ul>solute acetii' acid, U.S. P.; 4.27 parta of hydro^'en a(
B.P. The Omiiin dilute acotic acid in 30 per cent.
UnimoiituDi Tprebintliiiire Aootioum (U, P.). — Liniment of Tiirpt'ntirii? and .
Acid (composed of oil of turpentine, glacial acetic acid, and liniment of cam]
Dilute acetic acid i:^ the \msn of the Afvtn, or olticial vinegatB, exoopt A<
Cantharidis (B. P.), which contains glacial acetic acid.
Pharmacology and Toxicology. — Acetic acid is a clear, colorless :
having a strong vinegar-like odor, with acid taste and reaction. It mixes
ACIDUM ACETICUM. 91
vater or alcohol in all proportions. Glacial^ or absolute, acetic acid is a
czystalline solid at 59** F.; it attracts moisture from the atmosphere^ and
should therefore be kept in well-stoppered bottles. Acetic acid in tho
strongest form acts as an escharotic to tiie tissues; and, if taken internally,
is a violent corrosive poison, causing vomiting of sour-smelling liquid, also
intense pain, followed by convulsions and fatal coma. If the case is pro-
longed, gastro-enteritis is produced by the acid. It has some antiseptic
quaJjties, and, if swallowed, slightly increases the acidity of the urine.
Aeetiun, or vinegar, which contains from 6.3 to 7 per cent, of acetic acid,
is not official in either the United States Pharmacopoeia, or British Phar-
macopceia, as dilute acetic acid takes ite place. The use of a 60-per-cent.
acetic acid is recommended by good authority as a menstruum for extracting
the active principles of drugs, with which it seems, in many instances, to
form soluble compounds.
PyroligneouB acid, or crude acetic acid, a dark-brown fluid having a
anoky odor, obtained from the destructive distillation of wood, may be used
with advantage as a disinfectant. Glacial acetic acid is partially eliminated
by the intestinal canal, but chiefly by the kidneys. In cases of poisoning,
milk or flour and water should be freely given, and vomiting encouraged.
Weak alkaline solutions should be administered as chemical antidotes.
Therapy. — Glacial acid is used successfully as an application to lupus,
epithelioma, ulcers, papillomata (or warts), and nasal hypertrophies, and
also as an application to ringworm and other forms of tinea. A mixture of
30 parts of acetic acid and 2 parts of salicylic acid is esteemed an efficacious
appUcation to venereal warts. Vinegar (not official), or dilute acetic acid,
has been given internally to check night-sweats and to relieve diarrhoea.
After constipation has been overcome vinegar has been employed with good
effect in the treatment of lead colic. Vinegar is a convenient antidote for
poisoning by caustic alkalies. It is also used externally for the relief of
headache, and the entire surface of the body may be sponged several times
a day with vinegar and water to reduce high temperature and acid sweating.
It will also prevent the formation of bed-sores. The vapor of vinegar dif-
fused through the sick-room is, according to Dr. S. J. Bumstead, of Decatur,
m., beneficial in cases of catarrhal, membranous, and diphtheritic croup.
Engelmann claims that the direct application of vinegar answers a good
purpose in diphtheria. Warholm recommends the use of vinegar for the
pnrpose of relieving or preventing nausea, vomiting, and headache following
the inhalation of chloroform. A compress saturated with the liquid is placed
oTer the nose and kept in that position until consciousness has returned.
The following liniment is useful in chronic rheumatism of the joints.
It is Stokes's or St. John Long's liniment, the Linimentum Terebinthinae
Aceticum of the National Formulary: —
B 01. terebinth 100| c.cm. or f Jiiiss.
Omm recent,,
01 Hmoni« 4] c.cm. or f3j.
Acid, acetic 20 c.cm. or f3v.
Aqiue ro8» 851 c.cm. or fjiiss.
K et ft. linimentum.
Properly diluted, acetic acid is sometimes able to mitigate the intense
praritus of urticaria. It is capable also of checking moderate bleeding, as
from leech-bites, superficial wounds, and epistaxis. In post-partum hffina-
onbage, weakened acetic acid, or vinegar and water, expressed from a mop
92
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
or sponge into the cavity of the womb, will cause that organ to contn
prevent the loss of more blood. Acetic acid may be of serrice in b]
from the stomach. Dr. E. Maguire reports good results in acute gon*
from the use of injections, consisting of 1 part acetic acid to 4 of
ACIDUM AKSENIOSUM (B. P.).— Arsenious Anhydride.
Dose, 0.001 to 0.004 Gm. (or gr. V.o-Vis)-
ARSENI TRIOXIDUM (U, S. P.).— White Arsenic (As.O^).
ACIDUM ARSENOSVM (V. S. P., 1S!K)).
Dose, 0.002 to 0.005 Gm. (orgr. V,o-7,j).
U, S, P, Preparations,
Ar8«ni lodidum, — Arsenic Iodide. Do9e» 0.0027 to 0.008 Gra. (or gr. V**"
Sodxl Arsenas. — Sodium Arsenate. Dose, 0.0027 to 0.005 Gm. (or gr. Vn
Sodii Arseiiua Kxsicciilii^^. — Dried Arstnato of Smliimi. Dohp, two-thirds
cediiijLj.
hiqtior Afidi Arsenoai. — Solution of Arsenous Acid ( 1 per cent.). Doae,
0.60 c.cm. (or mi-x).
Liquor Pntasnii ArseiiiliK. — Solution of Potnssium Arsenite (equal to
I'pnt. of nrsenit' trinxi<lp.), Fovvjcr'n HoIutJon. Dow, 0.06 to 0.60 com. (or w
Liquor Sodii ArrtL-nfttiy. — Solution of Sodium Arsenftto (I per cent, a
arscuuteof sodium l. Dose. O.Utt to O.tIO v.vni. (or irii*x).
Ijquor Arseni ct Uydrargyri lodidi. — Solution of Arsenic and Mercuric
(1 per cent, each of arsenic iodide and red mercuric iodide). Donovan's Sc
Dose, 0.00 to 0.00 c.cm. (or wri-x).
B, P. Preparations.
Ferri Arsenas. — Iron Arsenate. Dobo, 0.004 to 0.015 (or gr, '/«-'/«).
Arsenii lodidum. — Arsenioua Iodide. Dose, 0,003 to 0.013 Gm. (or gr. '
Sodii Ansenas.— Dos*, O.UOHi to 0.006 Gm. (or gr. V*.>-Vw).
Liquor Arsenicalis. — Araenical Solution, Fowler's Solution (1 per cent.).
0.06 to 0.60 c.cm. (or mi-viij).
Liquor Sodii Arseuatia. — Solution of Sodium Arsenate (1 per cent.). Doi
to 0..50 c.cm. (or wi-viij).
Liquor Araenii et Hydrargyri lodidi. — Solutton of Ar&enioua and Mi
Iodides. (Same strength and dose as L'. S. I', preparation.)
Liquor Arsenici HydrochloricuB. — Hydrochloric Solution of Arsenic (100
contain 1 Gm. of areenioue auhydride). Dose, 0.12 to 0.50 ccm. (or mii-viij).
Pharmacology. — A white, nlniost tasteless, henvv jKiwder, conte
not less tlmii 9r».S per cent, of pure flraonic trioxide. It is soluble in ^0
of cold water or ir> of boilinjr water; nlso in glycerin mid in bydrocli
acid solution. When thrown upon burning charcoal it volatilizes, tlu
lick}- fiunes Uein^^ very poisonous. It is nM^o^ized by Marsh's test: h
peneration of bydroi^en in tlie presence of a solution contaiuin*: ar
arsenuretcd hydrogen is produced, which leaves a dark ring on a eold
held in its flnnu' : this i\ho i(H extremely poijionous if inlmled. Reinsch*
eonsiets in addinj: a few drops of hydroclilorie acid to the suspected roU
and inimersino: in it a polished plfite of copper; the solution bein^^ h<
mctnllic arsenic is deposited upon the copper. Arfsenie po8soi>8es antis
qualities, an<l ]*res«*rves bodies from decay: when death occurs froi
effix'ts, it, therefftre, remains for a long time in the stomach, liver, and,i
"Annual of the Universal Medical Sciences," 1890, vol
ACIDUM ARSEKOSUM. 93
organs. Owing to its tastelesfiness and want of color, arsenous acid is fre-
quently given with homicidal intent, but it is the most easily recognized
by its tests of all the mineral poisons. Paris green, or Scheele's green,
is an impure copper arsenite, used for killing potato-bugs, and as a pig-
ment'in wall-papers, and is a frequent cause of poisoning.
Clemens'! solution of anenio bromide is made by boiling powdered
arsenous acid and potassium carbonate (of each, 4.74 Gm., or gr. Izziij) in
distilled water (60 c.cm., or fjij), and the resulting solution cooled. Add
295 c.cm. (or f^x) of water, then bromine, 7.7 Gm. (or gr. 117), and after-
ward enough water to make 473 c.cm. (or Oj). The fluid is kept four
weeks, being frequently shaken during the first week, or until it forms a
permanently-clear solution. The dose is 0.06 to 0.30 c.cm. (or mi-v) daily,
freely diluted and given after meals.
Gftcodyle, or kakodylio acid (see Acidnm Caoodylicum), is a white
mstalline powder, soluble in water.
Fhynological Action. — To the surface of the skin, if moistened, arsenic
acts as an irritant, and produces inflammation and sloughing. Arsenic is
readily absorbed, and is supposed to enter into combination with the red
blood-corpuscles. It diminishes the elimination of carbonic acid and prob-
ably of urea.
Taken in small doses, arsenic exerts a tonic effect upon the nervous
system, stimulates the circulation, and permits an increased amount of ex-
ercise to be taken without fatigue or short breathing. Large doses depress
the action of the heart and diminish blood-pressure. The respiratory cen-
tre is stimulated by small and depressed by large quantities. Medicinal doses
decrease, and excessive amounts increase, the metamorphosis of nitrogenous
tissue. When administered for a long time, the system becomes habituated
to its use and much larger doses may, in some cases, be taken without seri-
ous consequences. The arsenic-eaters of Styria can take 0.50 to 0.65 Gm. (or
gr. viii-x) at a dose. It is said that but few can tolerate such large doses.
Mid they are careful not to drink water afterward; so that absorption prob-
ably goes on very slowly, at the same time that it is eliminated rapidly by
the kidneys. It is possible that the tolerance may be partly explained by
heredity, as imitators of the arsenic-eaters, sooner or later, experience the
toiic effects of the drug. Inflammation of the stomach is one of the results of
poisoning by arsenic, even when introduced per enema or absorbed through
the general surface. The urine becomes scanty, albuminous, or bloody.
The skin is affected by arsenic; superficial oedema, especially of the face,
appears, and may be followed by eczema, urticaria, herpes zoster, bronzing
in patches, or exfoliation of the epidermis. The hair and nails may fall and
conjunctivitis may occur. If the remedy is not discontinued at this time
the puffiness of the eyelids and face may increase until a general anasarca
is the result. Cases of idiosyncrasy have occasionally been observed in
vhich the prolonged administration of arsenic in medicinal doses has given
rise to urethritis, which gradually abated when the use of the drug was
abandoned. The digestive organs are stimulated by small doses, but large
ones cause gastro-enteritis, with burning pain in the epigastric region, vom-
iting, purging, and collapse resembling Asiatic cholera. In fact, when symp-
toms of this kind appear in the absence of an epidemic of cholera, they
are very likely caused by arsenical poisoning, and should always excite sus-
picion of the administration of arsenic. Arsenical poisoning is occasionally
94
PHARilACEUTICAL XnERAPEUTIC AGENTS OR DBUGS.
accompanied by paralysis of one or more extremities. According to t
servation of Dr. Thomas Buzzard, the continued use of arsenic will
sionally give rise to multiple neuritis. Arsenic is eliminated from tl
tern by the kidneys, and can be readily detected in the urine, when re
ingested. Knecht and Deardon* have shuwn that m sinall part arsei
capes from the system through the hair. Their method employed "W
only one of detection, but also estimation, and obtained as high a prop
of arsenic as 1 to 10,000. There is also at the present time abundaj
denee to show that the fate of arsenic in the body is partly in the hai
this fact cannot but be of the utmost importance in medicine, esp
in toxicology.
The neuritis and paralysis so often observed in alcoholics may at
be due, not to alcohol, but to a contamination of arsenic in the c
beverages. The attention of the profession has recently been called t
important subject by Dr. E. S. Reynolds, of Manchester, England, wl
nounced at the meeting of the Manchester Medical Society on Novemb
1900, that the epidemic of multiple neuritis then existing in that cit
caused by arsenic in the beer drunk by those so affected; he found thi
arsenical contamination was due to the use of sulphuric acid employed i
preparation of glucose being made from arsenic pyrites, the acid bein(
taminated witli arsenous acid to the extent, in some instances, of 1.
cent, of its weight, the arsenized glucose carrying with it as high ai
Gm. (or gr. ij) of arsenous oxide to the gallon of beer. This depl<
occurrence, it is hoped, will serve as a warning to brewers of the danj
substituting cheap and impure products for the proper ingredients,
general appearance of the patients was described- as frequently, liut ■
means always, that of persons suffering with alcoholism. Usually th
tients walked with difliculty, in an ataxic manner; pigmentation o
skin in various parts of the body was observed in almost every case, c
of exposed parts and of the axillne, the groins, the areola; of the breasts
the region surrounding the umbilicus. In many cases there was hi
erythema, or an eruption of pnpules; cramps and pains resembling
gurant pains of tabes dorsalis were common; and the soles of the feet
exceedingly tender, so that walking, besides being ataxic, was exquii
painful. Other symptoms noted were tremors, exaggerated reflexes, *
nution or absence of knee-jerk, and a condition resembling en'thromeU
nausea and vomiting were often complained of, but in many cases then
no vomiting. The exact number of cases poisoned in Manchester alo
not definitely known, though ut one time more than three hundred case*
been under observation.
The vagina also has been used as a route for the introduction of an
into the system, and a number of eases have been reported in which it
thus administered criminally, either in solution or in crystals. In the
century a peasant in Hungary, as reported by Mangar, poisoned three v
by introdufing iirscriir into the vagina after coitus. JliUirrda^ n»]>orts a
of a young woman who apparently had committed suicide in this way
the autopsy there was found acute inflammation of the surrounding or
and a paper package containing arsenic crystals was found in the vag
* Lancet, March 2.3. IftOl.
*yew York SMicfil Jourvfil, December 15. 1000.
* rtntralhlatt fiir Gj/nakologie, No. 50, 1806.
ACIDUM ABSBN08UM. 95
vault, imbedded in thiek fibiinouB exudations. The patient died with symp-
toms of peritonitis.
In exceptional cases of poisoning by arsenic the gastro-intestinal symp-
tonu are not prominent, but profound collapse or stupor may be the chief
manifestation and herald a speedy death. After recovery from the imme-
diate effects of overdoses of arsenic various disorders, especially of the
afimentary canal and nervous system, may occur as a result. Myelitis,
peripheral neuritis, motor paralysis, hypersesthesia, or anaesthesia are among
the after-effects of this drug. A case fell imder the observation of Dr. Boget
in which epilepsy occurred as one of the secondary effects of the poison.
Chronic arsenical poisoning is not uncommon among workmen on account
of the extensive employment of this substance in the arts. A summary of
the most typical manifestations of this form of toxaemia is thus given by the
late Professor Taylor: "Dryness and irritation of the throat, irritation of the
rnucons membranes of the eyes and nostrils, dry cough, languor, headache,
loaa of appetite, nausea, colicky pains, numbness, cramps, irritability of the
bowels attended with mucous msoharges, great prostration of strength, a
fererish condition, and wasting of the body."
In workmen employed in making arsenical dyes local affections are
produced by constantly handling the substance. Among these effects are
nlo^s about the roots of the nails, papular and eczematous eruptions, and
eryBipelas. To these local difficulties the constitutional sjrmptoms of chronic
intoxication may subsequently be added. Afler death from arsenic, fatty
degeneration of the heart, liver, kidneys, and other organs has been found.
The temperature is depressed by toxic doses. Fly-poison, or cobalt, an im-
pure arsenical oxide, is sometimes swallowed by mistake; so is rat-poison,
made by mixing arsenic and meal ("rough-on-rats" contains 50 per cent.).
Arsenic is excreted from the body by the kidneys and intestinal canal. It
also escapes by way of the skin, and it has been found in different secretions,
as the saliva, tears, and milk of nursing women to whom it had been admin-
istered.
As arsenical intoxication is occasionally due to wall-paper, the follow-
ing test is of easy application in suspicious cases: A small piece of the paper
placed in strong ammonia-water will give rise to a bluish color if arsenite of
copper be present. A yellowish deposit upon a crystal of silver nitrate,
moistened with a drop of the fluid, points to the presence of arsenic. Death
has been caused by the ingestion of 0.13 6m. (or gr. ij) of white arsenic. On
the other hand, considerable amounts have been taken without fatal conse-
quences, the immunity being, in all probability, due to prompt emesis and
the form in which the poison was taken. Death from arsenic usually occurs
within horn eighteen hours to three days, but it has taken place in twenty
minutes, while, on the contrary, the patient has lingered imtil the sixteenth
to twentieth day.
Antidotes. — ^The antidotes to arsenous acid are the freshly-precipitated
sesqoioxide of iron, or the official ferri hydroxidum cum magnesii oxido, of
which about 1.30 Om. (or gr. xx) must be given for each grain of arsenic
nrallowed. The solution of dialyzed iron is also a convenient preparation
for this purpose. Calcined magnesia and milk may be freely administered,
and the stomach emptied by the stomach-pump, or by free vomiting.
Oleaginous or mucilaginous drinks are also serviceable. If purging has not
occurred, the bowels should be emptied by magnesium sulphate or Eochelle
96
rUAEMACEUTICAL THERAPEUTIC AGENT'S OH DRUGS.
Ealt. The case siibgequently may require treatinent for resulting
inflammation. Tlie autopsy reveals lesions of the oesophagus and st<
with erosions and ecch^Tnoses, congestion of the lungs, and fatty de^
tion of different organs. The arsenic may be detected not only in tt
tents of the stomach, but also in the urine and in the tissues, especia
liver and great nerve-centres. The antidotes to Fowler's solution e
ferric salts, especially the official solution of ferric acetate, to which
ammonia should be added to neutralize the free acid.
Therapy. — When administered internally, arsenic has oocafii
shown considerable power over morbid growths, and is the only rem<
have at our command that has any effect upon the development of
of the viscera. In epithelial cancer and other superficial growths ar
paste has been employed (cinnabar, 70; dragon's blood, 22; arsenou
8), but, as previously stated, it is a very painful treatment, and ma
be applied to a small area at a time on account of the danger of pro<
toxic effects. The excessive use of an arsenical paste or powder has
death by absorption of the poison.
Dr. Wight regards arsenic bromide as the most efficacious agent 1
venting the dissemination and extension of malignant growth. In sa
he recommends a combination of this preparation with calcium cart
In ague and ohronic malarial disorders, and also as a proplv
against malarial poisoning, arsenic is used very effectually in small do8<
may be combined with quinine and iron: —
B Lin- potassii araenitla |18 to [30 c.cm. or wiii-i
Tr. cinchona comp TpO e.cm. or f3ij,
M. Pro dosi.
9 Sodii arsenatis
Mass, ferri cHrbonatis 1
Quininffi Bulph 1
M. et ft. piU no. xx.
Sig.: One tlirce times a day.
066 Gm. or gr. j.
3 Gxn. or gr. x.
3 Gm. or gr. x
B Araeni sulpbidi 13 Gm. or gr. IJ
Aloini 065 Gm. or gr. j,
Ferri pyrophoephatis 2 60 Gm. or gr. zl
M. et ft. pil. no. xx. I
Big.: One three times a day.
Dr. C. F. Bryan believes that arsenic acts as a prophylactic ap:ain5t
let fever and, perhaps, against diphtheria and influenza. The use of a
in pulmonary tuberculosis is advocated by Dr. Karl Hochhalt, who ;
that in fifty cases the appetite improved, the weight increased, and the
diminished^ wiiile Fnwlcr's solution wns beinp administered, hi neiu
arsenic frequently exercises a very happy effect, especially when given i
form of the solution of sodium arsenate. Larger doses are required for
cases of chorea, but the effect is very marked. According to Dr. Wi
Murray, of Newcastle-on-Tyne, the most effectual method of treating c
is by the administration of large doses of Fowler's solution. He begi
giving 1 or 1.20 c.cm. (or mxv-xx) three times a day, in the middle
meal. He claims that these heroic doses may be given for a few days wi
distnrliing the stomach, and that it cures clioroa witliin a week. A
metiiod is to begin with a small doiie, and increase eacli day until the
mum is reached ; then stop for a few days, and begin again.
60
Gm.
or gr. viij
32
Gm.
or gr, V.
32
Gm.
or gr. V.
ACIDUM ARSEXOSUM. 97
A course of arsenic has a valuable tonic influence in organic heart dis-
ease, and under its use dyspnoea, palpitation, and oedema improve. It also
corrects intennittency of the pulse. This remedy is of service in certain
fomis of chronic albuminuria. Dr. Phillips has employed it with advantage
for many years in albuminuria following scarlatina. Arsenic will not in-
frequently succeed in relieving haemorrhoids.
It may be administered with advantage thus: —
B Liq. sodii arsenatis^
Fluidext. nucia vomieee aa 41 ccm. or fSj.
£Ux. gentians 150] ccm. or f3v.
M. Sig. . One teaspoonful in water after meals. Used in neuralgia and chorea.
Sawyer* higlily extols arsenic in gastralgia, where pain exists when the
stomach is empty and is relieved by taking food. He gives 0.0027 Gm. (or
fr. Vj«), in pill with some vegetable extract, three times daily, half-way
between meals.
A pill highly extolled in the treatment of neuralgia ia: —
B Arseni iodid |065 Gm. or gr. j.
Ext. belladonnce fol,
Morphin. valerianat. aj
Pulv. ext. gentiansD
Pulv. ext. aconiti
M. et ft. piL no. be.
Sig: One to three piUs during the day.
Some spasmodic disorders of respiration, asthma, hay fever, and chronic
catarrhal bronchitis are controlled by arsenic, and, if there is no acute in-
flammation^ it may be used with the atomizer. Arsenic is of service in
catarrhal pneumonia. Cases of periodical sneezing, dependent upon reflex
action, have been cured by the use of this remedy.
In irritative dyspepsia, with morning vomiting and clean, red tongue,
arsenic ia of service; also -in the diarrhoea coming on immediately after
eating. In skin diseases arsenic is valuable in proportion to the absence of
irritation or acute inflammation. In all chronic processes, especially when
accompanied by desquamation or infiltration of the skin, such as psoriasis,
the persistent use of small doses is often curative; also in the dry form of
eczema and impetigo, as well as in pemphigus and lichen. In the vesicular
or bullous eruptions of children small and repeated doses of arsenic are
nffoally followed by speedy improvement. It is contra-indicated in the early
itage of each of these affections except psoriasis. Sawyer^ recommends
arsenous acid for gastralgia given in pill form with gentian or other vege-
table extract.
Prof. 0. Lassar* gives an account of three cases of cancroid in which
the internal use of arsenic was followed by a disappearance of these growths;
in one case sections were made of the growth before treatment, which upon
examination gave the appearance of a beginning epithelioma; the arsenic
vas administered in pills containing 1 milligramme, increasing the dose to
the physiological limit and continuing treatment for several months. In
'Lancet, July 4, 1896.
•Iflficr*, July4, 1896.
'Berliner Klinvtche Wockenschiift, March II, 1001.
98
PHARMACEUTICAL THEEL4PEUTIC AGENTS OR DRUGS.
one patient there had not been a recurrence of the growth at the
eight years.
Dermatitis herpetiformis and recurrent herpes are benefited by ■
minietration of arsenic. It is generally of service also in the treatn
chronic urticaria. The internal administration of arsenic will pr
benefit in chronic scaly affections. The persistent administration o:
doses of arsenic is usually of seryice in the small pustular and papular
of acne, especially in cases dependent upon debility or anaemia.
The following are serviceable formulse in the diseases referred to
li Liq. potAMii araenitia 41 c.cm. or f3j.
Tinot. nueia vomica TJSO c.cm. or f3ij
M. Sig.: From 1£ to 20 drops in water three times a day.
R Sulphurifl aubUmati fllSO Gm. or gr, c
ArMt'iii trioxiiU |O0B Gm. or gr. j
M. et ft. capsulie no. xx.
Sig.; One after n^eaU.
In diabetes mellitus, the solution of arsenic bromide (not official),
in Vichy water after each meal, has produced remarkable results in the
of Clemens, probably owing to its action upon the liver.
Quinquaud has experimentally demonstrated that, in animals fee
arsenic, diabetes cannot be produced by lesion of the bulb. In disc
the liver or kidneys, especially the early stages of cirrhosis, arsenic som<
has a very decided effect. In vomiting and diarrhoea, especially in in;
copper arsenite in infinitesimal doses (0.0005 Gm., or gr. Vi28> ^o wate
c.cm., or foiv, a teaspoonful being given every hour or less) has bee
lowed by good results; but the older method of using Fowler's soluti
the same way is probably better, because less poisonous than the c
arsenite, the effect being largely due to the antiseptic action of the ai
which acts more elTiciently in the soluble form*
The vomiting of pregnancy is often remarkably relieved by the ai
istration of a drop of Fowler's solution immediately before each meaL
same preparation is valuable in chronic gastritis (especially when it hafl
produced by alcohol), in chronic gastric ulcer, and cancer of the stoi
Arsenic is sometimes beneficial in chronic rheumatism. In rheum
artliritis Phillips testifies that under the continued use of this drug h
known the joints to return to their natural size. In angina pectoris A
asserted that arsenic was of decided service in mitigating the severity i
tacks, especially in ansemic patients suffering from overwork and an:
Syphilitic affections are sometimes better treated by the combination of
cury with arsenic than by mercury alone. Donovan's solution is espei
useful in old syphilitic skin lesions.
Dr. H. Smith has reported a case of secondary syphilis, in which ar
produced a rapid improvement, after mercury and iodide of potassiuna
failed. An isolated case of trichinosis was successfully treated by Dr. Mi
by means of Fowler's solution in doses of 0.30 c.cm. (or tnv) thrice (
gradually increased until constitutional effects were produced. Pre^
to its administration the patient was steadily growing worse. Done*
solution in doses of O.fiO c.cm. (or nix) three times a day is said to doj
in gleet- Finally, in chlorosis and auBemia the tonic effects of arsenic
ACIDUIC ARSENOSUM. 99
well be combined with those of quinine and of iron. The usual dose of
aisenous acid is 0.0027 Gm. (or gr. ^/^^, to be cautiously increased. The
best method of administration is in solution. Arsenic iodide has been found
extremely effective by R. St. Philippe in cases of chronic eczema, inflam-
mation of the eyes, intestinal catarrh, and other manifestations of scrofula.
From 0.30 to 1.20 c.cm. (or mv-xx) a day, of a 1-per-cent. solution, in cold
vater, of arsenic iodide were administered, with no local treatment except
sterilized water. Recently he has confirmed this, after an experience of over
3CK) cases.
In a case of leukaemia which Dr. Drew treated by means of an arsenical
solution, in ascending doses until the physiological limit was reached, the
spleen, which had been greatly enlarged, became, in the course of three
months, diminished in size, the proportion of wiute blood-corpuscles was
decreased, and the number of red corpuscles was augmented. When amenor-
rhcea is caused by congestion of the uterus, anaemia, or chlorosis, the admin-
istration of arsenic will usually be followed by a return of the catamenial
flow. Professor Renaut, of Lyons, advocates the administration of arsenic
by the rectum. Three injections may be given daily, of a solution contain-
ing a third of a milligramme (gr. Vi«o) in 5 c.cm. (mlxxv). The treatment
may be continued for months. Should any rectal irritation be caused, the
addition of a few drops of laudanum will obviate it. This treatment is
highly recommended by Renaut in the early stage of tuberculosis; also in
diabetes mellitus, and in exophthalmic goitre.^
Radcliffe was the first to use arsenic hypodermically for the relief of
chorea, in 1866, and since then it has been frequently used in scaly skin
diseases, lymphadenomata, ^nd nervous disorders. This method is also of
advantage in the treatment of obstinate cases of malaria which have resisted
the action of quinine. Very marked hypertrophy of the liver and spleen
due to malaria may be reduced by the injection of Fowler's solution. Dr.
Hq^, of Rouen,' used hypodermic injections of 1 to 1000 solution of arsen-
0116 acid in inoperable cancer. In a case of epithelioma of the cheek he claims
to have effected a complete cure. Planel obtained the same result in a case
of cancer of the breast. This agent has also been used in several cases of
recurrence of cancer; in some the progress of the disease has been distinctly
rt'tarded, in others the treatment had no effect. Hu6 used the following: —
H Arscni trioxidi |20 Gm. or gr. lij,
Cocaine hydrochloridi 1| Qm. or gr. xv
Aqnee destUlatfls 90| ccm. or f^HJ.
Of this, 1.20 to 2.50 c.cm. (or mxx-xl) were injected into the substance
of the tumor, at intervals varying from two to eight days. In the successful
ease of epithelioma above mentioned Hu6 gave daily injections during sev-
eral months.
The ointment of oleate' of arsenic is also a useful application in the
treatment of old ulcers, epithelioma, and lupus. The following combina-
tion will be found of service in the diseases just named: —
' Vouvw^ue RmUde9, April 24, 1898.
•Semaine MMiodU, Nov. 6, 1895.
' See "Ointments and Oleates, especially in Skin Piseases/' by the author. F. A.
DtTif, 1890.
10** rnARMACEUTlCAL TILERAPECTIC AGENTS OR DttL'GS.
I) Morphine sulphatia 113 Gm. or gr. i
Zinci chloridi 32 Gni. or gr, t
Pulvcris tnarftntro 4 Gm. or 3j,
Ungt. arseni oleatia I5|5 Gni. or Jas.
M. Sig.: Apply on old muslin for several hours.
Arsenic iodide (0.25 or 0.32 Gin. to 4 Gm,, or gr, iv or v-5j) i
rneiit is a va!ual)Ic stiiiiiilatinf: isj^plitalioii in old dry eczema.
In warts, Unna advises the application of mercurial ointment c
ing from 5 to 10 per cent, of arsenic. E. Mansel Sympson declares t
internal administration of small doses of arsenic has a curative €ffe<
warts. After a week or two of this treatment the growths hegin to dis
Tlu' cjicodylale of truaiiual is a wiiite salt, wry finhihle in alco!
and glycerin. l)iit in water only r* parts in 1(»0. Tlit* addition nf 1 p
of free gnniiicol inakc^-i tlic watery solution iiioro pcrinanHii, and ai
local ajia?sthetic w[i<>n the sointi<m is us^ed hyiKMlerniieaUy, Introduc
medicine by Dr. Barljary, of Nice, in liJOd, Dr. Burlureaiix* has I
advocated its use in tuberculosis and in la grippe. One or two in;
of 5 centigrammes reduces temiXM-ature, and ameliorates all the syn
ACIDUM BENZOICUM (U.S. P., B. P.).— Benzoic Acid (HC.
An organic acid usually obtained from benzoin by sublimation,
pared artificially, chiefly from toluol. (See Benzoinum.)
ACIDTDI BORICUM (U. S. P., B. P.).— Boric Acid (HaBO.). Fc
Boracic Acid.
Dose, 0.32 to 2 Gm. (or gr. v-xxx). B. P., 0.32 to 1 Gm. (or gr
Preparations.
Ulyi'mtuiii Boroglyooriui {V. S. P.). — Glycerile of Boro|p;lyeerin. Gly
Acidi Boriri (B. I'.). — Solution of Roro^^lyeeride. (Contains 50 per cent, by
of borojilvi-erin.) For extcnml use.
SodU Boras (U. S. P.).— Sodium Borate. Borax. Dose, 0.32 to 2 Gm.
v-xxx).
UnijriK'ntum AM'\ Borid (U. S. P., B. P.).— Bnrie-Arid Oinlnifnt (10 p<
with parulhn ointment).
Borax (B- P.).— Borax, Sodium Biborate. Dose, 0.32 to £ Gm. {or gr. v-
Glycerinum Boracia (B. P.).— Glycerin of Borax (1 to G).
Mel Boracis (B. P.). — Borax Honey (borax, 60; glycerin, 25; clarified
400 Gm.).
Li(|iif)r Antirtepticus (U. S. P.). — Antiseptic Solution (boric auid, iJO Om.;
acid, 1 *Im.; thyinoK 1 Om. ; with oiiealyptUM. 0'2'>; pi'pperinint *iil. 0.50 G
gaulthiria, 0.25 (int.; u\. thyme, 0.10 Gm.; iilcuhol, jriO f.iin.; with ^ullicjeiit V
make KMJO o.cm.). L'rtetl a» a dentifrit-e ami an lui aiitiricptic spray fur the the
no«e. ilay be taken Intprnally in doses of 2 to 8 com. (or fSss-ij).
Pharmacology. — Boric acid is in transparent, colorless, six-sided
soluble in 25 parts of water or 15 parts of alcohol, and in 3 parts of 1
water or 5 of boiling alcohol. The alcoholic solution gives a green
Borax is soluble in 1(J parts of cold water, but not in alcohol. The sol
of boric acid is greatly increased by the addition of borax. When a a
of equal parts of boric acid, borax, and water are heated together a ac
is obtained known as the tetraborate of sodium^ which is apparently
salt, as it is of neutral reaction. Sodium tetraborate is a white, im
'■ liiitlrtin Grit, df Th^rapeutitiur, January 23, 1900.
ACIDrU BOBICI'M.
101
vviiki^ resdily soluble in vrater and free from caustic or toxic properties.
woe add baa a fcebly-acid taste and borax a sweetish, alkaline tnste and
'"'*- —'t-.on. BoVoglycerin ib a comhiuation of boric acid (6'4 j)er
■ riji. An equal quantity (»f glyt-crin added to this makes the
fisu- of boroglyooriu. Lister's antiseptic ointment for dressing
fVQC^li <* l>y addin<r 1 part each of lioric acid and white wax. to 2
pn> each of paraflin and aln)ond-i:)il. Boratetl lint or l)orated colton-wool
iiivmriMfit tHktton) is made by steeping the Fuhstancc in a saturated solution
* xifie acid and allowing it to dry. Boral, a trade preparation, consists
'^mm\ r^ftrt? of boric acid and acetanilide, in (ine powder.
Physiological Action and Therapy. — Boric acid is antiseptic. The pres-
«fr ni II food notably retards the airtion of saliva uikui t^tarch, Afi
^k^n \ iiuents made by C T. Fox, under the direction of Professor
VcbefyOt i.'v*luinbus, Ohio.
Chittenden and Gies* found that moderate doses of boric acid (up to 3
fia^ or gr. xl v, daily) are practically without influence on protcid metabolism
^vpoo general nutrition. The same is true of borax, up to daily doses of
' 'itn. (or gr. Ixxv). Larger doses of borax from 5 to 10 Gm. (or oiVi-iifis)
*k;it, hare a direct stimulating effect upon proteid metabolism, and lead to
aoeased cjccretion of nitrogen; also of sulphuric and phosphoric acids.
Hry retard the assimilation of proteid and fatty foods. With very large
imm there is a tendency to diarrhrea from increased secretion of mucus.
|paz d«CTeaaea the volume of urine, gives it an alkaline reaction, and, owing
t» "fi excretion by this channel, raises the specific gravity. Neither borax
»• acid liaB any inlluence upon the ptitrefaetive process**? of the in-
^^iii%r. They are rapidly eliminated from the body (twenty-four to thirty-
ex boon).
Boric acid is rapidly eliminated in the urine and is said by Max Griiber
the elimination of urea and the quantity of urine passed. Acci-
from its use are rare; but a few cases have been observed in which
bmt acid excited cutaneous eruptions. The eruptions which may be ex-
ited by the internal use of boric acid assume a number of forms. Erythema,
nalaa. blebs, generalized urticaria, and confluent nibeola-like rashes have
Wb obaerred. Disturbances of the nervous system have also been caused.
Tfca •ymptoms have been attributed to non-elimination of the acid by the
bdacya. Suppuration of the ear, or running from the ear, is cured by
dfltDsing the canal and insufflating finely-powdered boric acid. In the
tntiDent of aural suppurations and wounds Dr. Jaenicke, of Gorlitz, rec-
mmoidB sodium tetruborato, which is also considered as a valuable appli-
■n^ in conjunctivitis and keratitis and is said to restrain the formation
rfpM. Dr. J. Darri5 Pierpont suggests that finely-powdered boric acid is
ttmdr meana of dia^osticating small perforations of the memhrana tym-
MtL After the external ear has been cleansed and dried the powder is
Sni into the canal until the membrane is completely coated. Wlien an
^minMiian is made, a few hours subsequently, the perforation, if present,
rSMppemr aa a dark or discolored spot upon a white field, the discharge, in
^MttDr throuja:h the opening, having partially or wholly dissolved the acid.
IWdered boric acid is regarded by McCandliss' as an excellent application
4m4V<£V** Jnumot of Phjjiioloin/, «Un., 1808.
Chirn^ J#r«f{cai MUiittnary Journal, Ugc, 1890.
102
PHARMACEUTICAL THERAPEITIC AGENTS OH DUUUS.
to leg ulcers. It is entirely miirritating when applied to the akin, ai
been used as a dressing for wounds in powder or ointment.
JL B. Wild.* after citing a nniiiher of cases, including some of hi
distinguishes two forms of intoxication from boric acid — one in wl
large quantity of the drug is rapidly absorbed from the alimentary
from a serous or other cavity, or from an extensive raw surface; ia
cases vomiting and diarrha?n, general depression, and partial paralysis
nervous and muscular systems occur, and may cause death. A rash is
in many instances, especially when the patient recovered or lived 8om(
after the absorption of the drug. The other class of cases results fro:
administration of boric acid or borax in comparatively small doses foi
periods, and the symptoms appear at a variable time after the comnC
ment of the drug. In some of thpse cases it is mentioned that the Id
were diseased, and the author gives, as a possible reason for the iram
to the injurious effects of boric acid, its very rapid elimination by h<
kidneys.- FurthcTmore, it is possililo that cast's of intoxieatiou ocrur
frequently than is at present recognized. Boric acid may unwitting
taken in food and cause a toxic skin-eruption which may be mistake
eczema, psoriasis, or exfoliative dermatitis. It may be noted that a 1 ti
solution corresponds to 1.13 Gra. (or gr. xviiss) per pint of the acid, a
large dose for an infant on milk diet and one likely in some cases to
duce disturbance of the alimentary canal. It should also be ascertained
the milk ordered in cases of kidney disease is free from excess of boric
or boras. The use of boric acid or the borates in surgery and their int
administration ought to be carefully guarded in patients with diseased
neys, and immediately discontinued on the appearance of dermatitis or <
toxic symptoms. In suspected cases examination of the urine may a
valuable evidence of the presence of the drug,
A solution of boric acid is an agreeable application in conjunct!
and is very efficient in the treatment of burns, applied upon lint or absor
cotton. The saturated solution is used in various chronic, scaly, and ]
sitic skin eruptions, and is the best remedy for bromidi*osis of the fei
fetid perspiration. Among the beneficial combinations are: —
B Aridi borici 2] Gra. or Sss.
Glycerini,
Ticct. opii aa 15[ c.cm. or fjss.
Aq. camphor 30| ccni. or fly
M. Sig.: Ten drops to be insUHed into the ear for earache. (Dr. Prout)
B Acidi borici,
Btsmuthi subnit aa 12j 6ni. or 3iij.
M. Sig.: For running from the ear and in excesaive and fetid perspiration.
B Acidi borici 81 Gm. or 3ij.
Pulv. zinri carb. imp. 15|6 Gm. or 5m.
IkL Sig. : In acute eczema, and erythema.
B Acidi borici 41 Gm. or 3j.
Aquffi hamamelidia dt^t 12o| c.cm. or f Jiv.
M. Big. : Use in fetid pcrspinition and in an oily state of the skin.
^ La»ort, No. 31»:i2, p. )i:i.
' Merck* ft Arrhirr», Jan., 1899.
ACIDUH BOBICUM. 103
In pharyngitis Dr. Capart prescribes the following combination: —
3 Sodii boratU 4{ Gm. or 3j.
Sodii sftUcylatis 2 Gm. or Sss.
Decoctionift altluen 180| ccm. or fSvj.
M. 8ig.: To be given in divided portions through the day.
Whitla, Keegan, and others haye employed boric acid in typhoid fever
with good results. The temperature was lowered and the diarrhoea checked.
Dr. Tortchinsky^ has used uiis remedy in 240 consecutive cases of typhoid
fever, and reports very favorably of its action. It is stated that the course
of the disease was considerably shortened and that complications were very
rare. The effect of the boric acid was enhanced, in the late stages accom*
panied by cerebral symptoms and in relapses, by a combination with quinine.
The same writer has obtained equally satisfactory results from the use of
boric acid in the summer diarrhoea of children.
Good results have been obtained in erysipelas, even of the phlegmonotis
form, by the application of lotions containing this remedy.
Borax in substance, mixed with white sugar, is applied to aphthous sore
mouth in infants. Aufrecht recommends the internal administration of
borax in the stomatitis of elderly and debilitated persons in whom the dis-
ease extends to the oesophagus and stomach, causing dysphagia and defective
nutrition. A piece of borax of about 0.13 to 0.20 Om. (or gr. ii or iij) placed
in the mouth is said to be useful to speakers and singers by producing saliva-
tion and relieving hoarseness; its solution is a cooling application to super-
ficial inflammations of the skin, and for pityriasis versicolor and seborrhoea
of the scalp, or dandruff.
The late Dujaxdin-Beaumetz used the following as a favorite prescrip-
tion for a dentifrice: —
Gm. or 3viV4.
Gm. or gr. xv.
26 Gm. or gr. iv.
ccm. or Oi*/*-
9 Acid, boriei 25
Phenolis liquefacti 1
Thymol S
AqiMB 828
M. et ftdde:—
Sp. menthse 160 ccm. or mx.
Sp. anisi. 9|25 ccm. or fSiisa.
Coed q. 8. ad colorand.
Sp. Tini rect. 90| com. or fjiij. — ^M.
The above author lays stress upon the importance of attention to the
mouth, in many diseases, but especially in diabetes mellitus, in order to
avoid lesions of the mucoua membrane, gums, and teeth.
A lotion containing borax may be used in order to allay the itching of
urticaria and parsesthesia. Internally, borax, in 1.30 Gm. (or gr. xx) doses,
relieves irritable bladder and reduces the acidity of the urine. It has, in
Bome instances, given encouraging results in epilepsy. The general tend-
ency of borax is to diminish the number of attacks. It will sometimes suc-
ceed in cases which potassium bromide has failed to relieve. A combination
of the two drugs has disappointed expectation. It is recommended to begin
with doses of 0.60 to 1 Gm. (or gr. viiss-xv) and rapidly increase the amount
until the limit of tolerance or a decided effect upgn the disease is produced.
Professor Mairet, of Montpelier, states that when daily doses of 8 Gm. (or
3ij) are insufficient to hold the attacks in check it is to be feared that larger
^British Medical Journalj Jan. 14, 1893.
104
PHARMACEl'TICAL THEnAPHUTIC AGEXTS OU DRrcS.
doses will prove no more successful. When the paroxysms have Le<
strained, he advises the reduction of the amount to about 4 Gm. (or 3
diem. Among the disadvantages of the prolonged administration of
are salivation, impairmert of appetite and digestioii, diarrhoea, emaci
swelling of the face, «dema of the lower extremities, cutaneous rasheSj
junctivitis, fissures of the lips, fall of the hair, and alterations in the
According to Dr. G. Lemoine, a blue line, resemblin','^ that of lea^
Boning, may form upon the gums after the prolonged use of borax.
Gowers has, when administering borax in epilepsy, seen psoriaa)
velop in several instances, and is disposed to attribute the disease of th«
to the influence of the drug. Both psoriasis and eczema have been attril
by other writers to the ingestion of borax. Borax is said to be better 1
when administered in glycerin instead of aqueous solution, or when i
tinal antisepsis is conjoined. Dr. Ch. Fere, after an experience of six
with borax in epilepsy, regards it as distinctly inferior to the bromid
efficacy. The renal trouble excited by prolonged use of the drug doe
always subside on suspension, and one case is mentioned which termii
fatally from uremic coma. When the epileptic attacks are nocturnal, a
tion of the drug should be given during the night. In order to cove
taste of borax M. Gay recommends solution in an infusion of licorice
the addition of a little glycerin; in sweetened milk and strong coffee;
syrup of orange-peel with julep. Syrup of orange is said to be the
vehicle. Professor Lashkevich considers the borate of ammonium of se
in phthisis. It is said to reduce the expectoration and, in some cases
fever, ile combines it with conium, hvoscyamus, or some other seda
Dr. Golding-Bird asserts that borax cannot be employed with impunil
women, as it has a stimulant action upon the uterus, and states that in
instances he has seen it produce abortion. Some have employed bora:
the purpose of exciting uterine contractions in protracted cases of h
It has also been administered in amenorrhoea and dysmenorrhcea.
Dr. Sacaze, of Montpelier, reports an excellent result from the m
borax in a case of paralysis agitans. It was first given in 0.25 Gm. (or gi
doses three times a day. After a few days the dose was gradually incre
to double that quantity. Improvement was rapid.
Several cases of poisoning, some of them fatal, have been repoi
apparently due to the local application of boric acid or its solutions tc
tfrnal cavities: the vagina or stomach. The symptoms were reductioi
temperature, depression of spirits, sickness of the stomach, feeble pulse, t
in some instances, hiccough and ccchjrmoses. The mind usually remai
clear, but coma sometimes occurred.
Solution of boroglyceride (50 per cent.) is a pleasant and efficient aj
cation for conjunctivitis, pharyngitis, and as a dressing for wounds
granulating surfaces, having the important advantage of not being poii
0U8. It is especially recommended for the local treatment of diphtht
Boroglyceride ointment, made by adding to it unguentum aqua? rosie,
pleasant application for sunburn, pruritus, and other skin ailections. Bo
acid ointment (in lanolin or zinc ointment, 1 to S) is used as a dressing
wounds and ulcers. The sdution of boroglyceride is a valuable applical
in chronic eczema of the palms of the hands and the soles of the feet. I
also useful in subacute and chronic eczema of the genital organs, especii
when the scrotum is invaded. It ran he prpscribed with witch-hazel.
ACIDDM CARBOLICUM. 105
The addition of borax is said to increase the laxative effect of glycerin
suppositories.
ACIDTTM CACODYLIGnH. — Cacodylic, or Bimethalarsenic, Acid is a
white crystalline powder, odorless, soluble in M'ater, and containing 54.4 per
cent, of metallic arsenic, which is equivalent to 71.4 per cent, of arsenic
oxide. Cacodylic acid and sodium cacodylate have lately been occupying the
attention of Continental investigators as substitutes for the usual prepara-
tions of arsenic on acco\mt of being less toxic in their effects. The cacody-
lates of potassium, magnesium, lithium, quinine, iron, guaiacol, and mer-
cury have also been introduced.
Dr. DanloSj^ of Paris, France, made a second report of his investigations
with the use of the sodium cacodylate before the Paris Medical Society on
June 16, 1900. He has treated some sixty cases of psoriasis, with good
results, although he has to note a tendency to relapse, the method of ad-
ministration being by hypodermic injections. Internally this author has
used cacodylic acid with good results in lupus erythematosus, and in tuber-
culosis of the skin.
Dr. M. H. Billet,^ attached to the military hospital at Constantine,
Algeria, reports thirteen cases of. malarial cachexia more or less pronounced
that had been treated with cacodylate of sodium. This drug following
immediately upon treatment by quinine, had restored the red blood-cells
from about 3,500,000 per millimetre to normal, in the space of from fifteen
to twenty days. The number of injections was from four to six, at intervals
of three or four days, the dose employed being 0.23 Gm. (or gr. iii V4) for
each injection. The haemoglobin proportion had been raised simultaneously
with the increase of red blood-corpusclos. It has also been noted that the
offoniilve garlic smell of the breath, when given internally, is obviated by
h}'poclcrmic administration.
Dr. William Murrell, of London, reports toxic neuritis and other bad
rt'sults, from doses of 0.6 Gm. (or gr. j) three times a day. He considers
it a dangerous drug.
ACTDTTM CAMPHOEICUM (U. S. P.)— (See Camphora.)
ACIDTrM CABBOUCTJII (B. P.).— CarboUc Acid. PHENOL (U. S.
P.). (C,H,OH).
DofC, 0.03 to 0.13 Gm. (or gr. ss-ij).
A constituent of coal-tar, obtained by fractional distillation, and sub-
sequently purified.
ACIBUM CAKBOUCTJM UaUEFACTUM (B. P.).— Liquefied Car-
bolic Acid.
Contains 10 parts of water to 100 parts, by weight, of phenol.
PHENOL LiaTTEPACTUM (r. S. P.).— Liquefied Phenol.
Contains 90 per cent, phenol, with 10 per cent, water.
PTeparaiions.
Olyceritum Phenolis (U. S. P.). — Glyoerite of Phenol (20 per cent).
Glycerinum Acidi CarboHoi (B.P.).— kilycerin of Carbolic Acid (20 per cent.).
^''Bulletins et If ^moires," vol. xvi, p. 5HS.
*Kew York Medical Journcl, Aug. 25, 1900.
106 PHARMACEUTICAL THEEAPEnTIC AGENTS OH DRUGS.
Sodii PhcnoUulphomia (U. S, P. ),— Sodium phenolsulphonate. Sodii S
carbolas (B. P.). 1X)»(», 0.32 lo 2 Gm. (or gr. v-xxx).
Unguentiim Pliprnlis (U. S. P.). UngiUMitiim Acidi CarboUci (B. P.).— Oil
of Phenol (U. S. P., 5 per cent.). Carbolic Acid Ointuu-nl (B. P., 4 per cent.).
Trochiscus Acidi Carbolici (B. P.).— Phenol Lozenge 10.005 Gm., or gr. j
Tolu basis).
BtippoBitoria Acidi Carbolici (B. P.). — Phenol Suppositories. Elach co
0.0G6 Gm. ^or gr. j) with white bees-wax and cacao-butter,
ZiiH'i Plu'iiolsiilphftims {U. S. P. ), Sulphncarbolat^* (B. P.). — Phenolaulpl
of zinc. Dosf^T O.Ofl to DJJO Gm. (or gr. i-v).
Phamiacolog^y. — -Liquefied phenol is a liquid obtained during tb
tillation of coal-tar Itctwcen the ternporalureB of 180* and l^O'' C. (35
374° F.). What is called crude carbolic acid is distilled at a somewhat !
temperature, and contains also cresylic acid and other substances ?
render it unfit for medicinal use, except as a disinfectant for drains, et
mixture of coal-tar constituents has, under the name of saprol, been
posed as a cheap disinfectant. Saprol is a dark-brown, oily substance
floats upon the surface of water, which extracts from it carbolic acid, c;
and other soluble products of coal-tar. In 1-per-cent. solution, saprol
energetic agent, and is well adapted to the disinfection of dejecta in barr
prisons, and schools. It must be borne in mind when using this fluid tl
is of an inflammable nature.
Pure carbolic acid is crystalline at ordinary temperatures, and at
is colorless, but reddens after exposure to the air. It has a charaete
odor and pungent taste; it is very soluble in all the usual menstrua, ha
the peculiarity of bein^ liquefied by 5 per cent, of waterj but the fui
addition of water produces turbidity until the proportions are reverse
to '^0), when it remains permanently clear and is not afTected by fui
dilution. It resembles creosote in its disinfectant properties, but differs ;
it by being converted into picric acid when nitric acid is added to it; whe
with creosote, nitric acid forms oxalic acid. Resorcin is also of a sii
character, but is in the form of a powder. Both creosote and resorcin
be considered separately.
The following unofficial preparations are sometimes used: —
Unofficial Preparations,
Aqua Acidi Carbolic! [8 Gm. in 473 c.cni. of water, or 3)j in Oj). Dose, 4 to
c.cm. (or fSi-ij) ; also aa a \\aah« gargle, or spray.
Carbasua Acidi Carbolici (gauze, containing carbolic acid, 1; resin, 5; par
7 part«).
Oleum Acidi Carbolici (1 in 20 of olive- or cotton-seed- oil).
Carbolic-Aind Camphor. — Disnolve U pArls* acid in 1 of alcohol, and mix wit
parts camphor, fonoing a clear, oily solution.
Liquor Sodii Carbolatua (N. F.). — Solution of Carbolate of Soda (carbolic
12.60 Gni.,or gr. cIxAxviij ; caustic soda, 2 Gm.. or gr. x.vxj; wiiter, I'JO com., or f;
For externa] use, properly diluted. Pb^nol-iwdique.
Liquor Sodii Boratia Compositua (N". F.). — Dobell's Solution (borax and soc
bicarbonate, each, 8 Gm., or 3ij ; carbolic acid, 1.56 Gm., or gr. xxiv, in water;
c.cm., or Oj). For external use in spray for nose and throat.
Tribromophenol. — A compound of Bromine with Carbolic Acid with strong
mine odor. In the form of soft, white needles; used aa an antiseptic externally
internally. Dose, 0.20 Gm. (or gr. iij).
Parachlorphenol. As an antiseptic.
Calcium Carbolatura. — Carbolated Lime. For disinfecting purposes.
Physiological Action. — Carbolic acid and its preparations are dis
guished by their destructive action upon the lower forms of life, but, ow
ACIDUH OARBOLICUM. 107
to their tarry smell and toxic effects, they cannot be used for preserving food,
and are not popular in the household. When applied to the skin, carbolic
acid causes irritation, and sometimes sloughing. Gangrene sometimes fol-
lows the use of carbolic acid as a surgical dressing. According to the ob-
serrations of Dr. E, T. Eeichert, this result is most apt to be caused by the
use of moist applications and occurs especially in weak subjects, women and
children. According to some reported cases, the presence of chronic alco-
holism or diabetes seems to favor the occurrence of this accident. Carbolic
acid is a local ancesthetic. It is also readily absorbed through the skin, and
toxic effects have been produced in this way, although much more frequently
by the absorption through the raw surface of a recent wound. Two cases
of coma due to the application for a variable time of a 5-per-cent. solution
have been reported by R. Clement Lucas and W. Arbuthnot Lane. The
urine is diminished in quantity, and on standing acquires an olive-green
color; this is generally the earliest symptom of intoxication. We also notice
loss of appetite, nausea, vomiting, frothy salivation, difficulty in swallow-
ing, and nervous symptoms. The pupils are contracted and the functions
of the brain and spinal cord are affected, suspended reflexes and impaired
sensibility and motility being observed. Large doses exert a depressant in-
fluence upon the circulation, and after lethal amounts the heart stops in
diastole. Death occurs from respiratory paralysis; the temperature is at
first increased, but afterward is reduced. La severe cases there is shock,
great pallor, and sudden death. At the autopsy the drug may be recognized
by its penetrating odor; evidences of corrosive action may be seen if taken
in concentrated form, but even in small quantities it produces gastritis. As
elimination takes place principally by the urine, the kidneys may be con-
gested or inflamed; the blood is dark and imperfectly coagulated.
According to the observation of Dr. W. J. Wilkinson, the number of
red blood-corpuscles is reduced, but the percentage of haemoglobin remains
unaltered. Zwaardemaker has shown that rats and cats are particularly sus-
ceptible to the action of carbolic acid. After a poisonous dose death some-
times comes on with great rapidity. In rare cases it is delayed for several
hours or days. The fatal dose varies within wide limits, the minimum being
rather more than 4 Gm. (or 3j).
Treatment of Poisoning. — When carbolic acid has been swallowed
prompt treatment is required. The soluble sulphates (soda or magnesia)
are the best antidotes, but the liquor calcis saccharatus, or syrup of lime, is
tlso useful, if at hand. Alkalies, soap, albumin, flour and water may be
given, and the stomach washed out with the stomach-pump. Oils should
not be given, as they favor absorption. The bowels should be freely opened
vith magnesium, or sodium, sulphate. Collapse is relieved by hypodermic
injections of atropine, by hot applications, arterial stimulants, and friction.
The soluble sulphates should be administered in small doses for several days,
in order to remove the carbolic acid from the system. Professor Carleton,
of New York, states that vinegar is an excellent antidote to phenol. When
applied to a cutaneous or mucous surface which has been burnt by the acid
the characteristic whitish appearance produced by the caustic at once dis-
appeara and subsequent scarring is to a large extent prevented. Vinegar is
also said to be equally good as an antidote when the acid has been taken into
the stomach, and it is recommended that the patient should as soon as pos-
sible drink some vinegar mixed with an equal part of water, after which other
108
PHARMACErTICAL TilEKAPEUTIC AGEXTS OB DflUGS.
measures may be taken to more fully counteract the poison. Drs. P
and Powell state that alcohol is an absolutely safe and sure specific a|
the escharotic action of concentrated carbolic acid. Dr. Gross, of
Wayne, further suggests the use of alcohol internally as an antidote fo
bolic-acid poisoning. Cases successfully treated by alcohol given freely,
by the mouth and hypodermically, have been reported by Dr Kel
Brooklyn, and Dr. Hair, of Bridgeport, Conn.' As cases of poisoning b
agent are focconiing quite common, it has been suggested that every phyi
should keep on hand sulphate of soda, which is a prompt and safe ant
Therapy, — TIr' aiitizviintlic and aiitisc^ptic qualities of li<niefiod p
have been largely utilized in surgery, although it has now been nearly a
seded by the solutions of mercury, which have no offensive odor. Fon
the spray of carbolic water was considered an indispensable feature o
Listerian method, but this has been found to be unneccesary and has
abandoned, as asepsis can be secured without it. The solution is still
as a detergent and as an application upon dressings. In the treatme
carbuncle or malignant pustule, after incision and scraping, the applio
of pure carbolic acid not only acts as an antiseptic, but also as a local j
thetic, relieving pain.
Dr. Oscar H. Allis, of Phiiadelphia, and Dr. B. F. Gardner, of Bk
burg, Pa., apply undiluted cnrholir arifl in the treatment of woundi
burns. The tissues turn while immediately after its application and are
cleansed by douching with sterilized water. They have witnessed fro:
use in this manner neither shock nor 83'stemic absorption. It also exei
hirinostatic clfect, espet-ially upon the caiiilliiry vessels.'-' Czerny*' re
three cases in which carbolic-acid solution was applied to the fingen
gangrene resulted. In two of the cases, a 3-per-cent. solution was ap]
but it was kept on for several days. The duration of the application is
important tliiiti the coiici-nlrntiou. T^r. llouijoll^ liiis collwtod forty-
cases of earholic-acid gangrene and calls attention to the fact that i
been caused by solutions as weak as 1 or 2 per cent. He warns phyai
to discard its use as a dressing for the estrcmitiee in all strengths. Carl
acid camphor, being free from offensive odor, may be used as a substitut
the pure acid. In weak solutions carbolic acid has been used as a
fiiticide in various forms of tinea; and it has also been used topically fo
prevention of pitting from small-pox. An ointment containing car
acid and camplior lias proved of service also in mitigating the pruritu
companying variola. In the treatment of burns, in the form especial
carbolized oil, it is much employed. In acute vesicular eczema, eryth
and in dermatitis, especially from various poisonous subBtances, the ai
has employed this combination with great service: —
B Pliciiolis liiiiicfac'ti |38 Gm, or gr. vj.
Pulveris zinci cnrb. imp 31( Gm. or 5j.
Liq. cftlciB,
Glycerini na 00| c.cm. or fjilj.
M, Sig.: Shake well, and mop frequently over the surface.
' The Medical Butletin, Feb.. 1900. p. 57.
* Pee pftpor hv Dr. Osoar H. Alli.s, on "Carbolic Acid Used iu Pull Sirens'
Surgery." in Alviiicat Uulletin, Jan., 1894, p. 4.
* Muehrner wcdirinischi' Woohviifirhrift. Anril 20, 18fl7.
* liritrtiijr ziir IJini'^thr rhiniiyjlr^ Ji. 10. TT. 3.
ACIDUM CARBOLICUM. 109
An ointment containing carbolic acid, sulphur, and camphor is most
effective in many pruritic diseases of the skin, especially papular eczema,
psoriasis, lichen, and urticaria (or nettle-rash): — /
B Phenolis Uquefacti 132 Gm. or gr. t.
SulphuriB 8ubl. 2 Gm. or 3ss.
CamphonB > . . . 66 Gm. or gr. x.
Ungt rinci oxidi 3l| Gm. or 5j.
M. Sig.: Apply frequently to the irritable eurfiice.
Lotions containing carbolic acid also allay the itching which accom-
panies jaundice.
In the vulvitis or leucorrhoea of young girls lotions or injections of car-
bolic acid in the strength of 5 parts to 1000 of water are beneficial, pads of
lint saturated in the same solution being used to separate the inflamed parts
in the intervals. The gonorrhoea of females has also been successfully man-
aged by the application once or twice a day of tampons moistened with the
following mixture: —
H Phenolis liquefacti II Gm. or gr. xv.
Alcohol, vel sp. odorat 301 com. or fSj.
Aqtue ; 75| c.cm. or fSiise. — ^M.
Scabies has been cured by friction with a l-to-15 carbolized oil.
Internally, carbolic acid, sometimes, rather unexpectedly produces
symptoms of poisoning, which fact restricts its use. In fermentation accom-
panying flatulent dyspepsia and in dilated stomach, carbolic acid will check
the process and relieve the symptoms. It is useful in irritable vomiting,
given frequently in broken doses. The author suggests the following pre-
scriptions in the variety of dyspepsia referred to: —
B Phenolis Uquefacti . ^ |25 Gm, or gr. iv.
PuIt. aromatic! |75 Gm. or gr. xij.
M. et ft. pil. no. xij. In capsulte duris.
Sig.: One before meala.
Q Phenolis liquefacti |32 Gm. or gr. v.
Synipi acacue,
Aqus cinitamomi aa 45| c.cm. or fSisa.
M. Sig.: One teaspoonful before meals.
Carbolic acid is also of service in the treatment of diarrhoea. It has been
used in pill form in the treatment of tape-worm. It is part of the so-called
specific treatment of t3rphoid fever in extemporaneous combination with
tincture of iodine (1 to 2 of iodine) in doses of 0.12 to 0.18 c.cm. (or mii-
iij) every three or four hours, given in mint-water. The acid has been
given in typhoid fever imassociated with iodine. Surgeon E. H. Quill, of
the British army, has used in typhoid fever a combination of carbolic acid
and chloroform (the proportion of acid to spirit of chloroform being as 3
to 10), and gives the most favorable reports of this method. In puerperal
septicsemia, alone or alternated with quinine, it has been thought to answer
a good purpose. Carbolic acid has been recommended by some writers as a
valuable prophylactic against scarlet fever. In offensive breath, the cause
may be in the mouth, throat, or bronchi, and in any of these cases the use
of the steam-atomizer with a 5-per-cent. solution of carbolic acid will often
relieve the patient very promptly. Caries of the teeth may be relieved by a
110
PHAnMACEUTIOAt, THEBAPEITIC AGENTS OU DRUGS.
mouth-wash containing carbolic acid or phenol-sodiquc, well diluted,
same applied with a brush or atomizer has been used in diphtheria and
ous forms of sore throat. Weak solutions are used in hay fever, chronic
catarrh, coryza, and influenza, and afford marked relief; the one kno^
Dobell's solution is widely used for the purpose, and for cleansing the
trils. It is the liquor sodii borntis c'omp. of the* Xatiomil Formulary.
Subcutaneous injections of a 2-per-cent. solution have been mad
checking the progress of erysipelas, and parenchymatous injections inb
lungs in pulmonary phthisis. In the early stage of furuncle, and ii
larged lyinpbatic glands, tlie parendiymatous injection of the same sol
often proves cirectiial in preventing tbe formation of pus. The same m*
has been employed with success in the treatment of chronic synovitis]
it has proved of service in certain forms of functional spasm, accompi
by localized pain, the injection being made at the painful spots. Caa
tetanus have been successfully treated by the subcutaneous injection,
joined with warm baths and enemata containing chloral and potaa
bromide.
Dr. F. E, Place has treated successfully tetanus in horses by hypode
injections of pure carbolic acid. His method is to inject in the neighborl
of the neck and shoulders 4 Gm. (or 5j) every two houi-s, for the first th
two hours of treatment, and leas frequently later. A large swelling apj
at the site of the injections, but disappears in about fourteen days. Si
times there is a loss of hair over the spots, but it is not permanent. Ht
never administered less than G4 Gni. (or 5xviss) in a successful case.^ Nii
and Amy5- have reported 4 cases of tetanus in the human subject treate
injections of 2-per-cent. solution of carbolic acid under the skin in
neighborhood of the wound. The patient who received the largest quai
was the only one to recover. In each case chloral-hydrate and potass
bromide were given simultaneously in large doses*. The case which te
ered received 17.20 Gra. (or gr. cclxvij) in eight days, of which 6.5 Gm.
gr. c) were given in the first twenty-four hours, without untoward effec
any kind.
Dr. Flavel Woods,^ of Philadelphia, reported recently a satisfac
recovery from tetanus by means of large doses of carbolic acid. This met
was introduced by Baccelli. Bab^s* speaks of it in very high terms,
says thfit the statistics of the antitoxin treatment do not show any better
suits. Bab^s injected 0.50 Gm. (or gr. viiss) of a y.-per-cent. solution al
the spinal column every two hours. Areoli injected a 2- or 3-per-cent. si
tion in small doses, the patient receiving 0.32 Gm. (or gr. v) a day. '
Accademia Medica, of Rome, published these statistics: One death in
cases with Baccelli's treatment; 8 deaths in 40 with Tizzoni'a serum; 4
11 cases with Behrin^'s serum No, 1 ; 2 in 9 cases with Behring's serum Nc
Lieutenant-Colonel W. G. H. Henderson" reports success with the carbo
acid treatment of tetanus in both man and animals. Of 20 patients trea
three times a day with injections of 0.13 Gm. (or gr. ij) of carbolic acid
1.20 c.cm. (or mxx) of water, 7 recovered. Kitasnto has demonstrated t
* rjancet, Feb. 24. 1900.
* 8t. Loui9 Medical Rcviete, Dec.» 1899.
•Editorial in Medicfil Record, Oct. 21, 1899.
' "Twentieth Century Practice of Medicine."
*Laneet, June 3. 1899.
ACIDUM OARBOLICUM. Ill
carbolic acid acts as an anaesthetic, then as an antiseptic^ and as an antidote
to the toxin of tetanus.
J. M. Atkinson recommends large doses of carbolic acid hypodermically
in treating the bubonic plague, and reports a successful instance of its use.^
Subcutaneous injections of carbolic acid were found very eflfective by
Skultecki in 2 cases of severe erysipelas and 1 of septic puerperal fever; aU
recovered promptly, and he recommends the treatment as strongly as it has
already been lauded for tetanus and anthrax. The erysipelas patients re-
ceived seventy-two to eighty-four injections, a total of 1.44 to 1.68 Om.
phenic acid (or gr. xxi'/^-xivj), in a 2-per-cent. solution, 1 c.cm. (or mxv)
every four houra. The puerperal fever was treated with 0.38 Gm. (or gr. vj)
of phenic acid every three hours, the first day, and afterward with 0.30 6m.
(or gr. ivss) every lour hours, for a week, when the cure was complete.*
A. Strubell reports a severe case of gangrenous and necrotic anthrax
spreading from the tip of the nose, with chills, fever, etc., completely cured
with scarcely a scar, by frequent injections of a 3-per-cent. solution of car-
bolic acid, a total of 400 Pravaz syringefuls in eighteen days, combined with
copious stimulants, warm baths, and hot cataplasms at a temperature of 50"
to 55° C, applied locally every ten minutes, night and day. The growth
of the anthrax bacillus is checked at 40** and permanently arrested at 42**.
Cultures from the nose were very virulent, but no bacilli were foimd in the
biood.* ^
Ziemssen recommends in tonsillitis the injection into the substance of
the gland of 0.50 c.cm. (or mviij) of a 2-per-cent. solution. Relief is rapid,
often after only a single injection has been made. As a prophylaxis against
frequent recurrent attacks of tonsillitis, gargling the throat with a carbolized
alcoholic solution has been advised. The pure acid (1 to 1.30 Gm., or gr. xv-
u) has been used by Levis as an injection into the tunica vaginalis, in cases
of hydrocele, with successful results. In haemorrhoids, carbolic acid, either
ptire or diluted with oil, has been employed with satisfactory results; but
there have been some accidents. It has also been recommended in weak
wlution for the treatment of ascarides by enema, but the danger of absorp-
tion is too great for its use in this way; it may, however, be applied ex-
ternally, as it is an excellent antipruritic.
The vapor of carbolic acid may be inhaled for whooping-cough or
phthisis, in the place of the spray, by placing a few drops upon some ab-
Eorhent cotton in an inhaler.
Dr. H. Ernest Schmid relies entirely, in every stage of whooping-cough,
upon the use of a spray composed as follows: —
H PhenoUs liquefacti
Menthol (4-per-ceiit. »ol.) 15
Gocftin. hydrochlor. (3-per-cent. sol 11
Glycerin 4
Aq. Uurocerasi q. b. ad 30
38 Gm. or gr. vj.
c.cm, or fSiv.
c.cm. or fSiij.
ccm. or 131.
c.cm. or fSj. — ^M.
The solution is used by means of an atomizer every third hour, the
nozzle of the instrument being directed as far as possible into the mouth
* Lancet, Dec. 9, 1809. See also article on the "Bubo Plague," by author, in
teviied edition of "Reference Hand-book on the Medical Sciencea." WiUiam Wood
*Co,.New York. 1900.
^Umaine M^dicule, May 25. 1898.
*ifuncltener medidniache Wochenachrift, Nov. 29,
l\2 I'lIARMACEL-TICAL THKRAPEITTIC AOEKTS OH DHrcS.
of the patient. The use of a weak solution of carbolic acid hy atomic
combined with its internal administration, is of service in pulmonar
p:rent'. In the S('i>tic dist^aso.'S. — sniall-pi>x, septica'mia, puerperal fever,
the pheiuili?uli>honate6 liave been used with asfiericd success. In ^
fever Dr. Waugh hafl had good n^sults fr(»in zinc phenoIftul])honjite, iu
of 0.13 to 0.20 Gnu (or ^'r. ii-iij), four or five times a day. It has i
viinTa^'-c, over the carbolic acid and iodino treatment, of being le:?s depi
to the heart and less inJLirimi.'^ to the kidneys.
Prof. M. Charteris, of Glasgow, believes that pure carbolic acid
good results in the treatment of typhoid fever. He gives it in the f<
a pill containing 0.16 Gm. (or gr. iiss) of pure acid made up with so]
nocuous powder and covered with keratin, for the purpose of delaying
tion until it has passed into the bowel. He is also of the opinion 1
may be useful as a prophylactic and therapeutic agent in cholera, ani
it might, with advantage, be tried in diphtheria in doses of 0.13 Gm. i
ij) every two hours.
ifagnesium phenolsulphonate is said by Dr. G. Tarozzi to be aui
cious laxative and intestinal antiseptic in doses of 1 to 2 Gm. (or |
XXX ).
Farachlorphenol — obtained by the action of chlorine on phenol-^
by Girard, of Beine, to be more stable, energetic, and constant in actio!
other drugs and its toxicity is much less than mercury, cresol, or pi
Sui»eutancous injections of 1 Gm. (or gr. xv) per kilogramme of body-i
are reLpured to form a toxic dose for a dog or rabbit. A 2-per-cent. so
kills the epores of anthrax in an hour, whereas a 5-per-cent. soluti
phenol requires twenty days. It forms a valuable antiseptic dressil
wounds or for cleansing surgical instruments.
Fhenosalyl.' — -CombinationH of anti^eptir tinl)8tances liavi? ortei)
proposed for the purpose of securing inerea^ed action, lessened to;
greater solubility, etc. Dr. J. de Christmas, of the Pasteur Institn
Paris, has <levised a mixture width he lenu."^ PhenosalyU liir (onni
whieh is as follows: —
Phenol 90 parts,
Lactic Hcid 20 part*
Salicylic acid 10 partSi,
Menthol 1 part.,
Thi^ forms a clear, syrupy liquid, which partially crystallizes £
temperaiorc!^, Init ujxui the addition of a small (quantity of glycerin, a
solution n^sults. This will not again crystallize and rtnidily dissolves in
water, alcohol, and ether. In cold water it is soluble to the extent of
cent. Experiments have shown that phcnosalyl is considerably less p'
ou8 than carbolic acid. It has been used in 1-per-cent. solution for th
infection of hands and instruments, for irrigations, etc. A solution r
same strength pro%*ed rapidly curative in a case of impetigo, while
5-per-eent. phenosalyl pencils were beneficial in endometritis and uretl
Phenosalyl has been advantageously used as an antiseptic in obstetric
A 2-per-cent. solution injected into the bladder was productive of exc-
results in purulent cystitis. An ointment of 1 part of phenosalyl to 1
160 parts of vaselin was successfully employed by Dr. Berger in bleph
enitia and a 0.2- to 0.4-per-cent. aqueous solution in different forr
conjunctivitis. Scheurlen and Bechmen, a few years ago, published tl
ACIDDM CHROMICUM. 113
salts of experiments proving that the germicidal action of carbolic acid is
decidedly increased by the addition of sodium chloride. A solution of 1
per cent, of carbolic acid with 24 per cent, of common salt gave better
results than 6 per cent, solution of carbolic acid in plain water.
ACIBTJIC CHEOMCUM (B. P.).— Chromic Acid (CrO,)
CHBOHn TBIOXIBUH (IT. S. P.).— Chromic Trioxide.
It should contain not less than 90 per cent, of chromic anhydride.
Preparations.
Potassii Dichromaa (U. S. P., B. P.).— Potassium Dichromate. Uoae, 0.006 to
0.012 Gm. '(or gr.V«-V.).
Liquor Acidi Chromiei (B. P). — Solution of Chromic Acid (25 per cent, of CrO,).
Pharmacology. — Chromic acid occurs in the form of small, crimson^
needle-shaped crystals, deliquescent and very soluble in water. They shoidd
not be added to alcohol, as mutual decomposition takes place, sometimes
explosively. An explosion results instantly from a mixture of 1 part of
chromic acid with 2 parts of glycerin. For the same reason chromic acid
should never be combined with spirit of nitrous ether,
FhyBiological Action and Toxicology. — On account of its marked
afl&nity for water and its contained oxygen, chromic acid rapidly destroys
tissues, forming an eschar, and it is a powerful antiseptic. In solution
(from 5 to 20 per cent.) it acts as a caustic. When swallowed it is a cor-
ro«ive poison, and requires prompt treatment by demulcents and alkalies,
with irrigation of the stomach. If death does not occur at once from shock,
it may result from inflammation and sphacelation of the mucous coats of
the stomach. Workmen in factories where chromic acid is used are liable
to have perforation of the nasal septum from the local action of the acid
applied accidentally upon the fingers. Eczema of the hands is liable to
occur in those engaged in making the bichromate solution used for dyeing
purposes- Cloth dyed with this material is apt to produce ulceration of the
integument. The electropoion fluid (Liquor Electropoeieus, N. F.), or
battery^floid, contains potassium dichromate in powder, 186 Gm. (or gvi) ;
commercial sulphuric acid, 180 c.cm. (or f^vj); cold water, 1419 c.cm. (or
^xlviij). Being of an attractive red color, and in such common use among
physicians, it may be swallowed by mistake, and instances of poisoning in
this way are not uncommon. In such cases, soap-suds and milk may be given
at once, and the stomach carefully washed out with a soft tube, as vomiting
may rupture the stomach. Arterial stimulants and external counter-irrita-
tion and hot applications may be required. Chrome yellow, or lead chro-
mate, has been used by bakers in order to give a rich color to cakes. The
s^-mptoms are principally indicative of lead poisoning.
Therapy. — The solution of chromic acid is an excellent remedy for warts,
syphilitic mucous patches, and enlarged tonsils (0.65 to 30 c.cm. of water,
or gr. x ad aq. f5j), applied with cotton or a camel's-hair brush once or twice
a day. It has also been used in gynaecological practice in uterine hsemor-
Asge and endocervicitis, and has been injected into haemorrhoids, and ap-
plied to hypertrophies of the nasal chambers, and also to some malignant
p^wths. Sweating of the feet (hyperidrosis) is relieved by sponging the feet
daily with a weak solution. Parasitic skin diseases, sycosis, lupus, tinea cir-
dnata, and condylomata require a stronger solution (6.60 to 30 c.cm., or gr. c
114
PHARMACEUTICAL THERAPEUTIC AGEXTS OR DBUGS.
to fjj). As the caustic action tends to spread, it should be used with ca
covering; the neighboring gurfnce with petroUiluiii, or some other pro!
ointment, and promptly rcmo^nng excess of aeid with an nlkMline wash
In favns, after the crusts have been removed, an ointment compoi
follows has proved serviceable: —
B Pota«8. dichromat II Gm. or rr. xv.
Adipia 3l| Gm. or Sj. i
M. ft, ungt.
A 1-per-cent. solution of chromic acid in water has been fout
Professor Knnfman, of Alfort, to be an excellent remedy in cases of ^
bites. As an application to chronic ulcers the following combination ii
ommcnded: —
R Clironiii Irioxidi 21 Gm. or gr. xx
Acid, tnnnic 1 30 Gm. or gr. xx
Miir|vhirisB sulpli |32 Gm. or gr. v,
Clilorflli liydrati 23|32 Gm. or 3vj.
Aquee 473| c.cm. or Oj.
M. Sig.: Apply frequently with camers-hair brush.
Chromic acid has been successfully used by Dr. W. R. H. Stewa
the treatment of ranula and cystic goitre. After the tumors had been op
their contents washed out, and after haemorrhage had ceased, a satu
sohition of trioxido of chroniivira w;i?api>lird to several points of the cyst-
Chromic acid is not used internally; but tlie potassium dichromate has
administered in doses of 0.006 to 0.012 Gm. (or gr. Vio-Va); ^t acts i
emetic in doses of 0.048 Gm. (or gr. */*)- It has been used in chronic i
matism and sypliilis, made into pill with some vegetable bitter^ but^
doubtful utility in these conditions, j
Potassium' Dicliromate. — Dr. Joseph H. Tluut, of Brookl\Ti, praise
action of f)otiiSf?ium dirlironifito as an expectorant in catarrhal conditio:
the respiratory tract. To children of a year old, he is accustomed to gi
in 0.0033 Gm. (or gr. Vso) doses. When the respiration is seriously en
rassed, he repeats the dose every fifteen or thirty minutes until the 8]
toms are ameliorated, when he diminishes the frequency to hourly inter
Following the suggestion of Vulpian, Professor Fraser, of Edinhu
has, with advrtntage, made use of potassium dichromate in numerous i
of aggravated dyspepsia,* some of which were associated with distin<
symptoms of gastric ulcer. The remedy was generally given in the do5
0.005 Gm. (or gr. Vis)^ sometimes increased to 0.01 Gm. (or gr. Vn), t
times a day. Professor Fraser adnscs that the remedy be given during :
ing, while the stomach is, as far as possible, empty. He states that potass
dichromati' is capalde of relieving, and often in a short time uf r<'tno\
the entire group of symptoms, except constipation and anaemia, encounb
in dyspepsia. It is particularly useful in alleviating pain, nausea, and v
iting. In gastric ulcer it did not succeed in checking hiemnrrhage.
obstinate vomiting, gelatin capsules, each containing 0.006 Gm. (or gr. \
have been given every hour or two, with good results. In gastraleia
they have been successfully given, 1 three times a day, on an empty stomi
by Bradbury, of London.^ Professor Fraser, of Edinburgh, read a pc
'lancet, April 14. 1894. * Lancet, Sept. 14. 1895.
ACIDUU FOBMICUM.
115
hdan the International Medical Congress at Rome on the use of this salt,
seoDauDcnding it in certain affections of the stomach.*
PaCaautun dichromate has likewise be<'n adminiBtered with assorted
ladt in locomotor ataxia. Dr. Diago reports very favorable results from
Af odiifliTe ■dministration of this remedy in seveu cases of haemaiochyluria,
tknv of which depended upon the presence of filariss. It was given in the
km of 0.02 to 0.03 Gra. (or gr, V»-ss) in half a pint of water. He regards
iWmH sc of value in the treatment of pernicious malarial anaemia. In cases
rf poMoniDg by pota^ium dichromate the same means are employed as in
Arauc-ttcid poidoning. At tlie present dav it is rardv prescribed iuter-
ACTDUIC CrTRICTJM(U. S. P., B. P.).— Citric Acid(H,C,H,0, + H,0).
0.65 to 2 Gm. (or gr. x-3es). B. P., 0.32 to 1.30 Gm. (or gr. v-xx).
Preparation,
Aridi GStrici (U. a P.).— One per cent. Dose, 7.50 to 30 c.cm. (or
Sr^
Fhsraftoology. — Citric acid is an organic acid, usually prepared from
k^uD-jnice; it occurF in the form of colorless crystals soluble in less than
own weight of water. Citric acid is soluble likewise in alcohol and
■. It ifl not infrequently adulterated with tartaric acid, which may be
ited in the form of bitartrate by the addition of a strong neutral solu-
; of carbonate of potassium. It has a sour taste, not unpleasant in weak
ioDA. In substance it is irritating to the gastro-intcstinal mucous mem-
aod may thus act us a poison. It renders the urine acid. It is elim-
to •ome extent by the bowels, but principally by the kidneys.
ttcrmpy. — In the proportion of 37 Gm. (or gr. dlxx) to 473 c.cm. (or
Oj) of distilled water it forms a solution of the average acidity of lemon-
^ h may be further diluted and SM*eetened as a refripjerant drink for
fj9 been used also as a substitute for fresh lemon-juice in the treat-
^1 '--. but is less efficient.
1 has likewise been employed for the purpose of relieving in-
leCTit^ of the liver and catarrhal jaundice. A l-per-cent. aqueous solution
•^ ritric acid is said to be useful as an injection in gonorrhoea.
Citric acid has the power of sterilizing polluted water.
ACnnnC FORMICTTM.— Formic Acid (011,0,).
Fharmaoology. — Many sjnvies of ants contain formic acid in its own
term. The r»M «nt, Formica Rufa, indexed, contains about half its weiglit of
^m p«cutiAr constituent, the name of formic acid having been derived from
Ifc^ f^rt. Th'**** "fits possess no stings; but they can inflict very irrit4iting
«i«Didi apr ■ n body by bitinjr tbrouL'h the skin with their strong
mmtiMc$ hi - formic acid into the flesh. The powerful irritation
hm art np was at one time utili;;ed in therapeutics by taking rlieuuiatic
^'- «n an ants' nest, and making the insects angry so that they
rxpo*od surface around the atfected joints, llecently, this
a^> ( in 1C70) two physicians, Wray and Fischer, obtained
i»: ri,.-il
I in scientific medicine by substituting the hypodermic noe<llG
ufiect for the introduction of the formic ncid. Xearlv thnn.-
iM^^. ApHl U. 1W4.
,' thnn.' i
IIG PUARMACEUTICAL THERAPEUTIC AGESTS OR DRUGS.
acid by distilling ants with vater-vapor. They introduced the solut
formic acid into medical practice, principally for external use as a r
oient, and, to a limited extent, for internal use, as a general stimulai
aphrodisiac. It has been only lately discovered that formic acid, b
methane derivatire, can be ]iroduced in different ways, notably I
oxidation of methyl-alcohol, or liy breaking up oxalic acid in the pres€
glycerin. The latter, devised by Berthelot, is the method now gei
adopted.
Formic acid readily combines with bases to form a series of
known as formates, which offer special advantages for the internal ad
tration of thig active aj^ent. It hap been demonstrated that the al
formates, notably the sodium and calcium formates, have a very stiraii
fflt^'t ujion the nuiscular elements, both fitriated and non-striated, Hu
of Paris, in n communication to the Academy of Medicine (March 14, ]
reported, as the results of exton.sive laboratory investigation, that *^i
acid salts increase tlie work performed by the muscular tie^ues, tlir
four-fold, without fatigue." He regards them as superior in their effc
caffeine, kola, strychnine, or spermine. Dr. Garrigues, alM, as the
of liis personal observations, reported to the Academy (March 28,
thai the administration of the formatci? induces not only an increase <
muscular Btrcngth, but alr^o piimulates the appetite. This stateraer
been confirmed by Clement, of Lyons, and others. The conditions in
the formates of calcium and of godiuni have been administered succesi
were certain forms of eonstipation, incontinence of urine, defective
holism, and poor circulation, especially in phthisis, general asthenia,
rexia, and amcmia. The duses of the formates vary according to ci
stances. Tn Huclinrd's physiological experiments upon himself and p
they took from ^^ to 'A grammes per day (15 grains, two or threi* times a
with very decided benefits, as shown by the ergograpli, ami, he claimj
without any deleterious after-effects. In phtliisical patients, the urine ■
tion was increased from 20 to 52 grammes. Other observers have cone
that the more lasting results can be obtained by giving small doses,
times a day (0.06 to O.oO Cim., or gr. j-v) for a prolonged period,
glycero-phosphates are synergistic with the formates, and they nu
used in eomliination with strychnine or other cardiac tonic.
Pure formic acid (TICO. OIT, molecular weiglit 4.">.(j7) has the pe<
property of acting both as an aldehyde and as an acid. It i? crj'staUi
but, at a temperature above S.3° C, it is a colorless liquid, having a
pungent odor and burning taste. It is caustic and destructive to the
wiien applied lu full strength.
Therapy. — In modem therapeutics, formic acid is coming into t
a counter-irritant, in a oO-per-cent. stdution ; and in more dilute form,
to 3 per cent. For internal adiuinistration tlie German Pluirmaec
provides spiritus formiearnm. or spirit of ants, which is composed of 3
formit' acid, 35 parts alcohol, and ^'^ parts water. This f^olution mj
given in doses of from *20 to 30 Tuinims, as a genernl stimulant, acting
much like ammonia. The oiVper-cent. solution has been applied Ic
with success, as a counter-irrit^int, in treating neuralgia and rheuma
It has also been used to prevent bed-sores. I'he ?V.^.-per-cent. solutii
used in acute rheumatic nrtliritis. It has recently been used hypodennw
with remarknblv beneficial results, bv Dr. Lcuiis B. Crouch (Medical R{
June 24, lOOr.)".
ACIDUM HYDEIODICUM DILUTUM. 117
ACIDTTM OALLICTrM(U. S. P., B. P.).— GaUic Acid(HCAOB + HaO).
Dose, 0.13 to 0.65 Gm'. (or gr. ii-x), B. P., 0.32 to 1 Gm. (or gr. t-xv).
An organic acid usually prepared from tannic acid (U. S. P.). A tri-
hydroxybenjEoic acid. It may be prepared by the action of diluted sulphuric
acid on tannic acid (B. P.)-
Fharmaoology. — Galls are lumps or nodes upon the oak-tree, caused
by insects. They contain about 50 per cent, of tannic acid, which, chem-
ically, is an anhydride of gallic acid, and, in fact, is convertible into gallic
acid by acids or simply by immersion in water. Its solutions strike a black
color in the presence of iron, and they should not be prescribed in combina-
tion with chalybeates. Gallic acid is in the form of long needles, nearly
colorless, slightly acid, though less astringent than tannin; it is soluble in
100 parts of cold water, 4 ^/j parts of alcohol, or 3 parts of boiled water.
Therapy. — Like tannin, gallic acid has the effect of restraining secre-
tion, reducing swelling, and hardening tissues. It is eliminated by the kid-
neys under its own form. In solution, as the glyeerite (1 part to 8 of glyc-
erin) it forms a favorite application to sore throat or tonsillitis; and the
ointment of gallic acid is a good application to hsemorrhoids, being an im-
provement upon the ointment made of powdered galls. The alcoholic solu-
tion is useful as a local application to ^e membranes in diphtheria.
Internally, gallic acid is given in haemorrhage (1.30 Gm., or gr. xx, at a
dose) from the alimentary canal, kidneys, or lungs; also in monorrhagia, but
here it is inferior to ergot.
In haemoptysis, xdcer of the stomach, hemorrhage from the bowel,
especially in typhoid fever, the following formulae can be used: —
Gm. or 3ij.
c.cm. or fSj.
066 Gm. . or gr. j.
c.cm. or Sj.
com. or fSij.
B Acid, gallic 8
Acid, sulphuric, arom 4
Morphinae sulph
Tinct. cardamom, co au
AqusB rowe 60
M. 8ig. : One tea«poonful in water every hour c»- two.
H Acid. ^Uic 8| Gm. or 5ij.
Glycenni 901 c-cn*. or fSiij.
U. Sig.: One teaepoonful every half-hour or hour until relieved.
This combination is a useful application to subacute pharyngitis or
tonsillitis.
It has also been used to reduce the quantity of albumin in Bright's
disease. On account of its astringent effects gallic acid is useful in a number
of disorders attended by excessive secretion or transudation, as chronic bron-
chitis, cystitis, chronic diarrhoea, dysentery, and the night-sweats of phthisis.
It is likewise serviceable in purpura haemorrhagica. It retards the progress
of pyelitis or pyelonephritis, and diminishes suppuration. Combined with
opium, it has been found beneficial in diabetes insipidus.
ACIDUM HTDBIODIGUM DILUTUM (U. S. P.).— Diluted Hydriodio
Acid.
Contains not less than 10 per cent, of absolute acid and about 90 per
cent, of water. Dose, 0.30 to 2.50 c.cm. (or wiv-xl).
Preparation.
Sympus Acidi Hydriodici (U.S. P.). — Syrup of Hydriodic Acid (contains about
1 per cent., by weight, of absolute acid). Dose, 2 to 15 com. (or ffixxz-f^sa).
118
niARMACErTICAL TnEUAPEUTIC AOEXTS OB DRUGS.
Pharmacology. — Hydriodic acid is a gas which may be prepared
action of iodine upon phosphorus in the presence of water, with the
gentle heat. It is colorless, but produces white fumes in air; it can be
iied or even rendered solid by strong pressure and a low tcmperatu:
solution of hydriodic acid in water, if exfxjsed to the air, soon becom
colored, and after a time deposits crystals of iodine. The solution
official, but the U. S. P. recognizes a syrup.
Therapy. — The syrup of hydriodic acid is a valuable means of
ducing iodine into the system. When administered in this way the iot
liberated in the body, and is peculiarly active in its nascent form, and
cially adapted for administration to scrofulous subjects and cases of cat
pneumonia of the chronic type. In some skin diseases of the same cha
the syrup of hydriodic acid, when properly made, has proved of great
It is very efficacious in spasmodic asthma, especially of that variety wh
linked with the gouty diathesis.
The syrup of hydriodic acid is an efficient remedy in tertiary sv]
acute and chronic rheumatism, lumbago, rheumatoid arthritis, chronii
poisoning, bronchitis, exophthalmic goitre, and other affections in *
iodine is indicated.
Dr. James Craig, of Jersey City, speaks very highly of the syr
hydriodic acid in acute rheumatism. He gives from 7.5 to 11 c.cm.(0T f3
in a winecrlassful of water every two or three hours until relief is experie
afterward reducing the dose and continuing the remedy for several d
required. The pain and fever are reduced within forty-eight hours, a:
believes that this treatment exerts an important influence in preventinj
diac complications. Its power over serous exudation and fibrous adl
inflammation is well illustrated in pleurisy with large effusion, or in p
pleurisy with adhesions. As the latter is a prominent predisposing cai
phthisis, it is important that it should receive attention early and be
come by the administration of iodine, especially in the form of syn
hydriodic acid. Wile has used this preparation with success in various i
of lead poisoning.
AciDUM hydrobromicum: DILTJTUM (U. s. p., B. p.). — Dl
Hydrohromio Acid (HBj + [HjO],).
Dose, 2 to 7.50 c.cm. (or mxxx-foij). B. P-, 1 to 4 c.cm. (or mxv-
Pharmacology. — Hydrobromic acid resembles hydrochloric aci
being official only in solution, each being a gaseous substance. Dil
hydrobromic acid contains 10 per cent., by weight, of absolute hydrobr
acid (hydrogen bromide, B. P.). It is a clear, colorless solution with an
taste, and can be given in Icmon-syrup or simple elixir.
Therapy. — Hydrobromic acid should be an excellent antiseptic
dressing wounds, being sedative, non-poisonous, and bactericidal ir
action. It was introduced as a substitute for the bromides, but it has
fulfilled the expectations of its projectors, although it has some ano(
and hypnotic effects. It is more pleasant to take than the bromides, is
apt to produce an eruption or physical depression, but it is more irritai
the stomach. In some cases of nervous cough, neuralgia, headache,
nervousness it has a good effect, but is ordinarily given in too small d«
Its action in epilepsy may be compared to that of the bromides, but
gastric irritability which it excites is a bar to its continued use.
d
ACIDUJI UYDHOCHLORICUM.
119
SciwrmiU has found it useful in headache due to eyestrain. In cases of
assaying tinnitus after taking quinine it is paid to give prompt relief,
clhotigh it often fails in relieving tinnitus from other causes. Two flui-
fuchias (7.50 ccm.) arc equivalent to 18 grains (1.16 Qm.) of potassium bro-
To rcUcYe irritatiTe cough in phthisis:-
» CV)Jtia»
Aridi hvdrobronuci dil.
Stt. aurantii
M. Doae, 1 or 2 ttfftspoonfuli.
B ACIDUM HYTBOCHLOEICTTM (U S. P.,
HbBIHrtj K^uiatic Acid (contains 31.9 per cent.
HIliK ftcid^ with water, 68.1 per cent.; B. P.
af hydiogra chloride). (HCl + [H5O].)
1065 Gm. or gr. j.
301 ccm. or f5j.
60| ccm. or fSij.
B. P.). — Hydrochloric Acid,
by weifjht of absolute hydro-
, 31.79 per cent., by weight,
^^^^L Arm
Preparation.
.AriuuEu Hydrochloricura Dilutum (U.S. P., B. P.). — Diluted Hydrochloric Acid
UAA lO per crnt. of fthnolute hydroohlorio a.cid in water: B. P. containa 10.58
•C hydrofcm chloride ia lOO parts of water). Dobc, 0.60 to 2 ccm. (or wx-xxx).
Pkazmacology. — Tbe acid itsolf is an irritating, irrespirable gas. Its
•4atMiift are clear, colorless, and decidedly acid. When applied to the skin
fj mre antiseptic and astringent: in some persons with delicate skin hydro-
ic acid is irritnting and slightly caustic. The salts of hydrochloric acid
f» nfllcially termed hydrochlorides. Prominent among them are apomor-
fkaoB^ cocaine, hydmstiniiie, morphine, pilocarpine, and quinine hydro-
Pfayiiological Action and Toxicology. — When taken internally in poi-
doees, it acts as a violent irritant, causing burning pain, a strong
iMfte in the mouth, red and swollen tongue, and discoloration of the
Vomiting occurs at once, and may be accompanied by bleeding. The
frtitot ia at first feverish, but soon falls into collapse, and dies of shock or
ion. Violent gastric inflammation is found after death, and the
and mouth show the effects of a corrosive poison. The vapor
tf aBUunua escaping near the vomited matters produces a white cloud of
nuDoniuzn chloride. The treatment is the same as for other corrosive min-
e*i *^".ic — demulcent drinks, flour or soap and water, milk, oil, or eggs.
Th nates may be given cautiously, for fear of rupturing the stomach
^T tr.c e**2aping carbonic-acid gas. The stomach being softened by the acid,
': Usonlfl be evacuated by the tube rather than by emetics, if vomiting does
aoC occur apontaneously. There is, moreover, danger that, in the act of
matttinir* a portion oi the acid may find its way into the air-passages and
ftw ftill further extend the mischief. Subsequently, the patient must be
tRBf«*rT f. r t!io resulting lesions, which are not limited to the intestinal tract,
li^ n of the kidneys and lungs may also occur. Medicinal doses
ifitooijitv WM appetite and promote digestion.
nermpj. — Topically, hydrochloric acid is applied to septic wounds, dis-
mtHxtg wound*, or bites of rabid animals. It has also been used, mixed with
.■_-.*t. 1'-,^.-_„ . .,_ - ., — . _•_ ^-phtheria.
diseased
iotmI proportion of honey, as an application to the throat in dip'
k impotiBnt that this application should be made only to the (
I
120
PHABMAOEUTICAL THBHAPEDTIC AGENTS OH DRUGS.
surface. It is a good addition to baths in cases of skin disease, as pitji
versicolor or tinea^ and in full strength it is used to destroy warts ol
hands of children. The undiluted acid has been successfully used as a fl
ter-irritant in sciatica. Dr. Gennatas, of Montpelier, applies three or
coats by means of a small brush, along the affected nerve, and wraps ui
part in cotton. The application may be repeated in twenty-four or e
eight hours>
Dr, Morris, of New York, has, in some cases, utilized hydrochloric
for the removal of carious and necrotic bone. Through a sinus or ine
a 2- or 3-per-cent. solution of hydrochloric acid in distilled water is inj<
every two hours, or at bed-time, according to the circuiustanccs of the i
The exposed portion of bone is rapidly decalcified, after which there i
jected every second day an aeid-pepsin solution made by adding 1 c
(or mxy) of hydrochloric acid and 2 Gm. (or 5ss) of pepsin to 120 ccm
fjiv) of distilled water. The decalcified bone with caseous or fatty mat
is digested out within a few hours, leaving exposed clean dead bone, w
can be attacked in the same manner.
When hydrochloric acid is given well diluted, it is acceptable to
stomach, being one of the constituents of the gastric juice. When fermi
tion of the food takes place, causing flatulence, or "windy dyspepsia," it
be due to a deficiency of this element. At all events, cases of weak digef
and dyspepsia are sometimes much benefited by 0.60 to 1,20 ccm. (or mx
of the diluted acid with half the quantity of tincture of nux vomica, i
each inenl. Where acid stomach is caused by the presence of bacteria,
antiseptic action is best obtained by administering the hydrochloric
when the stomach is empty, shortly before eotiug. It is also held that
excessive secretion of hydrochloric acid (which forms one variety of
stomach) may be prevented by administering an acid solution just be
eating, on the rule that acids check acid secretions. Hydrochloric acid sc
times affords great relief in nausea. In intestinal indigestion with diarrl
this agent is also very effective, given one or two hours after meals,
temporary administration of pepsin in combination with the acid is of g
value in eases of this kind, but the pepsin should not be continued too h
or the peptic glands may lose their functions,
A digestive mixture which is very beneficial is; —
B Acid, hydrochlor. dil lfi| e.cm. or f3iv.
PepBiii. pur 151 Gm. or 3iv.
Glycerini 90| e.cm. or fSiij.
M, 6ig. : One teaspoonf ul in water after meals.
In fevers, where the secretions are very much diminished and hyc
chloric acid is not secreted, its administration is of great service in assist
digestion. In typhoid fever, dilute hydrochloric acid is very useful (0,6i
l.SO ccm., or mx-xx, every three hours), and it exercises an important
fluence upon the contents of the bowels, being slightly astringent and j
venting the multiplication of bacilli. Relapse is less frequent under 1
treatment because autoinfection is less likely to occur. In other infecti
zymotic diseases — as scariet fever, small-pox, or diphtheria — hydrochh
ncid, or compound chlorine solution, may oe administered in the same m
*^ Lancet, Nov. 20. 1897.
ACI0UM HYDHOCYAKICCM DILUTUM. 121
It is seiriceably combined with the tincture of iron in the treatment
of diphtheria, and the mixture may be used both internally and as a local
application. The presence of a mineral acid has been shown to diminish
the virulence of the toxins of diphtheria.
In phthisis it is serviceable in disinfecting to some extent the alimentary
canal, checking excessive sweating, or watery discharges from the bowels,
and promoting constructive metamorphosis.
A very beneJScial combination for phthisis is: —
3 Add. hydrochloT. dil.,
Tinei. nnds vomicA aa 12 30 c.cm. or fitcc.
Tlnct capsici 4 ccm. or f3j.
Tinet. cinchonee 150 ccm. or fSv.
M. Big.: Two teaspoonfula in water after meaLi.
The liquor pepsini (!N*. F.), or liquid pepsin, contains saccharated pep-
sin, 40 parts ; hydrochloric acid, 12 parts ; glycerin, 400 parts ; and water, to
make 1000 parts. It is practically an artificial gastric juice, and can be
used locally to cleanse wounds, or injected into the bladder to dissolve
blood-clots. The usual dose for indigestion is a tablespoonful after eating.
Chlorine, for bleaching or disinfecting purposes, can be obtained by
ponring hydrochloric acid upon manganese binoxide. It is a greenish-col-
ored, intensely-irritating gas. (See Ghlomm.)
ACIDirM HTDEOCTANICXTM DIlTmrM (U. S. P., B. P.). — Diluted
Hydrocyanic Acid (Prussic Acid). (HON + [HaO].)
Dose, 0.06 to 0.30 ccm. (or mi-v).
Phannaoolog^. — ^A liquid composed of 2 per cent., by weight, of abso-
lute hydrocyanic acid (hydrogen cyanide, B. P.) and 98 per cent, of water.
It is colorless, faintly acid, with taste and odor of peach-kernels, rapidly
loses the volatile acid when exposed to the air and light, and deteriorates
if kept too long; so that the dose is variable. We should always commence
with the minimum dose and cautiously increase, because of the different
degrees of activity of this preparation. Cherry-laurel water (Aqua lauro-
cerasi) is official in the British Pharmacopoeia, but not in II. S. P.; it is also
of very variable strength, but is used in considerably larger doses (2 to 8
com., or wixxx-3ij). Diluted hydrocyanic acid is also present in the com-
pound tincture of chloroform and morphine (B. P.) . The cyanides of potas-
sium and of silver are official (U. S. P.). By the addition of an acid to
either of these salts, it will be decomposed and hydrocyanic acid set free, as
in the following prescription : —
B PotaasU cyanldi
Add. dtrfc
Syr. Tolutani 60| vel 90
K. Big. : A teftspoonful as a dose for an irritable cough,
065 Om. or gr. j.
32 Gm. or gr. v,
ccm. or ftii vel iij.
Physiological Action and Toxicology.-^Hydrocyanic acid is very poi-
sonous as a gas, and given in the ordinary solution, in sufficient quantities
to cause death, it is almost immediately fatal. In cases where it does not
cause death at once, there is great prostration of bodily powers; weak, flut-
tering pulse; cold extremities, and impending collapse. Atropine, hypo-
12S
PUAKMAC£UTICAL TilEBAPEUTIC AGENTS OR DRUGS.
dprmically, is the physiolo^ral antidote. The chemieal antidote is pi|
carb. 1.30 Gm. (orgr. xx) in water, 120 c.cni. (or 5iv), followed by ; — '
B Fcrri sulphate
Tine t. f erri chlor 3
Aquse , 124
M
66 Gm. or gr. :
88 Gm. or 3j.
4 Gm. or ^iv.
According to Dr. Johann Antal, cobalt nitrate is an efficacious chei
antidote, but no time should be lost before eraptyiag^ the stomach witl
aid of stimulating emetics. Cold affusions to the spine, with frictions
faradifim to the surface, and liot applications are also efficient. The peo
bitter-almond odor of the ejecta indicates the character of the poison. D
generally occurs by suffocationj from paralysis of respiration. Elimina
as well as absorption, of hydrocyanic acid is very rapid. Ringer states
if life can be supported for half an hour recovery will usually occur,
feasor Kobert advocates the use of hydrogen dioxide as an antidote to hj
cyanic acid. He uses a 3-per-eent. solution hypodermically and a 30-
cent. solution for washing out the stomach. Vomiting is to be cncourj
and artificial respiration practiced. Where poisoning has occurred b}
halation, it will not be necessary to wash out the stomach. Kob
method of treatnieut lias been used for several years in English ]
iiig and smelting works, where a great deal of cyanide is used, lie
onimends a cabinet containing both solutions in hermetically sealed fli
with hypodermic syringe, also a stomach-tube and funnel, to be kept
stantly ready for immediate use in chemical laboratories, photogra
studios, gold-beating establishments, where the acid or cyanides are U£
Locally, hydrocyanic acid at first slightly irritates the skin, but aJ
ward acts as a sedative. It should not be used in skin diseases when the i
is broken, for fear of absorption. It has some action upon the brain, e
ing vertigo and hebetude; the respiratory centre is enfeebled and the ra^
nerves paralyzed, producing great muscular feebleness. The condud
power of the sensory ner\'e3 is diminished. It is a decided cardiac sedat
the pulse becoming slow, with lowered arterial tension. The poison
acts upon the respiratory function of the red blood-corpuscles, and prev(
them from carrying suthcient oxygen to the tissues.
Therapy, — llydrocynnic acid has been used as an antispasmodic
various forms of reflex vomiting, such as the vomiting of pregnancy ;
that of phthisis. It has also been employed in nervous cough, in irritt
heart, and asthnia. Whooping-cough, acute mania, and melancholia r
also be relieved by the administration of hydrocyanic acid. As it is rapi
eliminated from the system, the dose should be repeated at short interv
Its sedative effect upon the gastric mucous membrane renders it valuabh
painful affections of that organ, such as gastralgia, ulcer, and cancer. T
same benefit is obtained from its use in enteralgia. For external use it v.
be added to rose-water (7.50 to 240 c.cm., or foii-foviij) with a little glycei
to be applied in cases of troublesome pruritus.
ACIDUM HYPOPHOSPHOROSUM
Acid. (See Acidum Phosphoricum.)
( U. S. P. ) . — Hypophosphor
* Merck's Archives, March, 1000, p. 94.
ACIDUM LACTICIM.
123
ACZDnX HYPOPHOSPHOROSTJM DILUTTJM (U. S. P.).— IHlute Hy-
fipko^horoaft Acid. (See Acidum Fhosphohcum.)
I
ACIDirM LACnCUM lU. S. p.. B. P.).— Lactic Acid ( IR',,11,0,).
An organic acid, usually obtained by subjecting milk-sugar, or grape-
•-:;%T^ to lactic fermentation; composed of 75 per cent., by weight, of abao-
..:* lactic icid (hydrogen lactate, li. P.) and 25 per cent, of water.
Preparations.
Bfimptm C&lcii LactopliO!4pliAtis (U. S. P.). — Synip of Calcium Laotopliosphate.
ff^m, i ttf 730 ccrm. (or fSse-ij).
Wmri ImcXmb. — Ferrous UictAte. Dosp, 0.13 to 0.32 Gm. (or gr. iiv).
Zkaimacology. — A colorless, odorless, syrupy liquid, with an acid taste.
Ui icooont of carelessness in manufacture it may contain hydrochloric, sul-
OT tarcolactic acid and traces of metallic impurities. It is soluble in
sad alcoholic solutions. The ordinary dose is from 1.20 to 2 c.cm.
iir rnxX't^es), diluted and sweetened.
njsuilofical Action. — Lactic acid is present in the stomach during
^ digestion of carbohydrates, especially during the first stage of gastric
n. When in excess, it forms one variety of sour stomach, and causes
ID different parts of the body, headache, etc. It has been asserted that
itxsm is due to an excess of this acid in the system, and the fact that
eymptoms sometimes develop after partaking of sour milk or
kilk acid ee^ms to lend support to this view. Such patients are benefited
fcy tbe Mte of alkaline treatment. Large amounts act as depressors to the
ivfoOB system and decrease the normal alkalinity of the blood, thus favor-
rngmrtl^c and neuralgic attacks.
Bcrmpy. — Locally, lactic acid, diluted with water and glycerin, has
Ian ased in tuberculosis of the throat and larynx and in diphtheria and
a eolvent of false membrane. In lupus or tubercular ulceration of
Um^e it has been found very useful, as well as in lupus of the face^
" <16 to 30 per cent.).
A •olutioD of lactic acid varying in strength from 10 to 30 per cent.
10 m beneficial application to many laryngeal tumors. In a 20- to 40-
it. iolution it has been employed with good result in suppurative
and nlcen of the nasal fossx. AIosctig-Moorhof has used concentrated
acid locally in caries, lupus, and epithelioma.
lo the external lesions of tuberculosis. Dr. Zippel, of Hamburg, pre-
la the application of gauze tampons soaked in lactic acid. In the treat-
moA of lubcrculous iistuls the same writer recommends the introduction
^9«da composed of a paste made by gently heating 50 grammes (oiSv) each
tf Mlatin, lactic acid, and water, and then adding 30 grammes (5j) of men-
Ak. Tbc rods made of the congealed paste are covered with a layer of
^vith deficient secretion, pepsin may be combined with
'I after nioal?. Lactic acid is useful in lirha;niin and i)hos-
lu thp green diarrhoea of infancy, attributed by Hayem to a
tliift ^gewi Well diluted (4 c.cm., or foj, in a tumblerful of recently-
^^}^^» **'eetened with white sugar, of which solution a teaspoonful
giTdi erery half-hour or hour, according to the case) is a very effi-
124 PHABMACEUTICAL THERAPEUTIC AGEXTS OR DRUGS,
cient remedy, controlling" irritability of the stomach, relieving paioj
changing the character of the discharges. It has been shown, however,
some of these cases are due to a specific microbe, while others depend
hepatic disorder. In the latter class of cases the remedy ia of no ti
Lactic acid is also of value in the vomiting of newborn babes caused by
gestion. It is likewise useful in the diarrhcea of typhoid fever, intei
catarrh, and intestinal tuberculosis. Dr. N, V. Lojkin regards lactic a(
of great value in the treatment of chronic dj'sentery.
From theoretical consideration, the use of lactic acid in diabetes me
was proposed by Cantani. Cases have been reported in which, coni(
with appropriate dietetic regimen, it appeared to favorably influenc*
disease and lessen the quantity of sugar excreted. In other cases, ago;
proved a faihire.
Dr. Foucaut, of Orleans, suggests the use of lactic acid as a pre
lactic in gout. lie gives 4 c.cm. (or f.>j) a day for three weeks or a m«
when the remedy is discontinued for ten or eleven days, after whichi
resumed in the same manner It is said to reduce the number of attackj
to render them less painful. ,
Lactic acid has been successfully used in arthritis deformans. J
torin/ in a case of ten years' standing, the last year of which the pa
kept her bed, began with 0.60 c.cm. (or mx) on an empty stomach, no
being allowed for an hour and a half afterward, and gradually increa8e<
dose to 2.50 c.cm. {or mx\) a day. In three weeks the woman could ge'
of bed and walk a little, the iiftins being much relieved and the joini
cumferencc slightly diminishod. The improvement continued uiilil no
was required* and ordinary duties could bo resumed. No intermil med
other than luetic acid was given, and no external treatment except 8
massage.
The ammoniacal decomposition of the urine which takes plac
chronic cystitis is checked by the administration of this remedy.
Ferrous lactate is in the form of greenish, crystalline ecales or cr
and is used as a chalybeate tonic, being less astringent and constipating
other iron salts. Zinc lactate has been used in the treatment of epileps
0.13 Gm. (or gr. ij) doses, thrice daily, gradually increased to 0.65 Gm
gr. x).
ACIDTTM NITItlCirM: (U. S.R, B. P.).— Nitric Acid (HNOJ.
Preparation.
Acidum Nitricum Dilutum (U. S. P., B. P.). —Diluted Nitric Acid (contalr
per cent., by weight, of absolute nitric acid; B. P., 17.44 per cent.). Dose, O.J
1.20 c.cm. (or mv-xx).
Pharmacology, — Nitric acid (U. S. P.) contains GS per cent., by wei
of absohite nitric acid and 32 per cent, of water. B. P. contains 70
cent,, by weif^dit, of hydrogen nitrate.
The anunonium, lead, and eodium nitrates and nitrohydrochloric
are oflBcial in the IL S. P.; potassium and silver nitrates, spirit of niti
ether, bi&iTiuth subnitrate, and diluted nitrohydrochloric acid in U. S
' La Mtdeoine Modeme. vol. ix.
ACIDUX XITRICfil. ^^^^ 125
"P. The solutions of ferric and of mercuric nitrate are official in the
■ , and solutiuu of ferric nitrate and acid solution of mercuric nitrate
j^ b. P.
n7Biolog:ical Action and Toxicology. — Diluted nitric acid when ap-
fbtd to the skin produces a yellowish discoloration. Stronger applications
MBMioo a bullous eruption resemhling pemphigus.
latrodnced into the stomach in a concentrated solution, nitric acid is a
okat corroeiTe poison, and produces vomiting, pain, and distress, at once,
Uknnd bj inflainmation and sloughing of the mucous membrane of mouth
tad fBtophAgas. Alkalies, demulcents, and milk diet constitute the treat-
■sbL ratal accidents occasionally happen from inhaling the fumes of
Bstric, or other mineral, acids. In small doses nitric acid stimulates the in-
glandfi.
When its use has been too-long continued, nitric acid causes salivation,
and bleeding gums, with loosening of the teeth, foulness of the
la«stk« dyspepsia, colic, headache, and debility. These untoward effects
diaappear when the remedy is suspended.
Therapy. — Nitric acid is an oxidizing agent in the laboratory, and when
in etrong solution it has a decidedly caustic action, staining the skin
It is the preferred caustic for venereal sores, warts, poisoned wounds,
;;^edijena. In uterine ulceration, prolapse of bowel, and
■ acid i:? a useful application. Nitric acid has been suc-
OMlttUy employed in the form of a lotion or foot-bath in the treatment of
'*«llilaxxi8. Introduced into the system in small doses, well diluted, it acts
la astringent tonic, especially useful in cases of atonic dyspepsia, in uric-
tfid iH^thwia and oxaluria. Small doses of nitric acid are servicea1>Ie in
ACBtatiti&. In broken-down syphilitic subjects, or in chronic liver disease,
atrie acid is a useful restorative.
A rery yaluable prescription, especially for the treatment of chronic
rTpliilifi, is as follows: —
B Jui6i njtrici dil , 12130 ccm. or wcc,
rhiidrxtracti lapptr *. 90| ccm. or fjiij.
flaUrTtraoti xanthoxyli 60| ccm. or fjij.
M. ctf ■ Od? or two Iciittpoonfuls in water three times a day.
Tp ^Tilnte solution (O.fiO or 1.20 to 30 ccm., or wx-xx to f^j) it has
;*. '. in ra«w^ of phosphatic calculi, to wash out the hladder, and it may
w . :" -r injection into sinust'S connected with dead bone. A few drops
rf6::r:t ijiid to 30 ccm. (or fjj) of water is an excellent stimulant application
wiadolent nJcers. In whooping-cou^h, or bronchial catarrh, it has been
id«9atcd, and in hoarseness of public speakers a few drops in a glass of
•Iter afford relief. It is inadvisable to continue too lonsf the administration
^BifnV «.-:*?_ fl*. in that case, it excites gastro-intestinal catarrh. The same
T^^. to the other mineral acids.
ij3 iTJuii> olvin diseases, such as impetigo, lepra, acne, the addition of
mine 9eid to the bath has l>een found useful in addition to its internal ad-
mamtntiou,
JBgtnm. Camphora Acida (N. F.). — AntidYsenteric mixture, or Hopes
^phor mixture:—
126
PHARMACEUTICAL THEHAPEUTIO AGENTS Olt DRUGS.
B Acidi nitrici* 1 75 c.cm. or fiixxv1|
Tincturn? opii 1 20 c.cm. or wixix,
AquBB campliornj 100 c.cm. or fSiiisB.
M. Dosi', a tablespoonful every hour or two, according to syiuptonis.
for diarrliOEiis of relaxation, t-spccially in elderly persona.
Diluted nitric acid will often relieve chronic diarrhoea, and ita eS
may be increased b}' the addition of witch-hazel, thus: —
3 Acidi nitrici dil 10! c.cm. or mclx.
Fluidext. humanielidia 11 c.cm. or f3iij. |
Syrup. auranlU iSOj ccm. or f^iv.
Al. Sig. : From one to two tca^poonfulft in water three or four Umea a di^
In the daily dose of 4 to 15 c.cm. (or f5i-iv) dilute nitric acid has »
times proved successful in diabetes insipidus, and it is said to allay the t
of saccharine diabetes.
Full doses of well-diluted nitric acid, every fourth or sixth hourj
useful in intermittent fever. After the paroxysm has been broken ui
quinine, nitric acid may be aen'iceably given, in order to relieve inact
of the lirer and intestinal glands. Small doses of nitric acid are bene)
in aphthae and ulcerative stomatitis.
Nitric acid reddens morphine, and probably decomposes it; and, tl
fore, should not be prescribed in solutions with this agent, as the rule,
nitrites have a decided lowering influence upon the temperature and
culation; they will be considered in connection with arayl nitrite.
ACIDUM NITROHYDROCHLOKICUM (U. S. P.).— Nitrohydrochl
Acid, Nitromuriatic Acid (nitric acid, 18 parts; hydrochloric acid, 82 pa
Preparation.
Acidum Nitrohydrochloricum Dilutum (U.S. P., B. P.). — Diluted Nitroh}
chloric Acid (Dilut'ed Nitromnriiitic Acid J (contaiHS 4 parta of nitrir acid, ]
hydrocliloric noid, and 78 parts of distilled wntt»r). I>»*c, O.SO to 1.20 r.cm*
mv-xx ) .
The B. P. preparation i» confiiriernbly stroiigor (Nitric Acid Enj] liydroch
acid fjiv; diHtilli^d water fjxw. )
Symptoms of poisoning and methods of treatment same as given ui
Acidum Hydrochloricura.
Pharmacology and Therapy. — The strong combination of nitric
hydrochloric acida is nllicial only in the U. S. P. It should be allowi'i
stand for tw^ wcekfi after mixinir, and kept in a cool place. The coin
traterl Rohition readily dissolvos gold leaf when imiuei-sed in it. For mod
purposes, it should be greatly dihitod. It is supposed to have a special ari
xipon the hepatic functions, and is a good tonic and nstrinfient. It has b
applied upon eomprespes in ehronic liver disorders, in a si>lution (15 e.c
or f'ss, to 473 c.cni.. or Oj, of water).
Internally, the dihite aoid i."? given in plenty of wnter, nnd genori
through a glass tube, in torpidity of the liver, the chronic hepatitis of
tropics, and in the early stage of hepaile cirrhosis. It is of service in cliro
diarrham and dysenteric diarrhcen. This aeid has been occasionnlly hue
to produce salivation.
*The original formula for this preparation called for nitrous acid, but as c
mercial nitric acid usually contains som*? nitrous, it mar ho URcd as ahove.
ACIDOM OLEICUM.
127
ACaxm OLEICUM (U. S. p., B p.).— Oleic Acid (HC^jH^O.).
An organic acid, prepared in a sulficiently-pure condition, by cooling
eoBBcrdal oleic acid to about 5" C. (41* F.), then separating and preserv-
9g tb« liquid portion.
Preparations.
QlmtaBi Airopann <U. S. P.). — Oleutc of Atropine (2 ];cr cent.).
OIntam Cocaine (U. S. P.J.— Uleate of Cocaine (5 per cent.).
Olfliiiii Qnin iru^ — Oleatc of Quinine (25 per cent.). . *
CW— twin Veratriiue (U. S. P.}.— Oleate of Veratrine (2 per cent.).
niwatiini Hydnugyri (U. S. P., B. P.)-— Oleate of Mercury (U. S. P. preparation
^miMitm 9)L£3 per cent, ^^ith oluic acid, representing 25 per cent, mercuric oxide).
CaglMeBtum Uydrargyri Oleati» (B. P.). — Mercuric-Olcate Ointment (1 to 3 of
rq^ocatum Zinci Oleatta {B. P.). — Zine-Oleate Ointment (50 |>er cent.).
Ikarmacolcgy. — Oleic acid is an oily, yellowieh, tasteless liquid, grad-
aZIf becomiikg brown, rancid, and acid when exposed to the air. It is
sahible m. water, but i^oluble in alcohol, ether, etc.
Oleic acid, fresWy prepared, is a bland and unlrritating application
^dttikin. and was brought forward as an addition to ointments and lini-
BflBlsto increase their penetrating power, but lanolin has now largely taken
^ plic« for this purpose. Lately, greatly through the influence of the writ-
: -1 of the author, it has been much used in the manufacture of oleates,
•«j£h arc now produced in the form of true chemical compounds, instead of
mixtures, as heretofore.
Tb« following is a summary of the action of the oleates, from "Oint-
itB and Oleates, especially in Diseases of the Skin''^: —
The Oleates,
JiaamHiac 01e«te. — Xot verr active. Can be used in neuralgia.
Oleate. — Diluted one-half with Urd or home fatty substance, it forms
it of the oleate of aluminum, which is decidedly astringent 'It is useful
the muc<>-j)urulrnt discharges of dermatitis and eczema, and in chafing,
, especially in infants and young children. In hyperidrosis and in bromi-
it m very efTective. This ointment is also a uwful dressing to burns, foul ulcers.
ftad sinuses.
WB Oleate — A valuable alterative and eschftrotic, but it roust be used
MOtfaiii The »teate. when melted with lord or ointment base (1 to 4 or 1 to 0),
I tW ointment of arscnum oleate. This hns little action upon a healthy skin,
vktB tbe epidermis has been removed, or on granutnting surfaces, it produces
and destroys the vitality of the tissues to a considerable depth. When
it exertfl a most excellent alterative impression upon the integument;
in itlc^nitiMa epithelioma, in lupus (after scraping), and in old scrofulou«
*«*• ihim 6a of great utility. In sycosis, soborrhtpa. tind chronic pceeroa it is like-
«i» «f w»t rfcce. After scraping or puncturing the affected area, it can be umhI to
irarta. corns, horns, eondylomata. old granulations, and na?vi. It may be
y combined with opium, belladonna, hyoscyamus, arnica, arrow-Voot,
tfc. ' Kor foriiMiIir, %«• author's *to<>k on **' Mf*«tes." i
Oleate. — Not very active. Constitutional elTccts not produced except
s^Bv fefM Mirfare^ are snointed.
Mamuth Oleate. — Emollient and slightly astringent. In all puatular eruptions,
s fWHtifl. it relie'ves the itching and often aborts the pustules. It allays irritation
S Hjijinlaa ms%d aiinbuni. In none rosacea, it relieves the inflammntion. and. in
a^HBOS trith acorifl cation of the stirface. in curative. In acute ecxeina, this oleate
%aHCto«4 ladUpenaable in arresting the progresA of the malady. Cracked and sore
'
"Qifiil ErfHion- Philadelphia: The F. A. Davis Company, Publishers. Phy-
' Stu<l«nta' Keady- Reference Series. 1890.
138
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
nipples are usually healed by the olcatc-of-bismuth ointment (1 part of bismuth'
to 7 parts of ung. aquse rosse).
Cadmium Oleote it stimulatinff and irritating. It hat been used in d
eczema with great infiltration, exuoerant gronulationa, and enlarged gland
strength of the ointment being adapted to each case.
Cocnint' Oloiitu (U. S. P.) I'outainft '» pfr cent, of the alkaloid. It can b<
bincd with equal parts of ointment or hinolin. It has not answered expectati*
a local anodyne or anresthetic. but has b<»en used with some Umefit in pt
pudendi and ani, or eczema marginatum.
Copper Oleate, in the form of 10- or 20-per-cent. ointmeut, has no visible
upon the healthy akin, but penetrates deepiv into the lolliclea, where it ex
stimulating and antiseptic action- It is deeiuedly astringent to the broken d
raw surface, reducing exuberant granulations, checking haemorrhage from ir]
sores and old ulcers. Owing to iti» parasiticide action, it is the best remedy fi
various forms of ringworm. In tinea versicolor, even in favus, it is equally cfl
in destroying the pura&ite without epilation. Cojjper oleate, melted and sprea*
plaster, will very often cure worts, corns, bunions, and thickened conditions i
epidermis. The ointment above referred to is also useful in freeklea and oth<
colorations of the skin. It is esfietitiril that the sa.lL should be made from pun
acid, as otherwise the application may be accompanied by irritation or inflamo
of the skin. The weaker ointment (0.32 to 0.65 Gm., to 31.1 Gm., or gr. v-x
should be first tried and the strength gradually increased.
Iron Oleate is a valuable styptic and astringent. The use of a weak oiii
in the inflammatory form of eczema, in which the surface is raw and bleed!
followed by good results; also in pustular eczema, sycosis, furuncles, and in sera
sores. Mixed with the oil of ergot or any bland oil. the iron oleate is of gm
vantage in dry seborrhoea and in patches of alopecia. The early stages of acne rJ
are often entirely relieved by the weak application of ointment of iron i
In ulcers caused by arsenical poisoning, this has given better results than any
remedy in the hands of the writer, especially with tlie addition of I per ci
carbolic acid.
F.end Oleate. melted with equal parts of lard-oil, or lard, forms a cream-c<
semisolid ointment, which is superior to Goulard's cerate or Hebra's litharge oint
It allays irritation in papular or pustular etKema, and also in fissured eczema >
hands or feet. In hard and indurated papules, as in acne of the face, neck, and
it is excellent in its clIin-tM. Thymol, naphtlml, curbulir acid, oil of chamomile,
of cade may be combined with it, according to the case.
Manganese Oleatfi has been used (a 10- to 20-per-eent. solution in ointmei
a remedy in amcnorrha^a and other uterine affections, applied with friction f
flbdomt^n. rrolmbly its asserted good efTects are to be attributed to the mi
rather than to any constitutional effect from the manganese, as tliere is no ev]
of its absorption.
Mercuric Oleate (U. S. P., B. P.). — The ointment of mercuric oleate is a y
ish substance of fatty consintence. it is stimulating to the skin, and has a d'
alterant action n|>on the glandular structure.-*. In old eczema, with thickening ■
skin, this twofold action ia very beneflcial ; also in pnpuhir and tubercular lesion
infiltration attendant upon abscesses. In intlammation of the hair-follicles, s}
and wrofulodermata it is quickly curative. Its bactericidal action makes it val
in all cases of parasitic invasion of the skin: and, in the treatment of louaines
addition of picrntoxin (Va of 1 per cent., or gr. i-J]) is advisable, in order to d<
the vitality of the nits. If it is desired to produce a constitutional impression, h
may be added, or mercurous oleate substituted. In fact, mercuric oleate is aba
only very slowly. I^rge quantities have been applied to the surface without
ducing constitutional effects.
Mercurous Oleate. — This ointment contains a higher percentage of mercury
the preceding (41.6 per cent.); it is aubstitutod when it is desired to make a
profound impression upon the structures of the skin, or to practice the inur
treatment of syphilitic affections, and for this is far superior to either the ord
blue ointment or the mercuric oleate. In old 8pot« of peoriaaift and chronic pi
and palmar eczema it can be used alone, or combined with some form of t
uaphtliol.
Morphine Oleate has only a feehle action upon the integument, and hi
special advantage.
ACIDUM OXALIOUH. 129
Nickel Oleate, in the form of ointment with some latty base, has a very decided
utringent action upon abraded surfaces. In the proportion of from 6 to 20 graina to
the ounce of lard it acta well in epithelial ulcerations, old callous ulcera, or chronio
Quinine Oleate (U. S. P.), 25 per cent, alkaloid, has some antiseptic action, bat
has no special advantages.
Silver Oleate coagulates albumin, and, when sprinkled over sores, coats the sur-
face and excludes the air; at the same time it stimulates granulations and cleans off
the surface. Dissolved in oleic acid and mixed with lard (5 to 60 graina to the ounce )»
it forma a dark-brown, pliable ointment, which may be applied in cases of eryiipelaa
to keep Uie inflammation from spreading. In superficial lupus it sometimes lessens
oeU-innltration and reduces active Inflammation. In boils, carbuncles, eczema around
the genitaia or on the buttocks, especially if attended by irritation or itching, marked
relief followa the application, either alcme (m* combined with opium, belladonna, or
hyoecyamuB.
Strychnine Oleate has no special value as an ointment.
Tin Oleate. — ^The ointment (0.65 to 4 Gm., or gr. x to Ix-Sj) ia & ^yiah-brown
ointment, possessing some astringent and tonic action. It is of especial service in
diseases of the nails and in irritation of skin around the nails (agnail, etc.).
Veratrine Oleate (XT. S. P.) is official in 2-per'Cent. solution in ointment. It hat
decided counter-irritant and benumbing effects upon the skin, making it useful in
some cases of neuralgia or tender spots.
Zinc Oleate (U. S. P., B. P.), is a fine, pearl-colored powder, soft and soap-like to
the touch, is astringent in its effects, and can be used as a dusting-powder in hyperi-
drosia and bromidrosis. In local sweating of the axillffi, genitalia, hands, or f^t,
f^teeially when attended by maceration o7 the epidermis, this agent is very useful.
Murrell, of London, has also used it in .the sweating of phthisis, combined with thymol
(1 to 300), Salicylic acid (3 per cent.) or French chalk may be added to it, for
the treatment of local afi'ections, such as comedo and acute vesicular eczema. In all
such acute inflammatory affections it can be used with advantage, where greasy
applications cannot be borne. It has also been used in gynecology as an application to
cancerous ulceration of the cervix uteri. Here it may be combined with iodoform
(zinc oleate, 1; iodoform, 2 parts).
ACIDXTM OXAnClTM.— OxaUc Acid il^,Cp^2B.^0).
Fhannacology and Therapy. — Oxalic acid is an irritant poison, and is
sometimes taken by mistake for Epsom salts. Its antidote is lime, chalk,
calcium carbonate, or whitewash.
Dr. F. J. L. Hart* reports two cases of poisoning by oxalic acid: One
in^ance was a boy, aged 15 years, who had taken about 12 Gm. (or 3iij) of
the acid; he had several convulsive seizures, his pupils were dilated, lower
jaw fixed in a tetanic spasm, froth exuding between the teeth, and pulse
could not be felt — stomach- washing and the hypodermic injection of apo-
morphine, 0.006 Gm. (or gr. ^/io)> were resorted to as well as brandy, strych-
nine, and digitalis. The patient in a few days made a good recovery. In
the second case the quantity taken was unknown, the patient dying withia
one hour. •
Dr. Talbot Jones, of St. Paul, has reported four cases in which acute
articular rheumatism was apparently produced by prolonged contact with a
Eolntion containing oxalic acid. The patients, engaged in making bluing,
vere accustomed to keep the hands and forearms immersed while stirring
the solution.
According to Taylor, 4 Gm. (or 3j) is the smallest quantity of oxalic
acid which has been Imown to destroy life at the age of sixteen years, death
occurring in eight hours. Under three minutes is given as the shortest-
* lancet, Oct 1, 1898.
130
PHARMACEUTICAL TIIERAPErTIO AGENTS OR DRUOS.
known period of survival alter an unknown quantity of this poisoil
been takiin.
Oxalic acid has, at the suggestion of Dr. F. Poulet, been emploj
an emmenagogn^ie. Dr. A. W. Marsh hag found it useful in nnienon
He remarks that the remedy is not unpalatable, and. in medicinal (
is unirritant to the stomach. Dr. Marsh also recommends oxalic ac
the treatment of acute cystitis from whatever cause. He is accusfe
to prescribe: —
H Acidi oxalici 1 1 G"»- or P", xv,
Svr. nurant. cort 301 c.cm. or fjj.
Aqii* 9m c.cm. or Qiij.
M. et ft, sol. 1
Sig.: TeHBpoonful every four hours.
Poulet has found oxalic acid useful, likewise, as an expectora)
asthma, capillary bronchitis, and tuberculous bronchitis. He recoran.
the following formula; —
R Acidi oxnlici 2 Gm. or 3s3.
Infua. eamelliae 180 ccm. or fjvj.
Syr. nurant cort. 00 c.cm. or fjij. ,
M. et ft. sol. I
Sig.: A teaspoonful every hour.
In some cases where oxalic acid wfts given in 0.032 Gm. (or gi
doses. Dr. F. W. Talley, of Philadel|)hia, ol)servi^d that the remedy ct
nausea, gastralgia, and an eruption resembling urticaria. When adir
tered in solution the acid nuist be disgolvcd in t'ither rain or distilled m
in order to avoid the deposition of oxalate of calcium of hard water.
ACIDUM PHOSPHOEICTm (U. S. P.) — Phoaphoric Acid.
ACIDUM PHOSPHOEICUM CONCENTRATUM (B. P.).— Concenti
Phosphoric Acid.
ACIDITM HYPOPHOSPHOROStTM (U. 8. P.).— Hypophosphc
Acid (30 per cent, absolute acid).
Preparations.
Acidum Phosphoricum Dilutum (U. S. P., B. P.). — Diluted Phosphoric Aoi*
per cent., by weight, of oithopho.sphoric acid; K. P. contains 13.8 parts of hydi
orihophosphattO. Doac, 0.12 to 1.20 coin, (or wii-xx).
Acidum Hypophoaphoroaum Dilutum {U.S. P.). — Dilutwl Hypophosphi
Add (conlnins 10 per cent by weight of absolute acid, with flO of water). Dose,
to 2 c-cni. (or »/(x-xx.\).
Syrupus Hypopliosjiliituin Compo:^itiim {U. S. P.). — Compound Syrup of I
phosphites. Dc>st», 4 to S com. [or 3i-ij ) .
Pharmacology. — Phosphoric acid in the solid form, glacial phospli
acid, is not ofhcial. The official phosphoric acid is a colorless, odor
syrupy liquid, containing not less than S5 per cent., by weight, of abso
orthophosphoric acid and not more than 15 per cent, of water. The Bri
concentrated phosphoric acid contains only 66.3 per cent, of hydrogen or
phosphate. The diluted acid contains 10 per cent., by weight, of abso
orthophosphoric acid and 90 of water (13.8 parts of hydrogen orthop
phate in B. 1\). The dose of phosphoric acid is 0.13 to 6.5 c.cm. (mij-vi
ACIWM PHOSPHORICL'M.
131
?^a>lMfiii>l Action. — Phosphoric acid, locally, is an irritant, and
ti iome escharoiic effect. When taken internally, well diluted, it aids
litioa anil growth, as it is an essential element in all bony and vascular
in the form of phosphatea. It is also, like nitric acid, a stimu-
kax to oxidation. It improves the appetite and the digestion, increases
■ovtion, u>d is synergistic with the vegetable bitters. Phosphoric acid has
ken kaown to give rise to an eruption resembling that of pemphigus.
Tkermpy. — In all debilitated conditions of the system, in anaemia, in
4e€xluitwtioii of prolonged lactation, in bronchial catarrh of the ajred. phos-
acid IS an excellent tonic; it is also useful in struma and wasting
Its action being different from phosphorus in substance, it is less
Dt in the treatment of neuralgic conditions.
Pboephoric acid is especially valuable as a tonic in the following for*
ft Aodi pbo«pborici dil 15
Tl3ct. nucifl Tomica 12 2
Ttect. fern chloridi 60
^rr pruDt \"iTg. 75
N '"■? ' From one-half to one teaspoonful in a wineglass of water, taken through
h«L«r mcala.
ccxn. or fSsa.
30 com. or mcc.
c.cm. or fjij.
c.ctn. or fjiiss.
S AcfiA* fAiOsphorici dU 1
8UjtJuia« sulph
QiftmMk 34
8yr. ■vrantii 105
c.cm. or f3iij.
03 Gm. or cr. ss.
ccm. or IZ'tx.
ccm. or fSiiiss.
One teaipoonful in wineglaas of water, taken through a tube after
Vadcr the name of liquor acidi phosphorici compositus (N. F.) an
tA tonic ia furnished, composed of the following ingredients: —
Botie-sah 1000 parta.
Ncilpburic acid (free from aracojc) 7S0 porta.
Water 4000 pwta.
ei-
>kieh ic spproximated by the following formula: —
UQVrm rHO^l'HATlM ACIBL'S ACID BOtfTlOX OF PHOSPnATES.
CiUii pfaoaphatifl 25 Om. or gr. 384.
phoAphatU 4 25 Gm. or gr. ft4.
phMphatU 2 10 Gm. or gr. 32.
FIbtI pbo«phali« 4|25 Gm. or gr. 54.
Aeiai phosphorici (tp. gr., 1.710) 60 c.cm. or m 808.
^■B q* •• ad 4731 ^■'^Qi* ^^ fSxvj.
M. SIg.: TlUa preparation may be given in teaspoonful doses, well diluted with
Giren before myala, phosphoric acid is beneficial in h\7)eracidity of the
iMBftch, whether due to increased production of hydrochloric acid or the
wmit of ferineDtative changes in the food. Phosphoric may reasonably be
^rdemd to the other mineral ncids in the treatment of typhoid fever when
^ pivdofninftA ^ symptoma denote great nervous prostration. In diahefes
^Sm nhoephortc-acid lemonade answers a useful purpose by a&suaging
^^ 1^ t^MB been employed in rickete.
132
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
The diluted solution may be applied as a stimulant to indolent I
and it has been proposed to inject it into enlarged glands.
The comiwimd syrup of the hypophosphites is a jwpular and an I
able tonic. (See formula pven under Calcium.)
Dose, 4 to 8 c.cm. (or 3i-ij jj given in water, three times a day. i
ACIDUM PICEICTTM.— Picric Acid.
Pharmacology. — Picric, or earbazotic, acid (trinitrophenol) is i
form of pale-yellow scales, soluble in water, and has a very bitter
Owing to its power of coagulating albumin, its watery solution foi
convenient test for albumin in the urine ; it is also a test for peptones. ]
doses cause Yorailing, purging, and collapse. Internal dose from 0*
0.13 Gm. (or gr. ss-ij) ; of the ammonium salt, 0.03 Gm, (or gr. ss.)
Therapy. — The application, five to ten times daily, of a G-per
solution of [licric acid has been found useful in erysipelas. Picric acid
stitutcs also a good dressing to superficial burns, and has been use
several years for this purpose in the Charity Hospital of Paris. A
rated solution (about 0,5 per cent.) of picric acid is applied upon
presses. It exerts an analgesic eifcct upon the surface. It usually
rise to no irritation, and the only disadvantage of the method is tha
solution communicates a yellow stain to the tissues with which it c
in contact. Dr. Charles Willems* of Ghent,* speaks favorably of it:
in burns of the first and second degrees; he uses it in the form of an
ment in the strength of 1 to 2 per cent.; he has never observed any
symptoms from its use, and the only inconvenience has been a yellow
coloration of the skin, which may be got rid of by alcohol washing or
watery solution of carbonate of tithium. The late Dr. Quinquaud re
mended picric acid as a local remedy in epithelioma. In chronic ec;
Calvelli claims good results from the application, several times a da
a solution of 1 y. parts of picric acid in 250 parts of distilled water.
The ammonium salt has been highly praised in the treatmd
whooping-cough and malaria, the average dose being 0.032 Gra. (or g:
four or five times daily. Dr. Marten Clark asserts that this salt has pi
eflficient in malarial neuralgia. Picric acid should be used, cither inter
or externally, with caution, since it is apt to excite urticaria and other 8}
toms of systemic intoxication.
Shoes lined with leather dyed yellow by picric acid have been kr
to excite violent dermatitis, the feet becoming swollen and being cov
by innumerable vesicles, which coalesced and became filled with pun;
serum. Constitutional reaction was also observed.
ACIDUM SALICYLICUM (U. S. P., B. P.).— Salicylic Acid (R€,E.^
Dose, 0.32 to 1.20 Gm. (orgr. v-xx).
Preparations.
Ammonji Salioylus (U. S. P.). — Ammonium Salicylate. Dose, 0.12 to 0.60
(or gr. H-x).
Bismuthi Subiialicylaft (U. S. P.), Bismuth salicylat* (B. P.). — Dose, 0.1
1,3 Gm. (or gr. ii-xx).
Quinine RftUcylaa (U. S. P.). — Quinine Salicylate. Dose. 0.13 to O.QO
(or gr. ii-x).
^Annalcs de la SocUt^ Beige de Chintrgie, May 15, 1898.
AGIDUK 6ALICTLI0UM.
133
Sovntii SftlkyU* (L\ S. P.).— Stroutium SAlicylatv. Dose, 0.30 to 2 Gm.
^gt- T-3be).
Lhhii Salicybu (U.S. P.). —Lithium S&licylate. Dose, 0.32 to 2 Om. (or gr.
Pbenji SalicTlu (U. S. P.).— Phenvl SaUcrlate. (See Salol.)
^o^ SabcyUft (U.&P^ B. P.) .—Sodium Salicylate. Dose. 0.65 to 2 Gm. (or
1^ X xxz».
Uv^aflBtuiB Acidi Saticylici (B.P.). — Salicylic-Acid Ointment (2 per cent.).
Aaylltm. — Aoetrl-aalicylic Aci<L Dose, name as Salicylic Acid.
Fiiarmacology. — Salicylic acid is an organic acid existing naturally in
— liiiialioD in various plante, but most largely prepared synthetically Irom
ozbolic flcid. It occurs as fine, white, needle-shaped crystals, soluble in
tfi pAits of eold or 14 parts of hot water; and in alcoholic solutions in
IQ putt of chloroform, 60 parts of glycerin, and in 2 parts of olive-oil (by
■d of heftt). Thirty c.cm. (or fgj) of sweet spirit of nitre will dissolve 1.04
Gb. (or gr. xvj) of salicylic acid. The solution remains clear even upon the
rirfrrtop of water. Crystallized salicyhc acid is pure and without odor;
fttcd acid has a rather peculiar, disagreeable taste; the sublimed acid
pink colored, and smells of phenol. Dialyzed salicylic acid is pre-
11 ia claimed that the natural acid made from the oil of gaultheria
k»the best and purest form in which to prescribe it.
njnolof^cal Action. — Salicylic acid is an antiseptic and antiferment,
md prerents souring of beer, cider, or milk, or the putrefaction of urine.
flSTTHte the action of saliva upon starchy food. It is injurious only when
1 eoBstantly and in relatively large doses. It is very irritating to raucous
and is not to be administered in pill, powder, or capsule, but
rfn^ft in eolution, and preferably with ammonium or potassium acetate,
inzn citrate, or ammonium phosphate, which increases its solubility
r, or it may be given in some syrup or elixir of orange.
lUcen internally, it reduces abnormally high temperature. In health
i action is not observed, although some observers assert that a slight re-
is produced. Sometimes headache, giddiness, and ringing in the
■nkave been noticed, but usually no marked effect is seen upon either pulse
irnmiration. According to Vanden Corput, salicylic acid diminishes the
Incootial activity of the testes, although it is asserted to cause congea-
fi« of the uterus and ovaries. It may produce abortion and, therefore,
Aoold ba cautiously given in pregnancy, especially when a tendency to
akMJoo or premature confinement exists. Toxic doses cause slowing of the
hnalfcing'. Convulsions, nausea, burning in the throat, vomiting, and gaa-
ttk irritjibilitT have also been observed to occur, followed occasionally by
■buninnria, ha^maturia, or almost complete stoppage of urine. This is a
^Tiatjon from the normal action, for in ordinary cases it acts as a diuretic,
•ilfc afi^t increase of elimination of the urates and urea. Piccinini states
ttst* afC£r the administration of sodium saHcylate, peptone is to be found in
Af mine. Salicylic acid is absorbed with rapidity, but slowly eliminated.
h teste nephritis it diminishes the quantity of the urine and increases the
■eportioD of albumin. It is stated that deleterious etTects are particularly
I to occur in drunkards from the use of salicylic acid.
The t»**tm^nt of intoxication by this agent is that for an irritant poi-
tlie atomach should be washed out with warm water, decoction of coffee
ler^> ***^ ^^^ patient treated symptomatically. The effects rapidly
t off «« th« acid is carried out from the system by the urine, principally
134
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
without change, partly also as salicin and salicyluric acid. Probably
also escapes in the sweat and saliva. After excessive doses the urine bee
olive-green in color, from the presence of indican and pyrocatechin. T
substances result from the action of the pancreatic juice upon salicylic
or it may indicate the presence of phenol in the salicylic acid. A soli
of chloride of iron strikes a violet color with urine which contains sali
acid. In the body, the acid combines with glycocol in the liver and
where, and becomes converted into salicyluric acid. The ingestion of
cylic acid, or sodium salicylate, may be followed by the development of
ous cutaneous lesions. Erythema with oedema, intolerable itching and
gling of the skin, and fever have been caused by large doses of the so*
salt. Other effects which have been observed are vesicles, pustules,
patches of ecchymosis.
Therapy. — For external use salicylic acid may be combined with c
as a dentifrice. A similar mixture may be used for the relief of fetid
spiration (feet or ajiilla), or witli talc or corn- or rice- flour. In jL,'an;xrei5
sloughing cancer, it may be applied. Sut causes burning pain. D^es:^ing
be saturated with an alcoholic solution and subsequently dried. It is n
powerful as carbolic acid, yet it has the great advantages of bein^ odo
and freer from danger of toxic symptoms following absorption. It is
used in solution as a substitute for carbolic acid in the details of the mo
antiseptic method. (A solution can be made by adding 8 parts of bora
100 parts of boiling water, and, when dissolved, adding 10 parts of sali
acid, and filtering when cool. On account of its irritant action it is r
good application for diphtheria or croup.) A saturated solution of salii
acid, in collodion, is a very effective application to corns and warts. Tine
of cannabis Indica is often added, but it produces an unsightly stain wit]
conferring any additional advantage. The solution of salicylic acid in
lodion is likewise asserted to be an efficacious application in scabies, thel
having previously been cleansed by means of a hot alkaline bath. An <
ment containing this substance is sometimes of benefit, especially in chr
eczema and in ulcerated lupus vulgaris. A similar application is efficac
in lupus erythematosus of the face and eyelids. A powder composed
parts of salicylic acid, 15 parts of zinc oxide, and 30 parts of powdered sti
may be employed to relieve the itching of urticaria and in ecz<
From 0.32 to 4 Gm. to each 31 Gm. (or gr. v-lx to Jj) of lard, lanolin, or o
excipient will sometimes remove freckles. On account of its germic
virtue, it may be advantageously used in the treatment of tinea circin
It has been found useful as a topical application in thrush and catar
stomatitis, in which conditions it acts as a local anodyne. It allays the bi
ing pain of the erosions left after the vesicles have ruptured. The solu
is made by dissolving 1 part of acid in sufficient alcohol and adding 250 p
of water. Salicylic-acid solutions have likewise proved of value in irriga"
of the large intestine for dysentery. Acute intestinal catarrh has t
treated in the same manner with very successful results. In the la
malady the internal use of the remedy may be conjoined.
Salicylic acid may also be employed in fetid l)ronehitis as an inhala'
with a steam-atomizer, using 15.5 Gm. (or ,>ss) of borax in 503 c.cm.
f5xvij) of boiling water, to which 15.5 Gm. (or ^ss) of salicylic acid is t<
added. The same solution can b€ used in catarrhal pneumonia, in phth
etc.
ACIDUM SALICTLICUM, 135
The following formule will be serviceable as local applications: —
B Addi Balicylici 8 Gm. or 3ij.
Bismuth, aubnitrat 15 5 Qm. or Sss.
PuIt. anci oleatia 8 Gm. or 3ij.
H. Sig.: Dust over the surface. Useful in excessive or fetid sweating and in
•eborrhoea oleosa.
B Acidi salicjlici 2| vel 4
Ungt. hydrarg. nit 12
jinthol
Gm. or Sss vel 3j.
Gm. or Siij.
66 Gm. or er. x.
fv.
Betana^b
Ungt. sinci oxidi 19 5 Gm. or
H. Sig.: Rub well into the surface several times a day. For fissured eczema of
the palms of the hands and soles of the feet.
Lassar's paste is an excellent application for dry eczematons patches : —
B Actdi salicylici |65 Gm. or gr. x. — ^M.
Zinci oxidi,
Amyli aa 81 Gm. or 3ij.
Petrolftti 161 ^"^ ^^ 5^^" — ^•
M ft. unguentum.
Internally, the i^se of salicylic acid in acute rheumatism (0.65 to 1.30
6m-, or gr. x-xx, doses every hour until 4 to 8 Gm., or 3i-ij, have been taken)
for two days is generally followed by prompt relief. On account of its com-
parative insolubility, salicylic acid is now less used than sodium salicylate,
vhich is given in the same doses. It is believed that the soda salt is rapidly
converted into the original acid by the carbonic acid of the blood.
Salicylic acid approaches the character of a specific remedy in acute
rheumatism. Its most marked effects are reduction of the articular swell-
ings, the pain, and the fever. But it is not able to prevent the occurrence
of heart trouble or of relapse. It is a good practice, and perhaps shortens
the absolute duration of the case, to reduce or abandon the salicylic acid
after it has produced its most notable results, and to replace or combine it
with an alkali. It does not prevent hyperpyrexia, since that condition has
been known to occur while this remedy was being administered. It will
sometimes give rise to delirium when administered for a considerable period
in the treatment of rheumatism. The virtue of the salicylic treatment is
much less decided in chronic rheumatism, though stiffness and pain are re-
lieved in a certain proportion of cases. In subjects who are much debilitated
quinine salicylate may be employed, or, if anaemia be marked, the salicylate
of iron. In muscular rheumatism salicylic acid will sometimes afford relief,
and will often fail. The pain and swelling of rheumatoid arthritis are some-
times relieved and the progress of the disease arrested by sodium salicylate.
The same salt is, in some instances, serviceable in gonorrhoeal rheumatism.
In acnte articular gout and in irregular gouty manifestations good results
have likewise attended the use of salicylic acid or the sodium salicylate.
It has been found that the local application of salicylic acid is bene-
ficial in acute articular rheumatism. The drug acts by absorption, as it
may be detected in the urine within half an hour after the application has
been made. Dr. Bourget, who has long relied upon the external use of sali-
cylic acid, regards the following as the best formula: —
B Acidi salicylici,
Adipis lanre hydrosi aa 10 Gm. or SJiRS.
Olci terebinthintt rectiflcat 6 25 c.cm. or fSiiss.
Adipis 77 5 Gm. or Siise.
Ft. unguent.
136
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
It must be noted, however, that cases of intoxication have occum
a result of the excessive local use of the remedy.
When the salicylate causes gastric disturbance, it may be given bj
rectum, which should be previously washed out by mr-ans of a cath
enema. It is well to combine laudanum with the salicylate in order to
vent irritation of the bowel. Labeeb has witnessed benefit from the ,,
use of salicylic acid in sprains, irrespective of the presence of the rhemi
diathesis.
Salicylic acid, or its sodium salt, has been found usefid in those a
tions so often associated with or dependent upon the rheumatic diath
B8 the various forms of neuralgia, especially migraine, trifacial neura
and sciatica, chorea, tonsillitis, urticaria, and erythema nodosum. Sod
salicylate is serviceable also in erythema multiforme, especially when, i
frequently the case, the disease is dependent upon a rheumatic diath
The remedy suppresses the eruption and relieves the articular pains,
sciatica, Ringer prefers it to any other remedy. Rheumatic iritis may(
yield to its influence.
Gay has successfully employed this remedy in Meniere's disease, gt
0.20 Gra. (or ^v. uj] three times a day. The attacks of vertigo, which
been very frequent, rapidly diminished in number and severity. As impr
ment progressed, the remedy was suspended during considerable inter
In the experience of Dr. Strizower, salicylic acJd is an excellent ren
in the treatment of gall-stones. He is accustomed to give it in O.Go Gm.
gr. x) doses three or four times a day in the intervals between attack
colic, and states that it prevents the formation of concretions and has'
their expulsion.
Salicyhc acid has been successfully used as an anthelmintic. Ti
solium has been removed by five hourly doses of 0.50 Gra. (or gr. viij) ei
preceded and followed by a dose of castor-oil. Round-worms and soat-wo
are destroyed by the same agent, the latter by the local effect of an inject
the former by the internal use of the drug.
Salicylic acid may be given in 0,32 Gm. (or gr. v) doses in order to pu
the foul breath sometimes present in phthisis. Improvement has someti
followed the administration of salicylic ncid, or its combination with sodi
in dinbetes. An antidiabetic powder employed by Dr. Monin is compc
as follows: —
B Sodii bicarbonat 621 Gm. or 5ij.
Sodii bonzoat. 39 Gm. or 3x..
Sodii salicT-lat 19 S Gm. or 3v.
Lithii carbonat ISp Gm. or 5m.
M. Sig.: Teaspoonful at each meal.
The same remedy is of service in diabetic neuralgia. It is also *
ployed for its antipyretic effect in typhoid fever, pneumonia, erysipelas, !
phthisis, but it is regarded as especially serviceable in blood-poisoning i
sapraeniia, pyaemia, etc., and the eruptive fevers of children. Dr. de R
attributes prophylactic virtues to this substance in case of exposure to s(
let fever. Dr. C. A. Bryce esteems salicylic acid as of decided efficacy in
treatment of small-pox. He states that it reduces temperature, relieves pi
and limits the development of pustules. In relapsing fever it is said
render the relapse shorter and of less severity. It promptly checks
yeasty vomiting dependent upon the growth of Sarcina ventriculi. Soi
ACIDUM SAiaCYLICUM.
137
disturbances of the circulation occur from medicinal doses in
I €rf fcTcr. It is very probable that in some of these cases the results
lOTsttbtetable to impurities in the salicylic acid. Urticaria, erythema, and
entaneous symptoms have been noticed after its administration.
fttt dceqiMTDation has sometimes followed the erythema. In exceptional
I the exhibition of salicylic acid is followed by haemorrhage, usually from
Cfet gVB* or nose. The soda salt is believed to be free from this objection.
Bemlieiiii makes use of hypodermic injections of salicylic acid in order
toirlicrc the night-sweats of phthisis. The solution which he employs con-
luf 6 Om. (or oise) of the acid in 30 c.cm. (or fjj) distilled water, to which
■ added 11 c.cm. (or foiij) of glycerin and 15 c.cm. (or f^ss) of alcohol. He
■jfltU 8 ccm. (or mxxx) of the solution on four or five successive evenings.
Tkt wane writer has reported five cases of inoperable cancer of the cervix
tfBriia which the injection of salicylic acid into the growth was followed by
AnpoBTiDce of the hsemorrhages and otfensive discharge, with diminution
B tw sixe of the tumor. Sodium salicylate in 0.65 Qm. (or gr. x) doses will
etimefi assuage the pain of carcinoma.
Dc Becker has treated a number of cases of acute pneumonia witli sali-
:acid. He gave to a child of four years 0.10 Gm. (or gr. iss) every hour
f'^tt fOcc*g>pftil result. In adults he gives 0.50 Gra. (or gr. viij) every two
rlkrw*- ' ' As soon as the expectoration is free, he diminishes the dose.
Bit «^: ►.-e, tea, chocolate, and milk are good vehicles for the medi-
d*t. He believes that if salicylic acid is given early (on first or second day)
t will be found a true abortive of pneumonia. He treated twelve cases, with
mt death; the fatal result was due to meningitis. The others rapidly reeov-
tRd."
The granular effervescent form is a good one in which to administer
^ Htliejlates, or they may be given in effer\*e8cent draughts, or in combina-
te like this: —
a 8odU MUcylaUs 8
T&act. Uvanclule comp 15
gjmy. auratitii 105
Gm. or 3ij.
c.cm. or f3iv.
com. or fSiiiss.
M. Si^.: Give b ublespoonful every three (or four) hours for acute rheumatism.
The following prescriptions may likewise be recommended as beneficial
tions in acute rheumatism, gout, and neuralgia: —
Gm. or 3ij.
c.cm. or fjiv.
C.cm. or fjj.
B A^di saUrynci 8
AaC arlheris nitrosj 120
tWc cardamom, co. 30
31. &g, z Two tc«»poonfuU in water erery two boars.
S Aadi «alicyiki
J^, axntnon. acetatt«
Aqmm cmmvhoras .
Bp€. mih^rim nitrosi
13{ Gm. or gr. cc
as 18160 C.cm. or f3v.
q. s. ad aO| c.cm. or fjij.
A traspoonful in uaitr every two or three houra.
%
The appended formula is serviceable in chronic rheumatism and gout: —
B JUidi
kli<^lici 12
•vt. rltamuj purebiaiur.. H
iiial. tN. !■.) .120
Om. or Siij.
c.cm. or i3ij.
C.cm or iliv,
iL &M" -^ tableapoonful in water two or three times s day.
■ 0rtti^ Sf^*^^^ Journal, Epitome, 1062. 1898, p. 87.
138 I'U^nMACEOTlCAL TUEKAPEUTIC AGENTS OK DRUGS.
On account of its influence upon the utero-ovarian circulation, the i
may be advantageously given in cases of amenorrhaeii and dysmcnorrh
Sodium Ealicyiate has been used with excellent effect in chronic plem
It promotes absorption of the effusion by a powerful diaphoretic action, c
parable to that which it exerts in rheumatism.
Since the use of salicylic acid has sometimes been followed by anaei
Professor Peabody, of New York, combined it with iron, as follows: —
I^ Acid, salicylic 1130 Gm. or gr.
Ferri pyrophosph |32 Gin. or gr. v.
Sodii phoBphat 3|25 Gm. or gr. 1.
Aquse Idj c.cm. or fSas.
M. Sig.: To be taken at a dose.
ACIDITM STEAHICTFH (U. S. P.).— Stearic Acid (HCi^H.^Oa).
Stearic acid is an organic acid which, in its commercial, more or
impure, form, is usually obtained from the more solid fats, chiefly tall
It is a hard, white, somewhat glossy, solid; odorless and tasteless, and ;
muncnt in the air. Insoluble in water, it dissolves in about 45 parts of a
hoi at 15° C. (59** F.); it is readily soluble in boiling alcohol and in et
Stearic acid has no physiological action upon man and is employe<:
medicine only in the manufacture of glycerin suppositories. The fiiec
fatty oils, of either animal or vegetable origin, consist mainly of a mixt
of three fatty principles, — olein, palmitin, and stearin, — which are g
erides of the corresponding acids. Immanuel Mimk has shown that fi
acids alone are competent to produce the nutritive effects of fat, the glyc<
being unnecessary and sometimes injurious. Senator has advocated,
cases that cannot tolerate codliver-oil, the administration of the fatty ac
which can be given in keratinized pills so as to pass through the stom
unchanged. He regards the saponiiied fat acids, or soda-soaps, as prefers
either to fats or pure fat-acids. Being already in a soluble and absorbs
condition, they make no demands upon the digestive capacity of the
testines.
ACIDITM SULPHORICINICTnU.— Sulphoricinic Acid.
Pharmacology. — This derivative of castor-oil is only slightly irrit
to the skin, though rapidly fatal to animals when injected into the ve:
pleura, or peritoneum. The sulphoricinate of sodium is made by exa<
neutralizing sulphoricinic acid with soda.
Physiological Action. — The salt is antiseptic and deodorizing and
hcres well to the skin. Berlioz found that a 10-per-cent. solution entir
destroyed the odor of five or six times its weight of very fetid pus.
Therapy. — The sodium salt has been used as a topical remedy
ozjena, diphtheria, and laryngeal tuberculosis. Several antiseptic cc
pounds have been prepared with the sulphoricinate of sodium. Sulp
ricinated naphthol forms an emulsion whieli lias been used in oz:pna. S
phoricinated creosote is used pure, or made into an emulsion with wai
in laryngeal tuberculosis. Sulphoricinated salol has been employed eitl
in its own form or diluted, as an application to ulcers. Sulphoricinai
phenol is made by dissolving, with a little heat. 40 Gm. (or ,v V^) of pi
carbolic acid with 100 c.cm. (or f^iiifaij) of sulphoricinate of sodium.
ACIDUM SCLPHUHICUM.
139
■teboD of one-fourth of this strength is used in some of the hospitals of
Itei in diphtheria. The mixture adheres well to the surface and does
Mt irriute or cause pain. It is applied upon pledgets of cotton, and is
Mt ruhed off by gargles or irrigations. A comhination of 10 parts of
■U, Z parts of creosote or terpin hydrate, and 80 parts of sulphoricinate
d M^om is also serviceable as a topical application in diphtheria.
lb
ACIDUli STJXPHTJKICirM (U. S. P.. B. P. ) .—Sulphuric Acid
Preparations.
Sulphiiricum Dilutum {V. H. P., B, P.). — Diluted Suli>hiiric Acid
& P.I cODtAitiH 10 (HT cent., by weight, of absolute sulphuric acid; U. V.» 13.65
seatt. of bydn>geii Bulphntel. Dose, 0.30 to 1 c.ein. (or mv-xv).
Aeidviii Salphuricum Aromnticum (U.S. P., B. P.). — Aromatic Sulphuric Acid,
ir of Vitriol (U. S. P. contftma sulphuric acid. 100 c.cm.; with tincture of ginger,
^iB.; oil of dxtnanioii, 1 com.; and alcohol, q. s. to make 1000 c.cm.). Dose,
im 1.20 r em (or mx-xx).
narmaeolog^. — The official U. S. P. acid contains not less than 92.5
fs cent., br wcijjht, of absolute sulphuric acid and not more than 7.5 per
of wuxer. The B. P. acid contains 98 per cent., by weighty of hydro-
i iolphate. It must be colorless^ without odor, and of an oily consistence.
xrry canstic and corrosive, and should be kept in glass-stoppered bot-
The commercial acid (oil of vitriol) contains various impurities, —
lead, nitric ucidj etc.
Thysiological Action and Toxicology. — Sulphuric acid, in full strength,
dttrs aaitnal substances and has a strong affinity for water. Applied to the
dbn, U Acta aa a caustic, redissolving the coagulum formed and penetrating
ivplT, taming the surface black. When taken internally, the lips and other
|vu of ihe mouth are blackened, and smptoms of corrosive poisoning are
indoeed; there is intense pain, with efforts at vomiting. Collapse and death
WKj npidJj ensue from the intense congestion of the oesophagus and stom-
•di, or it may occur secondarily from the resulting gastric ulceration and
mnttnteB of the ce£ophagu8.
BdiAl lesions have been found by Drs. Eugene Frankel and F. Reiche
ii tiaoe CMCfi of poisoning from sulphuric acid, one of which caused death
ttirelionr&y while the other two cases were fatal in from two to four months.
Ik mpfte^mtice of the organs was much the same in the three cases. In
mA, cooirtilation-necroBis was present and was more extensive in the first
ftn is the succeeding cases, in which the lesion was limited to small patches.
The *toinach-piimp, if employed, should be used with extreme care on
^EBQBt of the danger of tearing the softened mucous membrane or of
ii|>liiilnjt tb^ etoraach. Alkalies should be given, with milk or soap-water,
mi morphine hypodermieally to relieve pain, combined with atropine as a
^nita^ stimulant. Oil, white of eggi, and magnesia are also appropriate.
S^ialccnts and appropriate treatment for the succeeding inflammation will
b maided Sulphuric acid is sometimes maliciously thrown upon a person.
It in the face. In such a case soapy water is to be used to wash off
of acid, and an alkaline wash applied; to relieve pain, opium in-
I^hDjt will be needed. The subsequent treatment is that of an ordinary
140
PHAHMACEUTIOAL THERAPEUTIC AGENTS OR DBtJOS.
Sulphuric acid is eliminated to a small extent by the kidneys and pi
ably also by the lower bowel and skin.
Therapy, — On account of the pain following its application, enlph'
acid is not much used as a caustic, although it is an efficient destroyei
tissue. Velpeau used it in cancer^ and Eicord for chancres, the acid b€
mixed with some absorbing substance like sawdust or charcoal. In ca
and necrosis, and suppurating cavities ot sinuses, it may either be app
upon a glass rod or on lint, diluted with 4 to 6 parts of water.
Internally, dilute sulphuric acid acts as an astringent and antisej
The elixir of vitriol is the preferred form for checking the night-sweati
phthisis, and in some cases of diarrhoea. Sulphuric acid, with water, sw*
ened so as to make a pleasant drink, is a valuable prophylactic against 1
poisoning, often used by operatives in lead works. It also has been foi
to be a preventive of attacks of Asiatic cholera, when taken regularly dm
the prevalence of an epidemic.
ft Acid, sulphurici diluti fi 26 c.cm. or fSiiaa.
Tr. opii dcodorati , 4 c.cm. or f3j.
Elixir aromatici 30 ccm. or f5j.
Aquse q. 8. ad 120 ccm. or fJJv.
M. Sig.: Take a tablcBpuonful for catarrhal dysentery every hour or "
Watch with care the action oi the opium.
Sulphuric acid has been given as an a.-^trintrent in tV7)hoid fever. It i
be preferred to hydrochloric acid when the diarrhcca is excessive. Lead c
is relieved by the use of sulphuric acid, and the constipation of lead poia
ing is effectually treated by a combination of diluted sulphuric acid, quit
sulphate, and magnesia sulphate. On account of its astringent proper
it is beneficial in hiemorrhage from the uterus, stomach, or intestinal cai
and in purpura. The following prescriptions have been found beneficial
li Acid, sulph. aromat 7|50 c.cm. or fSij. I
Fill i<I<*\t nut i hiinijimelidis,
Fluidextracti ergotie aa 60] c.cm. or fjij.
M. Sig.: Two teaspoonfuls in water every two or three hours. U&e eapeci
in haemorrhage from lungs, stomach, or vomb.
fi Acid, eulpb. aromat 15
Magnesii sulph 02
Spt. chluroforini U
Inf. rosce galUcs q. a. ad 240
ccm. or fSs*.
Gm. or 5ij.
e.em. or fSiij.
ccm. or fSviij.
M. Sig.: A tablespoonful every three hours,
and constipation.
Useful in hajmorrbage from rect
B Acid. Bulph. dil 161 com. or fj^s.
Quininae sulph 175 Gm. or gr. xij.
Tinct. opii 7 50 c.cm. or f3ij.
Syrupi ct aquoe q. s. ad 90[ ccm. or f^iij.
M. Sig.: A tenspnonful in water every four hours in enteric fever with t«
eney to diarrhcsa and sweating. Also useful in sweating of phthisis.
Liquor Acidi Sulphurici Halleri (Haller'a acid drops) — not official-
a mixture of equal parts, by weight, of acid and alcohol, gradually adc
with constant stirring, taking care that the temperature of the mixture d
not get so high as to vaporize the alcohoL It contains ethcTj alcohol, 8
phuric acid, and sulpho-ethylic acid, and is used for the same purpose
ACIDUM grLPHCROSUM.
141
te aroniatic acid^ in about half the dose, on account of the larger amount
AiUm SnlpliOTiiiicuin, or ethyl-siilphiiric acid^ is prepared by adding
■ipbaric ftcid to alcohol in combining proportion. It is freely soluble in
Aobol, and mixes with water (1 or 2 parts) without losing its oily character.
11 ia • jfvUoirifih liquid, with slightly astnngent taste, and is neutral in re-
«tm. The ethyl sulphates are crystallizable and soluble in water. The
ittrjl-ffolphate (or sulphovinate) of sodium has been used as a saline ca-
ftastic Ethyl-sulphuric acid is an example of an acid ether, and is a solvent
aphor (25 per cent.), iodoform (3 per cent.), sulphur, naphtalin, chry-
etc., and can be used as a vehicle for these remedies in the treat-
of akiii diaeaaeB.
k ACIDnV STTLPHUIIOSUM (U. S. P., B. P. ) .—Sulphurous Acid
■ Bote, 0.30 to 4 c.cm. (or mv-f5j), well diluted.
H Pteparationa. — In combination with a base, sulphurous acid makes sul-
B^fiea. Of its combinations, the following are official in the U. S. P. : so-
■ turn fiu!phiti\ sodium bisulphite, and sodium thiosulphite.
narmacology. — Sulphurous-acid gas (sulphur dioxide, SOj) is pro-
t !ig snlphur in the open air; when combined with water, it
ti ii acid. It has a sour, sulphurous, somewhat astringent taste,
md cnotatns *>.4 per cent., by Aveight, of the gas, and not more than 93.6 per
mmL of water. Tlie P.P. acid contains the equivalent of 5 per cent., by
njght, of sulphurous anhydride, or dry sulphur dioxide.
Fhyaiological Action. — This acid and its salts are very destructive to
Ibv forms of animal and vegetable life, owing to their affinity for oxygen.
ft ii Dot well borne by the stomach, and sliould be given freely diluted with
its taste and odor are very unpleasant. Locally, it does not excite
irritation in medicinal doses, but inhalation of air containing from 1
to I parta of sulphurous acid per 10(tO produces in animals intense inflam-
of the respiratory passages and lungs. Injection of a 5-per-cent.
into the stomach was found by Dr. L. Pfeiffer to excite severe gas-
Animals not killed by the acid recover very rapidly from the imme-
effecta, though they may subsequently perish from inflammation,
haa demonstrated that 96.5 per cent, of sodium sulphite is eHmi*
in the urine as sulphate, the remainder only as sulphite. Nearly all
rfa lanre quantity of sulphite administered was eliminated in five hours.
Tl^rapy. — As a local antiseptic or bactericide, sulphurous acid is highly
m those forms of skin disease caused by parasitic invasion, such as
tonsurans and tinea versicolor. It may be effectively used in tinea
by the simple device of Dr. Schiister. A net of strings is stretched
the lower third of a card-board box made to fit the head. A saucer
ntig biirninsr sulphur is laid upon the net of strings and the box cor-
Th« patient must sit still for half an hour. An abundance of sul-
icia gaa is generated, the sulphur ceasing to bum, of course, as
p mil th^ oxygen is exhausted. In various forms of sore throat it is
but particulaTly in diphtheria, where it can be used topically and
taken internally.
It i» bcnefi*^^®^^^ applied to unhealthy or sloughing wounds or ulcers.
.|^ ~ 5 c^cm- (or foi-ij) of the official acid to 30 c.cm. (or fjj) of water.
■
142 Vn.UtlCACEUTICAL THERAPEUTIC AGENTS Ott DIIUGS.
or water and glycerin, is of service in chilblains and chapped hands. J
phurous acid, as Ringer points out, may be used in such a manner as to i
scabies with the utmost rapidity. This method consists in exposing
patient, his head excepted, to the influence of sulphurous-acid gas, gener
by burning 46.7 Gm. {or oxij) of sulphur in a suitable closed apparatus, j
clothes should be, at the same time, put in boiling water. Dr. Dewar^
omniends equal parts of sulphurous acid and of water as an etficient drei
in erysipelas. 1
in fermentation of food in the stomach, flatulent dyspepsia withi
stomach, pyrosis, dilated stomach, etc., sulphurous acid, properly dill
has been recommended. In typhoid fever it has also been used, and,i
asserted, with success, and may be tried in measles, scarlatina, and small-
In Bome bronchial atlections — catarrh, whooinng-cough, dilated bronc
tubes — it may be inhaled with a steam-atomizer. It is also of great ser
in many skin al5*ections, such as urticaria and purpura, after other met!
have failed.
The author would recommend the following formulse for the dise
just referred to: — 1
H Acidi sulphurosi, |
Syrup, zingiberis aa 60) c.cm. or fjij,
M. S'\g,t From one to two teaspoonfuh in water three" times a day.
H Acidi aulphurosi.
FIui*iL'Xt. erg\>t(e,
Syrup, aurantii aa 30] c.cm. or fjj.
M. Big.: Two tea«poonfuU in water tliree or four times a day.
The fiulphitps and hyposulphites are employed to fulfill the same \]
cations. The administration of the sulphites in pyasmia was advocated
Polli, but later clinical observers have not been able to obtain the good
suits that he reported. (The sulphides will be considered under the Jian
Salphur.) VH
ACIDTTM TANNICUM {U. S. P., B. P.).— Tannic Acid (Tannin).
Dose, 0.U65 to 1.30 Gm. (or gr. i-xx). B. P., 0.13 to 0.32 Gm. (or
Preparations.
CoUodium Stypticum (XJ. S. P.). ^Styptic Collodion (consists of 20 part-«
tannic acid, 5 of alcohol, 25 of ether, and 50 of collodion). For external use as
astringent.
Vnguontum Acidi Tannici (U.S. P.). — Ointment of Tannic Acid (contttins
per cent, of tannic acid).
Glycoritum Acidi Tannici (U.S. P.). — Glycerin and Tannic Acid (20 per cei
Trochisci Acidi Tannici {U.S. P., B. P.).— Troches of Tannic Acid (oach 0
Gm., «r gr. j; B. P.» 0.03 Giti., or gr. ss).
Glycorinum Acidi Tannici (B. P.). — Glycerin of Tannic Acid (20 per cent.).
Suppcsitorin Acidi Tannici {B. P.). — Tannic-Acid Suppositories (0.20 Gm., or
ii], of tannic acid).
Tnnnalbin. — Tannic Acid and AJbiunin. Dose, 2 to 8 Gm. (or Sssij).
Tannnlbin.
Pharmacology, — Tannic acid is a common constituent of vegetable
ganigms, especially those noted for astrin^ency, such as oak-bark. Gi
contain about 50 per cent, of tannic acid, which can be obtained by expos
powdered galls to dampness and afterward dissolving out the tannic acid w
ACIDrai TAJfKIClTM.
143
tie tad of ether. It occurs in light-yellowish scales, soluble in 16 parts of
aid mmt€T, and slightly soluble in alcohol. It is likewise soluble in glycerin,
Jtwaywhttt aJbumin and gelatin, and strikes a black color with preparations
^MMUa^iroD. Solutions containing tannic acid (decoctions of black tea or
iAi) ire antidotes for poisoning by some metallic salts, and especially
■tlMQj or tartar emetic, and the alkaloids.
IkfaoiogicBl Action. — Tannic acid^ when locally applied, has an
*=r^r*^t action upon the tissues, owing to its affinity for albumin. In-
:t acts as a weak acid upon the digestive tract, but when its chem-
• -• are satigfied by combination with a base or neutralizing it with
- no longer capable of precipitating albumin, and therefore no
>eft an astringent action upon the parts with which it comes in
ace, according to Stockman, it can exert little, if any, action
»««cular system, and, as it is not excreted by the bronchial mucous
- :^\ ^ery little, or none, upon the flow of the bronchial secretions.
V^aiii«|^rd to its action upon the kidneys, as it is excreted principally by
Aadktnoely it ia conceivable that it may have some influence in diminishing
liVBamrra, although even this he regards as doubtful. Lewin, however,
aE^BBenda the administration of tannic acid in the form of an albuminate,
tkk& it free from irritation and is more readily absorbed (tannic acid, 2
^; vater, 90; mix well, and add white of egg, 10 parts). The external
€atrraal nse of tannic acid mar occasion erythema or urticaria.
Tkcsapy. — As a local astringent, tannic acid heads the list. A com-
ol iodoform and tannic acid (2 to 1), finely powdered, is a good
ypowder for moist eruptions, some forms of eczema, and for insuflla-
tcsto the nose to reduce secretion in catarrh. After the severity of the
ition has somewhat subsided, the glyccrite of tannin is a good sp-
in acute eczema. It may be applied twice daily, and allays the
pain and itching. A solution of tannic acid and camphor has been
Evith good results as a topical application in erysipelas anc^ lyraphansitis.
' riy<*rtie of tannic acid is a g<M»d topical applicntiou to tonsillitis or
Dgitia. It tnav also he use<l as a j^pray. properly diluted, in haiinoptysis.
i$Uigigcr solution (oO per cent.) has been recommended by CapuUauo ^ as
lto«nff for burns nf nil de^inx's. For disorders of the lower bowel, ulcers,
Pf^p^ hasmorrhoid-s, pn>lapsuR, and to expel thread-worms, n solution may
ititeted, or suppoeilorii^ used, each containing 3 to 5 grains, with caoao-
l» or starch.
Liebersolm has obtaine<i good results in severe acute dysentery from
^oe of hot ent'm.ata of tannic and boric acids. The injections were given
-.^ .v^<.^. hours and consisted of a 4-per-cent. solution of boric acid, in
■ to. (or gr. x) of tannin were dissolved. A few drops of laudanum
▼»-» icoi..: i»» cnch enema. The effect was to arrest ha?morrhage, diminish
9H tad icT' -iiiw-. and materially abridge the course of the disease. A plan
ItmtOient ii^ ^ <:d by Cantani has been used with advantage in the
l^tBge of ci Large enemata of tannic acid are thrown into the
Ibert^nd the lUo-ciwal valve. From G to 13.5 Gm. (or 5iss-v) of tannic
BMlved in * litw^ (or Oiv) of woter, with the addition of 2 c.cm. (or
) of Im u<1^ti u m And 46.5 Gra. (or 5iss) of powdered gum arabic, are in-
j^jput Cimp*'^ , yrpuq>b>T IS, l«»i«!.
144
PHARMACEUTICAL THEUAPEUTIC AGENTS OB DRIGS.
A solution of tannic acid is useful in cases of leucorrhcea. The glya
or iodoform-tannin, is an excellent application for catarrhal inflamml
of the cervix uteri. Even in carcinoma uteri the glycerite of tannic a^
efficient in moderating discharge and allaying odor. Its virtue ml
assisted by combining it with a email proportion of liquetied phenol. 1
The odor of oza»na and other affections attended by fetor may, aet
ing to Dr. B. W. Richardson, be overcome by the application of cotton-^
previously moistened in a saturated watery solution of tannin and driec
In gonorrhcea, after the acute stage has passed off, tannic acid is a
ful medicament. In men it may be administered, dissolved in water,
urethral injection. Dr. Hanika, of Munich, has treated gonorrhoea bj
ing the urethra with a powder consisting ol equal parts of tannin, iodca
and thallin sulphate. The powder is introduced through a metal tube]
or twice daily immediately after the patient has emptied his bladdeta
women a watery solution may be used as a vaginal injection, or the vi
may be packed with gauze covered with tannin. Solutiona of tannic!
may also be employed for the purpose of hardening tender nipples and t^
feet. A concentrated solution of tannin may answer a useful purpose
palliative remedy in ingrown nail. A lotion of tannic acid is frctjuentl
service in herpes. It is useful in phagedenic ulcers and alopecia circ
scripta. Made into a pomade, it has been found of benefit in dan^
Ringer recommends the glycerite of tannic acid in otorrha?nj not, hoi»i|
during the acute stage, but after this has beon relieved and hut a mod<
discharge is left. The remedy is more beneficial when the menibnina 1
pani is intact. The canal is filled with the solution, which is rctainc*
cotton-wooL
With alkaloids tannic acid generally forms insoluble compounds
should not, therefore, be prescribed with preparations containing salt
quinine, strychnine, etc. i
Xotwithstanding the chemical arguments urged by Dr. Stocla
tannic acid has long been successfnllv administered as an astrin^^iit rem
As, however, it enters the blood under the form of gallic acid, its rei
effects are, in reality, due to the latter acid. Tannic ncid is preferably
ployed as a local application, gallic acid as a ByRtemic remedy. The th
peutical uses of gallic acid have been already described, and need not be '.
repeated. |
Tannic acid has boon u^ed in tuberculosis undor the thoory that it is
to destroy the banillus of the disease, M. Arthaud has detailed the ref
obtained in two thousand cases from this method of treatment. He ch
that the effect of tannin is superior to that of creosote.
ACIDUM TARTARICUM (U. S. T., B. P.).— Tartaric Acid (1
H,OJ.
Dose, a.3'3 to 1.30 Gm. (or gr. v-xx).
Preparations. — The U. S. P. official salts are antimony and potass
tartrate (tartar emetic^, iron and afnmonium tartrate, iron and potass
tartrate, potassium tartrate, potassium and Podium tartrate (Fochelle s]
and pntni^r^imn bitnrtrnte (cream of tartar). Scidlitz powder, or pn
cfFerveBCcns compoaitus (U, S. P.), pulvis sodee tartaratse cffervescens (B.
is dispensed in two small papers,, a blue one containing 8 Gm. (or 3ij'
pota.?sium and sodium tartrate, with 3.60 Gm. (or gr, xl) of sodium hi
ACIDCM TaiCULORAOETICUM.
145
A i
}
^**«Jr, ftuci a white oae containing 2.25 Gm. (or gr. xxxv) of tartaric acid.
-n administered tbeao are separately dissolved, each in about GO c.cnu
" "* water, and the two eoiutione mixed and drunk while effervescing.
mon inipn3ves the flavur of the dose.
JfHarmacology and Physiological Action. — Tartaric acid ie obtained bj
decomposition of cream of tartar (potassium bitartrate) found in old
<'-caak&. It is laxative and sli^fhtly diuretic. It reduces the alkalinity of
*!«yo<I and makes the urine acid. In larger doses it is an irritant; indeed,
•i it resembles oxalic acid, and the morbid appearances are also
lie same. In excessive amounts tartaric acid retards and weakens
ntg of the heart. Its saturated solutions are irritant even to thte
fi-w instances death has resulted from the ingestion of this sub-
. e ityraptom^ are best relieved by demulcents, the alkalies, mag-
.«ik, soap, milk, etc.
frapy. — Certain of the tartrates are used as laxatives, magnesium
rding a good substitute for the citrate. Rochelle salt, in 15.5 Gm.
- before breakfast, is a good remedy for habitual constipation-
:trate (in doses of 0.65 to 1.30 Gm., or gr. x-xx) exerts a de-
i i; action, and in combination with washed sulphur (1 to 2) it
icellent laxative remedy for haemorrhoids.
• ' ination of diuretic and cathartic virtues renders potassium
useful in the treatment of chronic Bright's disease. It re-
ee <edeni« and delays the manifestation of uraemia. For a similar reason
* Q*eful in ascites. Potasvsiuni tartrate, or Rochelle salt, proves of utility
a b^patic indigestion accompanied bv an excess of uric acid in the urine.
Lathium bit-Tiriti* also is useful in lithemia and chronic rheumatism-
^HMTiru
ACTDUK TRICHLOHACETICUM (U. S. P.)-— Trichloracetic Acid
iT!(\rl,U.).
FhATiDaoclo^ and Therapy, — This acid, a crystalline and deliques-
t «;jf>e.!dnce, readily soluble in water, is an efficacious caustic and astrin-
r^ri Ii has been successfully employed in the removal of enlarged ton-
hied follicles of the pnarynx, and polypoid excrescences. Its
more strictly limited than that of some other caustics, but
^» for use when large masses of tissue are to be destroyed. It
iied to the pharynx without any previous antesthetization. In
lowever, the surface should first be touched with a 10-per-cent
^ ».^v s^rynx with a 20-per-cent. solution of cocaine. It is notable for
#» di J II can* of the eschar which it produces. Trichloracetic acid is a
ivrSocAblc application to warts, vascular nsevi, pigment patches, and in-
dent olcers.
Am ah afrtringcot^ the following combination is recommended: —
r^ T 15
■ villd 19
\. ),<, Tri< hlorvcctjci 16|6 to 31
(,lTi « Tim
60
5 Gm.
or Jm.
4 Gm.
or 3v.
Gra.
or Jsft-j.
c.cm
or fjij.
i
U. thg- : Appl/ to the affected Burftcc on a pledget of cotton.
j>f * !-!-.», Bronner employs trichloracetic acid in the treatment of
kos uae of a 10- to 15-per-cent. aqueous solution and applies
to the roucoue membrane covering the septum and turbinated hones.
146 PlLMiMAOEDTICAL TUEUAPEUTIC AGENTS OH DRUGS.
The operation i8 repeated two or three times a week for several we
Cozzoliijo recommends the use of trichloracetic acid in epistaxie, touct
the bleeding-point with a piece of cotton saturated in a solution of 1
(or gr, xv) of trichloracetic acid to 30 c.em. (or fjj) of water.
ACONITINA (U. S. P., B. P.).— Aconitine.
Averiigo dose, 0.00015 Gm. (or gr. ^''^oo)-
ACONITUli (U. S. P.).— Aconite. (Monk's-hood.)
ACONITI RADIX (B. P.).— Aconite Hoot.
Preparations.
Fluidextnirtmn Acnniti (U. S. P.).— Flui.l Kxtruct. of Aconite. (100 e.cn
UlDB 0.4 Cm. of Aconitine.) Pohp, O.OWJ to 0.00 c.cm. (or m'/„)-j).
Tinctura Aooniti (U. 5^. P.. IJ. P.).— Tincture of Aconite {10 per cent.; as
to contaiu in viwU 100 c.cm., 0.045 Cm. of aponitinv U. S.). I)osp. 0.(lt( to 0.30 i
(or mi-v). B. P., 0.30 to 1.20 com. (or mvxs)\ if frequently repented, 0.12 to
cem. (or mii-x). (Tlie V, S. P. formula is iieiVrlv twice the strength of that of
B. P.).
Unguentum Aconitinfe (B. P.). — Aconitine Ointment (2 j>er cent.).
Linimcntum Aconiti (B. P.). — Liniment of Aconite (500 Gm. in 760 com.).
external use, witli caution.
Fharmacolo^. — The dried tuherotis root of Acouituni Nape
( Han uncu laces), collected in autumn, yielding, when assayed hy U. S.
process, not less than 0.5 per ccjit. of aoonitine. The British Pharmacop
requires that ilio root^: -ilial! Ik- ^^ollentcfl frmu ])hHits cultivated in Gi
Britain. Monkshood is a porennial plant indigonous to Europe, but so
times cultivated here in gardens for its ornamental spike of blue flow
All parts of the plant are poisonous, but the active principle* an nlkaL
Aconitine, exists in greater proportion in the mot, aspnniated with piprac(
tine anil aconine. (Napulliiie is probably identical with aconine.) Accuii
erystalli'/os in rhombii:- or lioxagoual plates; is soluble in alcohol, other, i
ehloroforrn. and in '.V^Ol\ jiarts of wnter.
Dunstim and Cash luive found that different samples of aconitine dl
extremely as regards toxic properties. What has been termed "amorph
aconitine" contains but a very small proportion of true, or crystalline, ace
tine, which is the official form. Wtien aconitine is heated at its mclti
point there is obtained a new alkaloid, wj^ich they proposed calling pyracc
tine. This suhstarnv re^idily dissolves in aeids, forming salts which can
crystallized. Tlie solutions of these salts have a bitter t^ste, and are
toxic in small doses. When heated with diluted acids, or witli water ii
closed tube, pyraconitinc and its salts are eonv(Tted into benzoic acid and
alkaloid, which has been named pyrnconinc. Pyracouine is soluble in wa
and ether. It combines with acids to form crystalline salts.
All the species of aeonitum are, as a rule^ virulently active, but
napellus is the only ollicial one. The root of aconite in winter-time 1
been dug up in the garden and eaten in mistake for horse-radish, with fa
eonsequences. It is only necessary to be aware of this liability in order
efFectually guard against the error. The aconite-root is premorse, and
not tapering throughout its length, as the root of annoraeia is; it is also
ACONITUM. 147
a brown color, and when scraped has a disagreeable odor, and does not give
out the irritating vapor that is so characteristic of the latter.
Phytiol<^oal Aotion. — The effects of aconite are those of its active
principle, aconitine. Many researches have been made, but the results have
differed so widely that it is evident the various investigators have worked
with impure or different substances. In the physiologic investigation by
Professors Cash and Dunstan,^ the greatest care has been taken to insure
the alkaloids used being chemically pure. They found that aconitine
kills mammals by its action on the respiratory centre; diacetyl-aconitine
has much the same action, but is not so powerful, while benzaconine and
aconine are much weaker. On the heart, all have finally a depressing effect,
but aconine, compared with the others, proved to be rektively harmless. It
was found that atropine and digitalis exercised a certain amount of antag-
onistic effect to aconitine. The addition of the two diacetyl groups to aconi-
tine slightly weakens its action, but produces no radical change. The re-
moval of an acetyl group from aconitine, to form benzaconine, greatly re-
duces its toxic power and greatly alters many of its minor effects, although
in a ffeneral way its depressing action on the respiration and temperature
resembles that of aconitine; but it is no longer a strong heart-poison. Aco-
nine is very much less poisonous, it has a curare-like action, and actually
strengthens the heart and opposes the asequence and inco-ordination which
aconitine produces. The introduction into its molecule of benzoyl, and
still more of acetyl, to form the other alkaloids, heightens its lethal
effects and modifies its action to a very remarkable degree. The au-
thors also found that there is a certain antagonism in action between
aconine and benzaconine, on the one hand, and aconitine, on the other.
It should be mentioned here, in explanation of the difference in effect
from different specimens of aconite, that the alkaloidal strength and
the physiological activity of the plant are much affected by circum-
stances of its growth, the wild varieties being more poisonous than the
cultivated. In this way the well-known differences in the activity of differ-
ent specimens of the drug are explained. Murrell has called atten-
tion to the fact that English aconitine is seventeen times stronger than
the German, while the French is variable, but generally between these.
The crystalline variety (DuquesnePs or Merck's aconitine) is to be pre-
ferred when prescribing, on account of its uniform strength. Aconite re-
duces cardiac action and blood-pressure, diminishes excitability of cerebral
centres, the sensory tract of the cord, and the peripheral terminations of sen-
Eory nerves. It also promotes the action of the skin and kidneys. The ex-
ternal application of preparations containing aconite has sometimes been
attended by redness and the development of vesicles, pustules, and blebs.
Tlie internal use of aconite will occasionally produce profuse diaphoresis
together with vesiculation and more or less itehing.
Toxie Effects. — Theodore Cash" thinks that the uncertainty of aconi-
Hne is due to the mixture vrith the other alkaloids of aconite, which differ
to a great extent in potency and physiological action. The difference in the
lethal dose is shown by the following table: —
* British Medical Journal, Nov. 11, 1899, p. 1365, from Philosophical Trans-
ttrtioHS,
*BHtish MtdicalJoumal, Oct. 8, 1898.
148
ril.UiMACEUTlCAL TIlKIUrKUTlC AHENTS OH DUL'US.
KABBIT. FROG.
A w AAAAio n ( 0.000580 Gm. March
^co^^^^^e ^'^^^^^ ^^' \ O.OOU Gm. July. j
Benzaconine 0.0273 Gm. 0.284 Gm. i
Aconine probably 0.28 Gm. 1.055 to 1.75 Gm. ]
per kilogramme of body-weight. Aconitine is about 2Q0 times ae toj
benzaconine, and 2000 times as toxic as aconine. The aconitine, ia<
doees, slows and steadies the pulse, with a slight decrease of pressurej^;
zaconine has a like effect, in a much more marked degree, while aconintf
this property. The first produces the characteristic tingling of the irt
membrane and impairs sensation, gtmerally by its action on the perip
sensory nerves. The other two have no such action. They all have a
taste, but the last is not so marked. Death from aconitine is primari^
to respiratory failure, although in small doses it at first stimuliites if
spiratory centre, then finally depresses it by paralyzing the sensory fibi
the pulmonary vagi. Benzaconine acts much like the above, except t]
has very little effect upon the sensory nerves, while it depresses the i
group and also the muscle-fibres. It also lacks the antipyretic actit
aconitine. Aconine is not such a cardiac depressant as are the two oi
but, as above stated, actually strengthens the heart and opposes the
quence and inco-ordination which aconite produces; upon the motoi
tern it is a decided depressant and acts like curare, i
Applied to the skin or mucous surface, aconite first is slightly irr
but this is soon followed by numbness, whicJi may be accompanied bj
gling sensations. If a bottle containing aconitine be held to the nose, pa
irritation of nose and eyes results. In relatively large doses death o
very promptly, and, if given hypodermically, the fatnl result may folic
less than a minute, according to Wood. It is destructive to all forms o:
mal and vegetable life; sonietimes very small doses produce extremely 6€
symptoms. A case of decidedly marked impression from a quantity i
to 0.18 c.em. (or miij) of the tincture has been reported by Woodburi
which vomiting; loss of power of extremities, with panesthesia and n
ness; loss of sight, mild deliriiim, weak pulse, and threatened stupoi
collapse occurred, l.ife being saved apparently only by very prompt anc
oroiis treatment. The fii*st symptom observed in a case of poisoning is 1
ing or tingling in the mouth and throat, soon extendini^ to the extrem
and sometimes over the whole body. The surface of the extreniitiea is
or clammy and numb, but at the same time the patients complain that
feel as if the limbs were flayed. Sight may be lost and hearing dulled
ordinarily the intellect remains clear. Convulsions occur occasionally,
pulse becomes weak nnd variable; slight exertion may bring on a fatal
cope. The unisicular t^lrongth is early affected, so that the |Kitit^ut is ui
to stand. Owing to the lowering of the blood-pressure and the dilatati^
the arterioles caused by the aconite, the heat of the body is at first broi
with the increased blood-ilow, to the surface, and there the blood losi
heat by radiation and the temperature of the interior of the body is qu
lowered. The depression is accompanied by increase of perspiration, w
' "Proceedings of the College of PhyBiciaiiB of Pliiladelphiaj" third series
X. p. 450.
ACONITUM. 149
still further reduces temperature. This occurs more obviously when there
is pyrexia present than when the temperature is normal to begin with.
Death results from failxire of respiration generally, but it may occur Bud-
d^y from syncope, as already stated. Aconite, applied locally, first paralyzes
the sensory nerves, beginning with the end-organs and ascending the trunk
to the centre. The motor nerves are next affected. The reflex function of
the cord is impaired. Uncertainty still exists, however, concerning the mode
and order in which aconite affects the different portions of the nervous sys-
tem. Binger concludes, upon the basis of his and Dr. Murrell's experiments,
that aconitine paralyzes all nitrogenous tissues, abolishing the functions,
first, of the sensori-pereeptive centre, acting next upon the nerves, and,
finally, upon the muscles. Similarly, first the ganglia of the heart are at-
tacked, next its nerves, and lastly its muscular structure. After a fatal dose
has been taken the symptoms usually make their appearance very rapidly,
and death may result in half an hour. The average time required to produce
death is rather more than three hoxirs, the longest case on record being five
and a half hours.
Antidotes. — The antidotes to aconite are tannic acid, astringent in-
fusions, alcohol, and ammonia. Digitalis appears to be the physiological
antagonist to counteract the depressant effect upon the heart, or tincture of
strophanthus may be substituted. The hypodermic injection of atropine
also acts in the same manner. Inhalations of amyl nitrite, administered
freely, appeared to save life in Dr. Elliott^s case. The patient should be
kept in a recumbent position, with his head lower than his feet, and be kept
warm. The stomach-pump, artificial respirations, ether or alcohol, and
tincture of digitalis or strychnine hypodermically, a hot pack, even faradiza-
tion over the epigastrium and cardiac region, are each useful.
Therapy. — Locally, the benumbing effects of aconite have been utilized
in the treatment of neuralgia, the best combination, probably, being the
Baltimore liniment, or the linimentum aconiti et chloroformi (N. F.): —
B Tt. aconiti,
Chloroformi aa 12150 c.cm. or fSiij, mviij
Ijiiiiinent. saponii 75{ c.cm. or fjiiss.
M. Sig.: Poison. For external use. To be applied, with friction, along th6
eoarse of the affected nerve.
The oleate of aconitine (2 per cent.) has also been used with asserted
good results for neuralgia. An ointment of aconitine is official in the British
Pharmacopoeia. This preparation contains 0.65 6m. (or gr. x) to 26 Gm. (or
gr. ccccz) of lard, the aconitine being dissolved in 6.20 Gm. (or gr. Ixxx) of
oleic acid before being rubbed up with the fat. Aconitine ointment will often
assuage the pain of chronic rheumatism, gout, and myalgia. It serves the
Bune purpose, also, in herpes zoster, but care must be taken, in this affection,
not to apply it to the abrasions produced by rupture of the vesicles. The
Mine ointment also affords relief in neuralgia of the skin, paraesthesia or
pnxritns, papular eczema, and prurigo. It must never be placed upon a raw
rarface.
Its control over the circulation places aconite in the first rank in the
treatment of the fever process; in many cases we may get the best results
if given in fractional doses (every ten, fifteen, or twenty minutes, give a tea-
tpoonful of water from a tumbler in which 0.60 to 1 c.cm. (or mx-iv), of
150
PIIAnMACEUTICAL TIIERAPEUTIO AGENTS OH DRUGS.
the tincture has been dropped). This is invaluable in the treatme:
the ephemeral fevers of childhood and hyperpyrexia attendant upoi
exanthemata. In adults the results are also very positive; so that aconii
almost entirely taken the place of the lancet in the antiphlogistic treati
Aconite, however, should be avoided in typhoid fever or other diseai
asthenic character.
In the early stage of inflammatory processes — pneumonia, pleurisy,
carditis, peritonitis, erysipelas, rheumatism, meningitis — and in chile
diseases, it modifies materially the severity of the symptoms, reduces
perature, and moistens the skin.
In the treatment of rheumatic iritis Dr. Jonathan Hutchinson w
mends the tincture of aconite in 0.60-c.cm. (or mx) doses* three times
(equivalent to tinctura aconiti, U. S. P., 0.30 c.cm., or wfv), ^iven in
bination with alkalies and the iodide of potassium. He looks upon ac
as of service in mitigating the pain of carcinoma. It also serves a n
purpose in acute congestion of the brain. In spasmodic croup aconit
lievea the dyspnoea within a few hours. Aconite has been recommend
a sedative in relieving the vomiting of pregnancy. It is asserted that a(
is an antidote to the sting of the scorpion.
Asthma, especially in children, and preceded by coryza, is gen4
benefited by the use of this remedy. Ringer states that a drop of the tine
every hour, is useful in acute gonorrhrea. In coryza and quinsy, or i
tonsillitis, it is highly prized for its influence in shortening the cour
the disease; and it has also been given to abort or prevent urethral
after the use of instruments. It affords prompt relief in congestive dys
orrhoea; and in araenorrhcea, produced by exposure to cold, it is often
cacious in re-establishing the flow. In facial neuralgia the extract mi
given internally, in combination with quinine and a carminative, viz.:-
H Fliiidextracti uconiti 125 Gm. or gr. iv.
QuininsB bieulphat 4 Om. or 3j.
ftperin |32 Gm. or gr. v.
Div. in pil no. xx.
Sig.: Give one every two hours until relieved, and then one every four
u long as needed.
In migraine, or sick headache, it may be combined with cam
Indica: —
B Tr. aconiti 12 c.cm. or mij.
Tr. onnnabis IndiMB 1 c.cm. or mxv.
Tr. cardamom, co q. a. ad 4 c.cm. or f3j.
M. For one dose, to be repeated every hour, or two hours, until patie
relieved.
Tincture of aconite will relieve the pain of epididymitis and of c
glandular struftiiros, commencing with 0.32 c.cm. (or jmv), to bo folic
by 0.13 c.cm. (or vtlj) every half-hour until pain is relievjed or the I
shows its effects by lowered rate and diminished arterial tmsion. In i
0U8 palpitation and overaction of n lieart somewhat hypcrtrophied. jind ii
tobacco-heart, aconite, when cautiously used, gives much relief.
*Tho tincture of aconite of the British Fhannacopreia is only one-half ol
strength of the tinctura aconiti of the United States Phttrmacopmia.
ADEPS.
151
Aeonitiiie should neyer be ^ven, even in the smallest dose, where there
m% vcak or fattv heart. It was used by Gubler in the treatment of facial
I, and Seguin also advocated the crystallized aconitine in trigeminal
in doses of 0.0002 to 0.00024 Gm. (or gr. Vaop or Vi^o), to begin
leprated cautiously, and gradually increased until numbness is felt
all the body, with chilliness and, in some instances, even nausea and
wHKztin^. Xapelline has also been used in facial neumlpa in doses of 0.03
Qb. (orgr. as), repeated every two hours until the pain has disappeared.
^•on has employed the crystallized aconitine nitrate in the treatment
af imal erystpeW, and reports that it almost invariably diminishes the
4witTon of the disease and prevents the occurrence of complications. It
aaTRj energetic salt, but it can be readily administered and regulated as
li^aida do0e by dissolving it in a mixture of distilled water, glycerin, and
^nhoU having exactly the density of distilled water, so that 3.10 com. (or
al) contain o.boi Gm. (or gr. Va*). It may, therefore, be used in the dose
rf 0.00002 Gm. (or gr. Vaaoo): 1 minim of the solution. He usually add§
.lUBOl Gm. (or gr. V»J of aconitine nitrate to a mixture, and gives it, in
landed dofies, in the course of twenty-four hours.
Aconitine cannot be regarded otherwise than as a dan^i^erous remedv.
Itina bren found that the toxic dose and the susceptibility both vary greatly
idiflerent aabjects.
ADEPS (U. 8. P., B. P.).— Lard.
Preparations.
1 Adipis (U. S. P.).— I^rd-oil.
Brnzoinatxis (U.S. P.). — 13cnzoinatod LarJ (benzoin, 2 per cent. During
5 per c*nt., or more, of the lard should be replaced by white wax).
Adcp* Bcnzomtus (B. P.). — Benzoated Lard (benKoin, 3 per cent.).
icology. — Lard is the prepared internal fat of the abdomen of
^■■iMfii^ Linne (class. Mammalia; order, Pachydermata), purified by \va8h-
m^ with water^ melting, and straining. The specific gravity of lard is about
CLJ38. It is entirely soluble in ether, benzin, and disulphide of carbon. It
mdlt at or near 95^ F. to a clear, colorless liquid. It consists chemically
rf ^ per cent, of olein^ or fluid fat, and 3S per cent, of the hard fata,
pilaitiii and stearin, The olein may be separated by pressure, or by the
mt of boiling *ilcohol. The salt with which it is frequently impregnated
WKj be removed by boiling the lard with twice its weight of water. The
IndcDcy to rancidity is obviated by the addition of benzoin; it may also be
—til""'* ^v digesting tlic lard witJi botjinaphthol. or poplar-buds. As a con-
fix: lual fat. lard is largely used in pharmacy as the basis of ointments
ad '.ej^aitj?; and in domestic practice it is universally employed as a lubri-
By the addition of benzoin it is prevented, not only from becoming
ad, ' ;igret'able odor is also imparted to it; dehydrated lard is pre-
t% .0 presence of water is considered objectionable. Lard-oil ia
prixnc'^ utM-il for illuminating purposes. It can be adminisiered, in caset
rconctttre |Kii£oning, as an tintidote. except where phosphorus or carbolic
iiaa bo^n swallowed. Lard is an article of food, or, more correctly, it
rmpJoj^l in preparing other articles of food.
Jiexapy-' — I-J**"*! brt!* more penetrating power than petrolutuuj or vaselin,
rttre- a^*^^^^ (sueli as mercury or the alkaloids) can be combined with
152 PUAUMACEUIICAL TUEHAPEUTIC AGENTS OH DUUOS.
it for administration by inunction. Washed lard, beaten up with an et
quantity of lime-water, and a few drops at oil of bitter almonds, thymol
of carbolic acid added, makes an eletjant substitute for carron-oil as a di
ing for burns, or for some acute inflammations of the skin. Stiffened i
a little yellow wax, it forms the simple ointment of the U. S. P. 1
preparation is well adapted to fulfill the general indications of a fat, ani
serve as an excipient for more active ingredients. When the secretory ft
lions of the skin are suppressed, inunction with lard serves as a partial £
•titute for the natural secretion, softens the hard tissue, and reduces
heat. It sheaths the surface, and prevents the contact of the atraosph
air with its floating germs. It lessens or prevents the effect of irritant i
charges. Lard softens and removes scabs. The free application of sin
ointment relieves the intense heat of the skin and itching in scarlatina, i
at the same time it assists in reducing the pulse-rate and temperature of
body. Inunction is likewise of value in measles. It has been claimed t
it is useful as an antidote to strj-chnine, and that a dog which has ha
poisonous dose of strychnine will recover if given lard froely. ■
I
ADEPS LAN-ffi (U. S. P,, B. P.).— Purified cholcsterin-fat of shei
wool, !
ADEPS LANiE HYDROSTTS <U, S. P., B. P.).— Hydrons Wool-fat.
Tliis is tiie ])urificd fat of the wool of the s)ie<'p. iiiixt'cl with not m
than oO per cent, of watL'r. (LanoHn is n trade name for Adeps lana\)
Phajmacology. — In the washings of wool is found a variety of fat whi
owing to the presence of cholesterin, combines readily with more than
own weight of water; it does not become rancid, and resists saponificati
It is neutral and is a good vehicle for remedies to be used by inunction,
it passes readily through the skin; it is not adapted as a protective
this reason. The sheepy smtll of the fat is removed by repeated washic
and pure lanohn is now obtainable that is nearly odorless.
lanolin used as a medicament contains from 25 to 30 per cent, of wal
which is not, however, chemically combined, and is readily separated
heat. Anhydrous lanolin is completely eohibie in ether, benzol, and chlo
form; sparingly soluble in stronger alcohol; and insoluble in water. Pu
fied lanolin is of an unctuous, tenacious consistence and whitish color. 1
A. Gottstein, of Berlin, has demonstrated that lanoHn is indestructible
impermeable by micro-organisms. Its employment may, therefore, be
garded as an aseptic measure.
Physiological Action. — Lanohn has a soothing action on a delicate
irritable skin. It is not used internally, but only as an unguent.
Therapy. — Lanolin is a serviceable dressing in cases of burns, seal
erysipelas, frost-bites, erythema, and dermatitis. Its property of absorbi
water, its blandness and aseptic nature, render it an excellent medicamc
or base in acute eczema. In chronic eczema with infiltration and in psoria
lanolin softens the skin and favors the action of remedies with which it m
be combined. Lassar highly recommends it in the treatment of impeti,
contagiosa. When suitably diluted and perfumed, it is an admirable toil
pomade. It rapidly heals chapped hands and lips, and may be spread up'
the face before retirinfr at night in order to soften the skin after exposure
cold and wind. Lanolin, in conjunction with appropriate internal remedi*
Tcstores the lustre or gloss of the hair when it has been lost in consequen
ADHATODA JC8TICIA.
153
tic disease. It is valuable in the treatment of atrophy of the hair,
ami covnteracts that dry, harsh condition of the hair which is natural to
fli^K xDdiriduals. Senile atrophy of the skin may be benefited by the per-
HtaBt md syMeinatic use of lanolin. Inunction with this substance is one
^ tki best means at our disposal for the obliteration of wrinkles. Lanolin
tile proper performance of the glandular functions of the skin, and
ioas in anidroeis and comedones. In iclithyosis and scleroderma it
the surface of the integument. It is an excellent vehicle for the
made use of in tinea versicolor, tinea favus, and the varieties
of ODfla trichophytina. It is admirably adapted to serve as an ointment basis
the oleate of mercury or copper in the treatment of the affections speci-
L Ob account of the ready miscibility of lanolin with mercury and its
fflBKnuTe pover, it is peculiarly serviceable in the inunction treatment of
^pkilic. In affections of the nasal nnd genito-urinary tracts^ lanolin is
^fgwaX advantage combined with cocaine hydrochlorate.
It is a good vehicle for the anodynes — atropine, cocaine, morphine,
: — in cases of neuralgia or rheumatic joints. As an ointment alone
iv the ere, lanolin is too thick, tenacious, and sticky, and to remedy
defects a combination of 1 part of benzoinated lard to 3 parts of
has been preferred; this makes a fine, smooth ointment, which has
fcmnd a good vehicle for eye ointments, and, even alone, is often used
X$ spfplj at night to the eyelids in conjunctivitis and almost all external
nmations. Lanolin containing a large proportion of water is efficient in
■in* the itching which accompanies measles, scarlet fever, and chicken-
in. Tne gradual evaporation of the water produces a cooling effect upon
ftctkin. In these affections Dr. Klein adds to 31 Gm. (or 5J) of pure an-
Mmas Luiolin 1*^ Gm. (or 5iij) of vaselin and 1S.5 c.cm. (or f3v) of distilled
liter. Ufbreich recommends the injection of a lanolin cream into the
for the relief of infiammation and erosions of the rectum and lia?mor-
Lanolin seems to heighten the efficacy of many of the drugs for
it U employed as an oiniment-base. This is especially the case as re-
padb c^TjBttTooin. Applied upon a bougie it has been found of advantage
■ ibe treatment of gonorrhoea.
ASHATOOA JVSTICIA.' — Adhatoda vasica, A. gendarussa, or A
?karaMO0log7 and Fhysiological Action. — The leaves of this plant
ciooging to the Acanlhacea*. indigenous to India and neighboring
stnds) IiATc been used with asserted benefit in pulmonary and catarrhal
Aetitfoa. It contains an alkaloid. Vasicine, combined with adhatodic
•si HoofH*r found it poisonous, when used in infusion, to flies, frogs, and
d tJbe anvaller organisms, but harmless to large animals.
Tbarmpy. — In asthma, 0.65 Gm. (or gr. x) doses of the powdered
^Mt* ' times daily, afford great relief, the patient being also
|g^, fho leaves in a pipe, or to inhale the smoke. On ac-
■■it of ita ba< ii properties, Dr. H. H. Rusby has recommended
l^mt of adhAt* ision in diphtheria, and it has been suggested that
Saicbt aUo bo eiTieient in typhoid fever, and by inhalation of the spray
hm ibc atomizer io casea of phthisis and fetid bronchitis. It is prob-
r of tbe tJniTerml Mediml Sciences." 1890, toI. t, p. A-7.
154
J'llAHMACEL'TlCAL TIIERAPKUTIO AGENTS OK DRCOS.
able that it might also be useful in infucLious dyspepsia due to the all
mai fermentation of food in the stomach.
ADONIS VERNAUS. — False Hellebore, or Pheasants Eye, f
perennial herb (bt?lo]iging to the Raimnculaceaf), indigenous to Eui
having bright, showy flowers. There ore Uso annual species, the A. testii
flowering in May, and tht* A, autumnalis. flowering In September;'
former has orange, tlie bitter red, flowers; hence the common name ol
chamomile.
Physiolo^cal Action. — The active principle, Adonidin, appears t
a mixture, coii.sisting ui' yrllow adoiiidoquercitrin, adonidodulcit, ado;
acid, with a brown glucoj*itb'. and a hitter, poisonous gkicoside^ pieradon)
according to the analysis of I'odwissotzki. Adonidin ia a yellowish-W
hygroscopic, bitter powder, devoid of odor, sohible in water and alc<
insoluble in ether, chloroform, and benzin. jNIcrck has isolated a cr}'sta
principle termed Adonite, which lias been shown to be a peota!iydric ale<
converted into a sugar by oxidation. Adonite is very soluble in water
has a slightly-sweet taste, but, according to Robert, has no decided pW
logical action.
Whether used, as the peasants of Russia are said to he in the h
of doingj as an infusion, as the fluid extract, or in the form of adoni
adonis acts upon the heart as a stimulant or cardiac tonic, rcsemblin
its action digitalis or strophanthus. Adonis is said to increase the art<
tension and in large doses causes diastolic arrest of the heart. In L
doses the first rise is succeeded by a decided fall of arterial pressure, ^
paralysis both of the heart and blood-vessels.
It is claimed that, in moderate doses, adonidin is devoid of dai
from cumulative effect, and that it agrees well with the digestive org
Huchard, however, found in some cases, that it caused vomiting or (
rhoea. In a case in which 0.20 Gm. (or gr. iij) of adonidin was takei
mistake, vomiting and diarrhcea were prominent symptoms. The actio
this drug is very promptly manifested. In accordance with the obse
tion that it increases arterial pressure, there is an increased flow of ui
but adonidin exerts no efCect upon the secreting structure of the kidneys.
Therapy. — Internally in cases of raitral or aortic regurgitation i
claiuicJ to be of grcjit vahio. In functional irregularity of the heart J
Da Costa found much benefit from adonidin (in doses of 0.003 to 0
Gm., or gr. Vso'Vm thrice daily). In cardiac asthma it also affords n
to the dyspncen. The fluid extract (normal) is a good preparation in d
of 0.06 to 0.12 c.cra. (or nn-ij) cautiously increased.
Professor Bckhtereff has observed a favorable influence fronJ
addition of adonis vernalis to a bromide solution in the treatment
epilepsy. The combination which he has for several years employed ii
B Pofaas. bromid 8| to 12
Tinct. adonidia 4
Codeinffi sxilph
Aqure
M. et ft. sol.
Sig. : Tflbleflpnonful from four to eight limes a day.
,240
Gm.
c.cm.
20 Gm.
c.cm.
or 3ii-iij.
or f3j.
or gr. iij.
or fjviij.
The tincture of adonis a^tivalis, an allied species, in O.fiO c.cm. (or i
^THER.
155
three times a day, is reported to be efficient in removing fatty tissues
tfma the heart and relieving the dyspncea which accompanies obesity.
ADEEHALIinTM.— Adrenalin, Epinephrin. (See Glandulee Supraren-
^^^ X8CULVS HTPPOCASTANTTM. — Kippocastannm, Horse-chestnut.
^^^ PlMrmacology and Therapy, — The horse-chestnut. .Esculys hippo-
riftimiiii (Hippocastancffi), is a large tree cultivated in Europe and North
P Aaerica as a shude-lree; its original habitat was India. The bark coa-
tns tumic acid and two neutral bitter principles — ^iEscnlin and Fraxin*
Tktir effects are those of the vegetable bitters; the bark also has some
ntipcnodic powers. A fluid extract, with dilute alcohol, is the best prep-
I oatKOD. The fluid extract has been administered in malarial disorders and
I m tt«ara]gic affections in doses of 1.20 to 4 c.cm. (or mxx-iZj). JEscuIin
•onirs in the form of brilliant, white crystals and is soluble in hot water.
k» said to have been given with good result as a substitute for quinine
LBAlarial fevers, especially of the remittent form.
JETHEK (U. S. P., B. P.).— Ether (iEther Fortior, U. S. P. 1880).
iETHEE PUEIFICATUS (B. P.).— Purified Ether [(C.HJjO].
Omc» 0.60 to 2 c.cm. (or mx-xxx) for repeated administration; for a
Sftsie administration, 2.40 to 4 c.cm. (or mxUlx).
PrBparations,
.£th«reum (U.S. P.). — Ethereal OU. Equal volumes of ether and heavy
tafwtML
^Irittts jEtheria (U.S. P., B. P.).— Spirit of Ether. Dose, 0.30 to 2 cent, (or
Spiiitus .-Etheris CompositUB (U.S. P. B. P).— Compound Spirit of Ether, or
mmnn'm Anodyne (U. S. P., composed of ether, .325 c.cm.; alcohol, 650 c.cm.; and
«tWrmiR. 25 c.cm.). Dose, 0.30 to 2 c.cm. (or mv-xxx).
Spuitua .ttheris Nitrosi (U.S. P, B. P.).— Spirit of Nitrous Ether, or Sweet
of Nitre. Dose, 2 to 4 c.cm. (or fSss-j).
FfcOTinacology. — Ether is a liquid composed of about 96 per cent., by
vt^gbt, of absolute ether, or ethyl-oxide, and about 4 per cent, of alcohol,
matmining a little water. "A volatile liquid prepared from ethylic alcohol
temction with sulphuric acid. It contains not less than 92 per cent.
ime of ethyl-oxide. It was formerly termed sulphuric ether* (B. P.).
led ether is: "ether from which most of the ethylic alcohol has been
r^ by mashing with distilled water and most of the water by sub-
st dJ5tinatinn in the presence of calcium chloride and recently-pre-
fmd lime" (B. P). It is a thin, very diffusive, clear and colorless liquid,
rid a r- " chnrflctoristic odor, a burning and sweetish taste, after-
iteali^ '--•,' ■ ^' "^^^^ ^ neutral reaction. It is soluble in all proportions
1 akobol, chloroform, benzol, benzin, fixed and volatile oils; aissolves in
rt ttn tiiTiea its volume of water at 59* F.. and it boils at 98.6** F. It is
mn inflammnblo, and its vapor, mixed with air and ignited, explodes vio-
' " The vapor is slightly irritating to the conjunctivae, and at first to
jnchial mticous membrane.
k
fllfliologio&l Action. — When ether is poured over the skin it evapi
uickly that a sensation of cold is experienced, and when its applici
on is continued, as with the atomizer, the temperature of the part is lowere
and it may be frozen, which is announced by eudden blanching of the sku
When the escape of the vapor is prevented ether acts as a counter-irritan
causing reddening; even vesication may be produced.
When taken internally, ether is a diffusible stimulant, resembling ale*
,ol in its effects, which, although manifested earlier after ether, are moi
transitory. When introduced into the circulation, by absorption from tl
stomach or the rectum, by inhalation, or hypodermically, it is found tempt
rarily to increase arterial tension and acts as a cardiac stimulantj the heai
continuing to beat after failure of respiration. In these respects it ia anta^
onistic to chloroform, which lowers arterial pressure and is a cardiac sedativ
Ether-vapor is inhaled pure, while chloroform-vapor must be combined wit
95 to 97 parts of atmospheric air. Upon the nerve-centres ether acta vei
much like alcohol, atlecting (1) the cerebrum; (2) the sensory, and later tl
motor, functions of the spinal cord; (3) the sensory centres in the raeduU
oblongata; and (4) finally the motor centres in the medulla. Kemp^ foun
a decided increase in the amount of indican excreted after ether, and b
the use of the oncometer demonstrated a special contraction of the arterioU
of the kidney, and damage to the secretory cells. Therefore the presenc
of albuminuria or pulmonary cedema is usually regarded as a eufficien
centra-indication to its use.
The State of Anaesthesia. — Anjestheeia produced by the inhalation c
ether-vapor, when complete, nearly apprcximates the state of coma. It aj
proaches by well-defined stages, the first being one of excitement or exhij
aration; the second is narcosis: the third is abolition of sensibility am
reflexes, and, carried further, it ends in paralysis and death from failure o
respiration, owing to paralysis of the centres in the medulla oblonffato. Tb
nerve-centres are affected in the following order: The higher centres in th
brain, the motor and sensory centres in the medulla spinalis, and, ulti
mately, the sensory and motor centres of the medulla oblongata. The vapo:
of ether is at the beginning of the inhalation irritating to the air-passagea
and may cause strangling sensations to the patient, but this soon passes awa^
as anesthesia becomes established; it may be necessary, at the outset, t(
allow some admixture of air, so as not to frighten the patient, but as soot
as may be possible the pure ether-vapor ia to be administered, so as to pre
vent efforts at vomiting. Owing to this irritation of the bronchial mucom
rnembrane, there may be produced congestion or cedema of the lungs, espe-
cially when the patient is not kept warm during the operation, or pneumonia
^may follow
The presence of bronchitis centra-indicates the use of ether. Accord-
ing to the observation of Poppert, osdema of the lungs is the frequent im-
mediate cause of death from ether, and is due to the toxic influence of the
anesthetic. Scnger draws attention to the danger of cerebral hiemorrhage
during ether-narcosis, in patients sulTering from arteriosclerosis. During
operations upon the mouth, and particularly in the extraction of teeth, the
blood running down the throat mav cause asphyxia. A few "dontV should
be borne m mind when administering ether:—
^Ncw York Medical Journal, Nov., 1809.
JBTHER.
167
I. Don^t give it to a patient whose kidneys are diseased.
8- Don't give it when the stomach contains undigested food; the pa-
Ehould be fasting for at least four hours, if possible.
3. Don't give it without removing artificial teeth from the mouth,
are liable to fall into the throat.
4. Don't give it unless the clothing is so loose as to allow freedom of
lion.
L^ 5. Don't give it when the pleural cavit)' is full of fluid,
^k 6, Don't give any anaesthetic to women, eepeeially young women, ex-
Htipt in the presence of witnesses, who can testify as to your actions during
Vfte period of unconsciousness of the patient, as under such circumstances
" vooMD fionetimes acquire fixed delusions which can only be met by testi-
mtmy abeohitelT proving their falsity.
7. Don't forget that ether-vapor and air make an inflammable and
fl^osire mixture, and that ether may take fire from the actual cautery as
ml as from a candle.
fi. Don't forget that there are different qualities of ether, and that
Am proper kind for surgical purposes is the official ether of the best make.
9, Don't forget that ether, like alcohol, lowers temperature, and that
ibe patient shoxild not be too much exposed to cold during operation.
10, Don't forget that ether causes death by respiratory failure, and
the color of the lips and ears is a better guide to the state of the blood
the radial pulse.
II. Don't forget that the ansesthetic state is a state of danger, and the
pitkikt i£ not safe until the effects of the ether have entirely passed off.
18. DoD*t forget that ether is eliminated rather slowly by the lungs and
1^ kidneys; so the patient should be watched for several hours after the
aAniaistration.
Xhe Choice of Aneesthetics. — The ancesthetic agent should be suited to
ftc operation and to the circumstances of each case. For many trivial opera-
tidM, or thofie which are rapidly performed, pure nitrous-oxide gas is sutli-
cieit and much safer than the others. In young children chloroform-vapor
s tmamr of administration than ether, and comparatively free from danger
vfccB properly administered. It also is preferred where the actual cautery
vto be u^ed, or where lights are required near the patient. In midwifery
inctiec it also is the preferred anaesthetic. For all ordinary cases ether is
■fa' than chloroform, and is by far the most frequently used.
A valuable paper has been published by Dr. Julliard.* of Geneva, upon
the Illative safety of ether and chloroform. From the records of several
hmdrrd thousand administrations of ether and chloroform it was shown
tftst the mortality from the latter is from four to five times greater than
faiUB ether ^[ethylene bichloride has been tried in England to some extent,
Ht as ordinarily sold it appears to be merely an alcoholic solution of chloro-
^yi Kthyl-bromide is of more recent introduction, and when pure
well for short operations, but does not have decided advantages
the be»t ether, except in having a slightly more agreeable odor. For a
Epperation it is well to precede the amesthetic by the administration
fO to 1^0 com. (or fjii-iv) of whisky. In a similar manner an hypo-
riection of morphine n 0^n Om. (or gr. VJ a°d atropine 0.0005 Gm,
^^ioale de ta Suiatte Romans, Feb.. 1B91.
158
PHAKUACEUTICAL THEIt^PElTlC AGENTS OH DUUGS.
(or gr. V120) may be given before operating (Nussbaiim's method). Variot
mijctures of anjesthetics have been proposed, the beet Icnown being the A. (
E. miitiire of the London hospitals^, containing alcohol, 1; chloroform, J
and ether, 3 parts; but, owing to the different density and var^nng rates t
diffusion, it is impossible to tell just how much of each is being given; ther
fore, these mixtures are not recommended. Gurlt finds that when a mixtu:
of agents was used the proportion of accidents from asphyxia was great*
than when chloroform alone was employed. By the use of an inhaler, ethe
vapor mixed with oxygen can l>e administered, the gas passing through
wash-bottle containing the other; by this method asphyxia is avoided an
greater safety secured.
Where a patient dislikes ether, or takes it badly, the administration mfi
commence with nitrous oxide and ether substituted later, or it may be pD
ceded by a few whiiTs of chloroform. Dr. A. Diaz de Liano has invented a
apparatus by means of which ether can be administered at a temperature <
88° F., and claims that by his method the disadvantages both of cold eth«
and chloroform are obviated. It is claimed by some clinicians that the pn
liminary application of cocaine solution to the nasal mucous membrane prt
vents irritation, and the unpleasant after-effects are, to a large extent, pn
vented.
The production of surgical anaesthesia by absorption of ether-vapc
from the mucosa of the rectum was advocated by Pirogoff in 1847, and wa
prominently called to the attention of the profession by Axel Iversen, c
Copenhagen, and Daniel Molii^re, of Lyons. Alore recently, Stcdman/ c
the Sheffield Hospital, made a plea for this method. It is accomplished b
attaching to a rectal tube a rubber pipe connected with a bottle, partly fille
with ether, which is placed in a bucket containing warm water. The absenc
of irritation of air-passages, struggling, and vomiting by this method suje
gests its adoption in suitable casea. On the other hand, it is slow in actioi
requiring from five to thirty-five minutes, and it may be necessary to supple
ment it by ordinary inhalation. At least two deaths have been caused b
rectal etherization. In another case, death retfultcd from rupture of th
intestine at the site of an old cicatrix from an ulcer which yielded unde
pressure of the vapor. Calderon^ believes ether-narcosis by the rectum ti
be of special service for surgical operations ai>out the head, and reports ;
mastoid operation done successfully upon a child with its aid.
What is called "primary an:esthesia" occurs early in the administrotioi
of the ether, at the time when narcosis begins. During this stage, whicl
is very brief, small operations, incisions, punctures, etc., may be done with
out waiting for complete amesthesia. In order to ascertain when it occurs
the patient is directed to extend one of his arms perpendicularly upward anc
to hold it up as long as he can. At the moment when narcosis occurs th<
arm falls, which is the signal for the operator to cut and for the adminis-
tration of ether to cease. The patient regains consciousness at once, an£
generally there is no vomiting or other ill effects.
Treatment for Toxic Effects. — When a patient appears asphyxiated^
rhythmical traction upon the tongue by Laborde'a method^ artificial res-
piration, inhalation of ammonia, slapping the exposed surface of the chest
with wet towels, and the application of the faradic current to the epigastric
' Quarterly Medical Journal, Sheffield, Jan. 18, 1805.
* Pacific Medical Journal, March, IflOO.
.£TH£R.
i5y
i will osoally restore him. Rubbing the body so as to keep up the cir-
, or the use of stimulating encmata, is also of service. Oxygen might
taJBUUstered, or a mixture of oxygen and nitrogen monoxide (2 to 1), or
,_BTiBitrite cautiou&ly inhaled so as to flush the brain and medullary centres
«n blood. Xitroglycerin, 0.0006 Gm. (or gr. */ioo)j ^^7 ^e given hypoder-
uL Effects of Ether. — The unpleasant results which sometimes follow
rW*^-- f. ..*r-!.tion of ether, such as nausea and vomiting, ma}' be overcome
• lent a cup or two of eitiier strong, hot coffee or t*ia. After
■ -ns, where it is especially iniportiint to prevent vomiting,
'fit the administration of any food, medicine, or water
: a period of 12 to 24 hours, or longer. Thirst can be re-
• »ns of water into the rectum, and strength sustained by
- iiTc njvniata. Suppositories or small liypodermic injections of mor-
nuv Im^ iriven to relieve pain. For dental operations, ether is pre-
Id > irm, on account of greater safety. In the event of nausea,
u wakefulness supervening after extracting teeth, Dr, Dorr
aiboat 1.60 Gm. (or gr. xxv) of potassium bromide in strong
.or fiom a few minims to 4 com. (or f.'j) of compound spirit of ether
tj ( X.- » »_"
The author can also commend sodium bromide (1 to 1.30 Gm., or gr.
II, ID goda-water, soda-mint-water, or cinnamon-water), camphor-water,
anmiatic spirit of ammonia, caffeine citrate or hydrobromate (0.0(55 to
Gm^ or gr. i-iv, at a dose), tincture of caps^icum (0.60 to 1.20 e.cm., or
x^at a dose), or the effervescent salts of sodium or caffeine bromide, all
WB heinp especially suitable for the treatment of the ill effects following
iteim^lratiozi of ether. In order to control hiccough and vomiting
anesthesia. Dr. Bernard Joes is in the liabit of making digital com-
_ of the phrenic and vagus nerves against the sternal end of the clav-
He states that, as a rule, vomiting immediately ceases. The pressure
laetsQocd for a few momenta in order to prevent a return of the sickness.
.Ficderick Silk's* conclusions on "ether pneumonia" are; 1. Ether in-
is only one of the minor exciting causes of croupous pneumonia.
Jlxnalatini? properties of the vapor may even help to ward off an attack.
coDuitions of the mucous membrane of the air-passages are uni-
cther, and their tendency is to subside on withdrawing the
In m small proportion of eases, however, an inflammatory condition
and the patient's life is in jeopardy. Other concomitant causes
ireneralJy be found at work: e.g., cold and exposure. 3. To limit
^ncy, careful precautions will usually suffice, especially in the direc-
«i^aToidin;Er exposure, cold, and draughts.
fLmfmpY -Ether may be used locally for its refrigerating or detergent
^0T^ m finr^cal operation. It dissolves fat from the skin, and is
hI £p ^ ' ^ the hands by surgeons, in connection with antisep-
^ 'pi, may be use<l to bernimit a part of the skin before
»ii ; and, in chorea, ether-spray has been applied to the spine
,,:^. The ether-^pray is nl&i often very serviceable in allay-
^f tictiralffia. especially when peated in a superficial structure.
pmm
fiber Ut
directed immediately ujxm the course of the aching nerve. Sir
'i»«<ar<Mo**^-
March, 1(KK).
160
rnAHMACEL'TlCAL TIIEBAPEDTIG AGENTS OR OUUdS.
James Sawyer jxiints out that ctlKM* is the best nienstruuin fur the solut
of many remedies to be used upon the skin ; ether being a good solvent of
active principlefi of many drujrs; nnil aUo of wliacoouR matter. It may
used as a menstruum for rnakiji^^ t'thL-rtsil tinctiirps nr tiniineiits. In sti
gidatcd heraia. 30 ta (iO com. (or t7^i-ij) of utluT may be sprayed upon
tumor, as eueetssfully employed by Fiuk<'lsteii^^ and ("insciiljaner. or allo^
to fall upon the surface drop by drop.
Dr. Charles E, Ilughes, of St. Louis, has had good elfect from lavem
with ether for the relief of pain; thus, in severe headache he has pou
ether on the scalp freely with prompt cure.
A case in which a fistula remained after an operation for cholecys
omy has recently been described by Dr. John W. Walker. Seven mon
later a stone again entered the duct and was dissolved by a mixture of eq
parts of ether and glycerin placed in a small glass tube attached to a syrit
the tube pressed directly upon the stoue and the ether-glycerin injected d
by drop.
Ethereal preparations may be used internally for hysteria, colic, and
passage of biliary or renal calculi. Durand's remedy for gall-stones is ec
parts of ether and turpentine-oil, given a teaspoonful at a dose.
Ether is a diffusible stimidant, and can be used hvpodermically in hej
failure (1.20 to 2 c.cm., or mxx-xxx). Taken with water or syrup (2 t
c.cm., or f.lss-j), it atTords relief in flatulence, spasmodic asthma, or co
It bus siijiilnr cllVct^ to \Uo^ of alcohol, and a luibit of etlKr-driuking-
in like manner been established in some persons (although the odor of
breath plainly announces to others the fact that it has been taken), but
effects are more transitory than those of alcohol.
The internal administration of ether is capable of relieving mild atta
of angina pectorifi. It is a good plan to combine O.GO to 1.20 c.cm.
mx-xx) of ether with codlivcr-oil when the latter substance is not well boi
Ether facilitates the digestion and absorption of the oil, probably by incn
ing the secretion of pancrentic fluid. Hoffmann's anodyne in 2 com.
f5ss) doses is useful in sick headache. The hypodermic injection of froi
to 2 c.cm. (or mxv-f5ss) of ether in the neighborhood of the affected n€
has proved of value in sciatica, gastralgia, and various forms of rheumi
neuralffia, Barth obtained very excellent results in typhoid pneumonia fj
these subcutaneous injections of ether. The injections were given from i
to four times daily, and were followed by notable increase in the stren
and volume of the pul?e. Castel reports favorably of the same method
small-pox. After puerperal, pulmonary, or other severe haemorrhage ot
thrown under the skin stimulates the heart and may avert fatal syncope
The following combinations of ether will be found serviceable: —
H Spt. ictheris comp 6(1
Tinrt. cnpsici ' 4
Spt. aininon. anunntic 12 S
Mint, sodaj et nicntlifr (X.K.) 6n
M. Sig.: A tensponnful in water every few minutes until relieved. This
scription is especially imeful in the treatment of syncope, flatulence, and neryoui
hystericnl paroxysms.
' "Treatment of Straugiilntotl l!ernia by Applications of Ether, after the Met
of Fiiiklofttoin." <7orr//r Mrrlirah- (fr dtra/thonrff. No. 3. ^ffirfli 1, IrtftS.
'See interenting nddn'S'^ on "Ether-drinkinfj. its PrcvahMiw ami Results,*'
Erne^^t Hnrt. dplivercd Iwfore the Society for the Study and Pure of Tnebrietv
the Provinfiat Mrtlical Jourual, Xov. 1, lftf>0.
c-cm. or fjij.
c.cm. or f3i.
25 ccm. or mcc.
c.cm. or fjij.
JETUER.
IGl
R Stiaritn<% ••(brris romp..
FlakUxtr4uni I
ipu
linL
TiBcl. Tatrhutiie tiuunouiatiie.
30| c.cm. or f5j.
p.: Tho U'lifcfMK'nfuls in water even' fifteen or twenty minutes. For hy»-
ervotts ftick headache, neurasthenin, angina peotoriti^ and spaBitiodic asthma
The diagnuetic use of etlier anaestlietria is frequently illustrated in sur-
ptrr. vbere it is <»rni>i*\ved in order to examine fracturt^K, expl<ne eavitiefl
t. . r«.-..-i...i .rT^... iT.^ ^,r foreign luxlies, and to detect malingering. Emerson
<t»^ the employment of ether-vapor, in place of hydrogen
^ >*^nn > • if detei'mining" the ])resence of perforations in the inles-
fosw 4ft«'r "n»y- f'"*r g-imsliot wounds/
SfFuitiu iEtheris Compoaitas (U. S. P., B. P.). — In hysteria, flatulent
cofic, and oerrousnej^ this solution is much in demand. Compound spirit
«€«lher « likewise very serviceable in the treatment of hiccough, functional
prir" ^ of the heart, or syncope. It will often afford relief in gastralgia,
mt iiictinies prove of marked benefit in angina [ictloris. It is a
&f -■iniulant and antispasmodic, and is popularly known as HofT-
Bi.. yne.
Tbtr /ollovriug fonnula*. containing conij>ound spirit of ether, are
»f a] : —
B Sodii bic«rbonatis 6| Om. or Siss.
SpC ammon arom.,
Tiact. dairiberis aa 41 com. or f3j.
Sjptntiis Athens comp 120| c.cm. or fjiv.
JC S%.x Two teaspoonfulB in water for hysUria or flatulence. Repeat when
B Spirit u» «fthen» eomp.
Vim
30
AOl
c.cm. or fjj.
c.cm. or f^ij.
S||s. : FTT>m itm*-h»U to a tuMesfMHuifiil. iu watl^^, every hour or two, as %
in Kvnt4^nii, dviimenorrhii'a. or llntulent colic.
^nritiu -fftheria Nitrosi (XT. S. P., B. P.), spirit of nitrous ether,
Molarlr known as sweet spirit of nitre> is an alcoholic solution of ethyl-
•>»;.. vw TJmiit^ when freslily prepared and tested, not less than 4 per cent
It ift made by the action of sulphuric acid upon sodium
w carbonate, water, and alcohol.
a<'o|HT*iaa dini*et tliat it should be kept in small, glass-stoppered
djK-e rcTuote from light.- or lire. Very much of the spirit
I>en!i«^d i.« defieirnt in strength, and has become acid from
Wb«^ llii^ i»rt»» fKTurred it should not lie used. Tho loss of the ethyl-
;. fir»>vt»nti'<l, tit a large extent, by a eombinntion with an alkali or
. tato or citrate. When fresh, it rendeni excellent service in tea-
-.^, wcll-<liluted, given s**veral times a day, in scanty secretion of
•rlv people.
-•ther rcecmblcs the other nitrites in its sedative effects upon
^^^ tit ita action is overcome or modified in this form by the com-
^i^^j^ In, Mntity of alcohol accompanying it, which really makes
fcraiht of : '^ ether a diffusible stiranlant For this reason Whitla
^ citmiu et '
mr
m^
•J^r*M»l f»f '^'
\mffifiu\ Sfrdical Aanon'ation. .fulv 2^, IftOS.
162
PlIABMACBrTlCAL TIIKUAI'EVTIC A0ENT8 OH DRCOS.
especially commends it in the dropsy of debilitated subjects. In fever
may be given in cold water or lemonade, or in combination with other ren
dies, as aconite or veratnim viride. It acts upon the ekin as well as up
the circulation, and reduces the temperature. It is useful, above all, in t
febrile affections of infancy and childhood. It enters into Brown mixti
(Mist, glycyrrhizse co.), of which it constitutes 3 parts in 100, forming
popular roinedy for acute bronchitis, and which is used as a vehicle for q
nine and other remedies.
Spirit of nitrous ether can be employed in the following combinatio
with advantage: —
Q Spiritus cetheris nitrosi,
Aqute caznphone,
Uq. ammon. acetatis aa 60
Antimonii pt potasaii tart. .,,, .......
Morphinie eulphnlia .«.
M- Sig. : A tablespoonfiil in water every hour or two until relieved,
broncbitia, acute rlieuiiiutism, and in fevers.
c.cm. or fSij.
nfiS fim. or gr. j.
03 Om. or gr.
fSij. I
r j- 1
For aci
B ^piritua letheria nitrosi,
Elix. humull (N.P.),
Syr. Inctucflrii aa 60| c.em. or fjij.
M. Sig.: From a half to a tableapoonful every hour when unable to sleep,
ieeablc in insomnia^ general ncrvouancBs, and debility.
J
a;THEE ACETICUS (U. S. P., B. P.).— Acetic Ether. 1
Dose, internally^ O.GO to 2 c.cm. (or mx-xxx).
Acetic ether is a liquid composed of about 90 per cent., by weight,
ethyl-acetate (CJI^.CHaO^) iiiKi about in por cent, of alcohol contain!
a little water (U" S". P.). It is soluble in ID part^ nf wafer (at .59'' F.), a;
mixes in al! proportions with alcobril. ctlier. rblorofonri, nnd fixed or vo]
tile oils. It enters into cologne water (tij>iritnf^ odonitii?, U. S. P. 18J>0).
haa similar elTects upon the system to t'lliyl-oxide, and also can be nsed
inhalation nc an nuirsthetic, but is slower in its nrtion.
According to the experiments of Krautwig on rabbits, moderate qua
tities of acetic ether greatly increase the respiratory capacity, the eflFect an
menting in proportion to the dose. There was no influence from the sai
quantities upon the blood-pressure and no ill effects upon the heart. I
halation of the vapor of acetic ether allays laryngeal and bronchial irritatio
In spasmodic asthma and in nervous cough also it mny be used with go
effect. It is rather more irritating to the skin than ordinary ether.
aiTHEK VALERIANICUS.— Valerianic Ether.
Pharmacolog:y and Therapy. — Valerianic ether, or the ethylic eth
of iso-valerianic: acid, is a colorless fluids having an odor resembling that
valerian. It is ii less volatile fluid than ordinary ether. The dose of vale)
anic etker is 0.12 c.cm. (or waj), but in practice it is found preferable
dilute it with sulplmric ctbor, luid it is llius prepared and put up in seal
gelatin capsules, each capsule cnntuinin;i abuut 4 drops. Vulerianic other
a aerviceable remedy in dyamcnurrhiea, nervous hcadjiche and exciteuiei
aathma and other simsmodii.- disorders, neuralgia, and nervous vomitin
It is of advantage in mania a potu, by controlling arterial and nervous e
-aiTHYLIs BHOMiDCM. ' 163
Bt 4l»cl tremor. In periodic hay fever. Dr. J. D. ChrLsiinaii, of AUea-
PtL, found it decidedly useful.'
MTSYIJS BROMTDTTM.— Hydrobromic Ether, or Ethyl Bromide (C^
'■■ Mr) ( It niu?t not be confounded with Ethylene Bromide.)
nuxDACoIog^. — This liquid has rather a pleasant odor and sweetish
':■ When pure it is colorless, volatile, non-inflammable, and resembles
T or chiorofonn in its effects when taken internally or by inhalation.
it tfftij slightly soluble in water, but freely soluble in alcohol and ether,
ikktrafonn and oiL Air and moisture cause its decomposition. Under
t^ iafheoce of light the bromine gradually separates, causing discolora-
Utt of the ethyl, when it becomes unfit for use, owing to the poisonous
Ac^ at bromine.
Aetm^. — For anffisthesia, the pure ethyl bromide only should be
mei, MS dangerous symptoms, even fatal results^ have been ascribed to
^ OM of impure preparations. It is thought that some, sit least, of the
tcjl ca^efl may have been caused by the employment of ethylene bromide
>uke for ethyl bromide. An easily applied test for the purity of ethyl
-■— litf ia g-iven by Sternberg: if a drop of ethyl bromide be let fall in a
^Mion of potassium iodide 3 centimetres (about 1 y^ inches) deep, it
teid reach the bottom without being colored violet. In experiments upon
aaaU, <'tbvl bromide has generally proved fatal by arrest of respiration.
EmUct, however^ has reported a case in which death occurred from a
wUbi cesaation of the heart's action. Chumical examination demon-
Oitcd that a pure sample had been employed. In other cases, which did
MC t^munale fatally, the inhalation of ethyl bromide occasioned nausea,
^vitiiig, collapses spasm of the glottis, cyanosis of the face, or other dia-
QHUf ejmptoms. In some instances irritability of the stomach, loss of
Mttit, and prostration continued for days after the anaesthetic had been
la doea^, it stands between ether and chloroform, and probably
pies th© same relative position with regard to safety. Its character-
effects, when inhaled, are the rapid approach of aniestbesia, its brief
fantian, and the rapid return of consciousness. It is, consequently, ill
Aattd for tise in prolonged operations. When sprayed upon a part it
fMoeea local anaesthesia. It may be inhaled in epilepsy, chorea, and
^eriMiiroodic diseaso^ (about 4 o.cm., or f->j, at a time). Not very in-
temble and not unpleasant, it may be used instead of ether for minor
aniealopcr - One advantage which ethyl bromide posi^esses is that
fl£w not ij *^P mucous membrane of the upper rcsjiiratory tract.
Thaacent is n" ^priate for use in the reduction of fractures and die-
'•^Kii«*. Its it I ^ to e.xeite muscular spasm. It it* reparded as unsafe
^* of drunkards and those suffering from disease of the kidneys,
Fr^ni :i r-» ries of experiments relative to the action of ethyl bromide,
fltiif>yK.-.iir>T coocludes that small quantities produce narcosis without
Arterial pressure. liarge amounts diminish blood-pressure by
1^ th© peripheral vasomotor constrictor system. It is without
vpon the central vasomotor dilator system or upon the vagi. Toxic
'V«rfiMl fTM/rrfla, Jan, 1892.
164
Pir.\RM.VCHL'TlL'.\L Til KHAPEmC ACIENTS OR DRVOS.
doses disturb the action of the heart, but, as a tuIl\ produce arrest of re
ration before that of the heart. The same precautions should be ta
in administering ethyl bromide as when giving chloroform.
Coryl. — Under this name a mixture of methyl chloride and ethyl cl
ride has been employed as a local aiia?sthetic in dentistry and minor i
gery. Though it does not produce as much cold as methyl chloride, it
the advantage of being a fluid at 32° F., while the latter boils at a m
lower temperature.
Ethylene Bromide. — This iluid has at first a sweetish and sul
quently a burning taste, and an odor which resembles that of chlorofo
It dissolves in water and mixes with oil or alcohol. Ethylene bromide
been used with success in a number of ciises of epilepsy as a substitute
potatssiuni lirninide. It contains IH).li prr <vnl. nf bromine. The d(x^
adults is from O.IS to 0.*) c.cin. (or miii-viij) tlirice daily, and can
gradually and- cautiously increased to 2 c.cm. (or foss) two or three ti]
a day. It can be admirn'stered in wine or in capsules, Tt is never usod
inhalation, .
.SITHYLIS CARBAMAS (U. S. P.).— Ethyl Carbamate, or Ethyl t
thane ( ('()\H..(H',,H. ). This is an t^tcr of ciirltiimiuic acid, obtained
the refU'linii of [ilcolutl upon urtji or one nf ]t?i salts (T', S. P.), It can t
be oliTnined l)y tbe action of aminnnia or ethyl carbonate, or fhlorocarbon;
and likewise by direct union of cyanic acid with ethyl alcohol. Ethyl c
bamato, or urethane, is in the form of tasteless, white crystals, which
soluble in water, alcohol, ether, chloroform, and glycerin. Tfic lujui^us ?*>
tion i> of a neutral reaction.
Physiological Action. — Yon Jaksch^ found it markedly liypnotic
doees of 0,50 to 1 Gra, (or gr. viiss-xv) in various pathological conditio
Urethane is not an siualgesic, and does not relieve the neiinilgic pains
locomotor ataxia, for instance. Urethane resembles paraldehyde in be
free fnun any decidedly df'j)rcssing action upon the circulation and respi
tion, differing in this important n'spwt from chloral liydrat(\ and its all
When the i-irculation is wcnk, urethane is to be preferred as a hypno
instead nf chlnraK nlthough tbe latter has a stronger hypnotic action (Cu
ing). Overdoses, however, cause distinct depression of the spinal co
heart, and resinration. Death froui a fatal rjuantity is caused liy asphyj
Therapy. — In adults it is recommended for use as a sedative and h^
notic, where otlier a^onts cannot be used* in doses of 1 ttm. (or gr. x
every two hours. Deninie regards it especially suited to children, givi
0.25 Gm. (or gr, iv) at the age of 1 year as a true hyT^notic. He consid
that larger doses are safe even in weakly children, as he has seen no off*
upon the circulation, respiration, digestion, or nerve-centres. As an enen
1)0 used it successfully in ''dfunjisiji. It may also ]»e given in solution hv}
dermically in dog(»s about on*^-fourth of those for ordinary use. Abb
reports a case of tetanus eureil in tAvo days, from 0.5S Gm. (or gr. ix)
urethane every t^'o hours, with 2 Gm, (or gr. xvx) administered at nig
Jfaresti, also, successful Iv treated a ease of tetanus by means of urethai
Prof. J. P. Crozer Griflith looks uiMin urethane in ordinary doses, as an t
J;ihrt'Hl»enolit der Phurm. T!»erap./' 1886.
AOAttlCUS ALBITS.
165
, CT ^ ' - '" ' 1c hypnotic, though in large doses it may at times prove
.1 iiri'thane may Ije ooinltinotl,- forming Chloral-urethane,
^BtlonbvlK vMiuiJUU of which is known u^ Somnal. TTralium- is a similar
I", if not ideutical with, somnal. Uralium is a crystalline suIj-
!o in alcohol and ether, but insoluble in cold Mater. It has
* **^ an hypnotic in dost^s varying from 1 to 3 Gm. (or gr. xv-xlv).
£THYIJS CHLOEIDTrM.— Chloric Ether, or Ethyl Chloride (CjH.Cl).
K'* r 1 "'iVirji!.' i^ a onjorltss HumI of fthcroal odor, and boils at 50° F.
iiaBethcsia by its rapid evaporation. The skin is first
. ».,.. ..:.ich it becomes perfectly white, and a snow-white coat-
- upon its surface. Ethyl chloride is put up in hermetically-sealed
>-s containing 9.25 c.cm. (or f5iiss), one end being drawn out into a
t- When this is broken off the heat of the operator's hand
a fine spray upon the surface to be anaesthetized. Ethyl chloride
- used successfully to allay the pain of neuralgia, lumbago, and
It has also been found serviceable in minor surgery and den-
irnuit-reially, it is supplied imder the name of **Ke!ene/' by whicli
' i.>wn in EuTo|K*. Etiiyl chloride has also b»vn etiiployed for gen-
- -la, hut it is loss safe than ether, A death has boon reported from
I T«H>rge K. GiflTord.'
iTHYLIS lODIDUM.— Hydriodic Ether, m Ethyl Iodide (C,HJ).
T 5 is very analogous to ethyl bromide, iodine merely replacing the
^---!--^ It can be administered from a vial in drops on a handkerchief
«^ gelatin capsules containing 0.30 c.cm. (or mv) each. It is not used
fcrprod'- ■■- r ".niesthesia, but may be cautiously inhaled for syphilis, bron-
^ikK. pK catarrh, whooping-cough, asthma, or other spasmodic dis-
Do&c, U.3 to 1.2 c.cm. (or mv-xx), by inhalation.
AGABICITS ALBITS. — Purging Agaric. (Polyporus officinalis, Boletus
hsiQ*; onier, Basidiomycetes, Hymtnomycetes.) The European larch
in « fungus which grows in large, hoof-shaped masses horizontally from
tjmnk, and penetrates, with its mycelium, deeply into the wood. The
collected in Europe and Apia Elinor, and, after peeling and
they form yellowi>ili-white, friable, spongy, irregular balls, from
of an orange up to that of a cocoa-nut. It has a heavy, fungus-
«dnr; * sweetish, followed by a bitter, nauseous taste; and its powder
srhtatiDi; to eyes and nose. It largely consists of resinous matter.
Id doses of 0.05 Gm. (or gr. x) or more it acts as a purgative^
.mall doeof i.s tonir and anhydrotio.
Thyiological Action. — In small doses (0.065 to 0.32 Gm., or gr. i-T)
ip<^ t» Htrnpiiu*. hut does not dilate the pupil. It is a compound
i^\ principle of which is termed agaricic acid. Hoffraeister has
t' -tance uau.'illy employed under the name of ngaricin or
Bi~. . : npure product. Pure agaric acid is a white, light, crys-
of the UnJi^crsnl Muilicul Sciences. "
A-luO.
1899. vol. V, p.
tt H^tfh il^pUali, Milnti. Feb. tf, nnd HrHish Metiira) Journal, MnrrH
July 8, 1D06.
166
PHARMACEUTICAL THERAPE0TIC AOEXTS Ofl
talltne powder, of a silky lustre. It crystallizes out of absolute alcoho
groups of tuft-like needles or as distinct rosettes. Its melting-poin
138** C. (280.4* F.). The free acid is but slightly soluble in cold wa
but is moderately soluble in boiling water. Its alkaline combinations
freely soluble, but its heavy metallic salts are insoluble. It is a str
local irritant, and its subcutaneous injection results in active inflam
tion, with the production of pus. On account of its slow absorptior
produces no grave symptoms in warm-blooded animals. The subcutane
or intravenous injection of a soluble salt first excites, and then paraly
the vagus and vasomotor centres. Death is preceded by convulsions,
results from cessation of respiration or, in animals when artificial resp
tion is kept up, from the extreme fall of blood-pressure. The infiue
upon the secretion of sweat is not central, but is exerted upon the att
tory glands. I
Therapy. — Agaricin, in doses of 0.005 to 0.066 Gm. (or gr. Vu-jl
used to check night-sweating, and sometimes to suppress lactation.
B Agaricin 066 Gm. or gr. j. 1
Acid, sulph. aromat 16
Elixir 4fi
066 Gm. or
c.cm. or f3iv.
c.cra. or i^isa.
fl
M. Sig.: Take one drachm every four hours in water.
Agaricin also suppresses perspiration due to other morbid causes,
solution of agaricin in alcohol has been suggested as of value in hyperit
818. It has also been recommended to combine a small quantity of Dov
powder with each dose of agaricin, when there is a tendency to loose:
of the bowels following its use.
In order to reduce the fever and restrict the night-sweats of ]
monary tuberculosis, Dr. J. M. Anders sometimes resorts to the follow
combination: —
K Quinin. aulphat.,
Antipyrin aa
Agaricin
M. et ft capflulse no. xij.
Sig.: One capsule three times a day.
1155 Gm. or gr. xxiv.
|lO Gm. or gr. iss.
AGAEICUS CHntURGORTJM.— Polyporus Igniarius is an allied i
gus to the preceding, but is used solely on account of its porous texti
It has been employed as a mechanical haemostatic and for its slow burn
as a moxa. It may be soaked in potassium nitrate or chlorate soluti
which makes it more inflammable.
AGABICUS MUSCARIirS.— Amanita Muscaria, or Fly-fungus (Ba
iomycetes, Hymenomycetes), is a poisonous mashroom, consisting lar^
of fungus-cellulose. Its active principle is a syrupy alkaloid, Muscan
It is without taste or odor, but produces powerfully-intoxicating eff<
somewhat analogous to ])iloc[irpine in its action, and antflgoni7:i?d by al
pine. Amanita Vema, or Plia]l<iidcs, allied species of niuslirooms, are ^
poisonouB. In addition to muscaria, they contain phallin, and also a tl
principlCj which haa not been isolated. For the latter two elements no a
ai;athin-
167
>!!nr!. They act like serpent-venom, in eausing solution of
Trt'Htinent of niushroom-poi6<)ning should commence with
tft to ck*ttr tJie aliinentan' eanal ; then use atropine and diffusible
Is. Digitalis may alsti be given hypodermically, ajid etimulating
^tfMJJi administered,
Fkyiiolo^cal Action.— The action of the heart and of the lungs is
iauiusbed by Urtiv dofi*.'s of agaric, the heart being finally arrested in
fartnti'. S; .liisf^ diminish blood-pressure and reduce temperature,
•h^oQ^ ll.' V heat may be secondarily inere>ased. The secretions
il tkv skill, the hven aud intestinal tract are increased, while that of
^ kidneys is sometimes reduced or suppressed. The muscular system
m rd^xed* but convulsions may occur from accumulation of carbonic acid
m iktf blood. Upon the brain a marked narcotic or stupefying effect is
ttecrred, ^o that it has been used in Asia as an intoxicant. The pupil con-
tacts from the effects of the internal administration, while the local
ippBcalion of muscarine may cause dilatation.
Tkcn&py. — Administered medicinally, muscarine has some reputation
it cb«^ng the lever and sweating of phthisis. It may be used in affec-
MS of the respiratory tract where there is a deHciency of secretion or in
Cavrders of the alimentary canal where the same indication is to be met,
•ad to overcome a tendency to constipation. Muscarine can therefore be
htned with such drugs as belladonna, hyoscyamus, strjxhnine, aloin,
.gradfl, or sulphur, with advantage, as in the following formula: —
U MnmMTiom 120 Om. or gr. iij.
Ext. niici* voniii'W |065 Gm. or gr. j.
Aloml.
Ext. lM*riiulonni» foliur aa 110 Gm. or gr. ist.
£xt. geotianas l{ Gm. or gr. ryj.
M. «C ft. pO. no. xTj.
Skg.L One pill two or three times & day. Beneficial in constipation and in cat&T^
The dose of muscarine is usually 0.008 to 0.13 Gm. (or gr. */8-ij)i in
wIiImmi, or muscarine nitrate may oe given in somewhat smaller doses.
tm the sweating of phthisis, Murrcll uses a 1-pcr-ccnt. solution, of which
fte do9« IS 0.30 c.cm. (or mv).
AOATHTW is the name bestowed upon a new synthetical compound
r.^.,«-A«^ by Dr. Israel Boos, of I'rankfort-on-the-Main. It is a derivative
Hcjd, and its chemicjil compositiou ia expressed by the title
:* ^ j-aiiiehvde-metliylphenylliytlrazin.''
Airathtn occurs in the form of small, light-green, crystalline scales,
JBtituN 11 or taste, insoluble in water, soluble in alcohol and ether,
Dr; 74*' C. (KIS'* R).
Fhysiological Action and Therapy. — Moderate doses have no ill effect
I qniniiiN When administered to the human subject, agathin gener-
M^ appetite and excretion of perspiration. It has been found
"" in neuralgia and rheumatism, being generally given
Grn. (or gr. viij) two or Three times a day. Its effect
4. : ' rtt.NJ, and its us*', it is clnimed. does not usually
•"1 by any drawbacks. On the contrary, Ilberg and
kstm obak^rveti i which agathin gave rise to headache, vertigo.
t '^
168
PHAUMACEITICAL TU KlIAriil'TR' AtiKXTJ* OU DlirCS.
insomnia, vomiting, diarrhcea, thirst, sensation of heat, and smarting pa
during micturition.
ATLANTHirS GLANDULOSA.— Ailanthns-tree, or Chinese Sumac
The Ailnnthus, or Tree of Heaven (belonging to the natural order Simai
baceai), i)roii<rhl trom I'liinu, is* nmv njitunili/.ed in this cfnintrv. and. bei
oruamenUl. h uhmI a^; a j^batU'-tiVi'. TJii' iunor hjirk. \vhit:li ih thi.; |>ari u»(
contains an oleopfi:iu arnl a vulatiie oil.
The fluid extract (O.GO to 4 com., or mx-foj) and the tincture (in do*
of 2 to 7.5 c.cm., or fSss-ij) have been used. The bark may be given
doses of from 0.32 to 0.65 Gm. (or gr. v-x).
Fhysiological Action. — When taken in full doses, ailanthus naupeal
and purges; it also gives rise to vertigo, headache, pains in the back a"
limbs, and prostration, with numbness or tingling. Both respiration a:
pulse-rate are reduced; death results from arrest of respiration.
Therapy. — The fresh bark has been used in the treatn^ent of taj
worm, iu decoction (15.5 Gm. to 473 c.cm., or Siv-Oj) or the oleoresiu (in
c.cm., or f5j, doses). It has also been used in malignant scarlatina,
Bpasmodic disorders, and in dyspepsia. An infusion of the leaves has be
employed in dysentery.
AIB.' — A mixture of oxygen and nitrogen, with smaller quantiti
of carbon dioxide, argon, and ^'atery vapor, together with accideni
organic and inorganic constituents, composing the atmosphere, which y
breathe. (For the ett'ects of air, sim- section devoted to Climatotherap
also Pneumotherapy and Pneumatic Differentiation. For Liquid Air, a
section on Keat and Gold as Therapeutic Agents.)
AIROL. — This is a trade designation for bismuth-oxyiodogallal
which is a grayish-green, odorless, tasteless ]>owder. It is insoluble
alcohol, water, etc. It has been employed as a surgical antiseptic dastin
powder or as an emulsion with glycerin (10 per cent.), or also as an oirj
ment, as a substitute for iodoform. Airol has also been u?ed internally
an intestinal astringent, in doses of 0.13 to 0.32 Gm, (or gr. ii-v) sevet
times daily. In ophthalmic practice Bonivento had good results in for
cases of infectious, ulcerous keratitis, the remedy being lightly dust)
upon the affected area after preliminary antiseptic cleansing. Its applic
tioD is usually painless.
turn.)
ALBAHOIN.— A trade name for gelatose silver nitrate. (St'f Arge
ALCOHOL (T. S. P.). SPIRITUS RECTiriCATITS ( B. P.).— Alcoh(
Spirit of Wine (TJIOlI).
Preparations.
Alrnlinl Dilitlum (P. S. P.). — Diluted Alcolml (iHpitil pails nUtiliol iiiul wntei
SpirituB Pnimenti (U. S. P.). — Whi»ky {contflinf* about 60 p«r cent, of alcohol)
Spiritus MyrciflB (U.S. P.). — Bay-rum. For external use.
ALCOHOL. ^^^^^^^^^ 109
Aibum (U. S. P.).— WTiitc Wine ( 10 to 12 per cent, alcohol).
Rabnim (U. S. P.).— Red Wine (10 to 12 per cent, alcohol).
Absolutum (U.S. P., B. P.).— Absolute Alcohol (containing not more
cent., by weight, of water).
Vini Gallici (U.S. P., iJ. P.). — Brandy (contains about 60 per cent, of
IGMorm Spiritus Vini Gallici (B. P.).— Mixture of Brandy (brandy, 113 c.cm.;
hv«ter. US r.cm. ; re6ned sugar, 14 Gm.; two yelks of eggs). Dose, 30 to
(or IBi-ij).
Aurantii (B. P.). — Orange-wine (contains 10 to 12 per cent, alcohol by
K
Tiaam Xericum (B. P.). — Sherry Wine (contains not less than 16 per cent, of
' by volume).
Not Offfcial
Spiritns GeneTK. — Oln (dilute alcohol flavored by juniper-berriea).
^ikftns Jamaic«nsts. — Jamaica Bum (spirits from molasses).
%irtt«» Odoratus. — Bau'dt-Coloijnf, Cologne-water.
JUoohol ia a liquid composed of 91 per cent., by weight (94.y by vol-
t»»l. ' ' ' ' 'hoU and of 51 per cent., by weight (o.l by volume), of
■4?*T - .:wlv, o.H-^0 at .M»° F. It is a transjmrent. enlnrlt^ss, vola-
■ ■ e-ulistaricv. with a I'liaraoteri.'itif, punjrent, rnther ugrt^^aMi-
The British Pharmacopceia recognizes absolute alcohol and
nctafcd spints, the latter containing 90 per cent., by volume, of ethyl-
\0^mx\^e. Proof spirit contains 50 per cent, of absolulo alcohol.
FkarmACology. — The hydrate of the hydrocarbon radical (C^Hj) ia
Jy understood to be meant by the term alcohol, although many other
ane known tn the chemi.'it. Kthyl-nlcohol, also, is the alcoliol
^ hasodjt whisky, wine, and various spirits and cordials. Its effects upon
tW organism are less toxic than those of other alcohols, such as amyliCy
■Bihjiic, or butylic. During distillation of grain, unless carefully managed,
ble amylic alcohol will pass over with the ethylic, especially if the
be continued too long. By keeping whisky stored for several years,
fte wmjlic alcohol becomes largely changed into various ethers, which ira-
■it a flaror or bouquet to the spirit. The United States Pharmacopoeia,
inRforv, rlin*<.*t»i that grain-spirit (whisky) slionld be at least four years old,
mk tba spirit from fermented grapes (brandy) at least four years old. Wine
taadc bj fermentation without distillation. Hed wine is a deep-red, alco-
Wic liquid, made by fermenting the juice of colored grapes in the presence
diiym ekins; white wine is of a pale-amber or straw color, and is obtained
•■ fann^'**"*'/ the unmodi6ed juice of the grape, free from seeds, stems, and
.*^ Genevffi (ein, or Hollands) is not official: it is obtained by
j Iterries to diluted alcohol. Rum, or molasses spirit (spiritua
c . icencis), is made by distillation from sugar or molasses which
adaxgoDc ulcohoUc fermentation; it is about the same alcoholic
ongth aa whisky.
AJiXihoI dii(SoIveg alknloids, fatty and resinous substances, and is largely
mi i« a menstruum in obtaining the active principles of drugs in an avail-
•Uf form for administration. It is the basis of the U. S. P. spirits, tinct-
wm. iffwl elixirs; epirits being solutions of volatile substances in alcohol;
liitiUML »olntions of active principles of plants, generally obtained by
iwmttOD And percolation. An eli.Tir is a cordial flavored with orange
M^frrup generally used as a vehicle for other remedies Malt liquors — ale,
W porter etc.— «re produced by fermentation of mnlt and hops, and con-
I
tain nutritive niaterial, together with a small proportion of diastase, wh
makes them iiaeful in certain cases of weak digestion. They contain a
from 6 to 10 per cent, of alcohol. Malt liquors can be taken by those ^
suJTer from the cerebral effects of wine, but to some they are unpleasani
their effects upon the brain, owing to the oil of hops which they conf
(Rossbach).
Absolutely-pure alcohol is rarely found, even in the laboratory of i
chemist. Owing to its great affinity for water, it will in time abstrao
from the air. Absolute alcohol; of the shops, usually contains about 2 !
cent, of water. It is a colorless, pleasant-smelling liquid, with a sharp, w|
taste. When added to water, heat is developed, and the mixture does I
measure as much as the sum of its constituents, owing to combination. \
sides its affinity for water and its power as a solvent, it has a coagulat
action upon albumin, and is an antiferment when in solution containinj
least 18 per cent, of alcohol.
Physiologrical Action. — Owing to volatility, it gives a cool sensation
the skin at first, but afterward, if evaporation be interfered with, it cai
irritation and heat, and, if continued, produces inflammation. It |
hardens the integument by abstracting water from it, coagulating some
its albuminoid constituents, and dissolving its fat. It has the same efi
v.pon mucous membranes, thus enabling it to act as an astringent. It ^
some anaesthetic action, possibly by reducing the congestion by its cool
or constringent effects upon the smaller blood-vessels.
After alcohol, in the strength of ordinary spirits, is swallowed, in sit
quantity (15 to 60 c.cm., or f^ss-ij), there is a sensation of heat in the «
gastrium, which soon diffuses itself over the body. The experiments of ;
Beaumont showed that small amounts increased the vascularity of the stc
ach and stimulated the flow of gastric secretions. Under favorable circu
stances, thereforcj alcohol increases the digestive power, causing an a'
mented gastric jxiice. If taken in large quantities, appetite is lost and nau
appears, and the digestive power is suspended. As a result of long-ci
tinued indulgence in alcohol, the stomach undergoes changes in its coi
new areolar tissue being formed, which, by its subsequent contracti
strangulates the gastric glands; hence, dyspepsia and gastric catarrh, w
morning vomiting, are very common among drunkards. In addition
structural changes, alcohol, in excess, precipitates pepsin from the gast
juice, and thus increases digestive difficulties.
H. Wendelstadt,* of Bonn, as a result of some experiments made toH
termine the inllucnce of alcohol on the respiration in man, found that thi
was much individual variation, but in 29 cases in which pure alcohol v
ingested, 7 showed diminution of respiratory activity; but, when the alcol
was taken in the form of wine, only 2 showed such diminution, while t
amount of increase in every case in which it occurred was greater. The
crease was also more marked in cases of fatigue or debility. He thereft
concludes that in debilitated states of the body, alcohol, especially in i
form of wine having much aroma, is the best stimulant.
Dr. Glascr has recently studied the effect of alcohol upon the kidn<
and urine. He finds t!u»t a moderate quantity of alcohol causes irritati
of the kidneys and alters the solubility of the urinary salts, favoring 1
T
'Lancet, Feb. 17, IIKM).
ALCOHOL.
171
pj i'IuIjuc of lime and uric acid. The influence does not extend be-
tr-sii hours, but the continued use of alcohol produces a cuinula-
et. Dr. David Cerna, who has also investigated the action of alcohol,
that in large doees it enhances coagulation of the blood, while in
qsuatjties it destroys the ozonizing power of that fluid and causes a
■pantiuUi of haexnoglobin from the corpuscles. Over-indulgence in alcohol
]mi kMKg been thoujjht to impair the Bexual nower^ and there seems reason
to infer fruni «?rtam experiments made by m. Bouiu und M. C. Gamier*
&it it mav actually cause decided degenerative changes in the testicles.
fiifing ■* ' ] chronic alcoholism in a number of white rats, in two of
li* rant* ■-• found atrophy of the testicles, with almost complete de-
tfnction oi theliura of the seminiferous tubules.
Dobois ' i that certain plants exuded droplets of moisture over
itfoifac^ when exposed to the influence of chloroform, ether, benzin, and
ikabol. ^Tr- '-•insiders the process on indication that the vapors penetrated
tie proE' I of the plant-tissues and forced out the water, taking its
ylue. ^Kj.t'1 - bases a theory in regard to the effect of narcotics in man on
the cbserration of this phenomenon, suggesting that certain substances in
lit protaplasxna of the cell, — the lecithin, etc., — so important to the healthy
bDctMnting of the cell, are dissolved out of their normal proportions of solu-
aad combination in respect to the other components of the cell, — the
T, salts, albumin, etc., — -by the tension of solubility between them and
driarofonn, alcohol, and other narcotics, analogous to the effect of salt in
tfcff m^niem. If this theory is correct, then all chemical substances which
iiiilii fat and bodies resembling fat — lecithin, protagon, etc. — must pro-
te» a narcotizing effect on living protoplasma, and the effect would be
■■t marked on the cells which contain the largest proportion of these eub-
IdBcca: the nerve-cells. The effect would also depend on the mechanical
iCnsty of the narcotics for the other constituents of the cells besides the
yttj matters^ especially the water, and also on its co-eflicient of division in
twxture of water and fatty substances.
Upon the nervous system alcohol first has an exciting effect, followed
1^ -s, — -on and coma. The arterioles are dilated, thus admitting more
yop '.' brain, and this is succeeded hy diminution of mental activity,
1^ uj tae effects of the alcohol upon the ganglion-cells, weakening their
A Mnailar effect is seen on the spinal cord, usually occurring later
, bat aometimes preceding, the brain s}Tnptoms. The reflex action of the
it reduced and the power of co-ordination impaired, so that walking is
Efring gait, and finally the knees will no longer support the body.
I paralyzing effect is also seen in the sympathetic system, since the dila-
tiZaoD of certain vascular areas must be due to the loss of function of the
«»ciinoior nerve«. The action upon the centres in the medulla is seen in
Aa lowered temperature, the slowing of the pulse after a preliminary accel-
oitkm, and the sighing respiration or stertor. Death is produced by re-
mawtorj paraly^'is and lowering of the bodily heat. From this it is seen that
Aocbnl will not protect from cold, but will actually hasten the occurrence
ildoath from cold. The experience of Arctic voyagers is to the effect that
ftow peraons endure the rigors of the winter best who abstain from alcohol.
Ik. Parkv«> In the Ashnntee campaign, also found that the fatigue of march-
i
* Ptysm: lfMical«» Jan. 17. 1000.
'Arrhtr f. Krp. Pnth. «. PhfirmakolOf;i'', xH'i. 2 to 4.
172 I'lIAKMACEUTICAL Til miAPEL'TIC AOENTS OK DKUflft.
ing in the tropics is borne better without the aid of a spirit ration, owi
to the diminution of muscular and nervous energy and capacity for wo
due to the physiological action of this agent. The only advantage deri^
from its use was to take away the feelings of fatigue after the men fc
come into camp, and thus enable them to eat. It is also useful, in the t<4
of hot drink, to revive a person, who has been exposed to cold, after i
exposure has ceaseil. Major Charles E. Woodruff, United States Army,
lievee that small quantities of alct>hoI are useful in the tropics, to countefi
the stimulating elfect of excessive sunlight. ^^
As to the changes that alcohol undergoes in the body, Anstie sta
that a variable amount (4 to 15 c.cm.. or foi-iv) disappears, or is burnt up
the blood or the tissues; this quantity may be increased by habit. T
excess is thrown off by the lungs, kidneys, bowels, and possibly by the sk
Pn)f. \\\ {). Atwiiter, of Miildletowu, (.'onu., from experiments to del
mine the effects of nuxieriite (ht^va of alonhol, frmm] : 1. That extremely lit
of the alcohol was given off uueonsuinod. "2. That in tlie oxidation all of t
potential energy of the alcohol was transformed into heat or muscular euerj
3. That the alcohol proteeted the material of tlie hoily from consumpti
just as effectively as the corresponding amounts of sugar, starch, or fat.
is, however, to lie borne in mind that the inllueuee of the aknhol upon i
circulatory and nervous functions is et^pecially iii4)ortant, and that thi
nnitters did not come within the limits of Atwater's experiments.^ T
inference souglit to be drawn from tliese experiments that aleohol is a Bf
and useful food is questioned by Woodbury and Egbert, who assert tli
akohol at Un^ best is useful only as a stimulant and excitant to the circu
tion and nervous systems rluring emergencies, nnd they quote authorities
prove that as a food its objections outweigh its alleged ndvantagos.*
Toxicolo^. — The symptoms and treatment of acute poisoning
alcohol differ so much from those of the clironic form of alcoholism tb
each state must be separately considered: —
1. Acute poisoning by alcohol manifests itself by an exaggeration
the physiological action. The rapidity with which grave symptoms appe
is in proportion to the quantity of alcohol taken, its form, and, to soe
extent, its temperature, as hot drinks more rapidly intoxicate than col
Where a large quantity Is taken at once, as when a whole bottle of whisl
is drunk on a wager, or a comparatively large quantity administered to
child, the stage of excitement is too brief to be noticed, and the patient fa)
at once into a stupor, which may be followed by coma or fatal convulsior
Where the administration is spread out over a longer period, drunkenne
comes on progressively, but ends in unconsciousness and insensibility, ar
the patient is said to be dead-drunk, because of his complete helplessnes
Since alcohol increases the blood-supply of the brain (and especially sin*
drunken men are apt to fall heavily and strike their heads), the state t
alcoholic coma may often be accompanied by meningeal hsemorrhage <
apoplexy. Intoxicated persons shoidd never be allowed to sleep off the
drunkenness, but should be treated as if they were poisoned, as — in fac
— they are. The treatment consists simply in evacuating the stomach wit
emetics (mustard, etc.,) or the pump, and administering ammonia, eithc
,1
* Bulletin No, 69. of the V. f?. Department of ApricuUure, Nor., 1899.
'Journal of the American Medical Asfiociaiion, March 31, 1900.
ALCOHOL.
173
fbt ATonutic spirit or the carbonate, both by the mouth and by inhalation.
The fpiiit of Mindcrerus likewise fulfills the 6aine purpose. Digitalis may
W given hypodennically; on if the patient is noisy, morphine and atropine
mmoiexnte doee«. It is said that 30 or 60 c.cm. (or f§i-ij) of cider-vinegar
ks • fobering effect; and after emptying the stomach with the stomnch-
it i* well to introduce a pint of warm coffee, — it should not be hot
for fear of injuring the stomach during unconsciousness. Artificial
on and electricity may be required to keep up the breathing and
fivfciit the undue accumulation of carbonic acid in the blood. Cold affu-
•BOft should be used with care, on account of the lowering of temperature
*f the alcohol; but heat and sinapisms are of great utility. Apoplexy, or
««rbrtl haemorrhage, may be suspected when there is marked deviation of
fte^pM or unequal dilatation of the pupils, especially if there is co-existing
pmijOB of one side of the face or of the arm or leg. In such a case the
of eurgical interference would come up, to decide upon the pres-
of fmcture of the skull or meningeal hsemorrhage and the appropriate
taatmect therefor.
8. Chronic poisoning by alcohol may be shown by the changes taking
]faee in the stomach, liver, and kidneys; increase of fibrous or areolar
taroe, followed by contraction and destruction of the characteristic secret-
inf c^Ib, «nd fatty infiltration; or, in other words, the type of cirrhosis due
i»tbt long-continued action of alcohol upon the tissues. Gastric catarrh,
indigestion due to deficient action of the liver, and albuminuria from con*
tactod and crippled kidneys are commonly met with in old alcoholic sub-
icti. Chronic laryngitis and bronchitis, also chronic catarrhal pneumonia
ad fibroid phthisis, are also frequent in such subjects. The effects, how-
fftr, ire moct marked upon the nervous system. Dr. Wilks has reported
■0 of paraplegia and numbness. Anaesthesia and violent shooting pains
Ir* foUowcd the long-continued and excessive use of alcohol. A case of
^anotor disturbance due to the habitual use of alcohol has been recorded
k'Dr. G. Ka^mpfer. A man, who had been an excessive drinker, was at-
tKfcad* within half an hour after taking any alcoholic fluid, by an eruption
«»1m» *kin itiUiS-ifftinp of patt•lle^^ of erythema of variable size and tf>l<tr.
The damage produced by the habitual consiunption of alcohol is not
^mg^^^ *- •»•<* drunkard, but is transmitted to his children. It has been
Hoidmj vm that the offspring of alcoholics are degenerates, afflicted
nik IBorLt;il craving for drink and subject to epilepsy, idiocy, chorea, hys-
tsv, and phvsical defects. When alcoholic poisoning is mentioned, we
^menBr understand it to mean delirium tremens or mania a potu. These
ataoc identical; the latter is, to all intents and purposes, an acute attack
tfsania causc^d or incited by alcoholic excess. Delirium tremens, on the
iMnrr »a • milder form of delirium, due partly to the action of the alcohol
»« tba brain* but also very largely to anaemia of the great centres. In
^fcnoer the patient is violent, and requires several men to control him;
^ooee controlled, and the proper medicines given (potassium bromide,
- hy^robromatc, or chloroform inhalations), the patient, after a
• - cN-t-r*. ti?"^l'y rapidly recover?. In delirium tremens the symp-
of anteraia of the brain; it is apt to occur after a
. .,^ 'fC several days, during which very little food is eaten
t bv vomiting from the excess of alcohol. Hero the patient
dcliVium, and has hallucinations of sight and hearing, which
PBM I
lagu.
\€t
in many cases may not greatly annoy him, but, on the other hand, h
visions may be horrifying and very distressing. These patients are het
treated with digitalis, and amyl nitrite may be cautiously given by inhah
tion, or nitroglycerin by the mouth. Nourishment must be given in a fori
readily assimilated and at short intervals, hot broths, well seasoned, bein
the most acceptable to the stomach. If, as is usually the case, the patiei
has been a steady drinker for a long time, alcohol should not be entire!
withheld from him, but given in combination with food. In such subjeci
the blood-vessels are generally the subject of atheromatous changes, an
the heart requires its accustomed stimulation in order to carry on the cii
culation. If the patient cannot sleep, he may be helped by sodium broraid
and chloral (aa 0.65 Gm., or gr. x), by hop-tea with capsicum, or the an
moniated tincture of valerian. For the debility and tremor, nnx vomic
has proved very useful in comparatively large doses of the tincture (2 com
or foss, or more). Hypodermic injections of strychnine nitrate are ala
^LflsefuL After death from chronic alcoholism the organism shows change
^Kn every part, which Biirtholow suMinied up in two words, ''fibrosis an
^Heteatosis.''
^B By inliaUng the vapor of jilcohol, coaiplete aiuesthesia may he pre
^pduced, and the different degrees of intoxication up to insensibility. In sue!
^^ cases the stomach need not be emptied, but artificial respiration in the ope:
air, or the inhalation of oxygen will soon restore the patient to consciousness
^tTbis may be hastened by a stimulating enema.
^f Absinthism, a form of alcoholic poisoning attended by epilepsy, follow
1^ ing indulgence in absinthe, has been already discussed.
^^ Methylic apirit, or wood-alcoliul, on ai-munt of its cheapness, is 8om€
^ftiimes used to adulterate whisky, or as a substitute for it, and is largely em
^■"ployed in the arts. Under tlie name of Columbia spirits it has an extensiv
I sale. It is much more toxic than pthyl-alcnhol, and has the peculiar propert;
^vof causing optic neuritis and blindness.
^P Therapy. — Alcohol may be used as an evaporating lotion in cases <X
"local inflammation, or of bruise or sprain. Diluted alcohol (90 c.cm., or fgiij
with lead-water (30 c.cni.. or fjj) lind morphine acetate {0.G5 Gra., or gr
i), applied upon a single layer of cloth or absorbent cotton and allowed t<
evaporate, forms an excellent lotion to keep down inflammation, and in poim
of cleanliness is much better than the old lead-water and laudanum. Absolut*
alcohol is used as an astringent application to exuberant granulations (poljrpi
in the ear, and also applied as just directed to control acute inflamraatior
of cellular tissue, and in erysipelas. Ordinary alcohol is a good appHcatioi
to prevent bed-sores, and for this purpose it is customary to add a little alun
(4 Gm. to 473 c.cm., or 3i-0j). Hot applications of alcohol relieve pain, and
in facial neuralgia, cold in the face, or toolluicbe, the eiuplnynicnt of a smal!
flannel bag containing hops and dipped in hot whisky will generally afford
marked relief. In some skin diseases, as ulcers, loss of hair» frost-bite, ei^
cessive secretion of sweat or oil, fetid sweating, freckles, and vegetable para-
sitic affections, concentrated alcoholic preparations may be used. Somfi
useful formuliB are here added: —
B Alcoholia,
Glyceriti boroglycerini *. . . . aa CO] c.cm. or Qij. '
M. Sig. : Apply freely in excessive or fetid swefttlng, and in vegetable parasitiQ
[diseasea of the akin.
I
I
ALCOHOL. 175
When glycerin does not agree, we may prescribe:-
Q Alcoholis 60
Cocainffi hydrochloridi
Addi borici 4
acm. or fSij.
32 Gm. or gr. v.
Gm. or Sj.
If. 81^.: IJBe with old muslin or cotton in frost-bite, oily secretion, freckles,
tod other pigmentary deposits.
9 Spt. vini galUci ]20| c.cm. or fjiv.
linct. nucis vomicse 15| c.cm or fjss.
Tinct. capsici 7{60 ccm. or fSij.
M. Sig. : Apply on the scalp for loss of hair, with friction once daily.
Leloir recommends the local application of alcohol or an alcoholic solu-
tion as an effective abortive measure in herpes. The same treatment will
relieve the pain of herpes zoster.
L. NeustadP reports a case confirmatory of Biers and Salzwedel's ex-
perience as to the great value of alcohol dressings in tubercular lesions.
In the case referred to there were tendo vaginitis and osteitis tuberculosa
of the left hand. After the daily applications of a compress wet with alco-
hol for sii weeks, it was completely cured, although it had been pronounced
a proper case for amputation previous to the treatment. Angerer has also
reported 7 cases of local tuberculosis treated by alcohol, 3 of which were
cured and 4 remarkably improved.
Its antiseptic virtues and the astringency which it possesses in con-
Mquence of its power of coagulating albumin renders alcohol, when properly
diluted, an excellent gargle in pharyngitis, stomatitis, scurvy, and salivation.
It is also useful to apply an alcoholic lotion to the nipples of nursing women,
in order to prevent the formation of fissures. Alcohol possesses considerable
value as an haemostatic, and may be utilized in cases where capillary oozing
occurs, the following prescription being very valuable: —
Q AlocAolis,
Lilt, saponis,
Fluidext. hamamelidis aa 30{ c.cm. or fSj.
M. Sig.: Employ as a styptic in local heemorrhage.
To the action upon the digestive organs and the stimulating effect upon
the nervous system and the circulation are to be ascribed the usefulness in
the treatment of disease of alcohol judiciously given. It is not used in
sickness to reduce temperature, although it accomplishes this in health;
Eor is it given as a narcotic, although its sedative action may not be un-
desired. In almost all cases it is intended to act as a restorative,, and, there-
fore, its administration must be kept well within physiological limits. In
fiome cases, especially in typhoid fever, unfortunate results have followed
:tg use with too free a hand. In most cases of fever, from 60 to 120 c.cm.
for f^ii-iv) of whisky daily is amply sufficient for an adult, and more than
thif may do harm. It is judicious, however, to make allowance for the
patient's previous habits. One accustomed to the daily use of alcoholic
bererages will, generally speaking, require proportionately larger doses than
an abstainer, when attacked by any severe disease.
In phthisis a tolerance seems to exist, and patients can take relatively
Urge quantities without showing symptoms of intoxication. The late Austin
^Proper medMnUi^ Woohensehrifi, Feb. 15, 1900.
176
PHARMACErxICAL THERAPKI'TIO AOKNTS f)lt lUtl »;s.
Flint reported the case of a young lady who took a pint of whisky daily i
nearly two year^, for piilnioiiary phthisis, iiml was finally cured. In t
course of a disease, when the powers of life are succumbing, the first sou:
of the heart is weak; the pulse feeble, soft, and irregular, but genera
rapid; when syncop<? or delirium threatens, akxihol si\ould be given, c
deavorin^ to combine it with food, such as broth, milk, grne], etc. T
period at which these symptoms generally appear is, in typhus fever, abo
the end of the first week; in typhoid, al the end of the second week;
small-pox, when the secondary fever commences. The excellent practic
rules formulated by Dr, Armstrong for the use of alcohol in fever may
confidently followed. Alcohol is beneficial when the dry tongue moiste
under its use, the rapid pulse becomes more slow, the skin less parched, a
the respiration more tranquil, and, it might be added, where it suits t
patient. If opposite results follow, the remedy should be suspended. '
the above rules. Ringer adds that alcohol does good when it produces sle
and quells delirium. In measles, when the eruption turns dark or hiem<
rhagic, alcohol is best given in as large dnses as will be borne, and at she
intervals, as pointed out Ly Dr. John M. Keating. In acute iuflamniatio]
as in pneumonia, when the heart begins to fail and s}Tnptom3 of dcbilj
appear, alcohol can usually lie given with marked benefit. In hyposta'
congestion of the lungs, typhoid pneumonia, or the pneumonia of the ag(
alcoholic stimulation is particularly indicated. Diphtheria, phlcgmono
erysipelas, and tuberculosis of bones, joints^, or glands are affections in whi
stimulation is demanded. The strong^er alcoholic beverages — such as wii
whisky, or brandy — are valuable in old age, when digestion is weak and i
Bomnia marked. Hot spirits and water, cautiously administered, is usei
as a restorative in the condition of shock the result of injury. During cc
valescence from fevers, when the structures of the heart and stomach ha
been altered by the fever process and digestion is weak, it is often fou
that malt liquor in some form increases appetite and digestion, iraproi
nutrition, and enables the patient to sleep better at night. In the same wi
persons who follow sedentary occupations, and whose bodies are insu:
ciently nourished, often find much benefit from the use of alcohol in mc
erate quantities, given just before or after or taken with their meals. Its an
septic powers are useful in infectious dyspepsia, where digestion is stopp
by the growth of micro-organisms, which set iip excessive fermentation
the stomach and intestinal canal. Its acknowledged value in the zymoi
diseases, and pre-eminently in diphtheria, is partly due to its antisepi
action in the alimentary tract. In a similar manner, in cholera epidemi'
alcohol has decided prophylactic effects, and this is not controverted
the fact that persons weakened by debauches and alcoholism arc most lial
to perish from the disease. In cholera infnntum, also, brandy exerts i
excellent influence; and, indeed, in many bowel disorders among adu!
(which are often connected with the growth of micro-organisms) alcohol
the form of brandy or red wine (port or Burgundy) is of great assistance
the trealment. When flatulent colic or neuralgic pains occur in the abd
men, cloths wet with Imt whisky externally, and some liot toddy internal!
give prompt relief; in infants, gin and hot water is a remedy often used i
colic by old nurses.
Forms of Alcohol. — In order to estimate the effects of different fon
of alcoholic liquors, the following comparative strength should be remei
bered: —
ALCOHOL. ^^^^^- 177
f, whUkT, rum. gin. cordials.. .30 to 50 per cent, of absolute alcohol.
h and Italian sweet wines 13 to 17 " " " **
a»d claret 8 to 11
Alt or porter 4 to 6
filovt or beer 4 to 5 ' "
g*~ **■ 1 to 3 " " " "
Champe^e contains from 8 to 10 per cent., but the presence of the
cmoBir-acid gas makes it more "heady"; that is to say, the cerebral stim-
ilftiao is produced more quickly, and with a smaller quantity of alcohol
Aui bj the still wines, and the after-elfects in the way of headache or
■vebnl congestion are less apt to occur. Moreover, the carbonic acid acts
M% sedative to the stomach, thus making champagne especially serviceable
vfaete the stomach is irritable, and where prompt stimulation is required,
m xxk MAfickness or in yellow fever. Where the expense is an insuperable
objection, a good substitute may be made extemporaneously by the addition
«f Gtrbanic-acid water or koumiss to wine or brandy.
ipegud Applications. — As an antidote in snake-bite, alcohol enjoys an
atmaiTe reputation, which has not much scientific foundation. The liquor
ihoold be giTen only, a wineglassful or so at a time, repeated at intervals^
tat should not be given in excessive quantities on account of the danger of
fatal alcoholic coma. A ligature should be thrown around the limb or mera-
kr bitten, if possible, and the part cut out or cauterized; if a finger, it might
k Mier to amputate it. If not, the ligature should after awhile be loosened
fndnally, and immetliately tightened upon the reappearance of the symp-
iBaBft. In this way the system will be able to throw oif the poison; whereas,
rTf«^ wh(»lo quantity were to be introduced at once, it would be overwhelmed.
\ iiere acts, not as an antidote, but as a cardio-vascular stimulant
w. 5- t- v.|. the circnlntion until the poison is eliminated.
In septic poisoning — septicaemia, saprjemia, dissecting wounds, etc. —
dtobol is considered to have an antidotal effect, and, with quinine, consii*
tileB the ^reat rclianee for overcoming the tendency to a fatal result and
htpuig up the strength. Alcohol is, in some measure, antidotal to the poi-
■Bof use DaciUus tuberculosis, and it is to this action that its unquestionable
iriov in prolonging life in phthisis is due.
T*\^Ar^ nrid Powell' claim that alcohol is the best antidote for carbolic-
Phelps declares it a safe and sure local application to prevent
i I. action of tlie latter upon the s^kin and mucous membranes.
' - ; -tiinces have Wu reported in which a fatal dose of the acid had
1, l>ut, owing to prompt use of whisky or brandy, the patient
(9^^ Phenol.)
!•! not» a? the rule, be given in liver disease, nor iu nephritis.
!• wines and malt liquors are inadmissible, but, if a stimu-
hisky may be used cautiously, on account of the tendencj
_w fcjj;;ijtr> ...»3^c^... . Malt liquors and sweet wines are injurious in diabetes,
LdfT wine, whisky^ and brandy sometimes answer a useful purpose in that
bj promoting nutrition without increasing the loss of sugar. During
' coixTsc of a gonorrhcea or urethritis, it is customary to forbid the use of
bol in any fonn. It should not be used in hypertrophy, with overaction
j« heart.
For tho relief of cancer of the breast, Hasse, in 1873 (at a meeting of
• Mrrrk'B A rrhlcts, Dec. ISW.
178 PHARMACEUTICAL THERAPEUTIC AOEXTS OR DUUOS.
German Physicians' and Naturalists' Association), presented a communi*
tion advocating injection of alcohoL The subject of the treatment of cant
by interstitial injections of alcohol has since been reviewed editorially by I
C. E. lie M. SuJMUs.^ Dr. Edwin J. Kuh has reported a case of pritnarv d
cer of tlie nnso-plittrAiix cured by injections of alcohol. '• but subst'(|uently
ports several faihires of the treatnit^nt/
ALETEIS. — Star-grass, Blazing-star, Mealy-starwort, Colic-ro
ptris farinosa (Liliaceae) is an indigenous plant, the leaves of whi
spread upon the ground in the form of a star. The rhizome contai
starch and a bitter principle, hut appears to be free from tannin. T
virtues of the root are extracted by alcohol. In snuill doses ulelris is
bitter- tonic; it increases the appetite, loosens the bowels, and promo)
the secretion of urine. In larger quantities it acts as a cathartic a
emetic. Aletris has been used in colic, chronic rheumatism, and drop
It is said to be serviceable, likewise., in dysnicnorrhcea. The dose of t
powder is 0.65 Gra. (or gr. x). An infusion (1-16) is given in tablespooni
doses. The National Formulary contains a fluid extract.
ALLIUM.- Garlic.
Preparation,
SjTupiw AUii. — The syrup of ^rlic contains rt.iHc (20 pt*r cent.), with iHIu<
acetic udd, and sugar. Dtiso, 0.00 to 4 ccm. (or wx-fSj).
Pharmacology. — Garlic is the bulb of the Allium sativum (Liliacea
a native of Asia and Egypt, but now naturalized in Europe and Americ
and refi*»nib!ea the oninu and loek in its chfmicfil oharaetors. Its acti
principle is a vohitilc, oily substance (n/?.*i jkt cent.). Garlic i.s more acti
than the others, owing to possessing a larger proportion of the active pri
ciple. The bulbs 'may be kept unchanged for years bj placing them in lar
glass bottles containing a small amount of alcohol and securely closing t
bottles by stoppers of glass or cork, as proposed by Mr. A. P. Sharp (Pn
A. P. A., 1864). The pharmacopoeia directs that garlic should be used wit
out being dried.
Physiological Action and Therapy. — Garlic is antiseptic, but its effec
are chiefly those of a stimulating expectorant. Wiile its antiseptic pro
ertfes have been tried in phthisis without successful results, it is useful as ]
expectorant in chronic bronchitis, or in suffocative catarrh (capillary bro
chitis of iufjints). Here it may also be made one of the ingredients of poi
tices to be applied to the chest, or the oil may be used externally, but t!
offensive odor of garlic will in most families be a bar to its use. A garl
poultice may also be successfully employed in infantile eonvulsiont?, ai
relieves the pain of gastro-enteritis. The &>Tup is a good addition to couj
mixtures, hut cannot be used in conjunction with alkalies, such as ammoniu
carbonate or the bromides, on account of its containing free acetic acid. Tl
syrup of garlic can be administered thus with service in the treatment
bronchitis, especially of children: —
^Monikhf Ctfrlo[iafliti of Prartiral Mcdivinr, Jan.. 1898.
' Mrdirni Rrront. April IT. l!^I>7.
' Philadciphia Mcilk-al JounmK Mny 28, 1808.
ALLIUM CEPA.
B Symp. ftUii 60| c.cm. or fjij.
MC ether, nitroei,
GljrccTiBi aa 30| c.cm. or fjj.
IL Si^. : From od« to two teAApoonfuIs in water every hour or two.
B Syrup. alUi 901 c.cm. or fjiij.
SjTu^ picis liquidK 00{ c.cm. or fJij.
Jft. S%.: A tfiAflpoonful or two in water every two or three hours.
179
The jnice of garlic in the dose of 2 to 5 drops has been given for the
TTous vomiting.
.^, like the onion, has antiscorbutic effects, and is a stimulant car-
Dose, 2 Gm. (or gr. xxx); best given as a syrup. It is destructive
icoid or round worms. It is also etHcient against ascarides when
I iffumistergd bv the rectum. Garlic is a domestic remedy in whooping-
and t garlic potiltice applied to the perineum is said to relieve
AUyl-tribrozmde. — This compound, otherwise known as tribromhydrin,
ely pelait-d to the oil of garlic, is a colorless or faintly-yellowish fluid,
has a specific gravity of 2.43, solidifies at 50° F., and boils at 422'' F.
fl-txibromide dissolves in ether, and in 5-drop doses, inclosed in capsules,
been given with advantage in various spasmodic affections, as hysteria,
whooping-cough, infantile convulsions, and angina pectoris.
ALLTUM CEPA. — The onion (Liliacese) is cultivated everywhere, and
lb is commonly used as a food. Onions are also largely used in
practice as a cataplasm for "earache" or for acute bronchitis;
kdded to sugar and water and given as a cough-syrup. Parkes
^Practical Hygiene'*) states that "on account of its volatile oils the onion
tzibe ia largely used, and is a capital condiment, and has an effect as an
asdacarbatic." The oil appears to be identical with that derived from
fuiic, (CjHjjjS. Onions contain phosphoric acid, citrate of lime, mucil-
and sugar, in addition to the allyl sulphide.
AccordLig to the careful studies of Dr. Pilacki, the consumption of
causes a decrease of the assimilation and metabolism of nitrogenous
tarial. 1*he assimilation exceeds the loss of nitrogen. The urine is gen-
crallj increased. The diminished assimilation may be due to the injurious
^ <ifcc t of large quantities of onion upon the gastric juice and digestion,
^^^ft Popoff has shown that onions neutralize the acid of the gastric juice,
^^^n «mu]I quantity, however, onions promote digestion. Onions, and
^^Bt ^^arlic, produce a decided augmentation of secretion of bile. In
^^■et;d ^ivnt dependence is placed on the onion as a prophylactic against
W^ '* oints out that, owing to the large proportion of sulphur
rkirb it t .the Spanish onion may be satisfactorily employed in
cases oi skin disease in which it is desirable to administer sulphur.
ae action of the volatile constituepts enhances that of the sulphur.
B«ile<l Spanish onion, eaten freely at bed-time, is an excellent laxative.
iIV author mentioned values the onion particularly in chronic catarrh of
larger respinlory tubes. According to George Covert, sweet milk
MXt* the ouor of onion from the breath.
180 PH^VRMACEUTICAL THERAPEUTIC AGENTS OR DRrG8.
The raw sliced onion can be used as a counter-irritant; ita volatil
constituents are especially irritating to the conjunctiva.
ALNITS. — Alder-bark. The bark of the American alder or tag-aldei
Alnus serrulata (Betulaceje), contains tannic acid, a resin, and an oil. I
is used for its astringent effects, chiefly in the form of Huid extract or in
fusion (diluted freely), as a mouth-wash for spongy gums, a gargle fo
sore throat, an injection in leucorrhoea, and for applications to ulcers
Internally, it has been given in diarrhoea and hajniatuna. It is reporter
to have alterative effects, and has been used successfully in scrofula, syph
ilis, and some cutaneous diseases. The dose of fluid extract is 0.6 to 2.i
c.cm. (or mx-xl). Alnuin, an alcoholic extract, compulsed principally of th
resin, has been empluycd internally in doses of U.065 to 0.20 Gm. (o
gr. i-iij).
ALOE (U. S. P., B. P.).— Aloes.
ALOE PURIFICATA (U. S. P.).— Purified Aloes: a Strained Alcoholl
Extract.
Dose, 0.065 to l.:3Cl Urn. (or gr. i-xx).
17. S, P. Preparations.
Aloinutn.— Aloin. Dose, 0.006 to 0.13 Gm. (or gr. 'A^-ij).
Extractura Aloea.^Extract of Aloes. Doac, 0.03 to 0.32 Gm. {or gr. ss-v).
Pilulas Aloes. — Pills of Aloes. Dose, 1 to 6 pUls,
riliila? Aloes et Ferri.— Pills of Aloes and Iron. Dose, 1 to 5 pills.
Pilulte Aloes et Mastiches. — PilU of Aloes and Mastic. Dose^ 1 to 5 pilU.
Pilulre Aloes et Myrrhee. — PilU of Aloes and Myrrh, Dose, 1 to 5 pills.
Piliila? La\aliv:t LoinpiisitiP. — Ccnipoiind Liixutive Pills (aloin. i^. '/j; bella
donnu exi.. gr. V»; stryelmiue, ct. Vm? ipocnc, gr. Vn; glycyrrliiza, gr. 'Z^, each pill)
Pilulffi Rhei Compositne. — Compound Pills of Rhubarb. Dose, 1 to 5 ptlls.
Tinedira Aloes. — Tinrtiir^ of ANips (1(1 per rent.). Dose, 7.50 r.cm. (or 3ij).
Tinctura Aloes et Mynhec. — Tincture of Aloes and Myrrh (of each, 10 pe
cent.). Dose, 2 to 7.50 c.cm. (or f5s3-ij).
B. P. Preparations.
Aloinum. — Aloin. Dose, 0.03 to 0.13 Gm. (or gr. ss-ij).
Extractum Aloes Barbadensis. — Extract of Barbadoea Aloes. Dose, 0.065 tc
0.26 Gm, (or gr. i-iv).
Pilula Aloes Barbadensie. — Pill of Barbadoes Atoes. Dose, 0.25 to 0.50 Gm
(or gr. iv-viij).
Pihila Aloes Socotrinte, — PHI of Socotrine Aloes. Dose, 0.25 to 0.50 Gm. (oi
gr. JT-viij).
Pilula Aloes et Asafcetidie. — Pilt of Aloes and Asafetada. Dose^ 0.25 to 0.5G
Om. (or gr. iv-viij).
Pilula Aloes et Ferri. — Pill of Aloes and Iron. Dose, 0.25 to 0.50 Gm, (or gr.
iv-viij).
Pilula Aloes et Myrrha*.— Pill of Aloes and Myrrh. Dose, 0.25 to 0.50 Gm. (oi
gr. iv-viij).
Tinctura Aloes. — Tincture of Aloes. Dose, 2 to 4 c.cm. (or fSss-j) for repeated
administration; for single administration, 6 to 7.5 com. (or fSiss-ij).
Decoctum Aloes Coniposiluni (B. P.), or Baume de Vie, contains about 0.25 Gm.
(or gr. iv) aloes to 30 c.cm. for fjj), with cardamom, licorice, saffron, and myrrh.
Dose, 15 to CO c.cm. (or fSss-ij).
Aloes also enters into compound extract of colocynth and compound tinctura
of benzoin (U. S. P., B. P.) ; compound pill of colocynth (B.P.) ; compound
pill of liyoscyamus (B. P.) ; and compound pill of gamboge (B. P.).
ALOE.
181
Plurmacology. — Aioe is tht- in^jiisgated juice of tlie leaves of Aloe vera,
Ji^^ ^ .in.-M-t>. and AW Perrvi (Liliaceie). Owing to the fact that aloe
6v^aar -.uas foreign matters, the. United States Pharinacopa»ia directs
IhA h*T -\'^ proparations?. purified aloes only should he used (ohtaiued
ly diasoiving commercial h\ol^ in alcohol, parsing the solution through a
foxiDrr, and aUowing the alcojiol to evaporate). This occurs in dark
9mmi» of « yt'Uowiish-hrown color, the fracture presenting a liver-like ap-
peimirc *•--.> sometimes called hepatic aloes). It ha^? a very Litter
iHlr. b- in alcohol, Icj^s cioluhle in water (unless boiling), and cxin-
lKn» Aioui emodin, a trace of volatile oil, and a resin, Barbadoes aloes and
dp* ■ioi'? i-nch contains a special variety of aloin. known as barbaloin and
ttUloin)» which may lie distinguished by tests from thut present in Soca-
tnae «i<»^^. which is called socaloin. They are now equally othcial.
Aloinum ^U, S. P., B. P.). or Aloin, is a neutral principle obtained from
Urcral Tarietiee of aloes, chiefly Barbadoes aloes (yielding barbaloin) and
fiwnfiii or 21aiizibar aloes (yielding socaloin), dilfering more or less in chem-
iai compoeitioii and physical properties according to the source from which
ft tt derived. It is a yellowiph-white, or bro^^-nish crystalline substance, solu-
Uff m hot water and alcohol, sparingly soluble in ether, chloroform, and
hosoL It 15 of neutral reaction, destitute of odor, and its taste, which is
•Bfttiah at first, subsequently becomes very bitter.
XlijBiological Action. — The principal etfect of aloes is that of a slowly-
purgative^ principally affecting the large intestine. It increases the
"Ltic movements without producing excess of secretion; so that the
formed and only slightly softened. It is a true cholagogue, in-
mMJTH]^ the secretion of biliary salts, and renders the bile more watery when
pTtn in large doses. As it sometimes gripes, it is best to combine some
^eminatiTe with it. It may cause irritation of the bladder, diminution of
Kae, and albuminuria from renal congestion. It also has emmenagogic
Moperties. Following large doses, the uterus and appendages are more or
W in a fttate of congestion and hiemorrhoids are apt to be irritated. If
ibm has been an overdose and these symptoms are aggravated, it would be
■rfiiii III to give large draughts of demulcents, and an anodyne in the form
d ui opinm etippoaitory. It is stated that such phenomena do not follow
fte adsoinietration of aloin, which requires only about one-third or" one-half
it doM in order to produce the physiological effects of aloes.
The chemical and physiological investigations of Professor Meyer seem
Si a>dh ' 't aloin itself is not an active purgative, but that it becomes
piadisa! inpot^rx^ in the intestine into emodin, or trioxymethylan-
ttnfvinone. It is tliought that this may account for the slowness of its
Powdered aloes, dusted upon an abraded or blistered surface, may be
Krferbrd and exert a purgative effect. Aloin has been detected in the urine.
Thsnpy- — Aloes, or aloin, is a slowly-acting purgative, and, therefore,
^mJd generally he administered at bed-time; in this way it operates during
and gripingifi avoided. For the same purpose it is well to combine
ith a carminative, as in the compound decoction, or the compound rhu-
pill, which J8 a useful purgative for an ordinary attack of constipation.
TW fnllowing are likewise excellent formulfe to use in the same class of
182 PHARMACEUTICAL THERAPEUTIC AGENTS OR DHrOS,
a Vini aloes,
Fluidext. rharani purahianae aa 221 ccm. or f3vj.
Elix. aromatic q. 8. ad 180| c.cm. or fjvj.
M. Sig.: A tables p 00 niul morning and erening.
B Alo€s purificatffi 121 Gm. or 3iij.
Pulv. glycyrrhizee comp 124] Gm. or 5iv-
M. Sig.: From one-half to three teaspoonfulB in water or milk, early in the mom-
iog or ou retiring.
Kohlstock has experimented in the clinic of Professor Senator^ of Berliflj
with aloin and other cathartics applied locally to the rectum. The aloin was
dissolved in a small quantity of glycerin and subsequently in formamide, 1
Gm. (or gT. iv) of the former to 10 Gm. (or gr. cl) of the latter. A do8€
representing:, of the aloin, 0.38 to 0.50 Gm. (or gr. vi-viij), was found effi-
cient, in all mild cases of constipation.
The pill form is also useful for the expulsion of ascarides, which are
apt to lodge in the ca?cura. With this may be combined injections of aloes ir
solution (4 Gm. to 473 c.cm., or 3i-0j} and irrigation of the bowel. For the
latter purpose, in young children, a soft catheter can be inserted beyond the
sigmoid flexure of the colon.. In aniemia affecting young girls (chlorosis) Sii
Andrew Clarke claimed that constipation has much to do with its causation:
he called it fsecal intoxication. Here aloes, in combination with iron, is oJ
much service: —
B Aloes purificatw 81 Gm. or Sij.
Alasase ferri carbonatia 2 60 Gm. or gr. xl.
Pulv. aromatici 1 130 Gm. or gr. x.x.
M. et ft. pil. no. xx.
Sig.: Take one or two at bed-hour.
Sir Andrew Clarke's pill is likewise valuable: —
B Aloin.,
Ferri Bulph. exsic,
Ext. belIadonn» ale. (B.F.),
Ext. nucia vom.,
Pulv. ipecac,,
Pulv. myrrh,
Saponis' aa |03 Gm. or gr. as.
M. et tt. pil. no. j.
Sig.: One pill one hour before last meal, should. the bowels not act during the day
Ipecac is omitted if there is any cardiac weakness.
In cases of hysteria, with anajmia and constipation, the pills of aloes,
with asafetida, may be given (3 to G daily). These have also a carminative
effect. An atonic condition of the muscular coat of the large intestine maj
allow its contents to accumulate, to press upon the common bile-duct, and
obstruct the passage of the biliary secretion into the upper bowel. This con-
dition and the jaundice which is its result are relieved by the administra-
tion of aloes, with which belladonna and strychnine, or hyoscyamus and
ipecacuanha, may be very usefully combined, in such formulse as the follow-
ing:—
Gm. or 398.
i
H Aloes purificat« 2
Ext. bl'lladonna folior
Strychnine sulphatis
M. et ft. pil. no, xij.
Sig.: A pill three times a day.
065 Gni. or gr. j.
03 Gm. or gr. ss.
ALOE.
183
Ell, nurii^ vomk'ce
Pair, ipecflcuanhae
)t eC ft. pit no. x.
Skg.z A pill three times a day.
065 Gm. or gr. j.
66 Gm. or gr. x.
065 Gm. or gr. j.
13 Gm. or gr. ij.
Aloes is &n excellent emraenagogue; given for several days before the
ttptcttd period, it is generally successful, especially when employed thus: —
a AMau
Mam. feiri c«rb
ApioL
Ji. et fL capsaUe no. xij.
S%-: A capsule morning and evening for five or six days before the menstrual
113 Gm. or gr. ij.
240 Gm. or grr. xxxvj.
4 c.cm. or
Si.
la scanty menstruation, depending upon anaemia, the chalybeates
Aa«U aifio be poshed, preferably usisg the preparations of iron which are
art <^ti«tiDating, such as the dialyzed iron, or the carbonate, or pyrophos-
phs' r than the sulphate, which is contained in the oflBcial pill. When
indigestion is caused by deficient secretion of bile, aloes is of spe-
loc and enjoys a reputation as an ingredient in **dinner-pills" of many
Where the mental symptoms of dyspepsia — drowsiness, depression of
S" ts, or melancholia — are marked, the use of a good aloetic pill imme-
dj after dinner is often effective.
ui cases where there are hieraorrHoids, the aloes sometimes irritates
&cm ; under such circumstances the proper course to pursue would not be
li neglect such a valuable remedy, but to operate surgically upon the piles
ad remoTe them. The passive turgescence of the inferior hsemorrhoidal
voada, however, is not infrequently relieved by the use of aloes. Whitla
Maks of having obtained surprising results in obstinate diarrhoea in ehil-
on OT "■ *■- from the administration of a few 30- to 60-c.cm. (or f.v-ij)
4flMS o: mjx>und decoction of alcK?s (B. P.). We may prescribe the
loflorving. fur an adult with obstinate diarrhcea: —
M Aknsi
Salpliuris subl 6
Est. IwlUdonxui folior.
Si. d ft, eapsulff no. xx.
Q^: A capMtle three times a day.
13 Gra. or gr.
50 Gm. or gr.
13 Gm. or gr.
I
In snsall doees aloes acts as an hepatic and intestinal tonic. Where diar-
A«n is nsaintflined by the action of germs of fermentation, the increased
Ibv of bile exerts an antiseptic effect and the diarrhoea may be checked after
tprehminarj purge; although the rule is that, where diarrhoea is due to irri-
from abnormal condition of the contents, the cause of disturbance
he removed by a more prompt cathartic, such as sulphate of magnesia
\m the citrate) or by nn antiseptic purgative like calomel or blue mass.
Aloetic purgntives should be usea with care during pregnancy and lactation.
TW ndUr of women talcing aloes will purge babes whom they suckle. Aloes
mar h^ iia«M! as a derivative in cerebral disorders.
ji 't» of aloes is prepared by evaporating the tincture and adding
- J , ..is mixture may be applied to fissures, abrasions, and ulcers.
ter Xaete of aloes is sometimes utilized by applying a solution to the
:z£tT-<ads of children in order to break them of the habit of biting their
mmtM
184 PHARMACEUTICAL TFIERAPEUTIC AGENTS OR DKIOS.
nails or suckiiig their thumbs, or to the nipple when it is desired to weai
an infant, \rhich is unnecessary cruelty. The compound tincture of benzoli
contains 2 per cent, of aloes. This fact should be borne in mind when treat
ing cracked nipples with this preparation, as the infant may be weaned to(
early.
AIPHOZONE.— DiBuccinyl Peroxide, or Succinic Dioxide (('(K>H
Cir.( H.t'n )^,( »^. A iii'W ly-uilnMluri'st clifinical (Mim|POUiHi, wirit poworfu
germic'iile proptTties, diseovernl liv Pidf. A. M. ('ln\cT, of tlu' I'uivL'rsitj
of Michigan. It is a. wliito, crystalline powder, soluble in about iMt parts ol
water, fidorless, and with sliglit bitter imte. In fombinntion with water ii
undergoes bydrolysis, and forms succinic perucid. It is claimed to he equa!
to mercuric bichloritlc as a germicide. It is usc<l in W^n ^^ '/noo polution at
nrj exteninl application. It has also licen userl internally, Ijotli as a gargU
and tu lie swaltowi'd, in ly[>]ioid and other iurccuous diseas^e^i. Dose, 0.12
dm. (or gr. ij). in half a glassful of water.
ALTH^A (U. S. ?,).— Mar&hmallow.
Preparation.
SjTupus Althfwe. — Syrup of Altheea (5 per cent.).
Pharmacology. — Tbi- drit^d rrxtt nf Altluea nflieinnli^ < Mi'l^'^<'<?"P}T ^^^'
lectcd froni plains (d' j^ccnnd year's *,^rn\vtli. and deprived iff it^ pfridenn. It
conlains a nuu ilnginous [iriutiple, with about 'J ]K-r cent, of asparag^, but
no tannin. Altha>a is a constituent in uiassa hydrargyri (blue mas^s) and
pboftplionis pills.
Therapy. — The powdered root treated with hot water may be used as a
poultice. It is slightly diuretic, on account of the asparagin, which would
make it of service in children's diseases in the form of a fresh infusion, espe-
cially in Bright'e disease. The confections are usefiil in sore throat, in scar-
latina, and diphtheria. The syrup is an agreeable addition to cough-mixt-
ures. Dose,, indefinite. Althfea combined with benzoinatcd lard is a bland
dressing for skin diseases. Asparagin has been recommended as a diuretic
in gout and cardiac dropsy, in doses of 0.065 to 0.13 Gm. (or gr. i-ij).
ALUMEN (U. S. P., B. P.).— Alum (AlaKjCSO,], + 24HjO).
Preparations.
Ahintini Hydroxidum (I*. S. V.). — Aluminum Hydroxide. lk»»e, 0,20 to 1.30
Gm. (or jrr. iii-xx).
Aluniini Sulphas (U.S. P.). — Aluminum Sulphate. For external use.
AUimen Exsiccatum (U.S. P., B. P.). — Dried Alum (alumen usturn, or burnt
alum). Dose, 0.(105 to 0.32 Gm. (or gr. i-v).
Glyocrinum Aluminis (B. P.).— Glycerin of Alum (about 13 per cent.).
Pharmacology. — The U. S. P. alum is potassium aUun (r'.uitniuing not
less tbau 9*:V /.^ per cent, of pure aluniinum and potaseiuui sulpliate). The
"Britisii rhiiniuuopivia rocogui/.ts \h){]\ ptttassium alinn and anunouium alum
(nluiuinuni ami auurinuiuni sulphate^. Alum is in tlic fonn of tran>luront,
wliitf, nctubcdral crystals, with a pwwtish, njitrin^a'ut ta.^^tc and acid reac-
tion. It contains water of crvstallization, which tan Itc driven off by heat.
ALl'MEK. ^^^^^^ 185
.?r;.^! iiluiiK AinitiQQia uJum, which wa* formerly the official alum,
the same pn^jwrties, and is often dispensed for alum. The
fmi-jmiT-<uni Is not officifll. In ai>penrance it is like silver, hut is much
mod in«re durable; is us<*ful for making surgicsl and household
Ffcynological Action. — Dried alum is astringent, and is a mild escha-
:iot fungous ^rranulations. The glycerite (20 per cent.) is useful in cases
rf toasillitifi or pharyngitis of subacute character. In solution alum con-
4aM« tuKues by coagulating their albumin, and acts as an astringent.
Xkenpy. — It checks excessive sweating in phthisis when applied with
ftifon^ (4 Gm. to 473 c.cm., or 5i-0j of whisky and water). It is used as an
, in leucorrhcea and in gonorrhoea, and a watery solution of the glyc-
im useful ftfi a collyrium in conjunctivitis. In the latter affection alum-
netixnea applied (2 Qm,, or oss, beaten up with the albumin of a
In chronic granular conjunctivitis. Dr. W. T. Montgomery, of Chicago,
use of: —
B Ctopri sulpha t.,
ZlBct sulphat.,
Frrri salphat.,
PAiuttints aa 132 Gm. or gr. v.
Aq. ilcvtfl 30| com. or fjj.
v. S^.t Brush upon the inside of the lids once daily.
Applied locally in the form of powder or saturated solution, alum is an
wariknt stTptic. A most useful alum stvptic combination is the follow-
R A :i: jT.i.. (rhcerini, »B. P.),
AlfohrlM,
Lia. ■aponis sa ftO| c.cm. or fS>j-^M.
Compresses soaked in the preparation just formulated, or a solution of
Abv mar be nsed to restrain capillary hsemorrhage from wounds, bleeding
h^ thm gmns, or leech-bites. In epistasis a plug of cotton moistened in
,4^ft-«Stcr amy be passed into the nares; a solution may be thrown in by
imMiaa or ponrdered alum may be snuffed. These measures will frequently
Csvoccssfnl. In ciironic pharyngitis, tonsillitis, and nasal catarrh the
Klioo of powdered alum is bene^cial. A prescription composed thus is
^kicffertual:—
ft FWvol liqurfacti 118 C.cm. or ;/iiij.
AtomlnU ^lycoriin 901 c.cm. or fjiij.
nrtBoliB ioUitIi 2| Gm. or 3«s.
;e App\j with cotton or a cfime|*s-hoir brush once or twice a day over
Ji mmj aliKi be used in solution as a gargle with good effect. The local
I of a solution of alum is of benefit in cases of mercurial ptyalism.
I asserts that garjbrling the throat with 4 to 8 Gm. (or oi-ij) of alum,
J»ed in about ISO to 210 c.cm. (or ovi-vij) of a decoction of barley with
'tUition of 7.50 c.cm. (or foij) of honey of roses, is a serviceable practice
dte caar of speakers and singers, shortly before using the voice.
Aa injection of alum is a serviceable astringent in haemorrhage from
L
180
PUAR.MACEUTIC.VL THEKAPEUTIC A(iKNT8 OK DKL'Oa.
the rectum or \r\ gonorrhcea.
mended: —
For gleet, the following formula is recon
IJ Pulv. aluminia 81
Fiviidext. geranii 15
Aquffi roaffi 135]
6tn. or 3ij.
ccm. or fjBs.
c.cm. or fjivas. — M
Tu tJie vulvitis of cl^ildren^ n p-Dlution of n drfiulim of alum to a pint •
water is a serviceable local application and may from time to time be nst
ae an injection. A solution of 0.65 to 473 c.cm. (or gr. x to the pint) ifi
useful injection in chronic cystitis, as it relieves vesical pain and frequem
of micturition, while decreasing the production of ropy mucus,
A lotion containing alum may be successfully employed in the prolapse
bowel of children. From 4 to 8 Gm. (or 5i-ij) of alum to 473 c.cm. (or a pii
of water, or alcohol), is a beneficial application in hyperidrosis. It is sa;
that 0.65 Gm. (or gr. x) of alum, placed upon the tongue, will sometini'
arrest a paroxysm of asthma (Ringer). According to Ringer, many cases i
chronic oziena are rapidly relieved by irrigating the nasal chambers with
solution containing a drachm of alum to the pint of water. The discharge
checked and the foetnr removed. Pruritus of the vulva sometimes yields to
hot alum solution. The local astringent action of this substance is sometim
found beneficial in purpura. An ointment containing alum is often useful
herpes, and the same preparation removes the offensive odor of bromidrosi
The following formula are of service in the diseases just named: —
R Pulv, aluminia 41 Gm, or 5j.
Ptienylis stalicylHtis 21 Gm. or 3s8.
Bismuth, subnit 4 Gm. or 3].
Ungt linci oxidi 31 1 Gm. or Sj. — M,
B Tulv. nluminis 15
Glycerini 30
Aqufp hamamelidiB 150
5 Gm. or 5*9.
c.cm. or f5i-
p.cra. or fjv. — M.
In chilblains, also, a solution of alum has been used with asserted a
vantage.
As an emetic in croup, a heaping teaspoonful of alum may be dissolvi
in 120 c.cm. (or f'iv) of simple syrup, of which a teaspoonful is given eve
fifteen minutes until vomiting is produced. It is useful in bronchorrho
and in whooping-cough, especially where the secretion is excessive. Givt
internally, alum checks haemorrhage and profuse discharges. "WTiitla esteen
it the best remedy in haemorrhage of the bowel due to typhoid fever. It nu
be given with good result in the ha?matemesis dependent upon chrhosis
the liver and in haemoptysis. The local action of alum may be aided by i
internal administration in the night-sweats of phthisis. It checks excessi'
production of mucus in chronic gastric and intestinal catarrh, and it reliev
the pain of gastralgia and enteralgia. Alum is an efficient remedy
some fonns ofdiarrhren.
Clysters containing alum have been successfully employed in chron
dysentery, and even in the acute form of the disease have sometimes be(
found of service. The drug may likewise be given internally in the manag
ment of dysentery.
Whitla considers the internal exhibition of alum of service in leuco
rhcea. The following formulae are advised: —
ALPMEX.
187
r
alBminis 12 Gm. or 9itj.
Wilph ATom. ..,..,,,., 4 p.cm. or f3j.
.t, gvr^nii 60 c.cm. or fjij.
9jrmp. zin^iberis 90 c.cm. or fjiij.
X. Sg.z One to two teaspoonfula in water every half-hour or hour until hsemor-
h muted. For hemoptysis, hiematuria, znenorrhagia, and uterine hemorrhage.
M Ptetr. alanunifl,
FWBjIift saiirylatis aa 6|d0 Gm. or gr. c.
3L ti fL cap>nlie na xx.
Sp-: A capsule three or four times a day. Employ especially in cata.rrh of the
■ad iVMtaUtia.
E Potr. aluxziinia 13 Gm. or gr. cc.
Tiact- kino 45 c.cm. or ISias.
Tiaet. opii camph 30 c.cm. or fSj.
Acidi sulph. arom 4 ccm. or f3j.
Spt. Tini gallici q, b. ad 150 c.tm. or fjv.
3C One to two teaspoonfula in water every three or four hours. Serviceable in
iHir ^AirtKea, dysentery, and in hiematuria.
have been reported in which alum was thought to be useful
mellitu3. It would probably prove of more decided utility in
i^et«« insipidus
^^J& comparatively large doses (2.60 to 4 Gm., or gr. xl-3j) alum acts as a
^^^pe, uid hfts been used in colica pictonum. In this condition it relieves
I^^Ki and overcomes the constipation. I)r. Phillips speaks of its being
miiil m other forms of gaetralgia and colic. It has proved of benefit in inter-
: feTer in 0.32 (im. (or gr. v) dose?, although its action is not uniform
i affectioD. Irnn-alum has been employed in intermittent htematuria.
in the ear, a solution of aluminum acetate (25 per cent.) may be
intr* !he ear frequently, and the canal plugged with cotton. Alum
OS an adulterant of baking-powder, and its use for this
un . . ...ily causes indigestion.
Tfie aluminum salts are antiseptic and can be used as injections for leu-
(0.65 Gm. to 30 c.cm., or gr. i-f5j)» and saturated solutions are mild
The oleate of aluminum arrests morbid discharges when used as
application.
AXU1DI0L is the trade-name given to a substance discovered by
of Bre«lau. It consists of a mixture of aluminum salts of naphthol-
ic acid, and contains o per cent, of aluminum and 15 per cent, of
Aluznnol occurs in the form of a fine white or light pink-colored
frte from odor, not hygroscopic, readily soluble in water, soluble
leaa so in alcohol, and insoluble in ether. Its solution in alco-
odlibit? a beautiful blue Ruorcscence. The solutions possess an acid
te of alumnol is sweetish and astringent. Alumnol pre-
a and gelatin, but is redissolved in excess of those sub-
It possesses marked penetrative action. It strikes a blue color
tlntions of ferric chloride. Alumnol darkens upon exposure to the
out losing its properties.
logical Action. — This substance is antiseptic, astringent, and,
trat4*d fornu caultrant.
nxnool exerts no toxic influence, except when employed in very
188
PIIARMACEITILAL TIIERAPErXIC AOEN'TS OR DBUOS.
large quantities and under very favorable conditions for absorption,
practice, no aluminum was found iu the urine of patients who had be
treated by large doses and for a considerable period.
Therapy.— Aluiiinul is a fccrvitcable applicatit»n to ukors^ wounds, a
abscesses. Jt may be used as a lotion, ointment, or jilaster. For 1
irrigation of abscess-cavities it may be used in a 10- to 2u-per-cent. so
tion. A 1-per-cent. solution is beneficial as an injection in gonorrhc
and in endometritis, due to gonorrhcea, sticks or bougies containing frc
2 to 5 per cent, may be employed with advantage.
A 4-per-cent. solution dropped into the eye arrests the flow of tei
for several minutes: a property which will, in certain instances, mate
ally facilitate examination.
Dr. Stipanics, of Budapest, has used alumnol with advantage in t
treatment of chronic rhinitis, hypertrophic rhinitis, simple ozaena, aci
and chronic pharyngitis, tonsillitis, etc. This writer regards the reme
as of special efficacy in affections of the larynx. Hoarseness due to larj
geal catarrh was speedily removed by inhalations of Vj- to l-per-cei
aqueous solutions. Dr. Wolffberg recommends a 4-per-cent. solution i
the purpose of cleansing the eyes in gonorrhoeal ophthalmia. By 1
Brieger alumnol has been used with success in the treatment of purulc
inflammation of the middle ear,
M. Chotzen has reported his experience with this remedy in more th
three hundred cases. He describee it as a beneficial application to cha
cres and chancroids, balanitis, and erosions. Solutions containing from
to 5 per cent- are of value in moist and papular eczema, acne, and furunc
losis. An alcoholic solution of 2.5 to 10 per cent, is effective in urticar
sycosis, and psoriasis. Incorporated with lanolin, in the strength of 2
5, 10, and 20 per cent., it is successful in eczema, seborrhcea capitis, pso
a.sis, and favus. In erysipelas and iupug, ahmiuol is abo employed wi
good results. In these affections Dr. Chotzen applied the remedy accoi
ing to the following formula: —
R Alumnol 4|
Adipid lanse Id
Paraflini monis 13
Cereajn* 2
M. et ft. ungt.
Gm. or 3j.
Gm. or 3v.
c.cm. or fSiiiss.
Gru. or 3ss.
Aluminum acetioo-tartaricum. — This compound occurs in the for
of almost-colorless pieces, having an odor resembling that of vinegar,
slightly-ncid and not disagreeable taste. It is soluble in water, but n
in alcohol. It is chiefly used as a mouth-wash and gargle. A 50-per-cer
solution is recommended in the treatment of frost-bite. This substan
has been applied also as a dressing to wounds. It is non-toxic, astringer
and antiseptic.
Boral and Cutol. — Alumininn iinrotartrate (under the name of Bora
and ahinuinuu borotnnnale (under the title of Cutol) have been broug
forward as antiseptic and astrincfent preparations, suitable for use in de
nuitolair.v. Borul is soluble, ainl cutol is insoluble, in water. Tlie latt'
may be rendered soluble by the addition of tartaric acid> in which form
' Ce rosin i« a nntiirnl ininornf pvi>flti»*t whidi cl"f**"ly rf^ciiiMt's nbit*' wnx.
consistR of a mixture of solid paraRin with some oxygenated bodies, and is found
Galida and aouthcm Utah.
AMHOKIACUH. 18^
is claimed to be useful as an injection in gonorrhoea. Gutol has been em-
ployed with alleged success in facial erysipelas.
Aluminum boroformate. — This compound is made by heating to-
gether boric acid, formic acid, and alumina. It occurs as large crystalline
scales, soluble in water, contains 33.5 per cent, alumina, and has been used
as a substitute for other preparations of aluminum. A solution of boro-
fonxiate, saturated with ammonia and evaporating the clear fluid, consti-
tutes aluminum ammonio-boroformate.
Sozal. — Under this name an organic salt of aluminum has been in-
troduced for use as an antiseptic application. Sozal is obtained by dissolv-
ing aluminum hydrate in phenol-sulphonic acid. It is a crystalline sub-
stance, readily soluble in water, glycerin, and alcohol. Sozal has an astrin-
gent taste and a faint odor of carbolic acid. A 1-per-cent. solution was
found beneficial as an injection in abscess, tuberculous ulcers, etc.
ALVELOZ is the milky juice of Euphorbia heterodoxa, belonging to
the Euphorbiacese: a native of Brazil. The usual irritating effects of the
juice of plants of this genus is very marked in alveloz, which is said to act
as a caustic upon the skin verv much like zinc chloride. It has been used
in treating cancerous and syphilitic lesioiis with asserted success, and the
application is comparatively painless.
AMBEAQBISEA. — Ambergris is an odorous, fatty substance, found
in large masses floating upon the water, and is believed to be produced
in the intestines of the spermaceti-whale. It has a consistence like wax^
softening at the temperature of the hand, and melting below the boiling-
point of water; it is almost entirely volatilized by heat, and is inflammable.
In composition it is like cholesterin, and is not aaponifiable. It is believed
to have some antispasmodic effects, and is official in the French Codex as-
a 10-per-cent. tincture. Ambergris is used in making perfumery.
AMmOFOBM. — A trade name for Hexamethylenamine.
AMMOHIAGUM (B. P.).— Gum Ammoniac.
Dose, 0.32 to 1 6m. (or gr. v-xv).
Preparations.
Emplastrum Ammoniaci cum Hydntrgyro (B. F.), — ^Ammoniac and Mer-
nirr Pla»teT (contains ammoniac, 2 oz.; mercury, 3 oz.; with olive-oil, 56 grains;
and sublimed sulphur, 8 grains).
Mistura Ammoniaci (B. P.). — ^Ammoniacum Mixture (ammoniac, 6; syrup of
Tohi, 10; distilled water, 150). Dose, 16 to 30 c.cm. (or f5as-j)-
Emulsum Ammoniaci (not off.)> — ^Emulsion of Ammoniac (4 per cent.). Dose,.
4 to 15 ccm. (or f3i-iv).
Pbarmacolofi^. — Ammoniac is a gum-resin obtained from Dorema Am-
moniacum (Umbelliferse), containing a volatile oil. It occurs in the form of
t€are, of variable size, hard and brittle, having a faint, unpleasant odor and
& bitter-sweet, somewhat acrid, taste. It forms a milky emulsion when
rubbed up with water.
Therapy. — ^It is a stimulating expectorant and laxative, and resemblea
190 PELiaMACEUTICAL THERAPEt'TrC AOEXTS OR DBCG8.
asafetida in its effects upon the system. It has been used, with alkaliei
relieve chronic bronchitis and asthma. It is especially beneficial in chr
bronchitis associated with emphysema, or occurring in aged persons,
algid stage of cholera has beun treated in tlie Fiume Hospital by gum
raoniac intemal]>% conjoined with stimulants and the hypodermic injec
of ether. Warm baths were also administered. The piasters are usefu
glandular and joint swellings. By fusing ammoniac and other resins ^
caustic potassa resoroin is obtained, which is a valuable antiseptic
official.
1
AMMONIUM. — AnimoniixTO has not been isolated and is known on]
its corabiuations. which are numer<n]s and important. According to Amj
its constitntirin is Xfl^; it is therefrtre a compound radical, and as sue
forms permanent salts whicb are analogous to potassium snUs. Amnii
(XHj,) is a gas, which can be liquefied by pressure. It is soluble in water
m alcohol.
U, S. P. Preparadons (Liquid).
Aquft Ammoniffi. — Water of Ammonia (containa 10 per cent, of gaieous as
nia). Dose, 0.12 to 0.60 c.cm, (or mii-x).
Aqua Ammouise Fortior. — Stronger Water of Ammonia (28 per cent, gas
anmionia). External use.
Lininicntura Ammoniffi.^Liniment of Ammonia {ammonia-water, 35; alci
6; cotton-seed oil, 60 com.). For external use.
Spiritus AmmonisB. — Spirit of Ammonia (10 per cent.). Dose, 0.30 to 1 <
(or mv-xv).
Spiritus Ammonife Aroniaticufl. — Aromatic Spirit of Ammonia. Dose, 2 iA
c.cm. (or fSsa-ij).
Liquor Ammonii Aoetatis. — Solution of Ammonium Acetate. Spirit ol
dereniB. Dose, 4 to 15 c.cm. (or f3i*iv).
Tinctura Guaiaoi Ammoniata. — Dose, 2 to 4 c.cm. (or i»xxx-lx).
Tinctura Valeriame Ammoniata, — Dose, S to 4 c.cm. (or tSss-j).
B. P. Preparations (Liqtiid).
Liquor Ammoniae. — Solution of Ammonia (contains 10 per cent., by weigh
ainiHitnia. NH,).
Liquor Amnionise Fortis. — Strong Solution of Ammonia (32.5 per cent,
weight, of ammonia, NH,).
Liquor Ammonii Acetatis. — Solution of Anunomum Acetate. Dose, 7.5 t
c.cm. (or f3ii-vj|.
Liquor Ammonii Citratis. — Solution of Ammonium Citrate. Dose, 7.5 t)
c.cm. (or f3ii-vj).
Spiritus AramoniiE Aromaticus. — Aromatic Spirit of Ammonia, Spiritus An
ni« Compositus, Spirit of Sal Volatile. Dose, 1.20 to 2.40 c.cm. (or tnxx-xl),
Spiritus Ammonia; Fcetidus. — Fetid Spirit of Ammonia. Dose. L20 to 2.40 c
(or m.xx-xl).
Linimentum Ammonite. — Liniment of Ammonia (solution of ammonia, 25 a
almond-oil, 25 c.cm.; olive-oil, 50 c.cm.).
Ammonia is contained in several of the B. P. official tinctures, also in the
moniated Liniment of Camphor.
Official Solid Preparations,
Ammonii lodidum (U.S. P.). — Ammonium Iodide. Dose, 0.32 to 0.65 Gra.
8T. v-x).
Ammonii Salicylas (T. S. P.). — Ammonium Salicylate. Dose, 0.13 to 0-65
(or gr. ij-x).
Tit OX
AMMOXU'M. I'Jl
AimmmSk V«Wrku <U* S. P.). — Ammonium Valeriatc. Done, 0.13 to 0.32 Cim.
AsMooii Benzoas (U. S. P., B. P.)— Ammoniuzn Ben2o«t«. Dose, 0.13 to 0.05 Gm.
ivfr. O-ZK
AflUMMui Bromidum (U. S. P., B. P.).— Amznonium Bromide. Do«e, 0.66 to 1 Gm.
MT^. x-rr).
ABAOttli OtrboDM (U.S. P., B. P.). — Ammonium Carbonate. Dose, 0.13 to 0.32
m UDGm, lor gr. ii-v or xx).
AjMbOttii Chloridum (U. S. P.» B. P.).— Ammonium Chloride. Dose, 0.32 to 1.30
Trc>«<!iii*ci Ammonii Chloridi {U. S. P.). — Troches of Ammonium Chloride.
•:iiTryTTfamnum Ammoniatum (U.S. P.), — Ammoniated Glycyrrhixin. Dose, 0.03
ia 4Jtt titn, { or gr. &a-v ) .
Hj^r%rgjTum Ammoniatum (U.S. P.). — Ammoniated Mercury, White Precipi-
ate. Uanl only externally.
Anmottii Pbospbaa (B. P.). — Phosphate of Ammonia. Dose, 0.32 to 1.30 Gm.
MTgr. T-xa).
Pharmacolagy and Physiolo^cal Action. — Ammonia is a gaseous body,
rritating, even suffocating, to tlie air-passages, and may cause acute
3£u2imation with cedema of the glottis. It stimulates the trifacial nerve,
the blood-tension by reflex action upon the vasomotor centre, and
Its syncope. If applied to the skin it is rubefacient, and, if diffusion
ta ptrrented, it vill soften and vesicate the skin. The strong solution also
fmncef Tecication and softens the cuticle. Ammonium chloride, on the
«tber handy is cooling and absorbent. The chloride, after absorption, hastens
•wth^hsl proliferation of the bronchial mucous membrane and liquefies
lEKkcned mucoiifi secretions. The carbonate is probably decomposed in the
^fstire tract, and its effects are identical with those of the gas or of aqua
•sBKmia in stimulating the heart and circulation.
Ammonui acts upon the ganglionic nervous system especially, and has
toU effect upon the higher centres, thus differing from alcohol. It in-
fmmes the functional activity of the spinal cord and is a promptly acting
ODdiae stimulant. Its accelerator nerves and the heart itself are stimulated
tTns«'dicinal doses of ammonia. Blood-nressure is moderately increased, but
• j-^r .^>?es ammonia interferes with the oxygen-carrying power of the red
Wood-corpuscles, and if long continued produces emaciation. Ammonia
I'hsiir stitnulates the respiratory centre. In small doses the aromatic spirit
^■BUBonia act£ as an antacid and a carminative; but the protracted use of
mijiinis. by neutralizing the gastric juice, enfeebles digestion, and may
4r«finste gastro-intestinal catarrh. Injected into the blood-vessels, the
ll«od-corptiscles are liable to become dissolved, and after death the blood
■Baxna naid. Ammonia likewise assists in maintaining the solution of the
Ana of the blood. Such injections are likely to be followed by vomiting.
TW carbonate mav be given for the same purpose by the mouth, but, in large
^asa is apt -*: vomiting. Ammonia increases the secretions not only
M the bron jcous membranes, but also the intestinal, and may set up
Aafrbcea. '1 he volution of ammonium acetate acts upon the skin, especially
afsrar. AmmoDia has no special action upon the kidneys, except that the
vca is increased by oxidation of ammonia, according to the observation of
f« lu.^.^ Jonea, who also found that nitric acid made its appearance in the
the administration of ammonia or its salts; it is eliminated espe-
': ' hroncho-pulmonary tract, and skin. Ammonia pos-
0 virtues.
Poiwning. — Aa the ammonia-water, or "spirit of hartshorn," is found
I
193 PHARMACECTICAL THEBAPEUTIC ACENTH OR DRVOS.
in every household, cases of poisoning by accidental swallowing not ra?
occur. When the stronger solutions are swallowed, there is great distres
burning pain along the oesophagus and in the stomach, with choking senw
tions from inhaling the gas or the admission of a few drops into the laryn
After death there are evidences of softening and acute inflammation of tl
stomach.
Treatment. — Vomiting is likely to occur immediately, but if not, tl
administration of large quantities of bland liquid, such as water, oil, or mil]
would be serviceable, and if the solution of the gas has been taken it ms
be neutralized with vinegar or lemon-juice. Treatment should be prompt!
instituted in order to avoid such a degree of inflammation as would prodm
stricture of the oesophagus. If the patient is in a state of shock, warm i)
fusion of cofiee may be administered by the mouth or rectum and tinctu]
of (ligitalifi, or strychnine given hyiJoderniically. The diet should be liquii
only.
Therapy. — The local uses of ammonia have been already intimated. ]
sprains, bruises, and old rheumatic swellings the liniment is of service, esp'
cially if some oil of turpentine or chloroform be added.
The water of ammonia may very serviceably enter into the compositic
of a stimulating application iu nloperia. In the iK'ailacho, whirli attends di
ordered nuMiptnialion or the menopause, Dr. Tilt lias seen Uaspail's si<?dati^
lotion afford much relief. This preparation contains 60 c.cm. (or f'ij) <
stronger ammonia, 62.2 Gm. (or ^ij) of common salt, 9.2a c.cm, (or foiiss) *
spirit of camphor, and 1 litre (or Oiif,>ij) of water. The liquid may be appli<
upon a sponge or linen cloth. Weak solutions of ammonia will sometim
relieve the itching of urticaria. For this purpose 7.5 c.cm. (or foij) of tl
official water of ammonia may be added to a pint of water, or ammou
carbonate may be employed in the strength of 4 Gm. (or oj) to 130 c.cm. ((
f^iv) of water. The following combinations of ammonia are also of servi^
for external use: —
I^ Aqum ammonicB,
Fhiidext. nniicce,
T-in. gaponia.
Olei tcrebinthinc aa 60| c.cm. or fjij.
M. Sig.T Rub in well several times a day. For rheumatism, bruises, and sprair
B Lin. ammoniffi 601 c.cm. or fjij.
Spt. c-hloroformi SO] o.cm. or fSj .
Lin. menthol' 601 c.cm. or fjij.
TincL opii 30] c.cm. or fjj.
M. Sig. : Apply well oyer the surface, when necessary for lumbago, neuralgi
and sciatica.
R Spt. animon. aromat lo\ c.cm. or f^sa.
Tinct. cflpaici 301 c.cm. or IX j.
Spt. lavandulffi 7 1 50 c.cm. or fSij.
Tinct. nucia vomica 151 c.cm. or fXss.
Lin. camphorsB ~5\ c.cm. or fjiiss.
M. Sig,: Apply with friction to the scalp for loss of hair and for dandruff.
'Linimcntum menthol as suggested by Martindale (see **The Extra Pharm
copojia/' London) is composed of menthol, 3 parts; chloroform, 4 parts; and oliv
oil, q. s. to make 16 parta.
AMMONIUM.
193
I II Tia*l! ri) I Lr III
M. tliimble-blistering may be practiced over tbe paiulul spots
ppiug 3otue stronger aqua ammouiffi upon absorbent cotton^
; f^crinin^ u with a watch-glass or thimble in contact with the skin.
Spirit of ammonia is a good application to wounds caused by stings of
k or stuikif-bites. In the latter case, ammonia-water can also be injected
I a vein in order to counteract the depressing effects of the Tenom. In
; bj eewcT-gas intravenous injection of the official aqua ammonia haa
fc. Ammonium-chloride solution (8 to 15.5 Gm. to 473 com., or 5ii-
j) removes ecchymosis from contusions. This solution is applicable
to epididymitis after the acute stage has subsided. It is, in fact,
Jent dressing in the latter stage of superficial inflammation, and pro-
riiie abaorption of exudation. Dr. J. H. Freeman, of Nevada City, Cal.,
recommends ammonium chloride in the treatment of rhus-toii-
Iron poisoning. He dissolves 8 Gm. (or 5ij) of the salt in 120 c.cm. (or
5^) of water, and directs it to be applied to the affected parts two or three
IJBtta day. The swelling and the burning pain rapidly disappear.
Internally, ammonia is invaluable as a cardiac and nervous stimulant in
>nia and all typhoid conditions, in poisoning by prussic acid, in syn-
jaiid in heat-eahaustion. The carbonate is the most eligible form, given
dotes of 0.33 to 0.65 Gm. (or gr. v-x). In capillary bronchitis in infanta
^ following answers a good purpose: —
ft Asunonii rsrbonatia ^.. |75 to 1
Syr. toliitani «^t.....i 16
Liq. anunonii acetatu 76
60 Gm. or «■. j
c.cm. or Riv.
c.cm. or fBiiM.
xU-zzir.
X. S%-: Give » U«spoonful every hour or every two hours.
According to Dr. Beverley Robinson, ammonium carbonate, in rather
ta»md frequently-repeated doses, is very etftcient in aborting a cold. The
Hnring formula is often most efficient as an expectorant, especially in the
kft* ctage of bronchitis: —
i
ft AiBBMmiS cftxb.
9tt. •^i^eji* . - .
4
15
11
30
jP|»t I niornmrini 11
jLq. ramphore q. t. ad 120
Om. or Sj.
ccm. or fSiv.
acm. or fSiij.
ccm. or fSj.
c.cm. or fSiij.
c.cm. or i$iv.
One to two teaspoonfuli ever^r hour or two until relieved.
In the broncho-pneumonia of children, Marfan orders: —
acetat,
btnaoat. .
|p.rlfriiF«11
^fyr. toliitAni,
^ acaciJ» ■
H Sic- : Deasertvpoi
ll&O Gm.
4 ccm.
^•.
XXIV.
na 60| c.cm. or fjij.
on/ul every ho\ir or two according to age. The quantity of
according to age.
Tbtf Talue of ammonium carbonate in scarlet fever has been extolled
•? fmru Wilkinson, and Witt. It was employed in 0.20 to 0.32 Gm. (or gj,
»-t) do«€#r hourly, or at longer intervals, according to the severity of the
mt. Il reduce* fever and cerebral excitement and promotes sleep. The
of ammonium acetate is also highly recommended in scarlatina.
H
194
J'llAliM.Vl IJl rU'AI, TIIKIi.AI'Kirif AdKNTS OK OKl'OS.
The plan is to administer the remedy in large doses, which have been fouB^
to be well borne, even bj children. The carbonate has likewise been em
ployed in measles, in vrhich disease Ringer states that he has used it largel
with considerable ijenefit. The same salt is valued by some practitioners ii
the treatment of small-pox and erysipelas.
Delirium tremens, being usually associated with cerebral ansemia am
weakcntMl cardiac notion, uiay bi- hrncHtt'd bv ainmniiiuiii curljoiuitc.
Ftir the relief di* persistent cpista.vitJ, small do^^s, t».i;i to Ll.:^0 Uni. (o
gT, ij-iij). may be givtm frnni three to six timpg a day, nr every ten minute
duriujr the lia*morrJi!iu'c.
Ammonium carbonate and acetate have been used in diabetes mellitiu
Eichhorst states that in two of his cases the use of the carbonate was fol
lowed by rapid disappearance of the sugar from the urine; 3'et the progres
of the pulmonary lesions was not interrupted.
Pereira says that liquor ammonii acetatis is available in those cases o
fever of a continued type where all violent action has subsided and the brail
is not much disordered. Its diaphoretic action should be promoted b;
diluents and by warm clothing.
The aromatic spirit of ammonia may be given in threatened syncop'
and should be well diluted with water when administered. It is also usefu
in heat-exhaustion with small quantities of tincture of capsieuni, which alsi
relieves nuusea. It is likewise of service in the sour stomach ajid lympanitee
which not infrequently occur in hysterical women. Nervous headache i
often relieved by the same preparation. Ammonium chloride may be admin
ifitered thus as an hepatic stimulant: —
I^ Ammonji clilor 121 Gm. or 5iij.
Sodii chlorid 4 Gm. or 3j,
Kluidi'xt, tarnxat'i 60 c.cm. or fSij.
Decocti aloes co ad 240[ c.cm. or fjviij.
M. Sig.: A dessertspoonful to a tablespoonful in water three or four times ■ day
The chloride increases the flow of bile (Ringer)^ and is, therefore, usefu
in torpor of the liver, sick headache, biliousness, and also in jaundice due U
obstruction of the gall-ducts. It has some reputation as an emmenagogue
Ammonium chloride is esteemed of value in catarrh of the stomach anc
bowels, and Bartholow considers it usefu] in the first stage of cirrhosis.
M, Marotte esteems this salt as of value in cholera. He administers il
in doses proportionate to the severity of the disease and states that it pro-
duces a return of warmth and perspiration and also stimulates the kidneyt
to action. Dr. J. J. Trussewitsch regards ammonia as one of the best cardiat
stimulants in cholera. He gives it by hypodermic injection, making use oi
3 to 8 drops of the saturated solution diluted with a syringeful of water.
The effect is prompt, and continues for some time. It may also be given
internally in the same disease.
In myalgia and neuralgia this salt is capable of affording relief, and
should be given in rapidly-increasing doses until the effect is obtained oi
the system becomes intolerant of the remedy. It has also been used in in-
termittent hsematuria. It is best given in capsules, on account of its nau-
seating, sea-water ta«{f. Licorice cover.-^ the tiisti* in mixture.';.
Dr. H. Campbeirs favorite prescription for neuralgia of the fifth nerve
is: —
AAIMOKIETM.
195
% Aammii ehloridi 2
XteoLcriaanii
ItecL aeoaiti •<*.•,,«*,
FhdAcxt. glre^TThizir •«,*.«.. 4
A^mm q. s. nd 30
K. SSy.: To be taken in one dose every hour when the pain comea on, until
t Are taken.*
6m. or gr. xxx.
60 ccm. or mvMw,
06 c.cm. or mj.
c.cm. or f3j.
c.cm. or f3j. — M.
Dr. G. Corrie states that ammonium chloride is an excellent remedy in
cystitis from various causes. He gives it in doses of 1 to 2 Gm, (or gr. xv-
ixxj, aud obtains marked and rapid relief.
In bronchitis m its first stage, with deficient secretion, it may be com-
follows: —
Om. or 3ij.
Gm. or pr. xvj.
c.cm. or mxxx.
C.cm. or fBiv.
% AMBonii chloridi 8
Pateaaii iodidi « *.^t« 1
TIarL ipecmcuanhK 2
Ififft. gfycTTThixB comp q. &. ad 120
IC. 8ig.: Dose, a tablespoon ful every four boura.
Thi£ formula is of special service in acute catarrhal pneumonia. The
cUoride is particularly valuable in chronic bronchitis accompanied by pro*
hm fccretion. It is asserted that the continued use of large doses of this
«lt nuj excite ulceration of the stomach. It is also a remedy of great utility
IB tropical or malarial fevers, such as are encountered in India. In these
fct€3g. f^f a highly inflammatory type, it must be given in doses not less than
I V- *.m. (or gr. xv-xx) several times daily.
V iyt;at(\- of ColomlK), Ccvlon. ri'ports oxcellent results from am-
■oaiviD chloride in acute, tropical dysentery, given in 4 Qm. (or 3j) doses
cvtrj four hours and the patient placed on milk-and-arrowroot diet. In the
mmjtmtj of cases blood disappeared from the stools on the third or fourth
hn. In a few cases this treatment was supplemented by small doses of opium.
lalodia amrDonium chloride is esteemed to be especially valuable in malarial
intja of n highly-inflammable type; it should be given in doses of 1 to 1.30
<bL (or gr. xT-xx).
la catarrhal conditions of the respiratory tract Krakauer recommends
^ nae of ammonium chloride in the form of a spray. Ammonia carbonate
■iT also be tiMd as an emetic in such cases. In the later stages of pneumonia
u/nt (iifitinn is promoted by the same remedy. Liquor ammonii acetatis is
mit of our most reliable diaphoretics, and enters into the composition of
fever mixture*: —
Fluid' >U |16 c.cm. or gtt iij.
9pL c ' ni . . 161 c.cm. or fSiv.
Uf. arrjmoMii aeetatii 75| c.cm. or fSiiss.
M. S4f . • Give a deasertapoonful every two or three hours in fever.
Both the ammonium chloride and the solution of the ammonium ace*
( are effect! rely given for the purpose of quickly removing the eflfects of
_t>l or £ol>ering a drunken person.
Aflunonium bromide has a special influence over whooping-cough, and
be aabatituted for the potash salt in epilepsy and nervous aflections. A
• xrv TorM 3ie4ital Journal, Sept 23. 1899.
*»rMMh yt^irat Journal, May 7. 1898.
19G PIIARMACELTHJ^L THKUAl'EUTiC AGENTS OK DRUGS.
double salt, ammonium and rubidium bromide, has recently been introdu^
as a remedy for epilepsy. The substance is readily soluble in water. Its dos(
\b that of the other bromides. Active doses are from 2 Gra. (or gr. xxx) up-
ward; as much as 8 Gm. (or 3ij) daily, or even more, may be given, dissolved
in syrup of lemon and water. Laufenauer has used it in all the epileptic
states with the exception of hystero-epilepsy.* In acute rheumatism with
nervous svniptonif:. Do Costa rcp<"trtod good results from the use of amnion'
ium bromide {1.30 \n 2.fin Gni., or gr. xx-xl) several times daily.
A very suitable prescription for insomnia and in gouty subjects is:-
B Sodii bromidi 21
Tinct. lupulini '. 60
Spt chloroformi 7
Aqutt camphorse 60
50 Gin. or Svas.
c.cm. or fjij.
60 c.cm. or fSij,
c.cm. or fjij.
M. Sig.: Two teaapoonfuls in water every hour or two when nececuary.
The valeriate enjoys souie rupiitation for its iiil!ui*iHe over hysterica
manifestations, and may be given in capsules (0.32 to 1.30 Gm., or gr. v-xx'
or as an elixir* (not official): —
H Amnionii valeriatis 6!S0 dm. or jfr, c.
Elixir aurantii 240| ccm. or f3viij.
Aquce ammonii - .q. s. ad react, neut.
M. Sig.: Dose, u Uiblcrtpoonfui, wnU fliluU^d, in iien'ous attack*? of women.
Of the remaining salts little need be said. The phosphate is diuretic
and has been used in gout, which may be connected with deficient excretioi
of urea. The beuzoate, \vhere the urine is nllcaliue, as in cystitis, has advo
cates, as it is excreted as hippuric acid, and thus prevents phosphatic de
posits. The nitrate is only used to prepare nitrous-oxide gas, which it yield
by exposure to heat. The sulphate is used in making other salts. The iodidi
may be employed in syphilitic affections, where the other iodides are to<
depressing.
In the strength of 2 Gm. (or .^s) to 30 c.cm. (or f^j) of glycerin, am
monium iodide is recommended as an efficient local application to enlarge(
tonsils, being painted upon the glands once daily with a camers-hair brush
Ammonium borate, according to Professor Lashkevich, reduces expectora
tion and, at times, the pyrexia of pulmonHry tuberculosis.
Aqua nmmonire mny he admmiEtered by cautious inhalation, h'V'pnder
mically, or by the mouth, in shock, in chloroform-narcosis, in poisoning h
hydrocyanic acid or hydrogen eulphide, and also in heart-clot, thrombosis
and snake-poisoning. Where a prompt etfect is needed, the remedy shouh
be injected directly into a vein (O.fiO to 1.20 com., or mx-xx) diluted witl
sterilized water.
AMYGDALA AMARA (U. S. P., B. P.).-^Bitter Almond.
AMYGDALA DULCIS (U. S. P.. B. P.).— Sweet Almond.
The pharmacopoeias recognize two varieties of almond (Rosaceae): 1
Amygdala amara, the seed of Pnmus Amygdalus; variety, Amara. 2
'MMicfil BuUftin. July. 1890.
*Ib the National Fnrmiilnry the elixir of ammonium valerianate coninins vanill
•nd K littU rhtorofom) to onvpr the odor nnd taste of the 8«lt, of y^hich tfacre_j|r
present 0.13 Gm. (or gr, ij) to 4 c.cm. (or fSj). ^"
AMYGDALA.
197
Amj^AmIa dolcis, or sveet almond, which is the seed of Fnmus Amjgdaliis;
* ty, Dulcb.
PrepdraHona.
AmfwdaSm Amane (U. S. P.).— Oil of Bitt«r Almond. Dose, 0.015 to 0.06
UK. (« «V.-j>.
Aqttfr Amygdalje AmMre (U.S. P.).— Bitter-Almond Water. Doee, 15 o.cui. (or
Srrtt|Hu AmTgdalffi (U.S. P.). — Syrup of Almond, "Orgeat" Syrup (coutaiuing
hdk ***«?t and bitl^-r Hlinondsi. l>>Kt\ 7.5 to 15 com. (or f3ii-fSHs}.
Spiritus AmygdaUe Amarse (U.S. P.), Spirit of Bitter Almonds. Dose, 0.06 to
tJI c^cm. {ormi-xx).
Amygdale (U. S. P.).— Emulaton of Almond (sweet almonds). Dose,
U Is U c^cm. (or fSii-fSBs).
QlnnD Anygdalffi Expreeeum (U.S. P.). — Expressed Oil of Almond (either bitter
). Doee. 7.5 to 16 can. (or f3ii-Qss).
»
Uttgueatum Aqufl& Rosse (U.S. P., B. P.}. — Ointment of Rose-water ("Cold
Otofun Anijgdftle (B. P.). — Almond-oil (expressed from the Bitter or Sweet
*>.
Mistarm Araygdal« (B. P.). — Almond Mixture (compound powder of almonds,
9Gm.: distilled water, 160 c.cm.).
PtatriA Amygdalae Corapositua (B. P.)- — Compound Powder of Almonds (contains
flv«ft alncNida* 20 Gm. ; sugar, 10 Qm.; acacia, 2.5 Gm.).
nArmacology. — Both varieties of almond contain fixed oil and emul-
but only the bitter variety has also amygdalin. Hydrocyanic acid is
temcd wb€n amygdahn and emulsin react upon each other, and it is to
tbt acid thus formed that the sedative and antispasmodic effects of oil of
ktcer almond are due. Its toxic effects are also iaentical with hydrocyanic
wait uid call for the same treatment.
Therapy. — The volatile oil of bitter almond must not be confounded
axtfa the fixed oil obtained from either variety by expression, the latter being
a Ua&d application, especially in the form of ung. aqus rosse, to irritable
fkm or chapped hands or lips. In doses of 4 to 7.5 c.cm. (or foi-ij), it is laxa-
XXPtr and may be used as a substitute for olive-oil. The oil of bitter almond
kK been employed in emulsion as a local application in pruritus, and in-
InalJy for the same purposes as hydrocyanic-acid solution. The official
^nlnon i* made with sweet almonds, forms a soothing application, and may
ht combiDed according to these fonnulte: —
EoiiiIb. amyf*dalsB
Hianiuth. iiubnit. .
XhrnX'ti** iiMlidi
30
4
4
c.cm. or f5j.
Gm. or 3j.
Gm. or Sj.
Sig^t For local application to freckles and skin pigmentations.
B KiDula. amysdalce
7?'
Hjrdrars. chlor. corros.
301
SC »#.;
chloridi
Valuable in skin pigmentations.
20
25
% HyArmrg, chlor. corros
Emttla. amygdal«
Sig-t For rxtemal use in ocne rosacea.
|065 to 113
120
Gm.
c.cm.
Under t)io name r»f Bcsorbin, Leberaiann has introduced a mixture
iB aaid to be very readily absorbed by the skin. It is made by eraul-
poreat almond-oil vith distilled water, a small quantity of yellow
198
I'llAllMACEDTICAL TKEIUPELTIO A(JKNTS OK DRUGS.
wax, gelatin, and soap^ and is brought to an exact consistence by the addition
of a little lanolin. It is recommeDded us an excellent vehicle for active drugs
in medication of the skin, and may be used in ichthyosis, pityriasis, sclero-
derma, sclerema neonatorum, seborrhoeic eczema, prurigo, and scabies. Re-
sorbin will, it ia claimed, promote the absorption of mercury by the skin.
Bitter-alraond water is a good vehicle in which to administer narcotic
drugs. The syrup of almond may be appropriately added to cough-mixtures.
The emulsion of almond is an agreeable demulcent, and may very well be
employed as a vehicle of more active remedies.
Flour prepared from blanched sweet almonds is used in making bread,
cakes, and puddings for diabetic patienta. Almond-meal is used instead of
soap for the toilet, rendering the skin soft and smooth.
AMYUS NITKIS {V. 8. P., B. P.).— Amyl Nitrite. A liiiuid contain-
ing about »S(t ]K*r rent, of amyl {chiefly ipomnyl) nitrite^ wJicii rtt^saycd by
IT. S. P. pmeess. (Thero is alw) an flniyl nitrjili^; hut it never is ui;tHl inter-
nally.)
Dose, O.Oir. in n.32 c.cm. (or nt^/^-y), intomally; by inlitilation, 0.18 to
0,30 c.cm. (or miii-v).
Pharmacology, — A clear, pale-yellowish liquid, of an ethereal, fruity
odor, an aromatic taste, and a neutral or slightly-acid reaction. It is insolu-
ble in water, but soluble in alcohol, ether, and chloroform, in ail proportions.
It volatilizes at ordinary temperatures, and should be kept in a glass-stop-
pered bottle, or in small glass pearls, each containing 0.18 to 0.30 c.cm. (or
fniii-v). Vessels or tubes containing this fluid must be handled with care, as
it readily explodes at ordinary temperatures. It results from the reaction of
nitric acid upon amylic alcohol, and may be contaminated with nitric or
hydrocyanic acid.
Physiological Action. — No local effects are ascribed to this remedy, but
when taken internally, by the digestive tract, or by inhalation of its odor,
very remarkable phenomena are produced. There is at once observed a flush-
ing of the face, with fulness and throbbing of the temporal vessels, the
patient complaining of headache, fulness, and oppression, with giddiness
and confusion of ideas. The reflex excitability of the cord is diminished.
The brain is indirectly influenced, and its functions exalted by the temporary
congestion. The action of the heart becomes excessively rapid, with weaken-
ing of the pulse and marked lowering of arterial tension, owing to the gen-
eral enlargement of the vessels, due to action of the drug upon the muscular
coats of the arteries, and not to the nervmis system or vasomotor centres.
Larger do^*es oeciision fjiilinvrif eiinliac fiction, arrest tJikiii<r phu-e in diastole.
According to the investigations of the late Prof. Leech, of Manchester, the
nitrites affect especially the blood and muscles. They depress the nerve-
centres and nerves, but their action in this respect ia less marked. Amyl
nitrite diminishes oxidation, and the arterial and venous blood both become
of the same dark color. Respiration and temperature are both reduced.
Sugar appears in the urine after inhalation, probably as the result of in-
creased circulation in the liver. It increases the flow of urine, possibly, in
the same way, or because the liver-sugar may act as a diuretic. In poisoning
from amyl nitrite the blood assumes a characteristic chocolate color, due to
the formation of mcthaDmoglohin,
In some patients the nitrites excite gastric irritation and diarrhoea.
AMYUS XITKIS.
Leech regards these compounds as useful, unirritating diuretics.
kmjl lutrite is absorbed and eliminated with great rapidity.
Itenpy. — From a consideration of its physiological action Dr. Lauder
kmtOD was induced to recommend the use of amyl nitrite in the paroz-
fimof tngina pectoris, and clinical experience has shown the value of the
'f. Whether the relief be due to lowering of arterial tension, as Brunton
. or to the alleviation of the neuralgic condition, as claimed by John-
, it not very material, since by inhalation of a few drops of this remedy
p«tirat has complete control over the attacks. Dyspnoea due to other
I of cardiac disease and to pulmonary lesions is also relieved by admio-
ttation of this remedy. It is particularly adapted to symptoms dependent
I dtieMe of ihe mitral valve, but aortic incompetence, according to Pro-
I-iw^h, offers no objection to its use in small quantities when the
facs' - oppressed. In asthma, where the spasmodic element is strong,
iB\ •_ promptly affords amelioration,
Ulizmann recommended as an injection in chronic cystitis, where the
flovtion is catarrhal and has a bad odor: —
% AmjIU nitrilis .... 130 c.cm. or mv.
Ai|«w» «l#«*tilUt* 120| rem. or fjiv.
M. &9-t Tableepoonful in wgter Bufficient for a vesical injection.
Amrl nitrite can often be resorted to with benefit for aeasickness, espe-
daily in this formula^ given by Martindale: —
c.cm. or TOxvj.
c.c-m. or fSij.
B Aroyli* nitritiN . ]|
Akobolis 7|5
IGmv et Bild^: —
PdIv. tmgftcanthe 138 Gm. or
Jl4|iMB dc«tUUUe q. a. ad 120| ccm. or
T^ poirdered gum trBgitcanth should he in a dry four-ounce bottle, into which
I amyl aoloUon U poured, and the wat«r added gradually aftenvnrd. Shake welL
^ 4 to 73 ccnu (or f3iij).
ffT. vj.
ff« o*^;k,,^^t'^ tetanus, neuralgia, chloroform-narcosis, and in strychnine
nitrite has been tried with gratifying results; in whooping-
in it xias lailcd. Benefit results from its inhalation in neuralgic dysmen-
^ and it ie recommended by Dr. Winterbum for the relief of after-
CHis practice is to saturate a small piece of tissue-paper with 5 or 6
of the nitrite and place it in ^ tightly-corked 8 Gm. (or oij) vial, from
vbdi the patient can inhale when the pain is severe. Professor Benedikt
ttOHafB^nds a miiture of 5 parts of amyl nitrite with 10 parts of volatile oil
d firanrl, for the relief of angiospastic hemicrania. Five drops are to be
M9fd upon a handkerchief and cautiously inhaled. Amyl nitrite is bene-
loal m ini|?raine dependent upon local vasomotor spn^m.
In ADJ^mic epileptics, the inhalation, iniinediatfly bt^l'urc a lit. may
pnrrent tin: fit. The roinedy sliould n^tt Ik» given to plethoric cpi-
nor to elderly people with brittle arteries. It is particularly adapted
kTtkoae caaca of epilepsy in which an appreciable interval occurs between
a aura and convulsion. Dr. S. Weir Mitchell states that amyl nitrite may
-'fvantagrouidy employed as a means of diagnosis between undoubted p€til
<nd attacks simulating that disorder, but caused by temporary congea-
nerve-centres. In the latter class of cases amyl nitrite intensifies the
200 PHAKMACErnCAL THEHAPEUTIC AOENTS OB DBUGS.
paroxysm. Sir Crichton Brown has found this agent specially serviceable i]
the status epilepticus.
Inhalation of amyl nitrite is sen'iceable in stimulating the heart in th
event of sudden failure, which may occur in fatty heart or after haemorrhage
It has proved beneficial in intermittent coryza. In intermittent fever it wi)
ivert or suppress the chill, but is without influence upon the hot stage.
In the treatment of epidemic influenza, or grippe, where pneumonia oc
curred as a complication, Dr. S. Solis-Cohen* had successful results fror
the administration, iuttTiuilly, of '» drops of aniyl nitriie in alcohol, ever
three hours, associated with atropine sulphate, 0.0005 Gm. (or gr. Vuo), an*
strychnine sulphate, 0.003 Gm. (or gr. V2o)j every five hours; also, for a time
ammonium carbonate, 0.65 Gm. (or gr. x), every hour, at first, afterward a
longer intervals. Although recovery was delayed by infection with ery
sipelas, the patient made a good recovery.
In case of unpleasant, or serious, symptoms after the use of nitrite o
amyl, the cxhilntiun »>f aim^ionin by inhalation, hy the niotith, or intrs
venous injfctimi, and tlic hypndenriic injection of atrojiine or ether (ethyl
oxide) with cold water or ice-bag to the head, sinapism to the epigastri
region, a mustard foot-bath, at the same time keeping the patient in th
recumbent posture, will very soon be followed by relief.
AMYL VALERIANATE, Valerianate of Amyl, is an active prepara
tion, which is regarded as a valuable hypnotic and antispasmodic. It i
combined, according to Dr. W. F. Wade's formula, by taking 1 part of amy
valerianate to 19 of alcohol, to which is added amyl tfcctate in the propoi
tion of 0.0(i c.cra. (or mj) to 60 c.cm. (or f^ij). Dose, 0.37 to 0.5 c.cm
or mvi-viij). This dissolves cholesterin readily, and is considered bette
"in cases of gall-stone than either chloroform or ether.
Amyl valerianate relieves the pain of hepatic colic and prevents reciu
rences. It has been found of advantage in muscular rheumatism and i:
dysmenorrhcea. It is useful likewise in relieving hysterical manifestations
Amyl valerianate is a colorless liquid of pleasant taste.
AMYLENE HYDRAS.— Amylene hydrate is tertiary amylic alcoho
(dimethylethylcarbinol).
Pharmacology and Physiological Action. — It is n mobile, oolorles
liquid, with a camphor-like odor. It boils at 102.5° C. (216.5° F.), am
at 200** C. (392° F.) is decompoi^od into amylene and water. It forms com
pounds with chlorine, bromine, and with iodine. Oxidation converts i
into acetic acid and acetone. Miscible with alcohol in all proportions, ant
is soluble in eight parts of water.
Harmack and Meyer state that amylene hydrate at first excites, bu
afterward successively paralyzes, all the nerve-centres. It likewise de
presses the temperature. In medicinal doses, 3 to 4 c.cm. (or mxlv-foj)
it is said not to affect the respiration, the frequency of the pulse, or thi
action of the heart, but acts principally upon the cerebrum. In excossivi
doses it depresses the medulla and spinal cord, and causes death by respira
tory failure. According to the experiments of Peiser, amylene hydrat-
diminishes the waste of nitrogenous tissue. He therefore regards it ai
* Philadrlphia Hojipttal Rfport$, vol. i, 1890.
AyACAHDICM.
201
pptimlarty adapted to those cases in which an hypnotic is needed for
pralonged use, and in which decided nitrogenous waste occurs.
Ikcrapy. — It may be used as an antispasmodic in doses of 1 to 2 c.cra.
(««XT-ixs>. ^ven in capsules, in alcoholic solution (mixed with beer or
«iDe),or w.' :ious preparations. It has been used in insomnia and
TMBiin In I tions Dr. Hans Evonsen regards auiylene hydrate
WflBmevhat uneenaih, but finds it particularly useful in cerebral amemia.
It ha« b«en given also in delirium tremens, and in nocturnal epilepsy.
Jkaefa coincided with Wildermuth as to the efficacy of amylcne hydrate in
fctqaeat and severe attacks of epilepsy, especially where the bromides
lare failed. He thinks that pelii mat and nocturnal epilepsy are much
batfited by the drug. It has also been recommended for whooping-cough
■Dd to relieve the cough of phthisis. No dangerous after-effects have been
iibiiinJ from the use of this remedy.
AMTLTJM (I'. S. P., B. P.) —Starch.
Preparations.
Giywrvtam Amyli (U.S.P.).— Glycerite of Starch (10 per cent.). Local use.
GlyveriDaiD Amyli (B. P.). --Glycerin of StArch (about 12 per cent.).
_naimacology and Therapy. — The official (F, S. P.) starch is the
obtaiiiod from the fruit of Zea ^lays ((^iraniinese). The Brit-
>p«T'ift diretts that starch be procured from tlio grains of com-
■rheat. Tritimni sativum ; maize, Zea Mays; and rice, Orvxa sativa. It
- 5f. i"f»-.rfaDt olenient of food, and forms a large part of nee^ wheat, bar-
- lot, and ntlier commonly-used carbohydrates for administration
V tije i<u*K. Starchy food phould not be given to young infants, who have
s^fafBcirni saliva or intestinal juices to digest them, for they may undergo
Mtrrfartive changes in tlie bowel and cause colic and dinrrhcea. Starch
HI % fine, white powder, bec^»ming adhesive when moist, ami is a good appli-
fii6oo for hums or scalds, and for intertricro, or chafing in infants. With
WTrnff u nr.T tli" starcb-granulcs swell and burst and a homogeneous mass
• •ra very well as a poultice for alleviating local inflamma-
■ ■ is 0 useful application in some skin affections, thougli
imes proves iiTitant, on account of its affinity for water.
aurcU - Tit antidote to most corrosive poisons, when mixed with
for free iodine, as it turns blue when brought in contact
rtJ Starch-water is made by mixing up a tahlespoonful of
1 water to H smooth paste, to which a pint of boiling water
I aMMi, while stirring.
B Aii«* amyli 301 ^ c-cm. or fSj.
nUtDulhi cubnlt. 2| * Om. or 3m.
Ttoct. opti |30 to |60 c.cm. or mv vel x.
If. f*ig-- Injrot Into the bowel when necessary. I'w in diarrhcra after each
AJfACABDIirM.— Cashew-nut.
FluiniLacology and Therapy. — Anacardium occidentale (Terebin-
r) is a >:m«ll tree, indigenous to tropical America, and naturalized
parts of Africa. The nut is inclosed within two shells, between
lennUined an acrid, oily liquid, which turns black when in contact
20'i PIIAHMACKUTICAL THEUAPEUTIC .MJEXTS OR DRFOS.
with the air. The principal constituents of this fluid are Anacardic Acid,
a white, crystalline substance, and Cardol, a yellowiBh or reddish oil.
The juice, or oil, is an active local irritant, and has been employed
for the destruction of corns and warts, for the cure of obstinate ulcers, and
ringworm. It has also been used as a topical agent in the treatment ol
leprosy. The tubercles and a portion of skin surrounding theni are
painted with the oil, which is then rubbed into the akin. After a little
oozing a scab forms, and when it falls it is seen that the tubercle is dimin-
ished in size. The oil should not be applied to a surface of more than six
inches square. In young persons and upon parts where the integument ia
thin the oil gives rise to violent irritation.
AWETHI FEUCT¥S (B. P.).— Dill-fruit.
Preparations,
Oleum Anethi (B. P.).— The Oil distilled from Dill-fruit. Dose, 0.03 to 0.18 c.cm,
{or mas-iij).
Aqua Anethi (B. P.). — Dill-water. Distilled from the fruit. This ia a pleaannt
carminative and stimulant agent ordinarily employed to relieve flatulence or colic.
Dill-vrater is an agreeable vehicle which derives its value from the volatile oil.
Pharmacology and Therapy. — iHIl \i^ the thiutl ripe fruit of Auethnm
graveolun.-i {Fanf. rmht'liii'ura.^), n nutivy of Spain and tho south of France.
Tlie seeds, as the fruit is L'omuionly culled, have a stronp: iiromatic odor,
le?^ agreeable than fennol-swd, and a nioilenitdy jiiiugi'nt ta.str. The princi-
pal ttvnstitncnt is a jjakMellow. volalilo oil. having a liot. swt^ij'tish-acid taste.
Dill-fruit has the property common to all aromatics, but is rarely used
in this country. In flatulent colic of infants the oil can be given in doses
of 0.06 to 0.18 c.cm. (or mi-iij) on some sugar; the dose of the fruit to adults
is from 1 to 4 Gm. (or gr. xv-5j).
ANHALOMTTTM. — Tln» tlricd tops of .Viihnloniuni Tjcwinii (Cactact'a*).
Pharmacology. — Mrnoiil hntlons. "pollott',"' have lu^en used, in the
religious ceremonira of tlie Indian tribes t>f the Stiiithwest, as an intoxicant.
Prentice and Jlorgan,' who investigated the pliysiologicn! action, found
that three *T]utton8" were usually sufficient to produce churacteristic
effects. Among these are hallucinations of vision, color-phenomena pre-
dominating, hut with remarkable figures and forms. The mind was com-
paratively unimpaired, but the muscular system was much depressed. The
pupils were dilated. The heart-action was at first slower and stronger,
then rose to normal, and was never depressed. Tliere was a sense of full-
ness of the stomacli and occasionally nau.^^ea and vomiting. The ])assage of
time was unnotic<Ml,*nnd insomnia existed for twelve to twenty-four hours;
in thip respect, and in tlio ahs<Mice of exhilarating cluiracter from the visions,
a sharp contrast is offered to cannabis Indica. Similar results were re-
]>ortrd by Wi'ii' ^litrlirll. Sr\'or;iI vrrv toxic jilknloids liavc bi'i-ri isolated:
Anhalonine, or Fellotine; Mescaline; Anhalonidine; Lophophorine; also
a n'sinoiis suUstaiu-c. width appears to bc^ an im])ortnnt constituent. An-
halonine, in dvcidi'd ilosi-s, luts like strvchniuL' as a i-onvulsant and tetanJ2=
* Medical Rrroni, Aug. 22, ISOG.
A>'I>CAL EXTRACTS, 8ECKETI0XS, AND SEUlilS.
203
It in fmgs. In luau, small aiiiounts Hct like opiiiin, n^ a calinuut,
only weariness and ternporarv slcepleesacss, in dosee of 0.049 to
10 '.'jn-*/ !»)• Al'tor perfioual fxporieuc*' Dr. Havelock Ellis
Mi- iicuouiena of inoscal intoxication aiv mainly a saturnalia
I - -t^. and chiefly ^n or^' of vision. He believes with Dr.
U 1^ thortf is every likelihood that moseal will become popu-
JE. it ceruunly has a )tnii\i future before it with tliose who cultivate the
OM^nvdin^ dnigs. At the same time it is of no little interest to the
ifcwkJugMt and ]>fiychologiBt.
Aer^py. — The jniwdered buttons;, fluid extraet, and tinctures nm<le
kom them have been used in the treatment of various conditions dependent
^DQ oerroiis irritability, and with considerable success. In therapeutic
imm (flanl extraet w/^«-j, gradually inorea?od to mii-iij — or 0.0'>') to 0.20
LOL)* it doM not produce insomnia, but frequently removes its cause, and
Mcvuxlucrs t«» natural sleep; it has been of most use in sATuptomatic treat-
mekL ft3 in c&Bea of ner^-ous headache and cough, active delirium, mania,
|lf)MkoQdriasi&. and melancholia. It has also been used &< a respiratory
in pneumothorax and angina pectoris. It has been n:'Com-
as an adjuvant to digitalis when used ae a heart-tonic.
AJTEHAL EXTRACTS. SECEETIONS. AND SEKTTMS.
kEtermacology. — Various remedies of animal origin are now made use
ia tbrrapeutics. They contain certain complex organic compounds of
' afiac, phoaphoros^ nitrogen, etc.; in some instances products of bacterial
mmity < ptomaines, toxins, antitoxins, etc.), and in others some internal
«fvtioa of normal glands or organs, which have been ascertained by
si and observation to be available for the treatment of disease.
of extracts of organs, senune, and disease products. For in-
, the extract obtained from the sheep's testicle by M. Brown-S^quard,
[cBplojed by him and others for the relief of organic and functional
tfiaorders and certain constitutional diseases, owes its activity to and
under the lith' of H|><'rmin hydrochloride, the virtue of testicular
: hariog been shown to depend upon the presence of sp^rmin: a sub-
rhich is also contained in other glands, especially the pancreas.
Ihjaiolo^cal Action. — The injection into the human body of extracta
" from animal tissues may prove of service by modifying the consti-
ttiaa of the blood, or by supplying to it elements of which it stands in
aai. Il is conceivable that, when the functions of certain organs, espe-
■^ylhoae concerned in nutrition and sanguification, are suppressed, the
■ferivtiain of ii^^ corresponding serums, secretions, or extracts derived
Im healtby animals may prove beneficial. Acting upon this theory,
PMnaliiiiU representing muscular, nervous, cardiac, suprarenal, renal,
Wthrrosd substance have been employed in practical therapeutics. As
te4e manner of formation of antitoxins, A. C. O'SuUivan holds that the
VMctimoIatefi the cells of the body to produce the antitoxin, and that it
•»t the bloorl-cells, but the tissue-cells, that do so. When we come to
Mile what fb*? particular cells are which produce antitoxin, we are met
Vfrwtrr '-^''^ulties. Tetanus affords the most promising field for solv-
jf tliii n, because it is evident that tetanic poison acts directly
*lk(CC2il/ai iierv<*"* system. Wasserman has shown that an emulsion of
204
PHAHMACECTICAI. TlLJilUPEUTIC AGENTS Oft DfiUOS.
Ihe brain of an animal which is sensitive to tetanus has strong antitetan
properties, while if the animal has been poisoned by tetanus its brain los'
this power. Here we have a case of neutralization of antitoxin by toxi
and this, not in the serum, but in the brain-ceils themselves. Other e:
periments tend in the same direction, and we may say that in the case *
tetanus, at all events, the cells of the brain, which are those attacked I
the toxin, are also those which produce the antitoxin. It is easy to s<
that such a thing is extremely hard to prove or disprove in other diseas*
where no specific cells are especially attacked, and, of course, the vie
goes counter to all the work of Metclinikol! and his pupils ou the pr
tective action of the wandering cells of the body. As to the secor
question, how do the antitoxins act? the facts which have been establish*
are the following: 1. The toxin enters into chemical, or molecular, cor
bination with the cell-protoplasm, and when in this combination is ne
tralized: i.e., is innocuous for other cells. 2. The toxin enters into cher
ical combination with the antitoxin, and when in this combination is ne
tralized. 3. The antitoxin is produced by the cell, and is thrown off 1
the cell into the blood. 4. The cells which produce the antitoxin are tl
same cells as those which combine with the toxin. We are almost forci
to the conclusion that the element in the blood which proceeds from tl
cell and neutralizes the toxin in the blood is the same element whi*
neutralizes the toxin in the cell. And so Ave arrive at the first part
Ehrlich's hypothesis: "That element or group of atoms in the cell-prot
plasm which combines with the toxin when it is thrown of! by the c«
into the blood is the antitoxin." But we have seen that it is the acti<
of the toxin on the cell, and that only, which stimulates the coll to pT
duce the antitoxin; that is to say, when any of the combining groups
the cell-molecules are taken up by the toxin, they are replaced by the ce
and replaced in very much increased numbers, as usually happens in i
tissue-regeneration. Ehrlich supposes that these combining groups, whi
they become numerous, lose their hold on the cell-molecules and pass ov
into combination with the molecules of the fliiid in which the cell
bathed, and so get into the blood, and that the injection of a given qua
tity of toxin will stimulate the cells to produce many hundred equivaler
of antitoxin. But there is more than this, for toxin does not merely coi
bine with cell-protoplasm, it also destroys it. There is plenty of eviden
to show that the part of the toxin-molecule which poisons is not the sai
as that which first combines with the cell-molecule. The toxins of dip
theria and tetanus, when kept in the liquid state, gradually lose their t03
power down to a certain point, but tlu-y do not lose their power of coi
Dining with antitoxin. It takes exactly the same quantity of antitoxin
neutralize a given quantity of toxin, no matter how long it has been ke
or how weak it may have become. In Ehrlich*s terras, the haptopho
group in the toxin-molecule remains unaltered, while the toxophore gro"
is changetL Thus, the toxophore group is ranch leas stable and less rap
in combining tlian the other, and hence is probably much more comply
Many facts connected with ihe infectious diseasea receive a ready explar
tion by means of this hypothesis: e.g., what is a naturally-immune animt
A naturnlly-immune animal is one whose protoplasm-molecule contai
few or none of the groups capable of combining with the toxin in questic
Again, the incubation-period of a disease, which appears in poisoning
JiNlllJlL EXTRACTS, SECRETIOXS, AND SERUMS. 205
1 tfl well as by the living organism, is the time in which it takes the
group to get to work after the toxin has been anchored on the
le by it3 combining group. Again, it is found that the produc-
&■■ of immunity and of antitoxin, although the cause of both is the same,
i0 &DC at all run parallel to one another in amount. An animal in the
«trfj ftages of immunization may be hypersensitive to the poison while its
Mood it full of antitoxin; and, on the other hand, in the later stages ani-
tr« oft*n found to be practically completely immune, while their
' yields BO antitoxin at all.
Therapy. — 1. Organic Extracts. — A glycerin-extract of gray matter of
ip^s brain has been used by M. Constantin Paul with encouraging re-
[ in neurasthenia, locomotor ataxia, and senile debility. Dr. Dana has
" amendment in the same class of cases from the use of a glycerin
teaiD-«xtTmct, and instances particularly a case of rapidly-advancing bulbar
mky in which marked improvement was effected. Seven months after the
a^nming of the treatment no trace of the disease remained except slight
Ugoe idfter long conversation or mastication. In regard to some of the
vnatt is specially stated that the injection of water had been ineffectual,
a fxooi that the amendment was not due, a.s thought by some critics, to
am iiOggestion. Dr. Julius Althaus. of London, has also given favorable
tetinkODy concerning the effect of injections of nervous substance. The
ksiB-extract, which he terms Cerebrin-alpba (in order to distinguish it
firm thr alkaloid cerebrin obtained from brain-matter), was prepared by
Kxing 1 part, by weight, of rabbit's brain with 1 part of glycerin and a
CS-pcr-cent. carbolic solution. The extract of the cord is made in the
■Be manner and is called Myelin-alpha, to avoid confusion with the mye-
fc which ia one of the constituents of the central nerve-fibre. Dr. Althaus
had that the extracts were of no benefit when swallowed, as they were
inoaipo^ed by the gastric juice. When injected into the substance of
■aide they were active in the average dose of 0.30 c.cm. (or mv). Both
ipiBts aeemed of equal service in cerebral and spinal diseases. They were
loallcial in locomotor ataxia, progressive muscular dystrophy, and in
tfcosa maladies and conditions mainly characterized by loss of nerve-power.
b fa&ctional nervous disorders good results were obtained from the use
rf dieae extracts alone, but in organic affections they seemed to act chiefly
• •djuTanta to other treatment. They were useful also in promoting con-
nkjcrncc from acute diseases and in relieving the disabilities of old age.
Fvom hif ex]>erience. Dr. Althaus also dissents from the idea that the re-
■lt> ar« simply due to suggestion.
BaMa has employed an emulsion made by mixing normal brain and
ifiBal cord with broth in the proportion of 1 part of nerve-tissue to 5 of
Wotk. About 4 c.cm. (or f3j) of the mixture was injected and proved useful
M eaaea of epilepsy, melancholia, obstinate insomnia, chronic headache,
matica, and other disorders of the nervous system.
Socrmin hydrochlorate or hydrochloride, according to Professor Poehl
1^7 r, i« the active agent in the orchitic fluid in producing the
|k%-.j..L.';.,wil phenomena chronicled by 'SI. Brown-S^quard, in his cora-
aHaJcatinn in the French Academy. It is obtained from the testicular
|caa of tho lower animals hy n carefully-conducted process, which protects
^ nrodnct from contamination hy infectious micro-organisms and isolates
hfmfcallj pure, n* a salt of hydrochloric acid, S[>ennin is a cr^-stalline
i
206
l-JlAliMACEUTICAL TUEBAPErTlV vVliKNT.s OU PIirGS.
finb?tanco, snhiblc in wator nnd aUsnliite akoliol, Imt insoluble in ether.
jiUs()ri)s wnlvr and carbonic acid from the aToiosphorf. From experinien
u|if>ii rabbits, I>r. SidrkwclK nf IK^troit. declares that this agent prodiic
[towcrfnl niul prolon^'rd stiiniilation of the synipalhetic nervous systoi
iitost, strou;;ly iminirrsti'd tlin^u/^li tin- ^penrlatit• jdexus. It stiniuhiteH tJ
vasomotor eentri', iiirrca^os blond-[)n:'P8iire, and aids oxidation. In tox
doses it indiioeii dit^treasina: tetanie spasm and interferi^ with respiration 1
spasmodic fixation of rnustdoii, including the diaphra^im. Cutaneims hype
a^slliesia and increnr^ed inusculnr activity were t*bt;t'rved. Sexual erethifl
was marked in many instances. Hie liypodcnnic injection of an extra
from ilie recent tcstich^s of minnnials was found by Brown-Se<piard*
have a stiniuhitiii^'' cifoct u[>on nutrition, and to lie f>]»ecial!y active as
restorative in failing nutrition due to ohl agi-. Dr. H. P. L<x)niis, of Xc
York, found ttiat the injections, "as claimed, j>ro<luce nutritive modilicatio]
in the tissu<'s of elderly men, due, probably, to stimulation of the uerv
centres.*' In tuberculosis this substance has also been rocomuiendec;
^larked imjiroiement has lu^en reported as occurring in some cases of leproi
after the injintion of testicular fluid. In locnmotor ataxia ami varioi
forms of pjiralysis the same tn-ntmeul has bc^-n followed by auiendmen
Several luindred cases of Labes have been treated by tliis method by ditterei
obrJiTvers and in a very large projiortion llic symptoms nf {he disease we
unmistakably relieved. In hysteria, on the contrary, little or no good hj
resulted from the injections. They were also found inefficient in epileps;
In delirious epilepsy and in various forms of insanity the practice has bee
followed by improvement. In annemia, also, good results have been ol
tained. Brown-S6quard claimed that testicular fluid had been used wit
decided advantage in about 100 eases of cancer, in nearly ail of whic
cessation of pain and ha'morrhajre and cicatrization of ulcers demonstrate
the efficacy of the method which ho advocated. He also asserted that I
was cognizant of cases of disappearance of uterine fibromata and of morbi
deposits of connective tissue in the heart, arteries, and muscles. It
stated by those who have practiced this method that better results hav>
as a rule, been obtained in organic than in functional diseases. In chorei
however, Professors Oilier and Tessier and other writers have ^sntnosse
rapid improvement in consetjuence of these injections. Notable amelion
tion has, in a large number of cases of tuberculosis, followed the use <
these injections. Professor Poehl, of St. Petersburg, is of the opinion thf
the injection of spcrmin is of service in Asiatic cholera, particularly in th
early stage of the disease.
The injections of an extract were followed by relief in cases of ir
Bomnia, hypochondria, feeble heart, cardiac asthma, and f^pinal irritatioi
as reported by Dr. H, C. Brainerd, of Cleveland.
The most decided results from the use of animal tissues or extract
have been obsena^d following the administration of Thyroid preparation]
esfMH'ially in llic treatment of uiviedrma.'' This di-^case depends upo
' 8ee paper by the author on "The Case of Dr. Browii-S^uard," The Timea an
RegiMer, Nov. 30,^1880.
* See lecture by Dr. D. Uspenski, on "Brown-S^uard Fluid in Tuberculosis,** i
DeuUche medizinal-Ztitung, Dec. 29, 1890.
* See report of London Clinicfll Society, Lanctt, Feb. 4. 1893; uIm) the BrUi*
Mfdical Journal, Feb. 4, 1893.
INIMAL KXTIUCTS, SKCnETIUNN AND KfcUtrMb.
207
*Kiiiooa 01 the fiinctious of the thyroid gland. Dr. Murray, of New Castle,
^g*— *^, demonstrated that grafting of a healthy thyroid upon the body of
Ikt psbent or the injection of an extract made from the gland is foUowed
bf resmkable and rapid amelioration. Thyroid extract is made by cutting
tatfbad into thin slices, bruising, and adding about 4 c.cm. (or f5j) each of
I (Ijvena and sterilized water to each gland. After standing for twenty-four
was the fliiid, which is thick and of a dull-red color, is strained. The
fmnuiy of the extract thrown in is 1.55 c.cra. (or mxxv), and the operation
■ vppemted once or twice a week, according to the severity of the case and
Ac tate of improvement. At the end of a month or six weeks the condition
tai j^cnertlly been so signally benefited that the procedure can be practiced
at koger intervals. The extract is prepared by mincing the gland, freshly
tifcrn frcrm a healthy animal, maceration, and filtration under pressure. The
Bftpafstion and injection should be made with every antiseptic precaution.
^jWmuiKrous favorable cases, in all stages, which have been reported, leave
^^^■losa for doubt that in this method we have acquired an effective weapon
H^Bst a disease which had been unamenable to any other mode of treatment.
B^ It has been demonstrated by Dr. Hector Mackenzie, of London, and
■ Ilr. E- L. Fox, of PIvTiKiuth, that the administration of the th3Toid or a
l^fetno-itxtracc of the gland, by the mouth, is, perhaps, as efficacious as the
^JBCtioii. The gland may be given raw, finely chopped, seasoned, and added
U b«af*tea, or it may be lightly fried. Thorough cooking would probably
itim its virtue. It is not necessary that a large quantity of the remedy
Awilif be taken. Half a gland or, at most, one gland, or an equivalent
^matity of the extract, twice a week, is sufficient, and if a proper amount
ii ocavded vomiting and increased frequency of the pulse are produced.
Otinn ma^ be enjoined as regards the sudden resumption of physical
cnraae when improvement takes place. A sudden or excessive strain upon
aviaiened heart mav occasion syncope.
Sluidttlfle Thyroideas Siccae (U. S. P.).— I)isiiratt:*d Thyroid Glands.
TV.tr^.iiTi.iirn fciiccuni (B. p.). Dry Thyroid is **tlie clcaneil, drie<l. nnd pow-
»1 glands of the sheep (oris arir^), free from fat.'* Liquor Thy-
tvtdn \i*. i'-) is a liquid thai et)ntain!? the products of the fivsli antl ht*altliy
cUbaL in a 0.5-j»iT-rrnt. phenol solution witfi glycerin. The dose of the
|MV> " (<ir gr. j), gi\en in cai»iiuU% thrw times a day. to be grad-
to 1 <iiu. (or gr. XV). The ilost- of the litpiid Is O.Uo to 1
■.^),
^. > MvCohen has observed that thyroid extract has a very decided
power, and has employed it with satisfaction as a diuretic in a
-♦V, r.i, apparent disease of the thyroid gland. He speaks also of a
. uly in which the administration of the same remedy alle\iated
iiggests that it may be of service in a recent case by preventing
ireement of the pituiUiry body.
\utwerp,* has found that the continued administration of
- exerts a depressing effect upon the functions of the pelvic
axid a stimulating effect upon the lacteal glands; in every case
■BHmiiagia was cun.'d by them and menstruation became normal, while the
hetcal aecTftions were remarkably increased. He also recommends it for
^ea&^eative disturbances of the pelvic organs.
ttP
4
• ttuU. 4r VAcad. dr UHl. de Rrlgiqur
208
puak.maci:l:tjcal rmiitArKLTic AuJiMb on dkuos.
In some forms of amenorrhoea, especially of the congestive variety
th}Toid extract in small doses may be employed with asserted good results
At a recent meeting of the Liverpool Medical Institution Dr. Glynn relatei
that in young girls in whom temporary amenorrhoea, or a delay in men
struation in consequence of slight developmental changes occurred, th
administration of thyroid extract in doses of 0.03 Gm. (or gr. ss) at bed
time proved sufficient to re-establish or to institute the function of men
Btruation.
Byrom Bramwell and Arthur T. Davies have reported several cases o
stubborn psoriasis and eczema which were cured by thyroid feeding or th
use of tablets of thyroid extract. Bramwell was led to make use of this ageu
on account of its favorable effect upon the skin in myxoedema.
Bruce^ reports his obser\'ations with thyroid extract in twenty-thre
cases of insanity, including mania, general paralysis; puerperal, lactationa
climacteric, syphilitic, and alcoholic insanity; he founcl that, to obtai.
benefit from this treatment, it was necessarj' in some cases to give maasiv
doses (4 Gm., or gr. Ix, daily). Its administration is contra-indicated i
cases of mania where the excitement is acute, the loss of body-weight rapic
and danger of exhaustion from mahii^similation of food; but a course of th
lh\rijitl treatment led to ultimate rocovDry, where the recovery had been pn
tracted, or where a tendency to drift into ik^nientia existed, and especiall
in the insanity of the adolcecont, climacteric, and puerperal periods.
From an investigation of the chemical composition of the thyroid glanc
Dr. Frederick Gourlay states that it contains no ferment capable of dissoh
ing mucin, that the only proteid which can be obtained from it is a nuclec
albumin, and is inclined to believe that its usefulness in the treatment c
myxcedema is due to the presence of the nucleo-albumin. He asserts, alet
that the secretion of the gland does not consist of mucin. The dried an
powdered gland has also been employed under the name of Thyroidin. Th
powder is of a grayish-yellow color and a peculiar odor. It is thought to I
better tolerated than the gland. The virtues of an entire gland of mediui
size are said to be represented by 0.59 Gm. (or gr. ix) of the powder. Tb
efficacy of the gland does not seem to be lost by drying. The powder hi
been usually administered in the form of pills in daily doses of 0.10 to 0.2
Gm. (or gr. iss-ivss), which amount may be gradually doubled. Dr. Byroi
Bramwell has derived the same results from the use of this preparation s
from the gland itself or its extract.
Dr. J. D. Menzies, of the British navy, reports several cases in whic
thyroid tablets were of advantage in precocious malignant syphilis, specifi
medication being suspended. Dr. N. Yorke-Davies asserts that, in the trea*
ment of obesity, the use of these tablets is of great assistance.
According to experiments and extended clinical observations of Eorge
th}Toii1 extract, though ofton ptiieacions, is siWl not a suitable remedy for a
cases of obesity. The advantages claimed for tlie method an? that it effec'
positive results, and t]ds without in any way restricting the patient's diet c
his ordinary habits of life ns regards exorcise and occupation, — matters oftc
of gn-at importance in privnto practice; but certain wrll-murkcd subjectii
disturbances — snob ns iDilpitfltion, restlessness, tremor, and insomnia — ^
hand in hand with tlie nnprovementa, and give the individual more or lei
'Journal of Mmtal Science, No. xli, 1895.
AMMAL EXTRACTS, SECitETIONrf, AND SEUl'MS.
20J>
>
^< — '-t. Th}Toid tablets are sometimes used by patients without mecli-
i;i . anil commonly for the reduction of adipose. G. Carri^re (Nord
MtiUaUf, Lille, Xoromber 1, lHOo) has seen six cnse? of sudden angina,
ptmrm^ry n-(1i»mo, acute asystolia, from such unauthorized use of the reni-
edr. ' pioni* were violent and alarming, but the suppression of thy-
wmA r 'U banished tliem completely and permanently. Some fatal
ttiE» hate lie^n refMiried. The toxic etfects from this agent are grouped
taprtber omler the general title of Thyroidism. The principal contra-indica-
lioB i* \o lie found in constant, greatly-increased nitrogen excretion, an in-
A^ ' '^ ' _ , ill albuminous breaking-down, and which cannot be ter-
It Iv cutting off the drug, but continues for an indefinite
^^^^^ "' ^'"i' i»it<r its administration has hcvn stopped.
^m Thyreoglobulin constitutes about 10 per cent, of the gland (wet) and
*M»*«tn* the iodine constituent of the th}Toid in the original form it has
m the gland. According to Oswald/ thyreoglobulin was found to have the
tmme influence on the excretion of nitrogen in animals in metabohc equilib-
ham as ihe entire gland. His view is confirmed by its action in two cases
4f DTXc^ema. He obtained from thyreoglobulin a product resembling
^|iot}> -iipposed to be the bearer of the specific qualities of the gland),
Btt c z 14,3 instead of 9.3 per cent, of iodine.
Dr. Ciiarles Macalester, of Liverpoob used preparations of the Thymus
Slaad with advantage in cases of pseudohypertrophic paralysis and general
Itjinphsdenoma.
Mikulicz, in ten cases of goitre and one of Graves's disease, obtained
CBDonraging results from the use of thymus glands. He gave at one dose
^# or 15 Gm. (or oii '/Viv) of raw sheep's thymxLS, finely cut up and spread
^BoD tcmat. The ouantity was gradually increased to 25 Gm. (or oviss),
^^ 9'eplmn. n snliiie, glycerin extract of Uic cortical substance of the kid-
■rr, has H.-^n pr<']>'^>scd as a remedy in cases of nephritis. Subcutaneous in-
yrtinn^ *»f nephrin will, it is thought, prove of service in the treatment of
Br»tntB. M- Dieuhifoy has described the results of his experimental use of
■rplirin in an aggravated case of uraemia. The patient suffered with sup-
|ic«sckio ttf urine, anleuia of the lung, copious perspiration, and diarrhoea, an
alMui'lAiit*e of urea being contained in the excreted fluids. After injections
i4 orphrin. urine was again sei-reted^ sweating of urea ceas^^d, the mind
dcmr«<l. «nd the patient was able to ppeak. Furtlier clinical experiments
been made bv Teissier and Fraenkel. Tht^e observers found that the-
I
4
4
^
JBJcdinn "? n trhcerin-extract of sheep's kidney in patients suffering froiu
aiyhr '-d the j>owrr to excrete toxic sul^stancea in the urine. The
iDbj«i:' ., ed a sense of general amelioration. Albumin, at least in
carets di«^p[»eanHl from the urine during the days when the injections
ifivni- Th»'n:» was litth^ or no influence upon the quantity of urine-
.1.
Glaadnltt Snprarenalcs Siccse (F. S. P.), Dcsiccnted Sujirarcnnl
Gtexfet)*- ^f^' "th*' rlt'MMi'd. ilri*'d. and powdered suprarenal glands of the
rf>»rp ri)-*). i.r o\ (Bos tjiunijs). freed from fnt." This substance
\mk DC.:. :. ..nd to possess extraordinary astringent powers upon the smaller
Uood-veiveit, causing intense anemia when applied to the surface of mucous
tbranefl. The adrenal extract, owing to its convenience and activity, is
mrd, TTorA., 1899, xxxiil.
210
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
largelj used in order to produce bloodless operations in nasal surgery. Ex-
tensive operations upon the septum, or upon the turbinated bodies, are now
performed without hjemorrhage by means of a preliminary application of
a solution, which may be prepared as follows: —
B Olandul. suprarenalum sicca 4
Acid, boric 1
Cinnamon-water 15
Camphor- water (hot) 30
Distilled water (hot) q. a. ad 00;
Macerate for four hours, then filter.
Gm.
Gm.
com.
c.cm.
c.cm.
or 3j.
or ffr. xvj.
or f3iv.
or f5j.
or fjij.
Dr. E. A. Peters' has used a 10-per-cent. solution of the suprarenal
extract for the pain in carcinoma of the niamrase. stricture of the cesophagus,
tuberculosis of the larynx, and periodontitis. In none of these patients was
there any apparent delett*rious effects.
Suprarenal extract has also been used in Addison's disease, with grati-
fying results in some cases, beginning with 0.13 Gm. (or gr. ij) three times
a day and gradually increasing until 1.30 Gm. (or gr. xx) are taken daily,
extract, for the pain in cjircinoma of thv iiiamuwv, stricture of the oesopha-
gus, tuberculosis of tlio larynx, and periodontitis. In none of these patients
were there any apparent deleterious effects.
In 1901, Takumine and Aklrich, working independently, isolated the
active principle of tlie suprarenal ghind. Adrenalin (Ci(,IIi-XO„), which
occurs as a light, \\h\b\ inicrocrystallinc p<nv(lci\ of a slightly-bitterish
taste, leaving a numbed feeling on the spot of the tongue where it is applied.
The nanus Epinephrin uuA Suprarenin have been appliod to similar deriva-
tives, by Abel and vnu Fdortb. ExjiorinRnts shoAvcd tliat o drop of an
aqueous solution in the strength of 1 to ln.OOO l)lanchcd the normal con-
junctiva within thirty to sixty seconds. Dr. Emil Mayer- gives his results
with the use of this agent in thirty-five rhinologicol operations. He found
that an application of a 1 to 1000 solution produced blanching of the tis-
sues within a few secf>nds, the operation? b(*ing pitlicr bloodless or attended
with very little ha'morrhage, and in uo instance was there any constitutional
disturbance.
Dr. E. Fletcher Ingals' suggests that, if adrenalin is dissolved in a
normal salt solution, it lessens the pain and smarting. He has found that
a 1 to 5000 in normal salt solution acts with the same rapidity and in-
tensity as the solution made with 2 Gm. (or gr. xxx) of the desiccate"] gland
to 30 c.cm. (or fjj) of water. In acute coryza, acute Inryn^otraeJieitis. and
acute laryngitis this agent has promptly reduced the swelling and coiiges-
tioTiy and in a few days the patients weni well. In order to prevent fungous
formations in these solutions Dr. Tngals has suggested the following: 1
part of adrenalin to 5000 of liquid containing 0.50 Gm. (or gr. viij) of boric
acid, cinrnmon, and camphor-water, of each, 7.6 c.cm. (or foij); and dis-
tilled water. 15 c.cm. (or f,3ss).
Abel'* gave the name of Epinephrin to w bt>dy he isolated from ad-
renal extract, and to which he attributes the well-known effects on blood-
pressure of this substance. From the reactions of epinephrin it would seem
^TAtncri, March 2. ll>ni.
* PhiJndelphia Mrd\v<i\ Journal, April 27. 1001.
' Jounwi of the Amrrican J/crfi/yi/ Aaaodatloyi, April 27, IftOl.
*Z€it8chr. f. physiology. CAcmiV, xxviii. p. 318.
AXUCAL EXTIUCTH, SECRETIOXS, AND SERUMS.
211
^ Srloog lo the group of animal alkaloid?, and it is either identical with
•->«AUn, or is a derivative from it. It is obtained from aqueous extracts
si tt< ulnenald by the action of benzoyl-chloridej and from the benzoyl com-
i-jijijon thus formed Abel isolated the free base, and made a piorate, bisul-
fiatt. bjdrochlorate, and hydrobromate, as well as a triacet}*lnephrin and a
^^r " I'rnzin derivative. Its various decomposition reactions seem to
afr . Lnephrin a place among the pyrrol or skatol bases; treatment
»tUi -uiui^ alkalies forms a dark pigment, which the author denominates as
fpinrphrinic acid, and a base of coniin- or pyridin* like odor. On fusion
crti Tw>ta£einni; appreciable quantities of skatol result.
The free base cannot be produced except at the expense of its physio-
hpeai ^cacy. On the other hand, most of its salts react on the system
ftn eneceticallr; they have a slightly-bitter taste, cause a partial anses-
lifr- •' tongue, and produce a local vasoconstriction. When introduced
B3 rcnlation, small doses at first excite and then centrally depress
•BF] . heart-failure follows larger amounts. The insolubihty of the
jwoarauoc, however, which increases on keeping, unfortunately renders it
«fufla avail therapeutically than might otherwise be expected; since the
zic doae is far above that required to produce the physiological action.
.'•eiytiirin, the normal pigment principle of the urine, in part exhibits
cblUt properties to epinephrin, and the probability of a relationship be-
rvt^n the two bodies seems very great.
Extractmn Pancicatis. — Many cnses of diabetes are dependent upon or
•t ^:*5t a^sociattd with dLsoase of the pancreas. It has been demonstrated by
Sakonld and Ton Mering that removal of the pancreas causes glycosuria,
jpttpective of the nature of the diet. If, however, only a small proportion
«< Uk gland is left behind, diabetes does not develop. Furthermore, when
peees of the pancreas taken out of the abdominal cavity were grafted into
OM abdfsminal wall the advent of diabetes was prevented. Minkowski was
M to beliere that the pancreas performed some function indispensably
auMMmry to the normal transformation of sugar within the organism. Pro-
kmct Lupine has ingeniously argued that the pancreas generates a ferment
ajikh is necessary to assimilation of amylaceous foods. In view of these
fvCa and bvpotheses it was thought that the ingestion of the pancreas or
pnpantiona derived from that viscus might prove serviceable in the treat-
^mt of some forma of diabetes. Clinical experiments have been accord-
airik made in that direction and the results, which, unfortunately, fall far be-
)iv *TTi*-f ration, have been published by Mackenzie, Hale- White, Neville,
IT©. istini, and N. S. Davis (Jr.). The patients subjected to this
adhuu (iii^e generally experienced improvement of subjective symptoms,
od tooie hare gained in weight. The quantity of urine was not, as a rule,
in one case reported it was even increased. The specific gravity
were uninfluenced, and in most cases the amount of sugar was not
• ssened. In one case ingestion of raw pancreas was followed by
h«*ma. accompanied by fever. We may, nevertheless, agree with
,.»n of ifackenzie: "For myself I would rather find an improve-
■ ' general condition of the patient, increased strength, dimin-
and diminished quantity of urine as a result of treatment, than
Tc GMiiiniition of the amount of sugar in the urine without such im-
ient. - . » It is evident that liquor pancreaticus is no specific,
the effect* in these cases are encouraging enough to induce me to make
212
PHARMACEUTICAL THEEAPEtTIC AGENTS OR DRUGS.
further trial of it, and it is possible that in cases of true pancreatic diabetes
the benefit nii^ht be greater."
The United States Pharmacnpo^ia recognizes as official Pancreatinum :
a powder which consists of the enzymes naturally existing in the fresh
Eancreas of warm-blooded animals. The British Pharmacopoeia containa
iquop Pancreatis: a liquid containing the digestive principles of the fresh
pancreas of the pig. These preparations are used mostly as digestive agents,
especially in those disonses and conditions where starch and fat are imper-
fectly digested (see Pancreatinum) , As these preparations contain the active
principles of pancreas, and are more paliitable than the raw gland, they may
be administered in those cases of pancreatic diabetes where irritability of the
stomach is a prominent feature. Tlie injection of pancreatin into malignant ^
growths ha? been nTontly advoocated.
An extract prepared from the Parotid Gland has been used in doses of
0.13 to 0.32 Gm. (or gr. ii-v) in some nf the functional disorders of the pelvic
viscera, especially ovarian neuraliria, with gratifying results. Improvement
has also been noted in acromegaly after the use of an extract from the
Pituitary Gland; and preparations of Cardiac Tissue have been injected
hypodermically for the relief of weak heart.
Bone-marrow has been given with decided advantage in ansemia by
Dr. J. Dickson Mann, of Manchester, and Professor Fraser, of Edinburgh.
The pnrt which marrow performs in the development of red corpuscles allows
us to believe that in this substance we have gained a valuable remedy. Dr.
Mann thinks that, as the tisstie-forming power is more active in young than
in old animals, the bones of the former are preferable as a source of marrow-
extract. The extract which he employed was made from the heads of long
bones of animals freshly killed, together with other portions of bone which
contain red marrow. The bones are broken into small pieces and digested
in glycerin with fretjnent agitation. Several days are required to accomplish
complete extraction. The result, after filtration, is of a red or reddish-brown
color and has no unpleasant taste or odor. It may be given in leaspoonful
doses once or twice a day, either by itself or spread between thin slices of
bread. Dr. ilann gives the results of a case ef haemophilia in which extract
of bone-marrow was employed. A boy had been rt-peafedly treated for
attacks of hiemorrhage which had left him the subject of pronounced
aniemia. After a few weeks of treatment by bone-mnrrow a marked increase
in the number of red corpuscles had occurred and his face acquired a healthy
color. The same result was obtained in aniemia from other causes. Professor
Fraser's case was one of pernicious ana?mia, which had lasted for about four
months, when the patient entered the hospital. Treatment by means of iron
and arsenic, both alone and combined, was altogether ineffectual, and the
proportion of red globules and hnemoglobin steadily fell. After the admin-
istration of bone-marrow — which was given, uncooked, by the mouth —
improvement was almost immediate, the quality of the blood began to
change, and at the end of six months the man was practically in a normal
condition. Dr. W. G. Bigger has published the history of a case of letika?mia,
which was apparently cured by the use of bone-marrow, given raw, spread
upon thin slices of bread, and produced a remarkable improvement in the
symptoms of the disease. At the end of several months the boy was reported
as perfectly well and the ^;plcon of normal size.
2. Serums and Antiioxius, — Blood has been used as a restorative for
AMMATr EXTH.\CTS. SECBETIOKS, AKD SEBUUS.
213
is^
^jr^r T».ape, Ixith hy the stomach aud hy transfusion. Solares strongly
th > tJje serum from the lilood of bullocks as a nutritive agent in
?i- . especially in children. He considers it suiM?rior to inuscle-
^ ali»iiifi. It may be ^iveu by the mouth or the rectum. An
ifticA^: i of investigation relate?^ to the cmpLiyment of Blood-serum
A* m hit -il agent and to the modification of the blood by means of
iMTtrriiii pHniucts and llie production of iniuumiiy or cure. Tlie funda-
■mtal T<r:n. idc is the alteration of the scrum in such a manner as to ren-
«ler it ivo to certain specific bacterial products. This method of
nstmir n applied experimentally to several dHn>:enm8 infectious dis-
cviSw - vrjis one of the first mahulies to be thus studied, Behring
bftft COL ii»? of ex|}eriments vith a view of first rendering an animal
jmmvv by inoculntion with the toxin elabnrated by the bacillus
•f • ;iud, pccoudarily, utilizing the senmi of the immunized ani-
tt» :jvi» remedy for the established disease in another animal or
li man. iDununity is secured by successive injections with the toxin of
fl.f.»M« fn gradually-increasing doses. He believes that he has proved that
■li? of the immunized serum into the subjects of tetanus will cure
The quantity of the modified serum must bear a certain pro-
ihe ^>ody-weight ; so that much more is required for men than
.UMtiviU. Dr. Behring succeeded in preparing a standard serum
IQS antitoxin. The longer the stage of incubation and the more
lit tlie «»urse of the malady, the more favomble is the effect of the
t-fi'»ns- A number of ca?es in the human subject have l)eon reported in
• txfcvory appeared to be due to the employment of this method. The
,ijrT i...ii?i niv said to be in themselves harmless. In one of the successful
pVe^ the period of incubation was only six days. Dr. Joseph F. Hobson, of
^L reports the successful treatment of a case of tetanus, which de-
md the tenth day after a con»pound fracture of the til)ia. An injec-
t( l4*i i-.L-m. (or f3ii */J of the serum was given, and repeated at in-
_of four to feix hours for the next five or six days, when, owing to
ji*-ut, tliey were given with less regularity. Besides the serum,
"Tiydrale, 1 Gm. (or gr. xv). and hyoscine hydrobromide. 0.0006
(or ^. '/,cw)* were given every four hours; also morphine sulphate
' ■ '^', 0.016 Gm. (or gr. V*)* was given about four times daily
rkl was sh*epless or nervous. The local wound was not laid
(vd henlthy. Ue<*overy followed, the serum being dis-
wmi tenth day. These procedures and their results have not
Ittled to meet with adverse criticism, but in view of the inadequacy of for-
m^ T:.rhi-»t\s the path of inquir>' is certainly legitimate, and it is probable
tki: lead to an effectual means of combating a severe disease. The
aeX' —um is now also prepared in a dry state and sent out in tubes
•Ml :^' 4 or 5 Gm. (or 5i-i VJ: a quantity rather larger than the
■c -*rded as curative in the case of a man. The dose varies
Met'- verity of the symptoms, and is repeated for several days
a nB«ili!^r qtiaiiUJy, The dried serum is to be dissolved in distilled water
oi #obcutane^usly injected. Several cases of recover)' from tetanus of
csomatic origin have been reported, in which intracerebral injections of
etxtoxin » ere givt^n, in connection with other treatment. Roux and Bor-
from experiiuente at the Paris Pasteur Institute, demonstrated that the
toxin i< extracted from the blood and is fixed by the nerve-cells,
.
214
PHARlUCEUnCAL THERAPEUTIC AOBXTS OR DRUGS.
while the tetanic antitoxin, when injected into animals, remains in the
blood; so that the antidote does not come in contact with the poison, and
the two substances, though so near to each other, fail to meet. This ex-
plains why, in man as well as in animals, the subcutaneous and intravenous
injections so often fail, for when ihey are resorted to the nervous system, as
pointed out also by Dr. George G. Ranibaud, has already fixed a smaller or
greater quantity of the toxin, and while the antitoxin, thus administered,
neutralizes the toxin circulating in the blood and limits the poisoning, it
does not reach that which is attached to the cerebral or spinal cells. Of 45
tetanized guinea-pigs, treated with intracerebral injections, 35 recovered;
of 17 others, treated with simple subcutaneous injections, only 2 survived;
of 17 not treated with antitoxin at all, all died.
The technique of the operation in man is simple. After the removal
of a small button of bone by a trephine (V* inch), the intracerebral injec-
tion is made, into a neutral area, such as the forepart of the frontal lobes.
The quantity of the serum injected is small (5 to 6 c.cm. of a concentrated
serum made by drying 10 parts and thus redissolving in 5 parts) by the slow
introduction of which any undue compression is avoided. In addition to
the intracerebral injection, it is necessary to give antitoxin intravenously
or subcutaneously for a few days, so that thereby the toxin circulating in
the blood and nny that may later be secreted at the site of injury, may be
neutralized before it can affect 'the nervous centres. Out of 9 cases thus
treated, collected by Rambaud, 4 recovered and 5 died. Successful cases
have been likewise reported by Dr. Charles A. Church, of Passaic, N. J.;
Dr. E. Forgal, Montpellier, France; and Dr. Semple of the Army Medical
School at Netley, Enprland.^
Scrum Antidiphthericum (U. S. P.). — Diphtheria Antitoxin, This is
a fluid separated fmni the blood of a horse, Eqnus Cabnllu?, L, imnumizod
through the innrulatimi of di]>htherin toxin. It should be kept in sealed glass
eontainerfi, in n dnrk place, at temperatures between 4.5** and l-'»° C. (40"
and 59° F.)- Brhring onginally obtnined a curative serum from the blood
of sheep which had been rendered immune tn diphtheria. Thip senim has
been clinically employed by Heubner, Henoch, von Bergmann, Kossell, and
other observers ivith encouraping results.
Highly-satisfactory results are obtained from the official serum, which
is nmv universally made from horse-serum. Diphtheria antitoxin of good
quality is now manufaetured in this cnunlTV bv manv municipal lnl>orntorie9,
also by H. K. Mulfoid .*f Co., of Phihdelpliia ; Parke, Davis & Co., and Fred-
erick Steams &■ Co., of Detroit, and otheris.
The use of diphtheria antitoxin is not altotrether free from accident.
The injections may occasion erythema, urticaria, fever, swollen glands,
arthritis, hematuria, and albuminuria. They have also been thought to
favor an increased tendency to paralysis. Several deaths have been reported
directly following an injection of antitoxin. Owing to the precautions taken
at present in the manufacture, such accidents are now extremely rare. The
usual custom is to administer a maximum dose once daily flOOO to 1200
units), but Dr. John H. iNfusser advocates giving smaller dngea (500 units)
and repeating them every four or six hours, according to effect. Accumulat-
ing experience having shown the safety of this agent, larger doses are now
^British Medical Jounutl, Jan. 7, 18&0,
ANtUAL EXTlLiCTS, SKCRETIONS, A\D SEKUM9.
215
I
!. The ordinary dose given by some' is 2000 units, and thjg may
itA ererj' three hours in a severe case. Every care sliould be taken
fresh antitoxin and to sterihze thoroughly the hypoderiuic needle
nd plAc« of injection, which is usunlly in the hmibar region, or buttocks,
Off bKvfen the shoulder?, or under the skin of the abdominal wall. The giiid-
iag priDciple in tbe administration of the serum is that it must be given
ntil U»e characteristic effects are produced, namely: shriveling of the false
aonbrane, diminution in nasal discharge, correction of fetid odor, and gen-
«nl iniprruement in the condition of the patient.
Edwin I?o?*-»ntlmP hns taken much pains in obtaining statistical in-
fonn^rion respecting the mortality records in eases of diphtheria, and with
till? end has obtained reports from one hundred and fifty-seven cities, in
tike United States, having organized bureaus of health. A summary of the
reralts 13 as follows: —
I Number of cases previous to the senun period, 182,256, with a mor-
ItStj of 38.4 per cent. Number of cases since the antitoxin period, 132,548,
with A mortality of 14. G per cent. The latter were not all treated with
ieniiD; in computing those cases treated with the serum alone the mor-
UHtj was 9.8 per cent.
Jefferie Turner* records his experience of the treatment of diphtheria
*za the Children's Hospital, Brisbane, and compares the results obtained
liace tlie injection of antitoxin was begun in that institution with those
obirrred in the same hospital in the preantitoxin period, from July, 1889,
UBTTf 1895. As regards laryngeal cases, in the author's experience an
mortality of 59.2 per cent, for the preantitoxin period has been
icvd to an average mortality of 18.6 per cent, since the use of antitoxin.
g the same periods, whereas formerly only 8.4 per cent, of tlie laryu-
' fcsl CAMM recovered without operation, since the introduction of antitoxin
flB average of 38.4 per cent, have recovered without operation. As regards
•pention cases alone, whether intubation or tracheotomy^ or both, the aver-
^^K« mortalit}* of 65.7 per cent, for the preantitoxin period has been reduced
^m) an arrrage of 28.4 per cent, for the antitoxin period. The author states
^■^t ■ five years that have elapsed since the introduction of the use of
^^^3' the diminution in the hospital mortality of diphtheria has been
' Bof ' -rt of marvelous to all but a few who had mnde themselves ac-
Cith the thorough and uninipenchable experimental basis on which
new treatment had been based." He emphasizes the importance of its
aKr?v «'! ministration, and concludes that, with certain necessary qualifica-
tioT 39 the occasional difficulty of diagnosis during the early stages,
•do « t:ii'i "Ught to die of diphtheria."
Paenmonia Serum. — Prs. 0. and F. Kleinperor recommend a curative
snun for croupous pneumonia. Immunity in rabbits was produced by in-
|gtaon# of sali\a from pntients, a glycerin extract of pncunnxocci, and,
m^er certain conditions, bouillon-cultures. Immunized scrum acts with
m»Tt certainty when injected directly into the blood-current, and is believed
la Deutrahze the poisonous products of the pneumococci. These investigators
ode that "we have in the serum of immune rabbits, the poisonous
• .Vrtr York UrHionl Journal November U, 190.3.
f'Ut^iml /'rT«, ^iit in, jiMK>.
• tm4rrmatiirHal Mriical Jovnial of AmtralaHa, Bee. 20, ISMK
■
21 C
PHARMACEl'TICAL TUEKAPEl'TIC AOEXTtt OH DHL'GS.
action of which we are able to destroy, a specific against pnetimonia." The
action of tlie material was tried ia six patient? Buiferinsj vitli pneumonia,
and in every case there was a considerable reduction of temperature, pulse,
and respiration. The effect was manifested in from sis to twelve hours, and
in two cases the temperature remained normal, while in the remaining cases
it rose at the end of six hours. In several cases treated by other observers
an improvement followed the ui:e of this method. In other cases failure has
resulted. In one case of pneumonia following influenza, Fourriere derived
benefit from the injection of 11 c.cra. {or foiij) of goat's blood, the operation
being repeated four days later, the blood presumably acting by virtue of the
bactericidal 4uality of its serum.
An antipneumococcic serum now in the market 1;=^ <»btainLMl by injecting
living cultures of ihe pneuniococcus into the veins of a horse, and, when
immunity has become established, separatiu;.'; the seruin from the recently-
drawn blood of the animal, and, after the addition of a small amount of
preservative (tricresol), it is sealed up in small flasks. This remedy is used
by hypodermic injection (dose, 10 to 20 c.cm., or foii 'A-v) in cases of acute
croupous pneumonia. The results reported by Dr. James C. Wilson^ were
not very encouraging, affording a mortality of 23.2 per cent, against 20 per
cent, by other methods; hvjt this is jtmnounced a temjJting field for further
investigati'tii!^ in ^ii-runt-thenipy.
Similar experiments have been made, with excellent results, in the
treatment oi tjhtmirrs in the hort^e by means oni inHiumi/-ed s^runi, Mallcin,
but have not yet l»een extended to the human subject. JIalkin, as it is
called, is now employed principally fur diagnostic purpctses. but it should not
be used when the teaipetature is above nnrnuil, Beruheiui has made use
of tlie same jtrineiple in ihe treutmeut of mnre than !'>(» eases of tabereulosis
and a.sserts that ibo efTeet was benetieial, iiml stales that in thirty i^atients
the physical signs and synijjtnnis had sliown improvement fur five inunths.
Prophylactic and curative inoculations have been recently employed
against hjphoid fewr. Fraenkel and Mnnehot nbtained a sterilized liquid
from a culture of typhoid bacilli in bouillon, made from the thymus gland of
a calf. They employed it clinically upon fifty-seven cases of typhoid fever,
administering 0.5 c.cm. (or mviiss) of the sterilized fluid by deep injection
into the buttock, without unfavorable local or general effects. The next day
1 c.cm. (or 7/ixv) was similarly injected into the buttock of the other side.
In the majority of cases the second injection produced chilly sensations,
elevation of temperature, foHowed by a decided fall. The injections were
given every other day, with amelioration of symptoms and early deferves-
cence. Klem}>erer and I^vy suhseipjontly injected similar bouillon cidtures
of typhoid bacilli into dogs and obtained a blood-scrum capable of immuniz-
ing susceptible animals and of treating the disease, after infection.
In Sonth Africa this preventive antityphoid inoculation was carried on
in officers and men, during the siege of Ladysmith, of which Dr. A. E.
Wright- gives sf»nie statistics, in tabular forin. He states tliat wliilr it is at
this stage impossible to determine precisely that the inocidated were pro-
tected, yet the results would appear to be distinctly encouraging, inasmuch
as they show that the proportion, on the one hand, of attacks, and, on the
^Journal of the American Medical Asaocintiont Sept. 8, 1000.
^Brituih ^rcdiv^tl Journal, July 14, IIMIO.
AXIUAL EXTRACTS., SECHETIO.VS, AND SEfirilS-
*m 1 i
' liand, of deaths, from typhoid, was seven times smaller in the inocu-
lum m the uninoculated. Dr. A. Conan Doyle, in a letter from South
!•' xUv lir\(i»h JJftlical Journal, ivgvots that iuoculation for enteric
Dot nutde coinpuUory% and considers this a mistake, which will not
ftud in any suUequeut campaign, li it had been made compulsory,
nj vooW have escaped from most of its troubles. The strong im-
;rsioq, hii n experience, is "that, although it is by no means an
alsdnUf f: • , it certainly modifies the course of the disease vt-ry
Ci^.— ... J.- another infection which it is sought to control by injection
' laeeuution with products derived from the cholera bacillus. Professor
; has separated from cultures a material which he terms anticholerin:
' a ckar, brownigh-yellow viscid liquid, which has been purified by removal
if products deleterious to the animal organism. Anticholerin has no toxic
act upon man, but is thought to antidote the virus of cholera. A trial
m a Bainbiii:g hospital, limited to serious cases, is said to have given
ine rfsuils.
M. •-' has devised a method of vaccination with matter derived
- r.. ( oiuires of cholera bacilli, and is now engaged in prosecuting
- ' -t^ on a large scale in India, with what bentfit remains yet to be
Ihe theory is now advanced that the bactericidal power of blood-
resides in the nuclein, the reproductive element of blood-cells, and
ast the Duclein contained in immunized serum acts by stimulating the
of sanguification. In response to this stimulation a fresh supply of
tin is given to the blood.
Ifi ttjiJtilig the soruui of the lamb and of the ox has been injected
1 subjects, in a uunil>er of cases, by Italian clinicians, and the
' tlie malady have undergone decided improvement. The
■yed was about 6 c.cm. (or foiss), thrown, upon alternate
;o the subcutaneous tissue of each buttock. S'o other medica-
'-^ in these experimental cases. Cotterell made use of dog's
;ii.e5 of recent syphilis. The rash and other manifestations
,.^ --- , i ared under the inliuence of the injection. • Some observers
tbougbt that improvement followed the injection of dog's serum in
inr tuberculosis and neurasthenia. The serum of the dog was
qpaiunentally employed by Tommasoli in three cases of lupus. The
•aikfid, however, proved of doubtful utility. Though the lesions were
iiwirablj iDodifi«'d» especially in one case, the disease took on fresh activity
ii ihe end ' 'ith. The subject deserves continued investigation. It
t^',.iS%:» : blood of animals insusceptible to syphilis may have an
aKi - action (o the virus of that disease.
rt upon the pronerties and uses of Nuclein has been made by
- \% It i« f»blnine(i from the nuclei of vejretable colls, the pulp of
" '* vi^lk of egg. It is distinguished from other albumins or
presence of phosphoric acid. Nuclein is a colorless or yel-
' '•■ in water and alcohol, but soluble, after I6ng boiling,
ng and in water. It is given in the daily dose of
xx-xh ), and causes n considerable increase in the nuuiber
Presumably for this reason it is etTicacious in pleurisy,
ot her infectious diseases. Nuclein i? thought to be possessed
-ji»»^i.K. y.i\ue in latent tuberculosis, producing a transient fever, with
218
PHARilACEUTICAL THERAPEUTIC AGENTS OR DRCGS.
congestion of the apices. The action of nuclein upon micro-organisms hi
been studied by Dr. Victor C. Vaughan, who, by its use, succeeded in curin
guinea-pigs sufftTiiig with tulierciiloi^iB prodiKied by inocuhitiou. This ii
TGstigator also states that the injection of nuclein into guinea-pigs rendei
them immune to pneumonia. The same method of therapy has Ijeen applie
to tuberculosis in tlie hiuuan *iul»jovt, wilh very eucouragiug res^ults.
Adamkiewicz has endeavored to arrest the progress of carcinoma h
iujectiou of a substance which he calls Cancroin and which is a product <
the living cancer-cell. In respect to chemical composition, cancroin !
identical with or closely related to neurin. As prepared, cancroin is a
aqueous solution of neurin, to which carbolic and citric acids have bee
added. Blood-serum or toxins from horses inoculated with erysipelas ha^
lately been used by parenoliyinatous injection in caroinonifi. "The meag(
reports are conflicting. A scrum antidotal to streptococcic infection ht
been administered subeutaneously by Roger, with reported favorable result
in several cases of puerperal fever, erysipelas, and suppurative tonsilliti
Anti-streptococcic serum brought out hy Mamiorek as a remedy for scarh
and suppurating diseases has been used by Baginsky in scarlatina, who foun
that it is not a specific in the sense that antitoxin is against diphtherii
Louis Fischer has reported unfavorable esperiences with this agent.
Sarcoma has been successfully trentecT by Coley, of Xcw York, Uy a
original method. The folIowin*r ore his directions for use of the combine
toxic products of erysipelas and prodigiosus: Inject dose every day into th
tumor, or in its neighborhood if inaccessible, aiming to get a rise of tem
perature to 103* to 104° F. Begin with 0.03 c.cm. (or mss) and increas
dose as required. If the patient shows little or no reaction, the dose can b
increased beyond 0.5 c.cm. (or w^viij) without danger. If too great depres
sion follows the injections, they may be given at longer intervals: two day
or more. Shake the bottle before using, and keep well stoppered in a coo
dark place, — on ice is best. The needle of the hypodermic syringe shouL
be passed through an alcohol-flame before and after using. After removin
stopper place sterilized needle of the hypodermic syringe into the bottle ani
withdraw enough, or a little more than enough, for the required dose, an-
quickly close the bottle. For first few doses, up to O.IS or 0.34 c.cm, (or mi:
or iv); dilute with boiled water.
Antivcncne is a curative serum obtained from a horse which has bee]
immunized against snake-venom. According to Dr. Joseph SIcFarland, i
is a very efficient antidote against the poison of venomous snakes. In th
Infernational Medical Magatintf September, 1900, he gives the results o
experiments upon animals, and demonstrates the protective value of anti
venene. The following is the treatment to be pursued when a patient ha
been bitten by a poisonous snake: 1. Immediately stop the circulation i]
the bitten part of the body, so as to prevent absorption of the poison. %
Incise and enlarge the fang-wound and extract the poison by suctioi
(preferably by a cupping-glass, or with the mouth, if the mucous membrani
of lips is sound). 3. Inject hypodermically 0.18 to 0.37 c.cm. (or miii-vj) o:
a fresh lO-per-cent. aqueous solution of calcium chloride into about a dozei
places around the wound. 4. Give strychnine hypodermically to stimulah
the respiratory centre. Whisky should not be given at all, or only in ver]
i small doses, because an excess of alcohol still further depresses the hear
already depressed by the venom. 5. Immediately inject 10 to 20 c.cm. (o)
ANI8DM. 219
5ii */,-v88) of antivenomous senim, and repeat the injection frequently, Mc-
Farland advises people living or going into regions where there is danger of
snake-bites to carry a bottle of antivenomous serum with them. He pro*
Bounces permanganate-of-potassium injections of little value. Dr. Louis de
Plasse, of New York, claims to have demonstrated the curative eflEects for
Calmette's Antivenene in rattlesnake-bite.
AHIOPOL. — M. Sedan, of Marseilles, has recently introduced an anti-
fennent under this name, for which he claims remarkable power as a safe and
always reliable antiseptic and an excellent deodorizer, even the most fetid
cancerous or gangrenous wounds becoming odorless. This new product is a
solution of trimethanal. In a solution of 1 to 100 it destroys, within five
minutes, nearly all microbes; in the streiigth of 1 to 10,000 or even 1 to
20,000 it sterilizes any culture whatever. The exact bactericidal proportion
has been fixed by M. M^rieux, director of the Pasteur Institute at Lyons, at
1 to 5600; but numerous experiments prove that the tubercle bacilli, con-
tained in saliva, are destroyed in six hours by a solution of 1 to 500, which
is a very satisfactory result.
It is necessary to understand the action of the strength solution used;
doses that are too strong will sterilize a wound, but will dry it and prevent
cicatrizing. A moderate dose, 1-4000 to 1-3600, on the contrary, favors
healing. For the nostrils or mouth, a solution at 1 to 15,000, at the least,
and 1 to 3000, at the strongest, produce complete disinfection. For dis-
infecting the hands and surgical instruments, a proportion of 1 to 2000 gen-
erally suJSces.
ANISI7H (TJ. S. P.).— Anise.
ABISI FETJCTU8 (B. P.).— Anise-fruit.
Dose, 0.60 to 1.30 Gm. (or gr. x-xx).
Preparations*
Oleum AnUi (U.S. P., 6. P.). —Oil of Anise. Dose, 0.30 to 0.60 c.cm. (or mv-z).
Aqua Anifti (U.S. P., B. P.). —Anise-water (oil, 2 parts per 1000). B.P., dis-
tiOcd from fruit.
SpirituB Anisi (U. S. P., B. P.). — Spirit of Anise (10 per cent.). Dose, 4 to 7J(
tan. (or f3i-ij). B. P., 0.30 to 1.20 c.cm. (or mv-xx).
Anise also enters into the U. S. P. official spiritus aurantii composltus, elixir
tromaticus, and tinctura opii camphorata.
Anise, or sweet cumin, is the dried, ripe fruit of the Pimpinella anisum
(Tmbelliferse). The physiological effects are due to its volatile oil, which
is also found in star-anise (Illicium verum). It is carminative, and, having
tn agreeahle odor and taste, is much used, in sweetened infusion, in treating
flatulent colic in infants. Anise may be used in the form of hot, sweetened
infusion ; or given combined with other agents, as in the following : —
9 Magnesii carb 2 60 Gm. or gr. xl.
Spt. chloroform! 30 c.cm. or mv.
Syrup. simpUcis 7 6 ccm. or fSij.
Aqua anisi q. s. ad 30 ccm. or f^ij.
U. Sig.: A teaspoonful, for a child under one year, eveiy hour.
In bronchial catarrh, anise is expectorant and sUghtly sedative, and is
therefore used in cough-mixtures. It has likewise been regarded as possess-
ing the power to stimulate the secretion of milk, but without much ground.
2'H\
PH.'^RMACErTICAt THERAPEUTIC AGEXTS OR DRD66.
ANTHEMIS (U. S. P.).^Chamomile.
AUTHEMIDIS ILOEES (B. P.).— Chamomile-flowers.
Dose, 0.13 to 0.50 Gm
0.03 to 0.18 c.cm. (oi
Preparations.
Extractum AnthemidiB (B. P.). — Extract of Chamomile,
(or gr. ii-viij).
Oleum Anthemidis (B. P.). — OH of Chamomile. Dose,
wiss-iij).
The tlricfl flawcr-Jieade of Anthemis nobilis (Camposita?) collects
from rnltivated plants. Tlie Briti?li Pliarmacnpfpia n'(]iiire.c thnt the flower
gluiiiltl bf e\])an(le(l before iieiiig cuiltrteih 'J1ie oil hns a ]>">\vrrful lowerinj
Gction upon the reflex excitability of the sitiiinl cord. The hot iiifa.^ion act:
ns an emetic when freely used. lu smidler ciuantity it i!= aromatic ftud car
luiriativct and farors perspinitinn and the action of the kidneys. It check;
reflex cough. A very good eombination after a severe cold, iu simple ferer
and often in acute* rhcnmatism, is prepared In* pouring 473 e.em. (or 1 pint]
of boiling wnter over *n Gm. (or ,^ j ) each of chanioinile-flower<i! and tht
leaves and flowering tops of boneriet. T]\e patient should drink about one
Imlf, hot^ on retiring, as a diaphoretic, or the entire pint, should emesis b*
desired. A very excellent preseripiiou for flatulence, and esi^ecially flatu
lent colic in children, is : —
Infus. anthemidis,
Mist. BodsB menth aa 90| c.cm. or fSiij*
Sig.: From one-half to two tables poonfuU when necessary.
I
Locally, a chamomile cataplasm may be used when heat and moisture
with some sedative action, are desired. The recent infusion is employee
either hot or cold in domestic practice, in the treatment of colds, bronchitis
and intestinal disordergj or dyspepsia. The oil has been proposed as an anti-
dote in strychnine poisoning, and is useful in spasmodic asthma. The oil
of chamomile^ on account of its sedative action, is a very good addition tc
fatty preparations for various inflammations of the skin. Used in the oint
ments named, it will prove of value: — ^
IJ 01. nnthemidis (30 to |60 c.cm. or mv vel x.
Bismuth, subnit 4] Gm. or 3j.
Ungt. zinci oxidi 3l| Gm. or 5j.
M. Sig. : Apply well over the surface for er}-Bipcla8, acute eczema, and erythema
B 01. anthemidis |37 to
Hydrarg. chlor. mitis
01. eucalypti
Adipirt lano! Jiydrosi 31
M. Sig.: Use upon old muslin, and apply to the surface in infantile eczema and
in f'^borrhoea.
ANTHRAROBIinJM. — Anthrarobin is a yellowish powder, not solubk
in acids or water, but soluble in alkalies, glycerin, and alcohoL Anthrarobin
is related to chrj'sarobin, for which it is a useful substitute as an application
in skin diseases. It produces less irritation and staining than chrysarobinj
and is said to have no toxic effects. Autharobin is excreted, for the most
part, by the urine unchanged, though some of it is oxidized to form alizarin.
It colors the skin yellow and the hair red. In psoriasis, tinea versicolor, and
75 c.cm
65 Om.
30 c.cm. or mv.
Gm. or 5j.
or wivi vel xilj
or gr. X. .
AXTIMON'ICM. ^^^^^^ 221
! in lO-per-cent. ointment or alcoholic solution, which should
bcflMd'. -. least every week.
Aiit:.rj.r^!im can be prescribed thus, with advantage: —
B AntiLrarobini 4| Gm. or 3j.
Cb^ hydmrg. nitratis .*.•,..-. (2 Gni. Or 3>*3.
Unyt. cinci oxidi 31 1 Gm. or Jj . — M.
fW ckronic erxema and psoriasis.
B Antkrarobiiii 4| Gm. or 3j.
ITagt. hjdnrg. oleatia (10 per cent) 31| Gm. or 5j-— M.
Cw ia tinea vtrsicolor, as well as in ringwonn and favua.
HydTOxylamin Hydrochloride (XH.OHHCl), a substance allied to
wtkrarDlttQ and rhr^-yintljin. (Kcin'* in the fonu of colorU^s, hygixn-coplc
tTTttaU. ' ■ in water, alcohol, and glycerin. It has tlie advantatre of not
<nfiiny ii. bat is hitrbly irritant aud is capable of producing toxaemia.
It hm htyiu ii-^^l in psoria?i^, Iu]>u8, scnbieH, and vegetable parasitic diseased.
ffrdnflfyLftmin hydrtx-hloride should not be applied, to begin with, in greater
^rmfftb than V'|„ of I per cent, dipsolved in equal parts of alcohol and
riwrin. The proportion may be gradually increased within the limits of
iVfaDee. Thi? componnd is not adapted to internal use. It is employed
dirtily m photography a? a developer.
MWUMOimrM.. — Antimony.
U. S. p. Preparations.
AvUfDomi et Potassii Tartras. — Antimony and Potassium Tartrate, Tartar
Do*«, 0.001 ti to 0,0115 Gm. lor gr. Wj).
TIansn Anliinotiii. — Antimonial Wine (contains about 4 Gm. tartar emetic to
*-i inno crm., '»r 0.13 *^;»i., ur gr. ij. in each 30 c.cm.. or fjj). Dose, 0.12 to 2 c.cm.
■. \xy, «« an expootornnt, or 4 to S c.cm. (3i-ij| as an emetic for adults.
TAT rtneiic also enters into syrupus ^iUte compositus (U.S. P.). Mistura
^frjrrhixm compoMtA (U.S. P.), or brown mixture, contains antimonial wine, 6
VVU iji It"*, «»r ot tJirtnr emelir. iibout U.OOS Gm. in 30 c.cm. (or gr. '/, por ounce).
B. P. Preparations.
AaUtKKiniuni Tartarntum. — Tartarated Antimony, Tartar Emetic. Dose, as »
O.0027 to 0.008 Gm. (or ^. Vj*-V,) ; as an emetic, 0.005 to 0.13 Gm.
p. i-ii).
Amtiasunii 0\iduin — Anlimonious Oxide. Dose, 0.000 lo 0.13 Gm. (or gr. i-ij).
AaUmomii Nigrum Parificatuia. — Antimonious Sulphide (for pharmaceutical
>.
JUitiiitonram Sulpfauratum. — Sulphurated Antimonv (• mixture containing anti-
■^M«« «iil|>liiiU* nml oxide, nntimonic sulphide and oxide, and sulphur). Dose, O.0tl5
to4U Cm. <or er. i -ii*.
Pa|« 1- -li-*. — Antimonial Powder. I\»'*c. 0.20 to 0..38 Gm. (or gr. iii-vj).
ron2_i i Sutx-hloridi CompoMta. — Compound Pill of Mennirous Chlo-
Viaazn .-iiitiii-.titrtle. — Antimonial Wine. Dose, O.rtO to 2 com, (or mx-xxx) ;
1^ P1«mSDcr*« Pill. Dose, 0:25 to O.&O Gm. (or gr. iv-viij).
i«-. 4 to K r.cm. (or fSi-ij) to adulLs.
ST
Pltarroacolo^v — Antimoninm and potassium tartrate, or tartarated an-
' \n/\, 4- 11.0). iB in colorless, transparent rngtals,
_ v.. ...lin not li/?* tliJin 99.5 per cent, of pure antinionium and
nm utrtnit-*, nnd should bo kept in well-ptoppcred bottles** (U. S. P.).
n - ^rful irritant, and, applied to tlie mucous membranes,
\ n. To the «kin it gives a sensation of burning, with
foiluwed by a pustular eruption, resembling small-pox, aud deep
I
222
PHAHMACEL'TICAL THERAPECTIC AGENTS OU DRUGS.
ulcers, whidi are slow* in healing. When swallowed, it is a depressing eraetie
also causing an increase of the secretions of the intestinal tract, with occa*
sional diarrha?a. It has a powerful diaphoretic action, and is elin\inflted bj
the bile, milk, sweat, urine, and the intestinal secretions. Upon the circula*
tion it is depressing; under its influence the heart's action becomes weal
and irre^ilar. and the arterial tension is lowered. The pulsations are like-
wise retarded. The depression of the vasomotor system i^ both centric and
peripheral. Respiration het-nrnt^ slower and the bronchial sfxretiona art
increased. The brain is not directly affected, except that under certain con-
ditions tartar emetic exerts a sedative action, esjieeially when combinec
with opium. Large doses diminish reflex excitability of the spinal cord
and may produce both motor and sensor paralysis. A special action hai
been noticed ujxm the liver, the waste of nitrogenous elements being in-
creased, with diminished oxidation of the non-nitrogenous elements. Ex-
cessive doses have a toxic eifect upon motor nerves and muscles. The rate
of absorption from the stomach and intestines is slow, and the rate ol
elimination liv all the cliannels of excretion is also slow.
Toxicology. — PoisonouB doses of tartar emetic (0.065 Gm., or gr. j,
or more), cause vomiting, with burning pain at the epigastrium, severe
colic, purging, and email, frequent pulse and early collapse, with much pros-
tration of muscular system, rapidly occur. Kespiration is shallow, and, aa
in cholera, the patient suffers from cramping pain in the calves of the legs.
In some cases furious delirium has occurred. Death is usually preceded bj
stupor or convulsions. Toward the close of the ease the urine may become
bloody and scanty or may be suppressed. In some instances vomitin? is ab-
sent and there is profound nervous prostration. Repeated small doses ol
tartar emetic may occasion a chronic intoxication, evidenced by nausea^
purgation, a small, frequent pulse^ and, fmally, death from exhaustion. In
this class of cases suspicion should be aroused that the drug has been admin-
istered for criminal purposes. Absorption and elimination are rapid. The
drug is eliminated by the mucous membrane of the stomach and bowels, but
especially by the kidney. Death may result from exhaustion, or from re-
sulting gastro-intestinal inflammation. The antidote is tannic acid, which
renders the salt insoluble, to be followed by demulcents and anodynes to
relieve the pain. Depression is counteracted by alcohol and digitalis. Tartar
emetic is incompatible with acids, alkalies, and drugs containing tannic acid.
Infusions of coffee and tea are, therefore, both physiological and chemical
antidotes to tartar emetic, and may be used to irrigate the stomach. The
body shoukl be kept warm by hot-water bnjrj=, and cardiac and respiratory
stimulants given rather freely. Chmaic poisoning pniduces constant nausea
and entire anorexia, with subnormal temperature, moist, clammy skin,
diarrhcpa. and, finally, death from exhaustion.
Therapy, — Tartar-emetic ointment is a powerfid counter-irritant, but
is seldom used on account of the datiger of producing sloughing and scars.
The treatment of inflammation by tartar emetic in large doses has been
abandoned, but fractional doses (0.0016 Gm., or gr. V40) alone or in combina-
tion with Dover's powder (0.13 Gm., or gr. ij) and nitre fO.^O Gm., or gr,
iij) have proved very servicable in sthenic pneumonia and in pleurisy. In
bronchial inflammation with deflcient secretion the wine of antimony, or
compound syrup of squills, is frequently given. Dr. I. G. Davis writes with
approval of the action of the golden sulphuret of antimony in chronic bron-
ANTIXERVIX.
223
He admini^ere it in doses of 0.0012 to 0.002 Gm. (or gr. Vjo-Vso)
ox:wntr*l vith sngar of milk.
IT emetic should not be given in croup (especially diphtheritic), as
' depressing. For broncliitis in children. Ringer advises a solution
I Gm. (or gr. j) to 473 c.cm. (or Oj) of water, of which a teaspoonful is
kfrren every quarter- or half- hour. Tartar emetic should rarely, if ever,
E adai&LStered to infants or very young children.
Smmil doees of tartar emetic have also been recommended in orchitis,
tonsillitis, parotiditis, muscular rheumatism, and spasmodic
A combination of tartar emetic and opium is very serviceable in
delirium which attends some cases of typhoid and typhus fevers,
condition in delirium tremens is relieved by the same treatment,
ktA also been used with success in puerperal mania. Ringer states
tckona i£ sometimes benefited by tartar emetic given in doses sufHcient
l^indiice Tomiting, once or twice a day. Administered in the same man-
^ St has been found capable of relieving rebellious cases of lumbago and
orfthr rheumatism. In acute gonorrhoea Surgeon-Major Lawrie regards
lusL (or mxx) of antimonial wine, given every second hour, as an excellent
la some skin diseases — as chronic eczema, psoriasis, and other scaly
-the use of tartar emetic, or the oxide, or sulphurated antimony,
doco», and frequently repeated, is of much service.
Hut to-called tolerance of antimony was due to the fact that after the
iry of the s^'stem became lowered by its action, comparatively large doses
flU be swallowed without producing vomiting.
AT
AJmHXB.VTN' ( Salicylanilid-bromacetanilid) is a proprietary com-
of acetanilid, salicylic acid, and bromine, with the formula C..Hs^^
,iOn» ( 1'<:M] + ('.jH^Br.XnX'IIjCO. according to its introduct-T,
& Badlauer, of Berlin. It is a white, crystalline, granular powder, with-
«ior. and almost tasteless. This substance is soluble in alcohol, dilute
and hot water, and almost insoluble in cold water; it is more soluble
slightly acidulated with hydrochloric acid or in dilute solution of
potmeaa. The dose is 0.32 to 0.50 Gm. (or gr. v-viij).
Ihyiialo^eal Action and Therapy. — Its physiological action is similar
of oth^r remedies of this clflss: it is antiseptic, antipyretic, and hyp-
It TV " ' ^ antipyrin in its effects upon the sensory nerves and has
vwd u 'V (1) to relieve pain; (2) to produce sleep; (3) to allay
cotigb; (4) to reduce fever; (5) to arrest fermentation in infec-
rw^ricia. In the small doses usually given (0.32 to 0.50 Gm., or gr.
es headache and restlessness and produces natural sleep. In
■ f influenza, or grippe, tliis drug roducos tlie fever and allays
esness. AHiere cough becomes spasmodic and paroxysmal,
jises a sedative effect and produces sleep. It is of advantage
agh (0.0fi5 to 0.13 Gm., or gr. i-ij, every two hours) or in
irr of cardiac or bronchial origin. It has been used in Ger-
nth all<v<'*' siKTo^H. in dinltote*i, rt*dufiiig both the swgnr and the
of urine; and it is stated to be particularly serviceable in acute
•«. .-1 . iifuatism. Dr. Ludwig Sior, of Darmstadt, ascertained that
.a was given in 1 Gm. (or gr. xv) doses at hourly intervals
F&rec n«''"r», beginning about noon, it exercised a decided influence in
224 PHARMACEUTICAL THERArECTIC AGENTS OR DRUGS,
reducing temperature. The miniimim temperature was generally red
from six to nine hours after thy admiaistratiou of the first dose. Abo'
twelve hours from the same period the temperature began gradually '
ascend. The reduction of temperature was not accompanied by unpleasa:
manifestations. As a rule, copious perspiration and, frequently, a sleep
several hours were produced. In acute rheumatism its action was equal
that of sodium salicylate. It was beneficial in trifacial neuralgia, migrait
the pain of transverse myelitis, and in headache from various causes. As t
analgesic it was usually given in doses of 1 Gm. (or gr. xv), repeated, wht
needed, twice during the day. In the cases where it was used no deleteria
eilects upon the heart or nervous system were detected.
ANTIPYRINA {V. S. P. | .— Antipyrine.
PHENAZONUM (B. P.). (See Phenazonum.f
I
APOCYNUM (U. S. P.).— Apocynum (Canadian Hemp).
Preparation.
Fluidextrftctiim Apoi^vni (V. S. P.l.— Kluiilcxlriicl of Apor.vniim. Po-^o. 0.30
1.20 f.<i?i. (or /jrv X.X). (KM) per cent.)
Pharmacology and Therapy. — The dried rliizamo and roots of Ajkx
ninn ('iiini;iUiniirii. oi" of closely nllicd 3]>eeii-v of Apoeynum (Apocynacea
contains the bitter, resin-like tiluc^>siilcs. Apocynin mid Apocynein, t
fonni-r nohible in alroln>], tbf hitter in wiU.r. Thisi^ jiriiiLiplcs iu sm
<loses act upon the eireulation, like strophantluw. n.s a toiiio. In larj
anmunts ihey are emetic, cntluirtie. nn*1 diuretic.
Apocynum usually.* but not coniiiantly, increases arterial tension,
acts as a diuretic without irritating the renal epithelium. It is probal
that the emetic and cathartic effects of this drug are due to apoc^Tiein a'
its diuretic virtue to apocynin. The decoction of apocynum is irritant
the stomach and bowels, but the tincture is free from this disadvantaj
The tincture (1 to 10) has been employed in the daily doses of 4 to 6 c.c
{or mLx-xc). A decoeti'in has been used in the dose of 30 to 60 com. (
fji-* j ) ill ^be treatment nf dropsy, but the iiuid extract i? mnre reliable.
Dr. W. T. Eichmond regards apoeynum as of value in the treatmc
of ascites, Bright's disease with or without dropsy, and valvular heart d
ease with general anasarca. He employs the fluid extract, beginning wi
7 or 8 drops, and gradually increasing till the desired effect is obtaim
Toleration is established by continued use, and the dose must therefore
raised from time to time. Dr. Richmond has also seen it of service in jav
dice. In the dose of 0.015 to 0.03 Gm. (or gr. VrVs) apocynin hag been us
as an expectorant.
Dr. J. Olinski has found that apocynum relieves the functional cl
turbances which accompany organic heart di.sease and diminishes the ai
of dullness in dilatation. The drug seems to have no cumulative effect.
APOMORPHIN^ HYDHOCHLOEIDTrM (U. S. R, B, P.).— Apom
phine Hydrochloride {r,,[l,,No,HCl).
Dose, 0.003 to O.OOfi Gm. (orgr. V-o-Vio) 1)"^ hypodermic injection. '
the mouth O.dOn to 0.015 Om. (or gr. Vio-V*)- "
Pharmftcolo^ and Therapy. — Apomorphine is an artificial alkal<
prepared from morphine or codeine by pure hydrochloric acid, 20 parts
AI-OMORPfllN-.K nVDltOCULOKtlM M.
125
ktter being added to 1 pail of the former, iu a strong glass tube, and
* to A high teniperature, Apomorpliine hjdrochloride occurs in the
of oolorle«3 or grayish-white crystals, soluble in wnter and alcoliol,
insoluble in ether or chloroforn).
AeoonliDg to the investigations of Rcichert, toxic quantities of apomor-
)^SB« rive rise to convulsions followed by paralysis, chiefly of spinal oripn.
Bvui vhen given in ordinary medicinal amounts extreme prostration and
oeostToIUibTe vomiting may follow^ with weak, thready pulse and low
mttnl premure. Poisonons doses cause rapid and irregular respiration.
Apoawrphine hydrochloride ie a svhteniic emetic and can be u^ed hypo-
4ermicallj in the dose of 0.008 Gm. (or gr. V») to empty the stomach. In
^nUcrdoccs it can he given as an expectorant in bronchitis. It is of value
a tike treatment of dry. hacking cough, attended with httle or no secretion.
ift the result of a scries of clinical experiments, MurrelP has ascertained that
rsf'TE'^rnhin-p, eiven by the month, is tolerated in much larger doses than had
He was able to administer 0.065, 0,10, or 0.13 Gm. (gr. i, iss,
ly without exciting nausea. In these quantities he found apo-
■'■Lloride an oJccoUent expectorant in chronic bronchitis, bron-
-^., anu emphysema. Murrell usually prescribes the apomorphine in
wild cherry, of tar, or of lemon. The addition of a few drops of
hloric acid to the mixture is advantageous. The same observer
t^d apomorphine as a spray with very satisfactory results. He
jcutlj given as much as 2 c.cm. (or foss) of a 1-per-cent. solution in
^ _:.., water for each inhalation. A combination of apomorphine and mor-
iksat is raloable, and has been employed by Rossbach in phthisis. The
tmt^ *"'--m€s lees frequent and the sputum more fluid.
rphino hyrlrochloride is often s(^rviceable in the treatment of
Trtirr, uie writer prescribing it thus: —
B Apotoorphi-n
hvdri>chIori<ii
'^•ric. dilui. .
:r<M.'IiIori<li
13
Gm. or gr. ij.
e.cxD. nr fSiss.
Mon irtK'IiIoridi . 066 Gm. or gr. j.
tfilvT. t".uM!ii 80 ccm. or Rj.
Aq. rhloroforttii ..q. 9. ad 24<)[ r.rm. or fSviij.
|"fiijp : Fifteen cubic ceniinieirea, or half an ounc«, every third hour until
is relieved.
Vis or strophanthus may be combined with the above if there ii
T f-».-utac debility.
Apomorphine should not be continued too long, as it is liable to pro-
'I
ultD'
lema.
mrbe
F. Samuels bos written of the value of apomorphine in
vinp 0.0013 Gm. (or gr. Vm) every ^\e or ten minutea
produced. If the child is unable to swallow, the remedy
rd beneath the skin. J. S. Horelcy has found this alkaloid
••-^ , ^.iiitrollin^ convulsions. He successfully employed hypodermic
f 0.004 to O.OOfi Gm. (or gr. Yis-Vio) tn a case of strychnine poi-
nriter recommend* apomorphine in the treatment of convul-
1- phenomena of hyi^tcrift. In hypodermic dof^s of 0.002 Gm.
i^' \ m) apomorphine hydrochloride is a valuable sedative and hypnotic
'-0»tl
£<.CP^ In I*" -^'
'•rphine and Apocodeinc, with Reference to their V«ltt«
■ lit of Chronic Hronchitii,** by William MurreU, M.D^
Will. March. 1801.
22G I'MAItMvVCEUTICAL TUKUAl'Kl'TlC A0KNT8 Oil Dltr<JK,
in casus of in&LHiinia. tldiriuni treiiiont;, and iiu)rf>lnnisiu. Tlic first ilosc
should be not niort^ than half the abovf, in order to test the tolerance of
the patient. Vomiting iilwav? indicates ton large a dose. Thtrc is no dan-
ger of a (Ini^ hatiii Wiwg acquired. The renie<iy may also be n?ed in mania-
cal deliriiiiii, hystL'n>-e|iilt*]>fiv, eliorea, Mnd per?iptent hiccough. It ha.s bt^ui
adniinisteri'd to }>rtKluee relaxation ol" n ii;.'iil os uteri. Aponiorphine may
also !»e uilininistered, in coiiibinaliou with ^trythnine, by the mouth. Paul
E. Reehet, of Xew (h'h'anf^, give?* 0.(K»y Gni. (or ^r. Van) "f t^-ieh of tht-se,
at three-hour intervals, in delirium ehrinauui. or acute aleoholisni.
AQUA (U. S. P.).— Water (Efi).
I'oisihle Avater in its [iure>t attainable irttate.
AftUA DESnilATA (U. S. P., B. P.).— Distilled Water.
A colorless limpid liquid, without odor or taste, and perfectly neut
to litmus- paper.
AQUA HYDEOGENH DIOXIDI (U. S P ), UQUOE HYBROGENn
PEROXEDI (B. P.).— Solution of hydrogen dioxide. (See Barii Dioxidum.)
ARASA is a native of Brazil and Uruguay. The portion used is the
bark of the root. It is employed in South America in cases of metrorrhagia,
2 Gm. (or 5ss) of the hark being boiled in a cupful of water and administered
for several days before and during the menstrual period. The taste is said
to resemble that of cascarilla, and no unpleasant i^econdary effects have been
observed.
AEEGA. — Areca, or Betel nut, istluseedof Arerarati-rlui ( l*nluiacefe).
E. Jnjinp fMiind time alkaloids in areca-nut : Arecoline, Arecaine« and*
Ouvacine. Another, ralleil Arecaidine. is an isoiuer nf areeuinc. Arecolinr
is nietliyl-iireeaidine, inul is convertible intti arecaidine iiinl the latter intf»
an^coline. It also contains tiinnit- nn<l ^^ullic acids. Aretaine i? a crystalline
body, soluble in water, insoluble in alcohol, ether, and ehlornfonn. Areca-nut
IB a ]K)Wcrful tituiacide and poiiion. The alkaloid arecaiiie slows the heart
and respiration, and purges by increasing intestinal peristalt*is. I'owdereil
areea has for a long time been used us a tieniaeide in vet(M'inary ]>ractice.
More recently this remedy lia?; been used for the same purpose in the
human subjcit. Dose, II. 'V^ to l..'iit Mm., or gr. v-xx (1 to 8 Om.. or oi-ij, as
a vermifu;:e). The fluid exiniet is the best preparation. Its administra-
tion should be preeinled nnd folliuved by a purgative like castor-oil. Betel-
nut is believed also to increase the secretions from the salivary glands, -and
has a slightly stimulating etfeet U))on the eerebrul centres. Large doses may
cause tetain'e ((mvujsions, F)eath is caused by respiratory failure.
Arecoline hydrotromide is a myotic. When afiplied in \/^-iK'v-t*ent.
watery solutii'U. it causes n sliizlit stinging si'nnation for a few moments, but
leaves no conjunctival or ciliary congestion. Chetwood-Aiken' considers it
superior to eserine in the treatment of glaucoma. Its action is more rapid
and more powerful, but its effect is of shorter duration, and is devoid of
the beiulache and t»ther unpleasant nfter-elh-els so often noted with t-serine.
Ijavagna' describes the action of arecoline, a drug extraetcil from the
British Medunl Joumol, Jan. U. 1899.
^GioiTUilr thWn U. Kroiicmin tli }friiirinn tli Forttta, lsl>5. \o8. 3 and 4.
AKCENTUM.
221
tfii' Italian ari»ca tn-e. Frohner found smue tinic ajjo tliat arix:olino
ii the be«t sialagogue, being superior to pilocarpine, and that it equals
■Buw as a laxative.
Dr. liSTa^iia has ol)»en'ed that the instillfition nf a drop of a 1-per-cwit.
of ihc hviirobromidc into the conjunctival sac causes a sensation
tvAluith, and afterward some lachr^Tnation and spagni of tlie eyelids. The
lasts scarcely more than a minute, and is followed by alight hyper-
of the conjunctiva and subcorneal injection, which disappear after
tninutee. After '2 minutes, violent clonic spasms of the iris are pro-
and there is distinct diminution of the pupillary space. The myosis
I iivtij noticeable after 5 minutes, and reaches its maximum in 10 minutes.
Tins Bflximuni is maintained for 25 to 30 minutes, after which the pupil
to enlarge, and becomes normal once more after about 70 minutes.
AttlBK end of 90 minutes the pupil is about one-half millimetre larger than
***"*T^ Dr. Lavagna has not noticed any modifcations in intra-ocular ten-
mam du* to the drug. Before acting on the iris, arecotiue causes a spaeim of
Ak dimry muscle, which gives rise to increased refraction in the eye for the
being.
AUGEimjM. —Silver.
Preparations.
±,^^^ti Cyanidum (U. S. P.).— Silver Cyanide. Dose, 0.0016 to 0.003 Gin. (or
(Should contain not less thjtn lM).ft |H»r rent, nf [>ure silver cyanide.)
Nitraft Fusus (U. S. P.).— Molded Silver Nitrate, Lunar Caustic. Ar-
Induratus (B. P.). — Toughened Caustic (Do to 5). External use.
1 Nitma Oilutus (U.S. P.). — Diluted .Silver Nitrate (^'ilver nitrate. { part;
^tt f-rtTr-r'r* mtrate* 2 |)art«). Argenti Nitran Mitigatuft (6. P.). — Mitigated Caus-
tK. fUtwl tt*r.
'"rag (U.S. P.. B, P.).— Silver Nitrate. Dose, 0.01 to 0.03 Gm. (or gr.
.-^rg^ww <^'Xidum (U.S. P., B. P.).— Silver Oxide. Dofte, 0.03 to 0.13 Gm. (or
Fhaxxnacolo^. — Metallic silver is a white metal taking a hiirh polish.
^Ki U4A <«»jIv aiftH'totl by acids or by oxygon, although readily tarnished
^ calphttr. It is oflicial only in the form of salts, of which the nitrate is
wm^ largely used. Silver nitrate is an anhydrous salt which crystallizes in
^kirh wr rhomhir plates. It w readily soluble in oolH water, and has a
flfUllif -TO. Upon the addition of hydrochloric acid or a soluble
tyaridf **n of the nitrate, a white, curdy precipitate is formed.
• prrectpitate is wholly soluble in ammonia. The crystals, fused and cast
iUm^ present the form of round, grayish sticks. The cyanide is con-
at for thi* fxl«*mpornneou6 preparation of hydrocyanic acid, which is
[>le by adding an excefta of some mineral acid to the solution con-
LlBBiw thia salt. Melnllio silver is used in surgery in the form of silver
- HTid for jiinking cannnbe for trat*hef>tomy, catheter?', etc.
.cal Action. — Silver nitrate, in weak solutions, acts as an
it^ anti. in substance, coagulates the albumin of the tissues and de-
»f.!r vifjililv. acting as a caustic. The mitigated stick of lunar caustic
" -ial in its action; the pure nitrate may cause sloughing
Uiie objection to its use is the discoloration it leaves behind,
»iniDg black after exposure to the light. (VNTien the physician's
ijoed with nitrate of silver in making an application^ the color
228
PIlARilACECTICAL TIIERAPEITIO AGEXTS OR DRCGS.
may be removed by washing with a solution of cyanide of potassium. Accord-
ing to Hahn, the stains may be removed from the skin or clothing also
by a solution containing 5 Gm. (or gr. Ixxv) each of corrosive sublimate and
ammonium chloride in 37 c.cm. (or f.lx) of distiliod water.) Local applica-
tions of silver nitrate whiten muc(»iis membrane. Wien swallowed, symp-
toms of irritant poisoning appear, with pnin, distress, and vomiting. Com-
mon salt is the antidote, and vomiting should be encouraged by administering
warm salt water; after cleansing the stomach the bowels shniild be purged
by oil. When any of the silver salts (hut especially the nitrate) has been
taken for a length of time, a state-colored line appears along the gums and
there is darkening of the conjunctiva, and soon afterward the entire surface
of the body becomes dingy or slnte-colorcd, due to the deposit of metallic sil-
ver in the pigment-layer of the skin ond in all the constituents of the skin
below the Malpighian layer. This condition is known as Argyria, and is per-
manent. The patient should therefore be carefully observed during the
administration of silver, and the remedy from time to time intermitted.
Argyria has also resulted from the local use of silver nitrate, as reported by
Hutchinson, in the Annah of Surgery for April, 1892. In medicinal doses
the silver salts act as a tonic to the nervous system and changes occur in the
blood; tissue-change is increased; the flow of bile is also increased, and in
larger doses there is embarrassment of the respiration, depression of the cir-
culation, and reduction of temperature. Tetanic convulsions or paralysis
may be produced by overdoses, the paralysis being of central origin.
Therapy. — Silver foil, or metallic silver in very thin sheets, is employed
as a surgical dressing for wounds. At Johns Hopkins Plospitol the practice
originated of applying silver-leaf dressings for bums, the lesion being sim-
ply covered with the leaf without the use of any adhesive material. It is
fin excellent protective dressing which may be painlessly removed and re-
newed. It prevents suppuration and is said to reduce shock. In Albany
Hoepitfll it has been used as a dressing for laparotomy wounds, the leaf being
retained by a giuize coinprehS and Imudcige. Silver nitrate is used locally in
2-per-cent. solution, dropped into the eyes of newborn infants to prevent
purulent conjunctivitis (ophthalmia neonatorum) after the method of Crede.
G. E. De Schweinitz^ has seen marked conjunctivitis neonatorum appear
after the employment of Crede's method and has also observed severe cases
of conjunctivitis with haziness of the cornea, and one case of persisting con-
junctival haemorrhage, which nearly proved fatal. He insists that Crede's
method should be reserved for the eyes of those children who have passed
through a birth-eanal known to be infected, or from which the suspicion of
infection could not be positively eliminated prior to the birth. Whenever
infection, or the suspicion of infection, can be excluded, Crede's method is
not necessary, milder methods of prophylaxis being suflleient. The miti-
gated stick is a good application to granular lids, chancroids, small-pox ves-
icles (in order to prevent pitting), and in general to excite a healthy action
of granulating surfaces. In gynaecology, the lunar causitic, in solid form, is
used in chronic cervical catarrh and in venereal sores. An application of
the solid stick to the scrotum has a good elTect in acute epididymitis or
orchitis; also along the course of the atTected vessels in lymphangitis of the
forearm from a poisoned wound of the finger. Thoroughly applied to the
* PhiladflphUi Medical Journal, vol. iii. 351,
AUliENTL'M.
229
' ' y the bite of a rabid animal, it is claimed by Youatt to be a
nst hydrophobia. For chronic nasal catarrb, it may be
>;um acacia, pulverized, and blown into the throat or nose. In
-, tonsillitis, and laryngitis, solutions (made with water or spirit
^ tther of 1.30 to 2.60 Gm. to each 30 c.cm., or gr. xx-xl per ounce)
o^ with excellent results; Dr. Horace Green advocated the stronger
'i with a probang to the larynx in diphtheritic croup. In
...'.-■ ',u-c« these solutions arc valuable in gonorrhcea and urethritis.
': abortlTe method of treating gonorrhoea has had its advocates, and
. "- :illj in ihe injection of a'strong solution of silver nitrate dur-
:age of the disease. Pn»fe;?sor Diday insisted upon the iui-
*'i Uie following points: Tlie strength of the solution should be
'I. to 30 c.cm. (or gr. xxiv to fj^j) of distilled water, which, in most
■ It slight pain at the moment of injection; if sharp pain
iately the tluid should not bo allowed to remain for more
' lids: when the pain is moderate it is allowed to remain for
«.;i,A;^^, .iv;.urding to the tolerance. This method has been abandoned
aeeotint of the liability of producing sloughing and stricture of the
■ r results are now obtained from the employment of the new
c is with alliuniin, casein, or nuclein, which destroy the gono-
i, axtii arc ie>3 irritant to the mucous membrane.
In rrjaipelas the disease may sometimes be arrested by delimiting the
Act«d area with silver nitrate. It has also been used with good results in
pnhtQ* rulrK, herpes, eczema, and lichen, when they occur in eircum-
ienb««) patches. Boils may sometimes be aborted in this way, and a stye
« the ere may be checked by an early application. Buboes are treated by
C^nJir-r, wliclhor •*tij>puratiou has occurred or not, by puncture, tlirougn
vkkdi a 5J-per-cent solution of silver nitrate is injected. Recovery is said
U W rapid and the formation of an unsightly scar is avoided. After disin-
fartioa of the wound, Simmons recommends the injection of a solution of
idrar mtrate, with a view to preventing the development of tetanus from
|«Drtured wounds. The solution which he employs contains 0.65 Gm. to 30
X to f^). Dr. Lazzaro proposes silver fluoride as an efficient local
in anthrax. It is a brown or blackish-brown hygroscopic mass,
' ' in water, antiseptic, equal in caustic effect to the nitrate, and
• the anthrax bacillus, while harmless to the human organism.
'^ nitrate is useful in restraining the bleeding from leech-
.L- course of a chronic illness, bed-sores threaten to form,
aiiun of 8 solution containing 1.30 Gm. to 30 c.cm. (or gr. xi
. _r nitrate will avert the mischief. Ringer has found the same
ul in whooping-cough. A solution may be applied to the throat by a
or * r^- or it mny be used in the form of a spray. The latter method,
-pplicable to children less than three years of age. The stain
fv^docrc, raoreovcr, is a serious objection to the spray. A strong solution,
m tike aolid atick, is a good stimulant to indolent ulcers and to ulcer of the
w^mo A 8.60 Gm. (or gr. xl) solution in nitrous ether has been used in
6Ma trichnphvtOBis, A solution containing from 1.30 Gm. (or gr. xx) to 7.6
um. (f " '^30 c.cm. (or f^j) of water may be successfully employed, by
mgeetioi^ --. ^.a^U quantities (a few drops) into the sac of an hydrocele or
fpbe tumor. A aponge probang saturated with a very weak solution of
t tfvrr aitmte is sometimes of service in spasmodic stricture of the cesophagus.
2.10 VIUKMACEPTICAL THERAPEUTIC AGENTS OK DUUUS. "
Applications shoiikl be iiiiidL* occHsionally, at iutcrvnls of Ht'V*>rnl dnys. In
pseudomembranous enteritis it is a good practice, in the intervals ot parox-
3rBms, to irrigate tlit- Intwe! with i).'.V2 to O.G.t Oni. (or ^r. v-\) of silver
nitrate in a pint nf \vnt(.^r. Prolopsi-d rcvtum, ei?[)ecially in oliihlron, is bene-
fited by fnntorixatir>n witl> niirigiitcd silver nitrate.
On Mcodiint at tJif staining of tlie skin, silver nitrate ie now little used
internally, although it has acknowledged effects upon the nervous system.
Caccianiga has collected 60 cases of acute lobar pneumonia in which treat-
ment by silver nitrate seemed to be clearly beneficial. Of the group only 3
died. The dose was from 0.10 Gra, (or gr. iss) in children (eight to ten years)
up to 0.25 to 0.32 Gm. (or gr. iv-v) in adults, given in pill or suspension. In
cases of urgency, a 0.50-per-cent. solution of protargol was injected hypo-
dermically. Beyond some vomiting, no ill effects were observed from the
treatment either by silver nitrate or protargol. The most marked effect of
the silver salt was the reduction of the temperature, which began in tlie
first twenty-four hours and was noticed in all the cases. Apyrexia occurred
by crisis in 48 cases, by lysis in 12. When small doses were given, apyrexia
generally occurred by lysis; with larger dnsos, by crisis. In the defervescence
due to silver, the pulse did not come down at tlio samp time, hut later. 8ilver
oxide is said to be less subject to this objection and equally efficient, especially
in the early stages of locomotor ataxia and in epilepsy. A double salt, the
sodium and silver hyposulphite, has been recommended by Curci and others
as efficacious in locomotor ataxia, and free from the disadvantage of staining
the skin. It is very soluble in water, does not coagulate albumin, and may
be given by the mouth in iloses of 0.045 to 0.20 Gra. (or gr. ^A-iij), or h>T30-
dermically, from O.Ol to O.o4o Gm. (or gr. Vn-^/i) ^^ the course of the day.
In gastralgia, also, the silver salts are sometimes remarkably curative. They
have effected improvement, likewise, in chronic gastritis and ulcer of the
stomach. The silver nitrate has been successfully given for the purpose of
allajnng yeasty vomiting. When, in typhoid fever, symptoms of irritation
in the alimentary tract become prominent, and peritonitis or lijemorrhage
apppnrt* ijinninenf. the following prescription was used by \Vitlitui» Pepper,
in the Philadelphia Hospital: —
B .Argents nitrntia . . . / 113 Gm. or gr. ij.
Mucilag. acaciae G0| ccm. or fjij.
M. Siff.: A teaspoonful three or four times daily, combined with tincture of
opium or bclIadoriDn, if necessary, for diarrhoea or constipation.
Silver nitrate sometimes yields good results in enteritis or colitis, espe-
cially if ulceration is present. Silver nitrate or oxide may also be given as
follows: —
B Argenti nitratis,
Extract! opii na |13 Gm. or gr. ij.
M. et ft. pil. no. vHj.
Sig. : A pill every four hours, for gaitric ulcer.
B Argenti oxidi 113 Gm. or gr. ij.
Ext. belladonnte fol 1005 Gm. or gr, j.
Ext, gentianoe 1|30 Gm. or gr. xx.
M. et ft. pil. no. xvj.
Sig.: A pill throe times a day.
AUfiKSTrM.
231
An efficient prescription for neuralgia and chorea ;-
B Afg«nU Ditratia
'^ ipecac.
Bulphatis
KaciL acAcue
30
00
Si-
"J-
f.z A teaspooaful in wat«r, three tinies a day, before meals
chronic diarrhceA, especiftlly of phthisi&.
20 Gm. or
com. or
065 Gm. or ffT. j.
c.cm. or ftij.
Exertfi marked
la gwtric catarrh, the gastro-intestinal catarrh of phthisis, ulcer of the
"i, or chronic diarrhoea we may combine it as follows: —
B OodetM
Afffcati aitnt ^•
PbIt. Bcaciie
Dtt. in pU. DO. xij.
fi|f.: GiT« one every two to four hours.
|20 Gm.
|38 Goi.
q. 5.
or gr. 111.
or gr. Tj.
f
lo catarrhal juurulice. silver nilrato has hoi'u given in O.OO.") Gm. (or gr,
^,,c^-^ u-iili iiiUjinta^rc. In pill form theetfect is more sustained and the
II in hirger doses than when in solution. When used in
Mi liir Mnmach. the remedy is l)est given half an hour or eo before
«r<ltT that the local effect may be eecured. It should not bo used
jH»nod '. tMthcr in pill or in solution.
Drventery, with ulceration of the large bowel, is very much benefited
ly hrjpe injections of weak solutions of silver nitrate (0.0075 to 0.015 Gm.,
* er. V ,-'/4, tn ;50r.('n»..nr fjj^of mueilao;*^). Bartholow advi^jed the internal
mt of the nitrate^ combined with opium, in addition to the treatment by
otjretion^. According to the same writer, both tlic nitrate and the oxide are
wmSul in nervous dyspepsia, cholera infantum, and jaundice depending upon
ottnii of the bile-ducts. Silver is sometimes beneficial in chorea. Silver
vide j? occafiionally able to check profuse perspiration, and may prove use-
W rrhagia. The nitrate has given relief in obstinate enteralgia.
^ rocq, of Brussels, claims that silver nitrate is a valuable remedy
a phthisis, promoting appetite and digestion, diminishing cough, expectora-
fcco, and night-sweats. lie administers from 0.009 to 0.02 Gm. (or gr. Vt"
* ,) during the day. Mr. P. A. Brady, forty years ago, regarded this salt as of
Beat Tal«e in the treatment of phthieis. He was accustomed to give it in
2ms of 0.01 Gm. (or gr. V4) combined with 0.20 Gm. (or gr. iij) of Dover'a
|nvdrr tlinn' tinu-s a day. Dr. Thomas May.s, of Philndel])hia, reported some
MBarkable results from. hypodermic injections of solutions of silver nitrate
the akin of the neck, over the pneumogastric nerve, in the treatment of
y^faChifeia ymlmonalis. In Home ranes. striking benefit was noted.
Vanoiie reinedic-'* have been proptsed for tlic Argyria, or tlio skin dis-
lon produced by silver. Tnfortunately, none has proved reliable, and
a iha T««t majority of cases the stain proves permanent. It has been claimed
#Bt Miatering will lighten the color. Dr. Eichmann st-ates that in two cases
thr eol<^r diMpp'^orod after the use, four times a week, of pota^^h-and-sonp
litha. le has been given internally for the same purpose.
.1* cmnuoii now as fnrintTly, <ince silver is no longer
iliinyed in ihe tp'atment of epilepsy and locomotor ataxia.
.wUroine is a lo-per-ornt. sohilion of silver plioriphate in nn aqueous
n i>f •■fhylencdinmin. This snlutir»n \^ said to <y>ntain as nnieJ) silver
p-pt'-T-o-nt. M»ltitinn nf silver nitrate. Tlii^* new combination is
232
PilAUMACEUTlCAL TUKUAI'KL'TIC AGKXTS OU DULOS.
brouglit forward ats a substilutu i'or the silver nitrate. Argeutaiuiuc is a
permauent, limpid fluid, readily miscible with water, of an alkaline reaction
and anuuoniacal odor. It does not precipitate albumin, and has a very
slight c:iii»^tio action. The *^oh^tioD is -a clear, colorless liquid, and, according
to Dr. St'luifrer, }»oijiie.4.*es bactericidal properties which will render it valuable
in the treatment of gonorrha-a and diphtheria. In the anterior urethra it
should not l>e used stronger than l-tiOdO; for the posterior urethra, 1-250.
In ophthaluiohigy it ha? been ut^ed in o-j)er-eent. strength. It becomes de-
composed when left exitosed to the light.
Arg:entxun Cred^,^ or soluble metallic r^ilver (colloidal silver), as origi- '
Dally reconnnended by B. Crede, of DreBden, at the Moscow Congress, is
used in medicine as a lO-per-cent. ointment: the nnguentnm Crede. It is
employed by inunction, ubing 3 Gjn. (or gr. xlv) for an adult, or for children
1 Gm. (or gr. xv), especially in septic cases. More recently Cred6 has used
colloidal silver in a pill, containing 0.01 Gm. (or gr. '/«) ^^"'^h sugar of
milk, glycerin, and water, q. e., giving 2 pilU two or three times daily in
acute erysipelas, and in cases of gaslro-intestinal disease in which it has been
customary to give tlie nitrate of silver. Argyria was not observed.-
Dr. Oscar Wcrler' warmly advocates the use of the lactate and citrate
of silver, for the power of penetrating the entire organism and effecting a
general disinfection of the entire body. In sepsis he obtained good results
by inunction and the washing of the wound with citrate-of-silver solution
(1 to -1000). The metliod by inunction with ungucntum Crede (made with
eoluble metallic silver) and local application to the wound of silver-citrate
Bolutinn, is suited both to chronic sepsis and furunculosis.
Argonin. — An organic combination of silver with casein has been
introduced under this name by Drs. Rohmann and Liebrecht. Argonin con-
tains oue-fificenth the amount of silver present in the nitrate. It is soluble
in water, non-irritant, not precipitated by salt, and is claimed to be antidotal
to the gonococcuB. Dr. Johann Jtdliuok, of Budapest, Hungary, has
written on a new preparation of artjoitln called *'Argonin L." He extols
this preparation as having the advantage of not decomposing after being
kept in solution for several months, and again containing 10 per cent, of
silver instead of 4.2 per cent, as in ordinary argonin. The author uses a
1-pcr-cent. solution in urethritis. Imth anterior and posterior. (See also
Lar§fin.)
ARISTOL— (See Thymol lodidum.)
ABMORACIA EADIX (B. P.).— Horse-radish Root. I
Preparation.
Spiritua Arnioraciffi Compositus (B. P.). — Compound Spirit of Horw-radish.
(Contains aUn bitter orange-peel aucl nutmeg.) Oofie, 4 to 7.5 c.cm. (or fSi-ij).
PharmacologT' and Therapy. — The fresh root of Cochlearia Armoracia
collected from cultivated plants.
Horse-radish, in its fresh state, grated to a pulpy mass, to which n little
Tinegar is added, is a familiar condiment as a dressing for meat at our tables.
It ig pungent, and excites the flow of secretions of salivary and gastric glande
'Tliis is also cnllpd "('(i!liii%n>lijm." as prepared ])V vim Heyden.
*Kh'tt. Thrntfi. ^yurh^•ttM^'hrlft, ISflS,
* Deiitsrhe i»edi(irtii*rhr Worhrth^rhrtft. Ot. ft. \90H.
ARXICA.
233
mhI iliniQUt^ the appetite. It contains an active principle analogous to the
loiitik oil of tnustanl, and yields about 0.5 per cent, of oil. It also contains
a little resin. Externally, horse-radish is rubefacient. Internally, it is a
to the stomach and increases the urinary flow. The addition of
borae-radish to cider makes it actively diuretic, and useful in dropsy.
tbnen med with success in scurvy. The dried root is not employed in
e. The compound spirit is a good addition to other diuretics.
AUnCA (U. S, P.). — Arnica-flowers (Leopard's-bane).
Bow, in substance, 0,65 to 2 Gm. (or gr. x-xxx).
ARSICX BHIZOMA (B. P.).— Arnica-rhizome.
Ooae, in Fubslaurc, o.^;.") to 2 Gm. (or gr. x-xxx).
Preparations.
Tbr-*"--, ^minp {V. S. I*.).— Tincture of .■Vriiicu (20 jwr vetit.). Dose, 0.00 to
l> : ■ ArmCTB( B. P.), — Tincture of Arnica from the root. (5 per cent).
Plurmacology. — Arnica^ florcs, the dried flower-heads of Arnica mon-
tton. aiB official in the U. S. P.^ but not in the B. P., wluch recognizes only
fc- riiiBoroe and roots. The plant belongs to the natural order Compositae,
md it is indigenous to northern Europe and Siberia and also the northwest-
«» P*rt of the Unitf'd States. The flowers are orange-yellow, disk-
if^jcrt. with rays, of feebly aromatic odor, and of a hitter, unpleasant taste.
IhMillT'I&inin has been obtained from the flowers, but the principal con-
c'^t^A to ^ULch its local effects are probably tlue is a volatile oil; besides
r« is a ^lucoside, Amicin. and also inulin^ tannic acid, resin, and
r-^x^r unimportant elements. According to some writers, arnica also con-
Inw two alludoidfi; amicine and oytisine, tbe latter of which is apparently
identical with the principle of the same name derived from the laburnum.
Fhymiological Action. — Applied to a delicate skin, arnica frequently
fmdiMic* redness and' inflammation resembling erysipelas. A pustular erup-
(irn mar also be produced by the application of this remedy. It acts as a
«■■- tant and revulsive. Internally^ in small doses, it has some stimu*
kbi.^ ...i.wivnce, raising the blood-pressure and the action of the heart, pro-
4KSD;r a feelinja: of warmth over the body and increasing the secretions. It
^ bev: " ' '. small quantities of arnica exert a stimulatinp influence
t} -trie nervts. Larir**r dt)St'S cause depression, parah'sis of
IT 1(1 by vomiting and collapse. Death results from the cpssa-
p»; 1 t's octiotu aiwl in part from the awumulation of carbonic acid
I the biood. Atropine is the physiological antidote, with stimulants, arti-
fwpiration, and counter-irritation.
Tkerapy. — Tincture of arnica is externally used in domestic practice
* • -I.' foreign pracfitioiiers as a n>mefly for sprains, contusions, myal-
imfltism and local paralysis, and it is also believed to have some
-. U is asserted by some authorities that any
It ;ig absorption of ecohy Miosis is really due to the
of i >iiv which is coiiuitoTily used. The author, from clinical
«fwr>ri>rc. that arnica has most efTective local action upon the tis-
fM» 1 rhfumatism, boils, abscesses, and in all thickened condi-
&R^ ^* t..^ ™:.^ument. The following combinations are especially of
234
PHAKMACKrTlL'AL TllEiUPiil-TlC AGENT8 Oil DBUUH.
B Tinctura arnica?,
Lin. saponiet,
Tinct opii nn 30] c.cm. or f5j.
M. Sig.: Apply with friction for boiU, abscesses, and thickening of the skiid
B TiiU'tuni rtniioip.
Aquie hauiaiiielidis (lest aa 90{ c.cm. or fjiij.
M. Sig.: Use on niualm or lint for hflemorrliagea, A rheumntip joint may
covered with cloth* saturated with the arnica and witch-hazel, the combination often
being more elTecUve when applied hot.
Arnica has been used internally in large doses in mania with high arte-
rial excitement, in delirium ebriosum, and in acute rheumatism in sthenic
Eubjects. Small doses of the tincture are useful in fever attended with much
depression. This remedy may likewise be beneficially employed in chronic
diarrhoea, chronic dysentery, and in various forms of haemorrhage. It has
been thoupht to be u?efid in paralysis of the bladder.
ARSENI lODIBUM {\\ S. P., li. P. ) .— Arsenous Iodide (A3I,). (See
Arseni trioxidum.)
ASAFCETIDA (U. S. P., B. P. ) .— Asaf etida.
Dose, 0.65 Gm. (or gr. i).
Preparations.
Emulsum Asafcetidse (U.S.P.). — Emulsion of Asafetida (4 per cent.). Dose,
15 to 30 c.cm. (or fjss-j).
Pilulro Asnftrtidrn (U. S. P.).— Pills of Asafetida (each containing 0.20 Gm., or
gr. iij, of usafetida). Dose, 1 to 4 pills.
Tinctura Asafaelidip (U.S. P., B. P.).— Tincture of Asafetida (20 per cent).
Dose, 2 to 4 c.cm. (or fSsa-j).
Pilulflp Aloes et AsufaHidiP (B. P.). — Pills of Aloes and Afafetida (t'qual pari*
of each*. Doso. 0.25 to O..i0 (Sin. (<tr gr. iv-viijt.
Spiritus Ammonia; Kcetiduft (B. P.^.— Fetid Spirit of Ammonia (contains 7.5 Gm.
of asafetida in a nien8tr\ium of 10 parts of strong solution of ammonia with 00 parts
of alcohol: &0 per cent.). Doso, 1.20 to 2.50 c.cm. (or mxx-xl).
Pilula Galbani Composita (B. P.). — Comjwund Pill of Galbaniim (contains 33
per cent, of asafetida). Dose, 0.25 to 0.50 Gm. (or gr. iv-viij).
Pharmacoloiry- — Asafotiila is deriveil from the rhizome of Ferula foe- ,
fidiu antl jimbubly from other Fi])rcit*8 uf Fenda (T^nibeliiferfr), and is
obtaiiit'd, by in<isioii, fi'oin tin* h'vin;^ mot. The smirce of the nsafetida of
comment numt still be ronsiiN-rrd doubt fnl: it usually is brought to tins
country from Afghnnistan nnd ludin. Tlio i]r\)^ is an riily ^mn-resin and is
rt fonilflie I'Ster of asan'^inotannol. It occurs as rough, irreguUir, rather s<"»ft
miusses. of hrowc color, somenhat giirlieky odor, and aerial to the taste. The
odor depends upon a volatile oil, wliich appears to be allylporsulpbide. The
agent also contains ferulaic acid, resin, gum, bassorin, with tmecF of acid
calcium nuilate (PeUetirr) uml in coiumeree ibtually is much nthdterated.
Physiological Action. — The effects are moderately stimulating, anti-
spasmodic, and expectorant. Large doses cause vomiting and diarrhcea, espe-
cially in persons unaccustomed to its iife. Tn medicinal doses it is car-
minative, and ibcreases the qnantity of the gastric juice. The sexual func-
tions are said to be stimulated, and a general feeling of warmth is diffused
through the body. Asafetida increases the action of the heart and arterial
stimulates the functions of the skin and kidneys, and is a mild
excitant. It is eliminated by the Uifigs, bowels, skin, and kidneys.
Therapy. — Asafetida is not used locally (although the plaster was for-
■■rij official), since, to those unaccustomed to its use, the odor is very
This, howcTer, makes it additionally useful in treating some
disorders, such as hysteria. Qoodell advised that a teaspoonful of
Ifca tincture be mixed with hot water under an hysterical patient's nose, and
Bha prt-n liv the stomach, nr as lui enema. In uervousuesii of children, the
fib an* ser\'icable, and in colic, or oonvulfiinnH, the emulsion or milk of
aafftida may be used freely as an injection. The mixture of magnesia and
■rfffti^a (not official) is used as a carminative for infants with colic, but
fttopiiim in it must not be overlooked. The pil. galbani comp. is used for
fadeoce and intestinal indigt^tion, in flderly ixxtple. The combination
•".'h tloca is theoretically useful in amenorrhoea, but, practicall}', it is just
■z 'Jusa cases that asafetida can only rarely be used, on account of its odor
ai taste. Italian physicians recommend the systematic administration nf
■detida during pregnancy, when there is a history of previous abortions,
«vben abortion is immediately threatened. It is given in doses gradually
mtm^ng from 0.20 to 1 Gm. (or gr. iii-rv) a day, after which the amount is,
il tb* same m.anner, reduced. Its use is not advocated, however, in cases
it upon syphilis, tuberculosis, or disease of the uterus and its ap-
The favorable influence nf asafetida in tlH»se eases has been oon-
by Warman, who found that the drug reduced haemorrhagCj had a
taaquillizing^ effect, and was particularly useful in cases of habitual abor-
IK. Small doses of asafetida are valuable in the later stages of bronchitis,
npgiillj that occurring in old people. Its combination of expectorant and
itive virtues likewise renders it of service in emphysema. It may
be advantageously employed in spasmodic asthma, especially used as
30|
Af an
ccm. or fjj.
c.cm. or fjias.
■ sa(oetid«e
.1 mroon. valerianatts,
hamuli ftfl. 45|
A tMupoonful or two in water every hour or two.
antispasmodic and expectorant, asafetida has been employed in
abgoptng-cough. It may also be given with advantage in chorea, especially
Afli that affection occurs in weakly girls about the period of puberty and
aaadatad with menstrual dithculty. In the flatulence and constipation of
^jorfiondriasis, it is a good remedy, and is especially appropriate on account
dv Sted exhilarant effect upon the brain. The mixture of asafetida
■ir^.... ....o the rectum is efficient in promoting the expulsion of flatus, and
asr be reeorU-il to in the tympanites of typhoid fever. Asafetida can i)e
fjflKd int<»mally, thus: —
I
E tiDd aMfortidff.
T1ac<- rardamom. co
apt. »mmcn arom. •
Aqua DKnth. pip. . ■
aa 30
... 4
... 60
ccm. or f5j.
c.cm. or fjj.
c.ciii. or fXij.
K. f^g ■ One to two tettspoonfuts in water every tno or three hours.
.•^APR'^T — » 'Miciuni bcUi-naphthol-alpha-monosulphouate ( tC,(>H«
• i haa. for convenience, been termed asaprol. It
wdor, vory soluble in wairr and alcohol, and is destruc-
23G PliAEMACEUTICAL THERAPEUTIC AGEXTS UK DUL'GS.
tive to many forms of bacteria. It is administered in daily doses of 2 Gm.;
(or gr. xxx), pradualJy increasing to 4 Gm. (or 5j). Aj?iiprol is incompati-
ble MJth alkaline idrnlidcs, sulphates, and with nio^t of the alkaline salts.
Quinine nnd its salts are also incompatible with thin compound, Aaaprol
redacts febrile temperature and augments the secretion of urine. This sub-
stance lias renderod service in the treatment of intluenza. gaiit, asthma, boils,
carl>uncle8, tum^illitis, etc. Asaprol is of advantage in acute rheumatism,
and in chronic foi*ms of the disease it is useful in relieving pain. It is use-
ful, also, in atonic dyspepsia. This remedy has been employed as an anti-
pyretic in typhoid fever and pneumonia and as an analgesic in sciatica,)
intircnstal neuralgia, and tic doidorcaux.
ASCLEPIAS.— Pleurisy-root.
Preparation.
i
FliiiilfNtnifttiin Asclepiadia. — Fluid Extract of Aselopins. Do(it\ 1 to 4 ccm.
(or »ixv-f3j).
Pharmacology. — The root of Asclepias tuberosa (Asclepiadea?) containB
resin and fatty matter. Asclepiadin is a mixture of re^in and glucoside, pre-
cipitated from a strong alcolndic tincture by t!ie addition of cold water, or
tannic acid. It has been giveu in doses of 0.065 to 0.3'2 Gm. (or gr. i-v).
Physiological Action. — The infusion is used in the southern portion of
this country as a diaphoretic and expectorant; in large quantities it is emetic
and cathartic. It depresses the hearths action and increases the functional
activity of the skin and kidneys.
Therapy. — The recent infusion (31 Gm. to 473 c.cm., or 5J to Oj ; dose, a
wineglassful) is used in domestic practice for colds and pulmonary affectionB
of an inflammatory and catarrhal character. In diarrhix^a, dysentery, and
painful disorders of the stomach or bowels it is often eiTective. a very good
prescription being: —
B Fluidext. asclcpiadia 60 ccm. or fjij. ^M
Spt. vini gallici 30 c.cm. or f.^j. ^B
Syrup, rubi idasi 90 c.cm. or fjiij.
M. Sig.: A teaspoonful to a tablespoonful every hour or two, for diarrlKea and
dysentery.
As a diaphoretic, it is used in the exanthemata, in order to facilitate
the eruption and reduce the fever, and it is said to be advantageous in articu-
lar rheumatism, in controlling the inflammation and reducing the hearfa
action.
A decoction, made from the root-bark of Asclepias syriaca, also poa-
eesses diuretic properties, and has been found useful by Dr. G. D. McGauran
in the relief of renal dropsy. In cedema of cardiac origin it appears to be
of no avail, A tincture of the root of Asclepias verticiilata has a popular
reputation in the South as an antidote to the bites of venomous serpents
and insects, as well as in hydrophobia. Three hundred and si^cty c.cm. (or
ffixij) of a hot saturated decoction are said to relieve pain, produce perspira-
tion, and promote sleep.
ASEPTOL. — Sozolic Acid. A syrupy, dark liquid, freely soluble in
alcohol, water, and glycerin. It contains orthophenol-snlphonic acid (33 Vg
ASPIDIUM.
23?
I) diluted with water, and resembles carbolic acid in odor, though
It id less caustic, but is decidedly antiseptic, and is said not to be
When usi.'d, it is to be diluted ( 1 to 20 or more) for surgical practice.
ASPASjIGUS. — AsparagTis. The root of Asparagus officinalis (Liliaceie),
ibe& 'n^h, is used in decoction or infusion (31 to 62 Gra. tiD 473 c.cm., or
5^ to Oj) as a diuretic, laxative, and blood-purifier. The fre&h shoots are
Wtim food, and increase the flow of urine, while imparting to it a peculiar,
fanj odor: in some cases it has apparently caused congestion of the kidneys,
•all bstnaturia. Aspara|^, which is obtained principally from the root,
ttf af«d4tive action upon the circulation, reducing the force and frequency
tl thr heart's action, and causing frontal headache. The peculiar odor
CK^tted by urine passed after the ingestion of asparagus depends, in all
pniMbilitT, according to Professor Nencki, upon the presence of methyl-
vercsptan. This substance is thought to be produced in the albuminous
icnt^ration which accompanies the germination of the plant.
Xferapy. — Asparagus was believed by the ancients to have valuable
ijirodi*iac properties, and was used as an emmenagogue; the writer con-
sas the obserration of Ehrhardt, that a discharge resembling that of gonor-
iam or orethritis may be caused by eating asparagus. Asparagus is usually
■Kide*' '' iful in gonorrhcea. Though it increases or even excites scald-
81^ jfft -n appears to be very uncertain. Berkely Hill,^ in a series
iltvent . allowed one-half the number to eat asparagus and found
te »iii- i partake of it with impunity, while in others it produced
■E}ca»«d congestion and flow of discharge.
TH<* ingestion of asparagus^ therefore, causes, in some individuals,
fedftxirfaance of the functions of the kidney and a notable decrease in the
^MOttt of urine excreted. A fluid extract is used in doses of 4 to 15 c.cm.
It has been claimed that asparagus has special effects upon the uterus
• la oiTtocic after miscarriage, or in labor., A tincture (1 part of the dried
^ to 8 of proof-spirits) is used as a diuretic, in doses of 2 to 4 c.cm. (or
Oin": ^7 T>T. Jefferson, of England. Asparagin, in dosee of 0.13 to 0.20 Gm.
Ir ^ u may be used as a diuretic in dropsy, and, according to Whitla,
Wf^M.r i" act in gout like weak doses of colchicum. It is- also of some
KTice in cardiac dropsy, chronic rheumatism, and gout. The combination
flnnainn vriih one of the bromides for the latter affections in this pre-
* ■ is often of value: —
U JLMpmtmgin 1| Gra. or gr. xvj.
Sodii bromidi 19|4 Gm. or 3v.
SjTVp. aurantii 120| c.cm. or fjiv,
JL Si^.: Two tcaspoonfuls in wnter three or four times a day.
ASProrUH (V, S. p.).— Aspidium.
TTfTT MAS (B. P.).— Male Fern.
Do«e (in povder), 2 to 6 Gm. (or 3s3-is£).
Preparations.
tHuLf ■in fl AvpMii (U.S. P.). — Oleorefiin of Aspidium. Dose, 2 to 7JS o.om. (or
¥
"Tliraoic i;r«'t*»»"iti« and it* Trtfttment," I-ondon, 1890.
23G I'lIAHMACEUTICAL THERAPECTIC A0ENT8 OK DRCOS. ^H
tive to many forms of bacteria. It is administered in daily doses of 2 CHH
(or pr. xxx), gradually increasing to 4 Giii. (or 3j). Asaprol is incompati-j
ble witli alkaline idodidcp, sulpliatos, and witli most of the alkaline salts.
Quinine and its s:ilts are also imonipatible with this compound. Asaprol
reduofs feljrile tcniperature and luiguu-nls the secrelion of urine. This sub-
stance has rendered service in the treatment of influenza, gout, astlinia, boilS|
carbuncles, tonsiUitis, etc. Asaprol is of advantage in acute rheumatism,;
and in chronic forms of the disease il is useful iu relieving pain. It is use*
ful, also, in atonic dyspepsia. This remedy has bo<'n employed as an anti-
pyretic in typhoid fever and pneumonia and as an analgesic in sciatica,
intercostal netiral^ia, and tic ikiulorcaux. j
ASCLEPIAS.— Pleurisy-root. ^M
P Preparation. ^H
KhiidcxtrMftum AscIepindiB. — Fluid Extraft of Asclepias. Do»*». 1 to 4 c.cnu
(or mxv-fSj).
Pharmacology. — The root of Asclepias tuberosa (Asclepiadeee) contauiA'
resin and fatty matter, Asclepiadin ig ji mixture of resin and glucoside, pre-
cipitated froit) a stronj; ulcoiiolic tinclure l»y the addition nf cold water, or
tannic acid. It has been given in doses of U.065 to 0.3'si Gm. (or gr. i-v).
Physiological Action. — The infusion is used in the southern portion of
this country as a diaphoretic and expectorant; in large quantities it is emetic
and cathartic. It depresses the heart's action and increases ihe functional
activity of the skin and kidneys.
Therapy. — The recent infusion (31 Gm. to 473 c.cm., or Sj to Oj; dose, a
wineglassful) is used in domestic practice for colds and pulmonary affections
of an inflammatory and catarrhal character. In diarrhoea, dysentery, and
painful disorders of the stomach or bowels it is often effective, a very good
prescription being: —
B Fluidext. osclepiadia 601 ccm. or fjij.
Spt. vini gallici 30 c.cm. or fKj.
Syrup, rubi idai 90] c.cra. or fjiij.
M. Sig.: A teaapoonful to a tflblespoonful eveo' hour or two, for diarrhoea and
dysentery.
As a diaphoretic, it is used in the exanthemata, in order to facilitate
the eruption and reduce the fever, and it is said to be advantageous in articu-
lar rheumatism, in controlling the inflammation and reducing the heart'a
action.
A decortion, made from the root-bark of Asclepias syriaca, also pos-
sesses diuretic properties, and has been found useful by Dr. G. D. McGauran
in the relief of renal dropsy. In redema of cardiac origin it appears to be
of no avail A tincture of the root of Asclepias vorlieillata has a popular
reputation in the South as an antidote to the hites of venomous serpents
and insects, as well as in hydrophobia. Three hundred and sixty c.cm. (or
f^xij) of a hot saturated decoction are said to relieve pain, produce perspira-
tion, and promote sleep.
ASEPTOL. — Sozolic Acid. A syrupy, dark liquid, freely soluble in
alcohol, water, and glycerin. It contains orthophenol-sulphonic acid (33 Vt
ASPipiuM. 237
per cent) diluted with water, and resembles carbolic acid in odor, though
fainter. It is less caustic, but is decidedly antiseptic, and is said not to be
toxic. When used, it is to be diluted (1 to 20 or more) for surgical practice.
ASFABAGTJS. — ^Asparagus. The root of Asparagus officinalis (Liliacese),
when fresh, is used in decoction or infusion (31 to 62 Gm. to 473 c.cm., or
Ji-ii to Oj) as a diuretic, laxative, and blood-purifier. The fresh shoots are
used as food, and increase the flow of urine, while imparting to it a peculiar,
heavy odor; in some cases it has apparently caused congestion of the kidneys,
with haematuria. Asparagin, which is obtained principally from the root,
has a sedative action upon the circulation, reducing the force and frequency
of the heart's action, and causing frontal headache. The peculiar odor
emitted by urine passed after the ingestion of asparagus depends, in all
probability, according to Professor Nencki, upon the presence of methyl-
mercaptan. This substance is thought to be produced in the albuminous
disintegration which accompanies the germination of the plant.
Therapy. — Asparagus was believed by the ancients to have valuable
aphrodisiac properties, and was used as an emmenagogue; the writer con-
finns the observation of Ehrhardt, that a discharge resembling that of gonor-
rhcea or urethritis may be caused by eating asparagus. Asparagus is usually
considered harmful in gonorrhoea. Though it increases or even excites scald-
iiiff, yet its action appears to be very uncertain. Berkely Hill,* in a series
of twenty cases, allowed one-half the number to eat asparagus and found
that some could partake of it with impunity, while in others it produced
increased congestion and flow of discharge.
The ingestion of asparagus, therefore, causes, in some individuals,
a disturbance of the functions of the kidney and a notable decrease in the
amount of urine excreted. A fluid extract is used in doses of 4 to 15 c.cm.
(or 5i-iv).
It has been claimed that asparagus has special ef ects upon the uterus
as an oxytocic after miscarriage, or in labor., A tincture (1 part of the dried
tops to 8 of proof-spirits) is used as a diuretic, in doses of 2 to 4 c.cm. (or
tops-j) by Dr. Jefferson, of England. Asparagin, in doses of 0.13 to 0.20 Gm.
■or gr. ii-iij), may be used as a diuretic in dropsy, and, according to Whitia,
appears to act in gout like weak doses of colchicum. It is- also of some
service in cardiac dropsy, chronic rheumatism, and gout. The combination
of asparagin with one of the bromides for the latter affections in this pre-
scription is often of value: —
Gm. or gr. xvj.
]^ Asparagin 1
Sodii bromidi 19 4 Gm. or
Syrup, aurantii 120 c.cm. or fjiv,
M. Sig.: Two tcaapoonfulfl in ivater three or four times a day.
ASPIDIUX (U. S. P.).— Aspidium.
mix MAS (B. p.).— Male Fern.
Bote (in powder), 2 to 6 Gm. (or Sss-iss).
Preparations.
Oleoresina Aspidii (U.S. P.). — Oleoresin of Aspidium. Dose, 2 to 7.5 ccm. (or
B»ij).
' *M:hnMuc Urethritis and its Treatment/' London, 1890.
238
PHAKMACliLTJCAL TUKlUl'EUTiC AGENTS OK DIUTos,
Extractum Filicis Liquidum (B. P.). — Liquid Extract of Male Fern. Dose, 3 to,
fl c.cm. (or ffixlv-xc).
Pharmacology, — Aepidium is tlit* dried rbjy/iiiie of llie Dryoptfri:* FilLx-
nms aiid of Itn<»ptori8 uiarginalis (Filice^) (U, S. P.), and the rhizome
of Afipidiuru Filix-majH (B. P.). The 'Mnk' Fern, or lirvttptfris Fili\-nia&,
is found in ahiiost every portion of tlie world; the tiiar^inahB i» in-
digenous to Nortli AnnTJca, The rhizome, the portion oniploved (which
deteriorates on heing retained for a long time), lias a swwtisli-hitter, astrin-
gent taste, with wmie Hli^riit (»dfir. It etuitMiiifi an nelive priiiei|)le, Filicio
acid, a fixed and volatile oil, filix-tannie, and gallie aeids. Its virtues are
due Id the ethereal extract, or ole«rev*:in. The rhi/oniLM>f nolle fern eontainsin-
tereellnlar glaml^, whieh liold a greenish yeeretion. When seetions of this
are. preserved in glyeerin, crystnln are fornud, which are soluble in ether.
It is to this peeretion that the antheljnintie ipudities of the drug are due,
according to Lauren.^ The oleoresin of aspidium is a dark, thick fluid, of a
hitter and nauseous taste. Aee<^rding U> Professor Kol)ert its virtues do not
depend rntirrly upon the lilieie aeid pnvsent, Ijut iilso upon the ethereal oil.
From hin eheiuical and physitdogical invegtigatittnK E. Poulssori eonehides
that the crvHtaUiue suhstanee heretoffMe known as fdieie acid is really the
anhydride of the a*dd, nnil he pmposes to nail it Filicin. (hi standing, filicie
anhydride precipitates from preparations of male fern as a granular, white
powder without taste or flnu-lh insoluhle in water, but sojutde in boiling
flicohoL If tliese small crystals are dissolved in alkali aiul repreeipitated by
aeid, they litHome again rnnserted 1o the arttvt* form of filicie acid.
Physiological Action and Toxicology. — Agpidiuni possesses the power
of expelling, and perhaps destroying, ta^nige. Harley believes that it is only
able to detach the entozoon from the intestinal wall. It is especially active
against the bothriocephalns latus.
Large doses of the ethereal extract, or oleoresin, may occasion nausea,
vomiting, and choleraic diarrho?a, followed by death from the congestiorf
and inflammation of the gastrc^-intestinal tract by the irritant action of the
drug. In the Wiener Hinisrhe \Voche?ischrift is reported the case of a child,
5 Va years old, to whom 7.5 c.cm. (or foij) of the oleoresin were given, in
three doses, within one hundred minutes. In an hour and a half, part of the
tapeworm was expelled, then vomiting occurred, and somnolence, which was
followed by twitching, sopor, and trismus of ten minutes' duration, ending in
death five hours after the last dose of the extract.
A post-mortem examination of a case of poisoning and death from male
fern revealed congestion and ecchymoses of the stomach and blood-clots
over its surface. Poisoning from male fern should be treated by the admin-
. istration of magnesium sulphate and by the hypodermic injection of water
of ammonia, from O.tiO to 2 c.cm. (or mx-foss), properly diluted. Accord-
ing to Prevost and Binet, death usually results from paralysis of the heart,
which is found, after death, firmly -contracted and unresponsive to irritation.
Male fern generally reduces the amount of urine secreted.
Therapy. — As a tseniacide, the ethereal extract, or oleoresin, is the most
eflieient preparation, but being a thick, hitter, njist:H>us siihslanee, it is
best given in capsules. It can be given, but not so welL in milk or mucilage.
It can be acceptably administered with an equal quantity of aromatic syrup
' Therapmtische Monatshefi, April, 1899.
ASPIDOSPERMA. 239
of rhubarb. The doee should be preceded and followed by a purgative,
Cdomel may be given as a preliminary purge. A full dose of castor-oil, two
houis after the administration of the remedy, will usually bring away the
entire parasite. Trousseau and Pidoux advise the restriction of food to a
milk diet for a day or two previous to the institution of the treatment.
Whitla has found tiiat male fern is efficient among children, in a reduced
dose, when combined with turpentine.
This combination of male fern often acts well: —
Q OleorefliiuB aspidii, 21 ccm. or f3sa.
01. peponifl expreasi 15 ccm. or fjsa.
01. terebinthliuB 2| ccm. or mxxx.
M. 8ig.: Take at a doae after fasting, and foUow by a purgative.
Lanara claims good results from the application of male fern in eczema.
The formula which he employs is as follows: —
R Ext. filicis liquid! (B. F.) 281 ccm. or Sviiss.
Alcoholis 15{ ccm. or fjSB.
Ext. myrrh.,
Sxt. opit aa 4{ Om. or 3j.
H. Sig.: For external use.
In several cases of cysticercus disease, Dr. R. Feletti has observed im-
provement to follow the use of ethereal extract of male fern. The result was
especially favorable when the lesions were situated in the subcutaneous or
muscnlar tissues.
In Finland, the aspidium spinulosum is used as a tseniacide more fre-
quently than the official drug, as it is a more common variety in this region.
It was found to be equally efficient in doses of 1 to 4 Gm. (or gr. xv-lx) of the
extract, by Lauren and Schumann.
ASPIDOSFEBUA.— Aspidosperma (Quebracho).
Preparation.
Kluidextraetum ARpidospermatip. — Fluid Extraet of Aspidosperma. Dose, 2 to
4 cxm. (or f3sB-j).
Pharmacology, — The bark of Aspidosperma Quebracho-bianco (Apo-
t\Tiacese) : a large tree of Brazil. It contains six alkaloids, the most im-
fKjftant of which is Aspidospermine. The others are named Aspidosperma-
line. Aspidosamine, Quebrachine, Hypoquebrachine, and Quebrachamine,
It also contains tannin and two sugars (quebrachit and inosit).
Aspidospermine commercially consists of the mixed alkaloids of the
I'ark. It occurs in the form of colorless crystals, insoluble in water, moder-
ately soluble in alcohol and ether.
Quebracho is also found in Catamarea, of the Argentine Republic, where
it has a popular reputation as a febrifuge and antiperiodic. Another species,
the red quebracho, contains a large amount of tannin and less of the bitter
principles. It is used largely for tanning leather, and is sometimes mixed
with white quebracho as an adulteration.
Phynological Action. — Quebracho is bitter and stimulant to the salivary
elands, astringent to the intestinal tract. In large doses in animals it pro-
ducea paralysis of the limbs, of central origin.^ It also causes salivation,
paralysis of respiration, and diminished frequency of the heart's action;
» F. Penzoldt, Berliner klinische Wo€hen9chrift, No. 19, 1870.
240
PHARXLVCEUTIOAL TUEIUPEDTIO AOEXTS OH DRUGS.
death is caused by paralysis ami convulsions due to apncea. Moderate doses |
retard breathing, and make inspiration slower and fuller. Aepidospermino j
increases the respiratory movements in the higher animals by stimuiatingl
the respiratory centres. It is said also to cause an excess of oxygen to be
taken up by the red blood-cells, and may thus induce apnaa. In man it I
has no influence upon the temperature or the frequency of the pulse, but is
said by Hale to ''impart some tonicity to the heart/'
Therapy. — The special action upon the motor apparatus of respiration j
makes quebracho valuable in treating dyspncea of all kinds, whether bron-
chial, cardiac, or nervous. In emphysema, with or without asthma, it haa^
been very serviceable in the form of fluid extract, 1.20 to 2.50 c.cm. (or,
mxx-xl), several times a day. Quebracho is also of service in spasmodic
croup. Dr. Picnt states that it is advantageous to the respiration when taken
before hill-climbin-:. The effect of quebracho in relieving cyanosis Is very
marked. In the case of a child, suffering with double pneumonia. Dr. Law-
rence witnessed decided improvement of the respiration and circulation fol-
low the use of this remedy. This drug very sensibly diminishes the pulse
and temperature in acute rheumatism and inflammations of serous mem-
branes. An elixir, d wine (G per cent.), and a tincture (40 to 50 per cent.)
have also been used. The alkaloid, aspidospermine, has been employed as
a febrifuge, and, according to Guttraann, its dose as an antiperiadic is 1.20
Gm. (or gr. xviij), the ordinary dose being 0.005 to 0.13 Gm. (or gr. i-ij). It
is soluble in oils or 50 parts of pure alcohol. Bardet has given aspidosper-
mine in d^yspnuea with good results. In serious cases the drug can be well
administered by hyjmdcrmic injection, (^uclinuhine hydrochloride has been
given both by the mouth and by hypodermic injection for the relief of dysp-
nn?a,the dose employed being from 0.065 to 0.13 Gm. (orgr. i-ij). Triturates
of V,o and Vjoo of aspidosperniine (all the alkaloids) are also used. The solid
extract is a useful preparntinn for asthma, given in n.n(t5 Gm. (or gr. j) doses
three times a day. The fluid extract is no longer otlicial.
ASPmiN, or aeetyl-salieylie acid. (C„H,CO(J-Ht'U,CH,), is obtained
by heating acetic anlirdride with salicylic acid; it occurs in white,
crystaline uc^edlcs, which have a melting-point of I3b° C. (875° F.). It is
readily pohil)if in alcohol nud ether; not very s<^>liihle in cold water; but is
soluble in an acid solution like gastric-juice, and gives with ferric chloride,
a blue color.
Wnhl«reinuth^ reports his results in 10 casci; ButTering witli rheumatoid
manifestations; in 2 cases of acute rheumatism in which sahcyiic acid and
antipyrin had been used with negative results, aspirin was given in doses of
3 Gm. (or gr. xlv) daily; the patients improved almost immediately; pain
and swelling disappeared within a few days, without any gastric disturbance.
The remaining S cases were not true joint rheumatism; some had scarlet
fever, others diphllicria or angina; these patients were given 1 Gm. (or gr.
xv) three times daily for eight days without feeling any ill effects. The
action of aspirin on the rheumatio joint is identical with salicylic acid, and
is, according to this author, to be preferred to sodium salicylate, chiefly
because of its non-irritating character when administered by the mouth; it
should be given in powder, and not in a solution. Elbersou^ observed a
general epythema produced by five grains of aspirin. It nelded promptly
* Thcrap, llomtt.. No. 7, 3n04.
'Thcrap. \fonat., May, 1801).
d
AURiCNTII COBTEX. 241
to salines, and a dusting powder locally. Tinnitus aurium has been noticed
after its administration, and it often causes profuse perspiration. Occaflion*
ally it depresses the heart. It is recommended as a good antipyretic for la
grippe.
ATEOPIHA (U. S. P., B. P.).— Atropine (C„H„NO,).
ATBOFIKiB STTLPHAS (U. S. P., B. P.).— Sulphate of Atropine. (See
Belladon2La.)
AUBANTn AMABI GOBTEZ (U. S. P.). — Bitter Oran^re-peel. The
dried rind of the fruit of Citrus Amara, Citrus Bigaradia, and Citrus Vul-
garis (Rutaceae).
ATJEANTn BITLCIS COBTEX (U. S. P.): — Sweet Orange-peel. The
tmdried, outer rind of the ripe fruit of Citrus Aurantium (Rutaceae).
AVBANTn COBTEX BEGEKS (B. P.).— Fresh Bitter Orange-peel
"The fresh outer part of the pericarp of Citrus Aurantium."
AUBANTn COBTEX SICCATTTS (B. P.). — Bried Bitter Orange-peeL
"The dried outer part of the pericarp of Citrus Aurantium."
U. 8. P. Preparations,
Oleum Aurantii Corticis. — Oil of Orange-peel.
Fluidextractum Aurantii Amari. — Fluid Extract of Bitter Orange-peel.
Sympus Aurantii Florum. — Syrup of Orange-flowera.
Syrupus Aurantii. — Syrup of Sweet Orange-peel.
Tinctui^a Aurantii Dulcis. — Tincture of Sweet Orange-peel (20 per cent.).
Tinctura Aurantii Amari.— Tincture of Bitter Orange-peel (20 per cent.).
Spiritus Aurantii ComposituB. — Compound Orange Spirit. Used in making the
elixir aromaticum, and also the aromatic fluid extract of rhamnus purshiana.
Ellixir Aromaticum. — ^Aromatic Elixir.
Aqua Aurantii Florum.— Orange-flower Water,
Aqua Aurantii Florum Fortior. — Stronger Orange-flower Water.
The dried ped of bitter orange enters into the U.S. P. compound. tinctures of
cinchona and gentian. Orange-flower water is used in syrup of calcium lactophos-
phate.
B. P, Preparations,
Aqua Aurantii Floris. — Orange-flower Water,
Sympus Aurantii. — Syrup of Orange. Dose, 2 to 4 com. (or fSss-j).
Syrupus Aurantii Floris. — Syrup of Orange-flower. Dose, 2 to 4 ccm. (or
f3»-j).
Tinctura Aurantii. — Tincture of Orange. Dose, 2 to 4 ccm. (or f3ss-j).
Inlufum Aurantii. — Infusion of Orange-peel (dried bitter orange-peel, 6 Gm.;
boitiiw distilled water, 100 ccm.). Dose, 15 to 30 ccm. (or fjss-j).
InfuBum Aurantii Compositum, — Compound Infusion of Orange-peel (orange-
peel and lemon-peel, with cloves, in boiling distilled water). Dose, 15 to 30 ccm.
(orf5»-j).
Vinum Aurantii, — Orange- wine (wine made by the fermentation of a saccharine
■olution to which fresh bitter orange-peel has been added; 10 to 12 per cent, of
aleohol).
The dried bitter orange-peel enters into the 6. P. compound spirits of horse-
radish, and compound tinctures of cinchona and gentian; the tincture of orange into
aromatic syrup, and aromatic syrup of cascara.
242
PHARUACErTICAL THEBAPEUXlC AOEKTS OR DRUGS.
Fharmacolo^. — The United States Pharmacopoeia preparations are
obtained from tlie bittor, Citrus auiara, Bigaradia^ or Vulgaris, and from
the sweet orange, C'ilrufi aurantium (Aurantiacetv) : the fruit of small trees
vhich ^iinv in warm regions of the East<-*rn and Western Hemispheres. The
British Plianna(H)jKeia j>ri'p:)nitiuns are made from the outer part of the I
poriearj> of the Citrus Aurautium.
Therapy. — Urange-juicc, with water and suji^ar, may be used as a drink
for fevers and as an antiscorbutic. Care should be taken, after typhoid
fever, not to allow ehildren to suck the juice from the orange, as death has
been caused by the passage of a seed through an ulcerated patch in the in-
testine. Death has also been caused by a child's eating the heah rind, which
contains the volatile oil. Erythema, a^dema, vesicles, and pustules may be
occasioned by paring bitter oranges. The elixir is an agreeable vehicle for
other reniedieSj having the alcoholic strength of a cordial. The other prepa-
rations are pleasant Havoring agents.
AUEI ET SODH CHLOEIDITM (TJ. S. P.).— Gold and Sodium Chloride
(AuCl, + NaCl).
Dose, O.Oai to O.OOG Gm. (or gr. Vso-Vio)-
Pharmacology. — A mixture composed of equal parts, by weight, of dry
gold chloride and dry sodium chloride, containing not less than 30 per
cent, of metallic gold. On account of its position among metals, gold has
been credited with having some special medicinal value, altliough not a nor-
mal constituent of the human body. It is practically non-corrosive, and
was formerly used to some extent to protect instruments from rusting.
In a pure state, gold is too soft for most purposes, although it is the best
material for wire and for filling teeth. The only gold preparation official is
the gold and sodium chloride. This forms an orange-colored powder,
slightly deliquescent in the presence of dampness, freely soluble in water.
It is easily deconipoBed by sunlight and by or.iianic mattcrj and is best dis-
pensed as a tablet triturate. Lainer has recently prepared a gold and potas-
sium chloride by dissolving pure gold in aqua regia by the aid of heat and
adding a concentrated solution of potassium chloride. The compound is
said to be stahlc and neither acid nor deliquescent, but no clinical reports
of its use have yet been made.
Physiological Action. — The effects of the gold and sodium chloride re-
semble those of the mercuric chloride. It has very decided bactericidal
powers. According to Sternberg, a solution of 1 to 40,000 restrain the
growth of anthrax bacillus, and one of 1 to SOOO destroys it. This statement
has been questioned by L. Hektoeu. who fonnd that 1 to 40,000 delayed the
growth, but that 1 to SOOO did not destroy it. A strength of 1 to 1000 de-
stroys the bacillus of diphtheria and 1 to 500 the bacillus of typhoid fever.
Gibbes and Shurley demonstrated its bactericidal power against bacillus
tuberculosis by physiological experiments upon animnls.* In concentrated
Bolntion it has an eseharotie action upon tlie skin. Internally, in very small
doses, it nets upon the giaudular structures of the stomach nnd liver, — stimu-
lating nutrition and assimilation ; but, in larger doses, it produce? violent
gastro-onteritis. witliout uleeratii^n or salivation. These svmptonis have
been produced in an adult by 0.0*i5 Gm. (or gr. j), and this same dose has
^ Thcrapcutio Gozftte, April 15. 1801.
AUBI £T 60DII CHIX)RIDUH. 243
produced death in a dog in four minutes, as reported by Daniel R. Brower.*
In ansemia it increases the percentage of hsemoglobin and the number of red
blood corpuscles, but large doses reduce the oxidizing power of the red blood-
cells. Large doses excite salivation, but do not affect the teeth, cheeks, or
gams. This salt exercises a constipating effect upon the bowels. Upon the
brain and spinal cord its effects are those of a tonic. In some instances it
produces decided mental exhilaration. When its use has been too long con-
tinued it gives rise to what has been termed "auric fever,** a condition charac-
terized by profuse sweats and an increase of saliva and urine. The remedy
acts upon the kidneys, increasing the urinary flow, and the secretion, after
large doses, is colored yellow. Renal hypersemia with albuminuria is caused
by toxic doses. It is claimed that gold has aphrodisiac powers, causing pain-
ful erections in men and increasing the menstrual flow in women. Gold is re-
moved from the body chiefly by the kidneys, but to some extent also by the
liver and bowels. For the gastro-enteritis, vomiting, etc., similar to corrosive
chloricle of mercury, caused by large doses, the antidote is albumin and
demulcents.
Therapy. — From the physiological action upon the glandular system of
the stomach and liver, and the resulting improvement in the powers of as-
dmilation, gold may be especially valuable in atonic dyspepsia, enabling the
p&tient to digest more food. It is of decided service in nervous dyspepsia.
Mso, in gastric catarrh, chronic inadequacy of the hepatic functions (torpid
liver), and early stage of cirrhosis, the gold and sodium chloride is a useful
remedy. Administered in this prescription, it often is most effective in gas-
tric catarrh and torpid liver; —
03 Gm. or gr.
Gm. or I
Gm. <« !
Q Ami et sodii diloridi
Ext. nuclB vomicsB
Est. tAraxad 4
M. et ft. pU. na xzx.
Sig.: Two pills three times a day.
20 Gm. or or. iij.
In cirrhosis, of the kidney, and albuminuria due to interstitial nephritis,
iccording to MiDard, it has a special place. Culbertson reports relief of a
case of albuminuric retinitis from gold and sodium chloride. This salt is
beneficial in arteriosclerosis and the vertigo of the aged dependent upon
atheromatous vessels, and also in vertigo due to indigestion. It is useful
in hysteria and functional impotence. In spasmodic affections (whooping-
cough, laryngismus stridulus) it has some advocates. Where amenorrhcea
or dysmenorrhoea is due to deficient innervation, and not to local lesion or
obstruction, this remedy has given good results, and also in habitual abortion.
Uncomplicated chronic ovaritis is benefited by the administration of gold.
The double salt is also said to afford relief from ovarian neuralgia. Follow-
ing out th€ physiological action, we find that, in spinal sclerosis, premature
senility, in depression and hypochondria, it has a high degree of efficiency.
This remedy has also been given with advantage in neurasthenia, progressive
general paralysis, utero-ovarian c(Vng€stion, menorrhagia, subacute metritis,
Dymphomania, and spermatorrhoea. Dr. John Strahan, of Belfast, suggests
that it may be useful in insomnia dependent upon cerebral ansemia. In the
treatment of impotence, Professor Glenn, of the University of Tennessee, has
fonnd the following combination of service: —
* Journal American Medical Aasociationj Oct. 1, 1899, p. 754.
244
PHAEMACEITICAL THERAPEUTIC AGENTS OB DRUGS.
I^ Auri et sodii chloridi
Strychnin. Bulphat
Zinci phoephidi
Ext. dumiausB 4
M. et ft. in capsulas no. xxx.
Sig.: One capsvle thrice daily.
20 Gm. or gr. iij,
0^ Gm. or gr. j.
20 Gm. or gr. lij.
Gm. or 3j.
Gold and sodium chloride is, in some cases, an efficient substitute for '
mercuric chloride in the treatment of syphilis, and it has been given in this
combination, where there was an undue susceptibility to mercury, with de- \
cided benefit: —
^ Auri et sodii chloridi
Ext. eaDguin9.riffi
Ext. calumbfe 2
M. et ft. pil- no. xxx.
Sig.: One pill three times a day.
065 Gm. or gr. j.
13 Gm. or gr. ij.
Gm. or gr. xxx.
Gold also proves of avail in the late manifestations of syphilis, and is
sometimes effectual, after failure of the mixed treatment by means of mer-
cury and iodine, or when these remedies cannot be borne on account of
idiosyncrasy or debility. It has been of service in ulcerations of the throat,
laryngitis, oza?na, diseases of the bones, and syphilitic cachexia. Dr. J. A.
Bobinson reports two cases of diabetes mellitus in which gold and sodium
chloride caused a steady decrease and final disappearance of glycosuria. In
hypochondria and melancholia the double sM is highly recommended. In.
one case of pyelitis. Dr. G. Frank Lydston, of Chicago, found the h3^podeTmic
injection of gold and sodium chloride to produce decided improvement.
Gold chloride is useful in the treatment of chronic tobacco poisoning and
morphine addiction.
From the results of fifty-two experiments made upon various species
of warm-blooded animnls, Cnlmette concludes that the subcutaneous injec-
tion of gold is antidotal to the poison of the cobra di capello. He believes
that the venom may be neutralized, even after it has been absorbed, and
that the treatment' may be successfully applied to human beings. His
method is to cast an elastic ligature around the limb, to inject 7.50 to 9.25 ;
c.cm. (or f3ii-iiss) of a l-per-cent. solution of gold chloride into the wound '
and beneath the surrounding skin, not more thnn 1 c.cm. (or mxv) being
deposited at any one spot. Injections are also made at the level of the liga-
ture as well as between it and the heart. The solution may be thrown either
into the connective or muscular tissue. As soon as the injections have been
made, the ligature may be removed. The method merits trial in the case of
bites from other venomous serpents, since, as Weir Mitchell has shown, the
poisons are substantially of the same chemical composition. |
In appropriate cases this salt may be given under the skin. Thua
Gibbes and Shurley^ have reported successful results in twenty-seven cases
of pulmonary tuberculosis, by gold and sodium chloride given hypodermic-
ally, in doses of 0.003 to 0.01 Gm. (or gr. Vso-V*)^ during three to eight
months. Pepper also reported a case of phthisis apparently cured by this
drug.^
Dr. Joseph Drzewiecki reports the cure of a case of lupus by the internal
» Loc. Ht.
* University Medical Magazine, Dec., 1896.
BALSAMUK PEBUTIANUM. 245
administration of the same salt in the dose of 0.0003 6m. (or gr. V150) three
times a day.
AVEHA. — Oat, the fruit of Avena sativa (Gramineae), is used as a food
in the fonn of meal, of which cakes, gruel, or norridge is made. It is a
highly-nutritious food, containing oil, nitrogenized principles, carbohydrates,
phosphates, etc.; but on account of its concentrated form and the presence
of irritating fragments of the outer coat, containing silica, oatmeal is likely
to cause indigestion, and in young children diarrhoea. The habit of eating
porridge with milk and large quantities of sugar is apt to cause sour stomach
and pyrosis, which may be avoided by using butter or cream and salt instead
of the milk and sugar. Skin eruptions have been attributed to the use of
oatmeal, particularly eczema, in infants, which are cured by a change of diet.
An alcoholic tincture of oats has been supposed to have a sedatiTC action upon
the cerebral centres and to remove the craving for drink. For the latter, it
Tould be more rational to recommend an infusion than a tincture.
AZEDAKAGH.— Asedarach (Pride of China). The dried root-bark
of Melia azedarach (Meliaceae) is used in our Southern States in the form
of a decoction (124 Gm. to 946 c.cm., or 5iv-0ij, boiled down to 473 c.cm.,
or Oj), as a vermifuge, in cases of round worm 15 c.cm. (or f^ss) being
given to a child every two or three hours until the bowels are freely moved.
Large doses may cause vertigo, dilated pupils, and stupor. A fluid extract
has been also used (dose, 4 c.cm., or fSj), but the fresh decoction is the best
preparation.
BAISAKUK CAKADEITSE.— Canada Turpentine. (See Terebinthina
Canadensis.)
BALSAWIM PEEUVIANUM (U. S. P., B. P.).— Balsam of Peru.
Doie, 0.30 to 1 c.cm. (or mv-xv).
Pharmacology, — A balsam obtained from Toluifera Pereirae (Legu-
minosae) TJ. S. P.; Myroxylon Pereirae (B. P.) : a tree of Central America.
It is a brown, heavy liquid, of fragrant odor and a warm, rather acid taste,
containing resin, volatile oil, and both benzoic and cinnamic acids. It is
inflammable, burning with a white sinoke and fragrant odor. It is entirely
soluble in 5 parts of alcohol, and should not diminish in volume when agi-
tated with an equal bulk of benzin or water. The National Dispensatory
states that the balsam contains 60 to 64 per cent, of benzyl benzoate (C7H5
C^H.Oa), a colorless oil, vanillin, cinnamic acid, benzyl cinnamati, and 30
to 38 per cent, of resin, composed of benzoic and cinnamic esters of peru-
Tt^ino-tannol,
Physiological Action and Therapy. — Peruvian balsam is carminative,
stimulant, and expectorant. It has been extolled in Europe by Landerer
tnd Schnitzler in phthisis pulmonalis and chronic bronchial catarrh, given
in capsules or emulsion, and also used in an inhaler. Professor Landerer
has convinced himself that the virtue of balsam of Peru in tuberculosis de-
pends upon the presence of cinnamic acid, which he has of late employed in
place of the balsam. The cinnamic acid of which he makes use, however, is
obtained from storax. It is colorless, crystalline, feebly soluble in cold water,
freely soluble in hot water, alcohol, and warm oil. A 6-per-cent. emulsion
of the acid is prepared with almond-oil, yelk of egg, and normal salt solu-
246
rilAHMACLlTICAL THERATECTIC AGEKTS OR DBUOS.
tion. Before use, the emulsion must be rendered alkaline by a few drops of
a 25-per-cent. solution of liquor potassae. The emulsion is preferably thrown
into a vein. The method is not applicable to the later stages of pulmonary
tuberculosis. From 0.12 to 0.37 c.cm. (or mii-vj) of the emulsion are in-
jected twice a week. In lupus, Landerer employs an alcoholic solution of 1
part of cinnamic acid, 1 part of cocaine hydrochlorate, and 20 parts of alco-
hol., 0.06 to 0.12 c.cm. (or nii-ij) being injected into the nodules till 0.60
c.cm. (or mx) have been used at one seance. At the end of a week the pro-
cedure is repeated. As it is a deodorant and antiseptic, it is useful as a local
application to open wounds and compound fractures, and also in the treat-
ment of oziena and old ulcers. In uterine affections we may u^e: —
R Todoformi 1515 Gm. or 3iv.
Balsflmi Peruviani 7 6 c.cm. or fSij.
Adipis lanse liydrosi 62| Gm. or 5ij-
M. Sig.: For local application on absorbent cotton or carded wool.
In infantile eczema we may prescribe: —
B Acidi borici 21 Gm. or 3sa.
Balaami Peruviani GO c.cm. or mx.
Adipis lana' hydrosi 3l| Gm. or 5j.
01. amygdalte expressi q. s. ft. ungt.
M. Sig. : Apply frequently upon soft linen.
Balsam of I'eni, pure or in an ointmontj is an efficient application Tn"
pruritus of the vulva and senile ]>ara'sthesia. It is likewise efficacious in
scabies. Lcucoplakin, or local epithelial thickening of the mucous mem-
brane, is removed by applications of Peruvian balsam; in leprosy it may be
thorou^hlv rubbed into the affected areas. It is also a good local application
for diphtheria. The internnl use of Periivian bnlsam hns been recommended
by Tnvusseau and Pidoux in chronic intestinal catarrh and typhoid fever.
Nuggia has found it sen'ieeahle in the gastro-intcstinal disorders of child-
hood. The e.xtornal application of balsam of Peru has, in some instances,
been followed by an erythematous, urticarial, or eczematous eruption. Dr.
Lohaus has reported a case of fatal gastritis in a six-dny-old babe caused
by balsam of Peru which had been applied to the mother's nipples on account
of fissures.
BAISAMUM TOLUTANUM (U. S. P., B. P.).— Balsam of Tolu.
Dose, 0.32 to 1 Gm. (or gr. v-xv).
Preparations,
Tincturn Tohitnna (U. S. P., B. P.).— Tincture of Tolu (20 per cent.). Dos©,
2 to le.cm. (or fSss-j).
SyrupuB Tolutanus (U<S. P., B. P.),— Syrup of Tolu. Dose, 7.5 c.cm. (or f3ij)
or more. B. P., 2 to 4 c.cm. (or f3as-j).
Tinctura Benzolni Coinposita (U. S. P., B, P.). — The compound tincture of ben-
zoin contains Tolu. Dose, 1.30 to 4 c.cm. (or fmcx-iZ}).
Pharmacology and Therapy, — A balsam obtained from Toluifera Balsa-
mmn (Legiiminosje; U. S. P.); Myroxylon Toluifera (B. P.): a tree of New
Granada. It is a resinous exudation, which yields 7 per cent, of an acid,
aromatic, oily liquid, chiefly benzyl lienzrijilp, with a little benzyl cinnaraate
Also 0.5 to 1 per cent, of a volatile oil, chiefly Tolene, and 75 to 80 per cent,
of resin. It has an agreeable odor and taste.
BABII CHLORIDUK. 247
Balsam of Tolu ia, when fresh, a thick, viscid fluid, but is, in time, con-
verted into a hard, translucent solid. It is slightly antiseptic and expecto-
rant; the ayrup is a favorite basis for cough-mixtures, chiefly on account of
its pleasant taste. The balsam itself may be administered in emulsion with
egg or mucilage. It should not be used during acute attacks of inflamma-
tion. The syrup coven the taste of chloral or croton-chloral.(Brunton).
BAPTISIA. — Wild Indi£^. The root of Baptisia tinctoria (Legu-
minosae), indigenous to North America. Bapttsin, an impure resin, is con-
sidered to have cholagogic properties (dose, 0.065 to 0.32 Gm., or gr. i-v),
and has been found of service in amenorrhoea. The decoction or fluid extract
may be used as a cathartic in large doses, or tonic astringent in small. In
n-pboid fever and bowel disorders, small doses of a tincture have been used,
but not according to the best practice. The decoction may be employed as
a douche in nasal catarrh, chronic ulcers, leucorrhoea, etc., or as a mouth-
vash in stomatitis.
BABn CHLOBISTrK. — Barium Chloride* Barium, in its action upon
the blood-vessels, resembles both ergot and digitalis. It causes the cardiac
contractions to become more slow and forcible. Tonic spasm of involuntary
muscular fibre is produced, peripheral blood-vessels are constricted, ana
blood-pressure rises. Peristalsis is likewise excited. Overdoses give rise to
salivation, thirst, vomiting, purging, embarrassed breathing, slow pulse,
dilated pupils, and paralysis of the extremities. In experiments upon ani-
mals Pilliet and Malbec found that barium chloride, injected subcutane-
onsly in toxic doses, caused diarrhoea, albuminuria and haemoglobinuria, and
convulsions, followed by rigidity. After death lesions were found in most of
the organs. The glomendi of the kidneys were particularly affected, .and
hemorrhages into the straight tubes were also observed. According to M.
Bardet, barium chloride occasions coagulation of the blood, and death results
mechanically from embolism. Death has occurred in consequence of 0.17
Gm. (or gr. iiss), the quantity not having been taken in one dose, but in
daily portions of 0.015 Gm. (or gr. Va)- The symptoms of intoxication mani-
fested themaelves at the end of a week. This, however, must be regarded
as an exceptional case. The drug, in small medicinal doses, is devoid of
active poisonous properties. Barium chloride is a white, crystalline sub-
stance, of a bitter and disagreeable taste, readily soluble in water. This salt is
scarcely soluble in absolute alcohol, hut dissolves in rectified spirit. The
sulphates are incompatible with the salts of barium. In cases of poisoning
the sodium, or magnesium, sulphate, with white of egg, may be used as
antidotes. Usual dose is 0.006 to 0.03 Gm. (or gr. Vio"Va) ^^ solution.
Therapy. — Barium chloride may be used as a cardiac tonic in valvular
insnfficiency with irregularity of the heart. The late Prof. Da Costa ob-
serred that, in these conditions, ii^ relieves pain and the sensation of un-
easineas, acting as a fairly good diuretic and capable of being given for a
considerable period without disturbing digestion. In minute doses it is a
stimulant and alterant, and mav be used in scrofula.
Prom an administration of this salt to seventy-six children, Lelli con-
dndes that it is efficacious in the gastritis which accompanies the torpid
form of scrofula, but that it is injurious in the florid form. In the begin-
ning, the remedy irritates the mucous membrane of the bowel and renders
248
PlLUllIACECTICAL TUEUAPEL'TIC AOEVTS Oil DUIOS.
the process more acute, but the membrane is iinally favorably modified.
Barium has been recommended likewise in chlorosis and in cachectic con-
ditions. In amenorrhoea it has been given with advantage. It has yielded
good results in varicose veins and aneurism. It alTords relief to the vascular
phenomena of exophthalmic goitre.
An ointment of barium chloride (V, to 1 per cent.) has been used for
reducing enlarged glands.
BAEn PIOXIDUM (Xot Oflicial).— Barium Dioxide (Ba03).
Preparations.
Aqua H^rdrogenii Dioxidi (U.S. P.)* — Solution of Hydrogen Dioxide, or Peroxido
of Hydrogen. Three per cent, by weijflit of pure lU*j, ti^uivjilenl Il> ten volmiu'S of
avnihible oxygen.
Liquor Hydrogenii Pcroxidi (B. P.). — Solution of Hydrogen Peroxide. Dose, 2
to 7^ c.cm. (or fSss-ij).
The dioxide, or peroxide, of barium should be anhydrous and kept in
vell-cIosGd vepsels. It is used in the manufacture of the solution of bleach-
ing liquid, or dioxide of hydrogen, now entering largely into use for medical
and Burgical purposes.
Pharmacology. — The commercial dioxide of hj'drogen is a colorless so-
lution of this agent in water. It is, when undiluted, a syrupy fluid, destitute
of odor, of a harsh, slightly-acrid taste, has a specific gravity of 1.45, and is
of very unstable composition. Its formula is H.O., and it decomposes into
water and nascent oxygen, yielding 475 times its own volume of oxygen and
leaving behind 1 vohime of water. The freshly prepared oflicial solution con-
tains about 3 per cent., by weight, of the pure dioxide. This dilution is a
clear fluid, having but little odor or taste, and is of a slightly-acid reaction,
corresponding to «boiit 10 volumes of avnilablo oxygen. Another stn^ngth
employed by surgeons is called the IS-volnme solution, becfluse each portion
of the solution yields 15 volumes of the oxygen. It is an active oxidizing and
antiseptic agent. As it grsdually decomposes it must be kept in a cool place
and in loosely-stoppered bottks in order to prevent explosion.
Physiological Action and Therapy. — The solution of hydrogen dioxide
destroys pus and the micro-organisms, which excite suppuration, and coagu-
lates the albuminoid components of the inflammatory products. It has also
the property of checking fermentation. It is destructive to the pathoge-
netic micro-organisms and is an excellent agent for purifying drinking-water.
Dr. Jakovleff has asccrtnined by experiment that the solution of hydrogen
dioxide increases the general acidity of the gastric juice and the proportion
of free hydrochloric acid, but diminishes the amoimt of lactic acid. It pro-
duces a marked incrense of the digestive power of the gastric juice. When
pure and of official strength, it is free from irritating qualities, and can be
poured over wounds, injected into sinuses, or into the ear, or used as a spray
in ulcerations of the pharynx and of the larynx. It produces a frothinj? up
when it encounters pus, owing to the liberation of oxygen, and the cessation
of this commotion indicates the removal of all the pus. The surface of the
woimd or ulcer becomes blanched, but is not injured by the application.
As a rule, the fluid exerts an aualgesic elTect upon the surface with which it
is brought into contact. Tubercular and memjnar}' abscesses especially are
BABII DIOXIDUM. 249
▼ell treated in this way. Boils, carbuncles, fdons, and ulcers are improved
and their pain assuaged by the use of this remedy. Unhealthy or poisoned
wounds and phlegmonoiis erysipelas receive decided benefit from the use of
hydrogen dioxide. This solution is a beneficial application in cases of senile
gangrene, phagedena, and syphilitic ulceration. It is peculiarly adapted for
injection into cavities, fistulas, and sinuses communicating with bones or
joints. This fluid, moreover, possesses the valuable property of disintegrat-
ing carious or necrosed bone, and is, therefore, of service in hip-joint disease.
Granular pharyngitis and stomatitis are benefited by the same application.
It has been utilized with advantage for the purpose of disinfecting cavities
in carious teeth, in the treatment of abscesses of the alveoli or antrum, and
for bleaching discolored teeth.
For the last-named purpose it is made into a naste with chalk or cuttle-
bone. It enables the dentist to blanch and fill at tne same sitting a sensitive
pulp or cavity. Dr. H. F. Brownlee, of Danville, Conn., made use of hydro-
gen dioxide with marked advantage in a case of empyema which was char-
acterized by the excessive amount of pus evacuated from the pleural sac.
For comedones, Unna advises the use of a preparation containing from
20 to 40 parts of hydrogen dioxide, 10 parts of lanolin, and 20 parts of
vaselin. The application of the liquid is also of avail in acne. Hydrogen
dioxide, on account of its bleaching properties, may be used to decolorize the
dark lanugo hairs which not infrequently disfigure the faces of women.
M. Gallois prefers hydrogen dioxide to tincture of iodine, as a parasiticide
application in pityriasis versicolor. It is also effective in trichorrhexis
barbae.
Dr. Golovin commends the action of hydrogen dioxide in various dis-
eases of the conjunctiva and cornea. In ulcers, of the cornea suppuration
is diminished and healing promoted. Infiltrations undergo absorption. The
remedy is of value in hypopyon, and may render operative interference un-
necessary. Hydrogen dioxide is likewise beneficial in phlyctenular conjunc-
tivitis and acute gonorrhoeal ophthalmia. It has been used with good results
in dacryocystitis. It is serviceable in suppurative diseases of the ear. Hy-
drogen dioxide has given very favorable results in the treatment of mastoid
disease, being doubly beneficial by virtue of its action, both upon the pus
and the bone. Care should always be taken to provide a free outlet for the
frothv discharge caused by the peroxide, or pain will be increased and pus
may be driven deeper into the attic and cells, and extend the infection.
In ulcerative tonsillitis, fetid breath, and in some bronchial affections,
a spray of dilute hydrogen dioxide is productive of benefit. A spray of this
agent is likewise of utility in chronic nasal catarrh, ozaena, and scarlatinal
anjrina. It should be made alkaline before using. Hydrogen dioxide is a
useful application in mercurial and other forma of storaatitiB, and is also
Used as a disinfectant of the mouth during febrile and wasting diseases.
In diphtheria and croup its value has been established; a 2-volume
lolntion is specially recommended in young children as a local application,
and particularly after separation of the membranes in order to remove the
odor and disinfect the surface.* It is stated by Dr. A. Jacobi, of New York,
that in certain instances even a weak solution proves irritant to the throat,
abrades the mucous membrane, and that it, consequently, sometimes proves
»Dr. E. R. Satiibb, "On the Medical Uses of Hydrogen Peroxide," Qaillard'9
MtdUsal Journal, March, 1889.
250
PHAHMACEUTICAL. TKEIL^PELTIC AGENTS OR DHU08.
detrimental in diphtheria and must be abandoned in such cases. In gyna-
cological practice this remedy has effected improvement in vaginitis and
endometritis, and in chronic cystitis. It may be beneficially employed, like-
wise, in septic conditions resulting from abrasions or wounds of the female
genital tract. It has been used with success in the treatment of gonorrhoea,
of both sexes. It is thought to be especially valuable in the chronic form
of the disease. Dr. Willard Parker Worster, of New York, has obtained good
results from the treatment of chancres by hydrogen dioxide. The ulcer was
sprayed every day and in the interval kept covered with iodol.
In surgen* of llie nose, hydrogen dioxide is urkI as a styptic. It is
also of advantage in the treatment of passive hjemorrhages. It may be em-
ployed in the form of a spray for the relief of pulmonary hicmorrhnge, or
injected in cases of hcematuria and hfemorrhages of tlie lower bowel. Spray-
ing the post-nasal passages with a 1- or 2-per-cent. solution, combined with
an alkali, will generally check epistaxis, even of severe typc.^ In carcinoma
of the rectum or uterus it relieves pain and cleanses the diseased surfaces.
The use of a spray of a 10-volume solution is recommended as a disinfectant
of the sick-room in case oi eruptive fevers and other infectious diseases.
It has been administered, well diluted, in gastric affections, and has
been found useful in flatulent dyspepsia, heartburn, catarrh of the stomach
and bowels, etc. It would probably be of service in the treatment of gastric
ulcer. It has even ameliorated the symptoms of cancer of the stomach.
Hydrogen dioxide, combined with tannin and injected into the intestine, is
beneficial in chronic dysentery. Irrigation of the bowel by means of liquid
soap, potash, and glycerin, combined with the internal administration of
hydrogen dioxide, was found by Dr. Elmer Lee to yield favorable results in
Asiatic cholera. In cholera nostras, typhoid and yellow fevers, the use of
this agent either by irrigation or by the mouth promises to be of superior
efficacy.
Sir Benjamin Ward Richardson, of London, has employed this agent
for more than thirty years, beginning at a time when it was regarded as a
chemical curiosity. He has reported a case cf epilepsy of long standing cured
by the use of 7.5 c.cra. (or f."5ij) of a 10-volume solution twice daily in water.
He advises a systematic trial of this remedy in epilepsy, especially in the
Jacksonian variety. From a number of formula which have been published
by Dr. Richardson the following have been selected: —
It Acid, tannie |0^
Glycerin 30
Sp' vini rectificat 15
Aq. deatiUat 120
Aq. hydrog. diox. (10 vol.) q. a. ad 240
M. Sig.: An antiseptic and astringent gargle.
B Aq. hydrog. diox. (10 vol.).
15]
Acid, tannic, pur |32 Gm
Aq. rossB q. b. ad 2401
M. Sig.: A useful colljrium.
B Aq. hydrog. diox. (10 vol.) 75
Acid, sulphuric, dil 2
Glycerin 16
Aq. destillat q. a. ad 180
*3:
Sib
M. Sig.: Dose: two tablespoon hi Is, well diluted,
colliquative sweating of phthisis.
Gm.
or
PT- X.
com.
or
m-
c.cm.
or
ilSB.
c cm.
or
fjiv.
c.cm.
or
fSviij.
c.cm.
or
f3iv.
Gm.
or
gr. v.
c.cm.
or
fjviij.
e.cm.
or
f.?iis8.
c.cm.
or
fSas.
ccro.
or
fSaa.
c.cm.
or
fSvj.
An excellent mixture in the
' \itc York Medical Journal Nov. 25, 1892.
BELLADONNA. 251
Q Aq. hydrog. diox. 751 c cm. or fJiiBB.
Liq. morphm. hydrochlor. 4| c.cm. or f3j.
Syr. tolutan 22 c.cm. or fSvj.
Aq. desUU q. 8. ad 180| ccm. or fSvj.
M. Sig.: Dose: one ounce, diluted with iced water. Recommended in astiienie
broochitiA and phthisis with severe cough and sleeplessness.
3 Aq. hydrog. diox 761 com. or fSilas.
Syr. codein 7|5 ccm. or f3ij.
Sp. vini rectificat.,
Glycerin aa 221 ccm. or tSrj.
Aq. deetillat. q. e. ad 180] ccm. or fSvj.
11 Sig.: Dose: one ounce in iced water. A palliative of decided value in dia-
betes, giving much better results than codeine alone.
B Aq. hydrog. diox 76
Acid, phosphor, dil. 4
Syr. ferri superphos 22
c.cm. or fSiiss.
ccm. or f3j.
ccm. or f3vj.
Glycerin. 30 ccm. or fjj.
Aq. destiU. q. a. ad 180 c.cm. or fS^j-
H. Sig.: Dose: one oimce in iced water. Recommended in asthenic cases. Used
vitb advantage in the early stages of phthisis.
Fyrozone. — Thia name has been given to different standard solntions
of hydrogen dioxide in water and ether. Medicinal pyrozone contains 3
per cent, of hydrogen dioxide in water. It is used internally and externally
as an antiseptic remedy. Antiseptic pyrozone is a 5-per-cent. solution in
ether, and is recommended as an application to ulcers, rhinitis, and diph-
theria. In this strength pyrozone is used by dentists duriiig operations,
luiving been found of decided assistance in arresting bleeding and keeping
the parts perfectly dry. Caustic pyrozone, a 25-per-cent. solution in ether,
is an efficacious remedy in common and 83rphilitic ulcers, sinuses, etc. In
dentistry it has been employed for the purpose of bleaching the teeth, in
the treatment of dental abscesses, and in pyorrhoea alTColaris (Eiggs's dis-
ease).
BELLADOinr^ FOLIA (U. S. P., B. P.).— Belladonna-leaTes.
BELLADOinr^ RADIX (IJ. S. P., B. P.).— Belladonna-root.
Dose of powdered leaves or root, 0.006 to 0.13 Gm. (or gr. Vio-ij)-
U. 8, P. Preparations,
I.EATS8.
Extractum BeUadonns Foliorum. — Extract of Belladonna-leaves. Dose> 0.0015
to 0.065 Gm. (or gr. V«-j).
Tinctura BeUadonnce Foliorum. — Tincture of Belladonna-leaves (li) per cent.).
Dose, 0.30 to 1.20 c.cm. (or mv-xx).
Uneuentum BelladonnEe. — Ointment of Belladonna (contains, of the alcoholic
atraci, 10 per cent.).
Eoiplastrum BelladonnsB. — Belladonna Plaster.
PQulse Laxative Compositce (U. S. P.). — Compound lAxative Pills (aloin, 1.3
Gm.: strychnine, 0.06 Gm.; extract belladonna-leaves, 0,8 Gm. ; and ipecac, 0.40 Gm.j
with licorice in powder, to make 100 pills. Each pill contains about 0.0005 Gm. [or
FV,»] of strychnine, and 0.008 Gm. [or gr. Vgl of belladonna-extract). Dose, 1 or
SpiUs.
PflulA Podophylli, Belladonnee, et Capsici (U. S. P.)- — (Each pill contains resin
of podophyllin, 0.015 Gm. [or gr. V.l ; extract of belladonna, 0.0075 Gm. [or gr. VJ ;
apsicum, 0.03 6m. [or gr. ViT; with acacia and sugar of milk.) Dose, 1 to 3 pills.
252 PHARilACECTICAL TUEIUrEUTIC AGENTS OR DRV03. ^M
BOOT. ^*
Flu idex tract um Belladonnas Radiets. — Fluid Extract of Belladonna* root. Doae,
0.006 to 0.12 p.cm. (or f«*/,.>-ij).
Lininientum Belladonnte. — Belladonna Liniment (contains, of fluid extract, 96;
camphor, 5 parts). i
B. P. Preparations. J
LEAVES. ^M
Extractum Belladoiime Viride, — Green Extract of Belladonna (from freah learl^
and young branches). Do8«, 0.015 to O.Olio Gm. (or gr. 'A-j)-
Succus Belladonnaj. — Juice of Belladonna. Dose, 0.30 to 1 c.cni. (or wv-xv),
ROOT.
Extractum Belladonna* Alcoholieum. — Alcoholic Extract of Belladonna (contatn-
ing 1 per cent, of alkaloids of belladonna-root). Dose, 0.015 to 0.00*) Gm. (or gr. V«-j).
Extractum Bellaaonnce U()uidum. — Liquid Extract of Belladonna (contains V«
of 1 per cent, alkaloids). Dose. 0.03 to O.OG ccm. (or m8a.-j).
Tincturu Beliadonnte.^Tincture of Belladonna. Dose, 0.30 to 1 c.cm. (or mv-xv).
Linimentum BeJIadonnie. — J^ininient of Belladonna (contains liquid extract of
belladonna, 25 c.cm.; camphor, 2.5 Gm.; dintiUed A\'ater, 5 c.cm.; alcohol, 00 per
cent., q. s. ad 50 com.),
Unguentum Belladonnse. — Belladonna Ointment (100 parts contain 0.0 part of
the alkaloids of bclladomia-root).
Eniplaatnmi lielladonniE. — Liquid Extract and Resin Plaster (contains Vi p«r
cent, of the alkaloids of belladonna-root).
Suppofiitoria Belladonnnf. — Belladonna Suppositories (each contains O.OOl Gm.,
or gr. Vwi of the alkaloids of bclladonna-root). ,
Active Principles and Preparations,
Atropina (U.S. P., B. P.). —Atropine (C„HaNO,). Dose. 0.0003 to 0.001 Gm. [or
gr. V«,.V«).
Atropine Sulphas (U.S. P., B. P.). — Atropine Sulphate. Dose, the same as atro-
pine.
OU>ntuiii .\trupiute (U. 8. P.). — Oleate of Atropine (contains 2 per cent, of
atropine).
Utigiientum Atropinre (B. P.). — Atropine Ointment (2 percent.).
Liquor Atropinffi Sulpliatis (B. P.). — Solution of Atropine Sulphate (1 per cent.).
Dose, 0.03 to 0.06 c.cm, (or wss-j).
LamelljB Atropinro (B. P.). — Discs of Atropine (each 0.013 mgr., or gr. V»». of
atropine sulphate).
PhaLTmacologfy. — The dried leaves and the root of Atmpa Belladonna
(Solanar-ete), or doadly nifrht^^hade. are caeh official. The dried leaves must
yield, when assayed by the United States Pharmacopccia process, Bot less
^han 0.35 per cent, of its alkaloids. The root is required to yield not less
than 0.5 per cent, of its alkaloids. It is a native of Europe, and is culti-
vated here. All parts of the plant are active. Tiie erect, purplish, branch-
ing stems stand about three feet high, and the leaves with short stalks are in
pairs of unequal size, oval, entire. The large, cultivated leaves are said to
have less of the active principle than the smaller leaves gathered while the
plant is in flower. The roots are taken from plants at least three years old;
those which are tough and woody, breaking with a splintering fracture,
should be rejected. Belladonna contains atropine and hyoacyamine, or
belladounine. The United Slates Pharmacop»T?iR defines atro])tne as ''^an
alkaloid derived from Atropa Belladonna and otJier plants of the same
family. As it occurs in commerce, it is usually accompanied by a small
portion of hyoscyamine, from which it cannot be readily separated." The
sulphate of atropine is a more permanent salt, neutral to litmus-paper, read-
BELLADONNA. 253
ily soluble in water, and is generally preferred for medical purposes to the
alkaloid. Atropine chemically is tropyltrope'ine (formula CiTHjgNOj), and
lias been synthetically made by heating together tropine and tropic acid. By
substituting different acids, Ladenberg obtained salicyl-tropeine, benzoyl-
tiopeine, cynnamyl-tropeine, etc. Atropine and hyoscyamine are isomeric,
bat the former is the more stable form.
Thynologieal Action. — Locally, belladonna affects the end-organs of
the sensoiy nerves, and reduces painful sensibility, contracts the vessels, and
checks the action of the sweat- and mammary glands. It is readily absorbed
through the unbroken skin, and symptoms of poisoning have appeared after
its topical application. When applied to the eyes, belladonna (or its alka-
loids) widely dilates the pupil and relaxes the ciliary muscle, so as to tem-
porarily paralyze the power of accommodation of me eye. Double vision
may be observed. In tiie throat, it produces dryness and choking sensations^
and this is one of the first effects of its toxic action. The skin is also dry,
the face flushed, and the surface-temperature increased 1" or 2** F.
Upon the brain it has an exhilarating effect, and a talkative delirium
of mila form may appear. In some cases the delirium is of a violent type.
Subsequently, sleep usually occurs. In the lower animals (frogs) atropine
produces arrest of breathing, followed by convulsions. The transient flush-
ing, or erythema, which appears after its use, is probably due to its effects
upon the sympathetic system, as a stimulant. In some instances it produces
a rash, which closely resembles that of scarlet fever and which may even be
followed by desquamation. The influence of the drug upon the heart and
circulation is believed to be indirect through the nervous system. Bella-
donna paralyzes the inhibitory filaments of the pneumogastric nerve, and, as
a result, the heart, under the influence of the sympathetic plexus, runs at a
rapid rate without being checked by the paralyzed pneumogaatrics. The
force of the heart's beat is also increased. Coincident with this, and as a
result of its action upon the blood-vessels, arterial tension is increased. In
toxic doses, however, blood-pressure is reduced. The contraction of the
smaller vessels may be due to action upon the muscular flbres of the walls^
or it may be secondary to the action upon the nervous system. Respiration
becomes more rapid, owing to stimulation of the respiratory centre. Con-
tradictory statements have been made in regard to the effect of belladonna
upon the respiratory centre. Dr. David Cerna, as a result of experimental
and clinical study, coincides with the observation of Reichert, that *^atropine
acts upon the respiratory fimction in two opposing ways, one (peripheral)
tending to diminish, the other (central) tending to increase, the increase or
the decrease of the respirations in the normal animal depending upon which
one of these factors predominates/'
The flow of urine is increased at first as the result of increased arterial
tension, but there is no increase in the solid constituents of the urine. Larger
doses decrease the quantity of urine, apparently by virtue of a paralyzing
action on the terminations of the vagus, if we may accept the experimental
results of Lazaro and Pitini.* The secretions generally are checked, notably
those of the mouth and skin; the flow of milk is also arrested by it. Though
intestinal secretion is at first diminished, it is, probably, subsequently in-
creased, since the alvine evacuations become more frequent and more liquid
*Ar^lMo de Farm, e Terapia; v, DeulacAtf medizinahZHtunff, If^b. 3, 1898.
B Alropin. sulphat.,
Duboisin, Bulphat aa
Cocain. hydrobromat. 2
Aq. deatillat DO
20 Gm. or gr. ivaa,
Gm. or RT. XXX.
c.cin. or ftijj. — M.
In eye-practice, belladonna is used less frequently to dilate the pupil and
relax the accommodation in order to facilitate examination of the eye and
determine its refraction, than to prevent mlhesions between the pupillary
border of the iris and the len?, or to avoid protrusion of the iris through
an ulcer of the cornea. According to the observation of Dr. George Carpen-
ter, the instillation into the eyes of infants, though it may cause phyeiologi-
cal symptoms, is unsatisfactory as regards its action upon the pupil, dilata-
tion being generally very tardy and mcompletc.
Some oculists consider atropine santonate as the best combination as a
mydriatic, but atropine sulphate is the salt generally employed, in from
0.015 to 0.25 Gra. to 30 c.cm. (or gr. Vriv to fjj). The same solution is
beneficially used in treating diseases of the ear, pain from inflammation of
the middle or external ear, or membrana tympani, or carRohe, being re-
lieved by dropping it in warm, when necessary. (See also Homatropine.)
254 PHARMACErTICAL THERAPEPTIC AGENTS OR DRUGS.
during the administration of belladonna. In small doses it stimulates to i
more rapid movement the muscular coat of the bowel. Belladonna is elim- H
inated chiefly by the kidneys, but partly by the bowels. Like other alkaloids,
atropine is, to a certain extent, destroyed by the liver. I
Toxic Effects and Antidotes. — Poisonous symptoms occasionally appear ,
as the result of the introduction into the system of a very small quantity, ,,
either by absorption, as stated, or by passing from the eye into the nose, and I
thence into the throat. In such cases nothing more serious occurs than dry-
ness of the throat, dilated pupils, possibly an erysipelatous or erythematoua
eruption upon the skin, and some fever and restlessness. Larger doses cause
thirst, dryness, and aching of the fauces; flushing, rapid pulse, and hurried
breathing; without decided increase of temperature, followed by coma or
convulsions and death. The physiological antagonists which may be em-
ployed as antidotes are morphine, physostigmine, muscarine, and jaliorandi
(or pilocarpine). McGowan reports a case in wliich two injections of 0.03 Gm.
(or gr. V2)» of pilocarpine unquestionably saved life. Chloral-hydrate has
also been used as an antidote. According to Binz, morphine is particularly
serviceable in alla}iDg the restlessness and mental excitement caused by
belladonna. F'ailing respiration is combated by strychnine. External heat
will be useful if a state of collapse occurs. Animal charcoal, fixed alkalies,
and demulcents, followed by free evacuation of the stomach and bowels, may
also be prescribed. The compound tincture of iodine is a ch<?mical antidote,
precipitating the atropine and rendering it inert.
Therapy. — Belladonna ointment, or the liniment of belladonna, may
be used with good results in neuralgia and chronic rheumatism; also in local
sweating. In the form of atropine it is a mydriatic, but is less used now
than formerly, as it is liable to cause glaucoma. The solutions of atropine
for ophthalmic practice, or for use hypodenuically, should be freshly pre-
pared and sterilized each time, in order to avoid the development of penicil-
lium in tlie liquid, which destroys the alkaloid, besides giving us an infected
solution. M. Berger advocates the combination of alkaloids, believing that
in tliis manner the same effects may be obtained by smaller doses. As a
mydriatic he employs; —
BELULDOyyA.
955
03 Gm. or gr. as.
10 Gm. or gr. i«a.
c-cra. or mij.
Gm. or Sj.
Rigidit J of the oe uteri during labor is said to be relieved by local appli-
i of belladonna ointment. The same preparation is useful in epaBms of
tkt Mck of the bladder or of the sphincter ani, and in vaginismus. If rubbed
7aa the abdomen, the eitract of belladonna is said to check the vomiting
pttgnancT and to relieve other reflex disorders dependent upon the gravid
olmK. In leucorrhcea dependent upon inflammation of the eervii uteri,
Wbdoims, in association with tannic acid, is a soothing application and re-
i discharge.
It relieves the pain of herpes zoster, and of irritable and malignant
It also is sen'iceable in painful haemorrhoids and Assure of the anus.
h cheeks the suppurative process in boils, and promotes the resolution of en-
arjffd glands. For any local pain^ the appended formula, known as Lud-
irr'» ointment, is very useful: —
B Atrcminae ralphatis
ACOMltilUB
OW Uglii
Fetrohiti 31
X, Si^. : To be used by nibbing in a piece about the size of an ordinary pea.
Belladonna ointment may be advantageously employed in the relief
, cf mlaiiicd joints. The following are also good combinations: —
B Unct. benadonnsE 21 Gm. or Zst.
Jk4£pke lAiue hydroiii is's Om. or Sss.
Orati plnmbi subncetat 12| Gm. or 3iij.
UagC zinci oxidi 15j5 Gm. or in.
Sarriecftble in furuncle, abscess, carbuncle, and herpea xoater.
B Cocaine hydrochloridi. , . 132 Gm. or gr. v,
Ub^ belladonmi; 3l| Gm. or |j,
M. rt ft. ttis^
A food application in ulcerated carcinoma or sarcoma, irritable ulcers, etc.
The pupils and throat should be carefully watched when belladonna
st IB uaed upon open surfaces. Accidents, probably due to idiosyn-
r, somrtixnes follow the use of atropine solutions in the eye. In addition
!»tbe osujil tnanifestfltion of belladonna poisoning, cellulitis of the eyelids
mi face, ar^ " - txis Ims been observed. In some persons the use of oven
ysffctlj iif lutione of atropine proves markedly irritant to the con-
^ Bfc ll I ■ afid give* rise to what is known as "atropine conjunctivitis." It
&f«ii9 mctB as an irritant in certain cases of iritis, especially those occurring
rbcGxnatic patients with posterior synechia?. Its use requires great cau-
la tn glaucoma. In lat<»nt cases it may excite an acute exacerbation. In
iBUBatcTTT glaucoma it increases intra-ocular tension. Belladonna is an
ficjellest local remedy in intercostal neuralgia or pleurodynia, and in the
r^t pafnfT of phthisis. The liniment may be applied with friction, and is
_'ent. but strapping the chest with belladonna plaster is
tent in pleurodynia or neuralgia. The plaster usually
relief in irritable heart. The same preparation is ef-
and myalgia. It may be spread upon the abdomen in
neuralgia, or, in these affections, the agent may be em-
• iu the method of Trousseau. This consists in combining
rn. (or gr. i-ij) of the extract with 0.38 to 0.50 Gm. (or gr.
') oi laxinic acid, and applying it to the cervix uteri upon absorbent
256
rilAnMACEl'TICAL THERAPEUTIC AGENTS OR DRL'OS.
cotton, or introducing it into the vagina in the fonn of a sxippository.
combination is often valuable in leucorrhoea: —
This
B Ext. hcllii'lonnie foliorum 1160 Gm. or gr. xxiy.
Acidi tannici 6| Gin. or 3ia«.
Olci theobromatis q. i.
M. et ft. ftuppositoria no. xxiv.
Three or four suppositories maj be used daily.
lOB^
A suppository containing the extract of belladonna, alone or in union,
with opium, is very valuable in dysmenorrhoea dependent upon spasm of the
cervix uteri. Belladonna, locally applied, has the power of alleviating that
perversion of sensibility known as parsesthesia^ or pruritus. Hence, a lotion
or ointment containing this agent may be sticcessfully used in pruritus of
the genital.s, urticaria, and chronic eczema, attended with excessive itching,
A prescription like the following may be written: —
B Betannfththol l|30 Gm. or gr.
TJngt. cHinphorse,
Ungt, menthol aa 81
Ungt. belladonnffi 15J6
M. et ft ungt.
Or:—
Gm. or 3ij.
Gm. or 5bs.
B Acid, cflrholiei 21
Linimenti belludonnse 60|
Glycerini,
Aq. rosee ^ . . .aa i20|
o.cm. or fSss.
c.cm. or fSij-
c.cm. or il'iv. — M.
The liniment of belladonna, applied several times a day, has a remark-
able power in restraining local excessive sweating. A solution of atropine
in equal parts of alcohol and chloroform, the strength being- 1 per cent. (0.32
Om., or gr. v, of the alkaloid to 30 c.cm., or fjj, of menstruum), will some-
times, according to Earthulow, allay obstinate cerebral or reflex vomiting.
Instead of belladonna, atropine may be used in proper quantity in form-
ing ointments and lotions. The following is an elegant ointment for use in
chronic ovarian, uterine, or pelvic disease: —
B Atropin. sulphatis 113 Gm.
01. neroli 3T com.
Ungt. aquie tossb 15|5 Gm.
M. et ft ungt.
or gr. ij.
or rnvj.
or Sas.
It has been asserted that atropine oleate (made by dissolving 1 part of
atropine in 30 parts of oleic acid and adding 50 parts of olive-oil) makes a
suppository of far more uniform composition than when extract of bella-
donna is employed.
Belladonna is chiefly employed internally to alleviate pain, relax spasm,
and check excessive secretion or morbid discharge. It is a valuable remedy
in neuralgia, especially of the trifacial nerve, though other forms are fre-
quently amenable to its influence. Anstie esteemed it superior to any other
agent in neuralgia of the pelvic viscera. Belladonna is beneficially given by
the mouth in dysmenorrhea, e8p>ecially if the disorder is due to spasm of the
neck of the womb.
Atropine is often productive of the happiest results in gastralgia, en-
teralgia, and gastric ulcer. As neuralgia is often expressive of insufficient
BELLADOKKA. 257
nutrition and is generally associated with ansmia, a combination of bella-
donna with iron^ strychnine^ and other tonic drugs is frequently successful,
A formula similar to the following has been widely used: —
3 Ext. beUadonzifiQ fol
Quinin. Bulphat. 1
Ferri sulphat. exaic
Strychnin, sylphat
Oleoresinae piperis
Arseni trioxioi
M. et ft. pil. no. xv.
Si^.: A piU thrice daily.
25 Gm. or gr. iv.
40 Gm. or gr. xxij.
50 Gm. or gr. viisa.
016 Gm. or gr. V4.
012 Gm. or gr. Vb.
50 ccm. or mviisa.
For the relief of migraine, Trousseau was accustomed to administer
U.Ol Gm. (or gr. */<,) of the extract of belladonna, every hour, until the symp-
toms Tanished or vertigo made its appearance. The form especially amen-
alile to this treatment is the congestive headache, in which the pain is of a
dull, compressive character, made worse by stooping over, with swelling of
the face and throbbing of the temporal arteries, aggravated by noise; by
movement of the body, efforts to read, or any intellectual exercise. In such
cases the combined action of belladonna with a purgative like podophyllin or
aloin is especially effective. The tincture or fluid extract of belladonna, or
airopine sulphate, is useful in relieving the spasm of laryngismus stridulus,
hiccough, spasm of the oesophagus, or local convulsive manifestations of
hysteria. Intestinal, hepatic, or renal colic is ameliorated by this remedy.
Belladonna is likewise of service in lead colic. A combination of atropine
and potassium iodide is recommended as possessing decided efficacy in the
treatment of plumbism. Belladonna has also been successfully employed
for the relief of strangulated hernia, 0.015 Gm. (or gr. ^/^ of the extract
being given hourly, spontaneous reduction occurring after administration
of four to six doses.
Atropine in doses of from 0.001 to 0.0045 Gm. (or gr. ^A©- Vu) ^^s been
successfully employed by Dr. Batsch, of Grossenhain, in cases of intestinal
oktruction where the symptoms were subacute or where there was necessity
to temporize. In some cases a single injection sufficed to produce an evacua-
tion, followed by recovery. In others, the injection resulted only in the es-
cape of flatus and a small quantity of faeces, deflnite relief only following a
second injection on the next day.
Belladonna is of service in epilepsy, but needs to be given persistently
in gradually-increasing doses for a long period of time. It is particularly
apphcable to the pBtit mal or nocturnal epilepsy and to anaemic subjects.
Wachenheim reports a case of the treatment of epilepsy with combined usage
of atropine and potassium bromide. He considers epilepsy in idiopathic cases
u due to an autointoxication, producing an abnormal irritation on the part
of the cortical cells. According to his theory, the mechanism of the treat-
ment is as follows: The bromides diminish the sensibility of the cortical cells,
which have become hypersesthetic to variations in the blood-supply; atropine
Btimulates the vasomotor centres, thereby making the blood-supply more uni-
iorm. In the "early stages of treatment bromides are useful to dull the irri-
tability of the cortex until the proper vascular tonus is established. When
that point has been reached, they are of less importance, and may be reduced
or withdrawn. Neither the bromides nor atropine can in any way meet the
causal indication. If the disease depends on a passing intoxication, these
258
PUAUMACKUTICAL THEJIAI'EUTIC AGENTS OH DHUG8.
drugs will suspend the destructive action of the epileptic seizures until the
materia peccans has ceased to act; if there is a permaniint cause, as seems to
exist in the majority of ca^es, such treatment will naturally be at best only
a palliative. Belladonna is one of the most esteemed remedies for whooping-
cough. It should he exhibited in sulticienlly large dosee to produce dilata-
tion of the pupils, and is generally well borne by children in proportionately
large doses: —
H Tinctura belladonnee fol 3 c.cm. or ml.
Vin. ipecacuunhce 1 I'.cm. or tnw.
Syr. tolutani q. b. ad 60 ccm. or ill).
M. 6ig. : Give a teuspoonful evory Lour Lo a child fivo years of age until relieve
or physiolugical eiretts are obaerved, and then coutiime every three or four hour
with sanit* or half the quantity.
Belladonna is sometimes of signal service in spasmodic asthma. The
most advantageous method of administration is that proposed by Dr. Salter,
0.65 com. (or mx) of the tincture being repeated every two or three hours
until disturbance of vision occurs or relief is obtained. The paroxysm may
likewise be alleviated, thou|,di less certainly, by smoking belladonna-leaves
in a pipe, or made into a cigarette. The tinctiivc of belladonna is cnpable
of allording marked benefit lu exophthalmic p')itre. When nocturnal in-
continence of urine is caused by spasmodic contraction of the bladder, the
fluid extract of belladonna is the best remedy which can be employed. The
same treatment may be of avail in the incontinence of the aged. Atropine
sulphate possesses considerable efficacy in sperrmitorrhoea and prostate rrhcea.
It is best given at bed-time. Torticollis and mu.-cular cramps are generally
ameliorated by belladonna. Precordinl patn and overaction of the heart are
relieved by the internal use of belladonna. This drug enters very serviceably
into remedies for habitual constipation. In disease of the kidney it relieves
congestion by its action on tlit^ nrtt'riob's. In typhoid and typhus fevers. Dr.
John Ilarley has derived decided ndviintage from the use of IfcHadonna,
which cleans and moistens the tongue and quiets the brain. Inflammation
of the pharynx and tonsils is lessened I'y the use of belladonna, which may,
with great utility, be combined with aconite and given in n solution of potas-
sium chlorate. A suitable prescription may be thus formed: —
R Potass, fhloratis 5|20 (im. or gr. Ixxx.
Acid, hydrochloric, dil 6 Gm. or f3isa.
Tr, nconiti 1 c.cna. or mxvj.
Tr. belladonna' fol 2 c cm. or f3sa.
Infus. rhoia glabrae q. s. ad 120 c.cm. or fSiv.
M. et ft. flol.
Sig.: Tablcspoonful every third hour.
i
On account of its marked influence upon the throat, belladonna has been
used in scarlatinal ansrina. Much has been written concerning its value as a
prophylactic in scarlatina, but in the experience of the author no reliance
can be placed upon the drug as a preventive of that disease. It possesses
some virtue as an internal remedy in erysipelas, and in this affection also i?
usefully given irt conjunction with aconite, especially if much fever and
delirium are present. It is sometimes able to check the vomiting of preg-
nancy. Aphonia due to fatigue of the cords soon disappears under the use
of atropine. Belladonna is useful in allaying nervous cough, and, according
BELLADONNA.
259
to Bsrtholov and Fothergill, has an excellent effect in caseous pneumonia,
CMdtd it be given in the stage of deposit before softening has taken place.
•it doses of belladonna or atropine three or four times u day check the
' discharge of mercurial ptyalism. Prof. H. Kobner, of Berlin, linds
the administration of belladonna facilitates the treatment of certam
of the mouth, as leukoplakia, mucous patches, syphilitic ulcera-
>cCg^ as it re-strains salivation and the consequent rapid removal of the
produced by the caustic. He usually gives the extract of belladonna
iirfrr rl in water^ but atropine pills may be used with equal advantage.
Tbf -"' -Treating which occurs in weakly children, after slight exertion
•rdttxir , is suppressed by belladonna. The copious watery discharge
if tliefir&t sta^je of acute coryza is controlled by atropine, which is one of the
krt remediefi also in the nigbt-sweats of phthisis, given at bed-time in the
km of 0.0008 to 0.001 Gm. (or gr. Vso-Voo)- The free discharge of chronic
Inttchitxa is restrained by belladonna. Colliquative diarrhcea is arrested by
dui remedy, according to M. Delpage. In certain cases of metrorrhagia^
vhieh had proved unamenable to other remedies, the hypodermic injection
«f the atropine sulphate, in the dose of 0.0003 Gm. (or gr. Vaoo) twice daily,
hm bvcs attended with complete success. Usemoptysis has also been con-
tnllcd in ilie same manner. Atropine is useful in ulcer of the stomach when
ipanied by hyperacidity. The remedy is beneficial in hyperjemic and
itory conditions of the brain or cord. Li^geois and other writers
•mmlj rvcomniend the internal administration of belladonna in chronic urti-
Airopine sulphate is a valuable agent for diminishing the effect of
It may be given, in the dose of 0.0006 or 0.0008 Gm. (or gr. 'Aoo- Vtb)>
kvpodermicaUy, after a severe injury or prior to a surgical operation. Sir
Leader Brtmton suggested that the hypodermic injection of atropine may
pr^rr of aervioe in the algid stage of cholera, and cited the case of a child who
RBorered apparently as a result of this treatment. Great caution should be
ei'<} in employing this method, for, as pointed out by Professor Manas-
; *ilh the revival of the circulation and absorbent capacity, toxic mani-
■l)on might very readily be produced. In many cases it is advisable to in-
IKt alropino into the atfected tissues (parenchymatous administration). In
tep-ftratcd neuralgia of large trunks, as, for instance, in sciatica, the most
Mid relief is obtained by this method. In sciatica and myalgia it is a good
iba to combine a small quantity (0.008 Gm., or gr. Vb) of morphine sul-
fhitr with the atropine solution for subcutaneous injection. The effect of
^b ii\}cr\}<^u\ is heightened by the combination. Dr. I. L. V'an Zandt' uses
«lrr ite, 0.001 Gm. (or gr. */«oK hypodermically in the algid state
rf - 1 jiialarial fever. If no decided elTects are produced in twenty
\ minutes, the dose is repeated. As a synergist for the atropine he
- h nine sulphate, 0.002 to 0.003 Gm. (or gr. Vao-Vjo)- Stirling
• he hypodermic use of 0.0004 Gm. (or gr. V150) of atropine valu-
4Uc ID. a c-aae of hasmorrhage from the lungs. In tic douloureux, likewise,
Ul^puio f-hrown under the skin is egpecially useful.
jforetti recommends the hypodermic injection of atropine in paralysis
tfdaiUL Ortermayer esteems the same procedure as a valuable sedative and
mbtct hypnotic in the treatment of insanity. Massey has obtained good
tsotl* in angina pectriris from the subcutaneous injection of atropine cora-
ijffvvdf .ircA^r^r*. .\pril, 1901.
2G0
PIIAUlt-lCEUTICAL THERAPEUTIO AGEXT8 OR DRUGS.
bined with morphine. Leszynsky has reported the successful employment of
hypodeiTaic injections of atropine in a case of muscular torticollis, which was
probably due to the influence of lead, as the patient was a painter. Various
remedies, including electricity, had been used M'ithout effect. In torticollis
excited by other causes the same procedure is of advantage. Some writers
are of the opinion that belladonna retards the growth, as well as lessens the
pain, of cancers, and promotes the absorption of enlarged lymphatic glands.
Atropine is serviceably employed as an antaf^onist to a number of powerful
vegetable poisons, as opium, morphine, physostigma, agaricus muscarius, etc.
BENZALDEHYDUM (17. S. P.).— Benzaldehyde, Synthetic Oil of
Bitter Almond, (Sco Amygdala Amara, page — ). •
BENZANILID, — Phenylbenzamid is a white powder, which melts at
321.8° F.J is insoluble in water, soluble in alcohol, and, with difficulty, in
ether. In chemicfil composition it is closely allied to acotanilid. It is with-
out odor and has a slightly caustic taste. It is given in single doses of 1 Gm.
(or gr. xv), and from 4 to 6 Gm. (or 5i-iss) may be administered in the
twenty-four hours. Though at lirst well borne in these amounts, intoler-
ance is generally manifosled after several days* use.
Physiological Action.^Iien:ianilid depresses febrile temperature. Its
effects are manifested from half to one hour after exhibition; the maximum
is reached in four or five liours; the temperature then begins to ascend, and
reaches its original height in ten to twelve hours, Respiration is not usually
affected, though occa.sionai]y it is hastened. The pulse is rendered more
slow and soft. Benzanilid produces no alteration in the quantity or reaction
of the urine, but communicates to that fluid a greenish or even blackish
color. After having been used continuously for several days it gives rise to
pallor of the face and cyanosis of the mucous membrane. Dr. Luigi Cantu,
of Pavia. states thnt it npjx'ars to have a cumulative effect.
Therapy. — The activity of benzanilid seems to be limited to the reduc-
tion of temperature, having no influence upon the course of the disease. It
has been given in typhoid fever, rheumatistn, pneumonia, neuritis, sciatica,
malaria, etc. Dr. Cantu did not perceive any good effects from its use in
chorea, neuritis, and sciatica. It exerted no favorable influence in malaria.
It relieved the puiii nf acute rheumatism, but did not prevent extension of
the <li<eiise tn other jnintK. ^
BENZINUM (T;. 8. P.).— Petroleum Benzin.
BENZINUM PUBIFICATUM (U. S. P.).— Purified Petroleum Benzin.
Lose, OJ>n to 2 c.cm. (or nix-f5ss), in mucilage or capsule.
Phannacolo^. — A purified distillnte from American petroleum, eon-
si:*ting i»f hvilroearbons (CJl,^ and C,JI,4 and hojuologous compounds),
ehieflv of the nuiTsh-gas series, and having a specific gravity of from 0.63S
to tl.lU)0, and boiling at 47)° to 60° C. (113° to 140^ F.). Ben7in, or petro-
h'Uin-etlier, is a clear, colorless, diffusive liquid, yielding inflnniniable vapors,
wbiclu when mixed with air, arc explosive; it, therefore, should be kept in
well-stopponvl bottles, or tin cans, in a cool place, remote from lights or
flame. It is soluble in alcobob etber, au'l oils, but insoluble in water. Fats,
nsiufs. and caonichouc are dissolved hv it.
BENZOINUM. 261
Physiological Action. — Benzin resembles oil of turpentine in its local
effects, especially when applied with friction. It is likewise an irritant when
swallowed, but does not cause vomiting nor diarrhoea. It produces intoxica-
tion, faintness, headache, palpitation, or convulsions, which may end fatally;
death may also be caused by gastro-enteritis, though relatively large amounts
have been taken and the poisonous action overcome. The treatment should
be directed toward evacuating the stomach and bowels, and counteracting
the effects of the agent by diflEusible stimulants and atropine, or ether, hypo-
dennically.
Therapy. — Externally, benzin is used as a counter-irritant, applied upon
a flannel bandage, or with friction, for neuralgic or rheumatic pains, but its
(xlor is penetrating and unpleasant. Locally, benzin has been used as a
dressing for wounds and ulcers. The addition of 2 per cent, of menthol
makes it a local anaesthetic. Its action must be carefully watched,
however, as it has been known to cause extensive blistering and death from
exhaustion. Internally it is not used in medicine, although it is a domestic
remedy for lumbricoid worms and taenia. It is claimed to be a good para-
siticide in itch and pediculosis. (See Petroleum.) Benzin has been em-
plojed with success in the treatment of trichinosis, and is thought by Dr.
Putter, from an experience with twenty-seven persons who had eaten trich-
inous pork, to possess prophylactic virtues against this species of poison-
ing. Benzin has been administered by inhalation with asserted advantage in
whooping-cough. It has recently been used for producing anaesthesia in
Schleich's method, which employs a combination or mixture of ether, chlo-
roform, and benzin. It has been shown, however, that the benzin has de-
cided toxic effects, and that patients, sometimes, show a tendency to rapid
collapse, requiring artificial respiration to prevent a fatal accident.
BEHZOnniM (U. S. p., B. p.).— Benzoin.
Preparations,
Adeps Beozoinatus (U. 8. P.). — Benzoinated Lard (2 per cent.).
Tinctura Benzoin! (17. S. P.). — Tincture of Benzoin. Dose, 2 c.cm. (or fSsa).
Acidum Benzoicum (U.S. P., B. P.). —Benzoic Acid. Dose, 0.32 to 1 Gm. (or gr.
T-XV).
Tinctura Benzoini Composita (U.S. P., B. P.). —Compound Tincture of Benzoin
(C. S. P. contains benzoin, 12 Gm. ; aloea, 2 Gm. ; atorax, 8 Gm. ; Tolu, 4 Gm. ; alco-
hol, q. s. ad 100 c.cm.). A number of old remedies resembled it in composition, such
as Turlington's balsam, Friar's balsam, Jesuit's dro4>s, etc. Dose, 2 to 7.6 ccm. (or
f368-ij).
Trocbiscus Acidi Benzoic! (B. P.). — Benzoic- Acid Lozenge (0.03 Gm., or gr. ss, of
benzoic acid in each, with fruit basis).
Adeps Benzoatus (B. P.). — Benzoated Lard (benzoin, 15 Gm.; lard, 500 Gm.).
Ammonium and Sodium Benzoates are official in both pharmacopceias, lithium
beazoftte in the U. S. P. only.
Pharmacology. — Benzoin is a balsamic resin obtained from Styrax Ben-
zoin, and from another unknown species of Styrax (Styracege). The best
quality is in light lumps or tears, but it also occurs in large masses. It con-
tains, besides resin and a volatile oil, from 14 to 20 per cent, of free benzoic
and cinnamic acids, the latter in small proportion. It also contains Styracin,
2 to 3 per cent., some vanillin, styrol, and benzaldehyde, with phenol-propyl
cinnamati, 1 per cent., and 75 per cent, of the cinnamic esters of benzoresinol
2()i
PHARMACEUTICAL THERAPEUTIC AGENTS OU DHDOS.
and rusinotannol. The latter yield about one-tliird their weight of ciuuamic
acid. Benzoic Acid is in white, lustrous ecales, or friable needles, permanent
in air, haviiip^ a slight, nromiitic odor of benzoin ; a warm, acid taste ; and an
acid reaction. It is soluble in 500 parts of water, 15 of boiling water, 3 of
alcohol, or 1 of boiling alcolioi, in fitted oils and alkaline solutions. Benzoic
acid melts at 250° V. It forms neutral salts with the alkalies.
It is volatilized by heat. Two other sources of the benzoic acid of com-
merce are known: it is a derivative of toluol and also of hippuric acid, the
hippuric acid being derived from the urine of horses and cattle. The benzoic
acid may retain some traces of its source, and, therefore, the pharmacopoeia
directs that it shall sraell of benzoin. Benzoin prevents fat from becoming
rancid, and hence it is, in small quantity, a useful addition to ointments, for
which the benzoinated lard is a good basis.
Phyaioloi^ical Action. — In solution in the form of the tincture, benzoin
is protective to excoriated surfaces, and, like other gums, is antiseptic. After
absorption it has a stimulating effect upon mucous membranes; part of it
is decomposed in the system to form hippuric acid, and, being excreted by
the kidneys, increases the acidity and the quantity of the urine. Benzoic
acid haa some power in preventing the growth of bacteria, possessing the ad-
vantage over carbolic acid of being non-poisonous. Sodium benzoate haa a
stimulating effect upon the liver, and, according to the experiments of Carl
Virchow, increases nitrogenous elimination from the kidneys. Benzoic acid,
or sodium benzoate, inhaled or taken internally, may, in exceptional in-
stances, give rise to an erythematous, or small papular, eruption. In some
cases of idiosyncrasy, urticaria may be produced-
Therapy. — The tincture, especially the compound tincture, is used to
paint over abrasions and excoriations in order to protect the surface, par-
ticularly in cases of tender nipples. It may also be painted on the skin for
chilblains after bathing the surface with 5-per-cent. solution of carbolic acid.
It was formerly employed as a dressing for ulcers. As an expectorant, we
may give tincture of benzoin in chronic bronchitis. The ofHcial camphorated
tincture of opium (paregoric elixir) contains benzoic acid. In troublesome
cough, the combination with opium is necessary, although the opium checks
secretion and expectoration; a better combination would be: —
B CodeiTiEB 138 Gm. or jfr. vj.
Acidi benzo*ci 16|5 Gm. or 3iv.
Syr. tolutani,
Aqufp cflznphors a& 90| o.cm. or fjiij.
M. Big.: Take a deesertapoonful every four hours.
Inhalations of steam impregnated with the compound tincture of ben-
zoin are beneficial in acute and chronic laryngitis. Morell Mackenzie used
a vapor of the compound tincture of benzoin, 1 teaspoonful to a pint of water
at 140*^ F., inhaled frequently, for acute laryngitis.
The following gargle is recommended in pharyngitis: —
B Sodii henzoat
Tinct. benzoin 2
Infus. rosee fol. 15
65 Gm. or gr. x.
r.cm. or fSss.
ccm. or f5B«. — M.
Sodium benzoate is also used with advantage in chronic diarrhcea and
dysentery. In 0.65 to 8 Gm. (or gr. x-ixx) doses it is very useful in liver dis-
orders, likewise in chronic indigestion dependent upon inactivity of the
BENZOIKUit. 263
liver and accompanied by an abundant excretion of nric acid. This salt is alao
of Bervice in septic and febrile diseases, in doses of 8 to 15.5 Gm. (or Sii-iv)
daily (Senator). Owing to its solubility, it is preferable to benzoic acid, and
is equally as efficient in acute rheumatism. In scarlet fever and small-pox,
sodium benzoate reduces the temperature and mitigates the severity of the
disease. This salt has proved very useful in the treatment of diphtheria,
administered internally, and at the same time applied by insufflation to the
seat of the lesion. Its employment has seemed to be attended with good
results in typhoid fever and whooping-cough. The same remedy in the form
of 8 Jipray has been extolled in phthisis, but it has no such decided effect
upon the tubercle bacilli as had been hoped. Benzoic acid, in daily doses
of 10 to 12 Gm. (or 3iiss-iij), has been found of service in acute rheumatism,
but is inferior to salicylic acid. In erysipelas, benzoic acid has been given
vith reported good results. It is of advantage in the treatment of chronic
bronchitis.
In its exit from the system this acid acta as a gentle stimulant and local
antiseptic to the bladder and urethra. In chronic cystitis with fermentation
of urine and deposit of phosphates, benzoic acid is extremely useful, reduc-
ing the alkalinity of the fluid and the irritability of the bladder. For similar
reasons it sometimes proves of service in chronic gonorrhoea, in obstinate
irritation of the urethra due to the condition of the urine, and in incon-
tinence caused by an alkaline reaction of the urine. In all these conditions
KKiinm or ammonium benzoate may be used instead of the acid. Benzoic
acid promotes the solubility of gravel, whether composed of urates or phos-
phates. A favorite formula of Dr. Golding-Bird was: —
3 Sodii carbonatiB 6| Gm. or Sias.
Acid, benzoici 2 60 Gm. or gr. xL
Sodii phosphatia 12 Gm. or Siij.
Aq. ferventis : 120| c.cm. or fjiv.
Solve et adde: —
Aq. cinnamom 2251 ccm. or f^viiss.
Tr. hyoscyami , 16| ccm. or fSiv.
M. Sig.: Two tabiespoonfuU three Umes a day.
In ursemic conditions, and what has been called lithsemia, lithium ben-
zoate has a most happy effect, carrying oS the excess of uric acid and urates,
acting also as a diuretic. Even in albuminuria, the benzoates have been used
with advantage, especially calcium benzoate.
Freckles may be removed by the topical application of tincture of ben-
zoin, containing corrosive chloride of mercury: —
Q Hydrarg. chlor. corrot !03 Gm. or gr. bs.
Uncttire benzoini 0 26 c.cm. or fSiiss.
Glycerini 7 60 ccm. or f5ij.
Aqnse rosre 180| ccm. or f Jvj.
M. Sig.: Ub6 as a lotion to affected spots.
The above may also be used in pityriasis versicolor, or moth-spots, and
chronic urticaria. The compound tincture of benzoin is sometimes able to
relieve the itching of urticaria and eczema. A solution of benzoic acid in
cologne-water makes a pleasant application, frequently successful in urti-
caria- Mixed with an equal quantity of glycerin, the tincture or the com-
204
tMlAUilACEUTlCAL THEIUPia'TIC AGENTS OU DUL'OS.
pound tincture is useful in chapped lips and liand?. The compound tincture
is a good styptic, and yields excellent results when injected into old sinuses.
It disinfects the tract, and promotes healing. Benzoic acid is an efficient
antiseptic application lo nnhfalthy wounds and ulcers.
As a dentifrice, Professor Miller recomnaends: —
H Acid, ihymici
Acid, benzoici 3
Tr, eucalj-pt. fol 15
Alcohol, nbsolut 00
OI. gauUheriie 1
25 Gm.
Gni.
ccra. or ?5ss.
c.cm. or fSiij-
55 c.cm. or git. xxv.
or gr. IV.
or gr. xlv.
M. ^ig.: A teaspoonfu] or two in half a glass of water, as a mouth-wash.
Bismuth benzoate is an excellent dressing to chronic, unhealthy,
aloughing ulcers, chancroids, open buboes, chancres, and ulcerated lesions
of late syphilis. It is usually applied in the form of a powder, the surface
having previously been thoroughly cleansed by a weak solution of corrosive
sublimate or liydrogen dioxide.
BENZOL ( Jl. P.). - Benzol or Benzene. Phenyl hydride.
Pharmacology. — A mixturL^ of homologous hydrocarbons obtained from
light coal-tar oil. It contains about TO per cent, of benzene (CallJ and 20
to 30 per cent, of toluene (CoHsCIIg). This is distinct from and should not
be confounded with benzin obtained from petroleum. It is a thin, colorless
fluid, very volatile and inflaniniubJc, and has an aromatic, not very unpleas-
ant, odor. It is almost insoluble in water, but dissolves in four parts of
alcohol. It may be obtained by distilling a mixture of benzoic acid with
lime, or by fractional disi^tillation fmm naphtha: a derivative of coal-tar.
Physiological Action. — Benzol is antiseptic and antiparasitic, with but
little local action beyond the extraction of oily matters from the skin. Owing
to its i-olvent action upon many alkaloids, it might be useful in local medica-
tion by enabling the remedy to penetrate the skin. Taken internally, benzol
produces intoxication^ anaesthesia, and coma.
Therapy. — It has been given in a few drop doses as a remedy for dys-
pepsia, and also in trichinosis. It is employed in pharmacy as a solvent, but
is not often administered, or employed in practical medicine. Dr. A. Da
Socca has used, locally, with alleged good results, a mixture of 1 to 6 of
tincture of iodine and benzol in diphtheria. Benzol has been advantageously
given in whooping-cough by Dr. Robertson, in doses of 0.12 c.cm. (or mij)
in mucilage to children six mouths of age. The same writer reports good
results from the use of benzol in inflnenzo. He administered it in the form
of an emulsion in lemonade, 0.:^) c.cm. (or mv) at a dose, repeated every
three hours. It was always well tolerated. It had the effect of reducing
temperature and relieving the general discomfort. Convalescence was gen-
erally rapid. ^
Nitrobenzol. — This product, known commercially as the oil of mirbane,
or artificial almond-oil, is used extensively in the mnnnfacture of dyes, per-
fumery, and explosive compounds. Cases of acute or chronic poisoning fol-
low the absorption of nitrobenzol. The workmen subjected to its influence
frequently suffer from a train of symptoms which have been studied by Dr.
Prosser WTiite, The usual manifestations are sleepiness, headache, languor,
and a severe form of anaemia. There is a decided loss of weight, the appetite
^London Lancet, Kov. U, 1893.
. - '-apncious or altogether fails, nausea and vomiting may oecur, the
1 - • i*-. nn.'f's darkened in color and contains aniline. The temperature of
t^ U:- ■ 'v raised, but the extremities become very quicklj- chilled.
Then waste of the muscleSj especially those of the extremities.
Hyperrstiieeia is a characteristic symptom. Sensation in the extremities may
ht dlghtly impaired. The sexual opi>ctite is weakened or lost. The reflexes
$n genemWy enfeebled. The eyes are not iisnaliy affected, though nitro-
kuol maj prtxluce a peculiar form of retinitis, with f^rcat defect of sight.
IW pulse ifi feeble and thready, arterial tension is low, the blood is chocolate-
or black. The corpuscles are decreased. No direct antidote is
It is said that, when taken into the stomach, nitrobenzol may re-
for aome time unabsorbed, and an emetic or the stomach-pump will,
tWfgfore, be of service. A saline cathartic is also advisable, but oils, fftts, and
<al»hol are uot recommended. (Viunter-irrilation to the chest, friction of
IW limbe, and ammonia as a stimulant may be employed. Artificial res-
piratkin is of avail. Dr. White states that 1 c.cm. (or vixv), taken by the
—nth, has ••aused death. Letheby and Filehne pive the fatal dose as vary-
mg Crosn 0,12 to 7.5 o.cm. (or f«ii-f3ij). A case has, however, been reported
ly Dr. r ^ -. 1. of Vienna, in which a woman, it is stated, took nearly 105
CJXL. (■ -) of nitrobenzol and yet recovered. The symptoms were deep
^«Bon»y fe» '1 respiration, small pulse, and dribblin;: of urine, which
«atain«d t ^ c agent. Camphor injections were administered and arti-
iod respiration was practiced. Consciousness returned and recovery fol-
WrJ; on the fourth day the urine resembled that of a case of cystitis.
S. P.), GLUSn)TJM (B. P.), or Saccharin,
arid (C'-I1,.^N0,^S) is a coal-tar doriv-
^'^ZOSULPHINIDTrM (IT.
'-hr»-(;ulpbamino-l)fnzoic
'•'tl in Proffhsor Kemscn's laboratory of Johns Hopkins Uni-
"^t described by C. Fahlberg in 1S70, It is a sweet imide de-
rnm toluene (B. P.). It ia a white, crystalline powder, with an acid
n, but an intensely-sweet taste. Its odor, which becomes stronger on
.C. i* frtintly suggestive of nitrobenzol. This substance is soluble in
part* of cold water, readily soluble in alcohol and ether. Saccharin dis-
'-« al^to in jclvcerin. Its solubility* in water is promoted by the addition of
am hie: " '»• in the proportion of 2 parts to 3 of aaccliarin. Com-
lial ea< < niuy contain a large number of impurities. Pure sac-
' 11 can bo jf»e|»arated from the mixture by means of ether. Dose, 0.13 to
Off^. (nr grr. ii-v),
^ charin fonua soluble salts with the hydrates of carbonates of the
--' = . It melts at 220'' C. (428" F,), and when fused with potassic
IS salicylic acid. One part dissolved in 70,000 parts of water
mpmxi» -olution a dietinctlv-sweet taste; it is about 300 times sweeter
^ka cMu^ - ^i"* which it resembles in taste, except for a peculiar slight
fcror of LittiT iilnionds.
7>»\^« joloerical Action. — Saccharin is excreted by the kidneys unchanged;
t d in the body, and has little if any elTcct upon digestion,
. .inenr? of C. T. Fox have demonstrated that, when added
rin checks the action of saliva upon starch.
noticeable effects upon the urine are that it does not so readily
ntntinn, and the chlorides are slightly increased. Pure
irm w* not possessed of toxic or deleterious effects upon the human
266 rUAUHAOKLlTICAL XUEKAPEOTIG AUENX8 Oil DBUG8. ^
organism, even in doses as large as 5 Gm. (or gr. lixv). Saccharin has con-
siderable antiseptic virtue, which, according to Constantine Paul, is impaired
when it acts in an acid medium.
Therapy. — Saccharin is uhiefly employed to take the place- of sugar in
the diet of obese and diabetic patients. For this purpose it is beat prescribed
in the form of a syrup containing 10 parts of saccharin and 12 parts of
sodium bicarbonate in 1000 parts of distilled water, made with gentle heat
at 40° C. (104° F.). It has also been claimed by Dreschfeld that saccharin
relieves some of the symptoms of acid dyspepsia. Dr. James Little asserts
that saccharin freely administered is an efficient remedy in chronic cystitis
with ammoniacal urine. Two parts of saccharin dissolved by means of 3
parts of sodium bicarbonate are said to fonn an excellent tooth-wash. Four- I
nier his found a moutli-wash containing saccharin eiiicacious in aphthae.
By Dr. Fclici, of Rome, it has been utilized as an application in ozsena. The
cmists having been removed by vaselin-oil and the cavity cleansed with a
saline fluid, a solution containing from 0.50 to 1 Gm. (or gr. vii-xv) of
saccharin is appUed twice daily to the affected parts. The remedy was espe-
cially usefu! in cases where there was atrophy of the turbinated bones and
mucous membrane and in those characterized by the odor and discharge of
ozo^na without apparent anatomical changes.
Saccharin is largely used in confectionary to add to glucose and make
it correspond more closely in sweetness with cane-sugar. It may be com-
bined with quinine, in order to overcome the bitterness: —
R Quinin. sulphat 41 Gm. or 5j.
Saccharin 2| Gm. or gr. xxx,
M. et div. in chartulffi no. xxx.
S\g.: Take one four times a day.
BERBERIS (U. S. P.).— Barberry.
Preparation,
Fluidextractum Berberidia (U. S. P.). — Fluid extract of B«rberia. Dose, 0.10* ,
to 0..10 com, (or fnii-v|.
The rhizome and roots of the Ore^jon grape, or Berberis aquifolium. or
of athfr species of Berberis (Borboridaceje). It contains an alkalnid,
Berberine, which also exists in Hydrastis.
Berberis is tonic and diuretic^ and is believed to act as an alterative, mak-
ing it valuable for the treatment of blood diseases, dyspepsia, hepatic dij?-
ordor, habitual constipation^ and skin ili?enses dependent upon unhealthy
secretions or conditions of the digestive tract. Vehsemcyer claims to have
produced decided iTiiprovnmi'nt, in the case of an infant afflicted with leu-
ka?mia, by the administration of borberine sulphate. Berberis hns been
topically employed in conjunctivitis, and the berberine hydrochlorate has
betm u?ed with advantage as an injection in gonorrhuea. Internally, ber-
berine or its hydrorlilorate Tnay be ^iven, in doses of 0.015 to 0.32 Gm. (or
BETANAPHTHOI (U. S. P.).— Betanaphthol; Naphthol (B.P.). (See ]
NaphthoL
BISMUTHUM. 'lOr
SISMUTHUM.— Bismuth.
Freparaiions.
Otras I U.S. P. |.— Bismuth CitTate. Dose, 0.065 to 0.32 Gm. (or gr. i-v).
Iii el Ammoniw Citras (U.S. P.). — Bi«muth and Ammonium Citrate,
to 0.32 Gin. (or gr. iv).
■thi Subcarbonaa (U. S. P.). —Bismuth Subcarbonate. Dose, 0^2 to 1.30
l«rp. r-xjc).
BhiBiiHii BnbnitrM (U.&P., B. P.)-— Bismuth Subnitrate. Dose, 0.32 to 1.30
Bhmn"
laUki Cju-bonas (B. P.).— Bismuth Oxycarbonat^. Dose. 0.32 to 1.30 Gm. (or
t).
Bbimathi Salicylas (U. S. P.. B. P.).— Bismuth Salicylate. Dose, O.OG,') to 1.30
Qb. Cv gr- i-xx).
Btoaalhi SabffaJka <U. S. P.).— Bismuth Subgallate. Do&r, 0.3 to 1.30 Gm. (or
Binsothi Dxiaum (R P.). —Oxide of Bismuth. Dose, 0.32 to 1.30 Gm. (or gr.
Liqoor BUmutht et Ammonii Citratis (B. P.). — Solution of Bismuth and Am-
■■laBi Cftrmte, or Liquor Bismutbi (0.05 Gm. in 1 c.cm., or gr. iij of bismuth oxide
•» '^' ' Do«e, 2 to 4 c.cm. |or fSss-j).
iiiarus Bismutbi Compositus (B. P.). — Compound Bismuth Lo/enitre (bismuth
■• nate, magneaium carbonate, heavy, of paeh, 0.13 Gm., or gr. ij; prectpitated
. :im cmrbooate, 0.25 Gm., or gr. iv, with rose basis).
'--logy and FhyBioloi^oal Action. — Bismuth in the metallic
ie in], and ha? no medical iiitero.<'t. Its salta, however, are of
CTaJut, the insoluble ones differinfj greatly in their applications from
vhich ar»^ soluble. Tlie subnitrate and subcarbonate arc, or should
K IS the form of white, impalpable powder, which has a slight astringent
ad abaorbent action when dusted upon excoriated or ulcerated surfaces.
TW free nae of subnitrate of bigmuth a«i a dressing for wounds or ulcers may
W to absorption and poisoning. Among the consequences are acute stoma-
tCM^aod a dark disroloration of the gunis, spreading over the entire mouth,
ttwed br diarrba>n and nephritis. Dr. F. P. Ilenry,* of Philadelphia,
rtfl a fatal nroident of this chanicter. Whon taken internally, these
have very much the 54ime effect along the digestive tract as upon the
mhte of the body, cliecking excessive secretion and exerting a sedative
aivncr. When injected under the skin, part of the salt i? ahporhed and
^woemff may result. Or. if large doses are taken by the mouth, death may
%Am from ^nstm-^nteritis, the symptoms being very much like those caused
•^ nlA Icftd, and mercury. After death, bismuth is found in the liver and
Of rbc^ra, and in the urino and saliva. A purplish line upon the gums,
*alliiur that of lead, has been noticed. The treatment is by demulcents,
wAqtjf out tho stomach, and the ndministration of the antidotes to ars^^nic,
nA which native bismuth is usually combined. When the soluble prepara-
toiare given for a considerable lime, the bismuth is apt to accumulate in
fcBfer: bnt this is not likely to follow the administration of the insoluble
j^ rr,i i.,^j^j^ or eli.xirs, purporting to contain bismuth in combina-
Ib V ^^- are unscientific and may be dangerous. The discharges
(^ . ' ■* blackened by bismuth. The tongue becomes coateil with
i^t^ The prolong(»d administration of bismuth subnitrate
ivWn known U» cause a larsre intestinal concretion. It may, under these
alao give rise to plough? in the mouth nuii gastro-intesHnal
ftlao t« dr«qnamativ<» nephritis and albuminuria.
L ^Jomrx
Jomrp^**^ ^f ^^ .4meruH2fi itedical AMOciaiion, Dncember 7, 1001.
■
2fi8
rHARMACEUTICAL THEUAPECTIC AOKNTS OR DRIG8.
Therapy. — Tn using bismuth it is essential that it shall be pure and free
from arsenic When well made, the subnitrate, or subcarbonate, is very use-
ful as a dusting-powder for excoriated surfaces, and as a dressing after
wounds or amputations; but w^hen used freely has led to poisoning by ab-*
sorption. However, it is valuable in small wounds and in some old ulcers.
Combined wilh mucilage (4 Gm. to 180 or 240 com., 5j to o^'i-viij), it is a
good injection for gonorrhcea during the early stage; or it may be used as a
soluble boupe, or as a vaginal suppository for leucorrhcea. The same prep-
aration is likewise useful in ulcer of the rectum.
The addition of a small proportion of carbolic acid or acetanilid will en-
hance its antiseptic effect. In acne, intertrigo, and erythema in infants, or
in vesicular eczema, the subnitrate, or subcarbonate, of bismuth may be
lightly dusted over the surface. In the case of wounds, the red oxyiodide is
preferred by A. Sidney Reynolds^ to iodoform, as an antiseptic and also as
an ointment in skin diseases. This salt is a local anjeethetic and antiseptic.
It does not stain the skin or clothing, and may be employed as a dusting-
powder or an ointment. It is an excellent appHcation to chancre, chancroids,
open buboes, ulcers, unhealthy wounds, and phlegmonous erysipelas. The
following is a good combination: —
Q Naphthalin 2 Gni. or 3»3.
Bismuthi subiodidi 4 Gm. or 3j.
Unguenti simplipis 25 Gm. or Sriss.
M. et ft. ungt. Useful upon chancrea, chancroids, and gyphilitic ulcers,
Subnitrate of bismuth in powder haa been used with success in simple
oza?na, snufTed into the nostrils, though it is inferior to other remedies. It
may also he employed in aphthous or nursing sore mouth, and in mercTirial
ptyalism. It may be of service in chronic conjunctivitis and granular lids.
Made into an ointment, it is an excellent applicatif>n to chancroids, irritable
ulcers, erjrsipelas, blisters, pemphigus after the bullte have ruptured, leaving
raw surfaces exposed, the erythematous and bullous forms of burns, and in
the first stage of dermatitis. . In these conditions an ointment may be thus
composed: —
H Bismuthi subnitratis 2 Gm. or Sss.
Pulv. marnntSB , 15 5 Gm. or Jsg.
Morphinaj siilpIiatiB i..«...«....«i .. 20 Gm. or gr. iij.
Adipis Innae hyd 15 5 Gm. or S^b-
M. et ft ungt.
An ointment consisting of bismuth subnitrate and boric acid, with
lanolin and olive-oil, is regarded by Wertheimer as particularly appropriate
to the treatment of burns in childrm. An ointment containing the oleate
of bismuth is also valuable in diseases of the skin. It may be prescribed as
follows: —
B Ext. belladonnsB folior 165 Gm. or gr. x.
Ext opii 1 130 Gm. or rt. xx.
Ungt. bismuthi olpatis 15|5 Gm. or
M. For furuncles, cnrbunclea, and eczema of the genitals.
CT. >
598.
*
The internal administration of insoluble bismuth preparations is prin-
cipally based upon their local action upon the stomach and intestinal tract.
• Medical 7{nc9, Oct, 1888.
BISKUTHUM. 269
They form a coating over the infamed or irritated surfaces and keep them
fioffl coming in contact^ while they also exert an astringent and sedative
effect. In gastraigia, irritable stomach, and some dyspeptic conditions they
are of much value : —
B Bumuthi subnitraiis 8 Gm. or 3ij.
Pepaiui aaccharati 4 Gm. or 3j.
Cteosoti 24 com. or miy.
M. et di7. in chartulse no. xij.
Sig.: Give one every hour until relieved. (The oil of gaultheria may be substi-
tuted for the creosote, in case of children, and the powders made smaller.)
In painful dyspepsia and gastraigia, Dujardin-Beaumetz prescribed : —
1^ Bismuthi subnitratis,
Magnesise,
Crets prseparatffi,
Calcii phosphatis aa 10| Gm. or Siiss.
M. et div. in chartulsB no. xl.
Sig.: One powder before each meal.
Bismuth may be given in j)owder also, as: —
Q Bismuth, subnit.,
MagnesU carbonatis aa 41 Gm. or 3j.
MorphinsB sulphatis |065 Gm. or gr. j.
M. et ft chartuUe no. xij.
Sig.: A powder every hour or two. Employ in gastraigia, dyspepsia attended
vith acidity, and in cancer of the stomach.
In half-grown children with irritable stomach, the result of improper
feeding, a good combination is: —
9 Bismuth, subnit. 2| Gm. or Sss.
Sodli bicarb.,
Pulv. rhei aa |65 Gm. or gr. x.
M. et ft. chartuls no. x.
Sig.: A powder every four hours.
The following liquid combinations of bismuth are likewise of service,
especially in gastric catarrh and some varieties of dyspepsia: —
H Bismuth, dtratis 81 Gm. -or 5ij.
Glycerini pepsinse (B. P.) 90| c.cm. or fjiij.
M. Sig.: A teaspoonful before meals.
9 Bismuth, subnit 8
Pulv. rhei 6
Pulv. acacie 8
Spt myristicse 7
Aquse menth. pip 240
H. 8ig-: A tablespoonful in water every four hours.
Gm. or 3ij.
Gm. or 3iss.
Gm. or 3ij.
50 c.cm. or f3ij.
ccm. or fSviij.
The salicylate is a soft, white powder; insoluble in water, alcohol, ether,
and chloroform, but soluble in acids. In gastro-enteritis, or summer com-
plaint in young infants, the salicylate gives excellent results in small doses
(0.065 to 0,13 Gm., or gr. i-ij). This combination is likewise valuable in the
'liarrhcea of typhoid ferer, in which it is serviceably given with naphthol.
Bismuth salicylate is useful for the purpose of securing gastric antisepsis in
(^Dcer of the stomach. It may be associated with betanaphthol or ealol.
This salt, also, is highly esteemed as a remedy in infantile diarrhoea.
^70
PHARMACEUTICAL THERAPEUTIC A0EST8 OB DRIOS.
Gastric ulcer is much benefited by the subnitrate in 0.C5 to 1 Gra. (or
gr. 2-xy) doses, given every three hours, or oftener, if there is much pain.
Where malJo^Bant ulceration is guspected, opium and belladonna may be ad-
ministered at the same time. The vomiting of pregnancy may sometimes
be relieved by bismuth subnitrate. It serves a useful purpose in the chronic
gastritis bo common in drunkards. In acidity of the stomach it is useful,
and also in flatulent dyspepsia. A combination of bismuth with charcoal is
-efficacious in the latter condition, as: —
^ Biamuthi subnitratia,
Pulveris nTomatici aa 8!
CRrboniB ligni (recentia) 15|5
M. et div. in chartiilee no. xij.
Gm.
Gm.
or 3ij.
or 5fls.
In diarrhcea. tJie subnitrate is usually a reliable remedy, but, as Einger
advises, it should be preceded by a doae of castor-oil, in order to remove fer-
menting material or other causes of irritation. In the diarrhnea of phthisis,
it can be given in combination with pepsin or pancreatin. It may be given
in hot milk to children; but it is almost tasteless, and may be placed at
once upon the tongue and washed down with water or milk. In chronic '
diarrhcea, bismuth sul>nitratB not iufiequently atlords marked relief. Ab
excellent prescription for diarrhcea, particularly when acute, is : —
It Bismuth, subnit. 781 Gm. or Siias.
Pulveris myristlcsE 2(60 Gm. or 3 ij.
Aqure cinnfimomi,
Syrup, acacire aa 60| com. or ii'ij.
M. Sig.: Two teflspoonfulR every Jia]f-hour, or hour, until relieved.
In cases of infantile diarrhoja, when the stools are grceni.sh, contain
casein, and are accompanied by abdominal pain. Dr. Zinn^ relies upon the
following prescriptions: —
B Bismuth, flubnitrat 3 Gm. or gr. xlv.
Liq. calcia 6 c.cm. or fSiss.
Syrup, aurant. 15 c.cm. or fjsa.
Aqufc focniculi 60 c.cm. or fjij.
Sig.: Teaspoonful every two hours.
M.
B
M.
Bismuth', subnitrat 3
Syrup, aurant 15
Infus. calumbfe 60
Sig.r One or two teaapoonfula every two hours.
Gra.
c.cm.
c.cm.
or gr. xlv.
or fSsa.
or Qij.
In epidemic dysentery, large doses of bismuth Imve been administered
with benefit. Trousseau was accustomed to order bismuth injections in
dj'sentery.
A solution of bismuth and ammonia citrate is official in the British
Pharmacopceia. An extemporaneous formula may be used, like the follow-
ing:—
Bismuth! et ammoaiic citrat
Aquflp rUloTofonni 15
Elixir aurantii 45
32 Gm.
c.cm.
c.cm.
or gr. V.
or fjsa.
or f5is&
4
M. Sig.: Take 16 c.cm. (or fjaa) three or four times daily, for irritable stomach
This double salt has been employed in the treatment nf acute and
chronic diarrhoea. P. Vigier has prepared a bismuth benzoate as a substi-
BISMinilLM.
371
ime lor the ^ - — Mi salicylate, or &ubnitrato. Bisatuth benzoate contains '27
per ccDt. of : acid, and may be advantageously used as an intestinal
MdMpbc, anii 15 a preferable substance to the Balicylate as regards its elim-
■iliiHi by the kidneys.
KsBBth Subgallate, or Dermatol. — Under this name Dra. Heinz
aoi Liebrechi have introduced a new combination which occurs in the
iarm of m fine, saffron-yellow powder, odorless and innocuous; insoluble
a viter, alcohol, and ether; not hygroscopic or otherwise affected by ex-
tc «ir or light. It possesses astringent, antiseptic, and desiccant prop-
This substance is also possessed of local ana-sthetic power. It is of
Tfiliie in lesions attended by profuse secretion, as eczema, burns,
V . and diseases of the eye and ear. Dr. Eugene Doernberger
Mt results from its use in pemphigus, herpes zoster, and ab-
of the skin occurring in children. Dermatol has been advantageously
to chancroids and ulcerated chancres, to balaJiitis, varicose and other
of the leg. Suspended in raucilage, it has been used as an injection
«aeateaud chronic gonorrhoea. ^lixed with an equal quantity of castor-oil,
QnnBiaxi has employed it in the treatment of sore nipples. It is considered
if vtloe as a dressing to abdominal wounds and in perineoplasty. Tampons
■■le of gatize impregnated with dermatol are of service in the treatment of
va^nal catarrh. A powder composed of 20 parts of dermatol, 10 parts of
avch, and 70 parts of talc is a good application in hyperidrosis of the hands
wtd feeC Dermatol may be used pure as a dusting-powder, as a 25-per-cent.
amtaient, a collodion emulsion, and as a 10- to 20-per-ccnt. gauze.
Colasanti and Dutto report favorably of the internal employment of
iuaiatol in different forms of diarrhwa, including that of typhoid fever and
ttbcrcQloats. It was given in daily doses of 2 to 3 Gm. (or gr. xxx-slv) in
fcidad portion^- Dr. Austin Mint recommends bismuth suhgallate in the
Mtment of fermentative dyspcpt^ia. He has had excellent results from its
Wt SB chronic c^scs, giving 0.32 Om. (or gr. v) in capsule or tablet before
m-^ttrr each meal. A number of loose combinations of bismuth have lately
hem introduced as antiseptic remedies. Fhenol-bismuth, cresol-bismuth,
itoJ bttftllAphthol-bismath are decomposed in ihe stomach, the phenol and
cscBol being absorbed and eliminated by the kidnej's, while the bismuth is
iteoct cotni>I*'tely removed by the bowels. Naphthol is partly eliminated
ndb the tirine and partly through the intestine. In daily doses of 1 to 3
Qm. (or gr. rv-xl?) Dr. jasenski. of St. Petersburg, gave phenol-bismuth
wah adrantage in typhoid fever, acute and chronic i:astric and gastro-in-
^tfina) catarrh, and in diarrhoea. Tribromphenol-bismnth is a yellow, in-
nlgki^ •-^'^wder. without odor or taste and almost free from toxic action. It
5 per cent, of bismuth oxide and 50 per cent, of tribromphenol.
- "pe, of Prague, recommends it as a valuable agent in the treat-
cholera. Bctanaphthol-bismuth is a brown, odorless powder,
iter, and containing 80 per tent, of bismuth oxide. In doses
(or »»r. xv-xxx) it acts as an excellent intestinal antiseptic.
Mith and tribromphenol-bisniuth are etticient remedies
; -la, and chronic intestinal catarrh dependent upon the
of njicro-orpanisms. Dr. Reynold W. Wilcox has found the former
iMiiKMilnl to answer an excellent purpose in chronic membranou^s enteritis.
BaChiwtaxi-
afiemientai
TM«osiphenol*'bismuth possesses rather a sweetish taste,
iMiiiiM ril properties nf other compounds of bismuth.
and shares
212 PHAIOIACEUTICAL THEIUPEUTIC AGENTS OR DBLGS.
Bismath chrysopliaiiate has been introduced under the name of dermoL
It is an amorphous yellow powder of neutral reaction, insoluble in the ordi-
nary menstrua. It is proposed for use, in tlie form of ointment, in disetises
for which chrysophanic acid is employed.
Thioform is a combination ol bismuth, sulphur, and salicylic acid, and
occurs in the form of a light, grayish-yellow powder insoluble in water,
alcohol, and ether, Thiofonn is dcviiid of odur or taste. It is comparatively
free from toxic effects, and has been used with success upon burns, ulcers, and
sloughing wounds. Dr. E. Tromm reports favorably concerning its actioa
in conjunctivitis, purulont ophthalmia, and the etrumous ophthalmia of
children. Thioform has also been employed as a styptic in the operation of
enucleating the eyeball.
Bismuth sulpliite has been found useful by Cesaris and Racchetti as
an intestinal antiseptic and ant}ielinintie. Bismuth tannate has been iised
internally as an astringent in diurrhiea in doses of O.Go to 2 Gm. (or gr.
x-xxx).
BOLDUS. — Boldo, or Peumus boldus (Jilonimiaccffi), is an evergreen
belonging U> the wester-n coast of South America. The dried leaves and
steriis contain a bitter extractive, a volitilo oil, and a bitter alkaloid (about
0,1 percent), Boldine. A limture (.') per cent.) is used in (KW c.cm. (or
my) doses or niorc, gradually increasing:, and produces vomiting and purging
in full doscH. and also a nedaiive or njin-otic ctTovt upon the brain. In small
doses it is carminative and stimulant to the stomach.
Therapy. — In South America, xhis plant has some reputation for its in-
fluence upon genito-urinary disorders, ganorrhcea, gleet, cystitis, and ca-
tarrhal inflammations of the kidneys. It has also been used for rheumatism,
and as a tonic in dyspepsia and general debility. In cirrhosis it is especially
rwoinmciulnl by Campenon. Boldine, the active principle^ hns li}']motie
powers, and has been successfully tried in France as a substitute for opium or
chloral ( Junmville) . It also has a local ;uia\-*thptic actimi, like cocaine.
BOBAX (B. P.).— Borax. (See Aciduni Boricum.)
BROMUM (IT. S. P.).— Bromine.
Dose, tt 12 to 0.18 c.cm. (or mii-iij), vreli diluted.
i
BROMOFORMUM (V. S. P. ) .— Bromof orm, Tribromomethane (CH
Br3).
Dose, n.(M; to 3.25 c.cm. {fny\).
Preparations.
Olcii Bromidum (U.S. P.). — Calcium Bromide. Dose, 0.32 to 2 Gim, (or gr.
v-xxx).
Lithii Bromidum i U.S. P.).— Lithium Bromide. Doee, 0.32 to 1.30 Gm. (or
gr. v-xx).
Zinci Bromidum (U. S. P.).— Zinc Bromide. Dose, 0.066 to 0.13 Gm. (or gr. i-ij).
Ca.mph*ra Monol>romata (U.S. P.).— Monobromated Cnmphor. Dose, 0.065 to
0.32 Gm. (or gr. i-v).
AniHionii Bromidum (U. S.P., B. P.). — Ammonium Bromide. Dose, 0.65 to 2.60
Gm. (or gr. x-xl).
PotttBsii Bromidum (U.S. P., B. P.),— Potassium Bromide. Dose. 0.65 to 4 Om,
(or gr. x-Sj).
BROMUM. 273
Sodii Bromidum (U.S.F.,B. P.). —Sodium Bromide. Dose, 0.65 to 4 Gm. (or
gr. x-3j).
Acidum Hydrobromicum Dilutum (U.S. P., B, P.). —Diluted Hydrobromic Acid
(10 per cent). Dose, 1.20 to 7.5 com. (or mxx-f3ij).
Unofficial Preparatiofu,
iEthylis Bromidum. — ^Bromide of Ethyl, or Hydrobromic Ether. For inhalation
u a general ansesthetic
Auri Bromidum.— Bromide of Gold. Dose, 0.01 to 0.03 Gm. (or gr. Vt to Vi).
Auriet Ammonii Chloridum.— <,'hloride of Gold and Ammonium. Dose, as
above.
Kiccoli Bromidum. — Nickel Bromide. Dose, 0.065 to 0.32 Gm. (or gr. i-v).
Syrupua Ferri Bromidi. — Syrup of Ferrous Bromide (10 per cent.). Dose, 0.60
to 4 ccm. (or mx-f3j).
Coniinse Hydrobromidum. — Coniine Hydrobromide. Dose. 0.004 to 0.005 Gm.
(orgr.Vi.-Vu). •
Phurmacology. — Bromine, which obtains its name from its offensive
odor, is a brownish-red, non-metallic liquid element, obtained from sea-
water; combining readily with alcohol, ether, or chloroform; and soluble
in 33 parts of water at 59° F. When added to water, ozone is liberated. It
completely volatilizes upon exposure to the air, giving off a highly-irritating,
suffocating odor like that of chlorine, with which it may be contaminajed-
The pharmacopceial tests require the chlorine to be not more than 3 per cent.,
and that there shall be only traces of iodine.
Physiological Action.— It is unfortunate that the smell of bromine is
80 obnoxious, since it is a true disinfectant, rivaling mercuric chloride, and,
it is claimed, has even more influence than that agent in preventing the
derelopment of spores. A 2-per-cent. solution in water destroys the spores
of anthrax. Applied to the skin, it is a penetrating caustic in its pure state,
and, diluted, is astringent and antiseptic. Internally, its effects resemble
those of iodine and chlorine, causing paralysis of the brain-centres, death re-
sulting from paralysis of respiration.
In cases of poisoning by swallowing this agent, the stomach must be
thoroughly irrigated, and a purgative like croton-oil administered in alkaline
solution (Vichy water). When inhaled, warm vapor from the steam-atomizer
with alkaline solution (Dobell's solution) would afford relief to the irritation.
The bromides taken upon an empty stomach in concentrated form sometimes
csuse gastralgia, which may be relieved by hot water and an hypodermic in-
jection of morphine, combined with atropine, if stupor be present. After
death the bromides are found in the brain, principally (Doyon).
In medicinal doses the bromides and hydrobromic acid exert a sedative
effect upon the functions of the brain, produce insensibility of the mucous
membrane of the fauces, and allay irritability of sensory nerves, as is very
well, shown by their effect in the treatment of tinnitus aurium after admin-
istration of quinine. It has a special action upon the genito-urinary tract,
obtnnding sensibility and preventing erections or ovarian excitement. On
the other hand, sodium bromide has, in a few instances, been known to pro-
duce nocturnal erections and seminal emissions £rom relaxation. The bro-
loides act directly upon the spinal cord, reducing reflex action and, when
continued, diminishing motor power and producing paralysis of the legs.
The circulation is also affected by their action upon the cardiac ganglia. In
the case of potassium bromide, we have superadded the toxic action of potash
Dpon the heart-muscle, by reason of which, when given in large doses, the
274
PHARMACEUTICAL THERAPEUTIC AOEXTS OR DHrOS.
arterial tension is reduced and the pulse-rate lowered. Id the usual dosea,
however, this effect is hardly obserrable.
According to the studies of Germain S6e, potassium bromide causes
dilatation of the heart. The right side of the organ appears to be more
decidedly ntFectcd, It wag said {by Hammond) to reduce the cerebral cir-
culation, causing anaemia by contraction of the arteriole?. It i^ probable that
the hypnotic effect of bromides is due more directly to their action upon the
brain-centres, especially the motor and intellectual portion of the cortex
cerebri. To its faculty of reducing reflex nervous excitability is to be ascribed
its well-known antispasmodic effects in convulsive disorders. No marked
effect upon temperature or respiration has been observed from medicinal
doses; very large doses may reduce both, and also diminish tissue-waste. ,
The xatc and the force of the heart's action are lilfewise diminished i
and arterial pressure reduced by excessive doses. When continually admin-
istered in moderatelj^-large doses, the bromides sometimes excite nausea and
diarrhcea. A sedative action is exerted by the bromides upon the sympa- '
thetic nervous system.
The bromides have considerable diffusive power, and are found in most
of the secretions and in the interior of glands like the liver; after long
administration they accumulate particularly in this organ, and the amount
of bromide retained in the liver is very great. It has been surmised that
this saturation of the system by bromide predisposes to tuberculosis. M.
Fere states that, although he has seen nothing in patients to corroborate the
supposition, guine£-pi^s saturated with potfissium bromide and inoculated
with tuberculosis succumb more rapidly than animals to whom the salt had
not been given. It has likewise been shown that the bromides accumulate
in the brain and other organs. The glandular elements of the skin are stim-
ulated and an acneiform eruption follows their prolonged use.
The use of the bromides is occasionally followed by the development
of erythema or a brownish discoloration of the skin. In other instances it
has caused an eruption similar to that of eczema, wheals, or ulcers. The
effect upon the skin may be produced within a day or two after administra-
tion of the drug, but usually occurs only after saturation of the system. An
eruption occasionally appears upon the body of a nursinp; infant, when the
mother is upon a course of bromide treatment. The bromides are eliminated
from the system by the secretions generally, but more particularly by the
glands of the fauces, skin, bronchi^ and bowel*, and by the kidneys. Ab-
sorption is much more rapid than elimination.
Therapy. — P'or its caustic effect, bromine has been used in alcohol (1
to 2 or 3) in hospital gangi-ene, and in gyna?cology as an application to can-
cer of the uterus. Diluted with sweet oil (O.GO c.cra. to 30 c.cm.. or mx to
f5J), it is a sedative dressing for rhus-poisoning or chancroids. Broraipe is
employed, like carbolic acid, as a disinfectant for drains, but is too offensive
for use in this way in the sick-room. The bromides arc not often used as
topical remedies, though an aqueous solution of the strength of 0.65 to 1.30
to 30 c.cm. (or gr. x-xx to fjj) may be serviceable in paraesthesia. Finely-
powdered potassium bromide is stimulant to chronic ulcers, and has been
advantageous in epithclinma. It has been applied, added to 5 parts of glyc-
erin, to hajmorrhoids and fissure of the anus, in order to relieve pain. In
treating laryngeal diphtheria, or membranous croup, the
used: —
he following may be
BROUUM.
275
M WOlBi
PutMJB^ii brotnidi 4
Sjrrupi eimplici-*
Deeoti alUufcA-
28
.q. s. ad 120
30 c.cm. or rnv.
Gm. or 3j.
c.cm. or f3vits8,
can. or fjiv, — M.
' a child of one year, the bromine should be reduced to one-third, and
I me to four years two-thirds, of the quantity in this formula, of which
lOcxm. (or f5j) are to be given every hour, while the symptoms are urgent
(Bedobecher). The official solution oi hydrobromic acid has not answered
te expwrUtion of those who urged its use as a substitute for the bromides;
ii WMj be iesB liable to produce acne, but it is irritating and less etHcient.
It BWj be given for the relief of tinnitus aurium, headache, or to prevent
It sjinptoms from the eftecta of quinine: —
R Qutainjp hydrobromidi .
Arid, hydrobromic. dilut 16
Elixir aurantii 105
M. Si^-: I>ooe, a Ublcspoonful after meala.
65 Om. or gr. xxiv.
c.cm. or ftss.
ccm. or fjiiiss.
I
Speeial Applications. — The special use of the bromides is found in the
tastmexit of ccnTulsive disorders, such as spasm of the larynx or epilepsy.
btbe former affection a few doses of 0.G5 Gm. (or gr. x) or more in a child^
mt wnaUj sufficient to accomplish a cure; but in the latter the treatment
Aed extends over months and years. When the bromides are continued for
tka^ time, bromism is apt to be produced, the physiological action of bro-
xiat being shown by eruptions upon the skin, especially of the face; loss
4i«flexee; dragging, heavy sensations; and difficulty in locomotion, and
ii Moe cases special tendency to convulsive attacks appear. It therefore
Weoaa«« necessary to intermit the bromide or change from one to another,
adL if there is too much depression of the vital powers, digitalis may be
■venbed in combination, or strychnine given hypodermically in minute
iaH (0.CM>O5 to 0.001 Gm., or gr. Viio-V«o) several times daily. Brown-
Ismrd preferred a combination like the following, in treating epilepsy, for
cdiild ten vears of age: —
B Pot*««U iodidi 4
Pola^ii bromidi 31
Awmanii bromidi 10
pMaaffii bicarbonatlv 2
SnirituB chlorofonni . . . . ! 7
IftfttA) cttluRibe q. i. ad 180
Gm. or 3j.
Om. or Sj*
Gm. or 3iift8.
60 Gm. 6r gr. xl.
60 c.cm. or i3ij.
c.cm. or fjvj.
!£. Doae« 7-5 ccnu (or f3ij) morning and noon and II c.cm. (or fSiij) at nigbt,
I^Ukiatf th*> quantity after the convutsiona ceane, but contintiing the remedy at
fff tmperimUy at the time when the 6ts nre liable to recur. If the pHtienl be
«Mk, t^ Snfiuuon of digitaJis may be iubetituted for the caluniba.
JL Gh. F^r6 states that most of the ill effects of the bromide may be
swdrd b; the simultaneous administration of an intestinal antiseptic. In
" I nnuiiretnont of epilepsy he has often made use of the following cora-
PMaaalfi bromid. . 6| Gm. or Sisa.
■«.--•,*■,. ! 41 Gm. or Sj.
, yXmt, 2| Gm. or 3ft».
^^S '• 1 <^ ^ <SiTfded into thrve doieft. One dose to be tAlcen three times a day.
2T6
niARMACEUTICAL THEUAPEmC AGENTS OB DRUGS.
Qm. or 3iij.
Gm. or 3iv.
c.cm. or f5j.
c.cm. or fSiv.
c.cm. or fjviij.
This com-
In treating epilepsy, the partial insensibility of the fauces is the guide
to the administration of bromides; this Bhould be established as booh aa (
possible and maintained during the continuance of the treatment, which
should not be pushed to the point of bromism. Small doses of arsenic will
prevent, to some degree, the eruption in persons eepeciallj susceptible to
bromides, and it is well to alternate the iodides with the bromides in order
to prevent undue accujnuJation of the latter in the system. The beneficial
action of the bromides is particnlarly marked when epilepsy is due to dis-
order of the sexual apparatus. On the other hand, the pelit mal is much
less amenable to their influence than the general convulsive seizures. Potas-
sium bromide has a certain sphere of usefulness in whooping-cough. It is
of no avail when the bronchitis is severe, or when pneumonia is present; but
in simple uncomplicated pertussis, above all when convulsions or a tendency
to convulsions exist, this remedy is of great service in allaying the congestion
of the nervous centres. Spasmodic asthma is, in some instances, consider-
ably benefited by the exhibition of bromide, and its efficacy is enhanced by
combination with the iodide. The bromides are of decided value in infantile
convulsions, especially wlien these depend upon reflex irritation. They are
likewise of service in the convulsions symptomatic of simple meningitis, and
not altogether without avail in alleviating those of tubercular meningitis.
Uraemic convulsions may sometimes be successfully treated by potassium bro-
mide in combination with chloral-hydrate, assisted by active purgation and
diaphoresis. AVhen cholera infantum is associated with excessive nervous
irritability, potassium bromide serves a useful purpose, as it does also in those
cases in which flatulent colic of infants is connected with marked intestinal
spasm. Dr. Harvey Vanatta, of Seal, Ohio, administered potassium bromide
with success in a case of invagination of the bowel.
In treating nervous irritability, restlessness, and insomnia it is well to
combine bromides with other hypnotic agents: —
H Potasaii bromidi 1| vel 1130 Gm. or gr. xv vel xx.
Chlorali hydrati |65 Gm. or gr. x.
Aqu8B camphone,
Syr. lactucarii aa 4] ccm. or f3j.
M. Sig.: Pro dosi. For nervous headache with insomnia.
The sedative and antispasmodic effects are increased by combination
with gelsemium, asafetida, or valerian, and smaller doses are required than
when each ngrnt i^ a'lniinistertMl alone. In Mi*ni(>ro'e disease, Ferreri reports
good results irom the use of large doses of potassium bromide in conjunction
with ferric valerianate. In the affections of the genito-urinary organs the
bromides are of especial value when apaam or pain is present. The quantity
of urine is increased and also the proportion of urea. The sexual functions
are depressed; and the bromides are largely used as anaphrodisiacs in pria-
pism and nymphomania, especially when given in conjunction with tartar
emetic in minute doses,
A good formula used by the author for gonorrhcea with chordee is the
following: —
R PotasAii bicarb 12
Potaftsii bromidi 15
Tincturffi hyoBoyami 30
Spiritus ihloroformi 15
Inf. buehu q. a. ad 240
M. Sig.: A tAbleajKJonful in barley-water every three or four hours,
binaiion relieves scalding and chorde«.
the I
4
BBOHUH. 277
The following are also valuable prescriptions containing the bro*
mides: —
B Sodii bromidi 271 Gm. or Srij.
Antimonii et potasBii tart |03 Gm. or gr. m.
Aqum camphonB,
Spiritus cetherii xutron aa 451 ccm. or fSiea.
Syrupi aurantii 60| ccm. or fSij.
M. Big.: Two teaapoonfuli in water eyerj two or three hours until relieved.
Seniceable in epididymitiSi cystitis, and prostatitis.
ft AmmJidi bromidi,
SaloL aa 4| Gm. or 3j.
M. et ft. capsuUe no. xij.
Sig.: Two capsules every hour or two. Employ in gonorrhcsa and all irritable
ANiditions of the genito-urinary organs.
The menses are delayed and rendered less in quantity, by the use of the
bromides. When znenorrhagia is caused by ovarian congestion, potassium-
bromide restrains the flow, and the same agent sometimes proves of service
in metrorrhagia. In the profuse and irregular menstrual discharges, which
often occur as the menopause is neared, the same remedy is of value. The
headaches, flushing of the face, subjective sensations of heat, and other
anomalous symptoms which characterize the same period receive notable
relief from the bromides. Chordee occasionally yields to the same agent.
In Bpermatorrhoea and atonic impotence, dependent upon irritation or sub-
acute chronic inflammation of the deep urethra, the bromide is valuable by
diminishing the reflex irritability of the genital centre in the cord. But, in
diunal pollution due to debility of the genital centre, this remedy is harm-
foi and should be avoided. In all cases of reflex nervous disorders having
origin in ovarian irritation the bromides have a well-established reputation,
bat should not be given freely in ansemic subjects. In reflex cough — or so-
called uterine cough, atomach-cough, ear-cough, etc. — ^we may give: —
9 Potassii hromidi |32 to 165 Gm. or sr. v vel x.
Syr. pmni Virg. 7|5 ccm. or 6ij.
M. Take every four to six hours. The above is also useful In the cough of ehil-
dren, in smaller doses.
When it is desired, in laryngology, to make an examination or an opera-
tion upon a very sensitive throat, the use, for a few days, of full doses of
potassium bromide will greatly assist in reducing such hypersesthesia. In
Tarioos hysterical throat affections, the bromides are of the greatest value.
In irritability of the bladder in women who use sewing-machines, or
others, the following is serviceable: —
B Potassfi Tel sodil bromidi 1130 Gm. or sr. xx.
Infns. UV8B ursi 4| ccm. or ?3j.
H Sig.: Take every hour or two tmtil relieved.
In migraine, the combination with opium is valuable : —
B Tr. opii deodorat. 4
Potassii bromid. 8
Acid, hydrobrcmle. dil 00
Syr. auraotii q. s. ad 120
ccm. or fSj.
Gm. or 3ij.
ccm. or fSij.
ccm. or fjiv.
M. Sig.: Take a dessertspoonful in water, every two or three hours.
278 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS. T
Cases of maniacal excitement, puerperal, alcoholic, or other, are relieved
by full doses of bromides, especially when combined with chloral .
Many acute attacks of fever in children, with delirium, are promptly
cured by bromides, in small doses given every few minutes. Seasickness and
the vomiting of pregnancy are controlled by small doses of bromides in
effervescent salt; large doses have occasioned temporary derangement of
mind, and have brought this remedy into disrepute because improperly used.
In poisoning by strychnine and in tetanus, large doses of the bromides have
proved successful in subduing the convulsions.
In acute cerebral congestion potassium bromide is of great value through
its influence upon the vasomotor system. It is very serviceably given in con-
junction with the fluid extract of ergot, which aids its action by constringing
the cerebral vessels. The headache and wakefulness are also relieved by the
bromide. The same drug is efficacious in allaying cerebral vomiting. In-
Bomnifl, caused by nervous strain or excessive mental application, is success-
fully treated by means of the bromide. The headache of pachymeningitis Is
generally best controlled by a combination of potassium bromide and iodide,
as: —
B Potaasii iodidi )0| Gm. or Siiss.
PotasBii bromidi 1*15 Gm. or 3v,
^ Syrupi ourantii,
H Syrupi aimplicis au 60| c.cm. or f^ij.
M. Big.: Dose, two teaspoonfuls three or four times daily.
In exophthalmic goitre, the excessive cardiac action may often be re-
strained by the bromide. This remedy may be useful in subacute and acute
rheumatism, especially when the aciite form of the dipease is accompanied
by considerable fever and delirium. The restlessness and delirium of the
third we^k of typhoid fever are often admirably controlled by a bromide. The
same agent is very eflficacious in preventing the night-terrors of children.
It is claimed that potassium bromide is useful in diabetes mellitus of nervous
origin. The salt relaxes nervous spnsm of the oesophagus and allays the nerv-
ous symptoms of rachitis. Potassium bromide and iodide are recommended
in eliminating metals — as mercury, copper, or lead — from the system. The
bromide may be useful in reducing enlarged lymphatic glands and spleen,
though far inferior to the iodide. A bromide addition to a prescription in-
creases the effect of hypnotic or narcotic medicines, and it is often able to
obviate the unpleasant consequences of opium.
Victor Augagneur has found potassium bromide of service in certain
syphilitic manifestations. Dysphonia or aphonia sometimes occurs, espe-
cially in women, in the sixth or seventh month of the disease. In the belief
that it depends more upon disturbed innervation than upon the erythema
of the laryngeal mucosa, he is accustomed to give bromide in combination
with potassium iodide with very good results. In serious tertiary disease of
the larynx the iodide may give rise to dyspnea. In this condition it is ad-
vantageous to practice mercurial inunction and depend upon the bromide to
reduce reflex excitability. When the dyspnoea has been allayed, the bromide
and iodide may be administered in association. The addition of the bromide
to the iodide is also of value in cerebral syphilis.
According to Dr. Wilks, the bromides often have a good effect in caus-
ing reduction of goitre. They have also been used with success in order to
diminish the volume of fibroid tumors of the womb.
II
BBOHUH. 279
During administration of the bromides the digestive functions maj
become disordered, and it is necessary to occasionally give cholagogal cathar-
tics to keep the liver up to its work.
In comparing the bromides we observe some difference in their effect
and therapeutic applications.
Potassium bromide is the most frequently prescribed, and is the most
efficient. Where the circulation is weak, the other salts, especially the am-
monium salt, are to be preferred.
Sodium bromide is the least toxic, and is preferred in cases where nutri-
tion is poor, especially in anaemic women and children. It is not so efficient
in cases of a uric-acid diathesis or lithsemia, as other salts, and notably that
of lithia.
Lithium bromide has been thought to possess more hypnotic power than
the potassium bromide. Ammoniiim bromide combines the stimulating
action of the ammonia with the hypnotic effect of bromine, and is useful in
cerebral rheumatism. The manifestations of bromism are not so readily ex-
cited by the ammonium salt as by that of potassium or sodium. Ammonium
broniide is useful in whooping-cough.
Nickel bromide, introduced by Da Costa for the treatment of epilepsy,
has the advantage of the smallness of the dose, but the disadvantage of the
metallic poisoning when too long continued. It is best given in effervescent
salt or in the form of a syrup mixed with orange-flower water. The salt is
green in color, deliquescent, and soluble in water. It is well borne by the
stomach, relieves congestive headaches and convulsive movements. Zinc
bromide is little used; it is supposed to combine the well-known action of
line upon the central nervous system with the bromide action. The syrup
of ferrous bromide has been employed for chorea in anaemic children, with
good resTilts.
Strontium bromide appears to have decided advantages over the other
bromidies in the treatment of epilepsy. Dr. Antony Hoche has published^
notes of successful cases and says that he has not met any case in which the
bromide of strontiimi, given in the prescribed doses and according to his
method, has failed to diminish the number of the attacks. In many in-
itances there had been no return for periods extending to two, three, or
eren four years. He usually begins the treatment of epilepsy by ordering
2 Gm. (or 56s) of the strontium salt, night and morning in some vegetable
tonic infusion. Should this dose not control the attacks, he rapidly in-
creases it until he flnds the quantity that will suit the individual case. In
cases where there is distinct warning before the attacks he gives 2 6m. (or
Sb) at once, and directs this dose to be repeated every hour, if required.
In this way he has succeeded in preventing an attack. In order to get the
fnll benefit of the treatment he has found it necessary to give this remedy
in large doses and to continue it for a long period. Dixon Mann in his
"Manual of Medical Jurisprudence" says, with regard to the safety of this
treatment, that strontium salts cannot be regarded as poisonous. He had
himself taken 12 Gm. (or 3iij) daily for weeks without any unpleasant symp-
toms. The strontium bromide does not cause the depression that follows
the potassium salt.
Bromaiaid. — Fischedick and Koechling have introduced a compound
'lancet, Oct. 15, 1S08, p. 987.
280
PIIARMACKrxICAL TIIEItAPEPTIC AGENTS OH DRfaS.
of the aniline group containing 75 per cent, of bromine and designated bj
them as bromnmid. It is obtained in the form of colorless, odorless, and
tasteless needle-shaped cn'stals, insoluble in water, but soluble in boiling
alcohol, ether, chlorofonn, and the fijied oils. It melts at 243° F. and
volatilizes at 310° F. without change. No symptoms are produced in doga
by doses of 2 Gm. (or gr. ixx). The pulse-raie is, in adults, retarded by a
dose of 0.65 Gm. (or gr. x). Bromnmid reduces a febrile temperature 1°
to 2.5° F. without excessive sweating. It does not disorder digestion or
produce diuresis. This substance has been employed as an antipyretic and
antineuralgic in doses of 0.65 to 1 Gm. (or gr. x-xv) several times a day
to adults and 0.065 to 0.32 Gm. (or gr. i-v) to children. Bromamid may
be administered in capsules and wafers or suspended in a fluid.
Bromipin is a solution of bromine in sesame-oil (lu per cent.). It
has been used internally in the treatment of epilepsy by Zimmermann, of
Hanover. The dose is 4 to 15 c.cm. (or f3i-iv) three or four times daily;
with epileptics the dose may he increased to double this quantity. (One
tablcspoonful of bromipin represents about 1.49 Gm., or gr. xxiij, of com-
bined bromide, equivalent to 2.20 Gm., or gr. xxxiv, of potassium bromide.)
Bromoform. — Tribromometbane. If to methane, or marsh-gas (CHJ,
be added 3 atoms of bromine in substitution for 3 of hydrogen, we get methyl
bromide, or bromoform (CHBr^), analogous, therefore, in coni])osition to
chloroform or iofJoform. Bromoform is an oily liquid, having an agreeable
odor resembling that chloroform. It has a sweet taste, does not atfeCt the
mucous membrane of the mouth, and has no irritant effect. It is rapidly
decomposed by light. Its density is 2.7i, and it boils at 150** C. Insoluble
in water, it dissolves in alcohol and ether, its reactions being similar to chlo-
roform. It usually is prqscnt in small proportion in commercial bromine,
and is made by adding bromine to a solution of an alkaline hydrate in alcohol
or woo<]-spirit. A fluid "anur of l^rmnnfnrni contain? .360 drop:^.
Bromoform was first introduced by Stepp, of Nuremberg, in 1SS9, as
a valuable remedy in whooping-cough. In children aged from six months
to one year, 0.12 c.cm. (or mij) maj* be given three or four times daily, and
the dose is increased by about a drop for every additional year of age. The
dose for adults is 0.545 to 0.80 c.cm. (or mvii-xiij) in capsules. Bromoform
diminishes the frequency, severity, and duration of the parox}'sms of per-
tussis, has a favorable influence upon the mucous secretion, and generally
abolishes vomiting and the hjcraorrhages within a short period. The most
severe cases are perceptibly benefited within eight da^'s. Dr. S. Solis-Cohen
has used bromoform with beneficial results, as a local application, in the
treatment of tubercular and other ulcers of the throat. He recommends its
combination with iodoform. The local application of bromoform is also of
utility in ozaena.
Dr. Ponticaccia reports that bromoform, given in daily doses, pro-
gressively increasing from 1 to 3. 25 c.cm. (or mxv-1), has an excellent
sedative t^leci in cases of acute mania. He found the same remedy of value
in delirium tremens, in which it allayed restlessness and induced sleep.
Several fatal cases of [)oisouiiig frnm bromoform have lnvu repi^rtod, the
paliont in each case being a clnld who had taken a large quantity (30 to 40
minims).
When bromoform is given suspended in a gummy mixture, accidents
have bnp]>cned through neglecting to tborouglily shake the bottle, before
BRYONIA. , 281
pouring out the medicine. It is insoluble in dilute alcohol, but may be dis-
Bohed by the aid of glycerin, and a formula has been proposed by the late
P. W. Bedford which forma a perfect and palatable solution (each fluidrachm
contains 0.06 c.cm.> or mj, of bromoform): —
3 Bromofonn 1| ccm. or mxvj.
Alcohol,
Tr. cftrdam. co. aa 716 ccm. or fSij.
Glycerini 45| ccm. or fjiss. — M.
Bromogallio Acid. — This substance, otherwise known as bromogalloli
reaembies bromic acid, in which two atoms of hydrogen have been re-
placed by bromine. The blood of a dog poisoned by bromogallol was of a
Bftffron color and contained a large quantity of methsemoglobin. Respiration
was at first accelerated, but afterward retarded. Lupine and Cazoneuve, of
Lyons, have employed it as a succedaneum of potassium bromide. It appeared
to be useful in chorea, but less efficient in epilepsy than the salt of potas-
eiam. This preparation, known also as gallobromol, has been used with
success locally in eczema rubrum and other stubborn forms of -eczema in the
fonn of a 1- to 2-per-cent. solution, powder, or ointment. In cystitis and
epididymitis 2- to 4-per-cent. solutions have been employed by irrigation.
^mol, or Tribromphenol, is obtained by the action of bromine in
excess on carbolic acid. It possesses antiseptic properties, and has been used
with advantage in the local treatment of wounds, ulcers, and diphtheria. In
the last-named affection Pademaker recommends a mixture of 1 part of
bromol with 25 parts of glycerin. Bromol has been given internally in
cholera infantum in doses from 0.005 to 0.015 6m, (or gr. ^/la-VJ- On
the ground of his experimental and clinical investigations. Dr. Tschourilow
states that tribromphenol is an excellent application in erysipelas. He made
ose of it in the form of a 1-, 2-, or-3-per-cent. ointment.
BEYONIA.— Bryonia (Bryony).
Preparations.
Tinctura Bryonue. — Tiiieture of Bryonia (10 per cent.). Dose, 4 to 15 ccm. (or
l^ir).
Bxtractnm Biyonitt Fluidum. — Fluid Extract of Bryonia. Dose, 0.30 to 1 c.cm.
(or «IT-XT).
Bryonin. — ^The active principle. Dose, 0.01 to 0.02 Gm. (or gr. VrV«).
Pharmacology. — Bryonia alba and Bryonia dioica (Cucurbitacese) are
the official sources of the root known as bryonia, which must be recently
driKl. as an old drug is useless. It contains two glucosides, Bryonin and
Bryoaidin; tlie former is a poison, and is the principal constituent; it ap-
p^rs in pearly crv'stals or in white powder ; it is very bitter ; soluble in water
and alcohol. On being boiled with diluted sulphuric acid, bn'onin splits up
into glucose and a resin, Bryogenia. A second resinous principle, BryoresiEy
i? also found in the root.
Fhyiiologioal Action. — The juice of the fresh plant blisters the skin.
The drug, taken taken internally, acts as an irritant, and is a hydragogue
cathartic. It also increases the flow of urine. Br\'onia acts as an irritant
npon serous membranes, and in toxic doses causes gastro-intestinal inflamma-
tion, with nausea and vomiting, and gives rise to symptoms of meningitis.
l*^th has followed in several cases. Its antidotes are opium and stimulants.
283 PHAKMACEITICAL THEBAPEUTIC AGENTS OR DRUOS, ^"
Therapy. — As there ere better purgatives, bryonia is not required for
this purpose. It is reported to have been used with success in atonic dys-
pepsia. It is used, in small doses, in rheumatism, pleurisy, and other serous
inflammations, after the fever has abated. It appears to be especially serv-
iceable in the muscular pains and stiffness following colds. In chronic
bronchitis it has been advocated. Brj'onia has been recommended in the
catarrhal stage of %vhooping-cough and in cases of enlarged spleen from
chronic malaria, and, also, by Petresco, in cases of hiemorrhage, especially |
in epistaxis. In chronic or aubnctUe pharjTigitiB, the tincture has been em-
ployed, with asserted good results.
BUCHU (U. S. P.)-— Buchn.
BUCHU FOLIA (B. R),— Buchu-leavcs.
He Preparat ioiu.
Fluidextriwtum Buehu (U. S. P.).— Fluid Extract of Buchu. Dose. O.tiO
4 c.cm. (or mx-f3j).
Infusum Diuhu (B, P.|. — Infusion of Buchu {one to sbcteen). Dose, -t to 8
c. cm. (or fSi-ij ).
Tinctura Buchu (B. P.).— Tincture of Buchu (20 per cent). Dose. 2 to 4 c.cdl
( or f 3s8-j ) .
PhannacoIogT', — The dried leaves of Biirosina bctulina (Rutnccir),
derived fr«ini gontl-sized^ erect,, and widely-liranching shrubs of southerti
Africa. Tliey contain an aleoresin, which is the most active coostitueut.
They also contain a bitter glucosido, Barosmin, The oil of Buchu contoina
30 per ceut. of the characteristic, crystallizable phenol kuowu as diosphenol
(^^'inHjcO^). The fluid extract does not unx rejidily with water, on acc<>unt
of tJie jirfSunce of the oil and extractives.
Fhyfliological Action. — Buchu-Ieaves have a strong, mint-like odor and
a bittiT, pungent taste. When takon into the stomach, a warmingr, canuina-
tive effect is produced by small doses, but very large ones cause irritation.
The volatile oil diffuses into the blood, slightly stimulating the circulation,
increasing the quantity of the urine, and imparting to it a peculiar, aromatic
odor. In process of excretion the remedy acts as an astringent and disinfec-
tant upon the urinary organs, especially the bladder. As a portion is
eliminated by the bronchial mucous membrane, a stimulating influence is
also exerfed here in relaxed conditions accompanied by increased secretions.
When used to excess or for a long period, or in too large quantity, the kidneys
suffer and de^enernte or inflammatory conditions are initiated.
Therapy. — The principal use of this agent is for disorders of catarrhal
character affecting mucous membranes and diseases of the genito-urinary
organs. In incontinence of urine, or want of tone in the bladder, good re-
sults usually promptly follow its administration, Buchu affords relief in
irritability of the bladder, in subacute or chronic cystitis, and in pyelitis.
Through the enterprise of the owners of proprietary remedies, buchu has a
popular reputation for the cure of gonorrhoea, but, owing to the quantity of
alcohol contained in the fluid extract, this should not be used during the
existence of acute inflammation, and only with great care in chronic ure-
thritis, or gleet. The recent infuesiou is perhaps tlie best prepiiration. It
may be combined with uva ursa (5iv of each to a pint of boiling water).
CICTUS.
283
ITkcre are many good reasons for believing that the much-advertised
for gonorrhoea contain no buchu-leaves whatever, but are
Mir from the leaves of uva ursi and other domestic plants. Buchu resem-
Ha <n] of turpentine very much in its physiological effects, and is useful
ii Midi the same class of cases. In gleet it appears to be highly serviceable.
Bachtt has been used with success in chronic bronchitis, atonic dyspepsia,
iftBEfeft; and in chronic rheumatism it may be administered sometimes
«ift adra&tage. Not having very decided diuretic properties, it is of little
i^aeia dropsy.
BinSA PASTORIS.— Shepherd's purse is a small plant belonging to the
*^enE, a native of Europe, but growing luxuriantly in this country in
■hhated lands during the months of April and May. The plant has a
tear, astringent, and strongly-pungent taste. It contains a volatile oil,
MKmbling oil of mustard, a glucoside, bitter principle, resin, etc.
According to tob Oefele, the virtues of the plant depend upon the pres-
oot of busuuc acid, the salts of which, with iron and sodium, may be given
■IlIOOxd. (or gj. iss) doses several times a day. Of the tincture, made with
Ml leaves, the doee is 0.60 to 4 or 15 c.cm. (or tnx-foi-iv), given in cases
tf kcraorrhage from the lungs, kidneys, or uterus, and also in diarrhoea and
fyKBtery. A fluid extract is also made, the dose of which is from 2 to 4 c.cm,
*efaes-j). Hoth preparations are miscible with water without precipitation.
BUm^CHLORAL HYDRAS (B. P.). — Butyl-chloral Hydrate. (See
ainal Hydrate.)
CACTUS, — Cactus. Xight-blooming Cereus, the Cereus grandifioria
fOttiBeem), is a plant of Mexico, with large, showy, nocturnal-blooming
favBi^ of pearl-white petals, which have a heavy perfume. A tincture of
dv frafa etems and flowers (124 Gm. to 473 c.cm., or o^^'^j alcohol) is
by Babini to be a valuable cardiac tonic in doses of 0.06 to 0.30
(or mi-T) three times a day. Probably these doses mio:ht be much in-
aa Knnge gave 1.20 c.cm. (or mxx) at once, and II. C. Wood was
to perceive any effect from them at all. A difference might be
lied for on the ground that some use the fresh plant and others the
J and leaves recently dried, the latter being the stronger preparation.
Ik cooatitti^*uts of Cactus are unknown. It contains several acia, glucosidal,
nawMtf bcK^ies. and also an alkaloid, which is present in very small quantity.
Innrt and Boy-Teiseier determined that, in frogs, cactus increases cardiac
l,,.. »K*,( ^j,e effect is transitor)*. Dr. Re^-nold W. Wilcox states that
phy^ '1 action of cactus is upon the intracardiac ganglia and ac-
itor mn*--*, through the cardiac plexus of the 8}Tnpathetic system, and
tat tbrt^ ^** "*> interference with the inhibitor}' nerves, nor does its admin-
■zxtino ♦? nny very marked vasomotor changes. It shortens the ven-
(nraisr - ^nd increases the blood-pressure. Sultan has extracted an
msr '■■ pl^» which he terms Cactin, from the young flowers of the plant.
He^jkir^ i.iiit cftctin increases the energy of the cardiac contractions, height-
iftartPTtai tension, and has a direct action upon the motor centres of the
^ml coftl- It produces reflexes, increases the general nervous tone, and
«a b« naed for a long period without causing gastric symptoms or cumuln-
Both pulse and bloofl-pressure are reduced by toxic amounts.
284
I'HAUMACEUTICAL THERAPKITIC At*EXTS OR DRUGS.
The action of the heart is rendered irregular and it is arrested in systole.
Death is preceded by clonic and tetanic convulftions, caueed by overstimula-
tion nf the motor tract of the e<n*d. I>r. Wilcox found it especially useful
in uncompensated cases of vulviilar dL'jease, in relative incrompeteney due to
muscuiar degeueration. in weak hearts after ty[d>oid fever, m funitional
heart dif^coses from alcohol, dyspei>sia, sexual exhaustion, etc., and in the
paljdtation of exoplithalniic goitre. In aortic regurcfitation. he considers
it to be the drug par excellence, while in mitral stenosis it should be avoided,
Watson Williams has found cactus bi-neficinl in mild cases of angina pec-
toris. Cactus has also prov^'d itsi'lf oHicieut in cardiac dropsy.
CADMIUH.- — Cadmium is hiund (-(uubined with ziiu-, in native ores.
It resembles tin in general appearance, and its salts are white and perma-
nent; they are soluble in water. They are astringent and resemble the
correspondino; zinc salts, producing emesis, but they are principally employed
for their local effects. SiuuU doses of the salts of L-adniium e.xcite (wliether
given by the mouth or hypodurmie injection) inthunmatiou of the gastro-
intestinal mucous membrane, and ulceration may occur. In addition they
may cause giddiness, loss of consciousness, and retardation of circulation and
of respiration. Alkaline carbonates and white of egg are the proper anti-
dotes. The ointment of the iodide (1 to S of lard) or the oleate may be used
in chronic enlargement of glands or joints, and especially in goitre. It has
also been recommended as an application in cases of enlarged gpleen. It
is said not to discolor the skin. Lincke has made use of injeetiona of cad-
mium sulphate in leucorrhoea and gonorrhoea. The sulphate may be em-
ployed as an astringent wash (in solutions, Yj per cent.) or as an ointment
(1 to 40 benzoinated lard). In solution the sulphate is used as a oollyrium.
CAFFEINA fU. S.P'., B. P.).— Caffeine, Theine (C^H^oN.O^ + H,0).
Dose, t).13 to 0,G5 Gra. (orgr. ii-x). B. P., 0.0G5 to 0.32 Gm. (or gr. i-v). (
Preparations,
Caffeina Citrata (U. S. P.).— Citrated Caffeine. Doae, 0,065 to 0.32 Gra. (or
gr. i-v).
CalTeina Citrata Efferveacens (U.S. P.).— Effervescent Citrated Caffeine. Dose,
4 to 12 Gm. (or 3i-iij).
Caffeince Citraa (B. P.). — Caffeine Citrate. Dose, 0.13 to 0.05 Gm. (or gr. ii-x).
Caffeinte Citras Efferveacens (B. P.). — Effervescent Caffeine Citrate. Dose, 4 to
6 Gm. (or 3i-ij).
PharmacologT'. — Caffeine is a feebly-basic proximate principle obtained
from the dried leaves of Thea sinensis (Temstromiaceas), or from the dried
seeds of C'oUV'a arabica (Knbiaocie), and found aUo in olhtr ]>hnit>, or pre-
pared syntfictically (U. S. P.). An alkaloid usually obtained from the dried
leaves of Camellia Thea, or the seeds of ColTea arabica (B, P.). Paraguay
tea, or mate, the Brazilian holly (lle.K Parao^ieneis), also contains caffeine,
and is laro^ely used as a hot beverage and stiraulnnt in South America. It
exists aim in the kola-nnt of Africa, the fruit of Sterculia acuminata {Ster-
culiacea?.). It is closely related to theobromine, existing in tlieobroma cacao,
and to cocaine, found in erythroxylon cocn, both in chemical composition
and effects upon the human body. Caffeine has been synthetically made
from Alanine; and also by heating, in closed tubes, theobromine silver with
methyl-iodide.
Citrated caffeine is most frequently employed in medicine on account
CAFFEINA.
285
■fiu greater solnbility, but Tanret has recently shown that by the addition
if «i eqaal weight of sodium salicylate, or benzoate, tJie solubility of caffeine
vfTefltly increased. Antipyrine has also been found to have the same action ;
m XhMt bj this means the hypodermic administration is greatly facilitated.
Oaeuid A half Gm. (or gr. xxiv) of antipyrine will enable 1 Gm. (or gv. xv)
cIcsffoBe to dissolve in 30 c.cm. (or f.^j) of distilled water, with the aid of
bmt, forming a p«rmanent1y-limpid solution.
Caffeine is in the form of colorless, silky, inodorous crystals, sparingly
leiiible in alcohol and cold water (75 parts), but much more Bolublc in boil-
iBf vater (9.5 parts). It is precipitated from its aqueous solution by tannic
Kid« or solution of potassium iodide and mercury; with the latter reagent
die deposit is crystalline, whereas, with other alkaloids, the product is always
OBorpliotu when this test is employed. Caffeine was first extracted from
taSet in 1821, by Felletier and Ca^entou, and by Robiquet and Runge.
' ig to Wurtz, it chemically is methyl-theobromine (or trimcthyl-
ine). Thf^ caffeine of commerce is usually derived from damaged tea.
Physiological Action. — It has been claimed by Dr. Mayp, of Philadel-
aUi, that ihe physiological effects of (he caffeine obtained from coffee differ
nm tboae following the administration of the alkaloid from tea. Mays
ommB that theine possesses analgesic properties which are absent in caffeine;
aJ that the latter will not affect the heart, while the former causes palpita-
tatt. Thc-ine, he has asserted, when injected hypodenmically, produces local
■M^Kpctg •whereas pure caffeine will not affect sensibility. Tanrot and
fyprd. ■ ** cfintrary, regard caffeine ns an efficient local anicsthetic. It
Im beeri that the well-known difforenoes in the physiological effects of
mend coffee were due to other constituents, and especially to volatile oils,
ml in the ordinary method of manufacture these might still contaminate
dr caffeine. It has been shown that tea contains another base, theophylline,
mmeric^ but not identical, with theobromine and paraxanthine. The pres-
ort of this boae might also affect the physiological results. The experi-
— f of I>uiiatan and Shepheard demonstrate that caffeine and theine are
ftstieal in chemical properties. Investigntions with caffeine prove it
«i have verv decided physiological p«->wers. There is. after its administra-
^■a, at first increase, but later diminution, of the activity of the reflex cen-
tov of the spinal cord. In frogs convulsions and muscular rigidity are
owd; the heart's action is at first accelerated and afterward slowed. Arte-
la] preaanre at first rises, but subsequently falls. Caffeine stimulates the
TMttmotor centre and exerts a direct influence uprm the heart. It assists the
fivteiB to reaist hunger and fatigue. It has a decided diuretic action. The
^f^, f tirea is at first increased, afterward diminished. Sobieranski,*
iHt: - 'S of experiments in the line of Ludwig's theory of urinary secre-
ji^f^ found that, in animals killed at various intervals after the injection
4 OHlieo-cftrniiTi, this substance was secreted by the glomeruli alone; it
^m nercT found in the baeal epithelium of the convoluted tubules, which
|nT(4 airain that this epithelium does not secrete. Further experiments
■vred that after the administration of diuretics, and while the system is
Ut under their inffnence^ the injection of indigo-carmin varies in its ef-
h^ With cafTi^ine. the cells of the convoluted tubules were no longer
tf^Bcd onlr a weak coloration here and there in the secreting epithelium^
•Cfwrrrtf*'"'^ ffir PhynU*1offif, April 4. 1900.
286
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
which he explains bj the assumption that caffeine paralyzes the absorbing
power of the convoluted tubulesj and to this he ascribes its diuretic action.
The diuretic salts — sodium chloride, nitrate, and acetate — produce their
effect through the blood's increasing the secreting power of the glomeruli
while only slightly affecting the absorbing function of the tubules. Urea
and kindred substances stand between these, as they raise the osmotic co-
efficient of the glomeruli on one hand, while they diminish the absorbing
power of the convoluted tubules on the other.
When caffeine is given in ordinary doses the rate of respiration is re-
duced, blood-pressure lowered; temperature slightly increased, afterward
diminished. The cerebral functions are stimulated, and, in many persons,
wakefulness results. Delirium, alone or associated with visual hallucina-
tions, is sometimes excited by the administration of caffeine. It counteracts
the effects of narcotic remedies, and fe valuable in the treatment of opium
poisoning, although not a complete antidote. When taken into the stomach,
caffeine diffuses readily into the blood, and is eliminated by the kidneys and
the liver, principally. Small doses increase the appetite and facilitate diges-
tion; there is some irritation of the digestive tract, increasing peristalsis and
in some cases causing venous congestion and haemorrhoids. From a dose of
0.75 Gm. (or gr. xij) of caffeine, Dr. Pratt experienced restlessness, sleepless-
ness, mental depression, and tremor. A dessertspoonful of the citrate of
caffeine produced nausea, stupor, extreme pallor and debility, soft pulse,
slow and sighing respiration; but recovery followed the use of emetics, hot
applications, and brandy. Zenetz^ calls attention to the dangers of caffeine.
"With doses of 0,20 to 0.32 Gm. (or gr. iii-v), two or three times a day, the
blood-pressure rises slowly, but steadily, and the quantity of urine is in-
creased. Between the fourth and sixth days the patient complains of con-
striction in the chest, dyspmea, and restless nights, due to increased blood-
pressure. Death may result from tetanic contraction of the heart. Caffeine
continues to be excreted, from the urine, for at least ten to fifteen days after
the last dose is taken; so that it resembles digitalis in producing a cumula-
tive effect. Caffeine should be used with caution in all renal diseases, in
arteriosclerosis, and atheroma, and all cardiac diseases secondary to them.
Another danger of catrcine consists in the existence of idiosyncrai^y or exces-
sive susceptibiiitj', Zenetz reports three cases of, in his opinion, death from
caffeine; in each the heart was found to be so strongly contracted that it
could be cut with difficulty. One was a youn^ man with croupous pneu-
monia, who was only taking 0.20 Gm. (or gr. iij) three times a day and who
died suddenly on the third day.
Therapy. — In migraine, caffeina citrata may be administered, 0.065 Gm.
(or gr. j) every hour, with excellent effect; or a cup of strong tea or coffee
given. Where there is co-existing liver, kidney, or stomach disorder, a purga-
tive should begin the treatment. Anaimic headache also may be relieved by
the administration of caffeine. The hypodermic injection of this agent is
eometinicfj dhciciit in nenrnlgin ; or it may he administered as follows: —
R Caffeinie cilnvtie ... ij30 Gm. or gr. x-\.
Acetphpnctidin
Pulv. aromntic ftft 2[ Gni. or Sss.
M. ct ft. c:liurtulue no. .\.
Sig.: A powder every two or three hours. Serviceable in migraine, and in neu-
ralgia about the scalp, face, and in sciatica.
' Wiener mcdicinlsche Wocftrnschrift, Dec. (*. 1809.
CAFFEINA. 287
H CaffeiiuB citrat 1|30 Gm. or gr. xac
Acetanilidi 1 30 Gm. or gr. xx.
Ext. cannabis IndicflB |20 Gm. or gr. iij.
M. et ft. capsuls no. x.
8ig.: A capsule every two or three houra for neuralgia.
B CkfTeinse citrat.
Ammonii bromidi 12
£lix. guarans 60
Gm. or 38S.
Gm. or 3iij.
e.cm. or fSij>
M. Sig.: A teaapoonful every hour or two until relieved of pain of neuralgia.
In despondency and hypochondriaflis, caffeine, or a cup of hot coffee
infusion, will sometimes serve a good purpose. It may be given in order to
dissipate the drowsiness which is often produced by a hearty dinner.
As a cardiac stimulant in valvular diseases, dilated or fatty heart, or
in the myocarditis accompanying rheumatism, in low fevers, and in dropsy
due to weak heart, caffeine may be given hypodermically (0.065 to 0.13 Gm.,
or gr. i-ij, every two to four hours), or the sodio-benzoate may be employed
as recommended by Huchard. When being administered in these cases,
caffeine vn\\ sometimes give rise to so much insomnia that its use will have
to be abandoned, or, at least, temporarily suspended. Dr. Petrescu, of
Bucharest, indeed, claims advantage from largely increasing the usual doses,
uid states that he has administered with good effect as high as 2 to 4 Gm. (or
gr. xxz-lx) daily for several consecutive days. Misrachi recommends the use
of the sodio-benzoate in puerperal haemorrhage, and states that when given
hypodermically it acts more rapidly than ergot. In chronic Bright*s disease
caffeine diminishes albuminuria and dropsy. It may be used in co-operation
with hydragogic cathartics in ascites. Ursemic coma may sometimes be
lightened by the hypodermic administration of caffeine. The hypodermic
injection of caffeine is also of assistance in the treatment of opium poisoning.
It may be used during the intervals of administration of digitalis, or, where
this drug is too slow, given in the following combinations: —
H Caffeine citrat 3{25 Gm. or gr. 1.
Liquor potaasii citratia,
SpirituB etheris nitrosii
Infua. digitaUa aa 60| c.cm. or fjij.
M. Sig.: A half-teaapoonful in water every three or four hours. Employ in
T»lTuUr insufficiency, attended with dropsy.
In weak, dilated heart, with gouty tendency, and in nephritis, the fol-
lowing are useful: —
H Caffeinse citrat.,
Lithxi citratia aa 6 £
Strychninee sulphat.
01. gaultherise
H. et ft. capaulffi no. xz.
Sig.: One every four hours.
B Caffeinae citrat. 3 i
Tinct. atrophanthi 4 f
Aqne camphorse 90
M. Sig.: A teaapoonful three times a day. Use in parenchymatous nephritis
Attended with dropsy.
In pneumonia, or congestion of the lungs with weak heart, in elderly
patients, caffeine is an excellent remedy in moderate doses (0.065 to 0.13 Gm.,
50 Gm. or gr. c,
015 Gm. or gr. V*.
30 c.cm. or mv.
26 Gm. or gr. 1.
50 Gm. or tnlxx.
c.cm. or fjiij.
288
riLARMACEUTICAL TnEILVPECTIC AGENTS OR DRUGS.
or gr, i-ij, given hypodermicallj every two to four hours). It is likewise of
value in the weakened heart of typhoid fever and pneumonia, after the febrile
Btage has passed. In the diarrhoea of relaxation, typhoid fever, sporadic
cholera, etc., the sodio-beuzoate or sodio-salicylate may be used, in combina-
tion with nux vomica or strychnine.
Cholera infantum and the diarrhcea of phthisis are "not infrequently
benefited by caffeine. An asthmatic parosy&m may often be relieved by thia
remedy. On account of its tendency to produce wakefulness it has, gen-
erally in the form of a strong coffee (either given by the stomach or injected
into the rectum), long been a valuable adjuvant in the treatment of opium
poisoning.
Caffeine Tri-iodide. — This compound, a dark-green crystalline sub-
stance, readily soluble in alcohol, is a slinnilant and diuretic, which has been
used in cardiac dropey in the dose of 0.13 to 0.25 Gm. (or gr. ii-iv).
Caffeine-flulphonic Acid. — This compound, introduced by Drs. Heinz >
and Liebrecht, is claimed to stimulate the secreting power of the kidneys
without increasing blood-pressure. It has been given in the form of a so-
dium combination, and, while acting as a good diuretic, had no ill effect
upon the digestive processes. The salt is, therefore, well adapted to the
treatment of cardiac or renal dropsy. Caffeine-sulphonic acid will also unite
with lithium, and it is thought that this salt will prove useful in lithiasis,
gout, and gravel.
CAJUPUTI OLEUM (U. S. P.).— Oil of Cajuput. (See Oleum Cajuput
CALAMUS (U. S. P.).— Calamus (Sweet Flag).
Preparation.
ti.) I
Fhii»U*\t(Tirtiiin Calmni (L". S. P.). — Fluid Extract of Calamus. Doee, 1 to
4 ccni. {or mxv-f3j).
Pharmacology. — The dried, unpefled rhizome of tlie Acorus calamiid
(Aracoiv) h slitrhtly nromjitic and quite puncront to the tisto, and is car-
niiiijuivo. It coiiTaiiiji n noutrnl. bitter glucoside, Acorin, a nitrogrnons prin-
ciple» rt volatile oil, benzoic acid, etc.
Therapy. — In consequence of its feebly-aromatic taste, calamus is some-
times useful, and is popularly employed, in overcoming a tendency to flatu-
lence, by chewing it slowly and SM-allowing the saliva. It is sometimes
adopted as a subslitute for tobacco, }jy those who desire to overcome the
hal>it of chewing. It is a constituent in various "bitters'* used as appetizers
and stimulants. An infusion (31 Om. to 47^ c.cm., or o^-Oj) may be ad-
ministered in wineglassful doses as a stomachic tonic.
CALCIUM.— Calcium.
27. S. P. Salts and Preparations. •
Calx. — Lime. Calcium Oxide. Not used internally.
Calx Chlorinatft. — ChlorinnttNl Lime ^available chlorine, at least 30 percent.);
often improperly callvti Hiloriilt* of limp.
Calx Sulphuratn. — .Siilphurnted Lime iTnuJe Calcium Sulphide). A nuxture
containinir nt lenHt ()(1 ppr ccnx. of ('jiIciniM Mrnittsiilpliide, to^etlier with unchanj^ed
Calcium Snlphntp, and fitrlKni. in varvifi^ [irnportion*. Dow?, 0,01,j to 0.13 Oiiv (or
gr. Vri.il.
Caloii Broinidum.— Calcium Bromiile. Dose, 0.65 to 4 Gm. (or gr. x-5j).
I
CALCIUM.
289
ObIcU CftrboiULS Prsecipitatus.— Precipitated Calcium Carbonate, X>o»e» 0.65 to
CJBO«. (or ft. 3L-xl).
Caleii Caloridum. — Calcium Chloride. Dose, 0^*2 to 2 Gm. (or gr. v-xx).
C^ktt Uypopltoftphia. — Calcium Hypopho&phite. Duao, 0.65 to it Om. (or gr.
C&lc&i Fho»{>liA» l'nin:ipitalus. — Precipitated Calcium Phoflphate. Ooae, 0.65 to
Z G^ <or gr. x-xxx}.
CWWii rtqtphaa Exsiccttus.— Dried Calcium Sulphate. Contains 05 per cent., b;
of calflsum sulphate and about 5 i>cr cent, of water. (Plaster of Paris for
ponxMea.)
OtwiM Ww'parata.— Prepared Chalk. Dose, 0.05 to 1.30 Gm. (or gr. x-xx).
Hrrlmrpyrum cum Cveta. — Mercury with Cliatk (mercury, 38 Gm.: rhftlk. 57
^4^U together with honey and water and afterwards dried). Doi^, 0.065
lor gr. i-x).
iaBini«ntttsn Calcic. — Lime Liniment (ei)ual parts of linie-water and linae«d-oll).
OImibaI nae (fomierly known as carron-oil).
Uqr- ^ -^ is. — tSoluliMn of Calcium Hydroxide, or Lime-water. Dose, 15 to 60
. (ix A saturated solution containing not Ichi^ than 0.14 per cent, of
Wd. .f Umc.
MiacmrM cri?t;r,— Chalk Mixture (compound chalk-powder, cinnamon -water, and
trU Doa«, 4 to 15 c.cm. (or f3i-iv).
PkHaaaa cum Calce. — Pota«sa Vith lime. Vienna or Caustic Paat« (equal parta
' fy>4ii^««i and lime|.
'*rrtae Compositus. — Compound Chalk-powder (prepared chalk, 30 Gm.;
■E^ ::t.; sugar. 50 Gm.). Dose, 0.32 to 2 Gm. (or gr. vxxx).
■'3'nipus Calci*. — Syrup of Lime. Dose, 2 to 4 cxrm. (or f3as-j).
Sjrupus Calcii I^actophosphatis. — Syrup of Calcium Lactophosphate. Dose, 4
^ IS r,«m. (or f3i-i%'t.
Si I mm* nypophosphitum. — Syrun of the Hypopho9phit«R (calcium, 45 Gm.;
15 Gm. ; sodium, 15 Gm.; dilute hypophosphoroufl acid, 2 (Jin.; spirit ol
_ar, sod water to make 1000 c.cm.). Dose, 2 to 15 c.cm. (or fSse-iv).
drrvpos Hypophosphitum Compositus. — Compound Syrup of Hypophosphite*
""Ba cftlriuDi hypopho^phitc, 35 Gm.; potassium hypophospliitc, 17.5 Gm.;
lijpophosphite, 17.5 Gm,; ferric hypopho^phite, 2.25 Gm. ; manganese hypo-
s' Om.; quinine. 1.1 Gm.; strychnine, 0.115 Gm.; sodium citrate, '3.76
4U«tail hjpophoHpliunis lu-iil, 15 c.cm.; siigur and water to UHH) c.cm. I. Dose,
4 to IS cm. <or f3i iv).
B. P. Salts and Preparations.
Calx. — Ljbi« (obtained by calcining chalk, lime-stone, or marble).
C^x Cblorinata. — (^lonnated Lime, containing 33 per cent, of available chlorine:
C^Xx S^iilpburata. — Sulphurated Lime (a mixture containing not much less thai
9 Mr ••at. of calcium sulphide [CaS], with calcium sulphate and carbon). Dose,
«4U to OJMS Gm. (or gr. 'Aj).
ChlcU C&rbonas Prwcipitatus.— Precipitated Calcium Carbonate (Precipitated
k>. T>o«e. 0.65 to 4 Gm. (or gr. x-lx).
Calcfi Chloriduni. — Calcium (^orlde. Dose, 0.32 to 2 Gm. (or gr. t-xxx).
QUctt Hydras. — Calcium Hydroxide (Slaked Lime).
Cklcii Hypopbo»phis. — Calcium U\ pophosphite. Done. 0.65 to 2 Gm. (or gr.
x».
i:alril Pho«phaii. — Calcium Phosphate. Dose, 0.32 to 2 Gm. (or gr. v-xxx).
Cnrta Pr»parata.— Prepared Chalk. Du«ie. 0.n5 to 4 Gm. (or gr. x-lx).
Hyiiimjgyiugi cum Creta. — Mercury with^Chalk. Dose, 0.065 to 0.32 Gm. (or
U^Qor CVilcis. — Solution of Lime (Lime-water). Dose, 30 to 120 c.cm. (or fji-iv).
Lsqoor Calciii Chlorinatw. — Solution of Clilorinated Lime (3 per cent, of avail-
■" ' r). Dose. 1.20 to 4 ccm. (or mxx-fSj).
liqvor Calcts Saccharatus. — Saccharated Solution of Lime (calcium hydroxide.
a Qhlj refined sugar. \00 Gm.; distilled water, 1000 c.cm.). Dose, L20 to 4 com.
i-lx). ContainM alwut 2 per cent, of calcium hydroxide.
LiMUwiitiim Calci«. — Liniment nf Lirne (equal parts of lime-water and oHve-oil).
Lodo Hydrargyri Flava. — Yellow Wash (corrosive sublimate, 0.46 Gm.; lim*-
L).
IS
290
PHAttMACEUTICAL THERAPEUTIC AOEN'TS OR DRUGS.
Lotio Hydrargyri Nigra. — Black Wash (calomel, 0.685 Gm.; glycerin, 6 e.cm.;
tragacanth iiutc-ilage, 12.5 c.cm.; lime-water, q. e. ad 100 c.cni.). r^or external use,
Mifltura Cretse. — Ohalk Mixture, Dose. 15 to 30 c.cm. (or f^as-j).
Piilvia CretcB AromoticuB. — Aromatic Powder of Chalk (cinnamon-bark, 80 Gm.;
nutmeg, GO Gm.; clovea, 30 Gm.; cardamom-aeeds, 20 Gm.; sugar, 500 Gm.; prepared
ehalk, 220 Gm.). Dose. 0.65 to 4 Gm. (or gr. x-3j).
Pulvis Crelfie Aromaticus cum Opio. — Aromatic Powder of Chalk with Opium
(containing 0.005 Gm., or gr. j, of opium in 2.00 Gm., or gr. xl). Do»e, 0.05 to 1.30
Gm. (or gr. x-xx).
Syrupus Calcii Lactophosphatia. — Syrup of Calcium Lac to phosphate. Dose, 4
to 16 ccm. (or f3i-iv).
Pharmacology. — Lime is an alkaline earth which is usimlly obtained by
calcining any native calcium cnrbonate, such as chalk, liuiestoue, or mar-
ble, driving off tlie CO, and leaving enlcium oxide, which, when fresh
from the lime-kilns, is in large, hard, grayish-white masses. In this stnte
it is known as quicklime, which has a great afl&nity for water, even slowly
taking it from the air. Under the inflnence of moisture, lime generates bent
and breaks np into a wet powder, which is a mixture of calcium oxide and
calcium carbonates, and constituteB slaked fine. When tliis is mixed with
three or four parts of water, the product is called ''milk of Ume.'^ It is
alkaline in taste and reaction. Calcium oxide is only slightly soluble (1-760)
in cold, and even less so in hot water. Chalk, or calcium carbonate, is a
valuable antidote in cases of poisoning by carbolic, sulphuric, or oxalic acid.
It is found in the household in tooth-powder, convcjuent for prompt adminis-
tration.
Physiolog'ical Action. — Some preparations of lime are sedative, others
astringent or caustic; quicklime is irritating and caustic to mucous mem-
branes. Lime-water and chalk are astringent and alkaline; they reduce the
acidity of the contents of the alimentary canal, thus relieving irritation, and
filso exert a slightly aptringent effect. In patients suffering from deficiency
of lime in the food, lime-water is a useful and acceptable remedy, and may
be continued for a long time. Calcium phosphate serves an important func-
tion in promoting the nutrition of the motor apparatus, — bone, cartilage,
tendon, and muscle. The presence of a certain proportion of lime-salts in
the blood is essential to general nutrition. When this amount is reduced,
disturbances arise, affecting particularly the bony and lymphatic glandular
Bystems. Calcium chloride is more of an irritant; it has a reputation for its
influence as an alterative. Pota.ssa ^vith lime, or Vienna paste, is used in sur-
gery as a caustic. According to the investigations of M. Binet, the salts of
the alkaline earths are capable of causing respiratory and cardiac affections.
from which death may directly ensue. They may also cause derangement
of the gastro-intestinal system. Eventually they may occasion loss of nerv-
ous excitability and muscular contractility. Toxic doses of calcium arrest
the heart in systole. Calcium exerts a special action upon the nervous sys-
tem, occasioning a condition of torpor with preservation of reflex excitability
and sensibility.
Therapy. — Lime is an ingredient in depilatory powders, which are now
superseded by the process of removal of hair by electrolysis. Freshly-slaked
lime absorbs the products of decomposition, and is used ar a disinfectant in
cess-pools, manure-heaps, etc.; but the chlorinated lime, which prevents de-
composition by virtue of the available chlorine, is far better. In the treat-
ment of onychia maligna. Professor Vanzetti recommenils the application of
CALCIUM. 291
caustic lime. Lime-water is a stimulating dressing for wounds and ulcers,
and, combined with oil, is used as a dressing for bums. <jarron-oil consists
oi linseed-oil and lime-water. It is suggested that the addition of V, to 1
per cent, of thymol augments the value of carron-oil by rendering it aa anti-
septic application. A better dressing is made by beating up lard (unsalted)
with lime-water and adding a few drops of oil of bitter almonds. A very
good prescription to use in bums will be: —
B Calda pnecip " 41 Gm. or 3j.
Phenolia Uquefact 8| Gm. or 3ij.
01. olivEB,
Aqiue calciB a& I60| ccm. or f^v. — M.
Carron-oil also relieves pain caused by the stings of wasps and other in-
sects. According to Dr. Joseph Bell, applied to the face on a mask of
cDtton-wool, it will decidedly diminish the pitting in small-pox.
lime-water is of undoubted value alone, or combined with glycerin, in
the treatment of acute vesicular eczema. It may be employed for this as
well aa other varieties of eczema, especially when the surface is dry and irri-
tahle, with very great relief. Pruritus, which often becomes intolerable in
eczema and other inflammatory afections of the skin, and itching present
in old persons, may be relieved or cured by the application of lime-water,
with rose-water, glycerin, or one of the oils. A very suitable application in
the diseases just referred to is: —
B Liquor calcis 90
CreosoU
Pulveris zinci carb. (impur.) 31
Glycerini vel ol. oUvfle 90
M. Sig.: Shake well and mop over the surface.
c.cm. or fSiij.
60 c.cm. or mx.
Gm. or 5j.
ccm. or f3>ij<
For the relief of pruritus ani. Dr. A. L. Berger advises the use of a
pledget of cotton-wool soaked in the solution of chlorinated lime and intro-
duced into the bowel. In seborrhoea, hyperidrosis, bromidrosis, and in
bruises of the skin and deeper structures, the preparations of calcium are
often used with great benefit. The following are excellent combinations: —
9 Calcii carb. prsecip. 3I{ Gm. or Sj-
Glyceriti boroglycerinie 16| c.cm. or fSw.
M. Sig.: Smear over the parts bniiaed.
Q Calcii chloridi,
CUdi carb. pnecip.,
Pulv. amyli aa 31| Gm. or 5j.
M. Big.: Dust over the aurface, eapeciaUy in oily conditions of the akin and in
exceasive and fetid perspiration.
Prepared chalk is employed very largely, alone as well as an ingredient
of many very good dentifrices, on account of its antacid, astringent, and
sedative action upon the gums and the mucous membrane of the buccal cav-
ity. Garreteon recommended the appended formula as being a good tooth-
powder: —
9 Crettt prepAT.,
Polv. uidis Flor. aa 1616 Gm. or Jaa.
PuIt. osais sepice 8| Gm. or Sij.
Olei limonis q. a. — M.
292
i'UAiiilACKUTlCAL TiiEK-iPKLTlC AGKNTS OH. DUUOb.
Prepared chalk is a good dusting-powder in intertrigo and hyperidroE
and may be used upon the surface of ulcers as a protective dressing.
The preparations of calcium are especially useful in childhood because
of the deficiency of lime in the food of many children. Lime-water added
to milk gives material foV bones and teeth, improves nutrition, and overcomea
a tendency to rickets. It relieves irritability of the stomach and vomiting.
The syrup of lime, or the English saccharated solution of lime, contains
more of the base than the solution, and is a convenient antidote to poisoning
by oxalic, sulphuric, and other mineral acids. In children's diarrhcea, often
due to sour stomach, chaUc mixture is very useful, and may be combined with
an antiseptic and opiate: —
n
Creoaoti
Tinct. opii caxnph.
Mist, creta ,
124
c.cm. or wiiv.
4] c.cm. or f3j.
q. s. ad 6o| ccm. or fjij.
M. Sig.: A teaapoonful every t^o hours to 0 child two years old.
4
The same mixture is useful in adults, with corresponding increase of
dose and the addition of a decided astringent, such as tincture of kino, or
fluid extract of coto-bark.
The following combination is said to be useful in phthisis and chronic
pulmonary alfections: —
B Creosoti 10
Alcoholia {90 per cent.) 90
Calcli phophat 10
Aqus deatilUta 18
Syrupi 106
Vini alba (Mnlnga) q. b. ad lOOO
Each tablespoonful contains about 0.16 c.cm. (or miias) of creosote and
0.32 Gm. (or gr. v) of monocalcic phosphate.*
Other very effective prescriptions containing lime are: —
c.cm.
or fSiimxl.
c.cm.
or f5iij.
5 Gm.
or 3v.
6 c.cm.
or (Zy.
c.cm.
or fjiiiu.
c.cm.
or Oiifjij.-
-M.
M.
rhoea.
Calcii carbonatiB pr»cipilflU 12
Tincttirte gambir 30
Tincturae opii 7
SpirituB chloroformi 15
Pulvcria acaciic B
Aquee menth. pip 195
Gm. or 5iij.
ccm. or f5j.
c.cm. or f3ij.
c.cm. or fSiv.
Gm. or 3ij.
c.cm. or fSviBs.
Sig.: One or two tcaspoonfuU in water every hoar or two, for acute diar
^ Liquor calcis,
Fluidext. coto eorticie,
Syrup, acacin ua 30| c.cm. or fSj.
M. Siff.: From one to two teaspoonfuU in water or milk every three or four
hours, for chronic diarrhtea.
nii^ '
Special Applications. — In tlic diarrhcea of relaxation in young children
lime-water alone may be sufiiciont where the motions are too frequent and
watery an<l ncid iu their reaction. It is also used per e»ema against threail-
wonni-\ nritl it niflv be given as an injection in leucorrhtea. In fliphtheria
inneh relief is experienced from tlie use of a spray of lime-water, preferably
with the steam-atomiwr, directed to the fauces, or from inhallnt^ the vapors
from ;*laking lime; it is chiimod that the lime loosens the fnlse membrane
' Journal de» FraUclem, Feb, 24, 1900.
OALCIUM.
293
^^ fnArTi'filtt' flic^lves it. It is also useful in the same manner in croup and
fii- The vapor obtained from chlorinated lime Ib advantage-
m.- n hay fever. In adults, where it is desirable to administer
OBi u found necessary to add lime-water to it to prevent curdling.
Ic il feeding of infants the addition of lime-water to cows' milk is
«f —nr^ by rendering the curd more soft and flaky, and conse-
^- of digestion. Milk and lime-water will not infrequently
■fci: - ... : . .-., and even, in some instances, the pain of gastric carcinoma.
Ib ihe UttPr affection it also allays the vomiting. The prolonged adrainis-
traooD of lime-water renders the urine alkaline, and hence it may prove use-
t%\ iti lithiasis. It has been shown that, under the same circumstances, car-
hoBiic acid may appear in the urine. The acid is united to the lime and
oom the fluid to emit an ammoniacal odor. In combination with opium
flid aromatics, as in the puh-is creta^ aromaticus cum opio of the British
r^limaiojiii ill chalk is of great value in diarrhoea. The carbonate of oal-
CHB is likewise beneficial in diarrhoea, and, finely powdered, is a good
rroplicfttioB in intertrigo and acute eczema. Calcium phosphate is useful in
-^^i^f; also in amemia, general debility, diarrhoea, in small doses, given
--vpentlj ; it appears to have a stimulating effect upon the liver, and sliould
^ jn^'f*!! in preference to mercury to infants with clay-colored stools, and
jamidioe. The anemia due to profuse suppuration, or to lactation, may
- remedied by the administration of this salt. It is advantageous, more-
»»T!f, in molHties ossium, delayed union of fractured bone, caries and
rwTT^U. and scrofulous inflammation of the lymphatic glands. The
nd phosphate has been warmly recommended as relieving the sickness
hurata is useful in styes, acne, and furuncles; given in 0.015
ift u.<^ Giii- vor gr. V4-^) doses several times a day, it hastens maturation of
^talci. If given early, it prevents the formation of pus, but, if suppura-
&Ma liaa occurred, calcium sulphide limits its extent and favors early and
anaplete evacuation. This combination is serviceable in both acu^e and
c^rrrtdc eczema. It is likewise beneficial in the suppuration of scrofulous
liMtdc. Dr. Frank P. Norbury finds it useful in acute tonsillitis, especially
tf atmiDOUs patients, with a tendency toward rapid suppuration. It prevents
m limits the formation of pua. Dr. Witherle, of St. Paul, states that cal-
OTm iulphide is beneficial in the early stage of pulmonary tuberculosis,
• n in ao$e8 as large as can be tolerated. The swelling of the upper lip and
of the nose so often seen in scrofulous children may be decidedly ira-
MVT«d br the exhibition, night and morning, of 0.015 Gm. (or gr. V«) doses
il«mlcinin sulphide. In diphtheria, during the period when the membrane
slaoarning and suppuration is taking place, Phillips recommends the ad-
kzBtfCration of this salt in doses of 0.01 to 0.015 Gm. (or gr. V»-V«) every
fevor everv two hours. A case of elephantiasis has been reported in which
Aa ftaJt was" successfully employed.
It is given with good effects in ophthalmia and sores in scrofulous chil-
hm. Calx eulphurata is the official equivalent of calcium sulphide, which
te iMen U5ied in conjunction with defervescents by Dr. T. M. Lloyd, of
JkwU^B, N'. Y., in measles and scarlatina, with the apparent result of
9M/ds^g the course of the fever. In pertussis the same remedy reduced the
amher and severity of paroxysms. It was administered in doses of 0.03 Om.
fifp gg\ half -hourly to children between two and five years of age. Rubbed
i
294
PHARilACEUTICAL TUERAPEUTIC AGENTS OE DRUGS.
up with sugar of milk it was taken without repugnance. This salt will occa-
sionally produce an eruption of vesicles, pustules, and furuncles. Dr. A. M.
Osness advocates the treatment of diphtheria hy local swabbing with a mixt-
ure of carbolic acid, tincture of chloride of iron, and alcohol, and the internal
administration of calcium sulphide, 0.05 Gm. (or gr. ^/^), every half-hour for
a period of thirty-sis hours, water being taken freely to help elimination of
the toxin.
Calcium chloride (not calx chlorata) is given, well diluted, in glandular
enlargements, and is said to be curative in eczema and lupus; it ia claimed
that it aids cicatrizatioa in tubercular ulcerations, and is useful in chorea
and colliquative diarrhoeas in strumous children. Calcium chloride allays
vomiting produced by the presence of sarcinae ventriculi.
Dr. Crombie, of the East Indian medical service, has found calcium
chloride efficacious in the treatment of boils and pneumonia. Dr. A. E.
Wright has ascertained by experiment that the addition of calcium chloride
to blood renders coagulation more rapid, lie has given the salt internally
with advantage in a case of haemophilia, and suggests that it will prove useful
in the treatment of internal hsemorrhage and aneurism. He has known it
to arrest an obstinately-recurring epistaxis and a severe li.rmoptysis. In
a case of haematemesis and gastro-intestinal haemorrhage in a child 4 days
old, L. A. Parry^ gave frequent doses of 0.32 Gm. (or gr. v) of calcium chlo-
ride every hour during the day and every two hours at night. The child
took 10.35 Gm. (or 160 grains) in three days, when the medicine was discon-
tinued l^tx-au.sc bleeding had ceased for twenty-four hours. In cases of
haemopliilia ret|uiring surgical operation, great advantage has been observed
from the administration of calcium chloride for a few days previous to opera-
tion, for reducing the bleeding.
Dr. S. Solis-Cohen prefers the calcium chloride to any other drug in
the treatment of haemoptysis, administering it in doses of 0.fi5 to 1 Gm. (or
gr. x-xv) every second hour in glycerin, simple elixir, and water, or infu^Jicn
of gentian. Dr. Saundby has employed the same salt with success in purpura
hcGmorrhagica, administering 0.38 Gm. (or gr. vj) every two hours during
the day. Sir J. Sawyer has employed the chloride in chronic pulmonary
tuberculosis with good results, and states that in addition to its other advan-
tages it will often suppress night-swents. Both the chloride and the car-
bonate have been serviceably given in order to restrain haemorrhage caused
by a fibroid tumor, and to check menorrhugia.
Calcium hypophosphitc has a special reputation ff>r the treatment of
phthisis, and is a useful tniiic in i^uch cases. The official syrup of the hypo-
phosphites, in appropriate cases, is one of the best general systemic tonics
that we possess. It may be substituted by the following, when more strych-
nine or iron iR desired : —
B Synip. ferri Inctnti:** ....
Synip. hypophofipliiturn aa 120| c.cm. or f^iv.
Strychninae sulphatia |015 Gm. or gr. '/•■
M. Sig.: A half-tablcspoonfal in water three times a day.
Calcium bromide was brought forward, by Hammond, as a substitute
for bromide of potassium in cases where the depressing effects of the latter
^The lAJncei, July 16, 1898.
CALCIUM.
295
^^■■Jd forbid its use, such as epilepsy or chorea in auiumie subjects (in do&eg
^^^■to S Gm.y or ."te-ij). Professor Germain See regarded both the bromide
HHa cUoffide aa advantageous in the treatment of dytipepsia and many dis-
Vvflcd eoDditions of the stomach. This salt would, however, seem well
" rfwttfd to falfill the indications of a bromide in rachitic subjects. The bro-
'«nrifi held to coaiain one-sixth more bromine thnu the potassium bromide.
Hq^ Woods prefew the calcium oxyiodides to the other iodine preparations,
LsowUiining more iodine. According to the testimony of Dr. Beebe, who
^■b OMTobomted by Dr. Lawrence, idorlized calcium is of service in mem-
HWmmmu croup. These writers advise that 0.01 to 0.02 Gm. (or gr. */«-'/■).
B ftifcln d in wnter, should be given every fifteen, thirty, or sixty minutes,
> aatdiiiy to the severity of the symptoms, (irube reported^ good resultB
B dUbetCB nnellitus from the *'cgg-sheir' treatment, the patient talking a
lutponnfol of powdered egp-shdl daily. This is also useful in boils. He
W# suggested a powder in imitation of egg-shells for the same jnirpose and
n-fH>rtfi very encouraging nsults. (1 rube's powder contains calcium car-
V-oate, 93 parts; with calcium phosphate and magnesium phosphate, each,
I V> parts. Of this4 Gm. (or 3j) are to be tak^ daily. The syrup of calciiun
ketophoephate (made by dissolving calcium phosphate in lactic acid, with
OBge-flover water and syrup) is a pleasant and very useful remedy for im-
mrrtag- nutrition in young children, especially if there be a scrofulous taint.
u contains about 0.75 Gm. (or gr. xij) of calcium phosphate in each ounce.
It ss also a valuable agent in treating many skin diseases due to malnutrition.
rU« combination may be advantageously prescribed, in vesicular emphysema,
chnmic bronchitis, phthisis, debility, and wasting diseases, thus: —
B ^jTup. calcii laotophosphatis 90
OIri gmultherie 2
PttlTeii* aeacue 4
f.|ooor pfluicrestici 30
OIm morrbufle 150
3C «t ft. «IDUlU0.
S^i A tableepoonful three times a day.
c.cm. or fjxij.
c.cm. or nixxx.
Gm. or 3J.
com. or fjj.
c.cm. or fjv.
Dr. H. V. Knaggs ascribes valuable antispasmodic properties to calcium
balphiie, in spasmodic diseases. He gives 0.003 Gm. (or gr. Vzo) to a child
TIBS Tear old, sutTcring with convulsions from dentition, meningitis, and even
Btc tuberculosis. A saturated aqueous solution of the bisulphite is an
,11. .^f non-poisonous disinfectant. The preparations of chalk, if given
sea for a considerable period of time, may form intestinal concre-
V nicium salicylate, a salt which is soluble in water, has been recom-
^'^tod^d as a remedy in diarrhrea, especially that of children. The dose is
ftvwn 0.50 to 1.30 Gm. (or gr. viii-xx), and it is given either alone or combined
vitb bsaznuth aalicylate. It is a white, odorless, and tasteless crystalline
povdcr.
Calcinm carbide has been used in inoperable cancer of the uterus by
of St. Petersburg, for its caustic action when brought in contact
vater and the disinfecting properties of the acetylene. Under its use
rhaiM? has been checked and the ulcerative processes retarded.
» Thems>mtl9cKe MonaUchefte, May. 1890.
296
PUAItilACEUTICAL THEKAPKUTIC AUEX'fS OH UULU».
Calcium Eosolate is a eulphosalt of the aliphatic creosote esters,
and is said to contain 25 per cent, of creosote. Its formula is given as
(CpH-S^^O, 2)3083. In lar^^e doses it produces griping pains in the intestines,
with diarrhoea. The tlierapeutic dose is from 0.25 to 0.65 Gni. (or gr. iv-x)
three or four times a day. It is a grayish powder, feeling to the touch like
finely-pulverized pumice-stone. Its odor is slightly punirent and somewhat
ethereal, its taste a little acrid and leather)-. It is soluble in from 8 to 10
parts of cold and in 7 parts of hot water. It is very slightly soluble in
alcohol, and insoluble in chloroform nnd turpentine, but is readily dissolved
by hydrochloric, citric, and by some other organic acids, while it dissolves
only slowly in acetic acid.
Dr. Heinrich Stern,* of New York City, gives the hii^tory of a remark-
able case of diabetes inspidus, in a boy of sixteen years, who was passing over
one and one-half gallons of urine per day that had a specific gravity lighter
than water. He was dwarfed in stature to that of a child of seven years, and
for a long time had shown no signs of development. Under the calcium-
eofiolate treatment, in conjunction with 3 c.cra. (or wixlv) doses of fluid ex-
tract of ergot four times a day, h^ for the first time in years steadily began
to increase in weight, lost his nervousness, the hydruria gradually dimin-
ished; though occasional increases occurred for a brief period, there was an
increase in the excretion of solids, and thirst was diminished. At the time
of the report the patient still continued to improve.
Five cases, reported by Dr. Stern, of diabetes mellitus under treatment
with calcium eosolate and a milk diet ceased excreting dextrose, gained in
weight, and improved otherwise. One of the cases at a later date died of
endocarditis. Ten cases of phthisis showed decided signs of improvement
under small doses of the eosolate in conjunction with other remedies.
4
CALENDITLA (U. S. P.).— Marigold.
Preparation,
Tinctura Calendulae {U.S. P.). —Tincture of Calendula (20 per cent.). Dose, 2
to 4 com. (or fSss-j).
Pharmacolo^ and Therapy. — The dried ligulate florets of Calendula
oflBcinalis (CrtiupcKitje) rnntuin Calendulin, n vulntile oil, an a!Mor]dious bit-
ter prinriplr, yellow coloring mutter, ptc. It is used hs mi emmeuagogue
and as ii diaphoretic, in rt-cent infusion. Ju the form of tincture, it is
reputed to he Ionic, antispasmodic, and alterative, and may be employed
locally as a revulsive in 8i)rains, bruises, or in superficial burns and scalds,
resembling nmica in its applications, though less active.
CALITMBA (U. S. P.)-~Ca!umba (Columbo).
CALTTMBiE BABIX (B. P.).— Calumba-root.
Dose, 0.32 to 0.65 Gm. (or gr. v-x).
Flnidextractura Cnhimbfe
to 2 c-cm. (or wixv-xxx).
Preparations,
(U, S. P.).~nuid
Extract of Calumbu. Dose,
* Journal of the American Medical Association, xxxiv, p. 467
iWMIUHMA.
297
CoJumbfle (U.S.?., B. P.)-— Tincture of Caliuuba. Dose, 4 to 7.6 ccm.
Lienor Calumbe Cooccntratus (B. P.) . — Concentrated Solution of Calumba
flcafaan^, fiOO Gm.; alcohol [90 per cent.]. 225 ccm.; distilled water, q. b. ad 1000
L|. Dose, 2 to 4 c.cm. (or f3as-j).
Imforam Cklumboe (B. P.). — Infusion of Calumba (5 per cent.). Dose, 15 to 30
L (orOa^j).
Pharmacology. — The dried root of Jateorrhiifia paluiata (Meuisper-
I*. ) ; Jiitoorrhiza Cnlumba (B. P.) of Africa contains, among
El -, bcrboriuo, calunibin, calumbic acid, and starch. It is free
fi«n tannin, and therefore its iiiT'i)arationg may be coml»ined with iron.
Tliymiolog^cal Action and Therapy. — In composition and physiological
Acdon calumba. resembles quassia and gentian, though lighter and more
acrveible than some of the other remedies of this class, and more acceptable
to the etomach. As a bitter tonic, calumba may be used during conva-
laccooe, or in atonic dyspepsia or other enfeebled constitutional conditions.
h a bcliered to be somewnat sedative and antispasmodic; in cases where
tikii qaalitj is required it would be better to use the fiuid extract or powder
ftca th€ tincture. A small dose of the tincture or infusion of calumba will
iftcn rdiere nan&ea and vomiting. Atonic diarrhoea is benefited by calumba.
When the tincture is prescribed as an appetizer, the danger of forming the
akdiol habit should be kept in mind: —
B Ext. calombsB 13 Gm. or gr. ij.
Sodii bicarb 05 Gni. or gr. x.
PoIt. rhei 32 Gm. or gr. v.
Pair, zingiberis 66 Gm. or gr. x.
If. «t ft. chart. Mitte tales no. xxx.
Si|r. : Take one before each solid meal, for weak digestion.
As m good carminative mixture Dr. Crutchfield prescribes: —
R Tr. cAlotabs lit c.cm. or f3iij.
8p. ammoD. aromat. 6 c.cm. or fSiM.
Tr. eardam. co ,.., q. a. ad 90) com. or fSiij.
M. Poflc: Tableapoonful in water aa required.
■
Dr. Schultz has had very good results from the tincture of calumba in
^ trestment of gastric catarrh. Calumba has been especially recommended
m a Talnable tonic in convalescence from influenza. Dr. A. F. Myers,' of
■»aming Glen, Pa., considers calumba as the best of the vegetable tonics;
loth as a stomachic in mild forms of dyspepsia and as a general corroborant
ia the convale^ent stage of acute diseases and in general debility.
CAMBOOIA (U. S. r.. B. P. ) .—Gamboge. Pipe Gamboge.
Boae, 0.006 to 0.20 Gm. (or gr. Vio-i»j)-
raui
rgr hr Tlij).
Preparation,
Cambogiir Compofcita (B. P.). — Compound Pill of Gamboge (containing
Bftrbadoea aloes, compound cinnamon powder, of each. 1 part; hard soap. 2
ffyrup of glucose. 1 part Mix to form a maaa). Dose, 0.25 to 0.50 Gm.
I
* Mf^it^^ o^^ Siirfficat Rtporttir, May 16, 1898.
29 s
PIIAUMACEUTICAL THERAPEUTIC AGENTS OK DRUGS.
Phannacolog:y. — Gamboge is a gum-resin, obtained from the Garcinia
Hanburri ((TiittilVne) : a tree of Siam. It consists largely ol* cambogic acid
(73 per cent.), and is partly soluble in alcohol and ether, and forms an eraul-
eion witli water. It has no oflicial propiirationa in the United States Phar-
maeopoein, and is rarely administered by itself, but is a constituent of the
compound cathartic pill (enoli pill containing 0.015 Gm., or f^r. ^/^, of gam-
boge).
Physiological Action. — Gamboge is not a systemic, but a local, irritat-
ing purgative. It is at first insipid, but aftenvard produces an acrid taste,
with increased secretion of saliva. In tJie intestinal tract, it has a drastic,
hydriigogic, cathartic effect. It stimulates the intestinal glands, but not the
liver (Eutherford)» and is also believed to have some power as a diuretic, as
it imparts a bright-yellow color to the urine. It carries off the bile in the
intestinal canal and prevents reabsorption. Large doses cause vomiting and •
gastro-enteritis.
Therapy. — Gamboge has no local effect beyond staining the skin. It
was formerly used in cardiac dropsy as an hydragogic cathartic to carry off
large quantities of fluid and promote absorption, but the compound jalap-
powder accomplishes this result more quickly, agreeably, and certainly.
The comptDund cathartic pill is a good remedy for constipation and at the
beginning of the treatment of malarial poisoning. In minute doses (0.006
Gm., or gr. Yk,, every hour or two) it is claimed that gamboge affords much
relief in flatulence and intestinal indigestion.
CAMELLIA. — Tea. The estemporaneously-prepared infusion of the
dried leaves of Camellia thea (Ternstrcemiaceae), or Chinese tea-plant, is now
60 widely used at the table as a beverage that it has given its name to the
evening meal. It contains caffeine (or theine), theophylline (Rossel)/ a
volatile oil, tannin, etc. Green tea is made from the younger leaves, dried
with a moderate heat, so as to retain their color (sometimes fraudulently
colored with Prussian blue, turmeric, and copper), while the black tea is
made of the older leaves, and contains more tinnin. (See Caffeina, page-
284).
Physiological Action and Therapy. — The effects of tea are not fully
represented by caffeine; probably theophylline, which is isomeric with theo-
bromine, and the volatile oil assist in producing its physiological action upon
the system. Dr. Thomas IT. Mays claims that the physiological action of
caffeine derived from Camellia is different in its effects from that of coffee.
It is an antidote to narcotic poisoning by virtue of its caffeine, and to anti-
mony and many alkaloids on account of its tannin: it is also a physiological
antidote to agents which depress nerve-function or the heart. In small doses
infused with boiling water, tea is an agreeable stimulant, removing a sense
of fatigue and giving a feeling of well-being. It is useful in headache from
overwork or worry, and will often relieve migraine. Tea is an accessory food,
but, on account of its convenience, it often becomes the principal article of
food for persons who think that they cannot spare time to prepare a ful!
meal, or have not the appetite to eat it. lu many cases of what has been
called tea-drinkers' dyspepsia, in sewing women, it is found, upon inquiry,
that the tea is drunk with every meal, and that very little food is taken with
^Zeitsc^rift fur PhyMoloffi/trhe Chemie. ThtrapeuHc Qazctie, March 15. 1990.
OAMPHORA. 299
it except bread or hot biscuit. Such cases of debility, palpitation of the
heart, flatulence, anorexia, constipation, etc., are not really instances of
**theiBm," but cases of starvation and chronic indigestion, and require good
food, sunlight, exercise, and tonics. Men who deal in tea, and constantly
taste it, only exceptionally show symptoms of nerve-disorder ascribable to
this cause; even tiien it may be due to idiosyncrasy, for persons have dif-
ferent degrees of susceptibility to the effects of tea. Some cannot use it at
all; others are proof, apparently, against any ill effects. Many can drink
black tea who cannot stand the effects of green tea. Strong green tea may
embarrass digestion and give rise to constipation. Tea may also diminish
the tendency to sleep and in people of highly-nervous temperament may
cause obstinate wakefulness. Ordinarily, the moderate use of tea relieves
fatigue and disposes to mental cheerfulness,
Theocine, or synthetic theophylline, has been used with good results as
a cardio-vascular stimulant, and &]&o as a diuretic in dropsy. It acts chiefly
npon the secreting fimction of the kidney. It relieves air-hunger in cardiac
dTspnoea or asthma. Dose, 0.25 to 0.30 Qm. (or gr. iv-v), given usually
with sodium acetate.
CAMPHOEA (U. S. P., B. P.).— Camphor (CioH„0).
Dose, 0.065 to 0.32 Gm. (or gr. i-v).
ACIDTJU CAHPHORICinil (U. S. P.).— Gamphorio Acid.
Dose, 0.30 to 2 Gm. (or gr. v-xxx).
Preparations.
Ceratum Camphoree (U.S. P.)* — Camphor Cerate.
Camphora Monobromata (U. S. F.). — Monobromated Camphor. Doae, 0.065 to
0^2 Gm. (orgr. i-v).
Aqua Camphone (U.S. P., B. P.). — Camphor-water (U. S. F. contains 8 Gm. ta
1000 ccm., or gr. iv-l5j). Dose, 4 to 16 ccm. (or f3i-iv).
Spiritus Camphoree (U.S. P., B.P.). — Spirit of Camphor (10 per cent). Dose,
0^ to 1.20 ccm. (or mv-xx).
Linimeninm Camphors (U.S. P., B. P.). — Camphor Liniment, Camphorated Oil
(eamphor, 20; cottonseed-oil, 80 parts). External use. (In B. P. olive oil is used.)
Linimentiun Camphorea Ammoniatum (B. P.) . — Ammoniated (or Compound)
Uiument of Camphor (camphor, 60 Gm.; oil of lavender, 2.5 ccm.; strong solution of
tmmonia, 1(X) com.; alcohol [90 per cent.], a sufficient quantity to make 400 ccm.).
tlnctiira Camphorse O>mpoaita (RP.). — Compound Tincture of Camphor (Pare-
Korie, or Paregoric BUixir: tincture of opium, with benzoic acid, camphor, oil of anise,
ud iitcofaol). Each 4 ccm. (or drachm) contains the equivalent of 0.016 Gm. (or gr.
Vi) of opium, or nearly 0.6 miUigframme of anhydrous morphine in each cubic centi-
nietre. Dose, 2 to 4 ccm. (or f3s&-j).
Camphor ia a constituent in the following official preparations: Camphorated
tincture of opium, compound morphine powder, and cerate of subacetate of lead
(U.S. P.); soap, belladonna, and chloroform liniments (U.S. P., B. P.); compound
tiBetnre of camphor and mustard liniment (B.P.).
Phaimaoology. — Camphor is "the dextro-gyrate modification of the sat-
urated ketone C^HigCO, obtained from Cinnamomum Camphora (Lauri-
Dejfi), and purified by sublimation." The tree is a native of the East Indies
«nd China. It contains a solid, volatile, fatty substance, or stearopten, which
f^tists in all parts of the plant and crystallizes naturally in the wcJod and un-
•ier the bark. As collected by natives, it is called crude camphor, which is
^bsequently purified and sublimed in this country. Camphor comes in white,
tnualncent, partly-crystalline masses, of penetrating, aromatic odor and a
300
I'SAHMAOBUTICAL THERAPEDTIC AGENTS OB DEC08.
cool, acrid taete. It is lighter than water, in which it is very sparingly solu-
ble, but is readily dissolved by alcohol and ethereal substances. Camphor
is quite soluble in milk, which may often, therefore, be used as a convenient
Tehicle. It is easily ignited and bums with a smoky flame. With chloral-
hydrate, camphor combines when triturated, forming an oily liquid. When
three parts of camphor are rubbed with one part of crystallized carbolic acid,
a clear liquid is lorraed. Camphor cannot be powdered by trituration alone, |
but can be when moistened with alcohol, chloroform, or ether.
Physiological Action. — When applied to the skin, camphor slightly irri-
tates and reddens the surface, and probably diffuses through into the deeper
structures, so as to eiert a local sedative effect. In considerable doses, cam-
phor causes vertigo and confusion of ideas, diaphoresis, delirium, or stupor,
followed by epileptiform convulsions and maniacal excitement. There ifl
lowering of the reflex excitability of the spinal cord and muscular weakness.
In some cases the first manifestation -of its toxic action has been a sudden
loss of consciousness with or without convulsions. Upon the circulation a
stimulating effect is observed from small doses and the arterial tension is
raised, but larger doses cause prostration and weakness of the heart's action
Camphor is antispasmodic, and is a valued sedative in allaying abnormal
nervous excitability often encountered in women, especially in cases where
opium disagrees or is undesirable. It is, in full doses, a sedative to the gen-
erative functions and allaya pain attending menstruation. Poisoning has
followed the use of a saturated solution in alcohol (Rubini's tincture, or so-
called '*mother-tinetuTe"), which should not be used for internal administra-
tion 88 so small a quantity as 0.50 c.cm. (or mvij) has produced poisonous
effects. Toxic doses give rise to inflammation of the stomach. In cases of
poisoning, if any of the drug remain in the stomach it should be removed
by the stomach-tube, the patient allowed to drink cold water freely contain-
ing magnesium sulphate (31 Gm., or .>j), and the symptoms combated with
arterial stimulants and hypodermic injections of morphine and atropine.
Camphor is eliminated by the kidneys, lungs, and sudoriparous glands.
xhcrapy. — Camphor is highly prized in the household, for headaches
and various neuralgic pains, tho spirit, or "Eau Sedative/'* being applied
upon a handkerchief or a flannel bandage. It is also a common ingredient in
popular liniments. Camphor-chloral is used in neuralgia and myalgia as a
rubefacient and anodyne. It dissolves morphine readily: —
B Mnrphinie sulphat 1130 Gm. or (fr. xx.
Camphor-chloral 8| Gm. or 3ij. — M.
For local application to painful spots.
Cavazzani applies to chancroids, with excellent results, a mixture of 5
parts of cbloral hydrate, 3 of camphor, and 25 of glj'cerin,
A combination of camphor and carbolic acid (3 to 1) is a valuable anti-
septic dressing for wounds, the odor being more pleasant than that of car-
bolic acid, and, the solution being anodjoie, it cannot be diluted with water
or glycerin, hut mixes with oil or alcohol. It is a beneficial application in
herpes and erysipelas, in vaginitis, vulvitis* and partesthesia of the vulva.
* The Atjua Scdativa (N. F.) consists of ammonia water, 125 c.cm. (or fjiv) ;
spirit of ramplior. 12 com. (or f3ii.i) ; sodium chloride. 05 (im. {or 5ij gr. Ixxiv) ; and
water sufficient to mnkc 1000 c.cm.. or two pints. This is nlfio known as "Eau
Tkft liquid overcomes the fcetor of lochial discharges On account of its
CBOthedc proi>erties it is useful in the treatment of inverted toe-nail. It has
Wa foccefisfull^* griven by the mouth in doses of 0.30 to 0.60 com. (or gtt.
f-x) for the relief of gastric and intestinal catarrh. Carbolic-acid camphor
■ • Bcrric^able local remedy in pharyngitis or tonsillitis. ParaBsthesia may
vftcB be relieved by the topical use of this agent, either in its pure state or
vcikefied bv some suitable excipient.
Sttlol and camphor, and betanaphtol and camphor, also form fluids bav-
ataiottble antiseptic powers. By mixing equal parts by ■weight of camphor
ibsolnte alcohol, and dissolving pyroxylin in the solution (in the pro-
ftftiOB of 1 to 40), an excellent substitute for collodion is obtained, Cam-
fhaid u the name given to the fluid, and it is also a good solvent for salicylic
9tH carbolic acid, and iodoform. Camphoid forms, in drj'ing, an elastic
Sm, which is not dissolved by water and is a good coating for abrasions,
■■ufitjal wounds, etc. A mixture of equal parts of canjphor and menthol
intied with a mineral oil has been used successfully by Dr. Seth S. Bishop,
i& A 10-per-oent. solution, in acute nasal catarrh and laryngitis. In h}'per-
dsfhic rhinitis a 25-per-cent. solution can be used. A 3- to 5-per-cent. solu-
tm iB sufficiently strong for injection into the ear for disease in the tympa-
A solntion of camphor in ether (30 to 180) has been applied to ery-
Bttlatoas inflammation with benefit. Camphor has been used for the pur-
■BM of aborting boils. The seat of inflammation is touched three times a
ay with an alcoholic solution, and, after this haa evaporated, the surface is
with camphorated oil. Powdered camphor, likewise, is an efficient
fttion to indolent ulcers, and has been used with success upon specific
of the genitals. Inhalation of a solution of camphor in cologne-water
fncft relief in that form of headache, which may occur at the menopause.
Cnphor and morphine, locally introduced or applied externally on a hot
ftoaeed poultice, allays toothache. A liniment or ointment containing cam-
fhor is nseful in chilblains. The camphor ointment of the National For-
■nlarr (camphor, 22; white wax, 11; lard, 67 parts) may be used as an
ippHcation to indolent ulcers. Camphor, either alone or combined as fol-
1w^ jields serviceable antipruritics in eczema and parsesthesia: —
K OampboTK.
Btttatiaphrliol. a& |65 Gm. or gr. x.
OX. anthemidis ..
Basmuth. tubnit. .
Polv^rifl marnntEp
17b|^ zuici oxidi .
30 c.cm.
or mv.
4
Gm.
or 5f.
4
Gni.
or 3j.
31
Gm.
or Sj.-M.
65 Gm.
or (rr. X.
2
Om.
or 3ss.
flO c.cm.
or mx.
60 c.cm.
or mviij.
Bpbor«
Svlpnarii tublimaU 2
OL •aralypti
Ct«oM>ti
Uagrt. aqu* roMP.
Un^ xiDci oxidi aa 1515 Gm. or ^ia. — M.
Camphor with palicylic acid (14 to 11) combines with the aid of heat^
iftd, in the fonn of ointment, has been used in lupus and chronia ulcers.
The odor of Ciimphor is inhaled with some relief in coryza. Camphor cerate
• Asse/ni application for chapped hands and roughness of the akin, or the
lior cAn he incorporated in suet or lanolin: —
302 PHAUMAOEUTICAL THEttAPEUTIO AGENTS OE DECOS.
Om. or 3ss.
18 c.cm. or miij.
24 c.cm. or miv,
Gm. or Sij.
M. Sig.: Rub a small piece in the palm of the hand until soft, and appl^ over
the surface for chronic eczema; chapped hands; fissures on the lipa, at the angle of
the mouth, or around the nipples, aniu, or genital organs.
B Camphors 2
01. neroli
Phenolis liq •«*. *.. •>
Sevi .»... 62
3 Camphorffi 1
01. juniperi 1
Adipis Inna; hydrosi 31
M. Sig.: Use in the diseases above named.
30 Gm. or gr. xx.
20 c.cra. or fiixx.
Gm. or 3j'
Internally, camphor is valuable as an anodyne, antispasmodic, and car-
minative, in disorders of the digestive organs attended with pain or cramps,
and is generally combined with astringents and opiotes. Velpeau's diar-
rhoea mixture consiste of eqxial parts of spirit of camphor, tincture of opium,
and compound tincture of gamoir.
For diarrhoea Hope's camphor mixture is useful, especially in diarrhoea
of relaxation in elderly subjects. Parrish's camphor mixture (mistiira cam-
phorae aromatica, N. F.) is also valued: —
B Tr. lavandulse co. , 120j c.cm. or fSiv.
Sacchari 15 6 Gm. or 5s«.
Aquae camphorce 473j c.cm. or fjxvj.
M. Sig. : A tableepoonful every three hours for diorrhoBa.
4
This remedy is likewise very serviceable in infantile diarrhoea. It has
been found efficient in j^Vsiatic cholera, provided it be given at the inception
of the disease.
Camphor, in 0.13 Gm. (or gr. ij) pills, is serviceable in dysmenorrhcea,
hysteria, and obscure nervous manifestations in women. It may likewise be
given to relieve palpitation of the heart. Monobromated camphor is es-
teemed a valuable remedy in ehordee and irritable bladder; it has also been
used in spasmodic ailections, hysteria, epilepsy, chorea, delirium tremens,
whooping-cough, etc.
IJ Camphone 1(30 Gm. or gr. xx.
j-Ktheris q. s. ad ft. pulv.
Ammonii carbonat. II Gm. or gr. xvj.
Pulv. opii |26 Gm. or gr. iv.
M, et div. in chartuls no. xij.
Sig,: Give one every two or three hours, in coryza.
In order to allay the mental excitement of hysteria, M. Blocq orders: —
B Camphor, monobrom 31 Gm. or gr. xlv.
£xt. quassise 2| Gm. or 3ss.
Byrupi q. a.
yi. et ft. pil. no. XXX.
Big.: One, two, or three pills a day.
It has likewise been successfully employed in spermatorrhoea. Dr.
Bourneville has obtained excellent results from the administration of mono-
bromated camphor in the treatment of epilepsy, accompanied by frequent
attacks of vertigo. As a result of his studies, Dr. Bourneville concludes that
in vertiginous epilepsy the administration of monobromated camphor alone
is remedial, but in the typical paroxysmal variety it should be given together
CAMiniORA.
303
■'•*■ 1 combination of bromides. It is a curious fact that the addition of a
irops of camphor to a glass of water will, when injected into the rectum,
a prompt evacuation of the bowels, thus offering a means of over*
t*?ndency to constipation.
•r has at times been successfully employed in the management
' .elancholia, and delirium tremens. A combination of camphor
-m relieves the after-pains of labor. The same drugB are advan-
«_.y given in the form of a suppository after operations upon the ure-
1, and in prostatorrhcea (enlarged prostate), cystitis, and, in fact, in
tii doEases of the genito-urinary organs, according to these formulse: —
B Caaohortt,
lodolortn. vel anstol. vel iodoL..*.^4-tT<- ^^ 4|
OL thecbromAtie q.
M. *t ft. suppoe. no. xv.
Sg.: iBarrt one, when neoessaiy. into the bowel.
B Cttmpbone,
Lapalhii na
Exx. belUdonne folior
OL UirobronmliA .
M. rt ft- vupposiloria no. x.
8i|f.: lasrrt one in the boMcI every two or three hours.
Gm. or 3j.
41 Gm. or Sj.
(Id Gm. or gr. iia».
• q. e.
* - camphor escapes from the system largely by the bronchial mucous
-ine, it is a useful remedy in chronic bronchitis, especially when
-^sr in the weak or aged, or associated with emphysema. Its stimulant
render it useful, also, in capillary bronchitis and typhoid pneumonia.
bstance may be very serviceably administered in typhus or typhoid
r in the eruptive fevers, in order to strengthen the action of the heart.
-<r Baelz.* of Tokio University. Japan, in fact, for five years has
— hor to the exclusion of all other medication, in typhoid fever, ad-
_• 1 Gm. (or gi. xv) daily. He considers it superior to any other
at he has employed,
influenza Dr. F. W. Devereux Long prescribes: —
ft Spiriftu camphone.
Tr. Uii^nd. CO »ft 71
8pL rhloroformi 4
Mueila^. tr«^caiith 00
AquM q- s- ad 180
M, 8^-r Two tableapoonfuls every fourth hour.
fJniment of camphor, or camphorated oil, is an excellent application to
laollrti and painful breasts during lactation. Injections subcutaneously of
?D5phnrate<3 oi! ore said by Alexander to be of benefit in tuberculosis, acting
ening the heart, and reducing fever. In laryngeal tuber-
it (linvtly to the U'sion. Obstinate liiccouglis were re-
V a hypodermic injection of camphorated oil, by James Tyson. Dr.
I- M«u3^is has mJule Uiw* of thin combination in threatened heart-failure, in
^^■«»a, pneumonia, typhoid fever, and other debilitating diseases. This
mter gave 2 to 4 c.cm. (or gtt, xxx-lx) daily of a 1-per-cent. to 5-per-cent.
«M«ii&. B- Aloxandcr ■ has for eleven years used, in the treatment of pul-
e.cm. or f3ij.
c.cm. or f3j.
c.cm. or fjij.
c.cm. or f5vj.
*j0mrmai of the JLmrricnn Mrdieat AHmtcintion, p. 1238» vol. xxxiii, Nov. 11, 18W.
mediciniAcht Wochenjtchrift, Kcb. 27, IfXX).
304
I'HARMACEUTICAL TlIEKAPEt'TIC AOENTS OR DKIGS.
mnnary tuberculosis, hypodermic injections of the camphorfltod oil of the
Gemian Fharmacopa?ia (11 to 9), with remarkable benefit The injections
nre made once a day, 1 to 3 eg. (or gr. ^/o-^/j) each, in febrile or afebrile
cases, or 1 eg. (or gr. V^,) every day for four days and then suspended for
eight. Improvement is noted after the second injection, even in advanced
eases. Dr. Courtin reports good results in the treatment of tuberculous
adenitis from injections of a mixture of 1 part each of betanaphthol and
camphor and 4 parts of 60° alcohol.
Borneol is i\n artilicial camphor obtained from oil of turpentine by treat-
ing it with hydrochloric acid. It is said to be identical in chemical compo-
sition, and to closely resemble, in its ph3'sical characters, the natural cam-
phor. According to Stockman, it has the same effects upon the circulation,
but shows a tendency to depress or paralyze the pneumogastric nerves, and
induces palpitation of the heart-
Camphoric Acid is the product of the oxidation of camphor with nitric
acid. It occurs in the form of fine, white, crystalline lamellae, melts at 368.6**
F., is slightly soluble in water, readily soluble in ethylic alcohol and ether.
It is without odor, but*has a somewhat acid and slightly astringent taste.
In a healthy person it produces congestion, of the face, neck, and conjunctivffi,
with pain in the ]win\. It checks the secretion of sweat, even in the normal
man, hut seems to have no influence upon the saliva or to cause dryncsi^ of
the throat nnrl skin. Cnmy^horii- acid is oliminatcd in the urine and pre-
serves this fluid from undergoing putrefactive changes for several days. It
may bo given in doses of O.riO to 4 Gm. (or gr. viii-lx). The ammoniacal
urine of cystitis is speedily cleared and rendered acid by the administration
of 1 Gm. (or gr. xv) three times a day. It is of avail, also, as a local remedy
in chronic cystitis, the bladder being washed out twice daily with a Va-per-
cent. solution. A stronger solution than 1 per cent, is too irritant for use.
The 1-per-cent. sohiiion in wjitnr nuiy he used in larjmgological practice as a
spray in catarrhal affectioii:^: it probably exerts some antiseptic as .well as
a serliitive effect. The local application of a 2-per-cent. solution of camphoric
acid is useful in acute eoryza.
A 1-per-cent. solution is also a serviceable gargle in many forms of sore
throat. Alone, or in combination with other remedies, such as horic acid or
sodium borate, it is valunlile in treating strangury and irritability of the
bhulder, and in the night-sweats of phthisis. The suppre^ssiou of night-
sweats is produrtd by daily doses of 3 Gm. (or gr. X5x), or more; cer-
tainly by singfe doses of 2 Gm. (or gr. xxx), according to the experiments
of C'umbemale. Dr. Howard has also seen camphoric acid repress profuse
perspiration in acute articular rheumatism. In a case of myoma of the
uterus in which excessive nocturnal sweating had followed electrical treat-
ment. Dr. Ralph Stockman, of Edinburgh, ordered 1 Gm. (or gr. iv) lof cam-
phoric acid at night, and after taking it for two weeks the tendency to sweat-
ing completely disappeared and never returned. The same author has
used it in cases of hyperidrosis after influenza, am^ in other cases where
there was certainly no tubercle present, and, in all of them, doses of 1 to 2
Gm. (or gr. xv-xxx) gave fairly satisfactory or good results. Dr. Stockman
emphasizes its value in non-tubercular cases. He considers it as efficient as
atropine, but in some obstinate cases it is less powerful as an anhydrotic than
picrotoxin. Its toxicity is very slight. It may be used in spermatorrhoea
CAXNABIS IKDICA.
305
WBi ifi enuresis; and it has also been thought to have some influence over
tfik' v*a^ hysteria, and other spasmodie affections.
0^j*w«a«ipliOT. — By the action of hypochlorous acid upon camphor, and
tnating \he product witli an alcoholic solution of potassium hydroxide,
"lot (Cj^Hj^O,) ie formed, which cryfitallizes in needles, has the
and taste of camphor, and can be sublimed without change. It melta
tf IK* C. (or STS.*)** F). Oxycnmphor rotluces the excitability of the
nspntory centre, and has been used by Rumpel, of Hamburg, and others, in
kmm of 0.50 to 1 c.cm. (or mviij-xv) ; the maximum quantity in the day
iufM not be more than 4 c.cra. (or 3j). Oxycamphor in oO-per-cent. solu-
tiRO, in alcohol, is the most convenient for prescribing. Thig solution ia
"" — commercially nlso by the name ( registereri ) of Oxaphor. Rumpel
- the drug in the following combination: —
R SpWtna oxrc&niphor (50 per cent.) 121 com. or 3iij.
telriln^ vini ,. 6 c.cm. or 3j^.
Fiald«- '<i g1ycrrr1iiz» 3| e.cnu or mxlr.
JUfOS' > tffi q. s. nd ISOJ c.cm. or 5vj.
X. Duwe, a tablespoooful containing eight inininu.
CA2IXLUE COBTEX.— Canella-bark.
Dose, 0.60 to 2.G0 Gm. (or gr. x-xl).
The bark of Canella Winterana (Canellacese), deprived of ita corky
«}rT and dried. This aromatic bark is sometimes called "white cinnamon.
I: cubtAins a Litter extractive, Engenol, and a volatile oil, but no tannin. Aa
tcarmxniitiTe, it is used in hot infusion. For dysmenorrhopa, the powder of
and canella (X. F.), anciently known ns hicra picra (aloes 8 parts,
2 p«rt«) , is given, in doses of 0.65 to 0.30 Gm. (or gr. x-xi) .
CAHKABIS IKPICA (U. S. P , B. P.).— Indian Cannabis, Indian Hemp.
Preparations.
P^ald«9Ctnletutn Cannnbia Indiorc (U, S. P.). — Fluid Extract of Indian C&n-
e, 0 06 to 060 c.cm. (or mix).
ExtTVCtun Omnabifl Indict (U.S. P.. P. B.).— Extract of Indian Cannabit.
, am Gm. (or gr. <«). B. P.. 0.015 to 0.065 Gm. (or gr. V.-j).
Tlii»«tnra rannnbis Ioi)ict«> (U. S J*., B. P.). — Tincture of Indian Cannabis (10 per
. Xj. S. p.: 5 ptr cent. B. P.). Doae, 0.12 to 0.50 com. (or mil-viij), U. S. P.; O.SO
«»lv.aB. lor mv-xT), B.P.
Pharmacology. — Cannabis Indica officially is "the dried, prepared tops
«f tbe pifft ' * h\nis of Cannabip sativa (Frticacea?), ^ro^m in the Eaat
an*: d while the frnits are still undeveloped and carrying the
of t' iral resin." Indinn hemp should not be confounded with
llhpiin i: -u which is snmetimes called white Indian hemp, or vith
iporTnuns i JiiiiKihinum, Canadian hemp. A native confection made from
haup is railed '^ha^hieh** or "^ninjah"; an inferior kind is known as
^mng.^ The American and East-Indian plants are botanically the same,
kgi tbe latter contains n larper quantity of the active principles, which are a
Mm, a rr>lfltile alkaloid Cannabinine, and a yellow, aromatic, volatile oiL
Tram tbe latter may be obtained Cannabene, oif which the hydride is a crys-
llAae «nhetanoe. The resin appears to he, or to contain, the active con-
C]faD#nt nf thr dnijff. Wood. Spively. and Eastrrfiehl, in addition to several
Wnvrw-tf. i«olntc<I n substance fmm the resin for which they proposed the
306
PUAKMACELTICAL THEnAPEUTIC AGKNTS OR UKIGS.
name of Cannabinol. By oxidizing the resin with nitric acid, Bohi. and
Fnmce obtained a metalline subtiitance, oxy-cannabine' lC2„IL..jN:.U7).
Cannabin tannate haa been employed in jnedicine in doses of 0.005 to OSo
Gni. (or gr. i-x), but it does not appear to have very active therai)eutic pow-
ers, t'hurrus is the native naiuf for tiie impure or crude resin. A watery
extract (the Extraeturn Cannabis ludine A*junsuni Fluidum), according to
Dr. Cowan l..oes, has a manifest anodyne and hvpnotic elTect, wliile free from
the intoxication, bordering on poisoning, which follows the use of the alco-
holic prcijarutions. The dose for odults is from 2 to 4 c.cm. (or i«xxx-Lx).
It i? claimed by Dr. Leee to he especially valuable for tlie relief of cough in
hiberculnsiB of the lungs and also as a soporific in diseaaes of children.
Hasliishin is an unofBclal nlcoholic extract waslied with water, used in dys-
pepsia and gastric neuroses. (Dose, 0,04 Gm., or gr. ^/^^ per day).
PhyMological Action. — Indian hemp has no local action. Upon the
digestion and circulation no evident effect is produced. It acts like opium,
in first stimulating the nervous system and afterward depressing the vital
functions. The primary stage of intoxication is accompanied by exhilara-
tion, uliich lasts for some lime before sleep occurs. During this period the
imagination is actively engaged, intent upon visions of its own creation,
which at first are pleasant, but which after awhile may become terrifying.
It is noticed, as one of the first manifestations of the toxic elTect, that the
ideas of space and time are disturbed and become exaggerated; there is often
a curious sense of double consciousness. Numbness and tiuffling in the ex-
tremities are observed, followed by anaesthesia and diminution of muscular
sense. Cannabis is antispasmodic, analgesic, hypnotic, and, in the East, is
believed to he aphrodisiac. If a large dose be taken, coma or catalepsy may
supervene, but a fatal effect rarely follows. The subsetpient results from
indidgcnce in this drug as an intoxicant are dullness and lassitude, vertigo
and headache, and diuresiSj but not constipation. Freijuent uj^e of the drug
brings about mental deterioration and unfitness for labor. The abuse of
Cannabis Indica is a prolific cauee of insanity in Eastern countries. An
irresistible impulse to kill is, according to Dr. Thomae Ireland, occasionally
one of the characteristic symptoms of intoxication from this drug. Dr. C.
R. Marehall reports an interesting personal experience in which the char-
acteristic toxic symptoms were produced by a small dose of Cannabinol,
0.1 to Q.13 Gni. (or gr. iss-ij).^ A case has been reported by Dr. J. Xevins
Hyde in which, after a dose of 0.065 Gm. (or gr. j) of Cannabis Indica, a
papular anfi vesicular eruption made its appearance upon nearly every part
of the body, and gave rise to severe itching. Toxic symptoms have been
manifested after taking two doses of 0.75 c.cm. (or fwxij) of the English
tincture, four liours apart, as in a case reported by Dr. Antony Roche."
Therapy. — Owing largely to the uncertain quality of the drug, hemp
is not employed to the extent that its physiological action would warrant.
Cannabis Indica has been found extremely useful in acute dementia
due to mental anxiety, and also in melancholia. This agent also may be
Buccessfuliy prescribed in order to combat the wakefulness of delirium
tremens, and good results have been ascribed to it in the management of
^ Dr. C. R. Marshall, on 'The Active Principle of Indian Hemp," Laneet, Jan.
23 1807.
^Lancet, Jiin. 23, 1897.
* Lancet, y>s*i. 24, im»8.
CANXABIS INDICA. 307
tetaniu. It has been employed with advantage in chorea, and may some-
times be of avail in epilepsy. Amelioration has been produced by this
remedy in senile trembling and paralysis agitana. In fieuralgia and migraine
good resalts follow its cautious use. In other painful affections, Cannabis
Indicft may be resorted to with advantage. Dr. Stephen Mackenzie has
foimd cannabis of value in the severe headache of cerebral tumors, in chronic
and persistent cephalalgia, and in the violent pains of locomotor ataxia. He
has fonnd it of service also in gastralgia and enteralgia. It may be admin-
istered to mitigate the snfEering caused by the passage of an hepatic or' renal
calculus. In acute or chronic rheumatism, in gout, and in carcinoma hemp
may often be very serviceably substituted for opium, over which it has the
adrantsge that it does not derange the secretions.
Cannabia Indica quiets the delirium of cerebral softening. Dr. R. T.
Edes, of Boston, has, in a number of instances, observed the use of this
drug to banish the tendency to bad dreams. It allays the itching of eczema.
Id the itching which accompanies many cutaneous affections, and particu-
larly in senile pruritus, the internal administration of Cannabis Indica will
often afford relief. In various uterine disorders it is used to relieve pain
ind bring about contraction of uterine muscular fibre. The pain of dys-
menonhcea may not infrequently be controlled by Cannabis Indica. Its
influence upon the muscular structure of the womb renders it valuable in
menorrhagia. Its virtue is enhanced, in this affection, by combination with
ergot. It has been found particularly useful in the abundant floodings which
sometimes precede the menopause, and, in fact, it possesses considerable
power as a general hemostatic.
Cannabis Indica has also been used with advantage in uterine subin-
Tolution and chronic endometritis. The headaches which attend the grand
climacteric will sometimes yield to this remedy. In combination with nuz
Tomica it is regarded by de Schweinitz as of value in headache dependent
Dpon retinal asthenopia. It may be productive of good results in impotence
imconnected with gross lesion. In spasm of the bladder and dysuria it gives
relief, and also, in acute gonorrhoea with chordee, we see good effects from
ita eihibition. It can be given in either of these combinations with marked
benefit for relieving the latter distressing symptom: —
B Fluidextrftcti cannabis Indies 2
Sodii bromidi 12
Mift tode xnenth 90
Symp. aurantii 60
cctn. or f38s.
Gm. or 3iij.
ccm. or fjiij.
ccm. or ^ij.
Sig.: A tablcBpoonful at bed-time. Repeat every bour or two until relieved.
120 Gm. or ffr. iij.
4l Gm. or 3j.
|38 Gm. or gr. vj.
B Extract! caanabii Indies 120 Gm. or ffr. iij.
Chlorali hydrati 4 Gm.
Extract! opii |38 Gm.
OL theobromatis q.
M. et ft rappodtorlK no. xlj.
Sig.: Insert one in the bowel on retiring, and every two or three hours when
^^1m with chordee.
By some practitioners it is esteemed of value in acute and chronic
Wright's disease, the presence of hsematuria especially indicating its employ-
Jwnt. Trial has been made of the drug in diabetes mellitus. Though it
|MT, at times, be able to moderate cerebral irritability, it exerts no marked
infinence upon the course or severity of the disease. The spasm of asthma
308 PUAIIMACEUTICAL TUEBAPEUTIC AGENTS OR DKUGS.
is sometimes very rapidly relieved by hemp. In whoopiBg-cough, also, it
may prove of aervice. It is a good remedy in irritable or reflex cough.
Mackenzie recommends the use of Cannabis Indica in hay fever and
hay a^ithma. Germain See wnnnly rwnrnmends Cannabis Indica as a gastric j
sedative of particular value in f iiuutioDal disorders of the stomach and bowels
attended with pain, acidity, and flatulence. He advises 0.04 Gm. (or gr. V4)
of the extract to be given in three doses, or it can be prescribed in the form
of the fluid extract, and creosote added with great advantage: —
I^ Fluidextructi cuunabis lii'liae 3
Crcosoti
Syrup, ftcaciffi 90
M. 8ig. : A teaspoonful before meals.
10 c.cm. or mi.
30 c.cm. or mv.
c.cm. or fjiij.
J
It is also of value in the treatment of gastric ulcer and may be com-
bined with silver nitrate, the efficacy of which it increases. Cannabis Indica
is said by Macconnell to be of value in diarrhoea dependent upon indigestion.
Cannabis Indica is said to do good in exophthalmic goitre, and to cure, in
some instances, the opium or chloral habit. The tannate of cannabin is a
good hypnotic, and has been used for insomnia among the insane. The same
Sroperty is shared by cannabin and cannabinone, both of which are given in
OSes of 0.03 to 0,13 Gm. (orgr. ss-ij). The oil of hemp-seed (oleum cannabis)
is a drying, fixed oil expressed from the seeds; it is green in color, disagree-
able to smell, and bland to the taste. It is used in the manufacture of a
green Boft-soap of deservedly high reputation in treating eczema and other
skin diseases.
The tincture of Cannabis Americana is regarded by some as equal in
value to copaiba or sandal-wood in the treatment of gonorrhcea. The prep-
aration should be made from the fresh plant and be given in doses of 3 to
6 drops three or four times a day after subsidence of the acute symptoms.
CANTHARIS (U. S. P., B. P.).— Cantharides. (Spanish Flies.)
Preparations.
CoUodium Canthoridatum (U.S. P.). — Cantharidal CoUodion (60 per cent).
Ceratum Cantliaridis (U. S. P.). — Cantharidea Cerate (cantharidea, 32 Gm.; yel-
low wax and resin, aa IS Om.; lard, 22 Gm.; oil of turpentine. 15 c.cm.).
Emplaatnim Picia Cantharidatum (U.S. P.)- — Plaster of Pitch and Cantharides;
Wftrming Plaster (Burgundy ^tJteh. 02 Gm.; cerate of cRntharideB. 8 Gm.)-
Tinctiirii rnntlmriiliK 1 1 . S. P., It. P. ( . — Tiufturi' of l nntlmrides ( 10 per cent.).
Doee, (U.S. P.), 0.00 to 0.00 c.cm. lor mix). (The British tincture is only IV* per
cent,). Do&e, 0.30 to 4 c.cm. (or mv-3j).
Acetum Cantharidia (B. P.). — Vinegar of Cantharides (10 per cent.}.
Liquor Epiapasticua (B. P.). — Blistering Liquid (50 per cent, with acetic ether).
Un^entum Cantharidia {B. P.). — Cantharidea Ointment (cantharidea, bruised, 1
Gm.; l>enzoflted lard, 10 Gm.).
Emplaatrum CantharidiB (B. P.). — Cantharidea Plaster (36 percent.).
Emplastrum Caiefaoiens (B. P.). — Warming Plaflter.
CoHodium Vesicans (B. P.). — Blistering Collodion (blistering liquid, 40 c.cm.;
pyroxylin, 1 Gm.).
Pharmacology. — Cantharis vesicatoria (class, Inaecta; order, Coleop-
tera), thoro;iplily ilried, at a temperature not exceeding 104" F., occurs in
pbannacy, either whole or in a more or less fragmentary condition, or as a
brownish powder, in which the bripht-green fra^ents of the elytra are very
noticeable. The dust is very irritating, and the eyes should be protected
when the drug is powdered in the mortar. The perfect flies are stronger
CANTHABIS.
309
i A^ powder, which often has been damaged by the ravages of mites or
hmet forms of life. The active constituent is Cantharidin, the anhydride,
«<lftCtaaCy of cantharadinic acid (discovered by Eobiquet in 1810) which is
fitaniwl diiefly in the soft parts, and especially the generative apparatus,
tl» bloody and in the eggs (Leidy). It is soluble in alcohol, ether, chloro-
Sms. etc. Beeidefl this, which constitutes rather less than 1 per cent., there
««• green oil, black matter soluble in water, a yellow viscid matter, fat, cal-
osm «nd magnesinin phosphates, acetic, formic, and uric acid-=, and a volatile
Mmdple itpon which the fetid odor depends, and which, according to
uifefidorff, acts upon the system like cantharidin. The green coloring
■■fcter appears to be identical with chlorophyl.
Phyiiologieal Action. — When applied to the skin, an active preparation
d emiharides causes burning pain with hyperjemia, to which, in the coursa
rft few hours, succeeds the formation of vesicles, exhibiting a tendency to
na together and form a large bleb corresponding with the area of applica-
boB. If the action is continued, sloughing and ulceration result. The
Oforgement of the capillaries in the superficial structures is associated with
of the deeper structures. When applied to the chest, the lung un-
Bth becomes pale and ana?mic, and, if its action be too long continued,
may cause inflammation of the pleura; or it may produce perito-
I if applied to the abdomen. Slight elevation of temperature attends the
mtkm of the blister, which may be followed by depression of temperature
■id weakening of the heart's action. Constitutional effects may be caused
br absorption of the active principles through the integument. When intro-
daecd into the stomach, cantharides is capable of setting up much irritation
md eren eastro-enteritis, with vomiting, or purging and tenesmus. The
■ctH^ principles soon pass into the blood, and at first slightly stimulate the
iMTta action; but the effect is most marked upon the genito-urinary organs,
m the kidneys are the chief organs by which they are excreted. Extreme
ffTitation of the bladder is produced, the urine is voided frequently, and,
wmg to the congested state of the kidneys, often contains albumin and
llaa£ There may be suppression of urine. Associated with this is priapism,
vift pain in the glans penis, urethra, bladder, and aching in the renal region.
Soughing of the external genitals has been known to occur in consequence
rf ihe administration of cantharides. Toxic doses, according to Cautieri,
MBiaa rapid diminution of blood-pressure, decreasing the force of the heart's
1, but increasing the pulse-rate. In fatal cases inflammatory changes are
in the alimentary canal, with intense hypera?mia of the bladder and
The mlgar notion that cantharides causes erotic Bensations, or increased
fsaal power, has no foundation except in the evidences of congestion and
iafiasBtnation of the urinary passages just referred to. The resiilts of swal-
lawmfT a few grains of Spanish flies may be quite serious, and it is regarded
h^ ■ as a penal offense to administer this drug surreptitiously and with
e» The treatment of poisoning by cantharides is by bland drinks
■adoptateflandahotbath. Bismuth and cocaine are also of service. Animal
^sicoal haa also been recommended as an antidote. An anaesthetic may be
Therapy. — Blisters are usually spread with cerate of cantharides, or
iwferably with the cerate of the extract of cantharides, the prescription
leiBg M follows: —
310
PHAHMACErTICAL THEUAPELTIC AGENTS OR DBUOS.
H Cerati cantharidis, q. 8. ^ j
Fiat emplastrum 2 X 3 in. ^H
Sig.: Apply to designated spot and allow it to remain four hourt. Then renu^l
it and aiibntitute a moist compress.
The skin overlying the effusion should not be removed, but simply
punctured to allow the serum to escape; the spot is then dreseed with some
bland fat, such as suet or benzoinated lard. A good way to raise a blister
is to use the blistering collodion and paint one or two coats over the desired
area, and lay over it a piece of waxed paper, under which the bUster raises
in a few hours. Saint-Philippe has suggested that the danger of strangury
may be lessened by the preliminary use of an alkaline diuretic until the urine
has become alkaline. It is also a good plan to sprinkle a small quantity of
morphine and camphor over the surface of the plaster before it ia placed in
position, Blisters are employed therapeutically to relieve pain, to reduce
inflammationj and as revulsants to promote absorption of inflammatory
products. The warming plaster is very useful in pleurodynia. Meningeal
or pleural inflammation may be checked by the prompt application of a good-
sized blister to the scalp or to the chest. In iritis, blisters behind the ears
are often serviceable. Dr. C. Ziem recommends painting cantharidal col-
lodion behind the ear, extending downward as far as the jaw, in the treat-
ment of certain acute inflammatory affections of the eye. He makes use of
the same method for relief in cases of abscess of the thyroid gland, and in-
flamniiitiou of the fmntnl sinus nnd nntrum of Highmore. In poncarditis,
marked relief may be afforded by blistering. A blister over the stomach will
arrest obstinate vomiting; and gleet is sometimes cured by a blister to the
perineum. Vesication of the back of the neck is said by Swan to be a useful
measure in cases of incontinence of urine. Neuralgia is promptly relieved
by a small blister to the painful point; and neuritis is cured by fly blis-
ters; that is to say, a succession of small blisters along the course of the
nerve. In acute rheumatism, marked relief is sometimes afforded to a swollen
joint by surrounding it with small bUsters. A blister over the affected joint
is a good remedy in chronic synovitis. A large blister over the heart, applied
early in the course of acute rheumatism, is often remarkably successful in
reducing temperature and relieving pain; probably, also, it is of use in
obviating the tendency to endocarditis, or curing it if present. In pleural
effusion, absorption may be hastened in a similar manner, and also the clear-
ing up of the lung after pneumonia. The warming plaster here may be worn
for several days, if the skin is not too sensitive. Blisters must be used with
caution in aged or debilitated patients; also in children. They should not
be applied to parts deprived of vitality by paralysis, or to cicatricial tissue,
or where the skin is poorly nourished. The possibility of absorption and
serious results should be kept in mind. Nor should a blister be allowed to
remain on too lon^. Cantharis should not be used as a vesicating agent in
the case of patients whose kidneys ore damaged. The cerate, or tincture, of
cantharides enters sometimes into the composition of pomades or lotions for
the treatment of alopecia circumscripta, and cantharidal collodion painted
over the patches, every week or ten days, is at times efficacious.
In small doses, not exceeding 0.1^ to 0.18 c.cm. (or mii-iij) daily of the
tincture, cantharides has been commended as a stimulant to the urinary
organs, in hffimaturia, Bright's disease of the kidneys, pyelitis, cystitis, in-
continence of urine, gleet, and leucorrhoea; but is contra-indicated in active
CAOCTCHOUC.
311
\
of inflnmumTion. Given in this manner, it is claimed to relieve
chftrdee. Binger recommends full doses of the tincture of cantharides^ in
OBinbination with tincture of iron and phosphoric acid or nux vomica, in
tibe impotence due to old age, sexual excess, or masturbation. Cantharis has
ham employed with success in amenorrhcea due to atonic conditions, and haa
•■ppreaBcd passive seminal emissions of the same character. Cutaneous
•foeaoUy eflpecially psoriasis and other squamous diseases, are sometimes
SBch benefited br similar small doses of the tincture. It has been used to
pfodnce abortion, and, in these small doses just mentioned, has emmenagogic
pr r '' - There is some evidence to show that the internal administration
«f ■ of cantharides may check the progress of cancer. Several cases
hi '>rted in which the tumor remained stationary and the s}Tnp-
tftti i, or in which, many years after removal of the growths, there
ktd been no recurrence. It was given in association with the wine of cam-
that.
Fdtamum cantharidate has been introduced by Professor Liebreich as
— Ht in tuberculosis, especially of the larynx. It is given by hypodermic
Ut in doses of 1 to 2 decimilligrammes (or gr. ^/aoo-Vaoo)- The in-
^cciion excites a Moderate degree of pain, but is not generally followed by
|ro«K>«or^ febrile reaction. In cases of simple inflammation and tuber-
ed' of the larynx, potassium cantharidate causes an exuda-
tiaij h is, however, quickly reabsorbed. Hoarseness diminishes
sad swaliofnng becomes less difficult. Tuberculous ulcers show a tendency
to he«I. In pulmonary tuberculosis it has been found without effect upon
t^ fever, cough, expectoration, or physical signs. The treatment is apt to
cnate sli^t albuminuria and urobilinuria. Peterutti has reported three
CMcs treated by him more than three years previously, according to this
nethod^ with, at the time, apparently unfavorable results. He subsequently
ivaad two of the cases completely cured and the third so much improved as
ts ^nulate a cure.
Benefit has sometimes resulted in cases of lupus and granular lids. The
ax»e method is said to have occasioned improvement in non-tubercular
dbfmic laryngitis. Dr. Ch. Talamon states that, although he has witnessed
aa favorable effects of- potassium cantharidate in tubercular cases, he haa
vhaerred that the salt possesses a decided diuretic action, more especially in
tabcrenlous patients. In order to avoid the pain to which these injections
pre liw, l>r. Hmnig hus employed Cocaine Cantharidate in tuberculosis and
HBM other chronic affections, as 02n?na, nasal and laryngeal syphilis, etc. He
mm a tolution of 3 to 6 parts of the remedy in 2000 parts of chloroform-
vatcr, and the quantity injected is equal to 1 to 5 decimilligrammes (or gr.
'/■^^-•/j^ <*f cnntharidin. Cocaine cantharidate is rather a simple mixture
a chemical combination and occurs in the form of an amorphous, white
ir, destitute of odor and having a saline and pungent taste. It dissolves
difficulty in cold water, but is readily soluble in hot water. It is in-
aotable in ether, alcohol, and benzin. Cantharis tincture, internally, has
ttm made use of as a systemic stimulant in adynamic conditions.
CAOUTCHOUC (B. P ).— India Rubber
Preparaiion.
Ufaor Caoutchouc (B. P.). — Solution of India Rubber (India rubber, 50 Gm.;
" aad carbon btsalphid«, of «Ach, 600 c.cm.).
812
rilAUMACKl'TICAL TllKHAPEL'TIC AGEN'l^S 0» DUrGS.
Pharmacology. — The prepared milk-juice of Hevea Brasiliensis, and '
probably other species; knowu iu conmierce as pure Para rubber. (See
£lastica.) I
CAPSICITM (U. S. P.).— Capsicum (Cayenne Pepper, African Pepper)
CAPSICI FEUCTTTS (B. P.).— Capaicam.
Dose, 0.UC5 to 1.30 Gm, (or gr. i-xs).
Preparations.
S. P.).— nuid
ITrT'
Kxtract of Capsicum (alcoholic)
Dose, 0.003 to 0.12 Gm,
Fluidextraotum Capsici (U
Done, 0.06 to 0.30 c.cm. (or mi-v).
Oleore.Mna Capsici (U.S. P.). — OleoreBin of Capsicum,
(or mV»-ij).
Emplastrum Capsici (U.S. P.). — Capiicuro Plaster (contains oleoresin).
TirKtiiru Capsici ( l*. S. P.. J>. P.). — TinttiiH' **S ( apr-icuin. Do-**-. 0.:iit to 1 r.rm.
(or »iv-xvi, Tli(* t'nitcti Stalt's pifparuLion is 10 pi*r cent, strength, and the British
preparation is only 5 per cent.
Pilulffi Podophylli, BoUftdonnae, ct Capsioi (U. S. P.).— PilU of PodophyUum,
Belhidonim, and lapmicum (resin of podoph^llin, 1.0 Gra. [or gr, XAivsa] ; extract of
beUadnnnnlcuves, 0.8 Rm, [or gr. xtj'/J: wipsioiim, 3.2 Gm. [pr gr. xlix] ; sugar of
milk, aoiicia. and glycerin, to rnukf lill) pill.-^i. L>i>*f. 1 pill.
Unguentum Capsici (B. P.).— Capsicum Ointment (bruised capsicum-fruit, 12
Om.; spennaceti, Q Gm.; olivet)!], 44 Gm.).
Pharmacologfy. — The dried, ripp fruit of Cnpsicum fasti^atum (Sola-
naci'ie), di-privtHl of its calyx (U. S. P.) ; tiie dried, ripe fruit uf Capsicum
miniiiium (B. P.), constitutes capsicum, or red poppi?r, which grows in the
Ea.st Indies and on the coast of Guinea. Different varieties are cultivated all
over the world for culinary and medicinal purposes. The Capsicum aunuum
is most common in this country, of which there are a number of varieties,
having ditrcrcnt-fihaped pods or large berries, the latter being picked green
and used for pickHug with vinegar. The chief constituent of red pepper is
a crystalli7,al>le, acrid sidj^tancc. Capsaicin (Thresh) ; also a yellow oil, rosin,
and a volatih^ alkaloid wljich in its odor resembles coniine.
Physiological Action and Therapy. — Capsicum occasions irritation when
applied to the skin, and may produce vesication^ it acta as a counter-irritant
in relieving pain in the structures beneath, especially in neuralgia, subacute
font, chronic gout, rheumatism, and bronchitis. In the mouth the taste is
ot and pungent, causing free flow of saliva, and similarly increasing the
flow of castric juice, producing warmth in the stomach, expelling flatus, and
giving increased appetite and digestive power. Overdoses of capsicum will
give rise to subacute or chronic gastritis. Excessive amounts cause severe
pain, vomiting, and purging.
Capsicum stimulates the action of the heart and increases the digestive
functions. It promotes the excretion of urine and possesses an aphrodisiac
influence. A prescription of much utility in debility of the sexual organs
is: —
aa 4| Gm. or 3j.
H Pulveria capsici,
Extracti cocee
M. ct ft. pilule no. XXX.
Sig. Two pills throe or four times a day.
Capsicum plaster may be used when mild counter-irritation is desired.
The tincture of capsicum may be employed with advantage in chilblaina
CAPSICUM.
313
vhcB the surface is unbroken. Dr. Rheims recommends that a Btrong tinct-
v« of capsicum-pods should be mixed with an equal quantity of mucilage
flfpvifi arabic. The mixture is brushed two or three times upon tissue-paper,
viuch SB then applied to the affected surface and quickly relieves the itching
wni ptiB. Discolored bruises and chronic rheumatic pains are likewise
Waefited by the same treatment. Sawyer suggests a tincture of capsicuni
■ttdr with official, pure ether iu place of rectified spirit. He reports* that
itlxr, by its action on the sebaceous secretion of the skin, is preferable to
•ieshol ae a menstruum for drugs designed to produce a therapeutic effect
m or through the skin. It has also the advantage that oil of turpentine or
a Utnd oil is easily miscible with it, if requisite to add either. He states
Hat a mixture of equal parts of ethereal tincture of capsicum, liquor am-
BOBttB, oleum terebinthinte, and oleum lini forms an excellent rubefacient
iaaaent. An infusion of capsicum pods applied upon a piece of lint is re-
■vkably efficacious in acute torticollis.
The tincture of capicum is an excellent application to the mucous mem-
kane of the mouth and especially the gums. It enters into very many tooth-
«Mh€«, the following, used by Garretson, being very serviceable: —
Unct- caprici . .
Sntritu* odor&t.,
AlcrohoUa
7|6 com. or f3ij.
aa 60
Tinct. quilUje 45
Tiii«t. g^iitianie comp 30
Acidi acetici diluti 16
PiMtiolis liquefacti
c.cm. or fjij.
ccm. or f^iss.
c.cm. or fSj.
c.cm. or <Ss8.
12 ccm. or mij. — ^M.
Capaicum infusion is used as an application to scarlatinal sore throat,
luted as a gargle in tonsillitis, pharyngitis^ or may be used as a gargle,
H Tlnd. rapsici 4
PotJi«0ii cfaloratU 12
Gtyr^rini flO
Acidi hrdrochlor. dil 11
Aqiur rone ad 360
ccm. or fSj.
Gm. or 3iij.
c.cm. or f5ij.
ccm. or f3iij.
ccm. or i3xij.
Capcicum may be used externally as a hair-lotion for promoting the
c^iUary growth: —
R Tinct, captici 151 com. or (|ss,
lilt. VuilUja 30 ccm. or fSj.
Glycerini 7 6 c.cm. or f3ii.
TineC cantharidia 11 c.cm. or (3iij.
Spiritus roaroarint 45 ccm, or fSiw.
Aquae roa» 240 c.cm. or fjviij.
M. Si^-* Drop on the hair night and morning and brush the acalp well.
CttpBicuxn is given internally after a debauch or in cases of drink-crar-
&is a substitute for alcoholic drinka in extemporaneous infusion 31 Gm. to
(or 5i-^U» ^VJ)-. Dose, 15 to CO c.cm. (or f3ss-ij). In chronic catarrh of
the ttomach of drunkards, the tincture of capsicum, in 0.60-c.cm. (or gtt. x)
4aM9 before meals, serves as an appetizer. The tincture of capsicum is a
valuable etimulant in delirium tremens. It may very serviceably be admin-
iHcred in beef-tea, and supports the heart, allays restlessness, and promotes
* V^ndon Lancet, May 17. 1800.
314
PHAIIMACEUTICAL THERAPECTIC AGENTS OU DRUGS.
sleep. Capsicum, in fact, pofisesses a slight narcotic power, and can be given
thus with luarktd effect: —
B Tincturec capaici 7 5 c.cm. or fSij.
Sodii bromidi 12 Gm. or 3iij.
Elix. lupuHni 120 c.cm. or fSiv.
M, Sig.: Two t«aspoonfulfl in water erery hour or two.
It is an excellent remedy in flatulent dyspepsia: —
B Pulverifl capeici 2140 Gm.
Extrarti nucis votnice 20 Gm.
Extnicti pancreatia 4| Gm .
M. el ft. capsul(e no. xx.
Sig.: A capsule after meals.
or gr. xl.
iij.
or
or
w
Capsicum is beneficial in typhoid fever and typhoid conditions, as a
stimulant. It acts also as a useful adjuvant in the treatment of malaria. As .
this substance invigorates the muscular coat of the arteries, it may be ad- I
vantageously employed in order to control haemorrhage from the lungs or
the womb. On account of its irritant effects, it is contra-indicated in acute
inflammation of the stomach or bowels. As excretion takes place by the
kidneySj capsicum should be prohibited in inflammatory conditions of the
genito-urinary tract; but in chronic disorders it may often be employed with
advantage. In chronic nephritis, pyelitis, cystitis, and prostatorrhcea it fre-
quently proves decidedly beneficial.
CARBO ANIMAIIS (U. S. P.).— Animal Charcoal. (Charcoal prepared
from bone.)
Dose, IG Gm. (or %ss) in poisoning by alkaloids (for each grain).
CAKBO LIGNI (U. S. P., B. P.).— Charcoal. (Charcoal prepared from
soft wood and very finely powdered.)
Dose, Q.liS to 2 Gm. (or gr. x-xxjc). or more, B. P., 4 to S Gm. (or.li-ij).
Preparation, |
Carbo Animalis PuriflcatUB (U.S. P.).— Purified Animal Charcoal. Dose, 0.6fi to '
4 Gm. (or gr. x-3j). i
Pharmacology. — Animal charcoal is prepared from bone by exposure I
to heat; and wood charcoal is obtained by a similar process from soft wood. I
The former occurs as a black powder or mass, the latter in large fragments |
preserving the shape of the billets of wood, or as a fine light powder. Puri- j
fied animal charcoal is the charred bone after treatment with hydrochloric
acid, which removes the earthy salts and leaves only the carbon. Recently-
burned charcoal readily absorbs gases. It is an excellent deodorizer, and it
destroys organic impurities by oxidation, decolorizing solutions containing
them and rendering them inoffensive to taste or smell, but it is not, prop-
erly speaking, an antiseptic. It is a useful filtering agent, when fresh, for
purifying water. Internally, it is given in too small doses to exert much
effect of this kind in the intestinal tract, but it aids in purifying the stomach,
partly by mechanical action. It increases secretion and peristalsis. Robert
B. Wild,^ in a pri2e essay on "Charcoal as a Therapeutic Agent," says we |
»yrMJ York Medical Journal, April 4, 1896.
CAKBONEI DI3CLPHIDCH. 315
hflTe in charcoal, whether dry or mixed with water, a powerful oxidizing
agent, and one which, being non-poisonous, can be administered in large
doses.
Therapy. — Charcoal is a good dressing to old or offensive gangrenous
ulcers, as it absorbs the foul material and iueans the wound. It is generally
utilized in the form of the charcoal poultice, being beaten up with bread-
crumb or flaxseedmeal ; or a small bag filled with powdered charcoal may be
l&id upon the poultice when it has been placed in position. It is sometimes
used for tooth-powder, but it is open to the objection of scratching the teeth
and discoloring the gums. Charcoal filters are useful in pharmacy, but not
in the household, because, if not renewed daily, they lose their virtues, and
only act as a breeding-place for germs of putrefaction and disease. Charcoal
in powder or animal charcoal may be administered in cases of poisoning by
organic poisons. In flatulent dyspepsia recently-burned charcoal is some-
times beneficial. It has been used to relieve the pain of gastric, ulcer and
nstralgia. In France it is sometimes prescribed as magnesia noire, and in
England the term ''black magnesia" is sometimes applied to powdered char-
coal.
CABBONEI BISUIFEIBTrM (U. S. P.).— Carbon Bisulphide (CS,).
CABBOHIS BISUIPEZDUH (B. P.).— Carbon Bisulphide.
Pharmacology and Therapy. — Carbon disulphide is a clear, very dif-
fusive inflammable liquid, of strong, offensive odor. It is a highly-refractive
4uid, has a sharp, distinctive taste and a neutral reaction. It is highly poi-
sonous, and its odor is also an objection to its internal use. It gives rise to
severe headache and marked nervous excitement. Frequent exposure to its
fumes occasions anaemia, physical and mental debility with, in some instances,
amblyopia and epileptiform convulsions. Workers in rubber factories are
liable to be affected by inhalation of carbon disulphide. The symptoms
noted by Stadelmann* consisted of digestive disturbances, muscular weak-
ness, tremor, ataxia, increased muscular irritability, painful muscular spasm,
disturbed sensation; altered knee-jerk, sometimes increased, sometimes
diminished, etc. These symptoms are not uncommon in Oermany. Bern-
hardt states that the poison may affect the peripheral nerves and even give
rise to a degenerative neuritis or paralysis. Hysterical symptoms have been
observed. Stadelmann found no changes in the optic disk. Poisoning by
this agent is treated by means of bromide and chloral, with the addition of
stimulants if the circulation is depressed, although it is a valuable antiseptic,
and has been used in typhoid fever, dyspepsia, and in gastric cancer. It has
eome anaesthetic and anodyne properties when inhaled. Locally, the vapor
has bee& proposed to be applied for glandular enlargements and in defective
secretion of cerumen in the ear. Local ansesthesia may be produced by the
spray in neuralgia, etc. W. S. Cline claims that 15 c.cm. (or f^) of the
disulphide of carbon, being well rubbed over the painful parts, will cure
sciatica.
Rubber stoppers should not be used for bottles containing this sub-
stance, and these should be kept away from flame and in a cool place.
^Berliner klinische Wockenschrift, June 13, 1896.
316 PHAHMACECTICAL THERAPEDTIO AGENTS OR DBDOS. ^J
CARBAMOMITM (U. S. P.) — Gardftmom. ^M
CAKDAMOm SEMIKA (B. P.).— Cardamom-seeda. ^M
Dose, 0.32 to 1 Gm. (or gr. v-xv). ^M
H Preparations. flH
Tinctura Cardamoml (U.S. P.). — Tincture of Cardamom (10 per cent.)- Dowe,
4 to 7.5 c.cm. (or fSi-ij).
Tinctura Cardamomi Composita (U.S. P., B. P.). — Compound Tincture of Cardar
mora (U.S. P. containe cardamom^ 2; cinnamon, 2; caraway, 1: cochineal, Vi; glyc-
erin, 5; in dilute alcohol, q. a. ad 100 pans). Dose, 4 to 15 c.cm. (or f3i-iv). B. P.|
2 to 4 c.cm. (or fSss-j).
Pulvis Aromnticus.^Aroinntic Powder (U. S. P.); consists of canlamon and
nutmeg, oa 19 Gm. ; cinnamon and ginger, aa 3fi Gm.
Pharmacology. — Cardamom is the dried, nearly-ripe fruit of Elettaria
repens (Zingibfraccie) (U. S. P. ) ; the drieil, ripe seeds of Elettaria Carda-
momiim (B. P.), It comes from MiilaUar. although other sources are recog-
nized in commerce. The seeds are inclosed iu capsuh'.s, the latter being
Taluelesa except aa a protection for the Fornier. which eontaiu a volatile ou
hohling a cauiphoracet^ua substance in sniutioii.
Therapy. — The seeds of cardamom are sometimes chewed and swallowed
to relieve flatnlence, or the tincture or compound tincture may be used, the
latter being a valuable carminative combination. Where alcohol is objec-
tionable, the aromatic powder may be substituted for the compound tincture
in the treatment of atonic dyspepbia and flatulence, or an iufusion may be
used (30 Gm. to 240 c.cm. [or 5j to fS^'^ij])-
CAKDirUS BENEDICTUS,— Blessed Thistle. Thi.^ plant belongs to the
Compoeilffi and is a native of Asia and Europe. The leavoSj sometimes the
flowering tops, are used in decoction (1 to 8), and a fluid extract and solid
extract have also been used. A bitter neutral principle, Cnicin^— crystal-
lizing in colorless prisms, soluble in alcohol, less so in water, — appears to be
the principal constituent; potassium nitrate is also present.
Therapy. — Carduus is a bitter tonic used in Germany in digestive weak-
ness and chronic hepatic complaints: best given as the fluid extract (1 to
4 c.cm., or mxv-foj, at a dose), in which the menstruum is dilut»*d alcohol.
Cnicin has been given in doses of 0.32 to 0.66 Gm. (or gr. v-x) in intermittent
fever, but in these quantities it is apt to cause nausea, vomiting, and diar-
rha^a. The Carduus Marianua^ or St. Mary's Thistle, another variety, is used
for the same purpose, but it is especially in repute for treating cases of gall-
stones. It has also been extolled as an hsemostatic, laxative, and diuretic
(Lobach).
CASOTA.^Carrot-fniit. The seeds of Daucus carota (Fmbelliferae), of
a grayish color, about Vg inch in length, contain a volatile oil of aromatic
odor and taste. Used in powder as a carminative and diuretic.
CARTHAMUS.— Safflower. Tlie dried florets of Cartlmivm.^ tinctorius
(Con^posita')* This phmt contains a yellow coloring-mutter, Safflor-yellow ;
a red coloring-matter, and carthamim, or cartlmmiuic, acid. The latter is
a red-brown powder, which, when mixed with chalk, forma "rouge.'' Inter-
BftUj, tiuB agent is slightly stimulant and laxative. Hot infusiong are
dufrfkocvtie. and are popularly given to expedite eruptions in exanthematoua
^mmta (8 to 16 Gzn. in 480 c.cm. of boiling water, given in doses o£ a wine-
CA£Tm (U. S, p.) —Caraway.
CABin FRUCTTJS (B. P.).— Caraway-fmit.
Bote. 0.65 to 2 Gm. (orgr. x-xxx).
Preparations.
Otawn Ofcii tU. S. P.).— Oil of Caraway. Dow, 0.06 to 0.30 ccm. (or tfii-v).
OlMim Carai (B. P.). — Oil of Caraway. Do«e, 0.03 to 0 18 c.cm. (or msa-iij).
AqoA Carui (B. P.). — Caraway-water (50 Gra. to 1000 c.cm. distilled to 600
Ckrav ay «nt«r«
of cardamotn
the compound
in the compound spirit of juniper (U.S. P.)
(U. S. P., B. P.), and spirit of juniper (B, P.).
Pliarmaoologj and Therapy. — The dried, nearly ripe fruit of Carura
(Umbellifera?) contains a volatile oil, and is prized as a condiment.
It is med as a stimulant in flatulencej or in conihination to prevent griping
[•f dtber medicines. A case has been reported in which 4 c.cm. (or f3j) of the
' «fl of caraway produced cerobrnl congestion, delirium, and rigors in a man.
Quway ha? >>een thought to possess galactagogic properties.
CABYOPHYLLIFS (U. S. P.), CARYOPHYLLITM (B. P. ) .^-^love*.
EUGENOL (F. S. P.).— Eug«noL
Dose, 0.20 c.cm. (or niiij).
h^)
OWnm OaryophylU (U.S. P.
Preparations.
B.P.).— Oa of aovea.
DoM, 0.06 to 0.87 e.em. (or
lafiurwB QuryopbyUi (B.P.). — Infusion of Cloves (2Vs P^ cent). Dose, 16 to
(orOM-j).
eDt«T9 into the U. S. P. preparations of compound tincture of lavender,
tiacture of rhubarb, aromatic syrup of rhubarb, and wine of opium.
Pharmacology, — Cloves are the unexpanded flowers of Eugenia aro-
Ej::ca <Myrtacea?), U. S. P.; the dried flower-buds of Eugenia caryophyllata
B. P.)- * large tree of the Spice Islands and Africa. They are dark
teovn in color, about half an inch long, and have a strong, spicy odor
ad pun^nt, aromatic taste, owing to the presence of a heavy volatile oil
flB to 20 per cent.). They also contain Eugenin, tasteless crystalline sub-
itance; tannic acid; and a neutrnl, tasteless, odorless body, Caryophyllin,
which CT^TStalUzes in needles. Eugenol, called also eugenic acid, constitutes
iovr-fiftha of the hulk of oil of clovrt;, is an unsaturated, aromatic phenol,
1C17- aoloble in alcohol and but slightly soluble in water. It is also obtained
frn pimento, cinnamon, camphor, sassafras, and other similar volatile oils,
Oufg ■tiiTlnw arc the flower-stalks of the cloves; mother-cloves are the whole
findi.
P1lJ*iolog:ical Action. — Cloves are stimulant, carminative, and anti-
«tic. The oil has some anesthetic influence over painful areas. In over-
!■■• it will cause nstro-enteritis, has a soporiflc effect, and occasions' death
f«»piratoTy lailure. The oil of cloves is eliminated by the kidneys,
V bronchial mucous membrane, and skin. It possesses antiseptic virtues.
318 PHAHMACKUTICAL THEItAPElTIC AGENTS OR DRrOS. ~
Therapy. — The oil of cloves is used to destroy sensation id the nerve of
hollow, aching teeth, and quickly relieves pain. In combination with lan-
olin, it may be used for eczema. The infusion is used internally as a stom-
achic tonic for the relief of flatulence and pain, but it is generally given in
combination with other remedies. Fracti>)nal doses. 0,03 or O.OG c.cm. (or
gtt. S8 or j) of the oil of cloves, given in a little water, will rapidly allay ex-
cessive vomiting. Dentists sometimes use oil of cloves, mixed into a paste
with thymol iodide, in carious teeth, as a root-filling.
The growth of tubercle bacilli is retarded by tincture of cloves, and
Mannotti, in eighteen cases of local tuberculosis, obtained marked improve-
ment from injections of a 10-per-cent. emulsion of cloves in olive-oil. In
lupus vulgaris the repeated application of oil of cloves is said to cause separa-
tion of the epithelium and retrocespinn of the nodules.
The oil of cloves is a parasiticide and has been made use of as an appli-
cation in pediculosis. Eugenol, a constituent of the oil of clovos, has been
combined, by a patented process, to form a eompoimd termed benzoyl-
eugenol, or benz-eu^enol. This product, it is thought, may prove useful in
the treatment of tuberculosis.
The acetamide of eugenol, a crystalline substance, is an active antiseptic
and is also an excellent local ansesthetic. This compound may be advan-
tageously employed in dentistry and minor surgery. It is prepared by acting
upon the sodium salt of eugenol with mnnochloracetic acid, adding alcohol
and chlorine-gas and treating with a strong solution of ammonia. Another
combination which has been introduced is cinnamyl-eugcnol, a colorless,
crystalline substance, destitute of odor and taste, soluble in hot alcohol, ether,
and chloroform. This compound has been applied to the treatment of tuber-
culosis.
CASCA CORTEX.— Sassy-bark.
Pharmacolog^y. — The Erythrophloeura Guineense (Leguminosse) is a
large tree growing on the coast of Africa, which furnishes the ordeal-bark
of Angola; otherwise casca, or sassy-bark. It contains an alkaloid, Ery-
throphloBine. A tincture (10 per cent.) has been used by Brunton, in doses
of 0.30 to 0.r>0 c.cm. (or mv-x).
Physiological Action. — The powder causes sneezing when inhaled. The
infusion or tincture gives rise to vomiting, purging, and intoxication, fol-
lowed by death during convulsions. Upon the circulation erythrophla?um
has an action like digitalis. Wilcox, of New York, found that in its action
upon the vaso-motor system, it resembles digitalis and ergot combined.
Therapy. — In its native country sassy-berk is employed in the treatment
of intermittent fever, flatulent dyspepsia, diarrhoea, and dysentery. Brunton
finds the tincture useful in dilated heart without valvular disease; also in
mitral disease and dropsy. The indications for its use are a rapid, low-
tension pulse with venous congestion.
According to Prof. Germain See, sasgy-bark is very useful in dyspnoea,
markedly increasing the depth of inspiration. It disturbs the digestion more
than di^fitalis. The liydroclilorido of erythrophlo^ino is a salt in the form
of a powder, soluble in water, which can be administered hypo dermic ally in
doses of 0.001 to 0.005 Gm. (or gr. Veo-Via) as a local analgesic, but it is
inferior to cocaine for this purpose.
819
CA9CARA AMABGA— Honduras Bark.
Fkhrm^colo^Y and Therapy. — The Cascara amarga (Simarubaceae), or
Ifaotess burk, has some reputation as a tonic and alterative. The fiuid
flititet (doM, 2 to 4 c-cm., or foss-j, several times a day) may be used in
9plulilr chronic liver di&ease, nasal catarrh, and skin diseases (eczemai
iyphilodermata, etc.).
ABA SAOKASA (6. P.).— Cascara Sagrada. (See Bhamnus Fur-
CASCARTT.T.A (B. P. ) .— Cascarilla Bark.
Bote, 0.13 to 1.30 Om. (or gr. ii-xx).
Preparations.
Utvsam CKAcarilUe (B. P.). — Infusion of Cascarilla (5 per cent.). Dose, 15 to 30
Tteetufm OiMCAiilU (B. P.)-— Tincture of Cascarilla (20 per cent). Dote. 2 to 4
tm (or f3M>j).
Pkftrmacolog7. — The dried bark of Croton eluteria (Euphorbincese)
f t'rii* Bahama Islands. It hns a warm, rather bitter taste, and emits a
: odor when burned. Cascarillin is a bitter neutral substance, with
.iipr nil, resin, and tannin as the principal constituents. There are no
pry^parations, but the fluid extract, infusion, and tincture are used,
itoof whirh is miscible in water.
Tkermpy. — Cascarilla is a light tonic, somewhat stimulant and carmina-
tvcrtnd the infusion has been used in low fevers. It may be profitably em-
limd as a tonic in convalescence from typhoid fever or other exhausting
CASSIA FISTULA (TJ. S. P.) —Purging Cassia.
CASSIA PUI^PA fB. P.).— Cassia-pulp.
Dose, 4 Gm. (or 5j).
Pharmacolo^. — Tlie dried, ripe fruit of Cassia fistula (I>?guniinosa£),
• tnt of the West Indies, is in cylindrical pods of a dark-brown color, con-
*amg from twenty-five to one hundred seeds in separate cells, and a dark-
Vrvn, ftrfjft, sweetish pulp, having an odor like prunes and containing about
*• VfT cent, of sugar. Good cassia yields about 30 per cent, of the pulp,
^iik ift the niedicinal part of the dru^. This is laxative in its action in
Ahi of a drachm or more. There are no official preparations of cassia, but
I Af MCifection of senna contains 16 per cent. Cassia fistula promotes the
of bile and communicates a brownish or greenish tint to the urine.
k
CASTAHXA-— Chestnut.
Preparation.
n«i«trstrmctum Castiineie. — Fluid Extract of OiMtnut. Do^e.
4 to
loolo^ and Therapy. — The dried leaves uf Cnstanea denlata
I y^^f "ff ) , colWtod in Si'ptcniber or October, while they are yet gn^n,
*" in tannin, gallic acid, salts, and gum. A recent infusion has
320
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
been employed witli alleged success in whooping-cough, and might, on ac-
count of its nstringencY, be used for diarrhoea of relaxation. For the latter
purpose the fluid extract, of which the dose is 1 to 4 e.cm. {or f 5 V^ to j),
is preferable,
CASTOKEITM.— Caatar is the dried preputial follicles, with their secre-
tion, of tiie Castor fiber, or heaver, and freed from the small oil-sacks, asso-
ciated anatomically with them. It is of unctuous consistency, a brown or
reddish-brown color; a pungent, disagreeable smell; and a hitter, nauseous
taste. It is soluble in alcohol and ether. Cantor contains a volatile oil, a
peculiar principle, of crystalline structure, termed Castorin, and salicylic
aldehyde, together with other organic and inorganic constituents.
Therapy. — This substance has a certain stimulant effect upon the nerv-
ous system, and acts as an antispasmodic. It has been given in doses of
0.32 to 1.30 Gm. (or gr. v-xi) to control the spasms of hysteria and other
convulsions, the tremors of typhoid fever, and those dependent upon an
adynamic condition. It may be given with advantage in tympanites. Castor
is supposed to jiosjscps emmenagogiie properties, and has been administered
in ninennnlia^si and uterine colic. It is best given as the ethereal tincture
(of the Xfitional Fornuilary), in doses of 4 to 12 c.cm. (or foi-iij).
CATAPLASMA KAOLINI (U. S. P.).— Cataplasm of Kaolin. This
new introduction into the pharmacopoeia consists of kaolin, in N*"*. SO pow-
der. .577 Gm., with boric acid, thjTuol, oils of gaultlieria and peppermint,
and glycerin, 375 Gm. It forms a smooth, light-gray paste, resembling soft
putty in consistence. It is of agreeable odor and appearance.
When used, it should be spread on the skin as hot as it can be borne, or
apjilied on strips of bandage.
This agent is hygroscopic, antiseptic, and resolvent. It is of great ad-
vantage in local inflammations, in cellulitis, sprains, boils, and also in in-
ternal inflammations, such as pleurisv. pneumonia, bronchitis, peritonitis,
synovitis, mastitis, and orchitis. After being applied to the surface, absorb-
ent cotton may be kid upon it, and a roller-bandage applied.
CATECHir (B. P.), or GAMBIR (U. S. P.).— Qambin or Pale Catechu.
Dose, 0,065 to 2 Gm. (or gr. i-xxx). B. P., 0.32 to 1 Gm. (or gr. v-xv).
Preparations. <
Tincturn Gambir rnmpo»iU {V. S. P.) — Compound Tinrturp of Gnmhir (gam-
bir 5 per cent., nnd oinnamon 2'/, per cent., in tlilutfil uli'oliolt, 1>ihi', 2 to 8 com.
(or Ssfi-ij).
Trochisci Gambir (U. S. P.). Catechu (R P.).— Troches of Catechu (0.005 Gm.,
or gr. j. eftch). Po«<». 1 or mnrp.
Pulvia Catechu Compositus (B. P.). — Compound Powder of Catechu (catechu,
100; kiao, 50: kraraeria, 60; cinnamon, 25; nutmeg. 26). Doee, 0.65 to 2.00 Gm. (or
gr. x-xl).
Tinctura Cntechu (B. P.). — Tincture of Catechu <20 per cent.; cinnamon, 5 per
cent). Dose, 2 to 4 c.cm. (or fSss-j).
PharmacologT-. — Gambir is nn extract prepared from the leavps and
twigs of Ouroopnrin Gambir (Ruhinoefc). Ignited States Pliarmacopceia ;
an extract rvf tbe leaves and younjr shoots of Fncaria Gambir, British Phar-
macopcria: a large tree of Pegu, It is in large masses, hard and brittle.
CAULOPHYLLUM.
321
sd porouB <m fracture; taste strongly astringent and sweetish; very
^tirodor. The coostituenls of gnnibir extract, or cutch, are Catechn-tannie
ioid and Pyrocatechin/ or Catechol, tlie latter being insoluble in water;
trat ibfc- extract i-^ ♦Mitirely soluble in akoliol, though insoluble in ether. It ia
ain] aldo «& a - " . as "cutcb-brown.''
Tfceimpy.— r is a valuable astringent. It may be used as a mouth-
ctth for spongy gums, a gargle in pharyngitis, or as an injection in gonor-
i or leucorrhcea; but is most frequently employed in diarrhfj^aa of relaza-
• '^ '' yield of gambir has become insufficient to supply the demand,
tie il ilinistry of France has entered upon the cultivation, in
Okekin China, of a tree, the Brupiicra gymnorhiza (a variety of mangrove
mtd as a dyestuff), the bark of which yields on extract which has been found
tB anrver all the purposes of catechu.*
CATHA. — African Tea. A small shrub of Northwestern Africa, used
tj the natives as a stimulant and temporary substitute for food. Forskall
fsv< it the name of Catha edulis (Celastraceie). The leaves are chewed like
tlK»e c" hroxylon coca, and are invigorating and restorative; the
VMct : 's like that of tea, mate, or coffee. The plant has been
aalrzed without detecting caffeine. Fliickiger has isolated a liquid alkaloid,
btrimc. An alkaloid, which seems to be the active principle, has been ob-
ttmed by Prof. Ugoliuo Mosso, of Genoa.* To this substance the discoverer
itm given the name of Celastrine. It is present in the plant in such small
^■HBtities that its exact chemical composition has not yet been determined,
^rt It IS probably related to caffeine. During a primary stage and in small
: -^t-*. celastrine is stimulant to the nervous system of frogs; during a sec-
- stage, and in large doses it is depressant. It produces an excitant
: upon the heart of the same animal. In dogs and rabbits blood-pressure
ttd respiration were not notably influenced, but the activity of the sym-
■^thetic nerve was modified. In his experiments Professor Mosso found
■.Ktnne fatal in amounts in which cocaine is merely excitant. In intoxica-
1 from celastrine. t;cnsibility is preserved to the last, ami convulsions are
iing. The stimulant effect of celastrine is essentially manifested upon the
aain, vithout leaving a trace of depression or visible disturbance of function-
Ik fpmal cord, vagi ner^•es, and heart may share the stimulant effect, but
m leia powerfully affected.
In mediiin*'. Vaiha might bo useful as an arterial and nervous stimulant
14 ooca« and probably would afford a cheap substitute at the table for the
\re tea eo largely used, if once introduced in this country.
CAULOPHYLLTTM.— Caulophyllum, Blue Cohosh.
Aeae, 1 to 2.60 Gm. (or gr. xv-xl).
Preparation.
FloidoxtnKHum CaulophyHi. — Fluid Extrnot ct CnulophylUim. D«we, 1 to 2.50
0wiM0 J^mmal of Chrmhtty and Phamutcp, 1890,
1900. p. 178.
Uf^icai ttulUiin, Aug.. 1801.
21
*
1
p. 313 -, American Journal o/
322
PHAUMACEUTICAL THEKAPEITIC AlJES'TS OU DUUaS.
Pharmacology. — The drit'd rhizoint' and rontif of Cauluiiliyllum thalic-
troidoa (BeiiH'ridiicwe), or squa\r-r(>ot, a plant iudigunoiis to this country.
It contains u sfiiHinin-likp ghicoftid**. Leontine, and two n'sin^^ It jil.«o rnn-
taiiiH a sniall pn))Mii-tii»ii of n h-diK' alkaloid, kntrwii iis Caulophyllin.
Therapy. — Caiilophylkim is emmenagoguc, parttirifacicnt, and diuretic.
It has some reputation in the treatment of rheumfitisni. It probably ha?
some value a,ti an expectorant, (tvvin^ to tht' presence of Leontine, which i»
analogous to eenegin found in Polygala senega, and might be valuable in
bronchitis and catarrhal pneumonia.
CEDRON. — Cedron-seed. The Siniaha cedron and 8. ferrii^inea (8inia-
nihaccte), small trees of South America, contain two bitter principles:
Cedrine and Cedronine. The si^ds are also known as '*rattlf^snake-beans.''
Therapy. — Cedron-seed has a reputation in South America for curing
malarial affections, and is largely used in derangements of the digestive or-
gans, diarrhoea, cholera morbus, etc. It is also claimed to have decided
influence over the course of hydrophobia, and is said to be of value in treat-
ing poisoned wounds, bites of venomous snakes, insects, etc. The remedy is
used both topically and internally, the usual dose being 0.0G5 to 0.13 Gm.
(orgr. i-ij); but Dr. Purple gave it in doses of 1.30 to 2 Gra. (or gr. xx-xix)
every four hoiirs^ in intermittent fever, with satisfactory results.
CERA.— Wax.
Preparations.
Cera Alba (U.S.I*.. B. P.).— White M'ax {vellow wax, blcaclied).
Cera Flava (U.S. P., B. P.).— Yellow Wax.'
Ccratum (U. S. P.).— Cenite (whitu wax, 30; petrolutiim, 20; lard, 50>.
AI»K> phUth into ct'rat**i* *'f nuiiphor, mnthjiritJc^, (*p«niiiu'*'ti, leHin, um] omi-
poimd resin.
Pharmacolo^ and Therapy,- -Y<Hovv wax i^: w snlid substmietv prepared
frf>m the honcycomti <»t the hci\ Afjis inellifica ( Hynioiioptcra). It is insolu-
ble iu water and t-old alf-nhn], but solubU^ in boilinjj lilroluil, t^her. L-hbim-
forni, »ind oils?. It rtf a (roft i*olid, liquefying a little above the body-tempt^ra-
ture, and is uuirritatin;r, except niechanioally, to the skin and ninedus niciii-
branen. VVhi(e wax i;= yellr>w wax, bleached. It is larjjcly u.sod Ui jrivc ron-
sistency to ointmcTit*^ and !5n])p'isit'»T'ips.
Epidermin.— 'I'his name has been given to a new ointment base, pre-
pared by S. Kohn by melting 1.')..') Gni. {or ^ss) of white wax and triturating it
in a warm mortar with an equal quantity of powdered .sum arnb.ie until an
homogeneous paste is produced. To this mass is then added a boiling mixt-
ure of 15 c.cm. {or f.^ss) each of water and glycerin, and the whole is stirred
together until cold. The result is a semifluid, creamy substance which, when
applied to the surface in a thin layer, forms an adherent and flexible coating.
Drugs which are to be incorporated with epidennin should be previously
rubbed up with glycerin.
Cearin is n white, rntlier .-ioft ointmcut-base. e*)nsisting of 1 pnrt of
(^arnaulia wax and -1 parts nf lii|iiid ]>iirratbn. According tn Isslcili. it is
cheniicallv unchangeable, nintnu'nls (if jxitassiuni ioditle (without .<ndiuui
hyposulphite) and nf red mercuric oxide rcmaini]!g unaltered for I'ight
[uouUis. Il will take up about 15 per cent, of water.
CERII OXALAS fT'. S. 1\. B. I'.s. --Cerium Oxalate (CV,.rC',.0,l,
9H.0).
* Doie, 0.065 to 0.65 Gin. (or gr. i-x).
CKTACKIM.
323
f. — < Vtiuiii oxalate consists (.-luetly of a mixture of ci^rium,
^Ij^iiMeodymiuni, and lanthanum oxalates, and other rave earths of
il' (U. S. p.). It is a >vhite, granular powder, odorless and taste-
Ife- ule in water or alcohol.
IlKimpy. — Sir J. Y. Simpson brought forward this remedy as one of
gRAt Tminc in treating the vomiting of pregnancy, in which it is sometimea
wrrfffftil, but often fails. It is useful in controlling excessive cough in
I or chronic bronchitis, and in nervous disorders, chorea, epilepsy, and
ftoirhcea. This salt occasionally proves useful in vomiting depending
I uterine disease, or even in cancer of the stomach. Cerium oxalate has
fcaca raecesefully employed to relieve obstinate vomiting occurring during
tfK coime of typhoid fever and phthisis. Dr. Busey prescribed it for the
yupoae of relieving nausea and headache produced by opium. It is a seda-
tive to the gaBtric mucous membrane, and may allay the pain of gastralgia.
k s» beneficial in dyspepsia occasioned by depressed or deranged innervation
•f the stomach. The following prescriptions, containing cerium oxalate,
ksre been employed with benefit: —
1^ OBfii oxaUtis 0 Om. or Siu.
Bliaiuth. fiubnit 10 Om. or Siiss.
Spiritiu chloroformi - 7 6 com. or f3ij.
Liquor caJcis,
fiyrup- acacie na aO| com. or f5ij.
IL Sig-: Two tea«poonfu1s in water when necessary for nausea and diarrhoea.
B CmrU oxalatis 2:00 Gin. or gr. xl.
Kxt. hyoacjami |20 Gin. or gr. iij.
Kxt. conii • 38 Gin. or pr. vj.
fvi. ppotiauit [13 Gm. or gr. ij.
M. rt It. pil. no. xij.
^i^. : A pill «verY four hours for nausea and vomiting, especially of pregnancy.
Ceritnn oxalate is also occasionally efficacious in chronic diarrhoea. It
» kzwnrn to Ite coiitaininateil with other uirtals, !*uti» m^ arr^enic, lanthanum,
iic, to which some of its therapeutic efTecte have been attributed
If the remedy be pure, it may be given in doses of 0.65 Gm. (or gr. x)
cienr four hours. Failure from its use has been ascribed to the smallness of
^dcwr which is generally prescribed. Cerium nitrate was also employed by
Bpson, who regarded it as useful in irritable dyspepsia with gastrodynia
I pjTonSt Afi ^^H as in chronic vomiting. The dose is the same as that of
CETACEUM (U. S. P., B. P.) — Speraaceti.
Preparations,
^Te^jmlum Aquis Roa^ (U. S. P„ B. P.). — Rose-water Ointment.
:l GeUcei (B. P.). — Spermaceti Ointment (Bpermaceti. 20 per cent;
benzoin, and almond oiU
I ,r.ii:i[T ■ .'tnri'i. — N|»friitm«'li (.Vr^te (10 |n«r rniit).
Fhamuoology. — Spermaceti is a peculiar, concrete, fatty substance ob-
ItaiiK-U fn»iu tin- head of Phy»eter macrocophnhis (class, ^Taininalia; order,
IW*c*a*). or &|>enn-whalc. It has very little taste or odor, and can be re-
wd to A fK»v«](*r by tlir addition of a little aU-ohoI. rnlikr ordinary fat^^i
4o«9B fi'^ 3'ield glycerin uheu saf>onitifHK but Ethal. it i^« atnioi^t pure
324
riLillMACEUTICAL THEBAPErTlO AOEKTS OH DBUG8.
Cetin, or paltnitate of cetyl. It is not actfd upon by a boiling dilute solution,
of sodti, and loaves no grease-spot on paper. Melting point, 50° C. (or
122^ F).
Therapy. — Used almost exclusively as an ingredient in ointments, al-
though an L'Uiulsjion ^vith wax and yelk of egg is recommended as a demul-
cent in irritation of tlie bowels. The imguentum aqua? rosie, or "'cold
cream," is an elegant appplication. for excoriated surfaces and chapped bonds
and lips.
CETRARIA.-
-Iceland Moss.
Preparation.
DecuotuiH Cetrarise. — Decoction of IcetitDd Moa« (5 per cent.). Doiie, 30 to 130
ccm. {or fji-jv).
Pharmacology. — The sea-weed* Cetraria islandica (Lichenea), is found
in northern latitudes. It contains Liohenin, or lichen-starch (70 per cent.),
which forms a mucilage when hot water is added. Liohenin is a yellowish-
white powder which swells up in cold water and dissolves after eight hours'
digestion in hot water. There is also cetrann or cetraric acid, a bitter prin-
ciple (about 2 per cent.), which can be removed by washing with a weak
alkali. Cetrarin occurs in the form of snow-white acicuhr crystals. It com-
bines with alkalies to form salts. Cetraria also contains small i^uantities of
lichstearic acid. The dried plant was formerly official (U. S. P., 18^0).
Therapy.— It has some value as a food, and its demulcent qualities have
led to its use in pulmonary affections and bowel disorders in the form of
decoction. In such disorders Iceland-moss jelly is an agreeable demulcent.
It is made by adding to a quart' of boiling water a handful of well-washed
moss, the juice of two lemons, one glass of wine, and a quarter of a teaspoon
of cinnamon. The moss is first soaked for an hour in a little cold water, then,
placed in the boiling water and allowed to simmer until dissolved. It is
then sweetened, flavored, and strained into molds.
Kobert has ascertained that cetrarin increases intestinal peristalsis, aug-
ments the number of red and white blood-corpuscles, especially when they
have been reduced by disease, and is a mild stimulant to the central nervous
system. It may, therefore, prove of service in chlorosis attended by loss of
appetite and constipation. The dose is given as 0.10 to 0.13 Gm. (or gr. ise-ij).
Cetrarin, when injected into a vein, causes an increased secretion of saliva,
bile, and pancreatic juice. In accordance with this action it has been bene-
ficially employed in dyspepsia.
In loiMfind, (■(Mniriii is *steomod prophylactic against a prevalent form of
elephantiasis. Dr. Eckfcldt states that cetraria possesses antihsemorrhagic
power and has been recommended in haemoptysis. The powder, blown into
the nostrils, will arrest epistaxis. A tincture of cetraria is a ^ood application
to spongy gums. The therapeutical properties of the lichens have been
studied by Dr. Eckfeldt. Rocclla tinctoria is astringent, diuretic, and a
demulcent expeck>rant. Species of the cjenera Usnea and Alectoria are use-
ful, locally and eystemically, in hiicmorrhoids. Amone the Parmeliaa, sev-
eral exert an antiperiodic influence. Reindeer-moss is a demulcent tonic,
diuretic, astringent, and alterative.
CHAULMOOGRA-OIL.— Chaulmoogra-oil. The expressed oil from the
seeds of lIvflinHnrpurt Kinv.ii. and perhaps also of Qynocardia odorata
(FUcourtiacvK-). The seeds conhiin g^nocardic acid, also hydrocyanic acid.
Tbr oil if soluble in ether, chloroform, and alcohol.
ardic acid is a yellowish, oily substance, of an acrid, burning taste
tmi ; *>dor. In leprosy, chauhnoogra-oil has been used with remark-
4blf leoutl rveolte, both locally Jind internally. When unable to cure the did-
mac, it has in inost cases delayed the progress and mitigated the symptoms.
It has been positivly demonstrated that, under the combined internal and
■cxteroal admmistratioQ of chaulmoogra-oil, the bacilli present in the blood
^pMtv diminished in number or actually disappeared. The remedy is given
Hta grmdaallT-increasing doses, but is apt to excite intolerance. Recently
BcEpCfimrnt^ have been made with chaulmoogra-oil in leprosy by subcuta-
r »MWM i' !is. Tourtoulia Bey, of Cairo,* relates the case of a Copt, in
«bom t ■ , rous macules appeared some three months after an attack of
Cetei (evidently leprous fever) at the age of 15. There was no leprosy
m the family hislor}% but there were lepers in his native village. He first
j one under observation at the age of 35, when he presented a characteris-
[ tinlly leprous appearance. The patient wae given subcutaneous injections
«f Aanlmoogra-oiL Tubes containing 5 c.cm. (or fSj ^/^ of the sterilized
ifl -f - -^^pared in Paris. The improvement was marked after 50 injections.
Ft- jections of 5 c.cm. (or f5i Vi) each followed, in all during 1895,
»: ons; 106 in 1896, 87 in 1897, 50 in 1898, when the patient refused
teL_ , _ V more, as he considered himself cured. Tourtoulis persuaded the
ptient to submit to 33 more injections in 1899 (first five months), so that
ahoirether In six years he was injected 584 times, amounting to a total of
9T26 r,cm. (or 680 fiuidraehms) of the oil. The injections were made on
&r ' ^ of the upper and lower limbs, with a long needle introduced
IRi . . They gave rise to but slight pain. With the usual antiseptic
}Vtcauluiri>^ Tourtoulis never saw abscesses follow. The author does not
viiii to conclude from this single case that chaulmoogra subcutaneously will
«vr leproev, as there is always the possibility of spontaneous retrogression of
taromata to be borne in mind. In the discussion on Tourtoulis's remarks
fSoc de Derm, et de Syph., Paris, July 13, 1899) Hallopeau pointed out
_ tkal Jeanaelme and he had injected chaulmoogra-oil, 10 c.cm. (or f3ii Vi) *
VBCk, mto the buttocks, but in one case there was a severe outbreak of
arfnlfli, Qnd this led them to give up this mode of treatment. Du Castel
kid tried the subcutaneous method at Saint-Ix)uis. Tjocally, it may be
1 livable, ci>mbined with other ointments, in treating other skin dis-
wmm. Chronic eczema, psoriasis, and lupus are benefited by the application
if «n ointment containing chaulmoogra-oil. Chaulmoogra-oil has been ap-
■iicd with success in cases of scabies and pediculosis. The ointment has
wkmwiae been used upon the enlarged glands of scrofula and in chronic
tic arthritis. From 1.20 to 2 c.cm. (or njxx-xxx) of the tu'l to the
of excipient is the average strength of the ointment.
M Zb»cl cMrboQAt,
pul 1- mAfnaUe KA 4 Gm. or 3j.
ilmoogne f rW aoidi gynooArdiei) 2 c.cm. or fSw.
I *^r»rg. animoniat 8 Om. or 3ij.
Afitin* ianiv hydroAi. ]&6 Gtn. or Sm.
IL «« ft- us^
For chronic cczetna, psoriaaU, ftcrofuloderuiu. lupus, and lepra.
itm de Derm, el de fSjfph,, July. 1890.
32<;
PHARMACErTICAL THERAPEUTTC AGENTS Olt DRUOS.
Gynocardic acid has been used both eitemally and internally in lep-
rosy, syphilis, and rheumatic affections. Its dose for internal use is from
0.03 to 0.20 Gm. (or gr. ss-iij), and externally as a local appHcation with oil
(10 per cent.).
CHEKAN.— Cheken. The leaves of Myrtus chekan, or Eugenia chekan
(Myrtaceae), a shrub or small tree of South America. It contains tannin
and an ethereal oil; also chekenon, chekenic acid, cheken bitter, chekenetin.
Of these the ethereal oil alone offers medicinal interest (Weiss). This is
antiseptic, diuretic, and expectorant.
Therapy. — Cheken was introduced froili Chili through the enterprise
of Messrs. Parke, Davis & Co., as a remedy in chronic catarrhal inflammation
of the respiratory passages. Dr. Murrell, of London, extols it in the winter-
cough of elderly people, and in other forms of chronic bronchitis. In Chili
it also enjoys a reputation in the treatment of rheumatism. The dose of the
fluid extract is 4 to 11 c.cm. (or foi-iij).
CHELIDONIUM.— Chelidonium, Celandine.
Dose. O.Co to 2.(50 Gm. (or ^r. x-xl).
Pharmacology. — Ct'laiuline is the dried plant of Cliclidoniuni niajus
(Papaveracea*), luiind both in Europe and Xortli America. It contuins two
alkaloids, Ghelidonine and Sanguinarine, in combination with Chelidonio
Acid. A bitter, yellow, crystalline principle, Chelidoxanthine (Probst), is
also present, besides tannic acid, starch, celluloee, etc.
Physiological Action. — It has a bitter, acid taste, and stimulates the
secretions of the glands along the intestinal tract, including the liver. In
considerable doses it causes vomiting and purging, diaphoresis, and increases
the urinary secretion and also the secretions of the bronchial mucous mem-
brane.
Therapy, — The fresh, milky juice may be used as a local irritant, and
has been applied upon warts and corns. Internally, in doses of 0.(J5 Gm. (or
gr. x) of the extract, it acts as a drastic purgative, and ha? been used in jaun-
dice due to catarrhal swellitit^ nf the bile-dnct.«5. Dr. Jo-seph Hodniond claims
to have had good results from chclidonium in epithelioma of the tongue and
of the lip, and also in cases diagnosticated as cancer of the oesophagus and
of the liver. It may nho be given as a lluid ^^\trnct, and a rocfut infn^^ion
(.Mil 'Huuv to tlie pint). Dose, 15 to 30 t-.riji. (or Sss-J),
CHENOFODITTM.— Chenopodium, American Wormsecd.
_ Dose, 0.05 to 2.f>0 Gni. (or gr. j-xl).
^ Preparation.
Oleum Chenopodii (U.S. P.). — Oil of Chenopodium. Dose, 0.30 to 1.20 c.cm. (or
rnv-xx).
Fhanuacology. — Amorican woniisrcd i.s the drifd rip*' fruit of Clu^no-
podium aiiibrnsioidep, variety Anttieluiintit-uin (Clienopodiaoea*), n j>lant
of North America and Europi'. It hna a peculiar aroniatio odor and a warm,
bitter tnrito. Ite properties ore due to iW ])n*siMire of a j)t*cu[iar volatile oil,
u thin, yellnwish, ofFensively aromatic liiiuid. which, when diptilled, is
the otficial oil.
rlllNOLINA.
327
?V^«^"i"^cal Action and Therapy. — The volatile oil acts as a stimulant
»n arul ihtvous systi'in, imilting it iieTviceahlo in chorua and
X The oil of chenopodiiun has been employed in hysteria. In
>I>«i*linni IS ci^ttvined ns nn aid to digi'i^tiou iind a^ an eiumena-
fBpu. Lt. Mtihllo regards it as an excellent carminative in the treatment
«lnifaciile colic. Its common use is for the expulsion of lumbricoid worma,
' iad it i* li«?l pivi'U in (K>8t*s uf o.iJO c.cni. (or /»x), in capsuk'f* or emulsion,
tiiree times a day, castor-oil being administered the following day; or the
nmetjy may be administered nijjhf and morning for several days, and fol-
K3 br a brisk catliartic.
Chenopodium album, white goose-foot, lamb's quarter, or hog-weed, a
L common in cultivated ground, and flowering in July and August, is
to po^tse^s hfleiiiostatir projierties. A tinctnro madu from the leaves and
rra by absolute alcohol is given in the dose of 1 or 2 drops frequently
tied in acute haemorrhage, and in the same dose, two or three times a
ij, for the purpose of preventing recurrence of bleeding.
rHUWAP-HTTA (U. S. P.). — Chimaphila, Pipsissewa. (Prince's Pine.)
Preparaiion.
noiitcxtnictuiii (niiiniiphilif (T. S. IV) — Huiil Kxtrnrt of ( liiiiwpbilji. Dose,
\IS^ tM A cjem* (or mxx-fSij).
Vhaniacology. — The dried leaves of Chimaphila umbellata (Ericaoeae)
in tJininu and a colorless, hitter, crv.stailine, neiitnil princi|)le, Arbntin,
mi A colorless and tasteless substance, in yellow crystals, Chimaphilin. The
Cnsh liMvi'Tt ixrr «|sf» r:li;L''ht!v irritating.
fbysiolo^cal Action and Therapy.^Pipsissewa is diuretic and altera-
The urine is darkened by the use of this remedy. It has very little
ct a|>on the heart or circulation. Upon the digestive organs it is tonic
I actnngent. As it is not an irritating diuretic, it can be used in Brighfa
Aimfe and nephritis; also in hsematuria. In litlia'mia, gout^ rheumatism^
a-' ' '1 disorders this is a valuable remedy. As it favors elimination,
ft /- - . : iiieitl ;roo<l ii'sults in si'rofuia, skin dii^easeK, gleet, leiicorrhtwi, and
mirnnittt*nt fever. A decoction (62 Gm. to 473 e.cra,, or Jii-Oj) may be
■■od, but a good fluid extract is better.
OKZVA-ROOT. — The rhizome of Smilax glabra and Smilax China
(Smilaccir) of China and Japan has the same constituents and properties aa
- - !^n, Imt IS more active. It is* best given in the rnrni of fluid extract
I M i-rt>fit. in doK's of v* to 4 c.eni. (or loss-j), several times a day.
CHXHOISINUM. — Chinoidin, Qninoidin, is a mixture of alkaloids,
tly aroorphous, obtained as a by-product in the manufacture of the
lallixable alkaloids of cinchona. (See Cinchona.)
Chinoidin possesses tonic and antiperiodic properties. It is a dark-
adored substance, and is active in about double the dose of quinine, but Ib
apt to diBorder the stomach.
CHDJOLINA.— Chinolinc, or Quinolinc, a cfdorletw, oily li(iuid, darken-
on expo?un» to light, in a eonwtituent nf c<ml-tar. It is prepared com-
"■ 'iv trvnting aniline or nitrobeuzol with glycerin in the presence
ratin/r agent. It may also be obtained by the distillation of qui-
•
328
rUAUMACCLTK'AL TIIIilUPKlTIC AGKN'TS OR DUrOS.
nine, cinchonine, and strydmine with potassium. The odor recalls that of
nitrobenzol. It is slightly soluble in water, and the solution possesses a
pungent taste. Chinoline is readily solnldo in alciihol. ether, and eliloro—
iomi. It is a hygroscopic substance.
In its chemical characters it is so closely related to quinine as to lead
to its substitution in medicine. Dr. Julius Donath claims that its physio-
logical and therapeutic effects are also identical with the natural alkaloid.
The tartrate is the salt chiefly used, which is in shining, silky crystals, with
penetrating odor and pungent taste, pernjanent in air, and soluble in water.
It is slightly soluble in alcohol; insoluble in ether and chloroform. The
free base is highly irritant to the gastric mucous membrane. A salicylate
has also been prepared.
PhyBiological Action ajid Therapy. — Chinoline is a valuable antiseptit-,
but its offensive odor has prevented its application in this direction in med-
icine; however, it is believed that much of this objection can be removed by
better modes of preparation. If it could be obtained without odor or taste,
it would be a valuable agent for the preservation of food. The tartrate and
salicylate are also powerful antizymotics. Internally, these salts are anti-
pyretic and antiperiodic, in doses rather larger than those given of quinine
(2 Gm., or 3ss, daily, for adults).
It may be given to children in peppermint-water, or syrup and distilled
water, or to adults in caps-ules or wafers. Neuralgia dependent upon a
malaria] tnint is f»ft"'n relieved hy c-hinoline tartrate. In zymotic diseases,
other thftn malnrial, chinoline has not. proved satisfactory as an antipyretic,
because it has been found to be too depressing in its effects upon the heart.
As a topical application in diphtheria, it may be diluted with alcohol (2 per
cent.) and used with a spray, or painted on with a brush, to the affected part.
A solution of the tartrate (V2 to 1 per cent.) has been used as an injection
for gonorrhoea.
Analgen, or Labordin, is a ik^riv;Uivi' (>f diinoHne. It is a white, crya-
talline ptnvder, iusolulile in water, soluble in hot alcohol ami in acids. It is
ortl^o-cthoxy-ana-mono-henzoyl-aniitlo-fjiiiiioliui.'. It hns bwn used with suc-
cess in neuralgia and has alleviated rhcunmlic pains. In some ca.'^es it
causes the urijie to assume a dark-red color. This tint is due to a change
which analgcn undergoes in the organism. The molecule may be entirely
destroyed or the benzoyl group which enters into its TOuiposilion may be
separated with cfMuph'te oxidiition of tin* ri'^idiie. In the lnlii*r mcnt the
urine is reddeued by the action of tbc free nniido {iroduccd in the uric acid.
Dose is from 0..5() to 1 Gm. (or gr. viii-xv).
CHINOSOL. — GhinoBol is described by the manufacturers as a neutral
compound of oxychinoline. It is a bright-yellow, crystalline powder, readily
Boluble in water, not caustic or corrosive, and is said to be non-toxic.
It does not coagulate albumin. It is very readily precipitated by alkalies. It
has a slightly-aromatic odor and an astringent taste like carbolic acid.
It stains the hands yellow; but the color is readily removed by fresh
water. It is reported to be forty times more active in checking fermentation
than carbolic acid. Chemicallv, it is osy'-quinoline-potassium sulphate.
(CoH„N,OS(KK + II,0),
Physiolo^cal Action and Therapy.— Chinosol is antiseptic, disinfectant,
deodorant, and bactericide. Professors Emmerich and Kossmann, of
rULOft-VLFORMAMlDL M.
329
„^ -v I TYe used it in surgical work, and prefer it to corrosive sublimate
acid. Bonnenia^ says that ehinosol combines large antiseptic
fomt:T^ liith a relatively small power of doin^ harm. In frogs ehinosol
^horned iiseli to be a central poison; but he administered to a rabbit 1 Gm.
- xt) bv the mouth and one and one-quarter hours later another dose of
(or gr. xxx) without any had effect. It has a deterrent action upon
roagulAtion of albumin, and hinders the conversion of albuminoids iato
;oDcs. Internally, it has been used with some success in pulmonary tuber-
caiosifi. Dr, Alexander MacGregor, of London, reports clinically on six cases,
■nd alatee that, from the observations which he has been able to make, he is
cnoTineed that it is a valuable drug in the treatment of this affection.^
CTTTRATA (F. S. P., B. P.).— Chirata (Chirctta).
Dote. 1 to 2 Gm. (or gr. xv-xxx).
iv
Preparations,
. JS. !».).— Fluid Extmtt of Chirata
I
Uose, i).m
Dose, 4 to 7.5
Doa«,
Fluirilextrartiim Cliinitrp
to S ^.^ai. (or mx-xxx).
Tn>ctnra C'hiraljr ( H. I'.i. — Tim-tmc of <')iir«tn (10 per wnt.).
C^l« (or f3i'ij).
I^uor ChirftUe Concentratus (B. P.). — Concentrated iioluUon of Chiretta
Ito 4 cjcm. (or fSsA-j).
Infavinn Cfairate (B. P.). —Infusion of Chiretta (5 per cent.). Dose, 15 to 30
c^B. (or f3sa-j).
PhArmacolo^. — The entire plant, Swertia Chirata (Gentianeae), of
I&dia, i« used as a bitter aromatic tonic in the East, but rarely prescribed in
dui cotiniry or England. It contains two amorphous principles, Ophelio
Mtii and Chiratin (Hohn), but no tannin.
Therapy. — Chirata resembles gentian very closely, to which it is allied
fcpUnically, but it is more bitter. It has similar therapeutic applications in
sConic dyspepsia, etc. Chirata may often be very serviceably combined with
limctth sobnitrate, or with hydrochloric acid, for the relief of the sick
tfosnach of drunkards. It is useful in functional inactivity of the liver. By
ili actsoD on the liver it indirectly overcomes constipation. As it contains
ae tannic acid, chirata can be prescribed in combination with iron, if desired.
CHLORALFORMAMIDUM (U. S. P.) , or Chloral! ormamide, or Chloral-
formulfl CC],OH<OH)NH(HCO), is formed by the direct union
rmamid**, nnt! anhydrous cliloral. It is made up of white, granular
which melt at 230" F., and are soluble in water and alcohol. Hot
t not be used in making solutions, as the sub.stnmM' is destroyed
U^i^ ^- 't i* dccomj>osed by caustic alkalies and alkaline carbonates.
" fM n.* ' ifj 114** F. : at higher temperatures chloral is liberated,
ilfonnamide is 1 to 2.6 Om. (or gr. xv-.\l). It may be
r cncb<*t,s, but a nuich better method of administration is
. [lortion of wine, whisky, or brandy. Its best effects are
kiuf^ Drhi*n rxbiltifcd jin hour or an hour and a half before bed-time.
'f»^"*'ological Action. — Chloralformamide is free from local irritant
pn It has but n slight taste and exerts little or no deleterious influ-
The d^
in c;i
iTt*
* TherapeutUehe Momt$heftf, Dec, IRQO.
" f ■■rflin i^amcct, vol. i
I Sim.
t>o.
XU)
IMIAIiMACKrxlt'AL TIlKIUPIiCTIO AGENTS Oil DHUiJS.
rnce upon digofition. It has iK'eu ^^iveu far iiionllis continuously witljout
causing any decrffa«u of Uk* Ix^dily weight. The compound has no action
upon tilt' bowels or ki<lneyH. According to the testimony of most observers,
it e.xcrts little *>r nn (h-prcKsant iniluciue upon tlic eirculatiun. Ijanggaard
and Mairet tmd Bo!?c. bowevcr. ntatc that it reduce?* bbwid-prei^surc, and en-
join caution in its iis'- wbcn orirnnic honrt disease exists, rhonilfonnaiuide
ig tlwjiight to ha\c a stiiimlaliii;,^ clTcet upnn the reiipiralory centre. The
chief physiological action of tliis agent is that of an hypnotic. Sleep is
oftfn producwl within half an hour after its adniinisfitration. Soinetiine»
drowsiness wntliiues upon the following day. Large doses have <.M'casionaUy
produced hradnche. vertigo, sickiiesst of the t^tomacli, thii*st, incoherence, and
cardiac depression.
Dr. Pye-Sraith has reported a case in which 6.20 Gm. (or gr. Ixxx) of
chloralfornianiidc given i!i tWit r<|ual ])ortioni- at eight hours' interval, gave
risu,' to severe universal diTuuititis folbnved by profuse desijuanuition. There
was fever wbieh lasted a week, and the urine was slightly albuniinons.
Therapy. — C'liloralfonnarnide is ])rincipally employed in the treatment
of insomnia, especially when flue to nervousness, neurasthenia, hysteria, or
chronic alcoholism. It has been beneficially used as an adjuvant in epilepsy,
and is of value in relieving the paroxysms of cardiac asthma. So far as has
yet been observed, the cxislenee of organic disease of the heart is no positive
contra-indication to its ciu]ibiyrnent. The efTects of cidoratfonnaniidt*. like
those of every active drug, n'lpiirc to l>c ranfully watched. Dr. W. Hale
White has given it with advantage in Si'veral cases of cardiac valvular dis-
mse. As a rule, chloralfonnaniide will not overcome sleeplessness caused by
pain, though in a nund)er of instances it has succeeded in cnrcinoiua, rlicu-
matis!Ti, niMinilgin, alcobnlic neuritis, her[)es zoster, and dyaiiienorrha'a.
rblornlformaniide is cHicacious in broncliial asthma, cmpliysenui, pleu-
risy, and [)ulninn(uy tuberculosis by causing sleep, and. eonsequently, ]M*eserv-
ing strength. It has. nuiieovor. been successful in overcoming wakefulness
attendant upon cirrhosis of the liver, ulcer of the slomach, nephritis, and
pelvic disorders. It has likewise, in the same manner, been of service in
typhoid fever, erysipelas, and diabetes. This remedy has also a sphere of
usefulness in nervous and mental disorders. It is most useful in melancholia
and ehronic mania. In inulr mania, and progressive paralysis, it often fails.
It is of service in idiocy with hallucinations, acute and chronic paranoia,
periodic |)syehoses, and multiple neuritis. Chloralformamide is of service in
senile dementia, but is useless in cases where excitement is a prominent
feature.
In the cerebral disturbances of children it answers a very irond luirpose,
and it has been given with good effect in acute simple meningitis. Dr. Alt,
of ITidle. has obtained satisfactory' results from using ehloralformamiile in
chorea, and Dr. Hexamer, of Stamford, Conn.> employed it successfully in
alcoholic tremor. As an hypnotic and sedative it is beneficial in whooping-
cough, influenza, laryngismus stridulus, and persistent tinnitus aurium. X
sfdution <N>ntaining 2 (irn. (or gr. x.\.\) each of chloraltunniuuide jind pnta.*-
ti)\\m bromide to the oimce is known un<ler the name of chlorobrom ami is
highly rcc(fmmonded by Prc»fessor f'iiarteris nnd others as serviceable in
cases of seasickness. Tt ha^ alsn bei-n Fnund of value in obstinate vomiting
from other cana*^.
CULOnALVM UYDRATUM.
•AM
CHLORALUM HYBRATTJM.— Hydrated Chloral
CHLORAL HYDRAS (B. P.).— Chloral Hydrate (CJlCl.O H-H^O).
Doic, 0.13 to 1.30 Gm. (or gr. ii-xx).
Preparation.
Symptts Chloral (B. P.).— Syrup of Chloral (0.65 Gm. in 4 c.cm , or gr. x in f3j).
>« 2 t<i 7^ ccin. lor fjaa-ij).
Pharmacolog^y. — Chloral hydrate is a crystalline solid, coniposeil of
lilehvile, or cliloral, with oue molecule of water. It is in colorlt?(*tf,
t er)-etak ; of bitteriph, caustic taste ; of ethereal, but slightly-acrid
liable in water and in alcohol. Pure hydrate of chloral should he of
■ iH^lml rvactioa. The crystals volatilize slowly at ordinary temperatures,
«B<^ \ be kept in a tightly-stoppered bottle; Uiey melt at 135° F. and
W "^^ F-, and are at the same time decomposed into anhydroua c.hlorHl
and water. Chloral for uiCH^Iical purposes should be recrystaUized, and
^*'»ls should be dry, and not roadily attract moisture from the air.
T rated eulphuric acid be added to chloral it is converted into a
;t.-, ^.ti(J Mjb.stanre having the same composition as chloral, but not
le in water, flhloral also combines w'ith alcohol to form crystals of alco-
l«» il, which are Kssi goluhle tluin liydrate of chloral. When tritu-
aiMi ^- ii[)hor, mentliol, thymol, or crystals of carbolic acid, hydrate of
dkloral ftimis a permanent, oily liquid, lu contact with iron, even in small
^OAatity., crystalii of chloral-hydrate acquire a ]K'culiar yellow discoloration
m ootiac'iucuce of the liberation of free hydrochloric acid.
Fhysiolog:ical Action and Foi8onin§^. — Chloral hydrate is antiseptic and
^dative, although slight irritation may occur at first. It is an hypnotic,
aanng sleep by producing an anaemic condition of the brain, the patient
vakiiig after several hours as from natural sleep. Unpleasant after-effects
cionally observed. The reflex activity of the spinal centres is weak-
mxkd this, extending to the medulla, causes paralysis of the respiratory
centre. No effect is seen upon the sensory nerves, but the motor nerves are
^lidoAlly affected, muscular weakness being one of the prominent phe-
w^g*^ip<fc flttcnding chronic chloral .poisoning. Chloral acts powerfully upon
tiM- iMArt, lowering and weakening its rate of movement through a local
ililn«noe upon the ganglion and muscle. With this there is lowering of
tftcriml prcfisure, aided by dilatation of the superficial vessels. When death
m catuM by chloral, the heart is arrested in diastole. The decided fall in
the bodily temperature is probably secondary to the cooling of the blood
iy dilatation of the cutaneous blood-vessels. Dyspnoea may be produced by
ai^OffyeioeDt of the lungs, due to the weakened cardiac action and to the
lacaJ rnlargement of the pulmonary vessels. Death is produced by respire-
lorr failure usually, although it occurs sometimes with such suddenness as
l^iead to the supposition that it is due to syncope from direct action upon
Aebcart.
In a few cases, death appears to be due to some deleterious action upon
tlM blood, resembling scurvy, as purpuric and scorbutic eruptions occur, with
•voOco* oJcerated gums, great prostration, and collapse. We treat the first
daa of cnseB of gradual respiratory failure, by artificial respiration and the
idminifitrstion of Mimulants externally, by friction, local warmth, and sina-
aiid internally by hot coffee, and artificial respiration, galvanism, etc.,
332
PUAUMACErXICAL THERAPEUTIC AGENTS OB DRUGS.
and also physiological antidotes, such as atropine and Btrychnine. Dr. Colens^
recently reported to the London Clinical Society, a case of recovery from
chloral poisoning in consequence of the use of atropine and strychnine hypo-
dermicall}'. In the second class of cases, unfortunately, death occurs too
quickly for the action of remedies; but hypodermic injections of ether, atro-
pine, or strychnine, "with evacuation of the stomach by the pump and the
introduction of hot alcoholic stimulants, might he serviceable in saving life.
In the third class of cases transfusion of blood might be required, or the
administration of large doses of the tincture of ferric chloride. There is a
remarkable variation as rei^arda the quantity capable of producin^r a fatal ef-
fect. Cases are on rect>rd in which from 15.5 Gm. (or Jss) to 31 Gm. (or 5i)
produced alarming symptoms, though recovery took place. On the contrary,
death has been cau.sed by a single dose of 2 Gm. (or gr. xxx). Chronic chlo-
ralism — presenting symptoms of muscular weakness or paralysis, moral per-
vcrsion^ feeble heart, epileptiform convulsions, and delirium tremens— is re-
lieved by prompt removal of the drug and the administration of tonics, espe-
cially nux vomica or strychnine. Animals poisoned witb chloral liydrate
recover if they are kept warm. In some cases an erythematous rash follows
the administration of chloral, and dfstjuamation of skin from the fingers
around Ihe extremities has been noticed. Other cutaneous manifestationa
which have been noticed in consequence of the administration of chloral are
wheals, papules, vesicles, pustules, petechiae, and ulceration. Toxic doses
have been followed by symptoms of purpura hemorrhagica.
An eruption from chloral is especially apt to occur in children, in weak
and cachectic patients, and in those who suffer from disease of the nervous
system, as hysteria, chorea, myelitis, or general paralysis. The commonest
cause of such a rash, however, is the ingestion of alcohol at the same time
with chloral.
This substance is removed from the system principally by the kidneys;
it also escapes by the breath, to which it gives a peculiar odor. In large
amounts chloral is irritant to the kidneys, may excite nephritis, and cause
the passage of bloody urine.
It is probable that some of the serious effects following the administra-
tion of chloral are properly attributable to impurities in the drug. If the
crystals have a pungent, acrid odor, they should not be used; recrystallized
chloral hydrate should be ]>reforred for medical use. Where the heart is
seriously affected and its walls are thin and weak, chloral, aa a rule, should
not be given. It is also dangerous to use it freely in alcoholic subjects. Ac-
cording to the experiments of MM. Cadeac and Malet upon dogs, morphine
administered by the stomach and soon followed by a rectal injection of chlo-
ral produces complete anaesthesia, which continues for more than half an
hour.
Therapy. — The antiseptic action of chloral ia utilized in surgery, where
5-per-cent. solutions are used as stimulating dressings for suppurating wounds
and foul ulcers. This solution also may be applied to parasitic skin affec-
tions (tinea versicolor). It is also used to check itching in eczema and
prurigo. In urticacia Quinquaud uses a lotion containing 30 parts of boric
aeid, 5 parts of chloral hydrate, and 180 parts of distilled wat.pr. Dr. Marc
S^e is in the habit of using an ounce of a 10-per-cent. solution for injection
into the sac of an hydrocele after the fluid has been evacuated. In two or
three days a large effusion takes place, but is soon absorbed. The same solu-
CHLORALUK HTDBATUH.
333
tiott majr be BdvantageouBly injected into the neighborhood of varicose veins.
rbr WcK>d graduall)- coagulates and the veesela contract. Dr. J. Palvy, from
hiB experience in fifteen case^ believes that the injection per rectum of a
■rfstion contaiiiing from 1 to l.GO Gm. (or gr. xv-xsv) of chloral-hydrate is an
efficient remedy in haemoptysis. In combination with other remedies, it is
ID anodyne and counter-irritant in neuralgia and rheumatism: —
B rikloTmli hydrAti
lia. «apomt
• 8|
.120
Gm.
C.CTXl.
or 3ij.
or fjiv. — M.
For application to pleurodynia, lumbago, etc., the combination of chlo-
ral and camphor may be used: —
& Campbone,
Oiloral bydrati .
' rt adde: —
AdipU lane hydrosi
3C. For neuralgia.
311
Om. or 5j.
Gm. or 5j.
I taj a
f
■ Mr. Leanoz Browne praiees the virtue of a mixture of equal parts of
■ ckiora] hydrate and camphor as an application in neuralgia. The mixture
telDS a clear fluid, which is applied over the affected part. He has found it
«f creat aerrice in neuralgia of the larynx and in relieving spasmodic cough
aso toothache. Chloral is useful in trismus nascentium, the cramps to which
IffCgBant women are often subject, singultus, and spasmodic and nocturnal
ttlutssis. Dr. Lyon Playfair recommends chloral for the purpose of relieving
^t pain of parturition. It may be administered either by the mouth or
laetvm* and it is asserted that two or at most four doses of 1 Gm. {or gr. sv)
och at inten'als of twenty minutes minimize suffering without weakening
tha energy of the uterine contractions. This remedy has also been used in
aaea of rigidity of the os uteri. In spasmodic croup Holt advises: —
R CWorali hydrnti 5 Gm.
Potacsii bromidi 3 Gm.
AJDOionii bromidi 2 Gm.
Aqtue clnnamonit .... 60 c.cm.
M. Si^.: Of this the dose for a child about seven years of age ia one teaspoonful,
la kc related in twenty minutes if not relieved.
or gr Ixiv.
or gr. xlr.
or Sas.
or fSij.
In diphtheria a garsrle of 2-per-cent., followed by application of a 20-
C-cmt., solution is said to cause prompt disappearance of the false raera-
Two or three grains of chloral to the ounce of water (0.13 to 0.20 Gm.
I to30 cxm.) has been successfully used as an injection in gonorrhoea. Garret-
o employod the following combination, containing chloral, with good
'dfcrC* aa an injection in gonorrhcna: —
H Chlorall hydrati
Plumbi aretati*
Aqu* dvst.
aa [50 Gn». or gr. viij.
...2401 e.cm. or ftviij.— M.
The principal symptom for which chloral is prescribed is insomnia
metstal overwork, or occurring during the course of typhus or typhoid,
lelinum tremens, in phthisis, or in the aged. In acute mania^ especially
inaed by aJcohol, very large doses have been followed by the best effects
y;H PHARMACEUTICAL THElUPEl'TrC AOENTS UU DUUGS.
When injected (4 to 8 Gm., or 3i-ij) into a vein, general anaesthesia is pro-
duced; but this method has no special advantaore, and presents some decided
disadvantages. The restlessness and insomnia present in general paralysis
of the insane are allayed by the administration of this remedy, and it is also
beneficial in spasmodic afTections, chorea, whoopincr-cough, asthma, uterine
pains, and tetanus. A dose of chloral at bed-time is useful in paralysis
agitans, and may be able to ward off an attack of nocturnal epilepsy. Chloral
atfords relief in laryngismus stridulus. The hypodermic injection of 0.32
to 0.C5 Gm. (or gr. v-x) of chloral-hydrate, in combination with 0.008 to
0.015 Gm. (or gr. */»-'/*) tjf morphine sulphate, is highly recommended in
cholera morbus attended with collapse, and in the algid stage of Asiatic
cholera. If the patient cannot be made to swallow, an emulsion may be pre-
pared with egg containing 4 to 8 Gm. (or 5i-ij) of chloral, and given per
enema. This drug also acts as an antidote in cases of poisoning from physos-
tigma, picrotoxin, and strychnine. If, on account of spasm, the patient can-
not swallow, the antidote may be serviceably administered by the rectum.
In cases of undue arterial excitement, durinfi the early stage of pneu-
monia, in overaction of an hypertrophicd heart, or in the increased arterial
tension of Brighfs disease, chloral judiciously used may be of service. It is
given with much benefit to allay the discomfort of seasickness. In con-
gestive headache with insomnia a combination like the following is advan-
tageous : —
R Chlorali hydrnti 4] Gm. or 3j.
MoTphinap hydrobromat 1065 Gm. or gr. j.
Aqusf oiinpliorae 60; com. or fiij.
M. Sig.: A dessertspoonful every two hours until relieved.
It haft been found useful in scarlet fever by Wilson, who gives 0.005 to
0.13 Gm. (or gr. i-ij) in a little syrup of lactucarium and water every two or
three hours for a child Hve years of age. Sir Benjamin Ward Kichardson
esteems chloral as a valuable antipyretic in typhoid fever. In tetanus 0.65
to 1.30 Gm. (or gr. x-x.t) should ho given every hour or two, accordina; to the
gravity of the case, gradually lengthening the intervals and afterward reduc-
ing the dose. In convulsions after labor, an enema containing 4 Gm. (or 5j)
of chloral should be thrown into the rectiun, or 2 to 2.60 Gm. (or gr. xxx-xl)
given by the mouth. Dr. Deshages, of Orleans, advocates the hypodermic
injection of chloral in puerperal eclampsia and also in convulsions from other
causes. In the convulsions of children it is a very prompt and ellicient
remedy. For restlessness and insomnia chloral may be very advantageously
prescribed with potassium bromide, as: —
H Chlonili hydrati ]2| Gm. or 3Uj.
PotflMii bromidi ISp Gm. or 3v.
Syrupi !at:tucarii,
Syrupi nurantii aa 60| c.cm. or fjij.
M. Sig. : A desscrUpoonful at bed-time.
Giotfrt'di rt'conuiiends chloral hydrate to he u.«ed as an antidote in co-
caine poisoning, giving doses of 3 to 4 Gra. (or gr. xlv-5j).
For the relief of night-swoats of phthisis. 4 Gm. (or 5j) may be dissolved
in 90 c.cm. (or f^iij) of dilute bathing-whisky and the patient's skin bathed
with it. This is also a good application to prevent bed-sores.
The compounds of chloral with camphor, salicylic acid, and with car-
ClTLOIlALrM HYDRATrM.
335
Wk acid are useful as antiseptics, especiallv the latter, which is free from
■npiflftaiiit odor and ig anodyne as well as antiseptic.
Tlu* unpU-;i?Mint taste of chloral hydrate may he overcome hy mixing its
jBhstioc nith lemonade.
Butyl-cMoral-hydrate (B.P.),chlora]-'hutyHcnm, orcroton-chlnral (dose,
<.r* --. ^ u> Gm., or gr. ii-xx), is obtained by the action of chlorine upon
•c^ hjde and collected by distillation. It is the hydrate of trichlor-
btttyiaiaenjde, and is in the form of white, shining, crystalline scales, hav-
iag a pimg:ent smell and a disagreeable, acrid taste. Butyl-chloral-hydrate
■ foloble in alcohol, ether, p-lycerin, and hot water. The action is like that
«f chloral, but said to he less depressing to the circulation and heart. It la
aoFV snodjne, and is especially useful in neuralgia. In neuralgia of the face
OJW Gm. (or gr. v) is given every half-hour. Liebreich, who was the dis-
<wgnei of this drug, praises it as an hypnotic in doses of 1 to 2 Gm. (or gr.
rv-zxx). Croton-chloral gives relief in headache due to eyestrain, and
Rmgvr has found it very beneficial in migraine. It has also proved service-
Me in djsmenorrhoE'a.
The following combination is recommended in neuralgia: —
R Bntrl-rhloral hydrat 8 Gm. or 5ij.
Alc<:>holis 7 6 c.cxn. or f3ij.
EJix. ^araiiA W can. or fjiij.
H. S«g.: A t«aapoonful every half-hour or hour.
A mixture of butyl-chloral and tincture of camphor is recommended as
.Atopicml apphcation in neuralgia.
The following formula has been published as of service in migraine: —
H Butyl-chloral hydrat 1
Tr. gr^lftemii 9
Tr onnabis Ind
Oljrrrin 16
q. B. ad 90
Gm. or gr. xv.
com. or mxxx.
ccm. or mxv.
c.cm. or fXsB.
ccm. or fjiij.
IL Sif^.t A third to be taken at once. The doae to be repeated in half an hour.
It tnay also be administered ill the form of a solution containing 10 parts
«f T *- " lural and *?h part>; of glycerin to r^O parts of distillod wiiter.
experiments upon frogs Grigorescu states that butyl-chloral is an
\t hysiolnjical antidote to strychnine.
___:al-caffeine. — A molecular combination of chloral with caffeiue
anscotj itself in the form of white, shining crystalline scales, easily soluble
a cold water. Professor Ewald, of Berlin, has used chloral-caffeine sub-
dtanconelir in single doses of 0.20 to 0.28 Gm. (or gr. iii-ivss), or in daily
4hc» of 0,38 to 0.87 Gm. (or gr. vi-sliiss). The injections ordinarily occa-
■OB hut little pain. Belief was afforded by this method of treatment in
iatfftiinnfltory rheumatiBm, sciatica, emphysema, and nephritis. It was also
fattfti) of fcrvice in chronic constipation.
Domiol is ft conihinntion of chltmil hydrate with junylmc hydr»it«' in
cgval mnleciilar proportion. It is a colorless oily fluid of a camphoraceons
ii^pr and of a peculiar, though not unplensantly. pungent taste. Dr. 0.
FochSt *^*'' orisrjnator nf this combination, finds it less liable lo cause toxic
^feu than chloral by itself, '"about 24 per cent, more of chloral in the form
of joTTi^ ' . than when tnki'n as uncoiTibinod chloral hydrate.''
Bcdn^ " ^^^^^ ^he lesser toxicity of the combination is refer-
«U« to the gradual occurrence and slow progress of disunion of the prepa-
336 rilAU.UACEUTlCAL TUERAPEITIC AGENTS OR DRUGS. ^m
ration. Dr. J. Arnold Goldmann, of Vienna/ reports the use of doriniol
in twenty-four cases, principally for its hypnotic effect, lie found it to
have a prompt and reliable hypnotic action and also an undeniable seda-
tive effect, that it can be depended upon to manifest its action in relatively
small initial doses of 0.37 c.cm.(or wivj); that larger doses, often up to
2 to 3 c.cm. (or wiixx-xlv), employed occasionally in individual cases, hav€
no evil consequences. It is said to have no cumulative action, and its long-
continued use gives rise to no tolerance. He also found that 0.75 c.cm. (or
mxij) of dorraiol, given with 60 c.cm. (or fjij) of gum mixture, as an enema,
produced a perfectly satisfactory hypnotic action, the sleep lasting between
five and seven hours in a case of a man, 54 years of age, suffering with
cancer of the stomach. By the mouth it may be given in capsules of 0,5
c.cm. (or wiviij) each. One capsule at night is usually sufficient, but in cases
of much excitement, such as hysteria, he gave 3 capsules three times a day
with only good results.
CHLOBALOSE. — Chloratose (Anhydro-ffluco-chloral) is produced by
the action of anhydrous chloral on glucose. It crystallizes in fine needles,
is very bitter to the taste, readily soluble in hot water, but dissolves with
dilhculty in cold water. In the process of manufacture a second substance
results. This is known as Parachloralose, and crystallizes in the form of
fine, pearly lamella?, which meit at 229° C. (41^.2° F.). The melting-point
of chloraluse is given as 184° to 186° C. (303.2° to Sed-S** F.).
Physiologrical Action. — According to the experiments of Prof. Ch.
Richet and l>r. Hflnriot, chloralose has a marked hypnotic effect upon dogs,
when given in small doses. In large quantities it is toxic. Chloralose stimu-
lates the spinal cord. Reflex action is not diminished, but may even be
exaggerated. It is claimed that, even in large doses, chloralose causes no
diminution of arterial pressure. Temperature is reduced from one-fifth to
three-quarters of a degree. Chloralose is said to produce an increased
excretion of urea and chlorides.
Therapy. — From 0.20 to 0.38 Gm. (or gr. iii-vj) occasioned a dreamless
and refreshing sleep, which was not followed by nausea or headache. It
was administered advantageously in some cases where chloral and morphine
had been badly borne. Sleep is generally produced in half an hour after
administration of the drug, is tranquiS, and unaccompanied by perspiration.
Fer6 has given chloralose in doses from 0.75 to 1.50 Gm. (or gr. xii-xxiv)
without ill effects. The effect is maintained from four to ten hours. Large
doses have been known to cause flushing of the face, tremors, epileptiform
convulsions, headache, uncertainty cf speech, and urticaria. A number of
cases, however, have occurred in which doses of 0.20 to 0.38 Gm. (or gr.
iii-vj) occasioned convulsions or cataleptic symptoms, while cyanosis with
collapse has also been observed as the result of moderate amounts. Hys-
terical individuals are particularly susceptible to its influence. According
to Flemming, chloralose is of benefit in functional insomnia and in that due
to psychical excitement, hysteria, neurasthenia, overwork, and functional
cardiac irritability. He found it of service also in attacks of epilepsy and
somnambulism, but states that it fails in wakefulness dependent upon alco-
*lfercV> Arohices, Oct.. 1900.
CHI-OROrOKMCM.
337
I
bolk excitein«nt, multiple neuritifi, and any painful organic lesion or
penpbcral irritation.
In cftsee of insanity, without excitement, it produces sleep; when ex-
dtcatot 10 preeent it will usually act as a sedative, and, at least in some
iMttBO«a» is capable of banishing hallucinations. Dr. J. Sacaze has obserTed
A sappRBEion of night-sweats produced by the administration of chloralose
ia potfaisis. In hectic fever he has used with advantage a combination of
qttminc mnd chloralose. This writer has also found chloralose of service in
ochrr chronic pulmonary affections, such as chronic bronchitis with bron-
chiectasis and fetid secretion, accompanied by copious perspiration.
Parachloralosc has been thought to possess hypnotic properties, but,
aeeording to the experiments of M. Richet, it is an almost inactive body
vith neither toxic nor therapeutic effect.
CHLOBETONE.— This is the trade designation of tri-chlor-butyl alco-
h'.'l ^a- oton-chloroform). It is formed by slowly adding equal weights of
ciiiur^form and acetone to caustic potash, and is isolated by distillation. It
li a irbite, crystalline solid having a camphoraceous odor. It is sparingly
Mluble in cold water (1 per cent.), but freely soluble in strong alcohol, chlo-
r^onn. ether, and glacial acetic acid. Its solutions are antiseptic. Chlo-
Rtooe is A local anaesthetic, resembling cocaine, especially as a substitute
A infiltration ansesthesia. On the central nervous system it acts as an
anaathetic and hypnotic, without depressing the nerve-centres. Doses of
(1,90 t*> (kS5 Gm. (or gr. iii-x) in tablet, cap?ule, or elixir, given at night,
aa ousness and induce sleep. Dr. Freeman F. Ward has also found
It - ^ jrreat =enice in quieting the irritation caused by hyperacidity of
the aiomacfi of nervous origin. He stated that it also acted well in whoop-
ing-cousb, giving one or two doses during the night, of 0.13 Gm. (or gr. ij)
ftifaolri n in a little brandy. It is also used in acute alcoholism and in sca-
ncknefis. In cerebrospinal fever, it has been used for spinal injection. Dr,
L. S. IK- Forest, of New Haven, Conn., after withdrawing from 30 to oO
il fluid, introduced 15 to 35 c.cin. of chloretone solution (5
Mt*).»
CHLOROFORMUM (U. S. P., B. P.). — Chloroform, TricLloromcthano
(CHCIJ.
Preparations.
dnoLstim Chlorofonni (U.S. P.). — Emulsion of Chloroform (chloroform, 4 c.cia.;
oil of Almond. 6 c.cm.; trngacojith, 1.6 Gm.; water q. a. ad 100 c.cm.).
4 to 7J( ccni- (or {3i-ii).
SpinUia Chloroforml (U. 8. P., B. P.).— Spirit of Chloroform (6 per cent.. U. 8. P. ;
S per erxil.. H. P.). DoAe, 2 to 4 ccm. (or f3aa-j). (For repeated adminUtration. 0.3O
to IJtO e.^tn., or mT-ju. B. P.)
Uti&cpentum Chloroform! (U.S. P., B. P.). — Chloroform Liniment (U.S. P. con-
tmiam cbforofonn, 30 o.cm.; koap-liniment. 70 c.cm.; B. P. contains chloroform, 50
cjob.; Unlni«tit of camphor. 50 c.cm.).
Aqua ChloTofomii (U.S. P., B. P.).— Chloroform-water Done, 4 to 15 c.cm. (or
tfMrK
Ttnettirs Chloroformi et Morphime Composita (B. P.). — Compound Tincture of
CMiiiffmin Aod Morphitre (chloroform, 75; morphine hydrochloride, 10; diluted hrdro-
M^aic acHd. M); tincture of capsicum, 25; tincture of Indian hemp, 100; oil of' pep-
MiBiiiit. I '/li givcerin, 260; alcohol, q. ». ad 1000). Doae, 0.30 to 1 c.cm. (or mv xvi.
U cftch O.W> c.cm. (or mx) there is 0.05 c.cm. (or m •/.) of chloroform, 0.03 c.cm. (or
»J$pmrHttl Jmrriran Mnitral A8»f>cSation^ Dor.
I
4
338
PHARMACEUTICAL THERAPEUTIC AGENTS OK DRrCfi.
mu) of diluted hydrocyanic acid, and 0.0055 ccm. (or gr. Vu) o( morphine hydro-
chloride.
MiHtitra Chloroformi et Cannabis Indieie Coraposita (N. F.). — Compound Mix-
ture of Chloroform nnd Cannabis Indica (ohlorotorm tinodyne) (chloroform, 125
c.rm. [or Z^v] ; ether. 35 coin, [or Six] ; tincture of cannabis Indica, 125 ccm. [or
Jiv); tincture of oapsiciim. 65 com. [or Jijl; morphin© sulph.itiA, 'i.5 Gm. [or gr.
xxxvii] ; oil of peppermint, 2 o.cm. [or mxxx] ; glyeorin, 125 com. (or %i\-] ; water, 65
c.i-m. [or 5ij»txl] ; alcohol, q. s. nd 1000 (or 2 pints],) Each fluid dra«lim represents
about rVj minims of chloroform, 7'/, minims of tincture of cannabis Indica, S*/*
uiinimK of linctur« of cnpnicum, and Vj of a grain of morphine sulphate. This prep-
araliou i.s Hniictimes called "Chlorodyne" (a trade naracK
Fhaimacology. — Commercial chloroform is impure, only containing 98
per cent, of chloroform, and is used solely for pharmaceutical purposes, as
a solvent, or for external application. Official chloroform is a purified chlo-
roform, prepared especially for medical purposes. It is '^a liquid consisting
of i*fl lo l)i),4 per c<.*nt., by weight, of aljsolute t.hloroform and 0.0 to 1 per
cent, of alcohol." It is a heavy, clear, colorless, diffusive liquid; of a char-
acteristic, pleasant, ethereal odor; a burning, sweet taste; and a neutral
reaction. It is obtained I»y adding ciilornl hydrate to an alkaline solution,
or by the action of chlorinated lime upon ethyl-oxide, or alcohol, and dis-
tillation. It is afterward purified by the addition of sulphuric acid, sodium
carbonate, and lime, and redistillation. Chloroform is only sparingly sol-
uble in water, but mixes with alcohol and ether in all proportions. It ia
itself a remarkable solvent, dissolving most alkaloids, resins, gutta-percha,
caoutchouc, paralfm, iodine, bromine, fixed and volatile oils, etc. Chloro-
form is not inflammable, but when mixed with alcohol it may he burned,
and chlorine-gas will be evolved. Tiichardson, of London, has shown that
chloroform-vapor, in the presence of a naked flame, is decomposed, forming
irritant compounds largely of hydrochloric acid. The accumulation of the
fumes in the atmosphere may he suftioiont to produce bronchial inflamma-
tion. Chloroform-vapor is much denser than atmospheric air, and diffuses
slowly, Chloroform is unfit for anfl?sthetie purposes unless it be absolutely
pure and fuliiils the tests of the pharmacopceias. "If 5 cubic centimetres
(mlxxx) of purified chloroform be thoroughly agitated with 10 cubic centi-
metres (mcl) of distilled water, the latter, when separated, should not affect
blue litmus-paper (absence of acids), nor test-solution of silver nitrate (ab-
sence of chlorides), nor test-solution of potassium iodide (absence of free
chlorine). If a portion be digested, warm, with solution of potassa, the
latter should not become dark colored (absence of aldehyde). On shaking
10 cubic centimetres {mcl) of the chloroform with o cubic centimetres
(mlxxx) of sulphuric acid in a glass-stoppered bottle, and allowing them to
remain in contact for twenty-four hours, no color should be imparted to
either liquid. If a few cubic centimetres be permitted to evaporate from
blotting-paper, no foreign odor should be perceptible after the odor of the
chloroform ceases to be recognized." The purified chloroform contains
about 0.6 to 1 per cent, of alcohol. It must be kept in glass-stoppered bot-
tles in a cool and dark place.
At the suggestion of Professor Liebreich, M. Pictet, of Geneva, has
applied his process for the liquefaction of gases to the production of abso-
lute chloroform. At 70' C. (158* F.) a crystalline body separates from liquid
chloroform. The fluid, from which the cr^'stals have been removed, re-
crystallizes somewhat below 100** C. (213** F.) and the second crystallization
represents absolute chloroform. At 15" C. (59** F.) the purified compound
CHLOROFORSIUK.
339
kii A tpccific gTBTity of 1.51 and is said to be perfectly stable without the
addition of alcohol. It has uot yet been demonstrated as certain, however,
ib*t ihe Pictvt process i$ superior to the methods of purification heretofore
■Dplojcd. The dccompoeition of chloroform under the influence of light
MM air is regarded by some chemists as a natural characteristic of the fluid,
Old not due to the presence of impurities. It hns, in fact, been demonstrated
&Mtj without the addition of 1 per cent, of alcohol, Pictet's chloroform un-
itrgoes decomposition, and that no sensible difference exists between this
md anr other well-purifled product.
Chloroform was discovered in 1831 by Mr. Samuel Guthrie, of Sackett^a
Harbor, X. Y., and about the same time by Soubeiran in France, and Liebig
i& Germany. It was first used as an anaesthetic by Sir James Y. Simpson, of
Edinbtirgh, in 1847.
Fhysiological Action. — When kept in contact with the sldn for some
time, it causes irritation and. finally, vesication. After absorption it exerts
a aedative eflfect. Internally, it produces a feeling of warmth in the stomach
and acts as a carminative, antispasmodic, and sedative; large doses are irri-
tant. Wlien introduced into the circulation, whether by absorption from
the broncho-pulmonary mucous membrane during inhalation or by that of
the Etcmach, the effects are the same. After a brief period of stimulation the
drarmixig efect of the drug is manifested, and in overdoses it is a cardiac
praoD, acting by destroying the contractility of the heart-muscle.* Prof,
John A. MacWilliam, of Aberdeen, has demonstrated that, even when gently
adminiatered in moderate quantities and with due admixture of air, chloro-
iocm ciaoaesan appreciable dilatation of the heart. This dilatation may pre-
cede the loss of the conjunctival reflex, and affects both sides of the heart.
It frequently occurs before any fall of blood-pressure. Artificial respiration,
therefore, often fails to revive the patient because the enfeebled and dis-
tiaded heart is unable to maintain the circulation. The dilatation is not
prodticed through the pneumogastrics, but is the direct effect of the drug
apon the cardiac mechanism. In a later series of experiments this writer baa
Aown that the primary stage of cardiac acceleration is due to a more or less
aamplcte paralysis of the vagi produced by the chloroform. The subsequent
lecardation occurs ''through a depressing or retarding influence exerted on
the iatrinsic rhythmical mechanism of the organ." The occurrence of anses-
theata is announced by complete muscular relaxation and abolition of the
aODJanctival and cremasteric reflexes. Dilatation of the pupils while the
asbjeet is fully under the influence of chloroform is an ominous sign.
CUoT' > eliminated by the lungs and the kidne}'s. It proves irritant
to tb^' - as it escapo? from the pystciu, and may set up nephritis.
Tht ailministration of chloroform, especially if prolonged, is often fol-
hnred br the appearance of albumin and casts in the urine: a fact which
m»gff^ta tJirtt the renal secretion should be examined before the patient is
plr- * "Viler tJie influence of tlie anaesthetic. It generally kills in Europe'
rica by heart-panilysis, though, according to the recent report of
'■ '1 Commission to t]»e Briii,<h MtuHcol Journal, in India it kills
.e of respiration. According to Binz, death under chloroform-
ie generally due to sudden paralysis of the respiratory centre.
*T||BMifhnf 1 howi*vpr, tlio honrt stop^ bofnre the respiration and again, in
* ttryort f>i Special Ctitoroform Committer. Brithh Mtdtcal Jovrnal, July 22,
the il
I
340
PHARMACEUTICAL THERAPErXIO AGENTS OR DRUGS.
other cases, paralysis of both systems takes place simultaneously. Hare has
demonstrated, in the administration of both chloroform and ether, that there
is a sudden fall of blood-pressure, during which sudden death may occur from-
syncope, or heart-paralysie, at an early stage of the anaesthesia. It has no
special effect upon the blood, unless the decided lowering of bodily tempera-
ture is to be attributed to its action upon the red blood-corpuscles, interfer-
ing with their function as oxygen-carriers to the tissues. The absorption of
chloroform by different tissues of the body has been studied by Pohl. In
the blood of dogs profoundly influenced by the anaesthetic the blood con-
tained much less than it is capable of dissolving, but the red corpuscles held
about two and a half times more than the serum. The chloroform is not
combined with the haemoglobin, but with the lecithin and cholesterin of the
corpuscles. A larger proportion was found in the brain than in the blood,
and Pohl believes that the chloroform is retained by the cholesterin, lecithin,
cerebrin, and other substances very soluble in chloroform. The liver con-
tained less than the blood, and only traces were found in the urine. A less
quantity was present in the fat than in the blood, which may be attributed to
the scanty blood-supply of adipose tissue. Chloroform appears to be absorbed
most rapidly and abundantly by tissues rich in substances which are soluble
in that liquid. After administration has ceased, the chloroform is reabsorbed
by the blood and eliminated by the kidneys. Upon the nervous system the
effects are \^Ty positive. Chloroform first affects the brain, then the sensory
part of the spinal cord, then the motor tract, then the sensory parts
of the medulla oblongata, and finally the motor portion of the medulla,
thereby producing death from failure of respiration unless the heart has
already succumbed to the drug,
Death from syncope, as already pointed out, not infrequently happens
from chloroform before complete anaesthesia has been produced. Such acci-
dents are from three to four times more common from chlorofonii than from
ether. According to Sir Benjamin Ward Richardson, chloroform causes
death in one of four ways: by apnceal syncope, by epileptiform syncope, by
cardiac paralysis, and by shock. That the toxic action of chloroform depends
largely upon the presence of impurities is shown by the experiments of du
Bois-Eeymond. The residue left after the separation of pure chloroform by
Pictet's process was found to exert a much more powerful influence upon the
circulation and respiration than the purified product.
Attention has been recently directed to the effect of chloroform and
ether narcosis on the liver. Bandler, of Prague, performed a herniotomy
on an hitherto strong, healthy man, who was. however, a hard drinker, using
chloroform as the anjesthetic. A few days afterward icterus developed, and
the patient died with cholremic symptoms. As leucin and tyrosin were found
in the urine, intra vitam, the diagnosis of acute yellow atrophy of the liver
had been made, and it was confirmed by the necropsy. Bandler has been
"since studying the literature on the subject and experimenting on animals,
to determine the exact effect of chloroform narcosis on the parenchymatous
organs. He states that every case of chloroform narcosis showed degeneration
of the liver-cells afterward, while this degeneration was absent or very slight
after ether narcosis. He therefore urges the importance of avoiding the use
of chloroform in cases where there is reason to suspect that the liver is not
perfectly normal, and using ether instead.*
* Journal of the American Medical Association, Feb. 20, 1890.
CHLOROFORMUM.
341
At iht? reevnt meeting at Nancy, of the CongreR des Soci^tes Savantee,^
Professor Gamier reported the result of a number of experiments made by
Dr. Lambert and himself. After the inhalation of chloroform, the glycogen
ta the lirer decreases, while the reductive power of the blood increases. The
action of chloroform upon the blood in vttro confirmed the results obtained
tia Hrd, Gamier believes that under these conditions hydrolysis of the glu-
cose occurs, with the formation of a fermentable sugar belonging to the
iMSOce group.
Therapy. — Chloroform is used as a local sedative, antiseptic, and coun-
ter-irritant, and, owing to its solvent action upon the alkaloids, it is a
OKfol vehicle for anodynes. The solution of gutta-percha in chloroform
(liquor jfutta-perchae) is sometimes used as a protective in small-pox and
ojazpeias. This is likewise a useful application in psoriasis, herpes zoster,
■Bperfieial bums, furuncles, and fissured nipples. Chloroform is an excel-
lent hsmostatic and promptly checks superficial haemorrhage when applied
^oa lint or absorbent cotton. A lotion containing chloroform is often of
iHTice in urticaria, and a liniment made with chloroform, aconite, and cam-
phor eoothes the pain of neuralgia and chronic rheumatism: —
B Cbloroformi,
Tinct. opii,
Tiiwt aeonit a& 161
Liniznent. saponis 75|
M. Sig.: For external application.
c.cm. or fSu.
c.cm. or fjiist.
Another good formula for a local anaesthetic is that devised by Dr. Par-
B Chloroform i,
Tinct. aeonit as 111 c.cm. or fSiij.
TincU capsici » 4| c.cm. or f3j.
Tinct. pyrethri,
Ol. caryophylli aa 21 c.cm. or f3M.
Caaiphore 2| Gm. or 3m.
H. 8|g.: For external use. The camphor is first dissolved in the chloroform
aad Xhm ok\ of doves and the tinctures sre tnen added.
Chloroform may also be used, as suggested by Southworth, in the fol-
lowing combination to overcome a rigid perineum in labor: —
B Chloroiormi
ifitiieris
Splritus odont.
M. 8%.: Apply locally.
T' nirc acts quickly and well, large heads safely passing the peri-
■wm. lad previously seemed to thmiton an extcuf^ive rupture. Ap-
fk:- a ifiiuill <N)nipre^s, chloroform hastons suppuration in boils.
-ch' ifcomniends a oomliination containing: pure chloroform as a
•prsT for its local anajsthetic effect in minor surgical operations, incision of
A MrooTchtfl, evacuation of a glandular abscess, extirpation of a superficial
fl^helioma, as follows: —
60
com.
or fSij.
30
c.cm.
or f3j.
473
c.cm.
or Oj.
* Merw UHirck dtr VEtf, 1001, Xo. 8.
* Ali9€m€imt Utdidniachr VmtrahZeitunff, Ko. 14, 1890.
342
PHARiTACKUTICAL THERAPEUTIC AGEXTS OK DRUGS.
B Mentholi 4
Chlorofonni 37
iStheris 56
Gm. or 3j.
c.cm. or iZx.
c.cm. or f3xv. — M.
The local anjestheeia lasts from two to six minutes.
Internally it is useful in gastralgia as chloroform-water, or in combina-
tion with anodynes, as in chlorodyne. It has also been given in hysteria,
asthma, irritable cough, and seasickness.
Chloroform-water has been found serviceable in spasmodic croup. A
few drops of chloroform, taken in water or upon sugar, will often relieve
vomiting when not due to inflammation of the stomach. Chloroform-water
is often of service in alleviating the vomiting of pregnancy. Chloroform, in
0.75 to 1.20 c.cm. (or mxii-xx) doses, is said to promote a rapid disappear-
ance of the albuminuria and anasarca of pregnancy. Small doses of chloro-
form mitigate the pain and check the vomiting caused by gastric ulcer. In
this condition it is beneficially combined with bismuth. Chloroform, inter-
nally administered, relieves the paroxysms of whooping-cough. In diar-
rhoea, spirit of chloroform is beneficially added to a mixture containing
astringents and opium. The chill of intermittent fever may often be averted
by the administration of a drachm of the spirit of chloroform. The same
preparation, given alone or in combination with morphine, allays hicwjough.
The microbicide action of chloroform makes it serviceable in some cases
of flatulent and fermentative or infectious dyspepsia. It has even been
claimed to be useful in cholera in this way.
Dr. Werner has used chloroform in 130 cases of typhoid fever. It had
a favorable influence upon the diarrhcea and tympanites and lessened the
nervous manifestations. None of the patients died or suffered a relapse. He
employed a l-per-ecnt. aqueous solution, of which he gave 4 to 7.5 c.cm. (or
f3i-ij) every hour or second hour, increasing the intervals as improvement
occurred. Steep also reports good results from its use in typhoid fever.
The spirit of chloroform is used with especial advantage in the treat-
ment of cholera morbus, and often for its sedative action upon the system.
The spirit of chloroiform can be advantageously combined and used with
aromatics and other remedies: —
B Spiritua chlorofonni I5| c.cm. or fjss.
AqusD camphom^
Spirjtus letheris comp aa 601 c.cm. or fjij.
Tinct. capsioi 7|6 c.cm. or f3ij.
M. Sig. : A dessert«pooDfu1 in water, vhenever neccBsary, for cholera xnorbua i
in stomachache or intestinal pains or flatulence.
B SpirituB chlorofonni , 18 5t* c.cm. or f3v.
Creosoti 37 c.cm. or wtvj.
Spiritua ammon. arom 7 5 c.cm. or f3ij.
Aquffi menth. pip q. s. ad 150 c.cm. or fjv.
Sig.: A teaspoonful or two before meals for nausea or vomiting.
M
Spiritus chlorofonni 151 c.cm. or fSss.
Morphinse sulphatis 066 6m. or gr. j.
Aquae cinnamomi q. s. ad 120| c.cm. or fjiv.
Sig.: From one to two teaspoonfuls every half-hour for after-pains or in
nervous or njsterical altacki.
In fevers the spirit of chloroform is useful to reliere restlessness and
M.
OHLOROFOKJiUll.
343
imtative cough in pneumonia, bronchitis, or pleurisy, usually given in a
*^cTer-niixture" combination.
Special Application. — The important application of this remedy is for
producing aniD5thc?ia during surgical operations. It is the most pleasant,
At most active, and the most convenient aniesthetic. Unfortunately, its
dcilh*recoTd is so much higher ihan that of its great rival, ether, that
MO«t surgeons in this country prefer to use the latter, although its odor
m not agreeable, and it requires a much larger quantity to produce uncon-
tcigggnese, and it has a preliminary state of excitement or intoxication.
(BemarkB upon the state of ana?sthesia and the choice of auEesthetics may
be found under the head of iEther.)
The Administration for Anaesthetic Effect. — The administration of
dUorofonu for surgical operations requires skill, intelligence, and experience.
The greater number of fatal cases, by far, have occurred in the hands of those
who do not appreciate the responsibility they assume in using this powerful
aguit. The method to be followed is, first, to eliminate all cases of weak or
diaesfie ^ * " • ; and, if the operation is to be a long one, requiring prolonged
adain. ii of the anaesthetic, cases of kidney disease must also be ex-
doded. ilie j»atient should not be in a sitting posture, nor should the
tUandrrm be administered soon after a full meal. The clothing about the
aaek a' -t should be loose enough to allow respiratory movements, but
dtf pat iiould not be too much exposed, on account of the lowering of
liBiprracure and the possibility of congestion of the lungs or kidneys subse-
fDCBt to the administration. The chloroform should be pure, and about 2.40
to 4 ccm. (or mxl-f5j), poured upon a napkin or towel and held a little dis-
tmoc aboTe the patient's nose or mouth, so that the dense vapor in falling
ikftU mix with air.
Aocording to Clover, the chloroform-vapor should be diluted with 20
votomcs of air, and he has devised a special inhaler designed to accomplish
this dilution. An improved apparatus, now in use, is known as Dr. Junker^s
iakalcr. In many cases full ansesthesia, or coma, is not needed for small
«p«ntion£, parturition, passage of gall-stones, etc.; consciousness may be
■reserved while the sense of pain is temporarily abolished. Dr. Sayre, of
>rw York, uses a much smaller amount of chloroform (0.30 to 1.20 c.cm.,
or iptt- T-xx), but administers the vapor in as concentrated a form as he can,
cvoiduif the admission of air as far as possible* and speaks very confidently
•( the efficiency and safety of this method. If the patient struggles violently
imxing the inhalation^ he is liable to get an overdose, and under such cir-
cuBStascce the administration of the anaesthetic should be entirely discon-
taitted UJstil the breathing becomes normal and it is seen that the aniss-
tiicaia is becoming fainter. The experienced ansesthetizer will devote his
tfltire attention to his patient, and carefully note any change in the rcspira-
tBiB. pupil «f the eye, or color of the skin. The patient's pulse also should
W vatcbe'' - the administration of chloroform, and, if it suddenly stops
«r bccom* - ling, Xelaton's method should be at once employed, in
vhkh the patient is placed in a vertical position, with the head downward,
v^tT« «-fiflcial respiration is employed, which is usually successful. La-
U rh'^d of rhythmical tongue-traction is very useful in restoring the
fworation. Tracheotomy may be required, and inflation of the lunps with
tte belloura has been successfully performed. Sir Benjamin Ward Rich-
rvirarda artificial respiration as the most important measure for the
344
PnARMACEt'TICAL TIIEHAI'EVTIC AGENTS OR DRUGS.
relief of chloroform narcosis.- Mouth-to-mouth insufflation may be prac-
ticed in the absence of a convenient apparatus. Amyl nitrite or ammonia
inhalations should also be practiced, or ether, digitalis, or whisky injected
hypodermically. ElTorts at resuscitation should not be discontinued in less
than one hour, as patients have recovered after artificial respiration had been
continued for this length of time. The faradic current is likely to do more
harm than good, as it interferes with other measures, and if applied to the
phrenic nerve may cause stoppage of the heart by inhibitor}' action. Slap-
pin^^ tlic chest and natts wita tho fringe of a towel wet with cold water was
the favorite R'jifjuret.' of Professor S. I). (iros>. If vomiting occurs after the
administration of chloroform, Lewin has found tluit by wetting a towel with
\'inegar and placing it on the face of the patient the vomiting will be
checked.
Digitalis, hypodermically injected, is a valuable agent in combating the
depressant effect of chloroform upon the heart. The conjoined use of strych-
nine has been practiced on account of its stimulant influence upon the cir-
culation and respiration. Small amounts of alcohol are valueless in this
emergency, while large quantities only assist the paralyzing action upon the
heait. When danger threatens, the angle of the jaw should be raised and the
tongue drawn forward, so that no mechanical impediment shall be olTered
to free respiration. In the Gottingen clinic, Konig*s method of intermittent
compression is practiced in a modified form. The praecordium is rapidly and
forcibly compressed at the rate of 180 or more per minute. The air-passages
must, at the same time, be sedulously kept free from mucus and open.
Dr. David R. Fly* prefers chloroform o\*er ether for general aniesthesia,
the one great disadvantage of the former being the care required in the ad-
ministration. The principal contra-iudications to chloroform are heart
troubles; emphysema, with dilated right heart; fatty degeneration of the
heart-muscle, and uncompensated valvular disease. Ether is also contra-
indicated in all these conditions. Neither ether nor chloroform should be
administered by artificial light from an open flame, the first because it is
inflammable and the second because it becomes decomposed and produces
highly irritating vapors, which cause spasm of the larynx, or inflammation
of the air-passages. In administering chloroform, it is important to gain the
confidence and co-operation of the patient^ because struggling and resistance
often disturb the judgment and lead to the employment of a larger quantity
than is desired. Chloroform ought never to be administered rapidly, for the
sudden entrance of a small quantity into the circulation is more dangerous
than the gradual absorption of a larger quantity. In major operations, be-
fore the administration of the chloroform, it is customary with surgeons to
give the patient 15 to 30 c.cra. (or fo^s-j) ^^ whisky as an arterial and cardiac
stimulant. The administration of a dose of nux vomica in the form of tinct-
ure or of strychnine as a guard against accident is recommended by Milne
and Wiggleswortli. Chloroform is also often administered by inhalation for
the relief of infantile and puerperal convulsions. In puerperal tetanus the
inhalation of chloroform is a valuable measaire. A combination of chloro-
form, given in this manner, and chloral, administered by the mouth in large
doses, has been especially praised. Augustus D. Waller, on account of the
acknowledged dangers of chloroform, considers it unjustifiable to employ it
*Neu> York Uedical Journcl, Nov. 5, 1S98.
CHLOKUM.
fcr onnor smgicfll operations. He condemns the open method of adminis-
tntmi «i! account of the uncertainty of the dosage and its increased risk.
Th^ 'taintv of quantity administered can be most easily avoided by
fB|I' .. I he principles of Junker's method, in which the quantity is ac-
omitfiy mi-ai^urt'fl and it> dosage rejjulated accordingly.*
The paxoxTsms of whooping-cough are checked or moderated by this
agtnt- ADont 2 c.cm. (or foss) may be poured upon the hand of the mother
lad held near the child's nose, or it may be vaporized by means of hot water,
0.12 to 0.18 c.cm. (or gtt. ii-iij) being used for each year of the child's age.
Tmd in the latter manner, four times daily, it is said to shorten the parox-
ismml f^age. In severe cases of chorea, in which the convulsive movements
tatarfere with deglutition and rest, chloroform inhalations answer a very
good purpose by inducing sleep, which is followed by notable improvement.
Administered at first three times a day, and less often as the symptoms im-
fBvre, this plan is said to ciure the disease, on an average, in twenty-eight
itjft. Chloroform is of value in painful delivery, not given so as to produce
aconactousnees, but merely to blunt the Bensibility. Used in this way, the
! contractions are not weakened nor the danger of post-partum haemor-
thaya n»creased. Chloroform is better borne by women in labor than by any
fdm'dasa of subjects. But if pushed to anresthesia the contractions become
laa Ti^roua and hjeraorrhage is favored. It is asserted that the inhalation
if chloroform for a few minutes at a time, several times a day, is beneficial
ia phthisis, relieving the cough and reducing the temperature. For this pur-
fm^ ■' — ^^r recommenda also the hypodermic injections of atropine (V, to
I P' _ :•- * '',-,,-V/fl,.) with morphino hydrot^blnride ((KOOo to 0.0(18 Gm., or
JT. ' ,^-- ^} : for the latter Dr. I^borde substituto^ mu'ceine.- In sciatica
Bartbolow has given deep injections of 0.60 to 1.20 c.cm. (or nix-xx) of chlo-
jaluim, near the sheaih of the ner^'e. In some cases this method has also
afforded marked relief in facial neuralgia.
CHLOBUV.— Chlorine.
Preparations.
S. P.). — CoiU|>ound Solution of l
(0.4 to 0.5 per cent, chlorine.
Lime (30 per cent.
I
ilftrinp. Dose,
Dose, largely
of livni table
U«|Uor Chlori Compositii^ ( I*.
A - --,.. ...r SteH-jl. \v.»ll ililuti'd.
rntft.— 4 lilorine-water
L_ : : > com. (or f3i-v).
IvkiK i. ii*i»riniUrt (I. S. IV t. — Chtorinnt«*d
't . T>o9e, 0.20 to 0.38 Gm. (or at, iii-vj).
.•■ I'liIcirinHtiP I r. S. P., B. P.). — Solution of Chlorinntrd S^^drt, Lft-
ion (2.4 per cent, available chlorine). Dose, 0.00 to 2.C c.cm. {or
lilutcd.
inata (B. P.)-~Ch1orinated Lime (contains 33 per cent. o( available
Liquor Calcic Chlorinata (D. P.). — Solution of CbloriiiBted Lime (about 3 per
^-if available chlorine when fresh).
• wfttor i« a (•>i*nfli i)r«*p(trntjtm of the nlx^ve solution, made with potoa-
-1 of wHliuro. It i^ rtl«o umimI for disinfection.
Pharmacology. — Chlorine is not itself official. It is a gaseous element,
•illi more than twice the density of air, of a greenish color, stronc And suf-
tatrnting odor, irrespirablc, and, even in a state of dilution, very irritating
• r*<- HritUh Medical Journal, April 23. 1898.
• Jhrraprutie Oasrttt, b*pt., 1890. ji. 03».
340
PHAKICACEUTICAL THEILiPEUTIC AGENTS OR DRUGS.
to the air-passages. For disinfecting purposes, it may be disengaged bj' add-
ing h^'drochloric acid to inaaganeBe dioxide. Chlorine is soluble in water,
and under the influence of sunlight slowly decoraposes that liquid, combining
with the hydrogen and setting the oxygen at liberty. Owing to the affinity
for hydrogen, chlorine acts energetically upon organic substances, and often
destroys them. Coloring matters of organic origin arc bleached when ex-
posed to its action. Chlorine is an efficacious disinfectant, decomposing
hydrogen sulphide and destroying putrefying material. It also destroys the
infectious miasms in the air, but should be in excess and in a closed room in
order to be very effective. The gener-ation of chlorine in the same room
with patients is of very little use so far as disinfection is concerned. The
combination with hrae {chlorinated lime, or bleaching powder) is largely
used for disinfecting drains and cess-pools.
For the sick-room, the solution of chlorinated soda (Labarraque's solu-
tion) is more convenient and less offensive, for use in commodes, bed-pans,
etc., or for internal administration. The inhalation of ammonia-gas is anti-
dotal to chlorine when absorbed by the air-passages, ammonium chloride re-
sulting from their combination. In cases of occidental poisoning from swal-
lowing a chlorine solution, albumin, in the form of milk, eggs, or flour, ifl
the best remefly at our oomniand, I'nllowod by an emetic.
Physiological Action. — Chlorine-gas, in concentrated form, when di-
rected upon the skin^ causes smarting and redness, followed by erythematous
or pustular inflammation. It is a disinfectant, destroying parasitic vegetable
growths. The inhalation of dilute chlorine is irritating to the lungs and
stimulates the end-organs of the pneumogastric nerve, causing coughing and
strangling sensations. Internally, chlorine was formerly given in various in-
fectious diseases, but this is rarely done at the present day, although Labar-
raque'i? solution, or the conipnund solution of diloriue, has decided influence
in maintaining the stomnch in an aseptic state during low forms of fever.
Therapy. — Chlorine solution is used to clean offensive ulcers and to re-
move patches of pityriasis. This liquid is also an excellent disinfectant to
sloughing wounds, and may be injected into abscess-cavities, sinuses, or
fistuiiB, for the purpose of removing and neutralizing unhealthy or decom-
posing pus.
Schmidt-Eimpler praises the action of chlorine-water as an antiseptic
in operations upon the eye. He has found it especially useful in cases of
dacryocystitis. In plastic operations upon the lids, traumatisms of the eye,
corneal suppuration, and serpiginous ulcer, irrigations with chlorino-water,
several times a day, have given satisfactory results. This liquid has the ad-
vantage that it does not, like corrosive sublimate, produce corneal infiltra-
tions after the installation of cocaine, but prevents suppuration without in-
juring the cornea. Chlorine-water was found to be less irritant to the con-
junctiva than the mercuric chloride, and. when kept in closely stoppered
bottles, excluded as much as possible from the influence of the air and light,
remains stable and active for some weeks. It is fit for use as long as it pre-
sents the characteristic odor of chlorine. Prior to the operation the con-
junctival cul-de-sac and globe are washed with chlorine-water, and when com-
pleted the lids are covered with muslin compresses wet with chlorine-water
and cotton sterilized with corrosive chloride, the whole being fixed by a ster-
ilized bandage.^ As an antiseptic wash, it may be employed in puerperal
' See Buffalo Ucdicul and Surgical JoumaJ, May, 1802.
CHLORUM.
347
» »u.' pan i)i l^barraque's solution to 10 or 12 of water is a useful
in vairiiiitis. The same solution may be used as a prophylactic
r"^ ' from bites of serpents or insects. Chlorinated oil^ — that is,
:ted with chlorine — is a very efficient remedy in scabies. It
arte without irritating the ekin. ,
A ctimpound known as Chlorophenol (trichlor-plienol) has been em-
p)OT«^l aue a lotal application in erysipelas, in the form of a 1-, 2-, or 3-per-
ointment. The results are said to have been excellent. It is thought
: the remedy would be more efficacious if given by subcutaneous injection.
A cot::' :i of chloriue and pla-nol i« higlily praised by Dr. J, E.
L Louis, as a valuable lotion to ulcerated mucous surfaces,
■• the TO'tuiL, iio&e, and thnuit, or as an injection into the vagina, uterus,
VW4rr or rectum, in an inflammatory or ulcerated condition of tliose or-
gUfc. A 10- or 20-per-cent. solution was employed. Tlie evaporation of the
C likewise renders the fluid a serviceable disinfectant. Dr. Bumey Yeo has
good results from the use of chlorine-water in tj'phoid fevej*. Labar-
F fliqne'ff solution may be similarly used, much diluted with wat<?r. The sore
1 ftroBt of scarlet fever is also benefited by the same methods. Gangrene of
I fte Booth or tongue is likewise amenable to the same influence. According
I to some obsen*ers, chlorine-water has an action upon the liver and is usefm
I s chronic disease of that organ.
I The solution of chlorinated lime' of the present pharmacopceia is one
I tithe best antidotes to hydrosulphuric acid, ammonium sulphydrate, potas-
I na fulphide, and hydrocyanic acid (given in doses of 1.20 to 4 c.cm., or
■zx-f3j). Sheets wrung out of this solution may be wrapped around the
[My of a person dead of infectious disease or in a decomposing condition.
|CfckinDe-gas has been utilized by Dr. Diver in the treatment of chronic ulcers
rtf tiic leg. A piece of absorbent cotton was charged with the gas by beincf
I pbcnl in a bottk' containing about 8 Gm. (orSij) of potassium chlorate, and
[a drachm or more of hydrochloric acid. The cotton was laid upon the ulcer,
with gutta-percha tissue, and secured by a bandage. The Shurley-
plan of treating pulmonary tuberculosis consists in the inhalation of
_ IS and the hypodermic injection of gold and sodium chloride. The
I maj be evolved from chlorinated lime, from 2 to 23.3 Gm. (or 3ss-vj) being
ipitaii out in a shallow dish and from 1 to 3 drachms of diluted hydrochloric
aod added, stirring with a wooden spoon or spatula. It is best to begin with
S T- r^isa) of chlorinated lime, increasing the quantity each day until 12
«r 1> ^ - :.i. (or 5iii-iv) are used. During the inhalation of the gas the atmos-
jhcre of the room should be charged with a spray of saturated solution of
^aimm chloride. The patient should breathe through the nose, as cough
^Hkaa leas likely to be excited. The time during which the gas is respired
PBat^T- t two minutes. This period is gradually lengthened to twenty
I «r lilir: les. In mild cases and in laryngeal phthisis the inhalation of
I dttarlDt^wat^r suffices.
I At the Harper Hospital, Detroit, Iklich., a face-inhaler is employed.
I Chlohne inhalations seem to be of value in arresting the progress of casea-
L tica. Hvpodermic injections are used in the Shurley-Gibbes method, which
I » tefuo oy the preliminary administration of iodine. (See ledum.) The
I 'OUoriml4vi Oil." Soe paper by the author. Mcdif'fil Bulletin, 1884, p. 271.
L. ' ni» ■ticniflh of tliia solution in the Briti^li Pharmacopoeia is one avoirdupois
B^^d of dilcrjnatrd lime to th« impt'riftl gallon.
348 PHARMACEUTICAL THERAPEUTIC AGEN'TS OR DRUGS. ^^
gluteal region is selected as the proper site of operation. The dose of iodine
generally used at first is V^ eg. (or gr. V12) daily, increasing gradually until
0,03 Gm. (or gr. ss) and in some cases 0,065 Gm. (or gr. j) is reached. The
gold-and-sodium solution is then injected daily, beginning with 2 or 3 mg.
(or gr. Vao or VaJ and ascending until a dose of 0.012 or 0.02 Gm. (or gr.
Vb or Vs) is attained. At this point the quantity should be diminished to
6 mg. (or gr. Vk,) daily if the treatment is to be continued. At this stage
it is considered better to alternate the injections. If albuminuria occur, the
iodine should be suspended. Little or no tendency to hfemoptysis has been
observed. Catarrhal manifestations and fever may, in the beginning of the
course, be temporarily aggravated, but improvement is said to follow. In
some instances, anorexia, listlessness, diarrhoea, and asthmatic symptoms re-
sult. Iodine alone cannot be long continued. The alternate use of the rem-
edies prolongs the effect of the iodine. It is recommended that, as a rule,
the alternate use should begin in the second or third week of the course,
gradually decreasing their use to once or twice a week.^ The authors of this
therapeutical method hare, in a number of cases, witnessed improvement as
regards symptoms with diminution of physical signs and disappearance of
bacilli from the sputum,
CHONDEUS {l\ S. P.).— Chondrus. (Irish Moss.)
Pharmacology and Therapy. — (_lKin<lniP, Irish moss, or carragheen, is
the dried plant of C'lKtmlrus crit^pus (Gigartiuacwe), which has been
bleached and dried by exposure to the sun. It ia in hard, translucent, yel-
lowish-'wlnte fragments of sea-weed, with characteristic odor and saline,
mucilagiuous tasttv It contains iodine and bromine in small quantities;
its j>['incipnl constituent ia nniL-ilage. hut it contnins no starcli.
Irish moss contains a peculiar principle called carragheenin, which is
distinguished from gum by not being precipitated from its watery solution
by alcohol, and from starch by not turning blue upon the addition of tincture
of iodine. Boiled with milk and water (1 to 16) and properly sweetened with
white sugar and flavored, it makes blanc-mange; or, in more dilute decoction
(1 to 100), a demulcent drink for the sick. It has not much food-value, but
is deemed useful in bronchial affections.
CHOPPARO AlffARGOSO is a small, thorny bush (Simarubacete) which
grows in southwestern Texas. It bears pink flowers and red fruit. All
parts of the plant have an intensely-bitter taste. It seldom creates nausea,
has no effect upon the bowels, and seems to be eliminated principally by the
kidneys, as its odor is perceptible in the urine. It possesses also some anti-
periodic virtues. In large doses it causes flushing of the face and a sense
of fullness in the head. Dr. J. W. Mixon, of Wrightsboro, Texas, reports
that he has obtained excellent results from the administration of chopparo
in dysentery, and suggests that it mi^ht prove useful in typhoid fever as
an intestinal antiseptic and tonic. A fluid extract of chopparo amargoso has
been prepared by Sharpe & Dohme, of Baltimore, the dose of which, as a
tonic, is from 0.60 to 15 c.cm. {or mx-foss), and as a stimulant from 11 to
30 c.cm. (or foiii-f^j). The plant yields its virtues to boiling water, and is
frequently given in the form of a decoction.
* Therapeutic Gazette, April 15, 1891.
CHRYSAROBIXL'M.
349
CHBOMn TRIOXIDUM (l*. S, P. ) —Chromium Trioxide. See Aci-
Abk Chromicam.
CHBYSAROBIinJM (U. S. P. ) .— Chrysarobin.
AHAROBA (B. P.).— Cmde Chrysarobin.
Bo«e, O.0U8 Gm. (or gr. V»).
Preparatwn,
Ufigmnttim Cbryurobin! (IT. S. P., B. P.).— Ointment of Chrysarobin (5 p€r cent,
■Hfc betuolsiatfH] l«rd). (The British ointment is not so strong, being 1 to 24, or only
• ScUk OTfr 4 per cent.)
Phjumacolog^. — Chr)'sarobiii in its commercial, somewhat impure,
fonn 13 a neutral principle extracted from Goa powder, a substance found
irTh>i>itni ill the wood of Voiiacapoun iiraroha ( I^^'-umiiiosiv). which iji a
Mbre of the East Indies and Brazil. It is an orange-yellow powder, odorless
md «-«riT.^iit taste, nearly insoluble in water and in alcohol, but soluble in
tfL* luric acid, and ^olutionts of alkalies. It is not identical with
<fcr>-"riL»jiic acid, ns was formerly gupy>osed,
Pkynological Action. — In comparatively large doses (2 Gm., or oss) it
mntm irritation of the intestinal mucous membrane, and gives rise to vomit-
■cand purging, with large, bilious stools.
It excites inflammation of the skin from its local application, and pro-
a yellowish-brown stain of the skin and clothing. (The stain is re-
ble with a weak solution of chlorinated lime or soda.) It is said that
kot benzol will remove the discoloration from hair and clothing, provided
tkit DO 80«p or alkali has been used. A yellowish hue is communicated to
iteiinneb> ■ -irobin. * This color turns red upon the addition of alkalies.
IW'VnTTiMt be diffuse, or exprest^ed by frilliculnr frufitions. Chrysa-
n^' .t^iii* ilk', and dostructive to epipliytie organisms.
- -py. — The principal internal use of chrysarobin is for its cathartic
it has been administered internally, in doses of 0.008 Om. (or gr. V,),
times daily in psoriasis. But its extremely-irritant effect upon the
ilXfgtirf^ mucous membrane so soon compels its abandonment that it is prac-
fiedly xalueless as a s}'8temic remedy. When applied externally for a con-
'We period, a small portion may probably act by absorption. Chrysar-
-' iirld not In* allow('d to come in I'ontact with the !n.'althy
: I.MS, the disease for which it has been principally employed,
be carefully rubbed into the affected area. The parts should then
kt eovered by t bandage in order to protect the linen. Another method of
nplyizig chr}'sarobin is by making a paste of it by means of water, rubbing
^ paste upon the patches after the scales have been removed, allowing the
Miiuie to barden, and, finally, pencilling collodion over the surface.
ClxryMTobin is curative by its stimulating action on psoriasis, chronic
■Pi>»^ and regctable parasitic skin diseases; but the official ointment should
kt£liited acTeral times before application, for fear of exciting too much in-
lorr reaction. Chronic eczema and the second stage of rosacea also
benefit from chr^'sarohin ointment. The same preparation has some-
• proved of service in lupus vulgaris.
j^ rery good combination in chronic eczema and psoriasis is the follow-
i
350 PHARMACEUTICAL THERAPEUTIC AGENTS OE DRUGS.
B Olei cadini 2] ccm. or fSsa.
Chrysarobini 1 30 Gm. or gr. xx.
Unguent, zinci oxidi 31 1 Gm. or Ij. — M.
A 6-per-cent. solution in liquor ^ttse-percbffi has been used with ad-
vantage in chronic eczema and a 10-per-cent. Bolution in psoriasis. Dr. Dale
James writes that the most cleanly manner of employing chrysarobin is by
dissolving 1 part in 7 parts of chloroform, and stirring about an equal quan-
tity of soft petroleum into the mass. The preparation is applied by means
of a brush. Chrysarobin has been recommended by Dr. Robinson, of New i
York, as an excellent application in alopecia circumscripta. It may be con-
veniently used in the form of a stick, made up according to the following
formula slightly modified from that given by Dr. Leistikow, of Hamburg: —
H Chryaarobini 311 Gm. or 5j.
Colophoiiii (vel resinee) , 4| Gm. or 3j.
Cer» flav 311 Gm. or 5j.
01. olivae 30| ccm. or fSj-— M.
Euroben, or chrysarobin tannate, soluble in chloroform, acetone, and
ether, is used as a succedaneitvi for chrysarobin, especially as a skin varnish
for chronic scaly skin eruptions.
CIMICIFITGA (U. S. P.).— Cimicifuga, Black Snake-root, Black Cohosh.
CnnCIFUGiE RHIZOMA (B. P.). — Cimicifuga, Actfieee Eacemosa
Radis.
BosSj 1.30 to 2 6m. (or gr. xx-Jixx).
Preparations.
osw I
Fluidextroctnm Cimieifugte (V. S. P.). — Fluid Extract of Cimicifuga. Dose^
0.30 to 2 ccm. {or mv-fSss).
Extractum Cimicifugce (U. S. P.).— Extract of Cimicifuga. Dose, 0.0C3 to 0.32
Gm. (or gr. i-v).
Tinrtuin Cimicifuga* ( L'. S. P., B. P.). — Tincture of Cimicifuga (20 per cent.;
the Britiih tincture is only 10 per cent.). Dose, 4 to 7.6 ccm. (or f3i-ij). B. P., 2 to
4 ccm. (or f3fts-j).
£xtractum Cimicifugs Liquidum (B. P.). — Liquid Extract of Cimicifuga. Doae^
0.30 to 2 ccm. (or ffiv-xxx).
Pharmacology. — The rlried rliizome and roots of Cimicifuga racernosa
(Ranunculaccffi), a plant common in woods in northern United States, con-
tain a neutral principle of acrid tnste, soluble in dilute alcohol, water, chlo-
roform, or ether. Its chemical nature is not known positively. Mr. George
H. Davis has discovered a volatile oil in the recently-gathered roots; and
Prof. George B. Wood thought that this might be the active principle, since
the drug deteriorates upon keeping. It also contains two resins. So-called
ciinicifugfln, or macrotin, is an impure resin, deposited from the concentrated
tincture upon the addition of water. There is also in the recent drug, be-
sides the volatile oil, some tannic and gallic acids. The odor of the plant ia
rather fetid.
Physiological Action. — Cimicifuga has decided elTccts upon the human
system. Small doses stimulate the digestive function and increase secretions
along the alimentary canal. The secretions of the bronchial mucous mem-
brane are also increased, the action of the heart stimulated, and the urine
» Bsgmented in quantity. The menstrual flow is increased, and some aphro-
dkuc qualities have been ascribed to the drug. Upon the heart and circula-
tion sn elfect is noticed resembling that of digitalis^ though less marked.
Full doe«s slow the pulse and increase its force, raise arterial tension, and
■UBiQlate uterine contraction; the latter action recalls that of ergot, though
it H lees powerful. Cimicifuga lowers the reflex activity of the spinel cord.
The pupils are dilated; dimness of vision, vertigo, intense headache, nausea,
and Tocmting result from large doses. Even soporific effects have been ob-
vrv«d, with reUef from pain or spasm. Death may be caused by failure of
mpiration.
Therapy. — The applications of cimicifuga are in accordance with its
phjsiological activity. Externally, a saturated tincture is said to relieve pain
ra Hieuxnati&m and neuralgia. In chorea it is of decided value, especially
in veak ansmic children. It is, moreover, very applicable to those cases
vhich manifestly depend upon rheumatism, or to those which develop in
pA at the age of puberty and are associated with menstrual irregiilarity.
& neoral^ia, especially when the consequence of rheumatism, cimicifuga ia
af undoubted benefit. In certain cases of sciatica improvement follows the
■dminifitration of this agent.
A formula of Dr. Metcalf for sciatica is: —
B Tr. aconit.,
Tr. oolchic. sem.,
Tr. beUadonn. foL,
Tr. eizuicifuge aa 7|50 c.cm. or f3ij.
IC Stg.i Six drops erery six hours.
Cimicifuga was introduced into England by Sir J. Y. Simpson, as a
" stmtdj for chronic rheumatism, myalgia, and hypochondriasis with depres-
It is beneficial in melancholia, especially when that condition is asso-
ditc^ with functional or organic uterine or ovarian disorder. Cimicifuga is
n-^wiae serviceable in some cases of acute rheumatism, and Ringer has found
jfcftd in rheumatoid arthritis. The fluid extract is the best and most
nuable preparation. In uterine subinvolution, ovarian neuralgia, and amen-
aiibu;a it is highly commended. It has a good effect, also, in other consti-
tTt?^«*l manifestations dependent upon disorder of the female generative
mteaa, as* for instance, convulsions caused by disturbance of the catamenial
taDCti^n, and in puerperal mania. Congestive dysmenorrhoea is likewise re-
fiewd b3' liiis remedy. Cimicifuga is often beneficial in menorrhagia and
sttrorrhagia. By reason of its action upon the womb, cimicifuga may be
tBplored during parturition as a substitute for ergot. Though not so pow-
trftd aa the latter drug, it strengthens the normal uterine contractions. For
Cf toni *^"=, it is used in treating gastric catarrh and irritable stomach
rfak'''^ also in delirium tremens and functional impotence. In weak
BC rt it is safer than digitalis. On account of its stimulating
^^', lie uterus, it should not be given during pregnancy.
in headache from eyestrain cimicifuga has been given with benefit, and
-tally useful in acute bronchitis as an expectorant. Cimicifupa is like-
iiable in chionic bronchitis attended by profuse muco-purulent secre-
• -nay even be Ber\iceably prescribed in phthisis, as it facilitates ex-
J, Bustains the appetite and digestion, and reduces fever,
^ucifugrt inav be administered as iu the appended formulje: —
352
PHARMACEUTICAL THERAPEUTIC AGENTS OK DRUGS.
B Fluidext cimidfiigic 45 c.cm. or fJiM-
Tinct. nucis vomicfle 4 c.cm. or f3j.
Tinct. cinchonee conip q. s. td 150 ccxn. or fSv.
M. Sig.: A teftspoonful or two in water every three or four boura. For ovariB
and uterine neuralgia and amenorrh(BA.
B Flnid^xt. oiiiiioiftifrffi 30] c.cm. or fjj. '
Morphinie sulphntis {065 Gm. or gr. j. ,
Spiritus aetheris nitrosi, ,
Liquor ammonii acetatia aa 60| c.cm. or fSij-
M. Sig.: Two teaspoonfuU in water every three or four hours. For neuralgia,
■cute rheumatisni, and acute bronchitis.
H £xt. cimicifugae 1 155 Gm. or gr.
Ext. belladonna? folior 065 Gm. or gr.
Pulr. capRici |76 Gm. or gr.
M. et ft. pil. no. xij,
Sig.: From onp to two pills three timet a day. For gastric catarrh,
tremens, and functional impotence.
CINCHONA (TL S. P.).— Cincliona, Peruvian Bark.
CINCHONA EUBRA (U. S. P.).— Bed Cinchona.
CINCHONA KUBHa; CORTEX (B. P.).— Bed Cinchona-bark.
U. S. P. Preparations, Alkaloids^ and Salts.
Flniilextriiotuin Cincbonie. — Fluid Kxlrnct of Cincliona. Dose. 0.60
c.cm. (or mx-fSij).
Tinctura Cinchonee. — Tincture of Cinchona [20 per cent.). Dose, 2 to 7.5 c.cm.
(or nix.vxf3ij).
Tinctura Cinchonoj Composita. — Compound Tincture of Cinchona (red cinchona,
10; bitter orange-peel, 8; serpentaria, 2; glycerin, 7.6; alcohol and water, q. a. ad
100 parts). Dohe, 4 to 15 com. lor fSi-ivl.
Quinina. — Quinine. A while, aiiiorphoua powder, soluble in 1670 parte of water
and in 0 part* of alcohol. Dose, 0.005 to 0.05 Gm. (or gr. i-x).
OJprttiim Quiniiiie. — (Uente of (^>uinin<' (25 i>ercent.).
Quininn? Sulphas. — Quinine Sulphate. Do&e, 0.065 to 0.85 Gm. {or gr. i-x). In
snow-white, loose, filiform crybtaU, fragile, and in a light, easily-compressible mass;
lu&treless lowing to superficial efflorescence), odorless, having a persistent bitter tast©
and neutral reaction. Soluble in 740 parts of water, and in 65 parts of alcohol at
15° C. (59* y,\, in smiili proportions of jicidulated water, Verjr slightly soluble in
ether. Aqueous solution, especially if acidulated with fiulphunc acid, has a vivid,
blue fluorescence. WTien treated firbt with fresh bromine-water, and then with
sli^'ht excess of water of anunonia, llie 8alL producer an emerald -green color {thai'
leioitttin). Crystals are formed of the same color by treating an acidulated solution
of quinine sulphate with saturated alcoholic solution of iodine {herapathltcif).
Quininre Disulphas. — Quinine Bisulphate. Dose, 0.0(i5 to 1 Gm. (or gr. i-xv).
Similar to the aufpbate. but much more soluble, dissolving in 10 parts of water or 32
parts of alcohol at 59° F.
<Vitinina' liydrobroniidum. — Quinine Hydrobromide, Dow, 0.065 to 1.30 Giu. (or
gr. i-xx).
Quininu- Hydriichlnrjiliim. — Quinine Uydrofhloridi*. Dose, 0.065 to 1 Om. (orgr.
i-xv). Soluble in 34 parts of water.
Qiiiiiirm* Salieyla>. — .Snlicyhitf of Quinine. Dose. 0.065 to 1 Om. (or jrr. j-xv).
Cinchonince Sulphas. — Cinchonine Sulphate. Dose, 0.32 to 2 Om. {or gr. v-xxx).
In white needles, soluble in Ott jmrts of water and in 10 parts of alcohol. Very bitter.
Cinchonidinfle Sulphas. — Cinehonidine Sulphate. Dose, 0.32 to 2.60 Gm. (or gr.
v-xl).
Ferri et Quinina* Citras. — Iron and Quinine Citrate (contains 12 per cent, of
quinine. 85 of ferric citrate). Dose, 0.13 to 0.65 Gm. (or gr. ii-x).
Ferri ct QuininsE- Citras Solubilis. — Soluble Iron and Quinine Citrate. Dose, 0.20
to 0.05 Gm, (or gr. iii-x).
CINCHONA.
353
I
nixir Fcrri, Quiniiuet, et Str^'chninie Pboepbatum. — Elixir of Iron, Quinine, and
6to^rti>i— PtK»phute. Dom.\ 4 tu t^ c.cm. lor 3j-ij).
Gljrc«ritum Ferri, Quinine, et Strychmnte Phosphatum. — CJlycerite of the Phoa-
pWl«* of IroxL, Quinine, and Strychnine (used in making the syrup). Dose, 1 to 4
AOB. <or OTXV-Sj).
Sjrupu* Ferri, Quinine, et Strj'thiiinfie Phosphatum. — (See Ferrum.) Dose, 4
ccm. (or 3j|.
Vixtusn Fcrri Amaruin. — Bitter Wiue oi Iron. Dose, 4 to 7.6 c.cm, (or f3i-ij).
B. P. Preparations, Alkaloids, and Salts,
Hxtractum CinchonEe Liquidum. — Liquid Extract of Cinchona (5 per cent, of
alkaloids). Dose, 0.30 to 1 c.cm. (or mv-xv),
lafumm Cinchonje Aciduin. — Acid Infusion of Cinchona (red cinchona-bark, 50
OiB.£ aromatic sulphuric acid» 12.5 com.; distilled water, 1000 c.cm.). Dose, 15 to
■a. (or f5»*-j)-
Tliicttira Cinchone. — Tincture of Cinchona (1 Gm. of alkaloids to 100 c.cm.,
vith red cinchona-bark). Doee, 2 to 4 c.cm. (or fSss-j).
Tiitciura Oinchonie Composita. — Compound Tincture of Cinchona (bitter orange-
pccU SO; ^rpentary. 25; cochineal. 3.2; »afTron, 0.3; tincture of cinchona, 300 c.cm.;
■kttlMt <q. & ad lOUO). Dose. 2 to 4 c.cm. (or f3sa-j).
Quinizue Sulphas.*— Quinine Sulphate. Dose 0.065 to 0.65 Gm. (or gr. i-x). In
■Ikj*-vhit« filiform crystals, taste very bitter. Soluble in about 800 parts of water,
tW *oJution having a bluish fluuresoence; when water is acidulated with a mineral
mad the ftalt ia entirely soluble. When solution of ammonia is added to aqueout
MlotiaBs of quinine salts, it forms a white precipitate soluble in ether and in excest
■f Um solution of ammonia. Quinine sulphate when exposed to dry air, the 15 mole-
mim oi water are reduced to 4, due to etTlorc>tccncc.
Quiniiue Hydrochloridum. — Quinine Uydrochlonde. Dose, 0.005 to 0.05 Gm. (or
gr.l-xK
i^iuiMB Hydrochloridum Acidum. — Acid Quinine Hydrochloride. Dose, 0.065 to
OifiS Gm. (or gr. i-x).
TiBctura Quinime. — Tincture of Quinine (quinine hydrochloride, 2; tincture of
s 100). Dose, 2 to 4 c.cm. (or f3s3-j).
'ioctura Quinine Ammoniata. — Ammoniated Tincture of Quinine (quinine aul-
Lt#, 2; aolntion of ammonia, 10: alcohol, 90 c.cm.). Dose, 2 to 4 c.cm. (or fSsa-j).
S^rrupos Ferri Phosphatis cum Quinina et Strychnina. (See Ferrum.)
vimun Quinime. — Quinine-wine (quinine hydrochloride, 2 Gm.; orange-wine,
ITS cjeaa.). Doae, 15 to 30 c.cm. (or fJssJK
Pfhila Quinlnic Sulphatis.— Pill of Quinine Sulphate (quinine sulphate, 30; tar-
luie Acid, 1: glycerin, 4; tragaeanth, 1; to make a pill-mass). Dose, 0.13 to 0.50
Qb. (or gr. ii-vtij).
Fcrri et Quininee Citras.— Iron and Quinine Citrate. Dose, 0.32 to 0.65 Gm.
(or ^. T-x).
Some tTnofficial Preparations.
Kxlractum Cinchona-. — Kxtnut of Ciuohonn. . Dose, O.Ol! to 0,65 Gm. (or gr. i-x).
Quinina* VHliTiaimtiK. — Vnlcrinnnte of Quinine. Dow, wime as sulpluite.
rir«.li.,Tilrrrt — (.inchonine. Dose, 0.32 to 2 Gm. (or gr. v-xxx).
',' Sul|>hnfl. — Sulphate of Quinidine. Dose, 0.32 to 2 Gm. (or jjr. v-xxx),
Ci ;um.— Chinoidine. Dose, 0.20 to 2 Gm. (or gr. iii-xxx). A mixture of
ft* AUokltMda, in an amorphous form, and dark colored; obtained from the residue left
feoai tb* manufacture of the crystalliEable salts.
Qatninae Hydrochloraa Carbamidata. — Double Salt of Quinine and Urea. Soluble
to fta e<lpAl part of water, and used hy{K>dcnnically in congestive chills. Dose, 0.065
WOjfft Urn. tor gr. i-x).
QataetozD, or Hospital Quinine, is the mixed alkaloids precipitated by an alkali;
In^^r need a* a febrifuge in India. Dose, about the same as quinine.
tinelionidin» Salicyhu. — Cinchonidine Salicylate. Dose, 0.13 to 0.65 Gm. (or gr.
Ctnrhoninie lodosulphaa. — C^nchonine lodosulphtte (60 per cent iodine). A sub-
ititeto for iodoform.
Pbarmacolo^. — The Cinchona of the United States Pharmacopceia is
F dried bark of (Mnchona Ixdgt-riana (Molus) ; Cinchona Calisava {Wed-
r iliat^. 2
354
niARMACECTICAL THERAPEUTIC AGENTS OR DRUGS.
dell) ; Cinchona officinalis (Linne) ; and of hybrids of these and of other
Bpedes of ciuchoua (family, Itubiacea?), yielding, when assayed by the
official process, not less than 5 per eent. of anhydrous cinchona alkaloids,
of which at legist fonr-fiftlis phoiild lie soliil)le in etlier. Cinchona rubra
(U. S. R), is the dried hark of Cinchona >necinihra (HnlujKca-). yielding
not less than *i per cent, ol' luihytlroiis cincliona alkaloid. Cinchona Rubrse
Cortex (B. P.) is the drii-d bark of the stem and branches of cultivated
plants of Cinchona succinihrn; **wheu used for purposes other than that
of obtaining alkaloids or their salts, it should yield between 5 and G per '
cent, of total alkaloids, of which not less than iialf should consist of quinine
and cinchonidine." Cineliuna flava (non-cillicial), which is the hark of the
trunk of Cinchona Calisaya, contains at least 2 perceut. oi quinine. There
have been isolated fnun ciiicliona-hark about twenty alkaloids, differing
slightly in physical qualities, solubility, reaction, and afUnitic-?, hut all pos-
sessing, to greater or less degn^e, the cluiracteristie phvt^iological actions of
'quinine. They may be divided into two groups: (1) quinine, quinidinc,
and quinicine; (2) cinchonine, cinchonidine, and cinchonicine. 'i'hese
exist in the bark cond»ined witls ciucho-tannie, kinic, and kiunvic acids,
Avitli a tasteless, inactive substance, — cinchona-red. While South America
renuiins the principal source of cinchona, yet the cultivation of the tree
has been so successfully carried an in luiHa iuul Java thut a considerable
portion of the su]>plY is now derived from this source. The eonstflutly-
growing ilciiiand for (piinine has stimulated chemical investigation; and
laboratory products^ chiefly of the coal-tar series, are now offered in great
variety, which closely appmaeh the cinehrma alkaloids in physical and
eheniieal characters, and which also have been proved valua)>le as antipy-
retics. Prninincnt auunig these are chinoline, antijtyrin, acetanilide, resor-
cin. kryofin. and naphthidin, which will be considered se]>arately under
their indivithud titles. Thus far, however, no synthetically-prepared salt
rivals quinine and einchonine in their control f»f nudarial manifestations,
or in their tonic elFects upon the system when given f(»r a length nf time
iu small doses.
By chemical modification of eupreine, a base fonnd in the Gemijia
peduncnlata, MM. Grimaux and Arnaud have, by synthesis, obtained a sub-
stance absolutely analogous to, and perhaps identical with, quinine. They
have also derived otjjcr bodies similar to quinine, which are ethers of eu-
preine and are endowed with decided physiological properties. Quinine is
chemically the methylic ether of eupreine. By following a similar process
to that by which eupreine is transformed into quinine, two new alkaloids
have been discovered. Ethylie eupreine has been denominated quinethyline
and propylic eupreine has been given the name of quinopropyline.
With regard to the comparative nlkaloidal value of the different barks,
the C. Calisaya contains the greatest proportion of quinine, the C. succi-
rubra the greatest amount of tannin and coloring matter. Under the name
of pale barks, the C. niicrantha and C. condaminea were formerly othcial;
they are intermediate between the two just named, in their alkaloidal
value. The C. pitayensis, cuprea-bark, and other quinine-}ielding barks
are employed in manufacturing the alkaloids, but are not specifically
named by the pharmacopceias; all are official which contain at least 5 per
cent, of the total alkaloids of cinchona and 2.5 per cent, of quinine.
Quinine sulphate is a snow-white crj'stalline substance of a silky lustre.
CIKOHOKA.
¥
»
vhich becomes somewhat opaque in dry air from efflorescence. It becomes
ftUowifih on exposure to sunlight, is phosphorescent on trituration at 320'
l^. At & red heat it decomposes and burns slowly without any residue. Thia
mix IS soluble in 740 parts of cold and 30 parts of boiling water, is readily
•ohible in alcohol and acidulated solutions, and in glycerin. It dissolves
qisringiT in chloroform and is nearly insoluble in ether. A delicate test for
qoinine is the production of an emerald-green color when a solution of one
©fits salts is treated with bromine-water followed by the addition of aqua
.flBUDOoia in excess.
Phynological Action.-pThe preparations of the bark are not fully rep-
icMOted by the salts of the alkaloids, because they possess astringency, which
k abeent from the latter, and because the physiological action is increased by
th« aaiociation of different principles in accordance with the well-known rule
of combination of synergistic roaiodi*?*?. For iiitornal administration, how-
crer, the bulk of the powdered bark is inconveniently large. In 1820 Pelle-
tjer and Caventou first isolated quinine, which has since taken the loading
pbce in therapeutics of fever, and is second only to morphine in importance.
As the other salts approximate more or less closely to this, we may omit con-
fideration of their physiological action and simply take quinine as the type.
Qoinine is a powerful antiseptic, and is very destructive to infusorial and
T«gietable life. A solution of V^ of 1 per cent., 0.065 Gm. to 30 c.cra. (or gr.
i-5j)t destroys micro-organisms, and double this strength prevents fermenta-
tion and putrefaction. Upon the basis of his numerous experiments, Binz
concludes that the remedial action of quinine in malaria is due to its direct
action upon the specific micro-organism of the disease. Upon the sound skin
TCTT little effect is, as a rule, produced, but upon a part denuded of epi-
dcnnis, or upon mucous membranes, it is a decided irritant. Rashes, how-
«Tcr, may be caused by the direct action of cinchona. Workmen employed
ia making quinine are not infrequently attacked by erythema, vesicles, or
ponnlee. It causes muscular contractions when applied directly' to the
am9cle, but not when applied to a nerve (Eulenberg). It is therefore a mus-
c' ■ K and not a nerve-irritant. Taken into the etoniach, it exercises
a 1: . .- - ect upon its contents, checking abnormal fermentation and destroy-
ing infectious micro-organisms. For this purpose it should be given in solu-
tioo or in powder (capsule), so as to insure its solution in the stomach. In
moderate doses it stimulates the muscular fibres of the stomach, increasing
it- " " power, and also, by its irritant action, incivasea tlie secretion of
g: ico and, as a bitter tonic, improves the appetite. In large quanti-
ti -'»'r i* alK)lished, and tlie excess of irritant action causes arrest of
g-i - - . retion.
In cxceesive doses it may cause nausea and vomiting. Its prolonged use
fn large amounts has been known to cause gastritis. No influence has been
noticed upon respiration, and very little upon temperature of a person in
health. In conditions of fever, the administration of several full doses re-
dvc^ the temperature nearly to the normal; and there appears to be a toler-
ance during this condition, for the system can stand a much larger quantity
at a dose tlian it can in health, without producing toxic effects. This may,
CB part, be due to the fact that absorption is checked by the fever. The effect
Qpon the nervous sj'stem of small doses is best seen in cases of debility, where
the arent acta as a tonic, invigorating the vital functions and aiding the di-
mtioD and assimilation of food. In larger doses, 8}'mptoms referable to the
35G
PHABMACEUTICAL THERAPEUTIC AOEXTS OR DHCGS.
brain are noticed, such as fullnefis, frontal headache, deafness, ringing in the
ears, and mental dullness. These symptoms are attributed to partial anaemia
of the brain, owing to contraction of blood-vessels and lowered heart-action,
possibly to direct action upon the multipolar cells, analogous to the action
of morphine. There is stimulation of the sympathetic and auditory nervea
(Gubler). With deafness there is associated disturbance of vision or tem-
porary blindness, due to extreme contraction of the arterioles and anaemia
of the retina, the optic nerve being perfectly white, resembling white atrophy.
This condition of the eye-ground is more or less permanent, but the function
of vision is restored. Amblyopia has been produced in an extremely-sus-
ceptible individual by so small a dose as 0.13 Gm. (or gr, ij).
Large doses lower or abolish the reflex excitability of the spinal cord»
Soon after being introduced into the stomach it diffuses into the blood and
may be detected in the urine, elimination taking place slowly and lasting
for several days. The quantity of urine is slightly increased in persons un-
accustomed to its effects; the uric acid is decreased and urea not constantly
affected. Medicinal, and especially massive, doses of quinine have, however,
been observed to cause a marked decrease in urea, and it is thought that
the diminished elimination of nitrogenous waste depends upon a depressant
influence exerted by this drug upon tissue-changes within the body. Full
doses of quinine may cause congestion of the genito-urinary tract.
Quinine probably escapes from the system by other routes, as it has been
detected in the sweat, tears, and milk of nursing women. It has been found
also in bile niid in dropsical effusions. In the blood, quinine arrests the mi-
gration of the white corpuscles and checks their amceboid movements; the
red cells are rendered less adhesive and their oxygen-carrying function is im-
paired. The experiments of Sokoloff upon rabbits show that quinine exerts
a favorable influence upon the healing of wounds. Inflammatory degenera-
tion of tissue is notably decreased. It probably tends to destroy infectious
micro-organisms in the blood and tissues. The pulse-rate is increased by
moderate doses, but larger ones (4 to 6 Gm., or Si-iss) cause lowering of the
pulse and of arterial tension. In animals death results from paralysis of
respiration after large doses of quinine. In the human subject very few
well-attested cases of death following the ingestion of quinine are on record.
Recovery has followed the use of such enormous quantities as 15.5 or 46.5
Gm. (or 5ss-i8s), though it is very probable that in such cases the entire
amount was not absorbed. In Bazire's case death was caused by 155.5 Gm.
(or Jv) taken in the course of ten days. In some patients various forms of
eruption have been noticed upon the skin, even purpura.* A scarlatiniform
eruption occasionally follows the ingestion of a small dose of quinine. In
other instances the eruption has resembled that of measles or erysipelas.
Desquamation is a sequence, and may be prolonged. The rash is often at-
tended by severe burning and itching sensations.
The artificial alkaloids derived from the cinchona bases generally exert
a more decided influence upon temperature than does quinine, causing a
reduction of several degrees even in healthy individuals. When injected
subcutaneously these substances also produce total ana?sthesia of the neigh-
borhood into which they are thrown. Cupreine is shghtly toxic, and doea
not occasion convulsions. Quinethyline produces tremor and the symptoms
' Cases by Dr. Frank Woodburv reported to State Medical Society of Pennsyl-
TUiia> PhUadelphia Medical Times, Sept 18, 1886.
OINCHOXA.
357
«l qniiuDe intoxication. Quinopropyline is th« most toxic member of the
IBM, and caosee a profound stupor.
Poisoning. — The toxic 6}Tuptonis produced by quintne and allied salts
are spoken of collectively as Cinchonism, which ordinaril}' is not allowed to
go further than tinnitus aurium. Where these symptoms are annoying, or
the patient is suffering from an overdose, the alimentary tract should be
cleared by a purge, and brandy and a cup of hot coffee administered, or a
doae of ergot. Where there is much irritation of the skin, urticaria, or ery-
thema, a warm bath containing sodium bicarbonate is useful; an hypodermic
injection of morphine may be necessary. Dilute hydrobromic acid (2 to
7^0 can., or f5sa-ij), given with ordinary doses of quinine, prevents the
oeoirrence of ringing in the ears or headache. Some patients show idio-
eyncraay to the effects of quinine; urinary irritation, even congestion of
the kidneys and hjemorrhages, may follow quite a small dose. Some, in-
deed, cannot take a single grain without great inconvenience from cin-
chonism. It must, therefore, be given with caution when cystitis is pres-
ent. Quinine will also, in some individuals, occasion decided irritation of
&e gastro-intestinal mucous membrane.
A case has been reported by Dr. Krannhals in which the administration
of 0.20 Gm. (or gr. iij) of quinine to a young woman was followed by high
ferer, bloody vomiting, and bloody diarrhoea. Erlenmeyer has recently de-
•cribed a case in which the nervous reflexes were greatly exaggerated after
the administration of a single dose of 1 Gm. (or gr. xv) of qiiinme, followed
br t Gm. (or gr. xxx) in broken doses on the succeeding day. Examination
of the patellar reflex at that time occasioned a series of general convulsions,
wilh riolent contraction of the arms and the entire body. Quinine is elim-
inated rather slowly and principally by the kidneys.
Therapy, — The application of powdered bark was formerly one of the
accepted methods of treatment of ulcers, but is now obsolete. A 1-per-cent.
aoiation of quinine sulphate is recommended as a topical treatment of slug-
fiah, unhealthy, infected wo\inds. The powdered salt, dusted upon chan-
csoide, has been found to promote rapid healing.
In hay fever a spray of cocaine, followed by a spray of quinine hvdro-
cUorate (0.3S Gm. to 30 c.cm., or gr. vi-f^j), used frequently, is highly rec-
omncjided. A solution of quinine, sprayed into the throat, is attended with
food results in diphtheria. Quinine has also been used as an injection in
fOBOTrhopa for its antiseptic action.
In cystitis, irrigation of the bladder with a 2-per-cent. solution preventa
doeomposition of the urine. The hypodermic injection of quinine is of great
ralur in pernicious malarial attacks and in sun-stroke. The best salts for
ikia purpose are the neutral hydrochlorate, the hydrobromate, or the car-
lamjd-hydrochlorate (hydrochlorate of quinine with urea). Injections have
alK> been made directly into a vein, in order to obtain prompt results. Dr.
J. R. Gilbert, of Dallas, Texas, suggests that life may be saved, in desperate
eaaea of malarial poisoning, by injecting 2 Gm. (or 3ss) of quinine into the
curclaticin, administering cardiac stimulants by the mouth simultaneously.
The tolntion should be freshly made and filtered and a perfectly-aseptic syr-
t«ge uaed, as otherwise abscess or septicemia, or even tetanus, may follow.
Tbe cryatallized bisulphate may also be similarly employed. Freshly-pre-
cipitsted quinine lactate, which is soluble in four times its weight of water,
9 well adapted to hypodermic use, giving rise to little pain. The crystallized
ttlt however, is soluble only in 16 to 20 parts of water.
358 PHABMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
As an ordinary tonic, in conditions of debility or convalescence, the
tincture of the bark, either simple or compound (the latter being more astrin-
gent), is more useful than the alkaloids, for reasons already stated, and be-
cause the alcohol in the tincture is synergistic. In cases of diarrhoea the
antiseptic action of cinchona is very valuable, and quinine is of service in
typhoid fever, especially during the second week; but it does not approach
the character of a specific, as it does in malarial attacks.
Some writers praise the action of quinine in summer diarrhoea and
cholera morbus, and suggest that it would prove efficacious in Asiatic cholera.
Professor FuUerton has strongly recommended its use in cholera, giving it
in doses of 1 to 1.30 Gm, (or gr. xv-xs) in the course of two hours at the be-
ginning of the attack. He values it likewise as a prophylactic remedy.
In ordinary chills and fever 1 Gm. (or gr. xv) daily of the sulphate, or
bisulphate, or 0.75 Gm. (or gr. xij) of the hydrochlorate or hydrohromate,
given in two or three doses, at least five hours before the time of the expected
paroxysm, will generally prevent its appearance, or greatly modify it. The
treatment should be continued for a week or ten days, diminishing the dose,
or suspending it, if cinchonism appear, but resuming the full dose at sep-
tenary periods, after the Appearance of the last chill, for a month or more.
The following prescriptions may be used in malaria: —
I^ Quirtinse eulphatis 8
Acidi Hulphurici arom 4
01, menth. pip.
Gm. or 3ij.
c.cm. or f3j.
30 c.cm. or mv.
c.cm. or fjj.
c.cm. or f5iv.
60 Gm. or gr. xl.
065 Gm. or gr. j.
30 Gm. or gr. xx.
13 Gm. or gr. ij.
Fluidext. glvcvrrhizip 30
Glycerini ..'..' 120
M. Sig.: A teaspoonful or two every three or four hours.
B Quininie Bulphatia,
Ferri pyrophos , aa 2
Arsenii trioxidi
Piilveris capsici 1
Aloini
M. et ft pil. no. xx.
8ig.: A pill three or four timea a day.
H Tinct. cinchonce comp l&Ol c.cm. or fBiv.
Tinct. nucis vomiL'se 4| c.cm. or f3j.
Fluidext. tjimxnci.
Fluidext. rhamntia pnrshinnie ia 60] c.cm. or fjij.
M. Sig.: A half to a tableapoonful in Mater three or four times a day.
A patient once poisoned by malaria may find it necessary to take a
course of quinine for several weeks each year, at the season when the attack
first appeared; and if unacclimated persons, wishinc^ to stay in a malarious
locality, or traveling through one at certain seasons of the year, will make
nee of the prophylactic action of quinine they may escape infection by taking
from 0.25 to 0.38 Gm. (or gr. iv-vj) daily. In somewhat larger <1ose cin-
chonine is considered preferable to quinine for this purpose. Tu children,
as well as in adults having a weak or irritable stomach, it is more convenient
to administer the remedy in suppositories of cacao-butter, on account of the
bitter taste and unpleasant effects on the difi:estion. The taste of quinine
is tolerably well disguised by sweet or vanilla clmcolate, or by coffee pi*e-
pjired with milk and sugar, the dose to be f(^II*iw(*d by a sip of coffee which
contains no quinine. Ringer states tliat an oqual portion of powilered gin-
ger conceals the taste of quinine. Boiled or mashed potatoes will also re-
CINCHONA.
359
o t«»te from the mouth. In enlargement of the spleen (jigue-cake)
qninine is ver\' rllicient. In intermittent fever it should not, as a rule, be
gitm during thp paroxysm, because its irritant action may increase the
D€rt<iU5 disturbance; but in other fevers pyrexia is no coutra-inclication to
its moderate um*. In infectious diseases, hfemorrhngic measles, small-pox,
diphtbem, and pyaemia, quinine, combined with alcohol, is the chief re-
liucc
This drug quite favorably influences the broncho-pneumonia of measles
■nd counteracts the tendency to caseous degeneration. It is a serviceable
RBwdj ic chiidren in lobular pneumonia dependent upon other causes.
Combioed with iron, quinine is very serviceable in erysipelas. Sixty-five eg.
(or gr. x) of quinine, given with Dover's powder, opium, or morphine, are
efficient in averting an attack of acute catarrh. The same quantity of qui-
■ine, given at the be^nning, will sometimes abort acute tonsiUitis and pre-
wnt the formation of pus. As quinine checks the principal phenomenon in
htfammation and suppuration, which is the escape of the white blood-cell,
■nd, bj preventing the exchange of oxygen by the red blood-celle, reduces
niflftminatioD, it is especially serviceable in pneumonia and other localized
inflanunations, and also in reducing discharge from abscesses and preventing
apneznia or pyiemia. Btirtholow considers that a larger dose (1.30 to 2.60
Gm., or gr. xx-xl) has the power, if administered during the congestive stage,
brfi>re rxndali'tn haj* ociurred, of sujipressing or modifying a croupous
pVM^uxuouia, pleurisy, or endocarditis.
In this country quinine is rarely, if ever, given in such large doses as it
kat been in Germany for the purpose of reducing high temperature in ery-
lipelas, scarlatina, or rheumatism, although Liebermeister regards it as being
a better antipyretic than the cold bath. It is not considered advisable to use
•Qcfa larg^e amounts in typhoid, on account of the inflammation of the patches
IB the small intestine, quinine being a gastro-intestinal irritant. In typhoid
and other fevers it may be administered in the following manner, especially
if the action of the heart be weak: —
FluidejctrAct. finrhonje 22
Tinct. cardanioin. comp 15
Spiritua eptherie comp 30
Tinct digiUlis 7
J^quce chloroformi ad 300
ccm. or f3vj.
c.cti). or f3iv.
ccm. or fSj.
c.cm. or f3ij.
ccm. or fSx.
»
Si^.: A htilt to a tableipoonful every three or four hours.
In whooping-cough, which is regarded by some as a parasitic infection,
its oae has been attended by much beneflt in comparatively large doses^ con-
joined with the local use of a spray of quinine solution (Henke).
In many disorders of atonic character, such as neuralgia, dyspepsia,
aight-aveats of phthisis, general debility, neurasthenia, quinine is highly
MaiiMabTf It is particularly valuable in those manifestations of neuralgia
vfaicb result from anosmia or malaria, and is well combined in the former
cmt with iron, and in the latter with arsenic, thus: —
B Qnininm lulphiitis.
iiMmme irrri mrVionatia aa 21 Gm. or Sea.
Kxt. nuci* votiiicA 20 Gm. or gr* iij>
Ext. brilndonmr folior. .... |065 Gm. or gr. j.
3IC. ei ft. pit no. xij. f]
Wig- ' A V^^^ three or four times a dny.
360 PHARMACEUTICAL THEKAPEDTIC AGENTS OH DEC08.
9 Quinince sulphatii 4| Gm. or Sj.
Sodii arsenatis,
Ext. ignatifle ale. aa |13 Gm. or gr. ij.
M. et ft. pil. no. zz.
Sig.: A pill three times a day.
Dr. St. John Hooea has called attention to the dangers of quinine^ on
account of its causing serious disturbances of the ear, even when taken
in small, though long-continued, doses. Professor Charcot, however, rec-
ommended the administration of quinine in M^ni^re's disease. His method
was to give 0.38 Gm. (or gr. vj) twice daily, at meal-time, for fifteen days.
The drug is then discontinued for eight days, when it is resumed in the same
manner. The noises in the ear and the vertigo may be aggravated at first,
but this effect soon subsides. Four or five such periods of alternate exhibi-
tion and discontinuance generally result in a cure. Many skin disordexB
and eruptions are due to malaria, in which quinine produces good effect, as
pointed out by the late Dr. L. P. YandelL In old malarial cases, the sul-
phate of cinchonine or cinchonidine may be substituted for the more expen-
sive quinine salts : —
B Chloroformi 2| c.cm. or mxxx.
CinchonidinflB sulphas 3|10 Gm. or gr. xlviij.
Tinct. cardamom, comp 7 5 ccm. or »ij.
Mucilaginis acacise q. s. ad 120| ccm. or fjiv.
M. Sig. : Take a dessertspoonful every four hours for malarial toxaemia.
Q Chiiio!dini 4
Cinchonidine sulph 2 (
PiperinsB
Cupri siilphat.
M. et ft. pit vel capsulflB no. xxx.
Sig. : One or two every three or four hours In severe malarial chills.
Other evidences of chronic malarial intoxication — as diarrhoea, dysen-
tery, jaundice, and chorea — disappear under the administration of quinine.
Intermittent hsematuria, when due to this cause, is cured by the judidont
administration of quinine. In view of its irritant effect upon the genito-
urinary system, quinine will sometimes excite or aggravate hsematuria in
those suffering from malaria. This fact should be remembered in the man-
agement of malarial hematuria; in fact, it has been claimed that the hema-
turia is really produced by large doses of this drug administered in the treat-
ment of the disease. Alexander Haig points out the fact that ordinary acid
sulphate of quinine contains 20 per cent, of xanthin, which is physiologically
and pathologically equivalent to uric acid, and which may therefore aid in
the destruction of red blood-cells and liberation of hsmoglobin, which is the
cause of black water. Small doses of quinine, temporarily employed, are use-
ful in cases of catarrh of the stomach, whether due or not to alcoholic excess.
Its action is aided by association with a mineral acid. Quinine is an excel-
lent remedy in aphthous ulceration consecutive to enterocolitis, and in the
yeasty vomiting produced by the growth of sarcina ventriculi. The same
agent is of utility in the treatment of ascarides and taenia, not so much, per-
haps, by virtue of a direct toxic influence upon the parasites, as correcting
+>»<> unhealthy condition of the intestinal mucous membrane, which favoza
• development. Tonic doses of quinine render excellent service in de-
m tremens. The laryngismus stridulujs to which rickety children are
Gm.
or Sj.
60 Gm.
or gr.
xl.
38 Gm.
or gr.
vj
13 Gm.
or gr.
ij.
CINCHONA. 361
subject is ameliorated by quinine hydrobromide. This salt is preferred by
Huchard^ in the treatment of grip, in which he gives from 1 to 1.40 Gm. (or
gr. XT-xxiJ) per diem, for the first few days, or: —
H Quininft hydrobromidi.
Extract! ergotee aa |10 Om. or gr. iss.
M. et ft. pil. Mitte taleB no. xxx.
Sig.: Six to ten in the course of the day.
In many skin diseases dependent upon lowered nutrition, — as, for in-
stance, acne, impetigo, or ecthyma, — small, daily doses of quinine are bene-
ficial. This remedy is of value as a support to the system auring the course
of a prolonged suppuration; and a full dose is prudently given before the
use of a catheter or bougie, in order to prevent the occurrence of a chill. It
is an excellent tonic in bronchorrhoea. Good results have been claimed by
certain French physicians from the use of quinine in acute rheumatism, but
the experience of most observers is unable to confirm these reports. It is
of more decided benefit in chronic rheumatism, especially when occurring
in aged or debilitated subjects. In these cases it is best given in conjunction
with the tincture of iron, or in the form of salicylate, or with potassium
iodide: —
R Quiniiue aulphatia 4 Gm. or 3i.
Tinet ferri chloridi 30 ccm. or fSj.
£lix. gentians 120 ccm. or fjiv.
H. Sig.: Two tcaspoonfnla three or four timei a day.
3 Potaaaii lodidi 27 Gm. or Svij.
Spiritus chlorofonni 7 6 ccm. or fSij.
Iinct. einchome comp 800 ccm. or fSz.
K. Sig.: A half to a tablespoonful in water three or four times a day.
Spedal Applioationi. — ^In obstetrics, quinine is valued as an oxytocic,
increasing the energy of the uterine contractions, though not capable of in*
citing them. The late Dr. Ellerslie Wallace approved of quinine in uterine
inertia during labor when it accompanies general muscular atony. In such
cases it increases the expulsive force of the uterus and greatly reduces the
danger from sepsis. Abortion has been produced by the administration of
quinine and strychnine as a tonic, the accident being attributable to the
utter agent. Quinine is also useful in aiding in preventing putrid infection
from the uterine discharges, in the treatment of so-called milk-fever (a mild
Bepticaemia) or milk-leg, and also in cases of uterine subinvolution after par-
turition. In small doses it stimulates the menstrual flow and acts as an
emmenagogue. In anaemic patients, it may be given combined with iron : —
^ Ferri et quinine citratis 41 Gm. or 3j.
OL tanaceti [60 ccm. or mT.
M. et div. in pil. no. xx.
Sig.: One four times daily, or two morning and night.
Warburg^t tincture is highly prized in England in fevers, and in shock
or collapse. Thirty ccm. (or fgj) contain 0.65 Gm. (or gr. x) of quinine, in
combination with aromatics, half of this quantity being given at a dose and
■BvIUtln de I'AcadHnie de M44ecine, Paris, Feb. 27, 1900.
362
PHABaiACECTICAL TUKRAPEUTIC AGENTS OR DHUGS.
the remainder in three or four hours.' Its administration is to be preceded by
a brisk purgative. In severe cases of poisoning by malaria, large doses are
absolutely necessary to save life when given by itself, but when given in the
above combination much smaller quantities are found to answer the purpose.
Cinchonidine is useful in malaria. The Therapeutiscke Wochenschrifi
(Jan. 12, 1900) gives the following formula for internal use: —
B Cincbonidine sulph 1
Acid, tartarici
Mist, acacia? 120
M. Take in the course of the day., in three or four dosea.
Gm. or gr. xv.
75 Gm. or gr. xij.
ccm. or Jiv.
For subcutaneous injections the formula is: —
^
XT.
Gm. or gr.
80 Gm. or gr. xiij.
ccm. or mxlv.
li Cincbonidine flulph. 1
Acid, tartarici
Aq. destill 3
M. Each ccm. of this solution contains 0.25 Gm. of cincbonidine. A daily
of 1 Gm. (or gr. xv) cincbonidine by Uie luoutb ia usually Buflicieut, but 1.20 to
Gm. (or gr. xviii-xxij) can be taken without detriment.
dOM
1.40
Cinchoninc lodosxilphate is the precipitate resulting from the addition
of a solution of iodated potassium iodide (Bouchardat's reagent) to a watery
solution of the cinchonine sulphate. It is collected and washed free from
iodine, and dried. The resulting product is an amorphous, impalpable pow-
der, of a brownish color, without odor, insoluble in water, though soluble in
alcohol or chloroform. The dose of this preparation is from 0.065 to 0.32
Gm. (or gr. i-v). The interesting point in connection with it is that it con-
tains 50 per cent, of iodine. M. Ivon- has recently coinplrtod soine studies
upon the antiseptic qualities, made with this agent, which, on account ^f its
effects, he styles Antiseptol, and recommends as a substitute for iodoform
on account of the low price and superiority as a surgical dressing.
Cinchonine iodosulphate^ or antiseptol, has the action of the two sub-
stances that enter into its combination, being at the same time free from the
toxic effect^ which follows sometimes from the use of iodoform. Extemallj,
it has beefi used by the wiiter for its antiseptic action with excellent results,
^ Tbe National Fomnilnry 1ms tbe following formula for Warburg's tincture
(without ttloes), under the nnme of Tinctura Antipcriodica (N, F.) : —
B Rbubnrb,
Ang-elica-seed aa 36{ Gm. or 5j av. gr. Ixxxviii.
ElM'ampnne,
Saffron ,
Fennel .aa 18 1 Gm. or gr. ct-lxiv.
Gentian,
Zwloary,
Cul)eb,
Myrrh,
^\'bite agaric,
Camphor aa 9\ Gm. or gr. cxxxii.
Quinine sulphate lOOi Gra. or fiij ftv. jrr. oxiviii.
Diluted alpohol to make oOOOj ccm. or 10 pints.
This preparation, imule without aloes, U intended to serve as a stock tiuc-ture
from which rojn^Inr Warburg's tincture is to be mnde. when required, by adding IV4
per cent, of tincture of nloea, to the preceding formuln. "Warburg's tincture without
aloes" is often prescrilH'd.
»i^ Progri's Mcdicoi, July 12. ISOO.
vspeoallj in the treatment of chronic ulcers^ sinuses, abrasions, lupus tuI*
fam» mbBCCMca, chronic acne, and various inflammatory thickenings of the
■■tgfumgpt. The following fonnulie may be recommended: —
1^ CfachonmR iodosulphatis 41 Gm. or 3j.
T7a(i. zioci oxidi 3l| Gm. or 3j-
IC Far chronic acne, ec£emA, and psoriasis.
B Cincbonintt iodoeulphatia 4 Gm. or 5j.
Ol eucalypU 60 c.cm. or mx.
Adipjs lanift hydrosi 31 Gm. or Sj.
H. For •jphilis. chronic ulcers, and eczema.
Contrm-indications to the use of quinine consist in: —
1. liiiosTiTicrusy, where severe tinnitus auriuiii, headache, ekin erup-
or purj>ura, are caused by small d<-*es, and where this cannot be over-
br the u?e of bromide?, ergot, or arsenic.
2. Acute inflammation of the genito-uriuary tract, or congestion of the
bdaeys.
3. Acute inflammations of the gastro-intestinal tract.
4. Inflammation of the middle ear and dullness of hearing (nervous
5. Infants sufFering with eczema.
It is stated on the authority of Brown-Sequard and Albertoni that
^Bttirit* find cinchonidine increase the freouency of epileptic convulsions.
tmparative antiperiodic rahie ol the alkalosis was thus estimated
^ '■ .. ;nw: "(^uinidiue is first as an antiperiodic; quinine comes next,
nine requires about twice the dose in order to equal quinine. Cin-
tcntmioiDe is a little stronger than cinchonine. Amorphous chinoidine is
[■jhcwit on^^fourth the strength of quinine." In the Tnitod States army, the
by** Mierally given the preference over tlie sulpliate on account
<rf . , i>ihty. The hydrobromide and valerianate are supposed
ti came less nervous irritation in susceptible subjects than the other salts.
IV addition of a few drops of dilute sulphuric acid to quinine sulphate,
vbra in epilation, makes it much more soluble; or the bisulphate may be
inscribed in pill form. The acid hydrochloride (B. P.) is useful for
ktpnd^rmie injection; but contains one-tenth less of the alkaloid than the
kvdrcM : ' ' The borate, carbolate. and salicylate have been introduced
■i *»!>•- i-vieeable in neuralgia. Quinine sulphovinate is a very solu-
Ut «ii: ng only twice its weight in water to <lis8olve it, and may be
WtA b 'licaily. M. Grimaux lias recently succeeded in producing
maam neir double salts of quinine, the hydrochlorosulphate, the hydriodosul-
phat«, and the correspond intr phosphates.
The hydrochlorosulphate is a granular, grayish-white, amorphous pow-
far and has an extremely bitter taste, is soluble in its own weight of water,
itaqnal in strength to the sulphate, than which it is more rapid in its action
M account of being more readily absorbed. The physiological and thera-
■vutical effects are the same as those of the sulphate. Its solubility renders
k particularly serviceable for hypodermic use.
(Saehonamine, a new derivative of quinine, has been studied by M.
Afaind, who finds that it has as marked an effect and is more soluble than
L Cinchonaroine is obtained from cuprea-bark. It is said to be six
364
PIIAEMACEUTICiX THERAPEUTIC AGENTS OR DRUGS.
times more toxic than quinine, is endowed with only slight antiseptic power;
but reduces abnormal temperature, and may be serviceable in malaria. It ia
said to exert a decided sialogogic influence.
Clinical experiments with the salts of the synthetical alkaloids have
been carried on by Profc-ssor Bourni, of K<x4iofort. The liydrochloride of
cupreine is efficient in malaria, but must be given from the bep^inning in
doses of 1 to 2 Gm. (or gr. xv-xxx). This salt produced no ill effects. It was
without influence upon the pulse. The sulphate of quinethyline appears to
be superior as an antiperiodic to quinine. It was employed in maximum
doses of 0.75 Gm. (or gr. xij). The sulphate of quinopropyline is the most
energetic member of the series. In a case of typhoid fever it produced a
marked reduction of temperature. A dose of 0.50 Gm. (or gr. viij) gave rise
to buzzing in the ears, vertigo, nausea, and general malaise. It is active in
about half the dose of quinine*
dnininee Tannas, — The tannate is sometimes called "tasteless quinine/'
because the bitterness is almost entirely overcome by the combination, and,
also, largely because of insolubility of the salt. Although insoluble in water,
it is soluble in the acid gastric juice, and when administered with food, or
soon afterward, it answers equally well with the other salts. In the com-
bination with sweet chocolate, all objectionable taste is overcome, and, made
into troches, or compressed tablets, each containing 0.065 Gm. (or gr. j), we
have a sort of confection: probably the very best form in which to administer
quinine to children. It may be made extemporaneously: —
H Quinince 1
Acidi tannic!
Syrupi cinnamomi 90
M. Each teaspoonful contains 0.065 Gm. (or gr. ;} of quinine,
sulphate is used, the tannic acid must be doubled.
65 Gm, or gr. xxiv.
75 Gm. or gr. xij.
com. or fjiij.
If the quiniiw
B Quininte hydroohloridi 1|55 Gm. or gr. xxiv,
Acidi tannici,
GlycyrrhiKin. ammcniat aa |76 Gm. or gr. xij.
M. et div. in chartulte no. xij.
Sig.: Three daily.
4
Regarding the method of administration of this very bitter agent, sev-
eral devices are adopted to enable patients to take it, among the best of them
ia the gelatin- or sugar- coated pill, the hard capsule, cachets de pain, or
conseals. The following mixture is an agreeable method of administration
in solution: —
^ Quininie sulphatis 113 Gm. or gr. ]j.
Acid, citric [38 Gm. or gr. vj
SjTupi aurantii florum 4| c.cin. or f3j. — ^M.
This is to be placed in a wine-glass containing sodium bicarbonate, 0.20
to 0.32 Gm. (or gr. iii-v). in saturated solution, and then drunk during effer-
vescence. The National Formulary provides a good vehicle in compound
taraxacum elixir: —
H Quininse aulphatia 1155 Gm. or bt. xxiv.
Elixir tarA.\aoi eomp. (N. F.) 90| c.cm. or ftiij.
M. Sig.: A teaspoonful to t tablespoonful. according to circumstances.
'La Tribune M^icaU. July 6. 1894; The Medical Bulletin, Sept., 18M, p. 349*
CINNAMOMUM.
365
An adult can take a powder of quinine in a dessertspoonful of Bjrnip
of rtd orange, or syrup of wild cherry, without experiencing much unpleasant
Some prefer to take it in a little whisky and water. Other prepara-
rhich may be used with more or less success in order to disguise the
of quinine are cascara cordial and the aromatic syrup of verba santa.
When given in powder, quinine may be rendered nearly tasteless by rubbing
nwith one-fourth its weight of ammoniated glycyrrhizin. The ammoniated
tfizxr of glycjrrhizin is also a good excjpient for the sulphate, which is sus-
#qi4^ in the mixture. No acid should be added when the extract is used.
xfce Bfugar-coated or gelatin-coated pills are most commonly used, and, if
l^jperh' made (and it they contain the full amount of the drug), they an-
OTCT, if not too t]T\ and hard. In cases of irritability of tbe stomach and
farrfafBa it is better to use the drug in the form of a solution. Ciuchonine
M^Aate may be serviceably employed instead of quinine, especially in the
tnatment nf children. Cinchonine is effectiml in malaria and does not
sociaoci buzzing in the ears, though it gives rise to a sensation of dr^^uess
■ tbe node and mouth and may cause paresis of acommodation with altera-
tion in tlie size of the pupil.
The tannate of quinidine is also almost tasteless and may be used with
adtutage in dyspepsia, diarrhoea, and nephritis.
£Qquinine. — By the action of ethyl-chlorocarbonato on quinine, accord-
ing to von ^oordeu,' quinine carbonic etlier is formed^ which possesses the
csratiTe properties of quinine without its bitterness, or producing nausea,
aowTT in the ears, depression of spirits, etc. It has been therefore called
Bl^niniin It is a crystallizable substance, sparingly soluble in water, but
ft^ilv soluble in alcohol, ether, or chloroform. The chloride of Euquinine,
bafvrrer, is easily soluble in water. Euquinine may be given in sherry-wine,
MsBl, or coca. The dose is 0.12 to 1 Gm. (or gr. ij-xv), which in healthy peo-
ple produc-esi no effect. Beneficial results have been reix)rted in febrile states
«Dd in "whooping-cough. It reduces temperature in pyrexia. In supra-orbital
•miml^a, ine effects were especially good. It is jriven usually in powder
fcfm. St. George Uray.' of St. Lucia, West Indies, has found very good re-
■Ita in malarial fevers. He denies the statement made by others that it
•in not cause cinchonism, as he had experienced tinnitus aurium, deafness,
^hd other phenomena, just as from quinine. He considers it a more power-
tn] antipyretic and antimalarial agent than quinine itself.
CnraAMOMUM (F. S. p.).— Cinnamon.— Two kinds of cinnamon
m oflBcially recognized by the United States Pharmacopa?ia : Cinnamo-
snoD Saigonicum (U. S. P.), Saigon Cinnamon, the dried bark of an un-
tecnnLnc<) species of Cinnamomum (Lauracca?), and Cinnamomum Zey-
ksiram (U. S. P.), Ceylon Cinnamon, the inner bark of the shoots of Cin-
aamcmium zeylanicum (Laurace^e).
dHHAMOMI CORTEX (B. P.). — Cinnamon-bark. The dried inner
isrk of ahoots from the truncated stocks of Cinnamomum zeylanicum, Ob-
tatDcd from cultivated trees. Imported from Ceylon and distinguished in
SB Ceylon cxnticmon.
• CfmtraihUitt fur innfre Mfdicin, Nov. 28. 1807.
'TMe British iitdieal Journal, F«b. 26, 1808, p. 651.
366 FHAa^ACECTICJLL XHEEAPEUXIO AGENTS OR DRUGS. H
^ Preparations. ^*
Pulvis AromaiicuB (U.S. P.). — Aromatic Powder (cinnamon, ginger, aa 35 parts,
cardamom and nutmeg, aa 15 parts). Dose, 0.32 to 2 Gm. (or gr. v-xxx).
FluidextrtH-tuiu Aromaticum ( L". S. I'.). — Aroniiitic Fluid Exlnut (aromati
powder exhausted with alcohol, 1 Gm. :^^ 1 ccm.). Dose, 1 to 4 c.cm. (or mxv-fSj)
Oleum ('inniimomi (U. S. P., B. P. I. — Oil of Cinnamon. Oil of Cassia. Dose, 0
to 0.18 c.cm. (or mi-iij).
Cinnaldehydum (I*. S. P.). — Cinnaniio Aldehyde (obtained from oil of cinnamon^
or prepared sjTithetioally, contains not les^ tlmii U5 per cent, of pure cinnuniic uldeJ
hycfe). DoBG. about the fiiame as the oil. I
Tinctura Cinnamomi (U.S. P., H.P.I. — Tincture of Cinnamon. Dose, 4 to IS
c.cra. (or f3i-iv). B. P., 2 to 4 c.cm. (or fSss-j). j
Aqua Cinnamomi (U.S. P., B, P.). — Cinnamon- water. Doee, 15 to 120 ccm, (or
fSss-iv ) .
Spiritua Gnnamomi (U.S.P., B.P.). — Spirit of Cinnamon (10 per cent, of oil)J
Dose, 0.06 to 4 c.cm. (or mx-f3j). B. P., 0.30 to 1.20 c.cm. (or mv-xx).
Pulvis Cinnamomi Compositus (B. P.). — Compound Powder of Cinnamon (cinna*J
mon, cardamom, nnd gin^r. equal parts). Dose. 0.65 to 2.60 Gm. lor gr. x-xl). 1
SjTUpua Aromaticus (B. P.). — Aromatic Syrup (tincture of orange and cinnamon-!
water, each, 260 c.cm.; syrup, 500 c.cm.)- Dose, 2 to 4 c.cra. (or fSss-j). I
The following U. S. P. preparations contain cinnamon as a constituent: Aro-1
matic sulphuric acid, compound tincture of cateehu. compound tincture of lavender,!
syrup of rhubarb, aromatic tincture of rhubarb, aromatic syrup i>( rhubiirb. compound'
tincture of cardamom, chalk mixture, and wine of opium.
(For Cinnamic Acid see Styrax.)
Pharmacology. — Cinnamon is the inner bark of the shoots of Cinna-i
momum /evlaiiicum (Cevlon cinnamon), or the bark of an undetermined]
species of Cinnainonmni (Saigon rinnnnion). The hark of several undeter-
niineil speoi^^s of Cinnainonuiin >:rown in China (Cinnanioniuin caf?sia, Cas^!
gia cinnanum, ^n- Cliiiu'se oiiuianion) U also used, but is not now officialJ
Tho British PhannamimMa specifies tlie source as cultivated trees from'
Ceylon. Besides the volatile oil, which is u?ed for flavt>ring purposes, cinna-
mon contains tannic acid, niut-ilape, tMdoring inatler, an acid, and iJgninJ
The oil consists almost eiitirely of cinnaldohyde.
The Ceylon cinnamon is the choice variety, but the greater portion of
this valued epice brought to this country is the cassia cinnamon, the flavor
of which is less sweet and more pungent and astringent. The physiological j
properties aie the same. '
Physiological Action. — Cinnamon is an aromatic, with considerable i
astringcncy. It acts as an hamostatic, not so much through its astringent
constituents as by virtue of the volatile oil, which may be used efficiently
alone.
Therapy, — In cases, especially among children, where counter-irritation ^
is needed, the use of spice jdastcrs 18 recomniended, as in croup, colic, neu-
ralgia, etc. They can be obtained already prepared for use. or may be pre- '
pared extemporaneously by placing aromatic powder between two layers of |
flannel and moistening it with hot whisky. As a stomachic, in flatulence
and feeble digestion, cinnamon is of some value, but its carminative effect
is most frequently utilized in combination with other remedies, especially
purgatives, to prevent griping. It is of service in diarrhoea, as in the chalk
mixture, to which other agents may be added: —
3 Bismuthi salicylat j066 to 120 Gm. or gr. i-iij.
MiaturBB cretffi 4| c.cm. or tZj.
M. pro dofli.
For irritative diarrhoea of infants, especially summer diarrhoea, this dose to bvj
repeated according to urgency every hour or more.
d
GIKNAMOMUM.
367
Finely-powdered cinnamon, gixen in doses of 4 to 6 Gm. (or 3i-ias), moni-
isf: and CTening, is said to be an efficient remedy in acute dysentery. It will
•t tiaaea be found capable of allaying nausea and vomiting, or even of reliev-
ing WMirirlmfrn. In passive uterine haemorrhage we may give an extempo-
xuwovis infoflion in milk, or give the oil upon sugar. The oil may also be
■litised, at least as an adjuvant, in pulmonary haemorrhage.
Dr. J. C. Ross claims that large doses of cinnamon, internally admin-
Mcsed, are of value in the palliative treatment of carcinoma of various in-
ttmal organs. He states that pain is alleviated, the odor decreased, and the
gawial condition improved. Dr. Ross directs that from 11 to 13 ounces of
Cfjlon cinnamon be placed in 3 quarts of water, boiled down to a quart, and
deeanted without filtering. Of the mixture a pint is to be taken every twenty-
Irnrr hours.
\';i: 1' us vegetable essences have been shown by M. Chamberland to pos-
-^- ••! V juarked antiseptic power. The oil of cinnani'jn has bet-n utilizoa by
H. Locaa^Cfaampionni^re as a surgical dressing. Employed in full strength
it is Terr irritant, but dissolved in retinol to form a pomade it constitutes an
«seeUent application to sutured wounds after operations. Dr. J. Chalmers
r^ Coata, of Philadelphia, recommends the oil of cinnamon as an injection
i& gonorrhoea. He first cleanses the urethra by diluted hydrogen dioxide,
Aer which he injects the oil of cinnamon dissolved in one of the liquid-
prtrolenm preparations. The solution is made of the strength of 0.06 c.cm.
to 30 c.cm. (or fni-f5J) on the first day, 0.12 c.cm. to 30 c.cm. (or mii-f5j) on
the aecond day, and thenceforward 0.18 c.cm. (or miij) to the same quantity
of TneTt<*truuiiu Inhalation of a spray containing the spirit of cinnamon
i* wd by Dr. Capsus to be of decided service in all forms of malaria, cases
vhich had proved unamenable to quinine and arsenic improving within a
liars. The following are useful formulae for antiseptic ointments : —
B RetiDol
r^ne eterilisat.
CinruUdehvdi ....
701 Gm. or 3u3ij.
23 4 Giu. or ovj.
ll cctn. or mxv.
H Retinol
IVl;r 9>lrTili£iit.
Cinxittl'Jehydi-
BcttBoL «i cenr
OM nniumonii
Olei r>rigHni,
des gvmnii .
70| Gm. or 5ii3ij.
23|4 Gm. or 3vj.
11 c.cm. or tnxv.
1( Gm. or gr. xv. — M.
03|3 Gm. or 5iij-
ll c.cm. or mxv.
aa 2!50 c.cm. or mxl.
. . . 2| c.cm. or mxxx. — M.
. . 03|3 Gm. or Jiij.
aa l|55 c.cm. or mxxv. — M.
J. Hilton Thompson claims that the oil of cinnamon is of great value in
tbc treatment of pulmonary tuberculosis when administered by inhalation.
T^ patients like the odor of the oil, and will wear the inhaler almost con-
Uwinuly, In ««ltlition he givrs tonic ronie<li(»s. and conlinuoa tho treatment
nMDths. Under this method of administration the bacilli become lesa
368
rilABALlCEUTIOAL THERAPEUTIO AGENTS OR DRUGS.
Several cases showing marked
4
HUDierouB and all the symptoms improve,
benefit are reported.^
COCA (U. S. P.).— Coca.
C0C2E POUA (B. P.).— Coca-leaves.
Preparations.
Fliiidtxtractura Cocab (U. S. P.).— Fluid Extract of Coca. Dose, 0.00 to 4
ccm. (or inx-fSj).
Cocaiiire 11 vdrocliloridum (U. S. P., B. P.). — Cocuine Hydrochloride. Dose,
0.015 to O.OGo Gm. (or gr. Vd).
Ejttractum Cocib Liquidum (B.P.). — Liquid Extract of Coca. Dose, 2 to 4 ccm.
(or fSsa-j),
I oniinft (U. S. P., B. P.). — Cocaine. Dose, 0.015 to 0.03 Gra. (or gr. V. to >/,).
Oleatum Cocainse (IT. S. P.), — Oleato of Cocaine (contains 5 per cent, of cocain«
oleatc in ulivo oil). Used ub a local uniesthotic. ,
Viniim CorjB (U. S. P.). — Wine of Coca (roiitaius fluid extract of coca, 0V« per
cent.j in red wine}. Dose, 30 to 60 ccm. (or f5j-»j)- I
Ungiientiim Cocainfc (B. P.). — Ointment of Cocaine (4 per cent.). '
LamellHB Cocainte {B. P.). — Discs of Cocaine (each contains, of cocaine hydro- i
chloride, 0.0013 Gm., or gr. V»).
Injectio Cocainse Hypodermica (B. P.). — Hypodermic Injection of Cocaine (10 I
per cent.). Dose, by subcutaneous injection, 0.12 to 0.30 ccm. (or mii-v).
Troohiscus Krameri® et Cocainm (B. P.). — KrHnipria and Cocaine Lozenge (con-
tains of krameria extract, 0.065 Gm., or gr. j; cocaine hydrochloride, 0.003 Gm., or
gr. V»). ]
Pharmacology. — Cocoa is the dried leaves of Erythroxvlon Coca, La- :
marck (Erythrnxyloneap), a small tree of Peru and Bolivia, known com-
mercially as Huanuco coca, or of E. Trnxillensc (Rusby). knoAvn com-
mercially as Truxillo coca, peldinp-, when aiisnyed by official proce^.s not
less than O..^ per cent, of the ether-snluble alkaloids of coon. It contains
a cn'stallizablo alkaloid, Cocaine (which has hopn nscortained hy Loosen to
be methyl-benzoyl-ecgonine), besides oilier aikaloidnl derivatives of ec^o- >
nine. It also contains wax, Coca-tannio acid, nnd a t-oncrete, volatile, odor-
ous substance. Tropaeocainej nn iinfllocjotis rtlknlnidnl oonipnund. has l)een
found by Giesel in the tsmall-lenved coca-phmt of Java. It is ]^rn]>uble tliat
the fresh leaves contain a volatile principle of considerable physiological
activity, which is lost after a sGA-voyagc, by pnrtial fermentation and dry-
injr, as maintaineil by Dr. H. H, Eusby. They also contain coca-tannic acid
and some oil, aromatic and coloring matters, etc.; but cocaine, after all, is
the most important constitnent. As cocaine is decomposed into hen7oic
acid and ecgonine by the action of mineral acids, these should not be pre-
scribed with the fluid preparations made from coca-leaves. A precipitate
also results from a mixture of the sohitious of sodium bromide and cocaine
hydrochloride. The f-alt?' of citcnine iire incompatible with those of mer-
cury. A mixture of cocnino and menthol is said tr» form a very irritant com-
bination. Cncnine nnd silver nitrate are incompatible.
Fhyfliological Action. — Coca and to a marked degree cocaine cause local
numbness or ansesthesia when applied to mucous membranes and when in-
jected hypodermically. When cocaine is applied to the conjunctivae, sensi- '
bility is reduced, the pupils become dilated, and the accommodation im-
paired; it constricts the blood-vessels, diminishes the intra-ocular tension, ,
^British Mcdicai Journal Nor. 7, 1896, p. 1374,
COCA.
3G9
enlargement of the palpebral fissure and protrusion of the G3'€ball.
It occasions an irregularity' ut the curneal surface, or haziness, which does
Dot appear, however, to depend upon loss of epithelium. When applied to
the loBgue, it causes numbness and loss of tactile sensibility without affecting
dw moTeznents. The application of cocaine to the pharyn:c, or larynx, and
waml chambers, reduces the sensibility so as to permit manipulation or opera-
txon, and also by its effect upon blood-vessels reduces congestion and inflara-
aation. Taken in small doses frequently repeated, coca acts as a general
tonic and prevents waste. In somewhat larger doses it is a nerve-stimulant,
increafiing the blood-supply to the nerve-centres, improves the digestive pow-
tti» increases the force of the heart's action and arterial tension by its in-
npon the vasomotor centres and cardiomotor ganglia. It also gives a
of well-being that enables the organism to bear more fatigue and tn
in the powers of the body with less food or less sleep than usual. Coca
the flow of urine, but the quantity of urea is lessened; it thus acta
»m tn indirect food by preventing waste. After an overdose the pulse becomes
ap»d and weak, respiration is labored and shallow, and oppression of the
ta complained of, with threatening collapse, clammy skin, hallucina-
and delirium. Clonic convulsions of cerebral origin are occasioned
the bodily temperature markedly increased. Death is due to the paralysis
' rftlic heart, the spinal centres, or the centres in the medulla. Diarrhoea is
pradBGed by large doses, with headache (Hammond). According to the
itttdiea of 31. Maurel, coca has an action upon the leucocytes, causing them
to become globular and rigid and to lose their property of adhering to the
vails of the vessels. In this manner thrombi and emboli are formed and
death t£ apt to result from pulmonary embolism. Oley has ejcperimentally
determined that the liver diminishes the toxicity of cocaine. In some cases
of poisoning from cocaine, albumin has been found in the urine.
Poisoning. — The treatment is the same, generally speaking, as for toxic
I ^Dtca <' ne. Morphine, atropine, chloral-hydrate^ paraldehyde, sul-
phantti' .imyl nitrite, chlorofuim, alcohol, and ether are physiological
antidotes. Strophantliin, or strychnine, may be given hypodermically, for
baart weakness.
I Ammonia and digitalis may likewise be made use of in order to coun-
H|^Dct the milder toxic manifestations of cocaine. In severe cases Dr. S.
^^^Krholl hag employed with service a large teacupful of clear coffee, which
^^^E be -^ered cold orhot/ In some cases toxic effects have apparently
^^^Bn 1^; :. with great depression and imminent collapse, by extremely
r aiante doses, as where cocaine is used as a mydriatic, or applied to the
I thn^-t TM^Ae, or urethra. They can only be explained by idiosyncrasy, and
ii tb^ ms usually promptly disappear after the administration of stira-
'he inhalation of ammonia or ether. A form of protracted acute
has been lately described by Hallopeau, who has, in several in-
ed the injection of a single small dose to produce distressing
ch may endure for several months. The symptoms bear much
biaut^ to those which immediately follow the injection, and consist,
above «n. t'f persistent headache, accompanied by profound malaise, insom*
■it, nil ■ 'f the limbs, vertigo, syncope, mental excitement, and loquac-
ity,* i: lonaily happens that the application of cocaine solution to
•W€9trrti yrdicnl Reporter, Sept.. 1862.
•Lm Tri^mmfi JUNicate, Dec 4. 1890; Medlcnl BuUetin, Jan., 1891.
3t
370
niAUSlACl-LTRAL TUliUAl'KL TIC AUENTS OH DItl'OW.
certain portions of the mucous membrane is followed by great muscular re-l
laxatioD, a weak pulse, dysphagia, and pharyngeal paralysis without loss of
consciousness. This condition has terminated fatally in a few cases when
the amount of drug absorbed could have been only a fraction of a grain, and,
therefore, the result was in some manner caused by reflex action and pos-
sibly was partly psychical in ita nature. The parts most susceptible to the
action of cocaine appear to be the middle turbinate bone and upper fossa of
the nose, and the male urethra. A case of serious poisoning; following the
injection of cocaine solution into the urethra for dilatation of a stricture is
reported by "Brennan,^ when morphinr, nitroglycerin, and ainnionin were
used fis antidotes witli sutrcss. Mrtpian has called att^ntiun- to a peculiar
disorder of sensation attending chronic cocaine poisoning. It is a feeling
as of foreign bodies, grains of sand, worms, or microbes under the skin in
any part of the body. This has been called Magnan's symptom. There is
a generally recognized danger of forming the cocaine habit, and examples are
not wanting of unfortunate cases of this kind among members of the medical
profession. Cocainisin, the result of constant use of this drug as a stimu-
lant, ia met with, especially among neurotics and degenerates; possibly
the addiction may be, in some cases at least, the first manifestation of in-
sanity. In a large number of cases, moreover, those who fall victims to the
cocaine habit are also addicted to the use of morphine, the double intoxica-
tion leading to the most serious deterioration of health. Appetite and
strength decrease, tremors, and hallucinations occur, and insanity may finally
supervene. Medicinally, cocaine addiction is most successfully treated by
large doses of chloral-hydrate, or potassium bromide in combination with
chloral. Coeainc is eliminated by the kidneys, much of it, however, being
oxidized within the system.
Therapy. — Tbo introdurtion of cocaine as a local aiuvstln'tic is due t<>
Dr. KoIltT. who first called attcutioii to its us(f\ilness in eve-surgery in
IKS-f. Its iufluc'iu'c in causing local iina^iiiia and dilalation of th(^ pupil hav-
ing been diSi-overcd, it has becronic one of tho rancssary drugs in cyt'-pructice
(a 4-per-cent. solution being the usual strength employed, as first recom-
mended by Koiler). Anaesthesia of the conjunctiva results in fmni one to
five uiinufcs after instillation of c^Haino. Th(^ connjlctcd <1ilatation of the
pupil does not occur until ten or twenty minutes after the instillation; it
continues for about nn hour, and then gradually disappears. Though im-
paired, the accommodation is not entirely paraly/cd. and it returns even
while the pupils n-uiain dilatid. The conditions of the cvi' in which
rocaine is particularlv apfiliciildo are diseases of the cOujuiR'tiva and
cornea, accompanied by pain and i)Iiotopliobia. By its liK-al anaesthetic
properties it facilitates many of the operations u|>on the eye. The removal
of foreign l»odics imbedded in the I'ornea. the excision of pterygium, the
cauterization of corneal ulcers, dilatation of the lacr>Tnal canal : the opera-
tion for strabismus, staphvlonuu or chalazion ; iridcctomv. and extraction
of the lens arc now all n(co!ii|)li.<lu'(l by tlu- nid of c(H'aiuc ana»fitliesia. When
u«h1 too freely, it [iroduccs a steamy condition <if the cornea.
According to IM-. Arthur O. Hobbs. nf Atlanta,*' cocaine should never be
* .Vruj York Mcdiro J Journal, Nov. 19. 1S9H.
* .V iinr/if nrr mrdiriniHchr Worhrttift^hnff, ISfllt. |i. 1175.
'T)iP l'«pR ninl AhuHM of rofiiinp. with Kf'fi*r»Mu*f to MucrniH McmbrflJU'* K'spe- j
daily." The Southern Medical Record, Kov., 18P2.
COCA.
371
\tstd vhen an abrasion of the cornea exists. He regards it as contra-indicated
ftke in any corneal inflammatioD, and thinks that it should not be prescribed
bejood the acute stage of any form of conjunctivitis. It is not so well
adapted for use when enucleation of the eyeball is to be performed, though
this operation may be done when the alkaloidal solution is injected deeply
arooDa the orbit. Mr. Leahy has found cocaine serviceable in gonorrhoea]
ophthalmia. He incorporates 0.03 Gm. (or gr. bs) of atropine sulphate and
0-2-> Gm. (or gr. iv) ot cocaine sulphate in fi.r»0 Gm. (or gr. c) of petrola-
tmn (oknc acid or lanolin is perhapss a better vehicle to favor the absorption
of Iht* drugs incor|M5rated). and a])plics the mixture bpuoath the upper lids.
Dr. P. Richard Taylor, of I>niisviiU\ osti'cins tocaine as superior tn the
iDydrijiti<te usually employed in the treatment of iritis. Hp juivijies its use
IB a ciMuvntratod form, as its effects in o(»ntracting the vessels limit its
alMorptkin. He is accustomed to employ a 35-per-cpnt. watery solution, or
an (MUtinent c-om[>oped of 25 prtrts of cocaine to 100 parts of petrolatum.
The tablets or discoids of cocaine now supplied by manufacturers are useful
IB making extemporaneous and perfectly sterile solutions of any desired
ftPfD^h.
In aural surgery, a solution of c^fcaine may be introduced within the
auditory canal for the relief of acute and chronic purulent otitis, ulcers of
the caBaK of to facilitate operative procedun^ within the tympanic cavity.
Albert Gray, previous to paracentesis of the membrana tympani. uses a
^ or K»-{KT-<x'nt. solution, in equal parts of alcohol and anilin oil. Cocaine
appli«<<l to the lower nasal passages and tlie orifice of the Eustachian tube
w A raltiahle assistance in catheterization of the tube through the nose.
I>r. Ticano has reported a case in which a few drops of a o-ppr-ccnt. solu-
tkm of <xx*aine introduced through n catheter into the middle ear soon
'•miting and diarrh(T?a, which continued for several hours. By
'U of this remedy to the mouth of the tube, the inflation and
iBJcction of remedial liquids into the tube and the middle ear are rendered
tench easier of performance. Bonain's local anaesthesia comprises the anaes-
thcaia of the external surface of the tympanic membrane with a mi.xture of
phmoU menthol, and ct>caine hydrochloride, aa 1 Om. (or gr. x\) ; or 2 Gm,
(or 3«) of the phenol to 0.5 or 1 Gm. (or gr. viiss-xv) of the other ingredients.
7"r nial surface of the membrane and the mucosa of the tympanum are
mi- ''d with 2 or .S drnpg of a one-tenth solution of cocaine, inistillfMi.
thn>ugh an incision or inci.sions nuule in thi- TiK'Uibrane, with a Hartmnn
I cuinala. mounted on a small syriup*'.
^L In chronic laryngeal tuU-rrtdosis, Froft-ssor M<tnre makes use of the
^P Mkrwing i-ombination applied hv nimiw of an atomi/er: —
t
I
|2d to 166 Gm. or gr. iv-x.
H t'ooain. hydrochloric
flilornli hydniti,
P<iUm. bromid no 2| to 3
Olycrrin 45
Aq aMtillmt 180
ft- BOl
; To be used three or four times a day. from three to five minutes on emoh
Om.
c.cm.
cu?m.
or ^. xxx-eW.
or fSiss.
or fgvj.
In ih'ntal and imsal ^ur^'cry. this substance fulfills numerous indica-
tk>na. Tlie bn-nl anfrstbesia produced by cocaine porniits operation for in-
jirn n«il« A"<^ the removal of intralaryn^real tumors.
372
I'ilARMACElTlCAL TUKUiVPEL'TlC AGENTS OR DRUGS.
Cocaine is best applied on a compress, or in wafors with golatin, in
the tliroat or nose, for siiiijilu catarrh, phar3'iigiti8, laryngitis, and for the
relief of hay fever (4- to 20-per-cent. solution). Dr. Isidore Gluck avoids
the toxic etfect that sometimes ensues by using the iuUowing local applicii-
tion ; —
3 Phenolia liquefact 112 c.cm. or wij.
AqufiB dcstilt 4| c.cm. or f5j.
M et ndde: —
Cooainfle hydrochloridi |65 Gm. or gr. x.
M. Plienol rentiers the solution aseptic and increaaes the analgesic effect of
the cocaine.
A L'hemical combination, cocaine phenate, has been more recently intro-
duced, and has been employed with advantage in most of the conditions
where the hydrochloride has proved useful. (Jocaine phenate is a yellowish
substance, of the consistency of honey. It melts readily when heated. It is
soluble in alcohol. The dose is frora'0.005 to 0.01 Gm. (or gr. VirVe)- It
may be applied locally in solutions varying in strength from 1 to 10 per cent.
When plflced upon the tongue it obtunds both taste and tactile sensibility.
It produces profound ansesthesia of the conjunctivn, witli dilatation of the
pupil^ partial paralysis of accommodation, slight lacrymation, and often tem-
porary ptosis. Anjesthesia is of rather slower development than from the
use of the hydrochloride, hut is of longer duration. The phenate, also, is
much less apt to be absorbed and produce systemic effects. Cocaine phenate
has been used in operations upon the throat and nose with advantage by Dr.
D. B. Kyle.^
Good results have likewise been reported from the use of this salt by Dr.
C. A. Veasey and by German observers.
The following combinations are recommended*: —
Cooain. phenat.
Menthol
Alcohol, dilut. .
10 Gm. or gr. isa.
25 Gm. or pr. iv.
25 c.cin. or fSiiss.
M
Sig. : For inhalation in diaeasca of the larynx and bronchial tubes.
B Cocain. phenat 120 Gm
Pulveria acidj borici 2| Gm
M. Sig.: For insulTlntion in rhinitia and chronic nasal catarrh
or gr. i;j.
or gr. XXX.
Parker advocates a combination with reaorcin, in order to overcome the
unpleasant or toxic effects which sometimes follow the application of strong
solutions of cocaine to the nose or throat. The association of these drugs
seems to add to the antiseptic and astringent action of the cocaine. Dr.
Gauthier is accustomed to conjoin with the cocaine solution prepared for
injection 1 drop of a 1-per-cent. solution of nitro>rlycerin, or the official
spirit of glyceryl nitrato. In this manner ho aims to nntagonize the influ-
ence of the cocaine upon the cerrbral blood-vessels. Bignor asserts that
acid solutions produce but little anaesthetic effect, nud advises that the ordi-
nary solutions should be rendered neutral. When an excess of sodium car-
bonate is added to such a solution, the alkaloid is liberated and forms a
* "Phenate or Carbolate of Cocaine as a Local Anesthetic." Th^rapctitic Qazeite,
Jan. 16, 1803.
^Journal d« MMtcint de Paris,
COCA.
373
fiselT-^rided mixture. He terms this euspension ^*niilk of cocaine/' and
itate$ that, when freshly made, it produces an excellent aujtsthetic effect.
Dr. John pdwin Rhodes, of Chicago, makes use of a combination, which
be thicks intensifies the anaesthetic property of cocaine and perhaps hastens
the uuesUiesia. His formula is as follows: —
B Atropin. flulphatis
Strophanthini >.4««
Coca.in. hvdrochloridi 1
Pb«tioIis lit^ucfitot
Aq. deatiUat q. s. ad 30
IC For hjpodenmc use.
03 Gm. or gr. se.
012 Gm. or gr. 'A-
30 Gm. or gr. xx.
32 Gm. or gr. v.
ccm. or iZ}.
I
Thi* solution has, injected in doses of 0.12 to 0.50 ccm. (or mii-viij),
yroducei] olmost complete local anaesthesia without constitutional disturb-
■WT Ii has also been used by means of an atomizer in the phaj}'nx, larynx,
iifed liBsal cavity.
Professor Schleich has devised a method of producing local nnii?sthesia
ior Borgical operations by marking out the line of incision by a succession
of intradennic injections of weak solutions of cocaine and morphine.
Th^ ' " wing are the formulse for the solutions used by Schleich for
pvodu ! ana?sihesia: —
So. 1. Strong: —
n CwaEne t, ■ VTnridi
Itophln 'oriili.
Sodli fhloi urilized)
Aqtnr dcstUlate [st-eriliscd), q. s. nd 100
2 Gm. or gr. lij.
025 Gm. or gr V-
2 Gm. or gr. iij.
ccm. or f^iiiSiisa. — M.
No. t
B
Normal: —
' ' 1 Tidi
-ioriiJi.
..IP ,o.T7iiUzed) . . .
Aqu» dcsLillntiP (sterilized)
H Gm. or gr. iss.
1025 Gm. or gr. */».
|2 Gm. or gr. iij.
.q. 9. ad 100| com. or fSiiifSiiss. — M.
No. 3.
B
Weak:—
• • ■ ' .ridi
I'^riili. . .
HM.i nil v:>t- iilfZcdj . . . .
destillate (stcriUEed)
iOI Gm- or gr. V»-
005 Gm. or gr. Vi..
2 Gm. or gr. iij.
ccm. or fSiiifSiisa.— M.
Aqwr destUlate (stcriUEed) q.
Oae drop of a 40-por-cent solution of formalin should be added to each
of lb«»e wlutions to preserve them. The fluid is injected in such a manner
ftftt the part to be operated upon is completely surrounded by wheals of the
ittjectfd fluid. These wheals may be carried into the deep tissues. The area
for the primary needle puncture may be anaesthetized by a drop of 95-per-
mit- eoJution of carbolic acid.
In order to avoid throwing the cocaine into a vein, Magitot advises that
it be injected into the substance of and not beneath the skin or mucous
flMBbrane. Except in the case of operations upon the head, the patient
ihoald be in a recumbent position when the injection is made. The dose
•bmU be in proportion to the extent of surface to be anaesthetized, but
diAtild never exceed 0.08 to 0.10 Gm. (or gr. i Vriss). It is well to divide the
jo»> "-'N^ oeveral portions, leaving an interval of several minutes between
«it ian. If toxic manifestations follow the first portion, further in-
iteuon must he abandoned.
374
pharhacki:tical therapeutic agents or drugs.
Bagot* combines sparteine with cocaine, which obviates the depressing
effect of the cocaine on the heart, while rendering the anesthesia more last-
ing. He has a powder prepared beforehand: cocaine hydrochloride, 0.<i36
Gm. (or gr. '/j), and sparteine sulphate, 0.048 Gm. (or gr. ^/^). When ready
to use, the powder is dissolved in 1 or 2 c.cm. (or mxv-xxx) of boiled water.
As much as 8 to 12 eg. (or gr. i V^-i ^A) of cocaine can thus be injected, in
fractional injections, without accident. In operating on a tumor, he injcett; 1
c cm. (or mxv) of the weaker solution on one side, and waits seven or eight
minutes before injecting the other side. He can then commence the opera-
tion in a few minutes on the side first injected. If the operation requires
over twenty minutes, a third injection can be made, which keeps up the
anaesthesia for three-quarters of an hour.
An ointment or solution of cocaine has been employed for the purpose
of relieving the pain of cracked nipplea, but it has been found to have the
further effect of diminishing the secretion of the milk. For the suppression
of lactation. Dr. Joire, of Lille, recommends the application of a solution of
1 Gm. (or gr, xv) of cocaine in 9.50 c.cm. (or fSiiss) each of water and glyc-
erin.
An ointment eontnining coca or cocaine hydrochlori^le is an n(Jniirable
local remedy in affections characterized by severe pain or distressing itching.
The extract of coca (2 to 4 Gm., cr gr. rxx-5j) may be incorporated in 31 Gm.
(or 5j) of lard, or the salt of the alkaloid may be used in the proportion of
0.25 to 0,50 or 0.65 Gm. (or gr. iv-viii or x) to 31 Gm. (or 5j), or as follows: —
Gm. or 3ss.
c.cm. or mv.
Gm. or 5j.
Gm. or Sss.
B Extract! coc«e 2
Creo»oti 30
Ungt. zinci oxidi 31
Ungt. plumbi subacetatis 15
M. For subacute eczema or pBoriaBis.
B CocaiiiiB hydrochloridi 65
Plurabi carbonatis 4
PulveriB marantee 4
01. eucalypti 24
Ungt. zinci oxidi 31
M. Useful in acute eczema, dermatitis, burns, and irritable ulcers.
Gm.
Gra.
Om.
or gr. X
or Ij.
or 5j.
c.cm. or miv.
Gm. or 8j-
Gm.
B Cocflinft' hyrlrochloridi 75 Gm.
Atropinu> aulphatis 006 Gm.
Phenol I ki , 30
01. anthem idifl ,24
Ungt. zinci oxidi 31
M. For herpes, herpes zoster, dermatalgia, and parflestheaia.
B Extract! coc» 4
Zinci carbonatis 8
ComphonB
Sulphuris sublimati , 1
Ungt. aquee rosee 31
For eczema around the genital organs.
Cocaina? hydrochlori Ji
Mentholi
Bismuth, subnit 4
Ungt. zinci oxidi,
A(U']w lantc \\yiX aa I5|5
Beneficial in urticaria, herpes, and herpes zoster.
or gr. xij.
or gr. j.
c.cm. or mv.
c.cm. or mlv.
or Sj.
M.
M
Gm.
or 3j.
Gm.
or 3ij.
65
Gm.
or gr. z.
30
Gm.
or gr. XI
or Ij.
Gm.
65
Gm.
or gr. X.
65
Gm.
or gr. X.
or 3j.
Gm.
►|5
Gm.
or Su-
' a<isett€ MMical de Liige, Dec. 1, 1898.
COCA,
375
B CSMM-I^rdrochloridi,
Hydnrg-. chloridi mitis aa 106 Gm.
Zmti carbonstU 4| Gm.
Bttanrnphihol.,
Otapborv aa 132 Om.
Vugt xinci ojtidl 3l| Gm.
If. Valuible in infantile eczema.
These ointments are serviceable in dermatitis^ acute eczema^ derma talgia,
^Wpct zoster, ponvsthesia, urticaria, burns, and irritable and painful ulcers.
'Bfanler recommends the use of a 1-per-cent. cocaine salve made up with
mfui parts of lanolin and vasclin, in cases of herpes zoster. The tendency
tB^fCftd is removed immediately, and pain at once disappears, with a re-
niUat cure in from eight to ten days. Cocaine ointment allays the pain of
■kentei] carcinoma and is beneficially applied to painful haemorrhoidfi. On
•eeoont of its astringent and slightly-stimulant action, coca ointment is
•HMtimes an efficient application in acne and rosacea. An anodyne oint-
BCBt maj be thus composed: —
B Cocaine hydroclilomti j65 Gm. or gr. x.
Morplunv talphatia 13 Gm. or gr. Ij.
Albnfkam mlphatiB 065 Gm. or gr. j.
PttlTcris marantce 4 Gm. or 5j.
UafQenti tinci oxidi 3l| Gm. or Sj-— M-
In the tn*atment of bums, cocaine bvdrocUIorifle shonld be preferably
with hydrated wool-fat, since the latter .«ub«tanoe possesses im-
dnolytod eflicacv in the treatment of this form of lesion.
6
B Corairup hydrooMoHdi 1
Adipt4 Unap hyd 46
Sodii bicarbonatis 8
OL oXvim q.
LH tt ft. ungt. mollis.
R < V^^injp hydrooMnriili 66
Adipt^ la nm hyd 31
BMonnth *iibnit. rel |dumbi carbonatift 8
OL oliTB q. 8.
M. «t tL ungt. mollis.
Gm.
Gm.
Gm.
or gr. XT.
or 5iss.
or 3ij.
Gm. or gr.
Gm. or Ij.
Gill, or 3ij.
Cocaine is a valuable remedy in pruritus ani or vulvn? and in some csfies
liMi. In rhus jxyisoning and frytlu'iiia, a solutiou of rocaine promptly
thr burning pain. Cocaine can be employed in the form of a aolu-
aecordmg lo the follomng formulffi: —
B CormiiMB hrdrocbloridi
Ptvmbi acetati*
G1yc«Tini 45
Aquc desti1l«t0 135
B Tocaln* hydro^bloridi. .
CW<iaott . .'
Clyerrini 30
Aquae hamafnelMfs detl 00
M. Skg.: Spray into the nose or throat in simple cntarrh. pharyngitis, laryngitis
I ia hay fvrcr.
20
Om. or gr. iij.
66
Gm. or gr. x.
com. or fjiaa.
c.cm. or fSivaa.
and chronic gonorr
IS
Gm. or gr. ij.
5U
«.cm. or ffiviij.
c.cm. or fSj.
c.cm. or (Sitj.
37G
rHAttAIACKUTICAL TJHilurLriU' AtiENlj* OU DKCOS.
U Cocaince liydrocliloridi |25 Giu. or gx. iv.
(jlyctTit piuiiibi siibiicetat
Aqiite hamamclidis dest aa 60| c.cm. or fjij.
M. Sig.; Apply over the surfaoe an »uft Uncn, fur burning iiiid itcliing of ery-
ttipvlaa, poisoning of the skin from various plants, and in aunbuni and superficial heat-
burns.
I^ Cot'aintp liydrochloridi.
Hydrustiiii hydrurliluridi aa |20 Gm. or gr. iij.
Aqute rosiB 120| c.cin. or tjiv.
M. Sig. : Mop upon Uie skin or apply ^itli old inualin ur cutton. fui scburrhusa
oleosa, urticaria^ acne, and rosacea.
Brusliing tlie surface with a lO-per-cnil. cocaine soIuUon to which 1
per cent, of carholic acid lias been added is reconuiK'ndod for relieving pain
in acute tonsillitis.
In gastralgia, the use of cocaine, or of a hot infusion of coca-leaves, is
often highly Borvioenblc and yields pronifit relief. Cocaine liydrochloride
is an eflicient remedy in nausea and vomitini:. In the hands of Dr. Manassein
it yielded excellent results in the incessant vomiting and collapse of cholera
morbus. Prompt relief often follows its use in migraine. In seasickness
and the roniitiug of pregnancy, the nlkaloid is often useful. lu the latter
condition it hfis been used by the mouth, by injection into the epigastrium,
or applied in ointment form to the os uteri. Mr. John Phillips afforded per-
manent relief by administration of the following mixture: —
f^ ropninip hydrnchloridi lOOfl Gni. ur pr. V,»
Tiu:.»t. fturantii - iOO c.cm. or tnx.
Miet. chloroformi 2 c.cm. ur fjss.
Aquce q. e. ad 4i c.cm. or f3j.
M. Pro dosi.
J
A. Pozzi reported^ that, at the Obstetrical Clinic at Turin, five cases of
pregnant vomiting, which persisted in spite of the hypodermic injection of
morphine and the internal administration of cocaiuc, were rapidly cured by
Tibone by subcutaneous injections of 0.01 Gra. (or o:r. Va) of the cocaine
hyilrochloride in ihe epigastrium, repeated once or twice n day before meals.
Food was retained, and neither pulse, respiration, nor temperature was in-
juriously affected. The general condition gradually improved, the patients
gained weight, and the vomiting did not return when the injections were
omitted. Pozzi suggests that this treatment may prove useful in other forms
of vomiting.
Dr. Carlson has reported a severe case of ptyalism accompanying preg-
nancy, in which rapid and complete relief was obtained by a few hypodermic
injections of cocaine.
As an analgesic mixture which may replace an opiate, Portier recom-
mends:—
3 Cocaince hydrochloridi
Acetphenef idin I
MftliylHfetrtiiilidi
Acid, salicylic I
M. et div. in chart, no. x.
6ig.: One powder every three hours until pain has disappeared
60 Gm.
or gr.
vii*s.
50 Gm.
or gr.
xxiiss.
50 Gm.
or gr.
VUBS.
Gm.
or gr.
XV.
^Arch. d' Ost. c Gyn., 18^8.
COCA.
377
Wben coca is used as a tonic in cases of debility, slow convalescence
after ferer, veak digestion, etc., it is usually in the form of an elixir or wine,
Um alcohol in these cases being synergistic, and possibly in many instances
I llie more active agent in the combination. In these conditions the dangers
ol the fonnation of an alcohol habit must be borne in mind, and a change
Lwid^ to the solid extract or an infusion. In lar^Tigeal tuberculosis associated
^■Htl I. the use of cocaiue has heim found of marked benefit. In the
^^^i <ontlary sypliilis, Dr. U, \\. Taylor often makes use of coca,
^T^pfciallj in the case of debilitated subjects, as a tonic adjuvant to specific
^ BMicatioa. He cmplovs the Huid extract and may combine it with the
campoand tinctures of cinchona and gentian. The weak heart of typhoid
■ ■'I'd by 0.015 Gm. (or gr. V*) doscE, every two hours, of cocaine
- ri'i-oimnendt'd by J. M. DaCosta. According to Tlioring-
is if dcvitJod cflicacy in yellow fever, as it quiets the stomach
ites tJie heart.
A decided aphrodisiac ctTcct has sometimes been ascribed to cocaine,
biOt in two cases Dr. Arthur G. Uobbs has observed a contrary influence.
consequence of an application to the throat and nose a rapid and perma-
tl relief of priapism followed after the usual remedies had been employed
vain. Tlie cocaine had, in each instance, been employed on account of
Dasal and pliaryngeal inllamniation. Wells has likewise oi)served
Iffect follow applications to the nasal and pharyngeal raucous
aes. This writer has satisfied himself experimentally that cocaine
sexual excitability in men. He has likewise observed the same
effect follow the internal administration of the rcmody.
\nri"us nervous disorders — hiccough, nslluun, chorea, paral_>nsi3
atcoli^'lic tr<»njorH. senile tremor — Barthoiow declared that cocaine
■•-on.' fnvorible etft'cts than any otlier n*Miedy. In asthma, Dieula-
•ti «tr<>rd4»d r<4i*»f liy the npplii-r.tion of g .Vper-eent. solution to
''*'T6. Pr. J. K. Bftuduy. of St. Louis, has found the alkaloid
.1' ill KM'lancholin, tliongh in tltr expfrii'uce of most neurolo-
ijit pennnnent avail in this atlection.
il, of London, recommends the local u^e in neuralgia of a 20-
pcrcenL «luiion of tlic c^x^aine hydrochloride dissolvi.'d in oil of cloves. Of
solation 0.30 to O.CO c.cm. (or mv-i) is rubbed in with the finger over
iM«t of pain. The pain nf gouty joints may also be diminished by local
of this ci^nibination.
' writers have testified to the efficacy of cocaine in small-pox. A
•I internally in doses proportionate to the age of the patient.
of Algiers, states that a marked tolerance for the remedy
^ctbU in this disease. He states that the evolution of the pustules is arrested
lad that the course of the fever is shortened.
Waugh has used coca largely in the treatment of alcoholism. For acute
he temporarily employs the following: —
B Tinet capaici
Vini eocm
K. 8ig.: A tablespoonful every two to four hours.
. 301
.210
c.cm. or f5j-
ccm. or fSvij.
To aspist in overcoming the habit of alcohol drinking, he gives coca-
|1«TC9 in the form of a masticatory, which can be easily carried and taken
Eli attracting notice. He believes that the source of the longing for
378
PHAiaiACELTIl'.U. TIIEHAPKL'TIC AUKNTS »>U DRl'GS.
ciriuk is often to he found in tlit? mouth, and that coca when chewed exerts
a local annesthetic effect, as well as a general systemic action. The wine of
coca is useful in sriving tone to the vocal cords and preventing hoaraeness
in professional speakers and singei-s.
The rcctid injection of a cocaine solution relieves the tenesmus and pain
of Iijimorrlioids. Used as an injivtitui, or iipplied upon a pler^jzet of cotton,
cocaine allows many gynaecological operations to be painlessly performed.
Vesico-vaginal fistulte, laceration of the cervix uteri, and urethral caruncles
have been succGBsfuUy treated in this way without a resort to general anaes-
thesia. Cocaine likewise affords relief in vaginismus. Dilatation and curet-
ting of the uterus, trachelorrhaphy, colporrhaphy, and perineorrhaphy can
likewise be perforuuMl in the mn\e niannen A solution applied, by means
(if a gauze compress, to the uterine neck may relieve rigidity during hihor.
Shortly after tlie introduction of cocaine as a local anaesthetic Dr.
Leonard Coming,, of New York, demonstrated that it was possible under
its influence to remove large tumors and perform amputations. Continuing
his researches, he developed, in 1885, a method of injecting the drug into
the vertebral canal between the spinous processes. Professor Bier, of Kiel,
put Coming's suggestion to further clinical trial by means of the lumbar
puncture/ and his example was speedily followed by many of the distin-
guished surgeons, notably Tufiier, H^clus^ Oherst, Murphy, and Marx. The
method employed is to introduce a suitable needle between the fourth and
fifth himbftr vertebra* into the subarachnoid space, allowing a small quantity
of the cerohro-spinal Ihiid to esoapr, and injecting with a hydopermie
syringe a solution containing 0.00.% to 0.01 Gm. (or gr. Vis"^/e) ^^ cocaine.
Analgesia of lower half of the i)ody follows in a few minutes and persists
for scvcrnl hours. Tuliier* published 125 cases, including 5S laparotomies^
of lumbar puncture with five deaths, though be states that only one death is
directly attributable to this treatment. Spinal cocainiznlion has also been
used by Krcis and "Nfarx* in obstetrical prnctice, who found that the cocain-
ization did not interfere with the functions of the uterus. These injections
are often attended with more or less severe after-effect: headnchc, vomit-
ing, depression, and rising temperature. In a number of cases observed by
the author a series of most alarming symptoms followed the use of this
meth<id, so that it is not without diiuger.* Six dciitlis have been recently
reported by P. Rectus in hia statistics of leas than yoOU applications. Intra-
rachidian injections of cocaine as a therapeutic method have been tried re-
cently by Dr. Acliard in cases of sciatica. Marie and Guillian"' report its use
in one case of sciatica, when 5 milligrammes (or gr. Viz) were injected, with
an immediate noticeable improvement, the man being able to get up and
walk about without any appreciable pain. When a small dose is given there
is no associated cutaneous anapsthesia, nor arc there any constitutional
symptoms occasioned, while the relief is as prompt as in the larger quantity.
Anaesthesia of the lower extremities and of the lower part of the abdo-
men, by the injection nf a very minute quantity of '/a-p^'i'-'-^Piit. solution of
cocaine hydrochloride into the spinal canal, is now a well-established surgi-
^ Deutsche Zeitftrhrift fiir Chirugie, vol. ii, p. 361, 18fl9.
•Art Sftnaivc Mvdirnlr. ^iav Hi, 1900.
* Mnliml yeicM, Aiiguflt 'Z^', lOHO, and Maiwal Recortf, Oct. fi. 190(».
^Journnl of fhf Anu'iirttn Wtflical Aftfif)riation, Xov. 24, IflOO.
' lanrrt. April V\. 1001.
coccrLrs.
:\7d
■^ --*•■' M re. Xo injurluim tirecti* were obrtenx'd in the ^ix major surgiod
ione under tliis form of ana?sthcsia by Bier, of Kiel.* The aver-
• of the drug administered was 0.005 Gin. (or gr. Vis)- An»8-
*tth tlie lower extremities iei uj^uaily prudueed in about eight or
aiiauttr-^ jifttT the injrcfcion of the drug into the hinibar region of the
■i! '"Tinnl. Sehlowitfioli has also rejiorti'd- four cases in which he had
. employed this method for major operations, such as a Pirogfjff
. ..i^:.--ii. of llie foot, extirpation of inguinal glamls for melanosan-oma,
« n^M^^tion of the knee. Sensation returned in every case within a
■ '"me. and there were no serious after-etfects ohiser\'ed. The patients
only from a slight chili and elevation of temperature and pulse.
ttr* liAd V" ' _' preetxied by vertigo and ficndnche, though in the more
MEcnt inTev iis these afterH?ffects have Ikvu more prominent.
Xtf^nrwl infiltration is practiced by injecting a solution of cocaine directly
atfo the shefttbf or areolar tissue around tlie nerves supplying a part. The
eRcmibr acts upon the nerve-trunks at the level of the injection, and the
«atire part dL«tai to the injection-level is rendered anaesthetic. This, which
wm «aggr«ted by Oberst, is easy of performance, and is free from danger.
It ia eapecially applicable to the digits. In amesthetizing a finger, a soft-
rubber tube is lirst tied around its base, to arrest the circulation. ThAk
««T 10 mininis of sterilized 1-per-cent. sohition of cocaine is injected around
mA digital nerve, distal to the tourniquet. In about ten minutes, the en-
tile finger i? anaesthetic and can be subjected to operation, without pnin>
By iho addition of a small quantity of adrenalin the action it^ int<>npified.
Cocaine is used as an injection into the urethra in gleet and previous
ta panage of instruments or surgical operations. The injection of a few
isiMpa of a 4-per-cent. solution into the urethra in case of stricture of large
aoore niay succeed in relieving retention of urine. In such procedures,
havener, it must be borne in mind that the urethral and rectal raucous
sonbrmnee absorb with great rapidity, and a strong solution must, there-
fare, be avoided. Berger hUs reported a case of death from injection of
U GiD. (or gr. viij) of cocaine dissolved in a spoonful of water, the fluid
Sciof; allowed to escape immediately and the entire quantity being ap-
parently recovered. Death has followed tlie injection of a .Vper-cent. solu-
tioD of cocaine into the urethra, apparently from sluK'k.
Cocaine, or the fluid extract of coca, in conjunction with other remedies,
"» a phriioloijical antidote to luircotir poisoning by opiat(»s or picrotovin, and
■ay be used hypodennically. The subcutaneous injection of cocaine has been
foQod useful in cases of scorpion-bite. The treatment rapidly relieves pain
tod restricts it to the part stung.
COCCnXITS— COCCTJXUS niDICTO.— Indian Berry, Fisb-berry.
Preparation.
PicrotoKSiiiuii (U.8,P., B. P.). — Ptcrotoxin (the Active pricciple). Dow, Vi to
1 ■«, <or ar. Vw-V*). B.P„ 0.00065 to 0.0027 Qm. (or gr. V«-7«).
Pbanaacolo^. — Cocculus Indicus is not official, but its active principle
'DnL Zeit fUr Chirurgie, vol. If. p. 344.
'rentrolhlatt fur Chtturrfir, B. 2H. iKiM). p. IHO.
380
rHAKMACEUTICAL THERAPECTIO AGENTS OK DRrtiS.
i8. It is the fniit of Anamirta paniculata (Menispermaceae), a native of the
Malabar coast and of India. In 181*-?, BouUav di?covert'd and iaolated a pecul-
iar bitter principle, which he denominated Picrotoxin, — a white, crystalUz-
ablc, neutral substance, sohible in loO parts of cold water, or in 25 of boiling,
and very soluble in alcohol and ether, but not soluble in oils, Picrotoxin
does not form salts. Like digitalin, picrotoxin appears to be made up of
several bodies, which vary in their chemical properties and effects. Barth
and Kretschy assert that it contains at least three: (1) picrotoxin, a bitter,
poisonous principle; (2) picrotin, a bitter, non-poisonous principle; and
(3) anamirtin. To these has been added cocculin (which is said to be iden-
tical with anamirtin). These pharmaceutical bodies may have scientific in-
terest, but, practically, the prescriber is confined to the picrotoxin of
Boullay, which is official in the United States Phannacopceia. In the peri-
carp have been found menispermin, paroraenispermia. hypopicrotoxic acid,
resin, fat, and pum, which do not put^scss much medical interest.
Physiological Action. — Cocculin, or picrotoxin, is very destructive to
lower forms of life, and to many acts as an acrid, narcotic poison. In lower
animals death is preceded by convulsions, and in a fatal case of a child six
years old, poisoned by absorption of a strong alcoholic solution of the fruit
applied to the scalp, tetanic spasms occurred Where this aj?ent has been
swallowed, the usual treatment, by evacuating the stomach, should bo prac-
ticed, with inhalation of ether or ammonia and the internal administration
of cliloral or bromides. There is an antagonism between chloral and picro-
toxin, and this can be utilized when poisoning: has oocuiTcd from absorption
through the integument, ^'annic acid and stimulants are also useful.
In an article by William Murrell, of London, on "Picrotoxin and its
Properties,"^ this able authority states that the peculiar convulsions pro-
duced by this agent "differ essentially from the tetanic condition caused by
Btrychnine, and are due to stimulation of the motor centres in the cerebrum,
or in the medulla and cord. They assume various forms, the swimming, run-
ning backward, and moving round in a circle being the most common. Picro-
toxin raises the temperature, stimulates the respiratory centre, and in large
doses produces salivation." It acts as an anhydrotic by stimulation of the
respiratory centre. 'It is allied to Cicutoxin — the active principle of the
water-hemlock — and to Coriamyrtin, derived from Coriaria myrtifolia.
These drugs stimulate the origins of the iuhibitory fibres of the vagus, the
vasonlar and respiratory centres, and the motor areas of the medulla ob-
longata. In its action on the secretions picrotoxin is allied to Pilocarpine
and Muscarine, and is antagonized by atropine and other members of that
group. The best antidotes to picrotoxiii nro chloral hydrate and bromide of
potassium." On account of its poisonous effects, cocculus has been used, from
ancient times, made up into paste and thrown into the water, where the fish
are stupefied by it, and are easily captured. Death has occurred in a boy
from eating a small quantity (40 grains) of such paste, but it is said that the
flesh of the fish so taken is edible. This unsportsmanlike method of fishing
in most parts of this country is illegal. On account of its bitterness, cocculus,
or "fish-berry," is sometimes added to malt liquor to save hops and check
fermentation. Possibly this may enter into the solution of the problem of
what is the matter with a msm when he is drunk, and still further emphasize
• The Medical Bulletin, Nov., 18»0, p. 402.
coccus.
381
Ac importance of regarding intoxication as a condition of poisoning, de-
■wwfi'ng prompt, intelligent, and skillful treatment.
Tkeimpy. — Cocculus is an ancient remedy for phtheiriasis, or lousineea,
'ct c«re should be exercised in the case of children, or where there are
i naons on the scalp, not to use strong solutions, nor to leave them for
--nr minutes in contact with the skin. The hairy scalp, after being thor-
vrashed with soap and water, is wet with a solution (15 to 120 c.cm.,
^- of the tincture to fjiv water), or decoction (1 to 16), and after a few
.nate« washed off with an abundance of warm water. Two or three daily
if>pIicitions are sufficient, especially in cases where the hair can be cut short,
0 in charitable institutions and asylums. It has been claimed that an oint-
; of picrotoxin is equally etficient with the decoction, but it cannot be re-
" a« being as safe. For the same reason, cocculus is not advised in the
taatment of tinea and other skin affections, although still used for this pur-
ptee in India A small quantity, however, of picrotoxin — not exceeding 1
per ctnt. — may be usefully prescribed, in combination with ointment of mer-
cme oleate, for the relief of animal and vegetable parasitic diseases, as
acabies, pediculi, trichophytosis, and tinea versicolor.
PicTotoxin in small doses appears to act as a bitter tonic to the digestive
tract, and has therefore been advised in atonic conditions of the stomach
and inteBtinal indigestion attended by torpor of the intestinal walls, and cnn-
idpation. Flatulence and colic ore relieved by the use of picrotoxin. The
PHDedy has likewise been successfully used in painful dyspepsia, vomiting,
vertigo, and other reflex manifestations dependent upon imperfect digestion.
In epilepsy, chorea, alcoholic tremor, paralysis agitans, and functional
acrroos disorders (migraine, dysmenorrha}a) picrotoxin has been used suc-
ctacfDllT by Planat and Hammond, Gubler, Phillips, and others. It has been
famd beneficial in epilepsy, especially when the attacks occur by night or
•ndtie to anaemia. According to the experience of Dr. d'Amore, picrotoxin
m of fpeoial benefit in advanced cases of the disease. In a number of cases
4ibaerTed hj d'Amore its effect was more permanent than that of atropine.
Sonaola and Gioffredi have recently reported a case in which picrotoxin
0ec<«dcd in checking profuse hyperidrosis which developed consecutive to
ta ittack of influenza. There is good evidence in support of the statement
ttade br Murrell aa to its value in controlling night-sweating in phthisis in
iotmoi 1 mg. (or gr. Vno), in a pill with sugar and tragacanth (a single dose,
«t bed-time, or given three times a day). It does not have the disagreeable
Ktion upon the throat and skin that atropine has, and frequently succeeds
whet^ that fails; but it is slower in producing its anhydrotic effect, requiring
»<»rTal days. Bokai regards picrotoxin as an excellent antidote to opium by
nafon a! the stimulant action of the former substance upon the respiratory
tad vasomotor centres.
COCCUS (U. S. P., B. P.) —Cochineal.
Preparation.
Tlactara Q>cci (B. P.).— Tincture of Cochineal (I to 10). Dose. 0.30 to 1 c.cm.
4
Phannacology.^ — Tin* <lri<'d fcnmle inswts of Pseudococcus cacti (In-
; order, Hemiptera), when crushed, produce a very briliiant-red color-
Id
38S!? FUAUMACELITICAL TUJifl-VP£UTIC AGENTS OR DRUGS. ^W
ing matter, which consists principally ol" earminic acid, various salts, tyn»siid
urea, fatty mutters, etc. The British Phjirniacopa?ia defines coccus a^ *'th«
dried ft'cundatrd female insect Coccus cacti, reared on Xojialea coecinelli-]
fcra and on other species of Nopalea/' The iiigincnt called Caxmine iti thi
coloring nintter precipit-ated from the denntiou by acid^. and the salts o;
tin, or hy ^^elatin ; and other colors — such n? lake, purple, and lilac — nuiy bo]
obtained by various reatronts. It is highly prized in the arts as a colorioi
agent. As such it is also used in phiiniiacy, and is an ingredient in the]
compound tincture of cardamom.
Physiological Aotion. — The physiological actions of cochineal are not
very evident, but it is believed to have antispasmodic and anodyne qualities.
Therapy. — Cochineal was used by a preceding generation of physicianh
for whooping-cough and in neuralgia. Its brilliant color poesibly might haTe
led to its use under the old doctrine of signatures. j
COCHLEAEIA. — Scurvy-g^aaa, Cochlearia officinalis (Cmciferse), an,
annua] or biennial plant of northern Europe and United States, contains
tannin, a bitter principle, salts, and a volatile oil. It is stimulant, diuretic,
and laxative. Cochlearia is popularly eaten as a salad, and is efficacious in
scorbutus, chronic rheumalismj and chronic malaria. The juice has been
used externally for the purpose of stimulating indolent ulcers, and, diluted
with water, as a mouth-wash for spong3'' gums and ulcers of the mouth.
COCTTXATTA. — Cocillana. The Cocillana of Bolivia, a Ouarea of un-
determined species, is a large tree belonging to the Meliaceae. The name
Sjcocarpus Rusbyii, bestowed upon the tree by Professor Britton, has been
generally accepted. It was discovered and brought to this country by the
American botnnist, Dr. H. H. Rushy, wlio also introduced pichi. another
valuable South-American remedy. The constituents of the bark have not
bi'L-u determined, but ii is probable that, it owes its effects tn an active jirinei-
jde, resinous in character, S4)luble in chlomforni (Schrcnk), or perltaps an
alkaloid (Bupby). The odor of the resinous principle i.^ ]>eculiar and char-
acteristic; its taste is better, mawkisli. and slightly astringent.
Physiological Action and Therapy. — The bark is used as an expec- j
tonint, having an influence upon the respiratory organs similar to ipecac, |
but "superior to it in certain diseases of the air-passages, in which the I
latter is often used," in the opinion of D. D. Stewart.* It also has a tonic |
etTect upon the digestive organs, and gives promise of usefulness as a laxa- '
tive. In native medicine cocillana is used as an emetic and cathartic. A I
free discharge of mucus, nausea, and gagging, with some tendency to per- ^
spiration, also dizziness and lassitude, were caused in one case where 1.30*
Gm. (or gr. xx) were given. Larger doses (2 to 3.25 Gm., or gr. xxx-1)
caused vomiting at the end of an hour, evacuations of the bowels, sneezing, i
and prostration, the effects resembling those of emetine. The active prin- i
ciple is excreted chiefly by the mucous membrane of the respiratory tract,
upon which it acts as a stimulant. >
Small doses improve the appetite and digestion. The alvine discharges |
under its use contain mucus and bile. This drug stimulates the sudoriparous
' Medioal Nncs, Aug. 24, 1889.
lOUKINA,
;iK3
When ^ven iii considerable quantities it causes copious perspira-
tmi, aocompttnied by prostration of muficular strength. Excessive quantities
cKite severe gaftro-intestinal irritation, and have, in some reported cases,
cMMd death.
This drug^ finds its special usefulneBs in bronchitis, particularly the sub-
•eat« and chronic forms. The fluid extract is preferable to the tincture in
armi* bronchial attacks. Cocillana is an effective remedy in coryza, spas-
croup, persistent hoarseness and cough after measles, the cough of
asthma, hay fever, and in the declining stage of pneumonia. It
Rlieres ihe cougli of puhnonary tuberculosis.* Small doses of wcillana have
likrvisc been used with success in atonic dyspepsia. The fluid extract diluted
vith wmter aud used as a spray has been recommended as a useful application
in acute and chronic coryza.
CODEINA (U. S. P., B. P.).— Codeine (C„H„NO, + H,0).
Dose, 0.015 to 0.13 Gm. (or gr, VrU)-
^
(T. S. |»
Preparations.
n. P.).— Phosphat* of Codeine.
Dosp. 0.015 to (\,n
VttAmn^ Phri4phas
(or AT. V. ij)-
CVwitur SiiIplmR (t*. S. P.). — Sulphnto of Codeine. Dosr. the 8unie.
S^rvpus Codeinre (B. P.). — Syrup of Codeine (codeine phosphate, 4.57 Gm.; dit-
WAtcr. 12.5 c.cm.; syrup* 987.5 c.cm. ; 4 c.cm., or f3j, = 0.015 Ora., or gr. Vi)-
'. 2 to 7.5 c.cm. (or f3u-ij).
An •lkalt»id oontain*Ml in opium (d.l tn ? \n'V tH*nt.). It is preparod
friMD ofiiuni. and also artificially from morphine, t'odeine docs nr)t dit«r>nltT
tbr sUnoaeli or l>owels, and does not give rise to sweating: or eruptions upon
tbe skin. A fpw case*! have been reported in whichdizziness, nausea, vomit-
iaf?, nr ' tration were oauseil hy eo<leine in iiuHliciual dfipes. Behier
hft» r 1 raw of chronic co<k'ini8rn: l»ut those untoward efftx-t:* are
r* li. It in more antispasmodio than m(»r])hini^ and has less nareotio
ef: I»e\vfnmyor ). It is used preferahly in the trciitini'ut of cT^uph,
cmnps in the slnnmeh or hawols, and in uournltria nnd painful afFoetion? of
ike ipMuio-urinary organs. In diahctcs it iht-eks the formation of 8ugar^
md in »nni<' r«w»» jMrinanentlv arrests it. In th^'sp vhsp» it is borne well in
briTpr amount*, as nnich «f Oj».=l to 1 Gm. (or ^r. x-xv) daily having been
takrti with iM^nefit. FrasfT claims. hnwcv«^r, that iM|ually good eff*H'tii may
Ir ' d iu Hitmllcr dfi?*t'K from rnor|>hin(' hydrochloride, whicli ii^ alfw^
1- ; i'hrafM'r.
In lite trentment fif mental dinordcrs. siu'h hs nirlanoholia. pHVchii*
dirtnriinn<r ns.'wviHfed with chnri^rr in >rencnd sen:*iliility. anxiety, and moral
ilfenu^, codeine ha^ heeij f<nind iL*efnI by .lull's C'laiisfic (Paris Thcpip).
lufiUlr ail a l)Vf)noHe in the insoninin of melancliolia. It is popitively
u ted in intense excitement and in maniacal conditions. Dr.
r finds c*Mleinp of vahii* in pulmonary tnherculogis with insutHcient
inn. tronbIe<iome couirh nnd theBt-|niins. In hron<bitifi it alsn
Lr Mfi disonler of the stomach, and even seemed to
^ii' ' l'f*iH. In pertiititiis it** use wiis nttenile*! with pMnl
a! (5.
' S«^» prtfirr t»v author on "Tlic Thrriipcutioii! Applicntions of Cocillann" in
ITirffawf Batfrtin. Feb.. 1893.
*P^ut. "'*•'*■ Horfc. and Wrrklp Mrri. R^it-tr; Xm-. 2f>. iSftO.
384
I'UAKMACKUTICAL TUERAPKLTIC AUKNTb OB DRUGS.
COFFEA.— Coffee. The dried seeds of ColTea Arnbicn (Rubiaceff)
are only oHicially recognized as one of the sources of caffeine: its most
important constituent. Before roasting, coffee contains Caffeine and caffeo-
tannic acid. Dr. Palladine has isolated a new alkaloid which he terms
caffearine, and which occurs in the form of crystalline needles, soluble in
water and alcohol. CnfTcine Iiydroelilorido is very soluble in water, but doe« .
not dissolve in absolute alcohol. During roasting a volatile oil is developed
and several substances formed, which give to coffee its aroma and flavor,
these cmpyreumatic substances being known collectively as Caffeone. It ia
suggested, therefore, that the use of coffee may prove of some prophylactic
value during epidemics of those infectious diseases which are commonly
transmitted through the medium of drinking-water. Strong infusions of
cotfecj as I^uderitz has shown, are destructive to the organisms of typhoid
fever, erysipelas, ;ind cholera. (See also Caffeina.)
Phyaiological Action. — Coffee differs from caffeine in being more stimu-
lating to the intestinal tract, especially increasing the peristaltic movements,
which are not affected by caffeine. Taken in tlie morning, before rising,
coffee will often produce a laxative effect. It produces a general feeling of
warmth and well-being, dilates the superficial blood-vessels, and lowers arte-
rial pressure. It also stimulates the nervous system, in some persons causing
exhilarating effects upon the cerebrum and increasing capacity for intel-
lectual labor, and frequently is the cause of headaches in persons who take
it habitually or in excess. A case has been rt'ported^ in which nbout 77.6
Gm. (or o^iss) of the ground berries were made into a strong infusion and
swallowed by a vigorous man. Two and a half hours later he was attacked
by dizziness, severe cardiac pains, palpitation, nausea, vomiting, and gen-
eralized tremors. The tremors persisted for twelve hours after all other
symptoms had disappeared.
The habitual use of coffee is one of the causes of pruritus ani. Over-
indulgonrc in its use is also apt to disturb the liver aiul cause the familiar
manifestations known as ''biliousness/' or even slight jaiuidice.
Therapy. — It is valuable as a stimidant in cases of narcotic poisoning,
especially by opium. In ^ome cases it produces fullness of the portal cir-
culation, interfering with the activity of the hejiatic functions and causing
hBemorrhoids, Its laxative effects are useful in persons leading sedentary
lives, in preventing constipation. It has some astringent and antiseptic
qualities, and is believed to have some effect in preventing malaria. Accord-
ing to the observation of Dr. Alice McLean, the use of coffee by nursing
women diminishes the secretion of milk. The tluid extract of the unroasted
coffee contains caffeine, but no caffeone. It is used in anffimic headaches,
and in cases of low fever as a cardiac stimulant where collapse is threatened.
COLA.— (See Kola).
COLCHICI SEMEN (U. S. P., B. P.).— Colchicum-Beed.
COLCHICI COHMUS (T. S. P., B. P.).— Colchicum-com.
Dose, 0.13 to 0.3ii Gm. (or gr. ii-v).
COLCHICINA (IT. S. P.).— Colchicine. An alkaloid obtained irom
C<dcl]icuui.
* Thcrapatiiiche Monaivchefte, Man-h, 1890,
COLCniClM.
385
^
Preparations from the Root,
fjstrmr-tvkm Colehui Cornii (U. S. P.).— Extruct of Colehicum-oorm. Dose, 0.015
Hi. iin Colchiei Ra«licU. — Fluid Extract of Colchieumroot. l)o»c, 0.12
lo ni4 c ' " "T mii-ivi.
Viaum Colchiei Rjidiois. — Wine of Colchi cum- root (40 per cent.). Dose,
tJO to 2 r.cm. lor Mv*f3u).
Extnctuiu Colehici (B. P.).— Extract of Colcbicum.. Dose, 0.015 to 0.005 Gm.
Viaum Colchiei (B. P.).— Colchicuxxi-wine <20 per cent.}. Dose, 0.60 to 2 ccia.
f«r Mx-xxz).
Preparations from the Seed.
Fhjiili\tri»rtiiin dtlchici ^;pminis (U. S. P.). — Fluid Extract of foiclucMim-
DoM. 0.12 to 0,30 com. {or mii-v).
Tinctiira t'uK-hici S<-Tiiini!* ( U. .S. V.). — Tincture of Cokhicum-»tH?d ( 10 per cent).
0 30 to 4 c.cm. (or mv-f3j).
Vionm Colchiei Semiiii^ (U. S. P.). — Wine of Colohioum-secd (10 per cent.).
Ifeeae, O.fi0 to 4 ccni. (or rnx-fSj).
Ttaictura Colchiei Scminura (B. P.).— Tincture of Colchicum-seeda (20 per cent).
Dcee, OJO to 1 c.cm. (or niv-xv).
Colchicine (non-official).— Colchicine (the active principle). Dobc, */« to 1 mg.
(or gr. V-.-V«).
Ptormacology. — Colehicum-conti is the dried eorm of Colrhicum
antnmnale fLilHiea*). or meadow-saffron, yielding 0.35 per cent, of col-
AirsD^- CoU-hicura is native to the temperate parts of both Europ,^ and
^BBVtbem Africa. The seefl is also olfieial. It contains Colchicine
^■(.55 per cent., or rather more in the seeds than in the root) ; and traces
^mL- Tenttrine in combination %\'ith gallic acid and a fixed oil are found.
^^HlK talue of eok'hicum is tested by its bitterness, due to the pres-
^Tfee of colchicine, an alkaloid, appearing in small crA-ptals (CJciger and
Hfl«^*>. which is soluble in water and alcohol, but is changed by moat acids
i«i> Colchiceine, a neutral substance, and a resin, both isomeric with col-
dbrine. Wine and vinegar extract the medicinal principles from the drug,
ftDd the official extract is made with the aid of acetic acid. Propably each
^ ol them contains a small amount of colchiceine. In ordering the wine it
H if wttmrnry to designate which preparation is required, as the wine of the
^r aeli dii7erB in effects from that of the root, on account of the difference in
B asBtCAt of colchicine, which is not entirely equalized by tlie phannacopceinl
Bvpedient of altering the proportion of crude drug in each. The fresh
mti contains a small portion of volatile, but very active, oil» and the best
ptfvparatjoo would be a tincture made from the fresh seeds in alcohol ; but
cokhicine. wh^n administered in granules, pill, or by hypodermic injec-
tion. M «aid to secure the full therapeutic effect.
1^ FliTiiologicftl Action. — When applied to the skin, colchicum acts as an
B irritant, causing h^^perseroia and smarting, and the dust inhaled causes f^neez-
V a^and conjunctival injection. In small doses it occasions an acrid taste in
B ike month, increased eecretions from the salivary glands due to reflex action,
" and gartro-intestinal disturbance, which increases with the quantity taken.
The pulfe-rate is decidedly reduced, and in some cases a diaphoretic effect
ii obserred. A single large dose or small ones long continued cause violent
waiting «iid purging (first serous, then mucous, then bloody), or acute
jtutro-inteetiDal irritation. Marked symptoms of collapse supervene; tlie
polfe hecomtB small, rapid, and thready; the skin cold and bedewed with
386
PriABMACEUTIC-VL THERAPEUTIC AGENTS OR DRLTr8.
Bweat; respiration bIow and painful. Death ensues from collapse, the brain
remaining clear to the last. Sometimes nervous symptoms, flying pains, and
numbness may appear, and occasionally, though rarely, convulsions (Erun-
ton). Pains in the joints and urinary passages also may be produced by
colchicujn.
In some instances the action of the kidneys is but slightly affected, in
other cases it is increased, and again it may be diminished or suppressed.
In fatal cases of colchicum poisoning the blood has been found of a dark
color and impaired coagulability. The intestinal mucous membrane is
highly iniljuned, and this effect is equally produced even when the alkaloid
has been given by the hypodermic method. A very large dose does not cause
a more marked effect than a moderately large one. The action upon the
alimentary canal is the same, whether the drug be swallowed or hypodermic-
ally injected. When, during the administration of colchicum, there appear
irritation of the fauces, loaded tongue, loss of appetite, flatulence, uneasiness,
or pain in the stomach and diarrhuea* the drug is beginning to exercise toxic
effects, and should be discontinued or suspended for a time. Colchicum has
a selective action upon the sensory nerves and spinal cord, which are more
or Ices paralyzed; the brain, motor ner\'es, and muscles are not affected.
The inhibitory fibres of the vagus arc paralyzed only by very large doses.
The discharge of bile and of urine is largely increased; Rutherford claims
that it is a true chdagogue, and Christian and others assert that it is
diuretic, increasing the quantity of saHs as well as the water, both of which
have been denied by Gubler, who simply regards it as cathartic, only exer-
cising good effects when three or four discharges from the bowels are ob-
tained daily through its action. When s}Tnptoms of poisoning make their
appearance, the patient should be kept in a recumbent posture^ encouraged
to vomit, and allowed to drink freely of infusion of tea or coffee^ on account
of the tannin they contain as well as their action as arterial stimulants.
Xforphine and atropine may be administered hypodermically in small doges.
The administration of oil is of service on account of its emollient effect upon
the mucous membrane. If collapse occurs, heat and cardiac stimulants are
required. If there is much distress, sinapisms should be applied to the
abdomen and the patient kept warm. Poisoning may occur in refilling pre-
scriptions, as the preparations vary greatly in their activity; some samples
of fluid extract contain very little, if any» of colchicine, while others are of
standard strength, t^atal cases have been reported from taking 9.25 to 13
c.cm. {or foiiss-iiips) of the wiue of colchicum-root. Dangerous symptoms
have been caused by doses of Q.Ol to 0.02 Gm. (or gr. Va-Va) of colchicine,
and 0,03 Gni. (or gr. ss) of the alkaloid has caused death.
Therapy. — Colchicum may be used in small doses as an ingredient in
cholagogic pills, but its chief use is in the treatment of attacks of gout and
in the relief of symptoms more or less directly attributable to gout, as dys-
pepsia, bronchitis, asthma, etc. In rheumatic arthritis or rheumatic gout
we may give: —
B TinctuwE colchici aem IflO e.cm. or mx.
^1 PotaasiS i(Mlidi [65 Gm. or gr. x.
^f Syr. saranparillse comp ft! c cm. or fSiss.
^ Aqiiff d^stillntiE 2t c.cm. or fSss.
M. Pro doai. Take every three or four hours, well diluted.
COLOHICUU.
387
B Vitti colchici urminii 15
Sodu «aUoyUtU 12
Sodii iodidi 4
S{nnt<u chloroformi 11
lal bnchu ad 240
IC. £%.: A t««8poonful every three or four houn.
Scudtmore's gout mixture is also very efficient: —
R MftfDoii Milph 62
Uai^esii rarbonatis 8
Vini colcbici •eminift 22
Aqtue menlh. pip ad 300
M. Sif.: A tableapoonful every four houni.
ccm. or fSiv.
Gm. or 3iij.
Gin. or 5j.
ccm. or fSiij.
ccm. or fSviij.
Gm. or Jij.
Om. or 3ij.
ccm. or fSvj.
c.cni. or fSxij.
Colchicum is generally given in acute attacks of gout, in combination
nth an alkali: —
B Magsetii sutphai IS 5 Gm. or Jsa.
McfBesic 8 Gm. or 3ij.
Ti»ct colchici sem 7 5 ccm. or f3ij.
Synipi zingiberis 30 ccm. or fjj.
Aqiue menlbse pip 150 ccm. or fSv.
IL Sig.: Take a tablespoonful every t\vo hours, until the boweU are freely
•ercd from four to aix times m twenty-four hours.
Or the extract of the root may be given (0.065 to 0.13 Gm., or gr. i-ij)
[ ■PTvrml times daily, or the wine of the seeds in 2-c.em. (or f3ss) doses: —
B Oolchicmse
CodciBft
Qifciainc hydrobromidi 4
Sf. M ft pU. no. xl.
flig.: Take one every two hours for gouty neuralgia.
03 Gm. or gr. bs.
65 Om. or gr. r.
Gm. or 3j.
The wine of the seeds is, perhaps, the preparation most frequently pre-
I ioibed, and in an acute paroxysm of gout is best given in a moderately large
(2 to 4 ccm., or fSsa-j). Within a few hours the pain is allayed
tbe beat and swelling begin to subside. In order to secure relief it is
, sot iif«e88arT that the drug should manifest its diuretic or purgative effects.
1 chronic gout, small doses (1 to 1.20 ccm., or w.xv-xx) three or four times
imj are appropriate. Though colchicum exerts an action which may be
IJvnued specific, it is nevertheless but palliative, since attacks recur. Of
Klflc or no value in acute rheumatism, colchicum is sometimes of service in
thtdronic form of this disease. Neuralgia dependent upon a gouty or rheu-
rnaHe condition is often effectually treated by means of colchicum, a drachm
•f tbe wtnc being given at bed-time, together with a dose of morphine sul-
phite. The same preparation is not infrequently serviceable in gonorrhoea,
tid t ccm. (or mxxi) at bed-time is an old treatment for chordee.
Cb. Abadie has found very minute doses of colchicine (0,001 gramme
««**/„^ gwin) two to four times a day to be of great value in scleritia,
whether dne to gout or rheumatism.
F. "Woodbury recommends its hypodermic injection in sciatica, into
tke dieaith of the nerves, also in muscular rheumatism.^ A combination of
edducine irith the natural salicylate of methyl is of value in subacute and
*mu$4rlphia ifffflcal Timc9, vol. xiii, p. 154.
388
PliARiUCKL'TlCAL THERAPEUTIC AGENTS OR DRUGS.
chronic rhenmatisin. In gouty neuritis, Dr. C. D. F. Phillips has foiiud th©
following combination beneficial: —
B Colchicin 1001 Gm. or gr. V«. j
Quinia. sulphat 065 Gm. or gr. j.
Ext. colocynthidia |065 Gm. or gr. j.
M. et ft pi!, no. j. Mitte tales no. xx. |
Sig.: One ptU three times a day.
Colchicum has also given good results in the treatment of ascites, gonor-
rhcea, and chordee.
COLLAEGOLUM. (Sec Argentum.)
COLLINSONIA CANADENSIS.'— Thia indigenous plant, belonging to
the natural order LabiataCj and popularly known as stone-root, or knob-root,
frows from April to October in richly-wooded soils throughout the United
tates. All parts of the plant may be used, but its virtues reside chiefly in
the root, and depend principally upon the presence of a volatile oil. It
possesses a rank, aromatic odor, and a warm, somewhat pungent taste.
Physiological Action.^ — ColUnsonia is a local astringent. It exerts a
sedative effect upon mucous membranes, and produces a sensation of warmth
in the stomach and bowels. Large doses give rise to diaphoresis, nausea, and,
perhaps, vomiting.
Therapy. — Collinsonia is a good local application to incised or contused
wounds. Four Gui. (or 3j) of the powdered root to 31 Gm. (or ^j) of lard
constitutes a stimulant application to indolent ulcers. The fluid extract,
diluted with 4 parts of water and used as a rectal injection, effectually
destroys ascarides.
This remedy, given internally, acts as an astringent tonic, antispas-
modic, and sedative. It increases the appetite, promotes digestion and
elirainatron, and is therefore useful in anemia, chlorosis, the early stage of
phthisis, and in convalescence from the eruptive fevers. Relaxed uvula,
chronic pharyngitis, and hoarseness due to impaired tonicity of the vocal
cords are benefited by the local action of coUinsr^nia. A cup of hot infusion
at bed-time will abort an ordinary cold, or mild lumbago. The fluid extract
is very beneficial in gastro-intestinal catarrh, whether dependent upon alco-
hohsm or other causes. The remedy is especially useful in the former case,
since it seems to lessen the desire for liquor.
Various spasmodic a flections are relieved by collinsonia. The hot in-
fusion is a useful remedy in spasmodic croup. In whooping-cough the
paroxysms are ameliorated, and it is valuable in nervous cough and the
irritative cough of pharyngitis. It is sometimes of service in chorea. Spas-
modic contraction of the sphincter ani not uncommonly gives rise to con-
stipation, ha?morrhoid8, neuralgia of the rectum, with vague pelvic and
abdominal symptoms. This spasm and the train of disorders dependent
upon it may often be relieved by the employment every night of a sup-
pository containing from 0.65 to 4 Gm. (or gr. x-3j) of powdered colliuponia-
root. Some cases of dysmenorrhcea are markedly benefited by the admin-
istration of the fluid extract for a week preceding and during the period.
It is probable that vaginal suppositories containing this remedy would be
' See paper by nuthor. in "Tranflftctions of the Ninth Internationnl Medical
Congress," vol. iii, p. 70. Washington, D. C, U. S. A.
of ■errice in vaginismus. Excellent results are obtained from coUinaonia in
RSftl and biliary colic. Spasm of the ducts is relasced, and the irritation
of th« ravcous membranes soothed. The increased flow of urine induced
bdlitates the expulsion of email calculi. Infantile colic and flatulent colic
it adalts ore also amenable to the influence of this drug. In combination
with aconite and morphine it is more rapidly eflicacious than any other
n«aimcni of acute cystitis, and should be tried in chronic cystitis.
Incontinence of urine in children and the dripping of a few drops of
uriEW in adalts after the act of micturition is apparently completed, due to
hjpncsthe&ia of the prostatic urethra or neck of the bladder, may be effect-
ttUj relieved by the fluid extract. The ^-riter has seen it arrest the discharge
f chronic gonorrhoea after the customary bleniiorrhetios had been ex-
-.iijied in Tain. It has likewise been found very beueflcial iu leucorrhoea
aad prostatorrhoea*
COLLODITTM (U. S. P., B. P.).— Collodion.
Preparatwns.
CoUodium Stjpticuzn (U.S. P.). — Styptic Collodion. External use.
CoUodium Cantharidatum (U. S. P.).— C'antharidal Collodion. External use.
CoUodium Flexile (U.S. P., B. P.).— Flexible Collodion. External use.
CoUodhim Veaic&na (B. P.). — Blistering Collodion. External use.
Pliannacology. — Collodion is pyroxylin, or gun-cotton (-1 parts), dis-
t»lT^ in ether (75 parts) and alcohol (35 parte). The British Pliarmacopoeia
BTCft the proportions as pyroxyhn, 10 Gm. (or oiigs); ether, 360 c.cm. (or
g.;- • '-oi alcohol, 120 com. (or f^iv). Blistering collodion (U. S. P.) has
a- > (60 parts), exhausted by chloroform and evaporated (to 15 parts),
lown-'M j^ ihen added lie-\ible collodion {So parts). Flexible collodion (IT.
8. P ) i? collodion (92 parts), to which Canada turpentine (5 parts) and
e»*- ' -i parts) have been added. Styptic collodion (IT. S. P.) contains
Hl: i (20 parts) dissolved in alcohol (5 parts), ether (25 parts), and
oaUodum (q. e. to make 100). Collodion is a clear, syrupy fluid, smelling
' tfroBflj of ether; and should be kept in a glass-stoppered bottle, tightly
KBTkM, remote from lights and dre. When painted upon a surface, the
cdiCT quickly evaporates, leaving a film of pyro^cylin, which is adhesive and
loids to contract or pucker up.
Therapy. — Collodion is used to cover eicorfated surfaces and to seal
wounds. Larger wounds may be drawn together and kept in position
by strips of gauze, the ends of which are made to adhere to the skin by sev-
crml coflt< of collodion painted on with a camers-hair pencil. Sometimes it
giTM me to pain, irritation, and even blistering when a comparatively large
■fw ss thufl covered. The contraction caused by the drying of collodion is
^■de ate of in the treatment of the early stages of boils and styes, and the
pnnlec in small-pox, to prevent pitting, \\liere several coats are to be ap-
|dbed« the flexible collodion is preferable. It has also been used in herpes
Biter and erysipelas, and the compression exerted by it has been utilized
is the treatment of epididymitis, painting freely over the testicle and cord.
A cfMtinf of collodion is likewise beneficial in the superficial variety of
IwmuL 'nils substance is an exceedingly useful application to scalp-wounds,
m viiicfa. besides approximating the edges and excluding the air, it does
tvsr with the necessity for a bandage. The pressure produced by the con-
390
PUARMACECTICAL THERAPEUTIC AGENTS OR DRUGS.
traction of collodion has been successfully utilized in the treatment of um-
bilical hernia, varicocele, and spina bifida. In pruritus ani, if collodion be
applied, after antiseptic cleansing with solution of carbolic acid, marked re-
lief will be afforded.
Several cases have been reported by French physicians in which the
repeated application of collodion to the entire surface of the abdomen ia
tuberculous peritonitis was followed by recovery. In the nocturnal incon-
tinence of urine in male children it ia often advantageous to seal the orifice of
the urethra or the end of the prepuce with collodion. This method will not
infrequently break up the habit within a few weeks. The styptic collodion
may be used on cracked nipples, or for small wounds where an astringent'
may be desired. Extract of cannabis Indica (2 parts), with salicylic acid
(11 parts) in flexible collodion (87 parts), is a popular remedy for soft corns,
under the name of the green golution for corns (collodium salicylatum com-
positum, N. F.), which, however, would probably be quite as efficient with- 1
out the cannabis Indica. Iodine and iodoform have been used, dissolved*
in collodion, as an application to gouty or rheumatic joints, but the former j
sometimes has been lollowed by sloughing. Iodized collodion (contains 5
per cent, iodine in flexible collodion) is useful for chillblaiup.
Numerous collodion preparations have been suggested and employed
for various purposes. Among these may be mentioned a 10-per-cent. chiy-
earobin collodion; a cocaine styptic collodion, containing 5 per cent, of co-
caine hydrochlorate, 15 per cent, of tannic acid and 30 per cent, of alcohol;
diachylon, 10 per cent., each of lead plaster and alcohol M'ith 20 per cent, of
ether; a collodion for freckles, containing 2 per cent, of sulphophenyl-zinc;
collodions in which oleate of mercury, zinc, or other olcates are incorpo-
rated; a 10-per-cent. salol collodion for chapped hands, etc.
Crystalline. — A solution of pyroxylin in methylic alcohol has been in-
troduced under the name of crystalline. The preparation is similar to col-
lodion, but the solvent evaporates more slowly and the resultant pellicle is
perfectly translucent. An elastic crystalline, corresponding to elastic col-
lodion, has been made by Dr. Phillips, accorfling to the following formula; —
H CryataUin 18 5
01 ricini 6
Terebirtii. Canftdensia 0 25
An excellent white varnish is made by mixing: —
B Crystallin 30
01. rieini 4
Zinc, oxid 8
c.cm. or f3v.
cxm. or f3i V,.
c.cm. or fSiiss. — M.
c.cm. or fSj. .
c-cm. or f3j.
or 5ij. — M.
Gm.
Pyrogallic acid, salicylic acid, chrysarobin, corrosive sublimate, and
many other medicinal substances are readily soluble in crystalline, which
may, therefore, be used with advantage as a vehicle for various substances
in the treatment of tinea tonsurans, warts, eczema, acne, lupus erythematosus, ,
etc.
COLOCTITTHIS (U. S. P ).— Colocynth.
CDIOCYNTHIDIS PULPA (B. P.).— Colooynth-pulp.
Dose, 0.13 to 0.32 Gm. (or gr. ii-v).
Preparations.
Extractum ColocynthidU (U.S. P.).— Extract of Colocynth. Dow, 0.13 to 0.2aj
GsL (or fgr. li-iij).
UOLOCYNTHI8.
391
}*klu]je CAlhartiee Compofiitie lU-S. P.). — Compound Cathartic Pills (compound
extract of coloc^'Dth, 8ii lim. ; culouiel, 00 Gm.; rcsia of jalap, 20 Gm.; and g&mr
ht^ 15 Gm.. to make 1000 pills). Dose, 1 to 3 pilU.
PUalK Catharticfle Vegetabiles (U.S. P.). — Vegetable Cathurtic Pilla (compound
mract of cokKrynth. 00 Um.; uxirnct of hyoscyamus. 30 Gm.; resin of jalap» 20 Gm.;
I flRtart oi leptandra and resin of (KHlopliyllum. each 15 Gm. ; oil of peppenuint, S
coo.; to make UdK) pilU;. Ikt^, 1 tu 3 pilU.
j Cxtnctam Colocynthidis Compositum (U.S. P., fi. P.). — Compound Extract of
I OolocTBth. Dose. 0 25 to 0.65 Gm. (or gr. iv-x).
[ I'UaUe Colocynihidid C'omposita (B. P.). — Compound Pill of Colocynth (colo-
I f7«th*pulp. SO Gm.; Barbadoes aloes, 40 Gm.; scammony resin, 40 Gm.; potassium
I ■tplwfp. 6 Gm.; oil of cloves, 5 o.cm.; and distilled water, q. s.). Dose, 0.25 to 0.50
Ga. (or ^. iv-viij).
I PUalns Colocynthidift et Hyoscyami (6. P.). — PiU of Colocynth and HyoscyamuA
(a—pound pill of colocynth, 50 Gm.; extract of hyoseyamus, 25 Gm.). Boae, 0.25 to
I flUn Gm. lor gr. iv-viij).
Pharmacology. — The peeled, dried fruit of Citrullus coloc}Tithidi8
(Cucurbitacea*). L'oIoc\TJth is gathered T\*hen full grown, but still imma-
lore, dried and deprived of its rind, the seeds buiu^^ rejected before using.
The pUnt is a native of western .\sia, but cultivated in various portions of
the wt>rld. The pulp of the fruit after separation of the seeds, which are
inert, contains, in proportion of about 2 per cent, of the pulp, a yellow,
Mther amorphous or er}'5tallinej bitter, alkaloidal principle, Colocynthin,
ioiable in water and in alcohol; yielding a resin, Coloeynthein, when
tn«ted by acids, also Colocynthitin, insoluble in water and not possessed
o! porgative effects, a tasteless crvstalline body, probably a resin. The
ffeds contain a fixed oil.
Physiological Action. — In small doses, colocynth acts as a simple bitter,
incpctsiDg the secretions and improving appetite. In larger doses, it aug-
mentM the flow of bile and acts powerfully as a drastic and hydragogic ca-
thartic. Overdoses cause gastro-intestinal irritation, griping, and purging.
It is generally combined with other drugs to avoid this unpleasant action.
Colocynth has some diuretic properties and indirectly acts as an emmena-
gqgue. In excessive doses colocynth has caused death. Less than 4 Gm.
{or Sj) h«8 been known to produce a fatal result, though recovery has oc-
coiTMi in other cases after a considerably larger quantity.
Therapy. — Colocynth is a valuable purgative in chronic constipation or
aidity of the bowels. It produces soft, pulpy stools by stimulating peri-
xa Its griping tendency may be overcome by combining it with aro-
Batica or a small proportion of hyoscyamus or belladonna: —
S Extracti colocynth. comp 4
Kit. t^lUdonme fulior
Saponis
OI. caj uputi
IC ct f U pil. no. XX.
8|g.: Take one or two at night for habitual conBtipation.
Gm. or 3j.
13 Gm. or gr. ij.
65 Gm. or gr. x.
30 c.cm. or mv.
>In chronic dropsy of serous cavities, or cerebral congestion, the com-
pottod extract may be given with compound licorice-powder. The compound
Oithartjc pills are excellent for cases of embarras gastrxque, or so-called
kilioDSiiesfl. In chlorosis, colocynth is useful with iron. A principle known
vCftrallin, extracted from colocynth, exercises a stimulant effect upon the
lUominal organs and especially upon the intestinal glands. It also acta
opoa the abdominal and pelvic vessels and nerves and quickens peristaltio
392
PHARMACEDTICAL TIIEKAPEUTIC AGENTS OR DRUGS.
movements. Given in the form of a suppository, citrullin is successful in
relieving persistent constipation and, according to G. Archie Stockwell, 10
of value in hernia when strangulation is threatened. In solution citrullin
has also been used as an enema, and Kohlstock reports from the clinic ol
Professor Senator, of Berlin, that it yielded excellent results. Colocynthin
has hkewise proved of service, used in the same manner. These substances
produce no local irritant elTect nor occasion any tendency to constipation.
Small doses of colocynth are said to be useful in sciatica, ovaralgia, and other
forms of neuralgia.
COMDURANGO COETEX.— Condurango-bark. Several plants are
known as iMtnihiraii^Mi; hut the Ctnidurun^'o bianco, or ilarsdenia Condu-
rango ( Asolcpirtilaciw), is thut wliith hn.a the irreatest medical iiiti-rcst. The
bark is separated from the stem hv heatinp with a wooden mallet, miil after-
ward dried in the sun. It is from one-teuth to one-sixth inch in thicknes.s;
its extenial surface is smooth and of mi ashy-gray color. It contains a yellow
resin, extrnrlivo. tannin, etc, Tlie root contains 2 per cent, of a ^lucoside,
named Condurangin, wliich may l>o sei^araied into two partd. »nie of which
is soluble and the othor insohihlo in water. According to Kohert, condu-
rangin is a inixt\irc of at least two glueosides, and Carrara claims to have
isolated aui*ther glucoside dilFcring from condurangin in solubility, FHieki-
ger also fnmiil a small ipiantity of an alkaloid in condurango-bark. Hagcr
distinguislicd two principles: (a) condurangin, and (&) eonduraozin,
both insoluble in water; also condumnsteriu, cinnamic acid, autl a small
propiu-tion of an alkaloid resembling strvi-hnine. A fluid extract may be
used, in dose of 4 c.cm. {or f"ij). or a wine. 1*3 com. (f.">iv).
Physiological Action. — To the resin the effect of the bark is ascribed,
as it yields its virtues to alcohol. In the form of a decoction representing
8 or 12 Gm. (or 3ii-iij), howover. it also products decided therapeutic otTeot.
It has caused diaphoresis, increased secretion of urine, and even vertigo and
disturbance of vision, with increased activity, of the circulation. Brunton
failed to find any therapeutic value in a specimen examined by him.
Therapy. — About a generation ago condurango was brought to the
notice of the profession as a specific for cancer, and especially gastric cancer,
and reports were published of its wonderful cures in its native habitat.
Having failed to fulfill the extravagant claims that were made in its favor,
and no other use being then proj)oscd for it, condurango for a time was
allowed to retire into obscuritv. Some years ago, liowever, several promi-
nent German clinicians — lUilde. Bin/., Immermann, and Bioss — again
directed atteuiion to it, claiming that it was a good stomacliic tonic;
and in a large number of cases presenting snnptoms of cancer of the
stomach, in wliich the drug was used, the result was favorable. The remedy
was not without success in a single one out of over a hundred cases. This
remedy seems to allay the digestive disturbance and pain which accompany
organic disease of the stomach. Immermann advises the use of a wine of
condurango as a g(K>d propEirution. The tincture appears to be a valuable
remedy in gastric catarrh.
CONFECTIO EOS^ (U. S. P.).— Confection of Rose. (See Bosa
Oallica.j
COKirM.
393
COFITTM (T. S. P.).— Hemlock,
'COira FRirCTUS (B. p.).— Conium-fruit.
CONn FOLIA (B. P.).— Conium-leaves.
Preparations,
F)iud4>xtr«rtum Conii (L'. S. P.). — Fluid Extract of Conium. Dose, O.Ofl to
tJOccm. lor miv).
r.\ir*ctuni Conii.— Kxtrnot nf foniuni. Pobp, 0.03 to 0.12 t-.em. (or gr. b*-ij).
Tincturm Conii (B. P.).— Tincture of Conium (20 per cent.). Dow, 1 to 4 c.cm.
(« mxT-aj).
Surnu Conii (B. P.). — Conium-juice expressed from fresh leaves and alcohol
aMtd (on*-third of the volume) to prt-sen-e it. Dose, 2 to 7.5 com. (or fSaa-ij).
Coifuentuni Conii (B. P.).— Conium Ointment (conium-juice evaporated to one-
tlghih oiiiA volume and three times its weight of wool-fnt triturated with it).
Coniin*.— Coniine (the active principle). Dose. O.OOO to 0.08 c.cm, (or mVwj).
« oniiiue Hvdrobrmnidum. — < Vmiine IJyilruhroiiiidr. IhtM'. 0.*)i>.) to O.0.i<;m. (or
^ .:JI.
Consiitw Hj-drfichloridum. — Coniine Hydrochloride. — Doao, the same.
Pharmacology. — The full-;^r<i\vii bvit unripo fruit uf Conium macnilatuni
iriaii>clliuni-), ourcfully dried and preserved, aud yielding, when ussayed
br L*nitei! Stales Pharmacopceia prftcess, not less than 0.5 per cent, of
After being: kept for two years conium is unfit for use. The
J^Pharmacopa?ia aUo reco^izes the fresh leaves and young branches
r'*miuni maculatum colletted when the fruit begins to I'orni. By
hmiaiug iht^\ prt»!-5ing nut the juice, aud adding V5 as much alcolMd
ve obtain Succus Conii (B. P.). A tincture of the leaves (13 Vi per cent.)
VM form€rly official (dose, 2 to 4 ccm., or foss-j), but, like conium-juice, it is
nnreliable in strength, and should be abandoned in favor of preparations
irtmi Ihfc? ^ceils. The linhiiat of ht-n^lock is Europe and North America. It
QQQtaiDft three alkaloids ami both volatile and tixed oils. The most iinpor-
\m Coniine (or Cjmapine), a colorless, oily liquid, alkaline in reaction,
an arhfl, t<)hatr«i-like tas^to and a characteristic odur re^icmhlijig the
nf mic*?. Coniiue is soluhlt^ in alcohol; very slightly in water. It is
tile, and is deconiposed hy light or heat. It is most ahuiubmt
Ihi- nvnrly-rjpe fruit of the plant in its second year. Methyl-coniine,
»ch«^r alkaloid, is associated with the preceding, and alz^» Conhydrine, or
>iiii]i, a crystal lizable alkaloid, convertible into coniine by abstractioa
eii'iuents of one molecule of water, Paraconiine h<is also been
Another alkaloid has been isolated by Merck. It is believed to bo of
ir composition to conhydrine, and has, therefore, been termed pscudo-
MBkydriae. It forms easily-soluble salts. Their medicinal effects are less
^endenx th»n those of coniine.
B^^ Ph7«olo|^cal Action. — The local effects are sedative in painful con-
HHBml No influence upon secretion has been noticed. Gastric disturbance
^^HVfrom a full dose of conium; nausea and vomiting appear early. Fol-
lowing this, there are staggering gait, weakness of the limbs, numbness,
D€, ptosis, double vision, pupils slightly dilated, vertigo, lowered respi-
, and labored speech. After poisonous doses, there are loss of power of
^.commencintr in the lower extremities; loss of sight and of speech,
lly, ileaih from paralysis of respiration. Coniine cau.ses paralysis
irenic nerve; llie motor nervea of tlie accessory respiratory muscles
•
394
PHARMACEUTICAL THERAPEUTIC AGENTS Ott DRUGS.
become paralyzed later. Very large doses cause general paralysis ; but ordi-
narily the heart's movements seem to be unaffected, and the mind ren^ins
clear, until the brain is overcome by accumulation of carbonic-acid gas in
the blood. '|
In a case of hemlock poisoning, the stomach aliould be emptied and «
coffee promptly given, with hypodennic injections of atropine. Musciilar I
exercise dflays the action of the poison. Free counter-irritation by mus- «
tard would doubtless be serviceable. The physiological antagonists are [
strychnine, physostigmine, and atropine; tannic acid is incompatible, i
Upon the nervous system methyl-coniine acts slightly differently from '
coniine; the latter paralyzes the motor nerves from the extremities, gnid- ,
ually extending up to the motor centres; the former affects first the motor i
columns of the spinal cord. The sensory nerves and muscular irritability
remain unaffected. The eAcretion from the system of coniine is chiefly by
the breath and tlie urine. The use of conium is sometimes followed by an
erythemutoiis or papular eruption.
Therapy. — Poultices of the leaves of hemlock and flaxseed (2 parts of
the former to 6 of the latter), with boiling water, have been used as a sooth-
ing dressing to painful swellings; they should be applied with caution where
there are abrasions or ulcers. Conium possesses both anodyne and anti-
spasmodic virtues, and has long been reputed to exercise a deobstruent in-
fluence upon glandular and other enlargements. A hemlock ointment, made '
by bruising the leaves with sufficient water, extracting and incorporating
the juice with lard or other excipient, is an efficacious local remedy in pain-
ful maladies. It assuages the pain of cancer and may be beneficially spread
upon irritable or painful ulcers and painful haemorrhoids. It likewise affords
relief when applied over the seat of pain in neuralgia, herpes zoster, chronic
rheumatism, gout, or synovitis. The ointment is appropriately used in order
to reduce the volume of enlarged scrofulous glands, enlarged mammary
glands, liver, or spleen, and goitre. It may be spread upon the breast when
the secretion of milk is excessive or requires suppression. In whooping-
cough and asthma hemlock ointment may be applied to the chest to assist
the action of other remedies. Conium may be prescribed in form of oint-
ment as follows: —
005 Gm. or gr. j.
30 Gm. or gr. xx.
Gm. or ij.
B Extracti conii 4 Gm. or 3j.
Cocameo Hydrochloridi 32 Gm. or gr. v.
Atropinffi BiilphaUs
A'^eratrinre oleatis 1
Ungt. aquB ros« 31
M. For neuralgift, chronic rheumatiBm, gout, and synovitis, a small piece the size
of a pea being used for each application.
ft E.xtracti conii 4 Gm. or 3].
Mentholi 32 Gm. or gr. v.
Ext. bellndonnre folior 66 Gii or gr. x.
Unfft. zinci oxidi,
Adipis lance hyd. aa 16|5 Gm. or 5«»-
M. For painful cancer, scrofulous glands, herpes zoater, and enlarged mammary
glands.
The vapor of coniine, or the fluid extract with hot water in an inhaler,
yields good results in catarrh, laryn^itis^ irritative cough, and acute bron-
chitis, or the persistent cough of phthisis. The local hypodennic injection
of coniine has been employed in order to quiet the intercostal muscles in
COXVALLARIA HAJALIS.
395
_ and pneumonia; but the hydrobromate, being more permanent, is
a better preparation. Other painful and spasmodic diseases have been bene-
itcd bj the same method. Among these may be instanced angina pectoris,
cnphjaema, asthma, acute mania, and tetanus. Dr. Harley warmly advo-
ottea the nee of conium in chorea; also in nervous twitchings, blepharo*
suam, and post-hemiplegic tremor. In various spasmodic affections of chil-
mn^ conTulsions, spasm of the laryns, trismus, spasmodic wryneck, and
whooping-cough it has also been much approved. In ovaritis and in dys-
Bcnorrhsa its administration in the following prescription is frequently
followed with great relief from the pain: —
3 S««H conil 22
Polurii bromidi 12
Spiritiu chlorofonni 7
Aqua carophorae ad 240
ccm. or fSvj.
Gm. or 3iij.
ccm. or f3ij.
ccm. or fjviij.
M. Sxg.: From a half to a tablespoonful every two or three 'hours.
Conium has been highly recommended in paralysis agitans and hysteria.
In acute mania, mania a potu, and active delirium tremens it quiets motor
excitement, finding, as it does, its principal usefulness in diseases attended
bj excessive motor activity. In some cases it is well to combine it with a
little morphine for its effect upon the brain, and in others with potassium
broniide. Conium has been employed in epilepsy, but here it is inferior to
Att bromides. It may, however, prove of benefit in those cases marked by
vertigo and disturbance of the cerebral functions. Walshe has known it
to reheve the pain of gastric cancer. For the latter disease, as well as gastric
«ker, it may be used in this combination: —
I
R Tinctune conii 2
Morphiofle sulph
Pbeaolis liquefucti
Syrupi acacise 00
M. S\^.: A teaspoonful whenever in pain.
ccm. or f3Ba.
065 Gm. or gr. ].
24 ccm. or wiiv.
ccra. or ftiij.
H Dr. Seguin, of Xew York, recommended rapid increase of the dose until
H pbyaiological effects are noted. He gave 4 ccm. (or f3j) of the fluid extract
H at a do«e, and never less than 1.20 ccm. (or mxx). Owinjr to the very volatile
H ^racter of the coniine, it is possible to administer large doses of some old
W 8a>d extracts without getting any effects whatever. If the strong mousy
ador » miesing, the preparation will have very little therapeutic value. It
is ako said that preparations from cultivated plants, such as the succus, or
tiacture of the leaves, are apt to be inert. This explains the enormous doses
osed by Dr. Harley (15 to 90 or 120 ccm., or fjss to fjiii or fjiv) of the juice.
It bas been likewise noticed that children bear conium-juice well. Dr.
Squibb calls attention to the possible danger following dilution of the fluid
tctJict^ bj which a precipitate is formed, so that toward the end a poisonous
doae may be accidentally taken. Death has been caused by the adminis-
txition of 9.25 ccm. (or mcl) of the fluid extract. The poison administered
to Sorratea was apparently a strong, recent infusion of conium.
I
m
COHVALLARIA MAJALIS (U. S. P.).— Idly of the Valley.
Preparations,
Flui'W'xtmctum ConvaUariie (V. S. P.).— Fluid Extract of Convollaria.
t.U Co 0.30 ccm. (or miiiv).
Tbr NAtionjkl Kormulnry b1«o has a fluid oxtraet of the flowera.
Do9e,
396
PTLillMACEUTICAL THERAPEUTIC AGENTS OH DRUGS.
Pharmacology, — Tliu olHciiil di'tinitiou is tlie dried rhizome and roots of
Convallaria majalis (Liliaceae). This plant is a native of Europe, northern
Asia, and our Allegheny Mountains. Its rhizome is the size of a quill, its
flowers bell-shaped and six-lobed. The flowers possess a fragrant odor and
a bitter, acrid taste. All parts of the plant possess medicinal value, but ita
virtnefi ri^side prinoipjilly in tlin rhizoint^. Convallamarin is tJie most im-
porliuit au'tivL' [n'incijjle of the [ilnut. It is a bitter-sweet, white, cr\stallme
glucosidc (C;;3H^,40j^,), soluble in water and alcohol, hut not in ether and
ehlornfomi. It is prt'cipitiited by tannin, and, by aci<l9, is split up into
glucose and Convallamaretin. Tliere is als*^ an acrid (rhicoside. Convallarin
(C34H,..^0],), whicli simihu-ly splits up into irlueoso aJid Convallaretin. The
dose iif <'on\jil];uiutri!i is .(KJ Gin. (or gr. V'-)-
Phyaiologrical Action. — Convallarin, in doses of 0.20 to 0.25 Gm. (or gr.
iii-iv), acts as a purgative, but has no marked toxic effect. Convallamarin,
in st!iiill do^cs, excites voinitintr nnd luanifejit? n special influi-'ncc upon the
action of the hcnrt. At first the eoutnictions iire suddenly returded and the
blood-preasure increased; subsequently the cardiac pulsations are quickened
and arterial pressure further augmented. Finally, the l>€at is arrested.
Death may take place within a few minutes after introduction of the poison.
The reflex function of the cord is abolished; otherwise the action of the
nervous system seems but slightly affected.
Therapy. — In small doses this drug: strengthens the heart's action; in
larger quantities it restrains excessive cardiac activity. It has been found
of especial value in mitral insuf^ciency. It quickly relieves the dyspnoea and
palpitation, and, after having been given for two or three day.?, may be dis-
continued for a week or more without recurrence of the symptoms. Con-
vallaria seldom disagrees with the stomach, and no cumulative action has
been observed. As a rule, the appetite and digestion seem to improve under
its use and a regular action of the bowels is promoted.
Convallaria, and especially convallamarin, have, however, in some in-
stances, been known to cause haemoptysis, dyspnoea, and other disagreeable
symptoms. It increases the secretion of urine, and, when compensation hafi
failed, invigorates the heart and reduces cedema. In disease of the aortic
valve, though of some service, the value of convallaria is less marked. In
angina pectoris and various forms of functional heart disea.se this remedy
has proved beneficial. The favorable action of convallaria majalis in dropsy
of renal or hepatic origin has been announced by Janowski, who prescribes
it in an infusion of 4 Gm, (or 3]*) of the plant to iSO c.cm, (or f^^vj) of water,
a tablespoonful every two hours, changing later to a l-to-12 alcoholic tinct-
ure, of which 45 to 80 drops are taken during the day. It also favorably in-
fluences the diuresis in hepatic cirrhosis. In chronic Bright's disease, it
strengthens the circulation, relieves dyspnoea, increases the flow of urine,
reduces dropsy, and lessens the albuminuria. Good results have also fol-
lowed its administration in cardiac debility, due to pneumonia or tj-^hoid
fever. In some cases of idiopathic asthma it relaxes the spasm of the arte-
rioles. It sometimes is serviceable in tic douloureux and other forms of
neuralgia, insomnia, and in the restlessness of fever. The palpitation and
dyspnoea of phthisis are mitigated by the use of convallaria. It is of utility,
likewise, in the irregularity of the heart dependent upon acute pneumonia,
bronchitis, or emphysema, but is ineffective in fatty degeneration of the
heart.
^ COPATRA. ^^^^^^^^" 397
B Flui<l<it. eonvallariw 715 c.ciii. ot fSij.
SjTupi aurantii q. a. ad 601 <^<^^- or fSij.
IC Si^.: A teaspoonlul to a tAblc?poonful three times a day. Useful in mitral
Dcy and functional heart disease.
ft Potuaii bitartratis ..^.. 15(5 Gm. or S^s-
Fhudext. convallHriffl,,.,^^ fl c.cm. or fSiss.
Syr. ftimplici* q. a* ad 120| c.cm. or f Jiv.
K. Sig.: From one-half to one tableapoonful, in water, three or four times a day.
TalwbW in general dropsy from heart or kidney disease.
COPAIBA (U. S. P., B. P.).— Copaiba.
Dmc, 2 to 4 c.cm. (or foss-j).
Preparations,
Oleum Copaibee (U.S. P.. B. T.).— Oil of Copaiba. Dose. 0.30 to 1.20 ccm. (or
ES).
Mt— CopaibK. — Mass of Copaiba (copaiba, 94; magnesia, 0 parts). Dose,
to 2 Om. (or gr. x-3ss.).
Reuna CopailMC. — Resin of Copaiba. Dose, 0.50 to 1 C#m. (or gr. viii-xv).
narmacoIogT'. — Copaiba is '*tlie oleoresin of one or mnre South
American species of Copaiba (Le^iminogufi)" (U. S. P.), coming princi-
mUv from Brazil. "The oleoresin obtained from the trunk of Copaifera
lioiftlorfii and other species of Copaifera*' (B. P.). It is not, properly
•peaking, a balsam. In phypical character it is a clear, transparent, oily
^^■■ud. of a pale-straw color and a characteristic impleasant odor and tnste.
^^^Bfttba is insoluble in water, soluble in alcohol, etlier. volatile and Rxed
^^SC. It contains a larfre quantity of volatile oil (thr^ best specimens, 70 to
V W prf cent,), in which two resins are dissolved. Copairic acid, the princi-
~ pal one of tJie resin^, is crystallizable, with faint odor and bitter taste;
iiMolable in water, easily soluble in absolute aleohnl and in ammonia. Roth
the oil and the resin are medicinally active. It gradually thickens on keep-
mg, owing to the conversion of tiie volatile oil into rcein, and crystals of
I oopaivic acid are deposited.
A new substance, termed copaiba-red, has been found by Professor
Quin»*kp in the urine of persons taking copaiba. A rose-red, changing to
a '^ • -hade, is produced by heating the urine with concentrated sul-
pfc. The cubstance upon which this reaction depends is a colorless
ac»tL
Phjiiological Action. — Locally applied, copaiba is slightly stimulating
to thr skin and mucous membrane. The taste of copaiba is peculiarly dis-
agreeable, and it imparts its odor to the breath, being partly excreted by the
biDodiial mucous membrane. It is heating and irritating to the stomach,
aonng * " <• omctations and frequently exciting vomiting and purging.
Taken i mal doses, it soon interferes with the digestion, causing loss
of appt-' rdered bowels, and diarrhcea. Copaiba is very diffusive, and
fCifBlua* -tion at its points of elimination by the kidneys, bronchial
mattms membrane, and skin. Its special action is upon the mucous mera-
bftn* of the genito-urinary tract, and in large amounts it gives rise to irri-
tat»n or inflammation of the kidneys, in its discharge through these organs.
BSoodj urine, pain in the bladder, and strangur}' are occasional results of
tbe ai«n«ni«tratinn of copaiba. It acts locally upon the genito-urinary tract,
tt Cut fftimnlating and subsequently checking secretions. The resin has a
398 PHABJIACEUTICAL THEBAPEUTIO AGENTS OR DRUGS. ~
decided diuretic action and is also expectorant. Georginewski, however, who
made numerous experiments upon dogs and rabbits, states that enormoua
doses of copaiba occasioned, in these nnimals, only renal congestion, but no
inflammation or degeneration. The resin is preferable to the oleoresin, since
it is less apt to cause digestive disturbance. Its diuretic effects are powerful,
constant, and long continued. The urine gives a precipitate, when treatefl
with nitric acid, which may be mistaken for albumin; but it deai-s up
when heated.
During the administration of copaiba, a coarse, measly rash sometimes
breaks out over the body, especially in persons with a delicate skin; it also
causes annoying itcbing. In other cases, urticaria, erythema, or a bullous
eruption is caused. The author has observed a rash resembling that of small-
pox appear upon all portions of tlie body. Dr. Frederic Tresillian has ob-
sen-ed a case in whirh a purpuric eruption, accompanied by febrile action,
was apparently caused by Ihe administration of copaiba.
The administration with an alkali renders this accident less likely to
occur. The mass of copaiba (pihihc copaibae, U. S. P. 1870) was introduced
to the Pharmacopoeia of 18S0. but it is less efficient therapeutically than the
other preparations, and has been omitted from the present revision.
Therapy. — Copaiba has been used for its stimulating and antiseptic
effects in chronic skin diseases, psoriasis, lupus, and leprosy, being in its
action ver>' much like gurjun-oil.
Copaiba has been used^ with reported advantage, as a local remedy in
frost-bitee. It can be used with benefit in old ulcers. A mixture of equal
parts of copaiba and resin cerate is recommended by Dr. T. G. Stephens,
of Sidney^ Iowa, as an efficient application to the surface of indolent ulcers.
In thickened and irritable conditions of the tongue, mouth, rectum,
vagina, uterus, and the urethra it is also useful. Copaiba, applied to the
urethra in gleet, is sometimes followed by a complete removal of the dis-
charge : —
^ Copaiba?,
Glywrit borojrlycerim aa 2] c.cra. or f3»3.
M. Sig.: For ajipiication to the urethra with bougie or eamers-hair brush.
Internally, it is also given in the treabnent of psoriasis, and for this
purpose it is best administered in capsules, one or two hours after meals.
For bronchitis, given as an expectorant, and in dropsy, for its diuretic effect,
it is better to use the resin, which is nearly free from the objection, to the
volatile oil, of causing offensive eructations. In bronchitis its effects are
more decided after subsidence of tlie acute stage, and it is particularly valu-
able in chronic bronchitis associated with dihitations of the tubes and marked
by a profuse purulent discharge. In ascites and some kidney disorders the
resin is a valuable means of increasing the urine. Copaiba is of service also
in cardiac dropsy. The remedy is not, however, invariably successful in
removing these transudations, even when the conditions are apparently the
same. Ringer concludes that this difference depends upon individual pecul-
iarity, and adds that, whereas copaiba may cause bloody urine, he has seen
a large amount of blood in the urine quickly disappear when copaiba was
administered. The oleoresin is principally used as an antiblonnorrhetic in
gonorrhoea, after the acute stage has passed, and in cystitis and pyelitis. It
may be given in combination with cubebs, or in the well-known Lafayette
Mixture (mist, copaibae comp., N. F.): —
COPAIBA.
399
B Copaibe 60
Tt. Urftsdula CO 60
lif . poUSMD / 16
Sptritiu fttherit nitroai 80
^rrupi 160
MacilAginis Acaci« q. s. ad 473
IC To be well agitated when used (4 c.cm. = 0.50 cczn., or f3 = mvii8a)
iBful taken after meala.
c.cm. or fSiJ.
c.cm. or fjij.
c.cm. or fSiv.
c.cm. or fjij.
c.cm. or fjv.
c.cm. or Oj.
Doae, a
To each dose of the above, 0.18 to 0.30 c.cm. (or miii-v) of oil of sandal-
wood may often be added, with good results.
Copahin dragees consist of copaiba, 0.32 Gm. (or gr. v); cubeb, 0.65 Gm.
(orgT. x); calcined magnesia and sodium carbonate, of each, 0.065 Gm. (or
p. j); made into rather large pills, which are sugar-coated. They have been
kfj^dj med in the treatment of chronic gonorrhoea.
Among the many combinations of copnil/a found of service in gonor-
acd gleet, the author suggests the following: —
B Bolsie copaib« 14
Oleoref infle cubebs 4
Phenvli* salicylate 12
Pcpaiiic pur 2
M. ci (t eapsuls no. xl.
5%.: Txom aix to ten a day.
Gm.
c.cm.
Gm.
60 Gm.
or Siilas.
or f3i.
or 3iij.
or gT. xl.
Gm.
c.cm.
or 5iv.
or (3ij.
c.cm. or fjviij.
B Rciiiue copaibflB 1515
Acsdi sulpnurici arom 7|5
AeaeiK q. a.
Infua. roae 240|
U. Sig.: A tablespoonful three or fonr times a day.
B Rcainae copaiba 15 6 Gm. or Sss.
Fluidextracti glycjrrhizas 30 ccm. or f jj.
Spirituti etJieris nltrosi Ifi c.cm. or fjsa.
Aeads q. a.
AqoM cinnaniomi ad 240| ccm. or CSviij.
IL Sif.: A tablespoonful three or four times a day.
B Olei copib«.
Oleorctiiue cubeb« aa 4|60 c.cm. or mixx
Aloini,
Kxtracti belladonna (oUor
OL inenth. pip
M. el ft piluln no. xij.
8^.: From three to six pills a day.
aa 1063 Gm.
06 c.cm.
or gr. j.
or mj.
It is Mfe to begin the administration of copaiba in gonorrhoea as soon
f thi* mirial severity of the attack has subsided and the bowels have been
frpf ' d. In the chronic cystitis of women Dr. Whitla has derived
ptt :i from injection into the bladder of equal parts of copaiba and
win caator-oil. One ounce of this mixture is injected and allowed to re-
■till until expelled. Small doses internally administered often prove ser\'-
iecabJe in cystitis, and will also often allay irritability of the bladder do-
pndent upon prior attacks of gonorrhoea or excessive venery.
In th»? gonorrhoea of females an emulsion of copaiba is sometimes used
^sa injection. In certain affections of the intestinal tract this remedy is
400
PHABMACECTICAL TUERAPEUTIC AGENTS OR DRUGS.
sometimes of service. Chronic diarrhcea and dysentery may improve under '
the administration of copaiba after other agents have failed. It may prove
beneficial in chronic intestinal catarrh accompanied by ulceration^ and is
recommended by Allingham in chronic proctitis. Clark and others have
found it useful in pseudomembranous enteritis, given in the inten'als be-
tween paroxysms. It has been used successfully in the treatment of hsem- ;
orrhoids, 1.20 c.cm. (or gtt. xx) being administered in capsules four times i
a day, or 2 c.cm. (or fass) in combination with 1 c.cm. (or gtt. xv) of liquor j
potassae, taken three times a day. Copaiba has been advantageously given ,
l)y the mouth in certain inflammatory diseases of the eye, especially iritis j
and sclerotitis. In purulent ophthalmia it has been applied upon the skin ,
around the orbit and instilled between the lids with good effect. 1
COPTIS. — The Coptis trifolia, or gold thread (Ranunculaceie), is a i
native of the temperate portions of North .America and the Old World. The
entire plant is used, and was formerly official. The rhizome is thread-like,
and of a bright-yellow color. It is bitter to the taste, without odor. Its :
constituents arc Berberine, a yellow alknloid; Coptine, a n^'m: but no
tannin. i
Physiological Action and Therapy. — Principally on account of the ber- I
berine, coptis is a pure, bitter tonic, agreeing well with the stomach, and
without astringency. It is used to increase appetite, and as a general tonic. ,
Locally, the infusion has been employed in aphthous ulceration of the
mouth, and is a good gargle in ulcerative tonsillitis. The effects of berberine ,
are discussed below.
Tlie En.st Indian variety, Copti? tecta, of wliich the root only is em- .
ployed in medicine, contains a very large proportion of berberine, — more
than any other plant known.
A prescription containing gold thread, of much value in the treatment
of dyspepsia, especially when attended with diarrhoea alternating with con- j
stipation, is: —
R Fluidextnicti contitlis 60
Tinct. nucis voroicie 4
Aquse cinnamomi 240
M. Sig.: From one-half to a tablespoonful before meals.
c.cm. or fjij-
c.cm. or f3j.
ccm. or fSviij.
Berberine is an alkaloid found in numerous plants (berberis, coptis, ,
calumba, hydrnstis, menispermnm, podophyllum, xanthorrhizn, xanthoxy- i
lum, etc.), belonging to the natural nrrlcrs Berberidacere, Menispcrraaceae^
and Ranunculacea?. It occurs in yellow, prismatic crystals, soluble in hot
water and alcohol, but insoluble in ether. It yields bright-yellow, crystal- :
lizable salts, of which the hydrochlorate and sulphate are employed in
medicinal doses of 0.13 to 0.65 Gm. (or gr. ii-x). It is a bitter tonic, anti-
pyretic, and antiperiodic; also cholagogiie. It is useful in dyspepsia, malaria, ,
and diarrhoea. (See also Berberis.)
CORIANDRUM (U. S. P.).— Coriander.
CORIANDRI FRUCTHS (B. P.).
DoM, 0.32 to 2 Gm. (or gr. v-xxx).
CORYDALIS.
401
fBr«i-T)
Preparatioti3.
CoriAodri (U.S. P., B.P.).— Oil of Coriander. Dose, 0.06 to 0.30 c.cm.
r
Caiif«ctio Sennse (U. S. P.. B. P.).— Confection of Senna.
Pharmacology. — Coriander is the dried, ripe fruit of Coriandrum satl-
frmbelliferae). It is a native of Asia. The fruit, or seed, lias an
Dlf, ^picy odor, the chief constituent of which is Coriandrol, which is
iioraeric with borneoh Tlie fruit alsf> contains ilxed oil.
Tlicrmpy. — This agent is used as on aromatic and etomachic, and is
nfuallv employed to prevent griping from other remedies, or as a flavoritig
«xdpient. A few drops of the oil may be given upon sugar for the relief
of flatulence or colic.
COBNTJS.— Dogwood. The bark of the root of Comus Florida (Cor-
MCfK)y a small tree indigenous to the Tnited States, has decided physiolog-
idl properties. It contains a crystallizable, bitter principle, Comin, or
eomic acid; also tannic acid, resin, etc. As the active principle is altered
by air and heat, a decoction or aqueous fluid extract is not an eligible prepa-
ration in order to obtain the effect of the drug. Cornin is found also in
othrr species of dogwood: Cornus circinata, Cornus sericea, etc.
Physiological Action and Therapy. — Cornus belongs to the class of
vmtable bitters, and is used as a stomachic tonic to increase appetite, etc.
It nas also considerable reputation for control over malarial manifestations^
tod is considered the best substitute for cinchona among the native astrin-
gent bitters.
CORONILLA. — Coionilla varia (Leguminosse) is a shrubby plant, the
ficivers of which are arranged in little tufts resembling coronets. The active
pnnciplc is a glucoside, which has been termed Coronillin.
Pnyuological Action. — The drug possesses an unpleasant, bitter taste,
hot it increases the appetite and never excites gastro-intestinal disorders even
vbcn given in large doses. Spillmann and Haushulter have studied the
dleds of coronillin upon the human subject. As a result of their investiga-
tioBa thej concluded that coronilla is a cardiac tonic, the beneficial effects
of which arc manifested within twenty-four to thirty-six hours after inges-
tion.
Therapy. — In organic affections of the heart coronilla increases the
volume of the pulse, augments diuresis, diminishes oedema, and relievea
drvpon^. Coronilla is generally applicable to the same cases in which digi-
talis »* • f'ds. and is powerless in those conditions of degeneration in
▼hirh - fails. It regulates and reduces the action of the heart in
tachrcanim and abolishes painful reflex manifestations. In lesions of the
nitrai and aortic valves it is especially beneficial. The paroxysms of d3*sp-
Met dependent upon organic disease of the heart are mitigated by this
roDMiy. A tincture has been used in doses of 2 to 4 c.cm. (or fSas-j).
Cnronilla has no cumulative effect and does not disturb the digestive func-
Coronillin has been given in doses of 0,065 to 0.58 Gm. (or gr. i-ix).
COBTDAUS. — CorydaliB, Turkey Com, the Dicentra Canadensis
(Fuinariflcort>). a native of the northern part of this country, has some repu-
(llion as an alterative, especially used as a tonic in syphilis and other condi-
402
l'U.\U.MA4.:KrTU*AL TIlKHAlMa'TIC AUEXT6 Oil DUl'OS.
tions of debility. Tlie tubers are the part of the plant used; they contain an
alkaloid, Corydaline, combined with Fumaric Acid; also an acrid resin and
bitter extractive. An alcoholic extract, made by precipitating the resin with
water, is incorrectly t/^micd Corydalia, or Corydaline, by the bouinic physi-
cians, and has been given in <loscs of 0.0G5 to 0.32 Gin, (or gr. i-r).
COTARNINE HYDROCHLORIDE. (See Stypticin.)
4
GOTO CORTEX.— Coto-bark. This bark is obtained from a large tree
(fani. Liuiraceiv) of Bolivia, but its exact botanical origin in unknown. It
is received in ihp form of lint or curved pieecs n foot or more in length and
V4 inch broad. Externally it is of a cinniinion-brown color, but when
broken it appears studded witli numerous scattered golden-ytllow spots. It
has an aromatic odor, which is more percejjtibh^ when the bark is bruised.
The fjowder is very irritant to tlie Schuoiderian mucous membrane. The
taste is slmrp and slightly bitter, but not a.stringcnt. The active principle is
a crystallizablo substance termed Cotoine, of a pole-yellow color, slightly
soluble in cold vvuter, but soluble iu hot water, alcohol, other, eliloroforni.
and alkaline solutionn. (V^toiue in precipitated by liydrorhloric arid with a
vlear, yell<nv voUir. It is colored blooil-red by nitric acid, browuisli yellow by
■sulphuric acid, and black by ferric chloride. Cotoine possesses a rather acrid
taste. A bark differing in external appearance from coto, and probably
derived from an allied species, has been designated paracoto. Paracoto eon-
tains an active principle called Paracotoine, analogous to cotoine in com-
position and effects, but feebler. Powdered paracoto is unirritant to the
nasal mucous membrane. Paracotoine is of a bluish color, but slightly
soluble in boilinjj water, and is soluble in alcohol, ether, and particularly in
•chloroform.
Physioloifical Action. — Applied to the unbroken skin, powdered coto
causes heat and redness. Taken internally, it gives rise to a sensation of
warmth in the stomach, and in large doses to nausea and vomiting. Il
stimulates the secretion of saliva. Small doses may increase the appetite.
It is eliminated in tlie urine. Coto retards the development of bacteria and
the occurrence of putrefaction. It canses active dilatation of the intestinal
blood-vessels. Coto does not produce constipation in healthy individuals.
Therapy. — Coto and paracoto are remarkably etlicient remedies in diar-
rhcea. They are applicable to all varieties of the disorder, except that de-
pendent upon ulcers of the bowel, in which they have generally failed.
Abundant testimony exists as to its worth in functional diarrhcea, acute and
chronic gastro-intestinal catarrh, cholera infantum, the diarrhoea of typhoid
fever, of rachitis, insanity, and in that ftirm resulting from reduced nutri-
tion. It is exceedingly valuable in the treatment of tuberculous diarrhoea.
The author has employed the following prescription in chronic and in
tuberculous diarrhoea, the effect being complete cessation of all discharge:- —
R Muidtxtrftrti roin oort 7|5 com. or fSij.
Kluifloxlracti haimunelidis 16] c.cm. or fjsa.
Aquio cinnaraomi 3O0| c.cm. or fjx.
M. Sig.: A dessertspoonful every three or four hours.
Professor Albertoni, to whom we owe the most comprehensive study of
the physiological action of coto^ observed no favorable results in drunkards
CBKOLIXCM.
4(»3
or where the portal circulation was embarrassed, as in cirrhosis. He con-
miau it contra-indicated when there is hyperemia of the bowel and a
Uadeocx to inte&tinal haemorrhage.
CRAT^GUS OXYACANTHA.— The Kiijrlisli Hawtliorn (Rosncfsr)
Im^ Kii'ii iiitrotiutetl into this country from Europe, where it is innstly culti-
rat^ fwr hedges. It has fragrant corymbs of white or purple Howerp, and
ktf- larjn' tlioms make it protective as well as ornamental. The ivd herrie?
ConTiitii tiuinin, and if gatliered before ripening, are astringent. The flowers
contain a small proportion of trimcthylamine (or a substance wlding this
prinrip1r>, nnd amygdaline exists in all ])arts of the plant. The bark con-
ning oxyacanthine, which is not identical with that in Berheris. A normal
toicturi- (do?r tM;:i to 1.30 Gm.. or mx-xx), well diluted with water, has
bern used principally by l)otanic physicians in angina pectoris, precordial
bpfin«pion. and valvular insufficiency.
CEEOLnnJTf.^Crcolin is «tl>taiiied from English coal by dry distilln-
tioo. ih»' cnrlmlir arid htiu;; n'Hirivf»d, and the residue enmlsified by soap
wT caustic wwla, or suljihonatcd by the action of sulphuric acid. It is a
ijmpy, dark-browDy or blackish fluid of n tar-like odor. It mixes with water
IB all prripi>rttonP, forming an opaque, whitish emulsion. It is soluble in
iol. The exact chemical constitution of creolin has not been determined,
it e*^ms to consist largely of hydr<•nlrl>f>n^ joincil with cresols friv froni
«IT trwci^ of carbnlic acid, together with m small proportion of organic bases
«»f the pvridin order, an<l alkaline ash.
Physiolo^cal Action. — A 3-per-cent. aqueous dilution excites no irri-
tfttion when applied to the skin. When the skin is subjected to the action
•f 1 5-per-cent. dilution for a considerable time, a slightly burning sensation
malts, but soon disappears. Creolin is irritant to mucous membranes. It
» an efficient germicide, in some respects more powerful than carbolic acid.
It is more destructive than carbolic acid to the micro-organisms of typhoid
ferer, Asiatic cholera, and suppuration; while, upon dried spores of the
■athrax bacillus, carbolic acid exerts a more powerful inhibitory influence
than creolin. Carbolic acid is likewise the more efUcacious and permanent
disinfectant of putrefaction. Creolin possesses the advantage of being much
IwB toxic. It was at first, in fact, supposed to be entirely devoid of toxicity.
Thii claim can be no longer upheld, since several patients, especially among
tht 2m<iO midwifery cases reported by r)r. Bitter.* nf Breslan, showed symp-
laroM of nausea, chill, fever, dyspnoea, collapse, and albuminous urine foUow-
ii'. In one case, scarlatiniform rash — with thirst, fever, and itching
of .1 — was pro<luced.
The application of creolin has also been known to produce eczema,
hema, vesicular eruptions, and desquamation of the skin in large patches,
Uigtihtr with more or less severe constitutional disturbance. Dr. Fliesburg
reported a fatal case in a babe, three weeks of age, to whom 2 c.cm. (or
) of undiluted creolin had been given by mistake. Death occurred
tventr-seven houra after ingestion of the liquid.
Therapy. — It is almost exclusively as a local application that creolin
•0rifwA it rtltral Journal, Dec. 13, 1890.
404 iMIAUilACliLTlCAL TUElUrKl' I'lC ACiENTS OR DHCOS. ^
has been used, though it has been administered internally in a few inetancea
with the view of preventing gastro-intestinal fermentative processes. As
an efficient and safe antiseptic, it is very advantageously employed in a 1-
or 2-per-cent. solution to irrigate accidental or surgical wounds. A 2-per-
cent, dilution in olive- or linseed- oil, applied upon absorbent cotton, is an
excellent dressing to abscess-cavities, sinuses, to wounds left after resection
of bone, removal of a sequestrum, to compound fracture, sloughing ulcers
of the leg, etc. In addition to its parasiticide virtues, it is additionally
serviceable as a dressing to fresh wounds from its hfiemostatic properties,
promptly arresting the oozing from divided capillaries. A weak dilution of
creolin in water or alcohol makes a good wash in ozaena. Five or 6 drops may
be added to a pint of water, or we may follow the method of Moure and
prescribe: —
B Creolini 1| c.cm. or mxv.
Spt. vini rect lOSJ c.cm. or fSnias.
M. A teaspoonfu] of this Bolution is added to a quart of tepid water.
Schnitzler has used creolin in diseases of the larynx, especially tuber-
cular, by inhalation (1 part in 1000 of water), by insufflation (from 1 to
5 parts to 100 of sugar of milk), or 1 to 5 parts to 100 of water directly
to the diseased parts by mopping. Schnitzler and KortUm likewise recom-
mend it as a gargle in diphtheria. Applied in the same manner, creolin is
useful in tonsillitis. A 1-per-cent. solution has been found curative in
thrush and aphtha;. The injection, two or three times a day» of 2 to 4 pinta
of a Va-pc^'-cent. solution has yielded excellent results in dysentery. The
same injection is efficacious in serous diflrrho^a, colitis^ and enterocolitis.
In the summer diarrhcea of children and in cholera infantum the solution
may be advantageously employed in half strength or less, according to the
age of the patient. Given internfllly, it is reported to have given good
results in flatulence and to have succeeded in cases of taenia and oxyuris
vermicularis. The offensive odor of cancer is removed by creolin. A 5- to
lO-per-cent. creolin-oil is efficient in pediculosis and scabies, or prescribed
thus: —
B Creolini 2{ c.cm. or fSss.
Balaam. Peruviani 716 c.cm. or f3ij,
Adipis 3l| Gm. or 5j.
M. Sig.: Apply weU over the surface. Use in scabies.
A 1 to 1000 aqueous solution has been used in gonorrhoea. It has
seemed much more beneficial in gonorrhoea of women than of men. A
1-per-cent. solution is a very efficacious injection m the cystitis of women.
As a wash in puerperal septicjemia and as an antiseptic vaginal injection
before or after labor, a creolin solution is of value. Five or 6 drops to a
pint of water have been successfully used in otorrhcea. In extensive burns
and in bed-sores Kortiim recommends a 5 to 1000 aqueous solution. A
1- or 2-per-cent. solution is an excellent deodorant and stimulant dressing
to leg-ulcers. Rothe^ has used creolin in the form of an ointment with
marked success in the treatment of erysipelas, tinea versicolor, eczema, and
in scabies. Obstinate cases of pustular eczema have been cured by the
application of creolin-wa^r.
' Br\t\fth Jounml of Det-mftioloffy^ Xov., 1890.
CBEOSOTUM.
405
A 2-per-cent. solution is an admirable disinfectant to the hands of the
forgeon. A creolin-eoap is also made. The opacity of its watery solution
rtndevs creolin inferior to carbolic acid as an immersion fluid for instru-
aenta. Moreorer, resinous particles are soon deposited upon the instru-
■ents, though this drawback has been overcome by the manufacture of
TCTlij baring a perforated false bottom upon which the instruments may
mt. In the acute gastro-enteritis of children Schwing has obtained satis-
tacioTj WMilts from doses of 0.12 to 0.18 c.cm. (or mii-iij) of creoUn admin-
nCered in some demulcent vehicle. The internal administration of creolin
hu, however, been followed in several instances by decided choleriform
moifestations.
The addition of 1 to 2 per cent, of creolin deodorizes iodoform to a very
)MTgt degree, forming a compound with faint aromatic odor. The creolin
BMj be removed by washing with water.
CREOSOTDM (U. S. P., B. P.).— Creosote.
DoM, 0.13 to 1 Gra. (gr. ii-xv).
GUAIACOL (U. S. P.).— Guaiacol
GUAIACOI CARBONAS (U. 8. P.).— Carbonate of Guaiacol.
Dose, u.1:J io 1 Gin. (gr, ii-xv).
Preparations,
f
Aqu* Crcoftoti (U.S. P.).— Creotote-water (1 per cent.).
i«r Cm-iv).
Mietura Creosoti ^B, P.).— Creoaote Mixture
Cflst. or mxv; syrup. 30 ccm., or fSj; wat£r, q. 8. ad 473 c.cm., or fS^vj).
to 30 ccvi. (or fjAft-j).
Ungiicntum Creosoti (B. P.). — Oictment of Creosote
Dose, 2 to 15 c.cm.
creosote, spirit of juniper, aa 1
■ "' "■ Dose, 15
(1 to fl).
^
Pharmacolo^. — Creosote is a mixture of phenols and phenol deriva-
tiTce, chiefly guaiacol and creosol, obLiincd during the distillation of wood-
tar, prvft-rably that derived from tho boecli, Fagus sylvatica, or Fftgus
frrm^nea. The Britiali Fharmacopa?ia dt^cribes it as "a mixture of
fntfiacnl, creosol, and other phenols, obt^iined in the distillation of wood-
tar." rrroaote, therefore, is one of the product? of the distillation of wood,
w]> rom tar by fraotional distillation. It wds discovered in 1830 by
Bf- ii. It is lar;rely contaminated or substituted in commerce by
A substance obtained from the distillation of bituminous conl, made up
of carbiitic and cresylic acids prinri])all.v. Wood-tar crcsote is chiefly
amposed of the following phenols: Guaiacol, Creosol, Methyl-creoBol,
■sd Fhlor&l, The creosote made from heeoh-wood is of a reddisli-amber
eotor; it is the best for medicinal use. It is an oily liquid, nearly colorless;
■f nnolrr odor, caustic taste, and neutral renction; soluble in 150 parts of
«»(rr, arrd in all proportions of alcohol, ether, etc. Pure crcnsote should
h%' ific gravity of 10fi7 and distill at a temperature of 200" to 210°
C. 1 _ !> 110° F.). It difTors from carbolic acid in being less caustic
aad in not coajriilntinp collodion or albumin and in gelatinizing without
fftvtallizing nt a low tem]>erature. It has probably eqnnl. if not su-
pnior, antiiieptic elTectn, as seen in its power of preserving meat, from
rtich it derives its name. With the tincture of the chloride of iron, an
i
40i;
I'llAUMACEtnCAL THERAPEUTIC AGENTS OR DRUGS.
alcoholic solution of creosote develops a deep, greenish-blue color; but car-
bolic acid produces a light brown.
Physiological Action. — Creosote is a local sedative. A strong solution
applied to the integument may give rise to erj'thema, oedema, itching, and
pain. Internally, it very closely resembles the effects of carbolic acid as an
antEsthetic, antiseptic, and astringent. It escapes from the body by the
bronchial mucous membrane in part, and has expectorant powers; it is prin-
cipally excreted by the kidneys. Both absorption and elimination of creosote
occur with marked rapidity. It has been found in the sputum of tuberculous
subjects, to whom it had been administered medicinally.
Creosote has a special sedative action upon the nerves of the stomach
and allays irritability and nausea. It has a similar effect upon the bronchial
mucous membrane when its vapor is inhaled with the vaporizer or steam-
atomizer. Dr. Irsai, of Budapest, has demonstrated by experiment that in-
halation of creosote and guaiacol gave rise to decided hyperaemia of the lungs.
In overdoses creosote causes giddiness, depressed action of the heart, faint-
ness, convulsions, or coraa. The antidotes are probably the same as those to
carbolic acid, as Hare has announced that the soluble sulphates are effieacioufl
antidotes to creosote poisoning.
Therapy. — As a local amesthetic, creosote is largely used by dentists
in aching teeth with sensitive dentine, and as an application to an exposed
nerve-pulp, the remedy being taken upon a little absorbent cotton, and
excess removed by allowing it to rest upon blotting-paper before being in-
serted into the cavity of a tooth, from which debris of food or other material
should first be removed, by syringing with warm water. Creosote-water has
some hsemostatic qualities, and is an antiseptic dressing of value in slough-
ing ulcers, or for injection into sinuses. In gleet and other catarrhal dis-
eases creosote often acts well when used as follows: —
B Creosoti
Kliiiiicxt. ^eranii 2
Aqute roscB 120
M. Sig.: Inject night and morning into the urethra, — i
with warm water.
30 ccm. or mv.
com. or fSss.
ccm. or f^iv.
lone or slightly diluted
Creosote is believed to have special value in the treatment of burns and
in chilblains. In skin diseases of a scaly character and pruritus creosote
is a useful application; and in erysipelas the ointment is of benefit in reliev-
ing the pain and reducing the inflammation. This ointment relieves the
itching and burning of erythema multiforme and eczema, and is beneficially
applied to ulcerated surfaces and psoriasis. Creosote ointment is very ad-
vantageously prescribed in connection with lead carbonate, as: —
B Plumbi carbonutia 41 Om. or 3j.
Unguenti creoaoti (20 per cent.) 31| Gm. or 5J.
M. For er^'Bipelas, erythema, acute eczema, and buma.
A gargle containing creosote, in ulceration with sloughing of the mouth
or throat, purifies the breath and stimulates the ulcer to repair.
In laryngeal diphtheria, coincidently with the adrainistration of anti-
toxin, Dr. William Ewart, of London/ advocated the use of creosoted oil
(1 to 20, olive-oil) for the expulsion of tracheal false membranes. He prac-
• British Medicaf Journal, May 28, 1898
ticrt etrlj tracheotomy fur laryngeal diphtheria, and then, in order to pro-
note loosening, separation, and expulsion of the membranes, he injects inta
the trachea 1 c.cm. (or mxv) of the creosoted oil every two hours, but on the
ikird day every four hours. After recovery from diphtheria, the systematic
wm of « spray of creosote in liquid petrolatum-oil {1 to 60) to limit infection,
is a valuable expedient. This is also used with advantage in various chronic
forms of rhinitis, ozsena, etc.
For catarrhal laryngitis and tubercular disease of the air-passages, creo-
lote can be sprayed over the surface as in this prescription: —
c.cm. or f3j.
e.cm. or f3ij.
H Or«>»U 4|
Tbict. benzoin, co 7|5
Aqufl? hamamelidiB dest,
Glywrini oa 45| c.cm. or fjiss.
M. Sig.: Use in an atomizer. Spray over the surface thr«e or four times a day.
I
^^B It is inadvisable to make usg of the spray if a tendency to pulmonary
^^flfeniorrhage is present. Dr. John Dunn, of Richmond, Va., uses in atrophic
rhinitis: —
B 01. anisi.
Creosoti aa 1 120 c.cm. or mxx.
Pelrolati 31| Gm. or Jj.
31. Stg.: Introduce a Bmall piece within the nostril.
Taken into the stomach, it checks fermentation and reduces irritability,
allaying nausea and correcting the causes productive of diarrhoea. In fer-
mentative dyspepsia the following combination is recommended by Dr. B. W,
Richardson: —
B Creoaoti pur
.Alcohol, dilut. 75
Aromon. benzoat 8
Glycerin, pur 22
Infus. caryophylli 180
75 c.cm. or wixij.
c.cm. or fjiisa.
Gm. or 5ij.
c.cm. or fSvj.
c.cm. or fSvj.
V. Sig.: Tahlespoonful two or three times a day, between menU, in water.
Vladimiro de Holstein' finds in creosote an excellent means of combat-
ing chronic constipation, without exercising any purgative action properly so
ttUed. The creosote should not be prescribed in pills, capsules, or alcoholic
solutions, but pure and in drops. The effective dose is about 7 or 8 drops
taken twice daily, immediately after breakfast and after dinner, in a glass
trf milk, beer, wine and .water, or pure water. To bej^n with, 1 drop of creo-
fAte is administered, and that amount increased by 1 drop daily until the
dttirrd effect is obtained. In this way the necessary dose is determined for
tad) c«*e individually. This treatment has to be continued for some time,
•fime months in fact, and not only overcomes the chronic constipation, hut
at the wime time restores the appetite and braces up the system. Under its
iniliaence the stools become regular, bland, and copious, and free from pain
«r any ^ign of intestinal irritation.
It is a usefid remedy in seasickness and the vomiting of pregnancy*
ad in the summer diarrhoea of adults as well as of infants.
In obstinate vomiting of pregnancy Kaatzer prescribes: —
'Cf^n{cc y^dlca. May 15, 1809.
408
PHARMACEUTICAL THERAP£LT1C A(i£KTS OU DUCGS.
R CreoBoti pur 4 21 c.ctn. or fSts.
Alcoholis 30| c.cm. or f3j.
Tr. gentian, co.,
Fluidpxt. ooffeae vindia aa 9|2fi c.cm. or f3iist.
Aq. destillat 00| c.cm. or fjnj.
M. Sig. : To be well shaken. Dose, teaspoonful two or three times a day in milk.
Creosote has given good results in the treatment of intestinal hsemor-
rhage, gonorrhoea, and gleet. In seasickness the nausea and vomiting may
be overcome by this combination of creosote: — ■
B CreoBoti 130 c.cm. or niv.
MorphinSB sulphatis 1005 Gm. or pr. j.
Aquie menth. pip. 90{ c.cm. or fjiij-
M. Sig.: A tcDspoonful every two or three hours until relieved.
In chronic bronchitis, bronchorrhcea, and phthisis creosote has been
given with marked benefit, especially where cavities have formed, as in the
following combinations: —
B Creoaoti 100 to
Tr. ^ntinee comp 2
Spintua frumenti q. s. ad 7;5
M. Sig. : Take four times daily.
1 18 c.cm.
c.cm.
c.cm.
or mi 11).
or mxxx.
or fSij.
B Creosoti,
Tinet. capalci aa 4t
Syrup. acacJiE 30
Syrup, limonia 1201
M. Sig.: A teaspoonful with water after meala.
B Creosoti 2|
Syrup, fenri iod.,
Glycerini aa 90|
M. Sig.: A teaspoonful in water three or four times a day.
c.cm. or f3j.
c.cm. or f5j.
c.cm. or fjiv.
c.cm. or fSsft.
c.cm. or f3iij.
A combination employed by Professor Bouchard in the treatment of
pulmonary tiiherculosis is: —
B Creosoti 4
lialsom ToluUni 7
Terebinthinue 1
Acid, benzoioi q
M. et ft. pil. no. Ixxx.
Sig.: Ten pills to be taken daily.
c.f^ni.
c.cm.
Gm.
or f3j.
or f3i V,.
or gr. XV.
Creosote may be given in a pill, or the prescribed number of drops
added to a teaspooniu! of old Jamaica rum, diluted with water. In a con-
siderable proportion of cases, cough and expectoration are diminished and
fever and night-swcata are lessened. It is also given in tuberculosis by
hypodermic injection. P. Carles recommends for hypodermic injection a
mixture consisting of 10 parts of beech-wood creosote, 80 parts of tincture
of quillaja, and 60 parts of distilled water. The creosote is said to be dis-
Bolved by aid of the saponin, and not merely suspended. The liquid is
thought to be better adapted to the purpose than the ordinary emulsions of
creosote. It can be diluted to any extent with either cold or warm water.
Dr. G. Boll is in the habit of prescribing creosote with compound fluid ex-
tract of cinchona and administering it diluted with milk. Creosote has also
been administered with some success to consumptives in the form of a rectal
iiij«ctioii. It is stilted to have been well tolerated by the bowel, that it re-
4iKed fever, asd in some cases arrested diarrhcea. The taste of creosote was
poceiTed in the mouth in a few minutes after the injection had been made.
Another evidence of rapid absorption was the occasional occurrence of green
w dark-colored urine.
In the treatment of tuberculosis, cresote is, according to Jacobi, the
BQSt valuable drug which we possess. Sommerbrodt, who introduced this
nethod of therapy, was accustomed to increase the dose rapidly until the
point of tolerance had been attained. He generally gave the remedy mixed
with codliver-oil or olive-oil, and inclosed in a capsule. Under the influence
«{ creoeote the bacilli may disappear from the sputum and the physical signs
iBprove. In conjunction with its internal employment, Dr, Beverley Rob-
iaK»D, of New York, recommends frequent aud prolonji^ed inhalation of the
dmg. Inhalations often improve the condition of the larynx and relieve an
obstinate cough. The administration of creosote by inhalation in combina-
boQ with oil of peppermint, according to Carasso, causes disappearance of
^tubercle bacilli from the sputum. According to Sommerbrodt, the earlier
Hthe creosote treatment is adopted in tuberculosis, the more favorable are
Hfbe results^ He has used it also with advantage in scrofula. M. Burlureaux
KaMTibcs prognostic value to creosote in tuberculosis. The cases in which it
1 ii not well borne are, as a rule, beyond hope. Patients by whom it is tolerated
I are generally improved. Dr. F. Velten reports excellent results from the
j IK of creoeote in tubercular pleurisy with effusion. The effusion, fever, and
I atber sjrmptcms of pleurisy gradually disappeared,
Mr. Charles Lamplough' thus sums up the results of his observations
I «n one hundred cases of pulmonary tuberculosis treated wUh large doses of
baech-wood creosote: —
1. The best beech-wood creosote can be given with benefit, in amounts
J, Tarying from 7.5 to 15 c.cm. (or t«cxx-ccxl) daily, in cases of pulmonary
■tebercnlofiis.
H~ 2, The drug is best administered in codllver-oil or in a spirituous solu-
BtJon, and in some cases the "creosote chamber*' or oro-nasal inhaler may be
p4irdered in addition, with advantage.
3. The dose should be small at first, but it can be rapidly increased to
' t.SO c.cm. (or mxl) three times daily for an adult. In three cases doses of
t ccm. (or fnxxx) three times a day were well borne by children.
4. Large doses rarely cause any gastric disturbance; on the contrary,
the appetite is frequently increased, symptoms of dyspepsia disappear, and
codliver-oil is more easily assimilated. The cough, expectoration, and night-
ffveats are diminished, and the physical signs improved
5. Owing to its disinfectant action in the alimentary canal, the drug
^bablj diminishes the risk of tuberculous enteritis by self-infection when
latimta swallow their sputa; but, owing to the increased peristalsis which
It created by creosote, it is usually contra-indicated in cases where the ulcera-
tioe it ilresdv advanced.
6. The drug does not tend to cause hsemoptysis, but rather to prevent
ttt recurrence.
7. Creoaote does not irritate the normal mucous membrane of the
fenito-urinnrv imd.
* Brum Ucdicnl Jottmol, May 28. 1809.
410 PHARMACEUTICAL THERAPEUTIC AGEXTS OR DKUC8.
8. Owing to its extremely small cost, pure creosote can be given to a
much larger number of patients than the carbonates of creosote and guaiacol^
which, respectiTcly, cost four times and twelve times as much as the older
drug.
Dr. G. Bell derived decided benefit from the administration of creosote
in a severe case of perinephritis. In cases of suppurating glands, also, he
has witnessed good results from its use, and suggests that it may act as a
preventive of possible tubercular infection. This writer believes, moreover^
that it is of advantage in pyaemia.
Dr. Charles Eloy, of Paris, recommends creosote to be given in emulsion^
at? follows: —
H 01. amygdal. dulc ICOI c.cm. or fSv.
CrcoBoti 715 c.cm. or f3ij.
Misce et adde: —
Pulv. acariie 81 15 Gm. or 5"3v.
Aq. menth. pip 473| ccm. or fjxvj.
M, Sig.: From two to five tabUspoonfula a day.
Seitz prefers to combine creosote with codliver-oil, and makes an emul-^
sion with the aid of saccharin. Both creosote and guaiacol have been in-
jected beneath the skin or into the lung. Creosote affords relief in flatulent
dyspepsia, sarcina ventriculi, and gastralgia. It can be prescribed, in the I
diseases just referred to, as follows: —
B CreoBoti
Tinct. capsici 2
Aqun soase menth q. a. ad 00
M. Sig.: A UBSpoonful in water at meals.
30 ccm, or mv,
c.cm. or 1388.
c.cm. or fSiij-
H Creosoti |37 c.cm. or mv}.
Glycerini,
Syr. acacise na 45| e.cm. or fSias.
M. Sig.: A tenspoonful before meals.
Creosote has been successfully employed in diabetes mellitus by P.
Valentin, who gave it in daily doses of 4 drops, increased gradually to KV
drops. The sugar soon disappeared, and did not return even when a diet
containing starch and sugar was allowed. Similar results have been reported
by Audubert. Good effects have been obtained from creosote in typhoid'
fever, diphtheria, scarlet fever, and erysipelas. A. Atkinson has found it i
efficacious in the treatment of tape-worm. A mixture of creosote, spirit of
chloroform, and tincture of lavender may be used in sn inhaler in diseases-
attended with profuse^ bad-smelling expectoration. This mixture^ or those
of similar composition, all prove of great value in removing; the ofTensive-
odor of gangrene of the Inng in phthisis, laryngitis, chronic bronchitis, and'
also in asthma: — „
B Creoaoti,
Ethyl iodidi,
Terel>oni aa 4| c.cm. or f3j
M. Sig,; For inlialtilion. Ten to twenty drops in an inhaler when necesaai7"
B Creosoti.
Eucalyplolja,
Terebpni an 4| c.cm
M. Sig.: For inhalotion. Ten to twenty drops, as neresssrv.
d
OUEOSOTrM.
411
E CrrcHoti,
"niynioli.
Alcoholu an 4]
^ Sig,: For inhaUtioD. Ten to twenty drops.
c.cm. or f3j.
Koch's method of treatinp ervsipolaB, consists in applying the following
aeni, spread evenly with a camers-hair pencil, in a thin layer over the
cied part: —
R CreoMti vel creoUni 4 c.cm. or f3j.
lodoformi 15 5 Gm. or 3iv,
A<iipi* lame byd 38 8 Gm. or 3x.
M. After applying the ointment as directed, cover the aurface with a thin sheet
if fBtta-prrcha or rubber cloth.
EV. ?oupault recomnieDds the administration of creosote in full doses
• otomy in diphtheria, and nlso the application externally over
; a l-to-30 solution in alcolml and j^lycorin. Diijardin-Boaunu'tz
ipeaks of a patient who was at once tuberculous and leprous, and in whom
npid ftm^Iioration was produced by hypodermic injections of creosote. The
trasthetic patches of lepra, which had been utilized in inserting the needle,
k&i almost entirely disappeared. Creosote, in doses of 0.03 c cm. (or mss)
•ad npvard three or four times a day, has been recommended in the treat-
sent ol whooping-cough, and has been employed in the laryngeal and bron-
diial manifestations of influenza. Vehsmeyer made use of creosote in a
caae of typical leukaemia in a nine-month-old child. The spleen diminished
hi volume and the mucous membrane gained some color and, after some
BODths. the blood had become almost normal. The child subsequently died
of convulsions, but, in view of the general amelioration, it is suggested that
further experiment should be made with the drug ih the case of adults.
OiutiAcol (U. S. P,). — Creosote cont/iins from GO to 90 per vent.
'nf Onmiacol^ which is a colorless liquid, sparingly soluble in water, but very
in ether, alcohol, and fatty oiU. Jt is more agreeable in odor and
Uian creosote, and is said to be better borne. It improves the appetite
IOkI diseation and prevents or relievos flatulence. It is probably eliminated
Inngs. exerting a directly local beneficial action. GuaiacOl is usually
in single doses of r» drops, or in daily quantities of 20 to 40 drops.
bli baa proposed that it should be employed instead of creosote in the
ireaUnent of phthisis. It indirectly reduces hectic fever and checks niglit-
ita. When g-iven at an early stage of the disease, the bacilli diminish re-
rkably in number and may even entirely disappear. Ijabadie-Lagrave
kaa advantageously prescribed guaiacol in the form of pearls or capsules.
BcTi- - • ' Geneva, prescribes it dissolved in wine or codliver-oil.
ued experiment in the laboratory, however, has shown that
•rdinary liquid guaiacol is not a chemically-pure product, but a mixture, in
varying proportions, of guaiacol, creosote, and cresylol. The actual propor-
tiofi of guaiacol present in different samples varied from 10 to 50 per cent.
The rariation in composition may explain the untoward results which have
bfcn reported, where prostration or collapse followed the application to the
aarface of the skin of 1.20 to 2 ccm. (or gtt. xx-.\xx), of guaiacol. M. For-
1^ said that he had stx-n accidents produced with a cubic eentimetre of
miaco). I»eal ansesthesia may be produced sufficient for small surgienl
412
rilARMACEl'TICAL THERAPEUTIC AGENTS OU DHCOS.
operations by injecting 0.045 com. (or in "Z^) dissolved in olive-oil (1-20)
hypodnriuicallv, Although a much larger quantity might be used without
danger. Pure guaiacol has been s^Tithelically prepared, and occurs in the
form of colorless rhomhoidal crystals, almost insoluljle in water, soluble in
alcohol, oil^ and anhydrous glycerin. Its taete is somewhat sweet, but is
followed by a pungent and burning after-taste. MM. Gilbert and Maurat
observed that the principal effects of poisoning with pure guaiacol were
enfeeblement and retardation of the heart's action and tJie bi'eathing. Most
of the secretions were augmented, and especially that of the Incrymal gland.
At the moment of deiith, which takes place under comn, the temperature
may fall as low as 68° F.
Liquid guaiacol has been given in enema, and its vapor has been in-
haled. It has also been introduced into the system by subcutaneous injection
in the daily dose of 0.50 to 1 c.cni. (or mviii-xv). Professor Peter speaks
favorably of the use of the drug hypodermically, but adds the caution that
its effects must be carefully watched, as it is capable of causing hsemoptysis,
pneumonia, acute phthisis, and fat-embolism. Signs of evil import are the
production of a persistent bad taste in the mouth, a dark-colored urine, and
a marked rise or fall of temperature. Injections of guaiacol have yielded
good results in fetid bronchitis, chronic bronchitis, and bronchial dilatation.
In lupus, Dr. Moreau, of Tours, advises the hypodermic injection twice
weekly of a solution of guaiacol and thymol in sterilized oiive-oil. The mixt-
ure which he employs contains 2 Gm. (or gr. xxx) of thymol in 45 c.cm. (or
fjiss) each of guaiacol and sterilized oil. Of this preparation 1 c.cm. (or
mx7) are at first injected and the quantity is gradually increased to 3 c.cm.
(or mxlv). The injections are followed by considerable locnl and general
reaction. After six or seven injections had been given, the nodules generally
underwent retrocession ^nd ulcers cicatrized. The treatment may produce
serious symptoms, and is scarcely suitable for use when pulmonary or car-
diac lesions are present. The injections are painful. A combination of
guaiacol and thymol iodide was also used, hut was abandoned as being more
painful than the mixture with thymol. In fistula of the anus. Dr. Charles
C. Allison recommends injection of guaiacol with sweet almond-oil.
Guaiacol is readily absorbed by the skin, and it has been found that
a local application has the power of reducing febrile temperature. The
remedy is painted upon an area varying in size from 4 to 20 square inches
and prevented from evap*>rating by being covered with an im|iormcable
dressing. This method has been made use of in tuberculosis, erysipelas,
pneumonia, articular rheumatism, scarlatina, and typhoid fever. The re-
duction of temperature is accompanied by free perspiration. The quantity
employed was, as a rule, 2 c.cm. (or mxxx). The application gave rise to
nn jjepression of the circulation or respiration, albuminuria, or other evi-
dence of renal irritation, although it is advised to watch the kidneys. Prof.
J. M. Dn Tosta helievod that the local application of guaiacol is of advan-
tage where the cold-bath treatment is impracticable or where there is a
tendency to intestinal haemorrhage. The applications have been made upon
various portions of the integument without any noticeable difference of re-
sult. They occasioned increased diuresis.
Drs. Friedenwald and Hayden reported' a series of seventeen cases in
^yeio York Medical Journal, April 14, 1894.
CaEOSOTlK.
413
was tlnis rtpplietl ; among whiuh wore pnemnonia, U^ilmid
ary tuberculosis, malarial fever, intliienza, rheumatism, aud
A powerful antipyretic action was observed in these cases.
Ferrand uses equal parts of guaiacol and glycerin in allaying the pain
iatica and the chest-pains of tuberculosis. Compresses wet with guaia-
^{ 15 to 30 drops) will give almost iiumediale relief in neuralgia. Sabat-
( Practitioner, Febrtiary. 1896) recommends: —
B Mcntboli^.
OiMlftf^l, aa 1 1 Gm. or gr. xv.
Afcoholis I abii. ) |20 c.cm. or 3v.
M. To \>e painted on the skiu; not more than u drachm to be used at one time.
MaWeresco uses applications of guaiacol to the thorax posteriorly, cor-
isponding to the area of lung involved, with good results, in pulmonary
twerraloeis. In bronchiectasis the employment of guniacol-vapor baths
taA produced remarkable improvement, greatly diminishing the quantity
^ (4 the grei'nLsh expectoration and causing the breath to become odorless,
kM in a case reported by G. H. Parry.^ Professor J. M. Anders has used it
llrpcHlerniically in ^leiatica and supra-orbital neuralgia, 2 drops of guaiacol
boDg mixed with 10 drops of chloroform. He has given it internally with
Woefit in gattral^in. The absorption of pleural effusions is, according to
Si^alM, piunioted by paintinrr n]>nn the surface once daily for several days
s mixture thus composed: —
B Gttaiacol 3| can. or mxlv.
Ol^^cerin.,
Tr. iodi M. 1816 c.cm. or f3v. — M.
Paintings of guaiacol have been found by Balzer and Lacour to be bene-
in orchitis, relieving pain and reducing temperature. The drug was
»rd undiluted upon the inguinal region, but upon the scrotum it was applied
ia the form of an ointment containing from 2 to 5 c.cm. (or mxxx-lxxv) to
th€ onnce. Commercial guaiacol is often contaminated with cresylol and
creaoU and for this reason Drs. A. Gilbert and L. Maurat prefer the cheraic-
•IlT-pnre, synthetic guaiacol, which is in white, rhombohedral crystals, in-
nloble in water, but soluble in glycerin, alcohol, and oils. Allew McLane
HazDilton administers guaiacol in insanity, as an intestinal antiseptic, to
prerent the formation of toxins. In cystitis the use of a 20-per-cent. solution
«f ffiiaiacol, in sweet oil (0.06 to 0.12 c.cm., or mi-ij, being injected daily),
UNTOcated by Cohn as being more of a local ansesthetic than pure guaiacol.
Dr. S. Solis-Cohen believes that the application of guaiacol to the throat
iM» • prophylactic power against diphtheria. He employs a mixture of 10
per' 1. 1 part of menthol, and 10 parts of olive-oil.
.!ar uleeralion of the lar\^x, P. Watson Williams advocates
CQfiKtrtneut, followed by tlie application of lactic acid, followed by pure
^-gtuoBtoh and the use of a 20-per-cent. spray.
^B Professor Schueller administers guaiacol stirred into some salt water,
^k&y or ffonp, or, for adulto, in a glass of wine, preferring this method to the
^^fwstion in pills or capsules. In many instances he gives it by inhalation,
^^BT •qoeoiiff solutions (5 to 3000 or 5 to 6000) being employed. He has
■
' n€ iMnret. July 22. IHQO.
414
PUAUMACEUTICAL TIIKRAPEUTIC AGENTS Olt DRUGS.
obtained good results from guaiacol, not only in pulmonary tuberculosis,
but in lupus, hip-joint, and Pott's disease.
M. Picot has met with very encouraginn; results from the hypodermic
injection of a mixture of guaiacol and iodoform. As an excipient he em-
ploys sterilized olive-oil and vaselin, each c.cm. (or mxv) of the base con-
taining 1 eg. {or gr. Vfl) of iodoform and 5 eg. (or fwVfl) of guaiacol. This
combination is modified by M. Pignol, who adds 14 eg. (or gr. ii V^) of
eucalyptol to each c.cm. and omits the vaselin from the base. Dr. R. Rob-
ertson approves of this method of treatment in empyema, provided that free
drainage is maintained. Dr. William IL Gregg recommends the administra-
tion of guaiacol in the form of an enema.
Dr. Clemens has observed improvement in diabetes mellitus from the
use of 1.20 to 2 c.cm. (or mxx-xxx) of guaiacol thrice daily, suspended in milk
or codliver-oil. The polyuria was markedly restrained, the general condition
was improved, and, after four weeks of treatment, the patients could partake
of some saccharine foods without increasing the glycosuria.
Guaiacol Carbonate (!'. S. P.). — TJiis substance is a fine, crystalline
powder, devnid of taste or smell, insoluble in water, slightly soluble in cold
alfobol ; soluble in liot alrolml, other, and chloroform; gliglitly soluble in
glycerin and fatty oil?, tbo averiige dose in which this compound is given
being 0.(i5 (tui. (or gr. \), wliicli may be gradually increased to 2 to 6 Gm.
(or gr. x.\x-xc) per day. It lias been used by Scifert and Koelescher in a
number of cape? of tiibrn nla«i[S. These authors state that it causes no
irritiition of the gnstro-intostinal mucous mcmbrnne, that it pnstios through
the stoniath unohangod, and is decomposed in the intestine into giuiiacol
and carlxmic-acid gas. According to de Gratia and Casnretti, this decom-
position may take pbico in the stomach in the presence of fermentation.
Seifert and Koclescher witnessed improvement as regards cough, appetite,
and nutrition In (•onsequi-noe (ff its oniploynicnt. Tlioy nihniuisttMvd fi
Gm. (or .>iss) of tlie drug in divided doses during the twenty-four hours.
Guaiaeo! carbonate has also been given with advantage in typlioid fever by
Dr. F. Holsclicr, who remark^'d that it produced a moistening of the tongue
and an improvement in the chanieter of the stools. The remedy had a
favorable influence upon the hronelntis which accompanied the fever, dis-
infected ihe bowel, and generally ]>revont('d extreme proPtration and severe
cerebral synijitoms. lie gave the drug in the dose of 1 Gni. (or gr. xv)
night and morniug, Tn bladder-disease or elironic cystitis, Colin recom-
mends guaiacol carbonate dissolved in olive-oil (20 per cent.) ; 0.06 to 0.13
Gm. (or gr. i-ij) being injected into the bladder twice daily. It acts as a
local amesthetic and antseptic.^
Dr. F. C. Simpson, of LomVville, reports excellent results from the
employment of guaiacol carbonate in intestinal troubles due to neurasthenia.
Guaiacol Phosphite. — This is a definite chemical combination, first pre-
pared by M. Ballard, and which promises to prove of therapeutical efficacy.
It is a white, crystalline powder, of a waim taste, but not caustic. The com-
pound is very soluble in alcohol, ether, water, chloroform, and fatty oils;
slightly soluble in turpentine and glycerin. It contains 93.25 per cent, of
guaiacol and 7.75 per cent, of phosphorus. Daily doses of 4 to 6 Gm. (or
3i-is8) were given to dogs without evil consequences; but 15.5 Gm. (or Jsfi)
'^ Journal de MMecine, Jan. 2C. inofl.
ctrcosoTLM..
415
coma and death a few hours after administration. From 10 to 12 Gm.
iij) for a man seemed to be a maximum safe dose.
Btazoyl-^aiacolf or Benzosol, is a crystalline powder^ destitute of odor
«r teste, insoluble in water; soluble in ether, chloroform, and hot alcohol.
it is ft compound of benzoic acid and guaiacol. It is split up in the bowel
its constituents. It is well borne even in large doses. It diminishes
expectoration, and rales; but has no effect upon the bacilli. Benzoyl-
col may be prescribed in the dose of 0.25 Gm. (or gr. iv) three times a
, or daily doses of 1 to 5 Gm. (or gr. xv-lixv). Benzoyl-guaiacol, known
ftlfto as beniosol, may be given with chocolate and sugar. According to the
dinica] experiments of Professor Rummo, corroborated by those of de Grazia
and OwftTcUi, benzoyl-guaiacol is the most efficient succeddneum of creosote
«r gQaiftcoL
OtheT salts or compounds of guaiacol have been prepared, as guaiacol
oataammte (cinnamyl-guaiacol, or styracol), guaiacol salicylate (guaiacol salol,
or flalicyl-guaiacol), etc.
Onkiacol-di-iodide. — This 'compound is obtained from sodium-guaiacol
by the action of iodine and potassium iodide. It is a reddish-brown salt and
fetmrncB an odor similar to that of iodine. It is soluble in alcohol and fatty
«0s, bat rapidly decomposes. Guaiacol-di-iodide is given in the same doses
and for the same purposes as guaiacol.
Qoaiacol Salicylate. — This salt occurs in the form of white crystals,
bte from odor, soluble in alcohol, insoluble in water. Its dose and thera-
peadcal applications are the same as those of salol.
Creoftote Carbonate, or creosotal, is an amber-colored, clear, neutral, oily
Kqnid, of a sweetish taste, without odor. This compound contains 90 per
fCDt. of creosote. At ordinary temperatures it is viscid, but is easily lique-
fied by moderate heat. It is not irritating to mucous membranes and is
itftted to be much less toxic than creosote. Creosote carbonate is insoluble
m water, glycerin, and weak alcohol. It is soluble in all proportions in 95
Mr cent, alcohol, in ether, chloroform, and soluble in 4 or 5 parts of cod-
uTcr-oil or olive-oil. In the bowel it is separated into creosote and carbonic
add. It is said to improve the appetite and effect a gain in weight and
•trench. It can be administered in capsule?, dissolved in codlivor-oil, or
madf into an emulsion with tlie yolk of an egg. diluted with water, sweot-
and flavored. Professor van Leyden ' rof^orts a specific actiou of
ital in phthisis, and coses are reported sliowing complete tolerance of
nroiwly by the digestive organs and great improvement, in the local
«^fnp4iims and general health. After six to eight months' treatment, in
. all the evidence of pulmonary disease disappeared. Very favor-
's of the usefulness of thiji agent in acute pneumonia have ap-
pear^-ii. Ix'onard \V«*I»er, nf New York, reported i» cases, and H. W. Cum-
■inp". '>^ Hranie, Texap. "JO cases, without a death. Dujardiu-BoHurnetz
tl- •' d ver}- favorably upon this drug. It has tlie exceptional advan-
ta;:, rig n remedy of a price within the reach of the jKior. The dnsc is
•JJO cxnu (oT mv) three times daily, increasing the dose of 0.18 c.cm. (or
•iij), until l.fi.T c.rni. (or tnxxv) are taken at a dose. When marked im-
pityvrm«^t lias taken place tl»e remedy can be gradually reduced to 0.00
i
*'*CbaHt« Annalen.** Berlin, 1807.
41G niAKMACEUTICAL TIIEIUPEL'TIC AGENTS OK DULG8.
c.cm. (or my) Ihroo times a day. After a fow weeks Uie asoending scale'
can be agniu bi^niu.
Creosote Calcium Hydrochlorophcsphatc. — Under this cumbrous desig-
nation a mixture of creosote carbonate and dry calcium hydrochlorophos-
phate has been used in phthisis and scrofula. The mixture is a white, syrupy
mass and is administered in emulsion in the dose of 0.03 to 0.12 c.cm. (or
mss-ij) twice a day.
Oleooreosote. — An oleic ether of creosote, ol:>tained by the interaction
of oleic acid and creosote, is preferred by some authorities as being tolerated
in larger doses than a simple mixture of creosote and oil.
It is of a yellowish color and oily consistence, and contains 33 per cent.
of creosote; is insoluble in water, slightly soluble in alcohol; but dissolves
in ether, chloroform, and fatty oils. Oleocreosote is comparatively devoid ,
of caustic properties and is well borne by the stomach.
Styracol is prepared by heating together ^uaiacol and cinnamyl chlo- ,
ride and occurs in the form of crystalline needles, without color and prac-
tically insoluble in water. Styracol has been used as an intestinal antiseptic i
and in gonorrhcea, chronic cystitis, and pulmonary tuberculosip. As a locnl j
application it hiis been employed to promote healing of wounds and ulcers. ^
CRESOL (U. S. P.).— Crcwl (C,H,OH).
Prepnraiion, i
Liqtior Cresolis Compositus (U. S. P.). — Compound Solution of Cresol. (Cresol i
5 p<?r font, in linseedoil soap).
Pharmacology. — Crude carbolic acid consists largely of cresols. Thes^e '
are insoluble in water on account of the admixture of other hydrocarbons.
When separated from the latter the cresols present themselves in the form
of a clear fluid of a pleasant odor. This liquid is n combination of three ,
isomeric modilicationp: ortho-, mcta-. and para- cresol. Cresol (U. S. P.)
is n mixture of the three isomeric ere<(^ls obtained from eonl-tjir, freed from |
phenol hydrocarbon, oils, and water. It should be preserved in amber bot-
tfe, j)rotected from light. It is soluble in CO parts of water at 7T° F. or !
25** C. Its specific gravity at tlS*" F. varies between 1.042 and l.OlJt. and
its hoiliug-point is between 3iio° ami 401° F. Professor Cliarteris found
that moderately toxic doses produced in guinea-pigs convulsions ai the
hind-legs. Large doses immedintely gave rise to severe convulsions involv-
ing the whole body. A lethal dose for the goinea-pig appeared to be from
0.43 to O.otr c.cm. (or nivii-viij). BiK'teriolo<:ical experiments demon-
strated that cresol has nearly three times more germicidnl power than pure
carbolic acid. A l-per-eent. aqueous solution of cresol lias been found an
efficient cleansing upplicaiion to wounda and nn excellent fiuid for the dis-
infection of instruments.
Therapy. — Dr. Eobort Lee observed that cresol, when mixed with i
water in definite proportion, will, like carbolic acid, yield, on boiling,
B vapor of definite and constant strength. By virtue of this property the
fluid may be beneficially administered by inhalation in many diseased con-
ditions of the upper air-passages. Dr. Granville Macgowan' has found this
agent to have especial value in treating alopecia areata, one or two applica-
tions being sufficient for a cure. It is also a valuable remedy for the
* Joftntal of Cutaneoun and XeiTotia Diseatrs, May, 1899.
CRESOL.
417
I
traloxnit of ring-worm, pitATiaaie, and other parasitic aflfections. Cresol
hat been used as an internal remedy by Dr. H. Kolsch, who reported excel-
Wni results from its use in twelve cases of typhoid fever. These were treated
br ereeol eJceluftively. Alleviation of the malady was inarkcni. No cora-
plicatkiRfi or relapst?s occurred, and convalescence was rapid. In six of the
cfts^ in which cresol was employed from the earliest days, the course of
tike dueoae is paid to have been shnrtoned.*
GkWMal. — This is a compound nf creosote and tannic acid, a brown^
btgroscopic powder; soluble in water, alcohol, and glycerin; insoluble in
ether; an astringent and antiseptic. It has been given in daily doses of
3 Gm. (or gr. xlv) and is reported as of service in laryngitis and bronchitia..
Cresol Saponate. — By melting pure soft soap in a dish on a steam-
htth and mixing it with an equal quantity of clear, crude carbolic acid,
heating the solution until it remains clear upon cooling, a wine-colored
liquid 18 produced. Cresol saponate has a specific gravity of 1.060, is of
neutral reaction, and soluble in ali proportions in water, alcohol, or glycerin*
The liquid is possessed of useful antiseptic properties.
Sodinra Paracresotate.— Paracresotic acid is obtained by combining car*
bonic acid with paracresol in the presence of sodium. It occurs as white,
brilliant, acicular crystals; soluble in hot water, ether, alcohol, and chloro-
form. Sodium paracrcsotate is a fine crystalline powder; of a bitter, but
not unpleasant, taste; moderately soluble in water. In warm-blooded ani-
maia the salt retards the respiratory movements and reduces blood-pressure.
It poeacsses antipyretic and antiseptic virtues. It has been given iutemallj
in rhemnatism, typhoid fever, and the gastro-inte&tinal catarrh of nursing
lafants. This substance checks diarrha*a and acts as an intestinal disin-
fectant. The maximum doses of sodium paracrcsotate for a child two yeara
of age is 0,50 Gm. (gr. viiss) daily; for a child 4 years of age, 1 Gm. (or
gr. xv); and for one 10 years of age 3 Gm. (or gr. xlv). Beneficial resulta
have also been reported from the use of this soda salt in the treatment of
citarrhal pneumonia.
Kretin. — This compound contains 25 per cent, of cresol dissolved by
meana of an equal quantity of sodium cresoxylacetate. Kresin is a brown
liquid, with an odor like that of cresol, and forms a clear neutral solution
m water. It is said to be less poisonous and less irritant than carbolic acid,
It can. (or fSss) being given internally to a rabbit without deleterious
recolta. It does not render the hands or instruments slippery, nor does it
eorrpde metals. From Va* ^o 1-per-cent. solutions are efficient for disin-
Ifectant purposes in surgery. Kresin is likewise very useful in the die-
mfinrtioD of rooms, discharges, water-closets, and waste-pipes. A 6- and
10-per-cenl. kresin soap has been prepared and is adapted to use in various
iorm? of skin disease.
w Chlorphenol. — This name is given to a liquid obtained by the action
if chlnrinc-gus upon carbolic acid. It is a mixture of chlorphenols, and ia
■ dense, volatile fluid of pleasant odor. Chlorphenol is regarded by Passerini
>u of rahie in the treatment of pulmonary tuberculosis, chronic bronchitia,
bronchorrhcpa and gangrene of the lung, ozcena, and laryngitis. It is admin-
iiterrf by inhalation, the daily dose being from 1.20 to 2 c.cm. (or mxx-xxx).
Chlorphenol has l)een used as a local application to ulcers, especially those
dw to tubercular deposit.
' Jf#ilW>al Bitllrttn, Nov.. 1804. p. 420.
)
4
i
418
PHARMACEUTICAL THERAPEUTIC AGEXTS OR DRLOS.
Saprol is a mixture of crude cresols, contaimug pyridin bases, and used
for disiufection purposes.
Farachlorphenol is a solid substance, scarcely soluble in water, but
readily soluble in alcohol. It possesses decided antiseptic properties. In the
treatment of laryngeal tuberculosis the affected surface is first painted with
a weak solution. The strength of the solution may be gradually increased
to 50 per cent. After an application there is a slight burning sensation.
This, however, soon disappears, and gives place to an anaesthesia which con-
tinues for several hours. Farachlorphenol is also an advantageous applica-
tion to enlarged tonsils. It is useful, moreover, in disinfecting tuberculous
gputuiu. raiacblorphcnol is likewise of service in otitis media, suppuratioa
of the maxillary sinuS; and hypertrophy of the tonsils. This agent was
applied in the form of a solution, at first weak and subsequently more con-
centrated, until it might be employed in the strength of 50 per cent.
BromphenoL — This is a fluid of analogous composition to chlorphenol,
bromine taking the place of chlorine. Bromplienol is likewise a mixture, is
of a purple color, and has less of the carbolic-acid odor than chlorphenol.
Both these snbstacces are freely miscible with water, alcohol, and alkaline
fluids. Both have given excellent results in the treatment of erysipelas, as
reported by Dr. I. Tchourilow, of St. Petersburg. The remedies were used
in the form of a 2-per-cent. ointment.
Aseptol. — Sozolic acid, or orthophenolsulphonic acid, is obtained by dis-
solving carbolic acid in concentrated oulphuric acid. Sozolic acid is an
amber-yellow or reddish fluid, readily soluble in water, alcohol, and glycerin,
of a caustic taste, and a faint odor of carbolic acid. A solution containinz
from 30 to 35 per cent, of sozolic acid is commercially known as aseptoL
Diaphtol. — An analogous chemical compound (orthoquinolin-meta-
gulphonic acid) is termed diaphtol, and though not an energetic antiseptic
under its own form, is efficient when transformed into a diaphtolate by
being dissolved in an alkaline solution. Diaphtolate of sodium is a clear,
yellow fluid, very destructive to micro-organisms. Diaphtol is but slightly
toxic, does not give rise to gastric or intestinal irritation, and seems well
adapted to act as a disinfectant to the digestive and genito-urinary tracts,
Diaphtol is eliminated unchanged by the kidneys. Urine in which it is
pros4'nt nuiv be kept for several days without ahcrntion,
Guaialin. — The bon;!oic acid ester of methylene diguaiacol has re-
ceived (lie nanie of (funiiilin from its discoverer. Dr. S. I^wis Summers, of
Philndolpliia. It is a green powder representing in combinfltion 7 per cent.
of formaIdehyd(% :U) por cent, of benzoin, and over GO per cent, of guaiacol.
It is soluble in alcohoh but not in wnter. It is soluble in the gastro-intestinal
secn'iinns as it enters the blood and is discharged by the urine. It is claimed
to be superior as an antiseptic, io sjdicylio arid, or the carbonates of creosote
or of guiiincol. It is not only bactericidal in the digestive tract, but as it en-
ters the Utood it is olainiod to act as a gcncn^l disinfectant, especially to the
lungs and kidneys. It reduces fever icmpnrntnre. As a stimulant to the
mucous membrane, it is recommended in (lie trcntment of ga.<tro-intestinaI
catarrh. It is also useful in chronic bronchitis and in phthisis, reducing the
secretions, the fever, and the cougJi, and increasing the nppetite. It is said
to have no depressing elTect upon the heart. Usual do«e is 0.30 to 0.65 Om.
(gr. V to .\) several times a day, in capsules (0 to ^i Gm.. or 90 to 120 grains
in a day).
CRE80L.
419
StereioL — This name has been given by Dr. Berlioz, of Grenoble, to
an OBtiseptic varnish of which the formula is as follows:—-
B Pulr. aoftciff 264| Gm. or Sviiiet.
Brazoin..
Balftflm. Tcluian ft& 10[ Gm. or 3ii89.
Add. curholic. cryrt. lOlj Gm. or Jiii V».
Eu. ciniuimom 6 c.cm. or f3is8.
SAceharin 0 Gm. or Siss.
AleohoL q. s. ad 046| c.cm. or Oij. — M.
Steresol adheres like a varnish to the skin and mucous membrane, and
Ins been used with advantage in diphtfieria and tuberculous ulcers of the
ikiB aad tongue. The application produces no pain, the layer remains in
position for several hours, and it is stated that the carbolic acid does not
«ntii«]r evaporate from the compound until after an exposure of twenty-
four hour?.
TolyuL — The name tolysal has been given to a substance, which in
«h«mical composition is the salicylate of tolyp}Tin, the latter being a lately-
introduced synthetical compound analogous to anti pyrin. Tolysal occurs
io the form of small, almost colorless crystals, of somewhat bitter taste,
•El^tlT fioluble in water, soluble with difficulty in ether, easily soluble in
dcohol and acetic ether. In doses of 1 Gm. (or gr. xv) every two hours
toljul has no cumulative effect; it has a favorable influence upon sleep, and
giT« rise to no unpleasant after-effects.
Tolysal is of marked efficacy in acute articular rheumatism, as well as
in chronic forms of the disease, and in muscukr rheumatism. It has pro-
duced improvement in rebellious cases which had remained uninfluenced by
lie acid as ordinarily administered. Tolysal has also an analgesic effect
proved useful in the treatment of rheumatic neuralgia. In articular
enmatism it has been administered in daily doses of 3 to 6 Gm. (or gr.
v-ic). As an anodyne the dose is 1 to 3 Gm. (or pr. xv-xlv) and in rheu-
^tic neuralgia from 1 to 2 Gm. (or gr. xv-xxx) during the same period.
'olrgal exerts a decided antipyretic action in both continued and remittent
fevcfii. It is also useful in influenza.
Antitpasmin. — A substance upon which this name has been bestowed
consists of one molecule of narceine sodium and throe molecules of sodium
•licylaie. Antispasmin is a white powder, slightly hygroscopic, readily
folnbic in water, of an alkaline reaction, and contains about 50 per cent, of
pre narceine. This compound was found serviceable by the late Professor
Dnune in relieving various spasmodic affections, and was recommended as
well adapted for use among children. It was employed with advantage in
prrtuois and other forms of nervous cough. The dose is from O.OUli to
0.10 Om. (or gr. Vio-iss).
Salaktol. — This name has been unwisely chosen, since it bears too close
a resemblance to that previously given to a different compound, salacetol.
Stlaktol is a combination of sodium salicylate, sodium lactate, and hydrogen
diAxidc. It is reported to be an excellent application in diphtheria, being
painted upon the throat every two or three hours, and given internally
la labI(«poonful doses at the same intervals. Salaktol is also utilized as a
pigle and by inhalation,
Bonalyi. — A compound obtained by the action of 25 parts of boric acid
T. 3'i parts of sodium salicylate in the presence of a small quantity of dia-
lill-r-i w at<?r i» a ust'ful antiseptic for external application.
420
PHARMACECTICJlL TUEKAPEUTIC AGENTS OK DRUGS.
Salicylamid. — This is a yellow crystalline substance, without odor or
taste, and Buluble iu hot water. It is said to be elTicient in smaller doses and
to poBSCBS more analgesic power than salicylic acid.
Commercial salicylic acid may be contiiminated by the presence of para-
and ortho- cresotic acids, which have remained in the process of manu-
facture. Both these substances are toxic. Professor Cliarteris, of Glasgow,
found paralysis and death to be caused in rabbits by doses of 0.20 Gm. (or
gr. iij) of the former per pound of the body-weight. Orthocresotic acid
produced the same symptoms and was fatal to the rabbit in the dose of 0.065
Gm. (or gr. j) per pound weight. *The eresotnte of sodium has been em-
ployed therapeutically as an antipyretic in doses of 6 to 8 Grn. (or 3iss-ij).
Demme used it in acute rheumatism, catarrhal pneumonia, and typhoid fever
among children, and in the gastro-intestinal catarrh of nursing women.
CEETA PEEPARATA (TJ. S,
chalk pTvpnrations, see Calcium.)
r., B. P.).— Prepared Chalk. (For
CEOCTJS (B. P.).— Saffron.
Dose, 0.65 to 1.30 Gm. (or gr. x-xx).
Preparation.
Tinctura Croci (B. P.). — Tincture of Saffron (5 per cent.). Dose. 0.30 to
1 com. (or TM!c%').
Pharmaoolog;y. — The stigmas of Crocus satiTiis (Irideae) are official un-
der the title of Crocus. "The dried stigmas and tops of the styles of Crocus
sativus" (B. P.). They are obtained from cultivated plants in the south of
Europe. Spanish saffron has a strong, peculiar odor; an aroraaticj bitter
taste; end imparts a yellow hue to the saliva when chewed. So-called Amer-
ican saffron is a different plant, the Carthamus tinctorius, or safflower, of
which the flowers are used. Saffron of good quality, however, is cultivated in
Pennsylvania. A 10-per-cont. tincture was formerly official.
Therapy. — Saffron is slightly aromatic and feebly anodyne and anti-
spasmodic. A hot infusion called saffron-tea is made from the saffiowcr,
and not from saffron; it is used in domestic practire to bring out the erup-
tion in measles and scarlet fever and as a diaphoretic. In Europe, the tinc-
ture of saffron is employed as an emmenagogue and given in flatulent dys-
pepsia and colic. Ext(»mally it has been used in bruises, rhf-umatic and
neuralgic pains, and in the fnrm of ointment to haemorrhoids. In this
country its only use, as a rule, is that of a coloring agent in pharmacy.
CTTBEBA (U. S. P.).— Cubeb.
CTJBEB-ffi FETJCTUS (B. P.).— Cubebs.
Dose, 2 to 4 Gm. (or 5ss-j) of the recently-powdered drug.
Preparations.
Fluidextractum Culwbae (U. S. P.).— Fluid Extract of Cubeb. Dose, 0.00 to
2 c.cm. (or inx-xxx),
Oleoreeina Cub«ba (U.S. P.). — Oleoreain of Cub^b. Doae, 0.30 to 2 c.cm. (or
my 'XXX ) .
Trochisci Cubebse (U.S. P.). — Troches of Cubeb (0.03 c.cm.. or msa. oleoresin).
Oleum CubebfB (U.S. P., B.P.).— Oil of Cubeb. Dose, 0.30 to 1.20 c.cm. (or
mr-xx).
CUBEBA. 421
Tinctura Cubebse (B. P.). — ^Tincture of Cubeb (20 per cent.}. Dose, 2 to 4 ccm.
(or fSes-j).
Pharmacology. — ^The dried, unripe, but fully-grown fruit of Piper
Cubeba (Piperacese). This plant, cultivated in Java, contains a volatile
oil (15 per cent.)> and an acrid resin, Cubebio Acid, with fat, gum, etc.
Cabebene, a camphoraceoug substance, can be separated from the volatile
oil, leaving Cnbebeii, a liquid oil, behind. The deposit from the oleoresin
consists principally of Cubebin, which is inert, medically. The medicinal
activity of the drug consists principally in the volatile oil and cubebic acid,
which are both present in the oleoresin.
Physiological Action. — The effects of cubeb are those of an aromatic
stimulant to the stomach, improving the digestion in small doses and in-
creasing appetite, deranging digestion in larger doses and acting as an irri- '
tant. Cubeb increases the force and frequency of the heart's action, stimu-
lates the genital organs, and promotes menstruation. It is eliminated by
the skin (frequently causing an urticarial or vesicular eruption), Cubeb
may likewise produce, especially in young subjects, a bright-red rash, which
disappears in the course of a few days after discontinuance of the drug and
which may be followed by fine desquamation. It is also removed from the
system by the bronchial mucous membrane (acting as an expectorant and
antiseptic), but chiefly by the kidneys (increasing the quantity of urine and
disinfecting the urinary passages). The addition of nitric acid to the urine
of a person taking cubeb produces a precipitate which bears a resemblance
to that of albumin.
Therapy. — The powder of cubeb is considered a good application in
hay fever, chronic nasal catarrh, and follicular pharyngitis. In hay fever,
if it does not increase the irritation, it may be usef iil. In asthma, or sen-
sitive hypertrophies in the nose, cubeb cigarettes are smoked with relief.
Cubeb is also sometimes given internally in cases of chronic bronchitis ac-
companied by free secretion.
Cnbeb is principally used in blennorrhoea, cystitis, and purulent affec-
tions of the genito-urinary tract. In gonorrhoea it may be given in all
stages of the disease, acting best in the acute stage. Some patients, how-
ever, appear to be very susceptible to the effect of this drug, small doses
causing digestive disturbance, irritability of the bladder, and bloody urine.
A mixture of cubeb and alum is an efficacious, though nauseous, remedy in
chronic gonorrhoea. It may be thus prescribed: —
B Pulv. altimiiiiA 41 Gm. or 31.
Tinct Gubebee 120| ccm. or fjiy.
M. Sig.: A tenspooniul every four hours.
By a combination of cubeb and copaiba the effect of each agent in gonor-
rhoea is increased: —
B Oleoresinse cubebe,
Cdpaibtt a« 4| ccm. or fSj.
Pulv. sacch. alb.,
Pulv. acaciee .' aa 1616 Gm. or %6b.
Aqnm mentbse piperitee q. 8. ad 120| ccm. or fSiv.
H. Sig.i Teaflpoonful three times a day.
(Also see formulse under Copaiba.)
422
PHARMACEUTICAL THERAPErXIC AGENTS OH DRUGS.
Functional irritability of the bladder, so common in women, is often
relieved by cubeb. Cubeb is sometimes of service, also, in nocturnal incon-
tinence of urine. In chronic catarrh of the lower bowel and in the iutcr-
paroxysmal periods of pseudomembranous enteritis cubeb is likewise advan-
tageous. By some writers it is esteemed of value in the treatment of hsem-
orrhoids.
Atonic dyspepsia may receive benefit from the temporary employment
of small doses of cubeb, which are of service also in bronchorrhcca
The troches of cubeb may be used in the treatment of sore throat and
hoarseness, from two to five daily being allowed to slowly dissolve in the
mouth.
d
CUPRTTM.— Copper,
Preparations,
Cupri Sulphtta (U.S. P., B, P.). — Copper Sulphate. Dose, as an astringent, 0,01
to 0.13 Gm. (or gr. V,-ij) ; as an emetic, 0.32 lo 0.05 Gm. (or gr. v-x).
Cupri Acetaa. — Copper Acetate. Dose. 0.006 Gm. (or gr. Vw).
Cuprum Ammoniatum.^Animoiiiat^d Copper. Dose, 0.01 to 0.065 Gm. (or gr.
V.-j).
Cupri Arsenis. — Copper Arsenite. Dose, O.OOIO to 0.065 Gm. {or gr. Vm-J).
Cuprum Aluminatuin. — Aluminated Copper. Lapis Divinus. External use.
Ceratuiti Cupri Acetatis. — CernU of Copp<r Acetate. (Melt together yellow wax,
60 parts; Burgundy pitch, 25 parts; Europ<'an turpentine, .15 parts; strain, incor-
porate thoroughly ftnely-powdered acetate of copper, 6 parts; pour into molds, to
form cakes oi about I centimetre thickneaa). Green cerate, for corns, warts, etc.
Pharmacology, — Copper has but one official salt — the sulphate — which
is an irritating poison, although the metal is inert, because insoluble. Cop-
per was formerly used very much in making cooking utensils for family
use, but it was found that, unless kept very bright and clean* they would
give rise to poisoning by the formation of verdigris, a basic copper acetate.
Copper is sometimes added to pickles to make them of a brighter green
color, a fraud which can be detected by placing a blade of a knife, or polished
piece of steel, in the liquor; if it contain copper, there will be a deposit of
metallic copper upon the iron in the course of a few minutes. It is held that
the very small amount of copper that would be introduced into the system
by eating such a pickle would be only a mere fraction of a grain, and not
enough to cause symptoms. A far more dangerous source of poisoning is
found in the wall-paper pigments containing copper arsenite, which is very
poisonous. It is not only the green colors that are dangerous, but all vivid
colors, such as scarlet, crimson, or lake. It is especially velvet or embossed
papers that are likely to be loaded with pigment, and these should never he
used for a dwelling-house unless first tested and found to be free from
copper or arsenic by the ordinary tests for those poisons.
Fhysiolog^ical Action. — Wlicn locally applied, copper sulphate is an
astringent or a caustic, according to the manner of application. Injected
hypoderniiually, it causes coma and convulsions (in ci'its) and death from re-
spiratory failure; in overdose by the stomach it causes fatal gastro-enteritis.
Copper in very small proportion exists normally in the blood, and in minute
doees it exerts a tonic effect upon the organism. This is well sho\vn in some
skin diseases of a dry type, due to defective nutrition, and in incipient or
threatened phthisis. The secretions along the gastro-intestinal tract are in-
creased, as shown by the salivation, vomiting, and purging. It is a local, and
CUPHUM. 423
not a Bystemic, emetic. Copper is eliminated by the liver, kidneye, salivary
and intestinal glands. It may remain, like other metals, stored up for a
considerable period within the liver.
When any of the salts of copper have been swallowed in overdose there
are naneea, vomiting and retching, purging of blood and mucus, and rapid
depression of bodily powers; and the latter may be the more prominent.
In chronic poisoning, pharyngeal irritation, bronchial catarrh, colic, diar-
rhoea, or dysentery, salivation, ansemia, and emaciation occur. There is
sometimes a green line upon the gums. Jaundice and fatty degeneration or
atrophy of the liver ensue, and pulmonary congestion or consolidation may
set in. The effects upon the nervous system are seen in headache, defective
co-ordination, and weakness, with nervous vomiting. Toxic symptoms mani-
fest themselves very soon after the metallic salt has been taken. The chem*
ical antidote is potassium ferrocyanide followed by demulcents, eggs, milk,
oil, etc., and the stomach should be irrigated with an alkaline solution,
counter-irritation applied, and anodynes given. The incompatibles of copper
are metallic sulphides, alkalies and alkaline earths, iodides, and vegetable
infusions containing tannin.
Therapy. — Copper sulphate, in solid stick, is used as a superficial caustic
in indolent ulcers, exuberant granulations, and in syphilitic and other sores
in the mouth and throat. It may also be lightly applied in cases of granular
lids, or a solution (V4 to V» of 1 per cent.) instilled into the eye in subacute
conjunctivitis; but for this the acetate is preferred. A crystal of copper
snlphate is likewise serviceable as an heemostatic in checking haemorrhages
from slight wounds, leech-bites, or the surface of irritable lUcers. A solu-
tion of this salt is employed locally with benefit in order to suppress ex-
cessive and chronic discharges. In the strength of from 0.65 to 1.30 Qm.
(or gr. x-xx) to 30 c.cm. (or f^j) of menstruum it may be thrown into the
bowel for the relief of chronic diarrhoea or dysentery. The same method is
beneficial in acute diarrhoea of severe form. From 0.32 to 0.65 Om. (or gr.
v-x) of the sulphate dissolved in 30 c.cm. (or f5J) of glycerin is one of the
preparations which may be recommended for use in pseudomembranous en-
teritis. The fluid should be injected into the bowel during the interparox-
ysmal period for the purpose of modifying the condition of the mucous mem-
brane. A weak, aqueous solution of copper sulphate is an excellent stimulant
dressing to chancres and chancroids, and forms a good injection in leucor-
rhoea, vaginitis, and gleet.
Copper sulphate, made into the form of a pencil, has been employed
in the treatment of endometritis, introduced witnin the cervical canal and
held in place by a tampon of iodoform gauze. Although praised by some
writers, Boursier asserts that it may give rise to violent uterine colic, metror-
rhagia, a profuse discharge, and vomiting. The application is likewise
capable of causing a loss of substance of the mucous membrane, and may
be followed by atresia. Pencils or suppositories containing copper sulphate
should not be left too long in position. Dr. Tamier esteems a 5-per-cent.
sohtion of copper sulphate a valuable disinfectant for washing out the uterus
and vagina after delivery.
This salt enters into the composition of injections for gonorrhoea, and
may be advantageously combined as follows: —
m DHUC
,S.
75 Gm.
or gr. xij.
55 Gm.
or ffr. xxiv.
or l3j.
c.rm.
5 c.cm.
or fSij.
ccm.
or fjvj.— M.
p2 Gm.
or er. v. ^_
or f^as. ^^^
c.cm.
c.cm.
or f5j. ^B
c.cm.
or fJiisB.— M. '
424 niAHMACEUTICAL THERAPEUTIC AGENTS Oil DHUGS.
H Cupri Rulphatis
Zinci BulpliutU,
IMumbi acetalia aa 1 J
Fluidext. kraiiienre 4
Vini opii 7 J
Aquee roase q. 8. ad 180|
3 Cupri Bulphatia
Fhiiiloxt. geranii 15
Glycerini 30
Aquffi rose 75
The oleate of copper is an admirable flstringent, antiseptic, and anti-
parasitic preparation, especially valuable in the various forms of tinea
trichophytosis.
The sulphate is sometimes effective as a local stimulant in an indolent
impetigo, and a weak solution is efficacious in ulcerative stomatitis and
thrush. Thirty-one Gm. (or gj) of the sulphate in a half-litre (or f^xvij) of
water is a solution which has been found very efficacious in the treatment of
scabies. Other cutaneous affections — as psoriasis, chronic eczema, sycosis,
favus, acne, hypcridrosis, and bromidrosis — are ameliorated by the topical
application of copper sulphate or acetate in the form of an ointment or a
lotion, or the oleate made into a 10- or 30-pcr-cent. ointment. A gargle con-
taining 5 grains of copper sulphate to the ounce of water does good in re-
laxed sore throat. The sulphate, or other salts of copper, may be employed
externally in the following formulae: —
H Cupri Bulphntia |32 Gm. or gr. v.
Aqiice ImmomeHdis deal 150| c.cm. or F^v.
AI. for a gargle, or apply over the Burface for hypcridrosis or bromidrosis.
3 Cupri sulphatia 165 to 2| Gm. or gr. x vel xxx.
Acidi borici 4 Om. or 3j.
Creosoti 60 c.cm. or imx.
Ungt aquas roace 31 1 Gm. or 5j-
M. Useful in sycoeia and parasitic diseases of the skin.
In summer diarrhoea and cholera infantum copper sulphate is of un-
doubted efficacy. It is likewise a valuable remedy in the diarrhoea and dys-
entery of adults. Diarrhcea, whether acute or chronic, will often yield to
copper sulphate. It has been found of service in restraining tuberculous
diarrha^a, and has been highly praised by some wTiters for its virtue in the
diarrhccD of typhoid fever. Copper sulphate has also been administered with
good results in cholera. TiEnia may be dislodged and pasi^cd under the us^e
of small doses of copper sulphate. Phillips begins with about 0.01 Gm. ^or
gr. Y^) and gives -it every morning upon an empty stomach, gradually in-
creasing the dose until 0.20 to 0.32 Gm. (or gr. iii-v) can be taken without
vomiting. In actinomycosis, A, D. Bevan recommends copper sulphate,
0.015 to O.OG Gm. (or gr. V^-j) three times a day, and locally irrigation
with a 1-per-cent. solution.*
The same salt is useful in bronchorrhcea. A small dose of the sulphate,
0.003 Gm. (or gr. ^/.^o) three times a day, will sometimes allay the vomiting
of pregnancy. Small doses of the same salt, given with or after meals, im-
prove nutrition, and have been recummended as of service in ecthyma,
BCTofula. and tuberculosis.
**/oiir. Amer. Med. Aasoc., Nov. 11, 1!H)5.
CUPBUM. 425
Luton makes use in tuberculosis of a "cupric serum," made by dissolv-
ing 0.20 Gm. (or gr. iij) of copper acetate in 90 c.cm. (or fSiij) of his "arti-
ficial serum." Of this fluid 5 ccm. (or f3i ^/^) is an average dose for an adult.
Dr. A. F. Price, U. S. N., recommends the sulphate as a remedy in syph-
ilis. He states that it is of particular efficacy in syphilitic adenopathies,
and, although slow in removing syphilides of the secondary stage, it pre-
Tents the development of mucous patches and throat symptoms. He gives
it in an average dose of 0.002 Gm. (or gr. V»o) thrice daily and recommends
that its use should be omitted one day in each week.
Its action as a prompt emetic is best utilized in phosphorus poisoning,
where it is also antidotal. Copper has a very decided action upon the
nervous system, and the ammoniated copper particularly is used and highly
praised for its effects in chronic neuroses, epilepsy, chorea, hysteria, and in
the treatment of facial neuralgia. It is claimed that the administration of
0.005 Gm. (or gr. Vij) of copper sulphate every night at bed-time will relieve
the cramping pain in the legs from which pregnant women sometimes suffer.
In chorea, especially when connected with the presence of teenia or
other worms and in epileptiform convulsions dependent upon intestinal
worms, Phillips has witnessed good results from the administration of the
sulphate. In asthma, also, he has observed benefit from its use.
Dr. Boardman Eeed speaks favorably of the use of copper arsenite in
minute doses as an antispasmodic in cases of after-pains.^ He gives 0.000065
Gm. (or gr. Viooo) every half-hour with complete relief. It has also been
highly extolled in the treatment of diarrhoea of infancy, where it may exert
an antiseptic action upon the contents of the intestinal tract, when given in
small and frequently-repeated doses, as first suggested by Dr. Eeed. A solu-
tion prepared in this manner is often of marked benefit in after-pains, diar-
rhcea, and in cholera morbus; —
B Cnpri arsenitis |03 Gm. or gr. at.
Aqu» camphotflB,
Aqua cinnamomi aa 120| c.cm. or IJiv.
M. Sig.: From one- half to one teaapoonful every half-hour or hour until relieved.
Copper arsenite, in doses of 0.0013 to 0.002 Gm. (or gr. Vao-Vaft) a^ter
each meal, is said to be of value in the treatment of functional anaemia. In
four cases of epidemic cerebro-spinal meningitis, Kolipinski gave arsenite
of copper for the first and second days, every half-hour when the patient
was awake; as the symptoms improved the intervals were prolonged to every
three or four hours; on the fourth day the remedy was discontinued, when
convalescence appeared. With children he used 0.000025 to 0.00006 Gm.
(or gr. V24oo-Vi2oo) at a dose, with an adult 0.0002 Gm. (or gr. V«o)- ^^
pronounced chlorosis Li6geois has obtained good results from copper, ad-
ministered in the following form: —
ft Cupri acetat. neutralis 101 Gm. or gr. '/••
Sodii phosphat. crystall |045 Gm. or gr. *U
Pulv. fflycyrrh.,
Glycenni aa q. a.
M. et ft pil. no. j. Mitt talea no. xxx.
One or two pills were given twice daily before meals. The drug could
be taken for three months uninterruptedly without occasioning any derange-
* Time8 and RegUter, Dec. 6, 1800.
428 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
Pereira states that cusparia is valuable not only in interrnittents and ,
remittents, but also in the bilious forms of the latter, such as occur in the j
tropics. Williams and Wilkinson, and Hancock, corroborate this opinion; !
while Winterbottom is even more emphatic, and extols the drug in adjiia-
niic continued fcver.
A convenient tincture may be made in the usual way, by macerating i
the dried bark in coarse powder in five times its weight of alcohol. It should ;
be put in a well-stoppered bottle; allowed to stand eight days in a cool |
place, shaking twice daily; then poured off, strained, and filtered. The in- i
fusion is incompatible with metallic sulphates, antimony, lead and mercurial '
salts, silver nitrate, and infusions containing tannin.
Phyaiological Action and Therapy. — In small doses cusparia is a bitter
tonic, and in large doses of the recent infusion it causes vomiting or purg- :
ing. In South America it has been largely employed by the natives in the I
treatment of diarrhoea and dysentery. As a stimulating tonic, it may be
given for loss of appetite and weak digestion. The dose of the powder ia
from 0.32 to 2 Gm. (or gr. v-xxx). Nausea is prevented by combining it with
aromatics.
CUSSO (U. S. P., B. P.).— Kouaao, Brayera, Red Cuaso.
Dose, 15.6 Gm. (or oSs).
Preparaiion.
Fluidextractum Cusso. — Fluid Extract oi Kouhbo. Dose, 15 to 30 c.cm. (or
f5B8-j).
Pharmacology. — "The dried flowers of the female inflorescence of Hage-
nia Abyssinica (Rosaceae)," or "the dried panicles of pistillate flowers of
Brayera anthelmintica" (B. P.), a tree of Abyssinia. Bedall, of Munich,
foimd Kosin a crystalline resinous substance of acid reaction, combined with
tannic ncid, a volatile oil, and a resinous substance (Koussein), which is an
impure kosin. In large doses brayera is a gastro-intestinal irritant, and is
liable to cause vomiting, but no toxic effects have been observed. It is usu-
ally administered in infusion, 15.5 Gm. (or 5^) of the flowers in a pint of hot
water, the whole to be swallowed at once, for the expulsion of tape-worm.
It should be followed by a purgative in about two hours, castor-oil being
ordinarily used. Kosin is said to be less liable to cause nausea than the fluid
preparations. Brayera should not be given during pregnancy, for fear of
causing abortion. Konssein is an amorphous, yellowish-brown powder, has
a bitter taste, is soluble in alcohol, ether, and chloroform, and but slightly
soluble in water. It has been given as an anthelmintic in doses from I to
4- Gm. (or gr. xv-lx). According to a more recent authority. T^ichsenring,
the active principle of the drug is an amorphous substance which he called
Kossotoxine. It is insoluble in water, but dissolves in alcohol, ether, benzol,
or carbim disulphide.
Therapy. — In the treatment of tape-warm, it is given as a fluid extract of
the fresh flowers, in doses of 16 c.cm. (or foiv) to an adult; below 12 years
of ago the dose should be one-half of this quantity, or less. If it does not
cause evacuation of the bowel in four hours, a cathartic should be given.
CTDOniuM. — Cydonium, duinoe-ieeda are the seeds of Cydonium
vulgaris (Rosacea?). These seeds, containing about 20 per cent, of vegetable
DAMIANA. 429
mucilatge, were formerly official in order to provide the Mucilage of Cydo-
nium, which is best made with rose-water. It is used locally in inflamma-
tion of the skin, or conjunctiTitis^ or it may be used intemally^ <id libitum,
in disorders of the alimentary canal requiring a demulcent.
CYKOOLOS8T7M. — The root of the Cynogloseum officinale (Boragineae;,
an indigenous plant, is of interest, because it contains Cynoglowine, a brown,
amorphous substance, soluble in water and alcohol, having an alkaline re*
action, which Buehheim, its discoverer, found to possess narcotic powers.
Its physiological action is said to be analogous to that of curare.
CYPEEPEBIUM (U. S. P.).— Cypripedium, Ladies'-slipper.
Dose, 1 to 2 6m. (or gr. xv-xxx).
Preparation.
Fluidextractum Cypripedii (U. S. P.}.— Fluid Extract of Cypripedium. Doae,
0.6O to 1.20 ccm. (or mx-xx).
Pharmacology. — "The dried rhizome and roots of Cypripedium hirsu-
tum, or of C>T)ripedium parviflorum (Orchidaceae)." The roots have a
heavy, disagreeable odor, and contain a volatile oil, a volatile acid, resins,
and a peculiar tannin. Cypripedin is an impure oleoresin (dose, 0.13 to
0.20 6m., or gr. ii-iij)-
Fhysiological Action and Therapy, — In its effects it resembles valerian
as an antispasmodic, tonic, stimulant, and diaphoretic. It is given in neu-
rasthenia, nervous hypersesthesia, neuralgia, nervous headache, hypochon-
dria, insomnia, and epilepsy.
DAUAHA. — ^Damiana is a small, mint-like plant (Tumera diffusa,
micTophylla, or aphrodisiaca; natural order, Tumeraceae), bearing yellowish-
white fragrant flowers, which grow in southwestern Texas, Mexico, and
SoDth America. Other plants have, been sold under the name of damiana,
and it is probable that some of the uncertainty of result has been due to
the substitution of some other drug for the Tumera. The leaves are the
part used; they contain a yolatile oil, a resin, and other constituents. The
following preparations have been employed : Extractum damianae (extract
of damiana) ; dose, 0.32 to 1 6m. (or gr. v-xv) . Extractum damianae fluidum
(fluid extract of damiana); dose, 2 ccm.* (or f5ss). 61ycerol damianae,
phosphori, et nucis vomicaB (containing in each fluid ounce, damiana, 4 6m.,
or 3j ; phosphorus, 0.0025 6m., or gr. ^/jg ; nux vomica, 0.25 6m., or
jrr.iv) ; dose, 4 ccm. (or fSj). Elixir Tumera (N. F.), (15 per cent, of
damiana) ; dose, 7.50 to 30 ccm. (or fSii-fJj).
Fliysiological Action. — Upon the sexual appetite and function damiana
undoubtedly exerts some stimulant effects; but it is also a general tonic
Damiana is thought to have a reconstituent effect upon the spinal and
medullary centres. Upon the digestive organs it acts as a carminative, and
in larger doses as a cathartic laxative. It is slightly cholagogic, and is also
a stimulating diuretic
A case of poisoning from damiana has been reported, the symptoms
bemg closely analogous to those produced by strychnine. Eecovery by treat-
ment usual in intoxication from strychnine occurred.
430 PHARMACEUTICAL THKIUVPEL'TIC AOE2CT8 OR DRUGS. ^W
Therapy. — In nervous dyspepsia, neuralgia, cerebral exhaustion, neu-
rasthenia, or want of tone in the nervous system, also in sick headache or il
migraine, damiana has been found to be useful. It has been of service in
cases of paraplegia and hemiplegia and atony persisting after prolonged
illness. It is especially employed, however, in treating functional impotence
from any cause, combined with hygienic and other treatment, especially nux
vomica, iron, and phosphorus.
Damiana relieves irritability of the bladder and urethra, so often asso-
ciated with prostatorrhoea or spermatorrhoea. Softness and tenderness of
the testes as a result of sexual excess have been benefited by the adminis-
tration of this drug. In cases of abnormal sexual appetite it has manifested
a sedative influence.
DIGITALIS (U. S. P.).— Digitalis, Fox-glove.
DIGITALIS rOLIA (B. P.).— Digitalis-leaves.
Dose, 0.03 to 0.13 Gm. (or gr. ss-ij).
* Preparations,
Extractum DigiUlis (U.S. P.).— Extract of Di^talis. Dose. 0.015 to 0.03 Gm. (or
Flixidextractum DiRitalia (U. S. P.).— Fluid Extract of Digitalis. Dose, 0.03
to 0.12 c.cm. (or mBS-ij).
Infusiim DijritalU (U. S. P.. B. P.).— Infusion of Digitalis (1 V, per cent., U. S. P.;
or 0.08 ix-r cent., B. P.). Dos«, 4 to 15 c.cm. (or f3i-iv).
Tinftura Dipit^Iis {V. S. P.. B. P.).— Tincture of Dijritalis (10 per pent.. U. S. P.;
or 12 V, per cent, B. P.). Dose, 0.30 to 2 c.cm. (or mv-xxx).
Pharmacology. — "The ilried leaves of Digitalis purpurea (Scrophu-
Inriacoff), colli'ctod fmru pliiiits of the sfH'onH ypar'fl irrowtli nt the oom-
rnencement of Howcrinp:" (U, S. P.). ''The dried leaves of Dipitalis pur-
purea, Ijiiin6. Cnllcoted from ]>hiut^^ commeuein^r to flower" (B. P.), It
is now recognized that Digitalin, whioli wus formerly oflicial, and con-
sidered as the active principle, is a mixture of several bodies, the most
nctivc of which is cryptrtlHzahle Dig^toxin (Ct^TT^^Ou}, according to
Kiliajii, which, wilh Digitalinum venim and Digitalein, represents the car-
diac, stimulating lution of the drug, while Digitonin appears to exert a
contmrv effect, noting like saponin (Schmfodchcrg). M. Cloetta * finds
that the leaves, as wofl as the ^^eaL contain digitoniu, digitalin, digitoxin,
and coloring inattor connnnn to both. Tlie seed contains much more digi-
t^ilin than digitoxin, while in the leaves the reverse is the case. A fifth
siihstanco, Bigitin, seems entirely devoid of physiological and therapeutical
actions. These are all non-nit rogenoufl. and are glucosides. Xo alkaloid is
present in digitalis. It also contains tannin, volatile oil, fatty matter, red
coloring matter, chlorophyl, alhumin, staroli, sugar, gum, lignin, and salts.
Two acids have heen (liscovcrcd by M. Morino, — digitnlic and antirrhinic.
The varying solubility of the active principh-s in the vehicles used explains
the difference of tlierapeutical effect. Digitalin is insoluhle in water, but
soluble in alcoliol; digitoxin is insoluble in water, sparingly soluble in
alcohol; digitalein is soluhle in ether: digitonin, soluble in water, sparingly
in alcohol. According to Orlila, Nativelle's digibilin is principally digi-
^Arch. txp. Pathol ti. Pfc<irm., 1898, 41. 421.
DIGITALIS.
431
tein with a little digitalin; it ia a very active preparation. Balfour pro-
ifeouiaH it, after twenty years' experienee, a tlioroughly reliable and active
drag- One granule (V4 Hig*? «r |Cr. Vaso)* every night at bed-time is a
iof&ctent dose to produce a decided tonic effect on the heart. The
Pifilalimuii Germanicum (Merck) njipears to be a reliable and active prep-
aration. Dose, 0.(Kt3 to 0.015 lim. (or gr. V^ to \\), The tincture of
<Bptalis, and alcoholic fluid extract, contain both digitalin and digitoxin;
tke infusion contains principally digitonin and very little digitoxin. In or-
der to get the full physiological effect it is necessary to use the carefully-
•eiected leaves, according to the phannacopoeial requirements. The seeds,
•Itboogh said by Hitz to contain ten times as much of the active principles
uthit leaves, are not used in medicine, except possibly pharmaceutically, a3
t coarce of digitalin and digitoxin.
Phytiological Action. — Digitalis is readily absorbed by the skin, and is
thoQgbt to have some local sedative effects when used on spongiopiliu or
is a cataplasm. Although it has a bitter taste, digitalis has no tonic action
■pon the etomach, but, on the contrary, often disorders the digestion, and
ffiaj cause nausea, vomiting, or diarrhcea \rhen too long continued. Its
•ctiTe principles readily diffuse into the blood, reducing the rate of the
heart's action by lengthening the period of rest, or asystole, thus allowing
its carities to receive more blood. At the same time that it increases the
ifibibition it stimulates the motor ganglia and increases the force of the
contraction. Moreover, digitalis causes the contraction of the arterioles
tliroughout the body, and thus combines its effects with the preceding, in
order to raise arterial tension. Francois Frank, from a series of experiments
vitli digitalis and digitalin, found that, in mammifera, it slows the beat of
the accelerated heart, it regulates the arhythmical heart, and it greatly aug-
Bcnta the systolic power and the diastolic resistance. He holds that these
iflecti are developed equally on the two sides of the heart, contrary to the
fiew (if Germain See, and contrary to the German physiologists, who hold
thai die drug's power is manifested on the left heart. In a toxic dose digi-
talin produces, first, an excessive slowing of the heart movement, but a special
ArfaTtlinucal beat, manifested by the dicrotic pulse. Afterward the heart
accelerates itself, becoming irregular; the contractions are precipitated by
of semitetanic, ventricular movement, interrupted by prolonged inter-
i»n^ finally causing death, in systole, in both cold- and warm- blooded
la alike.' Germain S^e has ascertained that exhausting diseases occa-
flacctdity of the cardiac muscle, with consequent dilatation of the organ.
iBfOch condition digitalis diminishes the volume of the heart, but acts espe-
rlillr upon the fibres of the right cavities. The temperature is reduced by
mile conditions, though not in health. The slowness of its action
,...,-.. iUfc from thirty-six to forty-eight hours) in reducing fever and its
I E&cdihood of disturbing the stomach tend to preclude its use for this pur-
k pote in acute fevers. Its action upon the circulation may be summed up as
H IctBg that of a vascular stimulant, raising arterial pressure, lowering abnor-
" aal tfinperature, and steadying the heart. Upon the brain and spinal cord
ItprodocM little direct effect. The reflex action of the spinal cord is reduced
Ijlfrgv doees, and there is stimulation of the pneumogastric and vasomotor
3erre». It ie liable to cause headache, delirium, and vertigo, possibly from
i
^B^tUfin dc VAcadfmif <!e M^dccinc, July 2, 1895.
^Kma^
432
PHARMACEUTICAL THERAPEUTIC AGEVT9 OR DR0G8.
disturbance of the cerebral circulation due to the effects of the volatile oil,
or from Fick stomach. Syncope may be due to heart-faihire from overstim-
ulation after the drug has been used for some time, especially if the patient
suddenly sits up in bed or assumes an erect posture. It stimulates the vaso-
motor ganglia in the medulla. Large doses excite Setschenow's centre and
produce muscular paralysis, the peripheral nerves, both motor and sensory,
being also paralyzed. Kespiration becomes feeble and more rapid, coma and
convulsions follow, and death is attended by systolic arrest of the heart's
action, from its tetanizino- cfFcct upon the cardiac muscle or from exhaustion
of motor ganglia. The general action ujjon muscular tissue is to lessen con-
tractility and causo lassitude and want of vigor. The sexual functions are
depressed. The effect upon the kidneys is peculiar. The increase of arterial
tension in the glomeruli accompanying the general effect on the circulation
is assisted by a special action, by which tlie renal arteries are dilated, thus
acting as a true diuretic; while the excretion of urea is at first increased,
it subsequently diminishes. The greatest effect as a diuretic is obtained in
diseased conditions accompanied by oedema and low arterial pressure. Digi-
tahs also has some effect upon the muscular tissue of the uterus, stimulating
it to contraction.
Aconite and digitalis arc antagonistic. The former slows the heart by
expanding the peripheral vessels and lowering blood-pressure; the latter re-
duces the uuinber of contractions by stiniukting the inhibitory fibres of the
pneumogastric nerve, and tightens up the arterioles, thus causing increased
blood-preesnre. Aconite directly lowers the action of the cardiac motor
ganglia, and is a cardiac poison; digitalis indirectly exhausts the motor
ganglia by permitting overaction and exhaustion; in the former, the heart
is found, after death, in a condition of dilatation or asystole; in the latter,
it is in a state of contraction or systole. The action of aconite upon the
heart is rapid; the action of digitalis is gradual and slow; so that the latter
is not a practical antidote for the other. An erythematous, papular, or ery-
sipelatous rash will occasionally follow either the internal or external use of
digitalis.
Poisoning. — When digitalis or digitalin has been taken by mistake in
an overdose, tannin or infusion of tea or coffee should be given at once, the
stomach washed out and stimulants given. Saponin is the physiological
antagonist, according to Bartholow. The compound tincture of cinchona
might be useful, as it contains tannin, alcohol, and quinine. Ferrous sul-
phate or tincture of ferric chloride shoidd also prove useful. The patient
should be kept in a recumbent posture; hot drinks and hot-water bottles
should be around him and spirit of ammonia inhaled. As long as the func-
tions of the kidneys are maintained, it has been observed that symptoms of
so-called "accumulation" are not apt to arise. As already explained, these
are attributed to overstimulation and exhaustion of the heart, but possibly
there may be a urreraic element in some cases which would require appro-
priate treatment.
Poisoning from digitalis seldom has a fatal termination, and the maxi-
mum dose of digitalis or digitalin is not at present known. It is important to
note that digitalis is more active when given hypodermically than when taken
into the stomach. Thus, Piotrowska found that TTomolle and Quevenne's
digitalin in the frog is three times less toxic by the gaslro-intestinal canal
I
thfln svbcuUneously; Nativelle*s digitalin is one and a half tiroes less toxic
given bj the mouth than under the skin.
Therapy.— Locally, digitalis is employed combined with moisture and
lati in joint intlaramation, acting as a sedative and possibly reducing the
calibre of the vessels. Part of it is absorbed and carried to the kidneys, where
it produces a diuretic effect, especially when the hot application is made over
tht loins. A tablespoonfnl or more of tincture of digitalis may be sprinkled
vpon fipongiopilin, or flannel wrung out of hot water, and applied to the
Inmijar region; or a cataplasm containing 4 Gm. (or 3j) of the leaves, applied
in ca«^ of dysuria or Ruppression of urine. Bronchial congestion due to
hean disease may also be relieved by the local appHcation of digitalis.
Dr._ Pilatte has found the local application of digitalis serviceable in
dulhUins. The formula of which he makes use is: —
H Xluct. digitalis 61 ccm. or f3iB8.
TlijnuoL cryst 3| Gm. or gr. xlv.
Alcohol (70"),
Glycerin aa 135| ccm. or fSivas,
31. Sig.: Apply with friction.
Internally, it is chiefly prescribed, almost as a routine practice, as a
beart-tonic in all cases of failure of circulation due to the feebleness of the
bcart*6 action. It should not be used in valvialar disease cs long as com-
peBMting hypertrophy is keeping up the work of the heart; but when this
fails and dilatation is commencing^ digitalis will not only slow and steady
the heart, but improve the nutrition of the heart-walls by increasing the
preffiure in the coronary arteries and allowing them a longer time in which
tQ be filled. In heart affections where there is absence of dropsy, aud
vben the patient is passing an abundance of urine, digitalis is seldom dc-
naoded. In mitral stenosis digitalis is used in order to allow the left auricle
a longer time to empty itself into the ventricle; also, in tricuspid regurgita-
tion, with dilated right ventricle. It is not to be used in aortic stenosis, as a
rale, although exceptional circumstances may require its use for a time, to
rvgulate the rhythm of the heart, or to reUeve dropsy. On account of the
oppoeing action of the different principles contained in digitalis, Lauder
Brunton counsels that when, in disease of the heart, there is excessive con-
ftriction of the blood-vessels, digitalis should be given in combination with
Citrous ether.
In the course of the second of his Lumleian Lectures* Sir Richard
Douglas Powell, Bart., M.D., remarked that the commonest mistake that one
eWnes in the use of digitalis is that too large a dose is prescribed at first,
vhtch tends to premature arterial contraction and cumulative effects. Then
■vith the appearances of tliese physiological symptoms the use of the drug
itftoppod and that of some other medicine substituted until the pulse a^ain
calls for its administration. In this hap-hazard way of using digitalis the
heart is never held in good control. In exceptional cases, where there is
trr^nt need to push the drug, digitalin is best used subcutaneously. In ordi-
nary cn«e« n do«e of 0 Cn c.cm. (or mx) of the tincture every four hours, or
1 ccm. for mxv) every eight hours, or 0.30 c.cm. (or mv) every waking hour
fiifficient. Thus given, the patient being at rest, it generally takes about
hT»p dat^s before the pulse is under control and the urine begins to increase.
* lancet, Aprils, 1898.
434
PHAIOtACKlTICAL TIIERAPEUTIC AGENTS OU DRUGS,
When its decided eflecta are thus gradually developed, the use of the drug
should be steadily continued in doses calculated to maintain its etlect. With
ordinary watchfulness there is no risk whatever; timely warning of excess
is given by the pulse, which, having become slow, begins to exhibit small
intermediate beats and especially a tendency to go in couples. This is always
a sign to reduce the dose or to limit them for a few hours. The sickness that
occasionally supervenes with digitalis is most troublesome. An occasional
mercurial will sometimes prevent it, a change to digitalin in equivalent doses
may be tried, or a tumblerful of very hot water may be taken occasionally.
In some cases it is not to be overcome except by omitting the use of the drug;
the patient is usually well under the influence of the drug before this symp-
tom appears, in which case a small dose of digitalin by the mouth or hypo-
dermically may be sufficient to maintain its effects on the heart.
Cardiac dyspnoea or asthma due to engorgement of the pulmonary cir-
culation is usually relieved by digitalis; and functional weakness, with irri-
table heart or low arterial tension, with migraine, or delirium tremens, is
very promptly benefited by it. Dr. Jules Comby writes that digitalis is bene-
ficial in congenital maladies of the heart, with or without cyanosis, by
strengthening the cardiac contractions, which are almost always insul!icient,
and by promoting diuresis. lie does not, however, regard tlie drug as serv-
iceable in the case of infants or young children attacked by nervous palpita-
tions.
Large doses (15 c.cm., or f^ss, or more of the tincture) have been given
in mania a potu and acute mania, with success. Isa-mbert records the case
of a maniacal child, fourteen years of age, in whom the delirium yielded
to the administration of 30 drops of the tincture of digitalis. It is claimed
by Gowers that digitalis, associated with belladonna, promotes the efficacy
of the bromides in epilepsy.
It is a useful remedy in hemorrhages, as in menorrhagia or hfemoptysifl,
and in the first stage of pneumonia. Digitalis is of particular advantage in
the metrorrhagia or menorrhagia of plethoric individuals, or when dependent
upon mitral disease. For haemorrhage, the tincture of digitalis may be given
in doses of 1.20 to 2 e.cm. (or mxx-xxx) every three or four hours. Pogt-par-
tum haemorrhage may likewise be restrained by the use of digitalis, which
may here be appropriately combined with ergot. This remedy is of service
in controlling epistaxis, and is a valuable adjunct to the tincture of iron in
purpura ha&morrhagica. In the treatment of haemorrhages digitalis is use-
fully prescribed in combination, as: —
H Tr. digitalis 6 c.cm. or fSisa.
Tr catechu 30 c.cm. or fSJ.
FhndcNt. ergotw q. B. ad 60 ccm. or fjij.
M. Sig.: A dessertspoonful every hour or two,
The infusion, however, ia usually the most efficient preparation in
haemorrhage: —
B Plumbi acetatis 2160 Gm. or gr. xl.
Morphinie aceUt |D86 Gm. or rt. j.
Infus. digitalis 120| com. or Qiv.
M. et ft. Bol.
Sig. : Tftblespoonful every three hours.
Digitalis may also be prescribed for hjEmorrhage in phthisis and in the
first stage of pneumonia, thus: —
'4
DIO [TALIS.
435
B Extrmcti digitalis 120 Gm. or gr. iij.
Pulveris ipecacuanhse et opii .«,..«» 1)55 Gm. or gr. xxir.
IL ct ft. pil no. xij.
Sig.: A pill every two or three hours.
In persiiiient diarrhcea complicatiiig fever of a remittent type, Mr.
Harold HenlcT has obtained good results from a combination of digitalis and
sDychnine given in spirit of chlorofonn and water.
In exophthalmic goitre and in congestive headaches it sometimes suc-
ceeds remarkably in controlling the symptoms of disease In the treatment
of exophthalmic goitre Rockwell values a combination of digitalis, or stro-
pbanthus, with iron, ergot, and zinc bromide.
Besides the special action above referred to, as a cardiac tonic or current-
rmiUtor to the circulation, digitalis is the chief reliance in dropsy and serous
cCnsioDB, owing to its diuretic action. In acute rena! dropsy, the best effects
tie obtained by combination with calomel or other mercurial, and with squill,
15 m the famous Guy's pills: —
B Pulv digitalis [03 Gm. or gr. as.
Pulv. scillff 10 Gm. or gr. iss.
MaM hydrargyri (20 Gm. or gr. iij.
M. et (t. piL
6ig.: Take one or two at bedtime.
In cases of cedema due to Bright's disease, with scanty albuminous
aiifie, the following are useful: —
B Potaaaii acetAtie 261 Gm. or Svi gr. xl.
8piritua juniperi comp 45 c.cni. or fjiaa.
Inf digitflli"! IJ. a. ad 150) e.cm. or fjv,
M. Sig.: A dewertapoonful every three hours.
B I&fna. digi talis,
Infua. acoparii,
Tafua. buchu •. . a* 60| c.cro. or fjij-
X. Sig.: A deasertapoonful every three hours.
B Infua. digitalis,
Io(ua. taraxaci,
Spiritus aetheris nitrosi aa 60| c.cm. or fSij.
M. Sig.: A dessertspoonful every three hours.
Digitalis is of service, in promoting absorption, in pleurisy and hydro-
thorsx. In the bronchitis and broncho-pneumonia of childhood it is often
hecdSciil Dr. Broadbent observes that as difjitalis increases the elimination
of fluids and caffeine that of solids, the two agents should be combined in
fltder to obtain the same effect as that produced by a large single dose of
digiuliA.
In the ha'morrlmgic- diathesis, the tincture of digitalis is usually given
IB doses of 1 to 8 c.cm. (or mxv-xxx). The same doses may be given in cases
of carfhcal shock or syncope. When the patient is exsanguined, the remedy
•hould be administered by hypodermic injection, preferably in the form of
digitoxin.
Sperraatorrhnea with nocturnal emissions is benefited by digitalis in
mnfaination with ergot or with potassium bromide, according to circum-
•tancef. In this country it is not used for its antipyretic effect, although in
43G
PHARMACEUTICAL THERAPEUTIC AGENTS Ott DRUGS.
Germany it has been given h\ the hyperpyrexia of rheumatism and scarlet
fever. The infusion of digitalis is employed in the treatment of scarlatina,
especially when the urine becomes scanty. The following combinations are
very serviceable in the latter condition: —
B Inf. digitalis,
SpiritUB (ctheris nitrofii aa 161 c.cm. or f3s>.
Potassii bitnrtratia 8| Gm. or 5ij.
M. Sig.: A teaspoonful in water every three or four hours.
B Inf< digitaliflf
Mquor potassii citratis na 60| c.cm. or fSij.
M. Sig.: A teaapoonful every two or three hours.
In fibroid Inng, digitalis lessens the cough, steadies the heart, and re-
duces oedema. It has been successfully employed in erysipelas.
Digitalis is the physiological antidote to muscarine and to aconite, but
requires the aid of diffusible stimulants on account of its slowness of action,
when treating cases of poisoning by these agents. It may be administered
hypodomiically in such cnnop. as the otlieial tincture in combination with
whisky, and in purgicnl shock as recommended by Dr. Thomas G. Morton,
of the Pennsylvania Hospital, where it is also ueed in the treatment of sun-
Rtroke.
Masius and Van Aubel have used digitoxin with success to fulfill the
indications of digitalin. They administered it in the dose of 0.001 to 0.0013
Gm. (or gr. Voi'V^s)? ^nd observed no ill eifects upon the digestive func-
tions. Its action is said to be prompt and decided and its eilect upon the
circulation is manifested within twelve or twenty-four hours. The influ-
ence of the remedy usually persists for eight to ten days. In pneumonia it
reduces temperature within twenty-four to forty-eight hours. Digitoxin
relieves the cyanosis and dyspnoea of cardiac affections, restores force and
regularity to the pulse, and occasions marked diuresis. It was found useful,
likewise, in typhoid fever.
Contraindications. — M, Lucas Champonniere states that the indica-
tious for digitalis being frequency, irretadarity. weakness of pulse-beat, and
dropsy, it can be said in a general way that any other condition forms a con-
traindication. Among the special circumptances opposing its use are the
following: a slow pulse, due to weakness of the heart-wall; an incompetent
aorta, dyspepsia, any form of cachexia, also where digitalis has already been
used for some time. Death from digitalis liappens chiefiy in cases of
Bright^s disease, arthritism. severe ameraia, aortic incompetency, and delir-
ium tremens. Tn tricuspid insufficiency, digitalis may indirectly cause pul-
monary apoplexy, owing to sudden increase of pressure.
Digitalis should be given with great care, if at all, to persons with fatty
degeneration of the heart and dilatation. It should not be given in peri-
carditis, although passive pericardial effusion may be removed without much
danger. In simple hypertrophy, or compensating hypertrophy, or condi-
tions of high arterial tension or vascular excitement, it should rarely, if ever,
be given. In any disease accompanied by changes in the heart-muscle ol
atheroma of the blood-vessels, digitalis should not be prescribed except fot
a temporary emergency. In simple dilatation of the heart, however, this
remedy serves an excellent purpose. In typhoid fever digitalis is liable to in-
DISCOBEA rnxosA.
437
I
»
icea and cau^e vomitisg In gastritis or acute nephritis it
alfio prove injurious.
Digalen, or Digitoximim 8oluhile (t'loetta), is a recent introduction,
«Dd is claimed to have especial application for subcutaneous injection. It
il marketed only in solution, by the manufacturers.
DIONUT is a morphine derivative, and, chemically, is ethyl-morphine
hvdrochloridc. It is a white, niicrocrystalliue powder of a sonivwliat bitter
tute. It is soluble in about 7 parts of water and 1.4 of alcohol, and in about
to parts of 6}Tup. It is neutral, and ie precipitated from solution by the
ntoal alkaloidal reagents. Dionin is less narcotic than morphine, and more
iQ than codeine. It has decided analgesic action, and is said to hare no
ftoteworthy effect upon the digestive tract and to be free from disagreeable
bj-eff€cta. It has been used in bronchial asthma and the irritating cough of
phthisis, and especially as a substitute for morphine in overcoming the
habit. The usual dose is a little larger than that of morphine, and it may
br given cither by the mouth or hypodermicaily. Dose, 0.015 to 0.06 Gm.
ior gr. 'VJ) s^-^^pral times daily. For a child, one year of age, give 0.0005
Im. (orgr. V„o).
DIOSCOREA VILIOSA.^— Wild Yblj^l
Pharmacology. — Dioscorea villosa (Dioscoreaceae), wild yam or colic
root, grows abundantly in our Southern States, but less plentifully in the
Xorthcm and Western Slntfts. The part made use of is the rhizome. This is
withoQt odor when intact, but when bruised develops a slightly woody smell.
taste is somewhat pungent and sweetish-bitter. The powdered root is
jh-gniy in color, is soluble both in water and alcohul. The following
preparations are used in medicine: Decoctum dioscoreie (decoction of dios-
oorea); dose, 30 to 120 c.cm. (or foi-iv). Tinctura dioscoreae (tincture of
dktfcorea) ; dose, 0.60 to 2.50 c.cm. (or mi-xl). Fluidextractum dioscorere
(fluid extract of dioscorea) ; dose, 0.30 to 3 c.cm. (or 7hv-x.\x).
Thf mot contains an active principle called Dicscorein, also a resin and
a *^ like saponin, which cause its acridity. The physiological action
oi 1 has never been systeuuitically studied.
Therapy. — Wild yam possesses diaphoretic and expectorant properties,
but derives its principal value from its effect upon the hepatic functions. In
brge doses it is emetic. It is of especial service in the treatment of gall-
itone. It quickly relieves pain and spasm, and, provided the calculus or
eaJcoli ire not of extreme size, leads to their prompt expulsion. After the
eoDcr«*tions have passed into the bowel this remedy is of service in reducing
^ congestion or inflammation which they have caused.
Hepatic indigestion, with its train of evil consequences, is effectually
rriiered by the fluid extract in 1 c.cm. (or mxv) doses before meals. The
MDe preparation effects a marked improvement and gradual cure in chronic
floogcfition of the liver. In chronic malaria, this agent is of decided ad-
TaoUge and may be combined with arsenic, quinine, or nux vomica.
In chronic gastritis, the result of alcoholic excess, wild yam is very
Hrrircable, and may be prescribed thus: —
>8cc pap^ by the author, in JourncX of th^ Amcricnn Medical A99ficialion,
438 niARMACEUTICAL TIIEBAPECTIC AGENTS OB DRL'tJS. ^
H Tinct. bcllftdonniE foliorum 1150 c.ciu. or rnxxiv.
Tinct. nucia vomicie 4 c.cm. or f3j.
Tinct. dioscorete villoste - 15l c.cm. or fSss. ^i
Syrupi zinj^beris 75| com. or fSiiss. ^H
il. Teaspoonful in water every fourth hour. ^H
DIPTERYX. — The prepared ripe seeds of several i;|^>ecies of Coumarou-
sea, or Dipteryx (TjOojuiniiiosaO, are also known as Tonka beans, tlie frnit
of a tree of tropical America. The most important constitiK'iit is Cotunarin
(1.5 to 2 per cent.), which has a pleasant odor like vanilla. Upon tlie
human snbjeet, it is antispiisnindi<-. In I'tiU dont*?. it deprcsr^es the Iieart
after prciiniinary stimulation.
Couniarin is used as a rtavoriutj a^'ent, and lias Iteen added to iodoform
to disguise the peuetnitinp odor of this dru^. A iluid e\traet of <lipteryjc
has bi>en used in tlu^ trealnient of wliooping oongli ; dose, 0.3 to O.ti c.cm. (or
i/t\-\), f'onuirlii niav be useful in colic and in disorders of digestion.
DITA. — Dita-bark (Apocynaccjr) is from the East-Indian Archipelago.
It contains two bitter alkaloid:-, Ditain and Ditamine; has been used as an
antiperiodic in treatment of ague; and is said to be of value in dysentery.
The dose is 4 to 15.5 Rm. (or 5i-iv), best given in the form of a fluid extract.
DIITRETIN.— (See Theobromin, )
DRACONTIUM.— Skunk-cabbage. Tlie dried rhizome and roots of
Spathyenia fudida (Arace<e). a iicrbaccons plant of North America. The
bruised leaves have a very disagreeable smell, wliicli warrants its common
name. Resides this volatile ])rinoipb' tlw dru^^ contains a rnsin, tannin, etc.
Therapy. — It is regarded as an nntiepasmodic, and has been vised in
chorea and hysteria, asthma, and chronic catarrh, using the reeently-dried
root or a good fluid extract (two-thirds alcoholic). The dose is 0.65 to 4
Gm. (or gr. x-5j).
DROSEEA. — Sundew. The Drosera rotundifolla (Droseraccte). growing
in Europe and. North America* has a very limited use in medicine. The
entire [tlant is used, and a recent infusion or tiuid cxtrnct is the best mi^tbod
in which to administer it. It contains a resin, a red coloring matter, and,
according to G. Stein, citric acid.
Physiological Action. — Drosera is irritating to the skin, and the juice
is used as an application for corns or warts. Internally, it is expectorant.
Therapy. — It is used in chronic bronchial catarrh, and has some repu-
tation in the treatment of phthisis. In spasmodic affections of the chest,
whooping-cough, and paroxysmal asthma it is said to be serviceable. The
fluid extract, in doses of 0.30 to 1 c.cm. (or wiv-xv), is the best preparation.
A tincture is also used in the dose of 1 to 4 c.cm. (or mxv-foj). Drosera has
been employed with advantage in hay asthma, gastric catarrh, gastric ulcer,
and atonic dyspepsia.
DITBOISIA.— Dnboisia,
Pharmacology. — The leaves of the Duboi.^ift Miyojioroidis (Solanacea^),
of .\usiraliii, have a bitter, acrid taste, liut very slight odi)r, and contain an
alkaloid, Duboisine (now regarded as being identical with hyoscyamine),
witli a little Hyoscine. It nlso contains a very small proportion nf Psendo-
DrnoisiA.
439
t
ier agpxavatee its dcproesant effect upon the nutritive processes.
Miugt, therefore, he administered with caution to persons of feehle
Towing preparationB Imve been employed: Tinctura
JuiM>.M.i' oiiuture of chihoisia) ; dose, {).:M) to (>.(J() cciii. (or mv-x). Extrac-
mm duhoitiia^ tluiilinn (liuid extract of duhoiaia) ; i!osi'. <i.(»0 to 1.20 c.cm.
^or «ix-sxj. Kxtractum duhoisia* (oxtract of duhoirtia) ; do^-, 0.01 to 0.03
UnL <or gr. */•"*/;)- Duboisina* snlplias vel hydrobii^mas (duboisine 8ul-
' itf or hvdrobroinatc) : iIoho, 0.0004 to 0.*»0■^ (.ini. (or gr. V,,,u-V.io).
Phytiolo^cal Action. — The elTeots of duboisio are the same as those
I ■ 'ina. although, on account of its irreater sohihility, its effects are
ma: '. more quickly and ]>ass away sooner than those of belladonna.
Daboi&in^ may cause loss of appetite, headache, giddiness, and the symptoms
of belUdonna poisoning. According to Kvensen, duhoisine will Romt'Iiiiies
gire rife to hallncinations of si^ht. Loiacono and Masuro, in a number of
of epilepsy, observed improvement in two-thnds of the cases from the
of duboisine sulphate. Birnabee has found this remedy injected daily
riceable in the morphine liabit. The craving for morphine seemed to be
dtftroycd. Experience has shown that the fre<|uent administration of
dnbcifine exerts a deleterious influence upon nutrition, irrespective of what-
erer digestive derangement it may occasion. The presence of gastro-intes-
ttir
Hi.
constuution.
Therapy. — It is used in medicine for the same purposes as belladonna,
and is antagonistic to morphine. In ophthalmology a watery solution of
I per cent, may be instilled for raakin^j examinations, etc. Its effects upon
lb€ pupil pass off more quickly than a similar solution of atropine. Various
nerrous disturbances occasionally follow the use of a collyrium containing
doboi&ine: faintness and strange sensations in the head, as in Dr. Seely's
esse, and a feeling of impending death, giddiness, pain over the heart, and
Ihaliacinations, as in a case reported by Aubone.' Crouzet met with a case
m which the application of duboisine to the eye gave rise to frequent pulse,
cztrrme weakness, rise of temperature, and disturbances of speech similar
to those of aphasia.
"• Duboisine has been found useful as a sedative in cases of alienation
Mompanied by restlessness and groat mental excitement. Dr. H. Gollhorn
Im» lilrly pubiished a communication upon the use of duboisine sulphate
im tarioiis forms of cerebral disease. He administers the drug both by the
mouth aod hypodermically, the dose for injections being from 0.0008 to
^ 0.0013 Gm. (or gr. V^o-V.-.«) for women and 0.0013 to 0.003 Gm. (or gr.
H Vm'Vm) ^^^ men. In a few instances slight pain was caused by the injec-
r tJon«» but abscesses or extensive infiltration were not observed. The eases in
vhich a f.ivorable action was witnessed were progressive paralysis, senile
ddiKfitia, secondary imbecility, hallucinations, idiocy, acute melancholia,
MTt/wjfo mania, hallucinations from injury, and alcoholo-nicotinism. Dr.
Gr teems this preparation as a prompt sedative in cases of alienation
Ul^ th excitement. It possesses the advantage over hyoscine of being
arous. A rapid subsidence of the tremor of paralysis agitans, ac-
to Dr. Mendel, of Berlin, follows the hypodermic injection of
4aboiirne. The effect continued for several hours. Professors Albertoni,
Btimondo, and Samuely have witnessed a notable effect upon the convnlsiona
• JftfitflcAt BvUfiin, Jan.. 1800. p. 14.
440
PHAHMACELTICAL THERAPEUTIC AGENTS OR DRUflS.
of hystero-epilepsy, produced by the injection of 0.0004G Gm. (or gr. Viao)
of duboisine sulphate.
The effect of the reme^Iy nmy not Ij^ at once apparent, but may be
postponed to the second or third day. To correspond with this slowness
of action, its influence is generally continued for a considerable period.
Duboisine is, in j^eneral, more efficient in chronic than in acute insanity.
It is not adapted for use as a p^eneral hypnotic, as the sleep which it produces
is not of a refreshing cliaracter. It has. however, a bencticia! effect as an
hypnotic in cases of in.«oninia caused by intense motor excitement.
4
Dnse, 2 to 4 c.cm.
DITLCAMAEA,— Dulcamara (Bitter-sweet).
Dose, 2 to 4 Gm. (or gr. xxx-5j).
Prcparalion.
Fluidoxtractum Duicamarffi. — Fluid Kxtiftct of DiiUanmrn.
(or mxxxfSj).
Pharmacologry. — The dried young leaves of Solanum Dulcamarn (Sola-
nacefe) ^re olhtial in lu^j^t plmrinarctpd'iiis, but not ia tlie United States
Pliarmacopa'ia. A iltH-rntion may l)e made (1 to IH). A substance exists
in this plant whicli yields a bitter alkaloid, Solaninc, crystallizing in white
needles, readily soluble in alcohol, lets soluble in water; its salts are soluble
in either alcoliol or water. It also contains a bitter glucoside, Dolcamarin.
Fhysiolog^oal Action. — Eruptions upon the skin attended by duskiness
and itching are among the effects of poisoning, which is likely to occur in
children, from eating the berries. It also causes vomiting, dizziness, con-
vulsive attacks, abdominal pains, thirst, heat and dryness of the throat, rapid
respiration and pulse, and prostration of vital powers. In the ordinary doses
if does not produce these effects, but acts as a sedative and mild narcotic.
The treatment in cases of overdose would be large amounts of warm
water and mustard to wasli out the sl'omach, and hypodermic injections of
morphine and atropine, with diffusible stimulants by the mouth.
Therapy. — Dulcamara is seldom used at present, although it is believed
to be serviceable in chronic skin affections <vf a scaly character. The recent
decoction may be used as a diaphoretic in rheumatism, or acute bronchitis
and colds. A distinct anaphrodisiao etfect has been noted in patients during
the adiuinistration of dulcamara. The extract may be given in mimia. and
especially nymphomania or satyriasis.
Desnos has reported favorably concerning the use of solaniiie in painful
affections of the stomach. He usually adniiniptered it in pill form and in
doses of 0.045 Gm. (or gr. ^/^) half an hour before meals. If the pain is very
severe, the remedy may be henelioinlly given in gummy solution. Solanine
was found of service in gastralgia. ]>ainful dyspepsia, alcoholic gastritis with
or without dilatation of the stomach, ulcer of the stomach, and cancer of the
pylorus. Good results have also been reported from the use of solanine in
various forms of neuralgia, in locomotor ataxia, asthma, muscular rheuma-
tism, chronic bronchitis, and the vomiting of pregnancy.
It is claimed that dulcamara is beneficial in the diarrhflea of children,
when this condition is caused by exposure to cold or damp.
ECHINACEA. — Echinacea angustifolia, a plant growing in our Western
States, is said to possess active therapeutic properties, especially as an anti-
ELASTIC A.
441
I
ptic. A tincture made by macerating 1 pound of tlie fresh root in 1 pint
of ilcohol has been used, diluted with water, as a local application to chronic
nlcerv, abecess-cavities, and wound:?. Internal ly, in doses of 0.60 com. (or
10 drops), it is recommended in cholera infantum and cholera morbus. It
ii wUbo reported to be useful in t^-phoid fever, malarial fevers, measles, small-
pox, erysipelas, diphtheria, boils, and carbuncles. The tincture has been
Jtaed with a?gerted success in the case of several individuals who had been
bitten by rabid dogs. In some cases it seems to be prophylactic, while in
others it favorably modified the symptoms. It is said to be an antidote to
bit«s or stings of venomous insects or reptiles.
SIOOK. — Eipin is tlie generic name given by Dieterich' to a group of
compounds of albumin with iodine in stable combination. The preparations
are intended to replace the iodine preparations hitherto used, both internally
and externally. The following are to serve as a basis for various medicinal
preparations: Alpha-eigon^ occurring as a light-brown, odorless, tasteless,
and insoluble powder, containing 20 per cent, of combined iodine, which is
liberated by both acids and by alkalies, more readily, however, by acids;
alpha-eigon sodium (sodium iodoalbuniinate), an almost colorless, odorless,
and nearly tasteless powder, containing about 15 per cent, of iodine, soluble
in cold, but more readily so in hot water, and principally intended to replace
potasaium and sodium iodides; beta-eigon (iodized peptone), with properties
Rmilarto those of the above-mentioned preparations, but specially intended
for OBe where large quantities of iodine are required to be ingested, and a
more ready and rapid absorption required because of weakened digestive
foDCtions or of gastric affections. Five parts of alpha-eigron sodium are
oqnal, in iodine-content, to 1 part of potassium iodide: and 5 Vj parts are
equal to 1 part of sodium iodide.
Tiscber and Beddies studied the effect of topical application of alpha-
cigon in wound* of various descriptions, and report that it manifested a
prompter and more satisfactory action than iodofonii. It was found very
aitisftctory in boils, felons, and tuberculous atid venereal processes of the
akin. The autbors also used alpha-eigon sodium and bcta-eigon internally,
in malignant syphilis, syphilitic laryngitis, scrofula, nnd tuberculous lung
trouble. The doses were 3 Gm. (or gr. xlv) a day, gradmilly increased to 10
Urn (or jrr, cl) daily, taken, in malt extract or wine.
ELASTIGA (U. S. P.).— India Rubber (Caoutchouc, Liq.).
CAOTrrCHOTTC (B. P.).— India Rubber.
Preparations,
i.mpUstnim Adbttfth-um (U. S. P. J. —Adhesive plaster. (India rubber, 20
furtii Prtrolatum, 20 part**; Tvead-phisti^r, 000 parls.)
Liquor Caoutchouc (B. P.). — Solution of India Rubber (India rubber, 50 Om.;
Wnxol and carbon bisulphide, each, 500 c.cm.).
Plutnnacology. — "The prepared milk-juice of several speciea of Hcvea
fEuphorbiaccMp : Ilovoa hrasillienBis, B. P.) known in commerce as Parn rub-
htT.'* India ruhher occurs in cakes or balls, or hollow. I>ottlo-shrtped masses;
eit^rnallj brown or brownish-black, internally of lighter tint. It is dense,
■
442
PHAUMACEL'TICAL TlIKnAPKLTIC AGENTS Ott DRt'GS.
very elaetic, and, when pure, or nearly pure, floats on water. It is quite
insoluble in water, diluted acids, or dilute solutions of alkalies, but is soluble
in chloroform, carbon disulphide, oil of turpentine, benzin, and benzoL If
heated to ISo" C. (257° F.), it will melt, remaining soft and adhesive after
cooling. Odor faint, peculiar; nearly tasteless.
Is used in pharmacy for making rubber adhesive plasters. The rubber
bandage is used in surgery.
ELATERIITTTM (U.S. P., B. P ).— Elaterin.
ELATERIUM (B. P.).— Elaterium.
4
Preparations.
Trituratio Elaterini (U.S. P.).— Trituration of Elaterin (1 to 0 milk-sugar).
Dose, 0.006 to 0.04 Gm. (or gr. V»-V«).
Pulvia Elaterini ConipoBitus (B. P.). — Compound Powder of £lat«hn (1 to 39
milk-sugar). Dose, 0.005 to 0.25 Gm. (or gr. i-iv).
Pharmacologry. — Elaterin is "a neutral principle obtained from Elate-
rium: a suUstantc deposited by the juico nf Ecballium Elateriuni (Cucur-
bitaceae)" (U. S. P.). The active principle of Elaterium {B. P.). The freshly-
expressed juice of the fruit of the squirting cucumber, upon stnndinjr, de-
posits a peculiar, resinous substance, which, when collected upon muslin and
dried, forms flat pieces of variable thickness and irregular shape, of a pale-
preen or grayish color, mostly amorphous, but containing some crystals. This
constitutes commercial, and formerly official, elaterium. Elatcrinum exists in
the proportion of from 15 to 40 per cent, in elaterium. On account of this
variability in strength the latter has been dropped from the U. S. P., and
the more reliable elaterin substituted. The elaterin is extracted from
elaterium by chloroform and precipitated from the chloroform solution by
the addition of ether, in which it is nearly insoluble. In prescribing, elaterin
must not be dispensed for elaterium, as it is from two to six times stronger.
Elaterin in crystalline, odorless, intensely bitter and acrid, soluble in chloro-
form, fusel-oil, or carbon disulphide, and in 125 parts of alcohol. It is a
neutral substance, and is not precipitated by tannic acid or by salts of mer-
cury.
Physiolog^ical Action. — Elaterin is violently purgative, causing profuse,
watery stools with griping, and in large doses producing great prostration.
Death has resulted from excessive doses. Dangerous symptoms require de-
mulcents, opiates, and stimulants. It must be used with caution in elderly
persons. It purges when injected hypodermically, but to obtain its full
effects it must be mixed with the bile. It also occasions an oxcessiye flow of
saliva.
Therapy. — In ascites, uraemia, cerebral congestion, pulmonary tederaa,
and poisoning by narcotic substances, elaterin affords a ready means of
evacuating the bowels, and of reducing the volume of circulation by drain-
ing water from the vessels, or *1jleeding throufjh the tissues.*' It should not
be given for ordinary constipation, as it is too depressing. On account of its
great activity a small fraction of a grain may produce collapse from hyper-
catharsis. It is not safe to begin with a dose larger than 0,003 Gm. (or gr-
Vao)- The trituration, therefore, in which the drug is reduced by triturating
it with 9 parts of sugar of milk, is an eligible and useful preparation. Ac-
cording to Dr. Ilyde Salter, a small dose of elaterin, given on alternate morn-
ings, is of value in dropsy dependent on aortic disease.
EriiEi>a.v.
443
£L£CTBOZONE. — An antiseptic solution obtained from sea-water by
putud decomposition by electricity, the chlorides and bromides being con-
verted into hypochlorites and hypobromidea.
pTTPlffT — Tht' concrut*.', resinous exinlation from i'nniiriuiu i'«jniinuiie
(BurBtTHcvir). This is a trw of the Philippine lelamls and other tropical
tocaiitiefi which affords an oleoresin, olitaimnl from incisions into the living
Uuk. Elenii soixifwlmt rcseinliles grunuhir lioney when fresh, becomes more
solid and friable when kept for some time. The taste is rather pungent and
j liittrr. Jt contains HO j>or t-cnt. of nninrplinu3 resin, Brein: 25 per cent, of
' czjBtallizable resin. Amyrin {ik Amyrin^ nnd /;, Amaryn) ; about 10 per
1 ant. of a volatile oil. henidcs a rrystullizable. bitter, acrid substance,
L Iryoidin; iilwi. hrcidin and eli-mio aeid.
B Physiological Action. — It has stiraiilatinrf and irritating properties, and
^bs only used as an ingredient in piasters and ointments, or for upe externally.
^Ht is stnular to other tcrebinthinate agents in its effects. The British Phar-
Hmcopceia recognizes an ointment of elemi, composed of 8 Gm. (or 3ii) of
Briemi and 31 Gm. (or 5j) ef simple ointment.
' Therapy. — Used as an application to enlarged joints, and as a resolvent
to swollen glands. It may also be applied to indolent ulcers, and is a good
dressing for bums, blisters, and chilblains.
kV^^rRVJ.Xk RIBES. — Babarang. The Enibelia ribes (Myrsincff) is a
Bkbing planl of southern China, eastern India, and Malaya. The dried and
jrder^ fruit is used, or the fluid extract of the fruit (dose, 4 to 15 c.cm.,
f5J-iv). It is an efficient anthelmintic and tieniacide; is beliered to be a
«pccific in rheumatism; and is an alterative in chronic skin diseases. In
caies of flatulent dyspepsia it is claimed to be serviceable. The active prin-
ciple was found to be an acid, which has been named Embelic Acid (Warder),
and 15 insoluble in water. It forms salts with soda^ potash, and ammonia,
the litter being most readily obtained crystalline.
Anunonium embelate occurs in the form of red needles or powder devoid
^^fliMte. This ammonium salt was found efTective as an anthelmintic against
^^^^^■n doses of 0.38 Gm. (or gr. vj) for adults, or 0.20 Gm. (or gr. iij) for
^^Blaren. It is administered in syrup, to be followed by castor-oil. It has
the advantages over male fern of smallness of dose and tastelessness. It kills
the worm. The powdered seeds may be given with milk early in the morn-
iagf fasting, followed by a purgative some hours later. The dose of the
sovder for a child is 4 Qm. (or 5j), twice a day, as a taeniacide, or about
Ae same quantity of a fluid extract.
EPHEDRA. — Mormon Tea. The stems or the whole herb of Ephedra
Mitovphilitica (Gentianaceae) is used in Arizona as a recent infusion, or in
thr ' f fluid extract (dose, 4 to 7.5 c.cm., or f3i-ij) as an alterative, and
Ci|K in the treatment of gonorrhoea and syphilis. It contains a peculiar
kind of tannin, to which its etTecta are probably attributable, according to
Pwf. Oscar Loew's analysis; although in a Japanese variety, E. vulgaris,
Plofcaaor Nagai discovered an alkaloid^ which he named Ephedrine.
The physiological action of ephedrine has been studied by Professor
BoeoalovTfiKi, who concludes that it influences especially the motor apparatus
«f the heart and probably also the cardiac muscle. It at first reduces blood-
444
PHARMACKUTICAL THEBAPEUTIC AGENTS OB DRUGS.
pressure temporarily and accelerates the pulse, but arterial pressure is finally
elevated and the pulse retarded. The respiration is quickened in the begin-
ning by small doses, but, under the influence of larger amounts, sooner or
later becomes slow and irregular. The pupils are dilated and salivation
occurs. Professor BogosloMski places the active dose of the alkaloid at 0.10
to 0.50 Gm. (or gr. isa-vss) for adults. The best preparations for use are the
fluid extract and the ephedrine hydrochlorate.^ The alkaloid occurs in the
form of colorless crystals. Ephedrine hydrochlorate is also colorless and is
soluble rn water.
Ephedrine, in 10-per-cent. solution, is a mydriatic, dilating t)ie pupil
without irritation in forty to sixty minutes. Under the name of Mydrin a
combination of ephedrine and homatropine has been employed, and is
esteemed particularly serviceable for diagnostic purposes on account of the
transitory character of its action. Mydrin is a white powder, soluble in
water. It is used in the strength of 10 per cent.
Therapy. — Dr. H. H. Rusby* is satisfied that the reputation of this drug
as a remedy in gonorrhcea and in syphilis has some solid foundation. As an
antiblennorrhagic its action is probably very similar to that of astringents
now in use. As a remedy in syphilis, he says, its value is, probably, solely
that of a depurative. In the removal from the system of the accumulated
products of thp disease, ephedra will take rank with any agent now in use,
with the single exception of potassium iodide, and it may well serve tQ
alternate or combine with that drug. It is also considered by persons living
in the region of its growth to be a *'surc and speedy cure for skin diseases."
Ephedra vulgaris has long had a popular reputation in Russia as an
antirheumatic remedy. Clinical experiments by Dr. Bechtine in the service
of Professor Popow showed it to be of value especially in acute articular and
muscular rheumatism. It was also found to have some laxative effect and to
act as a decided diuretic.
EPIGiEA. — Trailing Arbutus. The Epigaea repens (Ericaceae) is a
small, herbaceous plant, with sweet-smolliug flowers. The part used is the
leaves, which are odorless, bitter, and astringent. They contain Arbutin,
Ursone, and tannic acid.
Therapy. — The constituents of the plant are very much the same as
those of uva ursi and chimaphiln, and its uses are similar. It is given as an
astringent in vesical catarrh, blennorrho?a, etc.
EPimEPHRIN. (See Animal Extracts.)
ERGOTA (U. S. P., B. P.).— Ergot (Ergot of Rye).
Dose, 0.G5 to 4 Gm. (or gr. x-5j).
Preparations.
Fluidextractum Ergotee (U. 8. P.).— Fluid Extract' of Ergot. Dose, 0.60 to
7.60 com. (or mx-f3ij).
Vinuiii Ergotffl (U. S. P.).— Wine of Ergot (20 per conl.). Dose. 4 to 15 c.cin.
(or f5i-iv).
Extructum Ergot» (U.S. P., B. P.).— Extract of Ergot. Dose, 0.13 lo 0.65 Gm.
(orgr. ii-x).
' Medical Bulletin, Aug., 1804.
^ Diuffgista Bulletin, ISSR, p. 220.
ERGOTA.
445
-Liquid Extract of Ergot.
Dose, 0.60 to
Dote, 2
Exirmctum Ergots Liquidum (B. P.)
t ejCB. (or ntx-xxx).
Tinctarm Krgot« Ammoniata (B. P.)- — Aniroonlated Tincture of Ergot
InScrm. I'or fSas-ij).
lojcctio Ergotje Hypoderroica (B. P.). — Hypodermic Injection of Ergot (about
Sf«r r«il.J. Doee, 0.18 to 0.00 c.cni. (or wiii-x).
Infusom Ergotse (B. P.). — Infusion of Krgot [C per cent.). Dose, 30 to 60 c.cm.
(or Qi ij)-
Pharmacology. — Ergot is the compact spawn or "sclerntium of the
tfehvicepe purpurea (class, Fuugi) replacing the grain of rye, Secale cereale,
Gramineae" (U. S. P.). The sclerotium of Claviceps purpurea originating in
tht owy of secale cereale (B. P.). The ergot of rye is the only one official,
although it also affects other grasses. The Ustilago maidia of corn is very
fimilar in chemical composition and efTects. Ergot is in compact masses,
from 1 to 2 inches long and about Vs ^^^^ thick. The grains are nearly
triangnlar, somewhat curved, and marked lengthwise by three grooves, thick-
est in the middle and tapering toward each end; of a dark-purplish color
externally, they are nearly white in the centre. They have a heavy, un-
pliMant odor, and a fatty, mawkish, disagreeable taste. The addition of a
itrong alkali develops an odor like that of herring-brine (due to tximethyla-
min). Ergot contains about 35 per cent, of fixed oil, a peculiar sugar, and
two coloring matters. Chemists have isolated or derived a number of more
or I»«s active principle^*, the most important bein^ those which act apecitically
apon the uterus. Cornntine is an alk«loid. insoluble in water and petroleum
fther, bat soluble in ether, chloroform, and alcohol. It is precipitated from
add eoliitions by alkalies, but is redissolved in excess. According to Keller
tiie specific action of the dnig is due to this alkaloid, which is much more
ftable than has been stipposrd by other investigators. Recent physiological
terte hare di^monstrated thnt the full vaso-constrictor and oxytocic power of
the ergot Tf^idos in cnmutine. Tt has been observed that a fluid extract of
ergot which possessed decided vflso-constnVfor activity, Inst it enliroly when
ihe cornutine was extracted.' Ergotinic Acid of Kobert has little effect
vh«i taken into the stomach, where it is probably decomposed. But when
injerted hypodermicallv, it exerts a depressing and panil}'sant action upon
thp flpinfll pord, and to a less degree on the brain. It has a narcotic action,
nr " iirs from respiratory paralysis. It is claimed to have no effect
hi .id uterus. Kobert claims that ergotinic acid is the basis of
the sclerotic acid of Dragendorf, and is the principal ingredient in Ergotin
(TWinje«n). Valden reports- the isolation of a substance, which does not
pTodoce gangrene or convulsions ; but has an energetic ecbolic action on the
pr«fnn rus. This principle he calls Clavin; it is soluble in water,
nucrr.. le. formula C^H^jNaO,. It does not form salts. It has
In- hy Humni and by Vahlen, in 2-pcT-cent. solution by subcutaneous
'1 , O.m to 0.02 Gm. (or gr, V/q-V/^K for uterine inertia in labor.
1 ^n *]iould be freshly jtrepnred. Sphaeelinio acid (probably identi-
Sphacelotoxin ) , according to Robert, represents the portion of the
tng jrancrenous ergotism through its action upon the blood-vessels
...-. motor centres, and acting on the uterus with comutine in causing
iDtT«ction of its muscular fibres. A substance similar in composition to
*Saii0tml fitanilnrd VfJipwnMatonf, Philndclphia, lOOtf. p, 571.
*DculMrk Mrd. WiH-h., Aiifri>>«t lO, 1U05.
■iid
PHAnMACKUTlCAL THEftAPElTIC AOCNTS OU DUUGS.
cliolesterin, and therefore termed er^rostcrin, lias l)een extracted from ergot
by C. Tanret, As both sphacelic acid aiid cornutine lose their properties
by keeping, it ic inipoilant to use frosli ergot. Afterbeing kept for one year,
ergot is unfit for use.
Physiological Action. — No local effects are observed from application
of ergot to the skin; upon mucous membranes it acts as an astringent. Upon
the nervous system little effect is produced directly, although in ergotism
we have convulsions and other nervous symptoms, caused indirectly. It in-
duces anaemia of nerve-centres by exerting a selective action upon their
blood-vessels, which it causes to contract. When introduced into the cir-
culation, there is, first, a fall of blood-pressure, soon followed by a rise; the
primary fall is most marked where a large amount comes in contact with the
heart-muscle, which is depressed by it, and paralysis of the heart may cause
death, after intravenous injection of ergot. The secondary rise of blood-
pressure represents the effect of the physiological stimulating action of the
drug upon the vasomotor centres and upon the unstriped muscular fibres in
the arterioles.
The action of ergot upon the uterus is due to a primary influence upon
the lumbar cord, according to the experimental study of Hemmeter. It pro-
duces intestinal peristalsis and contraction of arterioles and capillaries by a
centric action. The effects of ergot upon the parturient uterus are those of a
stimulant to the contractions, increasing their force and frequency until the
full action is brought about of tetanic contraction of the organ. Upon the
non-parturient uterus the effects are more evident in checking the blood-
supply. The lower animals abort after eating ergotized grain, and in some
States there are laws against the administering of ergot to pregnant women
in order to produce miscarriage; but such result does not follow the use of
ergot in ordinary medicinal doses, although in chronic ergotism this accident
may occur.
Toxic Effects, — When an overdose is administered, effects result which
are known collectively as acute er|fotism. The symptoms are peculiar rest-
lessness, with anxiety, headache, vertigo, dilated pupils, tinnitus aurium,
with hyperacusis, the action of the heart is slowed, the pulse is weak, res-
pirations reduced in frequency, and, as the effects increase in intensity, sud-
denly nausea and vomiting occur, even when the drug is introduced hypo-
dermically. This cerebral vomiting is distinct from the local effects of the
drug when taken by the mouth, when vomiting may occur early if the stom-
ach is very sensitive. Coldnet:s of tlie surface is a prominent symptom and
seems to depend upon a general depression of temperature.
Chronic ergotism occurs in regions of the country, notably in Europe,
where rye-bread is the staple food, in seasons when ergot is moat present
in the grain. It appears in two forms, the convulsive and the gangrenous,
the former being characterized by vertigo, dimness of vision, and numbness
of the extremities, followed by tonic contractions, particularly of the flexor
groups of muscles. Attacks of dyspnoea also occur, resembling asthma,
caused by tetanoid contractions of the respiratory muscles. Cramps of
abdominal muscles, colic, and diarrhcea take place; the pulse is slow and
weak; the surface of the body is cold; the symptoms increase in intensity;
the special senses are affected; hearing and smell are lost; the pupils are
permanently dilated, and vision is impaired. The case may be terminated by
clonic convulsions or death result from exhaustion. The gangrenous form Is
ERUOTA.
447
I
I
I
I
Lod by the intensity of the local phenomena, the numbness of the fingers
ixk^ toe« terminating in vesications, and moist or dry gangrene, more or less
eztensiTey destroys these parts, or may affect the nose or other portions of
tbebodj. It is evident that in chronic ergotism there is a profound dyscrasia,
pcfhaps attributable as much to the unhygienic mode of life and poor food
■I it I* to the toxic effects of ergot. Such grave effects are not observed from
the medicinal administration of ergot, even when continued for a long time.
The prolonged administration of ergot has, however, been known to cause a
vesicular, pustular, and furuncular eruption, with petechiae.
Treatment of Poisoning. — The phenomena of acute ergotism are easily
c<JDtroIled by placing the patient in a hot bath and administering cardiac
and arterial stimulants, such as coffee. Amyl nitrite, aconite, veratrum
riride, and tobacco antagonize the effects of ergot upon the circulation. The
treatment of chronic ergotism is mainly hygienic and symptomatic.
Therapy. — Ergotin made into a paste with water has been employed
locally in conjunctivitis, gonorrha'a, endocervicitis, acne rosacea, and in-
cipient boils. Ergot is valuable in hEemorrhoids, prolapsed rectum, and re-
Ukirion of the sphincter ani, when applied upon a tent or introduced as
suppositories. Incontinence of urine, due to relaxed Fphincter, is cured by
ergot driven in this manner, or administered by the mouth.
By Dr. T. Clemens, ergotin h said to be a v;ilu;il)le remedy in the ani-
DMiniacal cystitis of paraplegic patients. The bladder is injected with a solu-
tion containing about 4 grains to the ounce, and the drug is, at the same
time, administered by the mouth.
Chronic follicular pharyngitis is sometimes improved by the topical ap-
plication of the fluid extract, or of ergotin in the proportion nf 0.65 to 1.30 to
30 com. (or gr. x-xx to fSj). The oil of ergot is a valuable local medicament
ta aeborrhoea, removing the sebaceous material, and, at the same time, by its
Mtrinffent and stimulant action, benefiting the diseased follicles and glands.
Loc^n*. in tv>ngfstive conditions, ergot may Iw prescribed according to the
appended formulje: —
Kxv ergot* 2
Coraitup liydrochloridi
Plambi cnrbonBtis • 4<. 2
15
Ungrt, aquff rowe
Fnr extpm&l use in acne rosacea and in boils.
Gm. ur 3s8.
32 Gm. or gr. v.
Gm. or Ssfl.
Gm. or 58«.
B Fttt ergoUB
^ulptiuris sublimati
M^ntholi
• ' l>flIadonnip folior ...^*.«
v r.^t. zinci oxidi
IL Valuable in Assures of the. nose, rooath, rectum,
Gm. or 3j.
Gro. or 3ti.
|32 Gm. or gr. v.
|65 Gm. or ftv- x.
. 15|5 Gm. or Jsa.
and in hsmorrlioidi.
9 Rrt, ergotse 132 Gm. or gr. v.
Ouaphorv . 65 Gm. or gr. x.
Rrt* opii .... ■ |17 Gm. or gr. iiss.
Plumhi a<vtflti« IJSO Gm. or gr. xx-
Oi theobromntW q. s.
M. et ft suppoaitoris no. x.
*»4(r InM'it onr in thn bowel when nece»«»ry. for proU|wMH] reottim. diftrrlnm. or
* ftamre of rectum.
I KlnidiMttriwti prKi>t«
Kltiiilrxtrnoti hnnwimplidif* an 4.^| c.cm. or f.^i««.
Glrcrrini 30] c.cui. or f3j.
' <•' ^pp)J several times ■ day for chronic pharyngitis and nasal catarrh.
448
PHARMACEUTICAL THERAPEUTIC AGENTS OU DRUGS.
B Olei ergotse 90 c.cm. or fjiij.
Adipis laiire 31 Gm. or 5j-
01. verbenas 30 c.cm. or mv.
01. rosce 18 ccm. or miij.
M. Sig.: Hub into the scalp well once or twice a day for dandruff. Useful, also,
in lou of hair and aycosia.
Ergat ie a reliable remedy in the several forms of capillary haemorrhage,
and in overcoming the congestion attendant upon and causing the oozing.
In hEemoptysiSj epistaxis, hscraaturia^ bloody discharges from the bowels
(mclfena), and in uterine hiemorrhage, ergot in 2 ccm. (or f.>ss) doses of the
fluid extract, repeated every hour or two, will generally promptly cause
cessation of the bleeding. Ergot may be prescribed for various hiemorrhagea
with advantage, combined with geranium and witch-hazel: —
B Fliudoxtracti ergiitaj 45
Fhiiilextracti peranii 30
Fluidextraeti hamamclidis 45
C.cm. or fSiss,
c.cm. or fSj.
c.cm. or f^iaa.
4
4
M. Sig.: A teaspoonful or two every half-hour or hour until bleeding ceasea.
Blaschko, of Berlin, employs the following formula in heemoptysis: —
H Er^otin,
Acid, gallici aa 1| Gm. or gr. xv.
Svr. althffiffi,
Aq. destiU aa 22| c.cm. or fSvj.
M. Sig.: Teaspoonful every two houra.
Binz considers, however, that the action of ergot in stopping ha?mor
rhagee, other than uterine, is doubtful.
In severe cases of post-partum haemorrhage a better practice is to ad-
minister the fluid extract or ergolin by subcutaneous injection. The same
method is preferable when ergot is used in the treatment of fibromyomata
of the womb. Where uterine hfemorrhages are due to submucous polypi or
fibromyomata, ergot not only checks the haemorrhages, but may cause the
separation and expulsion of the growth; in such cases the progress of the
treatment should be accelerated by dilatation of the cervix uteri, incision into
the capsule, if one exists, and removal of the growfli by surgical operation.
In multipara, where there is a history of floodincj after previous labors, full
doses of ergot should be given just before the delivery of the child. The
usual rule for the administration of ergot is to wait until the child's head is
upon the perineum before giving it; otherwise there may be an hour-glass
contraction, or tetanic contraction with unyielding os, and the child's life
be endangered. The administration of 2 to 4 c.cm. (or fSss-j) of fluid extract
of ergot, after labor lias terminated, prevents relaxation of the organ and the
formation of large clots, which cause after-pjiins. An antiseptic preparation
of ergot, especially designed for subcutaneous injection, is supplied under
the name of Ergone (P. D. & Co.). It is standardized, and is kept from
spoiling by a little chlorctniie, which it contains.
In subinvolution of the uterus, Professor Barton Cooke Hirst recom-
mends:—
I^ Strychnin, sulphat |003 Gm. or gr. V„.
Quinin. sulphnt.,
Ext. erpotiT aa |085 Gm. or gr. j.
M. et ft pU. DO. j. Mitte tales no. xxx.
Big.: One pill three times a day.
065 Gm.
66 Gm.
13 Gm.
32 Gm.
or gr. j.
or gr. X.
or gr. ij,
or gr. ▼.
. 0.
c.cm.
c.cm.
or fSiss.
or fSij.
EBOOTA. 449
In night-sweats, ergot may be given alone in full doses, or combined with
picrotoxin or atropine. This remedy has likewise been found of advantage
in the treatment of galactorrhcea. Ergot is often of avail in hyperidrosis.
It is efficacious in all varieties of purpura, and in severe cases of the hsmor-
riiagic form may very properly be hjrpodermically injected. This drug is
of nlue in the treatment of chronic diarrhoea and dysentery.
In dysentery of children, accompanied by severe pain and excessive
tenesmus, the following preparation is beneficial:—
9 Cocain. hydrochloridi
Ext. er^t»
Ext. opii
Tbymolis iodidi
OL theobromatis q.
M. et f t. tuppoe. no. x.
Sig.: One every two or three hours.
Q Fluideztracti ergotee,
Fluidextracti hamamelidis aa 461
Elix. guaranie 60|
M. Sig. : Two teaspoonfuls in water every two or three hours, for an adult.
In passive or hypostatic congestion of the lungs, it may be combined
with digitalis with advantage: —
9 Ext. ergotsB 25 Gm. or gr. iv.
Extracti digitalis 20 Gm. or gr. iij.
Pulv. ipecacuanhn et opii 1 55 Gm. or gr. xxiv.
M. et ft pil. no. xii.
Sig.: A pill every tJirce or four hours.
9 Ext ergot» 1) Gm. or gr. xv.
Glycerin!,
Aqnse destillats aa 41 c.cm. or fSj.
Aqua phenolis 2{ c.cm. or mxxx.
H. Sig.: Inject hypodermically 1.20 to 2 c.cm. (or mxx-xxx) from two to four
timei a day in hemoptysis.
In diabetes insipidus the fluid extract of ergot produces marked effect
on the disease, having a decided influence in controlling the urinary excre-
tion. Favorable results have been claimed in diabetes mellitus from the
hypodermic injection of ergotin or ergotiniri. It is serviceable in congestive
dysmenorrhoea, paralysis of the bladder, congestive form of migraine, and
in hypersemia of the spinal cord. It is claimed that ergot is capable of re-
lieving whooping-cough. Varicose veins are restored to their normal calibre
by hypodermic injections of ergotin, and Bartholow strongly recommends
this mode of treatment as efficacious in varicocele. The needle should be
thrust among the enlarged veins In such a manner aa not to wound their
walls. Injected into the neighborhood of an aneurism, or administered by
the mouth, ergot proves valuable by favoring the coagulation of blood within
the sac. Enlarged spleen may be reduced by the same methods. In view
of the fact that ordinary pharmaceutical preparations are not aseptic, and
that ergot fluid extract cannot be readily sterilized by heat without injury,
manufacturers now supply a special form of ergot for hypodermic use, the
usual dose being put up, singly, in small hermetically-sealed glass flasks.
Each bulb contains 1.20 c.cm. (or mxx) of aqueous solution, representing the
equivalent weight of ergot.
450
PUARMACEUTICAL TllERAPECTIC AGENTS OR DRrOS.
Ergot combint'il with iron lias very oflon a beneficial action in enlarged
spleen : —
H Fluidextrncti ergotte,
Tincturac fcrri chloridi,
Glycerini aa 30| e.cm. or fjj.
&I. Sig.: From one to two tca«poonftil9 in water three or four times a day.
From its effects upon the vascular supply of the spinal cord, Brown-
Se*jiiard has proposed its use in some forms of paraplegia attended by signs
of local irritation and hyperiemia of the cord. It is useful in congestive
headache and in chronic miinia, and has been used with asserted good re-
sult in pperniatorrhma iind incontinence of urin*?. The hypodermic injection
of a slerilizod fluid fxtnut is Brtid trj alTord ndicf in facial neuralgia and in
itisonmin. In dt^lirium Ireuious, uiul the wi't bniiii of drunkards, ergot hypo-
dL'rmicallj is of groat value, according to F. X. W'igger and F. A. Living-
ston.^
From Budapest, cornutine is rccommonded as having an efficient action
upon unslriped muscular tissue, while it is, at the same time, less dangerous
thnn the olUcr con^tiiuonta of ergot. Pure connitine is almost insoluble in
water. The hyilnxlilorute, or citrate, is more readily soluble. Dr. Meiscls
lins administerud tlu^ drug in daily doses of 1 eg. (or gr. \'n)> divided into
four portions. In hirinorrlinges from the genito-urinnry orirans cornutine
rapidly caused a cessation of the bloe<ljng. lie observed it to act promptly
in gonorrhcpa accompanied by ha^morrhnge from the bladder or urethra, in
ha^niorrhatre from cystitis, and during the lying-in period from atony of the
womb. Professor Bokai also has given cornutine citrate, with excellent re-
sults, in spenuatorrhcpa of the paralytic type,
T\'hen impaired vision depends upon congestion of the retina incident
to dilaled or hypertrophied heart, and in cases of epilepsy when hemicrania
occurs in the intervals of rest, when the pupils are contracted and vision
disordered, ergot has been used with advantage. In the treatment of psy-
choses, associated with intracranial congestion and perhaps inflammation,
ergot is a valuable adjunct to other modes of treatment.
EEIOBICTYON (TJ. S. P.).— Eriodictyoa (Yerba Santa).
Preparation.
Fluidextractum Eriodiotri (U. S. P.).— Fluid Extract of Eriodictyon. Dose,
1 to 4 e.cm. (or mxv-fSj).
Pharmacology. — **The dried leaves of Eriodictyon ralifornieum (ITy-
drophyllnee.i») ," of (^dif'ivTiin, have n fragrant odor and an aromatic, sweet-
ish taste, and contain ahtuit 0 per cent, of a greenish-y<»llow. ncnd. and bitter
resin, which forms soluble snlts with basis, and unites with quinine to form
a orystnlHue quinine resin. Thev also contain a smnll qunnaity of nmorphous
brown Ericolin, and also Eriodictyonic Acid (crystallizing in yellow phites
of sweet-acid tnste), and a volatile oil. The effect? are most evident in
the bronchial mucous membrane, to which it is a stimulant and expectorant.
The extract of eriodictyon is not ofheial (made by evaporating the fluid
extract to a pilular consistency). Do.^e, n.go to 1 (1m. (or gr. iii-xv). ^H
' \ft^rck'3 Arrhires. April, lOO,"?. ^H
*
Therapy. — Yerba Santa has a reputation in the treatment of bronchitis,
krjngitis^ and consumption. It has likewise been found beneficial in
muaam, and may be very well administered in conjunction with grindelia
Tobneta. It is used as a vehicle for the administration of quinine, the bitter-
DOBS being overcome by the aromatic principles of the plant. The National
Fonnalary provides an aromatic syrup of eriodictyon, of which a teaspoon-
fttl completely masks the bitterness of 0.13 Gm. (or gr. ij) of quinine sul-
pbate, as in the following formula: —
B Quisine sulphatis 3110 Gm. or gr. xlviij.
Flaidpxt. liellad(»tin« radiris 12 com. or mij.
Svnipi criodiotyi aronmtici (M. P, q. s. ad ftO| c.cm. or fjiij.
M. Big.'. A t^aspoonful four limes daily in laryngitis or chronic bronchitis.
EBYTHEOPHL(EUM.— Erythrophlceum. (See Casca Cortex.)
I
ESCHSCHOLTZIA. — The Eschscholtzia Califomica (Papaveraceffi), or
the California poppy, enjoys a reputation upon the Pacific coast of this
coantrj as a soporific and analgesic. It is represented by a number of
nhetieSy and it is necessary to obtain the genuine species, as some appear
to be inert. It is claimed that it possesses a small amount of Morphine,
although other principles contribute toward producing its effects, among
which is SangTiinarine. Professor Schmidt, from his examination of the
plant, is unable to confirm the statement that it contains morphine.
Physiolo^cal Action. — The etfects upon animals are gradual slowing of
rapiration after a brief preliminary increase of rapidity; death is due to
fuiure of respiration. The effect upon the nervous system is that of a
narcotic. The motor nerves are aflfected before the sensory. Tlie cumulative
«fecis in human subjects resemble those produced by codeine. Though its
tarcotic effects are not very decided, yet they continue for a considerable
period after its discontinuance.
Therapy. — It is claimed that the eschscholtzia is an efficient, though
hannlesfi, soporific agent, especially for children. It relieves pain and
induces sleep, relieves tremor, and agrees well with the digestive organs.
Eschscholtzia, in the form of the fluid extract or the syrup (2 to 18.5 c.cm.,
of f3t«-T, at a dose), is a good addition to a cough-mixture where the use of
opram is not considered advisable.
EUCAINE, A AND B (Alpha-cucaine = Eucaino ITydrochloride "A,"
aoi! Bcta-encaine = Euoain** HyilnH'hloride *T^"). — The manufacturers an-
n* at when eucaine is ordered they will hereafter invariably supply
V le, unless otherwise specified. Both agents are in the fonn of a
c^ illine powder, soluble in water. They have been introduced
ftf - .„.. .- ...iitute for cocaine in minor surgery and as a local ansesthetic.
Eoctine-B is claimed to be five times less toxic than cocaine and one-third
■ toxic as Eucaine-A. The solutions should be made with distilled water,
tad they can be sterilized by boiling. It is said that they will keep an
iodefinite time without spoiling. A 5-per-cent. solution may be injected
tfito the gums previous to extraction of teeth, and is much safer for this
MIMHB thtn 2-per-ceDt. solutions of cocaine. Beta-eucaine is used in
fldbUdiV method of local ana?8the&ia, also in ophthalmological and laryn*
(oiogict] practice for the same purpose that cocaine was used.
452 PHARMAOBUTIOAL THBttAPEDTIO AOBNT8 OH DRUGS. '
Recently eucaine has been used to produce spinal anjEsthesia (see Coca)
by lumbar puncture, allowing the surgeon to perform painless major opera-
tions below the diaphragm. It has the advantage over cocaine in that the
solution may be sterilized without impairment of its eflBcacy. Though
spinal anaesthesia is of advantage in selected cases, yet the danger attending
its use must necessarily restrict its general employment in major surgery.
EUCALYPTI GTTMMI (B. P,).— Eucalyptus-gum.
Dose, 0.13 to 0.32 Gm. (or gr. ii-v).
A ruby-colored exudation, or so-called red gum, from the bark of the
Eucalyptus rostrata, and some other species of eucalyptus. Imported from
Australia.
EUCALYPTUS (U. S. R ) —Eucalyptus Leaves.
Preparations.
Fluidextractum Knoalypti (U. S. P.).— Fluid Extract of Eucalyptus. Dose,
0.30 to 4 ccm. (or mv-f3j).'
Eucalyptol {U.S. P.).— Eucalyptol (C,«H»0). Doge, 0.30 to 2 c.cm. (or mv-xxx).
Oleum Eucalypti (U.S.?., B.P.).— Oil of Eucalyptus. Dose, 0.18 to 1.20 c.cm.
(or mjii-xxl. B. P., 0.03 to 0.18 ccm. {or mss-Uj)-
Unguentura Eucalypti (B. P.). — Eucalyptua Ointment (10 per eenl.).
TrochiRcua Eucalypti Gurami {B. P.). — Eucalyptus gum Lozenge (0.066 Gm., or
gr. jf of red gum witli nimpte basis).
Pharmacology. — The blue gum of Australia is a tall tree that has been
of considerable intcTcst to sanitarians, since it is easily cultivated in marshy
grounds, and is said to render raalBrious districts, such as the Campagna,
healthy. This is partly on account of the volatile oil and resins of the tree,
and partly because it drains the soil of water, the exhalation of water from
the leaves being equal in amount imch day, on an average, to the weight of
the tree. The official portion of the plant (U. S. P.) are "the dried leaves
of Eucalyptus globulus (Myrtaccae) collected from the older parts of the tree."
They have a camphor-like odor and a pungent, bitter taete; contnin a volatile
oil, a erystallizfible resin, and some tannin. The official volatile nil is distilled
from the fresh leaves of Eucalyptus globulus and some other species of
eucalyptus. The oil is soluble in absolute alcohol, and in 3 volumes of 90
per cent, alcohol. It is also soluble in ether, cliloroform, and the fatty oils,
but does not dissolve in water. It does not become resinous on e.xposure to
the air. The volatile oil, by fractional distillation, ib separated into three
oils of dilTeront density, the lightest and most important being Eucalyptol
(or Cineol, about 50 per cent), the others beirtg Pinene and EudeamoL
Pure eucalyptol is officially defined as '*a neutral body obtained from the
volatile oil of Eucalyptus globulus (fam. Myrtacom), and from other
sources." It is a colorless fluid and has an odor and taste resembling that
of camphor. Tlie fluid extract, being made by percolation with alcohol,
is a strong tincture. A medicated water, made like the oflRcial waters, is
useful as a vehicle for alkaloids for hypodermic use, as it prevents fer-
mentation and deterioration ; it is also a vehirle for medicated sprays. Alka-
lies, mineral ncids, and metallic salts (iron, mercury, lend, zinc) are chemi-
cally iTicoitipatible with preparations of this drup: while tonics, simple and
aromatic bitters, essential oils, turpentine, camphor, cubeb, etc., are syner-
gistic, and increase its physiological and therapeutical efFects.
EUCALYPTt'S
453
I
I
I
I
Fhy&iological Action. — Eucalyptus is obnoxious to lower forma of life
lad is a good disinfectant. Applied to the skin, the oil is an irritant, in-
CTMnng the local blood-supply and partly diffusing into the blood, where
it produces systemic disease. The vapor of eucalj^tus, inhaled in quantity,
iIbo produces systemic effects besides its local action upon the bronchial
mucous membrane. In the mouth it is pungent, aromatic, camphor-like, or
retembling cubeb in its impressions upon the nerves of taste. Eucalyptus
excites the flow of saliva and leaves a disagreeable, hot, astringent flavor.
In the stomach a 6en£ation of warmth is felt, and it acts as a carminative
ind antiaeptic; the appetite and digestion improve, and the secretion of the
gastric juice and of the intestinal fluids is increased. It favors the evacua-
tion of the bowels, and the alvine evacuations are somewhat more copious.
This drug is a diaphoretic and diuretic, the eucalyptol being eliminated
largely by the kidneys, but also through the skin and bronchial mucous mem-
brane. Eucalyptus sometimes communicates to the urine an odor which has
be^n likened to that of violets. The excretion of urea is augmented; the
action of the heart is increased; the arterial tension is at first increased,
then lowered. The respiratory movements are accelerated. Eucalyptus
inhibits the amoiboid movements of the white blood-cells. Very large doses
cause gastric distress, indigestion, diarrhoea, with congestion of the kidneys,
the characteristic odor of eucalyptus being recognized in the urine, breath,
and discharges from the bowels. The action of the heart and lungs is de-
creased and the temperature falls. Wakefulness is one of the physiological
results, but it may indirectly favor sleep in debilitated conditions of the sys-
tem. Paralysis of the respiration causes death in the lower animals to which
a lethal dose has been given. Its action may be summed up as antiseptic,
carminative, digestive, tonic, laxative, diaphoretic, expectorant, and diuretic.
Several cases of poisoning from the oil of eucalyptus have been reported.
Dr. Alfred Neale, of New Norfolk, Tasmania, observed a fatal case, death
being preceded by great embarrassment of respiration. A large quantity of
blood was found in the pleural cavities, the lun^js were collapsed and blood-
1m% and the right heart contained frothy blood. A fatal case has recently
bftD rt-jiorted from England,* A man, 34 years of age. swallowed six
drachms with an equal quantity of hot water. He soon became imcon-
aciouft, and died two days later with acute congestion of the lungs.
Therapy. — Eucalyptus is used as an antiseptic in the treatment of
wounds and ulcers, acting as a substitute for carbolic acid. An ointment of
encalyptuB is otlicial in the British Pharmacopceia, which is a good dressing
ii> * ■ ir, indolent, or unliealthy ulcers. The tincture, or the water, of
ei - may be used externally for the same purpose. A combination of
eucaUptus and iodoform is a serviceable application to chancres and chan-
cmidi. The oil is a very useful addendum to preparations for the relief of
chronic eczema, in which the following combination is often found bene-
fidaJ: —
Hvdrarg. tmrnonlftt 1
OIH eucalypti
B»»t«nnphthol
Pulv. tTiamnt« 8
Unguent zind oxidl 31
Gm. or gr. xv,
50 c.cm. or mvUJ.
65 Gm. or sr. x.
Om. or lij.
Gm. or 5j. — M.
Jottmai of the Anttrican Medical AsBOCiaiion, February 17. 1906. p. 624.
454
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
The vapor ma}' be used by dropping' the oil upon hot water, or upon
cotton-wool placed in an inhaler; or the steam-atomizer may be employed,
with eucalyptol-water for inhaJation in phthisis, dilated bronchial tubes,
bronchial catarrh with fetid expectoration, etc. Applied directly to the
diseased membrane, or inhaled in a vaporized state, the oil is a good anti-
septic in diphtheria. As a local application in diphtheria, Dr. Marion
ThraHher, of San Francisco, uses a 10-per-cent. solution of eucalyptol in pure
alcohol. One part of the oil to 50 of plain or medicated water, may be advan-
tageously used as an injection in gonorrhoea. It may likewise be employed
as a mild counter-irritant in bronchial and arthritic inflammations. In
alopecia, when the scalp is covered and the glands occluded by a thickened
and vitiated sebum, the oil of eucalyptus is of very material service. Its local
stimulant effects sometimes prove valuable in anidrosis. A soap (sapo
eucalyptoli) containing 5 per cent, of the oil is of uljlity in the treatment of
foul wounds, or ulcers, and bromidrosis. In asthma, cigarettes may be
smoked, containing leaves of eucalyptus, with belladonna or coca, and
stramonium-leaves, associated with tobacco, if desired, and much advantage
derived from it, especially if the fiunes are inhaled. The fluid extract is
an efficient stomachic in indigestion due to deficient secretion or to gastric
or intestinal catarrh; by its use the intestinal tract becomes more healthy in
character, and no longer affords a place of development for intestinal para-
sites. Eucalyptus is an eflftcient remedy in the vomiting caused by sarcinsB.
In the ordinary oxyurides, or seat-worms, injections of a decoction of eucalyp-
tus-leaves are useful, and this preparation may also be employed as a gargle
for sore throat and stomatitis, scurvv, etc. The stimulating efTect upon the
circulatiuD of the volatile oil, is well shown in eases of palpitation, irregu-
larity, sudden Hashes, and flatulence. As the drug is antiseptic, and es-
capes by the bronchial mucous membrane to a considerable degree, it is serv-
iceable in chronic bronchitis, in the declining stage of pneumonia, in in-
cipient phthisis, gangrene of the lungs, and diphtheria.
M. J. Roussel employs a mixture of eucalyptol and carbolic acid in
some bland vegetable oil in the treatment of tuberculosis. He makes use
of three different preparations, which respectively contain 10, 15, and 20 per
cent, each of eucalyptol and carbolic acid. To the mixture he has given
the name pheneucalyptol and uses it by injection. He claims good results,
in phthisis, anthrax, epithelioma, and lupus. The injections are said to be
practically painless.
In acute bronchitis or laryngo-tracheitis of children. Dr. S. Solis-Cohen
prescribes; —
R Amnion, carbonat. j50 to 11 Om. or gr. vili-xv.
Amnion, chlorid 1(40 to 3110 Gm. or gr. xxii-xlvuj.
Fluidext. eucalypt O] c.cm. or fiiaa.
Syr. acAcice,
Syr. Tolutan aa. 151 c.cm. or fjss.
AquoB 60| com. or f Jij.
M. Sig.: A teaepoonful in milk or water every two or four hours for a child two
years of age.
In subacute cases he adds a little paregoric to the above or a similar
mixture.
When there is an anaemic state of the nerve-centres manifested by
chorea, neurasthenia, hysteria^ and asthma, benefit is derived from eucalyptol
EUCALYPTUS
455
I
gnen in capeulet, emulsion, or simply dropped upon sugar (0.12 to 0.30
ccm., or mii-Vy at a dose). In rheumatic or malarial headache it sometimes
protes efficacious. The oil of eucalyptus affords decided relief to the head-
ache vhich accompanies epidemic influenza, and is likewise olTicaoious in the
ocnimlgia which may follow as a sequel, and in migraine. The elixir of euca-
iTptus ( N'. F.) is a good restorative. It represents gr. V/^ of eucalyptus in
Mch dnichm.
Eucalyptus is believed to be especially serviceable in catarrhal affections
d the genito-urinary organs, desquamative nephritis, pyelonephritis, chronic
ctUrrh of the bladder, with putrid urine, and in gleet It likewise effects
nnproTement in vaginitis. In fevers, especially malarial fevers, it is useful;
bat it is inferior to quinine in controlling the paroxysms, being mostly em-
ployed in chronic malarial poisoning and in convalescence from acute attacks,
»hen it may be used in alternation with cinchona. This remedy causes re-
duction of the enlarged spleen, or ''ague-cake," due to malarial toxa?mia.
Ih". Benjamin Bell recommends tincture of eucalyptus to be given in
4-c.cm. (or foj) doses ever}' third or fourth hour in typhoid fever, and believea
thit it exerts a favorable influence upon the diarrhcea. In scarlatina it is a
good practice to add 5 drops of the oil of eucalyptus to 31 Gm. (or 5j) of pre-
pared lard, for use as an unguent to the general surface.
The red gum, or eucalyptus rostrata, is a pleasant astringent and is used
io the form of the fluid extract as an application for tonsillitis and pharyn-
gitis. Mr. Joseph W. England originated the following formula for a gargle,
»hich is in use at the Philadelphia Hospital: —
Potasttiam chlorate 81 Gm. or vs. cxx.
Boiling water 12()J c.cm. or iSiv,
Powdered fllum 41 Gm, or 3j.
Strongrr ro«e-wtter 78{50 c.cm. or f3u3v.
glycerin ,
fiyrtip aa 151 c.cm. or f3iv.
Fluid extract of eucalyptus ro&trata (red gum) ... ll{ ccm. or f3iij.
Dissolve tlie potassium chlorate in the boiling water, cool, and reserve.
Dtasolre the alum in the stronger rose-water, add the glycerin, syrup, and
flttid extract of red gum in the order named, and then add this to the re-
•enred portion.
The product is a transparent ruby-red liquid, of a very agreeable odor
tod taste. To use, take a tublegpoonful, add an equal volume of water, and
girgle ever}* three or four hours, or more often, if required.
It is a singular fact that fluid extract of red gum has not been received
with more favor by the medical profession than it has. It possesses many
•dvantages over other vegetable astringents; unlike sumach and catechu, its
liquid preparations remain clear on dilution with water, and, what is more
iniportjiDt, the astringency it exerts ou mucous surfaces is peculiarly per-
l. Stronger rose-water is double the strength of the usual rose-water,
gives, of course, a correspondingly stronger flavor of rose to the gargle.
ibiT it mieht be of advantage, in some cases, to flavor the gargle with
a few drops of oil of gaultliorift in place of the rose-water.
XttttUjrpt^l* or eucalyptcne bichlorhydridc, is a crystallized product
i^ffred from the essence of eucalyptus, by treating it with hydrochloric acid.
KoraJypieol occurs in the form of white, micaceous scales, having a cam-
"lomceous odor and a peculiar, faintly-bitter, persistent taste. This sub-
456 niAnMACEUTICAL THERAPEUTIC AGEKTS OR DfiUGS, ^^
etance ie soluble in ether, chloroform, fixed and volatile oils, petroleum ether,
and acetic ether. It is almost insoluble in water and glycerin. In alkaline
solutions and cold alcohol it is partially decompoeod, a substance having the
odor of lerpiuol being formed. According to the report of Dr. I^fage,
cuealyptcol is well borne by the stomach, is innocuous, and is decomposed j
in the intestine into liytlroclilr»rie ncid and eucalyptol. j
Euealyptcol is an clHcient antiseptic, minute quantities preventing
putrefaction* though it does not check the action of the digestive ferments.
When taken by the mouth it is eliminated by the lungs, kidneys, and bowels.
Eucalypteol is likewise eliminated in the saliva. When subcutaneously in-
jected it is removed almost exclusively by the lungs.
Therapy. — Eucalypteol exerts a decided antiseptic action upon the
bowel. It is appropriate to the treatment not only of diseases of the respira-
tory passages, but also to those involving the intestine, such as enteritis, diar-
rhoja, typhoid fever, fetid diarrhiea, the green diarrhcea of infants, etc.
In phthisis it allays the cou^h and other symptoms. It is preferably
given in powders or cajisulea. The usual dose is 0.03 to 0.20 Gm. (or gr. sa-
iij) or 0 total, daily, of 1.55 Gm. (or gr. xxiv) to adults.
EUGALIOL.— Pyrogallol Monacetate. (See Pyrogallol.)
EUGENOL (TJ. S, P.), — Eugenol. An unsaturated aromatic phenol
obtained from the oil of cloves and otlier source!?. It nmy be employed aa
a substitute for oil of cloves. (Si'o Oleum Caryophyllum.)
EUONYMUS (U. S. P.).— Euonymus (Wahoo). '
EUONYMI CORTEX (B. P.).— Enonymus-bark.
■ Preparations, ■!
Fluidextractum Euunj-nii (U. S. P.).— Huid Extract of Euonymus. Dose, 4 to
8 c.cm. (or f3i-ij ) .
Extractuu) Euonynii {U. S. P.).— Extract of Euonymus. Doae, 0.13 to 0.26 Gm.
(orgr. ii-iv).
Extractura Euonymi Siccum (B. P.). — Dry Extract of Euonymus. Dose, 0.065 to
0.13 Gm. (or gr. i-ij). '
Fharmacology. — ''The dried bnrk of tbc root of Euonymus atropurpurea
(Celnstriica^)*' cont>iin8 a bitter, finiorphoiB substance; aUo, resins, ouonic
acid» and aspnrgin. Tlie impure resin, with the bitler priueiple, is known
conuuoreially as Enonymin ((1o.sl\ 0J>'S to 0A3 Gni., nr gr. ss-ij). The
priiK'ipnl constituoDts are Euonymin nTid Euonic Acid. It niso contains a
fixed ttiid a volatile oil, resins, hitter (.^Mraciivc, eu\ True euonymin is an
amorphous, odorless, bitter principle, soluble in alcohol, nnd slightly in
ether. It is probably n crystalline ghicoside.
PhyBiolo|:ical Action. — Euonymi.8 is in small doses a tonic, increasing
appetite and gastric secretions; in larger doses it is an irritant and cathartic.
Euonymus ie also an expectorant and diuretic, and exerts considerable in-
fluence upon the liver, as a cholagogue, resembling rhubarb in its action.
The excretion of uric ncid is at first increased, but subsequently diminished.
Therapy. — It has been employed as a cholagogic purgative, especially
in conjunction with antiperiodic treatment, in malarial poisoning. In torpid
liver and chronic constipation it aids the action of other remedies. Intes-
tinal indigestion and jaundice are benefited by the administration of this
EUPHORBIA PILULirEfi^i.
457
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I
tfTPDt. As a diuretic, it has sIko been emplo^'ed in cases of dropsy. Euony-
min is a convenient form in which to prescribe it, although the solid extract
ii pTftctically the same. It is claimed that it will cause the disappearance
^Iftlhtiniin from the urine in acute Bright's disease. It also relieves a form
of lambagOy which is more of a soreness and tenderness than actual pain.
A preference is expressed for the preparations obtained from the green, freah
drag by the eclectic physicians, who esteem it highly.*
EUPATOEIUM (U. S. P.).— Eupatorium (Thoronghwort, Boneset).
Dose, 1 to 4 Gm. (or gr. xv-3j).
Preparation.
Fluideitnictum Eiipatorii (U. S. P.). — Fluid Extract of Eupatorium.
tb>4cxin. (or inxxx-(3j).
Dose,
Ph&nnacology. — The dried leaves and flowering tops of Eupatorium
prfolialnm (Conipositse), an indigenous plant, enjoy considerable reputa-
tion in recent infusion ( bonesf t-tt-a) for acute colds, rheuniiitism, and
*lvHmenorrha''a. Tlioy contain Eupatorin, a ver}' bitter glueoside, with vola-
tile oil. jrum, and' tannic acid. The root yields 5 per cent, of inulin.
Therapy, — The hot infusion (1 to 8) is a diaphoretic and (in large doses)
tnwtic, acting like chainomile-flowers. The powdered dried herb is a domes-
tic remedy for dyspepsia, but is best given in fluid extract.
Hie Eupatorium purpureum, gravel-root or trumpet-weed, an allied
ipeciee, contains in its root an acrid resin and an oil, and is a etimulating
diuretic. It is best given as a fluid extract of the root in dose of 2 to 7.5 c.cm.
(or mxji-foij). Crystals of Euparin sometimes deposit from the fluid ex-
tnct; it is a yellow, neutral crystalline principle, distinct from, but resera-
bLing, fjnercitrin.
ETTPHOBBIA PILITLIFEEA.— Snake-weed. Euphorbia pihilifera (Eu-
phorbiacese), pill-bearing spurge, is a native of most tropical countries. The
Ttricty which has been introduced into medical practice comes from Queens-
Undy Australia. It is an annual herbaceous plant, growing to the height of
«nc or two feet. The fresh root is red; the dry is reddish brown. The stalk
if more or less procumbent and covered with yellowish hairs. The leaves
are of a deep-green color. The fruit incloses three seeds, which bear some
resemblance to a coffee-grain. The plant yields its virtues to water. The
•qtifoug solution seems to contain tannin, but no alkaloid. The following
are oseful preparations of this agent: Ducoctuni euphorbia? pilulifer©
(d«coction of euphorbia pilulifera); dose, 60 c.cm. (or f.vj)- Extractum
cnphorbiff pilulifera? (extract of euphorbia pilulifera); dose, 0.065 to 0.13
Gm. (or gr. i-ij). Tinctura euphorbiae pilulifera (tincture of euphorbia
f>il^ ' ' ""^: dose. 0.^50 to 2 c.cm. (or mx-xxx). Extractum euphorbias pilu-
t: ^um (fluid extract of euphorbia pilulifera); dose, 2 to 4 c.cm. (or
■ucxx-ir>j).
Phyiiological Action* — A strong solution of this drug has no irritant
effect upon the skin. The taste is slightly astringent. It causes no redness
or smarting of the tongue or buccal cavity, but is irritant to the gastric
JtMtmal of iffdicine and Science, May, 1808.
458
THARiUCEL'TICAL TllEUAPEUTIC AGENTS OB DBUG8.
mucous membrane, and may occasion nausea or epigastric pain. No effect
has been observed upon the spinal cord or muscular system. It produces no
change in the calibre of the capillary vessels. The secretions are unaffected.
Small doses are fatal to frogs and guinea-pigs, first accelerating and then
retarding the respiration and circulation, probably acting directly upon their
respective centres. It is thought to be eliminated by the liver, and is devoid
of cumulative effects. The case has been recorded of a gardener who, after
handling several species of euphorbia, was suddenly attacked by burning of
the conjunctiva,— extending to the cheek, mouth, nose, and fauces, — in-
creased lacrymation, sneezing, and constant desire to urinate. The mani-
festations were attributed to idiosyncrasy.
Therapy. — Euphorbia pilulifera is chiefly of value as a remedy In
spasmodic asthma, though it is not without merit in other thoracic diseases.
iJr. Marsset, to whom we owe our knowledge of its physiological action,
employed it in a number of cases in private practice, and reports others from
the service of Dujardin-Beaunietz. It was iound of signal benefit in parox-
ysmal asthma, whether uncomplicated or connected with chronic bronchitis
and emphysema. The effect was favcrable and prompt, irrespective of the
origin of the disorder. This remedy has also been used wiUi good effect in
the treatment of hay asthma. Dr. Tisan has found the remedy beneficial
in the dyspnoea of cardiac disease. In Australia the plant is highly esteemed
for its power of allaying the asthmatic paroxysm, it has likewise Ijeen found
of service in chronic bronchitis, especially when occurring in old people.
Dr. Marshall has prescribed it with advantage in phthisis, in which it checked
the cough, promoted expectoration, and exerted some anodyne influence.
The decoction is slightly tonic. The leaves have also been smoked in a pipe
with satisfactory results in cases of asthma. This remedy may be beneficially
combined with potassium iodide in asthma associated with chronic bron-
chitis. A formula which has been recommended for asthma is as follows: —
H Ext. euphorb. piluUf. 21 Gm. or gr. xxx.
Nitroglycerin |006 Gm. or gr. '/ !•■
Sodii lodid.,
Potass, bromid aa 1 [30 Gm. or gr. xx.
Tr. lobelifie l[20 c.ctii. or wixx.
M. et ft pil. vel capsul. no. x.
Sig. : One, two, or three pills or cupaulea three timeft a day.
EUPHOEBIUM. — The Euphorbia resinifera (Euphorbiacese) is a native
of Morocco, the ofiicia! portion being a gum-resin, which flows from incisions
in ihe stem and hardens in the air. The substance is yellowish, opaque, or
filightly translucent, and brittle; without odor, but the powder causes much
irritation and sneezing; taste acrid and burning. It is insoluble in water,
only partly soluble in alcohol. It consists of an acrid resin (38 per cent.),
euphorbon (522 per cent.), gum (18 per cent.), malatee (13 per cent,), etc.
Phyaiolog^cal Action. — It is irritating to the skin, and vesicant, owing
to the acrid resin. Euphorbon is a drastic purgative and emetic.
Therapy. — It is employed only fur external purposes as a rubefacient
and counter-irritant. When combined with cantharidcs, it forms a good
vesicating plaster (Janin's plaster).
The Euphorbia corollata, or large flowering spurge, is emetic, dia-
EUPUTHALINUM HYDROCULORIDE.
459
I
I
I
and expectorant. The root is used (1 to 1.30 Gm., or gr. xv-ix),
of which a decoction may be made.
EITPHORIN. — Phenylurethane. This compound, introduced by Pro-
feiEor Giacofift^ of Turin, is an aniline product, occurring in the form of a
white crystalline powder, sparingly soluble in cold water. It possesses a
faint, ari^matic odor, and a taste which^ at first feeble, becomes warm and
ttUiing dilatation of peripheral blood-vessels.
Physiological Action. — Euphorin is antiseptic, antipyretic, and anal-
gesic. It diminishes suppuration, and reduces abnormal temperature by
ausing dilatation of, peripheral blood-vessels.
According to Dr. C. Curtis, its effect in depressing temperature mani-
fests it*<lf in from half an hour to two hours after administration, and may
eoQtiniie for as long a period as ten hours. It is said to occasion no serious
•econdary symptoms. In some instances cyanosis has been observed, but it
does Dot seem to cause collapse. It likewise promotes diaphoresis. Euphorin
is thought to increase the excretion of urea. When given by the mouth, it
it not followed by the appearance of phenol, aniline, albumin, or sugar in
the urine.
Therapy. — Euphorin in powder has been used with advantage upon
Qlcerated surfaces, and has been found capable of stimulating repair in
chrvtiic lesion^. Peroni and Bovera report favorably of its efficacy as a local
agent in various cutaneous manifestations of syphilis, having employed it in
ttinttv-one cases in doses of 0.20 to 0.3S Gm. (or gr. iii-vj). Bergerio found
it aerviceable in ulcerative cervicitis. He employed it in the form of powder
bj insufflation and as a 1 to 3 alcoholic solution. Euphorin has been advan-
tagfousl^ used in surgery as a substitute for iodoform. It is an efficient
aji^'cation in wounds, burns, scalds, bed-sores, herpes, and other cutaneous
(tuftao, especially those of vegetable parasitic orip^in. In aphthous stoma-
titia it is equally of avail. Professor Stiller, of Pesth, administered euphorin
in different forms of neuralgia, including hemicrania and sciatica, and, in
OMCt cases, observed relief of pain. He also found it beneficial in cases of
dironic articular and muscular rheumatism, and rheumatic fever. By other
ohacffera it has been successfully employed in supra-orbital and intercostal
nenralgiSy syphilitic pains of the limbs, and orchitis. In acute rheumatism
evpborin has sometimes been found more efficacious than the sodium
aalicylate.
BUPHRASIA.— Eyebright. The Euphrasia officinalis (Scrophulari-
soeftK * sJnall herb of the White Mountains and Lake-Superior region and
alio of Europe, with opposite leaves and spikes of blue flowers. In spite of
ita name it is not official in the United States Pharmacopoeia. It is astrin-
gent, containing tannin, euphrastic acid, etc. A tincture (10 per cent.) ia
tnefol in incipient catarrhal affections, hay fever (dose, O.GO c.cm., or mx
frery iwo hours), and measles.
EUPHTHALMIN HYBROCHLORIDE is a colorless crystalline Bub-
1 eucaJnc B. In aqueous solutions its action is tlmt of a
- the same relation to encaine that homatropine does to
"Osrier, of Paris, reports that after his repeated use, covering
i
I
460
rilAUMAOEUTICAL THEEAPKtJTIC A0ENT8 OR DRUGS.
quite a period of time, he has yet to observe any of the unpleaeant symp-
tonis often met with after the use of the other well-known agents; to obtain
full dilatation of the pupil he uses 1 or 2 drops of a 5-per-eent. solution.
He also noticed that a rapid dilatation followed, while the power of accom-
modation was unat!ected. Dr. Graiulclement uses a solution containing 0.25
Gin. to 10 c.cni. (or gr. iv-melx) of distilled water, while Dr. Edward Jack-
eon prefers the combination of euphthalmin with cocaine to produce
mydriasis.
EUEOPHEN. — laobutyl-ortbo-cresol Iodide. Europhen is the product
of the action of iodine upon isobutylorthocresol in a solution of potassium
iodide. It occurs in the form of a fine, soft, amorphous powder, of a light-
yellow color, without taste, and havin^r a faint, not unpleasant odor. The
odor almost entirely disappears when the substance is made into a mixture
or solution. Europhen is insoluI>lc in water or glycerin, but dissolves in
alcohol, ether, chloroform, and fixed oils. The specific gravity of europhen
is half that of iodol and one-fifth that of iodoform. Europhen is easily
decomposed by lijjht and heat, and should be kept in a dark, dry, and cool
place, and its solutions he made at a low temperature. The average pro-
portion of iodine contained in europhen is 27.6 per cent. Its solutions, upon
standing, throw down a precipitate, consisting of an organic iodine com-
pound, soluble in water. Europhen contains a very small percentage of free
iodine. It is incompatible with starch, metallic oxides, and the salts of
mercury.
Physiological Action. — Europhen adliercs firmly to the skin, mucous
membrane, and open surfaces, "When taken into the system it undergoes
little change. A very small proportion of iodine is found in the urine, and
the greater portion passes through the intestinal canal unchanged. Euro-
phen is non-toxic, but by a chemical action prevents the development of
patliogenie micro-organisms in culture-media.
Therapy. — Europhen, in the form of a powder or 10-per-cent. ointment,
is an excellent dressing to ulcers of various kinds. Log-ulcers often heal
rapidly under its influence. It forms a valuable application to wounds,
chancroids, open buboes, ulcerated chancres, condylomata, and ulcerated
lesions of secondary and tertiary syphilis. Dr. P. J. Eichhoif used it with
advantage in scrofuloderma, lupus vulgaris, and deep burns, but found it of
no avail in favus or gonorrhoea. He notes, however, that excellent results
were obtained from europhen in the treatment of the erosions and ulcerations
of the uterine neck of such frequent occurrence in association with gonor-
rhcea. The powder may be applied twice daily, or a tampon charged with
europhen muv be introduced.
The author has used* this substance with success in the treatment of
incised, contused, and lacerated wounds. In chronic ulcers of the leg and
Bcrofulodermata, also, it exerted a beneficial influence and led to rapid cica-
trization of the lesions. A lupous ulcer wus decidedly improved by the
application of europhen, and eventually healed. In one case of superficial
epithelioma an ointment containing 4 to 8 Gm. (or 5i-ij) of europhen to
31 Gm. (or Jj) effected a cure. In a second case, after europhen first, and
subsequently aristol, had been used without much result, a mixture of equal
* "Europhen: with CUnic&l Reference to Europhen and Europhen-arUtol." By
John V. Shoemaker, A.M.. M.D. See Medical Bulletin, Sept., 1802.
EXALOtNE.
461
I
P
I
ptrU of europhen and aristol, made into an ointment, was applied with
«Ure sDccess. A lO-per-cent. ointment of europhen was efficient in sycosis,
and the powder, dusted upon the surface of a carbuncle after the necrotic
timoe hta been removed, promoted the healing of the wound. Papular acne
w%B cured bj the application of an ointment containing from 4-8 Gra. to
31 Gm. (or 3i-ii to Sj) of base. In the second stage of rosacea a marked
ixDproTement followed the use of an alcoholic solution of europhen. The
ptpnles and pustules, together with the roughness of the skin, disappeared,
and the capillary injection was diminished. An ointment was advantageous
in erysipelis and in the dermatitis caused by poisoning by rhus toxicoden-
dron. Applied as a dusting-powder, europhen proved beneficial in herpes
progenitalis, herpes zoster, seborrhcea oleosa, hyperidrosis, and hromidrosis.
An ointment was of assistance in the treatment of alopecia circumscripta.
The powder was of value in several cases of acute vesicular eczema, while
the ointment rendered good service in some severe caScs of chronic eczema.
The writer obtained a good result in one case of psoriasis from the use of
an ointment containing the equal mixture of europhen and aristol. In
ryphilitic ulcers the experience of the writer is coniirraatory to that of Eich-
hoff. From the clinic of Professor Jurasz, of Heidelberg, Dr. von Szoldrski
reports a favorable influence in three cases of laryngeal tuberculosis with
abundant secretion. He esteems europhen of value after operations upon
the nooeor larynx. Dr. Lowenstein has obtained good results with europhen
in perforating ulcer of the nasal septum, and in epistaxis dependent upon
arofiion of the septum. Dr. Nolda employed europhen successfully in three
caaes of suppurative inflammation of the middle ear. Dr. Fernandez rec*
ommends europhen in cases of accidental or operative traumatisms of the
eye, in conjunctivitis and keratitis. He generally employs a 1-per-cent. oint-
ment. Europhen powder forms a convenient dressing, on account of its
adheciTe qualities and the fact that it does not harden into a compact cake
npon the surface to which it is applied. Dr. K. J. Schumann, of Athens,
Tenn., states that, in dental practice, europhen as a root-canal dressing can-
not be surpassed. He makes a paste by combining europhen with a drop or
two of carbolic acid. In pyorrhcea he cleanses the parts, applies protargol
tolation (20 per cent.), and fills pockets with europhen. EichhofI has
experimented with it hypodermically in the treatment of ayphilis.
EZALGUffE. — Methylacetanilidc is a neutral derivative of the aromatic
aeries, witli the formula C^H.NCCHJCIT.CO, and is one of the three
BJf'thyl derivatives of acetanilide. It is in fine, acicular, or long tablet-like
crystals, the first being obtained by evaporation from solution, the latter
from fusion. It is sparingly soluble in cold water, more sn in hot water>
and extremely soluble in diluted alcohol. Dose, 0.065 to 0.38 Gm. (or gr.
i-T}), or from 0.38 to 0.75 Gm. (or gr. vi-xij) in the course of the day.
Exalgine is devoid of odor or taste, and is of neutral reaction.
Phyiiological Action. — Exnigine has bei^n brought forward by Brigon-
r ' ' ' rhin Hospital, and has been extensively employed as an anal-
i: ■ t being principally manifested ufwn the sensory nerves. Exal-
giiu', uhuh is also an antiseptic, is eliminated by the urine, the amount of
which it iliminisbea. It reduces abnormal t«nnpernture like other members of
the groap, and is claimed to be equally eflficient in about half the dose of anti-
pyrin. Broadbent has reported a case in which 0.25 Gm. (or gr. iv) doses
463 PHARMACEUTICAL THBBAPEUTIC AGENTS OE DRUGS.
of exalgine had been ordered on aceouht of neural^a. The first dose relieved
pain^ but caused some dizziness. After the lapse of some hours, feeling a
slight return of the pain, the patient took 0.76 Gm. (or gr. xij) at one dose.
He immediately fell prostrate, was unconscious, and frothed at the month.
The pulse was feeble and slow, the eyes closed, and pupils normal. Upon
recovering consciousness he complained of noises in the head, was nauseated,
and experienced pain in the hypogastrium. Evacuation of the stomach and
stimulation were followed by recovery. In the case of a 2-year-old child,
to whom 0.32 Gm. (or gr. v) of exalgine had been given in mistake, Dr.
Reynery, of Havana, observed that the face and hands were of a dark-blue
color, there was copious vomiting of mucus, with free perspiration, rapid
and feeble pulse, prominence of veins of the neck, and pulsation of the
carotids. The urine was dark gray and albuminous. There was diminution
of sensibility in the lower limbs. The child was revived by the use of stimu-
lants, and the symptoms gradually disappeared. As it is soluble in diluted
alcohol, it may be given in water flavored with elixir of orange or rum.
The smallness of the dose gives it a decided advantage over some other
preparations of this group.
Therapy. — In all forms of neuralgia, especially the visceral fonns,
exalgine has been shown to have marked control over pain. It is said to
decrease the quantity of sugar excreted in diabetes mellitus. In diabetes,
from 0.38 to 0.75 Gm. (or gr. vi-xij) daily may be given. In facial neuralgia
and myalgia, especially in anaemic, neurotic patients, good results are ob-
tained from doses of 0.065 Gm. (or gr. j) every four hours. Lowenthal
administered exalgine in thirty-five cases of chorea. It exerted no specific
influence, but the severity of the manifestations was reduced. He concluded
that the effect of the drug was much more favorable when its administration
was begim early in the disease. Moncorvo recommends exalgine in the treat-
ment of painful affections of children, to whom it is acceptable in taste and
by whom it is well borne. He gives it in doses gradually ascending from
0.045 to 0.25 Gm. (or gr. 'A-iv), and considers it as equally efficacious as
antipyrin in small doses. Visceral neuralgia, dysmenorrhcea, nephritic colic,
and angina pectoris are relieved by the use of exalgine. The solubility of
exalgine in water is promoted by the addition of an equal quantity of sodium
salicylate: a combination which will often be of therapeutic efficiency.
EXODnf. — The trade name of diacetyl-rufi-gallic-acid-tetramethyl-
ether. Is said to be tasteless, and does not excite nausea. It acts as a cathar-
tic without griping or diarrhoea. Defecation occurs in 8 or 10 hours. It is
supplied in tablets (0.50 Gm., or gr. viiss), two being the dose for an adult,
one for a child.
FABIAITA IXBEIGATA.— Fabiana imbricata (Solanacese), or PioU, a
South-Amencan plant, is a shrub, or small tree, which grows upon high,
dry hill-tops. Its branchlets are arranged in the form of plume-like sprays,
which have a peculiar, light-bluish-green color, due to the large amount of
bluish or greenish-gray resin, with which all its tender parts are covered.
Its principal constituents are a bitter ether-soluble alkaloid, Fabianine;
a volatile oil containing Fabianol, a crystallizable resin. Besides these, the
drug contains tannin, starch, and an abundant proportion of a glucoside
analogous to esculin. The medicinal preparations are made from the dried
leafy twigs.
FEL B0VI8.
Phyiiological Action. — A tincture of pichi has a disagreeable, persistent
bitter taste, and, unless combined with an alkali, its resin is precipitated
npoa the addition of water. Pichi exerts a stimulant effect upon the kid-
BejBy but its ph^siolopcal action has not been closely studied. Administra-
tjoa of the resin-acid to frogs caused narcosis, followed by paralysis and
dntiL Th€ fluid extract, when given to human subjects in medicinal doses,
hfts no disturbing effect upon the stomoeh, but, on the contrary, improves
ibe appetite. The essential oil (»f pichi acts as a stimulant to secreting
organs generally, and modifies or cures chronic purulent discharges from
nooous membranes.
Therapy. — Its therapeutic influence is chiefly manifested in affections
of the genito-urinary apparatus. In enuresis noctuma pichi has often a
most beneficial action. The following combination will be found useful: —
B Fiui«l^»\trii('tiim (uliiftiije 4| c.cm. or f3j.
Tinct. beUadonnie foliorum |76 c.cm. or wxij.
Aqa» cinnamomi 00| c.cm. or fjiij.
IC. 6ig.: A t«aspooiiful moming and night for a child.
It has also been efficaciously employed in gonorrhoea, especially'during
inflammatory stage. Pichi is beneficial in epididjTnitis and prostatitis,
1 baa been given with success in jaundice and dyspepsia dependent upon
insufficient secretion of bile. The oil is of service in the treatment of
Qchial and intestinal catarrh. It is of value in lithiasis, or calculus of
ih** kidney or bladder. In chronic renal congestion and calculous pyelitis
(hi«i drug is of service, except when degeneration of renal tissues exists. Dr.
Hal. C. Wyman reports very favorably upon Uiis remedy in cystitis depend-
-«ftt on stricture or manipulative procedures within the urethra, and like-
rife in cases of lumbago and sciatica associated with the deposition of unc
acid. As a diuretic in cases of gravel and calculi the following combination
will often prove of service: —
H Fluidextractum fahinie 60| c.cm. or fSij.
Liq. potass 18|5 ccm. or f3v.
Tr. nucts vom 7 5 ccm. or fSij.
Eltx. calisavflfi q. s. ad 12o| c.cm. or fjiv,
M. Sig,: Teaspoonfal in hot water every four or five hours.
Pichi is likewise of service in prostatic inflammation or hypertrophy,
and is raloable in gonorrhoea attended by complications in which it is neces-
wy to suspend the use of local methods.
FABIHA TEITICI (B. P.).— Wheatcn Flour. The grain of wheat,
Tritjcmn sativnni (Oraminea). ground and sifted.
FEL BOVIS (U. S. P.).— Ox-fi:aU.
Preparalions.
F»l f%o\\m riiritlcntiim l U. S. P.t. — Puri tied Ox -gall fpilulnr ronsistencc)). Fel
Pitriflcattim (B. P.).— Purifiwl Ox bile. Duho. 0.32 to 1 Gm. (or gr. vxvK
Pharmacology. — Fresh bile of Bos taurus (class, Mammalia; order,
Runiiaintia) is a greenish-brown, viscid liquid, with a peculiar, nauseating
I
464
PHAKMACECTICAL THEILVPEUTIC AGENTS OU DRUCiS.
odor and bitter, olTeaHivt: tasle. Its solution frotlis when shaken and saponi-
fies fat. Its reaction is alkaline; specific gravity, 1018 to 1038.
Physiological Action and Therapy. — Ox-gall is antiseptic and laxative,
assisting in the absorption and digestion of fats in the intestinal tract and
stimulating peristalsis. The local application of bile causes absorption of
hypertropliies, and enlarged tonsils. It may be used internally to assist the
digestion and assimilation of fatty foods or of codliver-oil, and may be given
in habitual constipation with deficient assimilation. Ox^gall has likewise
been used for the purpose of expelling lumbricoid worms.
In jaundice, Harley recommends the use of ox-gall, given in capsules,
in order that it may reach the duodenum without being acted on by the stom-
ach. It is also of benefit in liepatic and intestinal affections.
H Ft'IUs liovjs piirifii'ftti,
Magneaij carbonatis aa 6150 Gm. or gr. c
01, menth. pip |06 ccm. or mj.
M. ct ft. capsulm no. xx.
Sig.: A capsule three or four times a day, after meals, in dyspepsia and coo-
itipation.
R Fellis boviB purificati 4| Gm. or 3j.
Exlracti nucia vomicae,
Aloini aa |0fl5 Om. or gr. j.
0!. cinnamomi |06 c.cm. or mj. '
M. et ft. piL no. xx.
Sig.: Two piUa between meals. Serviceable in torpor of the liver and in dys-
pepsia.
FERMENTUM.— Yeast.
Yoast is tlic ferment obtained in brewing beer, and is produced by
Saccharomycea cerevisia?. According to Schlossberger, its composition is
carbon, 49.9 per cent.; hydrogen, G.6 per cent.; nitrogen, 12.1 per cent.;
and oxygen, 31.4 per cent. It contains^ as proximate constituents, cellulose,
albuminoids, fats, and resinous substances.
Pharmacology. — Yeast is a pale-brown, viscid, frothy liquid, with a
bitter taste. Used externally in a poultice for boils and suppurating wounds
or foul ulcers, and internally as an alterative tonic In furuncles and typhoid
fever. Dr. M. B. Thompson has reported thirty-seven cases in which yeast
was used in tlie treatment of typhoid, in all of which recovery took place
without relapse. It is said to cause disappearance of suijar from the urine
in diabetes. Dose, 15 to 30 ccm. (or fo^s-j) before meals. Roos^ has used
yeast (dried at 86** F.) in powder in doses of 0.50 Gm. (or gr. viij) two or
three times a day in the treatment of constipation. He reports twenty cases;
sixteen were so benefited that their evacuations were easy and copious, and
in most of them the appetite was increased. Cerevisine, a proprietary article,
is a pure desiccated yeast, and has been used with success in the treatment
of psoriasis, herpes, and some varieties of eczema in dosea of 1 teaspoonful
three times a day.
FERRTJM. — Iron, Metallic iron in the form of fine, bright, and non-
elastic wire (F. S. P.). Wrought iron in the form of wire or nnils free
from oxide (B. P.).
'iV. 7. Med. Jour,; Med, Bull, May, 1901.
FEKItUM.
465
U, S. P. Preparations.
r FriTi, Quiniuse, et Strychnime Phoaphatum (U. S. P.)> — Elixir of Phos-
yiatm of Iron, ijuiiiiiu'. and Strychnine. Dose, 4 c.cm. (or 5jf (containing strycli-
^i I Kerri, Quininn* pt Strychninw Phosplmtum). — Average dose, 1 c.cm.
lor m\ .lining gr. '/km of strychnine).
h Carbona^ Saccharatus. — Saccharated Ferrous Carbonate. Dose, 0.13 to
\or gT. ii-xj.
T^rri Chloridum. — Ferric Chloride. Used as hemostatic and phannflceutically.
Feni Citras. — Ferric Citrate. Uo»e, 0.32 to 1.30 6m. (or gr. v-xx).
Ferri hypophosphis.— Ferric Hypophosphite. Dose, 0.32 to 0.C5 Gm. (or gr. v-x).
Ferri Phospbas ^solubilis. — Soluble Ferric Phosphate. Dose, 0.32 to 0.05 Gni.
(orgr. v-x).
Ferri Pyrophosphaa SolubilU. — Soluble Ferric Pyrophosphate. Dose, 0.13 to 0.32
Gb. (or gr. u-v).
F»Tri Sulphas.— Ferrous Sulphate. Dose, 0.0G5 to 0.32 Om. (or gr. i-v).
Ferri Sulphas Exsiccatus. — Dried Ferrous Sulphate. Dose, 0.005 to 0.32 Gm. (or
Ferri Sulphas Oranulatus. — Granulated Ferrous Sulphate. Doae, 0.065 to 0.32
(orgr. i-v}.
Ferri et Amnionii Cilras. — Iron and Ammoniuu] Citrate. Dose^ 0.20 to 0.32 Gm.
(or gr. iii VI. (.Should nlway*^ be givon in solution.)
Ferri et Amnionii Sulpha.s. — Ferric Ammonium bulphate (Aramonio-ferric Alum).
Do«e, 020 to 0.32 Gm. for gr. iii-v).
Ferri et Ammonii Tartraa. — Iron and Ammonium Tartrate (Ammonio-ferric
Tartrate: about 25 per cent, ferric oxide). Dose, 0.32 to 1.30 Gui. (or gr. v-xx).
Ferri et Poiassii Tartras.— Iron and Potabsium Tartrate (Potassio-ferric Tar-
irat*). Do^, 0-32 to 1 Gm, (or gr. v-xv).
Ferri et Quininse Citras. — Iron and Quinine Citrate (ferric citrate. 85; quinine,
ritrir arid. 3 i^ut-i). Dose. 0.20 to 0 32 Gin. (or gr. iii-v). (Suitable for pills.)
Ferri et l^uinime Citras Solubilis. — Soluble Iron and Quinine Citrate. Dos^ 0.20
lo il.fiS Gm. (or gr. iii-x). (Bej^t prescribed in solution.)
Ferri et Strychninae Citras. — Iron and Stn'chnine Citrate (98 Gm. iron and am-
•oaism eitiate; 1 Gm. each of strychnine and citric acid). Dose, 0.065 to 0.20 Gm.
f«rfr. I'ttU.
Fern Hydroxidum. — Ferric Hydroxide. (Hydrated Oxide of Iron freshly
fV<ri|rftaUtl by the addition of sn excess of ammonia to the solution of the ferric
•olpliale and washed and Htrained. For use as an antidote to ar^enous-acid poison*
liL 2D grains to l»e taken for each grain of arsenic swallowed, a tablespoonful the
offttaary ilow as an antidote.)
Ferri Hydroxidum llydnitum cum .Miignrsii Oxido. — Ferric Hydroxide with ^lag-
inm Ovidi'. ( S>ln1ion of ferric Hulplmto. 50 c.cm.. or f3xiiis8: miiia»p*i«. 10 Gm.. or
^ution of ferric Milphat^* i.s to be diluted with 100 c.cm., or fSxxvij, of
'^■pt in « lfiin'\ well— ttippcrfd Iwttlc until ncc<led for use. The magnesia
• I»t in a bottle (iUcd ahout three-fourths with water, ^^^len required for
(i#-«irt is til hoslmWi'n int«i ii hoinoyonrni** thin magma nnd the iron solution
and «4hakcn together until a uniform smooth mixture rettultn. Anti-
■ruisu
M« t.
Ft run
Ii#lii»ir
PHactj'fti" '
r.i-duirtum. — Urduced Iron. Dose, 0.066 to 0.32 Gm. (or gr. i-v|.
Ferri Thloridi.— Point inn nf Ferrie Chloride (29 of ferric chloride).
"i in making the tincture. Done. 0.12 to 0.60 c.cm. (or mii-x).
li rt Ammonii Acctatin. — .Solution of Iron and Ammonium Aeetat«
iirei (rontnin;! tincture of ferric chloride, 40 c.cm.; diluted acetic
t : Hiiluti<m of ainmuniuin neetnte, 500 c.cm.: aromatic elixir, 120 c.cm.;
t rem.; wnl«-r. n suflicient *itiantity to Tnako lOOOc.cml. Should be fre«hly
lit n unnled. (This preparntion is about twice as strong ns thnt of 1890 Phar-
nt>-*e. 2 to H fcni. (or fShs-ij).
■ li Sub^ulphati^. — Solution of Ferric Subsulphat^? (Monael'a Solution).
't com. (or mii-x).
r-iii Tersulphatis.— Solution of Ferric Sulphate (for making hydrated
rnrbonatis— Mass Ferrous Carbonate, Vallet'a Masa (ferroun »ul-
46G
PHARMACEUTICAI. THERAPEUTIC A0EXT8 OR DRUGS.
phttlc, 100; Hodium carbonate, 39; honey, 38; sugar, 25; Byiup nn 1 wnttr, q. s. al
100 parta), has 42 per cent, ferrous carbonate. Do6e, 0.'20 to 0.32 Gm. ^ar gr. iii-v) .
Miatura Fern Composita. — Compound Iron Mixture. Griffith's Mixture (ferroua
sulphate, 6; myrrh, 18; sugar, 18: pola»isiuni onrhonate. S: spirit of lavender, 60;
ro8ewHter, q. s. ad 1000 imrts). Dose, 30 to CO ccm. (or fji ij).
Piluls Aloes et Kerri. — i'ilU of Atoea and Iron (aloea, iron sulphate, aromatic
powder). Doee, 1 to 3 pilla.
Pilulie Fern Carbonatis. — Pilla of Ferrous Carbonate (Blaud's Pilla). — Iron Pill.
Doae, 2 to 5 pilla.
Pilula; Forri loJidi. — PilU of Ferrous Iodide. Dose. 2 to 4 pilla.
Syrupus Fi-rri ludidi. — Syrup of Ferrous Iodide (5 per cent ferrous iodide).
Dose, 0.30 to 2 c.cm. (or wv-xxx).
Syrupua Ferrj, Quininae. et Stryohnince Phosphatum. — Syrup of the Pho-iphates
of ]jron. Quinine, and Strvchuine contaiua about 0.07 Gm. (ct. IVi) of iron; 0,10 Gui.
(or gr. iss of quinine, and 0.00O82 Gm. (or gr. V«) of atrychnine to 4 c.cm. (or fSj ).
Dose, 2 to 4 c.cni- (or fSsa-i).
Syrupua Hypopbo«pnitum. — Syrup of Hypophosphites (ferroua lactule, 1 per
cent.). Dose. 4 to 15 (■.cm. for fSi-iv).
Svnipua Hypophosphitum Compositus. — Compound Syrup of Hypophoaphites.
Tinctura Fcrri Chloridi.^Tinclure of Ferric- Chloride (13.28 [ler cent, of ferric
chloride; i^olution of ferric chloride. 3;>; ttlcobo], q. s. ad KK) part«). Dose. 0.30 to 1.30
c.cm, (or tnv-xx).
Vinum Ferri Ainarum. — Bitter Wine of Iron. Dose, 4 to 15 ccm. (or f3i-iv).
Vinum Ferri. — Wine of Ferrio ritrate* (containa iron and iimuiimiimi
citrate, 4 parts; tincture of sweet orange-peel; syrup, and white wine). Dose. 4 to
15 c.cm. (or f3i-iv).
B. P. Preparations.
Ferri Arsenas. — Iron AraeuaLe. Done. 0.004 to n.nifr Gm, for 'jr. V. -' '.>.
Ferri Carbonas Saccharatuf*. — Saccharatod Iron Caii>ouutc. Dose, 0.G5 (or gr.x).
Ferri et Amiiionii <.'itra!*. — Imn mid AiiMnoniiiiii (,'ilr;iti!. (SImmiM nlwavs be
given in solution.) Dose, 0.13 to 0.32 Gm. (or gr iiv).
Ferri Phosphas. — Iron Phosphate. Dose. 0.32 to 0.65 Gm. (or gr. v-x).
Ferri Sulphas. — Ferrous Sulphate. Dorc, 0.005 to 0.32 Gm. (or gr. i-v).
Ferri Sulphas Exfiiccatus. — Exsiccated Ferrous Sulphate. Doae, 0.03 to 0.20 Gm.
(or gr. Bsiij).
Ferri et Quinine Citras. — Iron and Quinine Citrate. Dose, 0.32 to 0.65 Gm. (or
gr. v-x).
Ferrum Redactum. — Reduced Iron. Dose, 0.065 to 0.32 Gm. (or gr. i-v).
Ferruro Tartaratum. — Tartaratcd Iron. Dose. 0.32 to 0.05 Gm. (or gr. vx).
Liquor Ferri Acetatis, — Solution of Ferric Acetate. Dose, 0.30 to 1 c.cm. (or
mvxv).
Liquor Ferri Perchloridi. — Solution of Ferric Chloride. Dose. 0.30 lo 1 c.cm.
(or tt»v-xv). Compoimd of one part strong solution and three parts of distilled
water
Liquor Fcrri Perchloridi Fortis. — Strong Solution of Ferric Chloride (100 c.cm.,
or fSxxvij, contain 22.5 Gm., or 5v Vi, of iron).
Liquor Fcrri Pernitratia.— Solution of Ferric Nitrate. Doae, 0.30 lo 1 c.cm. (or
fMV-XV).
Liquor Furri Persiilphatis. — Solution of Ferric Sulphate.
Mistura Ferri Composita. — Compound Mixture of Iron (ferrous sulphate. 2.5
Gm.; potasaiun* carbonate, 3 Gm.; myrrh, (I Gm. ; sugar. 6 Gm.: Rpirit of nutmeg,
4.5 c.cm; rose-water, 437.5 c.cm.). Dose, 30 to 60 c.cm. (or 5>'>j)-
Pilulft Ferri.— Iron Pill. Dose. 0.32 to 1 Gm. (or gr. v-xv).
Pilula Atocs et Fcrri. — Pill of Aloes and Iron. Doae, 0.25 to 0.50 Gm. (or gr.
iv-viij).
8yrupU8 Ferri lodidi. — Syrup of Ferrous Iodide. Dose. 0.30 to 2 ccctl (or
niv xxx).
Synipus Ferri Phoaphatis. — Syrup of Ferrous Phosphate. Dose, 2 to 4 c.cm. (or
f3sa-j ) .
Syrupus Ferri Phoaphatis cum Quintna et Stryehnina.- — Syrup of Phosphate of
Iron, Quinine, and Stryilminc. Dose, 2 to 4 c.cm. (or fSss-j).
Tinctura Ferri Perchloridi. — Tincture of Ferric Oiloride (strong solution of ferric
chloride, 25 c.cm.; alcohol. 00 per cent., 25 c.cm.; distilled water, q. a. 100 com.).
Dose, 0.30 to 1 c.cm. (or mv-xvl.
ITRRUII.
4G7
Troi ' rem Redacti. — R«duccd-Iron Lozenge (contains reduced iron, 0.066
C^ OC ^' a BUDple baais).
ViDuiii icjji. — Iron-wine (iron, 60 Gm., or 3xiij ; sherry-wine, 1000 com., or
Qxuivj, Do«e, 4 to 15 c.cm. (or f3i-iv).
Timim Fcrri Citratis. — Wine of Iron Citrate (iron and ammonium citrate, 160
; offuige-wioc, 20 fluid ounces). Dose, 4 to 15 c.cm. (or f3i-iv).
Fharmacology. — Iron is a metallic element, the most abundant, the
CNirt widely distributed and most nsefid to mankind of all the metals. In
Its pure slate it is nialleable and ductile, and the pharmacopoeia directs its
OK, therefore, in the pure form of "fine, bright, non-elastic wire/*' out of
which preparations should be made. Ferric Baits in solution or in crystals
*Te generally red, and the ferrous salts green; they are likely to be decol-
tinxed by drying and become white. The iron compounds are also known
ttchalybeates, or martial preparations; a large number are used in medicine^
Wsides those found as constituents in natural water. The chemical tests —
Tf^etable astringents containing tannic or gallic acid, alkalies and their car-
bonales, acidulous salts and mucilage of acacia — are incompatible with iron
preparations.
Phyaiolo^cal Action. — As one of the proximate principles of the human
orginifcro. and playing an important part in the red blood-corpuscle (as
lutmoglobin) in the nutrition of the body, iron is a necessary element in the
food. When applied to the tissues, most of tlic salts of iron exercise an
tttringent effect, producing coagulation of albumin. Some of the prepara-
iwDfiy notably the solution of the subsulphate and the chloride, are very useful
m coagulating blood and checking haemorrhage, when localJy applied. A
sinular astringent effect is observed in the mouth and along the alimentary
auial. One of the objections to the use of most of the iron salts in medicine
athe'fact that they cause constipation and headache. The phosphate and
pyroph«>£phate are exceptions to this, being non-constipating. Only a small
pro}>ortion of the iron administered is assimilated, the larger proportion be-
ing discharged with the fffices, to which a black color, due to the formation
of the sulphide, is imparted. The portion absorbed is largely thrown out
ipin in the bile.
Iron augments the amounts of urea and increases the frequency of mic-
tiinKion« Ihe tincture of the chloride especially being credited with diuretic
pcoperties. It has a tonic influence upon the nerve-centres, but improves
aatiition principally by its effect upon the circulation. While iron has little
iwver of increasing the number of blood-corpuscles in health, this power is
i^own very decidedly in conditions of onsemia or hydrapraia, the number of
irbbule« being rapidjy increased and the hflemoglobin of the blood gradually
broojrhl up to the healthy standard. The absorption of iron preparations by
the alimentary' canal is accepted, by Binz, but he looks on them rather as
<timo!«»intr the blood-forming organs than as contributing directly to the
vmoglobin. llyaBheff* found Ihat salts of the heavy metals,
.;.... -, and manganose. administered in small amounts by the
\ia\e no appreciable ii»i1uence on the amount of hn'innglobin or on
N?r of the reds. Salts of iron, however, under tlie samo conditions
► fl marked effect in incren^iing the number of red.^ and the
[amoaot of ha'mogloliin. It is evident that iron not only stitnnlnto-^ the fuiic-
■
ifrwl*^* ^t- Het«rsburg, November 2, 1001.
408
niAUMACELTICAL TillittArKrTlC AUENl'tj UU DHUUS.
tion^ i)( the bloud-ijruducing organs, but directly. aids in the productiou of
iiaiiio^Hobiii. Tilt iniiuL'uce of tlie iron is tirst manifested in tlie increased
niiiitIxT uf red eorpiiseles; the inercase in the hajniogiobin is a later phe-
noniL-noii. The eosiiiopliiie cells also increase to a remarkable proportion
under the intluenee nf iron. Thit? is not ob8er\ed in animals nor in other
conditions in mini. The eot:in grajudes contain iron and apparently in a
stable organic tojubination, &a they give the iron reaction with ammonium
sulphate only after twelve to tAventy-four hours. It is supposed that the iroa*
present in the blood-corpuscles has the property of couvertiug oxygen into-
ozone, and tliat it thus promotes oxidation. The heart is also toned up byi
the etfecta of the imu pn'prtrati*ms, probably owing largely to tlie stunuhis«
of a belter bluod-f?upply to its walln. Tlie stomach is stimulated by iha
astringent action of the iron, und the nppetitr* and digestive capacity are im-
proveil under small doses not Un) loxij; ciintiuued.
As couhnnalory of this view, A. llotfmann, of Ilalle," Ims found that
absorption and excretion of iron tak^ place in the small intestine in man,
andj also in animals, in the colon, in recent observations he determined the
fact that all forms of iron were absorbed in the duodenum and entered the!
circulation iu transport-cells combined with albuminous matter in a com-
bination which had no toxic action. There was no apparent increase in thei
coloring matter of the blood from the use of iron. In fact, iron has a stim-'
ulating action on the physiological activity of the bone-marruw, and accele-l
rates the ripening and entrance into the circulation of the young cells; ihel
annclear erythrocytes. The action of the iron depends directly upon the I
fpiaiuity ahsdrbed. Iron slightly raises the t(?mperature of the body partlyi
by increasing lissue-wai^tc, partly by its ozoniziJig ctTccts. 8ome of ihsi
stnjngcr preparations— isuIphatcSj nitratCj iodide, and cldoride — are irritant,'
and, in large doses, poisonous. An acneic eruption sometimes results frora|
the intcnial administration of iron. |
Therapy. — The styptic qualities of iron are best shown by Monsel's solu-i
tion and the chloride, in powder or solution, when applied directly to thai
oozing surface, as in surgical operations, post-partum ha?morrhage, hrcraor-l
rhage from the uterus after miscarriage, or cancer of that organ, i
The resulting clot is very tough and dark colored, and makes a dirty, |
disagreeable mass, so that, io ordinary surgical practice, iron is rarely used*
as an hBemostatic, when a substitute can be found. In some forms of uterine I
hemorrhage Monsers solution may be used, diluted (1 to 24) or applied in'
full strength, upon a small swab to tlie inner surface of the uterus, if the oa;
has been previously dilated; or the vagina may be temporarily packed with|
tampons of absorbent cotton wet with a 5-per-cent. solution. . |
In epistaxis, or haemoptysis, a spray of 1- or 2-per-cent. strength of]
Monsel's solution may be inhaled. Excessive haemorrhage from leech-bites
or after the extraction of teeth may be controlled by the direct application
of the same agent. A solution of the subsulphate may be successfully used I
to restrain bleeding from hieniorrhoids. The snme preparation is etfectivel
in destroying syphilitic vegetations. Fissured nipples may be cured by paint-
ing them with a mixture of 1 part of Monsel's solution to 3 or 4 of glycerin.
A spray of the subsulphate is beneficial in chronic ozsena. In erysipelas the
tincture is an excellent local application. The astringent preparations of
' Miinchener mediscinlsche Wochenschrift, 1899, No. 29.
FEIIRUM.
4C9
I
I
iioa may be used with good effect as iDJections ia gonorrhcea and gleet. Two
tcm. (or fSss) of the tincture to Va pJiit of water, with 4 c.cm. (or foj) of laii-
dtnum or 0.75 Gm. (or gr. xij) of the sulphate to the same quantity of water
ind Uudanum, are forms in which iron may be used for this purpose. These
•riutions of iron, however, are open to the objection that they stain the.pa-
tirat's clothing. A liquid containing an astringent salt of iron is also a serv-
keable wash in leucorrhoea. In tonsillitis, pharyngitis, and diphtheria the
■me agent may be applied directly to the throat, either pure or diluted with
an equal qrmntity of glycerin; thas application is sometimes painful, but is
TPTj efficient. The tincture of ferric chloride, though less astringent than
MoDsel's solution, may be used locally in the same way. In diphtheria it
tan be administered internally in this form, and if, as is usually done, the
preparation is suitably diluted \sith water, and then taken through a glass
tnbe (so as to prevent the iron from staining and corroding the teeth), the
»lotion will come directly in contact with the pharynx as it is swallowed,
tod thus combine the local and systemic effects. In such cases it is some-
times prescribed in combination, as follows: —
B Tinctune fcrrl chloridi 30] c.cm. or fjj.
Potassii chlomUs 4 Gm. or 5j.
Syr. aurantii 60] com. or f^ij.
M. Si^.: Half a l«flspoonful to a teaspoonful every two hours, in water, in diph-
ll«ria or eryiipelns.
These styptic preparations have also been injected into naevi and vas-
cular tumors, to produce coagulation of their contents, but death has resulted
from the escape of some of the fluid into the general circulation.
Th*^ tincture of iron is a beneficial local application in certain affections
"f n It will in some instances relieve para?sthnsia and the itching
** impanies eczema. The conjoined internal and external use of this
preparation ie frequently of advantage in chronic disorders attended by sup-
pumtioD, as pustular eczema, impetigo, ecthyma, and rupia. A combination
of tincture of iron and glycerin has been serviceably applied in herpes.
Tlic principal emplo}Tnent of the iron preparations is for their effect
upon haeraatosis. They are pre-eminontty useful in cases of anaemia, hydrae-
mia. or chlorosis, and in many cases of debility. The well-known Basham's
mixttjre, or solution of iron and ammonium acetate (U. S. P.). is very com-
oonly given to overcome the anaemia of chronic Hrighfs disease of the kid-
Dej. Dr. James Tyson has called attention to the fact, however, that, as
Ttf^ris the degenerative and inflammatory conditions in the kidneys, it ifl
act always beneficial and, in fact, is often very injurious * Dr. Tyson says
that it should not be given in any case of acilte Bright's disease, nor where
Ihere ia not anaemia. If it causes headache, constipation, and reduces ex-
erctioD by the kidneys, it is doing harm.
Pr Andrew Smart, of Edinburgh, has found, by means of the apparatus
esiploytd for estimating the number of corpuscles contained in a specimen
of blood, that the sulphate is the most valuable preparation of iron in the
tratmcnt of ana?mia and chlorosis. The carbonate comes next in order of
fficiencT^ and the syrup nf the protochloride occupies the third place upon
the list. A combination with arsenic increases the efticacy of the sulphate.
*/ommat of the Am^can Medical A$aorUilion, July 23, 1898, p. 172.
n
470
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
The preparations of iron should not be used in plethora. As they all,
to a greater or less degree, interfere with the digestive function, checking
the secretions along the aiimeutary tract, and frequently constipate, the
state of the stomach should always be considered when prescribing iron.
Where the tongue is red and dry, as Fothergill has shown, iron always dis-
agrees, and should not be ordered. On the other hand, a pale, broad, and
flabby tongue, marked by the impression of the teeth, is especially indicative
of the demand of the system for iron. There are great differences in this
respect, however, between the several preparations of iron, and new chalyb-
eates are being constantly brought forward with the recommendation that
they do not derange the digestion nor produce constipation.
One of the most efficacious of the ferruginous preparations is the tinct-
ure of the chloride, but, in addition to its disturbing effect upon the diges-
tion, it is open to the objection that it stains and corrodes the enamel of the
teeth. This action is due to the presence of free hydrochloric acid. It ia
customary to direct patients to largely dilute the lii^uid, to imbibe it through
a tube, and to clean the teeth, immediately after taking the medicine, with a
weak alkaline solution. The virtues, without the disadvantages, of the tinct-
ure of iron seem to be possessed by a preparation devised by Dr. George W.
Weld, of New York. This syrup of the chloride consists of the official tinct-
ure with the excess of acid neutralized and a certain amount of the syrup of
gaultheria added for the sake of palatability. Each fluidounce coatains 24
minims of the tincture. It is said not to injure the enamel and not to derange
the digestion.
In ameiiorrlia'a, Bland's pills of carbonate of iron are of great service,
or the compound mixture may be used with excellent effect. Iron is of most
value in simple anamia, such as that following haemorrhage; it is of less
service where the anasmia is symptomatic and accompanies organic diseases
or blood poisoning. In such cages it acts more quickly when given hypo-
derraically, the ammoniocitrate dissolved in distilled water being preferred.
This salt has been successfully employed in the same manner for the
relief of subacute or chronic eczema, associated with or dependent upon
anaemia.
Da Costa extolled the citra'te of iron and manganese, administered
hypodermically, in anwmia. Professor Eummo injects every day, into the
interscapular region, half a eyringeful of a 1 to 10 solution of iron and
ammouiuni citrate in distillerl water. No inflammatory action is excited.
Dori has applied this method with success to chlorosis. As a result of
a comparative study lie states that the most satisfactory and rapid results
were obtained from the injection of iron and ammonium citrate. The usual
daily dose administered was about 0.065 Gm. (or gr. j).
In advocating the subcutaneous injection of iron in anaemia, Dr. Enrico
Magagni contends that when introduced by the mouth it is borne by the
portal system to the liver, which alone it directly influences, while upon the
hematopoietic organs it can only exert an indirect and altogether feebler
effect. When thrown under the sldn it is able to act directly upon the whole
blood-forming apparatus. A larger actual dose is, by this method, absorbed
than when it is given by way of the mouth. In consequence of the more
rapid absorption a more rapid effect is obtained. As the most convenient
place for injection Magagni recommends the nates, where the pain is almost
imperceptible.
FERRUM.
Th€ anaemia which results from chronic malaria is very amenable to the
ialocnce of iron. The enlarged spleen of malaria diminiBhes in size and
mtUnal neuralgia is relieved. Iron is of constant Eervice in the treatment
of Xketmlgia^ which so often depends upon a condition of anaemia: —
B )Imm. fcTTi carbonatis
Kxtncti liyoicyami
Podophyllotoxin
Quinintc sulphatis
M. et ft. pil. no. xij.
Sig.! From four to six pills a day, for neuralgia.
1
65 Gm. or gr. xxiv.
32 Gm. or gr. y.
065 Gni. or gr. j.
75 Gm. or gr. xij.
R Frrri et quinin»e citratis solubili:} 7{5
Liquor potas<^ii arsenitia HS
Elix. guaranae q. s. ad {K)|
M. Sig.: A teaepoonful three or four times a day. Use in malaria and neuralgia.
Gm. or 3ij.
c.cm. or f3ij.
c.cm. or f3iij-
Improvement takes place in pseudoleuksemia, or Ilodgkin's disease,
when iron is administered, especially in conjunction with arsenic, though,
the chalybeate preparations are of no utility in true leiabemia: —
R Ferri pyropho^phstis
ArMsni trio\i«li
Exlracti nucls vomicie
Extracti bellndonne folior. . .
M. et ft. pil. no. xx.
Sig.: A pill three times a day.
60 Gm. or gr. xl.
005 Gm. or gr. i.
20 Gm. or gr. lij.
13 Gm. or gr. ij.
The tincture of iron is, at times, beneficial in acute rheumatism It is
in the case of weak and pale individuals that iron is likely to be of service.
In such subjects the same remedy is capable of acting, to a certain extent,
as a prophylactic. It is frequently judicious in syphilis, when accompanied
l>T evidence of profound deterioration of general nutrition, to suspend spe-
Ltific remedies temporarily, and place the patient upon a tonic course con-
rtaining iron, which may be favorably combined with quinine, strychnine, or
ign«lin.
An eflScient mixture made use of in the Skin Clinic of the Post-graduate
School of New York is thus composed: —
B Ferri et aromon. citrat 4
Hydrarg. chlor. corr
Fotasa. iodidi 8
Vini ferri dulris (Malagn) q. s. ad 00
Sig.: Teiiftpoonful in water after meals.
Gm.
0<56 Gm.
Gni.
c.cm.
or 5j,
or gr,
or Ai|
or fSiij.
J.
In the so-called gonorrhceal rheumatism iron will generally be found
ppntageous. Hecquet for nearly twenty years has used ferrous bromide
liervous affections, and Da Costa found it useful in chorea. This salt has
ibo bten recommended as of service in leucorrha-a, diabetes, and tubercu-
is.
Anaemic epileptics are benefited by iron, which may be very appropri-
Irly given in the form of the bromide and combined with potassium bro-
Je, «:—
472 PHAKMACEUTICAL TllEnAPEUTIC A0ENT8 Oil DlirOS. ■
B Potasaii bromidi 2313 Om. or 3vj. ■
Synjpi ferri bromidi 22| ccm. or f3vj. H
Tincture chiraUCj H
^m Klixir aromatici aa 301 c.citi. or fSj- H
^B Aqufc cinnamomi q. s. ad 180| v.cm. or fjvj. H
M. Dose : A Ublespoonful three times a day.
Dr. Rosenthal advises subcutaneous injections of iron in nen'ous dis-
orders. He prefers either the ferrum pcptonalum, a syringeful of a 1 to 10
aqueous solution being given every second day, or ferrura oleatum, diluted
to 1 to 20 by olive-oil and used in the same manner. Ferrum peptonatum
has the advantage of greater solubility and stability. It is obtained by the
decomposition of ferric-chloride solution with solution of pepsin and occurs
as a brownish-yellow powder.
The following combinations containing iron may be employed with good
effect in gonorrhoea and syphilis: —
3 Pilulae ferri iodidi 4| Gm. or Sj.
Kxtracti ignatiie.
Extrat'ti U'lludonntw folior na jl3 Gm. or gr. ij.
M. et ft. pil. no. XXX.
Sig. : From four to six piUs a day in gonorrhoeal rheumatism and in gleet.
K Ferri phosphatis,
SaloUe aa 101 Gm. or gr. cl.
TerebenflB 7|5 ccm. or fSij.
M. et ft. capsuls no. xxx.
Sig.: Three to six capsules a day in gonorrhoea, gonorrhceal rheumatism, and
cystitis.
R Ferri et potassii tartratis 81 Gm. or 3ij.
Arsonii irioxiJe • |065 Gm. or gr. i.
Extract! cocje 4; Gm. or oj.
M. et ft. pil. no. xl.
Sig.: Two pills three times a day in syphilis.
H Liquor ferri maUtiSi
Aquffi cinnamomi,
Glycerini aa 301 ccm. or f Jj.
M. Sig.: One to two teaspoonfuls in water three times a day for syphilis with
irritable stoniach.
I^ Ferri laetatis 21«0 Gm. or gr. xl.
Extracti cnnnabia Indictee 110 Gm. or p*. iss.
Extract! rhamni purshiansB [20 Gm. or gr. iij.
M. et ft. pil. no. xij.
Sig.: A pill three or four tini9s a day in syphilis.
B Syrup, ferri iodidi 15| ccm. or fjss.
Fluidoxtrapti nucis vomica! 3110 ccm. or ml.
Aque cinnamomi 75| ccm. or fjiiss.
M. Sig.: A teaspoonful three times a day for infantile syphilis.
• Hysteria, especially when associated with anaemia and amenorrhoea, is
unproved l>y the systematic administration of iron.
In order to overcome the tendency which exists in neurasthenia to pal-
pitation of the heart Zerner makes use of: —
FEBRUM.
473
60 Gm. or gr. Uv.
c.cm. or fi-sa.
Gm. or 3iij.
e.cm. cr fSvj.
c.cm. or fSiiiM.
Gm. or 3ij.
32 Gra. or gr. v.
30 c.cm. or mv.
E Fcrri pyrophoephat.,
Zinei bromid aa 31
Tr. digitalis 15
Kxtracti ergoUe 12
Syr aurant. 22
Aq destni 105
11 Sig.: From one to three teaapoonfuls a day. ■
Certain cerebral disorders depend more or less inimediately upon ante-
miB, as some forms of puerperal mania and the insanity of lactation; chronic
Bunia and melancholia, also, are not infrequently due to impoverishment
of the blood. In all these cases the tincture of ferric cliloride is a valuable
remedy. The continued use of iron is very beneficial in rachitis. In this
diie«ae a combination of the ferric phosphate and calcium phosphate is espe-
ciallj advantageous: —
H Ferri phosphatis EolubillB,
Calcii pho«phfltis priBcipitat. aa 8
Extracti nucia vomic«
OL eucalypti
M. et ft. pil. no. xl. H
Sig.: Two pitU three times a day. ^
The stj'ptic preparations of iron, given internally, are useful in haem-
«nhtge. A drop or two of the nitrate or subsulphate solution, given in ice-
titer und frequently repeated, will usually check bleeding from the stom-
ach; 0.30 to 0.60 c.cm. (or niv-x) of the tincture given upon shaved ice
irtry half-hour is recommended in the hemorrhagic vomiting of yellow
lever. The tincture of the chloride is an excellent remedy in hamorrhage
from the bowels or kidneys, and in purpura haemorrhagica. Iron is useful.
likeuife, in the treatment of menorrhagia. Profuse discharges from mucous
fi^embrane?, due to chronic inflammation, are restrained by the exhibition
of iron, which acta as an astringent and at the same time favorably modifies
the nutrition of the cells. Chronic diarrhoea and dysentery, chronic bron-
chitis, proetatorrhoea, gleet, and leucorrhoea are ameliorated by a chalybeate
Dilatation of the stomach, dependent upon or connected with
I, is sometimes improved by the administration of iron, and, owing
tft it^ beneficial efl'ect upon the mucous membrane, the svrup of iron is
oieful in the treatment of thread-worms. (?'our c.cm., or f.lj, of the tinct-
ure to 240 c.cm., or Oss, of water is a good rectal injection when these para-
files are present.) By maintaining the quality of the blood and promoting
Dntrition, iron is of service in phthisis and emphysema. Affections of the
^H^T' :i''Iy imj^roved by this remedy. In fatty degeneration, dilata-
PHHfi' ;.ir disease, iron is demanded, in order to maintain the quality
«Ttne bl*x«l and the nutrition of the heart and to promote compensatory
growth. Tht* amemia and indigestion of Bright^s disease also receive benefit
from thi« remedy, especially in the form of the tinctnre of the chloride or
ac«ta1e.
Bamberger prefers to use a pill containing 0.02 Gm. (or gr. V,) of ferric
diloride, thrrc to six pills being given in the course of the day, or a pill of
UmfOB sulphate as recommended by Wiethe: —
B Krrri dulphaiis,
55od»i birarb aa 5| Gm. or gr. Ixxv.
Exl. tamxaci q. s.
ILet ft. pil, no, \\
Sig.t Three pilU to be given in the ntoming and three In the evening.
4T4
FHARMACECTICAL TIIERAPKCTIC AGENTS OR DflUGS.
25
c.cm.
or fSiiss
13
Gm.
or gr. ij
or fSiisa
25
c.cm.
5
c.cm.
or f5v.
c.cm.
or fjiv.
In addition he regulates the diet and administers decoction of cinchona-
bark.
The nocturnal incontinence of urine in children often yields to iron.
This is especially tiue of strumous children, for whom the syrup of the
iodide is the beet preparation. Iron is remedial in spcrmatorrhtTa when that
affection is the result of anspmia and relaxation. Both amenorrhcea and dys-
menorrho-^a are often due to irapoverij?hed Ijlood, and, wlitai this is the case,
are best treated by iron. The menstrual irregularity, ana^niu, and neuras-
thenia so often seen in overworked and luuk-rfed women in our ^reat cities
are conspicuously benelitcd by the adniinislration of the **four chlorides,' as
introduced by Professor G^hkIpII. Tho ^ombinjitixm may be made as fol-
lows:—
li Tinct. fcrri cliloridi 9
Hydrarg. chloridi corr
Liquor arscni fhloridi 9
Acid, hydroclilorici di\ 18
Synip. siinpliLis . . q. s. nd 120
M. et ft. Bol.
Sig.: Teaspoonful in venter three times a day.
The vasomotor disturbances incident to the menopause are often re-
lieved by full doses of the tincture of iron, ^iven several times a day. Phat^e-
dfcna usually occurs in dissipated and debilitated individuals, and iron in-
ternally materially assists the action of the appropriate topical applications.
Reduced iron, or Quevcnne's iron, is in such a minute state of sub-
division that it is readily acted upon by the acid of the gastric juice, and
generally agrees with the stomach. As it is tasteless, it may be given to chil-
dren in the form of chocolates, each containing 0.005 Gm. {orgr. j), and thus
forms an excellent tonic for anaemic and poorly-developed children. When
used for its systemic effect, small doses are as efficient as large ones; it is
best given when digestion is active^ — about half an hour after meals.
3 Ferri reducti 2160 Om. or f^. xl.
Sodii arsenntis 1005 P.m. or spr. j. ,
Extrnoti ipnntifp |3'2 Gm. or gr. v.
Extracti gentianae 1|.1U Gm. or gr. xx.
M. et ft. pil. no. xx.
Sig.: Take one three times a day, after meals, aa a general tonic for an adult
It is well to bear in mind that the prolonged administration of iron is
liable to cause intestinal concretions.
The diuretic action of the tincture of the chloride ia aided by saline
combination. Thus, in chronic Bright's disease of'the kidneys with oedema,
we may give: —
Ji Tinrt. ferri cliloridi.
Arid, phosphoric, dilut aft 715 c.cm. or f3ij.
Glycerini 30| c.cm. or fjj.
Liq. ammonii acetatis q. s. ad 180| c.cm. or fjvj.
M. Sig.: A tablespoonful three or four timei daily in dropsy attending Bright'g
disease or pregnancy.
Instead of this, we may order the official solution of the acetate of iron]
and ammonium (Rashnm's mixture), or the following: —
FEHRDM.
47S
B Tr. canUiaridia 41 c.cm. or fSj.
Tr. fern chloridi 60[ c.cm. or fjij.
M. Sig.: Give twenty to thirty drops, well diluted, four times daily, to be taken
llsovgli a gbuB tube, in gleet.
The eynip of ferrous iodide is valuable in strumous skin diseases, in con-
junction with eodJiver-oil. The same remedy, alone or in conjunction with
codliver-oil, is of undoubted efficacy in the treatment of enlarged strumoua
glands prior to the occurrence of caseous degeneration.
In erysipelas comparatively large doses of the tincture of the chloride
«re well borne (2.50 to 4 c.cm., or mxl-f3j, every two hours) and exert almost
1 specific effect, rapidly checking the force and progress of the disease.
Special Preparations. — Among the best-known preparations are the
solutions of ferrous malate and of dialyzed iron, both of which cfiuse very
little disturbance and rarely constipate. Tliat ihe latter does exert astrin-
gent effects, however, may be inferred from the fact that Dr. W. Judkins
has found it a useful remedy in the diarrhrea of childhood. Laevulose
ferride is another very eligible preparation of iron, difTering, in many re-
fpectt, from the others. It is of alkaline reaction, agreeable to the palate
and the stomach, and, it is said, can be mixed with the ordinary fluid ex-
tracts and tinctures without causing chemical union between the iron and
the tannin and the formation of insoluble tannates. Iron albuminate i? an
■romatic, reddish-brown, alkaline solution, which is said to be more readily
assimilable than other iron salts, less frequently the cause of gastric dis-
order, and is promptly assimilated, causing rapid increase in the globular
richnees of the blood. It may be given in milk (Dumont). Dr. J. A.
Ouchterlony* finds it especially serviceable when anaemia and debility are
ftaM>ciated with weak and irritable digestive organs.
The following are .^onie modern organic preparations of iron: —
Liquor Man^no-Ferri Feptonatus. — Dr. Gude has prepared a solution
flf iron and manganese which is well adapted to the treatment of chlorosis,
aiuemia, and the various secondary ailments which depend upon a deficiency
of red corpuscles and hemoglobin. This solution is a clear, dark wine-
colored fluid, of an agreeable, astringent, but non-metallic taste. It is given
in the dof^e of a dessertspoonful to a tablespoonful three times a day, and is
^•cc-entably administered in milk. This preparation increases the appetite
nd nas no prejudicial effect upon digestion. It can be steadily taken for a
iong period.
Haemogallol. — This substance is obtained from hjemaglobin by treat-
ment with pyrogflllol. It is a reddish-broM-n powder, and is given in the dose
of 0.13 to 0.50 Gm. (or gr. ii-viij). Hsemogallol is without taste and has no
disturbing effect upon digestion.
Hiemol. — Hn?mol is the zinc compound of hffiraoglobin prepared by
treatment with zinc dust. It is of a blackish-brown color and its dose is the
mme ts that of heraogollol. Haemol has but a slight taste. Both haemogallol
•ad haetnol can be readily administered as powders in wafer or mixed with
rtnd placed dry upon the tongue. They are readily absorbed and slowly
Itidnated. They have been beneficially employed in chlorosis, ansemia, and
dependent conditions, and Dr. W. H. Porter, of New York, has given them
in diabetes mellitus with reported good results. These preparations are
•Coir>»"nni'«'ton to LouisviUe Clinical Society. Oct 22. 1886.
4
4
I
47(:
PHARMACErXICAL TIIERAPEDTIC A0ENT8 OU DRlHiS.
regarded as of particular service in the ana?raia which accompaDies Bright's
difiease.
A number of metalh'c compounds of hscraol have been prepared and
proposed as substitutes for older salts. Bromhasmol, containing 2.7 per cent,
of bromide, has been experimentally used in epilepsy. Cuprohflemol, in which
2 per cent, of copper is embodied, and the dose of which is 0,10 to 0.13 Gm.
(or gr. isfi-ij), is thought to be serviceable in anaemia, scrofula, and tuber-
culosis. Ferrohaemol is a compound of iron and ha^mol; its dose is 0.50 Gm.
(or gr. viij). lodahsmol contains 1.66 per cent, of iodine. Mercuroiodo-
hfiemol is composed of 12.35 per cent, of metallic mercury and 26.68 per
cent, of iodine, in addition to the ha;niol. Metallic zinc in the proportion of
1.01 per cent, enters into the composition of zincohaemol, which is said to be
very useful in diarrhea and chlorosis.
Oviferrin. — A pennancut, organit; (oitii>iHind of iron and albumin of
egg, discovered by Barixt's and Uille, of Philadelphia. Its choniioa! forniula
is C^.Ni-SHjFegOa,. It is a clear ruby-red solution, the usual dose of
which is 15 com. (or Jss) (corresponding to 0,0G5 Gm. (or gr. j) of reduced
iron). It does not cause disturbance of the digestive function, nor cause
constipation. The autJior has found it very valuable in anaemia, and in
rheumatic and neuralgic condiiions. It is almost tasteless, and is readily
takt^n l>v chiklren.
Ferratin, — This name has been given to a fine powder, reddish brown
in color, obtained by Professor Schmiedeberg, of Strassburg, from hoge'
liver. Ferratin, as a rule, contains 7 per cent, of iron. Ferratin is believed
to be identical in form with the iron as contained in food. It occurs in two
varieties, one of which is insoluble in water, while the other, combined with
sodium, is readily dissolved in water by agitation. Water containing lime
forms with it an insoluble calcium ferratin. The daily dose of ferratin is
from 0.10 to 0.45 Gm. (or gr. iss-vij) for children and from 1 to 1.30 Gm.
(or gr. xv-xx) for adults. Ferratin has been found valuable in the treatment
of anemia, and especially of chlorosis.
HBBmofcrrum. — This is another new preparation of iron described as a
natural proteid compound of iron obtained from bullock's blood. The ad-
vantages claimed for it are palatabiiity, solubility, and freedom from dis-
turbing effect upon stomach or bowels. It is given in 0.20 Gm. (or gr. iij)
doses for the relief of debility and anaemia.
Iron-quinine chloride, a yellowish-red powder, soluble in water, alcohol,
and glycerin, has been used, both externally and internally, as a hemostatic.
In hremorrhage from accessible mucous membranes n concentrated solution,
or the powder itself, may be applied to the bleeding surface. Gastro-intes-
tinal and pulmonary haemorrhages may be treated by the internal adminis-
tration of this substance. The dose is from 0.10 to 0.20 Gm. (or gr. iss-iij).
FICUS (U. S. P., B. P }.— Fig.
Preparation .
Confectio Sennoj (U.S. P., B.P.). (See Senna.)
I
4
Phannacolo^. — The fig-tree is a native of the south of F^urope and is
cultivated in the southern part of the United States. The ofTicial part is
"the partially dried fruit of Ficus earica (Moracea^),'- which has a pleas-
ant taste. Figs are used as food, and contain G2 per cent, of sugar, with
PORILVLDEUYDLM.
477
f«t, salts, eic, Slus^i ha^ obtained from tlie leaves and steniB a new
£erBbent-Uke principle, which he terms craJine. It is said to be more encT-
getic than prpsin, and acts t-itber in an acid or uikaline medium. It has
BO mfluence upon carbohydrates, but its action upon fats lias not yet been
ifctidied.
Thermpy. — Fi^s are slightly laxative, and may be used to correct a ten-
dniL'T to constipation, especially in children. The seeds act mechanically in
stiiuuUting peristalis. Split open and lieated, they may be used, particularly
in tho mouth, to fulfill the indications of a poultice. The proprietary syrup
of fig» i^ aaid to owe its laxative quality to senna leaves.
mix MAS { B. P.).— Male Fern.
J>PO
Aspidium (U. S. P.),page 23T.
FLITOEESCEIH. — This is the name given to a body which results from
heating together resorcin and phthalic anhydride. It is of acid reaction,
ind, wben freshly precipitated, readily soluble in ether and alcohol, slightly
wluble in hot water, more freely soluble in alcoholic solution. Fluorescein
B of a dark-brown color, becoming green when added to water, and the
lolution exhibiting a beautiful fluorescence. Pluorescin is made by heating
inorescein with a solution of caustic soda and zinc dust.
Therapy, — Fluorescein and fluorescin are of service from their property
of staining abraded corneal surfaces, by which means such lesions may be
mdilv located. They have no effect in idcers of the cornea or interstitial
kentitis. These substances may be used also for the purpose of determining
the permeability of stricture of the nasal duct. Forced into the canaliculus,
tf there is the least opening: through the occlusion, some of the green solu-
tion will find its way into the nose. Sixty-five centigrammes (or gr. x) of
other substance may be dissolved in 30 c.cm. (or fjj) of water by the addi-
tion of 0,50 Gm. (or gr. viiss) of sodium bicarbonate.
FCENICTTLTTM (U. S. P.).— Fennel.
FCENICULI FBITCTTJS (B. P.).— Fcnnel-fniit.
Do»e, 1.30 to 2 Gm. (or gr. ix-3s8).
Preparations,
OUuin F<BnicuU (U.S. P.). — Oil of Fennel. Dose, 0.30 to I c.cm. (or mv-xv).
Aqua Funiculi (U. S. P., B. P.).— Fennel-water. Dose, 7.5 to 30 c.cm. (or fSii-fSj).
Phannacology and Therapy, — "The dried, nearly ripe fruit of Foini-
ndum Yulgare (Uml>ellifer«?)'' contains an agreeable volatile oil (3 per
rrnt.), which i* u.-^d as a flavoring and carminative. It is an ingredient m
the compound infusion of senna and conipound spirit of juniper (U. S.
P,>, ftod (■<»TiifH>iind licorice-|)ow(ler (U. S. P., B. P.). Fennel-tea (in-
foiioti! ft t« V3 (Jm. to 473 c.cm.. or Sij-iij to Oj) h used to relievo colio jn
in' ■' iicnorrlKva. The oil may be arlded to purgfltivr medicines
d-' [trcventing griping. Frnnd luis been th(»ught to linvo an
tnfloimcv in pn>inoting the secretion of milk.
rORMALDEHYDUM.— (See Liquor Formaldehydi.)
478 PllAUilACEL'TlCAL THERAPErTIC AGENTS OH DRUGS.
FEANGULA (U. S. P.).— Prangula (Buckthorn).
Preparation.
(U. S. P.).— Fluid Extract
of Frangiila. Dose,
Fluidextractum Frangulse
2 to 4 o.cin. {or f3s8-j ).
Pharmacolog^y. — "The dried bark of Hlianiiius Frangula (Rharanaceas),
<»flllected at least one year before being used.-' It is a European species of a
plant of which this country has a valuable variety in the California buck-
thorn, or Cascara sagrada. (See Bhamnus purshiana. ) It contains a
lenion-ycllow^ odorlei^s, and tasteless glucoside. Frangulin (or rhamnoxan-
thin). insohible in water, but soluble in alcohol or ether. The recent bark
ciintaiiis a gastro-intestinal irritiint, which is lost or modified by age, and
tlierelori' it is directed tliat only bark that lias been dried for a year shall
be used. Old bark contains Emodin, probably the most valuable constituent.
The fluid twtract is made with diluted alcohol, and better represents the
bark Ihan the preparations made simply with water, as the decoction (1 to
10) or the c\tnu-t.
Frangula conmiunicates a deep-yellow hue to the urine and faces.
Therapy. — Frangula is a good laxative or purgative, resembling senna
in its action. It can be used during pregnancy and is improved by the ad-
dition of a small amount of Bome aromatic to prevent griping.
FEANKEinA. — Frankenia, Yerba Reuma. A California plant, the
Frankenia grauditlora (Frankcniaccn?), is recommended as a mild astringent.
It is best given as a fluid extract, made with diluted alcohol, iu diseases of
the mucous membranes, as catarrh^ leucorrheea, gonorrhoea, etc. Dose, 0.60
to 1 c.cra. (or wx-xv) uf the fluid extract.
It has also been used with rejiorted success as a local application in
chronic rhinitis and oza?na, preferably in the form of a spray.
FRASERA. — Frasera, American Calumba. The root of Frasera VValteri
(Gentianea?) contains a bitter principle, Gentiopicrin, and a yellow, crystal-
lizable substance, Oentisic Acid. It is used hke gentian and other vegetable
I bitters. The fluid extract (alcoholic) is the best preparation. Dose, 2 to 4
c.cm. (or mxxx-f/Ij), several times daily, as a bitter tonic and gastric stimu-
lant.
FRAXINTJS, — Ash. The dried bark is bitter and astringent, contain-
ing bitter glueosidcs. Fraxin and Fraxetin, tiinnie acid, and volatile oil.
It has been used in infusion in the treatment of intermittent fever. An
infusion of the leavi^s has aNo bom used; they are dinphorotic. diuretic, and
purgative.
FTJCHSIK.^Fuchsin, RoBaniiine Hydrochloride, is a derivative of ani-
line, of special interest from the beautiful magenta-red solution which its
greenish crystals make with water. Like other preparations of this group,
it may happen to be contaminated with arsenic.
Dr. Elliot reports a ease of Pagct's disease in which remarkably good
results were obtained by the application of an ointment containing O.io Gm.
(orgT. iss) of fuchsin to 31 Gm. (or .5j) of lanolin and 26 c.cm. (or fSvij) of
rose-water. A 1-pcr-ccnt. alcoholic solution has been successfully used in
some cases of traumatic erysipelas. The intralaryngeal injection of a 2-per-
OALBANUM.
479
«i»t. waten' golulion of boric acid, saturated with fuchsiiij is said to be
beneficial in tuberculous laryngitis. When administered internally, it colors
the nrine and the saliva; and also the fluids of the body, since the vision is
effected (chromatopsia). It is claimed to have some influence over chronic
bdney disease and that some cases of albuminuria have been arrested by it
t^ven in doses of 0.03 to 0.25 Gm., or gr. ss-iv, daily, with some vegetable
rit7»ct). This remedy has likewise been administered with asserted advan-
tt^e IB typhus fever.
FUCITS VESICUL0SU3.— Fucus, Bladder-wrack, Gulf-weed. Fucus
vesiculosus is an al^'a, or unicellular plant, growing to immense size, forming
mimcB of sea-weed in the Atlantic Ocean, found principally in the gnlf-
ftream. It occurs in dried pieces of dark-brown or greenish color, with a
dtttgreeable, fishy odor, and a rather bitter, sea-water taste, it con-
tains mucilage, a bitter extractive, small amounts of iodine ami bromine,
with chlorides, phosphates, etc. It is supposed to be alterative and to have
the power of reducing obesity, probably from the observation Uiat pigs feed-
ing upon it in Ireland do not fatten. It has been used with ^onie suece?^ in
enlarged scrofulous glands, l>ronchocele, and psoriasis. The decoction (1 to
16) may be used before meals to take away the appetite for food, or if used
«rni it acts as an emetic. The fluid extract and solid extract are irrational
preparations; the only form in which in obtain the effects uf the plant is
tLr r«*ent dococ-tion. A charcoal from tlu* Ivavtv hns been um'd for L'oitre.
GALAHGA. — Galang;al, the dried rhizome of Alpinia otbcinaruni
(Ziiiifiberacea?), is a native of China, where it is highly prized as a nie<li-
cine. It is aromatic, resembling ginger and anise, and contains a volatile
<n\ and an acrid resin. Dose, 1 to 2 Gm. (or gr. xv-xxx).
Galanga is stimulating and carminative, resembling ginger or cubeb.
It is an ingredient in the powder for colds or catarrh, "catarrh snuff," and
'[also used in lozenges for pharyngitis and coughs.
GALBAITITM (B. P.).— Galbanum.
Dote. 0.25 to 0.50 Gm. (or gr. iv-viij).
Preparaiion.
PUulm Galbani CompoBita (B. P.). — Compound Pill of Gnlbanuzn (e^u>I parts of
MftfrlidA* myrrh, and galbanum). Dose, 0.25 to 0.50 Gm. (or gr. iv-viij).
Pharmacology. — A gxim-resin obtained from Ferula, galbanifltia (Fm-
U«llif«^rft*), and prubably from other allied plants. Like crude turpentine,
it crimes in tears or masses, often rough and dirty upon the surface. The
t«*te and odor are characteristic and warm, bitter, and unpleasant. Gal-
btnum contains a volatile oil, re^in (CO to 67 per cent), and gum. The
purified resin contains 20 per cent, of rmbellifcrone, combined and free,
tnd about 50 per cent, of Galbaresino-tannol (Conrady). By dry distilla-
tinr *-' -Titiful blue oil is obtained agreeing in its characters with oil of
>!,, chnmomilbi. By infusing galbanum with potasb, Hlasiwerth
i\i u'-\i ol.tained resorcin (see Eciorcimim).
Therapy. — A.^ a local applicatioUj it is stimulant, and the plaster is used
II « roan ter-irrit ant and resolvent over old swellings. Asafetida may be
H tinr
Ir
■i8(»
PIIARUACEUTICAL TIIEIUI'ELTK' AiJKXTS Oil DBrOS.
combined with it, as in tlic formeriy-oflicial nsafetida plaster. Internally it
is an expectorant and antii-[ia.sniudic. The couipoiind pills uf ^albanuui may
be used in chronic bronchitis; also in clironic rheumatism and rheumatic
affections. Some emmenagogic power has also been attributed to the com-
pound pills of galbauum.
OALEGA. — Goat's-me. Gakga oflicinalis and Galega apolinea (Legu-
minosa?), indigenous plants, stimulate the secretion of inilk. A watery ex-
tract possesses the properties and peculiar odor of the plant. In the daily
dose of 4 to (> Gm. (or .>i-ise), galega excites within a few days a notable
augmentation of the milk. According to M. de la Carriere, the increase
relates not only to the water, but to the globules also, as is shown by direct
analysis.
GALTUM. — Cleavers, Bed-straw. The whole plant of Galium aparine
(Rubiaceffi), a common indigenous herb, is used in domestic practice. Goliura
yields its virtues to water and alcohol, is bland to the taste, and devoid of
bitterness or astringency. According to Dr. Eckfeklt, it is aperient, diuretic,
and alterative. It may be used in the trcGtment of dropsy, incontinence of
urine, jaundice, icterus neonatorum, and strumous manifestations associated
with inactivity of liver and kidneys. Galium may be given in the form of an
infusion or a fluid extract, the dose of which k 4 to 7.5 c.cm. (or f3i-ij).
GALLA (U. S. P., B. P.).— Nut-gall, Galls.
Preparations.
Tinctura GfllUe (U. S. P.).— Tincture of Nut-gall (20 per cent.). Dose, 2 to 11
c.«m. (or fSsB-iij).
Unpuentum OaUm (U.S. P.. B. P.).— Nut-goU Ointment {2U per cent.).
Unguentum GaUae cum Opio (B. P.). — Call nnd Opium Ointment (gnU ointment,
92^ Gm., or 3xxiv; opium, 7.5 Gm., or 3i '/•)•
Pharmacology. — Galls are "excrescences on Quercue liisitanica (Cupu-
liferffi), U.S. P.; Quercus infectoria {B. P.) caused by the punctures and
deposited ova of the gall-fly, Cynips Gallie tinctorii^ (clas?* Insertn: order,
llymenoptoni).'' irails iirc small (2,5 cm., or 1 in., in diamet(»r), liard,
irrepilarly-sphoricnl Itndie?. Externally, they aiv dark green or j-'ray; in-
ternally, yellowish gray nnd dark in Iho centre, with a central cavity. The
important constituents are tannic acid (40 to 75 per cent.) and ^Mic acid
2 to ^^ per cent.). The Aleppo galls are considered to be the bo.*t ; light-
colored, spongy bulbs and go-callcd white galls are inferior. Their prepara-
tions are inconijiatihle with metallic salt? and generally form insolni)!(' pre-
cipitates with alkaloids.
The powdered galU are very astringent locally to the ekin and to the
gafitro-inteBtinal mncous membrane. Stockman doubts if they exert any
astringent eiTect in the blood or by systemic action; any such action he con-
siders as merely refle.v, from the effect upon the stomach.
Therapy. — In the form of ointment, galls arc used ns an application to
haemorrhoids: a drachm of powdered opium to each ounce of nut-gall oint-
ment is a good addition for this purpose. Nut-gall ointment is nl?o a useful
dressing to indolent ulcers, to eczema of the scalp after the srales have been
removed, to herpes, fissured nipples, chilblains, and alopecia circumscripta.
It ifi «1k) serviceable in prolapse of the rectum. Grose claims that an oint-
ment containing 1 part of powdered galls to S of vaselin is efficacious in ex-
ttnaive bums^ and that it restrains the tendency to subsequent cicatricial
mtnction.
The tincture of palls may he used, diluted with water, as a wash or
gmrgle; but, for internal use, gallic or tannic acid is preferable. An infusion
or decoction is sometimes made use of as an enema in diarrhoea and dysen-
lety. The aromatic .s}TUp of galls (containing galls, cinnamon, ginger,
hnndj, and sugar) is a pleasant astringent for children (dose, 2 to 4 c.cm.,
or«xxx-f3j). (See also Aoidum Gallioum.)
GAirRIH (IT. S. ?,).— Gambir. (Sec Catechu.)
GARBYA FREMONTn.— California Fever-bush, Skunk-bush. Garrya
Fr?m"!itii is an evergreen shrub found in tho higher localiiies of the niount-
= ' alifornia. The leaves, the port used medicinally, have little odor,
: .. ry bitter to the taste. Mr. D. J. Hoes claims^ to have found in the
Iftrrs a new alkaloid, which he terms Qarryine. Garrya possesses tonic and
intiperiodic virtues and is said to be a reliable cholagogue. Excessive doses
cause bnxiing in the ears. A solid and a fluid extract have been prepared.
The dose of the former is ,0.03 to 0.065 Gm. (or gr. ss-j) and of the latter
0.»;o to 2 c.cm. (or twx-xxx). Dr. Q, C. Smith, of Austin, Texas, writes that,
'■ '! ' \ r-rience of fifteen years, he regards this remedy as of more service
: ' ; ,...:uiic in treating ciironic or relapsing cases of malarial disease. He
sutes that it ifi of value, also, in acute pulmonary inBammatious.
I
I
GAITLTHEHIA.— Partridge-berry. Wintergreen, Tea-berry.
Preparations.
(U.S. P.).— Oil of Gaultheria. Doae, 0.12 to 1.20 c.ci
(oil of gnultheria, 5 per
Oleum GaulLheriGc
mB-xx).
Spiritus Gaultheriae (U.S. P.).— Spirit of Gaultheria
eret. in alcohol). Dose, 0.60 to 1.30 c.cm. (or mxxx;
^y•■'^m^ Ti.-iulic (U. S, p.), — Oil of Betuln. Oil of sweet birch (ft vtilntilo oil ob-
Ula^'i latinn from the bnrk of -sweot-birch, iilcntical with mcnthyl-salicyUta
lad D* ' ' ntical with oil of gaultheria). Dose, 0.06 to 0.3U c.cm. (or mi-v).
Uethjl Salieylas (U. 8. P.).— Methyl Salicylate. Artificial (or synthetic) oH of
vliltrgrecn. Doae, 0.06 to 0.30 c.cm. (or mi-v).
Pharmacology. — The Gaultheria procumbens (Ericaceie) is a small
plant grow'mg in the woods in North America; the leaves were formerly
official; thej contain a volatile oil^ Arbatin, Urson, Ericolin, tannic acid
€tc. The taste is aromatic, slightly bitter, and astringent; the flavor is agree
ihlf. Tlie volatile oil consists principally of Gaultherilcne and methyl
tahcylatc (99 per cent.), which yields a pure salicylic acid. The oil of sweet
hirrh is frequently sold for oil of gaultheria, with which it is nearly identical
Methyl wilicylas (U. S. P.) is the artificial, or synthetic, oil of wintergreen^
r he substituted for it. It is made by distilling salicylic acid with
1 nlcohol and sulphuric acid.
Therapy. — The oil of gaultheria is antiseptic and antipyretic. It may
be U6cd in doses of 0.60 to 1.20 c.cm. (or mx-xx) in articular rheumatiana
\al of Pharmacy, 1877.
I
I
483
PHAUMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
as a substitute for salicylic acid. It is efficacious, but is not as well tolerated
as sodium galicylate on account of its local irritant prnpertice. The oil, being
a salicyl compound, is also used internally in both acute and subacute artic-
ular rbeumatism with excellent results. In Bozzolo's clinic, where it was
first used for rheumatism, it is now looked upon as the most available of the
antirheumatics in the treatment of chorea in children. I'he oil of gaultheria,
combined with its own weight of vaselin, is employed locally over painful
points, and not only ameliorates the pain, but also acts beneficially upon the
chorea. SchoulP says that it is more particularly in the articular manifesta-
tions of rheumatism that it is successful, especially as a means of relievinp
pain, which disappears very rapidly under its administration, much more so
than with salicylate of soda. The swelling of the joints is somewhat longer
in disappearing, as is also the temperature, and salicylate of soda seems, in
this iiislance, more officacious. It is tht*refore proposed to administer the
two salicylates together, under which circumstances the similar dose of the
soda salt can be employed. Schoull has also employed a combination of
salicvlate of methyl and antipyrin, and has thus obtained some surprising
results in the reduction both of the pain and temperature. The author
points out that the amount of uriue should be watched during the adminis-
tration of this driig. Salicylate of methyl is also of extreme advantage in
subacute and chronic rheumatism, in which cases it presents a marked
superiority over the soda salt. The same may be said of gouty arthritis. In
certain other infective conditions as gonorrhcra, syphilis, and erythema no-
dosum, the effects, though good, are not so striking. The writer quotes
Koger as having obtained very good results in the arthritic complications of
eruptive fevers, especially scarlet fever, in which the action of antipyrin,
salicylate of soda, or salophen, is slight. The dnlg is also efficacious in neu-
ralgia, sciatica, some forms of neuritis, and herpes zoster,'and lit^htning
pains of tabes. Schoull has also tried salicylate of methyl in cases of orchitis
from mumps and with remarkable results, all the symptoms disappearing in
two days. Even in cases of epididymitis the efTucts are very favorable. The
treatment of mumps itself by salicylate of methyl has been tried by Picard,
of Troyes, with considerable success. Dr. John A. Wyeth, of New York,
regards the oil of gaultheria as a serviceable remedy in the treatment of
acute jjonorrhcca. He administers it in 6-drop doses three times a day.
The decoction of the leaves or a t^iiid extract may be used in bowel dis-
orders as an astringent. The infusion is in some parts of the country used
as a substitute for tea at the tabic. It is also used as a galactagogue and
emmenngogue. It is a good addition to liniments for rheumatic pains and
swollen joints. A combination of equal parts of oil of wintergreen and olive-
oil is n good application in such conditions.
Excessive doses of oil of gaultheria give rise to violent gastro-enteritis,
followed by convulsions, coma, and d«^ath. Half an ounce has caused death;
in another case recovery occurred after ingestion of the same quantity. A
child, two voars of age, died in convulsions, after swallowing 4 c.cm. (or
3j).=
Salicylamide, — This substance is made by treating oil of gaultheria
saturated ammonia-water. It has also been prepared from artificial oil of
Jnvrvnl dr M^tlerfnr. March Tfl. 1899.
Amfrirnn Journal of Mcdirnl Srientt'.f, Ffliruary, IWM.
GELSEMIUM.
483
»
en. Pure ealicjlamidc occurs in the form of colorless and trans-
stals. It is without taste and is moderately soluble in water. It
If claimed to possess the virtues of salicylic acid with greater analgesic power.
Sabcjlaxnide has been given in doses of 3 to 5 grains repeated several times
during the daj.
GELATHniM (U, S, P., B. P.).— Gelatin.
GELATINUM GLYCERINATUM (U. S. P.).— Glycerinated Gelatin,
Glycerin Jelly (g*;latin, Jno Gm.; glycerin, 100 Gin.; \vat<T to make 200
Gm).
Bt adding water and glycerin (of each 25 parts) to glycerinated
gvlatin (50 parU), gelatin suppositorii.'s may be made extemporaneously.
Fharmacolog^. — The air-dried product of the hydrolysis of certain ani-
aal ti&ues a* skin, ligaments, and bonos after treatment with boiling water.
It occurs in translucent and almost colorless she<*ts or r^hrt-ds. It dissolves
m botlmg water and (5 per cent.) makes a jelly on cooling. It is a basis of
y agn^eable and nutritive prepnrations for the sick, such as wine-jelly.
Thcfapj. — In eczema, where a dressing of more or less fixed character
if required, gelatin in the following combination is often used: —
G^atin 15 to 25 |>arta.
Zinc ojcide 10 to 15 parts.
Gljreerin 15 to 25 parts.
WaUr * 50 parU.
To this may be added ichthyol, 2 parts; this is heated over a water-bath
etch time it is employed, a good coating painted on with a brush, and when
putlr dry the parts wrapped with gauze bandage.
In 1895 Dastre demonstrated that the injection of a solution of gelatin
the veins of a dog rendered the blood more coiiguhible. This discovery
utilized in the treatment of aneurism of the first portion of the
Prof. K. Barth* describes a case in which he used gelatin injections
CD the strength of 1 Gm. (or gr. xvss) in solution (1 per cent.) every second
dty until twelve injections were given; later a second course was carried out,
utd the examination after the latter showed a diminution of the dullness
&Qm ft diameter of 4 V, inches to 3.34 by 1.95 inches; the subjective synip-
tomft (pain, discomfort, inability to make any exertion) had entirely disap-
pnrvd.
GELSEMIUM (U. S. P.).— Gelsemium (Yellow Jasmine).
OELSEMII BADIX (B. P.).— Gclsemium-root.
Do»e. 0.13 to 1.30 Gm. (or gr. ii-xx).
Preparations.
FJuitlrxtrartum Golnomii iV. S. P.). — Fluid Extract of Q«l8«mium. Dose,
OiU to 0,60 tcm. (or mii-x).
Tifirtiirn Olwmii (U. S. P.. B. P.). — Tincture of Uelsomium (10 per cent,; the
British tiiiPture i* al*> 10 per cent.). Dose. 0.18 to 1 com. (or miii-scv).
Pharmacology. — "The rhizome and roots of Gelsemium sempervirens"
(Lofiiuftcefe), U.S. P.; Gelsemium nitidum (B. P.): a climbing plant of
th« Mothem part of the United States.
'lfe«dl4^MT medicinUehf Wochen9ckrift, April 2. 1001.
•
I
484
PHAfiMACEUTICAL THEKAPEUTIC AGENTS OR DRUGS.
Two bases have boen extracted from gelsemium. Gelseminc is a crye-
tallizable alkaloid; Gelsemiaine is amorphous, of a pale, grayish-brown
color, bitter to the taste; readily soluble in alcohol, ether, or chloroform,
and but elighlly goluble in water. They exist in combination with Gel-
seminic Acid and a peculiar resin.
Physiological Action. — It has no special local action beyond slight seda-
tive intluence or astringency. Internally, it is a powerful motor depressant
and sedative, motion being affected before sensibility, in warm-blooded ani-
mals. It acts especially upon the centres in the spinal cord and medulla.
Small doses occasion injection of the conjunctivse, pain in the eyelids, con-
traction of pupils (if locally applied or in very large doses it may cause dila-
tation), with drooping of the upper lid, or, more decidedly, vertigo and con-
fusion of vision. Larger doses exert a paralyzing influence upon the spinal
cord; the power of voluntary movement is progressively lost, numbness and
staggering gait being observed as preliminary symptoms. Reflex irritability
is lowered, the pupils dilate, and the sensory columns of the cord become
paralyzed. No brain symptoms are produced directly, but the cerebral func-
tions may be disturbed by the accumulation of carbonic acid in the blood,
the result of paralysis of muscles of respiration. Death results from asphyxia.
In animals convulsions may appear. Little etfcct is observed upon the heart
directly; the pulse-rate is lessened by lowering the excitability of the excito-
motor ganglia of the heart (Ott) and the arterial pressure by diminution of
vasomotor tonus. It produces a decided lowering of the bodily temperature
and is diaphoretic. Languor, muscular depression, and prostration occur.
Poisoning. — In cases suffering with toxic symptoms from an overdose,
diffusible stimulants, hot drinks, friction to the surface of the body, and
artificial respiration are useful, after evacuation of the contents of the stom-
ach. Hypodermic injections of morphine and atropine are antagonistic to
gelsemium. Tannic acid and caustic alkalies and their carbonates are chem-
ically incompatible. In case of poisoning with gelsemium, the stomach
should be promptly emptied by an emetic or the stomach-pump. External
heat should then be employed, together with cardiac and respiratory stimu-
lants, as digitalis, ammonia, atropine, and strychnine.
The smallest quantity of gelsemium which is known to have caused
death is a teaspoonful of the fluid extract. In one fatal oase Professor
Wormley estimated that the quantity of fluid extract taken was equivalent
to O.Ol Gm. (or gr. Vo) o^ gelsemine.
Therapy. — Gelsemium may be given to allay excessive nervous irri-
tability, as in neuralgia, ovaralgia, tic douloureux, and in some cases of
myalgia. Gelsemium is frequently beneficial in lumbago. It will often allay
the pain of dental neuralt^ia. In facial neuralgia comparatively large doses
of the tincture (O.GO to 1.20 c.cm., mx-xx), every two hours, are well borne.
It has also been proposed as a remedy for tetanus, and might be useful in
hydrophobia to control the spasms. In painful spasmodic affections the fluid
extract or the tincture may he hypoderraically administered either to sup-
plement small doses of morphine, or as a substitute for this drug.
Dt. John B. Read treated a case of tetanus successfully by the adminis-
tration of 2.50 c.cm. (or mxl) of the fluid extract every second hour until the
symptoms began to ameliorate, when the dose was reduced by one-half and
continued for several days.
Kinger has found the tincture, in 0.60-c.cm. (or mi) doses thrice daily,
GEKTIANA.
485
boMCciAl in some cases of M^ni^re's disease. The same preparation, in 0.30
esm. (or m\) doses every quarter of an hour, will sometimes arrest an attack
of bilions colic. In the spasmodic stage of whooping-cough, in asthma, laryn-
panns stridulus, and torticollis gelsemium has given relief. It is of service
in migraine and in headache from eyestrain, in maniacal paroxysms, mania
1 pom, and infiomnia. Certain fevers, notably ccrebro-spinal and remittent,
«re benefited by the administration of gelsemium. When acute eczema is
accompanied by considerable constitutional reaction, gelsemium may be
pren with marked advantage. This agent, likewise, especially when admin-
iitered at bed-time, relieves the itching of eczema. It allays the pain of spas-
BKMlic dygmenorrhoea, favors dilatation of a rigid os in labor, and quells after-
puca. It is of considerable service in the treatment of haemoptysis. It is
«ed in email doses as an antispasmodic in coughs, and iu pneumonia and
pleurisy. A full dose of gelsemium may prove successful in aborting an
KBte coryza. It is safer, on account of possible idiosyncrasy, to begin with
ray small doses of the tincture or extract, and gradually increase until slight
drooping of the eyelid shows the beginning of full physiological effect. Gel-
Mmium may be employed locally in the treatment of prurigo in the form
of fluid extract, diluted. Dr. H. P. Nottage finds gelsemium exceedingly
useful in infiuenza, all forms of catarrhal fevers, and, especially, in neuralgia
where there is a tendency to recurrence or exacerbation on any particular
day or time of day. He prefers small doges of a fluid extract made from
the green root. It acts best when the pulse is large, full, quick, but easily
obliterated by pressure. He has also found it useful in the headaches which
occur at the menopause, together with flushings, the head and body hot, in
2- or 3-drop doses every three hours. It is useful in meningitis and con-
Tulaons, especially in childhood. In fractional doses (tincture diluted to
Vi«» '*n<J 2 drops given every two hours) it has been serviceable in vertigo,
or dizziness. In chorea, when the usual remedies fail, gelsemium is worth
trfing.
In the dermatitis caused by Rhus radicans Dr. Edson has successfully
awd a lotion containing 7.5 c.cra. (or foij) of the fluid extract of gelsemium
to 120 ccm. (or foiv) of water, a smaD quantity of carbolic acid and glycerin
being also contained in the mixture. It has been also used as a mydriatic in
eye j>ractice,
GZJrriAITA (U. S. p.).— Gentian.
GZKTIANiE KADIX (B. P.).— Gentian-root.
SoM, 0.50 to 2 Gm. (or gr. viii-xxx).
Preparations.
Fluid*'xtraotTiTn Oentisnoe (U. S. P.).— Fluid Extract of G<?ntian. Dose, 2
to 4 ccm. ior mxxx-fSj).
Extractuin GentianeD (U.S. P., B. P.).— Extract of Gentian. Dose. 0.13 to 0.60
Cm. {or gr. ii-viij).
TincttirA Gcntione Compoaita (U.S. P., D. P.). — Compound Tincture of Gentian
fU- S P. contains gentian, \6 Gm.; bitter orange-pcel, 4 Gm.; cardamom, 1 Qm.;
aieohnl and water, each, q. s. ad 100 com.). Do<tp, 4 to 7.5 o.cm. (or f3t-ij).
Infinum GentJanie Compoeituni (6. P.). — Compound Infusion of Geniian (con-
taim emtian. 12.60 Gm.; bitter orange-peel, 12.60 Gm.; fresh lemon-peel, 26 Gm.;
«ftd diatilJcd water, boiling, 1000 ccm.). Dose, 15 to 30 ccm. (or fSst-j)
PluuinACology. — Gentian is "the dried rhizome and roots of Genti
I
'M
PHAHMAOKUTICAL THEaAPEUTlC AGENTS OH DHUGS.
lutea (Gentiauacea;)'': a native of Europe. Many species are indigenous,
as the Oentiana puberula, G. saponaria, G. Andrewsii, and the beautiful G.
crinitfl, which ditfcr in thtTapevitical effects only in degree from the official
geniiau, and may be eriipluyed for like purposes. Both water and alcohol dis-
solve the iH'tive principle, wliiih is very bitter, and appears to be a glucoside,
Gentiopicrin, combined with gentiaic acid, a coloring ingredient. There is
no tannin present; although the preparations are darkened by most of the
iron salts (the citrochloride is excepted), due to a change in this coloring
matter, probably. Of the American varieties a decoction or infusion may be
used, although a fluid extract would better represent the drug.
Physiological Action. — Gentian is a simple bitter, Avith little, if any,
astringency, and has the same physiological action as others of this class.
When combined with an alkali its local effects upon the stomach are much
increased. From experiments upon dogs Dr. P. Terray concludes that gen-
tian is the most powerful stimulant to the automatic movements of the
stomach.
Gentian has been thought to exert a slight stimulant effect upon the
liver. The chalybeates are synergistic, with reference to general tonic
effects. It enjoys a reputation as a sulcedaneum for cinchona, as an anti-
pyretic and antiperiodic, though to a less-marked degree; its actions have
not been as much studied as those of the latter. No toxic effects have been
noted.
Therapy. — As a stomachic tonic, the preparations of gentian are de-
servedly esteemed in cases of weak stomach during convalescence, catarrhal
gastric disorder in infants, or ordinary atonic dyspepsia: —
B Sodii bicarb 1515 Cm. or 3iv.
Infusi gentianee comp 180| c.cm. or fSvj.
M. 6ig.: A tablcBpoonful or two half an hour before meaU.
It may be given with advantage in cases of atony of the stomach with
a moderate amount of dilatation. The compound infusion of gentian is a
good vehicle for administration of potassium iodide in cases where its tonic
effects would be useful. Combinations of gentian and iron are numerous,
but none are used so much as the Elixir Gentianae cum Tinctura Ferri Chlo-
ridi (N. ¥.):—
4
B Elixir gentianse 1201 c.cm. or fjiv.
Tincturre ferri citrochlorid. (N. F.) 10| ccm. or mdx.
M. Sig.: Two teaBpoonfuls after each meal.
4
The gentian mixture oflicial in the British Pharmacopoeia is, according
to Whitla, excelled by few remedies in the treatment of the vomiting of
pregnancy, especially when combined with a mineral acid.
The infusion, or decoction, is useful as a stomachic in gastric disorders
associated with gout or malarial fever, or the compound tincture may be used
where the alcohol is not objectionable: —
Tincturffl cinchonffi,
Tr. cardamom, comp.
Tr. gentians comp.. .
30]
GO
e.cm. or fSj.
c.cm. or fSij.
M
M. Sig.: A dessertspoonful to a tablespoonful in malarial dyspepsia and debiUtj
with loss of appetite.
Gentiana Guinquefolia. — The five-flowered gentian is common in the
G^UXICU.
487
Tnitecl 8Uteft. The whole plant is bitter, and may be given in infusion, but
I flair] extract of the root would be better (dose, 0,30 to 2 c.cm., or mv-xxj).
h may bo used for the same purpose as the preceding.
GEEAimrH' (U. S. p.),— Geraaium (Cranes-bill).
Do»c. 1 to 4 Gm. (or gr. xv-oj).
Preparation.
Flnidoxtractuni (icranii ( U. S. P.). — Fluid Kxtract of Geranium. Dose, 2
to 4 e.cm. (or mxxx-f3j).
1 Pharmacology. — An indigenous plant, found in the woods from Canada
to Florida, of which the rhizome only is official. The spotted geranium, as
it lA called, or Geranium maculatum (Geraniaceae), contains tannic (13 to
17 per cent.) and gallic acids, which are its most important constituents,
betides some resin, gum, starch, pectin, coloring matter, etc. According to
th« analyses of Trimble and Peacock, gallic acid does not exist in the plant,
hot is easily found in the rhizome after drying, and results from the easily-
decomposable tannin. A crystalline vegetable principle has also been found
in geranium by Dr. Edward Staples.
Ae geranium imparts its virtues to both water and alcohol, it may be
wed in decoction and tincture, as well as in the official fluid extract, which
is made with dilute alcohol.
Fhysiolo^cal Action and Therapy. — Geranium improves the appetite
and digestion and promotes nutrition. As it is decidedly astringent, the
I drug may be used, in fine powder, as a styptic in hiemorrhflges after extrac-
tion of a tooth, epistaxis, etc. Its astringency renders it an excellent haem-
ostatic. The MTiter has obtained good results from the local application
of the fluid extract, diluted with 3 or 4 parts of water, in buccal ulcer, fissure
of the anus, and metrorrhagia. Tlie same treatment promptly arrested a
lin*morrhage from the urethra and at the same time cured a rebellious gleet
which had been in existence for two years.
K Geranium mokes a useful throat- and mouth- wash: —
H B PotAuii chloratis Rl Gm. or 5ij.
H FluMext. geranii 22| c.cm. or fSvj.
^^^^ Glvrcrini 30 c.cm. or fjj.
^^^^ Aquit roflie q. s. ad 1801 c.cm. or f^vj.
I^^^PM. 8lg.: Add a tablcspoonful to two tablespoon fuls or more of water, and u«e
^ «» a P»1?le.
^ In LJitarrhal inflammations, as an injection in gonorrhoea, gleet, and
H leacorrfacea, the decoction is more serviceable, according to Prof. L. Johnson,
than a simple solution of tannin, doubtless from the fact that there is present
mucilaginous material, which acts as a demulcent. The fluid extract is
im' '•Tinlly in diarrhoea. In infantile diarrhoea the decoction may be
Ttrv I ;ibly administered in milk, which covers its taste. It is a valu-
able remedy in the early stages of phthisis, diminishing cough and expectora-
tion, reducing the fever and pulse-rate, checking night-sweats and hiem-
optysie. Under its use the appetite improves and the patient gains in
weight. In a rapid case of phthisis, accompanied by profuse night-sweats,
complete loss of appetite, and a severe, harassing cougn, marked temporary
[relief waa obtained by the follo^nng prescription: —
>6m pAp«r by author in the Atlanta Medical and Surgical Journal, Oct., 1880.
488
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
H 01. nienlh. /ip 1
Kluidext. geiiinii 46
Vini Portensi i 30
M. Sig.: Tea spoonful every third hour.
20 ccm. or mxx.
ccm. or f^iss.
ccm. or f3j'
Geranium is mild and imirritating, and especially suited to the later
stages of diarrhoea and dysentery in children. It haa also been employed in
internal hsemorrhage, wUh good results.
GEUM. — Avens. Two species of Geiim (Eosaceae) are used in medicine:
the Geum lubanum, or European avens, and the Geiun rivale, or water avens,
a native of North America. In each the root ia the part possessing medicinal
properties. Geum contains a bitter principle called Gein by Buchuer, a little
volatile oil, and a large proportion of tannic acid (10 to 40 per cent.). A
recent infusion or decoction would best represent the physiological action of
geum. thoui;h a fluid extract made with dilute alcohol is also used.
Therapy. — Avens is tonic and astringent. It is chiefly useful in relaxa-
tion of mucous membranes. An infusion made with boiling water is given
for diarrhcea.
GILLENIA. — Gillcnia, American Ipecacuanha. The Gillenia trifoliata,
or Indian physic, and Gillenia stipulaceffi, which is a species closely resem-
bling it, were formerly official,, but have been dropped from the phnrma-
copceia, as they are very inefficient substitutes for ipecacuanha. They belong
to the botanical family Rosacea?, and are indigenous to this country, growing
from Canada to Georgia. The part used is the root, which contains Gillenin,
a peculiar bitter principle, to which its therapeutic properties are due. It
also contains tannic acid, gum, resin, starch, etc. Dose of the root, 0.32 to
2 Gm. {or gr. v-xxx).
Physiological Action and Therapy. — Gillenia is an active emetic, and
in small doses is thought to resemble ipecacuanha as a tonic and cholagogue;
it is also diaphoretic and expectorant.
It has been used as a substitute for ipecacuanha, as an emetic, stomachic
tonic, and diaphoretiCj and in domestic practice in dyspepsia, etc.
GLANDULE SUPRAEENALES SICCiE (U. S, P.).— Desiccated Su-
prarenal glands.
GLANDUUE THYROIDEA SICCA (U. S. P.).— Desiccated Thyroid
Glands. (Scu Animal Secretiona, page *^03.)
GLONOIN¥M.— Glonoin (Nitroglycerin, Trinitrin), Glyceryl Trinitris.
Preparations.
SpirituB Glycerylis Nitratia ( V. S. P. ) . — Spirit of Glyceryl Trinitris ( I jxjr cent,
by weight). Dose. 0.(i:i to 0,18 ccm. (or mss-iij).
Liquor Trinilriai {B. P.). — Solution of Trinitrin, Solution of Nitroglycerin (1-
per-ccnt. hIcoIioIic solution). Dose, 0.03 to 0.12 ccm. (or msa-ij).
TaWllee Trinitrini (R P.). — Trinitrin Tablets (chocolate tablet* each containing
0.00005 Gm., or gr, Vmo). Thiae, 1 or 2.
Physiological Action. — Nitroglycerin, or ghnoin, has the same physio-
logical efTects as amyl nitrite, but is usually administered in solution. The
official Spiritus Glycerylis Nitratie, therefore, is preferable to the tablets.
The action is slower, but more permanent, than that of amyl nitrite.
CLONOIXUM.
489
Anta^uists. — The physiological antagoniste to the action of amyl
fiitnte and nitroglycerin are strychnine, belladonna, sclerotinic acid, and,
in general, those remedies which raise arterial tension and diminish blood-
*inpply to the great centres by producing contraction of blood-vessels. In
m$e of unpleasant or serious symptoms after its use, the exhibition of am-
monia by inhalation and by the mouth, the hypodermic injection of atropine
OT ether, with cold water or ice-bag to the head, mustard poultice to the
epigastric region or to the extremities, keeping the patient warm and in the
recumbent posture, will very soon be followed by relief, as the symptoms
jL «re usually quite evanescent.
B Therapeutic Applications. — Murrell praises this remedy highly, not only
" for typical angina, but for breathlesaness and attacks of pseudo-angina. Da
^CQ6ta has given it in Bright^s disease attended by high arterial tension
(cirrhotic kidney), in the following combination: —
H Olyc^rylis trinitritia |000fl6 Gm. or gr. Vw
Tr, digiUlis,
Tr. strophanthi aa |12 c.cni. cr mij.
Tr. belladoniuB [03 ccm. or mas.
. M. ei It. UbcUa.
■ 6%.: Take one every six hours until effect upon the pulse is obtained.
In the treatment of angina pectoris and severe asthma HofTmann' rec-
onuncuds subcutaneous injections of nitroglycerin in alcoholic solution in
dose of 0.0005 to 0.001 Gm. (or gr. Vno'Vao)* ^^ claims remarkable result*
from these injections, without any objectionable after-effects.
Dr. Elliot Bates has, in a number of instances, seen very marked relief
from the hypodermic injection of nitroglycerin in those cases of epilepsy
where the patient falls with rigid limbs. He administered it in the dose of
■ O.ooor.5 Gm. (or gr. Vioo)- Good results have been observed in hystero-epi-
lepsy from the hypodermic injection of the same quantity, the spasm being
oratrolled within a few minutes.
A few drops of the solution of nitroglycerin placed upon the tongue
have been used with success in order to relieve the craving of the opium
habituate. Dr. Speer records a case in which nitroglycerin was successfully
employed in morphine poisoning, 0.38 Gm. {or gr. vj) having been taken by
aUd aged 17 years. An injection of 0.0013 Gm. (or gr. Van) ^fls soon fol-
I lowed by an improvement in the respiration and, in half an hour, by vom-
H iting^ after which 0.00065 Gm. (or gr. Vioo) was administered in the same
H manner. Two hours subsequently the patient was out of danger. Case re-
■ ports great reUef in Raynaud's disease from the injection, thrice daily, of the
aame miantity of nitroglycerin gradually increased to 0.0013 Gm. (or gr.
'/»)- *n threatened collapse caused by pneumonia, drop doses of the 1-per-
H cent, solution, as advocated by Dr. Andrew H. Smith, of New York, act as a
H diffufiihle stimulant and often avert the danger.
Dr. Trussewitsch recommends the use of nitroglycerin in the algid stage
of cholera. One or 2 drops of the 1-per-cent. solution placed upon the tongue
Cii»*<« dilatation of the peripheral blood-veseels, decreases the blood-pressure,
and relieves the heart. Dr. Humphries employs nitroglycerin in various
forms of vomiting M-ith very good results. lie has also found it valuable in
acute or chronic gastric catarrh of the infant or adult, and has used it suc-
• /*Jli/frNiamj/{rv7{ Journal and TrnnMctionJt, June 28. 1800,
490 PHARMACEUTICAL THERAPEUTIC AUENTS OB DRUGS. ■
cesfifully in the vomiting of pregnancy. Given snbcntaneously it acted as a
prompt restorative in a case of poisoning from illuminating gas. Dr. D. D.
Stewart points out that a tolerance to this remedy is sometimes readily ac-
quired hy patients, whose anxiety prompts them to increase the doses. This
tendency must be guarded against by temporarily discontinuing the drug
from time to time and resuming with a smaller dose than that last used.
A remarkable example of acquired tolerance to nitroglycerin has been
placed upon record by Dr. G. E. Readings of Woodbury, N. J. The patient,
a woman, suffering from chronic interstitial nephritis, was placed at first
u])on the doses of U.onotiS Gm. (or gr. Vioo)^ which was gradually increased
until, in less than a year, she was taking an amount equivalent to 0.38 Gm.
(or gr. vj). The symptoms of the disease were by this time apparently cured.
On account of the explosive properties of nitroglycerin, it is advisable
not to accumulate too large a number of the tablets, nor to shake them vio-
lently. This objection, says Jlurreli, will not apply to the forms in which
nitroglycerin is ordinarily dispensed, however. The l-per-cent. solution, he
adds, is perfectly safe, and may be used without fear; in fact, most chemists
keep a 5-per-ccnt. solution. The same authority also gives a scries of experi-
ments made by himself in hammering and bringing a red-hot wire in con-
tact with pills of nitroglycerin, thus demonstrating their safety. All pilla
and tablets of nitroglycerin may not be so safe as those he referred to.
GLTJCOSUM.— Glucose, Grape Sugar (C«iri,Oe).
GLUSIDUM (H. (M.— Gluside. BENZOSTTLPHmiDITM (F. S. P.).—
Saccharinum. ( Sec Benzosulphlnidum. )
Glusitle, or henzoyl-pulphonicimide. is a sweet imide derived from
toluene. Its constitution is represented by the formula
CeH,<^^ >NH -181.77
• Ghiside, or saccharin, is a light, white, minutely-crj'stalline powder hav-
ing an intensely-sweet taste in dilute solutions. It is soluble in 400 parts of
cold water, 24 of boiling water, in 25 parts of alcohol (90 per cent.), and but
slightly in ether or chloroform.
On account of its sweet taste, gluside is in use commercially as an addi-
tion to glucose, especially in the form of cheap confectionery. As its effects
on the animal organism are scarcely toxic, 5 Gm. (or 3i VJ being adminis-
tered without any obvious effects, in a man, it has been employed in the diet
of diabetes, as a substitute for sugar, in sweetening coffee or other articles of
food. It is made into tablets with bicarbonate of soda to increase its solu-
bihty. The usual dose is 0.13 to 0.20 Gm. (or gr. ij-iij).
GLYCEEINUM (U. S. P., B. P.).— Glycerin (Glycerol).
Lose, 4 to 15 c.cm. (or f5i-iv). B. P., 4 to 7.5 c.cm. (or f3i-ij).
U. S, P. Preparations.
Glyceritum Acidi Tannici. — Glycerite of Tannic Acid (20 per cent.). For exter-
nal use.
Glyceritum Amyli. — Glycerite of Starch (glycerin, 80; starch, 10 parts). For
external use.
Glyceritum Boroglycerini. — Glycerite of Boroglycerin. Solution of Boroglyc-
cride.
(JLYCERINCM.
491
»
OYycmtum Hydrastis. — Cilycerite of liyilrustis. (Kach c.cm. = 1 Urn. ot
Olyreritum Phcnolia.^GIycerite of Phenol (20 per cent.).
tJlVt-Hritum Ferri. l^>uininB, et JStryohnincB Fliosphatiini. — Glyoerite of the Pho»-
|lutai of iToa. Quinine, and Strychnine.
SufpOAitoruk Glycerini. — Glycerin Suppofiitories.
B. P. Preparations.
Glyoeiinum Acidi Borici. — Glycerin of Boric Acid. For external application.
Glycczinum Acidi Carbolici. — Glycerin of Phenol (IG'/j per cent.).
Glycerinmn Acidi Tannici. — Glycerin of Tannic Acid (16Vi per cent.).
Glycerinum Aluminis. — Glycerin of Alum (14*/, per cent.).
Glycerinum Ainyli. — Glycerin of Starch (11 per cent.).
GlycerlniuD Boracis. — Glycerin of Borax (H 7» per cent.).
Glycerinum Pepsini. — Glycerin of Pepsin (4 c.cm., or f3j, contains 0.32 Gm., or
gr. », of pepsin). Dose, 4 to 7.5 c.cm. (or f3i-ij).
Glycerinum Plumbi Suhacetatis.— -Glycerin of Lead Subacetate.
Glycrrinum Tragacanthfe. — Glycerin of Tragacanth.
Sappositoria Glycerini (B. P.). — Glycerin Suppositoriea (each suppository con-
UlM 70 per cent of glycerin).
Cnj^uentum Glycerini Plumbi Subacetatis. — Lead-Subacetate Ointment (glycerin
of tfftd Mibacetate, 1; white paraf!in ointment, 6 parts).
Glycerin is also a constituent in several U. S, P. extracts, fluid extracts,
pill masses, mucilage of tragacanth, solution of pepsin, and other prepara-
tions.
PhArmacoIo^. — Official glycerin is ''a liquid obtained by the decom-
pofiiuou uf vegetable or animal fats or fixed oils, and containing not less than
Si per cent, of absolute glycerin." In the process for making lead plaster,
the obve-oil, being decomposed by the lead oxide, yields lead oleate and free
llycchn. It is also produced in the ordinary process of soap-making, being
1 constituent of the waste, from which it is now recovered in large quanti-
ties for commercial purposes. A purer glycerin is obtained by decomposing
itte bj steam, or superheated water, and distillation. A superior article is
Bade from vegetable fats by Messrs. Proctor & Gamble, of Cincinnati, which
i> best adapted for medical use. The British Pharmacopu?ia defines glycerin
IS **a trihydric alcohol associated with a small percentage of water. It is
obtained by the interaction of alkalies or of superheated steam, with fats and
fixed oils." It is colorless, resembling syrup, oily to the touch, without odor,
very sweet, slightly warm to the taste, neutral in reaction, hygroscopical,
lolubie in all proportions in water or alcohol, and insoluble in ether, chloro-
form, benzol, or flied oils. Under certain conditions it becomes a mass of
denae, brilliant crystals, but may be cooled to — 40° C. without congealing,
only becoming more viscid. Treated with strong nitric acid, it forms glonoin,
or nitroglycerin: a substance of powerful explosive properties,
Phytiolog^cal Action. — As it has an afhuity for water, glycerin absorbs
the latter from mucous surfaces and excites secretion. It is irritating in its
ooDcentrated state to both skin and mucous membrane, being entirely dif-
fmnt in its ejects from oils or fats, although, when diluted, it keeps the
ikiD moist and prevents cracking or chapping. Glycerin is absorbed by the
lido and passes into the blood. It has very little effect upon the stomach.
A etrtain amount is absorbed, with the effect of increasing nutrition and'
QBproTing the appetite; it is slightly laxative, and is said to lessen the eicre-
t)OD of urea, though, according to the experiments of Lewin, it exerts no in-
apon the quantity of urea eliminated. Large doses have produced
492
PHARMACEUTICAL TITERAPECTIC AGENTS OR DRUGS.
hffimoglobinuria, owing to some action, as yet unexplained, upon the blood.
In these cases the urine, accordiug to Fuchsinger, contains the coloring mat-
ter of the blood, but no free corpuscles.
In the case of a man who was accustomed to taking 90 com. (or fSiij) of
glycerin daily, but who used no alcoholic liquor, extreme cerebral excitement
was produced, according to the statement of Cunstantin Paul.
Glycerin is considered antiseptic, yet Koch found thnt it did not destroy
spores nor the activity of formed ferments, although a solution in water (1
to 3) arrests the action of some enzymes (pepsin, ptyalin, emulsin), and a
stronger solution (1 to 2) prevents the action of others (myrosin, diastase,
invertin), but preserves their activity unimpaired, and is used to preserve
them (Weniitz). Glycerin is destructive to parasites, intestinal and external.
It increases the action of codliver-oil, and is a solvent for some of the alka-
loids, though not for others. Owing to its sweetness, it has been used as a
substitute for sugar in the diet of diabetics, though saccharin has now largely
taken its place. According to the clinical observations of Pavy, gl3^cerin in-
creases polyuria, and he therefore opposes its use as a substitute for sugar.
It seems to augment considerably the quantity of glycogen contained in the
liver, tlunigh it probably prevents the transformation of glycogen into sugar.
Therapy, — Diluted with 3 parts of rose-water, glycerin is a good appli-
cation to the hands and lips to prevent chapping during cold weather.
Glyconin is also used for this purpose. The same mixture is one of those
employed in ichthyosis, after a warm-water, hot-air, or vapor-bath^ in order
to protect the diseased area and aid in maintaining its nutrition. In more
concentrated form it has been used with success in pityriasis, pruritus, acne,
eczema, fissured nipples, or acute coryza, applied with a brush or spray. In
combination with collodion (Vj per cent.) it forms collodiiim elasticum,
which is less painful than pure collodion, iind is a good protective for fissures
and abrasions. I'he daily application of glycerin is capable of causing a
steady reduction in the size of hypertrophied tonsils. The glycerite of tannic
or of gallic acid is a useful astringent as an application for sore throat, re-
laxation of mucous membrane, and upon tampons to the cervix uteri for
leucorrhoca. A pledget of absorbent cotton, saturated in glycerin, is an ex-
cellent application, also, in congestion of the womb, as, on account of its
affinity with water, it provokes an abundant serous transudation. The glyc-
erilum vitelli is used as a vehicle for chloroform or heavy powders. Glycerin
alone, or with some astringent or sedative^ is useful in preventing bed-sores.
Injected into the bowels, it is a mild enema, and in small quantities is effi-
cient in evacuating the lower bowel, and may be introduced in the form of
suppositories.
In obstruction by fa?cal impaction, the injection of several ounces into
the colon, through a long tube, was successful in the hands of Dr. Edward
Mayer, of Wilkes- Barre, Pa., in saving life after failure of all ordinary means
of relief. Glycerin administered by "the raoulh has a peculiarly soothing
effect upon inflamed End painful hemorrhoids. Equal parts of glycerin
and distilled water mav be used as an application to keep the tongue moist
in typhoid and other fevers; and a dilute solution may be sipped to
moisten the throat during an attack of tonsillitis or pharyngitis, although
the direct application by spray or brush should not be omitted. The red,
dry, and glazed mouth of advanced phthiF.is is moistened by the use of a wash
of glycerin and water. Reflex cough is often allayed by the application of
OLYCERISOM.
493
»
»
ffjrerin to the fauces, and, administered internally in 4-c.cm. (or fSj) doses,
the same agent may prove of advantage in the cough of phthisis. It may be
E'ven to infants as a laxative in combination with oil. Aarainistered alone, it
ts been used for the same purposes as codliver-oil, but is less efficient, al-
though poBseseing some nutritive properties. It is the best remedy in cases of
triehiniasis, administered in tablespoonful doses, as successfully used by Dr.
James M. Barton; and is used as a laxative in cases of piles. Some forms of
indigeetion are improved by its administration after meals; and it is the best
jolvent and preservative for pepsin, either from the pig or the calf, the latter
having been introduced by Dr. Frank Woodbury as the special digestive fer-
ment for infants or adults upon a milk diet. In acidity of the stomach .and
flatulence, glycerin in 4-c.cm. (or foj) doses two or three times a day is bene-
ficial. It is often extremely useful in improving the appetite. Dr. J. A. Pol-
lard esteems glycerin as of value in preventing stomach trouble during conva-
lescence from debilitating diseases. He claims also that it has considerable
power to control the vomiting of pregnancy. Ferrand regards glycerin as a
valuable remedy in biliary lithiasis and as a powerful cholagogue, capable of
affording relief in hepatic colic. In 18.5- to 22-c.cm. (or f3v-vj) doses it ter-
minates the attack. In 4- to 7.5-c.cm. (or f3i-ij) doses, taken every day in a
little alkaline water, it prevents fresh attacks. According to the experiments
of A. Hermann, its action is mechanical and depends upon its power to ab-
itract water from tissues.
Glycerin given in the form of suppository is often serviceable in reliev-
ing and overcoming constipation, especially when the lower bowel is inactive.
(Professor Remington recommends as the best formula for glycerin eupposi-
toriee: 40 grains of sodium carbonate, 80 grains of stearic acid, and 1080
grains of g}ycerin. The sodium carbonate is dissolved in the glycerin, the
rtearic acid added, and the mixture is carefully heated upon a water-bath
ontil efferveacence ceases. The solution is then poured into a suppository-
mold to make 12 suppositories.) Gelato-glycerin bougies are useful in ear-
ache, Richards states that further experience has convinced him more than
ever of the value of gelato-glycerin bougies in an early stage of acute otitis
media and in acute otitis externa. They can be inserted in the oar "without
difficulty by simply washing off the lycopodium powder with which they are
ooTered; they arc then very slippery, and, with the affected car uppermost,
euilj alip down into the canal. Here the bougie soon dissolves, the anodyne
is brought directly into contact with the inflamed surfaces, and the pain is
relieved. Besides being a medium for the exhibition of other remedies, the
glycerin is of itself distinctly curative, in that it tends to draw out more
aerum from within and lessen the tension. After insertion the ear should be
stoppered with absorbent cotton or gauze, and a lightly-filled hot-water bot-
tle placed at the side of, or over the ear. Many a case of acute earache in
children will, if promptly treated in this manner, at once subside without
going on to severe inflnmmation. The following fornnila is recommended: —
B rfaenolU liquofact 143 ccm. or mvij.
Troct. opii deodorat (37 ccm. or mvj.
CocAitue.
Atropinte iFulphaUa aa [20 Gm. or gr. iij.
Aqnff 3|20 ccm. or mlij.
Gelfttin. 1 120 Gm. or st> xviij,
GlvMrini ^. . . . OJOO ccm, or fSiimxxxviij,
M. et ft. boagles xlij.
494
PUAUMACEL'TICAL THERAPEUTIC AGENTS OR DRUGS.
After making, they should be covered with lycopodium, and dispensed
in a bottle, as they are hygroscopical. They should be no larger than will
readily slip in the external canal. The size made in urethral-bougie mold
has proved satisfactory.^
Grifhth has employed it with marked effect in the treatment of constipa-
tion. An enoma of glycerin and infusion of flaxseed (1 to 4) allaj's tenesmus
in cases of acute dysentery (Bartholow).
The injection, under strict antiseptic precautions, of about 150 com.
(or fgv) of glycerin into the womb has been successfully practiced in order to
excite premature delivery. The tube of the syringe is introduced as far back
as possible, between the wall of the uterus and the membranes. According
to Pelzer, from 30 to 45 ccm. {or foi-iss) are sulHcient to accomplish the pur-
pose. In the experience of Dr. Embden, this practice is not without danger,
and is liable to cause thrombosis or decomposition of the blood. He thinks
also that it may lead to the introduction of air into the circulation.
Semmola asserted that glycerin has antipyretic action ia acute in-
fectious diseases, in which he adndnisters it as follows: —
R Glycerin 00 c.cm. or flij.
Acidi tartaric! vel citrici 6 Gm. or 31 V*.
AquK 570 ccm. or Qxiz.
M. Si^.: Three tablespoonfuls, or an ounce and a half, to be taken every hour,
or half that quantity every half-hour.
Herman* states that, out of 115 casps nf nephrolithiasis, in 15 cases
concretions were passed and improvement was noticed in the patients' com-
plaints; in 29 cases concretions passed without bringing about any such im-
provement; in 25 cases there was improvement only of the patients' condi-
tion without any concretions being po-^^sed; in 46 cases glycerin had no
effect whatever. Thus, glycerin proved to be etlicacious in 00 per cent, of
the cases so treated, either by removing concretions or else by removing the
pain which accompanies this disease. He administers the drug according
to the weight and age of the patient, and states that 31 to 124 Gm. (or Ji-iv),
by weight, is his usual dose. He gives it in equal parts of water, at one dose,
between two meals, and repeats it two or three times during several days.
He has never had any disagreeable symptoms from it.
Externally glycerin can be combined with admirable effect as follows: —
B Glycerin i,
]-iquor calcis,
Aquce roaae aa flO| ecm. or fjij.
M. For excoriationa, erythema, superficial bums, and acalds.
B Glycerini,
AqtiflD hamatnelidis
Aquee rosce aa 60| c.cm. or fjij.
M. Uae on chapped face and hands, sore nipples, and hsmorrhoids.
B Glycerini,
Aqiiffi hamamelidis aa 00| c.cm. or fSiij.
Bismuth, subnit. vel sodii bicarbonalis 8 Gm. or 3ij.
Phenolia liqucfaot JGO c.cni. or mx.
M. For erjthemntoiis or v(H»icular erxema, bums, and seborrhoea, especially
around the axilla and genital organs.
* Journal of the American Medical Association, 1900.
* Medical Chronielc, 1899.
p
I
ft
GLTCT&RHIZA. "^^^^^F 495
Q OWcerini,
Acidi Uctici.
Aquc roft« aa 151 c.cm. or fSM.
IL For hvoUes and other pigmentattonB of the akin.
B Gl.Tcerini 1601 c.cm. or fjv.
Creoaoti 4| ccm. or fSj.
01. rotnth. pip |G0 c.cm. or mx.
M. Valuable for catarrh, pharyngitis, and UryngitU, in the form of a spray. It
tan be mopped on the akin or sprayed over the eurface for pruritua, eczema, and
arlicaria.
The glycerite of starch is a bland material, which can be impregnated
irith rarionfi medicaments, astringents, etc., for application to the eye or to
the skin. Ghxerin is a good vehicle for alkaloids, and it is thus used in vari-
ottfl difleases of the ear, in abnormal dryness of the external auditory canal,
ind impaction of cerumen.
niyi-i'rito i>f Bisiiiutli Ik)rate was recommended by Kej'ser as a good
remedy in phlyct<.'nular and scrofulous conjunctivitis,
Unna has devised a preparation termed casein ointment which may be
noticed in this place. It consists of 14 parts of casein, about Va part of potas-
ROJD and sodium hydroxide, 7 parts of glycerin, 21 parts of vaeelin, 1 part
of salicylic or boric acid, and about 56 parts of water. It is a thick, white
ana!sion^ which soon dries upon the skin and has been used in affections of
the ekin accompanied by itching. Various drugs may be incorporated with
the otntment.
The urine of persons using glycerin reduces copper in Fehling's test,
ind, being mistaken for glycosuria, is liable to lead to error. Tltis is not due
directly to the presence of glycerin, but to a decomposition-product.
OLTCOGEN. — Glycogen is a proximate principle of the human body,
rhcre it is found in the liver and also in the nucleus of the leucocytes. It
is also found in some fungi (mushrooms). It is a stimulant to thp oircula-
tinn, sustaining the heart, neutralizing toxines, and pro!>al)]y facilitates
phagocytosis. It has been used in lubiTCulosis, diabetes, albuminuria, neu-
n^tiiejsia, anitmia. and infectious conditions. In migraine, it is claimed
ttt be <*spoc:ialIy effective, giWng prompt relief. It jnay be administered sub-
mtaneoufly, or in capsules (0.00 Gm. or gr. j each). Dose, 1 to 5.
GLYCEKYLIS TRINITRIS, AND SPnUTUS GLYCERYUS NITRA-
TIS {V. 8. r. I.— (Sit' Glonoinum.)
GIYCYBRHIZA (U. S. P.).— Glycyirhiza (Liquorice-root).
GIYCYERHIZa: EADIX (B. P.).— Liquorice-root.
Preparations.
ictQin Glycyrrhiz* Purum (U.S. P.). — Pure Extract of Glycyrrhtza. Dose.
"td 4 Om. I or gr. v-3i).
(luidrxlmcium tilycyrrhijue (U. S. P.). — Fluid Extract of Glycyrrhiza
ide vvith aqua nninionin nnd alcohol). Dom. 1.20 to 4 c.cm. (or fflzxf3j).
Klixir Adjuvnn* i I S. V.) . — Adjuvant Klivir (cnnliuus fiuid extract lieorion,
1J0 part»: aroinntif elixir. 6S0 ports.) As a vehicle.
4yG
PHARMACEUTICAL THEEAPEUTIC AOKNTS OR DRUOS.
Mistura Glycyrrhizffi Compoeiia (U.S. P.). — Compound Mixture of Glycyrrhira,
Brown Mixture (pure extract, 3; paregoric, 12; antimonial wine, 6; spirit of nitrous
ethor, 3; mucilage of acacia, 10; ftyrup, 5; and water, q, b. to make 100 c.cm.). Doge,
4 to 15 c.cTn. (or f3i-iv).
Trochisci Glycyrrhizce et Opii (U.S. P.). — Troches of Glycyrrhiza and Opium
(extract of licorice and pulv. opium, with «I. anise, sugar, and acacia). Dose, 1 or 2.
Glycyrrhiziuuni Amraoniatum (U.S. P.)- — Animoniated Glycyrrbizin (for flavor-
ing).
Kxtrnctum GlycyrrhiKie (U. S. P., B. P.). — Extract of Glycyrrhiza (extract of
liquorice, B. P.).
Pulvis Glycyrrliiayp Compositus (U.S. P., B. P.). — Compound Powder of Glycyr-
rhiza (U. S. P. contains senna, Hcoriee-root. powdered; oil of fennel, washed sulphur,
sugar). Dose, 4 to 8 Gm. (or f3i-ij).
Extractum Gt^cyrrbizte Liquidum (B. P.). — Liquid Extract of Liquorice. Dose, 2
to 4 c.cm. (or f3as-j).
Pharmacology. — The dried rhizome and root of Glycyrrhiza glabra,
which yields tiio Spanish, French, or Sicilian licorice; or of G. glanduliferfl,
yielding the Russian licorice (Leguminosa?), United States Pharmacopoeia,
"the peeled root and peeled subterranean stem of Glycyrrhiza glabra and
other species" (B. P.). This plant is a nntivc of southern Europe. The
root contains on anior|»hous, bitter-sweet glucoside, Olycyrrhizin, which is
probnbly in combination •with ammonia; it also contains Asparagin, sugar,
rosin, starch, gum, peel in, coloring-matter, etc. Glycyrrhizin, when acted
upon by dilute acids, splits up into sugar and a brownish-yellow*, bitter sub-
stance, Glycyrrhetin* The resin is also bitter.
The aromatic glycyrrhizin masks the taste of sulphate of quinine when
Erescribed with it in about double the quantity, but the after-taste is still
itter. The elixir of aromatic trlycyrrhizin is a K^iod vehicle in which to
administer sulphate of quinine, but no acid should be added, since the qui-
nine is largely suspended and not dissolved. Licorice enters into the other
adjuvant elixirs for the administration of bad-tasting medicines. A syrup
of licorice may be used as a flavoring agent or as a vehicle.
Physiological Action. — Licorice-root is demulcent and slightly stimu-
lating to the bronchial mucous memhrnnes, and is laxative. It has an agree-
able taste, the bitterness being masked by the sweet principle, l)ut leaves an
acrid taste in the fauces. The extract covers the taste of other remedies.
The root i.s used as a dusting-powder and coating for pills.
Therapy. — The contpound infusion of flaxseed (U. S. P., 1S70) is a good
demulcent in acute bronchitis and diarrhoea. The extract is useful in re-
lieving dryness of the throat and hoarseness, especially if combined with
ammonium chloride. The troches contain 0.005 Gm. (or gr. y, J of opium»
and may be used where an opiate is not objectionable* but are dangerous,
since their pleasant taste leads children to take an overdose; one every hour
is sufficient for an adult with irritable cough.
The compound mixture is a good expectorant for bronchitis, and is often
combined with syrup of senega and ammonium chloride.
In constipation, especially during pregnancy, the compound licorice-
powder is very valuable; given at night on retiring, it causes one or two
natural stools in the morning, generally without griping. Wlierc a more
decided effect is desired, it may be combined with an equal portion of com-
pound jalap-powder.
OOSSYPilM PURIFICATUM.
497
I
I
GOSSYPllTM PURIFICATUM (I. S. P.), GOSSYPIUM (B. P.).—
Faiified Cotton.
GOSSYPII CORTEX (L*. 8. P.).— Cotton-root Bark.
Preparations,
GoMjrpium Purificmtum (U.S. P.). — Purified Cotton (absorbeot cotton).
KluitU'Xtracluiu llospypii HuUicia. — Fluid Extract of Cotton-root Bark. Dose,
i Ui 4 c.rni. (or fSss-j).
Olcutu Uouypii Seminis (U. S. P.)> — Cotton-seed Oil.
i'vfoxilinuiu iL, S. P.). — l*vru\ylin, Collodion Lotton. Soluble gun cotton.
Pharmacology and Therapy. — Cotton is a native of the Bouthem por-
o( lilt United States, and is "the hairs of the seed of Gossypium herba-
<Maivact'ie) and of other species of Gossypium freed from adhering
impurities and deprived of fatty matter. '^ The British Pharmacopoeia directs
*^e hairs of the seed of Gossypium barbadense, and of other species of
Go£s}'piuiD, freed from fatty matter." It is composed almost entirely of
Klluioee, and is in a mass of white, interlacing fibres, forming sheets of so-
called carded cotton-wool. By a preliminary treatment with alkahes to ex-
incl the fatty matters, it becomes absorbent cotton, which is of great value
m modern surgical practice, and has succeeded the sponge as a dressing for
«ound8. Absorbent cotton may be treated with various agents, so as to be
of special value (carbolized, berated, salicylated, or treated with mercuric
chloride, etc.). These are used to exclude air from wounds, burns, etc., and
afford some support, and may also be applied to a blister after puncture. In
mflamnaations, as in acute articular rheumatism, the part may be enveloped
JD cotton, either dry or moistened with anodynes, with great comfort to the
pauent. It is also a good material for tampons, or for making an artificial
rtr-driiiu after perforation. Cotton is much in use as a padding for splints.
bx. Whitla speaks very favorably of its use in phlegmasia dolens, enveloping
_^_ entire limb in a thick layer surrounded by oiled silk and carefully band-
it. Haemostatic cotton may be made by dipping absorbent cotton in a
folation of ferric chloride, and afterward drying and picking it, or dilute
JlonaePs solution may be used (1 in 24) and the cotton kept immersed in it
until used as a tampon, in uterine cancer, etc.
P}ioxylinum, or gun-cotton, is oflicial only as a component of collodion.
The oil of the seeds is bright, pale, odorless, and free from acrid after-
t««te. It ia a good substitute for olive-oil, and is frequently sold for it. It
mten into the l'. S. P. official liniments of ammonia and of camphor. In
pharmacy it answers a similar purpose to olive-oil.
The bark of the root of gossypium contains resin, tannic acid, and a red
coloring matter. A solid and a fluid extract can be obtained (both alcoholic),
tbe dose of the former being 0.065 to 0.32 Gm. (or gr. i-v); of the latter, 2 to
4 c^iD. (or foets-j). A recent decoction is also used in the South. It has a
jpvdal action upon the uterus, like ergot, and is employed in the same class
i4 cases — in scanty menstruation, dvsmenorrhcea, and during labor. Phillips
kfti found it nselul in haemoptysis, and in the West Indies it is administered
ta dysentery.
Pr. Poteyenko has extended the use of cotton-root bark to other hamor-
He speaks particularly of a case of persistent epistaiis which had
^^^^ 'arious internal and topical remedies, but which was promptly and
pmnanently checked by the administration of 1.54 can. (or mxxv) of th»
498
PHARMACEUTICAL THEttAVliUTlC AOK.VTS OK UKLGK.
fluid extract thrice daily for three days. Dr. Garrigues has found this drug
of special service in chronic uterinfe ha:'morrhage8, even when these depend
upon fibroids or carcinoma.
GEAl^ATUM (U. S, P.).— Pomegranate.
GRANATI CORTEX (B. P.).— Pomegranate-bark.
Dose, 4 to 8 Gm. (or 3i-ij).
PrBparation,
Fluidextraphim Granati (U. S. P.). — Fluid extract of Fomegrannte. Dose, 1.3
to 2 Gm. (or »ixx-xxx).
Decoctum Granati Corticis {B. P.). — Dcooction of Pomegranate-bark (20 per
cent). Dose, 15 to 60 c.cm. (or fjaa-ij).
Pcllcticrina; Tannaa (U. S. P.) — Tunuatc of Pelleticrine.
Pharmacology. — -Pomegranate is *'tlie dried bark of the stem and root of
Punica graiintxim ( Punieaceai)," cultivated in subtropical countries. The
rind of the fruit, though it is not official, contains very similar constituents,
and is also useful. The liquid alkaloid, Pellctierine (Vj per cent.), is found
in this plant in combination with punico-tonnic acid, and to these the pecul-
iar virtues of the bark are due. The tannic acid is largely in excess (20 to
28 per cent.). It has been shown that Pelleticrine is a mixture of four alka-
loids, three of whieh arc liquid and one solid. Pclletierine is a colorless aro-
matic, oily fluid, soluble in water, alcohol, ether, and chloroform.
According to Professor Fliickiger* the commercial pelietierine tannate
is a mixture of the tannates of the total alkaloids of pomegranate-bark.
Phyaiological Action and Therapy. — Pomerrranate has powerful astrin-
gent properties, and a decoction flavored with orange or aroniatics is useful
in sore throat or pharyngitis, and as an astringent injection for gonorrhcea.
Coronedi has determined that pelleticrine acts as a muscle-poison and prob-
ably produces a condition of rigidity. In excessive amount pelleticrine is
stated to have an action similar to that of curare, paralyzing motor nerves
without influencing muscular contractility or sensation.
The special use of this agent is for the destruction of tape-worms, a
•wineglassful of the decoction being taken every hour for three hours, to be
followed by a purgative dose of castor-oiL The drug itself, in large doses,
acts both as an emetic and purgative. The pelleticrine tannate, 1 Gm. (or gr.
xv) at a dose, in capsules, is an effective, but expensive, remedy. The decoc-
tion is 80 astringent that it may not be possible for the patient to take it,
in which case the same result may be obtained by evaporating it, in a water-
bath, to a pilular consistency, and administering the extract thus made in
gelatin capsules, preceded and followed by a cathartic. Pomegranate has
been used with success in the diarrhoea and dysentery of hot climates.
Dujardin-Beaumetz has witnessed good results from the employment of
pomegranate in Meniere's disease. In paralysis of the third and sixth nerves
M. Galezowski asserts that pelietierine is of service.
GRINDELIA (U. S. P.).— Qrindelia.
Preparation.
Fluidextractum (irindelice (U. S.
0.60 to 4 com. (or mx-fSj).
P.).— Fluid Extract
Grindelia.
GRIVDELU.
499
I
r
Pharmacology. — "The leaves and flowering tops of Grindelia robusta
ifid of Grindelia squarrofia (Compositfle)," a perennial California plant, con-
tiin a Toiatile oil, a resin, and, possibly, an alkaloid. The plant possesses a
beleamic odor, a warm, aromatic, and bitter taste. The resin is precipitated
bj wat£r. The active principles are not completely extracted by alcohol, but
in aqueous, alkaline solution has been found by Dr. W. P. Gibbons to be the
most satisfactory menstruum.
Physioloincal Action. — Grindelia creates a sensation of warmth in the
ftomach, and, in small quantities, if not too long continued, improves the
jppetite and digestion. It slows the action of the heart and lungs, and aug-
ments the blood-pressure. It possesses antispasmodic and expectorant quali-
ties. Large quantities dilate the pupil, produce an hypnotic effect, and par-
ilyxe first the sensory and then the motor nervous system. Death occurs
from paralysis of the muscles of respiration. The plant, however, ia but
feeblj poisonous. It exerts some diuretic effect.
Tkerapy. — Grindelia is an efficient local application in dermatitis caused
hj contact with the rhus toxicodendron, or poison-ivy. Cloths dipped in a
miitwe of 2 to 4 c.cm. (or fSss-j) of the fluid extract to 120 to 180 c.cm. (or
fJJT-TJ) of water, and laid upon the affected surface, will, in many instances,
afford rapid relief. This mixture has also been advantageously employed
upon bums and blisters. A combination with creolin is likewise efficient in
these conditions; —
Fluidext. grindelia 15| c.cm. or fjsi.
Creotini 7 5 c.cm. or f3ij.
Aqtue q. 8. ad 1501 c.cid. or fjv. — M.
An injection of the above strength is useful in vaginitis, or, applied upon
absorbent cotton, in pruritus vaginae. It may likewise be resorted to in leu-
torrhoea and endometritis. A weaker solution thrown into the urethra is of
•CTTice in gonorrhcea and gleet. Diluted with water or glycerin, the fluid
extnct of grindelia is a beneficial application to chronic or irritable ulcers,
and in these cases it is a good practice to conjoin the internal administration
-of the remedy. One part of fluid extract to 4 parts of water as a local dresa-
tBg> together with the internal exhibition of the same preparation, has been
foimd efficient in iritis.
Hi fumeg may be inhaled for the relief nf the paroxysm of asthma,
■fither by smoking in a pipe or saturated in a solution of potassium nitrate,
dried and burned upon a plate.
As an internal remedy, the chief value of trrindelia is in the treatment
of asthma The paroxysm may usually be notably abridged by the adraiais-
tration of 1.20 to 2 c.cm. (or mxx-xxx) of the fluid extract, repeated every
twenty or thirty minutes. Two or three such doses will, in many instances,
allar ihe spasm. After the attack has subsided, the medicine should be con-
ticQcd in order to avert recurrence. In the interval grindelia may very
profitably be combined with other agents having similar power, as, for ex-
ample:—
B PoUwii iodidi 23 3 Gm. or 5tj.
ISq. poUAsii arsenitii 6 t cm. or f3in.
JHuidext- (Trindpliff 60 ctm. or fjij.
Tlnct. euphorbi« pilulif 18 5 c.cm. or f3v.
riuidext. eriodictyi q. 8. ad 120 can. or fSiv.
ct ft. aoL
Tca^pooaful three times a day. For asthma nnd chronic bronchitis.
i
500 PUARMACEUTICAL THERAPEUTIC AGENTS OR DnUGS,
Another efficient combination in asthma is: —
3 Fluitlext. griiidelifie 601 c.cm, or IJij.
Potfl&sit iodidi 8 Gm. or 3ij.
Syrup. Tolutan q. s. ad 120| cczn. or fjiv.
M. et ft. sol.
Sig.: Teaspoon ful ever^ three houn.
A formula which has been recommended is: —
Q Amznomi iodid 8| Gm. or 3ij.
Fhiidext. grindel.
Fluidcxt. glycyrrhiz aa 15| cctn. or fjaa.
Tinct. lobclue,
Tinct. belladonn. fol aa 716 c.cm. or f3ij.
Syrup. Tolutan q. s. ad 120| ccm. or fiiv.
M. Ct ft 801.
Big.: Teaspoonful three times a day and additionally during a paroxysm.
Grindelia is eliminated in part bj the bronchial mucous membrane,
which it stimulates. It is an excellent expectorant in chronic bronchitis, and
hence when this condition, as is so often the case, complicates emphysema
and aethina, grindelia is no less efficacious than in pure nervous asthma. It
relieves cough and promotes expectoration in chronic pneumonia. It is
sometimes of advantage in ameliorating the cough of phthisis. In shortness
of breath due to anaemia, and in some cases of dyspncea dependent upon
valvular disease of the heart, p-indelia has proved beneficial. In certain
cases of hay fever this remedy has been used successfully. The paroxysms
of whooping-cough are diminished in frequency and mitigated in severity by
the administration of grindelia. As it escapes from the system principally
by the kidneys, it exerts a favorable influence upon pyelitis and chronic cys-
titis. The dried leaves may be moistened with nitre solution, and, mixed
with a little tobacco, rolled into cigarettes for use in asthma.
GUAIACOL (!■. S. P.).— (See under Creoaotum.) i
GriACOLIS CARBAMAS (U. S. P. ) .—Carbamate of Guaicol. (See
under Creosotum.)
GrAIACTTM iV, S. P.).— Gnaiac.
GITAIACI LIGNUM { B. P. ) .— Gnaiacnm-wood.
Preparations.
i
Guaiaci Resina (U.S. P., B. P.). — Guaiac. The resin of the wood of Guaiacum
officinale. Dose, 0.32 to 1 Gm. (or gr. v-3tv).
Tinctura Guaiaci Amnioniata (U.S. P., B. P.). — Ammoniated Tincture of Guaiac.
DoRe. 0.00 to 4 c.cm. (or wx-f3j).
Tinctura Guaiaci (U.S. P.).— Tincture of Guaiac. Dose, 0.60 to 4 c.cm. (or
mx-f 3j ) .
Pilulffi AntJmonii Compoaitce (U.S. P.). — Compound Antimonial Pills (contain
guaiac, sulphurated anlinionj', and csloDiel).
Mistura Guaiaci (B. P.). — Guaiacum Mixture (guaiac resin, 2Vi per cent, with
sugar, trapacanth. and cinnftmon-water). Dose, 15 to 30 c.cm. (or f^ss-j).
Trochiscus (iuoiaci Resinae (B. P.). — Ix>zengG of Guaiac Resin (each containing
050 Gm., or gr. iij).
Pharmacology. — The heart-wood of gnaiaeum oiTicinalo (Zygojihyl-
lacaa^), or of G. sanctum, enters into one United States Pharmacopoeia
official preparation ^f doubtful vahiej the compound decoction of sarsaparilla.
GUAIACUM.
501
•eltlom uw»d at present except as a vchicK? for jH^tassium iodide, to cover its
OApleiSAnt taste. The refiin is the most itiijiortant constituent of the wood
{^ to 25 per ceat.)? from which it is ohUiiiied by heatiug or by l.joiling with
water. Tlte rosin eontnins Guaiacetic acid (10 per cent.). Quaiaoonic acid
(TOpercent.),Guaiacic acid (a sniail i|Ujintity), and Betaguaiac reain (10
percent.), with ?<}un- Ouaiac yellow. The netive i)rinriples are iiisohihlu in
«uter, hui solulih* in ak-ohol and alkahne Kuids.
Physiological Action. — It is esteemed to be alterative and expectorant,
bat the taste is so unpleasant as to greatly limit its use in medicine. It is a
gastro-intestinal irritant, stimulating the liver, and is stated by some to act
ibo on the excretory organs of the skin; and, when it fails to act upon the
fikxny is diuretic. Dr. Murrell finds it an efficient laxative.
Therapy. — Ouaiac was formerly used as an alterative and antisyphilitic,
but it is not much valued for this at present, — only as an ingredient in the
compound preparation of sarsaparilla, which is used as a vehicle for the
iodiae«. In tonsillitis frequent small doses of the tincture will sometimes
cut an attack short.
As a gargle in acute tonsillitis Dr. S. Solis-Cohen makes use of the fol-
lowing preparation: —
B Tr. guaiaci ammoniat 16 e.cin. or fjss.
Tt. cinchon. co 7 5 c.nr- or f3ij.
MeU. deapuniat. 22 r cm. or f3vj.
Infus. cocsB 60 c.cm. or f5ij.
Sodii ealicylat 6 Gm. or Sifts.
Aqa» q. a. ad 180 f^.cm. or (Svj.
M. ct ft. aol.
Sig.: A tablespoonful to be used in divided portions and^ if advisable, a small
quantity may be awallowed.
In various neuralgic and rheumatic atfections, in rheumatoid arthritis,
in amenorrhu?a, and in dysmenorrha?a it is also very useful. In rheumatic
sore throat the ammoniated tincture may be administered internally, and
idded to hot water makes a good gargle.
The following is a formula used by Dr. R. B. Falkner, of Pittsburgh,
for a compound guaiac pastille: —
B Re^^tnic guaincum
Morphinie bimecunat.
Tinrturu* aconiti •*.
01. cinnamomi
Pulv. cinnamomi
PaatiB ribes nigri (or black-currant paste) ....
'The cinnamon disguises absolutely the taste of the guaiac, and| at the
Hin« time, adds to the therapeutic efficiency of the pastille. Guaiac, in this
nombination, is very pleasant, very potent, and very prompt in reducing the
inllammalory engorgement in tonsillitis, acute pharyngitis, and in the re-
ffiotal of arthritic throat affections. The peculiar acid of black currants
leema to enhance the efficiency of all these forms of pastilles, and the currant-
or paste renders the above formula permanently plastic, soluble, and
Tb« ammoniated tincture has been given for the purpose of relieving
chronic hoarseness dependent upon thickening of the vocal cords.
The compound known in Philadelphia as ZoUickofer's mixture is often
advantageons in chronic rheumatism. Its composition is: —
13 Gm. or gr. Ij.
00006 Gm. or gr. V,»
12 c.cm. or mij.
006 c.cm. or m Vjt.
005 Gm. or gr. J.
503
PlIARMACEVTICAL THERAPKUTIC AGENTS OB DEtJOS.
Pulv. resin, guaiaci,
Potau. iodid. aa
Tinct. colchici sem 2
Aq. einnamomi IS
Syrupi q. a. ad 30
»«
66 Gm. or
e.cm. or T3ss,
com. or fjas.
c.cm. or f5j.
M. Sig.: From a deaserUpoonful to a tablespoonful three times a day.
Good results are sometimes obtained from guaiac in clironic gout, gouty
bronchitis, and lumbago.
Dr. Augustus A. Eshner has found the following formula of service in
myalgia: —
H Tinct. guaiac. ammoniat.,
Fluidcxt. cimicifugoc
Fluidext. coc»
M. Sig.: TeaBpoonfuI before each meal.
In valvular lesions of the heart dependent upon a rheumatic element
Dr. A. E. TuBsey has prescribed with advantage: —
30| cxm. or fSj.
3 KcRinic guniacif
I>igitalis fol.
Quinin. Bulph aa 2| Gm.
Strychnin, aulph [065 Gm.
M. et ft pil. DO. XXX.
Sig.: One pill thrice daily.
or gr. XXX.
or gr. j.
The ammoniated tincture is regarded as the best preparation; it may
be given in milk, in glyceritum vitelli, or in aromatic elixir of licorice. In
chronic constipation MurrelP hns obt^iined very satisfactory results from the
administration of the resin in 0.65 to 1.30 Gm. (or gr. x-xx) doses, in a table-
spoonful of thick extract of maltj two or three times daily, according to the
case. It occasionally produces a rash. Murreil advises the trial of a triturate
with cream of tartar, sugar of milk, or some other inert substance.
Levy asserts that tincture of guaiacum is a valuable remedy in haem-
aturia. He gives it in doses of 2 to 4 c.cm. (or f3s8-j) in milk every four hours.
GTTABANA (U. S. P.). — Guarana (Pasta Guaranae).
Preparation,
Fluidextrut'tum Guaniiite (U. S. P.). — Fluid Extract of Guarana. Dose, 0.00
to 4 c.eni. (or mx-f3j).
Pharmacology. — "A dried paste prepared from the crushed or pounded
seeds of Paullinia cupana (Sapindaceee)": a climbing plant of Brazil. It
is in round masses or cylindrical sticks, resembling chocolate in color and
odor. It contains Guaranine (5 per cent.), an alkaloid practically identical
with Caffeine; tannic acid (25 per cent.), traces of volatile oil, saponin, etc.
Physiological Action.— The physiological effects are the same as those
of coffee or chocolate, but it is of very uncertain strength.
Therapy. — The principal use of giiarana is in nervous headache, 2-c.cm.
(or f.iss) doees of the fluid extract bein^^ administered every hour during the
beginning of the attack. It has also been used in diarrhoea. In the head-
ache of chlorosis Dr. Albert Robin, of Paris, often prescribes: —
^Medical BuUctin, Jan.
M.D., of London, England.
1891] "Guaiacum a« a Laxative," by William Murrell,
W. «t ft, pil. no. j.
Sig. : One such pill to be Uiken thrice daily.
GUBJITK. — Gurjun Balsam or Oil, or Wood-oil, is an oleoresin obtained
from the Dipterocarpus lurbinutus uud other species of Dipterocarpacese of
East India. The balsam flows from the wountled tree. It contaims from 40
to TO per cent, of volatile oil, some resin, and Qurjtinic Acid. It resembles
copaiba in physical and physiological properties, but is more acceptable to
the digestive organs and has less effect upon the kidneys. Dose, 0.60 to 7,5
c.cm. (or mx-f5ij), in emulsion or capsules, or with extract of malt.
Therapy. — Gurjiin-oil is antiseptic and alterative. It likewise exerts
a laxatire and diuretic influence. In combination with lime-water (1 to 4)
it is a useful application in psoriasis and chronic eczema. It has been em-
ployed in leprosy, both internally and locally, with asserted curative effect.
The oil has been administered successfully in the treatment of gonorrhcea
and «rleet, also in chronic bronchitis.
GUTTA-PERCHA.— Gutta-percha is tlie concrete milk juice of Pala-
luu gutta (Sapotacea?) : a tree of the East Indies. It is insoluble in water
in alcohol, but soluble in chloroform, oil of turpentine, and carbon disul-
"ide. It Boftens easily, and can be cut with a hot knife.
Therapy. — Used externally in sheets for making molded splints, as, after
softening with hot water, it adapts itself to the surface and soon hardens
~ it is also used in making mechanical appliances, such as pessaries,
ula, etc. The solution is used as a protective, like collodion.
A solution of 1 part of gutta-percha in 10 parts of chloroform is known
by the name of traumaticin, or hquor guttcB perchcB, and in the treatment
of certain cutaneous disorders answers a good purpose as a solvent for various
medicaments. The solution constitutes a cleanly application and one which
is not too easily removed.
GYNOCAEDIA.— Chaulmoogra, The ripe seed of Hydnocarpus Kurzii
< Flacouniaceae) , and perhaps also of Gynocardia Odorata. (See page 324.)
HJEMATOXYLON {W
Hcmatoxylon (Logwood).
S. P.), H^MATOXYII LIGNTTM (B. P.).
Preparations.
(U.S. P.).— Extract
of lleematoxjlon. Dose, 0.32 to
Extract urn TlfltmntoxTU
0.65 Gm. lor ?r. v-x).
Decoctnm Hfl^niatoxyli (B. P.). — Decoction of hog\vooi\ (5 per cent.). Dose, 15
to 00 c^m. (or fjas-ij).
Fbannacolo^. — Logwood is "the heart-wood of IIa?matoxylon cam-
pechianum (Leguminos^)": a large tree of Central America and the West
Indiea. It occurs as chips or raspings of a reddish-brown color. Tannin is
the principal medical constituent. It also contains Hematoxylin (12 per
cent.), a red coloring constituent resembling licorice in its taste, which is
lobU* in water and in alcohol.
Physiological Action. — Haematoxylon is astringent, tonic, and unirri-
tatinJT. It colors the urine and stools red, and has the disadvantage of stain-
ing the linen. It does not produce constipation.
n
I
504 PHAHMACECTICAL TIIEOAPRCTIC AGENTS OR DRCOS. ^H
Therapy. — ^Formerly used aa an astringent for children's diarrhoeas, but,
■as the medicine was occasionally spilt or vomited upon the clothing, it was
productive of much dissatisfaqtion, and was abandoned, especially since the
new dietetic and antiseptic method has come into vogue. Nevertheless, it is
of decided value in tuberculous diarrhoea, and should not be entirely over-
looked. The decoction has been used as an astringent in leucorrhcea and
bleeding haemorrhoids.
KAWAMEUDIS COETEX (B. P.)- — Hamamelis-bark (Witch-hazel
Bark).
HAMAMEUDIS FOLIA (U. S. P., B. P. ) .— Hamamelia-leaves.
PreparalioTis,
Fluidpxtraclnin HHnuuiH^lidis (U. S. P.).— Fluid Extract of llamainelU.
Dose, 0.60 to 4 c.cm. (or nix-fSj).
Extractum Haniamelidis Liquidum (B. P.)*— Liquid Extract of Hamamelis. Dose,
0.30 to 1 c.cm. (or mv-xv).
Aqua H)iniann-Iiilis ( r. K. P.). — Hamuim-lis wiitir (diKtillcMl i.
hiquor U&mamelidia (B. P.). — {Solution of Hamamelis (distilled from fresh
leavea).
Tinctura Hamanielidia (B. P.). — Tincture of Hamomelia (bark, 10 pvr cent.}.
Doae, 2 to 4 c.cm, (or f3s8-j).
Ungaientuin Hiiniainelidia (B. P.), — Hamamelis Ointment (10 per cent., with
lanolin ) .
Pharmacology. — '*The dried leaves of Hanuiinolifi vir^'iiiianii* (Hynia-
inelaceae) collected in autumn" are official, and, although not stipulated by
the phannacopti::riu, they should be fresh, as they owe their eiTieacy largely to
Bonie volatile principle not yet isolated; they also contain tannin and a bitter
extriutivc, coloring matter, etc. The British Pharmacopfpia direels "the
dried hark of Haiuaraelis virginiana," and "the leaves, fresh and dried, of
Hamamelis virginiana." The old leaves and many preparations arc de-
void of physiolopncal activity, but a well-made Ikiid extract, and especially
the distilled extract, have been found to have decided theraf)eutical power.
The bark of the younger branches is more astringent than the leaves; it
contnins about 8 per cent, of tannin, and can be used for the same purposes
as the leaves. F. Griittner, after a careful examination of the bark, found
fat, gallic acid, tannins consisting of crystalline and amorphous forms of a
body having a formula C'l^ll^^O., with a varying amount of water. These
bodies, which he calls Hamamelitanin, are dextrogyre, possess Ave hydroxy!
groups and one carboxyl, form definite benzoyl derivatives, and hydrolyze
to gallic acid. There is also a tannin hydrolyzing to glucose and gallic acid.
It also contains glucose. It is probable that the popular distilled extriact is
made from the leaves and smaller twigs, freshly gathered and treated with
dihite alcohol before distillation. Some of the undoubted good results of
this agent as a local application, as a wash, a gargle, etc, may be due to the
alcohol present.
* Sf« ]>nporfl by th^ author on "Hamnmolis Vtrj^nica/' read before the BritiBh
Medical Association, So<*tion of Therapeutics, at Brighton, Aug.. 188G— TAe Mt-dical
Register, Juno 4, 18H7; "UamanioHs in tho Treatment of Diseanes of the Skin.'* read
before tho Scition nf Dj-rmatolopy at the Mf»oting of Oenmin N'aturnlists and Physi-
cians, held in Berlin, Sept., lR«d— TAp Mcdif^al IhtUctin, Dec.. iHHfl. See uUo jtapor
on "liamiimelis and Alcohol," by Dr. K. H. Griffln— Urr/frfi/ Jirnmi, Dec.. iHiiO.
HAMAMELIS.
505
>
Physiological Action. — Negative physiological results from an inves-
hgition of the root have been reported by Wood and Marshall. Dujardin-
Betumetz, on the other hand, believed that witch-hazel owes its utility to an
action on the muscular fibres of the veins. Hector Guy' reports, after ex-
pehznents with witch-hazel, that it shows no special physiological action on
ihe vascular system, but that headache sometimes follows full doses.
Therapy. — For sprains, bruises, and superficial infiammations, the dis-
tilled extract is a pleasant and valuable application. It is also useful diluted
rith 2 to 3 parts of water or alcohol in inflammation of the gums, pharyn-
gitis, nasal catarrh after the removal of nasal polypi, in the form of a spray
or wafth. Either form may be injected into the bladder, properly diluted,
m cases of catarrhal infiamniation or haemorrhage. The topical application
of hamamelis is much more decidedly hsemostatic than is explained by our
present knowledge of its composition. It is a reliable agent in the treatment
of capillar}' haemorrhage from wounds, epistaxis, bleeding sockets after the
extraction of teeih, and in bleeding piles is one of the roost et^cient agents at
our command. This medicament, according to Flagg, is very efficacious in
chronic and incurable bfcniorrhagic, anemic, and inflammatory condi-
tions. Log-ulcers, o*;])ecially those oocasionod by varicose veins, aro
remarkably benefited by the application of a lotion or ointment containing
witch-hazel. This drug possesses a marked sedative as well as astringent
action upon congested or infiamed tissues. Hamamelis ointment often,
therefore, proves of avail in bums, erysipelas, eczema, and herpes. Excessive
secretion is likewise restrained, and for this reason it is sometimes of service
in seborrhoea, acne, and rosacea: —
c.cin,
Gm.
60 Gm.
or f3i-is8.
or 3j.
or gr. xl.
ccm.
Gm.
or mxxx.
or 3j.
L .,..._.
chronic rheumatism. A diluted fluid extract is an efficient lotion in car-
boncle, chancroid, freckles, hyperidrosis, and lupus erythematosus. In
burns and frost-bites the following combination is useful: —
B FluideKt. liamameltUis 4{ to 6
Zinci oxidi 4
Amyli 2
Glycerini 2
Vug. aquflp ro«B 31
M. An ointment for sunburn, eczema, intertrigo, etc.
B t.iq. plumbi subacetAtis,
Tittct. opii , '. aa 30
A*]. tuuiiumt-'Uiiia 60
Aquae 473
c.cm. or fSj.
com. or ($ij.
c.cm. or Oj. — M.
Ab an external application to relieve itching in pemphigus vulgaris: —
B Cr*o«oti 1 1 c.cm. or wjxv.
LiquorU calcU,
Aqii*- hnmHin»Mi<li- aa 90| C.cm. or fSiij.
K. Sig.: For externa) use.
Figures of the anus and ulcers of the anus or rectum are improved by
the application of a wash or ointment containing witch-hazel.
A l-per-cent. solution of creosote in decoction of hamamelis with the
' Tk^W 44 f flrU, 1884.
OOG PUARilACEUTICAL THERAPEUTIC AGEXTS 0« DBUUS. ^^
addition of boric acid has been recommended as an excellent injection in
gonorrhoea.
Given by the mouth, hamamelis is scarcely less astringent and sedative
than when applied externally. It renders good service in cases of acute or
chronic diarrhcea, enteritis, and dysentery. It restrains suppuration in pye-
htis and reduces the inflammatory congestion of cystitis. In haemorrhage
from internal organs it is an admirable remedy, and may be given with con-
siderable conHdence in bleeding from the stomach, bowels, kidneys, womb,
or lungs, and in purpura ha?morrhagica. Hamamelis is useful in chronic
bronchitis attended by copious discharge. It may be of service in the night-
sweats of phthisis. Its internal, conjoined with its external, use is productive
of excellent results in epistaxis and varicose ulcers. Varicose veins, varico-
cele, and internal ha?niorrhoids may, not infrequently, be entirely cured by
the persistent administration of hamamelis. It has been found serviceable
in phlegmasia dolens and often mitigates the pain of dysmenorrhcea. The
combined internal and external use of witch-hazel is useful in gonorrhoea
after subsidence of the acute stage, and in leucorrhoea. Witch-hazel, also,
has the reputation of preventing abortion.
HEDEOMA (U. S. P.).— Hedeoma (Pennyroyal).
Preparation.
Oleum HedeomcB (U. S. P.).— Oil of Hedeouia. Dose, 0.12 to 0.60 c.cm. (or mVi-x).
Pharmacology. — '*The dried leaves and tops of Iledeoma pulegioides
(LabintiL*)" contain an urnrnatic, volatile ml, which is official, and is its only
important constituent.
Phyfliological Action and Therapy. — Pennyroyal-tea, or a recent in-
fusion of the leaves and tops, is used in flatulent colic and recent suppression
of the menses. The oil may be similarly emplo3'ed, but is very seldom used
internally except as a constituent of emmenagogue pills. Dr. Wingate has
reported the case of a woman who took a teaspoonful of the oil of pennyroyal
with half a teaspoonful of the fluid extract of ergot. In an hour she was un-
conscious, with small pulse, cold extremities, and slightly-dilated pupils.
Several convulsions occurred, and opisthotonos was well marked. Morphine
and atropine hypodcrmically Avith heat externally proved restorative.
Hedeoma is carminative and can be used for flatulence. The oil has stimu-
lant, carminative, and emmenagogic properties.
The fresh herb is said to be obno.xious to mosquitoes, and may be hung
about the sleeping room, or the hands and face bathed with a recent infusion
or a solution of the oil in alcohol (1 to 10), in order to keep off these mid-
night marauders. The spirit may be used with an atomizer or as an em-
brocation for the same purpose.
HELIANTHEMUM.— Frost-wort. The whole herb of the Helianthe-
mum Canadenso (Cistaceae) is a domestic remedy as an alterative and astrin-
gent. It contains tannin and some bitter substance, A recent decoction
may be used, but a fluid extract made with diluted alcohol (dose, 4 to 7.5
c.cm., or f5i-ij, several times a day) is a better preparation for diarrhcea and
dysentery. It is also esteemed useful as a tonic in scrofula and syphilis.
HEUANTHTJS ANNinrS.— The Sunflower, or Helianthus annuus{Com-
positce), is a well-known plant, a native of Peru, but cultivated in many parts
HEMIDE8MI RADIX.
5or
»
»
L
! America and Europe and in China. It is valued chiefly on account of
Ibe filed oil obtained from its seed. The oil poBsesses nutritive properties
tod is an excellent illuminating material. Other constituents of the' plant
ire htlianthitannic acid, inulin, levulin, a dextrorotatory sugar, and a pecul-
iar oleoresin. In different parts of the world the sunflower is popularly
Cfteemed as a remedy in malaria. M. Moncorvo, of Rio de Janeiro, has
reported to the Therapeutical Society of Paris his clinical experiments with
sunflower in 100 cases of malaria occurring among children. He found that
the plant exerted a decided influence. In sixty-one patients, from one month
to twelve years of age, the action of the medicine could be watched for a
sufficiently long time, and all the patients recovered as rapidly as if they
had taken quinine. M. Moncorvo used the tincture and an alcoholic extract
and seems to prefer the former preparation. The drug was nearly always
wftll tolerated in the dose of 2 c.cm. to 9.25 c.cm. (or fSss-iiss) of the tinct-
ore, administered in a potion every two hours and taien in four or five
doees. The alcoholic extract was given in the dose of 1 to 6 Gm. (or gr.
iv-3i8s).
HZLLEBORUS.— Tbe Christmas rose, black hellebore, Helleborus niger
(Raniinculacese), is a native of Central and Southern Europe, and is culti-
vated in England and the United States for its showy flowers. The
rhizome with rootlets is the part used. The most important constituents are
two glucosides, — Helleborin and HcUeborem, — both crystalline, which are
cardiac and nervous poisons. There is no tannin.
Fhyuolos^cal Action. — The taste is bitter and acrid; the freshly bruised
drug, but not the dried preparation, has a somewhat rancid odor. The dust
is irritating and causes violent sneezing. Internally the effects are emetic,
drastic, cathartic, and emmenagogic. In its action upon the heart it re-
sembles digitalis. Venturini and Gasparini have ascertained that solutions
of helleborein, dropped into the conjunctival sac of rabbits and dogs, pro-
dace^ within fifteen minutes, such complete anaesthesia that the cornea can
be penetrated without causing pain. At the same time, the sensibility of
other parts of the eye and its appendages is left intact. The ansesthesia
it of longer duration than that due to cocaine. No alteration of the pupil
or the intrB-ocular pressure is produced.
Therapy. — Rarely used at present, except as an ingredient in some
proprif'tary cumienagogic pills. (For American liolobore, see Veratrum,
U. S. P.). Helleborein, which is soluble in water, has been experimentally
employivj in doses from O.OOC to 0.015 Gra. (or gr. '/lo-V*) as a substitute
for digitalis.
HELONIAS. — Helonias, False Unicom. The Chamaelirium luteum
(Oraj) or Helonias dioica (Pursh), belonging to the natural order, Melan-
thaccae, is a native of North America, east of the Mississippi. The root is the
portion used, and, from its resemblance to a horn, is called unicorn-root.
It contains a bitter principle, Chamfielirin, A fluid extract is made with the
aid of alcohol, of which the dose is 1.20 to 2 c.cm. (or wxx-ixx). It is
reported to be tonic and anthelmintic.
HEMIDESMI EADIX (fi. P.).— Hemidesmus-root.
Preparation.
flynipga Hemidesmi (B. P.).— Syrup of Uemideflmus (10 per cent). Dote. 2 to 4
e^em. (or fWj).
50S
PHARMACEUTICAL TUEIUPEUTIC AGENTS OH DRt'OS.
Pharmacology and Therapy. — The dried root of Hemidesmus iadicus
(Asclepiadacese), commonly known as Indian Sarsaparilla, or Nunnari, con-
taintf a Tolatilizable active principle: hemidesmio acid. It has tonic,
diuretic, diaphoretic, and alterative properties; and is also used for the
same purposes as sarsaparilla, usually as a decoction (62 Gm. to 437 c.cm.,
or ^ii-Oj). The official syrup is a more pleasant preparation.
HEPATICA.— Hepatica, Liverwort.
Pharmacology and Therapy. — The Hepatica triloba (Ranunculaceae) is
a native of North America. Its leaves contain mucilage and tannin; a recent
infusion of them, taken hot, is useful in the early stage of bronchitis. The
fluid extract may be employed as a demulcent astringent in diarrhoea. Dose,
2 to 6 c.cm. (or fSsa-isa), in fluid extract.
HEROIX^ HYDEOCHLORIDTna:.— Heroine Hydrochloride {(\,U,,
(Cjir^OJjNOHC']]. Horr»inc in im artilicial alkaloiil, diacolyl-morphine,
M'hich ifi almost inwihibir in \vater, hut its combination with hydrochloric
acid, as horoino liyth'ochkiriik\ is vory sf^hiblc, and is j>roferiililo for medical
use. Experiiiifnts tipnn juiininls M\n\v liprrnno to he less toxic thim morjihine
or codeine, which it ivseiribles in phypiolo^cal effect, especially as a sedative
for cough. Dopes of (i.iiO'2.''> in o.OOo Gm. (or gr. V^rVu) ^^*i^l usually
quickly relievo the coii^^h of acute bronchitis. Dr. John North found it
especially valiiiiblc in pneinunnia, relieving dyspnoea and cough, reducing
tempornturft and piilfic, and favoring sleep, in doses of 0.005 Gm. (or gr.
Via) flt night.
As re.rards the safety of this agent, it appears that the statements as to
its entire freedom from depressing action upon the heart cannot be relied
upon. Dr. A. L. Russell, of Midway, Pa., in a recent conimunicalion to the
Pennsylvania Medical Journal,^ reported two cases of sudden and alarming
attacks of heart-weakness during the administration of small doses (0.005
Gm., or gr. Via)- One case, male, 24 years of age, after taking this dose
three times a day for several days, "fell over on his face while at table in a
spasm of dyspncea, with marked cyanosis/'
Dreser recommended a dose of from 0,005 to 0.01 Gm. (or gr. */i2-*/e)»
hut Lco^ has srcn auplensiuif roi^ults, sucli as giddiness, nausea, and once even
fainting, after 0.01 Gm. (nrgr. ^/„), The narcotic action of heroine is much
less than that of either morphine or codeine. Thus, in sciatica, trigeminal
neuralgia, cardialgia, including the pain due to gastric ulcer and muscular
rheumatism, it either did not relieve the pain or did so only momentarily.
Leo found its action exceptionally satisfactory in the various forms of dysp-
noea. It increased the duration of inspiration and the amount of air taken
in. Tn hay fever, tlio inieruiil ndniinistnition of heroine liydroohloride in
small doses, 0.002 Gm. (orgr. Vao) every two or four hours, conjoined with
treatment locally with applications of suprarenal-gland extract, lias been
found useful by Abrams, of Hartford, and others. Leo employed it in 2
cases of uraemic dyspnoea, 8 cases of marked emphysema, 15 cases of chronic
bronchitis without obvious emphysema, and 5 cases of bronchial asthma.
Only in 1 case of emphysema and 2 of chronic bronchitis was no good effect
noted. Its action was almost magical in some cases. After one or two doses
* Sept^tnber, 1900» p. 200.
^Deutsche mviiicinitche Wochcnscfiriff, March 23. 189fl.
UEXAMETHYLEN TETRAMIN.
509
I
the patients were able to sleep in the recumbent posture. When the drug
iras discontinued, in emphysema and chronic bronchitis, the symptoms
mostly returned, but in many cases there was an interval of from eight to
fourteen days. Sometimes the expectoration became more difficult after the
use of heroine and for this tlie aiitlior combined it with potassium iodide.
EulmbcTg* used a 2-per-cent. solution of heroine hydrochloride for sub-
cntaneous injection, the single dose being from 0.24 to 0.50 c.cra. (or miv-
Tiij) of this solution, or 0.005 to 0,01 Gm. (or gr. V^-V*) of the salt. Thua,
the doses of heroine are less than those of morphine. Only on two occasions
(hd he use more than the above-named doses. Once he injected 0.02 Gm.
(or gr. V») in a patient accustomed to morphine, and once 0.012 Gm. (or
gr. Vj) in a woman with sciatica. In both cases unpleasant symptoms arose;
tins, in only exceptional cases should 0.01 Gm. (or gr, Vo) be given in a
Igle dose, and it should only be very gradually increased. The action of
Toine in allaying cough and in diminishing attacks of asthma and dyspnoea
is more rapid when given by subcutaneous injection than by the mouth.
Eulenbur^ thinks that it possesses a more marked narcotic and antineuralgic
aetion than is accredited it by Leo. He has found it of special value in those
Ino^ accus^tomed to the use of morphine. Tt may be of eervice, as a teni-
pi>rary eiibsiitute, in cases of the laorphine habit. The hydrochloride of
h*mine can also be given by the mouth, and here the single dose should not
exceed 0.005 to 0.01 Gm. (or gr. Vi2*V»)- The usual dose to begin with
should not he more than 0.002.*) Gm. (or gr. Va^)^ which may be added to
cough mixtures, or given in glycerin. In tuberculous larvngitis, it may be
applie<l l<*oally, as well as administered intonially. Arthur Strauss, of Bar-
men, Pnis,sia, claims that heroine has an'anaphrodisiac effect, when given in
(iosos of (».01 Gm. (or gr. \/„) each evening. George E. Petty, of Memphis^
Tcnn.. warns againf^t fonning a hcrnint' ndiliotion. which he finds is as hard
ro onTTome as tlie morf>hine habit itself. The antidotes to to.xic doses are
roffee^ and arterial stimulants, as in opium poisoning.
EETJCHEEA. — Hcnchcra, Alum-root. The Heuchera Americana be-
long to the Saxifragace^, and is a native of the United States. The root
contains considerable tannin (18 to 20 per cent.), and an infusion or fluid
extract is useful as a mouth-wash, gargle, etc., or may be given for diarrhcea.
■
HEXAMETHYLENAMIHA (U. S. P.).
pin, Formin, etc.).
-Hexamethylenamine ( Urotro-
HEXAMETHYLEN TETRAMIN.— This agent is fonned chemically
by the union of niiiinonja with formaldehyde. Tt is an unstable compound,
and mav \to decomposed by a focblo acid, or even by the jsodiinu acid phos-
pli -• nt in tlie urine, liberating formaldehyde, wliich again combines
'ri: T'dium salts present in the urine, as Ibc characteristic odor is not
manifc^. In medicinal doses it causes no digestive disturbance and only a
fwidrmlo incTcnso of urine. Tt is necessary, while treating a patient with
nmtropin. that the urine should he kept acid, otherwise the decomposition
wfll not orrur and tlu- disinf*»ctant action of the fonnaldehyde not obtained.
In gCTiito-urinary therapeutics urotropin is of value, especially in the
nvdical treatment of the diseases of the urinnr>' passages. Thus, in
lyrtttache mrdlcinUrhr Wochewtchrift, March 23, 1899.
610 PITARMACELTICAL THKRAPKDTIC AGENTS OH DRUGS. "
pyelitis, in cystitis with arumoniacai urine, and in chronic iDflammation of
the deep urethra. The average daily dose is 1 to 2 Gm. (or gr. xv-xxx), or
0.32 Gni. (or gr. v) four liruL's daily. This treatment has also been found
€fl5cicnt in phosphaturia, the urine clearing up almost immediately aiter the
remedy was taken. Nicolaier claims that it will even dissolve uric-acid
concretions.
The drug, though of undoubted value, is not quite so free from in-
jurious effects as has been thought. Dr. W. Langdon Brown* reports two
cases of hieinaturia following the use of 0.65 Gm. (or gr. x) of urotropin
three times a day, both patients recovering after discontinuance of the
<]rug. Dr. T, J. L. Forbes also reported an interesting ease of liaeniaturia
due to urotropin in a male, aged ij2 yeari?, suffering from cystitis of about
ten days' duration. The urine contained pus, but no blood, and was am-
moniacal; there was enlargement of the prostate; the patient was given
0.65 Gm. (or gr. x) of urotropin thrice daily in half a pint of warm water.
Two days later the patient expressed himself as feeling better, and the
urine was much improved; on the evening of the third day there was in-
creased ditTiculty in micturition, a burning feeling in the urethra, abdom-
inal pains, with diarrhoea, and marked haMnaturia; the urine was not
scanty. 'I'he urotropin wns withdrawn, and in five days, all traces of blood
having disappeared, he was again given 0.32 (irn. (or gr. v) of the drug,
and, after taking 1 Gm. (or gr, xv), felt a return of the burning sensation in
the urethra and again parsed a little blood in the last quantity of his urine.
Albuminuria may I'ollow the ingestion of urotropin, as in a case cited
by Dr. A. Griftitlu in which the albumin disappeared on the third day after
withdrawal of the drug.
HIRTTDO (B. P.),— leeches.
The speckled leech, Sanguisuga medicinalis, and the green leech, San-
guisuga officinalis, are recognized by the British Pluirmaeopoeia. The
animal of either variety is two or more inches in length, worm-like, having
a soft, smooth body. The American leech, Hirudo decora, is an inferior
animal, and does not withdraw as much blood as the other varieties. (For
further considerations see Leeches, Tari If.
HOLOCAIN is a synthetic product closely allied to phenacetin, and in
its actioa resembles cocaine. It is formed by the combination of molecular
equivalents of phenacetin and para-phenetidin with the separation of water,
the product being fine, crystals of para-di-eth-oxy-ethenyl-amidin. It is
basic in action and insoluble in water. The hydrochloratc, which is the
ealt generally used, dissolves in boiling water, but on cooling deposits all but
2 Va per cent. It is perfectly neutral and will keep for months without
change. It should be boiled in porcelain, as the hot solution attacks glaaa.
In 1-per-cent- solutions it rapidly produces ana?sthe8ia of the cornea without
altering the pupil, or intra-ocular pressure, or the corneal epithelium. Dr.
Hermann Knapp claims that it is superior to cocaine, as it has a very bene-
ficial action on septic ulcers of the cornea. Dr. Basket Derby considers it
of especial value in corneal ulceration on account of its bactericidal action.*
^British Medical Journal, June 15, 1001.
^Archives of Ophthalmology ^ vol. xxviii, Ko. 1, 1809.
HUMLLU8.
oil
I
^
HOMATEOPIN^ HYDROBROMIDITM (T. 8. V., H. P. ) .— Homatro-
pLac Hydrobromide.
Dose, 0.0008 to 0.003 Gm. (or gr. Vu'Vio)-
Preparation.
LAmclle Homatropinn (B. P.).— Discs of Uomatropine {each contains 0.00005
or gr* */hm of homatropine hydrobromide).
Pharmacology and Therapy. — "The hydrobromide (CieHjiNOaHBr),
of an alkaloid prepared from tropine/* is a reliable mydriatic for ex-
tniiiiation and determination of refraction in ophtbalmological practice,
baring the advantage over other mydriatics in being prompt in its action,
but more transitory in its effects, which pass away in from thirty-sLx to
fortj'-eight hours, while those of hyoscyamine last eight or nine days and
those of atropine continue for ten or twelve days. The ordinary solution for
paralyzing the accommodation is of the strength of I per cent., in distilled
water, a few drops of which are instilled into the eye every five or ten
minutes until the full effect is obtained. Some hyperaemia of the conjunctiva
generally follows its use, but not true inflammation, unless under very eicep-
Hoaal circumstances.
It is less irritant than atropine and much less apt to occasion systemic
intoxication. The only evidence of constitutional action usually observed is
a moderate retardation of the pulse.
Dr. Pooley has recorded the case of a girl 7 years of age, in whom
ifitellectnal, sensorial, and motor disturbances followed the instillation of a
2-per-cent. solution of homatropine every fifteen minutes for an hour. Sev-
eral days elapsed before the patient recovered her usual health.
In the treatment of choroiditis, and other disorders for which a mydri-
atic is used, atropine is more suitable because its action is more prolonged,
aad it causes less hyperaemia.
In making homatropine solutions, the water should be boiled juet before
ORDg, and small quantities only made at a time, as distilled water, unless
recently boiled, usually contains bacteria and other germs derived from the
air, which mi^ht induce irritation,
Homairopine hydrochloride and salicylate are salts which have a sijnilar
•ction to the hyJrobroniide, the dose of each being from O.0O05 to O.OO-'^
Oo. (or gr. V,,o-Vjo)- Besides the mydriatic properties alrendy referred to,
tbwe salts have likewise been used in checking night-sweats, especially of
phthisis.
HUinmJS (U. S. p.), LTTPITLUS (B. p.).— Hops.
Preparations.
TmctUTA Humuli. — Tincture of Hops (20 per cent.1.
f3*« JK
fliiWextnictum Lupniini.— Fluid Extract of Lupulin.
(o* flit xv).
Olrorrsina Lupalint (U.S. P.). — Oteorcaln of LupuUn.
for «li-v).
LopuUnum (U.S. P.. B. P.). — Lupulin. (The gUnduUr powder aeparated from
th« ftrobiles.) Dow, 0.13 to 0.33 Cm. (or gr. ii-v).
Infusum I.upuli (B. P.).— Infusion of Hops, Uoptea (5 per cent). Dote, 80 to
O&en. (or f5>->j)-
Dofto, 2 to 4 c.cm. (or
Dose, 0.30 to 1 c.cm.
Dose, 0.12 to 0.30 c.cm.
512
niAnMACKUTICAL THERATKUTIC AGENTS OB DBUGS.
Tinclura Luputi (B. P.).— Tincture of Hops (20 per cent),
(or f3fl8-j).
Dose, 2 to 4 ccm.
Pharmacology. — Hops arc "tin:- carefully dried strobiles of Humulus
lujjulus ( UrtitiiLT'it)? boarinj^ their natural <jlandular indumentum." The
otHcinI detiuitiou of lupulin is *Hhe gla:idular trieliainos separated from
the fruit of lluniuhis lupulutJ." The [•oiistituoiits are bitter Lupamaric, or
hoi)-Ijitter arjil, and hipulntiiiniii' udd, busides nearly 1 per cent, of volatile
oil, 9 to 18 per et-nt. rrsin, and 3 tn 4 per cent, taiiuia, etc. Hops likewise
contain n fermentable su;^ar, iliastaso. and a small tjuantity of asparagin.
Tlu^ fluid extract of lupulin is iiuide with alctihol; the nleoresin is e-xlracted
with t-tlirr; both arc t'liiriblo preparations.
Physiological Action.. — The preparations of hops are stomachic, tonic,
hypnotic, slightly diaphoretic, and anaphrodisiac. Although ueually devoid
of any local irritant effect. Dr. John W. Eckfcldt has met with several cases
of severe and prolonged dermatitis caused by the vapor produced in making
a hop ponltice. He ascribes the effects to the volatilization of the oil of hops
with its subsequent condensation upon the skin.'
Therapy. — Malt liquors, containing hops, are largely used as aids to
the appetite and digestion; unfortunately, many of them contain a very
small proportion of hops, the deficiency being made up with aloes or other
bitter substances, with cocculus Indicus, grains of paradise, glycerin, soap,
salicylic acid, etc., which detract from their value both from a medicinal
and a commercial stand-point, A well-made beer of good quality, however,
is a useful preparation of hops, and has considerable medicinal value as a
tonic during convalescence, or in feeble digestion, or as a stimulant to the
appetite and nutrition. The sedative effect of the hops is assisted by the
alcohol and carbonic acid, making beer useful in gastric catarrh with gas-
tralgia and as an hypnotic in neurasthenia with insomnia. In this condition
a hop-pillow is appropriately used. Though not of much efficacy in itself,
yet it assists in producing a narcotic effect. Beer may be given when all
other forms of nourishment are refused, as in diphtheria; and eggs or beef-
powder may be added to it to increase its value. The tincture of hops, or
the fluid extract of lupulin, are also alcoholic, but in them the proportion of
alcohol is so considerable as to make it the chief constituent. Malt liquors
increase the flow of milk during lactation.
The sedative effects of hops are obtained from a hop-poultice in local
painful affections, or the hops may be placed in flannel and moistened with
hot whisky and applied to painful areas, as in toothache or earache, where
the warmth and steam are very soothing.
The inhalations of the vapor of hops are often attended with good re-
sults, especially in diseases of the throat and chest. Lefferts used with
benefit this combination: —
B Sodii carbnnatis exsiccati 1 130 Gm. or gr. xx.
Aqufle fcrv. 040°) 473| ccm. or Oj.
Solve et adde: —
Extract! humuli 4| Gm. or 3j,
M. The vapor to be inhaled.
'"On the Poisonous Action of Hops," By John W. Eckfeldt, M.D., yedical
Bulletin, Jan.. 1892.
HYDRARGYRUM.
513
In delirium tremens hop-tea, with a quantity of Cayenne pepper, quiets
drink-craving and settles the stomach. In hysteria and nervousness prep-
•ralions of hops are useful medicaments. Hops — especially when employed
in the form of the infusion or tincture — are often most efficacious for their
hypnotic action in insomnia and restlessness. The following formulse are
Bttful combinations: —
I
B Tincl. humuli 90
Tinrt. cupsici 7
Gljrcerini fiO
c.cm. or fjiij.
5 c.cm. or f3ij.
c.cm. or fjij.
M. Sig.i A tablespoonful every hour or two for nervousness.
B Tinct. humuli.
Tinct, ammon. valerianatia,
Spiritus tetheris nitroii aa flO| ccm. or fjij-
H. Sig.: Two teagpoonfula in water every hour or two. Use in insomnia, hy»*
krk, and nervouraeas.
In irritation of the genito-urinary passages full doses of the oleoresin
of Itipulin afford much relief, and it has also been used as an anaphrodisiac
in . chordee, spermatorrhoea, and similar alTcctions. A very suitable
pr» • ^ n in genito-urinary irritation, of service in the diseases just re-
lerred to, is: —
B LapuHni,
Caiuphora monobromatie aa 4| Gm. or 5j.
01. tneobromatiA q. 8.
M. rt fL feuppmitorue no. xij.
';.[ Insert one into the bowel every three or four hours.
f HYDRANGEA. — Hydrangea. The dried root of Ilydrangea arbore&-
cnts (S.-jAiini^riUAw) has lon^ heen used l»y the ahoriginos. in the South, in
lh< form of a decoction, in the treatment of calculous niTootionp. A fluid ex-
trsci, made witli diluted alcohol, is a convenient form in which to administer
tiie rtmedv in doses of 2 to 4 c.cm. (or f3es-j). It is of especial utility in
gnrel and renal colic.
HYDEARGYHUM (TT. S. P., B. P.).— Mercury. Quicksilver.
"It .^h<>u!d be ViK'J per cent, pure, and be kept in strong bottles."
U, S. P. Preparations.
IlydnirgyTum cum CrctA. — Mercury with Chalk, Gray Powder (mercury, 38 Om.;
flrd honey. 10 Gm.; prepared ch&lk. 57 Gm.; water, to make 100). Dose, 0.03 to
Oj65 Om. (or gr. nx).
Hydrarprri Chloridum Corrosivum. — Corrosive Mercuric Chloride, CorrosW^
rhloridr of MVrrury. Corrosive Sublimnte. Do»e. 0.002 to O.OOfl Om. (or gr. V«.-V»»)-
Hydrargyri Chloridum Mite. — Mild Mcrcurous Chloride, Calomel, Mild Chloride
of Mercury. Dofte, 0.003 to O.GS Gm. (or gr. V,-x).
Uydrarjjyri lodidum Flavimi. — Yellow Mercurous Iodide, Protiodide, Yellow (or
) Iodide of Mercury. Dose. 0.02 Gm. (or gr. Vi).
Hydr«T)tyTi lodidum Rubnim. — Red Mercuric Iodide, Biniodide. Dose. 0.00125
IsOjOOA Om. (or jrr. V,.-V«).
Hydrarpyii (Hidiim Klavnm. — Yellow Mercuric Oxide. For external use.
RvdnirKvri Oxidum Rubrum. — Red Mercuric O.xide, Red rrecipitale. Doft«,
0.0012 to OftOfl Hm. (or gr. '/••V,.).
Hydrargyrum Ammoniaturo. — Ammoniated Mercury, White Precipitate. For
•xtmial u«e.
ti
I
614 I'llAUMACEL'TICAL THliiUrKLTlC AUENTfci OH UUlXiS. ^
Massa Hydrargyri. — Mass of Mercury, Blue Mass, Blue Pill (mercury, 33 per
cent., with althsa, licorice, glycerin, and honey of ro!»e; a 3-grain blue pill cootaina I
grain of mercury). Dose, 0.03 to 0.75 Gni. for gr. es-xij).
Emplaatrum Hydrargyri. — Mercurial Plaster (mercury, 30 Gm.; oleate of mer-
cury, 1.2 Gm,i le^d plaster, q. 8, to make 100 Gm.).
Enjplastrum Amuioniaci cum ilydraigyro. — Aramoniac Plaster with Mercury
(contains mercury, 18 Urn.; and amuioniac. 72 Uiu., with oleate of mercury, diluted
ae-etio acid, and lead plaster).
Liquor Arseni et Hydrargyri lodi'di. — Solution of Arsenic and Mercuric Iodide,
Donovan's Solution (1 per cent, each arsenic iodide and red mercuric iodide). Dose,
0.06 to 0.60 c.cm, (or mux).
Liquor Hydrargyri Nitralis. — Solution of Mercuric Nitrate (contains red mer-
curic o.\ide. 40 Gm.; nitric acid, 45 Urn.; distilled water. Id Uui.).
Uleutiiui liydtargjri. — Oleate of Mfn-ury (yollow mercuric oxide, 25 Gm.; oleic
acid, 75 Gm.).
Unguenium Hydrargyri. — Mercurial, or Blue, Ointment (mercury, 50 per cent.,
ttituraLvd with lard, buet, and oteate of mercury),
Litgwnliiui iiydlarg^Ii Dllutum. — Diliiteil with 33 per cent, of petrolatum.
Untjuentuiii Hydrargyri Animoniali. — Ointment of Ammoniated Mercury (am-
iiioniatcu mercury, 10 Gm. ; benzoinated lard, DO Gm.).
Unguentuiii Hydrargyri NJtralis.- Oiiitinont of Mercuric Nitrate, Citrine Oint-
luent (nien-ury. 7 Gm.; nitric acid, 17.5 Gni.: lard, 7ti Gm.).
Unguentum Hydrargyri Oxidi Flavi.^ — Ointment of Yellow Mercuric Oxide ( 10
per cent.).
Unguentum Hydrargyri Oxidi Kubri. — Ointment of Ked Mercuric Oxide (10 per
cent.).
B. P. Preparations.
Hydrargyrum cum Cretfl. — Mercury with Chalk, Gray Powder (mercury, 20 Gm.;
prepared chiilk, 40 Gm.). Dose, 0.005 to 0.32 Gm, (or gr. i-v).
Hviiiar^'Vii Perchloridiim. — Mercuric Chloride, Bichloride of Mercury^ Corrosive
Sublimate. Dose, 0.O02 to 0.004 Gm. (or gr. V«-7iJ.
Hydrargyri Subchloridum. — Mercuroua Chloride, Calomel, Hydrargyri Chlo-
riduui. Dose, 0.03 to 0.32 Gm. (or gr. ss-v).
Hydrargyri lodidum liubrum. — Mercuric Iodide, Biniodide of Mercury. Dose,
0.002 to 0.004 Gm. (or gr, V«-7,J.
Hydrargyri Oxidum Flavuru. — Yellow Mercuric 0.\ide. For e.xtcnial use.
Hydrargyri Oxidum Kubruiii. — Ked Mercuric Oxide. Dose, 0.0012 to 0.000 Gm.
(orgr. V«-V«).
Hydrargyrum Ammoniatum. — Ammoniated Mercury, Ammonio-chloride of Mer-
cury. \\'hite Precipitate. For external use.
Hydrargyri Olcas. — Mercuric Oleate (mercuric chloride, 32 Gra.; hard soap, pow-
dered, 04 Gm.; oleic acid. 4 c.cm.; distilled water, boiling, q. s.).
I'ilula Hydrargyri. — Mercury PilU Blue Pill (mercury, 40 Gm.; with confection
of roaos and iicorice-root). Dose, 0.25 to 0.5 Gm. (or gr. iv-viij).
Enqihiatrum Hydrargyri. — Mercurial Plaster (mercury, 82 Gm.; oUve*oil, 3^
Gm.; sublimed sulphur, 0.5 Gm.; lead plaster, 104 Gin.).
tlmpladtrum Ammoniaci cum Hydrargyro. — Ammoniacum and Mercury Plaster
(ammoiiincuTii, 328 Gm.; mercury, 82 Gm.; olive-oil, 3.5 Gm.; sublimed sulphur, 0.5
Gm.).
Liquor Araenii et Hydrargyri lodidi. — Solution of Arsenious and Mercuric
Iodides (1 per cent, each of arsenic iodide and mercuric iodide). Dose, 0.30 to L20
c.cm. {or tiiv-xx).
Liquor Hydrargyri Nitratifl Acidus. — Acid Solution of Mercuric Nitrate.
Liquor Hydrargyri Porchloridi. — Solution of Mercuric Chloride (1 Gm,, or gr.
XV, to make 875 c.cm., or fjxxx). Dose, 2 to 4 c.cm. (or f3ft**-j).
Lotio Hydrargyri Flava. — Yellow Wash (corrosive sublimate, 0.40 Gm., or gr.
vij; in solution of lime. 100 c.cm,, or fSxxvij). For external use.
Lotio Hydrarfiyri Nigra. — Black Mercurial Lotion. Black Wash (calomel, 0.685
Gm., or gr. xj. with glycerin and mucilage of tragacanth and solution of lime, q. s.
100 c.cm., or fSxxvii).
[jnimentum Hydrargyri. — IJinirnent of Mercury (ointment of mercury, 30 Gm.;
strong solution of ammonia, 10 c.cm.; liniment of camphor, q. s. ad 00 c.cm.). ^
Ptluia Hydrargyri Subchloridi Composita.^Compound Pill of Mercuroua Chlo-
ride, Compound Calomel Pill. Plunimer's Pill (contains calomel, 25; sulphurated
ntiiBony, 25; guaiacum resin, 50; castor-oil, 10.3; alcohol, 3 c.cm. or q. a.). Dose,
tS5 to 0.50 Gm. \or gr. i%-viij).
Unguenium Uydrargyii. — Mercury Ointment (mercury and lard, each, 160 Gra.;
prvpami suM, 10 Gmj.
ro^eotum Uydrargyri Ainmoniati. — Animoniatea-Mercury Ointment, NVhitCj
[pit«t« Ointment (aminoniated mercury, 30 Gni.; paraffin ointment, 270 Gm.)
Uuguentum Hydrargyri XitratiR. — MomiricKitrate Ointment (mercury, 100
Gm.; nitric acid, 300 c.cm.; lard, 400 0m.; olive oil, 700 Gm.)-
Uaguentum Hydrargyri Nitratis Dilutum, — Diluted Mercuric- Nitrate Ointment
[SO per cent, mercuric-nitrate ointment, with parftltin).
Unsruentum Hydrargyri Conipositum. — Compound Mercury Ointment (mercury
fltaf- •■ '"'M beeswa.x, yO; olive-oil, 90; camphor, 45).
um Hydrargyri lodtdi Rubri. — Mrrfurip- Iodide Ointment (4 per cent.).
^..i^-.;*tum HydrargjTi Olcatis. — Mercuric-Olcute Ointment (1 to 3).
rnjdTuentum Hydrargyri Oxidi Flavi. — Yellow Mercuric-Oxide Ointment (yellow
■erruric oxide, 0.5 Gm. ; soft paraffin, 24.5 Gm.).
Un^entum Hydrargyri Oxidi Rubri. — Red Merruric-Oxide Ointment, Rcd-Pre-
opitate Ointment (red mercuric oxide, 10 Gm. ; paralfm ointment. 90 Gm.).
Unjr«entum Hydrargyri Subchloridi. — Mercurous-Chloride Ointment, Calomel
OfetJurDt f 10 per cent, of mcrcurous chloride).
Triturations can be made with any mercurial and sugar of milk, usually in
proportions.
Phimnacology. — Commercial mercury is always impure, being com-
IwDcd with tin, antimony, zinc, and other metals. It can be purified by
treating it with dilute nitric acid, and afterward washing it free from the
idd irith water. In the pure state, it is a shining, silver-white metal, liquid
4t common temperatures, and having the specific gravity of 1*^.5. The chlo-
rides are the salts of the greatest medical importance. They are made by
doable decomposition; thus, mercuric sulphate and sodium chloride are
Itnturated together and heat applied, when the mercuric (or corrosive) chlo-
nde Fublimcs in the form of white crystalline masses or powder; in order to
form iht merourous chloride (calomel}, an additional proportion of mercuric
•ulphate is added before subliming. Owing to the tendency to combine with
j/kr ' ■ ■ ' !>, the presence of mercury may be ascertained by half-immersing
W^ in a suspected solution, when the mercury will be deposited as
igray or fiilver coating, if present. Reinsch's test and the reduction test may
U employed as in testing for arsenic, when the small globules of mercury
OUT be detected upon the glass, which are as easily recognized with the
^^ nucroficope as the crystals of arsenic.
^1 In accordance with the chemical theory of Mialhe, it is usually taught
^HA|^j|doniel is converted within the body into corrosive sublimate by the
^HHHBof Imodium chloride. As a result of careful experiments. Dr. Paul
^TlSS finds that, although this change may take place in the air, the access
«liir is practically excluded from the alimentary tract and that but a trace
«f oilomel parses into solution. This is the case even in the presence of or-
fiDic matter, and he arrives at the conclusion that sodium chloride is not
iacompatiblc with calomel. For the same reason it had generally been held
thai muriatic or nitromuriatic acid should not be given in conjunction with
tbo mild chloride.
k Toxic Action and Antidotes. — The salts of mercury are very poisonous
^^ to ill lowrr forms of life, mid mercurial solutions form our most convenient
tad Bueful antiseptics. Applied to the skin in concentrated form, most of
51t3
PHAHSIAOBUTICAI. THERAPEUTIC AOENTS OR DBCGS.
them are irritating, and some are destructive, to the tissuea. They easily
diffuee through the integument, and may in this way cause systemic effects,
even from the solutions employed for antiseptic purposes, but especially from
contact with mercurial ointment or fumigations. Various fonns of paralysis
are produced by the influence of this metal, especially among workmen who
are habitually exposed to its vapors. Mercury has a marked influence upon
the nervous system, causing debility with tremors. The nervous disorder ia
often accompanied by a brownish discoloration and a dryness of the skin.
Symptoms simulating those of chronic lead poisoning, including wrist-drop,
have resulted from prolonged mercurial inunction. Nerves of special sen-
sation may be affected. Neuralgia, epilepsy, and insanity may also occur.
Upon the salivary glands, mercurials have very stimulating effects*
The salivary secretions may be increased to several pints daily, the fluid at
first being albuminous and thick, but subsequently becoming thin and
watery. The irritation may cause inflammation, and ulceration or sloughing
of the mouth or cheek may result, especially where the patient ia in poor
physical condition or suffers with some cachexia, or is exceptionally sus-
ceptible to the action of mercury. The condition of the general s)'stem
accompanying the action of the mercurial upon the salivary glands and
mouth is known as "ptyaiisni,'* or salivation. A febrile movement of low-
type usually accompanies these manifestations. It has been found by Dr.
Petersen that disease of the kidney establishes a predisposition to the occur-
rence of ptyalism. For this reason, when the gums of a syphilitic patient
become affected, the urine should at once be examined.
Mercury also affecta the digestive organs, causing diarrhcea and a fetid
breath; if continued a sufficient length of time, emaciation also occurR.
These s^'mptoras, taken collectively^ constitute Hydrarg^ism, or Mercurial
Cachexia, or Erethism, which might be mistaken for malignant disease^
especially if accompanied by some enlargement of the liver.
A bright- or dark- red rash sometimes occurs upon the skin while mer-
cury is being taken. The discoloration may be attended by itching and may
be followed by desquamation. An eruption resembling that of small-pox
has been observed as a consequence of the use of n Va-pcr-cent. sublimate
solution as a vaginal wash conjoined with the application of a mercurial
ointment to the abdomen. Cases have been observed in which mercury
caused generalized dermatitis, with swelling, desquamation, subcutaneous
infiltration, fever, and prostration. This form of intoxication may even
have a fatal termination.
Pure metallic mercury ia not poisonous, and passes through the alimen-
tary tract unchanged, acting as a mechanical laxative. Acute poisoning by
corrosive sublimate occurs when a toxic dose has been swallowed. The symp-
toms are immediate and violent: these are vomiting; purging, at first serous,
afterward bloody; burning pain in the stomach and ojsophagus, suppression
of urine, face swollen and bloated, with much prostration of the bodily
powers, etc. Severe and even fatal Intoxication may take place from ab-
sorption through an abraded surface. Dr. Sackur has reported a case in
which death occurred in consequence of absorption of mercurial ointment
through some trivial fissures of the skin.
Albumin is the antidote to corrosive sublimate; eggs and milk should
be freely swallowed, the stomach washed out with a stomach-pump, arterial
stimulants administered, hypodermic injections of morphine and whisky
HTDRAAGTRUM.
517
I
I
pren, and external heat applied. After Ihe first eymptoms are over, the
patient is liable to perish from ulceration or stricture of the cesophagus, de-
ftrsction of the peptic glands in the stomach, salivation, and exhaustion.
Ptyalism is best treated by mouth-washea containing potassium chlorate
iBd tincture of myrrh, and by tonics and small doses of belladonna, or atro-
pse with morphine. The gums may become inflamed, soft, and bleeding,
ad the teeth loose, but under this treatment the inflammation subsides and
the t«eth again become firm. Salivation was of such common occurrence
when mercury was given freely that it was looked upon as salutary, and it
«18 thoQght necessary to "touch the gum" in order to obtain therapeutic
ranilts from the remedy; but this idea no longer prevails, and patients are
no longer fully salivated intentionally, this part of the so-called antiphlogistic
trtstasent having fallen into disuse.
Physiologic^ Effects. — The action of mercury upon the liver has occa-
sioned much controversy. The corrosive chloride in email doses is an hepatic
itimolant and cholagogue; but this action has been denied to calomel, which
acts principally upon the excretory glands in the lower part of the small
iniestine and colon. It is not yet known, however, in what form calomel
esters the bloody but it is possible that a soluble combination is formed with
tlhumin and hydrochloric acid; it is even possible that part of it may be
chsDged into corrosive chloride, in which case some action upon the liver
would naturally follow. Whatever ingenious explanation the laboratory may
hive to offer with regard to the cholagogic action of the mercurial?, and
flilomel especially, clinical medicine has already settled the fact that where
the tongue is heavily coated and the conjunctivae slightly jaundiced, the skin
sallow, and the liver inactive, with clay-colored stools, it can all be set right
with a few small doses of calomel, and bilious stools be produced.
Salivation is a reflex phenomenon and depends upon a primary mer-
etnial stomatitis. Both these effects are much more decided when the drug
is administered by iniuiction, Ricord found perfectly healthy salivary glands
ta a ptjahzed patient who died of an intercurrent disease. In administering
BCTcnry it is important that the mouth be kept in good condition. The
fnaence of carious teeth, for instance, is often the starting-point of a
itomatitis. P. Diday has reported a case in which this accident was trans-
fared by kissing from man to wife, and believes that we may admit that
certain of the numerous microbes which inhabit the mouth become virulent
under the influence of the mercurial impression.
The diuretic action of mercury has of late years attracted considerable
attention. It has been found that mercury, and more especially calomel and
Une pill, have the power of decidedly promoting the action of diuretics.
Boon^ claims that the absorption of mercury salicylate, which is incomplete,
m, howcTer, greater than that of calomel. It is stated, as the result of some
iavMtirations by F. Klemperer,' that, in rabbits, corrosive sublimate in-
{>cted into the blood was eliminated by the intestinal glands and kidneys,
a ftcute cases there was congestion of the kidneys, with extravasations, and,
if prolonged, the parenchyma showed signs of inflammation, with a deposit
of chalk in the straight tubules; while, in the doff, there occurred fatty
degtoerstion instead of chalky deposit. According to the studies of Calan-
toni, if death is not caused within ten hours, necrosis of the renal epithelium
* Brili$h Uediml Journal
* ThrrajfeutU QasciH, Oct.
15. 18W, p. 693.
518
PHARMACEUTICAL THERAPEUTIC AGEN'TS OH DRUGS.
occurs. Intestinal lesions are chiefly present in the colon, and consist of
hyperaemia, haemorrhage, and necrosis. No apparent relation exists between
the severity of the renal and intestinal lesions. In a monograph on the
action of mercury on the kidnevs Dr. Karvoneii* gives an account of hia
experiments on rabbits and dogs, various mercurial preparations having been
administered subcutaneouslyj and the kidneys afterward examined micro-
Bcopically. In all cases changes were detected in these organs, varying from
simple hyperaemia to marked nephritis with albuminuria and tube-casts.
The well-known deposits of Hmc-salts in the kidney were often obtained as a
result of the action of mercury. From hia own experience the author de-
scribes similar symptoms occurring in man. He also mentions the occasional
occurrence of glycosuria.
It is evident that mercury in small doses is capable of acting as a stimu*
lant to the kidneys, and this agrees with the observations of Jendrassik upon
the use of calomel as a diuretic. Small quantities of mercurials, therefore,
are useful additions to squill, digitalis, and other diuretic remedies.
The fact has been established that small doses of corrosive sublimate
(0.0006 Gra., orgr. V,ooj three times daily) favor physiological functions and
stimulate the blood-making glands. These constitute the so-called "tonic
doses" of mercury.
The metal is slowly eliminated in the urine and glands of the digestive
tract. It has been dotcc-ted in most of tlie tifsuo.*^ niul secretions of the body.
The bone-marrow nuiy retuiu it for a long period, and it may be found in
metallic gtobuh^ in the cancellated tissue of bones long after death. When
death results from mercury* diphtheroidal, hiEmorrhagic inflammation of
the large intestine is found.
The external, as well as internal, use of mercury may occasion local
paralysis, as in a case narrated by Dr. A. W. Foot, in which there was loss
of power in the muscles of the hand and forearm after rubbing cattle with
an ointment containing the red iodide.
Therapy. — 1. Local Application, or External Use. — A most important
field of usefulness for mercurials, at present, is in antiseptic surgery. The
soIutionvS have the advantage of convenience, being easily made and cheap,
odorless and permanent. The field of operation, having been well soaped and
shaved and washed with ether, is usually irrigated with a solution of cor-
rosive sublimate (1 to 2000, or 1 to 4000 and much weaker if the skin is
broken). For washing out wound-cavities, or the peritoneum, still weaker
solutions should be made use of (1 to 6000 or 10,000). In lying-in hospitals,
or where the surroundings are decidedly unhygienic, and also where symp-
toms of septic infection are manifested after delivery, the danger may be
averted by the free use of these mercurial antiseptic vaginal douches several
times a day. In modem surgery much attention is given to the proper dis-
infection of the hiuuls. Abbott^ states that of the numerous methods two
are thoroughly trustworthy, viz.: that of Fiirbringer and that of Welch, de-
veloped at the Johns Hopkins Hospital. Fiirbringer's method: 1. Remove
all dirt under and around nails. 2. Brush nails and skin of hands thor-
oughly with soap and hot water, 3. Immerse in alcohol, 95 per cent., for
not less than a minute, and before this evaporates (4) plunge the hands in
^ Britiifh XfediraJ Journal. June 11, IHOf*.
•"Hygiene of TraiiBiuissible Diseiwes." 1809.
HYDRAnUYRLM. 519
1 to 600 eorrosive-sublimate or 3-per-cent. carbolic-acid solution, and thor-
ooghlj wash them for at least a minute, after which the hands may be rinsed
ia warm vater and dried. Welch's method: 1. The hands and nails are to
be tboroughJy cleansed with hot water and soap. The water is to be as hot
la can be borne, and the brush used is to have been sterilized with steam,
this preliminary brushing lo occupy from three to five minutes. 2. The
hand* are then rinsed in clean, warm water. 3. They are then immersed for
one or two minutes in a warm, saturated solution of potassium permanganate.
While in this solution they are rubbed thoroughly with a sterilized swab of
ibeorbent cotton. 4. They are then placed in a warm, saturated solution of
oialic acid, and kept there until completely decolorized. 5. They are then
tboronghly washed in clean, sterilized water or fait solution. 6. Finally,
thej are immersed for two minutes in 1 to 500 corrosive-sublimate solution,
linced in water, and dried.
The use of corrosive-sublimate injections during and after parturition
haB caused a remarkable reduction of the death-rate in lyin^-in hospitals.
A nuTcurial solution has also been used to irrigate the uterus in puer-
f" csemia, but the practice is not without the danger of giving riae to
p.j _; by absorption.
Id 18b0, Koch demonstrated that bichloride of mercur>- (sublimate)
vaa the most powerful of antiseptics. It was fouud that in a solution of 1
to lOOU it would soon destroy the spores of anthrax: the most virulent of all
germs. This was true with regard to non-albuminous media, but when the
medium to be disinfected contained albumin, the mercury coagulated the
aibomin. formed an albuminate of mercury, which deposited, leaving the
fupernatant hquid practically free from mercury, and, hence, without anli-
•eptic power. Dr. Ernest Laplace,* in Koch's laboratory, seeking a method
to prevent this coagulation, and, therefore, to retain for the mercury its
tsme disinfecting power in albuminous as in non-albuminous fluids, found
that an addition of a small quantity of any acid to the ordinary solution
voald fulfill this purpose. Accordingly, the acid sublimate solution consists
oi:—
^^^^^ Mercuric Miblininte 1 part.
^^^B Uvdrochloric acid (pure) 5 parts.
^^V \Vat«r q. a. ad 1000 parts.
^^^ Hydrochloric acid is used preferably to all others. When, however,
the acid sublimate must be carried in a solid form, tartaric acid is substituted
for the hydrochloric acid.
M<*rourii* Mihliinnte. . ,..,- I part.
Tartnric acid 6 parts.
To be made into a tablet, wliich must be dissolved in 1000 parts of water.
This form was adopted by the Academy of Medicine of Paris, to be
QMd by midwives throughout France. The acid sublimate is the only dis-
infectant need in Koch's laboratory. It is also used in the Pasteur Institute
of Paris. Hesidea beincj the surest and most powerful antiseptic, it is the only
•olntion of mercury that will always retain its intejjrity, and never form a
deposit of earthy salts. It is used for all manner of disinfection, except that
• /l*-Mf»rAr mrflirintMrhr Witehrtvichrift, No. 40, 1887.
620
PnAHMACECTICAL THERAPEUTIC AGENTS OH DRUGS.
of instruments. In a solution as weak as 1 to 50,000 it retains sufficient
power to destroy the germs of suppuration.
Dr. A. C. Abbott enjoins caution in the use of corrosive sublimate upon
open wounds, for the reason that the albumin of the parts tends to counteract
its influence and tliat it materially injures the integrity of the tissues, im-
pairing the normal resistance of the solids and fluids of the body to the
attacks of micro-organisms. As a result of many experiments, he finds that,
under favorable conditions, only a certain numl)er of the pathogmitrtic mi-
crobes are destroyed by the mercurial, and that, though the remainder may
be temporarily attenuated, the effect disappears by successive cultivation in
ncnnnl media.
The biniodide (1 to 4000 or 1 in 20,000) is recommended by Miquel, and
Panas prefers it in eye surgery, it being less irritating than corrosive subh-
mate. It might also be added that there is much le>s danger of a mercurial
impression being made upon the system by absorption where this salt is
used, as the solutions usually only contain half as much mercurial.
The biniodide of mercury is not very soluble in water, but its solution
may be promoted by the addition of alcohol or of an equal qxiantity of potas-
sium iodide.
In ear affections, an ointment of yellow mercuric oxide, 0.32 to 0.65 Gm.
to 31 Gin. (or gr. v-x to ^j) of lard or cold cream, is much used to relieve in-
flammation and keep the canal clean.
In a case wlierc a mass of molten lead had run into the ear^ filling the
tympanum, Mr. A. Marmaduke Sheild* succeeded in removing the impac-
tion by filling the external meatus with liquid mercury, which seemed to have
a solvent action upon tlie lead. After remaining undisturbed in the ear for
fiixteen hours (he mercury escaped, mingled with lead, and on the following
day the latter metal was so softened that it could be easily removed.
An ointment of yellow oxide has been used in eye practice in the treat-
ment of chronic blepharitis, tinea tarsia and eczema, or by rubbing in at night
a largely-diluted citrine ointment. The irritant properties of the red oxide
render its ointment a usi'ful application to indolent ulcers, whether of syph-
ilitic or common origin; to enlarged scrofulous glands, or goitre, rosacea,
eclerodcrniu, and lepra. The olcate is a milder and a safer application,
though less ellicient. The yellow wash is a good application in scrofulous
conjunctivitis. Finely-powdered calomel may be dusted over the surface of
the lids in phlyctenular ophthalmia and corneal ulcerations. The subcon-
junctival injection of a 1 to 1000 solution of corrosive sublimate was orig-
inally practiced by Darier, 0.12 c.cm. (or mij) being introduced, and very
favorable ru-^iults have boon reported by Dr. Adolf Alt, of St. Tv^ui^.- from
the use of this method in iritis, iridochorniditis, exudative choroiditis, cen-
tral chorioretinitis, and detachment of the retina. The cases of iritis were
of all varieties, including those of syphilitic, rheumatic, and traumatic
origins. In the treatment of corneal troubles, however, especially parenchy-
matous keratitis, this writer observed no beneficial action. A certain number
of cases of sympnthctic ophthalmia have also been reported as cured by this
method of treatment. It is regarded, however, as unadapted to cases in
which the stasis of the local circulation prevents, either wholly or in part.
^Lancet, April 30, 1802.
'4.mcrican Journal of Ophthalmology , Feb., 1894.
nVDBAROYRUU.
521
»
I
I
•hsorplion of the injected fluid. Mercuric cyanide has been employed in-
ttced of the corrosive Bubiimate.
In granular conjunctivitis, the following ointment is beneficial : —
B Hydnrg. oxid. flav |20 Gm. or gr. iij.
Zinci oxidi.
Thymol,
Cocftin. hydrocUlorid aa 110 Gm. or gr. isa.
Camphor 03 Gm. or jrr. ss.
Petroliiti albiD 2313 Gm. or 3vj.
H. S'lg.i Apply locally.
B Hydrai:gyri oxidi flav 138 Gm. or gr. vj.
CamplioTw |20 Gm. or gr. iij.
Un^ aque roue,
Ailipis lanne hyd fla 8| Gm. or 3ij.
If. For irritable and inflamed eyelids.
Before applying calomel to the eye, the physician should always ask
whether or not the patient has been upon an iodine course, since a caustic
compound may form between the mercury and iodine and give rise to intense
pain, with intlammatory swelling of the conjunctiva and lids. Cases have
occurred in which this unfortunate accident has led to almost complete loss
of f is-ion.
The ointment of the red oxide, properly diluted, is a valuable resolvent
in eolarged glands, goitre, and ague-cake, the application being made in the
direct rajs of the sun, or before a fire. This ointment may also be serviceably
applied to indolent ulcers, seborrhoea, and lupus erythematosus. Ulcers,
especially venereal, are stimulated by the application of diluted acid nitrate
of mercury (1 to 10 or 20), but this preparation often gives rise to pain and
hsmorrhage, and should be used very cautiously upon soft parts for fear of
caofins sloughing. It should never be used for venereal ulcers in full
ftrm^Jth. A better method is to wash the sores, or condylomata, with solution
of chlorinated soda, and, after drying with absorbent cotton, dust calomel,
nr e«^ual parts of calomel and starch, over the surface, as practiced by Ricord.
The black wash also makes a good dressing in such cases and in rhus poison-
ing. In acne or eczema of the scalp, lotions containing 1 or 2 parts per
thounndy or, in infants, 1 in 10,000 of corrosive sublimate, are much used.
CoTToaive sublimate in the form of an ointment or lotion, V« ^o 1 P^r
ctiiL (or gr. ii-v to 5j), is employed successfully for the removal of freckles.
Calomel alone, or combined thus, is of service in herpes and irritation
tround the genital organs: —
R Hydnirgyri chloridi mitifl 12{ Gm. or 3iij.
I'i-niulh. subnit.,
Tutv. lyropodii aa 15|5 Gm. or las,
iL Sig. : Dual over the surface.
Calomel is also of much value, dusted over the surface, to diminish
fttubvrant granulations, as follows; —
B Hydrargyri chloridi mitis,
lodofomii aa 16|6 Gm. or Iss.
H 6ig.: Sprinkle over the ulcer or ulcerated surface.
Dr. J. B. Jamcs» of London, claims good results from the application
of calomel to hipmorrhoids, especially when the tumor is inflamed.
522
PIIARMACEDTICAL TIIER-^PEUTIC AGENTS OH DBUGS.
Calomel likewise forms an ingredient of many cancer powders for de-
stroying malignant growths upon and in the skin. Esmarch's painless pow-
der contains calomel, and is composed as follows: —
^.— M.
R Hydrargyri chloridi mitU SiZO Gm. or gr. Ixxx.
AiHonii trioxidi
Morphinte hydrochloridi aa 105 Gm. or
Pulveris acacin 31| Gm. or
For acne we may use the following: —
B Hydrarg. chloridi corroaivi 138 Gm. or gr. vj.
Mist. ainygdftlDB 180| ccm. or fSvj.
M. 8ig.: Apply night and morning.
Stronger solutions are useful in scabies, tinea versicolnr, ringworm,
and alopecia: —
H Hydrargyri chloridi corrosivi
Spiritus thymoli 7
Aqu£e hanianielidia 150
B Hydrargyri chloridi corrosivi
Spiritus TOBTnarini , 30
Aminonii chloridi 2
Spiritus vini reotificat 120
75 Gm. or gr. xij.
5 ccm. or f3ij.
ccm. or fBv. — ^M.
05 Gm. or gr- x.
ccm. or fSj.
Gm. or 3b3.
ccm. or fjiv. — M.
Mercurials are frequently used for their local effects upon mucous mem-
branes; for instance, in syphilitic ulceration of the tongue, lozenges of lic-
orico containing 0.002 Gni. (or gr. V;ifl) of corrosive sublimate may be nllowod
to diFsoive slowly in the mouth, and the solution, being swallowed, also pro-
duces its constitutional effects. In disease of the uterus and pelvic organs.
Dr. A. L, Smith, of Montrcnl, uses cotton nnd wool tampons containing mer-
curic chloride, O.OOfi Gm. (nr gr. Vio)? in conjunction with horoglyccride
olution (10 per cent.), introduced into the vagina twice a wet'k. Several
eases liave been placed on record of corrosive publimate poisoning from a
vaginal dniiohe (1 to *^00(>). This method of treatment is too dangerous to
be carried out by the patient herself; tlie ordinary corrosive sublimate tablots
are for surgical and obstelric use, and should only be employed by t!ie
physician, since the danger of poi!=oning u too great to nlb>vv Hiem to lie
around tlic hou&ie, within llic reach of i-hildren. Lanunilable accidents have
occurred through neglect of this precaution.
In acute fidlicular tonsillitis, good results have been re|>orted by A.
Sbrocchi,^ by local treatment with cornisive suldinuiie. A solution (1 to
1000) is applied carefully by menus of a cotton-wool sponge, to the whole
surfflco of the infliimod gland ; hut witlmnt wounding the mucous niembrnne.
The soft palate and uvula should a!i^o be brushed with the solution. The
sittings sliould be repented at intervnls of ;^ or 4 hours. This treatment docs
not avail for diplitherin. When four paintings fail to effect improvement, he
resorts to antiloxtn.
Red precipitate ointment hns been used for the anointing of cliapped
lips, the treatment of sores and cracks at mouth-comers, and for the cure
of fissured lips. By distending the fissures and filling them repeatedly with
the ointment — distending the fissure with each insertion of ointment — a
^Mrdirttl Bullrtin, Januarv. 1006.
I
HYDRAROYKCM.' 523
quality of cicatricial tissue is produced which, by its toughening, almost al-
ways prevents anv subsequent fissuring.
Dr. Marshall employed a o-per-cent. solution of the oxide of mercury in
oleic acid, adding one-eighth part of ether, for sycosis and parasitic and itch-
ing afftH^lions. The olratos are useful where imlnrntion exists. The official
oleate (25 per cent, of mercuric oxide) is preferable to bhie ointment in the
iflimction treatment of syphilis, being more elegant and cleanly, and equally
efficient. This preparation is of decided value in old patches of psoriasis and
dirooic eciema of the palms or soles. The mercuric oleate exerts a powerful
resolvent influence upon enlarged glands and upon a thickened, indurated
condition of the integument. It is, likewise, curative in animal and vegetable
parasitic affections.
In the treatment of eczema capitis, or impetiginoidea, in infants, much
benefit is derived from removal of crusts with sweet oil, followed by com-
E Teases wet with bichloride (1 to 10,000); and with due attention to general
ealth and the diet.
In the treatment of favus, Kinsh holds that there is nothing better than
persistent and repeated epilation, with brisk rubbing of a watery solution of
corrosive sublimate (0.005 to 0.008 Gm., or gr. Via-Vs) J^to the diseased
surface. This, however, should not be intrusted to the patient, who will
cither underdo or overdo it but he may apply some other antiparasitic oint-
ment, or antipruritic. Of the former may be mentioned mercurial and sul-
phur ointments, of the latter those enntnining tar, carbolic acid, crensote, etc.
In the varieties of trichophytosis and in phtheiriasis a diluted ointment
of the nitrate is often valuable. It is beneficial, also, in chronic eczema,
psoriasis, rosacea, sycosis, and in numerous chronic disorders of the skin.
The following formulae, containing one of the mercurial ointments,
may be employed in the diseases referred to above: —
B Ungt. hydrargj-ri ammoniat. 1615 Gm. or 5m.
OI?i lavanilulo^ (lorum 1 20 ccm. or mxx.
Ungt. zinci oleatis 15|5 Otn. or Isa.
IC Use in acne, rosacea, and chronic eczema.
B ITnjft. liydrargyri nitrmtii 15]5 Gm. or Sw.
Olei juniperi 2| to 7 5 ccm. or fSss vel f3ij.
Adipif* lano* 15|5 Gm. or 5ft».
M. For chronic psoriasis and eczema, especially of the bands and feet.
B Ungt. hydranDryri oleatis (20 per cent.) 311 Gm. or 5j.
_ ThymoHs iodidi 4| Om. or Sj.
H. Serviceable in animal and vegetable parasitic diseases.
H Ungt. hvdrargyri ammoniat 311 Gm. or 5j.
^(^nthoii,
Trtcainir !iydrooliloridi aa 106 Gm. or gr. x.
01, caryophjlU |00 ccm. or mx.
M. Beneficial in herpes, herpes coster, aeborrhcea, and eczema, especially of the
genital organs.
_ An ointment of calomel (1.30 to 31 Gm., or gr. xx-Jj, of lard) is also
Serviceable in siinilnr cases, and MetchnikofT has found it to prevent the in-
firtion of syphilip, if rubbed on Uie spot inoculated within one hour after
iiif^tion. A weak enlomel ointment if? of service in impetigo contagiosa and
ecthyma. The latter stage of dermatitis is also benefited by the use of this
unguent.
524
PHARMACEUTICAL THERAPEUTIC AOEXTS OR DRUGS.
In gonorrhoea or urethritis, either acute or chronic, irrigation of
the urethra with weak solutions oi corrosive sublimate (1 to 10,000), used
every four hours, is sometimes followed by rapid cure. A little tartaric acid
BhouJd be added to the solution to keep the mercury from becoming changed
into iui albuminate. In gonorrhoja and glefl, the injection of a solution of
nuTcur}' salicylate (V* to 1 per cent.) may rapidly remove the discliarge.
Mercurinl inunction or the subcutaneous injection of corrosive sublimate is
recommended as of advantage in gouorrhceal rlieumatism.
The application of mercurial ointment is a popular treatment for pubic
podicidosis. A case is reported by Wightnick, in which a patient palivated
himself by the free use of the remedy (m'iirly two ounces in three days),'
Professor Giiyon, of Parits, introduced the practice of injecting a solu-
tion of corrosive sublimate into the bladder for the relief of tuberculous
cystitis, and excellent results have been reported as obtained by the adoption
of this method.
In affections of the joints, orchitis, enlarged glands, an ointment contain-
ing 0.0(55 to 0.13 Gra. (or gr. i-ij) of morphine and 4 Gra. (or 5j) of calomel
in 31 Gra. (or 3j) is very useful in reducing the swelling and averting threat-
ened abscess. Jiy the use of the Vigo plaster, compression may be made
around a joint or a swollen testicle with great benefit. An ointment of sub-
limate (0.13 to 0.20 to 31 Gm., or gr. ii-iii to 5j) is also useful in the ulcerated
stage of lupns vulgaris. The oflicial blue ointment is useful in erysipelas as
a local apphcation, allays inflammation in paronychia, and is a good dress-
ing in chilblains and dcrnintitis. The sohition of mercuric nitrate, much
diluted (1 to 20, or more) is servicenhly appli*^d to warts, clianci-oids, syphi-
litic condylouiata, raucous patclies, and ulcers of the mouth. It should not be
used carelessly or salivation may ensue, or local sloughing.
Miller'- claims to have cured \S out of 17 eases of hydrocele by drawing
off the fluid aseptically and immediately returuing tlirough the cannula, 1
c.cm. (or mxv) of water^ containing 0.002 Gm. (or gr. Vsa) of corrosive sub-
limate, and leaving it in the hydrocele-sac. There is very little pain, but, if
complaint be made, he advises application of belladonna ointment.
2. Internal Administration. — Since fermentation is now known to play
an important part in disorders of digestion, it is to be expected that the anti-
septic powers of mercury would make it conspicuously useful in treating
digestive disorders. ^\Tien there is a foul stomach, coated tongue, some
vertigo or headache, constipation, and depression of spirits, — what is com-
monly called a bilious attack, — 0.65 to 0,75 Gm. (or gr. x-xij) of blue mass or
calomel, followed in from six to eight hours by a saline purgative, will en-
tiiely change the state of affairs. It is probably true that these doses are
larger than necessary, but, as the excess is carried away by the saline, no
harm is done. In some cases much smaller quantities given in broken doses
— say, 0.006 Gm. (or gr. Vio) of calomel with a little soda, given each hour
until five doses are taken — is sufficient to produce the same effect if followed
by a cathartic. If there is much engorgement of the liver, larger doses are
preferable, and we may use with advantage the old "ten and ten" (10 grains,
or 0.65 Gm., each of calomel and jalap). During the first week of typhoid
fever, two or three ful! doses of calomel are useful in cleaning the alimentary
* Lancet, Sept. 9, 1905.
'Lancet, Stpt. 4, 1897.
HYDRABOYfiUM.
525
^
ctBtl And luaking it to eonie degree aseptic. This is a part of the so-called
specific treatment of typhoid.
The corrosive chloride has likewise been used in the treatment of en-
teric fever, and Loranchet reports that in twenty-one cases, where tliis salt
was the principal remedy^ it caused decided amelioration of severe symptoms
and apparent abatement of the toxic manifestations.
Digestive disorders in infancy are very frequent, and often are promptly
controlled by mercurials. Mercury with chalk is a common injsrredient in
teething-powders, but should not be used freely unless the infant suffers
with congenital syphilis; for, although children are not easily salivated, yet
they may be affected by the mercurial, as is shown by the peculiarity in the
shape of the permanent teeth due to malformation, the result of the in-
cautious use of teething-powders containing mercury. Calomel is used for
the same purpose, as well as the corrosive chloride, both of which are par-
ticularly useful in mucous diarrhoea, or enterocolitis, in small or minute
doses, given every hour, suspended or dissolved in recently-boiled water. In
■tnunous children, with poor digestion, small appetite, and irregular bowels,
the following is a valuable tonic: —
B Hydrarg. chlor. corrosivi
Tr. gentinnir- t'ompoKitie 150
Syr. auraiitii 30
M. Sig.: A t4?aspoonful four times daily, at meal-timea.
032 Gm. or gr. bs.
e.cm, or fjv.
c.cm. or fjj.
^I In vomiting of adults and infants, 0.0006 Gm. (or gr. */,oo) of corrosive
INill^inate, or minute doses of calomel with soda, or saccharated pepsin, will
dVai check the irritability of the stomach, if the diet be properly restricted.
In vomiting infants, it may be necessary to stop the use of milk for a few
^m days, and rely altogether upon rice-water or albumin-water until the diges-
B lion is normal again. The vomiting of cholera infantum is often relieved
B by small doses of calomel, and the nausea of adults frequently yields to the
f same treatment. A minute dose of calomel, or corrosive subiimate, admin-
istered at hourly inter\'als, is advantageous in acute or chronic dysentery,
I soon causing the disappearance of blood_ and mucus from the discharges.
H The corrosive chloride, in doses of 0.001 to 0.002 Gm. (or gr, V«o-V»o) before
B each meal, promotes cicatrization of a gastric ulcer. The occasional use of
a mercurial purge aids in eipelling intestinal worms, and, in fact, calomel
is an efficient remedy against tape-worm. Given in fidl cathartic dose, mer-
cury also is an excellent anthelmintic in case of lumbricoid worms. It is a
common and good practice to use a mercurial in combination with santonin.
Mercury is no longer regarded as essential in the treatment of all forms
of inflammation of internal organs, but small doses are valuable in promoting
iht absorption of inflammatory exudations, especially in glandular affections,
in orchitis, in croupous pneumonia or broncho-pneumonia, tonsillitis, and
meningitis.
Calomel ia of special value in limiting or promoting the absorption of
inflammatory exudations of serous membranes. It is also efficacious in iritis,
Wallace Bcatty points out its value* especially in case of venous engorge-
nent, due to chronic pulmonary or mitral valve disease, or dependent on mi-
ll incompetence, or from failure of the right heart caused by emphysema
* Dublin Journal of Medical Science, Oct, 1800.
526
rHARMACEUTICAL THERAPEUTIC AGENTS OB DRUGS.
and bronchial and cardiac dilatation due lo chronic interstitial nephritia.
Also in cases of dilatation with genoral dropsy, without obvious valvular dis-
ease. He finds tJie metJiod most successful in hia hands, of administering
mercury, to be with small doses frequently repeatedj for its diuretic effects.
The plan he adopts is to give a pili containing 0.03 Um. (or gr. ss) of calomel,
usunlly witli digitalis or squills, every four hours, uiglit and day, for ten to
fourteen days. In case they produce purgation, he changes the pills to one
with opium, 0.008 to 0.03 Gni. (or gr. Vs-ss), instead of the digitalis. He
usually gives two sets of pills to l)e employed according to tlte circumstances.
The mercury acts by stimulnting the renal secretions and increasing the
activity of absorption at the same time. He does not pretend to say that it
is useful in all cases, but, when di^'italis and other cardiac tonics fail, the use
of mercury is often attended with the happiest results.
In ascites caused by disease of the liver, Palraa obtained excellent results
from the administration of calomel. The urine was greatly increased in
quantity and the trEusudation correspondingly diminished.
In a case of liypcrtrophic cirrhosis of the liver, Sior olisorved disappear-
ance of the jaundice and marked reduction iu the size of the liver and spleen
in consequence of the use of calomel In cases of hydatid cyst of the liver
Baccelli advises that after about 30 c.cm. (or fjj) of the fluid has been with-
drawn a corrosive-sublimate solution should be injected into the sac. Twenty
c.cm. (or fovss) of a 1 to 1000 solution are used in this manner, and, at tlie
end of five days, the parasite is dead and the symptoms steadily improve.
In the treatment of diphtheria. Dr. Daly,* of Pittsburgh, strongly ad-
vocated Keitor's method of using calomel. 0.13 to 0.32 Gm. (or gr. ii-v ) being
given every hour, or every two or three hours, to young cliildren, until tlie
discharges from the bowels appear as colorless serum, with a little greenish
mucus or bile upon the surface resembling chopped spinach. Then the in-
terval is lengthenedj but the same dose continued. Shorts* gives from 0.32
to 1 Gm. (or gr. v-xv) every two or three hours to an adult until the greenish
stools are obtained, avoiding salivation by the simultaneous administration of
0.32 to 0.50 Gm. (or gr. v-viij) of potassium chlorate. The corrosive chloride
has also its advocates in this disease, and here the system tolerates compara-
tively large doses, not only with impunity, but with benefit. From 0.0015
to 0.00() Gm. (orgr. V^'Vio) ^^' 1**^ given every two hours to an infant for
twenty-four to forty-eight hours, until tbe.worst part of the illness has passed
over, when the interval can be lengthened and the dose reduced. This has
the advantage of being less likely to cause salivation than the calomel. In
true membranous or diphtlieritic croup, this plan of treatment may avert the
necessity of intubation or tracheotomy. Rennert, however, has used with
very satisfactory results, in diplifherin, an application to the throat of La-
place's tnrtaric-ncid, oorro:;ivc-sublimatc solution, in the strength of 1 in 500.
His statements have been corr-*^ ho rated l)y Dr. ^f. Orabiim TulK of Philadel-
phia. In whooping-touuli, Kaubitschek report:^ favorably on the local em-
]iloymcTit of a 1 to 1000 solution of corrosive sublimate, npplied uy>on a cot-
ton tampon and pressed against the base of the tongue and swabbing the
tonsils, uvula, and soft palate. The procedure was repeated every day or
every second day with the result of materially modifying and abridging the
' "Transactions of American Lnrj'ngo logical Association," 1886.
* Physician and Surgeon^ Sept., 1889; "Annual of the Universal Medical Sci-
i?noeii/* 1890.
IIYDBAttGYKUM.
527
of the ilisonse. In diphtheria, Dr. E. L. B. Godfrey uses iron in
lion with corrosive mercuric chloride :-^
B Hydrargyri ebloridi eorroaivl 1065 Gm. or gr. j.
Tinct. ferri chloridl 7|5 c.cm. or f3ij.
Symp. timplicis 221 c.cm. or fSrj.
Aque q. s. ad Ml c.cm. or fjiij.
M. Sig-: A tefldpoonftU in water every three hours.
The yellow, mercuric subsiilphate is a valuable adjunct in the treat-
it. for 0.13 to 0.20 Gm. (or gr. ii-iij) administered to a child are followed
hj prompt eme&is and the ejection of false membrane from the throat.
Fordjrce Barker considered it uniformly successful in croup. It should not
be illowed lo remain in the stomach in case the first dose does not produce
rotniting, as it may cause gastritis or mercurial poisoning; it generally ia
rejected loo rapidlv for absorption to. take place.
In other constitutional diseases attended by inflammation of the throat,
we mmy give 0.02 Gm. (or gr. Vs) o^ ^^7 powder three or four times a day,
ts recommended by Ringer. This high authority also advises the same prep-
aration in the same dose, given hourly, in acute tonsillitis when the swollen
glands interfere with deglutition and respiration. In troublesome ulcera-
tions of the throat, corrosive-sublimate solution is often beneficial as a local
application, accompanied by other treatment suitable to the case. In diph-
theria, the best results are obtained by antitoAJn, and the internal adminis-
tration of mercurials, conjoined with local disinfection by salt-water douches,
potaasium permanganate, trypsin, toluol, or boroglyceride, instead of local
applications of mercurials, since where they are frequently used it is im-
poenble to estimate how much ha.« been swallowed.
tXhe appended formulae containing mercury will be of benefit in diph-
theria, acnte tonsillitis, and often in acute larj'ngitis: —
1
B Hydrarg^'ri ohloridi mitis 113 Gm. or gr. ij.
AntinioTiii ei poUiseii tart 005 Gm. or gr. j.
Sacchflri aibi 2| Gm. or 5aa.
M. et ft. chartulcp no. x.
' Big.i A powder every hour or two.
065 Gm. or gr. j.
c.cm. or fSj.
c.cm. or fSij.
B Hydrargyri chloridi corroBivi
TSnct. puoiaci 30
Clyccrini CO
3C Sig.: A half to one leH^pooiiful every two or three hours.
The sore throat of scarlatina is benefited by the administration of the
tfray powder, or the corrosive chloride. Petresco, after numerous bacterio-
logical and clinical experiments, relies upon Van Swieten's solution* in the
Treatment of measles, scarlet fever, and small-pox. In scarlet fever the solu-
lif'i ' ' corrosive chloride was applied directly to the throat, either by
pfi _ r in the form of a gargle.*
il;i|xjther,' in tlie troatraent of psoriasis, employs mercury externally
* V«n Swi*tpn'8 solution is composed as follows: 0.65 Gm, (or gr. x) each of cor-
w auhlimate pnd nmmonium chloride, dissolved in a pint of dintilled water. Dose,
tto<c.cm. (or f3aaj).
' "R^h^rrlien C1iniquc4 ct Expf^rimenUlea sur PAntisepsle MMicale." par le Dr.
LjVtmeo. Memnire pr^aent^ au Co^gr^• de Th^rapeutique A Paris en 1880. Jaaay:
^^merie National. 1880.
•"The Taraiitir Vafure of P»nria«i«. ita Treatment by Mercury," by E. D.
Uipotiirr. M.D.. K.K C.S . in liriti/th Mcfiiml Journal, Jan. 17, 1801.
5^8
PHARilACEUTICAL THEBAPEUXIC AGENTS OK DBUGS.
and internally, the blue pill or the protiodide of mercury being usually pre-
Bcribed. The writer has employed the mercurials, especially the corrosive
chloride hypodermically, in the treatment of several cases of psoriasis, with
a complete removal of all the eruption from the body, the dose and injection
used being similar to that already described in treating syphilis. Poncel, of
the Marseilles Hospital, has also employed injections of the corrosive chlo-
ride of mercury into tumors of a cancerous appearance, followed by their
complete disappearance. Dr. K. Cowan Lees, of Glasgow, reports that he
has met with some success in tlie treatment of sarcomata and carcinoraata
by injections of corrosive sublimate dissolved in olive-oil. He employs the
same method in pneumouic phthisis.
A case of traumatic tetanus in a child has been described by Celli, in
which success followed the hypodermic injection of corrosive sublimate, as
first practiced by Baculo. During seven days, nine injtvtions of about 0.005
Gm. (or gr. V,«) were given. Improvement was observed from the beginning,
and on the eighth day the patient was completely cured. Schwab has used
for congenital syphilis, the following, hypodermically: —
B Hydriirgyri biniodidi 0105 Gm. or gr. V*.
Sorlii iodidi 0|05 Gm. or gr. 'A-
Aquic dcBtillatjp 10| c.cra. or 3ijV>
M. Sig. : Dose for an infant, 0.10 o.era. (conUining 1 mg., or gr, '/••)-
The ointment of the nitrate, very much diluted, also mercurial oint-
ment, has long been used upon the face in small-pox in order to prevent the
development of the pocks and consdiueiit pitting. I'he eiroct probably is de-
pendent both upon the mercury and the exclusion of light and air.
For the local treatment of variolous pustules. Dr. Talamon advises spray-
ing the surface with a solution containing 1 Gm. (or gr. xv) each of corrosive
sublimate and citric or tartaric acid, 5 c.cm. (or mlxxv) of 90* alcohol, and
a suflicient quantity of sulphuric ether to make 90 c.cm. (or foiij)- ^^
makes use of the same method in the treatment of erysipelas. Dr. H. A.
Ingalls,^ of Cincinnati, reports a series of 3G cases of small-pox, 1 of which
was haemorrhagic and 13 confluent, treated without mortality, as a result of
the use of baths of bichloride of mercury (1 to 10,000) given twice daily. A
large bath-tub was brought to the side of the patient's bed and filled with
a warm (103^ to 105" F.) solution of bichloride, and the patient immersed,
except the head and shoulders, for about ten or twelve minutes, the nurse
gently rubbing the entire body with a soft cloth during the bath. After
the bath the patient was anointed with a mixture of carboHc acid, bismuth
subnitrate, and olive-oil. Dr. Ingalls reports the following'' observation of
this treatment: 1. There is practically no mortality. 2. The suppurative
fever can be shortened four to six days, if patient is treated from the onset.
3. A minimum of pitting is secured and an almost entire abi?ence of the
characteristic disagreeable odor. 4. The period of desquamatinn is mate-
rially lessened owing to the thinness of the scab-formation. 5. Pain is very
much reduced, morphine being rarely required. 6. The great distortion of
features, which gives us such repulsive-looking patients, is eliminated to a
great extent. On local treatment of erysipelas. Prof, l^oswell Pnrk, of Buf-
falo, said: "Of all the numerous applications which I have ever tried, I
^Journal of the American Mrdical Association, April 28, l&OO, p. 1044.
UYDUABGYRUM.
529
^
»
iiii\e found but one thing which has given the universal satisCaction afforded
bj tht following prescription or something equivalent to it: Resorcin (or
wphtalin), 5; ichthyol, 5; mercurial ointment, 40; lanolin, 50. The pro-
portions of these ingredients may be varied, and I often increase the amount
of jchihyol, especially when the skin to which it is to be applied ia not too
tender. The affected parts are anointed with this, and then covered with
oiled ailk or some impermeable material, simply to prevent its absorption
by ihe dressings; the parts are then enveloped in a light dressing and
bandaged. Whenever I have to deal with local evidences of septic infection,
I use an ointment essentially the same as this, and have learned to count on
it with more reliance than anything that 1 have ever resorted to. This one
better thing hinted at above is Credo's silver ointment, which is to be used as
d«fchbed. As the disease becomes mitigated, the ointment may, if desirable,
be reduced with simple lard, and may be discontinued when local signs have
disappeared. Abeorption of any of these preparations may be hastened by a
wries of scratches over the affected area with the sharp point of a knife, not
deep enough to draw blood, but deep enough to better expose the absorbent
f«B»el8 of the skin.*'
The special applications of mercurj' to the treatment of syphilis are so
important as to deserve more extended consideration than is given to other
diseases, and will therefore be considered here at some length.
Inunction Method. — Mercury may be applied to the skin with a view
to absorption, and for this purpose the ointment or the oleate may be used,
a piece the size of a marble or larger being rubbed upon the inner side of
the arms and thighs once or twice daily. The place of inunction must he
changed, as the mercury causes some local irritation, and a crop of papules
is likely to follow its repeated application to the same spot. A small piece
of ointment may be rubbed upon the soles of the feet before putting on the
itockings each morning, the friction in the act of walking being sufficient
to cause absorption. In the case of infants suffering with congenital or ac-
quired syphilis, the ointment may be rubbed upon the abdomen under the
btDy-band. This method is resorted to when it is desired to impress the
«T»tem rapidly, as, for instance, in the treatment of the inflammatory mani-
fntations of syphilis, especially in iritis. The constitutional effect can be
mwt rapidly nlitnined in this wnv without disturbing the digestive organs.
Ijerch* gives the following directions for tertiary syphilis: The raer-
airy may he given by inunction in doses from 3 grams to 7.78 grama (45 to
120 ^niin:*> of blue ointment. Tliis quantity should, in severe cases, be useii
each twenty-four hour?.
TIm* patit-nt is directed to divide the amount into two equal parts, and
we the one for eoch leg over the inside, with vigorous massage. It is neces-
ary Ift con! inn** the rubbing for fifteen minutes over each side to cause
aWr^tinn. and it is best tn control the Hme by the watch, as the process is
t^^ ^ too often tlie lime of rubbing is shortened by the patient. The
ati' the proc(*ss is repeated over the inside of the thighs in the san:ie
naitner* the third day the inside of the arms, fourth day, chest and abdomen ;
te fifth day the back must be treated, and on the sixth day a full warm bath
fardeansing purposen is administered. To prevent colds, especially during
ft* winter, the patients are directed to use the inunction before retiring*
• XA# Mtdiriil rttandnrd, December. 1906.
530 MIAK-MACKlfTKA!- TIHCIIAPKI^TIC AOEXTS OH UmOS. ^"
Thai patient may use the iminc-lion himself during tl»e firBt four days, after
I'lill instructions, or all rnay be given hy a professional mnsseur. Tliirly
inuuetifnis generally lonstitute a full treatment. In other words, tlie pro-
cess has lo he repeated t^ix times.
The late M. Quini^uaud, of Paris, claimed that the application of a mer-
curial plaster over tlie spleen is an efficient and convenient method of admin-
istering mercury in syphilis. The preparation of which he made use was
composed of CO parts of diachylon plaster, 20 ports of calomel, and 6 parts
of castor-oil. If a setoiul pla.-^ter wa:^ nf»t used the metal continued present in
the urine for a mouth or six weeks. By the alternate use and disuse of the
plaster during piriodf; of eight days ptyulisin is said to have been entirely
avoided. The plast<^rs eniyjloyKl were fonr inches s(iuan'.
In severe eases of euiistitutional sy|;hilis. I>r. rJy?iinecki has found it of ad-
vantage to associate the internal administration of quinine with the inunc-
tion of mercury. The class of cases in which this combination proved valu-
able was marked hy increased tissue-change. In syphilis, especially when the
infiltration is marked upon the skin, the elficacy of one of the mercurial oint-
ments may he increased hy combining with some stimulating oil or green
soap: —
H Ungt. hjdrargyri nitratU,
Sttpo viridifl aa 4615 Gm. or Jiss.
01. eucaJypti 2| c.cm. or fSas. — M,
IJ Unfit, hydrargyri ammoniat 621 Gm. or Jij.
K Olei anthemidis 2{ c.cm. or fSss. — M.
B Ungt. hydrnrgyri oleatis {10 vel 20 por cent) 62| Gm. or 5ij-
Olei cadini 7|5 c.cm. or fSij. — M.
B Ungt. hydrar^ri oleatia (10 per cent.) 311 Gm. or JSj.
Olei cflj*yophylli 1 12 c.cm. or mxx. — M.
On the basis of his clinical experience. Dr. Joseph Dymnecki also advo-
cates a combination of sulphur-bathfi and mereurial inunction. He believes
that the baths promote the action of the mercury, and finds that the chem-
ical incompatibility detracts nothing from the therapeutical effects. Watras-
zeweky prefers the use of calomel soap to morcuriol ointment in the treat-
ment of syphilis. The soap is made by triturating pure olive-oil soap with
calomel in the proportion of one to two or three. A piece of the poap equal
to 2 Gm. (or gr. xxx) is rubbed into a selected part of the body until nothing
remains but the foam. This is furthermore rubbed until it also disappears.
The method is cleanly, does not irritate the skin, and requires but ten or
fifteen minutes for its execution. Another method of keeping mercury in
continued contact with the skin is that adopted by Peroni, who adds to the
solution of gutta-percha a quarter of its weight of calomel. After the pa-
tient has bathed, hie back is painted with the solution, and when the chloro-
form has evaporated a mercurial varnish remains closely adherent to the
skin. This practice has been found of service when the internal use of mer-
cury is badly borne and is suitable to children aniicted with hereditary syph-
ilis or late cutaneous manifestationa. Welander has convinced himself, by
comparative experiments, that a greater quantity of mercury is absorbed by
the simple application of blue ointment to the skin than when friction is em-
ployed. If rubbed upon the skin before the patient goes to bed the bodily
irrBRAnoTnuM.
531
I
k
hnt vaporizes the metal, which is flhsorht?d hy the skin and lungs. He ad-
TiB«, therefore, that an excess of the oiutment should be used in order that
ibeorption should be continuous. The therapeutic effect of mercurial in-
onctions and pillow-slip method of admifiisterinfj mertfViry, Kutner* helievea
V> be largely, if not entirely, due to the inhalation of the mercurial fumes,
and not the absorption or taking up of the drug by the skin. He rubs the
nerrury into an air-tight box from which the fumes are inhaled through a
rubber tube and mask for half an hour a day. Mercury is found in the urine
IS in other methods of administration. No toxic effects have been observed
in any of the many patients so treated, and in each case recovery resulted.
The advantages of the inhalation method are that the "inhalation dose"
can be accurately determined and regulated, and the many annoyances at-
tending the inunctions are done away with Although stomatitis does not
rwult, it is best to gargle with potassium-chlorate solution after each inhala-
tion. The author evinces considerable enthusiasm over this method of ad-
ministering mercury, and, judging from his results, his enthusiasm is justi-
fiable.
Often the most rapid way to mercurialize a patient is by using the drug
in the form of suppositories. Fumigation is also a method of introducing
mercury into the blood by way of the skin. The usual method is to place
ih« patient in a vapor-bath until he is perspiring freely, and then to expose
th^ body to the fumes arising from 0.65 to 1.30 Gm. (or gr. x-xx) of calomel
sublimated by the flame of an alcohol-lamp. The fumes should not be in-
haled, and, therefore, the patient sitting on a chair has a blanket or his
clothing fastened around his neck and extending down to the floor all around,
making a canopy; under the chair is placed a small spirit-lamp, and over it,
upon a sheet of tin, is placed the mercurial. The patient, after about fifteen
minutes' exposure, is wrapped up in dry, warm blankets, and the skin allowed
lo dry spontaneously. If perspiration continue, it may require a small dose
of atropine. In this way the mercury is deposited upon the skin, and is
gradually absorbed, producing the greatest impression with the least dis-
turbance. Tliis method is especially valuable in controlling^ the skin dis-
order* attending syphilis (syphilides), and in the treatment of other mani-
tions of the poison when mercury is not well borne by the bowels.
The hypodermic method of administering mercurials has been practiced
"n Frame and in CJcM'many, ami, to a K^s *\\tont, iu this country. For
irpotH' sohitions of corrosive cliloride (hydrarg. chlor. corr., 0.0(>5 Qm..
gr. j : aijim* dt'Hlillata?, 7.5 c.cm.. or f3ij. Sig. : (».(I0 com.. (»r mx. n dost*
ft day) have bii-n gradually incn^ased, by drops, until 5n or more are
a'l 'cil, or until the physiological action of tiio mercury is apparent.
Til ■ ^ . (if trmtmcnt is as rU**inly, <|tiick in results, and more successful
than any oiIut in pn-vonting rolnpsos.
It majy however, cause irritation, and has, in some rare instances, when
given improperly, led to abscess and sloughing. If the hypodermic needle
ba properly inserted, the instrument and needle aseptic, the author has never
ob^rved any case of abscess follow the hypodermic injection of the corrosive
chloride of mercury. The moment the least mercurial impression is made
hf the subcutaneous injection, the dose shoiild be reduced to the smallest
amount. A few minims of the solution already named should be again in-
^Brrtimrr k1ini$ehe Wochfit*rlirift ; Medicnl Standard. March. 1900.
532
PHAHMAOEtTICAL TUERAPEUTIC AGENTS Oil DIIUOS.
jected into the muscle or skin, and the system kept under the impression of
the drug by injections every day or two, until all evidence of syphilis disap-
pears. In place of using small doses of mercury every day hypodermically,
the writer sometimes, especially in lean subjects, injects from 0.015 to 0.02
Gm. (or gr. V*- V») of corrosive sublimate two or three times a week into the
muscular tissue of the gluteal region or back. The hypodermic method thus
administered is for old cases of syphilis, especially in broken-down individ-
uals, and offers a most positive way of limiting or curing the disease.
The mercurial, when injected in these large doses, is, as the rule, slowly
absorbed and exerts only a therapeutic, and not a toxic, action.
The albuminate and peptonate of mercury have been proposed with a
view to obviate any acciilouts, but constitute little, if any, improvement.
The glutin-peptone sublimate, another compound used in the same
manner and for the same purpose, is obtained by the action of hydrocliloric
acid on gelatin. It contains 25 per cent, of corrosive sublimate, and is a
white, hygroscopicnl powder, which readily assumes the form of a colorless,
non-corrosive fluid. This preparation is used in doses of 1 Gm. (or gr. xv),
and is said not to occasion much pain nor give rise to abscesses.
Ill the clinic of the late Professor Auspitz the following solution was
employed: —
Hydrarg. chlor. corroaivi . . .«. 1
Sodii chtoridi 2
Aquo: dcstiUats 90
Gm, or gr. xv.
Gm. or gr. xxx.
ccm. or ijiij.
\S wi
M. Dose: 0.60 to 2 ccm. (or mx-xxx) every second day hypodermically.
Mathea states that no irritation results beyond a little tumefaction.
About twenty or thirty injections constituted the course of treatment, which
resulted in a cure. Liebreich recommends the formaniidate of mercury,
which docs not coagulate albumin, is neutral in reaction^ readily combines
with water, and is not precipitated by alkalies.
Formamidate of Mercury* is prepared as follows: 10 to 13 Gm. (or Siiss-
ii Vi of freshly-precipitated, completely-washed » and still moist mercuric
oxide are gently warmed with a little water in a porcelain capsuie, with a
gradual addition of 9.25 ccm. (or fSiiss) of formamide (resulting from the re-
action of ammonia upon ethyl-formate). As soon as solution has taken place
the resulting colorless liquid is filtered into a litre flask, and the latter filled
to the litre-mark with distilled water. Each cubic centimetre (or miv) con-
tains 0.01 Gm. (or gr. V«) o^ mercury, which is one hypodermic dose. It
should be dispensed in brown-colored bottles. Zeissel, of Vienna, after trial
of this agent, was well satisfied with it, and found twenty injections the maxi-
mum number required to disperse the syphilitic manifestations, even in severe
cases. Kopp's^ conclusions from over three thousand injections were less
favorable; he says that "Liebreich's preparation is decidedly useful in cer-
tain of the milder forma of primary syphilis, as also for slight secondaries.
The formamide should not be employed in severe cases where there are large
papules or thick infiltrations; inunction is still the best method of treating
these cases. The tertiary forms are likewise not to be treated by the
formamide. Relapses are by no means prevented by Licbreich's method; on
' "Notes on Hydrargyrum Formamidatum," by J. C. Wilson. M.D., PhiJcdclpkia
Medical Timett, vol.'xiv, p! 140,
*^Vicrteljahr8chrifi fiir Dcrmatologie und SyphiliSf 1885.
HYDRARGYRUM.
533
tbe contrary, they appear to be extraordinarily common after this treat-
in«xt/' In order to obtain more permanent effects than are possible by the
w* of the soluble preparations, it has been thought that by depositing the
more stable compounds under the skin a more lasting effect can be obtained,
iDd calomel is now used in this manner. The calomel may be suspended in
Kqiiid vaselin or olive-oil (1 in 10). There should be at least a week's in-
tfnnl between the injections, which arc usually thrown deeply into the tis-
sues of the buttocks or retrotrochanteric space (Resnier). The part should
be washed with antiseptic solution, and the needle sterilized before each op-
ention; tbe puncture should be immediately covered with emplastrum de
Vigo or by a drop of collodion.* It should he pointed out that the sub-
mtaneous injection of calomel, gray oil, or other insoluble preparation of
mercury, i« not without danger. There is a local deposit of the mineral at
the point of injection, with continuous slow absorption. Emholic pulmonary
infarctiun has occurred in direct consequence of the procedure, while in other
cases a dysenteric condition was established.
Mercnrj' henzoate and other mercurial preparations have been used in
tbe same manner for the same purpose. Gray oil ia much in vogue in
Vifnoft, while the salicylate, yellow ioditlc, and cyanide have been expcri-
nwntally employed by Roussel and Chernogulx)ff. Gray oil consists of mer-
f»r>\ lanolin, and olive-oil. A case has lately been reported in which a 30-
nt. solution (hydrarg., lanolin, aa 3 parts; olei olivie, 4 parts) had
n \i90i\ tlnring seven weeks as a subcutaneous injection. At the date of
tb^ last injection no sign of mercurialism was present, but a week later the
gum* beoime tender, ptyalism and violent ,i.'Hstro-enteritis soon onsned, and
in a month the patient died. The formula for administering the salicylate^
of mercnnr, employed by Keyes and Chetwood in 1894, was liquid petrolatum
(l.fi c.cin- or mxxx, holding in suspension O.lt Gm., or gr. iss, of the salicy- i
lite). D. A. Sinclair, of New York, reports^ satisfactory results from/
wrekly injections of the above into the muscular tissues, generally in the
ftut/'al region. Tn severe cases, he injected OA Gm. (or gr. vj) at once with-
o«t any hut the most gratif^-ing results. Tlie ordinary doge, however, ia
0.1 Oin. (or gr. iss), suspended in oil (allowing 0.016 Gm., or gr. */«» for
Iqk). Ihie care must be exercised to keep the mouth in good condition.
lb* treatment is kept up for three years.
Xeiimann has. in a number of cases, employed asparagin hydrargyrate
Jfftipared by dissolving 10 Gm. (or Siiss) of asparagin in warm water and add-
ing mercuric oiide until no more dissolves. The solutioBj when cold, ia
filtered and the amount of mercury calculated. It is then diluted to the
itrength of */:> I* or 2 per cent. This solution is a limpid, colorless fluid,
fcvoid otodor, but possessing a sharp, acrid, and metallic taste. It contains
no excess of asparagin. A daily injection, generally in the interscapular
region, was made of 1 c.cm. (or mxv) of the l-per-cent. solution, being equal
to 0.01 Gm. (or gr. */«)- Asparagin hydrargyrate is distinguished by the
npidity with which it is ahsprbed and eliminated. The injections are well
borne and accidents are rare.
The siiccinimide of mercury is a compound concerning which a report
*ffrt'«e General* de CUniqve et de Th^apfutique, Sept 12, 1880.
^yetff York Medical Journal, Octot>or 22, 1004.
534
PlIAn!kL\CEL'TICAL TIIERAPEL'TIC AGENTS OB DRUGS.
has htvn favorably madfe by *Uili<n. Tho salt occurs in the form of long
needleg, and is very soluble in water and alcohol. He made use of a solution
in distilled water, each cubic centimetre (or mxv) of the fluid containing
0.0027 Gm. (or gr. YjJ of succinimide of mercury. From V2 to 1 c.cm. (or
mviiss-xv) of the solution was injected every day and gave rise neither to
pain nor irritation. The treatment was found efficient, most of the cases
being in the secondary stage. An average of twenty-two injections was made
in each case. No salivation was produced. The drug was, in other cases,
administered by the mouth in doses of 0.02 to 0.03 Gm. (or gr. VrVa) w-ith
advantage, though the treatment was more prolonged.
The double hyposulphite of mercury and potassium occurs as colorless
crystals, easily soluble in water, and contains 31.4 per cent, of mercury. For
hypodermic injection 0.25 Gm. (or gr. iv) is dissolved in 9.25 c.cm. (or f3iiss)
of distilled water and from 0.50 to 1 c.cm. (or mvii-xv) is employed, equal
nearly to 0.005 to 0.01 Gm. (or gr. Vk-Vo) ^^ the corrosive sublimate.
The saUcylate of mercury may be readily prepared, according to the
following formula of Vacher: —
Bodii salicylat 2
Aq. destilUt 90
M. Each cubic centimetre (mxv) containA 0.01 Gm. (or gr. '/•) of !ui]icylat« of
mercury.
Gm. or gr. xt.
Gm. or gr. xxx.
c.cm. or fjiij.
A;nother mercurial salt which has been employed for hypodermic use
in syphilis is the thymolacetate. The injection is said to cause but little
pain, and is made every eight or ten days. Dr. Tranjen makes use of the
same preparation in tuberculosis. Dose, 0.10 Gm. (or gr. iss) in albolene or
glycerin.
Moncorvo and Ferreira have extended the use of hypodermic injections
to infantile syphilis, using by preference the corrosive sublimate and gray
oil. The former was given in doses of O.OOOG to 0,002 Gm. (or gr. Vioo"Va3)
to children varying from three months to fourteen years of age. The amount
of gray oil injected is said to have been *'froni two-fifths to the whole of a
Pravaz s^Tinge," the ages of the patients ranging from thirty-eight days to
twelve years. The result is stated to have been rapid improvement as re-
gards the cutaneous lesions and decided gain in weight and general condi-
tion.
It is claimed that if pure guaiacol be incorporated with the nil used
as a iiu'diuni for infrumu.'icuUir injections of mercurial.^, tlie process is ren-
dered practically painless. The following formula is the one recommended,
the guaiacol heing employed in the proportion of 3 per cent.: —
R Hydrarg. iod. rubr ^ 15 Gm. or pr. viij.
Guaiacol. pur 3 c.cm. or m\\v.
01. olivse ster So| com. or fjiij.
M. Sig.: For hypodermic use.
The injections are practiced daily or every other day, 2 c.cm. (or m.xxx)
representing appro-ximately 0.01 Gm. (or gr. Va) of the biniodide. The
needle should be inserted perpendicularly to the skin, pushed in its full
length, and the li(|i(iil injrctcd very slowly, the buttocks being i-liow^n as the
best location for {he operation.
IIYDlt\UUYRUM.
535
Tht Intravenous Injection of Mercury — Dr. Walter L. Pyle/ in a recent
article, gays that the advantages of this method are: 1. There is absolute
IBttiiiiy of absorption. 2. There ie no pain to speak of. 3. There is no
fiBturhance of the digestive tract during treatment. Slight salivation and
diiirhflea, temporary only, are the only local disturbances reported. 4.
There is more rapid absorption and therapeutic effect than by any other
method. 5. Less of the mercurial salt is required, fi. Absolute exactitude
of dosage can be obtained. 7. Not a single accident has been recorded. 8.
The method is perfectly reliable. All cases reported have shown some im-
provement, and never any retrsgresaion. 9. Abscesses do not form. 10.
There are no cutaneous irritations or eruptions, such as follow friction or
monctions. 11. The nervous symptoms sometimes associated with the
hypodermic method are never observed %vith the intravenous injections. 12.
h 15 successful often when all other methods fail. 13. There is no history
of recurrence after a cure. 14. Mercuric chloride hns a preservative action
on the rod blood-corpuscles, and hence must be valuable intravenously in
»uch a disease as syphilis, in which there is a strong tendency toward de-
struction of the red blood-corpuscles and subsequent anaemia. The disad-
vantages are: 1, The needle may not reach the vein; but this can be
remedied by applying the needle first and awaiting the appearance of a few
drops of blood. 2. Some of the blood may extravasate into the subcutaneous
titfue, adjacent to the point of injection; but this has rarely occurred, and
tbe blood is soon absorbed. 3. There is likely to be a sli^jht stomatitis at
bet. 4. There is the appearance of albumin in the urine after the injec-
tions, which, however, often follows hypodermic administration. 5. There
li, ts in all intravenous injections, a subsequent polyuria and increase of
wtt, but neither has any special disadvantage. 6. During the injection,
through a reflex action on the circulatory centre, fainting may supervene,
hot is of no vital import. 7. Jemraa has seen slight salivation immediately
ifter the injection of small doses. This is liable to happen in any adminis-
trvlion of mercury. In the opinion of the author the advantages so far over-
! the objections that, viewing the present status of treatment, we can
ept this as the most successful. He would not, however, advocate it
ra cftMfi easily amenable to ordinary treatment or in the early stages of
syphilis, but considers it of especial value in obstinate cases, resisting other
tTMtment, or in advanced cases of organic syphilis, or when immediate relief
ts urgently called for by reason of pain, encroachment on a vital part, or
rapid destruction of tissue. Investigation may prove it to be most valuable
immediately after the diagnosis is made, eliminating or destroying the syph-
ilitic virua before it has produced any decided effect on the general system.
At present there i& no evidence to warrant this statement; but, as the
method is virtually devoid of dangerous or untoward results, it should be
given some trial in the beginning of the disease.
Jn two cases of cerebral syphilis which had proved unamenable to
it, Buccelli resorted to the intravenous injection, usually into the
rt«l veins in front of the elbow, of corrosive sublimate with excellent
rcsnits. The solution was of such strength that 1 c.cm. (or mxv) corre-
Ipdrd (nliout) to 0.0004 Gm. (or gr. Vn-), and this was the amount in-
led to begin with, the o])enition being practiced every day and the dose
ing increased to 0.00?7 (Jm. (or gr. V44): —
^iTftfCeol Xcttji.
sac
PHARMACEUTICAL THERAPEUTIC AGENTS OU DRUGS.
IJ Hydrarg. cbloridi corrosivi 1 1
Sodii chloridi 3|
Aquae lOUO)
Gui. or gr. xv.
Gm. or gr. xlv.
c.cm. or OiifSxiv. — ^M.
In syphilis, the role of mercury lias been coasiderably nbbreviated ia
recent years. There is no denying that it does rapidly control the early
manifestations of syphilis and also those of congenital syphilis, so that it
may be considered, within limits, as antagonistic to the syphilitic poison.
The investigations of Leon Levi show that, in syphilitic subjects, the salts
of mercury favor metabolism, improve nutrition, increase the corpuscles
and haemoglobin of the blood, and augment the weight and the muscular
strength.
From a study of ninety-seven cases, Weilander states that, during the
administration of mercury in syphili??, the urine contained casts, the number
of which increased with the length of the treatment. After discontinuance
of tlie remedy the casts disappeared, as a rule, within a month or six weeks,
without causing temporary or permanent injury to .the kidneys.
As mercury is most efficient when it encounters the poison in the blood,
it should be given as soon as induration is observed around the primary sore,
and the treatment by small doses, avoiding ptyalism, maintained for several
months. In some cases there will be no further symptoms; in others, sec-
ondaries will appear, but will be much modified. In the secondary stage the
mercurial may bo combined with iddidcs, and the tertiary manifestations are
generally best treated by iodine without mercury. The mercury with chalk
is preferred by Mr, Hutchinson, of London (0.065 Gra., or gr- j, f^ur times
daily); Eicord prefers the yellow iodide (0.02 Gm., or gr. V^, three times
daily). Calomel is used by some, corrosive chloride by others. The elder
Gross was fond of a biniodide made extemporaneously, as follows: —
H Hydrarg. chlor. corrosivi 005 Gra. or gr. j.
Pota»8. iodidi 4 CJiii. or 3j.
AqxifiD destUlatee 180 c.cni. or fjvj.
M. Sig. : A tablespoonful three times a day.
It may be given directly, as in the "Syrup Gibert": —
B Hydrarg. iodidi rubr 120 Gm. or gr. iij.
Potassii iodidi C 60 Gm. or gr. cij.
Aquffi dt'Btillttta) ll| c.cm. or fSiij.
Cola et ndde
Syrupi q. g. ad 300] c.cm. or fjx.
M. Sig.: A half to a tablespoonful three times a day.
Ilurd* writes that the country physicians, as a rule, prefer the "mixed
treatment," believing that the corabinntion of mercury with potassium
iodide is admirably adapted to secondary syphilis, and that much less mer-
cury is needed when the mercurial is given along with the iodide.
The carbolate of mercury is highly esteemed by some writers, as being
rapidly absorbed and capable of being given for a long time without causing
ealivation.
In administering mercury for the treatment of sjrphilis, the author
recommends the preparation or the combination with it which he deems
best for each ease, depending in all instances upon the patient's system.
»*The Place of Mercury in Therapeutics," by E. P. Hurd, M.D., Therapeutic
Cazettc, Jfin. 15, 1891.
IlYDRARGYRfM.
637
Some do best upon calomel, others upon gray powder or the corrosive chlo-
ride, while in very many instances the biniodide or blue pill acts more de-
cidedly. One after the other of the various mercurials first named has often
to be tested, or combinations containing them made, before the form of the
drug suitable to the case under consideration can be selected and its use
continued for a proper time.
In the treatment of secondary and tertiary syphilis by mercury the
author suggests the following formulae:—
B Hjdmrgyri chloridi corroaivi 1066 Gm. or gr. j.
Fluidextracti xajithoxyli 160| ccm, or fjv.
M- Sig.: Two teaspoonfulft in water three or four times a day.
B Hydrargyri chloridi mitia 132 Om.
Sacchan albi 21 Gm.
U. et f t- in chartulie no. x.
&g.t A powder three or four times a day.
B HydrargjTi iodidi flnvi 132 Gm.
Quininee Bulpha tis 2|60 Gm.
IC. ei ft. ptl. no. XX.
Sig.: A pill three or four times a day.
or gr, V.
or 3sa.
or gr. V.
or gr. xl.
B Masaop hydrargyri,
Pttlreris zingibcria,
PulTeris capsici aa
M. et ft pil. no. x.
^.: A pill three or four times a day.
|65 or 1|30 Gm. or gr. x vel xz.
B Hydrargyri cum cretft,
Pulveris glycyrrhizs :.a
Creoaoli ,
M. et ft. chartulw no. xx.
Sig.: From four to six ptoudera a day.
165
106
Gm. or gr. x.
ccm. or mj.
or gr. j.
B Hydrargyri chloridi corroaivi 065 Gm
Ffuidextracti stillingine 60 ccm. or ftij
Tinct, gent, comp 90 ccm, or fjiij.
IL Sig.: Two teaapoonfula in water three times a day.
Mention has already been made of various methods of treating syphilis,
ind it is only needed to add that 4 or 8 Gm. (or oi-ij) of corrosive mercuric
chloride with twice as much common salt can be added to a bath for syph-
ihtic subjects with skin-lesions. AVhen the patient is much broken down,
cirhectic, and anaemic, mercury should only be given in the tonic doses
already mentinnod ; but. ns a rule, it is better that the genoral health should
be built up before putting the patient on a mercurial course.
I A novel treatment of acute articular rheumatism is advocated
Singer.* He recommends a solution
of which one-eighth is to be injected into the vein at the bend of the elbow^
fiirt thoroughly sterilizing the surface and applying a bandage around the
* C^miraiblott fUr dir Gcgnmmte Thrmpie, June, 189B.
by
B Hydrarg. chlnr. corroaivi.
Soidii chloridi
AquR di'fttillaUE
113 Gm. or gr. ij.
10 ccm. or melx. — M,
538
PHAKMACKFTICAL TllEIlAPKLTIC AGENTS OH DUH.'K.
arm to make the veins prominent; the bandage is removed after the needle
is introduced into the vein. He practiced this upon the two arms alternately.
He observed diminution of fever and of articular pains. Contra-indications
are general debility, renal disease, and idiosyncrasy.
As a rule, the mercurial preparations should, as much as possible, be
given alone, avoiding combinatinns that either lessen their elFiciency or pos-
eibly make them more active than is desirable.
Hydrargjrnim pjrroborate is a new salt which has been used to fulfill
the indications of mercury. The pyroborate is a brown, amorphous pow-
der, insoluble in water, ether, or alcohol. It has been made into an oint-
ment (1 to .50) with viiselin, or, when designed for absorption, with lanolin.
Mercurons tannate, an odorless and tasteless salt, insoluble in the or-
dinary menstrua, contains about 50 percent, of metallic mercury and is used
hy Lustgarten in dnses of 0.20 to 0.32 Gm. (or gr. iii-v). It is said that this
combination does not salivate or disturb the digestive functions. Mercuric
gallate, which contains about 37 per cent, of mercury, is said to be more
stable than the tannate and to cause no mercurial intoxication.
Hydrargryrolj Mercury Paraphenylthionate, is a compound of the
formula C^H^.OH.SOgHg, It was introduced by Gautrellet as a succednneum
for corrosive sublimate, over which it is said to have the advantage of not
precipitating the albumin of the tissues and of being seventy-five times less
toxic. It occurs in the form of brownish-red scales, having an odor resem-
bling that of gingor-brcHfl. Its specific gravity is 1.85, and in reaction it is
neutral. It is insohible in absolute alcohol, but quite freely soluble in water
and gl3'cerin, yielding beautiful ruby-red solutions.
According to Gautrellet^ hydrari^yroi in 1 to 250 solution completely
sterilizes bouillons; and introduced into a growing culture it precipitates
the alkali toxins. Its solutions are stated to be neither caustic nor even
irritant.
Hyrgolum is metallic quicksilver in allotropic form, Hydrargyrum
colloidale (von Leyden). It is soluble in water, and is used in 10-per-cent.
ointment for inunction in syphilis, causing less irritation than blue oint-
ment. It may also be givt.ni in pill form, 0.03 Gm. (or gr, ss) thrice daily.
Dr. Gotthcil, of New York, uses a 1-per-cent. solution, in water, in the
treatment of infantile syphilis, giving n.lS to 1.20 c.cm. (or miii-xx) thrice
daily.
Uercurol ik a compound witb nuclein in powder form, containing 10
per cent. <^f mercury. It is bactericidal, but is neither caustic, nor irritating.
In gonorrhica nnd cystitis, sohitions of \'._, to ;l jit-r tftit. arc cnifjloyod for
irrigation, with much success. For treatment of conjunctival afTcctions,
especially of infectious character, 3- to 5-per-cent. solutions are employed.
An ointment may also be used (5 per cent.), which is applied to ulcerj? and
burns, and as an nnliscptic dressing for nbsccsscs. It may be used as a
dusting powder in full strength for indolent tdcers ; or in 2-(H»r-<'cnl. solu-
tion, as a wet drc.^.sing. The latter is also usnl as an injei'tion in gonorHuta.
It is used internally in syphilis in doses of 0.015 Gtu. (or ^^r. ^ \). twice daily,
which may be increased. This is to l>c distinguished from Mercuriol. which,
acconlin;:^ to Dr. I/:'ngrfcltl, cousi.^ts of an iunalu;ain of mercury with slight
amounts of niiigncsiuTii. nhimiiiuin. jiiiliydroits lanolin, and alioon<l-oil, It
is prepared ff)r use by hypodermic inj<vtion by adding an eipnil quantity of
sweel ahiioud-oil. The doM' reeouinieuded is 0.05 to 0.2 ccm. (;/iV\ to iijK
HYDRASTIS.
539
I
fifth day. The mjection should be made deeply into the inuBcle. The
tsuUgain u detroinpo^'d by watt^r. The remedy acts like hydragyruni salicy-
kte.
HTB&ASTIS ( i . S. i'. ) . HYDRASTIS RHIZOMA ( B. P. ) .—Hydrastis.
Preparations.
FluiiifxtrHctum Hyiirastiw (l*. S. iVj. — Khiid Kxtiurt of HytlraHtis (contains 2
per crnt of bydrAstine). Do«e, 0.30 to 2 c.cm. (or mv-xxx).
HydrAHiina. — Hydraiitine. Done, O.Olo to 0.03 Hm. (or gr. % U) H).
H>-dr5i*tiiiinie HydnM-hlcridiini |l . S. T.). — Hydrastinine Hydrochloridt*. Do»e»
M3 to 0.13 Cm. (or gr. ^sij).
Glyceritum Hydrastis (U.S. P.)- — Glyccrite of HydroBtU (1 Gm. to 1 c.cm.).
Dow. 2 to 4 c.cm. (or fSsa-j).
Tinctura Hydrastis (U. S. P., B. P.).— Tincture of Hydrastis (20 per cent.; B. P.,
10 per cent.). Dose, 2 to 4 c.cm. (or f3as-j),
Extnictum Hydrasti** Tjquiduni (B. P.). — Liquid Extract of Hydrastis. Dose*
H0 to 2 c.ctn. (or Mv-xxx).
Pharmacology. — The official portions of golden seal, Ilydrastis cana-
densis, are the rhizome and roots. It is a small plant belonging to the
Kanunculacea?, and grows in rich, moist woods, from Canada to Carolina,
in the Alleghenies and westward. Its most important constituents are
Hydrastine, a white crystalline alkaloid, not bitter, although leaving an acrid
*fnsatifin in the mouth and throat, Berberine, a yellow and intensely bitter,
cTTrtalline alkaloid, and Ganadine.
Hvilrastis also contains a re>:in. r^tarth, su;.:ar, and a vulatili- principle.
Tbf substantv coinrncrcially kniiwn under the nanie of hydraistin is an im-
pure muriate or hydrochloride of berhorinc. By decomposing hydrastine
Willi th<* aid of gentle heat and dihited nitric aclil, u now alkaloid, Hydras-
tiaine, ia formed, togctlier with opianic acid. Tlie liydrochloTidc of liydras-
tiflin**, now oHicial, i.** "the hy4ln>ehloridc 4)f mii arttflcinl alkaloid derivixl
from hydrastine.'' It is iioluble in water and nholuij, but dis^-wdves sparingly
in rtlicr and cblornfonn. Tlic othcial (jlyceriteof liydnistis is an efficient and
fkii^ant pn»paration, of the strength of a fluid extract ( 1 Gm. lo 1 c.ciii.).
Physiolo|fical Action. — Ilytlraritis owes its activity to the hydrastine
wlii<-Ii it eontains, which lias oxytocic properties, and is abort if acient. It
his alsio wmie antipcriodic qualities, though ranking much below cinchona.
In ^niail amounts, it promotes ap])etitc, increases the gastric secretions, acts
u a cholflgogue, and stimulates peristalsis; in Inrger doses it deranges diges-
tii»n and cause's constipation. In pois<mou3 doses, death may be caused by
tU action upon the nervous system, from convulsitms or paralysis, and from
failun* of re^ipinition. Introduced into the circulation, it causes rise in press-
ure after a preliminary fall; if in large dose, the pressure falls, the irrita-
bility of the vagus is destroyed, and the heart's action is arrested in diastole.
F. liiodowski reports a case of a man, G9 years of age, suffering with bron-
thliu and excessive expectoration, with weak heart, in which two doses of
K?0 c.cm. (or mxi) of the fluid extract of hydrastis brought on dyspnoea,
with lividity of the face, and slow, easily-compressible pulse. The lungs
'''^'^ Lgested and oedematous, the heart apex-beat could not be felt. The
u»e of stimulants and counter-irritants caused the attack to pass off.
va$ thought that the drug had induced the attack by increasing the czt-
540
PHARMACEUTICAL THEEAPEUTIO AGENTS OR DRVGS.
The phyBiological action of hydrastinine has been studied by Serdtseff
in many experiments upon cold- and warm- blooded animals. Small doses
retard the heart's movements by fitimulating the inhibitory apparatus, both
peripheral and central. It increaees and strengthens uterine action by an
influence derived from the cerebral nervous system, probably by way of the
vasomotor nerves. Dr. David Cema has determined that hydrastinine de-
stroys the. irritability of muscular tissue and the excitability of motor nerves.
Very large amounts produce loss of functional activity of the sensory nerve-
fibres and also cause anaesthesia when locally applied. Small quantities in-
crease reflex activity by stimulating the spinal cord.
As hydrastinc is eliminated chiefly by the kidneys, it exerts some
diuretic action. Rutherford found that it also has a decided action
on the liver. The derived alkaloid, hydrastinine, being sparingly soluble
in water, the hydrochloride of hydrastinine has been employed, and the re-
sult of the investigation shows it to possess powers like ergot. It is used
in 5- to lO-per-cent. solution, hypodermically. The injections do not cause
pain and do not discolor the tissues, but they so readily control hemorrhage,
and especially uterine hamorrhage, as to constitute this agent a rival of the
preparations of ergot. Wild reports eeveral cases in which the hypodermic
use of hydrastinine gave rise to painful inflammatory patches in the throat.
Hordet asserts, as the result of his experience, that hydrastinine hydro-
cliloride has no influence in arresting lijuinorrhage from the womb during
labor or the puerperal period. The progress of involution is also unaffected
by the salt.
Therapy. — Hydrastinine hydrochloride, 0.*.?0 Gm. to 30 c.cm. (or gr. iii
to fnj) of glycerin, the late Dr. Keyser reported as excellent in some cases of
conjunctivitis granulosa. It is also used in nasnl catarrh, and in uterine ca-
tarrh, or leucorrhnpa, both internally and locally. In gonorrhrpa, after the
acule i^tage is passed, we iiuiy use hydrastine (commercial) in wat^T (I per
cent.) twice daily, or 2 c.cm. (or f3ss) of fluid extract may be added to 240
c.cm. (or Oss) of water, and used as an injection in subacute gonorrhoea,
vaginitis, and leucorrha?a. As a mouth-wash, in syphilitie afTtx-tions, the
tineture may be added to water and freely used. The fluid extract, either in
full strength or diluted with water, is likewise a beneflcial IocmI remedy in
mercurial or aphthous stomatitis and follicular pharyngitis. The same ap-
pHcation may be made with advantage in fissured nipplos and otorrhoea.
Hydrastis and Iiydrastinine hydrochloride possess a sphere of usefulnej^is in
dennatology.' From (1.13 io 0,38 Gm. to 30 c.cm. (or gr. ii-vi to f3j) of
water, or distilled witch-ha/.cl, makes an excellent lotion in ln7)eridrosis. Its
gtimiilant efTert upon the sebaceous glandular system renders it also of avail
in ncne and dry sebnrrhrea. A useful ointment may be prepared by incor-
porating Q.32 to 2 Gm. (or gr. v-xxx) of hydrastinine hydrochloride in 31
Gm. (or 5j) of ointment basis. Hydrastine ointment stimulates ulcers to
repair and at the same time destroys the foetor of unhealthy discharges. For
this reason it may he appropriately used as a dressing upon ulcerated car-
cinoma and in brnmidrosiFi. This ointment is an excellent application to
chancroids and chronic eczema: —
' See pap*r by the author, on "Hvdrastis and Hvdrastinine Hvdrochlorate in DU-
easps of the Skin," in the Medical Bulletin for May,' 1885.
HYDRASTIS.
541
9 Extract! ergottp^
Betflnuphthol aa 2
Hrdra^tininee hydrocUoridi |32 or 1
Btemuthi mbnitmtia 4
Ungurnti sitnplicis q. b. ad 31
Gm. or 3sA.
30 Gm. or gr. v vel xx.
Gm, or 3j.
Gm. or Ij.
)!. Sig.: Useful in hyperidroBiB, bromidroau, acne, and eeborrhcca.
R HTdrafttiDiiue hydroebloridi |32 or 1
Betannpbthol 2
Tinct, qulllajro 16
Timt. UaniHiuelidia (H. P.) q. a. md 120
l^ ei fl. sol.
\A lotion for h^'peridrosU, acne, and seborrhtBa.
30 Gm. or
Gm. or
ccm. or fjaa.
ccm. or fjiv.
Sea
. V vel XX.
B Fluidext. bydrastis,
Fluidext. ergoUe aa 30| ccm. or f3j.
\yi. Sig.: Um aa a local application. In fissure or prolapse of the anus, ulcera-
ol tbe rectum, hEmorrhoida, and ulcerations or erosions of the oa uteri
Unhealthy ulcers, sloughing sores, and chancroids are benefited by the
local application of the fluid extract. In affections of mucous membranes,
Secially of catarrhal character, hydrastis and its preparations are most
cient. In the chronic gastric catarrh of drunkards, in duodenal catarrh
with or without jaundice, or chronic catarrh of the intestine with ulceration,
it is an eicellent remedy. As a vegetable, bitter tonic, it is employed in
anorexia and convalescence from fevers.
According to Fedorow, the fluid extract of hydrastis, in doses of 1,20
cxm. (or mxx) four times daily, is an excellent remedy in the treatment of
obstinate vomiting of pregnancy, Jordan* reports that in an obstinate case
of membranous dynnenorrhoea 1.54 ccm. (or fwxxv) of the fluid extract of
hTdrastJs twice daily, beginning eight days before each menstruation, was
followed hy a cure. Tn malarial attacks, it is less efficient than quinine in
checking the paroxyems, but is useful as a stomachic and general tonic.
Hydrastis lessens the discharge of albumin in chronic Bright's disease, and
ftf mucus in catarrh of the bladder. Schatz pronounces it a useful agent in
controlling haemorrhages from the uterus. The effects of hydrastis in cancer
ire very probably limited to its action as a motor nerve-tonic and its stimu-
Iftting effect upon the digestive organs. The reports as to the favorable
iction of hydra*tinine in uterine hiemorrhage have been confirmed by Gott-
i^halk. Czempin, Kallmorgen, and other observers. An analysis of sixty-
four obstetric cnsos has been publi^lied by Bossi in which he made use of
hvdrastis. lie administered it with success in puerperal hsemorrhage, in
Bcenta prsp\ia during dilatation of the ns uteri, and as a prophylactic
dost po^t-partum hfpmorrhage from any cause. He employed the fluid
Mi in large doges (fi.?0 to 12.40 o.cm., or mc-cc, daily) for several days
tt anv period during prrgnancv without ill effect upon either mother or
child/
Bleeding hiemorrhoids are successfully treated by Mnrini* with fluid
extract of hydrastis. in sweetened water, 0.18 ccm. (or miij) being taken
erejy hour during the day. In an obstinate case that had suffered with
luemorrhagee for fifteen years, and in which hypodermic injections of ergotin
*Crnttalhl<it9 fiir QynHk,, No. 2. 18R0.
* independent MMicaU, April 17. 1A08.
542 PHAfiMACEUTICAL THEKAFEVTrC AGKN'TS OK DHL"OS. ^
liad failed, this treatment caused cessation of flow in a few hours after its
administration began. It was continued for ten consecutive days and there
was no return of haemorrhage. The same author pronounces hydrastis the
best pulmonary haemostatic. M. Marini maintains that it is the preferable
remedy in the hEemorrhages of fibromyomas, and that it is the best means
of combating the haraorrhagee of pregnancy at any stage, provided it is
taken at sufficiently prolonged inteiTals — that is, 1.20 c.cm. (or mxx) every
three hours or four times a day.
In conclusion, M. Marini lays down the following principal indications
of the drug: 1. Hydrastis Canadensis administered at any stage during
pregnancy, in amounts of from (5.20 to 12.40 c.cm. (or mc-cc) a day for sev-
eral consecutive days, has no dangerous action on the mother or on the foetus;
it is the same when it is given during labor. 2. Administered either during
pregnancy or during labor and delivery, as well as afterward, it exercises an
invariable ha?mo8tatic, curative, and prophylactic action on the uterus, with-
out exercising any ecbolic action on the uterine muscle or moderating the
contractions. 3. It is a much safer remed}' in the hands of midwives than
ergot.
il. Miirinj. a^ an o.xytocic, f»iund that it was not so rapid in its a(.*tion
ns f|iiinint% but he always used it M-ilhnnt the b^ast danger in tin* following
formula: —
B FtiiirloKtraoti liy<lniflti« 41 c.cm. or mix.
Sodii BalicylatiB 2 30 Gm. or gr. xxxvJij.
^m Sodii boratis 3 Gm. or gr. xlv.
^B Aquee menthie piperitA 106| c.cm. or fSiilss.
^* Sacchari q. a. — M.
A dessertspoonful of this mixture is to be taken every half-hour until
labor occurs. At the same time, two of the following capsules ore to be taken
€very fifteen minutes: —
B QuininBB sulphatU 1! Gm. or gr. xv.
Caffeinse |75 Gm. or gr. xij.
M. To make six capsules.
With the employment of these prescriptions, labor is hastened, post-
partum hBEmorrhage becomes less abundant, and there is less danger of
vaacular trouble.
Afcnnliiig to Housst*,* hydrastinine hydrtn-hloride, in pill form, is very
effective in uterine haemorrhages, phthisical night-sweats, haemoptysis, epi-
lepsy, and nephritis. Its haemostatic action is particularly shown in all cases
of congestive metrorrhagia, in monorrhagia, in hieraorrhage after parturition
and abortion, in haemorrhage consequent upon displacements of the uterus
or diseases of the adnexa, and in hsemorrha^e during pregnancy and labor.
In myoma and carcinoma it is of no use. It has no unpleasant etTects; it
does not upset the stniiiarh even when given in large doses. Ilydrastiainc is
partirulflrly distinguij^hod from cotamine by its gruatei* nipidity of action,
BO that it may bi* recoinnu-ndod as a ytimulani. in placf of t'tlier and i-am-
phor, in severe acute iniiviiia. rolHrniiK* liydrofl]Ir)ridt' slows the action of
the heart and gives tone to it. r^n that it is of great value nftcr logisos of blood.
* Archives Intemationairn dr Phcrmaeod)fnami€t Iv, 3, 4, and v, 1, 2; Central-
bJati f^r Qyn^kologic, Jan. 21, 1899.
llYOtSCYAMlS.
r.43
I
I
I
On the (itluT hanil, it hiis no vasomotor action, althou^'^h it streng'tlu'nfi and
accflt'ntt*.*s the c<»nt ructions of the gi;avi(l uterus;. Cotamlnc acts luore
elowly, but more permanently, and is preferable in chronic uterine affec-
tions, especially venous stasee. Both drugs increaee the pains of labor, and
pnjbably may awaken them. ll>drastinine contracts the uterine and in-
lefitinal blood-vessels; cotarainc dilates them. The author thinks, there-
fore, that both remedies are useful in haemorrhage due to uterine atony, but
hjdrastinine is to be preferred. Hydrastinine possesses unquestioned htemo-
static virtues, and Dr. Paul Strassmnnn, from an experience of twenty-seven
cases, considers it etlicacious in menorrhagia and metrorrhagia. He gave it
ia pill form in the dose of 0.03 Gm. (or gr. ss) and hypodermically as high
0.005 to 0.13 Gm. (or gr. i-ij). In some cases, however, this dose proves in-
^cient and, in order to produce the same effect, must be repeated twice
or tlirice durinij the day. Sucli liirj,^* doi*fs, however, an* unsafe; as tlie
rule, the hypodermic doso should begin with not more than 0.01 or 0.015
am. (orgf. V.-Vi).
Hydrastis is useful both in the ha?moptysis and night-sweats of phthisis
and is strongly recommended by Krusc. He administered 2 c.cm. (or foss)
of the fluid extract in the evening, and the result was maintained for three
weeks after a short course of this treatment had been discontinued. The
ability of hydrastis to control profuse perspiration, not only ia tuberculosis,
but al*o in other diseases, is confirmed by Olszewski and other writers. Ac-
cording to the investigations of Porak, hydrastinine is of special utility in the
biemorrhages of pul)erty and the menopause and in those due to lesions of
the appendages.
Hydrastinine has been proposed as a remedy in epilepsy, and in several
rises its experimental use has been followed by a diminution in the fre-
qnency and severity of convulsions.
HYDROCOTYLE. — Water-pennywort. Indian Pennywort. Hydro-
cotyle .\?iatica (Umbelliferre, Orthosperniii?), a perennial creeper indigenous
to subtropical Asia, Africa, and America, contains a peculiar oleaginous sub-
lUoce termed Vellarin, which has a bitter taste and a strong odor. In small
doses hydrocotyle is a strong stimulant to the skin. Large doses cause head-
ache, stupor, and vertigo. This remedy has been employed in various chronic
ftkin diseases attended by scaling and itching, in syphilitic and scrofulous
lesions, lupus, psoriasis, eczema, and lepra.
Tbirtv-ont' (i»n. (or ,", j ) of tlir dried I»*nvo(», made into an infusion
(with wMter. <)j). may l>o taken tfiroughout the day. Hydrot-otyle appears
l<i r\iTt a stimulating inflm'ntr u|K)n tlu* gonito-urinarv npparntus.
HYDROQENII DIOXIDITM (.-^ce Aqua Hydro^enii Dioxidi. U. S. P.,
tod Liquor Hydrogenii Peroxidi, B. P., niuirr Barium Dioxide).
HTOSCYAMUS (U. s. P.).— HyoscyamuB (Henbane).
H70SCYAMI FOLIA (B. P.).— Hyoscyamus-leaves.
Dow, 0.3;? to 0.65 Gm. (or gr. v-x).
Preparations
i:xtr«ctiiin Hyoscyami (U.S. P.). —Extract of HyoBcyaisus. Dom, 0.01 to O.OOtft
Cm. lor gr. V.-j).
nuitli-xtrnrtum IlyoAcyumi (U. 8, P.). — Fluid Kxtruct of H.voscynrons. Dour,
O.Ofi |« 0.30 r.rni. (or mi-v).
544
riMHilACKtXIC'AL XliiilUriiUXlU AGKKXa OK DUCG8.
H-^-oscyaminic Hydrobromidum (T. S. P.). — Hyoscyamine Hydrobromide. Dose,
0.0003 to O.OOOG Gm. (or gr. V»a-V.oo)-
lIyoacii)ae llydrobromidum ( U. S,*P., B. P.). — Hyoacine Hydrobromide. Dose,
the same, hypodefmicnily.
Tinctiira Hyosoyami (U. S. P., B. P.). — ^Tincture of Hyosoyamus (10 per cent.,
assayed; B. 1'., 10 per cent.). Dose, 1.20 to 4 c.cm. (or fnxx-fSj.).
Hyoscyamioffi Sulphfts (U. S. P., B. P.). — Hyoscyamine Sulphate. Dose, 0.0003
to 0.0000 Gm. (or gr. V»»-7,ao).
Extractura Hyoscyanii Viride (B. P.). — Green Extract of Hyoscyamus. Dose,
0.13 to 0.6 Gm. (or gr. ii-vnj).
Succus Uyoscyami (B. P.). — Juice of HyoRcyamiis. Dose, 2 to 4 c.cm. (or fSas-j).
Pilula Colocynthidis et Hyoecyami (B. P.). — Pill of Colocynth and Hyoacyamua
(compound pill of colocynth, 50 Gm.; extract of hyoBcyamua, 25 Gm.). Dose. 0.28
to 0.60 Gm. (or gr. iv-viij).
Pharmacology. — The dried leaves and flowering tops (B, P., the fresh
leaves, lowers, and branch) of Hyoscyamus niger (Solanacea?), collected,
from plants of the second year*s growth, yielding, when assayed by the
United States Pharmacopceia process, not loss than 0.(»y por I'ont. of mydri-
atic alkaloids. The rhief constituent is an nlkaloid, Hyoscyamine, which is
either amorphous, or in tufted crystals, yellowish or colorless; dissolves read-
ily in alcohol, ether, cldoroform, and bcnzin. Hyoscyamine is also very solu-
ble in water; with acids it forms permanent, crystnUizable salts. It is iso-
meric with atropine, and is prolmbly identical with daturine and duboisine.
Hyoscine (nlso known as scopolamine) is very much more powerful, even
0.0001 Gm. (or gr, Vboo) pi'oducing decided effects. TTyoscine occurs in the
form of an oily, alkaline liquid, having a narcotic odor, and it is deposited
from an ethereal solution in a crystalline mass. This, dissolved in solution
of hydrobromic acid, yields, by slow evaporation, crystals of hyoscine hydro-
bromide.
The root and the seeds contain more hyoscyamine than the leaves, but
their strength is more varinble.
The relations of these alkaloids to atropine are thus given by A. R. L.
Dohme: From hyoscyamine, Ladenburg obtained, by the action of alkalies,
tropine and tropic acid, which he found identical with the stibstances of
the same name obtained from atropine. On attempting to reunite the prod-
ucts from hyoscyamine, however, by means of dilute acids aa he had done
in case of atropine, he did not obtain hyoscyamine, as expected, but atropine.
This shows that hyoscyamine and atropine are isomeric, and that the latter
is the stabler form of the CiTHjgNOg molecule under ordinary conditions.
If hyoscine, whose formula was believed to be isomeric with that of atropine
and hyoscyamine, is treated with dilute alkalies and split up into base and
acid, different products are obtained than tropine and tropic acid. Laden-
burg called the bnse he thus obtjitnod froni hyosjcine, pseudotropine, which
means "false tropine," and gave it the formula CjiHirNO, which is the same
as the formula of tropine. Hesse has shown that this pseudotropine is not
isomeric with tropine, but has the formula CgHjaNOj, and further that
hyoscine itself is not an isomer of hyoscj'amine and atropine, but possesses
the formula Ci^HaiNO^. It hence contains two hydrogen atoms less and
one oxygen atom more than th<'^T. Hesse finds thnt when pure hyoscine is
sapouified by means of dilute nlkiilios^ it yields the compound C^Hj;,N02,
which he calls oscine, and tropic acid according to the equation: —
C„H„NO, + H,0 = C,H„NO, + C.H„0.. ■
hjoMiD* Meina tropie ftdA
HY0SCYAMU8.
545
*
I
The tropic acid gradually changes under the influence of the dilute
ilktli into atropic acid by losing a molecule of water, thus: —
tro|ile Acid ttrnpio Kcid
While the alkaline hydroxides at higher temperatures or by continued
tctiou will cause this decomposition of the hyoscine, the alkaline carbonates
and ammonia will not, and at ordinary temperatures and during the ordinary
manipulation of an assay, even the alkaline hydroxides will not decompose
the hyoscine or other mydriatic alkaloids. Ladenburg had obtained hyos-
cine in 1880 as an uncrystallizable syrup from belladonna and henbane, but
Bender in 1889 obtained it in crystals from the root of tlie plant Scopola
atropoidesy and ga^e it the name of Scopolamine. It also occurs in sensible
amount in henbane-seed, and in 8ome kinOg of Juboisia-Ieaves, as well as ia
small amount in stramonium-seed, belladonna-root, and perhaps also in
other plants. Scopolamine occurs in the form of large, transparent crystals,
but slightly soluble in water, readily soluble in alcohol, ether, and chloro-
form. Scopolamine unites with acids and the halogen bodies to form salts.
Some differences between the physiological action of hyoscine and scopola-
nine are accounted for by Hesse, who found in commercial scopolamine hy-
drobromate an admixture of a small proportion of atroscine (Cj^HajNO^):
a base isomeric with hyoscine. Atroscine is a strong base which completely
MQtralizee mineral acids, and ammonia or alkalies liberate it from its solu-
tion as salt in form of oil drops. Hesse made the hydrochlorate, hydrobro-
■ate, and bydroiodate of atroscine, all of which are soluble in and crystallize
readily from water in beautiful crystals. As hyoscine and atroscine yield
tbeaxne product on hydrolysis, it occurred to Hesse that it might be possible
to conTert hyoscine into atroscine. He had previously noticed that hyos-
c&ke in alcoholic solution loses its optical activity if alkalies are added
to it, which in the light of his recent observations led him to believe
that a conversion of the one into the other was possible. Schmidt has
alao obtained, from an optically-active scopolamine by the action of moist
■ilrer oxide, a well-crystallized base melting at 55° to 56** C. which he
called i-scopolamine: i.e., indifferent scopolamine. Numerous experi-
nentfi, however, soon convinced Hesse that this loss of optical activity
was due to a converaion of the hyoscine into oscine and tropic acid, and that
in no case was any other alkaloid formed. The i-scopolamine is. unques-
tionahlj identical with atroscine. The power of dilatation of the pupi! of
the eye of atroscine in O.l-per-cent. solution is more rapid than that of atro-
pine and fully as strong, and its paralysis of the optical accommodation is
Abo more pronounced, more rapid, and more lasting. We, hence, have here
an alkaloia which in all respects is superior to the generally-used mydriatic
alkaloids. From the above we learn that the name scopolamine which haa
for flome time now been in use in chemical literature and has even been
adopted by, and introduced into, the German Pharmacopoeia should be there-
fttim era.sC'd, since it ia merely a mixture of hyoscine hydrobromate and atros-
rii 'iromato, and not a chemical compound.* The United States
Pl.^......v...j'a?ia, although it introduced the title scopolaminiB hydrobromi-
doro in the last revision, explains that it is chemically identical with hyos-
rin* livdrobr'^midnm.
■i>rv9piafa' Cireulcr. Oct.. 1896.
SA
646
PHARMACEUTICAL THEIUPEUTIO AGENTS OR DRUGS.
Pliyiiolog'ioal ActioiL — The effects of hyoecyamus are similar to those
of beUadonna and stramonium, but it is more calmative and less irritant.
The delirium occasioned by it is not accompanied by hypera?mia. It is seda-
tive in painful aifections of the genito-urinary organs, and exerts a mild
diuretic effect. Hyoscyaraus occasionally gives rise to a bright scarlatini-
form rash similar to that produced by belladonna. It is carminative and
laxative to the digestive tract. Ilyoscyamine and, to a greater degree, hyos- '
cine are appropriate as hypnotics to iJisordiTCMl conditious of the mind accom-
panied by cerebral hyperemia. They lower the pulee-rate and frequency
of the respirations. The heart is slightly depressed; the respiration finally
is paralyzed.
Professor Kobert, of Dorpat, detennined that hyoscine reduced appre-
ciably the electrical excitability of the brain. The s^Tnptoms of hyoscyamiTa
poisoning are analogous to tlioso produced l>y belladonna, and are treated m
tlie same manner. J. N. Roussel has noted in hvo cases a peculiar effect upon
the gustatory sense after the administration of ordinary doses of hyoscya-
mine (V* mg., or gr. VaBo)- ^^^ patients (hysterical subjects) complained
that the hyoscyamine granules produced such a disagreeable taste, like asa-
fetida, in the mouth that they could not continue them. This efFect was,
on further investigation, not produced either by atropine, or by tincture of
belladonna or hyoscyamus given separately.
Therapy. — In painful nfTections of the bladder, liyoscyamng exerts a
soothing influence, when admiTiistcrod either by the mouth or in j^upposi-
torics. Decided relief is j^iven by hyosoyamufi in incontinence of urine due
to irritability of the bladder and in vesical tenesmus. Dyspnoea and tumul-
tuous action of the heart, dependent upon vahiilar disease, are materially
relieved by the rxliibition of hyoscyamus. In a^lic of various kinds and in
constipation it is beneficial, especially to correct the drastic effects of purga-
tives. Hyoscyannis has been -given witli ailvantage in chronic gastric ca-
tarrh.
In the pains of locomotor ataxia, and in tremor, hyoscyamus is very effi-
cient, as it is also in delirium tremens and the delirium of fever. Irritative
cough, asthma, or whooping-cough is sometimes markedly improved bv it.
The antispasmodic action of hyoscyamus renders it of avail in the manage-
ment of chorea and hysterical convulsions.
In nervous cough the following prescription will often be found of
servicer —
R Tinct. hyoscyami 15| c.cm. or fSss.
Syrup, pruni V'irg 105| ccm. or fjiiias. ,
M. Qig,i DcfiserUpoonful every third or fourth hour.
ITyoBcyamus is capable of ameliorating painful maladies, such as neu-
ralgia (especially vi.sceral neuralgia), herpes zoster, ami dysiiieuorrhcca. In
these affections hyoscyamus may be combined with opium in order to coun-
teract the constipating effects of the latter, or may substitute that remedy
when peculiar susceptibifity to its action exists.
Hyoscyamus excels belladonna and stramonium in hypnotic effect, and
is consequently useful when a remedy of this character is required by chil-
dren, by whom it is remarkably well borne. On tlie contrary, it ia not well
supported bv aged peopk\ In the iiisamiiin nf dnmk:irds, hyoscynmine may
be given, cither as the fluid extract; or hypodermically, as sulphate of hyo»-
HYOSCYAMCS.
547
I
in«, or hydrobromide of hyoscine, in doses of 0.005 0.01 Gm. (pr gr.
V»j-*A). A soothing exteraal application may be made (leaves, 2; flaxseed
mnlf 6; boiling water, 20) and employed for the reduction of swellings and
the relief of the pains of sores.
Professor Vemeuil mentions a case of obstinate neuralgia which was
cared by hyoscyamine, after resection of nerves and amputation had failed
toaiforo relief. Mr. Embleton has found a combination of hyoscyamine and
•tijchnine very useful in seasickness. But it is in asylum practice that the
bcrt re€ults from its use have been obtained. Chronic mania and delusional
inanity derive benefit from it. Ringer records a case where 0.065 Gm. (or
gr. j) of amorphous hyoscyamine was given in acute mania, and it quieted
the patient and produced sleep; but he considers it useless in delirium
tremena. Hyoscyamine separates from ether in an amorphous form, which
ii considerably lees potent than the crystalline alkaloid obtained from solu-
tions in chloroform. Amorphous hyoscyamine may be given from 0.01 to
0.O65 Gm. (or gr. V«-J)- dinger expressly states, however, that the maximum
doae cauaes sleep so deep and paralysis so marked as to be alarming, and that
BDiUer doees should be preferred. As a rule, much smaller doses are effi-
cient in acute mania than in the exacerbations of chronic mania.
A case has been reported by Dr. Hugh Hagan, of Atlanta, in which
alarming symptoms followed the administration of a single dose of 0.0027
Om. (or gr. V24) ^^ Merck*s hyoscyamine. The patient was a man, 57 years
of age, fiutfering from paralysis agitans. An hour after taking the drug he
became dizzy, lost his sight entirely, and subsequently complained of severe
headache, with soreness of the throat and tongue. The face was flushed and
he was much prostrated. The pulse was regular, respiration slightly accele-
rated, and there was considerable mental confusion. Subcutaneous injec-
tion of 0.015 Gm. (or gr. V4) of morphine and a little whisky relieved the
manifestations within a few hours.
The amorphous hyoscyamine of commerce contains an admixture of
kjfoecme, and confusion has arisen, therefore, as regards the proper dose.
Some authorities have asserted that the amorphous hyoscyamine has a much
noxe powerful action than the crystalline form. On account of this uncer-
tainty of composition, danger is avoided by using only the salts such as
hyoscyamine hydrobromide or sulphate, or hyoecine hydrobromide.
Hyoscyamine has also proved of great value in recurrent mania. Mur-
rell has found it of good service in chronic dementia, with agitation and
detlructivene^. It diminishes the number and violence of 'the attacks in
epileptic mania. Hyoscine hydrobromide produces similar results in much
ioallcr doeea (0.0013 Gm., or gr. V„, by the mouth; 0.0006 Gm., or gr. Vioo»
hjp<»dermically). Both of these agents have mydriatic effects, and can be
Med in ophthalmic practice to dilate the pupil; but duboisine is equally
eBeieot and h-ss expensive for this purj^so, and homatropine hydrobromide
■ifcr and more reliable. Hyoscyamine in crystals is an excellent mydriatic,
ahhijush amorphous hyoscyamine has been known to have an irritant effect.
In iml instances, hyoscyamine sulphate provokes painful spasm of
ruu^cle The contraction may be overcome by repeated instilla-
reraedy until paresis is obtained. In cases of great nervous ex-
- : .1 insoiiiiiin, Prof. S. B. Howe!! reported to the author that bvpo-
dfv vtions of from 0.0004 to 0.0008 Gm. (orgr. V,Bo-Vt«) of hyoscine
hydrobromide were usually followed, a few moments after administration,
548 FHARMAGEUTICAL THERAPEUTIO AGENTS OR DRUGS.
by cflm fllumber. Sleep generally continued for several hours, with no ill
effects, as a rule, upon awakening. Slight mental disturbance was occasion-
ally observed as the patient awakened, but even this condition rapidly dis-
appeared. Howell further states that injections of hyoscine hydrobromide
have never failed him, in cases which had been upon the protracted use of
morphine. Hyoscine hydrobromide may be used with advantage in doses of
0.0006 Gm. (or gr. Vxoo) to allay the convulsions of cerebro-spinal meningitis.
Hyoscine has been successfully used also for the purpose of checking q>er-
matorrhoea,
A toxic dose of hyoscine hydrobromide causes a rapid development of
vertigo, followed by sleepiness, loss of consciousness, and stupor. In a num-
ber of cases death has followed the combination of hyoscine with morphine,
when given hypodermically,
Malfilatre and Lemoine, after the use of hyoscine in sixty-two patients,
most of whom suffered from some form of insanity, conclude that it is an
excellent remedy in all conditions of insomnia with agitation. In some in-
dividuals it produces a temporary intoxication. In others the dose must be
constantly increased in order to maintain the hypnotic effects.
Hyofloine or scopolamine hydrochloride in ophthalmological prac-
tice, according to the estimate of Baehlmann, is about five times as
Cwerful as atropine. It is used in */io- to */8-i)er-cent solutions; of the
tter 0.37 or 0.43 c.cm. (or mvi-vij) may be administered daily to an adult
or used every fifteen minutes during an hour and a half. Weaker solutions
are employed in the case of children. (See Scopolamine Hydrochloride.)
H7PHAL — ^Monoohloral-antipTrin. Chloral forms two definite crystal-
line combinations with antipyrin; mono- and hi- chloral-antipyrin. The
first is known as hypnal, which is an oily liquid with an ether odor and chloral
taste.
Physiological Action and Therapy. — Dr. Schmidt, of Nancy, found
that 1 c.cm. (or mxv) is equal to about 0.50 Gm. (or gr. viiss) of cUoial as
an hypnotic; upon respiration it is about equal, while upon arterial pressure
and cardiac contractions it has less effect than chloral alone. In the stomach
it is more poisonous than the amount of chloral contained in it. In the
alimentary tract it is split up into its two constituents.
Dr. Fraenkel prefers it to chloral because it is nearly tasteless, is devoid
of qualities irritating to the mouth or stomach, and considers it an unrivaled
soporific, especially when insomnia is the result of pain. It is sparingly
soluble, and is given suspended in mucilage, in capsules or cachets. Mattison
writes^ that he regards hypnal as particularly adapted to children and to
patients with phthisis, lessening fever, pain, insomnia, and unrest. He
recommends the following formula of hypnal: —
5 Hypnal 1
Alcoholis
Eliziris vel lynipi ad 16
ccm. or mxv,
07 ccm. or mxj.
e.em. or fSaa.
M. Big.: One dose; to be followed by one- third of a tumbler of water.
HTPHONE. — ^Phenyl-methyl-ketone, Benzoyl-methide. Hypnone is a
lorless fiuid, insoluble in water or glycerin, and possesses an aromatic odor.
' Medical Record.
ICHTHYOCOLLA.
549
I
I
Hypnone is very soluble in alcohol, ether, chloroform, benzin, and certain
ctii, — as the oil of 'sweet almonds. It has been hypodermically employed.
It u preferably administered in capsiiles. It has some hypnotic power, and
u eliminated by the lungs and kidneys. In large doses it causes coma and
paialTBia of heart and respiration. Hypnone is thought to be especially
adapted to the insomnia of alcoholiem, and is likewise regarded as an excel-
lent sedative in mental affections and nervous insomnia in doses of 0.30 to
0.60 ccm. (or fnv-x).
HYSSOPTJS. — Hyssop, the herb Hyssopus officinalis (Labiatse), contains
about Vj pCT cent, of a volatile oil, with tannin and a bitter principle. It
is stimulant, carminative, and sudorific, and is given in solid or fluid extract
ilk stomach disorders, recent colds, etc.
HYSTERONICA. — Hysteronica, or Haplopappua, The Hysteronica
Baylahuen (Compositae) is a native of South America. It is a perennial plant
with oval leaves; bears a yellow flower; contains an ethereal oil having the
epedfic odor of the plant, a greenish-black resin (also of the same odor),
ram, and glucose. The resin is excreted by Ihe kidneys, the oil by the
longs. Dr. G. Bailie* reports that the infusion is an excellent remedy in
diarrhoea and it has produced good results in acute and chronic dysentery.
It has also been proved useful in the diarrhoea of phthisis or cancer.
Hysteronica allays inflammation of the bronchial mucous membrane, lessens
I «pectoration, and quiets cough without causing sickness of the stomach.
' It promotes the action of the kidneys and diminishes the offensive odor of
the urine in vesical catarrh. This remedy increases the acidity of the urine,
' nems to be without effect upon the perspiratory glands, and assists the heal-
ing of wounds. It may be need as a vehicle for remedies like the mercurials
is order to prevent the production of diarrhoea. Given in alcoholic tincture,
it do€« not produce constipation.* The tincture is made by macerating 100
Mrts of the drug in 500 parts of 90-per-cent. alcohol for ten days, and its
ooee is from 1 to 2 ccm. (or mx-xxx). A fluid extract in doses of 1.33 ccm.
(or mxx) i& given in milk, or almond emulsion, three times or more daily,
for chronic dvsenterv .
*
ICHTHYOCOLLA.— Isingflass (Fish Glue).
Preparation.
£fnp1astruin lohthyoooUe. — Isingtass-plaster, Court- pi aster,
Pharmacolo^. — "The swimming bladder of Acipenser Huso and of
other species of Acipenser (class, Pisces; order, Sturiones)*'; or, more def-
initely, the inner membrane of the swimming bladder, which is generally
ipread out in drying, forming flat sheets, or leaf-isingltiss. The kind im-
ported from Russia is the most valued. Chemically, it is an exceptionally
pure gelatin, known to chemists as glutin; it is free from odor and taste,
and is soluble almost without residue in boiling water and in boiling diluted
•Icohol. Isinjjlass does not dissolve in cold water, as gelatin does, and, there-
fore, is a valuable constituent of cements. Both are precipitated by tannin.
Therapy. — Isinglass is used for clarifying infusions, and may be boiled
*r«ri» lctt*r» Ttirmpcuiie Gmrtie, Sept, 1890, p. 640.
'Therapeutio Ocscitc, vol. xiii, p. 287.
i
650 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS. ^i
with milk for internal use in bowel disorders. A codliver-oil jelly is made
by means of isinglass, according to the formula given by Dr. Whitla in his
excellent work on Materia Medica; —
H Olei morrhuoB 1501 c.cm. or Qv.
IchthyocolUe 8 Gm. or 3ij.
Pulv. aaoch. alb. 48 5 Gm. or lias,
^L Olei aiuygcLp
^p Olei pinientiiB aa 24 ccm. or miv.
Olei ciniiamomi . . . ; 18 c.cm. or miij.
Aquco 30 c.cm. or fBj.
M. This preparation ia taken readily by children, and can be given in teaapoon-
fol doaes, alone or in milk^ ornngc- juice, etc.
The well-known court-plaster, spread on silk, affords a convenient
method of approximating small wounds and excluding the air; the addition
of an antiseptic, like salicylic acid, is an improvement, forming salicylated
isinglass-plaster.
ICHTHYOLUM.— Ichthyol is the Ichthyoaulphonate of Ammonium or
Sodium. A mineral deposit found in the Tyrol, of a bituminrvus character,
yields, upon distillation, a tarry-looking substance called ichthyol, so named
from the fact that the deposit appears to be the fossil remains of fishes. It
is purified ()y distillation and with sulphuric acid. Ichthyol has a decided
fishy odor, which to sonic is very unpleasant. The odor may be disguised by
the addition of 10 pt?r cent, of the oil of citronella, or by a mixture with
coumarin. It is faintly alkaline, and contains a resin and 10 per cent, of
sulphtir in the form of a sulphur arid. It is soluble in a mixture of alcohol
and other, readily mixes with ointment and fats. It is generally used in a
10- to ';?0-per-cent. ointment. A siTithetically prepared ichtliyol is supplied
xinder the trade name. Thiol
Physioloi^cal Action and Therapy. — Ichthyol applied externally, as
well as when internally ndunnifiteral. acts similarly, in many respects, to
sulphur and tar. The n-^in contained in ichthyol, makes it exceedingly ob-
jectionnble for external application on account of the sticky or gummy
deposit left upon the skin. According to the experience of the author, ich-
thyol is irritating to the integinnent of many, and is poorly absorbed in the
majority of cases. Ichthyol given internally has, in some instances in the
writer's experience, occasioned more or less gastro-intestinal irritation, fol-
lowed by diarrhcpa. Dr, A. Sbicquart, nf Brussels, has reported several cases
of gastro-intestinal ditTicnltics attended by various nervous manifestations in
which he found the internal administration of ichthyol very usefiiL He
gave the drug in the daily dose of 0.00,5 c.cm. (or w/Via)- ^^ ^^ ^^^^ ^^ check
the elimination of albumin in Bright^s disease and to be useful in pyelone-
phritis.
The free application of a 20-per-cent. ointment caused narcotism and
stupor in a child, followed, however, by recover}'. In the case of a woman
whose endometrium had been curetted on the preceding day, Rer^erio saw
a rapid pulse and general depression, which continued for about twelve
hours, follow the injection into the uterine cavity of a solution containing
one-third of ammonium ichthyol to two-thirds of glycerin.
Unna considers ichthyol (he best agent for treating certain chronic skin
diseases, especially eczema and psoriasis. A 20-per-cent. ointment is some-
times useful in acute erysipelas, and also for the pain and swelling of the
ICHTHYOLVM. ^^^^BT 551
joints tcoompaiiying acute rheumatism, Ichthyol has been applied to fur-
imefes, exudative erythema, intertrigo, herpes zoster, gout, and neuralgia. It
if nid to relieve the pain and promote the healing of cracked nipples.
Dr. Ram6n Guiteras, of New York, states that a 50-per-cent. ointment
his given him better resuhs than any other counter-irritant in gonorrhoea!
liieumatism. Ichthyol ointment has been employed in chronic eczema, acne,
urticaria, lupus, and" keloid. Dr. Agncw indorsed its value iii enlargement of
Innphatic glands, and it acts well at times as an application in chilblains and
barns.
Ichthyol has been extensively used in gynfficological practice. It has
been found of service in cervical and corporeal endometritis, perimetritis,
ind parametritis. It promotes the rapid absorption of recent exudates. Dr.
Richard Bloch esteems it particularly valuable in the treatment of painful
inflammatory diseases. Ichthyol exerts a good effect upon acute gonorrht^al
and non-specific vaginitis, in which it manifests also a decided astringent
influence upon the vessels. Jadassohn applied with advantage a 10-per-cent.
ointment of ichthyol in gonorrhoea! catarrh of the cervix. The injection of
a 2- to 5-per-cent. aqueous solution is beneficial in gonorrhoea of the male,
diminishing the discharge, relieving the pain, and preventing the chordee.
A Vj- to l"per-cent. solution may be employed to wash out the bladder in
cues of cystitis. Dr. Scharf! alleviated the pain end reduced the swelling
and inflammation of the prostate by the injection of a 10-per-cent. watery
solution into the rectum.
Unna advises the combined external and intemsl employment of ich-
thyol in leprosy, and several cases have been reported in which this method
of considerable apparent benefit. Dr. Oliiimn Dunicsnil,* of St. Louis,
Tted a case of the tuberculo-ana?sthetie form, in a woman, cured by
SAchm doses given three times a day. The roniedy has been used in small-
pox La order to prevent pitting. Dr. Lorenz has found an ointment con-
taining 1 to 10 per cent, of ichthyol serviceable in acute coryza and all kinds
of inflammation involving the mucous membrane and skin of the nose.
Thiolinio Acid. — This substance is prepared from a sulphurated linseed-
ofl by treating with sulphuric acid, and occurs as a thick, dark-green, viscid
mass* which is insoluble in water and soluble in alcohol. It contains 14.2
per cent, of sulphur, principally in organic combination. Thiolinic acid
conbines with alkaline bases, and its salts are soluble in water. The acid has
tftiint odor, which resembles that of oil of mustard. The salts are without
c»dor It is thought that thiolinic acid will prove to be an efficient substitute
lor ichthyol.
Ichthalbin, a combination of ichthyol with albumin, is tasteless and
odorlefifl and free from most of the objections against ichthyol, and is used
u a fubstitute for the latter as a dusting-powder. Dr. Samuel Wolfe em-
ploy* compressed tablets (of each, 0.32 Gm., or gr. v) in diphtheria and
Ttriotia chronic and subacute alTcctiona of the mucous membrnnes of the
ilim«nt«r>*, respiratory, and genito-urinary tracts; from 10 to 12 of these
taUeti were administered daily, with good effect. In florid and inflammatory
dcnnatoses. it is one of tlie beft internal renutlies, according to Wolfe. It
u a valuable intestinal antiseptic, and is preferable to ichthyol for i
ua.
■ thyo:
*Jomr. Amer, V^. Aa»qc., *hmo 13. 1{M)3, p. 1A»5.
k
J
652
PHARMACEUTICAL THEUAPEUTIC AGENTS Oft DUCOS.
Ichtkari^aii is sulphichthyolate of silver, and it is alleged that it pos-
sesses antiseptic power equal to silver nitrate. It is decomposed when taken
into tlie Btomach, forming iehthyol. Injected into the blood, it acts like
silver nitrate; but is less poisonous. It causes central motor paralysis of
the heart. In 1-per-cent. soluti^Hi in glycerin and water, is useful for gonor-
rhoea and vngliutifi ii]>])liud as a compress.
IGNATIA. — Ignatia, Bean of St. Ig^natius. The seed of Strychnoa
Ignatii (Loganiaceae) contains two alkaloids, both highly poisonous. Strych-
nine and Bmcine (from 0.5 to 1.5 per cent, of each). Strychnine and
its ealts are oiFicial. (See Nux Vomica.)
ILEX. — Holly. The leaves of several American species of Ilex contain
Caffeine, and may be used as substitutes for the Camellia thea. In the
Southern United States the Ilex cassine (Aiiuifoliaccje) Is used in this way
to some extent, but the r»razilian holly, Ilex Puragnayensis, is mnch richer
in caffeine, and is extensively used in South America, in recent infusion,
where it is knoMU as mate, or Paragiiay tea. The mate is the gourde in
whieli the infusion is made by pouring upon the leaves successive quantities
of boiling water. The following analysis will show the analogy and the
slight differences between the ilex and tea and coffee; it was made by Dr.
T. Cranstoun Charles: —
Tea
Roasted coffee
Mate
C« train*.
T»no(o AflJ.
Ash.
P«rc«uta|t«-
r«re«iitigi.
P«nMiiU(m.
3.10
22.70
5.80
1.20
6.80
4.60
0.79
21.(H)
4.10
4
Besides these constituents there are small amounts of volatile aromatic
oils, enipyreumatic products, etc., which m">dify the effects of each upon the
system, and upon different individuals. In the main, however, the effects
of mate are thosie of calTeine.
Physiological Action and Therapy. — Dr. Charles found holly stimulant
to the brain and also to the sympathetic system; the contractions of the
muscular tissue of the heart and of the bladder and intestines were increased,
and the whole muscular system stimulated to increased labor and wakeful-
ness. Ilex augments the flow of urine and amount of urea and phosphoric
acid. At present its therapeutic applications seem limited to the treatment
of headaches accompanied by constipation, especially when tea and coffee do
not agree.
ILUCIUM. -Illicium (Star-anise).
ANISI STELLATiE FEUCTUS (B. P.).
Pharmacology and Physiological Action. — The lllicium verura (^[ag-
noliaceae) is a native of China and Siam; its fruity which is official, contain?
a pleasant aromatic volatile oil reseinblincf that of anise, and also some fixed
oil. Two spices, 1. Floridanum and I. parviflorum, are natives of this coun-
try, being found in Florida and adjacent States. The Japanese variety,
lllicium Tcligiosum, contains a much smaller quantity of the oil, besides a
crystalline substance called sil-imin or s/a'A-imt, which is poisonous; so that
dangerous results have followed the substitution of the latter for the former,
such as violent epileptiform convulsions with cyanosis, ending in death.
lUicium-oil is often substituted for the oil of anise; and, in fact, it is said
to be the chief source. Dr. E. Barrel has isolated a poisonous glucoside from
the kernel oi lUicium parviflorum, which is not in the pericarp. The de-
coction of the seed, if the dose be sufficiently large, produces attacks of gas-
tric irritation and vomiting, followed by paralysis, anaesthesia, convulsions,
and death.
Tlierapy. — The medicinal virtues are similar to those of anise and other
carminatives. The crushed seeds are sometimes popularly applied externally
to allay the pain of earache, colic, rheumatism, etc. It also has some repu-
tation in Germany in the treatment of bronchitis, prepared as a tea, although
this form of administration is not recommended.
I
I
I
INDIGO. — Indigo is a vegetable coloring agent, obtained from several
species of Indigofera (Leguminosap) of India. It is prepared from the
jnices of these plants by macerating the green twigs and leaves and devel-
oping a kind of fermentation process. It is sold in masses of a blue or pur-
plish color, and should contain from 70 to 90 per cent, of Indigo-blue, or
Indi^tln. Indigo is insoluble in water and alcohol. The sulphate of indigo
is a pasty mass and mixes with water, forming liquid blue. Used chiefly as
a coloring agent and in solution for chemical tests.
Dr. J. L. Jones has used indigo with advantage in thirteen cases of
tmenorrhcea. He prescribes G4 Gm. (or ^ij) of indigo mixed with 15.5 Gm.
(oT 5ss) of bismuth subuitrate, and gave Va teaspoonful in water three
times a day. Under its administration the urine becomes bro^vnish green in
color and acquires an offensive odor. The stools are liquid and have an
obnoxious smell.
INGLUVIN.— In^Iuvin, A digestive preparation.
Dose, 0.32 to 1.30 Gm. (or gr. v-xx).
Fhannacology. — Ingluvin is prepared from the gizzard of the domestic
fovl. It is a soft powder, yellowish gray in color, and possesses a faint odor.
It is almost devoid of taste. Ingluvin is insoluble in water and the usual
menstrua; it can be administered stirred into water or milk. Ingluvin can
be conveniently given to children spread upon bread and butter. The powder
has the advantage of being compatible with alkalies. Its virtues depend
upon the presence of a peculiar bitter principle.
Therapy. — Ingluvin is of special benefit in the relief of sick stomach.
Ab it is free from irritant properties, it may be given with advantage when
▼omiting depends upon organic affections of the stomach, as acute and
chronic gastric catarrh and gastric ulcer. Nausea due to disease of other
abdominal or pelvic viscera, — as the liver, kidneys, uterus, and ovaries, — is
Ukewise relieved by the administration of this remedy. Ingluvin allays the
gistric irritability which accompanies tabes mesentcrica and marasmus.
It has been found of service in relieving vomiting produced by the
abttse of alcoholic liquors. It is of advantage in seasickness and in the relief
of the gastric irritability of bottle-fed babes. In the vomiting of pregnancy
it •pproaches the character of a specific. Ingluvin is beneficial in dyspepsia
when produced by functional inactivity. It checks diarrhopa caused by
indigcftion. By reason of its influence upon the stomach and bowels it is
of serrice in cases of cholera infantum and cholera morbus.'
•
' S** impcr by author on 'The Clinical Application of Inglurln"
Bulletim, June, 1803.
in the Medical
554
PHAKilACEUTICAL TllERAPEDTIC AOENTS OU DKLUS.
IITULA. — Inula (Elecampane). m
Dose, 1 to 4 Gm. (or gr. xv-5j) in infusion. ^
Pharmacolo^. — *'The root of Inula helenium (Compositae)" contains
Helenin, Alantic anhydride, and Alant-camphor, all crystalline bodies,
and Alantol, a yellow liquid. Alant-camphor, in taste and smell, suggests
peppermint. It is difficult to isolate these substances in quantity, and the
alantic anhydride probably differs from helenin only in being less oxidized.
Helenin presentB itself in the form of colorless cr>'Btals, free from odor, in-
soluble in water, soluble in boiling alcohol, ether, and oils. Alantol is a
yellowish, oily fluid, having an odor and taste resembling that of pepper-
mint, soluble in alcohol and boiling at 392* F.
The substance which has lately been used to some extent in medicine
under the name of helenin appears to consist of a combination of the cam-
phor, the anhydride, and helenin proper. Elecampane also contains some
bitter extractive, and about 20 per cent, of Inolin, — a peculiar kind of starch
not colored blue by iodine. Inulin occurs in the form of a white crystalline
powder. It is hygroscopical, without odor or taste, slightly soluble in water,
insoluble in alcohol, and, chemically, appears to be the anhydride of Isevulose.
C. Tanret has separated two substances resembling inulin, which he desig-
nates as pseudo-inulin and inulenin.
Physiological Action. — The active principles of elecampane have been
the subject of an investigation by Mr. T. J. Bokenham.' Korab, in 1885,
had found that the drug inhibited the development of tubercle bflcilli, while
Baeza stated that, added to the urine, it prevented putrefaction; that it
diminished all the secretions, but especially those of the trachea and larynx.
In small doses it was said to prevent the sialagogic and diuretic action of
jaborandi. Bokenham has demonstrated that any of the crystalline con-
stituents of elecampane will prevent the growth of the tubercle bacillus, if
present even in the proportion of 1 to 10,000. The result was the same in
the case of all the solid nutrient media usually employed in bacteriological
experiments. Liquid media containing large quantities of bacilli in sus-
pension become, upon addition of helenin, incapable of producing tuberculo-
sis, or even an enlargement of the nearest lymphatic glands, when inoculated
into healthy guinea-pigs. In studying its effects upon other organisms,
Bokenham found that rapidly-growing microphytes were practically unaf-
fected by the presence of even 1 part of the drug in 1000 of the nutrient
mcflium. On the other hand, the streptococci pyogenes, streptococci ery-
sipelatis, and bacillus typhosus refused to ^tow on these prepared media.
In experiments upon guinea-pigs no ill effect was produced by the drug
itself, however great the daily dose administered. In no case was the course
of the disease following inoculation with virulent material arrested, although
it was considerably retarded. The writer cited does not consider himself
justified in stating that any one of the constituents of elecampane-root pos-
sesses greater value than the mixed product, Marpmann states that the ex-
cretion of urine and uric acid is increased by inula, and he, therefore, sug-
gests that it may prove useful in chronic gout.
Therapy. — From its influence upon tubercle bacilli, it is possible that
helenin may prove useful in the treatment of tuberculosis. A few clinical
experiments have been made, but not sufficient to warrant any decisive con-
clusions as to the results.
^BriiUh Medical Journal, Oct 17. 1801.
lODOFORMUM.
555
I
Good effects have been reported from its use in malaria, catarrhal diar-
I, whooping-couph, and chronic bronchitis. On account of its antiseptic
'|l6pcrtie8y powdered helenin has been employed as a surgical dressing with
alleged benefit Helenin is said to exercise a favorable influence also upon
trsbercolous diarrhoea.
Hamonlc has reported very good results from the use of helenin in un-
cnroplicated leucorrhcea. Applied locally, it irritates the vaginal mucous
membrane, but, given by the mouth, it exerts a special influence upon the
glands of the cervix uteri. A few doses cause the disappearance of the glairy
discharge of catarrhal endometrftis. Hamonic has given the drug in the
form of a pill containing about 0.01 Gm. (or gr, V^) of crude helenin, two to
four pills to be taken in the twenty-four hours.
Inulin has been used, in the dose of 0.065 to 0.13 Gm. (or gr. i-ij), in dys-
pcpdA and chronic pulmonary affections. An inulin bread has been pre-
pmd for the use of diabetic patients. This principle has also been admin-
istered in whooping-cough.
Alantol has been given in the dose of 0.01 to 0.02 Qm. (or gr. Va-^/j), re-
petted every hour or two, in chronic bronchitis and pulmonary tuberculosis.
The powdered root of elecampane is used in decoction (15.5 Gm. to 473
can., or oss'^j)? sweetened and flavored, which is taken freely as a dia-
phoretic and expectorant in chronic bronchial and pulmonary affections,
dyspepsia, dysmenorrhcea, etc. It has been used, both internally and ex-
ternally, in eczema and psoriasis.
lODOFORMUM (U. S. P., B. P.).— Iodoform (CHI,).
Doae, 0.13 to 0.32 Qm. (or gr. ii-v).
Preparadons.
Unguentum Iodoform! (U. 8. P,, B. P.).— Ointment of Iodoform (10 per cent).
Sappositoria Iodoform! (B. P.). — Iodoform Suppositories (0.2 Gm., or gr. iij).
Fliarmacology. — Iodoform was discovered by Serullas in 182?, and in-
troduced into medicine in 1837 by Bouchardat, and also by Dr. R. M. Glover,
of London. It is produced by the action of iodine in the presence of alkalies
I alcohol^ aldenycle, ether, acetic ether, acetone, lactic acid, and in minute
dtitiee cartiohydrates or proteid corai>ounds. It occurs in yellow, scaly
which are insoluble in water, but soluble in alcohol, ether, and the
vnlntile oils. By a temperature of above 239° F. it is fused, giving
fViolet vapor?, and finally decomposes into iodine and hydriodic ncid.
oform is obtained from the ash of sea-weed in France. It may be made
'by subjecting a hydronlcoholic solution of potassium iodide to electrolysis,
[while a current of CO, is passing through the liquid. FilhoKs process con-
|»i«t« in adding iodine to a warm mixture of sodium bicarbonate, alcohol and
'water. It ia volatile and should be kept in well-stoppered bottles, in a cool
•od dark place.
" rm has a sweetish taste and a peculiar, penetrating odor, which
adi -istently to the vessels in which preparations of it have been made,
and u* ilie clothinjr and Imnds of those who use it. Many attemps have been
nade, witlj indifferent success, to mask the peculiarly offensive odor of this
•obftam***. The essential oils, balsam of Tolu or of Peru, Tonka bean, men-
ftol^ eoealyptol, thraol, naphtlialin.. tar, and creolin have all been used for
556
PHARMACEUTICAL THEBAPEUTIC AGENTS OR DRUGS.
this purpose, Lindermann's mixture consists of iodofonn, 1 ; balsam of
Peru, 3 ; and vaselin, 8 parts. Instead of vaselin, 12 parts of alcohol,
glycerin, or collodion may be employed. Pulvis iodoformi dilutus (N. F.)
contains iodoform, 2 ; boric acid, 3 ; naphthalin, 5 parts, with oil of berga-
mot q. s. It is a fine powder, and the odor is entirely masked. The iodo-
forraum aromaticatum (N. F.) contains 4 per cent, of coumariu. Other ex-
pedients which have been suggested are the addition of a small quantity of
the oil of citronella or mixture with recently-ground coffee. One of the
best ia that discovered by Shufelt, of dissolving the iodoform in the volatile
oil of camphor. This combination was iised both as an ointment and a
paste. If preferred, the odor of camphor ciin also be removed by the admix-
ture either of oil of bitter almonds or of Canada balsam. According to
Pagenkopf, the addition of a small quantity of Russian turpentine-oil im-
parts a peculiar and not unpleasant odor. Klint»^mann endeavors to accom-
pliah the same purpose by preparing a solution of iodoform in olive-oil. He
adds 1 part, of iodoform to 6 parts of olive-oil, and eliakes for twelve hours.
The clear, saturated oil filtered off contains about 3 per ceut. of iodoform.
The odor of iodoform may be removed from utensils or the hands by
washing with a watery solution of tannic acid, Dr, W. Washburn, of New
York, points out that, as chloroform and ether are solvents of iodoform,
they may be successfully iised in order to remove the odor of that substance
from the hands, nails, and clothing. Bienert states that washing the hands
once or twice with flaxseedmeal in water causes rapid disappearance of the
odor of iodoform. Oil of turpentine is also a good solvent.
The use of iodofonn has been almost abandoned since odorless substi-
tutes have been introduced.
Physiological Action. — Applied to the sound skin, to mucous mem-
branes, or to ulcers, piire iodoform (although containing 29 out of 30 parts
of iodine by weight) ia not irritjiting, but, on the contrary, blunts sensi-
bility and acts as a local anresthetic. Exceptions to this rule, however, occa-
sionally occur. Dr. Edward ifartin has, for instance, reported five cases of
leg-ulcers which were decidedly aggravated by the use of iodoform as a
dusting-powder. In two cases observed by ITabn, a vesicular eniption fol-
lowed the topical use of this drug, and a case of generalized urticaria, due
to the local use of iodoform, has been reported by Dr. C. IT. Powell, of St.
Louis, Mo. Commercial iodoform has been found to be adulterated with
picric acid and other substances, which may explain some of the unexpected
results.
Internally, in doses up to 0.38 to 0.38 Gm. (or gr. v-vj), it produces no
symptoms, except slight increase of appetite; iodine appears in the urine and
saliva within two hours and traces continue for several days. In larger doses,
iodoform produces decided narcotic effects in doge, with inco-ordination and
staggering, convulsions, and death. In man, poisonous effects have followed
its very free use in wounds, the principal symptoms being prostration, head-
ache, faintness, and persistent iodoform taste in the mouth. The tempera-
ture is affected, being increased to 104"* F. or more; the pulse becomes soft,
feeble, and rapid. The face may be flushed, the pupils contracted, and the
respiration stertorous. Delirium and suicidal mania have also been noticed.
Several cases of death have been caused in this way, preceded by great anx-
iety and restlessness and sudden collapse. In a few instances amblyopia has
lODOFORMCM. 557
keen observed in consequence of the absorption of iodoform. Mr. Priestley
Smith has descrihed the case of a patient in whom toxic amblyopia devel-
oped after baring taken 64.5 Gm. (or gr. m) in forty-one days, A fatal case
15 reported' in a woman in good health, who died of iodoform poieoning.
On the left leg there was a small varicose nicer which had been dressed
with iodoform powder. After this treatment tumefaction set in and the
leg became red and painful, and at the end of eight days there was a gen-
eralized eruption, which was manifestly due to the action of the iodoform.
On the legs, the thighs, and the body the exanthem was like that of measles;
on the arms and the buttocks it was characterized by a very diffuse scarlat-
inous redness. On the red ground of the eruption there was a great num-
ber of small, miliary vesicles, which were detached and contained a lemon-
colored liquid. She suffered greatly; her face was red and tumefied, and
there was profuse lacrymation, but no fever. The general condition rapidly
became worse, the face pale and drawn, and albumin was found in the
urine. Dyspnoea and weakness became progressive, and, in twenty days after
the onset of the symptoms, death occurred. Some years before the patient
I
made of the urine to note the quantity of iodine eliminated by it.
email pinch of powdered calomel is placed upon a white saucer, and then a
few drops of the urine to be examined are dropped upon it; a mixture of
Qxine and cajomel is then made with a glass rod. If the urine contains a
notable amount of iodine there is produced a well-marked yellow discolora-
tion, which should indicate that the iodoform is being absorbed in sufficient
quantity to produce danger.
In cases of death from this substance the kidneys, liver, heart, and vol-
nntary muscles have been found in a state of fatty degeneration. There is
DO doubt that in some patients an idiosyncrasy exists with regard to iodo-
form, just as there is with regard to the other iodides. In a case witnessed by
Demme, chorea appeared as one of the manifestations of iodoform poisoning.
A severe general dermatitis, followed by desquamation and accompanied by
A profuse diarrhoea, was observed by Kloman in consequence of the applica-
tion of iodoform to a chronic leg-ulcer. Urticaria has been witnessed as a
result of the external use of iodoform, and its administration internally has
been known to produce a purpuric eruption.
The first step in the treatment 6f toxic symptoms is the prompt removal
of the iodoform from the body in order to prevent further absorption; in
many cases this is all that is necessary. As remedial agents, stimulants are
required, and elimination favored, by sponging the skin frequently with
warm water and alcohol, and the administration of mild diaphoretics. It
ifl especially advised that iodoform should not be used with carbolic acid;
that only small quantities should be dusted over the wound; that close
tQluree and tight bandages be avoided and free drainage maintained. Some
ipecimens of iodoform have been found to he adulterated, and this fact may
have been responsible for the reported bad results as already pointed out.
PotaasJnm bicarbonate, given hourly in the dose of 0.G5 Qm. (or gr. x), is said
to counteract the toxic effects of iodoform.
4
me onset oi me symptoms, oeatn occurrea. &ome years oeiore me patient i
■ had had a similar eruption following upon the employment of an iodoform fl
I dreseiiig. H
I A simple test for iodoform intoxication has been suggested. A test is ^M
' made of the urine to note the quantity of iodine eliminated by it. A ™
4
* Rente MWcale de la Suiit$e Romande. 1896, p. 431.
ri
558
PHARMACEUTICAL TUEEAPEUTIC AGENTS OR DRUGS.
The potasaiuni bromide is also regarded as antidotal, not only as a
neutral potash salt, but also by virtue of its specific bromide action, and the
fact that it excels all other salts as a solvent for iodoform. Iodoform escapes
by the breath under its own form, and, by the urine, as iodide with a little
iodate.
Therapy. — The anaesthetic and antiseptic qualities of this agent make
it a useful application, especially in gunshot and infected wounds, chan-
croids, phsgedsena, and sloughing ulcers. It acts as an antiseptic, not by
destroying bacteria, but by sterilizing the soil in which they might develop,
and, possibly, by neutrahzing or destroying bacterial products. Either in
the form of powder or the official iodoform ointment, it is vaUiable in bed-
sores, lupus vulgaris iu the ulcerative stage, and enlarged or ulcerated
scrofulous glands.
An antiseptic and sedative combination, praised by Cavazani, is as fol-
lows:—
R Pulv. iodoformi 62] Gm. or Jij.
^m Acid, sulkylici,
^fe Bismuth] aubnitratis aa 2313 Gm. or 3vj.
^r Piilv. cauiphora ti] GnL or 3iaa. — M.
Iodoform constitutes a serviceable application also to syphilitic lesions.
The ointment reduces inflammatory action in buboes and may prevent sup-
puration. It is at times attended with very good results in chronic eczema,
and has been recommended in prurigo. In half or quarter strength this
ointment is useful in ophthalmia and granular lids. An <4intment com-
posed of 0.065 to 0.32 Gm. (or gr. i-v) of iodoform rubbed up with 31 Gm. (or
Sj) of excipient is recommended as an effective application in pannus, cor-
neal ulcere, trachoma, and chronic conjunctivitis.
An ointment composed of 10 Gm. (or gr. cl) of iodoform and 14.5 Gm.
(or Er. CCI3V) of carbolic acid to 31 Gm. (or 5j) of excipient is a serviceable
local application in nasal catarrh, due to chronic rhinitis.
Iodoform diminishes the pain of ulcerated carcinoma. In cancer of
the womb, a bolus or anodyne suppository is recommended by Ringer, con-
taining from 0.50 to 1 Gm. (orgr. viii-xv) of iodoform, incorporated in cacao-
butter. This suppository can be deposited in the cavity of the malignant
ulcer. The swelling and pain of orchitis are diminished by the application
of iodoform ointment. A saturated solution of iedoform in chloroform re-
lieves the pain of neuralgia and chronic gout.
It is a useful application, in the form of ointment or soluble bougies,
to the urethra in the treatment of gleet or chronic gonorrhoea. T. Thierry
finds it useful in the acute stage of gonorrhcea. He injects thrice daily a
mixture of 1 part of iodoform and 6 parts of oil of sweet almonds. In pain-
ful affections of the rectum and bladder, fissures, and haemorrhoids, sup-
positories of iodoform containing 0.32 Gm. (or gr. v) afford great relief.
An iodoform rectal suppository is likewise recommended for the relief
of chronic prostatitis, 0.30 Gm. (or gr. v), in coca-butter or gclntinc.
Its solution in ether (1 to 4), kept in red-glass bottles, is a valuable
agent in treating ulcers of the mouth and throat. It has been shown by
P. Carles that a saturated solution of iodoform in ether is very unstable,
liable to sudden decomposition, the liquid assuming a reddish color as a
result of the liberation of iodine. The addition of alcohol and absence of
light retard this change. Combined with tannin and triturated together,
lODOFORMDM.
559
I
I
iodoform is a good astringent for soft hypertrophies in the nose, or in-
sufflated into the pharynx for post-nasal catarrh, and into the nasal cham-
bers for ozaena. Finely powdered iodoform, used by insufllation, is a good
ipplication in laryngeal tuberculosis, relieving hoarseness and pain.
In order to overcome the practical ditlicultiea in the application of
powdered iodoform to tuberculous ulcers of the larynx, Dr. Sieraon pro-
poses that it be administered by inhalation. He employs a solution of iodo-
form in essential oils. An inhalation fldsk being half-filled with ordinary
turpentine-oil, 0.60 to 1 c.cm. (or mx-xv) of an iodoform solution are added
and this quantity is inhaled three or four times a day.* The following emul-
sion is recommended by L. Frey as an injection for cystitis: —
Iodoform 50 parts.
Glycerin 40 parts.
Distilled water 10 parts.
Trsgacainth 25 paru.
A teaspoonful of this mixture is added to a pint of warm water, and,
after being shaken thoroughly, used as an injection. The procedure is re-
peated every three days until four injections have been given, after which
ODce a week will suffice. The late Professor Billroth obtained most gratify-
ing results from the use of an iodoform emulsion in cold abscess and tuber-
colous caries. His mixture contains 10 Gm. (or oiiss) of pulverized iodoform
in 100 c.cm. (or f5iiif5iiss) of glycerin. After most scrupulous antiseptic
precautions the abscess is cut down upon and opened, the carious bone is
scraped thoroughly, and the cavity in each case cleansed. The inner surface
of the abscess-wall is firmly rubbed by a large pledget of iodoform gauze, the
voand is then stitched up, except a large opening through which the emul-
sion is poured into the cavity of the abscess or the bone. Recovery sometimes
takes place by the first intention. Usually a second dressing is soon required;
drainage-lubes are inserted, the deep parts close by first intention, and the
superficial granulating wound heals under an ointment. In other cases more
ttippuration occurs and recovery is less rapid, or, perhaps, the operation must
be repeated. The most forbidding cases of large abscesses, with numerous
finuljK, yielded the best absolute results. He applied the same method to
the treatment of echinococcic cysts, but added the caution that if the cavity
ia tery large there is danger of iodoform poisoning. This procedure is also
of value in the tuberculous joint disease of children and adults. Dr. K.
Garr^, of Tiibingcn, reports favorable results in goitre from the interstitial
injection of iodoform, dissolved in olive-oil and ether.
A 4-per-cent. solution of iodoform in spirit of turpentine has been
found useful, Administered in the form of inhalation, for laryngeal or pul-
monary tuberculosis and bronchorrhoea.
B lodofonn 41 Gm. or 3j.
01. terebinth, rectiflcflt- 30{ com. or f Jj.
JidTnini«ter from 0.18 to 0.30 c.cm. (or miii-v) by inhalation in phthisis and
rhirctAsiB with high t»*mponUnrf.=
Sbufelt's combination of iodoform and volatile oil of camphor has given
good results when inhaled in bronchiectasis and phthisis. Ghibret states
■ Procindat Urdiral Journal, Sept. 1, 1802.
• Dr. PiJwHI, Quoticrtt/ ftnUrtin of ClinU^al Surpcty of New York Postgraduate
H
560
PHARaXACEUTICAI. THERAPEUTIC AGENTS OK DBDO
that iodoform, freely sprinkled in the sick-room, diminishes the number of
paroxysms in whooping-cough and shortens the course of the disease.
Kapper has advantageously employed injections of iodoform in the
treatment of goitre. He makes use of a solution of 1 part of iodoform in
7 parts each of ether and olive-oil.
It may merely be added, in conclusion, that in children intoxication
rarely ocurs as a result of the local xist of iodoform, but that old people are
very susceptible to its action.
For venereal sores :^-
Q Iodoform 4 Gm. or 3j.
01. camphorse 15 com. or f3iv.
Acid, salicylic 15 5 Gm. or 3iv.
Amyli q. s.
M. Sig.: Make a stiff paste for application to ulcerated surface.
It can also be obtained combined with dressings, as iodoform gauze,
cotton, or wool, for use as tampons. WTicn applied to the surface of the
body dissolved in collodion, it reduces temperature. In cancer of the breast^
iodoform in powder, or in ointment, markedly relieves pain and renders the
progress of the disease slower.
Internally, iodoform has been employed as an alterative and as a mean*
of bringing the system under the effects of iodine in phthisis, scrofulous
affections, and liver disorders, but has not always fullillcd anticipations.
Dr. Whitia speaks in very favorable terms of the internal use of iodoform
in phthisis, confirming the reports of Dreschfeld and other writers. It ia
administered in pills, together with extract of gentian or other stomachic
tonic. The same combination has been employed in haemoptysis with the
most satisfactory results by Chauvin and Jorisenne. They have seen it suc-
ceed where crgotin had failed. If considered judicious, tannin may be in-
corporated in each pill. Thus given, it creates no gastric irritation. Dr.
Gavoy reports decided amelioration of tuberculous bronchitis from the hyp-
odermic injection twice daily of a quarter of a syringeful of a solution of 1
part of iodoform in 100 parts of oil of sweet almonds. In some cases of
neuralgia the internal administration of iodoform has given relief.
Some writers regard it of service in catarrhal jaundice and the early
stage of cirrhosis of the liver. In constitutional syphilis iodoform has failed
to approve itself as a superior remedy. In gastric catarrh iodoform renders
service in checking fermentations, but its powerful odor renders it ob-
jectionable to patients. Drs. Lardier and Pernet have obtained good results
in dysentery from the administration of iodoform in daily doses of 0.25 to
0.38 Gm. (or gr. iv-vj), given in capsules with opium. Favorable reports have
been -made by Professors Moleschott and Bozzolo concerning the use of
iodoform in diabetes. The remedy was given in daily doses of 0.50 Gm. (or
gr. viij). Other observers have failed to confirm these results. In 0.065 Gm.
(or gr. j) doses it has been used by Professor Sim and others in cases of taenia
and ascarides.
Odorless Iodoform has recently been brought to the attention of the
profession of the country by Messrs. Johnson & Johnson. It has the full
equivalent of iodine and has the physical characters of iodoform without i
the objectionable odor. It is a cicatrizant and causes the rapid healing ofl
wounds, acting in all respects like iodoform.
lODOlCM.
561
IH-iodoform. — This is another substance which has been brought for-
ward for liie purpose of obtaining the benefits of iodoform without the dis-
•dTantages pertaining to its offensive odor. Di-iodofonn is a definite iodide
of carbon, and is derived from ethylene or olefiant gas. It is a yellow sub-
ftanc«y almost free from odor at ordinary temperatures, melting at 377.6*
IF, decomposing into its constituents under 392°. Di-iodofonn contains
4.62 per cent, of carbon and 95.38 per cent, of iodine. It volatizes when
beated, and can be sublimed. Di-iodoform ig insoluble in water, and slightly
toluble in alcohol, but it readily dissolves in carbon disulphide, chloroform,
and benzin. It undergoes alteration when exposed to the light. It is said
to be well borne by the stomach, and to be comparatively non-toxic. Di-
iodoform has been used with success by M. Maquenne in the treatment of
^ tdcerated chancroids and wounds.
^ compo
■ jMre
Ik'
I
I
lODOLTJM (F. S. P.).— lodol (C^I.NH), Tetra-iodo-pyrol. By the
action of iodine upon the base pyrol a chemical compound is formed contaiB-
ing K8.y7 per rent, of iodine, — therefore a little less than iodoform, — but
harinir the im|>ortiint advantage of freedom from odor. lodol occurs as a
gW* ■'' powder, which (Inrkens upon exposure to light; insoluble, or
bm: h water; fredy rJolnhle in ether, chloroform, or alcohol, and in
f«tty oilsu It is soluble in tlie ^nstric secretions, and, like iodoform, is de-
tompoeed in the -organism. Iod<»l is rapidly absorbed, and iodine soon ap-
j«ini in the saliva and urine. It is said not to produce stomatitis or nasal
h. Professor Pick found thatt when given in qunntities as large as 2 to
(nr gr. xxx-xlv) a day, it produced no further inconvenience than
•Bfrr )ie and diarrhira. whicli, however, soon disappeared. The effoi^ts
of i'- -irnilar to those of iodoform, but it is said never to produce toxic
juljon when usod either as a topicii! application to wounds or when adminis-
tered internally in the ordinary medicinal doses. This statement, however,
mn*t be regarded as too positive. Pr. Marcus saw iodol cause death in ani-
mals from fatty degeneration of various organs, and a case has been reported
by Ijsuenstein in which the external application of iodol caused vertigo,
tinjr. fever, and aliniminuria.
Therapy. — Iodol may be dusted over wounds in the form of an im-
palpable powder, or it may be used in ointment or solution. An ointment
of iodol may be made of any desired strength, from 0.65 Gm. (or gr. x) to 31
Om. (or Sj) upward, and constitutes an excellent antiseptic dressing to
vracreal and common ulcers, furuncles, and carbuncles. A weak ointment
containing this substance is beneficial in variola, in which it mitigates the
active cutaneous inflammation. A stronger preparation may be employed
m tine* tonsurans, and is capable of modifying the course of psoriasis. Iodol
otntment is used with advantage upon the enlarged glands of scrofula, or
a^ou the ulcers consequent to their caseoua degeneration. Schmidt con-
"i'lere iodol superior to iodoform in the treatment of fistulc An ethereal
•ohuion (1 10 S) is used as that of iodoform is: in ulcers of mucous mera-
briDee. Dr. Tarbau, of Davos, obtained good results in ozaena from the
use '' 1 parts of iodol, tannic acid, and borai as a snuff. Cervicitis,
*tii. . and metrorrhagia have been decidedly benefited by the local
'Ppiuatif ri of powdered iodol. The topical application of iodol has been
ffund of service by Professor Pick in vaginitis, whether of simple or gonor-
rfawl oripin.
If
*
■
562 PHABUACEDTICAL. THERAPEUTIC AGENTS OR DRUGS.
Administered by insuflBation or inhalation, this remedy has afforded
relief in tuberculosis of the larynx or lung, and in bronchorrhcBa. The
powder has been found of service in various diseases of the eye, and is of
special value in catarrhal conjunctivitis. It is useful, likewise, in otorrhopa
associated with caries of bone.- lodol is also made into suppositories, soluble
bougies, iodol cotton, iodol gauze, etc. It may be administered internally in
any form — since it has very little taste and yields iodine to the organism
very readily — in the treatment of the tertiary stage of syphilis, in scrofula.
phthisis, etc. In these affections from 0.32 to 1.30 Gm. (or gr. v-xx) have
been given daily, and in the dose of 0.13 to 0.38 Gm. (or gr. ii-vj) thrice
daily Cema has seen good results from the use of iodol in diabetes. Favor-
able results have been published by Pick, Cervesato, Martin, Lublinski,
Seifert, Szadeck, and other observers. Cervesato, in three cases, saw absorp-
tion of pleural exudations promoted by the internal administration of iodol.
Good reports have been made of the use in cerebro-spinal meningitis of a
combination of 0.32 Gm. (or gr. v) of iodol and 0.17 Gm. (or gr. iiae) of
acetanilide every third -hour. Iodol is best given in wafers or capsules.
Caffeinated Iodol. — This is a* crystalline product obtained by mixing:
alcoholic solutions of caffeine and iodol in molecular proportion. It contains
74.6 per cent, of iodol and 25.4 per cent, of caffeine. The compound is of
a light-gray color, destitute of odor or taste, and is proposed as a substitute
for iodol. Caffeinated iodol is a stable body, and is nearly or quite insoluble
in most menstrua. This remedy is too expensive for general use.
lODUM (U. S. P., B. P.).— Iodine.
Dose, 0.03 to 0.065 Gm. (or gr. ss-j).
Preparations.
Ammonii lodidum (U. S. P.).^-AxDmoiiium Iodide. Dose, 0.32 to 2 Gm. <or gr.
V-zxx).
Argent! lodidum (U. S. P.).— Silver Iodide. Dose, 0.066 to 0.13 Gm. {or gr. i-ij^
Ferri lodidum Sacchantum (U.S. P.). — Saccfaarated Ferrous Iodide. Dose, 0.13
to 0.65 Gm. (or gr. ii-x).
Hydrargyri lodidum Flavum (U.S. P.). — Yellow Mercurous Iodide. Dose, 0.00S
to 0.02 Gm. (or gr. Vit-V.).
Liquor lodi (!k)mpo8itu8 (U.S. P.). — Compound Solution of Iodine, LugoVs Solu-
tion (iodine, 5; potassium iodide, 10; distilled water, 85 parts). Dose, 0.30 to 1.S0
ecm. (or mv-xx).
Zinci lodidum (U. S. P.).— Zinc Iodide. Dose, 0.066 to 0.20 Gm. (or gr. i-iij).
Syrupus Acidi Hydriodici (U.S. P.). — Syrup of Hydriodic Acid (I per cent, of
absolute acid). Dose, 2 to 16 com. (or fSas-fSss).
Pilulce Ferri lodidi (U.S. P.). —Pills of Ferrous Iodide. Dose, 1 or 2 pills.
Tinctura Todi (U. S. P.. B. P.). — Tincture of Iodine (iodine, 7 per cent.; witli
potassium iodide, 5; B. P., about half tliis strength). Dose, 0.06 to 0.30 ccm. (or
«ti-v). B. I*., double this dose.
Unguentum lodi (U. S. P.. B. P.).— Iodine Ointment (U. 8. P. conUins iodine, 4;
potassium iodide, 1; water, 2; benzoinated lard, 93 parts).
Liquor Arseni et Hydrargyri lodidi (U.S. P., B.P.). — Solution of Arsenic and
Mercuric Iodide f Donovan's solution. 1 per cent, each of arsenic iodide and mercuric
iodide). Dose, 0.06 to 0.60 ccm. (or mi-x).
Syrupus Ferri lodidi (U.S. P., B. P.). — Syrup of Ferrous Iodide. Dose, 0.60 to
4 ccm. (or mx-fSj).
Potassii lodidum (U.S. P., B. P.). —Potassium Iodide. Dose, 0.32 to 2 Gm. (or
gr. T-xxx).
lOOUM. 563
Unguentum Potaasii lodidl (U. S. P., B. P.). — Ointment of Potassium Iodide
(U. 8. P. contains potassium iodide, 12; sodium hyposulphite, 1; boiling water, 10;
benzoinated lard, 77 parts).
Sodii lodidum (U.S. P., B. P.). —Sodium Iodide. Dose, 0.32 to 2 Gm. (or gr.
v-xxx).
Arseni lodidum (U. S. P., B. P.).— Arsenic Iodide. Dose, 0.003 Gm. (or gr. V»)-
Sulphuris lodidum (U.S. P., B. P.).— Sulphur Iodide. Dose, 0.065 to 0.25 Qm.
(or gr. i-iv). •
Hydrai^yri lodidum Rubrum* (U.S. P., B. P.).— Red Mercuric Iodide. Dose,
0.0016 to 0.006 Gm. (or tpc. VwVi.).
Plumbi lodidum (U.S. P., B. P.).— Lead Iodide. For external use.
Unguentum Sulphuris lodidi (B.P.). — Sulphur-Iodide Ointment (2 Gm., or gr.
XXX, to lard, 46 Gm., or Z^bs).
liouor lodi Fortis (B. P.). — Strong Solution of Iodine (iodine, 60 Gm.; potas-
sium ioaide, 30 Gm.; distilled water, 60 com.; alcohol, 90 per cent., 360 ccm.). Dose,
0.06 to 0.12 ccm. (or mi4j).
Pliarmaoology. — Iodine is a bliaish-gray, non-metallic element, obtained
principally from the ashes of sea-weeds. It was discovered in 1811 by
Courtois, and its properties investigated by Gay Lussac in 1813. Iodine
melts and sublimes at about 226** F., but volatilizes at ordinary tempera-
tures, so that the upper part of the bottle containing it is usually filled with
the characteristic violet vapor of iodine. It is very slightly soluble in water,
requiring 7000 parts of water; on the contrary, alcohol and ether dissolve
it freely, forming dark-brown solutions. The addition of water to the alco-
holic solution precipitates part of the iodine, unless potassium iodide be
added to the solution. The tincture of iodine may be decolorized by the
addition of a small quantity of ammonia-water, followed by a few drops of
carbolic acid, or by combination with sodium hyposulphite, making colorless
tincture of iodine. The ammonia preparation should not be made in quan-
tity or kept on hand, as it may deposit the iodide of nitrogen, which is a
dangerous explosive compound. The combinations of iodine are numerous,
and many of them are official. Ethyl-iodide is not included in the pharma-
copoeia, but has considerable medical interest. It is prepared by the action
of alcohol on iodine in presence of amorphous phosphorus. Phosphorus
iodide is formed and reacts upon the alcohol, yielding ethyl-iodide and an
acid of phosphorus. The former distills into the receiver together with the
alcohol, which escapes the reaction. Water is added and the lower layer of
liquid is separated, dried with calcium chloride, and rectified in a water-
bath. Ethyl-iodide is a colorless liquid, but becomes brown when long kept,
if exposed to light. The syrup of hydriodic acid contains 1 per cent, of
absolute hydriodic acid, which is a gaseous body containing 99 V4 per cent,
of iodine by weight; it is readily decomposed, and is a valuable agent for
the purpose of introducing iodine into the system in the least irritating form,
though therapeutically active. The iodide of starch, amylum iodatum (not
to be confounded with amyl iodidum, iodide of amyi), was formerly official
as a means of administering iodine, but it has been given in quantities as
high as an ounce at a time with little noticeable effect, and is seldom used
at present. This may be explained by the fact that starch is the antidote
to iodine, and is the chemical test for free iodine, by which it is turned from
a white color to blue. Iodine trichloride occurs in yellow pieces, and is de-
composed by water into hydrochloric and iodic acids. It is liquefied by the
addition of iodine. Iodine trichloride is a stable compound if preserved
from contact with organic matter. Iodine tribromide has also been utilized
to a certain extent as a local application. The following are some newer
5C2
PHAHMACEDTICAL. THERAPEUTIC AGENTS OH DRUGS.
Administered bj insufflation or i^ihalation^ this remedy has afforde
relief in tuberculosig of the larynx or lung, and in hronchorrhcea. The
powder has been found of service in various diseases of the eye, and is of
special value in catarrhal conjunctivitis. It is useful, likewise, in otorrhoea
associated with caries of bone. lodol is also made into suppositories, soluble
bougies, iodol cotton, iodol gauze, etc. It may be administered internally in
any form — since it has very little taste and yields iodine to the organism
very readily — in the treatment of the tertiary stage of syphilis, in scrofula,
phthisis, etc. In these affections from 0.32 to 1.30 Gm. (or gr- v-xx) have
been given daily, and in the dose of 0,13 to 0.38 Gm. (or gr. ii-vj) thrice
daily Cema has seen good results from the use of iodol in diabetes. Favor-
able results have been published by Pick, Cervesato, Martin, Lublinski,
Seifert, Szadeck, and other observers, Cervesato, in three cases, saw absorp-
tion of pleural exudations promoted by the internal administration of iodol.
Good reports have been made of the use in cereLio-spiiial meningitis of a
combination of 0.33 Gm. (or gr. v) of iodol and 0.17 Gm. (or gr. iiss) of
acetanilido every third *bi)iir. Irnlol is best given in wnfcrs or capsules.
Caffeinatcd Iodol. — Tliis is a crystalline pmduct obtained by mixing
alcoholic solutions of cafTcino and iodol in molecular pn>portii:in. It contains
74.6 per cent, of iodol and 25.4 per cent, of caffeine. The compound is of
a light-gray color, destitute of odor or taste, and is proposed as a substitute
for iodol. Caffeinatcd iodol is a stable body, and is nearly or quite insoluble
in ma^t menstnm. This remedy is too expensive for general use.
J
Dose, 0.3-2 to 2 Gm. (or gr.
or gr. i-ij).
Dose, 0.13
lODITM (U. S. P., B. p.).— Iodine.
Dose, 0.03 to 0.065 Gm. (or gr. ss-j).
Preparations.
Animonii lodidum (U.S. P.). — Ammonium Iodide
r-xxx).
Argenti To<iidum (U. S. P.).— Silver Iodide. Doae, 0.065 to 0.13 Gm
Ferri lodidum Saccharatum (U.S. P.). — Saccharated Ferrou* Iodide.
to 0.65 Gm. (or gr. ii-x).
Hydrargyri lodidum Flavum (U.S. P.),— Yellow Mercurous Iodide. Dow« 0.006
to 0.02 Gm. (orgr. Vio-V.).
Liquor lodi Compositufl (U.S. P.). — Compound Solution of Iodine, LugoVa Solu-
tion (iodine. 5; potassium iodide, 10; distilled water, 85 parts). Dose. 0.30 to 1.20
e.cm. (or mv-xx).
Zinci lodidum (U. S. P.).— Zinc Iodide. Dose, 0.066 to 0.20 Gm. (or gr. i-iij).
Synipus Acidi Hydriodici (U. S. P.}.— Syrup of Hydriodic Acid (1 per cent, of
absolute acid). Dose, 2 to 15 com. (or fSsB-fSaa).
Pilulte Ferri lodidi (U.S. P.).— Pills of Ferrous Indide. Dose, 1 or 2 pilla.
Tiii^tura lodi (U. S. P.. H. P.). — Tincture of lodinp (iodine. 7 per cent.; with
potaaaium iodido. 5; 6. P., about half this strength). Dose, 0.06 to 0..')0 c.cra. (or
mi-v). n. P., double thi!» do«p.
Unguentum lodi (U. S. P., B. P.|. — Iodine Ointment (U. S. P. contftina iodine, 4;
potassium iodide, 1; water, 2; benzoiualed lard, 93 parts).
Liquor Arsoni et Hydrarjjyri lodidi (U.S. P., B. P.). — Snhition of Ar«enir and
Mercuric Iodide (nonox'nn'a solution. 1 per cent, each of arsenic iodide and mercuric
iodide). Dose, 0.06 to 0.60 rem. (or mUx).
Synipus Ferri lodidi (U.S. P., B. P.).— Syrup of Ferrous Iodide. Dose, 0.(?0 to
4 com. (or mx-fSj).
Potassii lodidum (U.S. P., B. P.). —Potassium Iodide. Dose, 0.32 to 2 Gm. (or
gr. v-xxx).
lunuM.
bm
I
I
I
Ungueatum Potaaui lodidi (U. S. P., B. P.). — Ointoieat of PotusBium Iodide
(U. S. P. conUuDs poUssium iodide, 12; sodium hyposulphite, I; boiling water, 10;
benzoinated lard. 77 parts).
Sodii lodidnxn (U.S. P., B. P.).— Sodium Iodide. Dose, 0.32 to 2 Gm. (or gr.
r-xxs).
Ar»eni lodidum (U.S. P., B. P.).— Arsenk- Iodide. Dose, 0.003 Gm. (or gr. »/>,).
Sulphuris lodidum (U.S. P.. B. P.).— Sulphur Iodide. Dose, 0.005 to 0.25 Gm.
(or gr. i IT).
Hvdrargj'ri lodidum Rubrum' (U. 8. P., B. P.). — Red Mercuric Iodide. Doee,
0.0Ol<( to 0.006 Gm. (or nr. V,«-Vw).
Plumbi lodidum (U. S. P., B. P.). — Lead Iodide. For external use.
Unguentuiu Sulphuris lodidi (B. P.). — Sulphur-Iodide Ointment (2 Gm., or gr.
XXX, to lard, 40 Gm., or $\s3).
Liquor lodi Fortis (B. P.). — Strong Solution of Iodine (iodine. 50 Gm.; potaa-
tkum iodide, 30 Gm. ; distilled water, 50 c.cm.; alcohol, 90 per cent.. 360 ccm.). Dose,
ClfM to 0.12 c.cm. (or mi-ij).
Phannacolo^. — Iodine is a bluish-gray, non-metallic element, obtained
pnocipHllv from the ashes of sea-weeds. It was discovered in 1811 by
Courtois, and its properties investigated by Gay Lussac in 1813. Iodine
melts and sublimes at about 225* F., but volatilizes at ordinary tempera-
tures, *o that the upper part of the bottle containing it is usually filled with
the characteristic violet vapor of iodine. It is very slightly soluble in water,
requiring 7000 parts of water; on the contrary, alcohol and ether dissolve
it freely, forming dark-brown solutions. The addition of water to the alco-
holic solution precipitates part of the iodine, unless potassium iodide be
added to the solution. The tincture of iodine may be decolorized by the
addition of a small quantity of ammonia-water, followed by a few drops of
carbolic acid, or by combination with sodium hyposulphite, making colorlesa
tinctore of iodine. The ammonia preparation should not be made in quan-
tity or kept on hand, as it may deposit the iodide of nitrogen, which is a
dangerous explosive compound. The combinations of iodine are numerous,
and many of them are official. Ethyl-iodide is not included in the phanna-
copoeia, but has considerable medical interest. It is prepared by the action
of alcohol on iodine in presence of amorphous phosphorus. Phosphorus
iodide is formed and reacts upon the alcohol, yielding ethyl-iodide and an
acid of phosphorus. The former distills into the receiver together with the
alcohol, which escapes the reaction. Water is added and the lower layer of
Liquid is separated, dried with calcium chloride, and rectified in a water-
bath. Ethyl-iodide is a colorless liquid, but becomes brown when long kept,
if exposed to light. The syrup of hydriodic acid contains 1 per cent, of
alMolate hydriodic acid, which is a gaseous body containing 99 V4 per cent,
of iodine by weight; it is readily decomposed, and is a valuable agent for
the purpose of introducing iodine into the system in the least irritating form,
though therapeutically active. The iodide of starch, amylura iodatum (not
to be confounded with amyl iodidum, iodide of amyl), was formerly official
as a means of administering iodine, but it has been given in quantities as
high as an ounce at a time with little noticeable effect, and is seldom used
at present. This may be explained by the fact that starch is the antidote
to iodine, and is the chemical test for free iodine, by which it is turned from
t white color to blue. Iodine trichloride occurs in yellow pieces, and is de-
eompo0ed by water into hydrochloric and iodic acids. It is liquefied by the
addition of iodine. Iodine trichloride is a stable compound if preserved
from contact with organic matter. Iodine trihromide has also been utilized
to a certain extent as a local application. The following are some newer
564
PHAilMACEUTICAL TILEBAPEUTIC AGENTS OR DHUOS.
compouncls: Atropine iodate (CiiHjjNOjHtOj,) occurs as colorless needles
soluble in water and in alcohol. Its solutions remain free from germs for
quite a length of time, so that the addition of an antiseptic is unnecessary.
Codeine iodate (Cj^HjiNOa + a^llOa) occurs as white needles slightly solu-
ble in water or alcohol; with age the salt decomposes, assuming a brown
coloration from the liberation of iodine. Lithium iodate (liiIO„ -\- 1-2H,0) is
a white powder freely soluble in water. Mercuric iodate (Hg[10s]2) occurs
as a white, amorphous powder, almost insoluble in plain water, but soluble
in water containing sodium chloride or potassium iodide. Quinine iodate
(Cjollj^N^Oj.lilOy) is a white, crystalline powder, soluble in water. Scopo-
lamine iodale (Ci:lla,N04.11103) occurs as colorless crystals, soluble in water
and in alcohol. Strychnine iodate. (C.^iH^jN^Os-HIOj) comes in long, color-
less needleSj usually conglomerated and soluble in water.
As the iodides are easily decomposed, this fact must be borne in mind
when prescribing them, and, as a rule, it is best to administer them simply
dissolved in water or combined \nth other iodides. When potassium iodide
is present in solution with corrosive sublimate the biniodide is formed, which
is again dissolved in an excess of the potassium iodide. Alkalies, alkaloids,
and metallic salts giMiernlly are incompatible with iodine and its salts.
The Iodine Test for Semen. — The difficulty of identifying spermatozoa
by the microscope in the case of old stains ia admitted. Florence, of Lyons,
has introduced a chemical teet whicK appears to be valuable,* judging by
recent reports. The reagent is one used in testing alkaloids, known as the
tri-iodide of potassium (Kit). ^^^ formula is: iodide of potassium, 1.65 Gm.
(or gr. xxv); iodine, 2.46 Gm. (or ^.r. xxxviij); and distilled water, 30 c.cm.
(or foj). When a drop of the liquid obtained by moistening a seminal stain
is placed side by side with a drop of this solution on a slide large numbers
of peculiar brownish-red, pointed crystals appear. They are rhomboidal,
and closely resemble hsemin crystals. Dr. Wyatt Johnson states* that he
readily obtained the reaction with stains a year old. He also confirms
Florence's statement that other secretions of the body — such as blood, urine,
sweat, saliva, tears, bile, milk, pus, nasal or vaginal mucus — will not p^ive
the reaction. With the semen of animals in some cases he obtained a doubt-
ful reaction. Dr. W. F. Whitney' also obtained the reaction readily. But as
alkaloids give a precipitate with the reagent, its value, like the guaiacura
test for blood, is chiefly negative. Tlie last writer has found the following
method of examining a seminal stain even as old as two and a half years suc-
cessful. A drop of fluid obtained from the moistened stain is evaporated and
fixed by a flame. The film is stained with eosin and methyl-green and
mounted. At the base of the head of the spermatozoa is an hemispherical
portion, which stains a deep green, while the anterior part and tail stain red.
This sen'es at once to identify them, as there is no other oval spore or ceU
which has an eccentric hemispherical nucleus. He furtliermore claims that
the test proves them to be human, as in no other animal is there a deep-
staining. W'hen this test is combined with Florences there ought to be no
difficulty in coming tn n conclusion.
Physiological Action and Toxicology. — Iodine discolors the skin, turn-
ing it brown, and, if sufficiently concentrated, acts as an irritant, and may
^Archives d'AnthropaJogie Criminelle, Jan.. Feb.. nnd March,
'Boston Medical and Surgical Journal, April 8, 1897.
* Boston Medical and Surgical Journal, April 8, 1897.
1896.
I
I
lODUM. 565
cause resicatioa or sloughing. After a coat of iodine there is some hyper-
ftmia, and the sensory nerves are stimulated 60 that the effects of a counter-
irriUnt are obtained; subsequently, the superficial epithelial layer becomes
dry and peels off, leaving a reddened surface. Its vapor is rather irritating
to the aix-pafisages. Iodine is a valuable antiseptic, and, when inhaled into
the bronchial tubes, or separated from the general circulation and deposited
upon the surface of the bronchial mucous membrane, it exercises a beneficial
inflaence upon the tissues and prevents decomposition of the secretions. In
the stomach it is at first irritant, but rapidly forms combinations with organic
or starchy compounds and passes into the blood, where it acts as an alterant,
and especially counteracts the effects of the syphilitic virus and promotes the
absorption and removal of its products from the body. To a less marked
'degree this remedy acts upon the tissues affected by tuberculosis, removing
•flete material and rendering them less favorable for the development o^
bacilli. The alkaline iodides are very soluble (potassium iodide dissolving in
its own weight of water), and diffuse readily into the blood. St^vckman and
Clinrt^ris found that sodium and potassium iodides, when given in the ordi-
nary doses, to man, by the stomach, have no depressing effects on the action
of the heart, or on the arterial tension.' They are excreted eepecially by the
air-passages, and frequently set up a coryza and profuse mucus discharge
from the bronchial mucous membrane.
The most common form of iodide eruption is that of papules, or wheals,
which are darker than the adjoining skin and surrounded by a zone of
inflammation (acneiform); but occasionally, from some peculiar suscepti-
bility to the action of the drug, the degree of hypersemia is so great as to
lead to effusion beneath the epidermis, and vesicles are formed, filled with
dear Ijrmph, which afterward becomes white or milky. Sometimes the erup-
tion is so universal that it resembles chicken-pox, purpura, or small-pox, but
is unaccompanied by fever, or by more than a transient elevation of tem-
perature. An acute eczema, accompanied by constitutional disorder, has
been obser\'ed as a result of the ingestion of this drug. Dr. K. W. Taylor
has described a remarkable case in which, after large doses of potassium
iodide, a number of large tumors appeared upon the face.
Other symptoms — such as headache, unpleasant taste in the mouth,
ptyalism, disordered digestion, malaise, and emaciation — appear after the
Ssteni has become saturated with the drug, and these symptoms indicate
e condition of iodism, which varies in degree from merely a few acneiform
pspulcs upon the forehead to a state of irritant poisoning. (Edema of the
glottis is an occasional effect of the ingestion of potassium iodide. This
manifestation, which takes place in the absence of any pathological condi-
tion of larynx or kidney, has been made the subject of a paper by Dr.
Groenouw. This writer refers the origin of the accident to idiosyncrasy, and *
remarks that it dor« not follow the repeated administration of large doses
of the salt, but manifests itself after a few comparatively small doses have
been taken.* Other unusual manifestations of iodine poisoning are occa-
nonally witnessed. Gautier has reported a case in which the symptoms were
thought to be due to prolonged inhalation of sea-air, and another in which
iodism was caused by inunction with potassium iodide. Each of these cases
wis marked by emaciation and prostration. In the second case fixed delu-
ticDS and melancholic mania were present. Severe neuralgia, especially of
*BrUi0h Medical Journal, June, 1001.
*R€Vua 44 LarynjjotoffU', etc., Sept. 16, 1890; Medical Bulletin, Feb., ISOl.
560
PHARMACEUTICAL THEIUrKUTlC AGENTS OK DRU08.
the trifacial, sometimes follows the administration even of small dosee of
potassium iodide. Pains in the extremities are also occasioned in some in-
stances. Jonathan Hutchinson has frequently noted a sense of numbness,
simulating sen&ory paralysis, but disappearing when the use of the iodide is
discontinued. Atfections of the nerves of special sense may be caused by
this drug; hypersesthesia of the retina, photophobia, fixed contraction and
dilatation of the pupil have been seen as the result of the ingestion of iodine.
Dr. Ernest Finger points out that, as iodine has been experimentally shown
to produce dilatation of the cerebral blood-vessels, with retardation of the
circulation, it should be cautiously given whenever intracranial lesions exist.
lie has known paralysis and retinal hemorrhage to be excited by its use.
The phenomena of iodism are particularly apt to occur in persons who
suffer from renal disease. Death on tlie sixth day, followed the free applica-
fion of iodine to tlie legs of a negro boy. •
In the absence of special idiosyncrasy, large doses are most productive
of iodism in children and old people. Maniacal symptoms have supervened
in consequence of massive doses.
Dr. W. L. Russel has reported a case of death from iodism. The ad-
ministration of a few small doses of potassium iodide combined with syrup
of ferrous iodide was followed by inflammation of the eyes, nose, and throat,
together with a bullous eruption upon the skin. Death occurred on the
tenth day after the first dose had been taken from a low grade of pneumonia
and inanition. A case of fatal cachexia thjreopriva^ from the administra-
tion of iodide of potassium has been reported. The goitre was a large one,
and the attending physician ordered the application of a salve containing
iodine, and the internal administration of iodide of potassium, 4 Gm. (or
3j) pro die. The effect of the medicine was very striking, and in three
weeks the tumor had grown much smaller; but from the beginning of
the treatment, in addition to symptoms of iodism. other symptoms —
such as vomiting, trembling, and tachycardia — were present. The iodine
was given up, but these symptoms of cachexia thyreopriva continued,
and the patient died in about one month after the beginning of the
treatment, with marked circulatory and respiratory disturbances, similar to
those seen in exophthalmic goitre. It appears that goitrous patients are
liable to a form of iodine intoxication, which is called by Geneva physicians
"Constitutional iodism," which may result from comparatively small doses.
Trousseau denied that this was attributable to iodine directly, and claimed
that it was a condition of latent Graves's disease, aggravated by iodine. In-
deed, as pointed out by Jaunin,^ the symptoms resemble closely the condi-
tion known as th}Toidism, sometimes seen after administering preparations
of th}Toid gland. \Vbatevt*r may he the explanation^ it must be admitted
'that some persons sliow n marked intolerance to the iodides, while othere
may take very large quantities, not only with impunity, but with marked
benefit,
Haic has called attention to a practical point, which is that, with the
administration of small doses of carminatives, the iodine reaction appears
more quickly in the saliva than when the potassium iodide is given alone.
He, therefore, recommends the combination of 0.60 com. (or mx) of tincture
* Correspondcfiz-blntt f, 8chv>€izer Arrzte, 1898, No. 3.
* Ret^ue Mtdicale de Ja SitUse Romande, May 20, 1899.
lODUM.
of eapsicuiDy with each dose, which also causes it to agree better with the
lUnAch.
The treatment of iodism is largely symptomatic, using starch if there
is free iodine in the alimentary caual^ deodorized tincture of opium, warm
UthSy and large draughts of water and demulcents. Ehrlich has drawn at-
tention lo the probable value, on theoretical grounds, of sulphanilic acid in
OTeicomiDgy or neutralizing, the effect of iodine. With regard to the dose,
6 ccm. (or foiss) may be given during the day ^^^thout inconvenience. It
should be given in conjunction with sodium bicarbonate to facilitate the
solution of the acid.
Chemical considerations have suggested the theory that the phenomena
«f iodism are due to the Uberation of iodine by nitrites present in the blood,
'Ihii change can only take place in regions whore tne reaction is acid.
According to Rdhmann and Malachowski, from 8 to 12 Gm. (or 3ii-iij) of
flodimn bicarbonate, given in two doses within twenty-four hours, will cause
the symptoms of chronic iodine poisoning to disappear. These writers like-
vise claim that, when potassium iodide and sodium bicarbonate are admin-
irtered in combination, the symptoms of iodism are prevented. The car-
boQite or the aromatic spirit of ammonium has been given with the iodide
for the same purpose, but with doubtful results. A few drops of F'owler's
folution, given in conjunction with the iodide, is, however, more effective,
and will usually prevent the development of iodism. The association of a
Email doae of belladonna or an equal quantity of the potassium bromide with
iodide is also recommended as a preventive of toxic manifestations from
iodine. It should not be forgotten that even a small dose of iodine will,
. in some persons, produce marked physical and mental depression without
be occurrence of coryza, sore throat, or disturbed stomach. An acute fonn
pf intoxication may also arise from the administration of iodine, the symp-
fomb being those of acute gastro-enteritis, the treatment consisting of starch-
rater, evacuation of the stomach, external heat, and h}7iodermic injections
"^ cardiac and respiratory stimulants. In a case of chronic poisoning, with
llarming prostration, AVhitla availed himself of the fact that elimination
"ikes place largely by the salivary glands, and directed his patient to chew
"itory-rrK>t : a powerful sialagogue. A hypodermic injection of pilocar-
} wtmld have a similar effect.
Death has occasionally been caused by iodine, whether taken into the
ftomach or injected into the cavities of the body. The fatal event may be
Jdtlared for a number of days and may then take place suddenly from heart-
liiiluTe. The vomiting excited by iodic intoxication is of a yellowish-brown
tlflf, or blue if starchy matter had been present in the stomach. Dr. W. 0.
[r ■ r has recorded a case in which the application of the tincture of
' ]■ - Temally caused extensive sloughing, symptoms of acute iodism and
ileath on the sixth day. The patient was a child of eleven years. In some
jd the cases where iodine was absorbed from the cavities of the body the
, contained the drug. Iodine, after absorption, enters into all the tis-
and fluids of the body. It is chiefly eliminated by the kidneys, partly
the form of an alkaline iodide and partly in organic combination. Ac-
fo Professor S^e, it accumulates within the system when given con-
. and can l>o detected in the saliva Jifter it has disapjiearod from the
nue. Iodine is probably excreted to some extent by all the mucous mem-
incA.
I
568
PHARMACEUTICAL THEUAPEUTIC AGENTS OR DRUGS.
The iodides remove certain metallic poisons from the system by com-
bining with them to produce soluble salts; m such cases large doses of
iodides might liberate so much of the metal from the tissues as to produce
symptoms of metallic poisoning. This is exemplified by the fact that potas-
sium iodide may occasion galivation in an individual who has been upon a
mercurial course. If a considerable quantity of the metal have been stored
up within the system, its solution and entrance into the circulation may be
foHowed by ptyalism. On the other hand, when there has been less accumu-
lation of the mercury, potassium iodide will rapidly remove it from the sys-
tem. The iodide thus exerts an apparently paradoxical action, in that it
sometimes relieves and at others augments mercurial ptyalism. In recent
cases of mercurialism, however, the iodide will but add to the mischief.
Patients should be warned, on the appearance of such symptoms or on
the occurrence of iodism, to discontinue the remedy at once. Some are
unable to bear more than a few grains, and even so small a quantity as 0.32
Gm. (or gT. v) may produce coryza, salivation, or a general vesicular eruption
upon the skin; others cjan take as many drachms without the slightest in-
convenience, and some dermatologists give from 4G.5 to G2 Gm. (or 5xii-rvj)
of potassium iodide a day for tertiary syphilis without producing iodism.
Part of the good effects of codliver-oil in these disorders is ascribed to a
small proportion of iodine which it contains.
In the normal condition the iodides and iodine have no effect upon tem-
perature or blood-pressure, when adniinistered by the ordinary channels.
Introduced into the veins, they cause slight increase, soon followed by de-
crease, of pressure. According to Germain See, potassium iodide reduces
the size of the heart.
Anaphrodisiac effects are observed after the long-continued use of
potassium iodide, and the belief is generally entertained, though disputed
by some, that such protracted use causes atrophy of the mammary glands
and testicles. A full or somewhat excessive dose of iodine has been known
to cause sexual cxcitementj and Professor Still6 states that it may give rise
to profuse menstruation or occasion abortion during pregnancy.
Owing to its solubility, potassium iodide is rapidly absorbed and rap-
idly eliminated. Within fifteen minutes after its ingestion it is present in
the saliva and urine. It is likewise removed by the akin, and in the milk
of nursing women. Iodine has been found in the urine of a suckling babe,
whose mother was taking potassium iodide. The urine is increased in quan-
tity by potassium iodide, though we lack exact knowledge of the effect of the
drug upon the urinary constituents. It often causes oxalates to appear.
In some instances its administration has been followed by albuminuria.
In a series of experiments upon himself, M. Georges Doux took 3 Gm.
(or gr. xlv) of potassium iodide twice daily for twenty consecutive days.
After the second day the quantity of the salt present in the urine varied but
little, and amounted to about 90 per cent, of the dose ingested. The normal
proportion of urea was decreased by about one-fifth. Seventy-five liours
after discontinuance of the drug no trace of it could be discovered in the
urine. The experiments were twice repeated with the same results. The
amount of iodide eliminated fell to 60 per cent, if a little absinthe had been
taken on the preceding day.*
^British Medical Journal Sept 27. 1890.
lODLM.
569
The effect of small doges of potassium iodide upon nutrition has been
fftudxed bj Yolkoff and Stadnitzki, of St. Petersburg. These writers report
ihMt the assimilation of carbohydrates in the food is but slightly diminished^
the nitrogenous exchange is increased, oxidation is diminished and the de-
•truction of organic albumin is increased, judging by the augmented quan-
tity of Bulphur in the urine. The weight of the body is but slightly de-
creased ana the assimilation of fat is diminished to a very slight extent
^ Dr. Haig believes tliat the iodides diminish the excretion of uric acid and
H the urates.
" Antidotes. — The treatment of a case in which iodine has been taken into
the stomach, should begin with the administratiun of starch in warm water;
or flour and water. Sodium bicarbonate may also be given. The starch-
iodine compound should not be allowed to remain in the stomach, but be re-
moved by stomach tube, or by vomiting. Small doses of pilocarpine may
assist elimination. The subsequent treatment is that of gastritis, mainly.
Therapy. — Iodine in substance may be used as a disinfectant for drains,
but it has no advantage over much less expensive agents which are better
antiseptics. In the form of tincture it is very generally used as a counter-
irritant and resolvent for various swellings, enlarged glands, buboeg, swollen
joints, abscesses, chilblains, and inflammation of the gpras.
The antiseptic action of iodine is utilized in surgery, by Nicholas
! Senn,* of Chicago, in preparing patients for operation. Douches containing
iedine have been used in obstetrics, to overcome septic infection. The para-
•iticide effects are shown when this tincture is painted over a spot of tinea
or ringworm, which may yield to this treatment. In chronic ring-worm,
K Dr. C. W. Cutler, of New York, uses with good results the following raix-
■ tm:—
^^^^ Chloralifl hydratis a& 311 Gm. or Jj.
^^^P Tr. iodi 30) c.cm. or (3].— M.
The local application of tincture of iodine is efficacious in tinea ver-
IBColor when the patches are not too large or numerous.
For toothache from exposed pulp, Garretson recommended the follow-
ing:—
B Creoftoti |37 com. or wvj.
Tinct. iodi.
Liq. plumbi subacctatts , . aa 4| c.cm. or f3j,
K Chloroformi,
I Tinct. opii aa 2| e cm. or f3M.
M. Sig.: Apply on absorbent cotton to the pulp. Brush the same on the lur-
rounding gum.
H The local application of the tincture of iodine has been recommended
H in order to arrest retraction of the guma in aged people.
H TTie dental ointment of potassium iodide, recommended by Flagg, con-
V nta of the following: —
^fc^^ B PotawU iodidi 1130 Gm. or gr. xx.
^^H T ipinris potasaa |12 vel 118 c.cm. or mij vel Hj.
^^^H ^ •rati simpIicU 3l| Gm. or Sj.
^^^ il et ft. ungt.
^B 'CoUtmhu* iiciiical Journal, August, ItfOS.
570
PHABMACEUTICAL THERAPEUTIC AGENTS OE DBUG8.
This is a valuable ointment, which will not discolor the skin, used in
producing ubsorptiou of iiuluralions on or about tiie face and jaws.
A colorless iodine ointment may be prepared according to the following
fonnulu: —
B lodi 1)30 Gm. or gr. xx.
Pota»8. iodidi 25 Gm. or gr. iv.
f>odii svilphitis 2|(50 Gm. or gr. xl.
Aquee q. s.
Rub the infrredients with the water till the solution is colorless. Then add:-
Adipis benzoinat 31| Om. or 5j- — M.
Dr. Dunin has givtn potassium iodide in about 100 cases of biliary colic
with considerable success. It acts most favorably in cases characterized less
by pain than by frequency of attacks and especially in those exhausted by
loss of sleep, anorexia, or prolonged use of narcotics. He prescribes 0.32 to
0.05 Gm. (or gr. v-x) twice daily for four or ^\e weeks and this is followed by
a course of Carlsbad water.
In pneumonia and pleurisy, especially of the chronic form, or fibroid
phthisis, great benefit results from painting the affected side of the chest
with iodine, giving several coats of the tincture with a camelVhair brush,
repeated each day until suflicient action is set up or the skin peels off. Part
of the iodine is absorbed and exercises a local alterative effect.
In chronic bronchitis, also, the tincture of iodine is serviceably applied
to the chest. The ointment, tincture, or liniment of iodine affords relief
in intercostal neuralgia and rheumatism affecting the intercostal muscles.
The conjoined internal and external use of iodine is of great value in bron-
chocele. In simple glandular hypertrophy, the compound solution of iodine
or potassium iodide, preferably the latter, is administered by the mouth;
while the tincture, liniment, or ointment is locally applied, care being taken
to avoid vesication. The ointment of potassium iodide is sometimes em-
ployed for the same purpose or the B. P. ofliciul ointment of the red mer-
curic iodide. The remarkably successful method practiced by the East-
Indian army-surgeons consisted in the application of the ointnieut ot the
red iodide, after which the patient was made to sit for some hovirs with his
neck exposed to the rays of the sun or to a hot fire. Assuming that the
action of the remedy was increased by the influence of heat, Dr. Dawson
Turner, of Edinburgh, suggests that the fact may be explained by the phys-
ical properties of iodine. A solution of iodine in carbon disulphide cuts off
the visible rays of the sun, but transmits the invisible heat-rays. From this
circumstance the deduction is drawn that diseased parts to which iodine has
been applied should not be covered, but subjected to the action of the heat.
Another excellent method consists in the injection of tincture of iodine
iuto the substance of the goitre. It is best to begin with no more than 0.30
c.cm. (or wiv). the operation being repeated weekly or semiweekly and the
quantity gradually increased to 0.60, 1, or 1.20 c.cm. (or mx, xv, or xx). In
cystic or calcareous degeneration of the thyroid this plan of treatment is of
no avail. Other hypertrophies are amenable to the same method, as, for
instance, enlarged lymphatic glands prior to caseation and enlarged spleen.
The cavities of abscesses and nionocystic tumors are, after evacuation, advan-
tageously flushed with water impregnated with a small quantity of tincture
of iodine. Empyema has been treated in the same way after aspiration.
lODUM.
571
Since proposed, in 1848, by Dr. Brainard, the injection of iodine'has
I practiced with varjing and doubtful success in spina bifida. Cures
Wre be€n reported, while, on the other hand, many failures, whether re-
ported or not, have occurred. If this operation be undertaken the quantity
injected ahould be small and the solution weak. No more serum should be
Tithdrmwn than the quantity of fluid about to be injected. Pepper and
others have injected the tincture of iodine into pulmonary cavities with a
view to disinfection, and, possibly, obliteration by healthy reparative inflam-
mation. Though the plan seems rational, it is not always feasible, is at-
tended by some pain and reaction, and certainly has never been generally
approved or adopted. The injection of iodine, as in the Shurley-Gibbes plan
I of treating tuberculosis, usually gives rise to considerable pain. In order to
I overcome this disadvantage Dr. A. 0. Squier incorporates with the original
mixture a small quantity of creosote or guaiacol and some iodoform. His
j fonnnia is: —
I
B Eomlyptol 2 ]
GoaUcol. par. 1
Iodoform
lodi
OL mmjgdaL dulc q. a. ad 30
M. Sig.: Prom 0.60 to 2 c.cm. (or mx-xxx) to be injected daily or alternating
whk gold-and- sodium solution as desired.
12 c.cm. or mxxxij.
c.cra. or mxvj.
60 Gro. or gr. viij.
26 Gra. or gr, iv.
m. or fjj.
A Bolution of iodine has been employed by Professor Durante, of Rome,
injected subcutaneouely or into the substance of a muscle in cases of pul-
monary and articular tuberculous disease. Dr. Mennella has made use of
ihe flame method in non-tuberculous affections of joints. Periarticular in-
jections of iodine caused rapid disappearance of the fluid in two cases of
hydrarthrosis of the knee of traumatic origin. A similar procedure was
efficacions in glandular enlargements, syphilis, grave malarial cachexia, and
otlier maladies.
The parenchymatous injection of a few minims of tincture of iodine
duca resolution of enlarged tonsils. In performing this operation the close
proximity of the carotid artery should be borne in mind. The ointment, ap-
plied directly to the tonsils by means of a caraers-hair brush, is said by
Cerchiari to accomplish the same result. The application of the tincture
diluted with seven or eight times its bulk of water will also generally pro-
duce the same effect.
The following prescription can sometimes be used with good effect in
I enlarged tonsils or in chronic pharyngitis: —
B Tinct iodi 4{ ccm, or f3j.
B Tinct iodi 4;
GIycerini»
FluiilejtirActi ergotm aa 30| c.cm. or fjj.
,M. Sig.: Apply once or twice a day with a camel's-hair brush.
Garretson employed in sore throat» especially that which occurs in
dfrgrmen and public speakers, the following combination of iodine: —
R Liq. iodi compositi 5
rh*»noli» liqiipfnct
61yc«Hni flO
Aqiue 420
To be used aa a gargle from eight to a doien time* a day.
c.cm. or fSimxx.
76 c.cm. or mxij.
ccm. or fSij.
c.cm. or fSxir.
572 PHAKilACEUXICAL THERAPiiUaiC AGENTS OK DKCGS.
The tincture of iodine is often painted upon or around patches of ery-
eipelas, and, although the application sometimes does good, it not infre-
quently aggravates the condition. It is judicious to dilute the preparation
with an equal quantity of glycerin or alcohol, or combine the iodine as fol-
lows:—
B Tinct. iodi 2
Phenolitu liqnefact 2
Glycerini 120
c.cm. or f3ss,
Gm. or 3ss.
c.cm. or fjiv.
M. Sig.: Apply with ft cflmel's-bair bniali several times a day for erysipelat.
In ringworm iodine may be used in the form of colorless tincture, or
in combination with the colorless oil of tar (1 in 4): —
B Potaaaii iodidi 8
01, mcnth. pip 1
Adipia lanae nj'd 31
Gm. or 3ij.
20 c.cm. or fnxx.
Gm. or Sj.
M. Sig.: Embrocation for painful jotnta, neuralgia, chronic rheumatism, etc.
Ringworm may also be efficaciously treated by means of iodized col-
lodion, 0.50 to 0.75 6m. {or gr. viii-sdj) of metallic iodine being dissolved in
alcohol and ether and added to 30 c.cm. (or f.5J) of collodion. The mixture is
painted upon the affected part for several successive days until a thick layer
IS formed. This layer is left undisturbed for a fortnight.
The tincture of iodine is one of the articles employed to prevent pitting
in small-pox. The solution should be painted over the surface of each pus-
tule. An ointment containing iodine is occasionally followed by good re-
sults in keloid and sclorodorma. Alone or combined with an equal quantity
of glycerin or carbolic acid, the tincture of iodine is sometimes beneficial
when painted upon lupous areas. Lentigo and chloasma may be cured by
the local application of tincture of iodine, and the same preparation added
to salt water forms a beneficial wash in chronic ozaena. In orchitis, after
active inflammation has subsided, the cautious local application of the tinct-
ure promotes absorption of the exudation material. The same treatment is
of service after subsidence of inflammation of the mammary gland or ovary.
Boils and carbuncles may be cheeked by paintin^j iodine freely upon
a neighboring vascular area. Iodine may be used as a stimulant to old ulcers,
especially in gymccology, as iodized phenol, although iodoform, on account
of its ana?8thetic effects, has largely taken the place of iodine. A saturated
solution of tannic acid in tincture of iodine is also a useful topical applica-
tion in chronic inflammation of the uterine canal. Dr. Routh states that
the vomiting of pregnancy is arrested by brushing the cervix and lower part
of the cervical canal with a mixture of equal parts of iodine, potassium iodide,
alcohol, and water. Professor Tarnier made uso of a mixture of tincture
of iodine (30 c.cm., or f^j) and potassium iodide (6 Gm., or 3iss) in distilled
water, 1 quart, as an intra-uterinc douche after labor. Dr. Chibret has pro-
posed the application of tincture of iodine in certain forms of corneal ulcera-
tion, touching the affected surface once or twice daily with a small roll of
cotton-wool moistened with the liquid. M. Sedan, who has made a trial of
the local use of the tincture in the case of rebellious ulcers of the cornea,
declares that the treatment is painful and unmanageable, and has a tendency
to produce ciliary blepharitis.
Russian physicians have employed iodine with marked advantage in
»
I
hsemorrboids. Ivanofl describes a severe case, rebellious to ordinary meth-
odSy in which the daily application of the tincture for three days caused
tlzDost complete disappearance of the large tumors. Preissman extols, in
the tame ctsndition, the application of a compress moistened in a glycerin
solution of iodine and potassium iodide. The iodide of starch is valued by
Mr Marshall as a dressing to syphilitic ulcers. ITydrocele is cured by evacua-
tion of the contents of the sac and injecting 1 to 1.20 com. (or m-xv-xi) of
tincture of iodine into the cavity. Severe inflammation results and the sac
becomes obliterated. Iodized wool is useful for making extemporized pessa-
ries. I. Rosenberg has found a 20-per-ceDt. solution of potassium iodide,
painted upon the tongue, eflBcacious in the treatment of leucoplakia.
Internally, tincture of iodine and camphor may be inhaled for acute
coryza and hay asthma.* Inhalation of the vapor of iodine is very beneficial
in chronic bronchitis with bronchiectasis, or profuse and fetid muco-puru-
lent expectoration.
The inhalation of iodine and turpentine is recommended in laryngeal
and pulmonary tuberculosis by Dr. Jolly and others, who claim that it is
tn excellent adjuvant to the other methods by which it is sought to relieve
the disease. This formula may be quoted: —
B Pulr. iodi 10 parts.
Alcohol 20 parts.
in a flaalc and add: —
)1. terebinthin. rectificat. 20 parts.
SpL lavacduke 10 parta. — M.
When the mixture is shaken the free iodine is lost and exists in the form
of a terebinthinate compound. It has no irritant effect upon the mucous
membranes.
Bartholow spoke favorably of the internal use of ammonium iodide in
acute catarrh, 0.065 Gm. (or gr. j) being given every second hour. Hay
asthma is ameliorated by larger doses of the same remedy, which is useful,
moreover, in capillary bronchitis and bronchorrhoea. An acute coryza may
not infrequently be aborted by 0.65 Gm. (or gr. x) of potassium iodide taken
at bed-time. Ammonium iodide is also recommended for the same purpose.
Potassium iodide in the same dose repeated several times a day is said to
relieve paroxysmal sneezing.
In phthisis, good results have been reported from inhalation, by means
of an atomizer, of fine spray containing 1 part each of potassium iodide and
corrosive chloride of mercury in 1000 parts of water, the solution being made
stronger or weaker, according to the effects upon the patient. From its
stimulating effects upon the kidneys potassium iodide is occasionally used
to heighten the effect of other diuretics. The oedema of Bright's disease is,
in some instances, markedly decreased by this remedy, though it has little
Sower to check the escape of albumin. Potassium iodide, from its special
etrrminntion to the mucous membrane of the air-passages, is frequently
combined with expectorants and cough-mixtures in order to render the
tecretions more fluid. Its stimulating action upon the absorbents renders
iodine useful, both internally and by topical application, in cases of inflam-
matory exudation or chronic enlargements. Where these are of syphilitic
*n^rapf%iUe Oazrttf, Oct. 15, 1890, p. 678.
574
PHAUMACEUTICAL THERAPEUTIC AGENTS OK DBUGS.
character the iodides are pre-eminently serviceable. For many brain dis-
eases, more especially those occurring during tertiary syphilis, where gum-
mata form or meningitis with exudation occurs, causing great pain, potas-
sium iodide in combination with bromide, is more efficient than any other
agent known; here the iodide must be given in 2 to 4 Gm. (or oss-j) doses,
and pushed in order to get its full effect. If given well diluted with water,
when the stomach is empty, no serious danger exists of producing iodism.
In aortic aneurism, potassium iodide, in doses of 1.30 to 2 Gm. (or gr. 3x-xix)
four times a day, with low diet and rest in bed, favors deposit of fibrin and
obliteration of the tumor; the treatment must extend over many months
or for a year or more. Many of these cases may be occasioned by syphilitic
disease of the aorta, and under these circumstances the iodide is doubly
serviceable. In the primary and secondary forms of syphilis iodine com-
pounds are of little use, but in the later changes of the skin, raucous mem-
branesj and deeper structures they act promptly, and we may prescribe them
with confidence.
In some of the late varieties of syphilis^ the author can recommend the
following formulas containing the iodides: —
B Potasflii iodidi 19 4
Tinct cimicifugffl 7 5
Syr. fiarsaparillas comp 150
M. Sig.: Two teupoonfuls in water three or four time« a
B Sodii iodidi 101
Vini cocffi 300|
M. Sig.: A tablespoonful three or four times a day.
3 Ammonii iodidi 19
Tinct. nucia vomtcae 4
Fluidext. rhamnus pursh , 30
Glycerini 120
M. Sig.: Two teaspoonfuls in water three or four times
Gm. oir 3r.
c.cm. or f3ij.
c.cm. or fjv.
day.
or 3iiss.
or fjx-
Gm.
c.cni.
Gm.
c.cm.
ccm.
c.cm.
i day.
or 3v.
or f3j.
or fSj.
or fjiv.
According to the investigations of Leone Levi, potassium iodide, ad-
ministered to syphilitic subjects, improves the quality of the blood, increases
weight and strength, but decreases the quantity of urea ex<?reted. Pellizzari
concludes that this salt has a chemical action upon the products of tertiar}'
syphilis and neutralizes the toxic material as it is formed.
An efficient combination for use in tertiary syphilis is: —
M
Hydrarg. iodid. rubri
Potaasii iodid 31
Tr. iodi 4
Syr. ferri iodid 30
Aquee 90
Sig. : A teaepoonful in water after eaoh meal.
20 Gm. or gr. iij.
Gm. or 5j.
c.cm. or f3j.
ccm. or fSj.
c.cm. or fSiij.
A combination of iodides is sometimes more efficient in late syphilis.
In the treatment of gonorrhoea! rheumatism, Schiiller, of Berlin, gives
potassium iodide (0.32 to 0,45 Gm., or gr. v-vij) every two hours for two or
three days. lie considers it especially beneficial in the acute form. For local
treatment he uses, in acute cases, compresses wet with carbolic-acid solution
(1 to 100). and in chronic cases mercurial ointment. Aspiration of the joint
* For the general medicinal treatment of late Byphllia see author'a
Treatise on Diseases of the Skin." D. Appleton & Co., New York, 1001.
Practical
lODUM.
575
is done where there is abundant effusion, and this procedure aids the action
of the remedy. In chronic gout and in gouty affections, potassium iodide
•fforda great relief, as it will also in chronic rheumatism. Considerable im-
provement sometimes follows the use of potassium or ferrous iodide in rheu-
matoid arthritis. Acute rheumatism is often relieved by large doses of
potassium iodide, or tlie latter in combination with sodium salicylate or
•aliciD: —
B Fotaasii iodidi.
Sodii salicylatis aa 14
Spiriius letheris nitrosi (K*
Syrupi aurantii WO
Om. or SiitBs.
com. or fSij.
com. or fjiij.
M. Sig.: Two te&spoonfulfl in water every two or three hours.
B Potaspii iodidi,
Salicin aa
H. et ft, capsuUe no. xx.
Sig.* Two or three capsules every two or three hours.
0150 Gm. or gr. c.
rin acute rheumatism or gout, when attended with constipation^ the fol
lowing prescription, containing potassium iodide, is serviceable: —
H PoUAsii iodidi.
Potaasii acetatis aa 14| Gm. or 3iiiss.
Fluidcxt. rhammis piirsh
Glycerini aa 301 o.cm. or fjj.
Aqiue cinnamomi 901 c.cm. or fjiij.
M. Sig.: Two t«aspoonfuls in water every two or three hours.
Potassium iodide is the most efficacious remedy in the treatment of
actinomycosis. In a case reported by Buzzi and Valeirio the fistulae began to
close, the swelling and pain to disappear in a few days, and recovery was com-
plete in three monthfi. In the treatment of psoriasis' large doses of one oi
the iodides, and preferably potassium iodide, is at times attended with com-
plete removal of the eruption. Psoriasis is, however, more frequently con-
trolled or cured by potassium iodide when the disease depends upon rheu-
matism or gout. In periostitis, resultint; from exposure to cold or wet* the
iodides are rapidly curative, and the tincture may also be applied locally.
In chronic mercury or lead poisoning the metal may be removed from the
sTStem by iodides, but the dose should be small and the treatment continued
for some time. Chronic bronchitis with thick, tenacious sputa, and asthma
«re very much helped by the administration of the iodides. Catarrhal pneu-
monia, acute or chronic, is benefited by doses large enough to liquefy the
sputa: —
H Potassii iodidi 141 Gm. or Siiisa.
Tinct. lobt'lifle 15| c.cm. or f3iv.
Spiritus fletheris cotnp 60] c.cm. or fSij.
Syntp. aurantii 75| e cm. or fjiiss.
M. Sig.: From one to two teaspoonfuls in water every two or three hours until
flHtvtd. Serviceable in chronic bronchitis and in asthma.
In the broncbo-pnounionia of measles. Dr. Bicento relics upon potjis-
sium iodide, which seldom fails to produce amendment within a few days,
provided tuberculosis be not present. Dr. Valten asserts that the adminia-
* Se** p«per by the author on "The Cause and Treatment of PsoHasU.*' Tranaac-
tkma of the PenngVlvania State Medical Society," 1888.
1
576
PHARMAOEDTICAL THERAPEUTIC A0ENT8 OR DRUGS.
tration of a large dose of potassium iodide — not less than 6 Gm. (or gr. ic),
given singly or in divided portions within twelve or, at most, twenty-four
hours after the initial chill — will bring about a rapid lysis or crisis of the
fever in croupous pneumonia. This method does not abridge the courae
of the disease, but, it is claimed, obviates the danger of cardiac collapse.
After the first twenty-four hours no benefit is derived from the use of the
remedy. The writer furthermore states that excellent results are obtained
in epidemic cerebro-spinal meningitis from the administration of potassium
iodide in doses of 3 to 6 Gm. (or gr. xlv-xc), given once or several times during
the day. Moody gives an account of several cases of the fulminant type and
also of a local epidemic in which the iodine treatment recommended by
Tanner was strikingly successfuL His conclusions were as follow: In the
fulminant or apoplectic form of cerebro-spinal meningitis no known treat-
ment offers any hope of cure. In the ordinary form, commonly known as
"spotted fever," potassium iodide is the only drug which has shown any
power to modify the disease. That drug should not be depended on alone,
but any means known to therapeutics should be employed whenever it ren-
ders the patient more comfortable or aids him to resist the exhausting con-
ditions of the disease. Finally, the writer does not consider the known in-
fluence of the iodide on absorption a sufficient explanation of its usefulness
in the disease, but thinks it more likely that it either has some quality that
acts as an antidote to the toxins secreted by the pathogenic organisms or ia
unfavorable to their development
In cardiac dropsy sodium iodide alone or combined with digitalis and
bnchu is often most beneficial in its effect. It can be prescribed thus: —
M.
Sodii iodidi 15|5 Gm. or 3iv.
Inftie. digitalis,
Infus. buchu ea 00| v-cm. or fjiij.
Sig.: Two tenspoonfula every three or four hours.
In Bright'e disease Semmola prescribes: —
B PotflM. iodid 1 Gm. or gr. xv.
Sodii phosphatia 2 Gm. or gr. xjlx.
Sodii chloridi 0 Gm. or Sisft.
Aque COO c.cm. or 3xxf3iij.
M. et U. 8ol.
Sig.: The entire quantity in divided dose* to be taken during the day.
Potnssium iodide is likewise of value in pulmonary emphysema and in
asthma, especially in that form associated with chronic bronchitis and em-
physema. In asthma dependent upon gastric conditions it is of little or no
avail.
In chronic bronchitis and pleurisy the following combinations are use-
ful:—
R Potaflfiii iodidi .
Syr. ferri iodidi,
Glycerini
M. Sig.: A tcaspoonful in water four times a day
B Potaaaii iodidi 1 55 Gm.
Potasaa brnmidi 4
Ammonii chloridi 8
Syr. eriodictyi aromat. (N, F, )
Aqufle aa 45!
M. Sig.
pec tors tion.
A deasertspoonful every two or four hours, for cough with scanty
lODUM,
577
Potassium iodide may be combined with potassium bromide for the
^treatment of epilepsy, as employed by Brown-Sequard.
Dr. Lauder Brunton states that potassium iodide is the most efficient
remedy in preventing the recurrence of attacks of angina pectoris. For this
purpose he prescribea it in doses of 0.33 to 2 Gm. (or gr. v-xix) three times
I day. Dr. Schweighofer has reported* a case of cretinigm, associated with
mrxoedema and goitre, in which decided amendment followed the use of
I like quantity of the same remedy, continued for nine months. The myx-
cedema and goitre were favorably influenced and the patient gained in in-
telligence.
Dr. Schleich, from his observation of ninety-two cases of deep wounds,
lielieTes that the administration of potassium iodide, in doses of 0.32 Qm.
(or gr. v) three times a day, promotes repair.
The tincture of iodine has been administered internally in 0.30- to 0.50-
; c.cm. (or mv-viij) doses in the treatment of malarial affections; and the
compound solution (Lugol's solution) is widely known as a remedy in scrofu-
■ affections of the skin and of the lymphatic glands, especially in syphilitic
Idren. The solution, with arsenic, is very serviceable in some old syph-
Htic skin diseases attended by thickening and scaling.
Rothe advises the use in whooping-cough of a combination of iodine
and carbolic acid.
Dr. Renzi has observed a favorable influence upon the progress of pul-
mooAry tuberculosis produced by the adminiBtration of a mixture containing
iodine, potassium iodide, and sodium chloride.
Zinc iodide is in wliite, needle-shaped crystals, and is unstable. It is
b«t administered as a syrup (4 Gm. in 30 c.cm., or Si-fjj); dose, 1.20 to 2.50
Cjcin. (or mxi-xl). It has been used in ointment, with lard (10 per cent.), in
I the treatment of tumors, and a solution (0.065 to 0.13 Gm. to 30 com., or gr.
*-ij to f3j) baa been injected in gonorrhcsa. Stronger solutions have been
applied to enlarged tonsils.
Small and repeated doses of ammonium iodide are efficacious in ca-
tarrhal jaundice. This salt may be serviceably employed in bronchitis and
broncho-pneumonia. It is also considered of advantage in the early stage
of cirrhosis of the liver and in chronic malaria, associated in the latter con-
dition with arsenic.
Drop doses of the tincture of iodine will sometimes allay the vomiting
of pregnancy. In the form of tincture, compound solution, or potassium
iodide, this agent has been employed in typhoid fever, and, though no
marked influence is exerted upon the course of the disease, the temperature,
or the diarrhoea, Liebermeister believes that it effects a notable reduction of
the mortality. Bartholow'a combination of the tincture of iodine and car-
bolic acid wems to moderate the severity of typhoid fever: —
H Tinct lodi 715 ccm. or f3ij.
ni<*notii4 Hq 4{ c.cm. or f3j.
M. Siff.: One to tbre« drops thrice daily.
rhantemrsse usea in fnninculosis during t>'|)hoid fever, a solution of
loVr ■■ irts) in acetone (5 parts), applied witli abs^rlxnit cottnn. This
M*l' ■ in stronger than tincture of iodino, and is niorp irritant wlu'U
fitthiy made. One application is usually sufticient to abort a boil. If used
"taiMcl. Pee. 16. 1893.
I
578
PHAKMACEUTICAL THEIUPEUTIC AGENTS OB DRUGS.
freely, it may excite an eruption, and even cause ulceration; applied to a
gramilating surface it causes pain.
Dr. Phillips has given with success the tincture of iodine in doses of a
few minims in cases of atonic diarrhtEa. This writer states, moreover, that
the preparation, uaed in the same manner, will often cure the tormina and
tenesmus of dysenteric diarrhoea.
Ringer states that "in some epidemics of diphtheria" the inhalation of
the vapor uf iodine proves of signal service, and Dr. S. N. Zenenko* has
BDoken very highly of the internal administration of potassium iodide in
this affection. From 0.03 to 0.20 Gra. (or gr. sa-iij) was given to children,
0.32 to 0.50 Gm. (or gr. v-viij) to adults, and repeated every second, third, or
fourth hour. Antiseptic gargles, alcoholic stimulation, and inunction of the
enlarged ccrvicnl glniuls with mercurial ointment were used in conjunction.
Of a series of twuuty-oue patients so treated, none died, while of nineteen
cases treated during the same time, in the same hospital (at Nijni Novgorod),
after ordinary plans, 84 per cent, ended in death. The internal administra-
tion of potassium iodide will sometimes reduce enlargement of the mammary
gland or testicle, and by some physicians is said to check the secretion of
milk. Sciatica and lumbago are sometimes relieved by the same remedy.
It is useful in the first &in^e of hepatic cirrhosis, in hypertrophic metritis,
and in various sy[)hilitic manifestations, especially when other remedies are
not well borne by the stomach. Uterine fibromyomata have been materially
decreased in size by the use of this remedy either given by the mouth or in-
jected into tlie substance of the growth. Chronic urticaria has been success-
fully treated with potassium iodide. Stern reported- five cast^ treated in this
way. None were syphilitic, and all were rapidly cured. The itching was
promptly relieved, and one patient became well after only 10 Gm. (or oiiss)
had been administered, although he had suffered previously for four months.
Baczkiewicz states that potassium iodide is readily absorbed by the rectal
mucous membrane, iodine being detected in the saliva in five to fifteen min-
utes after administration by enema or suppository. According to the numer-
ous experiments of Calautoni on men and animals, potassium iodide is ab-
sorbed as rapidly by the bowel as by the stomach; if speedy absorption is
particularly desirable it may be obtained by heating the solution to 98** F.
Elimination after injection into the rectum is as rapid as when it is taken
by the mouth.
Kobner administers a potassium-iodide combination by means of enema.
Given once a day at first, but subsequently twice daily, the therapeutic action
is said to be very rapid. He combines mercurial inunctions, and believes
that this method is equally efficacious and better tolerated than subcutane-
ous injections. His formula is as follows: —
B FotABsii iodidi : 3
Potasail bromidi 1
Extrai't. bL'lladonius folior
Aquee 210
Gm. or gr. xlv.
Gm. or gr. x\.
32 Gm. or gr. v.
c.cm. or ftvij. — M.
Twenty-four c.cm. (or foviss) of this solution are added to 60 or 90 c.cm.
(or foii-iij) of water and thrown into the rectum. Kobner frequently adds
from 0.30 to 0.60 c.cm. (or rwv-x) of pure tincture of iodine to each enema.
' Vrateh, No. 42, 1890; Satellite, Jan., 1891
^London Medical Hcrordcr, Nov. 20. 1890.
lODUM.
679
I
finds the mixture well tolerated by th€ large intestine. He has never
fobwrred any resulting local inflammation.
The potassium iodide and chlorate are incompatible, a deleterious salt,
pttatdum iodate, being formed.
Iodized starch has lately been employed with asserted benefit by a num-
bs of Ku&iian physicians as an intestinal disinfectant in typhoid fever and
Ttrions septic affections of the bowels. It was given in the dose of 0.50 to
0.65 Gm. (or gr. viii-x). Iodine trichloride, obtained by passing chlorine-gaa
oTer iodine, occurs in the form of reddish crystals, is soluble in its own
▼eight of water and freely soluble in alcohol. Either its aqueous or alcoholic
nlntion can be mixed with glycerin without decomposition. Iodine trichlo-
ride has been employed by Belfield, of Chicago, in genito-urinary and sur-
real affections. He finds it of advantage in tuberculosis and suppuration.
ll*of inBtillation in the posterior urethra, for irrigation of the bladder, and
'lor hypodermic injections, he made use of a ^/lo* to Vs'per-cent. solution,
either in distilled water or in 4 parts of water with 1 part of glycerin. Serous
carities were injected with the same solutions. For cleansing suppurating
Toojids 1- to 5-per-cent. solutions were employed. To ulcerated carcinoma
ind Tcnereal sores he applied a 5- to 20-per-cent. solution in equal parts of
water, glycerin, and alcohol. Dr. Pfiueger, of Berne, recommends iodine
trichloride in various affections of the eye. For subconjunctival injections
a 1 to 1500 solution was employed. As a collyrium, solutions from 0.1 to 1
per cent, were used. Gottschalk treated three cases of puerperal septicsemia,
of which two recovered, by means of hypodermic injections of a 1-per-cent.
nhition, from I to 2 c.cm. (or tnx\-xxx) being injected once or twice each
Iodine thbromide has been used by Kraus for gargles and inhalations
in diphtheria. His solution contained 1.30 Gm. to 531 c.cm. (or gr. xx-
fjzriij) of water.
£thyl*iodide is administered by inhalation (0.60 to 2 c.cm., or mx-xxx)
whenever necessary to relieve coughing, especially in bronchitis, asthma,
and phthisis, and is the most direct method of introducing iodine into the
blood.
lodantifebrin. — This substance results from the interaction of iodine
deride and acetanilid. It crystallizes in rhombic tablets, which are
dightly soluble in cold water, alcohol, and ether; more freely soluble in hot
alcohol and glacial acetic acid; is without odor or taste, and appears to pass
through the orotanism unchanged. Dose, 0.13 to 0.50 Gm. (or gr. ii-viij).
lodantipyrin. — This combination is prepared by a similar process to
that which produces iodantifebrin. lodantipyrin crystallizes in colorless,
hstrons, and prismatic needles, is without taste or special odor, is scarcely
•olohle in cold water or alcohol, but dissolves when these menstrua are
warmed. Dose, 0.1)3 to 0.13 Gm. (or gr. ss-ij).
Clinical experiments with both the^e bodies were carried on in the clinic
of Profesaor von Jaksch, and the results have been published by Dr. Munzer.
The aatipyretic effects of lodantipyrin are identical with those of antipyrin,
and« in all probability, it is decomposed in the stomach into antipyrin and
iodioc^ The reduction of temperature was accompanied by sweating, but
wta onattt-nded by collapse or chills.
lodiphenin. — lodipnenin. an iodine derivative of phenacetin, la a
dooolatv-brown powder, which, upon recrystallization from glacial acetic
580
PHARMACEUTICAL THERAPEUTIC AGENTS OB DRUGS.
acid, yields crystals of a steel-blue color. It is soluble in alcohol, ether, and
chloroform; almost insoluble in water; but releases a large proportion of
iodine when brought into contact with water. It is said to be very de-
structive to the staphylococcus aureus, but, according to Dr. W. Siebel, ita
physiological action depends upon the iodine which it liberates. It discolors,
and, if left long in contact with the skin, produces irritation. Iodine poison-
ing is liable to result even from small doses of the compound, when given
by the mouth.
lodipin is a trade designation for a solution of iodine in sesame-oil
(10 per cent.) analogous to bromipin. The taste of the preparation is rather
unpleasant, but patients are said not to object to it after they have become
accustomed to it. lodipin is taken internally for the same purpose as other
iodine preparations: for struma, cold abscesses, etc. It may also be adminis-
tered subcutaneously, 50 c.cm. (or f5xiiss) daily being employed in children.
The dose by the mouth, in children, is 4 c.cm. (or foj) three times daily.
Klin^^rmiiller claims especial advantages in the treatment of tertiary syphilis
by the subcutaneous use of iodipin. For hvpodormic use, a 2o-per-cent. iodi-
pin is employed. It also may be used for inunction, in struma, tuberculosis,
and syphilis.
lodo-eigon (alpha-eigon) is a pale-brown powder, tasteless and odor-
less, containing, it is said, 20 per cent, of iodine. It^ie used as a wound
dressing as a substitute for iodoform, but is claimed to be a more efficient
disinfectant. It is insoluble in water, but mixes with the secretions, forming
an emulsion-like dressing. It may be employed suspended in water as an
injection into sinuses, or simply dusted upon the wound surface. (See also
£i§on.)
Kosophen. — This compound, obtained by the action of iodine upon a
solution of phenolphthalein, is a light-yellow powder free from odor or taste,
and contains 60 per cent, of iodine. It is insoluble in water, and combines
with metals to form salts. Nosophen has been used in rhinitis, after opera-
tions upon the nasal cavity, and in venereal affections.
d
IPECACUAJraA (U. S. P.).— Ipeoac.
rPECACUANBLffi EADIX (B. P.).— Ipecacuanha-root.
Dose, as an expectorant, 0.016 to 0.13 Gm. (or gr. V4-ij); as an emetic,
1 to 2 Gm. (or gr. xv-xxx).
U. 8. P. Preparations.
Flnidextruetum Ipocftcuanhfc. — Fluid Kxtraet of I[»eoae. Doe^, as an exp©c-
torniit. O.O.T tn O.t'2 f.rni. (or m>**i-ijl : ns an onietip, 1 to 1.'20 n.rm (or mw-xx).
tsynipus IpecncuunhBD.^yyrup of Ipecac. Dose, 4 to 7.5 c.cm. (or f3i*ij).
Vinura Ipecacuanhoe. — Wine of Ipecac. Dose, 0.60 to 4 c.cm. (or mx-f3j).
Pulvia Ipeoaouanhm et Opii. — Powder of Ipeoac and Opium, Dover*a Powder (1
part each of opium and ipecac and 8 parts of sugar of milk). Dose, 0.13 to 0.65 Gm.
(orgr. ii-K).
Tinctura Tpecacuanlue et Opii. — Tincture of Ipeoac and Opium (deodorisced
tincture of opium, 100; Huid extract of ipecac, 10 ^ diluted alcohol, q. s. to make 100
com.), Dofte» O.Oti lo 1 c.cm. (or mi-xv).
B, P. Preparations.
Kxtractum Ipecacuanha: Liquidum. — Liquid Extract of Ipecacuanha. Dose, as
an expectorant, 0.03 to 0.12 c.cm. (or fnss-ij) ; as an emetic, I to 1.20 ccm. (or
fWXV-XX).
rPEOAOUANHA.
581
Ipecacuanhse. — Vinegar of Ipecacuanha (liquid extract. 5; alcohol, 00
percent, 10; dilute acetic acid, 85), Dose, O.tJO to 2 c.cin. for tnx-xxx).
Vinum Ipecacuanhn. — Ipecacuanha-wine. Dose, as an expectorant, 0.60 to 2
eAiL. (or tnx-xxx) ; as an emetic, 15 to 22 c.cm. (or f3iv-vj).
TruchiscuB Ipecacuanhe. — Ipecacuanha Lozenge (O.OltJ Gm., or gr. V*i to each
IflBEiige). Doae, 1 or more.
Trochiaeua Moq^hinee et Ipecacuanhae. — Morphine and Ipecacuanha Leung*
(iDoqihiiie hydrochloride, 0.0018 Gm., or gr. '/••; ipecacuanha -root, 0.005 Gm., or gr.
Va). Do«e, 1 or more.
Pulvis Ipecacuanhce Compositua. — Compound Powder of Ipecacuanha, Dover's
Poiriler (1 part each of opium and ipecacuanha and 8 parta of potassium sulphate).
DoM, 0^ to 1 Gm. (or gr. v-xv).
Pilale Ipecacuanhoe cum Scilla. — Pill of Ipecacuanha with Souill (compound
powder of ipecacuanha, 3; squill, in powder, I; ammoniac, in powaer, 1; syrup of
glucose, to make a masa). Dose, 0.25 to 0.50 Gm. (or gr. iv-viij).
Pharmacology. — The dried root, to which may be attached a portion of
the stt'in not exceeding 7 cm. in leu^h, of Cophaelis Ipecacuanha of A,
Bichard" (Rubiaceip), known cnmmercially as Kio, Brazilian, or Para Ipe-
cac, or the corresponding portion of C. at'jinuiiata, Karsten, known coininer-
cially aa CarUia^ena Ipecac, yielding wiien assayed not less tlian 2 per cent.
of ipecac alkaloids. In the British Pharmacopoeia it is called Psychotria
Ipecacuanha. Ipecap-root coutaini? about 3 per cent, of an alkaloid, Emetine,
and a glucoside, Ipecacuanhlc acid^ with a trace of volatile oil, tannin.
i</i- ' - ni, etc. Owing to the scarcity of the Rio root (C. Ipecacuanha),
lb* !• Carthagena variety (C. acuminata) ie now generally used. The
fonner contains Emetine, the more purely expectorant principle, in excess;
the latter contains Cepa*lirie, the more purely emetic principle, in excess.'^
Becent experiments seem to sliow ihrtt emetine is rmt homogeneous, hut is a
mixture of two or more different snhstiincc.'t. Paul an<i ['onmley confine
the name emetine to the amorphous alkalnid, and state that it properly is
netliyl-oepfleline, the crystallizable alkaloid being named cepeeline.. Eme-
tine is slightly soluble in water, hut it dissolves I'eadily in ether, alcohol, and
, «||]on>form.
Physiological Actiozt — The prolonged application of ipecac to the skin
iiritation, followed by vesicles, pustules, or even ulcers. Inhalation
ni the powdered root irritates the air-passages and occasions coryza, or, in
tome persons, an asthmatic attack. The powdered root has a slight, but
characteristic and nauseous, taste. Taken into the mouth, it increases
the salivary secretion and e.Tcites nausea; and, in the stomach, in a similar
waj, small doses (0.015 Gm., or gr. V^) promote secretion, while large onea
cause nausea and vomiting. Ipecac is a systemic emetic, and causes vomit-
ing when swallowed, and also when injected hypodermically in the form of
fluid extract, or the alkaloid, Emetine. This drug has a peculiar effect upon
the pulmonary circulation, sometimes causing hypcraemia, and at others re-
ducing the amount of blood in the lungs and producing relative amcmia.
Small do0es stimrdate the liver, and larger ones, after tolerance has been
eftabltehed, act as cholagogic cathartics. The active principle is excreted
by the liver and gastro-intestinal tract. The skin is relaxed and perspiration
incre«»ed; the secretions of the broncho-pulmonary mucous membrane are
also increased. No marked effect upon the circulation is noticed, but eme-
tine exercisee a solvent action upon the red corpuscles when injected into a
■ Sftic York ifryficat Journal, 1905. p. 1330.
■
682 PHAKJIACEUTICAL THERAPEUTIC AGENTS OR DRUGS- ^
vein. The pulse ie reduced in tension as a result of the act of vomiting,
■which also favors diaphoresis. Urticaria is occasionally caused by the in-
ternal use of ipecacuanha.
Therapy. — Ipecac has been used externally with benefit for inaect-bitea.
In the dermatitis caused by rlius toxicodendron the free application of
a wash containing powdered ipecac in the proportion of 12 Gm. to 473 c.cm.
(or 5iii-0j) of water, is warmly recommended by Dr. W. S. Gilmore. In the
form of a apray with a hand-atoraizer a dilute solution of the wine of ipecac,
as recommended by Murrell and Ringer, is of great service in emphysema,
fibroid phthisis, chronic bronchitis, and winter cough, in allaying the spas-
modic vomiting and liquefying the secretions. Einger dilutes the wine with
1 or 2 parts of water, and, using an ordinary hand-atomizer, twenty or more
squeezes of the bulb are made, and the spray deeply inhaled, once daily at
first, afterward more frequently. The mouth should be well rinsed out after-
ward and a piece of lemon-peel chewed to avoid a nauseating effect. When
fractional doses of wine of ipecac are administered (0.06 c.cm., or mj, every
hour or half-hour) they may act as a stimulant, and overcome obstinate
vomiting and retching, just as small doses of brandy do. In the vomiting
of pregnancy it is said that a single drop, taken ever}' hour, is curative; it
certainly makes a decided mental iiuprcssion, and also may overcome the
morbid action of the stomach by substitution. Bartholow, however, declared
that it had always failed in his hands. In haemoptysis, small doses of tlie
following combination have sometimes proved of service: —
B Piilveris ipecacuanhfle - 175 Gm. or gr. xij.
Bismuth, aubnit 1 55 Gm. or gr. xxiv.
Creosoti |37 c.cm. or mvj.
M, et ft. chartulae no. xij,
Sig. : A powder everj* hour or two until relieved.
In hiemoptysis small doses of the powder, short of producing vomiting,
ser^^e to reduce the bleeding by decreasing the pulmonary congestion. It
has also given good results in the treatment of epistaxis and uterine hcemor-
rhages. The fact that small doses of ipecac have a favorable influence in
arresting and preventing haemoptysis induced Onimus to apply the same
treatment to metrorrhagia, and he recently announced at the Paris Society
de Biologic that he had found it remarkably effective.
The wine of ipecac has been successfully employed in doses of 0.60 to 1
c.cm. (or mx-xv) for the purpose of overcoming uterine inertia in the first
and second stages of labor. It is said that the drug does not excite tetanic
contraction, but normal and regular expulsive efforts.
An attack of asthma may be cut short by full doses of ipecac, and an
occasional emetic is useful in whooping-cough and capillary bronchitis to
dislodge the secretions. Bond* Teporta excellent results in a case of epilepsy
from ipecacuanha, beginning with 0.60 c.cm. (or mx); the dose was grad-
ually increased to 2.30 c.cm. (or mxxxvj) three times a day. The severity
and frequency of the fits gradually diminished for a year, and then ceased
entirely. '
When, in bronchitis, the secretions are viscid and the cough hard,
ipecac in combination with other expectorants is generally resorted to. The
appended formulae containing ipecac are to be recommended in bronchitis:—
' Lancet, Sept 17, 1898.
IPECACUANHA.
583
B Vini ipecacuanlue
Svrup. scilliB
Tiact. o^ii camph
Glrcerini q. b. ad
M- Sig.: One or two teaspoonfuU whenever neccsBury for tlie relief of cough.
7
60
15
150
c.cm. or f3ij.
c.em. or fjij.
csm. or fjsa.
c.cm. or fjv.
Syrtip. ipecacuanhffl 16
AiDTiionii chloridi 8
Spiritus a?thpns nitrosi 45
Morphime sulphatis
S>rup. pruni Virg q. B. ad 150
c.cm. or f588.
Gm. or 5ij.
c.cm. or fSiBs,
065 Gm. or gr. j.
c.cm. or fjv.
M. Sig.: Two teaapoonfuls every hour or two for the relief of cougli.
For bronchitis, especially of elderly persons, ipecacuanha can be com-
bined thus with advantage: —
c.cm. or f5j.
Gm. or 3ij.
30 c.cm. or mv.
li Syrup, ipecacuanheo 30
Potassii nitratia 8
Creosoti
Glycerini,
Aquoe aurantii florum aa 60| e zm. or f^U
K. Sig.: Two teaspoonfuls in water every two or three hours.
^In croup, especially where the tnucus is not expelled, but is swallowed
or accumulates in the air-passages, nn emetic dose of syrup of ipecac often
gives great relief and may prevent suiTocation. For cases of this kind, it is
much superior to tartar emetic or the compound syrup of squill, also con-
taining this salt, which is too depressing. In delirium tremens, or acute
alcoholic poisoning, ipecac produces evacuation of the contents of the stom-
ach and stimulates the action of the liver. It is too slow in its action as an
emetic to be of much service in other forms of poisoning. In dysentery, 2.60
to 4 Gm. (or gr. xl-li) are given with wonderfully successful results; if nee-
«Maiy to quiet the stomach an opiate is administered about twenty minutes
previously; no liquids swallowed for an hour after the ipecac has been taken,
and absolute rest in the recumbent posture observed. The same treatment
ia useful in cholera morbus, and has been recommended in Asiatic cholera.
Ipecac deprived of its emetine has been found by East-Indian phy-
ncians equally efficient in dysentery. It is administered in about the same
doees as ipecac and is less apt to excite nausea or vomiting. In dysenteric
diarrhcea, when blood and mucus appear in the stools, small doses may be
given, combined with opiates or Dover's powder. Ipecac, with mercury and
opium, often acts well in both diarrhcea and dysentery:—
et opii 4| Gm. or Sj.
|05 Om. or |^. x.
B Piilveris ipecacuanh
Mas<)flr hydrargyri
Cnmphora,
Pulverifl capnici,
I*ulvcri» kino aa
1| Om. or gr. xr.
^1 Ipecac has been used in tuberculous diarrhoea with alleged advantage.
H It is said to have the power of restraining night-sweats.
f Eifietine has been successfully used in diarrhfBa due to indigestion. It
is given in the dose of 0.0002 Gm. (or gr. Vaoo). preceded by a calomel purge.
N«usi*a disappears and diarrhoea is rapidly controlled.
K. et ft. pit. no. XXX.
8|f.: One or two pills every hour or two until relieved.
584 PIIARMACELTICAL THERAPEUTtC AGENTS OB DBU08.
Ipecac is also used in fractional doses for insufilcient excretion of bile
and lorpor of the liver, and may be eombiuod with extract of digitalis, or
other agents, as follows : —
B Pulv. ipecacuanhfc [26 Gm. or gr. it.
Quininse hydrochlorat 4 Gm, or 3j.
Pepsin 1 55 Gm. or gr. xxir.
Olei eucalypti { 18 c.cm. or miij.
M. ct ft. pil. no. xxiv.
Sig.: Take one after meals.
Small doses of ipecac, given after meals, are of service in flatiilcnt
dyspepsia. When the tongue is heavily coated and the stomach containa
indigestible food, especially at the beginning of a fever, an emetic dose of
ipecac will prove very serviceable in relieving symptoms; it is a means of
treatment that haa been allowed to fall into undeserved neglect. In the
treatment of malarial poisoning, this method of stimulating the liver is very
useful previous to the administration of quinine or other antiperiodics. It
is of service likewise in the treatment of catarrhal jaundice.
In laryngismus stridulus, an emetic of eyrup of ipecac usually aborts
the paroxysm and alTords time for the use of potassium bromide to produce
its effects. Trousseau recommended its use in the puerperal state, in cases
of post-partum hemorrhage, and dysentery, etc. In other forms of ha?m-
orrhage, such as epistaxis, menorrhagiaj and metrorrhagia, ipecac is service-
able when given in doses sufficient to provoke vomiting. Dr. C. Burland
testifies to its value in controlling hrematemesis. He administers it in the
dose of 4 Gm. (or 3j) or more, made into a bolus with enough glycerin to
produce the necessary consistency.
The Euphorbia Ipecacuanha (Euphorbiaceff), Ipecacuanha spurge,
growing in the eastern part of the United States, from New York southward,
although belonging to a different natural order, yet contains in its root an
emetico-cathartic principle, which renders it a good substitute for ipecac
where emesis is required and catharsis is not objectionable. It is commonly
administered in the form of powdered root, but a fluid extract may also be
obtained. It is of more agreeable taste than ipecac.
nilS.—Iris (Blue Flag).
Dose, 0.20 to U.35 Gm. (or gr. iii-iv).
Preparations.
Extrartum India. — Extrapt of Xris. Dose, 0,015 to 0.065 (»m. (or gr. V»j).
Fluiilextractum Iridis. — Fhiid Extract of Iris. Dose, 2 to 4 c.cni. (or
wjtxxfSj) .
Pharmacology, — The Iris versicolor (Irideae) is a common inhabitant
of moist places and borders of ponds of the United States, and is one nf the
most attractive among our wild flowers. It is an herbaceous perennial, with
a thickened root-stock. I'he dried rhizome and rootn wt-ro formerly official
in the United States Phnrmacoprnia (Revision of 1890). The flowers are
large and ^howy, violet-blue, variegated witli greenisli-ycllow and white, with
purple veins; they nppear in May and June. It contains nn acrtd rosin,
upon which its medit'id activity depends, besides ordinary vrgetablo yirinei-
ples. Irldin is an impure resin» precipitated from alcoiiolic tiacture by
water.
J ALA PA.
585
I
I
Physiological Action. — The powdered root, when fresh, is a powerful
emetic and cathartic, less so after drying. It is a decided cholagogue, and
MkBO diuretic and alterative, having a stimulant action upon the intcBtinal
glands. It is best given in combination with aromatics and milder purga-
tivee.
Therapy. — In chronic hepatic derangements, especially of malarial
origin, the preparations of blue flag are very useful, and particularly the
recent saturated tincture. In duodenal catarrh, obstructive jaundice, bilioua
remittents, iris preparations are frequently used with advantage. In dropsy
they are also useful, both as diuretics and cathartics. Iris, administered in
imall doses, is very beneficial in sick headache dependent upon indigestion.
In larger doses it has vermifuge properties and may be used to expel the
round worm, ascaris lumbricoides.
B Fluidext. iridia.
FluicU'xl. Iiyihastis -.-.... aa 161 e.cm. or fjM.
Elixir ftromktic , 30| c.cm. or fjj.
M. Sig.: Take a dcsserUpoonftil in hot water before meals for indigestion.
IRIS FLOEENTINA. — Orris-root. Several species of the genus Iris
(Iridea?) furnish the rhizome known by the name of orris-root. It contains
a volatile oil of violet color and pleasant odor, much used in perfumery;
besides an acrid resin, starch, mucilage, etc. The powder, which is said to
be alterative, cathartic, and diurttic, is rarely employed tnternally, but is
used in making sachets, tooth-powders, and in alcoholic tincture, in per-
fumery and flavoring extracts.
ISO-ETHYLIN is the name of a new antiseptic formed by the destructive
distillation of ethyl alcohol, as formaldehyd is produced from methyl alcohol,
and posBeaaes some of the characteristics of the latter. Its germicidal power,
however, is slightly below that of formaldehyd. Dr. G. M. Randall, of Au-
gnata, Me., hopes it will prove capable of keeping milk from spoiling, while
harmleae. Experiments lately made on animals led him to believe that, in
miniiDain strengths capable of arresting bacterial growths, the iso-ethylin
doeanct interfere with digestion. Being volatile at 100* F,, he thinks that
the body-temperature is sufficient to drive it out of the milk and thus keep
h from interfering with the action of the gastric juice.
IZAL. — Izal is a by-product obtained in the manufacture of coke. It
was found by Dr. Klein, of London, that a 1 to 200 solution was destructive,
within five minutes, to various species of microbes. It is not irritant, how-
ever, in this strength to the human integument. This solution has been
OBcd for the purpose of disinfecting sponges and instruments, and for im-
pregnating gau2e intended as a dressing to wounda.
JABOEANDI FOLIA (B. P.).— (See Pilocarpus, U. S.P.)
JAIAPA (U. S. P., B. P ).-Jalap,
Doae, 0.33 to 1.30 Gm. (orgr. v-xx).
Preparations.
Rr»inA Jiiln|w {IT. 8. P., B. P.).— Updin of JnUp.
(vrfr. i-W».
Dose, 0.005 to 0.26 Om.
586
PHARMACEUTICAL THEaAFEUTIC AGENTS OR DRUGS.
Extractum Jalapa (B. P.). — ^Extract of Jalap. Dose, 0.13 to 0.32 Gm. (or
gr. ii-v ) .
Pulvis Jalapse Compositua (U.S. P., B. P.). — Compound Powder of Jalap (U.S.
P. contains jalap, 35 Gm.; cream of tartar, 65 Gm.)* Dose, 0.65 to 4 Gm. (or gr. x-3j).
Tinctura Jalapce (B.P.). — Tincture of Jalap (contains 1.5 Gm., or gr. xxiij, of
ream in 100 cem., or fSxxvij). Doee, 2 to 4 com. (or fSw-j).
Pharmacolog:y. — "The tuberous root of Iporacea Jalapa (Convolvu-
lacea>), "obtained from Jlexico, contains not less than 8 per cent, of resin
(U. S. P.); "the dried tubercules of Ipumuja Purga/' and should yield not
less than 9 nor more than 11 per cent, of resin (B. P.). The reein is
official and composed of Jalapin, a soft resin soluble in ether, and Con-
volvulin, a hard resin insoluble in ether, the latter of which has been
found to be the more active; also starch and sugar, of each about 18 per
cent. According to Professor Poleck, jalapin is a resinous glucoside, and
separates by the action of hydrochloric acid into sugar and julapinolic acid.
G. A. Kayser found that the resin is composed of a hard and a soft portion:
the former, constituting 70 per cent., is called Rhodeoretin (identical with
Jalapin). This substance purges violently in small doses (0.30 to 0.25 Gm.,
or gr. iii-iv), and is the most important active principle. It was renamed by
Mayer, who called it Convolvulin. Poleck suggests the name Orizabin, aa
a substitute for Jalapin, and confirms the statement that this resin is iden-
tical in composition and chemical properties with scammonin.
Physiological Action. — Jalap is an hydragogic cathartic, increasing
the intestinal secretions and the flow of bile; overdoses may produce hyper-
catharsis and prostration. Convolvulin is an irritant, and may cause gastro-
enteritis and collapse; it is a local purgative, and is not excreted in the urine
or faeces, but is probably destroyed by oxidation or by the hepatic cells.
Therapy. — The compound powder of jalap is one of the best hydragogic
cathartics for dropsy, either of heart or kidney disease; and in cases of pul-
monary congestion and distended right heart, with lindity, shortness of
breath, and so-called cardiac asthma, a teaspoonful of compound jalap-pow-
der affords great relief.
In dropsy dependent upon cardiac or renal disease. Prof. Joseph Jones,
of New Orleans, employed with advantage a diuretic and purgative ^^'ine thus
composed: —
H Fluidext. jalans,
Fluifiext. scilire aa 111
Fluidext. pilocarpi SOl
Fluidext. digitalis 2
Potass, nitrat 16]5
Vini Angelicce 1000|
C-cm. or fSiij.
c.cm. or fSj.
c.cm. or mxxx.
Gm. or 5iv.
c.cm. or Oiifjij.
i
M. Sig. : A tableepoonful every three hours.
Increased if neceasary.
The quantity can be gTaduall/
As an ordinary laxative^ the compound powder of jalap may be combined
with compound lieoricc-powdcr where the latter fails alone, and is a good
cathartic for children. Jalap may be used as a cathartic after administration
of santonin or calomel, or where a tseniacide has failed to bring away the
parasite. As a purgative, it is sometimes combined with calomel, but, as it
acts more rapidly than the latter, the effect of the mercurial is lost unless
it precedes the former from four to six hours. Jalap is not so rapid in its
action as croton-oil, but is more manageable. In haemorrhoids it does not
JOHIMBIX.
587
caii£e increased irritation, but relieves them by emptying the vessels above
and clearing out the liver.
Convolvulin is an efficient purgative and may be prescribed in doses
from 0.10 to 0.20 Gm. (or gr. iss-iij).
JAJCBOL. — Jambol. The Eugenia jambolana (Mvrtaceffi) is a tree
indigenous to tropical America and the West and East Indies, where
the acid fruit is eaten as food and as a remedy for diarrhoea and diabetes by
the natives. It has also been used to some extent in Europe in the form of
tn extract in the treatment of diabetes. In some experiments^ made in Pro-
fessor Binz's laboratory, it was shown by Dr. C. Graoser that in dogs in which
diabetes had been artificially induced by the administration of phloridzin,
the simultaneous exhibition of jambol reduced the proportion of sugar mate-
rially (80 to 85 per cent.). There were no signs of toxic action after admin-
istration of large doses, 6 to 18 Gm. (or Siss-ives) daily, of extracts partly
made from the whole fruit and partly from the rind or kernel. Mr. Thomas
Stephenson also finds that jambol possesses t!ie power of checking the action
of oiastasic ferments in converting starch into grape-sugar. The result of
his experiments was to show conclusively that the greatest influence over
the action of diastase was exerted by a preparation of the fresh kernels by a
r process avoiding the use of heat. The difference in the preparations made
Tise of by different obser\'ers probably explains Uie varying results reported.
Scott added powdered jambol tu malt and starch, and found tliat the
formation of sugar was prevented. M. Villie, however, w^ho repeated the
I experiment, obtained more sugar when jambol was present than wlien it was
[absent- Hildebrandt states, as the result of his experiments, that jambol
{revents the action of plant-diastase and the sugar-forming ferments in the
lood-serum, saliva, and pancreatic extract, but is without effect upon pepsin
^md trypsin. Many reports, for the most part favorable, have been made
in regard to the efficacy of jamlx)l in the treatment of diabetes mellitus. In
the majority of cases the amount of urine was reduced, the proportion of
[ sugar lessened and the general health improved under its use. In a number
of instances this amendment has taken place in the absence of the usual
regulation of diet. In pancreatic diabetes, on the other hand, Dujardin-
Beaumetz averted that the quantity of sugar in the urine is actually in-
I ereased. This writer regarded the drug as merely an adjuvant to the
dietetic management of moderately-severe cases of diabetes. Though the
eridence of different obsen^ers is not always in accord, yet from what has
|1)e«i published the drug certainly merits a trial and the closest study of its
therapeutic worth. In India jambol has long been esteemed of value in
diarrhoea.
JOhiMBIN is derived from the bark of the johimbehe-tree of the Cam-
l«roons. Berger* writes of his succ^'ss with this drug as an aphrodisiac. He
*"cJtca 7 cases ; 5 patients were suffering from "paralytic impotence" ; the re-
maining 2 were healthy individuals (sexually) and received the treatment to
demonstrate its harmlessness. The writer prepared a solution containing
0.01 Gm. to 20 c.cm. (or gr. V,-fovss) of water, of which 1.20 c.cm. (or mxx)
* lAincet, Not. 2. 1889; Thrrapevtie GazriSr, Jan., 1800.
»D€ut9<^e mei!icini9ch4 Wochcnsohrifi, April 25, 1001.
588 PHARMAOEITICAL THERAPEUTIC AGENTS OR DRrOS.
was given as a dose. The exhibition of the dnig prodneed erections and
power for coitus in a few days. Berger also states that if no reaction is
obtained within a week the dose should be increased to 2.50 to 4 c.cm. (or
mxl-lx). A. Eulenberg has used johimbin in cases of neurasthenic im-
potence with excellent results in doses of 0.60 c.cm. (or mx) of a l-per-cent.
solution. In some of the cases the effect of the drug passed off after a time
and required a repetition of the treatment. In animals the drug produces
a swelling of the testes and erections and large doses, 0.01 Gm. (or gr. */(),
had no deleterious effect upon the general health of the animal.
JUGLANS.— Juglans (Butternut).
Dose, 4 to 8 G. (or 5i-ij).
Preparation.
Extractum Jugtandia. — Extracrt uf Buttei-nut. Dose, 0.32 to 2 Gm. <or
rzzz).
J
Pharmacology. — The bark, collected in the autumn, of the root of
Juglans cinerea (Juglandacea?), a large tree of North America, contains
Nucin or Juglandic acid (resembling chrysophanic acid), also resin, volatile
oil, and fbced oil and tannin.
Therapy. — It is a mild cathartic* useful in chi'onic constipation and
dysentery.
Nut-oil is the &ced oil obtained by expression from the crushed seeds
of several species of Juglandaceae. Walnuts and hickory-nuts yield about
85 per cent, of a fine, bland, pleasant-tasting oil, which can be used in phar-
macy, or in medicine for massage, like other fixed oils. It is a drjnng oil,
containing linolcin.'
A decoction of walnut-leaves, used both externally and internally, is
said by Dr. Rodionoff to be of value in scrofula.
JOTTIPEEUS. — Juniper, Juniper-berries.
Preparations.
Spiritus Juniperi Conipo«itus (U.S. P.). — Compound Spirit of Juniper (oil of
juniper, 8; oil of caraway, I; oil of fennel, 1; alcohol^ 1400j vafcer, q. a. ad 2000
c.cm.). Dose, 7.5 to 15 o.cm. (or f3ii-iv).
Spiritus Juniperi (U.S. P., B. P.).— Spirit of Juniper (oil of jumper, 6; alcohol,
96 c.cm.). Dose, 4 to 15 c.cm. (or fSi-fJes). B. P., 1.20 to 4 c.cm. (or mxx-f3j).
Oleum Juniperi (U.S. P., B. P.).— Oil of Juniper. Dose, 0.30 to 1.20 c.cm. (or
»?iv-xx). B. P., 0.03 to 0.18 c.cm, (or maa-iij).
Pharmacologry. — The fruit of Juniperus communis (Pinacea?), an ever-
green of this country and northern Europe, contains from 2 tp 2 Va per
cent, of Q volatile oil, about 15 to 30 per cent, sugar, etc.; also a non-
cr>'stallizalile principle. Junipcrin. The yolatile oil also exists in the leaves
and other parts of the plant, and by macerating them in alcohol or spirits
a liquor is produced, commonly known as ^in, or spiritus Genevse. As the
commercial article is frequently adulterated with oil of turpentinj^ and other
ingredients known to the trade, the U. S. Pharmacopceia offers a substi-
tute in the compound spirit of juniper. The oil of juniper obtained from
"A Companion to the IT. S. PharmacoptEia/' Oldberg 4 Wall, New York, 188T.
KAMALA. 589
the wood is inferior to that distilled from the berries^ which is the official
form from which the spirit and compound spirit are made.
Fhyaiological AotioxL. — Juniper stimulates the kidneys, but in health,
while the discharge of urea is increased, the urinary water may be actually
diminished temporarily ; an overdose producing strangury and suppression of
urine. In diseased conditions, however, the flow of urine is much more free,
and especially where dropsy exists. The oil is carminative as well as diuretic,
and in alcoholic solution is a frequently-used stimulant. It is contra-indi-
cated in acute inflammation of the kidneys.
Therapy. — In various forms of dropsies, juniper is useful. In the form
of an infusion, to which 15.5 Gm. (or §ss) of cream of tartar is a good addi-
tion, a pint being drunk through the day, the effects are soon manifest in
Bright's disease and its attendant cedema and effusions. A combination with
potassium acetate is also very effective, as: —
B Fotassii acetatis 23
SpirituB juniperi comp 45
Infuai ftcopani 135
JLettt.noL
Sig.: A tablespoonful three or four times a day.
Gm. or 3vj.
c.cm. or fSiss.
com. or fSivss.
Juniper gives relief in passive congestion of the kidneys and the lum-
bar pain which accompanies that condition. This remedy is inappropriate,
however, in acute nephritis, on account of its stimulant properties. In large
doses it sometimes excites priapism, strangury, or hsamaturia. Beneflt ia
obtained from juniper in chronic pyelitis, prostatorrhoea, and gleet. Chronic
catarrh of the bladder is also relieved by its use.
The juice of the berries has been successfully used in doses of 7.5 to 11
ccm. (or f3ii-iij) as a diftretic for young children and in renal dropsy. The
oil may be dropped in boiling water and inhaled to produce the same effect.
In infantile colic a few minims of the compound spirit in hot water relieves
flatulence and pain.
Juniper-wood by destructive distillation yields an oil known as oil of
cade, official in both the United States and Bhtish Pharmacopceiaa (see
Oleum Gadinnm).
KAMALA.— Xamela (Bottlera).
Pharmacology and Therapy. — "The glands and hairs from the capsules
of Mallotus philippinensis (Euphorbiacese)," a small tree of India and China,
come to this country in the form of a finely-granular powder. It was
dropped from the last revision of the United States Pharmacopoeia. Kamala
is inflammable, and is insoluble in cold and nearly so in hot water, but is
largely soluble in alkaline solution, alcohol, and ether. From these solutions
a resin is precipitated by the addition of water. Kamala is liable to be largely
adulterated. The resinous material consists of several distinct principles, the
most important of which is called Eottlerin, which is obtained by exhausting
the drug with ether. In full doses, 4 to 12 Gm. (or 3i-iij), it is a drastic
pui^tive, and in India it is used largely as a vermicide. For tape-worm the
quantity named is given at a dose, mixed with molasses or other vehicle, with
a little hyoscyamus to prevent griping, and its operation may be made more
active by a dose of castor-oil, given after the last portion of kamala. A fluid
690
PHARMACECTtCAL THERAPEUTIC AGENTS OR DRUGS.
extract and a tincture (6 to 16 unofficial) are also used to expel lumbricoid
TTonns. In the form of ointment kamala is used in the East in the treatment
of Bcabies and ringworm.
KAOLINTTM (U. S. P., B. P.).— Kaolin (Al,[SjO^]3 + A1,0[OH] J.
Fuller's earth.
CATAPLASMA KAOLINI (U. S. P.).— Kaolin Cataplasm.
A native aluminum silicate, powdered and freed from gritty particles
by elutriation. Porcelain clay is employed iti medicine as a dusting-powder
for intertrigo and eczema, to relieve irritation, and protect the surface from
the air. It is employed pharmaceutically in pills as an excipient for silver
nitrate, potassium pormaupmate, eie. The cataplasm contains glycerin aa
an excipient, with boric acid, methyl salicylate, and oil of peppermint It
has been found useful in relieving cellulitis, aud in inflammntion of internal
organs. It should be applied warm and confined with a bandage.
KAVA-KAVA. — Methysticnm. The Macropiper latifoliura (Piper-
aceae) is a shrub of tlie Hawaiian Ishmds, having" a large root, which yields
about 2V2 P^r cent, of soft resin (consisting of two kinds, distingui«Iied
as a and b) ; about 1 per cent, of a neutral, crystalline principle, methysticin
(or kavnhin") ; nnd some yellow, volatile oil. This resembles piperine and
cubebin, and is probnbly inert, the medicinal qunlities depending upon the
resins and volatile oil. Tt is best pven in the form of a tincture or fluid
extract (X. F.), made with alcohol as a menstruum.
Physiological Action. — In the ITawaiian Islands the natives prepare an
intoxicating beverage by chewing the root and infusing it with water or
cocoa-nut-milk to grace their festivals. In consequence of prolonged use
Lutz has observed that the skin of the Islanders, especially upon the ex-
tremities, assumes a rlecidedly ichthyotic appearance, associated with a cer-
tain degree of atrophy resembling that of old persons.
The physiological action of kava-kava has been investigated by Lewin,
Pandolph. and others. Dr. David Cema has published an account of a series
of experiments* upon the same subject. When the fluid extract or the resin
is placed upon the tongue, a burning sensation is at first produced, soon
followed by an increase of saliva and local antesthesia. The loss of sensation
endures for hours, and normal sensibility slowly returns. The same be-
numbing influence is exercised upon the cornea and conjunctiva by a local
apphcation. A few minims of a solution injected hypodermically caused
complete ansesthesia in the neighboring parts. The loss of sensibility per-
sisted for a week.
The mucous membrane is rendered ansemic. Taken internally in con-
siderable quantity, it induces somnolence. As the result of his researches,
Cema concludes that kava-kava produces general anaesthesia, and is especially
a powerful local anBPsthetic. It diminishes and finally destroys the action of
the afferent nerves by affecting their peripheral ends. Reflex action is
diminished and ultimately abolished. Paralysis of spinal origin is an effect
of the drug. The action of the heart is rendered slower and more powerful;
arterial pressure is at first reduced and subsequently raised. Respiration is
* Thcrapeittic Gazette, Jan. 15, 1891
KIXO.
at first stimiilated, afterward depressed, and finally paralyzed. Small doses
of kaTi-k&Ta slightly increase, while large quantities reduce, bodily tempera-
ture.
Therapy. — ^In cystitis and chronic gonorrhoea, kava-kava is often re-
taarkal'ly successful. Acute gonorrhoea, retention of urine, and incontinence
of orine have also been notably ameliorated by the exhibition of this remedy
itnaided by any other form of treatment. It is likewise beneficial in leucor-
rhcea and vaginitis. It has also been recommended for gout. It is suggested
that the anaesthetic properties of this substance may prove useful to dentists,
ind that, though irritant to the conjunctiva, it may be employed subsequent
to cocaine for the purpose of prolonging the anjesthesia due to the alkaloid,
and may be used, also, to disguise the taste of bitter or nauseous medicines.
KEFIB. — Kefir is a product of the fermentation of milk, brought to ■
^Dcral professional notice by the writings of Russian physicians. It is pre- ■
pared by the natives of the Caucasus by the addition of a ferment collected
from a mountain-bush. The ferment consists of bacilli and yeast-cells, the
latter alone being essential to the fermentation. Kefir is a pleasantly-acid
ftoid, confaining 8 parts of alcohol and !) parts of lactic acid in 1000 parts.
Therapy. — Kefir is well tolerated by the stomach and has been employed
with good results in the treatment of dyspepsia, gastric catarrh, gastric ulcer,
ansmia, chlorosis, and scrofulosis. It is useful in maintaining nutrition in J
pulmonary tuberculosis and cancer of the stomach.
KEBTO (U. S. P., B. P. ).— Kino.
Bote, 0.32 to 1.30 Gm. (or gr. v-xx).
Preparations,
Tincliirft Kino (U. S. P., B. P.).— Tinctura of Kino (5, or B. P., 10 per cent).
!>•*«, 4 to 7.5 c.cin. (or f3i-ij).
PulvU Kino CompositUB (B. P.). — Compound Powder of Kino (kino, 75; opium.
5; cinn&mon, 20). Dose, 0.32 to 1.30 Om. (or gr. v-xx). This powder contains 5 p«r
ceol. of opium.
Fharmacology. — Kino is "the inspissated juice of Pterocarpus Marau-
pium (Leguminosse)": a tree of the East Indies. It occurs in fragments of
a nib}-red color, without odor, of a sweetish, astringent taste; scarcely sol-
uble in cold, but entirely soluble in boiling water; soluble also in alkalies.
Kinotannic acid is the most important constituent; there are also present
Xinoin, a crystalline neutral substance, Pyrocatechin, Pectin, etc. The offi-
cial kino is the so-called JIalabar kino; there are other varieties, notably one
from Botany Bay, obtained from several species of eucalyptus.
Phyiioloinoal Action and Therapy. — Kino is a mild astringent, useful
in diarrh'L'a, especially with chalk mixture and paregoric. Kino, locally
and internally, possesses some value as an ha?mostatic, and is a serviceable
r 'in pyrosis. The tincture is often an ingredient of injections in
■rt. and may be applied as a stimulant dressing to chronic ulcers.
Tid powder (B, P.) is used especially for ^astro-intestinal dis-
I»fl by diarrhoea. It has 5 per cent, of opium. Kino may also
be employed in solution as a gargle, but has no advantage over tannic acj
for this purpose.
592
PHARMACEUTICAL THERAPEUTIC A0ENT8 OR DRUGS.
KOLA. — Cola. The recent or drii-il Lt»tyledon8 of Cola vero, or of Cola
acuminntn ( Storeuliaceffi) are iiscd by the natives in various parts of Africa.
The seeds are chewed, and from the |x>wdered dried scchIs an agreeable etimu-
lani and nutritious beverage is prepared with milk and honey. The tree
grows to the height f»f thirty to sixty feet, bears some re^niblonce to the
horse-chestnut, is a native of the western coast of Africa, and is found as far
inland as five hun(]red or six hundred miles. It has been introduced, and
with success, into othiT tropical repoTis of Asia and South Anierioji. From
five to fiftei'ii seeds. &ome red and others white, are contained in a single
capsule. They contain a Irtrge proportion of caffeine or theine (2.348 per
cent.), together with tannic acid and theobromine (0.023 per cent.), other
constituents being sugar, albumin, ecllulose, starch, fat. and fixed salts.
Aco)rding to tho investigations of Dr. 1*]. Knebel, confirmed by A. Ililger,
the fresh nut contains no caffeine, hut a glucoside which, by decomposition,
gives rise to calTeine, glucose, and b>la-red.
These seeds have lately been employed in a number of clinical experi-
ments. An alcoholic extract has been made by exhausting the fresh nuts
Avith 5 parts of GO** alcohol, and a wine by macerating in a sweet white wine
for a fortnight. But neither of these preparations extract all the caffeine.
A tincture and a syrup have also been made, though water is an imperfect
menstruum on account of the starch contained in the seeds. According to
Simmonds/ there is also a false or bitter kola, the male kola, named also the
Oarcinia kola, the seeds of which are oval or cuneiform; these are four in
number, contained in a large berry. The false kola-nuts are destitute of
alkaloid.
Fhysiological Action. — The taste of the fresh seed is at first sweet,
becoming astringent and slightly bitter. From his investigations upon him-
self and otherSj H. U. Firth concludes that kola increases the secretion of
urine, stinuilates the nervous system and heart, and increases arterial tension.
It preven,t8 the feeling of exhaustion from exercise or hunger. It commu-
nicates an agreeable taste to water or food, and, according to Armitrous,
renders tainted meat edible and clarifies polluted water by a mechanical
action.
Dr. Kotliar studied the action of kola-nut upon seven healthy young
men during periods of rest and work, 4 Gm. (or 5j) of the powdered nut
being given daily to each subject. Both during rest and work the assimila-
tion of phosphorus and sulphur was increased. The metamorphosis of the
same elements was diminished during rest and at work, but more particularly
during rest. The breaking up of phosphorus aud sulphur compounds during
periods of repose and labor, as compared with that of nitrogenous compounds,
was diminished. The assimilation of chlorine was increased during rest, but
unaltered during work. The metamorphosis of chlorine was diminished
during rest and work, especially in the latter case.
Therapy. — Kola exercises a preservative action upon the teeth and
gums, and promotes appetite and digestion. It favorably modifies the func-
tions of the liver. It is, therefore, adapted to act as a remedy in dyspepsia,
whether of gastric or hepatic origin. It relieves the vomiting, vertigo, and
depression of seasickness.
For painful dyspepsia Dr. Monin recommends: —
^ Phnmwceutical Record, Jan. 5, 1891.
Its combined stomachic and astringent properties render it of service
m the treatment of ftcute and chronic diarrhoea. In its native country it is
thought to protect Europeans against affections of the liver, and the natives
esteem it as a prophylactic against dysentery. It has been proposed as likely
to be of service in cholera. As a heart-stimulant, it may be employed in
wetkened conditions of that organ, in fever, and in phthisis. Kola is useful
in cardiac asystole and in the debility attendant upon convalescence from
influenza. It is directly serviceable in disease of the heart as a diuretic.
Its favorable influence upon the nervous system suggests its employment in
OMzraJgia. It is stated that kola has a remarkable power of promoting cheer-
fulness, and may be very serviceably used in hypochondria and melancholia.
It is probably of value in overcoming the taste for alcoholic liquors. As a
substitute for coca or tea, kola may be given in cases of weak digestion, em-
plojicg the preparation kolafro, which is used like breakfast-cocoa. Kola
has a tendency to cause wakefulness^ and for this reason it is advisable to
•void its use in the evening. Dujardin-Beaumetz found kola of advantage
in the treatment of diabetes mellitus. The follnwint^ formulae are taken
from the columns of Le Journal de Medecine de Paris: —
B Ejct cinchon.,
Ext kolie aa 6| Qm,
Ext. rh*i 260 Gm.
Ext. nucis rom 50 Gtn.
Ferri arscnatis 20 Gm.
Ihilv. kolae ^ q. a.
M. et dir. in pH. no. c.
Sig.: Two pilfg with each meal.
B Vint kolv.
Vini cinchon.,
Vini frf?ntiaTi»,
Vmi calumbce aa 240| c.cm. or fSvilj.
Liq. potJjs. araeait 60 c.cm. or gtt. x.
Tinct. nucis vom |30 c.cm. oi gtt. v.
H. Sig.: A claretglaasful after each meal.
The preparations made from the fresh seeds — the fluid extract, wine,
fHxir — are elegant and very valuable restorative remedies,
or gr.
Ixxr.
or gr.
xxxviij
Of gr.
viiaa.
or gr.
"j.
i
, or!
KOtnnSS. — Kumyss, Milk-wine. Originally made in Asia by the
Tartars as an intoxicating drink by fermenting mares' milk, koumiss has
b«#D introduced into European medicine as a food and as a remedial agent.
It can be made for medical use by adding a small piece of compressed yeast
to diluted cows' milk containing a small amount of grape-sugar; it should
le kept in a cool place, with frequent agitation, and used on the fourth or
,-/.r , rpi^g ig^g pj.Qf g -^y Q^^^ (ColUge and Clinical Record) gave the
' J directions for preparing koumiss: Dissolve 16.6 Gm. (or .^ss) of
grap*.>ugar in 120 c.cm. (or f^iv) of water. Dissolve 1.30 Gm. (or gr. xx) of
jeut-cske in 120 c.cm. (or f.Vv) of milk. Pour both into a quart bottle and
in nearly to the top with milk. Cork tightly, fastening the cork with wire.
594
PHARMACEUTICAL THEaAPEUTIC A0EKT8 OH DltUGS.
Put into a cool place and shake two or three times daily for three days. Keep
for use no longer than six days. A cliumpagne-tap iiUroduced through the
cork is necessary. Kouinii?s contains about 16 per cent, of alcohol, and is a
pleasant, acidulous drink.
Physiological Action and Therapy. — The combined action of the car-
bonic acid and alcohol in koumiss produces an exhilarant impression. It
raises the arterial tension and assists in assimilation. It adds tone to the
stomach, aids the appetite, excites the action of the kidneys and skin, and
favors sleep. Koumiss, by reason of its utility as a nutriment during in-
flammatory action, is of great service in phthisis, scrofula, chronic bronchitis,
and in the treatment of surgical cases. In an irritable stomach it is a most
beneficial remedy in its sedative and nutritive effect.. In the nausea and
vomiting of pregnancy, owing to the action just referred to, koumiss very
often acts in a most happy manner, the nutrition and bodily vigor of patients
being increased by the continued use of koumiss during this period. At the
time of confinement, M*hen nausea and vomiting supervene, followed by
exhaustion, koumiss wiU often assist in restoring the fla.eging powers. Dur-
ing the state of lactation koumiss will be very grateful, will assist the nutri-
tion of the system, and will be productive of better and more nourishing
milk. Thominski has obser\'ed a decidedly beneficial effect from the use of
koumiss in two cases of irregular menstruation and in one case of abundant
nasal hiemorrhage.
In convalescence from acute diseases, in diarrhoea and dysentery, kou-
miss will be serviceable to feeble digestion, and will aid in assimilation. In i
cholera infantum, gastro-intestinal diseases of childhood, and in fevers kou-
miss is a most agreeable form of food. Koumiss serves as an excellent vehicle
for the administration of lactic acid to children suffering with diarrhoea.
D. H. Davies suggests the preparation of euonymizod koumiss as suitable to
cases of hepatic derangement attended by nausea and vomiting. It can be
made by adding 11 c.cm. (or foiij) of fluid extract of euonymus to every pint .
of the diluted milk from which koumiss is obtained. In the same manner
cocaine hydrochlorate may be incorporated with koumiss for the treatment
of cancer of the stomach. It is also an admirable remedy and food in acute
and chronic alcoholism, in albuminuria, diabetes, gastralgia; gastric ulcer,
and in the various forms of cancer and dyspepsia. Koumiss is especially
useful in cachexia of kidney disease (120 c.cm., or f5iv, four or five times a
•day)-
The amount of koumiss administered to each case should vary according
to the disease. In some instances from 30 to 120 c.cm. (or fji-iv) can be
given every one to three hours; in others as much as a good-sized glassful
or two can be taken frequently during the day and night. The writer has
administered as much as three or four quarts of koumiss a day in diseases
attended with much exhaustion, and often with decidedly good effect.
ZRAMERIA (U. S. P.).— Krameria (Ehatany).
KEAMERI^ EADIX (B. P.).— Krameria-root.
Dose, 0.32 to 1.30 Gm. (or gr. v-xx).
Preparaiwus.
Synipua Kranierue (U.S. P.). — Syrup of Krameria (fluid extract. 45; Bynip, Bfi).
Dose. 4 to 15 c.c'ni. (or (3i-iy).
Kiuidexlractum Kraineris (U. S. P.). — Fluid Extract of Kramerin. Dose,
I to l^ c.cm. tor mi-xx).
Extraciuui Kranieri* ( U. S. P., B. P.) .—Extract of Krameria. Dose, 0.065 to 0.66
^^BL (or gT. i-xi-
TiDctura KramericB (U. S. P., B. P.). — Tincture of Krameria (20 per cent). Doae,
4 W 15 com. (or f3i-iv). B. P., 2 to 4 c.cm. (or fSas-j).
Trochisci KrameriBe (U.S. P., B. P.).— Troches of Krameria (each, 0.065 Gm., or
gr. j, of extract). Doee, 1 or more.
Trochiflcus Krameriie et Cocainfle (B. P.). — Krameria and Cocaine Lozenge (ex-
tjact of Lrameria. 0.065 Gm., or gr. j; cocaine hydrochloride, 0.00324 Gm., or gr. V»).
Liquor Kramerie Concentratus (B. P.). — ^Concentrated Solution of Krameria.
Doae, 2 to 4 c.cm. (or f3fls-j).
lufusum Kramerise (B. P.). — Infusion of Krameria (50 Gm. to 1000 c.cm., boiling,
distiUed water). Dose, 15 to 30 c.cm. (or fSsa-j).
Fhannacology. — Krameria is "the dried root of Krameria triandra, of
K. iriua, or K. argentea ( Krameriaceae or LegumiaoBai)," (U. S. P.) ; "the
dri*Hi root of (1) Para Rhatany, a species of Krameria, attributed to Kra-
1 argentea. or of (2) Peruvian Ehatany, Krameria triatulra'' (B. P.)^
.- in^ in South America. It contains about 20 per cent, of Krameriotan-
iiic acid, which is the active constituent.
Physiological Action. — Krameria is a powerfui astringent.
Therapy. — In Peru it is largely used as a remedy for bowel disorders,
diarrbcca, dysentery, etc. The infusion is a satisfactory gargle for relaxed
throaty and the lozenge is also used for this purpose. The tincture of
krameria may be combined with chalk mixture in the treatment of summer
diarrhoea. Krameria is employed as a systemic remedy in epiataxis, hffim-
itaraeeia, hematuria, and other forms of htemorrhage. It is of service, both
locally and internally, in hsemorrhoids and leucorrhcea, and the tincture
or the fluid extract is used, diluted and in combination with other astrin-
^ gents, as an injection, in gonorrhoea. A mixture of the decoction and the
^■tincture was recommended by Trousseau as an injection for the treatment
^^<if fissure of the anus. The powdered extract enters into the composition of
I many tooth-powders.
LACTnCARIUM (U. S. P.). — Lactucarium, Lettuce-opiam.
Bote, 0.65 to 1.30 Gm. (or gr. x-xx).
Dose, 0.60 to 4 com.
:.cm. ■
Preparations.
Tinctura Laclucarii (U.S. P.).— Tincture of Lactucarium.
<er mx'Oj).
Synipus Lactuearii (U. 8. P.). — Syrup of Lactucarium (10 per cent of tincture).
Doae, 4 to 15 c.cm. (or fSi-fSss). •
Phannacologry. — "The concrete milk-juice of Lactuca virosa (Com-
fHieitae)," a wild variety of lettuce growing in Europe, but also found in
garden lettuce, Lactuca sativa. The only important constituent is the mixed
iub#l«nce, Lactucarium, obtained by evaporation of the milky juice. It is
in fattened pieces or cakes, of reddish-brown color, internally white or waxy-
^looking, of neavy, opium-like odor, and a bitter taste. French lactucarium,
ttg rimply a blackish-brown extract of lettuce, is inferior to that of the
aacopceia of the United States, which is made from the expressed juice.
ho French wrup of lactucarium (Aubergier), however, is considered an
ire a9 wrll ns an elegant preparation. Laclncarinm consists of Lactu-
or Lactucon; and the bitter principles, Lactucin, Laotuoopicrin, and
I
596 PIIAHMACEL'TICAL THEIUPKUTIC AOEXTM OH DHVGS. "
Lactucic acid. Mr. T. 8. Dyuiond hus slatted that a small proportion of
hyoBcyamine is containGd in lettuct*, but this has been diBproved. About 50
per cent, (consisting chiefly of lactiicerin) of lactucariuin is insoluble in
water. There is no aturcli present.
The syrup is pleasant to the taste; a glycerite may be made of the same
strength as the syrup, by using glycerin instead of simple syTup.
Physiological Action. — It is a feeble narcotic, and owes its reputation
largely to the obser^•ation that eating lettuce causes drowsiness. Its prepara-
tions vary greatly in activity, but are not toxic, and are therefore much safer
for children than those of opium. Some action upon the kidneys is also
observed, and it allays spasmodic cough.
Therapy. — Tho fivrup is ust'd iji tunigh-iuixturt'H for rliildrfn. To allay
nervous irritability, and aa a substitute for the soothing syrups containing
morphine, it has decided value. On account of its insoluble constituents,
lactnoarimn should be given in substance, or in the form of the tincture, or
the fluid extract of the Natiounl Pornmlary. The fluid extract may be used
in elderly persons, or where there is an idiosyncrasy against opium, to fulfill
the same ends.
Lactucin has been employed as a sedative and hjrpnotic in the doae of
0.066 to 0.13 Gm. (or gr. i-ij)."
LAMIlfARIA. — Laminaria, Sea-tangle. The cylindrical base of the
thiilhis of J^aniinaria Cloustoni, and of Ijiiminaria di^tata (Alga;), when
firied, are cut into approprinto lougtlif* and shape, and their surface made
smootli, to be used as substitutes for sponge tents in dilating the cervix uteri,
owing to their property, when moistened* of swelling up to several times
their original size.
LAPPA (IT. S. P.).— Burdock.
Doie, 15.5 Gm. (or 3iv) in recent infusion.
Preparation.
Fluidi'xtractwn Lnppce (U, S. i\j. — Fluid Extract of Burdot'k. Dose, 2 to 4
cem. (or mxxx-f3j).
Pharmacology. — "Tlie dried root of Arctium lappa, or of other species of
Arctium (Composiljc), collected from phmt.s of the first year's growth." It
contains a bitter princij^lc, volatile oil, n-siii, mucilage, sugar, and a little
tannin. There is no gtareh in burdock-root. ]>ut in its phiee inulin is found.
•Physiological Action and Therapy. — Burdock is diaphoretic, diuretic,
and laxative, without causing irritation. The fluid extract is used externally
for swellings, haemorrhoids, ulcers, etc., and internally for rheumatism,
syphilis, and chronic skin diseases.
Acunling to Stjuibb, the tincture* is n useful tonic and is held to be
curative iu fisoriasis.
The root is used for similar purposes to those of sarsapanlla in syph-
ilitic, gouty, and rheumatic affections, and in certain chronic skin diseases,
such as psoriasis. A fluid extract of the seeds (dose, 1 to 4 c.cm., or mxv-f3j)
and a tincture of the seeds (1 to 8) are employed; also an infusion or decoc-
tion of the seeds.
» "Ephemeria/' vol. i, p. 116.
The fresh leaves have been used as an application to bruises and eruptive
disorders.
LABGIN is a name given to silver-protalbin, by its originator, Lilien-
feld. of Vienna. It is a gray powder of low specific gravity containing 11 Vio
per cent, of silver. It is soluble in about 10 parts of water, making a reddish-
orown-tinged solution; such solutions should be' made with hot water.
Pexroli and Neisser claim a special penetration power as an antigonorrhceic
remedy, with destruction of the cocci in their nestSj with avoidance of irri-
tation of the mucosa. Pezzoli extols largin as the best of the silver com-
pounds. Prolonged injections of V4 to 1 Va per cent, of 10 c.cm. (or mcli)
ire used three times daily, retaining the quantity in the urethra from ten
to fifteen minutes, in treating specific urethritis. Furst has used largin in-
ternally, 0.50 Gm. (or gr. viij) in piil, as a substitute for silver nitrate, in
gastric ulcer and hffniorrhage.
LAUBOCEEASI FOLIA (B. P.).— Cherry-laurel Leaves.
Preparaiion.
Aqua Ijiurocerasi (B. P.).— Cherry-laurel Water (320 Gm., or Slxxxiias. in 1000
cjcm., or Oiifjij). Doae, 2 to 7.6 c.cm. (or fSaa-ij).
Pharmacologfy. — "The fresh leaves of Prunus laurocerasus" (B. P.),
ii belongs to the Rosacea?, contain Lauroceraiin, a compound of amyg-
nd amygdalic acid, and also Emolsin, which, when in the presence
water, form a volatile oil (benzaldehyde) and hydrocyanic acid, to which
owes its medicinal qualities. Cherry-laurel water is distilled from the
ah leaves, bruised and macerated in water; it contains the volatile oil and
hydrocyanic acid, but is of such uncertain strength as to almost preclude
its use in medicine.
Therapy. — It is used in Europe (very rarely in this country except by
foreign physicians) for the same purposes as bitter-almond water, and chiefly
f B vehicle for anodyne and antispasmodic remedies. A cherry-laurel oint-
aent, consisting of 1 part of essence of laiirel-wnter to 8 parts of lard, is
Itaed in Italy in painful affections, as neuralgia, herpes zoster, chronic rheu-
ilism. antl carcinoma. It \v<mld niakf an a^'tvcuble dressing for burns.
LAUBUS. — Laurel, Bay, or Bay-laurel. The leaves and berries (Lauri
olia and Lauri baccae) of I^aurus uobilis (Lauraceae), a tree of Southern
Europe, contain volatile oil, Laurin, or laurel-camphor; a liquid fixed oil;
Isolia fixed oil known as Laurostearin, and starch. The volatile oil of laurel-
il* insisting of a camphene and eugenic acid, is occasionally employed
lfr~- . . y in rheumatism. By boiling the fresh fruit in water and using
iure the expressed oil of laurel is obtained, which is used in the form of
tttmt'nt, as an anodyne. leaves, berries, and oil are atimnlant and narcotic.
, laurel ointment is official in the French Codex. It is composed of 1 part
leh of fresh laurel-leaves and laurel-berries, with 2 parts of lard. This
jaration is applicable to erythema, dermatitis, erysipelas, acute eczema,
"Mid superficial burns. The leaves are used in cooking for flavoring (bay-
ktTM, bay-laurel leaves); they should not be confounded with the leaves of
Myreia acris, from which the volatile oil of bay is distilled, that is used as a
i
PHARMACEUTICAL THEBAPEUTIO AGENTS OB DRUOB.
perfume (and enters into spiritus myrciae, or bay-rum), or Myricse Cerifera
Cortex, — bay-berry bark.
4
LAVA3n)TrLA,^Lavender, Lavender-flowers.
Preparations.
Oleum Lavandula Florum (U.S. P.). — Oil of Lavender-flowers. Dose, 0.13 to
0.30 c.cm. (or miii-v).
Spiritus Lavandulae (U. S. P., B. P.).— Spirit of Lavender (oil of lavender-flowera,
50; deodorized alooliol, 950 c.cm.; B. P., oil of lavender, .10 c.cm. (or fjj) ; alcohol. 90
per cent, 270 c.cm. (or fjix). Dose, 2 to 4 c.nxi. (or f3»fl-j). B. P., 0.30 to 1.20 c.cm.
(or niv-xx).
Tinctura Larandule Coraposita. (U.S. P., B. P.). — Compound Tincture (formerly
Spirit! of Lnvt'iulcr (V. tS. P. cnntrtiriM oil of liivcndcr. >l: oil of roH»^mnr>-. 2: «*jiii?on
cinnamon, 20; cloves. 6; nutmeg, 10; red saundcrs^ 10; in alcohol, water, and
diluted alcohol to make 1000 c.cm.). Dose. 2 to 4 c.cm. (or fSss-j).
Oleum Liivjindulffi ( B. P. ) . — Oil of Ijivcnder. Dose. 0.03 to 0.18 c.cm.
(or wisa-iij ).
Pharmacology. — The carefuly dried flowers of Lavandula angustifolia
(Labiatae), much cultivated for their perfume, contain volatile oil, some
resin, and tannin. The oil of lavender, distilled from the whole herb or'
flowering tops, is coarser than that distilled from the flowerg alone; of the
latter there are several varieties, diifering in value and fineness. The Eng-
lish ailj distilled from cultivated flowers, (known as oil of garden lavender)
is to be distinguished from the ordinary commercial oil, wliich ifi much lower
in price, and is made from wild flowers (also known as French oil of
lavender). An inferior, greenish, turpentine-like oil, distilled from Lavan-
dula spica, 18 known as oil of spike-lavender. The oil of lavender has the
property of checking decomposition. The compound tincture ie an elegant
preparation of aromatics and ptiniulants.
Lavender is carminative and stimulant. It is useful in flatulence, nerv-
ous dyspepsia, gastralgia, eolalgia, hysteria, and syncope. Lavender is said
to be possessed of considerable hypnotic power. It is used in perfumery, and
enters into the unoflicial spiritus odoratus and vinum aromaticum; also
liquor potassii arsenitis (U. S. P.), liquor arsenicalis (B. P.), and spiritus
amnionic aromaficus (U. S. P.).
LEDrM. — Ledum, Wild Rosemary. The small twigs, tops with unde-
veloped flowers and leaves of Ledum palustre (Ericaceae), hut without the
fruit even partly formed, contain volatile oil. Valerianic Acid, Ericolein,
Leditannic Acid, resin, etc., and are used in infusion, as marsh-tea. Ledum
is said to be somewhat narcotic, astringent, and tonic: it is used externally
to destroy parasites, and internally in diarrhoea and dysentery, gout, rheu-
matism, and chronic skin diseases. Dr. R. Hilbert, of Sensburg, reports that
an infusion of the leaves of this plant (G to 12 Gm. to 240 c.cm., or Siss-iii
to f'viij of water) acts as a good expectorant in bronchitis. It rapidly re-
lieTcs the pain and fever, especially in juvenile patients. In chronic bron-
chitis it diminishes cough and facilitates expectoration. This writer regards
ledum as especially valuable in bronchitis with emphysema occurring in aged
persons, as it renders the secretion less viscid, stimulates the circulation, and
lessens dyspna?a.
lEOKUHUS. — Leonurus, Motherwort. The flowering tops and leaves
of Leonurus cardiaca (Labiate) contain a bitter principle, some volatile oil,
LUiON.
etc. It is used in recent infusion, and, as a fluid extract, with dilute alcohol,
us njen?lruum to promote the menstrual diechorge, and in suppression of ^
the lochia. It is also deemed useful in hysterical pains.
LEPTANDEA (U. S.P.).— Leptandra (Culver's Boot)
Bose, 1.30 Gm. (or gr. xx).
Preparations.
Extractum leptandra (U. S. P.}.— Extract of Leptandra. Do8«, 0.20 to 0.65 Gm.
for gr. iii-x).
Fliiicioxtrnotnm Leptandnc (U. S. P.). — Fluid Extract of Leptandra. Dose,
2 to 4 c.cm. (or l3aa-j).
Pharmacology. — "The dried rhizome and roots of Veronica virginica
(Scrophulariacese)" contain a bitter principle. Leptandrin; also saponin,
tannin, resin, starch, etc. What is ordinarily designated leptandrin is merely
in impure resin or alcoholic extract. Leptandra is common in woods from
Vermont to Wisconsin and southward.
Physiological Action. — Leptandra-root, or Culver's physic, is a chola-
og\c cathartic. It should he dried, for in its recent condition it acts too
"iolently. The extract is an eligible form in which to use the drug, which,
in small doses, ia tonic and laxative. Leptandrin in its common form is
employed as a cathartic in doses of 0.065 to 0.13 Gm. (or gr. i-ij).
Therapy. — In indigestion, with deficiency of secretions and constipa-
^tion, leptandra has been found useful, and may be combined with podoph-
rllum, which it resembles in its effects, or with aromatics. When the stools
Mre clay colored and show a deficiency of bile, this agent may be used to
Tiring about bilious discharges, even when there is diarrhuea.
LIMON.— Lemon. %
Preparations.
Limotiis Succus (U.S. P.).— Lemon juice. The freshly-expreseed juice of the ripe
fruit of <itriia limonum ( AurnntiaieiB).
Liinonis Cortex ( U. S. P., B. P.). — Lemon-peel. "The recently -separated outer
. ritid of the ripe fruit of Gitrus limonum ( Aurantmcetr)" {V. S. P.) '; "the fresh outer
r^n of the pericnrpof the fruit of Citru* nicdif^a" (H. P.).
Prtparationg from the Cortex, or Rind.
Oleum Limonis <U. S. P.. £. P.).— Oil of Lemon. Dose, 0.03 to 0.18 c.cm. (or
iij); al«o used for flavoring.
Tincturn Liinonis CorticiA (U. S. P.).
Tinctura Limonis (B. P.). — Tincture of I-emon. Dose, 2 to 4 c.cm. (or f3«8-j).
SvTUpus Limonis (B. P.). — Synip of Lemon. Dose. 2 to 4 c.cm. (or f3»s-j).
Preparations from the Juice.
Synipua Aridi Citrici (U.S. P.)- — Syrup of Citric Acid. As a vehicle.
Acidum Cilricum (U.S. P., B. P.), — Citric Acid. Doac, 0.32 to L30 Gm. (or gr.
rxxz).
Pharmacology. — Lemons, owing to their pleasant flavor and agreeable
acidirv. are very useful in the sick-room. The rind is glandulous, and by
n yields an oil of great fragrancy, much superior to that obtained
Ll_. ......lation. When fresh, the rind of lemon, besides the oil above men-
tioDed, contains a bitter, crystalline glucoside, Hesperidin. Each lemon
elds from 7.5 to 30 c.cm. (or fSii-viij) of acidulous juice, containing citric
id (7 to 9 per cent.), besides phosphoric and malic acids, in combination
Jy with potassa and other bases. A solution of citric acid in water (2.30
.to 30 c.cm., nr gr. xxxiv to f.^j) correapondB in acidity with fresh lemon-
I
600
PHAHMACEUTICAL THERAPEUTIC A0ENT8 OR DRVOS.
juice, but not therapeutically on account of absence of other constituents.
Fifteen c.cm. (or fjss) of leiTion-juice Hhoukl nculralize '-2** gmins of potas-
sium bicarbonate, 20 of sodium bicarbonate, or l-i of ammonium carbonate.
Lime-juice, obtained from a smaller fruit of the same genus (Citrus acris),
closely resembles fresh lemon-juice, but acquires a peculiar, slightly musty
taste from the wood in which it is imported. When preserved, boiled in
syrup and dried (candied), lemon-peel is useful in flavoring, for cooking, etc.
Therapy. — Lemon-juice is applied to the surface of the skin to remove
freckles or ephelides, moth-spots, sunburn, pruritus, and ink-stains. Used
internally, lemon- or lime- juice ia antiscorbutic, probably owing to the
presence of phosphoric acid or potash salts^ as citric acid does not possess
this property. It is now so constant a companion of voyagers by sea that
scurvy is rarely seen, except where the regular ration of lemon- or lime-
juice has been neglected. It is also curative in scurvy, and in various scor-
butic manifestations upon the skin, or in the form of muscular pains. In
some cases of chronic rheumatism the administration of several ounces of
lemon-juice daily allorda marked relief. Lemon-juice has been likewise used
in acute rheumatism with, at times, apparent good results. Lemonade, made
by diluting lemon-juice with water and adding sugar, is a useful drink dur-
ing convalescence; it increases the urinary water and reduces the acidity of
the urine. Hot lemonade is useful as a diaphoretic in recent colds; its
effects are increased by the addition of a little whisky or gin. Neutral mixt-
ure, made by neutralizing fresh lemon-juice by the addition of crystals of
potassium bicarbonate, is useful as a refrigerant and to satisfy thirst in
to vers.
In typhoid fever the late Dujardin-Beaumetz advised the free use of a
vinous lemonade, made according to the formula: —
3 Syrup, acid, citrici 001 c.cm. or fjij.
^^ Vini nibri 24ti| can. or ijviij.
^H OU*i liuionm 11 c.ctn. or mxv.
^P AquflB q. 8. ad 1000] '-.cm. or OiifSij.— M.
Atheromatous changes in the arteries are retarded by the persistent use
of lemon-juice, which is also useful in obesity. In Italy, an infusion of the
lemon, the rind being incised to allow the juice to escape, is administered
in ague and other malaria! attacks attended by fever. Lemon-juice is re-
garded as of material assistance to other remedies in the treatment of torpid-
ity of the liver and catarrhal jaundice.
JJNBETL2B CORTEX.— Lindera-bark, Spicc-bush Bark. The Benzoin
odoriforuni (Lauracciv)^ Lindora benzoin, or ppicc-bush, is one of our com-
mon forest shrubs, belonging to the same natural order as the sassafras, the
cinnamon, and the camphor-tree. The bark and fruit contain a volatile oil,
resin, and the common vegetable principles. The bark has a pleasant, spicy
taste, due to the oil.
Physiological Action. — It is nromatic, sUmulantj and tonic, and a
recent, hot, weak infusion is diaphoretic.
Therapy. — In sonic tlit^oidors of fligestif»n tlir carniinnlivc and tonic
effects are available; the infusion is used in chills and to abort a cold. A
decoction of the inner bark made into an ointment with cold cream is
recommended by Hyde as a Valuable remedy in rhus poisoning.
LnnJM (U. S. p., B. P.).~Iin»ecd (Flaxseed).
Preparations.
Oleum Lini (U.S. P., B. P.).— Linseed-oil.
Linum CoDtuaum {D. P.)- — Crushed Linseed.
Pharmacology and Therapy. — ^"The ripe seed (drieii ripe, B. P.), ot
Ijumn usit-atissimiun (Linaeea'J," eomnionly oiilled flaxst'od, contains muci-
lagi', linolein, and giun (L5 per cent J. The hitter forms mucilage with
boiling water, which is not precipitated by tiUiuiii. M
A nitrogenous glucoside, termed linamarin, lias been obtained from ■
Uie young plant by MM. Jorisstm and Hairs. Liiiamarin differs in several
physical and chemical j)roperties from uiiiy^aliilin, and occurs as colorless and
odorless needles which have a very cooling and bitter taste. It is soluble
ID water and alcohol, but almost insoluble in ether. It is not present in the
»«<Is, which contain about 25 per cent, of albumin, and no starch. The
inverting coat of the seeds yields a very viscous mucilaginous substance to
b4:iihng water. Linum is demulcent and emollient. A hot infusion (15.5
Gm. to 500 c.cm., or Sss-Oifoj), flavored wiih licorice-root or lemoc-peel, is
ti^d in bronchial inflammations as a diaphoretic and expectorant; also in
cystitis, strangury, and hsematuria. A plain infusion is an excellent enema
for use in inflammation of the rectum, fissure, haemorrhoids, etc. Flaxseed-
tea is used as a demulcent drink in gastritis.
Ground flaxseed mixed with boiling water forms flaxseed poultice, which
is ipread at least half an inch in thickness upon muslin or flannel, and ap-
plied as hot as possible in order to relieve pain and congestion in peritonitis,
and in pneumonia, pleurisy, etc., as jacket poultices, renewed every two or
fnree hours. They should be covered with oiled silk to retain heat and
ni'jsture, and, if desired to increase the counter-irritant effect, a little dry
mustard or a few drops of turpentine may be sprinkled over the surface.
V.xty usually afford great relief to the patient. Laudanum, or lead-water
iiiiii laudanum, is often used with a flaxseed poultice in inflammatory and
painful affections. Flaxseed poultices are also applied to boils and abscesses
U) **if|rn the skin or to hasten ri|)ening. They are also applied occasion-
allr to ulcers and wounds to encourage granulations and bring about healthy ■
«CtlOD. *
The long-continued application of poultices is likely to bring out an
eruption of small boils upon the skin, the result of hypercemia and irrita-
tion. Poultices are often useful for temporary purposes, but too long ap-
mischievous. The integument and the vessels subjected to their
become relaxed, suppuration is prolonged, granulations rendered
unhealthy, and the repair of ulcers or wounds retarded.
Oil of flaxseed is an old application to burns to exclude the air; com-
Uthh] with lime-water, it forms Carron oil, which was formerly used largely
for thii purpose, having been originally used at an iron works of that name
in Scotland, where the workmen were frequently burned. It is dirty and
mx>n smells badly, and is now abandoned in favor of petrolatum and kaolin.
Whftli* flaxseed, in 15.5 Gm. (or 5ss) doses, have been ordered in habitual
■on as a laxative. Flaxseed candy is popularly used for phaniigi-
' - hee.«.
UPPIA MEXICANA. — Lippia Mexicana (\^erbenace»), a creeping^
9t€rgreen shrub, with very long roots and numerous branches, grows abun-
60a VUAUAIAOEUTIUAL TUKKAPEUTIC AUENXS OK DKLGS. ^
dantly in southern Mexico. Its medicmal virtues reside in the leaves and
stalks, especially in the leaves, whidch possess an agreeable, sweetish, and
aromatic taste. The plant contains a small proportion of tannic acid, an
ethereal oil, and a volatile camphor termed lappioL xV fluid extract and a
tincture have been prepared, the dose of the former being from 0.30 to 2
c.cm. (or tnv-xxx)y and of the latter from 2 to 4 c.cm. (or f5ss-j).
Fiiysiological Action. — Lippia causes a sensation of warmth in the
stomach, and in large doses may give rise to vomiting. This is succeeded
by free perspiration and sleepiness.
Therapy. — The drug is endowed with valuable expectorant properties.
It allays irritation of the bronchial niucons membrane and promotes healthy
secretion. Its effects are rapidly manifested. Lippia is useful in both acute
and chronic bronchitis. In the former it allays the cough, and in the latter
it liquefies the viscid secretion and facilitates expectoration. It is of service
in the cough of phthisis, has an excellent effect in irritative cough, and in
whooping-cough mitigates the paroxysms, though it is not able to shorten
the course of the disease. It has, in some instances, proved useful in spas-
modic asthma.
LIQITIDAMBAE.— Sweet Gum.— The Liquidambar stj'raciflua (Hama-
melacese) of North and Central America supplies a brownish-yellow balsam»
containing styrol (3 y^ per cent.), cinnaraic acid (5 per cent.), styracin, and
resin. It is identical with storai, according to Professor Maisch. The synip
of the bark of the root, made like the syrup of wild cherry, is a remedy used
for diarrhoea and dysentery in the Southern States.
LIQUOR FORMAIDEHYDI (U. S. P.).— Solution of Formaldehyde.
Pharmacoloi^y. — Formic aklohyd, or formalileliyde, is a colorless gaseoua
body (CHjO), with a pungent, irritating odor, and very decided antiseptic
and bactericidal properties. It was discovered by llofniann in ISfiS. It
may be produced by exposing a heated platinum spiral to the vapor of methyl
alcohol; it is therefore an oxidation product, Forriuildeliydu gas is obtained
conveniently by heating an aqueous solution. The officifil solution must
contain not less than 37 per cent, by weight of absolute formaldehyde
(H.COH^29.79). It should bo kept in wclI-stoppertHl bottles in a cool place,
protected from tlie light. Formnldi^hyde solution is a colorle?? fluid of jmn-
gent odor and mixes with water in fill jiroportinns. This, whon boiled, gives
off the vapor of formaldehytlc, and, less rapidly, at ordinary temperatures.
Paraform is the commercial title of a preparation in the fonn of pastilles.
This substance, which is a polymerizeil form of fonnaldohyde, may be used
to generate the gs^fi by nieaui? of a suitable lamp.
Fhyftiolo|;ical Action. — Formaldehyde is an cflieiont bactericide. The
vapor readily condenses upon objects in an apartment where the fluid is
exposed. It is, consequently, excellently adapted to the disinfection of
surgical and dental instruments, sick-rooms, hospital-wards, furniture, cloth-
ing, books, discharges, drains, etc. It destroys foul odors, and ponetrntea
fabrics without injuring them or destroying their color. Its inhibitory in-
fluence upon the growth of bacteria enables the investigator to fix, at any
stage, those organisms for the purpose of study or demonstration. This
property has been likewise applied to the diagnosis between the typhoid
bacillus and the bacterium coli commune, which organisms exhibit a markecl
difference of susceptibility to the action of formaldehyde.
UqrOR FORMALOEHYDI.
G03
»
iter
■ Sta
Foriualtlehyde-gas is only Blightlv toxic. Flies and insects nre not affected
by it; but liigher animals suffer from the very irritating character of the
rapor to the eyes and uoee. Undiluted formalin (40 per cent.), when applied
to the animal skin, occasions necrosis without suppuration. An injection
equivalent to about 0.37 c.cm. (or fnvj) to the pound of body-weight was
npidly fatal to guinea-pigs, the animal becoming comatose and dying with-
out convulsions. It reduces temperature from 2° to 4° F. It is eliminated
in the urine within twenty-four hours. Attention has been directed to the
use by dairymen of formaldehyde, in order to prevent souring of milk. The
Editor of the Cincitifiati Lancei'CUnic has recently called attention to this
form of adulteration, and attributes many cases of ice-cream poisoning to
this cause. He asserts that "the yearly mortality among children in New
York is ascribable more to formaldehyde milk than any other agency."
Glover reports h gievere urticaria following tiie application to the scalp of a
wash containing formaldehyde.
Treatment of Poisoning. — Andre reported a case of poisoning with one
flrachm of a 40-per-cent. solution, which was treated successfully with solu-
tion of acetate of ammonia. The action of ammonia on formaldehyde is to
form heiamethenamine (or urotropin), which is comparatively innocuous.
Aromatic spirits, or plain water of ammonia, may also be used.
Therapy. — Formalin has been employed in general surgery by de Buck
tad Vanderlinden, of Ghent. A Va-per-cent. solution was used for washing
hands,' cleansing the seat of operation, and for the disinfection of wounds,
ciTities, and sinuses. These writers have obtained excellent results from
itsaae as a wash and dressing after major operations.
The peculiar necrotic effect of formalin may render it valuable in the
de&truction of benign or malignant growths of the akin. Mitchell treated
urcoma successfully with compresses of 20-peT-ccnt. solution, covered by
gatta percha tissue, renewed once daily. A V^- to 1-per-cent. solution is
reconunended aa a serviceable application to sweating hands and feet. It
haa been demonstrated that this agent would prove a serviceable application
ia ptoriasis and lupus. On account of the ready diffusion of its vapors, M.
Potterin asserts that formalin is an excellent antiseptic application to the
rifin, FTiitable to the treatment of diseased conditions of the hair-roots and
follicles. Absorbent cotton moistened in a 2-per-cent. solution of formalin
and covered with an oil-skin bandage is usually well tolerated. A 5- to 10-
per-cent, solution has been used successfully in favus. Formaldehyde in
gaseous form is now generally used as a disinfectant. For disinfecting and
rteriliziDg purposes, special forms of apparatus can be obtained, which are
eonvonient and efficient, at a moderate cost. They are uf^ed in the United
State's army and in the Marine-Hospital service, as well as by local health-
nU.
5 In the practice of dentistry formalin may be used for the purpose of
Idlling the nerves of carious teeth. The inhalation of a very weak spray of
forrotlin may prove beneficial in chronic laryngitis, bronchitis, etc., but the
nasal mucosa ia too sensitive to permit its use in any strength which would
be likely to be serviceable, unless there is a preliminary spraying with
cocaine.
Formalin has been used in ophthalmology by Dr. M. Yalude. A solu-
tion of 1 to 2000 causes slight smarting when first applied to the eye, but
th« fensation soon vanishes. With a solution of this strength Vahide has
604
PHARMACEUTICAL THERAPEUTIC AGENTS OR DHD08.
successfully treated chronic conjunctivitis and ophthalmia neonatorum, anc
recoiDiupnrls its ailditinu to collyi'ia in orMiT t<t oifwt jitorilizatiou.
Formaldehyde has lately been used by ITahn^ in chronic joint affections
of tubercular origin, and also in tubercular abscesses and empyema. The
abscess-cavity is emptied by means of the aspirating needle and thoroughly
cleansed from the tubercular pus by repeated injections with boric-acid solu-
tion. Then a 1-per-cent. solution of foriualdehyde in glycerin is thrown into
the cavity, the amount used varying from one-third to one-half of the quan-
tity of pus withdrawn. The results have been markedly successful.
Id laryngeal tuberculosis and also in pulmonary tuberculosis the inhala-
tion of a spray, or simply of the vapor of hot water containing a few drops
of the solution, has been found very useful by Solis-Cohen. T. J. Gallagher,
of Denver, after cleansing the laryngeal ulcer with hydrogen dioxide and
applying cocaine, uses a local application of V2 ^^ 10 percent, which shrinks
vegetations and destroys micro-organisms. In whoopin^j-cough and diph-
theria sprays of 1 per cent., for twenty minutes, thrice daily are very efficient.
The hypodermic or iiif ravenous injtvtinns of weak solutions of formalin
have been employed in phthisis puinibnalis, and especially in puerperal
septicaemia. This method is not recommended, becnuae, as shown by W. H.
Park, of New York Health Dcprtrtmeut, the formahn actually redueeii the
resistance of the whit* blood-cells and tissues, to the infection.
UTHIITM.— The metal (Li).
Salts.
4
Lithii Benzoas (U. S. P.).— Lithium Benzoute. Dose, 0.32 to 1.30 Gm. (or gr.
v-xi).
Lithii Bromidum (U.S. P.).— Lithium Bromide. Dose, 0.32 to 1.30 Gm. (or
gr. v-xx).
Lithii Salicylas (U. S. P.).— Lithium SalicyUte. Dose, 0.32 to 1.30 Gm. {or gr.
v-xx ) .
Lithii CarbonaB (U.S. P.. B.P,).— Lithium Carbonate. Dose, 0.32 to 1.30 Gm.
(or gr. v-xx).
Lithii atras (U.S. P., B. P.).— Lithium Citrate. Dose, 0.32 to 1.30 Gm. (or gr.
v-xx).
Lithii Citras Kffervescens (U.S. P., B. P.).— Effervescent Lithium Citrate. Dose,
4 to S Gni. (or 3i-ij).
Pharmacology. — Tjithhun is ati silkiili oietal existing in niilure as a sili-
Ci\U\ in the nrmcmls, Lipidolite, Petalite, etc., or as tlic phoppliatc, ia Tri-
phyline and Amblygonite. It decomposes water at ordinary temperatures,
bill without m(?lliiig like sodium, and is le^s ca.'^ily o.xidized than either
sodium or potassium. TIio nu-tal (wliich is not oJHcial) rcftonihles tin. It
was fir.«t oblainod by TUiuson by eleclrolysis nf the chloride. Its salts are
soluble in water, but the carbonate and phosphate only slightly so.
Physiological Action, — Lithium urate is freely soluble, and therefore
when lithium, in combination with the vegetable acids, is administered,
these palls aie deeoiufjosed in ilie .^vstem and the litl)ium,ct»mbinin.ir with uric
acid, renders it soluble, and thus facilitates its expulsion from the body.
The.<«? salts arc al?o diuretic, and their ndminitjLratinn, therefore, produces an
increase in the urinary secretion. Lithium carbonate promotes the assimila-
'CenfraWmt fUr Chirurpie, No. 24. 1899.
LITHIUM.
G05
Uon and metabolism of nitrogenous material and increases the elimination of
urea. Some mineral waters largely owe their medicinal effects to the small
proportion of these salts which they contain, being rendered more effective
bj natural combination with other salts. According to the experiments of
M. Binet. toxic doses of lithium occasion arrest of the heart in diastole.
Therapy. — In the uric-acid diathesis the several salts of lithium are
ued with great advantage, even where chalky deposits exist. It has been
aisertefl tliat their prolonged use will dissolve uric-acid calculi in tlie urinary
puMgvs or bladder. Where there is vesical catarrh and alkaline urine, the
benzoate is the best salt to use, since it renders the urine more acid ; where
the urine is already too acid the other oilicial salts are preferable. In gouty
«ubjfcta, especfally those suffering with indigestion, lithium renders good
service, and can be given in the form of an effervcacent salt or in Vichy
watiT. In gravel, lithium affords prompt i*eHef. It may be aided by hexa-
mcthyenamine. Dr. Duche states that the local action of lithium is benefi-
cial to gouty joints and that gouty conjunctivitis is relieved by frequently
" ing the eyes with a 1 to 500 solution of lithium carbonate.
The salts of lithium have likewise been advantageously employed in
Tonic articular and muscular rheumatism. In rheumatoid arthritis they
sometimes seem to delay the progress of the malady.
M. Vulpian has found lithium salicylate of service in relieving the pain
which, after acute rheumatism, often lingers in the joints when the swell-
ing has disappeared. He believes it is especially beneficial in fibrous
rheumatism. In progressive subacute rheumatism he has seen it produce
great improvement. In the chronic articular form of the disease this salt
has a marked effect upon the joints.
In gout, subacute and chronic rheumatism, as well as in irritable blad-
der from excess of acid and in uric-acid calculi, lithium may be given thus:
wati^i
L mcth
■ cial t
B Lithii citratu 6| Gm. or Sisa.
Liquor nmmonii aoetatis,
Syrupi liinonis aa to{ c.cm. or fSij.
M. Sig.: Two te«spoonfula in water every two or three hours for rheuraatiftm
and gout.
B Uthii iodidi 41 Om. or 31.
Syrup, aarsaparillee comp 150{ c.cm. or fjv.
M. Sig.: A half io a tableapoonful three or four times a day for syphitia.
H Lirhi! aalicylatia.
Quinins sulphatis aa 2|60 Qm. or gr. zL
M. et fL capsulse no. xij.
8ig.i A capeule or two every two or three honra for rheuraatism and goat.
R Lithii bromidi 10 Gm. or Siiss.
Tinct. cardamom, comp 30 c.cm. or fJJ.
Clycerioi 90 c.cm. or f5>ij.
11 8ig.: Two teaapoonfula in water every hour or two hours for rheuraatism
ud gout
B Lithii benzoat 8| Gm. or 3ij.
Tinct bcUadonnw foUor 4|75 c.cm. or mlxxij.
Flujdcxtracti tritici (K)| c.cm, or fjiij.
II. Sig.: A teaapoonful every two or three hours for irritable bladder, depending
OB iscMs of acid, and in uric-acid calculi.
GOG PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
In pruriginoua eczema, caused by gout, a pill composed as follows may
be given with advantage: —
H Sodii bcnzoat.,
Litbii benzoat.,
Ext. gentian ', aa |065 Gm. or gr. j
Glycerin q. s.
M. Sig.: One pill three or four times ft day.
1
A combination of lithium carbonate with sodium bicarbonate is praised
by Dr. C. Lange as an excellent application in severe general parsesthesia.
In glycosuria, the combination of arsenic with a Uthia-water has been
vaunted as curative. The late Dujardin-Beaumetz suggested that the addi-
tion of strontium lactate to a lithia-water bids fair to prove of advantage in
the treatment of diabetes mellitus. Lithium bromide has been found bene-
ficial in epilepsy by Weir Mitchell, who states that it will in some cases suc-
ceed after failure of potassium or sodium bromide. The same writer regards
its hypnotic power as superior to that of the potassium bromide. The lithium
should always be administered in a large excess of water, and distilled water
is better for this purpose on account of its diuretic properties. The artificial
lithia-water containing a definite solution of lithium in distilled water is more
reliable than many of the commercial, natural lithia-waters. Lithium iodide
contains a large proportion of iodine, and is a good method of administering
this remedy, the only objection being its high cost. Woodbury* recom-
mends the administration of a solution of lithiuiu iodide by electricityj
through the cataphoric action of the galvanic current in tubercular syph-
ilides.
LITMUS, — A blue pigment from Rocella tinctoria (Lichenes), impart-
ing its blue coloring-matter, Orcein, tn water and alcohol. Paper stained
with a solution changes its color to red in the presence of an acid; the blue
color is restored by plunging the paper in an alkaline solution. Hence we
have blue and red test-papers for acids and for alkalies.
LOBELIA (U. S. P., B. P.).— lobelia.
Dose, 0.50 to 1.30 Gm. (or gr. viii-xx), as an emetic.
Preparations.
A
Tinctura Lobelia? ( U. S. P.). — Tincture of Lobelia (10 per cent.). Dose, 0.30
to 8 e.cm. (or tHV-f3ij).
Fluid ex traotum lx>lM'liin {V. S. P.). — Fluid Extract of Lolielia. (Acetic Acid
Menstruum.) Dose, O.Ofi to 0.<tO e.cm. (or mi-x).
Tinctura Lobelise i^^Itherca (B. P.). — Ethereal Tincture of Lobelia (20 per cent.
in spirit of ether). Dose. 0.30 to 1 e.cm. (or mv-xv).
Pharmacology. — Lobelia consists of "the dried leaves and tops of Lo-
belia inflata (Campanulaceae),*' "collected after a portion of the capsules
have become inflated" (U. S. P.), "the dried flowering herb of Ijobclia in-
fiata" (B. P.)/* It is a small horh, common by the waysides, with alternate
leaves, an erect, hairy stem, with blue flowers in the axils of the leaves. The
herb has a slight odor and a burning, tobacco-like taste. The chief constituent
* 'Transactions of the College of PhyBiciana of Philadelphia,' 1890, and Medical
LOBELIA. 607
b a liquid or viscous alkaloid, Lobeline, combined with Lobelio aoid and
Lobelacrin. It forms crjstallizable salts. The seeds contain about 30 per
cent, of oil. A neutral principle, Inftatin, which geems to be inert, was
isolated by Procter and Lloyd. Lewis states that lobelacrin is not a distinct
principle, but that it is a mixture of lobeline lobeliate with free lobelic
acid.
Physiological Action. — Lobelia has no local action, but there is some
danger that it may be absorbed and produce systemic effects if applied too
freely to the skin. Internally, it is a powerful depressant in large doses,
and sialagogue, expectorant, emetic, and purgative, according to circum-
stances. This drug frequently produces headache and vertigo, and may
cause death from exhaustion, or by paralysis of the respiratory centre. It
depresses the circulation and action of the heart, favors diaphoresis through
the violent emesis which it causes, and also lowers temperature. Lobelia also
promotes the discharge of urine and has some narcotic properties. Lobehne
fii«t increases, then diminishes, and finally abolishes reflex action. It gen-
erally increases artA-ial pressure and stimulates the respiration. In over-
doses it causes death by respiratory failure.
Should alarming symptoms follow an overdose of lobelia, the proper
treatment consists in washing out the stomach with a solution of tannic
icid, the external application of heat, and a hypodermic injection of alcohol,
ether, ammonia, or strychnine. Subsequently, moderate doses of opium or
morphine given hypodermically, will allay vomiting.
Therapy. — An infusion of lobelia (1 part to 16) has been used as a
lotion in dermatitis due to rhus toxicodendron. It has valuable antispas-
modic powers, though it is generally employed in too small doses, in asthma.
Ringer administers 4 c.cm. (or f5j) of the tincture every hour, or 0.60 c.cm.
(or mx) every ten minutes, immediately at the onset of a paroxysm of asthma,
with marked benefit in shortening the attack. Lobelia may be employed thus
for asthma: —
B Tlnct lobclis 30] c.cm. or fSj.
Tincl. hyoscyami 16] c.era. or fSw.
Aquse camphorfle,
8piritUB eetheris nitrosi «a 301 c.cm. or fSj.
Syrupi pruni Virg 15[ c.cm. or f5«R.
K. Sig.: A tcftBpoonfuI in water every half-hour or hour until relieved.
H Fluidextracti lobeliic . . 2j c.cm. or f3afl.
Sodii bromidi Ht|4 Gtn. or 3v.
SiTUp. ipecacuanhas 15| c.cm. or fSsa.
Glycerini 120| c.cm. or fSiv.
M. 8ig.: Two teaapoonfuh every one or two hours.
B Ac«tanilid. , , 4| Om. or Sj.
Tinct. lobelin 7 6 c.cm. or fSij.
?i>T. critulictyi nronuit. (N. F. ) q. 8. ad 00| c.cm. or fjiij.
M. 8ig.: Take a teaspoonful every quarter of an hour during attack of aathmn
mtil rtliered.
Tjobelid should only vimt exceptinnally bo employed as an emotio. as it
prixluces too much nniisea and depression, and vhen bo used has caused
death. For tho gume roaaon lobrlia is detrimental when dyspncea is occa-
lioned bv disease of the lieart.
608 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
Hysterical convulsious yield to a teaspuonful of the tincture injected
into the rectum (E. M. Hale). In angina pectoriPj t«n or fifteen drops will
give almost immediate relief (John M. Scudder). It is also useful in asth-
ma. Lubelia is esteemed of value in spasmodic laruiptis. The spasmodic
stage of whooping-cough is often ameliorated and shortened by the exhibi-
tion of this remedy. It is, relatively, better tolerated by children than by
adults. On account of its expectorant properties, lobelia is of service in
bronchitis, especially when the mucus is dry, the cough hard and barking, or
the expectoration is extremely tough and hard to raise. In the treatment
of whooping-cough and bronchitis lobelia may be administered as follows: —
B Tinct. lobeliae 71
Sodii bromidi 12
SpirituB ffitheris nitrosi 30
Syrupi limonU q. a. ad 90
M. Big.: A half to a teaspoonful every one or two houra to a child for whoop-
ing-cough.
I^ Tinct. lobeliflE 16
Aitiitionii iodidi 8
Spiritus setheris comp 60'
Syrupi Tolutani 75
M. Sig.: Two tcaapoonfuls every two or three hours for bronchitis
C.CZD.
or f3ij.
Gm.
or 3iij.
c.cm.
or fSj.
c.cra.
or fjiij.
to a
t^hild for
c.cm.
or fSsft.
Gm.
or 3ij.
c.cm.
or fjij.
c.cm.
or fSiisa.
i
In constipation ami ftecal iiiipai'tiun, the tincture of lobelia in 0.06-o.cm.
(or mj) (lusee every hour promotes j>eri8tal8is and etiinulates intestinal secre-
tions; or a O.CO-c.cm. {or mx) dose may be given at bed-time, acting as a
purgative in a similar way to toHncco.
Lobeline sulphate, a yellowish-white powder, is said to produce good
results in asthma and bronchitis in doses of 0.065 to 0.38 Gm. (or gr. i-vj).
Lobeline has been employed with success, principally in the treatment
of spasmodic asthma, by Dr. Silva Nunes, who claims that it is free from
nauseant or irritant properties and can be subcutaneously injected. He has
used it in doses of 0.01 to 0.05 Gm. (or gr. Vo'Va) for children and 0.05 to
0.38 Gm. (or gr. Va-'^j) for adults. Dr. Nunes writes that the administration
of lobeline produced a cure in eight cases of tetanus.
LORETIN. — Loretin is an iodine compound (meta-iodo-ortho-oxy-
quinoUne-suIphonic acid) originally prepared by Professor Claue, of Frei-
burg, as a substitute for iodoform. It is a yellow, crj'stalline powder,
entirely free from odor, slightly soluble in water and alcohol, and insoluble,
or nearly so, in ether and oils. With nietallic oxides it combines to form
salts. Its alkaline salts ore readily soluble in water. The calcium salt does
not dissolve in water.
Physiological Action and Therapy. — Loretin possesses antiseptic prop-
erties, does not irritate the skin, and is said to be devoid of toxic quality.
This substance has been employed as a surgical dressing by Professor Schin-
zinger, of Freiburg. Mixed with q small quantity of calcined magnesia it
can be serviceably dusted upon wounds or insufflated into cavities. A 2- to
5-per-eent. solution of the loretin-sodium salt is useful in the irrigation of
wounds. Gauze impregnated with the calcium salt answers a good purpose
as a dry dressing. Collodion containing loretin forms a good application to
many wounds, and when painted upon a large erysipelatous surface was soon
LVtorEKlX)\.
609
followed by a marked reduction of fever. The same preparation was bene-
ficial in lupus after cauterization had been practiced. Loretin powder was
beneficially applied to burns and eczema. Professor Schinzinger has em-
ployed It u-ith satisfactory residts as a dressing after major operations. A
favorable report of the usefulness of this remedy in veterinary surgery has
been made by G. Fenzling.
Biunnth loretin is a useful application to chronic ulcers, cutaneous
lesions of syphilitic ori^n, and moist eczema, being employed in these cases
tsa itowder, 10-per-eent. ointment, and paste. The bismuth compound has
slso Deen given with success internally in tubercular diarrhoea.
LOSOFHAN. — Tri-iodo-metacresoL Losophan is the trade name given
to the product resulting from the action of iodine on oxy-toluyl acid in the
presence of an alkali. It contains 80 per cent, of iodine, and occurs in the
form of white needles, which melt at 250.7° F. Losophan is slightly soluble
in alcohol, insoluble in water, readily soluble in ether, chloroform, benzol,
and, at a temperature above 140° F., in fixed oils. Losophan* is soluble in a
dilute solution of sodium hydrate, but is changed by a concentrated solution
into a greeniph-blnck, amorphous body.
Physiological Action and Therapy. — The effects of losophan muet be
closely observed, as it is a decided irritant. The value of this substance as
a topical remedy in diseases of the skin was investigated by Dr. Edmund
Saalfeld, of Berlin. He employed it in the form of a l-per-eent. solution in
3 parts of alcohol and 1 of water, and as a 1- to 3-per-cent. ointment. It
was found of service in different forms of tinea, in chronic infiltrated
eczema, squamous and fissured eczema. In prurigo anrl para^sthesia loso-
phan relieved itching. The application of a l-per-cent. losoplian ointment
accompliehed good results in certain cases of sycosis. It was useful, like-
wise, in acne and rosacea. In pediculosis and scabies it sometimes acted as
a parasiticide. It is inapplicable to acute inflammatory diseases of the skin.
I/>sophan is recommended by Dr. Descottes as a serviceable apj)lication to
leg-nlcers, chancres, and chancroids. He employed solutions and ointments
containing 8. 10, or 20 per cent, without, as a result, perceiving any iiYita-
tion of tiie skin.
LUPiniNTrM (U. S. P., B. P.)-— Lupulin.
Dose. 0.13 to 0.32 Gm. (or gr. ii-v).
LUPTOITS (B. P.).— Hops. (See Humulus.)
Preparations of Lupulinum.
Fluidcxtractum Lupiiliiii {V, S. P.). — Extract of Lupulin. Dose, 2 to 7,5
exm. for f3M-ij).
Oleorcsine Lupulini (U.S. P.). — Oleoreiin of Lupulin. DoMi 0.00 to 2 c.cm. (or
■B'XZZ).
•Tl»e glandular trichomes separated from the fruit of Humulus lupulns
(31i>r.u*ii')."
LTCOFEEDON. — Puff-ball. Lycoperdon solidum or giganteum (Fungi)
10 powder is hiemostntic. It is credited with narcotic properties, but has
teen occasionally used for food.
€10
IMIAKMACEUTICAL THER.\PECTIC A0EXT3 OR DRCQS.
LYCOPODIUM (U. S. P.).— lycopodium.
Pharmacology, — "The spores of Lycopodium clavatum and of other
species of Lycopodium (Lycopodiucea?)."' Ihcy contain nearly 50 per cent,
of an oil similnr to expressed oil of almonds. It contains about 2 per cent,
of lytopenlic acid.
Physiological Action. — Lycopoditiin, given internally, was supposed in
the past to have diuretic and antispasmodic action. Merrell states* that the
eclectics claim that lycopodium acts as a stimulant to the sympathetic vis-
ceral nerves, and therefore is of value in functional diseases of the organs
under their control. Greene believes that lycopodium stimulates the liver,
thus lessening the work of the kidneys, and that it also has an anaesthetic
elTect upon the mucous membranes.
Therapy. — Lycopodium is a bland powder, and (imlees contaminated by
addition of potato-starch) is an excellent dusting-powder for intertrigo, or
to prevent excoriations, especially in infants,
Lycopodium has also been employed for the treatment of rheumatism,
dyspepsia, pulmonary and renal diseases. Some physicians use it triturated
with sugar of milk, in minute doses, for affections of the mucous tract, par-
ticularly dyspepsia, pyrosis, ileocolitis, and for diseases cf the urinaiy organs.
LYCOPirS. — Bugle-weed. The Lycopus Virginicus (Labiatse) is a small
lierb comniori in wet places, resemblincj tlie mints, but wanting their aroma.
The whole herb is used in decoction or infusion, but a fluid extract is the
most eligible form in which to give it. It contains a volatile oil, with a little
resin and tannin.
Physiological Action and Therapy, — Bugle-M-eed is astringent and
sedative. It has been used in pulmonary disorders and phthisis to allay fever,
cough, and expectoration, liugle-weed is likewise stated to check hsemor-
rhage from the lungs and other organs. It reduces the force and frequency
of the heart's action, and acts as a sedative, and in large doses is depressant
to the nervous system. Hy virtue of the volatile oil it is somewhat carmina-
tive, and in small doses is considered tonic. It has been used in organic and
fum?tioual heart disease, and in f^xophtbalmns by i>r. Hector.- It is of
service in spasmodic cough in combination with belladonna, but rarely used.
LYSOL. — A liqiiifl coal-tnr product, containing 50 per cent, of pure
rresol. It is produced by dissolving tar oil in fnt, and saponifying and dis-
solving in nlrohol. In 1-per-cent. solution, it has been used as an antiseptic
vaginal doiicbp, and wound-drc.csing. With tbp addition of 1 per cent, of
Bodium hydrate, it is n useful agent for n-ndering tuberculosis sputa innoc-
uous. It is claimed to be five timc« stronger than phenol as an antiseptic,
and only one-eighth as toxic.
MAGNESIUM.— The metal Magnesium (Mg).
U, S, P. Sails and Preparations.
Miignesii Oxidum. — Light Mngiiosin, Calcined Magnesin. Dose. 4 to 15.5 Gra.
(or 3i-iv).
Magnesii Oxidum Ponderosum. — Heuvv Magnpsia. Dose, 2 to 15.5 Gm. (or
Sa«-jv).
' The Medical Standard, Chiongo. Jan., 1891.
* Chicago Medical Times, June, 1889.
UAONEBIUtt.
Gil
»
Htgnesii Carbonas. — Magnesium CarbonaU, Heavy Magnesium Carbonate.
Dose. 15.5 to 62 Gm. (or Sesij)-
Magnesii Sulphas. — Magnesium Sulphate, Epsom Salt. Dose, 4 to 31 Gm. (or
Magnesii Sulphatis Effervescena. — Effervescent Sulphate of Magnesia. Dosei
4 to 15 Gm. (or 5i-»v».
Liquor Magncsii Citratis. — Solution of Magnesium Citrate (dispensed in bottles
coatjuiuiig 473 acm.. or Oj. eflfervescing when opened). Dose, 120 to 473 c.cm. (or
Frrri Hj-droxidum cum MugneHiii. — See Fcrrutn.
Pulris Rliei Compositus. — See Rheum.
Talcum. — Mjigiic^ium Silicate. A Native.
Talcum Purifieata. — Purified Talcum. For e.\ternal use as dusting powder.
B B. P. Salts and Preparations.
Magnesia Levis. — Light Magnesia, Light Calcined Magnef^ta, Light Magnesium
Oxide. Dose. 0.32 to 2 Gm. (or gr, v-xxx) for repeated administration; for single
admioistrmtion, 2 to 4 Gm. (or gr. xxx-lx).
Magnesia Ponderosa. — Heavy Magnesia, Heavy Calcined Magnesia. Uea\^ Mag-
nesium Oxide. Dnse, 0.32 to 2 Gm. (or gr. v-xxx) for repeated administration; for
smgle administration, 2 to 4 Gm. (or 3s6-j).
Magneflii Carbonas Levis. — Light Magnesium Carbonate. Dose, 0.32 to 2 Gm.
(or gr. r-xxjc) for repeated administration; for single administration,^ to 4 Gm. (or
gr. xxx-lx),
Magneui Carbonas Ponderosus. — Heav^* Magnesium Carbonate. Dose. 0.32 to 2
Gm. <or gr. v-xxx) for repeated administration; for single administration, 2 to 4 Gm.
(or 5sa-j).
MAgnesii Sulphas. — Magnesium Sulphate, Epsnm Salt. Dose, 2 to 8 Gm. (or
im-ij) for repeated administration; single adminii^tration. 8 to 15.5 Gm. (or 3ii-iv).
Magnesii Sulphas Effervescens. — Effervescent Magnesium Sulphate. Dose, 4 to
15.5 Gm. (or 5i iv) lor repeated administration; for single administration, 15.5 to 31
Gm. (or 3s9-j).
Liquor Magnesii Carbonatis. — Solution of Magnesium Carbonate, Fluid Mag*
Mdft. Dose, 30 to (10 com. (or fSi-ij).
Pharxnacolo^. — Magnesium is a light, silver-like metal, which, rolled
in ihin plates or ribbons, can be ignited, and will burn with a brilliant,
white flame, forming a white smoke of the oxide. Magnesium carbonate is
of two varieties, one heavier than the other; by calcination in a crucible
they 3rield the two forms of magnesiiini oxide, light and heavy magnesia,
inm carbouate and the oxides are white in color, alkaline, insoluble,
reless^ or nearly so. 'I'he sulphate is in colorleiis crystals, of u rather
luraapous, bitter taste, and quite soluble in water; it occurs native, and is a
ooDstituent of sea-water. It enters into the compound infusion of senna
<r. S. P.). The sulphite is a white, crystiilliue powder, obtained from the
preceding: it ali>o is of slightly bitter taste, and is soluble in 20 parts of
vater. It oxidizes upon exposure to the air.
Physiological Action. — Magnesia (or calcined magnesia, as it is com-
monly called) and the carbonate have a slightly astringent effect upon the
ddn. When taken- into the stomach, they are antacid and laxative. Mag-
Bcsm may be used as an antidote to acids, and also in poisoning by phos-
phorus, copper, or arsenic; for the latter a U. S. P. official combination with
ferric hydrate is provided. The citrate and sulphate are saline cathartics;
the latter haa no direct cliolngogic effect, as whs formerly thought, but acts
principally as an irritant to the intestinal glands.
Aa a metallic poison, M. Binet has demonstrated that magnesia arrests
iht heart in diastole and causes a precocious paralysis of the peripheral
»
G12
PHARMACECTICAL THERAPEUTIC AOEXTS OR DIIUOS.
nervous system. It was shown by Claude Bernard that magnesium sulphate
produces a purgative elTect wheu iujecied into a vein,
S. J. Meitzer has found that magnesium salts, especially the sulphate,
have the property when applied to nerve-tittfiie of exerting a profoundly
inliibitory effect. Intravenous injectioua inliihit respiration and cause pa-
ralysis of the entire body. Sul)outaneoii8 injections produce deep narcosis
with complete muscular relaxation. Subnraclmoid injection by lumbar punc-
ture causes ahnost iniuiedinte anaesthesia and pnralysis of the lower half of
the body, lasting several hours.
Therapy. — Magnesium carbonate, which comes in small cubes, is used
locally I'l dry tlie skia and prcvt^nt dialing or ».'.\coriiition. Internally it is an
antacid for indigosti(m, heartburn, tmd pyrosip. and is used as a laxative for
infants. Sick headache, dependent upon gastric acidity, is relieved by the ad-
ministration of magnesium carbonate. Magnesia ponderosa is a convenient
form in which to administer the oxide; it may be given suspended in orange-
juice or milk. Magnesia has been used with variable success in B}Tnpathetic
vomiting and the vomiting of pregnancy. It is of service in neutralizing uric
acid, and may, therefore, be employed in lithiasis, though inferior in this
condition to' lithia. Tn adults, if constantly administered, it may form
large concretions in the intestines. The citrate is more purgative, and, in
the U. S. P. official effervescent salt and solution, is a pleasant cathartic for
simple evacuation of the bowels. The sulphate is more active, causing free
watery discharges. It may be given in repeated small doses, every hour, in
order to overcome faecal impaction; also in the constipation of lead poison-
ing:—
3 Magnesii eulpbatis 8
Morphinte sulphntia
Aquffi menthie piperitas 00
M. Sig.: A tablespoonfu! every two hours in lead colic.
Gm. or 3ij.
005 Gm. or gr. j.
c.cm. or Qiij.
4
In surgery, the discovery by Dr. Meltzer of the method of producing
analgesia of the lower extremities by intraspinal injection of magnesium
sulphate, has been utilized in operating. The dose employed was 1 com. of
a 25-per-cent. solution, for each twenty pounds of the weight of the patient.
The best time for ojicrntiun is three or four hours after the injection. Sensa-
tion and motion return in from J^ to 24 hours, without evil after-effects.
Dr. Matthew Hay advocates the use of magnesium sulphate in the treat-
ment of pleural and other serous effusions, administering 31 to 6S Gm. (or
5i-ij) at a dose and restricting the fluids drunk. The citrate and sulphate
cause little, if any, irritation, and may safely be used in enteritis or in peri-
tonitis to keep the bowels open. In many acute febrile disorders, small doses
of these salines are beneficial, and in atonic conditions they may be com-
bined with iron. The purgative mineral waters — Friedrichshall, Pullna,
Seidlitz, and Hunyadi Jauos — owe their property principally to magnesium
sulphate. The bitter taste of the Epsom salt is covered by adding some cof-
fee to its solution. It is the cathartic to administer in cases of the peculiar
diarrhoea caused by impacted masses of faeces in the colon, and in dysentery
it proves very serviceable associated with aromatic sulphuric acid and lauda-
num. In acute dysentery, mngnoflinm sulphate sometimes acts remarkably
well, often removing fever, the blood and mucus from the stools, together
with the tenesmus.
itAGNEBICM.
613
*
Dr. A. W. D. Leahy, who has treated ninety-five cases of acute dysentery
with magnesium sulphate, with only two deaths, recommends the remedy,
combined as follows: *'Take a sufficient quantity of sulphate of magnesia to
uturate 210 com. (or f5vij) of water, and to this solution add 30 cxm. (or
loj) of diluted sulphuric acid. The dose of this is a tablespoonful every hour
or two in a wineglassful of water until it operates. Sulphate of morphine
IMV be added, or a starch enema with laudanum.^ A little tincture of car-
damom will make the mixture more agreeable.
In a case of tetanus, the subarachnoid introduction of magnesium sul-
phate has afforded marked relief, and after a few uiore injections the patient
recovered.
That a small dose of Epsom salt hypodermically injected produces a
purgative effect, first asserted by Luton, has since received demonstration
by Dr. J. Percy Wade. The dose injected varied from 0.13 to 0.20 Gm. (or
gr. ii-ivss). The small was found to be as efficacious as the larger dose. The
procedure occasioned no local reaction. A small dose repeated within a
short time had a better effect than a single dose of larger size. The method
was successful in 67 per cent., and in only two patients was it a constant
failure. This expedient was adopted in the treatment of constipation in
the insane by George H. Roh6. In repeating these experiments^ Fincke
failed to obtain an equal degree of success, the proportion of cases in which
a purpative effect was produced amounting only to 13 per cent. In nnseniia
$ii <^orosis, which Clarke attributed to faecal intoxication, the following
cofnbination forms a useful tonic hixative: it is known as Mistura ferro-
3 Magnesii sulphatis ....
PoiaBBii bitartratis
F»rn siilphat exsiccftt.
Aqtue
. 31
4
.1000
Gm. or 5j.
Gm. or 3j.
65 Gm. or gr. x.
OiifSi
c.cm. or
fSij.
M. Sig.: A Hineglawful half an hour before breakfast each morning.
H Where a more-decided purgative effect is desired, the remedies should
^ be given in more concentrated form, thus: equal parts of Rochelle and
Epsom salts may be taken, — say, each a teaspoonful, dissolved in a small
qaantity of water; iliis dose to be repeated hourly imtil bowels move.
The sulphate relieves congestion of the kidneys, general an&Barca« the
(tdema of lung or brain which may occur in Bright's disease, ascites, ura?mia,
rectal and pelvic haemorrhage, especially when accompanied by constipa-
tion. It is likewise of service in stricture or cancer of the rectum and
fissure of the anus by liquefying the fsecal passages. This and other
atline purgatives possess the valuable property of being able to act painlessly
upon the bowels of a patient who is fully under the influence of opium: a
fact which renders them additionally useful in rectal carcinoma. When the
ttomtch is too irritable to permit its administration by the mouth, mag-
oesium sulphate may be given in the dose of 62 Gm. (or 5ij) by enema with
complete success. Epsom salt is likewise of service in the treatment of lead
colic, combined with a little dilute sulphuric acid, tincture of opium, and
•rnip of ginarer. Tlie effervescent magnesium sulphate of the British
Phftrmn<^pceia is useful as a substitute for saline mineral waters.
Magnesium sulphite has been recommended as a remedy for infectious
*Uneet, Oct 4, 1890.
614
PHARMACEUTICAL THERArEUTIC AGEXTS OH DRCOS.
dyspepsia and inflammatory or febrile diseases of infectious origin. This
salt has been found useful, likewise, in diphtheria. It is given in the form
of a tabletj allowed to dissolve slowly in the mouth, or the affected parts
are dusted with tlie powdered drug. It is said to promote a rapid disappear-
ance of the false membrane.
MAGNOLIA.~-Magnolia. The bark of Magnolia glauca, M. acuminta,
and M. tripetala (Magnoliacea?), all indigenous trees of our Eastern and
Southern States. The drug contains, besides resin ard tannin, a bitter
crystallizable, neutral principle, Magnolin, soluble in alcohol, but not in
water. A fluid extract made with alcohol is the best preparation.
Physiological Action. — An aromatic bitter, which can be used in appro-
priate dose as a tonic or as an antiperiodic. Diaphoretic properties are also
ascribed to magnolia.
Therapy. — Magnolia is used in debilitated conditions of the system
attending malarial attacks, rheumatism, etc. In intermittent fevers it has
been used successfully as a substitute for quinine.
MAIDIS STIGMATA.— Com-silk.
Pharmacology. — The styles and stigmas (Stigmata maidis, corn-silk)
of Zea mays, Linne (Graminea?), maize, or Indian corn, gathered when the
tassel has shed its pollen. They are said to contain an active principle which
is termed Maizenie Acid, which has been recommended for use in doses of
0.008 Gm. (or gr. Vs). The plant is too well known to need any description.
A native of America, it has been extensively cultivated in all temperate
climates. Some of its preparations are the following: Extractiim stig-
matorum maidis fiuidum (fluid extract of corn-silk); dose, 4 to 7.5 c.cm.
(or foi-ij). Vinum stigmatonim maidis (wine of corn-silk); dose, 15 to 30
c.cm. (or fSss-j). Syrupus stigmatorum maidis (syrup of corn-silk); dose,
15 to 30 c.cm. (or fjss-j).
Physiological Action and Therapy. — The preparations of corn-silk are
palatable and well tolerated by the stomach. Its principal action ia as a
diuretic, and it likewise seems to exert a sedative action upon the urinary
passages. When a*deraa is associated with an enfeebled condition of the
heart, corn-silk, by exciting diuresis, acts indirectly as a heart-tonic; the
pulse becomes regular and increases in force, while arterial tension is raised.
Corn-silk is of service in congestion of the kidney, chronic nephritis, and
pyeUtis. During its administration, albuminuria is lessened and the excre-
tion of urea is augmented. It also answers a good purpose in suppression
of urine. In lithiasig, renal colic, and hsematuria, corn-silk has been fotmd
of benefit.
It is useful in uric acid and phosphatic gravel. Irritability of the blad-
der, acute and chronic cystitis (especially the latter), retention of urine, and
prostatitis are ameliorated by this remedy. According to Dufau, it is contra-
indicated in acute traumatic cystitis and gonorrhceal cystitis, increasing the
pain of the malady. Other observers, however, report good results from its
use in cystitis dependent upon gonorrhcea or stricture. Some, after having
thoroughly washed out the bladder, employ the fluid extract of corn-silk
diluted with water as an injection, with asserted good results. Others speak
favorably of its use as an internal remedy in acute gonorrhcea. It has been
given with success in nocturnal incontinence of urine. In oedema of the
MALAKIN.
615
*
I
loir«T extremities, associated with disease of the heart and iu general dropaj
from heart or kidney disease, corn-silk is serviceable alone or combined
thtu: —
45| c-cm.,or fjiss.
B
Fluidextracti stigmfltorum maidis
Fluidextracti taraxud,
Infust digiialift aa 90| ccm. or fSiij.
Sig.: Two teaspoonfulB in water every three or four hours.
Fltiidextrncti Btigraatorum maidis 60
Potaasii bitartratis 12
Spiritua uethem nitrosi GO
Sig.: A balf-tablespoonful every two or three hours.
c.cm. or fjij.
Gin. or 3iij.
ccm. or iSij.
Com-Lusk. — Dr. J. W. Pruitt, of Russelville, Ark., asserts that a dis-
tilled extract prepared from the husk of Indian corn is an excellent remedjr
in chronic malaria. It is said to control temperature^ allay irritability of
the stomach, regulate the functions of the liver and kidneys, and reduce
enlargement of the spleen. It often exerts a mild diuretic influence. The
extract is clear and transparent, resembling hntled green corn in odor and
taste. It can be preserved by the addition of alcohol and glycerin, and is
administtred in the dose of 4 to 7.5 c.cm. (or foi-ij) every two or tliree hours.
TJstilago Maidis. — Ustilago, or corn-smut, is a fungus resembling
ergot, growing upon all parts of the Zea mays. It should be preserved in a
dry state, and should not be kept longer than a year. Corn-emut contains
about 5 per cent, of an amorphous, reddish-brown substance resembling
iclerotic acid.
The physiological action of ustilago has been studied by Dr. James
Mitchell, who ascertained that it destroys consciousness, paralyzes first the
Mssory tract of the cord and subsequently the motor centres of the cord and
motor nerves.
The fluid extract is used in a similar manner to ergot, in order to stimu-
late the contractions of the uterus tluriug and after labor. Dr. Dorland states
that ustilago excites clonic father than tonic contractions of the womb dur-
ing labor, and is, therefore, to be preferred to ergot. Estachy has given this
remedy with success in haemoptysis and spermatorrha?a.
The usual dose is about 2 Gm. (or gr. xxx), or 1 to 5 c.cm, (or mxv-lxxv)
of a fluid extract.
MAT.AKTy, — Salicyl-paraphenetidin. Malakin is the name bestowed
npou a combination of salicylic aldehyde with paraphenetidin and is closely
related in chemical composition to phenacetin. The compound appears in
the form of small, silky needles, of a yellow color, insoluble in water, slightly
•oluble in cold alcohol, but readily dissolving in boiling alcohol. It is in-
soluble in alkaline carbonates, but dissolves in a soda-lye, forming a soda
combination of an intense-yellow color. Malakin is decomposed by the
mineral acids, even when these are considerably diluted. It contains about
50 per cent, of salicylic acid. The latter substance, consequently, o{>erates
in the nascent state, and apparently in smaller doses than when administered
bj the mouth under its own form.
Physiological Action and Therapy.— The effects of this drug have been
investigated by Dr. Jaquet, of Bale,* who found that it exerted no influence
*Le ProffT^B Medical, No. 61, 1802; The Afedical BuUetin, Feb.. 1894.
■
616
PHARMACEUTICAL THERAPEUTIC AGEXTS OU DBUGS.
upon the respiration, heart, or blood-pressure of rabbits. That it was ab-
sorbed when taken into the stomach was shown by the presence of salic3^1ic
acid in the urine. It is decomposed by the gastric juice, and is insoluble
in the intestinal fluids. It is slowly broken up in the stomach, and the
absorption of its components proceeds gradually, for which reason its action
is not manifested till after the lapse of a certain time. The remedy is well
borne. Muntagnon asserts that makkin has a diuretic effect and facilitates
the elimination of uric acid.
In daily doses of -i to 6 Gm. (or 5i-iss) malakin has a beneficial action in
rheumatism. The temperature is reduced on the second or third day of its
administration, the local inflammation is diminished, and the pain is grad-
ually lessened. It does not cause, as far as has yet been observed, any
buzzing in the ears, loss of Appetite, or vomiting. Abundant sweating has
sometimes been seen at the period of crisis, and in one case Dr. von Bauer
observed unpleasant symptoms of collapse after eight doses of 0.50 Gm.
(orgr. viij) each had been taken at hourly intervals. The fall of temperature
Eroauced by this substance generally begins about two hours after a dose
as been taken. The temperature slowly decreases, reaches a minimum at
the end of three to four hours, when it commences to ascend. Malakin ia
not especially efTicaeious in the violent and persistent hyperpyrexia of the
eruptive fevers and pneumonia. It renders the most efficient service in the
later stages of typlioid fever and in the fever of tuberculosis. It generally
proved bcnefieial in pleurisy and peritonitis, llalakin is thought to be par-
ticularly appropriate for use in chronic maladies and when the patient is
enfeebled, on account of its freedom from depressant effect. According to
Dr. von Bauer, of Vienna, its antipyretic influence is less than that of anli-
pyrin and phenacetin. Favorable results have also been obtained from the
use of malakin in neuralgic affections.
MAILEIN. — Mallein is an organic product, a glycerin extract of the
eolultlc !inl>stan(*i\> jiroducod by ihc trlnu'ltTs bacillus, when grown in r)-per-
cent. glycf^riu beef bouillon. It pmdiurs iiuirked ilisturbnmv when injected
into an aninialj suITt^riiig with ghiiiders; and is used [trinripnlly for diag-
nosis in veterinary practice.
MAITTTM (U. 8. P.), Malt, and EXTRACTTTM MALTI (U. S. P. ». —Ex-
tract of Malt.
Pharmacology. — Malt is the seed of barley, Hordeumdistichum (Gram-
inea?). partially genniniited by iirlificial uicans and dritnl. Extract of malt
is made with wntcr at n ni<ideratc iieat and evaporated by means of a vacuum
npparatii.-i to llie cunKistoncy of thick bonoy. The sweet principle is niult-
sugnr, or Maltose. The method adoptod in making the "diastasie*' extract of
lualt, the author is informed by Jfr. Tjonis Genois, is to macerate well-maltf*d
barley in wnmi water for several hnur.'i, until the stflrchy matter has been
changed to dextrin and maltose; the infusion is then simmered with fresh
hops at a temperature under IHO*^ P., in order to retain the diastase and
otlier albuminoids unimpnired. and the resulting liquid subjected to fer-
mentation until the percentage of ovtractive matter amounts to about 12 per
cent, anil that of jiIcmIioI to about -1 ]»er cent. This takes from seventy-five
to one hundreil days. When pmpi^rly mtide, tlie extract and diastasic ex-
tract of malt not only contiiin all the nutritive substances of malted barley,
but also a peculiar ferment (diastase), which has the power of converting
MANACA.
G17
rdi to ihe s*>luble foriu, thus assisting in the digestion of amylnceoiia food.
ntlicial malt extract, R'8€Mnl)ling honey in density, is a good vehicle for
won. iho hypophosphitcs, quinine, etc.
Therapy. — Extract of mall is a valuable food, in concentrated form, and
ctstlj nssimilated. It is pleasant to the taste, can be eaten upon bread or
mixed with milk, and agrees with the digestive organs. It forms, with an
equal qnantitj of good codliver-oil, an emulsion which children readily take,
and which is useful in convalescence or wasting diseases. The water may
be entirely extracted in the vacuum apparatus, giving us dry extract of malt,
which is the basis of some largely-used food preparations for young children
and invalids. The other form of liquid malt just referred to is made by
fermentation, and several varieties of this malt are sold, varying in alcoholic
strength from the smallest traces to S or 10 per cent., making, in fact, a beer.
Bitter liquid malt is a valuable remedy in cases of general debility, deficient
digestive power, or loss of appetite. It is probably one of the best agents for
increasing muscular tissue and augmenting fat; many persons gain consid-
erable weight from a malt course. The use of malt liquors has been already
referred to under the head of Alcohol.
HANACA. — Brunfelsia hopeana (Scrophularineft;), Manaca, or Mercuric
TegelaJ is a Brazilian shrubj the root of which possesses medicinal virtues.
The bark of the root, when reduced to powder, has a yellowisli-brown color
and an odor which recalls that of cornmeal. An energetic alkaloid, difficult
to isolate in a state of purity, has been discovered by Dragendorff. Manaca
n oHicial in the Brazilian dispensatories, the dose of the powdered root being
given as 0.50 to 1.30 Gm. (or gr. viii-xx). In this country a fluid extract has
been made and may be given in doses of 0.30 to 1.20 c.cm. (or mv-xx).
PhyBiological Action. — According to the investigations of Dr. E. P.
Brewer/ of Norwich. Conn., manaca has no influence upon the brain or
laenaea, but stimulates the motor centres of the spinal cord, and in full
" oliahcs the reflex function of the cord. It depresses the cardiac
and respiratory reflex centres and stimulates the glands, especially the sali-
vary, gastric, intestinal, and cutaneous; also the liver and kidneys. Signs
that ita physiological action is produced are, in man, a feeling of band-like
constriction around the head, nausea, and profuse perspiration. When these
symptoms manifest themselves the remedy should he suspended or reduced
in quantity. In its home, manaca is regarded as purgative, diuretic, and
emmenagogic; also antis^'philitic and antirheumatic. In small doses it ia
resolvent, in large doses an acrid poison.
Therapy. — Manaca has been principally used as a remedy in rheumatism.
In the acute form of this disease the articular pain and swelling not infre-
quently subside rapidly after the development of the physiological efTects of
ine drug. In a considerable proportion of cases chronic rheumatism is
ameliorated by the administration of manaca. In muscular rheu-
this drug is likewise serviceable, and may be profitably combined
liti potaaaium iodide and cimicifuga, as in the following prescription: —
B |>r.i,t.«M i«xlidi 6| Gm. or 3ias.
K't. cimicifu^ii*,
1 irt. iniiniu'w aa 61 c.cm. or f3iss.
Syrup, furfluparillii' comp q. ». &d 12o| c.cm. or fSir.
M. Sig.! A ljibl«fi[ioonful four times a daj.
'Theropeutie Qazcite, 1882, p. 320.
618 PIlAUitACEUTIC.AX TlIEUAl'ELTIC AGENTS OB DRUGS.
In neuralgia of rheumatic origin manaca may sometimes be used with
advantage. In scrofulous manifestations and in secondary syphilis it has
been administered with asserted good eilects. From its action upon the
secretions. Dr. Brewer infers that it might be of benefit in gastric and gastro-
duodenal catarrh and jaundice dependent upon the latter condition, as well
as in simple jaundice due to inaction of the liver.
MAJTGANITM:.— The metal Manganese (iln).
Preparations.
Mangnni Dioxidum Prscipitntiim (U. S. P.). — Precipitated Mangtinesv Dioxide.
Dose, 0.13 to 0.66 Gm. (or gr. ii-x).
Mangani Sulphas (U.S. P.}- — Manganese Sulphate. Dose, 0.13 to 0.32 Gm. (or
gr. li-v).
Mangiini Hypophosphia (U. S. P.). — Hypophosphite of Manganese. Dose, 0.13
to 0.32 Gm. (or gr. ii-v).
Potassii Pennanganaa (U.S. P., B. P.). — Potassium Permanganate. Dose, 0.03
to 0.005 Gm. tor gr. ss-j). B. P., 0.065 to 0.20 Gm. tor gr. i-iij).
Liquor PotAssii PermangnnatU (B. P.).— Solution of PotAssium Permanganate (1
per cent.). Dose, 7.5 to 15 c.cm. (or f3ii-iv).
Fharmacolo^. — Manganese is whitish gray, very hard, and almost as
infusible as platinum, but in the metallic state is not used in medicine or
surgery. Jt exists in small quantity in the blood and bile, in company with
iron. The dioxide, or black oxide, treated with hydrochloric acid, yields
manganous chloride, water, and chlorine, and is Bometimes used to supply
chlorine in the sick-room. When heated with potassium chlorate, it under-
goes no change, but favors the steady evolution of oxygen-gas from the
potassium salt, and this method is generally followed for the production of
oxygon on a small scale for laboratory purposes. Permanganate of potas-
sium combines with and destroys organic substances, and is a chemical anti-
dote to morpliinr'.
Physiological Action. — Tlie sulphate is an emetic and purgative in
doses of 4 to 8 Gm. (or .>i-ij), and has also decided cholagogic properties; in
smaller doses it may be used as au hepatic stimulant. Overdoses of man-
ganese salts, especially if long continued, depress the system, lower the heart-
action, favor fatty degeneration of the muscles and of the liver, and reduce
blood-pressure. Excessive doses occasion gnstro-enteritis. These salts are
intestinal irritants. The black oxide has emmenagogic properties. Small
doses favor haematosis, acting, like iron, as a tonic. Potassium permanganate
is an oxidizing agent and a generator of ozone; it is a valuable antiseptic and
disinfectant. In the stomach it arrests fermentation, but probably is at once
decomposed as a result of its combination with organic material, so that it
is not absorbed into the circulation in its own form; but, nevertheless, in
whatever form it finally is absorbed, it does exercise a systemic effect, and
is considered a good cramenagogue.
Therapy. — In solution (0.065 to 0.32 Gm., or gr. i-v, to 30 c.cm., or f^j,
of water, or even more dilute) the permanganate is useful as a deodorant to
foul wounds, compound fractures, and ulcers; it is also injected into the nose
in ozsena, or used as a mouth-wash in diphtheria, scarlatina, necrosis of jaw,
cancer of the tongue, and conditions causing foul breath. In bromidrosis
(fetid perspiration) of the feet, sponging with permanganate solution and
the use of a drying-powder of starch and salicylic acid will often correct the
4
MANOANCM.
61£)
condltiou. Injections of permanganate are sometimes slightly irritating, or
even caustic, and they should not be used in gunshot wounds of the abdomen
or absceeees connected with the peritoneal cavity, for fear of injurious con-
teqaences. In treating purulent discharges from the external ear^ the per-
manganate is thought to favor perforation of the tympanic membrane, and
if used at all here it should be in very dilute solution. Dr. Albert Terson
has found solutions of potassium permanganate useful in purulent ophthal-
mia. He employs a solution varying from 1-2000 to 1-5000.
In the strength of 0.13 Gm. to 30 c.cm. (or gr. ii-foj), permanganate has
been used with success as an injection in gonorrhoea and leucorrhcea. An
ointment containing manganese dioxide has been used in tinea, scabies, and
porrigo. M. Galezowski, of Paris, has reported good results from the use
of batlis of potassium permanganate in the treatment of small-pox. In the
treatment of disorders of the uterine functions many practitioners speak
highly of the manganese salts, especially when the trouble is due to func-
tional, and not to any mechanical or obstructive, cause. Dr. John N. Up-
shur, of Richmond, Va., has observed benefit in membranous dysraenorrhcea
from the use of the oxide (0.13 Gm., or gr. ij, each) in gelatin-coated pills,
given four or five times daily. The permanganate is often not well borne
by the stomach. Manganese dioxide is also of service in amenorrhoea, or
sudden suppression of the menses as a result of cold, and when the menstrual
discharge is scanty and irregular. Manganese is useful in anemia and chlo-
roais, particularly when given in conjunction with iron: —
H Potaflsii permanganatis |32 Gm. or gr. v.
Mast, ferri carbonatis,
Quinine aulphatia aa |65 Gm. or gr. x.
M. et ft. pn. no. X.
Sig.: A pill three or four tiroes a day.
Aa an emmenagogue in chlorosis, Dr. Homer C. Bloom highly recom-
^ mends the following prescription: —
B Ferri peptonat |75 Gm. or gr. xjj.
Man$ifaTii peptonat.,
m Acid. oxaUci aa 113 Gm- or gr. ij.
f Alcohol 11 c.cm. or ftiij.
Aqiuo q. 8. ad 120| c.cm. or fSiv.
M. Sig.: Two teaspoonfuls three times a day.
Dr, Charles O'Donovan, of Baltimore, finds the black oxide of man-
gtoese to be the most satisfactory treatment for dysmenonrhoea, in doses of
I 0.13 Gm. (or gr. ij) about an hour after each meal, combined, if desired, with
H iron, or other adjuvants. No deleterious effects were observed even when
H the remedy was long continued.
H An unofficial syrup of the iodide of iron and manganese is a good altera-
^ tire tonic in scrofula and the debility due to prolonged suppuration. The
wide, in doses of 0.65 to 1 Gm. (or gr. i-xv), is recommended by Dr. Leared
in gastrodynia and pyrosis. The same preparation relieves catarrhal or
malarial jaundice, especially when combined as follows: —
B Mangnni oxidi 21 Gm. or Zm,
Reaiiue podophylli 113 Gm. or gr. Ij.
Extract, b«IIudonn» folior. , 1065 Om. or gr. j.
H. «t ft. capsule no. x.
flif.: A capsule three or four timet a day, in catarrhal jaundice.
€20
I'UARMACEUTICAL TUEHAPEUTIC AQEXXS OR DRUGS.
The permanganate is of avail in flatulent dyspepsia and lithiasis. It
has occasionally produced good resuils in acute rheuniatisni, and has been
employed, with varying success, in a number of infectious disorders, as scar-
let fever, diphtheria, erysipelas, septicajmia, and pyaemia. In the first two
named, this remedy, in solution, is applied to the throat with advantage.
It is also recommended, locally and internally; in snake-bites and in ery-
sipelas the local application of a solution containing 8 to 12 Gm. to 500 c.cm.
(or 5ii-iii to Oifgj) of water is beneficial.
Dr. William Moor, of New York, has called the attention of the profes-
sion to the fact that potassium permanganate is a chemical antidote for mor-
phine. The presence of albuminoids and peptones does not interfere with
this reaction. He has shown that an equal quantity, grain for grain, of per-
manganate is nntidotal in cases of poisoning by morphine. In cases of poi-
soning by opium, laudanum, or the uncombined alkaloid, he advises acidula-
tion of the stomach-contents with diluted sulphuric acid, or white vinegar,
in order that the insoluble morphine be converted into a soluble salt. To
secure the most positive results from this plan of treatment it is said to be
necessary that the antidote should act upon the alkaloid before absorption
has occurred, but Professor Hitzig has demonstrated that morphine, sub-
cutaneously injected into dogs, is excreted by the glandular lining of the
stomach, so that it may have some value even at a late period. A number
of cases of opium or morphine poisoning which have been treated by meiins
of potassium permanganate seem to show that it may be efficicBt when some
time has elapsed since the poison was swallowed, but as Cema has shown
it ia not a phj^siological antidote, and Ringer states that it is not adapted
to hypodermic use, being instantly decomposed by the blood.
Dr. Moor has experimented with other alkaloids, but finds that potas-
sium permanganate is without effect on atropine, cocaine, veratrine, pilo-
carpine, aconitine, and strj'chnine.
Professor BokAi recommends the administration of potassium perman-
ganate in phosphorus poisonings upon the ground that it converts the phos-
phorus into orthophosphoric acid, which is free from toxic action. Dr.
Hognos, of Budapest, has successfully treated in this manner two cases, in
both of which a large quantity of phosphorus had been taken. After the
Btomach had been washed out with tepid water, about a pint of Vio-of-l-per-
cent, solution of permanganate was injected into the stomach and allowed
to remain.
Antal has experimentally found that animals to which muscarine,
str^'chnine, colchicum, oil of savin, and oxalic acid had been administered,
followed by a Va- to Va'P^r-"^^^*- solution of permanganate, recovered, but
control animals, to which the antidote was not given, perished.
Experiments upon animals have led Dr. J. V. Kossa to believe that
potassium permanganate is likewise an efficient antidote to hydrocyanic acid
and potassium cyanide.
Manganese sulphate has been used in chronic rheumatism and neuralgia,
but with doubtful results.
MANGOSTANA.— Mangosteen. The rind of the fruit of the mango, or
Gareinia mangostana (Guttiferse). growing in India, contains tannin and a
bitter, crystallizable principle. Mang:ostin. The fruit is about the size of
a small orange; the rind is hard, dark brown, smooth, inodorous, with a
bitter, astringent taste.
MA RANT A.
681
P
*
Therapy. — Used in diarrhoea and dysentery; also in the form of decoc-
tion, as an astringent, in sore throat, nasal catarrh, leucorrhcea, etc. A fluid
extract of mango (dose, 2 to 4 c-cm., or f5es-j), made from the bark of
ilangifera Indies, of theeame natural order as the preceding, has very much
the same properties and is used for the same purposes. It is also recom-
mended as a hcemoBtatic.
MAITOA (IT. S. P., B. P,).— Manna.
_ Doae, 4 10 31 Gm. (or 5i-5j)-
Preparaiion.
Infu4um Stance Compositum (U.S. P.). — Compound Tnftwion of Senna, Black
Draught (consists of uenna, 6; raanna, 12; magneaium sulpliate, 12; fennel, 2; boil-
iag water, »0; coM water, q. 8. ad 100 c.cm.). Dose, 120 to 240 c.cm. (or fjiv-viij).
Ilnfuftiim Sonnte (B. F. ) containH no niannu.)
Pharmacolo^, — Manna is *'the concrete saccharine exudation of the
Fraxinus ornus (Oleaceffi)," or manna-ash of Italy, Sicily, and Asia Minor;
aUo Rowing elsewhere, but yielding manna only in eouthorn climates.
Other sources of manna exist, as the tamarisk, oak, and larch, and a email,
leguminous plant of India (Alhagi manna); but neither of these is of any
importance compared with that derived from the flowering ash-tree, which
is the universally-known manna, both commercially and medicinally. It
contains Mannite (70 to 80 per cent.), a sugar-like substance, and traces
of Frazin, a neutral, bitter substance found in the bark of several species of
ash; also glucose, resin, mucilage, etc. The flake-raanna is the selected,
homogeneous, clear masses; manna, in sorts, contains more or less foreign
material, such as straw, chips, etc. The best sort is scarce and expensive.
There are no official preparations, except that manna is a constituent of
compound infusion of senna (U. S. P.), or black draught, which a former
generation of physicians especially favored.
Therapy. — Manna is laxative in doses of 31 or 46.5 Gm. (or Si-iss) for
adults, but is liable to cause flatulence and colic. It has been used for chil-
dren, boiled in milk, alone or combined with senna, or it may be eaten as a
•ort of sugar, 4 to 8 Gm. (or 3i-ij) at a time. Molasses-candy is also a good
kzative, and is considerably cheaper.
MANZANITA. — The Arctostaphylos glauca (Ericaceae) is a native of
California. Its leaves possess medicinal properties, due to Tannin, ArbutiJi,
and probably, also, Ericolin and TTrsone, resembling uva ursa in composition
and metlicinal effects.
Physiolo^cal Action. — The drug is astringent, and in small doses tonic
and carminative. It is decidedly diuretic.
Therapy. — Manzanita is nsoful in various afTections of the urinary tract,
pyelitis, cystitis, stone in the kidneys or bladder; also in strangury, incou-
tmence of urine, irritation of bladder, etc. It is best given in the form of
a fluid extract (dilute alcoholic) in doses of 2 to 7.6 c.cm. (or fSss-ij) four to
six times a day.
MAEAKTA. — Arrowroot-starch. The fecula from the rhizome of the
Uaranta arundinaccse (Cannacese), of the West Indies and South America,
eonaists wholly of a beautifully-white starch in fine granules. It is used in
preparing nouriihing articles of food for the sick, with milk, eggs, etc.
4
622 PUARMACEUTIOAL TUEttAPEDTIO AGENTS OR DBD08.
MAREITBIUM.— Marnibium (Hoarkound).
Pharmacology. — "The leaves aud lops of Marrubium vulgare (La-
biata*)," a small herb of Europe and America; contains a bitter principle,
Marrabim, ^vith a peculiar voiatile oil, resin, taDnia, etc. It is best given
as fluid extract (dose, 4 to 7.5 c.cm., or f5i-ij).
Therapy. — lloarhound is enijiioyud as a bitter tonic and stomachic, and
as an expectorant, diaphoretic. laxative, and diuretic. It is popular in con-
fectionary as cough-drops, used for sore throat, cough, and catarrhal condi-
tions of the air-passages. When a diaphoretic effect is desired, the herb
may be used in infusion (31 Gm. to 473 c.cm., or oj to Oj), taken hot in recent
colds. The cold decoction is serviceable in chronic pulmonary affections.
MASTICHE (U. S. P.).— Mastic.
Preparation,
4
Pilulffi Aloes et Mnstiohes (U.S. P.). — Pills of Aloes and Mastic (purified sloet,
13 Gin.; mastic, 4 Gm.; red roee, 3 Gm,; water, q. s. to make 100 pills).
Pharmacology. — "A concrete, resinous exudation from Pietachia Len-
tiscus (Anacnrdiacca;)," consistiiip nf Mastichic acid (90 per cent.), soluble
in alcohol, and another resin. Mastichin, soluble in ether. It enters into the
U. S. P. official pills of aloes and mastic, and has no other application at
present in medicine, except that it may be used as a temporary filling for
decayed teeth, the ethereal solution being used to saturate a small plug of
absorbent cotton, which is pressed into the cavity. Mastic is also used in
making cements and varnishes.
MATICO (U. S.P.).— Matico.
Dose, 2 to 4 Gm. (or gr. xxi-3j).
Preparatiotis.
Fluidextractum Matico {V. S. P.). —Fluid Extract of Matico. Dose, 1,20 to
7.6 c.cm. (or mxx-f3ij).
Pharmacology. — "The dried leaves of Piper nn^sti folium (Pipcr-
acese)," of South America, contain volatile oil (IVj per cent.) ; a soft,
g:reen, piintjent resin; a bitter principle termed Maticin* Artanthic acid, and
tannin. The odor is aromatic and the taste astringent.
Therapy. — Powdered matico acts as a mechanical hasmostatic, the
roughness of the leaves favoring clotting of the blood when dusted over the
bleeding surface. Internally the fluid extract is used in inflammations and
catarrhal afl'ections of the urinary organs, as chronic cystitis, leueorrhoea,
incontinence of urine, and mcnorrhagia. In hfemorrhages from the stom-
ach, bowels, and kidneys, and even from the lun^, it has also been employed,
as well a? in diarrhcea and dysentery. The use of matico sometimes produces
erythema.
MATRICARIA (U. S. P.).— Matricaria (German Chamomile).
Dose, 4 to 12 Gm. (or foi-iij), in infusion or fluid extract.
Pharmacology. — "The flower-heads of Matricaria chamomilla (Com
positffi)" are official under this name. It is a European annual, bearing
small, yellow flowers, with white ray-florets; receptacle conical, naked, and
hollow. The odor of the plant is due to a blue volatile oil existing in the
4
flower-headfi, loscthcr with bitter extractive, tannin, etc. The blue color-
ing matter in Uie oil is a volatile principle called Azulene or Coemlein.
From the volatile oil are Blowly deposited crystals of matico camphor (C^^
n,oO), which is tlie most active constituent.
Physiolo^cal Action and Therapy. — A decoction, drunk as hot aa pos-
sible, is a remedy for colds as a diaphoretic; in large doses it acts as an
emetic. The cold infusion can be used in smaller quantities as a tonic and
stomachic. It is highly prized among the common people in Germany in
domestic practice for the relief of colds, rheumatism, dysmenorrhoea, etc.,
given in the form of tea. It is also considered antispasmodic and anthel-
mintic. It is used for the same purposes generally as anthemis, or chamomile,
MAYS. — Maize» Indian Corn, The maize, Zea mays (Qramineae), is a
c«real of North America, largely cultivated for food. The fruit, or Indian
com, Maidis fructus, contains: starch, 65 per cent.; nitrogenized substances,
8 to 10 per cent.; with a yellow, fixed oil, sugar, cellulose, and water. Green
com, boiled, is a highly-prized summer vegetable. There are many varieties,
but the principal ones are yellow corn and white com. When ground they
afford cornmeal (Maidis farina). Cornraeal is also used for food, as bread,
cakes, etc., and, with boiling water, makes a mush, or "hasty-pudding." The
hot, boiled mush also makes a good poultice, as it retains heat well. Corn-
starch (Slaidis amylum), made from the ripe corn in the same manner aa
wheatstarch is prepared, is also iin acceptable article of food, used for making
puddings, hlanc-mange, etc. It is in the form of a white, impalpable powder,
which can be utilized as a substitute for lycopcdium, as a diisting-powder for
pills and troches, and for excoriated surfaces, or as a baby-powder, (See also
maidis Stigmata. )
I
ItEL (U. S. P., B. P.). —Honey.
Preparatiofis.
Mel Rome {U.S. P.).— Honey of Rose.
Confcftio Rose (U. S. P.).^ronfection of Rose (red rose, 8 Gm.; sugar, 04 Gm.;
tUrified honey, 12 Gm.; stronger rose-water, 16 c.cm.).
MpI TVpiiriitum (l*. S. 1'.. B. P.) .— Claritiod Honey.
Mel Borftcis (B. P.). — Borax Uoney (borax, 60; glycerin, 25; clarified honey,
•iOOGm.).
Oxymel (B. P.). — Oxymel (clarified honey, S; acetic acid, 1; distilled water. 1
.). DoM, 4 to 7.6 c.cm. (or fSi ij).
Pharmacology. — Honey is "a saccharine secretion deposited in the
ip>-comb by the hivo bee, Apis mellifioa (class, Insecta; order, Hymenop-
)." A'ir^n honey is that obtained from recent combs by incision and
•trainiDp; when lieat is used to separate the comb the product is of a darker
oolor. and tliere is a loss of flavor. What is known as clarified honey is pre-
pared by heating honey on a water-bath, removing the frothy scum which
rites, and straining. The flavor of honey is dependent upon the time of the
9etton and the character of the flowers that furnish the saccharine material.
Il is l>clirveil that, at times, poisonous principles have been taken by bees
from nart'otir plants, and. conspqufntly, the character of the honey has been
tJfected injuriously. The constituents of honey are fruit-sugar, which re-
tr.ains always liquid, and glucose^ which tends to crystallize and thicken the
G24 PHARMACEUTICAL TIIKIIAPEL TIC AOEN'TS Oil DRUGS. ^"
honey. Much of the honey used for household purposes has glucose fraud-
ulently added, or it may be entirely an imitation honey.
PhyBiological Actioii. — Honey is slightly laxative, and a pleasant, sweet
article of food. It is a good excipient for pill-masses.
Therapy. — The old mixture of borax and honey, official in the British
Pharmacoptvia, for the treatment for babies' sore mouth is now rarely used,
' as the honey favors fermentation, and, besides, adds nothing therapeuti<;aily
to the mixture, for the borax acts better without it. In glycosuria, the use
of honey usually increases the quantity of sugar voided, and it has been used,
therefore^ to aid in the diagnosis of diabetes. In sore throat, mel rosjB may
be used as an application, in combination with astringents. A spoonful of
honey made into a paste with an equal quantity of ryeraeal and thickly spread
upon the inflamed surface is claimed by Ziem to he a good domestic applica-
tion to par-auricular abscesses. Oxymel is a pleasant addition to gargles
or it may be used as a vohiclc for astringents or expectorants, in doses of 4
to 7,5 com. (or f5i-ij).
MEIISSA.— Melissa (Balm).
Phannacolo§^. — "The leaves and tops of Melissa officinalis (Labiatae),"
a small herb growing in Europe and in the United States. It contains gum,
tannin, bitter extractive, and volatile oil. The odor of the plant is fragrant,
and it has an aromatic, slightly-bitter taste; the bruised leaves have a lemon-
like odor.
Physiolog:ical Action and Therapy^ — Melissa is carminative, and may
be used in infusion, medicated water (distilled), or as a fluid extract, the dose
of the latter being 4 to 7.5 e.cm. (or foi-ij). The compound spirit of melissa,
or Carmelite spirit, is a cordial containing a number of spices, which make it
a stomachic and corrective of flatulence.
MEMlSPERinJM.—Menispermum (Yellow Parilla, Canadian Moon-
seed).
Dose, 0.32 to 1.30 Gm. (or gr. v-xx), in infusion.
Preparation.
Fliiidextrnctum Mcnispermi. — Fluitl Extract of Menispeniiuin. EX»»c', 2 to 4
I'.cm. (or f3s8-j).
Pharmacology. — The rhizome and mots of Slenispermum Cauadcnse
(Menispcrmaceir), a plant growing in the eastern United States. The
rhizome may he several feet in length; it contains Berberine, also a white
alkaloid, soluble in alcohol and ether, sparingly soluble in water, which was
isolated by II. L. Barber.
Therapy. — Moonseed, or yellow pnnlla, is believed to resemble sarsa-
parilla in possessing diuretic, tonic, and alterative powers, and is also a laxa-
tive. In domestic practice it is used to purify the blood in scrofulous affec-
tions. It has no very well marked therapeutic properties.
MENTHA PIPERITA (U. S. P.).— Peppermint.
The dried leaves and flowering tops of Mentha piperita (Ijabiata;).
Preparations of Peppermint.
Aqua MenthfiB Piperita (U. S. P., B. P.). — Peppermint-water. Dose. 4 to 00 cera.
Siftii).
MENTHA VTRIDIS.
¥
Oleum Menthw Piperitee (U.S. P., B.P.).— Oil of Peppermint Doae, 0.06 to 0.30
€.cm. (or mi-T).
Spiritus Mentlisc Piperitse (U.S. P., B. P.).~Spirit of Peppermint Doee, 0.60 to
i c.cm. {OT wix-f3j).
Menthol (U.S. P.. B. P.). — Peppermint-camphor fa crystalline aolid) . Dose. 0.066
to 0.32 Gm. (or gr. i-v).
^Aleo eaten into compound pills of rhubarb (U. S. P., B. P.). ,
lor
MENTHA VIEIDIS (U. S. P.).— Spearmint.
The tlried leaves ami Howering tops of M).^ntha viridis (Labiate).
Preparations of Spearmint.
Spiritua Mentha Viridia (U. S. P.). — Spirit of Spearmint Doae, 0.30 to 1.20 c.cm.
I or mx'jo.).
Aqua Menthee Viridia (U.S. P., B.P.).— Spearmintrwater. Dose, 4 to 60 ccm.
(ori3iaij).
Oleum Mentliffi Viridis (U.S. P., B.P.).— Oil of Spearmint Dose, 0.12 to 0.30
ccm. (or mii-v).
Pharmacology. — The leaves and tops of both the Mentha piperita and
the Mentha viridis, of the natural order Labiatae, are indigenous to Great
Britain, but are naturalized in the United States and many other countries.
Each variety owes its properties to a volatile oil, from 1 to 1 V4 per cent,
being present, with some tannin^, in peppermint. The British Pharmacopceia
directs that the oil of peppermint be distilled from the fresh flowering pep-
permint, Mentha piperita, and the oil of spearmint from the fresh flowering
spearmint, Mentha viridis. Menthol, which is the stearopten or camphor
of peppermint-oil, is deposited, on coolings from the oil of the fresh herb
Mentna arvcnsis and Mentha piperita. It smells and tastes like pepper-
mint, is soluble in alcohol, ether, and the fixed and volatile oils, but slightly
soluble in water. Menthol occurs in the form of colorless crystals or fused
CTystalline masses, and resembles Epsom salt in appearance. It is quite vola-
tile, and melts at 108° to 110° F.
Physiological Action. — Peppermint, especially the oil, locally has an
anodyne, ancesthctic* and antiseptic action. Its taste is rather pleasant and
pungent, and it acts as a carminative and stimulant in the stomach, especially
in the form of the spirit; the troches are also used for this purpose as well
•8 to disguise a bad breath. Spearmint corresponds, in its effects, with pep-
permint, but is less powerful and less agreeable.
The taste of menthol is sharp an^J penetrating. When placed upon the
skin it gives rise at first to a burning sensation, which is succeeded by one
of coolness, and finally by numbness or analgesia. It has decided antiseptic
power being comparable in this respect to thvniol.
Therapy. — In nonralgia.oil of peppermint may be painted over the pain-
ful spot or along the course of the nerve. If the oil is employed, evaporation
should be prevented by covering the painted surface with oiled silk. It may
aim be used for myalgia and many local pains, commonly called rheumatic,
and is often of service in chronic gout. In flatulent colic, the spirit of pep-
ptrmint in hot water is a good household remedy, particularly applicable to
children. The oil -of peppermint allays nausea, and is serviceable in dis-
guising the taste of unpalatable drugs. Peppermint is a good addition to
ft' r^nipdie?. as in the compound rhubarb pill, to prevent griping,
n pudendi, peppermint-water is a good application, with 4 to 8 Gm,
(or 3i-ij) of borax to each pint.
Gl'()
I'lr
PELTIC AGE
111 a mmiiaT of east's nf pLilrnmiary tubeiculosis, iTMpi*ovfiiieiit lias fol-
lowed the inhalation of oil of peppermint, vaporized by means of hot water.
It is sliittHl that cough, fuvcr, aim nij^'lu-swoats were all relieved.
Mettthol has been employed almost exclusively as a topical remedy,
though it has been given internally in the dose of 0.32 Gm. (or gr. v) for the
relief of neuralgia. It is also recommended as an intestinal antiseptic in the
dose of 0.10 Gni. (or gr. ise), given in a capsule with oil of sweet almond, six
to eight boiii;^ tukLni daily. In this u*ay, it is very ortieicut against tlie hoi.»k-
worm, uncinaiiaflia.
Its principal usefulness is in the alleviation of itching and pain. It
may be applied in the form of a solid pencil or cone, an alcoholic solution,
or an ointment. It has also been administered by inhalation in hay fever
and diphtlierin. la the nasal form of hay fever, a mixture of menthol and
ammonium carbonate makes a very efficient smelling-salt. In neuralgia
(especially when it involves a superficial nerve), in herpes zoster, and denna-
talgia, a lotion or ointment containing menthol is capable of affording cou-
eidcrable relit^f. The pain of a carious tooth may be alleviated or removed bj'
placing a menthol solution within the cavity, or menthol dissolved in 15
parts of oil of cloves. The itching of parsesthesia, eczema, and urticaria may
often be alleviated by the same remedy.
By spraying witli a benzoinol solution of menthol, Dr. Elizabeth X.
Bradley was able to reduce an acute hsemorrhoidal prolapse which came on
during a severe attack of epidemic influenza and which had resisted the
action of other remedies. The use of the spray was almost immediately fol-
lowed by cessation of pain and diminution in the size of the tumors.
Inhalations of menthol have also been successfully resorted to in asthma.
It ig readily volatilized in a tea-pot by the addition of hot water. The tea-
pot being closed, the vapor is inhaled aa it issues from the spout. Ointments
and lotions of menthol may be compounded as follows: —
B Hioiiolib liq 2
Menthol 1
Ungt. aquffi rosiB 31
M. Sig.: For paraesthesia, urticaria, and herpes soetet.
Cm. or Sss.
30 Gm. or gr. xx.
Gm. or Ij. — M.
i
B Tinct. belkdonne fol.,
Tinct. aeonlti aa 61 c.cm. or f3iss.
Menthol 2 6m. or Zsa.
Alcoholia 00[ ccm. or fjij.
Glycerini,
Aqute roBie aa \5\ c.cm. or fju.
M. Sig. : Use as a local application in dcrmatalgia, herpes zoeter, and neuralgia.
Dr. Leonard A. Dessar publishes the following formula for an antiseptic
snuff-powder; —
B Menthol 10 parts.
Acid, tannic 2 parts.
Acid, boric % ^ 30 partA.
Bismuth, subnit. 20 parta.
Amyli 50 parts.
Cocainte hydrochlor,
Aristol aa 0.5 part.
M. Sig.; Make a fine powder.
MEKCDROL.
627
I
I
*
Dr. Woir recoramends menthol nibbed up with sugar (5 to 10 per cent.)
applied with a large camers-hair brush, as a local disinfectant in diphtheria,
tued early in the disease. He advises applications to be made several times
in the day, removing as much as possible of the membrane at a time. Kas-
lorsky prefers a 10-per-cent. alcoholic solution, appUed thrice daily by means
of a piece of cotton-wool. The same metliod is beneficial in the sore throat
of scarlatina and in catarrhal pharyngitis. A 10- to 50-per-cent. ethereal
Bolution of menthol, applied two or three times a day by means of a camel's-
hair pencil, is of service in aborting cutaneous abscesses, boils, carbuncles,
etc. In laryngeal and tracheal phthisis, and in the larjrngeal ulcerations
occurring during the course of pulmonary tuberculosis, Rosenberg uses a
20-per-cent. solution of menthol in olive-oil, introduced with a syringe or
a fpray into the larynx; two or three injections of 1 c.cm. (or mxv) each are
made at the afected spot, followed by inhalations of the same from boiling
water, or a respirator can be used. The relief from dyspnoea is very great.
Corresponding results have been obtained in pulmonary tuberculosis by the
daily application through the trachea in doses of 4 c.cm. (or f3j) of a 12-
pcr-cent. solution of menthol in sterilized olive-oil*
In bronchiectasis, the injection into the trachea, twice daily of 4 c.cm.
(or fSj) of the following mixture, as rea>mmeiided by Dr. T. G. Stewart,
was followed by speedy improvement: —
B Menthol 10 part*.
Guiiiacol 2 part«.
OUve-oil 88 ptrta.— M.
Dr. A. L. Benedict, of Buffalo, states that in a number of cases of atonic
dyspepsia he has derived advantage from the application of the menthol-
spray to the walls of the stomach through the stomach-tube. The organ is
first washed out and a I- to 5-per-cent. solution of menthol in liquid petro-
latum is blown through the tube. An instrument has been especially de-
signed for this method hy Dr. Fenton B. Turck, of Chicago.
In affections of the middle ear^ especially when the mucous membrane
is much EwoUen, Dr. Joseph Bronner has derived benefit from inflating the
cavity with menthol-vapor. A few drops of a 20-per-cent. solution of men-
thol in olive-oil, contained in an antiseptic capsule attached to the Eu-
stachian catheter, are slowly vaporized and inflated by Lucae's modification
of the Politzer bag. It is important that the use of the vapor should be
prolonged and the procedure is said to excite no pain or inflammation. Dr.
Cholewa, of Berlin, states that menthol will usually arrest the course of
fnrancle and suppuration of the ear. It controls diffuse inflammations of
the auditory canal and has occasioned marked improvement in cases where
the mastoid was involved and in which it seemed that operative procedures
would be demanded. He made use of a 10- to 15-per-cent. oily solution.
MEECUROL. — The nucleinate of mercurj' was employed by Ayres, of
Xcw Vork, in the treatment of 8>T)hili9. It is a soluble powder, containing
10 jtcT cont. of mercury. A 2-per-cont. solution is useful as a dressing for
nlcere. and as an injection in gonorrhoea. A 5-pcr-cent. Bolution is rocom-
Tttfudetl for trarhoma. Intemnllv, it is given in capsules, in doses of 0.04
to 0.10 Gm. (or gr. V* to IV,)- '
■ TkiTopfutigcht Uonaishefte, B«pt., 1800.
I
628 PHARMACEUTICAL THERAPEUTIC AGENTS OR DHIOS. ^^^
IIETHYLAI. — Methylene-dimcthyl-ether. Methylal is obtained by
the action of a mixture of sulphuric acid and manganese dioxide upon meth-
ylic alcohol. It is a colorless fluid, boiis at 107.6* P\, and is soluble in water,
alcohol, ether, fatty and ethereal oils. Methylal reduces arterial pressure
and has an hypnotic effect. It is rapidly eliminated. It has been used in
insomnia, but a tolerance is soon established and the remedy loses its in-
fluence unless given in constantly-increasing doses. Methylal has been given
with some success in asthma and intestinal colic. Methylal has also been
employed in order to allay the excitement of delirium tremens. For the
purpose of producing local antesthesia in dentistry methylal has been mixed
with 4 parts of tincture of coca. One part by weight of methylal and 6 parts
of almond-oil have been recommended as a liniment. Dose, 4 to 7.5 c.cm.
(or f3i-ij).
METHYL CHLORIDE.— Methyl chloride is a gas (chlormethyl, mono-
chlormethane) produced by the reaction between methyl alcohol and hydro-
chloric acid in the presence of zinc chloride. It is free from color and
possesses an ethereal odor; is soluble in water, alcohol, ether, and chloroform.
It becomes liquid under the pressure of five atmospheres at ordinary tem-
peratures. A spray of the liquid directed from the distance of about a half
a yard from the affected surfaces produces a freezing effect. The application
acts as an anodyne, and ia beneficial in various forms of neuralgia, chronic
rheumatism, and other painful conditions. The liquid methyl chloride is
supplied in small glass tubes, from which the spray issues in a fine jet. These
are used to produce local anaesthesia for small surgical operations.
METHYLENI BICHLORIDUM.— Methylene bichloride is a colorless
fluid having an odor ri'scnibling that of chloroform. It is prepared by reduc-
ing an nlciuholic solution of chloroform by zinc and hydrochloric acid. A
mixture of pure methylene chloride aud ether was introduced by Sir Benja^
min Ward Hiolmrdson as a general anirsihetic, but has not been extensively
used for that piirinise and is not fn^ from danger. The English methylene
chloride, or methylene, is of varinhle composition, and probably its virtues
depend upon the presence of chloroform. Richardson has also used it as an
internal remedy in doses nf 0.30 tn 2 c.cm. (or njv-xxx), and states that it
possesses imtist'ptic, stiinulani, antispasmodic, and anodyne properties. He
praises its action in t>*phoid fever combined with hydrogen dioxide, and in
acute rheunuilisni nssociatfd with sodiuin salicylate.
METHYLTHIONIN-a: HYDROCHLORIDUM (U. S. P.).— Methylene-
blne. Ah'tliyli-nf-lihid coinuninicntes a hhie color to the urino and fa?ocs.
I^rtri' doBcs will pniiK^Uincs cause a ficaldint; sensalion in the bladder. It has
an inhibitorv influenro upon various microltes. P. Ehrlich observed that the
plasraodinm of malaria and the red blood-corpuscles are strongly influenced
by this dye. According to the observation of Rosin, it arrests the move-
ments of the malarial parasites. As the methylene-blue usually sold as a
dye contains zinc chloride, it is important that, for therapeutic administra-
tion, a chemically-pure article should be obtained.
Therapy. — Solutions of mcthylcnc-blue have been locally applied with
advantage in vaginitis, smd to fi-itulnns tracts. Metliylene-blue lias been
found of service in malarial fevers by Guttmann, Ehrlich, Thayer, and others.
METHYI^VIOLlirr.
629
>
though whether it is able to prevent recurrence has not yet been demon-
strated. Although it has a decided action in malarial fever, it cannot be re-
gmrded as possessing any special advantage over quinine,
Methylene-blue has been serviceable, also, in trigeminal neuralgia, mi-
fniuCy herpes zoster, and muscular rheumatism. In neuralpa it may be
given in daily amount of 1 Gm. (or gr. xv) without producing any ill effects,
Netschajeff, of Moscow, has derived good results from the use of this
remedy in acute nephritis. He administered 0.10 Gm. (or gr. iss) thrice on
alternate days. The quantity of urine was increased, albumin and casts were
diminished, and oedema rapidly vanished. Methylene-blue is of service in
diphtheria, being administered internally and applied topically in watery
1 to 9 solution. Clinical experiments have been made with methylene-blue
in the treatment of tuberculosis. It reduces the temperature and in most
caBcs diminishes night-sweats. It may serve a good purpose in the early
stage of the disease, but in advanced cases has no effect upon cough, expec-
toration, or diarrhoea. Professor d'Ambrosio, of Naples, observed a remark-
able improvement in a case of ulcerated mammary carcinoma from daily
injections into the tumor of 1 c.cm. (or mxv) of a 1-per-cent. solution. Pain
and haemorrhage ceased and the tumor underwent retrocession, A. Darier,
of Paris, has cured superficial epitheliomata by painting them with a solution
containing 1 Gm. (or gr. xv) of methylone-blue dissolved in 5 c.cm. (or
n>i VJ each of alcohol and glycerin. All of the portion stained is then
touched with a steel probe which has been dipped in a 1 to 5 solution of
chromic acid. Crusts should be removed before the application is made.
Kahane, of Vienna, urges a trial in primary syphilis of: —
R Quininv sulphatifl.
MHtbvIthioninip hydroobloridi aa 6| Gm. or SUs.
Ar»o[iii trio\idi 01003 Um. or gr. '/«•
Ett. jilycyrrliizip q.a.
Ft. pil. no. xxT. Take one pill three times daily.
The internal exhibition of methylene-blue in gonorrhoea seemed to produce
8 ' effect upon the discharge. It has also been used with asserted
fi': , '• in this disease as an injection, a 1 to 200 or 1 to 250 solution being
u*ed from ten to fifteen times a day. D'Aulnay reports good results from
packing the vagina with a tampon saturated in a solution composed of 10
Gm, (or oiiss) of methylene-blue, 15 c.cm. (or f^ss) of alcohol, and 0.20 Gm.
(or gr. iij) of potassium in 210 c.cm. (or fjvij) of water. It has been pro-
posed to take advantage of the green color which this substance oommuni-
c:i ilie urine by adding it to medicines given to hypochondriacs and
I 1-3. in order lo detect deception as regards taking tiie medicine.
I- rvsults in elevon cases of beriberi from the use of mthylene-blue
Ai led by Professor Thur. The internal administration of the remedy
i« aUo apparently of some service in carcinoma.
ItETHYIIS SAUCYLAS (U. S. P. K— Methyl Salicylate. An ester
produri'il synthetically. It is the principal constituent of oil of ganltheria
and oil of betula. For flavoring purposes it may be regarded as identical
with thorn. Fonnuln. CII^^CjR.Oj. For use see Oaultheria.
ItETHYL-VIOIET. — Fyoktanin (pus-destroyer) is a descriptive name
applied to methyl-violet: an aniline dye which occurs in the form of a paste
tad in crystals. Chemically it is penta- and hcxa- methyl-para-roaaniline
«
G30
kCEUTICAL THERAPEUTIC AGENTS OH DRUGS.
livdrodiloriile, but is rather variable in conipositiou. It has been employed
ill tlie form of powdor, pencil, and solution. The paste can be readily mokled
into pencils. The powder is made by mixing 2 parts of metliyl-violet, or
pyoktanin, with 98 parts of talc or otiicr inert material. The solution may
be made of any strength, from 1 part in 100 to 1 in 2000. It is also used
*in the form of an ointment containing from 2 to 10 per cent. The same
title is given to another variety, yellow aniline, chemically pure and free
from arsenic. I'he latter is used in itphthiilinic practice; the former in gen-
eral surgeiy.
Physiological Action. — Methyl-violet is an efficient germicide. Accord-
ing to the laboratory experiments of Fessler, the micro-organisms of pus are
destroyed in fifteen minutes by exposure to a 1 to 1000 solution of pyoktanin.
This conclusion, however, is contradicted by Troje, who found that, although
the development of germs was inhibited by pyoktanin, yet even after sub-
jection to its action for twelve hours the pus-germs were not certainly
destroyed. The latter writer, therefore, asserts that pyoktanin is less pow-
erful than carbolic acid or mercuric chloride. Pyoktanin does not coagulate
albumin. A solution of this subetance dropped into tlie eye is said to cause
dilation of the pupil without paralysis of accommodation.
Methyl-violet, when administered internally, is rapidly absorbed, and
soon makes its appearance in the urine, giving a blue color to that fluid. The
urine of patients who have taken 0.20 Gm. (or gr- iij) two or three times a
day will remain aseptic for three weeks. This dose may cause intermission
of the pulse. Pyoktanin is irritant to the kidney and is capable of exciting
an acute nephritis, Combemale found that a dose of methyl-violet equal to
0,13 Gni. (or gr. ij) to the pound of body-weight was fatal to guinea-pigs.
The blood exhibited a chocolate discoloration, the heart was flaccid, and the
liver and mesenteric vessels were engorged.
Therapy. — Pyoktanin has been employed almost exclusively as a topical
medicament, though Ehrlich and Leppmann state that, given hypodermic-
ally, it relieves neuralgia and rheumatic pains. The diluted powder, the
solution, and the pencil of pyoktanin^ from the writer's experience, disinfect
suppurating or ulcerated wounds, stimulate reparative action in chronic
ulcers, and form excellent applications to chancroids, open buboes, gummous
ulcers, boils, and carbuncles. Unna uses as a dressing to chancroids a mixt-
ure composed of: —
B Pvoktaiiin,
Potassii bicarb an 1 Gni.
.Aquee defiUU 90 c.cni.
Alcohol 18 6 c.cra.
Reduce by beat to three ounces and add: —
IVoktniiin.
Sodii borai aa 11 Gm.
Aquae destill D0[ c.cm.
or gr. XV,
or fSiij.
or f5v.
or gr. XV.
or fSiij, — M.
Good results have been reported in gonorrhoea from the injection of
weak solutions. In some cases of chronic cystitis the injection of a 1 to
1000 or a 1 to 500 solution has been found markedly beneficial. As a dust-
ing-powder, it has been used upon moist eczema.
Stilling, in his original paper, laid great stress upon the value of this
agent in affections of the eye, especially corneal ulcers, parenchymatous
keratitis, and serous iritis. These assertions have not been generally con-
MEZBREUK.
631
•
1^
i#<I, In the experience of most ophthalmologists, pyoktanin is by no
means superior, if even equal, to corrosive sublimate. It is conceded, how-
erer, thai pyoktanin acts as a mild, local anKsthetic. In conjunctivitis,
dacryocystitis, etc., pyoktanin is best employed in the form of a solution.
In chronic ophthalmia, trachoma, and fistulous openings into the laciymal
ac the pencils of the drug are preferable to use. ^
In otology* testimony as to its value is conflicting. While in some cases
its use was attended with excellent results in purulent inflammation of the
middle ear, furuncle of the external meatus, or after removal of a polypus
Irom the meatus, in other cases of otitis pyoktanin proved a failure.
A persistent case of ptyalism was cured by Heitmann by the local appli-
ition twice daily to the whole 9f the oral cavity of a 0.1-per-cent. solution
pyoktanin. It has also been employed with good results in diphtheria
J Dr. C. Uoring. He applies a 3-per-cent. solution two or three times a
day to the affected parts, and finds it destructive to the false membranes. It
diminishes pain and fever without giving rise to toxic sjonptoms. Dr.
Horing states that he has in this manner treated 112 undoubted cases of
diphtheria, 110 of which recovered. In nasal diphtheria he introduced
(rithin the cavity and kept in position a tampon saturated in the solution.
Methyl-violet has been used as an internal remedy with asserted advan-
tage in acute gonorrhcea^ acute and chronic Bright's disease, herpes zoster,
and senile para?6thesia. The doses employed in these cases generally ranged
from 0.03 to 0.23 Gm. (or gr. ss-iiiss) throe times a day. In acute nephritis
it is said quickly to quadruple the quantity of urine passed and cause the
disappearance of casts, cedcma, cardiac and pulmonary sjTuptoms.
Solutions of pyoktanin have been injected into pulmonary cavities with
the result of reducing temperature and causing bacilli to disappear from th€
Eputum. A report in reference to the treatment of tuberculosis by this
method has been made by Petterutti and Mirto. These writers state that
injections of a 1 to 500 solution of pyoktanin directly into a cavit}' are well
borne, produce no reaction, reduce temperature, and cause disappearance of
bacilli from the sputum. The remedy has a deleterious effect upon the
bronchi if brought in contact with the mucous membraneSj and may also
■ exert an injurious influence upon the kidney.
The absence of odor is one feature which makes this substance prefer.-
able to iodoform. On the other hand, methyl-violet communicates a deep-
purple color to the skin or linen with which it comes in contact. This stain
may be removed, however, by dihilu hyiln^t'liluric or nitric iicid, or alcohol.
^METHYSTICUM,— Kava. The dried root of Macropiper latifolium
I I'i|mrHtx>iv) . ( See Kava-kava.)
:
fe
MEZEREUM (IJ. S. P.).— Mczereum.
UEZEREI COBTEX (B. P.).— Mezereon-bark.
Preparations.
Kliiitl<*\trnctum MeEcr«i {V. S. P.). — Fluid Extract of Mcz«r«>n.
M ta irritant.
It U alio a constituent of: —
l)w<x-lum SjUHjiparilliB (*omi)OAitura. — Pompouml Decoction of Sari«aparilln
l7«tHl only
I
PrtcUi
Se« paper on "Experiences with Pyoktanin in Opbthalmologicnl and Otological
" by Adolf AH. M.a. St. Louis Courier of MrdlciM, Jan., '"■
£32 PUAKilACfiCTICAL TliEIiAPEUTlC AGEXTS Ott DULGS.
Fluidextractum Sarsaparillse Coui]}o»itum (U, S. l*.j. — C'om|ioiind Fluid Ex-
tract of Sarsaparilla.
Pharmacology. — Mezereou is "the dried hark of Daphne Mezereum
(Tliytiiehuacea?)j and of other European species of Daphne'' (U. S. P.) 5
"the dried bark of Daphne Mezereum, or of Dsiphne Laureola, or of Daphne
•Gnidiunr' (B. P.)? arrowing in Europe aiid Agia iu mountainous regions. It
contains Daphnin, a Intter glucoside iu oolorlrss crystals, sparingly soluble in
cold Bolvcnis; an acrid, rubefacient, volatile oil, and a soft, brown, acrid
resin, which i? the nnhydrid*' nf Mezereinic acid. Mezereum is an ingredient
in tJie compound decoction and comjwund syrup of sarsaparilla (U. S. P.),
and the i^xtract enters into the compound mustard Hninient (T. S. P.). (See
Sinapis.) Unguentum Mezerei (not oflicial). Ointment of Mezcreon, con-
tains fluid extract of mezereon, 25; lard, 80; yellow wax, 12 parts, the
alcohol of the extract being entirely evaporated by heat. It is used as a
counter-irritant and to prolong the discharge from blistere'd surfaces.
Phyaiolog^cal Action. — The powdered bark is irritating to the skin,
and, when fresh, causes vesication; -it excites violent sneezing when inhaled
into the nostrils. In small closes internally it is sialagogue, laxative, and
diuretic, and is considered tonic and alterative. In large doses it is a vio-
lent, irritant poison, causing vomiting, purging, and inflammation of the
fltomach and intestines. Nephritis is said to follow its tonic administration.
The treatment would be eliminative and symptomatic. Demulcent drinks,
fitarch-wator, etc., may be freely swallowed, and hypodermic injections of
morphine given. The ointment is used as irritant to keep up discharges
from ulcers and blistered surfaces.
Therapy. — The use of mezereum in medicine is restricted to its external
application in the form of an irritant ointment, as first mentioned, and its
combination with sarsaparilla and other remedies in the forms above re-
ferred to, as an alterative in syphilis and chronic rheumatism, associated
with potassium iodide.
B Potassii iodidi 8| Gm. or 3ij.
Syr. sarsapanlls cc,
Aquffi aa 90| c.cm. or fJUj.
M. Sig. : A tab leap oonful two hours after meals for syphitii, rheumatism, and
■kin diseases.
Mezereum has also been successfully used to relieve toothache, and aa
a masticatory in paralysis of the tongue.
MITCHELL A. — Squaw-vine, Checker-berry, Winter-clover, Partridge-
berry. The whole plant of Mitchella repens (Rubiacea?) is used iu making
the infusion and fluid extract. It is a small, creeping, evergreen herb, with
red berries appearing in the autumn, which may remain until spring. The
leaves and berries have a flavor like that of gaulthcria; they apparently con-
tain a small amount of Saponin.
Physiological Action. — The preparations of Mitchella are said to be
astringent, diuretic, and parturifacient; they are also supposed to favor the
occurrence of menstruation.
Therapy. — In dropsy and suppression of urine the infusion is given.
m
MOSCHUS.
633
I
I
Iso in dysmenorrluTifl, menorrhagia, etc. Its name of "squaw-vine" was
led from its use by the Indians, who administered the infusion to women
Tor several weeks before the expected occurrence of parturition in order to
ficihtate delivery.
MONESIA. — The bark of Chrysophyllum glycyphlfeum (Sapotaceoe), a'
tree of Brazil and other varieties of the same species, contains, according to
Henry and Payen, Saponin, an allied body termed MoncBin, tannic acid,
gljcyrrhjzin, wax, a crystalline fatty substance, etc.
Physiological Action and Therapy. — Monesia possesses expectorant
properties free from unpleasant effects, and, by virtue of the tannin which
it contains, is astrine:ent. Small doses of monesia improve the appetite.
Large amounts disturb the stomach and cause constipation. Formerly em-
ployed in medicine, monesia had fallen into disuse, but has been studied
anew by Dr. P. G. RozanofF, of Moscow. It was found of benefit in acute
and chronic bronchitis, pneumonia, subacute enteritis, and diarrh<ea, given
in a mixture of 2 to 4 Gm. (or Sss-j) of aqueous extract of the bark to 180
c.cm. (or f^vj) of water, a tablespoonful dose every second hour. Monesia
was particularly valuable in co-cxistent catarrhal states of the respiratory
and intestinal tracts. It is said to possess virtue as a tseniacide. A decoction
containing 62 Gm. (or SU) ^^^^ o^ monesia and pomegranate-bark mil
usually prove an efficient combination. Monesia has also been given with
asserted advantage in dyspepsia, scurvy, scrofula^ luemoptysis, and menor-
rhagia. In the form of powder or ointment it has been applied to indolent
or unhealthy ulcers. An extract is given in doses of 0.13 to 0.65 Gm. (or
gr. ii-i); it may also be administered in aqueous solution, syrup, or tincture.
Moneain has been applied to ulcers, and has been used internally in the dose
of 0.032 Gm. (or gr. ss). Monesin is said to possess oxytocic virtue.
MORPHINA (U. S. P.). (See Opium.)
MO&EENIA. — Morrenia brachystephana (Asdepiadaceffi), a plant grow-
ing in the Argentine Republic and other South-American countries, contains,
according to the analyses of Seiior Pedro N. Arata, a fatty acid, resins, salts
of lime, a glucoside, starch, albumin, gum, and a small quantity of a sub-
•tance giving alkaloidal reactions. The alkaloid was obtained as a dark-
wddish mass, of pleasant odor and a very bitter taste, soluble in chloroform,
water, and nmylic alcohol.
Therapy. — The physiological action of the plant has not been studied,
but it has long enjoyed a local reputation as a galactagogue, and Del Area
ind Sicardo report favorably as regards its efficacy. From the leaves or root
an infusion is prepared in the strength of 93 Gm, (or Siij) to 473 c.cm. (or
Oj) of water, tnc dose being a tablespoonful.
MOSCHUS (U. S. P., B. P.).— Mnik.
Dose. 0.32 to 0.50 Gm. (or gr. v-viij).
Preparation,
Tioctura MoAchi (U. 8.P.).~TincluTe of Musk (6 per cent). Dofte, 2 to 4 c.cm.
for f3»j).
i
634
imAHMACEUTICAL T11£RAI»KUT1C AGENT8 OH DRUGS.
Pharmacology. — Musk is "the dried secretion from ibe preputial fol-
licles of iloschus moBcliiferue (class, Mnmnnalia; order, Ruminantia)"' or
musk-deer. The musk-sac is, in the Hviug male auimal, situated between the
navel and the genitals, but nearer the latter, between the skin and the mus-
cles of the abdomen. Musk in pods, or musk in the unopened sacs, is the
only kind to be used in medicine, each sac containing from 4 to 8.40 Gm.
(or gr. Ix-cxxx) of actual musk. It is imported from China. Genxiine Ton-
quin musk is composed of roundish, grains of irregular size, dark reddish
brown, of a peculiar, penetrating, persistent odor and a bitter taste. It i»
partly soluble in M'atcr, and less so in strong alcohol; dilute alcohol dissolves
about one-half. The odorous principle is probably a product of decomposi-
tion, constantly being formed; complete drying destroys it, but it returns
again after moisture has been added. It is also destroyed by hydrocyanic
acid and by camphor. Musk contains ammonia, fat, cholesterin, resinous
matter, fatty acids, etc. It is largely used in perfumery, being very lasting
and holding more evanescent perfumes with it. Musk in grains is much
adulterated, or spurious. An artificial rausk^ has been produced, but qui-
nine sulphate has the property of destroying its odor, while genuine musk
is in no way alTected by it.
Physiological Action. — Musk is a diffusible stimulant and antispas-
modic. It creates a sensation of heat in the stomach, and in some persons
excites nausea and vomiting. Headache and giddiness are also produced,
with stimulation of the sexual appetite. A primary excitement of the cen-
tral nervous system is succeeded by a more or less marked soporific effect.
According to Brunton, musk appears to stimulate the respiratory centre.
Artificial musk is reported to have little or no physiological or therapeutical
effect, even when used subcutaneously.
Some cases having been reported of death from symptoms of malignant
oedema after the puhcutaneous injection of tincture of rauskj Dr. J. Vnn
Cott, Jr., examined various tinctures as well as the musk-sac itself for the
presence of the bacilli of the disease. N"o bacilli were found in the tinctures,
but in two cases infusions of the sacs yielded the organism which presumably
had been attached to the skin removed with the sac.
Therapy. — Musk has been used in collapse of typhoid and other low
fevers. Musk is valuable in the pneumonia of drunkards and in other cases
of this disease occurring in debilitated subjects; also in hiccough, delirium
tremens, and in convulsions of children. In many of the manifestations of
hysteria — emotional crises, palpitation of the heart, vomiting, or spasm —
this remedy is of value. The same may be said regarding other spasmodic
affections, as chorea, whooping-cough, and laryngismus stridulus. It has
been considered beneficial in melancholia and irregular gout. Its high price
and the difHculty of obtaining an unadulterated article take it out of the
ordinary range of remedies.
MTJCITNA. — Mucujia, Cowhage. The hairs scraped from the pods of
Mucuna pruriens (Leguminosee), of the East and West Indies, were formerly
used as a vermifuge, 4 to 8 Gm. (or 5i-ij) beincr mixed with molasses and
administered to children suffering with round-worms. It causes irritation,
simulating an erythematous or urticarial eruption when brought in contact
with the skin. It is said that dishonest horse-dealers use cowhage to make
» "Artificial Musk," Pacific /ffwrrf, Dec. l.-S. IflflO.
MTRISTICA.
635^
I
ft
ft
Ebrses appear more spirited, by applying it to anus, or genitals, just before
cihibiting the animal for sale.
tfUSCABINA. — Muscarina. (See Agaricua Muscarius.)
MYHICA. — Myrica, Bayberry-bark. The Myrica cerifera (Myricacese),
a native of North America, contains in its bark a volatile oil and acrid resin.
Physiological Action. — Myrica is stimulant and astringent.
Therapy. — Externally, the infusion or diluted fluid extract of myrica
may be used as a gargle or injection in various affections of the mucous
membranes. It has also been employed in dysentery and diarrhoea.
MYEISTICA (U. S. P., B. P.).— Nutmeg.
Dose, 0.32 to 1.30 Gm. (or gr. v-ii).
pTcparations,
(U.S. P., B.P.).— OU of Nutmeg. Doae, 0.06 to 0.18 c.cm. (or
Doftc, 2 to 4 conL (or f3as-j ).
^ Oleum MyristicsB
wi-iij).
Spiritus Myristica* (B. P.). — Spirit of Nutmeg,
B. P.. 0.30 to 1.20 c.em. (or mv-xx).
I AIM entei^ into Tinctura Lavandula Composita (U.S. P.), Pulvia Aromaticus
(U.S. P.), Pulvis Cret«B Aromaticus (B. P.), and Pulvis Crela AromaticuB cum Opio
(a P.).
Pharmacoloi^. — The nutnieg is "the kernel of the ripe seed of Myris-
tica fragrans (MyrL'itifaceae)." The outer covering, or arillode, of the
fmit was official in the T^iited States Pharmacopu'ia under the name
of Macis, or mace. The tree is a native of the East Indies, but grows
also in the West Indies and in South America. The kernels of the
seeds are round or elliptical in shape, about an inch in greater diameter
end V* i^c^ IB smaller diameter. They are rather dense and heavy,
and contain 2 to 8 per cent, of a volatile oil (which is official), and from 25
to 30 per cent, of fixed oil, usually known as oil of mace, with some resin.
Nutmeg is fragrant, spicy, and somewhat bitter. It is useful in flavoring,
and enters into a number of pharmaceutical preparations: aromatic spirit
of ammonia, aromatic tincture of rhubarb, aromatic powder, compound
tincture of lavender, troches of chalk, of magnesia, and of sodium bicar-
bonate, and also is a constituent in vinegar of opium.
Physiolog^oal Action. — With aromatic and carminative qualities, nut-
meg unites considerable narcotic power, and in overdoses produces stupor
and delirium. Dr. John Gillespie has reported a case* where five powdered
nutmegs, taken to procure an abortion, had produced frontal headache, ver-
tigo, free perspiration and urination, narcosis, and collapse. The treatment
vaa an emetic of zinc sulphate (2 Gm., or gr. xxx), followed by small, repeated
doMs of aromatic spirit of ammonia. A similar case has been reported by
Waugh.
Therapy. — The volatile oil of nutmeg is rubefacient, and may be used
ifi rheumatism, neuralgia, and paralysis.
Nutmeg has been employed with advantage in itching and painful
hsmorrhoids, according to the following formula: —
• fhmdetphia Medical Times, vol. xvii. page 720.
636
PHARMACEUTICAL THERAPEUTIC AGEXTS OB DRUGS.
B Pulv. myriatic® 8
Acid, tannic 4
Petrolati 31
Gm. or 3ij.
Gm. or 3j.
Gm. or Sj. — M.
Internally, the powdered or grated nutmeg is employed as a carmina-
tive, anodyne, and astringent, to relieve sick stomach and for diarrhoea; it
also allays colalgia and intestinal spasm. Garretson employed nutmeg for
diarrhcea combined as follows: —
ft Pulveris tnyristics.
Bismuth, aubnit. aa 15 5 Gm.
Crets piteparatce 5 2 Gm.
Syrup, zingiberig 90 ccra.
M. Sig.: From a tcaspoonful to a desserUpoonful every two hours.
or Isa.
or gr. \tvx.
or f3"
5"J.
Small doses favor digestion by stimulating the secretion of gastric juice.
Nutmeg may be used to disguise the taste of unpalatable mixtures and to
prevent the griping of a cathartic medicine.
The narcotic properties of nutmeg render it of avail in the treatment
of delirium tremens* Mace acts similarly, but is used as a spice or condi-
ment more than as a medicine. The expressed oil of nutmeg may be com-
bined with wax and olive-oilj with heat, as ordered in the German Pharma-
copcEia, to form the myristicje ceratum used as a warming application to the
abdomen of babies suffering with colic or indigestion.
MTRRHA (U. S. P., B, P.).— Myrrh.
Dose, 0.13 to 2 Gm. (or gr. ii-sxx).
Preparations,
4
Tinctura Aloes et Myrrhee (U.S. P.). — Tincture of Atoee and Myrrh (of each,
10 per cent.). Dose, 4 to 15 c.cm. (or f3i-iv).
Tinctura MyrrJue (U.S. P., B.P,).— Tincture of Myrrh (20 per cent.). Dose, 2
to 7.fl c.cm. (or f5fts-ij).
PilulflB Aloes et Myrrh« (U.S. P.. B. P.).— Pills of Aloes and Mvrrh. Dose, 1
to 3.
It al»o enters into: —
Mistura Ferri Compoaita (U. S. P., B. P.). — Compound Iron Mixture. (See
Ferrum.)
Fhannacology. — Myrrh is "a gum-resin obtained from Commiphora
Mvnha (Burseraceae)" (U. S. P.); "a gum resin obtained from the stem of
Balsaniodendron Myrrha, and probably from other species" (B. P.). It con-
tains 60 per cent of gum, 35 per cent, of Myrrhin, a resin, and about 2 per
cent, of myrrhol, an ethereal oil; also some bitter principle. It forms an
emulsion when rubbed up with water, which dissolves about 60 per cent.
With alcohol it is partly soluble, forming a brownish-yellow tincture. ]!ilyrrh
enters into several preparations besides those mentioned above, as the com-
pound galbnnuni pills (B. P.) and compound rhubarb pills (U. S. P., B. P.).
Physiological Action. — Myrrh is slightly astringent and stimulant
locally, and internally is carminative in small doses, but large ones cause
Yomiting and purging. It has some expectorant qualities, and is a stimulant
to the ovarian and uterine functions.
Therapy. — Diffused in water, with the addition of a little carbolic acid
or thymol, tincture of myrrh is a good mouth-wash for spongy gums, sore
throat, or wounds after operations upon the mouth, or ptyalism occurring
MYRTOL.
637
I
^
•
fcfter ihe use of mercury. It may be applied in tlie full strength to ulcerated
gum5, aphthous patches, relaxed uvula, and freckles. It is also used in
dentifrices and to correct bad breath. A lotion or ointment containing
myrrh is a stimulant and antiseptic dressing to indolent or unhealthy ulcers.
An ointment made by heating together myrrh with wax and oils has been
found useful in those cases of eczema which require moderate stimulation.
Favorable reports have been made of its action in' atonic dyspepsia and
gastralgia, though it has usually been prescribed in combination with other
remedies. In amenorrhoea it is often given in conjunction with iron. In-
ternally, myrrh is considered valuable in checking excessive discharges,
bronchorrhoea, leucorrhoea, cystitis, etc. Under the name of myrrholin a
concentrated solution of 1 part of myrrh in 1 part of oil has been given in
tuberculosis conjoined with creosote in capsules. MyiTh has been used with
reported success in diphtheria. It is giv^n internally and applied locally
to the pharynx. In laryngeal diphtheria the patient is made to inhale every
hour or half-hour from 7.5 to 15 c.cm. (or foii-iv) of a 2-per-cent. mixture of
myrrh.
MYRTOL. — The Myrtus communis (Myrtaceffi) is a beautiful evergreen
ub or small tree, a native of the countries surrounding the Mediterranean.
Its leaves and berries contain a volatile oil. According to E. Jahns, the
myrtle-oil of Spanish origin contains various terpenes, cineol, and a camphor-
like body, and the myrtol of commerce should more appropriately be termed
rectified myrtle-oil. Myrtol is that portion of the oil of myrtle distilling
between 160^ and 170* C. (320' to 338" F.).
PhyBiolo^cal Action. — Myrtol is disinfectant and antiseptic. It causes
no irritation when applied to the sound skin. Upon an abraded surface it
gives rise to a slight burning sensation, which, however, soon disappears, and
a 9-per-cent. emulsion of mjTtol completely arrests the growth of the micro-
organisms of pus. The decomposition of organic material is prevented by
myrtol. Taken internally it promotes digestion. Large doses occasion nau-
sea and headache. It is removed from the system by the lungs and kidneys^
and communicates a violet-like odor to the breath and urine.
Therapy. — Externally, myrtol has been used with success as a disin-
fectant to surfaces covered with unhealthy, or decomposing, pus. It has
proved eflficacious in cutaneous diseases of vegetable parasitic origin, and
has been recommended as a local remedy in psoriasis. Given internally, it
has been found destructive to lumbricoid and thread- worms. Eichhorat
advises its use in chronic bronchitis attended with profuse and fetid muco-
purulent expectoration. The sputum becomes less abujidant, less purulent,
and less offensive. It diminishes foetor in gangrene of the lung. In pulmo-
nary tuberculosis it is said to decrease the number of bacilli. This remedy
has also given relief in chronic pyelitis and cystitis, and has proved useful in
passive hemorrhage. Myrtol was introduced to the notice of the profession
m 1878 by Dr. Linarix.* The extract of myrtle has been used by Dr. R.
Weil, of Berlin, with reported benefit in diabetes mellitus. It was admin-
iatertd in doses of 0.13 Gm. (or gr. ij) thrice daily, increased every three
day* by three pills until fifteen were taken in the day. The remedy was well
borne and caused diminution in the quantity of the sugar. Myrtol has been
■ **!)« TEinpIol du Myrtol ou rKsscnce de Myrte principalexneiit dans let Maladies
4n Voiea Reopiratoirea et Genito-Urinaires."
€38
rHAKMACECTICAL TilEIUPEUTIC AOKNTS OU DBIOS.
adrninistcred hypodennicallyj the solution used being 1 part of rayrtol to 4
parts of liquid puratlln or oU of sweet almonds.
NAPHTHALENUM (U. S. P.).— Naphthalene. Naphtalene (CjoH^).
Dose, QMb to 0.G5 Gm. (or gr. i-x).
Pharmacology. — NiiphUialene is a "liydrocarbon obtained from coal-
tar'' and purified hv distillation ; comes in white crystals, which may be com-
pressed into cakes like camphor, and liaving a peculiar, gas-house, or tarrj',
odor. It was discovered by Garden in 1830. Naphthalene is insoluble in
water, but solui)le in alcohol, ether, and chloroform. Being destructive to
insect-life, it is employed as a substitute for camphor in preventing the in-
vasion of luotlis.
Physiological Action, — Naphthalene may he prescribed ihternally as an
intestinal antiseptic in doses of 0.13 to 0.G5 Gm., or gr. ii-i (to children, 0.065
to 0.20 Gin., or gr. i-iij) every three or four hours. It may be given with white
sugar in capsules or wafers. It has also decided expectorant powers, although
its insolubility only permits a small quantity to be abBcrhed, which is dis-
charged as naplithol or jthenol by (lie bronchial mucous membrane or the
urinary passages, thus acting as a local disinfectant at the point of excretion.
It is devoid of local irritant properties. The urine assumes a dark color
and may contain albumin. A morbillifornt eniptioiij followed by desquama-
tion, has been observed after the adminititration of naphthalene.
In the lower aniraala, one of the effoets of naphthalene intoxication is
cataract formation, ihis condition following the ndrnini.stration of 1 Gm,
of niiplithalene per kilogram of body weight.*
Naphthalene Poisoning. — Kvers= records the case of chronic illness with
loss of appetite, headaclie, and eczema over both legs, wJiich was proved to
be duo to naphthalene poisoning. In this case the drug was used aa moth-
powder, and was sprinkled over some bedding. The symptoms subsided
directly the patient was removed from this particular room, but reappeared
when the same apartment was reinhabited. No other cause for the illness
could be discoverer]. Ev^rs had the naphthalene examined, nnrl no impurity
was detected. A case of typhoid is reported in which naplilhalene was adinin-
iatered by Gotxe.' The patient was given (' Gm. (or gr. xc) during the first
three days; after this the dose was increased to 7 Gm. (or gr. cvij). On the
evening of the sixth day the patient began to be restless, and on the follow-
ing evening he was delirious. The next day the patient was drowsy; the
respiration was labored and irregular. Lips and face cyanotic. Slight
twitching in all the muscles of the body. Pulse regular, 92 per minute. The
temperature had fallen to normal. The urine was dark brown, and after
standing for some time bcciinic black. When naplithalenc was discontinued,
the symptoms vanished in four days.
Therapy. — Naphthalene is a useful antiseptic in treating ulcers, cancers,
^ Jourwil of the American ^fedical Asencialion, Oct. 11. 1902 (von A*/iii.
^onatsblaU f, Auffcnheilkunde) . A. Lczeniua, of St. Petersburg. Russia, report* the
first case of actiuil cataract pnxlvifed in man by inp*Btion of nni)htbalcne. The
patient was a phnrmaciat, 36 years of age. who took 5 Gra. of naphthalene, ilU<iolvetl
in castor oil. within 13 hours.
' Berliner kliniache Wochenschrift, 18R4, p. 593,
■ Berliner klinijtche Wochen^chrift. 42. 1884.
NAl'HTHALENUM.
039
4nd pus-cavities; it can be used in watery emulsioD, in alcoholic solution^
or in a dry form. An alcoholic solution is used as au application to sprains
and bruises.
In addition to the affections named, a naphthalene ointment is advan-
tageously applied to chancres, chancroids, syphilitic ulcers, sloughing
wounds, chronic eczema, and psoriasis. This ointment may contain 30 grains
or more to the ounce of basis: —
H Hydrarg. chloridi mitia
Njipbtlijili-ni 4
Ungt. camphone 27
111. For chancroidsj ulcers^ and chronic ecsema.
65 GiD. or re. x
Gm. or 3j.
Gm. or 3vij.
As a topical application in diphtheria, Kuznecow advises: —
B Mentholi 4| Gm. or 3j.
Alcohol., q. 8. ad solv. et adde: —
Naphthrtlcni 4| Gm. or 3j.
01. terebinth.,
Glycerini aa 7|5 c.cm. or f3ij. — M.
In intestinal disorders due to infection — e.g., typhoid fever, diarrhoea,
and {Kissihly in cholera — naphthalene is of eminent usefulness indiminisliing
the activity of the bacteria of the intestinal canal, as shown by C. Sehrwald,
who alao advises the use of calomel in conjunction with naphthalene in order
to increase the bactericidal effect.
Naphthalene is said to diminish glycosuria when the patient is upon a
mixed diet. For dysentery, Rossback advises the injection into the rectum
of 0.6-5 Gm. (or gr. x) of naphthalene in decoction of marpbmallow, at a
temperature n( 100* F. Naphthalene has also been administered internally
in die treatment of this disease with pood results.
It has also been found efficacious in the treatment of ascarides and
tenia. For children a mixture has been recommended of the following com-
poaition: —
K
B Naphthaleni |28 to
01. ricini Ifi
OIci bergnmotta
50 Gm. or gr. ivaa-viij.
c.cm. or fSsa.
12 ccm. or mij. — ^M.
For tftnia, adults may take 15 j^rains of naphthalene before eating, to be
followed immediately by a dose of castor-oil. A single dose will often expel
the worm entire even when other remedies have failed.
Chavernac maintains that the vaporization of naphthalene in the room
exerts a beneficial influence upon whooping-cough. Scales of this substance,
dusted into the shoes and stockings, are said to be of service in hyperidrosis,
Kaphtalan, or Naftalan, is a dark-brown, unctuous substance with
•carcely anv tMlnr. It \s a purified naphthn mixed with 2 per cent, of anhy-
droiu soap. It appears to combine the therapeutic properties of tar with
thoe<*of nnplitha. It lias been used in eczema, sycosis, and common psoriasis,
as well EiJ in parasitic affections, such ns ring- worm and scabies. It 8t>me-
timea. wlien u»ed freely, causes an eruption similar to tar-acne.
640
PHAnMACEL'TICAL THERAPEUTIC AGENTS OR DRUCiS.
KAPHTHOL (B. P.),— Betanaphthol. ■
BETANAPHTHOL (U. S. P.),— Betanaphthol (0,oH,OH). '
Dose, 0.20 to 0.65 Gm. (or gr. iii-x).
Pharmacology. — Betanaphthol occurs as colorless scales, or as a white,
crystalUne powder; melts at 253.4* F.; is soluble in 75 parts of boiling water,
and is freely soluble in boilint;: alcohol^ ether, cblorofonn, and filed oils. M.
Charrin (Le Bulletin Medical) states that a saturated solution of boric acid
in water increases the solubility of betanaphthol. Betanaphthol has a pung-
ent taste, but is free from odor.
Both the naphthols and naphthalene can be readily tested by the dis-
tinctive color-changes which take place when melted in a test-tube with
chloral-hydrate, adding to the chloral solution a few drops of hydrochloric
acid and finally placing a small piece of zinc in the acidulated solution.
Physiological Action. — When taken internally naphthol ^ves rise to a
sensation of warmth in the stomach. The fjEces are softened and clay-col-
"ored. Diarrhoea is occasionally produced. Large doses sometimes cause
vertigo, buzzing in the ears, and symptoms of cerebral hyperaemia. Beta-
naphthol is slightly stimulant to the skin and mucous membranes, allays pain
and pruritus. It is one of the most powerful antiseptic agents, possessing
three times the strength of carbolic acid or iodoform and four times that of
creosote or naphthalene. It may be regarded as absolutely saf*% since, accord-
ing to Professor Bouchard^s investigations, nearly half a pound would be re-
quired to cause death in a healthy person weighing 150 pounds.
On the contiarv, cases of nephritis have been attributed to the influ-
ence of betanaphthof. Dr. Max Baatz has recently reported two cases, one of
which proved fatal, in which this result was attributed to the use of an oint-
ment containing naphthol. Both patients were children.
Therapy. — Botanaphtliol is a valuable local remedy in parasitic diseases
of the skin. An ointment containing 2 Gm. (or 3s8) to 31 Gm. (or 5j) is de-
structive to pediculi and their ova. The same preparation is equally fatal
to the itch-mite, and at ihc same time relieves the inflammation occasioned
by the parasite. It soothes the irritation produced by the bites of fleas, bed-
bugs, and mosquitoes. The various forms of tinea trichophytina yield to the
influence of naphthol ointment. A 10-per-cent. oiutmeut of betanaphthol
has been employed with advant^ige in cases of favus.
The itching of para^sthesia, urricnria. pemphiijus, and pruriEfo is very
successfully treated in the same manner. BL^anaphtlud is especially valuable
when the skin is rough and infiltrated. In chronic eczema and psoriasis it
is a reliable medicament. The secretions of the skin are favorably influ-
enced, and it very often proves useful in the treatment of hyperidrosis and
hromidrosis. Benefit also results from the emplo^Tuent of this substance in
acne, seborrhcea, sycosis, alopecia circumscripta, lupus erythematosus and
vulgaris, chronic ulcers, chancres, and chancroids. The remedy may be used
in the form of a powder, lotion, or ointment. It is often well combined with
bismuth or other mild powder, as: —
B NnplitljotiB l| Gm. or er. xt.
Biamuthi subnitratia 3I| Gm. or Ij,
M. For use aa a duating powder.
The odor of cancer and eczema is overcome by naphthol. It is an ex*
cellent antiseptic dressing to wounds, and may often be advantageously em-
ployed, according to the method of Professor Reverdin, by impregnating
WAPHTHOt.
prcTiously sterilized gauze bandages with an ethereal sohition. An aqueous
wlution may be used with good result in mercurial salivation and chronic
pharyngitis. Vaginitis, vulvitis, gonorrhoea, and gleet are notably improved
by the use of naplithol. For gouoniuea and >;lcc*t an injrt'liuu iimy be eom-
po&ed ae follows: —
B Naphtholis.
Glyccrini . . .
Aqnie
30
90
32 Cm. or gr. v.
c.cm. or f3j.
c.cm. or fjiij. — M.
fA solution of lietannphthnl in glycerin and water is useful in chronic
otorrhrt'a. Bvtamiphtlwd hns been employed in dificases of the ear, the results
being satisfactory in the majority of cases, though in a few the effects were
apparently injurious. The powder was generally blown directly upon the
■ diseased parts. At other times it was employed in the form of a 1 V^- to
3-per-cent, alcoholic solution, allowing it to remain from two to five min-
utes. The more profuse the suppuration, the more frequently should the
procedure be repeated.
An aqueous solution of the strength of 1 to 2500 has yielded good re-
eulls in purulent ophthalmia. In simple or granular conjunctivitis and
I trachoma, likewise, this agent has proved a valuable remedy. This sub-
stance is very advantageously combined with camphor. Camphorated naph-
th4d is fonned by adding 1 part uf naphtliol ti» t* parts of ciuiiphnr, nnd i? a
eolorless, syrupy liquid, well adapted for use as a local antiseptic. It
may be beneficially employed in wounds, ulcers, sinuses, diphtheria, tuber-
cular laryngitis, and, rubbed up with lard, it forms a valuable applica-
tion in manv diseases of the skin. M Reboul has used camphorated naph-
ihol with advantage in irrigation of diseased bones and jointii, nWess-cavi-
j titi*, and tuberculosis of (lie lilmldrr. lb* has al^o obtained good results iu
H tutjert-ulosis of glan*U from IIk* int'Tslitial injection of A to 5 minims of the
H fluid rvrry eight or ten days. Tlu' iinra|HT;toncal injection of camphorated
H naphthol has been attended with very encouraging results in tubercular
H peritonitis in the practice of Dr. Rendu, of I'aris. Eruptions have sonie-
H limes followed the topical use of camphorated naphthol. Inhalations of
bctanaphthol are of service in pharMigitis, olirunic nasal catarrh, hay asthma,
▼hooping-cough, and chronic bronchitis.
Bi^lnnaplithol i;! adniinistored internallv cbietly n.« a meanis of securing
tDtisepsis. Being almost insoluble, it is one of the best agents at our com-
mnnd for diiiinfection of tlie alimentary tract. In typhoid fever, it miti-
■ pitfs the severity of the disease and reduces the rate of mortality. The
ftoolB are deodorized, tympanites lessened, and the tongue moistened. Grave
delirium rarely makes its appearance. These results, announced by Pro-
If«Mor Bouchard, have been amply confirmed by the writer and numerous
ohserrcrs at home and abroad. Pr. Mitchell Bruce' concludes that the dura-
atioD of typhoid fever is shortened, and the tendency to secondary compli-
ratiomi overcome, by (he use of bctnna|»htliol. The testimony of Dr. P«»tresco,
of Bucharest, is strongly to the same effect.' The remedy is equally valuable
^rrtfcfifionrr, Dec, 1888.
•J. Ivtresco: "RechercheB diniquei et espfirimentalefl lur rAntiw|i»ie ^^CKlil'l^le,*•
Jaa. 1S89.
i
642
niAUMACEUTICAL THERAPEUTIC AGENTS OE DRIGS.
in the typhoid fever of young children. When the diarrhoea is profuse it is
advisable to foaibiiie ujiplithul with bismuth siUicylate, thus: —
I{ Xnphtholis,
Bismuth. Balicylat aa
M. et div. in chartulae no. xv.
Sig. : A powder every hour or as requiriHl.
8| Gm. or 3ij.
'1
1
Good results are derived from the internal administration of this drug
in diphtheria, erysipelas, and scarlatina. In Hatulent dyspepsia, chronic
gastric or intestinnl catarrh, and dilatation of the stomach, it is no less e)^-
cacious. The late Professor Dujardin-Beaumetz recommended, in dilatation
of the stomach, the following combination: —
H Naphtholis.
Biamuth. salicylat.,
Magnes. caloinat. aa I0|
M. et div. in chartulie no. xxx.
Sig.: One powder before each of the two principal mealt.
Gml or gr. c1.
In obstinate constipation, connected with disturbed digestion, the au-
thor has witnessed excellent results from 0.03 to 0.20 Gm. (or gr. gs-iij) dopes
of lit'taiiaplitho] giviMi tlirue or four tiiiu-s a diiy. By some practitioners beta-
na[>htiio] is hiirhly e^toonKnl as a vermifup^, pnrticvilrtrly useful for the de-
struction of round worms. Dr. G. A. Gibson, nf Edinburgh, has found beta-
nnphthol, in tlie dose of 0.13 (iin. (or ^r. ij) tliriee daily, of decided ctricufy
in the treatment of simple and j)ernicious iinasmia. Betanaphthol is likewise
often of utility in rhronie cystitis, and is well pfiven in the form of tablet
iritunites. ^!ilk, ^'lyeerin. and tnucihi^'c nre ulso excellent vi'liivlrs for its
admini.^tratinn.*
Salinaphthol, a conibitmtion of hntaiuijilithol with salicylic acid, is said
to act ?iniiliir!y to sahd, \vith(Kit liein^j as toxic, in nrliculiir rlRuniatisni, in
doses of from 0.25 to 0.50 Gm. (or gr. iv-viij).
Kobert believes that, by the action of the pancreatic juice and the in-
testinal fennents, niiphtliol witli salicylic acid, or palinaphthol. is split up
into salicylic acid in tlic urine. Lepinc,^ on the contrary, 3tnted that tlic in-
testinal Juice is incnjuiblf* nf producing this deooni posit ion. hut R<Iilod that it
may be brought about by the pancreatic secretion. The decomposition of
salinaphthol he reports may be iluc simply to an alkaline reaction.
Microcidin. — Under the name of microeidin, a combination of beta-
iiaphtliol with caustic soda has he*'n introduced, ^ficrocidin occurs in the
form of a white powder, the principal constituent of which is sodium naph-
tholate. Microcidin is sohil)lp in water, alcfiliol, and otlier; is said to be
superior to carbolic and horic acids in germicidal power, hut somewhat in-
ferior to uaphthol and incrcuric chloride. A weak solution is used upon
wounds and ulcers and for the purpose of removing the odor of gansrene,
Microcidin ha? been used with success in diseases of the ear, nose, and throat,
generally in the proportion of 3 to 5 per 1000.
* Sec papera by the author, "Xaphthol: it* Medicinal Use and Value," Jourwtl
of the Am(^'icnfi .Wrrfiea/ A9sociation, Oct, 1883; Thrrnpcutic Gazette, Oct. 15, 1H8U.
'Journal de M^decine de Paris, Nov. 16, 1890.
NAPHTHOt.
I
lydronaphthol. as the writer and others have already shown,* exists
aii inipuni form of betanaphthol.
Beaionaphthol, or betanaphthol benzonte. is obtained by the action of
izoyl chloride on betanaphthol. It is a whitish, crystalline, odorless, and
tasteless powder, soluble in alcohol (warm), insoluble in water. It has been
used with success as an intestinal antiseptic in doses of 0.20 to 0.65 Gm.
(or gr. iii-i).
Lactonaphthol, or Lactol. — M. C'oez has prepared a compound analog-
ous to beuzonaphthol. Lactonaphthoi. or hictol, is the lactic other of naph-
thoic and is decomposed in the alimentary canal into its components. It is
without taste and has been' taken without inconvenience in daily doses of 1
Gm- (or gr. xv).
Aaaprol. — This napie was given by MM. Dujardin-Beaiimetz and Stack-
ler to one of the derivatives of betanaphthol, via. : the sulphuric ether of
b' • hoi. in combination with calciunu the heta-naphthol-alpha-mono-
«i; : I' of calcium. Asaprol presents itsrif in tlie fonnof a white powder,
ejtremely soluble in water and alcohol. It is incompatible with alkaline
iodides, sulphates, and most of the alkaline salts. Its antiseptic properties
are nearly equivalent to those of sodium salicylate. It allays pain and re-
duces temperature in ditferent diseases, and is of special service in acute
infiunmatory rheumatism. It may be administered in doses of 0.38 to 1
Om, (or gr. vi-xv), or 4 Gm. (or 5j), in the day.
Asaprol is rapidly eliminated by the kidneys. Its presence in the urine
may be detected by the addition of ferric chloride, which produces a black
color tending to blue. Asaprol is comparatively free from toxicity. It does
not occasion vertigo or buzzing in the ears. It was tolerated without incon-
venience by dyspeptic patients and those suffering from albuminuria. In
ftome eases of influenza Stackler found asaprol efficient in reducing fever
and alleviating pain. He obtained good results from its use also in gout,
asthma, furunculosis, anthrax, tonsillitis, and various infective conditions.
Orphol. — Betanaphthol-bismuth (von Hoyden) : a naphtholatc of bis-
muth containing 80 per cent, of bismuth oxide and 20 per cent, of beta-
naphthol. In the intestinal tract it is decomposed into bismuth oxide and
naphthol. It is useful in infectious conditions of the intestinal tract and in
diarrhopa. Dose, 0.65 Gm. (or gr. x) every two hours. It may be obtained
in tablets of 0.3*^' Gm. (or gr. v) each.
lodonaphthol. — A combination of betanaphthol and iodine, known also
ii- ' -fe of iK't^maphthol. — a greenish-yellow, tasteless, and odorless pow-
0' le in chloroform, slightly soluble in alcohol, ether, and acetic arid,
aa<i insoluble in water, — has been applied as an antiseptic dusting-powder
to wounds and ulcers.
Haphthol, Alpha-. — AI[)lia- and beta- naphthols are obtained by heating
UigetJ»«T. for si?veral hours, naphthalene and sulphuric acid. A large quan-
tity of hot water being then added to the mixture, the excess of naphthalin
ii filtered off and the solution saturated with lead carbonate. From these
lf«d-fiaphtbalin guljihonates the respective acids are prepared, and from
the a* 1 with an alkjili two naplithols are made: the alpha and beta.
Bttari . which is ofTicial and has just been considered, is the first to
•S** pnp*r» by th* author: *'The ImnutAtions on BetAnaplttliol." ami "The
IfeCuuiphthol m. Hyilivinflphthol Contention/ Journal of ihr Amtriccn MedUnil As-
avtaijon. July 14, I'SSM, nml Mny 11, 18H9.
644
PIIAKMACEDTICAL THERAPEUTIC AGENTS OR DRUGS.
crystallize, and is readily separated from the alpha variety by boiling alco-
hol, in which the latter is insoluble.
A simple test for distinfruishing between alpha- and bcta-nnphthol is
given by M. Aymonier. A few drops of a mixture consisting of 1 Gm. {or gr.
xv) of potassium bichromate, 1 c.cm. (or rwxv) of pure nitric acid, and 10
c.cin. (or f5iimxlv) nf distilU'd water will at once produce with alphanaph-
thol a black jireeipitate, while betunnphthol is unchanged bv the reagent.
Pure alplianaplithul is ju'rf.'dly white, melts at 132°"C. {24\.G° F.),
and boils at '^^^W V. {">4ii.s° F.). (Jenois shows that when alphanaphthol is
treated witli ferric rhiorido the solution turns ^Tcen. and white dinaphthol is
precipitated. AI[ihan;i])liihol is insohible in cold 'and slightly soluble in hot
water. It is very soluble in ether and alcohol, from either of which it crys-
t-allizes in white, shining needles. Alj)hannphlhol lias an aromatic odor and
somewhat pungent taste, and is converted, with heat and hydrochloric acid,
into najihtluileno and sulphuric acid. (Jenois static that iinpuiv alphanaph-
thol is dan*:erinis and quite unfit for medicinal use.
Physiological Action. — Alphanajdithol, used internally, produce? warmth
in the stomach, stimulates the glands of the entire gastro-intestinal tract, and
tends to make the fa?cal discharges of rather a soft consistency. Large doses
have caused increase in the arterial tension and symptoms of cerebral hyper-
emia. The systemic action of alphiina|>hthol differs but little from that ob-
served from the administration of lH'tjuiaplitht>l. Alphanaphthol has marked
antiseptic properties. MaximovitEch reports (MercJc's Bulletin) that alpha-
naphthol. in the proportion of 1 to Ifi.ono of culture-gelatin, prevents the
growth of most of the various patliogenic njicrobes; even in the proportion
of 0.6 or 0.8 to 10,000 it retards the development of microbes by three to
eight days. Sternberg has d-^'nionr^t rated that botli iiaplitliols i-estrain the
growth of the comma bacillus according to the strength in which they are
used. Maximovitsch further adds that similar antiseptic effects were pro-
duced by betanaphfhol, hut twice as much, he reports, had to be used to pro-
duce tlu.' same results. Alphann}iht]H>l has a stiniuhiting and astringent
action ujTon the skin.
Therapy. — Alphanaphthol, from the writer's experience, is certainly a
good antiseptic. It is also a usL^ful disinfectant. Alphanaphthol solution,
from 0.065 to 2 Gm. to 30 c.cm. {or gr. i-xxx to ffj) of distilled or boiled
water, is serviceable in treating wounds or ulcers, and for all surgical proced-
ures requiring an antiseptic agent. Alphanaphthol solutions are beneficial in
seborrha^a, acne, rosacea, chronic eczema, and alopecia. Nasal catarrh, buc-
cal inflammations, pharyngitis, and laryngitis are often relieved or removed
by the application of alf*]i;uiaphtb!)l solutions. The solution can, in the dis-
eases just named, be used with advantajjc in the form of a spray. Solutions
of alphanaphthol can he oni|)hnvd with nilvantaf^^o in injections for gonor-
rhcea in both sexes, in gleet, iu leticorrha'U. and in irrttation and itilhimma-
tion of the lower portion of the rectum. Alphanaphthol incorporated in
some fatty substance (0.32 to 4 Gm. to 31 Oni., or gr. v to Ix to the ounce),
as lard, suet, hutterj lanolin, zinc or lend ointinent. can be used for very
many diseases of the skin, Kuch as chronic acne, rosacea, psoriasis, chronic
eczema, alopecia circumscripta, and for ohronie ulcerB. According to the
authors exporienir. alphana]>h1hol, \v]iil(_' n good stimulating and astringent
substance, having also antis*?ptic ])rr.yHTties, lacks, to a great extent, the
anaesthetic or sedative effects upon tlie integument which belong to beta-
NIRVANIN,
645
naphtliol. Further, the internal use of alphanaphthol has nut btH?n followed,
in the writer's experience, wiih that deciiled action observed from betanaph-
thol. AlpUanaphlhol can, however, be employed iutemally in froin 0.1)3 to
0JI2 Gm. (or gr. sh-v), three or four times a day, for chronic catarrh of the
stomach or bowels, and in constipation. It can also he u?:ed a? an antiseptic
in smaller doses (0.015 to O.Go Gm., or gr. VV^j three or four times a day)
iu typhoid and other fevers.
The author recommends, when t.\Tupanitos and nbdominal pains are
excessive in typhoid fever, the following combinations: —
B BfUnftiihtlinl
BisniuUt. subnitrat
Pulv. rhei
K\t. IteUadonniv folior. .
31 Sig.: Four to six such powders daily.
Or:—
R Bi'Unaphthol
Codein
Pulv. rhei
Cinnamom. zeylan
U. Sig.: Four to aix such ponders during the day.
50 Gm. or gr, viij,
28 Um. or gr. ivas.
20 Gm. or gr. iij.
01 Gm. or gr. V.-
50 Gm. or gr. viij.
01 Gm. or gr. V«.
10 Gm. or gr. isa.
20 Gm. or gr. iij.
KECTAOT)RiE COETEX.— NTectandra-bark, Bebcem-bark. The bark
of Xevtandra Kodiaei (Laurineae), of Britii^h Guiana, contains tannin and an
alialoid discovered bv Maclagan, Beberine (not the same a* berberiiie). The
aJJtaloid is said by Fliickiger to be identical with buxine, derived from Buxna
sempcrvirens and from pareira. Pure beberine is a white, amorphous pow-
der, bitter to the taste and devoid of odor, soluble in alcohol and ether, but
roaringly soluble in water. Beberine sulphate occurs in the form of thin,
atrk-brovt-Q scales, of bitter taste, soluble in water and alcohol. Another
^•fkaloid, termed Sipirinc, insoluble in ether, has been separated. Ncc-
tandrinc, also an alkaloid, is present in the wood.
Physiological Action and Therapy.— Beberine sulphate produces tetanic
fcasms in frogs. In the human subject the bark or alkaloid increases appe-
^te, improves digestion, is somewhat astringent, and possesses some anti-
periodic power. It is said not to produce headache or rinsjing in the ears.
it may be employed in atonic dyspepsia and conditions of general debility.
Bebeem-bark was introduced as- a substitute for quinine. Though often
successful in breaking up malarial fever, it is far less reliable than cinchona.
^ It has been given with benefit in periodical headache and neuralgia. This
■ remedy has also been employed with asserted advantage in menorrhagia,
H ieucorrhtBa, and strumous ophthalmia.
■ KIRVANIN is a synthetical product with properties resembling those
H of both urthoform and cocaine. It is said to have the following chemical
formula : di-ethyl-glycocyl-para-amido-ortho-oxy-benzoic-acid-methyl-ester
hydrochloride, and is produced by substitution. It crystallizes out from
ibsolute alcohol iu colorless prismatic crystals, but is readily soluble in water,
giving a neutral solution. A few drops of a o-per-cent. solution causes com-
I plete ana'fithesia of the conjunctiva. It also causes local anaesthesia when
■dministered hypodermically, so as to permit of minor surgical operations.
4
646 PHABMAOEDTICAL THERAPEUTIC AQENXS OK DltUGS.
It is decidedly analgesic, even in Bolutions of 1 per cent. Owing to llie
stabilily of the solutions, it is preferable to cocaine for infiltration anaesthe-
sia b}' Schleich s method. It is said to be only one one-hundredth as toxic aa
cocaine. As much as 0.50 Gm. (or gr. viij) has been injected hypodermically
without toxic effects. This agent is not adapted for application to the sur-
face of mucous membranes nor to the eye, as a rule, on account of its irri-
tating and non-penetrating powers as compared with cocaine or eucaine.
It is especially serviceable to dentists, in 5-per-cent. solution, to relieve pain
during extraction of teeth on account of its feeble toxic action and its more
prolonged anaesthesia than either cocaine or eucaine. It is" supplied in the
form of a powder and in tublets of 0.032 Gm. (or gr. ss) for hypodermic use.
NITROGLYCEEINUM.— Nitroglycerin. (See Glonoinnm.)
NTJCLEIN. — A proleid principle extracted from living cells, especially
ycHst-iiilturej^. It prodiici*s li^uutu'vlosis wlit^n administered by the month or
hvpodt'imically, and is used to combat sepsis, and infectious diseases. Com-
binations with various motiils are mado, i. r., with silver (nargol), with
co]>p('r ((■iii>rot), with iron (forriiiol), anJ with merourv (mt-reui'ol).
NTJX VOMICA (U. S. P., B. P.).— Fux Vomica, Poison Hut.
Doae, in powder, 0.065 to 0.25 Gm. (or gr. i-iv).
Preparations,
Fluidextrat'tuni Niiois Votnirce (V. S. P.). — Fluid Kxtruct of Nux Vomica.
lAsHJued 100 c.cui. ^ 1 Uin. of strychnine.) la one-fifth the strength of the pow-
dered extract. Dose, 0.06 to O.'iO c.cni. (or mi-v).
Extractum Nucis Vomicae Liquidum (B. P.). — Liquid Extract of Nux Vomica.
Dose, 0.00 to 0.18 c.cra. (or wi-iij).
Extractum Nucia Vomica (U. S. P., B. P.).— Extract of Nux Vomica. Dose, 0.015
to 0.03 Gm. (or bt. Vrw). B. P., 0.015 to 0.005 Gm. (or gr. V.-j).
Tinctura Nueia VomicjE (V. S. P.. B. P.). — Tincture of Nux Vomica (contains
1 per cent, of Btrychnino, and ia made from the extract; B, P., liquid extract). Dose,
0.30 to 1.20 e.<in. (or tMv-xx).
Alkaloids and Preparations of AlkaJoids,
Strychnina Nitrns (U. S. P.). — Nitrate of Stri'chnine. Dose, same as sulphate.
Strychnime Sulphaa (U. S. P.). — Strychnine Sulphate. Dose, gr. 0.001 to 0.003 Gm.
(or gr. Voo-Vw).
Strychnina (U. S. P., B. P.).— Strychnine. Doae, 0.001 to 0.003 Gm. (or gr, •/•-Vao).
StrjchniniE Hydrochloridum (B, P.). — Hydrochloride of Strychnine. Dose, 0.001
to 0.004 Gui. (or gr. V«-V,.).
Ferri et Strychninae Citras (U. S, P.).— Iron and Strychnine Citrate. Dose, 0.20
to 0.32 Gm.. (or gr. iii-v).
Klixir Ferri. CJuininae, et Strychnine Phoaphatum (U. S. P.). — Elixir of the
Phosphates of Iron, Quinine, and Strychnine.
Glyireriium Fi-rri, Quininic, et Strychninit Plmsplintum (U. S. P.). — Glycerite
of the Phosphatrfl of Iron. Quinine, and StrvtrhniiR*.
Syrupus Ferri, Quininw, et Strychnime Phosphatura (U. S. P., B. P.). — Syrup of
the Phospiitttes of Iron, Quinine, and Strychnine. Dose, 2 to 4 c.cm. (or fSsa-j),
Liquor Strrchninff Hydrochloridi (B. P.). — Solution of Strychnine Hydrochloride
{1 per cent,). Dose, 0.12 to 0,50 c.cm. (or mii-viij).
Pharmacology. — Xiix vomica is "the seed of Strychnos Kux-vomica
(Tjoi;anmcc!»')/' "f" Kast IiidieH, Yielding, when assayed by the process given,
not less than 1.25 per cent, of strychnine (U. S. P.). The seeds are disk-
shaped, ahout fin inch in diameter, covered with eilky hairs, of a greenish-
4
NIX VOMICA.
647
^
V color, and pfrayi^h-whiio internnlly. Odor none, but tlie taste is very
Tter. Strychnine tiiul Brucinc, with Igasuric Acid, arc the important con-
nts, besides fixod nil. tnuiiin, etc. A tliird alkaloid, isolated by Dcsnois
o3, and termed Igasurine, has been shown by Jorgeusen to respond to
nil tlir* tests for bnicine, and, in fact, to bo identical with it.
llie tincture of tlie present Pliarmacopiria is about 20 per cent, weaker
than that of 1800.
As the |>owdcred dni^ varies in alkaloidal gtrenjErth, in making the fluid
preparations, the Phnrniacopceia now requires them to be standardized in
onlcr to insure uniformity of physiologieal and therapeutical elTect. Strych-
nine represents the medicinal activity of nux vomica. Strychnine crystal-
hwic ont of alcohol in the form of colorless prisms and dispolvcs in pure sul-
jtbiiric acid without chanse of color. Tf a few drops of tills sohition be
pinced upon a white plate and an equal quantity of p<5iassiura-bichroniate
mdution be cautiously brou^rht into contact with its edge, a beautiful and
characteristic play of colors is produced, rantrin^ through hhic, purple, crim-
*^»n, and red-brown. This cnlor-chantre is distinctive, and is available as a
delicate test for strychnine. Morphine obscures this t<?st. and hence, if pres-
ent, shonld first be removed by means of an alkiiline mixture of chloroform.
A physiolo^cal test is also utilized in cases of suspected poisoning: O.nooOQ
Oiii. (or gr. '/jnon) *^f strvohnine sulphate in a drop of water, applied to the
'fried skin of a frog, will produce spasm in about ten minutes. Rrucine,
vhich gives rise to a similar physiological reaction, is likewise a crystalline
iKidy, doluble in 330 parts of cold or 150 parts of boiling water, has a
Rtrongly-bitter and persistent taste, and, although generally resembling
rychnine in its projwrtics, will sometimes destroy life without the occur-
ce of convulsions. Strong sulphuric acid strikes a blood-red or scarlet
lor with bmcine and its salts. Igasurine occurs in colorless, silky prisms;
more poUible in water than either of the other alkaloids: has a similar
titter taste and toxic action ; and is colored rose-red bv strong sulphuric acid,
ft like bmcine and its salts. These are all .soluble in water and in alcohol,
aking intensely-bitter preparations, thus rendering the pill form best for
idministration.
Physiological Action. — In minute doses, repeated three or four times
daily, which is the best way to get its tonic effect, gtrychnine increases the
appetite, stimulates secretion, improves digestion, and exalts the vital powers,
improving also sight and hearing. Strychnine is a etimnlant to the respira-
tory centre, also to the heart and vasomotor centres. Arterial pressure u
raided and the pulse becomes slower. The pupil dilates under its influence.
Peristalsis is increased and the bowels somewhat loosened; even diarrhcea
may result from full doses.
From experiments upon dogs, Agricolansk-}- has ascertained that large
dofes of strj'chnine suppress the pancreatic secretion. Smaller quantities
"ther produce no effect or slightly stimulate the gland. The presence of a
nil amount of strychnine in the pancreatic juice seems to promote its
sroylolytic action. Strychnine stimulates the genito-urinary system, has
iH>me influence upon the muscular tissue of the uterus, favors the occurrence
of the menses, increases the venereal appetite, and excites erections. Dr. E.
Manrel has published some interesting researches regarding the influence of
atryehnine upon the leucocytes of the blood. From his observations he be-
lieves that these cells exhibit, in different animals, a specific sensibility to
C4.S
rilARUACEUTICAL THERAPEUTIC AGENTS OB DRCGS.
its action, and that in accordance with the susceptibility of the leucocyte
is that of the animal. The functions of the spinal cord are exalted as well
as stimulated, according to Biernacki,* and especially those of the anterior
gray columns; but a very large dose paralyzes and destroys them. The brain
is not alTected directly until the accumulation of carbonic-acid gas in the
blood causes coma and insensibility.
Kitrnncki states, however, that subcutaneous injection of small doses
of strychnine nitrate reduces the electrical excitability of the cerebrum
This drug is absorbed rather slowly by the stomach, more rapidly by
the rectum, lis toxic effects are, consequently, more promptly manifested
after injection info the rectum than whtn aJniini^tered liy the mouth.
Strychnine Is slowly excreted by the kidneys, but elimination is more rapid
in cliildren than in old yjcople. Strychnine also escapes in the saliva. It,
therefore, tends to accumulate in the system, and produce muscular stiffness,
cramps, and other symptoms of toxic action. Dr. Woodley Stocker has ob-
Berved, in his own person and in others, flushing of the face, throbbing of
the head, giddiness, and faintness caused by doses of strychnine sufficiently
large to approach the physiological linnt.
On account of its slow rate of absorption and elimination, its exhibi-
tion should be occasionally suspended for a time, lest a dangerous quantity
ficcumulate within the system. Strychnine is a local irritant. It possesses
some antiseptic virtue, and, to a certain extent, inhibits the movements of
leucocytes, tluni;^h fur feebler in this respect than quinine. A bright-red
eruption has been observed to follow the administration of a small dose of
strychnine in exceptional cases.
Poiaoning by Strychnine. — When a relatively large dose (0.02 to 0.03
Gm., or gr. Va-ss) is given to an adult and absorbed, the face is drawn into
a grin (rii<us sardonicys), the lower jaw becomes immovable, the neck rijsid,
the pupils dilate, the reflixes arc heightened so that the muscles contract
epasmoilieally and i>ainfully; then paroxysmal attacks of tonic contraction,
especially of the extensnr muscles of the body, in wliich the patient assumes
the position of opisthotonos, occur; finally, the muscles of respiration be-
come tetanieally fixed, and death occurs from apnoea and carbonic-acid ac-
cumulation in the blood, producing narcosis. Dr. Perry has reported a case
of strychnine poisoning in which, four days after the immediate convulsive
effects had ceased, paralysis of the muscles of the upper and lower limbs and
of the intercostal muscles occurred. Dyspnoea increased rapidly and the pa-
tient died from asphyxia. The kidneys were injected. The fatal result may
ensue iu a few minutes if the dose be a large one. About 0.03 Gm. (or gr. ss)
may be regarded as a minimum fatal dose. It acts more rapidly and effect-
ively when given by the rectum, or hypodermically, than when swallowed.
As is the case with other active poisons, the lethal dose varies within consid-
erable limits. Death has resulted from 0.03 Gm. (or gr. ss) of strychnine or
0.20 Gm. (or gr. iij) of extract of nux-vomica; on the other hand, as much as
0.38 Gm.(orgr. vj)of strychnine sulphate has been taken without fatal etiect.
When a fatal dose has been taken death is not usually long delayed. Recovery
is the rule if the patient survives for three hours. Dr. Taylor, in his work on
poisons, states that six hours is the longest recorded period for a fatal issue.
A case, however, has been described by Dr. Thomas J. Henry, of "Warialda,
' Therapeuiiache Monatshefte, Aug., 1800.
JTUX VOMICA.
G49
I
I
New South Wales, in which death was postponed for nine hours after about
0.05 Gra. (or gr. x) had been taken, the patient in the interval having been
unWer treatment. A fatal case of chronic poisoning in a woman is reported
bj Dr. A. H. Falconer,* of Louisville, Ky. The principal symptoms were ex-
tivme weakness, muscular pains, stiffness of muscles at the back of the neck,
clonic convulsions of forearm with contracture of flexor tendons of fingers.
She also had vertigo, amblyopia, weak — but regular — pulse. Temperature
slightly elevated. Tongue coated and swollen, bowels constipated, frequent
chilly sensations. Delirium preceded death, which occurred during a con-
vulsive attack. The patient had taken 0.002 Gm. (or gr. V30) of strychnine
four limes a day for eight months, which had been prescribed by a physician
for *'nervousness."
A very instructive case, showing the after-effects which may be caused
by strychnine poisonins^, has been published by Dr. G. Honigmann, from
the clinic of Professor Kiegel, of Giessen.' A man who suffered from the
c)8>sical symptoms of this accident had recovered under the liberal use of
chloral-hydrate. At the expiration of twenty hours after taking tlie poison
only a minute quantity of urine had been voided. Albumin was unmistak-
My present. There was abdominal pain with constipation. During the
fircond night a amall quantity of clear urine was passed, which contained an
abundant precipitate of albumin. It deposited a sediment in which were
detected both white and red blood-corpuscles and a few hyaline casts. The
pain and constipation continued and the pulse remained slow and strong.
On the fourth day albuminuria persisted; the urine was still scanty; the
•ediment rich in blood-corpuscles, hyaline and epithelial easts, with renal
epithelium. The kidneys began to resume their functions upon the fourth
•nd fifth days, after the skin had been roused to free perspiration. The
illjiimin, casts, and cells began to decrease nt the same time, but did not
finally disappear until the fourteenth day. During all this time the pulse
remained very slow. The renal insufliciency and albuminuria were probably
due to limitation of the circulation through the kidney by contraction of
Its Teasels. But the composition of the sediment indicated that a more per-
manent injury had occurred. The reporter plausibly conjectured that the
renal epithelium had been affected, giving rise to an acute glomerulo-
nephritis.
Diagnosis of Strychnine Poisomng. — The convulsions do not resemble
IhoM occurring during the epileptic paroxysm, because they are always
tonic, and never clonic, in character. They may be distinguished from those
of tetanus by the history of the case and by the symptoms. In tetanus the
mufcies of the lower jaw are first attacked; locked jaw exists for some time
before the other muscles are involved; moreover, in tetanus they do not en-
tirely relax; some remain rigid; whereas, in strychnine poisoning, all the
mu^t-lfs are affected almost sinniltrt!»rt>u.^ly, the body being thrown into
pistiiotonoe witli each paroxysm. In what is known as tetany, the muscles
jut tJie neek arc usually not affi'ott*<l, but there is persistent rigidity of
othiT muscles. In hysterical convulsions the muscular contractions are not
pftin/uJ, and the patient does not retain full sensation, nor full eonscious-
m^M, but is in a dreamy or stupid condition. In convulsions of hydrophobia
tMOL
' The Am^rioan Practilionrr <tnd Sncti, July 1, 1898,'vol. xxvi, p. 9.
'Deutsche mcdicinitchc Wochcn^chrift, May 30. 1889; Medical Bulletin, Oct..
G50
PHARMACEUTICAL TJIEnAPEL'TIC AGENTS UU DKIOS.
the patient is semidelirious, thero are no tonic spnsms of muscles or cramps,
and there is a history of a wound from an aninial.
Antidotes and Treatment. — Tannin is the chemical antidote to nux
vomica and to strychnine. The antidote should bo given immediately, and
a convenient form is tea or cofTce that has been standing for an hour or more,
giving grounds or leaves and all, washincr out the stomach afterward with
warm water or coffee. After spasm has developed, the introduction of the
tube may excite convulsions. In order to obviate this occurrence the patient
should be placed under the influence of aniyl nitrite' or chloroform. The
same caution applies to catheterism. The physiological antidotes are potaa-
sium bromide, chloral, paraldehyde, and physostigmine, or Calabar bean.
Amyl nitritCj chloroform, or ether inlialations may be cautiously employed
at the onset of the paroxysms, and artificial respiration practiced. The
catheter should be used frequently* and the bowels thorou<jhly evacuated
with croton-oil. The physiological antidotes may be given by the rectum.
If relaxation does not occur, nitroglycerin may be injected hypodermically.
Animal charcoal and fats are useful adjuvants. Sanquirico prefers paralde-
hyde to chloral, and warmly recommends intravenous injections of a con-
siderable quantity of an 8-per-cont. soda solution, which produces active
diuresis and elimination. Opium and coniuni may also be brought into
requisition as physiolorrieal antidotes. Dr. Whitla'' writes witli decided ap-
proval of tobacco and alcolinl in poisoning from strychnine. He states that
he would not hesitate to use alcohol nlone in a desperate case, and believes
that it will alTord the best chance of success in dealing with the spasms, but
poisonous doses must be boldly administered by the mouth and rectum.
The use of tobacco should be discouraged, as it is not the antidote for strych-
nine.'* Chloroform hns been given by the mouth (4 to 7.5 c.cm., or fSi-ij)
successfully. Paraldehyde is also a reliable nntidote.
Siebold, in some experiments conducted upon himself as to the physio-
logionl action of strvchnine.* reports that tannin in (t.O'i Om. (orgr. x) doses
was valueless as an antidote. Charcoal in 31 Gm. (or 3j) doses had some slight
etlect, injections of morphine were useful, but chloral-hydrate and chloro-
form sufficed to entirely prevent the muscular contractions, when admin-
istered in time. Dr. \\\ D. Turner'* was led by the accidental observation
of the recovery of a dog from strychnine poisoning after eatinjr about 1?4
Gm.(or 5iv)of lard to make a series of experiments on dogs and other animals.
He records 13 experiments in all: 3 on dogs. 3 on hens, 1 on a crow, 4 on
hops, and 2 on calves. In all cases, except the first 2 hogs (which died from
0.13 Gm., or gr. ij, each of strychnine, with only 186.6 Gm., or oVJ» of lard ad-
ministered as an antidote, the last two, however, recovering from the same
dose of strj'chnine after taking 373 Gm., or Jxij, of lard), the animals recov-
ered, although the lard was not administered until after convulsions had well
set in.
Therapy. — Nux vomica is not applied externally, and, although an
oleate of strychnine is made, yet it has little, if any, use on account of its
' RnbtTt Biirrif^s reported (in the British McfJical Journal, April 1, 18S2) a
cn»e ftuccesRfuUy trpnted by inhalation of amvl nitrite.
» Op. cit., p. 338.
'"Chloroform ShouM'lip Vse<l in Strvchnine Poi5*onin(r. not Tobftoco." — Fntnrit
L. Hnynes. M.D., Philadelphia Medical Times, vol. xiv, p. 504.
* 77fr Chetniftt and lintfftfiAt, Sept. 6. 1R90.
*/r»rfiOM Lancrf, June 1; Xnr YoiK Medical Journal, July 23, ISOS.
NLIX VOMICA.
Gol
I
I
I
I
I
Bcertainty with regard to absorption. According to Dr. Thomas J. Mays,
of Philadelphia, an oleate of brucine may be used in parsesthesiu of the skin
and 10 relieve itching piles. Mackenzie has known anosmia to be benefited by
the insuttiation, twice daily, of a powder containing 0.00:27 Gm. (or gr, Va*)
of strychnine and 0.13 Gm. (or gr. ij) of starch.
fiJtrychnine not being very soluble, its salts, sulphate or acetate, may
be used hypodermically in the treatment of paralysis (0.0008 to 0.001 Gm., or
F"- Vio-V«o)t or injected into the tissues around the eye for amaurosis iu
tetanus,' as nn antidote to snake-poison^ and tobacco-alcohol amblyopia.
Mr. r>. B. Dott recommends strychnine hytlmchloride as regards solu-
bility, neutrality, and stability, and considers it the most useful of the salts
of the alkaloid. Strychnine nitrate is preferred by many on account of its
producing less local irritant effect. It may be used in doses of 0.001 Gra. (or
1^' */«o)> cautiously increasing until evidence of physiological action is mani-
fested. The dose is then temporarily decreased, to be again raised in such a
manner that the physiological etfect is obtained about once a week in the
ire«tment of such affections as tobacco-alcohol amblyopia.
The circumstantial reports of many Australian and East-Indian phy-
eicians, of a number of severe and threatening cases of snake-bite successfully
treated by strychnine, leave no doubt as to its value. It is necessary to em-
ploy the.remedy in large doses, carefully observing its effects. The symptoms
due to the snake-poison are progressively relieved and no tetanic spasms
indicative of strychnine intoxication are produced. According to the severity
of the condition, amounts varying from 0.05 to 0.20 to 0.25 Gm. (or gr. Ve^^i
or iv) were given in divided doses in different cases. Dr. E. A. Thomas ob-
tained the same results in five cases from strychnine administered by the
mouth, but, as the patient is generally unable to swallow, and on account
of the greater rapidity of its action when injected, the hypodermic method
Is usually the best. On the contrary, from an elaborate series of experiments
upon animals, Surgeon-Lieutenant R. 11. Elliot, of the British Army, con-
cludes that in animals poisoned by cobra-poison the subcutaneous injection
of fftTTchnine often hastens, while it could never be said to retard, death.
Dr. Bancroft,* afttjr experiments on guinea-pigs, declares that hypodermic
injection of strychnine for snake-poison is useless. The subcutaneous in-
jection of strychnine is beneficial in paralysis due to alcoholism, and has been
practiced with admirable results by Dr. Konigsdorfer in the treatment of
toadstool poisoning.
Internally, the tincture of nui vomica does good as a bitter tonic, and in
«ck headache from disordered stomach. Ringer gives it in l-drop doses in a
teaepoonful of water, every ten or fifteen minutes, until relief is obtained,
or for a couple of hours.
Cases of nausea and vomiting of pregnancy, not infrequently, yield to
minute doses of the tincture, a drop, or a fraction of a drop, being given in
water, and repeated every hour or two hours. This preparation, likewise.
*"Strvchniiic o^ a Preventive of Tetantw," bv Dr. Peyraud. Bulletin Uidiral,
fitpt 2, IStMl
I lie n« nn Antidotf to Snfike-frf»i*<^n.*' bv Dr. >(ijllpr. PrupnittH* Cirru'
tor o/t'i '/ <Ift:rttf, Jan., 1801; "Snake- poison and its Antidotes/* by T. Lauder
Braston. M.U.. F.R.S.. Brifitth Medical Journal, Jan. 3, 1891.
• "Strvchnine in Snukt* bite." Journal of the AmerUan MtuUral AHHiwiaOon^ Feb.
tl, 1801.
652 PUAItMACErTICAL TIIKnAPEUTIC AGENTS OR DRLTOS.
does excellent service in the morning Tomiting to which drunkards are sub-
ject. Nux Tomica, indeed, fulfills more than one indication in this class
of patients. It is beneficial in the chronic gastritis of alcoholism, and affords
support to the system when the accustomed alcoholic stimulus is suddenly
withdrawn. The poor apjietite and digestion, the miserable sense of weak-
ness, the insomnia and tremor are relieved by the tincture of nux vomica. At
the same time, and especially being combined with capsicum, it diminishes
the craving for drink, and is of value in assisting to break up the habit. Dr.
Jaroshensky has demonstrated by experiments upon dogs that the toxic and
narcotic eflecta of alcohol are neutralized by the administration of strych-
nine. Hypodermic injections of strychnine nitrate are recommended bj
various Kussian physicians as curative of the alcohol habit. Dr. Portugalow
has published a record of 455 cases treated with satisfactory results. He
employs the following formula: —
B Stryclinin. nitrat 1065 Gm. or cr. j.
Aquce deatillat 15| com. or T3»f». — M.
He begins with one or two daily injections of 0.50 c.cm. (or ffiviij), sub-
sequently reducing the quantity to 0.34 c.cm. (or miv). The treatment ir
said to destroy soon the taste for liquor, though, on the other hand. Dr.
Rabow states that his experience with the metliod has failed to con\iince him
of its value. Dr. J. Bradford McConnell, of MoTitreii!, made trial of strych-
nine injections in twenty-five cases of alcoholism. This writer testifies that
the craving for alcohol diminished riipidly and was completely lost in a few
days. The physical and mental health was gradually restored, but the effect
was not permanent, as most of the cases relapsed in from one to eleven
months.
Keener recommends thn addition of pilocnrpine to the strychnine solu-
tion in the strength of 0.065 Gm. to 30 c.cm. (or gr. i-f5J). At the same time
he administers internally the following mixture: —
B H3'drarg. chlor. corr |005 to
I'liitilext. stcrf'uliae 4
Kluidfxt. cacti grftndiflor , 30
Fhiidpxt. nrnioip •.•^.,. 9
Tr. aloea 7
Tr. cannabis Ind 15
Aq. deatill 120
M. Sig.: Teaapoonful every two hours during the da^r.
13 Gm. or gr. i-ij.
c.cm. or fSj.
c.cm. or fjj.
25 c.cm. or f3iiss.
6 c.cm. or f3ij.
c.cm. or fjsa.
c.cm. or fjiv.
i
The gastric catarrh dependent upon chronic disease of other organs, as
bronchial tubes, heart, or liver, is also alleviated, as Ringer has pointed out,
by the administration of 1 or 2 drops of the tincture in a teaspoonful or two
of water every two hours, or oftener, for twenty-four to forty-eight hours.
Prolonged and obstinate vomiting, due to mnlarin, has been overcome by
the administration of full doses of strychnine. In atonic dyspepsia and in-
sufficient secretion, nux vomica is useful in pills, with quinine and some
carminative. Owing to its effects upon motor nerves, it is valuable in con-
Btipation produced by defective muscular activity, and also in the form due
to lead poisoning. In the former condition the contractions of the lower
bowel become so energetic that, according to Whitla. the stools are occasion-
ally much altered in size, and may be seen to present the attenuated appear-
ance observed in stricture of the rectum. The eifects of nux vomica in
NT:X vomica.
653
*
constipation are often enhanced by a combination with a purgative and
chalybeate.
For constipation, nux vomica can be commended combined as fol-
lows:—
I
H Extracti nucU vomieee
Kxtra<-'ti belladonnx* folior
Extracti rhamni purah 1| to 2
M. et ft. pil. no. xxx.
Sig.: A pill after each meal.
32 Gm. or gr. v.
20 Gm. or gr. iij.
Gra. or gr. xv vel xxx.
R Extracti nucis vomicae
Pulveria ipecacuanhte
Extracti hyoacyami 1
M. et ft pil. no. \x.
&g.i A plU three times a day.
32 Gill, or gr. y.
65 Gm. or gr. x.
30 Gm. OT gr. xx.
Waugh recommends for constipation this prescription, containing nux
Tomica: —
^ Extract! nucis vornicte,
Aloes puriflcat i
Extracti belUidoniue folior
Oleoreaina capsici
M. et ft. pil. no. xx.
Sig.: One pill after each menl until two passagca occur in a dny. when half pills
trv to be taken; and the reducLiun i» to be continued until the habit of regular evacu-
itiona has been formed.
132 Gm, or gr. v.
20 Gni. or gr. iij,
12 c.cm. or mij.
Atony of the large intestine leads to prolapsus ani, and here> also, the
tincture of nux vomica is of advantage, both by internal administration and
local injection. Phillips has seen excellent results, in hajmorrhoids, from
I the tincture. In opposite conditions of the intestine, and for dilferent
H T«taon8, strychnine is remedial. In nervous or atonic diarrhoea it materially
H unsts the action of other remedies, and may be thus prescribed with ad-
H vantage: —
B Strychnine Rulphat 103 Gm. or gr. sa.
Acidi sulphurioi aromat 1815 c.cm. or f3v.
Aq. hamnmelidiB dest q. a. ad 120| c.cm. or f3iv.
M. et ft Bol.
filg,; A teaapoonful in water every three houia.
In dysentery attended by unusual prostration and tympanites, this rem*
edy ha? proved of advantage. In combination with a mineral acid it has
fr'' - seemed to do good in Asiatic cholera. Hypodermic injections of
61; '■ answer a valuable purpose in cholera, especially when collapse is
threatened or is present. This practice has been beneficially followed by Dr
French-Mullen in hundreds of cases.*
Strychnine is one of the best of the cardiac stimulants in failing heart
or weakness of the circulation. Prof. Thomas G. Morton uses it in surgical
ihock. Weakness of the heart due to depressed nerve-force and dilatation
of the heart are materially benefited by strychnine. It is a good plan to
pre this remedy sometimes in combination, and again alternating, with
digitalis. Iron is often profitably added to the combination, as: —
' Indian Mrdical aa:tlte, July, 1892.
654
PHAKMACEUTICAL THERAPEUTIC AUENTS OK DHUGS.
B Strychninie sulph 102 Gm. or gr. Vt.
Tinc'l. ferri chloridi 7 5 c.cm. or f3ij.
liifus. g«ntianEe q. s. ad 1S0| ccm. or fSvj.
M. Sig. : Tablespoonful in waUr three times a day.
In fatty heart it is capable of service, but should be given with circum-
epection, since it will sometimes induce a nervous and sleepless state, which
is decidedly harmful to the patient. In emphysematous asthma it is espe-
cially serviceable. The various forms of muscular paralysis — hemiplegia,
paraplegia, diphtheritic paralysis, wrist-drop — are well treated by strychnine
internally, or hypodermically (0.0005 Gm., or gr. Vuo) thrown deeply into
the affected muscles, in conjunction with electricity. It has also been em-
ployed with success in infantile palsy and writers' cramp. In progressive lead
palsy strychnine stops the advance of the disease if used in full doses, a care-
ful watch being kept up for toxic spnptoms and potassium iodide being given
simultaneously on account of its eliminative effects. The use of strychnine
three or four times daily is also stated to be of particular efficacy in lead
colic. Other forms of paralysis in which this agent renders conspicuous
service are torticollis; mercurial, malarial, and hysterical paralysis; neuras-
thenia from sexual excess, and aphonia due to paralysis of the vocal cords.
In conjunction with out-door life and calisthenics, nui vomica is useful in
lateral curvature of the spine. In atony of the bladder, leading to incon-
tinence or retention, a combination of strychnine and electricity forms the
most valuable restorative means at our command.
In general nervousness with depression of spirits Dr. Emmet pre-
scribes:—
Strj'chnin. atilphat
Quinin. siilph 2
Ferri pyropnoft 8
Spt. chloroformi 11
Glycerin q, a. ad 120
005 Gm. or gr. j,
Um. or Saa.
Gm. or 3ij.
c.em. or fSiij.
c.cm. or £5iv.
M. Sig.: Teaspoonful in a wineglaaaful of water four times a day.
In dyspnoea and shortness of breath attending emphysema, winter
cough, or phthisis, strychnine is useful.
Dr. Thomas J. Mays advocates the emplojTnent of large doses of strych-
nine in bronchial and pulmonary disorders, until some evidence of its
physiological action is manifested. Strychnine is of value also in maintain-
ing n*spiration in narcotic poisrvning, ns from opium. Nux vomica is of
eonsidorablo value in the treatment of phthisis. By promoting ciigestion it
maiiitaiiis nutrition. It relieves the vnuiitiuir to wliich ennsuniptivt? subjects
are Hfible, and, iis Murrell has shown, has some power to check night-sweats.
When given with the latter nlijeet in vi<'w, it is hpj^t ennibinoil with aromatic
sulphuric acid. Pinnoy has reported gnod results from the hypodermic injec-
tion of strychnine arsenate in four eases of phthisis; 0.24 to 1 c.cm. {or
w»iv-.xv) of a i/;-per-cent. solution in liquid vaselin was given daily.^ The
same salt, administered by the ni(?uth, has sometimes seemed of value in
diabetes mellitus. !>, Feilchenfold reports marked reduction in the quantity
of urine, when jxilyuria or rliabetos insipidus is trented by hypodermic in-
jections of strychnine nitrate, 0.005 Gm. (gr, Vw) daily.
*"Anmml of the Universal ITediool Sciencea." 1800. vol. v. p. A-ft6.
NCX VOMICA,
655
I
In amaurosis and failing eyesight the tincture of nux vomica may be
administered, gradually increasing the dose and watching its effects in order
to prevent toxic Bymptoms. Strychnine is especially beneficial in amaurosis
caused by abuse of tobacco or alcoht>I. In delirium tremens, large doses of
tmcture of nui vomica are not only well borne, but are rapidly curative.
Strychnine is not to be used while acute neuritis exists, or during the
period of vascular reaction after apoplexy. In hypertrophy of the heart it
thoold be given cautiously. In neuralgia due to impaired nutrition we may
employ : —
^ Zinci phosphidi |006 Gm, or gr. V,^
Kxt nucis vomicae [015 Gm. or gr. V..
M. et ft. vU,
Sig. : To be Uken every three or four hours.
I
In simple indigestion and atonic dyspepsia use: —
Gm. or gr. vj.
Gm. or gr. xxiv.
38
55
065 Gm. or
Gra. or
%:'
B Extmcti nucis vomicw
Quininic livdrochlorat. 1
PuIt. capsict
Ext. gentiBnoe 4
IL ct ft pil. no. xxiv.
ftg.3 Xftke one or two before meals.
In tobacco-amaurosis de Schweinitz recommends: —
Q Tr. nucia vomic« 7|5 com. or f3ij.
Sig.: Take 3 drops three timeb daily, increasing 2 drops daily uotil physiological
effects are obtained.
B Tr. nucis Tomicie.
Acid, nitrohydrochlor. dilut.,
Sjiiritus chloroformi aa 4| com. or fSj.
Infus. gentianiB q. s. ad 180| c.cm. or fjvj.
M. Sig.: Take a tablespoonful or two after each meal fnr natulent colic.
Strychnine sulphate, given h3rpodermically in doses of 0.0005 Gm. (or
gx. Vi:o)> ^8 a very efficacious remedy in gastralgia and visceral neuralgia in
general, as well as in the milder forms of angina pectoris. The same treat-
ment has also been recommended for infra-orbital neuralgia. The tincture
his been given with good results in those cases of chorea which arise about
the age of puberty, and seem to have no connection with rheumatism, as
me]] also in some cases of chorea major. In idiopathic epilepsy of ill-nour-
iibed patients, nux vomica will frequently afford a decided relief. Hffiraa-
tosis is promoted by nux vomica, and hence it is of value in the management
of anffmia, chlorosis, amcnorrhopa, and dysmenorrhcea. It is serviceable in
iurpura and in post-partum hiemorrhage. Dr. G. V. Hall and Dr. John
lilton Dnff have independently called attention to the value of strychnine
tn the late months of pregnancy and durinjr labor. These writers advise its
use in the case of women whose previous labors have been retarded, in those
ffubject to severe after-pains, or in whom a history exists of post-partum
hrmorrhage and subsequent subinvolution. On the other hand, even small
doeM of rtn'chnine given during this period will cause some women to
abort, and, as a nile. it should not be given for any length of time continu-
oiwJy to pregnant women. By promoting capillary circulation, it is
benefictAl in cases of habitual coldness of hands and feet. Strychnine aids in
656
PUAUMACEL'TICAL THEKAI»ELT1C AGENTS Oli DltUUS.
overcoming subinvolution of the utenis.
matorrhoea and impotence.
It is useful in botog cases of sper-
(ENOTHERA. — Evening Prinirnne (Onagra biennis, or (Enothera bien-
nis. Nat. Ord. Onagracese) is a familiar herb; known aJBd as 'Vure-al!/' A
fluid extract is used in doBQS of ujUt to 4 com. (or mx-oj) by the eclectics
principally; but they also have a tincture and an infusion of the pressed
leaves (also made by diluting tlie fluid extract). It is a sedative and altera-
tive, probably diuretic. An ointm(-nt of tenotbera it; used in children's
eczema. Evening prininise is uHeful in catar?*luil atTections. especially of the
acute kind (in broncliitin, pertussiB, gastro-enteritis, and dysentery). O. H.
Rohde. of Brooklyiu itraises its action in la grippe.' • i
OLEANDEE. — Nerium uleander (Apocyanficese), an evergreen shrub,
bearinir handsome flowers, ie a native of the country surrounding the Medi-
terranean.
Professor Schmiedeber^ has found in oleander-leaves a j^iucoside,
Oleandrin, and a second active substance which he has named Neriin, which
he bt^iieves tn l>e closely Allied tn, if not identical with, dtgitalin,
Physiolo^cal Action and Therapy. — The young twi^s and the leaves of
oleander are poisonous, and have proved fatal to children and adnlts. In
a lethal case reported by Kin^, of Bombay, the symptoms were burning pain
beginning in the epigastrium and subsequently involving the whole body,
unconsciousness, trismus, and convulsions. The pupils were widely dilated.
A decoction of the leaves and bark is popularly nsea in the south of France
as 8 lotion in various diseases of the skin. Dr. von Oefelo has recently ad-
vocfited the use of oleander as a succedaneum to digitalis in cases where the
latter fails or is ill borne, and reports seventy-fnur cases of cardiac disease
in which it was found advantageous. Its principal effect is said to be the
diminution of the rapidity of the pulse. Oleander increases the blood-
pressure nnd promotes the action of the kidneys. The influence upon the
circulation continued, in some instances, as long as two weeks after cessation
of administration. Oleander was given in the form of a 10-per-cent. tinct-
ure, in doses of 1.20 c.cra. (or mxx) three times a day. The fluid extract is
a better preparation, in dose of 0.06 to 0.18 c.cm. (or mi-iij).
According to the writer quoted, oleander is useful in diseases of the
kidney and niyocnrdium and in atheroma. It is contra-indicated by the
presence of vomiting or diarrha?a.
OLEUM BEE0AM0TT2E,— Oil of Bergamot.
Pharmacolo^ and Therapy. — A volatile oil from the Citrus Bergamia
(Aurantiaccffi), obtained by e.\[)reBsion from the rind of the fresh fruit,
which also contains Ber§^ptene, or bergamot camphor. The odor makes
bergamot valuable in perfuuiery; and it probably has antiseptic and stimu-
lating qualities, but is not used medicinally.
OLEUM CADINUM (U. S. P., B. P.).— Oil of Cade.
Pharmacology and Therapy. — Cade-oil is an oily product obtained from
the Junipcnii; Oxycedrup {Pinncew or CViniferw), the African, Sptirn^^b, or
prickly cedar, or large bro\vn-fruitcd juniper, a species of the Mediter-
^ Eclectic Rcvifxc, Nov. 15, 1903.
OLECM CAJ0PUTI.
657
nncau n*?iou> t|uite r^imilar to J. L'oniiuunis and J. Sabina. Trofger and
Fcldniami* found Cadinene present only in small quantities, the chief con-
•tiluert of the oil appoaiang to be a sesquiterpene, which was optically in-
sctivc and boiled at 250°-2G0° G. The oil of cade is useful as a stimulant
ipplicatiou in rhmnic eczema and in psoriasis. In the latter malady, after
lilt ' ive been rotnoved, Hebra's modification of Wilkinson's ointment
oft' - of considerable efficacy. Tlie formula is as follows: —
B Sulphurifl flublimati 1515 Gm. or Bbb.
OUi cadini 16| c.cm. or fjM,
Saponis Tiridis,
AdipiB aa 311 Gm. or 5J.
Crttie preparatce 10( Gm. or 3iiw.
M. tt it. ungt.
The following mixture, which can readily be weakened if it proves too
irridnt, has also been recommended: —
B Olc-i cadini 420
Tr. ijuillajce 37
Glycerit amyli 473
c.cm. or fjxiv.
c.cm. or fox.
ccra. or fjxvj. — ^M.
I
Gaucher* recommends a mixture of oil of cade in acetone collodion as
hirinff special advantages in psoriasis, lichenoid eczema, simple chronic
lichen, nummular eczema, seborrhoeic eczema, and in lichen planus. For
pitches of pfioriasis, it is preferable to chrysophanic trauraaticin. He rec-
ommends that only pure oil of cade from juniper and water-free acetone be
awd, otherwise the preparation will not adhere satisfactorily.
OLEUM CAJUPUTI (U. S. P., B. P.)— Oil of Cajuput.
Bote, 0 06 to 0.30 c.cm. (or mi-v).
Preparation.
SpiritUB CAJupQti (K P.). — Spirit of Cajuput. (contains oil of cajuput, 5 c.cm.,
OTfrixxv: alcotiol. 50 c.cni., or fSxiij). Dose, 0.30 to 1.20 c.cni. (or mv-xx).
Pharmacology. — "A volatile oil obtained by water or steam distillation
from the fnfh leaves and twigs of Cajuputi viridiflora (Myrtacete) : a tree
of thf Enst Indies.
Physiological Action. — Locally it is rubefacient, antispasmodic, and
tntiseptic. Internally it is carminative, diaphoretic, and diuretic, and sorae-
vhai Biimulating to the eircuktion. It is of a green color, and has a cam-
phomceous odor and neutral reaction.
Therapy. — Externally it has been used as a counter-irritant, usually
diluted with sweet oil, in myalgia and chilblains, and in various parasitic
affections, such as tinea, pityriasis, eczema, scabies, etc. Dclvaux states that
he has found oil of cajuput to be an efficacious application in psoriasis and
rosacea. It may also serviceably enter into the composition of a stimulating
ointment for alopecia. This oil has been successfully used, suitably diluted
with an emulsion, as an injection for ascarides, or seat-worms. Diluted with
glycerin or olive-oil it is a good local application in ear-ache. A drop of oil
of cajuput upon cotton placed within the cavity of a carious tooth relieves
toothacne. This remedy has also been given internally as a vermifuge.
*ArHk. tf. Pharm., 18M, 092.
*CovigirH d* la Sori^U FrancaiM de D«rmatologie et de STphiligraphie, I8dO.
CoS
PHAKMACBUTICAT.
BRAFETTIC
3BNT8 OR DRUOB.
The oil of cajuput has been used with advantage to relieve the prost
lion of typhoid fever. This remedy is of service in intestinal colic, choleti
moibua, and nervous vomiting, and also relieves "nervous dysphagia, hi<
cough, and dyspnoea, and it is said to allay the pain of dysmenorrhcea. I
principal use internally is for its stomachic effects as an adjuvant to tonj
remedies. It has been ndministered in comparatively larger doses (1 to J
c.cm., or mxv-lx) in the collapse stage of cholera, with good results. It 1
claimed to be useful in rheumatism and in various skin discuses. The ol
of niftouli or niiaouli, derived by distillation from the leaves of Melaleuci
viridifloria, a large tree of New Caledonia, possesses properties very similar
to those of the oil of cajuput. Niaouii-oil is of a pale-yellow color, has (
taste which recalls that of peppermint, and is analogous in chemical com
position to terpinoh It is soluble in alcohol, ether, and benzin. Niaouli
oil is well borne by the stomach and has been given in doses of 0.24 c.cni
(or fniv) in emulsion or capsule. It is said to have an excellent effect in bron
chitis, and in pulmonary tuberculosis it markedly diminishes the expectora
tion. Niaonli-oil has also been used by Dr. Blanc in other conditions Id
which the oil of cajuput is given. !
OLETTM CEOTONIS (B. P.).— Croton Oil, (See Oleum Ti^lii, U. S. P.|
OLETTM ERIOEE0NTI8 ([T. S, P.).— Oil of Erigeron. |
Dose, 0.60 to 2 c.cm. (or myi-xxs). I
Pharmacology. — **A volatile oil dislilled from the fresh flowering hcri
of Lf'ptllon t 'anadcnse." or Ciinada flea-lmno (Composite). It is an ainbel
colored liquid, with slightly-pungent taste and characteristic aromatic odoi
resembling that of turpentine. It has diuretic and hieraosiatic propertiei
The tluid extract (alcoholic) is also used. Dose, 4 to 7.5 c.cm. (or foi-ij).
Therapy. — The oil of erigeron is verv eflicient in cases of uteiiue haeoi
crrhage (metrorrhagia), especially wlien of passive character. Menorrhagil
may likewise be checked by the inhibition of this remedy. It has also beej
used in controlling other hirmorrha^es, such as epistaxis. |
Hffiniorrhage from the bowel is similarly arrested by the oil of erigeroil
Erigeron is often an effective rumcdy in haemoptysis. Dr. de Puy states thai
he has used this remedy with success in diarrhcea and dropsy, and it hai
proved successful likewise in dysentery.
This remedy may be given cither simply dropped ii[>on su^rar, or in a
emulsion.
QLEUM MORRHU-ffi (U. S. P.. B. P.). — Codliver-oil (Oleum Jecom
Aselli).
Dose, 4 to 15 c.cm. (or f5i-f5S8). I
Preporntlon,K. 1
Ennilsum Ok-i Morrhua' (I. S. P. (. — t,u(Uiver-oil Kmiilsion. Dos»e, 8 to 1
c.cra. (or 3ii-iv). J
Kmulmim Olci Morrhiiti' i-iitn Ilypophiwpbftihus (U. S. P. I. — CWIiver-oil Emit
sion with liypoplioflphiles. Dose, 8 to 15 com. {or 3ij-ir).
Pharmacology. — "A fixt-d oil, dlitiilnrd from the rn-sli livers of Gadi
Morrhua, and of other species of Gadus (class, Pisces; order, Teleostia
family, Gadida)" (TT. S. P.). "the oil extracted from the fr^sh liver of tl
^
cod, Gadus Morrhuo, by the application of a temperature not exceeding 180"
F.; and from which solid fat has been separated by filtration at about 23°
F. (B. P.). It is usually a colorless, or straw-colored, thin, oily, liquid,
consisting chiefly of Olein, with characteristic alkaloidal and acid, fatty
principles. The best oil is got from the Lofoten Islands, Norway, from our
Sew England coast. Nova Scotia, and Newfoundland. It contains a peculiar
principle named Gaduin, with Trimethylamin, and traces of iodine, bro-
mine, phosphoric and sulphuric acids, and biliary salts. Good oil should
not have a strong, fishy smell or taste; should not deposit much granular
fit at 32*" v., and should, when treated with sulphuric acid, give a violet
color-reaction, changing to brownish red. If 1 drop of the oil be dissolved
m 20 drops of carbon disulphide, and the solution shaken with 1 drop of
sulphuric acid, it will acquire a violet-blue tint, rapidly changing to rose-
red and brownish yellow. Contact with nitric acid and oil produces a red
color; on stirring with a glass rod the color becomes a bright rose-red,
rapitUy chan;ring to lemon vrllow. Gautier and Mourgiies in 1888, in cod-
ljv*T-oi], found S4*vi*ral new nlkaloidsj butylamine, amyhimine, oxylamine,
dihydrobutylamine, oxyooUidine, niconiorrhuine, dihydrolutidine, aselline,
and morrhuine, besides an unstable, fatty substance, morrhuic acid, contain-
ing pboepliorus and resembling lecithin.
From the study of sections of the fresh liver of the cod by J. Bouillot^
however, it would appear that the alkaloids found in codliver-oil exist in the
hepatic tissue normally, as he detected crystals of the alkaloids by the use
of the microscope.
These alkaloids — or, ot least, some of them — are now being prepared
for medicinal use, and the following free bases and salts can be obtained:
Amvline, with its hydrochlorate, hydrobromate, and bitartrate; dihydro-
lotidine, with its bitartrate; oxycollidine and its hydrochlorate; nicomor-
rhiiine and its hydrochlorate: and morrhuine.
Under the name of Oaduol, or Morrhuol, M. Chapoteaut has isolated
these principles, in the form of an amber-brown, bitter, aroihatic liquid,
pftrtiallr cryetallizing at a low temperature, and consisting of the free oleic
«cid of the oil, alkaloids, and the fatty combinations with sulphur, iodine,
bromine, and phosphorus. Thus, morrhuol represents the medicinal value
of codliver-oil in very much reduced bulk. The usual dose of morrhuol is
1 or 2 capsules, each containing 20 c.cm. (about njiiiss) taken with or im-
mwliitely after meals. Children take 2 to 4 daily and adults 6 to 8 daily.
CipBulefi of morrhuol creosote may also be obtained (each containing 3 '/j
minims of morrhuol and 1 minim of pure heech-wond creosote).
Fhysiolo^cal Action. —Ex tern ally, codliver-oil acts as a bland oil with-
out causing irritation, and is even instilled into the eye by oculists. Its
fthy Fmell ia an objection to its use by inunction, and yet in infants this is
toch a valuable method of introducing it into the blood that the objection
i« overlooked. Applied to the surface in fevers, it reduces bodily tempera-
ture. Internally, in doses suited to the powers of assimilation, it increases
Ihe appetite and improves nutritiou, enhances the number of red blood-cor-
|nucl«8t stimulates healthy cell-formation, and exerts an alterative effect.
Morrhuo], not being fatty (to the same extent, at least), does not directly
incrvasc the bodily weight, but otherwise acts physiologically in the same
minuer as the oil. According to Gautier and Mourges, many of the alka-
loids of codliver-oil, as butylamine, amylamine, and especially morrhuine,
660 PHARMACEUTICAL THEEAPEUTIO AQ£NTS OB DBUOS.
together with morrhuic acid, Btimulate the nerYOus ayBtem, promote tiasue-
change, cause a rapid increase of the urine and perspiration, and, propor-
tionately, sharpen the appetite. In addition, the phosphorus exists in or-
ganic combination capable of being readily appropriated by young cells.
The association of fatty bodies with biliary matter promotes absorption and
assimilation. The properties of the iodine and bromine are also enhanced
by the state of organic combination in which they exist.*
Bouillot has extended to the human subject the experiments made by
Qautier and Mourgues upon animals. His researches confirmed those of the
latter observers. The urea was greatly increased as well as the quantity of
the urine. Analyses furthermore demonstrated that the augmentation of
urea was due to a more complete oxidation of nitrogenous matter.
Erythema or acne is sometimes due to the prolonged use of codliver-oil.
Therapy. — In children suffering with marasmus, scrofula, chronic skin
affections, tuberculosis, and wasting diseases generally, the use of codliver-
oil by inunction daily, or several times a week, produces rapid improvement.
The patient is stripped and the oil applied over the surface of the body, with
the manipulations of massage, before a warm fire; a blanket is wrapped .
around him, which is to be kept on for an hour or two; the excess of oil
is then removed by a warm bath containing a little whisky or bay-rum. In
this way the child does not have such a disagreeable odor as when the oil
is simply applied under its binder. In the cceliac affection of children, char-
acterized by suspension of function of the pancreas, this method is particu-
larly applicable, and is absolutely necessary in order to keep up nutrition.
In cases of whooping-cough similar inunctions to the chest are very service-
able. These inunctions are likewise valuable in the case of children ex-
hausted by chronic diarrhoea, and of adults who suffer with chronic dysen-
tery and scaly skin diseases. The daily inunction of codliver-oil is of some
service in reducing the susceptibility to taking cold. The local application
of this agent is useful in chronic rheumatism and rheumatoid arthritis. The
internal administration or external use of codliver-oil is advisable in rachitis
and laryngismus stridulus. As an internal remedy it is sometimes effective
in habitual constipation in children. This oil has been used with advantage
in diabetes mellitus characterized by great debility, and is especially indi-
cated if it is associated with pulmonary tuberculosis.
Codliver-oil is used internally as a nutrient as well as a medicine. Its
value is most marked in chronic disorders attended by malnutrition, in
phthisis, chronic pulmonary processes, rheumatic affections, rheumatoid
arthritis, and atheroma. It is also very useful in nervous affections, chorea,
neuralgia and epilepsy, in syphilitic and strumous cachexia, and various erup-
tions upon the skin due to them. In convalescence from many diseases
codliver-oil is an easily-assimilated form of nourishment. Chronic gout is
ameliorated by the administration of codliver-oil. In chronic bronchitis it
is of service, facilitating expectoration and promoting the nutrition of the
dieeflsed me^mbrtin^'. Tt is also a valuable remedy in emphysema. Codliver-
oil is indicated in carits or necrosis of bone due to tuberculosis. In neuras-
& it may be gi%en with advantage. The exhibition of this remedy is
rial utility in manv cases of convalescence from measles or scarlatina.
^naics ^t TMrupniiique Midico-CMrurffioaUB, March, 1890.
OLEUM MORRHIJ.^.
661
»
»
I
In panims and chronic conjunctival affections, codliver-oQ has been instilled
into the eye with good results.
Bouillot found that the administration of the alkaloids of codliver-oil
was of decided benefit in the treatment of amenorrhoeic and neurasthenic
girls, feebly-nourished children, and old persons sofTering from chronic bron-
chitis. They were well borne by those who were unable to take the oil.
Special Forma. — There can be no question that the digestibility of the
oil is increased by mechanical and chemical conditions, as when given in the
form of a good emulsion (not a soap, but a minute subdivision of fat-glob-
ules in a mucilaginous medium, resembling milk), and by the addition of
pancreatin, and also by association with certain restorative agents, like the
hypophosphites or calcium lactophosphate. The immense demand for these
emulsions, stimulated by judicious advertising, has led to a very large pro-
duction and much competition among manufacturing pharmacists to sup-
ply the requirements of the physician and patient. In manufacturing on a
liTge scale, cost is carefully estimated, and the result in many cases is that
tn inferior grade of oil is used. Physicians frequently order an extem-
poraneous emulsion made with the best oil by responsible pharmacists, or
instruct patients how to make it (white of egg, pancreatin, oil, and, if desired,
I little whisky or Jamaica rum, stirred with an egg-beater or simply shaken
together in a bottle, make a very acceptable preparation). The following
combination has been recommended: To the juice of 7 lemons add 6 fresh-
laid eggs, shells and all, and beat them together thoroughly. Allow them
lo stand in a cold place for four days, and then add a pint of codliver-oil
ind half a pint of Jamaica rum. This mixture is well shaken and then
stiained through muslin; a tablespoonful may be given three or four times
I day. A serviceable emulsion for children is made by rubbing together
Codliver-oil and extract of malt (or maltine), equal parts. Gubb maintains
that codliver-oil forms a solution with aqueous extract of malt, and that
this combination is the most efficient means of disguising the taste of the
oil. If there are fishy eructations, liquid pancrobilin may be given with
the oil, or liquor pancreaticus, which will emulsify the oil and favor its
ahsorption. It is oetter sometimes to give the oil before meals, to avoid
eructations.
A 50-per-cent. emulsion may readily be made by rubbing together 8
pMts of the oil with 3 ports each of condensed milk, and glycerin, or syrup,
and 2 parts of water. A few drops of oil of bitter almond or wintergreen
render the mixture more palatable. A codliver-oil jelly may be prepared by
•caking 5 parts of gelatin in 30 parts of water for a few hours, heating until
dissolved, adding 30 parts of s}Tup, and finally 60 parts of codliver-oil, to
which some flavoring oil has been added. The mixture should be stirred well
•nd poured into wide-mouthed bottles or jars.
The following emulsions, containing codliver-oil will be found to be
•eniceable: —
H Olei Tnorrhuw,
Glycerin!.
Syrup, hypophosphiti oa 1201 c.cm. or fjiv.
Oiei cinnamomi |60 c.cm. or mx.
M. ft ft *mul. mint.
Big.: A tabUtpoonful three tirnes a day. Valuable for lubereulocii. debility, tnd
ikronic tk\n diBeaMs, such as eczema, psoriasis, acne, and seborrbcEa.
662 PHARMACEUTICAL THEKAPEUTIC AGENTS OH DfiUUB.
Q Olei morrhuflB 240| ccm. or tSviij.
Liquor pancreatini 601 cxm. or fSij.
Pulveris myristicR < 12| Gm. or 3Uj.
M. et ft. emul. mist.
Sig.: A tableepoonful just before meals. Use in debility and weak digestion.
B Olei morrhuse,
Liquor calcis aa 1501 c.cm. or fjv.
Olei gaultherisB |60 com. or fflx.
M. et ft emul. mist.
Sig.: A dessertspoonful three times a day. Serviceable in scrofula, tuberculosis,
and in chronic skin diseases.
Q Olei morrhufie.
Syrup, pruni Virg.,
Sbct. malti aa 120| c.cm. or fpT.
M. et ft emuL mist
Sig.: A tablespoonfui three times a day. Employ in debility, in diseases of the
throat, and in chronic bronchitis and tuberculosis.
B Olei morrhuee,
Spiritus vini Gallici,
byrup. hypophosphitum comp aa 1201 c.cn. or fliv.
01. roenth. pip |00 cem. or mx.
M. et ft emul. mist
Sig.: A tablespoonfui three times a day. For syphilis, scrofula, and chnmio dis-
Q Olei morrhuos 120| c.cm. or fSiv.
Olei eucalypti,
Creosoti aa 160 c.cm. <jr mx.
Spiritus ffitheris comp 30| c.cm. or Qj.
M. et ft emul. mist
Sig. : Two teaspoonfuls three times a day. Beneficial in tuberculosis and chronie
tuberculosis.
The preliminary administration of an ethereal preparation^ like Hoff-
man's anodyne or pure ether, in cold water will favor me digestion of the
oil by stimulating the flow of the pancreatic fluid. An addition of 1 per
cent, of oil of eucalyptus is said to make it more acceptable to the palate.
It is a good plan to eat a slice of lemon after taking the plain oil, in order
to remove the oily taste from the mouth. A piece of pickle before and after
taking the oil is stated to produce the same effect. Numerous other meth-
ods have been suggested in order to conceal the taste of codliver-oil and aid
its assimilation. Alcohol in some form is frequently used for this purpose.
Washing the mouth out with brandy or whisky will partially obtund the
sense of taste, so that a dose of oil may be quickly swallowed without excit-
ing much sensation. The oil may be poured into the froth of beer in such
a manner as not to touch the edge of the glass, or it may be taken in a hot
punch. A few drops of chloroform will, it is said, disguise the taste. A little
salt, itukm just before and after the oil, has been recommended. Some
prcteT to take it in black coffee. It is stated that tomato-catsup covers the
,e of cod liver-oil, and that chewing smoked herring, or a sardine, accom*
' ee the aume purpose. Others administer it in milk or in lime-water, to
ich A (irop or two of some essential oil may be added. A formnla given
Seig mflT offectually disguise the taste, while the odor of the mixture re-
jbles that of roasted meat: —
1
S Olei morrhun 20701 com. or f^lxx.
CreoRoti 2 50 t'.cm. or mxl.
Ssechariii |l7 Om. or gr. iiss.-
The following combination is recommended by Eisenschitz for the puT-
pow of dis^ruising the taste of the oil: —
B Olei uiurrhuoe 00 c.cm. or fSiij.
Sarcharin 25 Gm. or gr. It.
.^^er Acetic 2 c. ^m. or fSsa.
M. Instead of the acetic ether, 2 dropg of essence of peppermint or 1 or 2 drops
of cnence of cinnamon may be uaed.
Some patients prefer to take the oil before meals, and find the eructa-
tions do not occur, as when taken after eating. The mistake is generally
made nf giving it in doses larger than can he digested, with the result of dis-
I'rdering the stomach and even exciting diarrhoea. A ferratcd codliver-oil is
made hv dissolving 10 parts of iron benzoate in 1000 parts of the oil, with
the aid of gentle heat and frequent agitation. It is a clear, reddish-broMTi
liquid. The oleate of quinine may be combined with it in any desired
qnactity.
An arsenical codliver-oil is prepared by wanning 0.5 Gra. (or gr. viiss)
ofarsenous oxide with 20 c.cm. (or fovss) of absolute alcohol in a small flask;
the addition of a small particle of potassium carbonate causes solution of the
oxide without itself undergoing any change. The solution, being filtered,
is added to 1500 c.cm. (or Oiiifovj) of codliver-oil and warmed on a water-
Ulh until the alcohol is dissipated. The oil is perfectly transparent, and the
preparation can be administered to children in doses of Vj to 1 teaspoonful.
OLEUM MYRCIiE.— OU of Myrcia, Oil of Bay.
Preparation.
Splritus Myrciip. — Spirit of Myrcia (bay-rum). Externnl xi»e.
Pharmacolo^ and Therapy. — Tho oil of myrcia is a volatile oi
tilksl frnui the Icavci^ of PImenta ncri^ (Myrtucea?), or bay-tree, t>f the West
hiflia Islands. It contains Eugenic acid and a hydrocarbon. It is used only
as a perfume. The spirit, or bay-rum, is an agreeable cooling application in
Severs, headache, etc.
OLEUM NEROLI.— Oil of Neroli. Volatile Oil of Orange-flowers. The
oil of neroli is distilled from the flowers of Citrus aurantium and Citrus
tuljcuris (Aurantiaceae). Dissolved in alcohol (2 per cent.) it forms the spirit
of neroli, used for flavoring. The oil of neroli is obtained in the distillation
of orange-flower water, but is not the same volatile oil as that contained in
the water (eee Aqua Aurantii Florum), and orange-flower water cannot be
mad*' from the oil of neroli. i
OLEUM 0LIV5: (U. S. P., B. P.).— OUve-oil, Sweet OiL '
Pharmacology. — Olive-oil is "the fixed oil cxpnmsetl from the ripe fmit
of (Men euio])a'a (Oltncfu).'* It consists largely of Olein (more than two-
"hirds), with sonic ^i>\id far, Tripalmitin. The best or virgin oil is obtained
rom the crushed ripe fruit, by expression without heat; a second quality
i obtained bv the addition of hot water to the same crushed fruit and ex-
I
I
I
<>C4
PIUKMACEUTIUAL THERAPErTIC AGENTS OR DRUGS.
pressing again. An inferior grade is made from the residue, after boiling,
with the aid of very strong pressure. The best is nearly tasteless and with-
out color, the second has more taste and color, and the third is dark and
more or less rancid, with strong odor. The better varieties are used upon
the table, as salad-oil, and also in pharmacy. Olive-oil enters into lead plaster
and diacliylon ointment. Cotton-seod oil and peanut-oil are used very
largely as substitutes, but have not the agreeable flavor of olive-oil.
Physiological Action and Therapy. — OUve-oil is a lubricant and is
added to poultices, as an emollient, in pneumonia and in skin diseases. Car-
bolized oil (1 to 24) is a valuable dressing for wounds. Internally, olive-oil
is nutritious and laxative, and is a purgative for infants (in doses of a tea-
spoonful). During its use, the infant may pass lumps of white fat, resem-
bling beansj composed of undigested tripalmitin. In adults, it is a useful
remedy in all forms of irritant poisoning, except that by phosphorus; it is
also a good enema. Given internally, in the dose of 15 to 30 cxra. (or fjss-j),
olive-oil will often relieve simple constipation in adults, especially when the
condition has been produced by opium. It may be employed with advan-
tage as a demulcent laxative in haemorrhoids and fissure of the anus. Much
has been written of late concerning the value of this oil in gall-stone and
hepatic colic. It has been freely administered in large doses (90 to 180 c.cm.,
or f^iii-vj) and was thought to aid in the expulsion of the concretions. Wliile
it seems to have some power to alleviate pain, it has no other influence, and
the stones supposed to be passed during its use have been shown to be, in
many cases, merely fatty masses.
Olive-oil, in doses increasing from 15 to DO c.cm. (or f^ss-iij), has been
known to cause the disappearance of obstructive jaundice. Dr. Oliver re-
ports one case in which jaundice had been present for ten months, but van-
ished within three weeks under the use of olive-oil. At the same time the
general condition improved. The ingestion of a tumblerful or more of the
oil during the day is an old treatment, recently revived, for lend colic. It is
particularly advocated by Br. Weill, of Lyons. It is stated that pain is re-
lieved from the beginning of the treatment, that constipation begins to yield
on the second or third day and is soon succeeded by diarrhoea. The free
evacuation of the bowels is attended by the subsidence of the nervous mani-
festations.
The late Dujardin-Beaumetz expressed a favorable opinion of the action
of olive-otl in hepatic colic, and remarks that faihire constitutes the excep-
tion, that the large doses are well borne and do not cause vomiting. He was
in the habit of combining ox-gall with tlie uil in the proportion of 1 part
of the former to 10 parts of the latter. Rosenberg has experimentally dem-
onstrated that olive-oil stimulates the secretion of bile and promotes its
fluidity. This writer regards the bile as the immediate agent in the removal
of calculi.
Olive-oil Injections.* — Herschell states that the methodical use of
warm oil injections is one of the most useful procedures: (1) in cases do-
pendint; upon chronic mucomenibranous colitis; (2) in constipation asso-
ciated with spasm of the bowel such ns frei^uently occurs in neurasthenia;
and (3) to secure a daily action of the houcls in atony of the intestines.
Three to ten ounces of warm olive-oil should bo injoe+ed into the rectum at
'Lancet, October 1, U>04.
*
bed-time. This is retained over night and causes an evacuation the follow-
ing moruiug. The t»il must be given, slowly and easily, so as not to cause
an immediate evacuation. It is l)i-^t given from a large glass funnel sus-
pended a few feet above the paticnr, and through a rubber tube and nozzle of
large calibre. When llie oil is iiijiuHitieiit it may be supplemented by a
small water injection in the morning for a ft-w days. After two or three
veeks the oil need only be given on alternate nights.
In typhoid fever Dr, Owen F. Paget has used olive-oil by rectal injec-
tion, with good results. Reduction of temperature was noted and in-
testinal complications were wanting in his cases; diarrhoea was not a
centra-indication, but rather an indication for its use, according to this
writer. The quantity used was 473 c.cm. (or Oj) once daily, the same to
be retained from twelve to twenty-four hours.
In scarlatina and other febrile affections, the application of oil to the
fkin reduces the temperature. In the desquamative stage of scarlatina it
15 of prophylactic utility by restraining the dispersion of scales through the
itmoephere. Olive-oil has likewise been used by inunction in wasting dia-
eues^and is of undoubted service, though of less value than codliver-oil. In
icwe of extreme weakness and emaciation due to malignant stricture of the
CBBophagus, Caird practiced intramuscular injections of sterilized olive-oil.
It is stated that considerable benefit resulted from this procedure, and it is
fuggested that other conditions might be advantageously treated in the same
nitDDcr.
Inwcts, which occasionally find their way into the external auditory
meatus, may be easily removed by dropping a small quantity of this oil into
the canal. The late Dr. C. R. Earley administered sweet oil freely in cases
of snake-bites, and said that it had never failed in his hands. According to
Dr. Ct'renville, of Lausanne, the injection of 2 com. (or mxxx) of sterilized
olive-oil in obstinate and painful cases of dry pleurisy is of value by imi-
titin^ Xature in providing a lubricating fluid. The oil is thrown into the
pleural sac, the site of injection being the spot where friction-sounds are
nio.^ distinctly heard.
A white emulsion is made by rubbing up powdered gum acacia (20 Gm.,
or ;rr. cccvii j ) with olive-oil (90 c.cm., or foiij), and when thoroughly mixed
po'lually adding orange-flower water and syrup (of each, 60 c.cm., or i^i).
It ii ust'fl, either alone or in combination with opium, in treating dysentery,
leni'cmus, irritation of the bowels, etc.
lapanin is an artificial mixture, intended as a substitute for codliver-oil.
It iris devised by von Mering, and consists of 6 parts of oleic acid to each
IflO of olive-oil. It is free from disagreeable odor and taste, and is readily
emulsified and easily digested; it may be given with calcium and sodium
hv-- ' -Elites (0.65 Gm., or gr. x, of each) several times a day. Galatti^
^■' n palatable and well borne by children; under its use they in-
creuat in weight and appetite, but the tuberculous process does not seem to
be influenced by it. It costs more than codliver-oil.
Von Mering has also prepared a mixture known as tonic chocolate,
which consists of chocolate to which oleic acid has been added, and may be
nscd to some extent to take the place of codliver-oil.
Another proposed substitute for codliver-oil and which has the merit of
palatahility consists of linseed-oil, together with ferric hypophosphite, oil of
\ntiim1 of th* I'nivprMi Medical Sei#>nces," 1880, vol
6C() rUAKMACEUTIOAL THERAPEUTIC AGEXTS OU DfiCGS.
eucalyptus, oil of gaultheria, Irish moss, marshmallow, glycerin, and diluted
hydrocyanic acid. I
The alkaloidE, or active principles of codiiver-oil, are administered in
pill form, or in combination with wine, or tonic remedies, in the treatment
of phthisis and other wasting diseases.
OLEUM PINI {B. P.).— Oil of Pine.
Dose, 0.30 to O.GO cxm. (or mv-x).
Fharmacology and Therapy. — An oil is distilled from the fresh leave!
of Pinus Pumilio, growing on the mountains of Switzerland, Austria, and
Hungary. The oil is nearly colorless, having a pleasant aromatic odor and
pungent taste. According to the investigations of Schimmel, oil of pini
contains Icevo-pinine and Isevo-phellandrene, also notable quantities of esterfl
of bomeol, such as bomeol-acetate.
In the German spas pine-oil is the most potent agent in the celebrated
"pine-cure" treatment for catarrlial atTections of the respiratory tract, &fl
well as in the treatment for pulmonary tuberculosis; in the former condi-
tions the oil may be used by inhalation* and in the latter this treatmeni
may be enhanced by administering it internally in the form of capsules of
0.30 to O.CO c.cm. (or mv-x) three times daily. It may be added to a steand
or vapor bath (pine-noodle bath), for rheumatic pains, or chronic joint-affe<S
tions.
OLEUM RICINI (U. S. P., B. P.).— Castor-oil.
Dose, 4 to 30 c.cm. (or f3j-5j).
Preparalion.
4
MUtura Olei Ricini {B. P.)-— Castor-oil Mixture (ca«tor-oU, 76 ccm.; mucilael
of acaciee, 37.5 ccm.: orange-flower wAter, 25 e.cm.; cinnamon-water, 62.6 c.cm!).
Dose, 30 to 60 c.ciu. (or fjiij)-
Pharmacologfy. — Castor-oil is "a fixed oil, expressed from the seeds oi
Ricinus communis'* (Euphorbiaceas), cultivated largely as an ornamental
plant in our gardens, coming originally from India, The oil should be ob*
tained without heat simply by crui^hinc!; anrl pressing the seeds. It consisti
mainly of ricinoleic acid, combined with the base glyceryl as Eicinoleate oi
glyceryl, together with other fixed oils, a reein, and possibly an alkaloid
Ricinine (not purgative), and an acrid, drastic principle. It is a colorles^
rather viscid, oily liquid, of faint, peculiar odor, and a bland, nauseating
acrid taste. It is soluble in an equal part of alcohol. It is a good additioi
to liniments on account of its density, and enters into the compound lini*
ment of mustard and flexible collodion. Castor-oil is completely soluble ill
absolute alcohol, which is employed as a test for the detection of impuritiea
Pure castor-oil dissolves in spirit of 0.S38 specific gravity at a temperature
between 3S° and 43° C. (100.4" to 109.4'' F.), while foreign oils only di»
eolve at a considerably higher degree.^ According to the investigations oj
H. Meyer, the purgative properties are due to pure rieinoleio acid and iti
glyceride, the ricinoleates of calcium and barium, and ricineloidic acid. Caa
tor-oil is soluble in ether. The seeds from which it is expressed contain I
highly irritant principle termed ricin, which renders them poisonous, and
three seeds have been known to occasion fatal gastro-enteritis in a man.
•J. Arthur Wilson, in American Jourttal of Pharmacy, Dec, 1800.
OLEUU RICINI.
667
»
Fhysiologfical Action. — When applied to the skin no irritation results.
It is also very well borne by the conjunrtiva, acting as a protective and
sedative. The nauseating taste is largely due to its odor, and it can be taken
much better if the nose be held during the act of swallowing. The odor may
ilflo be overcome by peppermint and other flavoring agents. As a purgative,
it x$ classed as a laxative in small doses (0.60 to 4 c.cm., or mx-f3j), becom-
ing more active in full doses (15 to 30 c.cm., or fSss-J). The laxative effect
Tfsultfl about four hours after administration. Castor-oil will sometimes
have a purgative action when rubbed upon the abdomen of young children.
Therapy. — Castor-oil may be used as a menstruum to retain drugs in
contact with the surface. The following is a suitable formula: —
B Olei ricini 161 c.cm. or fjss.
Alcohc1i» 60| c.cm. or fSij.
Tinct. cautharidis,
Spiritus rosmarini aa 301 c.cm. or fly
Sptritus odorati q. §. ad 240[ c.cm. or fSviij. — M.
A drop of castor-oil in the eye will often relieve the irritation caused
by a particle of sand, or by granular lids. Dr. S. Mitchell has found a solu-
tion of cocaine in castor-oil to be an excellent application to corneal ulcer,
relieving pain and healing the lesion after other solutions had been used in
Tiin. Fomentations of the mammary glands with castor-oil plant leaves,
^Ited with hot water, are useful in promoting the secretion of milk. A
fluid extract made from the leaves has been used in the same manner and
ilso^ven by the mouth; a decoction has been employed in amenorrhoea.
Castor-oil as a purgative is useful in children, and in pregnant women,
for piles or fissures of the anus, or after parturition, acting without any irri-
tant effect, according to Brunton; but this is denied by Fordyce Barker,
who, from clinical experience, declared that it is not suitable for such cases,
ind in pregnancy or after parturition aloes is a preferable purgative. Caa-
tor-oil is a good vermifuge, and should be given before and after the admin-
istration of other anthelmintics. In acute diarrhoea or dysentery, treatment
«hould commence with 4 to 7.5 c.cm. (or f5i-ij) of oil, combined with 0.30 to
0.60 c.cm. (or mv-x) of laudanum. This removes irritating substances and
ttXJthea the intestines. Dr. Young, of Florence, has successfully treated
fcnte diflrrh(ra with small doses of castor-oil, and suggests the following fop-
mala: —
H Olci ricini 1
Sp. chloroforral 6
^lorplwnir hydrochloridi
Pulv. Rcacicj 10
Syr. ftimplieis 15
Aaum q. «. ad 120
3X. Sig.i A dessertspoonful every hour and a half for an adult.
Phillips, also, has found the above mixture efficacious. In chronic dys-
entery, Brunton recommends 1 c.cm. (or mxv) of castor-oil with 0.30 to 0.60
Cfm. (or mv-x) of tincture of opium, given three times daily, or used
thus:—
ft 01. ricini 2| c.cm. or fta.
c.cm. or mx vel xxx.
I
50 com.
c.cm.
065 Gm.
Gm.
or mxxiv
or fSias.
or p. j.
or Siisa.
c.cm.
or tlnn.
c.cm.
or f5iv.
01. ricini 21
Tinct. opii |60 to 2|
Syr. samapariUfe vel
Aqtue mcnth. pip 46|
Pulv. acAcie q. s.
Sig.: One or two teaBpooafula three or four times a day.
c.cm. or fSiM.
668
rilAllMACEUTlCAL THERAPEUTIC AGEXTS OR DRUGS.
In neuralgias, especially those affecting the trifacial nerve, Dr. Harold
N. Moyer, of Chicago, has found castor-oil remarkably efficacious. lie gives
a single dose of 30 to 60 c.cm. (or f3i-ij)> usually in a little Bass's ale. In
some cases this is given each morning before breakfast, with marked relief
from the pain, lie advises, also, washing the oil by shaking it with cold
water, when it has become old and perhaps a little rancid, or disagreeable
to the taste.'
A teaspoonful of oil will greatly relieve an infant suffering with acute
bronchial catarrh.
Special Forma for Administration* — It may be given in soft capsules,
which can be obtained of any size from O.GO to 15 c.cm. (or mx-f5s8). If the
oil be given the first thing in the morning, an hour before breakfast, 0.60
to 1.20 c.cm. (or mi-xx) are generally sufficient to open the bowels. Thii
dose may be given in a teaspoonful of peppermint-water and brandy, the
proportion being such that the oil neither sinks nor swims in the mixture.*
Some patients take oil rcndily when mixed with a little whisky, or coffee-
sjrrup. It may be followed by a piece of cracker, or a gum-drop, to prevent
eructations. Lemon- or orange- juice, coffee, froth of porter or beer, are
also used as vehioles, but the best is the nxlomporaneous dose prepared at the
soda-water fountain. It is stated in Merck s Reports that eastor-oil may be
made palatable by employing the following formula: —
Q Saccharin
del gaultheriiB 1
Alcoholis 15
Olei ricini 473
75 Gm. or gr. xij.
20 c.cm. or nixx.
ccm. or fSiv.
c.cm. or Oj.
4
The following mixture is recommended by a contributor to the Ameri-
can Druggists In it the disagreeable taete of the oil is replaced by a pleasant
flavor of almonds: —
Castor-oil 30 part*.
Bitter almouds 2 parts.
Sugar 30 partn.
Gum tragacanth V« part.
Orange-flower water 10 parts.
Water 120 parta.
1
The only drawback to this mixture is that a good deal of it is required
for a dose, a teaspoonful of the oil being contained in about five teaspoonfuk
of the mixture. The taste of codliver-oil is tolerably well disguised by
highly-seasoned beef-tea. R. R. Mitchell advises for the same purpose a
mixture of equal parts of the oil, aromatic syrup of rhubarb, and cascara
cordial. Dr. Wabah McMurray, of Sydney, Australia, sa^-s, to disguise the
unpleasant taste of castor-oil, n ^ood idea is to ask the patient to take some
cream in the mouth and apply it with the tongue over the entire surface.
This prevents the oil from adhering to the mucous membrane. The taste is
said to be disguised by hot milk, 1 part of the oil being shaken up with 4
of the milk. In children with griping diarrhoea and green stools contain-
* Journal of the American Medical Association, April 21, 1900, p. 081.
'BruTiton'8 "Pharmacology. Therapeuti**. and Materia Medica," 1885, p. 938.
* Boston Medical and Surffical Journal, Feb. 12, 1801, p. 175.
OLEUM RUT^. ^^^^^^ 669
"mg casein, to disguise the taste of the oil and act well, Dr. McMurray rec-
ommends the following combination: —
B 01. ricini 4| c.cm. or fSj.
Mucil. acflcice q. ■.
Tinct. opii |30 ccm. or wiv.
Ac|Ufe uienth. pip. Tel
Aqiue chlorofornii 60| ccm. or 13ij.
3*1. Sig.; A Uaspoonful every four hours.
A formula for a palatable castor-oil is thus given by N. J. Pritzker: —
B 01. ricini 90| ccm. or fSiij.
Vitellum ovi.
01. amygdftl. amar 112 c.cm. or mij.
Lactis recentis q. a. ad 120| com. or Qiv.
The oil should be added slowly to the egg-yolk, triturating thoroughly,
and the other ingredients are afterward added. The mixture can be taken
in milk, eyrup, or wine. The taste may also be masked by mixing the oil
with an equal part of glycerin and adding a drop or two of the oil of cinna-
raon or of gaultheria to each dose. According to a method devised by
Toellner and Bergmann, the finest castor-oil is repeatedly treated with hot
water, sweetened with sufficient saccharin to give it the flavor of syrup, and
the last trace of its original taste disguised by small quantities of oil of cin-
namon and essence of vanilla.
*
»
OLErM RTJTiE.— Oil of Rue.
Pharmacology. — Oil of rue is a volatile oil distilled from Ruta grave-
oJens (Rutace*, Rutese). Its color is light yellow, which becomes brown
when the oil is long kept; the taste is sharp and bitter; the odor is aromatic,
disagreeable, and distinctive. This oil is soluble in all proportions in abso-
lute alcohol. The oil is obtained from the leaves, which also contain a yellow
coloring matter called rutin, a crystalline substance, possessing acid proper-
titf ; aJsw) methyl nonyl ketone, methyl hoptyl ketone^ and lauric aldehyde.
Physiolagical Action. — Applied to the skin, oil of me occasions hyper-
emia, inflaBimation, and vesication. In ordinary doses it is carminative, and
IS a general stimulant to the circulation and the secretions. Large doses
cause gastro-enteritis, convulsions, stupor, dimness of vision, contracted pu-
Cils, fiuppreseion of urine, or strangury. Abortion may follow toxic doses. It
M a special action on the genito-urinary tract. Rue is eliminated and may
be recognized by its odor in the breath, urine, and perspiration.
Therapy. — The oil of rue is useful in amenorrhcea due to defective ex-
citement of the ovaries, and in passive menorrhagia of debility or following
•bortion. Hysteria, especially when associated with amenorrhcea, is benefited
by this remedy. It has been used with success in flatulence and infantile
coniiilsions dependent upon that condition. TTsed as an abortifacient, in
accordance with popular reputation, it has several times caused death from
irritant poisoning, as above indicated. Rue is beneficial in defective activity
of the sexual organs, acting as an aphrodisiac and as an emmenagogue. The
irritant properties of the oil of rue have caused it to be sometimes used as
topical remedy. It is said to have the power of destroying warts. Phillips
tes that the bruised leaves of rue laid upon the forehead will often check
ffpittaxis. Rne has been added to liniments for application to the chest in
niAKMACEUTICAL TUERAPEUXIC AOEXTS Oil DULUS.
thronic bronchitis. A decoction of the fresh leaves may be employed as an
linjecLion to destroy ascarides. Rue hae also been given internally in order
[to expel round-worms.
OLEUM SANTALI (U. S. P., B. P.)-— Oil of Santal, Oil of Sandal-wood.
Dose, 0.30 to 2 com. (or mv-xxx) in emulsion or capsules.
Pharmacology. — "Tiie volatile oil distilled from the wood of Santaluiu
nlbuin (yuntiiliKva:'), of India, yielding, when assayed by the official process,
not less than 90 per cent, of alcohols, calculated as santalol (U. S. P.). It
is a pnle-yellowish liquid, of a strongly-aromatic odor, a pungent and spicy
taste, aiul filiglitly acid reaction. It is readily soluble in alcohol, ether, and
chlon>rorm, and is used in perfumery. Sandal-wood oil is not infrequently
adulterated with some fixed vegetable or mineral oil, the essential oil of
cedar or copaiba. The fixed oils may be detected by their lighter specific
gravity and by the fact that if fixed oil be present it will not volatilize, but
will leave a permanent stain when placed upon a piece of unsized paper.
The essential oils are most surely recognized by the polarinieter, as they
diinini:^h the rotatory power of the sandal-wood oil.
Anotlier method for detecting adulteration is given by M. E. Mesnard.
The addition of pure sulphuric acid to unadulterated oil produces a viscid
liquid^ which soon thickens into a solid mass, of a light grayish-blue or gray-
ish color, end adheres to the glass. If the oil is impure the resinous mass
does not entirely solidify and remains of a deep tint with a distinct lustre.
Physiological Action. — Sandal-wood oil acts as an internal antiseptic
and as an astringent to mucous surfaces, checking secretions and causing
dryness of the throat and thirst. It is largely excreted by the kidneys and
imparts an odor to the urine, to which it gives also medicinal qualities, so
that it acts upon the urinary passages. Absorption and elimination are very
rapid, and it may be detected in the urine half an hour after administration.
This oil partly escapes by the broncho-pulmonary mucoii? membrane, and
here also exerts a local effect. Dr. S. Rosenberg observed, after daily doses
of 4 c.cm. (or foj), irritiition of the alimentary canal and urethra, with an
eruption of small red papules upon the skin and conjunctiva.
Therapy. — Sandal-wood oil is used principally in the treatment of gon-
orrhoea, even in the acute stage, given in capsules of 0.30 c.cm. (or mv) each,
one or two, three times daily. It seems to be beat adapted to plethoric in-
dividuals, with abundant discharge. It generally relieves the pain and dis-
charge within four or five days. If the discharge is not materially dimin-
ished within ten days the doses should be cautiously increased. The use of
the oil is not contra-indicated by the presence of any of the complications of
the disease. It is also valuable in pyelitis, cystitis, gleet, urethral hiemor-
rhagc, and chronic bronchial catarrh. Dr. Curtin, of Philadelphia, recom-
mends oil of sandal-wood in the treatment of obstinnte cough. He adminis-
ters it with advantage in [ilitliisis, catunhiil pnouinoiiia, and infiuen^a.
It is important to note that much of the oil of sandal-wood, especially
in the form of proprietary capsules, is impure, and is adulterated with other
oils. The French preparation, known as Santal Midy. prepared by Midy's
process from freshly-felled Mysore sandal-wood, is a reliable preparation,
put up in capsules of 0.30 c.cm. (or m\) each in the laboratory of Risaud
and Chapoteaut. Paris. The leading manufacturers of soft capsules in
this country also employ an oil of good quality and therapeutical activity.
OLEUM TIOLII. 671
The advantage of pure oil of sandal-wood over copaiba and cubeb is that
it does not nauseate or disturb digestion, and can be given with good results
during the inflammatory stages of blennorrhoea or cystitis. The fluid ex-
tract, obtained from the S. citrinum, or yellow sandal-wood, has been used
for the same purposes as the oil. The wood is largely used as an ingredient
of incense, in China, in temple-worship, and is prized for its perfume.
OLBUK SESAMI. —Oil of Sesamum, Benne or Teel Oil.
Pharmacology and Therapy. — "A fixed oil expressed from the seed of
Sesamum indicum" (Pedaliacese). It is similar to cotton-seed oil, bland,
inodorous, or nearly so, neutral in reaction, rich in olein, and is said to
keep better than olive-oil. In large doses it is laxative, and emmenagogic
properties have been attributed to it without much foundation. The seeds
are used as food by the negroes of the South.
OLEXJM SINAPIS VOLATILE (U. S. P., B. P.).— Volatile Oil of Mus-
tard. (See Sinapis.)
. OLEUM TEEEBINTHIN-ffi (T . S. P., B. P.).— Oil of Turpentine.
(Seepage 881.)
OLEUM TIGLH (U. S. P.), OLETTM CEOTOlHfi (B. P.).— Croton^il.
Dose, 0.015 to 0.12 c.cm. (or m V^-ij).
Preparation.
Linimentum CrotonU (B. P.). — ^Liniment of Croton-oil. (Croton-oili 20 c.cm.; oil
of cajuput, 70 ccm.; alcohol, 90 per cent., 70 ccm.)
Pharmacology. — Croton-oil is "a iixed oil expressed from the seed of
Croton Tiglium" (Euphorbiacese): an East-Indian tree. It is a pale-yellow,
or brownish-yellow, rather viscid, and slightly fluorescent liquid, having a
somewhat fatty odor, a mild oily, afterward acrid, burning taste. It is only
partially soluble in alcohol, about 60 per cent, will dissolve when fresh, but
the solubility and therapeutic activity increase by age. It is freely soluble
in ether, chloroform, carbon disulphide, olive-oil, and oil of turpentine. It
contains Tigliic acid (methyl crotonic, or crotonolic, acid), and also several
glycerides of fatty acids. It contains a vesicating principle and a purgative
principle. Alcohol dissolves about 20 per cent, of this oil, which carries
with it the vesicating principle ; the purgative constituent remaining in the
insoluble portion.
Physiological Action. — The topical application of croton-oil to the skin
causes irritation, inflammation, and a papular eruption, subsequently becom-
ing pustular. Occasionally its application produces a general papulo-pus-
tular eruption, scattered over the body. The pustules afterward dry up, and
may give rise to scars if the oil is applied undiluted. The pustules are
sometimes umbilicated, and, upon careless examination, the eruption might
be mistaken for that of small-pox. When 1 or 2 drops of croton-oil have
been swallowed vomiting may be produced, but in the course of an hour or
two copious watery stools are passed, with symptoms of irritant poisoning,
particularly when larger doses have been taken. Congestion of the gastro-
intestinal tract occurs, and death may ensue from resulting inflammation of
the bowels or peritonitis. Part of the oil diffuses into the blood, and pro-
duces glandular hypersemia, and possibly an eruption upon the skin. Some-
672
rHABJiACECTICAL TUEIUPEUTIC AGENTS OB DBCGS.
times, when applied to the skin, the contrary is observed, the remedy passing
through into tlie blood and causing watery discharges from the bowels.
When combined with an alkali, or with some other agents, while it promotes
the peristaltic action, the elfects are more manageable and there is less dan-
ger of general toxic etfects. It is a feeble hepatic stimulant according to
Rutherford. The toxic effects of croton-oil are combated by means of de-
mulcent drinks and opiates.
Therapy. — Croton-oil was formerly a favorite method of exciting coun-
ter-irritation, because it was convenient, simple, and rapid in its etfects.
On account of the danger of producing guppiiration and the resulting scars,
it is rarely resorted to at present. If it be diluted with '6 parts of oil of sweet
almonds it is a little less prompt, but the resulting inflammation is much
milder, and several applications are sometimes required in order to bring
out sufficient papules. It is valuable in disease of the chest, in incipient
phthisis, pleurisy, bronchitis, neuralgia, rheumatism, and glandular swell-
ings. Sciatica, in particular, has been benetited by this method.
Counter-irritation by croton-oil is likewise serviceable in chronic laryn-
gitis, ovaritis, and metritis, and in phlegmonous pharyngitis, especially of
the relapsing variety, frictions of the upper part of the neck with croton-oil
are strongly advised by Dr. Helbing, Dr. Charles Cobb states that half a
drop of croton-oil applied daily by means of a probe is an excellent remedy
in suppurative tonsillitis. Pustulation of the shaven scalp was formerly
esteemed beneficial in meningitis, but is a method of treatment scarcely to
be advocated. Its use in ringworm induces an artificial kerion, which soon
subsides and the disease disappears. It should not be used for this purpose
■in delicate children, especially those under six or seven years of age; it
should also be applied to a small spot, a little larger than a dime, and it
should be used only in chronic cases.
The liniment of croton-oil, oflScial in the British Pharmacopoeia, may
cause too much irritation, and can be diluted with advantage; for instance,
0.30 c.cm. (or mv) of this preparation to 30 c.cra. (or fjj) of olive-oil is a
stimulant application sometimes used in alopecia. In other cases of skin
affection, occasional small doses of croton-oil, given in pill, usually in com-
bination, are useful in clearing the alimentary canal.
Internally croton-oil is used as a drastic purgative in cerebral affections,
apoplexy, etc, acute mania, and in cases of injury to the head. It is service-
able on account of its depletory and derivative effect in ura?mic coma. In
comatose conditions the dose may be simply dropped upon the tongue, and
two or three times the usual dose are required. It is a better plan, however,
to dilute the oil with a little lard, butter, sweet-oil, or castor-oil. This medica-
ment is valuable as an hydragogue cathartic in the treatment of anasarca, and
in many cases where a complete evacuation of the bowels is desired, to bring
about prompt diminution of arterial pressure and derivative action. In some
instances it would be proper to give croton-oil in obstruction of the bowela
from impaction of faeces, lead colic, or paralysis. of the intestine. It may
also be used as a vermifuge to expel tape-worms, but is so violent that the
head is apt to be torn off and remain, unless an anthelmintic has been ad-
ministered previously. Croton-oil should not be given to a pregnant woman,
nor to a patient subject to hfemorrhoids.
In doses of 0.008 to 0.01 c.cm. (or m Va-Va)? i° a pi^l with licorice, it
makes an effective purgative, rarely rejected even in irritable conditions of
OPICit.
673
the stomflch. and promoting both peristalsis and secretion, thereby softening
and loosening masses which in the pouches of the colon may be retained for
weeks undisturbed by the ordinary hydragogic purgatives. This remedy acta
^ciently in dilatation and atony of the stomach where other remedies are
not absorbed, and proves of great service in sterconemia, which is at the root
of many obstinate functional conditions, such as asthma, migraine, epilepsy,
dyspepsia, and the eHects of high arterial tension.
OLEORESINiE ASPIDH (U. S. P.). (Sec Aspidium, page-237.)
OPITJM (U. S. P., B. P.).— Opium.
Dose, 0.015 to 0.13 Gm. (or gr. V^ij).
V. S, P. Preparations and Alkaloids,^
Opii PiUvis. — Powdered Opium { raoriiliiiic, not less than 12, nor more than 12Vi
per cent,). Dose, 0.03 to O.OtlS Gm. (or gr. as-j).
Opium C'raiiulatimi. — Grnnulatcd Opium (same stren^h as powdered opium).
Opium D«>dorutum. — Deodorized Opium (same atrength). Doae, 0.03 to 0.005
Om. (or gr. hs-J ).
Extraclum Opii. — Extract of Opium (morpliine, 20 per cent.). Dose, 0.015 to
0.03 Gm. (orgr. V«-8»).
Accliini Opii. — Vinegtir of Opium (10 per cent.). Dose, same a^ Tincture.
Tincturu Opii. — Tincture of Opium, loiudanura (each 100 c.cm. contains 1.2
to lJ£j Gm. of morphine). Dose. 0.06 to 1.20 c.em. (or nii-xx).
Tinclura Opii Deodorata. — Tinctura of Deodorized Opium (same strength as
tincturr). Dose, 0.06 to 1.20 com. (or mi-xx).
Tinrtura Opii Camphorata. — Camphorated Tinoture of Opium, Paregoric Elixir
(iMtwJtTed opium, benzoic acid, and cjimphor, of earh, 4 Gm. ; oil of anine. 4 c.cm.;
gircerin. 40 c.cni. ; and diluted alcohol, q. a. ud 1000 com.). Dose, 4 to 15 c.cm.
(or fSi-^ttS).
Vinum Opii. — Wine of Opium (10 per cent.). Dose, 0.30 to 1.20 c.cm. (or mv-xr).
Pulvis Ipecacuanhte ct Opii. — Powder of Ipecac and Opium, Dover's Powder
(ipecac and opium, of each, 1 part; augar of milk, 8). Dose, 0.05 Gm. (or rt. x).
Tinctura IpecacuanhsB et Opii. — Tincture of Ipecac and Opium, Fluid Dover's
Powder. Dose, 0.30 to 0.60 c.cm. (or mv-x).
PiJuItt Opii. — Pills of Opium (each, 0.065 Gra., or gr. j. powdered opium).
Trorhisci Glycyrrhiza* et Opii. — Troches of Glycyrrhiza and Opium (each, 0.005
'Gm., or gr. Vut of powdered opium).
Mibtura Glyoyrrhizffi Composita. — Compound Mixture of Glycyrrhiza, Brown
fixture (paregoric, 12; antimonial wine, 6; sweet spirit of nitre, 3: extract of Hcoric«,
ayrup, niucilagc of acacia, and water). Do&e, 4 to 15 c.cm. (or fSi-f^Bs)*
Eniplnf»trum Opii. — Opium Plaster (extract, 6 per cent.).
Codeina.— Codeine. Dose, 0.016 to 0.13 Gm. (orgr. V^ij).
t'odfiiidj PhoNphaA. — Plio?^phutc of Codeine.
Coileinic Sulphas. — 8ul|ihate of Codeine.
Morphinfl— Morphine. Dose, 0.006 to 0.016 Gm. (or gr. VwV»).
Morf^himc Acetas. — Morphine Acetate. Dose, 0.000 to 0.015 Gm. (or gr. Vj.-'A).
Morphiiiae Hvdrwhloridum. — Morphine Hydrochloride. Do*e, 0.006 to 0,015 Gra.
(OTgr. V„-V,).
MorphinsB Sulphas. — Morphine Sulphate. Dose, 0.006 to 0.015 Gm. (or gr.
Pulvift Morphinie Compositufl. — Compound Morphine Powder, Tully's Powder
ftnurphinc ftiitfilinte, l.o flm.; camphor, 32 Gm. ; glycyrrhiza tin No. 00 |K>wder),
S3 (Jm.; prtvipitated calcium rarlwnate, 33.5; and alcohol, a sulBcient quantity; then
add ihf? m'trpliine by rjir**ful admixture). Eurh 0.065 Om., or gr. j=:0.00l f;m.,
or gr. v., of morphine, and 0.02 Gm., or gr. */„ of camphor. Dose, 0.13 to 0.65 Gm.
(or gr. Ei-x).
* Ap*>mc»rphinc hydrochloride ( V. S. P., B. P. ) , dionin, and heroine, derivatives of
aorpbine, are de*cnb*d in their appropriate alphabetical plaeea.
674
PHAH31A0EUTICAL THEHAPEUTIO AGENTS OR DRUGS.
B. P. Preparations and Alkaloids.
£Iztractum Opii. — Extract of Opium (xnorphioe, 20 per cent). Dose, 0.015 to
-Liquid Extract of Opium (morphine, 0.75 Gm. in
0.065 Gm. (or gr. V.-j).
Extractum OpU I^iquidum.-
100 com.). Done, 1 ccm. [ur mxv — equivalent to gr. sa of extract of opium).
Tinctura Opii. — Tincture of Opium, Laudanum (1 c.cm., or mxv, = 0.0U5 Gm„
or gr. j, of opium). Dose, O.30 to 1 c.cm. (or mv-xv) for repeated administration;
single, L20 to 2 c.cm. (or rnxx-xxx),
Tinctura Opii Ammoniata. — Ammoninted Tifccture of Opium (containa 15 per
cent, of tincture of opium). Dose, 2 to 4 c.cm. (or fSss-j).
Tinctura Camphorae Composita. — Compound Tincture of Camphori Paregoric
Elixir. Dose, 2 to 4 ccm. (or fSss-j).
Pilula Plumbi cum Opio. — Pill of Lead with Opium (lead acetate, 6 Gm.; opium,
in powder^ 1 Gm. ; syrup of glucose, 0.7 Gm.), contains about 12 Vs per cent, of opium.
Dose, 0.13 to 0.25 Gm. (or gr. ii-iv).
Pilula Ipccacuanhffi cum Scitla. — Pill of Ipecacuanha with Squill (contains about
5 per cent, of opium). Dose, 0.26 to 0.50 Gm. (or gr. iv-vilj).
Pilula Saponis Composita. — Compound Pill of Soap (opium, 20 per cent.). Dose,
0.13 to 0.25 Gm. (or gr. ii-iv).
Unguentum Gallce cum Opio. — Gall and Opium Ointment (gall ointment, 92.5
Gm.; opium in fine powder, 7.5 Gm.).
Linimeutum Opii. — Liniment of Opium (equal parts of laudanum and of soap
liniment).
Emplastrum Opii. — Opium Plaster (opium in powder, 10 Gm.; reain plaster, 90
Gm.l.
Pulvis Ipei-acuanhae Compositus. — Compound Powder of Ipecacuanha, Dover's
Powder (opium in powder and ipecacuanha, each, 1 part; potassium sulphate, S
parts). Dose, 0.32 to 1 Gm. (or gr. v-xv).
Pulvis CretflB Aromaticua cum Opio. — Aromatic Powder of Chalk with Opium
(contains 2 Vi per cent, of opium). Dose, 0.65 to 2.60 Gm. (or gr. x-il).
Pulvis Kino Compositus.' — Compound Powder of Kino ((X>nt4i.in9 opium, 6; kino,
75; cinnamon, 20 Gm.). Dose, 0.32 to 1,30 Gm. (or gr. v-xx).
Pulvis Opii Compositus. — Compound Powder of Opium (opium, 10 per cent., with
black pepper, ginger, caraway -fruit, and tragacanth). Dose, 0.13 to 0.65 Gm. (or gr,
ii-x).
Suppoaitoria Plumbi Composita. — Compound I..ead Suppositories (each contains
0.2 Gm., or gr. iij, of lead acetate and 0.005 Gm., or gr. j, of opium).
MorphinjB Acetas. — Morphine Acetate- Dose, 0.008 to 0.03 Gm. (or gr. V*-bs).
MorphinsB Hydrochloridum. — Morphine Hydrochloride. Dose, 0.008 to 0.03 Gra.
(or gr. V,-»s).
Alorpliine Tartras. — Morphine Tartrate. Dose, 0.008 to 0.03 Gm. (or gr. Vt-sa).
Codeina. — Codeine. Dose, 0.015 to 0.13 Gm. (or gr. V,-ij).
Codeiuu* Phoeplma. — Codeine Phosphate. Dose, 0.015 to 0.13 Gm. (or gr. 'A-ij).
Liquor Morphlntc Acetatis. — Solution of Morphine Acetate (100 c.cm. contain
1 Gm., or mex to gr. j). Dose, 0.00 to 4 c.cm. (or fnx-3j).
Ltquur Morphinie Hydrochloridi, — Solution of Morphine Hydrochloride (same as
preceding) .
Liquor Morphinte Tartratis. — Solution of ^Eorphinfr Tartrate (same as preced-
ing).
Trochiacus Morphinip. — Morphine Lozenge (O.OOIS Gm.. oii gr. */„, in each).
Injectio Mori>hina; Hypodcrmieti. — Hypodermic Injection of Morphine (5 Gm.
in 100 c.cm.). Dose, by subcutaneous injection, 0.12 to 0.30 c.cm. (or mii-v).
Tinctura Cliloroformi et Morj)hincF CoTnposita. — Compound Tincture of Chloro-
form and Morphine (each 10 minims contain, of chloroform, 0.045 com., or mV«;
diluted hydrocyanic arid, 0.03 c.cm.. or wss; morphine hydrochloride, 0.005 Gm., or
gr. Vii)- Dose. 0..S0 to 1 c.cm. (or wv-xv).
Syrupus Codcinn*.— Syrup of Codeine (phosphate of codeine, 4.57 Gm. In 1000
com., or gr. '/« in each f3j). Dose, 2 to 7.6 c.cm. (or fSss-ij).
* The compound tincture of kino of the National Formulary contains 10 per
cent, of laudanum. Knch tcaspoonful is equivalent to one-half a grain each of kino
and powdered opium.
OPIUM. 675
Suppodtoiia Morphiiue. — ^Morphine Suppositories (each contains 0.015 Qm., or
gr. V«f of morphine hydrochloride).
Papaveris Capsulae. — Poppy Capsules. The nearly ripe dried truits of Papaver
sonmiferum (contain a small proportion of morphine).
Pharmacology. — Opium ia "the concrete, milky exudation obtained by
incising the imripe capsules of Papaver sonmif erum (Papaveracese), and
yielding in its normal, moist condition not less than 9 per cent, of crystal-
lized morphine when assayed by the U, S. P. process.'* "The juice obtained
by incision from the unripe capsules of Papaver soraniferum, inspissated by
spontaneous evaporation" (B. P.). Opium, in its inspissated form, occurs in
chestnut-colored masses or lumps, with an earthy, narcotic odor and bitter
taste. In its commercial condition, as a moist, soft solid, it loses about 20 per
cent, of its weight in the process of drying. When dried and powdered, the
pharmacopceia directs that it shall contain not less than 12 nor more than '
12Vi per cent, of morphine. The principal properties of crude opium are ex-
tracted by water, alcohol, and dilute acid, but not by ether. When a mass
of opium is broken it should exhibit a notched fracture, and should leave an
interrupted stain when drawn across white paper. Since all commercial
opium contains more or less admixture of foreign material, or adulteration,
the best preparation is the deodorized opium, obtained by dissolving and
removing narcotine and other matters soluble in ether, and standardizing
the product to the uniform strength of 14-per-cent. morphine. By employ-
ing deodorized opium in making Dover's powder a superior product is ob-
tained, less disagreeable to the taste and less likely to cause nausea than
that made from the ordinary powdered opium. A syrup of opium and ipecac
may also be made with deodorized opium, so that each teaspoonful will rep-
resent 10 grains of Dover^s powder. The preparations that pharmacy offers
to the physician, of this ancient and valuable remedy, are innumerable, but
they are all dependent for their activity upon the presence of certain proxi-
mate principles. It had been long suspected that a vis dormitlTa, or nar-
cotic element, existed in opium and gave it medicinal value, but it was not
until 1817 that a crystalline body was isolated by Sertiimer, which he cor-
rectly considered as the salt of an organic acid, to which he gave the name
of Heconio acid. The sleep-producing principle he named morphium in
honor of the drowsy god, but this has been since changed to Korphine, in
order to make it conform in terminology to the other organic alkaloids of
the pharmacopoeia. Since then, other alkaloids and proximate principles
have been separated horn opium, some of which possess narcotic power, some
have not, and one, at least, is a tetanizer resembling strychnine. The prin-
cipal constituents and alkaloids are as follow; —
Morphine (at least 9 per cent, in crude opium) is the principal narcotic
constituent. Codeine (Va per cent.); about half the narcotic strength of
morphine, but more calmative. Narcotine (2 to 10 per cent.); no narcotic
effects. Anarcotine, which is found especially in opium from India (and
which was formerly used as a febrifuge, but the use of which is now aban-
doned), appears to be identical with Narcotine, and destitute of marked
physiological properties, Thebaine, or paramorphine (less than y^ per
cent.); convukive agent and spinal excitant. Narceine (0.02 per cent.);
resembles morphine, but has less disagreeable after-effects. (A new and
more soluble narceine has been prepared by Dr. Laborde and M. Duquesnel.*)
*■ TherapeuUe Ocaette, Sept 16, 1890. p. 639.
676
FILlRilACEDTICAL THERAPEUTIC AOENTS OR DRUGS.
Papaverine (I'per cent.); narcotic and convulsant. Also cryptopine, pseudo-
morphine, protopine, cotomine, laudanine, codamine, rhceadine, moconidine,
laudanosine, lanthopine, and gnoscopine iu small amounts, with neutral
principlesj — meconin, meconoisin, and porphyroiin, — and meconic and
lactic acids. Morphine crystallizes in the form of colorless, flat, six-aided
prisms, destitute of siucll, having a very bitter taste, which melt at about
330° F., and are destroyed by more elevated temperatures. Morphine is
soluble in 5000 parts of cold water and <)I4S ether; but is sparingly soluble
in boiling water, freely solubh- in alcohol miuI i:hlorofuriu. The solutions of
morpliinc possess an alkaline reaction. It dis.solves without decomposition
in solution of potassium. On account of its insolubility in water, it is em-
ployi'd for niedicinal purposes preferably in the funn of its soluble salts.
Codeine is present in opium, combined with meconic acid, and is sepa-
rated from morphine by means of an alkaline solution. This is a colorless,
crystalline substance; anhydrous or hydrated, depending upon whether it
crystallizes from an ethereal or aqueous solution. Its solutions are bitter
to the taste and of on alkaline reaction. Codeine dissolves in water» alcohol,
ether, and chloroform. It is the methyl derivative of morphine and, as found
in the shops, ia of uncertain composition and may be contaminated with
morphine.
Apocodeine is a derivative of codeine, ohtained by heating codeine hy-
drochlorate with a concentrated solution of zinc chloride.
A new alkaloid has been discovered, named xanthaline on account of
the yellow color of its salts. Xanthaline is so feeble a base that when one of
its salts is placed in water the acid separates, leaving the alkaloid, which is
nearly white in color. By the action of nascent hydrogen on xanthaline,
another base, hydroxanthaline is formed, the sulphate of which occurs as
hard, white crystals.
It is probable that these principles exist in a highly complex arrange-
ment in opium, and that separately none of them completely represents the
drug; possibly some of tliem are derivatives of the others, and not proximate
compounds.
Some of the chemical reactions and testa of opium are interesting.
Solutions containing meconic acid turn red in contact with the tincture of
ferric chloride, and the same reagent turns morphine bhie, afterward chang-
ing to green; nitric acid turns morphine to blood-red, changing to yellow.
According to Worraley, the nitric-acid test is capable of detecting Vwoo*
grain of morphine, in the dry state.
A new test for morjjhine has been described by M. Laneal. A few drops
of a suspected fluid being placed in a porcelain capsule, there ia added an
equal q\iantity of a solution of 30 parts of uranium acetate and 20 parts of
sodium acetate in 1000 of distilled water. The mixture is evaporated over a
water-bath and, if morphine be present, a brownish-red or orange deposit is
left in the form of concentric rings.
Opium preparations, in solution, afford precipitates with solutions of
many of the metals in the form of an insoluble meconate. The alkaloids
are precipitated by the addition of an alkali, or tannic acid. It should also be
stated that there is present a small proportion of glucose in gum opium,
which chemically makes it incompatible with silver nitrate, and pills con-
taining these in combination may explode. The formerly much used lead-
water-and-laudanum mixture is dependent for some of its effect upon the
I
I
extemporaneously formed mcconate of lead, which is yellow in color and
unsightly and dirty; dilute lead-water with alcohol is colorless, and will
probably answer the purpose as well.
Hager has shown that opium and morphine in solution, when exposed
to a temperature between 203° and 212° F., lose a considerable portion of
their narcotic power. To these preparations he gives the name of mitigated
opium. After subjection to this process the residue may be reduced to pow-
der, from which preparations corresponding to ordinary opium may be made.
The mitigated preparations may be useful in cases of children, women, and
debilitated individuals.
Physiological Action. — Opium is a stimulant, narcotic, anodyne, anti-
Epasmodic, and intoxicant. Its taste is bitter and somewhat acrid; it gives
rise to a sensation of dryness in the mouth and throat, and subsequently to
ft viscid secretion, with huskiness of the voice. It restrains the movements
and checks the fiecretions of the stomach and intestinal canal. As a result
of his experiments, Nothnagel concluded that opium in moderate doses
stimulates the inhibitory nerves of the intestine, but paralyzes them when
given in excessive doses. This accords with the observed fact that under
the influence of this drug constipation is not infrequently followed by ei-
i^rated peristalsis and free evacuation of the bowels. The pancreatic and
hepatic secretions are lessened, and the stools sometimes become clay-col-
ored under the influence of opium.
The action of opium and morphine upon the bowel has been studied
anew by Spitzer, whose experiments were conducted upon frogs, rabbits, and
men. The sensitivtnese of the bowel to painful impressions was diminished
by small doses of the watery extract given subcutaneously, the effect being
due to a local influence upon the nerve-centres in the wall of the bowel.
Large doses are required to diminish peristalsis. Morphine has the same in-
fluence as opium, but the other alkaloids have little action upon the intes-
tine. In healthy men, opium, given subcutaneously, has somewhat less
action upon the bowel than when given by the mouth. Leubuscher has
made a comparative study of the influence of the opium alkaloids upon the
movements of the bowel. He concludes that morphine is the most efficient
agent in allaying intestinal movements. Papaverine comes next to morphine
in this respect. Narcotine is much feebler. Narceine and codeine are alto-
gether inetllcient. From 0.01 to 0.02 Gm. (or gr. Vo'Vi) o^ thebaine excited
violent intestinal contractions.
The drug is not perfectly represented by morphine, and many persons
who are able to take some of the opium preparations with good results are
made sick by morphine. Owing to the preponderance of morphine over the
other principles in opium, it will lead to no confusion if we consider them
together. In order to produce its charncteriatic effects, opium, or its active
principles, must be absorbed into the blood and carried to the motor, sen-
sory, and higher nenous centres, and to the terminal end-organs of nerves.
Hiring been carried to the brain and cord, the functions of the ganglion-
oells are at first stimulated, and secondarily depressed or inhibited, probably
owing to the salts' diffusing through the cell-wall and entering temporarily
mto combination with the protoplasm. Subsequently they are removed by
fresh supplies of blood and carried to the excretory channels, particularly the
alimentary canal and kidneys. E. Tauber found that when morphine was ad-
ministered b}7)odennically to dogs, for several days, he was able to recover
678 PHARMACEUTICAL THERAPEUTIC AGENTS OK DHUG8.
41.3 per cent, of the drug from the fsecea.^ Morphine has a different effect
upon dogs and bats. In the former it exerts a narcotic influence, but M.
Gtiinard has observed that it acts as an excitant upon cats. This effect is in
proportion to the dose employed. When lethal amounts were given, death
was preceded by convulsions.
Alt has shown that after injection, subcutaneously, morphine can be
detected in the stomach. Further investigation by Hitzig has shown that,
consecutive to this excretion of morphine by the stomach, the quantity of
the gastric juice is decreased and its acidity is lessened. When the action
of the drug is at an end an excess of hydrochloric acid is secreted. In one
case the same effect upon the acidity of the gastric juice was dononstrated
in the human being. Bosenthal points out that the salivary glands also
separate morphine from the blood. In the case of patients who were taking
no more than 0.05 Qm. (or gr. Va) ^^J ^^ characteristic reaction of mor^
phine could be obtained. A cumulative action was likewise observed. In
patients taking only 0.01 Om. (or gr. V«) daily the reaction failed to make
its appearance imtil after the lapse of three or four days. As the saliva is
80 much more easily obtained thtm the contents of the stomach, this observa-
tion may prove of medico-legal interest. Bosenthal has shown, moreoyer,
that the elimination of morphine is independently performed by the salivary
glands and by the stomach. After malong its appearance in tke saliva the
reaction could be obtained for several days, and it is probable that a consid-
erable proportion is excreted by this route. Morphine does not appear to
be destroyed, or materially altered, in passing through the animal organism.
It seems probable, however, that small amounts of the alkaloid are decom-
posed within the body, while larger quantities escape without change. Mor-
phine is likewise eliminated by l^e skin and kidneys. Elisnination seenoa to
proceed slowly, as morphine has been found in the urine several days after
the drug had been discontinued.
The ^aper of Drs. K. Stockman and D. B. Dott on '^The FharmacoloKy
of Morphine and Its Derivatives,"' and that of Dr. Stockman "On the
Pharmacology of Some Bodies Derived from Morphine,"* contain the results
of a laborious series of investigations in a very interesting field, and form a
valuable contribution to our laiowledge of the influence of chemical change
on physiological action, as well as to the pharmacology of morphine. Tbeir
conclxisions only can be stated here ; for details the reader is referred to the
original sources. Morphine primarily affects the nervous system; in amall
doses it depresses the action of the spinal cord ; in larger doses it stimulates
it, even to the production of convulsions. The late appearance usually of
increased reflexes is accounted for on the ground that at first only a small
quantity of morphine reaches the cord. It has been held by some observers
that morphine is capable of directly paralyzing the motor endings of nerves.
Stockman and Dott record experiments tending to show that morphine does
paralyze more or less completely the nerve-endings, but only when large
amounts come in contact with them. In the case of the sensory nerves the
action is much the same. In man, tetanic symptoms are very exceptional,
^"Ueber daa Schicksal des Morphins im thierischen Organismus," Srekiv fMr
Experimentelle Pathologic und Phcrmckoloffie, July 24, 1800.
^British Medical Jmtrnal, July 26, 1890.
* "Trnnsnetions of the Ninth International Medical Congress/* Washington, 18S7,
▼olume ill, p. 47.
>
I
for, after therapeutic dcses, the amount of morphine reaching the peripheral
nerres is not usually sufficient to affect them. In infants and young chil-
dren, however, convulsions not uncommonly occur as a result of poisoning
by opium. Viewing morphine (Cj^Hj^NOaJ aa a compound containing two
hydroxyl groups, the hydrogen of one or both of these groups may be sub-
stituted by more or less complex radicles, forming derived bodies, which,
being tested, produce positive physiological results, more or leas approach-
ing those of morphine. From these researches they conclude that chemical
changes, restricted to what may be called the outlying groups of the mole-
cnles, cause very Little change in the physiological action, but where a change
is made in the kernel or ground-work of the molecule the action is much
more profoundly altered. In codeine, or methyl-morphine, they found that
the narcotic action was much diminished by the substitution of tlie alkyl
radicle for the hydrogen atom, while the tetanic action and the action on
the motor nerves were increased. The paralyzing effect on the motor nerve-
endings was also more decided. Codeine is anodyne and hypnotic, and causes
leas general disturbance than accompanies the action of morphine. The
gracrative functions are depressed by opium, and in chronic poisoning the
menses cease and men become impotent while under its influence. Passower
has demonstrated that the abuse of morphine may occasion atrophy of the
female generative organs. In a patient observed during two years it was
inferred, from the early failure of menstruation, that the atrophic process
began in the ovary. During the period named the uterus diminished in size
by 1 Vio inches and atrophy of the vulva was evident. The secretion of
urine is lessened, but the bladder ia often rendered irritable and urine is
passed frequently in small quantities. On the other hand, partial paralysis,
with retention, may occur. Althoff has proved experimentally that degen-
eration of the posterior columns of the cord in the dorsal region was pro-
duced in dogs who had for a long period received hypodermic injections of
morphine. This observation is in consonance with the clinical fact that
morphine habituates, in some instances, manifest ataxic symptoms. This
drug increases the amount of urea and phosphoric acid eliminated.
The hypnotic action of opium is due partly to the lessened activity of
the cerebral cells and partly to a reduction of the blood-supply to the brain-
centres. It is therefore a cerebral depressant. Small doses, however (0.0G5
Gm., or gr. j, or less), temporarily lessen all the secretions except that of the
iJdn, and stimulate the circulation; the heart's action is increased, arterial
' raised, and the pupils contract and do not respond well to light.
. quickened at first, the action of the heart soon becomes more slow
had forcible. Immoderate doses may cause rapid and feeble action. These
effects are attributable to exaltation or depression of the function of the
pneumogastric nerve.
With this, in some persons, there is exhilaration and increased cerebra-
tion, with a sense of calm and indisposition to sleep until the effect passes
»way, when sleep occurs, from which the subject wakens with a headache,
diwrdered stomach, and constipated bowels. In others, cerebral activity
dow not occur, but the spinal functions are exalted and restlessness occurs,
with «ome irritation of the skin, or even an erythematous eruption. At times
I general rash, resembling that of scarlet fever, is witnessed, and this erup-
tion may be succeeded by desquamation. In a case reported by Dr. A. J.
Lmux the eruption was of this character, and its development was preceded
680
PnABMACECTICAL TUEIIAPEUTIC AGENTS OR DRUGS.
by severe rigor, fever, and headache. In other cases an urticarial efflores-
cence may appear. Itching of the nose and of the skin is a very common
result of a dose of opium. In some persons the soporific effect is followed
by severe physical depression, accompanying sickness of the stomach. In
others, email doses of opium or its alkaloids occasion sjTicope and alarming
dyspnuia. This substance exerts little or no local action. Its active prin-
ciples, however, are quite readily absorbed through the unbroken skin.
Morphine, hypodermically injected, is less apt to affect the appetite
and bowels than opium given by the mouth. If, however, the solution should
be thrown directly into a vein, temporary dyspnoaa and clonic spasm may be
produced. Larger doses arrest digestion and may cause vomiting, with dia-
phoresis. The heart and circulation become depressed, the bodily tempera-
ture reduced. A stuporous sleep is produced, with irregular and slow res-
piration, cool, clauiui}' skin, and pin-point contracted pupils. In other cases
coma-vigil and delirium may occur. Infants are extremely susceptible to
the influence of opium. The drug should be administered to them in very
small doses, if at all, and its effects carefully watched. Aged people, also,
bear it less well than those in the prime of life. Women are more amenable
to the drug than men, and usually require smaller doses.
If a fatal dose has been taken, the above symptoms intensify, the pulse
becomes slower, respiration is reduced to ^ve or six to the minute, the re-
flexes become abolished, and death occurs from paralysis of the respiratory
centre or carbonic-acid accumulation in the blood. Post-mortem examina-
tion may show some of the drug yet remaining in the stomach or intestines,
and the internal organs reveal considerable venous congestion, especially the
lungs. Laudanum is the agent most frequently takeu with suicidal intent,
and its presence may often be detected simply by the odor of the contents
of the stomach. Death has resulted from 15 c.cm. (or fjss) of laudanum
given in an enema to a patient suffering with enteric fever.*
As instances of its aberrant effects, Prof. Edward T. Eeichert points out
that morphine will sometimes cause wakefulness in doses which ordinarily
produce sleep and that instances are on record which show that in Bome
people the administration will give rise to pain. In experiments upon dogs
he has also occasionally found this alkaloid to act as a respiratory stimulant.
This idiosyncrasy must not be lost sight of. In many persons morphine,
in usual doses, causes excitement and restlessness. These idiosyncrasies
represent the persistence of the primary effects of the drug. The pain results
from a slinnilant or excitnnt effect upon the sensory cells of the nerve-
centres. When constipation is cflus^d by spasmodic contraction of muscles,
opium will rclieve this condition and produce bowel-movements.
The action of codeine resembles that of morphine, but is less decided.
It is not eo apt to derange the stomach or produce constipation. Codeine
is not so potent an anodyne or hypnotic as morphine. Excessive doses have
caused alarming prostraiion and distressing pruritus. In a case described
by Dr. Spratling the s\*mptoms produced by taking 0.50 Gm. (or gr. viij) of
codeine were nausea, vomiting, restlessness, convulsions, slow re?piration, in-
tense thirst, feeling of fullness in the head, and extreme irritation of the
skin. The patient did not sleep or lose consciousness, but the pupils were
fixed and contracted to a pin-point. It is stated that the codeine of the
' BritM Medical Journal, Nov. 26. 1808.
OPIUM. 681
shops often contains an appreciable quantity of morphine, and this fact
should be borne in mind when large doses of codeine axe prescribed.
. Intoxication from codeine is treated upon the same principles as that
produced by the ingestion of morphine or opium. A tolerance of opium
may be ultimately established^ and, in those to whom it is constantly given,
the dose must, from time to time, be increased in order to produce the de-
sired results.
Protopine, according to the experiments of Engel/ produces in mam-
mals an action similar to camphor, death following its use by a paralysis of
the respiratory centre. Fubini and Benedicenti have investigated the prop-
erties of lauunixLe, a crystallizable substance which forms- salts with the
acids. It appears to act principally .upon the spinal cord, causing at first
tetanus and afterward paralysis.
Dii^^osis of Opium Poisoning. — Opium poisoning may be mistaken for
cerebral apoplexy or alcoholic intoxication, but attention to a few points of
diagnosis will prevent error. The history may, or may not, assist in de-
ciding the question. In apoplexy there is no contraction of the pupils (ex-
cept in one case, which will be mentioned presently), the eyes are deviated
to one side, the sides of the face may not be synmietrical, and there is also
jHiralysia of one or both limbs. The symptoms come on suddenly, often on
rising in the morning; there is generally no history of taking any poison or
food immediately before the attack; the face is congested or pale, not
swollen and cyanosed as in opium poisoning. In haemorrhage into the pons
Varolii, there is contraction of the pupils, but, as such cases are rare and
generally fatal, the mistake will not be often made; moreover, the attack
is sudden and the entire body is relaxed with involuntary evacuations of the
contents of the bowels or bladder, which does not occur in opium poisoning.
In alcoholic intoxication the patient can usually be roused to answer ques-
tions; the pupils may be contracted, but will dilate when the patient is dis-
turbed, or his beard is pulled; the odor of alcohol may assist in the diag-
nosis. It is possible, however, for the patient to swallow laudanum at the
close of a dinJdng bout, and thus have both forms of intoxication. TTrsBmio
coma might possibly be mistaken for opium poisoning, but in this the pupils
are not contracted, oedema is generally present, and the urine contains albu-
min and casts; in alcoholism it will contain alcohol.
Treatment of Poisoning. — The stomach should be promptly evacuated
with quick-acting emetics, such as zinc sulphate or ipecacuanha, or by
repeatedly using the stomach-pump. Emetics must be given in large doses
because of the stomach^s insensitive condition. A tablespoonful of mustard
or alum in a pint or more of hot water acts as an efficient emetic, or apomor-
phine may be given hypodermically. Tannic acid may be given as a chem-
ical antidote. After the stomach has been washed out, a pint or two of warm
(not boiling-hot) coffee should be injected into the stomach and rectum.
Artificial respiration should be practiced both by Sylvester's method and by
the application of the faradic current, one pole to the cervical region and one
over the ensiform cartilage. No attempt should be made to directly faradize
the phrenic nerve, on account of the danger of paralyzing the heart. The
circulation should be maintained by massage, rubbing the blood up toward
the body from the extremities, and, if the blood is heavily carbonized, vene-
■ Gazette Medicate de Paris, Oct II, 1890.
682
PHARKACEDTICAL THEHAPEUTIC AOEXTS OE DRUGS.
section may be performed with advantage. The surface of the body may be
stimulated by the faradic brush, or by whipping with the fringed ends of
towels or with twigs. The patient should be made to walk about supported
by two assistants, as soon aa he is restored to consciousness, and kept walking
at intervals for six or eight hours, or until the influence of the opium has
entirely passed olF. Nevertheless, this exercise should not be too long con-
tinued on account of its exhausting effect upon the muscular system and
heart. The capital point in the treatment is maintenance of respiration.
If the measures instituted are found to gradually increase the number of
respirations per minute, the coma, in itself considered, need not be feared.
The catheter should be used from time to time in order to encourage excre-
tion by the kidneys. The patient should not be exposed too much to cold,
on account of his lowered temperature and the danger of causing a subse-
quent attack of pulmonary congestion. The physiological antagonists — atro-
pine, caffeine, or strychnine^ — may be used cautiously, but only in physio-
logical doses. Atropine may be injected hypodermically, in doses of 0.0005
to 0.0006 Gm. (or gr. Vi2(»-Vio())i if the respirations become very slow, but the
state of the pupil is no guide to the effect of the antidote. Strychnine can
be administered subcutaneously in from 0.0006 to 0.003 Gm. (or gr. V^oo*
Vao) every hour or two imtil an improvement in the respiration takes place.
Ammonia inhalations ore useful, and when properly used are harmless.
Opium poisoning produces no characteristic lesion. By reason of idiosyn-
crasy alarming results have followed the administration of small medicinal
dosee.
Permanganate of potassium was first recommended, in 1877, by Barker
Smith, aa an antidote to morphine^ experiments having shown that, when
taken after a large dose of either morphine or opium, it may entirely neu-
tralize the effect of those drugs. It is also an efficient antidote to other
vegetable poisons,*
Dr. William Moor, of Xew York, advocated potassium permanganate,
administered in conjunction with dilute sulphuric acid, as a chemical anti-
dote to opium. If given while the poison still remains in the stomach the
permanganate neutralizes the morphine. A quantity of the antidote at least
equal to the amount of morphine swallowed should be administered, well
diluted with water. Cases have been reported in which this mode of treat-
ment proved effectual even after absorption had occurred. Other methods
may be used in conjunction with this treatment. Hayes reports a case of
opium poisoning believed to be saved by hypodermic injection of 0.20 Gm.
(or gr. iij) of potassium permanganate, every hour, until 0.75 Gm. (or gr. xij)
had been given.** It is very doubtful,, however, if any anti'dotal effect can
be obtained by hypodermic injections of potassium permanganate, although
several cases are on record in which recovery was attributed to this cause.
Where the poison is still in the stomach, however, it may be destroyed by
washing out the organ with weak solutions of permanganate.
In desperate cases recourse should always be had to artifical respiration.
■ See poperB, "Strychnine in Poisoning from Narcotica." by Dr. G. A- Gibson, in
Practice, Dec., 1888; "Some of the Uses of \ux Vomica and Strychnine," by Dr
Frank R. Fry, in Weekly Medical Review, Feb. 23, 1889; "Strychnine in Opium Poison-
ing/* by Dr. Qara T. Dercum, in Cnivcraitu Medical Magazine, Jan., 1891.
* London I/incet, Oct. 31, 1890.
•^CTO York Medical Record, May 26, 1805.
OPIUM.
683
b
»
Dr. George E. Fell practices what he terms "forced respiration": a method
which consists in opening the trachea and forcing air into the lungs by means
of a mechanical appliance. He has used this method successfully in eleven
esses, of which five would, in all probability, have proved fatal under any
other treatment. As a result of this procedure he has seen recovery after
1.30 Gm. (or gr. xx) of morphine had been taken.
The action of opium on the heart, even when it has been administered
in large doses, is insignificant. There is, indeed, usually stimulation rather
than depression. In a case of profound opium poisoning reported by John
SLade Ely,* for more than six hours after cessation of spontaneous respira-
tion, and during continuance nf artificial breathing, the heart continued to
beat with good strength. It may be considered as clearly established by this
and other cases, that in acute opium poisoning, death is the result, primarily,
of paralysis of respiration. In a considerable niunber of cases of profound
opium poisoning in which artificial respiration was the only treatment re-
covery has resulted.
Inasmuch aa the morphine excretion occurs principally through the gas-
tric mucosa, lavage of the stomach is a useful method of treatment. As it
has been shown that potassium permanganate possesses a peculiar selective
iftion upon morphine, converting it by oxidation into harmless oxydimor-
phine, the gastric lavage is made more efficient by the addition of a small
proportion of potassium permanganate to the water. As also recommended
by Dr. Ely, the conservation of the patient's strength is of importance.
Artificial respiration is better than flagellations or other methods ordinarily
naed to keep the patient awake.
As a rule, no after-results follow recovery from opium poisoning except
pulmonary congestion, or the effects of the rough manipulations that the
patient may have been subjected to in the efforts made to keep him awake.
However, a case of amaurosis has been reported, and glycosuria also is said
to have occurred in consequence of the intoxication. The smallest dose re-
corded as having proved fatal to an adult is 0.01 Gm. (or gr. V^) of morphine.
When mothers are suckling their babes, any of the preparations of
opium should be given sparingly, if at all, because, being partly ehminated
by the milk, it may narcotize the infant. As previously stated, infants are
easily affected; and when children have coma or convulsions, and the pupils
are contracted, the attendant may suspect that some one has administered an
overdose of opiate to them.
Treatment of Opium Addiction, or Morphinomaiua. — The treatment of
chronic morphine poisoning, or opium-eating, is often more moral than medi-
cal. In such cases the will of the unfortunate victim is so weakened by self-
indnlgence that the acquired taste for the drug cannot ordinarily be resisted,
and he will acquire means for its gratification at any cost, or, if it is not
obtainable, he may destroy himself. The medical attendant, before under-
taking tlie treatment, must thoroughly gain the confidence of the patient;
he should try to establish an understanding, and, if possible, sympathy, with
him. He should make sure that the patient really wishes to escape from the
terrible thraldom of the drug, and will co-operate with his physician. The
patient ahould be put upon his honor, and pledge himself to obey orders
and confine himself to the quantity permitted by his physician and to med-
• YaU Jitdical Journal, October, lft03.
G84
PHABMACEUTICAL THEaAPEUTIO AGENTS OU DRUGS,
icines passing through his hands. The daily amount must first be accurately
determined, and an effort made at once to reduce this one-half, afterward
diminishing day by day, supplementing the treatment by ammonium vale-
rianate, fluid extract of coca, or camellia, with tonics, easily-digested food
frequently given, and some alcohol, in the form of an elixir preferably. It
is advantageous to change the form of the drug; if the patient has been
taking laudanum or other opiate, give morphine instead; if he has been tak-
ing morphine sulphate, change it to the valerianate or some other salt.
A change of scene is often beneficial. Massage is a useful adjunct to the
treatment.
Patients frequently take more of the drug than is necessary to satisfy
(heir cravings ; the first thing, therefore, to be done is to ascertain the mini-
mal amount which is required. The organs by which the drug is excreted
should be put in as perfect working order as possible, giving tea, coffee, and
moderate doses of sparteine to stimulate the functions of the kidney, and
using hydrothcrapentic meiisurea to increase the activity of the skin. Hyos-
cine hydrobromide is a valuable sedative for tlie ner\'ous imrest, but should
be given cautiously (ordinary dosp. by[>odcmiically. 0.0003 Gm. (or gr.
V-nn)* given once a day). Warm hatlis and pilocarpine hydrochloride will
maintain the function of the skin. This gradual method of suppressing the
drug phould only he employed in patient.* who show a marked morphine
cachexia. The abrupt method may be used when a medical man is at hand
to administer a dose of the agent in case of serious collapse, and is suitable
for cases that are not of long standing, or in which the patient is young and
free from cardiac or other visceral lesions. In most castas an intermediate
method, that of Erlennieyer, is advisable — a rnpirl method, but not abrupt,
combining the safety of the gradual nielliod with llie quickness of the other.
The patient must first be put into a condition to sustain the process of
demorphinization, and then each day a half of the daily dose may be cut
off: when the dose has become ver>' small the dnig may he altogether dis-
continued. For severe cases, eight to ten days are usually sulTicient ; for
sliglit cases, six to eight days. The advantage of this plan is that, w^hile
allowing a euPTiciently safe ^^^thdrawal of the morphine, affording a protec-
tion against collapse and sudden death, yet a long time is given for con-
valescence. In whatever way the deprivation is brought about* the patient
may he greatly relieved by counterai-iinj; the excessive acidity of the gastric
contents. This follows on the withdrawal of tlie morphine, which, being
in great part excreted by the gastric mucous membrane, has inhibited the
secretion of the gastric juice. This hyperacidity is not improbably the cause
of the vomiting, diarrhoea, insomnia, lumbar pains, etc. The desired object
may be obtained by causing the patient to drink Vichy or other alkaline
water. If the pulse shonld heoonie irregular and very weak, morphine must
be injected. But good feeding, with coffee and milk, should be sufficient
in most cases to prevent collapse. Cnre must be taken in employing otlier
hypnotics, such as chloral, bromides, sulphonal, and in using alcohol or
heroine, lest another habit should tie substituted for the morphinomania.
To lower blood-tension and favor eliniiuation. artificial serum may be in-
jected suhcutancously. Prognosis should be reserved, and prophylaxis ia
always more hopeful than cure.
OPIUM.
Dr. Paul Sollier^ gives some very instnictiTe views on his method of
treating patients who have for many years been addicted to the use of mor-
phine. When regularly injected in a continued manner, morphine causes^
after a considerable time, a more or less important diminution of the activity
of the nervoofi system, and a very marked slowing of the processes of gland-
ular secretion. When morphine is rapidly withdrawn, there is commonly
a resumption of the glandular functions; but this does not happen imme-
diately in all the organs at the same time, the different phenomena appear-
ing one after the other. Most frequently perspiration and sneezing open the
scene, accompanied with yawning. Then diarrhoja appears — at first ordinary
faeces, then pure bile, afterward loose motions, half-bilious, half-faecal in
character; mucous vomiting (gastric juice), then bile, where there is an}',
appears after the diarrhoea has started and stops before it. Spcrmatorrhcea
appears next, then salivation and muscular cramps. Each glandular ap-
paratus begins operations in its turn, without any determined order in this
sBCccssion of phenomena, which varies with each person and depends on the
different degrees to which the different organs of the body are impregnated
with morphine. The mechanism by which the system rids itself of morphine
appears to be an epithelial and endothelial desquamation of the impregnated
mucous membranes. These processes may be renewed during six or eight
weeks after abrupt withdrawal of the drug, and, when complete, correspond
to a rtsiilutio ad integrum of the affected organs. Assuming that these
premises are correct, it follows that the stronger the reaction of the organ-
ism, the more abundant will be the desquamation at first, and the more rap-
idly will organic regeneration be brought about. Hence the object in treat-
ing a patient witli the morphine habit is to favor as much as possible the
elimination of the altered glandular elements, to provoke the appearance of
each secretion, if slow in appearing, or if it slackens its work when begun
or stops too soon. To meet these indications it suffices to excite glandular
I activity by every known method, while at the same time lessening the quan-
tity of morphine. Purgatives, diuretics, and diaphoretics ought to be used
concurrently. Under the influence of these medicines, and the rapid dimi-
nution of the quantity of morphine, the resumption of glandular activity
begins before complete removal of the drug is enforced. The effort of the
organism at this time is therefore less intense, the emunctories being already
prepared. Hence it results that the heart is not forced to perform excessive
work, and the pain provoked by the reaction of the organism, etrivinsc to
free itself of its altered elements, is reduced as much as possible. Dr. Sollier,
since using this method, has not observed, even in patients with diseased
hearts, any signs of heart-failure or syncope, and still less has he been con-
fronted with the collapse which frightens so many morphine-takcra when
tqring to get cured, and physicians who have not had any experience in such
caaes. When the morphine-taker is thus prepared for weaning, not only is
there no serious accident to dread, but it is useless to give hira any heart-
tonic, such as sparteine or caffeine, for heart-failure need not be appre-
hended. When, on the other hand, weaning from morphine is begun with-
out having taken previous jirecautions to prepare for glandular elimination,
one is exposed to what may be called a false elimination of morphine. Sollier
explains this as follows: Weaning from morphine should not be confounded
*L« Prente y^dicale; Canadian Journal of Mrdieine and Surfftry, Oct, J898.
686
PHABilAOEUTIOAL XHEEAPECTIC AGENTS OB DIlCGST
with elimination of the drug from the system. Weaning may be put in force, .
but elimination may not follow. Should this occur, convalescence does not
take place, or else comes on in a slow, torpid manner, and besides even fatal
results may happen. He is opposed to the use of other hypnotics when treat-
ing a morphine-taker. Adjuvants, such as sparteine and cafTeine, are some-
times used if the heart is weak. Antipyrin and bromide of potassium are
used when there is a tendency to cerebral congestion. lie is totally opposed
to the use of sulphonal, bromidia, chloral, etc., and thinks that sulphonal is
very dangerous. By many observers the hydrobromide of hyoscine has been
foimd to be a very vahiable adjunct to the treatment of these cases. It is a
powerful sedative and hj'pnotic; but it should be given in small doses
(0.0003 Gm. or gr. Vjoo)* once or twice daily, and its effects should be care-
fully observed, as it is liable to cause hallucinations. With this is combined
strychnine sulphate, every two or four hours, and purgatives, such as calo-
mel, podophyllum, and ipecac. This is advocated by H. A. Hare,^ Bering,* of
Tulare, Rosenberg, and a number of others.
There is a fundamental fact to be borne in mind in the treatment of
this class of patients, as pointed out by Kellogg; it is that the majority of
persons who acquire the vice of drug addiction are peculiarly constituted,
and are cither those who live entirely upon the sense-plane, whose highest
aim is to gratify their appetites, and who, when the natural resources begin to
fail, stimulate them with various drugs; or they belong to a class of neu-
rotic, hypersensitive individuals, who are the products of the brain-destroy-
ing and race-deteriorating conditions of modem life. In such cases the drug
treatment should be secondary to hygienic measures, particularly diet, mass-
age, electricity, and hot or cold applications to the occiput and spine. Re-
lapses in such individuals should not discourage the physician or the patient.
Therapy. — Powdered opium may be mixed into a paste with water and
applied to an incipient boil with relief. Laudanum with water is a useful
application to sprains and bruiees; and it may be added to poultices to form
an anodyne fomentation or applied to wounds as an antiseptic and to relieve
pain. Laudanum and sweet-oil should not be used for earache, because in
case of perforation a child might be narcotized in this way, by the drug
passing down the Eustachian tube into the throat. Many anodyne liniments
contain opium, and when these are applied with friction the remedy is partly
absorbed. Such applications assuage the pain of chronic or muscular rheu-
matism, and even, at times, of sciatica. A warm lotion containing opium
affords relief in synovitis and orchitis. Laudanum is usually a serviceable
topical remedy in painful ulcers.
Opium may be combined and used thus locally: —
B Tinct. opii 30| c.cm. or fjj.
Chloroform i,
Tinct. aconiti aa 15
Ol. menth. pip 4
Lin. saponU 60
c.cm. or f5«8.
c.cm. or fSj.
c.cm. or fSij.
M. Sig.: Apply with friction over the Burfocc for neuralgia or rheumatism.
B Tinct. opii, ^
Aquie hnmamolidiR,
Aqufc camphora* aa 60|
M. For an application to acuta gout or rheumatism.
c-cm. or fSij.
* Therapeutic Qatette, June, 1002.
■ CaL State Journal of Med., July, 1005.
OPIUM.
687
B Tinct opii,
AJcoholis diluti,
AquA hnraamelidis
11. Serviceable in BynoTitUj felons, or orchitis.
< 00| com. or f^ij.
B Tinct opii,
FIui<lext. amicse.
Lin. Mponis aa 30{ ccm. or fSj.
M. For enlarged glanda and thickened states of the skin.
H Extract! opii,
Extracti amicae,
Extracii Ix^lladonnffi folior aa 41 Gm.
Ungt. bydrarg}''ri oleatis (10 per cent) Sl| Gm.
M. For arthriUfl.
or 3j.
or 5j.
Q Extracti opii 2
Coc'iiins hydrochloridi
Mentholi .* 1
Ungt zinci oxidi 31
Om. or 3rb,
05 Gm. or gr. x.
Gm. or gr. xv.
Gm. or Sj.
M. Beneficial in anal fissure, rectal eczemai and in haemorrhoids.
The inhalation of steam impregnated with paregoric, or the watery ex-
of opium, is beneficial in acute phar}iigitis and laryngitis. Hinger
*i!e5 the application of morphine, dissolved in honey or glycerin, to re-
Bwe the throat-cough of phthisiB. Thig solution, or an opiated lozenge,
ii not without efficiency, even when the cough is entirely dependent upon
the pulmonary condition. Gargles containing opium are often of benefit in
the diseases named:—
B Tinct opii camphoratee,
Tlnct hcnzoini comp.,
TlBct kino aa 30| ccm. or fSj.
K. Big.: Employ, diluted with water, as a gargle.
R Tinct opii camphomUc,
Aqute menth. pip.,
Glycerini ,
U. Big.: Use aa a gargle, diluted with water.
aa 90\ can. or fjj.
The oleate of morphine, with lanolin and a little chloroform, is a seda-
tire application, or we may dissolve morphine in chloral-camphor and apply
it over the site of pain. In various inflammatory conditions of the skin or
ooDJanctivse, fomentations with the recent decoction of poppy-heads is a
soothing treatment, but is less anodyne and astringent than laudanum and
hot water. Opium, morphine, and codeine may also be introduced into the
rectum in the form of suppositories, in painful conditions of the bowel and
aeighhoring organs, and also, for their general etfects, in producing sleep
ind quieting cough or restlessness. A warm bath and an opium suppository
*Je of material value in relaxing the spasm which often accompanies organic
ftricture of the urethra. These measures will frequently permit the escape
of enough urine to cause considerable temporary relief in retention and, at
tb« same time, facilitate the 'passage of a filiform bougie and catheter. An
opium suppository averts the chill which may follow instrumentation of the
niile urethra, quiets the nervous system after operations upon the female
pdvis, and relieves the pain and tenesmus of cystitis and strangury.
688
PHAAMACEUTIGAL TH£RAP£CT10 AOEKTS OR DRUGS.
Dr. von Klein, of Dayton, advocates the administration, in certain cases,
of morphine by the nostrils. In hay fever, a combination of morphine \ntli
cocaine in powdered gum acacia and sugar is of great value in relieving the
pain and irritation.
In painful affections of the upper air-tract the following has been rec-
ommended:—
3 Acidi tannici 61 Gm. or 3i gr. xr.
^m Morphinsa aulphatis |23 Om. rr gr. iiiss.
^H Pulveris acacice,
^^ Pulveris sacchari fta 3| Gm. or gr. xIt.
M. To be thoroughly triturated (0.40 Gm. ^0.01 morphine).
Sig.: For iusufilatiou, a pinch at a time.
Hypodermic Administration. — Morphine is frequently injected hypo-
dermically in order to produce its physiological and therapeutical effects, and
the rule is to begin with a dose, at the most, only half as large as would be
given by the mouth. Atropine is frequently combined with the morphine
(0.0003 Gm. and 0.01 Gm., or gr. V200 and gr. Vo)» and administered in this
way to enhance its effect in treating neuralgia; they are also used in this com-
bination previous to the use of chloroform, especially when a prolonged
operation is anticipated. In cases of local pain, as first pointed out by Dr.
Alexander Wood, of Edinburgh, who introduced the hypodermic method,
there is an advantage in making the injection close to the spot affected,
although, for a general anodyne or hypnotic effect, the skin on the arm or
dorsum of forearm is generally selected. The rules for hypodermic medica-
tion may be briefly stated as follows: —
1. The instrument must be surgically clean and aseptic.
2. The solution used should be made with recently-boiled distilled
water, or at least with recently-boiled water.
3. The patient should not be allowed to prescribe the injection, but
it should be used only when, in the judgment of the physician, it ia appro-
priate, necessary, and Justifiable.
4. The spot selected should be cleansed, and the needle pushed through
a fold of the skin pinched iip with the fingers of the other hand to that hold-
ing the instrument, being careful, in introducing it, to avoid proximity of
veins. The desired amount being gradually injected into the loose cellular
or muscular tissue, the needle is withdrawn, while with the finger pressure
is made over the slight puncture and the fluid is gently dispersed under the
skin.
It should be remembered that the morphine enters the circulation more
quickly than when absorbed from the alimentary canal, and once injected
cannot be withdrawn. In a strange patient, where idiosyncrasies are un-
known, it would be wise to give not more than 0.006 to 0.008 Gm. (or gr.
^/^o-Va) and watch the effects, repeating and increasing the dose if required.
On account of the extreme susceptibility of youn^ children to opium, the
hypodermic method is considered inadvisable for them; and in elderly per-
sons, or in patients suffering with Bright's disease of the kidneys, it is used
only with extreme caution.
Special Applications. — Opium is used symptomatieally to relieve pain
and irritation, to relax spasm, to produce sleep, to check secretions, and to
influence nutrition. The preparations of opium and its salts are so efficient
and convenient in the treatment of nil forms of pain that the habit of in-
*
>
p
dulgence is readily formed. It is therefore prudent for the physician not to
iofonn the patient of what he is using, or to always give it in combination
with other drugs. In some forms of brain disease, attended by congestion
of the hemispheres, especially in the form accompanying alcoholigm, opium
a inadmissible. Meningitis, however, is benefited by opium, and in the
cerebro-spinal form, in conjunction with ice-applicationa a^d other treat-
ment, the deodorized tincture should be given in doses large enough to keep
the patient from suffering. Professor Flechsig has formulated a method of
tilting epilepsy by an alternate use of opium and potassium bromide.
Small doses of the extract of opium are at first given, but the quantity is
^dually increased for about six weeks, when the patient is placed upon
Uri^e doses of the bromide. This plan of treatment is said to be generally
attended by good results and is thought to be especially applicable to juvenile
patients.
In biliary, renal, or intestinal colic, morphine, given by the mouth
or hypodermically, is the most common means of relief; also in angina pee-
torii, palpitation of the heari, or cardiac dyspnoea. It must not be forgotten
that, as pointed out by M. Huchard, the most important manifestation of
angina pectoris is not the pain, but the syncope with tendency to pulmonary
ittiema.
Small doses of opium — ^0.30 c.cm. (or mv) of the tincture, for instance —
have an excellent stimulant effect in the case of a w^eak or dilated heart. In
paroxysmal cardiac dyspnoea, as contradistinguished from asthma and that
due to pleural effusion, the h}'podermic injection of morphine is followed by
wonderfully good results, as pointed out by Allbut and confirmed by Ringer.
Respiration becomes comparatively free, lividity ditiap{)€ar8, and sleep is ren-
dered possible. At first 0.01 Gm. (or gr. Vo) twice or thrice a week is suffi-
cient; subsequently it may be necessary to gradually increase the dose. This
treatment more particularly applies to mitral than to aortic disease. In the
"iac accidents of rheumatism — such as myocarditis, grave forms of endo-
■ditis, and especially in pericarditis — the opium treatment, according to
Powell/ is of immense value, its object being to cause organic rest, so far as
organic rest can be given to an automatically moving organ, by diminishing
the rapidity of the pulse and quieting the restlessness and agitation of the
patient. When paroxysmal dyspnoea accompanies valvular incompetency
and greatly interferes with the patient's rest at night (the dyspnoea not being
due to pleural or pericardial effusion), much comfort is afforded by a small
hypodermic injection of morpliine. Dr. Alexander McPhedran, of Toronto,
pronounces opium superior to digitalis in these cases, and, in fact, indis-
peosable.
In bronchial and pulmonary affections, irritation of the sensory end-
organs often excites cough, in excess of what is demanded for the expulsion
of the intiammatory products from the air-passages. Moderate doses of mor-
phine or opium, added to an expectorant mixture, restrain the cough of irri-
tative origin, the irritation accompanying bronchitis being relieved by
opium, and cough overcome so as to permit sleep; the secretions are also
checked by it, so that it is a useful remedy especially in the declining stages
of bronchitis, but a dangerous one in the early or congestive stage, where
v«rn a small dose m»y he fatal. Sniall doses of Dover's powder, or of
Oaithrd'a Uedieal Joumal, May, 1900.
cyo
PIC.UIMACEUTICAL TlIKKArKtTIC AGENTS OR DBUUS.
Tull>''s powder (pulv. inorpliime cfi. ), n<lTuiui^tpitd by the inotitli, an.* useful
in controiling the eymptoms of bronchitie, and make the patient more com-
fortable.
In bronchial asthma, opium alone or combined as follows, has a most
decided action in giving relief and in assisting to check the morbid process: —
IJ Tinct. opii,
Tinct. lobcliee an 4
Ammonli iodidi 8
Fluiflevtnioli grindelie 16
Glycerlni q. s. ad 120
c.cm. or f3j.
Gm. or 3ij.
c.cm. or fjss.
c.cm. or f3iv.
M. Sig.:
paroxysm.
A teaflpoonful three or four times a day or at any time during n
4
in pneumonia, opium in very small doses is of advantage in relieving
pain and excessive c-ough ; hore it is best given in the form of Dover's pow-
der or in the following combinaiinn: —
Q Antimonii et potassii tart. «...
Puiv. ipecac et opii
Polasaii nitratis 4
M. Div. in chartuls no. xx.
Sig.: Take one every two hourSj in pneumonia.
OfiS Gm. or gr. j.
60 Gm. or gr. xl.
Gm. or 3j.
i
25 Gm.
or gr. iv.
(Mi5 Gm.
or gr. j.
75 Gm.
or gr. xij
In pneumonia and pleurisy, when the pain is severe, opium maj also
be prescribed as follows: —
I^ Pulveris opii
Hydrarg. chloridi mltla
Pulverit) aromotici
M. et ft. chartulie no. xij.
Sig.: A powder every lialfhour or hour until relieved-
It Pulveris ipecac, et opii,
Camphofffi monobromat aa 2| Gm. or 3s*.
M. et ft. capeulas no. x.
Sig.: A capsule every iialf-hour or hour.
In typhus and typhoid fevers, small-pox, and other acute fevers, at-
tended by poisoned blood and great delirium and restlessness, opium in ap-
propriate doses at night will often be of great service in maintaining the
Btrength of the patient. The above combination of tartar emetic and opium
is extremely efficacious in those cases of typhus and typhoid fever character-
ized by furious delirium, insomnia, and exhaustion. In various other condi-
tions the beneficial effects of opium are apparent. For instance, in rupture
of the uterus, bladder, or intestines, in peritonitis, the only chance of re-
covery consists in keeping the patient fully under the sedative influence of
opium, using the deodorized tincture in preference to any other form. In
the treatment of intestinal hiemorrhage of typhoid fever the value of small
doses of opium in supporting the circulation and promoting healing of the
intestinal ulcers is well established. In after-pains, in threatened abortion,
in some cases of dysmenorrhcea, the judicious use of an opiate will afford im-
munity from suffering.
An hypodermic injection of morphine is of much service in ovaralgia, as
in other forms of neuralgia. Another statement may be made here In regard
to the efiBcacy of this mode of treatment in neuralgia generally, viz.: not only
oriDM.
691
telhe attack temporarily relieved, but not infrequently the disorder is cured,
or, at least, remains in abeyance for a considerable period. Cancer of the
womb, or, indeed, malignant disease wherever seated, demands, almost with-
out exception, the administration of some form of preparation of opium.
Here, and, in fact, as in all essentially painful diseases, the remedy should
be given with judicious boldness. Excessive pain requires full doses; smaller
fail to relieve pain, increase nervous excitement, and are prejudicial rather
than beneficial. In the treatment of cancer, there need be little or no fear
of founding the morphine habit. Opium is useful in acute suppression of
the menses when owed to moral or emotional excitement. Severe and deep
bums are always marked by profound shock and excruciating pain, and in
these conditions the hypodermic use of morphine is invaluable. Herpes
zoster is another malady in which morphine, especially in union with atro-
pine, is of notable service in relieving the violent, lancinating pain.
In cough-mixtures, opium or morphine is a standard ingredient, but
co<leiiie, or heroine, has advantage's when the cough is violent : —
I
»
»
B C<xU'inic phosphatirf
Tinct. belladonns folior 4
Syr. pruni Virgiuianic q. 8. ad 90
20 Gm.
c.cm.
c.cm.
or fiT- "J.
or iZj.
or fjiij.
H. Big.: Take a teaspoonful, when cough U annoying, four or five times daily.
In phthisis, the above formula will be useful in checking the cough at
night and reducing tendency to night-sweats.
Codeine may be serviceably employed in acute and chronic bronchitis,
whooping-cough, inflammatory conditions of the bowel or peritoneum, and
in inflammation of the urinary passages. Its hypnotic and anodyne powers
tie decidedly less than those of morphine. It has been used with advantage
is diabetes.
Opium is very serviceable in treating diabetes mellitus, and is preferable
to codeine. Opium is, perhaps, the most efficient drug which we possess in
the treatment of this disorder. It diminishes hunger and thirst, the quan-
tity of urine excreted, and the amount of sugar eliminated. The progress of
the disease is checked and the condition of the patient ameliorated. Large
do§€8 are required and well-borne in diabetes mellitus. The proper plan ia
to begin with moderate doses, and r&pidly, but watchfully, increase accord-
ing to the ctTect of the remedy upon the glycosuria, or until symptoms of
narcotism make their appearance. Opium is also of service in diabetes in-
sipidus, though less active than in saccharine diabetes.
In treating chronic ulcer, the administration of small amounts of opium
several times daily will bring about a healthy condition and encourage heal-
ing. Given in larger quantities, 0.065 to 0.13 Gm. (or gr, i-ij) every three or
four hours, opium is of equal value in the treatment of phagedoena, alleviat-
ing pain and checking the tendency to spread. This drug is beneficial in
ulcerative stomatitis. Where there are excessive secretions opium will re-
duce them, as in bronchorrha?a, diarrhoea, dysentery, etc. In the diarrhoea
of typhoid fever, opium may be judiciously and usefully employed, and it
it often successful in controlling tuberculous diarrhoea. In various formulae
for cholera, opium holds a prominent place. In infants suffering with sum-
mer complaint, enterocolitis, or cholera iiffantum, all forms of narcotics are
so dangerous as to be almost prohibited. The object of treatment is evacua-
tion and disinfection of the intestinal tube, with administration of sterilized
I
692
PUABMACEUTICAL THERAPECTIC AGENTS OU Dlll'MS
food; where this has been done, opium will generally not be required. In
urgent case^, st^ircli-water cncmata may l>e given, containing a drop or two of
laudanum with 0.32 Gra. (or gr. v) of chloral-hydrate, in order to afford re-
lief from restlessness and pain.
In the diseases previously referred to, gpium is often so necessary ia
the treatment that we may append a few prescriptions containing this verjfi
important drug: —
Q Pulveiis opii |03 Gm. or gr. aa.
Pepsi III,
Bismuth, lubnit aa 31 Gm. or 3sb.
01. einnnmomi |0C ccm. or mj.
M. et ft. chartulte no. x.
Sig.: A powder every two or three houra for diarrhcca in children.
H Exlracti opii
Pulv. tpccaeunnhce 1
Hydrar^ri chloridi mitU
M. et ft. pil. no. xvj.
Sig.: A pill every hour or two for diarrhoea or dyaentery In adults.
50 Gm. or gr. viij.
00 Gm. or gr. xxiv.
06 Gm. or gr. j.
3 Tinct. opii ca^phoratae,
Tinct. cardamom, comp.,
Tinct. lavandulffi co aa 301 c.cm. or fjj.
Aquffi month, pip i>0| c.cm. or fjiij.
M. Sig.: One tableEpoonful every two or three houra for cramps and diarrhoea^
3 Tinct. opii camphorat«e 15
Syrup, rnei aromatic 7
Tinct. cardamom, comp 30
Aqu% anisi q. a. ad 150
ccm. or fjaa.
ccm. or f3ij.
c.cm. or fSj.
c.cm. or fjV.
KI. Sig.: From one to two teaapoonfuU every two or three hours for diarrhcea.
of children.
B Tinct. opii,
Spiritus menth. pip.,
Spiritus camphorse,
Tinct capaici aa 4{ c.cm. or fSj.
M. Sig.: Ten to forty dropa every hour or two for diarrh<Ba with crampa.
U Tinct. opii,
Spiritua chloroforml,
Tinct capaici,
Syrup, zingiberia oa 4| c.cm. or f3j.
M. Sig.: Twenty to forty dropa every half-hour or hour (or crampa attended"^
with diarrhoea.
B Tinct. opii camphoratA,
Mist, cretee,
Tinct. kino aa 60| c.cm. or fjij.
M. Sig.: From a half a teaspoonful to a tableapoonful every hour or two for
diarrhoea.
Nausea and nervous vomiting are generally alleviated by the adminis-
tration of opium, This remedy is useful in seasickness and the vomiting of
pregnancy, in each of which it i^ apt to be more efficient if given subcu-
taneously. The same method is of value in obstinate hiccough. The pains
of gastralipna, ulcer, and gastric carcinoma are amenable to the influence of
winch is, fuTthermore, useful in ulcer in restraining haemorrhage.
OPIUM.
I
>
There is a form of dyspepsia in which ppium is of signal service. This is of
an irritative character, occurs in thin people of an irritable, anxious tempera-
ment, and is indicated by a dry tongue, red at the tip and edges. Lead colic
is lessened by opium. In acute obstruction of the bowels, due to spasm, 0.03
Gm. (or gr. ss) of opium ever)' four hours, for two or three days, will often
reheve stereoraceous vomiting and permit normal evacuations. Even in
fecal impaction, good results have ensued from the daily injection of 0.03 to
0.OC5 Gm. (or gr. ss-j) of morphine in divided doses. This treatment is espe-
cially adapted to instances in which the gut has been injured by congestion
or inflammation.' In chronic constipation, opium alone or combined with
ipecacuanha often relieves the irritable bowel and assists in restoring tone
and a healthy action to the mucous membrane. In gastritis, especially the
tcute variety produced by alcoholisraj opium relieves pain and vomiting.
The nervous manifestations of exophthalmic goitre sometimes receive benefit
from opium.
The antispasmodic influence of this drug has been utilized in various
convulsive affections. It is of undoubted service in severe cases of chorea
in which twitchings abolish sleep, and it was given by Trousseau in large
do8€8 with good effect. The petit mal and nocturnal epilepsy are benefited
by opium. Scanzoni and Loomis have amply demonstrated the safety and
the value of hypodermic injections of morphine in ursemic coma. Dr. Jamea
T}-Kin' reminds us that Dr. Alfred LoomiSj who first advocated the hypo-
dermic injection of morphine for unemic convulsions, restricted its use to
acute cases of Bright's disease, and held that it is inadmissible in chronic
nephritis. In fact, the greater tlie dostmction of the secreting portion of the
kidney and the more chronic the process, the greater is the danger from
opium. He has seen fatal coma produced in such a case by the adiftinistration
of 7.5 can. (or foij) of paregoric. Although inefTicieacy of the climinative
OTgans ordinarily furnishes a contra-indication to the use of this remedy, yet
in acute urjemie convulsions the morphine promotes the airtion of the skin and
swms to exert a protective influence upon the nerve-centres. In tetanus,
the deep injection of morphine into the affected muscles seems to be of some
•cnice. A hypodermic injection of morphine will frequently break up a
■pasm of asthma. Opium is of advantage in emphysema, hay fever, and the
•ptsmodic stage of whooping-cough. Sixty-five eg. (or gr. x) of Dover's
powder alone, or, preferably, combined with an equal quantity of quinine
wlphatc, will often abort a cold if given in its incipient stage. Morphine
is a reliable stimulant in surgical shock and heat exhaustion; in both cases
it should bo administered with great care. In acute and chronic mania, and
in melancholia, opium is capable, in selected cases, of affording decided bene-
fit, especially in melancholia. Its administration in cases of alienation needs,
hofferer, to be directed with enlightened judgment. Dover's powder is often
rocccwfnl in checking the night-sweats of phthisis. The hypodermic injec-
tion of a small dose of morphine with atropine is of avail in hiemoptysis or
nt/rrint* hri'tnnrrhage. It also i.« effective in relieving cough and restlessness
•t nipht, in chronic pneuinnnin.
Apomorpbinft Hydrochloridum (F. S. P., B. P.). — Apomorphine Hy-
drochloridf, (See pnge '324.)
■PhiUipt. op. cit., p. 103.
"Tlie r*o of Iron and Opium in Bright's
ytiiml A»»o<riation, July 23, 1898.
DiswiAe," Journal of 0\e .Imrriean
694 PHAHlfACECTlCAL THERAPEUTIC AGENTS OR DRUGS. ^^B
Apocodeine. — ApocoJeine is an amorphoue, brown powder, of an allce-
line reaction, and soluble in ether, alcohol, and chlorofonn.
The properties of apocodeine are similar to, but weaker than, those of
apomorphine.
The physiological action of apocodeine has been lately studied by L.
Guinard. According to this writer, apocodeine has an hypnotic effect with-
out causing nausea and voraiting. It increases reflex action, and, in large
doses, occasions convulsions and tetanic spasms. In the opinion of Guinard,
apocodeine is not an emetic, and when it gives rise to nausea it is probably
contaminated with apomorphine. During the soporific action of this alka-
loid the bodily temperature is reduced, Apocodeine always excites hyper-
secretion of 8ali\a, bile, pancreatic and intestinal juices, and increases intes-
tinal peristalsis. The pupil is but slightly influenced during the sleep in-
duced by apocodeine, but during the convulsive period it is widely dilated.
Dujardin-Beaumetz stated that apocodeine was found useful in haem-
optysis, croup, and whooping-cough, and recommends it in doses of 0.015
Gm. (or gT. V4) hypodermically, and 0.04 Cm. (or gr. ^/a) by the mouth.
Dr. Murrell has demonstniti'd thiit npocodeine hydrochloride is beneficial in
chronic bronchitis by virtue of its expectorant properties. He administered
it by hypodermic injcctionj which, provided the solution be neutral, pro-
duces no local irritation.
Flagg states that when opium, or any of its ordinary preparations, fails
to produce a good effect, a solution of morphine bimeconate often acts well.
This preparation, he adds, is an anodyne of decided efficacy where ordinary
preparations of opium are not desirable or are contra-indicated. The dose
IB from 0.30 to 1.50 c.cm. (or mv-xxvj), as required.
Dr. Finney speaks favorably of the action of morphine hydrobromide.
It generally, though not invariably, produces quiet sleep and relieves pain
without being followed by the unpleasant effects which are sometimes caused
by other morphine preparations.
The other alkaloids and constituents of opium are of great interest, but
rarely used in medicine.
OREXINE AND OKEXINE TANITATE.— Tannate of orexine has been
introduced as a substitute for the basic orexine {phenyl-dihydro-quinazo-
lin*') and tiio hydiMohloride of orevino, nvor uliioh it has the advantage of
being an odorless and tasteless white powder (resembling chalk)^ is well
borne by the digestive organs, and free from unpleasant effects. Orexine
was introduced by Penzoldt in ISflO, and the tannate by Steiner. It is a
stomachic tonic, and in cases of deficient secretion of acid is an efficient
appetite-promoter. It should not be given where there is an excess of se-
cretion, hyperacidity, in ncuie inflammation of the ptomach, or in gas-
tric ulcer. Tablets ("orexoids," Merck), each containing 0.25 Gm. (or gr.
iv), may be used or the powder given in capsule or simply dropped upon the
tongue. From 0.50 to 0.75 Gm. (or gr. viii-xij) may be given an hour before
the principal meals (dinner and supper), the dose being washed down with a
large drink of water. It has been found beneficial in improving nutrition
in ansemia, chlorosis, tuberculosis, neurasthenia, and debility after acute
disease. Dr. Gennaro Scognamiglio* found by physiological tests that
orexine accelerated the digestive process in the stomach by stimulating the
* Wiener mcdicinische BlUtter, 1897.
OUTllOFORM.
695
»
*
I
peptogenic function, both in henlthy subjects and in dyspeptics, with a corre-
sponding increase in the power of gastric absorption and gastric movement.
Suiner recommeudt: it for diildren in place of ordinary bitter tonics for
anorexia. Orexine tannate is a -valuable anti-tmetic and gastric sedative in
pregnancy, according to Kohl. In liyperoniesis gravidarum, Scognamiglio
gave 0.32 Gm. (or gr. v) three or four times daily as a last resort, but with
complete success.
ORIGANTTM. — Origanum, Wild Marjoram. Origanum vulgare (Labi-
iUa) is a perciininl iu*rl> of luirnpi- nnd the United States, witli pale-purple
flowers. It contains volatile oil (I to 2 per cent,), with tannin, resin, and
wme bitter principle. It enters into aromatic wine. The oil is an aromatic
stimulant, carminative, and counter-irritant.
Therapy. — Rarely used internally or externally, though formerly em-
ployed 83 a diaphoretic, emmcnagogue, and stimulant tonic, or as a fomenta-
tion for bruises and sprains. It is also known as European Mountain Mint.
ORFHOL, Betanjiphthol Bismuth, contains 71.6 parts of bismuth oxide
ami '2'.\ of bet )na]>hthol in loose combination, the compound F[ilitting up in
the intestine into these two oomponents. It is a liglit-hrown powder* ncu-
tnil. almost tasteless and otlork'ss, non-toxic, ajul uon-nritating. Dose to
«<lult* up to 3 Gm. (or gr. :<\v) daily, or 0.(J to l,i> Gm. (or gr. x-xv) at a
'W. r^'ful in diarrlueii, ptomain poisoning, typhoid fever, and cholera
iufantum.
ORTHOFORM, or meta-amido-para-oxybGnzoic-methyl ester, is a nearly
tvlork's?, odorless, and tastele^ powder, slightly soluble in water and freely
so in alcohol. Its chloride is more soluble, hut is irritating. Orthoform
appears to have no physiological action even when swallowed in 4 Gm. (or
5j) dosffi. It has decided analgesic and antiseptic powers. Dr. Kallcnborger
found it not hygroscopic and quite harmless to the animal organism, as in-
jectinnj? of from 4 to 6 Gm. (or ."i-iss) given to animals did not produce any
toxic symptoms, and external applications of fiO Gm, (or 5xv) in a week
W no ill effect on the human subject. Orthoform has the poM'er of dimin-
ishing the discharge from wounds. It may be applied in the form of oint-
toCTil, rsptvially to bums. Dr. Kallenberger^ mentions that applied after
4e extraction of teeth it is a good local analgesic It is also valuable in
ctnoer of the larynx and other painful affoctions of the throat. It should
Dot be combined with formaldehyde, silver nitrate, or potassium perman-
^iwte solutions; or in powder with antipyrin or bii^uuilb subnitrate. It
ly 1k! added to phenol, calomel, iodoform, corrosive sublimate, salicylic
etc.
Orthoform has been used successfully by Dr. W. P. Nicolson,* of At-
Unta, Ga., for the purpose of making an arsenical paste painless when applied
U in escharotic in removing various kinds of growths. He reports the esse
of a man, f»0 years of age, who came to him for relief from a growth on the
rijjht side of the head, about the size of a hen's egg, projecting outward.
The growth was removed, and, after controlling the severe bleeding by
pressure applied a short time, the raw surface was freely sprinkled with
ponrderetl orthoform. Then, with a powder made of equal parts of arsenic
• BrrJinrr kllnhrhr Worhettftchi-ift.
* Atlanta JoumalRt^vord, I, p. 738.
61)0
rUARMACEOTICAL THERAPEUTIC AOENTS OH DUt OS.
trioxide and powtlorcd gum ncncia, orthnform was made into a paste and
applied to the cut surface and the patient pven a few tablets of morphine
to take when the pain liecame severe. The next day found the tai)lets un-
used, the patient having had no pain since the paste was applied. The
result was perfect, the growth being entirely destroyed.
OSMII PZKOXIDXTM.—Oamiuni Peroxide. Osmic acid is the tetroxide
of osmium. It forms colorless, acicular crystals, which sublime even at
ordinary temperatures, and are easily fusible to a colorless liquid, with irri-
tating vapor reseinbliiig chlorine, and capable of setting up inflammation
of the eyes or of the air-passages.
Physiological Action. — In animals, osmic acid is actively poisonous in
doses of only a few grains. A 1-per-cent. solution in water, or water and
glycerin, is injected subcutaneously in man in the treatment of painful
tumors and superficial neuralgia. No reaction, as the rule, follows these
punctures, but sanguineous cysts and boils have been reported. A painful
eruption upon the skin sometimes results from the application.
Therapy. — In some cases of neuralgia, the injection of a few drops of
the centesimal solution deeply into the neighJ)orhood of the nerve affected
affords prom]>t relief to pain. The following i? tlie tecjinique of the opera-
tion, as given by Bonnott and carried out by Murphy.' The nerve i> ex-
posed through a small incision about n half-inch in length. Tiie nerve is
elevated i\y means of a bhint hook, nml from five to ten tniiiiins of a fresh
1.5-per-cent. solution of acinic acid injected directly into its substance. An
ordinary hypodermic syringe and line netnlle arc used, and the solution in-
jected in several different places, to be sure that ever}- fiber is readied. After
tliis is accomplished a small amount of the solution is injected between the
nerve and its sheath in the bony cannl. During the procedure a small pled-
get of cotton is lield around the needle to iibsarb the excess of solution which
regurgitates and to protect the skin. The local action of the osmic acid on
the terminal nerve filaments exposed in the wound is proba])ly beneficial, so a
small nmnunt of it should be allowed to come in contact with them. After
the injection is completed the incision is closed with horsehair or catgut
suture; primary union follows, and healing is not interfered with by the
action of the acid on the tissues. It has altio beon applied to the skin in
treatment of chronic indurated acne and some tubercular syphilides. Ad-
ministered intemnlly in* epilepsy, in doses of 0.01 Gm, (or gr. V/^) daily in
pill form, it failed to have any beneficial effect in the hands of Dr.
Schroeder.^
Dr. S. H. Auerbach reports a good result in a case of goitre from
parenchymatous injection of 1.20 com. (or nnx) of a solution of osmic acid
in the strength of 0,0^5 Gni, (or gr. j) to 7.50 c.cm. (or f3ij) of water. The
injection was practiced once a day or once in two days for three weeks.
Local massage and the internal administration of potassium iodide were
conjoined.
OXYCAMPHORA. — Oxycamphor. Oxycamphor is a white crA-stalline
powder, soluble in two parts of cold, but freely in hot water and in alcohol.
The solution has a peppery, bitter taste. It is usually sent out dissolved in
^Journal of Am. Ucd. Assn., AugURt 22» 1003.
'Inaugural Thesis, University of Kid,
PANCRI-lATIN'l'M.
697
k
I
•Icobol, under tnenanie of Oxyplior, containing 50 per cent, of the drug.
The dost* of this solution is 3 ioH Gm. (or oss-ijj, (1 to 4 Gra., or gi*. xv-lx,
of oxycamiihor). It is not a stinnilnnt to the cerebrum, like camphor: hut
is a fiepa's^sant to Uie respiratory centre. It has been found useful in
asthma, dyspnoea, and whoop in g-cougli.
OXYMEL (B. P.).— Oxymel. (See page 543.)
PAMBOTANO. — Pambotano-bark. Pambotano, or Calliandra Houstoni
(Leguminosa:), is n Mexican shrub wlueh grows to the htn^jht of three or five
feet. Its active principle is unknown. Dose (given in four portions during
tiieijay), 77. r» Gni. (or ,viss) to iin ndnlt. and 31 (Uu. (or 5j) to a child.
Therapy. — Pninbotano has been given in recent decoction as a hot
drink; nr in the form of nn alcoholic elixir in malarial fevers, as a substi-
tnte for quinine, in cases uninfluenced by the latter drug. Successful re-
sults vcre obtained in many cases by Valudo, Bandera, Betances, Pellatan,
and other observers, in Mexico, Central Americaj and Kome. A series of
eight cases was treated by Dr. A. E. Roussel, of Philadelphia, by means of
paml>otano, with results which were decidedly encouraging, though not so
brilliant as some of those re]iorted from foreign sources. In two cases no
improvement seemed to be produced, the failure being possibly due to rejec-
tion of the remedy by the stomach. Gastro-intestinnl irritation is frequently
caused by pamlxitano.
Bambotano is reported to be also beneficial in diarrhoea, dysentery, leu-
corrhoea, and in certain diseases of the eye, as opacities of the cornea.
PANCEEATIinjM (U. S. P.).— Pancreatin.
Dose, 0.065 to 0.32 Gm. (or gr. i-v).
Preparation.
iJqvor Pftncreatis (B. P.)- — Pancreatic Solution. Dose. 4 to 16 c.cm. (or fSMv).
Pliarmacolog^ and Physiological Action. — Pancreatin is '^a mixture of
th* enzymeg naturnlly existing in the pancreas of warm-blooded animals,
u*uully obtained froin the frosh junicreas of the liog (Sue scrofa), or the
01. and consisting ])rineipally of amylopsin, the stjircli-converting enzyme;
myopain and trypsin, the enzymes that digest albuminoids; and stcapsin,
the Isozyme Ihat digests fai, and capable of converting not less than 25 times
its own weight of starch into water-soluble substances, principally sugar,
when tested by official process" (F. S. P.). It is presented in the form of
• fine, white powder, and is a digestive fennent resembling |)epsin in origin,
mode of preparation, physical characters, and therapeutic uses. The product
Jnay l>e obtained in the form of a powder; but a l>etter preparation is the
British Pharniaro|Heia official pancreatic solution, made directly from the
p.'Uicrt^ns in dilated aleoliol CJO jK>r cent.), I part pancreas is minced or di-
vided thoroughly by trituration with washed sand or powdered pumice stone
and digested in 4 parts diUited alcohol.
Pancreatin is an efficient digestive agent in an alkaline medium, thus
differing from pepsin. It will peptonize milk, gruel, oysters, and many arti-
cIcKof food, thus rendering them raore easilv digested and more nourishing
tor (he invalid. Aa it emulsifies fat, it will aid in the assimilation of codliver-
PHARitACEDTlCAL TOEIUFEUTIC AG£MS OU UKl7
1693
oil and prevent its coming up in the throat. Trypsin will -digest, and render
soluble, mucous and fibrous deposits.
Therapy. — In diphtheria, a spray of trypsin, or of pancreatin solution,
will dissolve the false membrane and favor its expulsion. A solution recom-
mended for this purpose contains 2 Gm. (or 3es) each of trypsin and sodium
bicarbonate, with 4 com. (or f3j) of glycerin to 30 c.cm. (or fgj) of water.
Dr. Samuel Johnson recommends the addition to this solution of corrosive
sublimate, 0.015 Gm. (or gr. Vi) to 30 c.cm. (or f5j). In haemorrhage
into the bladder, with the formation of clots, the deposit may be dissolved
in the same manner as by the use of pepsin. If pancreatin be administered
two hours after meals, it will assist intestinal digestion. It should be pre-
ceded by full doses of sodium bicarbonate, to insure an alkaline condition of
the gastric contents. The pancreatin may be prescribed as follows: —
B Puiveris pancreatini 4i Gm. or 3j.
HydrargjTi chloridi mitis , . . . jl3 Gm. or gr.
M. et ft. chartulee no. xij.
Big.: A powder two hours after meals.
>J-
R Liquor panercatid ( B. P. ) 90
Tinct. nucifl vomiciB 0
Glycerini 60
M. Sig.: A tablespoonful after meals.
c.cm. or fjiij.
20 com. or we.
ccm. or f5ij.
Pancreatin, or food peptonized by its action, is available in cases of
enfeebled digestion due to severe and prolonged illness and in wasting dis-
ease. Pancreatin is of particular value, as suggested by Boas, in cases
marked by great diminution of the gastric secretion. It is of service in some
forms of enterocolitis, in constipation, and in diarrhcea with light-colored
stools. It is frequently useful, moreover, in the vomiting of hysteria or
pregnancy. This substance deserves trial in those cases of diabetes asso-
ciated with disease of the pancreas. Pancreatin is particularly adapted for
use in those diseases or conditions in wliich starch and fat are imperfectly
digested. It is of service also, added to nutrient enemata, in cases where
the stomach cannot retain or digest food. It may be used in the same man-
ner in stricture of the oesophagus. Its alkaline reaction favors its etficiency.
In the treatment of cancer, trypsin has been injected into the surrounding
tissiies, with good results, by Shaw ilaokenzie, of I-ondon, and others. Tliis
trratment may be supplemented by internal adniinistrotion of pancreatin
and oxgall. Trypsalin is a sijccially devised product for use as a surgical
solvent.
PAPAYA. — The Carica papaya (Passifloraceie), or papaw, is a native of
tropical America. The tree grows without branches to the height of twenty
or twenty-five feet, and is crowned by long, large^ palmate leaves. It boars 1
a large melon-shaped fruit, of a yellow color when ripe and containing manyj
seeds. In the trunk, leaves, and fruit is found an abundance of milky juice/
from whif'h Wurtz, of Paris, isolated a peculiar fernrent. Papain. The atteni
tion of the profession was called tn this new digestive agent, which convortJ
albuminoids into pcptonop, starch into maltose, and emulsifies fat.*?, I)y D|
Finklor, of Bonn. Paprtin is soluble in water, tlioii^rh not in alcohol, btj
is active in either an acid or alkaline solution, and i? more energetic thq
pepsin in dissolving false nunnbranes. An aqueous solution of papain so
PAPAYA.
69^
^
^oil57l)ut disstilved in glvrorin it will kcop for an indefinite period. It is
best given, )iowcvi*r, in powder or ma<le into tablets.
M. Greshoff has extracted from papaw-leaves an alkaloid which he
terms Carpaine. It forms large colorless crystals, readily soluble in chloro-
form and absolute alcohol, but much less soluble in ether, and insoluble in
water. The hydrochlorate of this base is readily soluble in water, acts espe-
cially upon the heart, the movements of which it retards, and proved fatal
to A fowl in the dose of 0.20 Gm. (or gr. iij). Carpaine is crystal! izable and
Tery bitter. Von Oefele states that it docs not cause irritation or suppura-
tion when hypodermically injected. It has been used as a substitute for
digitalis in doses from U.OOG to 0.01 Gm. (or gr. Vio-Ve) ^^^'^y ^^r injections,
or as high as 0.02 Gm. (or gr. Va) by the mouth.
Marcano, of Bolivia, has found that a similar ferment, Bromelin, exists
in pine-apple and other plants of the natural order BromeliaccjB, and has
applied it to the peptonizing of meat on a large scale, making a preparation
of powdered beef, which is very easily digested, and the proteid matter of
which consists of 50 per cent, of peptones. It is known as the Mosquera-
Julia beef-meal. The juice of the fig and many other plants possess slight
digestive powers, as beautifully shown in the well-known Diona?a, or Venus's
fly-trap, and other members of the Brosera family, which Darwin found to
iecrete an acid juice which would digest small pieces of meat.
Therapy. — Papain has been used to dissolve the false membranes in
diphtheria and croup, by the spray, and by a camel's-hair brush dipped in
aqueous solution (2 or 4 Gm. to 30 c.cm., or gr. xxx to Si-f^j)- Though it
accomplishes this useful purpose, it has no power to prevent fresh formation
of the membrane, unless associated with a strong antiseptic agent like corro-
sire sublimate, sulphurous acid, toluol, or nK-nthol. An alkaline solution of
papnin has Iwen found beneficial in fissures and ulcers of the tongue. A
pftint containing 3.24 Gm. (or gr. 1) of pap.iin and 1.G2 Gm. (or gr. xxv)
of borax to the ounce of water has been usee! with success in the treatment
of warts and eczema squamosum chronica. Papain is claimed to have the
power to dissolve intestinal worms. It has also been injected into the in-
terior of tumors to promote absorption.
The late Dr. E. A. Wood, of Pittsburgh, employed papain, dissolved in
glycerin, as a spray in oztena, tuberculous ulcers of the larynx, and the cavi-
tiwof pulmonary tubercidosis. He reporii.'d lliat in eight months of trial he
liad been "more and more convinced of its efficiency in the lesions named."
In the various forms of dyspepsia, papain has been employed with good
effect. Grineritshi recommends papain* in habitual indigestion attended
with acid eructations, painful symptoms of gastric fermentation, and con-
stipation. He uses 0.13 Gm. (or gr. ij) of this drug in sugar of milk an hour
or two after taking food. The following combination is suggested: —
B Pap*5iii 2 Gm. or 3«a.
Liquor arotnonu AcetatU 60 c.cm. or f3ij.
Creototi 3 c.cm. or mv.
Glyc^rini 60 c.cm. or fjij.
H Big.: Two tcaspoonfuU tn hour or two after taking food.
It has been recommended, combined with bicarbonate of soda, in gas-
^Ay nauaeay gastric and gastro-inteatinal catarrh, diarrhoea due to in-
^BvUetin QHi&at9 de ThH-nprutinue.
700
PHAR^tACECTlCVL TUEUAPErXlC AOEXTS OH DRUGS.
digestion, etc. Sittmann has known papain to give rapid relief in acute
gastritis. He witnessed improvement, likewise, in a cnronic case of in-
digestion where an ulcer had undoubtedly existed at some period. In car-
cinoma of the pylorus this remedy gave marked relief. In dilatation of the
stomach the use of papain is productive of decided benefit. In some cases
the improvement has been so great that washing out the organ became un-
necessary. In one case it was observed that the stomach diminished in size.
PARAFFINTJM (U. S. P.). PARAFFINUM DURUM (B. P.).— Hard
Paraffin. ( See also page 707.)
A mixture of several of the harder members of the paraffin series of
hydrocarbons; usually obtained by distillation from shale, separation of the
liquid oils by refrigeration, and purification of the solid product. Insoluble
in water, slightly soluble in absolute alcohol, almost entirely soluble in ether.
It melts at 130° to 135° F. It is used as a base for ointments, for which it
is well adapted, owing to the fact that it does not become rancid like ordi-
nary fats.
Gorsunv, of Vienna, in 1899^ suggested the use of paraffin for prosthesis,
or the correction of some defect by the subcutaneous injection of paraffin-
A white petrolatum with a melting point of 40° C. (or 104° F.), is easily
introduced through an appropriato syringe. It has been especially useful in
restoring the shape of a saddle-back nose, as in cases reported by John W,
Murphy (CincinruxU Lancet Clinic, JIarch 14. 1903). The paraffin should
be recently sterilized by boiling, and a syringe used that has a thread on
the piston bar. Care must be t^ken not to inject while too hot, nor into a
vein. A special sjTinge has been devised by Heath, of St Paul, Minn., for
this purpose.
d
PARAIDEHYDUM (U. S. P., B. P.).— Paraldehyde (CeH,„0,).
DoM, 1,20 to 7.5 c.cm. (or mxx-fSij).
Pharmacology. — Paraldehyde, chemically, is "a polymer of acetalde-
hyde/* ordinarily produced by Ihe action of a small quantity of sulphuric
acid, or of zinc chloride, on ethyl aldehyde, or by conducting gaseous hydro-
chloric acid into ahlehyde at ordinary temperatures. It is a colorless,
mobile liquid, dissolving in 8 volumes of cold water, is less soluble in hot
water, but dissolves freely in alcohol and ether; crystallizes below 32°, lique-
fies again at 51°, and boils at about 225° F. ; has a burning, unpleasant taste
and a penetrating, cthcr-like odor. It may be given with syrup and a
vegetable bitter, or with aromatic water.
Phyaiological Action. — An hypnotic agent, exercising no depressing
effect upon the heart in ordinary doses and causing no headache or disturb-
ance of digestion. Paraldehyde is a good substitute for chloral, especially
in low fevers or where the heart is weak. It is also diuretic, but not dia-
phoretic. The mhd constituents of the urine, it is said, are not increased,
though in the case of three bo>'^ to whom paraldehyde was experimentally
administered, Gordon found a marked increase of urea.- According to the
writer just quoted, paraldehyde facilitates the digestion of fibrin. This sub-
stance is possessed of antiseptic properties. Death, preceded by unconscious-
ness and coma, has been caused by a dose of 22 to 26 c.cm. (or f3vi-vj) in a
PAUALDEHYDUM.
701
»
patient suffering with typhoid fever.^ A case has been reported in which
lOOc.cm. (or fgiiifSiij) caused unconsciousness and profound muscular relax-
ation. The patient remained unconscious for thirty-four hours, but recov-
ered by the aid of strychnine hypodermically, electricity, and stimulation.
Dr. Frederic Peterson, of New York, mentions a case of paraldehyde habit
in which a woman had taken doses of 30 c.cm. (or f5j) nightly, for months,
vitfaout any harmful result. On the contrary, bad elfects have been seen in
consequence of an 7.5-c.cm. (or fSij) dose taken for the first time. It is
judicious to begin with small amounts. The fatal result from a to.xic dose
is attributed to its action upon the respiratory centre. Its principal influ-
ence is upon the cerebrum. In some cases it has been accused of producing
ilbuminuria, but this might be explained by the presence of cirrhotic kid-
neys, with transitory attacks of albuminuria. Paraldehyde is very rapidly
alteorbed, and is eliminated by the lungs, its odor having been recognized
in the breath twenty-four hours after administration. Paraldehyde is also
eliminated by the kidneys and communicates its characteristic odor to the
orine
Paraldehyde is a physiological antidote to strychnine.
Therapy. — Bright's disease does not prohibit the use of paraldehyde.
In such cases, where insomnia is persistent, the dose should be 2 to 2.50 c.cm.
(or mxxx-xl) to commence with, given at the bed-hour, and cautiously in-
creased to 4 c.cm. (or f3j) if necessary. In the irritability, restlessness, and
insomnia attending heart disease, 1.20 c.cm. (or mxx) may lya given every
four hours, with larger doses at night, with marked benefit. In bronchitis,
pneumonia, and headache, paraldehyde is generally less useful than chloral
nydrate and bromide, but in phthisis with persistent insomnia, in 2.50-c.cm.
(or mxl) doses at bed-time, it produces a natural sleep lasting twelve hours.
Some patients, however, complain of headache next day and persistent
drowsiness, so that it soon has to be discontinued. Paraldehyde is, perhaps,
particularly applicable to wakefulness associated with psychical disturbances.
Verr favorable accounts have been given by various observers of its bene-
ficial influence in the cerebral manifestations of hysteria, in mania, melan-
cholia, and the general paralysis of the insane. Paraldehyde is the preferred
h\-]»notic' in the nourologicai clinic at Dorpat. It seldom fails to produce a
pood night's sleep, though, in some instances, tolerance is soon established.
It may give rise to indigestion and diarrhcea, but its use is not followed by
headache and depression. Paraldehyde has the dieadvantage of communicat-
ing to the breath an unpleasant odor which may persist for hours or even
days. Dr. J. G. Kieman has known the continued employment of paralde-
hyde to occasion obstinate ulcers of the nose and eruptions upon the skin.
It has been used with advantage in delirium tremens, morphinism, and
tpilepsy. Several cases have been reported in which tetanus was cured by
ptrtHchyde, which allayed the convulsions, diminished the pain, and re-
lieved the insomnia. According to Dr. William Mackie. paraldehyde is bene-
ficial in spasmodic asthma. Dr, Humphrey has witnessed decided improve-
ment in the character of the respiration in broncho-pneumonia follow the
administration of this remedy.
Dr. D. W. Ait ken reports a case of epilepsy in which a prolonged aura
' iMn^ef, Aug. 20. 1800.
"Tlu- Tfrpnotic Efllcicncy of PurnMebyiln.'* .Vnr York \frtliral Journal, Nov. 20,
■
702
PHARMACEUTICAL lUEUAPEUTIC AGENTS OK DKUGS.
gave ample opportunity to prevent the attack, and in which from 1 to 2
c.cin. (or mxv-xxx) of paraldehyde always succeeded in keeping of! the con-
vulsions. *Tor more than a year she has had no fit except on one occasion,
when there was no paraldehyde in the house. '''
In asthma, puraliklivde jifTords rapid and t'oniplete relief in the major-
ity of cases, the initial dose being 3 to 4 c.cm, (or mxlv-lx). A few cases
need an additional dose of two-thirds this quantity an hour or so later. The
hypnotic action of the dru^ is also especially valuable when the attack comes
on at night, as noted by Dr. J. P. Hearder.^
Paraldehyde, in order to disguise its unpleasant taste, may be adminis-
tered as follows: —
c.cm. or fSas.
20 c.cm. or wix vel ix.
Gm. or 3ij.
ccm. or fSJv.
IJ Paraldehydx IS
Olei piullherire |60 or 1
Pulverift flcacifle 8
Sfrupi pruai VirginianCB q. r. ad 120
M. et ft emulsio.
Sig.: A half to a tablespoonful in water every hour or two. Use as an hypnotic,
or to lessen bronchial or pulmonary irritation.
Dr. R. G. Eccles suggests the following as a good method of adminis-
tration:— •
R Paraldehydi 7
Chloroformi
Olei cinnamomi
Oloi amygdal. dulc 7
M. Sig.: Mix and take undiluted.
5 c.cm. or fSij.
fiO c.cm. or mx.
12 c.cm. or mij.
5 c.cm. or f3ij.
With the combined adminiBtration of caflfeine (0.25 to 0.50 Gm., or
gr. iv-viij, daily) and paraldehyde (2 to 3 c.cm., or mxsx-xlv, at night),
Cevello found, in cases of cedema, ascites, and pleuritic effusion, that the
amount of urine was greatly increased. A case has been instanced of senile
arterial depression accompanied by dejection, restlessness, and insomnia,
and in which extensive valvular disease of the heart was also present.
Paraldehyde had an excellent effect upon the restlessness and insomnia, and
when cardiac compensation began to fail it also rapidly reduced the dropsy.
PAREIHA (U. S. P.).— Pareira (Pareira Brava).
PAREIR^ RADIX (B. P.).— Pareira-root.
Dose, 2 to 4 Gm. (or Ses-j), in infusion (1-17).
Preparalions.
I
P.).
Fluid Extract of Fnreirn. Dose, 2 to
Dose, e to
Fluidextractiun Pareinc (U. S
4 c.cm. (or fSas-j).
Extractum PareirSD Liquidum (B. P.)- — Liquid Extract of Pareira.
7.6 c.cm. (or fSssij).
Pharmacology. — "The dried root of Chondodendron tomentosum" Moni-
spermacejp) is ofhcial as Pareira or Pareira-root; products of allied genera
also appear in commerce under the name of *'false Pareiras." It is a climb-
ing, woody vine of Brazil, where it is extensively used as a medicine. Pareira
^British hfedical Joumal, 1896. p. 527.
* British Medical JourtMl, 189C, p. 725.
PKLLLTIKttlXJi: TANNAS.
703
*
I
contains Beberinc^ a bitter, yellow alkaloid; also a soft resin, a proteid
substance, calcium malate, potaesium nitrate, and other ealts. The alkaloid
is identical with the beberine of Nectandra, and with Bnxine, the active
principle of boxwood; it has also been known as "pelosine," or ''cissam-
Physiological Action. — Pareira is slightly tonic, but is esteemed prin-
cipally as a diuretic and laxative, though^ probably, without much reason.
Thenpy. — It is principally used in fluid extract, decoction, or infusion,
with alkalies, in the treatment of irritable bladder, cystitis, pyelitis, chronic
urethritis, and leucorrhcea. In South America it is given internally for
snake-bite, and applied externally to the wound.
must
K is id<
TANNAS (F. S. P.).-
0..*)() Qm. (or gr. iij-nij)
Tannatc of Pelleti6rine.
PELLETIEEIN-a:
(Stv Granatum. )
Dose, fii.m 0.20 to
PENTAL. — Under the name of pcntal (because it contains five atoms
of carbon) von Merin^ has introduced a compound [Trimethyl-ethylenc
(CjHjo)] made by heating tertiary amy) alcohol \vith oxalic acid. Pental is
» colorless liquid, of low specific gravity and stron;r odor, is volatile and
inflammable, boils at 100.4° F., and is insoluble in water. It mixes in all
proportions with alcohol, chloroform, or ether. It does not decompose on
eipojure to light and air.
Physiological Action. — When inhaled, a loss of sensibility occurs within
two or three minutes without entire abolition of consciousness. Profound
narcosis may, however, be produced by means of pental. The return of
consciousness is gradual. This agent ie unirritant to the regpiratory tract,
and no ill effects upon the circulation or respiration have, as yet, been
reported. As a rule, no excitement is cauEed» but in some instances lAUgbter,
hallucination, or transient spasm has occurred.
From a series of physiological experiments upon dogs Dr. David Cerna
eoncludwl that pental causes a fall of arterial pressure tmd of the pulse-rate,
and produces death mainly by cardiac paralysis. Recovery from its anaps-
ihetic effects was often accompanied by wild excitement. He does not regard
it as a safe or even efficient general anjcsthetic. Pental rarely gives rise to
headache or vomiting. The conjunctival reflex is late in disappearing, and,
ocept fixation of the eyes, no marked change takes place in the color or
etpression of the face. The pupils are sometimes widely dilated. Pental
way be administered upon a handkerchief or by means of an inhaler, and
7.5 to 11 c.cra. (or foii-iij) usually suffice to produce ana?sthesia.
Therapy. — Pental has been employed in the operations of dentistry and
minor surgery. Holiaender and Weber have used it with satisfaction and
success in the extraction of teeth, opening of abscesses, etc. Teeth may be
painlessly drawn while the patient ie partially conscious. Pental has been
used in a large number of cases in the Kaiser und Kaiserin Friedrich's Chil-
dren's Hospital of Berlin, without dangerous accidents or after-effecta.
From other sources, however, several deaths have been reported as caused
by this agent. In a number of cases, moreover, Kleindienst detected albu-
min, blood, and casts in the urine after the administration of pental. Some
patients have been observed in whom it proved impossible to produce anaes-
thc-sia by means of this agent. Alarming cyanosis, dyspna^a, and cardiac
debility are sometimes caused by pental, and in a number of instances death
has taken place from the inhalation of small quantities.
701 I'llAK.MACEfTICAL TIIKnAPKUTIO AGENTS OH DRUGS.
PEPO (U. S. P.).— Pumpkin-seed.
Dose, 4 to 15.5 Gm. (ur 5i-5ss).
Pharmacology. — ''The dried, ripe seed of Cucurbita Pepo" (CucurBP"
taccttO. contains a resin (the active eonstiuent) ; a hhind oil. *tareh, sugar,
etc. The seeds may be crushed and beaten into u paste with milk and white
sugar, and the reeiiiltinj; emulsion strained; or the seeds niav be decorticated
first and the contents nibbed up with sugnr and milk, or sugar and water.
Therapy.— The principal medicinal use of pepo is for destroying tape-
worms. It is gener&lly eificient, cheap, and not very difficult to take. A
preliminary purge of calomel should be given in the morning and the emul-
sion swallowed fasting at night. In the morning, a laxative (castor-oil,
Rochelle salt, etc.) is administered, and the tape-worm is discharged, with
the head. It is said that the reain (in doses of 1 Gm., or gr. xv) or the fixed
oil (in doses of 15 ccm., or f^ss) are also efficient when administered in the
same manner. The combination of oleoresin of aspidium (or male fern) is
very serviceable in destroying the tape-worm: —
H Oleoreftinffi aapidii 4 L'.cm. or f3j.
Chlorofomii »K) c.cni. or mx.
EmulBJon, peponia 300 c.cm. or fSxij.
H. Sig. : To be divided into two doses, to be taken one hour apart, and followed
by castor-oil tn hour later.
PEPSIKUM (U. S. r., B. P.).— Pepsin.
Dose, 0.32-to 0,65 Gm. (or gr. v-x).
Preparations.
I
Pepsinuni Saccharatum. — Saccharated Pepsin (1 in 10). Dose. 0,32 to
2 Gm. (or gr. v-xxx).
Glycerinum Pepaini (B. P.). — Glycerin of Pepsin (0.32 in 4 c.cm., or gr. v in f3j).
Dose. 4 to 7.5 c.cm. (or f3i-ij).
Pharmacology. — Pepsin is a proteolytic ferment or enz3rme obtained
from the fresh stomachs of healthy pigs, and capable of digesting not less
than three thousand times its own weight of freshly coagulated and disin-
tegrated egg-albumin when tested by the official process. The British
Pharmacopoeia directs that tlie enzyme pepsin be obtained from the mucous
lininjc of the fresh and healthy stomach of the pig, sheep, or calf; it should
dissolve 3000 times its weight of hard-boiled while of eggs. Of the numerous
methods employed for obtaining for medicinal use the digestive ferment from
the gastric mucous membrane of certain domestic animals [hog, calf, sheep,
principally] the moat prominent are (1) scraping the acid mucous secretion
from the surface of the stomach, spreading on glass and drying in scales
[Beale]; (2) extracting by maceration in acidulated water and precipitation
with alcohol or lead acetate, and (3) by precipitation with sodium chloride
[SchefTer]. Saccharated pepsin is pepsin obtained from the gastric mucous
membrane of the hog, mixed with sugar of milk. It is a white powder, of a
peculiar, but not disagreeable, odor and taste, and a slightly-acid reaction.
Liquor pepaini (non-olTicial), or solution of pcpsiu. is an acidulated solution
of the preceding, containing glycerin (40 per cent.). It is an artificial gastric
juice, with an agreeable, acidulous taste; it should not become moldy, nor
acquire a fetid odor when kept for some time. Many kinds of pepsin are
upon the market, varying greatly in purity and digestive activity. Those
oontaining a considerable quantity of mucus, which have a strong odor of
the pig-st}', and which possess only feeble digestive activity, when tested
with boiled egg-albumin, should be rejected. Saccharated pepsin is really
triturate of pepsin containing 1 part of pepsin with 9 of milk-sugar. Pepsin
requires an acid medium in order to exert its digestive power upon albumin,
while trypein, or pancreatin, is active in a neutral or alkaline solution. On
iccouDt of its instability, pepsin is best given uncombined. The substances
with which it may be safely prescribed are few in number. As it is only
active in an acid fluid, it should not be given with sodium bicarbonate.
Physiological Action. — Pepsin is a constituent of normal gastric juice,
where it is associated with hydrochloric acid. It is an albuminous substance,
capable of causing changes in other albuminoids by a process similar to fer-
mentation, or catalysis, converting them into peptones or albumoses. It also
converts blood-coagula, fibrin, etc., from the solid to the soluble or liquid
sUte. It is an unorganized fennent, pecuUar to gastric juice of the higher
I taimals, although similar ferments have been discovered in carnivorous
plants, and in the papaw, pine-apple, etc. Alcohol precipitates pepsin, and,
j eien in dilute form, checks its activity. Alkalies and some mineral salts
! also precipitate it.
therapy. — Pepsin, in concentrated solution, may be locally applied to
I digest blood-clots in the urinary bladder; and, iu atomized solution or spray,
to dissolve the false membrane in diphtheria and croup. In the latter affec-
tion the diphtheritic membrane may be treated with this solvent, containing
b pep«iD: —
I A Pepsini 81 Gm. or 3ij.
^ft Acidi hydrochloric! dil'. |00 ccm. or mx.
^M Aquffi mentb. pip.,
^^^H Gljrcerini aa ]5| ccm. or f^Bs.
^^^H M. Sig.: Paint over the surlmce frequently or several times a day.
■ A 5-per-cent. solution of scale-pepsin, in adeps lanae, is a useful applica-
" tion to clean off old ulcers. Morris recommenda a 10-per-cent. solution,
icidulated with 1 per cent, of hydrochloric acid and heated to 100''-120° F.,
for washing out abscess-cavities, etc. In connective-tissue tumors of non-
mali^ant character, pepsin may be used, by parenchvraatous injection, to
promote absorption. Mr. John Clay has seen good results follow the applica-
tion of pepsin to cancer of tlie cervix uteri. He states that much of the neo-
plastic tissue may thus be destroyed^ and that in some instances an appar-
^ ently sound surface is obtained.
B The chief use of pepsin is to aid weak digestion, and it is invaluable
in atonic dyspepsia, especially following acute diseases. While the stomach
thould not be expected to depend entirely upon outside sources for its gas-
tric juice, yet the temporary resort to pepsin is often followed by the best
rwults. Given in this manner, pepsin acts, apparently, as a stimulant to the
gattric glands and promotes their functional energy. In chronic maladies,
each as ansmia, chlorosis, diabetes, tuberculosis, and carcinoma, the admin*
irtration of pepsin is of service in promoting nutrition. In malnutrition
foods may be partly peptonized previous to adxninistration, thus saving time
in stomach digestion. The use of peptonizing tubes, each containing suffi-
cient for a pint of milk, is of great assistance in preparing such food, espe-
cially in the case of infants. In irritable stomach pepsin may be given in
conjimotion with bismuth subnitrate or minute doses of calomel: —
roG
PHARMACEUTICAL THERAPEUTIC AGEXTS OR DRU08.
B Pepeini,
Bismuth, subnit.
Olei cinnnmomi
M. et ft. capsulffi no. xij.
Sig.: A capsule after meals.
41 Gm. or Sj.
|75 acm. or mxij.
IJ Hydrarg. chlor. raitis lOttS Gm. or gr. j.
Popsiiii 4 ! • . . I 4 Gm. or 3j.
Pulv. myristica? * , |25 Gm. or gr. iv.
M. ct ft. chartulee no. xij.
Sig.: Take one every half-hour to relieve nausea and vomiting.
4i
Pepsin is also useful in gastralgia, pyrosis, gastric catarrh, and apepda
of infauts. In gastric cancer or simple ulcer, feeding mny be carried on by
the rectum, provided some pepsin be added to the nutritive eneraata. But
this remedy, when given by the mouth, is frequently of value in relieving
the vomiting due to ulcer or cancer of the stomach. Sickness of the stom-
ach, produced by indigestion, is generally relieved by pepsin, which is some-
times able, also, to allay the vomiting of pregnancy. Infantile diarrhoea,
excited by the presence of undigested food in the intestinal tube, is mark-
edly benefited by the administration of pepsin. The most satisfactory shape
in which to administer pepsin to adults is in its pure form, as the saccharated
pepsin is too weak to have much digestive power: —
B
Pepsini 4
Kxt. nucia vomicae
Pulv. ipecac
Pulv. aromat 1
M. et ft. pit. vel capaulee no. xxx.
Big.: Take oue immediately after meals for'atonie dyspepsia.
Gm.
32 Gm.
13 Gm.
Gm.
or 5j.
or gr.
or gr.
or gr.
XV.
M
Olycerini pepsini ( U, P.) 301 e.cm. or f$\.
Acid, hydrochlor. dilut 4 c.cm. or ^j.
Aqufe anethi 45| c.cm. or fSiss.
Sig.: Take a teaspoonful after meala for indig&tiUoii.
B Pepnini 13 Gm. or gr. cc.
Strychninas sulphatis 015 Gm. or gr. V«.
Aloini 13 Gm. or gr. ij.
01. nienth. pip Oti c.cm. or mj.
M. et ft. capaulee no. xx.
Sig.: A capsule after meala. For atonic dyspepsia accompanied by constiimtion.
Kennct-winc is obtained by macerating calves' stomachs in sherr}' or
other light wines. It is useful in apepsia in infanta. The glycerite of calf-
pepsin is a more active find efficient preparation.
PEROXOLES. — Coiiibiuations of b yJrogen peroxide with menthol, cam-
phor, nnphtol, carbolic acid, thymol, etc., have received the names of men-
thoxol, camphoroxo!, naphtoxol, carboxol, thymoxol, etc. These combina-
tions have been used iu the dressing of wounds on account of their antiseptic
and healing powers.
PERSIO. — Cudbear. A dark, purplish powder, prepared from certain
lichens (Lecanora tartarea and other species). It is analogous to litmus, and
yields a coloring matter to alcohol. It is principally used in dyeing. The
tincture of cudbear is used as a coloring agent for liquids.
PBTB0LATU1£.
707
I
*
PETROLATUM (F. S. P.).— Petrolatum.
PETHOLATTTM LiaUIDITM (U. S. P.).— Liquid Petrolatum.
PAEAFFINTJM (U. S. P.), PAEAFFINUM DURUM (B. P.).— Hard
ParafiSn.
PARAFFINUM MOLLE (B. P.).— Soft Paraffin.
Freparations.
Petrolatum Album (U. S. P.)- — Petrolatum is n semisolid ,«iibstttnce, coiisisting
of bTdrocjirbonfl, chierty of the raarsh-gaa series, abtiiiiied hy diislillinj; off the lighter
uut more vokitile portions from petroleum und purifyiug the rt'sidxie.
Petrolatum Li<]uidum (U. 6. P.)i Paraffinum Liquiduxn (B. P.). — Liquid Petro-
l&tain, Liquid Paraflizi.
L'Dguentum Paraftlni (B. P.). — FarafHn Ointment (a mixture of hard and soft
ptnffin in the proportion of 3 to 7).
Bcnziniim (U. S. P.). — Petroleum Beiizin. A diatillute from American Petro-
Iwua, consisting of hydrocarbons, chiefly of tlie mnrsh-gas aeriea.
Benziuum Purilicatum {V. S. P.). — Purified Benzin ( use<l in pharmacy in
ittldiig deodorized tincture of opium and tincture of Incluearium.)
Rhiguteue. (Uaed for producing void by evaporation, chiefly from a spray.)
Pharmacology. — Petroleum is a very complex fluid, of Batuial origin,
known from time immemorial, and found in various regions of the Old and
New World. In this country the principal source of supply is the wells of
Permsvlvania, though it exists also in Ohio. West Virginia, Texas, and
Kentucky. Crude petroleum, though occasionally clear, usually presents a
greenish-amber tinge. Its specific gravity varies from 0.777 to 0.865.
Petroleum consists chiefly of two homologous series of isomeric hydrocar-
bons, at one extremity of which marsh-gas is found and solid paraflin at the
other. It is not a fluid of definite composition or fixed boiling-point. Amer-
ican petroleum consists chiefly of paraflins. Barbadoes tar, Seneca oil, and
Rangoon oil are thick varieties of petroleum. The Rangoon oil contains a
larger proportion of both the olefine and the benzol series than American
oil. Oxygen, nitrogen, and sulphur have been found in certain varieties of
wtroleum, but are present ae impurities, though, according to H. Vohl, all
kinds of petroleum contain sulphur. Petroleum does not saponify.
Naphtha, a name which was formerly applied to the lighter varieties
of crude petroleum, is now used to designate all that portion which distills
over at, or below, 123** F. By repeated fractional distillations the most vola-
tile hydrocarbons are obtained from naphtha. Bcnzin consists of the more
volatile portions, being very inflammable, and yields vapors, which, if com-
bined with air, are explosive. Coal-oil. usod for illuminating purposes, oon-
lesa volatile hydronirbons, which should not flash or evolve explosive
under a temperature of loO°.
Petrolatum, ]>etrohitum-jelly, or parnflin ointment, is a semisolid sab-
itmee, consifiting of hydrocarbons, chiefly of the marsh-gas series (Ci^H,„
etc.), obtained by distilling off the lighter and more volatile portions from
American petroleum and purifying the residue. It is an amorphous, pale-
fdlowish, odorless, tasteless, or nearly eo, translucent, fatty substance, in
tiiin layers more or loss Hunresei'nt. Petrolatum is insoluble in water, scarcely
lolablo in cold absolute alcohol, soluble in (!4 parts of boiling absolute alco-
hol, soluble in ether, chloroform, fixed and volatile oils. Special forms of
:08
PHAHKACEUTICAL THEttAPEUTlC AGENTS OR DttUGB.
petrolatum are applied under the names of cosmolin, vaselin, albolene, etc.
It does not become raacid, and is used as a basis for ointments as a substi-
tute for Inrd. It ia also ollicial as a liquid oil (petrolatum liquidum).
Physiological Action. — Petroleum possesses decided antiseptic power,
is stimulant, and, taken internally in small quantities, is antispasmodic, dia-
phoretic, BJid expectorant. It disinfects the gaetro-intestinal and respira-
tory mucous tracts. In large doses it givea rise to headache, vertigo, pain in
the throat and stomach, palpitation of the heart, vomitinsc, tetanic spasm,
;ur1 juiiy ciiuse death, liie iutialation of the lighter hydrocarbons, benzin,
gasoline, and naphtha, causes intoxication and stupor.
The vapor of naphtha has some irritating qualities to mucous mem-
branes, and produces oedema of the e^'elids. lu a case reported by Dr. J.
Leidy, Jr., a man was rendered unconscious by breathing the vapors of
naphtha from a tank, which he was set to work to clean
Therapy. — Kock-oil enjoys considerable popular repute both as an in-
ternal and external remedy. As a counter-irritant it is used in chronic rheu-
matism, synovitis, sprains, chilblains, and paralysis. It is likewise applied to
the neck or chest for inflammatory affections of the throat and air-pas-
sages. Crude petroleum is a beneficial application in diphtheria. It may be
painted upon the affected surface with a camers-hnir brush or by means of
a pledget of absorbent cotton. Patients who are old enough may also use it
as a gargle. The false membranes are reproduced, but are much smaller and
thinner than before the application. Mr. Sydney Turner, of Gloucester,
England, suggests, also, that petroleum be vaporized in the room occupied
by patients suffering from diphtheria. Larelier has employed this agent in
a series of forty-two cases, with only two deaths and without an instance
of communication of the disease to any other person. Of the fatal cases one
was moribund when first seen and in the second his directions were not
obeyed.
Crude petroleum is useful in certain forms of conjunctivitis. It is a
painless application and is well borne by the cornea. In granular conjunc-
tivitis (trachoma) it may be riibhod upon the affected surface with a stiff
brush. Petroleum is useful in nrtlinary ciitarrhal conjunctivitis and in folli-
cular ophthalmia. It is of service in some cases of trachoma, while in
others it fails.
Petroleum, alone or combined with other drugs, has been employed in
psoriasis, eczema, seborrhoea, scabies, and almost every variety of skin dis-
ease. In eczema, Kaposi recommends the following: —
R Petrolei 15] c.cm. or fjsa.
Emplast. plumbi ISp Gm. or Jss.
Diftsolv'e and thoroughly incorporate with the aid of heat, and add a little oil of
bergamot tx) flavor, if desired.
Sig. ; Apply to the affected surface on soft cotton or linen.
Despr^s advocates the use of petroleum as an application to ulcerated
carcinoma of the breast. In uterine cancer he has foimd that vaginal in-
jections of 90 to 120 c.cm. (or f,^i:i-iv) of petroleum answer a good purpose.
He recommends the same procedure in acute vHginitis.
The stimulating properties of petroleuni render it of service in loss of
hair and alopecia circumscripta. Petrolatum has been widely employed as
an unguent, and as a basis with which to incorporate more active topical
BTEOSELIKUBf.
709
^
Jicaments. It is cleanly, devoid of odor, is not subject to alteration, and
Tsvailable when the object is solely to cover tlie integument with a bland
protective layer. It frequently happens, however, that petrolatum contains
irritant constituents which have not been removed in the process of manu-
facture, and which render this substance useful as a stimulant ointment.
Viixen it is desired that a fatty material should penetrate the skin, one
of the animal fat;? — as lanl, snet, butter, or adeps lunic— is entitled to the
preference as an ointment base.^
Liquid petrolatum is available as au application for bougies, catheters,
and other instruments. It has also been employed, by means of the atomizer,
in inflammatory conditions of the nares, and after operations upon these
and other parts of the body. Liquid petrolatum has also been used as a
menstruum for suspending various substances in it, for external and internal
use. Some clinicians have been incorporating certain of the mercurial salts
in liquid petrolatum and employing the combination for hypodermic injec-
tion* into the tissues.
Internally, the crude oil has been given, in the oil regions, in teaspoon-
ful doses to children suffering with croup and whooping-cough, with asserted
/cood results. It is occasionally given in chronic bronchial and pulmonary
disorders with advantage. The inhalation of naphtha-vnp^.tr has been recom-
ijiended in asthma.
Petroleum, administered by inhalation and internally in the form of
tn emulsion, has been strongly recommended as of value in pulmonary tuber-
culosis.
It is employed in Germany as a vermifuge; dose, 1.20 to 2 c.cm. (or
mn-xix). The finer qualities of petroleum have been given with success
in cholera in similar doses.
Bhigolene, one of the lightest products of the distillation of petroleum,
i* an extremely volatile fluid, boiling at about 64 V»° I*'- So great is the
rapidity of its evaporation, that local temperature is depressed to 15° F. by
*8pray of rhigolene. The fluid should be kept in a cool place and in tightly-
corked bottles. It can be used with a hand-atomizer to produce cold for
local anaesthesia, as a substitute for ether. Rhigolene sprayed upon the skin
•oon deadens sensibility and facilitates the performance of any brief sur-
pcal operation. Its garlicky odor and inflammability are objections to its
ttte, except in the histological laboratory, where it is employed to freeze
•pccimens for section-cutting. Paquelin's thermocautery is fed by one of
the lighter hydrocarbons of petroleum.
PETBOSEUNIJM.— Parsley. The root of Petroselinum sativum (Urn-
Wlifcra») contains a caraphoraceous substance, Apiolin; a neutral principle,
ipiin^ soluble in alcohol and water; also a volatile oil. Parsley-root is
carminative, diuretic, emraenagogic, and slightly laxative, and stimulatea
the circulation, the skin, and bronchial mucous membrane. The alcoholic
•olution of a petrol-ethereal extract leaves behind, upon evaporation, a
product which, if treated by caustic soda, yields a thick, reddish liquid, which
boils at 270" C. (527° F.)/and has a specific gravity of 1.113. To this oily
mbfltance, which is the true active principle of the plant, M. Chapotcaut
hte given the name Apiolin. It is dispensed in capsules of 0.18 c.cm. (or
' Srff "Diseaaea of the Skin," 1901 ; aUo "Ointments and OIeiitc«," iitecond edition,
P(L 244. 245.
4
710
PHARilACEDTICAL THERAPEUTIC AGENTS OU DKUOS.
miij) each. A third principle, termed Carioly has been extracted from the
same source by Morgues and Laborde. The apiol of commerce appears to
be a mixture of Tolatile oil and resin, with apiin, apiolin, and cariol in
uncertain proywrtions. Apiol is also kiiowni as "Parsley camphor." It is
the dinjeth-oxy-rnethvlene ether of ailyl-tetraoxybenzene.
Physiological Action. — Thrown under the skin or into the veins of
guinea-pigs, cariol determined genital hyperaemia, increased urination, and,
subsequently, general tremors and slight convulsions, paresis or motor inco-
ordination, and, finally, death from asphyxia. The spinal cord in the dorso-
lumbar region was markedly congested. The uterine vessels of a bitch
became engorged when cariol was injected into the circulation. Apiol and
cariol possess a similar action upon the nervous and circulatory systems.
The former causes a rapid rise of arterial pressure, due to increased action
of the heart and stimulation of the vasomotor centres in the medulla ob-
longata. Cariol exerts a less powerful influence upon the circulation than
apiol. Both principles, and especially cariol, promote muscular excitability.
Apiol causes congestion of the uterus and ovaries, and favors the occurrence
of the menstrual discharge. Both apiol and cariol possess excitomotor prop-
erties, and their physiological action justifies their employment in genito-
spinal atony. ^ Mr. H. C. Whitney considers that the volatile oil is the true
emmeuagogic principle. From poisonous doses of apiolin Laborde observed
somnolence, stupor, paresis, motor inco-ordination, accelerated respiration
and circulation, and death from asphyxia. Small doses act upon unstriated
muscular fibres, especially those of the uterus, almost invariably causing
abortion in pregnant guinea-pigs.
Therapy* — The fresh root of parsley is preferred, of which a hot infusion
is administered in amenorrha^a and dysmenorrhoea. Parsley is also useful
as a diuretic in dropsy, strangury, gonorrhoea, etc. Owing to a favorable
report from a commission of the French Academy, apiol for a time was
employed in malarial alFections as a substitute for quinine, but, being found
to be much inferior in antiperiodic action, it is at present seldom prescribed,
except as an emraenagogue. In cases of scanty or deficient menstruation,
with pains, etc., 0,18 to 0.30 c.cm. (or miii-v) in a capsule can be given after
meals, thrice daily, for a week before the expected period. Apiol is espe-
cially appropriate when amenorrhcea depends upon antemia. It may be
given in combination thus: —
I^ Apiolini 3110 c.cm. or ml.
Aloini |066 Gin. or gr. j.
Sulphuris subl 3|25 Gm. or gr. 1.
M. et ft capsulce no. x.
Sig.: A capsule m'glit and morning a week before and during the menstrual
period. Indicated in amenorrhcea and dysmenorrhcea.
In cases of pronounced anmmia the action of the apiolin will be more
decided if a ferruginous preparation be given with it and continued in the
intervals between the menstrual periods.
Apiolin reijulates the menstrual flow, and thereby indirectly relieves the
pain of congestive or spasmodic dysmenorrhoea. It is u?eful likewise in
atonic amenorrhcea. This remedy may be administered with advantage in
all cases amenable to the influence of internal medication.
'La Tribune i/Mica/e, Noa. 2, 3. and 4, 1891.
PHENACETINT7M.
Ml
»
to
^
PHENACETIinJM (B. P.).— Phenacetinum.
ACETPHENETIDIinJM (U. S. P.)-
Dose, 0.32 to 0.65 Gm. (or gr. v-x).
Pharmacology.— A coal-tar product [CjH.OCeH.NHCOCH,] para-
•cet-phenitidin, occurriug m white, cryetalline powder, of elightly bitter
taste, without odor; soluble in alcohol, glycerin, lactic acid, and sparingly
in water. It is not toxic in ordinary doses, and is less frequently followed
by dangerous depression, than is the case with, some other membexs of the
aromatic group of coal-tar ]>roducts. The drug should be cheniieally pure.*
Dr. Ludwig Reuter, nf Heidelberg, has pointed out that a dangerous
imptirity is found in some samples of phenacetin, resulting from imperfect
conversion of paraphenotitlin into phenacctin. The contamination may
be detected by melting a small quantity of chloral-hydrate in a test-tube
to the heat of boiling water find adding one-fifth of phenacetin. If the
latter be pure the mixture remains colorless, but if paraphenetidin be present
& purple color develops, passing rapidly from red into blue. Paraphenetidin
has produced serious toxic effects in small doses, inflammation of the kid-
neys being observed in several cases.
Phenacetin can, according to Hinsberg, be distinguished from acetanilid
and antipyrin by finely pulverizing and heating it to ebullition with nitric
acid (1 to 10). An orange color is thus produced with phenacetin, while
the other substances give no reaction when treated in the same manner.
Fulmer {Annales der Chiniic Anahjiique, 1905) gives the following test for
acetanihde in phenacetin : One decigraiume of the suspe^'ted substance is
boiled for one minute with 1 com. of concentrated hydrochloric acid. The
mixture is diluted with 10 r.cm. of water, and filtered. To the filtrate are
added three drops of a 2-per-cent. solution of chromic acid. If the phenace-
tin \i pure, the aohition assumes a niby-red color, which is piTuiiiiient. If it
I'ontains nc<'tanilide, the solution assumes a dark green tint, nnd later a de-
posit is oh?en^od.^
Physiolo^cal Action. — A nervous sedative, with little effect upon
ihe circulation. In very large amounts, Ilare claims that it is more apt
to disintegrate the blood than antipyrin, but its influence upon other
Tit*! functions is not so severe, and it is therefore less dangerous. Phe-
nacetin is not, however, totally devoid of toxic influence. Cases have been
reported in which vomiting, collapse, cyanosis, vertigo, profuse sweats, and
«n urticarial rash have followed its administration. According to the ex-
perimenta of Drs. David Cerna and William S. Carter, moderate amounts of
phenacetin act upon the heart, causing a rise of arterial pressure, and prob-
ibly exert also a stimulant effect upon the vasomotor svstem. In large doses
tKe drug reduces blood-pressure, the reduction being mainly of cardiac
origin. Dr. Hirschmann, of Vienna, has observed that after the adminis-
trttion of phenacetin. an abundance of crystals was fiometimes found upon
the skin. Under the microscope they exactly resembled the crystals of
phenacetin, which had been given to the patient.
Phenacetin slichtly reduces normal bodily heat, but more decidedly
when pyrexia is present. It acts upon sensory nerves and relieves pain and
^Amtric^n Drugp^t, Dec. 11. 1005.
712
PHAUMACECTICAL THERAPEUTIC AGENTS OR DRUGS.
spasm. In eome cases an hypnotic effect seems to be produced. It favora
the action of the skin and kidneys, but is not decidedly diuretic.
Therapy. — Phenacetin was originally introduced into medical practice
as an antipyretic, and subBequentiy was found to possess analgesic powers,
resembling antipyrin in this respect. In diseases attended by hyperpyrexia,
such as rheumatism, pneumonia, typhoid fever, and phthisis puIraonaUs,
phenacetin exerts a very happy effect in about half the dosage of antipyrin,
the ordinary dose being from 0.20 to 0.50 Gm. (or gr. iii-viij). The fall of
temperature does not occur until half an hour after the drug has been taken,
and the reductiou continues for four to eight hours. As an antipyretic it is
considered by many good authorities as the safest and most efficient member
of the aniline group. Good results are said to be produced in malaria by a
combination of phenacetin with small doses of quinine.
In epidemic influenza, phenacetin rapidly relieves the muscular paina
and favora diaphoresis; the catarrhal symptoms subsequently require other
remedies. A combination of 0.25 Gm. (or gr. iv) of phenacetin with 0.20
Cm. (or gr. iij) each of salol and sulphate of quinine has been highly ex-
tolled. The dose is repeated every two or three hours until the pains have
subsided. In the nervous sequelse of this disease the late Dr. William F.
Hutchinson, of Providence, believed that phenacetin stands first in the list
of reniedies-
In ordinary colds, one or two powders (0.32 Gm., or gr. v) of phenacetin
rapidly remove all the symptoms. Where fever is present, the combination
of salol with phenacetin is especially useful in influenza and rheumatism.
The analgesic effects of phenacetin are very marked in various forms of head-
ache, including migraine and the headaches from eyestrain, having the ad-
vantage over antipyrin in less frequently causing a rash.
The following combination is recommended as beneficial in migraine: —
IJ Acftphenetidini 31 Gm. or gr. xlv.
CalTeina citrntm 20 Gm. or gr. iij.
Quininie hydrochloridi (15 Gm. or gr. x.
BenJHJsulphiiiidi (Bact'harin) ,,. |oi Gm. or gr, */«•
M. et div. in chartulse no. z.
Sig.: One powder at a doee.
In the neuralgic pains of tabes dorsalis, in herpes zoster, and intercostal
neuralgia, small doses, given every hour for three or four hours, usually af-
ford complete relief and cause sleep. Phenacetin is extremely useful in
chronic neuritis, and, according to Kater, is unsurpassed in the treatment
of cerebral disorder due to excessive indulgence in alcoholic drinks.
In whooping-cough 0.03 Gm. (or gr, ss) doses, dissolved in 10 drops of
glycerin, are readily taken by children, and afford prompt relief, permitting
sleep and nmeliorating the attacks.
In delirium a dose of 0.65 Gm. (or gr. x) will usually afford a quiet night.
Franz Mahnert* considers phenacetin a specific in acute articular rheuma-
tism, as it reduces fever, relievos pain, aud lessens the duration of the attack.
It has been found useful in some cases of fronorrha?al rheumatism, and is
worthy of more extended trial in this rebellious affection. Given several
hours before the time of the paroxysm of intermittent fever, it prevents
the chill, but not its recurrence. In insomnia from simple exhaustion.
' "Annual of the Univenal Medico! Scieneea," 1890, vol. v. p. A-106.
PHENACETIN0M.
713
*
>
\
pDenaoetin acts admirably. The late Dr. Traill Green, of Eaaton, Pa.,
found phenacetin of senice in checkinfr the frequent micturition of old
people. It did not appear to be necessary to administer the remedy con-
linnously in order to obtain the desired result.
Dr. M. H. Lees, of Ivnoxville, Tenn., reports that the local application
of finely powdered phenacetin is eflicacious in promoting the healing of trau-
matic, simple, and syphilitic ulcers.
Phenacetin has also been employed locally in an alcoholic solution or
in ointment in cases of rheumatic pains of joints.
Among the many compounds belonging to the aromatic series and re-
lated to phenacetin, the following are important: —
Lactophenin. — A substance bearing this name and closely related to
phenacetin has been studied by Landoweky. Lactophenin differs chemically
from phenacetin in containing lactic instead of acetic acid. It is a white,
rather bitter powder^ sparingly soluble in water. Lactophenin reduces ab-
normal temperature, but exerts little or no influence upon the circulation
and respiration. This substance has been given in pneumonia, influenza,
erysipelas, scarlatina, acute tuberculosis accompanied by fever, and in sep-
tiocmia. It has been employed by von Jaksch in typhoid fever with satis-
factor}' results; the doses were from 0.50 to 1 Gm. (or gr. viii-iv). Roth has
found it of value in acute rheumatism. Lactophenin was useful in some
cases of chorea and in the pains of locomotor ataxia.
Landowsky ascertained that it possessed value as a remedy in neuralgia.
He states,, moreover, that it exerts a genuine hypnotic effect. It was given
in daily doses ranging from 0.65 to 3 Gm. (or gr. x-xlv). In some cases it
gave rise to diaphoresis and slight vertigo.
Apolysin. — This compound differs from phenacetin in the substitution
of a citric-acid radical for the acetic-acid radical. It is a white or yellowish-
white, crystalline powder, with an acrid taste, soluble in wann water, less so
in cold (about 1 to 50). It has been claimed that, while it possesses the anti-
pyretic and analgesic effects of phenacetin, it is innocuous even in large
doses. This is questioned by David Cerna,* who has seen bad results and
eten death, in the lower animals, following the administration of apolysin.
While not toxic in ordinary doses (1.30 to 2 Gm., or gr. xx-xxx), yet care
8houI(! be exercised in its use in larger quantities.
Mcthacetin, — This compound differs from phenacetin only in contain-
ing a methyl in place of an ethyl group. Methacetin occurs in the form of
colorless, scaly crystals, is comparatively non-toxic, and has the advantage
of being five times more soluble in water than phenacetin. Methacetin pos-
Msses antiseptic properties and has been given in typhoid fever and pneu-
monia. In pulmonary tuberculosis its action was not favorable, as it gave
rise to copious night-?wenls. It has also been employed in neuralgia.
Dulcin (Paraphenetolcarbamide). — On account of its remarkably sweet
tttte, the name dulcin has been given to a substance the chemical composi-
tion of which allies it to phenacetin. It has also been termed sncrol. Dulcin
cmtallizes in the form of small, white tables, which are soluble in alcohol
ind ether, in 50 parts of hot water, and 800 parts of cold water.
Dulcin has a pure, sweet taste, and is said to be from 200 to 250 times
nrceter than saccharose. Its effects have been studied by Kobert, Kosael,
;
* Journal of the American Mcdirol Association, ,Iune 20. 18B0
714 PHARMACEUTICAL THERAPEVTIC AGENTS OR DECGS.
and PaschldB. It is without influence upon rabbits. In the daily dose of
2 Gm. (or Sss) it did not disturb digestion in the rabbit or dog. It had no
effect upon the respiration, circulation, or central nervous system. Large
doses had a toxic influence upon dogs, which died with such evidence of
blood-destruction as icterus. In experiments upon cats, Robert concluded
that doses corresponding to those which may be employed in the human
being are without danger. In abnormally large doses, cats sicken and some-
times die with cerebral symptoms. The same manner of death has been ob-
served in frogs subjected to subcutaneous injections of dulcin.
Aldehoff dissents from the observers above quoted, having found daily
doses of 1 Gm. (or gr. xv) harmfxd and even, in the course of a few weeks,
fatal to dogs, which died with symptoms of acute jaundice.
Dulcin has been used in the place of sugar to sweeten the food of obese
individuals, in whom it is desirable to limit the amount of saccharine food.
It can be employed in small doses with advantage in diabetes mellitus.
Ewald has given it in daily doses of 1.55 Gm. (or gr. xxiv). It is regarded as
innocuous when administered in moderate amouuis.
Fhenocoll is derived from glycocoU, or amido-acetic acid, and phenet-
idin, the water being abstracted. The new combination is a phenacetin,
which, by the introduction of the salt-forming amido group in the acetyl
radical, is rendered readily soluble. The hydrochloride is soluble in about
16 parts of water at 17^ 0. (62.6"^ E.), and the solution is of neutral reaction.
The salt crystallizes out of hot water in cubes similar to those of antipyrin;
out of alcohol, in which it readily dissolves, it crystallizes in needles.
The pure base, phenocollum purum, may be obtained by the action of
ammonia, caustic alkali, or alkaline carbonate upon a solution of the salt,
and occurs in the form of white, matted needles, which contain 1 part of
water of crystallization. Hydrated phenocoll melts at about 95** C. (203"
P.), the anhydrous form at 100.6** C. (212.9** F.). On account of its solubility
in cold water, the salt is preferable to the pure base for use in medicine.
Phenocoll is fairly stable when boiled in a dilute solution of an alkaline
caustic or carbonate, though prolonged boiling causes it to separate into
phenetidin and glycocol. It is similar in its behavior toward weakened
acids. After long boiling in concentrated hydrochloric acid, it is partly split
up into phenetidin hydrochlorate and glycocoll.
Phenocoll hydrochloride has a salt taste, with a sweetish after-taste
and an aromatiq odor, and is best administered in the form of powder. The
aqueous solution, neutral at flrst, develops an alkaline reaction at the end of
the second day. It is the salt most frequently used. The acetate, carbonate,
and the salicylate of phenocoll have also been prepared. The first-named
salt is easily soluble in water, and has been recommended as being well
adapted to hypodermic use.
Physiological Action. — Phenocoll exerts no deleterious influence upon
animals, and does not affect the composition of the blood. A dose of 1.50
Gm. (or gr. xxiij) was followed by no evil consequences in the rabbit.
The physiological action of this drug has been studied by Drs. Cema
and Carter, who conclude that in ordinary amounts it is practically without
effect upon the circulation, that large doses diminish the blood-pressure by
influencing the heart, that phenocoll reduces the pulse-rate by stimulating
-inhibitory centres. It then increases the rapidity of the pulse by
those centres. The final diminution is of cardiac origin. Upon
PHENACETINUM.
715
the blood itself phenocoll has no action. Phenocoll reduces temperature by
caufling an enormous diminution of heat-production without any alteration
of heat-dissipation.
In the human subject it is well tolerated by the stomachy and seems to
have no injurious effect upon the kidneys. After ingestion of about 5 Gm.
(orgr. lixv) the urine assumes a brownish or blackish-red color. The colora-
tiozi usually deepens when the urine is left long exposed to the air. Upon
the addition of tincture of ferric chloride, the color becomes still darker.
The drug is eliminated rapidly, and twenty-four hours after discontinuance
the reaction with the tincture of iron can no longer be obtained. Dr. P.
Balzer, as a result of experiments conducted in Professor Eichhorst's clinic,
states that phenocoll favors the elimination of nitrogen.
Therapy, — Thirty-two eg. (or gr. v) of phenocoll hydrochloride have re-
duced temperature in typhoid fever and pneumonia 3° V. or more without
causing collapse or cyanosis. In the hectic fever of phthisis, Dr. Hertel found
that 0.50 Gm. (or gr. viij) doses, thrice repeated at hourly intervals, reduced
temperature 1** C; 1 Gm. (or gr. xv) doses effected a diminution of 1 Vj** C.
within a few hours, and the reduction continued for about two hours. Five
Gm. (or gT, Ixxv), given in divided doses throughout the day, occasioned an
almost complete defervescence. In acute inflammatory rheumatism Hertel
found daily doses of 5 Gm. (or gr. Ixxv) valuable in the aUeviation of pain, but
with little direct influence upon the fever. As soon aa pain was abolished,
however, the temperature fell to normal. Sweating was occasioned, and in
wme instances Cohnheim observed chilliness to attend the reascent of tem-
perature. In two cases Dr. P. Balzer witnessed cyanosis as a result of the
administration of daily doses of 4 or 6 Gm. (or 5i-iss) of phenocoll. In some
instances phenocoll was successful when other antirheumatic remedies had
failed. Cohnheim obtained no good results from its use in chronic rheuma-
tism, and in the hands of Hertel it produced no effect upon a case of gonor-
rboeal rheumatism. Professor Eichhorst has made use of phenocoll in ty-
phoid fever, and states that the remedy seems to exercise a favorable influ-
ence on the sjrmptoms, and the course of the disease becomes milder. Pro-
feasor Albertoni states that he has extensively employed phenocoll in malaria,
and that excellent results were effected in a number of severe cases. Pheno-
cnll is sometimes successful in malarial cases when quinine has proved in-
effective. In malaria the remedy was given six or seven hours before the
expected paroxysm in the dose of 1 Gm. (or gr. xv). Phenocoll occasions no
unpleasant after-effects, and its taste is easily disguised by mixing it with
fugar. A combination of phenocoll and quinine will sometimes prove effi-
cacious in subduing an obstinate attack of malaria which has resisted either
remedy when administered alone.
It is claimed that phenocoll is particularly applicable to the treatment
malarial infection in pregnant women,
Cohnheim found the remedy efficacious in a number of cases of neu-
lalgia, especially when due to influenza. It was of no service in hysteria or
ibronchial asthma.
' Doses of 0.50 Gm. (or gr. viij) have produced a good result in migraine.
Dr. Modigliani has employed this remedy in juvenile cases. He found it
•dTantageous in chorea and convulsions and in various febrile disorders.
Dr. Q. C. Smith, of Austin, Texas, writes that he has found nothing
more efficient in the treatment of hectic fever than the following combina-
tion:—
I
716 PHARMACEUTICAL THKKA?EUTIC AGENTS OU DRUGS.
B PhencoU. hydrochloridi,
Salicin aa 3110 Gm. or gr. xlviij.
IfyilrflfltiiitF sulfili. l|55 Gm, or gr. xxiv.
M. et ft MpBuI. no. xxiv.
Sig.: One capsule every four to eight houra.
M
Dr. Carl Beck, of New York, has convinced himself by clinical eiperi-
mentfl that phenocoll is posBeesed of antiseptic virtues and has used it ex-
ternally in various cases, embracing accidental and surgical wounds, inflamed
and suppurating cases, etc. As a dry dressing, he at first used the pure pow-
der, but subsequently found that a 10-per-cent. gauze answered the same
purpose. A 5-per-cent. wntery and a 10- or 15-per-cent. alcoholic solution
were of advantage in certain cases. A 10- or 20-per-cent. ointment was ap-
plied to ulcers and burns, but, though the results were good, the healing
process seemed to take longer than under the use of gauze. An injection of
a 10-per-cent. alcoholic solution reduced the size and relieved the pain of a
cancer, rendering desirable additional trials in the same direction. Pheno-
coll has the advantage of being inodorous and not productive of irritation
or inflammation of the skin.
Salocoll. — Phenocoll salicylate has been given, for convenience, the
above name. Salocoll is obtained by the action of salicylic acid upon pheno-
coll hydrochloride, occurs in the form of a powder, has a sweetish taste, and
is not eafily soluble in water. It is given in the dose of 1 or 2 Gm. (or gr. xv-
xxx), and can be repeated twice or thrice during the day. Salocoll has been
shown to possess nntipvretic, antirheumatic, and antineuralgic properties,
and has been thought to be o^pecially useful in influenza.*
PHENALGIN is a coal-tar derivative, amraonio-phenylacetylaraid
(CgHr.NlT.,). It is used as an antipyretic and hypnotic, and is said to be a
vascular stimulnnt. [Is liable to be confused with a proprietary of the
samo name, which is an acotanilido mixture,] Doses are about the same as
acetphenetidinum.
PHENAZONTTM (K P. ) . ANTIPYEINA (U. S. P.).— Antipyrin. Pho-
nyl-dimothvl-i.si.-pvniznlnnc.
Dp«e, 0.32 to 1.30 Gm. (or gr. v-xx). Ordinary dose, O.SO to 0.32 Gm,
(gr. iij-v).
Pharmacology. — Antipyrin is a synthetical product belonging to the
aniline series, discovered by Dr Ludwig Knorr, who obtained a patent for
the process of preparation, but the time for its exclusive control in the
United States has expired, and il^ is now nffirinl. It is a white, crvstfllline
powder, of a 8lightly-l>itter taste, fn^ely soluble in water, alcohol, and chloro-
form, and loss readily soluble in ether Antipyrin melts at 113** C. (235.4**
r.). A solution of antipyrin added to a solution of ferric chloride gives rise
to a dark-bro\Mi color. With spirit of nitrous ether it shows a green color-
reaction, and is changed into ieo-nitroso-antipyrin.
Physiological Action, — Upon the unbroken integument it is devoid of
effect, but upon denuded or ulcerated surfaces its solution is said to exert an
analgesic inflnonce. Small doses do not ordinarily produce marked results,
either in animals or healthy men. Excessive doses cause slight depression
' The American Therapist, June. 1893.
PHBNAZONDM.
717
*
I
*
the norma! temperature, cyanosis, chillmesa, cardiac debility, and dia-
phoresis. Given to animals, it occasions epileptiform and tetanic conrul-
nons. Reflex movements are increased by small and decreased by large
doeee, Antipyrin depresses the functions, both of sensory and motor nerve-
trunks. Lethal quantities cause, in frogs, arrest of the heart in diastole.
Arterial tension is decreased by large doses, unless conyulsions occur, in
which case it is increased. Small doses augment blood-pressure. The effect
upon the blood-pressure is due to the direct stimulant or depressant influence
of small or large doses upon the heart. A solution of antipyrin applied to
divided blood-vessels arrests haemorrhage. Respiration is unaftected by small
doses; is lirst increased, but subsequently markedly decreased, by toxic
doses. In fevered animals it causes a decided reduction of temperature, pos-
nbly by a direct action upon the heat-centres. Toxic quantities give rise to
iiiethaemoglobin in the blood. Antipyrin is possessed of some antiseptic
power, and arrests fermentation. Absorption and elimination are rapid.
Antipyrin is removed from the system by the kidneys, the urine being some-
times diminished and sometimes increased in quantity.
It is said that, under the influence of antipyrin, the urine contains a
lowered proportion of substances representing nitrogenous tissue-change.
Ltrge doses cause a considerable decrease in the quantity of urine excreted.
Idiosyncrasy and Toxicology. — Many unpleasant and alarming, with
sometimes fatal, effects have followed the administration of medicinal doses
of antipyrin. Among these consequences are vomiting, profuse sweating,
cyanosis, collapse, salivation, dyspnoea, and epileptiform convulsions. Dr.
Perdriel suggests that antipyrin will be better tolerated by the stomach if
prescribed with sodium bicarbonate and tartaric acid in capsules, owing to
the influence of the nascent carbonic acid evolved.
The late Dr, P. Guttmann reported a case of poisoning from antipyrin,
in which the symptoms approximated those of the algid stage of cholera.
The fffical evacuations were, however, formed. The quantity taken had been
10 Gm. (or 3iiss) in divided doses.
Herpetiform eruptions have been observed after the use of antipyrin.
In some cases, again, small erosions or ulcerations have been produced."
ilorel-Lavallee has reported a case in which the prolonged ingestion of anti-
pyrin occasioned the development, upon the middle of the tongue, of a large
■pot of erosive glossitis which closely resembled agminated mucous patches
of the tongue. Cutaneous eruptions due to antipyrin assume in different
eases the form of erythema, urticaria, or pemphigus. At times a rash similar
to that of meafiles is produced. This is easily removed by administering
belladonna with the antipyrin or by giving an hypodermic injection of atro-
pine. In some cases, the eruption appears on the penis in the form of black
blotches accompanied by oedema, as reported by Foumier.* The eruption
appeared four and one-half hours after the first dose was taken. The patients
were alarmed, thinking that gangrene of the penis would follow.
M. Verneuil has, in two instances, observed partial gangrene follow the
hypodermic injection of antipyrin. When nutrition is lowered this agent
should not be injected at the seat of disease.
A number of fatal cases have been reported from medium doses of anti-
pyrin, especially in children, old persons, and those suffering from cardiac
' Annalea de Dermatologie el de SvphUigraphle, April, 1800.
718
PHAKMACEUTICAL THJiUAPEUTlC AOEXTS OR DBUGS.
debility or disease. In such cases, therefore, the remedy must he used, if
at all, with extreme caution. Poisoning is shown by restlessness, anxiety,
slow respiration, weak pulse, and vertigo. Treatment is by diffusible stimu-
lants, heart-tonics (strophanthus or nux vomica), and artificial respiration
or inhalation of oxygen. Atropine will also aid in the treatment. Heat
favors, while cold retards, the action of antipyriu. A habit of antipyrin
addiction is sometimes acquired and produces serious disturbance of the
health, nianifested by nervous irritability, loss of appetite, and decided im-
pairment of nutrition.
Incompatibles. — Phenol, chloral-hydrate, gallic acid, spirit of nitrous
ether, calomel, the preparations of cinchona; hydrocyanic, nitric, and tannic
acids; copper sulphate, ferrous sulphate, corrosive sublimate, sodium salic-
ylate, tincture of ferric chloride, syrup of ferrous iodide, tincture of iodine,
catechu, kino, and rhubarb.
Therapy, — The therapeutic effects of this substance may be summed
up as antipyretic, analgesic, and antispasmodic. When antipyrin is given in
febrile states, the temperature begins to descend, at the end of half an hour
to an hour, and reaches its lowest point of descent in three to five hours.
The average time during which the temperature remains depressed is from
six to nine hours. It is preferable to administer the drug in a few large doses
rather than in small amounts repeated. It should always be borne in mind,
however, that large quantities are apt to produce collapse. The descent of
temperature is usually, but not always, accompanied by profuse diaphoresis.
In place of sweating, increased diuresis is sometimes observed.
Antipyrin is of especial value in hyperpyrexia. It may be used with ad-
vantage in previously vigorous subjects, in disease of a sthenic type, when
fever is, in itself, a source of danger. In typhoid fever the best authorities
oppose resorting to this class of antipyretics to reduce temperature. It may
be used in typhus fever, small-pox, and yellow fever. In scarlatina, accom-
panied by excessively high fever, we may have recourse to antipyrin. It has
been found beneficial in erysipelas, reducing fever and apparently limiting
the spread of the disease. In croupous pneumonia it reduces the rate of
respiration as well as the temperature, but has no influence upon the pul-
monary inflammation. Antipvrin is etlicacious in the pneumonia and bron-
chitis of children. According to the comparative studies of the late Pro-
fessor Demrae, of Berne, relative to the use of antipyretics in the treatment
of the febril-o diseases of children, antipyrin is of particular value in cases
of broncho-pneumonia in which relapse and excessively high temperature are
quite marked. He employed, in the first period of recurrence, antipyrin in
aqueous solution, with a little sugar end a few drops of cognac. ^Vhen given
in this form it very seldom produces disturbance of the stomach, and very
rarely fails to effect Ihe desired reduction of temperature.^ In the fever of
pulmonary tuberculosis antipyrin ia seldom likely to prove of advantage, on
account of its depressant properties. In intermittent fever it is capable of
reducing the fever, but not of preventing recurrence. Some writers have
ascribed very excellent results to the use of this drug in puerperal fever.
Antipyrin is of efficacy in acute and subacute articular rheumatism, and
ia not infrequently successful in those cases in which sodium salicylate has
failed. It not only reduces the fever, hut also relieves the joint affections.
'See Medicol Bulletin, March, 1891, p. 95.
PHENA20XUM.
719
»
iTorable reports have been made as regards its action in gout. Potter men-
tions a case in which an acute paroxysm of gout was ameliorated and short-
ened by antipyrin. A dose of 1.60 Gm. (or gr. irv) was given at first, and was
followed by 0.65 Gm. (or gr. x) doses every second hour until decided relief
wafi obtained. In chronic gout, also, it is reported to exert a beneficial in-
flnence. The acute paroxysm is ameliorated and shortened, and the course
of the chronic form modified.
Antipyrin is efficacious in relieving pain in the various forms of neu-
ralgia, but as a rule has little effect upon that due to inflammatory diseases.
It is of particular avail when the neuralgia depends upon a gouty or rheu-
matic taint. It relieves the pain of malarial neuralgia, but will not prevent
a recurrence of attacks. Hemicrania is often markedly relieved by the ad-
ministration of this remedy.
According to Dr. Graeme M. Hammond, it is especially efficacious in
that form of migraine characterized by local heat of skin, flushed face, and
dilatation of the temporal artery. The same author recognizes its usefulness
in sick headache due to dietetic errors. A mixture or combination of anti-
pyrin, caffeine, and citric acid is recommended as of marked efficacy in vari-
ous forms of neuralgia, given in 1 Gm. (or gr. xv) doses. Excellent results
have been obtained in sciatica from the use of antipyrin, especially when
combined with quinine. It will often assuage the lancinating pains of loco-
motor ataxia. Pleuritic pains and the chest-pains of phthisis may be relieved
by means of antipyrin. It has been used in dysmenorrhoca with asserted
good success, and it has also been employed with a view to mitigating the
pains of labor. Antipyrin has also been successfully employed to assuage
the pain of hepatic colic.
The internal use of antipyrin is advocated by Blaschko in cases of
pmrituB dependent upon hysteria or other functional disorders of the nerv-
ous system. Ilis statements have been confirmed by the experience of other
obsen'ers.
Antipyrin mitigates the severity of a number of afTections characterized
by Bpaamudic action. In hysterical tremors and in chorea it is often of
serricc. It has been seen to alleviate the paroxysms of whooping-cough, and
in some instances it has seemed to shorten the course of the disease. C. G.
Kerley has given antipyrin (combined with bromide of soda) in over 400
eases of pertussis. The antipyrin was given usually combined with syrup
nf raspberry. It is not depressing when given with any degree of intelli-
firenc«; in fact, it is well borne by children in good-sized doses, and it con-
trob whooping-cough better than any other drug used by him. The parox-
jmtA are diminished in number from one-third to one-half without any
UDclioration of the individual seizure, or the seizures are less severe without
my change in the number of the attacks. In some both the severity and
Dtnnber were favorably influenced. In all the cases the disease was made
«uaer in some way. It was found that the two drugs given together more
effectually controlled the disease than when either were given separately.
At the out-patient department of the Babies' Hospital he used the drugs
bined in the form of a compressed tablet. For a child 8 months of age
Qm. (or gr. ss), of antipyrin, with 0.13 Gm. (or gr. ij) of bromide of soda,
fiven at two-hour intervals. For a child of 15 months 0.0(55 Gm. (or gr. j)
of tnlipyrin and 0.16 Gm. (or gr. iiss) of bromide of soda at two-hour inter-
«uae
^ effce
■ ai t
m
720
PilARlIACECTICAL THERAPECTIO AGEXT8 OVL DRUGS.
Talfl, Two and a half to 4 years, 0.13 Qm. (or gr. ij) of antipyrin and 0.20
Gm. (or gr. iij) of bromide of soda at two-hour intervals.^
Galvagno praises the action of antipyrin combined with resorcin, and
states that the duration of pertussis is decidedly abridged by the administra-
tion of a mixture composed as follows: —
B Resorcinolis,
Actipyrioffi aa If Gm. or pr. xv.
Syrupi sirapliria 30 c.cm, or ftj.
Syrupi acftcire I05| c.cm, or fSuiss.
M. et ft. sol.
Sig.: From three to five dessertspooDfuls each day.
In many cases of epilepsy, antipyrin is efficacious in reducing the num-
ber of convulsione. It is said to be particularly useful in epilepsy occurring
at the menstrual epoch. Its value is enhanced by a combination with am-
monium bromide., and it may be given, in the dose of 0.50 to 1 Gm. (or gr.
viii-xv), thrice daily, with 1.30 Gm. (or gr. xx) of the latter drug. The mixt-
ure has been continued for long periods without producing bromism. Du-
jardin-Beaumetz and others have observed benefit from the use of anti-
pyrin, in daily doses of 2 to 2.60 Gm. (or gr. xxx-xl) in diabetes mellitus. In
diabetes insipidus, also, good results have been reported. Antipyrin has
been used, with asserted good results, by Dr. M. H. Feeny in subacute
Bright's disease, and by Dr. Saint-Phiilippe in infantile diarrhoea, accom-
panied by pain and indigestion. Ale.Tcandre Paris treated a case of tetanus
successfully by means of antipyrin. Its favorable action in tetanus has been
confirmed by Cnviana and Venturoli. M. Clement considers it of value in
promoting absorption of serous effusions in pleurisy, and it is said to allay
the pain of glaucoma.
M. Guibert asserts that antipyrin arrests the secretion of milk, and may
be safely administered for this purpose in doses of 0.25 Gm. (or gr. iv) every
two hours. Others have successfully employed it for the same purpose. M.
B. Martin has observed good effects from its use in exophthalmic goitre,
urticariaj erythema nodosum, and senile pruritus. Dr. Gaudez has called
attention to its usefulness in cases of idiopathic incontinence of urine in chil-
dren. He combines a small quantity of sodium bicarbonate with each dose
and lays stress upon the importance of administering the remedy at six and
eight 0 clock in the evening. He is accustomed to give the remedy in full
doses according to age. It has been observed that in persons taking anti-
pyrin the liability to take cold is increased. Antipyrin has given relief in
Bome cases of lead colic. On account of its haemostatic, antiseptic, and anal-
gesic properties, antipyrin has proved an efficacious local remedy in a num-
ber of affections. Epistaxis is arrested by the application of the powder or
an aqueous aolulion of 10 or 20 per cent, strength. The bleeding is checked
without the formation of a clot. It is available after extraction of teeth,
operations in the mouth, and in minor surgery. Dr. Gamer has reported a
case in which uterine haemorrhage yielded to an aqueous solution of anti-
pyrin (4 Gm. to 60 c.cm., or oi-f^i], of cold water) applied to the canal of the
womb by means of a cotton swab. It has been used as an injection in hy-
persBsthesia or neuralgia of the urethra and bladder, and likewise in gonor-
rhoea. For use in gonorrhoea a solution may be made of 2 Gm. to 240 c.cm.
^Archivea of Pediatrics, April, 1900,
PU£XAZONUH.
I
(or 3e«-0ss) of water. In cystitis the injection of a 4-per-cent. solution of
Uitipynn allays pain and checks spasmodic contractions. The fluid is
liloivt'd to remain within the bladder for ten minutt'S. In hypertrophy of
the prostate gland the use of antipyrin, either administered by the mouth
or brought into direct contact wiili the mucous membrane, diminishes the
frequency of desire and reudere the act of micturition more easy and less
painlui. Antipyrin is also of benefit in nephralgia as well as in painful or-
ganic affections of the pelvis of the kidney and the ureter, as inflammation,
the presence of foreign bodies, etc.
A 0- to lo-per-cent. solution has been found an efTicacious application
in conjunctivitis, purulent dacryocystitis, trachoma, and pannus. I»r. E. B.
GleasoD has reported favoral)le results from the application of antipyrin in
inflammatory conditions of the mucous membrane of the upper respiratory
tract.* lie found that the analgesic effect of sohilions continues for several
hours, and may apparently be prolonged indefinitely if reapplied at intervals.
Antipyrin diminishes the reflex cough and asthma excited by certain nasal
tfftciions. Solutions of 1 to 3 per cent, generally give good results when
ttted with an atomizer inside the nose. To the posterior wall of the pharynx
k concentrated solution may be applied. Strong solutions may also be ap-
plied with benefit in cases of laryngitis. In painful laryngeal tuberculosis
Ut. Neumann has advantageously insufHated a mixture of equal parts of
BDtipynn and powdered starch.
A solution of antipyrin, either alone or combined with cocaine hydro-
chlorate, has been recommended as an efficacious topical remedy in painful
affections of the nose, pharynx, and larynx, as well as in cases of operations
upon those parts.
Dr. J. Euisson has observed an admirable effect in nocturnal enuresis
from the administration of three 0.65 Gm. (or gr. x) doses of antipyrin at
hourly intervals, beginning four hours before bed-time.
M. Vianna has ascertained that antipyrin is destructive to the bacillus
of Loffler and its toxic products. He, therefore, suggests that the drug may
prove nsi'ful in the treatment of diphtht^ria.-
A mixture of antipyrin and salol, or antipyrin-salol, has been found
efficacious as a local application in uterine hfpmorrhage. The fluid, applied
with cotton, is said to be free from danger, to cause no pain, and to have
an hftinostatic and antiseptic action.
A valerianate of antipyrin and quinine has also been prepared.
Salipyrin is a combination of salicylic acid and antipyrin. This sub-
stance can be made by gradually adding 73.4 parts of salicylic acid to a boil-
ing aqueous solution of 100 parts of antipyrin. On cooling, salicylate of
antipyrin is thrown down in the form of colorless, transparent crystals or
$cMies, which are very slightly soluble in cold water, but readily soluble in
alcohol, ether, or chloroform. According to Hitschmann, it is only in rare
instances that even large doses of salipyrin occasion a fall of blood-pressure.
The experiments of Alberto on frogs and toads show that small doses
of aalipjTin increase the power of the heart, medium doses produce arhyth-
mia, while large quantities cause arrest in diastole.
Salipyrin was used by Guttmann in doses of 4 Gm. (or 3j) or more in
twenty-four hours, given in doses of 1 Gm. (or gr. xv), the first dose to be
'Jfew York yrdivtil Jovmal, Oct. 29, 1802.
*Lt FrogiiM StMk-cl, April 2, JH92.
4«
722
PUARMACEUTICAL TllERArEUTIC AOE.VTS OB DfiL'GS.
double: 2 Gm. (orgr. xxx). It had decided antipijretic and anal^esitc action,
and was especially useful in the pyrexia of rheumatism and intermittent
fevers. Salipyrin has eometimes succeeded in cases of acute rheumatism
after the failure of sodium salicylate and antip^'iin. In other cages, again,
it has not seemed to exert a decided influeuce. It seems to be of little avail
in chronic rheumatism. In epidemic influenza it relieves the severe head-
ache, and often has a decided sedative and hypnotic effect. Professor Mosen-
geilj of Bonn, esteems salipyrin of value in the treatment of catarrhal affec-
tions unrelated to influenza, Ee recommends that the remedy should be
administered at the inception of the attack. In chronic nasal catarrh he has
had good results from insufflation of powdered salipjTin. Hitschmann states
that its most marked action is that of an analgesic. He has given it with
benefit in chronic myelitis with lancinating pains in the lower limbs, in
sciatica and other forms of neuralgia. He observes that it will sometimes
cause derangement of the stomach nr abundant perspiration. An eruption
upon the skin and tiniiilus auriuni occurred in a few cases after its use.
Kayser has employed salipyrin with advantage in a number of cases of uter-
ine haemorrhage. In nearly all the cases it produced a hemostatic eflfect,
■which continued for several days after the drug had been discontinued- It
was particularly useful in menorrhagia preceding the menopause. Salipyrin
has likowise been used with good effect in amrnnrrhcea.
Mi^^ainin, or Migranin, is a mixture of antipyrin, 89.4 per cent.;
caffeine, 8.2 per cent; citric acid, 0.56 per cent.; moisture, 1.84 per cent.
Prof. C. A. Ewald speaks highly of this combination in sick headache; it
is also useful in influenza, for relieving pain in the head.
Naphthol-antipyrin. — M. G. Patcin lias succeeded in comliiuiug anti-
pyrin with both iilphauaplithol and betannphthol, the former being a liquid
and the latter *a crystiilHzcd substance.
Tolypyrin. — This name has been given to a synthetical preparation
whifb differs from antipyrin by the substitution of a molecule of the
methyl group for one of the hydrogen atoms in the phenyl group. Toly-
pyrin is a colorless, crystalline substance, of a bitter taste, soluble in
water and alcohol, but almost insoluble in ether. It is colored violet
by ferric chloride and preen by sodium nitrate, potassium nitrate, and by
sulphuric acid. According to the investigations of Dr. von zur Miihlen,
toxic doses of this compound paralyze the central nervous system, but do
not directly destroy the irritability of the cardiac muscular tissue. Clinical
experiments were first mode with this compound by Dr. Paul Guttraann>
who found that it reduced the temperature in typhoid fever, pneumonia,
scarlatina, facial erysipelas, and phthisis. It was given in four doses of 1
Gm. (or gr. xv) each at hourly intervals. Tolypyrin lessens the pain and
swelling of rheumatism. No untoward effects have been observed from its
use, and it is eliminated in the urine. It is also beneficial in neuralgia. Dr.
Dornhliith has employed tolypyrin with advantage in neuralgia and other
varieties of nervous pains and also in inflammatory pains, as angina and
alveolar abscess, nervous insomnia, headache after epileptic attacks, and noc-
turnal enuresis in children.
Tnssol. — This name is given to a compound of amygdalic acid and anti-
pyrin. Tussol is said by Dr. Hehn to be useful in whooping-cough, reducing
the frequency and severity of paroxysms. The substance is soluble in water
and is given in doses of 0.048 to 0.10 Gm. (or gr. Vriss) two or three times
PKOSPHOUCS.
723
I
I
I
I
a 3ay to children lees than one year of age. From Ihe second to the fourth
year doses ranging from 0.23 to 0.38 Gm. (or gr. iiiVrVJ) may be employed,
aod for older children 0.50 Gm. (or gr. viij). No ill effects have yet been
reported from its administration,
Fcrripyrin. — This designation has been bestowed upon a double com-
bination of ferric chloride and antipyrin. Fcrripyrin occurs in the form of
an orange-red powder and is readily soluble in cold water. Uijlike the ferric
chloride, ^he compound is not corrosive. P^rripyrin possesses decided astrin-
gent properties. It is used in watery solutions of 18 or 20 per cent, for the
purpose of checking haemorrhage. It may be given internally in the dose of
0.50 Gm. (or gr, viij).
PHENOL (V. S. P.).— Phenol.
PHENYLIS SAUCYLATIS (U.
(SeeSalol.)
PHOSPHOKUS (U. S. P., B. P.).-
(8ee Acidum Carbolicum.)
S, P.).— Phenyl Salicylate, or Salol
Lose, 11.00048 to 0.00065 Gm. (or gr
Preparations.
Phosphorus.
Vio.
1 / _
).
Dose, 0.0025 to 0.006 Gm. (or
-Diluted HypophoBphorous Acid
ZiDci Pbosphidum (U. S. P.).— Zinc Phosphide.
Acidum Uypopboftphorosum Dilutum (U. S. P).-
(10 per cent.). Dose, 0.60 to 2 c.cm. (or mx-xxx).
Acidum Phosphoricum (U.S. P.). — Phoephoric Acid (not less than 86 per cent.^
bj weight, of absolute orthophoeplioric acid).
Acidum Phosphoricum Ditutum (U.S. P., B. P.).— Diluted Phosphoric Add (U.
& P. coutaining, by weight, 10 per cent, of orthophosphoric acid). Dose, 1.20 to 4
ccm. (or mxx-flj).
Oleum Plio&pborutum (B. P.). — Phosphorated oil (1 per cent., in expressed
almond oil ). Dose. 0.00 to 0.20 c.cm. (or mi-iij ).
Pilulie Phoephori (U. S. P., B. P.).~PbosphoruR Pills. (Each pill {U.S. P.) con-
tains 0.0006 Gm., orgr. V.«: of the B. P. mass 0.25 Gm., or gr. iv, contains 0,0013 Gm.,
«' gr. '/,., or 2 per cent.] Do>te. 1 to 2 pill*. B. P.. O.dtM to 0.l:i (^m. (or gr. i-ij).
Acidum Phoaphoricuin Concentratum (B. P.). — Concentrated Phoaphoric Acid
(ooDtaiiu 06.3 per cent, of hydrogen orthopho«pbate).
Spiritus Phosphori. — .Spirit of rhosphuruft. A solution of phosphorus (1.2
QnL) in absolute iilcohol (to make 100 part*). Do'w?, 0.3 to 1 c.cm. (or mv-xv).
The U. S. P. oflicial hypophosphites arc of lime, iron, potassium, and
•odiom; their preparations are: —
•Syrupuft Hypophosphitum (U.S. P.). — Syrup of Hypophosphites (contains of the
Umf salt, 45; sodium and potassium salts, 15 each; spirit of lemon, 5; diluted bypo-
pbomhorus acid, 2; sugar, 500; and water, q. a. ad lOOO parts). Dose, 4 to 30 c.cm.
(or fJifJj).
Svrupus Hypophosphitum C'ompositus iV. S. P.). — Compound Syrup of Hypo-
phosphites ( I part eaoh of ferrous lactate and potassium citrate ndded to the pre-
ceding enough to make lOO parts). Dose, 4 to 30 ccm. (or f5i-f5j).
The official F. S. P. phosphates are of iron (also pyrophosphate of iron),
•odium (and sodium pyrophosphate), and the precipitated calcium phos-
phate. The preparations are: —
Klixir Fcrri, Quininir, ft Strychninso PboBphatum.
niyiiTitimi Ferri. Quininic. et Sln.'chnimp PboHphatiim.
Liquor So«lii Phohphntis Composi'tus (I'. S. P.); Sodii Phosphus Effcrvescena
It. 8. P.) ; and Sodii Pliospbaa Exsiccatus (U. S. P.).
n^
PHARilACECTIOAX THERAPEUTIC AGENTS OR DULGS.
Syrupus Caldi Lactofhosphatis (U. S. P., B. P,). — Syrup of Calcium Lactophos-
phate (contains the preeipitated carbonate, lactic acid, orange-Howcr water, sugar,
phosphoric acid, and water)* Dose, 4 to 16 c.cm. (or f3i-iv). B. P.j 2 to 4 com. (or
f3BB*j ) .
Syrupus Ferri, Quinime, et Sti-ychninae Phosphatiim (U.S. P., B. P.). — Syrup of
the Phoflphatea of Iron, Quinine, and Strychnine. Dose, 2 to 4 c.cm. (or fSss-j).
Pharmacology', — Phosphorus, a non-metallic element, was obtaiQed by
Brandt, in luTiiJ, hy rlecomposition of urine. It is a soft, flesh-colored solid,
very inflammable, oildiziiig upon exposure to the air; the British Phar-
macopoeia directs that it be obtained from calcium phosphate. Phosphorus
melts at 110° F., and friction causes it to ignite at ordinary temperature. It
possesses an alliaceous odor, is insoluble iu water, sparingly soluble in alco-
hol, ether, and chloroform; more soluble in oils, and dissolves readily in
carbon disulphide. Occurs in nature as tribasic phosphate of lime in primi-
tive and volcanic rocks, anrl in tbo bones f>f vertebrates. Tlie oilicial (U. S.
P.) ro<]uiroment is Ihiit it sbnll tcntaJn not less than 9S*.5 per cent, of the
puro suhstanc!*. It should be kcpl fiimfnlly iinih'r water in a cool plaoo.
Physiological Action. — liv hrain- and nerve- tissue it exists in combina-
tion with lai as Urithin ; luid in all vascular structures, in the form of tri-
basic phosphate, it ia an im|)ortant constituent. Tt is excreted in small
quantity nnrnially by the urine in tlie ftvrin of pbitsphates; occasionally, when
oxidation is intcrfertd with nr an (\\ce.ss of plujspbonis introduced into the
blood, it is exercted iu its own lorni by the breath, urine, and perspiration,
making the person luminous. Phosphorus is likewise eliminated by the
liver. In meilicinal doses the action of phuypliorus upon the nervous system
is that of a tonic and stimulant, and it also accelerates cell-growth in organs
and tissues and particularly in the skin. Pba^phorus is stated by Binz to
produce its efrects by causing the deveKipment of active oxv'ren in cell-])roto-
plasm, the pnK-ess beintr compnmd with what occurs when phosphorus is
exposed to air with tlie production of ozone. On the circubition it acts pri-
marily as a stiniuhint, makinj^ the pulse fuller and more fre<]uent ; the
capillary expansion is flushed, nnd free perspiration follows; as a conse-
quence, the temperature of the surface is at first slightly raised, but subse-
quently falls several degrees. Smnll doses of phosphorus have a favorable
influence upon the comp<^sition of the haemoglobin; immoderate quantities
have a deleteri«ni(^ etTvct. The kidneys are alsn tluslu'ij, the ipiantlty of urine
becomes larger, the proportion of urates and urea is decidedly increased;
ha'inaturia often results from a poisonous dose. No influence is obsen^ed
upon digestion from -iniall doses, thoiigh larger ones cause irritation. ^Inscu-
lar power is enhanced ami pexual ap[ietite stimulated, ^fental operntions are
easily performed, and it is said tai-tile sensibility is heightened. Tlie body-
weight ifl increased. Jaundice may occur from interference with the func-
tions of the liver, and biliary acids may appear in the urine. Purpura is
sometimes due to the administration of phosphorus. Wegner has shown that
phosphorus also exerts a marked influence in promoting the growth of bone.
Phosphorus in substance is very inflammable and produces extremely pain-
ful burns.
Toxic Effects. — In -single pniionous doses, phoppliorus is a violent irri-
tant, causing gastric inflammation; and, if death does not quickly occur,
fatty degeneration of muscular tissues and acute yellow atrophy of the liver
will follow. This result may also succeed the medicinal use of phosphoms,
viiet
U port.
■ V,.)
»
when continueil too long, or if the dose be considerable. Xebeltlmu* re-
ported a case of a child two years of age, that had taken only 3 mgr. (or gr.
Vso) o^ phosphorus in the course of sixty hours, in solution in codliver-oil.
1 intoxication occurred, and the characteristic changes were found post-
irtem. When the poisonous action is very slow, as where workmen are ex-
posed to the fumes of phosphorus in making friction-matches, the toxic
effects are shown by the death of certain bonos, particularly the jaw-bone.
Ralph Stockman has demonstrated, however, that phosphor-necrosis, so
called, is really due to a mixed infection of tubercle bacilli witli pus-forming
micro-organisms. The condition of tlie jaw is precisely analogous to tuber-
filosis of tlie jaw in cattle. Moreover, these cases generally die with pul-
Bananr* phthisis.*
Acute PhoBphoms Foisoniixg. — When, as not rarely happens, an in-
fufiion of match-heada is swallowed, or phosphorus-paste* used for poison-
ing rats is taken with suicidal intent, or an overdose of a medicinal prep-
antion of crude phosphorus is swallowed, the first symptom is pain and
burning at the epigastrium, with vomiting. The vomited matter and even
the stools are sometimes phosphorescent, with intestinal irritation and purg-
ing; death may occur from exhaustion. The blood is robbed of its oxygen,
b«:omc8 black, unusually liquid, and loaded with products of decomposition;
the capillary tie^ues yield and the extravasations of blood produce purpura,
hflpmaturifl, and haemorrhages. Jaundice is frequent, and convulsions and
wrna are not uncommon. Temperature is reduced. The urine is usually
scanty and albuminous. In some instances it has contained sugar. After
the development of jaundice, bile-acids and biliary coloring matter make
their appearance in the urine. In women fatal doses generally cause a
bloody discharge from the uterus, and if pregnancy exists the drug occasions
abortion. One and a half grains of ph*'>pphonis have proved fatal. Taylor
irports the death of a lunatic after gr. Vh had been taken.
Antidotes. — Copper sulphate may be used freely as an emetic, followed
bf a purge of mngnesia or magnesium sulphate to clear the intestinal canal.
Alhuniinous and mucilaginous drinks, in which magnesium hydrate is sus-
ided, are useful. Oil, being a solvent of phosphorus, should be avoided.
Id French oil of turpentine, which contains oxygen, was formerly held to
be a chemical antidote. Oxygen inhalations have been proposed to over-
come the depression due to altere<J blood. Hydrogen dioxide has also some
antidotal power. Professor Bokai recommends potassium permanganate
18 an antidote to poisoning by phosphonis. Fn the stomach, manganese
Aloride is formed with the liberation of oxygen and the conversion of phos-
phonis into ortliophosphoric acid. He advises the use of a */,-per-cent
•olution of permanganate. At a later period alkalies are useful.
U the poison has been retained for a time, death will occur from fatty
itineration of the stomach, liver, and other organs. Phosphor-necro-
lii may be prevented by thorough ventilation of the work-room, or by the
workmen wearing masks or respirators, covering the mouth and nose, and
= Munch. Med. ^Vock., .\ug. 20. 1901.
^BriiUh Medical Journal, Jan. 7, 1800.
*Pho«T»honispMte, for destruction of house vermin, is made by rubbing together
tptrU 0^ phosphorus and sulphur with 6 parts of cold wat*r until thev liquefy. Then
Wd 2 part.9 of mustard-flour, 8 parts of sugar, and 12 of rye-flour, making a paste. To
y k?pt cIoHfly jjtoppt'red in tin boxes. Phospliorus matches each contain V» mgr. of
111 pnosphorus.
^
PHAHMACEDTICAL THERAPEUTIC AQElTrS OR DEUOS.
obliging them to have their teeth in good condition, as carious teeth are the
immediate cause of this form of necrosis, as already stated. The error in
diagnosis may be made of mist^ikiiig phosphorus poisoning for acute yellow
atrophy of the liver of unknown etiology.
Therapy. — In neurasthenia, or nervous debility, where the system is
weakened by anxiety, overwork, or sexual excesses, and in neuralgia, phos-
phorus is a valuable tonic and restorative, but has less control over pain than
many other agents. It is sometimes given with success in herpes zoster. In
small doses, continued for considerable periods, it is of service in arresting
fatty degeneration of the heart and ameliorating the symptoms due to that
condition. Phosphorus is of value in supporting the system when exposed
to severe and prolonged bodily or mental strain. Phosphorus is not infre-
quently of service in the treatment of angina pectoris. In reduced nutrition
of nervous centres this remedy is valuable, as in atheroma of the cerebral
vessels, white softening, insomnia of the aged, hysterical paralysis and mel-
ancholia, morphinomania, and chronic alcoholism. It checks sweating due
to nervous debility. Phosphorus may be employed as a restorative after
typhoid fever or tvphoid pneumonia, and phosphorated oil is said to be
valuable in intermittent fever. In antemia small doses in conjunction with
iron are of considerable service. In so-called pernicious ana?mia, or an-
haematosis, small doses of phosphorus seem to have some influence in check-
ing the progress of the disease. In rickets and osteomalacia, also, clinical
experience has pronounced in favor of phosphorus, especially in the form of
oleum phosphoratum given with codliver-oil.
B Olei phosphori (B. P.) 11 c.cm. or mxv.
01. morrhuEB 120[ c.cm. or fjiv.
M. Sig. : A teaspoonfii] to ft ttblospoonful four times a day.
The following prescriptions are recommended by Kassowitz in the treat-
ment of rickets in chiUlren: —
M.
Phospliori
BenzoBulpliinidi 5
niei liiiionia „
01. morrhuse , 105
Sig.: Dose, a teespoonful.
Gm. or gr. '/«-
Gm. or gr. lxx\-ij.
c.cm, or niij.
ccm. or fSiiifts.
101
Gm.
Phosphori
Oloi olivne 2«
Aoidi oloiei 2
Snpli. nib.
PuIt. acacise aa 1515
Aq. dcBt 105(
Dose, a teaspoonful.
Thomson uses: —
I> PhoBphori
Alcoholis (abiolut.) 22
Spt. menthee pip.
Glycerini q. fl. ad 60
Gm. or gr. '/».
c.cra. or fSvij.
or gr. XXX.
Gm.
c.cm.
or 5s8.
or fSiiiBS.
M
065 Gm. or gr. j.
c.cm. or wcccl.
60 ccm. or mx.
c.cm. or fSij-
M. Sig.: Six to twelve drops, after meals, three times daily.
WTien, in eruptive fevers (in scarlatina, measles, etc.), the exanthem does
not come out, or it recedes, the administration of phosphorus has been re-
sorted to with advantage. In some- instances phosphorus will render good
I
I
I
PHOSPHORUS, 7S7
service in the exhaustion of typhoid and typhus fevers. Travignot, Squire,
ind other writers have used this remedy with advantage in diabetes meilitus,
In scanty and irregular menstruation attended with headache, the continued
idministration of phosphorus exercises a beneficial influence on the char-
acter of the periods. Phillips commends the action of phosphorus in cases
of hysteria, dependent upon sudden fihock as well as those connected with
delayed or suppressed menses.
In skin diseases, phosphorus and its compounds are useful as substi-
lutcfi for arsenic, and in some cases are superior to this drug. In crops of
boils, acne indurata or inveterata, and eczema of nervous origin, calcium
phosphate or the alkaline hypophosphites are highly serviceable.
In lupus cr\ilieniatosur:, Dr. L. D. Bulklcy often prescribes: —
Q Phosphori [38 Gra. or gr. vj.
Alcohol, absolut 1 1 1 1 ccm, or ftxxi.
Dissolve uith heat and agitation and mix, v'hile still warm, with the following
mixture, aUo warm: —
Glycerin 2851 c.cm. or fjixsa.
Alcohol 45 ccra. or fSiss.
Spiritiis niciith. pip 16| c.cm. or fjss.
M. Each drachm cuntains 0.003 Gm. (or gr. Vw) of phosporua. Doso, 10 to
15 drop*.
Phosphates and Hypophosphites. — In some cases, medicinal doses of
phosphorus cnuse feebleness of the heart's action with threatening collapse
or acute gastric pain, and, in others, fatty degeneration of the muscles and
Tigcera. This does not occur after using the salts of phosphoric and hypo-
phoephoric acids and their preparations. The phosphates have physiological
ictions and therapeutical powers differing from those of phosphorus. So-
dium phosphate^ for instance, is a valuable cholagogue and is slightly laxa-
tive, making it of special service in treating children who pass clay-colored
^eces, and also in catarrhal jaundice, owing to its action upon the liver. It
b of benefit in rheumatism, either alone or combined, thus: —
B Sodii phosphat.,
Acidi salicylici aa C{50 Gm. or gr. c.
M« et ft. cap»ulK no. xx.
Big,i A capsule or two every two hours for rheumatism.
A sftturatLvl solution of sodium phosphate may be used in tablespoonful
Joitt aa a purgative.
For gout and rheumatism, Dr. F, L. Satterlee recommends the follow-
in? prescription also containing the sodium phosphate: —
li UUiii benzoat. 2| Gm. or 3sb.
Sodii hromid.,
Potsssii carhonat pur. aa 81 Gm. or 3ij.
Potassii scetat 46 5 Gm. or 3)8S-
Sodii phnaphat. 15|5 Gm. or S^a.
Svr cingiberis*
Aq. menth. pip »••« aa 180| c.cm. or f^vj.
M. Sig.: A teaspoonful to a tablefpookiful in half a glaaa of water every four or
•I houn after food.
Calcium phosphate, made soluble by combination with lactic acid itt
the form of the syrup of calcium lactophosphate, is a valuable reconstmctive-
*nd tonic in feeble children with deficient development of bone, and also in
7ZJ5 PHABMACBUTIOAL THERAPEUTIC AGENTS OR MVOS. ^H
BUTgQvy, in treating ununited fracture. Exhaustion and aniemia, produced
by long-continued suppuration or lactation, leucorrhoea, or chronic diarrhoea,
Are benefited by this preparation, which is also useful in caries. The com-
poimd syrup of the phosphates, or chemical food, has been found to be espe-
cially serviceable in thusc cases.
A class of preparations known as glycerophosphates of calcium, potas-
eiuni, and sodium are proii-cd by il. Albert Robin as of efficacy in the treat-
ment of various depressed conditions of the nervous system. They may be
given either by the mouth or aubcutaneonsly, in the latter case 0.25 Gm. (or
gr. iv) being an active dose. Dr. Robin has obtained excellent results from
the use of these phosphates in convalescence from influenza, in neurasthenia,
phosphaturia, phosphatic albuminuria, etc. In sciatica and Addison's dis-
ease he also witnessed notable improvement follow the use of the same prep-
Bratione. The subcutaneous injection of glycerophosphates proved of de-
cided benefit in an obstinate case of tic douloureux, which was accompanied
by distressing parfesthesia. As the solutions become contaminated easily and
are excellent culture-media, they should be preserved in sterilized bottles,
large enough to hold only one injection, or the solution should be made im-
mediately before using.
The hypophosphites Lave been largely used and highly extolled by Dr.
Churchill in the treatment of pulmonary consumption, especially the alka-
line hypophosphites, which should be perfectly pure, like those of Dr. E.
W. Gardner, of New York. The object of treatment being to obtain calca-
reous degeneration of the tubercles, calcium hypophosphite may be admin-
istered alone, having the advantage of being nearly tasteless; it may be given
in doses of 0.3ti to 1.30 Gm. {or gr. v-x.\') in pill form, or with an equal quan-
tity of milk- or cane- sugar. The following prescription, containing the
hypophosphites, is suitable as a tonic, especially in chronic bronchitis:—
li Acidi phoapborid dil l\\ com. or fSiij.
Syrup, pruni Virg 715 com. or fSij.
Syr. hypopbosphitum comp q. ». ad 150) c.cui. or f5v.
M. Sig. : A teaspoonful in water three or four times a day.
Caution. — As a subject of interest and possible importance, it should
be mentioned that the hypophosphites should not bo triturated in a mortar,
as they are liable to explode. Dr. II, Gilford, of Syracuse, while triturating
a nii.xture containinj^ 3 parts of calcium hypophosphite, and 1 of sodium
hypophosphite, made this discovery, the compound exploding like gunpow-
der, severely burning his face and destroying the sight of one of his eyes.
Phosphorus in substance or solution, on aroouut nf Its great toxicity, is
now rarely prept ribed ; Ihe restorative effet-ts being obtained by the use of
the hypopliosphitcr:. and phosphates, aiul Uioir preparations.
Dr. E. Q. Thornton re<;oriinieiulcd the sub.«litiitiou of the red, or amor-
phous, variety, made by heating vitreous ]>h(isphorus to 250° C. (182° F.)
in the absence of air. Amorphoii.'i ptiosphorns is ahnojit com])Ietely destitute
of taste or odor, has no inimedinte ctiustie eflect, and is claimed to be less
toxic than w^hite phosp!tonis; but in the form of mateliee has caused many
deaths, and isa known iis the "servnnt >iirls' pciison."
PHYSOflTIOMA.
729
•
I
I
I
PHYSOSTIGMA (U. S. P.)-— Physoatigma.
PHYSOSTIGMATIS SEMINA (B. P.) —Calabar Bean.
Preparations.
Tinotura Physostigmatis (U. S. P.). — Tincture of Physostigraa (10 per cent).
Dftse, I to 2 o.cm. (or mxv-xxx).
Eilractum Physostigmatia (U.S. P., B. P.).— Kxlract of PhyMstigma, Extract
of Cnlflbar Beiin. Contiihis 2 p(*r cent of alktiloidK.) Dose, 0.01 to U.03 Gro. (or
r • '''<•** ' •
I'hysostigniiiue Salicylas (U.S. P.). — Phyaostigmine Salicylate, Eserine Salic-
ylate. Dose. 0.001 to 0;003 Gin. (or gr. 7m-V»).
PliysostigininEe Sulphas (U.S. P., B. P.). — Physoatigmine Sulphate, Eserine Sul-
phate. Dose, 0.001 to O.0i»;j Gm. (or gr. V«-V«).
Lointellu? Phy*j.-«!*ti;5'niin£e (B. P.). — Discs of Physoatigmine. Discfl of gelatin with
■otnc glycerin, each weighing ahout 1.3 mg. (or gr. Vm) and containing 0.0C5 mg. (or
P' Vi«) of phyao:4tignune sulphate. For use in ophthalmic practice.
Pkarmacolog^. — "The dried, ripe seed of Physostigina veneuoeum"
( Letpiiumosav) , yielding, wlien assavi'd by United Stiites process, not less
than 0.1") jipr t'eiit. of ether-*iolul>le :ilknIoi(is. It contains the nlkaloids
Fhysosti^ine (also known as Eserine) and Calabahne, starchy matters,
oiU. etc. The salts of physostigmine vary in solubility; that with salicylic
acui is soluble and permanent. Jobst and He.sse, in 1864, first isolated the
active principle as an amorphous alkaloid, to which they gave the name of
plivsostigmine. Subsequently a crystalline, alkaloidal principle was found
in the seeds by Vee and Tx-ven. who gave it the name of eserine; the former
Wjtf tasteleMi, the latter has a bitter taste. Eserine dissolves sparingly in
vat(?r; it is easily soluble in ether, alcohol, and chloroform. In physiological
effpctfi they are analogous, and they are now regarded as different forms of
llie same substance. Bihrinper has recently di.9covered a crystalline alka-
loid, wluble in alcohol and ctlter, similar to, hut weaker than, physostigraine,
whitlt he proposes to call Eseridine. Another crystalline principle, Esera-
nine. api^enrs to be devoid of physioloi^ical activity. A substance termed
Physosterin, related to cholesterin, is also present in physostigraa. The
presence of physostigmine may be demonstrated by dissolving a small quan-
tity in 1 or 2 drops of fuming nitric acid. A bright-yellow liquid, which is
the result, darkens in shade when heated on a water-bath, and upon evapora-
tion the color changes to green. The addition of a drop of strong nitric
icid with heat produces a violet red, changing tn a dark-green solution.
^ Physiological Action and Toxic Effects. — The ordeal bean of old Cala-
is ft powerful poison, prodiicinfr extreme muscular debility, vomiting,
hw and weak pulse : it causes deatli eitlier l>y cardiac syncope or, in smaller
^Mtntity, by paralysis of the respiratory centre and suffocation. Atropine
<tianteracts the respirator}' depression, and strychnine stimulates the cord,
r.4Uld thus act as physiological antidotes. Applied to the surface of the body,
"'ect is observed, unless absorption occurs. When introduced into the eye,
igruine causes contraction of the pupil, hejrinning in about fifteen
niinutes and lasting for ahout eight hours, attended by slight twitchinsr of the
supra-orbital pain, dimness of %'i8ion, fall of intra-ocular tension, spasm
mniodation, and myopia. The pupil contraction is held to be due to
paralysis of the peripheral vasomotor nerve-fibres, and to stimulation of the
filirrs of the thinl nerve sujiplying the iris. Contraction of the pupil may
•Iso be produced by the internal administration of the dnig, but, rs the
■
730
i'n-\nMArEUTiCAr. Ti!KiiAiM:r'no aoknts on Ditrus.
rule, this rer^ult does not follow. This fact, as Phillips remarks, ma"
aid in distinguisMng poisoning by physostigma from that of opium. The
brain is not affected, but the spinal cord suffers great depression of both
motor and reflex activity. The conductivity of the motor nerves is also
reduced. The pulse and respiration become slower and fuller after small
doses, the arterial tension being at first increased; but in larger amounts, as
the system becomes more influenced by the toxic action of the drug, the pulse
becomes feeble and irregular and the arterial tension falls. This is explained
by the primary stimulation and subsequent exhaustion of the peripheral car-
diac filaments of the vagi. The secretions are slightly increased by Calabar
bean, and vomiting and retching are apt to occur. Peristaltic action as well
as the intestinal fluids are increased, and diarrhcea is a usual physiological
consequence. PhvsostigTnine suli>luitc i? said to o.\oite tlie pregnant womb
to contraction. The bladder and spleen also contract under the influence
of physostigma. The active principle is largely excreted by the kidneys, and
likewise by the saliva and bile, and has even been found in the gastric secre-
tions after intravenous injection. Physostigma is promptly absorbed, and
elimination takes place with corresponding rapidity. Even the prolonged
use of eserine drops, na a rule, has not given rise to any inconvenience.
Roubinovitsch has reported a case' of a man, 80 years of age, suffering with
glaucoma, who for three years had instilled into each eye, twice daily, 2
drops of Q Vj-per-ccnt. solution of sulphate of physostigmine. For eight or
ten months peculiar Fymptoras had followed each instillation. Sometimes
the patient became drowsy and passed into a state of sleep with dreaming;
Bometimee he remained awake, but seemed to lose a correct perception of
his surroundings; occasionally attacks of vertigo occurred. The case was
then investigated. Before instillation the rectal temperature was 97.7** F.
and the pulse was 80 and regular. Ten minutes after the instillation of 4
drops of the solution {representing about 1 mg. of eserine) the temperature
had risen Vas** ^^^ the pulse-rate had increased by 12 beats in the minute.
Thirty-five minutes after instillation the temperature had fallen "/so^^
the pulse had returned to 80, but the tension was increased. On aus-
cultation, intermittent action of the heart was found. The patient
was semiconscious and had intellectual and sensory troubles. ITe insisted
that !ie was lied to iUo <rroLind willi his jirnis suspended in the air. At the
Sttnie time tunic jt'rks luanifc^fitcd thiMns('l\<'s in the limbs. Tliree-quarters
of an hour after insitillation ho slept with qunsi^tiTtomus hreathiiig. He
awoke after about an hoisr, !=itill liaving delusions. He had arteriosclerosis
and polyuria, and, it was thought^ u slight degree nf granular kidney.
Possibly defective elimination by tlie kiflney? was the cause of the production
of to.vic symptoms by sufh n small quantity of t^sorine. The antidotes are
atropine and .strychnine subrutancnisly. also rhlnrnl livdrate and stimulants.
Therapy. — The salts of ]»hys(istignu*nc are iisimI by oculists t*) break up
adhesions of the iris, diminish intra-ocular tension, and prevent the pro-
lapse of tfic iris aflcr \v(mii>U or ulcer nf tlic cnrnea. Pliysostigminc is ser-
viceable in glaucoma ; n solution of 0.1 ;i Gnu to 4 c.cm. (or gr. ii-f3j) of dis-
tilled water, a drop being instilled into the eye every fifteen minutes, soon
gives relief. In tlie prodronud stage of glaucoma it has a tendency to abort
tlie attack. During the aeute inflammatory period it rcliovf;^ pain. The
' Lancet, March 17. 1000.
*
»
application of escrino, moRMDver, is useful as a preparation for the operation.
Id coal-iuiners' nystagmus, M. Homie finds that a wllvriiim containing about
0.10 Gro. (or gr. iss) of e&erine sulphate to 30 e.em. (or fjj) of distilled
wil^r is of service in diminishing the oscillation of the eyeballs. One drop
of the solution is instilled into the eye thrice daily, and stnr'chnine sulphate
is at the same time given by the mouth.
It is useful in photophobia, reducing the amount of light by contracting
the pupil, and diminishing the blood-supply by emptying the blood-vessels.
Eserine is also employed in neuralgia of the eyeball, and to counteract the
aceesive action of atropine. In ulceration or suppuration of the cornea
and in strumous ophthalmia the local action of eserine is very beneficial.
As a myotic, vre may prescribe a combination of: —
B Phvsio&tiKnnmc aalipylntiH 1
PiffxMirpin. liyJrobroiiiiili 2
Aq. de»Un DO
Sig. : Instil a few drops in the eye, a8 directed.
Gm. or gr. xv.
Om. or ST, xxz.
c.cm. or fiiij. — M.
Internally, physostigma is useful in constipation due to defective secre-
tion and to insufficient peristalsis, combined with other remedies, such as
belladonna.
B Ext physoetigmatis ]00 Gm. or gr. j.
Ext. R<»lIadonna! folior ; ^65 Gm. or gr. j.
Res. podophyUi * |20 Gm. or gr. iij.
01. ctjuputi' |24 ccm. or miv.
M. et ft. nil. no. xij.
Sig.: Take ofie or two at bed- time.
Bftrtholow used the following formula : —
B Tinct. phyaofttigmatis,
Tinel nuda vomicae,
Tinct. belladonnffl folior aa 7|5 c.cm. or f3ij.
M. Sig.: Thirty drops in water morning and evening for constipation of bowels.
This combination is useful in treating the digestive disorders of women
It the change of life, relieving headache, vertigo, and flatulence. This rem-
edy is said to be useful in the treatment of dilatation of the stomach. In
tetanus, physostigma gives excellent results, recovery following in more than
litlf the cases. Care should be taken that the extract or other preparation
ased i£ of good quality, and it should be pushed until decided physiological
effects are produced. Of the present assiiyed official extract (2 per cent,
alkaloids), the dose to begin with would be 0.006 Gm, (or gr. Vio), by the
ctomiu'h, repeated every two hours, and increased or reduced, according to
fffect The hypodermic method is to be preferred. In strychnine poison-
ing, wliile the symptoms are modified, there has been no case of recovery
from die use of physostigmine alone, but the bromides might be combined
»itli it advantageously. In other nerve affections, chorea, and epilepsy, and
in progre.Hsive paralysis, great improvement has been noted. Physostigma
been successfully used in infantile convulsions after the failure of chIort>-
In convuUive disorders of individual muscles of the face (histrionic
WtftD, tic, twitching of orbicularis, etc.) good results follow its employment.
Cilabar bean has likewise proved beneficial in writers' camp. It has been
Died with success in the treatment of obstinate cases of hiccough.
irom
^ Titli i
■ in pr
732
PHAHMACEDTICAL THERAPEUTIC AGENTS OR DRrOS.
Temporary improvement, or arrested progress, was observed by Ringer
and Murrell in paraplegia supposed to be due to myelitis. The same authori-
ties saw improvement follow administration of the drug in locomotor ataxia.
Physostigma is alpo capable, at least, in some cases, of controlliug the night-
sweat* of phthisis. Murrell gave 0.01 Gra. (or gr. Vc) of extract in pill two
or three times during the night, or 0.001 Gm. (or gr. */eo) of a physostig-
mine salt, and found that not only was sweating suppressed for the time, but
that in some instances it did not recur for three or four weeks.
Professor de Giovanni, of Turin, has enjployed physostigma with good
results in cases of renal hemorrhage. He combines it with ergotin, as: —
B Ext physoatigraatia 138 Gm. or gr. vj.
Ergotin 2| Gm. or gr. xxx.
Ext. gentian q. 8.
M. et. ft. pil. no. xxx.
Sig.: One or two pillfl a day, increased every day by one until tlie desired effect
U produced or the limit of tolerance is reached. The same combination has be«n
found of service in the treatment of aymptoms dependent upon atheroma of the
arteries. If an assayed extract is useil, the doso of physostigiiui siliould be not
more thnn 0.006 Gm. (or gr. Vw) to bogin with.
In some affections of the air-passages, bronchitis, congestion of the
•lungs, and pneumonia, physostigma may be used to lower the excitability of
the vagus and the activity of the heart and respiration. On account of its
tonic ofTei^t upon the muscular coat of the bronchi, this drug is occasionally
eerviceable in bronchial asthma and cnipliyHciua. The tincture of physos-
tigma, when well iiia<lt', is a good preparation, but, for hypodermic and
ophthahnological purposes, physostigmine salicylate is preferable.
PHYTOLACCA (U, S. P.).— Poke-root.
Dose, 0.0C15 to 0.13 Gm. (or gr. i-ij) ; or, as an emetic, 2 Gm. (or
gr. XXX).
Preparation,
Fluidextractum Phytolaceae (l*. S. P.). — Fluid Extract of Phytolacca-root.
Dose, emetie, 1 c.cm. (or mx^'); ordinary. 0.10 com. (or tnifts).
Pharmacologfy. — The dried root of Phytolacca decandra (Phytolacca-
cetv only is ntheiab The active principle hns not been isolated; but the plant
contains a resin Jind an nlkaloidal principle, Phytolaocine, and Phytolaccio
acid; bUo tannin, oil, atarch, etc. The active constituent appear?i to be a
glucoside rcseinhllug, or perhaps identical with, saponin.
Physiological Action. — The powdered root is irritating to the air-pas-
sages, and when inhaled causes pains in chest, back, and abdomen, with in-
jection and irritation of the eyes, and occasionally vomiting and purging.
Applied to the skin, it occasions an erythematous eruption and excoriations.
Poke is emetic, cathartic, narcotic, and is clninied to be alierntivc. As it only
acts slowly, and creates much nausea and depression, it should never be used
as an emetic. It reduces the force of the pulge and frequency of the heart's
action, and also the rate of respiration. It acts decidedly upon the nerve-
centres, paralyzing the cord and medulla, death being produced by carbonic-
acid poisoning from failure of respiration. As it is a remedy easily obtained
and used by a class of "herb-doctors," it is not surprising that cases of fatal
poisoning have occurred. The antidotes are the diffusible stimulants, — am-
PILOCARPUS.
T33
i^lcohol, and ether, — with hypodermic injections of digitalis and small
of morphine and atropine, with artificial respiration and counter-irri-
tation.
Therapy. — In follicular pharyngitis, tonsillitis, granular eyelids, maa-
titifi, maliomant disease, varicose veins and ulcers, and in a large variety of
skin disorders — such as chronic eczema, sycosis, favus, and abscesses — vari-
ous observers have reported good results from the external and internal use
of poke-root. The following formulae are recommended; —
H Pulveris Phytolacca? 4
Camphone
Extriicti U'llndoniio: folior 4
Ungt zinci oxidi 31
Gm. or 3j.
65 Gm. or gr.
Gm. or 3j.
Gm. or 5j.
3£. For chronic ulcers, fissure and fistula, and mammary abscesses.
R Pulvis pliytolnooff 41
Ungt. resinse comp 31
K. Useful in boils and carbuocles.
Gm.
Gm.
or 3j.
or 5j.
The fluid extract, applied upon absorbent cotton, is useful in checking
the formation of a bubo. The pain produced by burns is alleviated by the
local application of phytolacca. The fluid extract is esteemed valuable in
the treatment of syphilis, scrofula, rheumatism, and in chronic skin dis-
eases. The tincture and the fluid extract have yielded good results in chronic
riieumatism and rheumatic swelling of the joints. Phytolacca is highly
esteemed by the laity as a remed}' for acute nmstitia, applied locally and
taken internally. M. M. Griffith claims that this remedy has very decided
power in diminishing obesity. A. A. DeLong, of Azftlia, Indiana, reports the
snccef^sfnl treatment of goitre in young women by tincture of phytolacca,
five dropg every three hours; combined with local painting with tincture
•>f iodine, until the skin blisters. After a few days, when skin heals, the
daily pnintine with odine is resumed.
^
PICROTOXINTTM (B. P.).— Picrotoxin.
A neutral principle prepared from the seeds of Anamirta paniculata
(Menispermace»), or Cocculus Indicus. (See Cocculus, U. S. P.)
Bosc, O.oorif^ tn 0.0027 Gm. (or gr. '/loo-Vss)- Antidotes: atropine,
cUoral hydrate, diffusible stimulants.
PHOCAEPUS (TT. S. p.).— Pilocarpus. JABOEANDI FOLIA (B. P.).
Dose. o.G.) to 4 Gm. (or gr. x-Sj), in infusion.
Preparations.
Fluuloxtractum Pilocarpi (U. S. P.). — Fluid Kxlrnct of Pilocarpus. Dose,
1 to 2 c.cm. (or miv-xxx).
rilocJirpinir Hydrochloridiim ( V, S. P. ).— Pilocarpine hydrochloride. Dose,
d.OOS to fuvj Gm. (or gr. '/,,-V.
Pilocurpinap Nitras {V. 8. P.. B. P.).— Pilocarpine Nitrate. Dose. 0.003 to 0.03
Gm. lor jrr. '/«-'/:!.
Kxtmctuni Jaborandi Ltqutdum (B. P.). — Liquid Extract of ^aborandi. DoM,
OJO to 1 c.cm. (or mr-xv).
Tinctura Jaborandi {B. P.). — Tincture of Jaborandi. Doae, 2 to 4 c.cm. (or
fSia-j).
Pharmacolog:y. — **The dried loaflets of Pilocarpus Microphyllus and
Pilocarpus Jal>nrandi (Rutaceap), yielding, when assayed by United States
pwofss, not less tlinn 0.5 per cent, of alkaloids.'* The British Pharmacopoeia
734 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
recognizes only the second named species. The leaves should be fully grown.
They contain an alkaloid, first isolated by Hardy, in 1874, known as Pilo-
carpine (V4 to V2 or 1 P^r cent.). N. A. D. Jowett, in 1900, found a basic
fiubstance isomeric with pilocarpine, and is hence described as IsopilocarpiBt
It is a liquid, and can be obtained from pilocarpine by the action of heat or
alkalies. There is also present a small proportion of Filocarpene, volatile
oil, and probably a peculiar' acid. The active principles are soluble in alco-
hol, but only imperfectly so in water.
Physiological ActioiL. — In about fifteen minutes after jaborandi hu
been swallowed, the face flushes and perspiration occurs, with more or lea
salivation, the two being related to each other in such manner that if there
is little action upon the skin there will be more discharge of secretion from
the salivary glands, and when the skin acts freely the salivation will be less.
The profuse sweating removes not only water, but other matters from the
blood, as it has been found to carry off urea and certain excrementitious ma-
terials. Arterial tension is reduced and temperature falls 1" to 4**. The
decrease is due to a diminished heat production, but may, in part, be caused
by sweating.
The action upon the skin is attributed to vasomotor paralysis, and the
sialagogic action to stimulation of the peripheral nerves of the glands.
Jaborandi also increases the action of the heart and respiration, but in larger
doses depresses them by its paralyzing action on the vagus. Contraction of
the pnpil, with impaired power of accommodation, has been observed to fol-
low its use. The same result is produced by its topical application. Atropine
and muscarine are antagonistic in their effects to jaborandi or pilocarpine.
Pilocarpine readily diffuses into the blood, and is eliminated chiefly by
the skin and salivary glands. Most secreting glands are similarly affected,
to a greater or less degree. The gastric and pancreatic fluids are decidedly
augmented. A certain, though less powerful, stimulant effect is exerted
upon the liver. The lacr3rmal, mammary, and bronchial mucous glands are
also excited. It increases the discharge of urea by the kidneys, but not the
urinary water. Small and repeated doses of pilocarpine, however, have a
diuretic effect. It causes contractions of the uterus and may induce abor-
tion; it also reduces the size of the spleen. Children are less susceptible than
adults to the action of pilocarpine. Demme, of Berne, has observed that, un-
der four years of age, the action of this substance is more decided upon the
salivary glands than upon the skin.
Serious and even fatal consequences have occurred as a result of injec-
tion of medicinal doses of pilocarpine. After employment of 0.02 Gm. (or gr.
^/g) a patient suffered from profuse diaphoresis, salivation, lacrymation, a
discharge from the nose, sickness of the stomach, difficulty in breathing,
and a sense of cardiac oppression. Internal and external stimulation caused
the symptoms to disappear. Remy mentions a case in which the remedy
induced a series of epileptic attacks. In another case the patient suddenly
expired directly after an injection had been made. Such accidents shoold
teach caution in the use of the remedy. Pilocarpine should not be used in
the condition of status lymphaticus, or where there is danger of pulmonary
oedema. Atropine is a physiological antidote to jaborandi.
Therapy. — It has been noticed by Prentiss that under the use of pUo-
carpine the color of the hair darkens. It may thus be combined with a
stimulant application to the scalp: —
PILOCAKPLS.
735
H Klindr\in»cti pilo-arpi
Lin.
a poms
a a 15| c.em. or fSss.
. . 60 ccm. or fSij.
*
Spiritua odorati
M. Siff-: To be applied to the scalp once daily, with friction, for alopecia and
{tiling of the hair.
In cases where diaphoresis is desired in order to remove matters from
the blood or reduce temperature, pilocarpus is a convenient agent. Da
Co8ta uspd it in acute erysipelas, where it is so effective that it might almost
be regarded as a specific. In diphtheria, also, it is serviceable, but the de-
pressing effect upon the heart must be kept in mind. Pulmonary oedema,
too, may follow the administration of this drug; so that, although it is
capable of detaching false membrane, it is of doubtful value, demands vig-
ilant watchfulness, and should only be administered to previously strong in-
dividuals. Similarly, in mumps or parotitis it often abruptly stops the
course of the disease. In agalactia of nursinp women, small doses of pilocar-
pine restore the secretion of milk. Where there is oedema or effusion, the
fluid extract of jaborandi is very commonly employed, in moderate doses,
to keep up the action of the skin and increase the elimination of urea. In
diabetes insipidus, alternated with the fluid extract of ergot, it reduces the
urinary flow very decidedly. In asthma, or hiccough, an hypodermic injec-
tion of pilocarpine is sometimes promptly curative. Pilocarpine given sub-
cutaneously may be of service in controlling the convulsive attacks of hystero-
epilepsy and maniacal excitement. It was employed with much advantage
by Dr. Kemig in the status epilepticus. Dr. Ch. Fer6, on the contrary, whose
experience in nervous disorders is large, asserts that he has never witnessed
benefit from the injection of pilocarpine in epilepsy, and that sometimes it
even seems to bring on a paroxysm. Jaborandi has been advantageously em-
ployed in whooping-cough. In small doses it, or its alkaloid, is useful in
chronic bronchitis and winter cough. In doses sufficient to excite free dia-
phoresis, this remedy has proved very efficacious in the congestive stage of
pneumonia, rapidly ameliorating the local condition and reducing the fever.
When atropine is administered to check ni^ht-sweats in phthisis, it may he
combined with fluid extract of jaborandi, which, as pointed out by Da Costa,
relieves the dryness of the throat caused by the atropine. Pilocarpine itself
is by no means an inefficient remedy for this manifestation, and the hydro-
chloride may be given niglitlv in 0.003 Om. (or gr, */.„) dose by the mouth,
with, usually, a good effect both upon the sweats and the cough. Professor
Ringer has cured several cases of unilateral sweating by the hypodermic in-
jection of full doses of pilocarpine. In ptyalism. also, pilocarpine has been
tdrantageously employed in the same manner. In amblyopia of tobacco and
aJcoholic origin, and in amaurosis, pilocarpine is frequently used with good
effect, and also in many other lesions and disorders of the eyeball. A few
dropfl of a solution of pilocarpine (0.13 Gm. to 30 ccm., or gr. ii-f'j) may be
locally employed with advantage in rheumatic iritis. The subcutaneous use
of this remedy is also of avail in the same disease. Dr. G. H. Burnham, of
Toronto, reports a case in which this method was followed by very excellent
rwults. There was no iritis, but the centre of each cornea was studded with
infiltrations. The pupillary area was involved and vision was very imper-
fect. The infiltrations disappeared, vision gained greatly, and the general
mtnifestations of chronic rheumatism were also improved. Internally, the
tllctloid Ib sometimes beneficial in detachment of the retina, and decidedly bo
736 PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
in optic neuritis. Its action upon the pupil enables it to be used in place of
pbysostigmine. Staderini^ (Annali ai Ottalmologia) advises pilocarpine
nitrate, subcutaneously^ in many inflammatory diseases of the eyes, especullj
in those that are the consequence of rheumatism, as episcleritis, iritis, and
idiopathic optic neuritis. Pilocarpine nitrate thus given, he states, subdues
inflammatory conditions of the iris and of the ciliary body which supervene
when masses of the cortical substance of the lens remain in the anterior
chamber after the operation of extraction of cataract. Pilocarpine, the same
writer believes, promotes the absorption of non-organized opacities in the
vitreous humor, especially when these opacities are the consequence of recent
infiltration. Progressive myopia, he further adds, shows improvement of
vision after pilocarpine injection. In glaucomatous conditions of children,
when physostigmine does not agree with the patient, Drs. Saint-Oennain and
Valude advise a coUyrium containing 0.29 Gm. (or gr. ivss) of pilocarpine to
9.25 com. (or fSiiss) of distilled water. M. Berger adds pilocarpine to solu-
tions of cocaine for use in the eye in order to avoid difficulties of mydxiasia
and a disturbance of accommodation. His formula is: —
B Cocaine hydrochloridi,
Pilocarpin. hydrochloridi aa 1130 Gm. or gr. zz.
Aq. destilL 00| ccm. or Qtij.—M.
Dr. A. D. Macdonald records a case, believed to be one of labyrinthine
deafness, in which decided improvement followed the subcutaneous injection
of pilocarpine. Professor Politzer and others teach that the hypodermic in*
jection every day of 0.002 Gm. (or gr. Vao) o^ pilocarpine will cure certain
cases of inflammatory, syphilitic, and hagmorrhagic deposit within the laby-
rinth, especially when of recent occurrence. If, however, no improvement
has taken place after the lapse of a fortnight, Politzer believes that no advan*
tage will result from persistence in the use of the remedy. Pilocarpine ii
beneficial in acute suppuration of the middle ear, with perforation of the
membrana tympani. It is seldom useful when the membrane remains intact
and the cavity is occupied by hardened inflammatory products, though it has,
in some instances, promoted their absorption. Pilocarpine is of service in dry
sclerotic catarrhs of the middle ear. Politzer also employs pilocarpine locally
in affections of the middle ear to which it is adapted, injecting from 6 to 8
drops of warm 2-per-cent. solution through a catheter into the Eustachian
tube and tympanic cavity.
Dr. Suarez de Mendoza has, in three cases, relieved argent dyspncet
from oedema of the glottis by hypodermic injections of pilocarpine.
The action of jaborandi upon the glands of the skin makes it useful in
many cases of chronic skin disorder, especially of the dry character.
Klotz has recently reported very favorable results from the hypodermic
injection of 1.20 to 1 ccm. (or mx-xv) of a 1-per-cent. solution of pilocarpine
hydrochloride in chronic eczema. The hard, dry, and fissured condition of
the skin was remarkably improved. Dr. Poulet suggests that the same pro-
cedure may be of service in the treatment of elephantiasis arabum. In some
instances, jaborandi given internally has alleviated urticaria. Small doses of
jaborandi by the mouth, or of its alkaloid subcutaneously, have proved
remedial in hyperidrosis and bromidrosis. Pruritus is not uncommonly re-
» *TiIocarpine in Ocular Therapeutics." by G. Staderini, 8t. LauU CHniqw, Jan,
1891.
PILOCARPUS.
737
I
lieTed by this agent. The itching of jaundice is amenable to the influence
of pilocarpine. Dr. Robert M. Simon, of Birmingham, England, finds noth-
ing 80 useful as pilocarpine hypodennically iu the treatment of pruritus
wnilis. It affords marked relief to the itching and permits the patient to
sleep.
Pilocarpus can be administered for the diseases just named as follows: —
B Fluidextracti pilocarpi .
SpirituA ffitheria nitrosl,
6pirilu» juniperi
Syrup ^'
M. Sig.:
15| c.cm. or ffss.
aa 001 c.cm. or fSij.
limonia q. s. ad 180J c.cm. or fjvj.
Prom a half to a tablespoonful in water every two or three hours.
B Infus. pilocarpi,
Infus. digitalis aa 60|
M. Sig.: Pwo tcaspoonfulB every two or three hours.
c.cm. or fSij.
I
By Wilkoweki, the hypodermic injection of pilocarpine is re^^arded as
almost a specific in catarrhal jaundice. He attributes, moreover, a diagnostic
value to the procedure. Jf a treatment of ten to fifteen days produces no
effect upon the jaundice, the presence of a malignant growth of the liver
is to be suspected. For the relief of dry tongue, or aptyalism, J. P. Black-
mans strongly recommends 0.0003 to O.OOOG Gm.(or gr. Vsoo-Vioo)of pilocar-
pine, inclosed in gelatin and allowed to melt on the tongue, which should be
prcriously moistened with a little water. A moderate flow of saliva is ex-
cited within twenty-four hours, and general diaphoresis is never produced.
The dr^Tiess of the mouth, often so troublesome in diabetes mellitus, is
rehered by the following prescription: —
It Pilocarpin. nitrat 048 Gm. or gr. '/«■
Alcohol. (40* ) 6 c.cm. or mxc.
Aqiifc dest . . 7 6 c.cm. or f3ij.
>L Sig.: Five or six drops of this mixture, either pure or diluted with 2 c.cm. (or
fSaa) of water, are dropped upon the tongue several times a day.
Pilocarpine has been found useful in the exanthemata, in conditions of
suppression or retrocession of the rash.
Pilocarpine may be used hypoderraically for the same purposes as jabo-
rsndi by the stomach, and is less apt to be followed by nausea and vomiting.
Two eg. (or gr. V») under the skin generally causes free diaphoresis, while
0.03 Qm. (or gr. ss) produces such an amount of sweating as to frequently lead
to a dangerous degree of proiftration. The first dose should not exceed, for
iin adult, 0.01 Gm. (or gr. V/^). This dose usually is well borne, even by
guhjectfl of hoart dipense. Pilncarpine is a gond substitute for the Turkish
and other sweating baths in the treatment of ascites and serous effusions gen-
praJly, and of cedema. In insomnia, witli excitement bordering on mania,
the administration of pilocarpine hypodermieally onuses relaxation and
lowers arterial tension. E. F. Willougliby' has found this highly useful in
the first stage of influenza. Saundors, of St. liouis, praises it as an adjuvant
to antitoxin in the treatment of diphtheria, and oliiimR to have treated 300
cucfl without a death. Small doses are useful in croup.
Pilocarpine, subcutaneously, has been employed successfully in bella-
donna poisoning. McQowan relates a case {London Lancet) in which two
^The ThcrapUt, London, 1898.
I
738
PHARMACEUTICAL THERAPEUTIC AGENTS OU DHUOS.
injections of 0.03 Gm. (or gr. ss) each were undoubtedly the means of saving
the patient's life. The same procedure is recommended as beneficial in acute
alconolism.
It can likewise be used with good effect in the albuminuria of preg-
nancy. Dr. E. L. B. Godfrey has prescribed pilocarpine very advantageously
in this disease as follows: —
R rilooarpinffi liy'lrochloridi
Fotassii bicarbonatU 12
Acidi benzoic! 4
Tinct. cardamomi 15
Aqus q. ». ad 90
M. 8i^.: A teaspoonful in water every three hours.
13 Gni. or gr. ij.
Om. or diij.
6m. or 3j.
c.cm. or f^.
c.cm. or fjiij.
H
Pilocarpine is, however, an inappropriate remedy in oedema dependent
upon disease of the heart, and should never be employed if the heart-muscle
be decidedly weak and its cavities dilated. In malarial or renal dropsy, on
the contrary, (his alkaloid is of signal efficacy. Dr. Louis Waldstein claims
favorable results in oases of cnlRrcrcd lymphatic glands and lupus, from the
hypodermic injection of pilocarpine.
In chronic rheumatic disorders and some skin affections such diapho-
retic treatment is serviceable. Muscular rheumatism and sciatica have also
been ameliorated by the same method. In acute parenchymatoius inflamma-
tion of the kidneys, pilocarpine is of the greatest service, increasing the uri-
nary water and decreasing the albumin and blood. In acute scarlatinal
nephritis pilocarpine is a valuable remedy, especially employed as follows: —
R Fltiiiiextrncli pilocarpi I5f c.cm. or fjes.
Mistursc polassii citratis 60 ccm. or fjij.
Syrup, aurantii 45l c.cm. or f Jim.
M. Sig.: A teaspoonful or two every three or four hours.
In ura?mic accidents and puerperal eclampsia the hypodermic injection
of pUocarpine is of marked benefit, but, according to Phillips, eudaugers the
life of tlie foetus. H. Molliore, of Lyo^s, has witnessed good results in
nepliritis from the application of an ointment containing from 0.065 to 0.10
Gm. (or gr. i-iss) of pilocarpine nitrate to 93 Gni. (or Jiij) of soft petro-
latum. A stronger preparntion will eauj^c an eruption. He has found it use-
ful in all cases except when uncmia is present.
The fulgurant pains of locomotor ataxia may soractiraea be relieved by
subcutaneous injection of the alkaloid, and in septicaemia it has materially
modified the symptoms, even when failing to prevent death. In some in-
stances it has proved successful in hydrophobia. Professor Ringer found the
hypodermic use of full doses of pilocarpine of decided efficacy in cases of
unilateral sweating.
An hypodermic injection of pilocarpine may arrest an attack of hic-
cough, or of asthma, and should be given a trial in acute pulmonary cedcma.
A cold may be broken up by small doses of pilocarpine followed by quinine.
A dose of pilocarpine will generally succeed in averting or cutting short a
malarial chill.
PIMENTA (U. S. P., B. P.).— Allspice, Pimento.
Dose, 0.65 to 2.60 Gm. (or gr. x-xl).
Preparations,
Oleum Piment« (U. S. P., B. P.).— Oil of Pimenta. Dose, 0.03 to 0.32 c.cm.
(or msfl-v).
PIPEB.
739
Aqua Pinientje iB. P.). — Pimento-water (pimento, 250 Om., or S^* water, 10
litm, or Oxxj; distill onebaU).
Phannacolo^. — "The dried nearly ripe frnit of Piraenta officinalis**
(Myrtacea'). of tropical America, is an aromatic stimulimt, mainly used as a
spice to promote appetite and digestion. It contains a volatile oil, which ifl
oCGcial (3 to 4 per cent.), some Ibced oil, resin tannin, gum, etc. A fluid
eztract is also made, but is not official (dose, 0.50 to 2.50 c.cm., or wiviii-xl),
and an aromatic water.
Phyuolog^cal Aotioa and Therapy. — Allspice is a pungent^ aromatic
itimnlant, acting as a carminative, and stimulating the secretions of the
mouth and stomach. It may be used to disguise the taste of unpalatable
drugs, and is one of the ingredients of spice plasters. The oil can be added
to pill-masses to prevent the griping of purgatives.
PDIPINELLA.— Pimpernel. The root of Pimpinella saxifrage (TJm-
beliifcne), growing in Euro[>e, contains a golden-yellow volatile oil with an
odor regembling that of parsley-seed, some acrid resin, and benzoic acid.
Physiological Action. — It exerts decided effects over mucous mem-
branes, and 18 diuretic and expectorant.
Therapy. — Used in catarrh of various parts of the body, including
gastric catarrh and bronchorrhoea. It is best given as fluid extract.
TUTL OIETTM (B. P.).— Oil of Pine. (See Oleum Pini.)
PUnJS STKOBTTS.— White Pine. The inner bark of Pinus strobus
«I*iDAce8e). Of uncertain physiological action, but thought to be expeotor-
unt. Is an ingredient in syrupufl pini airobia compoeitus (N. F,), used as
j a cough remedy.
PDnrS CANADENSIS.— Hemlock Spmce. The dried bark of the
Tguga Canadcnr^is (Pinaceae) contains a considerable quantity of tannin,
T^th a little volatile oil, and is largely used in the tanning industry.
Therapy. — In the form of a dilute, alcoholic fluid extract this is a con-
Tenient agent to be employed where the effects of tannin are desired. It is
u«d principally as a local astringent in pharyngitis, tonsillitis, uterine
catarrh, and hemorrhoids, applied in full strength; or it may be used
diluted as a wash in leucorrhoea or gleet. This drug may be employed in
<3ianha?a of adults, although in such cases the prescription had better be
written at once for tannic acid in the desired quantity.
Caation, — A white extract of Pinus Canadensis of proprietary character
wntains zinc sulphate, and should therefore not be taken internally, but
used only as an extenial application or wash. It rapidly relieves the pain
<^t% bum, when applied in full strength, according to Dr. W. C. Wile.
PIPER (TT. S. P.).— Pepper.
PIPEE NIGEUM (B. P,).— Black Pepper.
Dote, 0.13 to 1 Gm. (orgr. ii-xv).
Preparations.
OleoresinK Pipcrl» (U. 8. P.).— Oleorcsin of Pepper.
•Vrj).
DoM. 0.016 to 0.00 c.cm. (or
740 PHARMACEUTICAL THEEAPBUTIC AGENTS OR DBUOS.
Pipemum (U.S. P.). — Piperin (a neutral principle obtained from pepfier, ud
occurring also in other plants of the same natural order). Dose, 0.03 to 0.66 Om. (or
ffr. 8^x ) .
Ck>nfectio Fiperis (B. P.).— Confection of Pepper (black pepper, 40;«eexm7-
fruit, QOi and clarified honey, 300 Gm.}. Dose, 4 to 8 Gm. (or 5i-ij).
FlLarmacology. — Pepper is the dried "unripe fruit of Piper nigrum"
(Piperaceffi) of India and neighboring islands. The berries are small,
pungent, and spicy to the taste, and of aromatic odor ; they contain Pipcrine,
volatile oil, pungent resin, fatty matter, etc. The oleoresin, extracted by
ether, contains the volatile oil and acrid resin, with a little piperine. The
latter is in pale-yellow prisms, and may be contaminated with some of the
volatile oil.
Physiologioal Action. — Pepper is an irritant externally and internally.
Owing to its pleasant pungency it is largely used as a condiment at the table.
It is decidedly stimulating to the digestive organs and to the circnlation, and
also, but to a less degree, to the kidneys, as it passes out of the body by the
urine. Pepper likewise promotes the action of the skin. If taken in ex-
cessive quantities its local action is sui&ciently powerful to excite inflamma'
tion of the gastro-intestinal mucous membrane, and cases are on record in
which pepper has produced delirium, rigors, and convulsions.
Therapy. — In flatulent dyspepsia and feeble digestion, pepper may be
advantageously taken with the food. It is an ingredient of the Asiatic pill
which has been used in haemorrhoids, with decided benefit : —
B Arseni troxidi 120 Qm. or gr. Uj.
Piperia ISjS Gm. or Ju-
M. et ft. pil. no. be.
Big.; A piU after meals for indigestion and hoBmorrhoids.
Lozenges containing pepper have also been successfully employed for
the relief of haemorrhoids, ulcers of the rectum, and fissures of the anus. Dr.
Whitla suggests that cubeb be added, and the balsam of copaiba be substi-
tuted for the inert honey which enters into the formula of the British con-
fection of pepper. He also recommends the following preparation in atonic
condition of the lower bowel: —
B Pulv. piperia nigri,
Pulv. carui,
Pulv. cubebffi aa 15|6 Qm. or Sss.
Mel despumatn q. s.
Ft. electuarium.
Sig.: A teaspoonful three times a day.
Pepper is largely used in domestic medicine as a gargle for sore throat
and is not without effect in relaxed uvula. It has also been made into an
ointment, and applied with success to tinea capitis. Piperin has some anti-
periodic powers, and is a good addition to a pill for chronic malaria. In nen-
ralgia it may be locally applied as a counter-irritant.
PIPEEAZni".— Piperazin, a synthetical compound [(C,H^NH), or
C4HJ0 Nj] , which may be prepared by several patented processes. Its chemi-
cal title is diethylenediamine. It occurs in the form of colorless, acicnlar
crystals, of a pleasant taste and freely soluble in water. It is an admirable
solvent for uric acid, with which it forms a neutral and very soluble salt.
PIPBRAZIK.
741
tperiinente iu the laboratory demonstrate the solvent action of a l-per-
i. solution upon calcuH, not only those composed of uric acid, but also
those containing calcium phosphate, ammonium urate, etc. Piperaziu urate
is said to be seven times more soluble in water than lilliium urate, and piper-
aziu will render soluble twelve times as much uric acid as lithium carbonate.
With hydrochloric acid it forms an eavsily soluble and crystallizable salt.
Piperazin is a deliquescent body, and should not, therefore, be prescribed in
the form of a pill or powder, but in solution con^^isting of 20 parts of
alcohol and S() of water. The dose is 1 to 2 Gm. (or gr. xv-xxx) a day, in
aeveral doses, diluted with plain or carbonated water. It combines with
cinchona, forming piperaxine cinchonate (Sidonal), and also with tartaric
acid (see Lysidine).
Physiological Action. — Piperazin is non-toxic and unirritant to mucous
membranes with which it comes in contact. It is without etiect upon diges-
tion, circulation, or respiration. This substance passes through the system
unchanged, and speedily appears in the urine in a state of combination with
uric acid. Piperazin has been recognized in the urine two hours after inges-
tion, Piperazin has no effect upon the acid reaction of that fluid, and does
not increase its quantity. Wittback, however, in studying the urine of pa-
tients taking piperazin, has observed cases in which its quantity was largely
increased. Tne specific gravity was always diminished. The acidity of the
urine was decreased. In some experiments upon themselves, Drs. Heubach
and Kuh, after taking 2.40 Gm. (or gr. xxxvij) during the day, experienced
severe headache on the following morning, and upon one occasion vomiting
occurred. Tremors, hallucinations, and clonic spasms have been obeerred
^ Stewart as a result of full doses of piperazin.
Therapy. — In accordance with its chemical properties, piperazin has
been found an efficient remedy* in litha?mia and other manifestations of tlie
uric-acid diathesis. Renal and vesical calculi, due to the deposit of uric acid,
hare been extruded under the influence of this remedy. Piperazin is like-
wise serviceable by dissolving the orj^anic matter contained in the stones.
Calculi in the bladder may also be attacked by the injection of a solution of
piperazin into the viscns. Dr. V. Schmey has obtained good results in
chronic cystitis by the administration of piperazin in sufficient doses to satu-
rate the urine. A solution in alcohol and water has been applied locally to
gouty joints and swellings, and aids the effect of the internal administration.
A combination of piperazin and phenocoU is warmly recommended for the
relief of gout. Piperazin has also been advantageously associated with
phenacetin in the treatment of gout.
Dr. Eccles has employed piperazin with advantage in chronic rheumatic
arthritis, and Dr. Heubach relieved lumbago by the hypodermic injection of
a 2-per-cent. solution, in quantity equal to 0.20 Gm. (or gr. iij) a day. The
iDJections gave rise to some pain, but did not cause abscesses or unpleasant
after-effects. Dr. Disbrow, of Newark, N. J., saw alleviation of panestheaia
from the administration of thia agent. Piperazin has proved of service in
rcnti colic and haemorrhage from the urinary passages. Piperazin was em-
plo^'ed by Gruber in a case of diabetes, 0.32 Gm. (or gr. v) doses being given
thrice daily, the diet bein^ at the same time properly restricted. The pro-
portion of sugar excreted was reduced and the general condition
ptient improved. Other writers have also observed subjective and obj
^proveinent follow the use of piperazin in diabetes.
of the J
ijective ^J
742 PHARMACEUTICAL THERAPEUTIC AGENTS OH DRUGS. ^^M
Piperazin may be acceptably given in the form of an aerated \vater,
1 Gm. (or gr. xv) being dissolved in a quart, and the entire quantity taken
during the day. It is also prescribed dissolved in distilled water and flavored
with a little ayrup of orange or other agreeable vehicle. Piperazin is incom-
patible with alkaloids and salts of iron, with tannic acid, alum, preparationa
of cinchona, Donovan's solution, potassium permanganate, sodium salicylate,
acetanilid, and phenacetin.
Lysidin, — Ladenburg has recently directed attention to this substance,
which is ethylene-ethenyl-diamin, a reddish-white, crystalline substance of
peculiar taste, suggesting the odor ol mice, which is so h^'groscopic that for
convenience in dispensing it is eupplied only in 50-per-cent. solution. It is
Btrongly alkaline, and is said to have five times the power of piperazin as a
uric-acid solvent. Professor Ladenburg uses it in gout, in daily doses of
1 to 5 Gm. (or gr. iv-lxxv) in aerated water. It is claimed to be entirely free
from toxic effects or disagreeable consequences.
Lycetol. — A substance known commercially as lycetol, which chemic-
ally is (li-niothvl-pipcrnzin tartrate, is thought to be superior to uncombined
piperazin, as the tartaric acid is claimed to split up into carbonic acid, alka-
linizing the blood and dissolving uric acid. Lycetol has a diuretic effect and
may be used in gout in the daUy dose of 1 to 2 Gm. (or gr. xv-xij). The
addition of sugar to a solution of lycetol produces an acid drink similar to
lemonade.
PISCIDIA EEYTHKINA.— Jamaica Dogrwood. The bark of the root
of Piscidia crythrina (Leguminosae), a tree of the West Indies, growing to
the height of twenty feet, has a hea^7, narcotic odor, recalling that of opium,
and has a bitterish, acrid tasto It contains Fiscidin* a neutral, crye-
tallizable, resinoid substance, insoluble in water, but soluble in alcohol, be-
sides other resinous substances, oil, tannin, etc., but it has not yet been
determined to which of these the physiological effects are attributable.
Some useful preparations of this agent arc: Extractum piscidia (extract of
Jamaica dogwood); dose, 0.13 to 0.65 Gm. (or gr. ii-x). Puhis extract!
piscidiae (powdered extract of Jamaica dogwood); dose, 0.13 to 0.f>5 Gm. (or
gr. ii-x). Pilula piscidiae (made from the extract), containing 0.13 Gm. (or
gr. ij). Fluidextraetum piscidiic (fluid extract of Jamaica dogwood);
dose, 2 to 7.50 c.cm. (or f3ss-ij).
Physiological Action. — According to the experiments of Prof. Isaac
Ott, Jamaica dogwood is narcotic to frogs, animals, and men. It enhances
the secretion of the skin, reduces the frequency of the pulse, raises arterial
tension by stimulating the vasomotor centre, the increase being soon fol-
lowed by a fall due to a weakening of the heart. It causes a tetanoid state
by a stimulant action upon the spinal cord. Jamaica dogwood likewise causes
dilatation of the pupil, followed by contraction as asphyxia develops. It
causes death by either heart-failure or, what is more frequent, by arresting
respiration. Pitcher has observed several cases in which alarming symptoms
supervened from 0.50 c.cm. (or ffiviij) doses every three hours. Jamaica dog-
wood, used medicinally in suitable doses, will not diminish the appetite or
cause constipation. It is seldom followed by nausea, headache, or other
unpleasant effects.
Therapy. — Jamaica dogwood, in hiemorrhoide, has been euccessfully
used locally in conjunction with lead acetate. A cloth saturated with the
PI80IDXA EHTTBBXifA,
743
I
fluid extract has been found efticient in superficial burns and scalds. Flagg
states that the fluid extract of Jamaica dogwood has been found to poseesa
decided value as a local and systemic analgesic. In general practice this com-
bination of effect is frequently desirable, and in dental practice it will be
recogTiized as especially valuable in treatment of periodontitis, alveolar ah-
Bcees^ pulp irritation, and other painful conditions within the oral cavity,
as topical applications, with directions to swallow the saliva, promptly induce
relief. Flagg also recommends 0.30 to 0.(50 c.cm. (or mv-x) of the fluid
extract given at the same time, in the diseases named, every hour or so as
reqiured.
Internally, Jamaica dogwood allays pain, relaxes spasm, quiets reflex
excitability, and promotes sleep. It is coDsequently well adapted to act aa
a substitute for opium, especially when, as is not infrequently the case, the
latter drug is not well borne. In the various forms of neuralgia, including
sciatica, Jamaica dogwood has proved of value. Gastro-enteralgia, conse-
quent to typhoid fever, has been also notably relieved by it. In the lanci-
nating pains of locomotor ataxia it has, however, proved ineiTicient. Dr.
Li^geois has found this drug of service in allaying the continuous cardiac
pain due to arteriosclerosis. When angina pectoris has developed he con-
eideiB Jamaica dogwood to possess a certain prophylactic power by virtue
of its sedative effect upon the circulation. As synergistic drugs he some-
times combines aconite and veratrum viride: —
B Tinct pisriditp.
Tinct. veratri ma 161 e.cTO. or Ijsa.
TSnct. Bconit. o|20 c.cm. or fSiiss.
Of the above mixture he gives, during one-third of tlie month, 1 c.cm.
(or mxv) three times a day, placing his patient, for the remainder of the
month, upon sodium iodide.
In pelvic neuralgia, the pain produced by fibroma of the uterus, and
in dysmenorrhcea piscidia has been found of much service. This remedy is
likewise able to quell the pains of false labor and of threatened abortion, in
which, and in dysmenorrhoea, it is well combined with viburnum prunifo-
lium, as: —
I
rinidpxt. pisciiliflp
FluiU(*xt. viburni pi-unifolii
Syrupi aurantii aa 30]
IL Sig.'. A tfoflpoonful. to be repeated every hour or two.
or ISj.
I
The pain due to a fractured bone may be assuaged by administrations of
this airent. which is also beneficial in acute or chronic rheumatism. The
ptins of inflammation may likewise be ameliorated by Jamaica dogwood.
In panophthalmitis, iritis, iridocyclitis, and in acute abscess of the auditory
meatus it is also capable of relieving the suffering. The pain of carcinoma
has been assua/rcd by this remedy, which may here not infrequently replace
opium with adrantace. On account of its antispasmodic virtues, it is of con-
iiderable service in alleviating the paroxysms of asthma and whooping-cough,
•nd cases of chorea have been reported in which it proved of benefit.
It is also beneficial to coughs of reflex origin, of bronchitis, and of
Clmonarr tuberculosis. Ilysterical convulsions have yielded to the in-
ence of this drug. Piscidia quiets restlessness and delirium, and induces
fbrp in delirium tremens and mania a potu, and has been employed with
744 PHAHMACEUTICAL THERAPEUTIC AQENTS OR DRDQ8.
gratifying succees in the insomnia of insane patients. In insomnia, however
caused, this agent fulfills an excellent service. Uterine colic and cholera
morbus likewise prove amenable to its action.
PIX BITRGTJNDICA (B. P.).— Burgundy Pitch.
Preparations.
H
EmplaatruTn Picis Burfrundicic. — Burgundy- Pitch PlasUr.
Emplostrum Picis Cuntharidfttum. — C'aiitbnridal-Pitch Plaster (cerate of can-
tharides, S; Burgundy pitch, 02 parts).
Euiplttstnim Picia (B. P.).— Pitch Plaster.
Pharmacolo^ and Therapy. — Burgundy pitch is "the prepared, resin-
ous exudation of Aliios exccka" (Conifora*) ; the resinous exiidalion obtained
from the stem of Picca excclsa (B. P.) : a tree of southern Europe. It is a
resin with traces of volatile oil. It lias some balsamic properties, and is
alightly irritating to the skin. In exceptional instances its local action is
severe, and it ^ves rise to vesicles and pustules, or even produces ulcera-
tion. TJte olliciiil plasters are mild counter-irritants. The warming plaster
is useful in chronic rheumatic swellings and in affectinns of the chest. Bur-
gimdy pitch has been thought to have some sjiocial action upon the rectum,
and for this reason has been given in ha?morrhoiils, made into a pill with tar.
Burgundy pitch ixlso enters into emplastrum galbnnum, ii'on phisto^r, and the
United States Pharmncopceia opium plaster.
Dr. L. M. Houser observed a case of intoxication in a child, 8 years of
age, who had eaten a email quantity of the exudation from the tree. The
symptoms were extremely dilated pupils, mental excitement with hallucina-
tions, and frequent micturition. The patient recovered, but the pupils re-
mained somewhat dilated for several days.
PIX CANADENSIS.— Canada or Hemlock Pitch.
Pharmacology. — The prepared resinous exudation of Abies Canadensis
(Conifera?) contains resin and a trace of volatile oil. The uses are similar
to Pix Bur^i^undica.
PIX IIQITIDA (U. S. P., B. P.).— Tar.
Preparations,
Syrupua Picia Liquidee (U. S. P.). — Syrup of Tar. Dose, 4 to 7.6 e.cm. (or f3i-ij).
Oleiun Piiis Liquidae (U. S. P.).— Oil of Tar. A volatile, oily liquid distilled
from wood tnr.
Unguentum Picis Liquidie (U.S. P., B. P.).— Tar Ointment (U. S. P. contains 60
per cent, of tar).
Liquor Picis Carbonia (B. P.). — Solution of Coa1-tar (prepared coal-tar, 200 Gm.;
quillainbnrk. 100 Gm.; percolated with nloohol. 90 per cent, q. a. 1000 e.em.).
Pix Carbonia Prwparata (B. P.). — Prepared Coal-tar (prepRred by placing coal-
tar in a. ahallow dish and maintaining it at a temperature of 120° F. for one hour).
Pharmacology. — Tar is a liquid, empyreumatic oleoresin, "a product
obtained by destructive distillation from the wood of Pinus palustris and
other species of pinus" (Pinaceae) of Europe and America ; that coming^ from
Nortli Cnrolina and Sweden is tlic host. The British Phnrmacopceia de-
scribes tar as "a bituminous liquid, obtained from the wood of Pinus sylves-
tris. and other s|ieciea of Pinus by destructive distillation ; known in com-
merce as Stockholm tar.^' It should be free from mechanical impurities. It
containB oil of turpentine, pyrocatecbin, acetic acid, acetone, methylic
acid, xylol, creosote, phenol, etc., and is blackened by wood-smoke. Tar ie
soluble in less than its own bulk of alcohol or chloroform, is slightly soluble
in olive-oil or oil of turpentine. By distillation it yields an acid Uquor called
pyroligneous acid, and an empyreumatic oil, called oil of tar, which is official.
The oil has but little color when fresh. It deepens with age to a dark-red-
dish brown. It is a volatile fluid, of acid reaction, has the odor and taste of
tar, and is «olubie in alcohol. What is left lithind is pix navalis, or pitch,
which ie a black solid, presejiting a siiining, fractured surface, melts in boil-
ing water, and consists of resin with various einpyrtainiatic resinous products,
which have collectively received the name of Pyretin. The creosote of tar is
of special interest on account of its antiseptic and preservative properties,
from whence it derived its name. The creosote of beech-wood is preferred in
medicine.
Physiological Action. — Tar is an irritant, and is liable to produce a
papular eruption upon the skin if applied too freely; its use internally is
also sometimes provocative of erythema, vesicles, or papules, accompanied
by severe itching. It is absorbed readily, so that, when a large surface is
exposed to its action, feverish symptoms, blackish urine, and symf)tom8 of
carbolic-acid poisoning may ensue. The stools become blackish, and, as well
IS the urine, possess the odor of tar. Epigastric pain, vomiting, severe head-
ache, or a sense of oppression in the head may also occur. Tar has an astrin-
gent effect upon mucous membranes. It has decided antiseptic power.
When tar is taken internally, small doses exert a stimulating effect upon the
circulation and secretory apparatus. Large, or too-long-continuea, doses
destroy appetite and impair digestion, depress the action of the heart, and
cause nervous exhaustion. Taylor instances a fatal case caused by the
accidental ingestion of the oil of tar. Large quantities of tar itself have
been taken without fatal consequences.
Therapy. — Tar is a good application to scaly skin diseases, such as
S>nafiis, but the official ointment is liable to cause irritation and should be
uted when used: —
»
Unffl.
Ungt.
picis liquid.,
zinci oxidi. .
81
23
Gm.
Gm.
or 3ij.
or 3vj.
M. For the relief of itching in chronic eczema.
Tar ointment has been used with success in scabies and tinea. It is
necessary, always, to be careful in applying tar, as it may excite dermatitis
or an acne-like eruption which Hebra called "tar-acne." Tar ointment is
of value in prurigo, and is sometimes capable of lessening this notoriously
rebellious affection. Pruritus ani is often allayed by a weakened tar oint-
ment. In some patients there is an intolerance of tar and even the smallest
quantity will excite irritation and cnusc a papular, eczematous eruption.
In the treatment of ha?morrhoids. Dr. Laciniz recommends n preparation
composed of: —
H Picia liouids
Ext. belladonn. folior..
Glyocrit amyli
M. Sig.: Apply morning and night
com. or nixlv.
Gm. or BT. xlv.
c.cm. or fSj.
Tar ointment, either in full strength or modified, is serviceable in
comedo, sycosis, pemphigus, lupus erythematosus and vulgaris. In
746
PHAHMACEUTICAl THERAPEUTIC AGENTS OE DBUOS.
order to prepare an unirritnting tar ointment, Stem advised that the tar be
previously allowed to stand for several weeks in a warm place. It will be
found that it separates into two layers, the upper of which is thin and syrupy,
while the lower is thick and often mixed with small solid particles. The
upper layer is destitute of irritant properties. An alkaline tar-water, made
by adding tar, 7.5 c.cm. (or foij); caustic potash, 4 Gm. (or oj); to water,
150 c.cm, (or fjv) ; is a useftd agent in the treatment of chronic eczema.
Pix Navalis, or pitch, is used externally in plasters. It is entirely dif-
ferent from the residue of coal-tar, or "pas-pitch. '^
A tar-water (made by mixing 1 part of tar with 4 of water) wa.s for-
merly official. It is a sherrj^-colored, slightly-acid liquid, having a strong
odor of tar. It may be used with nn atomizer or vaporized by heat in chronic
catarrhal disorders of the air-passages. Einger and Murrell have demon-
etratcd the usefulness of tar in winter cough, and have ascertained that it
materially lessens the tendency to taking cold. Dr. Phillips finds it of serv-
ice in chronic pulmonary tuberculosis; it improves appetite and digestion^
checks diarrhcea, and quiets cough. The tar-water spray is beneficial in
pharyngitis and laryngitis. It is also an efficient antiseptic application to
unhealt% wounds or ulcers. Tar is hkewisc taken internally for the same
class of diseases for which terebinthinate preparations are usually prescribed.
Pills containing O.OtiS or 0.13 Gm, (or gr. i-ij) are useful in winter cough
and other bronchial disorders. In many chronic skin disorders the internal
administration of tar is a valuable adjunct to local treatment. McCall Ander-
son speaks favorably of the action of small doses of tar, taken internally, in
both psoriasis and chronic eczema.
In oza?na, Moire recommends a combination of: —
Pulv. camphor 0
Tr. iodi U
Potass, iodid 2
Picis liquid 13
Alcohol. (90") 90
Aquas 180
Gm.
or
5i»9.
c.cm.
or
fSiij.
Gm.
or
3fls.
C.CMl.
or
fSiiiss
com.
or
«iij.
c.cm.
or
«vj.-
-M
i
The mixture is placed, upon a water-bath and the fumes are inhaled for
two or three minutes. The nasal chambers are then cleansed with a spray
of l-por-cent. carbolized alkaline water.
Lyaol, a new tar combination, is derived, according to Qerlach. from
tar-oils by boiling with alkalies and fats. It possesses the consistency of
soft, or potash, soap, is of a brownish color, contains 50 per cent, of cresols,
and is readily soluble in water.
Lysol is said by Gerlach to be a good disinfectant and antiseptic. He
employs a V-- to 1-per-cent. solution, in surgical operations. It is more easy
of application than soap and disinfectant fluids, and removes dirt, fatty mat-
ter, etc., from the skin and instruments. Lysol has the advantage of being
odorless and comparntively innocuous. Michelson has found it useful as a
wash in major and minor g>*na^cologicnl operations. In laparotomies he
made use of a 1-per-cent. solution for all purposes except irrigation of the
peritoneal cavity, for which a 0.3-per-cent, solution is sufficiently strong.
The weaker solution is also of service in obstetrical practice. A gauze satu-
rated in a 5-per-cent. solution removed the odor of cancer of the cervix.
This agent promotes the granulation of wounds. Catgut immersed for two
hours in a 5-per-cent. solution became as hard and resistant as if it had been
PLUMBUM.
747
*
I
treated by alcohol or oil of juniper. Lysol is likewise well adapted for use
as a disinfectant in the sick-room or hospital ward, schools, etc., and vrhere-
ever such an agent is required.
Ljsol is capable of causing toxic manifestations, as in a case reported
by Dr. Reich. The application of pure lysol tjo a large part of the body of
ayouLg man was followed by loss of consciousness and convulsions, violent
izifammation of the skin, and the appearance for two days of albumin in the
orine. On the other hand, Dr. Potjan records a case in whicb a teaspoonful
of lysol was swallowed by mistake without evil consequences.
Lysol has been used with satisfactory results in some cases of lupus.
Lysol has likewise been Euccessfully employed in gonorrhcea of the male
by Dr. V. CarvoUo in the form of a l-per-cent. solution injected into the
urethra three times a day to begin witb, and less frequently as the discharge
was arrested. Professor Parvin stated that, in cystitis of the female, injec-
tions of a V2-P<?r-cent. lysol solution gave good results. Dr. Haug recom-
mends irrigation with a l-per-cent. solution in the treatment of otorrhcea. A
l-per-cent. solution in ozrena, a 2-per-cent. solution in eczema, and a ^/,-per-
cent. solution in tongillitia have been used with benefit. The use of about a
pint of a l-per-cent. solution as an enema three times daily has been found
of service in dysentery. Lysol has been administered with advantage in-
Icraally in dyspepsia in doses from 0.048 to 0.50 Gm. (or gr. "A-viij) after
each meal. The taste may be disguised by essence of peppermint.
Pixel. — Another disinfectant prepared from tar is termed pixel. It
was devised by Dr. Raptchevski, and has the special merit of being exceed-
ingly cheap. Pixol is made by dissolving a pound of green soap in 3 pounds
of tar and slowly adding a solution of a little more than 108 Gm. (or 5^"S3)
o( either potash or soda dissolved in 3 pounds of water. The result is a
irrupy fluid which, in 5-per-cent. dilution, is used for disinfecting linen
lod washing the hands. A lO-per-cent. solution is an efficient disinfectant
of dejecta. A solution of the latter strength is said to be fatal to the micro-
organisms of suppuration, anthrax, typhoid fever, and cholera.
PLAlirTAGO. — Plantain. The leaves of plantain (Plautago major and
lanceolata; natural order, Plantaginaceae), an indigenous herb, are used
popularly as a vulnerary, the fresh leaves being made into a paste and applied
to wounds. In rhus poisoning, burns, scalds, bruises, and even erysipelas,
it is said to be cfBcient. An infusion may be administered internally, or a
fluid extract may be given in doses of 0.30 to 4 c.cm. (or mv-fSj), but it has
flo veiy marked physiological effects.
PLATINUM.— Platinum. No salts of platinum are official.
PLUMBIIM.— Lead.
Salts and Preparations.
Unguentuiu Diachylon (U.S. P.). — Diachylon Ointment.
Uraliun Plumbi Subacetatis {U.S. T.).— Qoulard'a Cerat« (20 of OouUrd'i ex-
trtct to 80 part« of cnmphor cemte).
Plumbi Nitnw (U.S. P.). — l^ad Nitrate. Used as a disinfectant. Ledoyen's
wlution is a foltition in water ( 12 V« p<t cent.).
Plumbi AceUa (U.S. P.. B. P.).— AoeUie of Lead (Sugar of L«ad). Dose, 0.065
to 0.32 Gm. (or bt. i-v),
Plurabi lodlduin (U.S. P.. B. P.).— Lead Iodide. Dose. 0.005 to 0.015 Om. (or
748 PHARMACEUTICAL THERAPEUTIO AGENTS OE DRUGS. ^
Plumbi Oxidum (U.S. P., B. P.) .—Lead Oxide, Litharge.
Eniplftstrura Adheaivum (U. S. P.). — Adhesive Plaster (rubber, 20 Gm.; petro-
lutuin. 20 Gin.; U'nd plaster 900 Cm.).
Einplastrum Plumbi (U.S. P., B. P.).— Lead Plaster, Diachylon Plaster.
Liquor Plumbi Subacetatia (U, S, P.), Li<iuor Plumbi Subacetatia Fortis (B. P.). —
Solution of Lead Subacctate. Goulard's Extract (contains lead acetate, 17 Qm.; lead
oxide, 10 Gm.; distilled water, q". s. 100 Gm.).
Liquor Plumbi Subacctatis Dilutus (U.S. P., B. P.).— Diluted Solution (strong
solution of lead subacetate, 3 per cent.). {The B. P. formula is about one-half the
strength of the U. S. P.)
Plumbi C.'\rbonua (B. P.). — Lead Carbonate. White Lead.
UngnciiLum Pluinbi Cttrl>onati» (B. P.). — Ointment of lead CarlKsnate (10 per
cent).
Ungiientum Plumbi lodidi (B. P.). — Ointment of I^nd Iodide (10 per cent.).
Unguentum Plumbi Acetatis (B. P.). — Lead-Acetate Ointment (4 per cent.).
Unguentum Glycerini Plumbi Subacetatia {B. P.). — Lead- Subacetate Ointment
{10 per cent.],
Glycerinum Plumbi Subacetatis (B. P.). — Glycerin of Lead Subacetate (nearly
15 per cent, of lead).
Emplastrum Plumbi lodidi (B. P.), — Lead-Iodide Plaster (contains lead iodide,
60; resin, 60; lead plaster, 400).
Suppo«itoria Plumbi Composita (B. P.). — Conijnound Lead Suppositories (each
contains 0.20 Gm., or gr. iij, of lead acetate and 0.065 Gm., or gr. j, of opmm in powder).
Pilula Plumbi cum Opio (B. P.).— Pill of Lead with Opium (contains 12 V» per
cent, of opium and 76 per cent, of lead acetate). Dose, 0.13 to 0.25 Gm. (or gr. ii-iv).
Pharmacology. — Metallic lead is readily affected by the oxygen of the
air or by carbonic acid of water, and, although not poisonous itself, its salts
are all deleterious, even in small amounts. Lead is therefore not a suitable
lining- for a reservoir for drinlcinpr-water, and lead pipes should not be upfd
for conveying water for liousehold purposes, unless lined with tin. White
lead and red lead are largely used both by painters and plumbers, who are
liable to be affected, owing to absorption through the skin. Lead chrpmate
is a yellow pigment used as a protective applied to the covers of hams, and
is also sometimes fraudulently used by bakers to color cake, in order to
make up for deficiency of eggs. Lead acetate is astringent and sweetish, and
has been swallowed by mistake for other dnigs» such as magnesium sulphate.
Fortunately, it is irritant to the stomach and acts as an emetic, but, if re-
tained long enough to be absorbed, coma or paralysis may ensue. Sugar of
lead has also been used in clarifying cider; and earthen vessels are glazed
with a flux containing lead, so that the sources of lead poisoning are numer-
ous. A case of lead poisoning in a young infant has been reported, caused
by the mother's cleaning out the nursing-bottle with lead shot. Poisoning
has also occurred from the use of cosmetics and hair-dyes containing lead.
Lead ie sometimes present in flour by reason of the mill-stones, by which the
grain was ground, having been repaired by filling their cracks with lead.
Chronic load pnisi>nii)g ha? hr-on produced in children by swallowing the
tin-foil in which certjiin kinds of candy are wrapped, which contains load
in large amount. A number of trades and occupations necessitate the
handling of articles containing lead, and, therefore, give rise to cases of
poisoning. Some persons are so s\isceptible that simply sleeping in a newly-
painted room will impregnate the system. Wall-papers containing lead pig-
ments have caused colic and miscarriage. Inlialation of the smoke given off
by burning painted wood may also cause Icarl intoxication.
Physiological Action. — Given in medicinal doses, lead salts are sedative,
astringent, and hemostatic. They enter the blood, slow the heart and res-
PLUMBUM.
749
»
*
piration, interfere with the nutritive functions of the red blood-corpuscles,
and lead to their destruction, thus causing anaemia. Lead escapes from the
blood by the skin, the liver, the kidneys, and intestinal tract. It is also
found in the lacteal secretion. The excretion of uric acid is reduced, and
thus lead favors the occurrence of gouty attacks in those predisposed. The
excretion of urea is likewise diminished. The intemperate use of alcohol
predisposee to attacks of plumbi^rn uf»on exposure. Persons working amidst
white lead may escape lead poisoning by using sulphuric-acid lemonade and
fatty articles of food, and by frequent bathing. Sulphuric acid forms an in-
soluble compoTind with lead.
In some persons the topical application of solutions containing lead will
cause brownish or blackish discolorations of the skin. Used internally, the
preparations of this metal may occasion erythema or petechiee.
Symptoms and Treatment of Lead Poisoning. — Acute lead poisoning
following a single large dose of one of tbe salts of lead is very rare; but
acute attacks as the result of slow absorption of the drug are very common.
The most striking symptoms are obstinate constipation with cramps ("dry
gripes"), loss of appetite, nausea, and vomiting of white, curd-like material,
the color being due to the formation of lead chloride with the hydrochloric
acid of the gastric juice. If the bowels open, the passages are of a blackish
hue from the presence of sulphide of lead. The abdominal muscles are rigid
and knotted and the wall of the abdomen is, in consequence, retracted. The
intestines are shrunken, tenesmus is frequent, and alternate contraction and
relaxation of the rectum can sometimes be felt. The liver is retracted and
may even be diminished in size. The pulse is generally hard and tense on
account, as Harnack supposes, of spasmodic contraction of the intestinal
blood-vessels. Vertigo or headache may occur, and neuralgic attacks; even
stupor and convulsions. Upon examination of the mouth, a blue line will
be found in the gums near their margin, over the incisor teeth, caused by a
deposit of the metal, or its sulphide, in the tissues. This line is particularly
noticeable in those who neglect the care of their teeth. In some instances
the conjunctiva becomes yellowish. Not infrequently there is redness and
swelling of various joints. In rarer cases asthma or visceral disease has been
produced by the absorption of lead. Various forms of paralysis may occur,
the most common being "wrist-drop," or extensor paralysis of the muscles
of the forearm. Electromuscular contractility is early affected, and may be
lost before the power of volimtary movement. As a rule, the paralysis affects
both wrists, the integument of which is frequently anaesthetic. Loss of sensi-
bility may also occur at a distance from the paralyzed parts. Strabismus and
aphonia have occurred and some cases have had a fatal termination from
ptralysifl of the respiratory muscles. In some instances deafness is one of
the results of saturnine intoxication. Hypenesthesia or ana?sthesia of the
integument may be produced. A fatal case of lead poisoning has been re-
ported' by Dr. G. L. Walton, in which ataxia was the prominent symptom.
Three similar cases have been published by Dr. J. J. Putnam. Among the
symptoms attending plnmbiim, or saturnism, are an offensive odor of the
breath, pallor, emaciation, muscular pains, and loss of power. Plumbism
is the frequent cause of abortion. The wives of workmen in lead factories
frequently abort, even when they are not directly exposed to the influence
n
* Bo$ion Medical and Surgical Journal^ Oct 30, 1890.
750
rHAHilACEUHCAL THERAPEUTIC AGENTS OR DRUGS.
of the metal. According to the investigations of M. Paul, of fifty children
born alive, the majority died within a IVw years after birth and only four-
teen reached the age of ten years. Amenorrhoea likewise occurs among
wonlen exposed to the influence of lead.
More or less complete amblyopia may develop slowly or suddenly and
may be associated with Jnllammation or atrophy of the optic nerve. Amau-
rosis and a train of nervous phenomena dependent upon alterations occur-
ring in the brain (lead encephalopathy) appear from the influence of lead.
A valuable memoir on the subject of cerebral symptoms due to lead intoxica-
tion has been published by Dr. Westphal.^ Four foi-ms have long been rec-
ognized under which the effects of the metal upon the brain are mainfested:
the delirious, comatose, convulsive, and composite. The last named is by
far the commonest, and in it the characters of the other three varieties ap-
pear to be united. Apoplectic and chorea-like forms have likewise been
observed. Progressive paralysis, paresis of the laryngeal muscles, and a
peculiar variety which runs a typhoid course have been described by different
writers. From a careful study of thirteen cases, Westphal divided them into
those which present general cerebral symptoms and those showing symptoms
due to pressure. The first group were characterized by depressed spirits,
dementia associated with melancholia, hypochondriasis, irritability, head-
ache, and vertigo. Convulsions wore very common, at times general, and
again limited to certain groups of muscles. In five cases the spasms assumed
a genuine epileptic character. Among pressure symptoms, the most fre-
quent was paresis in districts supplied by certain cranial nerves. Disturb-
ances of smell and vision, circulation and respiration, hemianfesthesia, and
hemiparesis were observed. The author finally enumerates four modes in
which lead acts «pon the central nervous system: (1) by direct influence
upon the brain, producing neuroses of various kinds, disturbances of intel-
lection, and symptoms due to structural change; (2) by influence upon the
blood-vessels, leading to ha?morrhage and softening; (3) by influence upon
the kidneys, resulting in the cerebral symptoms of anaemia; (4) by a com-
bination of the preceding methods.
According to experiments suggested by Prof. Thomas Oliver, hydro-
chloric acid is the active agent in promoting absorption of lead by the stom-
ach. Pepsin rather diminishes than iiu-reases the amount of lead dissolved.
The presence of proleids in gastric digestion also considerably reduces the
quantity. Bile dissolves three times as much lead as the gastric juice. The
presence of fat, however, reduces the quantity of the metal wliich passes into
solution. The pancreatic fluid has no influence upon lead, whether alone
or mixed with peptones, fat, or starch.
In obscure cases, suspected to be due to the influence of lead, the diag-
nosis may be positively made by means of a chemical examination of the
urine for the presence of the metal.
Chorea, neuralgia, and spinal disease have at times been obser^•ed in
chronic intoxication from lead. Cirrhosis of the liver, inflammation of the
parotid gland, atrophy of the intestines, arthralgia, and contracted kidueya
have also been due to the same influence. Acute and chronic asthma may
be among the results of this species of poisoning. Facial palsy has been
met with, and Dr. Putnam asserts that in children suifering from the effects
* Sec aummnrv of his paper in the Utedical Bullciin, Aug., 1889, p. 251, from
DmtUche medUinciZf^tunp, May 9, 1889.
rLUMBUM.
761
I
orlead the le^s and feet are generally paralyzed. In all doubtful cases the
tirine should be carefully examined for the metal.
The post-mortem examination reveals chronic catarrh of the gastro-
intestinal tract, thickening of the walls of the smaller arteries, interstitial
inflammation of the kidneys, with the deposit of lead in the nerve-centres,
and, in fact, in every part of the body. The lead, according to the experi-
mental researches of Prevost and Binet, accumulates especially in the kid-
neys, though they have found it in most of the organs and tissues of the
body. The longer the course of poisoning, the more lead is contained in the
kidneys. The metal may be found in these organs long after the adrainis-
trttion of the poison has ceased. The bones are rich in lead, which had been
ftored up in the form of a phosphate. The principal cerebral lesions of lead
encephalopathy are atrophy of certain regions, hasmorrhagic deposits, apo-
plectic cysts, and, above all, alterations in the cerebral vessels, such as endo-
and peri- arteritis, atheroma, and hyaline degeneration. Chronic plumbic
intoxication is very apt to lay the foundation of kidney disease. It should
not be overlooked that symptoms of lead poisoning may only be manifested
after several months' exposure has occurred. Thus a case has been reported
in vhich the symptoms of lead poisoning did not come on for six months
after a painter ceased working at his trade. Several cases of this character
have been reported, also, by KaulTmann (in the Birmingham Medical Be-
rwu), in which the patients presented symptoms of lead poisoning a number
of months after being exposed to the poison, in one instance after almost
two years. An analysis of the urine in these cases showed the presence of
lead, thereby proving that the diagnosis of the cause of the symptoms was
correct.
The manner in which this curious delay occurs is obvious when we study
the question of the elimination of lead. It is a substance which is eliminated
from the body very slowly, indeed, and, like other metals, has a tendency
to accumulate in the tissues, where it forms a fairly stable combination with
the protoplasm, and probably also with uric acid, as is illustrated in the de-
velopment of what has been called "plumbic gout." Further than this, al-
most every tissue of the body seems to be capable of containing it, though
the muscles and blood contain less than any other part. In many instances
it is evident that these delayed symptoms arise from the gradual deposit of
lead in the tissues during the period in which the patient is in a condition
of good health and nutrition, and that later on, when by reason of illness,
bad food, or unsanitary surroundings, a portion of the protoplasm of the
body is utilized for vital processes, the lead which has been deposited is
picked up once more by the blood- and lymph- streams and distributed to
the tissues, where it produces its effects. The editor of ihe Journal of the
American Medical Association remarks that this matter is not only of im-
portance from a medical point of view, but also because interesting medico-
legal questions arise in connection with it. Thus, for example, a suit might
be brought upon the part of a person who had been unwittingly exposed to
lead with the development of symptoms a number of months afterward, and
the defense might claim that it would be impossible for so long a period to
elapse between the exposure and the development of plumbic symptoma.
The cases just cited show, however, that this actually would not be a com-
petent defense.
Treatment of Acute and Chronic Poisoning. — In lead colic we may
752
PUABMACEUTICAL THERAJPECTIO AGENTS OR DRUGS.
^Te 1.30 to 2.60 Gm. (or gr- xx-xl) of magneBium Bulphate with 0.01 to
0.015 Gm. (or gr. Va-V*) of morphine, with syrup of ginger, and water
enough to make a tablespoonful even' hour or two, to relieve pain and
constipation. Belladonna, or atropine, has also been found eflftcient in
relieving the pain, while Barden hewer recommends pilocarpine as rapidly
accomplishing the same purpose. Alum is of value in the treatment of
chronic lead poisoning. Where the lead is in the tissues, it may be slowly
removed by the administration of small doses of potassium iodide, and
by vapor-baths or Turkish baths, keeping up also the action of the kid-
neys. Baths containing potassium sulphnle are also recommended. In the
treatment of progressive saturnine paralysis, strychnine is of decided worth.
Professor Oliver uses ferrous iodide if the patient is ansemic. Lithia, though
of little avail as regards subduing pain, increases the amount of urine. For
attacks of acute lead encephalopathy, this writer finds no treatment so effi-
cacious as inhalation of arayl nitrite, which quickens the pulse, reduces arte-
rial tension, and arrests convulsions. For suppression of the urine, he recom-
mends pilocarpine. I^I. Lavrand also recommends ferrous iodide, either alone
or associated with zinc phosphide as of value in arresting the progress of
plumbism. The practice of massage favors the elimination of lead, and the
galvnnic current is also of efEcacy.
Therapy. — Lead is used locally in the form of metallic plates in the
treatment of leg-ulcers, with good effect, to repress exuberant granulations.
Lead nitrate is employed in onychia with good result. As Goulard's solu-
tion, or cerate, it is applied to erysipelas, acute eczema, contusions, and in-
flammations of various kinds, but should be diluted. The early application
of Goulard's solution is occasionally able to abort a felon. This liquid will
often relieve itching, and is therefore of avail in para?sthesia and urticaria.
Lead-wnter with laudanum was formerly much used to relieve pain and in-
flnnimnlion: —
H LU\. plumhi mibnoptatiA diltiti 30
Tr. opii 60
Aquce destillatio 240
M. For external use.
ccm. or fSi.
c.ciD. or fjij.
ccm. or fSviij.
Lead acetate is used for the same purpose, and also as an injection for
gonorrhoea or leucorrhoea: —
B Plumbi acetatifl 176 Gm. or gr. xij.
Zinci sulphatU pO Gm. or gr. viij.
Aqutc roate 18| e.cm. or fjvj,
M. Sig.: Use 4 to 15 ccm. (or fSi-iv} as an injection every six hours for gonoi^
rhoea or gleet.
B Plumbi acetatU [65 Gm. or gr. x. '
Glycerini 15 ccm. or fSsB.
Aq. hainnmelidis dest 30 ccm. or fSj.
Aquic dest. 4fi| ccm. or fSiss.
M, Sig.: For injection, as directed.
a Plumbi Rcetatis
Phenolis liquefacti
Glycerini !■''
Aquaj rostt 10''^
M. Sig.: For injection, as directed.
50 Gni. or gr. viij.
13 Gm. or gr. ij.
ccm. or fJftR.
ccm. or fjiiisfi.
PLUMBUM.
753
In many acute and chronic diseases of the skin, the various lead salts
are most useful on account of their soothing and astringent action. The
following formulse are suggested: —
Plumbi acetatiB |tJ5 to 1
Morphinfie aulphatia
MentboU
CnK)6oti
Pulveriii mnrantse 4
Ungt. zind oxidi 31
30 Gm.
32 Gm.
135 Gm.
00 c.cir).
Gm.
Gm.
or gr. X vel xx.
or gr. V.
or gr. X.
or mx.
or 3j.
or Sj.
M. To be applied on a compress in subacute and chronic ec;ccnui.
m loUov
K
^^^^ B Plumbi carbonatis 1615 Gm.
^^^^ CreoAoti |60 com.
^^^f 01. olivee, q. a. ft, ungt. mollis.
H M. Useful in erysipelas, bums, and in bruises, especially when the skin aaaumcs
^1 s blue or a dark tiiigo, for tH-olinnosta.
^^Hssor
or Sas.
or mx.
U Plumbi carbonatis 8
Zinct carbonatis 15 i
01. eucalypti
II. A serriceable dusting-powder in acute eczema, herpes, and seborrhoea.
Gm.
5 Gm.
30 ccm.
or 5ij.
or IsH.
or mv.
In the treatment of the muscular weakness or paralysis following the
orption of lead, besides potassium iodide and occasional purges of mag-
nesium sulphate, with hot baths, etc., it is necessary to employ galvanism,
to keep up the nutrition of the muscles and prevent fatty degeneration, and
to employ systematic exercise, with massage. Semmola and others have pub-
lished the details of a method by which the continuous current was success-
fully employed according to a systemic— as opposed to local— method, the
poles being applied to the tongue and pit of the stomach. The sole reliance
was placed upon galvanism, and no potassium iodide was employed. The
blue line upon the gums disappeared at the end of about three weeks, and
at the same time the muscles began to be capable of feeble movements. The
method proved of no avail when cerebral symptoms were present.
Lead acetate fulfills a double purpose in the treatment of gastric ulcer.
It checks hsemorrhage and at the same time promotes cicatrization. In the
diarrhoea of typhoid fever and phthisis, this salt is an excellent remedy, and
can be prescribed with service thus in ordinary diarrhoea, as well as in that
from phthisis: —
R Plumbi acetatis,
I*ulv. ipecflcuanhsB et opii aa 1)60 Gm. or gr. xxir.
M. et ft. chartulca no. xij.
Sig.: A powder every hour or two until improred, then every three or four
hours.
B Plumbi acetatis II (Jm. or gr. xv.
Tinct. opii 7 5 c.ciu. or f5ij.
Tiact. patet'hu 30j ccm. or f^j.
Syr. zingiberis q. a. ad' 00| o.cm. or f Jiij.
M. Sig.: One to two teaapoonfula in water every hour or two for diarrhfra.
dOM for a child from two to six years old, from ten to thirty dropa
The
The acetate possesses some power, likewise, over the night-sweats of
pulmonary disease. It is of service in chronic gastric catarrh and diminishes
764
PHABMACEUTICAL THKRAPKDTIO AGENTS OE DBUGS.
the copious secretion of chronic bronchitis. Asthma associated with chronic
bronchitis and the catarrhal stage of pertussis are relieved by the same prep-
aration. Lead acetate has been found beneficial in dysentery, given either
by the mouth or in the form of suppositories, as follows: —
I B Plumbi acetatis,
I Camphonc aa 21 Gm. or 3bs.
I Extract! opii |l8 Gm. or gr. iisa.
I 01. theobromatis q. b.
I 3k£. et ft. suppositorue no. x.
^ Big.: Insert one into the bowel every hour or two for severe diarrbcea and dysen-
tery. especially when attended with tenesmus.
Lead acetate is useful in hypertrophy of the heart on account of ita
power of retarding the action of that organ. From its influence upon the
heart and its astringency, it is sometimes employed in the treatment of in-
ternal aneurism. Trocy advocates its use in pneumonia, especially when
that disease attacks drunkards or persons of depressed vitality. He claims
that the tempcratiire and rate of respiration are lowered, and the disease ia
prevented from passing into a chronic form.
Lead iodide has been administered internally in order to reduce enlarge-
ment of the spleen due to malaria.
In conjunctivitis, dilute lead-water was formerly much used, but if
ulceration of the cornea exist it may cause a permanent white patch. In
diarrhoea and sporadic cholera, lead acetate and opium pills are of great serv-
ice; and the acetate, in doses of 0.03 to 0.20 Gm. (or gr, ss-iij), is valuable in
internal hemorrhage or hjemoptysis.
A case of saturnine amblyopia is reported by Dr. C. B. Taylor in the
Lancet (September 17, 1898). It was a yoimg woman, who had been taking
0.65 Gm. (or gr. x) of lead plaster nightly for three weeks. The drug was
taken with the object of producing an abortion, but it only produced blind-
iness of one eye. Recovery followed the use of larger doses of potassium
iodide, baths, pilocarpine, and the constant galvanic current to the temples
(about 2 milliampdres) daily.
Special Forma. — The glycerin of lead subacetate of the British Phar-
macopa^ia is a good application to eczema. It corresponds in strength to
Goulard*s solution, but has glycerin as the menstruum. The liniment of the
subacetate is also a good astringent application to inflamed skin, chapped
hands, and bruises. White-lead paint is a good application to a bum or scald
where the skin is unbroken. The ointment of lead iodide is used as a re-
solvent on glandular swellings, scrofulous tumors, goitre, etc., and also as
an application in acne and other skin digeases. Dr. C. D. F. Phillips states
that this ointment is especially serviceable in acute mastitis with threatened
suppuration. It should be applied with steady friction. Chronic sjrnovitia
has likewise been benefited by the same preparation.
Lead nitrate, in very dilute solution, is useful as a wash in leucorrhoea,
and to correct the fetid odor of discharges from ulcers, etc. Fissures of the
nipples are cured by applications of a 2-per-cent. solution in glycerin, but
great care must be exercised if a child is nursing from the affected breast,
or lead poisoning may ensue. The oleatc of lead melted with an equal
amount of lard-oil is a useful application in eczema, acne, etc. Lead plaster
is employed by surgeons to protect parts of the body exposed to chafing by
splints or apparatus; it is also good to prevent bed-sores and as a base for
H
PODOPHTIXUM.
755
*
I
other ptaMM^ Hebra's diachylon ointment^ is made by melting equaJ
parts, b|NffiS^t^ of lead plaster and lin&eed-oil, to which a proportion of
b&lsaia of Peru and a little oil of lavender are sometimes added. Diachylon
ointment is serviceable in hyperidrosis. It should be spread upon pieces of
linen large enough to cover the foot, and separate pieces placed between the
toes. The foot is then covered with linen and bandaged, and this procedure
is repeated every day for one or two weeks. This ointment often proves an
excellent application also in subacute and acute eczema. In seborrhoea, der-
matitis, herpes zoster, and sycosis, the use of lead ointment is attended with
good results.
PODOPHYLLUM (U. S. P.).— Podophyllum, May-apple, Mandrake.
PODOPHYLLI RHIZGMA (B. P.).— Podophyllum Rhizome.
Preparations.
Fluidextractum Podophylli (U. S. V.), — Fluid Extract of Podophyllum. Dose,
0.60 to 2 c.crn, (or mx-xxx ) .
Resina Podophylli (U. S. P., B. P.).— Kealn of Podophyllum. Dose. 0.008 to 0.066
Gm. (orgr. '/••j).
Tinctura Podophylli (B.P.). — Tincture of Podophyllum (r«ain, 36.6 Om. in 1000
tan.). Dose, 0.30 to 1 ccm. (or mv-xv).
ExUAotuu) Podophylli. — Kxtrjict of Podophyllum. Dose, 0.13 to 0.25 Gm. (or
gr. ii-iv \ .
Pilulce Podophylli, B*'llndnnnie, et Cflpsici (U. S. P.). — Pills of Podophyllum.
Belladonna, and (.'upfticum. Do&e. 1 or 2 pills.
Pharmacology. — '*The dried rhizome of Podophyllum neltatiini (Ber-
beridacete)," growing in Uuitod States ami Canada. This plant contains
about 4 p»cr cent, of resin (r(>sina podophylli, V . S. P.), or podophyllin.
According to Podwie^otzky, two iictive principles are present, a neutral
crvstailine snbstanc-c, known ns Podophyllotoxin (C..^H.^«Oy), and Picro-
podophyllin, which are combined with an inert podophyllic acid. When
treated with potaasa. pyrocatechuic acid is (thtnined from the Fesin. It also
b*>iitalns a green oily and .sodium nnd potassium salts. By the action of
ammonia upon podophyllotoxin this siih^tjwice breaks up into picropodo-
phyllin and podophyllic acid. Podophyllotoxin is a biitor, white, resinous
powder, soluble in weak alcohol and in hot water, but is precipitated from
alcoholic solution by cold water excess. The othcial resin of podophyllum
coDsists of two resins, one soluble both in ether and in alcohol, the other only
in alcohol. The former, comprising from 75 to SO per cent., is the active
part : the other, according to Cadbury, being without nny effect. The resin
ii very irritant to the eyes, and when handled the dust is apt to cause con-
junctiritis. The resin of podophyllum is insoluble in benzol, like that of
jalap and pcammony, but differs from those in l>eing soluble in alkaline
^^hjtjnns, from which it may be precipitated by acids.
* An improved proceBa for making Hebra's diachylon ointment is given by Der-
in^: DisAolve lead acetate 200 grammes in 1 litre of distilled water and mix with
lOOgimmmee of white Castile poap previously dissolved in 1 Vj litroB of warm, distilled
wBior. Filter both solutions before mixinf^. The precipitate is then washed with
•TAtfiT. fr^ed «» much as possible from water by kneading, and 1 part is melted with
1 7i ^r1« of olivo-oil on the warm hath. The mixture is then triturftt«d in a mortar
until it form* a fine, white salve. — ^"Proceedings of the American Pharmaceutical Aaso-
ciatjoa/' 1881. p. 63.
75t) PHAHMACEUTICAL THEHAPEUTIC AGENTS OR DBCGS. ^
A Himalayan plant, Podophyllmn emodi, has been proposed as a source
of the official resin. The analyses of John C. Umuey show tliat, although
it yields nearly double the amount of resin which can be extracted from
Podophyllum peltatum, the resin, nevertheless, contains only about one-half
the quantity of crystalline picropodophylliu. Dymock and Hooper found
it to yield 12 per cent, of resin, which contains 50 per cent, of podophyllo-
toxin.
Physiological Action. — Podophyllum is a slow cathartic, acting upon
the hver and the intestinal glands. It also exerts its purgative effects when
introduced into the blood; also by absorption, when appHed to a raw sur-
face. In small doses it is laxative, in large doses drastic, and may cause jfas-
tro-enteritis. Podophyllotoxin has lately been isolated in a pure, crystalline
form, and Neuberger has made an experimental study of its physiological
action. Upon frogs and rabbits it has but little effect. Cats, however, proved
extremely sensitive to its influence. Severe vomiting and diarrhoea occurred
in a few hours after its administration. As death approached the animal
became apathetic and paretic, and the temperature fell. Similar effects were
produced in dogs. After death there was found great irritation, or even ab-
scess, at the point of injection. The mucous membrane and adenoid tissue
of the intestines were congested or inflamed; the liver and kidneys were
swollen. Neuberger, therefore, concluded that the substance acts simply as
an irritant, exciting catharsis in its elimination by the intestinal glands.
Therapy. — On account of the sraallness of the dose and slight taste of
the resin of podophyllum, it is very applicable to the treatment of constipa-
tion of 3'oung children, or the opposite condition of diarrhopa from want of
proper secretion. A grain may be dissolved in 30 e.cra. (or f'j) spirit of
ginger, and a drop or two given on sugar. Pn^per caution, however, must
be oxerciecd in giving podophyllum or its constituents to children, as fatal
accidents have occasionally happened in consequence of overdoses. It will
also be found useful in adults, administered in the same manner, to check
vomiting. In, chronic constipation the following formulae may be used : —
K Podophyllotoxini,
Aloini,
^^ Kxtrai'ti bplladonnffl folior.,
^^ Rxtracti i^atis Ea |13 Oni. or gr. ij.
^y Extract! taraxaci 2|G0 Gm. or gr. xl»
M. et ft. pil. no. xx.
Sig.: A piU three timca a day.
Bouchut recommends in infantile constipation this syrup: —
B Reainec podophylli 1048 Gra. or gr. ■/«.
AlcoholiB 5l c.cm. or f5i V,.
Syr. althaffi 90| c.cm. or fjiij.
M. Sig.: A defiftertapoonful daily.
It is also useful in malarial liver disorders and jaundice, and in dys-
pepsia dependent upon deficient secretion of the liver and intestinal glands.
In that form of sick headache associated with loose and dark-colored stools
podophyllum generally affords relief.
The tincture of podophyllum, in small doses, is a useful remedy in cases
of recurring tonsillitis, in ^'bilious*' patients, those with sallow complexione,
POLYTBICHUJM.
757
r
I
I
t
coated tongue, and constipated bowels. The method used by eclectic prac-
litionere is to add a few drops to half a glassful of water, and give a teaspoon-
ful every hour or two during the day.
POLYGONATI RALIX.— Eoot of Solomon^g Seal. The Polygonatum
gigaBteum and P. biflorum (Uliaceae), common plants in the eastern United
States, have peculiar, boot-shaped rhizome?, bearing the scars of preceding
leaf and flower-stalks, which look like the impress of a seal. They contain
a bitter, acrid principle, Convallaria, with other vegetable constituents, such
ft£ tannin, mucilage, etc.
Physiological Aotion. — Slightly tonic, astringent, and alterative.
Therapy. — Used externally, in decoction or fluid extract, as an appli-
cation to freckles, and for relieving bruises, sprains, and local inflammation;
also as an injection for leucorrhcea, menorrhagia, and as a wash for hjenior-
rhoids. Internally, it has been used in rheumatism, gout, and dropsy. It ia
claimed to have special effects upon relaxed mucous membranes.
POLTGOKlJlf. — Water-pepper, Smart-weed. The smart-weed, Poly-
gonum hydropiperoides (Polygonacejp), is a small, indigenous herb, with
narrow, green leaves and spikes of small, greenish or white flowers. It con-
tains Polygonic Acid, an acrid principle insoluble in water, with tannin, etc.
The active principle is dissipated by heat, end therefore an alcoholic tincture
of the fresh plant is the best form, or a well-made fluid extract. The dose of
the fluid extract is from 0,60 to 4 c.cm. (or mx-f5j). A solid extract has also
been prepared, the dose of which is from 0.065 to 0.32 Gm. (or gr. i-v).
Physiologfical Action. — Polygonum has a burning, acrid taste; inflames
the skin when rubbed upon it; and internally has stimulating effects, espe-
eifllly to the ovarian functions and to the kidneys. Polygonum increases the
number and strength of the cardiac contractions, prnmotes and increases
the capillary circulation, and causes warmth of the surface, accompanied by
an increase of perspiration.
Therapy. — Employed in domestic practice, externally as counter-irri-
tant and internally as an emmcnagogue, 2 c.cm. (or f3ss) doses of the fluid
eitract being administered for several days before the expected period, in
amcnorrhoea. Water-pepper is likewise of service in functional impotence.
On account of its diuretic rirtuc, it has been employed for the purpose of
»a«hing out sand or gravel from the kidneys or bladder. It has also been
UKd in diarrhoea, bronchitis, and catarrhal disorders.
A poultice made with water or vinegar from the leaves of Polygonum
ppfsicaria has been found an excellent anodyne application by Professor
rlagg. In dental practice he recommends the warm poultice as beneficial in
facial neuralgiii, while, applied cool, it relieves pathological conditions at-
tending the eruption of the lower wisdom-tooth.
POLYTRICHIUlf. — Haircap Moaa. Polyt'richium juniperinum (Musci)
i*a mossy plant, prowing abundantly throughout North America, in marshy
places. A fluid extract may be used in the dose of 4 to 7.50 c.cm. (or f.>i-ij).
Physiological Action and Therapy. — The taste of polytrichium is some-
what pungent, but not acrid. Dr. Eckfeldt states that it has a certain nau-
aant effect, is alterative, and a diuretic of considerable power. He declares
ftat the use of the drug for a few days cnuscs an appreciable loss of weight.
758 PHARMAOEirrtOAL THKRAPEU'm AGENTS OR DRUGS.
and that its physiolog-ical action merits a closer investigation than it has jet
received. Dr. Eckfeldt has employed polytTichium with advantage in drop-
sical conditions due to disease of the liver or kidneys. Its effects are
increased by combination with a diuretic or hydragogic cathartic.
POPTFLI CORTEX.— White Poplar-bark, American Aspen. The Popu-
lus tremuloids (Salicaeete), a forest-tree of the United States, contains in its
bark Populin, a bitter principle, resembling quinine or cinchonine in its
physiological and therapeutical effects. Poplar-bark has been used as a tonic
and antiperiodic in doses of 2 to 5 Gm. (or gr. xxx-lxxv) several times a day
in decoction or fluid extract. A sohd extract may be obtained by evaporat-
ing the fluid extract to pilular consistence. Dose, 0.13 to 0.75 Gm. (or gr.
ii-xij).
The terminal buds of the poplar have a balsamic odor, and contain vol-
atile oil haviug the odor of chamomile, resins, etc., and possess the medicinal
propertios oi terebinthinate substances. The ointment of poplar-buds (made
by digesting I'rcshly-bruised poplar-buds with twice their weight of hot lard,
and gently boiling until all moisture is dissipated) is a fragrant ointment
resembling benzoinated lard in antiseptic qualities.
POTASSItlM.— The metal Potassium, or Kalium (K).
^P Salts and Preparations.
PoUsaii H.vdroxidura (U. S. P.), Potassa Cauatica (B. P.). — Cnxistic Potash,
Potassium Hydrati?, PotusBium Hydroxide.
Liquor Potaseii Hydroxidum (U. S. P.), Liquor Potaa«a (B. P.). — Solution of
potassium hydroxide (5 per oent. ). Doae. 0.65 to 4 <im. (or gr. x-3j).
Antimonii et Potassii Tartraa (V. S. P.), Antiraonium Turtnratum (B. P.). —
Antinioriv and Potaaaium Tartrate, Tartar Emetic. Do»e, 0.0015 to 0,005 Gm. (or
gr.V--j)".
Potassii et Sodii Tartras (U. S. P.), Soda TartaraU (B. P.). — Potasaiuxn and
Sodium Tartrate, Kochclle Salt. Dof»e, 1..10 to 15.5 Gm. (or gr. X7(-3iv).
Potasaii Citraa KfTer^-escens (U.S. P.). — Effen-escent Potassium Citrate. Dose,
2 to 6 Gm. (or Ssa-ias).
Liquor Potasftii Citratia {U.S. P.). — Solution of Potassium Citrate.
(Effervescing draught is the extemporaneoua solution of potassium citrate, made
by mixing equal quantities of two solutions, one containing 6 Qm. of citric acid to
50 c.cm.; the other 8 Gm. of potassium bicarbonate to 50 com. It contains about
9 per cent, of anhydrous potassium citrate, with a little free citric and carbonic acids.)
Dose, 16 to 30 c.cm. (or f5sB-j).
Argf'iiti Nitras Mitigatus ( U. S. P., B. P.). — Mitigated Caustic (contains potas-
sium nitrftle. 2 pflrts. to silver nitrate, 1 part).
Pulvis Efferveseens Compositus (U. S. P.). — Piilvis Sodse Tartarataj EffGrvea-
cens (B. P.). — Sfidlitz Powder (sodium binirlwimte, 2.58 Gm., or gr. xl. and Roohelle
salt, 7.75 Gm.. or 3ij. in a paper together; tartaric acid, 2.25 Gm., or gr. xxjtviij. in
a separate paper. Dissolve separately in water and mix). Dose, 1 pair taken while
effervescing.
Liquor Polussii Arsenitis (V. S. P.), Liquor .^rsenicalis (B. P.), — Solution of
Potassium Arsenite. Fouler's Solution (strength correfijwnding to arsenic trio?cide
1 per cent.). Dose. 0.0(1 to 0.00 c.cm. (or mi-x).
Ferri et Potasi^ii Tnrtras (U. S. P.). Ferrura Tartaratum (B. P.). — Iron and
Potasniura Tartrate. Dose, 0.32 to 1 Gm. (or gr. v-xv).
Pota^sii BitartraH {V. S. P.). Potassii Tftrtras Acidus (B. P.). — Potassium
Bitartrate. Cream of Tartar. Dose, 1.30 to 15.5 Gm. (or gr. xx-5iv).
Potasnii Cyanidum (U. S. P.). — Potassium Cyanide. Dose, 0.005 Gm. (or gr. */«)■
Potassii Ferrocjanidum (U. 8. P.). — Potaaaium Ferrocyanide, or Yellow Prussiata
of Potash. Dose, 0.65 Gm. (or gr. x).
Jdtassium.
759
i
I
PousiU AceUa (U.S. P„ B.P.).— PoUaalura Acetate. Dose, 0.65 to 4 Gm. (or
gr. i-3j).
PoUsaii HTpophoephia (U. S. P.)-— PotaMJum. Hypophoaphite. Doae, 0.13 to 2
Gm. (or gr. ii-xxx).
Syrupua Hypophof^hitum (U.S. P.)- — Syrup of the Hypophosphitea. Dose, 2 to
7J> c.cm. (or f3s8-ij).
PoU;i»tiii DicliromAs (U. S. P., B. P. ) .— PoUsaium Diebromate. Dom, 0,012 Gm.
(Of gr. V.)-
PoU8sii Bromidum (U.S. P., B. P.).— PotaaaiOxn Bromide. Doae, 0.65 to 2 Om.
(or gr. x-3aa).
Potaaaii BicarboDM (U.S. P., B. P.).— Potasaium Bicarbonate. Dose, 0.32 to 2
Om. (or gr. v-xxx).
PoUMii Carbonaa (U.S. P.. B. P.).— Potaaaium Carbonate, Salt of TarUr. Dose,
0.18 to 1.30 Gm. ior gr. ii-xx).
Potaaaii Chioraa (U.S. P., B. P.).— Potaaaium Chlorate. Dose, 0.13 to 0.05 Gm.
tor gr. u-x).
Potaaaii Citraa (U. S. P., B. P.).— Potassium Qtrate. Doae, 0.66 to 2.60 Gm. (or
gr. i-xl).
Potaaaii lodidum (U. 8.P., B. P.) .—Potassium Iodide. Doae, 0.32 to 2.60 Gm.
loT gr. v-xl).
Potaaaii Nitraa (U.S. P., B- P.).— Potaaaium Nitrate, Saltpetre. Doae, 0.13 to
130 Gm. (or gr. ii-xx).
Potaaaii Permanganaa (U. S. P., B. P.). — Potaaaium Permanganate. Doae, 0.03 to
0.13 Gm. (or gr. ss-ij).
PoUaaii Sulphaa (U. 8. P., B. P.).— Potaaaium Sulphate, Dose, 1.30 to 4 Om. (or
gr. XX-3J).
Potaaaa Sulphurata (B. P.). — Sulphurated Potaasa. Liver of Sulphur. Dose,
0.13 to 0.50 Gm. (or ot. ii-viij).
Pulvis Jalapse Compositus {U.S. P., B. P.). — Compound Jalap Powder (U.S. P.
oontaine 05 parta of cream of tartar and 35 of jalap). Dose, 0.65 to 1.30 Gm. (or gr.
x-xx). (B. P. i* JHlap 5. ui.'id potassium turtrate 9, and ginger 1 pnrt. )
Trochiad PoUaaii Chloratia (U.S. P., B. P.),— Trochea of Potaaaium Chlorate
(each containing 0.32 Gm., or gr. t, of potassium chlorate j the B. P. formula contains
0.20 Gm.j or gr, iij, with rose basis).
Tinctura lodi (U. S. P., B. P.). — ^Tincture of iodine. (Containa poteasium
iodide. )
Unguentum Potaaaii lodidi (U.S. P., B.P.). — Ointment of Potassium Iodide
(potaaaium iodide. 12; sodium hyposulphite, 1; water, 10; benzoinated lard, 77 parta.
The B. P. formula contains 6 Gm. in 40 Gm.).
Potaaaii Tartraa (B. P.). — Potaaaium Tartrate. Doae, 2 to 15.5 Gm. (or gr. xxx-
Ur).
Liquor Potaaaii Pcrmanganatia (B. P.). — Solution of Potaaaium Permanganate
(1 per cent.). Dose, 7.5 to 15 c.cm. (or f3ii-iv).
Confectio Sulphuria (B. P.), — Confection of Sulphur (aublimed sulphur, 100 Gm.;
ffeam of tarUr, 25 Gm.; tragacanth, 1 Gm.; syrup, 50 c.cm.; tincture of orange, 12.5
txm,; glycerin, 37.5 c.cm.). Dose, 4 to 8 Gm. (or 3i-ij).
Ltnimcntum Poteasii lodidi cum Sapone (B. P.). — Liniment of Potesaium Iodide
vith Soap (about 10 per cent, of p>otaasium iodide).
PotaiAftft cum Calw.— Totassa with Lime. Vienna Paste (equal parts potassium
bydrate and lime). Eacharotic.
Pharmacology. — Potassium salts exist in certain minerals, but they are
derived principally from the ashes of plants; they are also present in ani-
mal tipsuee, espccinlly in the muscles. Potassium is a white metal discorered
bv Sir TTumphrv Davy in 1807. It docomposes water with such violence
»)• L'lit. into rx)ntart with it that it ignites the hydnigen, burning with
I ; )*» and forming the hyflrnte or cauj^tic potn?h. which is n most
powerful alkaline biis«*, soinltle in Inilf its weight of water. Whon dissolved
in 20 parts of wntor it forms liquor potrt.««e. Potaiwium chlorate, when
triturat<»d in n mortar with su^ar, sulphur, tannin, charcoal, plycerin, and
UumerotiB other suhBtanccs. and occasionally oven triturated alone, is liable
i
760
PHAIlllACEUTICAL THEIIAPEUTIC AGENTS OR DHCGS.
to explode; and therefore, in making the troches, the United States Pharma-
copceia directs that the chlorate shall be added to the other ingredients last
and mixed carefully by means of a horn spatula. The troches sometimes ex-
plode spontaneously. At all events, the U. S. P. proportion is too large;
there need not be more than 0,065 to 0.13 Gm. (or gr. i-ij) in each lozenge.
The dieromate also forms nn explosive mixture ■with glycerin. The salts of
potassium are usually colorless or white, and are generally soluble in water;
some of tliein are deliquescent.
Physiologrical Action. — Caustic potash abstracts water and fat from the
tissues and produces a soft eschar when applied to the skin, which is sub-
sequently separated by inflamrantion from the uninjured parts. Thie s\ib-
etance, moreover, dissolves the albiiminous constituents of parts with which
it is brought into contact. Taken internally in concentrated form, it is a
corrosive mineral poison, destroying the soft parts and causing much irrita-
tion and secondary inflammation of the larynx or cesophagus, loading to
stricture and gastritis. Even by liquor potnssis these symptoms may be pro-
duced, unless the remedy be very largely diluted. The carbonate is a pow-
erful antacid, both in the intestinal tract and in the blood, favoring the ex-
pulsion of uric acid, with which it forms salts more soluble than those of
sodium; the bicarbonate, however, is preferable for internal administration,
being more acceptable to the stomach. Under its use the urine becomes
alkaline.
Potassium is a cardiac poison : it is a muscle- and nerve-paralyzer
through an influence upon protoplasm, and is destructive to the ozonizing
function of red blood-corpuecles. These etTects are shown to a different de-
gree by different salts,, and vary with the dose. In physiological doses, they
increase the secretions, stimulate retrograde metamorphosis, and promote
oxidation; if too long continued, they produce anaemia and wasting of the
body. Small doses of the bicarbonate, taken before meals, stimulate the se-
cretion of gastric'juice and make the urine more acid; larger doses disorder
digestion, are partly decomposed by the gastric juice, which is made less acid,
and partly enter the blood, increasing its alkalinity and the alkalinity of the
urine also. In rare instances potassium bicarbonate has occasioned a ves-
icular eruption similar to that of eczema. The potas^^iura salts with vegetable
acids are generally decomposed in the blood, the vegetable acid being de-
stroyed, the base combining with carbonic acid and escaping in the urine,
which it renders alkaline. The salts with mineral acids are not decomposed,
but in passing through the body exercise more or less effect upon the blood
and certain organs. The nitrate, in large doses, exerts a paralyzing influence
upon the spinal cord, and produces great muscular weakness and reduction
of reflex sensibility. In moderate doses the nitrate raises arterial tension and
slows the heart's action, but larger doses weaken its movements and finally
arrest them. The fibrin of the blood is less coagulable and the red blood-
corpuscles have their oxygen-carrying powers reduced. The urine is in-
creased in quantity. Death has sometimes been caused by the nitrate in con-
sequence of its irritant effect upon the gastro-intestinal mucous membrane.
According to the experiments of Aubert snd Dehn, most of the potassium
salts, with the exception of the permanganate, have the same effect as the
nitrflic upon the circulation.
Potassium chlorate acts like the nitrate upon the spinal cord, but has
a more profound action upon the blood, disintegrating the corpuscles and
POTASSIUM.
761
_ it of a chocolate color (methanmglobinttMiiia). Tnken in toxic
doeeSy vomiting, with htejnatemesis, dehriurn, ha'niatogenous jaundice, and
coma result. The bodily temperature is markedly depressed by large doses
of the salts of potat?8iuin, and especially by the nitrate and chlorate. Pro-
fessor Albrecht* reported a case of a boy, three years of age, suffering with
stomatitis and diarrhoea, in whom two doses of 0.50 6m. (or gr. viij),, given
on successive days, caused death by collapse, with methsemaglobinfemia.
Landerer' reports a case of a boy, 18 years of age, who, for tonsillitis, had
been given 30 Gm. (or gr. 4(iO) of potassium chlorate, to be dissolved in
water and used as a gargle, lie dissolved the whole in hot water and drank
it in two portions within half an hour, in the evening. He subsequently
was faint and extremely thirsty, and drank some beer, which produced vio-
lent vomiting through the night and pain in both hypochondria. Next
morning he came to the hospital, with headache, faintness, and constipation.
His skin was anfemic, eyes and iips cyanotic; he had rigors and slight jaun-
dice. The liver was elightly enlarged; there was pain over the stomach and
kidneys. The urine was very small in quantity, only about 4 c.cm. (or f5j);
very albuminous, and deposited a brown sediment of altered blood-corpus-
cles. On filtration, the color was dark-cherry red. It gave the guaiac re-
action and, on spectroscopical examination, the lines of metha?moglobin.
Blood from the finger also showed altered blood-disks in masses, as well as
unaltered blood-corpuscles, which formed imperfect rouleaux. Death oc-
curred six days later, without convulsions or special anjemic symptoms.
During this time suppression of urine continued. The lesions, post-mortem,
were distributed through the body, but chiefly seen in the intestinal tract
(which was hypcra?mic, inflamed, and eroded in places) and in the kidneys
(which were much enlarged, redematous, capsule adherent, blood-vessels
overfilled, the tubes plugged with brownish masses, to which some detached
^ epithelial cells adhered). The liver and spleen were also enlarged. The
B symptoms appear to be primarily dependent upon excessive hlood-destruc-
B^|Dt blocking up the urinary tubules with the detritus, and the consequent
Vlil^hritis and anosmia. Jaundice and cyanosis were due to the same cause.
^ iia rational treatment Landerer advises blood-letting, followed by trans-
li fodon. The preceding case is presented here as a typical illustration of the
effects of potassium chlorate when taken in a poisonous dose. In many cases
deith occurs earlier from collapse; in others the patient becomes cyanosed
tad prostrated, but slowly recovers after stopping the medicine and using
uitidotes. It was formerly thought that the chlorate, which contains a large
proportion of oxygen, was capable of yielding some of it to the tissues, hut
this is not now believed possible, as the salt is excreted unchanged very
largely by means of the salivary glands. In giving potassium chlorate its
effci 'd always be closely observed, and. if drowsiness and scantiness
or *•! , ioD of urine supervene, the remedy should be at once discon-
tinaed. One of the rare effects of ingestion of potassium chlorate is the oc-
nrri ri.o of an erythematous, petechial,^ vesicular, or papular eruption. It is
ilmt susceptibility varies, as some patients take with impunity quan-
.ii.-s-« Unit are fatal to others.
'/^rt^'-r, Dro. 30, 1005.
•HritiJth Mi'divtxl Journal Dec. 13. 18M.
'Journal of the Am^rioan Medical A»»ociation. Ju}y 22, 10O5.
762
PHARMACEUTICAL TUEHAPEUTIU AGENTS OR DUUGS.
The nitrate, likewise, passes through the body unchanged. The treat-
ment of poisoning will be considered in the next paragraph. The sulphate
IB a powerful purgative, but is too irritant to be used for this purpose, except
in veterinary practice, and less pleasant than Rochellu salt. The bitartrate,
or cream of tartar, is diuretic as well as laxative. It is an ingredient in the
compound jalap powder, which is a very safe and efficient cathartic in dropsy
attending heart or kidney disease. The salts of potassium are eliminated
priDcipally by the kidneys, though the salivary, mammary, and sudoriparoua
glnnds also assist in their removal. A portion is also believed to escape by
the bowels, as the nitrate has been detected by Dr. Kramer in the faeces of
animals to which it was administered.
Potassium cyanide is very toxic in its elTects. Death has resulted from
doses of 0.20 to 0.32 (or gr. iij-v). Inhalation of fumes of an alloy of gold
with cyanide of potassium caused denth in half an hour, with symptoms
of cerebral congestion.^
Treatment of Poisoning by Potassium Salts. — Poisoning by potassium
cyanide is not very frequent, but it occasionally occurs, the s}'mptonis and
treatment being those of hydrocyanic-acid poisoning. Alkalies should be
promptly adminietercd to prevent decomposition of the salt by the acid gas-
tric juice, and the stomach and intestinal canal emptied as soon as possible,
followed by the administration of arterial stimulants, such as coffee and am-
monia, with cold aiTusions to the spine and friction of extremities. Death
is generally almost instantaneous. When taken nccidpntally, prompt treat-
ment may be successful. The Htnniach-pump should be used to wash out the
stomach, followed by antidob^s for pnipsic acid (ferric and ferrous sulphate
with potassium carbonate, inhalation of ammonia, etc.).
Potassium ferrocyanide is decomposed even by weak acids, with the
liberation of hydrocyanic acid. Acids should, therefore, not be taken after
the ingestion of the salt. Cases are on record in which death has been caused
by this mistake.
When caustic potflsh has been swallowed, itis necessary to use demul-
cents freely, with vinegar as a chemical antidote, and encourage vomiting,
giring digitalis and stimulants hypodermically to sustain the heart. After
death there is found inflammation, with softening, erosion, and sometimes
perforation of the stomach. Death may ensue from shock, cardiac paralysis,
or iuflnmmation of the stomach and intestines. Potassium chlorate causes
death by depression of vital powers* due to its destructive action upon the
blood and the congestive obstruction of the kidneys. The treatment is by
saline purgatives and diuretics, especially calomel and caffeine, with hot
baths, and, in case there is much cyanosis, transfusion of blood. Potassium
bromide causes gastralgia occasionally when taken into an empty stomach;
this is relieved by hot drinks and carminatives.
Therapy. — Although an efficient escharotic. caustic potash is not often
used, because it produces a bum that is attended by a good deal of inflam-
mation and pain. It was formerly the custom, in the treatment of diseases
of internal organs, to establish an issue by application of caustic potash, and
the resulting ulcer was kept irritated by a dried pea or a small piece of orris-
root; but this practice is rarely resorted to at present. On account of the
powerful, extensive, and penetrating action of this substance, it should never
'J. A. Post in Xew York Mfdu^al Journal, April, 1876
POTASSTITM.
763
I
need without precautionary measures being taken for the purpose of lim-
iting its etTects. A hole cut in a piece of adhesive plaster, or in several pieces
orerlying each other, then placed upon the skin, is a simple device by which
the application of the caustic may be circumscribed. Nor should it be left
long in contact with the integument, since its influence continues for some
hours after it has been removed. When the integument acquires a bluish
tinge, and the epidenn is softened, it is time that the remedy should be dis-
continued. The spot should then be washed with some weakened vinegar,
in order to neutralize any alkali which might remain. Finally, a poultice is
ipplied to the area of action. Surgeons use caustic potash in treating fistula
in and after operation, in order to prevent immediate union; also to soften
ingrowing toe-nails. Dr. Piirckhauer, of Bamberg,^ descnbes a method which
he has used with entire success in the treatment of this painfiU affection.
The portion of nail which needs to be removed is painted with a 40-per-cent.
solution of caustic potash. At the end of a few seconds the upper layer of the
nail has become so soft that it can be easily scraped off with a sharp-edged
piece of glass. The procedure is repeated until aU that remains of thnt por-
tion of the nail is a thin scale, which can be excised by means of a pair of fine
scissors. A valuable advantage of tliis practice is that the patient is able to
follow his usual vocation without the loss of any time.
In concentrated form, polnssitim permanganate acts as a caustic, and
may cause corrosive poisoning. In the Mt:d\cal DuJlctin for February, 1^06,
a case is reported from the authors clinic, in whicli forty grains produced
collapse, semiunconsciousness, and delirium. The successful treatment con-
dsted in evacuating the stomach; strychnine hvpodermically, an enema of
whisky and water, and a diet rr»strirtod to albuinin and milk. A weak
solution of potassium permanganate (0. 065 to 0.32 Gm. in 30 c.cm., or
gr. i-v to f5j) was formerly known as Condy's fluid; it is an oxidizing
disinfectant., and a useful agent in dilute solution for irrigating wounds
or ulcers. A solution of this substance is a serviceable application to the
throat in diphtheria and scarlet fever. Potassium permanganate is recom-
mended by Weir Mitchell as the best antidote to the venom of snake-bite,
provided that it can be brought into direct contact with the virus before
absorption, and has been commended by Dr. William Moor as an antidote
to morphine. For internal use the solutions must be greatly diluted.
The permanganate, and caustic potash as well, have been employed with
a view to neutralizing or destroying the poison of rabid animals, though the
mmlts have not been encouraging. A solution of the permanganate is an
efficient deodorizer in ozjena and inflammation of the middle ear. The
tolution should be only of a pink color for irrigation. Potassium bicarbonate
i« a good lotion (4 Gm. to 473 c.cm., or ."Si-Oj) for eczema and rheumatic
jointe, and in stronger solution as an application in pruritus Milvje, and to
MtPS of animals or insect-stings.
In cases of pruritus, Dr. E. B. Bronson, of New York, often employs
a lotion composed of: —
B Phwiolift liq 4| to 81 e.cm. or f3i-ij.
Liq. potnss. hydroxidi 4] c.cm, or f3j.
01 \\n\ 30| c.cm. or fjj.
M. Big.: Shake before using. A drop or two of bergamot oil may be added in
order to overcome the odor of the UnseedoU.
■Gee MIedical BiiUetin, March, 1B91.
764
PHARMACEUTICAL THEBAPErTIC AGENTS OB DRrOS.
In eczema of the vulva, LuBch recommends the following formula: — |
M.
Pot&sa. bicarb 4
Sodii bicarb 8
Glycerin 4 0
Tr. opil 7
Aqu» 240
Slg.i For use, night and xnomingSj as & lotion.
Gm.
Gra.
c.cm.
ccm,
c.cm.
or 3j.
or 5ij.
or fSifis.
or fSij.
or IJviij.
Leucorrhcea, dependent upon the excGssiye functional activity of the
glanda of the cervix uteri, is markedly benefited by vaginal injections of
weak Bolutions of potassium bicarbonate. The same solution has been used,
to wash out the bladder in order to relieve tlie cystitis attending uric-acid
calculi. Sulphate of zinc, alum, and potassium permanganate may he com-
bined in a powder, to be dissolved (a teaspoonful to a quart of hot water),
and used as a vaginal douche.
Potassium dichroraato, in solution, ie a good application to warts and
corns and to venereal excrescences of mucous patches. It is largely used with
siilphuric acid as a battery-fluid, and accidents occur by swallowing some of
the fluid; the S3miptoms of irritant corrosive poisoning at once appear, with
vomiting, pain, and restlessness, requiring the use of demulcents and ano-
dynes, and free evacuation of the stomach and bowels. Dr. J. E. Weaver
considers dichroiiiale of potassium especially useful in both lar}'-ngitis and
bronchitis, if secretion is stringy and hard to raise. After the second or third
dose the expectoration becomes loose and easy. In tonsillitis, where the
onset is rapid, the tonsils rough, raw, and angry looldng, with rauco-puru-
lent secretions exuding from the follicles, also, in cases of non-diphtheritic,
pseudomembranous tonsillitis, this remedy he regards as a specific. In treat-
ing laryngitis and bronchitis with this remedy one must be careful not to
use it too strong — not more than 0.065 Gm. (or gr. j) well diluted in 90 or 120
c.cm. (or f?,iii-iv) of water, a tcaspnonful every ono-half to two hours. But in
tonsillitis, the fiiicly-powdt'rod diehromiite should ha added to the water until
the latter is of a dark-lemon or liirht-orange shade, and of this a tea?poonful
should be given every hour. In these cases the only limit to the administra-
tion of the drug is nausea. If this symptom appears, lessen the dose. After
the third or fourth dose improvement should be noticed.
Internally^ where alkalies are reqiiired, the salts of potassium have been
very largely used. In acid dyspepsia, the bicarbonate, in considerable doses
after meals, neutralizes the excess of arid aud relieves heartburn and pyrosis;
while small doses, before meals, in atonic dyspepsia, stimulate the free secre-
tion of an acid gastric juice. In some cases of gastralgia the pain may be
relieved by the bi carbonate in some effervescent water. The same salt is of
value in the indigestion of obese individuals, also of rheumatic and gouty
subjects. It is of material assistance, moreover, in the digestion of fatty
food.
In dyspepsia, accompanied by hyperacidity with pain or vertigo, Robin
prescribes: —
B Potajw- bitart 12
Sulphur, fiubliinftti 5
Cretre preparatie 2
Pulv. ipecac, et opii 1
M. et div. in chartulse no. x.
Big. : One powder after each meal.
Gm. or 3iij.
Gro. or 3i '/,.
Gm. or 598.
Om. or gr. xr.
POTASSIUM.
766
In diarrhoea, excited by an excessive quantity of acid in the bowel,
potassium bicarbonate is an efficacious remedy. The carbonate in doses of
0.065 to 0.13 Gm. (or gr. i-ij) several times a day is a remedy of some utility
in whooping-cough. In some forms of bronchitis, especially in gouty per-
sons, the liquor potassae is a good addition to a cough-mixture, to liquefy
the mucus and facilitate expectoration: —
c.cm. or f3j.
c.cm. or fSj.
ccm. or fSvj.
H Liquoris potass&e hydroxidi 4
Syr. senegK 30
liiat glycyrrhizie co q. 8. ad 180
M. Sig.: T&lce a dessertspoonful in a winegUssfu] of water every three hooiB for
[bronchitiA, with scanty and tough expectoration.
As the urine is rendered alkaline under its use, liquor potassae is fre-
quently combined with other remedies in treating gonorrhoea: —
Liquorii^ jvotatifiae hydroxidi,
C<^ibse aa 22
Mucilag. acacin 00
Spiritus wtheria nitroai 22
Tincturee opii 4
Aquffl q. 6. ad 1 30
c.cm. or f3vj.
c.cm. or fSiij-
c.cm. or fSvj,
c.cm. or f3j.
c.cm. or fjvj.
I
M. Sig.: Take a tablespoonful well diluted, three or four times daily, in acute
gOBorrhcea.
In cystitia and pyelonephritis the same combination can be used, in
order to render the urine less irritating.' If, however, in cystitis, alkaline
decomposition has occurred, the administration of alkaline remedies will,
as Ringer points out, aggravate the disorder by assisting the transformation
of urea into ammonium carbonate. The alkaline treatment in acute rheu-
matiflm is suited to plethoric subjects, with strongly-acid perspiration. The
bicarbonate is used in doses of 1.30 or 2 Gm. (or gr. xjc-ixi) every four or five
hours in cinnamon-water, or the citrate or acetate may be given in full dosea.
If the system be -alkalinized early in the disease, there is less danger of car-
diac complication. Very often the treatment is best begun with potassium
iodide for a day or two, and then the bicarbonate is substituted. The iodide
ii of special value in chronic rheumatism in 0.65 Gm. (or gr. i) doses, with
compound syrup of sarsaparilla and water, three times a day. The carbonate
may be added to a warm bath for rheumatic cases with benefit, especially in
diseases of the skin of rheumatic origin. Potassium acetate is the most diu-
retic of these salta, and is useful in oedema, ascites, and other effusions: —
R Potasaii acetat 1515 Gm. or 3iv.
Fluiflextrncti pilocarpi |6 c.cm. or fSiss,
8pt. junip. CO flO] c.cm. or fjij.
H. Sig.: A dessertspoonful in water, every two hours, in suppression of urine.
The salt may also be used with advantage in cases of functional in-
activity of the liver. In litha?mia and disorders of the urinary secretion we
obtain good results from the administration of the citrate or bitartrate: —
B Potassii bitartrat (cryttals) 1516 Om. or gss.
InfuM. jiiiii|M*ri vel »oopurii 473| c.cm. or Oj.
M. et ft. Ml
8ig.: To be taken at intervals during the day, to increase the flow of urine.
The diuretic properties of the bitartrate render it valuable in chronic
Bright*8 disease. For the same reason this salt is of advantage in the treat-
766 PHAEMACEUTICAL TUERAPECTIC AGENTS OR DRUGS. ^*
meiit of puerperal eclampsia. Both the bitartrate and acetate are of avail
in oedema dependent izpon disease of the heart. The deposition of uric acid
and formation of stone in the bladder may be prevented by the persistent
administration of an alkali, and it is probable that small calculi or uric acid
gravel may thus be dissolved within the bladder. Continued alkalinity of
the urine is best maintained by means of the citrate, as that salt is less apt
to derange tlie functions of the stomach or exert a deleterious influence upon
the blood-corpuscles.
3 Potaasii citrat.,
Lithii citrat. aa 8| Gm. or 3ij.
M. Div. in chartuls no. xxiv.
8ig.: Take one in a glaas of Vichy water, every four hours, in lithcemia.
In hscmorrhoids the following is a useful laxative:^
U PotafiBii bitartrai. 31| Gm. or 5j.
Sulphuris loti,
Pulv. nromat aa 15|5 Gm. or Jsa.
M. Sjg.: A teospoonful once or twice daily, made into a bolus with orange-
syrup.
Sir William Gull esteemed potassium bitartrate as "of singular value
in alcoholic cirrhosis." Good results have also been obtained from its use
in the same affection when dependent upon other causes, and also in chronic
peritonitis.
Potassium citrate is of service in the first stage of acute bronchitis, and
in the form of neutral mixture or effervescing draught it afforde marked
relief to the nausea and vomitin? which accompany febrile affections. It
is, likewise, well adapted to the irritable stomach of phthisis. Incontinence,
from a ioo oonctint rated condition of the urine, is benefited hy its administra-
tion. Potassium and sodium tartrate, or Rochelle salt, is a very useful laxa-
tive, and is serviceable in fevers. It is the purgative constituent in Seidlitz
powders, which are most eflicicnt taken early in the morning, when the
stomach is empty. Except as a constituent of some mineral waters, potas-
sium sulphate is not used as a purpative; its action is too severe, and it is
very bitter. Being a hard and dry powder, the sulphate is utilized in phar-
macy for the trituration of powders iind pill-raasscs. Potassium nitrate in
small doses rcMluees temperature, and the force and frequency of the heart's
action, and is useful in the treatment of pneumonia, as in the following com-
bination : —
R Antimonii et potassii tartratls |015 Gm. or gr. V4.
Potnpsii Tiitrat , j20 fJm. or gr. iij.
Pnlv*. ipecac, ot opii |0G5 to [13 to (32 (Ira. or gr. i-ii-v
M. ct ft. chartula no. j. MHte tales no. xij.
Sig. : Take tine every two or tbrw hours. This nets upon tbi? skin and rpli«^ves
cough, nnd id far prefernblo to the conltar compomida on the score of safety.
Potassium nitrate is also used in acute rheumatism. TJnsized paper,
saturated in a solution of nitre, may be burned, and its fumes inhaled, with
good results in asthma. According to M. Corson, 0.13 Gm. (or gr, ij). of
potassium nitrate in a glass of sugar water, will relieve the hoarponess to
which speakers and singers are liable. Dr. Peter Buro, of Arva-Polhora. as-
serts as a result of clinical experience, that potassium nitrate is a specific
remedy in ty]ncal malarial intermittent, of whatever form. Tie administers
rOTASSIUM.
767
it to adults in ftingle doses of 1 to 1.55 Gm. (or gr. xv-x\iv) in either the
febrile or non-febrile stage, and states that it gives rise to no disturbance of
idigestive organs or nervous system. This salt is sometimes of value in the
itnient of haemorrhage. In ha?moptysis accompanied by febrile excite-
ment, it has been prescribed with advantage. In purpura simplex 0.65 Gm*
(or gr. x) doses, and in purpura httmorrhagica from 0.65 to 4 Gm. (or gr.
(i-^j) do5es hiive been reported as Buecessful. Lauder Brunton recommondB
for overcoming increased arterial tension : —
B Potawii bicarb 1 180 Cm. or gr. xx\'nj.
rotA«aii nitratjs 1 15 Gm. or gr. xviij.
Sodii nitrilis ...» |28 (im. or gr. ivss.
To be taken, dissolved in a glasafol of water, on rising each morning.
The compound solution of phosphate of eoda contains potassium ni-
trate. Potassium nitrite is depressing to the circulation, resembling nitro-
givcerin. according to AtkinsouJ It may be substituted for the latter
in the treatment of neuralgic heart affections (angina pectoris)
asd in epilepsy, in doses of 0.20 to 0.32 Gm. (or gr. iii-v). In
asthma, it also may be given in conjunction wntli inhalation of nitre-
paper fumes. Potassium cyanide is used as a means of introducing
- lyter fumes. Potassium cyanide is used as a means of introducing
iuiic acid into the system for the relief of the cough of bronchitis and
pbthisift. In nervous dyspepsia, Dr. J. P. Crozer GriiBth proscribes cyanide
of pK>tassinm in small doses, with extract of valerian, to be taken in pill or
cflpsule after each meal. The permanganate has been given internally, it
ifi said, with good results in flatulent dyspepsia and lithaemia. This salt,
however, soon disagrees with the stomach. Xeusser has recently reported
faTorablj upon the action of potassium tellurate in the night-Bwcats of
phthisis. He has found that this substance, in many cases, cither suppresses
or considerably diminishes the sweats. Pills containing 0.02 Gm. (or gr. V,)
were given at first, but, in some instances, it was necessary to double the
6oee after they had been in use for about a week. No toxic symptoms were
Mcr manifested; the appetite sometimes seemed to be improved by the drug.
It communicates a strong odor, resembling garlic, to the breath of the pa-
tient. The therapeutic action of potassium bromide is discussed under
Bromine.
Potasaium Chlorate is extravagantly praised by some and neglected al-
coft entirely by others. It has been shown that, administered in 1 Gm. (or
2T xv) dose.<; three times a day, it is serviceable in preventing disease of the
placenta, and thus enabling a woman to go on to the end of term who had
previously had several miscarriages. It appears, then, to be valuable in pre-
venting intra-uterine death of the foetus, if administered for four or five
montlu in the above doses. In maternal stomatitis it is regarded by some
authorities as the only remedy worth mentioning, in doses of 1 to 1.30 Gm.
(or gr. iv-xx) three times a day. In the sore mouth of mercurial salivation
it ahonld be given internally and used locally as a wash, and also in the
fDemlmnons and ulcerative sore mouth of children. From a review of its
action it appears that persons are not equally susceptible to its etfects, since
*j9wmal of Anatomy and PhyHology. Jan., 1888; paper on the "PharmAcologry
ti th* Vitrit^B and of Nitroglywrin," read Wfore Sfption on Therap**utip» and li(at«ria
Ninth International Medical Congress, Washington. D. C.» Sept., 1887.
768
PHAB5IACEDTICAL THERAPEUTIC AGENTS OR DHC03.
one can take, with very little evident effect, a dose which would produce very i
decided symptoms in another. Hence arises a necessity for commencing with'
small doses, and gradually increasing to the quantity required to produce the'
elTect. Dr. J. G. Sinclair Coghill, of Ventnor, Isle of Wight, England, con-
tributed to the ^^Proceedings of the Internatioual Medical Congress," at|
Washington, a paper on the subject, which fairly and ably sums up the value'
of the drug. Ue found it useful in cases of deficient oxygenation of the.
blood, especially in placental inadequacy (as above stated); also in pulmo-'
nary insufficiency, arising from many pathological conditions interfering:
with the function of the lungs. He finds it a cardiac stimulant in debility^
of the heart, whether organic or functional, probably by improving the:
quality of the bloodj where the blood is impoverished, as after haemorrhages,;
in anaemia, chlorosis, malarial cachexia, and in convalescence after acute;
diseases. In chlorosis he gives the tincture of ferric chloride in an effer-
vescing solution containing 1.62 Gm. (or gr. xrv) of potassium chlorate, thrice
daily after meals. Quinine, diffitalis, and nux vomica may also be used. Iti
is best given in aerated water after food. It has decided antiseptic effects,'
and these are well shown when there is suppuration along the genito-urinary'
tract. In typhoid fever, when the skin is dry and the lips parched. Dr. RJ
B. Norment, of Baltimore, prescribes: —
I) PotaM. chlorat 2( Gm. or Sss.
Spt (ether, nitrosi,
Liq. ammon. aoetat q. b. ad 90| c.cm. or fjuj.
M. Sig.; A desflcrtspoonhil every three or four hours.
The chlorate is also employed as a detergent wash, especially in thel
mouth and throat (8 Gra. to 473 c.cm., or oii-Oj), and in mercurial salivatioiij
it is particularly useful. In weaker solutions, it may be applied to unhealthy;
wounds, ur iujected into sinuses and into the bladder or rectum for local
inflammation. Haemorrhoids are often reUeved by the injection into the
rectum of a saturated solution of potagsium chlorate combined with a few
drops of laudanum. According to Unna, finely-powdered potassium chlo-
rate is the best antiseptic dentifrice. The mouth should be thoroughly]
cleansed after its use. '
Dillon's dentifrice is thus composed: —
R Puiv. potasflii chloratia 31|
I'lilv. plipiiylis BaUcylfltus (salol),
Pulv. cretiB,
PuIv. carlxni ligni,
Pulv. cinchoiuc aa 10|
Gm. or Sj.
4
Gm. or Siias. — M.
Potassium chlorate in fine powder is advantageously dusted upon aph-
thous spots, in the mouths of children, also over exuberant granulatione
and malignant ulceration, and acta as an antiseptic and astringent. Prof,'
P. D. Keyser had much success in treating small epitheliomata of the eyelids
by the daily application of finely-powdered potassium chlorate, and claimed!
that he had thus saved a resort to the use of the knife in some cases. Thai
troches of potassium chlorate are dissolved slowly in the mouth, so as to'
constantly moisten the throat, and in this way they are very valuable ia|
scarlatinal and diphtheritic sore throat.
In combination with arsenic (Fowler's solution), given intemallj
POTASSIUM.
?69
*
h
potassium or sodium diluraie lozenges, locally, are of singular efficacy in
ciergynienV sore throat, or follicular pharyngitis.
Dr. A. Harkin regard:? this salt as an etlicient galactagogue^ having
successfully used it for this purpose during many years.
In diphtheria, it should not be used in large doses on account of the
depressing action of the potash upon the heart and kidneys: —
E Potauii chloratis (pulv.) 4| Gni. or 5j.
Acidi hydrocblorici o{ c.cm. or fSisa.
Misce et adde: —
Tr. ferri chloridi 715 c.cin. or f3ij.
Aquie q. b. ad 120] c.cm. or f^iv.
M. Sig.: A teaspoonful to be given undiluted every two hours.
Free chlorine is generated in this mixturCj which is based on Watson'a
celebrated formula." It has been successful even where sublimate applica-
tions (1 to 500) failed to check the spread of thf* disease. ^Vhen freely di-
lute^l with water, the above formula, or the official liquor chlori compositus,
make? an excellent gargle. In the sovo throat of phthisical patients we may
give:—
B Potassii chloratis 2
Glycerioi 15
Morpliimi* hydroohlorid
Syrup, aurantii q. a. ad 120
M. Sig.: A teaspoonful occasionally.
00 Gm. or gr. xl.
c.cai. or fSss.
10 Gm. or gr. iss.
c.cm. or i$iv.
Potassium chlorate will often be found beneficial, also, in chronic bron-
chitis, and may be serviceably combined with ipecacuanha and senega. In
hjematuria, purpura, scrofula, and many chronic affections the chlorate has
been used in some cases with marked results. In many affections of the skin,
especially those attended with suppuration, the author can speak with un-
qualified approval of the action of the chlorate. In sycosis, pustular acne,
eczema pustulosum, furuncles, and carbuncles the suppurative stage is de-
cidedly abridged. It exerts a tonic influence in scrofida, and is peculiarly
appropriate in the case of debilitated subjects of syphilis. Potassium chlo-
rite, as a rule, should be prescribed alone, and not in combination with other
agents, which may decompose it.
J. N. Koussel, of New Orleans, reports' a roinarknhlp success in a case
of leprosy, which was treated wilh |)otasgium chlorate. The patient, a man
of •'»0 years of ago, liad tuhcrcuhir leprosy. At the end of one year's treat-
ment the ]c*sions had disappeared and ^nsation had returned.
Oxalate of potassium has been used by Cavazzani. in 1-per-cent. solution
hypodermic injection in the treatment of phlegmon and milk-leg, with
rtofl very encouraging results.
Potassium Dithiocarbonate.— This compound is obtained by the action
of cftibon disulphide on potash lye at the boiling temperature. It occurs
in the form of a crystalline powder, deliquescent, of an orange-red color,
Terr soluble in water and but slightly soluble in alcohol. Made into an oint-
ment of 5-, 10-, or 20-per-ccnt. strength, it has been used, with reported good
results, in various diseases of the skin, The stronger preparations may prove
irritant.
Poiassium iodide is discussed with other iodides under ledum.
*Ji>ur»al of (he Amcric'Sn MctUeat .l.«jtori/iffoiL. .Juno I.l, IftOS, (i, Hl:i5.
I
rro
PHARMACEUTICAL TIIEKAPEDTIO AOKNTS OK DRUGS.
FBINOS. — The black alder, Prinos verticillatus (Aquifoliacece). or win-
tei>berry, is an indigenous shrub, or small tree, bearing clusters of bright-red
berries. The barkj which was formerly official, contains resin, tannin, and
some bitter principle not yet isolated,
Physiolo^cal Actioa. — It is astringent, tonic, and alterative.
Therapy. — Prinos is administered in the form of fluid extract, or a de-
coction, in gastric disorder and diarrhoea. Antlpcriodic virtues have been
attributed to this drug. It is also used internally, as an application in
skin diseases, and as a topical application to indolent and unhealthy ulcers.
Dose of the fluid extract, 1.20 to 2 c.cm. (or wixx-xxx).
PROTAEGOL is a silver albumoso, said to ountaiu S.3 per cent, of me-
tallic silver. It is a yellow powder, freely soluble in water. It is said to
be less irritating than silver nitrate and does not discolor the skin.
It has been usod especially in the treatment of ]turuIont afToctions of the
conjunctivae, the Iacr}Tnal duct and sac. In?tillalion.^ of solutions varying
from 1 to 3 per rent, are rernmmendcd in conjunctival catarrh. It is espe-
cially destructive to the ffonomrcuii. In pnnnrrhnpnl nplithalmia. Dr. Edward
S. Peck, of New York City, and others have reported that the duration of the
disease is shortened and gonococci have disappeared earlier than by other
treatment. It has also been employed in plnce of silver nitrate in Crede*s
treatment Solutions sliould he kept in aniber-eolored bottles. Dr. William
L. Eichardson, of the Lving-in Iloppitnl, Boston, used protargol (2 per
cent.) in every baby's eves nt birth, for throe months. None of the redness
and swelling of the lids and none of the temporary' secretion that inunedi-
atcly follows tlie use of nitrate of silver (1 per cent.) wns observed. Cheney'
used protargol in a 2-or 4-per-eont. solution in the treatment of ophthalmia
neonatorum, in comparison with solution of nitrate of silver (1 to 2 per
cent.). The less degree of irritation from the former was very noticeablej
there was also less tendency to lacr^-mation and to the formation of fibrinoua
coagulate and false membranes in tlie protarerol eyes. It has been used
with success in Ti-per-ccnt. solution in empyema of the anlnim maxillare.
Also in the trcntmont of i^onoTrhrea in all stages. A 20-per-cent. solution
has been recouimendod to prevent gonorrhoea, a few drops being injected into
the urethra. In chronic ulcer, protargol may be used as a dusting powder.
Protargol can be prescribed with the ordinary pill basis. The maximum
daily dose is 0.G5 Gm. (or gr. x). It greatly relieved the symptoms in a
case of advanced carcinoma of the stomach. It wns foimd useful in chronic
diarrhoea and in ulcer of the intestines. In hiematemesis from gastric ulcer
its effect was said to be cNcellent, given in powder (0.50 Gin., or gr. viiss).
One case of Ioconiotx>r ataxia was greatly benefited, 0.20 Gm. (or gr. iij)
being given three times daily for nine months. (See also Largin for com-
parison.)
3i-ij).
PRTJinrM (U. S. P., B. p.).— Prune.
Preparation.
Confectio Sennae (U.S.P.J B. P.). — Confection of Senna. Dose, 4 to 8 Gm. (or
4
* Boston Mfdtoal and Surffical Journal, 1808.
PRUNUS VIBGINIANA,
771
Pharmacology. — **The partially drier!, ripe fruit of prnnua doraestica"
(Ro?aceae). Tlie prune-tree is cultivated as an article of food in all tem-
perate climates. The dried fruit is ofHcial. The French prunes are con-
sidered the best; they should he Uirge, sound, and not too dry. Very fine
fruit can now be obtained froni California. As stewed fruit, they are used
as a relish upon the table, and are generally liked. The cooked fruit is laxa-
tiTc, and ia jE-iven to women after confinement, and to children. They may
be made cathartic by the addition of senna or podophyllum, forming "medi-
cated prunes.''
^FIuidGxt^actum Priiiii Virginiaiue
Dos«, O.tiO to 4 c.cni. (or mx-fSj).
Infusum Pruni Virginiaiue (U.S. P.). — lufusion of Wild Cherry (4 per cent.)
I DoM, 30 to 120 c.cm. (or fji-iv).
ISynipUB Pruni Virginians (U.S. P., B. P.). — Syrup of Wild Cherry, Syrup
PEITNUS VIROINIANA (U. S. P.).— Wild Cherry.
PKITNI VIRGINIANiE CORTEX (B. P.)— Virginian Prune-bark.
Preparations.
iV. B, P.).— Fluid Extract of Wild Cherry.
of
Vuginian Prune (15 per cent., made by percolution, \vithoui heat). Duse, 4 to 15
(or f3i-iv). U. P., 2 to 4 .\fm (or fWj).
Tinctura Pruni Virginiann (B. P.). — Tincture of Virginian Prune (20 per cent).
Obw, 2 to 4 c.cm. (or f3»a-j).
The National Formulary hi»R n wine and also a Terrated wine of wild cherry.
Pharmacology. — "The dried hark of the Prunus serotina (Kosaceae), col-
lected in autumn," has an aromatic, astringent, bitterish taste, and on
maceration in water has the characteristic odor of hydrocyanic acid. This
ifl developed by the presence of water, as the bark contains amygdalin and
emulsin, which form hydrocyanic acid and an oil like the oil of bitter al-
mond. Amygdalin is a crystallizable glucoside, bitter to the taste, soluble
in water and alcohol, but insoluble in ether. Emulsin is an albuminous sub-
ftance, which dissolves in water, and is coagulated by heat, acids, and alcohol.
Glycerin aids in keeping the dissolved matters in permanent solution, and ia
therefore added to both the fluid extract and the syrup. The former more
fully represents the drug than the latter, since the tannin is soluble in the
dilute alcohol, but not in water. The infusion and syrup, therefore, are less
astringent than the fluid extract. A wine of wild cherry may be made by
extracting the medicinal principles from the bark, or by the addition of 2
parts of the fluid extract of wild cherry to 8 parts of sherry-wine. Dose, 4
to 15 c.cm. (or fSi-f^ss). The wine of wild cherry (N. F.) is made directly
from the bark, the monstrnum being dilute alcohol and Angelica wine.
4 or. (.>]) equals 1 Gm. (or gr. xv) of wild cherry.
Physiological Action. — Wild cherry is astringent, tonic, and sedative.
Tt« pleasant flavor has made the synip a popular vehicle for cough remedies.
It increases appetite and promotes digestion, reduces expectoration and
cough, and diminishes nervous irritability.
Therapy. — As a tonic, the infusion is very serviceable in phthisis, where
it also lessens the cough and expectoration, strongtlicns the digestive func-
tion, and reduces fever. In the cough of phthisis, we get good results from
the following combination: —
ym* to
H to 15
B from
772 PHARMACEUTICAL THERAPEUTIC AGENTS OU DRUGS.
B Codeinre phosphittia 113 Gm. or gr. ij.
Tr. belladonnfiB folior 7 5 c.cm. or f3ij,
Syr. pruni Virg q. b. ad 90| c.cm. or fjiij.
M. Sig.: A teaspoonfulj or two, when cougli is troublesome at night.
H
Wild cherry allays nen'ous or reflex cough, and moy very appropriately
Berve as a vehicle for more potent remedies in whooping-cough. Palpitation
of the hearty whether purely nervous or of dyspeptic origin, is benefited by the
administration of this drug. Cases have been reported by Dr. Clifford All-
butt in which wild cherry was of service in mitral insufficiency, and in dila-
tation of the heart with chronic bronchitis and dygpncea. In nervous de-
bility, insomnia, and poor digestion, small doses of the fluid extract are use-
ful as a stomaclue, taken before meals, lu such case?, also, the (K. F.) fer-
rated wine of wild cherry, containing tincture uf ferric citrochloride (N. F.)
in wine of wild cherry (N. F.) (85 c.cm. to 1000 c.cm.) ; also the fluid ex-
tract of wild cherry, 10 per cent., will be found good general tonics in doses
of a drachm or two several times a day.
PTELEA COETEX.— Ptelea-bork, Hop-tree Bark. The Ptelea trifoliata
(Rntacea?), a tree of North America, affords, in the bark of the root, an appe-
tizing toniCj occasionally useful during convalescence in dyspepsia, etc. ■ It
is best given in fluid extract; dose, 0.50 to 2 c.cm. (or mviii-xxx).
PTEHOCARPI UGNTTM (B.F.),— Bed Sanders Wood (Eed Sandal-
wood.) (See Santalum Rubrum, U. S. P.)
PITLSATTTJ.A. — Pulsatilla, Meadow-anemone.
Do5e» O.oori or <KM Gin. (or gr. i-v), in fluid extract, or tincture.
Pharmacology. — This comprises "the herb of Anemone Pulsatilla and
Anemone pnitensJri (Raiuinciilacea'). collected soon after flowerintr.'' care-
fully preserved and kept not longer than one year. Pulsatilla cttntains
an acrid, camphoraceous principle, which readily breaks up into Anemonin
and Anemonic acid. The active principle being volatile, the herb mus-t be
fresh or, ai leiist, not kept longer than a year. The best preparation is a
fresh alcoholic extract.
Anemonin occurs as white needles, slightly soluble in water and ether,
readily soluble in hot alcohol and hydrocliloric aeid. Anemonin may be
given "in du^es from 0.00C» to 0.03 Gm."(or gr. '/^^ to y.).
Physiological Action. — The recent plant has some irritant properties,
the juice causing numbness, tingling, and inflammation of the part to which
it is applied. Internally, it lowers the pulse-rate and temperature in the in-
ferior animals, and stupor and convulsions have been produced by large
doses. In considerable quantity in the human subject it causes nausea and
vomiting. In poisonous doses death results from respiratory failure and
convulsions.
Therapy. — Pulsatilla is reported to be adapted to the treatment of
acute catarrh of the respiratory passages unattended by gastro-intestinal dis-
order. Borchain praises its action in acute epididymitis, given in doses of 0.06
to 0.13 c.cm. (or mi-ij) of the tincture every two hours. Shapter has found
it useful in hysterical convulsions and reflect spasms due to uterine disease
Phillips states that he has seen puleatilla do good in mental disorders, and
in sudden suppression of the menses, or lochia. Anemonin is said to be of
PYEETirErSf.
avail in pertussis and irritative coughs. According to Dr. Bovet, it has a
decided sedative action in dysmenorrhoea and other painful affections of the
female pelvic or»:ans. He prefers a recent extract, on the ground that the
ftctive principle i? volatile, Aneinonin has been likewise used with alleged
success in asthma and epididymitis.
It has hct^n also used by liy]>*>dcrnuc injection as an antipyretic. Dose,
0.3 Gm. (or gr. iv). Used by Ij. Byk^ in typhoid fever and in erysipelas^
scarlatina, etc.
PYRAMILON, IT Dimethyl Amidophenyl-Dimcthyl Pyrazolon, is a
denvative of antij>yrin, which it resembles in it^ action, but is considered
milder and safer. It has been used as an antineuralgic and as an antipyretic
in iloees of 0.2 to 0,G (ini. (or gr. iij-x). In tabes it has been given up to
3.0 Gm .(or gr. xlv) per diem. In consumption, the dose should not ex-
ceed 0.5 Gm. (or gr. viiss) for the relief of hectic.
I
I
PTRETHRITM (U. S. P,).— Pcllitory.
PYBETHEI RADIX (B. P.).— Pyrethrmn-root.
Preparation,
Tinctura Pyrethri (U.S. P., B. P.).— Tincture of Pellitory (20 per cent).
I
Pharmacologfy and Physiologrical Action. — 'The dried root of Anacyclus
Pyrethrum'* (Compoeitae), a small plant of Africa, cultivated in Europe, con-
tains an alkaloid, Pyrcthrine, an acrid resin, a volatile oil, tannic acid, starch,
macilage, etc. Pyrethnnn has an acrid taste, and causes a free flow of saliva
(siakgogue), with a pricklin^^, pungent effect upon the tonp^ue when chewed.
If swallowed in considerable doses, it causes diarrhoea and tenesmus and
dysenteric or bloody stools, with depression and stujwr. The powdered root
IB irritating to the skin and causes sneezing when inhaled into the nos-
tril
Therapy. — In neural|?ic, rheumatic, and other painful affections of the
tongue or teeth, pellitory may be chewed or held in the month. Pellitory-
■ root is sometimes used as a masticatory in paralysis of the tongue, and may
^^>e employed in order to stimulate the salivary glands when their secretion is
^■Mdent. Dr. Whitla finds that the sialagogic action of pellitory constitutes
"«?*xc€llent means for the removal of iodine from the system. A few drops
of the tincture may be introduced into hollow, aching teeth; or, diluted with
water, it may be used as a stimulating mouth-wash or gargle in scorbutus
and fore throat, with relaxed nnicons membrane.
Pyrethri Florcs is derived from another species, the Pyrcthmm
rosenin, ^-r more jToporly. the Chryjianthomum roseum, growing in Asia,
hicli ihe half-exjmnded flower-heads are very d(»structive to insect life.
r the name of insect |Miwdt*r, or pulvis insecticidus, ihe yiowdered flow-
rs are largely used to kill insects. If a .«mnll quantity is placed upon a
late and wet with alcohol and ignited, the fumes will kill or drive from
le moni small insects, like flies or mosquitoes. It is also used in household
mv, and in furniture to destroy chink-bugs, and to remove fleas from
^rho Dalmatian powder is the be.'it; the Persian, or Caucasian, is less
•/iruMcA. Jferf. Woch., Jnn. Ifi, 1903.
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
effective. Schlagdcnhjuiffon and Keeb have discnvered in these flowers an
active principle, Mhich they name Fyrcthrotoxic acid. When hypoder-
micfllly injected into animals, it causes at first excitement, soon followed by
complete prostration and paralysis of lower extremities, and death by failure
of respiration and circulation. To cheapen the cost of the powder, many
dealers adulterate it with inert vegetable matter.
PYEIDINTJM.— Pyridine (CJI^N) is a clear, colorless, volatile liquid,
with charjuicri^iii.' odor niid pungent taste. Pyridine is soluble in water
and alcohol, and forms crystalline salts, which are likewise soluble in those
fluids. In aqueous solution it has a marked alkaline reaction. It boils at
116" C. (240.8° F.), and is miscible with water, oil, alcohol, ether, and benzin,
forming clear solutions. It gives precipitates with solutions of most metals,
but not with lend acetate and magiK*sium sulphate. Pyridine is the founda-
tion of a group of compounds known as pyridine bases, formed in the dry
distillation of bones and other nitrogenous compounds, and as a decomposi-
tion product of nicotine and some other alkaloids. It was discovered in 1846
by Anderson. Chapman and Smith have made it by synthesis, by dehy-
drating amyl nitrite with phosphoric anhydride. Nascent hydrogen con-
verts pyridine into piperidine.
Physiological Action, — Upon the healthy adult inhalations of the vapors
of pyridine mixed with air produce flushing of the face, witli quickening of
the pulse and of the reBpiration, the latter lasting only a few moments, the
former from fifteen minutes to ten hours, depending upon the amount in-
haled. Pyridine produces slight giddiness and sometimes headaches. Ac-
cording to Caiit^ni, pyridine exerts a markedly deleterious influence upon
the medulla and particularly upon the respiratory and cardiac centres. It
diminishes reflex irritability and causes a fall of blood-pressure. In large
doses pyridine causes a fall of temperature, cyanosis, paralysis, and death
from respiratory failure. It occasions the formation of methicmoglobin in
the blood.
In asthmatic patients, the quickening of tlie respiration is not observed;
on the contrary, the heart's action slowly falls to the normal, if it had been
previously accelerated, without change in rhythm or force, while the res-
piration becomes slower, easier, and fuller, the dyspnoea disappearing. In
most cases there is a desire to sleep, without narcotism or interference with
brain functions, the patient being easily wakened, as out of natural sleep.
The odor of the drug is soon recognized in the urine, and it is expelled by
the kidneys and in part by the lungs. Its elimiEation by the urine is re-
markably rapid. Pyridine is also possessed of some antiseptic pripertiea.
Therapy. — From the fact that tobacco-smoke, when inhaled, gives relief
in asthma, Germain See was led to attribute the efl'ect to pyridine, and from
clinical experience, in a woman suffering with asthma and dyspnea from
heart disease, he was induced to advocate its further employment. From 4 to
7.50 ccm. (or f3i-ij) were poured upon a plate, and the fumes inhaled by the
patient with her head directly over it. These inhalations were continued
from twenty to thirty minutes, and were found to afford much relief, and
frequently to abort or arrest the dyspnoeic attack. In a number of other
cases, including some both of pure asthma and of cardiac asthma, this treat-
ment was resorted to with remarkably good results. S^e believed that pyri-
dine is the most certain agent for bringing relief when iodine fails, and that
PYROOAI^LOL.
it is superior to the hypodermic use of morphine, its action being more last-
ing and better borne by the system. Dr. Nefl also reported good results.
Of 12 cases, 3 were of nervous asthma, with complete relief and no return of
the attack; 3 cases of cardiac asthma were relieved; 3 of bronchial asthma
had no return of attack; of 2 cases of dyspncea in advanced phthisis, 1 was
ilightly relieved, the other wag not benefited; 1 case of asthma, as complica-
tion of gout, was cured. All unpleasant symptoms were confined to casea
with lon^-standing emphysema, or valvular or degenerative heart disease,
villi small, irref^ajlar pulse. In advancod phthisis, it should be used with
ctre, and pn)bably will fail. Pyridine has givt^n relief in angina pectoris.
Cema writes that it has boon given internally in doses of 0.12 to O.IS com.
(or fflii-iij*) and as an injection with 300 parts of water in gonorrhcea. A
decided drawback to the usi' (if this remedy is its extremely disai^reeable odor.
H caj
I
PYBOGALLOL (U. S. R)-— PyrograUol, Pyrogamc Acid [C^H,(OH),].
Fharmacology. — Pyrogallol is a triatomic phenol obtained chiefly by
carefully heating gallic arid (U. S. P.). It occurs in the form of brilliant
while crystals, of a bitter taste and free from odor. It should be kept in am-
r-colored bottles, as the crystals darken on exposure to light. Pyrogallol is
iluble in water, alcohol, and ether. Its watery solution, in contact with the
&ir. absorbs oxvgen and acquires a browTi color, and the fluid changes from
a neutral to an acid reaction. The alteration takes place more rapidly if a .
caustic alkali be present. PjTogallol may be used dissolved in flexible
collodion* 0.«>5 to 2. CO Gni. to 30 c.cm. (or gr, x-xl to fjj), or as an oint-
ment with petrolatum (5 to 15 per cent).
Dr. Kromayer, in a paper read before the Sixth Congress of the German
Dermatological Society, called attention to some new reactive remedies, in
8 paper which stated that pyrogallol is a benzin with three hydroxyl groups,
each of which may be replaced by acid radicles. Thus, we may have a mono-
icetyl-pyrogallol, a diacetyl-pyropallol, and a triacetyl-pyrogallol, Pyro-
gallol njononcetate, or "Engallol,'* is a syrupy, dark-yellow liquid, soluble in
water; parogallol diacetate is a white powder not readily soluble in cold
water; pyrogallol triacetate, or "Lenigallol," is a white powder entirely in-
■oluhle in water, and is only gra^hially *lis.<iolved ou wanning, with aqueoua
«olations of alkalioe, with decomposition. Lonignllol is a mild preparation,
even ointments containing 50 per cent, with wool-fat causing no irritation,
n applied under a bandage. It is decomposed by the strongly alkaline
^mpiration, producing tlie characteristic darkening of pyrogallol, together
with its action on the skin, in cases of psoriasis, chronic eczema, and in
chronic impetiginous eruptions. It is asserted that lenigallol is non-poison-
ous.
Physiological Action and Therapy. — When applied to the skin, pyro-
jnilol causes a brown discoloration. The incautious application of pyro-
gdllol may cause inflammation of the skin, and this may result in extensive
ulceration and sloughing. It will also stain the hair and nails as well as linen
ipparel with which it comes in contact. If absorbed in sufficient quantity
tma substance excites vomiting, diarrhoea, disturbances of temperature, nerv-
OM manifestations and great prostration of muscular strength. Fatal casea
hare occurred from the free use of an ointment on large cutaneous lesions.
The urine is black and contains hieraoglobin, and the blood becomes of a
blackj^ or chocolate color. In doge poisoned by pyrogallol, hepatic lesions
"?76 PUAHMACEUTICAL THEttAPBUTIC AOKKT8 OH DRl-OS.
were produced identical with those caused by phosphorus. The mineral acids
act as antidotes. Pyrogallol poaaessea antiseptic properties.
Pyrogallol is eniployiHl oi^ an external ajijtlieation in certain diseases (tf
the skin. It has a good elTcct upon the iiati/lies of psoriasis, aud may be ap-
plied as an ointment or dissolved cither in flexible collodion or in aletdiol
witli the additinn of a little glycerin. r?ed in a similar manner, pyrogallol
is ficrviif'ablc in hijjuti, lepra, and syijliilitic lesions i»f the inlf;jUMieut.
Engallol has been used in place of pyrogallol for lr*cnl trt-atment in psoria.^is.
It is apptit'd pure, folh^wed in half an hour witii zinc oxide [towdcr or pa:*te.
Gallacetophenone. — This substance, a derivative of pyrogallol, was dis-
covered by von Nencki. Gallacetophenone is obtained by heating together
a mixture of 1 part of pyrogallol, 1 Vs parts of acetic acid, and 1 Va parts of
zinc chloride. It is a pale-yellow crystaUine powder, soluble in hot water,
alcohol, ether, and glycerin. The addition of sodium acetate promotes its
solubility in cold water. Gallacetophenone is possessed of antiseptic prop-
erties. It has been used in 10-per-cent. solution as a substitute for pyro-
gallol in the treatment of psoriasis.
Pyraloxin is a rlerivalive of [iyn><rallic ncid. TTnna found it less irritat-
ing and unt toxic. It is next to cbrysciiihanic acid in efficiency in psoriasis,
and is useful in lichen planus, and lupus lU-ytliemaUisiis. It is also a para-
siticide and is used in ringworm of the scalp in children, and in sycosis after
the hairs have been removed by x-rays,
PYROXTLINTFM (U. S. P., B. P.).— Pyroxylin, Soluble Gun-cotton.
A pnnhiit oltlaitH'd fiy Ihe action of nitrir and sulphuric acids on rottnu,
nnd consisting'' chiefly of tetrnnitraLc f ^',Jiio(OXO;f)^Oo]. ll shouKl be
kept in cartons protected from the light.
Gun-cotton is white, dry, and entirely soluble in a mixture of alcohol
and ether. It is inflammahln and vjolrntly explosive. (See Collodion.)
i
QTTASSIA (U. S. P.).— Quassia.
QUASSLffi LIGNUM (B. P.).— ftuassia-wood.
DoBC, G.6o to 2 Gm, (or gr. x-xix), in infusion.
PreparatioTis.
Kxtriutum guassiw (U. S. P.).— Extract of guussia. Dose, 0.0C5 to 0.20 Om.
(or gr. iiij).
Fluiiiextrnctiim Quasiiiin (U. S. P.). — KUiid Extract of Qunsum. Dofte. CIO
to 1 c.vm (or mv-xv).
Tim'tura Qiiassifo iV. S. P., 20 per cent.; B. P., 10 per cent.). — Tincture of
Quassia ('2<l per cent.) . Dtis*-, 0.(15 to 4 com. (or «(X-f3j).
Liquor Quassiie Conwnlratus (B. P.). — Concentrated Solution of Quassia (100
Gm. in alcohol [20 per cent.] IIOO c.cin.). Dose, 2 to 4 c.cm. (or fSss-j).
Infusum Quassia) (B. P.). — Infusion of Quaaflia (1 per cent.). Dose, 15 to 30
c.cm, (or fSaa-j).
Quttssiin. — The bitter principle. Dose, 0.015 to 0,0:i (or gr, V«'Vt)-
Pharmacology. — Quassia is "the wood of Pierasnm excelaa" (8imaru-
haeeie), knoun commercially as Jamaica (pinsaia, or of Quassia ntnara,
knowTi eonimereially as Surinnm ipiasaia, a large tree of the West Indies,
usually occurring in the form of billets or snuiU chips, nearly white, without
odor, but very hitter. Quai»sia-wood contains a hitter, neutral i)rinciple,
Quassiin. crystallizing in needles, and readily soluble in nlcohnl and in liot
QCERCrS,
777
vator. According to Massutiii. quassiin it* ft mixture of a and fi picrasmin.
It also has a minute quantity of volatile oil, l>ut uo tannin. The solid ex-
tract is aqueous, hut the fluid extract is made witii dilute alcoliol.
Physiological Action. — Quassia is very destructive to flies and insects.
A concentrated solution is poisonous to the lower animals, and caused seri-
UU5 gymptoms of narcotism, in a child of 4 years, as mentioned by Potter.
in the do?e of ahout O.Olo Gni. (or gr- V^J. Campardon found quassiin
to produce severe headache, burning pain in tlie throat and cesophagus, sick-
nttt of fitonaach, vertigo, restlessness, diarrhoea, and frequent passage, but
dimLniflhed eecretion, of urine. In small doses it is stomachic and tonic.
Therapy. — Quassia is a simple bitter, without astringency; it is a good
rtotnachic, and increases the appetite; it is used as a tonic in dyspepsia, where
it probably exerts both a tonic and an antiseptic aetion. Quassia is likewise
uiefttl in diarrhoBE dependent upon indigestion. It can be given with iron
on account of the absence of tannic acid, and often hns aromatica combined
with it to improve the taste. It is useful during convalescence to stimulate
the appetite^ and may be combined with nn nlkiili and given before meals.
In children, an infusion of quassia is a useful agent as an enema to destroy
ibread-wonns.
QTJERCUS ( U
. I . — White-oak Bark.
Flnldextractum Querciw (T, S. P.).— Khiiil Kxtrnot of White Oak.
■ t^tta. (or rnxv-3j).
DottC, 1 to 4
Pharmacology. — *'The dried bark of Quercus nlba (Ctipulifcra?) col-
Iwleil frum trunks or liranehes 10 to 25 years of age, and deprived of the per-
! idcrm,'* contains chiefly tannic and gallic acids, upon which its usefulness
' depends. The forni of tannic acid contained in oak-bark is known as
j Quercitannic acid. In addition, tliore has been fotind a bitter principle,
jOnercin; also pectin, toioring nuUter, etc. TluTe jirc no official prepara-
Itiftus; but a dtrfK-tion (1-1(>) is enipioyed, and a (had extract nuule with
tdiluteil alcohol is ohtainablr, but tlicy are rarely used. Oak-gnlls from
Juercus lusitaniea also contain tannin, and, as tliey answer a similar pur-
N>se, they are more couvenicnt for medical use than the bark, hut tannic
gallic acid is grnerally used in preference.
Physiological Action and Therapy. — A decoction of white-oak bark is
asionally used as an injection or wash in leucorrhoea; also in sore throat
ad nasal catarrh, but it stains clothing, and may well be substituted by
ilutions of tannic acid. The applications of tannic acid have been already
Econsidered. The powdered bark is an ingredient in tooth-powders; it was
also fonnerly used as an absorbent application to ulcers and as a poultice
in gan^ene. A confection or candy of white-oak bark is in popular use for
rflazed throat.
A concentrated fluid extract of Quercus alba is, according to the method
derised by Heaton, injected into the margin of the inguinal ring for the
ndicaJ cure of hernia, but the forms of operative procedure for radical cure
jenerally preferred by surgeons.
778
PHARMACEUTICAL THERAPEUTIC AGEXTS OR DRUGS.
QITILLAJA (U. S. P.)— Quillaja, Soap-bark. ^M
QUILLMiE CORTEX (B. P.).— Quillaia-bark (Panama Bark). ^^
f Preparations.
Fhiitlextrrtctiiiti Quillfiju {V. S. P.). — Fluid Extract of QuiUajft.
Tinctura Quillaja' (U.S. P.), Tinctiira QuillaiBB (B. P.).— Tincture of Quiilaja
(20 per cont.). (The U. S. P. formula is four times the strength of thai of the
B. P., of which the dose is 2 to 4 c.cm., or fSss-j.) Dose, O.CO to 1 c.cm. (or mx-xv).
Liquor Picis Carbonia (B. P.). — Solution of Coal-tar (quillaia-bark, 200 Gm.;
prepared coal-tar, 200 Gm.; alcohol, 1000 ccm.).
Pharmacol og:y. — The "dried bark of Quillaja enponaria (Rosaceae), de-
prived of tlie periderm," is brought to this country, from Chile, in flat pieces
several inches wide and from two to three feet iu length. The outer surface is
brownish white, the inner whitish and smooth. It has a splintery fracture
and is destitute of odor. The infusion of quilinja, when shaken, froths like
soap. This propcrt}' depends upon the presence of an irritant, poisonous
glucosideciillod Saponin, wliich is now licld to be a mixture of two principles
known as qnlllajic acid and qnillajasapotoxin, or sapatoxin. Dr. Heese has
determined that saponin derived from quillaja-bark is identical with that
from other ^onrt-efl and with sencgiu, oivurring as a constituent iu cuulophyl-
lum, sent^^ii, and other plants. Saponin was isohitod in ISoO by le Boeuf.
It is a white, crystfilline powder, the taste of which is at first sweet and after-
ward acrid. Saponin i^ slightly soluble in water, but more readily soluble in
strong and boiling alef>hol. Its saturated alcoholic solution is a solvent for
gums, resins, and oils, with which, after being mixed with water, it forma
permanent emulsions.
Phyfliological Action. — The powder of soap-bark and solutions of
saponin are strongly irritant to the Schneiderian membrane and excite sneez-
ing. In weak solutions, saponin is a local aniesthetic; in concentrated form,
it is a protoplasmic poison, and its local action destroys the energy of nerv-
ous and muscular tissue. Saponin exerts a specific influence upon the ali-
mentary tract, since even intravenous injections give rise to gastro-enteritis.
Schroff found that 0.16 to 0.20 Gm. (or gr. iiss-iij) of saponin produced irri-
tative cough and secretion of mucus in the bronchial tubes, lasting for sev-
eral hours; but no efTect was manifested upon either the kidneys or skin.
It causes pain when injected hypodermically. Locally applied, it paralyzes
both sensory and motor nerves, producing local paralysis with anajsthesia and
stiffness of the muscles. It counteracts the effects of digitalis upon the
heart. Saponin also paralyzes the respiratory and vasomotor centres, and
after large doses respiration fails before the heart ceases to beat. If injected
into a vein, death follows from cardiac paralysis, which accords with the
observation that saponin reduces the force and frequency of the hearths
action, and finally paralyzes it. Robert claimed that the effects of com-
mercial saponin nrc due to quilliijic lu-id and sapotoxin. The quillajic acid
has very active toxic properties when injected into a vein, in the lower ani-
mals. Sapotoxin has n mild taste, but is very toxic; and exercises a solvent
action upon the red blood-corpuacles.
Therapy. — It is principally as a topical remedy that quillaja has been
employed, but, although its range of application is limited, it exhibits de-
cided power. Quillaja^ is an excellent stimulant to chronic ulcers and
* See paper by author "On a Natural Soap and ita Use in the Treatment of Dis-
eases of the Skin/' The Medical Bulletin, July, 1879.
RE3INA.
chronic eczema, the affected parts being covered by a roller-bandage which
has been saturated in an infusion of soap-bark. The same preparation is
of value in hyperidrosis and bromidrosis. The hands and feet may be ad-
vantageously bathed in this solution every day or every second day, while
the axilla or face can be mopped by a sponge which has been dipped in the
infusion. In dandruff and simple pitjrriasis, the watery solution of soap-
bark is an etficient application. The tincture may be employed where more
powerful action is required, as in chronic eczema or alopecia circumscripta,
in which conditions it will often prove superior to the tincture of green soap.
Piffard recommends a mixture of fluid extract of soap-bark with glycerin in
certain forms of acne. A decoction of soap-bark is not unpleasant to the
taste and has been given as an expectorant instead of senega. In aortic dis-
ease with hypertrophy, Brunton suggests the employment of quillaja for
the saponin which it contains. Saponin may also be used, in small doses,
as an expectorant in chronic bronchitis. Senegin, which is probably iden-
tical, has been administered in 0.13 Gm. (or gr. ij) doses to check uterine
haemorrhage. Saponin might be useful in affections for which senega has
been recommended, as snake-root is thought to owe its activity to this active
principle.
The root of Saponaria officinalis (not official), a perennial herb, com-
mon around dwellings, known as soap wort or "Bouncing Bet," contains about
30 per cent, of saponin in the inner bark. The soiipwort has been used in
the form of a decoction, as an alterative in chronic skin diseases, scrofula,
and gonorrhopa.
k
QUIinNA. (Sr^^ Cinchona.)
EADIUM. (See Part III.)
RANUNCULUS.— Crowfoot or Buttercup.— None of the 250 species of
Crowfoot is official. Sir James Sawyer, of Pirrainghnm, recommends' an
ointment of the fresh herb of Ranunculus Ficaria in lard (1 to 4) in the
treatment of piles. By the addition of spermaceti (25 per cent.) supposi-
tories may be made with this ointment
RESINA (U. S. P., B. P.).— Ecsin, or Eosin (Colophony).
Preparations.
Cerfttum Regime (U.S. P.). — Reain Orate, BAslUcoa Ointment (resin, 35; yellow
K, 15; lard, 50 parts).
Cemtum Retina Compositiim [V. S. P.).— Compound Rosin Cerate (rosin,
ttVfe; yellow wax, 2214: suet, 30; tury>enlint», li>»j; and linseed oil, 13^^ parU).
Unguentum Kesinie (B. P.). — Reain Ointment (resin. 20 Gm.; yellow bees-wax,
10 Gm.; olive-oil, 20 Gin.; lard, 15 Gm.).
Lininu*ntnm Terebinthinos (U. S. P., B. P.), — Turpentine Linimt'nt (resin oe-
TBte. 65; oil of turpentine, 35 parts). The Liniment of Turpentine of the B. P. doea
ttOt contain resin.
Emplastrum Rcsinn (B. P.). — Resin Plaster (hard soap, 5; rosin. 10; lend
pUater, 80 parts).
Pbarmacolo^. — Resin is "the residue left after distilling off the vola-
^BriiUh Medieai Jow^al, January 2, 1904.
780
PHABMACBUTICAL THERAPEUTIC AGKNTS OE DRrOS.
tile oil froni turpentine" (IT. S. P.); "the residue left after the distillation
of the oil of turpentine from the crude oleoresin (turpentine) of various
species of Pinus (B. P.)." (See Terebinthina.) It enters into several offi-
cial cerates and plasters, to which it gives adhesiveness. Resin is insoluble
in water, but soluble in alcohol, ether, fixed and volatile oils.
Physiological Action. — It is slightly irritating to the skin, and inter-
nally is antiseptic and astringent in its effects upon the intestines.
Therapy. — Eesin lias been employed as a domestic remedy for diarrhoea,
a few grains, finelypowdered, being given every hour or two, but it is seldom
used internally. Tne fames coming from boiling resin may be inhaled in
chronic bronchitis and in winter cough. Resin cerate, or basilicon ointment
as it is sometimes called, is a popular dressing for ulcers, promoting cic-
atrization and granulation. Compound resin cerate, or Deshler's salve,
as it is populnrly collet), contains turpentine, and is more stimulating
than the plain cerate; it is sometimes applied to blisters to prevent
their healing too quickly and to promote suppuration. It keeps better if
mnilo with petrolatum than with linssecd nil, aa in the official formula. The
latter ghoukl be freshly made.
Betinolf or Resinol (Codol), is a liquid hydrocarbon, obtained by the
dry distillation of colophony, or of Burgundy pitch. It is of a brown or
yeilowiBh color, has the consistency of a fat, and has a slightly bitter taste;
its reaction is slightly acid on account of the presence of traces of picric
acid. It forms a varnish-like coating over a surface when applied. It shares
the antiseptic properties of the other balsams, and possesses the additional
advantage of dissolving a great number of active substances, such as oil of
cade, camphor, beta naphtliol, balsam of Peru, phosphorus, iodol, salicylate
of phenyl, chrysnrobin, cocaine, etc. Ketinol mixes with fats, oils, wool-fat,
glycerin, and petrolatum. By mixing a proper proportion of colophony, with
oak-leavos or sodium borate, a ma?# can bo obtained sufficiently adhesive to
allow it to be made into suppositoriea for vaginitis, etc.^ Retinol is non-
irritating when applied to the skin, and is an eicellent vehicle for medica-
ments in cutaneous diseases. It does not become rancid and is unchangeable
by time or light. It has an advantage of most of the new remedies in the
fact that the price is moderate.
Therapy. — M. Barbier gives a number of formulae for its use, from
which the following are taken: —
^ Retinol 10
Adipis Innrc liyd 6
Sodii bicarbonatis
M. et ft unguentum.
Gm. or Siiss.
Gm. or 3i gr. xv.
13 Gm. or gr, ij.
This is used in the ophthalmological clinic of Dr. Hubert for con-
junctivitis, simple or gonorrhceal affections of the lids or the tear-ducts, and
for the preparation of dressings and protection of instruments. The fol-
lowing, of greater consistence, may be ordered: —
3 Retinol.,
Reainn,
AHipift IiiniB hyd aa 8|
M. et ft. unguentum.
Gm.
' Dr». Balear and Chevalet, La Midecine Modeme, April 24, 1800.
»
I
BE80ECIN0L. "^^^I^^T 781
BetJDol is antisoptie, imirritating, and, in a large nuinhor of skin dis-
s, it gives excellent results, either alone or as an antiseptic cxeipient for
dOifT substaiiees.
Jd some skin affections^ the following may be used with advantage: —
H Retinol 81 Gm. or 3ij.
Gl jcerit amyli 11 1 ccm. or fSiij,
M. Sig.: For external ftppHcation ae directed.
Or this:—
B Retinol 1516 Gm. or 5iv.
01. cadici ISJ ccm. or f3iv.
M. Sig.: For peoriasis, chronic eczema, etc.
M. Vigier* states that retinol gives excellent results, in the proportion
of 6 per cent., in vaginitis and in blennorrhcea, as a topical application.
The effects of this mixture are beneficial also in chronic cystitis, but in acute
cases it often acts as an irritant. DesnoB reports very favorably of the use
of a 5- to 10-per-cent. solution of ealol in retinol in the treatment of subacute
cystitis. The solution is injected into the bladder where it is allowed to re-
main, exerting a local influence, for a number of hours.
RESOKCINOL (U, S. P. ) .— Eesorcin, or Resorcinol [C,H^(On),].
Dose, iKt\:>'\ to 3 Gm. (or gv, x-xv to xlv).
Pharmacology. — Reaorcin is a diatomic phenol, made by fusing gum-
KStDS with caustic potash. The process for obtaining it from gum-ammoniac
has already been described. It is now prepared from benzene, on a
Urge scale, synthetically. It crystallizes in small^ colorless prisms or plates,
has a neutral reaction, a sweetish taste, with slight pungency or acidity, and
an odor which resembles that of carbolic acid. Resorcin melts at 246.2* F.
and distills at 529.7° F. It was discovered by Hlasiwetz and Barth. It
should be kept in dark, amber-colored vials.
Besorcin is an ox3'phenol, homologous with orcin, derived from benzol
hj the substitution of two hydroxyl groups for two atoms of hydrogen.
Qiemioally. it is a dihvdroxybenzene, of which there are tbree forms,
namely: ortho-, meta-, and para-, the first is known as pyroeatechin or
catechol; the second as resorcinol ; and the third as liydroquinoL Reiiorcin,
when exposed to light and air, acquires a yellow-brown or reddish-pink color.
It ia soluble in water and other solvents, except chloroform and carbon disul-
phide. The best vehicles for medicinal purposes are alcohol, glycerin, and
syrup of orange. While the dose is usually from 0.32 to 1 Gm. (or gr. v-xv)
4 Gm. (or 5j) may be given at a single dose, as an antipyretic. It is a most
ifficient antiseptic and nntiferment. Andeer recommends fresh butter as a
fdiicle for making an ointment (1 per cent.) extemporaneously.
Besorcin may be tested by dissolving it in a solution of potassium hy-
droxide, adding a drop of chloroform; the mixture, being heated, will
ttfume an intense crimson color. If a slight excess of hydrochloric acid be
then added, the color will change to a pale straw yellow.
Physiological Action. — Resorcin is non-irritant to the skin, and, when
injected subcutaneously, causes very little inflammation and no suppuration.
■ ''Du Retinol et de »on Emploi en M«decine/' par F. Vigier. Jourml de MM^nt
4e fttrt*. Nov., 1890, p. 541.
782
PHAR1L40EUTICAL THEaAPEDTIO AGENTS OR DfiUOS.
In strong solutions it irritates mucous membranes and sometimes vesicates
them. In full doses (2 to 4 Gm., or gr. xx2-3j) resorcin acts as an antipyretic,
reducing the temperature for two or three hours, but at the same time has
the disadvantage of causing nausea, oppression, languor, and free perspira-
tion. Above these amounts it is not safe to go, since, by larger doses, cere-
bral sjTnptoms are induced, such as deafness, vertigo, confusion of vision,
convulsions (clonic and tonic), and rigidity of the muscles of the back of the
neck. Death has, in several instances, been caused, in children by washing
out the stomach with a 3-per-cent. solution of resorcin; in one case haemo-
globinuria was produced. In lower animals, death occurs from failure of res-
piration and paralysis of motor tracts in the spinal cord. It is excreted
chiefly by the urine, which it darkens or even changes to a bluish color;
the addition of tincture of ferric chloride to such urine causes it to become a
dark-violet color. Symptoms of poisoning in man are best treated by free
catharsis, diffusible sLimulauts, hot drinks, and diuretics; atropine and
strychnine might be given hypodcrmically.
Therapy. — The decided antiseptic qualities of resorcin, with its solu-
bility and not unpleasant odor or taste, make it a valuable application for
the throat and nose in diphtheria'; and in this disease it may also be ad-
ministered internally to disinfect the gastro-intestinal tract, and thus pre-
vent reinfection. It is considered also to be of service to impregnate the
atmosphere of the sick-chamber by the spray from a steam atomizer, of a
5-pcr-cent. solution of the same agent. In erysipelas, puerperal fever, and
septicemia, resorcin has been used, both locally and internally, with marked
benefit. A S-per-cent. solution is a good spray for various catarrhal and
other affections. In saturated ethereal solution, resorcin acts as a slight
caustic, especially to raw surfaces or mucous membranes. The powder may
be dusted on granulations, pure or combined with boric acid (1 to 20 or 1
to 10); it is very efficient in discharges from the ear. The ear should be
thoroughly cleansed with a solution of boric or carbolic acid, and dried; after
this the above powder can be blown into the canal. To foul ulcers and
sloughing wounds an ointment containing 4 to 8 Gm. (or 3i-ij) of resorcin in
each 31 Gm. (or 'J) is an excellent application. Chancroids and ulcerated
syphilitic lesions receive decided benefit from the same preparation. A con-
centrated alcoholic solution of resorcin is an efficacious local application to
leukoplakia. A 1- or 2-peT-cent. watery solution of resorcin is of service
in acute or chronic conjunctivitis and wounds of the cornea. It is likewise
a beneficial application to tuberculosis of the larynx, to mercurial and other
forms of stomatitis, and to thrush. In whooping-cough and hay fever this
remedy is advantageously used in the form of a spray, a 2-per-cent. solution
being eilicacious in the former disease, while in hay fever the solution has
been made as strong as 20 per cent. Moncorvo, who introduced this method
of treating whooping-cough, is accustomed to use a solution of chemically-
pure resorcin in sterilized water and apply it to the laryngeal mucous mem-
brane by means of a thick bnisih of camers hair attaclicd to a handle of flexi-
ble iron wire. Applications are made every two or three hours during the
day. Resorcin ointment has been employed with good effect in certain dis-
eases of the skin, as chronic eczema, psoriasis, alopecia circumscripta, and
lupus erythematosus. In the abortive treatment of herpes, M. Leloir em-
ploys the following solutions [Medical News): —
Resorcin in Diphtheria." CentralhJatt fiir die geaammte Thfrapie, H. 9, 1890,
RESORCINOI..
783
B RworciiiolU 2
(.Wnin. liydrocliloridi |60 to 2
Acid! Unnici 0
Alcohol. (90 per cent.) 90
Or:—
Gm. or 3bs.
Om, or gT. viii vel rxx.
Gm. or 3iss.
c.cm. or f3iij. — M.
n Cot'aiii. Iiydroehlorkli . 11 Gm. or gr. xv.
Ext cannabis Indies lol Gni. or 3iiss.
Spt. menth. pip 0 26 cenj. or fSiiaa.
Alcohol. (90 per cent) 00| c.cra. or f3ij.— M.
U. et ft. sol.
Petrini obtained good reeolts in acne rosacea, after the pustules had
been opened, by the application of the following preparation: —
B Rftsorrifiolin 1
IcbthTolis 2
Collodii flexil 30
Om. or pT. XV.
cxm, or f3ft».
c.cm. or fjj. — M.
Resorcin-soap (5 or 10 per cent.) as first used by Julius Andeer, haa
\etn found useful in ringworm of the scalp and other parasitic skin dis-
eases. According to the observation of Dr. Jamieson, a reaorcin-salicylic
superfatted soap shortens the desquamative stage of scarlatina. In a series
of caaes, washing the skin with this soap and warm water reduced the period
of desquamation bv two wet'ks. F*>i" wtlMH'rhn^io fK-^^pmn, Dr. Eddowes rec-
ommends:—
Resorcinolia 21 to 4
Glycerini |00 to 1
Acet canthftrid U
01. &mygd&le dulcU 15
8p. odoratlB 30
Alcoholis 001 to li50
Aquae q. b. ad 240
Gm- or Sfls-Sj.
20 c.cm. or mx-xx.
c-cm, or f3iij.
c.cm. or f3iv,
c.cm. or fjj.
ccm. or fjiii-v.
c.cm. or fjviij.
This forma a pleasant local application and relieves itching.
In the treatment of extensive patches of tinea versicolor. Dr. E. Bodin
uplojs an ointment thus composed: —
B Rcrir)rcinolia
Acidi taticylici aa II Gm. or gr. xv.
Sulphur, precip d| Om. or gr. Izxv.
Adipis Innu? Iiyd.
IVtroIati niollia,
Strl aa 23|3 Om. or 8vj.
U. et ft uogt
[)rcin is a better antiseptic than carbolic acid for internal administra-
can be given as an antif»Tinent in dyspepsia and digestive disorders.
Ingiftric catarrh, gastralgia, and ulcer of the stomach, resorcin has rendered
p>oA ienice. It ma3r be likewise used with success to allay nausea and vom*
itin^ and has been given with asserted advantage in seasickness. In gastric
deer, it relieves pain and checks ha?morrhage.
Prof. W. H. Thomson, of New York, has prescribed it in this class of
u follows: —
784
PUARMACEUTICAI. TliER-4PElTlC AGENTS OR DRr08.
^ Resorvinoliif, 8| Gm. or 3ij. ^^H
& Tr. aurani. cort., ^^B
I Glycerini, ^^M
m Syr. zingib aa 1 51 ccm. or fjas. ^^
■ Aq. menth. pip. q. b. ad 180| c.cra. or fjvj. 1
M. et ft. BoL ^H
Sig.: Two teaspoonfula in wineglassful of water after meala. ^^H
Resorcin is also serviceable in the diarrha?a of children. A solution!
has bcvn i^iieooss fully <'ni|>loyo(] ns an iiij>cti*ui in n:ounrrha?a and for wflsh-l
in<r out the bladder, there beiii;j: but little danger in these cases from abisorp-;
tion nf the remedy. In epitlielinina of the skin, resorcin has given excellent
results in the iiands of Dr. Mario Luciaui, wlin reports two cases of cutane-i
0U8 epithelioma in which he claims to have effwted a complete cure by the;
application of an ointment containing resorcin. He used this fornnila:—
3 Resorciiiolitt 101 Gm. or Siisa.
Petrolati 3l| Gm. or 5j.
M. Sig.: Apply once a day to the ulcerated surface, after previously clean&iog
with a 2-per-cent. watery solution of borax. i
One ease, a woman of 48 years, with an ulcer upon her forehead, was!
cured in three months; and in another* 60 years of age, with the same dis-
ease upon her lip of about a years duration, this simple treatment wasi
followed by an equally happy result. No microscopical examination appears:
to have been made in either case in order to establish the diagnosis (Joumali
of the American Medical Associati<m). In doses of 0.65 to 1.62 Gm. (or gr.
i-xxv), resorcin is claimed to have reduced the pyrexia of tuberculosis.
Besopyrin. — This compound is prepared by precipitating antipjrria'
with a molecular proportion of resorcin. The substance is insoluble in water
and crystallizes from alcohol in colorless, rhombic crystals.
Eucalypto-resorcin. — A combination has been made by M. Barbey bj
placing eucalyptol in contact with resorcin, in excess. This body is insoluble
in chloroform, from which it is deposited in the form of interlacing crystals.
The crystals are insoluble in water, very soluble in alcohol and ether, vol-
atilize at 100 degrees, giving off a strong odor of camphor.
lodoform-resorcin. — Dr, Bielniew vaunts a combination, which he tenna:
resorcinol. rompo^ed of cijual parts nf res4)rcin and iodoform. This is ao!
aniorphdus. yi'llowiph-lvrown powder, Imvinjr an odor vesend>ling that of
iodine. It has bpcn used upon leg-ulcers, unliealthy wounds, and syphilitic
lesions. Reson inol has been em]>loyod in tlie form of a powder, weakened
witli 4 parf.f! of stiircli. or as an ointinent in the strength of 2 to 4 Gin. (or
5ss-]) to ;M Oiu. (or .>j) of lard. Re^iorcinol is, however, a bad name for
this compound, since the same designation has been officially given to re*
sorein in refrrenr-e to its plienol elinraoter.
Pheno-resorcin is a mi.xture of 67 parts of resorcin with 33 parts of
phenol and combines the efiFects of these two antiseptic agents. Pheno-
resorcin is poluble, forming a liquid with 10 per cent, of water, and may be
used like carbolic acid.
RHAMNTJS CATHARTICirS.—Common Buckthorn.
Pharmacology. — The fruit of the common buckthorn, Rhamnus cathar-
ticus (Khamnaceae), is decidedly cathartic and cholagogic; the bark also has
these properties, and, this species being naturalized in this country, probably
it is often substituted for the official frangulu-bark, which is the alder buck-
RHAMNUS PCTB8HIAKA.
785
thorn, an allied species of Rhamnus. (See Frangula.) The official Rham-
nus purshiana is another variety of the same species. The fruit ifi purplish
black, and, when dried, is about the size of a pea ; tlie pulp eontaina
four seeds; odor slight; taste nauseating, bitter, and acrid. The active
principle is Bhamnocathartin, an amorphous, yellow, brittle substance. The
principal preparations are: Extractum rhamni eatharticfle fruetus fluidum
(fluid extract of buckthorn-berries); dose, 4 to 6 ccra. (or fSi-iss). Succus
rhamni catharticae (buckthorn-juice); dose, 1 to 4 c.cm. (or fniv-f3j). Syru-
pus rhamni cathartic© (syrup of buckthorn: buckthorn-juice, with ginger,
ingar. allspice, and alcohol); dose, 4 to 7.50 c.cm. (or f3i-ij).
PhjBiological Action. — All the species of rhamnus possess purgative
properties of greater or less activity, but some are mvch more violent in action
than others. Nausea, vomiting, and severe gripinc; pains often attend their
purgative action, to avoid which aroraatics are usually added, as in the syrup.
The common buckthorn likewise produces extreme dryness of the mouth and
throat.
Therapy. — Rhamnus catharticus may be employed in constipation and
in dropsy, and was formerly used in the treatment of gout and rheumatism.
RHAMNTTS PTTRSHIAWA (U. S. P.).— Cascara Sagrada.
CASCABA SAGRADA (B. P.).— Cascara Sagrada (Sacred Bark).
Preparalions,
Fluidextractum Rhamni Purshiana; ( U. S. P. ) . — Fluid Extract of Cnscara
Gifrmda. Dose, 1 to 4 c.cm. (or mxv-3j).
Fliiidextrncti Rhamni Purshianic Aromnticum (V. S. P.). — Aromatic Fhiid-
EirtrHct of Cascara Ji^ngrada. Dose, 1 to 4 c.cm. (mxv-Sj).
Extractum Cascane Sagradn Liquidum (B. P.). — Liquid Extract of Caacar*
6||^da. Dose, 2 to 4 c.cm. (or fSss-j).
Extractum Caacars Sagrada (B. P.). — Extract of Cascara Sagrada. Dose, O.IS
to OJSO Gm. (or gr. ii-viij),
SjTtipus Cascare Aromnticua (B. P.). — Aromatic S3mip of Caacara. Dose. 2 to
4 exm, (or fSas-j).
Fhannacology. — Rhamnua purshiana (Rhamnacete) is a shrub or small
tree, ten to twenty foot In'glu growing on the Pacific coast, and is ponietimes
Imavm as the California buckthorn. The dried bark is the official portion,
and ranst he collected for at least one year before being used (U. S. P.). An
azulrsis by Prof. A. B. Pre>cott^ showed its chief constituents to be a bitter,
brown resin; a red resin; a li^ht-yellow resin; tannic, malic, and oxalic
ftcidfl; a neutral, crystallizable pubetance; a volatile oil (probably identical
with Quebracholl, wax-stnroh, and a fat oil of yellowish color, tt contains
ooiwid<»rahle Emodin, which Jo^vett claims is not active-, and some Iso
CDiodin. Leprince extracted from tho bnrk a substance which he thouplit
^gfat be the active principle and which he called casoarin. Jowett
imM shotm that cascarin and purshianin are only impure emodin.
The active principle is probably a derivative of the ;?liicoside found
xa the bark. The alcoholic extract, treated with water and lead sub-
■^^^aie, precipitated a sticky mass which has active physiological effects.
iHxative principle is soluble in ether, but insoluble in water. Accord-
• M. Phipson. cascarin is identical with rhamnoxanthin derived from
11^ frangula.
•^>w Ptcparations," Feb., 1879, pa(rc 27.
786
PHARiUCEDTICAL THEHAPECTIC AGENTS OR DRCGB-
PhyBiological Aotion. — Cascara sagrada is not so much a purgative as
it is a laxative with tonic properties, the latter being attributed to the bitter
principle. In a nnniber of clinical cases, Mr. Milnes Hey has noticed that it
also produced a sensible diuretic effect. Caacarin appears to have a slight
•cholagogic action. In ordinary dosage it causes an easy evacuation of the
bowels without griping, does not excite nausea or diarrhoea, and its use is not
followed by constipation. Cascarin may be given in the dose of 0.10 to 1 Om.
(or gr. iss-xv).
Therapy. — Cascara sagrada, in the form of fluid extract (in doses of
1 c.cm., or nixv, three times daily), is useful in chronic constipation. The
■dose should be gradually increased until the bowels are moved naturally
once daily; the remedy can then be given less frequently and the dose re-
duced. It is a peculiarity of this drug that it is not a cathartic, and its use
should be preceded by a dose of castor-oil to clear the alimentary canal. It
has the advantage of producing natural motions of the bowels by its tonic
action upon the intestinal glands, increasing secretion and peristalsis. The
dose is reduced after the natural condition of the bowels is established; it
does not require to be given in increasing quantities, as do the ordinary resin-
bearing cathartics. It also is a valuable hepatic tonic in congested liver and
in duodenal catarrh. Cases of indigestion, with furred tongue, sallow skin,
eructations of gas, and constipation, are benefited by the following prescrip-
tion:—
30|
f5j.
4
B Fluidext. rhamni purshinnip
Glycerini.
Elixir aromat aa 16| com. or fSss.
M. Sig.: Take from one-half to one teaBpoonful. directly after eating, three
times daily, until the symptoms are relieved.
A combination made use of by Dujardiu-Beaumetz in cases of chronic
constipation is: —
B Fhiidevtrfloti rhamni pursh.,
Glvccrin. pur aa &0 c.cm. or fSiij-
Alcohol. 100") 180 ccm. or fjvj.
Syrup. Bimpl 3<iO c.cm. or fSxij.
Ol. tturantii 37 c.cm. or mvj.
01. cinnamomi 12 c.cm. or ifiij.
Aq. deetill q. ». ad 840 ccm. or CM •/..
id. Sig. : Dose, one or two teaspoonfula.
In cases of chlorosis, Lutaud gives: —
B Ammonii et ferri citrat 40 parts.
FUiidc'Xt. rhamni purshianie . . 40 partA.
Saccharin I part.
Aqus destillatee ...4000 parts.
Id. Sig.: A tca^poonful to be taken before each meel, for constipation.
In atony of the bowels a combination with berberis aquifolium is use*
ful:
K Fluidext. rhnnmi puri«h.
Flutdcxt. b*»rberidi8 aquifol..
Syrupi
M. Sig.: Dose, a teaspoooful four times a day.
30| ccm. or fS)>
RHB0H.
In constipation with gastric irritability, Dr. J. II. Bundv, of California,
who first introduced the remedy to the profession, proposed the following: —
R Fluidejtt. rhamni pursh 15
Fluidext. b*"rborjdia a<jiiifol 30
Acid, hydrocyanic! dilut 4
Syrup. ( vel ext. malti) q. a. ad 120
M. Sig.: Teaspoonful after znealf and at bed-time.
c.cm. or fSfia.
ccm. or f5j.
c.cni. or f3j.
c.cra. or i^ivt
I
According to the experience of J. C. Stephens, cascara sagrada is also
an edicient tsniafuge.
Where the bitterness is an objection, we may use as a vehicle a cordial,
in which the taste is well covered by aroraatics. The solid extract of cascara
sagrada makes a pill-mass which does not soften or decompose when made
up witii {iowdered inarshmullow. A t'oiinueroiol preparation, casearin (not
otBcial) is presented in scale form, which is not hygroscopic, is readily re-
Lduced to powder, almost tasteless, soluUk^ in wat^r, and contaius, it is
claimed, the active principles of tlie dnig. (Doee, 0.015 to 0.03 Gm., or gr.
RHETTM (U. S. P.).— Rhubarb.
EHZI RADIX (B. P.).— Rhubarb-root.
Dose, 0.065 to 1.30 Gm. (or gr. i-xx).
Preparations.
Fliiidcxtrftotum Khei ( U. S, P.). — Fluid Extract of Rhubarb. Do»e, 0.60 to
4 c.cm. (or mx-f3j).
MUtura Rhei et Sode (U. S. P.).— Mixture of Rhubarb and Soda ifluid extract
rhubarb. 15; fluid extract ipecac, 3; sodium bicarbonate, 35; glycerin, 350; spirit of
pcppermini, 36; water, q. a. ad 1000 parta). Doae, 4 to 60 c.cm. (or f3i-fjij).
Synipus Rhei Aromaticus (U.S. P.). — Spiced Syrup of lUiubarb (aromatic tinct-
ure of rhubarb, 16 per cent., and simple byrup). Dose. 16 c.cm. (or fiR6),
Tinctura Rbei (U. S. P.;.— Tincture of Rhubarb (20 per cent.). Dose, 1.20 to
lo ccm. (or m3:x-f5s8).
Tlnctuni Rhei Aromatica (U.S. P.}. — Aromatic Tincture of Rhubarb (rhubarb,
cinnamon, cloves, nutmeg, glycerin, diluted alcohol, and water, q. a. ad lOOO parta).
Do9c, 4 to 15 c.cm. (or f3i-iv).
Extractum Rhei (U.S. P., B. P.). —Extract of Rhubarb. Do8«, 0.13 to 0.66 Gra.
<or gr. ii-x).
Pulvia Rhei Compositua (U.S. P., B. P.).— Compound Rhubarb Powder (U.S. P.
containn rhubarb, 25; ma^eaia, 66; and ginger, 10 parta). Gregory's Powder. Dose,
2 to 4 Gm. (or 3as-j).
S}Tupu-» Rhei (U.S. P., B. P.).— Syrup of Rhubarb (U. S. P. contains fluid ex-
tract, 10 per cent.). Dose, 4 to 15 c.cm. (or f3i-iv). B. P., 2 to 4 c.cm, (or fSss-j).
Piliilffi Rhei Compositie (U.S. P., B. P.).— Compound PilU of Rhubarb (U.S. P.,
rhubarb, aloes, and myrrh). Dose. 1 to 3. B. P., 0.25 to 0.50 Gm. (or gr. iv-viij).
Tinctura Rhei Compoeita (B. P.). — Compound Tincture of Rliubarb. Dose. 2 to
4 Cjcm. lor fSsa-j) ; for a single administration, 7.5 to 15 c.cm. (or f3ii-iv).
Liquor Rhei Concentratus (B. P.). — Concentrated Solution of Rhubarb. Dose,
2 to 4 c.cm. (or fSss-j).
Infnsum Rhei (B. P.). — Infusion of Rhubarb (5 per cent). Doae, 16 to 30 c.cm.
(or fSss'jK
Aoidum Cbrvsophanicum. — Chry.«»phanic Acid.
Pharmacology. — Hhnhnrb is "the dried rhizome of Rheura officinale,
Rhenni palmatuni, and the variety tangutiourn, or prohahly other apecies
«
788 PHABHAOEUTIOAL THEBAPBUTIO AGENTS OR DBUG8.
of Bheum (Polygonaceffi), grown in China and Thibet, deprived of most
bf the bark and carefully dried (U. S. P.) ; ''the erect rhizome, or so-
called root, of Bheum palmatum, Eheum officinale, and probably other
species, deprived of more or less of its cortex, and dried'' (B. P.)* The
botanical origin of Bheum is Asia. The European rhubarb, R. rhaponti-
cum, is not one-half as active and is not recognized by the pharmacopcei&s.
The peeled and dried root of the Chinese or East IncQa rhubarb, of a light
color and characteristic odor, only should be used in medicine; powdered
rhubarb is inferior, and, when not adulterated, is at least largely made up
of inferior, damaged, and worthless, or worm-eaten, rhubarb. The actire
principles are a glucoside called Chrysophan, with Emodin and certain
resins; Chrysophuiio acid, Phseorhetin, Erythrorhetin, Aporhetin, Bheo-
tannic and Bheumio acidi« The grittiness of rhubarb is due to crystals of
calcium oxalate contained in the root. Cathartio acid, which appears to be
composed of several constituents, is purgative in doses of 0.13 to 0.30 Gm.
(or gr. ii-v) .
Physiological Action. — When taken into the mouth, rhubarb has a
peculiar, bitter, slightly astringent taste, and increases the flow of saliva;
m the stomach and intestinal tract the secretions are likewise increased and
the peristaltic movements stimulated proportionately to the size of the dose,
but after the first effects have been displayed the secretions are reduced by
the secondary astringent action of the drug. The resinous constituents act
upon the liver, increasing the quantity of bile; according to Butherfoid, it
is a certain, though not a powerful, hepatic stimulant. The bile secreted
under its influence has the normal composition, and it is, therefore, a tnie
cholagogue. The coloring matter is largely excreted by the kidneys, and the
urinary flow is increased. The color may resemble that of urine which cob>
tains bile, but may be distinguished from the latter by becoming purplish
red on addition of an alkali.
In small doses, up to 0.32 6m. (or gr. v), rhubarb is a stomachic tonic,
which makes it a valuable constituent in dinner pills to aid digestion and
prevent constipation. . As a purgative, in doses of 2 to 4 Gm. (or Sss-j), it acts
slowly and in the course of seven or eight hours produces copious yellov
.stools containing bile. Griping may be due to the drug itself, or to the bile
which is poured out under the action of its resinous constituents, notably
phseorhetin. The cathartic principles may be absorbed through the integn-
ment, when applied on a ^lutice or spongiopilin; it is, Uierefore, a systmc
purgative. These purgative constituents are excreted by the liver mainlyp
but also by the intestinal glands, the kidneys, and skin. After a woman has
taken a dose of rhubarb, her milk may contain enough of these principles to
purge the nursing child, and may acquire a yellowish tinge from the presence
of the coloring matter of the drug.
A case has been reported in which the internal administration of rhn-
barb gave rise to an hsemorrhagic eruption of macules, pustules, and blebs.
The mucous membranes were also affected, and free hemorrhage took place
from the urethra.
Therapy. — Rhubarb is a slowly acting purgative, of service especially in
the treatment of children's disorders caused by errors in diet, rich food, etc
The spiced syrup of rhubarb in teaspoonful doses may be given to an infant
rith indigestible food or curd in its stomach, or when ite gaatro-intestinal
ract contains mucus from bronchial catarrh, etc. The mi^rture of rhubarb
aJKEADOS rJiTALA.
789
and soda is a good antacid and carminative for babies suffering with colic
and cramps. In adults it may be given with special advantage in hot water,
fifteen or twenty minutes before eating meals, especially in cases of gastric
catarrh. In summer diarrhoeas of adults or infants the irritation arising
from the presence of unsuitable or undigestible food is at once relieved and
the cause removed by a dose of the aromatic syrup or tincture of rhubarb.
Where there is intestinal dyspepsia and colalgia or cramps, the sweet tincture
will be found very efficient and acceptable. Rhubarb may be combined
thus: —
li Pulv. rhei 6
Sodii bicarb 8
Spiritus ammonii aroinat. 1 )
Spiritus myrieticte 22
Infus. caryophylU q. a. ad 240
Gm. or 3ia8.
Gm. or 3ij.
cxm. or f3iii.
ccm. or f5vj.
c.cm. or fjviij.
K. Sig.: A baU to a tablespoonful three or four times a day.
In children with acid discharges from the bowels, the combination with
magnesia is especially useful. In weak digestion with deficient secretion,
BQulI doses of the tincture are valuable: —
B Tinct. rhei 7|6
Tlnct. cardamom, co.,
Elixir aromatic aa 15|
IL Sig.; Take twenty to forty drops before each meal.
c.cm. or I3ij.
ecu. or fjas.
Sidney Martin finds small doses of rhubarb efficacious in ascarides, his
prescription being: —
Q Tr. rhei 1120 c.cm. or mxx.
Magnea. carbonatis 120 Gm. or gr. iij.
Tr. zin^ber 06 c.cm. or mj.
Aquxe 1 1| c.cin. or (3iij.
31. Sig.: To be taken at a dose. Repeat two or three times daily, according to
the effect.
Urticariay due to indigestion, may sometimes be relieved by rhubarb
with magnesia, but without the ginger. It is a useful ingredient in purga-
tive pills, where a cholagogic e5ect is desired, especially where hffimorrhoida
are present: —
B MaaaflB hydrarg 38 Gm. or ;jr. vj.
Ext- rhei 20 Gm. or gr. iij.
Ext. colpcynth. co 38 Gm. or gr. vj.
Saponis 03 Gm. or gr. bs.
M. et ft. pil. DO. iij.
Sig.: To be taken at bedtime, and followed in the morning by a teaspoonful of
BodieUe salt in water before breakfast.
Constipation and heemorrhoids, during pregnancy, are benefited by the
administration of rhubarb. This remedy is considered by some practitionert
a* of special value in gouty eubjecta. Rhubarb has been known to cause a
macular, or vesicular, rash.
RH(EADOS PETALA (B. P.).— Red-Poppy Petals.
Preparation.
Sympus Rh(pados (B. P.), — Syrup of Red Poppy. Dose, 2 to 4 c.cm. (or f3ss-j).
790
IMLUtMACKUTICAL THEBAPEUTXC AGENTS OR DBUG8.
The fresh petals of Papaver rhoeas (Papaveraceae), or cornflower, have
a narcotic smell, when fresh, and it has been asserted that they contain a
amall proportion of the opium alkaloid, although Attfield was not able to
detect any morphine. Hosse isolated- from this plant an alkaloid, for which
he proposed the name of rhosadine, which appeared to be devoid of toxic
properties. According to the same observer, the juice from the capsulea con-
tains meconic acid.
Red-poppy petals are employed in pharmacy to supply a beautiful red
color to preparations. It is doubtful if they have any medicinal virtues.
I HHCEAS.— Red Poppy.
Pharmacolo^ and Therapy. — The petals of the red poppy, Papuver
rhoeas (Papaveraceffi), cultivated in gardens, contain a coloring matter and
Bhceadine, but only a trace of morphine. The preparations are used as col-
oring agents in pharmacy; although doses are quoted below, the remedy is
seldom, if ever, employed. The taste is mucilaginous and bitter; it may act
as a simple bitter, as a stomachic tonic during convalescence. The following
preparutiutis iire listed: Fluidextrarluui rhcvados (fluid extract of poppy-
flowers); dose, 2 to 6 c.cm. (or mxxx-fSiss). Syrupus rhoeados (syrup of red
poppy); dose, 4 to 7.50 ccm. (or f5i-ij).
EHUS AEOMATICA.— Fragrant, or Sweet, Sumach. The bark of the
root of Rhus aromatica (Anacardiece), growing in the eastern portion of this
country, contains a resin, volatile oil, and tannin.
Physiolog:ical Action. — Rhus aromatica is astringent, tonic, stimulant,
and diuretic.
Therapy. — Sweet sumach has been used as an astringent in diseases of
the kidneys and genito-urinary tract* as in cystitis and haematuria. It is like-
wise said to check menorrhagia and night-sweats. It is employed in atonic '
diarrhoea or summer ^lysontery, after a preliminary purge to remove offend-
ing substances from the alimentary canal. It has been lauded as a remedy
for nocturnal cnures?is of children, -1 c.cm. (or f^j) of a good fluid extract
being administered in diminished doses during the day. In larger doses
this drug has exerted a good effect in hysterical enuresis. In diabetes, both
mellitus and insipidus, it has also proved of service.
RHUS GLABRA (U. S. P.).— Rhus Glabra, Smooth Sumach.
I Preparation.
Fluidextrnctum Rhois GlabriC (U. S. P.I.— Fluid Extract of .Rhus Glabra.
Dose, 4 to 7.5 c.cm. (or f3i-ij).
Phannacoloi^. — ''The dried fruit of Elms glabra" (Anacardiaceae), a
common slmib iihuig the roadsides in the United States, cont^iins tannic
acid, besides potassium and calcium malates and a rod coloring matter.
Therapy, — Rhus glabra is a good astringent in the form of decoction,
or fluid extract, for a raouth-wash or gargle in stomatitis, spongi,* gums, or
pharjTigitis, and as a topical application in skin diseases and ulcers in do-
mestic practice. The following is a useful gargle for sore throat: —
. H PotaflsU chlorntis 81 Gm. or 5ij.
I Fluid*»xt. rhoi*- glnbrse 16 c.cm. or fjss.
Glywrini 45 c.cm. or fJiRs.
1 Aqua; rosie 120| c.cm. or fjiv.
M. Sig.: Add a tablespoonful to a winegl&sshil of wat«r. and use as a gargle, fre-
quently.
RHUS TOXIOODBNDHON.
791
RHUS TOXICODENDRON.— Khus Toxicodendron, Poison-ivy.
Pharmacology. — Tlic I'resh leaflets of Rhus radicals (Aiiflcardincete),
indigeTJOus to the eastern portion of North AmericH. The active principle
rwas thought l»j Maisch to he toxicodendric acid, but this haa since been
[found, when pure, to he non-toxic and have the characters of acetic acid.
The active principle i^ volatile and is probably a fat acid. A resin and a
peculiar fixed oil, toxicodendroU are present in the leaves. As the chief con-
Lt-tituent is volatile, the fresh leaves only are viaed; dried leaves are worthless.
Several other species of rhus, as the swamp-sumach (E. venenata), contain
tliis constituent. The swamp-sumach (rhus vemix or rhus venenata) has
[pinnate leaves, and somewhat resembles Rlius glabra. It always grows in
I wet ground. A closely allied species grows in Japaif (R. vemicifera). The
lac or varnish upon t'liincite or Japanese boxes is made of this species of
.suaiAch, and very susceptible individuals may be poisoned by handling them,
by being present when such varnish is used. The rhus nidieans is also
rn as rhus toxicodendi-on ; it is sometimes erecit and sometimes climbing.
The poison-sumach may be recognized by trifoliate, compound leaves, re-
sembling the ordinary ivy in having adventitious roots along the under side
of the climbing stem, with the exception that in the poison-sumach the roots
are given ofif in bunches at the nodes oppnsite the insertion of the petiole or
leaf-stem, while in the ivy they grow from the entire under side of the stem-
It is distinguished from the Pteloa trifoliata by having petiolate instead
of sessile Icatlcls. The pois<»nnus principle resides especially in the juice.
Physiological Action.— The frceh leaves are very irritating to the skin,
although the effect is much more marked in some individuals than in others.
In characteristic cases of poisoning there is set up an acute dermatitis, with
a great deal of oedema and hypera?mia of the skin; frequently vesicles or
blebs are formed, accompanied by much irritation and itching. This in-
fianamation resembles erysipelas, spreading from the parts first affected to
surrounding skin and mucous membrane. With this there is considerable
general disturbance, pains in the abdomen, nausea, and vomiting; diarrhea
or dinresis may occur, with passage of blood. Fever and profuse perspira-
tion may also be observed, with pains in the joints and lumbar region. The
effects of the poison last from a week to a fortnight, and are followed by
free desquamation of the affected surface.
Poisoning. — Many remedies have been advocated; the free application
of a carbolized alkaline wash to neutralize tlie poison, or soap suds, followed
bv fluid extract of grindelia diluted with water (1 to 10) or distilled extract
nf haTnamolis, is very good. Quinine sulphate in recently-boiled water (1 per
rf^ngth) is an efficient applicatiou,' according to Dr. T. J. Daniel, of
!io. Ark, Prof. Wormley preferred a mixture of 1 part of carbolic acid,
€p«rts of sodium bisulphite, and 100 parts of water. The fluid extract of
Virginia snake-root is said to be advantageous. Dr. S. B. Straley, of Hunta-
viJlc, X- J., has found that a strong decoction of chestnut-leaves applied to
the affected part every few hours has a very beneficial effect in reducing heat,
itching, and smarting. Other remedies which have been used with good
diect are decoctions of white- or black- oak bark, or dusting the surface
freely with powdered aristol. Relief may also be afforded by the use of lime-
witer or I^abarraqne's solntion. An infusion of lobelia, in the proportion
'Mtdu-at RuUetin, Sept.. lOOit.
792 PHABMAOBDTTOAL THBRAPBUTIO AOBNT8 OR DBCQS.
of 31 Gm. to 473 c.cm. (or Ji-Oj) of water, also is of service in this condi-
tion of local poisoning. Dr. E. L. Hinton eJttols an infusion of saK*afra8-
bark. Compreases saturated in the cold infusion are applied to the affected
surface, and the" warm infusion is given internally, sweetened or with milk.
When the inilamiuation is in the face, and accompanied by much swelling
of the eyelids, alum curd is very efficient. Ointment of the oxide of zinc
with carbolic acid (3 per cent.) is useful to heal the lesions of the skin.
Therapy. — Rhus toxicodendron is rarely employed in medicine, al-
though Phillips declares that it is useful in rheumatic pains and affections
of fibrous tissues; also in certain skin affections, erythema, erysipelas, herpes,
and pemphigus. In rheumatic paralysis it is claimed to be efficient. Dr. E.
Carmichael Rothrock co'Visiders rhus toxicodendron as an excellent cerebral
and spinal stimulaut. Extenmlly, 2 c.uiii. (or fSss) of the liiifture (1 to 2
of aIcoh*"l) in a pint of water may be used as a stimulating application., with
advantage, for sprains, chilblain?, bums. sHngs nf insects, etc.
A tincture (1 part of the dry leaves to 5 parts, by weight, of alcohol)
of rhus radicans, or poison-ivy, is recommended by Dr. Saint-Phillipe, of
Bordeaux, as a good remedy in the nocturnal enuresis of children. He ad-
ministers to children, under 6 years of age, 0.30 c.cm. (or mv) of this prepa-
ration nitjbt and morning.
mCIOT OLEUM (U, S. P., B. P.).— Castor-oil. (See Oleum Kicini.)
ROSA GALLICA (l\ S. P.).— Red Eo»e. The dried petals of Jiosa
gallica collected beforf/ expanding (Hosacwe).
ROS.a; GALLICJE PETALA (B. P.).— Red-Rose Petals. The fresh and
dried unexpanded petals of Kosa Gallica.
Preparations,
FliuElfxtraclum Ro^a? ( L'. 8. P.). — FluiU Extract of Rose (from red roBea|.
Doee, 0.30 to 4 c.cm. (or ?nv-f3j).
(?onfectio Rosee (U.S. P.). — Confection of Rose (red rose, sugar, honey, and
■tronger roae-water).
Mel Rosffl (U.S. P.).— Honey of Rose.
Pilulte Aloes ot Mastiches (U.S. P.). — PiUs of Aloea and Mastic. Dose, 1 to 3.
AquB Roece Fortior (U.S. P.). — Stronger Rose-water. (For making rose-water.)
Aqua Rosm (U. S. P., li. P.).— KoBe-water.
Syrupua Roscc (U. S. P., B. P.). — Syrup of Uoses (U. S. P. contains fluid extract,
12 Vi per cent.). As a vehicle.
Oleum RosiB (U.S. P., B. P.).— Oil of Rose ("attar of rose"). The volatUe oil
didtiUcd from the fresh flowers of Rosa damasccna (Rosaceoe).
Unguentum Aquso Rome (U.S. P., B. P.). — Rose-water Ointment, Cold Cream.
Confcctio Rose Gallioo (B. P.). — Confection of Roses (red-rose petals and
sugar).
Infusum Rosa* Acidum (B. P.). — Anid Infusion of Roses (red-rose petals, 25 Om.;
diluted sulphuric acid, 12.5 c.cm.; distilled water, boiling, 1000 c.cm.). Dose, 15 to
30 cctn. for fSss-j).
Pliarmacology. — Red rose contains tannic and gallic acida and a vol-
atile oil, which the pharniflCMijupias direct shall he ohtained from another
Bpecies. Eed rose is ao ingredient in the F. S. P. pills of aloes and mastic.
The British Pliarnincoincia contains an acid infusion of rose, which is an
agreeahle luoutli-wnph for low fevers. It may be given internally, and is an
agreeable method of ndniinistering gulphuric acid. Rose-water is a com-
ponent of the compound iron mixture. j
RUBIDIUM, ^^^^^^^^"^ 793
Fhysiolo^cal Action and Therapy. — PreparationB of rose are some-
what astringent. They are used as agreeable flavoring agents and vehicles.
The confection is a good base for pills. The compound infusion is of service
for overcoming the bad taste of magnesium sulphate. Aqua rosae is a favor-
able vehicle for eye-washes, urethral injections, and cosmetic preparations.
H Rose-water ointment is an elegant^ bland unguent, principally used as an
B excipient, but available in superficial bums, chapped lips or hands, abrasions,
H and erythema.
ROSMABINTJS.— Eosemary.
Preparations.
Oleum Rosraarini (U. S. P., B. P.). —Oil of Rosemary. Dose, O.OG to 0.3U c.cm. (or
nxr) .
Tjnctura Lavandula Composiia (U.S. P., B. P.).— <^ompound Tincture of Laven-
der. Do«e, 2 to 4 c.cm. (or mxxx-fSj).
Spiritus Rosmarini (B. P.). — Spirit of Roeemary (10 per cent, of oil).
Fharmacology. — The dried leave* of Rosmarinus ofiGcinalis (Labiatse)
flre aromatic, pungent, and bitter. They contain volatile oil (about 1 per
cent.), some resin, tannin, and a bitter principle. Rosemary enters into
aromatic wine, perfumed spirit, or eau-de-Cologne, soap liniment, and com-
pound tincture of lavender.
Physiological Action. — Rosemary is stimulant, diuretic, carminative,
emmenagogiie, and somewliat diaphoretic, but is now rarely employed in sub-
stance, the oil taking its place. The latter is stimulant and carminative. It
reduces temperature, imparts a peculiar odor to the urine, and in large quan-
tities has caused death. It is chiefly used as a rubtfucient in liniments and
ointments.
Therapy. — In alopecia from defective nutrition of hair-bulbs, a lotion
containing oil of rosemary and tincture of cantharides, with Cologne water,
is frequently given. It may also be used as a rubefacient for sprains and
painful joints, and is eflRcacious in the difTerent forms of pediculosis. The
compound rosemary ointment of the German Pharmacopoeia contains 1 part
each of oil of rosemary and oil of juniper-berries in 30 parts of ointment,
and is used in neuralgia, chronic rheumatism, and lumbago. The oil of rose-
mary 18 of some service as an internal remedy in hysteria accompanied bj
depressed spirits.
From 6 to 12 Gm. (or 5iss-iij) of the Rosmarinus sylvestre, dried and
powdered, taken as a hot, recent infusion, are said by Sznabl to produce a
decided diaphoretic effect.
RTTBIDIirM. — Rubidium is one of the rarer metals, and belonpfs to the
leries of the alkalies. It is of a soft, wax-like coni?istence: is easily fused;
'T-'liiy unites with acids and haloids to form salts, and ignites spontaneously
'' the air. Its salts communicate a violet color to flame and possess a high
electrolytic conductivity. Heretofore the cost of separating the metal from
the substances with which it was found united in nature has been too great
to allow its medicinal use. Recently, however, a new process has permitted
its more economical production.
• Rubidium iodide is the salt which has been almost exclusively used. It
i« a white, crystalline substance, which does not effloresce, is without odor,
794
PHARMACEUTICAL THERAPEUTIC AQENT8 OH DEU08.
and has a milder taste than potassium iodide. It is, moreover, more soluble
in water than the corresponding salt of potassium.
Fh7siolog:ical Action. — The salts of rubidium exert a far less depressan
action upon the heart than those of potassium. The iodide does not dimini&h|
appetite or impair digestion, does not disturb the circulation, and is less apf
than the corresponding salt of potassium to produce the phenomena o:
iodism. Rubidium chloride, according to Picket, causes death in anim "
by exhausting the nervous system and depressing the action of the heart.
Therapy. — Rubidium iodide has been used with advantage to fill many
indications of the potassium salt, for which it will prove, in many instances
at least, an efTicient substitute. In the eye clinic of Professor Scholer, of
Berlin, rubidium iodide in 5-per-cent, aqueous solution or vaselin ointment
of the same strength has been successfully employed in affections where the
action of an absorbifacicnt was demanded. Its internal use was conjoined,
and Professor Bunge, of Halle, reports it of value in chronic inflammation
of the eyes of a non-syphilitic nature, and especially in chronic optic neuritis.
Internally, it has been chiefly given in visceral syphilis, gummata, and late
ulcerated lesions. Its eflficacy is thought to be at least equal to that of potas-
sium iodide. It has also been found of avail in chronic rheumatism and in
the removal of old inflnmmatory exudations. A favorable report has also
been made of its action in gouorrhcKal rheumatism. Rubidium and am-
monium bromide was proposed by Laufenauer as o. succedaneum for the older
bromides, upon the ground that it contained a larger proportion of bromine
He prescribed it in daily doses of 6 to 6.50 Gm. (or gr. xc-c).
RUBITS (U. S. P.).— Blackberry.
4
Preparaiiotis,
Fluidoxtractum Rubi (V. S. P.). — Fluid Extract of Rubus. Do»e, 2 c.cin.
(orf3B»).
Syrupua Rubi (U.S. P.). — Syrup of Rubua (containing fluid extract, 25 per
cent). Dose, 4 to 30 c.cm. (or fSif3j).
inofficial Preparations.
Syrupus Kubi Aromaticus (N. F.). — Aromalio Blackberry-syrup (blackberry,
cinnamon, nutmeg, cloves, and allspice). Dose, 4 to 15 c.cm. (or fSiiv).
Elixir Rubi. — Blackberry-brandy (fluid extract blackberry-root, 5; aromatic
fluid extract, 7r. brandy. 13Vi; syrup of blackberries. 17: elixir. 17 parts). Do«e,
7.5 to 15 c.cm. (or foii-fjss).
Elixir Rubi Compoaitum (N. F.). — Blackberry Compound (blackberry-root, gallL
and cinnamon, each, 10 parts; \\'ith cloves, mace, ginger, in blackberry-juice and
syrup). Dose, 4 to In c.cm. (or fSi-fJtis).
Cordinlis Rubi Fructus.— BlBckbcrry-cordial (fresh blackberry-juice. 3; cinna-
mon, cloves, and nutniciEr, in tincture with dilute alcohol, 2; simple svrup. 3 part«).
Dose. 4 to 30 c.cm. (or f3i-f5j).
Pharmacology. — "The dried bark of the rhizome of Rubus villosiis,
Rubus nigrobaceus, or of Kubus cuueifolius" (IJosnceiu) is official (is Rubus,
The wood phouhl be rejected, only the bark bein^ of medicinal value. It con-
tains tannic noid (10 per rent.). The fluid extract is made by percolation
with diluted nl<'ohi>l, and contiiiiis <?lycerin (10 per cent.).
Phyaiolog^ical Action. — Blackberry is astringent.
Therapy. — In dianhcea of relaxation, especially after cleansing the
bowels with castor-oil, the preparations of blackberry are useful. The com-
5ABADILLA.
795
^nationB of the fruit for the table (jomSj preserves, etc.) ore not astringent,
and are not only useless in trenting diorrhcBa, but also injiirions, since the
hard seeds increase the irritation. The best form is the thiid extract, but
there ia a popular demand for blaekberryrcordials and blackberry-brandy^
for which formulse are given above. They are pleasant to the taste, carmina-
tive, and slightly astringent.
*
RUBTTS IDiEUS.-
-Raspberry.
Preparation,
Syrupus Rubi Idiei. — 8ynip of Raspberry. As a vehicle.
^^B Pharmacolognr. — "The fruit of Rubus idaeiis** (Rosacea) has a pleasant
flavor. It contains sugar, malic and citric acids, pectin, proteids, coloring
I matter, and a trace of volatile oil, consisting of compound ethers producing
ft the peculiar flavor.
" Therapy.— Its sole use in medicine is to prepare the syrup, which has
a pleasant, acid taste and a fruity odor. The leaves of the wild raspberry
(R. strigosus) contain tannin, and are used in decoction as an astringent in
diarrhoea. Raspberry-syrup with vinegar is a popular and grateful drink
in hot weather, added to cold water.
RUMEX.— Rumex, Yellow Dock.
Preparation.
FIuideaEtractiini Rumicis. — Fluid Extract of Riimex. Dose, 2 to 4 c.cin. (or
Pharmacology. — Rumex is **tho dried root of Rumex crispus, and of
other species of Rumex'* (Polygonaceje), growing along roadsides in Europe
ind America. The official root ia eight by twelve inches long, one-half inch
thick, somewhat fusiform. It contains tannin, chrysophanic acid, mucilage,
calcium oxalate, starch, etc.
Physiological Action. — Rumcx is alterative, tonic, and slightly astrin-
gent.
Therapy. — In strumous affections, especially enlargement of the glands'
ind cutaneous disorders, rumcx has been found particularly valuable. It is
deo considered antiscorbutic. In chronic larynfreal affections, with cough
and soreness under the sternum, it will give relief. The decoction is some-
times employed externally in various skin diseases and glandular swellings.
Also used internally in dyspepsia and liver disorders.
RUTiE OLEUM.— Oil of Rue. (See Oleum Rutse.)
SABADILLA. — Cevadilla. The dried, ripe seeds of Asagrjpa officinalis
(Llaccit). of Jloxico, contain Veratrinc, Ccvadinc» and Ccvadillinc, com-
bined with Cevadic and Cevadillic Acidj. Two new alkaloids have been
isolate by E. ^Icrck, who has called them Sabadioc and Sabadinine. Saba*
dilline wa? discovered by Meissner,
Physiological Action and Therapy. — An ointment has been used to de-
■trov lice and other vermin, and as a cure for itcli. Sabadilla was formerly
i a tAmiacide in doses of 0.30 to 1.30 Gm. (or gr. v-xx), but its action
I
i
796
PHAKMACEUTIUAL TUKRAPEDTIC AGENTS OH DRUGS.
was too violent, causing both vomiting and purging, so that it was aban-
doned. Cevadilla is a powerful emetic, cathartic, and anthelmintic, and
has been given in doses of 0.0(15 to 0.32 Gra. (or gr. i-v). It is seldom now
used, and its principal value is as^a source of the mixed alkaloids known as
veratrine. (See Veratrina.)
SABAL (U. S. P.).— Saw-palmetto. The partially dried fruit of Sere-
noa sernilata (Palmacea;). The saw-pahnetto grows along the sea-coast
from South Carolina to Florida, and is found as far as eight or ten miles
inland. This plant possesses a .creeping and branched stem, leaves of a
bright-green color, fan-shaped and spiculated. The roots, large and fibrous,
extend several feet from the stem, and are half-exposed above the sand.
The berries, or drupes, of a dark-purple color, and about the size of an
olive, ripen in October and. November. The seeds are very hard, and en-
vt'In])ed in a tough, fibrous membrane. The fruit contains a volatile oil
(soluble in alcohol), a fixed oil, and a large proportion of saccharin matter.
Fhyaiologrical Action. — The taste, at first sweet, soon becomes acrid and
pungent; to the pungent succeeds a smooth sensation, which extends from
the tongue and month to the larynx and nasal cavities, all of which parts
feel as if lubricated with oil. Saw-palmetto is said to increase appetite,
digestion, and strength, and to promote nutrition. It also exerts a sedative
and diuretic influence, and has been thought to have a special tonic effect
upon the reproductive system. The berries seem to have nutrient value, as
the animals who feed upon them rapidly fatten. The physiological action
of saw-palmetto has not been systematically investigated.
Therapy. — Saw-palmetto is said to be an excellent expectorant, and, at
the same time, a sedative to the mucous membranes of the respiratory tract.
Troublesome nervous cough is allayed and secretion promoted by its use.
This remedy has been employed with benefit in coryza, acute and chronic
laryngitis, and bronchitis. Bronchorrha?a with bronchiectasis is relieved by
the administration of sabal serrulata. Dr. Read^ states that an acute nasal
catarrh may be aborted by two or three doses, and that the vapor is inhaled
with advantage in chronic ozsena. Sabal is claimed to possess some efficiency
iii cardiac asthma. On account of its combination of tonic and expectorant
properties it has been found of eervice in phthisis pulmonalis, and especially
in tuberculosis of the larj^nx. Saw-palmettn is thought to be valuable in
atrophy of the mammae, testicles, or uterus, and to exert a lioncfioial influence
upon enlarged prostate. This remedy is likewise recommended for functional
impotence. A fluid extract is the best preparation. Dose, 2 to 7.50 c.cm.
(or f5sB-ij).
SA6BATIA. — American Centaury. The entire flowering plants of
Sabbatia annularis and of Sabbatia pnniculata (Gcnlianaccae) are used in
medicine for the same purposes as gentian, calnmba, and other simple bitters.
A solid extract, obtained by evaporating the fluid extract and adding 5 per
cent, of glycerin, may be given as a tonic in atonic dyspepsia in doses of
0.13 to 0.75 Gm. (or gr. ii-rij).
'"Sabal Serrulata, Saw-palinetto." bj Dr. J. B. Read, of Savannah, Ueorgia,
American Joui^al of Phniynai^, April, 1879, p. 109.
8A00HARUM.
nr
SABINA (U. S. P.).— Savin.
Preparations,
Fluidextrnctum Sabinie (U. S. P.). — Fluid Extract of Savin. Doae, 0.30 to
1^ c.cm. (or my-xx).
Oleum Sabinir (U. S. P.).— Oil of Savin. Done, 0.12 to 0.30 c.cm. (or wii-v).
I
Pharmacology. — The tops of Junipenis Sabina ( Conifera?) , a email ever- I
green tree coninion in the northern hemisphere, often cultivated as an
ornamental shrub. It contains from 5 to 10 per cent, of a volatile oil, which, ,
when separated by distillation, is official as oil of savin ; also tannin, reain,
etc. Oil of savin is colorless or yellowish, has a strong, characteristic smell,
and a burning taste. It is freely soluble in absolute alcohol.
Physiological Action. — Ijocally, savin causes rubefaction, or even ves-
ication. Internally, it is a stimulant to the digestive organs, increases the
action of the heart, and stimulates the bronchial, cutaneous, and renal secre-
tions. It causes hypenemia of the kidneys, of the ovaries and uterus, and,
in large doses, excites strangury, hffimaturia, violent vomiting and purging,
gaetro-enteritis, unconsciousnesSj stertor, and convulsions. Savin may, as
part of its toxic effects, cause abortion in a pregnant woman, and death has
occasionally resulted from its irritant action when administered for this nur-
pose. The odor of savin appears in the breath, sweat, and urine as elim-
ination takes place.
Therapy. — Savin used to be added to blisters, or blistered surfaces '
were dressed with savin ointment, to increase the effect, but this practice is ,
now obsolete. The cerate may be applied as a caustic for the destruction of
warts. A mixture of powdered savin and verdigris has been successfully
employed for the removal of condylomata. Powdered savin may be used
as a stimulant to indolent ulcers. A cerate or ointment of savin (25 per
cent, of fluid extract with resin cerate) is a serviceable counter-irritant
in chronic gout or rheumatism. This drug is efficient in tinea capitis and
scabies, and has even been used internally with success as a t»niacide. As
tn emmenagogue, Phillips considers it highly valuable and safe, in proper
doses. It is used in functional dysmcnorrhcea, in passive haemorrhages after
abortion, and, as ^Vhitla suggests, may prove beneficial in subinvolution of
the uterus.
SACCHARINUM.— (See Benzosulphinidnm.)
SACCHARUM (TJ. S. P,).— Sugar, Canc-sngar.
SACCHARUM PURIFICATUM (B. P.).— Refined Sugar.
Preparations.
Syrupua (U. S. P., B. P.).— Synip.
SjTTipu* Glucosi (B. P.). — Syrup of Glucose (glucow, 2; syrup, 1).
Pharmacology. — The refined sugar obtained from Sacchanim oflBcina-
nira, and from various species or varieties of Sorghum (Gramine«e) ; and
also from one or more varieties of Beta vulgaris (Chenopodiacese), U. S. P. ;
I crystallized sugar (C,.lIo.jO,, ) obtained from the juice of the sugar-cane
(B. P.^. The V, S. P. official synip consists of 85 parts of sugar, and water
q. s. ad 100 parts. Sugar is the basis of syrups, conserves, and many other [
798
PUAHMACEUTIOAX THKRAPECTIC AGENTS OR DBUOS.
pharmaceutical preparations. With lime it forms a chemical combinatum, —
the saccharate of calcium, — which is an antidote to carbolic acid; it is official
as Syrupus Calcis. Sugar takes a prominent place in modern life as an arti-
cle of food. According to Dr. Bossi. sugar excites uterine contractions dur-
ing labor. Sugar has a decided effect upon the mucous membrane of the air-
passages, and various confections and troches are used in moutb and throat
affections, and syrups arc useful in bronchial disorders.
Sacchamm lactis (U. S. P., B. P.), sugar of milk, is "a peculiar crys-
talline 3u*(ar obtained from Uie whey of cows' milk by evaporation and puri-
fied by recrystallizatioii." It is also known as lactose; cane-sugar is Bacoha-
rose and grape-sugar or starch-sugar is glucose. Sugar of milk is largely
made in Switzerland from the whey remaining after makiug cheese. It is a
white, rather gritty sugnr, less sweet than fiaccharosCj and has a neutral re-
action. It is used in pliarmocy, on account of its hardness, in making tri-
turates. Lactose enters into the U. S. P. formula for making Dover's pow-
der, and is used as a diluent for powders. It is said to be very commonly
adulterated.
Sugar of milk, in the daily dose of 8 to 15.5 Qm. (or 3ii-iv), given in an
abundance of water, exerts a decided diuretic influence and may be service-
ably employed in oases of renal inactivity or dropsy. Whon us*^d in preparing
infant's food, the diuretic effect should not be overlooked.
Diabetin. — Under this name, levulose, a fruit-sugar, has been introduced
as a food peculiarl}^ adapted to the use of diabetic patients. Levulose is a
pure, white, crystalline powder, soluble in water in almost every proportion.
It has a sweet taste and leaves no disagreeable after-flavor. Diabetin poa-
aeeses the same nutrient value as cane-sugar, nnd is said to be assimilated in
diabetes, a small proportion only being excreted by the urine.
SAFEOLTTM: (V, S, p.).— Safrol (See Saisafra*,)
SAGO, — Sago is a prepared starch from the interior of the stem of
Metroxylon sagu or Sagus Kumphii (Palmacea;) of the Indian Archipelago.
It occurs in hard, whitish, spherical grains, which form a gelatinous mass
with boiling water. Pearl sago is the beet variety. An imitation sago is
made from potatoes.
Therapy. — It is useful as an easily-digested and acceptable article of
food for the sick when added to broth, or in the form of light puddings.
SALEF. — The tubers of several species of Orchis (Orohidacese, Ophry-
deae) growing in Germany and France, collected in the autumn, deprived of
epidermis and dried. They contain Bassorin (48 per cent.), or vegetable
mucilage, and starch (27 per cent.). With forty times its weight of boiling
water, salep forms a thick jelly, which can be flavored and used as a nutri-
tious food during convalescence from acute diseases and in bowel disorders.
SAIICimJM (U. S. P., B. P.).— Salicin (C„H„0,).
Dose, 0.32 to 2 Qm. (or gr. v-xxx).
Pharmacology. — Salicin is "a glucoside, obtained from several species
of Salix and Populus (Salicacerp).'" It appears in white, 8ilk>' crystals, of
very bitter taste. When boiled with diluted acidp, it is ropolvod into grape-
-iBttgar, saliretin, and 8ali§:enin. or ortho-oxybenzyl-alcohol. Salicin dipsolves
799
I
m water. alcf>hoI''9olu tions nf cniistic potash and soda, and in glacial acetic
ncid. It ia very sparingly 8<,')luble in ether and insoluble in chloroform.
Salicylic acid and the ealicylates of sodium (see page 842), of
lithium, and of phvsost inline, are also otficial. The oil of gaul-
thcria, or of birch, also contains aalicin as methyl salicylate, and may
be used to obtain salicylic acid, which, howeyer, is usually prepared syntheti-
cally. Methvl sniicvlate is now official in the United States Pharmacopoeia.
(See Gaultheria. )
PHysiological Action. — Willow bark is an astringent bitter tonic and
anUperiodic. One variety, the Salix nigra, is considered a diuretic and sexual
sedative, the fluid extract being used in doses of 1.20 to 2 c.cm. (or mxx-xxx)
several times a day. Salicin acts as a bitter tonic, with antiperiodic and anti-
septic powers. It is not toxic in the human subject, and is acceptable to the
stomach. This agent ia excreted mainly as salicyluric, salicylous, and sali-
cylic acids by the kidneys. Snlicin is not entirely, or always, decomposed
after absorption, as it has been found in the urine under its own form. Its
pe from the body is slow.
Therapy, — Salicin is a useful, bitter tonic, in feeble digestion, in doses
of 0.13 to 0.32 Gm. (or gr. ii-v). In the diarrhfpa of phthisis it is effective in
restoring a more healthy condition and promoting digestion, and it also re-
duces the fever, given in doses of 1.30 Gm. (or gr. xx), two or three times
daily: —
H Salicin..
Bismuth, subnit.
01. einnamomi
M. et ft. capsulrc no. xx.
Sig.: One or two eapgults every hour or two for diarrhcea.
Salicin is a beneficial remedy in the chronic diarrhcea of children. In
acute rheumatism, Maclagan considers it safer than salicylic acid, as it does
not depress the heart, the dose being from 0.65 to 3.25 Gm. (or gr, x-1) every
three or four hours; or, in order to get the full antipyretic effect, these
doses may be administered every hour until two or three are taken, and then
less frequently.^ He also commends its use in neural^a and corj'za. In
full doses its antipyretic effect may be accompanied by free perspiration, but
it is not toxic, and can be given in amounts of several drachms daily.
Dr. E. B. Turner praises the action of salicin in influenza, having treated
more than two hundred consecutive cases by means of this agent, which was
given to adults in doses of 1.30 Gm. (or gr. xi) every hour for ten or twelve
successive hours, and to children in proportionate quantities, according to
their age. In pelvic pain, dependent upon or aggravated by a rheumatic
ditthesis, Jules Charon has often found 1 Gm. (or gr. xv) of salicin, admin-
istered in three doses, of decided efficacy. In certain cases of metritis, sal-
pingo-ovaritis, pelvic cellulitis, or peritonitis, and in lurabo-abdominal neu-
ralgia it may be given with advanto^c.
6150 Gm. or gr. c,
|o<i o.cm.mj. or
I
SALOI (B. P.).-r.JT.AH,0,).
PHENYLIS SALICTLAS (U. S.
Dose, 0.32 to 1 Qra. (or gr. v-xv).
-Phenyl Salicylate.
'9e« aUo article by nuthor on "Rheumatic Fe>'er'
*«'. for Febnuiry 24. 1006.
in .Vreo York J/tfdioat Jour
800
PHABMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
Phannacolosfy. — Phenyl salicylate, or salol, is an ester obtained by the
action of condensing agents upon a mixture of salicylic acid and phenol,
or the sodium compounds of the same (CgHgC^HgOa). Salol is a white,
crystalline powder, insoluble in water, odorless, and almost tasteless. It was
first prepared by von Nencki in 1883, and introduced into practice in 1886
by Sahli. In the organism it becomes decomposed, yielding salicylic acid
and carbolic acid in nascent form. It is antiseptic, germicide, and antipyretic
to a more marked degree, and is proportionately less toxic than either of its
constituents. Salol usually passes through the stomach unchanged. Its
decomposition is effected, in the intestine, chiefly by means of the pancreatic
fluid and pai-tly, also, by the intestinal fluids. According to the experiments
of Eeale and OrandCj salol may, at least in some cases, be broken up in the
stomach into its component parts. Salol is also decomposed by the action of
pus and the action of various bacteria.
The following tests are olRcial (U. S. P.) ; Phenyl salicylate placed
'Upon moistened blue litmus paper should not produce any reddish coloration
(absence of free acid). If 1 Gm, of ])henyl salicylate, shaken with 50 c.cm.
of water, be Altered, the filtrate should show no color, or at most a trace,
with ferric chloride test-solution previously diluted with 20 volumpp of water
(limit of uncombined salicylic acid and phenol). If a portion of the same
filtrate be tested with barium-nitrate tpet-solution and silver-nitrate test-
solution, it should show no turbidity (absence of sulphates and chlorides).
Physiological Action and Therapy, — It must not be forgotten that in
administering salol internally the therapeutic effect is due to the salicylic
acid and carbolic acid, and therefore that large doses cannot be given with
impunity, for fear of phenol poisoning, Salol is absorbed slowly and elim-
inated slowly, so that there is danger of accumulation in the system if given
too frequently, except where diarrhcea is present. M. Josias has reported the
case of a young girl who had taken 3 Gm. (or gr. xlv) of salol in forty-eight
hours, and in whom a large patch of scarlatiniform erythema, together with
rose-colored papules and spots resembling those of measles, appeared in con-
sequence upon various portions of the body. The inaumation of salol for the
relief of otorrhoea has been known to cause extreme swelling of the external
auditory meatus, tlie isthmus of the fauces, and uvula. Josefowitsch reports
the case of a man, 40 years of age, to whom 22.6 Gm. (or gr. cccl) had been
given in the course of four days, who sufTered with intense albuminuria and
violent pains in the loins. Black urine (carboluria) may continue for some
time after its ingestion. Robert insists that* from the large proportion of
phenol which salol contains, it is, comparatively speaking, a toxic substance;
so that any exceeding of the maximum dose must be regarded as hazardous.
Dr. Hesselbach reported tlie case of a woman, who died after taking 8 Gm.
(or .>ij) of snlol, within ei^'ht hours. It was found thftt she had been suffer-
ing with chronic nephritis, which was made acute by the drug. From his
study of the action of the aL^ent. Hcsselbaeh concludes, first, that the large
proportion of phenol contained in snhd renders it such a toxic substance that
its unrestricted therapeutical use is fraught with danger; and. secondly, that
in renal diseases, acute or chronic, salol is contra-indicated.* Dr. Chlapowski
has recorded a case in which death resulted from the ingestion of 1 Gm. (or
gr. XV ). In rare instances, an erythematous eruption has been produced by
* '*The Action of Salol on the Kidneyi," Therapeutic Gazette, Oct., 1890. p. 704.
SALOL.
801
b
e local application of salol, probably in consequence of its decomposition.
Salol is an excellent dressing for wounds, burns, ulcers, erysipelas, and
other cutaneous disorders. In impetigo contagiosa and pustular eczema,
Egasse applies with advantage a collodion composed of: —
Pbenylis salieylat 3
Cocflin. hvHrochloridi
Collodii flexilis 18
Gm.
or gr. xlvj.
20 Gra.
or gr. nj.
6 c.cm.
or f3v.— M.
Camphor is liquefied by salol. and this is highly esteemed by Cuirllier in
mippurative otitis. The meatus is first cleansed by a solution of boric
acid, and the camphorat-snlol applied upon a tampon of wool, which is left
in positioii not more than twenty-four hours.* For oztena, C'ozzolini recom-
mends:—
B Phenylis salic^'lat 8
Acidi borici 4
Acidi stUicjlici
Thvmol
Pulv. talci
M. Sig.: XTm by iosufflAtion.
Gm. or 3ij.
Gin. or 3j.
75 Gin. or pr. xij.
32 Gm. or gr. v.
20 Gm. or gr. iij.
Gm.
orSj.
or SlBB.
5
Gm.
5
Gm.
or 5***-
Gm.
or 5ij-
2
c.cm.
or mxx
The formula for an excellent antiseptic powder, used in some of the
hospitals, is given as follows: —
B Phenylis aalicylat. 811
Zinci flulphitia 46
Pulv. benzoini 15
Talci puriflcat 62
01. fa?mcuH 1
M. Useful for chronic ulcers, etc
M. Valude recommends, in ulcer of the cornea, the application of a pad
of moistened salol gauze which, with a gauze bandage, seals the eye and
maintains a certain amount of compression. The eye is first carefully disin-
fected, the dressing placed in position and not removed for three or four
days, when the ulcer is found to be in process of repair. M. Reynier emplojrs
a liquid mixture of salol and iodoform in the treatment of abscess-cavities,
bone-cavities, and fistulas. Salol mixed with iodofonn is liquefied under the
influence of heat, but the mixture solidifies when it cools. When injected
into a cavity, the mixture remains liquid and causes the gradual evacuation
of the pus.*
Reynier makes use of the same preparation in the treatment of lapa-
rotomy wounds.
In fermentative disorders of the stomach (dilated stomach especially),
in intestinal dyspepsia, salol, in 0-13 to 0.32 Gm.for gr. ii-v) doses, is remark-
ably cfTective in relieving the annoying symptoms of flatulence, pyrosis, pain,
eick headache, etc. In duodenal catarrh, or catarrh of the bile-ducts, with
f>T without jaundice, good results are obtained from salol. Salol is regarded
(>. Strizower as an excellent remedy in the treatment of cholelithiasis. It
16 paid to favor the escape of calculi and retard their development. It is
not given for the purpose of relieving colic, but in the intervals of attacks.
* Am^icnn Journal of Vharmacy, Jan., 1891.
•to MtdeoiM Uodcn\€\ Medical B^Urtin, Sept.. 1893.
802
rHABKAOEDTIOAL THEIUJ»EUTIC AGENTS OB DfiCGS.
in doses of 0.65 Gm. (or gr. x) three or four times a day. It has been em-
ployed as a succedaneum for salicylic acid in diabetes.
This substance is of value in diarrhcea, and is strongly recommended
by Moncorvo, of Rio Janeiro, in the malarial diarrhoea of children.
The following prescriptions containing salol are useful: —
I^ Phen^liti walioylutis 81 Gm. or Sij,
Pulv. ipecttcuanhflB et opii l]56 Gm. or gr. xxiv.
M. et ft. cliartulffi do. xl.
8ig.: A powder every hour or two until reUeved of diarrhcea.
R Plmn^vlis salicylHt
Bismuth, subnit.,
Oetfle propparatiB aa 4| Gm. nr 3j.
M. et ft. chartulte no. xij.
Big.: A powder every hour or two, for dmrrhoea,
R Phcnylis Halicylat 8 Gm. or Sij.
Bismuth .^^ubnitrat. 4 Gin. or 3j,
Misturoe creUe q. b. ad 90 c.cm, or f^iij-
Sig.i Dessertspoonful every two hours until relieved.
Cholera infuntuni, tlie diarrha?a of tul>crculosis and of typhoid fever are
also benefited by phenyl salioyhUe. i)r. \\, 1j. Cnrr has found it of de-
cided service in the first stage of acute gastro-enteritis. In doses of 0.25 Gm.
(or gr. iv), suspended in mucilage, Drs. Lardier and Pemet have given salol
with advantage in dysentery. Good results have been reported by several
observers from the use of this remedy in Asiatic cholera. If seems very apt,
however, to increase the gastric disturbance which accompanies cholera and,
as shown by the case cited by Girode, this remedy should be used with great
caution in ulcerous conditions of the alimentary tract.
Salol, being excreted as eahcylic acid, acts as a disinfectant to the uri-
nary passages, and is useful in pyeUtis, catarrh of the bladder, and ammoni-
acal urine. Dr. S. L. Abbott treated three cases of cystitis in women with
salol (0.65 Gm., or gr. x. thrice daily, or 0.33 Gra., or gr. v, every three hours).
Under its use the symptoms disappeared and the urine became acid, and the
patients were cured after the failure of other remedies. Testimony to the
same eiTect is given by Arnold, who remarks that it has afforded relief even
in cases of tuberculous cystitis.
In pulmonary tuberculosis, Grossi makes use of a solution of 1 part of
salol in 3 parts of almond-oil, subcutaneously injected. M. Heiz reported
twenty cases of blennorrhagia treated by salol, in which the disease lasted
only ten or twelve days. In the same communication* he praises it highly
in typhoid fever, giving it in doses of 4 Gm. (or 5j) daily, combined with bis-
muth salicylate. In a series of forty-nine cases of typhoid fever treated by
Posajnyi by salol, all of which were severe, the remedy produced marked
amelioration in 75 per cent., while in the remaining cases it produced no
good eiTect. In about nne-frairth of the number the diarrhoea ceased after
one or two days' exhibition of the drna, and in some cases was succeeded by
constipation. Salol is especially valuable in the treatment of acute rheuma-
tism, given in 1 to 2 Gm. (or gr. xv-xxx) doses, three or four times daily. It
reduces the temperature and causes free perspiration, and is somewhat anal-
gesic. It is. liowever, Ir^s ncoeptable to the digestive organs than salicin.
» Repertoire tic Vhnrmacie., July 10. 18»0.
ssvou
803
I
^I. GouguenLeim says tliat plumy! salicylate has a very manifest action
in suppurative eore throat (tonsillitis, etc.). It is valuable as an intestinal
and urinar)' antiseptic. It is especially serviceable in cystitis, enlarged and
irritable prostate, gouorrlia^a, and j^leet. In tlie treatment of diseases of the
genito-urinary tract, salol can be prescribed as follows: —
R PlienylU aalicylut 6|50 Gm. or gr. c.
T«rebeni 6|20 c.cm. or wc.
M. Gt ft. capsulfie no. xx.
Sig.: A capsule or two every two or three hours. For irritation of the genital
orgmxift. Valuable especially in gleet
The following have also proved of service in gonorrhoea and gleet: —
B Phenylia aalioylat C[50 Gm. or gr.
Ext b«»Iladonii«? folior {l3 Gm. or gr.
M. et ft. capsulce no. xx.
Big.: Prom four to six capsules a day.
I
R Phenylis salicylatis 6160 Gm. or gr. c
Ext crgot« IJSO Gm. or gr. xx.
M. et ft capsuUe no. xx.
Sig.: One or two capsules every two or three hours. For cystitis and in enlarged
' prostate.
Dr. J. "William White* recommends salol, given in capsules, as follows
in the treatment of recent anterior \u*ethritis; —
B Phcnylii* biilicyhitis
Oleoresin. eubebn
Cop&ibaa (Para)
Ftpsini
M. et ft. capsulffi no. j. Mitte no. xxx.
Sig.: One capsule four to six times daily.
White reported that the discharge thus treated, in two-thirds of the
cues, ceased within a week. In the majority of patients he also recom-
mended an injection of 0.13 Gm. (or gr. ij) of zinc Bulphocarbolate in a 10-
[to 15-per-cent. solution of hydrogen dioxide.
GrautzofT, in addition to its internal administration in gonorrhoea, em-
ploys it as an injection according to the following formula: —
23 Gm.
or
gr. iliss.
SO ccm.
or
mv.
tiO ccm.
or
mx.
065 Gm.
or
gT.\.
n Phcnylift walicylatis lOj
Pulv." acaciae 6
Aq. destillat ISWl
Gm.
Gm.
ccm.
or 3ii88.
or gr. Ixxv.
Oiv.— B
or '
-M.
Nicolaier has obtained satisfactory results in six cases of diabetes mel-
htua from the use of salol, giving 2 Gm. (or gr. xxx) three times a day. An
improvement generally resulted within eight days. In some of the cases
the diet was not restricted, and this writer particularly recommends salol
wheT€ an antidiabetic regimen is, for any reason, impracticable. Lutz ad-
Tocatcs the employment of salol in tuberculosis, and claims that it possesses
mcial value in acute phthisis. He is of the opinion that the drug diminishes
tne disintocrration of tuberculous material,
Salophen, <>r Acetpara-amidoaalol, crystallizes in fine, white scales. It
h ftlma'^t initoluble in water, readily soluble in alcohol and ether, and is desti-
Thr PhUadrlphia Medical Nctc9, June 14, 1890.
PHARMACEUTICAL THERABBCIIC AGENTS OR DfiUGS.
tute of taste or odor. It contains 51 per cent, of salicylic acid. Upon being
heated with soda-lye, it is split up into sodium salicylate and acetyl-para-
amidophenoL This decomposition takes place also within the organism. The
substance is not acted upon by the acid gastric juice, but decomposition takes
place within the intestine. No deleterious by-effects have yet been observed
from its use. It is regarded as of special value in the treatment of debilitated
patients. Salophen is claimed to be much less toxic in its effects than solol.
It can be administered to animals in the average quantity of 0.20 Gm. (or gr.
iij) to the pound of body-weight. Salophen can be safely given to men,
according to the investigations of P. Guttraann, in daily doses of 6 to 8 Gm.
(or 3iss-ij). Salophen is excreted by the fffices and also by the skin. After
evaporation of the perspiration, crystals of salophen or of a product of its
decomposition have been observed upon the skin by Professor Drasche, of
Vienna. The surface glittered as if sprinkled with diamond dust. Dr.
Hirschmann found that the admiuistration of several other bodies belonging
to the aromatic series (as sodium salicylate, acetaniiid, and phenacetiu) was
followed by an elimination in crystalline form. This result was noticed par-
ticuliirly after the use of phenacetiu. An abundance of beautifully-formed
crystals was found upon the skin after the administration of 1 Gm. (or gr. iv)
daily for three days.
Guttmann found salophen to have a favorable action in acute rheuma-
tism, in some instances diminishing pain and swelling within a few days.
Other cases, however, demanded weeks and months for their cure. It ia
unable to prevent relapse or extension to previously unaffected articulations.
Later observers have substantially confirmed this judgment. In chronic
rheumatism it will generally alleviate pain, but does not promote absorption
of periarticular exudations, nor does it prevent the cardiac complications of
the disease.
Salophen appears to be well adapted for use in diseases of children. It
has been administered with advantage in scarlatina, typhoid fever, pneu-
monia, and tuberculosis. The antipyretic power of salophen is but slight.
In typhoid fever from 4 to 6 Gm. (or 5i-iss) is needed in order to reduce the
temperature 1° to 1 Vi" ^' I^i phthisis the exhibition of 3 to 4 Gm. (or gr.
xlv-lx) causes a reduction. In two cases of cystitis the late Dr. Guttmann
saw no improvement after administering this drug. Salophen has generally
proved beneficial in neuralgia and, according to the studies of Dr. Edmund
Koch, has an excellent analgesic effect in the most diverse nervous disorders.
Salophen is particularly available in neuralgia dependent upon a rheumatic
diathesis. On account of its value as an intestinal antiseptic it has been pro-
posed to make use of salophen in cholera.
Salacetol hns b(^"u introduced as a substitute for salol, and is claimed fo
be free from the toxir- properties of the latter. Salacetol is obtained by
heating morKn-hlonict'tone with sodium salicylate. It crystallizes from
alcohol in the form of ecnlcs or lustrous needles. It is but slightly soluble
in hot or cold water, but dissolves in hot alcohol, ether, chloroform, carbon
disulfihide, benzol, and henzin. Its taste is slightly bitter and it melts
at 100° F. Salacetol is broken up in the intestine into salicylic acid
and acetol, the latter body being ehminated in the urine in the form of ace-
tone. Salacetol is unchanged in passing through the stomach. The absorp-
tion of salacetol is promoted by the conjoined exhibition of castor-oil. The
dose for an adult is from 2 to 3 Gm. (or gr. xxx-xlv) and children can take
SAMBUOI FL0RS6.
805
^
0.10 Gm. (or gr. iss) for each year of their age. When incorporated with lard
it is absorbed by the skin.
The virtues of salacetol have been studied by MM, Bourget and Barbey.
They esteem it an excellent intestinal antiseptic and have given it with ad-
vantage in choleraic diarrhoea. The administration of salacetol in acute
articular rheumatism causes a rapid decline of temperature and amelioration
of pain. At the same time the writers quoted recommend an application to
the Joints composed of: —
Q Acid, salicylic,
Adipis laiiffi bvd aa 10
01. terebinth.. .' 0
Adipie 93
Gin. or Siiss.
25 c.cm. or fSiiss.
Gm. or 8"j- — ^M.
Salacetol has likewise produced good results in chronic and muscular
rheumatism and, given in castor-oil, has been beneficial in cases of biliary
lithiaaie.^
SALVIA (TJ, S. P.).— Si^.
Dose, 0.65 to 2 Gm. (or gr. x-xix), in infusion or fluid extract (with
diluted alcohol).
Pharmacology.— *rrhe dried leaves of Salvia officinalis'^ (Labiatae), a
garden herb, used for its flavor in cooking. The leaves should be picked by
hand and carefully dried in the shade if intended to be used for medicinal
purposes. It contains from V: ^o V* P^^ cent, of volatile oiL Oleum Salvice,
witli tannin, resin, etc.
Physiological Action. — The infusion (25 per cent.), of which the dose
is from an ounce to a wineglassful, is tonic, astringent, and stimulant. The
Utter quality is increased in the fluid extract by the diluted alcohol, used
as a menstruum. MM. Cad^ac and Albin have demonstrated that the oil of
sage gives rise to epileptiform convulsions in the dog.
Therapy. — Infusion of sage by itself is a very good gargle and astrin-
gent wash for the nose or mouth. Internally it has been administered for its
tonic effects in fevers, and to check sweating, especially in phthisis pulmo-
nalis. Sage may be combined with other remedies as an injection for ure-
thritis or vesical catarrh. The compound sage-gargle consists of: —
9 AJuminia 16
Salvic 31
Mel despumaU 60
Aquce buUientift 473
Ft. infusum et cola.
Gig.: Dilute with \vater aod use as a gargle.
Qm. or Sir.
Gm. or 5j.
c.cm. or fjij.
c.cm. or Oj.
The infusion is also popularly used as an application to the scalp, and
to darken the hair.
SAMBUCI FIORES (B. P.).— Elder-flowers.
Dose, 16.6 to 31 Qm. (or 5ss-j), in infusion, drunk while hot.
Preparation.
Aqaa Sambuci (B. P.).— Elder-flower Water (a dlaUlled aromatic water).
• ThrrapfuHsvhs honaUhefU, Deo.. 1803.
806
PHABMACEDTICAL THERAPEDTIO AGENTS OE DEUGS.
Pharmacology. — ''The flowers of Sambucus nigra, separated from the
siulks" (B. P.), tliG pomnion European black elderberry. In this country,
(he dried flowers of Sarabucus canadensis (Caprifoliacese) were official in
the preceding edition of the Pharmacopoeia. The flowers are sometimes used
for flavoring purposes. They contain a small proportion of a volatile oil,
which has the fra;?runt odor of the flowers in a liigh degree; also valerianic
acid, acrid rcgin, and mucilage.
Physiological Action, — Elder-flower water, aqua eambuci ( B, P. ) ,
when freshly distilled, is a good vehicle for lotions and eye-washes. In hot
infusion, sambucus acts as a stimulant, diuretic, and diaphoretic, and may
he emetic if given in too large quantity. The ripe berries are edible, and
the juice is considered antiscorbutic and alterative; it is used in rheumatism
and syphilis. Elder-berry jam or conserve may be used as a food; it is
slightly laxative. The inner bark of elder is cathartic, and, in large do&ee^
emetic.
The phyBiological properties of elder-bark have been studied by Combe-
raalc. Large doses of the decoction of" the outer bark or of the whole bark
produced decided polyuria in dogs. Moderate doses gave rise to no consid-
erable increase of urine, but the temperature was lowered and the pulse and
respiration retarded. The decoction of the fresh inner bark was strongly diu-
retic. Large doses acted very rapidly, and the effect continued for more
. than five hours. In the meantime, the temperature, after first rising
slightly, sank to a tenth below the normal. The pulse also gradually be-
came more slow. A maceration of the inner hark exerted much less influ-
ence upon the kidneys, but occasioned nausea and vomiting, with subse-
quently a severe diarrhcea, associated vriih reduction of the temperature
and n^tardation of the pulse. A rabbit died after the injection of a large
quantity of the whole bark. The autopsy showed intense injection of all
the organs, witli puhnonHry hiemorrhages.
Therapy. — Dr. George Ijemoiue employed a decoction of the fresh inner
bark tlieru[ieutieally. Increased diuresis continued as long as the drug was
used. The best effect was obtained in acute nopliritis, and the drug is capa-
ble of good service in ascites and tedcnui. In two cases an acute eruption
upon the skin occurred wbile elder-bark was being taken: in one case of
small furuncles, in the other an urticaria. (Possibly the remedy may have
been accidentfilly mixed with swamp-sumach.)
SANGTJINARL& (U. S. P.).~Blood-root.
Pose, 0.13 to 1.30 Gm, (or gr. ii-xx).
Preparations.
Tinc'turii Sangtiinarifp (V. S, P.). — ^Tinctur* of Sangiiinaria
( 10 ytOT cent).
Dose, 0.60 to 4 com. (or rnx-fSj).
Fluidextractum Sunguinaria* (U. S. P.). — Fluid Extract of Sanguinaria. Doae,
0.20 to 0.30 o.cm. (ar miii-vl. (In the last edition of the United States Pharmaoo-
p<£ia, the menstruum of the fluid extract wan changed to acetic acid and water.)
Acetuni SanRwinariw. — Vinegar of Sanguinaria. Dose, 1 to 2.50 ccm. (or
mxv-xl) ; as an f'nietic. 4 to 18.5 c.cm. (or f3iv).
Pharmacology.— ''The dried rhizome of Sangiiinaria canadensis (Pa-
i)avpnu-wv), collecti'd after the death of the foliage," is about two inches
ong, cylindrical, reddish brown, containing small, red resin-cells; taste.
i
8AKGUIKARIA.
807
»
ft
• bitter and acrid. It contains ^\e alkaloids, Sanguinarme, Chclerythinc,
and y-homochelidonine, and Protopinc, with citric and miilic acids. As
separated by Konig and Tietz; sanguinarine is a colorless, crj^stalline sub-
stance, soluble in alcohol and chloroform. Its salts are of a blood-red color.
The commercial Songuinariue nitrate is said by Schlotterbeck to be not a
pure article, but to consist of chelervtlirine instead.
PhyBiolo^cal Action. — The powder is extremely irritating to the air-
pafisagcs, causing violent sneezing and free secretion. It is a feeble escha-
rotic. The taste is Jiarsh and bitter. Taken internally, it is a systemic
emetic, its action being followed by salivation and much depression, causing
also an increase of hepatic secretion. Sanguinaria may cause hypercatharsia
and act as an irritant, acro-narcotic poison. It is emmenagogue and ex-
Sectorant, and, after a preliminary increase of arterial tension, depresses the
eart's action; death is produced by paralysis of the medullary, respiratory,
and cardiac centres. The spinal reflexes are reduced and spinal centxea
finally paralyzed; the pupils become. dilated, the muscles relaxed, the skin
cold and clammy, with collapse of the vital powers; the fatal result often is
preceded by convulsions, either of spinal origin or arising from carbonic-
acid poisoning, due to failure of respiration.
Antidote. — The antidotes are diffusible stimulants, — digitalis, amyl
nitrite, strychnine hypodermically, with morphine and atropine, ii necessary,
to relieve pain or severe nausea. The patient should be kept warm, artificial
respiration be maintained, and warm water may be used to wash out the
stomach and bowels.
Therapy. — Blood-root has been used in powder as an application to
ulcerated surfaces, and is regarded by some as a cure for cancer; but it is
painful, and, if freely applied, may be absorbed and cause vomiting and other
symptoms of poisoning. Keyser employed sanguinarine nitrate (Merck's)
0.015 Gm. (or gr. V<)j ^Jth 30 c.cm. (or f^j) of glycerin, as a remedy for con-
junctivitis granulosa. Powdered sanguinaria, snuffed or blown into the
nose, properly diluted, excites secretion in chronic rhinitis. A decoction has
been xised popularly as a gargle in scarlatinal angina. An ointment con-
taining blood-root has been successfully used in tinea. The powdered root
is recommended by some aa a sternutatory in nasal catarrh, and the treat-
ment may be considered effective, because the patient will not be likely to re-
turn for further treatment. The conjoined internal use of the tincture —
dose, 0.60 c.cm. (or mi), thrice daily — is also advised. In small doses of the
tincture (5 or 10 drops several times a day), it is considered valuable in atonic
dyspepsia, gastric catarrh, or duodenal catarrh with jaundice. I*arge doses,
a teaspoonful to a tablespoonful of the vinegar, or the tincture, causes vom-
iting, with increase of hepatic secretion. It has been used in croup as an
emetic, but is too violent and too depressing.
In various spasmodic affections and disorders, accompanied by cough,
MB in pneumonia, asthma, bronchitis, etc., small doses of the tincture may be
given at short intervals. Sanguinaria may be prescribed thus with expecto-
rants for the diseases referred to: —
B Tinct ■anguinarin 4
Synipi ipecac 15
Tinct, lobeUm 4
Glycerini 15
ccm. or f3j.
c.cm. or f5«B.
com. or fSj.
c.cm. or fSM.
M. 8ig.: A teaapoonful every two or three hours, for subacute bronchiUs.
1808
3
r
^m M. Sig.:
^^V in bronchiti&
f ■
PHAnMACEUTICAL THERAPEUTIC AGKXT8
Tinct ftanguinaris «*l..a4» 7
Aiumonii bromidi 12
Spiritus (cthoris nitroai 30
Syrup, pruni ViTg q. s. ad 150
ccm. or f3ij.
Gm. or 5iij.
ccm. or fjj.
c.cra. or fjv.
Two teaapoonfuU in water every two or three hours, for asthma and
SangTimarine may be given slb an expectorant in doses of 0.005 to 0.008
Gm. (or gr. Via-V«) In pneumonia, bronchial catarrh, winter cough, etc., the
alkaloid having the advantage of not disturbing the stomach, although its
secretions are increased by fractional doses. A syrup ,of sanguinaria, made
by adding sugar to the vinegar, may be used as an ingredient in cough-
mixtures.
In hysteria, due to pain or moral causes, sanguinaria is said to be some-
times of advantage, either given alone or in combination with podophyl-
lum.' For various functional affections of the genital system, amenorrhcEa,
dysmenorrhoea, and in impotence, with seminal incontinence and relaxation
of the organs, sanguinaria is pronounced a serviceable remedy. Blood-root
can be combined as follows, for the diseases named: —
I^ Tinct. sanguinariic,
Tincturaj niicia voiniwc,
Kfuidext. crgotw aa 7|5 ccm. or f3ij.
M. Sig.: Twenty to forty drops in water three times a day, in aiiienorrh<
useful aUn in impotence and seminal weakness.
B SHogiiiTmi'iiiiP.
Aloini,
Ext, ignaiiffi aa 113 Gm. or gr. ij.
Ferri lactatia 1 po Gm. or gr. xx.
M. et ft. pil. no. xx.
Sig.: A piU three or four times a day; beneficial as an emmenagogue and in
genital debility.
Sanguinaria is also regarded as an alterative, on account of its influence
upon secretions, and may be used in syphilis, especially of the skin.
S ANT All OLEUM (U. S. P., B, P.).— Oil of Sandal-wood. (See Oleum
Santali.)
SANTALUM RUBKUM (U. S. P.), PTEEOCARPI LIGNTJM (B. P.).—
Bed Sauuders, Red Sandal-wood.
Phannacology. — "Tlie heail-wood of Pterocarpus santalinus'' (Legu-
minosie) usually is met with in the shops n? raspings. It contnina a red
coloring matter of a resinous chanietor, Santalin or Santalic acid, which is
Bolul)le in alcohol, but insoluble in water. It also contains Pterocarpin,
tannin, etc. Red saunders is used in phannncy for coloring alcoholic
liquors or tinctures. It cntora into the compound tincture of lavender. It
has no medicinal qualities.
SANTOinCA (U. S. P.).— Santonioa, Levant Wonnsced.
Dose, 0.20 to 1 Gm. (or gr. iii-xv).
SANTONIKUM (IT. S. P., B. P.).— Santonin.
Dose, 0.13 to 0.32 Gm. (or gr. ii-v).
Preparation.
Trochiflci Santonin! (U. S. P., B. P.). — Troches of Santonin, Worm Lozenges (ea<J
0.03 Cm., or gr. as. The D. P. troches contain 0.005 Gm., or gr. j).
0]eum Santonini. — (^il of Santonin.
4
'PhiUips, op. Cit.
8ANT0NICA.
809
I
Fhaxmacology. — "The dried, unexpandod flowor-lieads of Artemisia
pituciftora" (Cr>mpo8itiP)j growing in Turkestan and surrounding coimtries,
are known a& Levant wonnsecd. They contain 2 to 3 per cent, of volatile oil
and from ^/^ to 2 per cent, of Santonin and Artemisin (Oxysantonin). San-
tonin, when warmed with alkalies, is changed into Sanloninic Acid, of
which the sodium salt was formerly oificial. Santonin is described (U. S.
P.) as *'^he inner anhydride or lactone of santonic acid, obtained from San-
ica: or (B. P.), as "a crystalline principle derived from the dried iinex-
ded flower heads or capitula of Arteiiiisia Inaritima var. Stechmanniana,
T. As tlie object of administration of this remedy is to net locally upon
the parasites of the digestive tract, it is better to use the troches, made with
tantonin^ instead of sodium santoninate, because less likely to occasion toxic
effects. Santonin dissolves with difticulty in cold water. It is soluble in 250
parts of boiling water^ readily soluble in alcoho], chloroform, and alkaline
solutions, moderately soluble in ether, and insoluble, or nearly so, in
glycerin.
Physiological Action. — Santonin is a very popular vermifuge against
the round-worm, A.sraris himhricoides, and, to a less e.xtent, against the
thread-worm, Oxijuris rermicularis. It has no effect upon the tape-worm.
The crystals of santonin are colorless, but turn yellow upon exposure to
light. 'This effect is due to a partial change in its composition. Coloreii
santonin is an unreliable remedy. When taken into the body, the same
change occurs in the blood, which disturbs the nutrition of the cerebral
centres, so that chromatopsia is produced, the patient complaining that
everything has a lurid, yellow or greenish tinge, and he may even entirely
lose his vision for a few days. In exceptional instances the color perceived
was red or blue.
The urine is stained a greenish-yellow, or, if it should be alkaline, it
has a reddish-purple color. This is due to xanthopsin, a derivative of san-
tonin.
Elimination, which takes place by the kidneys, is slow, about two days
being required for the removal of an ordinary dose. The flow of urine is
considerably increased, and the calls for micturition are frequent. Acute
poisoning sometimes occasioned by children eatins^ worm-candy, or lozenges,
is manifested by cerebral and digestive disorder and muscular prostration,
with tremors, or even convulsions. Death occurs from respirator}' failure.
Urticaria has been caused by its prolonged administration. A case of urti-
caria has been reported as due to a single 0.20 Gm. (or gr. iij) dose given to a
child. In the case of a man 0.32 Gm. (or gr. v) caused, within three hours, "a
^eral raorbilloid eruption and an intense punctiforra rash on the mucous
meml'rane of the mouth and throat."*
The treatment of poisoning, having first cleared the intestinal canal by
• cathartic, is by diffusible stimulants, a hot bath, demulcent drinks, bella-
donna, and strychnine, with ether or chloroform to control convulsions.
Therapy. — Dr. G. Frank Lydston' says that he has found a substitute
for bromides in the treatment of epilepsy in santonin, which he has
used for nearly twenty years in the treatment of this affection. San-
tonin is a valuable antippasmodic in children. He claims that under it the
^The }fational Dlspmmiory, fifth edition, p.
•r*«nH»fw»ic Qnzette, Feb. 16, 1900.
1415.
810 PHARMACEUTICAL TUEUAPECTIC AGENTS OR DHUGS.
average epileptic patient shows bettor results than under the bromides.
Santonin acts well in cases in which the bromides for one reason or another
are not tolerated. It has proved of especial value in those cases in which
tlie bromides failed. It does not cause mental hebetude, nervous or circu-
latory disturbances, nor disfiguring eruptions. In adults, he be^ii^s with a
dose of from 0.13 to 0.32 Gm. (or gr. ii-v) of the powdered drug. The
point of saturation of the system is shown by a yellow color of the urine and
a varying degree of renal and vesical irritation. Caution should be exercised
in giving tlie drug, to begin with small doses, very gradually increased. Dr.
C. Negro, of Turin, has recently met with success in combating the painful
crises of locomotor ataxia with santonin. For this purpose a dose of 0.40
(or gr. vj) may be given at intervals of three or four hours.
In case children show symptoms of intestinal irritation, suggesting
worms, the discharges from the bowels, each day, should be watched in
order to detect the presence of parasites, and this may be assisted by a saline
purgative, such as magnesia, or rhubarb and magnesia, which removes the
mucus in which worms breed. Then a dose of santonin should be given at
night and followed by a purgative in the morning.
B Sontonini 120 Gm. or gr. lij.
Hydrarff. chloridi mitis 138 Gm. or gr. Tj.
Sodii bicarl) 175 Gm. or gr. xij.
M. et div. in chartulec no. vj.
Sig.: Give one each night to a child 6 years old.
4
Given as an anthelmintic, santonin in crystala, should be given on a
fasting stomach; a dose of calomel shoulrl be given 4 to H hours later, and
this followed in 2 hours by a saline.
Rex* gives the following prescription, containing santonin, for lumbri-
coid worms: —
B Santonini IftO Gm. or ct. viij.
Fluidfixt. spigeliffl et sennae 3o| com. or f5j.
M. Sig.: One teaspoonful three times a day. Shako the mixture before meas-
uring the dose.
In color-blindness, santonin has been tried with asserted success, but is
probably of no service in the congenital form, though it might be service-
able where vision has been impaired or the appreciation of color lost by acci-
dent or disease. It has been advocated as a remedy for some disorders of the
optic nerve, but without clinical evidence to support the suggestion. Noc-
turnal enuresis occasionally yields to santonin after the failure of other
remedies. By Mr. Whitehead, of Manchester, santonin is recommended in
amcnorrhcea, especially when that condition is dependeni upon chloranaemia.
Dr. Cadogan Mastnrman reported a case in which this method of treatment
was serviceable in severe uterine colic arising from suppression of the
menses. The adniiniptratiou of the reme<3y waa soon followed by the occur-
rence of the catamenia and relief of pain.
It should be given cautiously to feeble children, and be followed in a
few hours by a dose of magnesia or rhubarb. Some practitioners prefer
to administer santonin with castor-oil, ond, in the experience of Dr. Whitla,
this combination is of decided value in diminishing the danger of any ill
II
* The College and Clinical Record, Fet., 1891.
SAPO.
811
F«ffeets. Professor Demme was accustomed to administer santonin in castor-
[oil. but, as a rule, he preferred to give it in a slightly sweetened uleaginous
Ifioiution, 0.03 Gm. to 30 c.cm. (or gr. ss-fSJ) of olive-oil, believing it to be
[more elHcacious in this form than iu that of powder.
Santoninoxime (obtained by heating live parts of santonin with four of
[hydroAylaniine hydrochloride and lime in the presence of alcohol) occurs as
while crystals, insoluble in cold water, slightly soluble in boiling water,
foluble in alcohol and acetic acid. It is considered less toxic than santonin,
I and may l>e administered iu dostrs two or three times as large.* As an jmthel-
mintic, the dose for a child from 2 to 3 yeai»6 old is 0.(»48 Gm. (or gr. '/^) ;
from 4 to 6 years, 0.10 Gm. tor gr. iss) ; from 6 to 9 years, 0.13 Gm. (or gr.
ij) ; adults, 0.32 Gm. (or gr. v), divided into two doses, taken at intervals
I of an hour or two and followed by a cathartic.
SAPO (U. S. P.), SAPO DUETTS (B. P.).
from jtodium hvdroxide and olive-oil.
-Hard Soap. Soap prepared
ap prepared from
t SAPO MOLLIS (U.S. P., B. P.).— Soft Soap. Soar
^^■tofisium hydroxide, linseed-oil. iilcohol, and water (U. S. P.) ; potassium
^Pl^oxide and olive-oil (B. P.). Snpo viridis — green soap (U. S. P., 1880),
V SAPO ANIlfALIS (B. P.). — Curd-Bcap. Soap made with sodium hy-
droxide and a purified animal fat, consisting principally of stearin, con-
taining about 30 per cent, of water.
^ Preparations.
Linimtntum Saponis Mollis (U.S. P.). — Liniment of Soft Soap* (green soap, 65;
oil of Uvender, 2; alcohol and water, q. a. ad 100 parts). For external use.
Emplustrum Saponis (U.S. P., B. P.). — Sonp Plaster (soap. 10; lead plaster. 00
fmiU, U. S. P. The B. P. contains soap, 15; lead plaster, 90; resin, 2 Vi parts).
■ Linimentum Saponis (U.S. P.. B. P.). — Soap Liniment (U. S. P. contains soap,
7; camphor, 4^; oil of rosemary, 1; alcohol, 75; water, q. s. ad 100 parts).
Linimentum Potassii lodidi cum Saponc (B. P.). — Liniment of Potassium Iodide
with Soap (contains curd soap, 40 Gni., or 3xVi; potassium iodide, 30 Gm., or
STiise; glycerin, 20 c.cm., or fivss; oil of lemon, 2.5 c.cm., or mxacxviij; distilled
water, 200 c.cm., or fJvifSv).
I
I
Phannacologry. — Soap may be either hard or soft. The combination of
»oda and fatty acids makes a hard soap; potassa makes a soft or Jelly-like
aoap. The combination of potassium hyilroxide with linseed oil is official
as soft or preen soap, although brownish-yellow rather than f^een. The
wft soap, of the British Pharmacopoeia, is made with olive-oil with an ex-
oen of |>otassa. Even hard soap usually retains considerable water when
mt into bars, and, as this evapomtes, the sonp shrinks and becomes wrinkled
and hard, so that it m.ty be powdered. Old Castile soap is a good excipient
for pills, especially cathartic masses, and enters into compound extract of
coloc>Tith (cnrd soap, B. P.), pills of asafetida. of aloes and asafetida, of
opinra. and of rhubarb. Nearly all soaps are palmitates or oleates of
•odium or potassium, or a combination of them. These fatty aciHs may
•1m combine with other bases, as in the lead soap, emplastmm plumbi, and
I
' Repertoire de PharmaHe, 1890: Journal de M^deeine de ParU, Nov. 16, 1800..
'AUo known as Spiritua Saponis Kalinus of Hebrt.
812
PHAKMACEL'TICAL TUERAPEL'TIC AGENTS OR DUUOS.
lime soap, linimentum calci*. Soap also enters into the U . S. P. chlorofonn
liniment.
Fhysiolo^cal Action. — Soap is a useful detergent, removing grease from
the 6kin, together with dirt, foreign matter, bacteria, and epithelial scales.
In antiseptic surgery the field of operation is usually first washed with soap
and water and afterward with disinfectants. Taken internally, soap is a
laxative and is an antidote to acid and corrosive poisoning. In the form of
Boap plaster, it is a good protective for the prevention of bed-sores. Applied
to raw surfaces, soap augments secretions and keeps up discharge; soap and
bro\^'n sugar form a stiraulatinje* dressing. Soap acts an an alkali internally
and affords relief in cystitis, and was formerly vaunted as a specific for stone
in the bladder, but it has been proved that this claim was not well founded,
Suppositories made with soap and glycerin are very convenient for the pur-
pose of unloading the rectum, and small suppositories of soap will relieve
infantile constipation. In the treatment of diseases of the skin, the author
has witnessed signal benefit from the Judicious employment of medicated
hard soap. It is prudent to begin its use upon a small area, and, if it prove
beneficial, it can afterward be applied to the whole of the affected area. In
some instances medicated soap can be profitably used every day; in others,
two or three times a week, or even less frequently. Numerous active drugs
have been incorporated in soda soap.* Among these may be enumerated
boroglyceride, carbolic acid, euealyptol, naphtol, salicylic acid, corrosive sub-
limate, tar, etc. Most medicated soaps are made of 10-per-cent. strength.
Some of the more active substances, as carbolic acid, euealyptol, salicylic
acid, are usually but half this stren^h, while 1 per cent, of corrosive sub-
limate is a sufficient proportion. Dr. P. J, Eichhcff has recently recom-
mended the use of pulverulent soaps on account of the case with which
medicinal substances can be incorporated. A neutral soap is made by boil-
ing together soda solution and beef-suet and has been placed upon the
market as a fine, anhydrous, though hygroscopic, powder, which forms the
basis of all the soaps and is known as neutral soap-powder base. A super-
fatted base is obtained by the addition of 2 per cent, of oleic acid and 3 per
cent, of lanolin. By the addition of 2.5 per cent, each of potassium and so-
dium carbonates an alkaline soap-powder is prepared. Any one of these
bases may then be medicated by the incorporation of various medicinal sub-
stances. Green soap is more decidedly alkaline, and exerts a softening effect
on the tissues on account of the excei=s of potassa which it contains. Soap
preparations are not used internally, except in cathartic pills.
Therapy. — Powdered soap is an ingredient in some dentifrices and un-
doubtedly helps to preserve the teeth. As an ingredient in cathartic pills,
it prevents griping and is useful in ordinan.' constipation: —
9 Rea. podophylli
Ext. hi'lln^loTiTiff* folior
Saponis 2
01. cajuputi
M. et div. in pit. no. xij.
Sig.: Take one or two at b«d-time, as a laxative.
13 Gm. or gr. ij.
005 Gm. OT gr. j,
Om. or gr. xxx.
24 c.cra. or miv.
*For a liBt of medicated soaps, with a description of thrir composition and in-
dicationfl, see author's treatise on "Diseases of the Skin," fourth edition, 1901, D.
Applcton & Co.
SAPO.
813
Soap-suds, made by rubbing soap in hot water, form a convenient
enema for unloading the bowels: a couple of pints or more may be used, to
which some castor-oil or oil of turpentine may be added. Green goap is
useful in chronic induration of the skin, especially in the form of the
ir. S. P. official liniment, which is Hebra*8 apiritus saponia kalinus, and
may be diluted with Cologne water (1 to 3). It is useful as a cleansing
agent for the scalp in seborrhcea. In sprains, rheumatic stiffness and pains,
soap liniment is very useful, and may nave anodynes — like aconite, chloro-
form, or laudanum — added to it: —
B Chlorali bydrati 81 Gm. or 3ij.
Lin. saponis 150| o.cm. or fjv.
M. Sig.: Use with friction In rheumatic pains.
Soft soap is used in chronic eczema, the best form being the official lini-
ment, which is well rubbed into the affected area and followed by a soothing
application. In psoriasis, if there be much itching, we may use the follow-
ing:—
R Saponin niollis,
01 ei cadini,
Alcoholia aa 30| c.cm. or f3j.
IcL Sig.: Rub, every day or two, firmly Into the patchea, previously denuded of
■cales.
Liveing recommends the following: —
H Saponia mollis 30 c.cm. or fSj.
Alcoholia 4fi com. or f^iss.
Aqu£e 90| to 180 c.cm. or f3"i-vj.
Solve cola et adder —
01. lavandulos florum 1|20 c.cm. or mxx.
11 Sig.: To be nibbed in at suitable intervals and allowed to dry on. preferably
at night, in chronic psonuaii^, AC^e, tinea, and somutiniei* lupus. (PhilHpb. )
Kappesser, Senator, and others have found soft soap a useful appUcation
'to enlarged glands, whether "of simple inflammatory, scrofulous, or syphilitic
origin. Other scrofulous or tuberculous manifestations, aa diisease of the
mesenteric glands, periostitis, or caries, have been benefited by the same
'topical treatment. The same remark may be made concerning exudations
into serous cavities.
A caution should be given with regard to the use of ordinary toilet soap
upon delicate skins, especially in infants. Most soaps are too alkaline, ana
may contain irritating essential oils. Moreover, many cheap soaps are made
kwith animal fat which has not been properly purified, and therefore they
Jeontftin the bacteria of putrefaction and perhaps of disease. That vegetable-
tm\ soap ia preferable is acknowledged by the pharmacopoeia, which requirea
it to be made with olivc-oil. This is popularly called Castile soap, which
may be either white or colored, the former being preferred. A good cotton-
seed oil soap for the toilet or household is made alao. A pure, well-made
glycerin soap is probably the best for the skin, it having been made trana-
ptrent usually by dissolving it in alcohol, which is afterward driven off by
h«ftt.
Sapo Kalinus Venalis, or Schmierscife, of the German Pharmacopceia,
is conunon soft s<m|i, made with various kinds of oil (lin8ei?d, rape, hemp-
»eed, fish, etc.). It is used in treating scabies and for clearing the skin
preparatory to making applications.
814
PHAJtMACECTICAL THERAPEUTIC AGENTS OR DRCGS.
SARSAPASILLA (U. S. P.)— Sarsaparilla. I
I SAKS^ RADIX (B. P.).— Sarsaparilla. i
I Preparations. I
riuidextrat'tum Siirsaparillne (U. S. P.). — Fluid Extract of Saraaparitla.
Dose, 2 to 7.5 c.cm. (or fSss ij).
FluitU'Xtracttmi Siirsiiparillae rompositiini (U. S. P.). — Compound FIiii<i Ex-
tract of Sarsaparilla (8ar»apurilltt», 75; glycyrrhiza, 12; Bassafrafi-bark, 10; mezereuin.
3; glyceriDf 10; alcohol and water^ of each, q. s. ad 100 parts). Dobc, 2 to 4 ccm.
(or fisB-j).
Syrupua Saraftparillfe Compositus (U.S. P.). — Compound Syrup of Sarsaparilla.
Dose, 2 to 15 c.cm. (or fSes-fSss).
Liquor Sarsae Compoaitus Concentratua (B. P,). — Concentrated Compotind Solu-
tion of Sarsaparilla (saraaparilla, 1000; sassafras-root, 100; guaiacum-wood, 100;
dried licorice-root, 100; mezereon-bark, 60; alcohol, 225 cctn.; distilled water, q. s. ad
1000 ccm.). Dose. 7.5 to 30 c.cm. (or fSiifJj).
Extractum Sarsw Liquidum (B. P.). — Liquid Extract of Sarsaparilla. Dose, 7.5
to 15 ccm. (or fSii-iv).
Dwortura Sarsaparillw Compositum. — Compound Decoction of Sarsaparilla
(Horsaparilln. 10; sassiifra.s, giiKi:n'-wfK>d, and licorice-root, of each, 2; bruised moze-
reum, 1; water, q. b. ad 100 parts). Dose, 30 to 120 c.cm. (or fji-iv).
Pharmacclogy^The dried root of Sinilax mcdica (Mexieanj Vera Cruz,
or Tainpico Biirsajmrilla) ; Smilax ornata (Jamaica, Central America, or
Lima Sarsaparilla) ; Striilax papyraceiK (Bruzilian or Para Barsapariila ) ; or
a dried root kuo^vu comnicreitilly as Honduras sarsaparilla, which is
probably obtained from Sinilax officinalis (Liliacea?) (U. S. P.).
Smilax ornata, or so-called Jamaica sarsaparilla, is the only one roc-
ognize^d by the British Pharinncopoeia. Thi.' roots are sinalK nl>out ^/.>
inch in diameter, 6 or 7 feet in length; they are usually folded up into bun-
dles about 26 inches long. They are inodorous; the taste is mucilaginous,
bitter, and acrid. The flavoring known as sarsaparilla at the soda-water
fountain is made from the oils of sassafrns and gaultheria. Professor Kobert
found four glitcosities present in sar>aparilla: Parillin, Smila, Saponin, and
Sarsasaponin, combined with resin (2^/.^ per cent.) and (races of volatile oil.
It is principally to the sarsa-saponin that Profea^or Ivobert attributes what-
ever activity sarsaparilla possesses. Smilacin, so called, is a mixture of the
glucosides.
Fhysiologicfil Action. — The experiments undertaken to determine the
physiological eflects of sarsaparilla have yielded negative results, and de-
ductions from the therapeutical effects are not available because it is always
given with other dru^s, classed by Brunton among stimulant diuretics and
alteratives. It is probably inert, or nearly bo, in the doses usually given,
though moderate doses sometimes seem capable of improving the appetite
and digestion. In much larger doses it would, probably, give the physio-
logical elTects of j^aponin. The chief value of the official preparations of
sarsaparilla is that they are pleasant vehicles for disguising the tAstc of po-
tassium iodide and of mercury, with whieh tliey are usually prescribed for
8^'philis : —
I B Potaasii iodidi 15|5 Giu. or Zss,
I Syr. aarsaparillfle co.,
AquEc destillatn aa 90| c.cm. or fSJij.
M. Sip.: A dessertspoonful in a glass of water two hours after meals in syphi-
litic skin affeetiona.
Or, in the tertiary form of syphiliB, we may give the recent decoction,
which, if drunk hot, causes diaphoresis and diuresis, thus greatly increasing
4
BASSAFKAS.
815
Uie alterative effects. There is no evidence of a curative action of sarsa-
parilla by itself in syphilis; nevertheless, in debilitated subjects in whom
mercury has, for a time, lost its beneficial action, or become positively harm-
ful, a temporary recourse to sarsaparilla has been considered useful by ex-
cellent observers. Phillips believes that this remedy is serviceable in chronic
pulmonary affections, where there is much wasting; in chronic rheumatism
and cutaneous disorders, in which there may be suspected a venereal taint,
sarsaparilla is useful. Sir Astley Cooper considered it serviceable in ca-
chectic conditions of the system, caused by long-continued suppuration;
also, in chronic abscesses, old ulcers, and bone disease. In Germany, a com-
pound decoction containing alum, kino, calomel, senna, and aromatics (Zitt-
mann's decoction) is used in syphilis, chronic rheumatism, and in scrofulous
disorders. Sir Erasmus Wilson declared that in certain obstinate syphilitic
ulcers, especially upon the mucous membrane of the tongue or mouth, he
had obtained decided benefit from the administration of Zittmann*s decoction
after failure with mercurj' and iodine. The above formula is official in the
German Pharmacopoeia as dccoctura sarsapariUjc compositum. This is a
simplified formula of the ancient Lisbon diet drink, or decoetura lu.'^itaniens.
Dr. Clark, of Youngstown, Ohio, has foimd the following combination
UBcfuI in debilitated conditions of the system: —
B Syr. canap&HU. oa 60| com. or fSij-
Muidext. lappa,
Fhiidcxt. taraxaci aa 301 c.cm. or f5j.
Syr. ftcidi hydriodiei 120[ e.cm. or Qiv,
M. Sig.: Tcaspoonfui in water three tiine« a day.
I
I
f
SASSAFRAS (U. S. P.).— Sassafras.
SASSAFRAS RADIX (B. P.).— Sassafras-root.
SASSAFRAS MEDTJILA (IT. S. P.).— Sassafras-pith.
(U. S. P.).-
Preparations.
-Safrol. The nidhvlcne ether
of nllyl pyrocatficho!
Sa f roltitn
Oleum Sassafras <U. S. P.). — Oil of SaaaafroA. Dose, 0.06 to 0^ c.cm. (or mi-iv).
MuciUgo Sasaafrss Medullee (U.S. P.). — Mucilage of Sassafraa-pith (2 parta in
water 100).
Pharmacology. — Sassafras, "the dried bark of the ro<jt of Sassafras
varii-folium, collected in earlv spring, or autumn, and deprived of the
peridum'' (Lauraceaj), U. S. P., *'lhe dried root of Sassafras otficinale"
(B. P.), is common in the United States from Canada to Florida. The
principal constituent of the bark is the volatile oil; it also contains tannic
acid, resin, etc. The oil of sassafras is of a light-yellow color, and is a
mixture of two oils, one li^ditcr, the other heavier, than water. More than
one-half of the oil (CO to 80 per cent.) is safrolum, or safrol. This is hijrbly
toric, and acts upon the medulla, rausincr vasomotor paralv^is. It is t\\-
crrit^ by the kidneys as piperonylic acid. Sassafras also contains a peculiar
Strinciple. termed Sassafrid. Sassafras medulla, the pith of Sassafras varii-
olitim. contains miicila»,% which is used in pharmacj' as a vehicle or diluent.
Phytiolo^cal Action. — The oil is stimulant and rubefacient, and, taken
fntemally, is a carminative. It is largely used as a flavoring agent in con-
d
816
I'llABMACEUTICAL THERAPEUTIC AGENTS Oil DRUGS.
fectionery as well as phormacy. In the experience of Dr. John Bartlett, the
oil of sassafras is capable of exciting uterine contractions and causing abor-
tion. It has been known to occasion narcotic poisoning.
Therapy. — Sassafras is an aromatic stimulant, and small bundles of the
fresh bark are sold by herb-gatherers to be chewed for its flavor and as a
carminative. A recent infusion is used in some parts of the country as a
blood-purifier; or, taken hot, as an eramenagogue and diaphoretic. Sassa-
fras is generally given in combination with guaiac and sarsaparilla, and in
those cases where the latter agents are considered indicated. The mucilage
of sassafras-pith may be used as a demulcent drink in inflammation of the
stomach or bowels, especially when this has been excited by irritant or cor-
rosive substances. It is a cooling application to inflamed eyes or erysipelas,
and may be used as a vehicle for other remedies. The following is known
as Jacksoifs Pectoral or Cough SyTup. It is the Syrupus Pectoralis of the
National Formalarv:
B Morphiuffi hydrochloridi
Olei aasaafraa
Syrupi Acaciio q. s. ad 1000
Kflch teaspoonful contains gr. Vu o^ morphine hydrochloride,
55 Gm. or gr. viij.
5 com. or wvij.
c.cm. or tVij.
Another formula for this syrup is given by Remington: —
or mbdv.
or f 3 viij.
or 5ij.
or Oviij,
or lb. xiv (avoir.)
or gr. Ixiv,
I
i
B 01. ftas&afraa 4 c.cm.
Tinct. Tolutani 240 c.cm.
Magnefiii carb 62 Gm.
Aquce , 3784 c.cm.
Sacchari 6344 Gm.
Alorphimp hydrochloridi . . 4 25 Gm.
M. Rub up tlie tincture and oil with the carbonate, gradually add Vi pound of
Uie sugar and then the water, filter and recover 8 pints, in which disaolve the re-
mainder of the sugar. Diasolve the morphine in one iluidounce of water, add to the
syrup, and make the measure up to 10 pints.
oig.i Take a teaspoonful or more several times daily for oough (each drachm eon-
tains 0.002 Gm., or gr. '/«, of morphine hydrochlorate).
The Atherospenna moschata, or Australian sassafras, a tree of south*
ern Australia and Tasmania, contains an alkaloid called atherospennine and
d Tolatile oil, of a light-yellow color and a pleasant smell and taste, recalling
that of sassafras. A decoction of the bark acts freely upon the kidneys and
skin and has been used in rheumatism, secondary syphilis, and acute bron-
chitis. It liquefies sputum and facilitates expectoration. The physiological
effects of the oil have been studied by T^r. Ralph Stockman, who found that
in frogs and mammals it acted upon the Central nervous system, producing
at first excitement and subsequently marked depression. Respiration is re-
tarded, and after fatal dosr*8 the heart stops in diastole. The oil also pos-
sesses antiseptic properties.
SCAMMONia; RADIX (B. P.).— Scammony-root.
SCAMMONIUM (T. S. P., B. P.).— Scammony.
Dose, o.iiO to 1..S0 Gm. (or gr. x-xx).
Preparations.
Resina Scammonii (U. .S. p., B. P.).-
Om. (or gr. vxv) for an adult.
-Resin of Scammouy. Dose, 0.30 to 1
SCILIA. 817
Cxtractum Coloc-yntliidis Compositum {U.S. P., B. P.).— Compound Extract of
Coloeynth (U. S. P. contains resin of scaraniony, 14; aloes, TiO; extract of colocynth,
10; cmtliUiiom, <J: sortp. 14 pftvU). l>o»*', O.l.i to \.'M) <Iiii. (or ^r. ii-xx^.
Pilultt. Scanmionii CompoAita (B, P.). — Compound Scammony Pill (scammony
reain, jaUp resin, curd-soap, aa 25 Gm.; tincture of (pnger, 75 c.cm.). Dose, 0.25 to
0.60 Gm. I or gr. iv-\iij).
Pulvifl Scammonii Compositus (B. P.). — Compound Powder of Scammony (acam*
niony rc«in, 100 Gm.; jalap, 75 Gm.; ginger, 25 Cm.). Dose, 0.65 to 1.30 Gm. (or
gr. i-xxj.
Soammony is an injrredient in Pilulie Cnthnrlioac Compoaitie and PiluUe Cathar-
tic* Vcpt'tnliik"* (.1'. S. P. i,nnd Piliilii Colocynthidis Comi>08ita and Pihila Coloryn-
thidis et Hyowvunii {U. P.).
Fharmacology. — 8canmiony is '*a giini n^sin obtaineil l)y inoiBing the
living rcMJt of tNnivolviilus Sfanimonia"' (('oDvolvulacea*), It cnutains 70
tn i»0 piT cent, of a resin, ScammoniQ, tin- n-iriiiimler Ut-in^ ju'uni, starch, and
impurities. Scniiunony huf* a sliiilitly acrid taste and u fxruliar odor, which
recall* tliJit of cheei^e. Scaimiionin is a gliunsiilf, uvarly iniJoluble in water;
8<)Iul>1e in alcohol, chioroforni, ether, and alkaline solution*;. The rcain of
ecotuinonv. precipitated from a strong alcoliolic tincture by cold water,
rvpri'SL'ut!* the active jtart of the dni^, and ig aliont twice as etficieut.
Physiological Action. — This drug is an hydragogue cathartic^ and also a
fetbic eholagoguc; in large closes it caupc? symptoms of irritant poiaoning.
■ Absorption depends upon its intimate mixture with the alkaline bile and
intestinal fluids, and for this reason the action of scammony is liable to vary
in rapidity and power. Its effects are usually manifested in about four
^}lour*. It may cause crauijis in the Iwwels, especially if given alone. It
ehonid be combinc<l with other cathartics and aromatics.
B Therapy. — In children, where active purgation is required, calomel and
i^ammony may be given, triturated with sugar of milk. In cerebral affec-
tions and dropsies scammony is useful, especially in the form of compound
extract of coloeynth. It clears mucus from the intestines, and is an anthel-
mintic against both round worms and tape-worms. Scammony is serviceable
in obstinate constipation and impaction of faeces. It is a purgative well
adapted to cases of mania and hypochondriasis.
8CILLA (U. S. P., B. P.).— Squill.
Dose, 0.065 to 0.20 Gm. (or gr. i-iij).
Preparations.
IFIiiid«*xtractuin Sc-illie (I'. S. P.). — Fluid Extract of S<]uill (ncctie acid men-
■tniumi. Di*"^. o.iM*. to O.'iO c.cm. (or mi-iij).
Syrupus Scillw Composituft {U. S. P.). — Compound Syrup of Squill {squill, senega,
iBi tuflar C'inctirl. Di^tte, *>.*M» to 4 r.rm. (or mj'-fSi) ttfirtar pnictic. gr, V. in f5j).
r^ Ac»tura ^il!» lU.S. P., B. P.).— Vinegar of Squill (10 per cent.; B. P., 12Vtper
Mt.). Dose. 0.341 to 4 c.cm. (or mvfSj).
ITinctura Scillm (U.S. P.. B. P).— Tincture of Squill (15 per eent.; B. P.. 20 per
orntl. Po*c. 0.30 to 2 c.cm. (or mv-xxx). B. P., 0.30 to 1 c.cm. (or rov-xv).
Syrupus Scillw (U.S. P.. B. P.).— Syrup of Squill (vinegar of squill with sugar).
Do*e. 0.«0 to 4 ccm. (or mx fSj).
Oxyniel Scillte (B. P.).— Oxymel of Squill (squill, 75 Gm.; acetic acid, 75 c.cm.;
distilled water. 240 c.cm.: with clorified hone}', q. b. to make specific gravity of 1.320).
Dose. 2 to 4 c.rni. (or (Ssrj).
Pilula Ijjecacuanhic cum Scilla (B. P.). — Pill of Ipecacuanha with Squill {com-
pound powder of ipecacuanha, 30 Gm.; squill, 10 Gm.; ammoniacuni. 10 Ora.; syrup of
I
I B*"'
gineea*, q. s. to form a nints). Dose, 0.25 to 0.50 Cm. (or gr. iv-viij).
- * - •" - '■ ^' -^ — •" Pill • - -
Pilula SrillSB CompofliU (B. P.).— Compound Squill Pill (squill. 25 Gm.; ginger,
818
PHAHMAOEUTICAL THEHAPEUTIC AGENTS OH DRI'(;>.
20 Gm.; ammoniacum. 20 Cm.; hard »oap, 20 Gm.; syrup of gluco»e, 20 Cm.). Dow,
0.25 to 0.50 Gm. (or gr. iv-viij).
Pharmacology. — *T1ip bulb of Urginea ruaritiina (Liliaeea?), deprived
of its dry, membranaceous, outer scales, cut into thin slices, and
carefully dried, the central portions being rejected" (U. S. P.). It
should be kept in a dry place. The active principles are all glucosides: Scil-
lipicrin, Scilltoxin, aud Scillin; Scilhiin (Kuriz) is an amorphous, bitter
powder and is probably a pure form at Scillin. It is soluble in water and
alcohol, but not in ether. Sfpiills also conjain a bitter principle and a small
quantity of volatile oil, with a considerable proportion of calcium oxalflte
and sugar.
Physiological Action. — In large doses squill is emetic and purgative;
in smaller quantities, diuretic and expectorant. In excessive quantity it
gives rise to severe or even fatal gastro-enteritis. Cases of poisoning by it
nave been reported by Orfda, Pereira, Fagge, Christison, Stevenson, and
others. A carefully prepared British Pharmacoposial syrup of squills given
in officinal doses has, according to Dr. Truman {Pharmaceuitcal Journal
and Transactions)^ caused the death of two children with symptoms of
heart-poisoning. Squill, according to Dr Husemann, contains two heart
poisons, scillipicrin and scillitoxin; of these the last affects the heart most
strongly. Jn overdoses, squill is highly irritant to the kidneys, causes a
diminished flow of urine, which may contain Idood, or it may even suppress
the secretion. Husemann states that death has been produced by the in-
gestion of 1.55 Gm. (or gr. xxiv). In cases of poisoning, the treatment is
that appropriate to gastro-enteritis. Bnmton classes scillitoxin among the
cardiac tonics, as medicinal doses slow the heart and raise the arterial ten-
sion, like digitalis. When applied to the skin it is absorbed, and produces
systemic etTects. Elimination takes place by the bowels, kidneys, and bron-
chial mucous membrane. Squill has a bitter taste and feeble smell.
Therapy. — Squill is not used by itself, as an emetic, although the com-
pound syrup, containing antimony and potassium tartrate, is sometimes used
for this purpose in young children suffering with bronchitis or croup; but
it is too depressing far ordinary cases. In weak heart, associated with dropsy
or bronchial disorder, squill is especially useful, the vinegar of squill being
a good preparation. Its diuretic action is enhanced by combination with
calomel and digitalis. In ordinary catarrhal bronchitis squill is useful after
the first stage has passed, and the secretions are becoming more tenacious.
As the syrup contains acetic acid, it should not be prescribed with ammo-
nium carbonate. In whooping-cough it is very serviceable. It should not be
given in acute renal disease on account of causing irritation of the kidneys.
This remedy has been used with advantage in cases of chronic pleurisy and
pericarditis with effusion, and in cardiac dropsy.
SCOPAItlTJS (U. S. P.).— Broom.
SCOPAEH CACTTMINA (B. P.).— Broom-tops.
Dose, 0.65 to 1 Gm. (or gr. x-xv), in powder or in infusion.
Preparations.
SpartelniE Sulphas (U.S. P.).— Sparteine Sulphate. Dose, 0.01 to 0.13 Gni. (or
gr. V.-ij).
Infusum Scoparii (B.P.)* — Infusion of Broom (10 j>er cent.). Dose, 30 to 60 c.cm.
(orfSi-ij).
J
Succua Sooparii {B. P.). — Juice of Broom (from fresh top» with 25 per cent of
alcohol, 90**). Dose, 4 to 7.6 c.cm. (or fSi-ij).
Fluidextractum Scoparii. — Fluid Extract of Scoparius. I)use, 1.20 to :2.30 c.cm.
(or mxx-xl).
Pharmacology.— *'The dried tops of Cjiisus Scoparius" (Leguuiinosie),
of Europe, contain Scoparin, which is a crystalltznhle lunitrnl principle, and
Sparteme, a volatile liquid alkaloid. An infusion or decoction is frequently
used (1 to 16), D pint or more in divided doses being taken during the day.
A fluid extract is official, as well as Bparteine aalphate, which is given in doses
of 0.0027 to 0.03 Gni. (or gr. Vj*-'/^) hjpudcnnically, and 0.01 to 0.13 Gm.
(or gr. VV^J)> or more, by the mouth.
Sparteine sulphate ("l". S. P.) is "the sulphate of an alkaloid obtained
from Scoparius." It is n eryj*talline powder readily soluble in water and
alcohol, its fioliitions having a bitter taste.
Physiolog^ical Action, — No local action. Internally, broom, in large
doses, excites vomiting and purging, and in smaller doses causes marked
increase of urinor)' flow. It is o.^^scrtixl that scoparin is the agent which
upon the kidneys, and that sparteine act^i upon the heart as a stimu-
it or tonic, like scillitoxin or digitalin. Sparteine has also a decided effect
upon the nerves and spinal cord, lowering reflex action, paralyzing motor
nerves, reducing the electrical excitability of the vagus, and finally causing
death by respiratory paralysis, both as the result of its action upon the cen-
tre and upon the musck's of respiration. The action upon the heart, due
both to a nervous and muscular stimulation, is manifested soon after its ad-
ministration; the pulse becomes slower at first, and, in about an hour, arte-
rial tension is raised, lasting five or six hours. AMien taken regularly for
a few weeks, the effects continue for several days after the remedy has
been stopped.
According to- the experiments of Gluzinski, the effects of sparteine are
much more marked upon cold-blooded animals than mammals, and are more
striking in the former when the drug is applied directly to the heart (ban
»hen injected subcutaneously or into a vein.* Clarke found no evil results
following the administration of 0.004 Gm. (or gr. Vio) every four hours, or
js much as 0.75 Gm. (or gr. xij) in twenty-four hours, nor was there any
evidence of cumulative action when it had been given for several months.
Sooparius is a true diuretic, increasing both the virea and the water of the
urine, being more rapid in its actions, but weaker than digitalis.
A series of experiments by Dr. David Cerna, relative to the physio-
logicaJ action of sparteine, demonstrated that it causes a brief period of in-
creased muscular irritability, that it augments reflex action by a direct in-
fluence upon the spinal cord, this increase being subsequently followed by
a depression, that it causes convulsions of a spinal origin and generally of a
tetanic nature, that it gives rise to a primary increase in the rate and force
of the heart's action, by a direct influence upon the heart, the increase being
•con followed by a decrease, due to a direct cardiac action and stimulation
of the cardio-inhibitory centres; it augments blood-pressure by an action on
the heart and also by stimulating the central vasomotor system; subse-
quently the arterial pressure declines, owing to paralysis of the vasomotor
H doSE
H iucr
Knt
I
I
*Wi^cr mrdiciniBche Blotter,
1800, p. 91.
Dec. 26, 1889; The Medical BuUetin, March,
820 PHAHMACEITfCAL THEBAPEUTIC AQEXTS OR DRUGS.
apparatus and a depressant influence upon the heart; it exerts a direct action
upon the respiratory centres; it generally proves fatal by respiratory failure.
Germain S^e asserts that sparteine strongly and promptly reduces the
size of the hoart in conditions of diintation of tliis organ.
Therapy. — In renal inadequacy or deficiency of urine, owing to insuf-
ficient arterial tonsinn. sc*opnrius ij; an extcUeut remcilv; also in the cedGina,
or dropsy, accompanying heart-lesions. This remedy should not be given
during the progress of inflammation of the lungs, heart, or kidneys, but in
chronic parenchymatous nephritis broom may be used with advantage. In
hydrothorax and ascites, the use of broom, in conjunction with occasional
doses of compound jalap powder, is very successful: —
R Potasftii acetatis 61 Qm. or Siss.
Aceti sciUse 161 c.cm. or f3iv.
Infus. acoparii q. s. ad 240| c.cm. or fSviij.
M. Sig.: Take a tablespoon ful every four hours, as a diuretic
Scoparin has also been used as a diuretic in doses of 0.50 to 1 Gm. (or
gr. viii-xv) by the mouth, or 0.03 to 0.065 Gra. (orgr. ss-j) by hypodermic in-
jection.
Sparteine sulphate is used by Germain S^e, in weak and irregular action
of the heart, in doses of 0.01 to 0.015 Gm. (or gr. Ve-V*) every four hours.
It gives thf iiest results in failure of compoasation with initral valvulitis. In
irregular action of the heart this has been found specially serviceable. In
cases of valvular disease, with defective compensation, Gluzinski states that
small doses of sparteine sulphate (0.02 to 0.04 Gm., or gr. Va-'A) are more
efficacious than larger quantities. In cases of weak heart-action, where it is
necessary to administer an aniesthetic, sparteine sulphate (0.006 Gm., or gr.
Vio) ^'^^y t»e hypodermieally injected before the operation, as a matter of
precaution.
The author has found sparteine of service in cases of enfeebled cardiac
action from structural lesions and also where the innervation of the organ
was markedly disturbed. It is particularly valuable in disease of the mitral
valve. In advanced stages of this affection, when dilatation has begun,
marked relief follows the exhibition of sparteine. In cases of dyspnoea, pal-
pitation, and cardiac debility arising from an excessive deposit of fat around
the heart, sparteine is a valuable remedy. In dilatation resulting from
valvular disease the writer has often administered the remedy by hypodermic
injection. It is likewise beneficial in functional disease of the heart caused
by excessive bodily or mental labor, anxiety, etc. It has also proved useful
in the treatment of tobacco-heart. As sparteine increases the elimination of
urea, it is beneficial in chronic parenchymatous nephritis and in preventing
the development of uriemia. Its administration may be maintained for a
considerable period without causing disorder of the digestive fimctions.
In cases needing a cardiac tonic, but where digitalis and strophanthus
are not well tolerated, Dr. W. H. Thomson^ gives: —
B SpnrteinfiB sulphatis
Pulv. sciUfP
CaffeiDce citratw
Strychnince
M. et ft. capsulffi.
Sig.: Give one every two hours at first and gradually increase the interval.
Medical Record, March 1, 1000.
065 Gni. or gr. j.
03 Gm. or gr. ss.
10 Gni. or gr. jsa.
002 GiM. or gr. 7,^
SCOPOLA.
8S1
I
*
In ejcophthalmic goitre (Graves's disease), it is claimed to relieve all
the symptoms; and, given at the onset of a paroxysm of asthma (of cardiac
origin?), it promptly checks it. Dr. William Evans, of this city, has pub-
lished the history of a case in which the exhibition of sparteine was of de-
cided benefit in angina pectoris. Dr. Cerna has given the dru^ with advan-
tage in valvular lesions of the hjart due to acute articular rheumatism, car-
diac dilatation with failure of compensation, chorea associated with endo-
carditis, exophthalmic goitre, etc. Dr. Pawinski, of Warsaw, obtained good
results from the use of sparteine in cardiac disease complicated with nervous
disorders and in functional affections. Drs. M. Bali and Oscar Jennings
have found the hypodermic injection of 0.01 to 0.02 Gm. (or gr. Va-Vs) of
sparteine sulphate of value in supporting the heart and system in the sudden
or gradual withdrawal of morphine from those addicted to use of the nar-
cotic. Langlois and Maurange recommend the hypodermic injection of 0.01
Gm. (or gr. V«) o^ morphine and from 0.03 to 0.04 Gm. (or gr. ss-Vs) o^
sparteine sulphate preliminary to the administration of chloroform. In a
number of cases of tremors from various causes, Dr. Charles S. Potts, of
Philadelphia, has found sparteine beneficial. In the pulmonary tuberculosis
of young subjects, Dr. G. Maurange has witnessed a decrease of cardiac
action and improvement of the general condition result from the hypo-
dermic injection of the following solution: —
3 Spartein. sulphat |20 to
Eucalyptol. purificat.
01. olivae sterilisat. q. s. ad 100
38 Gm. or gr. iii-vj.
24 c.cm. or mi v.
ccm. or fSxxvij. — M.
^^^^ The sparteine is first dissolved in a minimum of water and mixed with
■ the oil. The water is then evaporated off and the oil retains from 0.008 to
■ 0.015 Gm. (or gr. Vg-'A) of the alkaloid to 4 c.cm. (or faj). Of this fluid he
H injects from 10 to 20 c.cm. (or melx-fSvss) every day for a month. Sparteine
H sulphate may be of service in allaying hysterical excitement.
■ A yellow precipitate is formed by a combination of sparteine sulphate
H and sodium iodide.
SCOPOLA (TJ. S. P.).— Scopola.
Do«c, o.0(J to 0.18 Gm. (or gr. i-iij).
Preparations,
Extractum Scopolie (l*. S. P.).— Extract of Scopola, Done, 0.016 to 0.03 Gm.
Fluid Kxtmct of S^'upoln. Voae, 0.00 to
Do»e,
<or gr- 'A to v.).
Fluidextrftclum Stv|wlaj (U. S. P.)
0.20 c.cm. (orwtiiij).
8oopolaniiTt9p riytlrobroniiduni {V. S. P.). — SoopolAmine Hrdrobromido.
tttD^a« Jlvofrrinc Hvdrobroinitle. 0.0003 to 0.0006 Om. (or V»»-*/w).
Pharmacology. — The dried rhizome of Scopola carniolica (Solanaccao),
yielding wlion assayed by ot^riul process not less than 0.5 per cent,
of uiydrintic alkaloids. Scopola is a European perennial herb, re-
sembling the belladnniin, but tmirh sniallor. The rhizome and leaves are
SrtmctiriH'8 used to iidiiltfTatf tlit* bcllndonna roots and leaves. An extract
of ftco|M»la has bcvn .'iubifUtulcd for that of bollndonna in making plasters.
The fluid extract is the best priparntiou ; nnd from it the solid extract is
made by oxpogjn;? it tn heat, which drives off the alcahnl and water. The
822
PHARMACEUTICAL THERAPECTIC AGENTS OR DRUGS.
constituents are almost identical with those of belladonna-root, but the pro-
portion of hyoscyamine is sonipwliat greater.
Fhysiologpcal Action. — The characteristic constituent of scopola is
Scopolamine, which is identical with hyoscine. This exist*, however, in
siualler rjuautity in the drug than the other alkaloids. Atropine and Hyos-
cyamine. Tlieir action lias already been given, on pagcg 253 and 546.
Therapy. — Scopola is used as a sedative in the insomnia of alcoholism,
mania, and cerebral excitement. It has also been given to check nocturnal
seminal emissions, in combination witli the bromides.
The author, in a communication to the New York Medical Journnl
(October 7, 1905, page 760), reported a case of scopolamine poisoning fronl
the mydriHtic use of this drug. The patient, seen in consultation with
Dr. Frank Woodbury, had used the drug for several months, while waiting
for a cataract operation. On obtaining a fresh preparation, he placed a few
drops of a Vs-of-l-per-cent, solution into each eye, and lost consciousness
for several liours, but revived spontunooiiply, but for several days he had
giddiness and mental confusion. In surgical practice, anaesthesia can be
obtained by hypodermic injections of scopolamine (gr. Vioo)» "^'ith morphine
(gr- Vfl) J these doses being repeated at one hour's interval previous to Uie
operation. This method was suggested by a German physician, Dr. Schnei-
derlin. It has been used both alone nnd in conjunction with general anies-
thesia with ether or chloroform. nnfortTinatfdy n number of deathR have re-
sulted, some 28 having been put on record. Probably for nmiiy patients the
dose of both drugs has been too large for safety. As preliminary to ether
ann?3thesia, scopolamine, alone or with a pmall proportion of nior|ihine, may
have a very useful appiicatifui, as loss ether is required, and ihore is no
vomiting.
Scopolamine hydrochloride has been introduced into ophthalmnlogical
practice, and. according (o the estimate of Raehlmann, is about five times as
powerful as atropine. It is used in Vio- to V«-p^r-cent. solutions; of the
latter n.:^7 or n.43 c.cm. (or w/vi-vij) may be administered daily to an adult
or used every fifteen ninutcs during an hour and a half. Weaker solutions
are employed fn tlic case of children. Scopolamine hydrochloride is said to
produce no unpleasant after-effects or double vision, and drynessof the throat
is not caused except by very large doses, but some cases have been reported
in which dangerous symptoms were observed after its use as a mydriatic.
Instilled into the eye, this salt has been of service in the treatment of iritis,
episcleritis with infiltrations of the sclerotic, pericorneal injection, pannus^
and suppurative inflammations of the anterior section of the eyeball. Raehl-
mann states that in five cases it caused a diminution in the size of a hypopyon.
It is said that it has no influence upon intra-oeular pressure, and is especially
valuable in inflammation of glaucomatous eyes. The duration of the myd-
riasis and the paralysis of accommodation was from twenty-four to forty-eight
hours. Dr. Thomas R. Pooley, of New York, has obtained pfiti^factory re-
sults from the use of scopolamine (hyoscino), but has observed three cases in
which it produced very marked toxic ctTects. Dr. Pharles A, Oliver considers
scopolamine (or hycjscine) bydrobromide. in plastic iritis, where quick and
active measnrcR are so necessary during the early stage, as very important,
but it is less valuable in prolonged cases, Tn the latter class of cases, where
more permanent eiTects are do.simd. be altomates it.-^ use with atropine. He
had not enconntcrod any symptoms of poisoning, although when he had
SENBCIO.
823
used it freely he had <)l»f!ervo*] giddinoi;s, inoo-ordination of movement, and
drowsiness.
SCXTTELLAEIA (U. S. P.).— Scutellaria (ScuUcap).
Preparat
a\ S. P)
ton.
-Fluid Extniot of Scutellarin. Dose,
Flviide^tractuni Scutellariue
I to 4 com. (or fS.-ss-j )-
Pharmacology and Physiological Action. — '^The dried plant Scutpllaria
lateriflora" (Labiatte) has a bitter taste, and contains a little volatile oil and
a bitter principle. The eclectic ''Scutellarin" is an impure extract, probably
devoid of medical qualities. It is given in doses of 0.13 to 0.25 Gra. (or gr.
ii-iv). The fluid extract is esteemed to possess tonic, antispasmodic, and
alterative jx^wers, but Dr. Lawrence Jolinson stated that if it possesses any
valuable medicinal properties the fact remains to be demonstrated.
Therapy. — In various diseases, accompanied by twitching of the mus-
cles, restlessness, tremors, — such as chorea, delirium tremens, epilepsy, etc.,
— Scutellaria has been employed, chiefly, however, in domestic practice. Its
claims for usefulness in hysteria and hydrophobia are not well founded.
SECALE COENTTTTIM.— Spurred Rye. (See Ergot.)
SEDUM ACEE. — Sedum acre (Crassulacea?), stonecrop or wall-pepper,
is a sn:nll, moss-like, spreading plant native of Europe. It grows in dry
fields and on old walls, with no smell, but has a mucilaginous and acrid taste.
PhysioIog:ical Action and Therapy. — The juice of the stonecrop is a
decided local irritant, and is capable of blistering the skin. Taken internally,
in large doses, it acts as an acrid emetic and purgative. The bruised plant,
or its juice, has been used with success upon indolent or unhealthy sores and
enlarged lymphatic glands. The juice has been used to remove warts or
corns. Dr. Louis Duval, of Madrid, asserts that sedum is of signal service
in diphtheria, made into a decoction with beer. Injection of the decoction
into the nares is said to be elTective in nai^al diphtheria. It is claimed that
this drug possesses the power of loosening the diphtheritic membrane, and
that it does not form anew. These statements have been confirmed by sev-
eral physicians in other European countries, and by Dr. P. 0. Wagener.*
The latter writer cannot commend the decoction in beer, but obtains the
tame eff'ects from the remedy used locally, and combined as follows: —
B O!. t«rebinthine,
Acid, lactici,
Fliiidpvt. H(X)niti sa 715 c.cm. or f3ij.
Klin*i#^xt. Htnli rt<*ris . . . ^ 30| c.cm. or fjj.
IkL This mixture is applied with a brush, every three minutes, for twenty
ntnutes, u-b^n vomiting occuia and the membrane is expelled.
I
*
SENECIO, the common rag^vort (Senecio Jacobcea), grows wild in Eu-
rope and North America. The entire plant has been used. Grandval and
Laioux have obtained from the underground parts two alkaloids Senecine
ana Scnecionine. These are very bitter to the taste and yield salts soluble
m water.
' Thrrapetitic Gazette, 1885, p. 449.
83-1 I'lIARMACEUTICAL THERAPKl'TIC AUEXTS
Physiological Action. — L)r. J, I>. BuikIi^ f<^iiiKl that wliilo an injection
of a small d<:)se ol' lui alcoholic L-xtrnc-t of the onlirL* phmt of senecio
given to a dog caused a rise of general blood-pressure, with a constriction
of peripheral vessels and of vessels of the intestinal area; lar;2:e doses caused
a fall of general blood-pressure, with dilatation of the intestinal vtsseU and
inhibition of the contractions of the intestinal coat. "Watery extracts pro-
duced a fall of blood-pressure and cardiac inhibition, due to the action of
the drug on the nerve-terminations in the heart, and not to direct action
on the nmsciilar libres of that organ.
Therapy. — The principal use of this agent has been in disturbances of
the menstrual I'linction. In amcnorrlucn. Delaeho luul Heiin used sonccio
in fifteen cases and found it to act prompt and well. They employed a solid
extract in doses of 2.5 Gm. (or gr. xxxvij) daily. Bardet and Bolognesis
used it in twenty cases of amenorrhoea and dysnienorrhoea and found that
it had the constant property of provoking menstruation and to relieve the
pain. Dr. William Murrell suggests that, in chlorosis complicated with
amenorrhoea, it is best to treat the chlorosis, and, after the quality of the
blood has been improved, to give the senccio. Ilis usual dosage was 7.5
c.cm. (or foij) of the 10-pcr-cent. alcoholic tincture three times a day.
Senecio has also been recommended in the impotence of the aged, but
there is no conclusive evidence as to its efficacy.
SENEGA (U. S. P.).— Senega. ^M
SENEG.ffi RADIX (B. P.).— Senega-root. ^^
Doae, 0.65 to 1.30 Gm. (or gr. x-xx).
Preparations.
4
Fluitk'xtnictum Senogse (V. g. p.). — Fluid Extract of Seneijii. D(»8(\ O.UO to
1.20 ccm. (or mx-xx).
Syrupus Senegre (U.S. P.). — Syrup of Senega (fluid extract, 200; ammonia-
water. 5; sugar, 700; water, q. s. ad 1000}. Dose, 4 to 7.5 c.cm. (or f3i-ij).
Liquor Senegse Concentratus (B. P.).— Concentrated Solution of Senega (a strong
tincture* 60 per cent). Doae, 2 to 4 ccm. (or fSss-j).
InfuBum Scnegie (B. P.). — Infusion of Senega (5 per cent). Doae, 15 to 30 c.cm.
(or fjas-j).
Tinctura ScnegK (B, P.). — Tincture of Senega (20 per cent.). Doae, 2 to 4 c.cm.
(or fSas-j).
The U. S. P. official compound sj-nip of squill contains 8 per cent, of fluid extract
of senega.
Pharmacology. — ''The driod r(u>t ul* Poly^ala SoncKu" ( Polyi^ahuvx)
knoi)l»y mot-stork, with HpreiKhritr, torlumis rootlet.*^, twisted and ke<ded.
It grows in the United States, ospeeiHlly in the Sioith. The netive prineiple^,
contained especially in the cortex, are Senegin and Polygalic acid, forming a
mixture aj)parently tlu* same as saponin fr*>m saponaria, the two bearing
similar relations to those of qiiillajie acid and qnillnjasajioloxin in qnillaja-
bark. It is a wliito powder, easily soluble in hot wattT nnd nlcohol. forming
a sonpy emulsion wlien Ttii.\<'d with water, even in small fjnantitios. The
fluid extract is uuide witli an aleoliolie menstruum, to whii-li i* added solu-
tion of ]n)tas.>iinii hydnixide (3 per cent.).
Physiological Action. — Senetja is irritating to the air-passages and
causes eneezing when inhaled. The root, when chewed, gives rise to a bum-
^Brilitih MrdioaJ Jnurnni. .lulv 'iS. 1000.
fe
rag ecD&ation. Wlicn swallowed in large doses, senega excites salivation and
gastro-intestinal and renal irritation. It is likewise irritant when applied
to the integument. It is a stimulating expectorant/ diuretic, and diapho-
retic. It docs not liquefy the secretions of the bronchial tubes, but simply
facilitates their expulsion. When the expectoration is tough and scanty,
«enega is of little use. It is usually given in combination with other ex-
pectorants and diuretics. Senega is excreted by the bronchial mucous mem-
brane, skin, and kidneys, exercising upon these organs a stimulating action.
Therapy. — Senega is useful in the second stage of bronchitis, or pneu-
monia in the stage of resolution. In chronic bronchitis, associated with em-
physema and occurring in aged people, it will often answer a good purpose.
By some practitioners it is esteemed beneficial in croup. In bronchial
asthma with emphysema this remedy is likewise of considerable efficacy.
Whooping-cough is sometimes ameliorated by the administration of senega.
In dropsy, accompanying renal disease, it is useful. In palpitation and also
in amenorrhilpa it has been found serviceable: —
B Fluiclext. Pcnegff',
Spt. chlorofomii aa 41 c.cm. or fSj.
Syr. pruni Virg q. 5. ad 60| c.cm. or fjij.
M. Sig.: Take a dessertspoonful e\'ery two or three hours, for cough.
Senega is not to be used in heart disease on account of the depressing
effects of its active principle. (See Saponin.) Senega has been adminis-
tered, in doses of 0.13 Gm. (or gr. ij) in uterine hsemorrhage. A decoction of
•enega-root, a pint being taken daily for a fortnight before the expected
period, has been successfully employed in amenorrhcea. In chronic rheuma-
lism, its diaphoretic and diuretif effects are useful.
SENNA (IT. S. P.).— Senna.
«
SENNA ALEXANDRINA (B. P.).— Alexandrian Senna.
SENNA INDICA (B. P.).— East Indian Senna (Tinnivelly Senna).
Dose, 4 to lU Gra. (or oi-iiss).
Preparations.
Kluidcxtraotum St^nniie (l\ S. I'.). — Fluid Extract of Soniin. IX*rto, 2 t(i 15
ccxD. (or mxxx-f3iv).
Infusum SenniB Compositum (U.S. P.). — Black Draught (senna, manna» Kpsom
Hit. I'-miel, wftter). I>>j*<'. (»0 to 120 c.cm. (or fjii iv) every four hours until it ojicr-
Infusum Seniifc (B. P.). — Infusion of sennft (senna, 10 per cent., with g^inger and
distilled water). Dose, 16 to 30 c.cm. (or fSss-j).
Syrupus Sennas (U.S. P., B. P.). — Sjrup of Senna (U. S, P. contains senna, oil
of rurinnder. alcohol, sugar, and water). Dose, 4 to 15 c.cm. (or f3i-iv). B. P., 2 to
7v5 c.cm. (or fS^s-ij).
Confectio Senna (U. S. P., B. P.)— Confection of Senna (U. S. P. conUina cauia
€jitu1a. senna, oil of coriander, tamarind, prune, flg, sugar, water). Dose, 4 to S Om.
(or 3i ij).
Pulvis GIycyrrhiz» Compositus (U. S. P^ B. P.). — Compound Powder of Glycyr-
duza (U. 8. P. contains senna, licorice-root, oil of fennel, washed sulphur, sugar).
Doae.4 to 8 Gm. (or 3i-iJ).
Mtstura Sennse Composita (B. P.).— Compound Mixture of Senna. Black l>raught
(magnesium sulphate, 250 Gm. ; liquid extract of licorice, 50 c.cm.; com|>ound tincture
«( cardamoms, 100 c.cm.; aromatic spirit of smnionia, 50 c.cm.; infusion of senna^ a
aufflcient quantity to produce 1(XK) c.cm.). Dose, 30 to 60 c.cm. (or fji-ij).
S2Q
PHAKMACECTICAL TUEttAPEUTIO AGENTS OH DfiUOS.
Tinctura S«nnffi Composita (6. P.)- — Compound Tincture o! Senna (aemui, 200;
with raising, caraway-, and coriander- fruit; alcohol, 45 per cent., q. i.). Dote, 2 to 4
c.em. (or fSss-j).
Liquor Sennee Concentraiua (B. P.). ^Concentrated Solution of Senna (senna,
1000 Gm., tincture of ginger, alcohol, and dietiUed water, q. s. ad 1000 c.cm.)- Dose, 2
to 4 c.cm. (or fSas-j).
Fluid pxtrnrt of senna enters into the compound eyrup of sarsaparilla {V. N. P ,
15 prtrts to 1000).
Pharmacology. — Senna is the U. S. PharniaeopcDial title for "the dried
K'lilletg of I'assia acutifolia (Alexanilria senna), and of Cassia aagustifolia
(India sonna)," plants of the natural order Leguminosa', which must be freed
from etalkfi, di&oolored leaves, and otlxer admixtures. Senna Alexandrina
and Senna Indica are named as official in the British Pharmacopoeia. The
cathartic effect of rhubarb, senna, aloes, and frang^ula is due to the presence
of the irritant anthracene (Cj^Hjo), or anthraquinonc, in combinations only
a few of which have been igolated. The principal constituent of semia is
Cathaxtin, or Cathartinic acid, an acid glycoside. Emodin or trioxymethyl-
anthraquinone is present in all the members of the above group. Rhubarb
and senna also contain ehrysophanic acid (dioxymothyl-anthraquinone).
Pure cathartinic acid is very liable to underji^o decomposition.
Physiological Action. —Senna has a faint, disagreeable smell and a
bitter, nauseous taste. Senna is an active, but not an acrid, cathartic. It
generally acts in about four hours, producing copious, yellow stools; any
tendency to griping may be avoided by using the deodorized fluid extract^
or by combining aroraatics with the other preparations. It is an hepatic
stimulant of feeble power, rendering the bile more watery. Its use as a
cathartic does not produce constipation. The menstrual flow may be ex-
cited by it, and if given to a nursing woman her milk may acquire purgative
properties. Injected into the veins, Cathartin produces iKith vomiting and
purging, and in overdoses it acts as a dniptie cathartic, but is never poipon-
' OILS in its efTecfs. It is too irritant to the bowel to use in full doses where
luvniorrhoids are present. When hiking senuii the urine becomes a purple-
rr-d color on addition of alkalies. The chryeophanic acid also gives a
yellowish tinge to the urine.
Therapy, — This drug is a safe, efficient, and, when combined with other
drugs, a pleasant cathartic for constipation, or where simple unloading of
the bowels is required. It should not be given where there is danger of abor-
tion, or where inflammatory conditions of the intestine exist. It is a favorite
laxative for pregnant women in the form of confection of senna and com-
pound licorice-powder, and the syrup is a good laxative for children. The
infusion is useful to carry off worms from the intestines. Senna and manna
(or black draught, U. S. P.) is an efficient, but uninviting, cathartic, and ha»
nearly gone out of use. because its place has been taken by more pleasant
remedies. Bartholow states that the addition of coffee masks the unpleasant
taste of senna. The following formula for a cheap and eflBcient laxative is
given by Mr. G. H. Dnnn: 15.5 Gm. (or Jss) of senna-leaves are placed in a
quart of water and boiled fifteen minutes in a covered dish. The liquid is
then strained and 8 Gm. (or 5ij) of dry sugar added; 248 Gm. (or ^v^U)
each of figs and prunes are cut up, Fidded to the liquid, and the whole is
boiled until the fruits get thoroughly soft. Dose, 1 teaspoonful after each
meal. A better method of making this would be to stew the fruit sepa-
rately, and, after it has cooled, to add 15 c.cm. (or fjas) of the deodorized
9EBPKNTABIA.
82r
fluid extract, since the active principle, cathartic acid, is destroyed by heat.
Laxative prunes may be made by adding syrup of senna or the fluid extract
to the stewed fruit. A confection of senna made into a flattened bolus (4 to-
8 Gra., or 5i-ij), and coated with sugar or chocolate, forms a proprietary
pharmaceutical known as fruit laxative, or "Tamar Indien,^' as it is said to
contain tamarind. They are readily eaten by cliildren. Dr. Angel Bilbao
has found that tlie administration of purgative doses of senna for a number
of annseeutive days diminislied or arrested incontinence of urine present in
the early stages of locomotor ataxia. The simple infusion of a few leaves,
roreeeds, in hot water, is popularly used in Russia, as a laxative.
Cathartic acid has lately been employed as a purgative, and Dr. Kohl-
stock reports from the clinic of Professor Senator, of Berlin, favorable re-
sults from its action. It may be given by the raouth in the form of a pow-
der rubbed up with sugar in the dose of 0.05 Om. (or gr. V«)j to children from
12 to 4 years, and 0.15 Gm. (or gr. ii VJ to adults. Kohlstock administered
it by the rectum, injecting 1 c.cm. (or mxv) of the following solution: —
Q Acid cathartic 8[ Gm. or gr- xlv.
Aq. de«tiUflt 7| ccm. or f3i Vi-
L Sodii bicarbonat. q. g, ad react, alkaline. — M.
■ Commercial cathartic acid, according to the Druggists* Circular ( Janu-
BT. 1904), is in reality a mixture of the calcium, magnesium, and potassium
salts of cathartinic acid as they exist in senna-leaves. It occurs as brown-
ish-black granules or scales, soluble in water. It is used instead of senna
chiefly in children. Doso for a child, 0.10 to 0.20 Gm. (or gr. ii-iij) ; adults
take 2 to 3 times as much.
SERPEITTAEIA (U. S. P.).— Serpen taria (Virginia Snake-root).
SERPEKTARTff: EHIZOMA (B. P.).— Serpentary Rhizome.
Dose. 0.65 to 4 Gm. (or gr. x-5j). B. P.. 2 to 4 c.cm. (or fSss-j).
Preparations.
Fluidextractum S<.'rpeiitariffi (U. S. P.). — Fluid Extract of Serpeiitaria. Dose,
0-00 to 2 c.cm. {or mx-xxi).
Tinctura Serpentariae (U.S. P., B. P.). — Tincture of Seq>entana (10 per cent.;
B. P.. 20 per cent.). Dose, 4 to 7.5 c.cm. (or f3i-ij).
Liquor Serpentariee ConcentratUB (B. P.). — Concentrated Solution of Serpentary
(•erpeoury, 500 Gm.; alcohol [20 per cent], 1000 c.cm.). Dose, 2 to 7.6 can. (or
i3«a-ij).
Infuaum Serpentariie (B. P.). — Infusion of Serpentary (5 per cent-). Dose, 15
to 30 c.cm. (or f3«8-i).
The compound tincture of cinchona (U.S. P.) contains 2 per cent. (B. P. 2V»
per cent) of serpentaria.
Phannacology, — 'The dried rhizome and roots of AristoWhia Serpen-
taria or of Aristolochia reticulata" (Aristolochiacece) : plants growing in
the southern and western portions of the United Stntes. The British Pliar-
macopoeia recognizep only Aristolochia SerpcntJiria as the source. The name
make-root, of itself, is not distinctive, and should not be used, because by
this title Beveral different plants are commonly called; for instance, Canada
Hiake-root is Asanim Canadense, or wild ginger; black snake-root is Actoea
ncemosa, or cimicifuga; evergreen snake-root is Pol3'gala paucifolia, or
fringed polygala; while rattlesnake-root, or senega snake-root, is Polygala
828
PHARMACECTICAL THEHAPEUTIC AGENTS OR DRUGS.
Sonega. Texas snake-root is Aristdochia reticulatfl, and Virginia
snake-root is Aristolochia Scrpentaria. Serpentaria contains a bitter
principle, Aristolochin, or Serpentarin (thmi^'ht to he identicnl with
elomatitin), sniulilr in water nnd ali-olml ; nlso a volatile oil (contaia-
inj^^ Bomeol), mu] some resin. TIk- jutive principle \s ni>r used in medicine.
All llie propnratious should i>c made from tho fresh rrmt. as it deteriorates
by keeping. A small jiroportirm of an alkaloid. Aristolochinc. hns been
found in the Argentina variety, combined with aristiaic, aristidinic, and
aristolic acids.
Physiolo^cal Action, — Serpentaria is a tonic, a cardiac stimulant, and
has some aiitipcriodic powers. It has a pungent, characteristic flavor, and
email doses promote appetite and digestionj and are slightly exhilarating.
Large doses cause considerable intestinal disturbance, flatnlence, tenesmus,
and frequent evacuations of semisolid stools; they are also productive of
nausea nnd vomiting, with much headache and dizziness. Ha?morrhoids are
irritated and menstruation is stimulated. The drug is expectorant. Al-
though asserted to possess aphrodisiac powers, it is doubtful if serpentaria
has any direct influence of this kind, probably acting simply as a stimulant
to the cirrulfltion and as a general tonic.
Therapy. — Thout^h physiologically active, serpentaria is rarely used
alone. In atonic dyspepsia, it is a usofiil adjum-t to cinchona in the com-
pound tincture. It is also a good general tonic. Tablespoonful doses of a
decoction of serpentaria are often able to allay bilious vomiting. The in-
fusion is a uscfiil wash for spongy gums, diphtheritic inflammation, or the
sore throat of scarlatina. In pneumonia of a low type, serpentaria is useful
in combination with the aromatic spirit of ammonia; and in bronchial ca-
tarrh it is a good expectorant. Its combination of expectorant and stimulant
properties renders serpentaria useful, also, in capillary bronchitis. It has
some reputation as a restorative in typhoid and typhus fevers, and in de-
pressed conditions of the system generally. In chronic rheumatism it may
be given in combination, with excellent results. In amenorrhoea dependent
upon amemia or chlorosis, serpentaria is said to have given good results.
Serpentaria bus alpo boon given with success in functional impotence.
SERUM AKTIDIPHTHERITICirM (U. S. P. ) .— Antidiphtheritic
Serum. (Stv Animal Extracts.)
SEVUM PILffiPARATTTM (U. S. P., B. P.).— Prepared Suet.
Pharmacology and Therapy. — "The internal fat of the abdomen of
the sheep, ovi? arirs (thiss. Mammalia ; order, Ihnuinantia), purified by melt-
ing and straining.'' If in well-closed vessels, it will ktep for an indefinite
time in a cool place, without turning rancid, wliicli woidd spoil it for phar-
maceutical purposes. Tt is a solid fat, with slijrht taste and very liltle odor,
consisting chiefly of stearin. It should not be used after it has become
rancid. It is used to give greater oousiptency to ointments, and colters into
the oHicial ointment of mercury. For warm weather, a good ointment can
be made as follows : —
B Hydrarp. chloridi mitis 2
Sodii honzoatia
Sovi prfpiirati 31
Olei BTny^alee ainarse
M. Sig.: For eczema or intertrigo. Apply upon soft linen.
60 Gm. or gr. x\.
55 Gm. or pr. x.
Gm. or 5j.
12 ccm. or mij.
BfLICOK.
829
SILICON.— Silica.
Preparation.
I
I
Liquor Sodii Silicatis (U.S. P.)- — Solution of Sodium Silicate, or Soluble Qlaia.
For external use.
Pharmacolog^y and Therapy. — Silicon is a non-metallic, elementary
body, discovered by Berzelius in 1825. Its atomic weight is 28. It is ob-
tained in two forms: amorphous and crystalline. In nature, its compounds,
with fluorine (silicon fluoride) and oxygen (silicic oxide), are widely diffused,
and are known as fluor-spar and rock-crystal, or quartz, and, in a granular
form, ag Bandstonc or i^aiKl. Ur>;ftallizt!d quartz, or rock-crvfitulj is used
for the manufacture of spectacle glasses and lenses. Window-glass is a mixt-
ure of potassium or sodium silicate with calcium silicate, and often contains
aluminum silicate also. It ia made by the prolonged fusion of potassium
or sodium carbonate with pure quartz, sand, and lime. Flint glass contains
lead, introduced in the form of red lead. Various colored glasses are made
by adding metallic oxides to the above ingredients previous to fusion.
Hydrofluosilic acid is a saturated aqueous solution of this acid, prepared by
passing silicon fluoride (which is a colorless, suffocating gas, producing white
fumes when allowed to escape into the air) through water. It is employed as
a reagent in the laboratory. The solution of sodium silicate contains about
10 to 12 pQr cent, of soda, and 20 to 24 per cent, of silica. It is a clear, al-
ftost colorless, viscid, odorless fluid, with alkaline taste and reaction, and
Vhnuld not produce any irritant effects upon the skin. It dries in a short
time, yielding a smooth, glassy surface. In making dressings for fractures,
«ucoessivi^ layers of bnndag*^ are applied smoothly to tho limb, rubbing the
■Diution into each layer of bniiilagc, until a sufficient thickness is obtained.
The dressing is then allowed to dry, and a finishing coat is given with the
brush, making a good permanent dressing. If desired, when applied to a
limb, the ap[»aratus may be plit up the back and front, and trimmed with
scissors, 8<"» as to make hvo lalcrnl molded splints. Sodium silicate has also
been useil to tnko the place of the gypsum «if the plaster jacket in tho treat-
n»ent of Pott's disease. Tbe silicate Hpparatus is neat, light, and can be per-
foratc<l for voniilatioiK
A solution of Potassium Silicate is used in the same manner as the
preceding, and, by some, a mixture of these two is considered preferable to
either alone. It also has antiseptic qualities, and has been used as an in-
jection, properly diluted, in gonorrhoea, vaginitis, and cystitis; or applied
as a dressing to erysipelas, with asserted good results.
The compound known as the sodium silico-fluoride has had a limited
use as an antiseptic. Laplace reports that in the laboratory, as well as in
the clinic-room, negative results have followed its employment as an anti-
septic. Flagg, on the other hand, in dental practice, says that sodium silico-
fluoride is both a disinfectant and antiseptic. It is used in the form of a
salt or solution (5 to 8 per cent.) in water. It is, he adds, noteworthy as
poflsessing the unusual and most desirable characteristics of being non-irri-
tant, non-poisoning, neither discoloring nor staining, of decided rank as a dis-
infectant and deodorizer, odorless, and of positively indefinite maintenance
of integrity. — tlip solutions of three years' duration giving ocular evidence
of being unchanged. The hydrated magnesium silicate has been utilized in
France as a protective and absorbent in diarrhoea, in the same way that bia-
*
«30
PHABIUCSDTIOAL THERAFE0TIO AGENTS OB DRUGS.
muth is ordinarily used, in doses of 4 to 7.5 c.cm. (or f3i-ij). Friction with
Band has been employed by Ellinger for detaching the scales in psoriasis.
SIMTJLO. — An herb of the Caper family, Capparis corriaceae (Cappari-
daceae), known as the simulo-plant, has had attention directed toward it by
the investigations of Eulenberg* and others. No analysis has yet been made,
and it is not known deiinitely whether or not it has any principle with posi-
tive therapeutic action. The kernel of the fruit, which is almond-shaped,
is the portion used. An alcoholic tincture of the drug has been employed,
but it is less valuable than a fluid extract, since the alcohol may counteract
the sedative influence of the remedy.
Phyfiiological Action. — The ph^'siological effects have not been inves-
tigated. Under its therapeutic use. Dr. Starr observed no change in pulse,
respiration, or temperature; no effect upon the pupils, no muscular weak-
ness, no mental depression or stimulation, and no digestive disturbance. It
appears to be quite innocuous, even in very large doses, according to Dr. V.
Paulc^t.
Therapy. — Simulo is one of the many agents which have been brought
forward to cure cases of epilepsy, and in other nervous affections favorable
results from its use have also been reported, Dr. V. Paulet found it to have
decidedly good effects in hysteria and chorea.' Dr. W. H, White used the
tincture of simulo in seven cases of epilepsy, giving 4 to 7.50 c.cm. (or f5i-ij)
three times a day. In all the patients considerable improvement took place,
though complete cure was attained in none. Dr. M. Allen Star finds that it
has some effect in modifying the frequency and severity of attacks of grand
maly but is in this respect inferior to the bromides. It is useless m.petit mal
and in hystero-epilepsy. About the only field nf usefulness for simulo would
appear to be when, for any reason, it is deemed necessary to temporarily sus-
pend the use of the bromides. Dr. L. C. Gray, in several cases, found the
drug useless.*
The tincture in dcses of 0.30 to 0.60 c.cm. (or mv-x) thrice daily, be-
ginning five days before the expected period, is said to relieve dysmenorrhoea.
Dr. Paulet recommends the drug as of service in ovaro-salpingitis.
SINAPIS (B P.) —Mustard.
SINAPIS ALBA {IT. S. P.), SINAPIS ALB^ SEMINA (B. P.).— Wliite
Mustard, Wliite Mustard-seed.
SINAPIS NIGRA (U. S. P.), SINAPIS
Black Mustard, Black Mustard-seed.
NIGEJE SEMINA (B. P.).
Preparations.
Oleum SinBpia Volatile (U.S. P., B. P.),— VolatUe Oil of Mustard.
ChartiB Sinapia (U.S. P., B. P.).— MusUrd Paper.
Linimcntum Sinapia (B. P.). — Liniment of Mustard {contains volatile oil of mus-
tard, 2 c.cm.; camphor, 3 Gm.; castor-oil, 7 c.cm.; alcohol, 90 per cent., 43 c.cm.).
Tinimpntuni Sioapis Com(X)«itiim. — romponiul Linimpnt of Mu«tarrt (\-oliitito
•oil of nmr^tarJ, ?>\ fluid extract of mczoreuni. 20; ciiniphor* 0; ciistor-oil, 15; Alcohol,
q. B. ad 100 parts). For external. ubp.
^
* Th€rQp*:Mtic Gazette,
• American Journal
■ Thrrapeviic Qasette,
. Oct 15, 1888.
of Insanity, July, 1890.
June 15, 1889.
BIVATIB,
831
I
t
Phannacologfy. — White and Itlack mustard are the seed of Brasslca nlba
Bd the serd of Bra.-^siea nigra (CruciiVra), respectively (U. S. P.).
They form the flour of mustard when ground to a line |n»\vder; eonunercial
flour of mustard is a mixture of both kinds of seeds ground together. It ia
this mixture whieli constitutes the mustard nf the British Pharmacopoeia.
Tiie pungency of the moist powder is due to the volatik- oil of mustard,
wliich doe.s not exist in the wliole seeds. The black and wliite varieties each
contain a cr}*stnlline suiistanco, — in the formt'i- Sinigrin, in tlic latter Sinai-
bin. — together with an albiiininotis ferment, Myrosin. When water is added,
boih sinigrin and sinalbin are split up by the myrosin nnd produce a volatile
oil which is not quite identical in the two mustards, that from the black
mustard being the more pungent. The action nf myrosin is suspended at
fiO** C. (140° F.) ; so thiit mustard poultice should not be made with boiling
water. "White mustard, even when ground and mixed with water, is inodor-
ous, hut when added to the black variety it increases the yield of volatile oil.
Both kinds also contain fixed oil, para-hydroxy-benzyl-isothiocyanate, or
"acrinyl fulphocyanidc," as well as Sinapine (fin alkaloid), brasaic acid,
and other vet'ctftblc principles.
Fhysiolo^cal Action. — Wlicn applied to the skin, if moisture is present,
mustard-flour causes hyperemia, and, if the action is continued, it will ves-
icate, making a painful and slow-healing blister. The volatile oil of mus-
tard causes rubefaction and generally ia used in combination, as in the
compoimd liniment, as a counter-irritant. When used alone, it should be
diluted with alcohol (1 to 60) or some other vehicle. It is a good substitute
for the mustard plaster, when applied upon flannel.
Therapy. — Mustard-papers (4 inches square) are very convenient for
applying counter-irritation (being always ready for use and only needing
dampening with cold water) in pleurodynia, lumbago, colic, croup, and
numerous other conditions requiring this treatment; can also be applied to
the calves of the legs, as well as other parts of the body where counter-irri-
tation is necessary. They should remain ordinarily about four or five min-
utes, but may remain longer; they should not be left on all night, for fear
of making a slough which would leave a scar. Mustard poultices to the feet
and legs are employed as derivatives in apoplexy and intoxication from alco-
hol or opium. In weak digestion, a little mustard, as a condiment with
meats, assists digestion and stimulates the secretion of gastric and intestinal
fluids.
Mustard foot-baths, made by adding a handful of ground mustard to
warm water, is a good revulsant in recent colds, sleeplessness, amenorrhcea,
headache, etc. Mustard-water is a useful emetic in narcotic poisoning. A
hot mustard-bath is an efficient aid to other treatment in allaying maniacal
excitement. It is of value, moreover, in cases of recession of the emption
in scarlet fever and measles.
In medicinal preparations, mustard is occasionally administered with
advantage as an internal remedy. Obstinate hiccough has been relieved by
an infusion made by steeping a teaspoonful, about 4 Gm. (or 3j), of mustard
in 120 c.cm. (or f'iv) of boiling water for twenty minutes and then straining
(Ringer). An alcoholic solution of the oil of mustard has been found of
efficiency in chronic gastric and bronchial catarrh. This preparation is said
to have been of service as a diuretic in dropsy. A mustard-whey, made by
832
rilAaMACElTICAL TlIEItAI'KUTlC AGENTS UK DRUiS.
boiling 15.5 Gm. (or 5ss) of nuistartl-flonr in a pint of milk, has also been
utilized in dropsy.
SISYRINCHIUM. — Tile root ami herb of Sisyrinchium iinxufitifoIiuiUy
or anceps (Aniaryllidacete), or blue-eyed ^raas, are used by North Ameri-
can Indiflns as an antidote to rnttlosnake |M»iH4)n. Tlie tincture or decoction
of tlie frt'ph root is pivcn intfrnnlly. and hx-ally llie powdered r«3ot it? applied,
as stated l>y C. L. TlnnHiluno.' 'I here is also a variety with yellow flowers
found in Jtissouri,
SODIUM (B. P.).— The metallic element, Sodinm (Katrium). Not used
in medicine, except in combination.
Salia and Preparations,
Sodii Hyilro.xitium ( l\ S. P.|. — Sodium lIvilinxiMo. Cnustic Soda.
LiqiifM- Sodii [Jytlroxidi (I. S. P.). — Solution of Sodium Hydroxide (5 per
cent, of tbe hydrate). Dose, 0.30 to O.flO c.cm. (or mv-x).
Liquor Sidic C'liIoritiHta; ( T. 8. P.. H. P.). — Solution of ChlorinnteU 8oda
I Labnrraque's solution). Should contain at IcaHt 2.G pt»r cent., by weight, of avail-
uhlc chlorine. Dose. 2 to *l p. cm. [or f3t»H-j).
Potassii ct Sodii Tartras (U.S. P.). — Potassium and Sodium Tartrate (Rochelle
Balt|. Dose» 4 to 15.5 Cim. (or 3i-iv).
Mietura Rhci et Sodae (U. S. P.).— Alixture of Rhubarb and Soda. Dose, 7.5 to
15 c.pm. (nr fSii-fSfls).
Pulvia Effervpflcens Compositus {U.S. P.). — Compound Effervescing Powder,
Seidlitz Powder. Dose, one powder.
Trochisci Sodii Bicarbonatis (U.S. P.). — Troches of Sodium Bicarbonate (eacb»
0.20 Gm., or gr. iij). Dose, 1 or more troches.
Sodii Acetaa (U.S. P.). — Sodium Acetate. Doae, 1 to 4 Gm. (or gr. xv-3j).
Sodii Bisulphia (U. 8. P.).— Sodium Bisulphite. Dose, 0.06 to 2 Gm. (or gr. x-3m>.
Sodii WaniH il\ S. P. ),— Sodimii llnmt--. P,ora\ i H. P.). Dosp, 0.(i5 to 2.60
Hm. (or jfr. x xl ).
Sodii Chloraa (U. S. P.).— Sodium Cllilorate. Dose, 0.13 to 0,65 Gm. (or gr. ii-x>.
Sodii Xitraa (U. S. P.).— Sodium Nitrate (saltpetre). Dose, 0.32 to 2.60 Gm. (or
gr. v-xl).
Sodii Pyropho«phaB (U. S. P.). —Sodium Pyrophosphate. Dose, 0.32 to 2.60 Gm.
(orgr. v-xl).
Sodii Arsenas (U.S. P., B. P.). — Sodiura Arsenate. Dose, 0.006 to 0.02 Gm. (or
gr. Vn-V,l. B. P., 0.0016 to 0.006 Gm. (or gr. V«*Vi*).
Sodii Arst'nas KxHircaliis (I*. S. IM . — Diicil Sodium Arscniate. (Tlits is nlso
officinal in B. P.. hut under the title "Kivlii .VrHrnas." » Dose 0.003 Om. (or gr. V»)-
Sodii Benzoaa (U. S. P., B. P.).— Sodium Benzoate. Dose, 0.66 to 1.30 Gm. (or
gr. x-xx).
Sodii Bicarbonfls (U.S. P., B. P.)- — Sodium Bicarbonate (baking-soda). Dose,
0.32 to 2.60 Gm. (or gr. v-xl).
Sodii Bromidum (U.S. P., B. P.).— Sodium Bromide. Dose, 1.30 to 4 Gm, (or
gr. XX-3J).
Sorlii Cnrhona** Monohydrntu;* ( l'. S. P.). Sodii rnrJjonas ( B. P.). — Soiliiun
Carbonate (washin^'-soila i . Dose. 0.12 to 1 <!ui. (or pr. ii-xvl.
SfMlii C»rlH>nas Exsiccatun (B. P.). — Dried Sodium Carlionato. Doi*e, 0.32 to
0.65 Gm. I or pr. v-x).
Sodii Chlondum (U.S. P.. B. P.).— Sodium Chloride (Ubie-salt). Dos*. 0.32 to
2.60 Gm. (or gr. v-xl).
Sodii Citrus [l.S. P.). — Citrate of Sodium. Dose, 24 to 40 Gm. (orSvi-v.l.
So<Iii Ilypophosphia ll'. S. P., B. P.). — S*idiiuu HyitophoRphite. DkiKe. 0..T2 to 1
Gm. (or gr. v-xv). Enters into th(* oflioinl tM>nipound «vntp of hypophosphite*.
'Surgical CUnic, April. lOO.t.
SODIUM.
833
I
Sodii lodidum (U.S. P., B. P.).— Sodium Iodide. Dose. 0.32 to 2 Qm. (or gr.
T-XXX).
Sodii Kitria (U.S. P., B. P.).— Sodium Nitrite. Dose, 0.065 to 0.20 Gm. (or gr,
i-iij).
Sodii Phoaphoa (U.aP., B. P.). —Sodium Phoaphate. Dose, 0.32 to 31 Om. (or
Sodii PhospliBS Effer\-e9C€na (U. S. P.. B. P.), — Effervescent Phosphate of
Sodium.
Sodii Pho-sphas Exsiccatus (U. S. P.). — Dried Phosphate of Sodium.
Liquor Sodii Phosphatia Compositue (U. S. P.). — Compound Solution of So-
dium Phosphate. (Each c.cm. contains I Gm. [or mxv] of the sodium phosphate.)
Dos^. 4 to S o.cm. (or f3j-ii).
Sodii Salicjlas (U.S. P., B. P.). —Sodium Salicylate. Dose, 0.65 to 2 Gm. (or
gr. X-3SSJ.
Sodii SulDhas (U.S. P., B. P.).— Sodium Sulphate (Glauber's salt). Dose, 16.6
to 31 Gm. (or Wj)-
Sodii Sulphis (U.S. P., B, P.).— Sodium Sulphite. Dose, 1.30 to 2 Gm. (or gr.
xx-5ss).
Sodii Thioaulphas (U.S. P.). — Sodium Thiosulphate. Dose, 0.65 to 1.30 Gm. (or
gr. x-rx).
Sodii Phenolaulphonflft (U. S. P.), Sodii Sulphocarbolas (B. P.) — Sodium Sul-
phocarbolate. Dose, 0.13 to 1 Gm. (or gr. ii-xv).
Liquor Sodii Araenatis (U.S. P.. B.P.). — Solution of Sodium Arsenate (I per
cent,). Dose, 0.18 to 0.30 c.cm. (or wiiiv),
Sodii Citrotartras EfTerveseens (B. P.). — Effervescent Sodium Citrotartrate
(mixture of sodium bicarbonate, tartaric and citric acids, and refined sugar). A
granulated, effervescent salt. Dose, 4 to 8 Qm. (or gr. Ix-cxx).
Sodii Phosphas Effervescens (B. P.). — Effer\'ea('ent Sodium Phosphate (mixture
of sodium phosphate and bio.irbonate, tartaric and citric acids). Dose, 4 to 8 Gm. (or
3i-ij; for repeated administration; for a single administration, 8 to 15.5 Gm. (or
3ii-iv).
Sodii Sulphas Effervescens (B. P.). — Effervescent Sodium Sulphate (mixture ol
■odium sulphate and bicarbonate, tartaric nnd citric acids). Dose, 4 to 8 Gm.
(or 3i-ij) for repeated administration; for single administration, 6 to 15.5 Gm. (or
3i3-iv).
Liquor Sodii Ethjlatis (B. P.).— Solution of Sodium Ethylate (contains IB per
pent of the solid substance, C-H^GNa).
Pulvi* Sodffi Tartaratoe Effervescent (B, P.). — Effervescent Tartarated Soda Pow-
der. Seidlitz Powder.
Soda Tartarata (B. P.). — Sodium Potassium Tartrate (Rochelle salt). Dose,
4 to 15.5 Om. (or 3iiv).
Sodii Santoninas. — Sodium Sant/ininate. Dose, 0.13 to 0.05 Gm. (or gr. ii-x).
Trochisci Sodii Santoninatis. — Troches of Sodium Santoninate. Each, 0.13 Gm.
(or gr. ij). Dose. 1 to 5 troches.
Liquor Sodii Ethylntin (B. P.). — Solution of Sodium Kthylate. For external
usr as a caustic (consists of sodium ethylate, 1.5 Gm., or gr. xxij, dissolved in abso-
lute alcohol. 30 c.cm., or (Jj ).
Pasta Londonicnsis. — London Paste is prepared by rubbing together equal parta
of caustic soda and unslaked lime. For external use.
Phftnnacology. — The metal Bodium, a monatomic, metallic elemeat.
Natrium (Na. = 23), was discovered by Sir Humphr}' Davy in 1807, the
same year that he succeeded in isolating the metal potasaium, which, in
many respects, it resembles. It is found only in the laboratory and in the
arts, not being used in its own form in medicine. Many of its salts are
official; they are generally white or colorless, soluble in water, and less
irritant than the corresponding potassium salts. They tinge the flame yel-
low, in the spectroscope, or when a small portion, on a piece of plantinum
wire, is held over burning alcohol. Sodium chloride occurs native in sea-
water and in salt-mines, and is found in all the fluids and solids of the
834
I'UAUALACEUTIUAL TUERAPEUTiC AGENTS OR DRCU8.
human body. Sodium urate is not soluble in water, and, therefore, when
uric acid is formed in excess, deposits of sodium urate are apt to occur in
various portions of the body. The potassium and lithium salts, with the
uric acid, on the contrary, are soluble in water, and assist in carrying off
from the system the less soluble uric acid. In gouty patients, therefore,
eoda-salts should be only cautioiialy given.
Phyaiolog^ical Action. — Soda, when locally applied, in concentrated
form, to muscle or nerve, is a paralyzing agent, but to a decidedly smaller
extent than potassa. Caustic soda in its action resembles caustic potash,
but has less tendency to spread. Solutions of the chloride are antiseptic, and
table-salt, as an article of food, plays a very important part in digestion and
in tissue-change. Weak solutions of salt (5 to 6.5 parts per 1000), if in-
jected into the veins, do not affect the integrity of the red blood-corpuscles.
The carbonate may be used in the same manner, to replace a quantity of
blood lost by haemorrhage, or in the collapse of cholera. Applied to the skin,
solutions of the bicarbonate are cleansing and non-irritant; and. in cases
of burns or scalds, insect-bites, or ivy poisoning, a saturated solution rapidly
relieves pain. Borax is also antiseptic and unirritating to the skin. The
hyposulphite is antiseptic by virtue of the sulphuric acid which it contains.
The ethylate is also an antiseptic, and decidedly caustic. Liquor sodse is
a valuable antacid, without affecting nutrition as much as potassa does, and
it is less poisonous to the heart and nerves. The acetate, beiijg the salt of
an organic acid, becomes converted into tlic carbonate in the blood; it is
diuretic, although to a less extent than the potassium acetate. Sodium car-
bonate is used in pharmacy in preparing other salts; as it is a good alkali for
combining with grease or fat, it is found in every household as "washing-
soda." The bicarbonate is used as an antacid when there is an excess of
acid in the stomach; given when the stomach is empty, it stimulates the
secretion of gastric juice.
Lino&eier and Lemoine conclude that sodium bicarbonate, in all
amounts, excites gastric secretion, the most useful dose, according to their
observalion, being 5 Gm. (or gr. Ixxv), given before a meal. An increased
secretion is maintained beyond the day of administration.
It also increases the alkalinity of the blood, reduces the acidity of the
urine, and relieves irritability of the bladder. Sodium chloride is a very con-
venient emetic, especially when combined with mustard-water. Plieraor-
rhages are sometimes cheeked by it through reflex influence. The nitrate is
refrigerant in fever, nnd increases the secretions of the intestinal tract. The
nitrite acts like the other nitrites, in depressing the heart's action and reduc-
ing blood-pressure. The sulphate is a bad-tasting and harsh cathartic; it
is a common constituent in purgative mineral waters, where its effects are
enhanced nnd modified by natural combination.
\s borax is largely used as a preservative for meat, the following ob-
servations are of special interest:—
Chittenden and Giess found that moderate doses of borax up to 5 Gm.
(or gr. Ixxv) per day, even when continued for some time, are without in-
fluence upon proteid metabolism. Borax does not tend to increase bodily
weight or to protect the proteid matter of the tissues.
Large doses of borax, 5 to 10 Gm. (or gr. Ixxv-cl) daily, have a direct
stimulating effect upon proteid metabolism, as claimed by Grubcr; such
soDitnc,
I
I
I
doses, especially if continued, Itad to an increased excretion of nitrogen
through the urine, also of sulphuric acid and phosphoric acid.
Boric acid, on the other hand, in doeea up to 3 Gm. (or gr. xlv) per day,
is practically without influence upon proteid metabolism and upon the gen-
eral nutrition of the body.
Borax, when taken in large doses, tends to retard somewhat the assimi-
lation of proteid and fatty foods, increasing noticeably the weight of the.
faeces and their content of nitrogen and fat. With very large doses there
is a tendency toward diarrhoea and an increased secretion of mucus. Boric
acid, on the contrary, in doses up to 3 Gm. (or gr. xlv) per day, is wholly with-
out influence in these directions.
Borax causes a decrease in the volume of urine, changes the reaction of
the fluid to alkaline, and raises the specific gravity, owing to the rapid elim-
ination of the borax through this channel. Under no circumstances have
the authors observed any diuretic action with either borax or boric acid.
The latter agent has little elTect on the volume of the urine.
Both borax and boric acid are quickly eliminated from the body through
the unne, twenty-four to thirty -six hours being generally sutTicient for their
complete removal. Rarely are ihey found in tlie faeces.
Neither borax nor boric acid has any influence upon the putrefactive
processes of the intestine as measured by the amount of combined sulphuric
acid in the urine, or by Jaffe's indoiyl test. Exceedingly large doses of
borax are inactive in this direction^ not because the salt is without action
upon micro-organisms, but because of its rapid absorption here.
Borax and boric acid, when i;iven in quantities equal to 1.5 to 3 per cent,
of the daily food, are liable to produce nausea and vomiting.
Owing to the rapid elimination of both borax aud boric acid, no marked
cimiulutive action can result from their daily ingestion in moderate quan-
tities.
At no time in these experiments was there any indication of abnor-
mality in the urine; albumin and sugar were never present.
In experiments undertaken to determine the influence of alkalies on
the excretion of uric acid, made by Dr. Spilker, under the direction of Pro-
fessor Salkowski, it was found that the addition of alkalies to the diet
diminishes the excretion of uric acid, or rather, its formation in the human
subject, while in the dog the reverse was the case.' This should teach us
to accept, with some reserve, the deductions from physiological experiments
in the laboratory, with regard to the action of medicine upon the lower
animals, especially where they conflict with clinical teaching and the results ,
of experience.
Therapy. — Sodium hydroxide (a corrosive poison in concentrated form,
the symptoms and treatment being the same as for poisoning by the eorre-
ftponaing polassium salt) may be used lorally as n snhRtitutp for t'aui?tic pot-
ash, being more manageable and less severe. A combination of equal parts
of Boda and lime, known as London paste, is a favorite caustic application,
especially for the removal of morbid growths, by some practitioners. Sodium
ethylate is one of the most powerful caustic preparations that can be used.
It combines with water of the tissues, and continues tg act deeply in ab-
stracting this element. It is serviceable in destroying warts and various mor-
*
' Tk^raptutie Gc2ette, Oct. 18. 1890. p. 706.
836
PHABMACEUTICAL THJERAPKUTIC AGENTS OR DRUGS.
bid growths, but is liable to leave the ekin scarred on account of 0$ de-
Btructive action upon the tissues. The writer has employed sodium ethylate
with great benefit in lupus erythematosus and vulgaris; likewise in callous
ulcers, epithelioma, and in thickened and ulcerated spots of syphilis. If
sodium ethylate is used for the removal of excessive growth of hair, espe-
cially upon the face (polytrichia), as has been recommended by Jameson, the
physician may expect, from the observations made by the author, more or
less scarring of the skin on account of the destructive action of this caustic
upon the true skin and deeper structures. Qamberini has derived good re-
sults in psoriasis from inunction with a 2-per-cent. mixture of sodium ethy-
late with olive-oil.
Sodium bicarbonate, in solution made with hot water, if applied to
burned or scalded surfaces, quickly relieves pain. It can also be used to
subdue inflammation in sunburn, rhus poisoning, pruritus, eczema, insect-
bites, etc. A 1-per-cent. solution of sodium bicarbonate is a good injection
in gonorrhcea. In a number of cases intussusception of the bowel has been
reduced by the action of carbonic-acid gas, which, in an emergency, may be
generated within the intestine by the action of citric acid upon sodium bi-
carbonate. The solutions are separately injected through a tube passed into
the rectum. According to Dr. Duckworth, the local use of a solution of
sodium bicarbonate in the strength of 2 Gm. {or 5s8) to 30 c.cm. (or f^j) of
warm water will often relieve toothache dependent upon dental caries. In
the cough of pulmonary tuberculosis, when the bronchial secretion is scanty
and viscid, good results may be obtained by the use of the following solu-
tion as a spray: —
XT-XXX.
B Sodii bicarbonat. 1| to 21 Gm. or,
Glycerini 4 c.cm. or
Aq. dest '. . . 105| c.cm. or fSiiiu. — M.
■ fSj.
Dimclas Grnnt recommends the following for the softening of cerumen
and clislodgment of impacted masses in the auditory canal; —
ft Sodii bicarbonatiB 1 Gm. or gr. xv.
Glycerini 11 c.ein. or fSiij.
AquK deatill q. B. ad 30 c.cm. or f5j.
M. To be dropped into the ear warm, and followed in a few hours by persistent
syringiug.
Borax acts very similarly, but is more antiseptic on account of contain-
ing boric acid. Both the bicarbonate and the borate are also employed in
solutions for washing out the bladder in cystitis, for injecting into the audi-
tory canal to remove cerumen from the car; and for intravenous injection
in collapse from cholera, etc. The following combinations containing one
of the sodium preparations will he found serviceable: —
B Sodii bicarbotiRtis 16|5 Gm. or Jas.
Aqure eampbonc,
Aquffi rnenth. pip aa I20| c.cm. or fjiv.
M. Sig. : For itching and b\iming«of the mucous membrane and skin In the
various eniptiuas upon the integument.
H Liq. soda chl6rinat«e 4| to 11
Tinct kino 60
Aquie ftO
M. A disinfectant gargle for ulceration of the throat.
c.cm. or fSi-iij.
c.cm. or fSij.
c.cm. or fjiij.
BODIOM.
837
f
B Sodii bonEOAt. 1 130 Oxn. or gr. xx.
CreosoU |30 c.cm. or ntv.
Glycerini,
Aquie rosn aa 15| c.cm. or fSss.
M. Employ with an atomizer in nasal catarrh, pharyngitis, and in laryngitia.
H Sodii birflrbonatia 12| Gni. or 3iij.
Glycerini,
Aquce bamamelidis dest aa 90| com. or fSiij>
M. To allay itching and burning of the skin, eepcoially in eczema, lichen, urti-
caria, dermatitis, burns, and frostrbite.
The solution of chlorinated soda, or Laliarraque's solution, also may
be advantageously applied in dermatitis due to the poison-ivy. In acute
tonsillitis, sodium bicarbonate may be rubbed upon the tonsils with the fin-
ger, with excellent results. In this affection a solution of the bicarbonate
has been beneficial, applied with a bru^h or mop, or used as a gargle. For ca-
tarrhal conditions, chronic bronchitis, etc., a solution of thia salt may be
used with the steam-atomizer, with hamaraelis, belladonna, or other com-
binations if desired. Sodium chlorate was recommended by Prof. Traill
Green, of Easton, to be used in place of potassium chlorate in acute affec-
tions of the throat or fauces. A lozenge made with tragacanth is just as
efficient, locally, as the official potash lozenge, and will not cause depression
of the heart like potash. Dr. C.Slagle, of Minneapolis, recommends sodium
sulphite as an excellent local application in diphtheria, employed as a gargle,
Bpray, or painted upon the affected surface with a camel's-hair brush. In-
ternally he prescribes the same salt in combination with sulphur and calomel.
In children suffering with oxyuris vermiculuris, or seat-worm, injections of a
Bodinm-chloride solution will brinp away the parasites and relieve the itch-
ing. Sodium thiosulphite is employed by Dr. Ohmann-Dumesnil in the
treatment of scabies. After a morning bath the patient is directed to ap-
ply:—
B Sodii thioflulphit 1801 Gm. or 5vj.
Aq. de«tillat ISOj c.cm. or fjvj,— M.
The solution is allowed to dry upon the skin. Before going to bed the
•kin is bathed with the following lotion, which may be diluted if found too
itrong: —
B Acid, hydrochloric. diL 1201 ccm. or fjiv.
Aq. destillat 180( ccm. or fSvj.— M-
The phenolsulphonate is useful as a disinfectant, being loss irritant and
not caustic; but for internal use the salicylate is safer. Sodium bicarbonate
is used as an antacid in gastritis and sour stomach, and affords temporary
relief, especially in combination with mint or rhubarb. M. Huchard rec-
ommends the exhibition of large doses (from 8 to 38.8 Gm., or 3ii-x, daily) of
this salt in the hyperacidity of the stomach which sometimes accompanies
diabetes, in the gastric crises of locomotor ataxia, cardiac disease with acidity
of the stomach, and in hepatic maladies. He mentions a case of diabetes in
which this treatment averted threatened coma.
The bicarbonate, with rhubarb, is especially useful in cases of catarrhal
jaundice. Sodium bicarbonate is of benefit when the urine is acid, and in
all forme of cystic irritation, and is especially useful in renal calculi, cys-
titis, gonorrhoea, gleet, stricture, and in enlarged prostate. The following
prescriptions, containing sodium bicarbonate, are recommended: —
838
PHAHMACEUTIOAL THERAPErXIC AGENTS OR DRUGS.
M.
M.
B
M
Gm. or 5iiis».
c.cm. or f3j.
c.cm. or wcc.
c.cm. or f5^'.
Sig. : Two teospoonfuls in water, three times a day, in acid dyspepsia.
lOj Gm. or Siiss.
e.em. or fSij-
Sodii birarbonaiift 14|
Tinct zing^iberis,
Tinct. capeici aa 41
Tinct nucis vomic« 12i4
Tinct. gent, comp q. s. ad 150{
tate.
Sodii bicarbonatis
Glycerini.
Aquffi menth. pip a& 60{
Sig.: T\\o teaapoonfula after meals, in acid dyspepsia.
Sodii bicarbonatis 4! Gm. or 3j.
Pulv. ipecacuanhee et opii 2J60 Gm. or gr.
et ft. chartulffi no. xx.
\.: A powder every two or three hours, for cystitis, irritable bladder or pros-
it Sodii bicarbonatis 2100 Gm. or gr. xL
Hydrargyri chloridi mitis |l3 Gm. or gr. ij.
M. et ft. chartulse no. xij.
Sig.: A powder every two or three hours, for acute gastritis.
*i
Wlu'ii 1180(1 as an antiilote to acids in corrosive poisoning, the mono-
carbonate is better than the hicjirbonate, on account of less (.arhon dio.\ide
being formed. Tlie thiosulphate is a useful^ antiseptic in sarcinons vomiting
and infectious dyspepsia. The salt was highly esteemed by Dr. Cadopin-
Magtermnn, who thoufrht, however, that Q.32 Gm. (or gr. v) doges nre more
eflBcicTit than liir;:cr quantities, and prescribed it as follows: —
B Tr. gentian, no 7
Tr. caMici 2
Sodii bicarbonat 8
Sodii tliiosulphatis 2
Chloroformi
Aquae q. s. ad 240
M. et ft sol.
Sig.: Two tablespoonfuls three times a day.
c.cm. or f3ij.
c.cm. or f3s8.
Gm. or 3ij.
60 Gm. or gr. xl.
60 c.cm. or mviij.
c.cm. or fjvlij.
Sodium thiosulphate is said to be of value in malaria] hacmaturia. So-
dium phosphate, on account of its cholagogic effects, is useful in cases of
inaction of the liver in children who pass clay-colored stools. Con«;tantin
Paul prefers sodium phosphate to sulphate as a laxative, and administers it
in the form of a lemonade, according to the subjoined formulae: —
R Sodii phoffphat 24
Ess. limoms 1
Syr. ainipl 80
Aq. destill 180
25 Gm. or 3vi V..
20 c.cm. or mxx,
c.cm. or fjij.
c.cm. or fSvj. — M.
M.
Sodii pboaphat. ' 24125 Gm. or 3vi V*.
Ess. limonis l|5d c.cm. or mxxv.
Acid, citrici,
Sodii bicarb ' aa 6| Gm. or Sins.
Syr. simpl 601 c.cm. or fJSij.
Aq. de«till. 240| c.cm. or fjviij.
An effervescing mixture.
i
mia.
Sodiiun phosphate is useful in habitual hepatic congestion and lith»-
Dr. Crocq. Jr., of BnisselB, has employed with advantage subcutaneous
839
injections of sodium phosphate in various affections of the nervous system.
The formula which he makes use of is: —
H Sodii phoephat 21
Sp. rectilicat, 4
Aq. dcstillat 12o|
c.cm.
c.cm.
or gr.
or i3j.
or fSiv, — M.
H Of this solution i c.cm. (or mxv) are injected daily and the amount
■ is gradually increased to 3 c.cm. (or mslv). In trifacial neuralgia, neuras-
H thenia, and hysteria the effects were very satisfactory. He regards the rem-
I edy thus administered as a powerful ner\'€-tonic, capable of curing func-
W tional disease, though it has only a palliative effect in organic disorders of
nerve centres. Remarkable improvement has, however, been produced
by this method in locomotor ataxia. Dn Forbes Winslow has reported a case
of the last-named malady, in which typical symptoms were present, but which
disappeared after twenty-five injections had been made. The patient seemed
to be completely cured. Professor Lemoine combines sodium phosphate
with potassium bromide in the treatment of epilepsy, giving 1.62 Gm. (or
gr. xxv) of the former salt at each dose. In order to overcome pain due
to anaemia or neurasthenia, M. Huchard uses an artificial senim, 5 to 10
c.cm. (or mlxxx-clx) of which is subcutaneously injected. IIis formula
is: —
B Sodii pho6phat 10
Sodii chlorid 6
Sodii Bulphat 2
Plionoli!* 1
Aq. doBtilUt 90
Increasing doses of sodium phosphate, given subcutaneously, are said
by M. J. Luys to have a beneficial effect in morphinomania.
Sodium acetate is not as deliquescent as potassium acetate, and has
tluB advantage over the latter salt. It has been given with benefit as an
antacid in acute rheumatism, and as a diuretic in dropsies. Sodium acetate
is likewise serviceable in p:out, and in the treatment of irritation of the
genito-urinary apparatus. The appended prescription is suggested: —
B Sodii Rcetatia 12 Gm. or 3iij.
Syr. flurantii 00 e.em. or fjiij.
Spiritua fetheris nitrosi 60 c.cm. or fjij.
M. Sig.: Two teaspoonfula in water, every two or three hours, for rheumatism,
at, or genital irritation.
Sodium benzoate is a safe and effective antipyretic. It has been em-
ployed for its antiseptic virtues in phthisis, diphtheria, the eruptive fevers,
and in irritation of the genital organs. The following combination of so-
dium benzoate is* recommended: —
B Sodii beuzoutis I2| Om. or 3iij.
Kluitlext. tritici.
Fluidftxt. buchu aa 75| c.cin. or fSiiss.
M. Sig.: A teaspoonful or two, every two or three hours, for cyatitia, or for an
irritable bladder and proAtat<>.
Gm.
or Siisa.
Gm.
or 3is8.
30 Gm.
or gr. xixvj
55 Gm.
or gr. XXIV.
com.
or fSiij.— M.
Li^geois recommends sodium benzoate in large doses in the treatment
of pharyngitis. In laryngitis and acute bronchHis, he prescribes: —
840
PliAKMACEUTICAL THERAPEUTIC AGENTS OK DfiCOS,
3 Sodii benzoat 4 Gm. or 3j.
Tr. aronit. ...kp... 120 com. or "txx.
Aq. laurooeraai 4 c.cm. or f3j.
Syrup. Tolutan.,
Syrup, codein.,
AqutB aa 60| com. or fjij.
M. Sig.: To be taken in the twenty-four hours.
Administered persistently in Bright's disease, he has obtained good re-
Bulte from this salt associated with tannic acid. It is useful in lithiasis by
converting insoluble urates into soluble hippurates, and thus facilitating
their removal from the system. M. Ilobert^ reports a case of poisoning fol-
lowing administration of sodium benzoate. Large erythematous patches,
with intense pruritus, in various parts of the body were observed, which
disappeared on discontinuance of the drug.
The followiuf;; mixture is pronounced useful in chronic bronchitis by
a writer in La Tribune Medicale: —
Ji. Sodii arsenai.
Sodii iodid 10
Aquie 270
10 Gm. or gr. isa.
Gm. or liiss.
c.cin. or fjix.
^
M. Sig.: A tabiespoonful three times a day during twenty days of the month.
Sodium citrate has been used to counteract the acidity of cow's milk
(1 to 500, or gr. j to each ounce}, in feeding infants, by F. J. Poynton.'
It is regarded as much superior to sodium bicarbonate for this pui*pose. It
softens the curd and obviates milk dyspepsia.
The pulvis effervescens compoaitus (U. S. P.) and pulvis sodae tartaratae
effervescens (B. P.), commonly known as Seidlitz powder, is a mixture taken
while effervescing, containing 2.60 Gm. (or gr. xl) of sodium bicarbonate
and 8 Gm. (or 3ij) of Rocholle salt (blue paper) and 2.25 Gm. (or gr. xxxv)
of tartaric acid (in a white paper).' The contents of each paper are dis-
solved in half a glassful of water (the blue paper first") and drunk while
effervescing, to relieve simple constipation. In obstinate vomiting small
doses of Seidlitz powder are often efticient in overcoming the nausea and
retching. A teaspoonful of sodium chloride, dissolved in a tumblerful of
water and taken before breakfast, will often answer the same purpose as
some mineral waters. In full doses sodium sulphate is an active cathartic;
in smaller quantities it acts as an aperient and diuretic. This salt has a
bitter and nauseous taste, which may be disguised by the addition of a few
drops of aromatic sulphuric acid, or by giving it in lemonade. In daily
doses of 10 Gm. (or ."iiss) sodium sulphate has been administered with de-
cided success in dysentery. It is recommended that the sodium salt be
assooiat(^d with naplifhol *^r other efficient intestinal antiseptics, a solution
of the latter bein^ tfivon by the mouth or injected into the bowel.
Sodium sulphate has been recently employed as a local application to
the inflamed area in erysipelas by Dr. G. L, Curtis.* The rationale of this
treatment is found in the affinity which sulphate of sodium has for oxygen,
abstracting it so rapidly from the diseased area aa soon to destroy the germ
^ Norrtiafidic MddioaJe, Jan. \, 1890.
*Bnf. Med, Journal, Oct. 21. 1905.
•These may also be put up without Rochelle salt, and were formerly officinl in
this shape ns Boda-powders, or Pulveres Effer^'escentes.
* Medical Record, April ^0, 1901.
BOOIUM.
S41
I
I
I
I
of erysipelas. Ilis method of applicatiou is first to thoroughly cleanse the
parts affected, being particular lo remove all greasy substances; a sufficient
quantity of sodium sulphate is mixed with cold distilled water to make a
thick poultice; the diseased part is covered with a single layer of gauze, and
over this is spread a thick layer of sodium sulphate, care being taken that
it extends considerably beyond the margin of the diseased area; this is
then covered with a few layers of gauze, and ice-water applied. He has
found that with an application of this kind the disease is brought to a
stand-still in from six to eight hours. If the disease involve the face, the
poultice is applied to the nose and mouth, openings in the latter being
made for breathing.
Sodium chloride has been injected into the veihs in severe haemorrhage
and cholera. In order to avoid the disadvantages and delays of this
method, Dr. Warman made trial of salt solution by the rectiun. In a
number of cases of uterine haemorrhage he found this procedure to be fol-
lowed by the most gratifying results. He employed about a tablespoonful
of table-salt dissolved in a quart of water. Dr. llberg, having observed good
results from the subcutaneous injection of a solution of salt in a case of
gastric ulcer, made use of the same method in a number of insane patients
who refused food. The treatment was satisfactory in all but one case. Ex-
perimenting upon himself he found that the instillation excited thirst and
hunger. About a pint of a V4-p^r-cent. solution was slowly introduced
through a trocar into the cellular tissue of the back or thigh, and its absorp-
tion aided by gentle massage. The normal salt solution contains about a
teaspoonful of sodium chloride to the pint. The method just mentioned is
knowTi as hypodermoclysis, and has been employed successfully in cholera.
Max Gordon reports three cases of poisoning from carbonic oxide or coal-g«s
S'; Hy treated by the intravenous injection of a saJt solution, after a
['I ly bleeding. Subcutaneous or intravenous injections of a solution
of labie-salt have Ix'en found useful in relieving unemic dyspncea or eclamp-
sia. (See also Hypodermoclysis.)
Sodium sulphide is recommended in the treatment of lead poisoning by
M. Peyrou, given iu the dose of 0.33 to 0.50 Gm. (or gr v-viij) a day. The
obser^•atioa was based upon experiments upon animals and was confirmed by
M. Quinquaud, who bad observed that the salt named produced an increased
elimination of lead in the urine. Sn<lium sulphide occasions the same result
in mercurial intoxication, and must be regarded as an excellent eliminative
agent in all cases of metallic poisoning.^
Sodium chlorate is praised as a remedy in the treatment of epithelio-
mata of the mucous membrane of the upper digestive passages. In a com-
munication to the French Association for the Advancement of Science M.
Brissaud stated that in cancer of the stomach he had obtained almost in-
credible amelioration by daily doses of 12 to 15.5 Qm. (or .liii-iv). Haemor-
rhages ceased, cachexia disappeared, and the tumor vanished in the course
of several weeks. He began with doses of S to 10 Gra. (or 3ii-iiss) per day
and, if no improvement oceurrt'd, he increased the amount lo 15.5 Gm. (or
St). He does not employ the drug if the slightest decree of albuminuria ia
present. M. I-*^pine, at the same meeting, declared that in the dose of 16.5
'Utificat Bullrtin, Frb.. lSt)4
842
PUAHMACECTICAL THJiRAriSUTIC AGENTS OB DKDG8.
Gm. (or oiv) sodium chlorate might cause the formation of methcpmoglobin
in the blood.
In a case of angina pectoris, Dr. Gingeot obtained good results from
sodium iodide given in alternation with spirit of glonoin, the former being
taken for ^ix, and tlu' liUter for two, weeks. Gordon Sharp lias employed
the sodium nitrate in angina pectoris and irregular cardiac action, and, on
ftccotint of its supt'rior stability, recommondR it as a substitute for amyl
nitrite. The maximum dose is given as 0.32 Gm. (or gr. v), but it is stated
that 0.0G5 to 0.13 Gm. (or gr. i-ij) is usually sufficient.
Sodium salicylate is used very largely in the treatment of acute rheu-
matism, and rlienmatic throat inflammation, pyrexia of influenza, etc. In
acute rheumatism, abouf 8 Gm. (or oij) a day, in divided doses, relieve pain
and fever. Salicylate of sodium has been ws^'d in ])nenmonia for a number
of years. According to Lio^pl,' 72 cases were treated among mining opera-
tives with large doses of sodium salicylate: 8 Gm. (or gr. c-xx) daily, or 0.65
Gm. (or gr. x) every two hours. Some of tliesc cases were exceedingly un-
favorable, occurring in persons of intemperate habit*, and 2 of the patients
were over 70 years o( ago. Not a single doath occurred an»ong these cases. A
number of typical recriidcsconces were noted, hut wiTe onsily controlled by
the same agent. Dr. Seliring^ treated To cases of pneiminnia with salicylate
of sodium in the ^amu doKa»:c. and !n:5t hut 1. Four r>f the patients were
over SO. nno bring H4 and nn Imbituitl dninkiird. Thore were also several
cases of mitral imd other valvular cardiac lesions. The patient who died
was a plethoric woman who had been troubled with cardiac svncope for a
long time beforp developing pneumonia. Of 12^1 cases treated, by other
physicians, with salicylate of sodium, onlv 1 died. Pr. H. KadclifTe Crocker
report.'' tlint he has friMjuently derived benefit from the use internally of
sodium snlicylnh* in psoriasis, f^sjierially in hypcrasmic cases of recent de-
velopment. Tie lin.« also witnossrd marked improvement follow its adminis-
tration in a ci\pe of lupus prvtbenmtosus.' Geniiain S6e commends this salt
as an eflicient ehol;i;:oinie. which increases the watery portion of the bile, and
is therefore of value in promoting the expulsion of gall-stones. On tlie otlier
hand, it has some di.sndvantngcs. Some patients cannot take it at all, aa it
is too irritating to the stomach. It often causes tinnitus aurium. and patehes
of enibema upon the skiu. A ease is reported in which, after taking IGO
grains in dO liours. it caused blindness in both eyes in a young girl suffering
with acute rheumatism. The natural salt is less likely to cause such acci-
dents than the synthetic or artificial salt.
Sodium salicylate, combined with theobromine, has such diuretic effects
that it hns been called diuretin, of which the dose is 4 to 6 Om. (or Si-iss)
daily, in divided doses. (See Theobroma.) Good results may be obtained
in fevers by using the fluid extract of erythroxylon coca to sustain the heart's
action and support strength, at the same time that sodium salicylate is used
to keep down temperature. After the administration of large doses of so-
dium salicylate, a crystalline deposit v^ill sometimes form upon the skin. It
is uncertain whether the crystals are of the unnltered drug or of decomposi-
tion-products. A neutral, or acid, sulphosalicylate of sodium has been pre-
' irirnrr mrdicfnifrhf Worfirvitrhrift, Mav 7,
* Medical Rrrord, April 22. 1S09.
' IntcrttationGt Medical Haffosine, Aug.. )895.
1S98.
SODIUM.
843
ft
ft
ft
ft
parea. 'ine acid salt is a white, crystalline powder, soluble in water, but
almost insoluble in alcohol and ether. Its taste is less unpleasant than that
of sodium salicylate, and it is said to be less apt to cause vertigo and buzzing
in the ears. This preparation has been used with success in acute rheuma-
tiszn.
• Sodium nitrate in doses of 0.20 to 0.25 Gm. (or gr. iii-iv), is recommended
by Pearce as serviceable in asthma. Dr. Angrisani, from an experience in
10 caseSt considers sodium nitrate as of service in relieving maniacal excite-
ment, lie gave it in daily doses of 3 to 5 Gm. (or gr. xlv-lxxv). It was usu-
ally well borne and relieved high arterial tension, restlessness, and hallucina-
tions. In two patients, who suffered from epilepsy of psychical origin, the
attacks could be prevented by the administration of G Gm. (or 3is8) of the
remedy in a single dose immediately after the appearance of the aura.
Sodium nitrite is a white, opaque crystalline substance, of a mild saline
taste and destitute of odor. It is a deliquescent salt, readily soluble in water
and slightly soluble in alcohol. It is best administered in an alkaline solu-
tion on account of its liability to be decomposed by the gastric juice. The
peculiar properties which this compound possesses depend upon the nitrous
acid which it contains. Its physiological and therapeutical effects very
closely resemble those of amyl nitrite. Of the pure salt the beginning dose
should never exceed 0.13 to 0.20 Gm. (or gr. ii-iij). Sodium nitrite has af-
forded relief in a number of cases of epilepsy. In angina pectoris its action
ieakin to that of nitroglycerin and amyl nitrite, but is less quickly produced
and is of longer duration. It may be beneficial in paroxysms of asthma and
dyspnoea.
Sodium Glycocholate. — Important constituents of the bile are the glyco-
cholatos and tji^irocholatep of sodium and potassium. It has been claimed
that a deficiency nf these compounds in the bile and blood causes the forma-
tion of gall-stones. The administration of sodium glycocholate acts as a
cholagogue laxative. It is useful in jaundice (unless tlie duct is occluded).
It ifi aI>io valuable in cirrhosis of the liver, and in constipation caused by
deficient flow of bile. The salt is given in doses of 0.30 to 1 Gm. (or gr.
T-xv), three times a day. It may be continued for several montJis in cnsea
with gall-stones. It is best given in capsule and may be combined with pan-
creatin.
Sodium Tellurate was brought fom'ard by Neusser in 1890 as a remedy
for the night-sweats of phthisis. It has been used in a number of cases by
Professor Combemale, who found it etHcient in single daily doses of about
O.OfiS Gm. (or gr. j). It is open to the reproach, however, of disturbing diges-
tion and communicating a strong garlicky odor to the breath. Sodium tellu-
rate is also able to suppress the sweating of rheumatism, typhoid fever, syph-
ilitic phthisis, and dyspepsia.
A 1- or 2-pcr-cent. aqueous solution of sodium fluoride has recently
been used with advantage as an antiseptic wash to the bodies of persons suf-
fering from infectious disease, in the erythema of newborn infants, and as
an injection in vaj^initis an^ cystitis.
Sodium Cacodylate, it is reported,' has been employed internally in the
treatment of various ocular affections with good results, particularly in re-
bellious Iierpetic keratitis. Galezowski has employed it locally in the eye in
the form of an oily or aqueous tv>llyrium as follows : —
* Mcrck'$ Afvhiic^, .Tune, 190fi.
844
PHARMACEUTICAL THEIUPEUTIC AGENTS OB DEUGS.
3 Cocainie hydrochloridi
Petrolati liciuiiU 15
SoUii wieodylnti
A few drops iu the eye two or three times daily.
25 Gm. or gr. iv.
Gra. or 3iv.
13 Gm. or gr. ij.
Sodium Eofiinate, — Eosin is a dye obtained by the action of phthalic
anhydride upon phenols. Soluble eoein is usually the potassium salt of thi»
compound. The corresponding sodium salt (CaQH^Br^OaNa^) has been used
in the treatment of epilepsy by Bourneville and Chapotin^ in doses of 1 Gm.
(or gr. xv) gradually increased to 3 Gm. (or gr. xlv). Under the larger doses 1
the number of convulsions materially decreased, but toxic symptoms ap-
peared, which required the treatment to be discontinued. They consisted in
redness and swelling of the face and hands, followed by ulceration and by
falling out of the nails.
SOLANUM CAEOLINENSE.— Horse-nettle.
This plant belongs to the Solanaceie. or Nightshade family, growing
abundantly in the southern United States, and known under a number of
popular names, as ground-potato, poison-potato, sand-brier, horse-nettle,
etc. The fluid c^xtrnct of the fruit is given in doses of 4 to S c.cm. (or oi-ij).
Kraus has isolated two alkaloidal principles, which he regards a
Solanine and Solanidinc, with an organic acid, Solanic Acid. According
to Dr. E. Q. Thornton, solanum in large doses depresses the respiration
and cerebrum, stimulates the spinal cord, but has no effect upon the cir-
culation.
Dr. Napier, of Blenheim, S. C, who introduced this drug, regards it
as diuretic, anodyne, and antispasmodic in its action; he also reports its
use in convulsions ol' hystericnl nr urit*inic origin and in traiinintic tetanus,
Solanum has recently been restudied chemically, experimentally, and
therapeutically by Dr. Morris C. Thrush (Inaugiiral Essay on "Solanum
Carolinense," Medico-Chirurgical College, Philadelphia, May 18, 1901).
Prof. F. Savary Pearcp, quoted by Dr. Thrush, regards it of especial value
in essential epilepsy, the attacks in the majority of cases being lessened
in severity and number. The dose of the fluid extract of the berries is
4 c.cm. (or f3j) four times a day, and increasing to 7.5 c.cm. (or f5ij) every
four hours, no ill etfects from this large dose being observed; the fluid
extract is more desirable than the tincture, on account of the lessened
quantity of alcohol,
SOLAinJM PANICinATTTM. — Jenibeba. Solanum paniculatum (So-
lanacoa?), or jerubeba, is a common, shrubby plant, which grows in the wild
country of the north of Brazil. It has a woody stem, and reaches a height of
eight or ten feet. The stem, branches, and under side of the leaves are
almost covered by a white, downy hair. An alkaloid, termed Jerubebinc, has
been found in the fniit and the root. Dr. Domintjos Freire, of Rio Janeiro,
describes two resinoid principles obtained from this plant, one of which is
inactive, while the second hn< a powerful purgative effect.
Physiological Action and Therapy. — The effects of jerubeba upon frogs
and guinea-pigs have been investigated by Duprat. Torpidity soon came on
after hypodermic injection of a hydro-alcoholic extract, and reflex move-
^ProgrU Midtcale, Jan. 6. 1900.
»
>
ments disappeared. Respiration was retarded* and the action of the heart
slow and irregular. A minute quantity of jerubebine hydrochlorate, injected
by Dr. Domingos Freire into a small bird, caused lethargy, with contracture
of the extremities, followed by tetaniform conviilsions and death. Jenibeba
is an excellent laxative, and ia said to be vahiable in the treatment of habitual
constipation. The drug is held in great esteem in Brazil, where it is cnn-
ridered tonic and alterative. In some cases of liver disease Dr. A. Michaelia
found jerubeba to increase the appetite and relieve indigestion,
SOLIBAGO. — Solidago, Golden-rod. The Solidago odora (Compositse),
or fragrant golden-rod. is a conspicuous feature of autumn landscapes in the
northern United States. It has many varieties, but the usual form is a way-
side herb with a terminal spike, or one-sided raceme, of yellow flowers. The
plant is yellowish green, fragrant, and yields, by distillation, a volatile oil,
resembling anise in odor. The fluid extract, made with diluted alcohol as a
menstruum, is often used as a flavoring cxcipient. A solid extract may be
obtained by evaporating the fluid cxtrnct to the proper consistence and in-
corporating with it one-twentieth of it*» weight of glycerin.
Physiologrical Action. — Golden-rod is carminative and gently stimulant.
The hot infusion produces diaphoresis and relieves the pains of dysmenor-
Thoea.
Therapy. — This drug is scarcely used by the profession, but possesses
some, though not very decided, medicinal value. The decoction and warm
infusion are used in domestic practice to produce diaphoresis, to relieve colic,
and to promote menstruation. The oil may be used for similar purposes,
and also as a carminative to relieve flatulence, etc.
SOMATOSE, an albuminous food-product prepared from fresh meat,
and retaining the proteid elements in soluble form, has been largely used
of recent years in wasting and exhausting disease, as a means of nourishing
the sick. It is in the form of a light-brown powder, almost odorless, and not
disagreeable to the palate. By adding a teaspoonful to a cupful of hot water
a form of meat-extract or beef-tea is made which is acceptable to very delicate
stomachs and even checks vomiting and nausea. It may be added to broth,
co&ee, gruel, or other food, in cases of typhoid fever, cholera infantum^ etc.
A combination with milk is also olTered, lactosomatose, and one containing
iron, ferrosomatose, which have a high therapeutic value in anamia, debility,
lactation, and other conditions requiring increased nutriment.
80MNAL.— Ethylatcd Chloral-nrethan— In 1889, Dr. S. Radlauer, of
Berlin, brought to the notice of the profession a compound of chloral, ure-
than, and alcohol which is considered a definite compound, and not a simple
mixture of these substances. It is a colorless liquid, resembling chloroform
in appearance; very slightly, if at all, soluble in cold water, but soluble in
hot water and in alcoholic solutions. The odor is faint, resembling spirit
of nitrous ether; the taste is very pungent. For administration it requires
free dilution, and can be given with aimple elixir, whisky, or syrup of
licorice.'
Hypnotic," by Frank Woodbury, MD., Dietetic Oaiette,
*
846 PirARMACEUTIOAL TUEBArEUTlC AGENTS OR DRUGS. ™
Physiological Action. — Dr. \\\ Gihiian Tliom])&oi!.* from n series of
experiments, both physiological and clinical, concluded that "the effects of
somnal are much more striking and certain than those of urethan, and far
less depressing than those of chloral. There is no vertigo or depression after
taking somnal, euch as may follow the use of sulphonal. The blood-pressure
is increased under somnal instead of beiag- depressed, as it is after taking
chloral. It does not disturb digestion, and does not affect the pulse or tem-
perature. Ordinary doses eauee the respiration to become slow and full,
while after ingestion of a toxic amount the breathing is rendered shallow,
rapid, and irregular.
An adverse opinion regarding this substance has been published' by
Dr. Langgaard, who maintains that its narcotic effect is less than that of
chloral, appears later, and is of shorter duration. Langgaard affirms that
respiration and circulation are affected in the same manner, and, at least, as
energetically as by chloral. The blood-pressure sinks, in rabbits, to 40 milli-
metres (15 "/^ inches) of mercury, or even lower, after doses that only pro-
duce two hours* light sleep.
Therapy. — Sumnal has l>een recommended for cases of simple insomnia
and sleeplessness after acute discnsep, delirium tremens, parturition, etc.
Dr. Evensen states, as n result of liis experience, that iroinniil may be em-
ployed in chronic mania and ^uiet inelancholin. but is without effect iu acute
mania. Tt should not be used in chi'onic intorstitial nephritis and endar-
teritis with ahnnrmally high tension, as it would increase the latter condi-
tion. Pain nr cun^h is not much nffected. though soothed bv the sleep pp>
duced.
SOMNOFORM. — This name (proprietary) has been given to a mixture
employed for general anai^sthesia. oontainiug ethyl chloride, 65; methyl
chloride, 30; and ethyl brr>uiide, 5 per cent. It is said to be largely used in
France, being considered less dangerou* than chloroform.
SOIOQfOS. — A trade name for chloraethanal alcoholate. Used as a
hypnotic in doses of 4 to 15 c.cm. (Si-iv).
SOZOIODOL.^ — Di-iodo-para-phenol-sulphonic Acid. From phenol is de-
rived, by combination with iodine and sulphuric acid, the remarkable sub-
stance, sozoiodol. which was first discovered by one of our own countrjinen in
San Francisco; but it was not until its manufacture was conducted upon a
larger scale in Europe that it could be obtained sufficiently pure for medicinal
use. The compououts of this renie<lv wo;ild indicate its value: it contains 55
per cent, of iodine. 20 per cent, of phenol, and 7 per cent, of sulphur. Tt
forms salts witli alkalies and with metals; those most used are potassium,
sodium, mercury, and zinc. As manufactured in this country by the ilal-
linckrodt Chemical Company, of St. Louis and New York, in a ptire form,
the salts are generally perfectly white, odorless, and vary in solubility, the
mercurial salt being the least soluble. The potassium salt, with 2 parts of
talc or other inert vehicle, may be used as a substitute for iodoform, being
free from all the objectionable features of the latter drug.
'Sew York Mcdiral Journal Nov. 2ft, 18ft0.
' Sihftieutnohe Afiotheker-Zeitung, Nov. 21, 1889; Afedical BuUftin^ Feb..
1890, p. 66.
80Z0I0DOL.
I
I
I
Physiological Action. — The sodium and potassium sozoiodolates are
non-irritating, and may be used in full strength as antiseptics and alight
astringents; but dilutions with talc^ sugar of milk, starch, etc., in the form
of 10- to 25-per-cent. triturations, form very efficient dusting-powders aa
substitutes for iodoform. The mercurial and zinc salts are more active, and
are used in solution (10 to 20 per cent.) for the same purposes. In solutions
ranging in strength from V^ to 2 per cent, sozoiodol and its combinations are
destructive to the miero-orgnnisms-of suppuration. Sodium sozoiodol has
been given to rabbits in doses of 1 Gm. (or gr, xv) without producing any
toxic effect. Sozoiodol is not decomposed within the body, but passes
through the organism uncbangod. According to Hutralini, the quantity of
urea eliminated after the ingestion of sozoiodol is materially diminished,
though the amount of urine is increased.
llicrapy. — As a topical application in uterine catarrh, or ectropion,
Nitschraann praises the soda salt, which is to be blown directly on the cervix
.and a dry tampon placed over it. He also uses a 5- to 7-pcr-cent. solution
in rhinitis hypertrophica, ozana, acute coryza,, and in inflammations of mu-
cous membranes generally, applied in a douche or by means of a camers-hair
brush. Dr. Scharf, of Constantinople, and the late JDr. Guttmann, of Berlin,
have reported good results from the insuflflation of the nasal cavities with
sodium sozoiodol in whooping-cough. About 0.25 Gm. (or gr. iv) was used
each day. The number and the severity of the paroxysms were reduced
within a few days, and in some cases the attacks ceased after about a week*8
treatment.
A 5-per-cent. sodium-sozoiodol solution has proved to be useful aa a
coUyrium in acute purulent conjunctivitis and in ophthalmia neonatorum.
The combination with zinc is commended in chronic inflammation of the
ear and upper air-passages. Dr. Seifert, of Wiirzburg, has obtained satis-
factory results in tuberculous ulcers of the larynx from insufllation of sodium
sozoiodol diluted with an equal bulk of some innocuous powder, such as
sugar of milk. The sozoiodol combinations have been applied with success,
it is said, to unhealthy wounds and ulcers, parasitic skin diseases, eczema,
impetigo, burns, derruatitis, and cracked nipples.
A 2-per-cent. solution of zinc sozoiodol is a useful gargle in stomatitis
and pharyngitis. A 1-per-cent. ointment of mercury sozoiodol, made with
lanolin, has proved a beneficial application to scrofulous and syphilitic ulcers.
Gaudin employs a 4-per-cent. plaster of the mercurial salt as a dressing to
chancres. Sozoiodol preparations have been advantageously employed in
dentistry as disinfectant remedies. An interesting observation was made by
C. Schwarz, who gave 2 Gm. (or gr, xxx) daily of sodium sozoiodol to a
diabetic patient without any restrictions as to diet. The symptoms at once
improved, the urine and sugar diminished, and in two months not a trace of
sugar could be found.* Buffalini tried the drug in phthisis (1 Gm.. or gr.
rr, daily) without results.
The sodium salt has been recommended as a substitute for carbolic acid
or creosote in cases of infectious dyspepsia, and may be administered in daily
dotes of 1 to 3 Gm. (or gr. xv-xlv). In affections of the external ear ac-
companied by free discharge Dr. Max Teichmann, of Berlin, reports good
reBulta from the use of potassium sozoiodol as a dusting-powder. Lithium
•Moiodol has seemed to be beneficial in several cases of articular rheumatism,
■"Annual of the Universal Medical Sdenws,*' 18«M), vol. v, p. A- 124.
850 PHARMACEUTICAL THERAPEUTIC AGENTS OK DBUOS.
are suffocated by being immersed in oil; poison is therefore imneceaiaiy.
An ointment consisting of 1 part of the oil of stavesacre to 7 parts of lard
has been found efficacious in prurigo senilis. Delphinine has been employed
in painful affections, as in neuralgia, where an ointment (2 to 4 per cent)
may be applied over the course of painful nerves. Given internally (0.006
to 0.008 Gm., or gr. Vio-V«)j it was found to act as a cardiac sedative and to
relieve excitement in acute rheumatism, by von Mering. It has also been
used in asthma and as an antipyretic in the same doses. A decoction of
stavesacre-seeds has sometimes proved effective as an anthelmintic, and Phil-
lips^ has known the tincture apparently beneficial in long-«tanding amenor*
rhoea and also in the nausea of pregnancy. Dr. W. B. Squire, of Worthing-
ton, Ind., uses stavesacre in irritable bladder with painful micturition.
STEAEATES. — Stearic acid, prepared from suet, has been combined
with copper, manganese, mercury, and zinc, forming powders which, in dis-
eased conditions (3 the skin, can be used either in their own form or in oint-
ments. Traces of other fatty acids are associated with the stearic add.
Therapy. — ^The compound zinc stearate is a serviceable dusting-powder
in intertrigo, hyperidrosis, and acute vesicular eczema. It is useful in allay-
ing itching. A distinctive property of this body is that it adheres very closely
to mucous surfaces and retains its position for hours, effectually preventing
irritation by morbid discharges. This compound is employed as a vehicle
for many other drugs. Mixed with boric acid, it is beneficial in bromidrosis,
parsBsthesia, ulcers, and eczema. The compound zinc stearate, mingled in
various proportions with salicylic acid, is applicable to hyperidrosis, eczema
rubrum, chancroids, ajid gangrenous wounds. The addition of tannic acid
renders it advantageous in bed-sores and prolapsed bowel. With th^Tnol
iodide it is serviceable in atrophic rhinitis and ozsena. Dr. X. F. Brown has
used this compound with advantage in acne, rosacea, and psoriasis; in vul-
vitis, vaginitis, and inflammation of the neck of the womb.
The compound zinc stearate with balsam of Peru may be employed by
insufflation in tuberculous ulcers of the lar\Tix. The union with chrv'sarobin
is a good application in psoriasis; with cocaine it may be applied to the nasal
paBsages in acute coryza and hay fever; with tar it is advantageous in chronic
eczema and psoriasis; with resorcin it is of utility in parasitic skin diseases
and syphilitic ulcers. A combination of compound zinc stearate with ace-
tanilid in the proportion of 1 Gm. (or gr. xv) of the latter to 4 Gm. (or 5j^
of the former substance is a useful application to suppurating wounds, to
which it serves at the same time a8 a deodorizing agent. Other active com-
pounds of stearates have been prepared and placed upon the market by Mc-
Kesson & Bobbins, of New York. The compound mercury stearate is rec-
ommended for the relief of parsesthesia and as a substitute for other mer-
curial combinations. The compound manganese stearate is considered as
preferable to the purified oxide.
STEEGUIIA. (See Kola.)
STUHNQIA (U. S. p.).— Stmingia (Queen's Root).
Preparation.
Fluidoxtrftctum StiUingi» (U. S. P.).— Fluid Extract of Stillingia. !>»>**•
0.60 to 4 c.cm. (or mx-f3j).
» Op. cit, p. 48.
I
I
I
STBAMOKTITM.
BBcolo^. — T)\v drioJ root of 8tilliii^ia sylvatica (Eupliorbia-
(ligeiu.iii? peronnifll, jcrnwing in the eouthorti portion of the United
Sbiltrs. The most iiot-eworthy constituent is a soft resin; it also contains an
kaloid Stillin^ne, a bitter, acrid principle, and some volatile oil.
Physiological Action. — When taken in rather large doses, this drug acts
is a severe cathartic and emetic. In small doses, frequently repeated, it is
believed to stimulate various secretions so as to warrant its being considered
alterative. It is also regarded as a stimulant to the heart and circulation.
Tlie tiuid extract is a good preparation.
The National Formulary provides a compound fluid extract of stillingia,
which also contnins corydalis, iris, sambucus, chiniaphila, coriander, and
Tanthoxylum. Dose, 4 to 8 c.cm. (or f5i-ij).
Therapy. — Stillingia has been employed as an alterative in syphilis,
scrofula, und liver tlieordors. In 8y[>hilie it is more effective combined with
other alteratives, such as clover, prickly ash, and sarsa'parilla. In jaundice,
haemorrhoids, constipation, and disordered digestion from insufficient action
of the liver, stillingia is valuable.
It has likewise been recommended in the first stage of hepatic cirrhosis
and in ascites due to that disorder. Intermittent fever being frequently
associated with torpid or deranged liver, the combination of this drug with
tntiperiodic treatment is very successfui. The National Formulary gives a
formula for a compound fluid extract which is a good vehicle and adjuvant
for potassium iodide in syphilis, chronic rheumatism, etc. In various
cachectic skin disorders also this combination is useful.
STOVAIWE. — The trade-marked name for amylene hydrochloride. It
is in gli>tcning scales, which are freely soluble in wat<?r and in ak-ohol. Re-
Reinbles Cocaine in its action as a local anjesthetic, and has been used aa a
substitute for the latter in subarachnoid spinal injection, combined with
adrenalin. The ordinary solution for local anaesthesia is three-fourths of
1 p*:^ rent. (0.215 Om. to 30 c.cm., or gr. iii \/^ per ounce).
STHAMONTUM (V. S. P., B. P.).— Stramonium-leaves.
STBAMONII SEMINA (B. P.).— Stramonium-seeds.
Preparations.
nxIrACturn Stramonii (U. S. P.). — ExtrAct of Stramonium (leaves). Dom*,
0.016 Gm. I or gr. V.).
Fluid^tractum Stramonii (U. S. P.). — Fluid Extract of Straiuoniuiii Uwivos).
tkwm, O.Ofi to 0.30 c.nn. (or mi-v).
Tinctnra Strnmonii (V. R. P.). — Tincture of Stmmonium (made from the leaf,
aaaayed 10 per crnt. Earh c.cm. contains about gr. V» of the mydriatic alkaloids).
Do*e, 0,Sn trt 1.20 com. (or wv-xx).
Fngueiitum Ptrninonii (U.S. P.).— Stramonium Ointment (extract, 10 per cent.).
Tinctum Strnmonii (B. P.).— Tincture of Stramonium (stramonium-leavea. 20
Gin., or gr. cecx; alcohol [45 per cent], q. a. ad 100 com., or fSxxvij). Dose, 0.30 to
1 c-cm. (or wivxv).
Kxtrnctum Strumoiiii (B. P.). — Extract of stramonium (ftccd). Dost*, 0.015 to
O.Mo Gm. (Of gr. Vt-j).
Phannacologfy. — "The <lrii^ leaves of Datura strnmonium (Solanacea?),
riridin^r. wltcn a^^'iaycfl hy I^, S. P. process, not h»ss tlian i)M per cent, of my-
ilriatit- a!knloi»lf»." The Briti!*l» Plinnnacoprpin arlmits also the seeJs and an
<«x1mrt of the w*es3s. The plant i? an annual with green storn, coarrio, rank-
smeliing leaves, and white flowers; the geed-capsnie is green and fleshy. It
852
FHAKMACEUTICAL THEBAPECIIO AQ£XT6 OH DBUQS.
grows wild in Europe and the United States, being commonly knowu here as
Jamestown weed (Jimsiin weed), or thorn-apple. The last name is unfortu-
Bate, for when the seeda are eaten by children poisoning occurs, sometimes
with fatal result. It contains an alkaloid, Daturine (0.02 to 0.03 per cent.),
which appears to be a mixture of hysocyamine with atropine, with a small
pro]>ortion of hyoscine. Dose, 0.0005 Gm. (or gr. Viao)-
Physiological Action. — The physiological properties of stramonium are
very muuh the same as tliose of bdladoima, except that the sympathetic sys-
tem is more influenced by stramouium, the heart becoming irregular and
more delirium being manifested under its use. It is held to be aphrodisiac
in full doses. Stramomum is eliminated from the system by the kidneys.
The toxic effects are not very ditTerent and the treatment is the same as for
belladonna poisoning. (See Belladonna.) Stramonium will also frequently
give rise to a scnrlatinifonn eruption.
Therapy. — The leaves of stramonium are sometimes used locally, in
a poultice or fomentation, as an anodyne for engorged breasts, tumors,
rheumatic joints, sprains, etc. The ointment is used for irritable ulcers*
cancer, hsemorrhoids, fissures, and painful skin aifections, especially around
the anus. It is much better if made from the extract of the fresh leaves.
When dried, they may be mixed with tobacco and smoked for asthma, the
fumes being inhaled so as to enter the bronchial tubes, an attack being
checked or materially alleviated in this manner. Some relief may be
afforded, in the same way, in a case of biliary colic and the passage of a stone
along the ureter, or gravel. About 1 Gm. (or gr. xv) may be mixed with aa
equal quantity, or more, of tobacco and smoked in a pipe, or made into a
pastille, with a little nitre, and moistened with alcohol, or burned on a hot
shovel in a closed room. Stramonium has likewise been administered inter-
nally in astlima with some sucess, but its action ia much more uncertain
when taken by the mouth than when inhaled.
In mania of acute character, puerperal or other, the tincture should be
given in decided doses, every two to four hours, until physiological symp-
toms are manifested. In spasmodic neuralgia (tic douloureux) and various
forms of visceral neurosis, dysmenorrhea, etc., stramonium may be combined
with other agents of the same group, or with opium.
In spasmodic eongh, the tincture might be used as a substitute for
belladonna^ in small doses. Stramonium is sometimes given with advantage
in chorea, epilepsy, and nymphomania. The remedy seems especially bene-
ficial when the last-named .afTection is associated with depressed spirits.
Chronic rheumatism is not infrequently benefited by its internal use.
STEONTIT BROMIDITM (U. S. P.).— Strontium Bromide.
Dose, 0.20 to 0.n5 Gm. (or gr. iii-x).
STRONTII lODIDTTM (IT. S. P.).— Strontium Iodide.
Dose, 0.33 to 0.65 Gm. (or gr. v-i).
STRONTII SALICTLAS (IT. S. P.).— Strontium Salicylate.
Dose, 0.32 to 1 Om. (or gr. y-T\).
Pharmacology. — Strontium combines freely with other elements, form-
ing fl long list of salts. The bromide (97 per cent, of pure salt), iodide (98
per cent, pure), and salicylate (98.5 per cent pure) are freely soluble in
water; the phosphate is not official, and is insoluble.
SfRONTIUM.
853
I
I
I
I
Physiological Actioa. — The physiological effects of strontium were but
little known until the investigations of Dr. J. V. Laborde, who reported his
results to the French Academy of Medicine, at the meetings of July 21 and
28, 181)1. Hifl experiments were made upon dogs and, in one instance, upon
the human subject. lie found that large proportionate doses of bromide,
chloride, carbonate, and lactate of strontium could be administered without
producing any deleterious effects. The lactate gave rise, in the dog, to
marked diuresis. M. Ch. F6re, in an independent investigation relative to
the comparative toxicity of the bromides when given by intravenous injec-
tion, ascertained that, in the rabbit, the potassium bromide is about iive
times as toxic as the strontium bromide. Strontium increases the appetite,
digestion, and assimilation of animals. Its salts retard fermentation and
putrefaction, and act as intestinal antiseptics. Laborde attributeB to them an
anthelmintic effect. The combinations of strontium are partially eliminated
in the urine and fffces, but a portion is retained within the economy and
deposited in the bones, liver, and, to a less extent, in the soft tissues.
Therapy. — Strontium bromide has been used with satisfactory results
in epileps}'. It is well borne by the stomach, and has not as yet been pro-
ductive of any of the phenomena of bromism. The paroxysms of hystero-
epilepsy have also been controlled by this salt. In true epilepsy it is per-
haps more efficacious than potassium bromide in diminishing the frequency
of paroxysms. According to the experience of Dr. Berkley, the improved
mental condition, lessened somnolence and excitability under the use of the
strontium salt should lead us to prefer it to the other bromides. Anthony
Roche, speaking from an extended experience with the bromide of stron-
tium, stated that he had never met with a case in which this salt, given in
the doses and method he mentions, had failed to diminish the number of
attacks. In many instances, there had been no return for periods extending
to three or four years. He usually commences the treatment by ordering
2 Gm. (or 3es), night and morning in some vegetable infusion. Should this
dose not decrease the attacks, he rapidly increases it, until he finds the quan-
tity which will suit the individual case. Where there is a warning of an
attack, he directs the patient to take 2 Gm. (or .>t?s) at once and repeat this
eTery hour, if required. In order to get the full effect of the remedy it should
be given in large doses and continued for a long period. Some patients have
tsken 4 Gm. (or3j) daily for several years without any ill effects. In the diet,
he, at first, prohibits the use of meat entirely, allowing only fish and vege-
tables, becoming less strict as the patients improve.
The digestive disturbances accompanying disease of the heart and kid-
neys are notably ameliorated by strontium bromide, The writer has wit-
neeaed marked relief follow its administration in nen'ous dyspepsia and gas-
tralgia. In dyspepsia associated with excess of hydrochloric acid, strontium
bromide produces rapid and decided relief. It has proved efficacious in cases
irhere the acid was deficient. In nervous vomiting and dilatation of the
stomach it is also beneficial. In acute catarrh of the stomnch it has been
found to control vomiting and allay pain. The \\Titer obsen-ed improve-
ment follow the use of the bromide in chorea. This salt also afforded signal
relief in senile pruritus. Germain St^c, in albuminuria, administers with
good effect strontium bromide and calcium bromide alternately, in doses of
4 to 6 Gm. (or gr. Ix-lxxv) in the course of the day.
•
854
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
Strontium bromide should not be administered in combination with
sodium bicarbonate, as a double reaction takes place between the salts.
Strontium lactate is of decided service in albuminuria. It generally
causes a rapid reduction of the albumin, but its administration should not
be too soon suspended. Strontium is not a positive diuretic in man, though
in several cases the writer has seen a pronounced diuretic effect from the use
of the lactate. The lactate is etficacious in scrofulous, gouty, and rheumatic
nephritis, in the albumiuiiria of pregnant and puerperal women, and in that
of cardiac origin, but is of no service after the manifestation of uraemia. Ac-
cording to Constantin Paul, strontium is only useful in the parenchymatous
forms of renal disease. It is of especial value where it is desired to moderate
the loss of albumin. The formula, recommended by Gaucher and Gallois'
is: lactate of strontium 50 Gra. (or 3xiij); water, 375 c.cm. (or f5xc); the
dose to be 45 c.cm. (or fjiss) per diem, equivalent to 2 Gm. (or oss) of the
strontium salt three times a day. Strontium lactate is of utility in subacute
or chronic gout and rheumatism. In eczema dependent upon Bright's disease
and psoriasis due to a rheumatic diathesis, strontium lactate efTects improve-
ment. It is advantageous in chronic gastric and intestinal catarrh. Dr. A.
Ried believes that the diuretic power of this salt is sufficient to constitute a
valuable temporary substitute for the salicylates in the treatment of pleuritic
exudations.
Strontium iodide is much better tolerated than potassium iodide, and is
not apt to give rise to gastric irritability or eruption upon the skin. This
salt is an excellent remedy in certain constitutional disorders. It is valuable
in the treatment of enlarged lymphatic glands, scrofuloderma, chronic ab-
scesses, disease of bones and joints, in scrofulous otorrhcea, ozasna, or oph-
thalmia. Lichen scrofulosum, strumous acne and eczema, and other aflcc-
tions of the skin occurring in scrofulous subjects, are improved by the ad-
ministration of strontium iodide. It is likewise beneficial in chronic eczema
with excessive infiltration and thickening of the skin. It is a good systemic
remedy in lupus vulgaris and in the early stage of tuberculosis.
Rheumatic manifestations often yield promptly to strontium iodide.
It is of particular service in subacute, chronic, and muscular rheumatism.
Sciatica and trifacial neuralgia dependent upon a rheumatic basis will often
yield to this remedy. It is likewise of avail in subacute and chronic gout.
Eczema, erythema multiforme, erythema nodosum, purpura rheumatica,
psoriasis, and pariesthesia, caused by gout or rheumatism, are benefited by
the use of this salt. The writer has seen good results from its emplo}Tiient
in large pustules of the scalp, tubercular syphilide, and in all the later mani-
festations of syphilis. Strontium iodide is useful in chronic bronchitis,
asthma, chronic catarrhal pneumonia, and chronic pleurisy. It will prob-
ably be found of avail in the first stage of cirrhosis of the liver or kidney. It
is useful in chronic lend or mercurial poisonincr. It may be employed in
aortic aneurism, and Germain See recommends it in various afTections of the
heart. Experience has shown it to be useful in arteriosclerosis and angina
pectoris. MM. Lahnrde and Malbec conclude that strontium iodide has a
manifest influence upon the heart and is of service in atfections of the myo-
cardium, lesions of the aortic orifice, and the arteries. This salt can be safely
^Lancet, April 25, 1896.
8TR0PHANTHTJB.
855
grven in comparatively large doses, and is well adapted to take the place of
potassiiim iodide whenever the latter salt is not well borne.
Strontium nitrate, in 2 Gm. (or 5ss) doses, has been advantageously used
in articular rheumatism. Laborde regards strontium phosphate as an excel-
lent nutritive and tonic agent. Strontium acetate is said to be an efficient
tjeniacide, given in a lo-per-cent. solution in water and glycerin, the dose
being 30 com. (or f^j) daily for five consecutive days.
Strontium salicylate has been employed in flatulent dyspepsia and in
Tarious conditions of intestinal fermentation, in muscular and subacute rheu-
matism and chronic gouty manifestations accompanied by digestive disturb-
ance. It is said to be well borne and to improve digestion. This salt is given
in doses of 0.32 to 0.65 Qra. (or gr. v-i) after meals and is best administered
in capsules.
STKOPHANTHTJS (IT. S. P.).— StrophanthnB.
STKOPHANTHI SEMINA (B. P.).— Strophanthns-Becda.
Preparations.
Tinctura Strophantbi (U. S. P., B. P.).— Tincture of Strophftnthus (10 per
cent; B. P., 2Vj per cent.). Dose, 0.12 to 1 c.cm. (or mii-xv). B. P., up to 4
ccro. (or fSjK
Extractum Strophantbi (B. P.). — Extract of Strophonthua (60 per cent, with
milk-sugar). I)oae, O.Olfi to 0.000 Gm. (or gr. Vd).
Strophanthidum (U. S, P.). — Strophanthin. Doae, 0.0003 Gm. (or gr. 7m)-
Pharmacology. — "The dried, ripe seeds of Strophanthus Komb6, de-
prived of their long awns (Apocynaceae)" (U. S. P.) : ''The dried, ripe
seeds of Strophanthus Komb^" (B. P.). From this African plant the na-
tives make a toxic extract known as the Konib6 aiTow poison. Strophantliin
is officially defined as a glucoside. or mixture of gluonsides, obtained from
strophanthus (U. S. P.), The strophanthin from S. hispidiis, and S. gratus
differ somewhat, and H. Thome suggests thnt they pliould be distinguished
by an initial, thus Kombe strophanthin would be K-strophanthin. and the
others h-strophanthin, and g-atrophanthin, respectively.
Strophanthin, having the -formula C^jH^^O,, (Amaud) is believed to
the only active constituent of Strophanthus hispidus and Strophanthus
Kotnh^. Strophanthin, like other glucosides, is easily decomposed by acids.
It hydpolyzes^ when hontod with very dilute hydrochloric acid, to two forma
of sugar and to Strophanthidin. Strophnnthin is precipitated by tannic
It is readily sohihlt* in water and alcohol, but almost insoluble in ether
cI»lon»fonn. Pure or impure strophanthin, or pharmaceutical prcpara-
ntaining the ghicoside, wlirn Iirnught in contact with pulphuric acid,
of ferric chlori<le being present, yield a bright-green color. The crude
dnig nmy contain other varieties than the official Komb^ seeds. Holmes,
who has given this point much attention, claims that only by purchasing the
K«dfi in the follicle and testing a seed from each follicle, can a reliable prep-
aration of strophanthus be made. An assay based on the amount of ex-
tractive contained in a given tincture of strophanthus, or other preparations
of the heart-tonic, is of little value to the physician, since the extractivee
consist largely of chlorophyl and other inert substances.
I
856
PHABIUCEUTICAL TUERAPEUTIO AGENTS OH DHCQ8.
II. Thorns' reports that the drug contains, besides strophanthin, smal
quantities of choline and trigonelline — ^a base found in fenugreek.
The active principle, Strophanthin, is a crystallizable glucosidc present
in different parts of the plant, but especially in large proportion in the seeds,
which are official. It is bitter, acidulous, insoluble in ether and chloroform,
but soluble in alcohol and in water. A good fluid extract would probably be
the best preparation, but the effects of the tincture have been most observed
by Profefisor Fraser,- of Edinburgh, who first introduced it to the profession
in 1870. Strophanthin may be administered simply dissolved in water, the
dose being 0.0002 to 0.0003 Gm. (or gr. Vaoo-Vaoo)- Bartholow advised
chlorofonn-watcr as a solvent, iu order to prevent the formation of penicil-
lium.
PhyBiologioal Action. — Strophanthus has no local action, apart from
the observation of Steinbach that an infusion of the seeds caused anaesthesia
when applied to the cornea. This local action has been studied by Gley* and
is common to both ouabain and stroplianthin, but is more decided in the
former substance. Tliree or 4 drops of a solution of 1 to 1000, dropped into
the cornea, anaesthetizes it for a considerable time, which may extend to sev-
eral hours. The effects are unaccompanied by any irritation of the conjunc-
tiva. Strophanthin and ouabain are much more powerful local ansesthetics
than cocaine, and the anaesthesia which they produce is total, including all
varieties of sensibility. The feclinp; of heat and cold is the last to be extin-
guished and the first tn revive. The drug, however, c-susos passive hypenemia
and may give rise to cloudiness of the cornea. Ouabain obtained from
Strophantlui? glaber is not identical with strophanthin, and Fraser suggests
that it b*^ cnllod acocantherin.
E. il. Iloiightou'* has also directed attention to the variability in phys-
iological activity of different specimens of strophanthus. and advocates
pharmacological assay, using frogs to determine the maximum and minimum
dosage. Not only is the crude drug often found mixed with other vegetable
substances, but the strophanthin supplied by different manufacturers is also
unreliable, because he found one sample ninety times as strong as another.
As strophanthin is doclnred to be three times as poisonous as atropine, ten
times as poisontnis as strychninf\ and twelve times as poisonous as absolute
hydrocyanic ncid. extreme caution is advised in prescrioing it, and to secure
a standard preparation.
Strophanthus is bitter, and prcmotcs appetite and digestion, if given
in small doses. Its principal use is a cardiac tonic, resembling digitalis.
It slows the heart-beat, lengthens the inten-als between the contractions,
and increases the energy ol the muscular tissue. Some effect is also seen
upon the arteries, but the rise of blood-pres,=»ure is due principally to the in-
creased force of the cardiac contractions. In fatal cases the heart's action
IB arrested in diastole. Strophanthus is described by Binz. as differing from
digitalis in acting more quickly, in not disturbing the intestinal canal, and
' BfT, d, Deuisch, Chem. f/r«., 1898, 271.
' Britijth Mefii*7al Jovtnnl, .T.an. "22, 1SS7. and "Tr.insactions of the Royn! Society
of Edinburgh," vol. xxxr, part iv (No. 21 1, 1890.
' Le Profjr^ji Metliml,yo\. 1«. 1S89, and March 1. 1890: Medical liuUetin. Mnrch
1800, p. 92, ttiid Juno. 1890, p. 218.
* "Tlip PhnrniMcoloffio A^sny of the Henrt-tonics." Journal of the Amtirican M9
ieal Annnt^intiOfi. Oct. 22. 1898.
STROPHANTnCS.
867
in not posdeesing a cumulative action, but the good efTects are Baid to be not
BO lasting. A quieting effect on the brain and medulla is attributed to 6tro-
phanthus. It has some diuretic power. In regard to the claim that it has
no cumulative effect, thiSj as pointed out by Bartholow, must largely depend
upon the interval between the doses, for if they are given too frequently
the effects must overlap each other. The prolonged use of strophanthus
sometimeB gives rise to diarrhoea. In animals poisoned by strophanthus
there is found marked evidence of irritation of the gastro-intestinal tract,
with irritation or inflammation of the kidneys.
Therapy. — Strophanthin has been employed as a local ansesthetic, ad-
ministered percutaneously by means of cataphoresis, the anode being moist-
aed with the solution, or a tissue-paper disk used containing O.Q0025 Gm. (or
Vrno) or more, and a current of 5 to 8 milliamp^res employed.^ Reynold
W. Wilcox, from an extended experience with this agent, says that stro-
phanthus was first brought to the notice of the French Academy of Med-
icine in 1865, but its first practical demonstration as a valuable heart-rem-
edy came twenty years later, when Fraser published the results of his long-
continued and patient researches. With wider and more rapid dissemina-
tion of knowledge, we may hope that, within a comparatively few years, we
may have strophanthus used as carefully as digitalis to-day. That it pos-
866868 distinct advantages over the latter drug is undoubted, and it is equally
certain that it is free from the greatest danger which the use of digitalis
entails — namely, vasoconstriction. Success in the administration of stro-
phanthus requires: 1. An active, well-made preparation from a reliable
source. 2. Avoidance of its use in fully or overcompensated hearts, in those
which present advanced muscular degeneration or mechanical defects of
high degree. 3. The use of not too large or too frequently repeated doses;
the dose of 0.30 c.cm. (or mv) of a reliable tincture three or possibly four
times a day is aufficient.
In conclusion, Wilcox holds that, considering the limitations just
enumerated, strophanthus is the drug of choice in: 1. All cases in which
we wish to establish compensation. 2. All cases of arterial degeneration in
which a remedy which causes more energetic cardiac contractions is required.
3. All cases of cardiac disease where diuresis is necessary. 4. All cases of
weak or irritable hearts. 5. All cases of cardiac disease in childhood or old
age.
Strophanthus is especially useful in the progressive heart-failure of
elderly patients, with attacks of dyspncea simulating angina. It is a service-
able cardiac stimulant in typhoid fever, and some authorities advocate ita
employment in angina pectoris. It can be prescribed thus: —
B Tinct Btrophanthi.
Tinct. nucia vomic»j
Tinct. cardamomi or 41
Aquffi ntonth. pip <» q. s. ad 150|
M. Sip.: A tcaspoonful or two every two or three hours.
c.cm. or fSj.
c.cm. or fSv.
At a meeting of the Edinburgh Medical Society (May 6, 1896) Dr. Q.
W. Balfour, on the contrary, expressed skepticism as to the medicinal value
^ FortHchrittfi Hrr Mctlicin, Yfh. 1, 1890. AIw> we article by Frederick Peterson,
"A Farther Studv of Anodal DitTu«iou as a Therapeutic Agent," Mrdical Rfconl,
New York. Jan. 31. '1891.
85S
PHAJlilACEUTICAL THERAPEUTIC AGENTS OR DBUG8.
of strophantbus in cardiac affections. Experience shows that many, if not
most, cardiac cases iu hospit^nls require no treatment but rest. Drugs only
are of pormanent vnlue which iuerease the elasticity of the myocardium, and
this action could only be permanent when accompanied by a corresponding
improvement in the general metabolism. This action is typically preserved
by digitalis, the elasticity in the myocardium is increased, and this is accom-
panied by a rise in the general blood-pressure. The only other member of
the digitalis group which had succeeded iu obtaining general recognition is
Btrophantlius, hut its action is essentially diilerent from digitalis.
The intravenous administration of strophanthin is recommended by
M. A. FraenkeP in dose of 0.00075 Gm. (or gr. ^Z^^) in sterile water. The
effect of the injection is seen in three or four minutes. In a ease of non-
componsatod heart lesion, the pulse becomes slower, dyspncea disappelars, and
free diuresis occurs. The ^rrave symptoms of asystole are promptly relieved.
The injections should not be too frequently repeated, as the remedy has the
same cumulative action that is seen in all the other members of the digitalis
group. Strophanfhin does not have much effect on the arterial pressure, but
it increases the iimjditude of the pulse, causing the slowing of the rate and
the diuresis.
Venous stasis is often relieved by a single injection ; the effect^ however,
does not last more thnn two or three days. It should be supplemented, there-
fore, by the intprnal administration of digitalis. Fraenkel considers tlie in-
travenous injection as a prompt and powerful cardiac ^stimulant of great
value in urgent cnses; but not to be considered as tiiking the place of the
internal administration of digitalis, when the treatment is to be continued
for uny length of time.
Strophanthin may also be administered hypodermically, in doses of
0.0006 Gm. (or gr. ^/,on)» not more than once daily. The hypodermic in-
jections are useful in chills, especially those of nervous character, such as
'chills due to urethral shock, following passage of a sound or an operation;
also in malarial or nervous chills.
Tn Bright's disease, the symptoms of nra?mia and dyspnceal attacks are
rapidly relieved by strophanthus, which also reduces the dropsy of chronic
kidney disorder. For exophthalmos, with irregular overaction of the heart
(Graves's disease), it has been riurcessfullv tried. Dr. E. D. Fergiipon^ says
that in eight cases out of nine, to which he gave strophanthus in exophthnlmic
goitre, there was marked relief: the other one had pre-oxistinE: pulmonary
disease. Pie thinks it a probable explanation that strophanthus relieves the
overtaxed heart by overcoming resistance in the systemic circulation. He
advises beginning with doses of 0.50 e.cm. (or mviij). and gradually increas-
ing them to 1.55 c.cm. (or mxxv). of a pood tincture, several times daily.
Dr. William A. Hammond, in an article in the Therapevtic Gazelle* on
^'Wenk Heart and its Treatment," considered ptrophanthus a valuable rem-
edy, though inferior to disritali?, and stated that it appeared to him "to bear
the same relation to digiialis that brucine dnes to strychnine, and when ad-
ministered with a view to its tonic effect upon the heart it should be given
' Prcwoodinp* Intornftttonnl MwHcn! CongrMa nt Liahoii, IftM: f,n ftrmani^
MediraJr. Mav 2. 1000.
' "Proceedings N. Y. Medical AsaocittUon," Oct 22, 1890; Medical Record, Nov. 1,
p. 602.
•Oct. 15, 1890. p. 668.
STnaPHANTIIlS
ID much larger doses than those ordinarily prescribed." Hare suggests ita
use in children, where digitalis does not answer well; but Demnie holds
the view that in children more care is needed in using strophanthua than in
using digitalis/ fluting that the toxic cirpct nf strophanthus on thi? heart-
muscle often occurs unexpectedly and more suddenly than with digitalis. In
the case of very young children, Demme observed strophanthus to cause indi-
gestion. If it cause nausea and cold sweating, it should be withdrawn^ and
coffee and brandy be administered. On the other hand, Moncorvo, of Rio
Janeiro, also an excellent observer, values strophanthus as a cardiac stimu-
lant and diuretic, especially in the diseases of children. He considers it
prompt and energetic, but devoid of danger, and claims that its good effects
last long after the cessation of its administration. The sedative effect of
strophanthus, although not very marked, has been noticed. It has been
proposed to utilize it previous to the production of anajsthesia by chloroform,
so as to lessen tiie stage nfeNcitement. Dr. Feilchenfeld,^ of Berlin, gives
0,30 c.cm. (or m\) of tincture of strophanthua on two evenings and the morn-
ing before operating. He regards it, in such cases, as more suitable than the
bromide of potassium.
Strophanthus has also been found useful in bronchial asthma and
whooping-cough.
In the treatment of psoriasis, the author has had some good results,
especially when the integument is much congested, from strophanthus, with
niLx vomica : —
li Tinct. strophanthi,
Tinctura iiiicis vomica! aa
7|5 ccm. or f3ij.
M. Sig.: Ten to twenty drops in water three times a day.
Dr. William Gemmel, of Glasgow, has made use of ouabain in 49 cases
of whooping-cough.^ He found it, when cautiously employed, to be of notable
benefit in all stages of the disease. It is destitute of cumulative action. In
an uncomplicated case it reduces the pulse, temperature, and respiration a
little below the normal. Ouabain increased the activity of the skin. The
bowels were unaffected. The excretion of urine was slightly increased.
The appetite and the general condition were considerably improved. Sleep
was sound while ouabain was being administered. This substance appears
to be clinically closely related to the official strophanthin.
Dr. Gemmell states that the dose of ouabain, to begin with, should not
CJceed 0.00006 Gm, (or gr. V,ooo) every three hours (0.0005 Gra., or gr. V,„,
dtilr). For children under one year of age, not more than 0.00003 Gm. (or
P- Vwofl) should be given every three hours. From the sixth to the twelfth
year* if the s>*mptoms are severe, 0.000125 Gm. (or gr. '/500) naaj be given in
each doge, but the action must be carefully watched. Ouabain may be ad-
ministered alone, dissolved in water, or in combination with potassium bro-
mide or chloral-hydrate. The simplest way is to dissolve 0.065 Gm. (or gr. j)
of ouabain in distilled water, so that each 0.06 c.cm. (or mj) of the solution
shall be equal to O.UUUOti Gm. (or gr. Vio»o) oi ouabain. Thus:—
I
' "Anniiul t\f the Vniversal Mediciil Science**
' /.cinrf /. March 3. 1000.
* Br%ti»h Urfiirnt ./oufitni, April 2rt, ISOO, p.
for 1800. vol. v. p. A-126.
050,
860
PHARMACEUTICAL THERAPEUTIC AGEXTS OR DRUGS.
R Llq. ouabain 3 c.cra. or roxlviij.
S>T. aurantii 15 c.cm. or f3iv.
Aquse q. s. ad 180 c.cm. or f5vj.
M. 6ig.: A teaepoonful every three hours.
STRYCHNINA (U. S. P., B. P.),— Strychnine. (See Nux Vomica.)
STYPTICDT. — Cotarnine hydroclilorido has received the special title
6t3rpticiB, owing to its power of controlling hsemorrhage. It is derived from
narcotine by the action of oxidizing agents, narcotine being an opianate of
cotarnine. The hydrochloride of cotarnine is a niicrocrj'Btalline, yellow
powder, with an intensely-bitter taste. Edmund Falk, of BerHn, found that
physiologically it acts upon the motor portion of the spinal cord as a para-
lyzing agent, it is slightly narcotic, it has no direct action on the heart or
blood-vessels. On the respiratory centre, after a transitory irritant action,
it is a paralyzing agent, a fatal termination being induced in this way.
Rousse and Walton claim a tonic action on the circulatory system, and assert
that it acts as a cardiac stimulant. It is useful in pulmonary and especially
uterine hremorrhage. It maybe given by the mouth in doses of 0.03 to 0.32
Gm. (or gT. ss-v), but is generally given hypodermically. In haemorrhage
from uterine cancer the results were negative.
STYKAX (U. S. P.).— Storax, Liquid Storax.
Dose, 0.65 io 1.30 c.cm. (or gr, x-xx).
STYBAX PKiEPAKATirS (B. P.).— Prepared Storax.
4
Preparation.
Tinotura Benzoin! Composita (U.S. P., B. P.). — Compound Tincture of Benzoin.
Dose, 2 to 4 c.cm. (or f5ss-j).
Pharmacology. — "A liquid balsam prejmrcd from the wood and inner
bark of Liquidamljar orientnlls'' (Ilainnmclidacea'), or Oriental sweet gum,
growing in Asia Minor. The British Phamiacopceia directs that the balsam
be obtiiined from the trunk nf Liquidanibar nrientalis, and purified by solu-
tion in ethylic alrohol. filtration, and evaporation of the solvent. StA-rax,
wliich is a true balsam, contains a volatile oil, Styrene, Cinnamio acid, and
Styracin (Cinnamyl cinnamate). The most important constituent of storax
is probably Storesin, existing both uncombined and as a cinnamic ether,
Styrone is a derivative of sh'raoin, and is chemically cinnamic, or cinna-
mylic. alcohol.
Therapy, — Mixed with two or three parts of olive-oil, storax is used in
treating scabies, and in some eutaneoi]? diseases requiring slight stimulation.
Storax is n good application to foul ulcers, and. made into an ointmout. is an
excellent dressing to the ulcers of frost-bite. It is a stimulating expectorant
in chronic bronchitis, generally used, however, in combination, both in-
ternally administered and by inhalation, the tincture being volatilized by
hot water. Storax has also been l)Toufi:ht forward as a remedy for gonor-
rhoea and gleet, for chronic catarrhal affections nf the genito-urinary organs,
and been found iLseful in nmenorrhn^a. Styrone, or cinnamylic alcohol, is
an efficient antiseptic, and its use has boon enthusiastically advocated.^
* "Styrone: A Consideration of its Value as nn Antiseptic," by H. H. A. Beach,
M.D., Boston Medical and Surffical Journal, Ati^. 1 and 8, 1880.
srccixnM.
8G1
It ie a prompt rleodoHzer of foul wounds or ulcersj-^BaugnBit or not,
— and in bronchial catarrh it can \ye used in a spray : —
B Styronis 4| c.cm. or f5j.
■ Glycerini,
I Aqun destillatae aa 30| c.cm. or Qj*
M. For external application.
Being non-poisonous, styrone can be used in emuleion with olive-oil
or water for injecting into cavities, as after the operation for empyema;
and, having an agreeable, cinnamon-like odor, it has been utilized in den-
tistry. Various combinations of styrone are suggested, as with liquid petro-
latum, 1 to V2, which was used with success upon the dressings, as au anti-
septic, after removal of the female breast.
Dr. Beach sujrgeste the internal use of styrone in the treatment of
cholera for the disinfection of the alimentary canal. It may also be substi-
tuted for carbolic acid in gargles, requiring antiseptic action and probably
wrould be a useful enema for oNUiridf^s or ulcerntion of the rectum. A solu-
ptloQ of 1 to 60, containing a f?nioll amount of glycerin, would be well suited
for internal use. Styrone i? likewi?? an excellent deodorant and disinfectant
in cflscs of purulent inflammation of the ear.
SUBLAMUTE. — Ethylenediamine Mercury Sulphate is a white powder,
readily soluble in water. It is used locally as a disinfectant for the hands in
surgery and g\Tiecology (l-to-5000 to l-to-500 solution). Internally is used
for syphilis (1- to 3-per-cent. solution. Dose, mxw or 1 com.). Also used
as a fixative for anatomical specimens in a 10-per-eent. solution. In the
•treatment of ringworm it has hecn used by Dr. Gottheil, of New York (1-to-
750 to 1-to-lOOO solution), and regarded as the most effective treatment
SrCCnnm. — Amber. Amber is a resin found among fossil alluvial
deposits in different parta of the world, representing the resinous exudation
of a number of varieties of extinct coniferous trees. The amber consumed
in this country is brought from the ports of the Baltic, but it has been found
in small quantities in New Jersey and Maryland, It is a light-vellow, brittle
solid, in irregular masses, resembling colophony. Water and alcnhol scarcely
act on it. It becomes negatively electrified by friction. By distillation oil
of amber and snccinio acid are obtained, and by repeated distillations from
nitric acid it yields a liquor from which ether separates borneol, or pure cam-
phor. Amber also contains a yellow resin, another resin, and a bituminous
principle, the latter constituting about 80 per cent. It also contains a
yellow coloring matter. The oil of amber has been so largely adulterated
that it is little used and is no longer official.
Physiological Action. — The rectified oil of amber (oleum succini recU-
ficatuni, formerly official) is stimulant and antispasmodic, and excites the
•ecrctions of the bronchial mucous membrane and kidneys. Locally it is
counter-irritant.
Therapy. — The volatile oil of amber has been used as a counter-irritant
to the chest in cases of whooping-cough, and has also been applied to the
hack, along the spine, for certain spasmodic affections, such as chorea and
infantile convulsions. It is a useful ingredient, in liniment, for chronic rheu-
matism, though probably inferior to oil of turpentine. It has also been used
862
IMIAIlMACKrTICAL THERAPEUTIC AGENTS OR DRCOS.
as an embrocation in chronic bronchitis. Internally it has been given for
omenorrhcpa, digestive disorders, with pain, but is rarely proscribed at pres-
ent. Flatulent 3yBp>epBia may be relieved by the use of this remedy. Dose,
0.30 to 1.20 com. (or mv-xx). The oil of amber has likewise been found of
avail in spasmodic affections, as hysteria, hiccough, whooping-cough, and
asthma.
SULPHAMINOL.— Thio-oxy-di-phenyl*amine. When the salts of oxy-
diphenylamine, dissolved in water, are exposed to the action of sulphur, a
yellow powder is precipitated, which is without taste, odorless, readily dis-
solves in alkaline solutions; and in alcohol, with acetic acid, it forms yellow
salts. In contact with animal liquids, sulphaminol, like salol, is split up into
its components, forming:: nascent sulphur and phenol.
Physiological Action. — From its nature it is inferred that it is an active
intestinal and systemic disinfectant. It is excreted by the urine, being con-
verted again into oxydiphenylamine. Professor Kobert found that in ani-
mals it is comparatively innocuous, even in doses of more than 0.50 Gm.
(or gr. viiss) for each pound of body-weight. He also declares it to be with-
nut poisonous properties when administered in the human subject.
Therapy. — Sulphaminol has ijeen tested as a disinfectant by Dr.
Schmidt, of Frankfort, in larjn^ologicnl practice, and found to be a good
deodorizer, as well as antiseptic. It favors the repair of wounds, and is said
to be of special value in the after-treatment of operations upon the nose.
Clinical observations in other fields of practice are wanting. It should be a
pood intestinal disinfectant in cholera Asiatica and summer cholera; also in
typhoid fever, dysentery, dittrrlupa, infectious dyspepsia, cystitis, etc.
STTLPHONETHYLMETHANUM (U. S. P. ) .— Sulphonethylmethanc, or
Trional.
STTLPHONMETHANTTM (U. S. R) .— Sulphonmethanc.
SITLPHONOL (B. P.).
Dose. U.G-'i to 1 Gin. (or gr. x-xv).
Pharmacology. — This is a synthetical compound, first manufactured in
Germany, by Baumann : chemic-ally it is diethyl-sulpliou-dimethyl-mothane.
It is a whitish, crystalline solid, without odor or taste, soluble in 1 00 parts of
cold water and in 18 or SO parts of hot water. It is generally administered
in hot broth, coffee, or milk. The insolubility and slow rate of absorption
of this substance, particularly when given in capsules or suspended in a
mucilage, are accountiil>le for much dic-appuintiaent in tlie use of the drug.
It was advised by D. I). Stewurt that the dose he given at bed-hour, and that
the sulphonal be completely dissolved in hoiling water, and dnmk as soon as
it has been cooled to a temperature which can be borne. At this point not
the slightest precipitation occurs. The solution, if desired, may bo flavored
with some such liqueur as crhne dc mcnfhe ("green-mint cordial"), Sul-
phonal is soluble iu alcohol, ether, and chloroform.
Physiological Action and Toxicology. — Sulphonal is an hypnotic. The
committee, of which Dr. T. Lauder Brunton was chairman, appointed by the
British Medical Association to determine the relative value of the different
hypnotics, especially with regard to the certainty of their action and question
of tolerance, reported* that sulphonal was an efficient hypnotic in doses of
* Britiffh Medical Journal, July 26, 1890; Therapmtic Oazettft Oct. 1890. p. 6S3.
d
SCLPHOVAL.
863
I
I
r65 to 1.30 Gm. (or gr. x-xx), given at night, and that it was generally well
borne, and its effects were not lost during periods of several months. In a
case of chronic gout 2 Gm. (or gr, xxx) produced no effect. In six out of ten
cases, in which 1.30 Gm. (or gr. xx) had been given, disagreeable after-effects
were noted; drowsiness the following day was observed six times, giddiness
four times, and headache and inco-ordination of gait, each twice. In seven
cases, with 2 to 4 Gm. (or gr. xxx-lx), drowsiness was noted four times, giddi-
nefis twice, headache twice, inco-ordination of gait and vomiting, each once.
Several cases showed that a second dose on the succeeding night (1.30 Gm., or
gr. xx) has a greater effect than on the first night. In some cases prolonged
use of the drug seems to diminish its effects. Thus, in a case (asthma and
bronchitis) 1.30 Gm. (or gr. xx) were given every other nieht for eight weeks.
During the first fortnight sleep came on in an hour and lasted twelve hours
each night. The drug was then omitted for a week, when the insomnia re-
turned. In the succeeding five weeks the drug, after three hours, produced
six hours' sleep. In a case of phthisis 1.30 Gm. (or gr. xx) were given every
other night for twenty-six days, except for five days, when the dose was
reduced to 0.32 Gm. (or gr. v), but afterward was increased. During the time
the patient was taking 1.30 Gm. (or gr. xx), after an hour he slept for six
hours. The drug was omitted for a fortnight, and, on recommencing it only
drowsiness and no sleep followed. In a case of neurasthenia with insomnia,
quoted by Mr. Priestly, sulphonal, 0.65 to i.30 Gm. (or gr. x-xx), did not lose
its effect during six months.
Smith, of London, finds that, while under the influence of the drug the
amount of urea and the quantity of urine are each slightly increased, no evi-
dence of marked destructive action upon nitrogenous tissues exists. Accord-
ing to Mackenzie, the phosphates in the urine are increased by small and
diminished by large doses of sulphonal.
In moderate doses the drug is completely changed during its passage
through the body into a sulphureted organic substance. Dr. William F.
Shirk, of Easton, Pa., finds that siilphona! acts especially upon the higher
nerve-centres. It produces relaxation of the muscles and a staggering gait.
Motor nerves are unaffected. Little, if any, effect was exerted upon the cir-
culation or the composition of the blood; upon the respiration the drug is
depressant. Dr. J. P. Crozer Griftith reported a number of capes where the
after-effects were more or less severe.* As a result of a review of tlie literature
of the subject and eighteen cases of his own, he concluded that the chief dis-
advantages of sulphonal are: 1. Its hypnotic action usually develops very
slowly. 2. This action is very liable to be prolonged throughout a greater
or lesser part of the following day. 3. It is difficult to determine the dose
which may be given with effect and with comfort in each individual case,
and this dose may vary at different times in the same case. 4. The drug is
liable to produce unpleasant secondary effects, which may even replace the
primary hypnotic action: chief among these are mental excitement, nausea,
Tomitinj;, dizziness, headache, languor, exhaustion, depression, and a stag-
gering gait; these symptoms may appear after large or after quite small
do$e$i. 5. It very often fails to exert any hypnotic action, either in any dose
whatever or in any amount which can be given with comfort to the patient.
It sometimes produces a scarlet eruption upon the skin, as noted by Engel-
* TKcr^xpcutie Gxuetie, May, ISOO.
864
PUARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
mann. The rash is, in some instances, characterized by severe itching. In
other cases a general pruritus has been caused without any eruption. Dr.
Hugh R. Beevor advises caution in the use of sulphonal, and believes that
it may exert a deleterious influence upon the composition of the blood. In
several cases which have been reported, the presence of ha;matoporphyrin
in the urine has seemed to depend upon the prior administration of sul-
phonal. When given daily for a considerable period, sulphonal slowly ac-
cumulates in the body and appears in perceptible amounts in the urine.
After the drug is discontinued it completely disappears from the system in
the course of two or three days.
Dr. Knaggs^ reports a fatal result on the third day, in spite of treat-
ment. The patient, after taking 31 Gm. (or ^j) of sulphonal, fell into a
stupor; pulse and respiration were slow, temperature a little elevated (lOU**
to 103° v.), and there was general and complete anjesthesia. Death resulted
from. failure of respiration.
Dr. R. R. Pettit also reports a case of death from failure of respiration
of a woman, after taking 2 Gm. (or gr. xxx). She was suffering from melan-
cholia, with hysterical manifestations. Dr. T. H. Dillingham,* however, re-
ports a case of recovery, after taking 6 Gm. (or oiss), in an elderly lady;
the symptoms noted were stupor, with slertorous respiration, pulse slow,
muscular inco-ordination, ptosis, slight facial palsy, dysuria, but no albu-
minuria. Patient recovered graduaUy in about two weeks.
Dr. Henry Waldo* reports a fatal case of htematoporphyrinuria in a
male, aged 33, after ten days of acute gastric irritation and two weeks of
cerebro-spinal symptoms and progressive toxic paresis following: a number
of daily doses of sulphonal; the writer thinks that the symptoms depend,
not so much on the direct action of the drug itself, as on chemical changes,
almost constantly alimentary in the first place, and probably hepatic, of
which sulphonal has been the exciting cause.
Symptoms produced by acute sulphonal intoxication are nausea, vom-
iting, muscular tremors, ri^^ors, paresis of the lower extremities, cutaneous
eruptions, disorders of vision, and weakened respiratory movements. The
urine assumes a port-wine color. After death, Stern found extensive necro-
sis of renal epithelium, together with minute hirmorrhages due to toxic
nephritis caused by the drug. On this account extreme caution must be
used in administering sulphonal when the kidneys are diseased. The red-
dish-brown color of the urine is due to the presence of haematoporphyrin,
but it is uncertain whether or not this substance circulates in the blood.
The presenoG in the urine of liemato-porphyrine is considered a fatal sign.
After poisoning, a trace of albumin and a few casts appear in the urine.
Most of the sulphonal is deconi|X>8ed in the body and is eliminated in the
form of ethyl sulphonie acid; but a small amount of unchanfred sulphonal
may be found in the urine. A condition of "sulphonalispi" has sometimea
been noticed after prolonged administration of this druj:. It manifests ■
itself, according to Dr. Vorster, in two stajre?. motor depressant and sensory
depressant. The latter stape is attended by dnnper on account of the cardiac
weakness which is present. This writer, who has used sulplional largely in
* Britinh ifrdical Jmtriutl, Oct. 25, 1890.
*MrdicnX Rfrord, Dee. 1.1. IRflO.
* British Medical Journal, Jure 15, 1901.
SULFUONMETHANUM. 8G5
the inBaue-asvlum at Kcinigalutter, has never witnessed any ill effects on dis-
continuing tlie remedy after its daily employment for weeks and months. In
order to avoid the occurrence of chronic poisoning, Evensen 6uggeat6 the
advisability of alternating sulphoiial from time to time with some other
h5T)notic remedy.
In a case of fleath from sulphonal Helweg found the cells of the an-
terior and posterior horns of the spinal column degenerated and their num-
ber diminished.
Dr. Lovell Gulland* has reported the case of a man, aged 39 years, of
alcoholic temperament. Owing to Insomnia, this patient had been in the
habit of taking 2 Gm. (or gr. xxx) of sulphonal nightly. In all he had taken
above 80 Gm. (or 5ii5ivss). A week before his death his gait was observed to
be staggering and his speech was thick, but this was put down to alcoholism.
When seen by Dr. Gulland for the first time he was stupid and sleepy,
though easy to rouse and intelligent when spoken to. His motor power was
greatly enfeebled and he could not articulate properly. The urine was deep-
claret colored. He died suddenly and the post-mortem examination showed
that the liver was chocolate colored, the kidneys were not cirrhotic, but con-
gested, the spleen was diffluent, the walls of the heart were very fatty, the
hlood was chocolate-colored, and the brain was congested. Microscopically
the liver showed no great change, but fatty infiltration at the periphery of the
lobules and hyaline degeneration of the walls of the portal vein were marked.
In the kidneys the secreting epithelium only was affected, the cells being
shrunken into masses of ^ninular protojjlasm; the spleen was full of "shadow-
I corpuscles*' and the suprarenal capsules showed some columns in which the
eella were pmall and shriveled. The blood showed poikilocytosis. As regards
ihe clinical svmptoms, co-ordination may be affected for weeks by the admin-
istration of a single dose. In chronic poisoning gastro-intestinal symptoms
generally first appear, nervous symptoms then appear, ataxia, paralysis of
the facial muscles, general convulsions, coma, etc. The urine containa
haematoporphyrin as well as unchanged sulphonal. The case usually ends
by heart-failure. In acute cases the symptoms may come on suddenly; the
sleep may be for days; hreraatoporphyrinuria seldom occurs in such cases.
The prognosis, as a rule, is good in acute, but not so in chronic, cases. Sulpho-
■ nal is not readily soluble, and so may remain in the intestinal canal or in the
blood for a long time, as it is not easily excreted by the kidneys. The consti-
pation which is usually present would assist in this accumulation. Sulphonal
mar cause death without producing hrematoporphyrinuria. This pigment
may be present in the urine also in cases of lead poisoning or in ha?morrhage
from the intestine, and, according to Henry Waldo, in rheumatism, pneu-
monia, enteric fever, and peritonitis, the most reliable means of detecting
hematoporphyrin in urine is by the spectroscope. The cause of death is
probably due to unemia (using the term in its widest sense). In acute
cases, 83 the poison is slowly absorbed, the stomach should be emptied
■t once and a purgative given. The kidneys should he encouraged to act
freely. Large enemata of warm water have been found useful. In chronic
caset the same remedies may be employed as well as large doses of
alkalies to render the urine alkaline and so stop the formation of hjemato-
porphyrin. Any discoloration of the urine should be t^iken as an indication
Lancet, Dec 17, 1898.
■
i
866
I'HARAIACEUTICAL THERAPEUTIC AGENTS OR DUUOS.
tn stop its use. There is some evidence that sulphonal exercises a deleterious
iuflueiioe uikui the liver, for Ihc relntiou of urea to the total nitrogen is
changed and the metabolism of the purine bodies is nlso affected, as stated
by Gushing. Sulplional should only be administered in solution; hot milk
and whisky toddy are pn'fvrred ns vehicles.
Therapy. — From the preceding summary, the therapeutic applications
of sulphonal may be readily inferred. It has been given successfully in nerv-
ous insomnia and in insanity. Dr. Vorster considers sulphonal peculiarly
beneficial in acute mania or mclnncholia, promoting sleep by night and quiet
by day. Sulphonal is of value in the treatment of delirium tremens and the
wakefulness so common in cases of addiction to opium. Dr. William H. Flint
considers it a safe and reliable hypnotic, but it is not an analgesic. It has
been introduced into the British Pharmacopceia, so that it may be regarded
as possessing established value as a somnifacient. Boettrich asserts that
0.50 Gm. (orgr. viiss) of sulphonal is generally successful in the prevention of
night-sweats. He thinks that the effects of sxdphonal equal tnose of atro-
pine, and finds the former to retain its power, the sweating being decidedly
less the nig!it after a dose has been taken. ^ Jeffries* reports chorea much
improved by the conjoined use of sulphonal and arsenic. He regards sul-
phonal as a valuable adjuvant to arsenic in the treatment of this disease.
The paroxyflm of asthma has been promptly relieved by the administration
of 1 Gm. (orgr. xv) of sulphonal. Dr. J. H. Mackay, of Madison, Neb., has
used sulphonal with advanlafre in insoumia due to influenza and alcoholism,
and Dr. Julius .Mthaus found it l)enpficial in relieving the psychoses, accom-
panied by insomniii, which occurred ns sequoia; of influonzii. Dr. Edmund
Andrews, of Chicago, states that the antispasmodic power of this remedy
is of more value than its hypnotic inftuence. He has found it of groat benefit
in arresting the muscular spasms of fractured limbs. It is useful also in
relieving the cramps of pregnant women. Sulphonal has been used with
success in cases of nocturnal emissions due to spasm of the ejaculatory mus-
cles front reficx irritation.
Dr. Julius Berenyi has reported a case of trismus neonatorum in which
sulphonal was successfully employed. The remedy was administered in the
dose of 0.20 Gm. (or gr- ii.i) i^i an enema and also given by the mouth. On the
sixth day of treatment the paroxysms had completely disappeared. Alto-
gether 10 Gm. (or Siiss) were employed without the occurrence of somnolence
or disagreeable after-effects.
It serves a useful purpose in quieting the irritability due to teething,
preventing convulsions and producing peaceful sleep. Sulphonal is bene-
ficial in epilepsy. This remedy alleviates obstinate hiccough and has been
recommended as a preventive of seasickness. The lute Dr. A. J. C. Skene suc-
cessfully employed sulphonal as an hypnotic after laparotomies, and it may
be given with the same object after other surgical operations, provided that
severe pain is not present.
Casarclli has made use of Fulphonal in tlie treatment of diabetes mcllitus,
upon which he observed this drug to have a favorable influence, gradually
lessening the quantity of sugar. The amelioration is evident after the remedy
has been used for several days in doses of 1 to 2 Gm. (or gr. xv-xxx) per diem.
1801.
^Therap. MonfiUhrftf, March. 1890; Amfricnn Practitioner and Nttcs, Jan. 31,
' Weekly Medical Revieto.
BULPHONETUYLMKI'UANIM.
8t>r
the dose of 3 Gm. (or gr. xlv), long continued, it produced a condition of
lethargy and sometimes delirium. But if intermitted for a day, or if the dose
be diminished, these manifestations cease. If the drug be abandoned the
sugar soon reappears.^
SULPHOireTHYLMETHANUM (U. S. P.).— Sulphonethylmethane.
Dose. 1 to '2 Gin. (or gr. xv-xxx).
Pharmacolo|^. — ''Difthyl-sulphon-methyl-ethyl-mothane is a product
of the oxiiJiUion of the menaptol obtained by the condouHation of methyl-
eihylketone with ethylniercaptan.'' It is known under the trade name of
trional. Totronal and trionnl are allied to Bulplional. liaving the same
ll^t'ral formula, except that, whereas sulphonal contain? only two ethyl
groups, trional and tetmnal contain thrive and four, respectively.
Trional occurs as brilliant tabJeta, tetronal as brilliant tablets and scales.
Both substances have a bitter taste, that of tetronal being, at the same time,
camphoraceous. Trional is devoid of odor, is readily soluble in alcohol and
ether, sparingly soluble in cold water, and is best administered in warm
water, milk, soup, or tea. Trional melts at 76* C. (168.8° F.). Tetronal dis-
solves in alcohol and ether, but is less soluble in water than trionaL
Baiimann and Kast have published the results of a number of physio-
logical experiments with compounds allied to sulphonal, from which they
drew the conclusion that the hypnotic action of this class is a function of
the ethyl groups in the compound, and proportionate in intensity to their
number, and that the SOa group exercises no influence in this direction.
These results were so suggestive that Berth and Rumpel repeated the ex-
periments clinically and on the human subject. The results obtained corre-
sponded to the observations made upon dogs only so far as to demonstrate
that tetronal and trional actually possessed hypnotic properties, but they did
not confirm the theory, since practically the same doses were required in order
to produce the same effects as those of sulphonal, instead of one-half to
two-thirds, as might have been expected. These agents might be useful in
ctaes where sulphonal cannot be taken. No injurious effects were observed
in any of the two hundred and twenty cases in which trional •and tetronal
wen^ adminiptcred.^
The use of trional, even when continued for a considerable period, has
seldom been productive of evil consequences, or established a habit. Its
disuse, moreover, has not been followed by any manifestations, except, pos-
sibly, the return of the insomnia for which it was originally given. It has
bttle or no influence upon the action of the heart. Schultze has, however,
r(?portt»d* a case in which trional had been given every night for four or five
weeks. The patient was a woman afflicted with melancholia and sleepless-
oes. Toward the end of the period named her condition, without apparent
caime^ became aggravated, the urine assumed a dark-red, almost black, color,
which wa« demonstrated to he due to the presence of ha?matoporphyrin. Dr.
Stuiirt Hurt* refers to certain rare and important sequclse following the use
I
*AHnaU*a de TfUraimttique yedico-CMfvrgictUe, Sept., 1800.
* i*h»iimar,uti> til Jtmrunl and Tranm^tions, Aug. 30, 1800, and Tkerafneuiio
ite, Oct. 16, 1890, p. 700.
* f}eut»f*hr ninltcinU^hr Wof*hrH»fhrift, P«b. 15, 1^04.
* American Joutnnl of Ihr Mf^icnl Sci^twts. April. 1901.
868
PHAHMACECTICAL TllEttAPECTIO AGENTS OH DRUGS.
of trional in doses of 1 Gm. (or gr. xv) every alternate day for two months.
The patient, a woman, aged 50 years, at this time was seized with sudden
gastro-intestinal irritation, followed by hiematoporphyrinuria and cardiac
disturbances; a few casta and some albumin were found in the urine. The
nerve-disturbance took the fonn of a peripheral neuritis leading to foot-
and wrist- drop on left and right sides; cerebral toxaemia — viz., periods of
delirum, mental confusion, and hallucinations of time and space — was also
noted. The patient lost flesh and had slight cedema of the ankles and con-
siderable physical weakness. Recovery followed in about twelve months. It
is, therefore, advisable that, in every case where trional is continuously given,
the urine should be carefully watched. From experiments upon animals, Dr.
Otto Bakofen determined that trional is toxic only in massive doses given
continuously, or with short interruptions. In his investigations he never
found any changes in the kidneys or observed hcematoporphyrinuria. Both
tetronal and trional have a slight cumulative action. When excessive doses
have been taken as a result of accident or from suicidal intent, the stomach
should be emptied, or, if free absorption has taken place, elimination should
be hastened by the use of diuretics, and stimulants should be administered.
Copious eneiuata of warm water are useful. In chronic poisoning by buI-
phonal or trional, it is only necessary to withdraw tlio drug, and to give
restoratives.
Therapy. — In delirium tremens, tetronal is less ethcient than sulphonal;
but, as an hypnotic, tetronal was found, in 14 cases out of 30, superior to the
latter drug, in (5 cases equal, and in only 4 inferior. Trional in 17 cases was
superior, in 6 cases equal, and in 7 inferior. Barth and Rumpel conclude
that the indications for the use of these compounds correspond with those of
Bulphonal, and in certain nervous conditions which ore refractory to this
drug the others may prove more effective, or, at least, are useful substitutes.
Dr. J, B. Mattison, of Brooklyn, has found trional of advantage in the treat-
ment of the opium, chloral, or cocaine habit, and regards it as the most pow-
erful hypnotic at present at our command. In accord with other observers,
he has failed to find it useful as an anodyne, but states that in painful con-
ditions a combination with codeine or phenacetin will often produce an
excellent result.
Dr. William Mabon, of the State Hoapital at Utica, N. Y., concludes
that both tetronal and trional possess decided hypnotic and sedative power.
Trional appeared to be of superior value as an hypnotic for the insane, but
tetronal seemed to give the best results as a sedative. The efficacy of trional
is principally displayed in simple insomnia occurring in functional or organic
nervous diseases. Trional caused sleep in most cases of alienation accom-
panied by moderate or severe excitement, but was without effect upon the
mental condition. In some insane epileptics, though trional was without
effect upon the frequency or severity of the paroxysms., it shortened the post-
epileptic delirium. According to some writers, trional is contra-indicated in
melancholia, hypochondria, or whenever mental depression is present. Tri-
onal given by the rectum in a somewhat increased dose has likewise proved
efficient. Koppers states that a dose of 0.S5 to 0.50 Gm. (or gr. iv-viij) of
trional is of value in rostraining night-sweatp. Snlphonal and trional have
the same theriipeutic action, except that trional is a little stronger. They are
safer than chloral hydrate, or any remedy containing the element chlorine,
especially in cases of fatty degeneration of the heart.
suLrnun.
869
I
I
SULPHTm.— Sulphur, Brimstone.
Forms and Preparations.
Sulphur Lotum (U. S. P.). — Washed Sulphur (sublimed sulphur thoroughly
stashed with water). Dose, 2 to 15.6 Gm. (or 388-3ss)-
Sulphur Sublimalum (U.S. P., B. P.).— Sublimed Sulphur, Flowers of Sulphur.
Dose, 1.30 to 4 Gm. (or gr. xx-3j).
Sulphur Prrecipitatuin (U. S. P., B. P.). — Precipitated Sulphur (sublimed sulphur
treated with Unie, hydrocliloric acid, and boiling water). The preferred form for in-
ternal ftdniinistrfttion. Dose, 2 to 8 Om. (or gr. xxx-3ij).
Sulplturis lodidum (U.S. P., B. F.).— Sulphur Iodide. (Iodine, 80 per cent)
Dose, 0.03 to 0.25 Gm. (or gr. ss-iv).
Unguentum Sulphuris (t. S. P., B. P.). — Sulphur Ointment (washed sulphur,
15, benzoiiiated lard, 85 parts; U. S. P.; sublimed bulphur. 1; b«nzoinated lard, 4
Gm., B. P.).
Pulvis GlycyrrhizH? Corapositua (U.S. P., B. P.)- — Compound Powder of Glycyr-
rhiia (contains washed sulphur^ S per cent.; B. P., sublimed sulphur). Dose, 4 to
8 Gm. (or 3i-ij).
Unguentum Sulphuris lodidi (B. P.). — Sulphur-Iodide Ointment (sulphur iodide,
2 Gm. ; glycerin, 2 Grn. ; benzoinatcd lard, 4*1 Om. ).
Trochiseus Sulphuris (B. P.). — Sulphur Xjozenge (each lozenge contains 0.32 Gm.,
or gr. v^ of precipitated sulphur).
Confectio Sulphuris (B. P.).— Confection of Sulphur (sublimed sulphur, 100 Gm.;
acid potaasium tartrate, 25 Gm.; tragacanth, 1 Gm.; eyrup, 50 o.cm.; tincture of
orange, 12.5 c.cm.; glycerin, 37.5 c.cm.). Dofte, 4 to 8 Gm. (or 3i-ij).
The Rulphite. thiosulphate, and phenolbulphonute of sodium are official, the
biftulphite in the U. S. P. only. (See Sodium.)
Pharmacology. — Sulphur is a non-metallic, solid element, found native
in Sicily and Iceland in the neighborhood of extinct volcanoes; it is widely
distributed in combination with metallic bases as sulphides, especially of
iron, copper, lead, mercury, etc. It is of a lemon-yellow color, tasteless, odor-
lees, and brittle. At a temperature of 111.5'* C. it melts into a brownish-
yellow, transparent liquid, which crystallizes on cooling. It is dimorphous,
haring^ two distinct forms of crystals. Sulphur is insoluble in water, but
very slightly soluble in alcohol, ether, and benzene; its best solvent is car-
bon disulphide. It is likewise soluble in the oil of turpentine and in alka-
line fluids. It has powerful chemical affinities, and in combination with
03cygen forms sulphurous and sulphuric acids, which, with bases, form sul-
phites and sulphates. Sulphur is an important constituent in certain native
mineral springs, which furnish sulphureted waters. In this place the action
of sulphur need alone be considered. The sublimed sulphur contains a trace
of free acid, which makes it slightly irritating, and, when taken into the
intestines, it occasionally causes griping. Owing to its insolubility in water,
stilphur, either washed or precipitated, has no effect upon the skin, although
when kept in contact with it for some time it may be partially oxidized, form-
ing sulphurous acid, which is an energetic disinfectant. In the alimentary
canal, the pure sulphur acts as a laxative, partly as a result of chemical
change (since hydrogen-sulphide gas is formed in considerable quantity,
and sulphur compounds are found in the blood) and partly mechanically as
ft dry powder. By the interaction of hydrochloric and hvposulphurous acids
Engel has lately succeeded in producing two new allotropic forms of sul-
phur. One of these appears as orange-yellow crystals of the rhombohedral
type which differ absolutely from any other form of sulphur hitherto known.
The second occurs as yellow flakes entirely soluble in water. The solution
decoropoees rapidly, giving rise to the ordinary amorphous sulpKur.
870
PHJ
The recognized ftulpliides are Calx Sulpburata (U.S. P., B. P.)» commonly ini»-
named sulphide of calcium (consisting chie^y of calcium monoeulphido and calcium
sulphate, in varying jirdtMirtitufi) : Aiuiinoiiii Sitlpliiduni: Aiitimoiiiiini Nigrum
l*iiriticatum fB. P.); Anlimuiuuni Sulphurutum (B. P.); and Pota^^sa Sulpburata
(B. P.).
Oil of Sulphur is tlie popxilar nam** of a preparation nuidp by boiling olive-oil,
8 parts, and 1 part of suhlinted sulphur tngcther in an iron pot until a uniform mixture
is obtained ; according to the old Edinburgh Pharmacopoeia, it was also known as
balsam of sulphur. The oil is partly decomposed, and the resulting preparation has
aji extremely fetid odor and acrid Uistc. The German Phannacopceia has a similar
preparation, made with linseed- instead of olive- oil.'
Spirit of Sulphur, or liquor fiimnns (Boyle), is the nome applied to a preparation
resulting from adding washed eulphur. 1 port, lo concentrated ammonia, 6 to 8 parta,
and passing hydrogen sulphide through the mixture until the sulphur is dissolved.'
Ichthyol contains a large proportion of sulphur.
Washed and prfcipitnted sulphur should rontain not less than 99.5 per
eent., and sublimed sulphur not k-^s than L'y jkt cent, of pure sulphur
(U. S, P.). Sulphur is a coii^titut'nt of the vvdiitilf oils of mustard. gariiCj
and asnfetida. It also onterr* into alUuniin and other protoid substance?.
It constitutes a large part of certain bacteria and algie. At least six ervRt-aU
lizable iiiadifications of suljyhur an* laiowiu and one amorphous. The latter
is insoluble in carhon dinnlpliidp. luit the crvtitaili* are s^ohddc. Both arc in-
solulde in water. The fumes of burning sulphur were formerly used as an
antiseptic for disinfection; hut tliip it? now nceoniplished better with for-
maldehyde.
Phyiioloirical Action. — The fact that sulphur enters the blood from
the small intestine is shown by its chemical effects upon silver coins or
jewelry worn by persons while taking it; secondly, by the physiological
effects, its appearance in many secretions; and, thirdly, its therapeutic re-
sults as an alterative. The intestinal secretions are moderately increased by
it, as well as the peristaltic movements, and the stools are rendered softer.
It is believed to exert a stimulant effect upon the raucous membrane and
skin, and strontr applications in the form of nn ointment bring out an enip-
tion of an eczematous character. Erythema, papules, or pustules are also,
in some cases, produced either by the external or internal use of this sub-
stance. Sulphur is excreted principally by the bowels, but also by the skin,
the perspiratory and the milk glands, and by the urine; in the latter it usu-
ally appears as a sulphate, in the others it is in the form of hydrogen sul-
phide. Sulphur plays an important part in the normal physiological proc-
esses of the body, bein;a: a constant constituent of albumin, and present in
nearly all the solids and fluids of the body. From this fact and others, we
are led to believe that su!phur is essential to the health of albuminous or-
gans and tissues., and is an important element in nutrition. The antiseptic
and germicidal effect of sulphur may exercise an important prophylactic
influence in preventing, under ordinary circumstances, the invasion of the
tissues by micro-organisms. A number of observations have been published
relative to the absorption of hydrogen-sidphide gas by the intestinal mu-
cous membrane and its passage into the blood, to be carried to the lungs,
where it escapes from the bronchial mucous membrane and acts as a local
disinfectant. This gives a hint of the unsuspected r61e. plaj^ed by sulphur,
of a pulmonary disinfectant and expectorant, in addition to the property,
^ DruffffifttH* Cir<*uJar, Jan., 1991.
* Dt^ffffista' Circular^ Jan., 1801.
SULPHUR,
871
»
for which it is already valued, of an intestinal disinfectant. It probably,
after absorption, favors the bile-producing function of the liver, since tauro-
cholic acid normally contains a iar;;e proportion of sulphur. Upon the cir-
colation, no direct effect is noticed, but it is believed that it increases the
heart's vi^ror, as it does that of muscular tissue in the arteries and in the
Tarious hollow viscera, as well as the volunuiry juuseles.*
Therapy. — Sulphur is used in a very large number of diseases externally,
and often with marked curative action. In acute infectious disorders (diph-
theria or scarlatina, for instance), the flowers of sulphur may be insufflated
into the throat or nose with marked benefit, limiting the spread of the dis-
ease, destroying the micro-organisms, and preventing blood-poisoning. In
scarlatina, erysipelas, measles, and small-pox, an ointment containing sul-
phur moderates the heat of the skin, allays congestion or inflammation, and
disinfects the pustules of variola. Dr. Iscar advocates the use of sulphur
internally in variola and gives to children 0.13 Gni. (or gr. ij) every hour in
a mixture of glycerin, orange-water, and syrup. Mr. J. B. Josset has em-
ployed sulphur-baths in the treatment of whooping-cough for fifteen years
with favorable results. The proper quantities for children are: From 3 to
12 months, V2 ounce of potassium sulphide to 10 quarts of water (15.5 Gm. to
9 Vi litres); from 1 to 2 years, V4 ounce to 15 quarts (23.3 Gm. to 14 litres);
from 2 to 4 years, 1 ounce to 2-4 quarts (31 Gm. to 22 V^ litres); from 4 to 6
years, 11 drachms to 30 quarts (42.5 Gm. to 28 litres); from 6 to 8 years, 14
drachms to 3S quarts (54 Gm. to 35 V^ litres); from 8 to 10 years, 2 ounces
and 3j to 45 quarts (Ofi Gm. to 42 litres). The temperature of the bath should
range from 96.4° to 97.8° (F.), and its duration should be from 25 to 45 min-
utes. The patients take one bath daily, and after the bath they are wrapped
up in hot towels and woolen blankets. Recovery usually takes place in two
weeks. In addition, an antimonial and sedative cough-syrup is used to quiet
the paroxysm. The use of baths containing potassium sulphide, or a resort to
a sulphur spring, are also of great value in gyphilis. In very many integu-
mentary inflammations, especially chronic eczema and psoriasis, sulphur
alone, or combined with other drugs, will lessen the congestion and over-
come the infiltration of the parts. It is often employed with advantage in
chronic acne and rosacea, but great care should be exercised in applying it
upon the face, especially if the sebaceous glands are in a patulous condition.
If brought in contact with the skin under the latter circumstances, the glands
often become filled with sulphur and occasion many black points (acne
punctata) upon the skin. The following formula are useful in acne, espe-
cially of the face: —
B ^^ulphiirift loti 41 Gm. or Sj.
Olyoerini 7 5 c.cm. or fSij.
AqufE roMt q. a. ad 30( c.cm. or fjj.
M. Si(f.: Apply with a soft sponge at night, after evacuation of pustules and
th« local use of hot water.
B Sulphuris Bublimuti,
I'ulv. iimrantffi,
SaloliB
I'ngt. ztnci oxidi
M. Si^. : For acne ; apply once or twice daily.
«a 41
... 811
* S*e paper by nnthor on '*The Physiolopical and Therapeutical Action of Sul-
pfaur," "Transactiona of the Pennsylvania Stiite Medical Society." 1800.
Gtn. or 3j
Gm. or 5j
872
PUARMACEUTIOAL THEtUPECTIC AGENTS OR DHUG8.
In alopecia, especially the circumscribed variety, sulphur often acts well
in assisting to restore the growth of the hair. In very many diseases of the
akin, especially those of a parasitic nature, this agent can be used more
effectively in the form of a sulphur-vapor bath. Sulphur is very largely em-
ployed as an external remedy in scabies, but it is also excellent for pediculo-
sis, tinea capitis, barbae and corporis^ and tinea versicolor. As a germicide,
its effects are most evident when combined with oxygen, as sulphurous-acid
gas. In treating scabies, ntj permanent result should be expected, unless
measures are taken to prevent reinfection by the parasite. The undercloth-
ing must be destroyed, or, at least, exposed to an elevated temperature for
several hours, and thoroughly washed with soap and boiling water. The
patient should take a warm bath, rubbing the interdigital spaces and flexures
of affected points thoroughly with potash or soft soap. After the bath the
following ointment may be rather freely applied to the affected spots, or
where itching is experienced, and allowed to remain until morning, when it
may be wiped off: —
3 01. cadinl 4
Un^. siUphurit 8
Adipis lanw 19
M. 8ig.: Apply at night, u directed.
ccm.
Gro.
Gm.
or f3j.
or 5ij.
or 3v.
4
A repetition of this treatment, once or twice, may effectually relieve
the patient of his parasites. When the sulphur ointment is used it some-
times causes an eczematous eruption, which may be avoided by diluting the
preparation. lu junlii ulnsis of (]te IhkIv, n siinilnr treatiuoiit to the above is
generally effective, providing the clothing be changed at the same time.
In either of the preceding cases the cure is not to be attributed to the direct
parasiticide effect of sulphur, but is owed to the fact that it makes a dense
and tenacious substance with lard, which suffocates the itch-insect. Indeed,
the late Professor Leidy was of the opinion that the sulphur is^innecessary,
as the oil would block up the air-pores of the acarus just as well without it.
Sin W. Arbuthnot Lane writes that he employs sulphur with decided
advantage as a surgical dressing in tuberculosis of joints and bones and also
in otiier infectious processes. The action is rendered more uniform and less
violent by mixing it with glycerin. This emulsion is allowed to remain in
the cavity for twenty-four hours, after which the seat of disease is irrigated
every day by a weak corrosive-sublimate solution or the sterile normal saline
fiolution. The same method is elHcacious iu the foul impetiginous ulcers
of rliildren. Finely-powdered sulphur is dusted upon a piece of gauze
which is applied to the ulcerated surface fur an hour or two, after which
the lesion begins to heal rapidly ; in some cases several applications may be
necessary. He hap. ninreovpr, found sulphur boneficial in the foul ulcerative
stomatitis so coinnion iu the cliihlren of the poor.
In sciatica, H. G. do ^Inssy t^nvelope the limb in a cloth containing a
thick paste of the flowers of sulphur. One night is sufficient to relieve the
patient. The urine acquires a very strong odor of hydrogen sulphide. L.
Duchesne also reports success with this in a case of several years' standing.*
Friction with sulphur affords relief in obstinate cases of chronic rheumatism.
Internally, sulphur is used as a simple laxative, especially combined
"Annual of the Univeranl Medical Sciences/* 1890, vol. r, page A- 144
SULPHUE.
yriih potassium bitartrate, in afTections of the lower bowel, irritable piles,
ritricture, lissure, or fistula. By relieving engorgement of the ha?morrhoidal
hve&eels, sulphur proves useful in cases of bleeding Irom piles. After opera-
tions upon the pelvic organs it is the best laxative to administer. The dose
ordinarily need not be more than 0.32 to 0.65 Gm. (or gr. \-x) daily in order
to insure a free evacuation of the bowels, and if it is continued for sonie time
we obtain valuable systemic effects. In chronic sore throat, associated with
L«r springing from indigestion, these small doses of sulphur, with some atten-
Ption to hygiene, will effect a cure. In digestive dilhculties due to disordered
action of the liver, which ultimately lead to lithftmia and structural lesions, '
the habits of life must first be corrected, and the hepatic torpor will then be
overcome by small doses of sulphur. Dr. Garrod has reported remarkable
Lrelief from obstinate hepatic colic by the daily use of a 0.3)^ Gm. (or gr. v)
^uiphur lozenge, persisted in for months. In hepatic disorder attended by
constipation, it may be well to administer a mercurial purge to initiate the
treatment, before giving the tonic doses of sulphur. Dr. Schulz recommends
the use of sulphur in certain cases of chlorosis. When iron is inefficient or
.cannot be tolerated the general condition is decidedly improved by sulphur,
■Uid after this remedy has been used for some time the iron eon be resumed
with success. He regards it as of no avail when chlorosis is complicated with,
catarrhal and inflammatory conditions of the digestive tract. The remedy
ehould be given in small doses.
Minuie amounts of sulphur sometimes do good in diarrhoea, especially
in cases of offensive watery stools of scrofulous children and in dysenteric
diarrhipa. As sulphur stimulates mucous membranes, it is useful in chronic
bronchitis, as Graves long ago pointed out in his clinical lectures. For this
purpose sulphureted mineral waters and the springs from which they flow
are justly celebrated.
This remedy is especially suitable to the chronic bronchitis, accom-
panied with copious secretion, of aged and debilitated persons. In whoop-
LiDg-cough, small doses of sulphur lessen the paroxysms; and the following
llormula, as modified from S^e^ may be administered: —
B Sulpliuns praecip 3 26 Gm. or rt. I.
m Ext. boIlaMoiinn' folior
m Pulv. ipecaruanhfe et opU
r Sarchari nibi 1 ;
M. et ft. capsule vel chnrtulie no. x.
Sig. : From two to ten oapeules or powders a day, according to the age of patient
and eflTcct produced.
f Garrod suggests that sulphur may be of service in cystitis, and, perhaps,
nn some disorders of the kidney. It might very properly be tried in tuber-
cular or gouty pyelitis, and likewise in disordered menstruation, when largely
or entirely functional in character. In muscular pains, attending lithffimia,
^ont, and rheumatism, Garrod employed small doses of sulphur in conjunc-
Ltion with iodine or arsenic, and he reported great improvement from this
ffreatment, even in rheumatoid arthritis. This remedy is alpo of avail in
those cases of neuralgia dependent upon the rheumatic diathesis. Sulphur
has not, hitherto, given very positive results in tuberculosis. Arbuthnot Lane
has given it as an intestinal disinfectant in anthraca?niia. The continued
administration of fractional doses of sulphur is often benefioial in seborrhcpa,
sycosis, chronic eczema, psoriasis, and other cutaneous diseases, especiallv
26 Gm. or gr.
065 Gm. or gr. j.
32 Gm. or gr. ▼.
30 Gm. or gr. xsl
BH
PHARSfACEUTICAL THERAPEUTIC AGEKT8 OR DHUOS.
when the upper hiycr of thi? skin and the glauds are iuvolvi'd. lii alopecia,
small doses of Bulphur will often increase the activity of the hair-forming
apparatus, and may also assist in restoring the hair to the parts. In diseases
of the nails, especially when they hecome brittle, covered with ridges and
white six)ts, the eoatinucd use of small doses of sulphur will frequently
bring nbout a healthy and polished appearance of these useful appendages.
For internal administration, calx Rulphurata is preferred to sulphur, on
aeeomit of its greater solubility. It is of special value in acne, given as a
pilL <i/i3 Ctui. (or gr. '/s)* several times a day. So-called volatile spirit of
sulphur was fonuerly believed to be a jmnacea in syphilis, rheumatism, dia-
betes, and cnnsumption, in doses of iM8 to 0.24 c.cm. {or j/tiii-iv), well
diluted. It ifi nuTely a solution of nmuionium j:ui[>hitle, and might be given
in larger do^os witluiut iloiug either mm Ii hnrm or good to the patient.
Sulphur has been highly esteemed as a fumigating agent for rooms
which have been occupied by patients suffering from contagious disorders.
Doubts have beon thrown upon its value as a disinfectant by the experiments
of Koch and Sternberg. These, however, related to the power of the gas
in disinfecting apartments and large masses of material. The gas was rap-
idly lost by diffusion and was found to have slight influence upon dry spores.
The investigations of Thoinot demonstrate that, while the anthrax bacillus
ifi resistant to the action of sulphur, the organisms of tuberculosis, glanders,
typhoid fever, cholera, and diphtheria are destroyed by the fumigations.
Associated with live steam, the fumes of burning sulphur are used with
marked advantage in disinfecting ships at quarantine and infected rooms.
The fact that plague is conveyed by rats has led to the introduction of the
following method of deetroyiug them in ships: Sulphur-dioxide gas is gen-
erated in a chamber in which sulphur is spread on a wire netting in the pro-
portion of 1 pound to every 250 cubic feet required. The sulphur is ignited
with the help of alcohol and the gas is pumped into the bottom of the space
to be treated. A pipe from the top of the ?pace brings air back to the gen-
erator. The oxygen in the treated space — for instance, the hold of a vessel
— is thus gradually replaced by SOo. This gas, being much heavier than air,
diffuses slowly, and the rats retire before it. When the hold is opened they
are found dead at the highest parts: those nearest the exit pipe. This is im-
portant, because otherwise rats may die behind partitions. The only draw-
back of this method is the tarnishing of gilding.'
Thiuret. — This name is given to an oxidation product of phenyl-
dithiobiuret, and occurs as a crystalline, odorless powder, insoluble in water,
but freely solulde in alcohol and ether. Wlien mixed with alkalies, sulphur
is disengaged in the nascent state. On this account thiuret is possessed of
energetic antiseptic properties.
STTMBin <TT. S.
P.). SUMBUL EADIX (B. P.).-
Prepantiions,
-Sumbul-root.
Extractum Sumhul (U. S. P.).— Kxtrnct of Sumbul. Dos*. 0.30 to 1 Gm.
( or gr.' v-xv ) .
FIui(lcxtm<>tiun Sumbul
com. (or nixv-f3j).
Tinctiirii Siimbul (B. P.)
to 4 c.cm. (or fSss j).
I
(U.
Dose, 1 to 4
S. P.).— Fluid Extract of Sumbul.
-Tincture of Sumbul ( 10 per cent. ) . Dos*'. 2
' Journal of the American yedtcal AsnodaHon^ May 18, 1901
SYMPHYTCM.
875
I
Pharmacology. — Sumbul is the dried rhizome and rooU of an un-
known plant «>i the family Umbellifera?, growing in Asia. In commerce the
root is in dried, transverse slices, has a decided odor, resembling musk, and
A soniewliat bittt^r, balsamic taste. It contains two ncidg, angelic and val-
erianic, two balsamic resins, a volatile oil, bitter extractive, etc.
Fhysiological Action. — In its effect upon the nervoiis system sumbul
resembles valerian, and is an efficient nerve-tonic. In small doses it stimu-
lates the appetite and facilitates digestion.
Therapy. — Sumbul is of value in hysteria and neurasthenia, in an»mic
women. For sucli caflea Goodell prescribed : —
B Exu sumbul,
Ferri Bulphatit exaiccat. na
Piilv. asafcetid^B
Arsenii trioxiili . ,
H. et ft. piluloe no. xx.
Sig.: Take one, thrice daily, after meals.
1130 Gm. or gr. xx.
6fi Gin. or pr. x.
{03 Gm. or gr. bs.
Sumbul 18 useful, moreover, in the treatment of neuralgia, functional
irregularity of the heart, restlessness^ the insomnia of chronic olcohohsm,
and nervous dyspepsia. As most of these disorders are associated with im-
paired nutrition and sluggish movement of the bowels the author has, in
^ many instances, associated it with nervine and laxative remedies, as in the
■ following combination: —
R Extmeti sitmhiil.
Pulv. asafoetido! aa
Ext rhamni pureh
Aloin
Ext. nucia voni
Oleoresinee zingiberiB
M. et ft. pil. no. j. Mitte no. xxiv.
8ig.: One or two pills to be given at a dose.
Mo Gm.
or gr. j.
03 Gm,
or gr. 88.
WW Gm.
or gr. v.*
008 Gm.
or gr. v..
OIB c.cm.
or m 7i.
This preparation promotes the action of the liver and bowels, impoves
mtrition, allays irregular nervous manifestations, and is beneficial in de-
pressed or excitable conditions of the nervous system.*
The tincture may be given in hysteria, chronic bronchitis with spas-
modic cough, also in delirium tremens, as a substitute for musk. By Russian
practitioners, sumbul is esteemed a valuable stimulant in typhoid fever,
atonic dyspepsia, asthenic diarrhoea, and dysentery. Dr. Granville, who in-
troduced this remedy into England, recommended it in epilepsy and dys-
nienorrho?a. Phillips testifies to its decided efficacy in facial, sciatic, or
ovarian neuralgia occurring in women of a quick and lively nervous tempera-
ment. He has seen it useful, also, in certain stages of phthisis, in the rest-
lessness of pregnancy, and the insomnia of chronic alcoholism. It is essen-
tial that a fresh specimen, in good condition, should be employed in making
the tincture, in order to get any results.
SYMPHYTUM.— Comfrey. The Svmphytum officinale (Boraginacese),
A small herb of Europe and the United States, has a root possessing some
medical properties. It contains some Aipara^^, a large amount of mucilage,
and traces of tannin. It is used in decoction.
» yt^ioal Bullrtin, May. 1893. p. 172.
87(> PUARilACEDTICAL THEHAPECTIC AGENT8 OU DRUOS.
Physiological Action. — The asparagin has little, if any, physiological
effects beyond slight diuretic action; but the mucilage makes it demulcent
and slightly astringent. The pulp of the root has been utilized as a means
of stiffening bandages applied to fractures.
Therapy. — The fresh root, bruised and cut, is applied to wounds, bruises,
cracked nipples, etc. Internally the decoction is given in diarrhoea, dysen-
tery, pulmonary affections, and other relaxed conditions of mucous mem-
branes. It is utilized for the purposes to which marshmallow is ordinarily
applied, in domestic cough-mi^itures, etc.
^ SYRUPTJS TOLUTANTJS (U. S. P., B. P.).— Syrup of Tolu.
^^^ Dose, 4 to U"> i\om. (or oi-iv).
^^B An agreeable addition to, or vehicle for, cough reraediea.
^^ SYZYGrUM: JAMBOLANUM. (See Jambol.)
■ TABACUM.— Tobacco.
■ Pharmacology. — **The commercial, dried leaves of Nicotiana Tabacum"
I (Solauacea*), indigenous to tlie southern portions of this country and culti-
B vated in different parts of the world, are no longer official, and have no official
H preparations. Carried to Europe by the Spaniards, it Avae taken to France,
H in 1560, by the French ambassador, whose name, Nicot, is preserved in the
■ generic title applied to the plant. Its active principle is a hquid alkaloid,
I Nicotine, tlie poisonous principle, which was discovered in 1828, by Posselt
H and Keinianu. The fumes, when burning, contain pyridine, hydrocarbons
of the aromatic series, small amounts of creosote, hydrocyanic and acetic
acids, sulphur and carbon compounds, and certain gases, but little, if any,
I nicotine, which is decomposed by heat (Zcisc). The existence of Nicotianin,
a caniphoraccoua substance, h«s bct^n atlirmcd by IIennbstiidt» which is held
to be chiefly responsible for tlie flavor or aroma of the tobacco, as it occurs
only in dried leaves. Fliickigor found about 10 per cent, of potassium ni-
trate, chiefly in the Ptems and veins. Potassium malate is also present.
Slight differences in composition exist in specimens grown in different
places, as it is well known that the variation in flavor and quality is very
decided. The best tobacco is grown in Cuba and Virginia. The Turkish
variety is almost free from nicotine, and is very mild. In the East, the
tobacco is sometimes tinctured with opium, in order to increase the narcotic
effect. The percentage of nicotine vario^ in different tobaccos (generally 2
to 8 per cent),
Fhysiological Action. — Toljaccu i& u nai ro-narcotic poison, acting,
as is well known, in small doses, upon persons unaccustomed to its use. It is a
nauseating emetic, its action bring accompanied by great muscular relaxa-
tion; the respiration and circulation are depressed, the temperature lowered,
and the surface becomes cold and moistened with perspiration. It is a stim-
ulant to the salivary and intestinal secretions, increases the peristaltic move-
ments of the bowel and the flow of urine and perspiration. From experi-
ments upon seven healthy persons unaccustomed to smoking, Dr. J. Ydan-
Pouchkine found that tobacco diminishes the quantity of free hydrochloric
acid in the gastric juice ae well as the digestive power of the fluid, retards
the action of pepsin, increases the movements and absorbent power of the
stomach. Tt is withont influence upon the acidity of the urine. The mus-
cles, which at first are relaxed, may be seized later by tremor or clonic spasms.
TABAOUM.
877
t
I
I
even tonic contractions, followed by paresis of a transitory character.
The nervous system is early affected by the drug. The motor nerves are
paralyzed progressively from the periphery to the central organs; there are
no marked effects upon the sensory nerves. Tobacco increases the excita-
bility of the heart by a direct action upon its intrinsic ganglia. The spinal
and cerebral centres become affected, and inco-ordination, a staggering gait,
and vertigo are prominent symptoms of the toxic action. Finally, collapse
and death may occur from paralysis of the heart or of the respiration. Sim-
ilar results also follow the inhalation of tobacco-smoke, though generally
they appear in a much milder form than when the drug is swallowed. Poi-
soning has also followed the application of tobacco-leaves to a wound, in
the case of a child twelve vears of age. Nicotine is a most active poison,
res4*inbling hydrocyanic aei(^ in the rapidity of its fnUl effects. Eight drops
will kill a horse; two drops will kill a dog. It afferts both the heart and
the blood-vessels, and nmy produce coronary spasm and angiha pectoris. This
is especially the case in old smokers (Peter). Nicotine retards the absorp-
tion of oxygen by the haemoglobin, and hinders haematapoiesis. The nervous
and arthritic are said to be more susceptible to the toxic effects. In a small
dose tobacco stimulates the spinal cord, bulb, and pneumogastric, but large
doses paralyze the vagus. Georges Petit considers that its action renders
the organism more susceptible to infection, and especially to tuberculosis.
The use of tobacco in the form of snuff, or by chewing or smoking, is almost
universal, and extends to xmcivilized and civilized alike, and is especially
prevalent among the robust and those who lead an active life. Occasionally,
from smoking an unusually strong cigar, or too many of them, there is
nausea and vertigo, even in practiced smokers. In such cases, a stimulant,
such as aromatic spirit of ammonia or cnnipound spirit of ether, promptly
alleviates the distress.
According to the records of the senior classes of Yale College for a
period of eight years, however, those who used no tobacco were 20 per cent,
taller than the smokers, 25 per cent, heavier, and had 66 per cent, more lung
capacity.
Poisoning and AntidoteB. — In cases of acute poisoning and collapse,
rdio-vascular stimulants may be given h>'podermically, and the patient
kept quiet and warm. Mustard-leaves may be applied to the chest and other
parts of the body, and artificial respiration practiced, if needed. Stimulat-
ing enemata. containing alcohol or turpentine, may be useful; and, if there
b much vomiting, brandy and ice may be given in small quantities. Tannic
acid and iodides are chemically incompatible, and camphor is a physiological
antidote. Nastnrtiura officinale is claimed to be the antidote par excellence.*
In what might l»e called chronic tobacco-poisonings we have various inflam-
mations of the month; epithelial cancer of the lip or tongue; follicular
pharyngitis: bronchial catarrh: rapid, weak, and irrejrular action of the
heart, which may become hypertrophicd ; dyspepsia and weakness of sight,
dne to restriction of the field of vision (scotoma), which may progress to
total blindnej»s. Color-blindness has been attributed to the excessive use of
strong tobacco. Muscular weakness and tremors and reduced capacity for
physical and mental exercise are common 9\Tnptoms of an abuse of tobacco.
Probably the need of something to restore the nervous system after using
' Uncet, Deo. ."lO. 1005; p. 1914.
878 PHARMACEUTICAL THEttAPEUTIC AGENTS OR DRUGS. ^
tobacco is one explanatiou of the frequent resort to alcoholic stimulants by
users of the weed. The habit of excessive indulgence is especially injurious
vhcn the furaes are inhaled, as in cigarette-smoking, as by this means the
poifionous products arc Ijrought directly into the air-cells, and are absorbed
by tlie blood. In all such cases the treatment must begin by reduction, or
complete cessation, of the habit of smoking, and the administration of
strychnine sulphate in small doses, with open-air exercise. If there is much
overaction of the heart, it can be steadied by small doses nf opium, in addi-
tion to digitalis or strophanthus.
Therapy. — Tobacco is rarely used medicinally, ita good effects as a ca-
thartic not being of sufficient value to counteract its depressing action upon
the heart and respiration, to which some persons are especially liable to
suffer. The only practical application is to afford an excuse for the pre-
scription of an Havana after a good dinner, as an aid to digestion. Tobacco
may be mixed with stramonium or belladonna, and the smoke inhaled, with
relief in asthma.
Pulverized tobacco, or snuff, is said to be elHcacious in breaking up
stubborn paroxysms of hiccough, a pinch being drawn into the nostrils by
a strong inspiration. Tobacco should not be administered internally for
etrychnine poisoningj nor in tetanus, nor used per enema.
Eudermol, or nicotine salicylate, has been applied in the form of oint-
ment (1 per cent.) in the treatment of scabies, by Wolters.* He used it in
€3 cases and in no case were more than six applications required. It has
been said to have the advantage over other remedies, usually employed, of
being free from odor and not staining the linen.
Previous to the introduction of chloroform and ether, tobacco was oc-
casionally employed in order to produce muscular relaxation in strangulated
hernia, after fracture of the femur, etc. Every purpose for which tobacco
was formerly used is now accomplished more efficiently and safely by anes-
thetics and other agents.
TALCUM ( r. S, P.).— Talc (Soapstone).
TALCUM PURIFICATUM [U. S. P.).— Purified Talc.
Tiilo is a native hydrous ntagnosium silicate {V. S. P.). The purified
talc is used ns ii dusting powder in er\ihema, prickly heat, and other pruritic
skin affectious.
TAMAKINDUS (U. 8. P., B. P.).— TamarindB.
' Preparation,
Confectio Sennae (U.S. P., B. P.). — Confection of Senna (containit Lamarinds, 10
per cent., U. S. P.: 12 per cent.. B. P.). Dose. 4 to 8 Gm. (or 5i-ij).
Pharmacology and Therapy. — The preserved pulp of the fruit of
Tamarindus iudica ( Leguminosa^, freed from the brittle outer part and
preserved with sugar. It is only used in medicine for the purpose of making
a refri,fi:erant and somewhat laxative infusion, and also as an ingredient in
the confection of senna. A tamarind whey, which may be used as a re-
frigerant in fevers, is made by infusing an ounce of the pulp in a little boil-
ing water, and adding this to a quart of milk.
* Therapeutische Uonntihefte, Aug., 1898.
TjLKNOFORM. -
879
TANACETTTM.— Tansy.
Pharmacology. — The leaves and tops of Tanacetum vulgare (Com-
positae), or commoa tansy, contain a bitter principle, Tanacetin, a Tolatile
oil, tannic acid, etc. Tlie oil contains lx)rneoI camphor, torpoms thujone,
and tluijyl alcohol. The dose of the volatile oil is O.OG to 0,1S c.cni. (or mi-
iij) ; a fluid extract and iin infusion, 4 (irn. to 473 c.cm. (or oi-Oj) are also
popularly used.
Physiological Action. — Tansy is an aromatic, bitter tonic, and, by virtue
of its volatile oil, it is diuretic and emmenagogue. Large doses, 15 c.cm. (or
f39fi) or more of the oil, taken to produce abortion, cause disturbance of the
respiration, depression of heart's action, clonic spasms, stupor, and death;
sometimes it causes abortion, but only because of its violent irritant action
npon the gastro-intestinal tract, which may lead to inflammation.
Poisoning. — The treatment of an overdose is the free use of demulcents
and purgatives to clean out the stomach and bowels, followed by opium, bis-
muth, and ditTusible stimulants.
Therapy. — Tansy is a useful ingredient in functional dysmenorrhoea,
amenorrhcca, and ovaralgia, in doses of 0.03 to 0.06 c.cm. (or mss-j), in pill,
or dropped on sugar. In supjtressed menstruation from cold it may be given
in conjunction with hot drinks and hot applications. It has some anthel-
mintic effects, but should not be used for this purpose.
TAmXAL^BIH is a preparation of tannin and albumin combined by ex-
posure to a temperature of 110** to 120** C. for five or six hours. It repre-
sents 50 per cent., by weight, of tannin. It is a light-brown powder, in-
soluble in water and the gastric secretionSj soluble slowly in intestinal fluids.
It is gently astringent, non-toxic, and not irritating. It is used in various
forme of diarrhcca. Dose for adults, 1 to 2 Gm. (or gr. xv-xxx). In infants
the single dose is 0.10 Gm. (or gr. iss) for every year of the child's age, given
two to four times doily. In follicular enteritis and tubercular disease of in-
testines, the preliminary administration of caBtor-oil is recommended by
Friedjung. Porter found it useful in gastric catarrh with fermentation. In
rectal disorders, tannnlbin may be added to a 6t4irch enema.
h
TAlfNIGEK. — This is a derivative of tannic acid in which two acetyl
and three hydroxyl groups are present. Tannigen was prepared by Meyer
in order that it might pass through the stomach unchanged and exert the
influence of tannic acid upon the intestine. It is a yellowish-gray powder,
soluble in water and alkaline solutions. The substance is devoid of taste,
does not disturb the appetite or digestion, and may be given for a consid-
erable period without producing tolerance or habit. It has generally been
given internally in doses of 0.20 to 0.50 Gm. (or gr. iii-viij) thrice daily, but
from 2.G0 to 4 Qm. (or gr. x!-lx) can be taken without bad results. Tannigen
nr»)ved useful in diarrhrea. more particularly in chronic cases. Its effect waa
less ditidf'd in acute diarrhtra, or thnt nf tubercular origin. Tannigen has
employed, also, in chronic inflammation of the nose and throat
TAKNOFORM is a condensation product of tannin and formaldehyde.
It occurs as a loose, reddish-white powder, which is odorless and insoluble in
water. It is antiseptic and desiccant, in 20 to 50 per cent, triturations with
powdered starch. It is especially useful in bromidrosis and hyperidrosis of
880
PHARMACEUTICAL THERAPEUTIC AGENTS OR DRUGS.
the feet. In eczema it has been applied as an ointment (10 per cent.), which
also is useful to relieve the itching of h»morrhoids. Tannofonn is also used
as an astringent and intestinal antiseptic, chronic diarrhcca, especially in
infantile diarrhoja. The dose for an adult is 0.25 to 0.50 Gm. (or gr. iv-viij).
It passes through the stomach unchanged, and even in large doses causes no
irritation of the stomach.
TANUOPIK. — Tannopin is a condensation product of tannin (87 per
cent.) and hexamethylenaraine (13 per cent.), flua was originally introduced
by Nicolaier in the treatment of affections of the urinary organs. It is a
brown powder, insoluble in most ordinary solvents, but splits up into ita
constituents by the alkaline intestinal juice. * Its antiseptic and astringent
value in catarrh of the bladder haviiipf hoen asserted, Schreiber, of Ebstein's
clinic, tried it in thirty-two intestinal cases, including acute and chronic
catarrh, tuberculous enteritis, and typhoid fever, giving doses of '/j to 1 Gm,
(or gr. viiss-xv) three or four times a day with very good results, especially
in the tuberculous patients. Carl Fuchs reports five cases of the use of this
agent for diarrhcea. The first was one of tuberculous enteritis in a case of
acute general tuberculosis; 4 Gm. (or gr. Ix) a day of tannopin were given
for two days, with the result that the daily number of motions fell from
twelve to one. The second case was one of acute diarrhcea, which was rapidly
cured, ae were also the third, fourth, and Hfth patients, puffering, respec-
tively, from heart trouble (wliich liad been too vigorously treated with digi-
talin), phthisis, and chronic diarrl}n\<i of uncertain origin. Tlie sixth pa-
tient, whose diarrhoea came on in the course of Bright's disease, did not react
quite so satisfactorily ; tannopin was given for some weeks, but the diarrhoea
did not cease entirely, thoufrh the stools were reduced in number from five
to two a day. In a ca.se of cystitis the smarting during micturition dimin-
ished, the flow of urine increased, and the urine itself became clearer and
less purulent. The frequency of miflurition wns not diminished, but the
amount passed ench time was increfjHcd. In this respect, tannopin is un-
doubtedly inferior to urotropin, its action on the urinary passages beine
only B\Tuptomatic : this was the conclusion arrived at by Schrcil>er as well.
As regards the intestines, it rapidly diminishes the watery stools in acute
enteritis, but in chronic diarrhoea its action is less constant, causing in some
cases complete stoppage, in others only limitation in the number of the de-
jections.
TARAXACTJM (U. S. R).— Dandelion.
TARAXACI RADIX (B. P.).— Taraxaoum-root.
Preparations,
(U. S, P.)
i
Fluid Extract of Taraxacum. Dose.
Dose, 0.65 to 2.00
Fluidextractum Taraxaci
4 to 7.5 c.cm. (or fSi-ij).
Eitrnctum Taraxaci (U. S, P.. B. P.).— Extract of Taraxacum.
Gm. (or gr. x-xl). B. P., 0.32 to 1 Gm. (or pr. vxv).
Extractum Taraxici Liquidum (B, P.). — Liquid Extract of Taraxacum. Dose, 2
to 7.5 c.cm. (or fSaa-ij).
8UCC11B Taraxaci (B. P.). — Juice of Taraxacum. Dose, 4 to 7.5 ecm. (or f3i ij ) .
Pharmacolo^. — "'I'he dried root of Taraxacum oflicinnle (Cichori-
aceae), collected in the autumn" (U. S. P.). It is a well-known common
TEREBINTHINA.
881
pt-ri'niiiBl of the Hekls of America nnd Europe, bearing a yellow head of flow-
ers on a slender pfilunele, from a cluster of radical leaves. AH parlsof the plant
contain a nuil<y,jKTiil juice, whit^li exudes when the plant is cut or bruised. It
contains asparagin (found also in asparagus, marshniallow, licorice-root,
wahoo or enonyiuus. the potato-plant, and the root of the locust-tree
iin<i els4'\vhere), which hna little, if any, thernpeutioal value. The
active princi[)k'i*, according to Sayre, are Taraxacin and Taraxacerin; tlie
former is dissolved out by Jiot water, the latter by alcohol. The root also con-
tains inulin, niannite, and resin. Leontodin is an eclectic preparation made
by precipitation from the tincture. Jt is an impure extract of taraxacum
rtnd i? given in doses of 0.005 to 0.13 Gm. (or gr. i-ij).
Physiological Action. — Dandelion preparations are bitter, and probably
rtimulate the digestive secretions and act as a tonic. It is a feeble, hepatic
stimulant (Rutherford). It is a laxative, and also diuretic.
Therapy. — In deficient secretion of gastric juice or of the bile in atonic
dyspepsia and torpid liver, taraxflcum acts as a mild stomachic and is of
service in duodenal d3'spep8ia. Dandelion is also prescribed in catarrhal
jaundice. It has no specific action in liver disorders, but is often combined
with other remedies which have such effect: —
B Potassii iodidi 4] Gm. or 5j.
Fluidi'xt. tarnxaci,
Syr. glycyrrhiae aa 60| c.em. or fjij.
H. Sig.: A tablespoonful four times daily, for drrhoBiB of the liver.
The fluid extract of taraxacum is an acceptable vehicle for nitrohydro-
chloric acid or ammonium chloride.
I
I
I
TEREBINTHINA (U. S. P.).— Turpentine.
TEEEBENUM (U. S. P., B. P.)-— Terebene. A liquid consisting of
dipentene and otlier hydmcarhons. obtained by the action of .sulphuric acid
on oil of turfK'ntine ntul suhsi-qucut rettification by steam {U. S. P.).
Dose, 0.30 to 1 c.cm. (or mv-xv).
Preparations.
Terpini Hydras (U. S. P.) .— Terpin Hydrate. Dom, 0.65 to 1.30 Gm. (or gr. x-xx).
Oleum Terebinthinte Rectificatum |U.6. P.). — Rectified Oil of Turpentine (redi*-
tilled from lime-water. Rectified oil of turpentine should always be dispensed when
oil of turpentine is required for internal use). Dose, 0.30 to 1 c.cm. (or mv-xv), or,
u tu anthelmintic, 15 c.cm. (or f^as).
Oleum Terebinthinie (U. S. P., B. P.).— Oil of Turpentine. For external use.
KranlMun < Mei Terebinthinn' ( l*. S. P.). — KtiiiiUion of (HI of Tur|)ontine. Dose,
4 r.cui. ((»r f 3] I .
Linimentum Terebinthinse (U.S. P.. B. P.). — Turpentine Liniment (resin cerate,
fio partA; oi) of tnrppntin*. 'A^ pnrta. V. S. P. Soft ttoap. 02 Om., or 5ij; distilled
w»lt*r, 155 (im., or i\ ; camphor, 31 Gm., or 3j; and oil of ttirpeBtine, 390 c.cm., or
f5\iij. B. r.i.
Linimentum Terebinthinn* Aceticum (B. P.). — Liniment of Turpentine and Acetic
Acid foil of turpentine, 100 c.era.; glacial acetic acid, 25 Gm. ; liniment of camphor,
100 c.cm,).
Linimentum Cantharidis. — Cnntharides Liniment (c&ntharides, 15 parts; oil of
turpentine, 85 part<). A strong counter-irritant.
Pharmacology. — TMriviUine iu *'a unncrete oleoresin. obtained from
Pirnis pflliistrir. nn<l from othor species of Pinus (Conifene)," It consists
of a volatile oil, which is known as oil of turpentine, or. incorrectly, gpirit
882
t'HAUMACEUTICAL TUEOAPEDTIC AGENTS OB DRUGS.
of turpentine, and resin. The oil is distilled from any variety of Pinus
capable of furnishing it, thongh the B. 1\ oil is distilled usually by the aid
of steam, from the oleoresin obtained from Pinus sylvestris, and other species
of Pinus; rectified, if necessary; and, at first, is a thin, limpid liquid, buT
afterward gradually absorbs oxygen from the air and forms resin, which
makes it thicker. Old oil of turpentine is an ozonizinfj ag:ent, and is recom-
mended in cases of phosphorus poisoning. Chian turpentine (Pistacia tere-
binthus), coming from Vhio and Cyprus, does not materially differ from the
ordinary form, except that it has a more agreeable odor, resembling that of
lemon or fennel; it is produced by a larch-tree (Anacardiaceaj), and may be
given in doses of 0.20 to 0.32 Gm. (or gr. iii-v), in an emulsion. White tur-
pentine (Thus Americunura, B. P.), identical with the solid matter deposited
by turpentine upon standing, is the spontaneous exudation upon the tree,
which is scrap>ed oil and sent to market in yellowish-white masses. The vari-
ous forms of turpentine are soluble in alcohol, forming what is commonly
called varnish. Turpentine is very inllammable, and bums with a heavy
cloud of black smoke of unconsumed carbon. The oil is inflammable and
explosive. The oil of turpentine possesses a peculiar, characteristic odor and
taste, has a specific gravity of 0.855 to 0.870, is soluble in alcohol, ether,
chloroform, glacial acetic acid, benzol, and insoluble in water. It is a solvent
for wax, iodine, sulphur^ phosphorus, and fixed oils. Rectified oil of turpen-
tine is oil which has been retlistilltd; it is the only form suitable for internal
administration.
Canada Turpentine, not a balsam, is official as Terebinthina Canadensis.
It is a liquid oleoresin, obtained from Abies balsamea, used principally in
the arts and in mounting microscopical objects.
Catramiuc is closely related to turpentine, but contains a larger propor-
tion of resin than the latter. Its physiological action reBcmbles that of the
oil of turpentine. It is eliminated in the urine in the form of a resin, and
is recommended by Vincenzo Gauthier in chronic bronchial affections with
profuse secretion.
Phyaiologfical Action. — Tl)e oil of turpentine bas welL-niarked antiseptic
quiilitics, Wlu-n applied to tlic skin it iirndnces redness, tingling, and irri-
tati<tn, and may cause intlanunation and blistering. In some cases it even
gives rise to uk-crntion. Some persons :iro very susceptible to its effects, and
the local application will cause marked systemic disorder, with an erythem-
atous rash. Desquamation may follow. Taken by the mouth, turpentine
will likewise occasionally give rise to an erythematous, vesicular or papiilar
eruption. In small doses (O.GO to 1.20 c.cm., or mx-xx), oil of turpentine is a
stimulant; in large amounts, an irritant. Doses of 4 to 7.5 c.cm. (or foi-ij)
cause burning in the mouth and stomach, with thirst; larger quantities give
rise to vomiting and purging, with tenesmus; these effects, however, may
be avoided by combination ^vith other agents, and especially demulcents.
Koutonzoff declares, as a result of experiments upon six healthy men, that
turpentine dissolves the albuminoids of the food in the stomach when hydro-
chloric acid is still absent; that it first diminishes and subsequently in-
creases the secretion of the gastric juice; that it moderately excites the
motility of the stomach and the absorbent power of the mucous membrane.
Upon the circulation, the effects are those of a cardiac stimulant, the pulse
18 increased in force and in frequency, but toxic doses occasion collapse, with
feeble pulse. According to Kobert, medicinal doses increase the blood-
TEBEBDJTHINA.
883
I
pressure by "powerfully stimulating the inhibitory reflex centre, and alao
the vasomotor centre/* but verj' large doses paralyze both centres, the blood
becoming dark and the heart paralyzed. Injection of oil of turpentine into
the vessels causes lowering of blood-pressure, M^ith increase of pulse-rate. In
small doses it produces vascular contraction. From the very diffusible nature
of this substance, it readily finds it« way into the circulation, and is carried
to the nerve-centres. After poisoning by it, the brain has the characteristic
odor of turpentine; it has, therefore, been inferred by Bartholow that it
exerts a direct influence upon the nerve-cells. It is through the nervous
system that its effects are mainly manifested. After moderate or continued
doses, slight exhilaration, like that following alcohol, is observed, followed
by an hypnotic elluct; toxic amounts cause delirium, with depressed intel-
lection or stupor, impaired physical power, defective co-ordination (followed
by paralysis), coma, with dilated pupils, and death. Such amounts have, in
addition, caused complete muscular relaxation, profound insensibility, and
abolition of all reflex movements. Six ounces have occasioned death in an
jidult, preceded by opisthotonos; "the brain, heart, lung, and viscera were
found gorged with blood."
Turpentine is eliminated by the skin and bowels, but principally by the
bronchial mucous membrane and kidneys. Its odor is perceptible in the
breath. It communicates to the urine a smell similar to that of violets,
though, when the dose has been large, the urine possesses a terebinthinate
odor. Heat and dryness of the skin and pruritus sometimes result from
the internal use of turpentine.
Treatment of Poisoning^. — Where persons have been made sick by the
vapor of turpentine, as by sleeping in a newly-painted room, it is necessary
to give them a supply of pure, fresh air, with cardial stimulants and diu-
retics, encoura^ring the action of the kidneys and skin by hot drinks and
pilocarpine. If large amounts hftve been swallowed, after emptying the
stomach and bowels by hot water and milk, and copious enemata, demulcents
witli opintet are required.
Therapy. — Oil of turpentine is a valuable counter-irritant in peritonitis,
pneumonia, bronchitis, asthma, and painful disorders, such as lumbago,
pleurod}Tiia, myalgia, etc. A turpentine stupe consists of a piece of flannel
heated by steam or by being wrung out of hot water, with a few drops of
turpentine sprinkled upon its surface just before application, Spongiopilin
may be similarly used. A mixture of equal parts of turpentine and yelk of
egg is also serviceably applied to the skin for the same purpose. A turpen-
tine stupe should be removed as soon as it causes pain. In rheumatic joints
A liniment containing turpentine is useful, but the official liniment requires
dilution: —
B Liniment, terebinthinie,
Tr. opii ott 301
Lin. saponiB 00|
c.cm. or fSj.
c.cm. or
For external use in rheumatism, to be used with {riction.
In peritonitis turpentine can be applied over the abdomen, either alone
or combined thus, with much benefit: —
R Olei tercbinthince,
Olei oHvffi AA 60! c.cm. or fXlj.
Tng^, hydrargyri ^ 62| Gm, or 5ij.
M. Sig.: Apply warm with flannel over the abdomen, In peritonitia.
■
PHARilACEUTICAL XnERAPECTIC AGEXTS OR DUl'GS.
Preparations containing turpentine are advantageous external applica-
tions in inflammatory affections of the larynx, pharynx, and tonsils. In
diphtheria it has been beneficially employed as a topical remedy, being ap-
phed by means of a brush, or adrainisitered in the form of a spray or bv in-
halation of the vapor. Dr. Charles Smith has derived advantage in diph-
theria from the continuous inhalation oia mixture composed of 1 part each
of carbolic acid and eucalyptus-oil and 8 parts of turpentine. Cloths satu-
rated in the fluid are hung or laid near the face of the patient, care being
taken that they do not come in contact with the skin.
In order to render the air-passages aseptic, Delthil recommends inhala-
tion of the following mixture: —
B Olei terebinthinie rectificat 330
Spiritufi lavandutn 00
Iodoform 10
.•Ether. Bulph 18
c.cm. or fjxj.
c.cm. or fjiij.
Gm. or 3iis8.
5 ccm. or f3v. — M.
The oil of turpentine has been used with success in the treatment of
severe bums, accompnnied by constitutional depression. Dr. H. Mclnnes
says that this treatment will at once relieve the pain; and the bum will heal
more rapidly than by any other treatment. He advises laying a thin layer of
absorbent cotton over the burn and then saturating it with the commercial
oil of turpentine, and apply a light bandage. As the turpentine evaporates,
more should be added, in order to keep the compress wet. When there are
large blebs, he opens them on the second or third day. The turpentine
should not be applied to tlie healthy skin, as it may act as a counter-irritant
and cause pain/ A tablespoonful of turpentine is a useful addition to a large
enema, especially M-h«n given for flatulent colic. Turpentine enemata also
assist in combating the stupor of narcotic poisoning and are useful deriva-
tives in sun-stroke and cerebro-spinol meningitis. Turpentine is efficacious
in the treatment of chilblains. An ointment of turpentine, official in the
British Phnrmacopceia of 1890, is used with advantage in chronic eczema,
psorifisis. and aloiiccia circumscripta. It may also be applied with good effect
to unhealthy or indolent ulcers.
Internally, the oil of turpentine is antiseptic and astringent in some
forms of diarrhoea, especially of a catarrhal character. •
It is valuable in acute dysentery after the violence of the attack has
somewhat subsided. Turpentine is likewise useful in epidemic dj^sentery.
A few drops of this oil form an excellent remedy in flatulence and may be
of benefit in ulcer of the stomach or bowels. In typhoid fever, small doses^
given in conjunction with the mineral-acid treatment, are a valuable adjunct,
especially when the tongue is red, dry, and clean, and there is abdominal dis-
tension. It i? I>ost driven in iht* ofhciid eninUiou : —
R 01. terebinthinflB rectificat 151 c.cm. or fjM.
Ol. amyKtJalffl expresai SJ c.cm. or 3jVi.
Syrupi *.•-» 2u{ c.cni. or SvjV*.
Pulv. acaciEC ln|5 Um. or 3iv.
Aqiifc *>.,».• q. 8. ad 100] ccm. or fjiiisff.
M. Becundem Brtera.
Sig.: One tablespoonful every two or three hours in typhoid fever, or the wholi
amount may be taken at once to remove a tape-worm.
ole 1
^Medicai Record, Sept. 5, 1800.
TEBEBI^THIWA.
I
I
>
The rather unpleasant taste of turpentine may be disguised by the ad-
dition of glycerin in the proportion of about 4 ccm. (or foj) to 30 c.cm.
(or fgj) 01 mixture. Glyceriiu with the addition of a di*op or two of oil of
gaultheria, is said to disguise the taste of turpentine.
This remedy is, furthermore, valuable in typhoid fever by relieving
tympanites and restraining haemorrhage. If diarrhoea persist or recur during
convalescence from this disease, recourse should be had to turpentine. In
various forms of hffimorrhage turpentine is valuable, as in hematuria, pur-
pura haemorrhagica, and in gastric ulcer. It has been found efficient in post-
partum hsemorrhage, and is peculiarly valuable in this condition on account
of the rapidity of its action. Turpentine also checks the bleeding of scurvy.
It is especially in passive haemorrhage that this remedy is of service. In
ha?maturia it has likewise been given with success, but it must be employed
only in small doses, and its effects very carefully watched. The unpalatable
taste of this liquid is not infrequently a bar to its administration. When
lliL' doso consists of but a few drops it may be given in a cap?ulo.
In chronic cystitis, pyelitis, and gleet, and in broncho rrhoea, small doses
of oil of turpentine check the discharge and act as an antiseptic. Incon-
tinence of urine, spermatorrhcea, and prostatorrhcea dependent upon relaxa-
tion are not infrequently relieved by turpentine. In addition to its strictly
therapeutical effects turpentine is serviceable in incontinence of urine by
overcoming the odor due to the dribbling of the fluid and converting it into
a scent resembling that of violets. In low fevers the addition of 4 c.cm. (or
foj) of this oil to a hot punch often rouses the patient from a condition of
stupor, and acts as a stimulant to the circulation. As a cardiac stimulantj
turpentine is of service in puerperal fever, phlegmonous erysipelas, and yel-
low fever, in capillary bronchitis, pneumonia, and emphysema. In gangrene
of the lung it diminishes factor. Tho vn|ior of st»:*nni, impregnated with
turpentine, is employed for inlialution in laryngeal and bronchial disorders.
A mixture of turpentine and ether (equal parts) is supposed to have
some influence in removing gall-stones, but it is not probable that it has
much effect in dissolving them, as was claimed by Dnrande; the effects are
those of a carminative and antispasmodic. It is useful in this combination
(1 part to 3 of ether) in colic as an anodyne. Dr. Hughlings Jackson used
oil of turpentine in chorea.
The vapor of turpentine has been used in Germany as a prophylactic
against influenza. The United States Consul at Frankfort reports that dur-
ing a recent epidemic of influenza, it was found that the workmen in a cer-
tain factory who were exposed to e.va^H)rating oil of turpentine, seemed to
l»e ]»roteeted from the disease. Purtlier trials confirmed this observation.
In erysipelas, oil of turpentine may he painted on the surface and taken
internally. It is a good local applination in ringworm, and has been also
employed successfully in some eases of psoriasis by Dr, Crocker in the form
of an embrocation with olive-oil (1 to 4), gradually increasing the strength
until the pure turpentiuo-oil is usod. The same writer has derived good
"ts in psoriasis and chronic eczema from tlie internal administration of
of turpentine in doses of O.fiO to 2.50 c.cm. (or m.x-xl) in emulsion
after each meal. King Chambers has found that an enema containing 15
c-cm. (or fjss) of the oil, or more, is of great value in sciatica; in which
fcffection this remedy is sometimes beneficially given internally in 15-c.cm.
886 FHAHMACEUTICAL THERAPEUTIO AGEXTS OR DRUGS.
(or f§8s) doses, repeated for several successive nights. In other form£ of
neuralgia it has proved of service. It seems to be of particular value io
debilitated or aged subjects, in whom degeneration of nerve-tissue has oc-
curred. In such cases 7.5-c.cm. (or f5ij) doses have been found more
efficient than smaller quantities. Phillips thinks turpentine particularlj
indicated when neuralgia is of rheumatic origin. The oil is of undoubted
efficacy in chronic rheumatism, relieving the pain and checking the progress
of the disease. Amendment takes place under the influence of turpentine
in rheumatic sclerotitis, iritis, and choroiditis. Nervous headache is some-
times relieved by this agent; 1.20 ccm. (or wxx) of turpentine thrice daily
is strongly recommended in lumbago by Dr. George Bird. According to
Begbie, turpentine is of service in hydatid cysts, especially of the lung.
Phillips has found this remedy, in doses of 0.06 to 0.12 ccm. (or mi-ij).
night and morning (not fasting), to be of service in certain chronic caj^ts
of albuminuria unattended by pronoimced symptoms- of Bright's disea^,
reducing the 'amount of albumin and improving the general condition.
As a general rule, the addition of 4 to 7.5 ccm. (or f 3i-ii) of oil of turpen-
tine to an enema makes it more stimulating, and therefore this expedient can
be adopted in narcotic poisoning. An enema containing tui^entine relieves
flatulence and constipation, and, as a derivative, is of value in sun-stroke and
cerebro-spinal meningitis. As an anthelmintic, it may be combined irith
castor-oil and is very effective against round worms as well as taenia.
Caution, — Being a stimulating diuretic, the oil of ttirpentine shoold
be used with caution, as it is apt to produce frequent and painful micturi-
tion, with bloody urine, strangury, and inflammation of the kidneys. These
symptoms may result from constant inhalation of its vapor. Hflematnria is
not uncommon among sailors engaged on vessels carrying turpentine. Pria-
pism, menorrhagia, and dysmenorrhoea are sometimes occasioned by tur-
pentine. The free use of barley-water and other demulcents, the hot bath,
and free purgation will generally quickly relieve the symptoms, unless
nephritis should occur. Turpentine should not be employed when cardiac
hypertrophy or atheroma of vessels exists.
Ghian turpentine was formerly recommended as curative in scirrhud and
other malignant disease of the uterus by Mr. Clay, of Manchester. This
writer insisted that the drug should be pure, that its use should be b^n
at an early stage of the disease and continued for a year after the mani-
festations have disappeared or the tumor has been removed by operation.
Its administration in doses of 0.32 to 1 Gm. (or gr. v-xv) has likewise been
followed by improvement in pityriasis rubra. The solid form is not an
eligible method of administration when it is to be continued for any length
of time, as it has been known to accumulate and form a mass in the
stomach.
Terebene is obtained by subjecting oil of turpentine to the action of
sulphuric Bcid and distilling at a temperature of 160^ F. It is a clear, mobile
liquid, having a peculiar, fresh-pine odor and pungent taste; freely soluble
in alcohol, chloroform, and ether, but sparingly soluble in water. In doses
of 0.30 to 1.20 ccm. (or mv-xx), it is given with benefit in winter cough,
with muco-purulent expectoration, by Dr. Murrell. He finds it useful ts an
antiseptic in flatulent dyspepsia; also in cystitis and gleet. In disetaes of
the genito-urinary tract, it can be prescribed as follows: —
TEREBINTUrXA.
887
B Terebeni 6120 com. or mc.
Tinot belladonne folior 4 c.cm. or mix.
Phenjlis &nlifvl OpO Gm. or gr. c.
M. et ft. capsulae no. xx.
Sig.- From four to six capsules a day, in gleet, stricture, and irritation of tht
bladder.
In bronchitis and bronchonhoea, in emphygema, in catarrhal affections
of the upper air-passages, even in phthisis, it has been found highly valuable
for inhalation. It has no specific action when administered in phthisis, but
probably exerts some local astringent and antiseptic effect upon the bron-
chial mucous membrane, by which it is chiefly excreted. Terebene has been
used with benefit in puerperal fever. In genito-urinary disease it has been
given as a substitute for oil of sandal-wood. It should be administered in
capsules in the dose of 0.30 to 0.60 c.cm. (or mv-x), repeated every three
hours. In some cases it irritates the stomach, and might then be made into
an emulsion. In other instances terebene has had a similar effect upon the
bowels or kidneys. A 5-pcr-ccnt. aqueous solution of terebene has been
locallv used as a disinfectant wash in surgical cases.
lerebinthine, a hydrocarbon of similar composition, Is obtained by dis-
tilling oil of turpentine with »n alkoli. By hydration, it is couverted into
terebinthine hydrate, commonly called terpin hydrate, a crystalline, solid
body, soluble in glycerin, water, and alcohol. It dissolves sparingly in ether
and chloroform. Terpin hydrate occurs in t!ie form of large colorless rhom-
bic crystals, destitute of odor and having a faint aromatic taste.
iferpin hydrate is "tlie hydrate of the diatomic alcohol Lerpiu** (U. S.
P.), It was usvd by Mauasse in forty-one cases of whooiiin;i!:-(.'ough. No
I ill effects upon kidneys or bowels were observed in children froin doses of
1.30 Gra. (or gr. xx). In doaea of 1 to 3 Gm. (or gr. xv-xlv), according to
ag^, the severity of the convulsive attacks was notably moderated. Dr.
Talamon makes use of the following combination: —
I
Gm. or gr. xv.
31
of age
Terpin. bydrat..
Antipyrin aa 1|
Syr. flurant. rort.,
Mucilag. acacice aa 60| com. or f3ij.
Sig.: One or two ouncea Bcveral timea a day for a child under four yeara
As a local application for diphtheria, Dr. Hutinel uses, in the Hdpital
dcs Enfants Mahidcs: —
B Terpin. hydrat 8|
vui
Gm, or 3ij.
Hydrarg. i-hlorid. corroa |28 Gm. or gr. ivaa.
Spiritus menthK pip.,
S|>. vini rcptiflcat. aa 901 com. or fjiij.
Spirilus ttiymi . . |37 c.cm. or mvj. — M.
Dr. Hugo J. Loebinger, of New York, uses terpin hydrate with ad-
vantage in hay asthma, giving it in 1 to 1.30 Gm. (or gr. xv-x^) doses. Terpin
hydrate, being a solid, is given in capsules, in bronchial affections, coughs,
catarrhs, colds, etc., in doses of 0.13 to 0.65 Gm. (or gr. ii-i).
Dr. William Murrell, of London, prescribes terpin hydrate in a solution
containing 0.32 Gm. (or gr. v) to 15 c.cm. (or fjss). made up with simple elixir
and flavored either with syrup of wild cherry, syrup of tar, or cherry-laurel
^
«88
PHARMACEUTICAL TKERAPEtTTC AGEXTS OH DHUOS.
water. For patients who cannot take sugar the elixir may be made wl'.h
-eaccharin. According to Dr. Murrell, terpin hydrate also possesses diuretic
properties and has been used with advantage in neuralgia. It should not be
confounded with a body of similar name, terpene, found in eucalyptus.
TZREBINTHINA CANADENSIS (T. S. P., B. P.).— Canada Turpen-
tine. The fir, Abies l^alsMinoa (PinMCca*). is indigenous to tho northern part
of the Uniti'd States and Canada. The Inilsain, or liquid oleort'siu. is ob-
tained by Cf*llc'ctiug the juico, which naturally exudes, and through 9p«ntane-
T)iis evaporation. It is a viscid, nearly traiiBparent, yellowish liquid, of rather
pleasant odor and bitterish taste, completely soluble in ether, chloroform, or
benzol. The balsam is said to contain about 20 per cent, of volatile oil.
When dried it is a tloar mass, entirely without structure; so that it is useful
in niicroscopical work,
Physioloifical Action and Therapy. — In their actions upon the human
body the various forms of turpcntino resemble each other so closely as not
to require separate treatment. It is probable that the good effects obtained
by Mr. Clay and Paracelsus, in the treatment of uterine disease with Chian
turpentine, might be obtained from our native turpentine. It may he ad-
ministered in capsule or eunilsionj and may also be applied locally. When
given in substance, it may form a concretion in the stomach. As a surjrical
dressing it also is useful, owin*; to its adhesive and antiseptic qualities, rc-
senibliug, in this respect, the balsam of Peru.
TEUCRIUM.— Water-germander, Woodsage. The leaves and flowering
tops of Teucrium scordeum (Labiatse), growing abundantly in Central Eu-
rope and naturalized in some of the States along our Atlantic coast, possess
medicinal properties. The taste is bitter and decidedly astringent. The virt-
ues of the plant depend upon an oleoresin. Teucrium also contains an
essential oil, which is warm and somewhat pungent to the taste. It may be
given in the form of an infusion, the dose of which is 30 to GO c.cm. (or
?oi-'J)» ^^ ^^ fi fl^'^ extract. The dose of the latter preparation is 4 to 7.5
c.cm. (or f3i-ij).
Physiological Action and Therapy. — Teucrium possesses astringent and
stimulant properties. Dr. John W. Eckfeldt reports that it is a useful anti-
spasmodic in certain nervous disorders, as whooping-cough and hysteria of
uterine origin. A syrup of teucrium is a good expectorant, restraining ex-
cessive secretion, and of especial service in the treatment of nervous coughs.
The same observer has found this remedy of service in amenorrh<ea and sub-
acute rheumatism. He states that it has been used as an alterative in scrofu-
losis. Teucrium is jjarlicuhuly valuable in cttlargcmcnt of the prostate and
in lui'raorrhoiiU. In the latter atfoction it may he used with good effect in
the form of n sup[Misitory, and alleviates the itching.
THALIIN.— Tctra-hydro-parachinanisol [Ci,noH^N(OCH,)]. Thallin,
a compound of the aromatic series, exhibits the form of colorless, rhombic
crystals, soluble in water, alcohol, and ether. It forms salts with tartaric,
tannic, hydrochloric, and sulphuric acids. The sulpliate, which has been
most generally employed, is a whitish, crystalline powder, of an aromatic
emcU and taste. Thallin sulphate is readily soluble in water, but sparingly
BO in alcohol.
TITEORKOMA.
88
I
I
Physiolog^ical Aotion. — Thallin possesses powerful antiseptic virtues,
and a 4- to 5-per-cenl. golution is capable of destroying micro-organisms.
Large doses depress cardiac energy and reduce blood-preseure. It rapidly
lowers febrile temperature by increasing the dissipation of heat, and the
effect may continue for several hours, — though, as a rule, it ii- of rather brief
duration. The reduction is often accompanied by profuse sweating and
extreme prostration. Vomiting and diarrhoea, chills, cutaneous rashes, cy-
anosis, or albuminuria may follow its administration. Thallin is speedily
eliminated by the kidneys. Solutions of thallin sulphate assume a brownish
color when exposed to air and light. In its elimination this substance com-
municates a dark discoloration to the urine.
Therapy. — Thallin salts were used with advantage as an injection in
gonorrhuea, the strength of the solution being from 2 to 2 Vc P^** cent. In
gleet a weaker solution has given a favorable result. When administered for
reducing fever, thallin sulphate has been employed in hourly doses of 0.032
to 0.065 Gm. (or gr. ss-j). In tuberculosis it reduces temperature very rap-
idly, but, even in small amounts, is apt to occasion alarming prostration.
Professor Demme recommends thallin in the treatment of typhoid ferer of
children. Other observers have spoken favorably of the influence of thallin
in the febrile affections of children. Dr. J. P, Crozer Griffith has derived
good results from its use in measles, scarlet fever, and other diseases char-
ACteri2ed by high fever and severe nervous manifestations.
THEOBEOMA.— Cacao, Chocolate.
Preparation.
Oleum TheobromatU (U.S. P., B. P.).— Oil of Theobroraa, Cacao-butter.
Pharmacolo^. — The prepared and dried, rijie seeds of the Theobroma
Cacao (Steroiiliaet'ir) are oval, and consist of shells and kernels, both of
vliirh contain an nlkaloidiU principal called Theobromine (about 2 per
cent.), similar to caffeine (the former being dinii'thyl-\anthinc, the latter
trimethyl-xanthiiie), also a yellowish-while, solid oil, known as Cacao-butter
(up to 50 per cent.), with a faint, characteristic, pleasant odor. This is
almost tasteless, and has a neutral reaction, melting at the temperature of
the surface of the body. It is nutritious, but in medicine is chiefly valuable
aa u ba£iis for suppositories, and for external application in massage. Choco-
late h an article of food prepared from Ihe roasted keraeb*, wliich are ground
into a fine paste with sugar and flavored with vanilla. Wlien this is added
to Iwiling milk in proper pro[)ortion, a pleasant restorative article of diet
i* made, but rather oily, on account of the presence of the cacao-butter.
^^l)nn the caeao-butter is partly removed by pressure and the kernels pre-
paretK as before, it is popularly known as breakfast cocoa, — an unfortunate
Tiamp, since it causi* confusion by resembling coco, or the coconut tree, and
ooca, or tlie erythroxylon coca, the latter also being the source of an ex-
hilarating beverage used in South America. Cacao-butter is chiefly stearin;
it does not become raneid. It has lM»en substituted in a milk-food for infants
in order to supply the deliciency of fat. since in all these j>reparations most
of the cream has to be removed, because it cannot i>e kept without developing
fatty acid^. Cacao-butter is largely used in making suppositories, of wnich
the following may be taken as an illustration : —
890
PHAHUACEUTICAL THERAPEUTIC AOEKTS OR DfiUOS.
H Ext kramcrue 132 Gm. or gr. v.
Ext. opii OH Um. or gr. 8S.
01. theobroraatis ll Gm. or gr. xv.
M. et ft. suppositorium no. j. Mitte tales no. vj.
Sig.: Insert one at night for irritable heemorrhoids.
In preparing suppositories, the addition of spermaceti causes the mass-
to congeal more rapidly and renders it less apt to adhere to the molds. There
is but one official suppository in the United States Pharmacopceia, that of
gl3'ceriD, which is niade with i^lyccriii, stt^nric acid, and sodium carbonate.
Those ofTicial in the Rritirtli Pharmacopoj'ia (besides the glycerin) are Acidi
Carbolici, Acidi TauniL-i. Hnllailoniuii, ItMlofdnni. Morphina% and Plumbi
Compotiita, all of which contain tliis intM'edient.
It has been suggested tliat Oleum Coooifl (U. S. P.). or Copruh-oil, may
be advantageously used in prejiariug suppositories. Tliis consists of c*H.*ODut-
oil (from Cocos nucifera) freed from its more liquid portion. It congeals
at 28° C. (82.4° F.), and posse.ssps the advantages of stilidifying rapidly, of
contracting in the niold^i, and of being able to take up a largo proportion
of water.
Physiological Action. — The physiological effects of theobromine are
analogous to those of calFeine, but it does not stimulate the central nervous
system to anything like the same extent, and is poisonous only in doses five
or six times as great as the latter drug. The effects upon the vasomotor
centre in tlie medulla are also much less. W. Cohnstein concludes that
in physiological dose.s, tliwbromine Jins no perceptible action upon the
heart, but that excessive quantities cause a gradual fall of blood-pressure.
Schroeder* demonstrated that cafreine acted as a diuretic by direct stimula-
tion of the renal epithelium, and subsequently has shown that theobromine
acts in the same way.^ He also showed that theobromine w^as less poisonous,
and that it was a more powerful and lasting diuretic. Gram' confirmed these
observations, but found theobromiue insoluble and likely to cause nausea.
He, therefore, recommends a double salicylate of theobromine and sodium,
containing about 50 per cent, of theobromine, as a substitute, which, from
its effects, has been called Diuretin, This salt has a bitter taste; is a white
powder, soluble in half its weight of hot water, and not depositing in cool-
ing. It is best given in solution with an aromatic water; in syrups it is
liable to deposit, and in powders it is apt U) decompose in a short time. He
gave it in 1 Gm. (or gr. xv) doses, five or six times daily. The action of diu-
retiu upon the heart very closely ropcmbles that of digitali.^.
Gram has also written of a corresponding compound with lithium, a
salicylate of theobromine and lithium, or theobromine-lithium. This prep-
aration may effectively take the place of diurctin, being more readily ab-
sorbed than the latter and active in doses of 0.20 to 0.25 Gm. (or gr. iii-iv).
A combination of theobromine acetate and of sodium acetate (five parts
to two of the latter) is knoMTi as Agurin, wliioh is offert^d as an imprnvoment
upon diuretin (sodium salicylate of theobromine) , and is said to be less
irritating than the latter, and can be given even in mild grades of nephritis.
Agurin is a white powder, easily s/>lnblo in water, and is .^lightly hitter.
'i4rfA(r fiir Erprriment. Patholoffie, xxii, 1886.
*rbidem, xxiv. 1887.
'Therapcutische MonaUfirftr, Jan., 1890.
TliEOBHOMA.
691
Dose. 1 Gm. (or gr. xv) three times daily. It is vised to best advantage ia
dropsy due to heart diseases, and may be given with digitalis.
Therapy. — Diuretiti has been tried in various diseases by Hoffmann,*"
who gave about 6 Gm. (or gr. Ixxv) daily; he found it useful in pleuritic effu-
sion. In acute nephritis, the amount of urine was tripled. In disorders of
the circulation attending lesions of the heart, Hoffmann reports in all great
dinresis, decrease in oedema^ and strengthening of the piilse. The diuretic
action is usually manifested within the first twenty-four hours, and grad-
ually reaches its maximum between the second and the sixth day. It falls
rapidly upon discontinuing the drug, or after the disappearance of the
dropsy. The amount of albumin in the urine was not much affected, except
that in the heart-cases there was distinct lessening. No cumulative effects
were observed, and the theobromine was rapidly excreted in the urine. Dysp-
nea, bronchitis, anorexia, and the general condition were all improved.
Sometimes slight diarrhoea was noticed, but the drug was well borne by the
stomach. Excitement and sleeplessness did not occur, but as the circulation
improved the patient slept better. In some cases, where digitalis and stro-
phanthus had failed to give relief, theobromine acted well, but, as a rule,
it is not so generally useful. It may be combined with them in certain casea
so as to assist in promoting diuresis. In Hoffmann's opinion it is much
superior to caffeine. It has the advantage, over calomel and other mercurials,
of acting u|K)n tiie heart as well ns the kidneys." Uiurelin is particularly
valuable in the treatment of dropsy dependent upon cardiac failure. Ac-
cording to the observations of Pawinski it is more efficacious in affections
of the heart-muscle than in valvular disease. In oedema due to renal lesions
it is of value, but is seldom of use in ascites of hepatic origin. In some cases,
ifter having been given for several days, diuretin will produce marked de-
pression. Dr. Demme regarded diuretin as useful in the treatment of chil-
dren. It causes a rapid disappearance of dropsy due to scarlatinous neph-
ritis and of anasarca dependent upon cardiac lesion. He found it generally
wfll tolerated, and that it can be given in tlie daily doses of 0.50 to 1.42 Gm.
(or gr. viiss-xxij) to children from' two to five years old and in proportion-
ately larger amounts to older children. It is inappropriate, however, to-
infants less than a year old, on account of the gastro-intestinal irritation
which it excites. In one case he witnesed a morbilliform eruption, with
abundant diarrhoea, after ingestion of 0 Gm* (or gr. xc) within four days.
Its action is more enduring than that of digitalin ; it is not dangerous like
calomel and does not produce nervous excitement like caffeine.
M. Huchard" has made extensive use of theobromine and concludes
that it is superior to digitalis and caffeine as a diuretic. Its prolonged ad-
ministration involves no inconvenience, provided that the daily dose does
not exceed 5 Gm. (or gr. Ixxv), and more especially if this quantity be given
in fractional doses of 0.50 Gm. (or gr. viiss). Exceptionally it may, however,
even in smaller doses, cause severe headache. Nausea and vomiting are rare,
as is also cerebral excitement. Once only did the exhibition of the drug
cause albuminuria^ and in three instances only was previously existing albu-
minuria increased by it. In these latter cases the4ncreased albuminuria coin-
cided with rapid disappearance of the oedema. M. Huchard prescribes the
' A trhivfiir Experiment. Patholoffie, xxviii, H. 1, 1890.
- I 'lement to Vie Brititth Mrriicnl Journal, Jan 3, 1801.
l^ Th^rapeutique, Jan. 8. 1890.
PHAHltACEDTIOAL THBRAPBUTIC AGEXTS OR DRUQ&.
theobromine after the following plan: 1st day, 3 Gm. (or gr. xlv) in fractional
doses of 0.50 Gm. (or gr. viiss) in cachets; 2d day, 4 Gm. (or oj) in 8 cachets;
and 3d day, 5 Gm. (or gr. Ixxv) in 10 cachets. This latter dose is continued
for three or four days. In certain cardiac diseases he prolongs the diuretic
action by the administration (consecutively) of 0.0005 to O.OOl Gm. (or gr.
^/izi'Va*) of digitalin given in one day. Theobromine is a direct diuretic, its
action being to induce a heightened activity of the renal epithelium. Its
employment is particularly indicated in arterial cardiopathies, in those com-
plicated with renal lesions, in hyposystole (heart-failure), and in interstitial
nephritis. The simultaneous exhibition of digitalis, caffeine, or lactose does
not increase its diuretic action. Theobromine diuresis is not prolonged
longer than three or four days, after the last dose is given. The drug is not
cumulative or toxic; it succeeds often when digitalin or caffeine has failed;
and it has apparently been of use in typhoid fever and pneumonia, where a
free secretion of urine is of importance.
Cacao-butter is a good emollient and protective to apply to excoriated
nipples of nursing women and to the thighs of children suffering with in-
tertrigo. Cacao-butter suppositories offer a favorable method of adminis-
tering remedies, especially in children. The following are appropriate doses
for children: Belladonna (0.01 c.cm., or m V„ of the tincture for a child of
one year, in 24 hours, divided into three or four suppositories, and increase
for every two years); bromides (1 Gm., or gr. xv, in 2 suppositories, for
every year, repeated at short inter\'al8 in spasmodic affections, larj*ngismu9
stridulus, etc.); caffeine (0.10 Gm., or gr. iss, with an equal quantity of
sodium benzoate, using 2 daily); digitalis (4 drops is the maximum dose of
the tincture for each year, divided into two suppositories). Nux vomica
(0.01 Gm., or gr. ^/j, for every two years, in three suppositories); strych-
nine should not be given until after ten years of age; opium (powdered
opium, 0.001 Gm., or gr. Vno for each year, and repeated in ten hours, dis-
continuing immediately at onset of toxic symptoms; it should not be given
to infants under two years of age); mercury (calomel, 0.048 Gm., or gr. V4>
for each year of life); iodides are well borne by the rectum and fully ab-
sorbed, 0.30 Gm. (or gr. iij)^ for each year of life, in two suppositories is the
maximum dnse; 0.048 Gm. (or gr. ^/J, if it is to be continued.^
THERMOL (acetyl salicyl-phenetidin) is a white, crystalline, tasteless
powder, devoid of aniliue toxic properties; is soluble in cold water, more
so in boiling water, and freely soluble in alcohol. Its action is that of an
antipyretic, lessening increased tissue-combustion through its sedative power
and controlling influence over the nervous system. Thermol is devoid of
any deprci^sant action on the heart, which makes it a valuable agent in
fevers. Dr. Oliver L. Miller- stntt^ thnt, in twenty-six cases of typhoid
fever treated at the Allegheny General Ilospital, thermol reduced the tem-
perature, without producing any deleterious effects on other organs. He also
noted a shorter duration of the disease in the majority treated.
In whooping-cough a child one year old may take 0.065 Gm. (or gr. j)
every two or three hourstuntil physiological effects are produced. The
dose for an adult as an antipyretic is from 0.25 to 0,50 Gm. (or gr. iv-riij).
' MHecine Modcrne; Pediatrics, May. 1898.
* International Medical Mafjazine, Feb., 1901.
THIOL.
893
I
I
In dvsmonorrhcwi, gout, rheumatism, and neuralgic headache, thennol is
given in closes of 0.30 to 1 Gm. (or gr. v-xv),
THUlANIN. — This name has been given to a combination of sulphur
with lanolin. The compound, which contains 3 per cent, of sulphur, appears
to differ from a mere mechanical mixture. It is as yet uncertain whether
the sulphur is combined with the cholesterin or with fatty acids. Thilanin
is an unctuous substance, of a yellowish-brown color and a sulphurous odor.
It is devoid of irritant properties. In acute, subacute, and chronic eczema,
the eczema of children, herpes, and sycosis, thilanin has proved of advan-
tage. It can be mixed with aqueous or olea^anous fluids. This compound
has been used with advantage in acne and psoriasis, and relieves the itching
of various diseases of the skin.
THIOCOL. — This name has been given by Roche to guaiacol-sulphonate
of-potassium. It has the advantage over creosote and guaiacol in being sol-
uble in water. It occurs as a white, microcrystalline, permanent powder,
which is odorless and of a faint, bitter, saline taste, but not disagreeable.
Thiocol is used for the same purposes elinically as guaiacol, and may be
prescribed in powder, tablet, or with orange or cinnamon syrup, or any con-
venient vehicle. The commencing dose is 0.66 Gm. (or gr. x), gradually
increased to 2 Gm. (or gr. xix), three or four times daily. It is claimed to
be free from toxic effects or irritation of the stomach, and is stated to be of
special value in removing the symptoms of phthisis and favoring recovery.
THIOL is a chemical, composed of hydrocarbons and about 12 per cent,
of sulphur. It occurs as a soft, gray powder, or scales, as prepared by Riedel,
who also furnishes it in liquid form, which contains 40 per cent, of the base.
Thiol is of agreeable odor and neutral reaction, is readily soluble in water,
but is less soluble in alcohol and ether. It is free from local irritant effect.
Dr. Laughlin has ompioy<*d thiol ointment with success in eczema, acne
rosacea, carbuncles, and boils. In facial erysipelas thiol constitutes an excel-
lent application. A 20-per-cent. ointment is a useful application in frost-
bites and chilblains. Thiol is likewise of value in the treatment of burns.
The powder is a good application to moist eczema, burns, erj'thema multi-
form^, and pemphigus. Liquid tliiol forms a varnish which, wi(h the addi-
tion of glycerin (r» per cent.), fonn^^ a brownish flexible protective layer. It
if* used in rosacea, eczema, lierpes hibialis, zt)ster, erythema nodosum, furun-
culosis, and burns. Thiol resembles ichthyol in clieinioal composition, and it
may produce the same physiological and therapeutical effects. It is said
to be non-toxic.
Thiol is employed for the same purposes as an antiseptic and local stimu-
lant as ichthyol, over which it has the advantage of being more agreeable in
odor.* In the daily dose of about Q.008 Gm. (or gr. V«), thiol has been suc-
cessfully given internally for the relief of constipation. Gottschalk employs
it in cases of pelvic exudation, acute and chronic endometritis, a 10- to 20-
per-cent, glycerin solution being used upon vaginal tampons and the abdo-
men rubbed once a day with a thiol ointment. Thiol ointment is irritant to
tlje skin, and its use must be, from time to time, discontinued.
^Wirnrr kHnhche Wochenachrlft, Xo. IB, 1800.
pBVi PHARMAOEfTICAL THEHAPEUTIC AGENTS OR DOtOS, ^
Thiophen is a hydrocarbon belonging to Uie aromatic series; is a color-
less volatile oil, insoluble in water, and possessed of a slight odor. Two com-
binations of thiophen have been made the subject of clinical experiment.
Sodium-aulphate thiophen is a white., crystalline powder containing 33 per
■cent, of sulphur, half of which is combined with carbon. Its somewhat dis-
agreeable odor is completely lost when it is made into a 5- to 10-per-cent.
ointment. The ointment has no irritant effect upon the skin, and has been
found beneficial in prurigo.
Thiophen di-iodide has been used as a substitute for iodoform. It is
made by replacing two atoms of iodine for two atoms of hydrogen in thio-
phen. Thiophen di-iodide contains 75.5 per cent, of iodine and 9.5 per
cent, of sulphur, both being in combination with carbon. U'he substance is
crystalline, insohible in water; soluble in alcohol, ether, and chloroform.
It inhibits the development of the microbes of suppuration, and has been
employed with success in the treatment of wounds and bums. This com-
pound has been successfully employed by Topolanaki, combined with sugar,
in the treatment of conjunctivitis, catarrh of the lacrymal duct, and abscess
■of the cornea.
Thio-resorcinum. — Thioresorcin is a sulphur-substitution compound of
resorcin. It is in ambcr-ycllow crystals, and is used instead of iodoform in
minor surgery. It probably might also be used internally, in the same doses
as resorcin.
THIOSINAMIN. — Thiosinamin, or allyl-eulphocarbamid, is made by
Seating together 2 parts of allyl-mustard-oil, 1 part of absolute alcohol, and
7 parts of solution of ammonia. It 'is a while, crystalline substance, aud
possesses a slight aromatic odor. This compound dissolves in alcohol in the
proportion of 1 part in 5, but is decomposed by solution in water. It is also
soluble in ether. Injections of this substance are said to increase the quan-
tity of urine excreted. They are productive of no injurious effect upon the
Icidneys. Thiosinamin promotes the absorption of e.xudations and of scar-
tissue.
Therapy. — Thiosinamin has been used by hypodermic injection, prin-
cipally in lupus. It waa the subject of a communication by Hans Hebra in
August, 1892, to the International Congrtss of Dermatology and Syph-
ilology. The remedy waa used by Hebra in doses of from 1 to 5 com. (or
mxv-lxxv) of a 5-per-cent. solution, injected twice a week under the skin
of the interscapular region, alternately on the two sides. Subcutaneous in-
jection of thiosinamin causes a local reaction of lupus, manifested by swell-
ing of the diseased surface, continuing for four to six hours, gradually sub-
siding -until, at the end of twenty-four hours, the skin had regained its former
aspect. Constitutional symptoms do not occur. As a result of the operation,
it is reported that lupous nodnles retrocede, ulcers become clean, the elevated
edges are leveled, aiul cirntrization takps place in n few weeks, Glas found
it of service in ri\Q cases of rhinoselcroma. Dr. Sinclair Tousey, of New
York, has met with great sucress by using thinainaniin injections for in-
operable tumors, cicatricial rontractnn^, and keloid.* Thio-siuaniin pro-
motes resolution of enlarged hnnphatic glands, Gspeeially in scrofulous or
tuberculous subjects. This remedy ha? been considered as of service in the
trontment of caries and necropig.
* New York Medical Journal, Ixiii, p. 579.
THUS AMEHICANUM.
895
I
It 16 Tiithout influence upon syphilitic lesions. The injections are snid
to have a decided effect upon corneal opacities. Dr. Latzko has found the
absorbent power of thiosinamin of service in gyncecological cases. Injections
of 9.25 to 37 c.cm. (or foiiss-x) of a 15-pcr-cent. solution caused the partial
or complete removal of pelvic exudates and allowed malpositions of the
uterus to be rectified.
Dr. Hanc, of Vienna, has made trial of thiosinamin in two cases of
urethral stricture. He emploved the remedy hypodcrmically, injecting at
first half and subsequently a Pravaz syringeful of a 15-per-cent. alcoholic
solution. He observed a rapid softening of the cicatricial tissue and an im-
provement in the smptoms. but the transformation was not permanent and
the parts were not ror^t'Mvd to the noruial condition. Longelnuuin in Miku-
licz's clinic used it successfully in two cases of Dupuytren's contracture.
One com. of the solution (thiosinamin 2, glycerin 4, aqua; destillatie 14
parts) was injected into the neighboring tissue daily. Mo ill effects were
observed.
THUJA.— Thuja, Arbor VitK. The fresh toi>s of Thuja occidentalis
(Pinacea^), or white cedar.^ growing in the northrrn United States, contain
Pimpicrin, a bitter principle; Thujin, a yellow coloring principle. Thujetin
is derived from the preceding. Itg most important constituent is a volatile
oil, which resembles savin in its physiological effects.
Therapy. — E.xternally, the recent leaves have been used, rubbed up with
ointment, as a stimulating antiseptic dressing for ulcers and condylomata.
A strong tincture may be applied externally, in warts and excrescences, and
^iven internally in 0.30 c.cm. (or wiv) doses. Four Gm. (or 3j) of thuja
added to 30 c.cm. (or f.^j) of warm water is said to constitute an excellent
injection in hydrocele, the fluid having been previously withdrawn from the
sac. In papillomata of various kinds Dr. Piffard speaks highly of it, and
considers it useful in gleet dependent upon granular urethritis. The oil has
been given with the view of expelling worms, but should be cautiously used,
is jt is a gastro-intestinal irritant. It has even brought on abortion in preg-
nant women, but only does so by the violent disturbance it creates in the
pastro-intestinal tract. In bronchitis the vapor of tliuja, steeped in boiling
water, often increases expectoration, and has a secondary astringent effect.
lliuja has been used both internally and externally, with some success,
in chronic rheumatism. In nmenorrhtca and prostatitis it has been found
of avail, and is said to have been serviceable in intermittent fever. This
remedy seems to exert a certain influence upon the growth of malignant
tumors, and has been thought to have a special power in restraining the
hemorrhage which they occasion. It has also been employed in hjemoptysis.
The Oil of Pumilio Pine, from an allied species, has been used in 4 c.cm.
(or foj) doses, given in milk, as a tseniacide. It is pleasant, effective, and
apparently a safe remedy.
THUS AMERICANTJM (B. P.) is identical with Terebinthina (U. S,
P.). (See page 881.)
The concrete oleoresin, which is scraped off the trunks of Pinus palustris
and Pinus Ta?da, when fresh, is of a rather soft, pale-yellow color. It is an
opaque, tough solid, with a terebinthinate odor. On keeping it becomes dry,
■The CupT«sftt]B thyoides, an entirety different tree, is also known by the nsnte
of while cedar, and more appropriately.
896
PHARMACECTIC.AL TIIKIUPEUTIC AGK\TS OR DRrOS.
brittle, translucent, darker in color, and fainter in odor. It is a crude, white
turpentine from two American varieties of the pine: the long-leaved pine
and the lob-lolly, or old field pine of the Southern States, As its medicinal
uses depend upon the volatile oil, its physiological action and therapeutic
applications have already been considered under the heading Terebinthina.
THYMOLIS lODIDUM (U. S. P.).— Thymol Iodide, or aristol, is made
by addiiif^ a sohttioij o( indinc in potassium iodide to an iU|iu'ous solution of
sodium hydrate containing thymol, when it is thrown down as an abundant,
red-browTi, amorphous precipitate. In the reaction an iodine atom is sub-
stituted in hydroxyl. The proportion of iodine present in aristol hae been
estimated by Cnrius at 45.S0 per cent. It is ditliymol diiodidc (CooH^^O^L).
Aristol is insoluble in water and glyctTin. sligiitly soluble in alcohol,
but readily so in ether. The addition of alcohol precipitates it from its
ethereal sohition. It is very soluble in chloroform nnd oils, but the solution
must be made by friction without the aid of heat, since aristol is decomposed
by the action of heat or of lig!it. The character of its chemical combination
renders it an unstable compound. Aristol is decomposed in contact with
ammonia, alkalies and carbonates, corrosive sublimate, metallic oxides, and
starch. It possesses but a slight odor, which agreeably recalls that of thymol.
In this respect it is decidedly preferable to iodoform.
Physiological Action. — Aristol adheres very readily to the skin, and
is, tlierefore, well adapted for use as a dusting-powder. It is free from irri-
tant action upon the unbroken skin. Applied to the mucous membrane, it
promotes secretifin. It is not absorbed, either through mucous membranes
or raw Eurfaces, and therefore produces no toxic effect. It has been given
internally by Neisser with no appreciable result. This experimenter found
that, when dissolved in suitable menstrua and injected into the blood, it
became decomposed and iodine appeared in the urine.
The absence of disagreeable odor and its freedom from toxic influence
ar« features which give aristol a great advantage over iodoform, and, from
the evidence now before us and continually accumulating, it seems probable
that in a wide range of conditions it may eventually supplant the latter
substance, especially since it has been admitted to the pharmacopceia.
Therapy. — The attention of the profession was first drawn to aristol by
Dr. EichholT, of Elberfeld, who warmly commended its local action in a
number of affections. His experiments have been confirmed by varioua
observers, both in Europe and America.
Aristol is remarkably efficacious in promoting rapid cicatrization.
Varicose ulcers of the leg, so common in the old or decrepit, heal very quickly
under the application of an ointment containing 10 per cent, of aristol. A
5-per-cent. ointment proved equally efficacious in the case of open buboes.
In lupus ulcers a smooth, sound, and healthy scar is at times obtained by
the use of aristol, either as a powder or in the form of an ointment. Eichhofl
points out the fact, which was confirmed by the investigations of Neisser,
that the remedy is ineffective in lupus which has not advanced to the
idcerative stage. The explanation is that aristol has no corrosive power.
It is not capable of destroying or penetrating an intact cuticle, and there-
fore can exert no influence upon the cells of the lupus nodule. Its action
is not upon lupus as suck, but upon the ulcer which is the consequence of
an advanced stage of the disease. EichhofF in several cases anticipated the
THYMOUS lODlDlM.
I
I
I
I
result by the formation of an artificial ulcer by the use of the sharp spoon
or Paquelin's cautery. In scrofuloderma excellent results have been obtained
by the use of the remedy under discussion. Overhanging edges should be
trimmed away, and if the fjranulntions are flabby the base of the ulcer should
be scraped before the aristol is applied. Vinal recommends a 20-per-cent,
ointment of aristol in the treatment of fissured nipples during lactation.
Upon the ulcers of late secondury, or tertiary, sypliilis, this remdv ex-
hibits a remarkable influence. EichhoiF, indeed, expressly asserts that as
a local apphcation in tertiary syphilis it is superior to any other agent. It
is of equal value in the ulcers of the congenital form of the disease, and in
the large, moist papules of hereditary or acquired syphilis. Another mani-
festation of this malady, which may bo amenable to the influence of aristol,
16 ozaena. Within a few days the foetor and discharge may disappear and
Bcabs cease to form. Simple oztena also is notably improved by the same
treatment. The insufflation of aristol has l.>een found beneficial in epistaxis.
In dry rhinopharyngitis, atrophic rhinitis, and dry lanngitis the insufflation
of aristol. with powdered starch, or milk-sugar, is ot decided benefit.
The writer is by no means desirous of advocating injudiciously and
prematurely the virtues of any medicament, especially in reference to such
a malign atlection as cancer. But, from the testimony of excellent observers
and from his own clinical experience, aristol appears to have a power not
hitherto exhibited by other remedies: that of originating apparently healthy
granulations and cicatrization of some cancerous ulcers. Eichhoff obtained
a prompt cure of chancres of the penis and lips, but strangely enough saw no
good ettects from the use of aristol in chancroid. His experience as regards
chancroid has been corroborated by Ncisscr. It is reported that this drug
is very good in ulcers of the cornea, in an ointment of 0.065 to 0.13 Gm. to
4 Gm. (or gr. i-ii to 5j) of lanolin and btnzoinated lard. He has derived
great benefit from it in pure powder on the ulcers of the lid and brow; it
causes such to heal up very quickly. It acts, he ndds, like iodoform, and has
not such a very penetrating and unpleasant odor.
I)r. James Wallace has employe?! aristol powder with success for the
purpose of clearing up corneal opacities in the chronic sta^re of interstitial
keratitis. This substance is likewise an excellent and prompt antiseptic. In
tinea tonsurans and tinea sycosis it generally proves efficient in the form of
an ointment containing from 5 to 10 per cent. In favus, however, it is of
little or no avail. In balanoposthitis, after the preputial sac has been thoi^
oughly cleansed, the application of aristol in the form of a dusting-powder
is of decided service.
Eichhoff, Ijassar, Oaudin, Neisser, and others hove witnessed decided
improvement from the use of this a,?ent in psoriasis. The author has found
it at least as beneficial as chrysarobin, while, unlike the latter, it docs not
atain the skin and clothing, and is free from the danger of exciting con-
junctivitis. In eczema squamosum, likewise, notable amendment has at-
tended its use. It serves a good purpose also in erysipelas. Rohrer has
employed aristol by insutTlation, with very fatiafactorv* results, in subacute
and acute inflammation of the middle car. The discharge speedily dimin-
ished, the mucous membrane became smooth, and the pcrforfltiona healed.
Inflamniation of the external ear was also very amenable to its influence.
Gucrra y Estane obtaine<I excellent results in twenty cases of disease among
children^ to whom iodoform is so repugnant, and, in fact, dangerous. An
898
niARMACEUTICAL THERAPIDTIC
tOEXTB OB DRCG6.
extensive ulcer over the parotid gland licaled in seven days, a chronic co ^
in six days, and in the case of an unhealthy ulcer over the thorax suppii
Hon ceased in twenty-four hours and cicatrization soon began. No ill ellects
were seen in any of the cases. Pollack, of Prague, has found aristol to pos-
sess marked eorbifacient virtues. An enlarged thyroid gland was perceptibly
decreased in less than two weeks and soon afterward the neck was quite
normal in size. In epididymitis, chronic tubercular adenitis of the neck,
parametritis, and typhlitis equal success attended the use of the remedy.
The author' has made use of aristol with advantage in hyperidrosis and
bromidrosis, either prescribed alone as a dusting-powder or combined with
boric acid. It restrains profuse secretion and overcomes offensive odor. An
ointment containing 2 Gm. (or gr. xxx) of aristol to the ounce of excipient
is serviceable in acne and rosacea. Dr. Kejzlar has employed aristol in
dentistry on account of its antiseptic properties in gangrenous pulps, in dis-
infecting the root-canals and carious cavities, before introducing the filling,
etc. On gangrpDoua pulps, he dusted aristol by means of a fine brush; for
cleansing the oanuls and cavities he used a lO-per-ceut. solution in ether.
The ether evaporates, and the aristol is left in the ca\*ity as a uniform coat-
ing. In chronic dysentery. Dr. B. M. Kandall. of Graceville, Minn., derived
Batisfactory nNiilfp from the use. throo times daily, of a suf)p09itory contain-
ing 0.20 Giii. (or gr. iij) of aristol ajid 0.0:;^ Gm. (or gr. Vg) of morphine.
At the Ilopital Saint-Louis, in Paris, an aristol plaster has been used.
The following is the method of its preparation: Finelj'-powdered aristol is
mixed with a small quantity of oil, and to the mass is added lanolin and
caoutchouc plaster, previously cooled and made very fluid by the addition
of benzin. The benzin is sufficiently evaporated to leave a preparation suit-
able for spreading upon muslin. An aristol gauze has lately been brought
into use as an antiseptic dressing. It is made by impregnating gauze vrith
an ethereal solution, and contains from 1 to 2 Gm, {or gr. xv-xxx) per square
yard.
The following formulns containing aristol will be found of great
service: —
B Th,\Tiioli3 iodidi
Pulv. zinci carb. impur
M. Sig.: Dust over the surface. Employ aA
excessive sweating and oily stute of the ekin.
aa 15|5 Gm. or Su-
dresaing to woanda;
Gm. or Ssi^
,4
also, itt 1
H Thymolis iodidi 2]
Ungt. zinei oxidi,
Ungt. plunibi subacelatis aa 1515 Gra. or Sss.
M. 6ig>: Apply well to the surface. Beneficial in infantile and chronic eoxema
and in psoriueis.
B Thymolis iodidi 3126 Gra. or gr. 1.
Ext. hoUadonnw folior |l7 Gui. or gr. iiaa.
01. tlu'obrnniatia q. s.
M. et ft. Buppoa. no. x.
Sig.: Insert one in the bowel when necessary^ to relieve pain. For cystitis an
profttutitis.
Dr. Brooke has employed arietol internally with decided advantage in
the summer diarrhoea of children, typhoid fever, in Bimple and complicated
diarrhoeas, and dysentery. He regards it as valuable in cases of offensive and
* See paper on "Ariatot" in the Medical Bulletin^ June, 1801.
THTMCS.
899
I
bloody muco-punilent discharges from the bowel. He gave it in doses of
0.32 Gm. (oi; gr. v) to the adult and in proportional doses to children accord-
ing to age.
lodonaphthol. — Tliis name has hoen bestowed by W. Braille upon a new
body, analogous to aristol, prepared by adding an aqueous solution of iodine
and potuiisiuni iodide to a i^olutioii cnutjiiniiig botannphtbol and potassium
hydrate. To this mixture is gradually added a solution of sodium hypo-
chlorite containing ten times its volume of combined chlorine. The new
body occurs in the form of a greenish-yellow pulverulent precipitate, which
is odorless and tasteless, insoluble in water, partially soluble in alcohol and
acetic acid. It soon darkens upon exposure to light.
THYMUS.— Thyme.
Preparations,
Oleum Thymi (U.S. P.). — Oil ol Thyme (principaUy used extemaUy). Dose.
0.06 to 0.12 ccm. (or mi-ij).
Tliymol (U. S. P., B. P.).— Th>Tnol idJS^J)), Doee, 0.03 to 0.13 Gm. (or
gr. isij). '
Phannacolo^. — The Thymus vulgaris (Labiatae), or thyme, is in-
digenous to Europe, but cultivated in gardens as an herb. The volatile oil
is otlicial (U. S. P.); it has a strong odor, a characteristic pungent taste, a
neutral reaction. It consists of two portions, the lighter and more volatile
l>€ing the hydrocarbons Cymene and Thymene, the second being chiefly
Thymol, which is a phenol. It should be quite free from carbolic acid, with
which it might be adulterated. Thymol is also obtained from the volatile
oils of Monarda punctata and Carum Ajowan (U. S. P.); from the volatile
oils of Monarda punctata and Carum copticum in addition to Thymus vul-
■!5 (B. P.). It crystallizes in hexagonal forms, nearly or quite colorless;
crystals, when rubbed, develop electricity and attract small pieces of
;aper, and has lately been obtained by two Japanese chemists from the oil
r-i Mosula japonica, a labiate plant.
Thymol has an aromatic, thyme-like odor; a pungent, aromatic taste,
with very slight caustic effects upon the lips, and a neutral reaction. It
liquefies with camphor. It is soluble in about 1200 parts of water and 900
of boiling water; freely soluble in alcohol, ether, chloroform^ benzin, glacial
acetic acid, and oils.
Physiological Action. — In its effects, the oil of thyme is very much like
the oil of peppermint or origanum, and, in fact» is often commercially sub-
ftituted for the latter. Thymol is a valuable antiseptic; it is less powerful
than carbolic acid, but, on the other hand, is ten times less poisonous and
much less caustic and irritating.
Thymol paralyzes the end-organs of sensory nerves in the skin and mu-
coufl membranes, but is a local irritant, and cannot be used well for the pur-
poaea to which cocaine is applied. It ia a powerful antiseptic and disin-
fectant. Internally, in doses of 1.30 to 2 Gm. (or gr. xx-xxx) per diem, it
cmies epigastric heat, sweating, ringing in the ears and deafness, and it
eMftpee chiefly by the urine, which is increased, and becomes olive-greenish
in color as after carbolic-acid poisoning. It lowers arterial tension and reflex
•ctioD, reduces the temperature, and may cause fatal coma. The nerve-civi-
trw of the cord are paralyzed by large doses.
900 rUAKMACEUTICAL THERAPEUTIC AGENT8 OH DBUQS.
Tfcerapy.^Volkman and other surgeons have utilized thymol in an'
septic dressings as a substitute for the more toxic and less agreeable carbolic
acid. It has been found a good application in eczema, psoriasiS, and ring-
worm. An ointment containing 0.G5 Gm. to 31 Gm. (or gr. x-oj) of thymol
is of service in acne and alopecia circumscripta. The addition of a little alco-
hol renders it possible to prepare a 1-to-lOOO watery solution, which is effi-
cient, and sometimes even needs to be weakened. A thymol solution is a
useful injection in leucorrha^a. Thymol has been used both locally and in-
ternally, with success, in diphtheria. In solution it has been inhaled with
benefit in laryngitis, and in phthisis it disinfects the sputum. In catarrh of
the upper air-passages, Dr. Clarence Rice recommends inhalatioHS of the fol-
lowing mixture: —
B Menthol.,
l^h(_iiol li(jiK>fnct aa
01. eucjilyf>ti 60
01. pijii pumilio 90
M. A t^aapoonful is add(>d to boilin? wnt^r and the steam inhaled or 2C or 30
drops arc placed upon & aponge or piece of cotton.
32 Gm. or pr. v.
c.cm. or f5ij.
ccm. or 15iij.
^
Thymol has also been administered internally in phthisis. It may be
inhaled with advantage in bronchitis, whooping-cough, and gangrene of the
lung.
Kuessner reported good results from the internal use of thymol in dia-
betes, vesical catarrh, and infantile diarrhrea. Bufalini states that thymol,
given in conjunction with a nitrogenous diet, restrains glycosuria, but is
without effect when the patient is upon a mixed diet. Surgeon-Major
Lawrie has reported two cases of chyluria of filarious origin successfully |
treated by means of 0.005 Gm. (or gr. j) of thymol every four hours, increased |
gradually to 0.32 Gm. (or gr. v). A modification of this method consists in the j
association of gallic acid and thymol. Nugent has reported a case of chyluria, |
in which the presence of the filaria was demonstrated in the urine, treated
with success by means of 1 Gm. (or gr. xv) of gallic acid and 0.13 Gm. (or gr. ,
ij) of thymol thrice daily, the quantities being increased to 1.30 Gm. (or gr. i
xx) of the former and 0.33 Gm. (or gr. v) nf the latter remedy. Rapid im- |
provement took place, the urine became normal at the end of two weeks. ■
Thymol has been employed with advantage in dentistry by Ilartraann, ,
of Miinster. He applies it for the destruction of the tooth-pulp, and also in
acute pulpitis. Glycerin is a pood vehicle, and, when diluted, a glycerite of
thymol makes a good mouth-wash. In acute and chronic intestinal disor-
ders, thymol has been employed by a number of clinical observers. Dr.
Frederick P. Henry has used thymol, prepared with Castile soap, in 0.13
to 0.20 Gm. (or gr. ii-iij) doses every six hours. He reports that, in
typhoid fever, the temperature falls, the stools become less frequent, cerebral
8}Tnptoms diminish, and the tongue cleans of! and becomes moist. Testi haa
employed thymol in one hundred and fifty cases of typhoid. He says that
the drug lowers temperature, diminishes tympanites, hinders fermentative
processes in the intestinal tract, reduces the excretion of the urea, and in-
creases the blood-pressure, without injury to the heart- Thymol has also
been given internally in articular rheumatism.
Campi has used thymol with success as a tjeniacide, according to the
following method: 18.5 to 22 com, (or f5v-vj) of castor-oil are given at bed-
T02T0A,
I
I
time, and the next morning, beginning early, 0.65 Gm. (or gr. x) of thymol
arc given every fifteen minutes. The worm is said to be expelled entire.*
Dr. Sonsino, of Pisa, has never witnessed any good results from the use of
thymol as a tieniacide, but states that it is of avail in cases of ascaris lum-
bricoides and especially oxyuris vermieularis. In the latter he administers
it by enema. Combined with lime water and linseed oil it is recommended
ft6 an application of value in the treatment of bums, especially in children.
Thymol Carbonate, or Thymotal, is a whit<? crystalline substance, with
very little odor. It is not affottod by acids or by the contents of the stom-
aich. It has been recommended by J. E. Pool as a vennifuge in doses of 2
Gm, (or gr. xxx) for adults, or 0.50 Gm, (or gr. viiss) for infants, three or
four times daily, for four days, followed by a purgative taken on the fifth
day.
Thymacctin. — Hoffmann, of Leipzig, has prepared this substance,
which bears the same relation to thymol as phenacetin to phenol. Thy-
macetin is a white, crystalline powder, slightly soluble in water, readily solu-
ble in alcohol, and sparingly in ether. It melts at ISG*" C. {ZIG.S" F.). It
has been given to dogs in doses of 2 Gm. (or gr. xxx) without causing symp-
toms of intoxication. In many cases it causes alight headache lasting for
several hours. It increases arterial tension and pulse-rate. In certain in-
stances it gives rise to digestive disorder and gastric catarrh. Jolly has ex-
perimented clinically with this product in a number of cases. It was with-
out effect in true migraine, but in other cases of headache proved equal to
phenacetin. It induced sleep in sixteen out of twenty-six cases of insomnia,
the avprn^e dose nect'ssary being 0.50 Gm. (or gr. viiss).-
Thymus serpyllum, or wild thyme, is very highly recommended by Dr.
Sidney E. Straley, of Andover, N. J., in the treatment of whooping-cough.
To tins obsen'er it appears to have almost a specific action. A tincture of
the green plant is harmless in doses as large as 4 c.em. (or foj) to a child of
eight years. The remedy is efficient in any stage of the disease; its action
is fully established in twenty-four hours and completed in five days.*
THYaOIDETTM SICCITM (B.P.).-
tracts, Jnices, and Secretions.)
Dry Thyroid. (See Animal Ex-
TILIA. — The dried inflorescence of the linden-tree of Kurope (Tilia
Tulgaris, T. parviflora, and T. graudiflora; natural order, Tilinccjp) has a
faint, but pleasant, odor and sweetish taste. The flowers are popularly em-
ployed in making an infusion for batliing the forehead for headache, also an
aromatic water, which is used as a vehicle, in France especially.
TONGA is a drug from the Fiji Islands, composed apparently of a mixt-
ure of severnl varieties of barks and roots, which are arranged in bundles.
Dra. Ringer and ifurrell, having made a series of experiments, which were
reported in ISSO, recommended it to the profession for further trial. It
•"Annuiil of tlte Universal Medical Sciences." 1890, vol. v, A-136.
»S«? iifitinh Mvritcol jQurml, .Marvli n». lHi)2.
•Medical BuJMin, 1893, p. 190.
M
■
902
rUARMACEUTICAL THERAPEUTIC A0EXT8 OB DRUGS-
was supposed to be derived principally from the Raphidophora Vitiensia
(Schott), a creeping plant of the order Aracefe, and Premna Taitensia
(Soliaucr), a small tree of the natural order Verbenacea?. A volatile alkaloid,
Tonghinc, Iins bfcu i^filated from the former; the latter contains some vela- ,
tile oil. I
Physiolo^cal Action. — Beyond slight drowsiness, Ringer and Murrell i
observed no sj'steniic etlects from 45 c.cm. (or fjiss) of the fluid extract, ,
given within three hours. The pupils and the secretion of the mouth and
skin were unaffected. The sensibility of the skin supplied by the fifth nerve
remained unaltered. They saw no influence upon the pupil from a topical
application. Dr. C. Bader states that the alcoholic extract, dropped into a
healthy eye, seemed to increase the power of accommodation, witncut affect-
ing the size of the pupil. He remarked, however, that in some cases large
doses, taken internally, caused great dilatation of both pupils. Dr. T. H.
Streets, .U.S.X., reports the experience of himself and several colleagues, '
They found a decided diminution in the excretion of urea from 30 c.cm. (or
fJ5J) doses, but no increase in the quantity of uric acid. The pulse, tempera- i
ture, and pupils were unchanged. Two of the four experimenters noticed
a tendency to cerebral congestion of short duration; one was slightly purged.
The symptoms dieappeaied in about two hours, leaving no after-effects.
Therapy. — From the claims made by its introducers, it was thought that
tonga would be a valuable addition to our list of antineuralgic remedies.
In order that it should gain a secure position among remedies, it would be '
necessary to exercise supervision over the source of supply, so that it shall
be of uniform strength and quality. Tonga is stated to be of marked service
in the treatment of neuralgia, especially when it involves branches of the i
fifth nerve. It has relieved paiu in a large majority of the cases in which it '
has been employed. The fluid extract should be given in 4 c.cm. (or f3j) |
doses, and repeated at intervals of about two hours, while needed. Tonga i
is rather slow in its action, and it requires about two hours for the full '
effects of the drug to be manifested. Dr. Bader has seen good results from
the local use of tonga in asthenopia, rheumatic iritis, and photophobia.
TRAGACAirrHA (U. S. P., B, P.).— Tragacanth,
Preparations.
MucUago Trngacanthffi (U. S. P,, IJ. V.). — Mucilage of Tragacanth (6 percent.).
Glyeerinum Tragacanthae (B. F,). — Glycerin of Tragacanth (trag&canth, 10 Gm.;
glycerin, 30 ccm.; an<J distilled water, 10 c-cm.).
Puivis Tragacanthfie Compositus (B. P.). — Compound Powder of Tragacanth
(tragacanth, gum acacia, starch, aa 25 Gni.; refined sugar, 75 Gm.). Dose, 1.30 to 4
Gra. (or gr. xx-3j).
Fhannacology. — Gum tragacanth is the product of trees growing in
Asia Minor and Persia. It is "a gummy exudation from Astragalus gum-
mifer, or from other species of Astragalus (Ijegumiiiosflp)." It is in white,
flattened bands, which, in drying, become curled or twisted, and are after-
ward broken in small pieces. It is hom-like, or tTanslucent; and, when
moistened .with water, it is converted into a gelntiiioiis mass. The soluble
gum is not identical with Arabin, but resemble? it; the insoluble portion con-
sists of Bassorin, Traganthin, and Adragauthin, and a little starch. Traga-
TRILLICM,
903
I
I
I
C4inth paste is adhesive, and is used in practical pharmacy to pasie labels on
I>ottle3, boxes, etc. It is also the basis of most of the United States Pharmar
-—^pcoia ofBcial troches, and is of service in emulsions for the suspension and
f "diversion of various powdered dru^s, and for codliver-oil, and as a pill basis.
Therapy. — Only used in medicine, other than already stated, as a
demulcent in pharyngitis, gastritis, and inflammation of the bowels. Large
amounts do not agree with the stomach, unless some antiseptic aeent, like
crw^sote or naphthol, is administered at the same time, to prevent fermenta-
tion. It contains a little starch, and has slight nutritive properties.
Dr. George T. Eliot, of New York, has introduced bassorin as a base for
the application of medicaments to the integument. Bassorin is a demulcent
substance, tasteless and odorless, converted into a viscous mass by the addi-
tion of hot water. When mixed with water, glycerin, and dextrin, a bassorin
paste is obtained, of jelly-like consistence and light-yellow color. This paste
is neutral, undergoes no alteration, does not stain the skin or clothing, adapts
itself perfectly to the affected surface, and may be readily removed at any
time by the aid of water. Solid substances can be incorporated with bassorin
paste in any desired proportion. Fluid preparations render it too liquid,
while alcoholic solutions cause it to become hard and brittle.
M. Vindevogel recommends that, in preparing ointments containing
large proportions of extracts or salts, 2 Gm. (or oss) of powdered gum traga-
canth be added for each cubic centimetre of the water employed in dissolv-
ing the salt or extract. The fatty body is added after trituration, and by this
method a homogeneous ointment of good consistence is made. If absorp-
tion of the unguent is desired, the bassorin of the gum proves a disadvantage.
TEIPOUUM PEATENSE, — The flower-heads of red clover, or Tri-
folium pratense (Leguminosffi), are fragrant and sweetish, containing a
^ flavoring principle and su^ar. The fluid extract and infusion are both em-
ployed.
Physiological Action. — It is considered diuretic and alterative.
Therapy. — The infusion of clover-tops is given to children suffering
■rith whooping-cough, with good results. The fluid extract, containing alco-
leol, is employed externally in domestic practice for wounds and ulcers. A
compound syrup of red clover, containing red clover, 2.10 Gm. (or gr. xxxij);
stillingia, 1 Gm. (or gr. xvj); berberis aquifolium, 1 Gm. (or gr. xvj); prickly-
asli bark, 0.25 Gm. (or gr. iv); burdock-root, 1 Gm. (or gr. xvj); poke-root,
1 Gm. (or gr. xvj); cascara auiarga, 1 Gm. (or gr. xvj); potassium iodide,
0.50 Gm. (or gr, viij), in each 30 c.cm. (or f^j) of the syrup, has been fur-
nished. It is useful as an alterative in syphilis, struma, and some
chronic forma of skin disease. It is also supplied without containing the
idc.
TEIKEESOL. ( See Crcsol. )
TBTTiLTTTM. — The Trillium erectum (Liliaceae), beth-root, growing in
woody place's in the northern United States, contains in its rhizome Saponin,
A little volatile oil, tannin, resinous and fatty matters, with much starch,
and some coloring matters. Tlie dose of the fluid e.^ract (N. P.) is 4 to 7.50
c.cm. (or f.>i-ij).
Fhysioloc^oal Action. — It is astringent, tonic, and antiseptic.
904
PIIAKMACECTICAL TUEEAPEUTIC AGENTS OR DRUGS.
Therapy. — lu genito-urinary affections, hsmaturia, and pulmonary
affections trillium is used in the form of a fluid extract, which is also used
exlerually for wounds. It is an ingredient in tlie compound fluid extract
of tftillingia (?oe page 851).
' TRIMETHYLAMINI HYDEOCHLORAS. — Trimethylamin, with di-
methylamin and tetramcthylammunium hydrate, are compound ammonia
bodies, discovered by ilotl'mann. Dimcthylamin is a combustible gas. Tri-
methylamin is also a gas at ordinary temperatures, with a strong ammoniacal
odor and an intense alkaline reaction; with methyl iodide it forms a salt
which, being treated, in solution, with silver oxide, yields silver iodide and
tetramethylammonium hydrate. The latter body, being subjected to dry
distillation, decomposes into triraethylamin and methyl alcohol. Trime-
thylamin [(CHa);,^] exists already formed in Arnica montana, Chenopodium
vulgaris, in the flowers of Crataegus oxyacantha, in ergot, in codliver-oil, and
in various decomposing albuminous compounds, particularly hen'ing-brine,
guano, urine, and coal-gas tar. Vincent extracted large quantities from the
re-sidue of the distillation of fermented beet-juice, or the refuse left after
making beet-sugar. Propyhiniin is usually an impure triraethylamin in solu-
tion; the name properly bclonirs to another, though similar, compound.
Physiological Action.^Tnnjcthyliimin hydrochlorate, in strong solu-
tion, acts as a caustic.; when applied to the lip it causes a burning sensation,
and the epithelium afterward exfoliates, leaving a superficial ulcer. Inter-
nally, it acts as an irritant to the digestive tract, and to its local action
Dujardin-Beaumetz ascribes the cause of the fatal result from a large dose;
be states, however, that as much as 5 Gm. (or gr. Ixxv) may be given without
fatal effect. Doses of about 1.30 Gm. (or gr. xx), repeated several times,
cause, in rabbits, general distress, tremor, with loss of motive power, hyper-
ffisthcsia, and increased reflex excitability; the same amount injected under
the skin produces death. In the human subject the first effect, from mod-
erate doses, is increase of the heart's action, but soon, especially if full doses
are given, the opposite condition is set up: the pul?c-rate and temperature
are lowered. No colic or diarrhoea occurs, but the odor and taste are so
unpleasant that the remedy is often rejected by the stomach. No increase
of perspiration or of the urine is reported,
Combemale and Brunellc state that trimethylamin provokes an ex-
cessive secretion of saliva and increases the alkalinity of that fluid. The
nasal and lacr}-mal secretions are augmented and a slight albuminuria is
produced. Dujardin-Heaumetz states that the excretion of urea is dimin-
ished by the drug. Fatal narcosis may occur from retention of carbonic-
acid gas in the blood, but Phillips ascribes death more commonly to the
depressing effects of the remetly upon the spina! cord.
Antidotes to Toxic Action. — ^The proper treatment of poisoning would
be hy external heat, and counter-irritation by mustard or turpentine, and
opium and belladonna or atropino to control the symptoms. The tincture
of capsicum, with digitalis, strophanthus, or nux vomica, would be useful
in counteracting the effects upon the circulation.
Therapy. — This drug was introduced for the purpose of treating acute
* rheumatism, and in cases with high temperature and active circulation it has
produced good effects. It has also been used as an antipyretic in otlier
maladies, in doses of 0.13 Gm. (or gr. ij) repeated every three or four hotirs.
TBITICDM.
905
I
ft should be given in capsules or in solution with peppermint-water, well
diluted. Trimethylanin is of service sometimes in chronic rheomatism, in
MThieh it has been also used as a liniment, 1 part being mixed with 3 parts
of glycerin. It has been administered in gout.
TRIONAI. (See Sulphonethylmethane.)
TRITICI FAEIKA. — Wheat-flour. The Triticum vulgare (Qrami-
nacea*K or wheat, is a well-known source of food. The farina is a line, white
flour, prepared from the seed; it is impalpable, inodorous, and of insipid
taste. It consists of starch, 70 per cent.; gluten, 12 per cent.; fixed oil, 2
per cent.; tot^ether with cellulose, sugar, and water. It yields about 2 per
cent, of ash, containing 50 per cent, phosphoric acid. It is hit^hly nutritious,
and contains a large amount of nitrogenous matters. With cold water, it
forms a granular, pasty mass, not very adhesive; but, with hot water, the
starch-granules swell up and burst, making a homogeneous, jelly-like
mixture.
Physiological Action. — It is bland and unirritating, and forms a good
•ntidf'fe, when mixed with water, in case of corrosive poisoning. The starch
is antidotal to iodine and its preparations.
Therapy. — Wheat-flour dusted upon an inflamed surface coats it over
with a layer which protects it from the air. It is a convenient apphcation
to recent bums and scalds, or erysipelas; but in hot weather it should be
asBOciated with some antiseptic to prevent the development of insects, the
oTt or larvae of which very often find their way into flour, especially if ex-
posed to the air. It has been asserted that a tablespoonful of flour, in a
glass of cold water, swallowed niE^ht and morning, will check the develop-
ment of boils. As the basis of bread, wheat-flour enters into the question
of nourishment for the sick, which belongs more to the province of the
nurse than the physician, although the medical attendant should be per-
fectly familiar with the digestive and nourishing qualities of any preparation
which may be submitted to his judgment, in order to pronounce upon its
fitness, or the reverse, for the patient.
I
TEITICITM (U.S. P.).— Couch-grass.
Dose, 4 to 15.5 Gm. (or 3i-iv), in infusion or fluid
extract.
Preparation,
(U. S. r.),— Fluid Extract of Triticuiu.
Do»e, 2 to
FIutd«xtraciuni Tritici
7^ c.cm. (or fSsa-ij).
Pharmacology. — The dried rhizome of Agropyrum repens (Gramineae),
gathered in the spring, and deprived of its roots. It is a common, natural-
ized perennial, a native of Europe and Asia; everywhere growing in the
ri<*Ids, and regarded as a weed. The rhizome c*mtains Triticin, a nitrogen-
ous gum, sugar (both dextrose and levulose), but is devoid of starch and
rpsin.
Physiological Aotion. — It is demulcent and diuretic.
Therapy. — Triticum may be given, in decoction, as a demulcent drink
in fevers. This preparation, or the fluid extract, is useful in irritability of
the bladder and chronic cystitis. In the latter affection, Sir Henry Thomp-
son recommends a pint of the infusion or decoction, to be taken during the
S)OG PUAUMACEUTICAL THKEAPBUTIC AGENTS OR DttCGB.
day. In chronic cystitis, irritable prostate, and in gleet, the writer has pre-
Bcribed the following with triticurn: —
IJ Fluidext. tritici IM)| c.cm. or fjiij.
Tiuct. beUadonnee fol 416 c.cm. or irilxxij.
Sodii biearbonati^ 8] Gm. or 3ij.
M. Sig.: A teaapoonful in water every two or three houri.
4
The following combination relieves irritable bladder or cystitis in
"women : —
5 Qm. or Sss.
c.cm, or fSj.
25 c.cm. or fSiiss.
c.cm. or fjse.
ft Potasaii eitrrttU 15
Fliudext. tritiei , 30
Tinct. belladonnee foL 9
Fluuifcxt. bucbu 15
Aqufe q- 8. ad 120 c.cxn. or fSiv.
M. et ft. sol.
Sig.: Teaspoonful in a wineglnsaful bf water three timet a day.
Tincture of hyoscyamus may be substituted for the tincture of bella-
doiuia in this fonnula.
The fluid extract is a pleasant, malt-like preparation, has some nutritive
properties, and possibly may be of value in chronic bronchial disorders.
The decoction is one of the many popular remedies for consumption.
TROPACOCAINE.— This is an alkaloid which has been obtained by
Gifsel from the small-leaved coca-plaut of .lava. Liebermann has determined '
that in chemical composition it is benzoyl-pseudotropein, and regards the
pseudotropein, which he has succeeded in separating, as identical with the
substance of that name derived from Ilyoscyamus niger. For the sake of
convenience the name tropacocaine has been adopted. Liebermann has sue- '
ceeded in preparing it by sj'nthesis. Although closely related chemically to
the solanaceous alkaloids, its physiological and therapeutical properties
closely resemble thoee of cocaine. ;
Physiological Action. — The physiological effects of tropacocaine were ,
first investigated by Dr, Arthur P. Chadboume, of Boston, who found that
in the frog the difference of action between tropacocaine and cocaine is
chiefly quantitative. In rabbits repeated small doses caused cerebral stim-
ulation, followed by a quiet interval. After this stage, inco-ordination and !
convulsions ensued. When larger doses were given, the convulsive stage was
short and was rapidly succeeded by coma, failure of respiration, and death. I
Small doses at first increase the pulse-rate, but there is, in general, no con- ;
siderabk temporary rise like that usually produced by cocaine. The increa.«e j
is followed by decrease of pulse-rate and a gradual, but steady, fall of blood-
pressure. Injection into tne jugular vein, more or less completely paralyzes
the motor ganglia in the heart and quickly lowers the tonus of the peripheral I
vessels. Tropacocaine produces complete local antesthesia more rapidly than .
cocaine, and, as a rule, the effect is more lasting. Tropacocaine has but half
the toxicity of cocaine. Although classified by Liebermann with the atro-
pine group, tropacocaine does not dilate the pupil. It may be substituted
for cocaine in equal doses. The solutions keep unchanged for months.
A number of experiments were performed by Dr. Hugenschmidt. of
Paris, upon human subjects. The injection of 2 eg. (or gx. Va) into the gum
slightly quickened the action of the heart without affecting arterial tension.
There was slight dryness of the throat, but no dilatation of the pupiL The
TUBEUCL'LIN.
yor
I
injection of double the quantity caused vertigo and a sudden fall of blood-
preesure. The regpiration was uninfluenced and the normal pulse-rate was
soon regained.
Therapeutics. — Tropacocaine was first employed therapeutically in the
ophthalmological clinic of Professor Schweigger. Both ihe physiological
and therapeutical investigations were carried on with a synthetically pre-
pared tropacocaine hydrochloride. The alkaloid derived from the plant
causes considerable irritation, but this effect is not produced by the syn-
thetically fonned product. Ocular aneesthesia is more rapidly developed than
by cocaine, and, although of shorter duration than that due to the latter
alkaloid, may easily be maintained by adding a drop of the solution from
time to time. It has been used in the form of a 3-per-cent. solution. On
account of the rapidity of its action, it is particularly adapted for the removal
of foreign bodies from the cornea. Tenotomy and iridectomy, also, are satis-
factorily performed under its influence. Tropacocaine has been advanta-
geously used in order to prevent pain from caustic applications to the lids, in
dividing strictures of the lacrymal duct, and opening Meibomian cysts. In
dental practice. Dr. Kugcnschundt has made use of solutions of tropacocaine
and has extracted roots, broken up the alveolus, and removed a bony seques-
trum without causing the patient any pain. Seifert has reported, concern-
ing the application of tropacocaine to nasal and laryngeal surgery, that
stronger solutions are required than are necessary in the case of cocaine.
He adds that severe hsemorrhage is apt to follow the employment of tropar
cocaine.
Dr. Willy Meyer^ refers to Schwarz's experience in producing spinal
anaesthesia; the latter found that 0.05 Gm. (or gr. '/•) produced as perfect
en analgesia as cocaine without any of its frequent symptoms, such as pal-
lor, perspiration, vomiting, headache, and rise of temperature. Ten min-
utes after the injection analgesia was usually complete, and lasted until
the end of the operation. He is not sure, though, that it can be sterilized by
boiling without impairing its efficacy. Dr. Kuykendnll, in producing spinal
ansesihesia, places O.OC Gm. (or gr. j) of tropacocaine in the barrel of the
syringe before introducing the needle into the spinal canal. The spinal fluid
flows into the syringe and dissolves the tropacocaine, which is now cautiously
injected.
Tropacocaine possesses antiseptic properties, ita eolutionfi keep well,
and it has the advantage of producing anjesthesia of inflamed tissues. It
is claimed that it does not occasion any haze upon the cornea.
TTTBERCUIIN. — On November 14, 1890, Koch, of Berlin, announced,
through the columns of the Deutsche medicinische Wochenschrift, that he had
separated a substance, "tuberculin," from the products of tubercle bacilli
which had a "specific" action in the treatment of tuberculosis. Although
the subsequent results obtained by the profession were not as satisfactory
as the first announcements led us to believe, yet it was, at any rate, a step
forward in an entirely new field of treatment for this disease. The dose of
tuberculin was 0.1 mgm. injected under the skin, and increased 0.1 mgm.
every day. When injected into men or animals, who are the subjects of
tuberculosis, it produces a great rise of temperature, while similar small
'i/edfcal NcKS, April 13, 1001.
908
PHARMACEUTICAL THKiUPEUTIC AGENTS OR DUCUS.
dosee injected into healthy individuals produce no rise of temperatureT
Among the other Bymptoms noted were pain in limbs, fatigue, some cough,
and dyspncea; at the site of the injection abscesses were also prone to de-
velop. Koch, in 1897, contributed a second paper on a product which he
termed, on account of its being an alkaline extract, TA (tuberculin); this
produces a similar reaction as the original tuberculin, only that of the TA
is more marked and of longer duration.
Finally, Koch described an elaborate process for making a purer extract
than his former ones; from this process he obtained two extracts — TO and
TR. The former (TO) does not produce abscesses at the point of injection;
otherwise its action is similar to TA and the original tuberculin; with the
TR preparation Koch claimed that, beginning with small doses and gradu-
ally increasing, animals could be immuued to the TR preparation and finally
to the tubercle bacillus itself.
Tuberculin as a diagnostic agent is of some importance. Its value as
a diagnostic agent of tuberculosis in cattle has been abundantly proved in
recent years, a striking example being in the herd at Windsor, England.' It
has been successfully used for this purpoH«e in the human subject also.
Dr. Max Beck- gives the details of 3137 cases which had been injected.
In 1154, or 54 per cent., the diagnosis was made by means of the tuberculin
injections. He states tliat, whenever a patient is found to react, a tuber-
culous focus, even though it may be small, must surely be assumed as being
located somewhere, either in the bronchial glands, lungs, or other organs.
Prof. J. M. Anders^ gives a table of 1470 suspicious cases of tuberculosis
with 71.80 per cent, reactions. ITe advocates its use in all suspicious (in-
cipient) cases in moderate doses, usnally in doses from 2 to 5 mpm.
A^rchow* early noted that tuberculin occasioned collateral hvpenemia,
softening of the tul>ercles, and liberation of the tubercle bacilli from tuber-
cles in the process of recovery; this condition is likely to follow massive
doses, which were used for their supposed therapeutic properties; but, in
Buspcctcd cases where the known means of making a diagnosis fail, this agent
may he tried, for at this period massive doses are not required. The thera-
peutic use of tuberculin is still in the experimental stage, as the reports of
results are conflicting.
TITMENOL. — This is the name given to a substance derived from
mineral oils, its title pointing to its orifrin from bitumen and oleum. The
impure mother-substance occurs among the unsaturated hydrocarbons of the
oils, and is separated by the addition of sulphuric ccid, a process of sulphona-
tion taking place, with the production of a compound consisting of tumenol-
Bulphon and tumenol-sulphonic acid. Tumenol has been used clinically by
Neisser in the form of powder, solution in sulphuric acid and alcohol, and
as an ointment or pinstcr. It was found serviceable in acute eczema, bums,
ulcrrs. nnd pnrn^sthesin, used externally (in 5- to lO-per-cent. solution).
Sodium-tumenol-sulphate is a dark-colored, dry powder, is soluble in water,
and is used for the same purposes as tumenoL
' London Lancet, vol. i tor 1899, p. 1041.
• Drutttvhe medicinische Wochcnschrift, vol. xxv. p. 137.
' yrw York MedimlJoumal, June 2:i, 1000, p. 906.
* Deutsche medicinische Wochcnschrift t 1891, p. 131.
I
TUSSILAQO. — Tussila^, ColtVfoot, The leaves and root of Tussilago
farfara (Coinp<>gita?)j growing in cold, clayey bankt^. in the Northern and
Midtlle States, contain mucilage, tannin, and a bitter extractive.
Physiological Action. — Tussilago is demulueut, tonic, and, as the name
indicates, it is also deemed expectorant or pectoral.
Therapy. — In cough attending chronic pulmonary affections, chronic
bronchitis, etc., colt's-foot is used, often in combination with licorice, or
hoarhound. The fregh leaves are applied in the form of a poultice to scorfu-
Jous ulcers. The fluid extract is a stomachic, and has some tonic properties,
ag chiefly to the alcohol which it contains. Dose, 4 to 7.5 c.cm. (or £5i-ij).
TTLMUS (U. S. P.).— Elm (Slippery^lm).
Preparatwn.
Mupilago Vhni (U. B. P.).— Mucilage of Elm (dried bark, 6 Gm.; boiling water,
100 ccra.i.
Pharmacology. — The *'1>ark of Ulmus fulva (TJlmaceie), deprived of
its periderm."' The red chn is a handsome forest-tree of North America,
ttkd its hark contains mucilage principally.
Physiological Action. — Elm-bark is used as a demulcent externally and
intenially. Tlie dried bark, in flat pieces or strips, is sometimes chewed, as
the taste is not unpleasant, and the mucilage moistens the mouth and throat.
Therapy. — Poultices of ground-elm bark, with lead-water, arc scrvice-
ible in erj^ipelas and various forms of local inflammation; they are used
cold or hot. Internally the mucilage may be given ad libitum in stomach
and bowel disorders, and in painful affections of the urinary passages, dysu-
ria, etc. Pieces nf elm-hark, of suitable size and fihape, may be made into
tents for the dilatation of fistulfe, and in the treatment of uterine affections.
UBETHAJTE.— (See JEthylis Carbamaa, page IG-l).
I
I
I
ITVA TJESI (IT. S. P.).— TJva Ursi (Bearberry).
TTVJE TTESI FOIIA (B. P.).— Bearbcrrydeaves.
Dose, 4 to 8 Gm. (or oi-ij).
Preparaiions.
Fluidextrnctum Vvtt Trsi ( L", S. P.).— Fluid Extract of Uva Ursi. Dose. 2
to 4 c.cm. (or fSssj).
Infusum Uve Ursi (B. P.). — Infu&ion of Bearberry (5 per cent.). Dose, 15 to
10 c.cm. (or fSss-j).
F.xtrnctiim Vvm Trsi. — Extract of Uvn Vm. Do«e, 0.32 to 1 Gm. (or gr. v-xt).
Pharmacology. — The dried leaves of Arctostaphylos Uva ursi (Erica-
ccsb), or bearberry. n small herb of North America and Europe, contain
tamiio and gallic acids, to which they owe their astringency. Three princi-
ples have been sepa rated. Arbutin, Ericolin, and TJrsone, the latter being
tastelesg. the others bitter and crystallizable, soluble in water and alcohol.
The two former are glucosides; the latter appears to be a resin. There is
alfK) a Fmiill f|iiJiMiity nf Ercinol, which is a volatile oil.
Physiological Action. — The preparations of uva nrpi are astringent, and
in proper dose carminative and tonic, but may constipate the bowels. The
910 PnARMACEUTICAL THERAPEUTIC AGEKT8 OH DRCOS.^^^^^^B
I aatringent principles pass of! by the kidneys and are sedative to the Tirinary
I passagea. An overdone of uva ursi produces vomiting, purging, and genito-
urinary irritation, with, soractimca, vesical tenesmus and haematuria.
Therapy. — The infusion or decoction of uva ursi is a valuable agent in
I treating irritation of the bladder, strangury, dysuria, pyelitis, or cystitis. It
may be combined with an alkali as follows: —
R Sodii bicarbonat. 621 Gm. or Jij.
j Decoeti uvae ursi 240[ c.cin. or f^vlij.
M. Sig.: Take a tableapoonful every two hours for vesical irritation, or in the
strangury foHowiog the uae of a bliaUr.
Uva ursi has some reputation in calculous affections, gravel, etc.
Arbutin is used in doses of 0.13 to 0.32 Gm. (or gr. ii-v) as a diuretic in dropsy,
and also in urethritis. Arbutin appears to be devoid of toxic properties and
communicates to the urine a greenish hue, which grows darker if the fluid
is allowed to stand. This change of color seems to be due to a partial de-
composition of arbutin into glucose and hydrochinone. The chemical change
probably occurs in the kidneys. According to Lewin, arbutin is the active
principle of uva ursi. Dr. Menche has given arbutin in daily doses of 0.75
Gm. (or gr. xij) with decided advantage in cystitis.
It has been asserted by Dr. Harris, of Alabama, that uva ursi causes
uterine contractions, and can be used as a substitute for ergot, but further
observations are needed to establish its value in this direction. Uva ursi has
been given with success in leucorrhoea, menorrhappa, chronic dysentery, and
bronchorrhrea, and is reported to have been beneficial in diabetes.
r VACCINIUM VITIS ID^A.— Vacciniima vitia idaa (Ericaceaa), moun-
tain cranberry^ nr cowberry, is closely related to uva ursi. It grows in vari-
ous European countries and in New Enprland. Ttbas a popular reputation as
a remedy in rheumatism. An investigation of its properties has led two Rus-
sian physicians, Drs. T. Hermann and S. Smimow, to conclude that the
plant really possesses value in both acute and chronic articular rheumatism.
It was given in the form of a decoction of the entire plant {8 to 15.5 Gm.
to 180 c.cm., or 5ii-iv to fSvj, of water), the entire quantity being taken in
the course of the dny.
Professor Winternitz, of Vienna, has successfully employed an extract
of bilberry (Vaccinium rayrtillus) in affections of the mouth, bronchi, kid-
neys, and bladder, and in diabetes. Dr. Weil, of Berlin, asserts that he has
used it with advantage in the treatment of diabetes mellitus. A decoction
of bilberry-fruit has been used with favorable effect as an injection in chronic
gonorrhoea.
I VALERIANA (U. S. P.).— Valerian, Valerian-root.
I VALERIANiE RHIZOMA (B. P.).— Valerian Rhizome, or Root.
I Dose, 0.65 to 2 Gm. (or gr. x-xix).
I Preparations.
I Fluidextractum Valeriana (U. S. P.). — Fluid Extract of Valerian. Dose,
2 to 4 c.cm. {or {3sa-ij).
Tinctura Valeriana (U.S. P.). — Tincture of Valerian (20 per cent).
7.5 ccm. (or f3i-ij).
Tinctura Voleriantt Ammoniata (TJ. 8. P., B. P.). — Ammoniated Tincture of Va-
lerian (powdered valerian-root, 20; aromatic spirit ol ammonia, to make 100 parti,
VAIiEBIANA.
911
fTT. 6. P. Vnlerinn. 200 Gm.; oil of nutmeg, 3.1 c.cm.; oil of lemon, 2.1 c.cm.; solu-
tion of ammonia. 100 c.cm.; nnd alcohol [60 per cent], 900 c.cm., h. P.). Do8C» 4 to
\7J& ccm. (or fSi-ij). B. P., 2 to 4 c.cm. (or fSss-j).
The U. 8. P. official valerianates are of ammonia, iron, quinine, and rinc; the
Iatt«r is also official in the British Pharmacopoeia.
P
Pharmacology. — **Thc Mai rhizome and roots of Valerinna ofHcinolis'*
(Valerianacca?): a native of Europe, but cultivated in this country. The
root contains a volatile oil, which was formerly ofRcial, and by oxidation
yields Valerianic acid. When the drug is recently dried it contains more
volatile oil and less valerianic acid; as it gets older, the oil decreases and
the proportion of valerianic acid increases, while the odor becomes more
marked. Valerianic acid is a colorless, oily fluid, with an odor resembling
that of the drug, and a strongly acid and burning taste. It also contains
Valeren, which is a terpine, and valerian camphor, with resin and water,
constituting Valcrol, which is changed by contact with air into valerianic
acid. An alkaloid has been extracted from valerian-root by M. Waliszewski,
(if Clichy, and named Chatinine by its discoverer, in honor of M. Chatin, late
Director of the School of Pharmacy of Paris. The same chemist has also
isolated a second alkaloid termed Valerine. Valerianic acid may be made
artificially by the oxidation of amylic alcohol, and it is from this acid that
the valerianates are formed; but it does not quite correspond with the
natural acid in its physiological elTects. Borneo! isovalerianate (or boriiv-
val) is now claimal to be the active principle of valerian-root. The ammoni-
ated tincture is a valuable pre]mration, owing to the stimulating and car-
minative effects of the ammonia. The effects of the valerianates made sjn-
thetically are inferior to that obtained from valerian-root. An elixir of
ammonia valerianate, however, is an excellent preparation when well made,
the odor and taste of the salt being covered by the addition of vanilla and
ittle chloroform; it contains 0.13 Gm. to 4 c.cm. (or gr. ii to the fluid-
im|, and is given in table^pionful doses. In this preparation part of
the r«v=ult must be attributed to the alcohol which it contains.
Phyfliological ActioiL — Valerian is antispasmodic and slightly stim-
ulating to the circulation. It reduces irritability and reflex contractions,
and is a sedative to the spinal cord. In small quantities, valerian excites a
sensation of warmth in the stomach, improves the appetite and digestion.
Bouchard states that valerian materially decreases the amount of urea ex-
creted. Large doses cause nausea and vomiting, diarrhoea, frequent mic-
turition, tenesmus, increased discharge of urates, with giddiness, hallucina-
tions, and mental disturbance, the oil being a paralyzing agent to the great
nerv^-centres. Elimination takes place through the kidneys, lungs, and
kkin.
Therapy. — There are no local applications, and the internal use haa
practically become limited to the treatment of nervous disorders in women,
especially nervous headache and hysteria, or hystero-epilepsy. The follow-
ing prescription, containing valerian, is serviceable: —
B Tinct. valeriantD ammon.,
8i)iritUB lEtheria comp.,
Tmct. faumuli «« 60|
V. Sig.: T\vo teaspoonfula in water, every hour or two.
com. or fSIJ.
ing.
912 PHARMACEUTICAL THKRAPEVTIC AGEXTS OH DttUGS.
The various nervoua disturbances which occur at the menopause are
relieved by the administration of valerian. This remedy is also of service in
pruritus dependent upon disorder of the nervous system. Valerian is of
advantage iu allaying the nervous phenomena of exophthalmic goitre.
Favorable reports have been made of its utility in diabetes insipidus and
mellitus. The improvement, however, does not continue. In various spas-
modic disorders in children, such as convulsions or chorea due to worms,
nervous cough, whooping-cough, and in delirium with depression, it has
been beneficially employed. The oil has been given to arouse patients from
coma during the progress of a fever, like typhus. Morphine valerianate is
sometimes used with the idea that it is better borne than the ollicial salts.
Zinc valerianate has been used in nervoua diseases, chorea, epilepsy, and neu-
ralgia, in do^es of 0.13 to 0.20 Gm. (or gr. ii-iij), with considerable success.
VANILLA (U. S. P.).— Vanilla.
Preparativn.
Tinctura Vanillie (U.S. P.). — Tincture of Vanilla (10 per cent), used for flavor-
Vnnillinum (tJ. S. P.) Vanillin.
Pharmacolofi:y. — Vanilla is the prepared, nearly ripe fruit of Vanilla
planifolia (Orrhidaceoe), a native of tropical America. The fruit appears
in market in bundh^s of about fifty pods, six to ten inches long, dnrk-colored,
one-relU:*d, containing a blackish pulp, in which are imbedded numerous very
small bliick seeds, and some crystals of the active principle Vanillin, The
odorous, active principle is soluble in alcohol; the pulp also contains fixed
oil, sugar, resin, etc.
Therapy. — Vanilla is used in flavorintr troches and in making articles
of food for the sick. It is added to chocolate during the preparation of this
article for the market. It is an aromatic, and probably exerts some stim-
ulating effects upon the human organism, which would make it serviceable
in nervous affections. Some persons are more influenced by it than others.
Vanilla is said to have aphrodisiac power, possesses stimulant and tonic
properties, and has been recommended as appropriate to the treatment of
dyspepsia.
Workmen exposed to the duat of vsDilla are frequently attacked by
papular eruptions upon exposed parts of the body, accompanied by itching
and swelling, and followed by desquamation. Coryza and conjunctivitis are
also produced by the same cause. Other effects which have been observed
are anaemia, headache, giddiness, irritability of the bladder, nervousness, and
sexual excitement.
VERATRINA (U. S. P., B. P.).— Veratrinc.
Preparations.
*
Oleatura VeratrinoB (U. S. P.).— Oleate of VeratTire {2 per cent).
Unguentwm Veratrinfle (U.S. P., B. P.). — Veratrine Ointment (4 per cent.; B. P.
is Z per cent.).
Pharmacology. — Veratrine is a "mixture of alkaloids obtained from the
seeds of Asagraa olBcinalis (LiliaccteV (U. S. P.); "from cevadilla, the dried
ripe seeds of Schttuocaulon officinale" (B. P.). Veratrine is readily soluble in
alcohol, chloroform, and ether; in water it dissolves in the proportion of 1
VKRATRUM.
913
»00, Protoveratrine and Protovcratridine have been recently sepa-
m the rhizome by Sulzberger. The first is extremely toxic; the
latter appears to be innocuous,
Physiolo^oal Action. — This agent is very irritating to mucous mem-
branes; it powerfully depresses the hearths action, reduces the temperature,
and causes fatal collapse. It lowers the sensibility of the sensory nerves.
The topical application of veratrine may give rise to erythema, pustules, or
petechia?.
Therapy. — Veratrine, applied to the affected spots, in the form of oleate
or ointment, quickly relieves neuralgic and myalgic pains. Vei'atrine oint-
ment mitigates the pain of herpes zoster, and is used in weakened form in
infantile paralysis, for the purpose of promoting the nutrition of the affected
muscles. This preparation is beneficially applied in cases of chronic swelling
snd stiffness of joints, and to the affected articulations in the beginning of
a paroxysm of gout. Veratrine ointment is useful in pleurodynia or chronic
pleurisy, alopecia circumscripta, chloasma, and pediculosis. For ordinary
use the U. S. P. official ointment is too strong, and should be reduced one-half
or more. Care should be taken not to introduce any of the ointment into the
eyes, or violent conjunctivitis may be set up. The effects should be care-
fully watched, also, when this ointment is applied upon or near an abraded
or denuded surface.
Veratrine has been given internally in rheumatism, neuralgia, etc., in
doses of 0,0012 to 0.005 Gra. (or gr. Voo-^/i-.')> ^^^ i^ ^^^ depressing. Taylor
records that alarming symptoms have been produced by 0.004 6m. (or gr.
Vib) of veratrine.
VEKATRUM (U. S.
Ftuidextractum Veratri
lo 2.50 c.cm. (or mi-xl).
TiTiPtiim Veratri (U. S.
0.19 to ] o.rm. (or mni-xv).
P.). — Veratrum.
Preparations.
(U. 8, P.).— Fluid Extract of Veratrum. Dose, 0.06
P.). — Tincture of Veratrum (10 per cent.). Dose,
I
Pharmacology. — "The dried rhizome and roots of Veratrum viride,
American hellebore; or of Veratrum album, white hellebore (Liliacea?),"
are official. It is nn indigenous plant which grows in damp places and from
its place of gfTOwth is called swamp-hellebore, also Indian poke, or poke-
• root; but is an entirely different species from phytolacca, which yields the
poke-root of the United States Pharmacopoeia. Veratnim contijinR Proto-
Teratrine, Jervinc, Rubi-jervine, Psendojcnrine; n bitter glucoside, Veratra-
marin, an*! Jervic acid. Covadinc is prpsout in Veratrum viride, but not in
V. album, according to Wright and Luff. Veratroidino. which wns formerly
I regarded as one of its constituents, is thought by Brunton to be, in all
K probability, simply rubi-jervine with resin. Jervine has not been used
■ medicinally; it constitutes about 50 per cent, of the total alkaloids. It
H is feebly toxic, and, it is said, does not produce vomiting. It forms crv'stal-
^^^tble salts with ncid?.
BB Phyiiologrical Action. — The action of veratrum is due to the alkaloids
~ which it contains. In small doses of the fluid extract, the pulse is lowered
in foree^ without at first affecting its frc<piencY; it afterward bocom*^ slow,
: eoft, and moderately full, and liable, upon the patient's making any exer-
9U
JPit^VHAI^CEUTICAL TIIERAPEUTIO AGENTS OE DaOGS.
tion, to become rapid, sninll, and even imperceptible. Nausea and vomiting
frequently occur, with much muscular weakness. Large doses bring on a
coudition of coUapst*, with retching, cold and clammy skin, imperceptible
pul&e» int( use inuscuhir weaknesF, giddiness, and gradual loss of conacious-
ue8s. Jervine is snid to lessen jrreatly the functions of the spinal cord and
medulla, especially the vasomotor cenire, and at the same time to cause
convulsions by irritation of motor centres in the brain, the principal effects
^eing shown in niusculnr weakness, followed by tremors, lowered blood-
Hressure, and slow pulse. Bartholow attributed death to asphyxia from
paralysis of muscles of respiration, and considered the cerebral effects to
be due to the acciimulntion of carbonic acid in the blood. It is possible that
the con\nilpion» may really be due, to some extent, to cerebral aniemia, and
that death may occur from syncope. An erythematous or pustular eruption
will somotiiues follow the internal emplo\inent of veratrum.
Treatment of Toxic Effects. — Notwithstanding the very formidable
symptoms produced by large doses, fatal effects are rare. An ounce of the
tincture has been swallowed without producing death, probably because the
prompt emesis which was excited caused the rejection of the most of it.
Ordinarily the eymptoms are rapidly relieved by the suspension of the rem-
edy and the administration of opium and stimulante. The head should be
kept low and the application of external heat is of assistance in the treat-
ment.
Therapy. — The form and mode of administration is of some importance.
The fluid extract is a saturated tincture, and resembles, in this respect, Nor-
wood's. The tincture was preferred by Bnrtholow in doses of 0.30 c.cm. (or
my), not at a longer interval than two hours. The recumbent posture must be
strictly enforced, in order to avoid the emetic effects, which are so depressing
that the remedy is never used for this purpose. In various forms of over-
action of the heart, hypertrophy, irritable heart, and the abnormal tension of
Bright's disease, it is of great service. It should not be used where there are
valvixlar lesions and the cardiac muscle is enfeebled, or where there ia
dilated or fatty heart. In aneurism, in conjunction with the proper regimen
and rest in bed, veratrum viride favors coagulation of the blood and dimin-
ishes the pressure, the effects being carefully watched so as to avoid vomit-
ing. In exophthalmic goitre benefit has resulted from the use of 1.20 to
1.55 c.cm. (or w/xx-xxv) daily of the tincture.* In the first stage of pneu-
monia and acute congestions of the viscera, there is an accumulation
of favorable testimony; it directly reduces the tendency to accumulation
of blood, and diminishes the danger of exudation. In pneumonia, when
taken at the very beginning, and doses of O.fiO to 1 c.cm. (or mx-rv) of the
tincture given every two hours or less, until there is a reduction in the pulse-
rate and temperature, veratrum will produce the best results; it is useless
after fibrinous deimsit lias taken pbicc. Tinctnre of veratrum baa been em-
ployed as an antipyretic in acute rheumatism. Tn active hiT?raorrhage or acute
mania, in the plethoric, this remedy also moderates the force of the circula-
tion, and may at once check the seizure. In typhoid fever it is inadmissible,
except in cases of hyperpyrexia with active delirium. In puerperal convul-
BJons it has been given in doses of 2 c.cm. (or fose) of the fluid extract every
fifteen minutes until vomiting is produced, or the convulsions cease. It
"ADDual of the Universal Medical Sciences," 1890, vol. r, p. A-137
VTBBABCUM.
915
should not be given if the circulation is we»k. Dr. Hutchens, of Bonville,
S. C-, advises giving a full dose of morphine hypoderraically, followed by
1.12 c.cm. (or mxriij) of tincture of veratrum in the opposite arm (prefer-
ably in the deltoid region), and then the administration of chloroform, and
venesection in a plethoric patient.' Veratrum, in small doses, often rapidly
relieves or cures tonsillitis, especially when combined with morphine, al-
though the latter is otherwise physiologically aiitaponiptir tn vrrntnim.
1| to 2
B Tinct. Ter*tri
MorphinK Biilphatis
Aque mcnth. pip 60
M. Sig.: A teaspoonful every hour or two, until relieved.
c.cm. or mxvi vel xxxij.
066 Gm. or ct. j,
c.cm. or fjij.
I
Phillips reports that this remedy seemed to relieve a case of persistent
priapism after antimony, belladonna, and bromides had failed. It is thought
that veratrum has been of value in preventing or diminishing the severity
of inflammation after abdominal injuries.
Yeratrone is an aseptic, non-alcoholic, permanent solution of veratrum,
■Mved to the strength of one-fourth of that of the fluid extract (U. S. P.).
"ft is convenient for hypodermic use without dilution. It is prepared by
Parke, Davis & Co., of Detroit.
VHEBASCUH. — The verbascum thapsus (natural order, Scrophulari-
acett), or mullein-plant, grows by the roadside and in neglected fields. Its
leaves are large and woolly, and it bears yellow flowers in dense spikes. The
leaves contain a large proportion of mucilage, and a small quantity of vola-
tile oil exists in the flowers.
Physiological Action and Therapy. — Mullein is demulcent, expectorant,
and contributes to nutrition. It has long enjoyed a popular repute in Ireland
as a remedy in pulmonary affections. Quinlan esteems it of considerable
value in phthisis and other wasting diseases. He states that this plant re-
lieves cough, diminishes expectoration, and increases the bodily weight. It
is given in the form of an infusion made with milk, 124 Gm. (or 51^) of the
fresh, or a corresponding quantity of the dry, leaves being boiled for ten
minutes in 473 c.cm. (or fjxvj) of fresh milk. This quantity is to be drunk
thrice daily, while still warm. Though the milk doubtless add* to the effect,
Quinlan saw benefit result from administration of the juice alone. The
taste is unpalatable and is disguised by the milk. It may also be of service
in bronchitis and asthma. Mullein has likewise been used in diarrhoea.
VERONAL is dipthylmalonylurea, or diethylbarbituric acid. It occurs in
small, colorless, odorless, faintly bitter crystals, which are soluble in 145
pMlaof water. It is hypnotic and sedative. DoseB, 0.50 to 1 Gm, (or gr.
Tiiaa-xv), given in hot tea or milk at bed-hour. One-half ounce caused death
in an elderly woman.'
^OMHnriVH M**dirnl Jitut^ni, April. IHOO,
*Uncrt, D«-. 30. I»0o.
91(J
PUAHiCACEUTICAL THEHAPEDTIO AGENTS OR DRUGS.
VTBUENUM OPTJLUS (P. S. P.).— Viburnum Opulus, Cramp-bark,
VIBURNUM PfiUNITOLIUM (U. S. P.).— Black Haw.
W Preparations.
Fluitlextrartum Viburni Opuli (U. 8.P.). — Fluid Extract of Viburnum OpiiluB.
Dose, 1 to 4 c.em. (or 7>ixv-f3j).
Fluiilf.vtniciuin Niburni J*runifolii ( U. S. P.). — Fluid Extmct of Viburnum
Prunifoliuiu. Dose, I to 4 c.cm. (or tnxv-f3j).
Pharmacology. — "The dried bark of Viburnum Opulua" and also "the
drjril bark of tlie root of Vil>urTiuin prunifoliuiu"' (Caprifoliace^), are both
official. The latter is a tree eonnnuu in the United State east of the Miesis-
sippi. Its height varies from ten to tliirty feet. It is generally found upon
rocky hill-sides, in rich soil. Its trunk rarely exceeds six inches in diam-
eter. The wood is heiivy, hard, and brittle, reddish-brown in color. The
bark of the root is (lie portion employed. The chemical ronstituents of the
bark are Viburnic acid, identical with valerianic acid ; Vibumin, a bitter,
resinous body, and also suirnr and tannic, oxalic, citric, and malic acids.
The bark of Viburnum rui'ntiniunitosum is sometimes substitute! for the
jirunifohiiin hnrk. Its properties are believed to be similar.
Physiological Action. — It sometimes causes nausea and vomiting, but
when retained it is a tonic, astringent, antispasmodic, -and ner\'e-8edativ€.
According to the experiments of Dr. R. L. Payne (Jr.), of Lexington, N. C,
upon cold- and warm- blooded animals black haw seems to be without in-
fluence on sensibility or consciousness, but has a decided effect upon the
centres of motion, producing paresis, followed by paralysis and, finally, loss
of all reflex power. Yiburnnm depresses the heart's action and fiill doses
cause diminution of blood-pressure, partly on account of cardiac weakness
and in part from a distinct action on the vasomotor system. Fatal doses
occasion paralysis of the heart prior to the cessation of respiration, the heart
being arrested in diastole.
Therapy. — The attention of the medical profession was drawn to
viburnum by Dr. Phares, of Mississippi, in 1866. This writer described it
as *'nervine, antispasmodic, tonic, astringent, and diuretic," tfnd of particu-
lar value in the prevention of abortion, whether habitual or otherwise, or
whether threatened from accidental cause or criminal drugging. An abun-
dance of testimony on both sides of the Atlantic has accumulated to con-
firm this statement as to its value in threatened abortion. Given before the
membranes have been detached, it rarely fails to quiet uterine action, pro-
vided the fcetus be living- A number of cases, having the tendency to habit-
ual abortion, have been treated with viburnum by Jenks, Chenes Revill, and
others with the most satisfactory results. Black haw affords relief to the after-
pains and the so-called "false pains." It has been found of value in the treat-
ment of dysmenorrhoea, especially when associated with profuse flow, and in
the absence of serious mochanical obstruction. Even in the latter case, how-
ever, it is often able to diminish the pain. In spasmodic dysmenorrhcea it is
thought to be more efficient when combined with Jamaica dogwood. Pr.
Allan S. Payne obtained very good results from viburnum in severe casc>s of
membranous dysmenorrhosa. In amenorrhuea dependent upon ansemia it is
likewise of service. In monorrhagia and metrorrhagia due to systemic causes,
as malaria, anaemia, disease of heart or liver, this remedy has proved particu-
larly valuable. The uterine hemorrhages which attend the menopause, as
VTOI*A TRICOLOR.
9ir
*
I
veil as the various vaeomotor and nervous disorders so frequent at that
period, are materially relieved by viburnum. Dr. R. D. Style, of Richmond,
Va., in charge of the sraall-pox hospital of that city, remarks that the occur-
rence of the catainenial epoch during an attack of small-pox is frequently a
serious and troublesome complication, but that the use of viburnum in such
cases obviates the necessity of a resort to mechanical methods of checking
hsemorrhage. The vomiting of pregnancy has occasionally been relieved by
this remedy, and its use has sometimes been attended with success in sterility
of the female. For its astringent effects viburnum has been given in diar-
rhoja and dysentery. Dr. R. L. Payne (Jr.), has seen marked reduction of
the tremor of paralysis agitans caused by the administration of viburnum.
He suggests that its antispasmodic virtues should render it useful in tlie
convulsions of hysteria and hystero-epilepsy, and in petit maL Locally, the
diluted fluid extract has been used as a gargle in aphthous sore mouth and
as a lotion to indolent ulcers.
Vibumin, which appears to be the active principle of black haw, has
been given in doses varying from 0.048 to 0.16 Gra, (or gr. '/^-iiss).
The Viburnum opulus, or cramp-bark, belongs to the same natural order
88 the preceding. It is used only in the form of fluid extract, and is given
to prevent or relax cramps of all kinds resulting from hysteria, dysmenor-
rhoea, or pregnancy.
VIOLA TRICOLOR. — Viola tricolor (Violaceae), heart's ease, or pansy,
is a native of Continental Europe and cultivated in the United States. Its
medicinal virtue resides in the leaves of the wild plant. Mandelin has dis-
covered that the plant contains salicylic acid. It likewise possesses a small
quantity of an onicrico-mlhartic alkuktid, Violine; also existing in Viola
odora, or sweet violet. The synip of viola, made from violets, is a somewhat
laxative vehicle for medicines, attractive to children and lesthetic patients.
Physiological Action and Therapy. — The little that has been recorded
concerning the physiological action of viola reveals a certain resemblance
to the effects of salicylic acid. Viola is said to produce a sense of confusion
and dullness in the head, with headache; some dimness of vision; salivation;
vesical tenesmxis, with frequent and profuse micturition; turbid urine,
with offensive odor ; a sense of heat over the whole lx)dy ; t^weats, itching,
and nettle-rash. The first publication upon the action of this drug seems
to have been by Schrack, in 1779, who recommended it as a specific remedy
in crusta lactea, or infantile eczema of the head and face. In Germany it
gradually fell into disuse, but is still employed in France, and the advocacy
of Professor Hardy induced Dr. H. G. PifTard, of New York, to make use of
viola in eczema. It is used as an internal medicine. An infusion in milk
of the fresh herb, deprived of root and flowers, was long employed. Hardy
advised a combination with eenna. Pitlard now makes use of the fluid ex-
tract, and speaks favorably of its results. It is most successful in the second
stage, with serous or sero-purulent exudation and crusting. Full doses, jriven
in acnte eczema, cause aggravation and extension of the eruption, with in-
creased local heat and itching. These effects continue several days. In
order to avoid them, Piffard advises that but from 0.06 to 0.30 c.cm. (or
mi-v) should, in beginning, be given to a young child, once or twice a day.
If no improvement occur, tlve dose may be increa^^ed; if aggravation result,
the drug should be discontinued for a few days, and then resumed in smaller
*
91S
PHAHMACEUTICAL THERAPEUTIC AGENTS OR DRC09.
quantity. A larger commencing dose (from 0.60 to 1 c.cm., or mx-xv) is
required in subacute or chronic eczema. In adults, 2 to 7.5 c.cm. (or f3ss-ij)
may be given as the beginning dose in subacute cases. It should be taken in
a small quantity of water, on an empty stomach, and, if possible, about half
an hour before meals.
VISCUM. — The mistletoe was formerly known botanically as Viscum,
but is now called Phoradendron (natural order, Loranthacese); the European
variety is P. album, the American P. flavescens. They are parasitic plants,
the latter growing on oaks, elms, etc. The plant contains mucilage, fixed
oil, resin, starch, etc., and Viscin f''bird-lime" or "bird-glue'*), a viscous,
glutinous substance; also found in other plants.
Physiological Action. — Mi.4letoe is a valuable oxytocic and nerve-seda-
tive. It is a cardiac tonic resembling digitalis in its action upon the cardiac
muscle. The berries are succulent and are eaten by birds; but are reported
to cause cmesie and catharsis, with prostration, bloody stools, and conrul-
sions in childron.
Therapy. — In epilepsy, chorea, asthma, and many other nervous affec-
tions mistletoe deserves further trial. In weak heart, with insufficient con-
tractile force, it has some value; in uterine haemorrhage it has been found
useful. Vificum has likewise been employed in dropsy and araenorrhcea. It
is of service in mcnorrhagia, and has been used during labor to excite uterine
contractions. The use of mistletoe during labor has been earnestly advocated
by Dr. W. H, Long, of the United States Marine-Hospital Service, upon the
ground of its rapidity of action and its ability to excite intermittent uterine
contractions. The dose is 0.[>5 to 4 Gm. {or gr, x-3j) in decoction, fluid ex-
tract, or tincture.
TITELLUS.— Yelk of Egg.
Preparation.
i
Glyccritum Vitelli. — Glycerite of Egg-yelk (freah egg-yelk, 45; glycerin, 55
parts). Exterual use.
Pharmacology. — A'itelluB is the yelk of the egg of the domestic fowl:
Gallus Bankiva {var., domestica: class, Aves; order, Oallina?). It contains
Vitellin, resembling casein. Lecithin, a phosphorized fat, with albumin, a
yellow and fixed oil, cholesterin, salts, sugar, etc.
Physiological Action. — Egg-yolk is a bland, oily substance, very useful
in making emulsions. It is highly nourishing, and, as it contains phos-
phorus, it is especiallj'- restorative to the nervous system. The glycerite is
a good vehicle for codliver-oil, for children.
Therapy. — Yitellus is beneficial in consumption and wasting diseases,
as a special food for the nen'ous structures, and it can be given in conjunc-
tion with codliver-oiL or a» a substitute for it. The glycerite is a good ap-
plication to sore nipples, chapped lips, ami hands. It is also used as a pro-
tective in erysipelas and other acute skin affections.
WACHICHIII. nr HTTAKCHICHILE. is n fever remedy known to the
Mexican natives aM"huHrkhic-hile" ( firononnced wa-chi-chile), and catalogued
in Date's Materia :Modica as *'La Espinosilla." • Dr. If. J. Smith states that
(ervantes named it Mexican phlox, and it is botanically Losselia coccinfie.
XANTHOXYLUM.
919
I
•
The Huarcliichile is a low shrub, growing preferably in moist localities in
mountainous altitudes, wliere the sun shines a portion of the day at least.
The plant is bright-green, with rich green leaves, and the flower is small and
pink, and apj>ears in July and August. The whole above-ground portion of
the plant is used, and when chewed it is intensely bitter. For use, the plant
is bruised and steeped in cold water. This cold infusion is freely adminis-
tered, and the uncertain claim is made that eight ounces of the plant will
cure a bad case of malnrinl fever. The properties ascribed to it are anti-
periodic and stimulant to the excretory organs. Ijong-continued cases of
malarial affections are said to have yielded to it in two days. The Mexicans
use this remedy to break up a cold quickly, in influenza, in chills and fever,
to remove the elTects of a spree. The women also use it to prevent falling
of the hair, rubbing it into the scalp thoroughly. In simple fevers of chil-
dren it is given with success in the form of recent infusion.*
WHTTERA. — Winter's bark, the dried bark of Drim>^ Winteri (Magno-
liaceae). of South America, contains "Winterene (C,:.!!.^) as a constituent of
its volatile oil ; it also has several uncrystnlliznhle resins. Tlie bark has aro-
matic properties reeembling cascarilla. It is used as a tonic to the digestive
organs (1.30 to 2 Gm., or gr. xx-xxx) in powder or infusion. It is also
highly esteemed as an anti-scorbutic.
XAMHIUM.— Clot-bur. The whole plant of Xanthium Btrumarium
(Compositffi), growing widely in Europe and America, poseesses medicinal
virtue. A fluid extract is given in the dose of 4 to 7.5 c.cm. (or f3i-ij). It
contains a glucoside, Xanthostnimarin, according to A. Zander.
Therapy. — Xanthium is alterative, hieraostatic, and is useful in hicmor-
rhage. In metrorrhagia, post-partum bleeding, and ha?morrhage8 occurring
during the climacteric period this remedy is of value. Clot-bur is serviceable,
likewise, in bleeding piles and in dysentery. In strumous enlargement of
lymphatic glands and in skin diseases of a scaly form it is reported to be
beueflcial.
XANTHOXYITTM: (U. S.P.).— Prlckly Ash, Tooth-ache Tree.
Doie, 0.65 to 2 Gm. (or gr. x-xix).
Preparation,
Fluidextractum Xanihoxyli (U. S. P.). — Fluid Extract of Xanthoxyhim. Dose,
2 to 4 c.cm. (or fSss-j).
Phaxmaoology. — The dried bark of Xanthoxylum americanuin, North-
em Prickly Ash ; or of Fagara Clava-Hcrculis, Southern Prickly Ash
(Rutaceffi). Their constituents are nearly identical. In the northf^m hark
(X. Araericanum), a tasteless, inert, cr)'st4ilHne body, Xanthoxylin. is
found, ixnd also, in both barks, an alkaloid, probably identical with berberine.
The bark al?o contains a volatile oil, resin, pum, a fixed oil, etc.
Physiological Action. — Prickly-ash bark is an aromatic bitter; it is also
diaphoretic, diuretic, and sialagogue. It causes augmented secretions along
the intestinal tract, including the liver, and has emmenagogue properties.
It is also considered alterative. Xanthoxylin slightly increases the action of
the heart and raises arterial tension.
('hivago Medical Time*.
920 PHARIIAOEDTIOAL THEBAPEDTIC AGENTS OR DRUGS. ^1
Therapy. — Xanthoxylum is used in a variety of disorders, from tooth-
ache to jaundice. It is an ingredient in the compound syrup of clover,
which is used in the treatment of syphilid and scrofula; it is ako used in
chronic and muscular rheumatism and skin disorders. Prickly ash is a very
effective tonic to the mucous membrane of the gastro-intestinal canal. It
assists glandular action and can be employed for the treatment of many dis-
eases in which the glands of the skin or mucous niemliranes are affected.
In functional dysmenorrhcea, or suppression of the menses, prickly ash
is BUccpBsful, in doses of 2 c.cm. (or mxxx) of the fluid extract, which is a
strong tincture:
In pharyngitis and post-nasal catarrh a decoction may he used as a wash
or gargle, and the fluid extract administered internally.
In liver disorders, combined with eascara and other drugs, it is often
very decided in its effects.
Xanthoxyli fractns, or prickly-ash berries, contain volatile oil and a
resin, and are antiseptic. They are used in fluid extract or decoction, in
aflfections of mucous membranes, especially diarrhoea, cholera morbus, flatu-
lence, cnlic, etc. The fluid extract is alcoholic, and doubtless the menstruum
aids in the effect.
Prickly ash is useful in constipation due to deficiency of the intestinal
secretions.
XEEOFORM. — Tribroniphonol-bismutlu A yellowish-green, tastelefis
powder, insoluble in ordiiirtry solvents. It consists of equal parts of tribrom-
phenol and bismuth oxide. It is used as a desiccating powder for wounds,
being practically odorless, non-irritating, powerfully antiseptic, and capable
of being sterilized by heat. It has alw) been used internally by Fasano, of
Naples, as an intestinal antiseptic in daily doses of from 4 to 8 Gm. (or
3i-ij) for the first thr(?e to six days, after which it was gradually reduced.
The agent was given in mucilage emulsion or in wafers or capsules, 0.50
Gm. (or gr. viiss) every two hours. There was complete tolerance by the
stomach. He also found it valuable in sporadic cholera. In diabetes, the
acetonemic cornea disappeared in a short time, and in unemia the symptoms
were also promptly relieved. Intestinal tubereulosis treated by xeroform
showed progressive amelioration, the remedy being given both by the mouth
and by the rectum. In lanngeal tubercular ulcers insufnation of this agent
relieved the 8}*raptoms and, in the course of several months' persistent treat-
ment, cicatrization followed. Hueppe, of Hamburg, used it in the treats
ment of cases of cholera during the epidemic in daily doses of G to 7 Gm.
(or Siss-i'/j). In t%7)hoid fever the stools become deodorized while this
remedy is being used.
XYIENE, or XYLOL.— A coal-tar product, diraethylbenzene (CJI,J,
resembling benzol and related to toluol, used internally (dose, 0.30 to 1 c.cm.,
or gtt. v-xv), and diluted as an external application in small-pox; also re-
lieves irritation of the throat when used as a spray.
ZEA (IT. S. P.).— Zea (Corn-silk).
Dose, 2 Gm. (or gr. xxx), in fluid extract, or infusion (1 to 8).
^m "The fresh stjdcs and stigmas of Zea mays (Gramincap)" contain
ZINOUU.
921
Maizenic acid, rcain, fi>cd oil, etc. Zea oxerte a sedative action upon the
bla(l(I<-'r. 'J'he st*e(l, conuuonly knowTi in tliis country as corn, contains a con-
siderable quantity of a bland, yellow, llxed oil, — *»leum 2ea maydis, — ^which
might be utilized in pharmacy in making ointments.^
ZDrCTm (U. S. p.).— Metallic Zino.
Salts and Preparations.
Oleatum 2inci. — Oleate of Ziuc (« ,veMo\vi»li\vhite mass of the consistency of
ointmmt ) .
Unguentum Zinci Oxidi (U. S. P.|.— Ointment of Zinc Oxide (20 per cent.).
Zinci Bromidum (U. S. P.).— Zinc Uromide. Dobc. 0.0G6 to 0.13 Gm. (or gr. 1-ij).
Zinci Carbonaa Pracipitatus (U.S. P.).— Precipitated Zinc Carbonule. Dose,
0.13 to 0.20 Gm. (or gr. iiiij).
Zinci lodidum (U.S. P.).~Zinc Iodide. Dose, 0.03 to 0.13 Gm. (or gr. sa-ij).
Zinci Phoaphid\im. — Zinr Phospliide. Dose, O.OO;* to 0.015 Um. lor gr. V»t-7»).
Zinci Acetaa (U. S. P.. B. P.).— Zinc Acetate. Dose, 0.03 to 0.13 Gm. (or gr. ss-ij),
or, as ail emetic, gr. 0,05 to 2 Giu. (or gr. x-xxx).
Zinci Chloridum (U.S. P., b. P.).— Chloride of Zinc.
Zinci Oxidum (U. S. P., B. P.).— Zinc Oxide. Dose, 0.20 to 0.05 Gm. (or gr. ili-x).
Zinci Steuras (U. S. P.). — Stearntc of Zinc.
l'ng\ietiluin Zinci Stearatis (V. S. P.). — <>intni*?iit of Stcaratc of Zinc.
Zinci Sulphas (U.S. P., B. P.).— Zinc Sulphate. Dose. 0.005 to 0.20 Gm. (or gr.
i-iij) as a tonic; aa an emetic, 0.65 to 2 Gm. (or gr. x*xxx).
Zinci Valeras Valerinnas (B. P.). — Zinc Vnlcrute or V'alcrianate. Dose, O.OOo
to 0.20 Gm. (or gr. i-iij).
U(\\mT Zinci Chloridi (U. S. P., B. P.). — Solution of Zinc Chloride (50 per
cent, bv weight).
Zinci Carbonaa (B. P.).— Zinci Carbonate. Doae, 0.13 to 0.60 Gm. (or gr. iiviij).
Zinci Phenol Sulphonas (I'. S. P.), Sulphocarbolaa ( D. P.). — Zinc Phenol-
sulphonate. Dose, 0.00 to 0.20 Om. (or gr. i-iij).
Unguontum Zinci (B. P.). — Zinc Ointment (15 per cent.).
Unguentum Zinci Oleatis (B. P.). — Zinc-Oleate Ointment.
Zinci Lactaa.— Zinc Lactate. Doee, 0.03 to 0.005 Gm. (or gr. aa-j).
Zinci Cyanidum. — Zinc Cyanide. Doae, 0.016 to 0.10 Gm. (or gr. V.-iw).
Zinci Permanganas. — Permanganate of Zinc. Used as au antiseptic nnd astrin-
(Mcit application.
Pharmacology. — Zineum is metallic zinc, in the form of sheets or of
irregular, granulated pieces. It is a silvery metal when poliehed, but goon
tarnishes, and, when exposed to the air, forms oxide or carbonate. Th€
line salts are white, and are usually soluble in water, but the oxide, carbonate,
phosphide, and cyanide are insoluble. The soluble salts are usually poison-
OQA, and zinc cannot be used for cooking utensils on this account.
Physiological Action. — Slost of the salts of zinc are astringents, but
some are corrosive poisons; among the latter are the chloride, acetate, sul-
phate, iodide, and cyanide. They produce pain, nausea, vomiting with great
retchinjr. and sometimes catharsis and muscular depression. Toxic doses of
line oxide, experimentally administered to animals by d'Amore and Falgone,
gave rise to vomiting. ha?raoglobinuria, albuminuria, and glycosuria.
Continued use of zinc salts causes symptoms of disorder of the nerve-
centres re^emhlins; those of lead poisoning, showing less tendency to accumu-
late in the system than some other metals; but, eliminntion, as in other cases,
takes place through the action of the liver and intestinal glands. In casea
' An intcraatiDg article an "Oil of Indian Cora." by Dr. Clmrlea O. Curtmon, ap-
peared in tlie DrvQtiian, July 25, 1680.
922
PHABMACEUTIOAL THEBAPEDTIO AGENTS OH DRUGS.
of poisoning, the object of treatment would be to favor evacuation and to
relieve symptoms. It is best to give flour and water, or milk, or soapy water;
the alkaline bicarbonates, especially soda, are the chemical antidotes. The
hj'podermic injection of morphine may be required to relieve vomiting.
Subsequently, the use of potassium iodide, warm baths, and laxatives wUl
remove the metal compounds from the tissues.
Therapy. — In weak solutions, the zinc salts may be employed as astrin-
gents. The acetate (0.03 to 0.065 Gm., or gr. ss-j) in rose-water (30 c.cm., or
f5j) is useful as a colhTium in conjunctivitis; it is beneficial, also, as an in-
jection in gonorrhoea and gleet: —
I( Zinci sulpb 32 Gin. or gr. t.
Bismuth, subnit. 6 Gm. or Siss.
Glyoerini 15 c.cm. or fSaa.
Aquae cinnamomi q, n. ad 150 ccm. or t$y,
M. For injection in gonorrhcBa after the scute stage lias passed.
3 Zinci sulph ^. |38 Gm. or gr. vj.
Tinct. opii deod.,
Tinct catechu aa 15| c.cm. or fjaa,
Aquffi rosse 00| ccm. or fjij.
M. Sig,: For injection in chronic gonorrhcea. or gleet-
Injections of zinc permaufrnnatc were highly esteeineil, by the late Mr.
Berkeley Hill, in ncute gonorrhoea. He gen^rnlly made use of a solution
containing O.OCS Gm. (or gr. j) of the salt to 240 c.cm. (or Oss) of distilled
\rater. The salt should nhvays be employed alone and in distilled water.
The sulphate of zinc mny be used to destroy smnll malignant growths
of the sivin. The water of cryptnlli/ation is driven off liy boat, and the salt
powdered finely and mixed with a little simple cerate, or oleate of zinc oint-
ment. The action is Hmitod by fipplying a piece of adhesive plaBtcr with
a hole cut in corresponding to the pnrt to be attacked. Several applications
may be needed.^
The sulphate is likewise used as a collyrinm (0.13 to 0,26 Gm. to 30
c.cm., or gr. ii-iv to f^j), especially when conjunctivitis tends to hecome
chronic, and is beneficial in inflammations of the skin. In acne Dr. Fred. J.
Lcviseur^ uses in conjunction with hot-water applications: —
B Zinci Hulphatis,
Potasaii sulphitia aa 41 Gra. or 3j.
Aquio rosn 120] c em. or fjiv.
Dissolve each ingredient Beparately in 60 ecm. (or fjij) of the ro«e- water, mix,
and add: —
Reeorcini 4| Gra. or 3j.
Sig.: Lotion; shake well. Thia ia to be used hot at night and cold in the
morning.
The ointment of zinc oxide is largely used as a protective and slightly
astringent application to acute skin affections, and to an ounce or more can
be added carbolic acid, 2 Gm. (or oss); oil of cade, 4 c.cm. (or f3j); tar, 2 to 4
c.cm. (or f5ss-j), and other agents^ according to the case, for treatment of
eczema, herpes, erysipelas, and burns. The zinc-glue recommended by Unna
as forming a stiff surgical dressing consists of 10 parts of zinc oxide, 30 parts
^D. n. Patton, Woodward, Oklahoma (Medical TVorW, Aug., 1003)
• Medical Record, Sept. 13. 1890.
ZINO0M.
h
CBch of gelatin, glycerin, and water. The preparation is rubbed into the
gauze or muslin of the bandage. The chloride is a powerful caustic and anti-
septic. In dilute solution (0.065 to 0.13 Gm. to 240 c.cm., orgr. i-ii to f^^iij)
it is useful as an injection in gononhcea or leucorrhoea. It has been sug-
gested that this salt may be rendered more efficient by mixing it with lanolin
or some bland oil and allowing it to remain for a few minutes in the urethra.
The following formula is proposed: —
Ti Zinci chloridi
AOijtit* laiiflE h^'drosi 6
Aqua 1 90
01. olivee q. a. ad 300
38 Gm. or gr. vj.
Gm. or 3iss.
c.cm. or fjiij.
ccm. or (jxij. — M.
In stronger solutions, or mixed into a paste with flour and water, zinc
chloride can be applied to lupus or malignant growths, to be used for creating
sloughs.
Zinc chloride, in the form of a paste, made with starch, or 4 parts of
zinc chloride; farina, 3 part?; zinc oxide, 1 part, as used by Vohwinkel, is
often a very effective application to morbid growths. Haberlin {Corre-
spondenz-blatt fur Sckireizer Aerzte), in inoperable uterine carcinoma, employs
8 paste of zinc chloride, which he re^^ards as a good palliative treatment.
Penrose, of Philadelphia, has likewise applied zinc chloride in the form of
a saturated solution by means of a tampon in malignant disease of the
uterus with decidedly good effect. This ealt may also be employed for the
purpose of destroying epitheliomata, nasvi, enlarged glands, warts, and con-
dylomata. The liquor is a strong preparation, and, greatly diluted (4 c.cm. to
473 c.cm., or f5i-0j), it is a detergent and stimuJaling application to old
ulcers, and has likewise been employed as a disinfectant for woimds. In
chronic laryngitis, F. J. Stewart' recommends daily applications with the
laryngeal brush, of solutions of zinc eliloride ( V2 t'^ I P^r cent.), combined
with frequent spraying with menthol in liquid petrolatum.
Zinc iodide is only used in ointment for enlarged glands (4 Gm. to 31
Gm., or oi-5j of simple ointment), or in solution as an application to enlarged
tonsils. The oxide, when in a smooth, dry powder, is useful as a dusting-
powder, for infants, but the carhonat*^ is better for this purpose. Oleate of
zinc has been already considered. W. D, Hasjam states that a mixture of
equal parts of iodoform and oleate of zinc is of great value in gyniecology,
applied by insufflation or on a tampon.
Zinc subgallatc hag been recently recommended as an efficient antiseptic
and desiccant dressing in the treatment of eczema, wounds, otorrhoea, and
haemorrhoids. The preparation is applied pure, or it may he diluted with
inert powders or ointments. Suspended in water and mucilage in the pro-
portion of 1 to 16 it constitutes a useful injection in gonorrhoja. Zinc snb-
gallate has been employed in doses of 0.03 to 0.25 Gm. (or gr. ss-iv) with
alleged good results in fermentative dy.spepsia and night-sweats.
The application of solutions of zinc, especially of the chloride, is not
without danger. It has been the practice of some gjmfpcologists to apply
tine chloride to the inner surface of the uterus in the treatment of metritis.
Dr. Pozzi warns against its use in young women and in acute inflammation,
on account of the risk of producing atresia and obliteration of the uterine
* Ouy'ti Bonpitnl Qazeiic, Jan. 27, 1000.
924
PHARMACEUTICAL THEHAPEUTIC AGENTS OE DRCOS.
cavity, or setting up tubal inflammation. Doleris^ prefers curetting to tlw
application of caustics, which also received the sanction of Goodell. Aseptic
curetting Is commonly safe, and causes no such ill effects, even in compli-
cated cases.
In a case of recurrent luxation of the shoulder, Dubreuilh overcame the
tendency to dislocation by six hypodermic injections, performed every sec-
ond or third day, of 0,12 c.cm. (or mij) of a 10-per-cent. solution of zinc chlo-
ride. The fluid was deposited in various portions of the anterior superior
portion of the capsule below the acromion process.
Injections of zinc chloride have also been employed, with reported ad-
vantage, in order to promote union of fractured bones. About 1 c.cm. (or
mxv) of a 1-per-cent. solution are injected into the neighborhood of the
fracture. The same procedure has likewise been made use of in pulmonary
tuberculosis. Dr. Jules Comby has resorted to this method in a number of
cases, and states that the results were favorable and that the treatment merits
further trial. The strength of the solutions which he used varied from 1 in
60 to 1 in 20, and 0.18 c.cm. (or miij) were introduced every third or fourth
day. All the cases thus managed were in an early stage, and the disease was
confined to the apices. The object of the treatment is to favor the formation
of fibrous tissue and produce a cure in the same manner as occurs in the
natural arrest of the disease. The same plan has been applied in cases of
tuberculosis of joints and in lupus.
Zinc sulphate is a decided astringent, and in doses of 0.65 to 1.20 Gm. (or
gr. x-xx) is a prompt emetic. It has been used for the latter purpose in nar-
cotic poisoning, croup, and for promptly evacuating the stomach. It is a
syetemic emetic, and causes vomiting when injected into the blood. As an
astringent, it has been administered in combination with opium or Dovers
powder, in diarrhoea, and chronic dysentery. In small doses, it has been
employed as an antispasmodic in asthma, chorea, epilepsy, angina pectoris,
hysteria, etc. The stomach becomes remarkably tolerant of the sulphate, so
t£at as much as 2.60 Gm. (or gr. xl) have been given, thrice daily, without ex-
citing sickness of the stomach. Such massive doses, however, should not be
long continued, as they eventually occasion superficial ulceration of the
stomnch. Zinc sulphate is also occasionally employed intemnlly for the
relief of bronchorr)ia}a.
In the treatment of chorea, zinc sulphate is used, beginning with 0.065
Gm. (or gr. j) doses three times daily and gradually increasing them until the
limit of tolerance is reached. A case has been recorded by Dr. J. Sidney
Hunt in which traumatic tetanus was successfully treated by a combination
of opium and zinc sulphate. Zinc phenolsulphonate is an antiseptic and
astringent. Dr. W. F. Waugh has used this salt for several years in cholera
infantum and typhoid fever, and all cases in which the occurrence of fetid
stools, with tympanites, etc., indicates the need of intestinal antisepsis. In
typhoid fever he claims to have treated upward of seventy cases, with no
death in any case where this salt was employed from the betrinning. The
dose is 0.03 to 0.065 Gm. (or gr. ss-j) for children, 0,16 to 0.32 Gm. (or gr,
iiss-v) for adults, to be given every two hours until the stools are odorless, and
thereafter in doses sufficient to keep the stools in this condition. The effects
are a reduction of the fever, tympanites, diarrhcpa, and delirium; the attack
* Provincial Medical Journal^ Dec. 1, 1890
ZINGIBER.
925
I
18 shortened and rendered less dangerous. When the Bynipton.s of cholera
infantum assume the dysenteric form, the zinc is given in enemas, 0.65 Gm.
in 00 com. (or gr. ^-fjij) of warm water. Zinc cyanide is used in Germp.ij
ae a substitute for hydrocyanic acid; the dose is 0.015 Gm. (or gr. ^Z^) grad-
aally increased to 0.10 Gm. (orgr. iss) given in a mixture. It has also been
employed in epilepsy, chorea, and in neuralgia, in painful affections of the
stomach, and dyemenorrhoea. Professor Laehkevich recommends the cya-
nide in the treatment of palpitation, want of rhythm, and pain in the region
of the heart.
In many nervous affections, the zinc valerate has special advantages oviix
other salts in neuralgia, nervous headache, nervous cough, ovaralgia, chorea,
epilepsy, etc.; if given in small doses, repeated at short intervals, it is bene-
fieiaL The night-sweating of phthisis is sometimes checked by zinc oxide,
given in pill form (0.20 Gm., or gr. iij, at night); the oxide may also be given
in the summer diarrhoea of infants or adults. In chorea the same salt is of
much value alone, or combined as follows: —
B Zinci oxidi 132 Gm. o* gr. v.
Ferri pyrophoe 2|60 Gin or g^ xl
M. et ft. pil. DO. XX.
Sig.: Two or three pills a day.
Zinc oxide is serviceable in gastralgia, and has eometimes proved useful
in epilepsy. Biirtholow bolioved that it is most successful when epilepsy is
the result of peripheral iritation, having its origin in the stomach. The same
writer esteemed the oxide as of prophylactic value in spasmodic asthma.
Whooping-cough and chronic alcoholism have their symptoms relieved by
tlie oxide, which has also been advantageously employed in chorea. The
tremors and unsteadiness due to chronic alcoholism will sometimes yield to
the influence of zinc oxide, and Gu6neau de Mussy reported it as of value
in subduing the tremor caused by mercurial and arsenical poisoning. Zinc
lactate has been serviceably administered by von Graefe and others in rapidly
developing cases of amblyopia, especially when of hysterical origin. Zinc
cyanide has sometimes relieved the pains of articular rheumatism, but its
use is apt to be followed by headache and it has been effectually superseded
by more modern remedies.
ZmOIBEB (U. S. P., B. P.).— Ginger.
Dose. 0.65 to 1 Gm. (or gr. i-xv).
Preparations,
Fluidextmctum Zingiberia (I'. S. P.) —Fluid Extract of Ginger. Dwe. 0,06
to 120 c-cm. (or mi-xx).
Oleoresinse Zingiberis (U.S. P.). — Oleoreiin of Ginger,
(or m«s-ij).
SynipUB Zingiberis (U.S. P.. B, P.). — Synip of Ginger.
fSliT)." B. P., 2 to 4 c.cm. (or fSss-j).
Tinctiira Zingilierin (U. S.* P., B.P.). — Tincture of Ging«r
Doce, 2 to 8 c.rm. (or rnxxi-f3ij).
It also enters into aromatic powder and compound rhubarb powder (U.S. P..
B.P.).
Pharmacolo^. — Oin^r is the dried rhizome of Zingiber officinale (Zin-
giberacoa*). cultivated in tropical countries as a spice. Ginger from which
the cortex has been scraped is also known as 'Vhite" or "peeled" ginger. It
10 leM active than the whole ginger. Green ginger is put up in syrup or
Dose, 0.03 to 0.12 c.cm.
DoB^, 4 to 15 c.cm. (or
per oettt).
926
PIIAKMACEDTIOAL TUBRAPEUTIC AGENTS OE DRUGS.
candied, aud used aa a digestive condiment at the dinner-table aa a correc-
tive of flatulence. It conies from different sources, but the Jamaica ginger
is preferred for culinary purposes, having the best flavor. An excellent gin-
ger conies from Shimonoseki, Japan. Ginger contains traces of an alkaloid,
but it5 activity depcn<ls principally on a volatile oil, consisting principally of
Qingerol, and also a pungent resin. The tincture, spirits, or essence of
ginger is a very popular remedy. Unfortunately, it is very frequently mode
with wood alcohol, which makes a cheaper article, but persons taking it too
freely are likely to suffer with s}'mptoin9 of araylic alcohol poisoning. A
characteristic Bymptom is atrophy of the optic nerve mid bUndness. Deatli
has been caused by the use of this adulterated product.
PhyBiologioal Action. — It is an agreeable carminative and stimulant,
increasing the secretions and promoting peristalsis. It increases slightly the
amount of urine, and acts as an irritant to the bladder and urethra. Ei-
temaUy it is rubefacient.
Therapy. — Ginger is added to purgative pills to prevent griping, and
to salines in order to disguise their taste. It is useful in atonic dyspepsia,
especially in elderly persons, and is of service in flatulence and diarrhoea.
The syrup is commonly used as a vehicle for stomachic preparations and
tonics. The addition of 4 to 7.5 c.cm. (or foi-ij) of the tincture to a glassful
of hot water (ISO c.cm., or f^vj) makes "ginger-tea," which is useful in flatu-
lent colic, in diarrhoea of relaxation, and in dysmenorrhcea due to cold. By
the use of a hot foot-bath with free use of ginger-tea, diaphoresis may be
excited and further progress of colds checked.
I
I
PART m.
HON-PHAEMACAI REMEDIES AND EXPEDIENTS EMPLOYED IN
MEDICDTE NOT CLASSED WITH DRUGS.
This portion of the work will be devoted to the discussion of certain
agenta and expedients employed in clinical therapeutics which cannot be
properly classed with drugs. Each will be considered under its own heading,
with the following titles: ^Electro-therapeutics"; '*Kinesitherapy, Massage,
and Rest-Cure'*; "Pneumotherapy"; ''Hydrotherapy and Balneology^';
'*Mineral Springs"; **Climatotherapy"; ''Diet in Disease"; "Psychotherapy,
Metallotherapy, and Suggestion or Hypnotism"; ''Heat and Cold," "Light
and Darkness," "Music," etc., concluding with a brief review of various
methods and expedients, chiefly mechanical and local in their effects. Al-
though the latter find a limited place in practical medicine, they are, as a
rule, surgical expedients, and are, therefore, in this place, less fully con-
sidered than they would be in a treatise specially devoted to that depart-
ment.
ELECTRICITY IN MEDICDTE— ELECTRO-THERAPEUTICS.
Present Standing and Importance of Electro-therapeutics. — The scien-
tific application of electricity to the human body for the treatment of disease
has recently been greatly stimulated by its remarkable commercial develop-
ment. Electrical science being essentially of modern origin, new principles
and new economical applications being announced almost daily, it becomes
absolutely necessary for a discussion of the employment of electricity in med-
icine to be introduced by a few words upon the present state of our knowl-
edge of this department of physical science. A very brief consideration of
the laws of electricity, with explanation of its terms and its technique, there-
fore, will precede a review of its therapeutic applications. It is unfortunate
and embarrassing, to the medical student particularly, to find confronting
him, at the very threshold of this subject, a mass of literature which has
come down from a period when purely empirical methods prevailed and the
nature of this force and its effects, both physiological and therapeutical, were
Tciy imperfectly understood. Not infrequently, even at the present day,
medical writers betray a want of knowledge of its fundamental principles.
There is less excuse for this now than ever before, because the ingenuity of
electricians and expert instniment-manufacturers has been attracted in this
direction and has brought to our aid apparatus of precision, both for thera-
peutics and for diagnosis, with which it is the duty of every physician to
acquaint himself. Even if he docs not purpose to apply it to a great extent
in his practice, he should do this much, at least, for his own protection^ since
he must at timea rely upon some form of apparatus; and some of the elec-
(927)
928
XOK-PnAHAUCAL HEMEDIES AXD GENERAL THERAPEUTICS.
trical instruments which are offered for sale are of poor construction, entirely
unfit for nieclical use. Moreover, many persons bring discredit upon medical
electricity by claiming to be epecialists who are mere tyros, if not open char-
latans, ignorant of the first principles of medical or of physical science. It
is a comparatively easy matter for the well-trained physician to recognize and
expose such pretenders, especially should they venture to boast of their
results in public or before medical societies.
The Foundation of 8acceu in Eleotro-therapentics. — The study of elec-
tro-therapeutics requires not only that we shall be versed in the laws and
terms of electrical science, but also that we shall have good anatomical and
physiological knowledge. It is, moreover, very evident that we must be
familiar with pathology in its most comprehensive sense, in order to form a
correct judgment, or prognosis, as regards the probable utility of electrical
or any other treatment in a given condition, so that this valuable agent may
not be brought into disrepute by being used in unsuitable cases. As it is
necessary that such knowledge shall be acquired systematically, all reputable
medical schools now strive to teach thoroughly tne principles of electricity
and the construction of medical electrical apparatus and batteries, this course
of study beinj: made practical and attractive by abundant didactic and clinical
instruction in this important branch of therapeutics. Since the best results
can be obtained in this direction only by a due recognition of the dignity of
this branch in the curriculum, it is hoped that there soon will be established
a chair of electro-therapeutics in every university and medical college in the
country.
Definition of Electricity. — The phenomena of electrification are due to
a condition of matter when it is acted upon by a peculiar force known as
electromotive force. This "electromotive force'' is a form of energy which
is convertible into and is, therefore, said to be correlated with the other
physical forces, in accordance with the well-known law of conservation of
force demonstrated by Ilelmholtz. That is to say that, whereas light, heat,
motion, chemical action (electrolysis), and magnetism may be obtained from
electricity, so, by the law of the correlation of forces, light, heat, motion,
chemical action, and magnetism may be transformed back again and be
manifested as electricity. These forces are all manifestations of molecular
motion due to radiant energy, acting under different conditions.
Principle Underlyinir Electrical ManifestationB. — It is upon this prin-
ciple that all forms of apparatus for economical and medical applications
of electricity are constructed. Atmospheric electricity, which Benjamin
Franklin proved to be identical with friction-electricity, certainly exerts an
important influence upon health; and instances have been recorded where
an electrical shock (lightning-stroke) has been followed by important phys-
iological changes (i.e., relief from paralysis, etc.); but no attempt at sys-
tematic therapeutic application has. as yet, been made with electricity from
this source directly. The usual sources are chemical action, heat, magnetism,
and motion (friction and dynamo).
The Electric Current: its Physical Characters and Properties. — Al-
though electricity is simply a condition of matter, or a "mode of motion," —
a "peculiar vibration or tension of the molecules of a body said to be electri-
fied,"— it is convenient to speak of it ns if substantial, and, in fact, as matter
in a fluid state. In some respects it appears to be analogous to water when
the latter is acted upon by the force of gravity and atmospheric pressure;
I
rK MRDlcrNK — ELBCTBO-TnKHAPEl'TlCS. 929
and authors have fallen into the habit, for convenience of description, of
speaking of it as 'Uhe electric liuid/' '*the electric current"; also of the
direction in which the current "flows"; its "pressure"; the "resistance" it
encounters from poor "conductors"; the "waste of the current"; a "con-
tinuous" or "interrupted" current, and so on, the simile being heightened
by comparing the dynamo, or source of the current, with a steam force-
pump. It must be constantly kept in mind, however, that this is figurative
language, adopted simply for convenience. It should not be inferred, for
instance, when the human body is in circuit, that anything material flows
through the body; the correct view is that the parts between the poles are
more or less affected by a peculiar form of molecular activity which takes
place in the tissues, and during this period the parts are in a characteristic
condition, which will be referred to later on. This change may be simply
physiological, and not inconsistent with restoration to a healthy condition;
or it may l)e pathological, and produce permanent lesions. If the current
be sufficiently powerful, decomposition will be produced (electrolysis), or
the parts adjacent to the poles may be carboniaea or blistered by the devel-
opment of heat produced by resistance to the current (galvanic cauterization,
or electrocausis).
Correlation of Electrical and Other Forms of Force. — Electricity, there-
fore, cannot be said to have a separate existence of its own, electrification
being simply a state or condition of matter depending upon the exercise of
a force which produces certain physical, chemical, and physiological etfects.
The laws governing electrical action have been formulated, so that it may
now be applied to medical and other economical purposes with precision
and absolute control. Progress in every department of science depends upon
the accuracy of measurement, which affords an opportunity for exact com-
parison and record. Electricity is no exception to this, although, owing to
its nature, it presents peculiar difliculties not met with in other departments.
Electncal force is so easily converted into other fonns of energy that
it almost defies ordinary methods of measuring, such as are used in estimating
velocity, weight, or heat. With the best conductors, its passage between dis-
tant pnJMts ('\<*0(^(ls ilic rMpidity of lifrht.
Electrification and Electro-magnetism. — As already stated, electrifica-
tion comprises the phenomena occurring in a peculiar state which matter
may assume under special conditions. Certain bodies, while in this state,
exhibit peculiar and characteristic phenomena. For instance, when two dis-
iiimitar metals, capable of bring electrified, are partly immersed in a liquid
capable both of permitting the passage of the current and of acting chemi-
caJlr ujwn one of them (i.e.. an electrolyte), if the free portions (or parts
rmtsidf' the fluid) of the two metals nre brought in contact or connectetl by a
metallic conductor, such as n piece of copper wire, certain results may U? ob-
(Served to occur. One ini-tal is slowly acted upon by the fluid ; the other i»
not; but bubbles of livdrogpu a|)portr upon its surface. Under such circum-
stani'i"* the external junction of the two metals will be found to possess elec-
trical properties. T'sually. for convenience, the metals are united by a con-
junrtive wire, which miwt also be capable of becoming electrified and of act-
ing as a Cf^nductor (or rhof^phore). When in this condition, in relation to tJift
two metals just mentioned, tlip wire will attract iron filings; or, if brought
over a compass parallel with the ut»odIe, or a bar magnet suspended by it«
centre, it will cause deflection of the mainietic needle, which, if the current be
930
XON-PHAItMAOAL lUifilEDIES AND GENERAL XHEHAPEUTiCb.
strong enough, tends to assume a position at right angles to the wire., deviat-
ing more or less from the magnetic pole and the so-called cardinal points of
the compass. If a coil of wire he suspended so as to be free to move in all
directions, it will, under the influence of an electric current passing through
from one end of the wire to the other, assume a north-and-south polar posi-
tion, in the line of the map:netic meridian of the earth. Such a coil, while
electrified, therefore, has assumed the properties of a magnet; it also attracta
small pieces of iron, and ma}' be used to convert a mass of steel or hard iron
into a permanent magnet. If into the centre of a long coil, or spool, of
insulated wire some soft iron (which does not become permanently mag-
netized) be inserted, we have a tcmporar}- electro-magnet formed, which only
exhibits the properties of a magnet when the current is passing in the coil.
This principle is of groat utility, and appears in the interrupting mechanism
of faradic batteries, telegraph-sounders, telephone-receivers, electric-light
generators (dynamos), and numerpus other forms of apparatus.
Intimate Relationship of Electricity and Magnetism. — There are many
points ijf similarity betwot-n ekvtricity and magnetism. The most plausible
explanation of the latter is that the magnet is in a permanent molecular state,
which corresponds with electric currents surrounding the poles. Similarly,
the conjunctive wire, during the pasage of the electric current, is in a
condition in which it influences the magnelic condition of other objects
near it. just as if it were surrounded by lines of force in a series of concen-
tric rings. This may be illustrated, if not demonstrated, by placing some
iron filings upon a plate of glass or a card and applying a strong magnet
beneath, or by running a wire carrying a current perpendicularly through
its centre. The iron filings will, under the influence of electricity, arrange
themselves in concentric circles, exhibiting the directions of the lines of
force, just as they do around the poles of the magnet.
Lines of Force. — These lines of force, in the case of the magnet, flow
in the air from the north to the south pole and l)ack again through the iron,
thug making a permanent closed cinuit. In the case of the wire, the con-
centric lines or whirls of force encircle the electrified conjunctive wire; so
that, when consecutive loops are arranged in the form of a helix or coil, the
lines of force become parallel with the long axis, and the coil now exhibits
magnetic properties. The space in which these phenomena are noted is con-
sidered the magnetic field, or area of induction. By reversing the experiment
and passing a permanent magnet into a coil of wire, a current of electricity
is temporarily set up, which is manifested at the extremities of the wire.
This is the principle upon which magneto-electric machines are made or
electric-light dynamos constructed. Coils or spools containing insulated
bundles of soft-iron wire may be placed upon a frame and made to revolve
rapidly within the matrnetic field around the poles of a large magnet. When
this is done electric currents are set up, which are momentary: but, when a
high speed is attained, they become practically continuous. By an ingenious
arrangement in wrapping the wires, the currents set up on entering the field
and upon leaving it, which are in different directions, may be "comniutat(*d."
or switched, so that they are made to reinforce each other, and thus make
a single current of definite direction and practically continuous.
Properties and Effects of the Current — The effects of electricity are (1)
physical and chemical, (2) physiological, (3) therapeutical. The methods of
generating electricity are (1) physical [friction-electricity, thermo-electricity,
BLBOTRICITY IX MEDICINE — KLECTRO-THEIUPEUTICS.
I
dynamo-electricity, etc.], (2) chemical [galvanic cell], and (3) physiological
[as shown by certain fishes, — torpedo, — and the hnman body to a less marked
degree]. Electricity is the same force under all circumstances; but each
form of current possesses certain qualities, which depend upon the method
of its generation. The principal qualities of an electric current are con-
stancy, pressure, and volume. Assuming that a current under consideration
is constant, or practically so, we have only to keep in mind the two latter, —
pressure and volume, — and when these are well imderstood the difficulties
of comprehension of electrical phenomena, about which so much has been
written, almost entirely disappear. Returning to the analogy already named,
of a pump forcing water through a pipe, we may regard every device for
originating a current of electricity as a pump of more or less power. To com-
plete the analogy, the discbarge-pipe should be long enough to go around
the circuit and terminate in the suction-pipe, so that, the pump being set
in motion and the apparatus filled with water, the Current of water will be
continuous. The force which starts the water is heat converted into motion;
that which starts electricity is electromotive force acting under a certain
amount of tension or pressure, which will be shown hereafter to be due to
difference of potential. If the power is withdraM-n, the circulation will cease,
because of the obstruction (friction, inertia) which the water has to over-
come. In hydraulics, the force required to perform tlie work, with the re-
sistance, is the subject of calculation, and the size and character of the engine
are regulated according to the work to be done. In electricity, the amount
of electromotive force or power of the apparatus is measured by volts instead
of foot-pounds, and the resistance or friction is calculated according to a
standard unit of resistance, known as the ohm. Just as. in the case of water,
with a certain amount of pressure against a given amount of resistance, a
definite number of gallons per minute will flow along the conductor, so. in
tlectrical terms, we have a definite volume or strength of current, resulting
from a certain amount of voltage against a ^iven number of ohms of resist-
ance. It is easily seen that a powerful pump would be at a great disadvan-
tage in trying to force water through a half-inch pipe, and this ditficulty is
increased should the pipe be long. In order to get satisfactory results the
pipe must be sufficiently large to carry off the water with facility and not
oner too much resistance by friction. Therefore large pipes are better con-
ductors than small, and short better than long ones. This is also true in
electricity, and the rule is that the conducting power (other things being
equal) of a conductor is directly in proportion to the area of the cross-
section and inversely to the length.
Electromotive Force — Difference of Potential. — To return, now, to the
first illustration of two dissimilar metals in the electrolyte, we find that the
current starts simultaneously with the joining of the metals (either directly
or by means of a conjunctive wire), which "closes the circuit" and makes a
current possible. The force which starts the current is called the electro-
motive force; it is always the same for the identical combination of metals,
and is independent of the size of the plates. The hypothesis with regard to
the origin of the electromotive force is that it is due to a difference of
potential of the two plates, the current flowing from the higher potential to
the lower, just as water will flow from the higher level to a lower in case two
w^Tvoirs aro connected. The higher is tlu' positive (or anode), and the lower
potentiai is called the negative (or catliode). and identical metals always
NOy-PHARMACAt REMEDIES AXD GENERAL THERAPEUTICS.
T . .^ - , , ^, Pressure, or electromotive
Intensity of current-strength = p^.
OT CS = t
have the eanie relation to each other when in tlie !=ame electrolyte, one being
known as the ^enernting plate, the other as the lollcctinjr plate.
Electrical Measurements: Volts, Ohms, and Amperes. — The unit of
measurement of electromotive force, as already stated, is tlie volt, which U
a little less than the electromotive force of the zinc and copper combination
in the DanieJl cell (which is 1 'Viooo volts). The unit of measurement of
resistance is called an olun; it is represented by the resistance offered by a
column of pure mercury, 106 centimetres long and 1 square millimetre in
area of cross-section, at a temperature of 33° F. This is called the legal
ohm, because it was adopted by the International Electrical Congress, which
met in Paris in 1884; it is a little less than the British Association unit,
wliich previously had been the stiuulard, — in tlie proportion of 1 to 1.01'22.
The resistance referred to is mainly that encountered by the lines of force
in passing through the surrounding media; the tissues composing the human
body, for instance, offer" considerable resistance to the passage of the current,
depending, of course, upon how far the current is required to pass through
the tissues, upon the size of the electrodes, and other circumstances.
The volt, or unit of electromotive force, is sufficient to overcome a total
resistance equivalent to one ohm and supply a volume of current equal to
one ampere. The ampere, therefore, is the amount of current produced when
one volt of pressure is opposed by one olim of resistance; it is the unit of
measurement of current-strength. It is directly proportional to and may
be measured by the amount of chemical decomposition (electrolysis) pro-
duced by the current in a unit of time. Thus, the current that will deposit
(h(»oni815 gramme (or 0.017253 grain) of silver upon a silver plate im-
mersed in a standard solution of silver nitrate in a second of time has the
strength of 1 ampere. This amount of electricity being more than is ever
required for medical purposes, the unit is divided, for convenience, into
thousandths, or milliamperes. Any number of amperes can be sent through
a conductor, provided the genuralor has sufficient electromotive force and
tlie oouduetor itself (.'nn ejirrv the riirn-nt ; if the resistance In* too i^reat the
wire will be deetroyed by lieing fusetl or vaporized. In other wordi=. where
the rosistanre becomes disproporttoiial, the oU*ctririty, according to the law
of correlation of forces, is liable to become converted into heat and light.
Ohm's Law. — The number of amperes of current flowing through a
conjunctive wire within a given time depends upon both the electromotive
force, or pressure, and the resistance. This is expressed mathematically as
follows:—
force (voltsK
Resistance, external and int-ernnl <ohros).
In other words, the strength of any current is directly as the
voltage and inversely as the totiil resistanoe. The above is known as Ohm's
law, which has constant practical applications, as will be demonstrated in the
pages that follow.
Fassag^e of the Current — Eheophores. Electrodes. Anode and Cathode
Poles. — To confine ourselves for the present to the galvanic cell, wv observe
that the electrical impulse start? from the surface of tho plate, which is
chemically acted upon (generating, or positive, plate), and is conducted .
(lirv>U|:li the electrolyte to the negative, nr cidlecting, pinto, fmni whence it
passes along the conjunctive wire in the opposite direction until the place
of origin is reached. Should the conjunctive wire be divided in its course.
BLBCTRICITY IX MEDICIXE — ELECTno-THEHAPEUTICS.
933
I
the end connected with the collecting plate will be the anode^ or positive;
the other extremity is the cathode, or negative pole, — these names having
reference to the cour&e of the current, which is always from the anode to
the cathode, or from tiie positive to thp negative pole. In the closed circuit,
therefore, the circuit is completed by the conjunctive wire above and by the
intervening column of liquid below. As metals are usually better electrical
conductors than liquids, it follows that the current encounters, under ordi-
nary circumstances, the greater resistance inside of the cell (internal resist-
ance), since the resistance offered by the conjunctive wire, which is a metallic
connection usually (external resistance), is comparatively small.
Practical Work of a Battery — Electrolysis. — It may be laid down, aa
a rule, for any given battery that its efficiency will be at the maximum when
the electromotive force is sufficient for the work desired to be done and the
external and internal resistances are balanced, or equal. The external re-
sistance arises partly from the nature of work to be done and partly from
the resistance otlered by the conductor, being increased according to its
length and diminished according to its thickness. This also applies to the
column of fluid between the plates. Therefore we reduce the internal
resistance if we bring the plates close together, and also increase their size
so as to expose a larger surface in contact with the liquid, which, in effect,
increases the thickness (cross-section) of tJie intervening column. The
electromotive force or pressure is increased by multiplying the number of
cells until we obtain the required voltage for the work to be performed, or
resistance to be overcome. The work is a part of the external resistance,
and both it and the required current-strength are now matters of mathe-
matical calculation and measurement. \Yhere the work does not require
much current-strength, as in heating the cautery, or electrolysis, the exter-
nal resistance, therefore, not being very great, the battery may be balanced
by increasing the size of the plates, using only a comparatively small num-
ber of cells. Where, on the contrary, the work requires great current-
strength, as where the human tissues are made part of the circuit, the plates
should be of convenient, moderate size, but the electromotive force must be
increased by additional elements (more voltage); so that for ordinary med-
ical work from 20 to 30 or more cells would be needed. It is evident, there-
fore, that the battery must be adapted to the work required of it; a gal-
vanocautery battery will not do for general medical purposes, nor can the
ordinary email-celled medical battery be economically used for the cauteiy.
The reason for this is obvious from the preceding explanation; any further
attempt at a mathematical demonstration would only cause confusion. The
Urger cells cause more rapid decomposition of an electrolyte (or deposit a
greater quantity of silver from the solution in the voltameter in a unit of
time), or afford jrroater ampi'rago of curreut with a good conductor, than
where small cells are used, because the larger cells have less internal resist-
ance: and this is found to correspond with the results of experience.
In order to ascertain the number of amperes of current flowing through
a circuit, divide the number of volts of electromotive force by the number
of ohms of resistance in the entire circuit. Thug, we have by Ohm's law: —
r* t i. * .lu * i X ^ (electroraotive force, in rolta)
C (current-strength m amperes) = ^ ,^^^^, ^,i^,-^„ „,,„„
The electromotive force of each cell, when acting and in good order.
■
934
XOX-PHARMAOAL nEMEDIES AND OENEEUL THERAPErTICS.
is fixed and is invariable for the same combination, without regard to the
size of the elements. The entire electromotive force (voltage) is the sum
of that of the entire number of cells. The resistance, however, is variable,
and depends upon many factors. As already stated, the work to be done
is to be counted as part of the external resistance. To this must be added
the resistance of the conjunctive wire and electrodes; also that within the
cell, or the internal resistance. Thus, where there are a number of cella
connected in series, the amount of the resistance of each cell must be multi-
plied by the total number of cells in order to obtain the total internal
resistance.
By electrolysis, chpuiical substances are resolved into theip ions. The
metals, alkaloids^ and other bases seek the negative pole (cathode), and ore
called "cations^'; the acids, iodine, chlorine, and sulpiiur, on the contrary,
fly to the positive pole (anodo), and are called "anions." Sudden reversals
of the current produce n scattering of the ions, in place of their collecting
at the poles. Now, if a solution of a salt be placed upon the human body
and a direct galvanic current be made to pass throuirh the solution and the
body, the ''cations'* uru carried along with the current into the tissues. This
method of introducing choniit'ftl agents into the body is known a? forcsis.
If tJie cations are curried into the body, we have tlie process of cataforesis:
if the anions are sent in (by reversing the current), we have anaforeais.
This has been applied to clinicnl medicine with excellent results; but in
using foresis far therapeutic purposes, a careful note must be taken of tlie
therapeutic effects of the two sets of ions. To illustrate, if, during foresis,
potassium iodide be placed upon the body under the anode, this salt will be
decomposed, the anions (iodine) will move toward the electrode close at
hand, and the cations (potassium) will bo driven through the skin into the
body, replacing probably tbe ?odium of the sodium chloride in the tissues
and forming pota.«5ium chloride. If, on the contrary, the current should be
reversed, the cations (potassium) would go to the electrode, and the iodine
would be driven into the tissues. It is evident that the action will be most
energetic rn the immediate neighboriiood of the electrode, and where the
current density is trrentest. The velocity witli which the ions travel varies
with circumstances, the strength of the current, size of electrode, their dis-
tances apart, etc. That they really enter the body is readily demonstrated by
using a solution of quinine sulphate by cataforesis; the quinine will be foimd
in the urine in a vei^ short time. The therapeutic appHcations of this
truly scientific method of administering remedies will be referred to shortly
(pajro 970).
Electrical Dosage and Measurement. — This is not the place to go into
the details of apparatus, but we may anticipate a little, in order to explain
how the cunent-strength can be measured absolutely by the amperemeter,
milliamp^remeter, or milliammeter. The resistance of a galvanic cell, or the
total resistance of a battery, may be determined by adding to the external
resistance (by means of apparatus constructed for the purpose, containing
graded resistance-coils) until the current is reduced to one-half of its former
strength, whence wo learn that the added resiptance just equals the orisrinal
resistance, because the current-strencrth is always inversely as the resistance.
If the current is taken directly from the cell, and there is no external re-
sistance, then the added resistance just equals the resistance inside of the
cell or battery. The internal resistance of any form of cell may thus be
ELKCTKICnV IK MEniCIXE — ELECTRO-THKRAPEUTICS.
935
I
I
I
I
measured by reducing the external resistance to a minimum, using a short
and thick conjunctive wire of copper or silver, so that the external resistance
may be ignored. After having measured the current-strength and estimated
the total resistance, the determination of the electromotive force, or voltage,
becomes a matter of simple calculation, since 3 M F (voltage) = C (in
amperes) X ^ (in ohms). (For static, or franklinic, measurement see
page 952).
In the foregoing reference to a combination of single eells to form what
is called a '^battery," it was stated that they are connected in scries, — i.e.,
the anode of one eel! being attached to the cathode of the next, — -the dis-
similar plates or elements being thus connected together. If, on the con-
trary, we join all the poles of the same character, — I'.f., all the zincs and all
the coppers, or carbons, — we have an arrangement known as a parallel arc,
or they may be combined in sets, or multiple arcs, of five, ten, or any other
desired number. The object of this arrangement is to reduce the internal
resistance when the external resistance is small; but, as it also reduces the
electromotive force, it is not a useful arrangement, except where the platci
are too small for the work required. With cells suiti'd to the purpose for
which the bnttcrv is to be applied, this expedient is unnecessary.
Sources of Electrical JEnergy Other than Chemical. — Thus far we have
considered only the cell as a source of electricity, producing what is called
the galvanic, or battery, current. Other forms of electricity will now be con-
sidered; these are induced, or faradic, currents; friction, or static, currents;
and magnetic, or dynamo, currents.
Faradic, or Induced, Currents. — The phenomenon of induction must
here be considered before proceeding further. It has already been explained
that an electric current is accompanied by a disturbance of the molecules of
the surrounding media, which occur in "whorls," or lines of force circulating
around the conjunctive wire. This is shown by the influence upon the com-
pass-needle, which assumes a position at right angles to the wire bearing
the current. If a coil of copper or iron wire be substituted for the magnetic
needle, electrical jihenomena will be excited and temporary currents started
up whenever the circuit of the primary wire is closed or broken. These are
more powerful if the primary wire be itself rolled into a spool or coil and
placed inside of the secondary or induction coil. It is necessary to have the
primary wire covered with insulating material, so that adjacent txirns do not
come in immediate contact with each other, and, also, to have it compara-
tively thick, go as to carry a large volume of current. On the other hand,
it is of advantage to have the secondary wire (also insulated) of fine wire,
BO as to bring as many turns or coils of it under the influence of the lines of
force at any given time, as is convenient. As the electromotive force (press-
ure, tension, or power of overcoming resistance) is directly in proportion
with the number of coils of wire brought under the influence of lines of force
(just as it is increased by the number of cells of the battery), it is evident
that a tine wire in the secondary coil will yield a current of greater electro-
motive force than a coaree wire. In this way the apparent paradox is ex-
plained of a galvanic current without surticient pressure to produce muscular
contraction (becau.se of the high resistance of the tissues), passing along a
wirf» nrmnged in a particular manner, inducing a current in a secondary coil,
of finer wire, and thus acquiring electromotive force or teni^ion to produce
both active itiusculnr rontractions and painful sensations.
d'dij
NON-PHAKMAtAL REMEDICS AND GENERAL TllEIUrEUTICS.
Varieties of Quality in Faradic Currents. — Tlio tloctromotivc force,
pressure, and intensity, or ciirrent-^trongth nf a faratlic current from a prop-
erly-constructed apparatus depeude j)riiifipally iipoTi {a) the strength of the
current caiTied by the primary coil and the fiize of the latter; (b) the actual
number of convolutions of wire exposed to the influence of lines of force in
the secondary coil when in action; (c) the suitability to the work of the wire
composing and connecting the extremities of the secondary coil, or the coil
to which the electrodes are attached. It is B<2en, therefore, that much de-
pends upon the gecondar}- coil, and the value r)f the c«nneetinfr wire as a con-
ductor. Many instruments are provided with connecting cords containing
cheap, braided, brass wire, which is a poor conductor; well-insulated, flexible,
copper wire is more suitable. Moreorer, the secondary coil should have a
large number of convolutions, and must, therefore, he made with fine wire;
although, if too fine, it will impair its conduciin«r power by introduciug too
much resistance. Finally, the flow of electricity through the primary wire
should have sutlicient volume for the work. Ordinarily, one small j/alvanic
cell will he nil that will l>e required to ^^enrrate the induc^^d current.
Mechanical Current-intemiptcr, or Rheotome — Neef's Hammer. — Since
the currents in the secondary coil are only manifested at the times when the
current in the primary wire is closed and opened, some device is needed to in-
terrupt the current in the first wire. This may be done by any mechanical
means, but the common method is that known as Neef's hammer. The prin-
ciple upon which this is constructed is quite ingenious. Taking advantage
of the fact that a current of electricity flowing along a wire arranged in a coil
will cause soft-iron rods placed therein to become magnetic, although they
immediately afterward lose their magnetism because soft iron cannot be per-
manently magnetized, we have the means of automatic interruption provided
by passing the current through an automatic interrupter, which, at the mo-
ment when the current is flowing, is attracted by the magnetic coil, thus
breaking the ournMit. It is at once released when the current eea.«08 to flow,
and a spring carries it hack to its original position, which at once makes the
circuit again, aud the process is repeated many times in a minute. The con-
struction of faradic or induction batteries is essonlially such as is here de-
Bcribed, with minor variations in details of the apparatus.
Coarse and Fine Secondary Coils — Adams's Faradometer. — It must be
remembered that tlie ordinary rules governing electrical phenomena hold
good with the induced current, and that, while we have increiised electro-
motive force bv increasing the number of convolutions of wire independently
of the size of tne wire, the conducting power is inversely as the area of cross-
section of the wire, and the current-strength is correspondingly reduced by
using the very fine wire, because it offers greater resistance. This is the ex-
planation of the muddle which some writers appear to have fallen into with
regard to the relative utility of the coarse and fine secondary wire coils of a
faradic battery. When large electrodes are employed, and only a small por-
tion of the body brought into circuit (as where individual muscles arc to be
acted upon), or, in otlier words, when the external resistance is low, the
coarse wire is more effective, because it has less internal resistance and
the current is bettor balanced. On the other hand, where a large part of the
body is to be acted unon or the electrical brush is to be used the external
resistance is great, and better results are obtained from the fine coil — which
has greater internal resistance, it is true, but also more electromotive force.
ELKCTRICITV IN MEDICINE — ELBCTaO-THEIlAPECTICS.
93;
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Sinusoidal Currents. — When a nn'tallic circuit (such as one containing a
coil of Aviiv, wound on a Sitft iron annatiire, whieli revolves between the poles
at an clcctro-inagnet ) r^'voive:* with uniform velocity, the current collected
by the bnishfi? is sinusoidal — the iulensity of the current is proportional to
the sine of the an^le between the plane of the coil and the line of com-
mutation. A fiiniilar current which doea not change in direction is called an
undulating current. The latter may be regarded, physiologically, ne a com-
bination of the sinusoidal with the continuous current, analogous to the com-
bination of gnlvanic and faradic currents already mentioned. The fre-
quency and amplitude of tlie imdulatious govern the physiologic action of
sinusoidal current^. Below a certain frequency no musculnr contraction
ppgnlts ; then it begins, and increases regularly up to 1000 to 'iOOO rtlti^rnations
per second, when the added fnviueney ceaso.«. and beyond lO.oi.K) alternatione
per second muscular contracti<ius cease altogether. With low frequency the
Wt result^! are obtained from frequencies of 20 to 150 per second. Non-
Btriated muscle rosimnds in n most marked manner to the excitation of the
sinusoidal current. It also np]>ears to have 11 special action on sensory nen'ea,
malcing it particularly useful in the tr*'atment of certain forms of neuralgia.
Slow alternations are mot^t effective in the transport of ions. When the en-
tire l3ody ifi submitted t<' the action of these currents there is a general
acceleration of the nutritive exchanges. D'Arsonval has shown tliat under
this influence the blood absorbs 20 per cent, more oxygen than usual. ^
Static Electricity. — The static, or friction, electrical machine is a
familiar source of electrical phenomena; hut within recent years great im-
provements have been introduced in the construction of these forms of ap-
paratus which have made them useful and available for medical purposes.
The principle upon which they are constructed is the old one of rubbing
amber, or glass, with a non-conducting materia!, like silk. The ordinary
form is that of a circular sheet or plate of glass, which is made to rapidly
revolve in such a way that it is slightly rubbed with an exciting material, the
glass and the rubber being insulated from each other and connected with
me terminal i>oets, from wliich the current may be taken. The static ma-
clune for medical use tx^ntains several plates of large size, composed of glass
or mica; and is run by electricity, water, or hand-jwwer.
Electricity and Life-force. — Electrical units of measurement — the volt
and the ampere — bear a fixed value and relation to other units used in
measuring force, light, heat, etc. From what has already been stated, it is
clear that the proper way to regard electricity is simply as a form of energy,
which may be converted at will into other forms. As Hippocrates wrote,
"There is no sacred disease, and all diseases are equally sacred," bo we may
Bay that "there is no mysterious force, but all forces are equally mysterious.*'
Tlie favorite statement of charlatans, that "electricity is life," is only true in
the sense that heat and other forces are essential to life; but none of them
ean be correlated or transformed into life-force, about which — as of every
other form of energy — we know absolutely nothing, except through its mani-
festations in connection witli matter and physiological phenomena.
Electrical Measurements. — The relations of electricity to other forms
of energy may be very briefly recapitulated. The prevailing system of meas-
urement in science is based upon what is known as the Centimetre-Oramme-
MluiUcmont, EUvtrioJlv in Modicino, Xow York, 100<t.
^
938
NOK-PHARUAOAL RBMHDIBB AKP OBXKBAt THERAPEUTICS
Second system of units, taking the units of lenj^th, the unit of weight, and
the unit of time as the basis of calculation. The amount of force acting
upon a gramme of matter so as to produce a velocity of 1 centimetre per
second is the Dyne, or centimetre-gramme-second unit of force. The force
exerted by gravity upon a gramme of matter at the level of the sea is 980
dynes; or, in other words, 1 d}T^e equals V&«o of the weight of a gramme
at the earth's surface. Having determined the value of the unit of force,
we nest find that the unit of work, or energy, is the work done in exerting
a force of 1 dyne over the distance of 1 centimetre, which is denominated the
Erg, and is equivalent to V73&7B00001) horse-power. For convenience in elec-
trical calculations, which, with absolute centimetre-gramme-second units,
would involve the use of numbers too large for daily use, the Electrical Con-
gress adopted a series of conventional units, consisting of the Volt, the
Ampere, and the Ohm. **The volt is equal to 100,000,000 ergs, or of abso-
lute centimetre-gramme-sccnnd units of force, or 10 to the eighth power
(expressed 10*); the ohm is equal to 1,000,000,000 absolute centimetre-
gramme-second units, or 10 to the ninth power (expressed 10°)."
The unit of electrical pnwer is the product of the pressure (electro-
motive force) vi a current in volts, when multiplied by the volume expregged
in amperes. Tlie Watt is the term used to express this volt-ampere unit of
electrical energy. It is equivalent to Vt+a horse-power (746 watti equal one
horse-power), from whence ^f, = horse-power of any given current. A
Coulomb is the working unit of electrical energy. When a current having
the strength of 1 ampiire passes through a 1-ohm resistance-conductor in 1
second of time, we have nn ampere-second, or coulomb, of electricity. It is
the unit of measurement of quantity obtained by multiplying the number
of amperes by the time in seconds.'
The Farad is the unit of capacity. The prefix me|^ means an increase
of one million times, and micro = Vioooooo^ they are often used in practical
electricity. Thus, the capacity of subraarin/? cables is usually about onc-thinl
microfarad per knot. A Frankliu i? the unit i-f static electricity (page 053).
Sources of Electricity for Medical Purposes. — The chief forms of appa-
ratus for the generation of electrical energy now in use are: —
The Galvanic CelL
The Faradic Cell.
The Static Apparatus.
The Magneto-electrical Machine, or Dynamo.
The Storage Batteries, or Accumulators.
Although the chief and most convenient sources of electricity for med-
ical purposes at the present day are the commercial direct and alternating
currents from the street-mains, made available for therapeutic applicatioi]
by means of a converter, or controller, and other forms of ingenious mec^
anism, yet the older forms of medical batteries, so called, are still largely en
ployed. A brief description of the principal forms of thepe now in use w^
be neccssnry in order to understand their further application; —
Galvanic Cells. — Galvanic cells are supplied of various forms and coJ
binntions, but essentially they are alike, and consist of two plates (gencrati
'For tlieso deflnitioiiB the author is eapfcially indebted to the very lucid exjj
lion of the subject contnined in "Electricity in ita Application to Medicine."
Wellington Adnms, M.D. George S. Davig. Detroit. In two vohimea, 1889 and
ELECTUICITY IN MliUICINE — KLECTKO-TUEIUPEITICS,
939
I
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and collecting) partially immersed in a fluid electrolyte, which acts chemic-
ally upon one (the positive, or generating, plate) and also conveys the cur-
rent across to the other (the negative, or collecting, plate), as already ex-
plained. The great fault of such an arrangement as a source of electricity
is that the current is not constant; it may start out with its full strength,
but from various causes it soon declines to almost zero. This is found to be
due to two principal causes: (1) so-called polarization of the negative plate,
by bubbles of hydrogen clinging to the surface, and (2) chemical changes in
the electrolyte, its action upon the positive plate making it progressively
weaker; and it also offers more resistance to the current because more dense,
owing to the formation and solution of a zinc salt. These objections to the
single-fluid batteries have been overcome to a large extent by inserting a
porous diaphragm between the two plates and immersing them in separate
solutions; thus, in the two-fluid batteries, as they are called, the negative
pole is placed in a cup of unglazed porcelain, which when moistened does
not obstruct materially the passage of the current. The negative plate is
surrounded by a solution which has a chemical allinity for hydrogen, and
which acts as a "hydrogen-consumer," thus preventing polarization. As
regards constancy, all chemical batteries will gradually run down, although
some do so much more rapidly and less regularly than others.
Different Forms of Cells, — It has been found that certain forms are
better adapted for medical purposes; and, as already explained, the battery
must be especially selected for a particular kind of work. Some are made for
cautery work, others for neurological and diagnostic purposes, and others
still for gynaecological practice, or for charging secondary or storage bat-
teries. Some are portable, others are stationary. The following are the
principal forms in use: —
Sinolk-Fluid Battsbies.
The Qrf^et Cell. — Positive element, zinc; negative, carbon; electrolyte, dihite
sulphuric acid containing chromic acid or potasaiuni bichromate aa a hydrogen-con-
eumer. The advantage of this form of cell is that the zinc can be lifted, by a mechan-
ical contrivance, entirely out of the tluid when the battery is not in use, or can be
unmersed to any desired extent according to the amount of the voltage that may be
required. It is convenient for ofllce work in connection with a farndic coil, or for
running & small incandescent lamp. This form of cell is comparatively expensive
and haa not sutlicient voltage for use when a part of the human body is in circuit,
unless a large number of cells are used; very compact and useful portntile batteries
of tbia kind, however, are now constructed containing from ten to sixty or more cells,
twenty-four to forty cells being well adnpted for ordinary medical purposes, but not
for gj'nft-cologicai «ork by Apostoli's method. The sululion used is known as the
"electropoion" (or electric generating) lluid; it consists of 1 part commercial sul-
phuric acid diluted with 10 parts of water, to which, after it has become cold, add
1 part of finely-fwwdered bioiintniHt« of jHitjish and di»*'H»Ive by ngitulion. The hite
Dr. Carl Seilcr ref'ommended the addition of sulpliuric acid to a conc<?ntratod solution
of bichromate of [wtuiih, then, aftor the poi»i»rtium sulphate has crystallixed out. filtiT-
ingofT (he solution, and subsequently ailding suilicient water to briug it up to the pro|«*r
projKjrtion desired. By some, sodium bichromate is wmsidere*! preferable to the
potassium salt.
7'fte' Lrclonch^ nil has zinc for the positive element, and originally a porous
cup containing manganese dioxide and gas-carbon for the negative, with a Mturated
solution of ammonium chloride ns the electrolyte; later forms, such as the Gonda
■nd the Axo, substitute Inrge blocks of gns-carbon for the porous rup. This has le
electromotive force, but is remarkably constant and requires vt'ry little attention.
It is in common use. on this account, for electrical b*dU nnd other purposes. Where
a hundred or more such eeUa are combined, the voltage, although not great, yei is
■
9-10 NON-l'lIAliMACAI. REMEDlJib AXi) (JENKUAt THEttArEl'lICS. ^H
eufiicient for must uiedical purposes. There is uo chemical action in this cell until
the circuit is closed. It contains no acids or poisouou:) solutions (except that chloride
of zinc is formed in it), it generates no corrosive vupors or oflensive odors, does not
freeze in winter, and only requires the occasional nddition of water or fresh solution
to. replace that lost by cvaporntion. One chnrge of the solution \ull last from six
or eight months to twenty-four or thirty, depending on the amount of use made ol
it. The Leclanch6 cell originally consisted of n cylindrical rod of zinc as a positive
element, and a i)orous cell in which the negative element, consisling of equal parts
of manganeee dioxide and gaa-carbon, was packed. In the course of time the negative
element had to be renewed. Later forms of this batter)', as stated above, Bimply
substitute blocks of gas-carbon for the porous cup, which never need renewing. One
form (the Law battery) is of this character and is of excellent construction, the
cells l>eing hermetically sealed by a cover, which prevents evaporattun and creeping
up of the ammonium salts. The electromotive force is 1.5 volts (1.35 according to
I>r. Adams's measurement) and gives a current of 1 to 2 Vi amperes thromjh n snort
circuit or where the external resistance is amall. This is the best form of open-
circuit battery for medical use, according to Adams.
The (irovUif C'rJ/.— The positive element is zinc and the negative copper; the
electrolyte, dilute sulphuric acid containing sulphate of copper in solution. This is
& great improvement upon the old 8ulpliate-of-cop|>er battery, which polarized (ran
down) very quickly. A large glass cell i« employed, and the copper plate is placed
at the bottom of the liquid, or near it, and upon it are placed some crystals of sulphate
of copper. Near and just below the surface of the liquid is suspended a horizontal
plate of zinc, armed with radii like the spokes of a wheel, in order to expose as much
surface as possible to the action of the nuid. The greater density of the sulpliate-of-
copper solution keeps it at the bottom of the cell, around the negative plate, where
it acta as a hydrogen-consumer; whereas, the sulidiuric acid, liberated by the de-
composition of the copper sulphate, ascends to the positive. The copper separates
from the solution in metallic form, and is deposited upon the negative plate, while
the crystals supply the place of that which was decomposed, and thus keep the solu-
tion saturated, making the cell continuous in its action. This form of cell is used
for telegraph work, but is not used for medical purposes. It is very uniform in
action, but has small electromotive force; it is generally worked with a closed cir-
cuit, while batteries for medical use are kept usually with an open circuit except when
actually in use.
The Hmre Cell. — Positive, zinc; negative, silver covered with platinum and with
a rough surface to prevent adhesion of hydrogen; electrolyte, dilute sulphuric acid
(1 to 20). This form of bttttery is almost ohsolcle in nii'dii-ul practice, although occa-
sionally used in connection with the faradic coil. It ha^ a high intensity, but is not
constant. It is useful in the arts for electroplating.
Two-Fluid Batterie.s.
The Danicll elefnrmt consists of a glass jar. or receiver, a positive plate of line,
with a negative plate of cojtfifr, the copper plate l>eing placed inside of the porous
cup, which contains a saturated solution of sulphate of copper, the zinc being placed
in dilute sulphuric ncid in the containing jar. t>ome crystals of copper salt are placed
in the interior of the porouj* cell, tn keep the fluid saturated. The internal resistance
of this cell is rather high, but is diminished by using large plates and placing them
close together. It has an electromotive force of 1.05 volt*, and i** quite constant. A
modification of this cell, by Siemens and Halske, of Berlin, was regarded by Hemak
AS an improvement, but, according to de Watteville, is no longer used. The interior
of the porous cell was packed with paper pulp, which, when wet with the solution, is
a better conductor than the solution alone. It has been supiTSwled by cells of higher
electromotive force and of simpler construction.
The Grove Cril — The generuling plate is zinc; the collecting plate is platinum,
the latter being immersed in dilute nitric acid (hydrogen-consumer), contained in a
porous vessel, and the former in dilute sulphuric acid. The advantages of this battery
are its high electromotive force (nearly 2 volts), its low internal resistance (usually
less than 'A ohm), and its simplicity. The objections are its cost, the corrosive fumes
which it gives off while in use (nitrous acid), which attack the connections, and,
finally, its want of constancy.
7'A»' Bunften CeU. — This is the same as the preceding, except that a large piece of
gas-carbon ia made to replace the small platinum plate. The electromotive force is
ELECTUICITY IN MKDICIS'E — ELECTRO-THElLVrEUTlCS.
941
vftn higher than the Grove; but the internftl retUtanco is also higher, since otirbon
is not so good a conductor as platinum. In this cell the bichromatc-ofpot^ish solution
may be placed in the porous cup inattnd of nitric acid, thus making it a double-cell
Grenet,
Dby Cells.
The Chloride-of-Silcer Bottct*if of dr la Rue. — Owing to the inconvenience of
acids, an effort has been made tn do auny with iheni by snb«titnting a paste made
of flour and Aulphate of zinc, in which the plates (chloride of silver, in the form of a
rod, and two nines) are pcrmnnently fixed and the celts hernieticiilly sealed. Although
the ceila are small, they are able to produce ducidec] |iihyii>^iu logical effects. The cells
are only dry in the sense that they are permanently closed. They each represent an
electromotive force of nearly 1 volt, and vary in internal resistance from 3 or 4 ohms
to V» ohm, according to size. When used through proper external resistance, these
batteries are applicable to many purposes. The cliief objection is their high coat and
the fact that, when exhtausted. they can onlv be renewed by the maker or patentee.
Tht? coinnieroial dry ve\H nM-d for electric W-IU and for spark-eoiU are ehpap and
can be us^d for mcdi'nl purfK^-te^, either ftir the galvanic mrrent (using 20 to 30
cells I, or for the inditntion mil [1 celh. or for illuniinatiiig a small electric lamp
|4 to B cells, with u n'sistjim-p coiM for diHgDo^tic purpOHH*. Th«y nMpiirc freqn«.»nt
renewal. The storage cells (4 to il fcllH^ arc largely uiicd for the gulvuuic cautery.
For most purposes, however, incliidin*? Ri»cntgen-ray work, the street current is
utilized by mean!* of a converter and controller.
The Care of the Battery. — In order to have the greatest, efficiency, it is
evident that the battery must be in good working order, the connections per-
fect, the electrolyte active, and the zinc clean. The best method of keeping
the zinc with a clean surface is to amalgamate it with a little pure mercury.
This is usually done by scraping away all foreign material with an old file
and washing the surface with «orae weak acid solution (sulphuric or hydro-
chloric, \isually); a little metallic mercury is now dropped upon the surface
and rubbed over it with a brush or piece of rag attached to a stick. The
line, when freshly amalgamated, shines like silver, and presents a tmiform.
amalgam-coated surface. When this is not done the current may be weak-
ened and diverted by what is known as "local action/' Small foreigii bodies
or impurities in tlie zinc, being electronegative to the zinc, set up little elec-
tric circuits and cause local action, which make holes in the plate and
weakens the current proportionately. No rule can be ^iven as to the time
when the zincs should be amalgamated or fresh solution used; it depends
very much upon the kind of cell and the araoimt of use, but, when the gal-
vanometer shows that the battery is much below its proper efficiency, this
attention may bo needed to restore it.
Eequiiemcnts of a Galvanic Battery. — Dr. Wellington Adams formu-
lated the following as the theoretical conditions of a perfect battery; —
1. A high electromotive force.
2. A low and constant internal resistance.
3. A constant electromotive force irrespective of the current produced
by the cell,
4. A consumption of inexpensive matcTials.
6. A lack of consumption of all material when no current is being
produced; that is, when the circuit is not closed.
6. A ready means of occasionally examining its condition and work-
ing and of adding fresh materials when required.
Work of a Galvanic Battery. — It should always be borne in mind that
the electromotive force of a galvanic cell is independent of its size, a cell no
larger than a thimble possessing the same electromotive force as one the size
942
NON-FHAKMACAL HKMEDIK.S AXU OENEKAL THEKAPKLTICS.
of a barrel where the elements are the same. The character of the element!^
therefore, determines the electroniotive force, or the tension, of the current,
all cells having similar elements possessing the same difference of potential.
Moreover, one cell will yield the same quantity or volume of current on a
short circuit, theoretically, as a hundred, and no more electricity can be ob-
tained from the latter than the former on a short circuit (no external re-
sistance). But one hundred cells arranged in series will have a hundred
times as much electromotive force, or power of overcoming resistance.
Finally, the strength of a current which any cell will give is largely affected
by its internal resistance, this depending upon the size or extent of surface
of the elements, their proximity, and the character of the solution and of the
negative plate, as conductors, and the amount of chemical action. The
pressure, or electromotive force, depends upon difference of potential, while
the quantity of electricity depeudt^ directly upon the chemical action upon
the positive plate: the current-stren^h is the resultant of these two factors.
Qalvanocautery. — For galvanocautery work, large Grenet cells may be
employed. In this case, the external resistance being small, the conjunctive
wire being short and a good conductor, everything is gained by increasing
the size of the plates and bringing them close together, thus diminishing in-
tenial resistance and balancing the battery. Polarization may be prevented
by agitating the liquid, or other means. From four to six cells of rather
large size are suRicient. A verj' good mechanical arrangement has been
devised, by which the zincs attached to a frame are raised or lowered by
pressing a lever or treadle with the foot; by this means the battery is only in
use for a' short period at a time, and polarization has less time in which to
take place. The storage battery is also used for galvanocautery work. (See
Storage Batteries.)
Faradic. or Induction. Apparatus. — The construction of this very useful
form of appnriilus has already been explained and the theory of its action
considered, by which currents of high electromotive force and small quantity
are obtained from those of low electromotive force with relatively large
quantity. Usually a dry cell or a small Grenet is used as a source of
electricity, which flows along the primary wire. As already stated, the
second coil should consist nf a large number of spiral turns of fine wire, each
insulated from the other; but an extra coil of coarser wire may be used when
the external resistance is small. The currents induced by the making and
breaking of the circuit in the primary wire, by clock-work rheotome, or by
the action of the automatic interrupter are of momentary duration and op-
posite in direction. In the wires connecting the extremities of the secondary
coil, in ordinary medical batteries, therefore on a short circuit, there is, prop-
erly speaking, no direction to the currents; they are rapidly-reversing to-
and-fro currents. At the same time, they are not of equal strength, and, if
the resistance be great, the current set up upon closing the circuit is unable
to pass around, and only the current set up at the time of breaking the cir-
cuit is left, which, of course, will be in one direction. Moreover, if the
interruptions are sufficiently rapid it will be practically continuous. It has
already been pointed out that, by a device known as a commutator, the first
current may be reversed so as to reinforce the other; hut this is not usually
found in a medical faradic apparatus. The poles of such a faradic apparatus,
may, therefore, be properly marked -|- and — (or positive and negative), if
the currents are all in one direction. In addition to the extra or induced
BIiBCTBlOITY IK MBDICTNB — ^ELBOTRO-THERAPEUTICS.
I
<;urrents set up in the second coil, there are similar induced currents in the
primary coil, as its electrical equilibrium is disturbed by the making and
breaking of the circuit. If connections are made with the ends of the pri-
mar)* coil this (which is generally, though incorrectly, called by instrument-
niakera "the primary current'') may also be utilized in medicine. The cur-
rent from this coil differs in several features from the current from the
second coil: 1. Owing to the fact that fewer lines of force are involved, the
intensity, or electromotive force, is much less than in the latter. 2. As at
the moment of starting the current the circuit through the cell is shorter
than through the electrodes, the first induced current passes through the
^ell, leaving the second only to pass along the rheophores; therefore it is an
interrupted induced current, all in one direction, and not a to-and-fro cur-
rent. 3. The current is increased in intensity by inserting a bundle of soft-
iron wire in the interior of the coil, or by bringing the secondary coil over
it, just as the secondary current is inerensed.
Number of Currents from a Faradic Battery. — Some batteries give only
the current from the second coil; some give, in addition, the extra current
from the primary coil. The only current of real general utility is that from
the coarse and fine secondary coils, having a high electromotive force and
Email quantity. This is capable of passing through a high resistance, sucli
as that offered by the tissues of the human body: a resistance which would
require from sixty to eighty cells of a galvanic battery, arranged in series,
to overcome. From this it is seen liow futile it is to expect to obtain a
galvanic current for medical purposes from the cell or cells accompanying
the ordinary faradic instrument. Therefore, medical batteries professing to
give, in portable form. Isoth galvanic and induced currents, so as to suit
all cases, will not fulfill the requirements of practice. Physicians find it
necesearj' to have both a faradic and a galvanic instrument, or several of
different kinds, suited to different cases. With regard to a variety and com-
bination of coils and their effects, we may quote from an article on "The
Different Physiological and Therapeutical Properties of the Induced Cur-
rents of Electricity/'* by Dr. A. D. Rockwell, who summarizes his conclusions
as follows: —
1. From the continnous-coil apparatus, owing to its combination of
helices, the wires of which differ in thickness and length, proceed four quali-
ties of current that vary in a most remarkable degree in all the properties of
electricity: physical, physiological, and therapeutical.
2. That the variation is observed most markedly when applications are
made internally to the vagina, uterus, rectum, or bladder, by the bipolar
method.
3. From the primary or first induction coil we obtain a current of quan-
tity that is barely perceptible externally, but internally, and especially by
the bipolar method, acts with greatly increased ePficiency.
4. From the combination of the primary and secondary induction coila
we obtain a current of greater tension, but which still acts mildly when ap-
plied externally. Applied internally, however, its effects arc far greater than
the first coil, both in exciting the sensibility and contractility, ana the utmost
caution must be exercised in it^ use. In the same degree, also, it acts upon
the vagina, rectum, bladder, and testet^. This current is especially applicable
Medical necord, Feb. 14, 1891.
944
NOX-PHARMACAL nEMEDIES AND GENERAL THERAPEDTICS.
in the treatment of enlarc^cmciits of the uterus due to subinvolution, but w
of little or no value when the enlargement is clue to fibrous tissue. It is of
especial value in post-partum liii»morrha'i:e, and, from its power to excite the
sensibility and contractility of the bladder and rectuni, it may be used with
^ood eflect when these organs are aniesthetic, or suffer from diminished or
lost contractility.
5. From a combination of the first, second, and third induction we ob-
tain the maxinuim power to excite both sensibility and contractility on the
external surface of the body, each additional coil simply ffivin? a decreasing
power over sensation and contraction. Applied internally, however, it acts
far less powerfully than either of the two previnusly-nnmed currents; but in
the ordinary forms of paralysis of voluntary muscles it will more readily call
forth contractions than the current from any other combination of coils.
6. From the first, second, third, and fourth induction coils combined a
current is obtained ditTerinp* from and superior to all the others in its seda-
tive and general tonic elTect upon the system at larcre. It neither acts upon
the sensibility nor muscular contractility when applied externally, as does
the third current of the series; nor with a tenth or even a twentieth part of
the acuteness, when applied internally, that characterizes the second current
of the series. For the purpose of general faradization, however, it is the
only proper current to use, and for applications to the vagina and uterus, for
the roHof of innny forms of pain, it possesses properties that are invaluable.
Rapid and Slow Interruptions. — All faradic batteries are now provided
with some form of the magneto-electric, automatic interrupter; although
the rheotome, or current-breaker, may also bo governed by clock-work, by
the hand, or any other convenient method. Ordinarily, the interrupter, or .
rhcotomc, is attached to a spring, as already described, and the interruptions
occur with such rapidity as to make a buzzing sound or even a musical note.
An improvement upon this is fouTid in some first-class instruments, which
enables the operator to increase the interval at will between the shocks, ac-
cording to the case. In some patients the muscles are thrown into tetanic
spasm by very rapid interruptions, Find here the slow interrupter is of great
service.
Size of laBtruments. — Fiuiulic batteries are made of different sizes and
various shapes. For treatment of cases of poisoning, or in obstetrical prac-
tice, and, in fact, in many niedieiil cases, the small case, such as the Gaiff^,
or one of its modifications and imitations, may be all that is required. But
for diagnosis and general clinical use, a better one. provided with slow in-
terrupter and a large secondary coil, is indispensable, such as is provided by
Otto Flciiuniiiii:, the Galvano-Faradic, the Mcintosh Company, and others.
Combined Currents — Galvano-faradization.— No real advantage ie ob-
tained by combining the primary and secondary currents in the faradic appa-
ratus; but do Watteville and others have combined the galvanic and faradic
currents in order to give greater volume to the latter, and enable it to pene-
trate more deeply into the tissues.
The Static, or Franklinic, Apparatus. — This is the oldest form of elec-
tricity known. It is exhibited when a piec€ of glass is rubbed with resin, or
when vulcanite is rubbed with silk. Now, if either the glass or the resin
be brouglit in the vicinity of some small pieces of paper, or other light
objects, phenomena of attraction and repulsion will be manifested. This
ELEcxaicr
MEDICINE — ELECTRO-THEUAPEDTICS.
945
I
■
i
I
condition is known as electrification; and it has been found, from various
eiperinients, that: —
1. Articles attracted by the glass are repelled by the resin, and those
repelled by glass are attracted by the resin; hence the theory that there are
tvo kinds of components of electricity, called, for convenience, a positive and
a negative.
2. Many other bodies, when rubbed together, produce similar phenom-
ena, and become either electropositive or electronegative.
3. Articles which give electropositive electricity when rubbed with one
excitant may give the electronegative electricity when nibbed with some-
thing else; so that the fcrm of electrical disturbance depends upon the re-
lations of the bodies which produce it. For instance, glass, when rubbed
with resin, produces electropositive phenomena; when rubbed with fur it is
electronegative.
4. The electrical conditions of both articles are disturbed, and to an
eiiual extent, the quantity of electricity upon the glass rod being exactly
equaled by that on the resin or fur.
5. The amount of electrical difference between the two bodies is known
as "the difference of potential," since it is the measure of the force which
would have to be exerted in order to restore them to their original state of
equilibrium.
G. Electrical phenomena are produced in bodies brought into the vicin-
ity of either a positively or negatively excited electrode. This is induction,
and the electricity thus caused is known as induced electricity. It is found
that, under such circumstances, in a body capable of conducting electricity,
the form of electricity will be contrary to that of the electrode, and they will
be mutually attracted. Kence the rule: "Unlike electricities attract, like
electricities repel, each other."
7. Electricity of this character is confined to the surface of bodies, and
can be confined or stored up in appropriate apparatus, — i.e., in what is known
as the Leyden jar, — and is, therefore, known as "st-atic electricity."
8. A body is charged by conduction when its electricity is conveyed to
it through a rheophore or metallic connection. It is said to be charged by
induction when the electricity is due to the action of surrounding bodies
without contact, as already explained.
9. Tlie phenomena of static electricity resemble and are identical with
electricity from other sources, when of small quantity and exceedingly high
tension (or electromotive force). The terms positive and negative, therefore,
resolve themselves into differences of potential, the current flowing from the
higher to the lower potential, as in the current from the galvanic cell.
The foregoing brief resume of the phenomena of static electricity is a
necessary introduction to the study of electrostatic machines. They consist,
essentially, of an apparatus designed to convert motion into electricity by
means of friction and inrluction.
Forms of Static Instruments. — Electrostatic machines are either fric-
tional or induction machines, the latter requiring to be independently
charged before they will act. Frictionnl machines are identical in principle
with the experiment first mentioned, where glass was excited by rubbing. In
its usual form the glass is a circular plate or disk suspended from its centre^
and capable of revolving when turned by a crank. It is provided with a rub-
ber or cushion of leather covered with amalgam of tin and mercury, this be-
946 NON-PHAEMACAL REMEDIES AND GENERAL THERAPErTICS.
948
Nojy-j
KL REMEDIES AXO GENERAL TUEOAPEUTICS.
ing slightly pressed against the side of the plate, so as to cause friction when
the plate is revolved. There is also a comb of metal, the points of which
do not quite touch the surface of the plate. The cushion and comb are con-
nected by means of inctuUic conductors, each with one of a pair of brasa
balls, which are the poles or electrodes of the apparatus. \A1ien the glass
disk is revolved the rubber excites positive electricity upon the glass surface,
and is itself negatively excited; owing to the amalgam, its charge is carried
to the electrode in connection with it. The surface of the glass which is
positively excited passes under the comb, which conducts the charge of posi-
tive electricity to the brass ball corresponding with it. The charge of
positive electricity steadily increases, until the difference of potential is so
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great as to cause a disruptive discharge between the two poles. This tem-
porarily restores the equilibrium of the glass, which passes again under the
rubber and the phenomenon is repeated. The pole in connection with the
comb which is positively excited will, if brought near the negatively-excited
pole, discharge itself as a spark passing between the poles, when the differ-
ence of potential is sufficient to enable it to jump across the intervening
space. If it is desired to apply this form of electricity to medical purposes,
light brass chains or other conductors are attached to the poles, and by means
of suitable electrodes sparks may be drawn from different parts of the human
body. If we insulate the patient by seating him upon a chair having glass
castors or a stool supported by glass, we may connect him with cither pole,
ELEOTRICITY IN MEDICINE — ELECtnO-THERAPEUTICS.
949
ne other pole being grounded, and he will then become stored with either
positive or negative electricity, and spnrks may be drawn by bringing the
opposite electrode, or any object by means of which comraxmi cation may be
had with the earth, near him. Other applications besides this so-called elec-
tric Imth will be mentioned farther on.
The Holtz Machin*. — The improve^d Holtz apparatus is regarded as the
best of the induction, or influence, machines. It consists essentially of two
vamished-glass disks, one being stationary, the other revolving. The sta-
tionary plate has two apertures, through which project the ends of two stripe
of paper, called inductors, which are attached to the outer side of the plate.
The free extremities of these inductors emerge upon the inner side opposite
a pair of metal combs, each connected by a metal rod and by a conductor
with one of the poles. The action of the machine is thus explained: "Let
one of the inductors be charged, — say, positively, — and let the two electrodes
be brought into contact. As a result, the comb opposite the inductor is
charged negatively by induction, and a positive charge appears at the other
comb, since the combs are in communication through the joined electrodes
and the positive electricity is repelled away from the inductor itself. Since
the combs consist of sharp points, the negative electricity upon the first comb
begins to discharge itself against the glass plate in a direction toward the
other inductor and comb. Both of these, therefore, discharge positive elec-
tricity on the plate, — the comb upon one side, the inductor upon the other,
—while the inductor itself receives a negative charge. Clearly, therefore, a
part of the negative charge upon the front of the plate is neutralized, and
the positive charge upon the back is carried around again toward the positive
inductor. This increases the action of the positive inductor, since the in-
ductor itself discharges negative electricity upon the plate and becomes itself
more and more strongly electrified positively. If the electrodes are now
separated sparks will pass between them"* when the plate is made to revolve.
The object of having the holes in the stationary plate is to diminish the
capacity of those parts of the plate which are opposite them, and thus cause
them the more readily to give up some of their charge. In some cases
Leyden jars are attached to the electrodes, the object being to increase the
energy of the sparks given off, and, in fact, make it resombie in its effects the
faradic curn^nt.
Magneto-electricity and Dynamos. — The fact that a magnet introduced
into the interior of a coil of wire is capable of disturbing its electrical equilib-
rium and instituting electrical impulses has led to the construction of med-
ical electrical machines, in which coils of wire, attached to a revolving frame,
are made to pass rapidly through the lines of force around the poles of a
large magnet. Currents are set up in the coil as it enters and as it leaves
the magnetic field, and by proper connections these currents are conveyed to
electrodes, by which they can be applied to the body. These currents are of
high tension, but of feeble quantity — resembling, in this respect, the faradic
machines, which are much more efficient and convenient, so that they have
driven the others out of use. Within a few years, however, improvements
have been made in the construction, and large magneto-electrical machines
are made, which are run by steam and are called dynamos. They are now
* Li«big »nd Rohd, "Practical Electricitv in Medicine and Surgery," p. 27. The
A. Davia Company, publishers, Philadelphia, 1890.
950
NON-PUAHMACAI. REMEDIES AND OENEHAL T)! KUAPEmCS.
employed in electric li^hlin^, and as a source of power for many purposes.
The wires carrying these currents in the street-mains have been utilized as a
source of electricity for medical purposes, and we may briefly refer to the
subject here. There is a distinction of great importance to be observed be-
tween the currents supplying the arc Light and the incandescent light; the
former requires a lO-ampere current, with electromotive force of about 60
volts, while the latter has something like Vj ampere, with an electromotive
force of 110 volts. Owing to this difTorence in quantity and pressure, it
is easily seen that their utility for medical purposes varies greatly. The arc-
light current is capable of causing fatal results, while no serious result would
follow the use of the incandescent (Edison) current, unleBS the conductor
was accidentally connected with an arc current flowing in an arc-light
wire, in which case its current would he immediately increased, and, unless
protected by a previous insertion of a fusible plug in the circuit before reach-
ing the patient, serious results might follow. Where an arc current only is
available, it is conducted through what is known as a ''converter," which is
essentially a coil of wire surrounded by a secondary coil, from which the
induced current, having higher intensity and less quantity, is obtained just
as in the faradic apparatus. It is not necessary to discuss the construction
of motors and dynamos, nor the diilerent methods of arranging the wires in
the armatures, in order to obtain currents of higher or lower potential.
For these details the reader is referred to Liebig and Roh6's work on
'Medical Electricity," to which reference has already been made, and other
monographs on medical electricity, electric lighting, etc. Small dynamos
have been constructed for nse in clinical work, but they are expensive, un-
reliable, and unsatisfactory, when compared with galvanic and static ma-
chines now furnished. The electric-light current may be utilized for run-
ning small motors for dental drills or nasal instruments, and the static
machines; and, by the use of resistance-coils, it is made applicable to all
medical purposes. It is also made available for medical use as a source of
electricity, through Faure's invention of the storage battery, in which the
current is completely under controL
Storage Batteriea, or Accumulators. — While the Ley den jar, one of its
modifications, is the only means, strictly speaking, for accumulating elec-
tricity, the name of storage battery has been, by general consent, applied to
a form of apparatus in which chemical action produced by a current of large
volume and low pressure is utilized to yield, at will, a current of low volume
and large electromotive force. The form known as the Plants cell originally
consisted simply of two insulated plates of lead immersed in dilute sulphuric
acid. If, through this apparatus, a current be passed for a certain length of
time, it will be found that certain chemical and pliysical changes have taken
place, and one plate is seen to be covered with a layer of oxide of lead. Now,
if the current be reversed, the other plate will become oxidized, and the first
plate will be deoxidized and again become metflUic lead, but the surface will
be converted into a spongy condition. The plates are now said to be
'"formed," the spongy lead being the negative piste and the oxidized the
positive — the current, in other words, flowing from the plate containing the
oxide through the circuit, or conjunctive wire, and into the cell through the
spongy plate. During the process of chGrging the cell the current is made
to flow in the opposite direction — into the cell through the positive plate,
and out through the other. After charging, the positive plate is etill more
ELECTRICITY IX MEDICINE — ELECTKO-THERArEUTICS.
U51
I
oxidized. Subsequently, when the circuit of the cell is closed, a current is
set up, which continues as long as there is sufficient diiTerence in potential
between the plates to overcome the resistance, and during this time the posi-
tive plate becomes progressively less and less oxidized, and the negative more.
in the present form of the Faure cell the lead plates are cast in molds, which
give the plates a peculiar shape. They arc called '*grids," because they
contain numerous holes or perforations, which are filled with oxide of lead,
mixed into a paste with sulphuric acid. Two oxides are employed, — the red
oxide (Pb:iO^) for tlie positive plate, and yellow oxide (PbO) for the negative.
After the plates have been thus prepared they are **formed'' by passing a
current obtained either from the electric-light main or battery, of proper
intensity, through them, when immersed in dilute sulphuric acid. When
several storage cells are used, they ore always coupled in parallel, the posi-
tive plates all being joined together by a lead strip, and the negatives simi-
larly united. In this way each additional cell proportionately diminishes the
internal resistance. The storage cell is largely used in medicine and surgery,
in connection with the galvanocautery; dental engine, or drill; and electric
light for exploratory purposes. It is usually found convenient to use from
four to six cells. They may be charged either from a large galvanic battery
(sixty to one hundred cells) or from the Edison iucandescent electric-light
current. Storage cells each represent an electromotive force of about 2 volts.
When in use, as soon as the electromotive force falls to 1.8 or 1.7 volts, the
battery should be disconnected and at once recharged. It should not be
allowed to run down further than this, and should not be permitted to re-
main, when not in use, in an uncharged state, for it will lose in efficiency if
neglected. The capacity of a storage battery is usually indicated in ampere-
hours: that is, by the number of hours it will furnish a current of given in-
tensity. A battery witli a capacity of lUO ampere-hours, theoretically, will
furnish a current of 10 amperes for ten hours, or of 5 amperes for twenty
houis, etc. In practice, however, the capacity diminishes with the intensity
of the current; so that the above battery might furnish 25 amperes for only
three hours, instead of four, or 50 amperes, possibly, for only one hour, in-
stead of two. The size of the cells and their number are made to correspond
with the particular work they are intended to perform, as the best work can
be done only when a battery is discharged at its ''normal" rate: that is, the
kind of work that it was made for. The cells may contain a number of plates,
thus greatly increasing the surface exposure and diminishing the resistance.
The objection to storage batteries is their weight; but recent improvements
have been made by which both the weight and cost have been materially
reduced.
Electrical Apparatus Other than Batteries — Electrodes, etc. — In addi-
tion to a source of supply of electrical energy for medical use, certain appa-
ratus is needed. The rheophores, or current-carriers, have already been
mentioned. The electrodes, or poles, are of difTerent shapes, adapted to the
part of the body they are intended to be applied to. As metallic electrodes
cause pain when strong currents are used, it is customary to cover the elec-
trode with a moist sponge or leather; what is better is a layer of absorbent
cotton, and moistened with salt-water because it is a better conductor than
plain water. Where large-volume currents are used it is necessary to in-
crease the size of the electrode in order to avoid electrolysis of the tissues;
for instance, in the Apostoli method one of the electrodes is made of a mass
<)o2
NON'-PilAUAlACAL UEMEDIliS AND GENKU-VL TUEUAPEITICS.
-of clay applied over the surface of the abdomen, while the other, being com-
paratively small, is usually made of carbou, and is applied so as to produce
the desired local effect upon the uterine structures. Electrodes for cautery
purposes are usually made of platinum, in the form of loops of wire of dif-
ferent sizes, according to their destined purpose. The wire may be used as
an ecraseur, and heated to the desired degree by the current as it cuts its way
through; but much tension cannot be put upon a unre that is heated, be-
cause it is soft and less able to resist when in this condition. The electrodec
ordinarily employed for the percutaneous method of administering electric-
ity are of great variety of shapes, varying with the taste of the user. They
may be double, each pole being insulated until joined by some object, such
as the mucous membrane; these are used for intra-uterine, laryngeal, or eye
work. A similar electrode is used as a searcher for bullets, an electric bell
being placed in circuit* which rings when metallic connection is nmdf*.
Galvanometers, Milliamperemeters, — the Dynamometer, Coulomb-
meter, and Electrodensimeter. — Besides tiatterics an<i electrodes, an instru-
ment for measuring tiie quantity or intensity of a current is needeiL The
galvanometer is constructed upon the principle of the deflection of a magnet,
by the passage of a current of electricity parallel with it. A magnetic nc»edle
surrounded by a coil of insulated wire will be deflected front its usual posi-
tion in relation to the earth's magnetism (north and south) and made to re-
volve more or less to a position approximating a right angle; the greater the
strength of current., the greater the deflection, although not directly related,
since doubling the current does not double the amount of deviation. As the
galvanometer is marked in milliamperes, it is commonly known as the
milliamp^remeter, or, abbreviated, simply milliammeter. Such an instru-
ment is called direct reading if it indicates at any moment the strength of
current in amperes. Very good instruments are made by Waite & Bartlett,
Flemming, and by Mcintosh. Wellington Adams pronounces in favor of
the Weston milliammeter. For exact measurement of electrical work a
coulombmeter is used, which depends upon the amount of decomposition or
electrolysis taking place within a certain time while the battery is in use.
An instrument of this kind is used in connection with the electric lamps, to
discover at stated periods exactly the quantity of electricity which had been
ufied. Besides these, practical electricians make use of another instrument,
known as the dynamometer. In this instrument the amount of attraction
between coils of wire, carrying currents in the same direction parallel with
each other, is measured by the amount of angular deflection. In the dyna-
mometer, instead of a magnetic needle, we have a coil of wire to be acted
upon. When the current is reversed it is changed simultaneously in both
coils, and the same effect is produced as when the current was constant;
hence, with this instrument, we may measure the strength of alternating
currents, which could not be done with the ammeter. The deflection of the
dynamometer is proportional to the product of the two currents; conse-
quentl}^ in order to determine the strength of the current itself, it is neces-
sary to take the square root of the amount of the anterior deflection of the
suspended coil.
Measurement of the Dose of Static Electricity. — Benoist has devised an
instrument, wliich he calls an electrodensimeter, for measuring the dosage
of static electricity. He describes it* as an aluminum-leaf electroscope,
' Archives of the Roentgen Ray, Junp. IflO.S.
ELECTUICITY IN MEDICINE — JiLECTUO-THEUAPEUTICS.
053
"wmcn IB graduatcMl Uitli in de^^rees and iu al'soliitc units, nr ^'franklins/'
per square centimetre. The eajmeity of the electrometer ctm be varitxl by
means of a second movable di^c parallel to the first, and so regulated as to
\te equal to that of a sphere of ten centimetres radius. Each franklin will
raise the potential of tlie electrometer by 10 C. G. 8. units of potential (or
10X300=^3000 volts I. The divergence of the aluminum leaf may be read
off (iirectly in franklins on the dinded quadrant attached to the electro-
meter.
Benoist places his patient on an insulated stool connected with an
electrostatic machine. The subject is now assumed to be covered with a
layer of electricity in mobile equilibrium. The density of this layer, or
the quantity in each cubic centimetre, is tlie factor which determines the
physiologic and therapeuHc efTects of the elect rof;ta lie bath. To measure
this density, he makes use of a proof-phme. consisting of a small metallic
disc, with an insulating handle. The back of the outstretched hand being
touched with this instrument, the latter is charged with the same electric
density as appertains to the patient. If the proof-plane be now applied to
an aluminum-leaf electn>scope of known capacity, such as Benoist's electro-
densimeter, the charge will be distributed over the whole of the condenser
plate, and may be measurnd by the extent of the repulsive action on the
aluminum leaf. Witli an ordinary elertrostatic machine, the patient will
be charged with from '> to 1.5 C. 0. S. units per square centimetre. The
difficulty of defining a C. G. S. unit led Benoist to suggest in its place the
term "franklin." A Franklin of positive electricity at a distance of one
centimetre from another franklin of positive electricity repels it with the
force of one dyne, which equals about one millicrramme in weight. A frank-
lin equals one-third of a niicrn-milUcouloinb (the coulomb being the practical
• unit of current electricity, or the amount passing any jwint in a circuit,
carrying a current of one ampere). The term frankln is proposed as the
absolute unit of electrical quantity, franklinization being already used for
M the medical application of static electricity. Electrical density, under these
B circumstances, then, would mean so many franklins per square centimetre.
H An elw^trica! bath, therefore, may be prescribed as a bath of ten franklins,
H the patient in this case receiving the exact dose equivalent to a density of
HL|bd C. 0. S. units per square centimetre on ihe back of the outstretched hand.
mT^ * Bifferent Forms of EheoBtat for Determining: Resistance. — A form of
apparatus for accurately measuring resistance, or ohmmeter, consists of a box
I containing a number of coils of wire, the resistance of which is definitely
known, which can he introduced into the circuit either in connection with
the unknown resistance or^n substitution for it, the latter being a more
direct method. This apparatus is known as the ^'AVheatstone bridge."
A rheostat — consisting of a column of water in a glass tube, or a series
of resistance-coils, or a mass of plumbago,' as in the Massey current-con-
troller— is almost indispensable in using the galvanic current, since by its
■ means the entire battery of forty to eighty cells is brought into action at
once, the current being gradually raised from zero to the desired amount and
afterward lowered again before removing the electrodes.
I
I
■A plumbago current-controller was patented by Dr. John Butler, author ol
"Bectio-'rhcTaj^utics and Eleotro-Surgcry." Philadvlphia, 1879 and 1882.
954
XON-PUAKMACAL UEMEDIES AND GEXERAL THEIIAPEUTICS.
Labile and Stabile Applications — Ascending and Sesoending Currentt
— General Faradization and Galvanization. — When the electrodus are kept
upon certain spots, the application is said to be "stabile"; when they are
moved about, it is a **labile" application. When the poles are so placed that
the current passes toward the periphery, it is said to be descending; when
reversed, it is ascending. This applies both to the faradic and galvanic cur-
rents. In general galvanization a moist foot-plate or foot-bath may be
attached to the negative electrode, while the positive, covered with wet cot-
ton, is held to the forehead or occiput. The caution is given by most
electro-therapeutists not to use very strong currents if the head is in the
circuit, nor to abruptly make and break or reverse the current; nor should
the application be kept up for a longer time than five to eight minutes.
General faradization is accomplished by applying one electrode to the spine,
in the cervical or dorsal region, and passing the other rapidly over the sur-
face of the extremities. It is often, and very advantagcousiy, combined with
massage.
Rheotome, — A mechanical device for interrupting the galvanic current
is called a rheotome, and is an indispensable part of the outfit, as furnished
by the principal manufacturers. The slow interruption may be made me-
chanically,— by the hand or foot or by clock-work, — but the automatic inter-
rupter is moBt commonly used. The same result may be accomplished,
though less satisfactorily, by brief applications, simply ''dabbing" one elec-
trode on the part, the oilier being i^tationary.
Current-collector, or Pole-board. — In a complete battery outfit it was
formerly considered absolutely necessary to have what is called a collector,
which represents the extremities of the wires communicating with the cells,
60 that by simple movement of a switch any number of cells are thrown into
circuit. The &implei?t form of collector is in the shape of a dial, consisting
of a single row of metal biittons arranged in a circle. In the centre is a
metallic post, which has a movable arm which swings around the circle,
bringing into action as many as are required, the buttons having a circle of
numbers just outside of them corresponding with the number of cells. If the
arm of the dial-collector be sufficiently wide to touch two adjoining buttons,
breaking the current will not occur when the arm is moved from one to an-
other. With n large battery two dial-collectors are employed,— one repre-
senting single cells, the other accessions of two, three, or five cells. Since
the introduction of tlic milliammctcr and the rheostat, or current-controller,
the necessity for a ])ole-board collector is much less imperative, and it may be
entirely dis5>ensed with without inconvenience.
The Current-reverser. — The commutator, or pole-changer, is also a
valuable, if not indispensable, adjunct to a good oattery. It is a mechanical
contrivance, by means of which the polarity of the electrodes may be reversed
without changing their position. This may be done by a simple switch; but,
where rapid reversals are required, the best form is a split button. The
revolving shaft carries a disk bound with brass, in which there are two
interruptions of continuity, or vacant spaces. Upon the circumference four
flexible metallic connections impinge, so that, as the handle is turned, the
poles are brought alternately in connection with each electrode. The ordi-
nary pole-changing switches have adjustable contact-springs beneath the
levers, which make close contact with the buttons beneath, the surface of
which should he kept clean and bright. By employing two pole-changing
ELECTRICITY IX MEDICIXE — ELECTRO-THEIL^PELTICS,
955
I
switches, one connected with a gahanic and the other with a faradic bat-
len", the change may not only be made from one polarity to another, but also
from the chemical to the induced current, without removing the electrodes.
Such a switch-board, as first devised by de Watteville, and known as a "cur-
rent-alternator, reverser, and combiner," is manufactured by the Waite &
Bartlett Company.
Some Points with Regard to Electrodes. — With regard to electrodes,
Erb recommends the following standard sizes: —
1. Fine electrode, Va centimetre (Vs inch) in diameter.
2. Small electrode, 2 centimetres {^/^ inch) in diameter.
3. Medium electrode, 5 centimetres (2 inches) square.
4. Large electrode, 6 by 12 centimetres (2 Va by 5 inches).
5. Very large electrode, 8 by 16 centimetres (about 1 '/^ by 6 Vi
inches).
The electrodes may be made of carbon (gas-coke), copper, or lead.
When a dry electrode is required carbon is preferred; it also makes a useful
form for intra-uterine applications. Where a large surface is to be covered
sheet lead may be employed on clay, as used by Apostoli. Electrodes are
often covered with leather or sponge, but the m<ist cleanly and convenient
covering is absorbent cotton, as suggested by Dr. G. Betton Massey, a fresh
piece being applied over the electrode for each seance. The cotton is moist-
ened with warm water, or with medicated solutions if desired for cataphoric
purposes. Various forms of electrodes have been devised for laryngeal, intra-
uterine, and other special purposes, which fill up the pages of the manu-
facturers' catalogues, and need not be detailed here. An exceedingly compact
and complete electro-therapeutic cabinet, having galvanic, faradic, and static
apparatus, with all the needed accessories, in a space of thirty-four by twenty-
four and sixty inches high, has been devised by Dr. Wellington Adams, of
St. Louis. Mo. It is not only an ornament to a physician's office, but he
claims that it is really the most useful cabinet that has yet been produced.*
Physiological Effects. — The utility of electricity in medicine depends
upon its power of producing physiological effects and stimulating certain
functions. It is known that all muscular movements are attended by the
liberation of electric currents, and, in fact, a form of battery may be made
entirely of muscles, as in Galvani's celebrated experiment. On the contrary,
currents of electricity, made to traverse a muscle in its normal state, will
produce contractions. In the same manner, if an electric current be applied
to a motor nerve, by introducing part of its trunk in the circuit, the muscles
to which it is distributed will contract; sensations of pain or numbness will
be caused by stimulating a sensory nerve; a peculiar taste in the mouth is
caused by passing electricity through the gustatory nerves; sensations of
flaahes of light are caused by electrically exciting the optic nerve, etc. So
that properly adjusted currents of electricity cause responses in accordance
with ihe physiological function of the organ to which they are applied. Very
little is known with regard to the electrical conditions of the deeper tissues
of the interior of the body during the period of the passage of a current
of electricity between the positive electrode (or anode) and the negative (or
cathode)^ when they are applied to the surface of the body. If the electrodes
:
'See "Electricity: ita Application in Medicine" by Wellington Adams, M.D.,
Tol. U, p. 33. George S. Davis, publisher, Detroit, Mich., 1890.
95G
XON-PHABMACJO. REMEDIES AND GENERAL THEOAFEtTTICS.
are dry, the galvanic current penetrates with difficulty, since the dry ekin
offerB a very high resistance and is a poor conductor of electricity. If the
electrodes are moistened with salt water, a small portion of the current passes
directly through, from one to the other, in a straight line, but the major
portion is deflected by various routes of less resistance, a considerable quan-
tity probably following the layer of fascia and blood-vessels under the skin.
When a nerve-trunk is included in the path of the current, the part of
the nerve near the anode is in a condition of decreased irritability and that
near the negative of increased irritability. In the normal condition the
greatest effect, therefore, is observed under the cathode, or negative pole.
By numerous experiments it has been found that the contraction occurs with
the weakest current, with cathodal closing; the anodal closing contraction
requiring twice the strength of current; the anodal opening contraction
about the same; while the cathodal opening contraction requires four times
as much. This may be expressed in e3Tnbol8 as follows: —
Normal nerve-muscular reaction = Ca. CI. O An. CI. C.> Ail 0. O
Ca. 0. C. The changes in the electrical irritability of nerve ajid muscle are
classed by Liebig and Rohe under three heads: —
1. Quantitative, or an increase, diminution, or total disappearance of
electrical irritability to one or both currents.
2. Qualitative, consisting in a modification in kind of the normal re-
actions of nerve and muscle to electric currents. This is the so-called ''reac-
tion of degeneration."
3. Mixed or combinations of quantitative and qualitative variations of
irritability. This class may also be included under the consideration of
"reaction of degeneration."
The reaction of degeneration of Erb indicates a departure from the nor-
mal conducting power of the nerve and muscle, and this is usually the result
of degeneration of the nerve, but it may be secondary to some lesion of the
BpiDal cord at the point of origin of the roots of the nerve. The phenomena
of reaction of degeneration are: —
Disappearance or diminution of nervous irritability to both galvanic and
faradic currents.
Disappearance of faradic and increase of galvanic irritability of the mus-
cle, generally associated with increased mechanical irritability.
Tardy, delayed contraction of the etimulatod muscle, instead of the
quick, lightnintj-like contraction of the normal muscle.
Appearance of certain decided changes of the normal formula, as just
given, to An. CI. C. > Ca. CI. C. > An. 0. C. > Ca. 0. C, or some modifica-
tion of this. But the typical change is the tardiness of muscle-contraction,
which indicates degenerative changes of the muscle or nerve, following
peripheral paralysis.
Monopolar and Dipolar Electric Baths. — The dipolar electric bath is
essentially different from the franklinic electric bath (general frankliniza-
tion), in which the patient is placed upon an insulated chair or stool and con-
nected with one (negative or positive) pole of a static or friction apparatus.
The results of some recent experiments are reported by W. S. Hedley, M.D.,
in the British MedicalJounxal (February 20, 1892. page 381), in which the
effects of the bath are carefully studied. For the dipolar bath the following
apparatus is required: An oak bath-tub six feet long, two feet six inches wide
at widest part, the waste-pipe being insulated from earth by a short length
ELECTRICITT IN MEDICINE — ELECTBO-THEttAPEUTICS,
of rubber hose inserted near the bath; a battery of seventy-four Leclanch6
celle, or other battery having an electromotive force of seventy-five volts;
the electrodes, thirty by twenty square centimetres, rest at each end of the
hath; the water is unmedicated, about twelve and one-half inches in depth,
and the temperature 98° F. The resistance of the water before the entrance
of the patient measures 165 ohms, but increases rapidly aa the water cools
(thug, at 92" F. it is 194 ohms; 87'' F., it is 264 ohms; and at 70** F., 440
ohms). A strap is stretched across one end as a head-rest, and the subject
lies immersed in the water except his head, the shoulders being eight inches
from the positive electrode and feet three inches from the negative. It was
found by measurement that a small portion of the electric current (or lines
of force) pursued the most direct course through the patient's body; upon
measurement, however, it was found that the strength of the current which
thus passed through the tissues was less than one milHamp^re; the waste of
current in administering a dipolar electric bath is, therefore, much in excess
of what is generally supposed. In proper hands this method of administra-
tion is an available method of general galvanization; if painful at all it is at
most only pleasantly painful, and, on account of its wide distribution and
even application, it is a good method for appropriate cases. The question of
density becomes a complicated one in this form of bath. Here it is evident
that not only the size of the electrode is to be considered, but the amount
of diffusion the current undergoes in passing through the water from the
electrode to the body. This depends partly upon the size of the electrode,
partly on the distance, and partly on the conductivity or the specific resist-
ance of the water. In other words, says Dr. Hedley, "we have not only to
consider the size and position of the electrodes electrizing the water, but we
have to look upon the whole extent of water in contact with the body as a
huge electrode, carrying a widely-diffused current with a density, of course,
diminished in proportion to its ditTusion."
Various other forms of electric bath are in use; for instance, in what
is Termed the needle-bath, where the patient is surrounded by coils of pipe
containing minute perforations through which water flows with force against
the surface of the skin, he may be placed upon an insulated mat connected
with one pole of the galvanic or faradic battery, while the other is connected
with the water-pipes; in this way the current is carried by the water acting
as an electrode. Where one electrode is held by the patient, applied directly
to different parte of the body, the other being immersed in the bath, we have
what is called the monopolar bath. The monopolar bath is not as well
adapted to the treatment of disea.se as the dipolar, according to Stein, be-
rause of the great difference of current-density between the immersed surface
and that part to which the other electrode is applied. Eulenberg considers
it quite unsuited for scientific work. In the dipolar bath the current-density
does not tluctuate, and polarization is at the minimum. Bartholow thus sums
up the effects of the dipolar bath: In faradic baths of ten minutes' duration
the electrical sensibility is increased, while a distinct diminution of motor
excitability takes place. The cutaneous sensibility to faradic stimulation ia
for a brief time increased, but afterward considerably lessened, while to the
galvanic the diminution of cutaneous sensibility occurs at once, and is main-
tained throughout. At first, both in faradic and galvanic baths of moderate
itrcngth, the frequency of the pulse ia lessened, after a time to rettirn to the
normal. With a powerful and long-continued current-action the frequency
I
958
KOir-FHARMAOAL REMEDIES AXD GENERAL THERAPEUTICS.
of the pulse increases during the bath, the tension of the vessel is elevatedj
and sometimes there is irregularity in the action of the heart. As respect^
the respiration in dipolar baths, galvanic and faradic, the number of the refti
pirations is increased and in volume deepened, while in monopolar this effect
is much less pronounced. The temperature is little affected in dipolar bathk
but is lowered in monopolar. As respects the excretion of urea» the effect of
the dipolar bath, galvanic and faradic, is much greater than the monopolars
AIL forms of electric baths stimulate the appetite, increase the digestive
power, promote intestinal peristalsis, and affect agreeably the mental state;
sleep is also promoted, and various functional nervous affections improved.'
A form of electric bath can be given with static electricity. The paJ
tient is placed upon an insulated platform, which is connected with one polfli
of the machine by means of a metallic chain. The other pole is groundedj
In this manner, tiie surface of the patient is covered with a layer of electrioH
ity, practically bathed in it. Sparks can be drawn from any part of tlie
body if desired, by a discharging electrode.
Electricity in Medicine. — Electricity, as a therapeutic expedient, be-
longs to a division which is quite distinct from the ordinary classes of reme-
dies. The various well-known forms of energy, — heat, light, motion, and
electricity, — when considered as therapeutic agents, may be grouped to-i
gether, for convenience, as ''imponderables," or simply as "forces." The dis-
tinction is very marked between material substances, like drugs, which tem-l
porarily become a part of the human body, and during this time affect certain'
functions and produce disturbances of nutrition, which may or may not bej
ultimately beneficial, and forces, which directly act upon tissues and cells,!
exciting normal irritability of muscles and nerves, and, when properly and!
Buccessfully used, aiding the functions of organs and strengthening vital i
powers. Electricity cannot, therefore, be considered as a department of thej
Materia Medica; it must be studied as a science by itself; but its applicationj
is an art which must be learned mainly by the bedside and from experience.!
Essential Identity of all Forms of Electricity. — It is of the highest im-|
poriance to bear in mind that electricity from any source is the same force;!
it only differs in degrees of pressure (tension, electromotive force), volume,
and constancy. Returning for a moment to the analogy of water passing
through pipes, we may have variations in pressore (differences of potential),
or the force whicli enables the stream to overcome obstacles, as well as in
Tolume, the latter depending principally upon the abundance of supply, the
size of the pipe, and the material out of which it was constructed. Under
precisely the same conditions of current-strength, or pressure, and resistance,
all the so-called different varieties of electricity will produce exactly the same
effects. The current from the induction-coil, which is intermittent and
reversing (to-and-fro current), as has already been stated, can be comrautated
or made to flow in one direction, and the interruptions may be so rapid aa
to make the current practically continuous; it then becomes capable of pro-
ducing the same effects — chemical and physiological — as are produced by
thf* cell-current. vStatic elwtricity, properly directed and controlled, also
will nifignetize iron, heat a wire, or cause clwlrolysis. The current from a
magneto-electrical machine will cause contraction of muscular fibres, produce
ln'rit and light, or electrolysis, when the same relations of pressure and vol-
ume and resistance are observed as with the chemical or galvanic current.
Different Effects Depending npon Various Modes of Applioation. —
Electric currents are applied through a greater or less extent of the body,
according to the relative position upon the surface of the electrodes between
which the force is technically considered as flowing. The effects vary accord-
ing to conditions; they are classed as irritative (or excitant), electrolytic,
thermic, cataphoric, and catalj-tic. The latter word is rather uncertain in
its signification; but it is a convenient term, under which may be included
the actual, but not easily demonstrable, dynamic molecular action of the cur-
rent, which has been already referred to in the preceding pages and which
possesses a powerful influence in correcting perverted physiological processes
and in restoring parts to a normal state. In ordinary medical applications of
electricity, — as, for instance, in treating paralysis of certain muscles, — this
dynamic or catalytic effect usually predominates over the chemical and elec-
trolytic actions, the latter requiring, for their production, much more pow-
erful currents than are ordinarily employed by physicians. The effects of
the electric current are, therefore, dependent upon the manner and method
of its application. For instance, if we desire to obtain the electrolytic and
cataphoric effects of electricity we employ a galvanic current of low poten-
tial, as in treating urethral or other strictures by the method of Dr. New-
man, of New York.^ Here, moist mucous membrane being in contact with
the electrode (negative), the energy of the current meets comparatively little
resistance and becomes concentrated upon a very small area, where it pro-
duces decided electrolytic and chemical effects. On the other hand, in ordi-
nary medical applications, where the percutaneous method is followed, the
dry, homy layer of the skin offers great resistance to the passage of the cur-
rent; hence the skin must be moistened, because moist tissues carry the cur-
rent better than dry ones.' When the current is diffused over a large surface
by using large electrodes, it has its density greatly reduced, and the local
effects are consequently less marked. Small electrodes, on the contrary,
concentrate the effects. For the pnx3uction of chemical changes, a degree of
intensity of the current is required which is highly dangerous to the integrity
of tissues, especially of the nerve-structures; therefore measures are adopted
for limiting the effects to the immediate neighborhood of the electrode. In
the Apostoli method one very large, external, abdominal electrode is em-
ployed, which diffuses the current at one pole, whereas it is concentrated
around the other pole by the use of a comparatively small intra-uterine elec-
trode. Since, even in the Apostoli method, where heavy currents are used,
no chemical changes in the blood or intervening tissues, except in the vicinity
«f the electrodes, have been noticed, it follows that chemical changes are not
to be expected from the usual manner of applying this valuable therapeutic
agent by currents used for medical purposes. Molecular, or phy8iolog:ical,
change, however, does take place, as is snown by slight increase of tempera-
ture and improved nutrition and power in parts under treatment. This is
«xplained by the hypothesis that the ultimate forms of matter — the atom and
the molecule — represent force in perpetual action, and this motion takes
place according to certain fixed laws. This is equally true of the molecules
•omposing the human body, where the motion is also directed by physiolog-
'Sw "Clinical lecture" reported for the Mrdicai HuUetin.
*The averajT? workinf? reHiHtance of the human body and akin is About 2000
•hma. when the electrodes are projierl)' moistened with hot water, yalt or soda may
te added to the water to reduce the skin resistance, but plain water U best, as it
•arrode« the eleetrodea less and there is no electrolysis.
960
N0N-PHAH3XACA1. REMEDIES AND GENERAL THERAPEUTICS-
ical law. Now, the electric current undoubte^Ily influences molecular motion,
and produces polarizing effects whichj within limits, are strictly physiolog-
ical; for this etTcct we have no better term at present than to speak of them
as the results of the dynamic molecular influence of the current, or "electrical
catalysis." The passage of a current of electricity, of either high or low
tension, may be supposed to produce a tendency to polarization of molecules,
all the electropositive atoms, as far as possible, arranging themselves in series
with the electronegative bodies, so as to form a sort of chain of molecules
of alternating electrical affinity, extending between the poles, when a portion
of the human body is in circuit. As previously insisted upon, no actual flow
of anything occurs, but successive waves of energy, when the circuit is closed,
follow one another along the conductor, and from the positive electrode to
the negative^ through the tissues. These dynamic impulses, if sufficiently
intense, or, in other words, if the current be strong enough, are capable of
rupturing the bond between the molecules of the tissues and causing chemical
change (electrolysis) and devitalization. In the latter case a blister and an
eschar or slough (electrocauais) may be formed in the immediate vicinity of
the electrodes and a burn of more or less depth result. Electricity of high
pressure may also act upon the nerve-centres directly and cause death, as by
a lightning-stroke, without producing lesions upon the surface of the body.
Much lower degrees of electrical energy are employed in medicine, which,
however, can be maintained within safe limits, and which produce only
physiological and therapeutical effects.
Physiologrical Effects of Currents of Electricity. — A current of ordinary
strength from a galvanic battery, passing along a motor nerve and muscle,
causes contraction of the muscle at the time of making and breaking the
circuit; but during the time the current is passing unijiterruptedly no mo-
tion occurs. The nerve, at this time, is in a peculiar state or condition known
as electrotonns. According to Pfliiger, the portion of the nerve in contact
with the anode (positive) loses its excitability and ia in a condition termed
anelectrotonic; the portion in contact with the cathode (or negative pole)
has its excitability temporarily increased, and is said to be catelectrotonic.
The anelectrotonus and catelectrotonus exist for a short distance from the
point of contact of the poles, and are increased, with the augmentation of
the current, up to a certain point, when they disappear. Bartholow accounts
for this condition on the hypothesis that the chemical constituents of the
nerve-trunk obey the laws of electrolysis, by which alkalies and hydrogen will
appear at the negative pole and acids and oxygen at the positive, the effect
upon the nerve being, to a certain degree, chemical. WTiere rapid reversals
are made the muscles to which the ner\'c is distributed will be thrown into
tetanic contraction (tetanus), and a similar condition occurs in certain mor-
bid states from the application of faradic currents of moderate strength.
This is especially likely to occur with the automatic, rapid interrupter, or
rheotome, and this makes it necessary to have, for examination of such cases,
a mechanism capable of making slow interruption of the battery current in
the primary coil, thus giving the muscle time to recover itself between the
shocks. The faradic current is more irritating and stimulating than the
galvanic; but when the interruptions are very rapid (from one hundred to
two hundred per second) the faradic secondary current becomes sedative;
and in many cases the anode relieves pain more quickly than the cathode.
The very rapidly interrupted faradic current exercises an anesthetic effect
ELEOTEIOITY IN" MEDTOIXB— ELECTRO-THERAPEUTICS.
9G1
I
I
Upon the peripheral nerve-ending, as deinonstraUil liy the late Dr. Hutch-
inson, of Providence, R. I. The influence of electrical stimulation upon the
nutrition of muscle has been experimentally studied by Debedat. The re-
Bults demonstrated a gain of 40 per cent, in the weight of muscles etimnlated
by means of an induction-coil current so arranged by alternating shocks and
intervale as to approach the condition of a muscle during the performance
of rhythmical gynina&tic movements. A galvanic current with alternate
periods of stimulation and repose caused a gain of 18 per cent, in weight.
Prolonged tet«nization of muscle without intervals of repose by the induc-
tion coil occasioned a loss of weight. The gain in weight was due to a true
increase of muscular tissue, while the loss depended upon destruction of mus-
cular fibres. From experiments upon his own person Truchot observed that
the effect of static electricity is to increase tissue-metabolism and to influence
it unfavorably, but concludes that in natients who suffer from imperfect
niet-abolism, especially neurasthenics, tne augmented change is beneficial.
The brush discharge from a static machine may be utilized for earning
Tsrioiis ions more dooply into tho tissues, by tho process of foresis.
Methods of ElectrodiagTioBls in Various Nervous Affections. — In study-
ing the effects of brain-lesions and nerve disorders proper apparatus is essen-
tial to determine differences in reaction and other evidences of departure
from the normal standard. For electrodiagnosis we require each of the
above-mentioned forms of current. The faradic coil should be constructed
upon the du Bois-Reymond pattern, in which the primary coil is of good size,
and there should be at least two secondary coils, — one of fine wire and the
other less fine, — and a scale in millimetres should be so placed as to indicate
the position of the secondary coil, as related to the primary. The current
is supplied usually by a single acid cell, of one and one-half or two volts, or
two cells may be used of the Leclanche pattern. The external resistance
being small, tliere is no advantage in having a larger number of colls. In
all faradic machines, when in use, the cell is on a short circuit; hence the
dry cell, having a tendency to rapidly polarize, soon runs down, and the
battery will not again work until the cell has time to recover. The dry cell,
however, is very convenient, in small, faradic batteries, for medical use,
where the instrument will only be in operation for fifteen or twenty minutes
at a time. To return to the large coil for diagnostic purposes, we find an
advantage, as previously shown, in having the apparatus supplied with a
slow, as well as a rapid, interrupter; and, for exact work, a clock-work rheo-
tome is an advantage. With such an apparatus, muscular contractions may
be obtained in some cases, in which no response will follow when the very
rapid interruptions are made; or the latter may simply throw the muscle
into tetanus, whereas the slow interruptions permit the muscle to recover
itself l)etween the successive contractions.
As previously explained, in the induced current from the primary coil
the impulses follow each other in proportion to the rapidity of the inter-
ruptions; but they are all in one direction: that is to say, that they consist
only of the currents set up by breaking the circuit, since those made by
making the circuit are short-circuited throng^h the cell. Therefore there is
a decided difference between the poles of the primary coil, and they may be
marked anode and cathode, stronger contractions being obtained with the
Mine strength of current when the cathode is placed over the muscle at the
motor point, or on the nerve.
96-2
KOy-PllAUMACAL nEilEDIES AXD GENERAL THEHAPEITICS.
AVith the secondary coil, which furnishes the to-and-fro current, it is
usually stated that there is no diiTerence between the poles and no polarity.
This is not strictly true, since the currents made upon breaking the circuit
are more powerful than those set up when the circuit is closed; consequently,
the current in one direction will be stronger than the other and polar dif-
ferences will be noted. Moreover, where the secondary coil is ver}' long and
the wire very fine, the resistance may be so great that the weaker current will
not be able to pass through the additional resistance of the human tissues,
and consequently we may get effects due solely to the stronger current, and
the electrodes will then show anodal and cathodal differences, just as with
the primary coil. The same result may be obtained from the secondary coil
by the use of a commutator, as in the Ruhmkorff coil, by which both cur-
rents are made to flow in the same direction. Therefore, practical elec-
tricians who claim that there is a difference between the polarity of the
electrodes from the secondary coil are quite correct, and those who maintain
that there is no difference are in error.
The size of the electrodes is of importance. The indifferent electrode
should be rather large, but the active electrode should be small. Erb pre-
fers one of ten square centimetres; Stintzing uses electrodes of less than
one-third of this size, — from one-third to one square inch of surface. The
electrodes are provided with handles of non-conducting material and of con-
venient shape; they have their metallic extremities covered ^rith leather, or,
what is better, absorbent cotton, thoroughly wet with a saline solution, so
as to favor the passage of the current through the skin. In order to obtain
results for comparison, we not only note the number of millimetres of coil-
distance, but we also use the same electrodes, moistened to the same extent
and applied to the same spots with equal pressure.
For general dia^osis, the patient, with as little clothing on as is con-
venient, is made to sit upon n stool, and a large flat electrode (positive, or
anode), covered with a wet napkin or absorbent cotton, is applied to the
sacrum, or the patient may be allowed to sit upon it. If this is inexpedient,
the feet may be placed in a ba.«in containing warm water, in which the elec-
trode is placed, connected willi the secondary or primary coil of a faradic
apparatus. The operator then applies the smaller (cathodal) electrode to the
spine, commencing with a moderate current, and slowly carrying the elec-
trode down the patient's back, upon each side of the vertebrae, noticing any
effects which may occur, especially if tender spots are discovered. Ana«-
thesia or hyperesthesia may be found, and, if so, the coil-distance in each
case should be recorded. Pain is not necessarily an indication of inflamma-
tion, nor of congestion, but these are common causes. When the electrode is
passed over bony prominences pain may be felt: even the rih? are sometimes
painful under the application, perhaps due to the elTect of the current upon
the periosteum or intercostal nerves. For testing cutaneous sensibility the
wire brush is useful, or an electrode consisting of a bundle of fine, insulated
copper wires, contained in a hard -rubber case. In this instance, one elec-
trode is to be placed between the shouidei*s and the active electrode is placed
alternately upon similar points on opposite sides of the body, when any
change or difference may be noted. Paraesthesia, or diminution of sensibility,
is a common symptom in many lesions of the brain, spinal cord, and periph-
eral nerves; but in the early stage of neuritis there is hypera^sthesia, which
also may occur in hysteria and some reflex neuroses.
rLEmUCrTT is MEDICIKE — EtECTRO-TKKRAPEI?TTCS.
t
I
In using the galvanic battery for electrodiagnosis we should have a
sufficient number of cells (forty to eighty) to supply the proper potential for
all required purposes, and the cells should not be too small for the work.
The cells should be connected in series, and not in parallel. They may be
connected with a pole-board and current-selector, or the current may pass
through a controller, or resistance-coils, and a milliamperemeter, by which
the strength of the current may be accurately measured. Where the potential
is high, as in the Edison current for electric lighting, it has been claimed
that, even though the current may be cut down by introducing resistance,
the effects of the current are not identical with those from a battery supply-
ing just sufficient potential for the work. The milliamperemeter may mark
the same strength of current, but patients complain of more pain, and this
is especially so in electrolysis for renioval of hair, small nievi, etc. For such
work, the galvanic cells are to be preferred, as they are more directly under
the control of the operator. De Watte»villo'& method is to place the electrodes
in position and commence witli ten cells, then adding cell by cell, as needed,
to get the reaction desired.
Attention has been already called to the physiological nerve and muscle
reactions under galvanism and the reaction of degeneration. The following
will show the method of comparing the electrical reactions of the muscles
of the arms, one of which is supposed to be paralyzed. Having bared both
arms and the chest of the patient, place a large, well-wetted sponge, or other
electrode, upon the sternum, connected with the positive pole, and apply
the cathode, or small negative electrode, to the motor points of the muscles
of the sound arm first and note the reaction, following this by similar appli-
cations to the affected limb.
The currents should be only strong enough just to produce contractions
in the healthy muscles, and the additional amount necessary to produce con-
traction in the paralyzed muscles, together with any alteration in the order
of the normal formulae, shoiUd be noted. The muscles should also be tested
with the faradic current in a similar manner. The patient must allow the
limb to be prefectly passive during the examination; if he will not do so, the
muscles may be examined after the subject has been anaesthetized. If, how-
ever, anodal closing contraction comes before cathodal closing contraction,
and several trials confirm the observation, then degeneration may be posi-
tively diagnosticated. The relationship of this symptom to various lesions
and diseafies is set forth in the accompanying table, on the next page, whieh
is mainly that of Erb.
When a lesion is in the cord above the dorsal enlargement, as in some
forms of transverse myelitis, all the nerve and muscle reactions will be nor-
mal for the parts below the trophic centre, except that, possibly, there may
be some increase in readiness of response to electrostimulation. If the lesion
involves the dorsal enlhrgement, of course, there would be the reactions of
detjeneratinn. If the lesion affect the basal gfanglia of the brain or the
hemispheres, there will be no change in the normal nerve-musfle formula
unless the disease, in its progress, produces chanjres in the cord, thus also
affecting peripheral nerves. In a hemiplegia resulting from a clot in the
eorpas striatum there will be no change in the reactions, except that in some
cues the muscles respond more readily than normal to both currents. In
old cases there may be a quantitative decline, due to degenerative changes,
both in nerve and muscle. In uncomplicated lateral sclerosis the reactions
■
H 964 yOK-PHARaSc^^SBSlBRN^oSJ^iPTILKllAPBOTlH^^^^^H
H are noTinal. In amyotrophic lateral sclerosia tliere will be both qualitative'
H and quantitative changes in the muscles or partial reaction of degeneration, i
H In anterior poliomyelitis, infantile paralysis, and in lead palsy the reaction
H of degeneration will be present. It will also be found m peripheral palsies
H of traumaticj rheumatic, neuritic, or diphtheritic origin. It is absent in all
H cerebral, hysterical, myelitic, and purely myopathic paralyses.
H In cases where the reaction of degeneratiou h limited to a definite, i
H peripheral, neuro-raueeular area the probabilities are in favor of the diagnosis
H of a peripheral lesion. When the degeneration" phenomena are observed
H over a larger area a central (spinal) origin of the paralysis is rendered prob-
H able.
^m Elkctvical Rkactsovs.
PK0M»SNT SriCFTOHS.
Skat o» Lsssok.
pATHOLOillCAL COlfDI-
T1U^» AND TllKLK
IXHUTION.
^K^ All noruitl.
ParalyidB.
Ho muscular degenera-
UOD.
PBih of lniptil»e froiu tbe
brain lunlcro-IatenU
coluuiQA) ; ortbebrmin
lt»elf.
LaCeral acleroels {Idio-
pathlc or ftoui cenbnl
dlaesw).
^V Nt-rri': >oriiial ' I'ttralVBU.
^K MukIi;: •^uoliUiUvu and i Mu»ruUr dcgcncra-
^^^B t^iiaiiUiHilve Altera- tioa.
^^H (Faniiil It D.)
'*Tru}>liic cijuljv" for
tbo tuuaclc, and also
Uie i>atb tif impulM
fkumibe brain (aot<irt>-
lateral ooluinaa).
Amyotrophic lateml sot^
roaia.
*
^V Nerrt: At flrM normal ;
^H iifterwarU dluiUiiabed.
^^^_ Uuscie: C^iialiUUvo aiiJ
^^^H tiiianttiutlve Dlt«r»-
No p&nlysla at flnt
Muscular (aflcrwanl
nervoiu) dttgeaera-
Lioii.
"Trophie e«*itrf" ex-
tending to multipolar
gauKlttiD-itillJt of the
anterior born of gray
matter.
ProiTMilTe muaolc-atro-
pUT (ofoaatrvl ori^}.
Bulbar paralftiik
Mild acuta poliomyaU-
Ua.
^^^H Musole:) gcnuTAltoD.
Paralralfl.
Atrophy of in iiwlt^ ami
nerves. Alwliiiou uf
reSex actloui.
MnUhK)Ur giiiiKliitn-oelU i Anterior poltoiuTelilii«
of llie nnteriDf lioru of , lufJantile paralysu.
tp-ay miitt«r. ' Lead [miaoning.
1
^^^^ All tiomijal.
P»raly«l«.
Ko degeQeratloQ.
Motor aerr^Abrea.
Ireumatfo or prwaara
piiralyais.
^^^~ Nerre: >'onuttI.
^m Uuitole: QunlluUreand
^H quaulltatlre atlcra-
0 lloB'- (PotUlK D.)
ParalTflls.
M uBc{U&r degcneratloD.
Mutur uvrre-fibrw aud
path uf Irupliic iudu-
ence to muscle.
Middle form of ditto.
^L Nerre: f Iteartion ofde-
^^^H Muacle:\ geoentioo.
Faralrala.
Muscular and Dcrroua
dt^neratiua.
Motor narve-rtbrea, path
of taotkUc influenco to
mtiiclc^ and path of
aame to nerve.
^^..^
^V Konnal.f'rdlmlnatloii to ' Pieudo-paraals.
^H maziidum excitation. Simple atrophf.
Muaoular fibr«. Muscular wasting la
phtUUls, etc.. and la
dineaJK» of the Jolat*.
Idiopathic myoclliB.
■ In light forms of rheumatic, traumatic, or pressure paralyses the re-
■ actions will remain normal, but in severer forms the reactions of degenera-
H tion develop themselves. In mnscular wasting, or' simple atrophy, as in 1
H phthisis, in diseases of the joints^ and in idiopathic myositis, the reactions
H are normal or may be quantitatively reduced. When the reaction of degen-
H eration, either complete or partial, occurs, we conclude that an alteration
H (degenerative atrophy) has taken place, either in the trophic centres or '
H motor fibres going to the affected muscle, although Gessler claims that no
■ such reaction is given unless the muscular structure has also undergone
^^ degeneration.
^^K It should be borne in mind that it is the density of the cun«nt in the
KLECTHICITY IN MEDICIXE — ELKCTHO-XnERAPECTICS.
965
I
I
nen-e which determines the amount of excitement, and not merely the
volume of the current as registered by the milliamperemeter, and that this
density in the nerve ie controlled by the size of the active electrode and the
location of the two electrodes (Adams), as well as the current-intensity. At-
tention is no longer given to the direction of th^ current, bo that no advan-
tage is gained by placing the two electrodes on the skin along the course of
the nerve. The indifferent electrode may be above or below the point of
application of the testing, or active, electrode, as it is the action of the pole
upon the part that is sought, and not the direction of the current.
Clinical Electro-therapeutics. — The clinical applications of electricity
are partly deduced from the scientific data just given, and partly derived
from experience. Although the essential identity of electricity from all
sources is insisted upon, it is to be noticed that, under different conditions,
and especially when supplied from different sources, the effects depend
largely upon the conditions and methods of application. In practice, there-
fore, it is convenient to speak of electricity from the galvanic battery, the
faradic coil, or the static apparatus as if they were actually different kinds
of electric current. Indeed, it has been f oitnd that no one form is applicable
to every purpose, and the physician, therefore, requires several forms of appa-
ratus, and it needs some knowledge of the subject and some experience in
order to determine which form shall be used. According to Rockwell, in
nearly all cases wh*ere electricity is called for, each one of the forms — fara-
dism, franklinism, or galvanism — might, at one time or another, possess posi-
tive value over the others. This authority gives the following differential
indications for the use of dynamic and franklinic, or static, electricity:
**Hemiplegia, accompanied by exalted muscular contractility, calls for a mild
and rapidly-interrupted faradic current, if for any form of electricity what-
ever. Indeed, this current is usually preferable, if the museular contractions
were only somewhat less readily called out than in the normal state. The
galvanic current is indicated when there is very great diminution of electro-'
muscular contractility. In meet cases of paraplegia, either complete or proxi-
mate, loss of farado-muscular contractility exists, — at least, for a short time,
— and the galvanic current alone is applicable. The faradic current might be
useful in attempting to improve impaired nutrition of the paralyzed mem-
bers. The constant (galvanic) current is alone applicable for directly affect-
ing the central nervous system. In the great majority of cases of neuralgia,
where firm pressure over the affected nerves aggravates the pain, the galvanic
current is indicated; if pain is not increased by pressure the faradic current
should be used. Hysterical hyperaesthesia calls for the faradic current.
While it is impossible, in many diseases, to say that a particular current is
indicated to the exclusion of others, it is possible to name a variety of condi-
tions where, as a rule, one method of treatment with one form of current
is superior to others. The faradic current is indicated, for its tonic effects,
in cases known as general dobilit>'." The static current has a special range
of Dsefulness, especially for office practice.
Some few distinct organic or functional diseases in every phase of their
manifestation, according to Rockwell, demand a single form of electricity.
For instance, asthenopia, accompanied by hypersesthesia of the retina and
ciliary nerves, seems to require the faradic current. It is also useful in the
paralysis following diphtheria, in which galvanism is of little service. Gal-
vanism is particularly useful in special irritation or neuralgia, and in certain
D6ti
>ON-PHAllMACAL UE3lEUlKb AND OEN'EIUL THEIL.\PEUT1C&.
neuralgic sequels of cerebro-spinal meaingitis; also, in treatment of exoph-
thalmic goitre and in restoration of the sense of taste or smell. It is superior
to faradisra in the treatment of skin atlections. The form of electricity re-
quired in chorea varies according to the general condition of the patient:
central galvanization in the well nourished, and general faradization in thoee
whose general nutrition is impaired. The same may be said of amenorrhcea;
but in dysmenorrhrwi the galvanic current is more frequently indicated.
"Franklinic electricity is less efTicacious as a constitutional tonic than
general faradization, but is a valuable supplement to the latter. The pain
of myalgia (muscular rheumatism) is relieved by franklinism sooner and more
effectually than by other methods, and it acts best when applied by a roller.
Franklinism is superior to either galvanism or faradism for relieving pain of a
chronic character, confined to no special nerve-trunk or distribution, with no
tenderncBS on pressure over the nerve. It is also most efficacious in treating
the enlarged joints of subacute and chronic rheumatism; and in facilitating
absorption in synovitis it is best employed in the form of sparks. It is often
superior to other forms in old contractions and in cutaneous anaesthesia. It
has, however, a far more restricted field than galvanism, and is less conven-
ient than either of the allied forms of electricity.''*
Central Galvanization: Cautions with Begard to its Employment. — The
method of central galvanization, as practiced by Beard and Rockwell, when
supplemented by skillful manipulation, has produced very striking results,
but it cannot be considered entirely safe in unskilled hands, and probably
should not be attempted by the average operator. "The object of central
galvanization," according to the authority just quoted, "is to bring the whole
central nervous system, — the brain, sympatlietic, and spinal cord, — as well
as the pneumogastric and depressor ner^'ee, under the influence of the gal-
vanic current. One pole (usually the negative) is placed at the epigastrium,
while the other is passed over the forehead and top of the head, along the
inner borders of the sterno-cleido-raastoid muscles, from the mastoid fosiw
to the sternum, at the nape of the neck, and down the entire length of the
spine." The application to the head is made by passing the pole (positive),
from one temple to the other, over the forehead, using from two to six cells
(about 2 to 5 milliaraperes), or increased until a sour or metallic taste in
the mouth is experienced by the patient. The electrode is allowed to rest for
a minute or two upon the cranial centre or vertex, because a current passing
from this point to the epigastrium traverses the facial-nerve roots and others
in the medulla, and also the sympathetic. A labile application or sudden in-
terruption of the current may cause dizziness or mental confusion. During
from one to five minutes, the electrode is next passed on both sides, down
the neck, as above described, thus affecting the pneumogastric, qs well as
the ganglia of the s>Tnpathctic. A weak current only is permissible here.
Proceeding next to the spine, an especial application is made over the cilio-
spinal centre, between the first and seventh cervical vertebne. Although
recent observations make it very doubtful if the current actually reaches the
spinal cord, there is no question about the effects upon the spinal nerves, and
so the cord may be affected indirectly; and the same remark applies to the
great sympathetic ganglia. The positive pole is carried the whole length of
the spine, the application lasting from three to six minutes. The whole
* Philadelphia Medical Timrs, vol. xiii, p. 346.
ELECTRICITY IN MEDICINE — ELECTRO-THERAPEUTICS.
907
I
length of the sitting required for central galvanization sliould not exceed
fifteen, minutes. The disrobing required is simply, in a male patient, the
removal of the coat and waist-coat and loosening of the clothing, so that
access can be had to the epigastrium and the spine; and, in female patients,
it is necessary to remove the corsets and to loosen the clothing ut the neck
and waist. The electrodes employed by Drs. Beard and Rockwell were a
sponge- or flannel- covered, flat electrode (negative), having an insulated
handle, by which it is held to the epigastrium by the patient himself. For
the positive pole a flannel-covered electrode is used, having the disk pftrallel
with the handle, so that it can be passed along the spine under the clothing.
The battery should be a constant one, and furnished with a rheostat.
Objections to Galvanization of the Sympathetic in the Neck. — The best
authorities speak of galvanization of the cervical sympathetic as a dangerous
procedure, on account of the proximity of the pneumogastric nerve. Brown-
Sequard remarked that he once tried to galvanize the cervical sympathetic
of a friend in order to relieve him of a violent headache. *'The effect was
ail we could desire against the headache, but the galvanic current (acting at
the same time on the sympathetic and vagus, the simultaneous action of
these two nerves cannot be avoided) produced such dangerous syncope that
I would never again attempt to apply galvanism to the cervical sympathetic
of man."
The galvanic current differs clinically from the faradic current in
having much greater quantity with less tension or ditlerence of potential,
and hence produces greater dynamic and physiological etTeci than the latter,
which, owing to very high tension, is apt to cause pain and excite muscular
gpasm, even with weak currents. It may be continuous or interrupted,
and, as it is definite in its direction, it is capable of being reversed. Owing
to its large volume, or quantity, it penetrates the tissues more deeply.
The Medico-legal Value of Electricity in Diagnosis. — Dr. W. B. Pritch-
ard reports^ a case of traumatic neuritis in which electricity proved of
much value in aiding the diagnosis. "A man, aged 49, received an injury
to his shoulder under circumstances which would have entitled him to some
compensation if any permanent damage had been done. WTien the swelling
had gone down he complained of great pain in and around the shoulder, and
of inability to raise the arm from the side. It could not at the time be
determined whether this was due only to the pain, or whether there was loss
of muscular power. There were tenderness and pain in the areas supplied
by the supra-acromial branch of the cervical plexus and circumflex ner\-e8,
and some hyperiesthesia of this region. In the course of the next few months
the pain and weakness remained much about the same, and it was then
found that the circumflex nerve gave the reaction of degeneration. This set
oil doubt as to the existence of a traumatic neuritis at rest, and the patient
succeeded in obtaining compensation without ^oing into court."
Special Applications of Electricity in Clinical Medicine. — Disorders of
the locomotive apparatus were probably the first to suggest the employment
of electricity in medicine, owing to the fact of the contraction of the healthy
muscular fibres when a current is made to traverse them, especially if the
position of the electrode correspond with the entrance of the ner\^e into the
muscle or the nerve-tnmk itself. Paralysis, therefore, was the first condition
^Kew York Medical Journal, Nov., 1800.
968
NON-PIIABMACAL KUMEDIES AND GEyERAL TIIERAPBUTICS.
to receive electrical treatment, and still is regarded as being especially amen-
able to the current. Pathological research and clinical observation have
finally revealed the varied causes of paralysis, and clearly show the reason
why a form of treatment bo elhcient in some cases is useless, or even injuri-
ous, in others. Paralysis of a muscle, or group of muscles, may be due to
purely local causes; it may be due to a lesion of the nerve-trunk, or in its
fibres of insertion or origin; it may also be due to a disorder of the centre
in the brain or cord corresponding to the muecles affected, or to reflex irrita-
tion. Occasionally vre see it caused by some remote or reflex cause which
influences the nerve-centres, as in paralysis following intestinal inflamma-
tion, or in the form known as hysterical paralysis. When a morbid condition
arises from such a diverse cause as in the example just cited, it is very evident
that the scientific treatment, which includes removal of the cause where it
is possible so to do, would depend upon the diagnosis. The first principle
of successful application of electricity, therefore, as already stated, is correct
diagnosis, and a clear appreciation of the objects sought to be obtained by
the current to be employed, aud in gome cases a combination of different
forms of current will be necessary in order to attain the desired result. If
to good diagnostic powers we add familiarity with the elfects of electricity
and skill in their applications to produce such effects in the living human
body, we are in a position to employ this invaluable therapeutic agent with
every prospect of success. In the following pages a review of some of the
recent and more useful applications of electricity is presented, but for a
complete exposition of electro-therapeutics we must refer to the systematic
treatises of Beard and Rockwell, de Watteville, Liebig and Rohe, and the
numerous monographs by Apostoli, Maesey, Adams, Peterson, and others.
Electricity for the Relief of Pain. — The late Dr. Hutchinson* employed
the faradic current by preference in mnscular rheumatism, observing strictly
the following precautions; A coil must be used which gives a fine, steady
current — i,e., one without jumps or sudden interruptions — and of adjustable
force. Only so much ought to be used as produces a distinct vibratory sen-
sation without sharp pain. Before applying the electrode see that the skin
is thoroughly dried and well powdered with a good conductor, and for this
purpose starch is not so good as a mineral substance like powdered clay.
The active electrode should be of poHshed metal, — a ball or rounded tube. —
kept dry and warm; the passive may be a small sponge, held in the band
or at any indifferent point. Betrinning with a force scarcely felt, slowly in-
crease, keeping the active pole in constant motion over the painful muscles,
observing carefully to avoid contracting a single fibre. If muscle contrac-
tion be produced, no good results. All the force must be expended upon
the skin; in other words, upon terminal nerve-filaments, which are alone
the seat of pain in this annoying disease. Every inch of skin covering
painful parts should be carefully gone over with the current, exercising a
steady, slight pressure, for about a half-hour, and applications repeated
twice daily until the case is well. It is unusual, he states, for a violent
attack to persist more than two days with this treatment. De Watteville
also recommends cutaneous faradization, and states that galvano-faradiza-
tion may, with advantage, be sometimes substituted for it. He also sa_\'8
that tlie galvanic current may be apphed: the current — moderate to strong
'Xew Engl<tnd Medical Uontiay, Sept., 1891
ELECTRICITY IX MEDICINE — ELECTBO-TnERAPEUTICS. 969
— IB passed for a few minutes, and the sitting concluded with a series of
interruptions or voltaic alternatives, so as to excite the muscular tissue to
contraction. We have obtained excellent results in pain confined to muscles
— myalgia, lumbago, stiff neck — hy a resort to static electricity, which
affords marked relief to the pain and does not require removal of the
clothing.
The treatment of articular rheumatism by electricity is exceptional, and
yet Dr. W. F. Robinson, of Albany, N. Y., reports excellent results from it.*
Therapeutically, he divided cases of rheumatism into two classes: those in
which only one or two joints are affected, which he always treats by means
of galvanism; and, secondly, those in which the rheumatic poison is more
extended in its action, involving joints, muscles, fascia, etc., for which he
employs static electricity. The electrodes, he writes, should be large and
carefully made. If covered with sponge, this should be soft and free from
gritty particles. In order to increase the conductivity of the skin, the
sponges ehould be saturated with a hot solution of bicarbonate of soda. The
caustic action and the electroh'tic action of the electric current are to be
avoided in the treatment of rheumatism. The action of vital stimulation
is to be sought; to obtain it the procedures of interruption and voltaic
alternation must be adopted. Voltaic alternation is a still stronger stimula-
tion than interruption, but it must be used with caution, for with strong
currents the pain and irritation are very great. Joint rheumatism, pure
and simple, is almost powerless to withstand the direct application of the
galvanic current. When the disease is more dittused, and involves various
tissues and organs in different parts of the body, static electricity is indicated.
The general charge is rarely used alone, and static electricity is usually
given, by means of special electrodes, in the form of sparks. The applica-
tions may be made on alternate days. The ui^ual length of the treatment is
ten minutes, for about five of which sparks are drawn, the patient during
the remaining five minutes simply sitting quietly upon the platform and
taking the general charge.
Dr. Robinson states that electricity has a twofold action that meets all
the indications of rheumatism: a specific action against the morbid process,
and a general tonic action that tends to build up the system depressed as
a result of the disease. Dr. Goelet, at the same meeting, stated that the
sedative effects of galvanism could best be had by currents of short duration.
He prefers a clay electrode, made of the consistency of putty, and maintains
it so by keeping it moist. A flat pad is made by rolling it on boards, as if it
were dough; it is gotten into shape, and, after having a metallic plate placed
on the back, is covered with a layer of absorbent cotton, and is then sewed
up in a gauze cover. On the back is placed rubber cloth, just as in sjxjnge-
covered hand-electrodes. To avoid the discomfort of a cold application, the
electrode may be kept on a warming-pan, consisting of a flat tin or zinc
jug filled with hot water. Dr. M. A. Cleaves also reported cases in which
marked benefit followed the use of the galvanic current in articular inflam-
matory erudations. Stabile applications, of 10 milliamp^res' strength, for
fifteen minutes, with the anode at the sternum and the cathode applied over
the affected joint, were followed by relief from pain, diminution of heat,
••*rrixeeding» of the American Electro-therapeutic AssociRtion," First Annual
Heeling. Philadelphia, 1801. Malical 7few9 reprint.
970
XOy-rUAKMACAL BEMED1E3 AND GENERAL THERAPEUTICS.
and increased mobility. The current was used daily for a week, and then
every two or three days, until thirteen seances were given, when faradism
was applied to the museles around the joint, with the cathode at the sternum
and the anode applied successively to the motor points of the various muscles.
The ultimate result was decided and satisfactory. Ankylosis, the reexilt of
chronic inilammatory processes, even with some osseous union, according
to Dr. von Kaitz, of New York, yields to the constant current, with the
assistance of massage and passive motion. The various forms of neuralgia
arc amenable to electrical applications — in all cases for amelioration, in most
eases for cure — in proportion as they are pure neuroses, and not the result
of decided structural change. Electricity, says Dujardin-Beaumetz, is one
of the most active agents in the treatment of rebellious neuralgias. Galvanic
currents are preferred to faradic. The negative pole is applied near the
nerve-centre; the positive pole (which is the truly sedative pole) may be
moved over the different painful points of the affected nerve. In tic
douloureux the currents should be very mild, — not to exceed 3 to 4 miUi-
ampcres. In sciatica much stronger currents are required (20 or more
milliamperes). He agrees with Apostoli in holding that the stabile applica-
tions should be continued until the pain disappears or some mitigation ia
observed. Duchcnne preferred the use of faradism, — applying the wire
brush over the affected area, and employing a very strong current with rapid
interruptions. Electropuncture, as practiced by Magendie, is no longer used.
Electrical Poresis (Anafoivsis and Ciitiiforesis). by means of which
mot-Iieaments arc earned through the skin under the action of electric cur-
rents, is a valuable addition to our resources. As ghown &ouie years ago by
AJamkicwicz, the wetting of the active electrode with cliloroforra favors
locJil absorption. Cataforesis was tirst recognized, and experiments made
with compounds whose cations wore nnalgesic were sucwssful. For instance,
we may use cocaine solution (li> to '2i) per cent.). Aconitine may be sub-
stituted, or any soluble alkrtloid. Diseased conditiou.s, ut or near the sur-
face, are easily treated lociilly by this means, even iucludhig painful tumore
and nohing teeth. If a considerable quantity of medicament is sought to be
introduced, we may have the electrode in tlie fnnu of a tube closed at one
end with a porous partition (du Bois-Rennond^s conducting tube, stopped
with a plug of clay), and siuce. accori]ing to Munk, the current should be
occasionally reversed, it is necessary to have both electrodes charged with
the fubstimee used. Dr. Arthur Harries' prefers cocaine cataphoresis to
hyixidermic injections. ITc employs a large negative electrode wet with a
salt solution, and tlie positive is small, covered with flnnnol, and wet with
a lO-per-cent. cocaine solution. A continuous current of 25 milliamperes is
then passed for forty minutes, the electrodes being kept moistened with the
solution. Peterson" claims that "the anaesthesia produced by a 10- to 20-per-
cent, solution of cocnine on the anode is sufficient for smnll operations, and
affords distinct relief for from four to eleven hours in cases of severe neu-
ralgia in superficial nerves." His method of securing accuracy of dosage,
which is as follows, is ingenious: "It is necessary to use a flat, raetfll
electrode, made preferably, but not necessarily, of platinum or tin. It may
ho of any convenient size and shape. A piece of filtering-paper or linen is
^ Loncft, Oct. 26. 1890.
*}tedical Record, Jan. 31, 1891.
ELECTRICITY IX MEDICINK — ELECTRO-TIIERAFECTICS, 971
cSnont over the metal surface ; tliis is soakeU with a Jetuiito quantity of tiie
solution to be used, and the eleotrode is thou applied to the skin. A narrow
Kift-mbher rim at the ed^e of tlie electrode pn-vcnts any lo;?t? by evaiKinUioii.
In order to have dni^s ready for use ai any time, ditks of paper to fit the
elwtrode may be charge<l with aqueous or alcoholic solutions and then allowed
to dry, a drop or two of menstruum hein^ added wlien tiiey are to be used.
The strength of current is reguLitcd largely by the patient's feelings, but
from o to 20 miniampen?s, or from 10 to 80 cells may be ui^'d for live to
fifteen minutes. The stronger the current, the shorter the duration of the
sitting. The indications are: 1. To produce local anesthesia for neuralgia,
superficial pains, and cutaneous operations, a 10- to 20-per-cent. cocaine
solution is used. Aconitine produces a deep analgesia, but it is accompanied
by severe smarting around the edges of the anasthetized area. Three or 4
drops of a l-per-cent. solution of helleborin cause a deeper and more lasting
amesthesia than cocaine, without producing constitutional effects. Both
ouabain and strophanthin, in doses of 0.00026 Gm. (or gr. Vj&o) or more,
are strong local ana?sthetica. One or 2 drops of chloroform bring about a
deep analgesia in a short time, but this is followed later by vesication. A
mild solution of carbolic acid may also be employed as a local anajsthetic
and analgesic. 2. For topical medication in various local lesions, — such as
tumors, rheumatic, gouty, and other swellings; various skin diseases, syph-
ilides, etc. In these cases iodine preparations, lithium, and mercuric salts
may be used. 3. To induce absorption of medicines from baths. 4. For
diagnostic purposes. Thus, if a pain were complained of in the region sup-
plied by the trigeminus nerve, it should disappear under this treatment;
if it did not, the lesion could be localized farther back, or it might lead to
the conclusion that it was an hysterical pain."
In a communication to the American Electro-therapeutic Association,
Peterson stated that special forms of electrodes are no longer considered
necessary, since ordinary sponge-covered electrodes will answer for solutions
vherc accuracy is not specially required, and metallic ones for the more care-
ful administration. The latter are eupphed with a narrow rim of rubber to
prevent evaporation, and a disk of cotton cloth, tissue- or blotting- paper
may be cut to fit the surface, and upon this the desired number of drops of
the drug in solution can be placed. Disks of filtering-paper containing a
known quantity of the remedy may be kept on hand for this purpose. Co-
caine employed in this way does not cure neuralgias. All that is claimed
for it is that it affords relief without producing constitutional effects, and
I is, therefore, superior to any narcotic given internally. Where the cause
of the neuralgia is deep-seated, the improvement is much less evident than
when the lesion resides in a superficial nerve, and Dr. Allen Starr calls
attention to this valuable hint in diagnosis, as regards the question of sur-
gical operation. If the pain be relieved temporarily by the treatment, the
leoon is in the immediate neighborhood or peripheral to the anesthetized
area, and this would suggest the possibility of permanent cure by neurec-
tomy or nerve-stretching. Dr. Fouvcau de Courmellea, of Paris, presented
a paper at this meeting of the Electro-therapeutic Association in which
he stated that the pain of hepatic or renal colic may also be made to dis-
appear by mcdicnmental electrolysis or cataforwis.
Dr. 0. Bettou Massey, of Philadelphia, reports success in some casea of
carcinoma uteri bv the cataforic destruction of the diseased tissues. His
■
973
NON-PHAKMACAL HEMEDIES AND GEXKitAL TiLEOAPEUTlCS.
method consists in the interstitial disseminatioa of the nascent oxychloride
of mercury, or of the mixed oxyehlorides of zinc and mercury, throughout
the growth by radiant cataphoreais. The current-strengths will vary from
350 milliamperes, in small growths, to 1500 in large ones, for durations vary-
ing from fifteen minutes to half an hour. Seven cases have been reported
cured, including both carcinomata and sarcomata.
In some surgical conditions, such as stricture of the urethra, rectum,
or a?sophagus, due to cicatricial stenosis, the application of the method as
practiced by Dr. Neumann, of New York, to stricture of the urethra, will
serve to illustrate the usefulness of skilful electrolysis. It should be under-
stood that this is entirely different from cauterization such as seen in the
Apostoli method. Much milder currents are employed, and the principal
object in view is to cause the absorption of the intlammatory exudate, or scar-
tissue, which softens under the electrolytic influence of the current; but
there is no charring of tissue and no subsequent sloughing. Insulated ure-
thral sounds are used, terminating in an exposed olive-shaped bulb, which
ahould be a little larger than the calibre of the strictured urethra. After
being made thoroughly aseptic, this is passed down to the tender spot in
the urethra and the negative cord attached; the other electrode, covered with
sponge or cotton of the usual shape, may then be applied to the thigh; the
current is then gradually turned on until -1 or 5 milliampL*res are passing.
The sound is then gently guided through the stricture, allowing it to make
its own way until the stricture is passed; the circuit may then be opened and
the electrode withdrawn. The sittings should be twice a week, and should
not exceed five minutes each. After each operation the parts should be
bathed with hot water containing boric or tarbolic acid. Some bleeding and
increased tenderness may be noticed after the first few applications, but
these become less, and in from ten to twelve sittings the cure is complete.
In many cases, though, no positive prediction can be made as to the time
required. Electrolysis was recommended by Heryng for the removal of hard,
diffused tuberculous infiltrations of the larynx and in chronic affections
of the vocal cords with little or no superficial ulceration. He found it of
service also in counteracting the tendency to dangerous haemorrhage in the
removal of nodules of the ventriciikr bands.
In new growths, tumors, etc., electrolysis promises to be of great service.
This method has likewise proved of value in promoting cicatrization of acute
and chronic ulcers. Dr. J. Inglis Parsons has reported* encouraging results
from the treatment of rodent ulcers by electrolysis. In ordinary cases he
found one application sufificient, but when the ulcers were large the opera-
tion was once or twice repeated. The procedure prevents haemorrhage, is
not followed by pain» causes no shock, and if the wound is kept aseptic no rise
of temperature takes place. Two needles are employed with a current-
strength of 200 to 400 milliamp^res. The caustic action of both poles is
freely used, and the current is constantly alternated with a hand-commu-
tator. The amount of destruction can be accurately regulated by increasing
or diminishing the strength of the current.
Pulmonary tuberculosis has been treated with encouraging results by
means of the introduction of germicidal agents by cataphoresis, as proposed
by Francisque Crotle, in 1890. The vapor of formnldehyde has been trans-
^ Lancet, Nor. U, 1893, p. 1175.
KLECTRICITT IK JTEDIOIKB — ^ELBOTRO-THEHAPBCTIOS.
ors
t
I
fused through the tissues of the chest. The patient is placed in an isolated
chair of the static machine and towels saturated with formaldehyde solution
are applied to his chest and back (the solution varies from 1 to 10 per cent.,
according to tolerance). The current is then startedj with effluvia or sparks
or both, and is made to pass through the lunfcs.
In connection with the introduction of various remedies through the
skin by electrical foresis* some remarkable results have been obtained by
Adamkiewicz, Peterson, and others. The fact that medicines may thus be
introduced into the body has been abundantly proved, and it seems evident
that this new method is capable of very valuable applications. The medica-
ment is carried directly to the diseased cell, and thus produces a more marked
effect than if it were diluted by the ciTCuJating fluid. Moreover, electrolysis
of fluids and solids tends to occur in the vicinity of the poles, thus liberating
remedies in nascent form, which is one of special activity. Dr. Woodbury
treats syphilitic new growths with lithium-iodide solution, using absorbent-
cotton electrodes, and urges a similar treatment of various tumors in the
same manner. The success of Dr. A. C. Garrett, who reported one hundred
and fifty-seven cures out of one hundred and eighty-six cases of tumors (in-
durations?) of the breast, by means of direct application of the galvanic
current, should encourage further experiment in this direction. "There is
reason to believe," says Dr. Roh6, "that the limitations of electrical treat-
ment of malignant tumors have not yet been reached." It was suggested by
Woodbury* that various chemical agents might be tested, until one be found
which has a special inimical influence to the cancer development, and that
the prospects then would be favorable for the successful treatment of malig-
nant tumors by the introduction of such agents by means of electrocatapho-
resis directly into the interior of the growth. Dr. Augustus le Plengeon, of
New York, states that, as far back as 1865, he used galvanic currents not
only to introduce medicaments into the human system, directly on the parts
diseased, but also to extract from them extraneous matters which caused the
disease — metals, mercury particularly — and in this he had been most suc-
cessful. Part of the good effects ascribed to electroforeais may be reaJly
due to electrolysis.
In goitre the galvanic current may be used percutaneously, but better
results are obtained by the use of needles with negative electrolysis. Dr.
James Hendrie Lloyd* uses three gold-plated needles well insulated to within
one-third of an inch of the point, connected by a branching cord so that all
were attached to the negative pole. The needles were inserted well into the
goitre, far enough to protect the skin by the insulating material. The posi-
tive pole, a large flat sponge, was applied to the nape of the neck. The
greatest strength was 24 milliamp^res, but this could not be kept up; the
average was about 15 to 18 milliamp^rcs, the seance being about twenty min-
utes. The author reports a patient as cured by fourteen applications.
In various forms of neuralgia, relief may be afforded from the action
of galvanism by anodal diffusion over the painful spots. In no painful
* pBper r*ad before the Philadelphia College of Physicians, "On the Employment
of the CatAphoric Action o( the Galvanic Current for the Removal of Syphilitic New
Orowtha. A Contribution to the Medical Treatment of Tumors." Medictil h'etcs,
June 21. 1890.
• "The Treatment of Goitre by Galvano-puncture.'* By James Hendrie Ucffd.
\0mk9rHtlf kedical Maffozine, Dec., 1800.
974
XOX-PHAHMACAL REMEDIES AND UEXEIIAL TIIER-APEL'TICS.
affection, eays Bortholow, is the application of electricity more conspicuous
for good than in sciatica. Large sponge-electrodes, moistened with hot
water, arc applied, both — labile and stabile — over the course of distribution
of the nen-e, using currents of 20 to 40 miiliamperes. The applications
should be made t^nce a day, if possible, or at least once daily. Intercostal
neurals^a and herpes zoster also yield to galvanism, using small electrodes,
applying one (usually the cathode) to the spine and the other to the distribu-
tion of the nerve in front; or to place the anode over the painful points
where the nerves become superficial, and the cathode on the terminals.
In migraine, in addition to the administration of remedies directed to
the stomach, we apply galvanism, in the same manner as just indicated, to
the supra-orbital nerve distribution. Galvanization of the sympathetic in
the neck and of the pneumogastric, as practiced by du Bois-Reymond, can
only safely be practiced by an expert. Faradism, with very rapid interrup-
tions and mild currents, may be used, in conjunction with gentle massage
(the electrical hand). Jn nervous vomiting, and especially the vomiting of
pregnancy, a descending current of voltaic electricity exerts a remarkable
remedial ef!ect, the positive pole being applied above the clavicle and the
Mttegative to the pit of the stomach. In angina pectoris Eulenbcrg reports
S%ood results from galvanism administered in the intervals between the
attacks. The indifferent pole may be placed in a basin of water, or in a
foot-bath.
Various forms of visceral neuralgia are amenable to galvanism. The
applications may be entirely to the surface of the body, or one electrode
may be introduced into the stomach, rectum, or vagina. Faradic electricity
may also be used; mild currents and frequent interruptions for the sedative
effects, and the electrical brush, with stronger currents, to the skin as a
counter-irritant.
In gall-Btone colic with impaction, good results have been obtained by
passing brief currents of high intensity, the electrodes being placed in the
hypochondriac regions. The electrical stimulus produces contraction of
the fibres entering into the common duct, and the consequence is that the
stone is discharged into the intestine.
The Static Current in Neuralgia — Morton's Method. — For pain not
accompanied by evidences of acute inflammation, perhaps no form of appli-
cation can equal franklinism. Indeed, Adams states that, ''in all vasomotor
disturbances, functional cerebro-spiual diseases, or neuroses, there is noth-
ing, in the author's experience, which equals in value the diffused and the
concentrated constant high-potential currents from electrostatic induction
machines." As already explained, the diffused constant current or electro-
static bath is where the patient is placed upon an insulated platform and
charged with the current. The concentrated constant current is obtained
by bringing an electrode near to any desired spot upon the suifncc. and
thus drawing a shower of sparks from this locality. In the former case the
circuit is completed at all parts of the body through thrair, and in the latter
by means of the spray coming from or going to a pointed metallic electrode
which is in connection with the ground. By an ingenious device of Dr. W.
J. Morton, of New York, contained in a peculiar-shaped instrument named,
in consequence, the *'pistol electrode," the current is tapped in the rheo-
Ehore, and the electrodes may be placed directly in contact with the patient's
o3y, just as in the application of the faradic current. In using this method
of Morton, as practiced by Bartholow, one brass chain is fastened to the
top brass knob of one condenser (the left one being the higher potential),
and another brass chain is placed around the base, over the metallic coating
of the other condenser, and to each chain an ordinary electrode (preferably
a carbon electrode), covered vith leather, is attached. The discharging rods
are placed at a distance apart, which is determined by the effect to be accom-
plished, which consists in the faintest tingling when the rods are nearly
together, or the most powerful muscular contractions when they are some
distance apart. The game kind of irritation of the sensory nerves is caused
by this interrupted current as that caused by the faradic; but it is softer.
The most powerful muscular contractions can be produced without causing
pain; and in this respect static electricity possesses distinct advantages over
faradic. The intermpting handle of Morton is dispensed with in Bartholow's
method; indeed, no special electrodes are required, and only as much of the
current is taken as is desired.
Either electri2ation* by sparks or by the Morton method may be em-
ployed with advantage in trifacial, intercostal, sciatic, and other neuralgias.
General franklinization is especially useful in hystero-epilepsy. Dr. Morton
reports brilliant results with static electricity in cases of neuritis, locomotor
ataxia in the earlier stages, and rheumatoid ^arthritis, which have been ap-
parently cured or their progress completely arrested by the use of the long
percussive spark and other forms of static electricity.
Dr. S. H. Monell regards static electricity as surpassing any other agent
in the management of hysterical conditions. He esteems it of superior value,
also, in combatinj^ nausea, dyspepsia, constipation, and colic. In chlorosis
and amemia it improves nutrition. It is an efficient cardiac tonic in both
functional and organic disease of that organ. This writer asserts that frank-
linism is the most powerful means at our command for relieving the pain
of locomotor ataxia, and that, used in conjunction with galvanism, it may
indef nitely arrest the progress of early eases. In all forms of motor paral-
ysis it has given excellent results. Static electricity is of decided service in
chorea, and in epilepsy it moderates the frequency and severity of paroxysms.
In exophthalmic goitre, gout, rheumatism, and lateral curvature of the spine
tliis fonii of fiiroe is of bcnetit. Imbert de la Touche. of Lyons, concludes
that obeaity of nenous origin nnd the fatt\' anseniia comiuou iu rM'iira.=th«"nia
We beneficially influenced by electricity, and that the static electric bath
is the preferable mode <>f application. The brush discharge from a static
shine may take the place of the anode in foresis. Tuberculous glands
also be treated in this way.
Aneesthesia is very commonly functional and often a manifestation of
hysteria. In such cases the anesthetic area will, under a few applications
of the faradic brush, rapidly recover its tactile sense. When the loss of
wn«lton is due to inflammation, compression, traumatism, or other lesion.
except actual loss of continuity of nerve-fibres, it will, as a rule, also be soon
restored by electricity. Wlien the galvanic current is employed the anode
chould be over the nerve-root and the cathode over the anR?gthetic area, or
the galvanic brush or faradic bnish may be used. In tri^minal anaeathesia
l.ichicr and Roh6 indorse transverse brain galvanization; galvnnizaUon of
fik and brandies of the fifth nen'e; the faradic brush to the anres-
'irface, or to a small area of the forearm, as recommended by Vul-
piati. HemiansBsthesia, due to central or toxic catises, very frequently yields
_^ are 1
■ is th
I
I
976
XOX-PHARMACAL REMEDIES AXD GENERAL THERAPEUTICS.
to the application of the faradic brush according to Vulpiaa'a method.
Tabetic and traumatic anseBthesia may be relieved, but not fully restored*
unless the nerve-trunks can be made to resume a normal condition. An-
osmia, or loss of the sense of smell, if not depending upon disease of mucous
membrane, may be cured by faradization. In weakness of vision, amblyopia,
amaurosis, anaemia of optic disk, and especially in tobacco-amaurosis (sco-
toma) electricity is of great value, the applications being made throu;;jh moist
compresses applied to the closed eyes: the anode locally, and the cathode to
the temple or the cheek. The strength of the current should not be greater
than just enough to cause faint flashes of light, and the seances should last
only a few minutes. Galvanism should also be directed tro the cervical sym-
pathetic and to the cilio-spinal region of the spinal cord. In anaesthesia of
the auditory nerves, and in tinnitus aurium, Brenner, Erb, and others have
conclusively proved the value of the polar method. The canal is filled with
warm water; a special electrode may be used, or the ordinary small electrode
may be dipped into the water and inserted into the ear. By the judicious
use of this expedient tinnitus aurium has been stopped after it had existed
for years. In some cases very marked improvement was noticed after the
first application or after a few applications.
Electricity in the Treatment of Paralysis. — The favorable influence
exerted by electricity over nutritive processes and cell-growth, especially
in the form of galvanism, has made it the indispensable remedy in the
treatment of various forms of paralysis, whether due primarily to nerve or
to muscle. It is not judicious, in hemiplegia, to employ the electric current
too early, on account of the lesion in the brain; but after the firi?t shock of
the brain-injury is over, whether an extravasation or an embolus, and the
parts are accommodating themselves to tlie condition and repair is going on,
in a week or two after the attack came on, the electric current may be used
to keep up the nutrition of the muscles, employing both galvanic reversals
and the faradic interrupted or labile applications. The precaution should
be observed of only using a current strong enough to produce moderate con-
tractions, and not continued very long (fifteen to twenty minutes for the
entire seance). In various forms of monopleg:ia and paralysis of individual
muscles, galvanization may show the reaction of degeneration due to local
nerve- or muscle- changes; but the systematic application of galvanism, at
first stabile, followed by a few current-reversals, and the faradic brush or
static breeze or sparks, will cause the norma! function to be restored. Hy-
gienic remedies must not be neglected, including massage, baths, and passive
exercise. In diphtheritic paralysis, or paralysis following typhoid or other
exhausting' diseases, brain and spinal galvanization, with direct applications
of both faradism and galvanism, should be resorted to. Static electricity is
also useful here. In lead palsy, mercurial paralysis, and similar toxic paral-
yses, the galvanic cnrrc^nt may be applied to the affected groups of muscles,
and the faradic to their opponents. Paralysis of the laryngeal muscles may
be treated by intralaryngeal applications of galvanism or faradism, with
special electrodes, as practiced by Elsberg or by von Ziemssen. Equally
good results, it is claimed, may be obtained by the method of Erb, in which
the anode is placed under the occiput at the root of the neck, and the ca-
thode applied to the front of the neck along the larynx and trachea. Fara-
dism may be applied in the same way, but weak currents only should he used.
In paralysis dependent upon chronic poliomyelitiB, Hammond has re-
Ip
ELEOTRICITT IN MEDICINE — ELECTB0-THEHAPEUTIC8.
977
ported several cases which seem to show that persistent daily use of galvanism
may measurably restore the function of muscles which, at the first examina-
tion, exhibited no visible reaction.
In aphonia of hysterical orig^in the faradic brush or the static spark ia
promptly curative. In paresis accompanying neuritis and perineuritis, gal-
vanism (anodal) is very useful, and farado-maasage applied when the acute
stage is over.
In facial paralysis due to inflammation in the course of the portio dura
the prognosis depends upon the extent of the lesion and its duration. In
slight cases the muscles may recover without any treatment; but this result
will be attained much more rapidly under mild faradization. Where the re-
action of degeneration is present, the patience of the operator and subject
may be put under a considerable strain; but galvanism (cathodal), with cur-
rent-reversals and the faradic brush, will, in most cases, bring about a cure
in the course of time. If the diagnosis be made at the beginning and an-
nounced to the patient, it may save later disappointment on account of the
apparent want of results from the treatment. Facial paralysis of central
oriJgiii is more serious in its prognosis than the peripheral form. Recoveries
are comparatively rare, but improvement may be expected from systematic
electrical treatment, with galvanization to the head and neck and polar
applications to the affected muscles.
Spasms and contractures call for the sedative applications of the gal-
vanic and faradic currents. Anodal applications in cases of blepharospasm,
oonTOlsive tic, histrionic spasm, contractures following rheumatism, are
sometimes very successful; in others, complete failures. In the latter the
spasm mny be due to some source of reflex irritation, such as latent hyper-
metropia, or myopia, dental caries, etc., which should receive attention before
attempting treatment by electricity. In hysterical spasms and contractures
the faradic brush or static sparks are useful, especially if disagreeably pain-
ful. Spasm of muscles of deglutition may be due to a wisdom-tooth which
ia about erupting, and incision of the overlying gum will relieve it, perhaps
assisted by a few applications of galvanism. Hystero-epileptic attacks may
sometimes be broken up with the faradic brush or strong galvanic current.
In epilepsy Erb recommends diagonal followed by longitudinal brain gal-
vanization to affect the motor area in the cortex; then snbaural and spinal
iralvanixation, limited to the cervical region, and general faradization for
iheir reflex effects. This is to be practiced between the attacks, in combina-
tion with the usual remedial and hygienic treatment.
In writers* cramp and other forms of co-ordination neuroses excellent
results are afforded by rest and electromassage. Erb lays down the rule
that the entire cerebro-spinal nervous system should be subjected to system-
atic electrization. First galvanization of brain and spine, then of the periph-
eral nerves. Faradization of the affected muscles is combined with massage.
By the method of Wolff, in which this is systematically practiced, a number
of cures have been reported.
In tetany galvanization of the spine and peripheral nerve-trunks and
the anodal applications to the spine (Erb) have given good results. In
tetanus proper, which is an infectious disease, not mucli can be gained by
electricity, although spinal galvanization, with galvanization of the periph-
ertl muscles, is said to have had a good effect upon the spasms. Chorea is
benefited by weak currents, or by general franklinization or faradization.
978
NON-PHABMAOAL REMEDIES AND OENEKAL THERAPEUTICS.
AthetosiB is said to have been improved by brain, spbaural, and central gal-
vanization, with currents from the spinal cord to the peripheral muscles
(Liebif,' nnd Roh^).
Explanation of Frodnction of Begeneration-Eeaotion Phenomena. —
When discussing, on a previous page, the question of electrodiagnosis in
paralysis, it was stated that there are important alterations in the electrical
reactions. If a muscle be paralyzed by sectioning its motor nerve, or by the
use of certain toxic ap:ents which affect the nerve only and leave the muscular
fibres healthy, we have a marked ditference manifested in the behavior of
the muscle under the electrical stimulxis. For instance, instead of promptly
contracting to tJie faradic current, we may find no response whatever when
this (secondary or induced) current is used. With the galvanic battery,
weak currents produce responsive contractions greater than in health, on
making and breaking the circuit, or on reversing the current. With a
stronger current, the muscle remains in a tetanic state of contraction while
the current is passing, which is an abnormal phenomenon. Later, patholog-
ical changes occur, both in the nerve and in the muscle, due to removal of
the influence from the trophic centres in the cord. When the lesion is
destructive and irremediable, there is a gradual failure of galvanic, as well
as of faradic, excitability of the nerve, ending in entire disappearance of the
same in a few days. Before this is complete we have the following "degen-
eration reaction"-: —
^fi. CI. (7.> Ca. at. Cf.> An. O. C.> Oa. 0. O,
This is well illustrated in a case of peripheral form of Bell's palsy, while
the central or cerebral fonn of facial paralysis does not present this reaction.
Electrodia^osis in Paralysis. — We may summarize with advantage the
results of the electrical examinations in cases of paralysis: —
Normal electrical reactions accompany diseases of the brain or spinal
cord (white columns).
Abnormal electrical reactions, differing quantitatively from the physi-
ological standard, usually accompany lesions of the gray matter of the cord
or the peripheral nerve-tninks. The character and extent of the lesion may
be judged by the promptness of response to the electric current and by the
presence of the reaction of degeneration.
Increased electrical reactions may accompany general hypersesthesia of
the nervous system, and, if accompanied by reflex contractions of muscles
in remote parts of the body, it suggests increase of spinal excitability, such
as occurs in strychnine poisoning, tetanus, hydrophobia, and other forms of
disease. Should this phenomenon be restricted to a single muscle, or group
of muscles supplied by a single nerve-trunk, the lesion is probably located
in the afferent nerve. Dr. Haynes' sums up the diagnostic points in paral-
ysis arising from disease of the gray matter of the cord as follows: —
*^When the abnormal reactions are uniform, extending over an entire
limb, the disease occupies a mass of its substance, as in the inflammation of
the substance of the cord (myelitis).
"If they are confined to certain physiological groups of muscles the
disease has generally been chronic and implicates the anterior roots of the
spinal nerves, as in progressive mnscnlar atrophy,
» •'Elcctro-thempcutics " C. il. Haynca, M.D., Chicago.
ELECTEICITY IX MEDICINE — ELECTRO-TIIEajLPEDTICS. 979
'T!f the degenerate muscles react in an irregular manner, neither accord-
ing to distribution nor function, the disease has usually been the result of
an acute inflammation of the anterior comua, which has destroyed some of
the nutritive centres and left others intact (poliomyelitia anterior).
■'When a nerve is found deficient in response, and muscle normal, it
shows alteration in the former, the latter remaining intact, as ia Bometimes
seen in the early stage of infantile paralysis.
"The electrical reactions in peripheral paralysis indicate with exactitude
the extent and distribution of the disease.
'*When the electrical reactions are normal it indicates a paralysis of
alight and temporary form; prognosis is favorable.
"Loss of response when either current is applied to nerve-trunks points
to nerve-alteration, and this is in proportion to diminution of action.
"Loss of response to faradisni, applied directly to a muscle, indicates
changes in the intramuscular nerves without necessary alteration of the
fibres themselves.
**Los8 of response with galvanism applied to the muscles shows a mod-
ification or destruction of the muscular tissue, and this in proportion to the
physical changes induced." *
The indications for the different forms of current are also well sum-
marized by the same author: —
"Galvanism is indicated in those cases in which we wish to excite the
nerves of the skin, to destroy the outer skin or mucous membrane, to produce
an increase of warmth, to produce a chemical process, and also blood-coagu-
lation.
"In certain peripheral palsies in which faradism fails, galvanism, prob-
ably in consequence of its uninterrupted duration, produces effects which
cannot be brought about by the necessarily rapidly-interrupted faradic
current.
"When a muscle has lost all power of responding to the stimulus of a
faradic current, in many cases its sensitiveness may be restored by the appli-
cation of a tolerably strong galvanic current.
"Faradism is indicated where we wish to excite cither the motor or
sensory nerves, to produce contractions of the blood- or lymphatic vessels,
to affect certain organs supplied by the sympathetic nerve. To Lacrease the
volume of a muscle: This it accompHshce through exciting muscular con-
traction, which increases the temperature and at the same time improves
the nutrition. To relax a tense muscle, or to loosen a peripheral contractor,
single shocks from a strong faradic current are generally more useful than
the galvanic.
"Galvanism not only acts as a powerful stimulant to nerves and muscles
when interrupted, but during the time it is passing without interruption
it produces a marked alteration in the nutrition. To this effect Remak gave
the name 'catalytic action/"
When paralyzed muscles exhibit the reaction of degeneration they are
more sensitive to galvanism than faradism; therefore the former should be
selected to improve their nutrition. With this exception, faradism is a more
powerful agent in the direct treatment of paralyzed muscles than galvanism.
According to Dr. Rockwell, in paralysis of one side of the body, or
hcmiplcg^ia, when the muscles contract more readily under the influence of
electricity than in health, electricity, if used at all, should be in the form of
980
NON-PHARMACAL REMEDIES AND OENEKAL THEEAPEUTICS.
a very mild faradio current; even though the muscular contractions are not
excited quite so readily as in a normal condition, the faradio is still to be -
preferred. On the contrary, when the contractility of the muscles is very '
greatly diminished, the galvanic current is indicated, the faradic current
being only employed after the muscles bejs^n to contract under its influence.
In most cases of paralysis of the lower half of the body, or paraplegia, there
will be found, after a short time, more or less complete loss of farado-mus-
cular contractilityi the galvanic current alone is useful in these cases to '
restore nerve-excitability, although the faradic may be usefully employed to '
improve the impaired nutrition of the paralyzed members. |
Paresis, or a condition of partial paralysis, is frequently materially
benefited by electricity, both galvanism and induced currents being em-
ployed. Here we may again caution against the use of too strong currents
and too prolonged administration. The contractions of the affected miiscles
should be slowly produced, so as not to fatigue the muscle or cause discom-
fort to the patient. In constipation, owing to defective peristalsis, often '
due to a paretic condition of the muscular tissue in the intestinal wall, very
prompt effects can be obtained by either faradism or galvanism. In using
the former a eponge-covered electrode, well moistened, is placed over some
indifferent point upon the surface, or it may be held in one hand; the other ,
(similarly prepared) electrode is passed around the abdomen in the direction '
of the large bowel, commencing at the right side, just over the ciecura, and
gradually following the ascending, transverse, and decending colon to the |
sigmoid fleiure. This may be accompanied by kneading the abdomen, or \
percussion (abdominal massage). For the application of galvanism an olive- '
shaped electrode may be passed into the rectum, the other being placed on
the surface of the abdomen, in the form of a flat sponge. A moderately weak
current, not strong enough to cause burning or other disagreeable sensation '
to the patient, is now passed, and the current broken and reversed several
times a minute. If the constipation be simply due to inertia or paresis the
effect will be prompt, pleasant, and highly satisfactory to both patient and
physician. The treatment of enlarged prostate is conducted in much the
same manner, with a specially-constructed electrode introduced into the
rectum. When the middle lobe is especially implicated, we may obtain very i
satisfactory results from the use of an insulated electrode introduced into
the urethra. In the treatment of Graves's disease "Cardew (Lamcet, July 4,
1891) advises^ a galvanic current, 2 to 3 milliampdres, to be applied three
times a day, six minutes to be taken in each application. The anode should
be placed at the nape of the neck; the cathode should be moved from the ,
mastoid process along the course of the great nerves. The electrodes are flex-
ible metal, covered with wash-leather, three and a half inches in diameter
for the anode, and one and a half inches in diameter for the cathode. Four i
Leclanch6 cells or three bichromate cells will suffice. Six Scholl's chloride- I
of-silver cells (dry) will be enough, and can be used by the patient in his '
home. The following directions are given: Thoroughly moisten the elec- |
trodes with warm water. Apply the anode to the nape of the neck, making '
firm pressure; apply the cathode to the mastoid, and move it up and down I
slowly along the sterno-mastoid muscle. Each application should last six
^Th4 Dnivertity ifedical Uagcuine, Sept. 1, 1891.
BLBOTEIOITY IN MEDICINE — ELEOTRO-THERAPBOTI08.
981
minutes. Instructions can be written out for the patients, and they can
apply the current at home. The author has used this means of treatment in
8 large number of cases, and believes it to be of great benefit in the vast
majority of cases of Graves's disease. He has had failures, but it has been
fiucce?efu] where other means have failed."
Electricity in Gynaecology — the Apostoli Method. — The convenience,
cleanliness, and efficiency of electricity have combined to make it an indis-
pensable adjunct to other therapeutic measures in various uterine and pelvic
disorders, and, indeed, in some it has proved to be Ois remedy par e-xceilence.
In the reaction from the ultramechanical measures of a preceding genera-
tion and the ultrasurgical tendency of the present, thoughtful physicians
have welcomed the treatment of many diseases of the uterus and adnexa
which was introduced and practiced with such brilliant results by the late
M. Georges Apostoli, of Paris. He first directed the attention of the pro-
fession to the treatment of endometritis by the use of galvanic currents of a
fitrength previously unheard of in medical annals. By means of what he
termed the "chemical, galvanocaustic current," of from 100 to 300 milHam-
peres, he succeeded in checking haemorrhage, relieving pain, removing
chronic inflammatory products, producing involution, and restoring normal
function and condition. The method can beet be explained in discussing its
therapeutical applications. The principal peculiarities of this method have
already been alluded to, and they are well illustrated in the following brief
Btatement of its applications: —
In endometritis attended by much hcemorrhage or other discharge
Apostoli used a metallic sound insulated, except at its termination in the
uterus, by a celluloid sheath nr cannula. The active portion of the electrode
is of platinum or of gold, so that it will not be corroded by the decomposing
fluid when used for the positive pole. Dr. A. H. Goelet, of New York, has
devised a set of graduated, interchangeable, non-corrosive steel tips for this
purpose, which are durable and comparatively cheap. Dr. Walling has used
gas-carbon tips, which are easily replaced if broken; they are made from
carbon points (such as are used in the ordinary arc lights), and are affixed
to a stout copper wire, which may be insulated with rubber varnish or by
melted shellac. Dr. Andrew F. Currier, of New York, employs vaginal and
uterine electrodes of aluminum with a cylindrical, removable tip of plat-
inum, the shaft being covered with thin rubber tubing. These possess the
advantaETcs of lightness, flexibility, and comparative cheapness. The second
electrode of Apostoli is a large flat surface of moist clay, which admits of
accurate molding to the abdominal wall. If it is not snugly fitted, under
the effects of high currents it may cause pain and even Mistering of the
skin. The objections to Apostoli's clay electrode are that it is heavy, awk-
ward to handle, and dirty. This may be obviated to some extent by the
plan of Dr. Goelet, of New York, in which the clay is made into the con-
sistence of putty and rolled flat; it is then enveloped in a layer of absorbent
cotton and covered with linen crash; finally, a sheet of rubber cloth is fast-
ened to the back, by means of which it may be handled and the patient's
clothing kept dry. The metal contact plate is pressed into the clay under-
neath the cotton, and a binding-post extends through the back, by which
the apparatus may be connected with the appropriate cord. Another device
for tne same purpose has been adopted by Dr. Franklin II. Martin, of
Chicago, and it consists of a concave, metallic, nickel-plated electrode, the
982
XON-PHARMACAL REMEDIES AND GENERAL THERAPEUTICS.
lower surface of which is a sheet of membrane surrounded by an insulated
rim to prevent the plate from coming in contact with the skin. AVhen used,
about a pint of warm water is poured into the interior through a central
opening in the plate, which is then closed with a screw-cap. The transuda-
tion of the water through the membrane produces a moist surface for con-
tact with the abdominal wall. This apparatus is cleanly, and it is claimed
by Dr. Martin to be capable of transmitting very heavy currents without
pain or local action upon the skin. The strength of current employed by
Apostoli should not be maintained long, — the duration will depend upon
the character of the case; usually it lasts from three to ten minutes, and
not repeated oftener than once a week or every ten days. For several days
after the application more or less sangtiinolent and serous discharge may
come from the uterus, but unless antiseptic precautions have been neglected
fever is not likely to be manifest. The number of sittings required for a
cure will vary very greatly according lo the chronicity and condition of the
case.
Hsemorrhages from the Uterus. — Apostoli called the positive electrode
"the haemostatic pole," and in persistent haemorrhages he employed positive
electrization by the intra-uterine sound, the negative being connected with
the abdominal large plate electrode. Dr. G. Betton Massey reports several
cases in which currents of from 40 to 50 milliamperes were curative in a
few applications. When heavier currents are used, he advises having two
flat electrodes, one on the abdomen and one at the back of the patient, both
connected with the same electrode, thus very much reducing the liability
to production of pain. The applications may be made every two or three
days. There is, probably, no agent of the materia medica which will check
haemorrhage so effectively and promptly as the positive pole; and it is far
preferable to the ordinary mineral or vegetable astringents or 8t_vptic8. Even
in cases of myoma or cancer the effects of the positive pole have been highly
Buccessful, while in ordinary menorrhagia, due to pathological conditions
of the mucosa, it is curative after a few applications, both of the hsemor-
rhagcs and the chrome leucorrhoea. In such cases swelling currents to 200
or 260 milliamperes are employed.
For the relief of a painful condition of the uterus or ovaries'the posi-
tive pole is used as above, but the current need not be more than 20 to 30'
milliamperes^ rarely a.? high as 50 milliamp<^res. The applications, however,
should be more frequently made, — every day at first, — seances lasting from
five to cierht minutes. In some cases this expedient will gain time and afford
temporary relief while the patient is being prepared for gurgical operation.
On the other hand, if an operation has been performed and the ovaries
removed, pain may still persist, and here electricity will meet the indication
better than any other resource.
Uterine Cancer Treated by Electricity. — The good effects Apostoli had
in the treatment of myomata with electricity led Dr. Wernitz,* of Odessa,
to use it in carcinoma of the uterus. He reports four cases of carcinoma of
the uterus in which he employed the galvanic current. The results he reports
are the following: —
1. Complete cessation of pain. Patients who could only be eased with
strong narcotic remedies enjoyed, after a few applications, complete freedom
^Berlimr klinische Wochenschrift, Sept 22, 1800.
ELECTHIOITT IN JIEDICINE — ELECTB0-THEBAVEUXI08.
983
I
I
I
I
of pain, good appetite, and sound sleep, in consequence of which their gen-
eral condition improved.
2. The discharges were decidedly reduced in quantity and hfiemorrhage
ceased.
"Whether a complete cure or cessation of the cancerous processes could
be expected after a long-continued apphcation of the galvanic current, Dr.
Wemitz does not venture to state. The favorable results so far gained by
him he ascribes to the chemical and electrolytic action of the current.
Sterility may result from many causes. If it results simply from im-
perfect development or defective nourishment of the uterus and ovaries, or to
catarrhal endometritis, electricity is of decided value. In the former case,
faradism, systematically applied, two or three times a week in the inter-
menstrual periods, will stimulate development, and, in the latter, galvanic
currents of mild strength will remove the cause.
Bysmenorrhcea may also be caused by defective development, and
faradism systematically applied will aEord marked relief. Where mechan-
ical causes ejcist, the discovery of their nature may suggest other expedients,
but the intra-uterine negative electrode, with weak galvanic currents, will
produce excellent results as regards the relief from pain and discomfort.
Inflammatory exudation, the result of peritonitis, may incarcerate the uterus
and ovaries and make them immovable. This is capable of amelioration, or
cure, through absorption of the exudate, according to the Apostoli method.
In subinvolution, which may be attended by pain, sterility, and menstrual
disorder, or hcemorrhage, faradism is very useful, but weak galvanic current*
(20 to 30 milliamperes) will materially assist in restoring the organ to a
normal condition. In all cases of h}T)ersecretion from the uterine mucous
membrane, the positive galvanic pole is promptly efficient in overcoming this
condition.
It is, however, in uterine myoma (or leiomyoma), myofibroma, and
fibroma that the Apostoli method comes in direct opposition to the practice
and teachings of the surgical gynaecologist. It certainly should be borne
in mind, throughout the discussion of the therapeutics of this form of neo-
plasm, that its life-history is not well known. The original cause of the
growths has not been discovered; they may remain for years of about the
same size and then suddenly take on renewed growth, or they may undergo
involution and become the seat of degenerative changes. In many cases,
especially if small, they may cause but little discomfort, and may be quite
accidentally discovered during life or post-mortem; in others they are,
without reference to their size or number, accompanied by congestion, ha?m-
orrhage, and various symptoms of disorder calling for relief. The submu-
cous variety tends to become polypoid, and readily admits of detection and
removal; the intramural and subperitoneal forms, on the contrary, are less
auilT recognized, and require a more serious operation for their relief. These
^owths are now scientifically treated by the method of Apostoli, which has
the indorsement of some of the best authorities, such as Sir Spencer Wells,
Keith, and many others equally well known as competent to decide upon the
relative merits of electricity and laparotomy.^ A very temperate summing
* Additional eridence as to the ralue of his method, conected from Eng1i«h and
AmericAD sources, was published by Dr. Apostoli in "Travaux d*Electroth<^rapie
Oyn^oologiqiie." Dm. Thomos Keith and Skene Koith state that durinf^ more than
two years in which they had employed ApostoU'a methods they had not performed
a single laparotomy for uterine fibroma.
984
NON-PHAIIMAOAL REMEDIES AND GENERAL THERAPEUTICS.
up of the present subject of controverBj may be given in the words of
Masse J : —
1. A properly-conducted electrical treatment of solid fibroids is harm-
less, will remove the irritation and pain due to their presence, arrest further
growth, and almost invariably cause a ^adiial diminution in their size.
2. Bleeding fibroids may be entirely cured of the haemorrhagic tend-
ency and pain, arrested in growth, and gradually lessened In size.
3. It is possible for the diminution in the size of the tumor to end only
in its complete disappearance.
4. In small intramural fibroids surrounded by unimpaired uterine tis-
sue, the current applications tend to promote their disengagement from the
uterine stroma and extension either into the uterine or peritoneal cavity. In
the former case a complete cure may result by delivery of the tumor, and
in the latter case a lessening of its symptomatic importance.
5. The time necessary for a satisfactory shrinkage should not be too
sparingly measured with the slow cases. Quick symptomatic cure and slow
shrinkage are often associated in the same case.
G. In fibroid tumors that have undergone cystic degeneration a treat-
ment by strong currents may do harm, being apt to set up changes in the
liquid contents of the cavities that may result in septicjemia.
A uniform result in Massey's experience is that the first two or three
applications, even if strong ones, do not usually cause an appreciable dimi-
nution in the size of the tumor, but a striking and almost inevitable conse-
quence is a prompt disappearance of any tenderness about the mass. If this
does not occur, it will be found, as pointed out by Apostoli, that some pro-
nounced disease of the appendages co-exists. Fetid or too abundant leucor-
rhcea is promptly relieved after a few apphcations. There is also a marked
improvement in the general physical hedlth of the patients under this treat-
ment; the abdominal walls increase in adipose, the appetite and digestion
improve, the bowels become more regular, and the chronic invalid finds him-
self restored to health and usefulness.
It is proper to state, however, that some observers have not had as happy
results with electricity as those just named. Dr. John Homans,^ of Boston,
communicated his results in 34 cases of uterine fibroma, in only 2 of which
had the size of the tumor diminished. The general health had improved in
15 cases, had been worse in 2, and 1 death was attributed to the treatment.
Profuse haemorrhage had been diminished to a normal or bearable degree
in 9, had been increased in 6, and unchanged in 9. Locomotion had been
made easier in 16 cases and more tiresome in 5. Pain was lessened in 6
cases, increased in 2, and unaffected in 5. The menopause occurred in 4
cases after treatment had been begun. In consequence of such unsatisfactory
results Dr. Ilomans discontinued the use of electricity in this class of diseases
in favor cf abdominal section. It is well kno\\Ti that the late Lawson Tait
was an outspoken antagonist to the Apostoli method. It is impossible to
reconcile the conflicting reports as to the relative value of these two radically-
different plans of treatment; but it may be admitted by both parties to the
dispute that electricity cnn never be practiced successfully by the general
practitioner, unless he knows more about electrical science than the average
physician does. Just as special skill is required to perform an abdominal
^ i^vincial Medical Journal, June 1, 1891, p. 362.
ELECTEIOITT IX MEDICIXE — ELECTHO-THERAPEUTIC8.
985
section for removal of the uterus and appendages successfully, eo we may
acknowledge that treatment of uterine fibroma requires special skill and
knowledge. We also may conclude that at present the data are wanting
which would enable us to say, at the beginning of treatment, which caeca
require surgical interference and which are proper subjects for electrical
treatment. It is claimed by Joseph Price that, in cases which come ulti-
mately for operation after a more or less prolonged course of electricity, the
operation is rendered more difficult, and that adhesions result directly from
the treatment. Just here there is irreconcilable antagonism between the ad-
Tocates of the two methods. Apostoli claimed good results upon diseased
condition of the uterine appendages. Dr. Willis E. Hallowell^* advocating
this treatment, says: "When we find the tubes and ovaries alone inflamed,
excepting for the present, at least, those cases in which they contain pus or
other fluid, hydro- and pyo- salpinx, ovarian abscess, and cystic ovaries, we
have in galvanism a very eflScient curative agent I have seen a number of
tubes about the size of the little finger, more or less hard and very tender,
become of normal size, consistency, and sensibility; and likewise ovaries,
variously enlarged, prolapsed, and exquisitely tender, become of normal size,
and, in many cases, return to their normal position."
The advice of this writer is much to the point. If pus or other fluid
be present and its infective character ]ye made probable by recency of occur-
rence, by fever, or by repeated attacks of pelvic inflammation, laparotomy
is indicated, and at once. He further declares that if we can satisfy ourselves
by good evidence of the existence of a closed collection of fluid, even though
we have no evidence of its virulence, it is adA-isable to remove it by opera-
tion. Laparotomy may even find an ally in electricity. The good effects of
the latter upon the general health and nutrition may place a patient in better
condition to pass through the ordeal of a capital operation; on the other
hand, an operation may fail in its trood results owing to cellulitic exudation,
which can be removed by subsequent electrical treatment. He concludes by
the statement of his "conviction that we have in electricity an agent which,
with careful study of what is already known and future investigations, will
become, in the hands of a good electrician and a thorough gynaecologist, one
of the most important weapons in the struggle against disease in woman,
though it can hardly become the panacea which many of its advocates have
claimed it to be."
Just what is claimed by the advocates of electrical methods may be
learned from a communication read by Dr. Apostoli at one of the Inter-
national Medical Congresses, of which the following summary presents the
leading points: —
1. The constant galvanic current is indicated principally in gynaecology,
in endometritis and fibroma; of paramount value in vascular derangemeuts
and pain (amenorrhtea, dysmenorrhoaa, and metrorrhagia); it is also a potent
means for arresting the growth of benign neoplasms, and promoting the
absorption of periuterine exudations. It exerts a very salutary resolvent
action in periuterine phloinnasiap, and in some cases of catarrhal ovaro-
salpingitis; but it is inefRcient and even does harm in high dosage, especially
il the negative pole is used in the uterus, in suppurative phlegmasias of the
appendages. This variable intolerance, which is increased by an inflam-
« NortHvmtem Lancet, 1S81, p. 85.
9SG
NOX-PHAlUiACAL RKSIEOIES AND OENERiX THSRAPEUXICS.
matory condition of the appendages, proves a valuable means of diagnosis in
determining the existence and character of periuterine, liquid effusions (san-
gmnolent or purulent), -which have been unknown or merely suspected, and
hastens in these cases a delayed or refused operation.
2. The effects of the constant galvanic current are polar and interpolar.
The trophic and dynamic interpolar action, which increases as the square of
the given intensity, is distinct from the polar action; this action, as Apostoli
has shown us, differs according to the pole used, giving us the calorific action
produced by the passage of the current (to increase interstitial circulation),
and, finally, the antiseptic action of the positive pole, the experimental dem-
onstration of which has been given us recently by Apostoli and Laguerri^re.
3. Galvanic applications in high dosage, used in varying amounts from
50 milliamperes upward, dependent upon the tolerance of the patient or the
clinical indication, are the fundamental basis of Apostoli's method, and
present the following points in their favor: (a) The utilization of vascular
drainage, a direct effect of the calorific action due to the resistance to the
passage of the current, and in direct proportion to the square of the in-
tensity. (6) The antiseptic or microbicidal action, which increases with the
given intensity, (c) The rapidity and efficacy of the results produced, which
are in proportion to the square of the electrical energy, the formula for which
is analogous to that o! the measure of the energy of other natural forces:
C = */a m V '. (d) The general applicability of this method to refractory
cases (painful and subperitoneal fibromata, fungous endometritis, etc.), and
to young women, (e) The infrequency of relapses, which, all things being
equal, are least apt to occur when the strongest currents have been employed.
4. If the vaginal application of the galvanic current (which is the
method proposed by Cheron for fibromata alone, and used since by A.
Martin, Brache, Meniere, Onimus, Carpenter, Mund^?, and others) gives any
results, they are very inferior to those of the intra-uterine application, which
should always be the method of choice: (a) Because it utilizes the maximum
of the given current and its energy, (b) Because it utilizes the antiseptic
action of the positive pole, which is entirely local, and is not present in the
interpolar circuit or at the negative pole, (c) Because it adds the derivative
and caustic action of the intra-uterine application, treating thus at the same
time the simple endometritis, or the secondary endometritis, which so often
complicates fibromata and periuterine phlegmasiie, thus insuring a more
rapid, complete, and permanent cure, (a) Because it is more effectual than
the vaginal application in relieving pain and producing a tolerance for
higher dosage, and, by thus allowing the use of currents of increasing in-
tensity, the vascularity is increased and the best results are attained.
5. Vaginal galvano-punctures, 2 to 5 millimetres (one-twelfth to one-
fifth of an inch) in depth, made with a filiform trocar of gold, insulated
throughout except at the point, are a very useful complement to the intra-
uterine treatment proposed by Apostoli, by better localizing the galvanic
action, and by increasing, in some cases, the efficiency of small and medium
doses.
The innocuity of his intra-uterine applications is proved: First, by the
parallel innocuity of the chemical and other harsh methods of intra-uterine
treatment; secondly, by the statistics gathered from all parts of the world,
and particularly by his own statistics, which he has widely published.
Details of Operation. — The apparatus required are a good battery or
ELECTRICITY IN MEDICINE— ELECTEO-THERAPEDTICS.
987
I
eotirce of electrical energy, capable of maintaining a current up to 250 or
300 milliamp^res when the body of the patient, a rheostat, and a milliam-
p^remeter are in the circuit. The electrodes have already been sufficiently
deflcribed. It may be stated, however, that for applications of less than 100
milliamp^res the clay abdominal electrode may be substituted by towels
wrung out of hot water or wet absorbent cotton laid upon the surface, upon
which the lead plate to which the electrode is attached may be placed. The
intra-uterine electrode, as pointed out by Massey, should be insulated nearly
to its extremity, leaving only about two and a half inches exposed, so that
it shall not cauterize the cervical canal and thus induce subsequent stricture.
This electrode should be so constructed as to permit of thorough cleansing
and boiling for several hours before it is used.
The battery should be tested prior to operation and the milliarap^re-
meter examined. This is done by placing all the cells in action and gradu-
ally turning on the controller, while watching the effect upon the meter.
The controller should then be reversed until the current is entirely cut off,
when the apparatus is ready for use in the operation. The conducting-corda
should be carefully examined, so as to detect any possible break. Determine
the proper size and curve of the sound, and properly disinfect it. The curve
is best made with the aid of an alcnhol-lamp, and while the sound is heated
the insulation may be secured by applying gum-shellac in such a way as to
cover all breaks and weak spots. Arrange the gynsecological table or couch
BO that it will be convenient to hold the sound in place with the left hand,
leaving the right hand to manage the current-controller.
The patient should be informed of the character of the operation and
of the necessity of keeping absolutely still, so as to avoid shock or disarrang-
ing electrodes or wires. The application should not cause pain beyond a
alight burning, and the patient should at once inform the operator if the
current causes more pain than this, when the current can be promptly dimin-
ished by the controller. The bowels should be evacuated by a purgative, fol-
lowed by an enema, and the vagina should have a preliminary irrigation with
an antiseptic solution shortly before the operation. If there should be any
pimples or abrasions on the surface of the abdomen they should be covered
with small pieces of waxed paper, or paper smeared with vaselin or lard upon
the surface next to the skin. The details are further described as follows
(abbreviated from Massey): —
Placing the Electrodes. — 1, Apply the clay (or the Martin) electrode
smoothly upon the abdomen, and attach to the binding-post the cord of the
plate which is desired to be indifferent.
2. Attach a disconnected conducting-cord firmly to the intra-utcrine
electrode, and insert it as any other sound is inserted, using all the precau-
tions recommended in the passage of this instrument. At first it may only
be possible to introduce a filiform, flexible instrument, but after a positive
cauterization subsequent introductions will be easier, and larger instruments
may be used. A speculum, as the rule, is not needed, as the sound should
be guided by the finger alone in its introduction; it should be held firmly
in place by the left hand during the passage of the current, the finger being
in the vagina.
3. AJfter seeing that the connections are all right and the controller at
aero, the cord of the intra-uterine electrode should be attached to the bind-
ing-post of the pole that ia to be active. The patient now being ready, the
988
UON-PUAEKACAL HEMEDIES AND GENEHAL THKEAPEUTIOS.
current is slowly turned on, until 30 or 40 milliamperes are shown by the
meter. After resting at this point for a few minutes 10 or 20 milliamp^res
may be added; but, as the rule, 40 or 50 miiliampdree will suffice for the
first treatment, especially if the patient be nervous. The meter should be
constantly watched, as well as the patient's countenance, and on the first
sign of pain the current should be reduced by the controller. The active
electrode may be moved, ao as to bring it in contact with all parts of the j
endometrium, care being taken not to perforate the fundus. The current
is maintained at its maximum from two to ten minutes, and then gradually
lessened. When heavy currents are used (200 or 300 milliamperes) the time
should be shortened, except in tumor cases. The decrease of current should
be gradually produced by slowly reversing the controller until the needle
of the meter falls to zero. The sound is then removed, and the abdominal
piale taken away. It is best to have the patient rest awhile before going
home, particularly if she is obliged to walk. Massey insists that, in every
case where at least 100 milliamp^fereB have been used, the patient should lie
down immediately upon reaching home, and remain inactive during the
remainder of the day, so as to avoid inflammatory reaction. There will be
sanguineous, followed in twenty-four hours by a purulent, discharge, and
there may be some colicky pains, but the recumbent posture, with antiseptic
vaginal irrigations twice daily, will soon cause these to subside. For the
treatment of many cases of endometritis, unaccompanied by hyperplasia,
currents of 20 to 30 milliamperes are quite sufficient, while the heavy cu>
rents are especially required in tumors, large hypertrophy, or inflammatory i
exudation. Three times a week is as often as the operation can be performed i
with safety; in many cases twice, or even once, a week will suffice.
Dr. Massey gives the following contra-indications to operations under
the Apostoli method: — . 1
1. The presence of the menstrual flow. ^u
2. The existence of acute metritis or perimetritis. ^H^
3. The co-existence of abscess anjrwhere in the pelvis. ^H
4. Pregnancy.
Faradism in Gynaecology. — Apostoli used the faradic current in acute
inflammatory affections of the uterine and periuterine tissues and append- I
ages. No stage of the inflammationj even the most acute, contra-indicates
the employment of the current. The bipolar vaginal electrode may be used,
applied in the neighborhood of the severest local pain. (Liebig and Robe.)
In amenorrhoea both galvanic and induced currents are employed. It
is not necessary to apply the electrodes locally to the uterus or ovaries, since
experience has shown that electricity applied to a distant portion of the body
will increase the menstrual flow, or stimulate it if arrested (except in preg-
nancy). The faradic current is employed in general faradization, dorso-
abdominal with tlie dry brush to the abdominal walls, the inner sides of the
thighs, and also to the soles of the feet.
In obstructive dysmenorrhoea Apostoli used faradization with a bipolar
electrode, the strength luring regulated by the feelings of the patient. Con-
gestive dysmenorrhoea may be relieved by weak currents, either intra-uterine
(Apostoli) or with the wire brush to stimulate the cutaneous circulation over
the abdomen, while galvanism from the cervix to the spine (anode to cervix,
cathode externally) may be combined with advantage. The same treatment
is advised for painful ovaries and nervous dysmenorrhoea; also for non-
ELEOTHIOITY IK
DIOINE — ELBOTRO-THERAPECTICS.
989
I
I
I
periodic or constant pains in the pelvis. Daily, or even twice a day, is not
too often for the application of faradic currents, which should be extremely
rapid and perfectly smooth, in order to obtain the sedative effects.
In threatened abortion an insulated vafi^inal electrode may be placed
against the os and a soft sponge electrode applied over the hypogastrium
or himbo-eacral region for ten minutes at each sitting, using raild, smooth
cmrents. Dr. W. T. Baird, of Texas/ used it in three cases, in which he
succeeded in arresting haemorrhage and preventing the expulsion of the
ovum, the patients afterward going on to full term. To arrest haemorrhage
after abortion, owing to a relaxed uterus, the same current may be employed,
either in the same manner or by using a double uterine electrode, by means
of which the current can be definitely localized in the uterus and produce
more forcible contraction (Liebig and Eoh^^). Even in placenta prttvia the
faradic current is recommended, as strong as can be borne, in order to pro-
duce strong equable contractions of the muscular fibres. Dr. Baird claims
that during parturition faradism is a valuable agent for relieving suffering,
and may take the place of chloroform. He uses the mediate method, one
electrode being placed over the patient's sacrum, the other being attached
to a wristlet upon the operator's arm; he then passes his hand over the
patient's abdomen during the pains. Premature delivery may be brought
on by very strong currents, either faradic or galvanic.
Vomiting of pregnancy has been treated by Bordier and Vemey* by
simultaneous galvanization of both vagi. The method adopted is to have
a flat metal electrode (covered with wash-leather) of about ten square
inches, placed over the epigastrium, while two small electrodes are set on
the sides of the neck between the lower bundles of the sterno-mastoids. The
latter are connected with the positive pole. The current should be gradually
increased or decreased, avoiding shocks. The strength of the current should
be 10 to 20 milliamperes. Food is taken, such as a glass of milk sipped slowly
during the application, and the current is increased if nausea appears.
Agalactia, or deficient secretion of milk after delivery, yields promptly
to faradic stimulation of the mammary glands. Dr. Fry reported a case of
suppressed lactation in which galvanism was employed with complete suc-
cess, only two applications being required. The active electrode (cathode)
was made of sheet lead, three by five inches, molded so as to fit over the
breast, and covered with absorbent cotton. The anode was placed at the back
of the neck. An average current of 10 milliamperes was passed for eight
minutes through each breast.
Involution of the uteruB after labor is hastened by faradization, accord-
ing to Apostoli and Tripier. Septic infection is thus prevented by securing
contraction of the organ. The lumbo-abdominal method is usually sufficient,
with daily sittings for a fortnight, or longer if necessary.
In disorders of the male genito-urinary organs electricity is largely used
with marked success. In paralysis, hyperaesthesia, stricture, functional im-
potence, all three forms of electricity may be employed locally.
Paresis or paralysis of the bladder resulting from various causes, with
retention or incontinence of urine, is often markedly relieved. An insulated
urethral electrode is passed into the bladder, the other electrode being placed
over the perineum, hypogastrium, or lumbar region, and a current passed
^American Journal of Ohgtetricn, April, 1886, p. 841,
* Archives d'ElectrothHvpie Mfdicalc, May 15, 1898.
990
NON-PHAHMACAL REMEDIES AN*D GENERAL THERAPEUTICS.
as strong as the patient can bear, gradually iacreasinc the length of the
sittings, though not exceeding ten minutes. The bladder should be partly
filled with a weak borax solution, so as to diffuse the current during its
passage; and if there should be decomposition of urine with cystitis, irriga-
tion of the bladder should be practiced once or twice daily, with mild anti-
septic solutions.
In nocturnal incontinence of urine faradiem is very successful, one elec-
trode being placed in the lower dorsal region of the spine and the other over
the pubes, or an insulated urethral electrode may be introduced as far as
the neck of the bladder.
Functional impotence, spermatorrhoea, and frequent nocturnal losses
may be relieved in a similar manner to that just indicated for nocturnal in-
continence of urine. In addition, the wire brush may be applied to the
external genitalia and to the inner side of the thighs, especially in functional
impotence and feeble erections. Mild galvanic cathodal applications to the
neck of the bladder will also markedly reduce irritability and arrest the dis-
charges in sperraatoTrhcEa.
Faradism ia Ecual Colic. — Dr. Carl D. S. Friih, of Philadelphia,^ re-
lates the case of a man, aged 48 years, wha was taken severely ill on June
22, 1900, with pains in the left kidney. He gave a history of three previous
attacks in which the pains were so bad that he went into convulsions. The
regulation treatment with morphine and atropine failed to give more than
momentary relief. He was then placed on his side with the sore kidney up,
the hip and legs elevated, and a faradic current, with interruptions of from
sixty to eighty per minute, was applied to the front and back of the organ.
One-half hour of this gentle tapping of the kidney eased the pain completely.
The patient passed water freely and was entirely relieved by this treatment.
In hypertrophy of the prostate Tripier recommended an insulated sound
in the urethra and one in the rectum, with the faradic current. An electrode
of special shape for the rectum has been made, at the suggestion of the
author, for application to the base of the bladder and prostate, the neutral
electrode being placed over the abdomen.
The high-frequency currents, according to d^Arsonval, confirmed by
Apostoli, is efficacious. Owing to its action upon the cell-function, it mod-
ifies general nutrition, promoting and regulating it. The clinical result
claimed is a progressive restoration of general health. Tests of the urine
show increased activity in organic combustion, improved diuresis, and easier
elimination of excreta, the proportion of uric acid returning to normal. It
is, therefore, of great value in gouty neuralgias, neurasthenia, dyspepsia,
eczema, vascular congestions, and manifestations of lithaamia. In chronic
forms of rheumatism and jrout it is useful, but not in the acute forms."
In enlarged lymphatic glands, when suppuration has occurred, the
galvanocauiery atfords an ideal method of openini; glands. The wire-point
cautery may he employed to make punctures into the substance of enlarged
glands, the gland-structure being partly destroyed and partly condensed or
absorbed under the action of the negative electrode (5 to 20 milliamperes
twice weekly). Strong, frequently interrupted faradic currents have also
been found useful in enlarged lymphatic glands.
■Jlfrdfral Record, August lltb; New york Medical Jounuilt Sept. 22^18
'Journal d*Bygiene, Paris, July 18, 1899.
KLECTRIOITY IN MEDICINE — ELECTE0-THKHAPEUTIC8.
991
I
In orchitis, after the acute stage has passed, percutaneous galvanization,
followed by faradization, reduces swelling and promotes absorption. In
atrophy of the testicle faradism with the dry brush and descending galvanic
currents to testicle and spermatic cord wili increase the circulation and favor
nutrition. In hydrocele percutaneous applications of both forms may be
practiced, but the effect is more prompt, according to Liebig and Roh6, if
the sac be punctured with a needle-electrode (cathode), using a current of
20 to 50 milliamperes to produce electrolysis.
Application of Electncity in Dermatology. — Various morbid conditions
of the skin are susceptible of marked amelioration under the action of the
several forms of electricity.^ Only a few of the principal applications can he
mentioned here.
Various nervous disorders, pain, hypercesthesia, anaesthesia, oedema,
urticaria, and neurotic bullous eruptions are successfully treated by galva-
nism or faradism. General electrization (electric bath, static '1)reGze," etc.)
is valuable in neuroses with cutaneous miinifestations. Itching^ or pruritus,
which is such an annojnnfj accompaniment to various lesions, is promptly, if
not permanently, relieved by swelling faradic currents. Static electricity haa
been used with success by Leloir in obstinate cases of para^sthesia, especially
when the anal and vulvar regions were involved. Raynaud's disease (local
asphyxia), it is claimed, may be checked and the angiospasm permanently
arreated by a strong faradic current. In a similar manner chilblains or
pernio may be benefited. In either, if trophic symptoms are present, the
combined treatment with galvanism and faradism is useful. Dr. Hugo Helv-
ing employs galvanism with excellent results in the treatment of frost-bitten
nose, applying both poles to the sides of the nose and passing a moderately
strong current for five or ten minutes, moving the electrodes slowly at the
same time. Static electricity removes the pain and soreness of a superficial
burn.
In various forms of inflammation of the skin, electricity may be judi-
ciously employed, especially in the more chronic forms. In eczema, the
author sees the best results from the faradic current applied by a metallic
ball electrode. Anodal galvanic applications also give good results in acute
forms, while in the chronic form with much infiltration the cathode is
preferable. In herpes zoster galvanism gives better results than faradism.
The anode to the spine and the cathode along the distribution of the affected
nerve, with mild currents, generally relieve the pain and check further
eruption. It is also valuable in the treatment of the resulting intercostal
neuralgia.
In alopecia the dry faradic brush over the bald spots is often beneficial.
The drawing of sparks with a static apparatus is recommended by Ranney and
others. Acne may be similarly treated with the faradic current, or galvanism
may be applied with anode to back of neck and the cathode to the seat of
eruption. In rosacea Dr. Hardaway practices electropuncture: introducing
a delicate needle into the enlarged veins and connecting it with the cathode,
a current (of 1 or 2 milliamperes) is passed through the needle, caiising
coagulation of the blood and occlusion of the vessel. Alultiple galvnno-
punctures of the hypertrophied skin will greatly promote resolution.
' For further clinical experience see author's work on
Ncir York: D. Appleton & Co.. 1901.
"Diseasei
the Skin."
992
N0X-PHAB3XACAL REMEDIES AND GENERAL THEUAPEUTIC6.
In keloid, hypertrophied scan, cicatrices, etc., the same authority has
obtained the best results from galvanopuncture. Warts, moles, and small
fibromata of the sldn yield readily to the same treatment without leaving
disiiguring scars. Currents of iJ to 6 milliamp^res are used. A small naraa
telangiectasis is successfully treated in this way, the negative needle being
thrust in variou3 directions through the base of the growth. Cavernous
angiomata and vascular nsevi are less amenable to this treatment, but with
judicious management and patience complete success may follow the appH-
cation of this method. The galvanocautery may be used in removing such
a growth. The x-ray treatment of skin disease is discussed (on page 999)
in connection with Eoentgen raye.
Removal of Superfluous Hair. — Electrolysis is now very generally em-
ployed in destroying hair-bulbs and removing hair growing in abnonnfll
situations. First employed by Dr. Michel, of St. Louis, in trichiasis with
successful results, the method was afterward extended by Dr. Hardaway to
the removal of superfluous hair in any situation. When properly used this
method causes neither pain nor disfigurement, but permanently removes the
source of the trouble. The method is easy and the instruments are few in
number; a battery capable of yielding a current of from Vs to 2 milliam-
p^res, a needle-holder armed with a No. 12 sewing-needle of steel or alloyed
platinum (the latter being preferable because flexible), and a sponge elec-
trode are all that are required. It is convenient to have the patient sit in
a chair with a good head-rest during the operation, and the operator may
find it necessary to use a good hand magnifying-glass to enable him to intro-
duce the needle directly into the hair-folhcle by the side of the hair. The
needle being attached to the cathode, the current is made to pass by the
patient touching, with his disengaged hand, the sponge of the electrode
held in his other hand. The effect of the current will be immediately ob-
served; the tissues around the needle will be slightly raised up, and froth
will issue from the mouth of the follicle. In about half a minute the hair
should be gently pulled with the tweezers or cilia forceps; if it does not
immediately come away the current should be passed a short time longer.
The circuit is broken by removing the hand from the sponge, which gives
less pain than if it be broken or closed with the needle. A sitting should
last not longer than tiflccn minutes, and the hairs destroyed should not all
be from one spot; otherwise there may be some inflammatory reaction, or
even sloughing and production of scars. After the operation a mild astrin-
gent lotion is ordered and applications of hot water directed to be made
several times daily to reduce hypcrfemia. If the operator has been successful
in destroying the papilla the hair will not return, but in a certain propor-
tion of cases the papilla escapes destruction and the hair is regenerated.
This may be due to a twist in the hair-shaft in its passage through the akin,
and partly to inexpertnesi? on the part of the operator. Some hairs may
require repeated removal before the papilla is finally destroyed. In young
persons, especially, new hair-papilla? are constantly developing in the skin,
and the appearance of new hairs after operation does not, therefore, mean
that the operation was a failure. Such patients it is necessary to warn
before operating that new hairs may appear though the older ones were
destroyed by the operation. In young individuals Ihe process may have to
be repeated several times before the operation is finally crowned with success.
The needle-holder of Hardaway is a good instrument, but one has recently
I
I
been devised by Leviseur which is a decided improvement. In this instru-
ment the needie can be held either directly projecting in a straight line or
at an acute or obtuse angle with the handle. The operator holds the instru-
ment like a writing-pen, with the needle at the proper angle to enter the
follicle with the greatest readiness.
Electricity for Preventing the Loss of the Hair, Premature Grayness,
Calvities.^ — The object of treiunient is to pnmiote nutrition of the scalp and
hair-bulbs. This is promoted by the practice of massage, the use of hot,
alternating with cold, douches, by the shampoo with either hard or soft soap,
and, above all,' by electricity. Both galvanism and faradism have been era-
ployed, and both are etticacious. The uninterrupted current should, in the
beginning, be a mild one, not exceeding 3 or 4 milliamp^res. It may be
applied by moistened sponge electrode;?, the hair also being moistened and
parted at intervals. An excellent mode of administering the current is
through a brush with metallic bristles. Faradic electricity is conveyed in the
same way through a wire brush, the patient holding the moistened sponge
electrode. The brush is to be passed over the scalp slowly until the skin
becomes quite red.
Bemoval of Foreign Bodies from the Eye with the £lectro*mag^et. —
One of the neatest applications of practical electricity to medical purposes
is seen in the removal of pieces of iron or steel from the interior of the eye
with the electro-magnet. Several forms have been devised since the instru-
ment of Professor Hirschberg, of Berlin, was first introduced, in 1855, vary-
ing in sliirht details, but all consisting essentially of a fine insulated wire
coil with a core of soft iron, to which is attached a tip, also of soft iron.
After closing the circuit, the current being furnished by a single galvanic
cell, the point of the instrument is brought to the edge of the wound, or, if
the foreign body be deeply imbedded in the eyeball, it may be necessary
to puncture the eojerotic and introduce the point of the magnet until the
substance is attracted by it and removed from the eye, the current not being
broken until the instrument is free from the eye. Of course, only particles
of iron and steel can l)e removed by the magnet, but, as they frequently find
their way into the organ, it is an admirable contrivance, since the foreign
body may be removed without causing further irritation.
Dr. Casey A. Wood, of Chicago, reported a case of electro-magnetic
extraction of a piece of steel from the vitreous chamber of the eye, with
preservation of sight. The magnet used is known as Snell's, manufactured
by Meyrowitz Brothers, of New York. With this he prefers a small two-
volt Btorage cell, which is more portable than the ordinary acid cell, and is
very efficient. The details of this case arc quite instructive. Atropine solu-
tion bad been instilled into the eye, shortly after the injury was received, by
the attending physician, and Dr. Wood saw the patient seven hours after
the accident. There was a penetrating wound of the cornea and iris, and
the anterior chamber contained blood. No clear view could be obtained of
the fundus. It was decided to wait until the effused blood had undergone
[absorption. The conjunctival sac was thoroughly disinfected, more atro-
pine instilled, and the eye dressed with boric-acid powder and a bandage.
Three days later a wound in the lens could be plainly seen through the
dilated pupil. Two clots were seen in the vitreous; only portions of the
* 5?ee Article by author on the "Hair with the Toilet. Care in HpnUh and
Treatroent in Pisons'e/* Medical liunctln, Philntlelphia, April, 1892.
■
994
NOX-PHAUSLACAL KEMliOlliS ANU OliNKKAL TllEILVPECTICS.
fimdus could be seen. It was decided not to attempt removal of the foreign
body through the ori^nal wound. Four days after the accident ''the patient
was anaesthetized and a strai^jht equatorial incision (ci^ht miUimetres long),
was made with a Graefe knife through the sclera, about a centimetre behind
the limbus, at the lower outer quadrnnt of the hemisphere. Another wound
of the same length, but at right angles to this, was first carried through the
conjunctiva and Tenon's capsule; so that when both wounds were closed
the vitreous chamber was elfectively shut oil from the outside air. A bent
and flat needle was carefully introduced into the vitreous, and, after several
reintroductions and *fighing' about, a small bit of steel was withdrawn, at-
tached to the tip of the magnet-end. Little or no vitreous was lost. A few
stitches were put through the conjunctival flaps, and the eye was again
dressed with boric-acid powder. The greatest care was observed as to the
use of antiseptics, and the wound healed without the least difficulty.'* The
extracted metal weighed 17.7 milligrammes.* Cases have since been reported
l)y Dr. H. F. Hansell and others.
Pausier recommends the introduction of medicinal agents into the eye
by means of electricity, in cases where the iris is refractory to the use of
drugs by ordinary apphcation. Some 1 to 300 solution of eserine sulphate
was instilled and a moist electrode placed on the eyelid through which a
descending current of 2 milliampcTCs was passed for forty minutes. At the
end of this time the pupil had diminished in diameter from seven millimetres
to two millimetres. Recurrence of the dilatation was again treated in the
sapie manner and with the same result.
Pterygium has been successfully treated by Horace M. Starkey, of
Chicago, by electrolysis. A fine platinum needle is introduced successively
at two or three difTcrent points, across and under the enlarged vessels, con-
nected with the positive pole, and a current of 3 milliainp^res passed for one
minute, at each place. In interstitial keratitis mikl faradization- is of great
value, according to de Sehwcinitz. Choroiditis, with floating bodies in the
vitreous, is said by Robert le Mond to be Buccesgfully treated by direct ap-
plication of mild faradic currents, once daily, with internal treatment by
potassium iodide and corrosive chloride of mercury.
In nose and throat diseases the galvanocautery has been extensively
used, and, in the opinion of some, greatly abused. The chief advantages
■over the knife and cold-wire snare are: the ease and convenience of the
apparatus, its perfect asepsis, and the counter-irritant and stimulating effect
to be obtained by minute points of cauterization. In skillful hands it war-
rants all the praise bestowed upon it, because its use is then limited to
appropriate "cases, while in unskillful hands it is indiscriminately employed,
and sloughing and necrosis being caused by injudicious application. The
source of power is now almost universally the storage cell, although the cau-
tery batter}' is quite suflicient for all ordinary purposes; when the time of
actual use is very bri^^f, jtularization does not have time to occur.
Nasal hypertrophies of mucous membrane are readily reduced by a
touch of the galvanocautery. The platinum knife or probe should be in-
serted in a universal handle, bearing a spring switch, so that the current does
not pass until the instrument is in place and can be instantly discontinued.
If the instrument adheres, it should not be abruptly withdrawn, or it will
^ Ametican Jounwl of Ophtha\moto\fy, April, 1891, p. 127.
ELBCTBIOITT IN MBDICINV — ^ELBCTRO-THBRAPBUTICS.
995
tear off a portion of mucous membrane and cause bleeding and an open
wound. On the contrary, if the instrument is permitted to remain for a
moment or two the natural secretions will be restored and it will easily drop
out. In applying the cautery to posterior hypertrophies the rhinoscopic
mirror should always govern the application, so that the operator can see
just what he is doing.
In Epranalar pharyngitis of singers and public speakers, accompanied
by thickening in bands and hunches of enlarged follicles, excellent results
follow the galvanocautery. Enlarged papillse at the base of the tongue can
be reduced by cautery-punctures, or removed without pain or haemorrhage
by the wide platinum snare.
As the rule, the wire should be heated to a cherry-red heat, and in nasal
work it is often of advantage to use a shield, such as an ordinary metal aural
or nasal speculum, or Shurley's ivory-blade speculum. It is a powerful
haemostatic and resolvent: and, when used as a destructive agent, its action
is perfectly under control, and is limited to the area operated upon.
The galvanocautery has also been advocated as an application to the
throat in diphtheria; but^ while we are in possession of such antiseptics as
hydrogen dioxide and chlorine and such solvents of false membrane as papain
and lime, it is not likely that this plan will receive much favor. In chronic
enlargement of the tonsila the use of the galvanocautery is often productive
of decided diminution in bulk.
In keratitis fascicularis and ulcerations of the cornea galvanocauteriza-
tion gives good results; and Daricr^ reports excellent effects in the treat-
ment of two cases of purulent ophthalmia. Antiseptic douches with instilla-
tions of iodoform followed its eauterization.
Chronic Diseases of the Middle Ear. — Dr. Baxter has reported ten cases
in which the use of the constant current was followed by improvement. The
patient is placed with the head inclined and the external auditory canal filled
with warm water. An aural electrode, or small wire insulated to within two
millimetres of its point, is introduced into the canal and the sponge electrode
is held in the patient's hand. From 5 to 10 milliamperes of current are
passed through the parts. The duration of an application is from three to
8LX minutes. After the operation the patient is kept quiet for a time, in
order to avoid the occurrence of vcrtiiro.
Direct Electrization of the Stomach. — Owing to the inconvenience of
the use of the stomach-tube, KussmauTs stomach-electrode, introduced in
1877, was never a practical instrumt-nt for local or direct electrization of
this organ. Dr. Einhom* has constructed a novel form of electrode, on
the principle of the stomach-bucket, and gives it the name of the "de-
glutable stomach-electrode." It consists of a hard-rubber capsule (about one
one-quarter inches in length) perforated with numerous openings, this
serving to protect the metal knob within from direct contact. The
connecting wire runs through a fine, flexible-rubber tube. The capsule is
readily swallowed and tolerated by the patient, and contact is secured, as in
Bardet's electrode, by water in the stomach. The faradic current has been
generally employed, and in all cases the degree of acidity of the stomach has
been markedly increased. The author makes a preliminary report, which
goes to show that most decided results have been obtained in cases of dilata-
I
^Jmirnnl American Mrdictil AnHtciaUon, Nov. 29, 18W,
•Medical Htvord, May 19, 1801.
99G
NOX-P
tion and in grave cases of chronic gastric catarrh. T\ro cases of pure gas-
tralo:ia showed an amelioration after use of the cocBtant current. He con-
cludes that faradization is most useful in dilatation and atonic conditions of
the cardiac and pyloric orifices, and abo in chronic glandular gastritis.
Gastralgia of nervous origin or dependent upon ulcer receives more benefit
from galvanism. The latter form of electricity has an excellent influence
upon cardiac affections dependent upon gastralgia. The majority of cases
of hyperacidity were improved, but required the administration of alkalies
in the usual way. Dr, Charles G. Stockton, of Buffalo, N. Y., devised an
ingenious electrode for direct electrization of the stomach in 1887. He re-
ported very good results from its employment in cases of weakened or absent
motility, gastric dilatation, catarrh, atrophy, etc. Dr. Boardman Reed, of
Philadelphia, has found the ordinary faradic current, applied by means of
the gastric electrode, decidedly beneficial in all cases of muscular atony or
atonic dilatation. He advises slow interruptions with a weak current. In
the condition of hyperchlorhydria he employs the hish-tension coil, with
five-minute seances, every second (hi}\ with good results.
Electricity in Intestinal Occlusion. — Where intestinal occlusion is due
to transient intestinal paralysis through d-efective innervation, Semmola
has pointed out that the constant current has a truly marvelous effect.
He reports a case of diarrhoea, followed by acute constipation and colicky
attacks, with obstinate vomiting and retention of urine. The positive elec-
trode, olive-tipped, was inserted into the rectum as far as the sigmoid flexure;
the negative pole, moistened with salt water, was moved about over the
abdomen in various directions, especially along the colon. A current of 10
milliamp^rea was used. Each application lasted nbout ten minutes, and was
used three times a day. At the end of the third application the retention
of urine ceased, the paroxysms were less severe, and the patient had visibly
improved, but it was not until the ninth application, at the end of the third
day, that the bowels were moved. The treatment continued two days longer,
and the patient recovered.^ In other cases of a similar nature even more
rapid relief has been obtained by faradism, an insulated sound with free
metallic end being iiipertcd iuto the rectum and a moistened conductor
ap]>Hed to the wnll of the abdomen.
*'Electrio Inicctions." — rndir this namn a method of using the con-
stant current in cases of fjecal accumulation and intestinal paralysis has been
dct'cribed. The rectum is filled with salt-water in order to avoid the cau-
terant effect of a direct application to the mucoiis membrane. A itiotallic
conductor connected with the positive pole ia inclosed in an elastic sound
and communicates the electricity to the water. The circuit is closed by
placing a large negative electrode upon the abdomen. MM. Boudet and
Larat nave utilized this with benefit in a considerable number of case*.'
The author has also employed this method for several years.
Effects of the Galvanic Cnrrenta upon the Vitality of DiBcase-germs.—
From various experiments by Cohn and Mendelsohn and others it has been
ascertained that the vitality of bacteria may be destroyed by the passage of a
current of electricity. Blackwood states that galvanism readily destroyed
all varieties of germs, from 25 to 175 milliamperes being required. Strong
currents, such as from 10 to 35 amperes, not only killed the microbes, but
' Communioalinn to Section of Medicine. British Mediral Associntion. firitfuh
MedicalJournnJ, Feb. 20, 1892.
ELECTRICITY l\ MEDICINE — ELECTUO-THErLVFELTICS.
997
cutised them to disa|ipoar entirely. Quantity, or amperage, is the main
essential, for low quantity under strong voltage was ineffectual, while high
amperage under comparatively low pressure was etFicieiit always. Blackwood
stales' that he has obtained satisfactory results in actual practice in a num-
ber of diseases, such as scabies, lichen, favus, etc. In typhoid fever, dysen-
tery, phthisis, diphtheria, interraittents, and sporadic cholera he reports
^ood results from the application of galvanism as above indicated. He
suggests this field to other experimenters as a promising one for further
investigation. According to reported experimeuls by Apostoli and Laguer-
riere," the action of the constant galvanic current upon cultures is in direct
relation to the intensity of the current estimated in milliflmpi.'res. A current
of 300 milliampcres and above, applied constantly for five minutes, kills
charbon bacteria, while lower degrees of intensity of current merely attenuate
the culture and render it less virulent. The positive pole alone produces this
effect; the interpolar action and negative pole are indifferent. The general
conclusion is that the continuous current in ordinary medical dose (50 to 300
milliamperes) has no action sui generis upon microbe cultures in an homo-
geneous medium, and that its unique positive polar action should be referred
to the liberation of acids and of oxygen.
Gonorrhoea offers a field for the use of the antiseptic effects of galva-
nmix; but, unfortunately, the urethra is too sensitive in the male sex to per-
mit the use of the high currents required; yet, in women, good results have
been reported by Prochownik,^ who treated ten cases of acute gonorrhoea
with very rapid recovery.
The electrical induction balance is an ingeniously-constructed ap-
paratus which will indicate the presence of a bullet or other metallic body
when buried in the tissues. Several varieties have been constructed, but
they are essentially the same, and depend upon the principle of better con-
duction of the galvanic current, and hence greater induction in a secondary
coil, when the metallic object is included in the field or interpolar region.
Dr. Kummer* recorded a case where a needle having become buried in the
knee, its precise location was detected by an ordinary galvanometer, and also
by a freshly- magnetized needle. Dr. Addinell llewson^ claimed that in a
similar way he had been enabled to detect, by means of a small pocket com-
pass, the presence of a fragment of an exploded shell imbedded in the mus-
cles of the back. Unless the projectile were of iron or steel this experiment
would not succeed with such simple instruments. The electrical induction
balance and the electrical probe, however, will detect the presence of any
metallic substance capable of conducting the electric current. Dr. A. B.
Kirkpalrick'* reports a case of gunshot wound in which the electrical probe
was need with excellent results.
The electrical probe of de Wilde consists of two insulated wires con-
tained in a flexible sheath, tha ends being brought out at the extremity of
the instrument. As soon as the wires touch a metallic object the circuit is
'\V. R. T>. Blackwood, M.D.. 'Haa Electricity any Action as a GerroicideT**
Mfdical Bunrtin, Feb., 1892.
' /,« Tribune MMiculc; American Lanctt, Dec, 1800.
* Crtttralblatt fiir (iyniikoUigiCy and Pacific livcord of Medicine and SurorrVt
Xov., 1891.
• Renie M^dlcale de la fiftisse Romande, Oct., 1890.
* Proceedings American Medical Association. Surgical Section. Vewport Meetinf^.
• Procwdings Philadelphift County Medical Society. Oct. 14, 1801.
998
NON-PH.iBMACAL ttEMBDIES AND GENERAL THEBAPEUTICS.
complete, and a Biuall electrical bell, or 'T)uzzer," indicates the fact. This
instrument reqwiree actual contact with the foreign body in order to produce
the signal.
Electric niumination in Medicine and Sorgery. — Czermak in 1858 first
called attention to illumination of the larjnix by transmitted sunlight, and
subeequcutly this method of illumination was greatly advanced and im-
proved by Voltolini, by whom the electric light has been utilized for this
purpose. Dr. W. P>eudenthal devised an instrument containinj? an Edison
lamp, which is applied closely to the larynx externally, while the laryngo-
scopical mirror is used in the usual way.^ The instrument is made by
Reynders & Co., New York. It apjwars to have special value for illuminating
the subfrlottic region of the trachea.
Gastrodiaphany. — The attempt to transilluminate the stomach-walls
was successfully accomplished by Einhorn. The instrument consists of an
ordinary stomach-tube with a small Edison incandescent lamp inserted in
its end, the conducting wires passing through the lumen of the tube. The
value of this method depends for success upon the translucency of the ab-
dominal walls, the absence of food in the stomach, and the emptiness of the
bowels. The stomiioh must be thoroughly washed out and half a litre of
water left remaining in the organ. The light is introduced, the patient being
in the erect position. The operation must be conducted in a dark room.
An absolute diagnosis cannot be made solely upon the use of the light, for
often the colon and the small gut will transmit the illumination, and the
result is misleading. The so-called red zone is very apt to be an indefinite
luminous abdominal area.
The use of electricity in the production of hot-air baths, with incan-
descent lamps or electricfilly-htated coils of wire, has been found etlective
in treatment of chronic rheiimntlsm and synovitis. In the sections on Light
and Heat also will be found an account of the application of the arc light
in phototherapy.
Dia^osis by X-rays. — Much attention has been attracted to the dis-
covery, by Professor Roentgen, of Wurzburg, that opaque bodies can be
penetrated by certain rays which are throw^n out from the cathodal ex-
tremity of a Crookes tube, and that, by means of the ordinary photographic
negative, shadows of opaque objects can be made to form pictures called by
Cattell sciagraphs. Thus, when the human hand is examined, while ex-
posed to these rays, the bones and articulations are clearly shown, and the
presence of any foreign body* like a j)iece of glass or metal, is also revealed
by its shadow. In this way bullets have been located in the tissues of living
persons and photographs obtained, as an aid to operation and for permanent
record. Mr. Edison has devised a fluorescent screen or apparatus for making
such shadows visible without the aid of photography, and this instrument is
now used in diagnosis, its application being-at present more surgical than
medical, although it is possible at times to detect gall-stones and foreigT)
bodies in the bronchi, intestines, stone in the kidney, etc., in this wav.
X-radiation has not accomplished as much in the department of laryn-
gology as in other branches of medicine. It has, however, proved of great
service to the larjTigologist in the detection and accurate localization of
foreign bodies in the upper portion of the digestive and breathing tracts;
^ Mcdiciniache IKonatgschrifi, New York, Nov., 1889.
ELECTRICITY IN MEDICINE — ELECTIIO-TUKRAVEITTICS.
99D
I
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ID determining the ossification in the laryngeal and tracheal cartilages, — a
subject which has never been accurately determined before tlie advent of
the x-rays; in the diagnosis of intrathoracic growths. The x-ray is likely
to prove of distinct value in the early diagnosis of tubercular processes in
the lungs.
Cases of foreign bodies in the trachea, abscess of lung following pneu-
monia, and solidified mediastinal gland, which gave rise to laryngeal symp-
toms have been diagnosticated by x-rays.
Dr. Morley Currie, of Toronto, has devised a method of making x-ray
obsen^ations on hollow organs. He incloses a metal chain within the stom-
ach-tube, which is then swallowed. By means of the x-rays anrl fluorescent
screen the chain and the point of the tube can be followed and the lower
border of the stomach accurately marked. This method may be applied to
examination of the cBsophagus, colon, rectum, urethra, bladder, vagina,
uterus, and nose. Excellent photographs of the pelvis have been obtfiined
with the fcptal head in various positions, and also photographs of vesical
calculi and other foreign bodies.*
The therapeutic use of the rays has opened a new field in the treat-
ment of various diseases, especially of the skin. Stenbeck, of Stockholm,
describes a case of rodent ulcer in the tip of the nose cf a woman, aged
67, treated by tlie Roentgen rays. The rays were applied for ten minutes
daily at a distance of 10 centimetres. Reaction occurred after four sittings,
and on the tenth pus appeared. After thirty-five sittings the ulcer waa
more healthy, and the epidermis began to grow in from the edges. After
a short interval the sittings were increased to fifteen minutes, and a second
reaction took place, followed by improvement. The epidermis grew over
the ulcer, the ed^e flattened down, and in a month a smooth cicatrix was
left, differing little from the facial epidermis, and surrounded by a slightly-
raised border.
Dr. C. Thurstan Holland,^ of Liverpool, England, reports the history of
a case of eczema treated by x-rays. He explains their action as rather that
of a stimulant of the tissues throughout the diseased area, enabling them
to bring about recovery. Sycosis aud favus are now to be added to the list
of those affections in which these rnys have given evidence of being bene-
ficial. At a meeting of the Tmperio-Koyal Society of Physicians of Vienna,
Austria, on June 2, 1899, Dr. L. Freund' presented three patients who had
been cured *'in from seven to thirteen exposures."
The use of the x-rays has at various times been productive of serioua
lesions of the skin, frequently tlie result of using a strong current at short
range. The cutaneous phenomena observed vnr}' greatly. An evanescent
hyperspmia or erythema may he induced, and this is the most usual experi-
ence. At other times n dermatitis is produced, with much redness, swelling,
veeiclee, and buUfe, according to its degree, followed by excoriations. Or
the process may be a deeper one leading to severe ulcerations and necrosis
of the parts. Those wlio emyWny the x-ra\'8 frequently are liable to a derma-
titis of the hands, associated with a change in the nails, the latter at times
remaining permanently deformed.
^ Domitiiou \frdical Monthly, July. 1S98.
•British Afcdicftl Jouninl. vol. i. 1800, p. 1024.
•aazHte IIcMomadiiirc de Midecin^ ct de CMrurgU, vol. xlvi, p. 575.
louo
NON-PHABMACAL lUiMEDlXS A^'O flRXKUAL THKRAPELTTIC8.
KIFESITHERAPY; MECHANOTHERAPY; MASSOTHERAPEUTICS.
MASSAGE AND EEST-CURE.
History. — Xinesitherapy (Kiw^if, motion), or the treatment of disease
by mechanical movements, ig a well-established therapeutical resource. The
high esteem in which gymnastics was held by the ancients for maintaining
health and vigor led inevitably to the employment of modified, and especially
passive, exercises in the treatment of appropriate diseases. Herodicus be-
came so famous for his application of gymnastics to the improvement of
health that Plato is said to have accused him of doing an ill service to the
State by keeping alive people who ought to die, because, being valetudi-
narians, they caused more expense than they were worth to the community.
In many places in the writings of Hippocrates we encounter expressious of
his high opinion of the value of systematic and scientifically-directed mass-
age. For instance, "It should be kept in mind that exercise strengthens and
inactivity wastes." "Friction can relax, brace, incarnate, attenuate: hard
braces, soft relaxes, much attenuates, and moderate thickens." The phy-
sician ought to be acquainted with many things, and, among others, with
friction." These extracts are from the Sydenham Society's translation of
the genuine w^orka of Hippocrates: in Littr§'s translation the last sentence
is more appropriately rendered, '*The physician should possess experience
in many subjects, and, among others, of massage."
The term massage (Maaff**!*, to knead or ruh) is applied to the employ-
ment of pressure, strain, and other peculiar manipulations of the soft tissues
of patients with the view of bringing about physiological and therapeutical
effects. Known and practiced by tlie Chinese from the earliest period, by
the ancient Persians, and later by the Greeks and Romans, its use, in one
form or other, is almost universal at the present day, not only among civil-
ized nations, but also among the abori^jiiial inhabitants of Africa and the
South Sea Islands. Among the natives of Tongo and the Hawaiian Islands,
for instance, a crude, though elaborate, system of shampooing is practiced,
which is essentially a form of massage. During the middle ages the nations
of Europe lost appreciation of this important handmaid of therapeutics,
which was permitted to sink into oblivion by the medical institutions. How-
ever, it continued to be practiced by the laity, who often associated it with
superstitious forms and observances, which brought it into still further
scientific disrepute. It is to the French that we are indebted for the re-
discovery and rehabilitation in medicine of this valuable therapeutic agent.
Toward the latter part of the eighteenth century, Tissot (1780) and Meibom
(1795) laid the medical world under obligation by their writings; the sub-
ject, however, attracted verj' little notice, until at a comparatively recent
period Mezger, of Amsterdam, and his pupils Berghman and Helleday (1873)
gave it a scientific foundation. The enthusiasm of a Swede, Peter Henry
Ling, was necessary to populnrize mechanolherapeutics, and in this he was
so successful, particularly in his native country, as to be regarded, by many,
as the creator of the modem movement cure. His leading physiological idea
was that the nourishment and development of the muscles depended upon
their use and amount of active movements they performed. The peculiar
merit of Ling, according to Schreiber (who has given us an excellent
I
I
I
I
I
I
*'Manual of Treatment by Mnssage and Methodical Muscle Exorcise'"), lies
in the fact that **he re-established the gymnastics of the ancients on a ecien-
litic basis, and, using the then known results of skilled German gymnasts,
penetrated still deeper into the writings of ancient nations, and became one
of the first to elaborate a complete system on an anatomical and physiological
basis."
Technique of Maasotherapeutics and Mechanotherapy. — The acientiiic,
mechanical treatment of diseases presupposes some acquaintance on the part
of the operator with regional anatomy and with the teachings of human
physiology. It is true that in the hands of uncultured persons, who practice
massage in an empirical manner, excellent results have been obtained, but
this is due to the fact that ignorant people are often shrewd observers and
are not modest in proclaiming their successes, while their failures are kept
in the background. The so-called art of bone-setting, by which stiffened
joints are restored to motion by systematic mechanical treatment, as prac-
ticed in this way, often is successful, and such cases are widely published;
whereas, if the treatment was a failure, the result would not be sufficiently
rare or interesting to be noticed.
Jn acquiring the art of massage it is of great ailvantage to have a
skilled instructor to teach the various manipulations and their applications,
and at the present time such experienced practitioners are to be found in
many of our large cities. It is a manual art, however, and cannot be
acquired either from written instructions or demonstrations, but by actual
experience. This being admitted, we may agree with Schreiber that "the
necessary knowledge and skill can very well be mastered without an in-
structor, if, with each mnnipuhuion, the final end, namely, the physio-
logical effect, be kept strictly in view," provided that this be confirmed and
established by sufficient personal knowledge of physiological, pathological,
and therapeutical processes.
In his "Art of Massage" (translated, with notes, by Benjamin Lee,
under the title of *'Tracts on Mnssage") Hcihmayr has very much simplified
the nomenclature and the multitudinous procedures of Ling and the French
writers particularly. He distinguishes the following principal methods of
application: —
1. Introductory massage. 2. Massage proper.
The divisions of massage are those of Mezger and his pupils, Berghman
and Ilelleday, and are now generally adopted by scientific writers and prac-
titioners:—
1. Stroking.
2. Friction.
Kneading.
Percussion.
L Stroking^ is done with the whole palm, with the radial border of the
hand, or with the thumb or ends of the fingers. The pressure may be as
hght as possible, and vary gradually from this to as much weight as can be
borne, the operating hand being reinforced by pressure made upon it with
the other, or the weight of the upper part of the body may be called into
play to give sufficient force to the stroke. The direction is nearly always
'Tninslnted. with the aullior's permiMion, by Walter Meodelson, M.D., of Now
Tork. PtuUdclphia; Len Bros, k Co.. 1887.
1002
NON-PHAHl
ERAPEUTICS.
venous (ctntripetul. or toward tlie heart), but in rare cases it may be artemT
(centrifugal, away from the heart).
2. Friction consists in more or less forcible, circular rubbing of a sur-
face, with the pulin of the baud usually, or with the fino^crs or final phalanx
of the thumb. During the manipulation the remaining fingers of the hand,
or, it may be, both hands, clasp tlie limb which is under treatment, making
it a point of support. It is advisable to begin at the border of the patho-
logicflUv-altered tissues, and work out the exudate into the surroundinff
healthy tissue in all directions, always concluding, however, with centripetal
strokings.
3. Kneading. — This is what is meant by "massage," which, howev»^r,
as an English word, is now used, in a comprehensive sense, to include all the
manipulations employed in manual mechanotherapy, and is applied to snch
treatment, even though kneading proper be not included in the prescription.
The restricted application of this term is to the method of picking up or
grasping a certain portion of muscle or other tissue with the fingers of one
hand and subjecting it to pressure between them, or upon a hard substance,
such as a surface of bone. Dr. Douglas Graham, of Boston, who is especially
skilled in massage, recommends that, in kneading, "each group of muscles
should be systematically worked upon, and, for this purpose, one hand should
be placed opposite the other; or, when the circumference of the limb is not
great, one hand may be placed in advance of the other, the fingers of one
hand partly reaching on to the territory of the other, so that two groups
of muscles may be manipulated at the same time, with grasping, circulatory,
spiral manipulations, one hand contracting as the other relaxes, the greatest
extension of the tissues being upward and laterally, and, on the trunk, fore-
arms, and legs, away from the median line. . . . It is well, first, to
go over a surface gently and superficially before doing the manipulation
more thoroughly and in detail.** For instance, to take up a limb of con-
siderable size, such as the leg, he finds three divisions of surface necessary:
the posterior and lateral aspects will form one; the stretching of the perineal
muscles from those of the anterior tibial region will make another; and
for the third a rolling of the tissues will be made away from the crest of
the tibia. "In large muscular masses we seize them, in successive portions,
with both hands, and squeeze in all directions, as one would squeeze water
out of a sponge," says Reibmayr. At the moment of making pressure a
certain amount of longitudinal traction may be practiced, which adds to
the value of the manipulation. Another, but much less effective, form of
kneading consists in rolling the limb between the palms of the hands. The
movements here are very rapid and pressure is less important, the principal
ctTect being produced by the frcqutmtly-rerurring stretching and forcible
Separation of the individual muscles, fasciae, and nerves. Dr. Benjamin Lee
judiciously sums up the characteristic features of this method in the fol-
lowing words: "Kneading is the procedure by means of which, above «I!
others, we act upon the circulation of the deeper-seated tissues and pro-
foundly modify the processes of absorption, assimilation, and destruction;
in short, of tissue-metamorphosis, — in other words, of life. Hence, our
aim should be, to as great an extent as possible, to avoid allowing any motion
between the hand and the surface of the skin, — that is to say, friction or
stroking, — and to compel the integuments following the motion of the hands
and fingers to describe the desired movements over the underlying tissacf.
TJASSAOB AXD nEST-CCRE. 1003
We thus not only act upon the circulation of the blood in the muscular and
visceral capillaries, but accomplish the very desirable objects of increasing
the elasticity of the skin, opening the areolar lymph-spaces, sundering
pathological adhesions l)etween the inferior layer of the skin and the tis-
sues beneath, and stimulating the flow of the areolar fluid. Just to the
extent thnt we allow rubbing do we lose the essential virtues of kneading."
Vibration is a form of massage, the alternate pressure and relaxation
being made with great rapidity. It is generally performed by means of a
mechanical contrivance, by which any portion of the body or limbs may be
thrown into vibrations at a rate of several hundred per minute.
Vapor-massage. — By the use of compressed air fluids may be nebulized
■nd driven with considerable force against the surface of. the body. Ordi-
narily, the objects sought after are the removal of adherent mucus from
the upper air-passages and the application of medicated solutions; but ex-
cessive force is injurious. An apparatus has been devised by which the
pressure can be rep^lated and made intermittent and the spray given at any
desired pressure, or to have a vibratory effect, producing results similar to
manual massage. Vapor-massagc has proved to be especially useful iu
affections of the nose, throat, middle ear, and bronchial tubes.
4. FerouBsion may be performed either with the border of the band,
the tips or knuckles of the fingers, the closed fist, or with some instrument
constructed for the purpose. The shocks should be rapidly, but not forcibly,
delivered, — usually from the wrist only. For this purpose various instru-
ments have been invented, such as Bennett's percussion-hammer, Granville's
percuteur, or electrical percusser; also, Klemm's or Huebsam's muscle-
beaters. The latter are useful for self-flagellation, but the hand remains the
beat instrument for accurately controlling the amount of force exerted.
After massage has been performed active and passive movements of the
neighboring joint-s are usually resorted to, especially in case of diseased joints
and in chronic cases with stiffened articulations. In the north of Europe
massage has been systematically combined with Swedish remedial gymnastics
(so-called movement-cure) with great advantage. In this method various
Idnds of g}'mnastic exercises are resorted to, and peculiar forms of apparatus
are provided to meet various requirements of treatment.
Electro-massage. — A massage electrode, in the form of a small roller,
affords an excellent means of combining the effects of electricity and mass-
age. It is usually connected with the faradic apparatus, but in cases of
paralysis or of exudation it miuht be very advantageously used with galva-
nism. Owing to its powerful effects, this form should be applied personally
by the phvsician, or, at least, it should be used in his presence and under
his direction, in order that tlie rules already laid down for the administra-
tion of electricity shall be duly observed.
The Roman bath is the term used to denote the use of some unguent,
such as cocoa-nut-oil, codliver-oil, or butter, in conjunction with massage.
Physiological Effects of Mechanotherapy. — As might be inferred from
the above description of the methods of massage, its physiological effects are
very obvious, though complex. They may be considered as mechanical,
thermal, electrical, and vital, the latter terra being applied to the force or
forces which resist disease and oppose death. The mechanical effects are
immediate and most important. Under the movements there is a stimula-
tion of the exchange of cell -contents, an increased activity in the movement
J
100-i
XOX-I'llAIIilA(-AL ijhxMKIilts AM» uKSKUAL TIIEUVPKrTICS.
of the areolar fluid, and noticeably iu acceleration of the blood-currents and
contents of both blood-vessels and lymph-channels. The glands behave in
a similar manner, although they are unaffected by mild electric currents;
*'every mechanical impression, such as stroking or pressure, whether over
healthy or intlaraed glands, causes the escape of large quantities of contained
lymph." Von Mosengeil injected a thick solution of finely-levigated, black
India ink into various joints in rabbits. Some were treated by massage;
others were let alone for control experiments. Upon subsequently killing
the animals, "In the cavities of the joints which had been kneaded no trace
of India ink was found, while in those which had not been so treated it
was observed in considerable quantities, mixed with synovia. On examining
the thighs, numerous and widely-scattered deposits of India ink were found
in the areolar tissue in those Urabs which had been manipulated. These were
entirely wanting in the others. . . . Well-marked deposits of the col-
oring matter were discovered in the intermuscular connective tissue. The
crural muscles were also stained black. The thighs of the unmanipulated
limbs were not in the least colored, the muscles being of a clear red. The
glands of the manipulated extremities which were situated above the joints
were stained intensely black, and the lymphatics leading to them could be
detected by the naked eye as two black cords. In the untreated limbs ink
deposits in the lymphatic system were entirely wanting."' Similar conclu-
sions are drawn from the results of Jawadski's experiments upon dogs. It
was found that massage made in the direction of the heart accelerated the
absorption of liquid substance introduced beneath the skin, and that it
considerably increased the eflects of those substances. The rapidity of the
absorption during the massage does not depend upon the quantity of the
injected liquid. Absorption is, therefore, stimulated by massage, and this
holds good in the synovial lining of joints as it does elsewhere, the process
taking place principally through the lymphatic vessels. In the blood-vessels
stroking and kneading caused increased rate of blood-movement; this being *
assisted in the veins, as also in tlie lymphatics, by the pressure of valves
in the inner walls. Randolph and Dixon^ found, upon examination of the
fteces of persons receiving inunctions of codliver-oil with massage, that there
was a notable increase of fat in the discharges, thus proving absorption of
the oil in SO per cent, of the cases.
The temperature of a limb, and very commonly of the whole body, is
slightly increased by massage. Arrested motion and friction give rise to
thermic efTects in the body as in the physical laboratory. Owing to physio-
logical causes, the whole of the heat thus developed in a body under massage
treatment is not made manifi^st by the thermometer, but is probably trans-
formed into other forms of enercry, ^x\ch as electricity or cell-force. Heat,
electricity* chemical action, motion, and lifo-force are intimately cormected,
and experiment and observation prove that properly-directed massage ele-
vates temperature and improves nutrition, partly mechanically and partly
through increased cell-activity. The vulgar notion that the operator directly
transfers electricity or so-called animal magnetism from his own body to
that of the patient has no other basis than this. Although a certain class
of operators make capital for themselves by pretending to confer health or
magnetism, their claims are either due to ignorance or to a deliberate at-
' "Transactions ol the College of Physicians" of Philadelphia.
MA8.SAi.iE AXI) HKST-CrRE,
1005
I
cempt at deception. ^Vhat passes from the operator to the patient is motion
and, to a slight decree, heat. The operator feels the result of exercise of his
muscles and becomes fatigued, not because he has parted with any mys-
terious force, but simply because massage is rather hard work.
Schreiber divides the physiological effects into two groups: —
1. Primary (purely mechanical) effects; i.e., the removal of lymph,
exudations, transudations, and extravasations; the destruction of exudations
by pressure, the removal of vegetations by friction, and the Bolution and
removal of adhesions.
2. Secondary effects, which act by increasing the circulation by stimu-
lating the nuipculnr and nervous systems, by setting up molecular changes,
and producing consequent changes in sensation, and by effecting alterations
in the process of general nutrition.
Pain in an inflamed area being caused by the pressure of some exuda-
tion upon sensory nerves, relief will be produced by removal of this pressure
under the etfects of mechanotherapy. Analgesia is, therefore, obtained by
massage. Inasmuch as manipulation causes an onward flow of the contents
of the lymphatics and blood-vessels, massage has an antiphlogistic action.
This is further dcmonetrated in its power of causing resorption of inflam-
matory products. It may also be regarded as an alterative on account of
its effects upon effused fluids and its power of restoring healthy action in
diseased parts. It is likewise a local stimulant and counter-irritant.
Neuralgia, or pain unaccompanied by inflammation, is usually the re-
sult of some lowering of the genera! nutrition, or the effect of a poison. such
as molaria. It may or may not be associated with any local lesion which
acts as an irritant. Massage is especially serviceable in the first class of
cases, owing to the improvement of local and general nutrition; but any
source of irritation — such as eye-strain, caries of teeth, indigestion, etc. —
should receive attention and be corrected if possible. The secondary effects
of massage are included under the general heads of stimulation of vasomotor
nerves and arterioles, with, in consequence, increased absorption and nutri-
tion, and muscular contraction with increase of heat. Mechanical stimulus
bears a strong resemblance to electrical stimulus in its effects upon the
human body. According to Schreiber, "Any source of energy conveyed to
a nerve from without first expends itself in producing molecular change, and
this is again converted into energv% manifesting itself through the various
forms of innervation." Hence, it follows that, as far as its effects upon the
nerve-tissue are considered, it may be regarded as identical \vith electricity,
within certain limitations. The proper appreciation of this is of much im-
portance in mechanotherap}' and is of daily practical application, especially
in the treatment of neuralgia. The normal functional activity of the nerv-
ous system, according to Heideuhain, Hallstein, Tigerstedt, and others, con-
sists of a species of wave-motion. The communicated motion or stimulus
is converted, in some unknown manner, into the form of motion peculiar
to nerve-substance. How molecular change is transformed into nervous
force is a physiological problem which has not yet been solved; but this
hypothesis of Tigerstedt is at least plausible, that nervous energy itself is a
form of wave-motion among molecules, and analogous, therefore, to light and
heat. Douglas Graham sums up the action upon the nervous system in the
following enthusiastic terma: "Upon the nervous system, as a whole, mass-
age most generally exerts a peculiarly delightful, and at the same time pro-
lOOr
NOX-PUABMAGAL REMEDIES AND GENEBAL THERAPEUTICS.
foundly sedative and tonic, effect. While it is being done, and often for
hours afterward, the subjects are in a blissful state of repose; they feel as
if they were enjoying a long rest, or as if they had just returned from a
refreshing vacation, and quite frequently it makes optimists of them for the
time being. An aptitude for rest or work usually follows, though generally
those who submit to this treatment feel gloriously indifferent, and needless
apprehensions are dispelled. I have never known anyone to take cold or
suffer from exercise in the open air after general massage when ordinary
care was observed. . . . Through the medium of the central nervous
system even local massage is radiated or reflected throughout the body, thus
acting at the same time as a nervous and vascular revulsive, or physiological
counter-irritant, if one may be allowed the expression. One of the best
examples of this, perhaps, is the relief from headache from manipulation of
the back and shoulders. It has long been known that strolcing the limba
often induces sleep. ... The transmitted and reflected influence of
massage must evidently be as numerous as the distributions and connections
of the sensitive nerves that are accessible to its impression. Briefly, it may
be said to act on distant parts by sympathy, by reflex action, and, as a variety
of the latter, by inhibition." "Furthermore, massage excites and awakens
the muscular sense in an agreeable and beneiicial manner, such as nothing
else does, restoring idiomuscular contractility and extensibility; and we know
that the state of our muscles indicates, and often determines, our feelings
of heal til and vigor or of weariness and feebleness." Estrndi'Te^ sums up the
effects of massage in similarly enthusiastic expressions of opinion. "I think
that this happiness, this quietude, this respiration more free, these ideas so
pleasing, are the result of the equilibrium which at this time reigns over all
the functions. The nervous system, no longer requiring to exert herself
against obstacles to respiration, to circulation, and to nutrition, enjoys a
tranquillity almost equivalent to repose, and then this state of oblivion,
de la vie expeciatif, in some manner leaves the imagination to dwell upon
the ideas of beatitude which come in multitudes to occupy the nervous cen-
tres, and these now have no need to concentrate a certain part of their
activity to control the functions, — to subdue some and to stimulate others.'*
Massage is the handmaid of medicine, in a literal sense, since the ab-
sorption, diffusion, and assimilation of remedies is favored by general mass-
age,— at the same time that the emunctories are stimulated and the excretion
of effete material by all the channels of excretion is encouraged.
Therapeutic Applications. — At the present day no physician can be con-
sidered well equipped for his duties unless he is acquainted with at least the
fundamtntal principle's of massage, and understands how to apply them in
practice. It is by no means necessary that he should himself be an expert
in the art of massagc^althou^h this would be a consummation devoutly
to be wished for his patient's sake, — hut he should know how to prescribe
massage as intelligently as be prescribes medicine, and should know whether
or not the work is projierly dune, ijo that his patient may receive the greatest
amount of benefit. It is too often the case that massage is "tried** in a case,
and left entirely to some amateur masseur^ who lacks tact and experience,
and, after one or two seaivces^ it is abandoned, and massage ie brought into
' Douglas ("iralmm, '
tion. J. B. Lippincoti Co,
Miiruiii) Therajwutica, A Treatise on Massage/
Philadolphin, lI>0-2. page 112.
Tliird Edi-
MASSAGE ASD KKSX-CURE.
1007
discredit. The physician owes it to himself and to his patieut to see that
the treatment is properly administered, and carefully adjusted to the strength
of the patient. Some cases are benefited by ten minutes of massage, but
would be completely exhausted by the full liour, which is the usual standard
of service rendered among the lower class of operators. The golden rule in
massage is that the operations should be conducted in such a manner and
for such a period of time as will afford the greatest benefit to the patient,
rithout being followed by any sense of fatigue; but, on the contrary, as
stated on the preceding page, he should feel rested and invigorated after
each treatment.
Neurasthenia and Hysteria. — Massage occupies an important place in
the so-called *'"re8t-cure" of Dr. S. Weir 5litehell. It must be remembered
that the subjects for this combined treatment of physical and mental
<}uietude, diet, electricity, and massage are either broken-down, chronic in-
valids or hysterical subjects, whose energies apparently arc in a state of
hibernation, or, at all events, in an abnormal condition as regards their
response to the requirements of the mind and the body. Such patients are
too weak for bodily exertion, often paretic, certain groups of muscles being
affected more than others; there may be, and often is, great emaciation, due
to want of exercise, and frequent pains and aches, owing principally to
deficient nourishment of nerves and defective innervation of organs. Cases
which have been bedridden for years have been cured by Mitchell, Playfair,
and others, by enforced rest, improved nutrition, and electromassage. The
psychological factor iu the Weir Mitchell treatment is certainly a valuable
adjunct. He insists upon isolation of the patient, forbidding all visitors,
especially members of the family, absolutely confining the patient to the
company of the nurse and the doctor, during the period of treatment, and,
in some cases, even interdicting all private correspondence. "Rest," says
the author of this treatment, "means with me a good deal more than merely
saying, *Go to bed, and stay there!' It means care that letters bring no worry-
ing news; that they are brief, and of such kind as a nurse may read aloud.
It means absence of all possible use of braiu and body. It means neither
reading nor writing, at least for a time, with the exception in cases where,
as is rare, there is no asthenopia. If the nurse can read to the patient, and
reading be borne without fatigue, let it be used, at first, for only a few min-
utes at a time. If this wearies, then let the nurse try to cull the bits of in-
teresting news from the papers, and, as she glances over the columns, talk
this to the patient in place of formally reading aloud. ... If you are
disposed to smile because I say let the nurse feed the patient, you will not
if, lying supine, you make the experiment of using your own hands in the
act of feeding. ... I believe th.^t I have done something to make rest
fashionable among physicians as an essential to the treatment of spinal
maladies, and, both in them and in the treatment of neurasthenia and hys-
teria, it is well that you clearly comprehend what it is that I mean by rest.
Your trouble will be, always, that the patient will desire to lie on a sofa, or
to make some such compromise, but in bad cases — and it is only of these I
speak — all this is but mere trifling, and you had better, on the whole, make
an error in the direction of a too absolute rest."* The fact is, that in many
' 'T^rcturea on Diseasefl of the Xervous Symtem, especially in Women," p.
PhiladelphU. I88I.
1008
NON-PHAHMAOAL REMEDIES AND GENERAL TUKRAPEI'TIOS.
of these patients there is a long history of domestic tyranny by the querulous
and exacting invalid, and the first battle to be fought is to establish the
authority of the physician. Unless he can secure an unconditional surrender,
80 as to be master of the situation and have hie directions obeyed, both in
letter and epirit. he had better retire from his charge of the case, and refuse
to accept any responBihility as to the regnlts of treatment, in order to pro-
tect his own reputation. After he has secured the co-operation of those in
authority, he is in a position to dictate the plan of treatment. The rest-cure
consists essentially in keeping the patient passive, in the recumbent poeture,
for a certain length of time, — generally about three months, — keeping up
nutrition by frequent feeding and the daily application of electricity and
massage. The moral influence of the association with the Irained nurse is
of great advantage to the patient, as is also the knowledge that the term of
treatment depends altogether upon the rate of improvement. In many
cases this knowledge and the irksomeness of unaccustomed restraint combine
to awaken an ardent desire to get well, which has a very happy effect upon
the results of the treatment.
In hysterical paralysis, whether monoplegic or paraplegic, or in hemi-
paresis, the treatment by rest and massage, as above indicated, is of tbe
greatest service, although in the lighter cases it may not be necessary, these
being the patients who are likely to be benefited by the static current. Weir
Mitchell, in the work already quoted, warns against allowing a convalescent,
hysterical, paralytic patient to overtax her strength, or the original difficulty
may return in an aggravated form. As regards the dietetic treatment, this
is not the place for its discussion, but it is proper to observe that many fat
patients are really thin-blooded and anwrnic, and the first step toward im-
provement is a decline in weight. Mitchell reports one case of a paraplegic
woman, weigliing one hundred and seventy pounds, who was put to bed and
allowed a milk diet mixed with a little rice-water or barley-water, the milk
being grfldually reduced to less than a quart a day; when she showed signs
of weakness beef-soup was added to tlie diet for a day or two. In one month,
under this regimen, her weight wa? reduced some twenty-four pounds.
Massage and induced currents, with a good diet, now turned the scale; she
gained in color nnd in flesh, and at the end of another month she could walk
without much trouble.
Dr. Benjamin Lee points out a posRible abuse of the rest-cure, and con-
siders that the treatment, in other hands than the author's, is capable of
producing injury rather than benefit. Tic regards (he movement-cure as
the essential agent in the restoration of these nervous invalids, and the
enforced rest, apart from its influence upon the morale as a means of sub-
duing the perverse will of a spoiled child, simply as an accident of the mass-
age and the acto-passive exercise necessary, to a certain extent, to reap the
full benefit of the method, not necessarily remedial in itself, and, without
the other means, as likely to do harm as good. Overfeeding" — which is in-
sisted upon — is only made possible by thr merhanii-al treatment, and, in its
effects, may really be undesirable and pernicious, by overloading the emunc-
tories to a degree entirely beyond their cnpability to take care of assimilated
material forced upon them in order to luiild up adipose tissue.* It is possible
that this fat may be deposited in abnormal situations, as in the liver or in
tbe walls of the heart. He holds that, in these cases of impaired nutrition,
hydrated blood, degenerated tissue, and depressed nerve-force, our object
SAGK AND UEST-CCRE.
1U09
fftiouid not be to overload the economy with carbon and lay on layer after
layer of adipose tissue, but to create a demand in the tissues farthest from the
centre for healthy blood, by breaking down and forcing out the dead-alive
cells, with their accumulations of morbid deposit, and sending them to the
emunctories to be excreted, and, as this demand begins to be felt, supplying
it cautiously, — principally with nitrogenous elements, — and not in excess of
the assimilating organs to manage it. It is evident that the results of the
Bo-called rest-cure will not be equally good in the hands of all who attempt to
carry it out, and, where it is practiced, the greatest attention should be given
to all tiic details in each individual case.
Massage in General Medical Practice. — Headache due to hypcraemia is
relieved by neck-massage, — stroking the tissues upon eacli side of the larynx
and trachea downward, thus accelerating the venous current in the numer-
ous superficial veins. Its operation is analogous to that of blood-letting upon
the cerebral vessels; the stroking, therefore, should be gentle, especially at
first, and not too frequently repeated, or it may cause syncope. Massage of
the mnsclps of the back, also, often relieves headache. In congestion of the
brain or membranes, whether active or passive, the intracranial circulation
may be diminished in this way, prc])aratory to the employment of slower
derivative agents, such as purgatives. In Bun-stroke Reibmayr is so con-
vinced of its good effects that he says it should always be instantly resorted
to. Hemicrania, of the congestive form, may be relieved promptly in the
same manner. In the anaeraic form of hemicrania, or migraine, massage of
the neck does uo good; but firm strokin<; uf the frontal and temporal regions,
with the eyes closed, usually brings relief. Ae such patients are readily hyp-
notized by gentle stroking of the head, this method should be employed with
circumspection, unless it is desired to produce hypnotic sleep. Nervous
headaches and some neuralgias are benefited by stroking and friction.
Norstrom, of Paris, finds neuralgias of muscular origin, which are accom-
panied by centres of induration in the muscles of the neck, and often by
tenderness along the nucha. These he attributes to chronic inflammatory
processes, and that the removal of their indurations by massage is invariably
accompanied by complete cure of the neuralgia.
In tabes dorsalis, or locomotor ataxia, good results have been reported
by Schreiber and others following the use of massage. The annoying symp-
toms of this disease are undoubtedly relieved by mechanotherapy and the
progress of the morbid lesions possibly delayed; but it cannot be said as yet
that the therapeutical problem in this interesting malady has been solved.
It is in sciatica especially that the most brilliant results have been re-
ported from the movement-cure. In sciaticas of rheumatic origin strong
stroking, alternating with percussion, along the course of the affected nerve
is usually successful in producing a cure in a short time. If pathological
changes in the course of the nerve have caused the sciatica, the succees of
ilie treatment will depend upon their discovery and their removal, either by
local massage or by other means. Wlicn tumors, or pathological changes
deep within the pelvis, have caused the pain, massage may fail and, in
fact, may aggravate the sutTering. In uncomplicated cases cure may be
hastened by combining massage and electricity. Painful points, eepecially
along the spine, are frequently met with, especially in women. As such
Ipointa are in some cases the point of departure for hysterical or epileptiform
I eonvulaione, it is important to relieve or remove them early by local massage.
*
1010
NOV-PirARMACAL REMKHIES AND OENKUAL TUEIUPErTICS.
In various neuroBes of occupation, professional nexirosee, of which
writers' cramp is a familiar illustration, massage is the only agent capable of
aiTording permanent relief. The method of Wolf in treating writers' cramp
has already been mentioned imder ''Electricity"; it is a combination of strok-
ing and friction, with both the galvanic and faradic currents. In cramp of
the calf of the leg the toes ehould be strongly adducted, so as to twist the
muscle, while friction is applied with the palm of the hand.
Chorea is a disease which is rapidly controlled by massage and gym-
nastics, as pointed out by Blache and Bouvier/ The treatment is by light
stroking of both upper and lower extremities and the chest, the patient being
held by attendants. The muscular masses of the back, especially at the
neck and along the spinal column, are also massaged. The treatment, last-
ing for about an hour, should be repeated daily for three or four days.
"After each treatment the irregular muscular contractions become less vio-
lent, and the patient gives it to be understood that he feels more comfortable.
Sleep, which had been completely interrupted during the continuance of the
most violent contractions, is gradually re-established, and speech begins to
return. For several subsequfnt days the light stroking and friction must be
persisted in, and the masseur may then begin very regular rhythmical,
passive movements." Following these, aeto-passive movements are encour-
aged for the next eight or ten days, when the patient may be encouraged to
try to walk alone. As soon as he is able to accomplish this, active gymnastic
exercises of simple character are superadded. By systematic training and
encouragement the control of the will over the muscles is gradually estab-
lished, while at the same time there is an improvement in the chlorotic con-
dition, the heart and arterial murmurs disappearing. This method of treat-
ment, according to its originator, Dr. Bhiche, is not followed by relapses, and
the patients apparently are permanently cured.
The therapeutical efTects of vibration may be briefly alluded to in thia
place. The late Professor Charcot testified to its beneficial influence in
paralysis agitans. The patient was seated in a specially-devised arm-chair,
which, by a mechanism set in motion by means of electricity, was made to
undergo rapid oscilhitory movements. Dr. Gilles de la Tourette has applied
a similar method to the head in megrim, insomnia, neurasthenia, melan-
cholia, etc. His apparatus, which is made in two pieces, bears some resem-
blance to a helmet » and upon its top is placed a small electric motor. The
motor produces a uniform vibration of (iOO revolutions per minute.
In rheumatic paralysis, or peripheral paralysis of a motor nen'c as a
result of exposure to cold, and also in lead paralysis, massage is an in-
valuable adjunct to the electrical and other treatment, and a tendency to
degeneration of the muscles and nerve may thus he overcome.
In infantile spinal paralysis and clnb-foot due to paralysis, massage.
systematicaliy practiced, improves nutrition of the parts and is often cura-
tive if early resorted to. Erb considers it of service as an adjunct to elec-
trical and other forms of treatment. It is often impossible for parents to
bring their children to be treated daily with electricity, and they can be
taught by the physician to employ massage at home. In central paralyses
the nutrition and circulation of the palsied parts can at least be improved
by massage.
" "Use of GymnaaticB and Massage in Chorea," Dr. Blache, PaHs, 1864.
HBAQB AKD BEST-CURE.
Dr. Murrt41 reported a case of recovery from chrome myelitis, in a man,
35 years of age, as the result mainly of massage.
In acnte catarrhs of the mucous membrane of the upper air-passages,
in coryza, tonsillitis, pharyngitis, an^a, and laryngitis, massage of the
neck is highly st'niccable. Wei^s employed this method with remarkable
meccs9, in a cliild with spasmodic croup, a single sitting relieving the most
ent symptoms; the short, wheezy respiration, accompanied by the most
painful tension of the respiratory muscles, soon became more free, easy, and
deep; the aphonia gave place to a voice which, although still hoarse, was no
longer mute, and the child became more tranquil and willingly underwent
the massage, inasmuch that it brought him such manifest relief. Bronchial
catarrhs, asthma of the pure nervous type, and even angina pectoris are
benelited by stroking, friction, and percussion with the palm of the hand
imlil the slan becomes intensely reddened. In eleven cases of dry and sero-
fibrinous pleurisy, Polakow observed favorable results from massage of the
chest, though in suppurative cases it is contra-indicated. During the treat-
ment tlie semus effusiou was rapidly absorbod.
In torpid liver, semiparalyzed condition of the intestines, and con-
stipation abdominal massage is capable of accomplishing much toward over-
coming the morbid state. As stated by Reibmayr/ we should bring it into
use in all those affections in which we desire to regulate the peristaltic move-
ments of the stomach and bowels; to exert a favorable influence on the cir-
culation of the blood and of the IjTuph so closely dependent upon those
movements, and hence, secondarily, on the secretion and excretion of the
digestive juices; to expedite the absorption of exudations; and, finally, to
dislodge obstructing fa?cal masses in the intestinal tube by direct mechanical
action. Massage may, therefore, be practiced in acute and chronic gastric
and intestinal catarrh, dyspepsia, cardialgia, dilatation of the stomach, in*
testinal obstruction (ileus), tympanites not dependent upon inflammation
of the peritoneum, ascites, and, finally, all the sequela of peritoneal inflam-
mation,— such as firm peritoneal or extraperitoneal exudations, swellings,
and adhesions, — always provided that the inflammatory process is completely
at an end. All inflammatory affections of the peritoneum, malignant tu-
mors, and deep ulcerations of the stomach or intestines contra-indicate its
employment. "For habitual constipation, especially in persons of sedentary
habits, abdominal massage, combined with pelvic gymnastics, constitutes
the most desirable, sure, and efficient remedy that we possess," in the opin-
ion of Benjamin Lee. Constant moderate pressure has an analogous action.
Dr. Feilchenfeld has successfully made use of a cushion containing three or
four pounds of shot included between layers of wadding. Thus an equable
pressure is maintained. The cushions are held in position by tapes and, as
a rule, an hour or an hour and a half of this application is sufficient to bring
about a movement of the bowels.
In hepatic congestion with jaundice, local mat^iaage '^ver the liver with
general abdominal massage for fifteen minutes daily are used, combined with
gymnastic exercises for pelvic muscles. Abdominal massage, both manual
and mechanical, is a valuable aid in strengtheninj; the abdominal and vis-
ceral muscle?, and to replace viscera. In cases of gastroptosis, after replace-
* "Tract* on Massage.'* No. 3.
delphia. 1887.
Translated, with notes, by Benjamin T.ee, Phila
■
1012
XON-PITARMACAL RKMKDIES AND OENEUAL THERAVErTICS.
merits by means of carefully-executed manual Swedish movements, tne
stomach may be retained iu place by the ahdominal supporter, applied while
the patient is in a reclining position. M. F. Cantni claims that abdominal
massage has undoubtedly a diuretic action, and is especially useful in cardiac
diseases.
Chlorosis and ancemia, as suggested by the late Sir Andrew Clarke, are
often associated witii. and dependent upon, constipation. Abdominal mass-
age to overcome the latter condition, combined with general massage of the
entire surface, will render most favorable results. In local oedemas and con-
gestions stroking, friction, and passive movements are rapidly curative.
Kheiunatic gout, or, more correctly, chronic rheumatoid arthritis, is,
according to Dr. Graham, amenable to massage, provided that the treatment
commence before the pathological changes in muscle, tendon, bone, and
surrounding tissues are too far advanced. Frequent visits and arduous work
are required, but in the end amply repay both physician and patient for the
time and trouble expended. He obtained gradual improvement from the
use of massage in five out of six cases of well-marked rheumatic gout; and,
by keeping up the treatment, four patients regained tolerable use of the
atTected limbs, and in one recovery seemed to take place. Berghraan and
Helleday, Courfield, and Balfour have reported cases similar to those of
Graham, where marked improvement resulted from the treatment. His
method was deep manipulation, without friction or inunction; passive mo-
tion as far as pain would allow, and sometimes farther; and resistive motion
as soon as it could be done. If pain lasts for several hours, and increasee after
subsequent elTorts, the treatment must be modified or suspended. Knead-
ing with one hand, so as to break u]3 indurations or disperse etfusions, while
the other hand pushes oloiig the circulation in the veins and lymphatics
above the joint, will often lead to absorption of products not too firmly
organized. Massage of the adjacent area acts as a physiological derivative,
and improves nutrition. The inutility of any other form of treatment make*
massage the only resource in this disease.
Jn heeirt disease, when valvular disease has resulted in insufficiency and
the compensatory hypertrophy is commencing to fail, at a time when there
is slight cedema, fullness of the venous system, symptoms of hyperaemia of
the liver, etc., general massage atfords marked relief. The fedema disap-
pears, the circulation improves, and the digestive organs perform their
duties in a more satisfflctory manner under the influence of properly-applied
massage. In weak heart, due to deficient innervation or to lowered tone in
the muscular tissue, following certain fevers, — such as typhoid, influenza,
diphtheria, etc., — the daily performance of general massage, with passive
exercises, will gradually restore vigor and tone to the debilitated organ.
Gentle, systematic, and resisted movements form an important part of the
Schott treatment nf Jieart disease as practiced at Nauheim, Germany.
Ill diseases of women, mnssafrr*, on acct>unt of itP corroborant power, is
a valuable emincnagotrue. It diiniiiihlius the sittTering attendant upon dys-
menorrhoDa, and may be instrumental in restoring such normal relations as
will overcome sterility. In malpositions and flexions of the uterus, with or
without prolapse, the application of pelvic massage afier the plan of Thure
Brandt, of Stockholm, has proved very successful. It consists in (1) raising
the womb; (2) massage of the organ and its ligaments; (3) forced abduc-
tion and adduction of the knees; (4) percussion of the lumbar and sacral
I
vertebrae. This method favors absorption of exudations, cicatricial bands,
adhesions, etc., and was indorsed by A. Reeves Jackson, of Chicago. With
regard to the correction of womb troubles, Weir Mitchell offers the follow-
ing rules in connection with the rest-cure: "In the case of married women
I make, or cause to be made, a thorough examination, to begin with. If
there be onlj congestive states and their consequences, 1 trust to the gen-
eral treatment for cure. If there be marked displacements or excessive men-
struntion, I like to correct the one and have the uterus well searched for
possible causes of the other. Should there be grave fissures of the neck of
the womb or perineal rupture, I prefer to have them relieved at once. Mis-
placed ovaries cause, in my experience^ a great deal of trouble, but both
Professor Goodell and I have seen a number of cases in which this annoying
complication righted itself spontaneously during treatment by rest."
Keyes, Thure Brandt, Eberman, and others have beneficially employed
massage in affections of ihe prostate gland. The method is practiced by
means of the index finger introduced into the rectum. The bladder having
been previously emptied, pressure and friction are made upon the gland,
pressure being made in a direction toward the pnliis and bladder. These
manipulations are thought to promote absorption of pathological products
by the lymphatics and blood-vessels. The method is unsuitable to acute
prostatitis, but may be advantageously employed in the deelining stage. If
suppuration occurs, massage is a serviceable procedure after the abscess has
been opened. The method is of special value in chronic prostatitis asso-
ciated with swelling, and in soft, uniform hypertrophies of the gland.
In skin diseases extended experience lias only confirmed the favorable
opinions expressed by the author in 1S84, in papers which he read before the
section of Dermatology and Syphilis of the Eighth International Medieal
Congress, at Copenhagen, and before the American Medical Association
{1883), on '^lechanical Remedies in Skin Diseases;' as to the practical value
of massage in this special field. He regards it as one of the most helpful
ints at his command. To consider a few of its applications, we may com-
ce witli seborrhcea capitis. Gentle massage is here of great service in
restoring perfect capillary circulation, promoting absorption, and imparting
a healthy tone to the tissues. It prevents falling out of the hair, and favors
a healthy new growth by improving the nutrition of the hair-bulb. In acne
indnrata and in glandular swellings in the skin, ninssage opens the clogged
absorbents, caiising the lesions to disappear and rendering the skin soft and
elastic. Many skin disorders are the result of disturbed digestive processw*
and constipation, and the application of massage to the abdomen, by knead-
ing and percussion, is of excellent senice in removing the cause of the un-
healthy condition of the skin. Excess or deficiency of pigment may be
remedied by massage, owing to its dispersing power and tendency toward
restoring normal action. In psoriaBia and scrofuloderma, gtnoral massage
is used to increase nutrition of the skin and promote the formation of blood-
corpusclep and consequent oxidation. In the itching of acute or chronic
eczema massage is directly beneficial, and patients may be instructed to use
it in place of scratching with the nails, which produces secondary lesions
and aggnivatcs the original condition. Many trophic disorders of the skin
Are influenced favorably by properly-administered movements.
Infiltration of the skin, accompanied by roughness and scaliness, is a
condition in which ordinary methods fail, but which will yield to massage.
- {188
■ ofn
I
1014
KOV-niARMACAL REMRDFES AVD GKNERAL TJTERAPEnTlCS.
In simple cases of rou^h, thick, and leathery skin, where it is desired to
enhance the beauty of its texture, its fairness, softness, and elasticity, there
is no agent so powerful as massage. Frequent warm bathing, an occasional
Turkish bath, and daily shower-baths are very valuable in stimulating the
cutaneous circulation, and should be supplemented by friction and knead-
ing. The well-recognized benefits of friction with a coarse towel are feeble
imitations of the results of skilled massage, such as gave suppleness to the
muscles and health and beauty to the skin of the ancient Greeks.
Massotherapy is the best means in our power for rendering old, infil-
trated, exudative material amenable to the action of the absorbent vessels.
In elephantiasis arabnm, deep kneading has led to excellent results. In the
intervals of the ap])lication ihe limb may be compressed by a bandage,
preferably of rubber. Very decided diminution of bulk has followed this
treatment. Ecchymoses of the face or other parts of the body, due to bruis-
ing and consequent eiTusion of blood xmder the skin, are very disfiguring
for the time; they may be rapidly dispersed and absorbed by rotary friction,
stroking, and gentle kneadino^. Hsematoma of the auricle, frequently occur-
ring in the insane, is believed to arise frequently from direct injury. At all
events, it gives rise to considerable deformity, and should be treated with
massage applied in the same manner. In furuncle, before suppuration has
occurred, gentle friction — first of the neighboring vascular area and finally
of the lesion — wnll relieve pain and promote resolution. The pain of lierpei
zoster is said to be decidedly lessened by well-directed local stroking over
the afTected nerve. In hypcridrosis and other disorders of the perspiratory
glands, good results may often be noticed after genornl massage, and the con-
sequent improvement of the general health. In sycosis, we have had excel-
lent results from general massage combined with local measures. Ecthyma
being an exprcEsion of faulty nutrition, massage similarly promises good
results by improvement of the general condition. Impetigo is similarly
caused and similarly benefited. In lichen planus and lichen scrofnlosiu
massage is of service, and it is calculated to counteract the constitutional
depression attendant upon lichen mber. Scrofulous and syphilitic lesions
of the skin, especially occurring in weak patients or those of feeble consti-
tution, or debilitated by intemperance, sexual excess, insufficient food, poor
clothing, and bad air are rapidly benefited by general massage and proper
hygienic management. Cicatrices and hypertrophicd scars may be softened
and caused to disappear by persevering applications of friction and knead-
ing, especially if codliver-oil be used locally, by inunction, at the same time.
Morbid growths of a benign character, hypertrophied tonsils, and
chronically-enlarged glands may disappear under general and local massage;
and inflammator)' thickening and indurations are often removed in this
manner.
In chloral poisoning, alcoholic coma, or opium narcosis, as suggested
by Dr. Murrell, massage of the extremities is useful in maintaining the
circulation until antidotes have time to act.
Synergists. — Hygienic measures of all kinds assist massage in bringing
the body to its highest state of physiological perfection. Pure air and ex-
ercise are powerful adjuncts; bathing, especially sponge- and shower- baths,
are too much neglected; affusion, or pouring, of either hot or cold water,
or each in turn, is a decided stimulant to the nerves and vessels of the part
treated; and, in fact, massage is greatly aided in producing the desired re-
UASSAOE AXD KKST-CrRE.
1015
I
suits by these and similar means. Proper clothing, both at night and during
the day, will assist the treatment. During massage the clothing should be
removed, or of such character as to permit the required manipulations. In
the use of apparatus, as in the Swedish system of mechanotherapy, and, in
fact, in the drill, either with or without appliances, a gymnastic suit of
flannel, with a belt at the waist, is indispensable. Intelligent supervision
should be given to the daily food of the patient, in order thot the best
results may be derived from the movement-cure. The diet should be plain,
nutritious, and, unless iu special cases where the contrary would be required,
it should be sparing. The object to be kept in mind by the patient should
not be the gratification of the palate, but the needs of the system. The
advice to exercise not for strength, but for health, may be accompanied by
the admonition not to eat for enjoyment of the pleasure of the table, but to
keep the body well.
Electricity is closely allied to massage in its effects upon the muscular
system, as it produces contraction and commotion in the body of the muscle
by acting upon the muscular fibres and end-organs of the nerves. As pre-
viously indicated, a combination of these valuable agents is used by means
of the roller electrode, using either faradism or galvanism. The hand of
the manipulator may also be made to act as an electrode and communicate
a current to the tissues operated upon. In delicate patients and children
this is the best manner of administering electricity, as they are reassured by
the knowledge that the current must pass through the body of the attendant
before reaching them. Jn the rest-cure faradic electricity is employed to
produce contractions of individual muscles, and, in effect, it serves as a
means of making passive motion. The massage is performed either before
or after the application of the electric current, but generally before.
Some drugs are of great value in assisting a course of massage. They
would generally be classed as nervo-tonics and restoratives, but it is often
necessary to regulate the action of the digestive organs and get theiji into a
normal condition before getting the beat results of the massage treatment.
If digestion is feeble, it may l>e well to give tonics and carminatives for a
time, until the improved nutrition enables the glands to secrete a better
quality of gastric juice and other digestive fluids. Where the liver is per-
forming its duties poorly, the administration of a good cathartic will hasten
the effects of massage, and in cases of constipation the use of a large warm-
water-and-soap enema, or the injection of a small quantity of glycerin into
the rectum, will assist the manipulations in moving scybalous masses. At
the same time, it is observed that eases of constipation which come for treat-
ment by massage are generally those which have been through the list of
purgatives; and pills and potions have lost their effect, owing to an atony
of the bowel-wall or paresis of the nerves causing peristaltic movements.
As already intimated on a previous page, feeding is to be regarded as of
more importance than drugging, and a judicious regulation of the dietary
will often make remedies superfluous, especially if abdominal massage be
properly practiced, in many disorders of digestion.
Tonic remedies proper or nerve-tonics, of which strychnine may be
taken as a representative, have been greatly ai'used in the treatment of
neurasthenic patients, who require massage and good hygienic treatment.
Drugs very poorly substitute gymnastic exercise and fresh air. If patients
should have their exercises regiilarly prescribed for them, and obey the
lOlG
NON-rUAIlMACAL nEMEUlES AND GENEHAL THERAPEUTICS.
directions of the experienced physician in regulating their periods of work
and rest, the supposed necessity for tonics would often disappear entirely
from the therapeutic problem. Owing to the great faith which patients
have in the mysterious virtues of remedies and the power of habit, they do
not feel satisfied unless they have a magistral prescription, and are taking
the regulation "tcaspoonful three times a day." It is, perhaps, a pardonable
weakness, perhaps a shrewd and judicious procedure, to concede something
to the prejudices of the patient and prescribe, if not a placebo exactly, at
least a mild stomachic; something bitter, — but not too bitter, — that he may
satisfy his sense of propriety with while he permits the massage and elec-
tricity to do their perfect work. The good results will be apt to be ascribed
to llio niodicine, but as our objot-t is to curu the disordcT, this undue exalta-
tion of one part of the treatment must be sutfered and ascribed to its proper
source: the ignorance of physiological processes on the part of the patient.
Contra-indications. — ilany cases of confirmed invalidism have drifted
into the habit of taking comparatively large doses of various narcotic reme-
dies, with which they stupefy themselves, and thus pass their lives in a more
or less intoxicated condition. It need scarcely be said that the use of drugs
which lock up the svcreticns, benumb the nerves, and lessen motility of the
muscles is entirely opposed to the objects for which massage is practiced,
and that such dru^s must be abandoned if improvement of health is ex-
pected under mechanotherapy. Fortunately, as MiirrcU has pointed out,
massage aids in overcoming the opium and chloral habits, and, if the patient
wishes to escape from the physical and intellectual degradation which their
constant use entails, no better way can be demised than a course of treat-
ment of this kind. For many reasons, it is preferable that such patients
shall be taken away from their friends and customary surroundings and
treated in an institution directly under the supervision of the skilled phy-
sician in charge. The treatment must be mental as well as physical, and
the first step to be taken is to secure the co-operation of the patient, and
make him sincerely and earnestly desire to throw off the evil habit and to
be restored to a normal state. If this be not secured the result will not be
permanent, even if massage and gymnastics are faithfully performed, be-
cause a relapse will be inevitable as soon as the opportunity of indulgence
is again presented. It is evident, therefore, that, unless the patient pledge
his honor to abstain in the future, massage will be only of temporary benefit
and will be brought into undeserved disrepute.
While massage may relieve pain in carcinoma and other forms of malig-
nant disease, it is considered inadvieable, since it favors the absorption of
the cancer-cells and their introduction into the neighboring glands and sys-
temic infection. In aneurism the sudering may be relieved by light friction,
but kneading or prcr^sure must be aviridcd. In ulcer of the stomach, massage
should not be practiced. It is considered injudicious, in atheroma of the
cerebral arteries and in softening or tumor of the brain, to perform general
massage; but gentle massage of the neck may be permitted, in order to assist
the return of blood from the brain.
In recent apoplexy, hemiplerria. or monoplegia, and effusions into the
spinal cord, it is better, for the first week, to abstain from massage. Sub-
sequently, light friction may be used, in order to maintain nutrition of the
limb by urging onward the lymph and blood in their respective vessels. If
local softening of the brain should occur (red softening), anything like
I
active or passive movements of the affected limbs should be avoided as com-
pletely as possible. In chronic niyclitii*, it is generaHv considered that mass-
age is of little value, but Murrell reports a remarkable case, which has
already been referred to, in which it produced almost a complete restoration
of motion in the paralyzed limhs. In recent neuritis the use of massage is
inferdicted, as the rule, although a slcillful operator will be enabled to afford
relief from pain and diminution of hyperteraia by progressive massage.
How to Prescribe Hassa^. — The usual method of proscribing masso-
therapeutics is to ])er8{inally interview the masseur or masseuse (male or
female operator), and indicate verbally, and, perhaps, by demonstration,
exactly the character and duration of the movements desired. This is the
best way, because the physician can remain and see the operations per-
formed, and have a demonstration of the manner in which his ideas are
carried into practice. Where t}ie physician has his own trained nurses, who
fully understand his directions and can be trusted to carry them out, this
inspection on the part of the physician may be dispensed with, as it involves
considerable loss of time. For his notes of cases, it is also desirable that
there should be some abbreviated form of indicating the exercises. In the
German and Swedish works on niecbanotherapy these directions are given
in terms which, to the uninitiated, arc entirely meaningless, especially in the
system of Ling and his immediate followers. Instead of indulging in such
an expression as this, for instance, "Left — rest — right — extended — gait —
left — side — support — standing," it would greatly simplify the matter if a
code of arbitrary signs were adopted, as in the transmission of messages by
the Atlantic cable. For instance, in regard to massage, the nurse may be
supplied with a card, on which may be printed the following: —
Xo. 1. — Massage.*
A. AU over 30 minuter
B. AU over 45
C. AU over 60 "
D. Head massage 5 '*
E. Over the chest 6
F. Over Htomnch and bowels 5 "
G. Over the throat 3
H. Over the spine fi
Xo. 2. — Fomentations, with Wet Coupresses.
A. Hot on back of neck and head, with ice-cold compresses over nose. ... 16 minutes.
B. Hot between shoulders, with ice-cold compresses over lungs 15 '*
C. Hot between shou1di?rs, with ice cold compresses over lungs 20 "
D. Hot between shrnilders, w ith ice-cold compresses over lungs 30 "
R Hot behind itomnch, with ice-cold rompreases over bowels 20 "
P. Hot behind stomnch. with ice-cold compresses over bowels 30 "
G. Hot on sacrum, with ice-cold compresses over bladder 20 '*
H. Hot on sacrum, with ire-cold compresses over bladder 30 "
No. 3. — Fomentations, Altebnatino with Compresses.
A. Alternate hot and cold, four changes, to dorsal vertebra 15 minutes.
B. Altemste hot and cold, four changes, to doraal vertebra 20 '*
C. Alternate hot and cold, four changes, to dorsal vertebra 30 "
D. Alternate hot and cold, four chonge«, to lumbnr vertebra 15 "
* Massage of the head is not included in A. B, or C; so thiit where this is desired
in addition St should be designated by adding D to the prescription.
1018
NON-P
THETIAPECTICS.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
Alternate
Altomnte
Alternate
Alternate
Alternate
Alternate
Alternate
Alternate
Alternate
Alternate
hot and cold, four changes, to lumbar vertebra 20 minuter
hot and cold, four chanpos, to sacrum 13 **
hot and cold, four changes, to Raerum 20 **
hot and cold to c(.'r\'ical vertebra 15 "
hot and cold to cervical vertebra 20
hot and cold whole length of spine 10 "
hot and cold whole length of spine 15 "•
hot and cold whole length of spine 20 **
hot and cold to painful part 15 "
hot and cold, six changes, to painful part 30 "
No. 4. — TKN-MiNUTE FOMEIITATIOXa.
two applicationfl.
A. Over stomach and liver 140**,
B. Over spleen 140*'.
C. Over bowels 140",
D. Over bladder 140*.
E. Over right lung 140°,
F. Over left lung 140"*.
G. Over both lungs 140°.
H. Over throat and bronchi 140°.
I. Behind atyniach » 140**,
J. Behind bowels 140*.
K. Behind lungs 140°.
L. Back of neck 140°.
M. On sacrum 140°, "
Ko, 5. — Fifteen-Minute FoArENTATioNS.
A. Over stomach and liver 140°, two applications.
B. Over spleen 140°, " "
C. Over bowela 140°. "
D. Over bladder 140°. " "
E. Over right lung 140°, *'
F. Over left lung 140°. "
G. Over both lungs 140°, "
H. Over throat and bronchi 140°, ** "
I. Behind stomach 140°, " "
J. Behind bowels 140'. " "
K. Behind lungs 140°. " "
L. Back of ueck 140°. "
M. On sacrum 140°. "
No. fi.— TWENTT-MlNUTE FOMENTATIONS.
A. Over stomach and liver 140°,
B. Over spleen ^ 140°,
C. Over bowels 140°,
D. Over bladder 140°.
E. Over right lung 140°.
F. Over left lung 140°,
G. Over both lunffs 140°.
H. Ovor throat and bronchi 140°.
I. Behind sioniach 140°,
J. Behind bowels 140°.
K. Behind lungs 140°.
L. Back of neck 140°.
M. On sacrum 140',
tw
o appHcAtions.
No. 7.— Thirtt-Mintjtk Fomentations.
Over stomach and liver 140°, two nppliestionB.
Over spleen 140°.
lASSAQE AKD KEST-CUt
lOli)
Over right lung
b
F. Over left lung 140
G. Over both lunga 140
H. Over throat and bronchi 140'
I. Behind stomach 140*
J. Behind bowels 140'
K- Behind lungs 140*
L. Back at neck 140*
M. On »acrum 140'
140", two applicfttiotu.
The prescription-blank Tould be as follows: —
Prescription Card for Treatment of
95.
ante-
<sidd
redd-
Szciyctibed b^
sn
0.2),
M,
T.
w.
T.
r.
8.
jCn
y«
,
At MTnt tinif No.
TlM maneur U reqiMrted lo ooDttDue thla trcauneDt iiiitil otberwiw directed, unlets obnoQa
ehaon iu lbs cuadittnn uf cbe paLleDi rtiudera desirable au earUer coDsullatioo of the prescnbltig
phjucUn. The titueofday majr beludlcalatl (TdesireiL
The above is actually in use in this city, and its practical value dem-
onetrated. The masseur or masseuse stands in the same relative position as
the druggist to the phyeiciun, and simply carries out his directions as indi-
cated by the prepcription.
Vibrotherapy. — A fonn of percussion massage, in which the hand, or
instrumentj is kept in contact with tlie surface, while a mild percussion force
is applied many times in the minute, causes a vibration in the deeper tissues,
which is capable of producing physiologic and therapeutic results. J. Morti-
mer Granville, of London, was among the first to place this method upon
a scientific basis and to use instruments for the purpose. Acute and sharp
pain, he compared to a high note in music, which is produced by ven' rapid
vibrations; while a dull, heavy pain resembles a low note, which is caused
by slow vibrations. He therefore applied a slow rate of meehanicnl ^-ibra-
tion in order to interrupt the rapid vibrations of acute pain; and conversely,
applied very rapid vibrations for the relief of dull pain. By thus introduc-
ing discord into the rhytlim of morbid vibrations, he claimed that relief or
cure of neuralgia can he effected. He devised an instrument which he called
a ''percnteur,*' which was so constnicted as to deliver a rapid succession of
iu:;;u
KOK-PlIAnMACAL HEMEmES AND GENKIUL rUERAFELTIGS.
blows of moderate force : both the slrenglh and the rate of the percussion
being subjected lo regulation according- to the ease.
A number of instruments and elaborate apparatus have been deWse<l for
producing mechano-vibration. In some of the?MJ tlie power is obtained from
compressed air; others work with a hydraulic motor: but the best forms
The Ch»ittano<>gii Vihrntor.
are mn by the eleetrie current, either alternating or continuous. A very
satisfactory form of viltrator is s^hown in the iKTompanying iUustration,
which is nmde by the Vil)rator Instrument Company, of Chattanooga, Tenn,
Other forms in which the electric current is ust^l. are the Wnite apparatus,
inrentcd by Dr. Henry Waite, of the Waite & Rartlett Electric Manufactur-
ing Company, of New York, nnd the Froley vibrator, of Philadelphia. The
special charnctoristic of the latter Is that it lias an attaduiient to, and is
PNEUMOTHEnAI'Y AXD PNECMATIC DIKFEUENTUTION.
1021
I
I
I
applied by, the hnnd of the operator, so that the force of the application ia
subject to Conscious control. Vibration can be used in connection with
other fonns of massage, or with the faradic or galvanic electricity, if desired.
Vibrotherapy iR useful in a wide range of functional disorders. It not
only stimulates the peripheral nerves, hut also the vasomotor and trophic
distribution. It acts upon the l^Tnphatics and veins of the parts, eo aa to
hasten absorption of effused products, or oliiuinnte waste. It regulates the
blood and nerve supply of crlandular or^rans, like the liver, which it induces
to increased ph}'sio!opc ncHvity. For hepatic disorders^ the vibrations are
directed to the right hypochondrium principally. In the treatment of in-
somnia, the vibrations arc made from the sixth dorsal vertebra up the spine
to the cervical region, for a short time: the patient then turns over upon his
back, and vibrations are made to the intestine and abdominal organs, the
latter with the view of attractino: the blood from the head. For nervous head-
ache, the vibrations should be directed along the spine, and be mild in char-
acter. BO as to produce a quieting and soothing effect. By an adjustment of
the apparatus, the stroke may be made stronger or wejiker as desired, and at
the rate of vibration preferred. This method is finding many applications
at the present day. and is a valnnblo ndjiinct to other methods of treatment.
By the use of vihmtherapy. Grfinville rlaiined that pain could be re-
lieved, the ccrobro-spinal and sympathetio ganglia Ftinnilated, torpid ne^^'e-
centres aroused in artion, the retVx irritability of subordinate centres sub-
dued, and these placed under tlie contix>l of the higher centres. The vibra-
tions may be propagated along the trunks and into the branches of the
principal nerves from their centres of origin ; or these may be called into
action, reflexly, by tlie afferent nerves connected with those centres. Among
its special applications is deficient motility of the digestive organs; in con-
stipation, for instance, it never fails to produce a movement of the bowels.
Wlien properly regulated, it has a sedative action upon sensory nerves.
At the Fourteenth International Medical Congress, held at Madrid in
1905, Dr. J. Riviere called attention to a comprehensive plan of treatment
which he calls "PhvsicMitlicrapy." This is a curarivc method based upon
the plan for increasing normal vital stimulants, by means of electricity, heat,
light, baths, massage, and, in fact, all agents and apparatus intended to
quicken physiologic processes. The object of the treatment is to improve
cellular activity : and especially to aid the trophic and excretory functions,
to regulate blood-supply, and overcome congestion and stasis. This is ac-
complished by apparatus for electrotherapy, vibrotherapy, radiotherapy,
phototherapy, hydrotherapy, pneumotherapy, and other well-known means
of kinesi therapy. In many cases, remarkably successful results have been
obtained in functional and nutritive disorders, especially those of a chronic
character, by a course of treatment such as just indicated, in which treat-
ment by drugs is either subordinated, or entirely omitted.
PNEITMOTHERAPY AIH) PWETJHATIC DIFFERENTIATION.
Pneumotherapy, atmiatria, or pneumatic medicine, considers the ad-
ministration of gases and remedies in a gaseous condition in the treatment
of disease. The effects of changes in density and of the use of remedies
under circumstances increasing or decreasing atmospheric pressure have re-
1022
NOK-PHARMACAL REMEDIES AND GENERAL THERAPEUTICS.
cently received so much attention that they will require separate discuBsion-
The subject, therefore, will be divided into: —
1. The administration of remedies in a gaseous form: Pneumotherapy.
2. The administration of such remedies under altered conditions of
atmospheric pressure, or in more or less condensed or rarefied form: Pneu-
matic differentiation.
A strict construction of the term "pneumotherapy" (wi^cv/ia, air or
irvcwftoK, lung, and OtpaTrcviu^ to heal) would restrict it to the consideration of
respiratory disorHers, but it may also be employed as applied to treatment by
the use of air or ^ses. An ancient medical sect, known as pneumatici, or
pneumatic physicians, founded by Atheoieus, held that an immaterial prin-
ciple or element existed, upon which depended conditions of health, the
excess or diminution of which caused disease. Previous to the revelations
of the microscope and the advent of modern pathology and chemistrj', this
was about as far as hypothesis could be expected to carry us toward the
discovery of the true nature of many diseases, but there is no good reason
for the existence of such a medical theory in the twentieth century.
In proceeding to consider the therapeutic employment of certain
gaseous substances, it is proper, in the first place, to devote a few words to
a gaseous compound known as atmospheric air, its composition, and the
effects upon the human system of alterations in the proportion of its eon-
sfituents and the results of its contamination. Air is a universal and indis-
pensable gaseous food. It is not a chemical compouud, but simply a mixt-
ure of oxygen (about one-fifth) and of nitrogen (about four-fifths) with
variable, but usually small, quantities of argon, helium, carbonic acid, am-
monia, watery vapor, dust, etc. We cannot dwell here upon the physiolog-
ical facts in connection with the effects of increase or decrease of carbonic
acid or the presence of certain contaminations, especially the various forms
of microbes and disease-germs. We may, however, in passing, point out, in
a very general way, the difference in the rate of growth and development of
children who have a plentiful supply of fresh, pure air as compared with
those who lead a sedentary life in house or school. The subject of the ven-
tilation of sick-rooms and apartments where many persons are crowded to-
gether, as in schools, factories, and work-shops, has been fully investigated
of late years, and the breathing of foul air is now regarded as one of the
principal causes of ill health and degeneration.
Conversely, in many patients the first therapeutic step to take is to
secure for them a greater quantity of pure air than they have been accus-
tomed to having. In modern treatises upon the practice of medicine great
stress is usually laid upon the importance of the ventilation of living-rooms,
and also of exercises in the open air. Drs. Trudeau and Sternberg found
that the mortality from consumption, in rabbits inoculated with tubercle
bacilli, was very much greater among animals confined in crowded, ill-ven-
tilated hutches than among others which were allowed to run out and live
in the open fields. Heated air has been employed in therapeutics not onl}'
in the form of the Turkish bath, but also used simply by inhalation. The
effects here being simply those of elevation of temperature, they will be con-
sidered under the head of heat. The effects of aifferences of atmospheric
pressure will be discussed in the present section, under the title of *Tneu-
matic Differentiation.'' The effects of breathing rarefied air are closely con-
nected with those attending residences in elevated localities, where atmos-
PNEUMOTHERAPY AND PNEUMATIC DltTEBENTIATION.
1023
I
I
phoric pressure is less than nt ordinary levels. This deserves careful study,
as upon it often depends the decision as to the proper eanatoriuni to send
an invalid. It may be accepted as an axiom that patients suffering with ad-
vanced disease of the heart, lungs, or kidneys are injured by removal to a
high altitude, as their systems do not readily become accustomed .to the in-
creased labor of breathing necessarily required by the rarefaction of the air.
This, however, will be considered, more in detail, under the subject of
"Climatology." Under this head, also, will be considered the effects of the
presence in the air of moisture^ and the differences between marine and
mountain airs and places.
The presence of ozone in the air, and its consequences, will be hereafter
referred to in discussing oxygen. When present, it is an important witness
to the purity of the air and its freedom from organic contamination. Where
great numbers of people live in crowded communities, ozone is never pres-
ent. If the fact is borne in mind that the expired air from the lungs con-
tains more or less excrementitious organic matter, it will be imderstood why
crowd-poison, or rebrealhcd air, may be the cause of disease. Besides the
increased quantity of carbonic-acid gas and the diminished proportion of
oxygen, the expired air further varies from the standard of pure air, in that
it has an excess of moisture, which contains odorous particles, and frequently
bacilli and other forms of bacteria. Atmospheric air, however, except in
special locations on the tops of mountains, may also contain many varieties
of bacterial forms, and also organic material, in the form of dust, which may
be of a very irritating character. The expectorations of tuberculous patienta
in the streets become dried, and tubercle bacilli have been shown by actual
experiment to be present in street-dust, as well as in the confined air of the
consumptive wards in a hospital. Manifestly, therefore, persons who, by
heredity or acquired predisposition, are liable to suffer from phthisis, should
live in a neighborhood where they can breathe pure air, as free as possible
from all irritating matters, and especially pathogenic substances, and they
should carefully avoid crowded vehicles or public halls. Consumptive nurses
should never be allowed to contaminate the air that young children breathe
by fondling and kissing them, infants being particularly liable to infection
from this source. Operatives who work in overcrowded rooms, such as cigar-
makers, cloak- and dress- makers, especially where there is much dust in the
air, show the effect of privation of fresh air in their pallid faces and wasted
frames, and they are also very subject to pulmonary affections from inhaled
particles, which act as irritants. The first prescription for a cough, under
such circumstances, would be fresh air, as pure as can be obtained. One of
the principal beneficial effects of the movement-cure and massage is seen in
the increased activity of the respiratory function which follows physical
exercises; but increased respiration will not be of great benefit unless, at
the same time, provision be made to supply a suflicient quantity of pure air.
The report of the English Army Sanitary Commission, publiehed in 1858,
is conclusive in its proof that "the excessive mortality from consumption
among soldiers, and in particular regiments, was due to overcrowding and
insuthcient ventilation. Previous to that inquiry the cubic space per soldier
in the barracks of the Foot Guards only amounted to 331 cubic feet, and the
phthisis mortality was as high as 13.8 per 1000. In tlie Horse Guards, on
the other hand, with a space per man of 572 cubic feet, the mortality from
phthisis did not exceed 7.3 per 1000. It was found that phthisis prevailed
1024
NON-PHAHilAOAL REMEDIES AND GENKBAL THERAPEUTICS.
at all stations, and in the most \aricd and healthy climates, the vitiated air
in the barracks being the only condition common to all of them. In con-
sequence of this excessive mortality, the Commissioners recommended that
the cubic space allowed per man in barracks should be increased and the
ventilation improved, with the result that, from the time their recommenda-
tions were acted upon, the number of phthisical cases occurring at all these
stations has materially diminished. Similar evidence is afforded by the
statistics of the Koyal Navy, and notably as regards the civil population, in
the report of the Health-of-Townis Commission, published in 1844. Indeed,
it has been fully established that not only phthisis, but other lung affections,
Buch as pneumonia and bronchitis, are generated, to a large extent, under
like conditions, and the same may be said of such diseases as scrofula and
others of an adynamic type/''
The announcement of the discovery of the tubercle bacillus by Koch,
in 1882, has not invalidated the above observation. On the contrary, these
observations are highly valuable, since they serve to explain the problem of
Busceptibility, or predisposition, by means of which some individuals acquire
phthisis, while others, under similar circumstances of exposure, succefisfully
resist the inroads of the bacilli. In fact, while the effects of constantly
breathing vitiated air may not be at once manifested, in the way of causing
pain or discomfort, otlicr than frequent headaches or feelings of malaise, the
consequencf^s. in unibinniuing the health, appear slowly, and are cumulative,
but not less injurious. This is now universally recognized as among "the
most potent and wide-spread of nil the predisposing causes of disease"
(Wilson}. Following the dictates of sound judgment and experience, civil-
ized nations have steadily improved the ventilation of dwellings and work-
rooms, and systematically remove from cities garbage and filth, which poison
the air by undergoing fermentation and putrefaction, and give off poisonous
vapors and disease-gemis. Especially in hospitals has attention been paid,
of late years, to this essential point, in order to secure an aseptic atmosphere
for the sick. By the use of forced ventilation, tlie supply of pure air is
mainfnincd, which is now generally acknowledged to be an important ele-
ment in the trciitmcnt of both i-ick and wounded.^
In the treatment of many chronic disorders, especially pulmonary affec-
tions, respiratory gymnastics, having for their object greater expansion of
the chest and an increase in the tidal air. are of acknowledged value, and
have been already referred to in the preceding section. In the treatment of
asphyxia from coal-gas, carbon dioxide, or hydrogen sulphide, fresh air is
absolutely necessary, as it is, also, in syncope and suffocation by drowning.
As already intimated, many cases of cholera infantum are due to local poi-
soning of the air, and can be cured only by a change to a purer atmosphere.
During tlie prevalence of yellow fever, cholera, sraall-pox, and other epi-
demic diseases it sometimes becomes necessary to remove a whole community
to a more sanitary locality, the best disinfectant being pure air, and plenty
of it.
Since the famous experiments of Dr. Priestley, there have been many
***Hnnd-book of Hygiene and Sanitary Science,'
Third edition, p. 65.
* For further phioidution of this subject, see recent
U.8.A., on "Hospital ConatnicUon."
George Wilson. London, 1877,
work by John S. Billiiigis
PNErMOTIIElClPY AN'D PNia'-MATIC DIFFERENTtATXOX.
1025
I
attempts made to render air more curative by adding to it various substances,
either in gaseous form or as a vapor, spray, or impalpable powder. The
latter forms will be separately considered later, and in another part of the
work will be given a number of useful formulae for medicaments to be used
by inhalation. Air may be made to carry, not only gaseous substances, but
liquids and solids in minute subdivision. An excess of watery vapor is pres-
ent in the Russian bath. It is also useful for inhalation by means of a croup-
kettle or steam-atomizer, after operations for tracheotomy, and also in cases
of catarrhal inflammation of the throat and bronchial raucous membrane.
Various volatile substances may be added to the water, such as oil of eii-
calyptiis-leaves, compound tincture of benzoin, iodine, and carbolic acid.
Smoke from burning nitre-paper, disused in the air, gives marked relief in
asthma, or pyridin may be volatilized for the same purpose. Tar, crcsylic
acid, phenol, and other substances may also be administered in this way in
pulmonary affections, and often with marked effect. Among the gaseous
substances proper, chlorine has been used, largely diluted, as a bronchial
stimulant, in narcotic coma or hydrocyanic-acid poisoning. Nitrogen is
inert, and the results of its inhalation are due to deprivation of oxygen from
the system. Hydrogen produces a peculiar squeaking voice, but otherwise
is negative. The effects of oxygen are so important that they will be con-
sidered in a separate section. Modern surgical anaesthesia depends upon the
paixture of a certain amount of vapor of chloroform, ether, ethyl bromide,
or ethyl chloride with the respired air. This is considered in detail in
the part devoted to drugs, under the individual headings of the articles
in question (snch as chloroform, ether, etc.), nitrogen monoxide, or laugh-
ing-gas, being considered under its own title.
Claude Bernard discovered that, under certain conditions, general anses-
thesia could be produced for the time by directing a stream of carbon-
dioxide gas directly into the throat and larynx; but this observation has not
yet been utilized in practical medicine. Bergeon some years ago brought out
a system of treatment for chronic pulmonary disease, the principal feature
of which consisted in the injection into the large bowel of a mixture of
carbon-dioxide and hydrogen-sulphide gases, with a view to their absorption
into the circulation and excretion by the lungs. Some good results in the
way of lessened expectoration, reduction of cough, and temporary improve-
ment of the physical condition have been noted after the clinical trial of this
method, but, as it is impossible for it to exert any antiseptic action upon
the tubercle bacilli, and the bodily improvement is only transitory, the prac-
tice has fallen into disuse. If it had succeeded in accomplishing all that was
claimed for it by its enthusiastic advocates, it would have afforded some sup-
port to the theory of Bcddoes that there is an excess of oxygen in the tissues
of consumptives, and that they are benefited by breathing air containing a
considerable proportion of carbon dioxide.
Attempts have been made to destroy septic matter in the air, or, tech-
nically, to **sterilize'' the air, in order to prevent infection of wounds during
operations. The antiseptic method of Sir Joseph Lister, as first formulated,
required a spray of carbolic-acid solution, so that the operation should be
performed in an atmosphere charged with this antiseptic. It was found that
this was not only inefficient and failed to fulfill the purpose, but it slso was
objectionable, and in some cases caused sjTnptoms of carbolic-acid poison-
ing. Lister has since acknowledged his mistake, and the spray has disap-
.
1U2G
NON-rUAttMACAL UKMEUIES AND OEN'KKAL THEKAPEt'TICS.
pcured from tlie operating theatre. Experience hae shown that, if evei
thing else coming in contact with the wound — the surgeon's hands, the inn
etrunients, and all the dressings, and the wound-surface itself — is rendered
aseptic by proper solutions, under ordinary circumstances the air may he
disregarded, except when contaminated by speeiai poi?^tns. like diplitheriaor
scarlatina. Dr. David Prince, of Illinois, however, has devised a very com-
plete aseptic operating chamber^ in which all the air is forced through anti-:
septic solutions before coming into the apartment. Where the air of ai
hospital is so contaminated as to require such a chamber, it would be safer
to remove the patient, if possible, to more sanitary surroundings.
OSYQEX.
Although not yet admitted to the United States Pharmacopceia, oxygen |
is a remedy of considerable therapeutic value, and, as an antidote to certain j
forms of poisoning, in some cases is indispensable to the recovery of the i
patient. It is administered in its purity or combined with other gases, such \
as nitrous oxide, nitrogen, or with atmospheric air. Oxygen is a colorless.*
oilorloss, and tasteless gas, nearly sixteen times as heavy as hydrogen, a little
heavier than atmospheric air (specific gravity, 1.1057), of which it consti-
tutes 20.81 per cent, by volume, or 23 per cent, by weight, of dry air, in
wliich it exists as a mixture with iiitrogeu, not chemically coinbined. T'nder
certaiu conditions, it appears under the allotropic forms of ozone and anto*
zone, in which it acts with peculiar energy. Under ordinary circumstances,
oxygen is a non-condensable gas, but Pictet has succeeded by cold and press-
ure in making it assume the form of a liquid apparently containing solid
particles. Water (IlgO) is a combination of oxygen with hydrogen (8 to 1).
Hydrogen dioxide is also a liquid; clear, colorless, syrupy, and of a specific
gravity of 1.453; it is a bleaching agent, and slightly caustic and somewhat
irritating to mucous surfaces. It evolves oxygen at a temperature of 70
degrees or above, the ordinary commercial solution claiming to yield fifteen
times its bulk of oxygen-gas. (See page 248.)
Preparation, of Oxygen. — Among the several methods of preparing
oxygen in the laboratory only those can be employed in medicine which are
convenient and which yield a pure gnf= fit for inhalation. The most available
method is by healing tlie solution of hydrogen dioxide, but where a consid-
erable quantity is required this method would prove too expensive. The
usual method is to heat potassium chlorate, so as to drive off some of its
combined oxygen; and, in order to do this safely and to obtain the gas in
steady volume, the potassium chlorate is intimately mixed with manganese
dioxide, which does not enter into the reaction, but simply acts mechanic-
ally. The gas obtained in this way is passed through several wash-botlles
coutaining dilute caustic alkali, and it is then collected in a receiver (ga^
ometer) and kept over water. If the extfMiv]torancou3 plan of making
oxygen is (Mtijiloyod. care should alwnys be taken to .^ee that tlie blnoxide of
manganese is |jure and cloan. if it contain coal-diijit or I'luirt^oal as an ndul-
^ In the liquid form, Olszewski, a Polish chemist, finds that oxygen has a briglit
•ky-blue color. This ia of interest not only as accounting for the bluenen of the
atmosphere, but nlso in point of view of the abaorption-apcctr* of oxygen.
I
I
KEUilATIO DIFFEREXTIATIOK. 1027
teration, n aerious explosion may rosiUt. It is, therefore, rocotnruonded to
heat jfrarlually some of tlie mi.\turo (4 of potash to I of manganese) in a
glaHfi teHt-tiiU\ up to a red heat. If it should explode, the small quantity
would do very little damage, especially when compared \rith that which
would result from the explosion of several pounds of the same mixture. For
each pailon of oxygen about. 14 Gni. (or nearly V, ounce) of potassium
cldorate will be required. Oxygen is now made on a large scale, commer-
cially, directly from atmoijpheric air, and is sold at a ven' low rate, being
delivered in steel cylinders, generally condensed so that a cylinder containing
from one hundre<l to two hundred gallons is of a convenient size for han-
dling. From such a holder or reservoir the gas is drawn into a rubber bag or
a gasometer for ordinary office use or individual administration.
Physiological Effects. — When inhaled, pure, oxygen is capable of caus-
ing considerable Irritation in the air-passages, and small animals immersed
in it perish in a few days with highly-congested lungs. Ordinarily, when a
moderate amount is inhaled in health, no irritation occurs. The gas, even
when pure, is pleasantly respirahlc, and from four to eight gallons can be
inhaled without any other obvious effect than a slight increase of activity of
the circulation and some nervous exhilaration. Slight giddiness may be
experienced for a few moments, but vertigo and headache are absent. In
addition to the quickening of the pulse, there is evidence in the lips and
finger-nails of increased oxygenation of the blood, and cicatrizing wounds,
with granulation-tissue, have been observed by Demarquay to become more
ruddy. The expiration of carbon dioxide is increased, and, according to
some observers, is doubled in amount. Uric acid is lessened in quantity,
according to KoUman, owing, probably, to the fact that a greater quantity is
oxidized in the system. The digestion and appetite improve, and there are
evidences of increased assimilation and resulting enhancement of physical
strength.
Therapeutic Applications. — As has probably been inferred from the
preceding paragraph, the chief application of oxygen is to conditions of
asphyxia and dyspna?a from any cause. Thus, in poisoning by coal-gas,
sewer-gas, hydrogen sulphide, carbonic oxide or dioxide, oxygen inhalations,
promptly used, are followed by immediate good effects. In dyspnoea attend-
ing pneumonia, morbid growths in the larynx, or other grave disturbances
of respiration, oxygen is of great service. In various chronic conditions the
systematic administration of oxygen is often of value in improving assimila-
tion and building up the system.
Thus, in aniemia and chlorosis, in chronic ulcers, and in strumous affec-
tions o.Tygen inhalations are practiced in one, two, or three daily sittings,
using from 1 to 4 gallons at a time, either pure or mixed with atmospheric
air or other gas, such as nitrogen monoxide. When a stream of oxygen-gas
is directed upon a granulating or gangrenous surface it is said that healing
is accelerated. When there is some impediment to the respiratory function,
as in etonosis of the larynx, croup, diphtheria, emphysema, asthma, heart
disease, oedema, or marked congestion of the lungs, the dyspnoea is greatly
relieved by oxygen inhalations. The cyanosis of pneumonia is overcome by
its means. In chronic pulmonary affections with reduced breathing ca-
pacity, we are now in a position to pass the same quantity of oxygen into
the lilood as is normally required, and thus put the patient on a more favor-
able footing for his ultimate recovery. As an illustration of its valae, the
102S
NON-PHARMACAL REMEDIES AKD GENERAL THERAPEUTICS.
following remarkable case of pneumonia successfully treated by its aid is ,
worthy of study. It was reported in the Boston Medical and Surgical Jour- ;
nal (No. 21, 1890): "The patient was a lady, aged 37, of neurotic tendencies,
who suiTered at first with ordinary lobar pneumonia at the base of the right '
lung. The general symptoms were very strongly marked, and, after the i
first few days of ordinary treatment, the disease spread to the upper part
of the same lung, and alarming and excessive dyspncea set in rather rapidly.
Energetic stimulation and counter-irritation appeared to relieve the condi-
tion to some extent, but it recurred and showed itself less amenable to
treatment. Inhalations of oxygen were given, the gas being simply con-
ducted to the patient's mouth, after having been passed through a wash-
bottle and diluted with 10 per cent, of nitrous oxide. Very decided relief
was given for a short time, but again and again the dyspnoea returned, each ,
time being staved off by the inhalation. At last it became necessary to keep
up constant inhalation. The supply of gas began to fail, and before a freih
store could be obtained the patient was moribund. The gas was then given
by artificial respiration, and the patient rallied once more. Constant inhala-
tion was then kept up for one hundred and six hours without intermission,
and at the end of that time the breathing was easy and natural, and com- ,
plete recovery followed without further incident. The temperature fell
during the long-continued inhalation, the average amount of gas being two ,
hundred gallons in each twenty-four hours." Dr. Blodgett states that the
effect of the gas was "almost as pronounced and evident as is that of a liga- ,
ture in haemorrhage." Dr. Lauder Brunton and Dr. Prickett report a case
of pneumonia^ where the patient was unconscious, livid, and almost mori-
bund; but, after the inhalation of oxygen and the hypodermic injection of
strychnine, he recovered his consciousness and his normal color, and ei- ,
pressed himself as feeling comfortable and well. Twenty-four hours after-
ward, however, breathing again became pmbarrnssed, and, notwithstanding
a somewhat freer use of oxygen, he died in a few hours. Dr. Skerritt, in |
the same journal (February 6th), gays: ''I have never seen such an extraor- ,
dinary effect upon cyanosis produced by any other means, and, for the
future, in any case of acute respiratory affection threatening to prove fatal,
I shall not consider that everything practicable has been done unless a fair
trial has been given to oxygen." I
Another writer suggests that, even where cases are manifestly in articw'o ,
mortis, they may be temporarily improved so as to sign or execute legal
papers by its aid. On the other hand, cases have been reported where in-
lialation was begim and the patient promptly died.' It is probable that the j
addition of 10 per cent, of nitrous oxide, by Dr. Blodgett, to the oxygen,
contributed materially to the successful result. The question of details of
administration will be again referred to shortly. In the dyspncea of heart
disease, the so-called cardiac asthma, it has been shown that the condition of \
the heart-muscle and the aorta is often an active or predisposing cause.
The change in the aorta may be small and those in the heart considerable,
or just the reverse. The aorta is more or less the seat of atheroma. The
change in the heart is often that of chronic myocarditis; the coronary
arteries are also found to be diseased.
'British Medical Journal?, Jan. 23, 1891.
'Colton, Brooklyn Medical Journal, Aug.. 1891, p. 52N.
PNEnrOTHERAPY AKD PNEUMATIC DIFFEKENTUTIOX.
1029
dail
In the diagiioii*, according to Dr. Heitler/ if the organic lesion be over-
looked, and a good prognosis given, it may be falsified by the patient dying
suddenly from heart-failure. The most valuable si^^ii is accentuation of the
second aortic eound. For the dyspnoea and cyanosis of cardiac insufficiency,
Dr. Heitler says the combined use of morphine and ether suhcutaneously,
with inhalations of oxygen, will cut the attacks short. In the opinion of
Dr. Catlin,* oxygen is pre-eminently the remedy for profound shock, either
from hffimorrhage or nervous drain, where the vitality is at too low an ebb
to take up the intricate history of assimilation and repair. He reports a case
of profuse haemorrhage at the sixth month of pregnancy, followed by mis-
carriage. The prostration was absolute, with shock and constant vomiting.
Continuous oxygen inhalations (mixed with air?) was administered, and the
patient immediately improved and made a good recovery. He also reports
cases of prostration during typhoid fever, in which oxygen was inhaled with
marked benefit.
Professor Tamier has used oxygen inhalations in the treatment of very
young children, and Bonnaire" has employed it in the newborn, especially
the premature infants who are placed in a ^'coureusc," or incubator. He
gives the following suggestions: —
"I. Whenever there is insufficient pulmonary hffimatosis, either from
obstruction of the respiratory passages or from weak action of the mechan-
ical apparatus of respiration, or from want of excitation of the respiratory
nerve-centre, oxygen administration is indicated. Apparent death in the
newborn is, therefore, the first indication, though this does not exclude
efforts at artificial respiration; besides, oxygen is not always available as
soon as required. But if the first dangers of asphyxia have been overcome,
and respiration is still ineffectual, or pulmonary disease imminent, with
general asthenia, oxygen will be found a valuable recourse.
"2. Oxygen is also indicated for disorders in the interstitial circulation,
of which sclerema in premature infants is one of the most common mani-
festations.
"3. Changes in the blood, of infectious origin like that which takes
place in the ha?maturic bronze disease, of which mention was made." (It
was used in several infants suffering with bronzing and haematuria: a dia-
ease resembling pernicious anaemia. It was administered for two hours
daily, and was successful in several cases in the first stage of the disease.)
4. Conditions in which there is decided depression of the temperature.
Ihxepsia, in its acute and chronic forms, is the type of such conditions."
^ Neumann* speaks iti higli terms of the administration of air containing
gh percentage of oxygen, under increased pressure, for which he employs
an apparatus of his own devising. By using a mixture with air, he avoids
the irritation caused by the pure gas, and the slightly-increased pressure
facilitates absorption. The pulse, at first quickened, is ultimately slowed.
No unpleasant head symptoms arise. There is no palpitation; in fact, the
heart's action is regulated. Sleep is often induced, even in men. In many
patients the night's rest has been improved, the breathing rendered easier,
' Ccntralblatt filr die Oesammte TKerapie, Oct., 1891
'Brooklyn MrdicalJoumal, Aug.. 1891, p. 521.
* Journal de M^decine, June 28, 1S91.
*Tkcrapeututrhr ^onatsheftv, Oct.. 1891.
1030
XOX-PITAKMACAL REMEDIES AND QENEHAL THERAPEUTICS.
and there has been induced a feeling of increaeed strength. In three cas
of tuberculosis, treated at the same time with Koch's method, the fever di»-*
appeared in two and was lessened in the third. The action of iron, when
given for chlorosis, may be increased by oxygen inhalation. Neumann has
thus treated severe cases of anannin, ronvaleseence from pleurisy, phthisis,
sepsis, and diabetes with good results. He thinks that it also may be of
service in gout, as it diminishes the proportion of uric acid in the urine.
Dr. Francepco Valenzuela has published a paper, in El SigJo Medico,
on new methods of administering oxygen, with esf)€cial reference to the
treatment of senile pneumonia. He administers the gas by the rectum, and
also by injection hypodermirally. He reports that in every case of senile
pneumonia, with dyspnoea, in which oxygen enemata were given, dyspnoea
was decidedly and permanently relieved. The ease and rapidity with which
the gas was absorbed by the intestine were remarkable; indeed, it seemed
to be as readily taken up by the intestine as by the lungs, four injections,
of 5 litres each, being absorbed in an hour. Thus, the intestinal mucous
membrane may be regarded as a valuable adjunct to the lungs in the func-
tion of respiration. In employing oxygen subculaneously Dr. Valenzuela
believes it important to introduce the gas in a nascent state. The arm was
selected for the injections, and the quantity of gas introduced varied from
half a litre to a litre. Cellular emphysema was. of course, produced, and a
sensation of heat was complained of, but both disappeared within a few
hours. There was no calmative action or slowing of the respirations, but
there was marked stimulation of the heart: a desirable result in the collapse
that follows pneumonia and fevers of a typhoid character, and cerebral con-
gestion and asphyxia. No mention is made of the temperature of the gas
that was administered: a point which, according to Dr. B. W. Richardson,
of London, is of great importance.
It has been stated that oxygen inhalations are of service in the vomit-
ing of cholera as well as in the algid stage.
Dr. G. Thompson,* from a review of the therapeutic value of oxygen,
arrives at the following conclusions: (1) in dyspepsia the gas controls the
subjective symptcms; (3) it is effective in cyanosis, by diminishing the fre-
quency of the. respiration and relieving the subjective dyspnoea; (3) oxygen
is of value in the partial inflammation of the lungs due to various causes;
(4) it is especially useful in the dyspnoea of chronic Bright's disease, unemia,
pneumonia, capillary bronchitis, asthma, catarrhal bronchitis, congestion of
the lung, and of the first jieriod of pulmonary oedema.
In surgery the topical application of a stream of oxygen-gas to ulcers
has been found to exercise a stimulating and curative effect. In surgical
ana5sthesia by ether, when there is evidence of insufficient circulation, oxy-
gen is a valuable aid to respiration. If a mask is used the oxygen may be
allowed to bubble through a wash-bottle containing the ether, until the color
of the patient is restored. In t-aseF of coal-gas poisoning and asphyxia, the
oxygen inhalations are also indicated.
Apparatut and Technique of Administration. — Samuel S. Wallian at^
tributes the failures observed from the use of oxygen to various causes, and
to many conditions under which the gas may be devitalized (?) by the im-
^Kor*Jk Magasin for LagerideMkahcn, Christiania, p. 274; "Annual of the Uni-
versal Medical Sciencea," 1691, vol. v, p. A117.
PXEUMOTHERAPY AND PXEIAIATIO DIFFERENTIATION. 1^31
perfect processes employed to evolve, store, and use it. He insists that the
oxygen should be freshly prepared and washed before using. Except in
special eases of narcotic poisoninf^, asphyxiation, syncope, and other serious
emergencies, the gas shonld be well diluted. The undiluted gas may be
piven in quantities of 800 to 1000 cubic inches at a sitting, once or twice
daily. It is more economical to dilute it with air, since a comparatively
small portion only is utilized at each inspiration. If nitrogen monoxide be
combined with it (oxygen, 2 parts; nitrogen monoxide, 1 part), as tliey are
synergistic, better results are obtained. Dr. Wallian also insists that patients
should be instructed or made to inhale the ga^ properly. The person being
erect, and the chest thrown a little forward, the lungs are then filled to their
utmost capacity, and the gas held as long as possible, then expired through
the nasal chambers. The respiration should be deliberate, and not hurried.
Better results can be obtained if patients are taught chest gymnastics, so as
to develop the muscles of respiration and increase the capacity; imperfect
habits of breathing, tight clothing, awkward position of the body, and
sedentary occupations are to be avoided, as far as possible. Oxygen may
also be administered internally, by charging water with it under pressure,
and Wallian recommends the mixture of oxygen and nitrous oxide, as above,
which are dissolved in the water under a pressure of one hundred to one
hundred and fifty pounds to the square inch. Oxygon-water has already
been used in the Paris hospitals by Dujardin-Beaumetz, with some good
results, in dyspepsia, debility, and chronic pulmonary or digestive disorders.
It has been highly extolled in the treatment of infectious diseases, like small-
pox, scailatina, diphtheria, etc., and in many forms of skin disease.
- For inhalations, the gas is supplied ordinarily in iron or steel cylinders,
containing forty and one hundred srallons, under pressure. Attached to the
cylinder is a cloth-covered rubber bag, which serves as a reservoir and enJibles
the quantity taken to be accurately measured. A bottle partly filled with
water is also attached, so that the gas from the reservoir passes through it,
and is then received into the bronchial passages in the form of moist oxygen.
A small gasometer may be attached, for the purpose of administering the
gas under pressure, or for use when it is desired to introduce -it into the
rectum. The gas may also be injected into the bowel by an ordinary David-
eon syringe connected with the rubber bag containing oxygen. In order that
absorption may be facilitated, it should be of the same temperature as the
interior of the body, or a little higher than the surface temperature.
Ozone and its Medical TJses.
Attention has already been directed to an allotropic condition of oxygen
which is known as ozone (from the Greek o^i;, a stench). It was so named
by its discoverer, Schonbein. who announced that the sulphurous smell pro-
duced by a stroke of lightning was due to this substance, which is also
known as "electrified oxygen.'' It is formed by the sparks from the static
electrical machine, and also during the electrolysis of water and during the
slow combustion of phosphorus in a moist atmosphere. Ozone was first
I obtained in appreciable quantity by von Siemens in 1854, who discovered
that the noiseless electric discharge was much more productive of ozone than
the intermittent discharge, and he constructed an apparatus for the pro-
duction of ozone by means of tubes. Subsequently, this has been still
I
1032
NON-PUAUMACAL REatEOIES AND GKNEKAL TUERAPEmCS.
farther advanced by the labors of the well-known firm of Siemena & Halske,
of Berlin, who furnish a comparatively cheap apparatus, by which an un-
limited supply of ozone can be obtained.
Ozone is a colorless gas, possessing a characteristic odor resembling
dilute chlorine. If the air contain only the one fifty-thousandth part of
ozone this smell is distinctly discernible. It is one of the most powerful
oxidizing agents known, attacking and destroying many organic fabrics, such
as rubber, paper, etc. Ozone has been liquefied at a temperature of 105**,
and under a pressure of 125 atmospheres. According to the investigations
of Chappius, ozone in this 8tate.is of an intense-blue color. The relationship
of ozone to oxygen is peculiar. In the formation of ozone three volumes of
oxygen become condensed to form two volumes of ozone. In the presence
of iodide of potassium and moisture one-third of the ozone is spent in lib-
erating the iodine and the other two volumes escape as oxygen. Test-papers
aro made by making a solution of starch and iodide of potassium, in which
bibulous paper is immersed and then dried and cut into slips of convenient
size. When it is desired to test for ozone one of the slips is moistened; if
ozone is present in the air it will liberate iodine, which, in turn, will act
upon the starch, producing a blue color. Ozone is found at the sea-shore;
in the forest, especially if of coniferous trees; at the summit of mountains
and high towers. It is usually absent in crowded cities and where organic
matter ia undergoing slow oxidation. Clouds owe their formation largely
to ozone, which is more hygroscopic than oxygen; but only the upper sur-
face of clouds and mists which are exposed to the sun's rays contain ozone;
it is not found in dark and thick mists. A great amount of ozone is formed
in the mist rising from the cold ground, under a clear sky, on a calm
autumn or winter day. As Schonbein demonstrated, atmospheric ozone is
only generated in considerable quantity when oxygen, moisture, and sun-
beams combine, as in the familiar illustration of the bleaching of linen upon ■
the lawn from the etTects of ozone. According to Scoutetten, under the
influence of light the green parts of plants exhale both ozone and neutral
oxygen, both of which are again taken up in part by the growing cells of
the plants.
Fhyaiological Effects. — Some interesting results in plant-life were ob-
tained by Ringk, a striking improvement being soon manifested after treat-
ing withered and drooping house-plants by ozonized water. Owing to its
powerful oxidizing etTects, ozone is believed to play an important part iti
nutrition. The red blood-corpuscles have the power of converting oxygen
into ozone, and it has been suggested that, since ozone has the power of ren-
dering albuminous solutions uiicoapulable by heat, it exercises a similar
effect in the human body, and prevents coagulation in the blood-vessels dur-
ing life. Protoplasm has the power of storing up ozone, which it subse-
quently uses as a source of energy. In many organ*, such as the liver,
spleen, and thyroid glands, ozone is found in considerable quantity; in the
muscles only slightly. Owing tn the superior fifiinities of nascent oxygen,
ozone plays an important part in tissue-change.
In concentrated form ozone is irritating to tlie air-passages, and may
cause iufiammationj salivation, bloody expectoration, and death. (Edema
of the lungs was noticed by Binz, who claimed that a comatose condition
supervened before any noticeable irritation of the bronchial tubes occurred,
and that guarded administration produced soporific effects. The effects of
PNEUMOTHEEAPY AND PNEUMATIC DIFFERENTIATION.
1033
I
I
I
an increase or diminution of atmospheric ozone upon the health of com-
munities has not yet been positively determined. Professor Falb, having
noticed a remarkable dimimition of ozone in the air in the summer of 1889,
was led to attribute the epidemic of influenza to this fact. The air-bacteria
are either destroyed or rendered less active in the presence of ozone, and,
where this is absent, infection is more apt to spread. Ozone is nature's
antiseptic agent, and Dr. B. W. Richardson, in his "City of Health," sug-
gested that there should he a building like a gas-house, in which ozone
should be made and dispensed by pipes to every house.
Ozone in Medicine. — It is believed that one of the principal advantages
gained by sending patients away from a crowded city, especially where in-
fection is present, is that the air is pure and contains appreciable amounts
of ozone in the country. When it is possible, children, especially, should
have frequent opportunities of getting fresh air; and, therefore, the chari-
ties which, like the Fresh-Air Fund and Country Week, take city children
out of town during the extreme heat of summer are of great value, both in
curing and preventing sickness. By special apparatus, it is possible to
charge distilled and sterilized water with ozone, or ozonized oxygen may be
passed through oil until it is saturated. These ozone preparations have high
value as disinfectants and deodorizers. Ozonized water is capable of pro-
ducing beneficial results in diseases of deficient oxidation^ as in ausmia,
chlorosis, lithaemia, and may be very usefid as a germicide in treating in-
fectious dyspepsia. Dr. Henry S. Norris, of New York, after the use of
ozonized water internally in the treatment of fifteen cases of phthisis, report*
that the results were beneficial in many of the cases. The oily solution is
claimed to have especial value in chronic skin diseases, by inunction; in the
dermatomycoses, or parasitic diseases; and in cases of infiltration of the
skin and glands.
Schmidt* has reported excellent results in two cases of epithelioma
following parenchymatous injections of ozonized w^ater, and considers that
it may also be serviceable in sarcoma and in tuberculous tumors. In the
treatment of diphtheria, Schmidt reports remarkable success from applica-
tions of ozone-water, and Eingk advises its internal administration. Dr.
Schnee, of Carlsbad, claims that ozone-water is of the greatest benefit in true
as well as in functional diabetes. In phthisis, ozonized oxygen (9 per cent)
gave good results, in the hands of Dr. A. Ransome.* The inhalations, which
wore taken three times a day (seven litres each sitting), were followed by
notable improvement, chiefly by gain in weight. Iodoform in pills and cod-
liver-oil were given, in conjunction with the oxygen, and much better results
were obtained with the oxygen than previously. In cystitis. Dr. Duhrssen,
of Berlin, obtained successful results following injections of ozone-water.
Oconized air may be obtained by the apparatus of Labb6 and Oudinj
which consists of concentric tubes, three to four millimetres apart, the in-
tervening space being traversed by the static electric current. To obtain
a sufficient quantity of ozone, they take the interior tube, sealed and con-
taining the rarefied air, which acts as a perfect conductor, and apply it to
the surface of the dielectric, which is of glass. The other armature of this
form of condenser is constituted by a metallic sheet applied to the internal
' MUnchrncr medieininche Wochetmcihrift.
* Hc4ical Recorder, London, May, 1890.
1034
NON-PIUUMACAL UEMEDIE6 AND GENERAL THERAPEUTICS.
face of the external tulx', and it is between the metallic sheet and the sur-
face of the internal tube that the current forms the ozone. The slightest
elevation of temperature which is produced in the cylindrical space sepa-
rating the two t'ul>es is sufficient to produce a current of air, which ascends
and bears along the ozone thus formed. Under the circumstances, the
air does not contain more than eleven to twelve hundredths of a milli-
gramme of ozone per litre, which the authors term the therapeutic dose.
Experimentation having shown the perfect innocuousness of these inhala-
tions, they w^ere given to children suffering with cachexia and anaemia, and
were not only well borne, but evidently curative, by increasing the oxyhaerao-
globin until it reaches the normal figure. It was found, also, that tubercle
bacilli were rendered less virulent, as a result of exposure of cultures to cur-
rents of ozonized air. IU\ L'tull*'*, jiftor an expcrii'iice of five months, upon
twenty-two cases, concludes that the daily inhalation of ozone increases the
oiyhsemoglobin in the blood from 2 to 4 per cent, in a short time, that in
pertussis these inhalations exert a distinctly curative influence upon the dis-
ease as regards duration and severity. Dr. W. J. Morton and Dr. Clarence C.
Rice, of Kew York, have observed tlic local elfect of ozone-gas upon eight
different patient?, all of whom suffered from various grades of atrophic
rhinitis and dry pharynx. 'The method employed was to instruct the pa-
tient to take a deep inspiration and then hold the breath while the ozono-
gas is allowed to pass into the nostrils through the tube. Tlie current is
passed as long as the patient can hold his breath. The immediate effect,
though differing in degree according to the volume of gas employed and,
probably, according to the sensitiveness of the nostrils, was a mild smarting
of the nasal mucous membrane for several hours, together with increased
secretion. The secretion, however, was more easily expelled, and at the end
of twenty-four hours the head felt unusually clear and tiie mucous mem-
brane more comfortable than before the application. The odor from the
nostrils disappeared after the second application. These results are encour-
aging, but whether permanent moistening of the mucous membrane and
decrease of secretions can be obtained by the use of ozone can only be con-
firmed after a longer trial. Dr. Rice has also made use of a preparation
called "therapol," a combination of sweet oil and 8.75 per cent., by volume,
of ozone, appl^ving it locally on cotton by means of an applicator, in two case*
of ozsena with the effect of deodorizing the nostrils.*
NiTBOOEN AND NiTEOOEN MONOXIDE (NlTROCS OxIDE).
In the mixture of gases constituting the atmospheric air, nitrogen sira
ply acts the part of a neutral body, or as a diluent for the oxygen. The
effects of breathing superoxygenated air have already been considered. If
we now turn to hypo-oxygenated air, or air containing increased quantities
of nitrogen, we are brought in face with the phenomenon known as ''asphyx-
iation.*' When pure nitrogen is breathed the effects upon animals is quite
uniform. Dr. George Johnson, in a paper on the "Physiology of Asphyxia
and on the Anaesthetic Action of Pure Nitrogen,"* found that the animals
rapidly succumbed as a result of the arrest of the pulmonary circulation.
The right cavities of the heart were found enormously distended and the left
> yete York Medical Journal, Aug. 10. 1803, p. 108 seq,
» Th€ British Medical Journal, Feb. 21, 1801.
DIPPKRENTLATIOK.
were comparatively empty: a condition which is evident during the life of
the animal, the change from the normal taking place progressively during
the progress of the asphyxiation. In the last stage of a?phyxia there is a
continuous increase of pressure in the pulmonary artery, while the systemic
arterial pressure is falling. The immediate cause of the arrest of the pul-
monary circulation appears to be the contraction of the pulmonary arterioles.
The phenomena which result from the inhalation of nitroiis oxide as an
anflesihetic, in the opinion of Dr. Johnson, are strictly analogous with those
observed in the early stages of asphyxia. At his suggestion, nitrogen was
employed at the dental hospital for extracting teeth in nine patients: "Tn
every case the result was the production of complete anffisthesia, with gen-
eral phenomena precisely similar to those observed during nitrous-oxide
inhalation. The pulse was first full and throbbing, then feeble; in the ad-
vanced stage respiration was deep and rapid, with lividity of the surface,
dilated pupils, and more or less jactitation of the limbs, the only difference,
in the opinion of some of those present, being that the aniEsthesia was less
rapidly produced and somewhat less durable than that from nitrous oxide,
though in each ease the tooth was extracted without pain." Subsequent
experiments with a mixture of 3 per cent, of oxygen gave the following
results: *Tive patients took the 3-per-cent. gas. Anaesthesia was complete
in 75 seconds (maximum) and in 60 seconds (minimum), the average time
required being 67.5 seconds. In each case the tooth was extracted without
pain, the duration of ansesthesia being somewhat longer than with pure
nitrogen. In each case there was lividity, dilatation of pupils, and more or
less jactitation." With a mixture containing 5 per cent, of oxygen the aver-
age time for producing anapsthesia was increased to 87.5 seconds. In each
of four cases there was complete anaesthesia. One patient had three molar
teeth extracted. ''Although she said she felt the last two, the sensation
appeared to be that of a pull, and not of acute pain. In most of these four
cases there was slight lividity before the removal of the face-piece. In only
one case was there slight jactitation of the limbs; the other three patients
were perfectly quiescent.''
An interesting feature in Dr. Johnson's experiments upon animals was
the effect of amyl nitrite in overcoming the contraction of the pulmonary
arterioles, and thus permitting the right side of the heart to become empty,
and the heart's action, previously almost suspended* was restored. By this
means life was prolonged until death finally occurred from increasing venos-
ity of the arterial blood. Inhalations of amyl nitrite may, then, be regarded
as the remedy for asphyxia, and at least a partial antidote to nitrogen or
nitrous oxide, especially when aided by artificial respiration.
The similarity of the anaesthesia produced by nitrogen monoxide to that
occurring from asphyxia by any neutral gas, such as nitrogen, hydrogen, or
carbon dioxide, was first pointed out by EHhu J. Thomson, in a commu-
nication to the Philadelphia Medical Times, in 1875. This theory of the
action of nitrogen monoxide in producing anflpsthesia denies any specific
action, and ascribes the effects solely to the deprivation of oxygen. While
this is possibly true of the complete amesthesia, yet it must be evident that
nnaller quantities of nitrogen monoxide produce a sense of mental and phys-
ical exhilaration and increase the pulse and respiration, which is not due to
diminution of oxygen, and does not occur with the other neutral gases above
mentioned. It is this preliminary intoxication which has given it the popu-
1036
NON-PHARMACAL REMEDIES AND GEN^EEAL THERAPEUTICS*
lar name of **laughing-ga8." It has already been suggested that the addition
of nitrogen monoxide to pure oxygen is useful as a respiratory and cardiac
stimulant, and its effects are preferable to those of oxygen alone; and this
combination is also decidedly safer than pure oxygen, which is sometimes
irritating.
In the American Journal of the Medical Sciences for August, 1891, ap-
peared an article by Dr. AVilUam W. Van Arsdale, giving a report of his
experience with a mixture of nitrogen monoxide and pure oxygen as an
anaesthetic. His object was to obtain anaesthesia without causing asphyxia.
From Paul Bert's experiments, it is known that the latter can be obviated
by the mixture of as much oxygen as is contained in atmospheric air (20 per
cent.); but, under ordinary circumstances, the tension of the nitrogen mon-
oxide is so reduced by this combination that no anaesthesia is produced, and
animals breathe it with impunity, just like atmospheric air. The problem
of obtaining the atmospheric superpressure was solved by Paul Bert in his
hermetically-sealed, glass operating-chamber, — like a diving-bell. In this
cage the patient, surgeon, and assistants were admitted, and, by means of the
air-pump, any desired density of the air was obtained. Under these circum-
stances it was found that the nitrogen monoxide and oxygen mixture pro-
duced anipsthesia without asphyxia. Dr. Van Arsdale sought to do away
with the expensive chamber, and substituted a mask for the patient's face,
whioh would admit of administration of the gas under pressure. He prefers
a 10-per-cent. mixture of oxygen, administered by an ordinary bag, rubber
tube, and an air-tight mask. The great difTiculty in most cases was found to
lie in the fact that patients would not breathe deeply, but this was over-
come by applying pressure; by placing a board weighted to fixe pounds
upon the reservoir-bag. His conclusions were, that many cases were un-
suitable to this method, the failures being due to nervousness, idiosyncrasies,
and possibly alcoholism. But ruling out these cases, he says; "In the ma-
jority of cases, however, in young, healthy individuals and in females, the
anaesthetic mixture, when administered under pressure, was found to work
well, and to be much superior to the pure nitrogen monoxide for surgical
purposes. It induces a state resembling a quiet, deep sleep, in which the
respiration is slow and regular, the pulse regular and full, and not much, if
ever, increased in frequency. The blood-pressure is not increased, and in-
sensibility to pain and unconsciousness go hand in hand.
"We have," he eays, in conclusion, **in the 10-per-cent. mixture of oxy-
gen and nitrogen monoxide, an angesthetic which may be administered with
perfect safety, and for a sufficiently long time to permit of the circumspect
performance of most minor operations, but one which may be characterized
as a weak anoesthetic. For, although it will plunge the average adult into
a state resembling peaceful slumber, in which anaesthesia and unconscious-
ness are well marked, it cannot gain victory over states of great ner\'0U8
excitement or dread, or certain habits or idiosyncrasies." In other words,
this form of anaesthesia resembles ether, which sometimes fails to produce
anaesthetic sleep, and recourse then is usually had to the more powerful
chloroform, or to scopohiminc-morphine narcosis.
Nitrogen monoxide has been used therapeutically in certain nervous
affections. Dr. W. R. BirdsalP published the results of his experiments upon
^Kew 7ork Medical Journal, March 7. 1891.
PIfEUMOTHERAPY ANT) PXEPMATIC DIFFERENTIATION.
1037
I
I
I
I
■
Sixteen patients euflPering with various neurotic complaints. In none of these
did he observe any positively beneficial effect. He used 20-per-cent. diluted
gas during a seance lasting ten to thirty minutes. The effects were transient,
and he concludes that the uses of nitrogen monoxide for medical and sur-
gical purposes must be restricted to its effects as an anssthetic and as a
placebo.
Nitrogen monoxide is usually obtained by heating ammonium nitra'te,
which decomposes at an elevated temperature and forms water and nitrogen
monoxide (NH^, NO^ = 2 H.^0 -j- "i^-fl). The product is washed by passing
through water, which soon becomes saturated with the gas. It is kept in a
gasometer, or in retorts obtained from manufacturers of the gas, in which
it is reduced to a liquid form by strong pressure. From these small cylin-
ders the administrative bag is filled, as occasion requires, for use in brief
surgical operations, such as pulling teeth, etc.
Oxygenated, aerated water is a proprietary article containing five atmos-
pheres of nitrogen monoxide in water. It has but little odor, and is slightly
sweetish to the taste. It has no special therapeutic effects.
The other gaseous elements are used in medicine only very exception-
ally. Hydrogen-gas will produce asphyxia, liko nitrogen monoxide, but its
inflammability and liability to be contaminated with metals like arsenic and
zinc make it dangerous. It has been brought to notice in the expedient of
Dr. Senn, of Chicago, who injected it into the bowels, in order to detect any
perforation, by the flame-test, but this has been found unsatisfactory, and
has been abandoned.
Pneumatic Diffebentiatios* and Treatment by Inhalation.
In the preceding article reference was made to an apparatus for the
administration of remedies under pressure. Pneumatic differentiation is
the process by which the air surrounding the body and that entering the
lungs are rendered of different pressures. It may be positive, negative, or
alternate. The first is where the air entering the lungs i§ maintained, dur-
ing both respiratory acts, at a greater pressure than that surrounding the
body. Negative differentiation is the reverse of this. Alternate differentia-
tion is where the other two forms are alternated successively, the air enter-
ing the lungs under greater pressure, and in expiration the pressure sur-
rounding the body being greater.
An apparatus was invented by Dr. Williams, for the purpose of apply-
ing this method of treatment, and is known as the "Pneumatic Cabinet."
The physics and physiological effects of pneumatic differentiations have
been sufficiently discussed in a number of communications, which appeared
some years ago, when the Williams Pneumatic Cabinet was first brought
to the notice of the profession. In an article by Dr. Isaac H, Piatt/ of
Brooklyn, on the ^'Physics and Physiological Action of Pneumatic Differ-
entiation," a very good resume of the subject is presented. It is very evi-
dent that this apparatus, which increases the air-pressure within the lungs,
and also enables us to diminish the tension of the external atmosphere and
thus empty the air-cells more completely, will not only produce fuller res-
piration, but also will act as pulmonary gymnastics, through the greater
activity of the bronchioles and air-cells. There is, in consequence, freer
'yac York SIcdical Journal, Nov. 6 and 13, 1886.
103«
NOX-PHAUUACAL ItKMliUIES AND OENEaAL TKKItAPfiUTICS.
ejcpanfiion and the opening up of collapsed lobules, while the expectoration
of exudative material and foreign bubstances will be assisted. The second-
ary ellects upon the pulmonary circulation will also be of considerable im-
portance in bringing a larger quantity of blood under the influence of the
air, but the elTect of this is not so great as would at first be expected, owing
to the tendency to increase of residual air, and the production of qualitative
or partial emphysema. Dr. Piatt concludes, from a summary of the effects
of pneumatic dillerentiation, that, "by means of the ditferential process in
its three forms, we can increase or diminish the diRicully of expiration or of
inspiration; we can increase or diminish the tidal air, the vital capacity,
the stationary air, and the residual air. We can, to some extent, control the
amount of blood in the lungs, and consequently control pulmonary conges-
tion and hfemorrhage, and we can raise or lower arterial biood-pressure. It
is hardly possible that such wide-spread phenomena can be induced without
producing other and secondary results, through the influence of the nervous
system and otherwise." Therapeutically, Dr. Piatt concludes: "The result
of my experience and study has been to convince me that a large share of
the benefit derived from the use of the cabinet is due to reduction of con-
gestion, and consequently of inflammation, in the dis^eased lung by the dif-
ferential pressure, in very much the same way as a bandage will afford relief
to an inflamed joint. In addition to this, undoubtedly, the increased ex-
pansion to which the lungs are subjected, and the passive exercise which
they are afforded, will do much to modify their nutrition and increase their
vitality."
The pneumatic cabinet has also been advocated as a means of conTej-
ing medicated vapors and gaseous medicamentB deeper into the pulmonary
Btructures than is possible by ordinary means. Although the enthusiastic
advocates of this treatment speak in high terms of the results, it really has
not been shown beyond question that such remedies are really introduced
more deeply into the air-cells and bronchioles than under ordinary pressure,
except in so far as air-cells which had collapsed or have been plugged up
have expanded under the pulmonary gymnastics. The subject is worthy of
more attention and study, but it is beyond the reach of the ordinary prac-
titioner. In institutions for treating pulmonary affections and hospitals
room may. well be found for such a highly-specialized apparatus, and a lim-
ited field of usefulness determined for it.^
More attention has been given to the subject of the administration of
air and other gaseous elements, under varying pressure, of late years, espe-
cially in Europe. In France, at Contrexevillc, there is an aerothcrapeutic
institute. The pneumotherapeutic institute of Brusaela is especially worthy
of mention. It gives: —
1. Baths of compressed or rarefied air, with or without supersaturation
with oxygen-gas.
2. Inhalations of compressed air with expiration into rarefied air.
3. Electrotherapy.
4. Acts as a depot for manufacture and sale of oxygen-gas.
4
^ Those intcrpsted in this subject may refer to the "Proceedings of the Ameripan
Climatological Association" for 1886 for papers by Professor Loomis. of New York;
Dr. Donaldson, of Baltimore ; Dr. Williams, of Xbw York, and Dr. Platt*s paper.
alreody referred to. The Philadelphia Medical Times^ vol xvi, p. 664, contains ,
abstracts of these papers.
PNELMOTHKiai'Y AND PNKirMATIC DIFFEUENTIATION.
1039
I
The effect of baths of compressed or rarefied air will be discussed
farther on, when considering the physiological effect of climate. Reference
can only be made here to the apparatus of Waldenburg, Solis-Cohen, and
others, for the administration, by a sort of gasometer, of compressed or rare-
fied air, the effects of which resemble those already mentioned as resulting
from the pneumatic cabinet. For further elucidation of the subject the
reader is referred to Dr. Arthur nill Hassairs work on "The Inhalation
Treatment" (London, 1880) and other recent literature in this field of
therapeutics.
Medicated Vapors — Atomization — Inhalation. — Volatile medicinal
substances may be vniiorized and the odor, smoke, or vapor inhaled; non-
volatile substances may be dissolved in any convenient menstruuna, such as
water, liquid pt'lrolatuni, oil. glycerin, etc., and made to assume a con-
dition of fine spray by means of an atomizer, of which there are several
kinds. In the first form to be described the apparatus consists of a conven-
ient-sized rubber bulb connected with an hermetically-sealed bottle or re-
ceiver containing the medicated solution, into which air is forced by com-
pression of the bulb, thus displacing the liquid, wliich escapes through a
tube with a capillary point, at the side of which a strong blast-air is forced,
thus comminuting the drops into a fine spray. In another form the air is
not forced into the bottle, but is directed across the extremity of the deliv-
ery-tube in such a manner as to produce a partial vacuum, which causes the
liquid to rise into the tube and to escape in a fine cloud. In an improved
form, the blast of air is supplied from a metallic receiver, into which it had
previously been forced by an air-pump. A well-known form is the steam-
atomizer, in which the steam from boihng water supplies the blast. In the
several forms of steam-atomizers there is the advantage of the warm moist-
ure, but the remedies should be in stronger solutions than for the hand-
atomizer, or dry atomizer, because of the dilution by the steam. Solid sub-
ftances may be finely powdered for insufflation and inhalation, although this
scarcely comes within the limits of the present subject. Below may be
found some formulse for use with inhalers and atomizers.
Formulffi for Inhalation. — These remedies may be ordered to be sim-
ply dropped upon a handkerchief and held to the nose, or poured upon
absorbent cotton, in a test-tube or special-shaped tube for inhalation, or
contained in a d respirateur of wire gauze covLTing I he nose and mouth.
For infants or invnlidj* the remedy, when vulntile, may be dropped upon the
patient's clothing or simply upon the pillow: —
li Spt. ammoniie aromat q. a
For inhalation in syncope, heart-failure, narcotic poiaoning, etc.. being careful that
the vapor or gfts is well diluted with air.
The following combination is much used in England: —
1. R riienol. li.| 4| Gm. or 3j.
Carbonii* li^ni 1515 Om. or Saa.
lodi 4| Om. or Sj.
Mix the pure carbolic acid with half of the wood chaixoal thoroughly: mix the
iodine with the other half, and mix together.
2. li Ammonii oarbonat 311 Um. or Sj.
Carb. ligni 1515 Gm. or Ssa.
Camphorffi 4{ Gm. or 5j.
104 iJ
XON-PHAU-MACAL REMEDIES AND GEKERAL xnERAPEUTICS.
M. Add Numbers 1 and 2 lightly together, add 1.20 c.cm. (or mxx) of oil of
lavender, and as much compound tincture of benzoin aa is needful to make a thick
paste, and put in a wide-stoppered bottle. (Mr. Durham, of London.')
The following is Brand's (of Vienna) remedy for acute coryza, and is
much used as an inhalation for nasal catarrh and coryza: —
B Phenol, liq..
Aq. amnionis fort. a& 1815 ccm. or fSv.
Alcoholi* 60| c.cm. or fjij.
M. Sig.: Keep in a dark place or in a tinted glass bottle.
H
A few drops are to be poured on blotting-paper, and this rolled into a
cone, and the vapor inhaled as long as it rises. The eyes should be kept
closed, on account of the irritating nature of the vapor.
1} CamphoriB 4| Qm. or 3j.
Sig.: Add to 473 c.cm. (or Oj) of boiling water, and inhale the vapor, for acute
coryza.
Beverly Robinson also reconunends the following: —
B Phenol, liq 4
Creosoti 4
Tinct. iodi 16
Alcohol 30
M. Sig.: For inhalation.
B 01. pini aylvestris 4
Succua conii,
Tinct. benzoin, co aa 7
Magnesii carb 2
Aquffl 30
M. Sig.: For inhalation with a nasal Inhaler.
By employing a receptacle holding hot water (a pint or less),
volatilization is hastened by the heat, and the effect is more powerful,
the dry form of catarrh, steam fumigation or atomization is better than
dry inhalation. The following require hot water: —
Gm.
or
.. g
c.cm.
or
iii,. ■
c.cm.
or
CCTR.
or
^
c.cm.
or
H
c.cm.
or
H
Urn.
or
H
c.cm.
or
■
B Tinct. b«TiKoini co ,
Sig.: A teflspoonful for each inhalation.
30| ccm. or fSj.
B 01. pini aylvestris 7|6 c.cm. or f3ij.
Magnesii carb 6 Gm. or Siss.
AqiuB q. s. ad 90( ccm. or fjiij, — M.
Or the following: —
B Creos«ti 15
Magnesii carb 4
Aqiue q. s. ad 90
M. Sig.: A teaspoonful for inhalation. (Robinson.)
c.cm. or f3iT,
Gm. or 5j.
c.cm. or fjiij.
B Tinct. Iodi co S0| c.cm. or fjj.
M. Sig.: For an inhalation 0.6 to 1.2 c.cm. (or tnx-xx).
* From "Xasal Catarrh and Allied DiseaMs/' by Beverly Robinson, second edition.
New York, 1885.
FNEUMOTHERAPY AND PNEUMATIC DIFFEUENTIATION.
1041
H Ain>lis niiritin 41 o.cin. or f3j.
M. Sig.: From 0.18 to 0.30 c.cm. (or miii-v) ma^ be inhaled from a handker-
chief; or ftmall, glau pearla, each containing the required dose, may be uaed in tha
•anit: manner.
H Chloroformi 41 ' c.cm. or f3j,
Tinct. lavandulee co ll| c.cm. or f3iij.
M. Sig.: A few drops may be inhaled for irritative cough, as in phthisis.
The following, which is known as Dobell's formula, is very largely em-
ployed Qs a detergent (Dr. Robinson uses thymol in place of carbolic acid): —
B Phenol, liq 2|00 Gm. or gr. xl.
Sodii borat.,
Sodii bicarb aa 8
Olycerini 20
AqUffi 00
M. Sig.: Solution for nasal spray to be used with the atomizer.
B Acidi salicylici
Sodii lM>r»t..
Sodii phospbat. aa 81
Chlonili hydrati l|3
Olycerini,
AquiP rosea aa 30]
Aquie q. s. ad 240
M. Sig.: Use frequently in initial stage of acute coryza.
The late Morell Mackenzie* recommended the following: —
Antiseptic Nasal Sprays or NehuUs.
R Phenolis liquidi puri
Aque
B Tr iodi |t8 c.cm.
Glyceriti acid, tannici |75 c.cm,
Aqu£c dest q. s. ad 30] c.cm,
3 Iodoform 216 Gm.
.Ether, (sp. gr., 0.735) .'. 30| ccm
B Potasaii permanganat.
Aqiue
B 9odii benzoat 1 13 Gm.
Aquae , 30j c.cm
B lodated zinc caustic 175 Gm.
Aquie dest 30| com
B Acidi tannici
Aquee
B Liq- Blumin. chloridi
Aq. dcj't
Alumen
Ferro-alumcn
Ferri p^Tohloridi
Ferri sulphus
Zinci chloridi
ZInci 9Ulphnt
Asiringeni Sprays
60 Gm.
20 Gm.
18 c.cm.
13 Gm.
13 Gm.
32 Gm.
"Diseaaea of the Throat and Nos«," Morcll Mackenzie, London, 1884.
1043
KOS-PHABMAOAI. UEMEDIES AND flCNKIlAL TnEaAPEUTIOS.
Detergenl Sprays,
Dobell'e eolution.
Potawii chloratis 1|3 Gni. to 30|
Sodii chloridi |32 Gm. to 30|
Sedative Sprays.
Potass, bromidi 1 13 Gm. to 30)
li Tr. belladonnie IC
Aquffi calciB 30|
Antiseptic Sprays.
Liq. calcis q. s.
Sodii sal icylat 1|3 Gm. to 30|
R Acidi tactici 21
Aquffi 30l
c.cm. or gr. xx-fSj-
t.cm. or gr. v-f5j.
c.fin. or gr. xx-fSj.
c.cm. or mx.
c.cm. or f5i. — M.
c.cm. or gr. xx-fjj*
c.cm. or mxxx.
c.cm. or fjj.— M.
4
There is often an advantage in having the liquid warm before spraying;
this is not required when the steam-atomizer is used.
HYDROTHERAPY AND BALNEOTHERAPY.
'™
The medicinal application of water by any method enmcs, stricf
speaking, under the domain of hydrotherapeutics, which is, therefore, a
very comprehensive term. Hydrotherapy {vButp, water, and **€pairtvia. ] treat)
comprises both the internal and the external u?e of water in the treatment
of disease. The numerous forms of external administration — by wet packs*
showers, douches, sitz or partial, plunge, and hot and cold baths^have
given greater importance to the latter of these methods, so that the popular
idea of "water-cure" is that it is mainly a course of bathing. Balneothera-
peutics (^oXo^roi-. a bath, and »€(>aweitj. I treat) is that department of thera-
peutics which deals with the application of baths in the treatment of disease,
the different varieties of which will presently be considered in detail. The
term "balneotherapeutics" is also applied more specifically to the science
that treats of the effects of mineral waters and baths, especially as conducted
at certain health resorts, known as '^baths" or ^'springs." Leichtenstem, in
von Ziemssen's "Hand-book of Therapeutics,'' defines balneotherapy as *^he
science of the therapeutical application of mineral waters," or "the science
of the method and mode of operation of bath- and well- cures." In con-
nection, therefore, with this topic, the composition and character, also the
physiological and therapeutical effects, of various more or less celebrated
mineral springs, require to be considered somewhat in detail. At the outset
of our discussion of the therapeutical applications of water and water-dress-
ings, we encounter the difficulty, as pointed out in the instructive and highly
valuable little treatise of Dr. Simon Baruch,^ of the existence of a belief on
the part of many enthusiastic advocates of hydropathy that it is a panacea,
and that it is a complete system of therapeutics rivaling regular medicine,
and destined; finally, to overcome it. This is unfortunate, since it has led
to the establishment of "water-cure" establishments for the treatment of all
' "t-'scs of Watrr in Modem Medicine/" Physicians* Keisure Ubriry, Detroit. 1892.
CNEOTHERAPr. 1 043
diseases, and too frequently these arc carried on in an empirical manner,
under the control of ignorant laymen or irregular practitioners. Moreover,
the influence of Priessnitz, who, by occupation, was a farmer, but who waa
an ardent advocate of hydropathic treatment for all diseases, is still felt by
his successors; so that there is still, in some quarters, decided antagonism
between the practitioners of scientific medicine and the sect of so-called
hydropathic physicians. This reproach of Iiydrotherapeutics is now about
to he done away with. Of late years the subject has attracted the attention
of able investigators and teachers, among whom stands, notably. Professor
Wintemitz, who by Dr. Baruch is styled the father of modern hydrotherapy,
and who is the author of the able treatise upon this subject in the fifth
volume of von Ziemssen's **nand-book of Therapeutics."
Historical. — It is simple justice to the ancient physicians to state that
the therapeutical, as well as the hygienic, value of water and bathing was
highly appreciated by them. In the **Vedas" of Susrotas water is often
spoken of as an article of dietetic treatment, and even as an antidote, the
number and the times of the baths being exactly regulated, and, indeed,
with great minuteness of detail. In ancient Greece, in the midst of groves
rich in springs, and in the vicinity of thermal springs particularly, stood
temples dedicated to ^-Esculapius. Prayer, fasting, and bathing were con-
ducted, under tke strict rules of the priests, and, after the patients had
pursued the required course, a votive offering was made containing brief
notes of the symptoms and treatment. In the halls of these temples Hip-
pocrates found a rich mine of therapeutical literature, which he utilized
with the hand and brain of a master. It is not surprising, therefore, that
his system of pathology was principally humoral, and that water played an
important part in his therapeutics. '*He was the first to maintain that cold
water warms, while warm water cools, the body. He was acquainted with
shower-baths and shampooing; he noticed that warm showers induce sleep,
and cold water, poured over the body, is useful in fainting. He treated
tetanus with showers, and in atlections of the joints he recommended the
pouring over of cold water as being useful in relieving the pain and curing
the affection. "Articulorum turaores et dolores absque ulcere et podagricas
affectiones . . . frigida large elTusa (aqua) levat et minuit, doloremque
solvit.' Withal, his views on the hygienic value of water were remarkably
enlightened. He pays, in the *Tractatus de Aere, Aqua, ct ljr>c\a, that 'the first
duty of the physician, when he comes to a town, is to become acquainted
with the peculiarities of the waters used there — whether they are boggy, or
hard, or soft, and whether they come from hills or rocks,* etc. Since ele-
vation of temperature was known to him as a symptom of fever, he recom-
mends the use of cold water against the different varieties of it; even. the
reactionary influence of cold applications was not unknown to him." He
also understood the principle of revulsion, as well as the heat-abstracting
action of cold-water applications. *'We perceive, also," continues Winter-
niiZf "in the introduction of therapeutical principles true to nature, the
first important beginnings of hydrotherapeusis in scientific medicine. From
this time, water commands a place in therapeutics, and, since its soothing
and anti-inflammatory properties are the most striking, we see how it ia
taken up by the different medical schoolg/' all makinjj greater or less use
of it, even with fundamental doctrines as much at variance as the humor-
alists or physiaters and methodists, or the dogmatists and empirics. In the
1044
NON-PHABilACAL REMEDIES AKD OENEHAI, THKBAPECTICS.
writinp:s of Galen due recognition is made of the value of water in thera-
peutics. With the exception of the celebrated code of health of the School
of Salernum, however, the writings of the middle ages contain little refer-
ence to this method. In the seventeenth century it began to receive greater
recognition, especially in England (Floyer; T. Smith), and, in the begin-
ning of the eighteenth century, in Germany. F. Hoffmann and Hahn,
toward the middle of the last century, advocated cold sponging in fevers.
Hydrotherapy received greater impetus toward the latter part of the
century, in England, by the writings of James Currie, William Wright, and
W. Jackson. The method was subsequently advocated by Reuss, Frohlich,
Brandis, Horn, and others. About 1743, John Sigmund Hahn, in Germany,
systematized the practice of hydropathy, but it was falling again into disuse,
when, soon after 1820, Vincent Priessnitz, a small farmer of Graefenberg,
in Silesia, began to treat every kind of ailment, chronic as well as acute,
with various hydrotherapeutic procedures, and added to the extexnal appli-
cations the abundant internal use of water, combined with active exercise
and a verj- simple diet, prohibiting, at the same time, all alcoholic beverages,
and also tea and coffee.* The error of Priessnitz has already been referred
to, and is one that medical-system makers generally fall into. It was that
there is a universal method of treatment applicable to all cases. He, how-
ever, succeeded in making the medical value of water t& be better appre-
ciated by both the profession and the laity, and the furor which his treat-
ment excited was of great value to regular medicine, in directing attention
again to this highly-important therapeutical resource.
Among contemporaneous writers, we may mention Ernest Brand, who
published his work in 1861, showing remarkably favorable results, especially
in typhoid fever, following immersion and compresses at from 54® to 68°
F. Beutels, Jiirgensen, Wintemitz, Charcot, Valleii, Dujardin-Beaumetz,
and numerous other authorities and teachers have, by their labors, brought
the science of hydropathy into system, and greatly advanced its practice.
Kneippism is a more recent development of hydropathy, under the di-
rection of an enthusiast almost as ignorant of medicine as Priessnitz, and, in
his methods and results, curiously recalling to our mind the history of that
great empiric. The Abbe Kneipp, having read Hahn's book, and cured
himself by the liberal use of cold water, according to its directions, he has
ever since been a zealous advocate of cold water as a remedy for all diseases.
Dr. L. Reuss' thus describes his method : —
He undertakes to cure a long list of maladies, from asthma to shingles.
For each of these maladies, Vater Kneipp'e principal, if not his only, madi-
cine is cold water, applied in the shape of douches, foot-baths, head-baths,
sitting-baths, and so on. Given in the form of drink, the water is often
mixed with infusions, decoctions, or alcoholic tinctures. Always, however,
water is the base of the medication. The simples recommended by the abb^
are very numerous, and the country people know them well. The leaves and
flowers and roots and berries which he uses oan be found, with few excep-
tions, at all our herbalists.
' Rcmnaim Weber: "Quain'a Medical Dicltooaiy," p. UtfT.
' Annclcjs ti'Hygi^nr PubUqne €t J« M^dtdme Legale; Tt««t «atf Befkt^, May
T, 1W2, from Litrrify I>iy*»t,
HYDROTHERAPY AND BALNEOTHERAPY.
1045
The ■worthy abb6*6 eystcm, however, is not one of therapeutics alone;
it is also one of hygiene. He maintains that the many diseases of our day —
affections of the heart or the chest, gastritis, anBEmia, nervous disorders —
were almost unknown to our ancestors, and are the result of our bad mode
of living. He declares that the most of our maladies are due to trouble in
the circulation of the blood. To remedy this, the body should be subjected
to the action of the exterior air, combined or not with the action of icy-cold
water. Children should be allowed to ^o without shoes or stockings. Adults
should often walk in the fields, even in winter, barefooted. In winter a walk
with bare feet in the snow is absolutely recommended, only the snow should
be fine, like dust, freshly fallen, and there should not be a cold and piercing
wind blowing. The length of this snow walk should not exceed three or
four minutes. A walk in running water has an incontestable tonic effect.
To keep well, according to Kneipp, you must dress and eat according
to a certain system. You must discard woolen clothing next to the skin,
Kneipp declares that if wool develops more heat than other cloth, it does
so to the detriment of the human body. You must wear next to the skin
a shirt of coarse cloth, as coarse as that of which grain-sacks are made. Fur
collars, fur gloves, knit vests, and shawls, and all that sort of thing, must
be absolutely discarded.
Finallyj if people want to get well and stay well, they must change their
diet and drink. They must eat food which is richest in nitrogen, — milk,
cheese, peas, beans, lentils, meat, and fish. They must avoid food poor iu
nitrogen, like the cereals, potatoes, vegctfibles generally, and fruits, and have
nothing to do with fats and oils. They must drink a minimum of wine, of
cider, of beer, and have nothing to do with brandy. Coffee, with or with-
out milk, chocolate^ and tea are anathematized, especially coffee with milk,
which debilitates the stomach, leaving it without digesting. Coffee with
milk and beer, Kneipp counsels to replace with coffee prepared from acoma
or with malt. This drink (Kneipp coffee) has nutritive and sedative quali-
ties, in which ordinary coffee is absolutely lacking, and has also an excellent
taste.
**Such is Kneippism. ^Vhethe^ it will make the tour of the world or
even the tour of all Germany, the future alone can disclose. At all events,
the system, if it cannot be recommended in its entirety, is not without com-
mendable features."
At the present day, the achievements of hydrotherapy and the advance-
ment of physiological and pathological knowledge demand from ever}' intel-
ligent physician an attentive investigation of its principles and practice. If
this should be generally done, it will, beyond doubt, lead to a more general
employment of such a valuable therapeutical aid. Professor Peter, of Paris,
inaec<T, went so far as to declare, in his preface to Duval's "Hydrotherapic/*
that "hydrotherapy suffices, in most cases of disease; added to other treat-
ment, it is a most powerful auxiliary. Can anyone speak better or say more
of it?">
Physiological Effects. — The erroneous idea has gained ground that the
only object of bathing, in acute diseases, is reduction of temperature. It is
true that pyrexia can be modified or reduced by this means, but other phys-
' Quoted by S. Banich, loc. oit., vol. i, p. 12.
1046
NO.N-PHAHMACAL REMEDIES AND GENERAL THKRAPEUT103.
iological and therapeutical results are produced, as will be seen from the
following brief review of the physiological eflects of water: —
Thirst is the sensation analogous to hunger experienced as a result of
privation from water or fluids, after profuse watery discharges or hieraor-
rhages, and also as a result of the drying up of secretions., in some cases of
fever. Life cannot be sustained without constant renewal of the water of
the organism, to replace that lost by excretion, exhalation, and evapora-
tion. Tissue-change and its functions are dependent upon the presence
of water in sufficient quantity. This is partly supplied by the water
contained in our food, and partly by the water which is drunk. Temporary
excess of supply leads to increased discharge by the excretions and enhanced
nietabolisra; whereas, relative deficiency produces a diminution in the quan-
tity of the excretions. Where the increased ingestion of water continues for
several days, it is observed that the volume of the blood is increased, and there
is an increased removal of the products of retrogressive tissue-change; the
blood, the tissues, and the kidneys being, so to speak, washed out by it. The
urine is more abundant and the solids are slightly increased. In conse-
quence of the removal of the used-up material, the organism is able to take
up a larger quantity of new nutritive substances. As a result, if not carried
to excess, so as to disturb digestion, plentiful water-drinking causes increase
of bodily weight; the urine, the saliva, bile, pancreatic and intestinal juices,
and the perspiration are increased; the proportionate increase being deter-
mined by circumstances of temperature and bodily exercise, clothing, etc.
The acknowledged benefits from a course of mineral waters are largely due
to the increased quantity of water swallowed, and it is found that certain
remedies, such as potassium iodide, are more efficacious when given largely
diluted with water, and many pharmaceutical preparations must be given
diluted, more or less, in order to make them less obnoxious to the palate.
Excessive water-drinking, especially of ice-water, causes digestive dis-
order; but what constitutes excess is relative, and not absolute, since some
persons may, without apparent ill effect, take quantities which would be in-
jurious to others. Used systematically, water increases the watery contents
of the stools and favors peristalsis, but excessive water-drinking dilutes the
gastric juice and tends to produce diarrhoea. It reduces the density of the
blood, and may interefere with the nutrition of the great nerve-centres and
of the heart.
The external uses of water produce different physiological effects in
accordance with the mode, duration, and time of application. The primary
effects are local or general abstraction of heat and the stimulation of greater
or less cutaneous areas. Indirectly, we have stimulation of the nerve-centres
and disturbance of fimction of the vasomotor system, and the resulting
effects upon metabolism, excretion, and assimilation. Hydrotherapeutic
measures, apart from their antipjretic applications, are sometimes divided
into stimulant and calmative, but no exact line can be drawn between these
two classes. Among the former, the full, or plunge, bath; cold-rain or
shower- bath; the douche, the spray- or needle- bath (circular shower-bath),
sponge- or towel- bath, of short duration, usually preceded and followed by
friction of the skin, are most used. The observations of Wintemitz have
shown that cold baths increase the absorption of oxygen and the elimination
of carbonic acid. A hot bath is a powerful nervous stimulant. The stimu-
lating effects of these are shown in the reaction which follows, accompanied
HYDHOTHERAPY iND BALNEOTHERAPY.
1047
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by a sense of exhilaration. Where the reaction does not occur, and the pa-
tient is blue and depressed after the bath, it fails of the anticipated good
effect, and will be injurious, if continued. Some individuala have an idio-
syncrasy in this respect, but where this is due solely to being unaccustomed
to bathing it can be overcome by a system of graduated baths. By altering
the temperature and duration of the bath, the effects may be conf5iderably
modified. The calmative effects are obtained from the wet pack, in which
the patient is enveloped in a wet sheet and rolled up in blankets; wet com-
presses; the hot foot-bath; the sitz-bath; the warm bath without motion.
The effects noticed are abstraction of heat, diminution of nervous irritability
of sensation, and mental activity, also, of the force and frequency of the
hearths action. There is a feeling of lassitude and a tendency to sleep. As
suggested by Weber (loc. cit,), ''These forms of application can be modified,
and the effects will vary in proportion. Thus, the wet-sheet envelope allows
ample variation by using warm or cold water; by using the sheet dripping,
or wTMng out; by making the sheet fit tightly around the neck; by moving
the sheet to and fro; by frequently changing the sheet, etc. The calming
and stimulating form moy he fitrthor combined by using, first, the wet-sheet
envelope, or the woolen-blanket envelope, for a sufficient period to produce
perspiration, and then a more or less cold bath or shower-bath of short dura-
tion." The various forms of hot-air and steam baths, combined with
douches and baths of various temperatures, in the forms commonly known
as Turkish, Roman, or Russian baths, are powerful hydrotherapcutic helps.
Ice may be applied so as to act as a stimulant, or, on the other hand,
as an antipyretic and sedative. To obtain the former effect, pieces of
ice are applied suddenly to dilferent portion? of the surface of the body,
thus exciting reflex action and stimulating the vasomotor nerves. They
may also be introduced into the rectum in chloroform or ether nar-
cosis, as rccomuiended by the late S. D. Gross. The ice-bag will often
relieve pain.
Obstetricians sometimes excite the uterus to contraction in post-partum
haemorrhage by inserting ice into the cavity. Applied over a nerve, ice may
produce ansesthesia, or even paresis of its peripheral fibres. Weir Mitchell
demonstrated that anatomical changes may be produced by intense cold
applied to the nerves, such as congestion with or without sanguineous exu-
dations. Briefly applied, cold produces a rapidly-passing congestion without
leaving traces behind, but, if prolonged, the nerve increaeeB in volume,
chiefly by dilatation of its blood-vessels. There may be actual effusions in
the structure of the nerve, producing more or less paralysis in the parts sup-
plied by it, but they usually disappear, although some of the nerve-fibres
may degenerate. **Thus," says Banich, **we may account for some cases of
acute neuralgia, myelitis, and acute spinal paralysis following great tempera-
ture effects." All observers are agreed upon one point which is of great
importance in clinical hydrotherapy, to wit: "an evanescent thermic appli-
cation excites, while a prolonged one depresses." There is a more energetic
reaction when the transition is abrupt from hot to cold, or the reverse, than
where it is graduated.
Irrigation of the mucous cavities of the bodies by large amounts of
fluid is a well-known and valued therapeutic measure. Large cold-water
enemata have been used as a means of reducing temperature in typhoid
ferer; injections of warm water break up masses of fieces and cause evacua-
1048
NOX-PHARMACAL IIEMEDIES AND GENERAL THEKAPEDTICS.
tion of the large bowel; irrigation of th^ stomach removes mucus and acts
as an antiseptic. Hot water is an excellent styptic and antiseptic.
The late Dr. John M. Keating urged the use of large hot-water injec-
tions into the rectum, the patient using the fountain-syringe before retiring
at nighty as an assistance in breaking up utero-rectai attachments and re-
ducing backward displacement* of the uetrus. While making the injection
the patient should be in the knee-chest position.
The practice introduced by RruH, of treating catarrhal jaundice by
means of cx^ld enemata, has found many supporters. On the first day from
800 to 1600 c.cm. (or 1 V^ to 3 V^ pints) of water at 59° F, are injected,
and on succeeding days the temperature is gradually raised to 72.5° F.
The appetite improves from the first, the hepatic and epigastric sensibility
is next relieved, and the strength increases. The method is said to succeed
in four to six days in recent cases or those of some weeks' duration. The
removal of the obstruction is accompanied and followed by polyuria, with
increased excretion of urea. The injections produce intestinal peristalsis
and overcome constipation. They also remove septic matter from the bowel
and facilitate the expulsion of calculi.
Clinioal Applications of Water in the Treatment of Disease. — In the
author's work on "Heredity. Health, and Personal Beauty"^ the relation-
ship existing between bathing and health is especially considered in the
chapters on "The Bath as Promotive of Health and Beauty" and on "Bath-
ing as Practiced in Ancient and Modern Times."
The internal uses of water have already been suggested; it is indis-
pensable both in health and disease. It is owed largely to the late Dr.
Hiram Corson and Dr. J. F. Meigs that the practice of refusing water to
children during fever has been abandoned; and the fevor-thirst is no longer
met by small sips of hot water, but the patient is allowed to drink freely of
cold water, which reduces temperature, slows the pulse and makes it fuller,
favors diaphoresis and excretion, and washes out the kidneys. As a matter
of precaution, it is considered advisable to filter and boil water, so as to
render it aseptic, especially when epidemics of typhoid fever, cholera, dysen-
tery, and similar diseases prevail. In the treatment of chronic gastric ca-
tarrh hot water plays a very important part. Since it is capable of flushing
the stomach and washing out the collection of debris and mucus, with bac-
terial and other microbic colonies, it relieves nausea and favors appetite and
digestion. Many persons have tried hot water for their dyspepsia, sa it was
a fad a few years ago, and afterward abandoned it because it did them no
good. The fact is that they used it improperly, and drank a cup of hot
water jvist as they sat down to a meal. If they had taken professional advice
they would have learned that they should take from 240 to 473 c.cm. (or
f5viii-ivj) of hot water at least half an hour before each meal, and in some
cases an hour is better. The water should be too hot to drink, and should
be merely sipped or taken by the teaspoonful. When this has been faith-
fully done for a short time patients are astonished by their improvement.
Nausea disappears, appetite returns, digestion is facilitated, and constipation
overcome. It may be necessary to order some compound tincture of gentian
or cardamom, or similar stomachics, to be added to the water, in order to
insure obedience and perseverance. In the temporary arrest of secretions
"Published by Th* F. A. D«ris Company. PhiUdelphU. 1800.
HYDROTHERAPY AND BAMfROTHERAPY.
lO-lf)
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I
and suspended digestion accompanying fever, water plays an important part
in keeping the mouth and throat from being parched, and in removing mu-
cus and epithelial debris from the intestinal and urinary tracts. Fever pa-
tients should, therefore, be encourafjed to drink pure water. The thirst is
often better relieved by carbonated water, such as Vichy or Giesshiibler.
M. Debove lays great stress upon the administration of water in typhoid
fever. M. Maillart, of Geneva, who has particularly studied this subject,
writes that water-drinking should be regarded as a special method of treat-
meot. He recommends that the patient should drink five or six quarts of
water during the day. This practice has a good etfect in reducing tempera-
ture, it allays nervous excitability and promotes the action of the kidneys.
The quantity of perspiration and urine is augmented, and a large amount of
urea is removed from the system. When the stomach contains objectionable
material, the simplest emetio is water, heated to about 90** F., into which
salt or mustard may be stirred if desired; but the water should be supplied
to the full capacity of the stomach, since it acta principally mechanically.
In summer diarrhoea of infants the following method is successful in
washing out the intestinal tube: A soft-rubber tube, such as No. 8 Ndlaton
or Jacques catheter, is gently, but firmly, pushed through the pharynx into
the stomach of the child, which is held upright in the nurse's arms. In very
many infants this is not a difficult procedure, as they will aid it by sucking
the tube. In older children it is more difliciiH, and had better be avoided.
The procedure should not be made in the presence of the mother, nor of
anxious friends, if it can be avoided, because the occasional anxious and
cyanotic appearance of the baby, although evanescent, and not denoting
harm, will interfere with the procedure in many instances. The catheter
being lodged in the stomach, it is connected with a fountain-svringe, from
which simple, boiled water, of 95° F., is poured. 'The infant will probably
vomit, but it is better to disconnect the catheter from the syrinsre, and allow
the water containing products of fermentation, mucus, and undigested curds
to escape through the tube. If the tube be not firmly held, it will be vom-
ited (Baruch). This brings up the question of irrigation of the stomach, or
larage, as it is called by the French. Lavage is both a diagnostic and a
therapeutic agent. The technique, as followed by Baruch, is as follows:
The patient is told to eat a hearty meal at 13.30 p.m., and to present himself
8t 6.30 P.M. for irrigation of the stomach by tepid water. "A long, soft, but
firm rubber tube, with open end, and one eye near the latter, is introduced
into the stomach. The necessary quantity of warm water (usually 2 to 6
litres, or about 2 to 6 quarts) being in readiness, a basin is placed upon a chair
in front of the patient. It is well to protect the clothing of the latter by a
doubled Bheet, — or, what I use in my office, an oil-cloth apron, — secured
around the neck and reaching over the knees. Artificial teeth, if present,
are to be removed. The patient is requested to sit upright, with his head
thrown back. The physician, standing on the right, dips the lower end of
the tube in warm water (oil is unnecessary, and injures the tube eventually).
Holding it between the thumb and forefinger, he introduces it over the
tongue until it strikes the back of the phar\'nx. The patient is now told to
bend his head forward. In the first effort gagging will ensue, but an abun-
dant mucus is secreted in the throat, which lubricates the tube. The patient
should be reassured, if he feels choked or distressed, by informing him that
this is the usual efTect, and that, if he will keep his mouth well open, he
yO?J-PHARMAOAL REMEDIES ANT> 0ENER-4L THERAPEUTICS.
cannot choke, because there is ample room in the pharynx for a larger tube.
The physician rnuet refrain from sharing the patient's excitement, and, by
his calm demeanor, reassure him when he, as is often the case, protests that
he ia utterly unable to do his bidding/' If a spasmodic contraction of the
CESophagus should occur, the operator should wait a few moments and have
the assistant pour some warm water down the tube. The tube can then
gently pass down into the stomach, the distance having first been measured
externally and a mark placed upon the tube showing how far it should pass
into the mouth. When in position, the warm water is poured into a fimnel
at the free extremity of the tube, from whence it passes to the stomach. If
vomiting ensue, the patient is instructed to lean forward over the basin and
allow the vomit to flow out around the tube and partly through it. If the
lower end of the tube become blocked up with undigested food, the funnel
may be held higher up, so that the water may flow with greater force. After
a half litre (or fSxvij) or so, according to the case, has been injected, the
funnel end is promptly depressed into the basin, and a reverse current is set
up by siphonage from the stomach. This should be done quickly, as sug-
gested by Baruch, while the water i» still flowing, in order to establish
siphonage. A neglect of this simple point defeats the proper emptying of
the stomach. This procedure should be repeated until the stomach is thor-
oughly washed, even if several gallons are required, using no larger quantity
at each injection than a pint. The washings are now carefully inspected.
If there is undigested food in quantity, it denotes feeble digestion; if there
is much gastric mucus floating on the surface, in a thick, tenacious, brown
ma8% it indicates gastric catarrh; if string}' mucus is present, it generally
comes from the throat or gullet; a red tinge to the water suggests that an
ulcer is probably present, in which case further use of the stomach-tube
should be suspended. In gastric catarrh, systematic washing cut of the
stomach is of the greatest service, in conjunction with proper diet and the
usual remedies. The irrigation may be practiced with warm Carlsbad or
Vichy water, dilute solutions of boric acid, borax, or nitrate of silver, or
simply recently-boiled water, every morning, or every second morning, grad-
ually increasing the intervals as the patient improves. Dr, Baruch cites
cases of nervous dyspepsia, in which there was neither mucus nor undigested
food in the washings of the stomach, in whom hygienic management and
hydrotherapy, externally applied, was successful after all the ordinary reme-
dies had been tried in vain. As regards the time of day, Kiissmaul, who, in
18G7, introduced this method of treating stomach disorders, selects the
morning, before breakfast. Riegol and others assign good reasons for pre-
ferring the evening, just before retiring to bed; while Baruch prefers the
afternoon, about 5.30 o'clock, the dinner having been taken at 13.30. In
fact, much must be left to the judgment of the physician and his under-
standing of the requirement of the particular case in hand. A word should
be here said about the abuses and possible dangers of lavage and irrigation
of the stomach. Cases have been reported of unfavorable results following
the use of the stomach-tube, and several cases of boric-acid poisoning have
resulted. It is evident that. great care should be exercised, and that the
operator should proceed cautiously at first, especially where there may be a
gastric ulcer, or with a nervous patient.
Bathing; is a very ancient therapeutical resource. The limits of the
present article only permit a very insufficient outline of its applications in
HTDHOTHEBAPY AXD BALNEOTHERAPY.
1051
I
medicine. The baths may be general or local. Of general baths, we recog-
iu2e the plain and the medicated, and, as regards temperature, we have cold,
warm, and hot baths. Baths of hot air, or Turkish baths, and of steam
(either plain or aromatic) hare been already mentioned. The present con-
sideration is restricted to baths by immersion of the body in water, either
plain or containing substances in solution. It has been established by recent
inyestigations that absorption through the skin, during a brief immersion in
a bath, is practically impossible, and that, therefore, medicated baths are
useful only for their direct effects upon the skin. There is little, if any,
absorption in a cold bath, and absolutely none in a hot bath. When it is
desired to administer remedies for their constitutional effects by the route
of the skin, the drugs should not be put into the bath at all, but should be
applied to the skin after the bath, upon compresses or by inunction. This
will be referred to again, under local hydrotherapeutics.
Baths are called cold, tepid, warm, or hot, according to the temperature
of the water. By a cold plunge is meant immersion of the body in water
below the temperature of 70° F. Anything below 50° F. is considered a
very cold bath. In some rare instances of hyperpyrexia, we may even add
pieces of ice to the water, as in the treatment of sun-stroke. The tepid
baths, of a temperature of 75° to 95° F., are intermediate between cold and
warm baths. The warm bath is from 95° to 104° F. Above this is a hot
bath, and very hot baths may be given up to a temperature of 114** F. As
already intimated, the phypiological effects depend upon the temperature
and duration of the bath. Under ordinary circumstances, when no time is
mentioned, the duration depends upon the objects sought to be attained by
the baths and personal convenience. Prolonged immersion is sometimes
practiced in some surgical cases and in skin diseases. The cold bath should
be brief, as the rule, and followed by friction with the flesh-brush or coarse
towel. This expedient is most valuable in invigorating the system, and is
utilized in the treatment of catarrh, in conjunction with local treatment.
Some patients bear cold better than others, but prolonged immersion is
depressing, owing to continued loss of heat. The secondary elTecte of cold
bathing — which accelerates tissue-change, augments the eicretion of carbon
dioxide and of urea from the system, and improves the appetite — are used to
advantage in many chronic disorders, and particularly in uthaemia and rheu-
matism. Cold sea-bathing has an important part in favoring neurasthenia,
especially in children; but in many instances it should be preceded by a
graduated system of warm bathing, until the patient is strong enough to
bear the shock of the plunge. Where motion of the body, as in swimming,
is combined with the cold bath, the depressing effects are less than when the
subject is kept quiet. The hygienic effects of a stay at the sea-shore also
enter into the advantage of sea-bathing. Children afflicted with rachitis
are generally improved by a sojourn at the sea-ahore and the practice of
sea-bathing. The warm bath is that generally resorted to for cleansing pur-
poees, and is accompanied by frictions of the skin. It is without shock; it
causes a moderate increase of capillary circulation, and scarcely affects the
pulse. As the stay in a warm bath is generally longer than in a cold bath,
the loss of heat may be actually greater than from a cold bath; hence the
aphorism of Hippocrates, that "a cold bath warms and a warm bath cools."
This is the form of bath which is generally resorted to in the treatment of
fevers, and which will be referred to in detail in discussing the Brand
1052
XOK-PHARMAOAL REMEDIES AND GENERAL TH£BAPEUTXCS.
method of treating typhoid, or enteric, fever. Hot baths exert a powerftu
stimulating eflect upon the nerves and blood-vessels of the skin, and are
used in narcotic poisoning and in overcoming a tendency to coma in low
fevers. Hot water injected into the rectum has been found useful in over-
coming shock due to loss of blood or surgical operations. Professor Baeli,
of Tokio, recommends the hot bath as a valuable measure in the treatment
of capillary bronchitis, broncho-pneumonia, rheumatism, nephritis, and in
the beginning of menstruation when accompanied by uterine colic.
Caution is to be observed in adapting the bath to the condition of the
patient. Cold baths are fitted for the vigorous and robust, but even in them,
as pointed out editorially in the British Medical Jourrnxl, it may be carried
to excess and become injurious. Cold bathing every morning throughout
the year may be conducted in such a way as to be beneficial, viz.: if the
plunge be brief and be followed by friction of the skin and prompt dressing.
But because it can be carried on with advantage by one person who reacts
well after it, it does not follow that another can do it with impunity, espe-
cially if he finds that reaction is slow after the bath. In the latter a mod-
erately warm plunge-bath or shower-bath might be borne well and be fol-
lowed by beneficial results. Open-air bathing in winter is not likely to have
many advocates in this uncertain climate, but it appears that it finds some
defenders in England, where school-boys, who do not like to be outdone bj
their seniors, we learn, are in the habit of taking a cold bath before the
morning-school. This is apt to be injurious to the weakly ones, and to re-
tard development in the strong unless followed by running or other active
exercise, to restore the circulation. Cold baths should never be taken when
exhausted or directly after a full meal, or if there be reason to suspect con-
gestion of any internal organ. The anaemic and debilitated may combine the
advantages of both the tepid and the cold bath by immersion in or sponging
with warm water, followed (while still standing in warm water) by the rapid
application of a sponge, wet with cold water, to the general surface or to the
throat and chest. Asthenic persons are often unable to take a full bath, and
subjects of vascular degeneration or heart disease should only use warm
water. The excessive use of decidedly warm or hot baths is relaxing to the
system and debilitating.
The treatment of typhoid fever by Brand's method requires a bath at
68* F. every three hours, where the rectal temperature is 102.'Z° F. or over,
lasting about fifteen minutes, the patient's body and extremities being
rubbed by attendants. With some modifications, this treatment of typhoid
fever is now in general use, and a very marked improvement has been ob-
served since its introduction. In the Practitioner for March, 1891, Dr. F.
E. Hare, of Brisbane, analyzes two series of cases of typhoid fever, — the one
including eighteen hundred and twenty-eight cases and treated expectantly,
the other comprising eleven hundred and seventy-three cases and treated
with cold baths. Dr. Hare deals most effectually with possible objections to
his statistics. He shows that the treatment has no effect upon the occur-
rence of perforation and haemorrhage beyond rendering the latter less dan-
gerous; that the death-rate from exhaustion and from pulmonary and cere-
bral causes is diminished, especially in cases of early admission to the
hospital; and that the prognosis becomes even better in women, since they
are less liable to perforation and haemorrhage than men. The lethal influ-
ence of the intestinal lesion ia lessened under this treatment, by moderating
HYDROTHERAPY AXD BALNEOTHfilUPY.
1053
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the diarrhoea and by sustaining the strength of the patient. Brand's rules
and cautions as to contra-indicaliona were observed. Dr. Hare incidentally
remarks that quinine is of much service as a cardiac stimulant in simple
p\Texial cardiac failure. The author concludes by saying that hospital mor-
tality may be greatly reduced — upward of 50 per cent. — by the cold-bath
treatment; but that it can hardly fall below 5 per cent., since the death-rate
from perforation and hseniorrhage amounts fairly constantly to 4 ^/j per
cent. As the result of the different liability of the sexes to these accidents,
the prognosis under the bath treatment is vastly more favorable in females
than in males, as above stated.
As this method requires a portable bath-tub, or subjects the patient to
considerable disturbance of body, which is opposed to the first principle of
treatment of typhoid, various methods have been devised to overcome this
objection. The patient may be placed upon rubber cloth and the edges
lifted up in such a way as to make the patient lie in a hollow, which may
be partly filled with water of any desired temperature. Niemeyers method
is somewhat similar, the patient being enveloped in a wet sheet, and water,
at the temperature of 70* F. or less, is then applied by means of a watering-
pot or rose-spray. The late Professor Da Costa preferred cold sponging,
repeated every hour or two when the temperature is over 102° F. The fol-
lowing is a method advocated by Dr. F. Feyre Poreher, of Charleston, S. C; —
"1. A soft towel, folded, is soaked in a basin of iced water, then wrung
out and applied over the forehead and temples.
"2. The palm of one hand and the arm are sponged off with another
towel, which has been dipped in the cold water and wrung out.
"3. The towel which has been left upon the head is turned and reap-
plied, so as to have the cold surface next to the skin.
**4. The other hand and arm are treated as was the first.
''This process, strictly followed, is continued for fifteen, twenty, or
thirty minutes, or until such time as the surfaces have become thoroughly
cooled and blanched, when it may be discontinued, — to be renewed when-
ever there is a rise in the surface-heat. Sometimes, if it does not cause
fatigue, both hands and arms, if hot and drj% are allowed to remain sub-
merged, or be bathed directly in the cold water."*
The late Dujardin-Beaumotz was an advocate of the hydropathic treat-
ment of typhoid fever, but was opposed to the cold bath. He summed up
Brand's method as follows: "You must administer baths of 64** to 68** F.,
of fifteen minutes* duration, from the fifth day of the fever; these must be
repeated day and night, every three hours, as long as the temperature of the
rectum exceeds 105,2* F.'' In applying rigorously this treatment, so simple
in appearance. Brand considered himself warranted in affirming that "every
ca^e of typhoid fever, treated regularly from the beginning by cold water,
viiW be exempt from complications and will get well." The method of Brand
is carried out rigorously at Lyons by Dr. Glenard, who reports such good
results in his ser\*ice that the meihod has extended to all the other hospitals
of Lyons. Ziemssen reports a great reduction of mortality in Germany. At
the same time Schmidt, of Erlangen, and others have shown that a rigorous
application of the cold bath to typhoid-fever patients is not without its
dangers, and the death-rate may be actually increased by it. Dujardin-
"TrinMctions of the Anocifttion of American PhyBicians," vol. i. p. 29.
1054
NON-P£lABaiACAL UEMEDIES AND OEKEBAL THEBAPECTTICS.
Beaiimetz, after a review of the question, asserts that "the method of Brand
is impracticable in the majority of cases and outside of military practice,"
and this applies to hospital as well as private practice. He bases this state-
ment upon the fact that it is not possible to begin the practice as early as
the fifth day in all cases, becauge many never enter the hospitals so early,
and because at times we cannot be sure of our diagnosis till after the sev-
enth day. Moreover, he justly states that "we cannot, without danger, sub-
ject all our fever patients to a rigorous and severe method, and where we are
ignorant of the cause even of the febrile process.'* Since the cold bath may
determine profound congestions, he declares that Brand's method is not free
from danger, and is itself a cause of not a few complications, especially
pulmonary congestions and inflammations. As regards intestinal haemor-
rhage, he believes that in certain cases the cold baths may favor these hiem-
orrha^ea in patients who are predisposed.
Jn summing up, he says: **! consider the exclusive method of Brand,
and the rigorous and mathematical rules which he has formulated, as de-
serving to be banished from the treatment of typhoid fever, and for this
reason especially: because it requires, in order to derive from it all the
results which it promises, to be applied before the diagnosis can be certain;
for, employed later, this system ouly glves^ according to the acknowledg-
ments of the most zealous partisans, results comparable with those of other
therapeutic methods, and with greater danger to the patients. ... In
fact, we have, for the treatment of certain manifestations of typhoid fever,
hydrotherapeutic means much less dangerous and quite as powerful, — not,
perhaps, from the point of view of hyperpyrexia, but from that of the other
symptoms of typhoid fever; for, in my opiniou, the advocates of refrigerant
medication have committed an error in vociferating: 'The hyperpyrexia! —
Behold the enemy!' The hyperpyrexia, as Peter has well said, does not con-
stitute all the danger of the disease, of which it is only one of the mani-
festations."
Dujardin-Beaumetz* preferred the tepid bath or the wet pack, applied
as follows: '*The patient, in a state of nudity, is wrapped, from head to foot,
in a sheet or blanket wrung out of ice-cold water. It is well, as a preliminary
step, to have a rubber blanket spread upon a mattress; over this you place
the wet sheet, in which you wrap your patient. Liebermeister advises that
this envelopment should be continued for ten minutes; for my part, I prefer
a shorter duration (of a minute or so), after which the patient is taken from
the wet sheet and removed to his bed. If I prefer wet wrappings, of short
duration, to the practice of Liebermeister, it is because I do not wish to
obtain refrigeration from these envelopments, but only a regulative modi-
fication of the nervous system, and this effect will be the more marked the
shorter the duration of the cold application. This is one of our most pow-
erful modes of treatment, in cases of typhoid fever of ataxic and adynamic
character. . . . Foltz has recently added cold lavements to the refrig-
erant medication. These lavements of water, at 50° F., lower the tempera-
ture of patients — in a feeble manner, it is true, but still appreciably, — and
this is a fact worthy of being remembered."^
' "Clinical Thempeutics " by Professor Dujardin-Beaumctz. p. 383. Translated
by E. P. Hurd, M.D., Detroit. 1885.
'"Clinical Therapeutics," loc. cit., p. 387.
HYDHOTHEOAPY AND BALNEOTHKEAPY.
1055
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I
ITie principal locul applications of hyrlrotlierapY consist of affusions or
douches, conipresses or partial pau'kiii;;^, and local iinmersioa. There are a
variety of methods of administering douches: the shower-bath; the douche
proper, in which a column of water falls or is projected upon tlie body; the
needle-bath, in which several rings, at diiferent levels, discharge minute
fitrcams of water, from all dircctious, upon the body; and the movable jet
or spray. Where the force of the water is rather preat, we should avoid
douching the head. The douche may be, like the full bath, cold, temperate,
or hot; but it has this advantage over the full hath, that the temperature
may he abruptly changed, thus producing rapid alternations of temperature,
M'hich are decidedly stimulating to the nervous system, both central and
peripheral.
In the so-called "Scotch douche" — a shower-bath, in which the tem-
perature, at the beginning, is about 86 degrees, and is gradually raised to
122 degrees, which is about as hot as can be borne — this is followed imme-
diately hy a douche about as cold as ice. The duration of the douche should
be very brief (ten to twenty seconds), and should be preceded by active ex-
ercises, to produce action oif the glands of the skin. It is, therefore, a meas-
ure better adapted to vigorous persons than invalids. It can be utilized,
however, in the manner described upon the preceding page as the method
" Niemeyer. The cold shower is of service, when directed against disorders
Btuated in various organs of the body, and, when followed by vigorous fric-
tion, or, as Gross recommended, whipping with the fringed edge of a towel,
it is a powerful nutritive stimulant. The cold douche to the lumbar region
stimulates the kidneys in suppression of urine; but in advanced Bright's
disease the wet pack is better, on account of the free perspiration which it
induces.
Dr. Hiram Corson, of Pennsylvania, highly recommended the cold
douche in the delirium of acarlatina and other eruptive diseases, the water
being poured from a pitcher, elevated a foot or two, and sufficient in quan-
tity to reduce the temperature and delirium. The influence of cold water
in reducing prolonged hyperpyrexia in scarlatina is admirably exemplified
in the circumstantial history of a case published by Dr. Ch. Talamon, of
Paris.* A high temperature with violent delirium and alarming adynamic
condition had existed for seventeen da>'s and cold affusions had been era-
ployed with temporary good effect when the systematic use of the cold bath,
according to the method of Brand, exerted the first positive influence upon
the fever, and was the only means which succeeded in definitely overcoming
the hyperpyrexia. In the words of the reporter, ""it may be said that the
cold baths literally resuscitated this patient, and M*e are convinced that, had
they been employed from the beginning, we should have obtained, in the
early davs of the disease, the result which was delayed until the twentieth
day."
M. Levestre is a strong advocate of the use of cold baths in the pneu-
monia of children. He states that the temperature is reduced after each
immersion, while the pulse and respiration were diminished in frequency.
Defervescence usually occurred before the seventh day.
Dr. Thomas J. Mays, of Philadelphia, is a firm advocate of the applica-
tion of iee-pouhices in the croupoua pneumonia of adults. The affected area
» La If^tTtnc Modems, Sept. 16. 1802; The Medicfit BuUctin, Nov., 1892, p. 427
105G
NON-PHARMACAL UEMEDIES A^D GENEKAL TUEaAPEL'TICS.
is gurroundcd by rubbfr ice-bags well wrapped in towels and another, is
placed upon the head. Other writers have borne testimony to the value of
this method of treatment. The cold douche to the spine is useful in chorea
and in muny other disorders of the spinal cord. The application of ice to
the spine, for seasickness, chorea, etc, will be referred to in the chapter on
**CoId and Heat" as therapeutic agents. The local application of moisture
is largely employed in medicine, in the form of stupes, cataplasms, or poul-
tices, and compresses; especially when used in connection with beat, it
favors local hypersemia and hastens the process of suppuration in abscesses
and boils. This method is also useful in relieving pain and relaxing tissues,
as where joints have become stitFened. Cold compresses, especiall}' when
some agent is added to favor evaporation, as alcohol, are useful in various
forms of inflammation. A common resource in pharyngitis, tonsillitis, and
inflammation of the throat attending scarlet fever and diphtheria is the
application of wet compresses, which may be dipped in ice-water, as recom-
mended by Dr. Hiram Corson.
To review the therapeutic applications of water, we would place at the
head of the list the hydriatic treatment of fever. Dr. Baruch has pointed
out' the principal reasons why this method is not in general use, as (1) it
is believed by many to savor of quackery; (2) the difl&culty of applying its
principles, and necessity of apparatus; (3) the necessity and dilHculty of an
exact technique; and (4) the objection of patients and the natural aversion
of some people to water. The main obstacle, however, is probably the ab-
sence of hydropathic teaching in the medical colleges, and want of appre-
ciation by physicians of the advantages of this mode of treatment, l^der
the direction of the leading clinicians of Europe and this country, a rapid
revolution is occurring in medical practice, and the expedients of hydrop-
athy are coming into more general use as the knowledge of their utility and
safety becomes more widely diffused among physicians and the community.
In typhoid fever, some form of bathing is now universally resorted to for
the relief of hyperpyrexia, although, as Dujardin-Beaumetz insisted, the
effects of the bath upon the functions of the nervous system are of greater
importance than the mere abstraction of heat, in favoring recovery and
diminishing liability to complications. In scarlatina, measles, and other
exanthemata the wet pack is useful in bringing out the eruption, relieving
restlessness, and reducins: fever temperature. In chronic metal poisoning
(lead, mercury, arsenic) the increased perspiration favors elimination. In
muscular rheumatism and lithjemia, and various forms of chronic rheumatic
inflammation of organs, the wet pack and vapor-baths are very useful. A
convenient method of obtaining a \apor-bath, without apparatus, is to strip
the patient and envelop him in a wet sheet, then seat him upon a cane-aeat
chair. Under the chair, upon the floor, is placed a small alcohol-lamp, over
which is a small receptacle filled with water. After lighting the lamp, the
patient is covered with blankets, which pass from his neck to the floor, thus
retaining the heat. In a few moments, perspiration will begin to come oat,
and profuse sweating will ensue. After ten or fifteen minutes the patient is
allowe<l to lie down upon a bed, and is thoroughly dried with towels, fol-
lowed by friction. If desired, medicinal substances may be combined with
this bath. For instance, some pine-needle-oil (oil of pumilio pine) may be
* Joumsl 0/ il«li»<otopy, Murrh. 1802^ p. 2.
I
I
added to the water. Some sulphur may lie burned at tlie time that the skin
is perspiring freely, or 0.05 to 1.3Q Gm. (or gr. x-xx) of calomel or red oxide
of mercury may be vaporized by placing them upon a metal plate, over the
lamp, aa a subfititute for the water-pan after free diaphoreais has been pro-
duced.
Another method of causing diaphoresis, which is a combination of hot
air and moisture, is conveniently used as follows: A small tin pipe (like a
rain-spout) is obtaiinid, which is rounded in the middle bo that the enda are
in planes at nearly a ri^ht anple to each other. The patient is placed in bed,
upon a rubber sheet, covered by a blanket. The liedclothing is brought
tightly around the neck and shoulders, but lifted from the remainder of the
body by means of half-hoops, or otht-r means of elevating the bedclothing,
80 as to make it into a hot-air chamber. The pipe is attached to the foot
of the bed bo that one end enters the cavity of the hot-air chamber and the
other is outside, directed downward. Under the latter is placed a lighted
alcohol-lamp, so that the heated air from the tlanie will pass into the pipe
and be carried under the bedcovers. The patient will be made more com-
fortable by having a compress, wet with cold water, applied to his forehead
during this period. After profuse perspiration has been excited and con-
tinued for the desired time, the patient is rubbed down and dried as before.
This is of great advantage in chronic rheumatism, Bnght's disease, ureemia,
and similar conditions.
In gouty or rheumatic inflammation, restricted to certain joints, the
local compress is serviceable, and good reports have been made of the appli-
cation of 10-per-cent. solutions tif salicylic acid or sahcylate of sodium to
the joints. By combining electricity with these compresses absorption ia
favored, and remarkably good results have been obtained, as has been
already stated in the article upon electricity under "Electrolysis and the
Cataphoric Action of the Galvanic Current."
In syphilis and skin diseases the bath is indispensable, and the appli-
cation of various forms of hydrotherapy is set forth in more detail than is
permissible here in the author's work' on "Diseases of the vSkin."
The results obtained at the Montefiore Home by Dr, Banich, in the
treatment of phthisis by hydriatic measures, have been so successful that
further trial of this method ia recommended. The technique of these pro-
cedures varies with each case. Brief applications of low temperature, as by
the douche or rain-bath, the wet pack, or rapid ablutions, are followed by
rapid reactions, and, if well borne, are exceedingly useful as tonics; while,
on the contrary, in cases sufTering from elevated temperatures and great
debility, more gentle procedures and higher temperatures are required. Dr.
Baruch warns against too cold applications, which are better indicated in a
febrile or mildly febrile condition. He gives the patients a thorough cleans-
ing with soap and warm water upon entering the hospital, after which a
day is allowed to elapse. "The patient is now wrapped snugly, quite naked,
in a woolen blanket, so that his entire body is excluded from air; other
blankets are piled over him; the windows are opened, and he is given a
small glass of iced water every ten minutes. Having lain in this position
an hour, now one part of the body is exposed and bathed as follows: 'A
*"A Practical Tiratiftc on Disejisca of the Skin/'
D. Appleton & Co., 1001.
fourth edition. New York:
1058
NOJf-PHAIlMACAL HEMBDnS ANO GENERAL THERAPEUTICS.
basin of water at 75 degrees is ready, into which the attendant dips hia
right hand, covered by a mitten or glove of Turkish toweling. With the
wet glove the face is well bathed. Now, one arm is exposed and rapidly
washed and rubbed, then dried and replaced under the blanket. Other
parte are then successively treated. At the termination of this ablution the
patient is rapidly nibbed all over with a coarse towel. The treatment is
repeated daily, the temperature of the water being reduced 2 degrees on
each occasion."* The next step is the dripping-sheet. "The patient, stand-
ing in a tub of water at 100° F., has a sheet, dipped in water at 70* ¥,;
thrown over hie head and body from behind, and is wrapped completely and
Bnugly in it. The attendant now passes his outstretched hands over suc-
cessive parts of the body, with some pressure on the sheet. He rubs the
sheet, not with the sheet. One or more pitchers of water, 5 to 10 degrees
colder, are thrown upon the parts that have been subjected to friction. The
sheet is removed and the patient thoroughly dried. This method requires
great care and skillful application. Its success or failure depends upon
ascertaining by previous treatment the reactive capacity of the patient.
The most usi-ful hydriatic procedure in phthisis, however, is the needle-bath.
Unfortunately, this finely-divided douche can only be administered in
institutions. The patient stands within a frame constructed of six semi-
circles of inch tubing, the upper one on a level with the clavicles. Each
tube has three lines of fine perforations, the upper one directed upward,
the middle straight forward, the lower downward. The water should have
a fall of not less than forty feet. The temperature adapted to the average
case of phthisis is 65*" F. Here the pressure with which the water strikes
the body affords a kind of massage, which assists in producing reaction even
in feeble individuals. But it should not be applied without previous train-
ing of the skin, as above described. The rain-bath is an apyretic of great
value if its temperature is not below 60 degrees nor above 70 degrees; it is
a stimulant and tonic if between 55° and 65° F. The skin should become
pink under it, and the patient must not be chilled by it; at least, anv
coldness he may experience should disappear after he is dried. This, indeed,
is the test of all hydriatic procedures. Decided chilliness continuing after
thorough drying and friction is an evidence of improper selection of the
temperature, duration, and method of the bath. These should be modified
as indicated by their effects." The progressive increase in weight and im-
provement of general condition in phthisis are accompanied by a diminution
in the expectorntion and the number of the bacilli.
Hydrotherapy in Nervous Diseases. — In many nervous affections dis-
turbances of function are due to some obscure lesion or fault of nutrition,
which can be removed or amended by judicious hydrotherapy. Professor
Erb says: "Cold and cool baths, in various forms, belong to the most im-
portant therapeutically-active agents in the field. This method has, since
it has been more carefully studied and more rationally pursued, made nota-
ble advances. Its results in all possible forms of chronic nerve-troubles are
extraordinarily favorable. There are few remedies which have an equally-
powerful influence upon the nervous system."' An excellent review of this i
* Dietetic and Bygimio Qazette, March, 1992.
"Article by Profeiwr Krb, of Heidelberg, on "Diftcasc* of the Nervous Syatem,'*
in "ZJemBacn'B Cyelopoedift."
HTDROTHERAPT ANT) BALKEOTHERAPT.
1059
I
I
I
subject is contained in a lecture by Prof. Charles L. Dana, M.D., of Nev
York, delivered before the Post-graduate College of that city.*
The various forms used by the neurologist are: —
1. General hydrotherapy, tonic hydrotherapy, sedative hydrotherapy,
and indifferent baths for mechanical purposes.
2. Local hydrotherapy.
Toiiic Hydrotherapy. — For purposes of stimulating nutrition and in-
creasing vasomotor tone we employ cold plunges, the rain-bath or shower,
the jet, cold sponging, cold sitz-bath, cold sheets, local applications of ice or
cold compresses, or cold rubbing, ice-bags, brine-baths, brief cold packs, and
sea-bathing. The technique of these is as follows: —
The Cold Plunge,— The bath is filled with water, at from 60^ to 70'
F. The patient steps in, immerses his body, and at once jumps out and rubs
himself vigorously, or is rubbed by attendants, until reaction occurs.
The rain-j jet-, shower-, or rucdle- bath requires a form of apparatus
which delivers the water in fine jets, either vertically or laterally, against
the body. The force of the water is an important feature, and both it and
the temperature should be properly regulated. In the rain-bath the patient
stands in a tub containing some warm water, and the shower is directed
" upon successive portions of his body. The water may be at first moderately
warm and gradually made cold, or it may be cold from the beginning.
Where it is desirable to give a shock to the peripheral nerves the latter is
preferable, or there may be a succession of showers, alternating hot and
cold. Kain-baths should not continue beyond one ot two minutes. A solid
jet of cool water may be thrown or allowed to fall with force upon the back
of the patient, either from a tap or a hose. In the latter case the jet may
be thrown from a distance of several feet.
Cold sitz-haths are taken, at a temperature of 70° to 80** F., from
twenty to thirty minutes. The cold sheet, or drip-sheet, is used by wringing
a cotton sheet out in cold water, and wrapping it suddenly about the stand-
ing patient, who is then vigorously rubbed.
Ice-bags may be kept in contact with the spine, in the lower cervical or
upper dorsal regions, for one or two hours, once, or several times, daily.
Tlie half-bath atid wash-off consists of a tub partly filled with water at
a temperature of 05" to 80" F. The water only half covers the reclining
body. While lying in it the patient is vigorously rubbed. A cold cloth may
be laid on the head. After five or twenty minutes, affusions of colder water
are poured over 'the shoulders and along the spine.
Brine-baths contain about 2 per cent, of salt (sodium chloride). They
are given, at a temperature of 100° F., from twenty to thirty minutes daily;
or four baths of 70** F. may be given for five or ten minutes, the patient
exercising himself or being rubbed in the meanwhile. The baths at Nau-
heim, which have come into notice in connection with Dr. Schott'e method
of treating heart disease, are a form of brine-baths. Grainger Stewart states
that similar results may be obtained at home by the use of baths and sys-
tematic exercises. The baths can be artificially prepared by adding 1 '/^
kg. of salt and 250 grammes of calcium chloride to 250 litres of water at a
temperature of 28° to 36° C, the strength of the brine being gradually
* The Dietetic Qazeite, Dec, 1801, p. 237.
lOGO
XON-PHARIIACAL ttEilEDIES AND OEXERAI. THEHAPEUTlCfi
increased. After twenty of these baths, then a Sprudel or effervescing bath
is given by adding effervescent ealt to water. These baths are very in-
vigorating.
The physiological effects of these different fomia of hydrotherapy
should be kept in mind. Cold applications produce a local contraction of
the blood-vessels, followed by dilatation. There is usually increased tissue-
metaniorphosis, increased secretion of urine, increased absorption of oxygen,
and increased excretion of carbonic acid. In non-febrile persons cold ap-
plications abstract some heat, but they also stimulate the heat-producing
centres, so that the total eilect is to increase the heat of the body. Only
very cold baths lessen heat-production as well as excretion of carbon dioxide.
Cold baths at first accelerate and then tend to retard pulse and res-
piration. Cutaneous sensibility is at first increased. After a cold bath there
is a sense of exhilaration and increased muscular power, provided the bath
be not too cold or too long continued. The duration necessary to produce
a reaction varies with different people, and some weak and sensitive patients
never can be made to react. Cold baths, systematically taken, furnish a
kind of vasomotor gymnastics. The neuro-mechanism controlling the
blood-vessels becomes more supple and the tendency to local congestion of
the viscera and mucous membranes is prevented.
The shower and jet furnish the most valuable means of securing tonic
effects in nor\-ous disorders. These are not used with cold water alone.
The temperature may be gradually changed from 1*5 degrees or more down
to 60 degrees or less, or the hot and cold may alternate. In this way, says
Dana, tonic effects can be obtained even with very feeble persons.
Sedative Hydrotherapy in Nervous Disorders. — The sedative baths are
the lukewann bath, the wt't pack, Turkish and Russian baths, the hot sitz-
bath, pedal baths, compresses and fomentations, and hot-water bags. The
following is the technique: —
The lukewarm baihs are usually at a temperature of 95 to 98 degrees,
and are given from ten minutes to half an hour, daily. If a slight tonic
effect is desired also, the patient should receive an affusion afterward, basins
of cold water at 60 or 70 degrees being poured over his shoulders. Medica-
ments, such as salt or pine-needle extract, may be added to the bath with
advantage.
The wet pack: A large, thick blanket is spread upon the bed, and over
this a linen sheet, wrung out of cold water (40 to 60 degrees). The nude
patient lies upon this, and the sheet is then smoothly wrapped about him,
the head and feet not being included. The sheet is carried between the
legs and made to lie evenly in contact with the body. Then the blanketa
are folded over him, and other blankets may be piled upon these. Some-
times it is well to place hot-water bottles at the feet and a cool compress
on the head. The patient lies in this pack from thirty to forty-five min-
utes, and is then rubbed off. A cool affusion may be given first. To increase
diaphoresis some hot infusion may be administered during the time the
patient is in the pack.
Turkish and Russian hatks, or hot-air and steam-baths, as given in
establishments devoted to the purpose, should have professional supervision,
and the temperature, ventilation, duration, and after-treatment, by jet,
shower, or plunge, carefully adapted to the individual case. A shower or
cold affusion to the lower spine is an excellent stimulant to the kidneys.
nTDROTHEBAPY AND BALNEOTHEBJi
1061
I
I
In a hot sitz-hofh the patient sits in water at a temperature of lOO'* to
125° F. for twenty or thirty minutee. Salt or mustard may be added. This
18 an excellent sedative in dysmenorrhoea; or hot cojnpresses, consisting of
flannels wrung out of hot water and covered with dry flannels and a rubber
cloth, may be substituted in local pains and inflammations. The hot com-
presB is often effective, when applied in this way over the abdomen, for the
relief of insomnia. Ilot sprat/s a^ud douches are used for similar purposes.
The hot spinal bag and hot-water bags for the feet should not be applied
at a temperature of over .120 deforces, and should be enveloped in flannel
and not placed in contact with the skin.
Warm baths increase heat-radiation and heat-conduction, and thus
lower bodily temperature; the warm, moist pack, followed by sponging with
tepid water, is the most convenient method of applying the water. On the
contrary, the bodily heat may be raised in the pack by applying hot-water
bags to the surface and adding blankets. **Warm baths increase the cir-
culation of the skin, lessen cutaneous sensibility, withdraw blood from the
central organs, increase the exhalation of carbon dioxide, but lessen respira-
tory activity, on the whole. Nitrogenous metabolism is increased from 2
to 3 per cent., and more urea is excreted. Pulse and respirations are in-
creased. Nervous excitement is lessened, and the general efTect is to cause
sedation and abating of languor."'
The wet pack is a most useful sedative in neurasthenia and insomnia,
and may take the place of medicinal sedatives, like the bromides. It should
be given three or four times weekly or for a short time daily. The luke-
warm bath ranks next in its sedative efficacy. Dr. Dana also points out that
applications of water to the feet and abdomen especially affect the intra-
cranial circulation, while those given to the thigh and wrists affect the
pulmonary circulation, in each case cold causing congestion, and heat
antemia, of the distant parts. (If this be a physiological fact it would
oppose the method of Dr. Porcher, given upon a preceding page, for the
reduction of bodily temperature in typhoid fever.) Cold to the spine is
believed to cause, at first, constriction, and, later, dilatation of the thoracic,
abdominal, and pelvic viscera; heat hti.s the opposite efTect. Hence, cold
applications are used to relieve cold feet and also anaemic conditions of the
viscera.
In nenrasthenia Dr. Dana recommendg wet packs and half-baths, fol-
lowed by shower, jet, or plunge. For weak, sensitive, and anseraic women
he prescribes, first, dry hot packs for a weelc, then wet packs, and, finally,
the drip-«heet or shower-bath.
In epilepsy dry and wet packs may be given; but the best method for
a fairly-robust person is that originally described by Fleury. This consists
in giving simultaneously the rain, shower, and the jet. The patient, stand-
ing in the shower, receives a jet of water on the posterior surface of the
body for fifteen seconds; then the jot alone for, fifteen seconds; finally, the
jet alone on the anterior surface of the body for thirty seconds.
In hysteria the rain-shower and the jet are usually most efficacious.
In locomotor ataxia lukewarm baths, with pine-needle extract, or half-
baths, with adusions and gentle massage, are indicated.
Dr. Dana, loe. Ht,, p. 23B.
1062
NOK-PHABMACAL REMEDIES AXD OENEUAL THEEAFEUTICS.
In peripheral pains from neuritis and neuralgia the continuous appli-
cation of ice-bags is often efficacious; and hot sand-bags or water-bags are
sometimes applied continuously to the spine for one or two hours, with the
purpose of increasing the circulatory activity of the cord.
Cold applications to the spinal column are resorted to with benefit in
chorea and other spasmodic disorders, such as persistent vomiting, hydro-
phobia, etc. The ice-bag to the scalp is of the highest service in cerebral
meningitis and cercbritis, whether primary or secondary; and it relieves
the headache and delirium in the specific fevers.
In two cases of tetanus accompanied by high temperature Bivi^
obtained good results from the use of cold baths, which reduced both the
fever and spasms and the patients recovered. Opium and chloral had failed
in each case to produce any decided amelioration.
The Physiological Action of Carbonic Acid Baths, — L. Fellner writes in
the BerL klin. Woch.y June T-^th, 1905, on the subject of carbonic-acid baths.
He states that in recent times the method of action of the gas in the bath has
been more exactly watched, and that, on the one hand, one finds a support of
the tlieor)' that there is a resorption of CO,, indicated by an increase of this
gas in the breath without any alteration of the quantity of oxygen; and, on
the other hand, the type of the stimulus on the skin has been more closely
studied. The thermic indifference point of carbonic-acid pas lies much
lower than tliat of the air, and if one takes a bath of 28* C. (that is, 82,4°
F.), the water feels cold, but the COa gas bubbles, which separate them-
selves from the water, exercise a warm stimulation. The two stimuli do not
alternate^ but exist side by side at numerous different points. CO^ acts
both on the sensor^' and the motor nerves in the skin. The subjective and
objective appearances of such a bath are as follows: After a few minutes one
feels a tingling and a peculiar sense of warmth. This sensation increases to
one of actual heat, and is most intensely felt in the perineum and around
the genitals. These localizations soon break out into a sweat. The skin
becomes reddened, and this may last for some time after the end of the bath.
Hffmorrhaids generally swell and may bleed profusely. Sexual <lesires are
enhanced. Metrorrhagia sometimes follows a CO, bath, and menstruation
may appear even when amenorrhcea has existed before. The pulse first
loses from four to six beats in the minute, and later quickens, so that after
being in the bath for from three-quarters to one hour, the pulse has gained
some four to eight beats. When the bath Insts lonirer than half an hour,
the respiration quickens up to eight additional breaths. Feelings of con-
gestion in the head, with sweating, take place. In conclusion he gives the
following as a list of diseases which may be treated by the carbon dioxide
bath: Those of the nervous system, aniesthesia, hyperaastliesia, neuralgia,
and peripheral paralysis of rheumatic, traumatic, and toxic nature ; next,
functional disturbances of the sexual organs, amenorrhoea, dvsmenorrhoea,
impotence, and absence of desire. As contraindications, he mentions ten-
dency to bleeding, chronic cardiac disease and chronic lung diseases, and
irritability- of the respiratory passages.
MINERAL SPEIKGS.
The subject of mineral springe has relations of the most intimate kind
with balneology and also with climatology, and naturally comes up for eon-
3IINERAL 8PBIN08.
10G3
I
I
aideration in close connection with the preceding section, in which the
therapeutic applications of water were dwelt upon. At the very beginning
it is proper to direct attention to the fact that the distinction between
water and medicinal water is not absolute, but simply one of degree. Pure
water only exists in the laboratory; in nature water is always, to a greater
or less degree, contaminated with various soluble substances, which it dis-
solves from the earth's crust or absorbs from the atmosphere. The degree
of contamination or impregnation depends upon certain circumstances
which are largely of a local character, the springs of one neighborhood con-
taining mineral and other ingredients, which are constantly present and
characterize them, so as to distinguish and make them different from other
springs, either of the same or of a distant locality. Therefore, degrees of
purity are recognized, while absolute purity is not expected; and where the
mineral contamination is sufficiently great to make the water produce thera-
peutic effects, we can divide the waters into classes in accordance with such
effects. It ia a matter of observation that springs and streams of water, in
addition to the natural contamination, may contain, by accident, or design,
other constituents, which are called pathogenic organisms, or disease-germs,
owing to their eflects upon the general health of those using such water.
These come under the general head of pollution. Thus, organic refuse,
excreta of animals or human beings, sewage and waste from manufactories,
etc., pollute a water-supply, and are a frequent source of epidemics. With
these pathogenic forms of contamination the present article has nothing to
do further than to give a mere reminder of a lurking danger which may un-
expectedly be encountered at health resorts and, with this very important
exception, among the most sanitary surroundings. As every intelligent per-
son, and especially every practicing physician, should be able to pronounce
upon the presence or absence of suspected impurities, and as physicians are
often called upon for an opinion as regards the wholesomencss of water, the
following tests may enable him to come to a decision. The clearness, trans-
parency, and general appearance of the water, as compared with a sample
of distilled water. The odor that it may have is developed by slightly heat-
ing some in a small flask and smelling it; the odor may or may not indicate
the presence of deleterious substances. Color and turbidity may depend
upon vegetable or mineral impurities which are not necessarily prejudicial
to health. Should these be absent it must not be at once decided that, be-
cause the water is clear, transparent, and odorless, it is wholesome; on the
contrary, the most attractive-looking water may contain dangerous pollu-
tion, and be entirely unfit for use. The total solids of a good drinking-
water should not exceed 25 to 30 parts in 10,000, the character of the solida
of course, affecting the results upon health. The total solids are determined
by evaporating a certain quantity of water to dryness and weighing the
residue. This may be subsequently subjected to chemical examination, if
desired to have a complete analysis of the water. Any gases which may
come of! from the water should be collected, measured, and identified.
Qualitative tests for organic matter with potassium-pcrmangnnate solution,
ind for chlorides by silver nitrate, for nitrates with pyrogalloK and for am-
monia by Nessler's reagent are usually resorted to. If the pennanganate
be decolorized after standing a few hours, it indicates presence of organic
matter, but not necessarily of animal origin; it may be vegetable and harm-
less. If a solution of silver nitrate causes an abundant precipitate of chlo-
106-4
XOX-PHAUMACAL REMEDIES AN*D GENERAL THERAPErTICS.
rides, this may be due also to mineral contaminalion, as well as to animal
excreta. The determination of nitrites and nitrates is of more importance,
since they lead to the suspicion of sewage contamination. "They are the
resultants of oxidation of nitrogenous organic matter, and, although water
containing them is not necessarily dangerous, their presence should render
a thorough examination of the source of supply imperative/' The p3T0-
gallol test is a|>plied as follows: Put 2 cubic centimetres of pure sulphuric
acid in a small test-tube and add 1 cubic centimetre of water to he tested.
To this mixture is added 1 drop of a solution of pyrogallol (65 centigrammes
in 30 cubic centimetres of distilled water, acidulated with 2 drops of sul-
phuric acid). The water becomes colored a dark amethyst or wine-browi) if
the salts are present. The depth of color indicates approximately the
amount of the impurity. A very delicate test for nitrous acid or nitrites is
that with potassium iodide and starch. Three hundred and fifty to 600
cubic centimetres of water, in a flask, are acidulated with a few drops of
dilute sulphuric acid, and a little solution of iodide of potassium added.
About 2 grammes of freshly [irepared starch are added, and the mixture
shaken. If nitrous acid be present the iodide is decomposed, setting free
the iodine, which combines with the starch, causing a blue color.' A new
method of testing drinking-water was derised by Prof. H. Erdmann, of
Halle, by the use of l-8-amidnnaphtol-4-(i-disuIphonic acid, which has the
peculiarity of rapidly combining with diazo compounds in acid solutions
and forming niono-azo coloring substances. This forms a test for nitrous
acid and nitrites, which, if present in decided quantity, indicate dangerous
organic contamination of the water. This test is now supplied in (1) a fluid
form and (2) V^ Om. (or gr. viiss) tablets, under the name of Helthin, by
J. F. Schwarzlose Lcihne, Berlin, and Schering & Glatz, importers, Xew
York.
Bacteriological testa are now made by all experts in water analysis, and
such determinations are absolutely necessary in order to decide positively
upon the potable quality of any water-si^pply. A rough bacteriolojrical test
can be made by placing a sample of the water in a clean flask and filling the
neck with absorbent cotton in place of a cork. The flask is now placed in
a warm situation (say, at a temperature of 90 to 100 degrees) for ten or
twelTc hours, nnd then examined. If it become cloudy and develop a putrid
smell, it should be regarded as unwholesome, and some source of pollution
suspected.
The mineral poisons, especially the common metallic forms, — lead,
copper, zinc, — are easily recognized by the hydrogen-sulphide test, and
arsenic by Marsh's test. In making the fonner test about hnlf a pint of the
water is placed in a tall glass and acidulated with hydrochloric acid. To
this an aqueous solution of hydrogen sulphide is added, and if. upon looking
downward through the column of water, a bro\\'nish or blackish coloration
or precipitate is seen, either lead or copper may be present. The precipitate
is collected nnd dissolved in hot. dilute nitric acid. To this a solution of
potassium bichromate is added, and if a yellow precipitate is thrown down
which is soluble in caustic potash the metallic contamination is lead. If the
precipitate thrown down by the hydrogen sulphide is dissolved as ahovCj
'Gporpp K. Roll/'. "Text-book of Hygiene/' p. 74. PhiladelphU, 1890.
MIXEHAL 8PRIXG8.
10C5
I
I
I
•na ammonia added, the appearance of a blue color will indicate the pres-
ence of copper. To detect zinc the hydrogen-sulplildi.' precipitate is treated
"writh caustic soda, again filtered, and liydrofren suli^liide added to the filter-
ing liquid. A white precipitate indicates the presence of zinc. The fol-
lowing summary is given of the inferences to be drawn from these tests by
Parkes' : —
If chlorine be present in considerable quantity, it either comes from
strata containing sodium or calcium chloride, from impregnation of sea-
water, or from admixture of liquid excreta of men and animals. In the
first place, the water is often allvaline, from R)dium earbuuate; there is an
absence, or nearly so, of oxidized organic matters, as indicated by nitric and
nitrous acids and ammonia, and of organic matter; there is often much
sulphuric acid. If it be from calcium chloride, there is a large precipitate,
with ammonium oxalate, after boiling. If the chlorine be from impregna-
tion with sea-wfiter, it is often in very large quantity; there is much mag-
nesia, and little evidence of oxidized products from organic matters. Lf
from sewage, the chlorine is marked, and there is coincident evidence of
nitric and nitrous acids and ammonia, and, if the contamination be recent,
of oxidizable organic matters.
"Ammonia is almost always present in very small quantity; but if it
be in large-enough amount to be detected without distillation, it is sus-
picious. If nitrate, etc., be also present, it is likely to be from animal sub-
stances, excreta, etc. Nitrates and nitrites indicate previously-existing or-
ganic matters, probably animal, but nitrates may also originate from vege-
table matter, although this is probably less usual. If nitrates largely exist,
it is generally supposed that the contamination is recent; the coincidence
of easily-oxidized organic matters of ammonia and of chlorine, in some
quantity, would be in favor of an animal origin. If a water give the test
of nitric acid, but not of nitrons acid, and very little ammonia, either potas-
sium, sodium, or calcium nitrate is present, derived from soil impregnated
with animal substances at some anterior date. If nitrites are present at first,
and after a few days disappear, this arises from continued oxidation into
nitrates; if nitrates disappear, it seems probable this is caused by the action
of bacteria or other low forms of life. Sometimes, in such a case, nitrites
may be formed from the nitrates. Lime, in large quantity, indicates cal-
cium carbonate, if boiling removes ihe lime; sulphate,, or chloride, or
nitrate, if boiling has little effect. Testing for calcium carbonate is im-
portant, in connection with purification with alum. Sulphuric acid, in large
quantity, with little lime, indicates sodium sulphate, and usually much so-
dium chloride and carbonate are present, and in evaporation the water is
alkaline. Large evidence of nitric acid, with little evidence of organic mat-
ter, indicates old contamination; if the organic matter be large, and espe-
cially if there be nitrous acid, as well as nitric, present, the impregnation is
recent." Finally, the microscope will often give valuable assistance by
examination of the sediment. De Chaumont divides waters into (1) pure
water, (2) usable water, (3) suspicious water, and (i) impure water, with
the following characters: —
Piirkoa's ^TTygienf/' vol. i, p. 7fl.
1066
NON-PHARMAOAL REMEDIES AND GENERAL THERAPEUTICS.
Phusical Characters.
1. Colork*80. or bluish tint; transparent,
sparkling, and well aerated; no sediment
visible to the naked eye; no smell; tiiste
palatable.
2. Colorless or Blightly g-eenish tint;
transparent, sparkling and well affrated;
no auBuended luntter, or else easily sepa-
rated by coarse filtration or subsidence;
no smelt; ta8t« palatable.
3. Yellow or strong green color; tur*
bid; suspended matter conHidcrable ; no
amell, but any. marked taste.
4. Color yellow or brown ; turbid, and
not easily purified by coarse filtration;
large amount of suspended matter; any
marked smelt or taste.
Miomacopical Charactera.
\. Mineral matter; vegetable fonns
with endochrome; large animal forms;
no organic debris.
2. Same tm No. 1.
3. Vegetable and animal forms, more or
less pale and colorless; organic dChris;
fibres of clothing, or other evidences of
house-refuse.
4. Bacteria of any kind; fungi; numer-
ous vegetable and animal forma of low
types; epithelia, or other animal struct-
ures; evidences of sewage; ova of para-
sites, etc.
The **liardne8s" of water is due to the presence of earthy carbonates or
sulphates, or both. The former constitutes "removable hardness " because
by boiling the carbon dioxide is driven off, and the base (calcium or mag-
nesium oxide) is precipitated upon the bottom and sides of the vessel. The
presence of earthy sulphates causes "permanent hardness," and the sum of
the two, if present in any /^iven specimen of water examined, constitutes the
"total hardness." The degree of hardness is determined by the soap-test.
The drinking of hard water is not necessarily injuriousj although, to persons
unaccustomed to its use, it may cause looseness of the bowels, or even dysen-
teric discharges. It has aleo been credited with causing stone in the blad-
der and goitre, perhaps without sulKcient proof. Hard water is wasteful of
soap, and in cooking vegetables does not soften the more solid portions; in
making tea and coffee there is a loss of active principle, so that larger quan-
tities are required of these materials.
Physiological Effects. — The effects of drinking natural waters may be
divided into two groups: (1) those due simply to an increased supply of
water to the organism; (2) those which may be ascribed directly to the
mineral or other ingredients which may be present. Keeping in mind the
bulk of fluid which is swallowed during a "course" of mineral waters, it ia
evideut tliat the effects of the water itself must be taken into consideration.
Water is necessary both for the digestion and the assimilation of food.
In excessive quantity it dilutes the digestive fluids and interferes with ab-
sorption. In the conversion of sugar, if there is an insufficient amount of
water, no fermentation will take place; if there is a large excess, instead
of vinous, acetous fermentation will take place. Drinking habitually an ex-
cess of water at meals often aggravates dyspepsia, and may produce flatu-
lence, and what Chomel termed "indigestion of fluids/' The drinking of a
glass of water, on first rising in the morning, clears the stomach of mucus
and has a laxative effect. Small quantities of warm water, half an hour
before meals, increase appetite and digestion. A large quantity of fluid in
the stomach favors vomiting, and, in cases where an emetic is given, swal-
MINERAL SPRINGS.
1067
I
I
a pint of warm water will greatly assist its action. The action of
in the intestines is similar to that m the stomach, and a too free in-
Julgence in fluids often causes or keeps up a diarrha»a, as it increases the
water, but not the solids, of the faeces. Water passes readily into the blood,
especially after privation or haemorrhage; in the latter case, the too rapid
ingestion of water may Lave an injurious effect upon the red blood-corpus-
cles, causing their destruction by osmosis. The excess of water passes off
by all channels of excretion, but it is principally noticed in the increase of
the volume of urine. Not only is the water increased, but the excretion
of urea, phosphoric and sulphuric acids, and sodium chloride is augmented,
the latter only temporarily, but the former permanently. From this it has
been inferred thut water leads to augmented disintegration of tissues con-
taining nitrogen and sulphur. But, as pointed out by Ringer, "simultane-
ously with the rapid disintegration a corresponding increase of assimilation
takea place in the same tissues, whence it happens that water, taken under
certain precautions, may increase both construction and destruction of tis-
Bue, and so act as a true tonic, improving the vigor of body and mind.
. . . The effects of water-drinking vary in different persons. The dis-
integration is greatest in weakly persons, on whom this process may produce
almost a febrile state. Disintegration is greater in children than in adults,
and greater, perhaps, in women than in men. A high temperature of the
water, or of the external air, increases disintegration. Bodily exercise pro-
duces the same effect." (Parkes.)
It is a well-known fact that there are other restorative agencies at work
at medical springs besides drinking the waters. The sanitary surroundings,
fresh air, the tonic effects of change of air and scene, the physical and moral
advantages of the regulated life, and eytitematized rest and exercise under
medical direction all assist in producing the effects which follow a visit to
the **Springs." This is especially seen on the continent of Europe at Carls-
bad, Vichy, Homburg, Ems, Kissingen, Baden-Baden, and numerous other
German and French health resorts.
The mineral constituents of medicinal waters enable us to identify and
classify them. They are usually divided into the chalybeate, or ferruginous;
the acidulous, or carbonated; the alkaline; the saUne; the sulphureted, or
hepatic waters; chemically indifferent, and unclassified waters.
The chalybeate waters contain a small quantity of iron, which is in
solution when fresh, but after bottUng tends to precipitate in the form of
oride. They sometimes contain, also, a minute quantity of arsenous acid.
They are divided into two classes: first, those which contain carbon dioxide,
and where the iron is in the form of a carbonate; and, secondly, those in
which the iron is in the form of a sulphate. In an«mia, chlorosis, struma,
incipient phthisis, and other conditions of debility they are highly useful,
but should be avoided by the plethoric and by those who are subject to head-
ache after taking iron.
The acidulous waters contain free carbon dioxide, and are sparkling
and agreeable, but frequently contain in solution calcium, sodium, and mag-
nesium carbonates. In rheum»tism, lithaemia, and dyspepsia the acidulous
waters are useful, especially when taken at the springs. These waters vary
greatly in the proportion of their soUd constituents, and thus different
M-aters of this class also possess properties which would place them in some
other group, with which tliey might be classed with propriety.
10(18
N'OX-rr{ARMACAL REMEDIES AXD OEXEHAL THERAPErXICS.
Alkaline waters cnntain, besides carhon dioxide, an excess of sodium
carbonate and other alkaline substances, and also chlorides and siilphates.
An example of this class is Vichy water. In the purest alkaline waters there
are scarcely any solid in^odients except the carbonates of the alkalies.
They are frequently met witli as thermal as well as cold springs.
Where there is a marked excess of sulphates and carbonates of the alka-
line earths, which are held in solution by an excess of carbonic acid, the
water is known as calcareous, or earthy, water. Calcium sulphate is the
particular salt present upon which the properties of these waters commonly
depend, usually associatod with cnletum carbonate. Such waters are "hard."
Calciuui jjhosphate is also sometimes found in calcareous waters, and is a
valualile constituent.
These waters are useful in the treatment of constipation, sluggishness
of digestion, and deficiency of secrelion, their purgative effects leading them
to be universally used. Those containing magnesium and sodium sulphate
are the best known, as Confess Spring, Saratoga; Cheltenham, and Fried-
richshall. Wiesbaden and Baden-Baden contain chlorides; Homburg and
Kissingen are slightly acid and contain traces of iodine and of bromine;
Carlsbad is an alkaline spring, and contains a small quantity of lithia; Vichy,
Ems, Apollinaris, and Hunyadi Jauos contain the alkaline carbonates.
In the Formulary of the American Pharmaceutical Association are
given the formulfr for making artificia] Carlsbad, Kissingen, and Vichy*salta
(sal Carolinum factitlum, sal Kissengense factitium, and sal Vichyanum
factitium). These are also combined with efTcrvescing salt, so as to produce
pulvis saJis Carolini factitii efTervescens, puhis salis Kissengentns factitii
efTerveecens, and pulvis snlis Vichyani factitii effervescens, and also pulvis
salis Vichyani factitii cfTervescens cum lithio. In many cases these artificial
compounds, which are closely modt^Ied upon the natural constituents of the
waters, form very acceptable substitutes for the original. In the treatment
of obesity Dr. William T, Cnthcll has had very good results from the use
of fresh Vichy and Kissingen water, drunk upon alternate days. When
they cannot be obtained fresh he prefers the artificial effervescent salts.
He orders a large glass of the waters to be taken, twenty or thirty minutes
after each of the three principal meals of the days. If the reduction in
weight by this means is not sufficient {two or three pounds per week) he
recommends the addition of a little lemon-juice to each glass of Kissingen,
and 1 teaspoonfu! of aromatic spirit of ammonia to each glass of Vichy.
He advises a moderately-restricted diet.
Saline waters are solutions of halogen compounds of the alkalies, com-
monly distinguished by the presence of a large amount of sodium chloride.
They also comprise solutions of calcium, potassium, lithium, and aluminum
chlorides, and may contain traces of bromine or iodine.
Sulphureted, or hepatic, waters are recognized by their odor of hydro-
gen sulphide, the gas Iwing derived from tlie oxidation of iron pyrites in
contact with water. The sulphides of sodium, calcium, magnesium, and
potassium are sometimes present in these waters, singly or together, but
always in very minute proportions. The hydrogen sulphide may vary from
a mere trace to forty-two cubic centimetres in the litre. These waters are
widely distributed, cold or thermal in various degrees. (A. N. Bell.)*
"Mineml Springs of the United States," Journal of Balneology, May, 1802.
3ffTNERAL SPBIKQ8.
m en.
B mt
Argon and helium, gaseous substances, discovered by Lord Rayleigh
and Profeesor Ramsay as constituents of the atmospheric air, have been
detected in the sulphureted waters of the Griffon Spring, near Cautereta
in the Pyrenees, by Professors Bouchard and Trovst of Paris, and also in
the thermal springs of Wildbad. It has been demonstrated, also, that min-
eral springs contjiin radio-iictivt* stil)StanL'e^» some ta a very marked degree.
This may exphu'n the wfil-established fact tliat natural waters are more
efficient in the treatment of disease than artificial substitutes from the
lal>oratory.
In the United States there are large numbers of medicinal springs, and
within the last fifty years there has accumulated a fund of information upon
this subject, which only needs to be systematized and published in order to
enable our own resources to be appreciated by American physicians. In
many cases patients are sent to the older health resorts in Europe who could
as well treated here and saved the discomforts of ocean-voyages. Much
•edit is due to Dr. A. N. Bell for disseminating valuable information in the
journal of which he is the editor, TAe Sanxiariany and also for the valuable
work, which he published some years ago in Wood's Librar}', on "Climatol-
ogy and Mineral Waters of the United States."^
l)r. Bell classifies our native springs as follows: —
ALKALITfE.
Adams, California.
Albury, Vermont,
Aluoif Virginia.
Berkshire^ Vermont.
Blount, Al&bnnia.
Borax, California.
CafioD City. Colorado.
Carlisle. Colorado.
Congress, California.
H^gin, Vermont.
Fry's Soda. CBlifornia.
Higbgate, Vermont.
Higttfand, California.
Lower Soda, California.
Manitou, Colorado.
Middletown. Vprmont
Milford, New Hampshire,
Napa Soda, California.
Newbury, Vermont.
Perry, Illinois.
Ravenden, Arkansas.
Rocky Mountain, Colorado.
Seltser, California.
Sheldon, Vermont.
South Pa-rk. Colorado.
Summit Sodn, California.
Vichy, California.
Wilholt Soda, California.
Caixic.
Bethesda, Wisconsin.
Birch-Dale, Vermont.
l3utlervvorth, Michigan.
Clarendon, Vermont.
Katon Rapids. Michigan.
Gettysburg, Pennsylvania.
Hubbardstown, Michigan.
Silurian, Wisconsin.
Chalybeate.
Abbeville, South Carolina,
Bedford, Pennsylvania.
Blii^shiirj;. IVnnsylviinia.
Cooper's Well, Mississippi.
Estill, Kentucky.
Fayette, Pennsylvania.
Gordon's, G«>rgia.
Greencastle, Indiana.
Kittrell's, North Carolina.
Madison. Georgia.
Manley, North Carolina.
Milford. New Hampshire.
Montvale, Tennessee.
Owofiso, Michigan.
Rowlands, Georgia.
Schooley*s Mountain. New Jenejr.
Schuyler County. Illinoia.
Sparta. Wisconsin.
Versailles. Indiana.
Purgative Saline.
Blue Lick, Kentucky.
Crab Orchard, Kentucky.
Klgin. Vermont
Eaculapian, Kentucky.
^K«w York: WilUam Wood k Co., 1880.
1070
NON-PHAHMAOAL BEMEDIES AND GENERAL THEnAPEUTlCS-
PuBGATHE Sauxe (continued),
Harrodsburg, Kentucky.
Midland, Michigan.
Fagofla, Colorado.
Saune.
Fruit-Port Well, Michigan.
Gmnd Haven, Michigan.
Louisville Artesian, Kentucky,
Michigan Congress, Michigan.
Mt. Clemens, Michigan.
Ocean, Alabama.
Salt, Virginia,
Spring- Lake Well, Michigan.
St. Louis, Missouri.
BULPHUBOUS.
Alpena, Michigan.
Balaton, New York.
Bladon, Florida.
Blue Lick, Kentucky.
Carlisle, Pennsylvania.
De Soto, Louisiana.
Dreinion, Kentucky-
French Lick, Indiana.
Glenn's, South Carolina.
Highgate, Vermont*
Indian, Georgia.
Indian, Indiana.
Lodi Artesian, Indiana.
Manley, North Carolina.
Minnequa, Pcnnsylvaniau
Monteatcno, Missouri.
Olympian, Kentucky.
Portea Springs, Colorado.
Salt Sulphur, Virginia.
Saratoga, New York.
Sharon, New York.
Sheldon, Vermont.
Shocco, North Carolina.
St Helena White Sulphur, California.
St. Louis, Misoouri.
Sweet, Missouri.
Valhemosa, Alabama.
West Baden, Indiana.
White Sulphur, Louisiana.
WTiite Sulphur, Montana.
White Sulphur, Virginia.
Uhclassifizd.
Alum, Virginia.
Birch-Dale, New Hampshirt
Borax, California.
Climax, Missouri.
Eureka, Arkansas.
Fairview, Texas.
Greeneleone, Florida.
Geyser Spa, California
Gej-sera, the American, Wyoming.
Iodide and Bromide, Miaaouri.
Piedemont, Texas.
Sheldon, Vermont.
Stafford, Connecticut.
Summit, Maine.
TRBRUAI* SPBIKG6.
Aqua Caliente, New Mexico.
Arrow-bead, California.
Buncombe County, North Carolina.
Calistoga, California.
Chalk Creek Hot. Colorado.
Charleston Artesian, South Carolina.
Des Cehutes Hot, Oregon.
Harbines, California.
Hot Springs, Arkansaa.
Idaho Hot, Colorado.
Merriweather, Georgia.
Middle Park Hot, Colorado.
Ojo Caliente, New Mexico.
Paraiso, California.
Pasao Roblea, California.
Salt Lake, Utah.
Seigler. Oalifomia.
Skagg'a. Cklifomia,
Volcano, Nebraska.
Warm and Hot, West Virginia.
Some of the above-mentioned springs have won a high reputation, and
the water is transported in large quantities to different parts of the country.
From what has been said previously, it is evident that the water-cure is
largely assisted by the sanitary surroundings. Some of the most remarkable
springs in the world exist in the beautiful Yellowstone National Park, where
thermal, alkaline, sulphurous, saline, and pure spring waters are found at
an altitude of about 8000 feet or more above the level of the sea
CUMATOTHEEAPY AND CLIMATOIOGY.
4
Climatology studies the influences exerted upon the atmosphere, and
upon individuals, by temperature, humidity pressure, soil, proximity to the
sea, lakes, rivers, plains, forests, mountains, light, ozone, and electrical and
OLIMATOTHKRAPY AND OUMATOLOGY.
1071
I
other physical conditions. Climatotherapy studies the curative effects of
climates and climatic conditions as factore of health. This brings us to the
definition of climate, by which we designate the characteristic and prevalent
characters of a place as regards conditions of atmosphere, its temperature,
moisture, purity or contamination, electrical tension and chemical constit-
uents, especially in their physiological relations.
Agreeing with the definition of Hamm and Humboldt, we may accept
climate, therefore, as comprising the whole of the meteorological phenom-
ena characterizing the state of the atmosphere at any place, particularly as
they affect our organs, or have au influence on animal or vegetable life. The
general character must be taken, not basing the conclusion upon the limited
observation of a few days, or even years; but a period must be taken which
is long enough to furnish the data for composing a type. Equal yearly
averages do not signify identical climate. A place where the summer heat
and winter cold are extreme has not the same climate as one where the range
is relatively small, though the yearly average may be identical. Hence we
need, says a recent writer,* separate determinations of summer and of winter
averages. The combinations of conditions of temperature and moisture may
be endless, while the averages of either may be hardly disturbed. These
facts make it hard to compare climates, even when they are steady for long
periods. In the capricious climates of our temperate latitudes, a just deter-
mination and comparison form a baffling task.
Climatic conditions are largely affected by the physical configuration
of the earth's surface, — the presence or absence of mountains, forests, lakes,
rivers, etc., — and also by the latitude. In the summer months the sun passes
north of the equator, until, at the summer solstice, it, at its zenith, is in the
zodiacal sign of Cancer; at the winter solstice the sun is at its zenith in the
sign of Capricorn. Two imaginary lines, drawn the one north and the other
south of the equator^ and parallel with it at a distance of 23° 28' in each
hemisphere, would include the torrid zone, which includes the north and
south tropical zones. Other circles, drawn at a distance of 6fi** 32' from
the eqiiator, or 23° 28' from the pole, in each hemisphere, mark the upper
limits of the north and south temperate zones. The areas included within
the polar circle around the poles are known as the frigid zones. Heat, from
a medical stand-point, is a very important factor in climate. Maximum at-
mospheric temperatures are met with in the tropics, minimum in the frigid
zones. The intermediate zones, which are the largest, present, also, the
most favorable conditions for human existence, with a great variety of
climates, though, on the whole, moderate in temperature as compared with
the polar or equatorial regions. Temperature is affected, also, by altitude.
As we descend below the surface of the earth the temperature increases at
the rate of 1° F. to every one hundred and twelve feet, and at less than two
miles we have the temperature of boiling water, and at thirty miles it is
estimated that, at the same ratio, "the heat is sufficiently intense to melt all
the rocks and metals contained in the eartlvs crust and to account for the
torrents of molten, fiery lava belched from the craters of raging volcanoes.
It is to this internal heat of the earth that hot springs and the warm water
of deep artesian wells are due" (Bell). On the other hand, temperature
*I>r, W. H. Laxrabee, Popular Science yonthly.
1072
XOX-PILlRltACAL BEMJiDIES AND GENEIIAL IHERAPEVTICS.
declines as we ascend above sea-level at a rate of about 1 degree for every
four liundred feet of altitude; so that, in the United States, high mount-
ains have their tops in the regions of perpetual snow. At a certain elevation
the moisture of the air eongeals into »now, and this forms the '*snow-line/'
which, for obvious reasons, is higher at the equator; but it is not uniform,
even on the same parallel, owing to local influences. The angle at which
the sun's rays impinge upon the surface is one great cause of the diversity
of temperature and the succession of climates from the equator to the poles,
and irregularities of the surface give rise to various differences of climate in
the same latitudes. The number of hours of daily sunshine in a given local-
ity is a feature of great importance in climate. The direction of the pre-
vailing winds, the amount of movement of the air, and the presence of
moisture also affect the salubrity of a locality and contribute to give it its
therapeutic value. Aqueous vapor in the atmosphere constitutes a moist
stratum which retards the process of nocturnal cooling of the whole atmos-
phere and prevents excessive alternations of temperature between night and
day. The atmosphere always contains some moisture at a temperature above
32° F. The temperature of a place exposed to the full rays of the sun is
greater than in the shade at every elevation; the difference, according to
Dr. Charles DenisoUj of Colorado, augments with elevation, there being "one
degree greater differentc between the temperature in the sun and shade for
each rise of two hunrlrf*d and thirty-five feet." This is owed to the fact,
above indicated, that the atmosphere is more easily traversed by heat when
the amount of moisture is small. At an altitude of four thousand feet and
upward the increase of heat in the sun's rays relative to the temperature of
the surrounding air becomes a marked feature, insomuch that, at an altitude
of from six thousand to ten thousand feet above the level of the sea, the
thermometer exposed to the rays of ihe sun usually registers about one-third
higher than when in the shade.
As regards valleys and hills, Dr. A. X. Bell observed that it does not
fallow, because the hills are higher than the valley, that they are necessarily
colder and the valley wanner. The hills enjoy more sunlight and less
raoieturc. The cold air, by reason of its greater density, descends into the
valley, and the warm air rises to the top of the hills, except where there is
tiutlk'ient wind to inoiluee disturbaiiue aiul intermixture of the higher and
lower strata of nir, when this exreption to the general rule will not ot-cur.
This affords a useful hint about selecting a habitation. "The damp and
chilly valleys, with their attendant ills, are more frequently chosen as build-
ing places than drier, warmer, and healthier hills." Winds arc produced by
differences of temperature and to changes of atmospheric pressure due to
expansion of air under the influence of heat. The direction in which winds
blow depends upon the distribution of heat upon the earth's surface and the
daily rotation of the earth. Winds always flow from a region of higher
pressure to a lower one, with a velocity increasing with the difference and
inversely as the distance.
When air contains all the aqueous vapor which it can take up it is
said to be at the point of saturatioa, which ia also the dew-point, because
above this point the moisture is deposited upon surrounding objects, in the
form of dew. The higher the temperature of the air, the more moisture it
is capable of taking up, in a geometrical ratio with the increase of tem-
perature. The quantity of water in a given volume of air is called the
CLlMATUTHliKiVPV AND CLiMATOUiOY.
1UT3
I
I
~ll>solate humidity. The ratio between the actual absolute humidity and
the point of saturation indicates the degree of dampness, or relative hu-
midity.
The atmosphere of the ocean and sea-shore is often supercharged with
moisture from the spray, which it carries even for several miles inland.
Winds from the sea are likely to have a high relative humidity. Winds
from the poles are cold; those from the equator are warm, as the rule, in
each hemisphere. AVhen the temperature of air is rapidly reduced, the abso-
lute humidity may approach the point of saturation, and the excess of water
be precipitated as rain or snow. When a warm wind from the sea meets the
cool air of a mountain-range, the excess of water is precipitated in the form
of rain, and the air has its relative humidity reduced. The result is that a
mountain-range parallel with a sea-coast will have a humid atmosphere upon
one side and a eomparativfiy dry one upon the other side.
The pressure of the iitinospnere at the sea-level is nearly fifteen pounds
to tlie square inch, which is equivalent to a weight of thirty iuchea
of mercury, as demonstrated by Torricelli. The total pressure upon the
surface of a man's body of ordinary size is nearly fifteen tons. This enor-
mous pressure is not felt, because it is evenly distributed and also for the
reason that the human organism is adapted to it by nature and has become
accommodated, or acclimated, to certain altitudes. As the pressure dimin-
ishes, at the rate of about one pound for each two thousand feet, one of the
factors in the therapeutic effects of high altitudes is probably the alteration
of pressure upon the bodily surface and the resulting physical changes in
the circulating fluid and the tissues. In mountain-climbing there is experi-
enced a feeling of exhilaration and a lightness which may be due, in part,
to the diminished density of the air. At an elevation of from ten thousand
to sixteen thousand feet, rapid breathing, dyspncew, and increased action of
the heart occur, with feelings of faintness upon slight exertion; and, if the
ascent has been rapid, as in a balloon, blood may pour from the nose and
mouth and other mucous orifices of the body. A removal from the level of
the sea to an altitude of two or three thousand feet, in the summer-time,
which is undertaken for sanitary and physiological reasons by large numbers
of the population, is more than simply changing from a polluted atmosphere
to a pure one, more than exchanging a humid atmosphere for a dry one, or
a hot for a cool one; it is throwing off from the surface of the body a certain
proportion of the atmospheric pressure and breathing a somewhat rarefied
air, which of itself causes greater inspiratory effort, quickens the circulation,
and increases metabolism.
As pointed out by von Petenkofer, Bowditch, and others, the nature of
the soil and the drainage and rise and fall of the ground-water have much
to do with the Iiealthfulness of a climate. Bodies of water give forth moist-
ure; bodies of sand and dry soil absorb it from the air. Sand being a poor
conductor of heat, the sun's rays do not penetrate deeply, and the heat i»
radiated at night, making the night cold and the days hot, which feature
characterizes the desert climate. An aUuvial soil (clay or loam) being a
better conductor, and usually being covered with vegetation, absorbs heat
during the day and does not readily part with it at nieht, partly on account
of the layer of moisture to which attention has already been directed. In
consequence of this fact, a modifying effect is exerted upon climate; the tem-
perature does not get so hot during the day and is less cold at night. For-
10 M
NON-PUAIIMACAL REMEDIES AND GENERAL TUERAPEUTICS.
ests protect the earth's surface from the action of the sun; the temperature
of the air of the woods is, therefore, cooler in the day-time, than the sur-
rounding atmosphere, and, as the result of interference with evaporation,
contains more moisture. Owing to the fact, in vegetable physiology, of the
decomposition of carbon dioxide by the green parts of growing plants^ in
order to appropriate the carbon, there is a constant evolution of oxygen in
the woods. The agitation of the air by the green leaves, especially in the
coniferee, causes some of the oxygen to appear as ozone, the effects of which
upon the human body have already been referred to. This agent, which has
been called "nature's antiseptic," is, therefore, likely to be met with in the
woods, and also upon the sea-ehore; but only exceptionally, and to a very
slight extent, in large cities. The fact that a forest between a marsh and a
city would protect the latter from certain fevers, was known to tbe ancients.
In recent times the marshes around Rome have been redeemed and made
habitable by the labors of the Trappists, who set out plantations of euca-
lyptus-trees, which naturally absorb large amounts of moisture from the
Boil. Trees have a very decided eifect, therefore, upon climate, not only by
protecting the soil from the rays of the sun and favoring the healthfulness
of a locality, but they also, as oxygen-generators and ozone-producers, as
well as carbonic-acid destroyers, play an important part in the preservation
of animal life.
Water has au important function in climate. On account of its high
specific heat, it abstracts heat from the surrounding air and cools the atmos-
phere in summer, and in winter it yields up its store of heat slowly, by
radiation, and thus modifies the rigors of climate at the sea-shore. The
gulf-stream makes northwestern Europe habitable, and the comparatively
mild climate of our Northwest coast is attributable to the warm current of
the Japan stream, each of which flows like a great river in the ocean, mainly
in a northeasterly course. Marshes arc caused by water spreading over a
portion of ground, on account of the ground being level and porous. Such
accmnulations of water, with little or no current, afford a favorable breeding
ground to the jiuopheles mosquito, who is the distributor of the plasmodium,
which, as shown by Laveran, is tlie source of malarial poisoning. As these
paludal manifestations usually appear in the spring and fall of the year,
they are soinetinies known as vernal and autumnal fevers; or, from the
pathological conditions, they are styled congestive chills, intermittent or re-
mittent fovprs, eliilla mid fever.
With regard to the atmospheric electricity and its effects upon climate,
very little is known of its relations to health ond disease. It is probable
that atmospheric ozone may be due to electrical conditions, and that the
purity and stimulating qualities of the atmosphere in some localities is due.
indirectly at least, to electricity. The frequency of thunder-showers in the
mountains undoubtedly contributes to the sanitary qualities of these highly-
prized health resorts.
As to the physiological effects of climate upon human beings, very
important facts have been established by investigations in the fields of
anthropology, ethnology, and vertebrate paleontology. Man is affected by
his environment, and the most important factors in the problem are food
and climate. Reserving the former for discu^ion in the section on "Die-
tetics,*' we may here devote a few words to the latter in connection with a
few fundamental facts in physiology and in pathology. At the same time.
p
it must be stated that they are, in social relations, very closely connected;
because a climate that is unfavorable for human life is also unfavorable for
the life of domestic and other animals upon which man depends for sub-
Bistence, and is also unfavorable to agriculture, so that insufficient food and
a severe climate act in concert to produce physical duj^radation. A very
hot climate, on the other hand, while it favors vegetation, also favors the
development of malaria and other piroplasmic poisons, like yellow fever,
which not only cause disease, but cause physical degeneration in races which
do not become acclimated. The dark-akinned races of men have acquired
the ability to live in the tropics with apparent impunity, but the white races
do not find the climate propitious, either with reference to individual health
or the rearing of their children. In a similar manner, certain families or
tribes of men, having for many generations lived in one locality and accus-
tomed to the climate (harmonized with the environment), may find great
dithculty in becoming acclimated should they remove into another region
having different c-hiiracters. Major Woodward, Surgeon in the United States
Army, has shown tliat the northern white races cannot become permanently
acclimated to the tropics.
Local influences may change so as to bring about a modification of
climate. This has been noticed after cutting down groves of trees, and
especially after draining alluvial soil. A very good illustration is given by
Dr. "W. J. Hutchinson of the effects upon the climate of southern CaJifornia
produced by the appearance of Salton Lake. It is claimed that this new-
formed body of water has increased the humidity of the atmosphere and the
rain-fall over a considerable area. The result has been a reduction of the
extremely high temperature which prevails in other parts of southern Cali-
fornia imd a great revival of vegetation.
The effects of climate upon phyeicnl conformation is an inviting field
of study. The Serranas, a native tribe of Peru, live in the high peaks of the
Andes and are short in stature, but have a remarkably well-developed thorax
and lungs, being about thirty-six inches around the chest, with a bodily
height of seven and four-Efths inches less than the average height of Eu-
ropeans.* The Esquimaux are a short, thick-set,, degenerate race, who
apparently are so worsted in their struggle with adverse climatic conditions
as to extinguish nearly every manifestation of intelligence except those
connected with the satisfaction of physical wants. On the other hand, the
hot weather of the tropics, on account, largely, of its excessive humility,
is enervating, and debility and anaemia are common results. In temperate
lones, however, man attains his highest physical, intellectual, and moral
elevation, and these regions furnish explorers, armies and navies, and the
pioneers of commerce and civilization who discover and rule less favored
races, and penetrate to the ends of the earth and make them tributary to
science and the social requirements of the age in which we live. Moreover,
the more cultured races, having acquired a knowledge of sanitation and espe-
cially of the causes of infection and disease, are able to apply this knowl-
edge for the protection of health. The excessive mortality which formerly
prevailed among the Enj/lifih troops in India and the West Indies was at-
tributed by the late Dr. Parkes to unsanitary conditions rather than to the
' Quoted by Dr. A, N. BeU from the OfllcUI Report of MedioAl Inspector B. F.
Qibb«fl. U. S. N.. on the Medical Topography of tlic Picitir Coiut of South America.
NON-PUARMAOAL REMEDIK8 AND GENERAL TIIERAPEtTTIOS.
climate itself. Under improved methods of sanitation, especially as regards
the purity of the water-supply and cleanliness of habitations, the mortality
has been steadily decreasing "until, in some stations in the West Indies
(as, for example, Trinidad and Barbadoes), the sickness and mortality among
European -soldiers are actually less than in home service. In India, a cent-
ury ago, people spoke with liorror of the terrible climate of Bombay and
Calcutta; and yet Europeans now Hve in health and comfort in both cities.
In Algeria the P'rench experience is to the same effect." Parkes also
directed attention to the greater necessity of sanitary precautions in hot
climates. "The temperature and the humidity of the air are highly favor-
able to decomposition of all kinds; the ellluvia from an impure soil and
the putrescent changes going on in it are greatly aggravated by heat. The
effects of unsanitary evils — which, in a cold climate like Canada, are partly
neutralized by the cold — are developed in the West Indies or in tropical
India to the greatest degree. In this way a tropical climate is evidently
most powerful, and it renders all sanitary precautions tenfold more neces-
sary than in a temperate zone." Dr. Bell coincides with these views, and
even in the case of pulmonary consumption, the prevalence of which in cer-
tain localities is usually held to afford a rough indication of the influence of
climate, he regards it as **a disease which, probably more than any other,
depends upon preventable conditions intimately associated with a foul soil
or density of population."
The good effects of the most salubrious climates may be overcome and
disease develop as the result of neglect of common sanitary duties and viola-
tion of physiological laws. The intelligent physician is able to point out the
causes of ill health and enable the patient to avoid them. The philosophy
of the modern exodus from the large cities to the country, sea-side, and
mountains which takes place in the hot months of the year, may be easily
understood from what has just been explained. It is the same in the cli-
matic treatment of disease. If pulmonary tuberculosis be due to overcrowd-
ing and a polluted atmosphere, the remedy is obvious: the patient should
be taken to a place which is not crowded and where the air is pure, and he
will be placed under better conditions for his recovery.
Mountain sickness, as pointed out by Dr. S. Edwin Solly, is that phys-
iological disturbance whicli occurs more or less in all himian beings and
animals who ascend to a high altitude. It has been proved that the dis-
turbances are due to the diminished oxygen-tension. In consequence of the
diminished barometric pressure the molecules of air are more widely sepa-
rated than at sea-lcvol, and tho actual amount of oxygen in each cubic inch
of air is lessened. Dr. Solly also has called attention to the physiological
effect of altitude upon the blood, when the oxygen-tension diminishes the
number of red corpuscles and the percentage of hfiemoglobin proportionately
increases. At 6000 feet the blood-cellfi would increase 4,000,000 to 5,000,-
000 and the hiemoglobin 16 per cent. In an unhealthy person the increa«e
would be even greater.
Classification and Climatotherapy. — No satisfactory classification of
climates can be made, and the distinctions made are often conventional and
relative. Hot and cold climates, humid and dry climates, marine and inland
climates convey certain general ideas to the mind. The climate of elevated
plateaus and mountains and the climate of valleys and plains differ to a
marked degree, owing to conditions which have been already considered.
CLIMATOTHERAPY AND CLIiUTOLOGY.
1077
I
The United States, in its wide area, offers a choice of every variety of
climate. An ocean cliraale may be enjoyed at the sea-shore or on islands
some distance from the coast. The mountain -ranges of the Appalachian
system or of the Rocky Mountains contains numerous health resorts of well-
earned reputation. The high table-lands of New Mexico and Arizona are
remarkable for their salubrity, while the valleys of California between the
Foot Hills and the coast-range of mountains afford spots of remarkable
fertility, beauty, and health-giving powers. We have the cold climates of
Maine and Minnesota, or the hot ones of the Eastern Atlantic Coast in the
Southern States; and in Florida we have a new-world Riviera upon the gulf-
coast, especially around Tarpon Springs.
Change of climate is frequently beneficial in disease, owing to mental
and moral conditions, or the psychological effects; on the other hand, it is
an act of cruelty to deprive some aemihelpless invalids of the comforts that
they are accustomed to enjoy and make them suffer the pangs of homesick-
ness, in addition to their physical weakness and disease. Moreover, in speak-
ing, in a general way, of climate in the treatment of disease, it must be
remembered that each locality possesses individual peculiarities, such as
dryness or dampness of the soil, excess of sun or shade, direction of prevail-
ing winds, the presence of forest-trees or bodies of water, as well as con-
venience of access and other circumstances not climatic (such as comfortable
hotel accommodations, good milk and other food in abundance), which con-
tribute very much toward the availability of any particular resort in any
special case. It is of importance, therefore, that pliysicians should acquaint
themselves fully regarding the advantages and disadvantages of health re-
sorts that they recommend for their patients, and it is better to do this by
personal inspection, wherever possible. Attention has already been called
to the fact that the most salubrious localities may lose all their advantages
by neglect of sanitary precautious; for we know that cases of typhoid fever
and dysentery, and other forms of ill health, may arise from foul drains or
an infected water-supply, even among the best surroundings.
As regards climates from the medical standpoint, a good classification
is that of Dr. Hermann Weber,* which, with some modifications, is as fol-
lows:—
(A) MARI51E Climates.
I. Marine CUmaten uAih High Degree of Bumtdity.
1. Warm and Moist Marine Climates: —
Illustrations: Madeira, Canary Islands, the Azores, Ceylon, Hawaii, Bahamas,
Bermudas, Vir^n Islands, Cuba, Jamaica, Barbadoes, Florida, Georgia, South
Cnrolina, Society Islands, Tahiti, Tonga, Fiji Islands. Tristan d'Acunha, St.
Helena.
2. Cool and Moist Marine Climates: —
Inland of Bute, RotheHay, Hebrides, Orkney and Shetland Islands. Faro? Islands,
Tofland, Bergen, Marstrand, Auckland Islands, Falkland Islands.
* Von Ziemssen's "Hand-book of General Therapeutics," vol. iv, Enjrli^h tmns-
tation. New York: William Wood A Co., 1895. In connection wiUi this subject, and
for information of which uant of space prevents proper discussion in this place, the
Trader is referred to the valuable treatise of Dr. A. N. Bell, of New York, on "Clima-
tology and Mineral Springs of the United States." and aUo to the more recent work
of T>r. Buflhrod W. James, entitled "American Resorts, with Notes upon tbeir Climate."
Philadelphia: The F. A. Davis Company, 1889.
1078
NON-rUAUMACAL REMEDIES AND GENERAL THEIlAPEtTlCS.
n. Marine CUmatts uHtk Medium Dtgrw of Humidity.
1. Warm Marine Climates of Medium Humidity: —
Tangiera, Algiers, Cadiz, San Lucar, Gibraltar. Ajaccio, the Songuinaires.
Pnlcrnio, Riviera di Levflnte, Pegli, Venice, Balkan Peninsula, Corfu, Crimea,
Lisbon, Vigo, Santnnder, Biarritz, New Zealand. Auckland, Mew Plymouth,
Wellington, Nelson, Virginia Deach, Old Point Comfort.
2. Cool Marine Climates of Medium Humidity: —
(a) Winter Resorta: —
Queenstown, Isle of Wight, Florida, I«kewood (N. J.)-
{b} Summer Resorta: —
North Coast of Cornwall and Devonahlre, Wales. Ireland, Brest, North
Const of Fronce, Belgium, Holland, Germany, Tasmania, Coasts of Eng-
land and [reland, Newport, Isle of Shoals, Nantucket, Mount Dt-sert,
Fire Island.
III. Marine Climates itiih Low Degree of Bumidity.
Tlie Western RiviOra, Nice, Monte Carlo, Mentone, Naples. Capri, Ischia, Malta,
the Balearic Islnnds, Smyrna, Athens, South Africa, Australia, New South
Wales, Sydney, Victoria, Melbourne, the New Jersey Coast, Long Branch,
Atlantic City, Cape May.
(B) Iiojiin) CLniATES.
irClimates of High Altitudes, or Mountain Climates: —
Davos-Platz, Davos-DOrfli, Davos Fraucnkirch Wiesen, St. Moritz, European
Alpine resorts. German mountain resorts, Northern Italy, Apennines and Mari-
time Alps, Peruvian Andes, Rocky Mountains, Colorado Springs, Denver, St.
Paul, Aaheville, South Africa, India, Mexico, Catakilla, Alleghenies, Cresson,
Green Mountains, White Mountains, Glen Summit, Pocono, Kane, Schooley'a
Mountain, etc.
2. Climaten of Low Levels: —
Dry and Warm Climatca: Africa, New Mexico, California.
Dry and Cold Climates: Minnesota, Canada.
Moderately Moist Climates: Rome. Pisa, Pau, New England States, Saratoga*
etc.
4
Choice of Climate for the Treatment or Prevention of Disease,
In detenuining the correct solution of the question as to the climatic
treatment in anj given disease, the physician hos to solve a complex prob-
lem, into which enter the psychical condition of the patient; his financial
ability, his capacity to endure the discomforts of travel, and his personal
preferences and habits of life, as well as the nature of his disease and the
advantages and physiological effects of the proposed place of residence.
Patients with seriously damaged lungs, kidneys, or hearts should not be
sent to high altitudes; or, if they insist upon making the experiment, they
must be allowed to make the change gradually, by resting for several weeks
or months at intermediate points. Patients whose vitality is exhausted, and
who are evidently doomed to early dissolution, should not be allowed to go
to distant health resorts, deprived of the comforts of home, and only to die
among strangers. A very sick patient does not enjoy scenery or the inci-
dents of travel, and often actually suffers more from homesickness than from
his disease. Phthisical cases in the second or third stage should, as the rule,
be kept from a moist climate, whether cool or warm, as the progress of the
disease is generally hastened. Invalids cannot endure hardship.
Summer residence in the country is a prudent, sanitary, and prophy-
lactic measure, by rare coincidence having for its support both fashion and
medical teaching. Its GfTects are most demonstrably evident in the younger
OLIMATOTUEKAPY AND CLIliArOI-Ooy.
1019
I
I
members of the family. In some instances, where health is impaired or
notably affected by residence in the city, a permanent change of place of
living should be advised, if practicable. Pure air, pure water, wholesome
food, and a regulated life are the conditions of health and longevity, and,
therefore, are factors in the therapeutic problem. \ patient cannot live on
climate alone, although, in popular discussions of the subject, this is dwelt
upon as if it were the only thin^ to be considered. With this in mind, we
will proceed to outline the climatic treatment of some principal diseases: —
Acute diseases, as the rule, should be treated at home, or in the imme-
diate vicinity.
Anaemia and Chlorosis. — Such cases are benefited by life in the open
air, where there is abundance of sunshine and the temperature does not
forbid physical exercise. The sea-coast, early in the summer, followed by
a stay at the mountains later, is advisable, together with out-door amuse-
ments and bicycle or horseback exercise. If much debilitated, a preliminary
visit to a good hydropathic institution would be of great value in building
up the nervous system and increasing h^Tmatosis. Weber recommends places
where the whole day may he spent in the open air without demands being
made on the bodily strength. Long sea-voyages are often curative.
Asthma. — Where there is no heart complication and no emphysema,
these patients do well at mountain stations, or on inland plateaus. Where
there is much bronchial complication, a dry climate should be preferred;
where the secretion is scanty, the patient may improve more rapidly among
the pine-woods, near the coast. We cannot predict, in any given case of
asthma, whether it will be benefited by a marine climate or not; but, as a
general rule, especially if there is emphysema present, these cases do better
at a moderate elevation inland. Mountain-climbing is useful as a form of
respiratory gymnastics, especially in catarrhal complications.
Children and nervous subjects are usually Ijcnefited by the sea-shore.
Hay-fever patients seek a pure atmosphere, free from dust and pollen. They
may find relief either in mountain resorts (Bethlehem. White Mountains,
Kane, etc.) or on islands (such as Nantucket).
Bronchial Catarrh. — Chronic bronchial catarrh, with merely increase
of secretion and a moderate amount of cough, may be benefited by either
a marine atmosphere or by mountain or inland climate. The change of
residence of itself is of service, even where there is not much difference in
climate, altitude, or temperature. In the declining stage of whooping-cough
syBtematic exercise in the open air is an important part of the treatment;
and, as a genera! rule, in chronic cough, unattended by much pathological
change, the best results are obtained from pedestrianism, especially in
mountain regions, such as the Catskills.
Blood Bisordera. — In morbid conditions of the blood the climatic treat-
ment is a useful adjunct to the ordinary treatment by alteratives, tonics,
and chalybeates. Careful regulation of the diet and hygienic management
are also required in all cases. Residence at the sea-shore exercises a power-
ful alterative effect, and, owing to the presence of ozone, it is a decided
stimulant to tissue-construction. Ab anfl?mia and chlorosis may result from
a Warm, humid climate, a change to a moderately cool, bracing atmosphere
ifi attended by improvement. A moderate amount of cold, even, will do no
harm if the clothing and living-rooms be properly adapted to the tempera-
ture; the cold will improve the appetite and favor out-door exercise. In
1080
NON-PHARMACAL HEMEDIES AXD GENERAL TnERAPELTICS.
cases attended by profuse menstruation sea-climates are often injurious, and
in early pregnancy abortion may occur at the sea-shore. The favorable
effects of altitude upon the number of red blood-cells, and the proportion
of hiemoglobin, have already been referred to.
Climacteric disturbances of health are greatly influenced by climatic
conditions. Not only at the change of life in women, — at the cessation of
menstruation, — but also at puberty do we meet with evidences of disorder,
particularly of the nervous system; but the circulation and organs of diges-
tion and assimilation are also affected. There may be delayed development
or insutficient evolution of the sexual system and deterioration of the gen-
eral health. In such cases change of climate, the excitement of change of
scene, and pleasure of voyaging are useful adjuncts to the means employed
to bring about the normal state. Premature senility, either of organs or
of the general system, is sometimes mistaken for ordinary disease, and use-
lessly treated by medicines. Lowering of general activity, easily-produced
fatigue, liability to catarrhal attacks, with impaired digestion, are the promi-
nent symptoms of this condition. By a resort to warm, sunny, and dry
climates during the winter season and a moderately elevated mountain
climate in the summer many of these complaints are overcome or avoided,
and in this way life may be prolonged and senile decay deferred.
Consumption. — The chmatic treatment of pulmonary phthisis, or con-
sumption, has been the subject of study from the earliest times, and an
abundant literature has accumulated upon it, including such valuable recent
works as that of J. A. Lindsay or C. T. Williams. It has also received
favorable consideration in the writings of Jaccoud, Austin Flint, Charles
Denison, Trudeau, and other authorities. No climate can be regarded as
possessing a specific elfect in arresting phthisis, although some exert a much
more favorable influence than others in bringing this about. According
to Flint, ^'Dryness, equability, and purity of the atmosphere are essential
elements of a favorable cliniule,*' and he further declares that "there is
reason to believe that the benefit derived from climatic treatment is often,
in a great meiisure, due to accessory circumstances."^
In his address read before the Berlin International Medical Congress
Dr. Weber considered the influence of climatic, local, and social conditions
on the occurrcntH'- and course of pulmonary tuberculosis. \s already stated,
no climate is entirely extinpt from plithisis. He agrees with Hirsch that,
if we consider the distribution of phthisis over the world, we must come to
the conclusion that the climatic conditions alone, apart from other condi-
tions, especially the social ones, will not afford a sufficient explanation of
that distribution. It is necessary to consider the temperature, condition of
the soil (dryness or dampness), the elevation above the sen-level, race, effect
of colonization, social circumstances, and the industrial pursuits. Phthisis
progresses more rapidly in the tropics than in the temperate zones, and he
considers that the hnt^illi are favored in their development by boat and
moisture, and also that their products are more toxic under such conditions.
Hygienic regulations are more apt to be obeyed at a health resort than
at home. There is also a freedom from the cares of business or the house-
hold, combined with associations with new acquaintances, affording diver-
* Pepper's "System of Medicine " vol. iii, p. 429.
CLIMATUTUEIUPY AND CLlilATOLOUV.
lUtJl
I
Rion and mental relaxation, which act as nerre-tonics. Very often patients
can eat more food when away from home than when at their own table. All
these accessory agencies are of value, and contril)ute to the undoubtedly
beneficial effects of change of scene. Cold and damp locations are to be
avoided, especially if the patient is thereby compelled to remain in his
room. The great object is to select a climate favorable to living in the open
air the greater part of the time. In New Mexico it is possible to remain
day and night in the air, on account of the dryness of the atmosphere.
Distance and convenience of access must be taken into consideration; so
that, if the patient becomes homesick or desires to be taken home, it will
not be impossible to bring him back without unduly taxing his strength.
If the patient be very feeble, it will not be advisable to disturb him with a
journe^v unless it be merely to the suburbs of the city during hot weather.
On the other hand, if the case be in its incipiency and the patient young
and his health not much impaired, it may fae better for him to emigrate,
and remain permanently in some climate that will agree with him. Dr.
Flint suggested that, if the patient bear hot weather well and is worse in
cold weather, he should ;:o south, at least during the winter; on the con-
trary, if he is always better in cold weather, he would do wisely in going to
a northern resort, such as Denver, Colorado Springs, St. Faui^ etc. Some
cases have done very well at Newport, but during the summer a stay in the
woods is to be preferred to the sea-shore, for reasons already indicated.
The Adirondacks have attained a world-wide reputation for the cure of
pulmonary diseases, and White Haven, Pa., Lakewood, N. J., and Asheville,
N. C, are also famous health stations for the cure of consumption.
Dr. Anderson, of Colorado Springs (6000 feet above the sea), says that
patients do not always tolerate this high altitude, and the expected relief
is not obtained. In a certain proportion of these cases benefit will follow
change to a lower alUtude, as 3000 to 4000 feet above sea-level, and resi-
dence there until improved and somewliat acclimated. He mentions ap-
provingly the Mesilla Valley of New Mexico, where are found combined the
important essentials of a maximum of sunshine and dry air, together with
only a moderate elevation.
Open^Air Treatment. — The majority of patients, however, are unable
to change from one climate to another, and all such should be advised to
live as much as possible in the open air. The early stage of pulmonary
tuberculosis, other forms of tuberculosis, neurasthenia, rachitis, chlorosis,
and antemia are susceptible of much benefit from this mode of life. Even
in hospitals it has been found beneficial to keep such patients about the
grounds or on the vorandns, and to hnvo them sleep on balconies.
Exhaustion from Overwork and So-Galled Neurasthenia. — These are
conditions, in a sense, aUied to hypochondriasis and hysteria, and, with
these, are benefited by combined balneothorapeutical and climatic methods
of treatment.
Indigestion and dyspepsia are closely related to the foregoing, being
largely functional and are greatly benefited by change of climate. TTie
same remark holds good for chronic diarrhoea, which can often only be per-
manently arrested by a sojourn in a dry and equable climate.
Insomnia is relieved by change of residence, either to the mountains or
the sea-shore. In nervous erethism, where patients are easily excited, it is
of importance to learn the character of the hotel to which they are sent,
1082
NON-PHAHMACAL HKSTEDIES AND GEXKR-iL TUERAPKDTICS.
inasmuch as their comfort and health depend prineipolly tipon freedom
from noise and excitement. If music and dancing until after midnight is
the rule of the house, their sleep may be more broken than at home. A
suitable environment is of as much importance as a proper climate.
LesionR of the Nervous System. — According to Weber, nervous dis-
orders should more often be subjected to treatment by climate than is
customary.
Leokffimia is apparently benefited by long cruises in yachts, and Weber
advises, in addition, prolonged stay in Epypt or Algiers. In advanced cases
little can be expected beyond extending the duration of life. In malarial
toxcemia moinitain regions are curative; damp situations are to be avoided
on land, but sea-voyages are useful.
DIET IN DISEASE.
d
The principles of dietetics, and likewise the physiology of nutrition,
apply equally in disease and in health, the only difference being that the
power of digestion and assimilation with the secreting and excreting func-
tions are more or less impaired; the food must, therefore, be of a character
suitable for assimilation, of nourishing quality, and administered in quan-
tities, and at such intervals, as appear best suited for the case. The aid
which properly-selected food can render in the treatment of disease is now
generally acknowledged. If, as Abernethy is reported as saying, it be a fact
that the cause and cure of most diseases is at the table, the importance in
therapeutics of food is no less than drugs. Oliver Wendell Holmes, nearly
thirty years aj^o, in his essay on the '*Border-lines of Knowledge in Some
Provinces of Medical Science," declared his high appreciation of this sub-
ject as follows: "I cannot help believing that medical curative treatment
wilt, by and by, resolve itself, in great measure, into modification^ of the
food swallowed and breathtd, aiul of the natural stimuli, and that less will
be expected from specific and noxious disturbing agents, either alien or
assimilable.'* Dr. Austin Flint, in his posthumous address on the "Med-
icine of the Future,'* prepared for the meeting of the British Medical Asso-
ciation in 1886, expressed a similar idea. "It is a pleasant thought that
hereafter the practice of medicine may not be so closely interwoven as
hitherto in the popular mind with the use of drugs. The time may come
when the visits of the physician will not, as a matter of course, involve the
co-operation of the pharmacist; when medical prescriptions will be divested
of all mystery, and have no force in the way of fortifying the confidence of
the patient. The medical profession will have reached an ideal position
when the physician, guided by his knowledge of diagnosis, the natural his-
tory of diseases, and existing therapeutic resources, may, with neither self-
distrust nor the distrust of others, treat an acute disease by hygienic meas-
ures without potent medication. When this time comes a system of practice
which assumes to substitute medicinal dynamics for the tns medicairix
JuiiurcB will have been added to the list of by-gone medical delusions."*
*^Thi3 and the preceding quotation from Holmes alao appenr in the admirable
uddreas of Mediral Director A. L. Gihon, U. S. X., President of the aeetion on Mediral
Climatolo^ and Demography. ''Transactions of the Ninth International Medical
Congress, held at Washington, 1887, vol. v.
niKT IN niSEASK.
1083^
I
I
The influences of climate, custom, and nationality upon diet and the
reciprocal relations of diet upon customs and ethnical traits are of the
highest importance in the study of demography. Dr. Gihon (loc. cit.) says
that "the food of a people largely determines its national characteristics,
but climate determines the food/' He supplies the followinsr apposite illus-
tration: '*The Chinese of the northern provinces live on millet and wheat
and vegetables, because these thrive best in the dry and dusty soil and severe
winter; while the moist, hot climate of Southern China produces rice, which
with fish, is the staple aliment of many millions of people. The lack of
variety harmonizes with the conservatism of the race, and has contributed
to that apirit of contentment and domesticity which, as in Japan, are ele-
ments of rare happiness not enjoyed by nations boasting a higher civiliza-
tion." The relation of this to the subject under consideration is twofold.
First, in selecting a dietary for a sick person, it is important to learn what
kind of food his stomach is accustomed to» as, other things being equal, it
will also be the kind that he can most readily assimilate. Secondly, many
diseases are traceable to the food being insufficient in quantity, or deficient
in quality, or improperly combined. Thus, insulficient nourishment pro-
duces anaemia (anhamatosis), emaciation, debility (neurasthenia), myalgia,
neuralgia, and probably rachitis, scrofula, and is an active predisposing
cause for phthisis. Food of inferior quality causes such wide-spread dis-
orders aa pellagra, beriberi, or kakke, and ergotism. Improperly-assorted
food causes Bright's disease, scorbutus, many of the disorders of infancy,
gout, rheumatism, and possibly cancer (?). Other disorders due to in-
fected food, such as trichinosis, hydatid disease, intestinal parasites^ and
infectious disorders, — cholera, typhoid fever, dysentery, etc., — need only be
mentioned here in order to put us on our guard, so that the dietary for
the sick may be quite innocent and free from such disturbing elements.
Dr. Gihon insists upon the relationship between food and climate, and
points out the fact that the climate of India and equatorial Africa is deadly
to those Europeans who keep up the style of eating and drinking that they
follow at home, whereas others who suit their dietary to the climate find
themselves not injured by it. Major Charles E. Woodruff, Surgeon IT. S. A.,
declares, on the contrar)', that the tropics are not suitable for white races,
especially the blondes, on account of the excess of light, which is too stimu-
lating for them. He denies that the white races can become acclimated to
the tropics.
The proportion to be preserved in the daily diet of man has been espe-
cially studied by the civilized nations of the earth in order to determine the
best ration to issue to large bodies of men employed in the military and
naval services, so as to maintain them in health and the highest degree of
efficiency. It may therefore be of interest to give a recent statement as to
the dietetic requirements of the army. The equivalent ration for United
States soldiers on duty in the tropics is calculated by Capt. E. L. Munson,
Assistant Surgeon U. S. A., as follows: —
1084
NON-FHARMACAL R£3£EDIE8 AND QEKERAL TIIERAPKL'TICS.
Artiolbs.
4^17 AS-
TITY.
Ox.
Frt'sUBeef
Or Fresh Mutton . . , .
Or Pork
Or Bacon
OrSiiUBeof . .
Of Dried Fish (Cod) . .
Or Fresh Fish (Average
Whole) .
Flour
OrSnaBrtMul
Or Hiinl Hreiid
Or Coniraeal
Benns
Or Peiiae
Or Hioe
Or Hominy
Potiitoea
Or Potuioes. 811 per cent. ; )
nnd Onitji}8.20 per cent. $
Or Potaiocs, 70 percent
ftnd C'liniied Tomatoes,
30 per rent. .
Dried Fruit . .
Siigjir ....
Or MohiMCB
Or Cane-syrup.
ent.;^
10
10
6
0
10
10
14
IS
IS
30
2 4
34
4
4
16
10
16
3
8.5
1 Kill
IgiU
Protein.
OB.
41.68
46.30
27 54
1.V04
40.27
45.87
31.73
55.08
58 8:j
73 13
50 40-
15.10
ltt.:i8
8 .75
9.30
9.50
8.00
8.16
1.77
NlTBO-
OBK,
Or.
6.67
7. as
4.40
3 40
044
7.26
5.07
7 00
8 61
n 74
7.yu
342
3 03
1 40
1.47
1.53
1.40
1.80
0 37
Kat.
Ob.
44.75
62.90
119 54
105.06
04 08
1.18
0.79
.5.60
680
6rt3
13 40
1.32
0.75
0 45
0.67
0.45
0.58
1.53
CABBOHT-f FTTRL-
SBATIS. VALVB.
Or. CAtX>BlCS.
380 46
2^)9 20
371.81
425.80
40 18
41.80
88-87
8875
81.70
73.09
03.50
38.80
94 25
56 05
50.25
600
720
1003
1043
1^
197
120
1850
1506
1926
1986
340
346
407
430
380
y40
297
220
.M97
209
269
The diet of athletes is of great importajice, as they require a nutritive
differing from a laboring man in that ilie work of the former is very severe,
but of short durdtion. The laborer's diet is adapted for a sustained exertion,
the athlete for short, but severe, exertion. W. 0. AtAvater made seven stud-
ies; four on Harvard-University crews, two on Yak-University crews, and
one on the captain of one of the Hiirvaid crews. The results of these inves-
tigations showed that the food consumecl by these athletes contained a daily
average of 155 Gm. (or 5v) of proteids, 177 Gm. (or 5v V*) oi fat, and 440
Gm. (or 5xiv Vi) of carbohydrates, and had an average energy value of 40S5
calorics. The prominent characteristic of such a dietary is the large amount
of proteid; the energy-value is equal to that of severe labor, the proteid is
sufficient for more severe labor than that of energy.
While physicians are rarely consulted with regard to the selection of
food in health, men being guided by the cravings of their appetite and the
force of custom in eating, yet a recognition of the existence of this factor
in any case of disease will naturally lead to such regulation of the diet as
is most favorable for restoring and maintaining health. This truth was
properly appreciated by the ancients, who made some applications of it,
guided by experience alone. It is a fact, as stated by Prof. J. Bauer, that
"the scientific basis of a system of rational dietetics could not be laid until
the first principles at least of the processes of digestion and metabolism in
the human body, under normal and under pathological conditions, were
known." Acquaintance with the chemical composition of foods and proxi-
mate principles and knowledge of the part played by each in the organism
DIET IK mSKASE.
1085
I
I
I
I
I
were necessary before we could properly solve the relation of the dietetics to
diseased conditions and make the proper selection of viands lor the sick.
Two diflBculties are met at the start: the kind of food that science would
indicate, as the most appropriate might be repugnant to the patient, who
would refuse to take it, or, having taken it, such food might not be capable
of being digested and assimilated as well as other articles which are less
desirable, but more digestible; secondly, the condition of the digestive
organs is such that their ability to eat ordinarily articles of food is sus-
pended. In many diseased conditions the waste of the tissues is increased,
while the power of the organism to assimilate food is diminished; so that
it is difficult, if not impossible, to introduce nourishment in euHicient quan-
tity to make up for the loss. This is especially manifest in acute febrile
processes, which are usually accompanied by more or less involvement of
the organs of digestion. If the power of digestion is suspended for the
time, it is necessary to withhold food, until it is, in part at least, restored;
otherwise the food would remain undigested in the alimentary canal, and,
becoming the subject of fermentative or putrefactive change, it would give
rise to additional irritation. Where it is not entirely abolished, we may aid
in keeping up the patient s strength by small quantities of bland, easily-
digested foods until he is in a position to take more substantial foods. If
emaciation is progressing and the patient losing strength, the administra-
tion of highly-nourishing foods is imperative; if they cannot be retained or
digested by the stomach, they may be administered by enema. In e-xtreme
emergencies, wc may even inject nutritive substances into the veins, or h}7)0-
dermiealiy, or blood may he injected into the peritoneal cavity. Baths
of milk have been proposed, but, as stated in a previous section,
they have no nutritive value. Fatty nutritious substances, like lard,
olive-oil, butter, codliver-oil, etc., may be introduced by inunction with
great benefit, combined Avith friction or massage to assist in their absorption.
On the other hand, in plethoric, well-nourished individuals, where the
?roce66 of denutrition is not going on very rapidly, entire abstinence from
ood for a brief period will So no harm. After surgical operations, it is
sometimes advisable to allow the patient to go without food for several
hours before the operation isporfornied. and for twenty-four hours afterward,
allowing nothing but water in teaspoonful doses.
The so-called hunger-cures, in which fasting ia followed as a thera-
peutic measure, are not popular at the present day; but they have, un-
doubtedly, much to commend them in cases of plethora and so-called sub-
acute rheumatism. In cases of acute pneumonia, food should be of the
lightest character, as the rule, and in most acute diseases, where the patient
is not asthenic, the diet should consist principally of what are called acces-
sory foods and light broths until convalescence is established, when a more
varied vienu may be permitted. It is evident that many circumstances re-
quire to be considered and duly estimated in laying down a dietary for a
patient. The extremes of life bear abstinence poorly, as the rule, and suc-
cess in treatment will often depend upon the maintenance of supplies of
food; on the contrary, well-nourished adults may live for a considerable
time with the minimum of nourishment. Less food is needed, as the rule,
in summer than in winter. At the present day there is a tendency to over-
feeding, both among the sick and the well; and where disorders are due to
excess of certain forms of nourishment, as particularly insisted upon by T.
.
1U80
NON-PHAKM.^CAL REMEDIES AND UENEK.U. THERAPECTIOS.
Lauder Bnmton and Milner Fothergill, diminution of food and carefiil
regulation of diet is of more consequence than drugs.
Some of the phases of the question of alimentatiomhave been more
fully considered by the author elsewhere^ than is possible here. It will be
only poesible to present here a brief outline of the paper referred to. The
fluids and solids which enter into the composition of the human body are
constantly the subject of change under the influence of cell-life, and after
serving their purpose are excreted Irom the body. This necessitates renewal
by process of nutrition, and such substances are introduced mainly by the
food and drink. ChcniicalJy, the proximate principles of the food are in-
organic (or mineral) and organic, the latter being divided into those not
containing nitrogen and those containing nitrogen. Non-nitrogenous sub-
fitances are again subdivided into hydrocarbons and carbohydrates. Carbo-
hydrates (starch and sugar) contain hydrogen and oxygen in the proportion
to form water. Hydrocarbons (oils and fate) are compounds of hydrogen
and carbon, combined with a small proportion of oxygen. In addition to
these three principal varieties of organic substances, we consume organic
acids, present in vegetables and fruits, and pectin, which occupy an humbler
position in regard to nutrition, but which assist in maintaining animal heat.
Nitrogenized organic substances And their type in albumin, and, on accoimt
of their importance, they are often called "proteids." Albuminoids are
characterized by the presence of carbon, hydrogen, oxygen, and nitrogen
with other elements variously combined. They occur both in the animal
and vegetable kingdoms. The pro])]cm of digestion is to render albumin,
sugar, starches, fat, and other food-ingredients soluble in the gastric and
intestinal fluids. Albumin is rendered soluble by being converted into pep-
tones through the activity of the gastric juice, and, in the small intestine,
by the alkaline pancreatic fluid. Starch becomes maltose and glucose; this
is partly accomplished by the saliva and partly by the pancreatic and intes-
tinal juices. The bile favors the absorption of fat by emulsifying it, and,
by its action upon the villi and its antiseptic qualities, preventing the fat
from being couverted into fatty acids. The pancreatic secretion also acts
upon the fatty articles, emulsifying them and favoring their absorption.
The portal blood and iiver transform peptones into serum-albumin, and
change the glucose derived from starch back again into an in&oluble form
called glycogen, in which shape it is stored up in the cells of the liver, to
be given out in small quantities, as it is needed to supply energy to the tis-
sues. Fat is absorbed and gradually assimilated by the lacteal vessels and
general circulation.
This review of the physiology of food is a necessary introduction to the
consideration of its proptr administration in health and disease. As the
present discussion is limited to the latter, we will omit discussion as to the
relative quantity of each form of food, only stipulating that each shall be
represented in a full dietary. In this country there is, without doubt, too
great consumption of nitrogenized food, which leads to diseases of the kid-
neys and liver, with many obscure symptoms that lind their place under the
heading of lithsemia or unemia. These are often removed by restricting
nitrogenous food or entirely removing meat from the diet.
"Food and Diet in Health and DiscaBe," Medical BuUetin, Jan., 1802.
DlfiT IN DISEASE.
108;
I
I
I
Uabitfi of eating affect the results. Some forms of indigestion or livfc-
pepsia are clearly traceable to insufficient mastication of the food. The
therapeutic teaching here is not to change the diet, but lo tell the patient to
«at more deliberately and chew his food thoroughly. G(tnd food may be
spoiled by poor cooking, and the digefctibility of food is very much afTected
by the manner of preparation. The frying-pan is such a frequent cause of
indigestion that it has been almost banished from well-managed households.
Different aliments vary as to their digestibility. This depends upon
their nature, mode of preparation, age, time of year, mode of life among
animals, and affects their value as foods. The flesh of young animals,
though soft and tender, is too albuminous and is less digestible tlian the
older members of the same species, — veal and lamb being less digestible
<han beef or mutton. If. on the other hand, the animal is too old, its flesh
is apt to be tough, unpalatable, and indigestible, but makes better broth
ihan the very young animal. Eggs and milk are much used in the sick-
room, on account of their nutritious qualities and ease of assimilation.
Among starchy foods, bread is at the Iiead of the list ; it is, when Avell made,
very acceptable and usually readily digested. If a little stale, or slightly
toasted, it becomes more acceptable to invalids or convalescents. Rice is
also a us<.'ful f-arbohydrate; with it may be named farina, tapioca, sago, and
cornstarch, from which many articles of food for the sick arc made. Pease
and beans are less digestible on account of their thick, testaceous envelope
and the presence of albumin in the form of vegetable casein or leguraen.
Potatoes, when baked, are usually acceptable to convalescents. Many vege-
tables are liable to cause indigestion, from the amount of cellulose which
they contain. Fruits are likewise beneficial to the system. Poor in albumiu,
rich in water, they arc chiefly of value on account of the vegetable acids.
salts, and carbohydrates which they contain. They diminish the acidity of
the urine, many of them produce a iaiative effect, and they counteract an
injurious influence of the undue restriction of the diet to dried and salted
meats. Apples open the bowels and will often allay nausea. Certain fruits,
on the contrary, possess astringent properties, and are useful in relaxed
conditions of the bowels. Tea, coffee, and cocoa are valuable arterial stimu-
lants, and, with milk and sugar, are nutritive. Chocolate contains about 20
per cent, of albumin and 50 per cent, of fat, with an alkaloid (theobromine)
allied to caffeine. It is a valuable condensed food; acting also as a mild
laxative. Its large proportion of fat will often render it unsuitable
for weak stomachs. The question of the administration of alcohol is con-
sidered in another place (see Part II). Lighter wines or malt liquors have
some nutritive value, and when used in moderation are useful, especially
among elderly people.
As regards the interval between the administration of articles of food,
this should be prescribed as carefully as the taking of medicine. Where the
tmount given at a time is small, the interval must be correspondingly short,
having in mind the total amount of nourishment to be taken in the twenty-
four hours. The night is long for a sick person and directions for the
administration of some light nourishment sliould be given. Sometimes in-
somnia is relieved by taking food at night. In dyspepsia and chronic indi-
gestion, the question of diet is difficult to solve. Many of these cases have
gastric catarrh, which requires to be relieved before digestion can be im-
proved. The microbes of fermentation and putrefaction, which cause flatu-
1088
NOX-rUAUMACAL liEMEDIES AND OENEIUL THEIUPEUTICS.
lence, pyrosis, and various nen^ous disorders/ are present, and interfere with
the iionnal digestion of foods. It sometimea is advisable to place such
patients upon a restricted milk diet, giving a tablespoonful of sterilized milk
every hour or hour and a half, increasing it, day by day, until six ounces
or more are taken every ninety minutes, at which it may be continued for a
specified time,- — a month or six weeks, — when articles of food, properly se-
lected, may be added cautiously to the dietary. Wliere there is marked
hepatic disorder, accompanied by oxalic-acid or uric-acid deposits in the
urine, with headache, pains aijout the hoJy, and lowness of spirits, it will be
advisable to limit tlic albuminous food or forbid meat altogether for a time.
In \ery severe cases of indigestion, especially in voung infants, it will be
advisable to administer only predigested food for a time.
In the management of consti[>ation much can be accomplished by se-
lection of the food. Articles of iscrvice in such a condition are those which
leave q residue in the bowel, as bran bread, certain' vegetables, as cabbage,
carrot, turnip, beans, asparagus, and spinach; those which produce transu-
dation into the intestine, as many fats; and those which excite peristalsis,
as oils, rioiicy and syrup are likewise of assistance. On the contrary,
fancy breads, biscuits, cakes, and rice are to be avoided.
In weak and impaired action of the digestive organs, articles whid]
readily ferment or turn acid should not be used; su?ar, honey, starch or,
starchy substances, and fnt should be avoided as much as possible. Bread
should be stale or toasted. Fish, fowl, pork, veal, chocolate, strong coffee
or tea, or an excess of water or of other liquids, should be interdicted.
Wines and liquors should he sparingly used, if at all. In the weakened
digestion of elderly people, articles of food which are easily assimilated
should be scloctod, whtfe indigostible food should be avoided. Dimin-
ished appetite and socretion demand the most nutritious diet. Soft, but
concentrated, food, broths containing malt-extract, milk-food, or some of
the better forms of baby-food are used with great advantage. The seden-
tary life led by such patients does not require much food, and little, if any.
meat. A little wine or malt liquor will assist digestion, if it is otherwise
suitflblcj especially in elderly people, or during convalescence.
Aniemia and chlorosis require a highly-nitrogenized diet, making the
change gradually, as the stomach may be intolerant. Oysters, sweet-bread,
underdone beof. with dish-gravy on potatoes or rice, with a glass of wine
or extract of malt, are decidedly beneficial. Koumiss answers well, being
both nutrient antl mildly stimulant. Kefir is milk, fermented by a form of
yeast, and is highly prized in Russia. An ai'^rated milk or milk charged witli
carbonic-acid pas has been introduced by Professor Botkin and used in cases
of feeble di^^cstion. It is said to be more palatable than ordinary cows'
milk and to constitute a refreshing drink, especially in summer.
Tn uouralgiii, the nutrition is often bolow jmr, and in patients subject
to neuralgia a generous dietary of easily-assimilated blood-making food, with
a glass of Hungarian or some native red wine at meals, and the free use of
butter, cream, and other fats, will often exert a salutary effect. A cheap
method of administering fat has been proposed by Dr. Mershinski. It con-
'T. Lauder Rrunlon: "On Poisons Formed from Food and their Relation (o
BiliousnpM and Dinrrhowi." The PracUtiont^r, Aup.. Sept.. and Oct., 18RS. Also, "On
Disorders of Digestion, their Consequences and Treatment," Ix)ndon. 1886.
DIET IX DISEASE-
1089
Bists in boiling together milk and lard for a considerable time; the resulting
fluid, containing a large proportion of fat, is generally well borne, and causes
an increase of weight. It is thought to be well adapted to hospital patients
suffering from malnutrition unconnected with disease of the stomach, in-
testines, pancreas, or liver.
Diabetes, in the mild form of glycosuria^ is e^isily controlled by limiting
sugar or starchy foods and leading an out-door life. Saccharine diabetes is
sometimes intermittent, and its causi.'s are not well understood ; evidently it
may result from several causes, some of which are slight and inconstant,
others are grave. In the uiun- R*ri<»us form of diiibetes luellitui^, the with-
drawal of starch and sugar from the dietary has very little etTect upon the
e.xcretion of sugar, which appart-ntly aitiies froiii the tii^sucs, since emaciation
rapidly continues. In either form, however, the diet is of great importance.
There is a difTerence of opinion as to whether sugar and starch are to be
actually prohibited or only reduced to a minimum quantity. Da Costa
allowed some wheat bread, in order to retain the co-operation of the patient,
who may rebel against a too-restricted diet. It is plnusibly argued that
absolute prohibition of starch will deprive tlie system of a necessary aliment
and increases nitrogenous metabolism; so that a small and regulated allow-
ance of amylaceous food will generally be found of advantage. The diminu-
tion in carbohydrates may be compensated by the ingestion of fat. Coffee
or tea may be sweetened with glycerin or with saccharin. Gluten bread for
diabetics usually contains starch. A bread made from almond-flour has
been recommended. Experiments have recently been made by Dr. W. Hale
White in regard to the use of the soya-bean in diabetes. This article is ob-
tained from a Japanese plant. The beans ore j^lohular, and about the size
of pease, which they resemble in taste. From their flour bread and biscuit
can be made and can be advantageously used as a substitute for wheaten
bread, as the bean contains but a small proportion of starch. The bread is
palatable, and Dr. White reports that it answers a good purpose. He thinks
that it is of more avail than gluten bread in reducing sugar in the urine,
and found no ill effects from its use. The beans can also be made into a
snup. Another substitute for wheat is found by Erbstein in aleuronat, a
vegetable albumin which contains about 80 per cent, of nitrogenous matter
and only about 7 per cent, of carbohydrates. Aleuronat is a dry, yellow
powder, free from taste or sniclL Fnuii it l>oth bread and broth can be n)ade.
The question of infant-feeding is too large to go into here. The chief
evils of bottle-feeding are (1) overfeeding, (2) too frequent feeding, (3)
impure milk, (4) dirty bottles or nipples, and (5) want of uniformity in
composition, quality, and temperature of the bottle. That food is best for
the child upon which it best thrives and grows, presenting the appearance
and physical characters of a healthy infant.
When it becomes nec(^sary to nrtifu-ifllly nourish an infant, the physio-
logical guide is the composition of mothers' milk, which contains (besides
water) fat, 4 per cent.; sugar, 7 per cent.; and proteids, 1 per cent. The
frequency of feeding and the quantity given at each time are inversely to
each other, and vary with the age of the child, its physical strength, and
digestive capacity; but the feeding should be at regular intervals during
the day, so that the child may form the habit of sleeping at night. Infanta
should not be fed on undiluted or unmodified cows' milk, on account of the
excess of casein, although this is less with the Alderney and Jersey than
1090
NOK-PHAfiMACAL REMEDIES AN^D OEXKlLiL THKRAPEUTICS.
with ordinary milk. In order to avoid the danger of tubercular infection,
of conimnnicnting tj'phoid and other disensos, it is advi3al)Ie always to scald
the milk. The addition of boiled water or rice-water, with a little salt and
sugar, and of lime-water, is generally approved.
For the home modification of cow's milk for children of different ages
the following table has been devised. By the use of a special dipper
(Chapin) the top milk may easily be separated; or a teaspoon may serve to
remove tho first ounre or two from the milk bottle. In the city, it is advis-
able to Pasteurize the milk as soon as delivered. The slight excess of acid in
cow's milk may be overcome by the addition of a little lime-water, or a little
milk of magnesia (half a teaspoonful) t^ each feeding, after the milk has
been boiled. A larger proportion of wat^r may be used during the summer,
when a smaller quantity of food is required by the child.
T\ihUfor Some Modijlcttht of CVwa' Mtll
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Malted soup is made by mixing a large teaapoonful of slowly-baked flour
with a little cold water and passing it tJirough a sieve, adding enough hot
water to make a quarter of a pint, boiling while stirring constantly, allowing
to cool, adding an equal quantity of fresh cold milk ^vith a teaspoonful of
plain diastasic extract of malt, and stirring well for a few minutoa. For
infants less than three months of ape, less milk and more water are used.
Rickets has been shown by Cheadle to be due to improper feeding.
The treatment is primarily and chiefly dietetic. Drugs are of minor import,
though lime and lime-salts, warm clothing, fresh air and sunlight, with
proper diet, may do good sen'ice. Fatty articles of food are useful, and
the diet should also be rich in starches and earthy phosphates in a form
easy of assimilation. Infants, soon aft4?r birth, are usually able to digest
and assimilate small quantities of starch, and clinical experience proves that
many infants do thrive upon gruel, porridge, barley- or rice-water, and
similar starchy foods, and their use is approved by Jacobi, Chapin, Huebner,
and others. Constant feeding with st-erilized milk may produce scurvy.
Obesity is a condition in which the system has accamnlated a large
proportion of surplus nutritive material in the form of adipose ti«sue. The
remedy is abstinence and abstemiousness. The bear retires for his winter's
nap in a comfortable condition of obesitv: but, after four or five months
have passed without eating, he emerges from his hollow tree a model of
leanness. Dieting is recommended for obesity, but it should not consist in
living solely on meat, as has been recently advised^ nor in a dry diet with
6ti
DIET IN DISEASE.
abstinence from water and other fluids as much as possible. Such measureB U
will reduce weight, but they will be likely to cause serious disorder of the
kidneys. It is better to simplify the diet, take systematic exercise, and
reduce the hours of sleep, taking laxatives occasionally to stimulate the
excretory organs. The free perspiration caused by active walking is better
than that induced by the Turkish bath, which should be indulged in with
moderation. The use of vinegar and other acids is said to reduce the sur-
plus flesh, but this should not be followed to any great extent, for fear of
bringing on digestive disorders or rheumatism. Mountain-climbing is the
best form of exercise, but this should not be carried to the point of fatigue,
until the muscles become firmer and more accustomed to out-door pursuits.
Changes in the diet, like the increase of exercise, should he made with cau-
tion. If the individual is a hearty eater he should be directed to curb his
appetite and gradually diminish his repasts. Articles containing much fat,
starch, or sugar must be omitted or very temperately consumed. Fat meats,
cream, butter, vegetable oils, nuts, fat fish, farinace^^ue subsU^nces, fruits con-
ining much sugar, beverages, such as beer, ale, and sweet wines, should be
efinitely discontiaued. If milk be used at all it should be skimmed; butter-
ilk may be used, if fresh. No chocolate should be taken, and tea and cotTee
used withoiit sugar, or sweetened with saccharin. The diet should principally
consist of lean meat, poultr}% game, eggs, green vegetables, and acid fruits.
Not much bread should be eaten; gluten biscuits may be used as a substi-
tute. The dietary which Mr. Banting followed in reducing his flesh from
two hundred and two to one hundred and fifty-six pounds, in about a year's
time, is as follows: —
Breakfast, at 9 a.m. From 156 to 186 Gm. (or 5^-vj) of cither beef,
mutton, kidneys, broiled fish, bacon, or cold meat of any kind, except pork
aud veal; a large cup of tea or coffee (without milk or sugar), a little biscuit
or 31 Gm, (or 5j) of dry toast, — making together 186 Gm. (or Jvj) of solids
and 270 c.cm. (or fjii) of liquids.
Dinner, at 2 p.m. From 155 to 186 Gm. (or Zv-yj) of any fish except
salmon, herring, or eels; any meat except pork or veal; any vegetable except
potato, parsnip, beet-root, turnip, or carrot; 31 Gm. (or 3j) of dry toast;
fruit out of a pudding not sweetened; any kind of poultry or game, and
two or three glasses of good claret, sherry, or Madeira, — champagne, port,
and beer forbidden, — making together 310 to 372 Gm. (or S^'^U) of solids
and 300 c.cm. (or f^x) of liquids.
Tea, at 6 p.m. From 62 to 93 Gm. (or oii-"J) of cooked fruit, a rusk
or two, and a cup of tea without milk or sugar, — making 62 to 124 Gm.
(or 5ii-iv) of solids and 270 c.cm. (or f^ix) of liquids.
Supper, at 9 p.m. From 93 to 124 Gm. (or *iii-iv) of meat or fish,
similar to dinner, with a glass or two of claret or sherry and water, — making
124 Gm. (or ^iv) of solids and 210 c.cm. (or fS^ij) of liquids.
In leanness, emaciation, and marasmus, the reverse course is to be
followed to that recommended in obesity. Frequent eating of easily-agsimi-
lated fatty and starchy foods, sweetmeats, an indolent life, warm baths, and
several naps a day will be apt to develop the form, especially if the mind be
cheerful in accordance with the old maxim: "I-augh and grow fat."
In the management of phthisis pulmonalis, or consumption, next to
the climatic treatment we would place the dietetic regulations. According
to Profesaor Peter, cases of consumption frequently have their origin in
f
1093
XOX-PHAimACAL REMEDIES AND GEXERAL THERAPEUTICS,
disordered digestion, which lowers the vitality to such a degree as to make
the organism susceptible to the disease, or, in modern terms, they are made
to afford a proper culture-soil for the bacillus tuberculosis. Some relation
evidently exists between insufficient food and consumption, and one of the
evidences of recovery is the fact that the patient gains in weight. While the
patient follows out the recommendations for the removal of leanness, he
should not take too large an amount of fat, on accoxmt of the mability of
the system to assimilate it, and the tendency to the occurrence of fatty liver.
Much depends in phthisis upon the condition of the digestive apparatus.
When appetite and digestion are unaffected it is well to adopt a system of
forced feeding and to administer as much milk, eggs, meat, cream, butter,
and cheese as can be assimilated. When gastric disturbance has been begun
our aim should be to render the food palatable, and it should be given in a
finely-divided state. The administration of porter and ale is beneficial at
this stage. If the patient can no longer partake of solid aliment without
digestive derangemonts, nourishment must be given in small quantities, but
frequently, and the stronger spiritous liquors are demanded. Assimilation
is favored by life in the open air and exercise or massage.
In what h known as latent or undevL-lopt^d gout, it is of importance
that the condition be recognized and due regulation of the diet urged upon
the patient by his medical attendant. Dr. William Roberts^ has called
attention to this, in an able manner, in a recent contribution on the neces-
sity of a revision of diet with advancing years. If the appetite remain good
while there is a process of degeneration going on in the liver and kidneys,
the power of taking food remains unaltered, while the assimilative powers
are on the wane. Some form of nutritive disorder necessarily follows.
There is frequently a tendency to stoutness; there is engorgement of the
abdominal organs, and the signs of latent gout are likely to appear. The
early recognition of this condition is very important, for thereupon depends
the prevention or postponement of degenerative processes, which hereafter
prove formidable. The most obvious indication is to lessen the quantity of
food, and this is a task of varying difficulty.
**Full feeders are rarely aware that they eat too much," says Dr. Rob-
erts. Where the appetite is really stron/^f and the digestion abnormally '
active, the patient finds it hard to resist the demands of hunger. In such '
cases, "the less concentrated forms of food are a useful resource (green
vegetables, salads, thin soups), which help to fill the aching void without
adding materially to the albuminoid and fatty intn'edients of the meal. Tea
and coffee are also serviceable in allaying an unseasonable craving for food.
A stiff cup of tea or coffee, shortly before dinner, certainly takes the edge
off a troublesome appetite. It is well, however, to proceed cautiously and
tentatively in this direction, for the promptings of nature, however ap- \
parently to us misdirected, are not to be lightly set aside. The effects of >
a contracted diet should be carefully and patiently watched, with an open
mind for every sign or suggestion, whether of warning, retreat, or of en- ,
couragement to advance. I need hardly add that, in regard to thip middle- |
life revision of the dietary, as it may be termed, particular attention should ;
be given to the quantity of alcoholic beverages. As a very general rule, the
^Britigh Medical Journal; American Lancet, Dec, 1891.
DIET IX DISEASE.
1093
I
I
I
I
tolerance for these articles diminishes with advancing years, and it is neces-
sary nearly always, with persons who have used them freely, to reduce their
quantity when middle age is reached." The consumption of fruit is bene-
ficial when a tendency to lithffimia exists, as the alkaline vegetable salts are
converted into carbonates, which pass otf in the urine.
With regard to the ability of the organism to assimilate nitrogenized
food in fever, exact observations have finally established the conclusion that
seemed warranted by experience. Huppert and Rieeell maintained that the
administration of albuminates intensified the febrile consumption, and is
comparable to pouring oil on a fire. This was opposed by Uifelmann, and
controverted entirely by some exact observations made by Bauer and Kun-
etle. A diet, therefore, consisting exclusively of carbohydrates is not desir-
able in fever, any more than in health, and, therefore, the addition of gelatin
to farinaceous broths, or the administration of beef-juice, bovinine, or Mos-
quera-JuIia beef-meal is advisable, wherever the digestive organs are capable
of assimilating it, and in quantities suitable to the condition of the digestive
organs. In typhoid fcYcr a milk diet ia preferred by most clinicians. Beef-
tea has been finally superseded by various prepared foods containing pep-
tones, beef-juice, or haemoglobin, as already mentioned. Toast-water may be
used to satisfy thirst; all the water drunk should first be boiled, and, if
cloudy, strained previous to boiling, before giving it to the patient. On
account of the duration of typhoid, the nourishment of the patient should
be properly looked after, in order to keep up his strength. Stimulants
should not be used as a matter of routine, but may be used sparingly, as an
accessory food, during the decline of the fever.
The diet of persons suffering witli albuminuria and Bright's disease
should be carefully watched, bearing in mind the statement of Prof. George
Johnson, that *'renal degeneration is a consequence of long-continued elimi-
nation of products of faulty digestion through the kidneys." The starting-
point of Bright's disease, in the words of Fothergill, is '^iver incapacity."
This incapacity of the liver, which prevents it from properly assimilating
albuminoids, may arise purely from mental worry or overstrain (Clifford
Allbutt); it may be due to an excess of excrementitious material in the
blood accompanying certain cachexias, as gout or lithEemia; it may possibly
arise from defective kidney action, the result of scarlatinal or other poison.
In any ease, when the products of malassimilation pass through the kidneys
they ultimately lead to degeneration of a granular character, which may or
may not be attended by albuminuria. In some cases the fault may be traced
directly to overindulgence in animal food. The first step would be to re-
strict the amount of lean meat consumed, and direct the patient to avoid
highly-seasoned food and spices. In many cases the best results are obtain-
able by placing the patients strictly upon a milk diet, which should be
skimmed, or, at least, not Alderney. The food should be sparing in
quantity, consisting largely of vegetables. Desserts may be allowed of a
simple character, but the patient should be cautioned against free indul-
gence in the pleasures of the table. As the rule, alcohol is forbidden. Soups
are useful, fish not objectionable. Cream, butter, and other fats are re-
stricted. Gruels, broths, vegetables, biscuits, bread, crackers, and cheese
may be mentioned among the articles which may be employed with advan-
tage. Albuminuria is not the vh^h of Bright's disease, and may exist tem-
porarily from dietetic causes, without degenerations of the kidjaeys. In a
*
1094
NON-PHARMACAL REMEDIES AND QENERAL TUERAFECmCS.
diet rich in albuminoid matter, the urine is apt to be albuminous. In such
a case, the remedy guggests itself in due attention to the diet.
The Bubject of the dietary in various diseased conditions is admirably
reviewed in the modem systematic works on the subject. In the pres-
ent place we have room only for some useful formula?, which may be
employed in the sick-room with advantage to the patient. At the present
time, the physician is not only expected to know what articles of diet are
suitable for the patient, but he is also expected to be able to give precise
directions how to prepare them, and, in emergencies, to step up and show
the nurse or attendant how the thing should be done: —
FORMULAE FOR SPKCTAL FOODS.
Beef-toa,
Take a pound of lean beef, free it from fat and fibrous tissue, cut into small
pieces, place these in a crock or fruit-jar, with a good cover. Add to it a quart of
cold water and ten or twelve drops of dilute hydruchloriL* acid, and stand in a
moderately-warm place for an hour; then let it simmer gently for two hours more,
then Rtrnin und season with suit and pepper, if dosired. It should be straiiuMl. nnd
administered botj an ounce or two at a time.
Bvcf-cssence.
The same as above, except that no water is to be added to the me-at, which
is placed in the fruitjar and the lid fastened down; the jar is then placed In warm
water, which is gradually raised to boiling and kept at this temperature for three
hours. It is then tnken out, strained, and aoaaoned with salt.
Bcef-juioe,
Broil small steaks lightly, and then make incisions into them and press them
in a lemon* Hquei'zer or winepress; tlic juiee to be taken hot, alone, or wiLli toaut.
Raw-Beef Infusion.
To a pound of beef, prepared as above, finely minced, add enough worm water
to cover it, and ten drops of dilute hydrochloric «fid. Let it stand for two hours, at
a temperature of ninety degrees, frequently stirring it with a glass rod. It should
be kept on ice, and administered with niilk or a little extract of malt.
Rata Beef.
Raw, lean beef, free from fat, may be pounded into a pulp in a mortar with
some white sufi^ar. and spread upon bread, to be tnken an a sandwich by young
children or rachitic infants. Or, with a rather dull knife, scrape a piece of tender
meat, so as to separate the pulp from the fibrous portion. The soft mass thus
obtained may be seasoned with salt and pepper, like sausage-meat, and eaten, spread
upon biscuit or bread; or it may bo molded into Mnull bulls and slightly browned
on the outside in a hot ovt-u. Meat-pulp may also be rubbed up with half its quan-
tity of granulated white sugar, and in this form is readily taken by young children.
Bvcftca, No. 2.
Prepare a pound of good runtp-steak by chopping it in small pieces and remov-
ing pieces of fibrous tissue and fat. Place it in a pint of cold water in a covered
saucepan. I>et it stand in a cool place for three hours, and then place it on the
fire, where it may simmer gently for fifteen minutes; season, and decant or strain
through a horse-hair sieve. The meat should be as fresh as possible, and the sauce-
pan enameled upon its inner surface. Beef-tea must never be allowed to actively
boil, and in reheating it should only l>e raised to the proper temperature for drinking.
I rahrn'feci Broth.
Two calves' feet are to be carefully cleaned and placed in two quarts of coJd
water, which is then brought to boil and kept boiling until the feet are reduced to
shreds; strain liquid portion off, and add a little salt, and pepper if desired. When
DIET IN DISEASE.
1095
ftdministered to tlie patient, it is to be ^vanIled. It may be made more nourishing if.
to each cupful, a beaten egg and two tablespoonfuls of fresh milk are added, and all
brought quickly to a boil before serving. A dash of lemon-juice improves the flavor,
and the broth may be taken with some crisp toasted bread.
Clear Brottn Sovp.
Take a ahin of fresh beef, cut it in pieces, and put into a saucepan with enough
cold water to cover it Bring it to a boil, and add a bundle of sweet herbs, vegetables
{a little sliced carrot, turnip, onion, celery, etc), also pepper and salt to taste. Boil
until the meat ia tender, then strain, and let it stand in a cold place until the next day.
Remove the fat from the surface and heat the broth, adding as much browning as
will make the soup a proper color. Beat up two eggs with their shelU until quite
A froth, and put them into the soup with a whisk. Let it boil gently for ten minutes,
when it may be decanted, or, if desired, it can be strained through a cloth, when it
will be perfectly clear.
Conaommi, or Bouillcn,
Take one or two pounds of beef from the leg, round, or chuck; wash well, cut
in pieces, and put on to boil with three quarts of cold water. Skim frequently while
boiling, and, when reduced to a quart, take from the saucepan and strain. Return
to the saucepan and odd a few thin slices of onions, half a pound of lean beef.
chopped fine and well mixed with three raw eggs. A few bay-leaves may be added.
Beat all thoroughly into the broth, which is to be returned to the flre and boiled for
about half an hour. It should be made clear by straining through horse-hair sieve
or muslin, and seasoned.
OystiTSOup.
The desired number of oysters, depending much upon their size, are allou'ed to
drain through a colander for five minutes, and the liquor preserved. A pint of boil-
ing water is then poured over them, which is thrown aside. Add to the liquor already
drained a pint of hot water, and put over the fire in a porcelain-lined saucepan. Boil
until all the scum has risen and Ima been skimmed off, then add half a pint of fresh
milk, one powdered water-cracker, a piece of butter, and a little salt and pepper.
One or two allspice may also be added. Boil for ten minutes, and, just before the
soup is served, turn in the oysters from the colander and let them scald for three
minutes, and then send to the table in a covered disb.
Chafed or Panned Oysters,
Take a dozen large oysters, drain off the juice, and preserve it. Have a silver
chafing dish or a porcelain-lined vessel over a ftre, and place a piece of butter, as
large as a walnut, in the vessel. When the butter indicates that the dish is sufB-
deotly hot. the oysters are turned in, and a little salt and pepper added. When the
oysters change color and curl up. they are placed in a hot dish. The oysterjuice is
now turned into the chafing-dish, with a little cream, and brought to a boil and
poured over the oysters. Dry toast may be cut into squares and served with the
broth, if desired.
Jiotui Oysters,
A dozen fresh oysters, not long out of their native bed. in their shells, are placed
upon a stove or on a moderately strong fire until the shells open a little. Tliey
oro then opened, preser>'ing the juice, if possible, and sen*cd hot. with a little black
pepper and salt, if needed. The tough pnrt uf the oyster (cartilaginous portion) need
not be swallowed, if the patient l»e delicate. This is said, by Dr. Henry Uartshome,
from persona] experience, to be relished and digested, sooner than any other solid
food in convalesceuce after fever.
TeffetahU'Soup.
Put two potatoes, a handful of pease, one ripe tomato, and a pieee of stale bread
into a quart of water, and boil to a pint. Add chopped celery or parsley and salt.
Keep in a covered dish. Strain when served, if for a delicate stomach. It may be
made more nutritious by adding the yelk of one egg to each cupful, or some meat-
extract, like Liebig's or Armour's.
^
109G
NOX-PIIABMACAL RKMEDIES AND OEXEIUL THEItAPEUTICS.
Brradand-Bvtxer Soup.
A piece o( well-baked, rather stale, bread i8 to be spread with good, sweet butter
and sprinkled with anlt and pepper. Pour a pint of boiling water over it and allow
it to stand for a few minutes. When cool enough, it may be eaten as an article of
low diet by convalescent patients.
Panada,
Two pieces of stale bread, deprived of crust, are to be toasted brown and cut
into small squares. Lay Uiem in a bowl and sprinkle with salt and a little nutmeg.
Pour on a pint of boiling water, and let it stand to cool.
Toa-8t-%cater.
Two pieces of stale bread are thoroughly browned in a hot oven. They ar«
then placed in a bowl or pitcher, and a pint of boiling water poured over them.
After standing until cold, thp water is poured olf into a pitcher and a slice or two
of lemon placed on top. If desired, it may be sweetened with some crushed sugar
and served cotd. Patients are allowed to drink it freely, in place of water.
Tamarind or Currantjcllp Water.
A refreshing drink may be ninde for patients, in summer particularly, by placing
some preserved tamarinds, free from their shells, m a glass of wnter which had been
previously boiled. Where tamarinds are not to be had, currant-jelly may* be used in
the same way, in cases of bowel disorder or to allay thirst in fever.
Lemonade.
Take two large, fresh lemons, and wash them clean with cold water. Roll them
until soft; then divide each into two, and use a lemon- squeezer or reamer to express
the juice into a small pitcher. Remove all the seeds from the juice; to which add
four or more tablespontjfuls of white sugar, according to taste. A pint of boiling
woter i» now added, and the mixture stirred until the sugar is dissolved. It should
be drunk while hot, and is very effective in producing perspiration. Ice-water may
be used instead of the hot water, and a piece of lemon-peel added: if desired, a weaker
lemonade may be made by using more water. This is a refreshing, acidulous, and
anti.'irorbutic drink, and is especially refreshing in hot weather. Limes or lime-juice
may be used instead of lemons.
Bfilk-jelitf.
Dissolve one ounce of gelatin in a cupful of warm water. Heat a quart of milk
with a pound of white sugar for about ten minutes, aiding the solution of the sugar
by stirring. Let the solution cool, and Ihen add the gelatin solution, the juice of
three or four lemons* and half a pint of wine or two wineglassfuls of brandy, stirring
the mixture slowly, and pour into glasses or molds and place in a cool place to stiffen.
The object of allowing the milk to become cold is to prevent curdling when the other
ingredients are added.
Gelatin.
An ounce of sheet gelatin is dissolved in a pint of warm water, and this brought
to a boil. Add a hnlf-cuprul of sugar, the juice of one lemon, and the white of an egg.
Beat together well and pour into a mold and keep on ice. Ser\'e a toblespoonful at a
time, Bo na to encourage the patient to nsk for more.
Wine-jfUu.
One box and a half of Coxe's gelatin soaked in wnter one hour mu«t then have
added three pints of boiling water, one pint of fherry-wine, and two pounds of white
sugar. The «hile of an egg and juice from three lemons are then added, and all
strained through a fine sieve. The rind of one lemon is then sliced and put in, or
small pieces of orange or other fruit Tised in place of the lemon-rind. Pour iato
cups or molds and allow it to stand until it hardens.
DIET IN DISEASE.
1097
Tapioca feliy.
On« cupful of Upioca is washed, nnd tlion p1ae«>d in three cupfuls of cold water
to aoak for four hours. It is then placed in a water-bath and heat«d until it begioa
to cicnr. adding nu»re lukewarni water if Um thick. When quiti* cloar add tlio juiee
of a lemon, a pinch of grated peel, and sweeten to taste. Pour into molds. Serve
cold with cream flavored with rose-water and sweetened.
Arrowroot- jfVu-
This is made like the preceding, using one cupful of boiling water to two heap-
ing teanpoonfuls of arrowroot, and the Mme quantity of white sugar. A tablespoonful
of brandy or three tablespoonfula of wine make an agreeable addition.
Restorative Jelly.
One-half box of Coxc*s gelatin^ one tablespoonful powdered gum arable; one-
half pint port-wine, a tablespoonful of lemon-juice, three tablespoonfula of white
sugar, and two cloves are mixed together and soaked for two hours. The mass is
then placed in a bowl in a basin of boiling water, or a water-bath, and the ingredi-
enta dissolved by heat and constant stirring. Boll for a minute after the ingrcdicnte
are melted, and then strain through a sieve or flannel jelly-hag. and set aside to cool.
The port-wine may be replaced by any other liquor or beef-juice, if preferred. In
the latter case, omit lemon and sugor and use salt. A spoonful at a time is sufficient
for very ill patients.
Wine-toh^.
Boil up half a pint of fresh milk and remove any scum that Is formed. Stir in
a winegtassful of sherry-wine and boil for a moment longer; strain as soon as the
milk ii cxirdled. Put on the ice, or^ if used as a warm drink, serve at once.
Milk-pH}wh ( Efjff'twg ) .
Beat the white of an egg into a froth and add to a tumblerful of cold, sweet
milk and two tablpspocnfuls of brandy well stirred in. The yelk of the egg ifl rubhed
up with a tablespoonful of granulated sugar and mixed thoroughly with the other.
A little nutmeg on tlie surface improves the flavor. It should be taken at once, quite
cold, and preferably through a straw or glass tube.
E*jQ-lemonade.
Take the white of an egg. a tablespoonful of pulverized sugar, juice of one
lemon, and one goblet of water and mix them intimately. A useful drink iu sore
throat.
Sago-milk.
Put three tablespoonfuls of sago in a cupful of cold water and let it stand one
hour. Add three cupfuls of boiled initki sweeten and rtavor to taste. Allow this to
simmer on a slow fire for half an hour; serve warm.
Rice-tcittfr \ Barley-water.
The rice, or barley, is washed and added to cold water, in the proportion of a
tablespoonful to a pint Allow it to stand in a »arm place for two hours, then boil
slowly for one hour, or until the water is reducpd to one-half, and strain. If too
Uiick, it may be thinned by adding boiled water or boiled milk. It is very useful
in cases of summer diarrhcea, especially in children.
Rice-milk.
Two tablespoon fulfl of rice and one teaspoonful of cornstarch are added tu two
pinta of milk, and boiled in a farina-boiler until each grain of rice is soft and the
whole assumes a creamy color. It may be sweetened and flavored as required.
Baked yUk.
If half a gallon of milk be placed in a jar and the top covered by tring writing-
aper over it, and allowed to stand in a moderate oven for eight or ten hours, it will
like cream in consistency, and delicious to the taste.
10D8 KON-PHABMAOAL REMEDIES AND GENERAL TUEEAFEUTICS. V
Flour-ball.
Tie up a quart of wheat-fluur in a pudding-bag tightly. Put into a pot of boil-
ing water and keep it boiling for ten or twelve hours. Take the hard maaa out of
tlie brtg and allow it to dry before the fire. Peel off and throw away the thin outer
portion, and grate down the uiuas with a nutuieg-graler into a powder, aa wanted
for use. One or two teaspoonfula of this may be rubbed into a paste with aozne milk
and then stirred into a pint of milk, over the fire. The milk should only be scalded;
that is, juHt brought to the boiling-point without being boiled. Thia is a valuable
article of food in diarrhoea, especiafly in children.
Effff-broth,
Mix two ounces of pearl-sago in half-pint of cold water, and let it stand half an
hour. Then boil until it becomes smooth and sufficiently thick. Beat the yelka of
four fresh eggs, with half a pint of cream: then mix with the sago, and stir i\\%
whole well with a quart of beef-tea or chicken-broth, just mude^ at a boiling heat.
Caudle.
Beat up a raw, fresh egg with a wineglassful of sherry-wine, and add to it half
a pint of hot oatmeal, Indian meal, farina, or gruel. Flavor with lemou-peel, nutmegs
and sugar.*
Farinaceous Beef-tea.
To beef-tea, prepared as in the formula first given, add a little well-cooked oat-
meal or cracker-duat, and serve hot. Barley-water or rice-water may be likewise
enriched by beef-tea.
Beef broth.
Take a ahin of beef (cracked), and cook, in sufficient water to cover it, for tvro
hours, with rice or barley and a potato. Season with a piece of onion, thyme, or
parsley, aa may be preferred. Allow it to cool, take otT the fat, serve hot, with some
of the rice or barley, if permitted, and salt or pepper as de<(ired.
Mutton-broth,
Cut up two pounds of lean mutton, without fat or skin; add a tablespoonful
of barley, a quart of cold water, and a teaspoonful of salt. I^et it boil slowly for
two hours. If rice be used, instead of barley, it need not be put in until half an
hour before the broth is done.
Chicken-broth.
Cut up an old fowl, remove the skin, and break the bones with a mallet. Cover
well with cold water and boil slowly for three bourn. Salt to taste. A little ric©
or tapioca may be boiled with it, if desired. Skim olf the fat and add a little parsley,
if deaired.
White Soup,
Add half a pint of boiled milk to an equal quantity of beef-tea and slightly
thickpn with flour. Some pieces of celerj', or celery-seed, may be added to flavor,
and strained out before serving.
Oyster brotK
. Cut into small piecea twenty-five oysters and put them in a chaflng-dish; let
them simmer gently for ten minutes at a moderate heat; skim, strain, add salt and
pepper.
Clam-broth.
Take three large clams (having thoroughly cleansed the sheila) and let them
stand upon the stove until the shells begin to open. Drain out the liquor, add an
equal qunntity of boiling water, a teaspoonful of finely-pulverized cracker-crumba,
a little butter, and salt to taste.
'This and some of the preceding recii>es are from The Trained Nurse in an
article on "The Food of the Sick," by Henry Hartshorne, M.D., LL.D., of Philadelphia.
DI£X IN DIS£ASE.
loyy
Hot CUifn^bouiHon,
Small quantities of clam-bouillon may be conveniently and rapidly prepared by
pouring about haU an ounce of the preserved juice (Burnham's) into a cup and filling
the latter to the brim with hot water. Some pepper may be added for the sake of
flavor.
Oyster-soup,
Take a quart of milk and bring it to the boiling-point and akim it. As it boils
Add a tablospoonlul of flour rubbed ttmooth \\ith an equal quantity of butter, fitirring
it until the milk is thickened by tlie Hour. Then add twenty-five or more oysters and
bring to the boiling-point, and remove at once or the oysters v^iU be tough. For
•eosoiuDg, one or two allspice may be added, with pepper and salt
Oy$ter» Chafed,
Heat the chafing-dish and place in it a lump of butter; when hot, turn in the
oyaters and let them simmer for a few moments i remove, and add condiments to taste.
Ri€€80Up.
Take hnlf a pint of chicken-stock and two tablcspoonhila of rice. Let them
simmer together for two hours, then strain and add half a pint of boiling cream or
milk, and salt to taste. Boil up nt once and serve hot.
Flour-QTueh
Mix a teaspoonful of flour with milk (*nough to make a smooth paste, and stir
into a quart of boiling milk. Boil for half an hour, being careful not to let it burn.
Salt and strain.
Flour-soup.
In a skillet place a lump of butter, and, when melted, add, with a dredging-box,
sufficient fiour to cover it; when this is thoroughly browned by the heat add a cup
of milk and water, and season with salt while boiling. Strain and serve hot. This
and the preceding are useful in bowel diaorders.
Flour-ball
Moisten a pint of flour with a couple of ounces of cold water, and tie up in a
balU tightly, in a strong cloth. Slightly moisten the cloth and sprinkle it with
flour, and boil for ten hours. Then take off the cloth and let the ball dry in a slow
oven for ten hours more. It ia then ready for use in making
BoiUd Flour Orttel
Grate two tablespoonfuts of fiour from the ball, mix it with cold water, to a
smooth paste, and stir it into half a pint of boiling milk. Simmer about three .
minutes and sweeten. This is a good food for children while teething.*
Predigested Food.*— To the earnest advocacy of Dr. William Roberta,
of Manchester, England, the profession is indebted for a clear conception
of the great value of the partial digestion of food before administration.
The process can be performed extemporaneously in any household, and ia
an inestimable boon in oases of profound debility of the digeBtive powers.
The following diiectionB are given by Dr. Roberts: —
Peptonisrd Milk.
A pint of milk is diluted with a quarter of a pint of water and heated to ft
temperature of about 140** F. (or the diluted milk may be divided into two equal
portions, one of which may be heated to the boiling-point and then added to the
* This and many of the preceding formula arc baaed upon those contained In the
exccUent 'Text-book of Nursing." by Oara S. Weeks. New York: D. AppletOD & Co.,
1885.
'For further observation on food, see author's papers on "Food and Diet in
Health and nisease, including a Review of Many Prepared and Condensed Foods,"
Medical BuUrtln, Jan., June, and July, 1892.
IIOU
NON-PHAttilACAL UKitEDIKS AN*D GENEflAL TH£BAPEUTICS.
cold portion); the mixture will then be of the required temperature. Two or three
teaspoonfulfl of liquor pancreuticus, together with ten or twenty grains of bicarbonate
of sodium iabout half a small te&dpoonJul) are then mixed therewith. The mixture
ia then poured into a covered jug and the jug is placed in a warm situation, under
a coaey, in order to keep up the heat. At the end of an hour, or an hour and a half,
the product is boiled for t\\o or three minutes. It can then be used like ordinary milk.
By skimming the milk beforehand and restoring the cream after the Onal boiling, the
product is rendered more palatable and more milk-like in appearance.
Peptonized Qruet.
A well-boiled, thick, and strong gruel, prepared from any of the fariuaccoua
articles generally used for that purpose (wheat^n flour, oatmeal, arrowroot, sago,
pearl barley, etc.;, ia poured into a covered jug and allowed to cool to a temperature
of about 140'* F. Liquor pancreaticue ia then added in the proportion of a tablespoon-
ful to the pint of gruel and the jug is kept warm imder a cosey, as before. At the
end of a couple of hours the product ia boiled and, Anally, strained. This preparation
ia not generally acceptable to invalids, but may be used in conjunction Vith pep-
tonized milk, as: —
Peptonized Milk-ffrttel.
Firflt, a good, thick gruel is prepared from any of the farinaceous article* juat
mentiuMfd. The gruel, while still hoiling hot, is added to an equal quantity of cold
milk. The mixture will have a temperature of about 125*^ F. To each pint of this
mixture two or three icospoonfula of liquor pancreaticus and twenty grains of bi-
carbonate of sodium are added. It is then kept warm in a covered jug under a coaey
for a couple of hours, and then boiled for a few minutes and strained. The bitterness
of the digestt^d milk is almost completely covered in the peptonized milk gruel.
Peptonized Houpi, Jclliea, and Iilanc-tnanij€9.
In order to vary the regimen and increase ita palatability. Dr. J. Milner
Fotliergill deacribes' other peptonized dishes which may be prepared. A soup may
be made by using peptonized gruel, which ia quite thin and watery, instead of simple
water, for the purpose of extracting shins of beef and other materials employed for
the preparation of soup. Jellies can be made by simply adding the due quantity of
gelatin or isinglass to hot peptonized gruel, and flavoring the mixture according to
taste. Hlanrinang*"* may he iniule hv treating peptonizt'd milk in the f^aine way
and then adding cream. In preparing all these dishes the operation of peptonizing
the gruel or the milk must be completed, even to the ^al boiling, before adding tha
fitilTening ingredient.
Peptonized Beef-tea.
Half a pound of finely-minced lean beef is mixed with a pint of water and
twenty grains of bicarbonate of sodium. . This is simmered for an hour and a half.
When it is cooled down to about 140° F., a tablespoonful of the liquor pancreaticiu
ia added. The mixture is then kept warm under a cosey for two hours and occasion-
ally shaken. At the end of this time the liquid portions are decanted and boiled for
five minutes. Beef-tea prepared in this way ia rich in peptone, and its nutritive
value in regard to nitrogenized materials ia about equivalent to that of milk. VMien
seasoned with salt it ia scarcely distinguishable in taste from ordinary beef-tea.
As a convenient method of peptonizing milk, Messrs. Fairchild Brothers A. Foster, of
New York, have now on sale "peptonizing tubes," each of which contains sufficient
extractum pancreatis to peptonize one pint of milk.
Peptonized OuaterSj Milk-toastf etc.
The late Dr. K. A. Ilandolph, in a case of asthma which was aggravated by
indigestion, found that, by treating slewed oysters, milk-toast, and other articles of
diet for the sick in this manner, the patient was able to ffet along without any
paroxysms as long aa he continued the use of peptonized food. The same expedient
miglit be useful in low fevers, dysentery, etc.
'"Indigestion, Biliousness, and Gout in its Protean Aspect*." Part I. By J.
Milner Fothergill, M.D.
DIET IX DISEASE.
1101
Koumi4$.
Koumiss, or milk-wine, ori^nally made by the TarUrB by fermeuting mares*
milk, is now prepared on a Urge scale in this country from pure cows' milk. It is
deservedly esteemed as a combintd stimulant and nutrient, very beneficial in wasting
conditions, and, from the carbonic acid which it contains. etBcacious in allaying irri*
lability of the stomach. Koumiss may be made at home, according to tlie following
directions of the late Prof. S. W. Gross; "Dissolve half an ounce of grape-sugar in
four ounces of water. Dissolve twenty grains of yeast-cake in four ounces of milk.
Pour both into a quart bottle and flU nearly to the top with milk. Cork tightly,
fastening the cork with wire. Put into a cool place and shake two or three timoa
daily for throe days. Keep for use no longer than six days. A champagne-tap intro-
duced through the cork is necessary. Koumiss contains about 10 per cent, of alcohol."
I
Bectal Alimentation and KTutritive Enemata. — It sometimes becomes
necessary to abandon for a time the usual route for the administration of
food, as in cases of gastric ulcer, persistent vomiting, and athrepsia in in-
fanoy. Under such eireuinstances we may resort to the rectum, and intro-
duce nutritive substances by injection. It is considered advisable to add
a certain amount of pepsin or pancreatin to the prepared food in order to
facilitate the formation of peptones and the absorption of albuminoids,
ililk-punch and beef-essence or infusion may be used, with advantage, or
sterilized milk, to which pancreatin and soda are added just before intro-
duction into the bowel. Dr. Spencer has suggested nutrient suppositories
made of beef chopped up, finely mixed with fresh pancreas or with pan-
creatic extract.
The quantity of fluid food used at each injection should not be more
than SO to 120 e.cm. (or fgii-iv), depending upon the capacity and toleration
of the patient. In infants, from 15 to 30 e.cm. (or fSss-j) is the limit. Irri-
tability of the rectum may be overcome by a preliminary irrigation with cold
water, or the use of an opium suppository or laudanum injection. The nu-
tritive enema may be repeated every four hours, and may constitute the sole
reliance for nourishment during a period extending over several months.*
In Ewald*3 clinic every case of simple gastric ulcer is fed exclusively
by the rectum for six days, with excellent results. The patients have been
free from pain on the third day. The method has also proved of value in
the differential diagnosis from neurotic cases with similar symptoms.
The introduction of normal salt solution into the rectum not only sup-
plies water and salt to the blood, and increases intravascular tension, but
also stimulates set*retions, espccinlly from the kidney. In fact, the use of
salt-water enenuita furnishes a valuable mclliod of flushing out the kidneys.
This is an inifiortant feature of the treatment after nephrotomy, nephrec-
tomy, or nephnipexy. In all cases in wliioli ether i? used as an aniesthetic,
ant] there is diminution of the urinary soeretion, this should he resorted to.
In r>r. H. A. Kelly's j>rivate ho8j)ital it lias bwn the custom, in all cases in
which the kidney has been operated u|Kin, to give one pint or more of nor-
mal salt solution by the rectum, every six, eight, or twelve hours, for several
days after the operation."
' "l^ei'trtl Alimentation and Medioation in Diseftses of the Skin," by J. V. Shoe-
maker. "Transactiona of the Ninth International Congreaa," vol. iv, p. 170.
* Amrrican Practitioner and .Veic*, Oct. 1, 1904.
1102
XON'-PHARMACAL BEHEDIES AND GEXERAL TMZRAPECTICS.
PSYCHOTHERAPY; HYPITOTISM Aim SUGGESTION;
METAIXOSCOPY AND METALLOTHEEAPY.
Psychotherapeia {i^vxyi and ^poTn-w), "the treatment of diseases through
the mind," plays a most important part in the ordinary every-day practice
of medicine. The influence of the mind upon bodily functions is so great
that every experienced, intelligent physician is glad to enlist so potent an
auxiliary, to some extent at least, in his treatment of diseased conditions.
The eminent Dr. Rush always made a point, wherever possible, of explain-
ing the action of the medicine which he prescribed for a patient, who, being
thus made acquainted with the expected results, himself unconsciously
favored their occurrence by what is known as ^'expectant attention." The
confidence that a doctor inspires is generally acknowledged to be a powerful
aid to his therapeutics. His hearty greeting acts like a stimulating cordial
upon the drooping spirits of his patient, who takes fresh courage from hia
cheerful presence. This power of influencing others so as to affect their
mental state or physical condition has been known and practiced since the
most remote period. In the early history of medicine, when the duties of
physician and priest were combined in the same person, many superstitious
rites and ceremonies were employed in the treatment of disease in order to
impress the mind of the patient and favor his recovery. The practice of
I he royal touch for the kings evil, or scrofula, which continued in Eng-
land up to the lime of Queen An^ne, is a later illustration, and the ancient
custom of wearing amulets to ward off disease has not yet entirely disap-
peared from even the most civilized communities. The wearing of iron
rings for rheumatism, amber beads to prevent croup, horse-chestnuts in the
pocket to protect from gonorrhoea, or gold rings in the ears to cure epilepsy,
and other superstitious observances are of the same character. On a larger
scale, we observe the so-called faith-cure, or Christian science, which could
only find supporters among persons absolutely ignorant of physiology and
correspondingly credulous and superstitious. The only proper criticism
upon the latter is that '^t is not Christian, and decidedly not science.*'
In order properly to approach this subject the student should read
Tuke's admirable essay, entitled "Illustrations of the Influence of the Mind
on the Body in Health and Disease, designed to Elucidate the Action of
the Imagination/" and also Pettigrew's "Superstitions in Medicine Con-
nected with the Histor}' and Practice of Medicine and Surgery,"' and, espe-
cially, the little work of Sir John Forbes, on "Nature and Art in the Cure
of Disease," each of which is classical and should be part of the necessary
course of reading for every candidate for the medical degree.
In every system of medicine practiced among rational beings the action
of the mind is not to be overlooked or ignored. Medicines that are repulsive
to the senses nf the patient, and that are taken under protest, are likely to
excite disgust and nausea even if they are not immediately rejected by the
stomach. Such remedies, whenever possible, should be substituted by other
pharmnceutical preparations having the same physiological action, but more
agreeable to the palate. The latter form will not only be taken more faith-
fully by the patient, but he will be more ready to acknowledge that they are
* London. 1884. Second edition.
« PhiladelpMn. 1844.
HYPNOTISM AND SDOOBBTION.
1103
I
doing him good, whereas he ie eure that the other will not benefit him and
ie anxious to discontinue it. It must be acknowledgedj however, that xin-
palatal)le remedies sometiraes afford a strong argument in favor of early
recoverv.
Hypnotism ( itws, Bleep), or artificial trance, is a condition accompanied
by loss of conacionsness and power of voluntary motion, but with preserved
intelligence and the ability to perform muscular movements under the ver-
bal directions of another person. Suggestion is the name given to the proc-
ess of instructing the patient in this way to do certain things. The patient
apparently surrenders entirely his individual will and volition, and becomes
an automaton under the direction of the operator. It has been said that the
effects may remain even after the hypnotic sleep has passed off, and that
patients will proceed at an appointed time to perform certain actions, sug-
? jested to them while in the hypnotic sleep, of which they retain no recol-
ection when awake. It has been positively asserted that subjects have been
hypnotized and instructed, while in this condition, to go on a certain date
to a named place and there commit a crime such as stealing a watch or at-
tempting to kill a person with a knife, and that they have afterward obeyed
the suggestion, which assumed the form of an uncontrollable impulse. The
relation of this to medical jurisprudence is very evident, and at present it
is attracting considerable attention. There is a therapeutic application,
however, which deserves some consideration. In some neurotic disorders,
characterized by pain, spasm, paralysis, or parsesthesia, it has been demon-
strated that, by hypnotism and suggestion, these symptoms can be made to
disappear either temporarily or permanently. The phenomena of transfer-
ence, by which a symptom (pain, paTal3'si6, contracture) is removed from
one part of the body to another, or even from one patient to another, is also
of much interest to the pathologist and clinician. The effects of certain
remedies, it was even claimed by Luys, may be produced simply by sug-
gestion, without administering them, but this was shown to be a fallacy by
Dujardin-Beaumetz. Closely related to this subject is metalloscopy and so-
called metallotherapy, which will be considered somewhat in detail at the
conclusion of this section.
Dujardin-Beaumetz, in a lecture' on "Suggestion in Therapeutics," ad-
mirably summarized our knowledge of the medical relations of hypnotism.
He traces it to the desire for the marvelous and mystical, which has always
exerted a dominating influence upon the mind of man. The fakirs of India
have employed it under one form or another, from time immemorial. The
fakir, in truth, is a charmer, — that is, a practicer of suggestion, — and he
develops in the individuals surrounding him phenomena of hypnotism aud
somnambulism. This also appeared in Europe under various forms, as the
thaumaturgists, the demoniacs, the rosicrucians, and performers of miracles
and of sorcery, which occupy so large a place in the history of the middle
ages. At a later period we observe these practices assuming a scientific
tendency; for, although the suggestive processes are always the same in
character, whether performed by Paracelsus or Charcot, there is in our own
day a desire to discover for the phenomena a scientific explanation. Para-
celsus in the sixteenth century assumed the existence in man of a special
animating principle to which he gave the name of animal magnetism. This
explanation was adopted by his successors, Van llelraont, Mesmer, and
Bulletin Q^n^rale dt TlUrapeutique,
1104
XOX-PIIARMACAL HKMEDIES AX0 GEXEUAL THEBAPEUTICS.
others, under various names (od-force, mesmerism, etc.), and this doctrine
of magnetifim was professed by many believers. About sixty years ago (in
1842) Dr. James Braid, of Manchester, England, succeeded in modifying
this opinion among scientific men, by showing that by the fixation of the
vision and attention upon some object, usually a brilliant one, it was possible
to provoke the same series of phenomena, which now received the name of
Braidism, or hypnotism. For a long time afterward the facts reported by
Braid failed to attract much attention, although reports were occasionally
published from surgeons of operations performed during the hypnotic state.
It is not until we come to the communications of Lasegue, in 18G5; of
Charles Eichet, in 1875; and to the numerous studies by Charcot from 1869
to the present time, that we fijid a due recognition of the phenomena of
hypnotism in their medical relations. Luys ascribes these phenomena to
fascination, such as is produced by a revolving mirror which is moved rap-
idly before the eyes of the subject upon whom this procedure is employed.
Whether caused by hypnotism, suggestion, or fascination, Dujardin-Beau-
metz stated that a series of phenomena are produced in certain patients
which may be summarized under three principal types: —
1. The cataleptic state.
3. The lethargic state.
3. The somnambulistic state.
The latter is the suggestive phase of hypnotism. Bemheim and Liebault
admit six categories of such hypnotized patients. In all of them the will
of the operator takes the place of that of the subject. In the beginning of
this provoked slumber there is somnolence and heaviness, and the power
of suggestion is feeble. It is, however, sufficient, for example, to prevent
the patient from lifting his eyelids without the permission of the operator.
In the first and second stages the patient may be acted upon after the
manner of automatic phenomena; subsequently, in the further stages, we
arrive at true suggestion, when the patient is related only to the hypnotizer,
who makes him execute movements or suggests to him illusions or hallucina*
tions. These nervous phenomena may vary in form in different subjects,
and also in the same subject, and the results are also determined to a con-
siderable degree by the expertness of the operator.
The means of evoking hypnosis, or the hypnotic sleep, are of the most
varied character. Por the passes of the magnetizers, Braid substituted fixa-
tion of the glance upon some object, — something brilliant, such as a bright
button, or even the finger of the operator. At Charcot's clinic the sense of
hearing is appealed to; the noise of a gong determines the hypnotic state as
well as the production of a bright light. In a word, every sensorial im-
pression may be utilized.
The Abbe Faria, in 1814, was the first to protest against the idea of a
magnetic fluid and to aifirm that the slumber of the hypnotized was pro-
duced by suggestion or by will. He fixed the glance of the subject, and
showed the back of the uplifted hand; then he advanced several paces, and
suddenly lowered his hand, ordering the subject to sleep. This is the
method of hypnosis by suggestion which is adopted by the school of Nancy.
Dujardin-Beaumetz produced sleep by fixation of the gaze and occlu-
sion of the eyes.
As for awakening the patient, this may be done in a number of ways.
The usual method is to tell the subject to awake, raising the voice in a tone
HYPNOTISM AND SUGGESTION.
1105
lit may be obUlned by breathing lightly upon
of command. The same resii
the face of the hypnotized.
The clinical autliority, from whom the foregoing has been quoted, classes
patients, who are to be eubjccted to hypnotism as a therapeutic resource,
into three classes: In the first class are the hysterics; in the second the neu-
rasthenics, the ill balanced, the hypochondriacs, the nervous; finally, the
third comprises all those sutTering from organic affections with lesions, and
in whom the nervous element plays only an absolutely secondary role. Sug-
gestion, or hypnosis, lias always produced its most positive effects in the
first group. This group is very numerous, and includes men as well aa
women. Male hysteria occurs not alone among the woll-to-do, but also in
the laboring classes. On this soil tJourish a number of pseudomaladies^
which, in their manifestations, assume the form and course of diseases oi
organs, producing gastric or pulmonary hysteria, for instance, which closely
resemble organic affections. The characteristic feature of all of these mani-
festations is thnt they can be made to disappear by hypnotism and sugges-
tioD.
It is among this class of suggestionable hysterics that we find such
brilliant examples of successful hypnotic anaesthesia, during which tedious
surgical operations may be performed or accouchement accomplished. A
large number of cases have been reported by surgeons of the use of the
hypnotic sleep since Esdaile published his records of several thousand cases
in India. Owing to its simplicity, it is admirably adapted to short opera-
tions, such as extracting teeth; [jut major operations have also been per-
formed under its influence by Esdaile and others.
The second group of cases — the neurasthenic, the hypochondriacal, and
the unemployed — are less influenced by suggestion. With such neuropathic^
the personal ini!uence of the physician and the assurance with which he
prescribes his remedies have more effect than the remedy itself. Here lies
the success of iittle particolored granules or miniature powders, "over which
certain physicians make magnetic passes before administering them"; and,
we might add, here is the secret of the financial success of some men whose
urance is only equaled by their ignorance.
As to the third group, it must be stated that, in the presence of actual
lesion, suggestion has a very limited field. Pain may be removed for the
time and the general state improved by the assurance of an early recovery,
the effects of a remedy may be enhanced by expectant attention. In fact
"every new remedy has a phase of success which belongs to the domain of
suggestion."
The proportion of patients who are amenable to suggestion is set down
very differently by various authorities. Dujnrdin-Beaumetz claimed that
the number has been very much overestimated. Even among the first class
of hysterics, who are the most susceptible to this mode of treatment, he
finds a certain number not hypnotizable; or, at least, there are, among
hysterical subjects, many affections which cannot be ameliorated by sug-
gestion; so that the actual proportion of those curable by this method is
much smaller than has been claimed.
The International Congress of Hypnotism, held at Paris in 1891,
J8 an illustration of the growth of this therapeutic method of late years
ind its present magnitude. Dr. Ernest Hart, in commenting upon the
hools and doctrines of hypnotism, pointed to the published addresses.
'
11U()
NOX-i'IIAUMACAL CEMEDIES AND GEXKRAL TnEUAPEl'TICS.
and discussions at this Congress, which he holds are suiriciont to sliow that
all is not yet clear, even as to llie nature, not to say the grouping, of the
phenomena which arc included under the name of hypnotism. The school
of La Salpetriere maintains that, in what it calls le grande hypnotisme,
there are always physical phenoinuua which arise independently of any sug-
gestion; wliile the school of Nancy holds that these phenomena are super-
added, and only make their appearance as the result of a suggestion, volun-
tary or not. It was Charcot who put the whole subject upon a scientific
basis, and who definitely disposed of Ihe claims of animal magnetism. Fol-
lowing him are a number of able observers in different countries of Europe
who have contributed greatly toward firmly establishing hypnotism within
the domains of science. Le grande hypnotisms constitutes the most perfect
and typical form of hypnotism. The who!e doctrine of Charcot may be
expressed in tlie following propositions of his favorite pupil, Babinski:
First, the physical characters observed in the hypnotism of certain subjects
allow the absence of simulation to be affirmed; secondly, hypnotic phe-
nomena may eflect a special grouping in three distinct states; thirdly, the
physical phenomena of hypnotism may be developed independently of any
suggestion; fourthly, hypnotism in its most perfect forms must be recog-
nized as a pathological or diseased condition. On the other hand, the doc-
trine of the school of Nancy may be summed up in the single word ''sug-
gestion.'' M. Bernheim offer? the following definition: '*The hypnotic state
is that peculiar, induced psychical state which augments, in divers degrees,
suggestibility; that is to say, the aptitude to be influenced by an idea
accepted by the brain and to realize it." The school of the Salp§tri6re
holds that, in any case, healthy, well-balanced individuals cannot be hyp-
notized; and that those who are capable of undergoing special psychical
transformation are persons wlio have a neuropathic constitution. This
seems like an important fact to establish, and indirectly confirms the opin-
ion already L|uutcd by Dujardia-Beaumetz that hysterical subjects furnish
the greater number of successful cases.
Hypnotism may give rise to accidents in certain cases, and, after hear-
ing an address by Dr. Ladame, the Congress demanded that public displays
of it should be forbidden, and that it should be considered as a therapeutic
method jind reserved fnr phyaiciang alone. At Nancy, the doctrine is upheld
that crime may be committed by a person under the influence of suggestion
as the result of such infiuence. Dr. Gilles de la Tourelte declared his belief
that the only possible crime which might be committed is on the person
hypnotized. Hypnotism is directly dangerous because it may end in com-
pletely upsetting the intelligence of the subject, and indirectly by the ex-
cessive influence which it gives to the operator over the subject, of which
the limits have not been determined. A death hae been ascribed to hyp-
notism. The accident happened to a youn^r Hungarian lady, who was
hypnotized by a layman with a view of obtaining information by ""clairvoy-
ance." The patient .'^eenied exhausted and after rcplyins: to a question "she
fell from her chair with a hoarse cry: her tongue protruded from her mouth
and she became collapsed. Her head was lowered, clothing loosened, arti-
ficial respirations performed after Sylvester's method, and ether injections
given; later she was wrapped in blankets, but she died almost in a few
seconds in spite of all." It was considered, after an autopsy, that death
was caxised by acute ancemia of the brain, incident to the hypnotic state.
I
I
with sj'ncope and heart-failure. It may, indeed, be questioned whether
the unfortunate result was directly due to hypnotism, since KrafTt-Ebing
writes that the victim was probably so constituted that death might have
been hastened when awake by a violent psychical force. At all events, the
possibility of such an occurrence should enjoin caution.' Hypnotism may
influence the actions of hysterical subjects, but it is dilTicuit to ascertain
up to what point this proceeding can, with advantage, be employed to cor-
rect the morals of children or evilly-disposed or criminal persons. Doubt
is still very permissible on this point, notwithstanding the long list of
observations which are found in Bernheim*s book. Beyond doubt, how-
ever, hypnotism is capable of rendering services in the study of experimental
psychology, and much has already been accomplished in this direction.
Hypnotism in General Practice. — It is a proper question to ask: How
far may hypnotism bo utilized by the general practitioner? In the first
place, it is a method which savors of charlatanism, and in a large number
of cases is not applicable. As Dujardin-Beaumetz has shown, it is service-
able principally among hysterical subjects. In other words, it is likely to
be an experiment doomed to failure in the very class of patients whose
esteem is most desired, — the intelligent, well-balanced, and sensible ones.
It is not surprising, therefore, that it has been avoided by the majority of
physicians. Nevertheless, in selected cases, it can be resorted to as a thera-
peutic expedient with brilliant results. Dr. Joseph Collins, of New York,
reports five cases in the New England Medical Monthly (April, 1892), and
directs attention to the fact that in suggestion we have a valuable corrective
agency for children who have acquired or inherited criminal tendencies.
In the cure of chronic inebriates it certainly desen-es a trial. In some cases
of insanity the outlook for suggestion is promising. It is among functional
nervous diseases that we find the greatest field for this measure. "It is for
hypera?sthc5ia. the various paralyses, contractures, spasms, convulsions, and
other nervous ailments of non-demonstrable organic lesions where it has
its greatest use. Supposed diseases, dread of diseases, disorders of digestion,
and other functions will, undoubtedly, in many instances, disappear under
the influence of mental suggestion."
The susceptibility of children to hypnotism was carefully considered
by Dr. Edgar B^rillon in a paper- before the Paris Society oi Tlypnology.
It is a matter both of scientific and medico-legal importance. The author
claims that 80 per cent, of children, from every class of society, may be
hypnotized at the first or second trial. The most singular part is that
children with the most marked hereditary nervous taint are the most diffi-
cult to hypnotize. Epileptics are highly susceptible. The author recom-
mends that suggestion be made use of in the treatment of such conditions
as insomnia, night-terrors, kleptomania, onanism, and other vicious habits.
B^riilon has instituted in Paris a psycho-physiological institute for the
treatment of diseases by hypnotism. He employs small mirrors which are
made to rotate by clock-work, sometimes substituting a magnesium lamp
or other bright, glittering object. The patient is placed in a comfortable
posture in a chair and directed to look fixedly at the object for ten or twenty
mmutes. If sleep does not come, then the patient is sent away and told
'Journal of the American iicdieol AMociation, Oct. 27. 1894
» fla^cttc MftliraU, Jtilv 25. IftOl.
1108
NOM-PHARMAOAL BEMEDIES AND QEITERAL THERAPEUTICS.
to return another day. In cases which do not yield to this method, a
vibrating coronet made of thin bands of n*etal is placed upon the head,
and adjusted by means of a nut to produce slight pressure on the brow.
A branch projects from the coronet and is made to rest upon one eyelid.
In order to waken the patient, it is generally sufficient to blow lightly upon
the eyes and command them to wake up. lii dipsomania, neurasthenia, and
hysteria this method has been very successful.
In his address before the Colorado State Medical Society, the late
Dr. J. T. Eskridge reviewed^ the entire subject in a masterly manner. He
declared that by suggestions during the stage of h\7>Dosi8 be had been able
to improve digestion, increase the appetite, and relieve constipation. As
a rule, tired and nervous feelings can be abolished by hypnotic suggestion.
Slight despondency may be overcome and raised to hopefulness. Headache,
if not too severe, is readily relieved; but he had not succeeded in relieving
acute pain, such as toothache or trigeminal 'neuralgia. Stammering has
been treated with marked success. Morbid fear of insecurity may be bene-
ficially intluenced. Willi regard to bad liabits, Dr. Eskridge stated tliat in
no case had he succeeded in breaking up any bad habit except by repeated
hypnotic suggestion. Experience has taught that the impressions made
by hypnotic suggestion are not very permanent at first, and are only made
so by repeated suggestion, extending over a considera)tle length of time.
Dr. Eskridge offered the following as the conclusions of his study of the
subject: —
1. That hypnotism is real, subjective, a;nd disassociated from any mys-
terious influence formerly supposed to be exerted by the hypnotist over the
subject.
2. That its therapeutic value depends upon the mental impressions
made during hypnosis, the latter rendering one more impressionable at the
time.
3. That much that is accomplished by the aid of hypnotism may be
obtained by repeated impressions without hypnosis.
4. That hypnotism may be attended by certain dangers to the hyp-
notist, the subject, and the conimnnity; but that, so far as the reputation
of the hypnotist or the health of the subject is concerned, proper precau-
tions will enable us to prevent any untoward effects, leaving numerous
dangers of a medico-legal nature to be guarded against when hypnotism
is practiced by unprincipled persons.
5. Tliat whether or not the therapeutic value of hypnotism is greater
than the dangers that cannot be prevented from its practice is not deter-
mined, and should receive careful attention at the hands of competent in-
vestigators, whose minds are not likely to be unduly biased by skepticism
or enthusiasm.
6. That no one should be allowed to hypnotize without a license from
the State to employ hypnotism.
7. That the practice of hypnotism should be limited to physicians and
other scientific investigators.
8. That no one of questionable reputation should be given a license to
hypnotize, and anyone so licensed should forfeit it on being convicted of
crime.
^New York Medical Joumcl, Aug. 1, 1891,
HYPNOTISM AND SUGGESTION.
1109
I
I
I
Dr. C. H. Hughes,* of St. Louib, in a discussion before the New York
Medico-Legal Society, declared that public exhibitions of hypnotism should
be prohibited by law. Hypnosis, according to him, is an abnormal function
of the brain, and the practice of inducing it should not be encouraged when
the subjects were persons who were very impressionable. Dr. Nolan* re-
ported a case of insanity following hypnotism in a soldier, the ■victim of a
neurosis produced by debauchery. Profound hypnosis was rapidly induced
by gazing at a bright object. From this state the patient did not com-
pletely emerge until the lapse of nearly four months. Throughout this
period of stupor the patient was disturbed by a recurring visual haHucina-
tion of an old hag, who seemed to rush toward him. Dr. Julius Solon*
also reported a case where an amateur at a friend's house volunteered to
hypnotize a fellow-visitor, anil, after two trials, succeeded so well that the
subject grew extremely excited, lost the power of speech, and then passed
into a condition of catalepsy; subsequently he had severe convulsions. He
had been hypnotized by being made to look at a diamond ring, and after-
ward the sight of anything glittering threw him into a state of violent ex-
citement. He went into a condition of grave hysteria, with maniacal
excitement, during which he had numerous convulsions; in the intervals he
would sing over, song after song, apparently all the songs he knew, and as
long as one remained unsung nothing could stop him. At the end of a
fortnight he had an attack of fever, followed by copious perspiration and
dyspnoea; a few days later he had a similar attack, and after this he declared
himself welL From first to last he was seriously ill for three weeks. The
cause of the fever was ascribed by his physician to inflammation of the
anterior part of the brain.
Dr. Moll, of Berlin, author of a book on hypnotism in the '^Contem-
porary Science Series," speaks favorably of suggestion in childbirth, where
it may be used always without damage, and sometimes with most signal
efficacy in relieving suffering. Dr. Moll attaches the greatest value to this
as a means of breaking up habits, such as morphinomania, drunkenness,
etc., which the patient is no longer able to controL
Dr. Hamilton Osgood* also speaks favorably of hypnotism, and believes
that the assertions of the leading hypnotizers of Europe, with reference to
the harmlessness of this treatment, when intdligently applied, are true.
The possibility of idiosyncrasy must be always borne in mind, however,
although Osgood has never met it in any of the patients whom be has hyp-
notized, nor have any, according to liira, who confine themselves to the
Kancy method.. The dangers lie rather in insufficient technical knowledge
than in hypnotism itself, and Osgood joins Moll and others in urging the
abstaining from suggestions which do not accord with the normal functions
of the organism.
Dr. J. Leonard Coming,"* of New York, in discussing the therapeutic
value of hypnotism, declares that the r31e it is destined to play is a subor-
'BritM Mcaical Journal April 11, 1891.
'Journal of Mental ScUmct; Druggists^ Circular, May,
*ycic York Medical Journal, March 14, 1801.
* ItoHton Medical and Surgical Journal^ lS9t.
* Journal of American Mtdical Association, Dec. 13, 1890;
1110
NOX-rUAEMACAL IlEMEDIES AND GENKBAL THERAPEDTICS.
dinate one; it is a collateral expi?di(?nt» invoked largely with the view of
renderine: the patient more tractable and amenable to other elements in the .
plan of treatment.
It should be borne in mind, as insisted upon by the late Dr. George
M. Beard, that the phenomena of suggestion are not caused by superior
will-power of the hypnotizer. There is no transfer of mental force; there
is merely a passive condition of the subject, which makes him act auto-
matically, in a manner suggested by another person, who has no power or
control beyond the mere suggestion of the idea.
Hypnotism and the law has been the subject of two essays read before
the Medico-Legal Society of New York, — one by Clark Bell, Esq., and one
by Jolm J. Keese, M.D.' The position taken by the former is that the bar
and judiciary are in duty bound carefully and calmly to investigate, and,
so far as possible, define the phenomena and place its true limitations re-
garding personal and certainly criminal reeponsibility. He would advocate
restricting its use to qualified investigators, but would oppose limiting it
to medical men. Dr. Eeese regards it as a true pathological state, even
though unaccompanied by any demonstrable change of structure. There
should be, in his opinion, legal Burveillance over private experiments and
public exhibitions.
In mrnliil disense Dr. Voisin' has had good results in conquering
hallucinations, overcoming delusions, and in quieting acute mania. He was
able to induce hypnosis in about 10 per cent, of his patients. Raulin nar-
rates the case of a girl, aged 18 years, with an hysterical laugh of four
months' duration, which began during the inhalation of chloroform for
some slight operation. The girl was easily cured by being hypnotized and
told to forget her inclination to laugh.
The editorial in the Medical News (October 10, 1891), on the thera-
peutic value of hypnotism, casts some doubt upon the advisability of sub-
stituting one neurosis for another, and suggests a strong relationship be-
tween experimental hypnotism and human vivisection. ''We must have a
better psychology and an infinitely more perfect pathology and pathogeny
of psychical disease before we shall be capable of intelligent use of hypnotic
control and suggestion as justifiable methods of cure." Dujardin-Beaumetz,
in the lecture previously referred to, sums up the value of this method in
the statement that ^^psychotherapy will never constitute more than an ex-
ceptional resource in the practice of our art, if we would limit it to the prac-
tice of hypnotism^ properly so called," since there will always remain a large
pathological group of organic affections against which we must employ
special medication, and in which hypnotism can never play any role. **To
suppose, for a single instant, that it would be possible, by mere affirmation,
to cause the disappearance of the entire train of morbid symptoms is an
illusion, and, worse, an error." Ernest Hart' very plainly summed up the
whole matter, as follows: —
''Hypnotism is a pathological modification of the nervous system, which
always indicates that the subject belongs to a neuropathic class. The com-
' Medicolegal Journal, March and Sept.. 1901.
^"Prowedinffs of Congress of Experimental Hypnotism, 1890."
and Surffical Journal, Sept 5, 1889.
* British Medical Journal, March 28, 1891.
Boaton Medical
inTNOTISM AND SUGGESTION.
IIEL
I
plete and typical form of hypnotism described by Charcot is rare. Sug-
gestion plays a considerable part in hypnotic phenomena, hut there are
somatic phenomena which are independent of it. Hypnotism may fre-
quently be dangerous, and very rarely useful. It may be the cauee of crime,
or of mental disorder; it can retjly cure no disease not more easily curable
by simpler and less dangerous methods. A considerable number of facts
attributed to it which have most impressed the public imagination, such as
the actions of medicines at a distance, the so-called telepathic communica-
tions, or communications made without speech, and the clairvoyant phe-
nomena sometimes described, are mere errors of experiment arising from
insufficient precautions and a too vivid imagination. Precisely those phe-
nomena which have been most publicly talked about and excited most
interest in 'psychical circles/ so called, are the least real. The hopes which
the therapeutic hypnotist aroused have not been realised, and any expecta-
tions of produuing by hypnotic methods any desirable moral or mental effect
rest upon a totally inadequate basis of fact, and arc far from being promis-
ing.*' Dr. Hart, in his monograph on **liypnotism. Mesmerism, and the
New Witchcraft," alludes to the dangers which may arise from an abuse of
hypnotic influence, and calls attention to its actual ailiancc, in many cases,
with humbug and fraud. He demonstrates that neurotic individuals have
been trained for purposes of exhibition and so-called scientific experimenta-
tion. John R. Hose* gives the four rules formulated by Bernheim and
Beaunis, which should always guide one in the application of hypnotism to
the treatment of all diseases: ''Never use hypnotism wiihinil the consent of
the subject or the legal guardian. Never hypnotize except in the presence
of a third party, who represents the subject. Never make suggestions with-
out the patient's consent, excepting those necessary to effect a cure. Never
use authority over a patient to secure his consent, if you have reason to
expect *3isngreeable results from the oxperiment/'
Metalloftcopy and Metallotherapy. — The possibility of affecting bodily
functions by the near approximation to the surface, or actual contact, of
various metals has been a belief of mankind from a very remote period, and
doubtless the phenomena exhibited by magnetic iron-ore had much to do
with giving it something like a foundation in fact. In the history of thia
subject the name of Dr. Perkins, of Connecticut, will always occupy a
prominent place, similar to that of Paracelsus in the early development of
hypnotism, and the parallel is not an unjust one to the American. Perkins
arranged a combination of metals in the form of a cylinder which could
be grasped in the hand or passed over the surface of the body. By the
application of these ^'tractors," as they were called, the morbid process was
believed to be drawn out; he applied them with remarkable results, and
many certificates of cures were obtained. This method had such success
here that it was introduced into England, where it was received with great
enthusiasm. It became nt once very popular. Crowds of all classes resorted
to the Perkinsian Institute, and wealth poured into the coffers of the shrewd
proprietor, until Dr. Haygarth opened an opposition institution, and dem-
onstrated to the world that he could obtain equally marvelous restdts from
imitation tractors made of wood. In other words, Perkins's method was
Journal of the American Medical A$aoeiatUm, May 20, 1899.
n.112
N0N-PUAR31ACAL REMEDIES AND GENERAL THERAPEUTICS.
mot metallotherapy, properly speaking, but an illustration of the influence
*of the mind over the body and of the curative effect of the imagination.
-Modern metalloscopy and metallotherapy are further illustrations, in all
•probability, of the action of this potent therapeutic adjunct under a more
ficientific drees.
Dr. Burq, in an inaugural thesis in 1851, called professional attention
to the curative effects of metals in the form of plates, when applied to the
ekin in cases of paralyses of motion or of sensibility occurring in hysteria.
The same metal is not applicable to all cases, — one being benefited by silver,
Another by gold, copper, or some other metal. He claimed that the internal
administration of the appropriate metal to the given case would likewise
produce favorable results. The detection and determination of the par-
ticular metal appropriate to each individual he denominated "metalloscopy,"
«nd the use of metal? in this way ^'metallotherapy." This is quite different
from the external use of magnets, to which attention has already been
directed. Among the phenomena claimed by Burq to be produced by a
piece of metal, such as a coin, properly selected according to the special
€ensibility of the subject, when placed in contact with the skin, is return
of normal sensibility in permanent hemianapsthesia (hyeterical) in from ten
to twenty minutes, through a space of some extent above and below the
point of application. Numbness, tingling, and other disorders of sensation
precede the return of sensibility in the area immediately adjacent to the
metal* and this gradually extends until the whole side returns to the normal.
At the same time an elevation of the temperature recognizable by the
thermometer and an increase of muscular power takes place. Where sight,
hearing, taste, and smell are also in a condition of auaE?Bthegia, as the general
sensibility is restored these functions also become normal. A commission
appointed by the Paris Academy, with Charcot at its head, having been
appointed to examine into their claims for metallotherapy. confirmed them,
and added what is known as "the phenomenon of transfer,'^ by which is
meant that with the restoration of normal sensibility upon the affected side
there is a decline, to a greater or less degree, of the sensation of the corre-
sponding area upon the opposite side. The phenomenon observed and the
results obtained by tlie commission were of such a positive character that
Charcot was led to ascribe them to electric currents stimulated by the
contact with the metal. Such currents could only be an exaltation of the
normal intercapillary electrical phenomena, since one metal could not orig-
inate an electric current outside of the body even when in contact with it.
Professor Westphal, of Berlin, after a careful investigation of the subject,
published his results, which, on the whole, were corroborative of those of
"Charcot and Burq. Dr. Hughes Bennett obtained equally striking results
from other substances than metals.
The method of application is to select disks, or large coins, or pieces
of wood coated with metal, and apply them to the affected limb either as a
bracelet or a single plate kept in position with a bandage. The effects fol-
low in a few minutes* so that experiment will readily determine which metal
is to be used. As the rule, an individual is susceptible to one metal only.
The order of usefulness is: iron, copper, gold, silver, tin, platinum.
Besides hemianesthesia or paralysis of hysterical subjects, cures of
writers' cramp, chorea, and neuralgia have been reported. When the metal
to which the patient is sensitive is discovered, it is sagely recommended to
HEAT AXD COLD.
1113
I
•conjRnue the treatment by the internal use of a salt of the same metal. In
giving this advice Barthoiow applied Burq s practice, already referred to.
The attentive student of the preceding section on hypnotism and sug-
gestion will find a sufficient and fully-scientific reason for the above phe-
nomena, without invoking any mysterious or occult influence of metals in
the treatment of disease, other than in the sense in which Burton, in his
celebrated *'Anatomy of Melancholy," applies to metallotherapy in his ob-
servation to the effect that gold is a potent remedy for lowness of spirits.
Within the last few years the subject of metallotherapy has almost
entirely disappeared from medical journals, and is omitted from our prin-
cipal text-books.
I
h
HEAT AlTD COLD.
I
Heat, as measured by the thermometer, is a purely relative term. Liv-
ing human beings have a normal standard of heat furnished by the surface
temperature of the body, which varies a little at different points, but may
be roughly stated to be about lOO"* (F.), or a little lesa (98.4'' to 98.6** in
the axilla, a fraction higher in the mouth or rectum). In certain states of
the system this may be exceeded by as much as ten or twenty degrees, and,
if this continues for a greater or shorter period, the patient is commonly
said to have fever, or pyrexia ('^p, fire). The bodily temperature, on the
other hand, may fall below the standard in collapse, coma from alcohol, loss
■of blood, starvation, or cancer. Vasomotor paralysis with dilatation of the
blood-vessels is sometimes the cause of notable loss of heat after severe in-
juries of the upper portion of the spine. In sclerema tieonatorum Dr.
Baumler^ has observed a temperature as low as 71.6** F. (23* C).
Cold may be defined as a lower degree of temperature than that which
is normal to the human body. Absolute cold would be a condition entirely
free from sensible heat; it is estimated at several hundred degrees ( — 459
degrees) below zero. Cold is unknown to us, practically, and by this term,
therefore, nve mean simply lower decree of heat. Articles which, when ap-
plied to the surface, abstract more or less heat from it, are said to be cold;
those whichj on the contrary, communicate heat to the body, are said to
be hot.
This fact is of considerable service in therapeutics, since we are able,
to a certain extent, to regulate the bodily temperature by means of external
applications. For convenience we will treat of them under two heads, viz.:
(1) the effects of hot applications or external heat, and (2) the effects of
abstraction of heat by relatively cold applications,
L Heat as a Remedy.
Physiological Effects of Hot Applicationi. — The primary effect of heat,
when locally applied to the human body, is that of an excitant or stimulant.
If the temperature be sufficiently high, — say, that of boiling water, — irri-
tation will be so great as to lead to serous effusion between the layers of
the epidermis, the external squamous layer being thereby elevated and a
' Quain's "Dictionary of Medicine," p. 1599.
11
NON-PHARMACAL REMEDIES AXD OENKRAL THERAPEUTICS.
blister formed, followed by more or less local inflammation. If the tem-
perature be even greater, necrosis of the tissues will take place, to a greater
or less extent, followed by sloughino:. The application of higher degrees of
heat, as by the actual cautery, is attended by shriveling and combustion of
soft parts, followed by decomposition, suppuration, and necrosis. More or
less pain is caused by the application of anything to the surface the tem-
perature of which is much higher than that of the body. After the appli-
cation of heat the electric currents in the sensory nerves are reduced, or
even destroyed. Heat may, therefore, act as a sedative in painful afTections
of the nerves. Moderate heat, applied generally to the surface, produces
important physiological efTects, which have already been referred to in dis-
cussing the effects of warm and hot baths. Dry heat is better borne than
moist heat, and glass-workers, metal-founders, stokers, and others con-
stantly carry on work at a temperature much greater than that of the human
body. It is recorded of Chabert, "the Fire King," that he frequently ex-
posed himself to a temperature of 400* to 600** F. without injury; and, in
the Turkish bath, the temperature of the hot room is ordinarily "from 140"
to 160** F.
The effects of exposure to an elevated temperature in dry hot air, for
a short time, — from half an hour to an hour, — are: a slight rise in bodily
temperature and an increased rate both of pulse and respiration, but more
of the former than of the latter. The capillary system becomes congested,
and the arterial tension is increased as a result of greater rapidity of the
heart's action. The action of the kidneys and skin is more marked, and
the proportions of chlorides and urea are increased. The skin becomes
bathed in perspiration, which, by its evaporation, keeps the bodily tempera-
ture down neaily to normal. In moist air this evaporation does not bo
readily take place, and much lower degrees of heat speedily become unsnp-
portable. It is on days when the humidity is great that sun-stroke is more
apt to happen, since, under such circumstances, the bodily temperature rises
until the brain is affected by the overheated blood, and coma or convulsions
ensue. This is more likely to occur if the person affected has been engaged
in active muscular effort, or was under the influence of alcohol at the time
of exposure-
Therapeutical Applications of Heat. — General or local measures may
be employed to exert thermic influences upon the body. The general ap-
plications may be made by means of baths of various kinds, including the
Russian or steam bath, and the hot-air bath, which have been already
referred to. A variety of the latter is kno^vn as heliotherapy, or the sun-bath,
which has a powerful effect upon nutrition, and in some chronic forms of
disease it has curative effects scarcely obtainable in any other manner. It
may be taken in a warm room, with the clothing removed from the portion
of the body to be acted upon, or the entire body may be exposed to the rays
of the sun for a period of half an hour to an hour; or the body may be
covered with clothing, and the warmth of the sun principally utilized.
That the sun's rays exert a powerful influence is shown by the acute derma-
titis which is caused by exposure to the sun while boating or swimming;
even blistering is produced, in severe cases, besides discoloratione of the
skin (tanning and freckles). The direct rays of the sun, concentrated by a
double-convex lens, have all the effects of the actual cautery, and may be
thus employed to destroy epithelioma, or small growths in the skin.
I
I
Local applications of heat may be made by means of epecial apparatus
for the- dry hot-air treatment, consisting of metal cases, usually heated by
electric lamps, or by gas-flame extemafiy applied, also by hot-water bags,
sand-bags, bricks, etc.,' or by cataplasms, fomentations, or local baths.
B.oeckel has shown that the virulence of chancroid is destroyed by a
temperature from 40° to 42° C. (104° to 107.6' F.). In accordance with
this observation, Welander has made use of heat with excellent and rapid
effect in cases of chancroids and buboes. The heat was applied by means
of leaden coils connected at one end with a reservoir of water at a tempera-
ture of 50** to 52° C. (123° to 125.6° F.) and at the other with a waste-
vessel beneath the bed. The pipes are bent to correspond to the form and
locality of the ulcer, and are covered with a layer of moist cotton before
application.. In passing through the tubes the temperature of the water
is reduced to 40° or 42° C.
The general application of heat is useful where the body has become
chilled, or there is collapse, owing to loss of blood, or shock after an injury;
also in alcoholic intoxication. The patient may be covered with blankets,
brought close around the neck, but lifted up from the body into a sort of
a low tent, into which hot air may be carried from an alcohoI-Iamp or small
baskets, containing hot bricks or sad-irons, may be ranged by the side of
the patient. Circulation of the blood may be assisted by rubbing the pa-
tient's limbs toward the trunk. The hot bath has already been considered.
Baths of hot sand and mud-baths are used in Europe for the cure of rheu-
matism, paralysis, and spasmodic contractures of muscles. In collapse of
cholera, and in restoring persons apparently drowned, heat i^ of great im-
portance. Special forms of apparatus, consisting of large boxes of sheet-
iron lined with asbestos, which can be heated by the flame of lamps or gas,
60 as to raise the temperature to 300° or 400° P., have been made of various
shapes so aa to expose a portion of the human body to this elevated tem-
perature. As this treatment is especially used for the treatment of chronic
synovitis and painful and inflamed joints, the apparatus in most frequent
demand is that into which the atTected arm or leg may be introduced. In
traumatic, rheumatic, and gouty arthritis the results have been most suc-
cessful. The treatment usually lasts for one hour, and is given daily or
every second day. The effects are not only local in relief from pain, swell-
ing, and stifTness, but, as the patient generally perspires profusely while
taking the local bath, he has the benefit of a general hot-air bath, as well
as the local effects of the high temperature, which, in many cases, are re-
markable. The electric lamp apparatus is very effective and convenient.
Dr. E. S. Morse, of Ashtabula, Ohio, resorted successfully to the topical
application of dry hot air in a case of senile gangrene. The patient, two
of whose toes had been amputated, was 79 years of age, cachectic, the sub-
ject of mitral disease, and had symptoms of septicffimia. The hot-air treat-
ment was given twice daily for two weeks, by which time the wounds were
healed.
' Profeaaor Tamier has uwd warmth with remarkable recults in saving the live*
of prematurely bom or weak infants. He usca a box healed with hot-water bottles,
the heat being regulated with the thermometer. This appftratus is called a coiiV€U9e^
and is in general use in mntemities and foundling aaylums.
1116
NON-PUARJIACAL REMEDIES AND GENERAL THERAPEUTICS.
It has been experimentally shown that the paroxysms of idiopathic epi-
lepsy are preceded and accompanied by toxicity of the blood, urine, gastric
juice, and sweat, and Cabitt states that the hot-air bath is an excellent
means of preventing or amehorating epileptic attacks.
Topical applications of heat are called for in cases of pain, local con-
geations, or spasms, and to allay irritability by acting as a counter-irritant
Thus, in neuralgia or toothache, the application of heat with a rubber hot-
water bag, or with the hop-bag moistened with hot whisky, is often of signal
service. In a similar manner colic of various kinds — colalgia, gall-stone
colic, nephritic coHc — is promptly relieved by hot applications, either dry
or moist. In pneumonia and pleurisy hot poultices relieve pain and con-
gestion, favor perspiration, and moderate the fever and cough. Hot appli-
cations will often arrest superficial inflammation if applied early, and in
later stages they favor suppuration and separation of the necrosed tissues
from the living. A hot-water bag applied to the spine, in the dorsal region,
will stimulate the spinal centres and check uterine haemorrhage. In rheu-
matic inflammation of joints, subacute in character, the alternate applica-
tion of hot and cold applications causes rapid absorption of the effusion.
The many uses of poultices and the hot-water bag cannot even be enu-
merated here, but enough has been -mentioned to indicate their therapeutic
value. By combination of mustard or spices with a cataplasm or poultice,
the counter-irritant eiTect is greatly increased; but this is beyond the bor-
ders of the subject of heat by itself, which is now under discussion. The
higher degrees of heat are used as eecharotics.
The Chinese method of raising a blister is to immerse a plate of metal,
of ihe corresponding size, in boiling water. When thoroughly heated, it is
taken out and applied directly to the skin. As this is ver}' painful, it is not to
be compared with the ordinary method, and is not likely to come into favor
here with the profession or public. The actual cautery is a surgical instru-
ment, but it may be utilized in medicine in the treatment of chronic rheu-
matic or tubercular inflammation of joints. In sciatica the surface over
the course of the nerve may be lightly touched by the actual cautery, to
produce a counter-irritant effect, or a piece of flannel overlaid by hardware
paper may be placed along the limb over the painful area and a hot sad-
iron passed lightly over the surface.
II. Effects of Abstraction of Heat by Cold Applications.
Physiological Effects of Cold. — Cold applied to the living body pro-
duces some congestion of the superficial blood-vessels, soon followed by their
rapid and extreme contraction and lowering of the surface temperature. If
the exposure has been moderate, reaction follows, with redilatation of the
capillaries, augmented energy of the circulation,, and restoration of the nor-
mal heat. In weak or debilitated people reaction is slow or may not appear
at all; but there is a more or less lengthy period of vital depression, accom-
panied by enfeebled nutrition, and followed by a slow recovery. Prolonged
exposure to a low temperature may induce not only local and temporary
vascular syncope, but local or even general devitalization; beyond this point
only the physical and chemical effects of cold continue. Complete freezing
of a tissue or organ is never followed by complete restoration of function,
as the devitalized portion is necrosed and sloughs ofT. This condition it
^
HEAT AND COLD.
iiir
'known as frost-bite and ^ang^-ene. Less intense cold may lead to a tend-
ency to permanent dilatation of the capillaries of the skin, associated with
panesthesia and at times pruritus. This is known as pernio, or chilblain,
and causes much annoyance, to children especially. The application of
carbolized lotions or petrolatum with carbolic acid (3 to 5 per cent.) affords
much relief. Frost-bite may lead to loss of toes or fingers, or even require
amputation of portions of the feet, after severe exposure. Death frona
exposure to cold is attended by shriveling and lividity of the skin, muscular
weakness and rigidity, with mental symptoms, drowsiness, confusion, and
coma. These symptoms have been mistaken for the effects of alcohol, and
the error is more likely if the subject had been indulging in alcohol before
his exposure. The post-mortem appearances consist in a waxy anaemia of
the surface, varied by bright-red patches on the more exposed portions of
the body. Internal organs much congested. The reddish-brown stains
, along the course of the superficial blood-vessels are due to disintegration of
the blood-cells by the cold and diffusion of the coloring matter through the
vascular walls (C. E. Shelly').
In treating a patient who has been rendered unconscious by extreme
cold, the point to be borne in mind is that the restoration of heat should
not be rapid, but gradual. The patient should be stripped of clothing and
put between blankets, in a cold room; the surface should be stimulated by
gentle friction, using enow or ice-water to frozen parts, at first, and after-
ward dry flannel. The bladder should be emptied by catheter, and small
quantities of hot broth, tea, coffee, or beef-tea may be administered as soon
fts the patient can swallow. After reaction is established, but not at first,
some hot toddy may be given. Nutritive enemata may be administered, and
the patient carefully nursed, as recovery is usually slow.
Effects of Cold on Bacteria. — It has been shown, with regard to pathog-
enic bacteria, that their vitality is only suspended, and not destroyed, by
extreme cold. For instance, the bacteria of yellow fever, typhoid fever, and
the plague bacillus nre checked in their growth, but not killed, by freezing.
Therapeutics of Cold. — Two classes of cases are benefited by the appli-
cation of dressings, or other agents, of low temperature. These are: where
it is desired to have the primary and secondary physiological effects upon
nerves, blood-vessels, and cells of the part, and, secondly, where the physical
effect is principally sought after through the abstraction of heat or the
lowering of abnormal temperature. With regard to the latter, it may be
said that nervous symptoms of various kinds are produced by an abnormal
temperature of the blood as it flows through the vessels of the brain, and
in what Dr. H. C. Wood terms "thermic fever" the principal object of
treatment is to protect the brain-centres by abstraction of heat from the
blood. In tlie troatnient of pyrexia, cold is used as an antipyretic by nu-
merous methods: the cold bath, wet pack, sponging of the surface, or by the
water-bed or coils of rubber tubing. Cold-water enemata in typhoid fever
have some influence upon the temperature, and tend to make the patient
more comfortable.
Cold is not only antipyretic, but may be applied as a tonic and itimn*
lant, reaction being hastened by brisk friction. It also acts as a sedative
and anodyne by abstraction of heat and lessening the conductivity of nerve-
1
"Dictionary of Practical Medicine,'* edited by J. K. Fowler, 1890.
1118
NON-PHARMACAL REMEDIES AND GENERAL THERAPECXICS.
truuks; it may even be a local ansesthetic; but care should be taken not
to freeze the part to which it is applied. When properly used in this way,
it is sufficient to prevent the feeling of pain during small operations, and
is frequently resorted to. It is also an anaphrodisiac when locally applied,
or a shower of cold water is sent along the spine. It is antispasmodic, as
when a child with convulsions or spasm of tlie glottis is relieved by pouring
several pitcherfuls of cold water over the head and neck. The cold douche
is a powerful respiratory excitant in cases of narcotic poisoning and in
asphyxiated infants. In chorea, cold applied to the spine, either by the
douche or by ether-spray, has produced satisfactory results, and a similar
application may be made in hysteria. In hysterical catalepsy, hysteria
major, convulsions, etc., the sudden pouring of a bucketful of cold water
upon the face and mouth, from an elevation of three or four feet, frequently
has a marvelous eflect A similar douche of cold water from a pitcher is
useful when poured upon the abdomen in cases of inertia of the uterus,
either before or after childbirth. In suppression of urine, a cold douche to
the dorsal region of the spine often causes free secretion of urine. Con-
traction of the bladder may be induced in the same way. The application
of cold by baths has already been considered, but as an illustration of its
usefulness the following case may be quoted: Maurice Letulle^ describes
the case of a man with a severe attack of dehrium tremens. The tempera-
ture was 104.5'* F., and the face and extremities were cyanosed. Seven
hours after the beginning of the attack he was given a cold bath of 64.4'
F. He remained in the bath for thirty minutes, and at the end of that
time suddenly passed into a state of collapse, with the pulse remaining at
the same rate as when he entered the bath. lOS. The temperature had
fallen to 92.6° ten minutes after the bath had been given. From this
extremely low point the temperature gradually improved until twelve hours
after the bath had been ^iven, when it was normal. The patient did not
have a return of the delirium. Letulle regards this as a distinct improve-
ment upon the use of opium, chloral, or digitalis. The bath in the case
-described was administered for too long a time, but he thinks it is justified
in these very grave cases, and in the case in question it was followed by a
lowering of the temperature and a disappearance of the delirium.
The anodyne effects of cold are utilized in the treatment of inflamma-
tion, contusions, etc. Sprains, as a rule, are best treated with a local bath
of very hot water, followed by compression. Should pain follow, the dress-
ings may be wet with ice-water. This is also useful if there is pain after
fracture. In acute inflammation of joints, the ice-bag is of great service in
checking inflammation. Compresses of flannel wet with ice-water are use-
ful in tonsillitis, pharyngitis, and laryngitis. Amenorrhoea, or menstrual
suppression, has been overcome nt the end of three days by the application
of an ice-bag to the lower dorsal and lumbar regions of tlie s])ine. On the
eontrarA', uterine haemorrhage can be promptly checked bv a hot-water bag
(115° to 120° F.) to the spine. W. Frank Olenn^ points out that the appli-
cation of heat to the sjunal cord reducos the amount of blood in the lungs
and other vascular organs, and relaxes the capillary system, and is therefore
valuable in pneumonia.
' Presse MMoale, July 8, 1899.
' Lancet-CHnio, Oct. 14, 1905.
HEAT AND COLU.
1110
I
Dry cold is used by moans of an ice-bag or bladder filled with broken
ice. The skin should be protected by means of one or two layers of fianueL
or local freezing (frost-bite) may be produced. This method is used in
pneumonia, meningitis, and congestive headache. The ice-bag should be
partly suspended by a cord so as to take its weight from the head. This also
has some effect upon the general temperature. The method has also been
utilized in cases of fracture, in vertebral caries, in orchitis, or epididymitis,
and in numerous other conditions where it has proved exceedingly valuable.
Dr. John A. Jliller has used ice with excellent results in phlegmasia alba
dolens. A large towel was dipped in ice-water, wrung out and wrapped
around the alTected limb, after which a heavy flannel roller bandage was
applied from the too to the groin. Over the most puinful part^i, were placed
rubber bags filled with ice and kept in position by an additional bandage.
Pain was markedly relieved by this practice and the temperature was
speedily reduced. From tlie application of ice over the cardiac region M.
Jullien has derived great benefit in grave ataxic forms of typhoid fever, in
which death seemed imminent. The result was reduced frequency and
increased strength of the pulse, together with reduction of temperature and
disappearance of the cerebral symptoms. The application should be
watched carefully, as to its results, but there appears to be no danger in
prolonging it, while the general condition remains dangerous. In peri-
carditis, whether dependent or not upon rheumatism. Dr. D. B. Lees, of
London, made use of a similar method with satisfactory results. He was
led to its use in this disease by his experience with it in the treatment of
pneumonia. Dr. Lees concludes that the ice-bag when used with caution is a
safe application in pericarditis, that it is usually liked by the patient, tends
to check the violence of the local inflnnimation and to restrict effusion.
The application even seemed to assist in the absorption of fluid, which was
already present'; Dr. Angus McGillivray, of Dundee, states that the treat-
ment of ocular wounds by means of the continuous application of iced com-
presses has given him great satisfaction. Letulle and Ribard described their
method of the local application of extreme cold (''krymotherapy") to over-
come the anorexia of phthisis. Their plan is to apply during about half an
hour every morning, a biig, containing about 2 kilogrammes of carbonic-acid
gas, to the epigastric and hepatic regions. The skin is protected by a thick
layer of cotton-wool, and maintains a temperature of about 25^* C. A sec*
end application precedes the evening meal. Letulle and Ribard prefer the
above-mentioned method, and think that some organs, such as the liver,
are cooled more than others by the cold. The organism has to resist the
cooling process, and the result is an increase of nutritive changes, a burning
up of old materials, an absorption of new materials, and an increase of
appetite corresponding to the increased digestive vij^or.
By the employment of liquid air an intense degree of cold is rapidly
f>roduced. This has been recently introduced into medicine as a method of
ocal refrigeration. Campbell White has employed this agent in varicose
ulcers, chancroids, and some specific ulcers, lie believes that nothing will
80 quickly, thoroughly, and painlessly stimulate granulation as does the
proper application of liquid air. He has also used liquid air in sciatica,
British Medical Journal, Feb. 18, 1803, p. 344.
1120 NON-PIIABMACAL REMEDIES AND GENERAL THEBAPECTICS.
herpee, and intercostal and facial neuralgia, obtaining permanent relief by
applying liquid air to the spinal end of the atTected nerve.
Care should be taken in applying cold to weak or elderly people, and
in those with a marked valvular lesion of the heart; for in all these cases-
reaction, if it occur, will be glow, and it might lead to catarrhal attacks.
The cold douche must not be used in fever if there be extreme weakness and
feeble pulse, with delirium and cool, clammy skin.
Evaporating lotions, used in treatment of contusions and inflammationft
around joints, are merely a method of obtaining refrigeration or cold; but
as they commonly involve the use of various medicaments other than cold,
they need not be considered here.
Small pieces of ice, allowed to melt in the mouth, allay irritation in
cases of sore throat and also nausea, and thirst in cases of fever.
LIGHT AND DAKKNESS.
^
Light and darkness are relative terms. Just as cold is merely the aV
sence of heat, so darkness consists in the deprivation of light. Like heatr
also, it is a form of energy, and is regarded essentially as a mode of molecu-
lar motion. Modern physics recognizes, in fact, a very intimate relation
between light and heat. In the rays of the sun and those emanating from
an ordinary incandescent or luminous object^ such as a lamp or fire, light
and heat are always associated. The rays of light are less diffusive than
heat-rays, and the latter may he separated by passing? through a saturated
solution of alum, which abeorbs the heat-rays, but permits the light to pass.
In what is termed phosphorceoence in insects and luminous bftcteria, the
heat-rays are deficient. In addition to light and heat, the rays of the sun
contain energy, in a form of peculiar activity. These obscure rays, which,
in the solar spectrum, are found in and just beyond the violet, are known
as the actinic rays. As it has been found that the actinic rays produce "very
marked chemical and photographic effects, it is very probable that part of
the physiological and therapeutical effect of the sun's rays on the human
organism may be ascribed to this source. The effect of sunlight upon the
nervous system is sometimes excessive and injurious. In the West Indies,
for instance, sun-stroke is much more to be dreaded than in more tem-
perate countries, as it frequently sets up myelitis, neuritis, or some degen-
erative process in the body, which results in paralysis, insanity, or chronic
invalidism. Even in our Northern cities meningitis is often caused by the-
sun's rays. From this we conclude that sun-stroke, or insolation, is some-
thing more serious than thermic fever, or a temporary overheating of the
blood, the effects of which, by the way, are more marked in the lower animals
than in man.
The Finscn light is obtained from a large arc lamp of 30.000 candle-
power, or twenty times as powerful as the ordinary arc lamp for illuminating-
purposes. A specially-prepared large carbon is used for the upper carbon,
and a smaller one is used in the bottom holder. When properly adjusted'
and witli the necessary amperage, a maximum number of violet and ultra-
violet rays are produced. A much larger proportion of chemical rays is
found in the arc-light thnn in the sunlight. During the use of the lamp the
LIGHT AND DARKNESS.
1121
rays of light are po intense, that it is necessary for all the attendants and
patients to wear dense smoked glasses. An aluminum hood about two feet
wide surrounds the lamp; it is fringed upon its lower border with deep
crimson-colored paper, in order to protect the patients from undue exposure.
bThe concentrated rays are carried from the arc to the patients through four
telescopic converging tubes, suspended at an angle of 45°. These tubes
contain a series of rock-crystal lenses, so arranged that spaces for running
water are left between them. By means of this water-screen and the rock-
crystal lenses, all rays except the violet rays are shut off or intercepted. If
it were not for the stream of cold water kept constantly running through
the reservoirs, the intense heat of the arc would crack the lenses and bum
the patient. A siniikr apparatus, called a compressor, is also interposed.
This is provided with two large rock-crystal lenpos. with a water reservoir
■between them, through which water is kept running. This part of the ap-
Iparatus is used to compress the affected area and make it bloodless during
|ihe treatment, thus favoring local action nnd deeper penetration. Dr. H,
John Stewart, of Chicago,' who furnished the preceding description, after
a personal inspection of the Fiuficn Medical Light Institute, at Copenhagen,
states tliat in six years this has grown from a small shed, where they could
treat hut one pntient at a time, to a magnificent institution, where they were
-treating. ^00 ]toopl^ daily, in 1004: similar light-healing hospitals have
bei^n started in the principal larfre cities of the world. It is probable that
such instituti\'* will be ostablishrd in every large city in this country within
a short time. The treatments are given to patients who are l\nng on couches.
The affected area to be treated is placed about ten inches from the distal end
of the converging tubes, and the tissues are flattened by the compressor.
The treatments, or seances, take about one hour daily in lupus and rodent
ulcers; in other cnses. from ten to twenty minutes, depending upon the form
of disease. It is claimed by Finsen that 07 per cent, of lupus \-;ilgaris pa-
tients can he cured, even when the whole face is involved. The light treat-
ment give* no pain. Immediately after, an erythenifitons spot, or a blister,
appears where the light hns been directed. In five or six days the scab falls
off, and the ulcer is seen to be healed. There is no scar, but a redness re-
mains for a variable period, ultimately leaving the skin soft, white, and
■nncontractod : except where there has been loss of tissue from the disease
before treatment.
Physiological Effects of Light. — The tissues of the body are nearly
opaque; but, with a high decree of illumination, such as may be obtained
from the electric arc light, there is found a considerable amount of trans-
Jucency. We may also introduce electric lamps into the mouth, the phar-
yni, or the stomach in order to examine the extent and amount of trans-
lucency of the surrounding structures. It has recently been shown that the
rays of the sun are capable of passing directly through the body, to a limited
extent. T'nder ordinary circumstances, it is probable that sunlight, to some
degree, actually penetrates the skin and enters the soft tissues, stimulating
and vivifying the cells by its warmth and actinic influence. That it doee
exert some very important effect upon nutrition is demonstrated by the fact
that persons who pursue occupations that keep them constantly in the shade,
and away from the sun, acquire a peculiar pallor, and become anjemic.
» 7*** Southern Practitioner, Jan.. 1004.
Tl
1122
NOK-PUAHAfACAL REMEDIES AND OENEBAL TIIERAPECTICS.
Moreover, not only are human beings dependent upon light for health, but,
as a rule, animals depend upon it for their existence. The Mammoth Cave
of Kentucky has very few species of the higher orders of animal life, and
these show evidences of defective development and iniperfeclions of struct-
ure. It is a well-known fact that plants need light, in order that the cells
may properly elaborate chlorophyl. Since the color of chlorophyl is due to
a soluble salt of iron analogous to htcmatin, which is the chalybeate com-
pound to which the red blood-cell owes its color, the paleness of plants
gro\%Ti in darkness is strictly analogous to the paleness of mill-operatives and
weavers, whose occupations keep them from exposure to sunlight. Light
is not only necessary to physical health, but also for the moral nature.
Darkness is depressing to the spirits and unfavorable to intellectual devel-
opment. The punishment of the dark cell has been abolished almost en-
tirely from penal and reformatory institutions, on account of its unfavorable
influences upon the mind and the tendency to cause insanity which has
been observed where it has been practiced. There can be no question that
the superior intelligence and quickness of comprehension of the human race,
among the highly-favored nations, is due, in great part, to their success in
providing artificial illumination for all classes of society, — literally tnming
night into day.
It has been experimentally demonstrated that sunlight inhibits or re-
tards the growth of pathogenic microbes. Tubercle bacilli will not grow
upon culture-media in direct sunlight, and even ordinary daylight is fatal
to thera within a period varying from a few minutes to several days. Dif-
fused daylight exerts an adverse influence upon the Klebs-Loeffler bacillus,
or organism of diphtheria. Janowski observed that the growth of the
typhoid bacillus was checked by the diffuse light of a cold winter's day,
and that direct eunlight destroyed the microbe in the course of several hours.
As a result of experiments, he concluded that these effects depended upon
the chemical rays. Strong sunlight is injurious or fatal to anthrax spores.
The deetinictive effect of light upon bacteria has been pointed out bv Dawnes
and Blunt,* Geisler,- and ninny others. In 1S94, Dicudonne proved
that direct sunlight in the summer, would kill eptorcs in two hours;
diffused daylight, in about five hours; electric arc (900 candJc-power), in
eight hours; and incandescent light, in eleven hours.
This bactericidal effect was attributed by Fiusen, of Copenhagen, to the
violet rays, or ultra-violet rays, of the spectrum. These rays, he obtained
from a specially constructed arc light, by which all the other rays are re-
moved from the light. Quartz crystal lenses are used in condensing the
light, as ordinary glass obstructs the violet rays. (See page 1120). The
electric light likewise has a similar action, which, according to Professor
Marshall Ward, is direct upon the spores, and not due to a chemical altera-
tion in the culture-medium as had been supposed by some writers,
J. Mount Bleyer, of New York,' called attention to the favorable influ-
ence of the sun's rays upon metabolism. The exposure of the human body
(nude), to sunlight or the electric arc light, especially increases the assimi-
* Proceedings of the Roval Society of London, 1877.
•Centrnlblatt fflr Bakteriologie, 1892, vol. xi. p. 181.
■ Medical Record, Jan. 31, 1903.
LIGHT AND DARKKESS.
1123
I
I
lation of iron and increase of hemoglobin, for instance, when Blaud's pill,
the ammonio-citrate, carbonate, or other chalybeate preparations are taken.
Ferdinando Battistini (Rivista Critica di Clinica Medica) uses the elec-
tric-light bath according to Keilogg's method, with forty lamps rendered
incandescent by a current of 100 to 110 volts. He begins with a tempera-
ture of 30° C, progressively increasing up to 5U°, and rarely to 60° C. The
duration of the bath is from fifteen to twenty minutes. In all cases copious
sweating occurs j>romptly. The pulse and the respiration are increased in
frequency. The effect on the blood-pressure varies. In persons whose circu-
lation was noi-mal, or in whom arteriosclerosis was in the initial stage, the
pressure was very slifjhtly increased, or else not affected. In a second group
of patients, apparently norma! or else suffering with grave arteriosclerosis,
tlie pressure was as high as 35-60-70 mn. of mercury. ArrhjiJimia was
noticed in some cases. The cardiac area was, as a rule, not affected. The
sphygmographic curve was usually fuller during the bath, and occasionally
there were signs of dicrotism. The autlior c-onchides that this method of
treatment should be used very cautiously on patients with a weak heart, or
on those suffering with arteriosclerosis.
Therapeutical Deductions. — The chemical rays of light are especially
useful in medicine on account of their power (1) of destroying bacteria, (2)
of exciting inflammation of the skin, and (3) of penetrating the skin. In
the method pursued at the institute of Dr. Pinsen, at Copenhagen, direct
rays of sunlight or the light of electric arc lamps of 50 to 80 amperes is
employed. The light is concentrated by means of a convex lens. In order
to avoid burning the skin, the heat-rays are cut off by a screen, consisting
of an ammoniacal solution of copper sulphate, confined in a cell on one side
of the lens, made by deepening the frame of the lens and attaching a plain
piece of glass. The lens is hung upon an upright stand, so that it may
be raised or lowered, and turned on a vertical and horizontal axis. In the
case of the electric light, a system of lenses inclosed in a tube, resembling
a telescope, is used. An area of skin of about one and one-half centimetres
('/o inch) in diameter is treated for one hour every day. Redness, swelling,
and perhaps bullae may appear, but necrosis has never been observed. The
most striking results have been attained in cases of lupus vulgaris and ery-
thematous lupus. Dr. George G. Hopkins, of Brooklyn, N, Y., gives photo-
graphic illustrations to demonstrate the effects of treatment. Dr. Finsen
applies the same treatment to carcinoma, in some cases of which very en-
couraging results have been obtained.
Kozlovski, in Vrach, has published an account of his treatment of
rheumatism and neuralgia by means of exposure to the electric arc. Kozlov-
ski fitted up a consulting-room with a suitable plant for producing the
electric arc. With these he obtains an electromotive force of 50 to 60 volts
and a current of from 250 to 300 amperes. The patient is protected by blue
spectacles and also by a screen of cardboard in which an aperture is cut to
allow the light to fall on the affected region of the body. To this it is
exposed for from three-fourths of a minute to two minutes. In the course
of three months Kozlovski treated 38 patients, varying in age from thirteen
to seventy years, by the electric light. There were 8 cases of sciatica, all
of which recovered; -i of neuritis; 3 of lumbago, all of which recovered;
3 of occipital neuralgia, of which 2 recovered; and 2 of trigeminal neuralgia,
1 of which was greatly benefited. In most cases three or four sittings pro-
1124
NON-PHARMAOAL REMEDIES AXD GENERAL THERAPEUTICS.
duced an amelioration of the pain. They were continued. at intervals oi
three or four days, but the total number of sittings never exceeded a dozen.
As the absence of light favors ansemia and consequent lowering of vital
tone from defective nutrition of the great centres, it is obvious that where
this cause is operative it should be recognized and corrected in the treatment
of ohlorosiB, scrofula, scorbutos, consumption, debility, dyspepsia, nen-
ral^a, and a host of other disorders of impaired nutrition. Neurasthenia,
when unattended by latent organic affection, should be treated by sun-
baths, gentle massage, life in the open air, and easilj'-assimilated nutritious
food. In weakly children this course is followed by very satisfactory results,
and a tendency to marasmus, scrofula, and ansmia may be thus overcome.
Anhcematosis is corrected by the actinic effects of the sun's rays, and the
early stage of progressive anaemia may be amenable to this form of treat-
ment in conjunction with proper diet and appropriate remedies.
In the treatment of the sick, a light, cheerful room is of great assistance
to recovery. Especially should an invaUd have a room into which the sun-
light may enter. The eruptions of the exanthemata are made easier by
light and heat, and the course of the disease favored. Where it is not
desired to favor eruption, the part of the body may be covered with a
piece of muslin or an ointment which is impervious to light. Thus, in
small-pox, pitting of the face may be prevented by having the patient wear
a mask of linen, or by covering the surface with mercurial ointment. In
some cases of aoute mania, or delirium, it is advisable to have the sick-room
partially darkened, and in hysterical neurosis it is sometimes observed that
the patients are extremely sensitive to sunlight. On the contrary, persons
suffering with melancholia and hypochondriasis are benefited by light and
attractive surroundintrs. The low spirits of dyspeptics are dissipated by a
daily walk in the open air, while regular, systematic out-door exercise is of
great benefit to the patient in strengthening the digestive functions and
enabling him to "outlive his dyspepsia." Dr. J. W. ELime, of Fort Dodge,
Iowa, has devised a combination of mirrors, which are employed to concen-
trate the sun's rays, which, after passing through a screen of blue glass,
are directed upon the patient's body, at the distance of about eight feet, eo
that the rays will be focused upon the part to be treated.^ He has used it
in chronic joint diseases, in parasitic affections of the sldn (such as lupus),
and suggests its use in puhnonarv tubcrculosi.*. 0. V. Thayer' has used
the sun's rays through a conve.x lens, as an actual cautery to diseased tiasuefi.
He declares that within the period of two minutes the infecting chancroid,
and the Hunterian chancre, are deprived of their contagion and become
changed to a simple ulcer, which readily he^ls. Htemorrhoida, when ex-
ternal to the sphincter ani. are destroyed and slough away, without unpleas-
ant svmptoms. Indolent ulcers are stimulated to new reparative action bj
the sun's rays. Granular surfaces which bleed easily are changed, and
hflpmorrliages from small arteries or veins at once checked. Parasitic dis^-
eases of the skin are cured. Small malignant growths can be completdy
destroyed. L«pus is aI?o surcessfnlly treated,
The Boent]^n Eayi in Medicine.— Of all the forma of radiant energy
with which we are aci^uainted, the peculiar manifestation discovered by
■ JovnMi of the AmeHean JfAftool jlaaootatfoit, liay 12, 1900.
* Pmeifle Medieai Jomrmat, Oct.. WSo.
LIGHT AKD DARKK£SS.
1125
Professor Eoeiitgen^ of Wurzburg, in 1805, ha& pi'oved to bo of the greatest
value from a tlierapeutic standpoint. Wlion the frequently-repeated im-
pulses of the static, or indirect current, arc made to pass through the partial
vacuum of a Crookes tube, there proceeds frora the cathode a stream of
radiant energy, part nf which passes through the glass bulb and is projected
in a straight line. This includes the so-called x-rays, but these are asso-
ciated with other rays, according to Freund, the radiation consisting of (1)
heat, (2) ozone, (3) cathode rnya, (4) ultra-violet rays, (5) rays of material
particles from the anode, (6) Roentgen rays, (7) sparks and electric dis-
charges from the surface of the tube, (8) electric, or electro-dynamic, waves,
and (9) rays of an unknown character. The only constituents which need
he considered are the x-rays proper, the unknown rays, and the electric dis-
charges from the surface of the tube. When the tube is held too near the
surface, it is possible that the shower of material particles may be also
effective, especially in causing destmction of vitality. The ultra-violet rays
are not intense, and probably do not escape from the tube in any great
number, as they are checked by glass. The source of x-rays is an exliausted
glass bulb placed in the path of an electrical discharge, or rapidly-consecutive
discharges, obtained by means of a TiuhmkorIT coil, or an influence electrical
machine. The x-rays have more decided effects than the Lenard rays, in
photographing the invisible. X-rays pass directly through opaque sub-
stances, but their intensity is diminished by some more than by others.
Metals, the osseous frame-work of the body, and solid organs (or tumors)
throw more of a shadow than the softer parts. Photographs thus obtained
are called skiagraphs, and an instrument, like a stereoscope, for examining
the parts, is called a skiascope.
The apparatus for x-ray examination is now a part of the equipment of
every general hospital. It is of the greatest service in the diagnosis of
fractures luirl in examination during the progress of the case.
Apparatus. — Various forms of tubes have been tried, some of which
posBCj^s ilwided advantages. The unipolar tube, for instance, of Samuel
Stem' has a special application for deep applications in the cavities of the
body, as in laryngeal or vaginal cancer.
Reduction of the Vacuum in a Crookes Tube. — W. T. Stewart' proposes
what is apparently a simple method of lowering the vacuum of tubes that
have become too hard. Some time a^o. it was stated by English observers that
a tube could be softened by baking it for several hours. This has led Stew-
art to devise an oven which will give a uniform temperature and not subject
the tube to a higher temperature in one place than another. The outer sheU
of the oven is composed of sheet iron lined with asbestos. Within this ia
an inner shell of corruprated iron with openings, by which the heat is dis-
tributed equally over all parts of the chamber. An alcohol burner furnishes
the necessary heat. It requires from five to fifteen minutes to satisfactorily
reduce a tube.
Caldwell' describes an x-ray tube for treating internal parts, as the
cervix uteri, rectum, larvnx, etc. The target is placed not within the
spherical part as usual, but at the end of a tubular projection from it. In
^Archives of the Hocntgrn Ray, Sept., 1&05
* American X-rau Journal, Feb.. 1903.
• Veir York Medical Journal, May 12, 1P02.
112G
NON-PHABMACAL HfiMEDIBS AND GENERAL THERAPEUTICS.
using the x-ray apparntns, Inaden shields and specula are used to protect sur-
rounding tissues, although uterine caucer is treated by rays from a high
vacuiini tube, directly through the perineum, or through the abdominal
wall. The high tension tubes are less likely to produce dermatitis than the
low tension. By repeated exposures the tube tends to become harder or of
higher tension. "With regard to these Clarence E. Skinner, of N'ew Haven,
says :^ "A practical point involving some difficulty is the rapiditj' with which
the vacuum of high tubes will be worked up beyond a manageable limit by
the long and frequent seances demanded in therapeutical applications.
Chemical regulation of the vacuum is a partial success, and ordinarily will
nearly double the life of the tube. The method of overcoming the difficulty
that has given me the most satisfaction, however, has been to have the tubes
made without chemical and exhausted to medium vacuum. Then when the
tube refuses to glow from use, have it baked, at a temperature of 350" F.,
for from thirty minutes to ten hours, according to the idiosyncrasy of the
individual tube. If the tube is baked too long the vacuum will get too low,
but that can always be overcome by running the tube hard for a few minutes
upon a static machine with open spark-gaps."
For the protection of the operator, various devices have been suggested.
One of the best of these is the screen of Talley and Neweomet," which con-
sists of three sections, each 24 inches wide and 6 feet high, which are joined
hy hingefl. Each section is made to hook rigidly at right angles with its
fellow, thus making three sides of a box six feet high. By leaving one side
open, the patient can easily be placed in position, or removed. Two sides of
this screen are lined with sheet lead. In one is a movable window for the
fluoroscope, which should be large enough to give a shadow of the whole chest
without being moved. The third side is not covered vrlth metal, but simply
with black pnper to enclose the x-ray tube, and thereby lessen the light in
the room, and at the same time to act as a frame for measurements and
plumb-lines used for centering the x-ray tube. The side directly opposite
has the frame for the fluoroscope adjustable for different positions. Over
the fliioroscope is placed a piece of plate-glass, which is transparent to light
rays, but blocks the x-rays to a great extent. At the same time it serves
another purpose, in protecting the screen from being scratched by the point
of the pantograph, which is used for recording the conditions as they are
shown to exist. The pnntograph is firmly attached to the same side of the
screen on a soft piece of wood, so that paper can bo easily placed under the
pencil and held by a few thumb tack.*:. The tracing on the glass over the
fluoroscope will ho thus easily recorded, about ^/^^ its natural size, which is
very convenient for clinical records. It is best to have this instrument
attached to the side, not to the protecting connecting side, as it will lessen
the danger of the operator's coming in the range of the active ray. Tt is
advised, in order to minimize the danger to the patient, to adopt the cardinal
rule, not to expose the body to the ray longer than is consistent with thor-
ough examination, and not to reexamine at too clopc range. It is also
important in use only onoiigh energ>' to penetrate the body, which is much
less in a dark room than in one only semi-dark, and at the same time the
st be accustomed to the darkness. T
eye
-ray
kept
' The Medical fitandard, Marcb. 190.3.
^JournaJ nf the American .Vedicnl Atiftorintion, Feb. 24, 11)06; pnge 't^^.
LIGHT AHBDS
1127
least a foot away from the body; and IS inches is better. Besides lessening
the danger of burn, there is nho less distortion of the shadows on the screen.
Unfortunately in heavy subjects, it will be found that 18 inches distance
is too far away for a good i>eiietration.
Much experience in skiagraphy and in liandling tubes should be had
before attempting therapeutic applications. This work is inuch more satis-
factory than it used to be, M. IT. Kass^ibian* has taken instantaneous
.ekiagraphs in one second, the time of exposure depending largely upon the
'size and character of the apparatus employed, the degree of vacuum of the
tube, and tlie t!iickness of the part to bo skiagraphed. The time employed
by him in skiagraphing the hand is one second; vrrist, two seconds; forearm,
three seconds; elbow, three to five seconds; shoulder, ten to fifteen seconds;
knee, ten to fifteen seconds; hip, forty to sixty seconds; face, ten to fifteen
seconds; cranium, forty to sixty seconds; thorax, twenty to thirty seconds;
abdomen, fifty to ninety seconds. These figures are a mean of those ob-
tained in individuals weighing between 125 and 145 pounds. For an
increase of weight of 15 pounds, one to two seconds must be added to t!ie
estimate. The time with the static macliine is from one-fifth to one-third
greater.
The advantage of short exposures lies in the greater definition obtained ;
they do not cause bums and the marring of plates which comes from the
movements of the patient.
A. D. Rockwell states' that, as regards the equipment for x-ray thera-
^peutics, it varies but little from that of x-ray diagnosis. The same exciting
'apparatiip, whether static mflchine or induction coil, is equally efficient for
both uses, but there is sonirthing to be said in the way of differentiation of
tubes. When a tube of low resistance is used to skiagraph a hand, for
example, the shodmvs nf the l>ones are quite distinct, indicating that the
rays have been absorbed. With a tube of high resistance, on the contrary,
ever}*thing is lighter, the shadows are less sharp, showing that most of the rays
have passed through. Tubes of low resistance (or low vacuum), therefore,
have not much penetrating power, and are recommended for the treatment
of superficial diseases, since the surface absorbs so much of the light. Tubes
of high resistance for high vncuum) have greater penetrating power, and
are to be preferred fnr deep-v^eated pnthftlntrjcal conditions. As regards the
distance thnt the tube should be placed from the patient, this will vary
according to the apparatus used. Ordinarily, the limit.^ are from 4 to 12
inches, or about 8 inches on the average, depending also upon the disease,
the desired length of exposure, intensitv, etc. Exposures may be made once
or twice a week; rarely once a day. The time of exposure is from fi\o to
twenty minutes. As some patients appear to be very susceptible to the
. efliects of the rays. Beck recommends that the preliminary exposures shall
'not be longer than five minutes, and after a weok. ten minutes. If, after
a third exposure (two weeks after the first), no reaction follows, the patient
apparently possesses no idios^-ncrasv. Then the treatment may be given
ever>' two or three days, and at last daily, unle<5s intense reaction ocnirs.
During the tentative exposures the distance of the tube should be at least
four inches ; later this may be reduced to one inch.
1
' Amrriean \-)nt/ Jonrnah Feb.. 1003.
*The MrtUrttl C'ntic, Feb., 1903.
1128
NON-PHARllACAL REMEDIES AND GENERAL THERAPEl'TICS.
Ueed witli such precautions, find witli a tube suitable for the kind of
work, the x-rays can be applied with safety to the patient. If the limits of
caution arc exceeded, tnnninfr of the skin, erythema, and sloughing of soft
parts down to the bono may lie induced. Such accidents have led to suits
for malpractice. Ton frequent exposure, in tlie attempt to hurry the treat-
ment, may leafl to local and general sepsis.
Effects of the X-rays. — \\ Idle bactericidal eflfecti; can be demonstrated,
yet, as u^ed in ordinary therapeutic applications, it is probable that the
bactericidal influence is neplt^ble. in the opinion of Samuel Stern. ^ The
effect of the x-rays upon cellular elements of tissues may be comprehensively
stated as stimulating, at first and in small doses; but destructive if used too
long, too frequently, or in too large doses. The fact that diseased tissue has
feebler vitality than healthy tissue is at the fnundntion of the therapeutic
use of this agent, since it will be destroved before the healthy tissue beconies
affected. E. Dalous and J. Lassere Toulouse (Annafes dc Dormaioloine,
Paris), write: *'Thp microscope reveals tliat there are certain special lesions
due to the action of the Roentgen rays on the epithelium, an actual *radio-
epithelitis,' as Palous style? it. Similar niodificntions occur in the tissue
of a neoplasm, and as they develop thoy induce a macrophagic connective-
tissue reaction. All the cells of the neoplasm do not feel the effect of the
rays to the same degree, some being more sensitive than others. In the sound
epithelium the basilar layer, or stratum fjorminativum. and the cells of the
mucus layer, immediately above, are affected most, and the corresponding
cells in an epithelioma. On the other hand, the cells of the prickle layer
and of the hornv layer are too firmlv interlocked and too large to be effect-
ually attacked by phagocytosis. The latter process, besides, seems to be
secondary in importance. The hipfoloiric findings described explain why
epithcliomata of the typf^ of the cancroid and the squamous epithelioma are
less favorahlv influenced by radio-therai\v than epitheliomata of the baso-
eellulnr tvpe, columnar epithelioma, and rodent ulcer. The Roentgen rays
are decidedly elective in their action. The most sensitive cell? in the
neoplasm are those which are derived from cells which normally are most
sensitive to the action of the rays. In cutaneous epitheliomata, therefore,
the squamous and the columnar types, the former arc resistant to the x-rays
and the lalter succund) to them, corresponding to the elective action of the
x-rays on the cells of the sound epidermis.''
The first effect ujKin the tissues is a siimulation of the vaso-constrictor
nerves, tlierehv inlerfering with the blnod supply of the part exposed. This
condition is followed soon by gradual paralysis of these nerves, if the stimu-
lation is continued, and hyppra?mia is produced. This may develop local
dermatitis; or there may be local gangrene of very slow progress, but gen-
erally deep and extending to the bone. Tn some cases, where the applica-
tions liave been too frequent or prolonged, molecular disintegration takes
place, which leads to septic infection and death from exhaustion. It has
happened to persons frequently exposed to x-rays, as o]"»erators or assistants,
that injiirious results have ensued. TiOss of hair, chronic inflammation of
the skin of the backs of the hands, fingers, and arms, and even malignant
degeneration and epithelioma have been observed. One of the effects upon
^ New York Medical Journal, March 10. lOOa.
males has been sterility or inipoteiire. With tlip nse of what are called
*'hard tubes/' in which there is a good vacuum, and the protective appliaaccs
now obtainable, and with proper care, tlie evil effects of the x-rays can be
entirely avoided.
Roentgen Bays in Diagnosis, — In surgery the diagnosis of fractures
in bones, dislocotinns, sprains, morbid growths, calcnii in the urinary pas-
sages, or in the bile ducts, location of foreign bodies, detection of anomalies
of development, and many other (i-onditjons nre now made by the aid of
x-rays as a routine procetJiire, in all hospitals, and is extending in private
practice. In medical ease.^, various morbid conditions of the lung and
pleura can be plainly demonstrated ; effusions and new growths located; also
foreign bodies. Hypertrophy of the heart, pericardia! effusion, aortic
aneurism, enlarged bronchial glands, arc also recognizable. Floating kidney,
gastroptosis, hepatic dislocation, ectopic gestation, appendicitis, are also
.made evident.
The screen of Talley and Newcomet facilitates skiagraphic study of
various lesions^ especially in those of the heart and lungs. Here the fluoro-
scope gives the shadow of the living pulsating organ, and the size of the
heart can be ascertained. Pneumonic consolidation, or abscess cavities, are
plainly discovcrod.
Eoentgen Eays in the Diagnosis of Pulmonary Diseases, — J. F. H.
Dallv bus an exhaustive article in the Lancet of June 27, 1903, on the value
of the Roentgen rays in the diagno<^i9 of thoracic conditions. This new
method of investigating the chest should not be separated from tlie ordinary
methods of physical research, although an accurate diagnosis may some-
times be based on the x-rays alone.
The writer's observations were made with an induction coil, capable
of giving a 14-inch spark at high pressure, between the terminals of the
secondary coil. !Miieller\s tubes nf moderate hardness were used. Both
radioscopy and radiography are indispensable in the investigation of intra-
thoracic conditions. The choice of one or the other depends upon circum-
fltances. Radioscopv ^liould be used at first, combined with auscultation
and percussion. This may be followed i>y (he taking of radiographs from
different points, the latter supplementing the fluoroscopic investigation.
The text-books on physiology* state that the diaphragm is flattened in
expiration. Examination with the rndioscope shows that the curve of the
diaphragm is not altered, but that it descends and ascends without alteration
of the cnn^ature, and that in quiet breathing the excursion amounts to about
half an incli ; in forced respiration the depression amounts to 27^8 i^f'li^s on
the left to 2Vn inches on the right side. Repeated observations show that
loss of motility of the diaphragm is the earliest indication of tuberculosis.
Before any shadow due to the tnlierculous process nf the lung is visible, tlie
artion of the diaphragm is les.*?ened on the affected side. The typical
shadow cast l)y early tuberculous deposit is mottled or stippled. This ap-
pearance is eharactf^ristic and is simulated only by new growth. Other
shadows for which the tuberculous shadow may be mistaken are those dne
to adhesions or to such normal appearances as the mammary shadow or the
pleural and pericardial lines. All of these mav he distinguished by their
greater homogeneity and regidaritv. Consolidation shows a shadow of
moderate density, and this is increased if the lung be congested. The loss
of permeability due to caseation throws a still darker shadow. Appearances
1130
KON'-PUARMAOAL REMEDIES AKD GENERAL TUERAPEGTIC8.
presontecl by cavities vary according to their size, position, and whether
empty or not. Cavities only half an inch in diameter have been clearly seen
during life, and their existence verified post-mortem. A cavity at the apex,
or on the side nearest the focus tube and close to the surface of the lung,
appears, if empty, as an area of unusual transradiancy. If full of pus or
retained secretion, if embedded in the centre of the lung, or in a mass of
consolidation, it may not appear, or it may be found lighter or darker than
the surroundinj? tissue. In many cases cavities appear^ upon examination,
to be smaller than the auscultation sounds indicate.
In pleurisy, in the early dry stnge, there is no shadow. If there is
efftwion the jippearancos vary according to the nature and amount of the
fluid. A purulent effusion yields a darker shadow than a serofibrinous
effusion, the shadow in each case being homogeneous.
Emphysema, bronchitis, and asthma are so frequently associated that
they can be grouped under one head. Emphysema is indicated by bright^
ness of the lungs as a whole, or if only parts of the lungs be affected, by
brightness of those parts. Thip brightness is intermediate bc^twoen the
normal clearness of the lungs and the exceptional brilliancy seen in pneumo-
thorax. Bronchitis has no peculiar nppeanincos. The shadows in cases of
asthma are similar to those in emphysema.
In pneumonia due to engorgement and exudation, a light shadow is
cast. Consolidation gives a dense shadow, with ill-defined edges. In doubt-
ful cases where pneumonia is suspected, but there are no physical signs, the
Eoentgen rays are often of service. By their aid a central patch of pneu-
monia may be revealed. The excursion of the diaphragm is limited in
pneumonia, as it is in tuberculosis and pleurisy. Whenever this limitation
is noted, these conditions should he considered. Restoration of diaphragm-
atic function is found by experience to be a more accurate test of recovery
than alteration of the physical signs, or diminution in the opacity of the
lung.
The location of foreign bodies by this method has gained
universal application. In the case of foreign bodies in the eye or
brain, many ingenious methods have been devised for exactly locating
Oie object^ thus grciitly facilitating its removal by surgical operation,
and unnecessary probing is in this way avoided. In gunshot wounds-
of different portions of the body the missile is readily recognized. In all
forms of calculi existing in the bladder or elsewhere this method affords
the most satisfactory moons of studying their number and location. In the
diagnosis of calculous nephritis it offers the only possible means of positive
diagnosis, except an exjjloratory operation. It also shows the absence or
presence of calculi in the other kidney. Consolidated areas of the lung in
pulmonary phthisis may be recognized by their relative opacity, and skia-
graphs may be obtained from time to time. Mediastinal tumors have been
differentiated from aneurisms, tumors of the liver have been recognized, and
the size and movements of the heart demonstrated. Dr. Charles L. Leonard
has suggested that the outlines of the kidney, shown in the skiagraphie
examinations for renol calculi, make it highly probable that the position
and size of renal tumors, or the mnlformation or entire absence of a kidney.
will be readily detected. If we desire to follow the outline of the spleen
more fully, we can, by filling the stomach and large intestine with air, con-
trast the dark area of the spleen with the light area occupied by the gas.
LIGHT AND DARKNESS.
1131
[ through which the rays readily pass. When it is desired to examine the
large intestine, air may be pumped into it, and its outline, such as the sig-
moid flexure, and the dpscending colon, be easily followed. By dis-
tending the stomach, and in some cases the large intestine, we can detect
some pathological conditions in or about the pancreas. When fluid is
present, the examination should be made with the patient lying on his
back and the tube on a level with the fluid, the rays from it passing through
the abdomen horizontnlly. Patients with suspected "phantom tumor"
should always be examined by the x-rays. The administration of sub-
nitrate of bismuth in half-ounce doses causes the digestive tract to become
opaque to the x-rays. By examining in this way, at various periods, the
outline of the stomach and the progress of the bismuth along the intestine
can be demonstrated.
Therapeutics. — In skin diseases, the x-raya liave a very extended range
of usefulness, especially in parasitic and chronic affections. Thus, non-
parasitic sycosis, alopecia circumscripta, (tinea decalvans), pityriasis,
tubercular lesions, lupus, sarcoma, and epithelioma have all been success-
fully treated. Mycosis fungoides has also yielded, but requires continued
treatment to successfully overcome the tendency to relapse. Tn acne vul-
, garis (both pustular and indurated varieties), good results have been re-
rported by numerous observers. Pagot's disease of the nipple has been cured.
Stem advocates a combination of the high-frequency spark and x-ray
applications, and declares them of extreme value in the cure of all forms
^ of epithelioma. In other forms of malignant growths, they arc useful in
1 relieving pain and assisting in prolonging life, but should only be used in
non-operative cases or in conjunction with surgical measures. In internal
diseases, they are useful in Icnkiemia, Hodgkin's disease, various forms of
chronic tubercular conditions, in subacute and chronic rheumatism, lum-
bago, sciatica, and other neuroses. He claims 100 per cent, of cures in
sycosis non-parasitica, and almost as great percentage in eczema and in
I psoriasis. Although useful in acne vulgaris, it is not of much value in
rosacea. It is highly valuable in favus, tricophytosis, keloid, lichen, my-
cosis fungoides, folliculitis decalvans, and hypertrichosis. The x-ray, or
high-frequency spark, or the combination of both, is very valuable in the
treatment of all forms of pruriginous affections due to any cause.
F. IT. Williams, in two cases of herpes zoster, reported immediate relief
from pain and burning sensation.
Chronic leg ulcer has been cured by radiotherapy, applications being
made at intervals of 3 to 7 days. (W. Tj. Heeve.)
In rhinoscleroma, Gottignics (Journal Medicale de Bruxelle, June 18,
1903) reported in one cmo marked improvement under the treatment.
In locomotor ataxia, John W. Daniel, in two cases of ver}' marked type,
. obtained remarkable improvement, both in abilit}' to walk and in eyesight
} (Medical Age, June 10, 1003).
Aotinomycosis was successfully treated by A. D. Bevan {Medical Rec-
ord, May 30, 1903) by large doses of potassium iodide internally, and
x-rays to the tumors.
L In the tronliiieiit of pseudolcukeemia, or H^dgkin*? disease, numerous
^observers report siioccfiss. Thus, J. T. Dunn {International Journal of
Surgery, October, 1903) reports a case involving the glands of the neck.
1132 XOS-FHAKMACAL REMEDIES AND GENBltAL THERAPEUTICS.
i ted been in progress for seven years, and the patient had lost fiftj'
!■ m wwght. After fifteen treatments there was decided improvement
a ^uft of sixteen pounds. A further series of treatments rei?tored the
mi to normal. F. H. Williams (Medical News, October 3, 1904) finds
in Hodgkin'ft disease the x-rays will prolong life, and in some cases
Scrofaloud adenitis, especially of the neck, yields readily to x-rays. In
leukaemia, Oliver T. AVillinms {Bio-chemical Jounml, April,
I), after x-radiation, observed a marked increase in the number of leu-
, vith an increase of nitrogenous excretion and of uric acid, A rise
t^Bperatnre also was observed {100.6"). He concludes that, in this
exposure to x-rays produces a disintegration of proteid material in
\Vbt kwcocvtes, the products formed giving rise, in some coses at least,
grate "constitutional disturbance. It is suggested that when x-ray
[l^fApT is used in this disease, the patient should be allowed a sufficient
between each exposure to excrete the toxic products which are formed.
dailv estimate of the uric acid excreted affords an indication of the
th of such intervals, and also gives an intimation of the safe dose of
3t'-rav5 TO be used.
Malignant Growths. — William Coley, of Xew York, found that x-rays
haw a Terv decided inhibitory action upon the various forms of sarcoma, in
fctfVtain cases sufficient to cause the entire disappearance of inoperable
tw»or». Yet there is a strong tendency to local or general recurrence, and
Ift MO iitftauce had sufficient time elapsed to warrant the statement that the
had been cured. In deep-seated and inaccessible growths, especially
^aftfkdkMvll, the results from the toxins will probably be better than those
' froB the x-rays.*
A Supposed Sarcoma of the Kidney Cared by the X-ray. — C. R. Eich-
laond* in the New York Medical Journal of May 30, 1903, describes the
««9e of a married woman, forty years of age, who began losing flesh and
it|r«tigth and showed decided ana?mia in the latter part of September, 1902.
lu tl^ autumn of the same year a growth was found in the right side of
llM abdomen, which developed rapidly. It was believed to be a sarcoma of
tiA kidney. The patient was given daily treatments of fifteen minutes
Meti for nineteen consecutive days. The general condition rapidly im-
evfd and the tumor ceased to grow. At the end of nine weeks from the
a tltatment was begun, the growth had disappeared, so far as could be
jMMWtned by bimanual examination. At the time of the report she was
afyarently as well as before the development of the severe symptoms.
IK>h*Tt Reyburn, of Washington, D. C. states that if malignant growths
vHXH»r At or near the surface of the body, this is the very best method of treat-
lamV He bt'lieves that tliere are three methods in which the beneficent
liOti^Xft \^i the x-rays and the continuous current may take place: —
FtT»4.--ln the very earliest periods of the morbid growths, these agents
.^9^^v tlw»ir stimulating and nutritive effect upon the vital processes.
"--xx«d. — In the second, or more developed, condition of the morbid
^•'•m\i\^ wiwn we apply strongpr currents of electricity, or give more vigor-
^m^ T^THy iTtvitnient, we inhibit the growth of the tumor.
XW« MHlical Joui-nal, Aug. 8. 1903.
LIGHT AND DARKNESS.
1133
Third. — AVlieu the gro>\'th of the tumor hns more fully developed, we
have to depend upon the necrotic or caustic effect upon the morbid growth
of strong application of the x-rays, or powerful gnlvanic currents. Dr.
Reyburn believes that **bne reason why the x-rays often fail to cure these
growths is that the application of them, or of the continuous current, is
made over too small a surface of the body. It should always be remem-
bered that the cancer cells are infiltrated into the tissues over a much larger
area than the apparent surface of the tumor; a space three times the size
of the tumor ehould always be treated by either the x-rays or the continued
current."'
TTnfavorable Action of X-rays. — When this method was at first intro-
duced, it was used by crude methods and inexperienced operators. Cases
were reported in which severe dermatitis had followed the prolonged ex-
posure to x-rays and evpn epithelioma of the soft parts occurred, in some
cases requiring amputation. Dr. Philip Mills Jones' declares that their
character is that of necrosis, or local gangrene, in every way analogous to
an ordinary burn, and not due to any action of electricity upon the part,
nor to minute particles of metal projected into the tissues. These accidents
are now very rare. Every tube in action evolves rays of low and high pene-
trating powers, in varying amounts, according to the degree of vacuum and
other conditions. The rays of low penetrating power are given out when
the vacuum in the tube is too low or when the tube is "soft," to use Pro-
fessor Roentgen's recent designation. Dr. A, Clifford Mercer says that
"a ^ard' tube or one with a high vacuum and requiring a high potential to
work it, will give rays that pass freely through the flesh, and, not being
absorbed by the skin, cannot, of course, do injury. ... To avoid any
risk of x-ray bums we must work the tube at such a high vacuum as to
give rise almost entirely to rays of great penetrating power, or non-absorb-
ability; or we interpose between the tube and skin surface a screen, which
will cut off the more injurious rays by absorbing them."*
In the treatment of x-ray bums, moi«t alkaline dressings, or the cata-
plasma kaolini, will be found agreeable. In addition, Henry G. Piffard,
.of New York, recommends zinc chloride, and high-frequency currents or
■ultra-violet ray?. The descending constant current might also be used to
stimulate normal metabolism. Internal treatment with the glycero-phos-
phates and chalybeate preparations would be indicated.
Tilden, Brown, and Osgood (American Joumcl of Surgery, 1905,
No. 9) state that mon by their presence in the x-ray atmosphere incidental
to radiograph for therapeutic use, or testing of tubes, may after a period of
time be roiideifd sterile. The statement is based upon the discovery of
ten x-ray workers who wore the subject of total- azoospermia, although none
of them had suffered from any venereal disease or traumatism involving
the genital tract, and none were conscious of functional derangement. Sub-
ksequent observations have increased the number of observed cases to
' eighteen, in all of whom either total azoospermia or oligonecrospermia was
demonstrated. Indeed, all nf those who had been working extensively in
x-rays for more than three years, failed to show spermatozoa in their seminal
' \etp York Metiicnl Journal, March 17, IftOfl,
^Piu^fic Rrrofff, Ort. 15, 1898.
'Philadelphia Maiical Journal, Jan. 6, 1000.
1134
NON-PHARMACAL REMEDIES AND GENERAL TUEttAPEUTICS,
fluid. A few engaged in the work for a shorter time, and particularly
those who exercise care in avoiding direct exposure to the active tube, fthow
varpng stages of oligonecrospermia. Several cases subject to infrequent ex-
posures showed normal spermatic fluid. In none of these cases was there
noted even a transient erythema of the scrotumj nor was there any deterior-
ation of sexual activity. Of the married men none have begotten children
since they undertook x-ray work.
Attention to this result of x-rays was first excited by Albers-Schoen-
berg, who exposed five male rabbits and six guinea-pigs, and made four-
teen matings with unexposed females for periods of ten days to- six months,
without a single lifter being produced, although the male covered the female
as frequently as the normal animal does. Autopsy on these animals showed
spermatozoa in the seminal follicles or testes in but one. These animals
were observed for four and a hnJf months after cessation of exposure, but
failed to impregnate. Bergonie and Tribondeau reported similar results in
white rats.
Halberstaedter concludes from his experiments that the ovaries are
markedly more sensitive to the x-rays than the skin.
Philipp reports a case trcnted for pruritus uni, the time of total expos-
ure being 195 minutes. Seven months later examination of the seminal
fluid showed complete azoospermia. Philipp noted that after two ex-
posures eaoh for fifteen or twenty minutes for the cure of pruritus the
number of spermatozoa was not diminished, but that they were all dead.
This patient was so greatly relieved from his pruritus that he insisted upon
two further treatments, after which the spermatozoa disappeai'ed. Five
months later the semen was found swarming with living spermatozoa.
The rays seem to produce a degeneration of the specific epithelial cells,
though human spermntozna in seminal fluid expoeod for thirty minutes
present no demonstrable cliange in form or motility. As a means of pre-
vention it is suggested that tlie operator of the Roentgen tube should work
behind a screen impermeable to the rays and should expose himself only
when absolutely necessary, and then only for an extremely short time.
The Therapeulic Gazetie says in commenting upon this: In view of
the recent legislative activity in regard tn the prevention of the breeding
of idiots, hopeless epileptics, and criminals, if the sterilizing effect of the
x-ray be permanent, this might prove a useful tneaus of ridding commu-
nities of children cursed from their birth nnd destined to become a burden
and expense to the state, and at the same time might make legislation directs
to this end feasible by satisfying those whose objection is based upon the
performance of a more or less mutilating surgical operation.
RABlUM. — Curie and Madame Curie have recently given to the
scientific world (19Q2) a new element, radium, which is in an unstable
condition, and constantly rediates energj'. It yields an emanation which
appears to be identical with helium gas. Radium, fortunately, only has
been found in very small quantities, and is obtainable only in combination
as salts of radium. It is so destructive to life that it can only be used in
tubes containing tcn-ihousandths of a milligramme. Different tubes vary
in physiological nnd therapeutic activity.
Action of Eadium on Living Tissues. — Thies (Trans. Ammcan Medi-
cine, August 26, 1905) found that this was much like that of the Roentgen
HC8IC.
113B
rays. He made a series of experiiuciits, mainly on rabbits, with the follow-
ing results: Tissues exposed very close to it for a long time were always
killed, but those exposed at a distance were often stimulated to growtli.
2'hc rnosi siiscepiible tissue was adenoid; second, skin and other epiihelial
tissues J third, arteries and veins; and fourth, striped muscle. Elastic tis-
sue and cartilage were much more resistant. The eosinophilea were often^_
found in large numbers after exposure. ^^M
Dr. Darier, in a communication to the French Academy of Medicine,^*
I states that he has successfully cmph\vcd radium in the treatment of cer-
tain forms of neuralgic and rheumatic complaints, tlie pain being romov
* by the action of radium on the nervous centers. A case of facial paralysii
was quickly cured by two applications of radium in only slightly active'!
form. Dr. Darier considers that the injurious eflects on the nervous system
|flt first observed were due to insufficient experience in the use of the new
I agent. Trachoma has been successfully treated by applications of a tube
^containing radium bromide. Care must be exercised in handling these
tubes, as they occasionally explode, owing to greatly increased internal^
tension.
?r-
iveS
?mV
MUSIC.
emai^
Music belongs pre-eminently to the domain of psychological medicine.
It is, therefore, appreciated to a greater degree by the neurologist and
alienist than by the general practitioner. Man is something more than a
definite combination of chemical compounds, and even more than a mere
rational being; he is a moral and emotional individual, and this particular
portion of his organization is the most innate and personal part of his
nature as revealed to him by self-consciousness. When a man's feelings are
touched, he is aware that he is profoundly moved, and that, whatever it
may be in this structure which is affected, it lies deeper than his reasoning
powers or his physical frame. When a man's sympathies are excited, he is
impelled to a certain course of action by a more powerful force than that
which he recognizes as emanating from his reasoning powers, or from what
are ordinarily considered as the imperious demands of his bodily appetites.
Happiness and misery, affection and aversion, love and hate find no place
in natural philosophy or science, but they are powerful factors in human
life, and in determining its issues for good or evil. Man is so constructed
that his reasoning powers and emotions cannot be separated, nor can we
think of these apart from their embodiment in a corporeal frame by which
they are brought into material relationship and communication with the
world. This being the case, the complete nature of man must come within
the domain of medical science, which, indeed, finds expression in the old
aphorism, **mens sana in corpore sano,'' health of the body not being com-
plete without there is also mental health.
Physiological Effects. — Music, in addition to its influence upon the
emotions, has a decided influence upon the body. M. J. Rambosson read a
paper before the Acad^nrie des Sciences Morales et Politiques (July 18,
1877), entitled "The Influence of Music on the Physical and Moral Nature
of Man." In this eseay he al!irmed that there is (1) music which acts
cpecially on the intelligence and the motor nerves; (2) that which acts
iiao
NON-PIIARMACAL KEilEDIES AND GENKRAL THERAPEUTICS.
specially upon the nen-es of sensibility and on the sentiments; (3) that I
which acts siinuUaneously upon the motor nerves and on the sensory, — :
that is, on the inteUigcnce and the sentiments. From experiments made by
Dogiel upon m^n and the lower animals, the following deductions are drawn: ,
(1) Music exhibits an influence upon the circulation of the blood. (2) The ■
blood-pressure sometimes rises, sometimes falls. These variations in blood-
pressure depend essentially on the influence of the excitation of the audi-
tory nerve on the medulla oblongata, which is apparently in direct con- !
tinuation with the auditory nerve. (3) The action of musical tones and i
pipes on animals and men expresses itself, for the most part, by increased |
frequency of the cardiac contractions, and hence it follows that the auto- i
matic centres of tlic heart act with greater energy. (4) The variations in i
the circulation, consequent on musical sounds, coincide with changes in the |
respiration, though they may also be observed quite independently of the
respiration. (5) The variations in the blood-pressure are dependent upon \
the pitch and loudness of the sound and tone-color. (6) In these variations '
of the blood-pressure the idiosyncrasies of the individuals, whether man or '
the lower animals, arc plainly apparent; and even the nationality, in the
case of man, has some effect.^ l
Dn Herbert Lilly, in the year 1880, wrote a pamphlet on the "Thera- '
peutics of Music," in which he claimed that music directly influences the
brain, in some individuals more than others, women being more readily i
afTected than men. *'*lt8 efTecta are transmitted by a reflex action, through ,
ners'e-media, to the sympathetic system governing the vascular supply. The j
vessels are made to dilate by gtimulation of the vaso-inhibitory nerves or
paralysis of the vasomotor nerves, and so the blood flows freely and imparts \
that sense of warmth which is felt by us by reason of the local hypcrceraia
thus produced. By blood-supply is nutrition effected." The important in- !
fluence upon the bodily functions of the imagination has already been
referred to on a previous page. This, also, is under the influence, to m
greater or less extent, of music.
The ancient habit of introducing music at banquets is based upon the
well-attested fact that digestion is fflvorc?d if the mind be pleasantly enter-
tained during the time of eating. On the contrary, unpleasant thoughts or
violent emotions will take away appetite and retard digestion. Children are
usually fond of music, and their uninstrncted attempts at dancing show the
stimulating eftects which it exerts on mind and body. In the adult life,
when the musical taste is more cultivated, the feelings may be swayed by
music ''from grave to gay, from lively to severe." The sense of pleasure
and elation of spirits from inspiring military music has been experienced
by most of us; but when to these are added the charms of association as
famih'ar airs are heard, the influence is deeper and more affecting. As an
illustration, we may mention the effect produced by the unexpected hearing
of patriotic airs when in a foreign land. Music may be instrumental or
vocal, or both combined: "words to music fitly joined." Vocal music has in
it a personal element far greater than instrumental, and the mother's songs
to her fretful infant contain a subtle influence to soothe and comfort the
child. In the same manner it is observed that in hospitals cheerful singing
* Letter to British Medical Journal, by Frederick K. Harford, of the St OcOIa
Guild. Nov. 14, 1891.
I
I
I
I
w vm* grateful, especially to tln^se whose troubled minds increase tlieir
restlessness and physical suffering. Music diviTts the mind from bodily
pain and leads it into more pleasant channels.
Therapeutical Applications. — In dentistij, a pleasant application of
music is that in wliich, during the administration of the anaesthetic gas,
a music-box is made to play lively airs. This directs the patient's thoughts
into an agreeable direction, and no apprehension beforehand is felt, nor is
there any recollection of the tooth-pulling afterward, the patient on recovery
being ready to afiirm that he had been at the opera or a ball. A further
use might well be made of this in practical surgery. In nervous hj'pochou-
driacs, people who are morbidly anxious about tncmselves, it is more effective
to recommend the opera on one or two nights weekly — eVen opera-boutfe,
if grand opera be not appreciated — than it is to prescribe ammoniated tinct-
xixe of valerian, coca, or damiaua. For depression of spirits or a tendency
to melancholia, lively music, such as a concert by a military band, for those
who enjoy it, and vocalization of tender or pathetic ballads for those
of more sensitive nerves, are resources within the province of the skilled
physician, who knows how to "minister to a mind diseased" even if he does
not throw *^ph}'8ic to the dogs."
The State Pathological Institute of New York has recently investigated
the question of the influence of certain musical tones and strains upon the
nervous system, particularly in the case of the insane. By the aid of the
ergograph, which is an instrument devised to note the amount of fatigue
experienced by the muscles of the hand and arm used in psychological
experiments, it has been found that when a lively air was played upon a
harp more effort was put forth before fatigue was shown, while certain tones
on the ^cello caused the opposite effect. This subject is an old one and is
practically utilized in employing military bands to play enlivening aira
during a march.*
A notable example of the influence of harmony in melancholia came
within the personal experience of the author. Having charge upon one oc-
casion of a gentleman atllictod with melancholia, the capitals of Europe were
visited in search of every advantage of travel and recreation, but nothing
touched the settled gloom of the patient until, in Vienna, we resorted to
the grand opera. While listening mechanically to dulcet symphonies inter-
twined with the mellifluous notes of enrapturing cadenzas, following each
other in rapid succession and harmonic progression, there appeared in the
patient^s face and demeanor the first manifestation of interest which had
been noticeable for months. Subsequent visits not only confirmed the opin-
ion first entertained, but continued and augmented the impression thus
produced, until within a few weeks we had tlie satisfaction of witnessing
a complete recovery.
In his famous "Anatomy of Melancholy" Burton gives an elaborate
account of the medical qualities of music, telling us that **l)0Bide8 that
excellent power it hath to expel many other diseases, it is a sovereign cure
against despair and melancholy; will drive away the devil himself." Jaques
Bonnet, in his "Histoire de la Musique et de ses Effets," tells how on one
occasion he was entertained by a friend — then in the service of the Prince
of Orange — with the performance of three first-rate musicians. This was
* PhiUidcJlthia ASedical Journal, April 28, 1000, p. 034.
T3
1138
>QN-PHARMACAL REMEDIES AND GENERAL- THERAPECTICS.
the remedy, he informed him, which his master employed to get rid of mel-
ancholy whenever therewitli oppressed.^ The chronic dyspeptic is very apt
to be sad, morose, irritable, or hypochondriacal; euch shoidd be encouraged
to resort to the concert and opera for entertainment and improvement.
Those who have become weary from continued pursuit of an engrossing in-
tellectual occupation may be most happily refreshed through the instru-
mentality of music.
In the case of many nervous children, it is a measure of the highest
utility to give them a musical training as an outlet for their excitability and
as a means of soothing perturbed consci oneness. In case there is a tendency
to narrow chest and insufficient vital capacity, the respiration may be made
more full by having the patients learn to perform on wind instruments.
In Paris, musical performances are resorted to, with marked advantage,
in hospitals, and some investigations have been undertaken in order to
determine the influence of different kinds of music, especially in nervous
cases. A St. Cecilia Guild has been formed in England, by Canon Harford.
The objects, as set forih in the prospectus, are: —
"1. To test by trials, in a large number of cases of illness, the power of
soft music to induce calmness of mind, to alleviate pain, and to cause
sleep.
"2. To provide a large number of musicians, specially trained to sing
and play the very soft music which alone should be administered to those
whose nerves are weakened by illness. These musicians should be in readi-
ness to answer promptly the summons of a physician.
"3. To hire or build, in a central part of London, a large hall, in which
music shall be given throughout all hours of the day and night, this music
to be conveyed by telephone attached to certain wards in each of the chief
London hospitals.
''4. To obtain opinions and advice respecting the class of illnecs in
which music is likely to be most beneficial, arid to collect and record all
reliable accounts respecting permanent benefit that has followed the use of
music."
The work of sending musicians to hospitals and infirmaries has already
commenced, and it is intended to continue the experiment long enough for
a definite conclusion to be arrived at as to the senices which music is likely
to render to the sick. The scheme is said to have the warm approval of
Miss Florence Nightingale and Sir Richard Quain and other eminent phy-
sicians.*
Professor Tarehanow, of St. Petersburg, in a recent lecture, takes the
position that "music is of the greatest service in medicine," and that, by
the proper use of it, the system can be tuned like a musical instrument
Sufferers from nerve disorders, especially epileptics, can, he states, be
soothed by music, but the remedy must be employed with discretion. He
attributes the frequent failure of music to its being used at the wrong time,
or in unsuitable cases. He expresses the conviction that a time will come
when music, "in the hands of scientifically-trained physicians," will be ac-
knowledged to be an agent of great power for the relief of sufTering. That
it will relieve insomnia and ease pain, not by any analgesic action on the
* Tendon T^tt*>r to Metlu^al Proffre^s, Jan., 1892, p. 007.
• Editoriftl Atinotntion, Bn'<t»/i Medical Journal, Sept. 12, 1891,
VARIOtrS THERAPEnTIO METHODS.
iaerve-centres, but by distracting the sufferer's attention, will be admitted,
he British Medical Journal, in commenting upon this, observes, editorially:
"Here, we conceive, is the true field for music as a therapeutic agency, and
it seems to us highly improbable that it can ever do more. . . . Within
the limits which have been indicated, however, music may be a most useful
handmaiden to medicine; and in this age of 'nerves' it might possibly be
made to play an important part in the prevention of the many diseases
which are fostered, if not actually engendered, by depression and fatigue."'
Dr. Lilly, in the paper previously mentioned, states that there are two
principal classes of cases in which music might prove a useful remedy: 1.
Melancholic and depressed patients, dyspeptics, hypochondriacs, liver cases,
parturient women, men suffering from business reverses or family affliction,
— these require the tonic form of treatment. 2. Irritable, nervous patients;
alcoholic subjects threatened with delirium tremens, overworked business-
men, persons sutTering with hysteria or the mania of pubescence, pregnancy,
parturition, the climacteric and chronic insanity, and such like, — these re-
quire music of a soothing character. The mueic itself must be well chosen,
well executed, and scrupulously considered in relation to individual natures;
otherwise, it is of no value therapeutically. In order to be effectual, it must
be of the best quality, and devoid of impurities; it must be administered at
regular intervals, and in suitable doses.
It sliould be observed that, in this country, weekly concerts and the
frequent use of musical instruments constitute a part of the course of treat-
ment pursued in all the asylums for the insane and feeble-minded patients,
and the influence has been found to be favorable to recovery. Cases which
are excited by the music that the others enjoy are kept away from the con-
certs, although they might be soothed by soft music.
E. N. Malioutine, of Moscow, states that the vibrations of the tuning-
fork are transmitted from the vertex to the vocal cords and cause them to
vibrate in unison. In this manner, and with vocal exercises, he cured a case
of hysterical aphonia which had resisted all other methods, including sug-
gestion. He thinks that the procedure might be found of value in training
and improving the voice of singers.
The invention of the phonograph by Edison has greatly simplified the
^^koatter of giving music in regular doses and of the proper quality and
^^^Tariety. The use of sounds in Charcot's clinic, in order to produce high-
note effects, has already been mentioned under "Hypnotism."
4
VAEIOUS THEEAPETJTIC METHODS MORE OR LESS MECHANICAL
AND LOCAL IN THEIR EFFECTS.
Acupuncture. — The practice of inserting needles into the li\ing tissuea
for the relief of pain or other disorder occupies a prominent place in Chinese
medicine, and in some instances it is followed by strikingly beneficial effects.
The physiological effects of acupuncture are due principally to the re-
action of the part against the traumatism; in other words, there is estab-
■ Ue, tfii., Hiy 7, 18Q2.
1140 XOX-PHARMACAL REMEDIES AND GENERAL THERAPEUTICS. ^M
lishcd a focus in which there is a dilatation and rupture of small vessels,
hypersemia, afflux of leucocytes, and increased nutritive energy due to stimu-
lation of vasomotor and sensory nerves. This is accompanied by slight
swelling, moderate increase of local temperature, and tenderness upon press-
ure. The passage of the needles through dense tissues also favors the escape
or diffusion of incarcerated local effusions in the sheath of a nerve or around
a joint. It is not impossible that the insertion of a metallic substtmce into
the tissues may produce some alteration in the electric currents between the
muscles, blood, and nerve-plates, and so interfere with the conduction of
painful, afferent impulses along the sensory nerves.
Acupuncture is rarely resorted to at present, except in the modified
form of the hollow needle connpcted with the hypodermic syringe. The
hypodermic needle, indeed, is a very convenient agent for making acupunct-
ure. Care should be taken that the needle is always perfectly aseptic. In
sciatica a needle may be made to transfix the nerve as it passes over the bone
at its exit through the sciatic foramen, or the point where pain and tender-
ness arc most marked may be selected for the operation. In lumbago the
introduction of needles into the nffeoted muscles often affords marked relief
in a few moments. This is more successful when the pain is bilateral than
when only one side is atFocted, according to Ringer. Should the patient
shrink from the punctures, the spot may be made insensitive by the local
applications of ice and salt or by sprays of rhigolene or ether. Injections,
under the skin or into the deeper structures, of morphine, atropine, cocaine,
antipyrin, chloroform, or simply distilled water (aquapimcture) are often
combined with acupuncture for the relief of neuralgia. In acute rheumatic
affections acupuncture is useless unless in the combined form just men-
tioned.
In dropsy of the extremities, scrotum, etc., multiple acupuncture may
be performed in order to relieve tension and encourage oozing. If the
punctures are made with hollow needles they may be allowed to remain in
place, as suggested by Spender, or fine perforated trocars, with drainage-
tubes attached, may be used for the same purpose. Simple punctures close
again very promptly, and we therefore must resort either to drainage-tubes
or incisions. Exploring needles are convenient for making acupuncture,
and useful in establishing a diagnosis. Baunscheidtism ia multiple acu-
puncture, combined with counter-irritation. It will be discussed a few pages
farther on.
The combination of electricity with acupuncture (electropuncture) sug-
gests itself, and has been already considered under "Electricity." The diffi-
culty with it is that, except for the electrolysis of surplus hair and for small
growths in the skin, it is too painful. The electrodes are so small that the
current is under too high a tension just around the poles. Macewen, of
Dublin, recommends acupuncture in the treatment of aneurisms of large
arteries, like the carotid or subclavian. A long steel needle is introduced
into the interior of the vessel and the internal coat slightly roughened by
scratching with the point, in this way favoring the production of a white
clot and inducing the deposit of fibrin upon the interior of the aneurism,
so as to thicken and strengthen its walls.
In the Annais of Surgery for Januarjv 1891. Dr. Lewis S. Pilcher
furnished an editorial review of Macewen^s operation as described in an
VATII0U8 THERAPEUTIC METHODS.
1141
address delivered before ihe Midland Medical Society.' The operation in
question was designed for the cure of aneurism by inducing the formation
of white thrombi within the sac. This object is secured by irritation at
different times of the interior surface of the aneurism, this beinj? done by a
pin of suiticient length completely to transfix the aneurism and to permit
manipulation within it. Its calibre should be as fine as possible, the strength
being only sutllcient to penetrate the coat of the artery and the interrening
tissues. It is cylindrical, tapers to a point like an ordinary sewing-needle,
and has on the opposite end a somewhat rounded head; as the coats of
aneurisms vary in thickness, it is necessary for the pins to vary in calibrCj
since those which may pass readily through the walls of one sac may not
penetrate the thicker walls of another. They should also be finely polished
not only to facilitate their introduction, but to assist in rendering them
aseptic. The object of the operation is to secure a white thrombus in an
aneurismal sac, by irritating the wall of the aneurism in such a way as to
induce infiltration of the parietes with leucocytes and a segregation of them
from the blood-stream at the point of irritation. The irritation ought to be
just suiticient to set up reparative exudation, and should not exceed it; if
the irritation be pushed to such an extent as to induce softening of the
vessL'1-waIl, not only would the object be frustrated, but the pressure of
blood from within might cause the aneurism to burst. It is sought to have
several foci of irritation, in order to obtain which the inner surface of the
aneurism is lightly scratched by the pin, which may be introduced through
the wall at a convenient location, and the point then moved around in the
interior of the sac so as to accomplish the desired result in the manner
indicated.
It is considered desirable to secure as many points of irritation and
thrombi-formation as possible, so that the resulting clot may be large
enough to occlude the vessel. "The operation is preceded by careful cleans-
ing and asepsis of the skin over the aneurism. The aseptic pin is then made
to penetrate the sac and pass through its cavity until it comes in contact
with the opposite side, and no farther. Then irritation may be effected,
either by moving the pin over the surface of the inner wall or by allowing
the impulse of the blood-current playing on the very thin pin to produce
the same result.
'*If the wall penetrated by the pin, on introduction, be dense, the
former method vaU be preferable, as the force of the blood-current will
produce so feeble an action on the thin pin as to be insufficient to move
it to and fro M'hile it is firmly grasped by the dense wall. After acting
thus for ten minutes at one part, the point of the pin, without being re-
moved from the sac, ought to be shifted to another spot, and so on until
the greater portion of the internal surface opposite to the point of entrance
has been acted upon." In some cases several punctures will be necessary
in order to reach a sufficiently large surface of the inner wall. ^Vhile the
pin is in the aneurism, the protruding portion is surrounded by a bit of
aseptic gauze, dry or moistened with an aseptic solution. When it is with-
drawn from the aneurism, the part is covered with a moist antiseptic dress-
*
BriUah lUedical Journal, Nov. 16 and 22. 1800.
1142
XOX-PUARMACAL HEMEDIiiS AND GENERAL THEHAPEUTICS,
ing; for this purpose Dr. Mace wen prefers a watery solution of carbolic acid,
and he keeps this dressing in place for several days/
Antiseptics are agents which prevent the development and check the
activity of septic organisms. Inasmuch as these morbific agents are likely
to find entrance by traumatism or by being brought into contact with a
raw surface, the means of counteracting them is of great surgical interest,
but has less to do with medicine proper. As it has been found, however,
that the presence of bacilli and other forms of micro-organisms in the air-
passages or intestinal tract or in the blood or the tissues gives rise to various
diseases, such as diphtheria, typhoid fever, dysentery, diarrhoea, the exan-
themata, measles, scarlet fever, erysipelas, etc., it becomes of medical im-
portance to discover means of opposing them and of rendering them inert
or, at least, of so reducing their virulence that they may do the least amount
of harm. The problem is to find antiseptic agents which shall not be toxic
to the human body, or so slightly toxic as to be perfectly manageable.
Among these are alcohol, alphanaphthol nnd betanaphthol, formaldehyde,
acetanilide, antipyrin, chlorates and chlorides, creosote, guaiacol, hydrogen
dioxide, iodoform, iodol, creolin, naphthalin, tjuinine and other salts of cin-
chona, sozoiodolates of potassium and sodium, resorcin, salicylic acid and ita
salts, zinc phcnolsulphoiiatc, etc. For external use, carbolic acid properly
diluted (1 to 20 or 1 to 40) and bichloride of mercury (1 to 500 or 1 to
2000), potassium-permanganate solutions, sozoiodolate of mercury or of zinc
(2 to 5 per cent.) are very efficient. Arsenic and chloride of zinc are power-
ful antiseptics, but are too poisonous in their action upon the human body
to be need, unless with extreme care. Formalin is a non-toxic, but eflficient,
bactericide. The use and application of the agents named will be foimd
under appropriate headings in other parts of this work.
Aquapunctnre has already been incidentally mentioned under the head
of "Acupuncture," It consists in the use of a hollow needle to penetrate
the tissues and the injection of pure water, recently boiled and sterile. It
has been found from experience that this is often an efficient substitute for
morphine injections, and that, in patients who have been unable to sleep
without their evening hypodermic injection of morphine, the substitution of
water has been made without detection by the subject of the experiment,
and that sleep followed as usual. This is largely owed to the mental effect,
which is very important to obtain in eases of insomnia as an aid to sleep.
There is, however, a local effect of the puncture and injection of water into
the tissues which is worthy of attention. In addition to the effects of acu-
puncture, which are not inconsiderable^ there ia a local tension caused by
the fluid, which stimulates the absorbents to carry it away, and perhaps dis-
solves some morbific agent which causes pain or at least modifies the local
chemical reaction.
Aquapuncture is used in the treatment of neuralgia, and, being entirely
free from constitutional effects, it is better than morphine, antipyrin, and
other agents commonly employed. There is no probabiUty of the habit
being formed, as with the use of these narcotic drugs; and, even if it should
' From "Progress in Surgery in 1801," being the annual orntion before the
Academy of Surgery of Philadelphia, by Thomas G. Morton, M.D. Beprint from
Timci and Register of Philadelphia, Jan." 30, 1892. ~
VAaiOUS THERAPETTIO METHODS.
1143
be acquired, it will be harmless if care be taken to keep the needle and water
perfectly aseptic.
Aspiration. — The pneumatic aspirator is an instrument invented by
Dieulafoy for the removal of effusions or purulent collections by means of
suction, or atmospheric pressure. The apparatus consists of a receiver,
which, ordinarily, is a glass bottle of any desired capacity. Into this is in-
serted a cork having two perforations. Each perforation contains a metallic
tube containing a stop-cock, and attached at the free extremity to a rubber
tube. Finally, one rubber tube is armed with an aspirating needle, or trocar,
and cannula; the other tube is attached to a small pump or exhaust-syringe.
Now, the stop-cock attached to the needle being closed and the other one
open, the syringe may be worked so as to exhaust the air in the receiver,
when the stop-cock is closed and the partial vacuum maintained. If the
needle be now inserted into any collection of fluid, and the appropriate
stop-cock opened, the fluid will flow into the receiver until the supply is
exhausted or the vacuum has been filled. The process can now be repeated,
and this ia done until the desired quantity of fluid has been removed. It
may be necessary to empty the receiver several times during the operation.
The great advantage of this method is that no contamination of the con-
tents of the cavity by the air can take place; nor can air enter the wound
of puncture, if it be promptly sealed with adhesive plaster. Several modi-
fications of the apparatus are supplied. In one the syringe itself is made
large enough to act as the exhaust chamber, and, by a double stop-cock, the
fluid is drawn out by an upward movement of the piston, and by turning
the cock it is discharged through a long rubber tube into a basin or other
receptacle. Either form may be employed for injection by reversing the
process, thus irrigating, or overdistending, the interior of an abscess, as prac-
ticed by the late Mr. Callender.
The ordinary hypodermic needle and syringe may be employed for
aspirating small cavities or for purposes of diagnosis.
Capillary aspiration may be performed by attaching a long rubber tube
to a hypodermic needle and filling it with antiseptic solution, leaving the
extremity of the rubber tube beneath the surface of some water in a basin.
The hollow needle is now introduced, by a rotary motion, through the tis-
sues directly into the cavity, and retained in place by adhesive plasters.
The flow of the liquid is much slower in this case; but this is an advantage
in some cases, — for instance, in effusion into the pleura.
One of the dangers of aspiration of the chest is: the sudden alteration
of pressure upon the walls of the blood-vessels by the rapid removal of the
fluid might lead to congestion and, possibly, oedema. Wlien the apparatus
is not rendered aseptic, there is danger of exciting suppuration and septi-
cemia. Sudden removal of pleural effusions has been followed by death
within a few hours, apparently of shock.
Pneumatic aspiration is a useful expedient for removal of dropsical
effusions into serous cavities, serous exudations, or purulent collections in
any accessible locality. Hydrothorax, ascites, hydrocele, hydropericardium,
effusions into the pleune, pericardial sac, into the cavities of joints, are all
easily treated in this way. Purulent deposits, such as in psoas abscess, hip-
joint disease, which do not admit of open incision on account of danger of
septic infection, are properly emptied by aspiration. Overdistension of the
gall-bladder or urinary bladder may require aspiration, and if properly per-
n
114-4
NON-PHAIUIACAL REMKHTES AND GENERAL THERArEUTICS,
formed the danger from peritonitis is inconsiderable. Large effusions oi
blood — hiematocele, for instance — may be first injeett^d with a pepsin solu-
tion to dissolve the fibrinous clot, and afterward exhausted with the aspira-
tor. In pleural and pericardial serous effusions it is sometimes an advan-
tage to perform capillary aspiration, when immediate relief is not required.
The contents of ovarian cysts may be determined by examination of a por-
tion withdrawn by aspiration. Hammond advises the introduction of a long
aspirator needle into the liver in nervous hypochondriacs, in order to deter-
mine whether or not the symptoms may be due to abscess of the liver. In
the condition of extreme tympanites, where the liver is displaced upward
and the heart's action interfered with, the introduction of fine trocars or
long hypodermic needles through the walls of the abdomen and intestine
will permit the escape of the gn* and afford great relief.
Bandaging. — In medical practice the ordinary surgical roller bandages
are employed to make uniform pressure, in order to promote absorption of
effused material; to support inflamed or swollen parts, such as a mammaiy
gland or testicle; and to retain dressings, such as poultices or antiseptic
appliances. Bandages may be made of any convenient dimensions, and are
usually from two to throe inches wide and from six to eight yards in length.
They are ordinarily made from unbleached muslin free from sizing, but they
also are made from thin white flannel, gauze, or crinoline. The flannel
bandages not onl}' may be applied to make pressure, but also arc useful for
their retention of warmth. In fact, in catarrhal inflammations of the throat,
tonaillifis, laryngitis, etc., a flannel bandage around the neck is of consid-
erable service. Inflamed rheumatic joints, either acute or chronic, are often
materially relieved by a flannel bandage wound closely around the part. A
flannel bandage from twelve to twonly-four inches wide, according to cir-
cumstances, worn around the waist, in infants, and even in older persons,
is useful in preventing attacks of colic from exposure to cold.
In neuralgia accompanying neuritis, nr in herpes zoster, a flannel band-
age is an important part of the treatment. In acute pleurisy the application
of a bandage around the chest prevents excursion of the ribs in coughing,
and alleviates pain. It is sometimes useful to apply strips of adhesive plaster
in the same way as in treating fracture of the ribs; this not only affords
comfort, but keeps the efTusion from becoming excessive in quantity. In
chronic fileurij^y the application of a bandage and the application of counter-
irritants to the underlying surface considerably promote absorption. A
bandage of narrow strips of adhesive plaster is applied to an enlarged testicle
for the same purpose.
After delivery, the parturient woman is made comfortable by the appli-
cation of a wide bandage extending from the hips well up on to the chest.
This, in a measure, supplies pressure to the walls of the abdominal blood-
vessels and prevents syncope. A bandage is sometimes applied during labor,
previous to delivery, to support the uterus and abdominal walls.
Retentive bandapes are required in various forms of hernia, and also in
varicocele and in varicose veins. When the ankles tend to swell, bandages
are applied with much relief and decided effect upon the crdema. A tight
bandage around the head sometimes relieves headaches. In cases of apo-
plexy bandages may bo wound around the thighs and arms in order to reduce
arterial tension. When venesection is to be performed, a bandage is applied
around the arm so as to cause the veins to become prominent. In cases of
TAIUOUB THETUPEUnC METHC
1145
stinke-bite a narrow bandaf^e slmuld be tbrown around the finger, or the
Hmbj in order to prevent the introduction of the poiBon into the gencrpl cir-
culation, except by degrees. In ordinary cases bandages should not be so
close as to check the circulation in a limb, or gangrene may result. Reten-
tive bandages are used to keep dressings and medicated compresses upon
the surface of the body.
Brown-Seqiiard showed that the application of a tight bandage around
the big toe would, in some cases, check or prevent an e'pileptic attack.
Baunscheidtiam.— As already stated luider the head of "Acupuncture,"
the procedure, named in honor of the German who invented the instrument
employed in this manner of treatment, consists essentially in multiple punct-
ures of the skin, into which some counter-irritant application is rubbed.
The little instrument contains a spiral spring in a handle six or eight inches
in length. At its inferior end the instrument is enlarged to form a circle
from three to four centimetres (one to one and one-fourth inches) in diam-
eter. In this crown are concealed eighteen or twenty needles, which are
suddenly projected from a quarter to a half inch, when the spring is
pulled up and suddenly released. If applied to the skin a circle nf minute
punctures is made by this procedure. Now, if croton-oil, diluted with
sweet oil, be rubbed into these punctures, a decided inflammatory reaction
is produced, affording considerable counter-irritant effect. This method is
used principally for the treatment of chronic affections of joints attended
with pains and more or less exudation. It also affords relief in myalgia,
lumbago, and some forms *if neuralgia.
Blood-letting and Transfusion. — Blood-letting is not entirely a lost art
in medicine, but our therapeutical resources have so greatly increased within
the past twenty or thirty years that its usefulness has been very much re-
stricted.
General blood-letting is usually performed by opening a vein, — venesec-
tion, phlebotomy, — and the one selected is usually the median cephalic or
median basilic, although it may be performed from any large superficial
vein, such as the temporal, external jugular, or the veins on the dorsum of
the hand or foot. Arteriotomy is sometimes done in cerebral affections, liy
section of the temporal arteries. In persons known as ha?mophiles, or
bleeders, any cut or rupture involving a blood-vessel is likely to produce
haemorrhnge, followtd by the clTects of general blood-letting.
Although rarely resorted to at the present day, general blood-letting
is a valuable therapeutical resource. It moderates high tension and vascular
excitement, relieves congestion, allays nervous irritability and pain, and
relaxes the muscular system. It also moderates inflammatory action and
promotes absorption, and before the days of arterial sedatives was pre-
eminently the leading antiphlogistic remedy. The history of medicine con-
tains many instances of desperate cases where life was apparently saved by
frequent resorts to the free use of the lancet. Albert Robin, of Paris,* says
that blood-letting is distinctly indicated whenever it is necessary to stimu-
late the circulation of the blood, in cases of vascular stasis in mitral and
asystolic patients, and in acute a»dcma of the lungs. It may even be asserted
that blood-letting constitutes a valuable adjunct in a number of v*ry dis-
n
» Bfrdical Presn onH CircvUr, Feb. 9. 1898
1146
NOX-PHARMACAL REMEDIES AND GEKERAL TITERAPEUTICS.
similar pathological coDditionfi, provided they present the one element of
defective nutrition, or, to be more exact, of inadequate organic oxidation.
The place that venesection occupies in therapeutics is an uncertain one.
The late Dr. Hiram Corson strongly advocated bleeding for the relief of
pneumonic patients, and said that, as there is always more or lees attendant
congestion, any time is the proper time to bleed. There are others, and
these arc the majority of clinical teachers, who advocate bleeding in
pneumonia during the first stage, where there is a dilated right heart
from obstruction in the pulmonary circulation. Finally, many others, of
equally high authority, declare pneumonia to be a specific fever^ incapable
of being favorably influenced in its course or ierraination by abstraction of
blood, which, on the contrary, may do much harm. In acute pneumonia,
bleeding may be resorted to in order to reduce the toxinajmia and relieve the
circulation; the need of it must be determined altogetlier by the circum-
stances of the individual case. Bleeding is undoubtedly serviceable in
eclampsia, during pregnancy or parturition, or immediately afterward, pro-
vided there is high arterial tension as well as congestion of the brain. In
convulsions following exposure to the sun, bleeding will relieve cerebral con-
gestion; but it is highly injurious or fatal in the ordinary form of sun-
stroke. In narcotic poisoning and in urmmia, venesection is to be used with
caution, but it is a justifiable resort in severe cases. Professor Ewald recom-
mends bleeding in cases of unemia to decrease the arterial tension and re-
duce the quantity of toxins. It is not to be used in all cases of unemin, but
only where the condition of the patient and his heart will permit. General
blood-letting is of undoubted immediate service in some cases, also,
where there is overdistension of the heart and vessels in extreme pul-
monary congestion. It is of value in acute cerebral congestion accompanied
by convulsions. In pulmonary omphys-'einaj nu occasional bleeding will afford
prompt temporary relief and spare the patient much suffering in his last
days. Dr. G. Newton Pitt has recently described nine cases of thoracic
aneurism with or without aortic incompetence, in which venesection had
been followed by considerable relief to the acute symptoms, as pain, cough,
and dyspnoea.
In acute inflammations of strong, robust people, the judicious abstrac-
tion of blood often makes the patient more comfortable and lowers arterial
tension. In iritis, a good bleeding is remarkably beneficial at the outset of
the attack.
In patients of large, muscular frame when there has been a dislocation
of a large joint, the abstraction of blood has been resorted to in order to
produce complete muscular relaxation.
Blood-letting should be resorted to with caution in persons of feeble
digestion and weak assimilative powers, and rarely* if ever, in elderly per-
sons and verj' young children, in low fevers, in tubercular affections, and
in persons disposed to haemorrhage.
The local abstraction of blood is accomplished in a number of ways,
the most common being scarifications, multiple punctures (the antiphlogistic
touch of the late Prof. William H. Pancoast), and by leeches and wet cups.
Scariflcations are linear incisions, superficial, for the most part, cutting
into the derma or through granulating tissue, for the relief of local engorge-
ment, as in conjunctivitis, granular lids, etc., and tonsillitis. In cedema of
the larynx scarification is of great immediate relief; but in oedema of the
scrotum or lower eitremities it is objectionable because the incisions do not
heal readily. Multiple punctures may be skillfully performed with a fine
knife, or tenotome, and congested blood-vessels relieved of their tension.
It is absolutely required that the knife shall be surgically clean and recently
made aseptic, or serious results may be produced. A felon may be aborted
by early punctures through the soft parts to the bone.
A leech (hirudo) is an aquatic worm of simple annulated structure
found in different parts of the world. Its mouth is armed with cutting
teeth, with which it makes an incision through the skin and liolds on by
exerting a suction power; when it becomes filled with blood it drops off. It
can be made to drop off earlier by application of salt water. The European
or Swedish leech is about two inches in length, and will draw about half
an ounce of blood. If the bleeding from the leech-bite be encouraged by
warm fomentations, each leech can be estimated to cause the removal of one
ounce of blood. The American leech is smaller, and will only take about
one-fourth as much blood. If the discharge of blood from the leech-bites is
more than is desired, it may be checked by touching them with a stick of
nitrate of silver, a little Monsel's solution, or dry subsulphate of iron, by
pressure, or by a Bmall suture.
Cupa may be wet or dry. The cup is a small, bell-shaped glass, which,
at its upper extremity, has an opening guarded by a valve, so that, when
applied to the surface, and the small syringe-pump employed to abstract the
air, a partial vacuum will be formed and maintained in its interior. The
soft tissues rise up into the cup and become deeply congested by dilatation
of the blood-vessels. The spot may be scarified and the cup reapplied; so
that when the air is exhausted the blood will flow in to take its place. This
is called wet -cupping, and it is a valuable resource for local abstraction of
blood and a revulsive agent. When the proper apparatus is not to be had,
cups may be extemporized by egg-glasses or coffee-cups, the edges of which
are thick and not likely to cut the skin. The air can be exhausted by pour-
ing a few drops of ether or alcohol into the glass and igniting it; while the
vapor is burning the cup is inverted upon the skin and the flame is imme-
diately extinguished. The cup, in cooling, causes contraction of the air, and
the tissues are forced into the cavity by atmospheric pressure. A piece of
burning paper may be used in the same manner, to exhaust the air from the
cup.
Local blood-letting reduces local hypencmia and swelling, and, con-
sequently, relieves pain; it limits the destructive effects of inflammation and
favors restoration to the normal condition.
Cups and leeches are useful as revulsive agents and for local depletion.
The latter are useful for inflammation of glands and swollen joints. In
inflammation of the eye they are often resorted to. Cups are used in pneu-
monia» pleurisy, and other affections of internal organs.
Transfusion is the process by which there is introduced, directly into
the blood-vessels of a patient, either blood or blood deprived of fibrin, milk,
or various saline solutions. The transfusion of blood may be immediate or
mediate; in using defibrinated blood or fluids other than blOod, the process
is always mediate. In the form known as immediate transfusion the vein
of the patient is practically made a continuation of the vein of the donor
of the blood by means of a short rubber tube. The method usually followed
is to obtain a small rubber tube, having glass or silver tubes at its ends, and
1148
NOX-PHARMACAL REMEDIES AND GENERAL THERAPEUTICS.
with a bulb in its middle by which the blood can be urged forward on
course. It contains no valves; but when the bulb ie compressed the operator
must pinch the tube behind the bulb, and before the pressure is removed
from the bulb the tube must be released and pinched in front of the bulb
BO that the suction shall be in the proper direction. This is known as the
transfusion apparatus of Avelin^. The method of using it is to obtain the
assistance of a person who is in good condition and can spare from 240 to
3fiO c.cm. (or f^viii-xij) of blood. The arms of both donor and receiver are
properly prepared antiseptically. The median cephalic or basilic vein of
each is then exposed by a short incision and the wall of the vein cut so that
the cannula may be introduced, pointing toward the centre in the patient
and toward the extremity in the donor. The little apparatus is filled with a
warm saline solution so that no air will enter the vein, and is put in place
and confined there with a bandage, if necessary. Now, by proceeding as
indicated, alternately slowly compressing the buJb and again allowing it to
expand, the saline solution passes into the vein and is followed by blood.
The entire amount of blood may be estimated by counting the compressions
of the bulb, it having been determined previously by experiment how much
blood is delivered at each movement. The operation is concluded by bring-
ing the edges of the vein together with a fine suture and closing the wound
and applying a light compress of gauze with a roller bandage.
Mediate transfusion is a less simple procedure. The blood to be in-
jected is drawn into a bowl and whipped with some twigs in order to remove
fibrin and prevent clotting. The detibrinated blood, carefully maintained
at a temperature of 100° F., is drawn into a warm syringe and slowly in-
jected through an opening in a vein, as in the preceding method. The most
complete antiseptic precautions are required.
Arterial transfusion is rarely performed, although perfectly feasible, as
shown by laboratory experiments. The objection is that it involves per-
manent obliteration of an artery on the part of the donor. A superficial
artery, such as the dorsalis pedis, is selected, and, after dissection from over-
lying tissues, it is divided and a silver cannula inserted, connecting with a
rubber tube with its opposite extremity armed with another cannula, which
is introduced into a vein of the recipient. The force of the arterial circula-
tion will make the blood traverse the tube, which should be kept wann with
hot towels wrung out of bichloride Pohition.
Milk, on account of the preseucc of etilon bacteria and other micro-or-
ganisms, produces a septic reaction when introduced into a vein, and its use
for this purpose has now become obsolete. The same advantages may be
obtained from saline solutions, introducod either with a syringe or aspirator.
Tho following solution is recounnrndtMl by Hayem as a sort of artificial
blood-gorum: —
B Sodium hydmto 11 Gm. or gr. rvM.
Sodium chloride 5 30 Gm. or gr. Ixx.
Sodium sulphnte 25 Gm. or gr. cccxc.
Water, recently boiled and filtered 90| c.cm. or fSiij.
Of this from 1 to 4 pints may be slowly injected at a temperature of
100** F. It is important that, as recommended by Potain, the fluid be
injected slowly, ot a rate of 20 c.cm. (or fSvss) per second. The specific
gravity of the solution should be about 1.020.
VARIOUS THERAPEUTIC METHODS.
1U9
Transfusion of blood hus been practiced for years aa the rational method
of saving life where death is at hand from haemorrhage. In post-partum
haemorrhage, or loss of blood attending abortion, this method has proved
swccesfiful in many instances, as this is an emergency which finds the phy-
sician and attendants somewhat prepared. In other cases, as after surgical
injury, where there is an element of shock, or after pulmonary hsemorrhage
in tuberculosis, it has not been followed by a flattering degree of success.
In intestinal haemorrhage of typhoid fever it may be tried with a prospect
of good results. The quantity of blood need not be more than from 120
to 240 c.cm. (or f^i'^'-viij); it acts as a powerful vital stimulant to the heart,
and is capable of tiding the patient over an emergency. In morbid states of
the blood, transfusion has been performed, in a limited number of cases,
without very encouraging results. In anaemia it has failed, but in the htem-
orrhagic diathesis favorable reports are given by Dr. Joseph Buchser, of
' Is'ew York, though Dr. D. J. Brakenridge asserts that in pernicious anaemia
'transfusion exerts a beneficial influence, both on the blood of the patient
and on the blood-forming organs, causing a disappearance of abnormally-
formed blood-vessels and increasing the number of cells in excess of those
b*upplied by the transfused blood. In carbonic-acid poisoning and phos-
phorus poisoning, transfusion has boon used successfully. It has also been
recommended in the treatment of toxic svmptoms from unknown drugs, or
where there are no known antidotes. In urBemic poisoning, it has been
resorted to with satisfactory results.
Dr. A. Bier,* after a careful review of the symptoms produced when
animal blood is injected into man, thought that alteration in the com-
position of the blood might possibly confer bactericidal 'power on it, and
the sudden, intense, transient h3rperjEmia, the subsequent protracted, serous
I saturation of the internal organs and the skin, and the augmented metab-
' olism and appetite, could not fail to benefit certain chronic, sluggish,
infectious processes by giving them a general shake-up, as it were, and thus
allowing the recuperative forces of the organisms a chance to work. Reason-
ing from these premises. Bier applied the transfusion of defibrinated lambs*
blood as a therapeutic measure in eleven cases of advanced, incurable tuber-
cular aiTections. The amount injected at a time ranged from 4 to 20 c.cm.
(or foi-vss). The patients experienced transient flushing and swelling of the
face, chills, pains, and fever. The appetite, which had been absent, returned
after the first injection, and became ravenous in nearly every ease. One case
is reported in detail of a man with extensive open tuberculosis of the sacro-
iliac symphysis on both sides. About twelve transfusions were given in four
months, with disappearance of suppuration and almost closure of fistula.
Four cases of lupus al.^o phowod remarkable retrogression of the lesions.
Dr. Ilnddcr, of Jtontreal, u^ed injection of warm sterilized milk in
cases of cholera collapse, and Thomas, of New York, employed the same
expedient successfully in post-partum hsemorrhagfc. Injections of normal
salt solution, such as that of Hayem, have been very successfully performed
in the stage of collapse in Asiatic cholera, or in cholera morbus. Professor
Dawbarn, of New York, in similar cases, injects a hot (120° F.) saline solu-
tion into the femoral artery by means of a hypodermic needle and Davidson's
* Miinvhencr ntcfiicinischr Wochrttnchrifi, April 0, 1001 ; Journal of tfn^ Amerimn
Medical S^Hocialion, May U. 1901.
1150
NON-PHAEilACAL EEMEDtZa AND GENERAL THERAPEUTICS.
syringe. The needle is inserted into the vessel by a slow, rotary movement
and the end of the syringe is then tied over the base of the needle. About
473 c.cm. (or Oj) of the fluid is thrown into the artery at a time. The use
of the blood of the lower animals is advocated by Gesellius and others, but
is not to be recommended, on account of the difference in size of the blood-
corpuscles and the danger of conoimunicating infectious diseases or ifltro-
ducing parasitic organisms. The injection of blood into serous cavities,
such as the peritoneum, has been recommended by Ponfick and indorsed
by Bizzozero and Golgi, and has been successfully practiced.
Hypodermoclysis. — Instead of injecting normal salt solution, or artificial
serum, into the veins as a substitute for blood-trnnsfusion, the same result
may be accomplished, when t])e solution is introduced into the areolar tissue
by the process of hypodermoclysis, or subcutaneous injection by means of a
hypodermic syringe or line trocar nnd cannula. This procedure seems to
have a beneficial influence in diphtheria by diminishing tiie liability to heart-
failure. This procedure was practiced successfully by Lonot in tlie case
of an infant extremely exhausted by gastro-enteritis. All other methods
having proved ineffectual, artificial serum was injected subcutaneously into
the thigh, abdomen, and forearm. The serum contained about 6 Gni. (or
3iss) of table salt to 473 c.cm. (or Oj) of sterilized water. From 18.5 to
46 c.cm. (or f5v-xij) were injected once or twice daily for a week.
Eoget and Balvay report a case of diabetic coma with epileptiform con-
vulsions relieved by the injection of large quantities of normal saline solu-
tion, 7 litres (or about Oxiv) being given within a period of five days, and
three enemata of 585 c.cm. (or fjxviiss) each being also administered. Recov-
ery from the coma was complete, and the man lived for four months.
Dr. Robert Jardine,^ of Glasgow, gives a tabulated report of 22 cases
of puerperal eclampsia with 4 deaths. He attributed the small mortality
(3 of the 4 fatal cases being first seen when in a moribund condition) to
the use of saline solutions under the skin. Diuresis was established in a few
hours, and the quantity of urine in some cases rose to 60 and even 100 ounces
within the first twenty-four hours. An analysis of the urine before and
after infusion showed a marked increase in the urea and uric acid after the
infusion.
Normal salt solution is also used in typhoid fever with diminished se-
cretion of urine, by rectal injections, 1 pint daily, until the quantity of urine
secreted reaches the normal. Among the noteworthy effects are stimulation
of the cardiovascular system, diminished tendency to complications, and
when used early the nervous phenomena, such as insomnia, delirium, mus-
cular weakness, are less than usual, owing to the removal of the toxins from
the blood.
Intravenous injection of normal salt solution has been followed by suc-
cess in puerperal eclampsia, and in the collapse of cholera. Dr. H. F. Hanks,
of New York, approves very highly of the use of salt solution in the treat-
ment of surgical shock, especially after severe htemorrhage. In this condi-
tion nothing can take the place of intravenous injection of salt solution
(115" F.), using from ^/j to 1 */.^ litres (or fjxvii-li), as may be required by
the condition of the patient. When the pulse-tension is restored, the injec-
* BHtish Medical Journal, May 26, 1000.
VARIOUS THERAPEUTIC KSTHODS.
1151
tion is stopped. He also resorts to it in septicaemia, and urges all surgeons to
teach their assistants how to insert the injection-cannula, as no minor opera-
tion will ever bring better results than this operation when employed in the
emergencies mentioned.
Dr. Eugene Boise has written in the Medical News for September 10,
1898, of the value of intravenous injection of the saline solution after sur-
gical operations. With proper technique, he regards the intravenous route
as safe as any other, while it is much more rapid in supplying fluid and heat
to the system. In haemorrhage succeeding intervention, in shock, sepsis,
uraemia, and intestinal obstruction it is one of the most valuable therapeu-
tical measures we possess.
Enteroclysis; Irrigation of the Bowels, Injections, Clysters, and £ne-
mata. — Fluids or semifiuid substances are injected into the bowel through
the anal aperture in greater or lees quantity, according to the extent of
intestinal surface intended to be brought into contact with or to be affected
by the medicament employed. The objects to be attained are the direct local
effects upon the bowels, and the indirect or secondary effects, which are
caused either by absorption of a portion of the enema into the blood or by an
effect upon the nervous system or upon the temperature of the body. Ene-
mata or injections are given (1) to cause prompt evacuations from the bowels;
(2) to affect the thermal, chemical, or bacterial characters of the bowel con-
tents, or act upon its mucous membrane; (3) to introduce certain substaacea
into the circulation and produce systemic effects.
For making injections into the bowel a special instrument is employed,
which was formerly called a clyster-pipe; it is now known by the general
term of syringe. Various forms of syringes are offered to the profession.
The simplest syringe is one with a cylindrical barrel containing a plunger
and piston-rod, to which a ring or other conveniently-shaped handle is
affixed, the opposite extremity terminating in a nozzle. The best syringes
of this kind are made of hard rubber, which have almost entirely driven
those of glass or pewter from the market. For an adult the syringe should
have a capacity of from 120 to 240 c.cm. (or foiv-viij), which is usually
sufTicicnt for a simple enema, although larger quantities may be required.
In childhood, from 30 to 120 c.cm. (or fji-iv) will prove sufficient, and in
infancy from 15 to 30 c.cm. (or fsss-j) is ordinarily enough for an opening
injection. Continuous-flow syringes are of two kinds: (1) gravity, or so-called
fountain-syringe, and (S) bulb, or force- syringes. The fountain-syringe con-
sists of a bag, with a capacity of a pint or more, connecting at the bottom with
six feet or more of soft-rubber hose, to the end of which is affixed the usual
anal, rectal, or vaginal tube. The bag, filled or partly filled with the fluid
to be employed in the injection, is hung at the patient's bedside, from four
to six feet above the level of the lower end, when introduced into the vagina
or rectum; in this way tlie fluid gradually is introduced by hydrostatic press-
ure, without any other force being employed. The bulb syringes are of dif-
ferent shapes, but the principle is almost the same in all. A rubber-ball of
cylindrical shape, with tapering ends, and of convenient size to grasp in the
hands, is provided at each extremity with a valve, each opening in the same
direction. A supply-tube passes from a receptacle of water, or the fluid to
be employed in the injection, to one end of the bulb, and from the opposite
end passes the delivery-tube, terminating in a nozzle of hard rubber. By
alternately pressing and releasing the bulb, a current of fluid is sent along
1153 XOX-rUAUlLiCiLL EEilEDlES AXD OEXEttAL TUKRJtPELTlCS.
the tubing with as much force as is desired. In fact, there is danger of
using greater hydraulic pressure than was intended, and thus causing in-
jury to the bowel, especially when weakened by disease or ulceration, such
as occurs in dysentery or typhoid fever. One form of syringe makes use of
air-pressure, instead of hydraulic pressure, the fluid being placed in a bottle
connected with the delivery-tube and partly filled with the medicament
desired to be thrown into the bowel. VDion air is pumped into the bottle, the
liquid is forced out through the delivery-tube under less pressure than by
the usual plan just described.
(a) Some formulae for laxative encmata are as follows: —
Simple Laxative.
B Olei rioini vel olivs 60| ccm. or Qij,
Add to a halMitre (or fSxvij) of soapy water, and use aa an injection.
Siimvlaiive,
H Ol«i terebinthiiuB , . . . 161 e.cm. or Qsa-
Olei ricini 45| ccm. or Qiml
Add to a half or one litre (or fSxTii-xxxiv) of hot aoap-suda, and u*e aa an eneTna.
Purgative,
Q Tinct aloea 715 ccm. or f3ij.
01. olivffi 60| ccm. or fjij.
Id a balMitre (or fSxvij) of soapy water.
Evacuani,
B Glycerini 1 12 ccm. to 16| ccm. or mxx-fShr.
Use as a rectal injection.
In cases of obstinate impaction a long tube should be inserted, so as to
carry the glycerin into the vicinity of the mass and assist in breaking it up.
For Infants.
Q 01. olive opt. 15| ccm- or fjaa.
To be injected into the bowel to produce evacuation.
For Chronic Constipation.
B Sem. lini 15]5 Gm. or 5«b.
Make an infusion with a half-litre (or fSxvij) of boiling water, and, when cold,
■train through muslin. Use each morning, as an enema.
{b) Injections administered for the purpose of affecting the thermal,
chemical, or bacterial character of the contents of the bowel or to act upon
its mucous membrane.
When comparatively large quantities of fluid are thrown into the bowel,
the procedure is known as irrigation; and, when they pass the ileo-ca?caJ
valve, as "entcroclyais.*' Such large injections are not required for simple
evacuation of the bowels, but are employed for various purposes connected
with the state of the intestine or its contents. Thus, in states of fever, espe-
cially typhoid, large injections of cold water may be given, in order to re-
move the contents of the bowel, to reduce temperature, and for their effects
upon the nervous system. In cholera, a form of irrigation is highly praised
by Cantani, which is called enteroclyais, because by thia means remedies are
i
rARIOnS THKRAPEDTIC METHODS.
1153
carried, by an antiperistaltic motion, through the ileo-caecal yalve into the
small intestine. Tannic acid being very destructive to cholera cultures, and,
in the quantities employed, hannless to the human Bubject, was chosen as
the principal agent to be used in the injection. Cantani's formula is : —
9 Acid, tannic |6 to 20 Gm. or p. Ixxii-cecx.
Acacite pulv 60 Gm. or oxiiss.
Vini opii 2 c.cm. or f3s8.
AqufiB (temp. 100" to 104*" F.) 2000 c.cm. or OivfSiv.
M. Sig.: To be used after each evacuation of the bowels.
Out of one hundred and seventeen cases of cholera treated by the above
method, Lustig reported thirty-four deaths only, wliich is highly favorable
88 compared with other metliods of treatment. The same plan has been
used in cholera infantum and in summer, or sporadic, cholera, with excel-
lent effects. In addition to these injections of tannin into the bowel,
Cantani recommended hypodermoclysis, of a saline solution (3 per cent-
sodium carbonate and 4 per cent, sodium chloride), at a temperature a little
above that of the body (100.4" to 104** F.), into the subcutaneous con-
nective tissue, by means of a Pravaz, or lar^e hypodermic, syringe. In true
cholera, during the algid state, the practice of hypodermoclysis is said to
give startling results. Its object is to reduce the tendency to thickening of
the blood following loss of watery fluids by transudation. Its advantages
over intravenous injections consist not alone in avoidance of the danger of
opening or manipulating veins, but also in the process of absorption being
more uniform and natural. In one hundred and eighty-seven severe cases
thus treated, the mortality was 39 per cent. Enteroclysis is used for tlie
premonitory diarrhoea and the first stage, hypodermoclysis in the algid and
typhoid stages; when the treatment is begun with the disease already ad-
vanced, both are used.^ In some cases "peritoneoclysis," or injection of
saline fluid into the peritoneal sac, was cautiously practiced, without evil
results, except slight tenderness and tympanites. Enteroclysis, or irrigation
of the small bowel with warm water, is a valuable expedient in catarrhal
jaundice and gall-stones. In the treatment of thread-worms, or oxyurides,
large injections of salt-water or infusion of quassia, or of vinegar, are very
efficient in dislodging these parasites from their headquarters in the cscum
and large bowel.
Astringent enemata are sometimes employed to check diarrhoea, and
anodynes may be thus administered. P^or instance, laudanum (2 c.cm., or
mrzx) in starch-water is very useful in relieving pain and tenesmus. Nitrate
of silver (0.13 to 0.50 Gm., or gr. ii-viij, to 473 c.cm., or Oj, of warm water)
is used in dysentery, especially if ulceration be present; it may be repeated
once or twice daily. Carbolic acid, mercurial salts, and other agents which,
if absorbed, would cause poisoning, should not be employed per enema.
Very frequently diarrhcea is kept up by the presence of irritating substances
in the intestine. Irrigation of the bowel has been found to be a resource
of great value in such cases; and, even in infants, it has given highly-
satiefactory results.
I'he mechanical effects of the distension of th€ bowel are chiefly utilized
in the treatment of intussuseeption of the bowels; but they are also active
"Annual of tlio rniverwil Medical Sciences," ISSO, vol. i. D-32.
Tl
1154
NON-PHARMACAL fiEMEDIES AND GENEKAX THERAPEUTICS.
in every case in which the administration of an enema is followed by evacua-
tion of the boM'el contents. In some abdominal operations, it has been rec-
ommended to introduce a rubber bag into the rectum and distend it by the
injection of water, so as to lift the organs in front of the bowel higher up
in the pelvis, so that they may be more readily encountered by the supra-
pubic incision; the expedient just mentioned being of especial application
in the case of stone in the bladder.
Dr. John R. Lichty eays: "AVater is a valuable aid in the treatment of
the various fonns of diarrhcea and dysentery. In dysentery, nothing can be
used which will give more general satisfaction than enemas of plain cold
water. They are grateful to the patient, do not produce nausea, and very
largely relieve the tenesmus from the first. A noted physician has said of
this treatment: *It changes a huge internal into an external abscess, and
enables us to cleanse the bowels of their putrid contents,'" J. Dewitt
Graham praises the use of hot-water irrigation in the treatment of intestinal
disorders in children, thoroughly flushing the bowel with a copious amount
of hot water, using a long, soft-rubber tube that passes the internal sphinc-
ter, and provides an easy escape for the fa?ce3. The irrigation is continued
until the water comes away clear. This is repeated only as often as needed
to unload the colon, to relieve tenesmus, or to induce rest. The author has
used it with success in a child three days old,
(c) Injections into the bowel for the purpose of systemic effects are
of two kinds: (1) medicinal; (2) nutritive. Medicinal enemata of tannin
in cholera have been mentioned under the head of ^'Enteroclysis." In many
instances remedies are administered in the form of a suppository of cacao-
butter, which is fluid nt the temperature of the body; but the same medica-
ments might be given in stnrch-water or other vehicle by enema. Quinine
may be thus administered to children for malarial manifestations. Bromide
of potassium and chloral are useful in reducing restlessness and tendency to
convulsions in ciiildren; emulsion of asafetida is an excellent injection to be
administered in a case of convulsions where there is supposed to be indi-
gestible substances in the bowels acting as an irritant. Enemata containing
alcoholic stimulants are sometimes administered. Although this method of
administration of remedies is attended by some inconveniences, yet it is very
useful where the stomach is irritable or the patient is unable to swallow
drugs, as in coma, etc. It is capable of being extended in the case of chil-
dren, who object to swallowing disagreeable medicine. In the treatment of
phthisis, good results have been reported following the use of sulphureted
waters by enema. The administration of nutritive material by injection into
the bowel is of suflncient importance to be considered separately.
Eectal Alimentation and Intestinal Inhaustion. — It is a physiological
fact that the absorbing surface of the large bowel may be utilized to support
life when the stomach cannot digest food. Experience has shown, indeed,,
that life may be almost indefinitely sustained by the injection into the bowel
of certain articles of food in a physical condition favorable for absorption.
In gastric ulcer, for instance, it is ncceseary to allow the stomach time to
heal without being called upon to digest food, not only because of the pain
and vomiting following the taking of food and the danger of hasmorrhage,
but also because cicatrization will proceed more rapidly, if uninterrupted.
During this time, therefore, it is of great importance to introduce food by
a channel which so fully answers the purpose and which is so closely allied
VARIOUS TUEHAPECTIC METHODS.
1156
I
I
I
lo the Dornial. The same proximate principles of the food can be introduced
into the system when placed in the bowel as when they are taken into the
stomach, the chief differences being; that the food is not subjected to the
same churning process in the bowel as in the stomach, and, of course, no
gastric juice is furnished by the mucous coat of the large intestine. The
capacity of the rectum is considerably less than that of the stomach. From
this, we learn that nutritive eneraata should consist of food in form most
favorable for al)sorption and assimilation, and that the quantity should be
comparatively timall {about ItiU to ISO c.cm., or foiv-vj), in order not to
excite rcllex contractions of the muscles by reflex action and rejection of
the enema. It is desirable to sot up a tolerance on the part of the bowel
to the injections; and they should, at first, be given cautiously and a small
quantity at a time, and repeated not oftener than at intervals of four hours.
It may be necessary to reduce the sensitiveness of the mucous membrane by
a preliminary injection of tincture of opium (2 c.cm., or nixxx) in starch-
water, or an opium suppository may be introduced. In children, bromide
of potassium and chloral may be substituted for the opium, or simple injec-
tions of cold water may suffice to render the bowel lees intolerant. Cocaine
is so uncertain in its action in different individuals that its use is not deemed
advisable for this purpose.
The directions for preparins; nutritious enemata are very simple. It is
more convenient to have the substance in a fluid or semifluid condition and
strained, so that it will pass through the syringe. Meat suppositories have
also been used, but they are loss efficient than enemata. The basis of the
injection is usually milk» which should be scalded and partly peptonized.
To this, meat-L'xtniets, beef-juice, or beiitrn cgps may be added. If desired,
a small quantity of brandy or whii^ky can be added also. The enema should
not exceed CO c.cm. (or fjij) at first, and the frequency of administration
must be governed by the demands of the system and the tolerance of the
bowel. If alimentation can be conducted in this manner every four hours
and it is well bnrne by the patient, this interval should be maintained. In
some patients, however, the interval may have to be prolonged to seven or
eight hours, especially at the beginning. On n previous page of this work
directions will be found for peptonizing ditTerent articles of food, some of
M'hich on account of the predigestion, might be used for rectal alimentation.
The late Prof. ITcnry F. Campbell, of Augusta, Ga., called special attention
to this methoii of supportintr the powers of life by nutritious enemata, and
he maintained, by introducing the food above the sigmoid flexure, that the
liquid would be carried backward through the ileo-cweal valve into the small
intestine by a process of reverse peristalsis due to intestinal inhaustion. He
showed that the system could be nourished perfectly and life sustained for
many months by nutritive eneraata. Slilk injections containing the yelka
of 1 or 2 e^gs, with some powdered pancreatin or solution of pancreatin or
papoid, will be found the most available and generally efficient. The juice
of raw beef, or meat-extract, may be added to the enema after toleration has
been established.
This method is to be used in gastritis, some cases of dyspepsia, gastric
ulcer, carcinoma of the stomach, insufficient nutrition, persistent vomiting
or pain after taking food, and in marasmus and other affections of young
children. According to G. Singer, nutrient enemata given in gastric ulcer
<]imini6h the probability of recurrent hxemorrhage. This writer advises reo<
1156
NON-PHABMACAL REMEDIES AND GENERAL THERAPEUTICS.
tal feeding in some eases of gastric dilatation and in excessive vomiting of
pregnancy. In special conditions of disease it may also be resorted to with
advantage; its utility in skin disease is sometimes very marked. (See a
communication on "Kectal Alimentation and Medication in Diseases of the
Skin/' by the author: '^Transactions of the Ninth International Medical
Congress," vol. iv, pages 170 el seq.) For further discussion of the important
subject of alimentation the reader is referred to the section upon "Diet in
Disease" (page 1101).
Irrigation of the rectum with plain hot water is of decided service in
ehronic pelvic inflammations, with the exception of pyosalpinx. It relieves
tympanites and is of advantage in the early stage of intestinal paralysis
following sepsis. Rectal irrigation is of value in the treatment of hjemor-
rhoids. A jet of cold water from a bidet is especially recommended.
Setons and Issues. — These are expedients which had their origin in
former ideas of pathology, and, consequently, at the present day, are nearly
obeolete. Each depends upon setting up a point of irritation and suppura-
tion on the surface of the body, in order to produce revulsive or counter-
irritant effects upon deeper-seated pathological processes. A seton consists
of a strand of cotton or silk, or other material, passed through a small fold
of skin. A piece of silver wire nr a strip of sheet-lead may be used. The
thread may be carried through by means of a seton-needle, or the skin may
first be perforated for the purpose with a bistoury. The seton is allowed to
remain in position for several days or even weeks.
An issue is made by applying a cauterizing substance, such as caustic
potassa, to a spot upon the skin, aud, after the slough has separated, a dried
pea, glass bead, or piece of orris-root is kept in place over the open surface
by a bandage, so as to keep up irritation.
Setons in the neck (nucha) were formerly used in eases of obscure brain
or spinal disease and eye intlammations. In infantile hydrocele of the cord
a seton may be inserted for a few hours to set up adhesive inflammation.
Issues and setons are now rarely employed, because of the danger of the
wound becoming infected with erysipelatous, tuberculous, or other disease
germs, and because continued sup|uirntion may lead to septicsemia, Bright's
disease, or lardno^jiis de^eni'ration of kidneys nnd otlier orirnns.
Suspension in Disease of Spinal Cord, and Nerve-stretching in Nervous
Disorders. — Among the mechanical means occasionally resorted to in med-
ical practice is support of a portion of the body by suspension. Thus, in
internal curvature of the spine, systematic exercise with suspension more or
less complete, by instructing the patient to climb a ladder or a rope hand
over hand, is a highly useful device for strengthening weak muscles and
overcoming deformity. The same principle is applied in treating Pott's dis-
ease by Sayre's apparatus with a "jury mast.''
A suspension-belt encircling the elbows so that the patient may sleep
in a sitting posture, and a support afforded to the extrinsic respiratory mus-
cles, forms an apparatus of (^reat usefulness in asthma. About 1883, Mot-
schutkowski, of Odessa, published reports of the relief afforded in cases of
locomotor ataxia by suspension of the body from the shoulders. This
method, it seems, was first applied by Prof. J. K. Mitchell, in Philadelphia,
many years before. Motschutkoweki and, subsequently, Charcot arrived at
favorable conclusions from their experiments, and Prof. S. Weir Mitchell
FOnMUL^ FOB HYPODKUillC USE. 1157
has also published commendatory accounts ol his experience with a form
of apparatus of his own devisinp.
The effect of the treatment Ly the apparatus of Charcot or Weir
Mitchell is to take pressure from the intervertebral cartilages and to
Blraifrbten the curves of the spine. The good effects which have undoubt-
edly occurred in a number of cases may be due, as suggested by Dr. Julius
Althaus, to the fact that spinal meniugitiB usually is found associated with
pathological changes in the cord, especially in the posterior columns. Sus-
pension, produces a revulsive effect similar to that of cauterization and to
passive motion of joints by which adhesions are stretched or broken and
their absorption favored. Since suspension has given the most favorable
results in old, advanced cases, it is very probable that this is true. There ia
no evidence that the spinal cord is stretched by this process; on the con-
trary, it may be relaxed. There have been some unfavorable results re-
ported; but, considering the character of the cases, such accidents might be
attributed to other causes, and certainly do not constitute a bar to the treat-
ment when properly applied. Rosenbaum advises against suspension in pro-
nounced cases of myelitis and in recent paralysis agitans.
The diseases in which suspension has proved beneficial, besides loco-
motor ataxia, are spastic spinal paralysis, amyotrophic lateral sclerosis, and
neurasthenia, or functional nerve-prostration. S. Weir Mitchell is especially
convinced of its utility in Pott's disease of the spine.
The number of papers published during the last two or three years,
upon suspension in the treatment of nervous diseases, has been small, as
compared with the large number appearing soon after Motschutkowski's
early pjipers upon this subject. The same reports of improvement and dis-
appearance, in part or entirely, of symptoms, have characterized recent com-
munications. In a small proportion (in five out of twenty-five hundred cases
of Rosenbflum) the improvement is remarkable. The lancinating pains are
relieved, there is enhanced ability to walk, increase in appetite and bodily
weight and in sleep. The gastric crisis, in a few cases, become less frequent,
but panpsthesia of hands and fert and ocular symptoms are very obstinate.
Professor Leyden claims that the treatment of tabes by suspension pro-
duces no appreciable effect upon the pathological process; that neither on
therapeutic nor upon scientific grounds is it reasonable to expect such a
curative action, and that practical experience, when viewed with an xm-
prejudiccd eye, fails to show such effects; none of the results reported, he
says, go beyond the effects of suggestion.
At Charcot's clinical service at La Salpetriere, the form of suspension
is by the chin and occiput, and the instrument employed is Motschutkow-
ski's modification of Sayre's apparatus. Stillman^ recommends the upright
and recumbent curved board frames devised for orthopaedic purposes,
Bennzzi has tried forcible flexion of the spine as a substitute for sus-
pension, by forcibly flexing the body with the knees bent on the abdomen.
A tabetic female treated in this manner showed material improvement. He
experimented upon the cadaver and concluded that by this procedure the
relation of the spinal cord to the spinal column is so changed that the cord
is displaced upward three to four millimetres, and the vertebral columa
• Weekly Medical Review, St. Louis. Sept. 8, 1890.
1158 NON-PIIAUMACAL REMEDIES AND OENKRAL THERAPEUTICS.
lengthened from one and one-half to three centimetres, the increase in
length being due to separation of the processes rather than of the vertebral
bodice. The nerve-roots are displaced, but not noticeably shortened, with
the exception of the cauda equina; there is lowered tension of the cerebro-
epinal fluid. lie regards the beneficial efTects of suspension as due to trac-
tion upon the Cauda equina, stretching it and, throuRli it, the spinal cord;
this, he thinks, is best accomplished by forcibly flexing the body with the
knees upon the abdomen. Cagney, on the other hnnil, after extensive ex-
periments upon both the dead and living body, denies that it is possible to
stretch the spinal cord or nerve-roots by suspension; that, instead of exten-
sion of the spinal canal, there is a total shortening of it. He inferred that,
if the cord is benefited by suspension, it is by relaxation, and not by Btietch-
ing it.'
Nerve-stretchingf is an expedient for the treatment of various affections
of the nerves attended by pain. As it involves a surgical operation, — the
cutting down upon a nerve-trunk, isolating it, and subjecting it to more or
less forcible stretching, — it need not be discussed here. It might be said,
however, that in some cases of neuralgia (sciatica, etc.) this has been resorted
to with marked relief to the patient, and that it is now an acknowledged sur-
gical dernier ressort for such cases.
FORMULA FOR HYPODERMIC USE,
ALCOHOL.
H Spirit, frumenti 15] ccm. or fjss.
(Dose: 1.2 tn 2 c.cm., or mxx-xxx.)
Or, B Spirit, viui gnllici 16| c.cra. or fSss.
(Dose: 06 to 1.2 c.cm., or mx-xx.)
For syncope, hemorrhage, heart-failure, shock, cholera, and Bnalce-bitea.
AMYL NITRITE.
3 Amjl nitritis 41 c.cm. or f3j.
Alcoholis 11| c.cm. or f3iij,
M. (Dose: O.G to 1.2 com., or mx-xx.)
For an^na pectoris, chloroform narcoaia, strychnine poisoning, and surgical shock.
APOCODEIWB.
H Apocodvinte hydrochloridi 113 Gm. or p". ij.
Sodii chloridi 105 Gm. or jr. x.
Aqua? eucalypti IS] c.cm. or f Jss.
M. (Dose: 2 c.cra., or mxxx = 0.016 Gm.. or gr. V,.)
For chronic bronchitis, croup, whooping-cough, and haemoptysis.
APOUORPHINS.
B Apomorphinw hydrochloridi 113 Gm. gr. ij.
Aquie camphone Oil o.cm. or iitp.
M. (Dose: 0.12 to 0.5 c.cm., or mii-viij = 0.OU27 to OoiOS Gm.. or gr. V»-V,.>
For chronic bronchitis, bronchorrhoea, emphysema, hBemoptysis, chorea, whoop-
Sng-cough, laryngiemua stridulus, epilepsy, capillary bronchitis, and in narcotic poison-
in?-
'"Annual of the Universal Medical Sciences." 1801. vol. ii, p. B-38.
FORKUL^ FOU HYPODERMIO USE.
1159
AQUAPDirCTUBE.
B Aqiis desLilUts
(DoRe: 2 to 4 c.cm., or fSaa-j.)
For neuralgia, myal^a, and paralysis.
60| c.cm. or fjij.
AS6ENIC.
H Liquoria potaseii arsenatia,
Aquce destillats aa
M. (Dose: 0.3 to 1.2 c.cm., or mv-xx.)
Or, 3 Liquoria sodii arsenatia 4|
(Doae: 0.3 to 1.2 c.cm., or mv-xx.)
Or, Q Liquoria arseni et hydrargyri iodidi 7|5
(Dose: 0.06 to 0.6 c.cm., or mix.)
For chorea, neuralgia, epilepey, lymphadenoma, enlarged spleen, paoriaaiBi ajid
7|5 c.cm. or f3ij.
c.cm. or f3j.
com. or f3ij.
chronic eczema.
ATROPINE.
B Atropinae aulphati* 1008 Gm. or ct. '/••
Aquffi deatillate *. 16| c.cm. or ?5as.
M. (Doae: 2 com., or mxxx = 0.00101 Gm., or gr. 7»*->
For aciatica, ovarian neuralgia, dyamenorrhopa, surgical shock, cholera collapae,
pulmonary hccmorrhage, locomotor ataxia, mania, spaamodic asthma, aeaaickneaa,
poiaunlng from aconite, muscarine, pbysoatigmine or eaerine, and opium.
CAFFEINK.
3 CnfTpinee citratia 11 Gm. or gr. xvj.
AquEB destillats 30| c.cm. or TSj*
M. (Dose: 1 to 2 c.cm., or mxvxxx = 0.032 to O.OOG Gm., or gr. sa-j.)
For neuralgia, hypochondriaaia, asthma, organic heart diaease, chronic Brigfat't
diaease, and urnmie coma.
CARBOLIC ACID.
B Phenol. Hq. (purie) 125 Gm. or
AqUfe deatillatA 15| c.cm. or fjaa.
M. {Dose: 1 to 2 c.cm., or mTT.xxx = 0.016 to 0.032 Gm., or gr. V.-m.)
For erysipelas, phthiaia pulmonalis, funmculoaia, enlarged lymphatic glands,
bubo, and neuralgia.
CAaTOB-OU..
B Olei ricini,
Olei amygdalee dulcis •
M. (Doac: 4 to 15 c.cm., or f3i-iv.)
Useful in obstinate constipation.
gr. IT.
FSaa.
4
aa 30| c.cm. or fjj.
CHLORAL HYDRATB.
M.
Chlorali hydrnti ISjfi Gm. or 58s.
Aqufl! dcatillate 30| ccm. or fjj.
(Dose: 0.0 to 2 c.cm., or mx-xxx = 0.32 to 1 Gm., or gr. v-xv.)
CBLORAL HTDRATE AND UORPUi:fK.
Or. R f'hlonili hvdrali 8
Gm.
13 Gm.
ccm.
MorphinsB aulphatii
AquR deetillat» 30
M. (Dose: 2 c.cm., or mxxx^O.6 Gm., or gr. viiss, chloral hydrate; 0.008
Om., or gr. V„ morphine sulphate.)
or 3ij.
or gr. ij.
or ftj.
1160
KON-PHARMACAL HEMEDIES AND GENERAL THERAPEUTICS.
CRLOBAL HTBRATS, UORPHtNS, AtTD ATBOPINE.
Or, IJ Cblorali hydrnti 8| Gm. or 3ij.
Morphinie auiphatia 13 Gm. or gr. ij.
Atropince sulphatU |008 Gm. or gr. 7^.
Aquae de«tillat» 30] c.cm. or flj.
M. (Dose: 2 c.cm., or mxxx = 0.5 Gm., or gr. viiea. chloral hydrate; 0.008 Gm.,
or gr. Vi, morphine sulphate; 0.0005 Gm., or gr. Vm, atropine sulphate.)
For obstinate vomiting or hiccough, collapse from cholera Asialica, cholera
nofltruB, epaamodic asthma, mania, convulaions, and neuralgia.
CBLOROFORM.
H Chloroformi I6| c.cm. or fjaa.
fDoee: 0.3 to 1 c.cm., or mv-xv.)
Or, B Bpir. chloroformi 16| c.cm. or fjaa.
(Dose: O.ti to 1.2 c.cm., or mx-xx.)
For sciatica, tic douloureux, and other neuralgias.
COCAINE.
3 Cocaina; hydrochloridi 160 Gm. or gr. viij.
AquiB eucalypti t 30| c.cm. or f3j.
M. (Dose: 2 c.cm., or mxxx^ 0.032 Gm., or gr. as.)
For producing local aufcsthesiu. Also in seoaickneu and vomiting of pregnancy.
CODEINB,
•R Codeinffi phoHphatis 125 Gm. or gr. iv. ~
Aquce destillatce ISJ e.cm. or fSaa;
M. (Dofe: 2 c.cm.. or mxxx = 0.032 Gm., or gr. ss.)
For neuralgia, hypochondria, delirium tremens, mania, and diabetes mellitua.
CODLnnEB-OTI*.
I^ Olei morrhutE 30| ccm. or f3j.
(Dose: 4 to 15 c.cm., or f3i-iv.)
For scrofuloderma, parsesthesia, ecthyma, pemphigus, lichen, etc.
CONIINK.
K Coniinee,
Acidi acetici fort aa U183 com. or fSiiimxij.
Aquffi chlorofonui q. s. ad 60| c.cm. or fBij.
M. (DoAo: 0.00 c.cm., or mj, to begin with. 0.3 c.cm., or mv, contains 0.06
cem^ or mj, of coniine.)
Or, B Coniinie hydrobromidi |005 Gm. or gr. j.
Aquae eucalypti . . . ^ ^ 16| cent, or CSm*
M. (Dose: 0.6 c.cm., or mx = 0.00l3 Gm., or gr. V*^)
For pleurisy, pneumonia, angina pectoris, emphysema, asthma, acute mania, sad
tetanus.
COTOIKK.
B Cotoinre |5 Gm. or gr. riij.
Sodii bicarbonatis 113 Gm. or gr. xx.
AquK de^tillatA 15| c.cm. or Qm.
M. (Do»c: 0.6 to 2 c.cm., or mx-xxx = 0.021 to O.D*Jfi Gm., or gr. V,-j-)
For acute and chronic diarrhoea, diarrbcBa of phthisis and typhoid fever. Also
for night-sweats and Asiatic cholera.
OUBABA.
B Curarae 1066 Gm. or gr. j.
Aquae destillatc . ., 18|5 c.cm. or Rv.
M. (Dose: 2 can., or mxzz = 0.0066 Gm., or gr. Vi».)
FORMULA FOB HTPODEBMIO USE.
1161
Or, R CurarinEc sulphntis 10032 Om. or gr. '/»•
Aqufls destiUaUe 18|5 c.cm. or 13.%
M. (Dose: 2 c.cro., or mxxx = 0.00032 Gm., or gr, '/«►)
For tetanus, hydrophobia, chorea, and epilepsy.
DATtTBIWE.
B Daturinre !0I20 Gm. or pr. Vi.
Aquae eucalypti 301 c.cm. or f5j.
M. (Dose: 0.6 to 1.2 c.cm., or mx-xx = 0.00027 to 0.00056 Gm., or gr.
For neuralgia, aathma, epilepsy, and mania.
DIGITALIS.
B Tincturas di^talis 7|5 c.cm. or fSij.
(Dose: 0.3 to 1 c.cm., or mv-xv.)
Or, B Tineturse digitalis,
Spir. frumcnti aa 7|6 c.cm. or f3ij,
M. {Doser 0.6 to 2 c.cm., or mx-xxx.)
Or, TJ Digitalini [0129 Gm. or gr. */•-
Spir. vini gnllici,
A'^UBB deatilluta; an 715 c.cm. or fSlj.
M. (Dose: 0.6 to 1.2 c.cm., or mx-xx = 0.00055 to 0,0011 Gm.. or gr. VwVib.)
For heart-failurp, Rurgical shock, acute mania, hiemorrhage. and aconite poison-
b«.
V-.)
DUBOISINT.
B Duboiaimc hydrochloridi 10129 Gm. or frr. '/■•
Aqua* dcstillaUe 3o| c.cm. or fSj-
M. (Dose: O.C to 1.2 ccm., or mx-xx = 0.00027 to 0.00065 Gm., or gr. V,»-
For asthma^ locomotor ataxia, mania, sciatica, and dysmenorrhcea.
EBOOT.
B Fluidextracti ergotas
(Dose: 1 to 2 c.cm., or mxv-xxx.)
Or, B Ergotin. 2
Phenolis liq
Aque deBtillatffi 15
15| c.cm. or fSsa,
10 Gm. or gr. xxxij,
20 Gm. or gr. iij.
c.cm. or fjss.
M. (Dose: 0.5 to 1 c.cm., or mviiss-xv = 0.065 to 0.13 Gm., or gr. i-ij.)
For hcemoptysis, post-partum hemorrhage, intestinal hteniorrbage of typhoid
Hever, purpura, uterine fibromata, varicone veins, varicocele, aneurism, enlarged spleen,
enlarged probtate, leuksemia, and exophthalmic goitre.
XTHVB.
15| C.cm. or fSsa.
B iEtheris
(Dose: 1.2 to 2 c.cm., or mxx-xxx.)
For heart- failure, surgical shock, syncope from hsmorrhage, snake-bites, typhoid
priumonia, variola, sciatica, biliary and renal colic, poisoning from aconite and
veratrum viride.
OLOZfOm (inTBOOLTCERtH).
B Glycerylis nitmtia 1066 Ora. or gr. j.
Spir. vini rectificati 18|5 c.cm. or mccc
M. (Dose: 0.06 to 0.24 c.cm., or mi-iv.)
For angina pectoris, asthma, epllepay, tetanus, chloroform narcosis, and strych-
nine poisoning.
1163 NOX-PHARitACAL REMEDIES AND GENERAL THERAPEUTICS, ■
BOMATROPtKK.
IJ Homatropins hydrobromidi |0129 Gm. or pr. V*.
Aquee deflUIlatce 30| c.cm. or fjj.
M. (Dose: 0.8 to 2 cxm.. or mx-xxac = 0.00027 to 0,0008 Gm., or gr. Vm-Vi..)
For night-sweaU of phthiaia^ mania, and sciatica.
HYOscimc.
H Hyoacin» hydrobromidi |0129 Gm. or gr. '/#•
Aquie destillatae 37' ccm. or f3x.
M. (Dose: 2 c.cm., or mxxx = 0.00065 Gm., or gr. V„«.)
For chronic mania and dementja, insomnia, asthma, and sciatica.
m'oscYAMiirx.
Ti HyoscyaminiB sulpbatis 10129 Gra. or gr. Vt-
AquK eucalypti 30{ c.cm. or Qj-
M. (Dose: 1.2 to 2 ecm., or mxx-xxx = 0.0005 to 0.0008 Gm., or gr. Vm-V».)
For acute and ohronic mania, chronic dementia, epilepsy, paralysis agitans. and
chorea.
IIBRCCBT.
B Hydrarg. chlorid. corroa 1065 Cm. or gr. j.
Aquffi defitillats 7|5 c.cm. or f3ij .
M. (Dose: 0.6 c.cm., or mx = 0.006 Gm., or gr. Vu. once daily.)
Or, B Hydrarg. chlorid. corroa. j32 Gm. or gr. t.
Sodii chloridi 166 Gm. or gr. x.
Aqua destillatse 30j c.cm. or ^j.
M. (Dose: 0.0 to 1.2 c.cm., or inx-xx = 0.006 to 0.0129 Gm., or gr. Vw-Vi.
every second or third day.)
Or, B Hydrarg. chlorid. corros. 132 Gm. or gr. t.
Glycerini 4 c.cm. or fSj.
Aqua destillata 26| c.cm. or fSvij.
M. (Dose: 0.75 com., or mxij =0.008 Gm., or gr. V«> every second day.)
Or, R Hydrarg. chlorid. mitis 15 Gm. or gr. viij.
Olei olivse 15) c.cm. or t^^,
M. (Dose: 1 to 2 ccm., or mxv-xxx = 0.032 to 0.066 Gm., or gr. aa-j, twice
■weekly.)
Or, H Hydrarg. chlorid. mitis II Gm. or gr. xvj.
Petrolatj fl ISJ c.cm. or ftss.
M. (Dose: 1 to 2 c.cm., or mxv-xxx = 0.065 to 0.13 Gm., or gr. i-ij, twice
weekly.)
Or, B Hydrarg. formamid. |13 Gm. or gr. ij.
Aqua destillatfie '. 22| c.cm. or fSvj. ^
M. (Dow: 2 c.cm., or inrxz=:0.01 Gm., or gr. V«.) ^
Or, B Hydrargyri benzoatis |25 Gm. or gr. iv.
Sodii chlondi |032 Gm. or gr. as.
Aqua deMillata 45| c.cm. or fSiss. M
h H. (Dose: 1 c.cm., or mxT = 0.0064 Gm., or gr. V^.) ■
^H UORPHINZ. fl
' B Horphina Bulphatis 1066 Gm. or gr. J. fl
Div. in chart, no. riij. 1
(Dose: One powder = 0.006 Gm^ or gr. '/•» dissolved in 2 ccm., or mxxz, of
water.)
Or. B Morphina sulphatii |13 (^. or gr. ij.
Dir. in chart, no. riij. ^
(Dose:
foiimuLjE for hypodermic use. 1163
One powder = 0.01 5 Gm., or gr. V«i diBsolved In 2 c.cm., or mxxx.
For neuralgia, ursemic convulsions, asthma, angina pectoris, colic, and cancer.
UORPBINK AND ATBOFmS.
li Atropinfe sulphatia 1032 Gm. or g^.
Morphinse sul phatis 1 13
M. et div. in chart, no. cxx
(One powder =: atropine sulphate, 0.00027 Gin., or gr. V.*.:
■0,01 Gm., or gr. '/•; to be diMolved in 2 c.cm., or mxxx, of water
Gm. or gr. xx.
morphine sulphate,"
Or, li Atropinee Bulphatia
Morphins sulphatia
Phenolis liq
Aqufe eucalypti ....
015 Gm. or gr. V«.
38 Gm. or gr. rj.
32 Gm. or gr. v.
30| c.cm. or ^j.
M. Dose: 0.6 c.cm., or fnx=: atropine sulphate, 0.00032 Gm., or gr. Vwi>
morphine sulphate, 0.008 Gm., or gr. V*-)
For insomnia, asthma, hiecoughr myalgia, colic, herpes zoster, sciatica, angina
j)ectoria, cancer, and surgical shock.
UXIBCABINX.
B Muscarinie nitratls 175 Gm. or gr. xij.
Aquffi deslillat® 30| c.cm. or fjj.
M. (Doac: 0.6 to 2 c.cm., or mx-xxx = 0.015 to 0.048 Gm., or gr. V«-V«.)
For night-sweats of phthisis and atropine poisoning.
I
c.cm. or mss.
NICOTINK.
B Nicotime
Mucilag. aeacie,
Aquse destillat«e aa 4) c.cm. or f3j.
M. (Dose: 0.6 c.cm., or mz = 0.003 ccm., or m'/a., of nicotine.)
For tetanus.
08UI0 Aon>.
H Acidi oamici |065 Gm. or gr. j.
Aqufe de^tillatte 18[5 c.cm. or iZv.
M, {Dose: 0.8 to 2 c.cm., or mx-xxx = 0.O022 to 0.0005 Gm., or gr. VwVrt )
For sciatica.
PARACOTOIlfX.
B Paracotoini 1|55 Gm. or gr. atxiv.
Glycerini^
AquEB de«tillatffi aa 7{5 c.cm. or f3ij.
M. (Dose: 0.6 to 2 c.cm., or mx-xxx = 0.0e5 to 0.20 Gm., or gr. i-iij.)
For intestinal tuberculosis and other forms of diarrhoea.
PELLETIERIXK.
l^ Pelletierincp sulphatis 4| Gm. or 3j.
Aquic de«tillatce 7|5 c.cm. or f3ij,
M. (Dose: 0.0 c.cm., or mx = 0^2 Gm., or gr. v.)
For paralysis, tetanus, and hydrophobia.
PHT80STIOUIKS.
B Physostigiuinae hydrochloridi 1060 Qm. or gr. J.
Aquie destillattt 18|5 c.cm. or fSv.
M. (Dose: 0.6 to 2 c.cm., or mx-xxx = 0.0006 to 0.0016 Gm., or gr. '/.»-*
Or, B Physostigmina salicylatis 10129 Gm. or gr. '/•.
Aquie deAtillatce 15] c.cm. or fS^.
.if, (Dose: 0.0 to 2 c.cm., or mx-xxx =0.0005 to O.OOIG Om., or gr. Vm-V*..)
1164
KOX-PHARMACAL KEMEDIES AND GENERAL THERAPEUTICS.
Or, I^ Extracti phyBoatigmntis 125 Qm. or gr, \v.
Aquffi destillata? 221 e.cm. or Ryj.
H. (Dose: 2 c.cin., or nixxx = 0.021 Gm./or gr. Vr)
For tetanus, hydrophobia, and strychnine poisoning.
PU.OCAKPIXE.
R Pilocarpinac hydrochloridi |13 Gm. or gr. ij.
Div. in chart, no. xij.
(Dose: One or two powders ^0.011 to 0.021 Qm., or gr. Vi'Vft, dissolved in
2 c.cm., or mxxx. of distilled water.)
For hiccough^ aethina, dropBy, ursmia, and chronic eczema.
Or, R PilocarpiuDE nitratis 1| Gm. or
Aquis eucalypti 30| c.cni. or
M. (Dose; 0.3 ccm., or mv = 0.01 Gm., or gr. V.O
^i.
xvj.
POTASSIUM IODIDE.
B Potasaii iodidi 1515 Gm. or Sss.
Aquffi destillataj 30| ccni. or fjj.
M. (Do8C; O.U to 2 c.cin., or mx-xxx:=0.32 to I Oin., or gr. v-xv.)
For syphilis, psoriasis, scrofula, load poisoning, rheumatisui, and gout.
QiriNINE.
B Quinince sulphatifl 5
Acidi sulpliuric'i dilut 9
Plienolis liq
Aquoe deatillat«e * q. a. ad 15
2 Gm. or 9iv.
•£.ft com. or f3ils8.
13 Gm. or gr. ij.
c.cm. or ?588,
M. (Dose: 0.6 to 2 c.cm., or mx-xxx=:0.2 to 0.65 Gm., or gr. iii-x.)
Or, 3 Quinina hydrochloridi carbamidat«D 8| Gm. or 3ij.
Div. in chart, no. xxiv.
(Dose: One or two powders = 0.32 to 0.65 Gm., or gr. v-x, in 2 c.cm., or mxxi,
of distilled water.)
For pernicious malarial fever, malarial cachexia, and sunstroke.
6PABTS1NS.
R SparteinflB sulphntis |13 Gm. or gr. ij.
Aqufc eucalypti 15| c.cm. or IS^a*
M. (Dose: 0.6 to 1.2 c.cm., or mx-xx = 0.005 to 0.01 Gm., or gr. Vu-V..)
For cardiac and renal dropsy.
STBYCHNIKB.
It Stryi^hninsB sulphatia 1065 Gm. or gr. j,
Aqute eucalypti 30| c.cm. or fjj.
M. (Dose: 0.6 c.cm., or rnx = 0.0013 Gm., or gr. Va-)
021 Gm. or gr. */■•
035 Gm. or gr. j.
c.cm. or fij.
Or, 3 Stryc'hninBB sulphntis
Plienolia liq
AqUQD 30
M. (Dose: 1 to 2 c.cm., or mxv-xxx = 0.00065 to 0.0013 Gm., or gr. 7m- V*^)
For paralysis, pro^ssive muscular atrophy, neuralgia, amaurosis, amblyopia,
surgicul shock, and aconite poisoning.
URETHA5.
R -Tlthylis carbamatis 41
Aqme eucalypti 30J
M. (Dose: 4 c.cm., or f3j=0.5 Gm,, or gr. viisa.)
For insomnia, tetanus, mania, and neuralgia.
Gm. or 3
c.cm. or
a.
GENERAL INDEX.
PAoa
Able* balBunea 882.888
canadensis 744
AbruB 80
Absinthe 86
AbslnttaUm 172
treatment of 86
Absinthium 86
Abslnthol 86
Absolute alcohol 170
Acacia 87
Acacls syrupus 87
Accumulators 950
A. O. B. aasBsttaetlc mixture 168
Aceta 17
AceUnlllde 88
Acetanllldum 88
Acetic add 90
ether 162
Acetone 90
chloroform S37
Acetonum 90
Acetphenetldin 711
Acetum 91
cantbaridls SOS
ipecacuanluB 581
opll 673
sangulnarla 806
scUIaB 817
Acetyl-saltcyllc add 133,240
Add, hydrocyanic 197
pyrogallic 775
quinine hydrochloride 353
solution of phosphates W
Aclda 15
Acids 76
ofltclal 15
Acldum acetlcum 90
arsenloBum 92
arsenosum 92
benzolcum 100, ^1
borlcum 100
cacodylicum 93. 105
camphorlcum 299
carbollcum 105
chromicum 113
chrysophanlcum 787
dtrtcum 115. 599
formtcum 115
gallleum 117
hydriodlcum dilutum 117
hydrobromlcum US
dilutum 273
hydrochloricum 119
dilutum 119
hydrocyanlcum dilutum 121
hypophoBphorosum 122, 130
dilutum 130. 723
lacticum 123
nltrlcura 124
dilutum 124
nltrohy drochlorlcum 126
dilutum 126
olelcum 127
oxallcum 129
phoBphorlcum ISO, 723
roncentratum 130, 723
dilutum 723
plcrlcum 132
sallcyltcum 133
steartcum 138
sulphorlclnicum 138
■uIphoTlnlcum 141
PAQB
Acldum Bulphurlcum iS9
aromatlcum 139
dilutum U9
iulphurosum w.
tannlcum 14|
tartarlcum 144
trlchloracetlcum 145
Aclpenser huso 54s
Aconjne 146, 148
Aconite ui
fluid extract of 146
liniment 146
-root 146
tincture of 146
variability of 147,148
Aconltlna 146
Aconltine 146
amorphous 146
ointment , 146
Aconltl radix 146
Aconltum 146
Acorln 288
Acorus calamus 288
Acrlnyl sulphocyantde 831
Acupuncture , 1139
Adams's faradometer 9S6
Adeps 151
benzoatua 161, 261
benzolnatua 161, 261
laniB 162
hydroBUB I6J
Adhatoda Justlcla 168
Adhatodlc acid 158
Adhesive plaster 441, 748
Adjuvant 44, 61
Administration, modes of 62
of drugs 62
of oxygen 1030
of quinine 864
Adonldin 164
Adonldodulelt 164
Adonldoquercltrln 154
Adonis vernalls 164
Adontte 164
Adonitlc Rcld 164
Adraganthin 902
Adrenal extract 209
Adrenalin 210
Adrenalinum IK
^scuUn 166
iTlflculus hlppocastaneum 166
^ther 156
acetlcus 162
purlficatuB 165
valerlanlcuB 162
^thylia bromldum 163,278
carbamas 164
chloridum 165
Agarlric acid 166
Agartcln 166
Agaricus albus 165
chlrurgorum 166
muscarlus 168
Agathin '. 167
Agropyrum repens 905
Agu rl n 890
Allanthus glandutosa 167
Air 168
liquid .• 1119
ozone in 1028
Airol 168
Alant camphor 664
(1165)
1166
GENERAL IKDEX.
PAGE
Alantlc anhydride &W
AlEDtol I>M
Alcohol 168
as ft food 1'2
dllutum IJJ
potBonIng by JtJ
tertiary amyltc w
wood IJI
Aldor-bork Iw
black '70
Aletrla 1J8
AlltopnUtlon, reolfil "54
lAlkollea J^
Alkaloids, mydriatic oH
of codliver oil «5»
official 1^
Allium ITS
cepa '^
sativum 178
Allspice 738
Allylprraulpbldo 234
Allyl sulphide 179
sulpbocarbamld 894
.tribromldo 179
Almond, bitter M«
compound powder of 197
expressed oil of 197
mixture 197
-oil 197
artlflclal 2«4
Bwcet 196
Byrup 197
AInuIn 180
AInuB 180
BemilaU : 180
Aloe 180
chlnensla -. 181
purlflcata 180
perryl Ifit
Tera 181
Aloes 180
action of 181
and niiafetldR ptlta 234
and cnnella powder 805
and Iron, pltls of 466
and maatlc. pilln of 622
and myrrb. tincture of 636
hepatic 181
Aloln 180
cniodlD 181
Alolnum 180. ISl
Alpha eigon 441
eucalne 451
Alphanaphthol , 643
Alpinla offlclnarum 479
Alpbozone 184
Alteratives ;...., 77
Althipa 184
officlnalli 184
Alum 184
dried 184
Klycerln of , 491
Alumen 184
exslccatura 184
Alumini hydroxidum 184
aulphaa 184
Aluminum acetlco-tartaiicum ..*.. US
boroformate 189
boratanoats 188
borotartrate 118
hydroxide 184
BUlphote 184
Alumnol 187
Alum-root 609
Alvelox , 189
Amanita muBcarla ......* * 1A6
phalloldea 166
vrrna 166
Amber Ml
rectified oil of 861
Ambergris 18^
Ambragrlsea 189
Amblyopia from tobooeo 6&L
American centaury 79*
Ipecacuanha 488
wornuieed 326
Amlnoform, aeo hexamethylenamlne
Ammonia 190
aromatic spirit of 190
fotld Bplrit of 190, SU
llnlm.?nt of 190
stronger water of - 190
Wftter of 190
Ammoniac and mercurial plaster 189
emulsion 189
mixture 189
plaster with mercury 614
Ammonlacum 1S9
Ammonlatod Rlyc>Trhlzln 191, ^&6
linimonL of camphor 299
mercury 191
ointment of 514
tincture of gualae 190
tinrture of valerian 190
Ammonll bonzoaa 191
brorotdiim ..191, 273
carbonas 191
chlnridum 191
lodidum 190. B62
phoaphaa 191
sflHcylaa 182. 190
Valerias ....*..... 191
Ammonium 190
acetate, solution of 190
alum 184
benzonte 191
bromide 191, m
carbonate ,......- „ 191
chloride 191
troches 191
citrate, solution of ...••.•^•..... 190
embelnte 443
Ichthyoaulpbonate ......«.....*.... 5oO
phospbnte 191
iodide of 190
salicylate of 190
vattTlanate. elixir of ^.. 911
valerate of 191
Amp^r*' 9S3. 938
Amygdala nmara , 196
dulcis 196
Amygdallne ...•«*•«.,*.... 403
Amylumlne 659
Amylene hydras WO
Amyllne hydrochloride 6S9
Amylopsin 697
Amyl nitrite 198
valerianate , 300
AmyllB nltrla 198
Amylum Ml
lodatum ,...,.... fi03
Aniyrlu ,.,,. 443
Anaonrdlc add •.... 202
Anacardium ......t.*. 201
orcldentale 201
AnacycUie pyrethrum 773
AniPBtbeBla IM. 163
by cataforesla 970
by nitrogen monoxide 1035
by scopolamine 822
by the rectum IBB
dangers of IM
local IfiS, 168. 184
by 9chlelcb'a metbod S73
primary 168
spinal ,..., 37S
AniPsthetlCB 78
choice of 166
Anaforesls f34. 970
Analeptic remedies 84
Analgen , 32*
Analyses In pharmacy IS
Anamlrta paolculata SIO
Anamlrtin 189
Anapbrodlsiacs n. fTV-
Aiuircotlne 678
GENERAL INDBZ.
1167
pxaa
ceps 832
emonlc add 722
emonln 772
etht fructus 202
ptbum graTeoleoB 202
sellc acid S7S
sola, ordeal bark of 818
E:ostura-bark 427
sosturlne 427
balontdlne 202
balonlne 202
balontum 202
bydro-gluco-chloral 238
bydrotlCB SI
imal charcoal S14
extracts, secretions, and serums 203
iodol 219
ise-fnilt 219
-water 219
isi fructus 219
stellatffi fructus 552
iBum 219
3d€ 932
)dyne8 78
tbracene ..' 828
tbelmlntlcs 80
Lbemls 220
flores '220
:bemla nobllis 220
ihraqulnone 826
thrarobln 220
thraroblnum 2^
■-Idotea 66
:idotG to snake-potson 244
:idvscDterfc mixture 125
:icholerln 217
ti -emetics 79
Mfebrln 88
:Jmonlal pills, compound 500
powder 221
^Ijie 221
:iinonli et potkssll tartras 221, 758
oxidum 221
.imontouB oxide 221
sulphide 221
:imonlum 221
ntKrum purlflcatum 221
sulphuratum , 221
tartaratum 221, 758
Jmony 221
and potassium tartrate 221, 758
tolerance of 223
:Inervln 223
ipa rasitica 75
.iperlodlc tincture 361
.ipneumococcic serum 216
i py retlcB 77
ipyrlna 224, 716
ipyrln ; 224
-aalol 721
Irrhlnlc acid 430
lalallcs 79
iseptlcs 82, 1142
Isepttc formula ■■• H*
action of electricity W6
method ^
Lister's lOJS
powder 800
soluUon 100
BUi^ery 518
Iseptol 361
Ispasmln 419
Ispaamodlcs > ^
Istreptococclc serum 218
tltozln 212
Itoxlns. action of 204
». spirit of 116
.Ityphold serum 216
ivenene .> Z18
irodlslacB 82
In 709
ol 709
olln 709
pAoa
Apis mellifloA 222. «2S
Apocodelne 676. 694
Apocynsln 224
Apocynln 224
Apocynum 224
cannablnum 224
Apolyaln 71S
Apomorphlnaa hydrocblorldum 224
Apomorphlne hydrochloride 224
Aporhetln 788
ApofltoU method 981,986
contraindications 988
Aqua 226
acldl carbollcl 106
ammontaa 190
ammonisB fortlor 190
amygdals amarae 197
anethi 202
anisi 219
aurantil florla 241
florum '241
fortlor 241
camphorsB 299
carul •. 817
cblorata S46
chloroformi 337
clnnamoml 366
creoBotl 406
deatniata 226
fcenicull 447
hamamelldls 604
hydrogenll dlozldl 226, 248
lauroceraal 597
mentbte piperita 624
viridls 625
plmentsB 739
rosae 793
fortlor 792
sambucl 806
sedatlra 300
Aqus 17
Aquapuncture 1142
Arabic add 87
Arabin 97
Araroba 349
Araaa 226
Arbor Title 395
Arbutin 327, 444, 481, 621, 909
Arctium lappa ■. 59$
ArctosaphylOB glauca 621
uva ural 999
Areca 226
catechu ! ! ! ! 226
Arecaldlne ..!!., 226
Arecaine !!!!!!!]!!! 226
Arecollne 226
hydrobromlde !.!!!!!!!! 2^
Argentamine 231
Argentl cyantdum 121, 227
iodldum 562
nitras 227
dllutUB 227
fuBUB 227
Induratus 227
mitlgatus 227
oxidum 227
Argentum 227
Credfi •.. 232
Argonln 282
Argonln L 233
Argyrla 228, 231
AriBtldlnlc add 828
Arlstlnlc add 828
Arlstol 896
Arlstollc add 828
Aristolochla serpentaria 827
reticulata 827
Arlstolocbln 828
Arlstolochlne 828
Armoracla radix 232
Arnica 233
flowers 232
Montana S3|
1168
QENERAI, INDEX.
PAOB
Arnica, tincture of 233
rbliome 233
Amicffi florea 23S
rhlxoma 233
Arnicin 833
Arniclne 233
Aromatic fluid extract 338
powder 316
syrup of rhubarb 787
tincture of rhubarb 787
waters 17
Arrow-polton 428
kombd 8&5
- root starch 631
Arsenate of sodium 92
Arsool lodldum f2. B63
trloxldum 92
Arspolcal Codllver-olt 663
polsonlQg M
Areeolc bromide 93
und niurcurtc Iodide, solution of. ...514, 562
iodldo 563
Arsecloua anhydride ^ 92
Artaotblc acid • 622
ArtcmlBla abBlnthfum M
pQuctflora 809
Artemistn 809
Arterial transtualOD 61
Artiriflal muflk ..: 634
Artcrlotomy , 1145
Aanfetldo , 234
emulsion 234
pills 234
tincture 2tV4
Asafwtlda 234
Asagrcca offlclnalm 795.912
Awiprol 236. 64S
AsrlpplRdln 236
Aflcleplos. fluid extract of 136
lubcrosa 236
Aseptol 236. 41fi
Ash 478
Asiatic plH 740
AflpamBln 184. 237. 496. 512. 87S..R81
AspnrafTus 2.T7
AspDn. American 75S
Aspidll. oleoreslniB 237. 238
Aspldlura 2.T7
Bpinulosum 2X7
AspidoRnmlne ,.... 239
A!<pldo(tpcrma 239
Aspidoapermatla, fluldextractum 23>
Aspldosprrmine 2-'W
AsptdoBpermatlDo 239
A Rpl ration 1143
Aspirin 133. 240
ABtmgalufl srummlfer 902
AatrlDgfnts 77
local 75
AiheroRpfrma moscbatA 816
Atropa belladonna .' Sfi2
Atropina 3S2
Atropine? sulphas 2f>2
Atropine 252, BH
dlfcs of 252
iodate S64
oinlmpnt 262
oleate of 262
aulpbate 2^
solution of 252
Atroaclne Sl5
Atlar of rose 792
Aurantll amarl cortex 241
auldcxtractum 241
cortex reccDB 241
siccatus ,.., ..»•... 241
dulcla cortex 241
Aurl bromldum Z73
ct ammonll cblorldum :... 278
et sodU cblorldum 2i2
Arena 215
ATene 488
Axcdomch
Axulenc . .
Bacteria, effects of light on UXI
Bnim 04
Balneotherapy 1042. 104C
Balaam of Peru )4B
BaJsamum Penivlanum 246
Tolutanum Mi
Bandaglne 1144
Banting's method for obesity UVO
Boptlala HI
Baptialn , I4T
Barbaloln 181
Barberry 286
Barll chlorldum 247
dloxldum 348
Barium chloride !47
dioxide 141
Barosma bctullna 282
Baroamtn .388
Base, in a preacrtptlon 44.81
Basbam'a mixture 465
Basillcoa ointment 771
Basaorin ; 798, W2
Bath. Roman 1008
the electric light 1122
Bathing 1046, IWO
Baths, carbonic acid ..1082
electric ,. M6
Battery, care of ,80
fluid U8
work of electrical , .868
Baump do Tie 188
Daunscbeldtism 114B
Bayberry-bark 6X
Bay-Iaurcl G9T
-leaves ..• tfT
oM of 688
rum 188
Bear- berry ,«,.••.. 868
Bod-straw , 4M
Beech-wood creosote 406-
B»>bceru-bark 641
Bcbtrlnc 6<&. 788
Bolladoiina, action of upon the eyea 2S6
alcoholic extract of XI
green extract of ..» 8E1
-Juice aa
-leaves, extract of , 3G1
tincture of 151
leavea and root ..* 2S1
liniment IBI
liquid extract of 88
ointment ..^ m
plastiT n
-root, fluid extract of 382
suppositories 3BI
ttncturv ., 3B
BellAdoDDH* folia ...< Xt
radix flU
BoDtie oil tn
Benzaconlne , 168
Benzaldebyde 381
Benianllld ,.„, 888
Beosene ,.. 811
BvQzln ansatbosia 381
petroleum , 7«7
purified 707
Beuzinum 2«o, 707
purlflcatum 2«o, 707
Benzoic add lOO, 261
loECDge asi
BonEoln 261
compound tincture of 161.880
odorlfcrum 600
tincture of 261
Benzolnated lard .■•••••...161, 261
BenzoiDum , 811
Benzol tm^
Benzonapbtbol |9
Benzosal 41S
Bcnzosulphtaldum 244. 460
B^nwyl-pialacol
-metlilde
1
CiEN
P
■
ERAL
AGB
415
&4S
919
860
080
ss
080
666
1036
441
451
.601
640
643
«43
757
226
903
481
91 <»
481
267
887
. 096
272
287
Boletus larlclB
Bono-marrow
■
1
p
1(>9"
AOS^
. lOftfl
, MS ■
. 834
, 628
. S28
. 608
. 911
, 9U
il
■r
490
419
. 163
.UD4
206
1068
. 109
. 100
.801
. 881
831
. 428
284
448
669
. 879
. 099
478
888
273
. 104
279
. m
, 280
. 276
1280
. 281
. 281
. 281
. 4U
. tfS
. 010
. SIS
:S
. on
. 047
. 801
. OIT
. 801
. 448
.801
. 001
. 001
. OOL
. 001
.008
.001
. oot
:S
.000
. 000
loos
. 000
. 470
.788
. TOO
. 010
.040
.000
.000
:?SJ
. 104
-il
Berberlne 206, 297, 400, 5S9
bydrochlorlde
024
Boneset
Boral
Borate of sodium
V.V.V.ioi
Berberis
oqulfoUum
Bergaraol, camphor
oil of
Borax
100
In food
101
honey
Borneol
100
.304, 401
Bergapteofi
Bergeon'a treatment for tuberculosis
Beta elifon
acetate
-Isovalertanate
Bornyval
aiicalne
Betagualac restn ,
Boric acid
Betansphthol
benzoate
-blsmutb
.271
glycerin of
ointment
Boroglycerlde
Boroglycerln
glycerlte of
Peta vulgaris
Betel-nut ,
Beth-root ,
Borsalyl
Betula. oil of
Bos taurus
Bilberry
Braldism
Braln-<>x tract
Brand's method of cold bathing.
Brandv
nirch. oil of sweet
Bismuth
' V
and ammonium citrate
betanaphthol
t:>hry*optaanate
mixture of
Brassic acid
Brossica alba
nigra
Brnyera anthelmlntlea
Rrnxllian holly
Brein
Brimatone
Bromarolde
Bromeline
citrate
loscngei compound ... . ...
oxide .,
oxycarbonate
oxylodogalUte
sftllcylate
287
287
18R
887
287
271
287
TJt
372
2fi7
3«7
2fl7
287
067
287
•s;
182
067
197
440
. 853
. 794
794
. 794
794
794
. S2r>
. 9lfi
807
816
614
090
479
. 623
466
04<
. 316
. 926
. 389
. 308
. 810
. 213
.U45
800
212
71
1149
821
. 614
. 614
. 443
S78
. 072
.373
H
subcarbonate
BUbgallatfl
subn 1 trate
sulphite
tannato
nismuthl et ammonia citras
, carbonss
citras
'.267
Bromhipmol
Bromide of calcium
ethyl
f-tliylena
."..'.ios;
RmmldAB. comparison of
Rromlnp
Rromlpin .,
".V.'.V.OTO
oKldiim
ftnllrylas ,,„,
Bromism
fttiboarbonas ....,...•...,
Rromoforni ,,,,,.,„,...
272,
Bubgftllaa
RUbnltnui
..087
Rromognllol
Bromogalllc aeld
Rromol
subsalicylas
Blsmutbum ....,...,
Bromphenol ,
Rromum ,
Bitter almond water .,,.,..
-8W<»»t ,
Qroom ,
wine of Iron
infusion of
Blackberry ,
julcp of
aromatic syrup of **.. .•«....
-tops
brandy , .,,.,
*'*'
mixture
compound
Brucine .,
-cordial ,
Brtignlera gymnorhtia
Plack drnuffht
..081
Brunfelsla hopeana
-haw
BryoRpnln
hellebore f
Bryoldin
raaimcsia .. ..
"
Bryonia ,
mercurial lotion •*..
alba
wavh
diotca
Bladder- wrack
fluid extract of
Plane-mange
..348
Bryonidin ,
Cloud's pills
Bryonin
Bleaching powder
BlesBed thistle
Bryony
tincture of
' •'
Blindness from essence of ginger ...
Bryoresin ,,,,
Blistering collodion
liquid
..000
Buch u
fluid extract of
BUstP-rs
..009
folia
Blond , ,
infuBlon of ,,.,
-letting ...,,...
oleordsin of
- root ,
-serum
....
tincture of
Buckthorn
states of, in disease *.*.I.
fluid extract of
syrup of , ••..,.••.
transfusion of
..00.
Blue robosb ,
Bugle- weed ....•■
olntm<*nt
Bunsen cell
pill
Burdock
Bobarang
fluid extract of ...•■...
Boldlne
BupffunflT Ditcb . «...«. ka. .«»•■•
Boldo ,,,
plaster
Boldus .,..•
Burnt alum
1
K 1170 ^^^H
^1 nnm iraatfrnnir
(IBN
p.
I
ERAL
HOB
28S
sn
7n
588
58t
6S9
835
etfi
S8»
889
M4
100
106
283
S83
668
6S7
»4
CZl
384
2»l
2SA
Z»4
SS4
&»2
285
384
2SI
284
386
286
S84
.897
. ©7
. 657
. 728
. 729
728
. 288
. 288
.288
. 288
. »8
. 288
. tn
'. no
. 288
. 272
. »6
. 108
:208
. »B
. 38i
. 288
. 7U
. 28$
.717
. 288
,79S
.10
. 2M
Calx
^» P-JkOC^J
■ bSBiiKpm
•M ^^'^^l
^f Botlereap
^V Butternut
^M i*7(trnrt nf
!.!."!..'
Bulpburata
4M O-m' "^J^H
Cambogia •*••
CamHIia
•M^^^l
^1 nnrrlMTTiinr
Camellia thea
C&inpbold . ....*■•-••■•.».•.•..
"'"S
^1 liutyl-chloral-bydrate .......■■•.
^H flllXintt .,., i>>.aa.,
Camphf^r •• •■*.««>*■■•■■ i*i-
^M '^n^Rf ,
artificial ..................
cerate
S^^^^l
^H -htitirr . *■■■■•■■■ ■■■
-cbloral
compound tioctar* oC .....
llDlment of • •••• •■•
»O.M^B
^H Carhftri dr pain
^H CncnfiTlatrr nf ipinlnral
H Cacodylo
^M ''a^tln , ...
n
menthol
"* ^^^^^H
-pbenol
aalol ,,,..
I!!!III!II1*I 101
^1 ''"rt'ifl
H «-^<io^ t»1I nf
589
aalfcrllc acid
„.... JOt
H Cadioeoe
^^1 '^HilnitMin
iplrtt of , ,
,.,.. 888
•water **..
298
^H rrpnilflfi ..Ill i>
.tii... 288
^B l^nrrnnrlnr
xnonobromata
Campborlc aold
Caxupfloroxol
^H diffi^ina
^H rifrats
H cfferrescena
^H '^""ftinip nltTBB
or hecntock pitch •
•^^^^^1
^H efferveaMns
turp<;oiizie •>•■<■
*'"*M^^^^I
H Caffeine S84w St. SXL.
^B action of
^H firrntfil
St4. 6fi2
Canadlao bnop
"" S^^^^l
mooDseed ." •■■•*•»•
** ^^^^^1
Casadlne
■■■ ^^^^^1
^H fiTTIlTf 17f . . ,
Canarl'itn cominuii9 ..........
T^^^^H
^H cffervesceDt citrate ....4..*
Cancer paate
^^^^^H
^^L -sulpboDlc acid
powders ...■■.•■■...
' Ma^^^l
^H^_ •f.l-ln^frf.^
of the skin . . . .........
.............. .M . 1
^^^^^■i^nWnnMA
CancrolD ... ■ • ■•
^^^^■/•allipnt
Cajie, sagar
Tn J
^^^^B
Canplta-bark ,
^^^^^H^a|iijiii»l vIvHdinAVta
wlDterana
^S^^^l
^^^^^Ki^*1n»uii- kAAn
Pmmlly* COrtffZ a
^^^^^^
^^^^^B «Hi».l K»«t A^ aI4
" ^^^^^1
^^^^^■^■I^>..*4m*
Caiinabln^ cannatft nf
^^^^^1
^^^y Calamus
CannablnlDi!
■■^ ^^^^^1
CftDri^hiQol .
S^^^^l
^H CalctI bromldum
273
Cannabis Amorlcaxia
2^^^^l
^H carbonaa prsedpltatus ...•..■>
extract of tndlan
'"*"* ^^^^^1
^H rblnrldiini' n
fluid extract of Indian . .
S^^^^l
^H bjdras
^m hrpopbospbla
^V pneclpltatus *•*
Indica
^^^^^1
■atlra
^^^^^1
cincture of Indian .........
^^^^^1
■ pboipbas
^K nnlpbis fTnlmitni .i
Cantbarldal collodion
^^^^^1
pltcb-plaster
** ^^^^^1
^H CatclDcd manasLa ...-.-
Cantbarldes
a^^^^l
^^V CntrlitTTi
cerate .•.•^....
^3^^^l
^H hmiTtliiit
ointment
Sh^^^I
plainer .,
«9^^^l
tincture of
^^^^^1
^B carbonate precipitated
Tinerar of ;,
^3^^^l
CantharTdtn ,
^9^^^l
Cantbaradlnic acfi
^^^^^1
C-antbaris
^^^^^1
^1 bTPophoaphlte
^H lactopbospbate. amp of —
^^H nrlilr . ■ ■ . i
.Vm.'si
Teaicatoria
^^^^^1
Caoutchouc
CaDi>aris corrlaeen
*^i9H
^H pboBpbale of ....•..*•.
sa
Capsaicin
212 1
^M precipitated
Capsicum
312 1
anTi\iuos •>■•
312
^^1 Bulpbate dried ..■■■■•••••■«••
fafft1?1at'iin
312
312
^^H nfTlrlnalla .....
-SM
. M
.288
. 481
. 887
.516
.288
.478
. 287
. 288
.287
. 2»6
. 297
. 298
. 287
. m
otntment . ......
^ 212
oleoreflia of ...............
212
^^B f^alrndiilin
plaater
212
^^^^ Caltfnmla ferer^bnab
tincture of ... ........
Hi
Capsici fructtia
2U
Caraway
oil of
water
CarbAimClr af*1d
217
tlT
>17
13} I
^^r Atnerlcan ................
Carhaaua acid! carboUel
106
Carbo animalla
: 314
purlficatna ,..
214
Carbolated lime ,
]06
1
Carbolic acid
10&
camphor
ointment
108, 107. 201
108 II
^M Carbo \\ga\
^H rnrhnllTfirl nil
OENEttAL
PA.OB
314
106
Caulophy Hum
fluid extract of
m
iiri
PAGE
821
321
H Carbon blaulphldc
316
:tis
tballctroldei *
322
Cauntir potash <
TftS
^1 Carbonel' dtsulphlduxn 3tS
^1 Carboxol "06
^H Carolnonui. parenchymatous Injectiona of
^H ■rnrinirt Af)
Caustics •!»<
.... 76
Cavenne neoDer ....■•■•...
318
312
Cearla
322
.116
Cedar
658
^H -seeds
^1 compound tincture of
^^1 tinrtiirr ctt ........
316
ai6
31fi
Cedrlne
888
CedroQ ■ ..■
888
Cedronloe ...»*,....•(, •«.
3J2
516
Celandine >
326
^H Cardamomum
^^1 Pfirdol
3ie
202
Celastrlne ..*.. ♦..
321
Centesimal solution
29
^^1 CarduuB b^nedlctua •...
31fi
CentlKTade decrees, to conrerl
Fahrenhett
Central calvanlzatlon
Cephiellne
Cepbniis
acuminata
Ipecacuanha <*,«ti
Into
... 85
»M
581
Ml
581
581
^^1 TnnHiinnn . .
318
^M Carica papaya ,
^H Cnrlnl • ■•
fills
^1 Carmelite ffplrli ..
624
.,. a82
^H Cnrminc
,.,,..-. :tS2
„, 21fi
Cera flava
322
tua/s
Corata
.... 18
^^^^^^1 (^nKonirkAAnln
:nH
Cerates ,,*.-
,... 18
^^^^^^r CnrrnfhfM'n
34g
CeratJ cupri acetatls
488
^V Carron-oll
■^ Carrot-fruit
^^^^ Oarthamlnlc acid
^^^K Cartbamus tinctortus
^^^H Cjirum
^^^H ajowan
^^^H rarvi
^^^H f ructuB
^^^^T CaryophylUn
^V Car>'nphyMum
^M CaryophylluB
^H Caara rortcx
^M Caacara aroarga
^1 saffrada
^^^^ aromatic fluid extract of
^^^^L aromatic syrup of
^^^^P extract of
^^^V Ould extract of
^V '^nftrfirtlln
601
316
816
480
817
iB'k
317
317
317
317
317
818
319
7g5
786
785
785
7S6
SIJ
Ceratum
camphors
rctacel
cantharidis
plumbl Bubacetatfa ,
822
899
328
806
747
reslniB
, 778
composltum ,....,...,..
TT9 1
Cerebrln- alpha ,,,..,...,
Cerealn ,»,...,.,.,...,
206
188
Cerpua grandlflorls
Ccrevlslne
888
.. .. 464
Cerll oxalas
Cerium, oxalate of
Cetaceum
Cetln
882
821
828
888
Cotrnrla *.
314
tslandica ,......,,.,.,.., •*.*.
384
Cetrarlc add
Cevadic acid .
324
796
H -bark
319
818
CoTadWla
CoTadinie acid
Cevadllllne ,
795
79S
795
^B tlrrturfl of
318
■ Caararlllln
^^^^^ Cnarnrin
819
,. 785 787
Cevadlne
..795, 913
Ceylon cinnamon
Chalk, aromatic powder of
with opium, aromatic powder of.
-powder, compound
•mixture ,
366
290
290
...87, 888
889
^^^H Casein ointment
m
201
^^^* Caaulu augusllfotla
^V actitl folia -k. ..
886
886
^m flaM.la
819
prepared
Cbaly beates
889
... . 467
^1 IT't M
8M
■ Pulp»
^m Cantanea
, 819
819
Chamflellrltt
607
Chamnpllrliiin lutAum
607
^M rff»ntBl-B ,
819
Chamomile ,
880
^m CAfftoroum
880
880
^B rnmtnT
880
floWfTB ••**•*■•••• ••••■••■ a
280
^^^ fl^tr
880
Gi*rman ... * • • * * *••*
61ft
^^^K
666
oil of , ,
290
^^^H mtvfiiM
608
Charcoal
. 814
^^^^ to disguise taste of
^F r.««tftHn
668
880
Charts ,
u
880
^m Cntttrni>»«ta ,,
....984, 970
Cbntanlni^ , ,
ftll
^m Cataplaama kaollnl
^1 Cataplasroata
^M Cataract, caused by naphthalene .
....880. 500
18
638
Chaulmooyra oil
884
Chccker-bpixy , »,
...... 688
Chckao myrtuB ..**>•■■.• . •
886
881
Chefcen
886
^H Catechu
^^L compound powder of ..........
8M
3N
•bitter
386
Chekenetin ,
S86
^^^^^H. ~*inr'" n'^i^ , , ,
......... 881
Chekenlc add
Chokenon *.,..•..,.
886
8M
^^^^H ••"'>'"•■'>
880
^^^^^ ••-»'-k"
890
Chelorythlne
aoT
^^^^^ ''stlir "nitllii
881
Cbt^lldunlc add .•....,•>....■■..•..•■•
.;; ;. m
^H rnfhnrrir srld
788
Cltt-lldontny ...•.,.
186
^H CaThnrttn
S88
Chelldonlum , ,.*•,•>.•
886
^H CathnrtiDlc acid
H Cnthod.-
^^M CiitrnnilTir
886
9X8
888
386
Chclldoxan thine ■■■«••....
888
Chemical IncomDatlbllltr .......■■*•■
46
^H rAiilonhTlIln
»i»
ChnnoDodluRi
S2i 1
■ 1172 ^^^
GENISKAL
PAOB
327
INDEX. ^^^^
Citnlcifuga, tlactura of
VAnm 1
8B8 1
^^1 ambrosiodofl ..»*.a..*Bb
..^ asfi
Clmlclfugln
Cinchona
acid Infusion of
callsaya
KO 1
ass
353
853
^H nil nf
„,^, 326
^^H Chprrv^laurol leavei . . •..^.a^^A
597
^^H ifntrr
121, W7
JM
condaminea
S54
3n0
compound tincture of .....
352
. . , SM
extract of
3SS
tt
(Java
354
^^1 Phlmnnblln
::;::::::: m
fluid extract of
368
B7
ledgcriana
853
. S>7
micrantba
IIS4
H Chlmaphllln
^M Ch Ina-root
^B Cblneso tea-plant
H Cblnoidin
^^^^ CbinnfdtDO
W
827
2ftS
an
863
ass
oIDcinaliB
„.,.. .. 334
pitayenilfl . .. .'
3S4
rubra
888
tincture of
CInchoDiB rubra cortex
868
368 1
succirubra
35«
^^^H Chtnollna
.......... an
,... ssg
CInchonamJne
Clnchonlcine
asi 1
^ CTilrntn
..,»,-,*.. SM
OlnchooldlDSB lodoaulphaa ....
iiaM'*ylaa
868
3S8
. . 829
^H Chiratio
^m Chlretta. concentrated solution
^H InfuBlon of
^H ChIorn>tbaDal alcobolate
^H Chloral atcoholate
^H rnfff^ln^ ,,,i ■■,, ,
820
829
589
846
331
S.V»
sulphas
CiDchonldlae aulpbat«
CIncbonina
Glnchoninie sulphas
868
3BS
868
868
Clnchonlne
358
lodosulphata
salicylate
sulphnte
368
168
858
^H -"nmpbfrr , i
S33
^^H taydnui
331
^^H hylrntf^ i ■ ■ < ■ i
„^, 331
Clnchnnlsm ...,,.
JS7
^^1 nnlnfinlnr
, 331
Clneol
i&i
^H Byntp ot .>,..,,, »..««»«>..
331
185
Clnoaldebydum 368
Clnnaznlc add 846. 863. 39X808
aldehyde 388
Olnnamomt cortex 885
^H fThrlntnii
g46
^H Chlornlamlde
^H ChloralfortDamldp
3»
389
^H rblornlformamidum
^^1 Chlnrnlnnn
359
camphoro)
sali?onum
tnylanlcum
8»9
385
„..'.. 3CS
^1 Cblnrnhim bydratum
^H Cblorctone
^H Cht^rlf othiT
n\
827
l«o
ClnnamoQ
compound powder of
385
388
^H rhlorM" nf Vmr
„ 2S9
oil of
su
^H nf ftWrr mil
941
«plrit of
30S
^B Chlorinated lime
■ oil
^H '^blrrrlnA , , ,
345
347
MS
tincture of
881
water
CInnamyllc aloohol
886
no
^H rnmrniind itnliitlfrn nf
316
Clssampelina .,.,,
708 1
^H Trnt'^r
345
Citric add
115 599
^^1 Chloro-broni
330
ayrup of
. .
^H n|i|rtfirn^Yn«
33fi
Citrus iiurantlum
borgamla >.
tlmonum ,
m
668
599
^^1 Chloroform nbsoliita .. ....... .
X\*i
^H nimlnlntrntlnn fif
S88 343
^^1 nnndynp
33<
medica ..,*.
TulgariB ,,
Cltrullln
698
841
391 '
^^1 '^m^lfriiTn
3:»7
^H ^'n'rni^Tit
337
^H -rfrU nf , , , , ,
837
Cltrullufl colocynthldls
C 1 ass tfi cation of druffs.
Clavlcepa purpurea
391
....6. 16, 72, 7(
445
^M watt^r
^H r*Kln|.nrArT¥^iTTt^
837
387
^H r*h1/vpnp^ATf|^]
847. 417
Clavln
44.%
^H r»h Inoity^ , ■ ■ . 1 ■ , ■
345
Cleavers ,
4X0
^H Chn'"'lnt" ,
389
Climate, choice of . ...
lOTS
^m ntt^i^Mi^ft,^ fpt ,
1.12
Inland
1073
^^L '^bnHpi*
85fl
marine
, 1077
^^^^1 CbondrjdP'ndron tomeotoaum ...
^^^^m Cbondma
^^^^P rhnnnni>A nmMr0-ft«f%
702
348
348
Climatology ,
1079
Climntotherapy
lOrro
Clot-bur
919
^^^^^ CbrlntTTinn mur , , ,
507
CloTpr, compound syrup of ...
red
903
90S
^r Phl'.^ml/* aj^l^
113
H fHn-rfrt«
118
Cloves
. . . 317
^H Chromil trloxldum ....•
113
Infuslnn of
T17
^M Chrysantbcraum roscum
773
oil of ,
317
^H Chi-v«nrr.hln
84ft
Clemon'^ solution
93
^B nlntnion^
349
Clrster
. . 54 1151
^m tMnnnfa ^f
360
Cnlctn
318
^H ChrTBarobtnum
819
Coal-oH . ,
707
^H Chrysupfanu
738
-tar, prefMr^ ,,,.
.... k .. . 744
H CbryBophaalc add
H CtaryBophyllaiD glycTphlffium .
^m ni/<iitnvln , , ,,,,
.787. 796. «2«
638
880
solution of
744 77s
Coca . -
368
fluid extract of . ..
im
H CiiulLlfuga, extract of
8S0
-leaves ,,,..
; ;; » i
^m nuld extract of
880
Ilnuld extract of
aS 1
^B r«**ftmA«« ,,
880
wln«> _ __ _
S 1
(nsyERAL ITfDEX.
4
1173^
PAOB
CocvB folia 3<8
CocAlDa 368
CocalDffi hydrocblorldum MS
Cocaine 96S
aooeatbcsla 868, ntS
caDtbarldate 311
cat&fqfetlB B70
dliks of U68
bypodonalc Injection of .iis
hjrpodcnnto Injection of 368
ointment of 368
oleate 368
phonate of 872
Cocalnlsm 868. 870
CoccullQ 880
Cocculus Indlcus ....* 379
Coccus .,.....« 881
Cochineal S8tl
tincture of 881
Cochlcarla .' 888
armoracla ..238
Coclllana 888
Coilamlne 876
Codeina 383, 678
Codelnic pboflpbaa 383. 673
flulpbaa 383. 673
Codeine 888
lodato 664
phosphate of 883, 673
sulphate of , 883, 672
sjrrup of 888,674
Codelnism, chronic 883
Codllvsr-oil 658
emulsion of 658,661
with bjrpophosptaates 9SS
Codol 780
CoITea arablca 284,384
CofToo 384
Cohosh, black 350
Cola 592
acuminata ,...,.......■ 693
Colchlcl cormua 381
semen T 384
Colchlclna 394. 886'
Colchicine 384. 886
ColcblcuiD autumnale 386
extract of 385
-corm, extract of 386
-root. Quid extract of 886
wine of ,. 386
-seed, fluid extract of 385
tincture of 385
wine of 3SG
Cold as a remedy 1116
Cold cream 1*7
Colic root 178, «7
Colocynth, compound extract ot 391
pin of 391
extract 380
and byoacyamus. pill ot 881, 544
ColocTntheln 881
ColocyoibldlB pulpa .-. 380
Colocyntbln • 381
Colocynthls 880
Colocrntbltln 881
Colorne water 161
Collsrgolum 881
Colllnsonia Canadensis 888
Collodia 18
Collodion 389
cotton ■.. 497
Collodions 18
Collodium 888
cantbarldstum « 808, 818
flexile 888
■typtlcum , 148. 880
veslcans .808. 889
Colloidal sUrer .' 888
Colophony TI8
Colt's-foot 808
Comfrey 875
Cotnmlniitioa 87
Commiphora myrrha 686
FAoa
Compound cathartic plU 298
mixture of chloroform and CADnabla
Indica 888
pill of gslbanam 884
spirit of ether 1B6
tincture of chloroform and morphine.. ^
Common buckthorn 784
Commutator or current rererser 964
Condurangln 382
ConJurango-bark 382
cortex 382
Cooduranztn 392
Conduranaterin 392
ConfectlaneB 18
Confections 18
ConfecUo plperts 740
roaa 892. 623.792
calllea 792
senna 770. 825, 878
Butpburla 758, 868
Conhydrlne 888
Conll folift sot
fructus 888
Conlina 808
Conllnoff bydrobromldum 273, 838
hydrocblorldum 398
Conllne 8»8
hydrobromldo • 278
Conlum 888
extract of 888
fiuid extract of 888
-fruit 888
•Juice 886
raaculatum •. 888
ointment 886
Uocture of 398
Corneals 864
ConaumpUoD, climatic treatment of 1060
ConLralDdlcallons to digitalis ... 188
Contusion 87
ConvallamaretJn 896
Coovallamarln ^ ^9€
Conrsllaretin 806
Convallaria, Ould extract of ..*•..•., 395
maJallB 886
Convallarln 886, 757
ConrolTUlIn 086. 58T
Convolvulus acamxBMila St7
Copaiba 887
masa of 387
oil of 387
-red 397
resin of •.. 397
Copahln dragees 389
Copalfom tansdorfU — 887
sennie ,...,..770, 886, 878
nulpburla 1B9, 869
CopalTlc add 807
Copper 438
aceUte 433
cerate of AH
alurolnated 488
ammonlated 133
araenlte ^ 48X
oleate of 484
sulphate of 488
Coptlne • 100
Coptis teeU , 400
trifolla 400
Cordialia mbl tractus 7M
Coriamyrtln 380
Coriander • 400
sativam 401
Corlandri fruotua , 400
Coriandrol 401
Cordlandrum 400
Comin 401
Coming's method for aoattliasla 378
Coronifla 40t
rnrla , 401
OoronUlIn 401
Corn-husk 616
-meal ■.. 683
1174
OBN^tAL INDn.
PAGE
Corn-allk 614. 920
fluid extract of 614
fljrrup of 614
-smut 616
•starch 201
Cornus 40L
Florida 401
Comutlne 416
CorrlRcnt 44, SI
Condolia 403
CorydnllDO 402
CorydallB 401
Coryl ; 1«4
Cotarnine bydroohlorlde k.... 800
Coto-bark 402
cortex 403
Cotolnc ..; 402
Cotton, fttworbent 497
purtfled 497
-root bark 4»T
Coucb-RTass 906
Coulomb 93S
Coumaiin 438
CoumarouBea 138
Courtploater &&0
Cowberry 910
CowhaKO 634
Cradlne 477
CraDo's-bfll 487
CrBtseKOB oxycantha 403
Creani of tartar 14S, 7S8
Credo's ointment 232
CreoDn , 403
Creolinum * 403
Crcoaal 417
Creoflol 406
Oreosotal 115
Creoaoto lf>6, 406
calcium hydrocblorophoapbate 416
carbonate 116
In tubcrculosfa 409
mixture 406
ointment , 405
Wftter 406
Crebsotum 406
Creool 106. 416. 610
bismutb 271
compound solution of 416
eaponato , 417
Cresylol 411
Creta propamta 289
Crocus 4S0
- aatlvua 4'JO
tlDcture of 420
Orookea tubes 1125
Croton chloral * , 336
ctluterta ., 319
-oil * 671
liniment , 671
Crowfoot 779
Cryptopia 676
Crystalline 390
Cubeb 480
fluid extract of 420
oil of 420
tincture of 421
trochee of , ,,„. 420
Cubeba 420
Cubebtu fructufl .,,., » » 420
Cubeben *........ 421
Cubebene .- 421
Cubcbic add ., 421
Cubcbln ,,,..., 421
Cucurbita popo 701
Cudbear 706
Culver's root 599
Cumin, sweet 219
Curaulatire action of druga S3
Cupplnit lt4S. 1147
Cuprelne SG4
hydrochloride ,.., 364
Cuprl acetaa ;..... »*... 422
arsenls 422
sulphas 422
Cuprohremol
Cuprum
nlumlnatum
ammoDlutum 411
Cu rare 4M
CuhuiDfl 421
Curcaa , 487
purgans * 48T
Cure, law of I
Current collector 8K4
of electricity 9tt
properties of electric MO
Currents, from a faradlo battery MS
Cufiparia-bark 417
coDceatrated solution of *.> 4t7
fibrlfuga 4t7
infusion of 4tT
Cu8parl£e cortex 487
Cusao 48ft
Cutch 3B1
-brown 381
Cutol 188
Cyanide of potaaslum Ill
of silver .*.. 123
Cydonlum 4tt
mucllaKe of 488
vulgaris 4tt
Cynapine IN
Cynips gallsB ttnctortse 480
CynogloBslue 481
CynosIosBum 481
ofBcinale 489
Cyprlpedln 423
Cypripedium tf8
blreutam , 429
Cytlslne 388
Cytlfius scoparlus 819
Damtana 42i
extract of 4li
fluid f^xtract of ..•* 4M
glycerol of 439
Dandelion 8B0
Danlcll cell 940
Daphne mesereum 888
Dt^)bntn 888
Datura stramonlttm 851
Daturine 8SS
Daucus earota , *, .........i.. 316
Deadly nightshade 358
Death from mercurial ointment U6
Decocta 18
Decoction of aloes, compound 180
ZIttmnnn's Sl£
Decoctions , 18, 87
Decoctum aloes compositum IfiO
cetrariEB , S4
grnnitt corticts ......^ 498
hmmatoxyli ; » GD3
lualtanlenft 816
sarsapartlla compositum 814
DeKr'n<>ratloD. reaction of * 8M. 978
Delphinine 840
Delphinium etaphlsagrla 819
Delphtnoidine Ml
DelphlslDc Sa
Delirium tremens r..ifl
Demu Iccnta T5
Dental use of tropococaine «..»..... 90f
Dentistry, artstol In 8M
thymol in 800
Dermutltia from picric acid 188
Dermatol ■.. 871
Dermatology, application of electricity to 961
Dermol 372
Desbler's salve 780
Dlabetln 198
Dtacetyl-morphine 608
Diachylon ointment 747
piaster . 748
Diagnosis, eUxer aneeetheala for 161
by x-rays 998,1129
of cerebru-Bpinal dlseasea. .963. 984. 97S, 979
Roentgen rays In 1128
6BNERAL IKDSZ.
1175
PACE
Dlacnostic tue ot tuberoulln 90S
Dt«Jy»is 39
Dialyzcd Iron *75
Diaphoretics 81
Dlaphtol ^18
Diccntra Ca&adeastfl 40)
DIchroQinte ot potacflum 113, 114
Didymlum 322
Diet la dtseas« 1082
DlgalfUi A. 437
DlgesUoD. icflueuce of boratee oa 101
DlglUlein 430
Dlgltalic ttcld 43*j
DlKiUtln 430
action of 431
Nati vcUo'a - . 43*)
DIsltallDum germanlcum • — 431
verutu 430
DtglUlls 430
accumulattOD of 431
extract of 430
iDfuBlon of 430
fluid extract of ......*.....« 430
folia 430
purpurea •.-»..«•..« 430
tincture oC ».«..... 430
Digitm , 430
DlgllODln i 430
DlcUoxiDum solubtle (Cloetta) -137
Din 202
Dlllon'8 dentifrice T«8
Dilute acetic acid 90
Diluted bydrobromlc acid lis
bydrocyan Ic acid 121
hydrlodic acid U7
bydrocfalorlc acid 119
nitric acid Ii4
ntirubydrocblortc acid t 126
Dimolbylamin W4
Dini<?thylarscDlc add 105
Dimethylketone 90
Dl-lodoform 5GI
DIonIn 437
Dlo«coron villoaa , 437
DlOBCoreln 437
Diphlhpria antitoxin 212
DIplcroearpuB turbloatua Wi
Dlptcryx 438
Disease due to etatea of blood 71
Dlalnfoctanta 82
Disinfection by sulpbur 874
Dlatilled water 226
DIU bark 488
DIUIn m
Dllainlne „,,. 438
Diuretics 81
Diuretic action of mercurr • 517
DIuretIn »42. 890
Dobpll'a solution 106
Dock, yellow 795
DoKwood / 401
DonoTan's solution w... 93. 563
Doaage B2. 8S, 83
Dosoa. Tarlctles of S3
Dormtol SflS
Dover's powder 580. B81. 873
Dracontiuni — 43S
Drlmys winteril ... ...-r. 919
Drop*, size of . .• . 3S
Drosora rotundlfolla *.. ■ 43S
Drugs SS
Dry coll 941
Dryopti-rlP flllx-nias 238
Duboisla myopotroldee 438
Duboieion? hydrobromldum 43!»
sulphas 439
Dubolslne 438
Dulcamara • 440
fluid extract of 440
Dalcaronrioe ,.,.... 440
Dulclo i 713
Ehirand's remedy for call-atones 1W
DyDamnraeter 952
PAOB
Dynamos 948
Dyne »3«
Eau do cologne 169
sedative 800
Ecbolica 88
Eclectic mcdlcloe ■ 8
Ecgoaiae ■ 868
Echinacea angustifoUa 440
Effects of electric current 980
EfTerveacent salts, how made 38
Efrerveflcing draught . 768
EgK-yelk. glycerlte ot 918
Elgon , 441
Elaallca 441
ElutcrlD 441
compound tK>wder of * 448
trituration of 448
Blatertuum 448
Elatcrlum 448
Elderberry, black 806
Elder-flower water 806
flowers ■ 806
Elecampane 5M
Electrical foresla 970
Induction tnlaooe 897
meaaurementa 933, 984, 937, K8
Electric baths 966
InJecUouB 999
Bl>?ctrlclty. definition of »..928. 958
sources ot 988
in gynmoologY 981
In medicine 927, 958, 966
Electrification 829
EJectrocausia 960
Electrodes 982, 951. 966
Electro- diagnosis 9fl0| 868
Electrolysis ...988
Bkctro- magnetism 989
-massage 1008
-motive force 988
unit or 938,888
•therapeutics, clinical *•'.... 966
Gloctropoion fluid .•••. U3
Electrozone 448
Elemi 448
ointment 448
Elm 909
mucllBKe of * 909
Elettarla repciu S36
Elixir Ig
adjuvana 485
of ammonium valerianate 188
aromatlcum 841
eucalypti 445
fprrl. Qulntnao et strychnlns) phofti-
phatum 363. 466
of phoffphates of Iron, qtilnlQe tnd
strychnine ....866. 465
rubl 794
compositum ,. 'jH
turners 488
Ellxlria
Elixirs
ElutrintJon ....,...,
Bmbella ribes .....,.«>•••.•.
Bmbellc add -_
Ernetlca i9
Bmetint' SBl
Emplastra 18
EnirlnntruTn adhvslTum 441, 748
nminaDlacl cum hydrargyro 189.814
belladonnie Itt
cantharldlfl ........,...* 806
caletaclena 808
capalcl 811
hydrargyri «14
opil * 878
picia - 744
burgundlcsB 744
cantharldatam .*. 808, 744
plumbi .748.812
lodidl 748
I lire ^^
^H Bmplaiitrutxi reilns
" GEN
P
■
£BAL
Aoa
77»
811
88
826
76
8
18
587
87
197
666
18
189
197
334
837
661
658
8S1
65
E4
U53
1101
66
1161
448
443
443
444
661
828
444
257
810
.76
611
»0»
516
69S
f>09
r>.^
450
451
450
460
088
448
446
446
446
444
444
115
44r.
444
444
444
446
446
410
621
460
856
318
318
:us
INDEX. ^^^^^^F
Bthcr, • auiphurtc ^ .
valerianic
PAOB
155
162
^^L ffp'^'^W
^^^^_^ 'Dmm/.nnfrAfpiMi
Ethereal oil ....*..
]&&
^^^K Bmodln
478. 786. 788
Ethyl -alcohol
16y
-bromide
..163. 273
.... 144
^^^^^B TI«*«nl..l»n1 •..-.«»«nAK*
-carbamato ■.■•■.■■■»•*.••
^^^H Bmulaa
•chlorido I
-hydroxide
-Iodide 166.
-sulphuric acid
165
168
odS, 579
141
^^^^ Emulsion
^H *'h1ti^
-urethane
Ethylenedlomlne mercury sulphate ..
Bthyllc cuprolne
Bthylis lodidum
Ethvlene bromide
IW
861
as4
165
IW
^M Bmulslons
^m Bmulsum nmmonlacl
^M amygdolffi
^H asafcetidiB
^H chlorofonni
^M oI<?l morrhus
^H num hypophoaphitlbut
^H tercbluthlDs
^^^^ End^rmlc method
^^^^L Baema, medicated
*"'.V.V."*tt8
..iiBi, iisi.
EucuIdl' & and b
461
hydrochloride •.«
..... iSl
Eucalyptone bichlorhydrlde *.,
ducalypteol
455
465
Eucalypti gumml
Gucalyplo-resorclD ..................
4^2
.... 784
Eucniyptol
Buciilyptiis
452
S91
^^^^^P nitt«.)ttVA
^^^^^B V«Apl^..fmln
elixir
fluid extract of
globulus
■ gum
oil of
ointment
rostrata
<S5
..... 451!
453
462
452
462
462
^^^^K Bntr>rocIysls
^^^^r BpbMra
^ Bntlsyphllitica
^H KphMrfni*
^^^^ hydrochlorate
^^^K Bpl(l«rmic method
soap
.... 454
^^^^^t ^p<r»<»"
troches
Water of
452
452
^^^^^K »pllrtp=|r R.«Aknnl*>«
^^^H BplQephrln
^^^^B BplBPBStiCS
^^^^H ITnanm
Euoolln
Eudermol
Eudesmol
481
878
462
^^^H Ercinol
^^^H Brotbism, mercurial
Eugallol
Kugonla aromatlca
caryopbyllata ......-...■....*■.
776
817
317
^^^K lr.l»»lln
450
ohelcan ....,•,,......,.•..«
826
^^^^H Vv'iff'OKnn
Jambolana
687
^V ^^!n:.4ij.tynf^
Eugenic acid .«•...
til
^H nromatlc syrup of
^H Callfornicum
Eug(*aiD
ai7
Eugonol
.806. 217
318
^M fluid oxtract of
■ Kr«
^H RrffTFIfr
acetamlde
Euonic acid
4.'>6
Eanonyml cortex
456
^H KrR'^fti'riTi
Euonymus
atropurpurca ■•■>..
ihC
466
^^1 Brgot, actliiD of on uterus.. .
^H ammoDiated tincture of ..
drv extract of *«......
466
^H M"**^^* , , ,
extract of *....**..•..,.
..... 4S6
^H fluid oxtrnct of
fluid extract of •.......•
4^6
^H hypodermic InJeoUon of .
^^H Infusion o^
Euparin
(67
Bupatorin .,
457
^H nf my., ^ ^
Eupntorlum .*......
..... 456
^H T'lnn ft
fluid extract of ■•...«•
467
^H Firrr^m
perfollatum
437
^H Ergotinlc add
purpureum ,
467
^H ErgotJsm, acute
Euphorbia coroUata •• «
hctorodoxa .
i'^
J.Si9
^H rbrftnlr
^H Kri'Tfrlln
481
Ipecacuanha ,,.*
..... 684
^B Brtodictyonic acid
pllullfera ,
.....467
^H Eruption from quinine
reslnlfera ,,,..
468
^B Erytbropblaeine
Buphorblum
468
^1 hydrochloride
Buphorbon
Eupborln
Euphrasia .,
458
469
439
^H Brytbropblicum gulneeose ...
^H Erythorrhetfn
..
788
368
368
76
451
729
729
729
tH8
328
166
162
166
157
156
166
168
161
^B Erythroxylon coca
284
oOlclnalls
....461 1
^H '^•"•f-'MI'^nnT* „
Eupbtbalmtn hydrochloride ...«.
..,^. 4S6
^H Pf^hnr^tirn
Buqulnlne
... . 86S
^1 F!"^)i"'hi^lti;ln rslifnrnlra . . .
chloride . .
:t66
^H lr«..riimin«
Buroben
..... 300
^^^^ tS«.M-Mln«
Europhea ,
4110
^^^^^^ naorlnA
Bxalgino ...^.w.*..
• .... 4<tl
^^^^^V 1?Br.Inn*lllB
ExClpiCDt a..
.... 45
^^^V nth.i
Pxb'IflrantB .,., >
.. - 78
^^^ R»h«r
Bxodin ...,,,.*,
..... 462
^M
Bxpectoraota ....)■«.*•
9\
^m nnoMthoHlf^
Bxpreaston ...i......
Exslccatlou ......v.
42
•t... 38
^B and chloroform, relative safety of ...
^B compound spirit of -
Extemporaneous furmnliB ■• ■ •
42
^B f^ntrn1nf1lr>B^lnr^B ^^
Bxtracta
18
^B -pneumonia
Extracts
18
^H Hplrlt of Qltroua
166
BxtractlOD of drugs .,,..
.. . 40 1
J
PAOB
Extractum aloes Barbadensta 180
aloea ISO
antbemldlB 2M
belladonn.'O alcohollcum SSS
foliorum Ifil
liquldum 8U
Tiride ass
cannabis I ndlcie 306
caacariB aaerads , 7SS
liquldum 7K
clmUTifiigip ■ 3tO
liquldum SfO
clncbonoB SSS
liquldum * 3Bt
coca? liquldum 8S8
colcblcl SIB
cormi S86
colocynthldii SM
compoaitum 891. 817
conll SM
dlffita-IU lao
ergotffi 444
liquldum 445
euonyml (56
slccum 456
fillcla liquldum 238
Sentlacs 485
glycyrrhla» 496
liquldum 496
purum 49S
bsmatoxrll SQI
bamamells liquldum 6M
hydraellB liquldum ....539
hyoBcyaml &4S
Tlride 544
Ipecaouanbic liquldum 590
irtdia 584
Jnborandl liquldum 73S
Jalaps ■. 586
Juglaadla 588
krameriae 695
leptandrce ...599
parelraD liquldum TOS
malt! 516
nucia Tomice 648
liquldum , 846
opii 878
liquldum 674
pancreatla .,.....- SU
pbysoatlgmaUfl 739
pbytolaocas 782
podopbylU 756
quaaain 776
rbel 787
aaraie liquldum 814
scopols 811
BCUtellarlK 818
Btramonll 851
alrophanlbl 856
Bumbul 874
tarazaci , 880
liquldum 880
UTip ural 908
Byebrlgbt 466
Bye, electro-magnetic removal' of foreign
bodtea In 993
b-Tablana lmbrlc»U -i«2
iFabianlne 463
iFablanol 4rt2
tVagua aylvatloa 405
^Fahrenheit degrees, bow coaverted loto
centigrade 85
Falae unlcom 507
Farad ^.,,, 988
Farodic aparatua 948
currcota , 986
Faradomrt^r ,,... 916
Farina trlllcl , 468
*1 bovla 468
Pennol , 477
■trxtit 4TT
•water 477
Fennel purlflcatum .....*..,. ..^ 463
Fermentum ,^..««.,.- 464
Ferratin 478
Ferric aootate, aolutlon of 468
FerrI araenas 92.466
carbonaa saccharatus 466. 466
chlorldum 4<R»
et nmmooil cltras 46a
tartraa 466
Qt potaaall tartraa 486. 768
pt qulolnn cltraa 852. 4K
solubllia 862. 165
ct Htrycbnlnie citraa 466
cltras 466
bydroxidum 465
bydroxldum hydratum cum magneaia
oxldo 465
hypopboapbls 463
lodldum saccbaratum » &62
lactas lis
pbofipbaa 466
fiolublllB 465
pyrophoapbaa aolublUa 465
sulpbaa ..«.., 463
exalccatua «,. 468
granulatua 465
■ulpbaa .., 465
Ferric ammonium sulpbata 466
cblorldo 465
BOlUtlOD of 463
citrate . 166
wine Of ., (66
bydroxlde .465
wKb magncaium oxide . . t6S
hypophospblte 465
pboBpbate. soluble 465
pyropfaoapbate, soluble 4tI5
Bubsulphate, solutioa of 465
eulphatc!, solution of 465
Perripyrloe 788
Ferrobiemol 476
Ferro-somatosc 846
Ferrous bromide, syrup of S7S
carbonate 468, 468
oblorlde, tincture of 466
Iodide, pills of 466, 6ti
syrup of 466. 568
malate 476
phosphate, syrup of 466
sulphate 466
dried 1 466
granulated 465
Fcrrum 461
reductum 465, 466
tartaratum 466, 758
Ferulalc add ., 284
Ferula fatlda 234
Ferula galbaniflua , 478
Fetid spirit of amraoola /.,..».... 180
Pev<»r, bydrlatlc treatment of lavi
Flcua *,,,,. 476
carica : » 476
PiB 476
Flliclc acid 38i
FlUcln 288
FIllx mas 237
FiDsrn tight 1180
Fish-berry S79
-glue , ;.. 549
Flag, blue 584
Flagg'a Iodine ointment 569
Flajuwed 601
tea 601
FlrxIWo collodion 390
Flowera of sulphur ,.,,, 868
Fiuidextracta 18
Kluldextractum aconltl 146
npocynl ,,,, SS4
aromatlcum , |M
SBClepladis , ,.,.. 236
aurmntll amurt , 841
belladoDDe nidleig ,„..,.... 2SS
bryonUe 2S1
bucha jgj
■ 1178 ^^^*
^H Flaidextracttun calami
PAOB
288
SM
Fowler's BoluUon
Fluorescein
PAOV
..92, 7S8
477
477
^^^^^1 AAn«.KI« Tn.«liUH
30&
^^^^H eapBlei
3U
Slfl
Fly-fungup
188
Fa?Dicull fructUB ••.......
877
^^^^H caulophylll
^^^^H oblmaphllie
321
337
329
Fffiniculiim
m
txr
Foods for tbc sick
Force! B
1094
.914.970
008
eo8
^^^H olzalclfugie
3S0
363
Fnrroatdehydc, solution of
Fomialln •..*..
^^^^^B
3«S
^^^^^^ *^i4lnla
S86
Formatea «...
11^
^^^^^H _«*«l*tl»
, 385
Formlo acid ......*..■*....*.*.. ........
..... US
^^^^^B «A«
... .... 393
Fo renin ■......■■.•■■.«.
. ... 608
^^^^^B P/tTtvallaflok
S95
Foxglove
..... 4»
^^^^^1 Mllh^hA
420
Frangula •
i;."«
^^^^^B n^pflfutfttl
429
fluid extract of
4lt
^^^H rfl.rl*»lia
430
Frnngulln .....■...■■■■.(••....
...•• 419
^^^^^1 .*«.I<.»».««HH
........... . 440
Frank^nla ......■•*..■ •*■....
.. .. <78
^^^^H «f-«<^»«
444
Franklin
PrankUn's apparatus
Fraacra
Prnx<»Un
M8
844
47S
478
^^^^^B
.., 460
^^^^^H
462
^^^H cuonytnl
-..., «6
467
Praxtn
.U6, 478
... 478
^^^^H frnDSUIos
^^^H gelsenill
478
483
4S6
Fraxious
omuB
821
FroBt-wort
.« . fi08
^^^H Klyc^rrhlzn
m
, 497
Fucbsln
4TS
Fucua veslculosla ...,,,
471
49S
Fuller's eartb ,
6M
^^^^m
498
Furaarlc acid
Gaduin ....
402
^^^^^m •runtManm
602
^^^^^^H htn.nn.»lli4la
604
^^^^^^1 t>l-l4pn*fla
639
Gad uol
OaduB morrhua
858
..... 8ES
^^^^^^H Ipurxi.xiunKan
680
^^^^H i»i.ii„
6S4
Galanga ...*.
Galangee
«>
478
^^^^^B
fi9&
^^^^^B Innnm
69C
Galbanuni
4}»
^^^^^B iTTrn'TnT
699
compound pill of ,
4T8
479
CM
^^^H lUpUllDl
611
,.,^ 614
Galega
.... 488
Galium
488
,,, B23
aparlne , ,,
..... 4B8
^^^^^^H >nAnlBnM*M*i(
634
Gnllft
48^
^^^^^B
631
GallacetO'pbenone
^^^^^^B ■lllMtB wn«v>lA«
, 64C
Gnll and opium olDtment
Gnlllr aold
::::: »
117
^^^^^B
,., 702
733
Gallobromol
. S8l
^^^^^^1
TS,**
Galls, .- U7. 142,
Galvanic battfir. requlremeots of ...
cautery
480.777 !
841
884
^^^B pninl VlrglDlftDflB
^^^H qunssin
771
776
778
cells
888
^^^^H rbamni purstalanie
785
786
Oalviino-csiitfry .....(•..
.Oa. 984
96t
nalvanomctors
^^^H .h»i
787
Gamblr
830
^^^H rbols glabroB
7M
...., 792
compound tincture of •-..
2M>
trocbes of
^^^H «.hi
794
OnmboRc
rorapound pill of
Gnngrone. aftor nntlpyrln Injection.
Gnrcinia hanburll
kola
mnngostann t,,
Oarglo of red gun
m
m
717
^^^^^B fifmrnta
795
797
^^^^^B •■ncMilna^ln
806
^^^^^B
814
^^^^^1
, 814
^^H vvlllm
817
819
Onrllc
178
^^^^^^1 *»nr.r.lm
821
Gonya Fremontll *
4SI
^^^^1 sent^RiC
4! 824
82ft
Garry Ine ., ,.
On!*t''rtdlnpbaDy ..■■■■4..
HV
^^^H Bcrpfntaris
^^^H ft sennie
827
..w.... 848
* 84S
, ; 849
OrfuUherIa
'" tfl
oil of
procumbcns ,.
spirit of
Oaulthorilene
GniiKn, carbolic acid
i^
^^^^B
860
^^^H stramnnll
851
874
OeIn
Oclntln
Gvlatlnum
::;:;»
^^^^^B
8S0
909
910
glyccrlnatum
48 [1'
^^^^^B
9l(i
Oolsemll radix
mI'
^^^^^B
91«
Oelsemlno
W'
^^^^^B
913
O^lsemlnlc add
Orlspmlnlne
Ot>lRemlum
'.'."' 484
4SI "
J
^^^H xanthoxyli
^^^H slnglberlB
919
925
OENEBAL INDEX.
1179
PAGE
iiuin» fluid extract of 483
Idum 483
aperrirens 483
cture of 483
9 splritui 588
n, compound tnfuiion of 485
tincture of 485
;ract of 4^
Id extract of 485
>t 485
na 485
ea 486
InquefoIIa 486
mad radix 485
►picrin 478. 486
iic acid 478.486
ium xnaculatum 487
rlvale 488
banum 488
ia 488
foliaU 488
In 488
169. 588
r, essence of 926
tid extract of 925
een 925
eoresln of 925
rup 4. 925
ea 926
icture of 925
bite 926
rol 926
il acetic acid 90
tcrs serum 216
lulae tbyroldeca slccae 207
iprarenales Blocs 209
. soluble 829
'In 488
linum 488
'se 798
■rup of 797
•aura 490
dum 264, 490
n 549
Tin of alum 184
f borax 100
C carbolic acid 105
f lead subacctate 748
f starch 201
f tannic acid 142
upposltories 491
:'rini alumlnls 184
?rinum 490
cldi borlcl 100. 491
cidi tannlcl 142. 491
lumlnls 491
myli 201, 491
oracls 100, 491
epalnl 491, 704
lumbi Bubacetatis 491, 748
rngacantbfD 491, 902
prita 20
pfitc of boroglyce^^n 100
t phenol 105
•t starch 495, 201
•f the phoBphateB 353
critea 20
eritum amyll 201,490
icldi carbolic! 105, 491
tannic! 142, 490
loroglycerln! 100, 490
'erri, qulnlnffi et Btrychnlnae phoa-
phatum 363. 466. 491
hy drastis 491. 539
phenolls 105. 491
7itelli 918
:erol damlanae 429
^erophosphates 116
of calcium, potassium, and eodlum .... 728
:eryl trlnltrls 488
ricinoleato 666
JORpn 495
conin 492
PAOB
Qlycyrrhetln 4»«
Olycyrrhlia 496
and opium trochea 496, 67S
compound mixture of M6, 678
extract of 486
fluid extract of '496
glabra 49«
glandulifera 496
radix 495
OlycyrrhUin 496
Olycrrhlzlnum ammonlatum 191, 496
Qoa-powder 349
Goat'8-rue 480
Gold and ammoniuxn. chloride of 273
and potasalum ebloride 242
and sodium chloride...* 242
bromide 273
-thread 400
Oolden-rod 846
QoBsypll cortex OT
OoBBjpium herbaceum 497
puriflcatum 497
QouIard'B cerate 747
extract 748
Qranati cortex 498
Oranatum 498
Granulation of drugs 38
Grape, Oregon 266
Gravity cell 940
Gray oil 633
Green soap 811
solution for conu 390
^Gregory's powder 787
Oreaet cell 939
Griffith's mixture 466
Grindelia 498
robuBta 498
squamosa 498
Grove cell 940
Guaiac 600
ammonlated tincture of 600
mixture 500
resin, lozenge of 600
tincture of 500
yellow 601
Gualacetic acid 501
Oualaci Ugni 600
reaina 500
Guaiacic acid 501
Oualacol 406, 411
cacody late 100
carbonas , 406
carbonate of 405, 414
dl-lodlde 416
phosphite 414
salicylate 415
Gualaconlc add 601
Gualacum 50O
officinale 500
sanctum 600
Quaialiu 4i8
Guarana 502
fluid extract of 502
Guaranine 502
Guarea 382
Gulf-weed 479
Gum ammoniac 189
Arabic 87
Gun-cotton 389
soluble 497
Gunjah 306
Gurjunlc acid '. 503
Ourjun-oll 603
Gutta-percha 603
Guvacine 226
Guy's pills 436
Gynocardla odorata S24
Gynocardlc acid 325
Habit, opium 6SS, 689
HsematlntcB 76
Hsmatoporphyrlnurla 864
HEBmatoxyli lignum BOS
Haematoxylln 603
H 1 180 ^^^
^m Heematoxy loo
^^m cunpechlanun
GENERAL
PAOB
60S
&n
INDEX. ^^^^H
Honeys ...•• .>. ....
PAOB
31
Hop-bark tree
Hope's camphor mixture ...>......
773
....116. MS
^H rrtrnrt of
W3
^^1 Hrt^TTioff rnifT)
476
Hop-tea ,
Hops. InfusloQ of
tincture ot
Horse-chestnut >.» >
6U
SU
iU
IK
^^^L Hrrmnrnllnl ■ i
475
^^^H Haemol
^^^B HnzDMUtlcs
475
S3
TU
-uoltle
-radish. comDOOnd spirit of ....
-radish root
HoBDttol Quinlns
8M
..i SIS
131
M
^^^^ electrical rcoiovaJ of
^H lotion
^H Hall»r's acid drops
^H HaEnamelldtB cortex
993
313
1*0
604
Huarchlchlll
:::::::; S
H folitt
^K^^ UamamelU. liquid extract of ....
^^^Hi fluid extract of
6M
604
604
601
HurouluB
BU
lupulus
Hunger-cure .■..»*....
::::::::S
Hydnocarpufl Kurzll
^^^^^^H nnliitlfTTi fit
.. . 604
HydranKca «..
Bt
^^^^B^ *lnAtllfn
6D4
arborescens
Hydrargism
Hydrar^ri chlorldum corroalrum
mltiB
lodldum mbrum
flsTum
oleas
oxtdum flavum
rubrum
V.V.'.'.'.'. 618
03
613
....&1S. 681
....513.683 1
m
us
613
^^H Vlrfflnlanffl
^^^F water
^ HaraiunHltiinln
^H Huuds, (lUinfecUon of
^H HnplopappUR
^H Hardness of water
504
604
604
618
649
1060
^H Hartshorn, spirit of ............
..... 191
B Hasblsh
■ HasblBhln
306
306
403
porchlorldum
subotilorldum
succlnimidum
Hydrargrrol
Hydrargyrum
ammoniatum
cum creta
6U
814
538
B38
613
....181. BIS
....389, EIS
^H Headache powders
^H tablnta
^H Heat ns a therapeutic measura . .
^m In pharmacy
^H Hebra's diachylon ointment
88
90
Ills
36
756
^^1 Hedconia, oil of ....
606
fnfmnTTll^ntlllll • . *>•••>.■
.. . 633
^H puleglold^s
^H M'»'1"/»mf^ ftlnim ii,
506
506
pyrobor&te ,.....,.«.•*...
E88
Hydrastlna
;i S
^H H^I^nln
654
Hydrastis
:::':;: s
^H HcltaDthemum
^H o.Tnadt nsi*
606
506
canadensis
Hydrastlne
HydrastlnlniD bydrochlorldum
HydrasUnlne hydrochloride
Hydrastis, liquid extract of -
!"■"!! 639
....6S». 641
....639. 6tt
^H Hellanthltannlo sold
507
^H HellnnthuB annum
....... 606
^H Hpltpbore, false ...,..,, «..,
1&4
^H M»>Mi.K#irolTi
507
fluid extract of
BB
H M«ii^K«rin
507
glycerlto of
§m
^H H"M"*»AnifT , ,
607
rblzonm
::i:::;;S
^H Helonias dlolca
507
tincture of
^H HemldeBznl radix
^H Hemldccinlc acid
607
SOS
Hydratod chloral
mm '■
Hydrlodlc acid, syrup of
KM
^H Hemidesmus Indlcus
507
Hydriodic ether ,
Itt
^H nfpT
S07
Hydrobromlc acid, diluted ...... .
'" m
^H ayrnp nf
,., fi07
(•ther
Hydrochloric acid ..,.*
Hydrochloride of erythrophlcDtne .
Hydrorblorldes
HydrD<M)tyle Aalatlca
:;::::;: B
^H TTfimMnV
393
^H Hcmp-Boed, oil of
308
^H Honhotip ,
(545
u»
git
^H Hepatic depressants
go
^B «tlninlan^«
80
Hydrocyanic acid
21^
^M HnpnfUn , ,
G06
Hydrogen
....... 18lf
■ • tHKnl-
GOB
dioxide solution
^ f|g
^K Heroins hydrocblorldam
SOfl
Hydrooaphthol .^..
<a
^H Heroine hydrochloride
508
Hydrotherapy ■
..1043. 1048
,., ta
^H Hesperldtn
^H H*'*r''h"rn AFni*rifnnn
589
509
Hydroxylamin hydrochloride
Hyoscloic bydrobromldum .........
641
^m Hrrrrn
,.,,, 441
Hyosclnc ...••..•
., , 8H
^H braslllcnsis
312
bydrobromlde
:;::;;;: S
^H HexAmethylenaralna
508
Hyoacyaml fluldextractum
:;:;:::: IS
H Hfxnoiotbylen tetramlne
^H Hi'TH pirrn , , . , ,
608
906
Hyoscyaminn bydrobromldum ....
, SIC
■ «i,..f^«
GIO
sulphas
f8|,
^H nrtoi-VjrttiY^fl ' ,
632
HyoscyamlDfl ■....*•.*....
";i;;"S
^H HofTman's anodyne **
166
bydrobromlde ..........4
981
^H Hnff-wef d
327
sulphate
5M
■ HHir *
S62
Hyoscyamxis , . . ,
548
^H Hfrlfrrnlne
510
extract of
sa
■ hydrochloride
^H Hotnatroplne discs of ■■*••••...*
610
,.., 611
fluid extract of
:;.::;;;«
green extract of ,
M8
^^S bydrobromlde
811
leaves
m
^H bydroctaloride of
611
Niger ;
; ;JS
^H salicylate of
6U
tiDcturs of .......*...■«.•
i".;:iiSS
^M Homatrbplnse bydrobromldum . .
^H HrMrmrbrlldnnlnn ■ > . i
811
807
Hypoal .,.,,
IS
HypDOne
MB
^^1 HirnilMmii bnrk
819
Hypnotics
It J
^1 sarsaparillft
^H Honey
■ clarified
814
883
623
Hypnotism
as a therapeutic resource
to general practice ..•
..nbl liM 1
nos i
HOT U
OBNERAL IKDEX.
1181
l-AOB
Hypodermic admlolstratlon of morphine.. 6S8
formulce 11B8
modlcatlon ...........65. 67
Hypodrrmoclysii .'....1160. U6S
Hypopbosphltea, cnuUon 728
diluted 711
compound syrup oC ISO, 289, 466. 7S8
•yrup of 8M. 406, TO
Hypophospbitum, ayrup of 72S
Hypophospborus acid 12Z, ISO
diluted 723
HypoplcroCoxIc acid SSO
Hypoqacbrachino M9
Hyrgolum 6SJI
baylahuen *..*.. ...'649
Hy»aop 649
Hyasopus 549
offlcloalla 649
Hyatcronlca .649
Iceland mosa SS4
decoction of 324
lehtbalbin 661
Ichtbargan 661
Icbthyocolla Ml
Icbtbyol tm
Ichthyolum BIO
Idloayncreay , tt
Isaaurtc acid '. 647
Igaaurine 647
Ignatia 652
caaalne &S2
Hex 65S
lUleium 86S
rellgioeum S6S
verum S19, ^3
Immunity 306
locompatlbillty 46. 46. 47,48
India rubber 811. 4U
solution of SU
Indian berry 879
corn 6Z8
bcmp •» 906
pennywort ..*....... > 643
physic 488
Barsapartlla *.. 606
Indlcan 134
Indigo 653
flutpbate of 658
Indigotln 663
Inflatln 607
Infusa M
Xnf uslo no .30. 87
Infuaum nurantll 841
compoBltum 841
bucbu tS3
caJumboe , 897
caryopbylU 817
caacazlllv 819
cblratn 889
clncbonn acldum S62
cusparla 4.... 417
dtgltalts 480
ergotte 446
gentlaom composltum „.., 486
EramerlB &95
tupuU Bll
prunt VlnrlDlaon 771
quaasliB 776
rhel 787
roMB acldum 793
scoparlt 818
sennie 621. S2S
compoiltum 681, 886
■enesie 884
Sf*rp«Dtui8e 887
uvEP ural 909
Inglurin 66S
Inhalation, formulae for 1039
treatment by 10S7
remedies tntroducod by 69
Injectlo cocninrr hypodcrmica 888
vnsniiv bypodermlca 446
morpbiDffi> hypoderralcft 874
TJLom
Injn^tlon ..kk.iw*...... M
Injections . U5S
hjrpod^rmto 67
Inoslt 239
Insect-powder ;...,♦,.* T78
tntenral of dosage 62
Intestinal Inbaustion 1164
obstruction K7
Intoxication 381
Intraveaoua adminlstratioD 69
injection of mercury 636
Injection of salt solution 841
louoctlon for syphilis 51£9
Inula •.-... . 554
helenlum 664
Inulin 664. B9«
Iodide eruptions 565
'of arsenic 92
of Iron, syrup cf .. 481
yollow mercnroiu .. 582
Iodine 563
compound aolutiou of . 503
ointment 662
colorleas , ••••..•.... 570
strong solution of ...., 563
tincture of ; 688
colorless 583
trlbromld«> 683. 679
trichloride 683. 679
lodipbenlo '. 579
lodtsm 666, 566
Iodized peptoos 441
lodo-antlfebrin *,... 579
-aoilpyrln 579
-flgon 580
loioform 66S
emulsion 668
odorless 580
olctmeot 666
resorcln 784
suppositories 666
lodoformum 666
aromstlcum 668
lodobsemol 478
lodol 681
caffelnated 682
lodolum 681
lodonapbthol 848
lodopin 680
lodnthyrin 809
lodum 688
Ipecac and opium, powder of UO. 878
tincture of 680. 873
compound powder of 681
fluid extract of 680
syrup of BSO
wine of 680.681
Ipecacuanha , 680
eompound powder of , 874
liquid extract of ..„, ....880
losenge 681
nwllr , 680
root „ 680
■purge 684
vinegar of 681
with squill, pill of 581
Ipecacuanhtc add 681
IpomoML JaJapa 688
Irldln 684
Iris 684
extract of 884
florentlna 886
fluid extract of 684
versicolor 684
Irish moss ,,.., 848
Iron 464
albuminate 4T6
aud ammonium acetate 486
citrate 488
Urtrste m
and quinlns citrats .....Kl.
and quinine citrate, aolnblo
ftod strychnine citrate ,
1182
QBNEKAL INDEX.
PAoa
Iron and strychnine phosphatee, glycer-
Ite of 465
elixir of 363
■ynip of 466
arsenate 92, 466
bitter wine of 466
citrate, wine of 467
dlalysed 47B
lozenge of reduced 467
mixture, compound 466
phosphate 466
pill 466
potassium, tartrate of 465,758
-quinine cblortde 476
reduced 465
-wine 467
Irrigation of the bowels 1151
IrrltanU 75
Isinglass 649
Iso-ethylin 685
Isoptlocarplne 734
Issues .1156
Izal 685
Jaborandl folia 733
tincture of 733
Jackson's cough syrup 816
Jalap, compound powder of 586
extract of 586
tincture of ' 586
Jalapa 685
Jalapln 586
Jamaica dogwood 742
rum 169
sarsaparllla 814
Jambol 587
Jateorrhiza calumba 297
palmata 297
Javelle water 34i
Jequlrlty 85
Jerubeba 844
jcrubeblne 844
Jervlc add 913
Jervlne 913
Johlmbin 587
Johlmbehe tree 587
Juglans 688
cincrea 588
Juniper-berries 688
compound spirit of 588
oil of 588
spirit of 688
Junlperin 688
Junlperus 588
communis 588
oxycedrus 656
aablnea 797
Junker's method 34S
Kakodyllc acid 93.105
Kallum 758
Kamala 589
Kaolin cataplasm 320, 690
Kaollnum 690
Katrine 321
Kavabln 590
KavB-kava 590
Keflr 591
Kelene ;., 166
Kidneys, action of alcohol on 170
Klnpsltherapy 2, 1000
Kino 591
compound powder of 691,674
tincture of 691
Kinoln 691
Kinotanuic acid 691
Knetpplsm 1044
Kneipp's method 1044
Kola 592
Kola-nut 284
Kola-red 592
Kosin 428
KosBOtoxIne 428
Koumiss '9
preparation of 'M
Kouaseln ITS
Krameria i*4
and cocaine loxenge 369, >'
Argentea ' •'•
concentrated solution of
extract of - •'»
fluid extract of ' •*
infusion of * ■»
Ixtna 'y*
syrup of ' *4
tincture of '■<>
trlandra "j'
troches of i>*
Kramerin radix 3d4
Kramerlotannic add
Kresin 4!T
Kumyss l^
lAbarraque's Bolutlon ^t-t
Labordin :-j»
Lactate of Iron il
Lactic add ir
Lactol e«
Lactonaphthol w
Laotophenin T *
Lactose T'<
Laetosom'atose ^*'*
L*actuca virosa '•'
Lactucarium :~*'-
syrup of '^'
tincture of '■»'
Lactucerln S-'
Lactucic acid '"■«
Lactuclu >>
Lactucon r. -5
Lactucoplcrla ' *5
Ladies-slipper *^
Ltevo-phyllandrlne *^
-plnene *^
Lsevulose ferrtde ♦"
Lamb's-quarter S-'T
LamellSB atroplna '-'
cocainaa >'"
homatroplnsB M'
physostlgmlnsB '-*
Lamlnaria doustonl '-•
dlgltata ''^
tents :<
Lanolin "i'*
Irftnthanym, oxalate of *
Lanthoplne 6r<
Lapis divlnus c
Lappa iM
Lard 161
-oil •.'■:
Largln v ?•*
Lasear's paste 12S
Latin terms and phrases i(
Laudanoslne ^^
Laurel, ointment of •>'
Laurln 5»:
Lauracerasl folia jS*
Laurocerasln '*ST
Lauroatearln C^jT
Laurus nobills 5»:
Lavement *4
Lavender, compound tincture of f- <^
. -flowers ^5
oil of 5*<
oil of i*1
spirit of 3^
Lavandula M
Lavandula angUBtltolla :»^
Bpica 5i»
Laxative pills, compound 2^1
Lead 747
acetate of 74T
ointment 7«
solution of 748
carbonate of Ttx
cerate of the rabaoetaAe of 717
OBNERAX. INDEX,
1183
I
PAOB
Lead iodide .663
iodide of 747
ointment of 718
plaator 748
nitrate of 747
olntmeot subacetate «.,.,..... 748
oxide 748
plaater 748
poisonlnK ,.,....(48, 749
subacelate. glycerin of 4S1, 748
ofntment 491
BUKor of ' 747
-BuppoBltorlca. oompouDd .4....... .674. 748
vltb opium, pill of 748
wlanchd cell WO
LeditAnnio actd S98
IfOdum BM
palustre » 598
Leeches 61O. 1146
Lemon 699
-juice WS
for acurry 600
-peel GM
tincture of TiM
oil of 686
syrup of 669
• tincture of S9f
Lemonade — 600
Lenigallol 773
Leopard's- bane 2SS
Leontine 821
Leontodon %l
LeonuruB - 698
cnrdlnra 698
Loptandra 699
t riract of B99
fluid extract of &9!t
Lrptaadrln 699
I^pptilon canadoDSe 6&8
Lvttucp opium S96
wild 006
Lovuloae ^., 798
Llehenln * * 12<
Llchrna 824
Llohatearic acid 124
Lleorictf, extmct of 495
powder, compound 471
wild 85
Light 1190, 1181
Lily of the Valley ttS
Lime J88
bromide of 288
carbolated 106
chloride of 289
cblortaoted 388, 345
liniment 289
sacirbarated solution of 989
solution of chlorinated 889, 845
sulphurated 888
-water ;... 289
syrup of 289
Limon 699
Ltmonia cortex « 599
snccuB 5119
LinamarlD 601
Linden- tree 901
Llndcne cortex .......,......„.,., 600
Liniment Baltimore .^ 149
of ammonia 190
of turpentine 881
of turpentine and aeetle aeld 90. 91
LlnlmentfD 10
Llnltncntnm ammonia 190
aconitl 146
belladonna , 2£2
ealcia 289. 812
carophorce S90
ammonlQtum 899
cantharldea 881
chloroform) 837
orotonla 671
hydrargyrl i 614
menthol 198
opll 674
TAOI
Linimentum potaaelt lodldl cum aapone. .. 811
saponla Bll
mollis 8U
Blnapla 860
compoaltum 880
tereblnthlnw ........779. 881
accticum 90. 91. 881
Lines of force 980
Linseed, cruabed 601
-oil 601
LlDum 601
contuBum , 601
usltatlsstmum 601
Llpanln 665
Lippla Mexicana 4* 601
Llppiol 608
LIguc-flcd phcuol ..,.106. 106
Liautdambar OrlentalU 880
Btyrnclflua 661
Liquid extract of cinchona •...*• KS
of ergot MS
of hamamells BOf
Liquor acldt arseuosi it
cbromlcl , 118
pbosphortci compoaltus 181
BUlphurlcl HsUeri <.«. 140
ammonisB .....».* 186
ammonil acetatis ...» 166
citraUs 191
fortis 186
antlseptlcus 160
arscnlcalls *,.98. 758
arsenl et hydrargyrl lodldl 92. 614, 669
arsenlcl hydrochlorlcus 98
atroplniB sulphatiB m
blamutbl et ammonli oltraa 867
calcis .^, 886
chlorlnatjc .,, Stf
saccharatuB ♦.,.» 888
calumbip conccnlratua , 18T
caoutchouc 8U, 441
chlrato* concontratus 8tt
cblori compositus 848
cresolis compositus 416
cuspariic concentratua 427
e)ectrop<Blcus U8
opUpasticus 808>
ferri acetatis ,„ 466
et ammootl acetatis .........»...,« 466
chlorldl ..*,....;.. 466
percblorldl 406
fortis , 466
pernitratls
pt^rsulphatls 465
Aubsulpbatls 466
tersulphatis 4O6
formnldehydi OOt.
gutto^ percbn
hnmamelldis ,
bydnirgyrl nltratls 014
acldus 014
ptTchlorldl 614
hydrogenll peroxidi 226.948
iodl compositus 668
fortis 608
krarocrlflo conccptratus ...*« •...••»BOC
magnesll carbonatls 911
cltratls , 611
mangano-ferrl peptonatus 411
morphtov acetatla 674
hydrochloridl ., 674
tartratla 674
ponereatlB ill, 097
P'palnl m, 704
plots carbonis 744, 778
plumbi BubacetaUa .,..748
fortis .....*. 7a
dllutus T40
phoaphatum acldas 181
potaaare 7S8
pntasail arscnltls 98, 768
cItrattB 758
hydroxidl ,. T&8
lodldi rum sa|>one .t^.^.t^. •■».*•(.. T69
1184
QBKEEAL INDEX.
PAOE
Liquor potAMl permADsanatiB 618. 760
QuasstoB concentratUB T76
rhel concentratUB 787
sarsffi compoBltus concentratUB 814
seaegse concentratUB 824
aennaB concentratUB 826
BerpentariA concentratUB 827
sodffi chlorlnata 345.832
Bodll arsenltlB 92, 833
borattB compOBltuB ...> 106
carboIatuB 106
etbyletlB 833
hydroxidl 832
phoBphatUB compositUB 833
BlUcatiB 829
Btrychnlna hydrochloridl 646
thyroidel 207
trlnltrlum 488
zlncl chloridl 921
Llquora, strength of 177
Lister's antiseptic ointment tOl
Litharge 748
LtthU benzoaa 604
bromtdum 272, 604
carbonaa 604
eltraa 604
eff erreaceiw 604
sallcylaB 13S, 604
Uthlum ■ 604
benioate of 604
bromide of 272,604
carbonate of 604
citrate of 604
efferreBcent 604
lodate B64
salicylate 133. 604
Llthon trlptics 81
Litmus 606
LWer, action of mercury on the 517
yellow atrophy from phoaphorus 724
Liverwort 608
LIxlTlatlon 40
Lobelacrin 607
Lobelia 606
etherial tincture of 606
fluid extract of 606
. Inflata 606
tincture of 606
Lobellc acid 607
Lobellne 607, 608
Lobellne lobeltate 607
Lob-lolly pine 896
Local ansBBtheela 163
Logwood 503
decoction of 603
London paate 833
Lophophorine 202
Loretln 608
I^OBophan 609
LoBselta cocclna 918
Lotlo hydrargyrl flaTa 289, 514
nigra 290. 614
Lugol'B Bolutloa 662
Lumbar injection, anaeBtbesia by 378
LupuUn 611
fluid extract of 511
oleoreslQ of 511
tincture of 612
Lupulinum 611
LupuluB 611
Lupumarlc acid 612
Lycetol 742
Lycopodtum 610
claTatum 610
Lycoperdlc acid 610
Lycoperdon 609
Lycopprdon glganteum 60i*
LycopuB 610
Lyaidlne 742
Lysol 810. 746
Mare 635
Macrotin 350
Macropiper latifollum 6M
Magistral preBcrlpttoa •^
Magneeta, etferreaoent sulphate '••
heary , •* -
light «»
levlB r.l
ponderosa '•'*
Hagnesil cartxxnaB <u
levlB CI
ponderoBUB a*
oxtdum ^ ■ . ■ '! ■
ponderoBum C
sulphas ^11
suIphatlB efferreacenB r.i
Magnesium ':>
carbonate *".
solution of *.::
citrate, solution of < •
light carbonata of C
oxide of «
phenolsulpbonate
silicate i». ^•
sulphate of 41
Magnolia Cl4
glauca 61 4
MagnoUn « *
Maidis amylum *^
stigmata •"«
Maixe c:
Maiaenic acid «14. '-
Malabar kino :>>:
Malaktn ^'•
Male tern Z2'.
Mallein ««. €.i
MallotUB PhilipplnenBlB >'*
Maltose 614
Malt with codllver-oii •'
Hquora lO
Haltum »:<
Manaca r«T
Mandrake 735
Manganese '^' •
dioxide, precipitated C«
hypophoBphlte of o
sulphate of ^.*
Manganl dloxtdum praBclpltatum ^''^
hypophoBphis 4 -
Bulphaa r^
Manganum f •
Mangifera Indlca 4L"
Mango C"
MangoBtana 6^
MangpBteen €>
MangbsUn O
Manna Gl
Mannlte fir
Manxantta d
Maranta Cl
arundinaceas Cl
Marigold 2W
Marjonim, wild <W
Marrubiin C3
Marrublum 4:2
Tulgare tS
Marshmallow :S4
Marsdenta condnrango 3K
Marsh's test for arsenic tS
Martial preparations 4C7
Masaa ferri carbonatla 45S
hydrargyrl S!4
copaiba 3»T
Mascee Z\
Maases 2'
Maaaage X 1«>"
coDtralndicatlODB to ^f**i
how to prescribe l-^i:
In ^neral practice 1'^^
physiologic effects of ........l'>f
MasBo-therapeutlcB looa
Masticatory m
Mastlche O:
Masttchtc aeld Cr.
MasUehln tS
Mat§ SH -:
Materia medica 4, &. ?"•
GENERAL INDEX.
1185
PAoa
Tla Medica, Inorganic 6
organic 6
cin *.. 622
CO 622
camphor 622
luld extract of 622
■icaria 682
bamomilla 622
.11 of 419
-apple 766
3 : 62
]ow-anemone 772
mres of capactt7 and weight 31
■f length 81
! rented Tai»orB, etfects of 10^
cines, classification of 74
cine, rational 2
ico-tegal value of electro-diagnosis. ■ 967
ifiDotberapy. physiologic eftwts.of ..1003
)iiate of lead 677
>uic acid 676, 790
inin 676
>noBin 676
623
>oracfs 100, 623
Icpuratum 623
osae 623, 792
ili'uca virldlflora fi58
ssa 624
.fllclnalis 624
ita 21
ispermla 380
ispermum 624
struum 51
tba arvenslB 625
liperita 624
.'iridia 625
thol 625
iniment 192
thoxol 706
-tirial cachexia 614
)i ntment 516
dilute 614
plaster 514
uriallsm 616
curializatlon by hypodermics 531, 634
curie chloride, corrosive 613
iltrate, solution of 614
acid, solution of 514
ointment, diluted 515
>Ieate ointment 127, 515
>xide, red 513
yellow 513
odide. red 563
odate 564
surio-vegetal 617
curlol 638
3urol 538, 627
curous chloride, compound pill of ... B75
mild 613
odide, yellow 513
annate 538
curiodohsmol 476
r-ury 613
immoniated 613
ind potassium hyposulphite 534
3enzoate 633
'ormamidate of 632
ntravenous Injection of 635
odide, red 518
liniment of 614
:nasfl of 513
altrate, ointment of 614
nuclelnate of 627
Dlntment, compound 515
Dioate of 614
nnrapbenylthlonate 638
salicylate 533. 534
^ozoiodot 847
iuccinimlde 533
rontc doses of 517
with chalk 613, 2S9
cal buttons 22
caline 202
PAQB
HetallMGOpy lUl
Metallotlierapy UU
Hetallle alne 921
Hethacetln 713
Methsmagloblnnmla 761
Methylacetanlllde 461
Methylal 628
Metbrl-bromlne 286
-cephselino 681
chloride 628
eonllne 893
creOBol 406
sallcylaa 481
salicylate 481, 629
-violet 629
Methylene bichloride 628
blue 628
Methylenl btchloridum 628
Methylic spirit 174
Methylls sallcylaa 629
MetbylthloninsB hydrochloHdum 628
Methystlcln 690
Methystln 690
Metric system 81. 82
Mezerei cortex 631
ointment 632
Mezeremic acid 632
Mezercon-bark 631
fluid extract of 631
Mezereum 631
Mlaouli. oil of* 658
Microti din 612
Mff^ralDiD 722
Milk, intravenous Injection of U49
-sugar 798
transfusion of 61
-wine 593
Milllampdres 932
Mind, influence of 70
Mineral springs 1062
Mint, European mountain 696
Mistletoe 918
MiBturce 21
Mlstura ammoniac! 189
amygdalae 197
camphora acldl 12S
camphors aromatica 303
cbloroformi et cannabis Indies com-
poslta 838
creosoti 406
cretse 289
ferrt composlta 466
ferro sallna 603
gly cy rrhi za composlta 496. 673
rhel ot sodic 787, 832
senna) compoflita 886
Bplrltus vinl galllcl 169
Mlrbane, oil of 264
Mitchella 632
Mixed treatment for syphilis 636
Mixture, chalk 87
Hope's camphor 125
Mixtures 21
Monarda punctata 899
Monesia 633
Moneain 638
Monkshood ; 146
Monobromated camphor 272, 299
Monoc hi orm ethane 6^
Monsel's solution 465
Mormon tea , 448
Morphine acetas 673
hydrochloridum 678
sulphas 673
tartraa 674
Horphlna 678
Morphine 461, 678
acetate of 678
solution of 674
and ipecacuanha losenge 581
bimeconate 694
bydrobromide #|
hydrochloride 673
solution of >..,. 674
USij
OENEEAL IKDKX.
FAOa
Morphloe, hypodermic Injection ot 071
lozengo 074
pbarmacologT of 678
powder, compound 678
■ulpbatc of 97S
BUppQsi lories ....t •• 67&
tartrate u( 974
aolutioD of 674
tincture of chloroform and 974
MorphlDomanla .> CSS
Morrcnla 633
bracbystopbaoa 633
Morrbuine » •ir»9
Morrbuol 659
MortoQ'8 method 974
Moacbus (i38
MoBUla JnpoDica g9d
Motherwort .,, .,, 508
Mucilage of acacia .....*.............. S7
of Imsacautb 903
Muctlages Jl
MucilHginea , , Jl
Mucllugo acaclie gj
(lastMifraB mcdullB , S15
iragacaatbse , 902
ulml 909
Mucuua 634
prurlena 6S4
Mullein plant 915
Muriatic acid 113
MuBlc • 1U6
In bOBpitals for the Inaane 1189
Muscarine 166, 380
Musb-poultlce 633
MUBk 631
tincture of 633
Mustard 830
compound liniment of 830
tlDlment of S80
-papt'r 899
-Bced, black 830
-Beed. white 83(1
volatile oil of 830
-whey 831
Mydriatic ...,, 511
Mydrlatlet gS
Mydrloe 444
Mycllo-alpba 205
Myopsln 697
Myotics 83
Myrcla. eplrlt of 663
(ragrans , 635
Myrlca cciifera 6SS
Myrlstlcn 685
Myrl8tlc;E ceratum 636
MyroBln BSl
Myroxylon perelra 345
Myrrh, tincturo of 636
Myrrha 63S
Myrrbin 636
MyrrboUn 637
Myrtle-olI 637
Myrtol 687
Myrtufl communiB 6J7
Myxccdcma 206
Napelline 146
Naphtha 707
Naphthalenum csg
Naphthol 640
•alpha MS
-antlpyiine ....,.,.. 7tl
Naphtoxol 706
Narcelne 875
Narcotin? , 675
Natrium 832
Nectandra-bark 945
cortex 645
RodloBl t{g
Nertandrlne ^45
Nerf'B hammer ,... 939
Nephrin , 309
Nerlin $^
PAOS
Nerlum oleander 656
Nerve-slri'trhing XJM. 1158
Nervous disorder treated hy mualc 1138
Bytttem, effecla of alcohol on ITl
Neuraitbenla and byaterla treated by
maasa^e 1007
Neural iaQltraUoa S79
Neutral mixture 600
NtttouU. oil of 668
NIcouiorrbuiQe 6G9
NiccoU bromldum 371
Nickel bromide 378
Nlcotianln 876
NicoUne 878
eallcylftte 878
Nlgbt-bloumlng cereua 888
Nlrvanin ,.,. , 846
Nitre, Bwcot spirit of X6B
Nitric acid JS4
Nitrites action of the 198
Nitroben&ol 886
Nitrogen 1O84
Nitrohydrochlorlc acid 128
Nitroglycerin 488
flolutioo of 488
tablcU ,4n. 490
Nitrous oxide 1034
Nopalea coccinellifera .,,..,. 3SS
NoBopbeo 680
Nuclein ......117, 046
Nunaarl 608
Nut-galls 480
-gall ointment 480
tincture of ..,..,,, 480
-oil 688
Nutmeg 916
oil of 688
BplHt of 06
Nutritious cnemata U66
Nujc vomica , 848
extract of 846
fluid extract of 948
Oata 8(6
Obealty, dietetic treatment of lOBf
Oenothera 966
Ohm 838. 988
Ohm's law .,, 932,933
-meter 9f^
Oil of anise ,, 2J9
arnica 238
bitter almond ., 197
din 303
fennel 477
OIIb. official .. 18
Olntmt'ut for warm weather 838
of lour**! ., 68T
poplju--bud8 768
phenol , 109
rose water 187
Olen Europfca ,,,, 993
Oleander gsf
Oleaadrin 868
Oleata , jx
Olcate of atropine 18T
cocaine , , 187
mercury ^,..IZ7. 614
Quinine 127, 353
veratrlne , 117
Oleates ....«.,,.,.. ,21, 137
Oleatum atropinn „ .127' 2S2
cocalniB 127. :168
bydrargyrl 127. 514
quinintc 4 ., it7
veratrlne ....,.,,,,. 127
alncl 831
Oleic add IJT
Oleln 06a
OleoereoBote 419
Oleoreelna capalot ', SU
cnbebfB 480
lupulince , fill
piporiB 739
BlDgtberls « 925
Olporeslnae .^....
F
QEKERAX
PAOS
21
Opium-plaster
liquid extract of
-polftonlng
' 1187 1
PAOB
673
6T4
681
Olcoroatns
21
Oleum athereum
153
adlpls
amysdalsB ..••■■•••>>•>•••••
151
J97
powdered ^.
6Q
Tinegar of
WlDP of
Orangc-flowors, ayrup of
618
178
841
amaroo ...*■•■..».•*>>*•»•..■ .
\n
197
anctbl ••••■. ...'■>>■*•...•
Wi
volatile oil of
vater
60
Ml
Hnisl ■-
S19
ISO
strongor
241
auraotll cortlcli
borgamottJB
betulsB . ...>...•... .•*....
MX
656
4Sl
-peel, bittor
compound Infusion of ..
dried, bitter
Ml
841
%a
cadlnum
eajuptl
cannabis
...6tt. 666
::::::: SS
fluid extract of bitter ..
frosh. bitter
Infustoo of
sweet
tincture of swe«t
•spirit, compound
syrup of
tincture of
-wine
Orayurl tree
Ordeal bark
811
Ml
841
241
241
241
Ml
241
1«». 241
427 I
81S
carl
carul
caryophylU
chenopodil
clnnamomt
m
m
317
tt«
M6
Sg9
copalbn
cori andi^
»7
... . m
crotonlB
<*ub€'bw
871
420
Orcein
Orchis
606
798
pucalyptl
orlgerontll
462
668
Orexine ,,.,.,,*,*
•4
tannate „
mi
frPDlcull
gaultbpr1»
goasypll aemlnla
in
481
497
Orgeat synip .......*..,.
...;.".;;;:; SB
Origanum . *.
Tiilgare ...,.,.,„».,,„
flK
junlp*»rl
laTandulflB -
MS
sag
Orlzabln
Orrlfl-root
Orpbol
Orthoform
:::::::::::: S
686
648, 685
<96
florum
llmoDia
S»8
5K»
Unl
nientbm pIpeiitB
Ml
625
Orthopbonnlsulptaonle aeld
Osmll pproridum
Osmium peroxide
Oubaln
418
696
686
IS9
rfrldit
morrhuflB
niyrclii>
TTiyrUtlca
62S
658
083
686
Ourouparta gamblr
OvlferrlD
880
478
ncroll
oMtib
phospboratum
picia Uquldas
pimontffl
plnl
riolnl *.
6ft3
663
T23
744
7S8
686
QB6
Oxalic acid
189
Oxapbor
80S
Ox-gall
461
purified
488
Oxycanthlne
■ .. JS
Oxycamphor
":.:;:;.;:; K
Oxycamphora
ro«»
^^ roamarinl
792
7«S
M
Oiycollldlnc ,,
Oxyconllne
Oxygen . ...
:::::::::::: S
^^^^^^1 ■sKInn
797
given aubcutaneously
Oxymel
::::;:;:::: :3B
^^^1 salvls
M6
,, (TTO
SCllltB .,
817
^^^^^1
808
Oxyphor
887
^^^H uaaaLfraa
^^^H aeitaral
815
671
82n
Oxyqulnollne
Ozonised air
888
ins
Osone. mcrtlral use of
Palatable castor-oil ^,.
1081, 1032
MS
^^^^^m
SSI
^r r«ctlflcatum
■ tbymie
m tigin ....•
■ voratrlncB
■ Ollve-oU
881
899
671
912
663
Palaqulum gutta
602
Palmltate of cetyl
ttt
Pambotano
,.... 88T
Pancreatic aolutlOD
887
H Onagra blennti
H Onion
■ Ophellc ncld
■ Opll pulrti
H Opium
^M Bildlrtinn
666
1T9
329
6ra
678
6sa
Panerentin , ,,
::.::::::::: SK
Pancreatlnum
in. itr
Pansy
Papaver rhmBB j j , i i
817
.,... 789
Bomntferum ^
678
Papaverine
H ammonlatPd tlnrture of
■ ammatlr powdr-r of chalk with
■ camphorated tincture of
^1 compound powder of
^M dcodoratum
^H d'»^5>r1f'"1
674
674
673
674
673
673
Papaverls capsuln .«.
""*'*'**■' gjr
Papaya
'8M
Papers, medicated
Paracblora lose
Paracblorpbenol
Piracotolne
...106. 112, 412
KIS
^B tlnoturo of
^M extract of
^H fn'nnMiif''d
673
673
673
Pararrrsotate of sodtam ..,.,^.
417
PararonI 1 ne
S92
Paragruay tea
Parafll n -ol ntxaeot
8M. 662
..... 700
^B KTanulatum
^H llnlmrnt
673
674
PamfllDum .,,,
^H ointment of call with ...•...••
674
durum ,,,
.... 700 707
■ pllla of
■ pill of lead and
6T3
674
liquiduni ............... ....
. . . 707
moUe
707
1188
GENERAL INDEX.
PAQB
Paraform 6M
Paraldohydo 700
Psraldehydum 700
Parampnlapermla ISO
Paramorphlae 676
Paraphenetolcarbamide 718
Para rhalany ...* .*....... BM
-ruhbor 812. 441
Paraallcldo romedlet 75
ParfnrhvmatouB Injection &8
P»r#.«gorlc elixir 199.678
Parolra 702
nuld extract of 702
Parelrw radix > 702
Partllln 8tl
Pari! green 93
Parotid gland * 812
Pnraley 703
camphor ,...710
PartrldKo-borry «1. 632
Pasta LondonlonatB 833
PastlUa 38
PaiilUola cnpana 602
curare ...486
P«>M('tlc'rlnfe taonai 498
Pttlletlerine tannate 418
PclIUory 778
tincture of 773
PeloslDO 703
Pi'Ilotp 203
Prllolioe 202
Pennyroyal 506
Peutal 703
Pepper, black 739
oonfeotlon of 740
olrorcHlii of 789
Peppermint 624
-con^phor 686
oil of 686
spirit of 686
-water 634
PetM) 704
Pepsin 704
glycerin of 491, 704
PepHinum 704
saccharatum , 704
Pcpto-maogan. Gude'i 475
PeptoDlied food 697
Percolation * 40
Peri toQcoclyBia 1153
Perkl D8 tractors 71
Peroxolos 706
Perslo 706
Peruvian balsam 845
rhaUny S86
Petrolatum 707
album 707
llquldum 707
Petroleum 707
-beniln 360
Fetroeellnum IW
sativum T06
Peumue boldus ITS
Pbo*orbetin 788
Phallln 1M
Pharmaceutical Incompatibility 47
testing 48
Pharmacopcela, Important cbansea In the
pew '..... 88
tbe V. S 4.11 TO
Pharmacology 4
Pharmacy 14, 19
Pheasant's eye 164
Pbeoacetinum 711
Phenalgen 716
PhenaEonum St4. 716
Phpnocoll 714
b> drocbloride *..... 714
salicylate 716
Pbonol bismuth ....«««. tt\
iclycerlte of « 491
Ilquefactum «,. 105
lozenge ]06
-sodique 106
PAOB
Phenol suppositories *. ^...t** HI
test for ..;:.*. .i m
PhcQDlsulpbonate of soda 4.»..i .101
sloe 101
Phcnoresorcin .t.. 794
Pbcnosalyl lU
Pbeuyl-act^tanide ...!.•■. •..••■....*. 89
Phcnytbcnzamld 860
Phenyl hydride 8M
sallcylaa 138
salicylate 128. 799
Phenylis sallcylatls 799
Phcaylurethane 669
Phloral 406
Pboradcndron 9l8
Phofiphatea of Iron, quinine, and strych-
nine, syrup of 466
Phosphorated oU 723
diluted 733
Phosphoric add 130, 723
concentrated 130, 733
Phosphorus .....733
pnsto Ttf
puis 788
red or amorphous 738
spirit of Ttt
Physctcr macroccphalus 39
Physic. Culver's 969
Pbyslcotherapy 1911
Pbyaiolofclcal nffects of electricity. 955. 9^9, MO
Incompatibility 48. 62
teat for strychnine 647
Physosttgua 789
extract of TM
tincture of « t^klV
TenenoBum k.« Jg
Physoetlgmatla semlna tH
PhysoatJgmlns aalicylaa «....« • TO
sulphas 789
PhysoatlgmiDC discs ». 789
salicylate of 789
sulphate of 789
Phyaoterln 739
Phytolacca .• T|9
decandra 788
extract of 788
Pbytolaccic acid 788
Pbytotaccinc : W
extract of ,
PIchI
Picradonldin ,
Picric acid
PlcropodophylUn
Picrotin
Plcrotoxln , ,
Plcrotoxlnum
Piffard hirperstatlc transformer ...
Pills
compound cathartic •.
laxatire ,
rhubarb
Guy's _
of aloea , 199
and asafetida 199
and Iron I99i 499
and mastic -< tf^
and mjrrh n
of Barbadocs aloes 189
of mercorous chloride, compound 881
of podophyllum, twlladonoa. and eaiK
fiicum IS
of socotrtne aloes ..899
Tegetablp cathartic •..891
PflocarvinB hydrochlorldvm 781
nitras 718
Pilocarpine J99. 714
hydrochloride of
nitrate of
PlIocarpu!>
fluid eitract of
jatwrandi
mlcrophyllus
PlIuU aloes et aaabMlda ..,
et ferrt i,
:I8
.189
■M
^^^^^^^^^^^^^" GKNEBAJ
^^V PAQB
^^H Pilula coIoc/DthidiB et byoBcraml im
^^B oomboglA comp09lta 237
^ ferrl 466
Kalbant compostta 234. 478
bydrarsyrl subcblorida oomposlta — &1&
plumbl cum oplo -.*74. 718
INDEX. ^^^^1
J*lHntbi oxldum
■ PAOB
.......... 7-18
Plumbinm
747, 749
Plummer's plII .
616
Pneumatic differentiation
1021, iua7
PoeumoDla scrum
au
Pneumotherapy
Podopbylllc acid
1021
7&0
saponlB composlta
BcammoDll composlta
FUuln
674
817
21
Podopbyllln. belladonna, and
pills
PodophyllotoxlD
Podophyllum
capsicum
861. SUE
756
756
aloes
180
et aaafcetida
^^m rt fprri
2M
..180. 46B
omcMll
766
^^^H tT TTinfttlrhnf!
..180. 6211
extract of
7b6
^^^V •f TrirrrlifiTt
..180. 636
fluid extract of
756
^^^" BurbadenslB
180
peltatum
766
P socorlniD
, ISO
rcBlna
756
L antimoDtl compoBlta
600
rhixoma
755
^^H ntffif"'*''1n*
31
tincture of
7o6
^^H cathartics oomposltae *
...... ©1
Poisons and antldotea
...., 66
^V TeseUbllla :
^^~ coloeyotbidis composltK
W ^t hywyBinl
891
:i;ii
,,,.,, 391
i'oiBoning by abatnthe *
M
Poisoning by Ice cream
I'oison-ivy, remedies tor •*
fiW
.,.,.. 791
i ferrl carbonatls ■
466
rok»-root
783
lodldi
hydrargyri
Bubcbloridl composite
Ipecacusnbce cum aclUa
..466. 663
514
221
..u81. 817
..180. 2G1
673
Poleboard
9H
PoiyiTQiic acid
, , , . . «i34
PolyKonatl radix ,
757
Polygenic add
767
laxatlvs compOBltD
opll
PotyKonum
7S7
giKacteum ,.'.
767
pUoaphort
podopbylll. btUadooDEB et capalcl
qulnioEB BulphatiB
733
..SIX, 7&6
853
hyd roplperoldes
757
perslcar la
Polypharmacy
757
.., tt
rhel conipoBitie
..180. 787
H17
PolypboruB officinalis
16S
(i^illi?f» oompoBlt»
Polytricbium
767
Plmonta
73g
Junlperinum
Pomegranat"
767
«88
otnclDaUs , »
.... 739
oU of
.... 738
fluid extract of ■....
488
water of .....*••..
..,,. T.i9
PoDDT cansules
„ 876
^H^ pimpjii-riAl , ,
..... 739
Popull cortex
768
^^^B pi^pifxiiifi nnlniiTii
213
Populus
.•».*... .. 788
^^H UTtfrnf^a
739
Porphyroxln
67«
^^^mV\no nil
H6
PotB&b, yellow prusaiate of
768
^^■^ whit.
,, ,,, 738
,,.,, 768
^^^■vfnlf.rA/ir
848
cum caicl
n». 760
^^^■9fn«n«
.."... 46S
with lime
888, 768
^^H^nii* «>«tiB.4anBlB
738
Potassil aoetatU
768
^^^B pnlitatfia
■■'**' Z
bicarbonaa
bitartras
768
768
^^^m pnmllln
^^H ■imhtta
..... 73»
bromidum
372, 788
^^^F "T'^^Ttrli
744
carbonas
....:..; 768
^^ Piper
1 aniruBUroltum .,
738
631
chloraa
768
citras
768
1 cubcbR
411
cltras efferresosos
;::.::.::; TM
Disrum ,
.738, 740
1 46
cyanldum
til, 768
}*tpr>raconttlne
dlchromas
forrocyanldum
..113. U4, 769
768
PIperatlD ,
. . . 740
1 Plperln
. 740
hydroxldum
788
Ptp^rinum .,.,...
.... 740
bypophofiDhls
788
PIpslBsewa ,
3X7
lodldum ..;
682, 769
PlBcldla erylbrlna
PtatncbiB lectlflcus
743
628
nttras ,,,,
768
pfrmanganaB
618, 769
Pitch and cantharldes, piaster of....
306
c't aodU tartras .•..*•
768; 831
1 Pitch plaator
Pituitary gland, extract of
744
n2
sulphas <•.«*....* 1.
,,.. , 789
sulptaurata
768
1 Plx BureuDdla
744
tartras , , , ,
768
1 canadenBlB
. . 744
acldus .i*....*.i
768
1 carbonas prffiparata
f llquida
1 DavallB
744
744
746
Potassium
768
acetate of
;;;;:;:::. TO
Rlunr ...... t..i
184
Pixol
747
and fiodtum tartrate .«. . •*
': . tS
Placebo
IS
nrBonlte solution of
768
Planugo
..... 747
bitartrate
768
• Planum
747
bromide
,,,, 878
Plasters
18
cantharfdate
, gii
Plaster of Paris
188
768
Janln's ,
461
BOlutiOD of
TBS
BBllcylated UlDglass
varming , ,,,,
660
808
cvanido •*.....
;;:;:::::; tS
dichromate ...r..
us. U4
Platinum
..... 747
dioxide ,
.......7^: la
Pleurlsy-root
336
dlt h 1 ncarbooate
„,.. 788
PI tim bl acHas
747
ferrocyantdUD ■....
...J...... 7B8
i carbonas
748
hydrate •«•.!. ••#•■
,/,, 781
I lodldum ..«.
563. 717
747
hydroxide *«.........•
,, 7n
1 nltrai •■•««•••
solution of
788
1190
QEKERAL INDBZ.
PAOB
Potassium hypophosphite 759
Iodide 662
otntment 663
with soap, liniment of 811
oxalate 768
permanganate 618
solution of 618
BlUcate solution 839
sozolodol 847
tellurate 767
Pottlttces 18
Powders 22
aromatic 366
compound acetanlllde 88
flnen^w of S8
Praaeodymlum 322
Precipitation 42
Preparations, strength of 26
Prescribing for children 63
IPrescriptloo, terms and phrases 64
wriUng 43.48.60. 64
Prickly ash 819
berries 920
Pride of China 245
Primary current 937
Primrose, erenlng 666
Prince's pine 327
PrinoB 770
Proof BBplrlt 169
Propytamln 904
Prosthesis 700
Protar^l 770
Protopine 676, 807
Protoveratrldlne 918
Protroveratrlne 913
Prunes, laxatlre 837
Prunum ^ 770
PrunuB amygdalus 196
dometUca 770
laurocerasns 697
serotlna 771
Vlrglnlnana 771
Pruni Virgltttnanfle cortex 771
Pnissic acid 121
PseudococcuB cacti tSl
Pseudoconhy drlne 393
PseudobyoBcyamlne 439
Pseudo-JerviDe 913
Paeudomorphlne 676
Pseudotropeln 706
Pseudotropine 644
Paychotherapy 70, 71. 1102
Paychotria ipecacuanha 681
Ptelea cortex 772
Pterocarpin 808
Pterocarpus marsuplum 591
santalinus 808
Ptyallsm. mercurial 616
Puff-ball 609
Pulmonary sedatives 81
Pulsatilla 772
Pulveres 22
Pulvis aoptanilidl compositus 88
amygdalGB compositus 197
antlmonlallB 221
aromatlcus 316, 366
catechu compositus 320
cinnamoml compositus 366
cretae aromatlcus '. . . . 290
cum oplo 290, 674
compositus 87. 2S9
efferTeacens compositus 144. 758, 832
elaterlni compositus 442
glycyrrhlsse compositus 496. 825
Ipecacuanhse compositus 5Rl, 674
et opU 5S0. 673
InsectlcidUB 773
jalapas compositus 586, 759
kino compositus 591. 674
morphinae compositus 67.1
opil compositus 674
rhcl compositus 787
Bcammonlt compositus SIT
sodffi tartaratse efferTe8cenB...144, 7.'>8. SSSt
PAOB
PuItIs tragacanth« oomposltas >C
Pumllio pine, oil of **.'
Pumpkin-seed T'>4
Puntea granatum 438
Pupgatlvea »•
Purging agaric ICS
cassia S19
nut 42T
Purified aloes 180. 181
animal chareoal 314
ether IK
Purshlanin 7«
Pustulanta 75
Pyoktanin O
n^aconine 146
Pyralozln T76
Pyramidon 773
I^rethrlne 713
Pyrethrl llores T33
radix Tn
Pyrethrum 771
-root 773
roseum 773
Pyrethrotoxic add 774
Pyretln 744
Pyridine 774, STC
Pyridlnum 774
I^roacetic spirit ••
Pyrocatechln 134. tXU 01
Pyrocatechuie acid 7S
I^rrollgnaeous add 91
^rroxylin 3M
Pyroxylinum 4»7, 776
Pyrozone 251
Quassia 7W
concentrated solution of 776
extract of 776
fluid extract of 771
Infusion of T7I
tincture of 778
Quassl« lignum 776
QusjMlln 774
Quebrachamlne 339
hydrochloride 240
Quebrachlne Sf
Quebrachlt ta
Quebracho 339
red 2S
Queen's root SSt
Querdn 777
Quercltannic acid 777
Quercus T77
alba 771
Infectorla 4«
lusltantca 48^
Quicksilver 513
Qulllain cortex tT'J
QulUaja 77^
fluid extract of 77^
saponarla 775
sapotoxln tts
tincture of 77^
Quillajlc acid 77«
Quince-seeds , 4JS
Qutnethyllne 354
sulphate 3^
Quinetum 354
Qulnicine X*i
Quinldlnce sulphas 3&>
Quinldine S4
sulphate -54
tannate 3G
Qulninae bisulphas ^
hydrobromldum 3'i3
bydrochloridum 3.'^
acldum ""ZJ
hydrochloras carbamldata T4
oleatum X>]
sallcylas 132 3«
sulphas I0!
sulphOTlnas 30
tannas 364
■ Qulnlna
1 QulnlDin T&lerlaaatlii
I QuInlDP. ammnnlated tlnctorc ..
OSKBRAL
PAOB
m
86S
861
S63
IKD£X. ^^^^1
Resisunce meaaarer —
Rest-cure, abuse of
ResorblB
. .!i6o^|
itiH
Heaorcta
, 478. 70^1
1 blsulpbate
.,.. Bt
Resorclnol
Resoprrln
781. TST^
1 hydrobromlda ,
gtt
M hyarochloiide
:::::::::: SS
363
Retlnol
780
785
^^■. brdrochloroaulpbate
^^^B Imlnt'T
m
5M
RbiiDinoxanthtn
RbuDiDUB c&thartlcua. .. .• •>. ■••
q^^^l
^^^P inll'TlntTT
.... .... 352
fratiEuia . .. .............
J^^^M
K -bulpbate. ptlla of
1 Btilnhovlnate . ..^
353
363
pu rah (ana ,
v^^^l
RbnlAnv .....................
* a^^^l
K Riilnhntn
352
Rhel radix
SSi^H
H^^l tannntc
361
Rb'Kipborea .*•••.,.*«.
' 9W^^
^^H tincture of
^^^H "iTtftnuitiT
363
363
RboofltAt ,
953
Rbeotfionlc acid * *
7B8
^^^H tHinn
363
Rbeolome
Rheum ,
986. 9M
787
^^^H QiilnnlJ^lyi
,., S27
^^K QuInoUne
an
Ml
officinale
palmntum .*
7CT
787
^^^H trr'riiT"
;;:::::":»
Hbuponttoum ../-
788
^^B Qalnopropyllne
^^H sulphate
^^B Radiotherapy
864
364
....im. 1134
1134
Rheumic acid
Rblfiolene
788
707, 709
Rhodeoretln
686
Rboeadine
676. 790
Rhcpados petaJa
R h'VRii I ...... 1 1 ,
789
790
^^^H nn llvlnfr tloaiiaa
1134
^^^K Da/iKlrultAvnlnlMaflnii
icti
Rhubarb
787
^^H RacblococalnlaatioD
^^H Ragvort
^^^f Pr*r"Ti'"*'*Tfr fl'*nHn
878
8»
«7f
and soda, mixture of
compound pill of
powder of
787
787
787
^^^^ Raapborrr «...
786
tincture of
concentrated solution of ...
787
787
m -Tineffar
786
h -ayrup
^^H Raspatl'a eau aedativa
^^H a^dative lotion
^^H Ration In the tropica
:::::::::: 31
:::::::::-,J8
870
extract of
787
fluid extract of
787
infusion of
-root ,
787
787
spiced syrup of ............
,...,. 787
^^^H T>B»»tAan«UA fuMn*
888
ayriip of
llnrture of
Rhus aromatlea .,*....
, 787
^
^^^H 0a«^^lnn n#im»n
966
^^H Rectnl altraentatloo
1101. IIM
1155
glabra
fluid extract of
::::::::::: 9
^^H Recttned spirits
^^H Red cincbona-bark
^^H morcurfc oxld<« ointment
^^ poppy
■ petals
1 BTruD of
168
868
614
780
789
739
radlcains
;:i;;::::;::Si
toxlcondendron
m
venenata
7M
vernlclf era
791
RIcIn
666
■ Drccfpltate ..■
618
Ricinlne
. . 666
^^^B rnnf
7»X
Riclntis communis
Rocella tinrtorla
Rochellc salt
666
, 884
, 758
^^^1 wtno
169
^^^H Da<1itnni4 itt%n
466
^^H Rennf'd sugar
797
Roentgen raya In medicine ....
,., 1124
^^H Refrl^rxant remedies
77
1
ray therapy
Rosa galiica
1131
,, 792
^^V Reindeer moss
^^H Retnsch's test for arsenic
^m Remedies. IncompntlbiUtr of ...
clasalfleation of
»4
n
47
74
Rosfp Kullicoe petaln
785
Rosaniline hrdrochlortde i
Rose, confection of
fluid extract of
honey of
WWW'.'Xl. 623
798
683. 793
combining of
46
Imponderable
oil of . .
792
mechanical
-water ,
ointment
798
ass. 791
new
pharmaceutical
Remedy, definition of
tf
atronger
.,, ... 798
Rosemary ,,.
.... . 7M
hygienic ....,..,
oil of
788
prophylactic
olfitmenL oomoound .. .....
.... . 788
sanatory ........<..
^Dtrtt of . . .
... ,(.. . 783
aanltary
wild
698
Remljla pedunnilalA ^^,,.,,ti
, 364
Rosrs. Add lofualoa of
confection of ■
BvruD of .. ...... .
792
792
792
^^^^E R frnnft-iflne 1 1
, 70S
^^^^V Rrnlfiii 1 ■ 1 1 1
, 779
^^^^B" nTrrnlTTnY
, 397
Rosin . . ..
V Jalaptc ..■ •••»■■•■•'■*•••>■■
686
Rosmarinus offlclnalli
aylveatro
Rotation In doaage
^i
m podopbylll .,
■ Bcammonil w..
■ Realn
766
...w ffMj
779
Rottlera - * .
H cerate .,..,
779
Rottlf*rtQ • ,,.,,
■ j^i
H compound •>•••
779
Rouge ....•.•.■«•■•..(
«iS^I
H ointment •*.
779
Rubefsrienta «. ,
ii^^i
1 plaster •■
778
Rubidium >..... t ••>■
«^^^i
B Reninm ,
tx
indldt /
•■■ j^^^i
1 Rasina
IS
RublJenrlDe
J
1192
(j£N'£IUL INDEX.
PAOB
Rubua 7»4
ounelfollua 794
fluid extract Of 794
syrup of ...,. 794
SabadHIa 785
:3Uba(llIllne 1S6
Sabadlne 7»6
Snbadmine 795
Sabttl , 79*
Sabbatia panlculata ^^
Sabloa 797
Saecbararum 797
Saccharaced lerroua iodide 562
carbonate ......^ 493
pepsin 704
Saccbario 964
Saoobarluum ,..,.*,,, 49Q
Saccburomyfics cercrlslie ........*........ 4M
Saccbarose *.*«.. 796
Bacobarum lactU 798
offlolnarum • 797
purtflcatum 797
Safflower 316
Saffrou 420
Safrolum , an
Saxe 805
8aeo 798
rumpbll 7»ti
Salacetol 804
SalaktuI 419
SaU'ii 7:*8
Sallclnum 798
Sallcy Inmldo 420, 482
Sallcylnte of ammonium <,.. 182
of quinine ISS
of sodium 133
SallcylttteH 799
Salk-yllo acid 182, 481
frnpUona I8(
ointment 133
Salicyluric acid 134
Sttligpriln 798
Sultrmphtbol 643
Sallpvrlne 721
Sallrctin 798
Saltvatlou, mercurial .• 616
Salocoll 716
Salol Its, 799. SCO
Salol-lodororm 800
SalopbcQ 808
Salvia 806
ofllclnalla 806
Saltx 798
nigra 799
Satnbucl florea 806
Sambucus Caoadeosls 806
nigra 806
Sandalwood, red 808
oil of, 670
Sanguinorla 806
Canadenala 806
fluid extract of 806
tin* turc of 806
vinrRnr of 806
Sansulnarlno 8S6. 4fil, 807
SanKUiauga medlclnalla 510
Santal-oll .. 670
Saotaltc add 808
Santalum album 670
nibrum ..^..t. 80S
Santonica .....* 806
oil of 806
Santonin ..............808, 809
troches .....< 808
SantoDlnum 806
Sapatoxin .....778
SaotonlDoxIme 8U
Sapo *.... 811
onlmalla 811
durua tU
eucalyptoli 464
knllnua Tunalls tU
roollla «!«.... tU
Saponarla offlclnalls •T'j
Sapoolo 632, 778. 814. 903
Saprol 106. 418
SaraiB radix »H4
Sarflaparilln 614
coocontrated oompouod lofuatoo of.... 814
compound decoction of 814
syrup of , 814
Indian 608
Ould extract of 814
Saraaparlllae decoctum coDipoaitum 815
Sarsaponln 814
Sassofrna 8U
AuKtral Ian 818
medulla 815
mucilage 81S
oil of 816
otnclnalo *. 8l£
pith of ..*.*.........*......... 81S
radix 816
vnrlfollum 815
Saasafrld 816
Saaaybark 818
Savin 797
Ould pxcract of 797
oil of WT
Saw-palmrtto 798
Scammonliu radix 816
Scammonln 586. 817
Scamtnonlum 816
Scammouy, compound powder of 817
pill, compound 817
rrsiu 818
-root 816
Scarincationa 1146
Scbmlersclfv 818
Sobfolv'a grreen 98
Scblclub'a method of aaeatbeala 878
Scllla 81T
Sollllo , 818
ScUMplcrln 818
SciUltoxln 818
ScIeroUc acid w 446
Scoparll cacumlna 818
Scoparln 819
Scoparius *.....«. 818
nuld I'Xtract of 819
Scopola 881
r&rolollca 821
extract of >4k.....8>l
fluid extract of 821
soopolamlnie, bydrobromldum 8tl
SroPoInmliiL' .....544. 645
hydrobromfde 821
hydrochloride , 828
lodato 584
Scurvy-graaa 888
Scutellaria 888
Uteri flora 888
Scutellarln 828
Sea-Langlo G88
Secale cereale 465
SedotlTea, local 75
hydrotherapy IO80
Sedum acre 888
SfidlltB powder 144,758.888
Semen, iodine teat for 684
Senecine 838
Seneclo 828
Jacobaa 888
Senecionlne 828
Senega ...^ 884
concentrated aolutlon of 884
fluid extract of 884
Infusion of ....'. ........*..» 834
syrup of 884
tlneture of 884
Senrgffl radix 8M
Sencgln 828, 884
Senna 886
Alexandrina 886
compound Infualon of 881, 886
compound tincture of 888
concentrated aolutlon of . . 888
GEKEBAT,
PAOB
g3S 878
^^^^^H
1
1
r
I
AOB
stz
779
B32
832
m
838
346
, 833
, S38
832
S32
, S82
, 883
882
832
832
, 882
. 832
882
882
832
882
833
883
888
883
883
, 838
888
888
833
888
833
833
832
, 833
833
888
833
833
833
833
S38
833
883
888
832
883
100
883
832
838
832
883
843
386
88t
832
833
833
430
418
S33
844
833
843
833
812
832
441
833
812
833
417
'^
833
883
883
833
811
833
1
836
■ Inrtlrn
836
Soda, bakini
chlorinated solution of .........
815
!^
tnixturfi of rhubarb and .......i
^^^^H *?tr''' «if>A>. 1^
8St
powder, tartarated effervescent
Bolutlon. chlorinated
urtarau
tartrate of potassa and
■*m
^^^H o^..
n
^^^^V a*>«HAi. «/.*«i1a«*
......... 798
.^ 22
^B Aiitldinhthprltloum
o]2
waablna •
H Pr rnlny'n ,.,
218
SodU Bcetaa
■ Serpentarlft
S27
.i. ...... 9X1
araeoas . •..•......••.■o.*..
,, ,9J,
exalcc&tua
Oti
^fc^^ tincture of
^^^H Serpcntartie rhlxoma ,
^^^H Serpentarin
^^V S«n>entary. concentrated solutioo
^^^^^ Infiinlnn of ,
W7
ar
888
of .... 8«7
8S7
benioaa « ..•.■..••«.•
bicarbonaa .*..•• **•*•«••*
blsulphis ••>.•..■>•
boraa •* *.
100,
bromldum
m
■ Sesxunum Indtcum
^^^ nil of
«n
,, 8TI
carbonaa
exalcratua
monobydratui
chloras
*•.*.>
^^^H Qflfnna
, UBi
^^^^^1 PftYMTTi rnTTBrftliiin
818
^^^^H CthAphepH*a pt'if'
chlorldum
cltraa
^^^^H ahAVpy orlmn
lit
^^^B Sinlagoguca
^^V fillip*
, 89
citrotartras effervesccna
bydroxtdum
hypophoaphla
lodldum 4
''M9,
■ Silicon ,
....,,».. 8tt
■ Silver ,...
^■^^ ^l^llm(>oe
, 770
n It TAB
^^^H r^na»ln
SS8
Dltris
phenolsulpbonaa
phovphofi
V.m
^^^B ^tt^ati^
,,..*.,.. 3SS
^^^^V tt^Mnli^^
227
^^^ ItMlIllft
*. . 582
phoaphoj etferreicena *....
■ lactate
...... 281
exalccatua
H nltmtri
SS7
DyroDboBohas s....i....
■ diluted
, MX
sal Icylas
111.
H molded ,,»..
117
santoolnas
^^^ oxid^
, 187
sulpbaa .'
^^^B phri«phB<>A
jjl
effervesoens .........*......•>.
^^^H prnfnihin
. - .. 6t7
BUlphlB •»....
^^^^H <;imahf> /-^rffi^q
831
sulpbocarbolas * *
^^^H ffif-fiifrln^B
, . 322
thloaulpbaa
Sodium
^^^H nimiiln
830
^^^ fi<ni.lhlTi
SSI
acetate • ......*.
^^^^ "'nnplTift ,
831
arsenate
solution of
...82.
■ SInapIs
, 810
■ alba
830
arivDBte. dried
bensoate
"w.
H olbtB semina
■ nigra
880
830
830
blborato
bicarbonate
troches of
^^K SiDapisms «,
^^M Sinlgrln
881
........ 831
btaulohlte ..
borate
^P Rlsfrptni^hfiim ^,
831
bromide ■••*».•.*••.
171,
■ anr^intlMhim
Rtt
cacodylato «.*.««•
105.
■ Skullcap
" •' MM
•caffeine sulpfaonate •
H '»xtrfl'*t ftf , f
.. sn
carbonnte • ••>>■•>
m Skunk-cabbAS^
^^^ -buah
^^H SaiHrt-we«d
488
481
757
MO
dried .*.......
chlorate «»•••«
chloride .>..».
citrate **
^ Smila
Smilacin
Smilax. China
Klftbra
med lea
oniata >
814
m
lV.'.[y.l 814
ritrntnrtrntn f^fTnrrraeftnf ■.
creosotate of
dlaohtolate ...■*!>
eoalnate .•.......*■■■•■■
ethvlate Bolutloa .......u.......
Saake-bfte. antidote tar
7Q
fflTOD^holfttd M «.*.... *.*««.aiABk*
treatment of ..«*.■••..•*...
ttf
iivdroxtdo ..•*•«».*.. a*. **.«fe
-poison , ,-.,..,.
mr
solution of •■••t.**««.>«>>t i«i
-root, block ,,,• t...
810
hypophosphtie *••.«••.■•..«..>••.«
•Tenom ,
ng
lodonlbumlnate •.•■••*•
-weed *
6oap-bark
::::;:::«
lodtde
noi.
nitrate .,
CaaiUc ;
compound pill of
8U
674
8U
nitrite ■.......•*•••!
parse reaotate ....>••.■.....■■>...■
DbenolsulDhonate •■.•>..■•
freen
hard
liniment of soft
8U
sa
8U
pboaphste
compound solution of
dried
..7r.
-Ilnlmont .......l..^. ■
Dotaaalum tartrate ......t.. .....
-plaater
•oft
Soapa. medicated
e:;;J
pyropbospbate
salicylate •
\\m.
santonlnata ....*■......... .-»
J
1194
QENEBAL INDEX.
PAOB
Sodium BRntoniDDte troches 883
al llco-fluorlde S29
silicate, solutlOD 831
Boiotodol , S47
sulpbate 838
efTervescent 833
Chtopbeo AM
sulphite <• 88S
sulphoriclnas 188
BUlphocarbolato .....<,..... 818
BUlpbosallcylate 811
tellurate M8
thiosulpbate 888
-tumoDol-eulphate MB
BoUnlne 4M
Bolaoum dulcamara 440
Bolldago S4S
odora 845
Solaoldtne 844
Solanlne 844
Solanum Carollnense 844
pantculatum 844
SolomoD'a seal, root of 7ft7
Solutions 38
Solution. Donovaa's 82
Dobell'B 106
Fowler's M
of ammonia 180
strong 790
of arsenic bromldo 88
and mercuric iodide 88
of arscnouB acid 82
of aracnlc, hydrochloric 82
of borate of sodtum, compound 106
of carbolute of sodium 106
of chromic acid U3
of ferric chloride 466
utroug 466
nitrate 466
aulphate 466
of hydriodlc acid 117
of potaasium arsenite 82
of sodium arsenate 88
of trlnltrln 488
Somatoso ., . 846
Somoal 845
SoniDoform 846
Somnos 846
Sorghum * 787
Sosal 189
Sosolodol S46
Soiollc acid * 286. 418
Spanish niea 308
Sparteine, sulpbatn of 818, 819
SpartelDtc* Bulphas 818. 819
Spearmint ,....., 626
0(1 of 636
spirit of „ 62S
-water , ,...,.,*,.,.., 63S
Speclflc erarlty 36
rrnir-dleB «.... 84
Spermaceti 328
cerate 828
ointment 328
Spermlo hydrochloride 206
Sphaccllnlc acid 446
Sphacelotoxln 445
Splce-buah bark 600
Spike lavender, oil of 698
Splgella 848
fluid extract of 848
marriandlca 848
and- senna, fluid extract of 848
Splgellne 848
Spinal anirstbesla by eucalne 462
with tropacocalnc 907
dtBeases. suspension for 1166
flexion , 1167
aedatlres ....t a.... 78
BtlmuIantB , 78
Spirit of ammonia « 180
of anise *............. 219
of bitter almonds .,...*.* 187
of ether .'. 166
PAOK
Spirit of wine 108
Spirits 88
rectiflcd W
Splrltua , 21
etherlB 166
composltus , U6« 161
nitrosl 166-
oinxnonise 180
fmtldus 180, 334
ammonll aromaticiu H^
amoracln composltus 232
amygdalae amane 187
antsl 219
aurantil composltus 241
cojuputi 667
campborffi 289
chloroforml 337
cinnamoml 366
formlcarum 116
frumenil 168
gauitbertffi 481
geneve 169
Jtycerylla nltralla 488
amalcenslB i 169
junipcrl 688
composltus 688
larandulsB 688
menths piperita 686
TlrldlB 6»
myrcls 168, 068
myrlBticee 636
odoratuB 168
phosphori 718
roBmarlnl 793
vlnl gallicl 168
Spray. antlBeptlc 100
Springs, clasBlflcatlon of 1068
Spruce, hcmlocli , , 739
Spurge, pill-bearing 467
Squaw'Vlne 6S2
Squill 817
compound pill of 817
syrup of 817
Hiild extract of 817
oxymel 817
pill of Ipecac and 817
iiyrup of 817
tlucturt] of 817
vUn'gar of 817
Staphlaagrla 819
Stapblsngrlne 848
SL Cc-L-elia Guild Id Hoapltmla 1138
SUrrh 801
glyccrlte of Ml. 490. 486
Iodide of 663
Star-ouiBQ ,,,.. 219, 662
Star-groBB , 178
Static appamtuB 844
Static electricity 837
doso of 868
StaTPBacre. fluid extract of 848
olntm<?nt --,.,. 848
Stavesagriv acmlna 848
Stcapaln 697
Stearates « . . . . . ^ . - - . 860
Stearic acid 138.850
Stcrcsol 419
Stllllugia 860
compound fluid extract of ......4»....- 861
fluid extract of 860
Bylratlca 8B1
Stllllngine 861
Stockholm tar 744
Stomach, direct electrisation of 994
Stomachics 80
Stone-crop .823
Storage batteries 960
Storax, prepared ;.... 860
Storesln 860
StoToine .....a 8S1
Stramonium 861
oxtract of ....,..................<...... 861
fluid extract of 861
-leavra 8S1
GENERAL IKDBX.
1195
PAGE
onlum ointment 861
Beds 861
lonli semlna 851
icture of 861
til bromldlum 852
dldum 852
.Ucylas 133, 852, 855
tlum bromide 86S
dido 852, 854
trate 865
illcylate 133. 852
hantbln 866
bantblniun 866
•bantblUdIn 886
•hantbuB 865
Ktract 865
:omb6 856
^rnlna 865
ncture K5
rhnlna 648
:bnlnea hydrochtorldum S46
itraa 646
ulpbas 646
:bntne 646
hydrochloride, solution of 646
3date 564
titrate of 646
►olsonlng by 648. 649
lulphate of 646
chnoB nuz vomica 646
itlcin 860
tlca 75
collodion 142, 889
ftcln 261, 602. 860
•ocol 416
■ax 860
oenzoln 261
prsparatuB 860
•ene 660
•ol 261. 802
rone 860
arachnoid Injection of magne^um sul*
phate .^ 612
cutaneous medication 65
tamine 861
salicylate of bismuth 132
ced&neum 63
clnlc acid 861
dioxide 184
clDlmlde of mercury 533
clnum 861
cue belladonnsB 252
conll 393
hyoscyami 544
scoparll 819
taraxact 880
^t, prepared 828
Tol 715
jar-cane 797
refined 797
^gestton 1102, 1103
phamlnol 862
phites 141
phocarbolate of zinc 106
phonethylroethanum 867
phonmethanum 862
Iphonol 862
iphoriclnate of soda 138
Iphorlclnlc add 138
Iphovinate of sodium 141
iphur 869
ronfectlon of 869
iodide ri63. 869
ointment 563, 869
liver of 759
lotum 8B9
lozenge 869
oil of 870
ointment 861
pntcipitatum 869
precipitated 869
Rplrit of 870.874
Miblimatum 869
sublimed 869
PAOK
Sulpbur, -washed 869
Sulphurated antimony 221
lime 870
Sulphuric acid 189
aromatic 139
diluted 1»
Sutpburls lodldum 663, 869
Sulphurous acid 141
Sumach, Ohlnese 199
fragrant 790
smooth 790
swamp 791
Sumbul 874
extract 874
fluid extract of 874
radix 874
root 874
tlncturo 874
Sundew 438
SuB-fiower 606
Suprarenal glands, desiccated SXId
Suprarentn HO
SuppoBitoria 21
acidl carbolic! 106
tannlcl 14t
belladonns 962
glycerlnl 491
lodoformi 666
morphlnsB 676
plumbl composlta 874, 748
Suppositories .22, 889
Surgical shock 436
Suspension 116C
Swamp hellebore 91S
Sweet gum 601
Sympathetic, galyanlsatlon of 987
Symphytum 87(
ofOcinale 876
Synocarpus Rusbyt 382
Synonyms of new remedies U
Syphilis, mixed treatment for 686
Syringes 66
hypodermic 66
Syrup 797
aromatic 388
of acacia 87
of calcium lactopbosphate 128
of citrtc acid 115
of ferrous phosphate 486
of hydriodic acid 117
of the phosphates, I., Q., ft S 724
of the phosphates tSS
Syrupl 28
Syrups 23
Syrupus 797
acidl citrlcl 116, 699
hydrlodlcl 117. 562
althcesa 184
allti 178
amygdalse 197
aromatlcuB 366
aurantil 241
floris 241
florum 241
calcil lactopboBphatls 289, 290, 724
calclB 289
lactophosphatls 123
chloral 331
codelns .- .383. 674
ferrl bromldl 273
lodidi 466, 582
phospbatts 488
pboepfaatis cum qui&lna et strych-
nlna 486
qulnlnflB et strychntnte phos-
pbatum 3S3. 466. 724
glucosl 797
hemldesml 507
hypephoaphitum 289, 466.759
compositum 130, 289
composltus 466, 723
Ipecacuanhn 580
kramerln 694
lactucarll ....*. 695
1 iiye ^^^
^H SyrupuB Ilmonls
■ OENF.RAT
PAGE
5W
Teat for morphine
pbeoacetiu
™^ PAO«
676
711
^H maldls sUfiu&toruni
614
^H pectoralla ~
^H plcls Uquld»
816
744
771
Testicular Julco
205
Tetanus
untltoxlo ......•••••••
618
211
^H rhri
787
carbolic acid In •..•■••••••
no
787
Teucrlum
888
^^H rhfrnflnn
78S, 7J0
Thallln
B88
^H rfiRir
792
BUlpbate
Thea sineosli
888
284
^H riitil
, . 7W
^K aromaticus
^^H, Idrol
^^^B aiu-saparlllEe composltiu .
794
796
814
gl7
Thcbain©
. . . ; C75
Thelne
Tboobroma cacao
Theobromine
....284. 298. 501
284. 889
298. 889
^^^~ composUaa
^^r scDes<B
817
i 824
-lithium salicylate
890
-sodium salicylate
Tbeoclne
800
298
^H fTfnntn
825
^H tolutanua
^m siDEtberis
^H ^ijiinit' rnnt i
, 822
Theophylline
Therapeutics, d«^Saltioa of ..
rational
t 2. 7U. 84
1
^H H'Wffrt flfiff
28S
general
70
^H sptrit of nitre ...........
156
Thermol ,
892
^H Swortia cbtrati
329
Thermometen
35
^1 Tabacum
876
«M
Thilanin ,,,..
801
Thlocol
80S
Tblofonn .......................
172
^H Table abowlog comparative etrc-n^h of
^B preparations o( preceding
^m and present pharmaco-
^H pfninfl *'-
Thiol
8N
Thiopbco
8M
dl-lodlde
894
Thlor**sorclDum
89t
^1 TabellcB trlnltrlnl .-..„
4gS
Thloftln&mln
.......... . S9I
^H Tamnr Indleo
K27
Thluret
874
^H T»m(ii<ln>«p 1 _
878
Thorougbwort
Thuja ocddentalis .
467
886
^H T^'rrTlnd^iit
87g
^B Tnrfln»
878
Thu etin .
895
^B Tntn, piiflfl^^ ,, ,
878
Thujln
896
H TnlPiim
878
Tbujono
86
^M piir)fi/.ntMni
,.. 878
Thus Anicrlcanum •
805
^B TflfinFilhlp , , ,,,,
141 879
Thymacetln
901
^H Tann^otin
879
Thyme, oil of •
89>
^H Tiinnfo^ntTi _ _ ^
, 879
Thynocne
,..., 899
^B *'lll(»nr«
, 879
Thymol
899
^1 Tarnk-r'B roiiTeuae
......,.»,.. 1115
carbonate
901
^B^^ T«nnf/^ •n|<f
,,,,, 142
Iodide
,; ... 896
^^^H* srlvcAfUa
142, 490
Thymolta lodldum
Thymus
gland
8M
899
208
^^^^B
142
^^^^f Bii»nnBlfnflA>
142
^^^^ rmi^hoa ^ ^ ^ ^
142
Bcrpyllum
vulgaris
901
879
^B Tnnnipftn
879
^B XftTinln __ _
821 622
Thymoxol
706
^.... 109
^B Tnnnftfftf-m
879
^B Tannopln
^B Tnn«y
880
879
Thyroid extract
too. 207
glanda, desiccated
solution
vrt
207
^B T»r
744
^B Tar-ncne
746
744
Tbyroideum slccum
, J07
Thyroldin
208
^B olatmeDt
^B^ nyr^ip fff , , , ,
744
744
Thyroldlsm
309
TlgUlc acid
Tills vulgaris
Tinctura ,
, 671
901 1
13
^^^^ -water
^^^K Tartaric anid
^^^H Tartar cmotlc
^^^V Tartarated antimonr
^f iron
■ TflroxRccrla
^B '''■n^Trp-'fn ,
746
144
JH. 758
321
468
881
881
Tlnctura aoonltl
146 '
aloe«
180
ct myrrha
flDtl periodica
180. 6J6
261
amlca;
288
■ Taraxacum
^B elixir, compound
880
864
284
auranttt
241
^1 ATtrnrt nf
880
aniarl
241
H fluid extract
■ -Juice
^B nffli^inaitt
880
880
dulcls
141
belladonns
162
foliorum
benzolnl .....•.....*
161
201
^m rndtT
880
^B Trn
298
compoalta
buchu ,
....146. 261. 800
S88
^B Affln^n ,
ni
^H hrrrr
,,.,, 481
byronl8P •■..••..■•.••..t...
381
^B T««l.«f]
071
calendula
calumba
206
sn
^^^^^ T<impA«.n»M*^
M
^^^^B ToviluinA
881. 886
campborte rompnslta
299
^^^^H 'Ti^xnKnnii***
..«81. «86
cannabis Indlcce
cantharldia
106
lOi
^^^^B tP<i»nK(n«k(n*
881
^F Canadenila
^B Terc>blDtblne
888
887
capslcl
112
cardamom!
composltA
cascarlllEB
ai9
sie
lU
^H Temln hTdrate
881, 887
^B Terplnl faydrafi
881. 887
OBKERAL INDE
nor
PAOB
Tlnctura caU«taa 31*0
chlrata 3»
cbloroforml et morphlno compoeUa
■S'S7. fi7l
clmlclfucm 3&U
clocbonsB 362
composlta 352
ctDDamoinl 366
cocci tSl
oolchicl sominlB 885
semiaum 88S
CODLi S&3
croci 420
riib«biB 421
digitalis 430
ergoUB amxDonlata 446
gallio 480
gambtr (.'ompoalta 320
fcrrl cblorldl 468
perchlorldl 4M
SoUemll 4ft3
geotlance composlta 435
ffualAci 600
animonlata • 600
bamamelidis 604
bumuli 611
hjrdraBtls 6M
byoBcyaml 644
lodl 662
Ipocaouanbffi et opil 680. 673
jaboraDdl 738
latapffi 686
kino 691
kraxDcriflB 586
Uctucarll 695
lavandulte composlta G98. 793
llmonU 699
cortlcla 699
lobeltw «06
irtherea eO<t
lupul! 613
moflchi 633
m^yrrhre 636
opit ammonlata 674
campborata 673
deodora ta 673
pbrsofltlsmatis 729
podopbylll 766
prunl Virglnlann , i...... 771
pyrethri 773
quaaslie 776
quIlIajK 778
Qulnluas 363
ammonlata 953
rh«l 787
aromatlca 787
composlta 787
s&DguinAria 806
■ctfln 817
iwn^StB 834
aenns composlta 836
Berp^ntJirin 827
atramoDll 8$1
stropbantht 8S6
snmbtil , 874
tolutana 346
Valeriana *..»,»..,.........., 610
ammonlata 190
vanllltB ..,.,......».,.*.,.».,,*,,... 912
veratn 913
xIngibcHs 986
TInrtu rp of alo^a 180
and myrrh 180
by pfTcolstloa 41
Tlncturi** tS
Tlnolvclly senna 816
Tobacco 876
cflfecta of ualng 877
Tolcne H6
Tolu. bnlsara of 346
synip of 846,876.901
tinclur<? 348
Toluene 864
Toluifrni balaamam 346
PAOB
Tolulfcra pereira 846
Tolutanus syrupua Ml
Tolrpyrin ...,.».... 78>
salicylatfl « 4U
Tolyeal ^
Tonga ....r^.. 891
Tonic hydrotherapy '. .1011
Tonka beans > ^
Tonics .,t,.. 1ft
Tooth-powder. Oarretaon's SSI
Tootb-«8»h lis
Topical treatment 61
Toughened caustic 817
Toxic effects ot ether 168, 168
Toxicodundric acid 781
Toxlcodendrol .* 791
Toxins 804
Tragantbin 908
Tragacantha 9QS
Tragacanth, compound powder of 903
glycerin of 903
TrnnHfuslon 1145. 1147
of blood 60
Traumatlcln 608
Troatmptit. empirical 8
object of 84
symptomatic 3
topical 61
Tree of heaven 168
Trtbromomethao* ^o*..*. 273, 380
Trlbromhydrln , 179
Tribromphenol 106. 281
-bismuth 920
Trichloracetic acid 146
Trlehloraldehyde 331
Trichtoromethane 317
Trlcblorphenol 347
Trimfthylamin 833, 659, 904
Triraethylamlne 403. 445
TrfmethylaminI hydrochloraa 904
TrlniPthyl-cthyllne 708
Trlmrthyl-xanthlne ,.•.-.« SK
Trifollum pratense .,...,. , Ni
Trigonelline 8M
Trlnltrln 488
tablets 488
Trinltrophenol 132
Trional 863, 887
Trlpolmltln 663
TrUlol faHna 906
Trttlcln 9C6
Trlticura 906
antlTum 468
Trtturntlo einterini 4*2
TrlluratlonoB S3
Triturations S3. S16
Troches 38
of glycyrrblsa and opium '416
Trocblscl 91
acldl tannid 14>
ammonll cblorldl ..«*•■....• 38(1
cubebte ......«• 480
gamblr 880
glycyrrhta» et opIl 498
Trochlscus acldl benaolcl 161
carbolicl 108
blsmuthl composltus 267
eucalypti 468
fcrrl redacti 467
glyesTrhl*,-© et oplI 673
gualacl realns 600
Ipecacuanhtt 681
kramerin 695
ct cocalns 868. 696
morphlnic 874
et IpocaruanhM 681
potasBll chloraUs W
eantonlnl fOO
sodll carhonatlfl «. 888
santonlnatla 888
Bulphurls ..*.. ••• 868
Tropacocainc 908
hydrochloride 907
Tropic acid •-•*••. 646
^^ 1198 ^^^™
^H Tropyltropeln«
^H Trypala
GENERA
PAGE
2S3
607
698
Ura ursi
■
extract of
fluid extract of ..,,,
gH
907
folia
909
57J
Infusion ....
909
908
Vacclnlura mjrrtilua
TlUa IdflBa
Valeren
Valeriana
910
910
9U
91A 1
401
^B Turnera diffusa
^M elixtr of
- 429
429
780. 881
^^^^ iuid acetic add. liniment of
881
ofllcinalla
911
779
Valerian, ammoniated tincture of
fluid extract of
rhizome
tincture
Valerianic aoid
910
m
910
910
.698. 875, 910
103
911
^^^B
^^^V reflned oil of
^ Tuflsol
^M Tuullaro
^H Typhoid, speolflc treatment of
^^B TTImiifl III > 1 ■ ■
881
881
72J
909
B26
..^4k..>'... 909
ether
Valerine
Valerol
.*..-.. 9U
^H fiTtrn . ,
...,^ 909
VnMctrp'f mnflfl ,...«■.
.... ... 4tt
^H nmb(*lilf prone
^m Uncarta samblr
^H irnfr^irntn
479
820
u
Vanilla
9U
planlfolia
913
Vanillin
9U
^H ITtifpirnffi
24
Vapor moasace
1091
^H UngURntum acldl boiHcl
^■^ carbollcl
^^K saUcTltd
^^^H Unntol
^^^H aconlUns
^^^^^1 aniin^ rnnm
100
10«
133
142
14«
..197. S88 798
Vasicine
,...*.... m
Vascular sedatives
79
stimulantfl .
. * 71
Vehlfle. In a prescription .........
......44. El 1
Vellnrln
S4S
Velpeau'B dlarrhsa mixture .....
393
^^^^H
jfil
VenescctlOD
Ventilation, effects of poor
Veratramarine
Verntrlna
Veratrinc
1145
1023
913
912. 795
.... 3S5, 912
^^^^^^1 hl^lllldlTTITm Ill
251
^^^^H capetcl
^^^H cantharldls
^^^H ceUcel
^^^^^1 fhrynnrnhlnl i i .
31t
308
323
„ 349
oil of
012
^^^^^H nnAnlnm
368
ointment
912
^^^^H 1 1
393
Veratrum
913
^^^H creosotl
^^^H diachylon
^^^H elcml
^^^H eucalypti
^^H calls
^^^^1 cum oplo
^^^H Kalli cum opll
^^^H Klycf-rlDl plumbl subaoetatla
^^^M hamamclldls
^V hydrarjryrl
^H^ nrnmnnlntn
405
747
443
4«
480
480.674
480
491. 74«
MM
514
514
album
912
fluid extract ,
.... 913
tincture
912
virlde
.. . 9U
Veratrone
. . . 912
Verabaacum
91S
Ihupsua ,
|]£
VerdlRrls
42S
Vormotith ,*....
as
Veronal
Veronica Vlrrinlca »,..
91B
G99
^^^^ compo6Uum
^^^^ dllutum
^^^H lodldl rubH
SIB
514
515
5H
Vibrator. Chattanooca
the Fraley
Walte & Bartlett'B
Vlhrothernpy
Viburnum opuluB
fluid extract of
prunlfolium
1090
1090
lOM
1019
9!t
916
916
^^^H dllutum
515
137, 515
^^^H TTTlflf flnTi
B14
^^^^^B
B14
fluid extract of
VloTina paste
916 1
280 7S9
^^^B subchlorldl
515
MS
Vina ......... ....:.;.....;:...:.
...... . 84 1
^^F IftilnformI , , , ,
........ . 555
vinegar
91
H ptiruinul
■ phonollfl
^H pIclB Itquida «..
707
toe
, , 744
Vinegars
Vlnum album ,
IT
antlmonlale
antlmonll
Burantll
nx
....IM. S41
^M plumbl acetatts ,.
748
■ lAi'iii
748
■ imtnnll Iftdldl
583. 7*i9
eoc»
colchlcl radlcis
aemlniB
terri
m \
^1 rMiInn^
779
■ Btaphftafrria
^H ntrnmonll
849
851
^H oulphiirln
869
amarum
363. 401
^K Indlfll
B«a. 809
citratls
ergotffl
IpecacuanhaB
4CT
444
.. 580 581
^H Tfrntrlnari
912
^H itlnrf ,
921
■ oleatlfl
■ oxidt
^1 Btenratla
137.921
931
tn
......... 42
opll
aulnlnffi
rubrum ,,,
871
KS
10
xerlcum
169
^^^^L T'^rnll'im
185
Viola, syrup of
917
^^^^H TTrnrKnn*
164
tricolor
917
^^^H Urglnea maiitlma
818
481
VloIIne
917
Virginian prune, tincture of
VlBcln
771
91K i
^^^^^^a T^rvftni* i i
444. 621. 909
609
^^^^^^ TTrntmnln 1 1 i i i ■ 1 1 ■ i i ■ i
Viacum
916
^V ITatllnrn mnMlS
UR «1K
vir<-Mii8 __
.. ata
GENERAL IXDEX.
1199
PAOB
Vitriol, elixlp of It9
VolU »a. »3S
VoUtilo olU II
Vouac&poua araroba ..» *.... Ml
Wachichlll ftl«
M'ahoo 45<
Wall-paper, arsenlo In ....>... -• S&
Warburg's tincture 301
Water 2M
action of charcoal on 3U
drlnklDK, effects of lOM
-germooder 888
ot dill 202
-pennywort M2
-pepper 757
physiologic effect* of 1046
Waiert, medicated 17
Wfltt ".... 938
Wax. white and yellow S8S
Weights and measures 19, 31
Weir Mitchell rest-cure 1007
Wet-pack 1054
Whale, sperm 323
Wheat-nour ..,, 4tt. 9Q&
Wheautone bridge .....,.;... .861
White arsenic IS
^liite goose-foot BIT
Whtte-oak bark 777
White poplar bark 758
White prenlpitatfl Sli
White wine Ill
Whiskey IM
Wild cherry, fluid extract of 771
InfuBloa of 771
syrup of 771
tincture of 771
Indigo 2i7
yam 427
Wllklneon's ointment «67
Wine, red 1»
white 168
Wines 24
Wiptera 918
Wintergrcpn 481
Winter's bark 913
WItch-hazol bark * 604
leaves .^...w... 604
water 8M
Wood alcohol .........,,••...•«», ,.....Af... 1T4
-sage , 888
-tar creosote 406
Wool-fnt. hydrous ...» 1SI
Woorara ^ ai. ....>.... ttO
Worm loseoges .■.. 808
Wormseod. American 286
Wormwood. European 86
levant 888
Xaotblum 919
strumarium 919
Xantbostrumarln 919
Xanthoxyll fructus 920
Xantboxyltne 919
Xantboxylum 919
Amerlcanum 919
nuld extract 919
PAOB
Xeroform 920
X-ray, action on malignant growths 1132
apparatus 1125, 1127
in therai>eutlc8 1131
for diagnosis 99S. 1123
unfavorable action of 1133
Xylene 920
Xylol 920
Yelk of egg 918
Yellow Jasmine 482
miTcurlc oxide ointment oU
pnrilla 624
wash 289. 614
Ycrba rheuma 478
aunta 460
Zea J20
mays 814, 623. 920
Zinc acetate 921
bromide 271. 931
ourbonate 9X1
precipitated 921
chloride 921
solution of 921
cyanide 921
-glue. Unna's 922
Iodide 663. 677. 921
lactate 921
oleate 921
ointment 137
ointment 9S1
oxide 921
ointment 911
permanganate 921
pfacnolsulphonate 921
phosphide 723. 921
Btcarate 921
ointment of 921
807.olodol 847. 8t8
sulphate 921
valerianate 921
valerate ...i 921
Ztncl acetaa 921
bromldum ITS, 921
carbonaa .4......... 921
pnectpltatua 921
cbloridum 911
cyaoldum 921
lodldum ..682. 921
lactaa 921
oleate ointment ^ 931
oxidum 981
permanganaa 931
pbcnolsulphonaa 108. 981
pbosphldum 713. Ml
•tearaa 921
iulpbaa ...*... 911
valerlanaa , 921
▼alerait » 921
ZInoobsemol „ 47t
ZIncum 921
Zingiber 926
officinale 916
ZIttmann'a decoction SIS
ZoIHckofer's mixture SOI
CLINICAL INDEX.
PAGE
Abdominal operallona. Dlsteasloo ot the
bowel In 1161
Abortion. Aaafetlda XS6
Electricity M8
Cold 248
Hamnmells EOS
J&tualca dogvood TIS
Opium 690
SaTlnc TOT
Viburnum prunlfollum 116
Abrasions. Aloea 163
BeoxoiD 262
Campbold « 201
ClnctaoDino iodosulphato 3&1
Glycerin 488
Hose olntoirnt 793
AbscessM. Alumnol 188
Arnica 2S3
Aspiration IH3
Bismuth Bubgallate '. 271
Csmphoroted nnpbtbol Ml
Contharls 310
Chiorlnp :M6
Chloroform 311
Ciucbonino idosulphate 363
Cr.-olin 403
f^ctilDncpa 441
Kormaldctiydo fSM
Honey 624
Hydrogen dioxide 249
Iodine 609, 670
lodopln 580
lodororm 559
Jamaica dogwood 742
Ltnum 601
Menthol «»7
Mercurol 538
Mercury 524
Pf^ntal 708
Pepsin 706
Phytolacca 783
Fotaasium oxalate .....«...*. 769
Py rnzooe Ufi
QulDlno 389
Salol 8D0
SarsaparillA * 815
SoKal 189
Strontium Iodide ..864
Tolypyrin 722
Acne. Alphauaphthol 644
Alumnnl 188
Almond 197
ArlHtol 898
Arsenic 96
Retanapbthol 610
Bismuth oleatc ,.. 127
subrarbonate .' 268
Rubnltrate 26S
rnlx sulphurata 292
Chrysnrobin 249
Clncbonlne lodosnlpbate ..263
Coca 276
Compound sine stearate 860
Copper 424
Crystalline 390
Elrrtrlclty 991
Ergot 447
Europben >* 461
Glycerin 492
Hamamellt 666
Hydrastis .* 640
HydroKen dioxide MO
Ichthyol 661
(1200)
PAO£
Acne (ronl'd). Iron oleate 12j(
Lead Iodide 764
oleate 128. 754
Lottophan y ....609
Massage 1000
Mercury 197. 621
Nitric add Ue
Osmium peroxide 686
Pboapborus T96
Potassium chlorate 766
Quillaja 779
Quinine , 861
Soap 812
Strontium Iodide 864
Sulphur 871
Thllaniae 898
Thiol 893
Thymol 90O
Zinc ttulpbato 912
Acromegaly. Pituitary gland extract 212
TTiyroId extract 207
Actinomycosis. Copper sulpbate 434
Potassium Iodide 6T6
Addison's Disease. Glycerophosphates ... 738
SuprnrensI extract 210
Adenitis. Tubercular. Camphor 30J
Thymol iodide 896
After-pains. Amyl nitrite 189
Camphor 306
Copper arscnite 426
UelBf-mlum , 466
Opium 302. 960
Viburnum prunlfollum 916
Agalactia. Electricity , 968
Pilocarpus 186
Agnail. Tin oleate 129
Ague, rsec Fever, Zlataria.)
Ague-cake. (See Enlarged BpUten.)
Albuminuria. Arsenic 97
Cnlctum benzoate 283
Com-5ilk «U
Fuchsia , 479
Glyceropbosphates 728
Koumiss &94
Pllocurplne 728
Strontium bromide 863
lactate 854
Tannic acid .,,, 143
Turpentine 886
Alcoholism. Ammonium 196
Apomorphlne 226
Capaicum 313
Cbloretone 337
Cimiciftiga ^^
Cocoa 377
Ipecac &88
Koumiss 684
Nux vomica «62
Pheoacetln 712
Plcrotoxln 881
Pilocarpine 738
Alcoholism, Chronic. Pbospbonis 736
Sumbul 876
Zinc oxide 926
Alopecia. Alpbanapbtbol 644
.\mmonia 192
Electricity 992
Eucalyptus ,. ..*...•.. •.•..! 4M
Iron oleato ^.. 128
Jaborandl .vf 785
Mercury 1 521
Oil of CAjuput ,% 667
Petroleum 706
PAQB
Alopecia {cont'd). Roaemary T93
Sulphur S73
Alopecia circuxuacripta. Alphaoapblhol M4
Botanapbthol - . . «0
CaBtharla 310
ChrysaroblD 860
Creaol iU
Buropbeo .,...,... Ml
Nut-gall 4m
Petroleum .^ T08
Quillaja * ,;...* 779
Realnol 7SI
Sulphur »* ..*..,* .«,»..... 87S
Tanntc acid .^ IM
Thymol MO
Tricresol ..., 411
Turpentine 9H
Verntrfne m
Amaurosis. Electricity 97C
Nux vomica 656
Pilocarpine 78S
Strychnine 666
Amauroslg. Tobacco. Electricity 970
Pilocarpine 73S
ZlDC lactate OSS
Amblyopia. Tobacco-alcohol. Strychnine. . tX&
Zinc sulphate 936
Ameaorrhoea. Aconite 160
Aloes 183
Amber ttl
Ammonium chloride IM
Aplol 710
Apiolln 710
Arsenic 90
Aaafetlda SSS
BnptlBtn 247
Rnrliim chloride .,.•,....,-. 248
Cfltithsrls .....311
Cantor 220
Clmiclfuga 361
Codliver-oll «80
Coiton-rooi bark 497
Electricity 983
Gold 248
Ouaiae 601
Indigo 668
Iron 470
Ifansaneae dioxide 019
oleate 188
Mistletoe 918
Muatard 811
Myrrh 837
Nux vomica 065
Oil of rue fifiS
Oxalic acid 130
Parsley 710
Polyconum 787
Quinine 301
RiclnuH-learra 807
■ Sallcyhc acid 138
[Sanguinaria SOS
■Santonin 810
Seoeclo 884
Seaega 886
Serpen tarla 888
Stavesacre 8S0
Siorax 881
Tansy 870
Teucrlum 888
Thuja 4 896
Thyroid extract 307
Viburnum prunifollum 018
Anasarca. Croton-oll OTS
Magnesia sulphate 018
AosBTOtn. Aloes 188
ApIoI 710
Arsenic 98
BeUnsphfhol 048
Bone-marrow 218
' Calrlnm phosphate 883,788
Shalyhcate waters* « 10<7
llirsiot herapy I07n
Coninsonla 388
Copper srt^Dlt* 436
Ansemla {cont'd). Cuprohnmol
Diet
Ferratin
Ferroaomatote
Formatea ...«
Hnmoferrum
Hnmogallol
Haemol
HamamvUa
Hydrastinloe ......,...,./
Iron .4
albuminate
reduced ,<
KeOr
Lactoftomatose ....................
Magnesia
Manganese ....,
Massage
Nux vomica
Orexlne
Oviferrin ..-•,
Oxygf-ri ■.
OxonisEed air
water
Popstn
Pepto-mangan ;
Phonphoric acid
Phosphorus
Potaaslum dichromata
chlorate
Qiilolue .,,....
Sodium solution
Static electricity .,,.
T*^ticular fluid
Transfusion of blood
Anipmla. Cerebral. Amylene hydraa
Oold
Ancemla. Pernicious. Boae-m&rrow .
PhoapfaoruR
Anipsthesla. Electricity
Aneurism. Acupuncture
narliim chloride
niood-lpltlng
Calcium chloride .....•..»,
Ergot ,
Gelatin ,-,>..
Lead acetate «...
Potassium Iodide
Strontium Iodide
Veratrum
Angina. Moaaage
Tolypyrin
Angina Pectoria. Allyl-trlbromld*
Amyl nitrite
Arsen le
Atropine
Cactus
Conllne
Cnnvallaria niaiaHa
Cratipgus ,
Rlwtriclty
Ether
ETftlgin
nionoln •
Hoffmann's anodyne
Jn mal ca dogwood ..., -....
lobelia
Maaaage ,,,,
Mescal buttooa ..,.......,..,.,;
Opium ,
Phosphorus .„
Potaflsiura Iodide
nitrite
Pyridin
Sodium Iodide
nllrtle
Snnrtelne sulphate
Sptritus glycerylla nltratlfl ....
Strontium Iodide ,. ,
Strophnntbus ^
Strychnine ....4,.
Zinc sulphate* ,,
Anidrnsls. Bueatyptas
Lanolin
1202
OUNIOAIi INDEX.
PAOB
iDOsmla. Electricity 976
Strychnine 656
Anthrax. ABaprol 64S
CarboUo acid lU
Cauatic potash 763
Bucalyptua 454
BllTer fluoride 229
Sulphur 873
AitldotM. For acetanllide: External
heat, alcohol, ether, atropine, and
f trychnlne 88
For aconite: Alcohol, ammonia, atro-
pine hypodermic ally, artlflclal res-
piration, digitalis, faradization,
inhalations of amyl nitrite, recum-
twncy, stomach-pump, strophan-
thUB, tannic acid Itf
For alcohol: Emetics or stomach-
pump, ammonia, disitalts, mor-
phine and atropine, coCCee, artlfl-
clal respiration, electricity, heat*
and sinapisms 172
strychnine 652
For amimoDlum : Oil, milk, Tege-
Uble acids, coftee, dlglUlls 191
For ammonium sulphydrate: chlor-
Inated-Ume solution 847
For amyl nitrite: Ammonia, atro-
pine, ether, cold water, mustard,
warmth 198
For antimony: Alcohol, digitalis, tan-
nic acid 222
For anenlc: EmeUc or stomach-pump,
cathartic, freshly precipitated ses-
quloxlde of iron, hydroxide of Iron
with magnesia, dlalysed Iron, cal-
cined magnesia, milk, oleaginous
or mucilaginous drinks 96
Fbr aspldium: Ammonia hypodermic-
ally, castor-oil 238
Fbr belladonna : Morphine, physos-
tigmlne, muscarine, pilocarpine,
animal charcoal, fixed alkalis,
demulcents, eracuatlon of stom-
ach and bowels ^4
pUocarpus 734
For caustic potash: Demulcents, emet-
ics, digitalis, stimulants, vinegar. 762
For caustic soda: Same as for caustic
potash 888
For chloral: Cocaine 332
B%r chloroform: Ammonia, amyl ni-
trite 838
For chromic trloxlde: Soap-suds and
milk, arterial stimulants 113
For cocaine: Alcohol, amyl nitrite,
atropine. chloral. chloroform,
ether, morphine MS
For conlum: Stomach pump or emet-
tts. coffee, atropine hypodermlc-
ally, muscular exercise, friction,
counter-Irritation, etrycbaine. phy-
sostlgmlne. tannic acid 394
For corroBlTe sublimate : Albumin,
wash out stomach, stimulants,
morphine hypodermlcally. external
heat 616
For croton-oU: Demulcent drinks,
opiates 671
For digitalis: Wash out stomach, tan-
nin, saponin, stimulants, ammonia
iDhalatfons, recumtwncy, heat.
Iron, cinchona 482
For ergot: Hot baths, aconite, amyl
nitrite, coffee, tobacco, veratrum.. 446
For ether: Artificial respiration. In-
halation of ammonia, flagellation,
faradic current, stimulating ene-
mata, amyl nitrite, nitroglycerin
hypodermlcally 158
For gelsemlnum: Evacuation of stom-
ach, heat, friction, artlflclal respir-
ation, hypodermic of morphine and
atropine, tannin, caustic alkallas
PAOB
Antidotes (oonrd).
and their carbonates, digitalis,
ammonia, strychnine 4M
For hydrocyanic acid: Ammonia 121
chlorinated lime-solution 347
atropine Ifl
hydrogen dioxide 411
permanganate of potassium CM
potassium carbonate IZl
For bydroBulpburIc acid: Chlorinated-
lime solution 867
For iodine: Starch-water, emetics.
sodium bicarbonate, layage, pilo-
carpine 56i
For iodoform: Stimulants, diaphor-
etics, potassium bicarbonate, po-
tassium bromide 657
For lead : Sulphuric -acid lemonade,
fatty food, bath ing, magneaiUB
sulphate, with morphine, bella-
donna, pilocarpine, alum, potas-
sium Iodide, vapor baths, Turkish
baths 7W
galvanism 7S2
For muscarin: Digitalis Iff?
For opium: Evacuate atomach. tannic
acid, artlflclal respiration, electric-
ity, massage, veneaection, whip-
ping, walking, catheterism. atro-
pine, potassium permanganate,
warmth, caffeine, strychnine, am-
monia CKl
cocaine J7V
coffee 216
gold and sodium chloride 844
nitroglycerin 4b»
plcrotoxin SSI
potassium permanganate 7C3
For oxalic acid: Lime, chalk, or
whitewash X2t
For pennyroyal: Morphine and atro-
pine hypodermlcally, heat iOC
For phenol: Vinegar, alcohol, soluble
sulphates, syrup of lime, atroi^e
hypodermlcally MT
For phosphorus: Copper sulphate 425
magnesium sulphate, albuminous and
mucilaginous drinks, French oU of
turpentine, oxygen Inhalations T2S
potassium permanganate CO
For physostigma: Chloral X4
atropine, strychnine 73»
For plcrotoxin: Cocaine 5T*
chloral 3M
For potassium chlorate: Saline purga-
tives, diuretics, calomel, caffelna,
hot baths, transfusion of blood TI2
For potassium cyanide: Same as for
hydrocyanic acid
For potassium dlchromate: Demnl-
cents, anodyne, emetics, purgatives 11&
For potassium sulphide: Chlorlnated-
Ume solution M7
For sanguinaria: Digitalis, amyl ni-
trite, strychnine, morphine, atro-
pine, warmth 889
For santonin: Diffusible stimulants,
hot baths, demulcent drinks, bel- ,
ladonna, strychnine, ether Mt
For strychnine: Amyl nitrite, bro-
mides,, chloral, tannin, chloroform,
physostlgmlne. artlflclal respira-
tion, animal charcoal, fata, chloral.
croton oil, paraldehyde, opium,
conlum. tobacco, alcohol ff»
For sulphuric acid: Alkalies U>
For tansy: Demulcents. purgaUvea,
opium, bismuth, diffusible stimn-
lants tl>
For tobacco: Warmtk, mustard, artlfl-
clal respiration, stimulating ono-
mata, brandy, Ice, strychntDe,
ether, tannic acid, lodldsa. com-
CLINICAL IKDEX.
1203
pAoa
Antidotes {cont'd).
phor, opium, dlffltalis, ■trophan-
tbufl : 877
Oold and sodium chloride 244
For trimethylBmln bydrochlorate:
Heat. counter-lrrltatlOD. opium,
belladonna, atropine, capsicum,
dlsltalls, Btrophantbus, nux Tom-
Ica 904
For turpentine : Fresh air, cardiac
stimulants, diuretics, hot drinks,
demulcents, opiates, pilocarpine. . 883
For Teratrum: Opium, stimulants.... 914
For sine: Flour and water, soap and
wafer, milk, alkaline blcarbonates,
morphine hTpodermlcally, potas-
sium Iodide, warm baths, laxatWes 922
Aorta, Disease of. Qulllaja 779
Apepsla. Pepsin 706
Rennet' wine 706
Aphonia. Atropine 268
Electricity 977
Mullein 916
Music 1137
Strychnine 654
Aphthous Stomatitis. Bismuth 268
Borax 103
Ooptls 400
CreoUn 404
Eupborin 469
Myrrh 637
Nitric acid 126
Potassium chlorate 768
Quinine 860
Saccharin .. 266
Viburnum prunlfollum 916
Apoplexy. Bandage 1144
Croton-oll 678
Mustard 831
Aptyalism. PelUtory 773
Pilocarpine 735
Argyria. Blistering 231
Potassium Iodide 331
Arteriosclerosis. Gold 243
Jamaica dogwood 743
Potassium ultras 767
Strontium iodide 864
Artb ritis. Baunscbetdttsmus 1140
Chaulmoogra-oll 3^
CodllTer-oi] 660
Colcblcum 886
Cold 1116
Eucalyptus ., 464
Heat 1114
Mercury 578
Arthritis Deformans. Lactic acid 124
Arthritis. Rheumatoid. Arsenic 98
Chaulmoogra-oU 325
Cimlclfuga 861
Codltver-oll 660
Colcblcum 386
Ferrous iodide 575
Franklinlsm 969. 971
Oualac 601
bydrlodic add 118
Iodine 571
Lithium 608
Massage 1012
• Ploerazin 741
Salicylic acid 136
Sulphur 878
Ascarldes. (See Worma,)
Aloes 188
CoIUnsonla 388
Garlic 179
Naphthalene 639
Oil of cajuput 6.^7
Phenol Ill
Quassia Infusion 777
Rhubarb 789
Ascites. (See Dropsy.) Apocynum 224
Aspiration 1143
Caffeine SS7
Colcblcum 887
Fjioa
Ascites (cont'd). Copaiba. 898
Elaterln 442
Elder 806
Magnesia 618
Massage 1018
Mercury 621
Paraldehyde 708
Pilocarpine 736
Potassium acetate 766
biurtrate 14S
Scoparius 880
SUlllngla 851
Asphyxia. Oxygen 1026
Asthenopia. Faradlsm 965
Tonga 902
Asthma. Acetanlltde 88
Acetic ether 168
Aconite 160
Adhatoda 158
Allyl-trlbromlde 179
Alum 186
Amber 861
Ammoniac 190
Amyl nitrite 199
Anemonin 778
Antlpyrine 719
Apomorphlne 286
Arsenic OT
Asafetida 236
Asaprol 886, 6tt
Belladonna 868
Caffeine 288
Cannabis Indica 307
Chloral 884
Chloralamtde 380
Chloroform 348
Cllmatotherapy 1076
Cocaine 377
Coclllana 388
Colchtcum 386
Contlne hydrobromlde 895
Conlum 396
Convallarla majalls 396
Copper sulphate 486
Creosote 410
Cubeb 421
Delpblnlne 860
Dionin 437
Dracontlum 438
Drosera 438
Eriodlctyon 461
Ether 160
' Ethyl Iodide 166,679
Eucalyptol 464
Eucalyptus 464
Eupborbla pilultfera 468
Gelsemium 486
Orlndella 499
Heroin 508
Hvdrlodlc acid 118
Hydrocyanic acid 123
Hyoscyamus 646
Ipecacuanha 688
Jamaica dogwood 748
Lead acetate 754
LIppIa 602
Lobelia 607
Lobellne sulphate 606
Massage lOlS
Menthol 626
Methylal 628
Mistletoe 918
Morphine 698
Mullein 916
Naphtha 709
Oil of chamomile 220
Opium 690
Oxalic add 180
Oxygen 1026
Oxyphor 697
Paraldehyde 701
Petroleum 700
Physostlgma 732
Pilocarpine 786, TS8
1204
CLINICAL INDEX.
PAOS
Asthma (cont'd). Potaulum bromide 276
iodide 276
nitrate 766
nitrite 766
PulaatUla 737
Pyrldln 774
Quebracho 240
Sansuloarla 807
Saw-palmetto 7M
Senega 826
Sodium nitrate 84S
nitrite W3
Solanine 440
Ssiirtelne sulphate 821
SpirltuB glyceryl nltratla 489
Stramonium 852
Strontium Iodide 8&4
Strophanthus 859
Strychnine 6&4
Sulphonal 866
Suspension 1156
Tartar emetic 223
Tbeocine 299
Tobacco 878
Turpentine 883
Valerianic ether 162
Zinc oxide 928
sulphate 924
Asthma. Cardiac. Adonldin r 164
Gbloralamide 830
Digitalis 484
Jalap 686
Saw-palmetto 796
Testicular extract 206
Atheroma. CodllTer-oil 660
Lemon 600
Oleander 666
PhosphoniB 726
Athetosis. Blectridtr .978
Athrepsla. Rectal alimentation 1001
Auditory canal. Vlceni of the. Cocaine... 871
Balanitis. Alumnol 188
Bismuth Bubgallate 271
Balanopoathltla. Ariatol 897
Bed-sores. Alcohol and alum 174
Chloral 334
Compound sine stearate ffiO
Creolln 404
Euphorln 469
Glycerin 492
Iodoform 668
Lead 754
SllTer nitrate 229
.Vinegar 91
B«rll>erl. Methyl ene-blue 629
Blliousnesa. Ammonium chloride 194
Compound cathartic pills S91
Mercury 624
Bttes of Animals. Asclepias ▼ertlclUata.. 236
Bites of Centipedes. Sliver nitrate 229
Bites of Insects and Serpents. Hydro-
chloric acid 119
Potassium bicarbonate 768
Bladder Atony of. Cold 244
Strychnine 647
Bladder. Diseases of. Bilberry 910
Hyoscyamus 646
Bladder. Hemorrhage Into. Pepsin 706
Trypsin 699
Bladder. IrrlUblllty of. Acetphenetldln.. HS
Borax 104
Buchu 282
Camphoric acid 304
Cannabis Indica 307
Copaiba 398
Corn -silk 614
Cubeb 422
Damlana 430
Lithium 606
Manxanlta 621
Monobromated camphor 802
Mullein 916
Pareira 703
Bladder (cont'd). Salol-retlnol TU
StSTesacre 860
TriUcum Mft
Uva ural fU
Bladder, OTerdlstenslon of the. Aspira-
tion U«
Bladder, Painful affections of the. Hy-
oscyamus 64<
Iodoform GB
Bladder, Paralysis of the. Arnica 224
Blectrlclty fW
Ergot 447
Strychnine 664
Bladder, Rupture of the. Opium no
Bladder, Spasm of the. Belladonna. 2ig
Cannabis Indica SflT
Bladder, Tuberculosis of the. Camphor-
ated naphthol Ml
Bleeding. (See Bamorrhage.)
Blenorrhoea. (See Chmorrhaa.)
Blepharadenltls. Phenoaalyl 112
Blepharitis. Chronic. Mercury S20
Blepharospasm. Conlum 2K
Blister. Absorbent cotton 497
Bismuth 26t
Compound resin cerau 7»
BlemI 4a
Grlndella <|»
Sarlne TtT
Blood Diseases. Barberry 3m
Cllmatotherapy vftt
Blood Poisoning. (See Septicamia.}
Bone, Carious. Hydrochloric acid UO
Bone. Necrotic. Hydrochloric acid UO
Bones and Joints, Dlseaaea of. Codllwr-
oll M»
Strontium Iodide tti
Bones, Diseases of. Camphorated naph-
„ ,thol C41
Gold M4
Sarsaparilla tis
Zinc chloride tM
Bowel, Atony of. Caacara aagr«da 7>C
Bowel Disorders. Acacia t?
Alcohol lit
Cannabis Indies iK
Cetraria 224
Codeine 2>l. lil
Oaultheria 4tt
Isinglass BO
OlWe-oll 004
Opium on
Salep no
Tannic acid 14S
Bowel. InTaginations of. Potassium bro-
mide tit
Bowel. Obstruction of. Crotoa-oll CIS
Opium on
Bowel. Prolapse of. Alum IK
Nitric acid 125
Tannic acid SO
Bowel, Ulcers of. Tannic add 143
Brain, Congestion ot. Aconite ISO
Colocynth Itl
Massage ...1000
Magnesium sulphate 012
Potassium bromide RO
Brain, Inflammation of. Atropine ISO
Brain or Spinal Disease. Setons IISO*
Breasts. Swollen. Camphor 301
Stramonium 862
Bright's Disease. Althsa 104
Antlpyrttt T>i
Apocynum 224
Caffeine 20r
Cannabis Indica 9BT
Cantharls HO
Chloral SM
Convallaria maialls 2K
Digluiis 4S
Bunonymus 4fT
Oalllc acid ur
Olonoln 40*
Hnmogallol 41S
CLINICAL INDEX.
1205
pAoa
Brisht'8 DlMue (cont'd). Hsmol 47J
Hydnutts i 541
Icbthyol 560
Juntper M9
Iroo 469, 474
MagDMla 613
PlpilBMwa 327
PotEMlum bltartrate 146, 766
Iodide 573
Pyoktantn 631
Sodium b€nioate 840
Strophanttaua 858
Veratrum 914
Water 1048
BromtdroaU. Alum Iffi
Aluminum cleat* 127
ArlBtol 898
Beuoapbtliol 640
Boric acid > 102
Calcium 291
Cbromtc trlozlde 118
Compound sine stearate 850
Copper 424
Bucalyptus 464
Buropben 461
Formaldehyde 608
Hydrastis 640
Pllocarpue 736
Potassium Iodide 576
permanganate 618
QuUlaja 779
Salicylic acid 134, 135
Tannoform 879
Zinc oleaU 129
Bronchial congestion. Digitalis 433
Bronchiectasis. Eucalyptus 464
Guaiacol 412
Iodoform 369
Menthol 687
Sulphuric add 140
Bronchitis. Acacia 87
AceUnllide 89
Adhatoda justida 163
Amber 862
Ammonium chloride 195
iodide 577
Anise £S
Antimony 22»
AnUpyrin ' 7i9
Apocodelne - 694
Apomorpbine 226
Asafetlda 235
Balsam ol Peru 246
Betanaphthol 641
Bilberry WO
Caator-oU 668
Caulopbyllum 322
Chamomile 220
Chloroform 348
Chondrus 348
Conclllana 382
Codeine 691
Colchlcum 386
Convallaria majalls 396
Copaiba .■ 398
Creosal 417
Croton-oU 672
Cubeb 421
Digitalis 435
Drosera 438
Hrlodlctyon 451
Bthyl-Iodlde 186, 579
Bucalyptus .• 454
Fabiana Imbrlcata 463
Formalin 604
Oalbanum 480
Garlic 178
Oualac 601
Guaiacol 413
Hepatica 508
Heroine 608
Hydrlodlc acid 118
iniclum 563
Inula 666
Iodine 670
PAOB
Bronchitis (conrtf). Ipecacuanha Stt
Jamaica dogwood 7tt
Kaolin MO
Koumiss wj
Ledum w8
Lime-water 292
Unurn Sg
LIppla «2
Liquor potasse * ••• 766
Lobelia 608
Lobeltne sulphate 6^
Massage lOW
Monesia 633
Mullein JJB
Mustard ^1
Nlaoull-oil 6M
Nitric acid 126
Oil of sandal-wood fJO
Opium wf
Paraldehyde 701
Phosphoric add 1^
Physostlgma 7«
Polygonum 767
Potassium dicbromate 114, 764
cyanide 7OT
Saacylic add 187
Sangulnaria m7
Sangulnarlne 80|
Saw-palmetto 796
Senega ^
Serpentarla w
Spirit ol ether IW
Squill r 818
Strychnine »}
Styrone 861
Sulphurous acid 142
Syrups 7M
Terebene w7
Terpin hydrate »7
Thuja g5
Thymol WO
Trttlcum 906
OTurpentlne 8M
Bronchitis, Acute. Acacia emulsion 87
Ammonium carbonate 193
Antlpyrln H?
Apomorpbine *»
Atherosperma moschata 816
Clmlclfuga »1
Conlum 394
Dulcamara «0
Heroine 52
Kaolin ^
Ledum MJ
Linum 6W
Lippla 62
Liquorice «5
CEnothera 666
Onion "J
Potassium citrate TW
Sodium bensoate 838
Spirit of nitrous ether 1»
Turpentine 886
Bronchitis, Capillary. Ammonia carbon-
ate MS
Ammonium iodide 673
Camphor 308
Garlic IW
Ipecac 582
Oxalic acid 130
Serpentarla ^
Bronchitis, Chronic. Alantol 666
Ammoniac IJO
Apocodelne ' ^
Arsenic 87
Belladonna ^
Benxotc acid 262
Benioln 262
Betanaphthol 6fl
Bryonia ^
Buctau ^
Camphor 808
Catramine 882
Cerium oxalate 323
Chekan 826
1206
CLINICAL INDEX.
PAOB
Bronchitis, Chronic (eonrd). Chloralote.. 836
Chlorphenol a7
Cimiclfuga 851
CUmatotherapr 107C
CodllTer-oU 660
Creosote 408, 410
Codeine 691
Cubeb 481
DoTer's powder 690
Elecampane 666
BucalTptUB 464
Euphorbia pUnlUera ^ 468
Oalbanum 480
Oalllc acid U7
Garlic 178
Ortndella 600
Oualalln 418
Ourjun 608
HamamelU 606
Helenln 666
Heroine 608
HjrpophoBphltes 728
Hysteronlca 649
Iodine 678
Ipecacuanha 68S
Iron 478
Koumiss 694
Lead acetate 764
Le^um 688
Llppta 602
Myrtol 637
Oil of rue 670
Petroleum -. 708
Pilocarpus 786
Potassium chlorate 769
Iodide 676
PhysoBtlgma 732
Reeln 'J90
Sandal-vood oil 670
Saponin 779
Sawopalmetto 796
Senega S26
Squill 818
Sulphurated antimony 382
Sodium arsenate 840
bicarbonate 836
Solanlne 440
Storax 861
Strontium todlde 864
Sulphur 873
Sumbul 876
Syrup of hydrlodlc acid 118
Syrup of lactophosphate of lime 294
Tritlcum 906
Tully's powder 690
TuBsUago 909
Wild cherry 772
Bronchitis. Fetid. Salicylic acid 134
Bronchitis, Tuberculous. Oxalic acid 130
Broochocele. (See Chitre.)
Broncho-pneumonia. Ammonia 194
Ammonium iodide 674, 677
AnUpyrln 718
Digitalis 436
Paraldehyde 702
Potassium todlde 676
Quinine 359
Bronchorrhcea. Alum 386
Ammonium Iodide 678*
Apomorphlne 226
Belladonna 259
Chlorphenol 417
Copper sulphate 424
Creosote 411
Cubeb 421
Iodoform 659
lodol 661
Myrrh 637
Oolum 691
Ptmplnella 789
Quinine 861
Saw-palmetto 796
Terebene 887
Turpentine 884
pxom
Broncborrcea (eont'di, Ura vnS 91*
Zinc salphata M6
Bruise. Alcohol lU
Ammonia IM
Calcium m
Calendula St
Capsicum SU
Crocus IW
Hamamella 606
Lapt» 6M
Liniment of lead subaoetata 7SX
Naphthalene 60
Opium «8«
Origanum 8W
Planum 7«T
Solomon's seal 757
Symphytum 878
Buboes. Arlstol BC
Bismuth ben«oate >86
oxylodlde 266
Europhen 680
Heat Ul«
Iodine 879
Iodoform 668
Mercury &24
Phytolacca 731
Pyoktanin €18
SilTer nitrate ta
Buccal Inflammations. Alphanaphtbol ... 864
Bunions. Copper oleate 138
Bums. Absorbent cotton 6V7
Acacia tX
Aceumilde 89
Adeps ]an« 158
Aluminum oleate 137
Bismuth 868
BUbgallate 271
Boric acid 188
Calendula 388
Carbolic acid 187
Carbollxed oil 108
Cherry-laurel sn
Coca 378
Collodion 389
Creblln 494
Creosote 668
Eleml 40
Eupborin tf9
Europhen 689
Orlnoelia 488
Hamamells 666
Icbthyol 6BI
Jamaica dogwood 748
Lanolin Ifi3
Lard US
Laurel 687
Lead carbonate 7SS
Lime-water 29i
Llnum 861
Loretln 868
Mercurol 638
Nut-gall 481
Orthoform 8K
Phenocoll 718
Phenol 107
Phytolacca 733
Picric acid 132
Plnua Canadensis 789
Plantain 747
Rhus toxicodendron 798
Rose-water ointment 79
Salol 868
SilTer .• Sa
Sodium bicarbonate 836
SoEoIodol 8<T
Starch 36t
Tannic acid 148
Tbloform 171
Thiol 86S
Thlophen dl-lodlde 9H
Thymol 988
Tumenol 988
Turpentine 886
Wheat-flour 888
PAOB
Buma \cont'd). White-lead paint 76»
Zinc oxide J22
t Calculus. CannablB iDdIca S07
CoIllDsonlB Si8
Bihor 180
Kubinna Imbiicala ...-.4.. 46t
Hydrangea 613
LIthtum 406
Manzanlta 6«!l
Nitric acid 126
Pot&aaium hydroxide T6B
blcurboDHte T66
Piperazlu 7*1
Sodium bicarboDate 6S7
StremDnium S^Z
Ura ural 910
C»rlK>u- Dioxide PoIsodIde- Oxygen 1027
Traiisruslou o( blood 1145
Carbuncle. Asaprol 236, 649
Belladonoa 2S6
Carbolic add .,...107, Ul
Echinacea *........ 441
Burophpn 461
Hamamella SOS
Hydrogen dioxide 249
Iodine 671
lodol 6Cl
Menthol 6S7
Pamcblorphenol , 112
Phonoi 107, 111
PotBHsiuni chlorate '69
Pyoklaoln 630
Sliver oleate 129
Thiol 693
Carcinoma. Aronlte 160
Alcohol Injectloni 177
Alvrlox 18t
ArlBtol 897
AraeDic bromide 96. 98
Araenum oleato 127
Belladonna 366, 260
Betanaphthol , 610
Cancroln 217
Cannnbia IndICA fln?
Cantharia 311
C«u«t)r potash 766
Ch*'rry-Jnurel 697
Chloriilnmlde SiW
Chlorororm Ml
Chromic trloxlde 113
Chelldonlum 326
Chlnn turpentine 896
Cinnamon 867
Cocaine 375
CondurauKO 883
CoDlum 396, 896
Creolln 404
Electricity 971
Eryviprlaa aerum 218
Gumphon iM
Hydrastis , 640
Hydrogen dioxide 260
Iodln*> trichloride ...* ,,.. 679
Iodoform ».,. 658
Jamaica dogwood 743
Kenr 691
Koumlis .t i.^,. 694
LiKht ....1121
Lysol „ 746 ■
Magnesia ,. ,. 613
Mercury , 628. 637
Methylene*blae 629
Naphthalene ...< i. .(.>,. 634
Opium «.....•«. .•!.«« 891
Orthoform , 696
Pancreatln > *.<..f 313
Papain 700
Pepsin 706
Petrolenm 708
Phpno)»oll .. ...•-, 7'6
Phytolacca 733
Potnflnlum bntmlde 274
rhlnrate 768
prrmangODate 618
Carcluuma (tytrit'd). Prota.r|
Rectal alimootatloa . . .-t
Reaorcin «i
Salicylic acid 1
Sangulnaiia ••
Sodium chlorate «$
cthylate \
aalicylaio )
Stramonium . .: »
Sulphuric acid *•
Suprarenal extract t
Teiticulor fluid «■
Thuja ]
Trypsin ^
Ztnc »i
Carcinoma. Oaatrlc. Arseote,
Bismuth salicylate •
Carbon dtsulpblde •■
Cerium oxalate «4
Hydrocyanic acid
Lime-water i
Protargol i
BDlanlne i
Carcinoma, Uterine. Bromla4
Calcium carbide ^
Hemostatic cotton ......
Icbthyol ,|
Iron ^
Salicylic acid i
Tannic acid i
Zinc chloride i
Cardiatgia. Massage ■
Carles. Calcium phosphate >
Hydrochloric acid i
Hydrogen dioxide «
Iodoform I
Lactic acid i
Nitric acid ■
Sulphuric add «
Thloslnamln ■
Caries of the Teeth. Carboll^
Salicylic add ,
Caruncles. Vretbral. Cocaine
Catarrh. Cocaine j
Conlum ..,i
Ethyl lodldo !
Buphraaia , |
FrankenlB ,,4
Glyceryl trinltraa J
Hops »,J
Manaca ;..., S
Marrublum i
Pimplnclla i
Polygonum ,.^
Resorcln ,.m|
Salipyrlne ,
Tnnulc acid ,
Catarrh, Acute. Amxnoalum |
Pulsatilla ,
QulnJn<> .....,'
Catarrh, Brnncho-pulmonary.i
carbonate ..j
Ammonium chloride ....a
Anise «4
Balsam of Peru |
Cheken ie
Mustard ..,..,, ^
rotarrh, Cerrlcal. Sliver nitl
Catarrh, Chronic. DrarontlO]
Cstarrh. Duodenal. Cascara
Iris i
Salol I
Sangulnarla ,^
Catarrh, Intestinal. (See Bn
Caurrh. Nasal. Alphanaphtlv
Alum
Baptlala 2
Beta naphtbol 1
Buchu . i
Camphoric «cfd
Camphor-menihol ... ...
Cascara ainarga
Cocaine
Ciibeh
I 1208 ^^"
H
H Catarrh, Nasal {cont'd). Ergot
^H HnmnTnrlls
■
llCAh
aoa
447
606
640
249
668
621
621
6S6
666
108
360
712
807
790
229
143
777
810
346
847
633
778
746
888
900
800
837
894
194
236
666
610
661
739
M7
. 271
. e03
249
. 606
. 039
. 800
. 881
690
1145
307
078
. 473
. 817
. 389
. 443
. 278
. 430
.1117
. 48X
. 689
. 886
. 836
. 850
. 860
. 661
.561
. 148
. 201
. 876
. 89
. 188
. 887
. 010
:S
. 371
. 433
. 468
. 400
. 860
. 008
. 848
. 039
Chancre (cont'd), Resorcio ...*
Sulphuric acid ••»
PAOB
782
140
^B HydrastiDlne bydrocfalorlde
^H Hydrogen dioxide
^H loflrtfnrni
Chancroid AcetanlUde
^
Alumnol . ■■•■.••*
168 i
BetanaDbthoI
(t40
^M Hango
^m MangosiADA
^1 M^nth"!
Blsmutn benzoat£ .
204
oxvlodide
268
subgallate
JTI
^H rKnnthtirn
Bromine ... ..........
274
^H PhATHOl
Compound zinc stoarate
$60
^H r^Mlnln'*
Copper sulphate
ni -Iodoform .....*..
123
661 1
^H ""TTyr'Tn*
^^M Sn ti^iiinnrln
KUcalVDtUB . . . ...
....... 463
^M KftlprLpnlfy^fifffY ^^,_
Kurophen
HsmaniellB
460
5U6 '
^B SilvT nilrntf*
^H Tfifinir nflil
Heat
IIU
^H whi^n./^p^ f.nrK
]{>'drasttB .,
oW
^^^v XoBiboxylum
^^^H Catarrh of Atr-pnasagea. Balsam of Peru
^^^V Balaam of Tolu
^^^^^ MnrniMiim
lodoforia
558
Liquid air
iiis
609
Mercury .....••
...... i2i
PusotlMa
NapbtbaleDe
Pyoktauln
«9
....... 1130
Tar- water
Terebcno
QulnlDC
J57 !
Tbvraol
Rcsorolo
.» 783
Catarrh of Blle-ducta. CbclldODium
Salol
Silver nitrate
....... 328
Chapped Hands. Benzoin
Camphor •
301
Catarrh of Lacrymal Duct. Sodium bicar-
bonate
Cold cream
324
Tbiopbeu dl-todldc
Catarrb of Stomach and BoveU. Am
moalum chloride
(Spo Gastro-enteritis,)
Caurrh. Pulraonary. ABclcplaa
Oil of pin** .. ..
Glycerin ,,
492
Lianolln
151
Ijlniment of lead subacetate ...
Sulphuric acid
:'a4
uo
Uguentum aquse rosie o...
7M
VltPllUfl
91$ '
Caurrh, Uterine. Hydraatlnlne hydro
chloride
Irhthyol
Chapped Lipa. Benxoln ■
zsz
Cold Cream
.... .324
Glycerin
193
PlnuB CanadenalB
Sodium sozolodol
CaUrrh, Vaginal. Blamuth BUbgallate. ..
Catarrh, Vealcal. (See Cy$UUa.}
Cavities. Formalin
Hydrogen dloxtdo
Lanolin
162
Mercury .,, , ,.,,
522
Rose
....... T9I
Uguentum aQUs rostt
TW
Vitellua
»18
Chilblains. Alum
186
Lorptln
Aluminum oleatc *•.».
127
Naphthalene ,.,.,,.... , ...
Bpnxoln ....■■..■
'SZ
Salol .
Painphor
m\
Styrone
Capsicum •.«.....
112
Cellulitis. K&olln cataplasm
Creosote
m
Cerebral AfTectlona. Arterlotomy
Cannabis Indica ..,,...
Croton-oU ,
Digitalis ...,...,
433
Electricity .••...<
977
Eleml ,
4tt
Iron
Ichthyol
&61
Scamcnony
Iodine ■....*....
,„-... Wt
Cerebral Congestion. Colocynth
Elatezin
Iodized collodion .••.....•••..*•
389
Mercurv ,...,.....
524
Potasstum bromide
Nitric acid
125
Cerebral Gxhnuatlon Damiana ....
Nut-gall
480
Corebrltle. Cold applications
Oil of cnjuput ,
657
Cerumen, to Soften. Glycerin
Papain
Petroleum
706
Rhus toxlcodf^ndron
793
Sodium bicarbonate
borate
Sulphuric ' acid
140
Thiol
Turpentine
888
S84
Cervicitis. Compound xinc stearate
Buphorin
Childbirth. (See ParturiHrw.)
Chin, to Abort a. Pilocarpine
Chills. (See Fever, Matohnt.)
Chloasma. Iodine
788
S73
Ichthyol
lodol
Tannic add ,
Chafing. Starch
Lemon- Juico
., mtt
Chat avion. Cocaine
Veratrlne
918
Chancre. Acotanlllde
Alumnol
Chlorosis. Aloes
Arsenic
182
86
Arlstol
Barium chloride
Cetrarln «
::::::: IS
BetansDhthoI ................... ......
Bismuth bensoato ■•.•.•...*<•••*'•••*•.
Chalybeate waters
1IW7
oxy iodide
Cilmatotherapy ...4..
1070
Colllnsonla -
388
Copper sulphate
Colocynth .«**•. ..•....•
, 391
Eucalyptus
Europhen
Hvdroffen dioxide
CODPer ..•*.a***a>»4*.
ISO
Diet
1082
Ferratln
^
Losophan
Mercury aoxolodol
Naphthalene
Quarana .,..,
Hflemosallol
«. ■
Hsmol ..■•*
J
Chlorosis (coifl'tf). IroD
KeOr
. Hagoesla
MftnR&n^sf
CLl^IOAT.
PAOB
408
e>i
eis
,,, 619
INDEX. ^^" 1209
pAoa
Cholera Morbus {cont'd). Ipecacuanha.... 583
Lead
764
Oil of cajupui .. ....■■.■
lU
MaffiiBfra
1007
Optum .. .....•*.«.
Ml
Kiiv Tomlrft ....
665
uuiniQc ..«..
, . SH
Orexlne
691
Suipbamlnol • .. «■
;;:;::.; SS
Oxy geo «!••.
1027
Tribrompbenol bismuth .......
no
OzoDlicd WKtffr
.. .... 1033
Xanthoxvlum
no
PepstD
70fi
Cholera, Sporadic. Enteroclyala ...
;;;;:.::i3i
Pepto-mangan
175
Xeroform
Chordce. Camphor
SM
301
PotaBalum cbloratQ
768
786
807
Static eleclrlcUy
,...,.. 976
Cantbarli
811
' Sulphur
873
Colchlcum
Lupulln .*....>••
887
5U
Zlocobamol
...,..,*...... 476
Cholelltblaals Salol
giMJ
Monobromated camobor .......
301
<;bolBra, Astatic. Alcobol ..
176
Potassium bromide
Chorea. Acetantllde
an
13
Ammoulac
, 190
Amraonluoi chloride
..„. 194
Amber
sot
AntlcbolerlD
217
Ammonlated copper
4»
Atropine
2G9
Antlpyrln
719
Caff«toe
288
, Stt
Camphor
301
Araenlc
....30. »
Chloral
331
Asaf etida
.....r: sS
Chloroform ,
342
DromoKallol ..••**.*
881
Copper nraentto
42,-,
Calcium bromlda ..........•■■•
,. 186
sulphate
424
chloride
8M
BDliTOClTSls
1151
C&mx)hortc acid
.... .. .. 80ff
Heat .'!..::::::::::;::
1113
CnnnablB Indlca
307
HydroKt'O dioxide
Hypodt-rtnoclyala
160
1160
CtTium oxniatc
8tt
817
lojectloo of milk
1149
Chloral
334
Dormal salt aolulion .
iDtraYenoua laJccUoa of
solution
U50
normal aalt
B9, 1148
Cblnralamlde
880
Cbioruform
840
860
, Ipecacuaaha
683
Cocaine
3T7
Kola
593
Codl|yer-oil
600
Lead acctato ,.
753
Cold
1117
Naphthalene
689
douche
1001
Nitroglycerin
489
Collinsonla •••»..••
888
Nux vomica ,
661
Contum 1.
830
Oil of cajuput
65g
Oracontlum .....••.■•••*•.•***■.
438
Opium
691
Electricity
368
■Oxygen
. looa
Ether ..■••
160
Paracotolne
40^
Ethrl bromide
Petroleum
709
BurnlYDtol *..b. «.
464
Qutntno .
Via
Kxiiiela .......y. k •■
468
Salol
g03
Ferrous bromide
Gaultherla
Gelsemlum *>. •■
;;.'";;; 488
486
Salophea
004
Sodium bicarbonate
, gM
borate
lOij
Hydrotherapy
1008
chloride ,,..,
..,,, g4i
Hyoscyamus ■
616
Spermin hydrochloride ...
.*•...... 9D6
Irpn
471
Strychnine
AM
Jamaica doawood ...•
7a
Styrone
Ml
LiacLonhenin .................
713
Sulphamlno]
, 882
Massage
Metallotberapy
1010
ml
Sulphuric acid ,,,.,
140
Tannic add
,,,,,, 148
HliUetoe
313
Cholera Infantum. Alcobol .
Bromol
,,,. 176
Monobromated camphor
Musk
301
684
^ .. . . sai
CalTelne
jftg
Opium
on
Copper sulphate
424
Phenoroll
.:;;i.:im
Goto .,,
40^
PbyBontlgma
7*1
Creoltn ,
Ecblnacpa
404
, 441
Pic ro toxin ................'
m
Quinine
, 360
EutiTuclyals
...1161
Salicylic acid
U8
Koumiaa
.,, 694
Scutellaria
... 888
Mercury
B]fi
Sliver
Bl
1 Orpbol
tB6
830
1 Potaealum bromide
Salol
178
, . §91
881
Static electricity
surer
Ml
Stramonium
8B8
2lno phenolaulphonate ...
Cholera morbus. Caffeine ....
m
188
Strontium bromlda ............
868
Strychnine
Sulphonal
Tartar emetic •
'"!"!! 868
Cedron
su
i Chloral
St4
1 Chloroform
fU
Tt'Btlcular fluid ....
863
Cocaine ..
3r76
m
Copper araenlte
415
.::;:::;J5
'Rcbfoact^a .....*•
,. 441
088
Hydrojfo dioxide
160
986
loKluvIn
KM
NUlphOt«
valerianate ...•••
....384. 388
Ml
lojocUona of normal salt w>tuUoa....!lui
1210
CLINICAL INDBX.
PJLQB
Chorioretinitis. Mercury 630
GhoroidltlB. Mercury &20
Turpentine 886
Chylurla. Filarloui. Tbymol 900
Cicatrices. Blectrtclty Ml
Haswige 100>
Cicatricial Oontracturea. Ttaloalnamln ... 8M
Cirrhosis of Kidney. Qold 243
Cirrhosis of Liver. Ammonium chloride.. IM
Ammonium iodide 677
Arsenic 98
Soldo 272
Chloralamlde 330
Convallarla majalls 306
Dioscorea TlUosa 437
Gold and sodium chloride 248
Iodoform 560
Mercury 626
Nltrohydrochlorlc add 126
Potassium bltartrate 766
Iodide 678
Sodium glycocholate 843
SUlllnsIa 861
Strontium Iodide 864
Climacteric Disturbances of Health. ClU
matotherapy 1076
Coal-Oas Poisoning. Oxygen 1026
Colalgla. He&t 1113
Lavender 698
Myrlstlca 636
Rhubarb 789
Cold Hands and Feet. Strychnine 656
Cold, to Abort a. Ammonium Carbonate 193
Acetphenetldin 712
Dover's powder 698
Oalangal 479
Gelsemlum 486
Llndera-bark 600
Mustard 831
Pilocarpine 788
Colds. Ascleplas 236
Bryonia 282
Colllnsonla 388
Chamomile 220
Colic. Acetone 90
Alcohol 176
Aletrls 178
Alum • 187
Anise 219
Asafetlda 236
Belladonna 257
Chamomile 220
GoUinsonia 388
Coriander 401
Goumartn 438
Crocus 420
Din-oll 802
Bther 160
Fennel 477
Oinger-tea 826
Hedeoma 606
Hoffman's anodyne 161
Hyoscyamus 646
lUlclum 552
Juniper 689
Methylal 628
Mustard 831
Myristica 635
Oil of cajuput 657
Opium 688
Peppermint 626
Plcrotoxln 381
Potassium bromide 276
Rhubarb 789
SoUdago 845
Splce-plaster 366
Static electricity 974
Turpentine 884
Xanthoxylum 920
Colic, Biliary. Amyl valerianate 200
Antipyrln 719
Cannabis Indlca 307
Colllnsonla a88
Oelsemlum 4S»
Colic, Biliary {camt'di. Olycvrte tfK
ileat 1U4
OUve-oil •*
Opium fl^
Potassium lodMo O^
Stramonium d
Sulphur ttt-
Colic, lufantlla. Chenopodlum V
Chamomile tt^
Dili, oil of SM
Colic. Lead. Alum UI
Antipyrln t»
Atropine and potassium iodide 262
Belladonna XT
Croton-^11 «3*
Magnesia, sulphate of OZ
Ollve-oll Wl
Opium ••
Strychnine 6S4. flft
Vinegar H
CoUCp Renal. Belladonna SI
Colllnsonla a^
Cannabis Indlca SR
Carraway Xn
Cloves SS-
Cocculus IB
Corn-slJk Cli
Blectrtclty nt
Bxalgln 46
Heat UM
. Hydrangea SU
Opium 00
Piperasln 741
Colic. Uterine. Castor 9»
Jamaica dogwood 748
Santonin tl^
Viburnum •it-
Colitis. CreoUn 6M
Cubeb 422
Olive-otl enemata 6M
Silver nitrate 2»
Collapse. Heat 1U4
Sodium chloride Ml
Warburg's tincture 30
Color-blindness. Santonin tn^
Caffeine 2D
Coma. Uraemic. Croton-oll fS
Coma. Diabetic. Intravenous aaltne laice-
llon m
Morphine flt
Valerian, oil of «2
Comedones. Hydrogen dioxide 20
Lanolin IS*
Tar 7«
Zinc oleate 121^
Condylomata. Arsenum oleate 127
Chromic trloxlde lis
Europhen <•
Mercury SXl. SM
Savlne 7W
TbujB •*
Zinc chloride 9B
Conjunctivitis. Abnis »
Alum I>£
Alumlnated copper 62»
Antipyrln ^
Barberry >•
Betanaptithol 6>^
Bismuth 2*
Boric acid tm
Boroglyceride •••
Cocaine ^3^
Codliver-oil «M
Copper €■
Cydonlum 610
Brgotln 661
Europhen 40
Formalin flK
Glycertte of bismuth 4K
Hydrastlnlne hydrochloride M0
Hydrogen dioxide M
Iodoform S»
lodol S«
Lead-water W*
CoDJUDcilvitl* ioonVO). LjLaolln
Lithium
. Mercury
Opium
ISxCAL
PAOK
la
804
.&», &S8
689
INDEX.
Constipation {cont'd)
Sodium glycochclate
lulpbate
sulpbovlnate
Stattc electricity
12111
PAO«
.... 848
.... 840
.... 141
.... 980
Petroleum
708
PheDoialyl
Protargol .. ..•■•••■••«■•«■•.•■.••..
m
, . . . 770
Stlllingia
.... 8S1
Sulphur
.... 871
PyoklanlD
631
Sulphuric aeld
Thiol
.... MO
Resorclo
R«tinol
782
780
Turpentine
.... HB
Sangulnarlne nitrate
Sodium soiolodol
tetraborate
807
817
101
Wild indigo
.... M7
Xaothoxylum
Yeast
Consumption. (See TuberculotU.)
Contracture*. Electricity
Contusions. Arnica
Cold
Load
.... 920
.... 464
.... 977
.... m
....lUT
.... 768
Thtoforni
272
Tbiophen dUlodlde
ZIdc acetate
BUlphate
Consttpatloo. Alkaline waters
Aloes
Alphanopbtbol
m ArecoUo
8M
92S
922
1068
181
646
227
Convalescence. Absinthium
Alcohol
Brain and spinal extracts
Calumba
CflBL-arlUu
Cinchona
Coca
CodilTer-oll ,
.... 86
.... 175
.... 906
.... 897
.... 819
.... 8SS
.... 871
.... 660
1 Aaafetlda
236
1 n&rbtfrry ,
266
^^^ Tl^t
247
^^^^ tlnllHl4»>lHH
258
^■~ BeUnaphtboI
Campbor
Cascara sagrada
Castor-oil
Cathartic acid
Cbloral-caflelne
CblraU
642
308
786
667
817
SIS
229
Colllasonla ,
. , 888
Com us . ..........*..............•..
.... 401
Formates ,..
.... Ui
Gentian .....•,.
681
Glycerin ....*..*.»4«*fc»»<
.... 4M
Glyceropbospbatea
Kola ,,,..., ,
.... ni
..'- 6I>
Cbrysarobln
Cltrullin
349
392
KoumlH , .. ,, ,i,,,i ,1 iL .L.ij.
.... BM
CodUver-oU
660
Malt
Potassium chlorate
Ptelea
Quassia
Quinine
Salep
Convulsions. AUyl-trlbroiXLlde
.... 617
.... 76S
.... 772
.... 777
.... 867
.... 788
.... 179
Coffee
Colooynlh
Compound cathartic pill
i Compound liquorice powder
384
391
298
496
Creosote
672
Croton-oll
Curcas
672
427
Amber '.
Apomorphlne
Asafftlda
BIood-l»«ttlng ,
.... 861
.... 885
.... 186
Diet
Blectrlclty
Enpmnta
Epsom salt
1094
996
1161
.... 613
Bromides
Calcium sulphite
Cftstor
Chloral hydrate
!!!! 880
.... au
^^ Eunonymua
^H Bxodln
456
463
601
^ Fig
Formates
477
H6
Chloroform
.... 644
Cimiclfuga .......4,.,.,....
.... SSI
Frangula
478
Cold water ..„,.
Conlum
....1116
.... 896
Gamboge
Glycerin
Gualac
298
.492, 4M
.601. S02
546
Copper sulphate
Gelsemlum ..,
Hyoacyamua
.Tnmaips dogwood
.... 486
.... 488
.... 546
.... 7a
Hyoscyamus
Hypnotism
1107
Jalap
Jerubeba
586
g4fi
Lobelia
.... Ml
Musk
.... 684
Juglans ,
. . 6t8
Oil of rue - ,i
.... 661
X>axattve pllla
..... 63
PhenocoU -.-......,
.... 714
t«eptandra ,
599
Physoatlgma ,
.... 711
LInum
601
Potassium bromide
PuRntilla
::;:Si
.... m
LobHia
608
Magnesia ,,
612
Solanum Caroltncae
.... 644
Manna ;
... . 621
Valerian -
.... 9U
Massage ..i , ... ii.,j. i
. . . 1006
Vpratrnm
. .. 614
Mercury
Muf>carlne
Nux vomica
614
716
668
Cornea. Abscess of. Thtopbes dl-lodtde. . 894
Cornea. Dfsf^Asps of. Cocaine I7t
Cornea, Infiltrations of. Pilocarpine 786
Cornea, Opacities of. Pambotano 697
Tbloslnnmln 894
Ollvp-oll
661
Onion
..... 179
Opium
693
Cornea, Wound of. Pbysostlgmlne ...
Reeorctn
.... 730
.... 788
^H nn-nsii
..*.. 464
^^^ PMfl^f..t(«
698
Cornral nbrasions. Fluorescein
.... 4T7
^^P PbTsoatlgma
^^^ Podophyllum
731
7M
Fluorescln
Corneal Suppuration. Chlorine
.... 477
.... 646
f PoUdslum and sodium lartraCe.SS,
1 Rbamnua catbartlcua
146. 7M
7g5
Si
Calomel • • ••■••
:::iS»
I Rhubarb
7t9
Caator-oU ................a..
.... §tf
1 fieammony
L SeldlltR powder
817
840
Cocaine
Blectrlclty
Holocalne ■>.*..
Hydrogen dioxide «-■•■«
.... S4»
1^^^^ Renna ■•■■
.,«. 826
^m Soap
...I. SU
1213
CLINICAL IXDEX.
PXOB
Corneal Ulcer {cont'd). Iodine 572
lodotorni 568
Pbysostigmiue 730
PyokUDlQ 630
Salol 801
TblopbeD di-todtde 894
€oruB. Arsenum oleate 127
Caahew-nut 202
CbelldoDlum 326
Collodion 3M
Cuppur oleate 128
Potassium dichromato 764
Sallcrllc add 134
8edum acre 823
Coryza. Acacia 87
Aconite « ISO
Adrenalin 210
Ammonium Iodide 573
Amyl nitrite 200
Arlatol 8»8
Atropine 259
Camphor 301
Camphoric acid 304
Carbolic acid UO
Coctllnna 382. 383
Compound eIdc stearat« SSO
Ffrrler's snuff 87
GetW'niium 485
Glycerin m
Ichthyol 661
Iodine 573
Massage 10O6
Matricaria 623
Phenol 110
Potassium iodide 673
Sallcln 1 7M
Saw- palmetto 796
Sodium soiolodcl 847
Stearates 860
Cougb. Acetanllide 88
Acedo ether .',... 162
Acetone , • 90
Amyleoe hrdraa 201
An**monln .,.....,•. 772
Antlpyrin 719
Antmpasmin 419
Apomorphlne 226
Belladonna 258
Cannabis Indica 307
Cerium oxalate 323
Cbamomile 320
Cbekan 326
Chloroform 343
Coclllana 383
Codeine , 883. 691
Cotllnsonla : 8S8
Conlum 394
Dionin 487
BschscbolUla 461
Ethyl Iodide 679
OalaogB 479
Oclsemlum 486
Glycerin 492
Grindella 600
Heroine 600
Hydrobromlc add U8. 119
Hydrocyanic acid IZ2
HyoacyamuB 641
Hystcronlca , 649
Ipecacuanha .' 682
Jamaica dogwood 743
I^ctucarlum 606
Llppia ODS
Lycopus no
Marrublum 622
Mescal buttons .' 2(^
Oil of sandal-wood 670
Opium 689, 691
Pilocarpus 786
Potnsslum bromide 277
Iodide 678
Resin 780
Uumex 796
Sanffulnartne .*.. 808
Cough imnfd). Saponaria TSt
Sassafras SM
Saw-palmetto TIC
Stramonium HI
Tar 741
Tcrebeno SB
Terplo bydrate 881
Teucrlum 818
Tusalla^o M9
Valerian ttt
Wild cherry TO
Zinc valerianate 9tt
Cramps. Camphor 302
Chloral bydrate tU
Codeine 818
Cramps of pregnancy. Chloral ..,, SS
Copper sulphate 46
Viburnum opulus ....91f
Cretinism. Potassium Iodide 617
Croup. Alum 188
Apocodelne 9H
Apomorpbine ,, Sft
Cfaloroform 341
Copper sulphate 4M
Hydrogen dioxide 849
Ipecacuanha 881
Lactic acid 128
Lime-water 218
Massage 1808
Mercurr 6ST
Mustard 831
Oxygen ION
Papain 418
Pepsin Itt
Petroleum 708
Sassafras 818
Sangul aaria 801
Senega 886
Spice plaster * 8l|
Squill 8U
Vinegar 91
Croup. Dtphtberltlo. Alum ,....188
Antitoxin ZU
Zinc sulphate 191
(See lUphtberia.)
Croup. Spasmodic. Aconite 160
Apomorpbine 126
Calcium, iodized 296
Chloral 818
Chloroform 841
Coclllana 388
Colllnsonia 888
Quebracho 140
Gurvsture. Lateral, of Spine. Static elec-
tricity 977
Cyanosis. Oxygen 1028
Quebracho Ml
Cystlcercua Disease. Male fern 888
Mercury 688
Cystitis. Alum 116
Ammonium benxoate 181
chloride 18S
Amyl nitrite 199
Antipyrine 731
Arbutin .444, 9»
Benxolc acid IB
Betanaphthot MS
Soldo 871
Bromogallol 881 j
Bucbu HI
Camphor 801
Camphoric acid 964
CanthsrlB 810
Capsicum SU
Cocaine JR
Cotllnsonla .* 888
Copaiba 8M
Coro-stlk W
Comutio • Hi
CreoUn ,4m
Cubeb «l
Bplgiea •"
Ergotln
Eucalyptus
PAOB
CysilUs (cont'd). FablBoa ImbiicaU 463
Gallic acid Il7
GrtDdeUa 500
Qualacol 41S
HamMnellB 605
Hexamethyleaamloa 6<W
Hydraatli 541
Hydrogen dioxide * ISO
UyaleroDlca 549
Icbtbyol ...«.« 5S1
Iodoform 5&9
Iron 47»
Juniper 588
KavB-kaTa 681
Lactic actd IM
LtiDuni 60t
Liquor potasse 765
Lithium bensoftte 606
Lyaol 746
ManxanlU 621
Matico 68S
Merrurol 638
Mercury 524
Mullein 91fi
Myrrh 637
Myrtol 637
Oil of sandal-wood 670
Opium 687
Oxalic actd 130
Oxone-water ...........1038
Pareira 703
Pbenoealyl 112
Piperazin 743
Potassium bicarbonate 764
silicate 829
PyoktanlD 630
Quinine 857
Resorcln 784
Hetlnol 781
Rhus aromatlca 790
Saccharin M6
Sage 805
Salol 808, 806
Salopben 804
Sodium bicarbonate 836
borate 886
fluoride 843
Styracol 416
Styrone 860
Sulphamtool 863
Sulphur 878
Tannopln 880
Terebene 886, 887
Thymol 800
Tritlcum 806
Turpentine 886
Urotropln 508
Ura ural 910
Dacryocyatltla. Aotlpyiio 721
Chlorine S46
Hydrogen dloxl de 249
Pyoktanin 680
Thiophen dl-Iodlde 884
Dandrviff. Ammonia mixture 182
Borax 103
Brnot 448
Qullldja 779
Tannic acid 144
(8ee Srborrhtta.)
Deafnesi, Labyrlntblne. Pilocarpine 786
Debility. Bebcrlne sulpbate 645
Boldo 373
Brain -extract • 906
Calcium phosphate 283
Calunoba 297
CantbariB 811
Capsicum 812
Chalybeate waters 1067
Cinchona 368
Coca .«.. 377
Corydslla 401
Ether 168
Fcrroaomatose 84S
rxom
Debility {cont'd), Hffimorfemim 47^
Iron 475
albuminate 47S
Lactosomatose 845
Light 1123
Malt 617
Manganese , 618
Nectandra-bark 646
On>xloe 684
Pepto-mangao 47S
Phosphorus 728
Quinine 358
SyrupuB calcll lactophospbatla 728
Wild cherry 772
Delirium. AcetpbenetldlQ 713
Apomorptalne 3M
Cannabis Indlca 307
Cold appUcatloua 1117
Darkness 1U4
Mescal buttons 80ft
FbenacellD 712
Valerian 913
Delirium Tremens. Ammonium acetate.. 185
Ammonium carbonate 194
Amylene hydras •• 301
Apomorpblnc 286
Arnica » 2S4
Bromoform 380 ,
Camphor ••• SOft
Cannabis Indlca 806
Capsicum »*....•. 816
Chloral hydrate 388
Clinlt.-iruRa 8S1
Cold batti 1646
Coulum 4 .•• 8M
Digitalis 4Si
Ergot 4S0
Hops 6U
HyoscyamuB 54f
Ippcacuanba 688
Jamaica dogwood 74S
Methylal 688
Monobromated camphor 803
Musk 684
MyrlBtIca 686 ■
Kux vomica 66( ■
Paraldehyde 76t ■
Potassium bromide S3.H
Quinine '^fl
Scutellaria « ^'^ V
Somnal 84C
Sulpbonal 888
Sumbul ...» Sn
Tartar emetic ....i tSB a
Delusions. Hypnotism U08 ■
Dementia. Cannabis Indlca 80^ V
Cbloralamlde 880
Dubolslne 488
Hyoacyamlne M7
Dermatalgla. Coca ...•* 874
Menthol 686
Dermatitis. Aluminum oleate 117
Bismuth 188
Carbolic acid 107
Coca 876
Oelsemlum 66S
Lanolin :...... 1G3
Laurel BIT
Lead TBt
Mercury Ot
Phenol 107
SoKolodol 847
Dermatitis Herpetiformis. Arsenic 08
Dermatoses. Ichthalbin .■•.. CBl
Despondency. Caffeine tt7
Gold MS
Diabetes Insipidus. Alum 18T
Antlpyrlne 780
Calcium coaolata 886
Codeine S8t
Ergot 440
aalllc add 117
Nitric add Wt
Oglum 681 .
1214
CLIKIOAL INDEX.
PAOB
DUbetes InsiplduB iwnVdi* Pilocarpus... 736
Rhus aromatlca 790
Strychnine 6M
Valerian 91t
Diabetes MeUltus. Alcohol 177
Almond-bread IM
Alum 187
Ammonia IM
Antinerrla S2S
Antlpyrln .720
Arsenic 98. 99
Benzosulpblnldum 490
Bllbernr 910
Calcium 295
eoBolate 296
Cannabis Indtca 307
Cbloralamide 330
Codeine 883. 691
CodllTer-oU 660
Creosote 410
Diet 1089
Dlabetln 462, 798
Dulcin 713
Ergot 449
Bxalfin 461
Oold and sodium chloride 844
Oualacol 414
Hemonllol 476
Hsemoi 476
Hypodermocljrsls 1150
Inulln-bread 665
Iodoform 660
lodol 582
Iron 471
Jambol 587
Kola 693
Koumiss 694
Lactic acid 124
Liquor pancreattcus 698
Lithium 606
MyrUl 637
Naphthalene 639
Nitric acid 126
Opium 691
Oxygen 1026
Ozone- water 1033
pRnoreatln 211
Pepsin 705
Phosphoric acid 181
Phosphorus 726
Pilocarpine 737
Piperasln 741
Potassium bromide 278
Rhus aromattca 790
Saccharin 266, 490
Salicylic acid 136
Serum, artificial 60
Salol 800
Sodium bicarbonate 837
Sozolodol 847
Sulphonal 866
Thymol 900
Trlbromphenol bismuth ; 920
Uva ursl 910
Valerian 912
Xeroform 920
Yeast ■ 464
Diarrhoea. Acetone 90
Alrol 168
Alcohol 176
Alnus 180
Aloes 183
Alum 188
Antlpyrlne 720
Ariatol 898
Arsenic 97
Asclpplas 236
Astringent enemata 1151
Belladonna 259
Berberlne 400
Betanapbthol 848
Bismuth 270
lorotln 609
salicylate y 268
Dtarriiosa IcmWdi
Blamutb subgallata 271
tannata '^^
Blackbsnr :>•
Boric actd lOJ
Bursa pastorls TH
Caffeine £A
Calcium carbonats SS3
chloride >4
phosphate 2tX TZi
sallcrUte 2M. S*\
Calumba »T
Camphor mixture Ut, ^r.
Cannabis lodlca ^^
Carbolic acid Uf
Casca SIS
Castor-oil 66T
Catechu Ti\
Cedron zzz
Cerium oxalate 2^^
Chalk 32
mixture m. 2»8. vt
Chestnut 3j0
Chloroform 3^
Cinchona "^f
Cinnamon 3K
Copper arsenlte 42S
sulphate 4J3
Goto ♦£
Creolin *'M
Creosote vT
Cusparia CT
DigiUlls 4-3
Emetine 1*2
Enemata lis:
Eucalypteol i«
Oaultberia 4<c
Oalls 4*1
Oamblr Z:'
Oeranlum i<
Oeum ♦*
Ginger S-J^
Quarana '>'.
Hamamells '<*^
Heienin j '>
Hellanthemum &<
Hepatlca ' *
Heuchera , '•*
Hydrochloric add *:
HysterlODica j4*
Inulin rc'i
Iodine 5:»
Ipecacuanha ^n
Irrigation of bowel I'^i
Jambol W7
Kino ; , SJI
Kola r-s
Koumiss 594
Kr^meria S»
Lactic acid ^^^
Lead acetate 7:3
Ledum r9«
Ltquidambar ^c
Liquorice 49*
Logwood V-*
Magnesia 612
Magnesium silicate ^r>
Mango «2l
Macgostana «r.
Matico «3
Mercury SS
Monesla CS3
Mullein 913
Myrica CS
Myristica C38
Naphthaleiie C8
Nux vomica C<i
Oil of erigeron crj
Opium ei
Orphol to. 696
Pambotano VT
Pancreatin 69S
Papain 6W
Paracoto 6tt
■Harrbtca {cont'd). Pepsin
CLINXCAX
FAOB
706
109
INDKX.
Diphtheria (cont'd). Cantharis
Carbolic acid , . . .
1
15
F
1
215
kom
SIO
U2
828
838
408
410
4a
•
188
484
008
m
418
G18
UO
848
UN
6S1
678
678
488
128
898
614
827
on
018
on
loao
.1081
OM
099
706
.708
. 768
678
. 081
. 861
. 867
. 788
.780
. 419
. 823
. 828
. 219
, 838
. 887
. 1S8
. 419
. 129
. 871
. HI
. 887
. 900
. 698
. SB4
. 91
.1108
.1006
.1146
. 818
. 345
.1189
. 178
. 184
. 224
. 710
. 910
. 223
. 230
. 237
. 284
..287
. 288
. 288
. 381
. 390
■
271
Chlaolla
Plnus Canadensis
73»
766
Cbloral
Cold
PolvKoniim
757
Copper sulpbate
CreoUn
. a. * •
"ioi"
Pf>mf»ffriiiiat<*
498
765
PriDoa ....
770
Ecblaacea
Protargol
770
Blhyleaedlamlne-silvcr-phoephaie
tion t
aolu
OuftHla
778
^QiilnidlTip tAnnntp
366
ECuctUyptus .. ...... •.• •....■
Quinine
RasnbeiTT
868. 300
796
Pormaldchydc
Gallic acid
Kmih
780
OualBcol
7S4
Hopa
Hydrochloric acid
Hjdrogea dloxlds
Vu9
Abubarb
789
790
^_ glabra
^^ft .Salacetol
^^^H *TnllTitn
790
806
7M
Hypodermociysls
Ichtbalblo
Iodine ,
^^H
801
t rtbnMiildv
^^^H f^ilvrr nltrntti
231
Iron , ••••
^^^H «Sn/l4Mm puruf<>-a.>r.tt.*a
417
Lactic acid . ,
^^^H
440
LI me- water ,
^^H
SOI
MaKoeslum aulpblto
^^H -Storobalne
^^H -SulphamlDol
ttS
M2
875
Mentbul
.828
Mercury , ■.••...
M(.*thylcDe-blue ....••■•.•..•.
140
Myrrh
876
Napbcbol
^^^^1 'Pvr^pt* vl'iTn
876
Nupblbalcns ■.*...•..*••.•.•....••
^^H Tannalbln
879
879
OxvEcn
Ozone- water
^^^^H ^*nni^nf»p>p
879
Pancreatln •..........«..•■■■•
^^^H -^Tannf^plrv
880
Papain ,
^^H Tbymol
9O0
884
Pepsin
Petroleu m
Phenol .,,,
.'.lib
^^H viDuroum pruDitoiium
916
9t
Pilocarpus
Potassium chlorate
^^^H YnntKn^yl.t^
920
^^^^H 9.ini* nrli^H ^ ^ ^ ^
,.,,. 916
Iodide ,
^^H aulpbsCc
984
478
permanganate
..818
PyoktaniD ,.,
^^^HSklMl-rhraik r*Sr/\nl<* Afnln^
.......... 284
Pyroxene
^^^L D^fl^^p.^l]
M|>
Quinine
^^^H
,,,.. 400
Resorcin
^^^H rV.pp«i- aiitphBta
, , m
Retlnol
^^^H Rtin«t<n« ^ ^ ^
sss
Salaktol ,
^^M
449
Scdum aero
^^H n^iu^ »^tA
U7
Serpcntarla
'
^ Iron ,
47S
Silver nitrate
Kola
fits
Sodium benxoat«
sulphite
..268
Nitric acid
...., 198
Kltrobydrocblorlc acfd
..„, 118
sulpborlcinate
Sllvfr Dttrate
tt8
Stcresol
Sodium beazoate
988
Sulphorlclnated phenol
Sulphur ....' ,,,..
VMS**^tlvf wt^&knesa. Carduua
S18
Absintbiuin ....
88
Sulphurous acid
Cota .....
m
Terpln hydrate ,,,,
Hops 512
Pepper 740
SUsUtloD ot stomach. BvUoapbUiol.... 642
0«Dttan ■***•
Thymol
Trypsin ...,...,.
Turpentine .,
Vinegar
Dipsomania. Hypnotism ..,,
Massage
Rcct&l alltnentatlon
1008
115S
Diaeases of Women. Massage
Dislocation. Dlood-lettlng
Salol
Strontium bromide
800
86.1
Drlnk-crarlng. Capsicum •....
Oat
IMpbtberia. Adbatoda Justlcia ..
Alcohol
153
Dropsy. Acupuncture •.•■.*
176
Aletrls
Altbira
184
Althiea
AntlDvrln ................>....
ni
A|M><'ynum < •■
Ad ll toxin
tu
Aplol ,......,
Argtfhtamlns • ■
882
Arbutln
Arson ic ,
88
Armoracla ■••■•
Balsuta of Peru
848
Asclepias syrlaoa
^enxol
184
Asparagin ■•..■■
8a
Cactus ,,,,
Coroalvccrldo >..
104
Caffeine .... ,....,
,.,, m
-Bulphonlc add
^romol ■.■■.
18t
trl -Iodide l
^■bIx BulnburatA ...........
,,, 181
Colocynth <.....*■.•.■■*>■•
^^^ "Camphorated Daphthol
841
Convallarla malalls
i
1216
CLIKICAX INBEX.
PAQB
Dropsy {cont'd). Copaiba 39it
Corn-silk 6i6
CrotOD-oU 672
Curcas .427
DtgltallB 435
Diuretln &»l
Elaterln 442
EunoDymuB 467
Oflllium 480
Iris 686
Jalap 586
Juniper 589
Kefir 591
Mistletoe 918
Magaesla 613
Mercury 526
Mltchella 632
Mustard 831
Oil ot erlgeron 658
Paraldehyde 701
Parsley 710
Pilocarpine 735, 738
Polytrlcblum 7o7
Pouaslum Iodide 673.676
citrate 766
Rbamaus cathartlcus 786
Scammony 817
Scoparlus 8^
Senega 825
Sodium acetate 839
iodide 676
Solomon's seal 767
Spirit of oltroUB ether 162
Squill 818
Strophanthus 857
Theoclne 229
Dysentery. Acetone 90
AilantbuB glandulosa 168
Alum 186
Ammonium cblorld« 196
Ariatol 898
Arnica 234
Asclepiaa 236
Astringent Injections 1161
BIsmutb 270
Bursa pastorts 283
Castor-oil 667
Cbopparo amargoso 348
Cinnamon 366
Cocaine 372
Codllrer-olt 660
Copaiba 400
Copper sulphate 423
Cotton-root bark 498
Creoim 404
Cusparla 427
Dlta 438
Bnemau ? 1161
Brgot 449
.QalUe add 117
Geranium 487
Glycerin 494
Hamamells 506
Hellantbemum 606
Hydrogen dioxide 250
Hysterlonlca M>
Iodoform 660
Ipecacuanha 63, 683
Iron 473
Irrigation of colon 1161
Juglans 688
Kola 593
Koumiss 594
Kramerla St6
Lactic add 124
Lead acetate 754
Ledum 698
Llquldambar 602
Lysol 747
Magnesia 612
Mango 621
Mangostana 621
Matico 622
Mercury 626
PAOX
Dysentery {cmt'dh MulltiB ca
Mynca «»
Naphthalene 6»
Nut-galls 4il
Nux Tomloi 6il
CEnothera 6i4
Oil of erlgeron ®S
OliTs-oll 6*4
Opium «»!
Pambotano &*
Pomegranate 4:^
Rhus aromatlca 79u
Salicylic add 1J4
Salol wi
Silver nitrato -21
Sodium benxoate >2
sulphato ^vi
Sulphamlnol h6i
Sulphuric add ipy
Sumbul S75
Symphytum §T6
Tannic acid 143
Turpentine «M
Uva ursl Si*
Vlrbumum prunlfoUum »!(
Xanthlum »19
Zinc sulphate ^4
DysmenorrhcBa. AcetanUlde 89
Aconite l»
Aletris iTx
Aloes and canella #6
Amyl nitrite SuO
Talertanate V**
Anemonln 772
Antlpyrln Ti»
At>lolln 7l»
Arasa 236
Belladonna SS<
Borax 104
Camphor 12»
Cannabis Indlca WC
Cerium oxalate OX
Chloralamlde S»
Clmldfuga 3S1
Codeine ta
Colllnsoala m
Conlum S9(
Cotton-root bark 497
CrotoD-cbloral 336
Elecampane 564
Blectrtclty fT7
Brgot 4«
Bther. compound spirit of 161
Bxalgln 46
Fennel 477
GalTanIsm 9tt
Gelsemlum 486
Ginger »f
Gold 243
Gnafac 5«l
Hamamells 516
Hydrastis Ml
Hyoseyamus MC
Iron 469
Jamaica dogwood 743
Manganese C19
Matricaria <B
Mltchella CO
Nux vomica Ca6
Oil of cajuput 6S6
Opium «91
Parsley 710
PlcrotoxlD 5*4
Pulsatilla 773
Sassafras S*6
Salicylic add IJ*
Sangulnaria 908
Savlne Ty»
Senedo 834
Slmulo no
Stramonium 8^
Sumbul 87S
Tuisy .879
Thermo! MS
CUNIOAL INDEX.
1217
PAQB
DyBmenorrboea (cont'd). Valerianic ether. 162
Viburnum opulus 916
pmnifolium 816
Xantboxylum 920
Zinc cyanide 925
Dyspepsia. Absinthium 86
Acidulous waters 1062
Adhatoda Juattcla 153
AUanthus irlandulosa 168
Alcohol 176
Aloes *. 183
Amber 862
Arsenic 97
Asaprol 236
Barberry 266
Bebeeru-bark 645
Beberlne sulphate 645
Beazol 264
Berberine 400
Betanaphthol 642
-bismuth : 643
Bismuth 268, 270
subgaUata 271
Boldo 272
Bryonia 282
Bucbu 283
Calcium 396
Calumba 297
Capsicum 314
Carbolic acid 109
Carbon dlsulphlde 316
Cardamom 316
Casca 318
Cerium nitrate 328
oxalate . .' 328
Cetraria 324
Charcoal 316
Chamomile 220
ChlraU 329
Chloroform 348
Cinnamon 367
Climate therapy 1076
Cinchona %9
CociUana 383
Cocculus 881
Codeine 383
Colchicum 3S6
Coptls 400
Creosote 407
Crocus 420
Cubeb 321
Damlana 430
Diet 1082
Drosera 438
Elecampane G&i
Bmbella rtbes 443
Eupatorlum 457
Fablana imbrlcata 463
Gentian 486
Gllienia 488
Olnger 926
Gold 243
Hydrochloric acid 130
Hydrogen dioxide 360
IngluTln 553
InuUn 554
Ipecacuanha 584
Kefir 591
Kola 592
Koumiss 594
Lactic acid 123
Lavender 698
Light 1123
Lycopodium 610
Lysol 747
Magnesia 614
Magnesium carbonate 612
pbenolsulphonate 112
Massage 1006
Menthol 637
Monesia 633
Music 1135
Myrrh 637
Nitric acid 126
Nux Tomlca ^2
pAoa
Dyspepsia (cont'd). Opium 693
Orexlne 694
Oxygen 1026
Ozonised water 1031
Papal n 699
Pepper 740
Pepsin 705
Phenol 109
Phosphoric acid 131
Pancreatltt 698
Picrotoxln 381
Podophyllum 756
Potassium bicarbonate 764
cyanide 767
dichromate 114
permanganate 620, 767
Ptelea 772
Quassia 776
Qulnldlne tannate 3^
Quinine 369
Rectal allmenUtlon 1154
Resorcln 783
Rhubarb 789
Rumex 795
SabbaUa 796
Saccharin 266
Salol SOD
Sallx 799
Sangulnarla 807
Serpentarla 8S8
aUrer 281
Sodium thlosulpbate 838
sozoiodol 847
Solanine 440
Static electrtclty 97S
Strontium bromide 863
salicylate 866
Sulphamlnol 862
Sulphurous acid 142
Sumbul 876
Taraxacum 881
Terebene 886
Trtbromphenol-btsmuth 920
Vanilla ..*. 912
Water 1048
Zinc snbgallate 928
Dysphagia. Cocaine 877
Oil of cajuput 658
Dyspncea. Adonis ttstlyalls 165
Amyl nitrite 199
Aspldospermlne 240
Caeca 818
Coronllla 401
DlglUlIs 434
Euphorbia plIulKera 468
Grlndelta 600
Heroine 508
Oil of cajuput 668
Opium 689
Oxygen 1026
Oxyphor 697
Pyrldln 774
Quebracbine hydrochloride 240
Sodium nitrite 843
Sparteine 820
Strychnine 664
Wild cherry 772
Dystrophy. Progressive Muscular. Hyelin-
alpha 296
Dysurta. Cannabis Indlca 307
Digitalis 432
Elm 909
Uva ursl 910
Ear, Disease of. Alumnol 188
Atropine sulphate 264
Bismuth subgallate 271
Boric add 101
Camphor-menthol 801
Electricity 996
Hydrogen dioxide 249
Menthol 626
Mercury 620
Mlcrocldln 643
Pilocarpine 736
Potassium permanganate 763
1 ^^^
^M Ear, DiscaBG of (cont'd).
OUNICAL
PAOll
M7
Bczema irortr'rf). Icbthyol
Iron
olealc
PAOa
560
468
ii8
esi
7n
KaoltD ,
...188, 680
.,„, MB
Laurel
667
860
Lead oleote
754
^^H Zinc Kozolodol ..
847
Utno- water
Liltbluni
291
606
^^H Tilar Iminrtii in OliTr nil
. .. 044
164
I^oretin
60S
^^H finrlr nt^ltl >
101
LoBopbao
Lysol
Mule ftTU
606
747
386
^^H Corntnr
367
174
^^^H Jamaica dogwood
^^^^^V Pfirnrhi' rilvr^rln
7tt
48S
MPDtboI
626
MtTcxir!'' oleate
188
^^^^^B Mnpn
GU
Mt^rcuruuH oloate *■■.
188
^r Illlclum
^^H Oil nf rniiiniil'
6S2
....... 067
Morcurv
...680 621
Myrrh
687
179
Naftalan
ens
^H Bccbymoses. Ammoiiluiii chloride
^B Gcblnococcic Cysts. Iodoform ....
^^m EclnnipslB. Blood-lt'ttliig
m
1006
660
U46
Naiihthalene
618
Nickel oleate ....*
U8
Nut-gall
490
CKnoibera ,,
6&6
^^H j *hlnml 1 1 1 1 ■ ■ i
854
Oil of cajuput ....... ••.»•. ..*•<
657
^^K rhlnmfnrni i i
M4
Papata
699
^H Hypod'^rinoclyBla UDO
^H Intravenous tojectloa of nornuU aalt
^H nnliitlnn ^''-''
Petroleum .....*..•
708
Phenol ,
,..,107. 109
Phosphorus 4...**4..
,. 787
^^H Pllnrnrplnn
788
Picric add ■••*•
138
^H PotassluiD blt&rtrat6 ••*
760
Potassium bicarbonate ....■..,<
76S
164
chlorate ..*••....
719
^^m' Vppntriim
914
Pyoktanln
680
^K Bcthyma. Copper sulphate
^H rronlin
4S4
404
Reaorbln
Reaorcln
188
788
^M Iron
^m Massage
^H Mercury
^H {}Mlriinr
•409
1006
638
861
Salicylic acid
,,, 184
Salol ;....
800
SaponfB «...*••
818
Silver nitrate ,
228
^K Bcsf-ma. AcetaoUlde
88
Ii8
Silver oleate
119
Sodium bicarbODBte
886 1
^^^^fe Adf-pH Innip
162
........ 181
Sosoiodol
847 '
Strontium iodide ,
854
^^^^^H
18B
lactate ..,.,,
, g^
^^^^1 Arlstol .y..
sn
.... ... 97
Suet
^ 618
Tannic add
.... 141
^^^H
100
Taunoform
880
^^^^H A *-a..t.iirr> aIab*>
127
Tar
....... 746
202
Thllanln
898
^^^H Betanapbthol
^^^H Btarnuto
^^^H lorcttn
640
868
6W
271
Thiol
898
Thymol
... 900
Thyroid extract
. . .807
Turpentine
884
104
Viola
Zlnf* oleate
917
189
^^^H nromoKsllol
881
188
oxide
. 918
I6t
aubffallate
Bk-iE'^ma, Acute. Blamutb oleate .
Coca
988
in
874
^^^^^^1
894
^^^^^^1 nKn.>pl>n»«
787
^^^^1 Calx sulpburata
»8
801
Compound zl nc stearate
Lanolin
Ijaurel ,
860
168
697 [
^^^^^^^^w^r^nnnahlB Tp.YtA| ^ , ^
SOT
^^^^^■^■CarboHc artd
....167, 106
; 464
Lcsd
... 758
Phenol
107, 109
^^^^^^^^Hpn h n ». n n. 1 1 ..
120
Tumenol
BcEemQ Chronic Adeps lanB . ..*
9m
162
^^^^^^Kr*K 1 » » 1
,. 382
^^^^^^^^H>r>ini.A<
318
Alpbanapbtbol
Antimony ......4..
OtI 1
, 888
^^^^^^^Bnnf B 1 n n
....,.,. 874
^^^^^^^■T nl»nla
U8
Arsenic todlde
Belladonna ....*.•
100
266
^^^^^^^^V-£1nmnniini1 >lnf m*»tti-»t^
860
^^^^^^Hn.»«t 1 »
........ 404
Betanaobtliol . .
6IO
^^^^^^^■rVAAMA »•
406
BoroKlycerln solutloo
Cadmium oleate .......t..^
.* 191
188
888
^^^^^^^Mn*|.^-iii»«
........ 890
^^^^^^^^^Vn 1 n «h !.• 1 nn
766
^^^^^^^^^Vn 1 f./<M¥n pn n A
6B6
886
^^^^^^^P«tnr.t.-I^)t« , ,, ,
877
849
^ 'BtirophoD
^^■^ Gallfl , »
461
, 480
488
Copper
.... 484 1
Hucalvpttis ••.4..>*....
468 !
Ell ropb en .*. . .^ . . . .
461
fiOS
485
^^^^H
492
Hvdraatis
Icbthyol
540
. 561
^^^^H riy,,^^^*^ •>«<ntn
143
^^^^^^■■^ trnil rMbsrrtstr . i i . . . .
........ 764
InAnfnrm ..•••.•••*•*
668
^^^^^^^^^^^■A *AH n
808
Lanotin * ■•»■■■■
m
^^^^^^^^^^^PU
6on
Iinnaar's paste ..•.*.
186
^ ITydrocfTtyle
wn
Mercury . ..
"621
J
CLINICAL INDEX.
1219
PAOE
Kcsema. Chronic (ctmPd). Naphthalene... 639
Oil of cade 657
Phytolacca 733
Pilocarpine 736
QuUlaJa 779
Reaorcln 782
Soap 813
Sulphur 871. 878
Tar 745
Tartar emetic 223
Turpentine : 884, 885
Effuslone, Serous. Digitalis 436
Diuretln 898
Pilocarpine 786
Elephantiasis. Calx sulphurata '. 293
Cetrarla 824
Massage 1006
Pilocarpine 736
Emaciation. Diet 10S2
EmissloDS, Nocturnal. Sulpbonal 866
Emphysema. Ammoniac 190
Apomorphlne 225
Asafetlda 235
Blood-letting 1146
, Camphor 803
Cbloralamlde 330
Chioral-caffelne 335
Codllver-oH 660
Conllne 394
CoDTallarla majalls 396
Orlndella BOO
Heroine 508
Ipecacuanha 582
Iron 473
Ledum 598
Mercury 525
Opium 698
Oxygen 1026
Phyaostlgma 731
Potasalum Iodide 676
Quebracho 240
Strychnine 664
SyrupuB calcll lactopbosphatls 727
Terebene 807
Turpentine 8^
Empyema. Formaldehyde 604
Gualacol 414
Hydrogen dioxide 249
Iodine 570
Styrone .862
Rmpyema of Antrum. Protargol 770
Endocarditis. Cantharls 310
Mercury 526
Opium 689
Quinine 359
Endocervttls. Chromic trloxlde 113
Erpotin 447
Iodine 572
Endometritis. Alumnol 18S
Cannabis Indies 307
Copper sulphate 423
Electricity 977
Orlndella 499
Helenln 554
Hydrogen dioxide 250
Ichthyol 551
Iodine 572
lodol 561
Morcury 528
Phonosalyl 112
Thiol 893
KnlarKed Mammary Oland. Conlum 894
Potassium Iodide S6S
EnlarRed Prostate. Electricity 990
Fnblana Imbrlcata 468
Salol 801
Saw-palmetto 796
Sodium bicarbonate 837
Teucrlum 888
Knlnrgod Spleen. Bryonia 282
Cadmium 284
Conlum 394
Ergot 449
Eucalyptus 4Ki
PAOB
Bnlarged Spleen (cont'd). Iodine 670
Iron 471
Lead Iodide 754
Mercury 521
Potassium Iodide 673
Quinine 859
Bnlarged Testicle. Bandage 1144
Potassium Iodide 678
Bnlarged Thyroid Gland. Arlstol 898
Bnlarged Tonsils. Ammonium Iodide 196
Caustic potash 782
Electricity 990
Glycerin 493
Iodine 569, 671
Massage 1006
Ox-gall 463
Parachlorphenol * 4U
Trichloracetic acid 146
Zinc Iodide 577,923
Bnteralgla. Alum 186
Belladonna 266
Cannabis IndJea 307
Codeine 690
Hydrocyanic acid 122
Silver nitrate 231
Enteritis. Alphanaphthol 645
Arsenic iodide 97
Eucalypteol 466
Eucalyptol 464
Fablana Imbrlcata 463
Hamamells 606
Lactic acid 13S
Magnesia 612
Massage 1006
Mon^la 633
Salicylic acid 135
Sassafras 816
Silver nitrate 229
Tannalbln 879
Tannoptn 880
Tragacanth 908
Enteritis, MembranoAs. Betanaphthol-
blsmuth 271
Copaiba 423
Copper sulphate 426
Cubeb 422
Olive-oil 664
Silver nitrate 229
Enterocolitis. Creolin 404
Koumiss 594
Mercury 525
Opium 692
Pancreatin 698
Quinine 360
Enuresis. (See Incontinence of Dritw.)
Ephelides. Lemon ....■ 600
Epidermis, Thickened. Copper oleate ... 128
Epididymitis. Aconite 150
Ammonium chloride 193
Anemonln 772
Arlstol 898
Bromogallol 281
Collodion 389
Fablana Imbrlcata 463
Gaultherla 482
Ice-bag 1117
Pulsatilla 772
Sliver nitrate 228
Epilepsy. Acetantllde 89
Adonis vemalls 164
Ammonlated copper 426
Ammonium and rubidium bromide... 196
Amy! nitrite 199
Amylene hydras 201
Antlpyrln 720
Bandage 1144
Belladonna 287
Borax 103, 104
Brain and spinal extracts 206
Bromamlde 280
Bromhsmol 476
Bromides 276. 434
Calcium bromide 2K
Camphoric acid Wo
1220
CUNIOAL INDEX.
PAOX
Epilepsy ietmt'd). Cannabis Indlca 307
Cerium oxalate S2S
Chloral 834
Gbloralaznide 330
Ctaloraloae 336
Codllver-oll 660
Conium .....' S9S
Cyprtpedlum 429
Electricity »78
DlffitellB 4S4
Ergot 450
Ethyl bromide 168
Ethylene bromide 164
Glyceryl trtnltras 489
Heat 1U4
Hydrastlntne hydrochloride 548
Hydrobromlc acid IIS
Hydrogen dioxide 260
Hydrotherapy 1048
Ipecacuanha K88
Lithium bromide 606
Iron 471
Mistletoe 918
Monobromated camphor 302
Music 1135
Nickel bromide 879
Nitroglycerin 489
Nux vomica 655
Opium 689. 693
Paraldehyde 701
Physostlgma 781
Picrotoxln 381
Potassium bromide 276
iodide 676
nitrite 767
Santonin SCO
Scutellaria 82S
Silver oxide 231
Simulo 830
Sodium eosinate 844
nitrate 848
nitrite * 843
phosphato 839
Solanum CaroUnense 844
Stramonium 861
Strontium bromide 879. 868
Sulphonal 860
Sumbul 875
Testicular fluid 806
Viburnum prunlfolium 916
Zino cyanide 924
lacUte 124
oxide 925
sulphate 924
valerianate 912
Episcleritis. Pilocarpine 786
Scopolamine hydrochloride 822
Bplstaxls. Acetic acid 91
Alum 185
Ammonium carbonate 194
Antlpyrin 720
Aristol 897
Bryonia 282
Calcium cbloride 294
Cetraria 324
Cotton-root bark 497
DlglUlls 434
Ergot 460
Europben 461
Geranium 487
Hamamells 605
Hydrogen dioxide ffiO
Ipecacuanha 582. 684
Iron 468
Koumiss 594
Kramerla 695
Oil of erigeron 658
Trichloracetic acid 146
Epithelioma. Acetic acid 91
Arsenic 96, 98
oleate 127
Arsenum oleate 127
Cbelidonfum 826
Chloroform 339
rAom
Epithelioma (oofil>tf). Bucalyptos 4a9
Europhen 4«
Lactic add * IS
Methylene- blue O
Ozonized water l"3l
Picric acid l«
Potassium bromide 2^~'
chlorate T^7
Resorcln 7"»-
Rue ♦*'-•
Sodium chlorate s-"
Zinc chloride 933
cyanide 9J^
(See also Carcinoma.)
Erosions. Alumnol 1^
Erysipelas. AcetanUlde v«
Aconite 14*
Aconltlne nitrate K>1
Alcohol ; 174. ITS
Aluminum borotannate 1m
Alumnol Iw
Ammonium carbonate IM
Antlpyrin 7^8
Antistreptococcic serum 21)
Argentum Ci^d£ 221
Aristol 897
Belladonna S8
Bensolc acid ac
Betanaphthol «C
Bismuth SO
oleate irT
oxylodlde as
sublodlde 3es
Borio add 103
Bromol ST.
Bromphenol 4lS
Camphor 306. S^Jl
Carbolic acid tlO. 3>»
Chamomlle-oll 23>
Chloralamlde Ja»
Chloropbenol .''4T
Cocaine JTC
Collodion >!•
Colloidal silver rj
CreoUn 4M
Creosote 410
Dlgttalta 1M
Echinacea 44t
Elm 9»
Europhen 461
Fuchsln 478
Oualaool 413
Outta percha 341
Hamamells 506
Hydrogen dioxide 20
Ichthyol ."*■*
Iodine >Tj
Iron 4««. *"•
Lactophenln 7 :
Lanolin l.v
Laurel 597
I^3i2 ,..,.... 752
Liquor guttae perdue '. 443
Loretin 6K
Mercury 524. 53
Phenol U»
Picric acid x'S
Pilocarpus 7%
Potassium permansanate 00
silicate 829
Quinine IS»
Resorcln 7S2
Rhus toxicodendron T».
Salicylic add l»
Salol i™>
Sassafras — SIC
Silver nitrate 229
oleate 12»
Sulphur 871
Sodium sulphate M«
Sulphur 871
Sulphuric add !♦*
Tannic acid 143
Thiol 9M
EryBlpcIoB (cont'd). ToIyp7rin ....
TurpenllBe
VUeUuB
Wheat-flour , -
CUNICAI
Pau£
72:
885
:::::::: JJI
Fffic&l InQDACtJoD Olvcerla .
PAoa
49a
Magnesia sulphate
Opium >...
613
603
Favus. Alumonol
US
Zinc oxide ........
nt
Betanapbthol
Chromic trlozlds
CoDoer
640
113
484
Erytbema. Blsmutb .
Carbolic acid
::::::::«
107. t09
Cocaine
8T4
oleate
188
Ctiamomlle-oll ....
130
Formaldehyde
608
Icbtbyol
,,. 061
Lanolin •.....*..■(■■■
1S8
Lanolin
IB
Mercury .•*••
S23
ItBurel
m
Phytolacca
783
Rhus toxicodendron
ROSti
m
FoLDftstum dlrhroDiAtA .... .«...
...v.... 118
:;::;:;: m
Sulphurous acid •.*
141
Sodium nuorldc ..
Erytbema MuIUformc.
Sodium salicylate
Strontium Iodide
Thiol
Creosote"!
843
406
138
864
8M
(See also Tinm Fovosa.)
Felons. Chloroform
filgon
8U
441
Goulard's cerate
758
Hydrogen dioxide
Mercury ointment
...849
684
Erythema Nodoium. AnUpyrln ..
Gnu Ittaerla , -
720
. . . . 48S
ScarlQcatlona
........1145
Salirylic acid
136
Ferer. Acacia
Aoetanlllde ,
37
SO
Strontium iodide .
^m Bxanthomata. Aconite
.. .. 364
149
Acetone .«
90
m
Aconite
119
^^H Light
i3
Alcohol .,
179
^^^K Pllrw<arnlnA
m
AcetpbenetidlQ
Ammonium acotate
713
194
^^B Excessive dlflcharges.
^^VSxcorlatloDB. Acacia
^^ Beneoin
Copper sulphate... 4SS
"
chloride
196
2g|
Anemonin
778
BUmutli
Ml
Antinervln
228
Cold cream
; : m
Arnica ., ■
383
949
Collodion
. . .- an
Aspldoepermtne
Corn-ttaroh
633
Bromamlde
990
Lycopodlum
ftlO
Bromides
tn
Magnesia carbonate
ExiTescenceB. Thuja
Exophthalmic' Goitre.
Araenlc
flU
Caffeine
, 387
S86
Tamphor
80S
Antipyrtn .
720
9$
Cascarilla ,
819
Chamomile ...,.i.
;;^.^ »
Barium chloride ...
148
Chloroform ,
148
Belladonna
.. .. 258
Citric acid
116
Cactus
'
XS4
Coffee ..,,,
WVZ. i&
Cannabis Indlca ..
Digitalis
107
Convallarla majalls ............
CuBparIa ,
896
487
4X
Electricity ,
MM
Diet
A..".m
OalTanlsm
" '
MO
Ether mixture
ui
Hydrlodlc add ....
Ug
Eucalyptus 1..
4U
Iodine
670
Gucblnin , ,
.r..«.. 386
Lycopiu
...... 610
Gaultheria ......,„.
,; S
Opium
aa»
Glycerin
::.;:;: S
Potassium bromide
Sparteine aulphate
Strapbanthua
S78
HuarchlchlH
919
Bai
Hydrochloric sold ...............
180
8&A
Hydrogen dioxide
9G0
Tbymus gland
208
HyoEcyamus
Kola
::;:::; K
Valerian - .
Oil
Veratrum vlrlde ...
914
Koumiss ,...
Magnesia
Muak
Neutral mixture
OUve-oll ,,.,.
Opium
Orange ».„.
Oxyroel
Phenocoll
S!
6U
684
600
Mi
:;::;;: a
634
7U
Eye. Diseases of. Abn
Arsenic lodldf
IB
85
99
Bismuth aubgallate
Cantharla
Copaiba
Btuphthalmln
tn
310
400
,.,.♦». 460
Rytfrogen dioxide
Leecbes
349
...... .1147
Potassium elirate
Quinine .•.*.......•.•....,..
Resorcln ..••4.»j«»i.ii.«
Salopben
::;:;:; tS
3B9
7S3
804
Mercuric oxide
*•.. ♦. MO
Pyoktanln
630
Physostigmlne . .
7M
Eye. Operations Upon.
Cocaine
OtalorlBe ..
846
870
Saf;e ,
8d6
Salicylic acid
SeldllU powder
Sodium b*'n«oate
sallcylati' .
.Spirit of nitrous ether
Tea
TBS
;;;*: Si
Eucalae
Tropncoealne
Eye. Rpmovat of Pore
Electro-magnetli
Eye. Traumntlnma of.
Eyeball. Dlaorders of
Bycllds. Granular. Pb
Byes, InDammatlon of.
Sasaafraa
Scopolamine hydroc
Bye-etralo. Cimicifuga
Crolon chloral ....
Ign Bodies
m
Europbeo ..
Pilocarpine
rtclacca ....
Rubidium.
hiorido" ;.*!."
481
907
From.
993
490
736
783
794
816
838
851
Thfillln
Ttjfrmol
:i:i:::S
1'olysa)
Trlmethylamln hydrochloride ..
Triticum
419
904
....... 906
Turpentine ..«••
884
Warburg's tincture *.«.....
Water .. ... .
S6S
. . 1046
88S
Hydrobromlo acid .
118
Fever, C«rebro-splnal. Aotlpyrln .
7W
1222
CUmOAI* INDEX.
PAOB
Fever. Cervbro-Bplnal {nmt'd). Chloretooe. 337
Copper nrseiiite 4K
QelBemlum 485
lodol 4 562
OpluDi 8S9
Pot&justum Iodide », 576
Fever, Mttlariul. Alum ....«......,• 1S7
AmmoDluni chloride *«,.4«. ..,».,« Ift*)
Amyl uttrite > 300
Atropine ..■.••.••■■•^•■•••••» 250
Casca .kt.*....«»*.k.k' 318
CedroQ , 332
CIncboDidlne 86S
Chloroform *..... M2
Colcln ....t"* * SIC
DiU «8
Echinacea * 4U
Buquinlne 365
Gelsemlum iSB
Oontian 486
Horee-cbeatout .t 155
IrlB SSTi
Nitric acid IIG
Plpaluewa 327
QulalDe 3:.7
Salicylic add 133
Fever. iDtermitteDt. HuarchioblU 918
StllllDgla 851
Strophanthln 858
Thuja B9G
Fcvrr. .Milk, (Sof Septtrtrmla,)
Pover, Puerpcrnl. Antipyrln .,..,.718
Ad tlBeptlc iferum 218
Qiilnlae 361
ReBorcln 783
Sulpbocarbolatea 112
• TiTebeno 887
Turpentine 885
Fever, Rheumatic. (See RheumatUim.)
Fever, Scarlet (See BcarJattna.)
Fever, Relapsing.
Fever. Typhoid. Adbatoda Justlcla 153
Acetpbenetldin 713
Alcobol 175
Alpbanaphthol 915
Alphozone 184
Anemonin 773
Antityphoid aeruxn S16
Aristol 898
Asaf etlda 235
Asaprol 236
Balsam of Peru *.... 246
Baptlala 247
Bfttha 1053
Belladonna fit8
BcnaonlHd , 260
B*-tanaphthol 641
Bismuth salicylate , S6f)
Bubfcnllato ...*«..«<».... 270
Boric acid 103
Caffeine 2SS
Camphor , 303
CanthartB 3W
Capsicum , 214
Carbol Ic acid 100
Carbon dlaulpblde 315
Cascarllla 819
Castor 32f)
Cerium oxalate , 323
Chtmnpblla 887
Chloral «S3. S»
Chlornlamldc S3n
Chopparo amarsoao SIS
Citric acid 600
Creaol 417
CreoBote 410
Chlorine 347
Chloroform 342
Cocaine 377
Cold-water enemata 11 5t
Convallaria raajalla 398
Copper BUtpbate <SI
Coto 403
Creaotate of sodium 430
PAoa
Fever, Typhoid (rofil'd). Diet lOW
Dfgltoxiu 438
Dliin-Un M
EcbtDUcea , 441
BucAlyptcol 4S$
Buralyptufl 4IB
Gallic acid 117
Glycerin 483
Guutacol 4U
carbonate ■ 414
Hydrochloric acid ISO
Hydrogen dioxide Ml
Hypodermoclyals .' UfiO
Ice U17
iDjecUona », ^^Sl
Iodine .....,•..«.,..*.••«..-*•••« Sn
lofllzed starch .....**..... 871
Lnctlc acid ..,,.* 314
Lactopbenin ..............**..•. 718
Lead acetate 7M
Malaklu <ll
Mercury 894
Metbacetln 711
Methylene bichloride CSfl
Muak Ml
Naphthalene 688
Oil of cajuput 8B8
Oltve-oll 666
Opium 680
rhenacetia 713
Phenocoll 715
Phenol 109. US
bismuth 271
Phenolsulpbonate of xl&c US
Phosphoric acid Itl
Phosphorus ,.,.. 7f7
Potaanium bromide tR
chlorate ...,.*.,.... Ttt
Prophylactic Inoculatloo 218
Quinine , IB|
Qiilnopropyllcc sulphate 184
Salicylic acid lH
Salol 808
SaIopb<>n 881
Rerpentaria • 8!8
Silver nitrate ^. .......... 280
Sodium benxoate 188) 888
paroereflotate .....417< 480
SomatosG * 84S
Spirit of nitrous ether 181
Strophantbus 887
Stilpbannlnol »• •« 8S
Sulphuric acid • Itf
Sulphurous add Itf
Sumbul 8n
Tannopia t 90
Tnrtar emetic .....i fli
Tballln JJ
Tbermol JJJ
Thymol ., 800
Trlbromphenol bismuth OW
Tolypv ri n t . . 711
THcrcnol 4W
Turpentine 8M
Voratnim •<*- 914
Xeroform •»••.••.• 010
Yen-it 414
Zinc phenolsulpfaoaate «tUt OW
Fever, Typhus. Alcohol $j|
Antipyrin tit
Belladonna *. £
Camphor , w
Cblnrnl hydrate W
Pucbsin Oil
Opium V
Pboflphoma ..,..,........*• ....
Serpentnrta -
Tartar emetic M
Valerian Oil
FeTer, Urethral. AcooUe *.*• 1#
Fever. Yellow. Antfpyrin TO
Cocaine • * !S
Hydroi^pn dioxide *• HQI.
Turpentine «
CLINICAL INDEX.
1223
PAQB
Fibroid Lung. DlgiUllB 436
Iodine 570
Fibroid Tumors. Bromides 277
Calcium 298
Pot&BStum iodide 678
Spermin 206
Fissure. Aloes 1S4
Belladonna 2S&
Flaxseed 601
Geranium 487
Glycerin 493
Uamamelis 505
Iodoform 558
Krameria 595
Lead nitrate 754
Magnesia 612
Mercury 524
Olive-oil 664
Papain 699
Pepper 740
Potassium bromide 274
Stramonium 852
Sulphur 873
Tannic acid 148
Fistulae. Caustic potash 762
Cocaine 872
Hydrogen dioxide 249
lodol 561
Methylene-blue 628
Pyoktanin 630
Salol 800
Sulphur 873
Fcetld Breath. Hydrogen dioxide 249
Foreign Bodies, Location of. X-rays 1134
Freckles. Alcohol 174
Almond 197
Benzoin 263
Collodion 389
Copper oleate 128
Hamamells 605
Lemon 600
Iodine 573
Mercury 621
Myrrh 637
Salicylic acid 184
Solomon's seal 757
ProBt-bite. Alcohol 174
Aluminum acetico-tartarlcum 188
Copaiba 398
Hamamells 606
Lanolin 152
Thiol 893
Furuncle. Aiumlnum acetate 185
Alumnol 188
Arnica 283
AAaprol 643
Belladonna 265
Calcium chloride 293. 294
Calx BUlphurata 293
Camphor 801
Carbolic acid UO
Collodion 389
Echinacea 441
Elgon 441
Egg-8hel Is 295
Ergotin , 447
Qutta percha 341
Hydrogen dioxide 249
Ichthyol 550
Iodine 572. 677
lodol 661
Iron oleate 328
Kaolin 320
LInum 601
Liquor gutt% pprchw 442
Massage 1006
Menthol 637
Mercury 628
Opium 686
Phenol no
Phosphorus 7M
Potassium chlorate 769
Pyoktanin 630
Silver 229
PAOS
Furuncle (cont'd). Sliver oleate 128
Thiol 551, 898
Wheat-flour 906
Yeast 464
Galactorrhoea. Ergot 449
Gall-bladder. Overdistension of. As- '
piratlon 1143
Gall-stone. Amyl valerianate 200
Cannabis Indica 307
Garduus Martanus 316
Dioscorea 437
Electricity 971
Enteroclysis 1151
Ether 160
Glycerin 498
Olive-oil 664
Sodium salicrlate 842
giycocholate 843
Salicylic acid 136
Turpentine 885
(See Calculus.)
Gangrene. Heat 1114
Mlcrocldln 642
Salicylic acid 184
White-oak bark 777
Gangrene. Hospital. Bromine 274
Gangrene of Mouth or Tongue. Chlorine.. 347
Gangrene of the Lung. Carbolic acid ... 112
Chlorphenol 417
Creosote 410
Eucalyptus 464
Myrtol 637
Thymol 900
Turpentine 886
Gangrene, Senile. Hydrogen dioxide 249
Gangrenous Pulps. Aristol 898
Gastralgia. Alum 186, 187
Arsenic 97
Belladonna 256
Bismuth 268
Cannabis Indica 307
Cerium oxalate 323
Charcoal 316
Chloroform 343
Coca 377
Creosote 407
Electricity 977
Ether 160
Guaiacot 413
Hoffman's anodyne 161
Hops 612
Hydrocyanic acid 123
Lavender 688
Lime-water 298
Koumiss 694
Manganese '^19
Myrrh 636
Opium 693
Papain 699
Pepsin 706
Potassium dlcarbonate 764
di- hromate 114
Rc^'rrln 783
Sll 230
Solanine 440
Strontium bromide 863
Strychnine 656
Zinc oxide 925
Gastric Ulcer. Atropine 259
Belladonna 1^
Bismuth 270
Cannabis Indica 307
Cbloralamlde 330
Chloroform 343
Conium 394
Diet 1101
Drosera 438
Hydrocyanic acid 122
Hydrogen dioxide 250
Kefir 591
Koumiss SQ4
Largin 597
Lead acetate 753
H 1224 ^^^™^ CLIXICAI
^H PAGE
^H Oaatrlc UIcit (oonVd). Mercury 625
^^^^ Opium 092
^^^^H PotaBsium dtchromate 114
^^^^B Protargol 770
INDEX. ^^^^H
Genlto-urlnary Dtseaaea {ronl'dy
Sodium b€>DWlat0 .. ... .
■
Storax ..,..,..,.,....,...
^^^V
TiTfbon *•«>*•■ ■ •■ **•■•••■•
IB ■
Trillium .,..,.,..*--,.
!.. fdi 1
^^^^^^^m Resorcln
^^^^^^K Silver Dttrati?
..... 7«3
MO
841
GlngiTitla. Hamamells ....-(
m
Glandf>rs Malloln .
,,, , nf
Glandfi, Enlarged Aristol ........
m
^^^^^^^^~ SAJnninn m.
.. ..440
Barium chloride .. ..........*
aa
^^M Ttirpi'ntlnr
884
....156. MD
^K^ Oaatrltls. Alpbanapbthol
640
, . 98
Bstanapbtbol campfaor ..■....>>
641
Calcium chloride ..••.■■■•«>.••*
814
^^^^^B Unxliim nklnot^A
. 247
Carbon dlsulpbld^ ........■....>
^,. tlS
^^^H lilamuth
^^^H Calumba
^^^^B Cupelcum
^^^^^k^^ Coodurango
^^^^^^H DloBcorea
270
297
m
»2
437
438
Conlum
Copper phosphate
Croton-oil . .. ..
m
4M
.... 67J
Blemi
Fucus
4tt
m
Lead Iodide
IchthTOl li,. . . . .........
in
.. . . Ml
^^^^^^B Electricity
^^^^^ Gold
^^H^ Hops
^^^B Hydrastis
^^^H Uyoscyamua
^^^H Iodoform
^^^H Lavage
^^^H Lead acetate it.«..».
... 977
243
512
5«
646
E&a
1049
..... 753
.... 601
lodoforni - -- » .
.... S68
Iodine
... 669, G70 1
475 1
M ercury ► ....,,.,.
cv
Ox-gall
Phenol
ts
Phosphoric acid ....^.**
Pilocarpine *,. .
738
. 7»
m
^^^^^B X«n«*n<i
. . 617
Rumex . •■•....
^^^^B M*i*pnKi' ,,
.....1O06
Sedum .,«..,,»...
^^^H
.... 831
Soap
Tbloslnamln
Zinc chloride
iodide
Glands Inflaniod Leeches ..•...«,
•;:;::::iS
^^^^B NHroriv'^nn
.... 488
^^^^B Nux romtca 4......*
^^^H Opium
.... 652
.... 693
.699. 700
.... 705
. . . 1154
^^^H P«paLn
Glaucoma. An tl pyrin ,
. n?
Arecollne bromhydrate ........
PhysoBtigmine
Pilocarpine
Scopolamine hydrocblorate . • • .
:;::::; 3
^^^^^H P^ni^rAjfi
783
^^^H Sangulnarla
^^^^^H Rllvfr nirrntr
.... 807
230
^^^H Sodium bicarbonate
^^^B Sol&Dlne
^^H StroDtlum bromide
.... 837
.... 440
.... 863
861
Gloct. Alphanaphthol
Alum
644
ne
Arsenic
Botauapbtbol
K
t0
^^^^b TnnnaIMn
879
Boldo
Buchu
Cantburla
Cocaine
Copaiba
Copper sulphate
Creottote ,
406
^^^B Tra^acantb
.... 903
....1048
^^^m Oaatro-duodeoal Catarrb. Clmtclfusa
.... 851
.. 888
^^^B Conduranso ■ . .
.... 392
402
^^^H
.... 418
Bucalyplus
Geranium •
456
487 J
^^^B Hydrastis
^^^^^1 Sitiif^MinBrin . , i
.... 540
807
Orlndella , ,
Qurjun *....»..«...,....
Iodoform .^....
Iron ••<«.».f.**
....469, 473 '
^^^■| \1nna/<fi
.... 617
^^^B Oastro-entoralKla. Jamaica dogwood
^B Oastro-cnterltls. Bismuth aaltcylate
^H Cnlllnnnrila
.... 743
.... 269
... 388
Juniper *....r,'4...,. •• .
689 !
^^^^ ''"tf
. . 402
Load acetate ,,
^^^^^L fr^Tilin
405
Mort'Ury ,,.
Bi
^^^^^H rS><Mn»a»#> nf >n.1l<im
417
Oil of sandnl-wood
Sm
^^^^^M RiKHlypt'in
.. .454
Plnus Canadenaia
mm
^^^H
. 178
Plpslsflewa
BT
^^^^^1 Hyi1rrtK''n dloTlin
... 2.^0
,...1150
Sale!
Sodium bicarbonate
S torai
Tercbcne
Thallln
iiiEi
^^^^m 17ypnr1nfmn/>ly>al>
^^^B
... (Mffl
^^H Sodium pan creaoute 420
^^V Gaatro-lnteaUnal Disease. Arsentum
^ r'y^^ '>'>'>
Thuja
age
^B Tifllnnni of Pfru
.... 246
Trlticum
zs
^^■^^ '^Tll'nnAfiln
358
Turpentine
Zinc acetate
§
^^^^ lobthyol
^^^H Iron-qulnloe chloride
^^^^^" KniimlsB
661
.... 476
594
Goitre. Aristol
MR
Arsenic
•«
^V Oastroptosls. Masaage
1O06
Barium rblorfde
Bromtdea
^
^M Gpnito-urlnary Dtseasea. Acacia —
^^^^ Camphor
^^^B Capsicum
^^^B Codeine * ^....^
.... 87
300
313
.... 383
.... 4R6
Cadmium
mi
Chromic trioxide
Conlum
3M
Electricity
....966. 980
^^^^H Tndin'' irlrbl'TrliltT
.... 679
FucuB veslculoBUS
Hydrlodlc add ..•.,.,
471
, U8
.. .162
... 513
Iodine ■..■•
!;.;;:; IS
ma
Todafnnn
PAOB
Goitre (conl'd). I^ad Iodide 754
Mercury 620
Oimlc add OM
Pby tolacctt TO
Potassium bromide 178
iodide 677
Thymui gland **
OonorrboDa. Acetic acid 92
Aconite 160
Alphanaphtbol 044
Alum la
Aluminum borotannate 189
Alumnol 1 188
Antimony 811
Antfpyrin 710
Apiol 710
ArKentaminn , 888
Arsooln ..,....,.888
Arbutus ......♦•♦♦.,.4.»w, ♦.,.»... 444
ArbutlD IIO
Ronzolc acid 8SS
B<*bortDe bydrocblorato 116
Betanapbtbol 641
Bilberry 810
Bismuth subaitrate 868
subgallate 271
Boldo 872
Cadmium 284
Cannabis Indies 302
Americana 808
Carbolic acid 109
Catechu 881
Chinolin 888
Chloral 838
Cinnamon 8^7
CItrtc acid 116
Cocaine i... .'.<... 876
Colcbtcuro 887
ColtlnBonia 888
Copaiba 888
Copper sulphate 488
Corn-silk ..,,4...- 814
Comutin ...060
Creolln 451
Creosote .«..» ..406
Cubeb -.. 481
Ephedra 448
RrKoIin 447
Ethylenodlamlne-sllTer-phos. solution 882
Eucalyptus 464
Buropben 400
Fablana Imbrlcata 468
Frankenla 478
Gamblr 821
Gaultheria 488
Qe'ranlnm 487
Orlndella ..-.. 490
Ourjun ,,. 603
HamamellB i..,^ SfM
HydrastiD 540
Hydrogen dioxide » 850
Irhtbargan 668
IchthyoT .......* 661
Iodoform 668
Iron 4S9. 478
Kara-kaTs ,*,* ».„. 691
Kino * 691
Kramerla 695
Lanolin 158
Largln 697
Lead acetate 762
Lysol 747
Mercurol .....688. 687
Mercury 684
MethylpDo-blue 689
Oil of crigeroD 158
Parsley , ....,,.. 710
PInuB Canadensis ,. 789
Phenol 109
Pomegranate 498
Potasaa hydroxide 786
Potaaalum bromide ..•..,....• 876
perraangauate 819
silicate 8»
Gonorrhoea (eoni'd) . Protargol —
Pyokianin
Pyrldln
Quinine
Resorcln k
Retlnot
Sage
Salol
Sandal- wood oil
SllTer nitrnle
Soiipwort i
Sodium bicarbonate '\
SCorax , ]
Styracol i
Tannic acid <
Tnnar emetic «
Thallln
Zinc acetate i
chloride .......4. ..,
iodide i
pprmaoganate
sozolodol *..*...*^f..
aubgallale .......... ».i.. ,...«.
Gout. Aconitlne ointment i
Aoetone I
Aii-ohol I
AKhii'a i
Ammonium phosphate i
Antlpyrin J
Asaprol i
Aaapargin i
Cannabis Indies i
Cocaine i
Codliver-oll
Colchlcum i
Collodion j
Conlum A
Diet 7i
Kiectrlclty ..,1
Gaultheria .i {
Of'ntian ■••.'■<1
Guaiac .....J
Ichthyol I
Iodoform i
Kara-kaTft }
t«ctlc acid I
Lappa J
Ledum 1
Lithium ,
Lithium-caffeine Bulphonate t
Lycetol i
LysldlQ J
Huak i
Opium i
Peppermint .^ 4
Piperasin i^
PtpBlasewa 4
Potasalum Iodide J
Rbaronufl cathartloua J
Rhubarb 4
Salicylic Add ...J
Bnvlne ,
Sodium acetate .J
phosphate ..«
aollcylate J
Solomon's seal J
Strontium iodide .J
lactate 2
sallcylntB ..J
Sulphur .1
Thermol :,
Trimetbylamin hydrochloride
Veratrlne -
Water
Granular lids. Abrua ................
Bismuth
Copper sulphate ,
Potiastum mntharldato
Silrer nitrate
Grarel. Oom-altk
Hydrangea
Lithium-caffeine lulpbonate
Polygonum
Uva ursi
1226
CLINICAL INDEX.
PAOB
Gums. Inflammation of. Hammamella.. B06
Iodine 669
Myrrh 637
HsmatemeslB. Alum 186
Calcium chloride 294
Ipecacuanha G94
Krameiia 595
Hamamells 506
Iron 47J
Protarsol 770
Pyrogallol 775
Sulphuric acid 140
Hcematochrlurla. Potaasluni dichromate. 115
Hsematuria, Alnua f 180
Alum 187
Ammonium chloride 194
Bursa paatorls 283
Cannabta Indlca 307
Cantharia 310
Corn-sUk 614
Cornutln 460
Ergot 448
Gallic acid U7
Qualao 503
Hydrogen dioxide 249
Iron 478
Iron-alum 187
Krameria « 596
Idnum 601
Phyaosttgma 732
Ptperazin 741
PtpBissewa 327
PotasBlum chlorate 769
Quinine 360
Rhus aromatica 790
Sulphuric acid liO
Sodium thloBulphlte 838
Trillium 903
Turpentine 885
Haemoptysia. Alum 186
Apocodelne 694
Atropine sulphate 259
Calcium 314
chloride 294
Cetrarla 324
Chloral 333
Corn -smut 615
Cotamine hydrochloride 860
CottoD-root bark 497
Digitalis 434
Ergot 448
Gallic acid 117
Gelsemium 485
Hamamells 506
Hydraatinine hydrochloride 542
Hydrastis 542
Hydrogen dioxide 250
Iodoform 558
Ipi cacuanha 582
Iron 468
-quinine chloride 476
Lead acetate 754
Matico 623
Monesfa 633
Morphine 693
Oil of cinnamon 367
erlgeron 658
PotaBslum nitrate 767
Pyrogallol 776
Quinine 360
Shepherd's purse 283
Sulphuric acid 140
Tannic acid 148
„ Thuja 896
Hemorrhage. Acetic acid 91
Agaric 166
Alcohol 176
Alum 185, 186
Arnica 233
Atropine 2r>9
Benzoin .' 264
Bryonia 282
Bursa pastoris 283
Calcium chloride 294
rA9m
Hemorrhage (conl'd). CannablB laAca. .. 3i/7
Capsicum 314
Chenopodium album 3ST
Cbioroform 341
Cinnamon 36$
Copper sulphate 423
Cotarnine 8«»
Comutin 4S0
Cotton-root bark 4:^7
DiglUlla 434
Ergot 4*8
Ether 1«
Ferripyrln T25
Gallic acid 117
Geranium 487
Hamamells 506
Hydraatinine 540
Hydrastis Ml
Hydrogen dioxide SO
Injection of normal salt solution Ml
Ipecacuanha I^
Iron 461 4T1
Iron-qulnlne chloride 476
Koumiss 594
Krameria S^
Largtn '3',
Lead acetate 7S4
Lycopus 61*
Magnesium sulphate 611
Mango 6J1
Matico 6:2
Myrtol €17
Oil of erlgeron Sii
of aandaT- wood 670
Opium 690
Physostlgma 72
Plperasln TO
Potassium chlorate 757
nitrate T6:
Savine 7^7
SlWer nitrate O
Sodium chloride 841
Styptlcin S«^
Sulphuric acid l^
Thioform ttZ
Transfusion of blood 114»
Turpentine 8S
Veratrum 9li
Xanthium 9U
Hffimorrhage, Post-partum. AceUc acid.. 91
Digitalis 43*
Ergot 44-4
Ether 16»
Hydrastis 54)
Injection of salt solutloo 84:
Iron 4*<
Ipecacuanha l%i
Nux vomica 6C
Turpentine SSr>
Xanthium Il»
Hemorrhage. Puerperal. Caffeine sodium-
benxoate 2**
Hydrastia 54>
HAmorrbage, Uterine. Antlpyrin 7J*
Bryonia 285
Capsicum 314
Chloroform 341
Chromic trloxide 133
Cinnamon 36T
Cotamine 860
Cotton-root bark 4&T
Ergot 4i<
Hamamells S06
Heat U14
Hydrastlnlne Ml
hydrochloride 542
Hydrastis 540
Ipecacuanha ^-85
Mistletoe TIS
Salipyrin Ttl
Savin T»:
Senega 835
Senegtn T7>
Sodium chloride 841
^^^^^^^^^^^^^^^^ CUNIOAL
^^ PAOB
Uiemorrbage iront'd). Sulphuric acid .... 140
(See also HenorrhOQia and MetrorthOQia.)
Ujemorrhagic DIatbeals. Bone-marrow .. S12
Calcium cblortde 294
DlKltallB 43ft
TraoBfusIon of blood 1146
HsmorrbotdB. Aloes 188
Asiatic pill --- -- T40
INDEX. ^^^^H
Hay Fever (cont'd). Eupfarasta .
Grindella
1
1
Heroine
J
lodino . . .1 .*••■... ..
il
Lime, chlorinated .*...>
Menthol
Morphine
Opium ...■■
••
BclladonDiL . ...........
X6
Phenol
Quinine
Resorctn
Terpene hydrate ...••
:::::::^|
Bruclne
Burgundy pitch
Bl
744
Carbolic acid
.,,. Hi
Caator-ol 1 *
M7
Valerianic ether
J
ObroxDlc trloxida •..*•
,, U8
Headache. Acetanlllde
Acetpbenctidin
1
■(
Cocaine
Colllneonia
Conlasn
.......376, 178
S88
SM
Aconite . ........
i
Ammonia
,... ,
Copaiba
Crocus
Crovfoot
Cubcb
400
421
778
4fl
Antinervln *..*.
Anllpyrln ••».......
*
Bandage
Bny - rum
Ergot
OaTllo acid
Oails
Qlyccrin
447
m
480
498
B<*bceru-bark
Brain and spinal extracts
CafTolne citrate
Camphor
HnmAni''llfi ,
BOB
Cannabis Indlca
Cbloral
i
Hydrastis
Iodine
gg
........... 678
Cimloifuga
Iodoform • •
S68
Coffeo
Iron
Jalap
KramerlA «
468
686
... ... S8I
Cold
applications
Croton>rbloral
Lappa
5M
Cypripedlum
Lichens
3S4
Damlana
1
Llnuxn
,,, 101
DIgltallB
Ergot
Ether
i
.]
Logwood
504
Menthol
US
Mercury ,,
.,.,. 621
Eucalyptus
1
Mullein
9]6
QelBemium
;.:.;;;!
Myristlca
885
Quarana
1
Nitric acid
115
Hydrobromic aeld
Hypnotism ...**. ..i.t
••"*
Nut-gall
480
Nuat vomica
Oleatfl of brucine
OHve-oll
653
661
B64
Uox
*'i
Iris
'MV.l'Ji
Maaneslum carbonate
....... 1
Pepper ,
740
MalaklD
...... 1 1
Phenol
Ill
Mescal buttons
MigralniD
Mustard
.;:;;:::3
1
PInus Canndensls
739
Plscldla
742
Potaasluui bitartrate
bromide
chlorato
146, 766
m
768
Nickel bromide
Nux vomica
Paraldehyde
1
•»
Rectal Irrigation
1161
Kbubarb
789
Phenacetin
■
Solomon's seal
757
PhospfaoruB .
*
Stlllingla
861
Physostlgmlnc
■* *•
Stramonium
852
Podophyllln
Sulphur
873
PotasBium bromide .......i.
Sulphuric acid
U8
Tea
Thymol ...■....«•...
..'..'..J
Tannic acid
,,.. 142
Tanooform
.......*... 880
Tbyroacetia
Toly pyrin ....*.•.•.«•••<
■ t«*«a«l>
Tar-olntmeot ,.,,
....^ 746
Teucrlum #..».#•..
888
Turp»*ntlne •.•>•
"*** **
Xantblum
919
Valerion
Zinc subgallate
923
Valerianic ether
Hair. Atrophy of the. Adepa
Lanolin
Hair. Loss of. Alcohol
Klectriclty
UnsD or
158
m
fi3a
Vinegar
Zinc valerate
Heart Disease, Functional. Aconite ..«
Adonldln ..«.. -- '
Hair. Pnmature Orayneas of. Bleclrieltr. 138
Halluci nations. Dubolalne 4M
HypDoUsm ,...., IIM
Belladonna
Cactus ■.
:.::::^
Cam phor
Compound spirits of ttber .
Convaliaria majalla ..........
1
Hsy Fever. Ammonium iodide
Arsenic
578
67
Betanaphthol *.*
Cannabis Indlca .,«..••
641
307
Electricity *
Eucalyptus
■ •***••■
Carbolic add
Ctlmatotherapy *,v
Cocaine *..■..*••.•
uo
1076
872
HofTaian's anodyne
Hydrocyanic acid
Lyoopua
Nitroglycerin
Opium . .*>...••
• ■•••••1
Coclllana
882
Comnound line stearate ....
850
Gubeb
421
Potassium chlorate
!;:.':!!l
^_ Dmaera
488
Sparteine aulphatn ... .
SUDlbul
]
^^^B miiphtrrMn fltiillfitra
,. 468
^^^^^^s
«
1228
CLINICAL IND£X.
PAQB
Heart Dlaeaae icont'd). Veratrum 914
Wild cheny 772
ZiDo cyanide 926
Heart Disease, Organic. Apocynum 224
Adonis Ternalls 1&4
Amy] nitrite 199
Arsenic 97
Barium cblorlde 247
Cactus 284
Caffeine 287
Casca 318
Cbloral 334
Chloralamlde 330
Convaltarla majalls 397
Cratagus 403
Coronllla 401
DtglUlls 438
DIureUn 891
Electricity 974
Orlndelia 500
Oualac 502
Hyoscyamus 546
Iron 478
Lead acetate 754
Lycoptts 610
Haasage '....1001
Mercury 525
Oleander T 656
Opium 689
Oxygen 1026
Paraldehyde 701
Potassium chlorate 768
Sodium bicarbonate 837
Sparteine sulphate 820
Splgella 848
Strontium Iodide 854
Stropbanthus 857
Veratrum 914
Wild cherry 772
Heart, Fatty. Clmlciruga 351
ConTallarla majalta 396
Phosphorus 726
Sparteine sulphate 820
Strychnine 654
Heart, Weak. Cactus 284
Cardiac tissue 212
ClmJclfuga 351
Com-sllk 614
Kola 593
Mescal buttons 203
Opium 689
Squill 818
S^ychnlne 653
Testicular extract 206
Trlonal 868
Mistletoe 918
Heart-clot. Aqua ammonlss 196
Heart-failure. Amyl nitrite 200
Camphor 303
Coffee 384
Ether 160
Stropbanthus 867
Heart-exhaustion. Ammonia 198
Capsicum 313
Hemianesthesia. Amyl nitrite 199
Anttpyrln 719
Caffeine 286
Electricity 966
Euphorltt .' 469
Massage 1006
Hemlcranla. (See Miffraine.)
Hemiplegia. Damlana 430
Faradism 966
Strychnine 664
Hepatic Disease. Darberry 266
GarduuB 816
Diet 1062
Dloscorea 487
Irts 685
Koumiss 694
Nitrohydrochlorlc acid 126
Ox-gall 464
Sodium bicarbonate 836
phosphate 727
PAOB
Hernia. Bandages U44
Belladonna 2S7
CltralUn 3»1
Collodion 390
Ether W6
White-oak bark 777
Herpes. Acetanillde »
Alcohol IT*
Alum 'M
Anthrarobin ~ ■
Arsenic ^
Camphor S-i*
Cererlslne 4*4
Buphorln 4j9. 461
Europhen 461
Hamamells atia
Iron 461
Liquid air r.l»
Mercury 511
Nut-gall t»
Resorcln TW
Rhus toxicondendron TSJ
SllTer nitrate r»
Tannic acid , 144
Thllanin «
Thiol SM
Yeast 464
Z tnc oxide 9:3
Herpes Zoster. Aconitlne ointment H$
Alcohol in
Bandage 1144
Belladonna 254
Bismuth subgallate 27:
Cherry-laurel 5S7
Chloralamlde 310
Coca 375
Collodion ZS
Conlum 394
Electricity >i4
Europhen 461
Oaultberia 4fi
Hyoscyamus M*
Ichthyol uv,
Lead TSCi
Liquor gutt» perclus 441
Massage lOOC
Menthol C6
Methylene-blue t>
Morphine oi
Phosphorus r»
Pyoktanln t.:
Veratrlne 53
Hiccough. Absinthium %
Amber v.Z
Apomorpblne TS
Belladonna ;'j6
Camphor soi
Chloroform :4Z
Cocaine 377
Compound spirits of ether i<i
Musk G4
Mustard fS\
Oil of cajuput C'
Opium ®i
Pyoktanin t:
Pilocarpine 738. T>
Sulphonal t46
Tobacco 878
Hlp-Jolnt Disease. Oualacol 414
Hydrogen dioxide Uif
Hoarseness. Alumnol 188
Borax l«
Coca J7T
Coclllana »C
Collinsonla 3fn
Oualac 5n\
Liquorice 416
Nitric acid IS
Potassium nitrate 766
Horns. Arsenum oleate 127
Mercury SSi
Hydatid Cysts. Turpentine 186
Hydnemla. Iron 60
Hydrarthrosis. Iodine in
CLINICAL IKDEX.
1329
PAOB
Hy drocf 1«. Aflplratlon 1U3
Carbolic acid ;...B8, lU
Chloral a34
Iodine K9. S7S
Mercury &Xi
Pheool S8. Ul
Stiver nitrate Vl»
Thuja BBS
Hydrocele of cord. Infaotlle. 8«toii 1156
I UypopiTicardlum. Aspiration 1143
> Hydrophobia. Cedron B2a
Cold applications 1117
Curare 4M
Bohtnaoea 40
Oeleemlum 486
Pilocarpine 738
Stiver nitrate KB
Hydrothorax. Aaplratldo 114S
Dlgltalla 436
Scoparlus SIO
Hypprtealbesia. Cyprlpedium 429
Prankltnlflm B25
HypersathoBta of Urethra or Bladder.
Antlpyrln 976
HyperPToeslB. Orexine flB(
Uyperldroats. Aguraein 188
AJcohol n«
Alum 186
Aluminum oleate 117
ArlBlol 888
Belladonna B4
DetaDapbthol 640
BlamutA aubgalbUe 171
Calcium 881
Can^borlc acid BM
Chromic trloxide JJM
Compound zinc stearale 850
Copper 414
Diachylon ointment 756
Formalin 608
Ergot 448
Buropben 461
Hamamella 506
Hydraatin 540
Hydrastla 540. 543
Naphthalene 639
Picrotoxin z 387
Pilocarpus 715
Prepared chalk 891
Qulllaja 779
Sodium tellurate Sa
Sulphuric arid .* 140
Tannoform 879
Zinc oleatp 129
Hypertrophies. Nasal. Chromic add .... 113
Iodoform 568
Trichloracetic add 146
HypoehoDdrlaslB. Asafetlda 888
Caffeine 887
Ctmlclfuga 860
Cyprlpcdlum 49
Qold 243, 244
Kola 688
Light UBS
Mescal buttons 808
Music 1189
ScammooT 817
Testicular extract 806
Hypopyon, Hydrogen dioxide 848
Scopolamine hydrochloride 882
Hysteria. Ally) trlbromlde 179
Aloea m
Amber 888
Ammonia 184
Ammonlntrd copper •.«».... 4. 486
Ammnnlnm valerate ..•...•«■*•■•. 800
Amy I valerianate 880
AnUpyrln • T19
Apomornhlne 885
Asaff'tlda « 188. 886
Belladonna •.•■#*•>*•• 867
Bromides • 875
Camphor 802
Campborle add •••#<•« «.. 806
PAOB
liyBtorla {cont'd). Castor 320
Chenopodlum 327
Chloroform 342
Cimicifuga 351
Cold , m?
Coulum , a!>5
Dormlol , 836
DracoDtlum 438
Ether 160. Ifil
Eui;alyptol 454
KrankllDlem 875
ooia : -
UolTman'a anodyne , II
Hops
Hydrotherapy ............lOi
HyoBCyamua -.... 54^
Hypnotism D03
Iron 472
Jamaica dogwood 743
Lavender , 6B8
Leonurus ,....,.,.... 593
Lobelia 608
Massage 1Q06
Metal lotherapy iili
Monobromated camphor 302
Musk 634
Oil of rue 659
Paraldehyde , 701
FhOBpborua 736
Pulaatllla ., 773
Rosemary 793
Sangulnaria 868
Simulo ., , 880
Sodium phosphate ......,.* , 83d
Spartetne sulphate 821
Sumbul 875
Teucrlum 888
Valerian 196, 911
Virbumum opulua 916
pninlfolium , 916
Zinc sulphate .,... 921
Hystero- epilepsy. Apomorphlne 224
Dubolslne 4lO
Frankllnlsm 975
Nitroglycerin 489
Pilocarpine 73*>
Strontium bromide Rl>3
Valerian 9! I
Viburnum pninlfolium 916
lebthyosla. Glycerin 492
Lanolin 163
Resorbln 198
Icterus Neonatorum. Galium 480
I dlocy. Chloralamlde 330
Dubolslne 439
Impriigo. Arsenic B9
Copper sulphate 484
Iron 469
NltHc add 126
Phenosalyl 112
Quinine 361
Sosotodol 847
Sulphur 871
Impetigo Contagiosa. LanollB 158
Mercury ,. 683
Nitric add 186
Salol 800
Impotence. Cannabis Indies 807
Cantbaris 811
CImlclfuga 361
Damlana 480
Electricity 965
Gold 843
Johlmbln 687
Polygonum 757
Potassium bromldo 877
Sangulnaria 808
Saw-palmetto 796
Sonedo 884
S'>rpcntar1a 828
StrycbDlne OU
Inanition. Rectal alimratatloa 1164
iDcobtlDSDoe of Urine. Antlprno
1 1230 ^^^^
^H lacontlneuce of Urine (cont'dy.
^H Benzoic acid
^H Buchu
^1 Camp>)orlc add
^H Caiitharls
^H Chloral hydrate
^^H ^nltiMTinnln
CLINICAL
PAOB
Belladonna. 258
262
282
305
310
S38
888
IKDKX,
Influonxa (cont'd). Tolyaal ....
Trioual
Turpentine ...
Ingrowing Toe-aall. Camphor
Caustic SK>taab
Tannic actd
Insanity. Atropine
Cannablne tannate
418
868
885
aoi
768
143
ts»
308 1
^H Collodion
^B Coro-silk
■ Cubit)
^m Kipctrlclty
^m Ergot
^M Fablnna ImbrlcaU
^m Fonuatea
^H Galhim
^H HyoBcyamut
^H IroD
^H Mansanlta
■ Matlco
^H Potataluni citrate
^H Rhus aromatlca .........
390
614
422
S80
■;:;:::::;^:lg
116
480
516
478
621
62'^
766
7M
Cbloraloee
Colo
886
403
Duboieia
419
Gualacol
.../. 418
HyoBiyamue
Hynoptlim
54T
, HOT
Iron
478
Music
1137
Sulpboual ...-M
886
Thyroid extract ,
, 807
Insect-bttcB. Ammonia ......*
193
Betanaphthol
Carron oil
610
881
^H rndtmnn
79S
Qedron
,., ,, , , ns
^H Pnntnnfn ,
,, 810
Chlorine
.::;!;.::..: tS
^H f^fnnn
8tt
Cocaine ,
^<'hlnBcf»a J
878
441
^H Ptryhnlnf , , ,
,.,., 660
^H Tfilypyrln , , .
7W
TpernruRsha
SS8
^H TiirTTAntfTir'
886
Potaaaium bicarbonate
Rhus toxicodendron
764
7JJ
^M iDdlgesUon. Aloea
^H Annfrtifli
183
235
Sodium bicarbonate
g-m
^H Cascara Mgrada
^m Cannabis Indica
^H Dloacorea
^H EuonymuB
^B Gamboge
^B Glycerin
^m Lime-water
^m Magnoatum carbonate ...
^m NuK vomica
■ Ox-ffall
^M PancreattD
^m Plcrotoxln
^m Potaaaium bltartrate
^m Rochclle Bait
H Rbubarb
^1 JnflltrattoEi. Mercuric oleate
^H Inflammation. Alcohol
■ Blood-letting
■ Cold
^H HnmnmfUn
786
^fl
437
4S6
2M
493
383
618
6S6
464
688
730
145
116
189
1J7
174
......U46
UlT
605
Insomnia. Alcohol
176
Amylonc hydraa
Apomorphlne
Brain and spinal extracts .
Bromides
CannablQ tannate
Cupslcum
an
228 1
206
196. 876
806
814
Chloral
Mj
Chloralamlde
Chloralose
m
... 836
Cbloretone
Climatotherapy
Codeine
8r
1078
888
Convallaria majalla
Croton chloral
Cyprlpodlum ,.,..
888
83S
429
Dormio]
, S36
Dubolslne .*....
Ergttt ,
m
4G0
Bschscholtzia *..
451
^B Hrnt , , .
1114
Gelacmium , »..
485
^H Llnum
^H Stnrch pniiltlff
:.:.::::::::.6oi
nt
Gold
245
Hops
Hydrotherapy
618, sia
,,., 3041
H SUtic electricity
^H Influenza. AcetanlUde
^H Acrtphenctldin
^H Amyl nitrite
m
88
7U
800
:. 22S
HyoBcine hydrobromlde ....
Hypnal
847. 822
648
Hypnone
Hynopttsm
Jamaica dogwood
Methylal
648
1101
7«
....^... 628
^M Arsfnlc
^^B Annnml i i i
86. 100
286
^^1 Anpirin i
..,, B40
Music
1117
864
Mustard
Paraldehyde
Pbenacotln »••*».*
831
701
711
^H Pnliinihn ,,,
808
^H Cnrhnllr arid
110
Phosphorus
788
880
Pilocarpine »..
757
H Cocillana
^M Crposote
■ KucalyptuR
■ Htmrchirhitl
■ OeUemiuir,
■ Oualacol
^m Knln
888
410
466
918
485
100
fits
Potassium bromide
riH
Somnal
$16
Spirit of nitrous ether
im
Sulphonal
860
Sumbu!
875
Tetronal and trlonal
TbymQccUn
m
<M11
^^ Luetopbcnln
^K Mlgminln
714
738
S'.G
Tolypyrin
718
Urethane
Vibration
161
1018
^^1 Oil nf aandal-woad ....
670
Wild rht-rry
772
712
Intertrigo. Aluminum oleate .
Bismuth
IfslaHaZ.)
IJ7
270
^H Phrnni
110
»., 737
^^1 Oiilnlnr
361
Cacao-butter
Chslk. prepared
Compouad sine stearate ,.
Ichtbyol
893
898
8GD
^H finltrin > > . ■
781
, 7a
^H Pnlnrnll
nt
, BGt
ai«
Kanlln ..
san
PAQB
IntertriBO iamt'd). Ljrcopodlum 610
Starch "^01
Suet 828
Intestinal Disorders. DalBam of Peru — St44
Blamuth 271
Cbamomlle 2^0
IrrlsatloD of bow«l * 11I>1
OlUe oil 6W
Ox-BBll , 4W
Salicylic acid IM
Thymol HW
IntesUnal Obstruction. Belladonna 267
Maasa^e 1006
Intussusception. DIstonslon of bowel 11S3
Potasalum broraidt.- £76
Sodium bloarboQoto 836
Iiidoeborolditls. Mercury 520
Iridocyclitis. Jamaica doffwood 7t3
Irla, Adhesions of. Physostlgmine 730
Iritis. Aconite 150
Blood'iKUng 1145
CantbarlB SIO
CocAina , S71
Copaiba 400
Grindclla i9»
Jamaica dog:wood 743
Mercury , . , 5S0. &23
Pilocarpine 785
Pyoktanin 630
ScopolamlDe hydrochloride 822
Sodium salicylate 136
Tonga 902
Turpentine 8M
Irritable Stomach. Bismuth 270
(See TomiUng.)
Jaondlcc. Aloes Itl
Ammonium chloride IM
Iodide en
Apocynum XU
Calcium phosphate ......•.........■■«•. SM
Carbollo acid ^.,.' 109
Chelldonlum 326
Citric add 115
Enteroc lysis 1151
Euonymus 4'.$
Fablana imbrlcata. 463
Onlliira 4B0
Iodoform , , .,., GtO
TpecacuanhA 584
Iris S»
L'moii 600
Manaca 619
Manganese 6lii
Maasage 1006
Muscarine ....166
Ollve-oll 664
Ox-gall 46S
Phenol .,,., lOfl
Pilorarplne 737
Podophyllum , 756
SanRulnarla 607
StllllnRla 6E1
SIlv».r nitrate ttl
Sodium bicarbonate 667
glycocholate 641
phosphate TIT
TnTtiTflpiim 861
XonthoTvlum 661
Joints. Dle^anrs of. AoctphenettdlQ 716
Camphorated naphthol 641
lodlni- 660. 571
Mcrptiry 534
Jofnu. InAamed. Amroonlae plaatsr 189
Belladonna IBl
DIgitalli 463
EllemI 4«
leeches 1<^iO
on of pine 6«6
Rbnt'ranry 706
Btnimonlum ointment 663
Turpentine 886
Veratrine 818
Joists. Tuberculoals of. Forma1d»hrde .. 604
Joints, Tuberculosis of {cont'd), lodol
Zinc chloride
Keloid. Electricity
Ichthyol
Iodine
Thiosloamtn
Keratitis. Abrus or Jcqulrlty
Atrol
A rtBtol
Electricity
Euroiiben ,.,
Pyoktanin
Sodium cacody late
tetraborate
Kidney, Disease of. (S«o Renal Z>(M(
Labor. Arbutln .,
Corn-smut «..«
Cotton -root
CrcoUne InJectlOD ........
Ergot
Hydrastis
Mistletoe
Monesia
Strychnine
Labyrinth. Deposit Within. Pilooai
Laceration of Corrlx Uteri. Cocaine
Lacrymal Duct and Sac. Dlseasei
Protargoll
Lactation. Agariein
Antlpyrin ,.,,
Cnslor-oll loaves
Pfrrosomatose
Koumiss
Galcga ,.,,
Hops
Lactosomalose
Malt llQuors
Morrenla
Phosphoric aotd
Pilocarpine _.
Potaaslum Iodide
La GrSprv*. (Sep Inftucnsa.)
Laryngismus Stridulus. Belladonna.
Chloral
Cbloralamldo
Codllver-oil
Conlum
Oelsemlum ,
Gold ,
Ipecacuanha
Lobelia ..,,
Musk
Quinine
Laryngltla. Alphanaphthol
Adrenalin
Antlpyrin ,,.p,...,.,.r.p,,T'
Artstol
Bandage
Benaoln , ,
Camphor-menthol i
Chlorphenol t«i
Cocaine ...,..,..„,.,,..
Cold , ,
Conlum ,.,,
Creosal ,
Creosote
Croton -oil , .
EriodlctyOD
Formalin
Gold
Lobelia
Massage
Mercury ,
Opium .-
Potassium dichromate
rantharidate
RumcT ,
Saw-palmetto ........... .
Silver nitrate
Sodlutn henxoate
Tar ,.
Thymol
Tufpeatlne ,
H 123? ^^"
CLINICAI
PiLOB
210
INDEX. ^^^^^
Leucorrb(Ea (cont'd). Helenln
HvdrastlnlDs hvdrochlorlds
1
^m Ergot
^H iMXynx, nis^asos of. Alumnol .
464
188
KH
Hydrastis
Iroa -
'.'.410'. 473
^H Crooltu •
^H larynx, SpaBin of. Bromides .
^H CoDium ....' —
^^H Pnnnin . i
408
875
884
ifkfi
KaTB-kava
681
Kraraerla
Lead acutate
nitrate
695
752
754
^H Lurvnx. TubiToulosia of...Adr«DaHn .. 110
^H Anttpyrtn 721
^^m Caiiii)hori'' actd WM
Llfflp- water >
2M
I^ffwood
MaoRO
604
621
621
^^^B Canlbandate of poUaslum ,.
8U
847
Mattco ,
Myrrh
Pambotaoo *..
628
637
697
^^^^H nAMMl<«A
J7X
.,„.. ISO
^^^B Creosote sulphorlctnate .....
188
461
Pfireim
70S
Pbcnol
PlDUs Ganadensis ..,.
108
739
^^^^H
DM
^^^H Pucbain
^^^B GuaiBCol
418
600
Potassium bicarbonate ...........
7S4
permanKanato ,,,
6U
Plpnlsftpwa ..••««*t«*
317
^^^B Trrdtir
578
Solomon's Feat .....•..*•.....■...
» 767
^^^^H tr.Ar,ff^wm
559
Tannic acid *
144
^^^H 1»rf»l
BBS
Thymol
Uva ursl
800
910
^^^^H Mn*ln
113
^^^^ft MfTirhnl
«7
Whito-oak bark ,.-..
777
^^^^^^H Nnphthol. camphorated ....
611
69.-,
Zinc chloride
Leukiemla. Arsenic
828
99
^^^^^^^P Ptinaln
S99
nprberlne sulphate ,.
BoDC-marrow ,,,.
266 >
212
^ Por&cblorphenol
^^^H Rcaorcln
418
788
796
Climatotberapy
Creosote
1070
4U
^^^H Sodium fiozolodol
^^^H SulpborclDatc
847
138
920
Leukoplakia. Balssm of Peru ......
246
Elvlladonna
Potassium Iodide
Resorci o
3S9
573
... . 788
^^M Alumlniini
18S
^1 Laad l^lHuulug. Alum
^^m P'^lln^onna
187
260
Lichen. Arsenic
97
Carbolic odd ...,.
.... , 186
^^^H Kvr1rin/1lr> af>iA
118
Oil of cade .,...........-,,
...... 657
^^^H
S18
Silver nitrate ,
za
^^^^K PnrnaNtiim hmtnlri*
178
Tar
745
^^^^^H^ i^AiA^
J7S
Lichon Planus. Massace
......lOOG
^^^^^^^■Rnftlnm mi1|ihl<«a
S4I
Oil of cade r. !,,
... .067
^^^^^^^^ultrrrtinlnp ,,, ,
65i
■Pyraloxln
Lichen Ruber. Massage
Lithsmia. Acidulous waters
Baths
Buchu
776
1006
1048
10S8
288
^^^^^^^■S»nnn»liiin tnAlA^
854
^^^^^^^^^Bl'^frhnr^r* n''f^ ,,,<:
140
^^^^^^^^^tri n op-B r
91
^V Leech-bitos. Acacta
^1 Acptic actd
^M Silver nitrate
H Leprosy. Balsam of Pertt
^H Onnhew-niit
88
91
m
246
M2
Lactic acid
Lithium bensoate
Ozonlzrd water •
124
606
1081
Pipernzln •■..«
741
^^^^ CUituluiuuKra-ull
^^^K Co4)aiba
^^^H Creosote
^^^^fc^ Gurjun
^^^^^^^Gyno>^nrdlc actd
^^^^^^^^HHv^rnrntTlf^
898
411
336. G08
32fi
543
PIpBlppnwa •,
327
Polygonum
7B7
Potassium bitartrate
permaoKanate ,,,.
..US. 7(K
..620. 7«7
ftSS
Sodium phosphate ,*
Sulphur , ,
... .. 873
^^^^K^^m1r\\t})yrt\
Sfil
Llthiasts. Cora-silk -.
.... . 614
^^^H Mercury
680
13S
Fablsna , «...
463
Glycerin ,
498
^^^V Pf*fnw"t"m f^btrrstfT ,
M9
Hydrangea
518 '
^V PYr^Rnll"!
776
Llmc-wttter
388 1
H Testicular fluid
^B Tiflnrftrrhnis Ainiin iii.
906
IBO
Lithla
60G
Litblum-cafrelne-BulpboData
Magnesia
Potassium bitartrate
citrate
888
612
766 1
766
^1 Alpbanaphthol
■ Alum
B BapHala Tw....
. 643
..185, 186. ISR
247
Mi
permanganate .
... . 620
^^B Ttf^1In<1nrTTiR
...;:.;:..;«
Salflt^plol . .. •
. 806
^H Plnmiifh 1 1
868
Sodium bpDnoale
Liver DtBeaso. Ammonium chloride
Chlorine
Cascara amarga
840
184
847
319
^H rndhifn
,,... SS4
^^1 Calplutn DhoBohsts .......
72S
^H rnnthnrin
810
^B rnrbrrllr nrld
109
asgrada ,. ..•••
788
H_ Catecbu , <
^^^_ Colllnsonia ,
^^^B Copper Hulpbate
...sn
.::::::::::«
178
Chlrata -.
Citric acid
329
115
Conlum .t......
394
Buonymus ..... ., .... ,,...,
456
^^^H Oamblr ...., ,, i«.
^V Geranium ....................
^^1 niTcerln ■«■•.■
in
487
. J 4if
Gold
243
Iodoform ^. .„•,..,
Ipecacuanha ^ .„,
Irla . . .....
558
684
585
^H flrindrlln .,,,,
*".:.;;:: m
^^^^^^ TTaninmi^IlK ■ . ■ , r i
KM
.T^rulMbB
ftlE
CLIKICAL INDEX.
1233
(conrJ). L«moa
PAOB
6J0
I^Wftffe 1006
flury 52<
_"_ acid V 12q
robydrochlorle acid 126
^dopbyllum 7S6
tassium acetate 765
^tmex 79'i
tilcarbonate »- . 837
-pboaphate ....TH, &«
tllllngla .-■- 851
tilphur 873
am-xacum 881
Cantboxylum , »20
Hydatid Cyal of. Mercury ^.-. 526
lotor Ataxia. Acetaxilllde *89
itlpyriD 718
, _\a extract S05
AceCphonntidln 7ia
Oannabig Indtca 307
Korclblo flexion , WKt
Krankllnlam 976
Oaultheria 48S
Hydrotherapy 1M8
Xlyoscyainua ,...-. 646
l^aetophenia .*.... 71S
Maaaage tOM
Myelin-alpba 2Q&
Pbysostlstna 7X2
Pilocarpine 788
Potassium dichromate 115
ProUrgol 770
Roentgen mya 1131
Santonin 810
Senna Kt7
Sliver S29
Sodium and silver hypoaulpbit* S30
bicarbonate SS7
pbosphate , 839
Solanlne , , 440
SuHpeniilon **•,** 11^
Testicular fluid »»«
pumhagn. Acupuncture .., »..*.1130
RftUflonna S6S
Chinml hydrate «.. ,,,. 833
rolllnsonln 888
Ethyl chloride l«n
Eunonymus 41*6
Fablana tmbrlcata ^... 463
Oolaemlum 48 1
Gualac 601
Hydrlodir add ..UN
Llgbt V2S
Mustard 831
Plperaxln 7*1
PotosBlum iodide fi78
RoseniAry 798
Sallcln , ,,.. 7M
Static electricity 989
Tartar emetic SKI
Turpentine ...84S, Sffi
Lunea. CoDRestlon of. Alcohol 176
Caffeine \ tTJ
Ergot 449
Oxygen lOZC
Pbysnattrma , 780
Lupus Rrythemntoaus. Beianaphlhol 640
Oacodyllr ai'id IW
Crystalline 890
HamamoUa BQR
Light tlSS
Mercury 581
Pho.iphorun 7'*7
Pyruloxin 776
RiHtnrcIn , 78'J
Salicylic acid 184
Sodium caeodylate 10r>
Kthylate 8:*6
sallcylnte 114. M2
Tar 74B
Lupus Vulgaris. Ae«tlc adA ............ VI
Aliimnol •« 18fl
Arislol 896
Aricnlc Iodide 98
Tt
PAQU
Lupus Vulgaris {cont'd). Arsenic oleati*,9)l. 1S7
Belanaphtbol 610
Blood-eerum -17
Calcium chloride '-iSA
■Camphor 301
Chuulmoogra-oll * ,,...,.,,..,... SS
Cbromic trloxlds ^ lU
Cbrysarobln 849
Cinchonlne todoaulphate 3SS
Clunarolc acid 248
Ciovfs 318
Copaiba , , 398
Eucalyptus 1 4f»6
Kurophen 469
Formalin iOI
Gold and sodium chloride .944
aualacol 4U
Hydrocotyle Stt
Hydroxylamin hydrochloride .......... Ml
Ichthyol , ..!,...,,
Iodine .,.,
Iodoform ....-.,.,
Lactic acid
Light ^......im
Loretln iBt
Lysol .,,,..-.,.. 74T
Merf'ury 114
Peruvian balsam S49
Potaaaium bromide ITS
cantharldatc 811
Pyrogal lol 779
RocDtgen rays 9W, llJl .
Salicylic add .184. SOt]
Sliver oleate , IJT
Soap
Sodium etbylate ,.,
Strontium iodide .,
Tar _ ::m
Thlosinamln ,....„...*. IN
Transfusion 1141
Zinc chloride 9tt
Luxation. Rerurrpnt. Zinc chloride ..... 914
Lyniphadcnoma Arsenic 99
Belladonna ||9
Thymus gland Ml
Lymphnngltln. Silver nitrate 99
Tannic acid 141
Malaria. AcetphenetJdIn 714
Ammonium iodide B77
plcrnte 13|
Antlpyrln 719
Aplol 719
Arsonlc 98. 99
Bcbeeru-bark 94t .-
Benxnnllld -*• •■
Bcrberin**
Bryonia .,
Capsicum Slf
Cedron »,.,.
Chlnoldln
Chinolln „ ««,.
Clncbonamlne Ma^
Cinrhontdlne
Cinnamon Iff
Coffee m
Cornus 491
Cusparla 4171
Cuprelne hydrochloride MiJ
niOBcorea , ,, 4171
Dtta 491
Rucalyptus 4fit '
Ruchlnin
Bunonymus ,.....,,......,.... 469
KraxlnuH 479
Gamboge Ill
(Inrrya rremontll 411
Grntlan 499
Gnnincol 41|
M^l.nln 189
IfilinnthuB annttua MV
Unr4r-cheatOUt - IB
Hiinr.hlohUl 919
Hydrastis 641
Iodine 571
k
1234
CLINICAL INDEX.
PAOB
UalaHa (oonl'd). Iris 685
Iron 471
Ipecacuonba 6M
Z^mon ..600
UunolU 614
Methrlene-blne 628
PamboUno 697
PhenoooU 716
Piperln 740
PodophyUttm 766
PotaMlom nitrate 766
QulnethTUne sulphate 364
Qulnloe 360
tannate 364
gulDoproprllne sulphate 864
UlpTrtn 721
Sodium cacodylate 106
BUUlDgla 861
Strychnine 666
Thuja 8M
(See also F0oer, Malarial.)
Malaria, Chronic. Arsenic 96
Brronla 282
GochlearU 382
Corn-husk 616
DIoscorea 437
Iron 470
PodophjUum 766
Quinine 360
Warburg's tincture 362
Malaria, Pernicious. Quinine 360
Malarial Cachexia. Potassium chlorate .. 768
Sodium cacodylate i(%
Malignant Disease. (See Carcinoma.)
Malignant Pustule. (See A.Mhram.)
Malingering. Bther 161
Mammary Qland, Inflammation. Camphor. 803
Iodine 672
Stramonium 863
Tartar emetic 223
Mania. Amylane hydras 201
Arnica 234
Bromides 276
Bromoform 280
Camphor 303
DIgltolis 434
DuDolstne 439
Dulcamara 440
(Selsemlum 486
Hyoicyamlne 647
HyoBcy amus 647
Iron 473
Mescal buttons 203
Musurd 881
Opium 683
Paraldehyde 701
Pilocarpine 735
S^ammony 817
Sodium nitrate 843
Sulphonal 866
Veratrum 914
Mania a Potu. Conlum 394
Digitalis 434
Oelsemlum iSS>
Jamaica dogwood 743
Valerianic ether 162
Mania. Acute. Chloral 834
Chloralamlde 330
Conllne 395
Conlum 394
Croton-olt 672
Darkness 1128
DigtUliB 432
Hydrocyanlo acid 122
HypnotlBm 1108
Opium 693
Pilocarpine 736
Scammony 817
Stramonium 862
Sulphonal 866
Mania, Chronic. Chloralamlde 830
Ergot 450
Iron 470
Opium 693
PAOa
Mania, Chronic (cont'd). Thyroid extract. 3K
Mania, Puerperal. ClmlcUuga 331
Iron 4?i>
Tartar emetic 23
Maniacal Delirium. Apomorphtne 224
Potassium bromide 277
Marasmus. CodllTer-oU *Jffi
Diet 10«
Rectal alimentation ii't
Mastitis. Kaolin 32-t
Lead Iodide 7$i
Phytolacca 7S
Mastoid Disease. Hydrogen dioxide 249
Measles. Alcohol 17<
Ammonium carbonate l>4
, Calx sulphnrata ;53
Coclllana 3tt
Crocus 43'v
Echinacea 441
CodllTer-oll «»
Euphrasia 4^
Lanolin 1.'4
Lard \:c
Mercury :r
Musurd <■'.
Phosphorus 7:?(
Quinine 3.''.*
Sulphur «t:
Sulphurous acid UZ
Thallln &^
Mel»na. Ergot 44*
Melancholia. Brain and spinal extracts.. 5e
Camphor 3<r:
Cannabis Indies 3r<
Chloralamlde Z.'
CImlclfuga Sii
Cocaine 877
Codeine 3K3
Dubolslne 43y
Cold and sodium chloride 244
Hydrocyanic acid 123
Iron 472
Light 1128
Kola -^
Mescal buttons 9-3
Musk ....♦ 04
Music «»
Opium 92
Paraldehyde ?n:
Phosphorus 7»
Somnal 946
Sulphonal ««;
Vibration ifti«
Meniere's Disease. Ferric ralerlanate ^4
Oelsemlum ViS
Potassium bromide 27'
Quinine 3(>>
Salicylic acid i»
Meningitis. Aconite 15*.-
Calx sulphurata ».'
Cantbarts XlO
Chloralamlde t»
Cold 1117
Oelsemlum ....is'
Mercury SJT
Opium C8>
Meningitis, Cerebro-splnal. (See Ftrtr,
C<rebro-«p<iMil.)
Menopause. Cannabis Indies S»T
Oelsemlum 4SS
Iron |T»
Phy sost Igma n**
Potassium bromide 2TT
Sallpynn m
Valerian >12
Viburnum prunlfollum 9tf
Menorrhagia. Bebeeru-bark MS
Bursa pastorls t^
Calcium chloride XM
Cannabis Indies V
Cimlclfuga Xa
DlglUHs 434
Electricity Ml
(Hlllc add liT
i
PAOV
HenorrbasU (conl'tf). Gold MS
HamamHls 60C
Hjrdraatlnlne hydrochloride 643
IpecacuAOba 682
iron 470
MotlPO 622
Mistletoe 918
Mltchella «33
Monesia , 533
Oil of Migeron ,,., It'>8
of rue 669
PotaHsium bromide £77
Rhus aromatlca 790
Sallpynn 721
SUvor nitrate £ll
Solomon's seal 757
Thyroid extract 207
UTa ursi 910
Viburnum prunlfollum S16
Xantblura 919
Menstruation. Scanty. Aloes 183
Cotton-root 497
Parsley 710
Pennyroyil 506
PhoHpborus 726
Xantboxylum 920
MeostrutttlOD, Suppressed. Hedeoma 606
Opium 691
Pulsatilla ..775
Tansy 879
Mental Disorders. Camphor 802
Codeine SSS
Pulsatilla 772
Mctrltia AbniB 86
Chlorine S17
Croton-oU .», 672
Gold 243
Potassium Iodide 573
Sallcin 799
Metrorrhagia. Arasa 226
Atropine sulphate 2S9
Clmletfuga ISl
nigltallg 48S. 4S4
Geranium 487
HydrastlDlne hydrochloride ^ 642
lodol 661
Ipecacuanha 683
Oil of erigeron 068
Potassium bromide 277
Viburnum prunlfollum 918
Xanthlum 919
Uloturltlon, Frequent. Phenacetln 719
Migraine. AceUnllide <t9
Acetphonetldin 712
Aconite 160
Amyl nitrite * 193
Antlnervin ..» 224
Antlpyrtn 719
Belladonna 168
Caffeine S88
Cannabis Indlca 160.907
Cocaine 878
Croton- chloral SS&
Damlana >>*• 480
Digitalis 432
Electricity •- 874
Errot 4«
Ether 160
Ethyl chloride 16*1
Eucalyptus 455
Eunfaorin 45^
Oelsrmtum ».... 485
Glycogen » 495
Mlrranln i 7S3
Metb7lene-blaa 829
Magnesia 813
Phenacetln 712
Phenocoll *. 716
Plcrotoxln 981
Potassium bromide • 977
Ballcyltc acid ..k..... 198
Tea 388
Vibration 1019
PAOB
Milk, to Promote Secretion of. Castor*
oU 887
Galega
Morreola 639
Papain 699
Potassium chlorate _!
Milk, to Suppress Secretion of. Antlpyrla. 719
Motllties Osslum. Calcium phosphate .... 293
Morbid Growths. London paste 98
Massage 1O08
Rttdlotnerapy 1134
Sodium ethylaie 836
Morbid Growths In Lamyz. Oxygen ....1026
Morphinomanla. Ammonium valerate.... 191
Antlpyrin 717
Apnruorphlne 838
Cattelne 38T
Camellia 9W
Coca 877
Diet 1088
Electricity iflS
Gold 844
Hot and cold applications 1117
Hypnotism UOJ
Massage lOOf
Paraldehyde 701
Pbosphorus ; 799
Potassium bromide 87B
Sodium phOBpbate 839
Sparipl no gJO
Mouth, Atrectlona of the. (See Aphth<m9
StomatltiH.)
Mouth. OperaUons In. Cocaine 873
Tropacocalne 907
MurouB Membranes. Inflammation of.
Belladonna 269
Crfosote 408
Sodium sozolodol 847
Mumps. (See ParoUtig.}
Muscular Cramps. Belladonna 3S9
Sulphonal 888
Mucous Patches. Acetanlllde 89
Chromic trioxlde m
Mercuric nitrate S84
PotasBlum dlcbromate 784
Myalgia. Aconltlne ointment ]48
Ammonium chloride 19|
Arnica 888
Atropine 8B9
Belladonna 386
Bryonia m
Campbor-chlonU SIS
CtnilftfuKa 860
Exalgtn 488
GplupTiilum , 484
Quaiac 501
Manaca gix
Methylene-blue ,, 8V
Oil of cajuput 867
Opiuni 888
PiVPermint ,...., 836
Pilocnrplne 738
• Static t-leclricity 974
Turpentine 881
V#»rBtrine olcate ,,.., 818
Myelitis. AnUnerrln , SSS
MasBagf 1008
Physostlgma 7SS
Sallpyrln tsj
Myocartll tls. Caffeine 987
Opium 898
Myopln. ProgrnsBlTe. Pilocarpine 738
Myrapd^mn. Potassium Iodide 577
Thyroid gland 906. 107
NirVl. Arsrnum oleate 127
Caustic potash 781
Klectrlclty 913
Iron 48S
Sodium ctbylate 88S
Trichloracetic add 148
ZIne chloride 931
Nails. Diseases of. Bulpbnr 874
Tin oleate , 189
^H Nnnal rHnr^nnrn Arrtlr mrld .
CLfKICAL
PAOB
fti
1 N UB^^^^^^^^^^H
Xfuraisu {cont «*. CocAtne
...jfi*fl
^M Electricitr
9n
;., a£2
Codeine •......•.....■..••...
' ' 'Im^S
^^H P«trola.iuxii . ..
7'«i
Codllrer-oil ,--
^oI''hl<'uni ,
'***t^^^^^l
253
^^^K PoUMium pcrmaneaoatc ...
ttO
140
Colocynth
Cocnpound aplrlta of ether
^H
8M
^^^1
^V NephraJcla. Aatlpyrln .,
m
tm
Convallaria maialLa
Cro4-ui •••■■■•■•
..^..^/iH
^^^^^ NrpiirlTlt '^fipfllniTTi , , ,
3li
Crnt on -chloral .....■■..
^■1
J2T
-oil
' flH
^^^H Chloraiamtde * ,...„...
^^^K Cbloral-cAffelne
a»
m
.,.,, SS8
C]rpr'P**dlOID ■■■••paata
b3
DamiaOA
2fl
Dflphlninc ........■•.■•*.
SB
^^^^m
Cl«
Diet :
Electrical for«eU .,..,..„.,...,,
Ergntln ....•.....,■•.•.•
. V ..... V y^i
^^^^^^H
., »\
^^^H
::vM.".9a$
^^^^^^H
456
Etber ••••••^. •...«.
....tSi, lOM
^^^^^H l^..i*_.
490
Btbyl chloride
^^^^H
243
i3i
^^^^H Hjrdrastialoe hydrochloride .
Ml'
Bucbinlo ........................
nH
526
Eupborin ..........■■■«•••■
nH
^^^^^^^^K MTthylTr trlilt
OS
Exfilgin ........... ..... .....
iSI
^^^^^^^H NephrlQ
21*
7W
GqJ van lain .■■•.■■•...■•.■••■•■■•
.2S|
Gaultheria
'" fBI
^^^^^V t>y«b»«ntn
csi
0«laeiniuin
484'!
^^^^^B r^iilnljlina *•«■!*•*
;,... Ml
GlrceroDhoBfihates .............
. TM
^^^^^B Qn^fi. ■.!••■
S90
Gold ... ..:...„..::.:::;::::::
saj
^^^M SpartclDe sulpfa&te
SW
K4
Oualac
ml
Gualaool .,....,,,.....«
:::::: SX
^^^^^H y^p^^nf tf ^if^^if ni»nAf>|ll
..........'tf4
Heat
. ... . QM
^^P NcrrouB Disorders. Arvenlc ....
»
Heltpborin ,
.:::::::»7i
^^■_ CH mate therapy ..■■
107«
Hops .„»,
&iS
^^^^^ r<A>.f»m ^ 1
»«
Hrdrobromic acid ..............
Hydrotherapy ...................
iMk
^^^^^L U|rnAptl«n
UJ3
^^^^^H Im^h
4TS
Hyoacyaniine ...................
"!."«S
^^^^H^ Vryr.lln .atpKa
205
Hyoacyamua ...••■*■*.•.
..IIII.Im
^^V P''***'*tf ^'T I
sn
Ichthyol
^H Wlli "hTry
Trt
Iodine
IB
^^^_ NervouBucss. A»«fetld&
xas
J75
Iodoform
;:::.::: a
Iron
Jamaica doewood
A
^^H Hopa
613
US
Kola "
BV
^^^^^^B
CM
Lactopbenln
Lanolin
"..:;.: m
^^^^^B VAi>*>*l||-ln At'ota—ilXA^
m
^^^^M Acetpheoetldla
712
H». 150
Light
'l^B
Liquid otr
flit
^^^^^B AiwtnUIn*
151. 971
Mal&kiD ,,
^^^H otHte
^^^^H Acupuncture
149
11»
1«?
Manaca ../,l
S
Manganese sulphate
:;""" S
Massage ,.
^^^^^^_ Alcohol
^^^^^^^ft Ammonia
^^^^^^^H Ammofi tatad copper
174
M2
425
1»4
Menlbol V/.lll,
' SiB
Metatlotheraphy -*..-.
MethacetlD
Methyl chloride
■M
^^^^V picratc
^^^H Amyl nitrite
^^^^H Aualeeo -
1*2
1»
I2S
SS4
Methylene-btue
" ^
Morphine ....,..,..,
'tm
Myrtatlc*
Napelllne
Nerve-stretching ,..,...
::-::«
^^^^M Antlpjrrtne
^^^^H AauapuDctur*
.*m
„/. M
Nux vomica
W/k
Opium
Mr
^^^H Aaaprol
s»
KS
Ostium peroxide
OTiferrln
ParotJd-aland extract
M
«fft
^^^^^^^^
1144
^^^^^^^H n>K««,«^i.>..^1r
Uh
Pellltcry
Pepper ,,,
;:::::: m
m
^^^^^^" n*n«/iA«n«
J64
^^^^^F Ronaln
.,,♦,,*-„ SSI
Peppermint ,.,^
Pheoacetln ....,,.,
Pbcnoroll
Phofphorus
:::;:;;•
^^^^^B
* • IM
^^^^^B Ttnnmamlit*
., sgo
^^^H r«#*l«.tt
IM
^^^^B r.fnphAr
800
"""' Ht
^^^^^B
300. S83
Polygonum perslearfg .....
Pyoktanin
>&»
US
TM
ISC
. TSI
fOI
HI
^^^H Cannabla Indiea
SOI
9X0
^^^^^^^_ r'at.Krtfi iflsiilnhMA
SIS
Radium
^^^^^^K
Mg
Rosomary
Sallcin .. t
^^^^^^^H r*>ia*i-v.l>nfM
BOT
^^^^^^H CblnoHn »....
^^^^^H Chloral
..,, »7
a»
aao
Salicylic add
Baiipyrin ......,,.„.,.
Salnph<*o .... ..... ...,,
^^^^^^^^^ Phlftn>fi7rTn
J41, BTi
Silver DitratB
^^^H~ Clmlcifac*
850
Sodium phospbat*
CLINICAL INDEX.
PAOB
Neuralgia Iront'il). SoUnlDe 440
. I>.ce-plu«ter S6«
Sutfc current 974
Stramnnlum S52
Rtrontlum iodld« 8&4
Sulphur 878
Sumbul 876
Terpin hydrate 886
Tolypyrin 722
Tolyaal 41»
Tonga MS
Turpentine 886
Valerianic ether 1S2
Veralrine »13
olrale 91S
Zinc cyanide 9X5
valerianate . . . ; 912. 935
Keu raathenla. Bath* 1068
niood-serum 212
Hraln-citrftpt 206
Chetiopodlum 327
CllmatothPrapy 1076
Codllvcr-oll 660
Cyprlpedlum , 429
Damlona ^ 430
Klectrlclty .,..*.-...... 965
Ether 161
Eucalyptol 4S4
Glycerophosphatea 728
Gold 243
Oualacol carbonate 414
Hops 512
Hydrotherapy ^.. 1048
HynopUsm 110S
Iron 473
LiKht : U23
Mapsage Ift06
Ollve-otI f;64
Orexlne ' 694
Pbosphonui 726
Quinine 359
Sheep's brain 20S
Sodium phosphate 839
Strychnine 6M
Sumbul 875
Suapenaion 1158
Vibration » 1019
NeurlUe, Aretphenetldtn 712
BenzanUld MO
CantharlB 310
Chloralamlde aSO
Colchloum M7
Frankllniam 974
OauUberIa 483
Hydrotherapy 1048
LIfht 1123
Pilocarpine 735
Rubidium 794
NlRht-Bweata. As&rlclQ 166
Alum 186
Atropine 259
Camphoric acid *. *........ 304
Chloral *......» Xil
Cbloraloae M6
Codeine 611
Coto 402
Ergot 449
Gallic add 117
Geranium 487
Hamamella 506
Homatroplne BU
Hydnutlnlne hydrochloride 643
Hydrastis 543
Ipeoac 583
Lpad acetate 7.*>3
Mpihyli^ne-blue 639
Muscarine 167
Opium atl. 692
pppperralnt ,...i 6S6
PhysoatlgmA 732
PhoBphorua 736
Plcrotoxtn ♦ ,„,..... Xi\
Pllornrplne ...*.r ••*>••* 735
Potaaalum telluraU ...* , 767
Quinlntf
:;:;:;:;:3
Nlght-sweaU {cont'd).
RbuH aromatlra . .
Sage
Salicylic acid
Sodium tcllurate .
Strychnine ||
SulphonaJ
Sulphuric add ........
Trional 4..*>.
Vinegar *»*»
Zinc oleate
oxide
NUbgallate
Night-terrora. Hypnotism
Patasslum bromide .. ..
Nipples. Sore. Acaolft ...
Alcohol
Aloea <
AHBtol
Benaoln ■
Bismuth oleate ,
•ubgallate .J
Cacao- butter i\
Cocaine «*'^
Collodion J
Glycerin A
Qutta perrha ••■••i
Gtycerlte of egg*yelk i
Hydraatia J
Ichthyol ^
Iron ^
Lead nitrate ..^
Nut-gall 4
Snxotodol i
Styptic collodion 1
Symphytum
Tannic acid J
Noae, Pharynx, and Larynx.
or. Alumnol
Antlpyrln
Cocaine
Bucalne
Hydrogen dioxide ...
Parafflne
Nymphomania. Bromides ..
Dulcamara
Gold
Stramonium
Nystagmus. Phyaoatlgmlne
Alkaline waters ..
Obeflly.
Diet ..
Dulcln
Pucua vealculoaua i
Lemon
Phytolacca
Saccharin
Thyroid tablets
n^d(>ma. Bandages
Com-allk 4..1
DiglUlla „.
niuretin
Elder
Iron
Magnesia
Massage
Paraldehyde
Pilocarpine
Pilocarpus ,
Potaaalum acetate i
bltartrate •]
ScoparlUB J
fRdt-ma of Olottia. Pilocarpine
GCdr^ma of Lungs. Blood-lettlo|
Elatnrin .■^
Pilocarpine ^
CEsophagns. Stricture of. Belial
OIlTP-Oll ,,
Pancreatin ji\
Potaaalum bromide
Silver nitrate
Suprarenal extract .«
Onychim. Lead nitrate — 4
Lime
1238
CLINICAL INDEX,
PAOB
OpbttaalmlA. AJumnol 1&8
Bebeeru-bark 545
Betanapbthol 641
Calx Bulphurata 293
Cocaine * 371
Copaiba 40O
Hydrogen dioxide 249
Iodine trichloride 679
Iodoform i'M
Jamaica dogwood 743
MiTcury 620
Petroleu m 708
PhyBoatlgmine 731
Potassium permanganate 610
Protargol 770
Pyoktanln 630
Strontium Iodide 8S4
Thloform 272
Ophthalmia Neonatorum. Formatln 604
Protnrnol 770
saver nitrate '£Hi
Sudiuui sotoiodol 847
Optic Neuritis. Pilocarpine , 736
Orchitis. Electricity 990
Euphoria 469
GaulthtTia 482
Ouslacol 413
Ico-bag 1117
Iodine 672
Iodoform &&8
Kaolin 320
Mercury 524
Opium 687
Sliver nitrate 228
Tarur emetic 223
Ob Uteri. Rigidity o(. Apomorpbtne 226
Belladonna SS9
Chloral 334
Cocaine 372
Gelscmlum 486
Osteitis Tuberculoea. Alcohol 17i>
Osteomalacia. Phosphorus 726
Otitis. Abrus 86
Alumnol 188
Aristol 897
Camphorated talol 800
Cocaine 86T
Europhcn 461
Glycerin 493
Hydrastis 640
LacUc add ,.... 123
Menthol vapor 637
Parachlorphenol 418
Pilocarpine 738
Resorcln 782
Otorrhoca. Betanapbthol 641
Creol in 404
lodol 662
Lysol 746
Potassium permanganate 619
PyokUnln 631
Strontium iodide 85-1
Tannic acid 144
;;tnc subgallate 923
Ovaralgta. Belladonna 266
Bromides 276
Cimlcifuga 351
Colocynth 392
Gelsemium 484
Gold 243
Morphine 600
Potassium bromide 377
Sallcln 799
Sumbul .^ 876
Tanay 879
Zinc valerianate 926
Ovaritis. Conlum 395
Croton-oil , 672
Gold 843
Iodine 669
Mercury GT2
Oxalurla. Nitric add IBS
OzEons. Alum 186
Alumnol 188
PAOB
Oeo^aa (cont'd). Aristol W
Bismuth Ml
Bromoform 389
Chlorophenol *. 417
Cocaine cantbarldate ttl
Compound zinc stearate ..t.. 8G9
Creolln 401
Creosote 406
Frankenla 4T8
Gold M
Hydrogen dioxide 340
Iodine CIS
Iodoform fiB9
lodol 6tl
Iron 401
Lysol 74T
Mercury «... US
Ozone IQtl
Papain M
Potassium permanganate 618, 763
Saccharin 2M
Salol 009
Saw-paimetto 701
Sodium Bozoiodol 047
sulphorictnate 1S8
Sozoiodol 040
Strontium iodide 004
Sulphoricinated naphthol 188
Tannic acid 144
Tar 740
Trichloride acid 146
Paget'a Disease. Fuchsia 478
Roentgen rays IISI
Pannus. Antlpyrln 711
Oleum morrbue Oil
Papilloma. (See Warts.) .
Iodoform 060
Parestbeaia. Aconite 140
Alum 100
Antipyrin 710
Balsam of Peru .....140
Belladonna 316
Betanapbthol 040
Borax 101
Boroglycerlde 304
Bromides , 014
Bnicine, olcate Oil
Camphor , 109
Carbolic-acid camphor 001
Cannabis Indies OUT
Chloral hydrate Olt
Coca 075
Cocaine SIS
oleate ... ISO
Collodion S90
Compound mercury stearate 000
zinc stearate flIO
Creosote 400
Electricity 010
Glycerin 40S
Grindella 400
Hamaraeiie 666
Hydrocyanic arid 13S
Iron 460
Leadvater 76S
Lemon 600
Lime-water 891
Lithium , 806
Ijosophan 609
Menthol » 636
Myrlatica • 630
Mercury stearntf* .,,.,,.... 080
Oil of bitter almond lOT
Oleate of bruclne »....• Kt
Peppermint 03B
Pilocarpns TOO
Plperazln T4i
Potassium bicarbonate ........*..*. tOi
hydroxide .«..*...... 700
Pyoktanln Oil
Silver nitrate S80
Sodium bicarbonate
Strontium bromide
Pnrsaibnla {cont'd). StroDtlum
CLINICAL INDEX. V
pAoa
lodldtt... 86i Pemphigus. Areealc .
893 Qptnuanhthal
1
Tumeool
ValerlBu
»oe
»12
Bismuth
Bubgallatc
Hamamells
..•■•■'
Paralvaitt Blectrlcltr
460
Ergot
Rhus toxicodendron
Tar
i
Ijent
nu
Massagv
'
1(106
Thiol
>•>■•<
kiyristlca
$35
Pericarditis. Aconlta .
Cantharls •...■■■*>(
Pflletlrrine . ......
498
Petmleuni
708
Ice
Rndltitn I.I 1 f 1 1
. uas
Mercury .. .#.....*••
.■
Rbuo toxtcodendroa ..
790
650, 654
Opium .
■
Squill
Psrtcornfal Injection.
drochlorlde
Perinephritis. Creosote
Periodontitis. Jamaica
Suprarenal extract .
Periostitis. Iodine
Peritonitis. Aconite ..
»i
doiin
::::"
Testicular duld
Para lysis Afiit&ns. Atrop
Borax
ne ...
2M
^W
]04
307
Chloral
Cocal nc •••.
838
,.. 337
CoDium
Duboialne
3»5
439
Camphorated naphthol .J
Codeine -.
Picrotoxlc
381
Vibration
1019
Collodion
, -
Vlbumuni
9t7
Kaolin
...■taJ
Paralyais, Uulbar. Drain extract
Stry^hniuo
SOS
1001
, flS4
Linum
Magneala
Ilalakla
Maaaaffe
.d
'ii
Veratrino
9]S
Paralysis, Local. Arnica .
Rhus loxicodeodron
Paralysis of the Bladder.
Ergot ■
Paralysis of the Tooguc.
Pellltory
Paralysis. ProgresaWe O
bydrate
SS3
Mercury
_ . T9-*
Opium
'i
Bloctrlclty 989
450
McKereum AX3
71Z
eneral. Chloral
m
Potassium bltartrate
Snllcln
-.»••*
Turpentine
Perspiration, fetid. (Sec Bfi
Pertussis. AcetanUlde 1
Acetpb'*netldln ..... --*-
Duboisine
4SS
Allyl-trlbromlde .....
1
Gold
£43
Alum t
Amber
1
Paraldehrde
Pbysostlgma
701
Til
Ammonium bromide
picrate
Paranoia, Cbronlc. Chloraiformamlde ... 3s6
Paralysis. Paeudobjpertrophtc. Thymus
gland 109
Paramt^miiB. Arietol 8M
Irhttivn] fi&l
Aroylene bydraa ....
Anemonln
■
Antlnervin
<
Aatlpyrln
Paraplegia. Damlaca ....
iSO
Antlpaamln
Apocodelne
4
ElfcLnclty
977
Ergot
460
Aaafetlda
Physostlgma
ParPsis. Klectiicity
Stryrhnlne
730
990
6S4
Belladonna
Benxla
•'
Benxol
Paronychia. (Bee Felon.)
ParotiilB. Gaultherla
Iodine
482
r^, 572
BetaQapbthol
1
Bromo^orm
Bryonia
Methyl salicylate
482
Cnlclura chloride ....
Pilocarpine
73i
Cannabis Indlca ....
i
Tartar emetic
S23
Carbolic acid
Calx aulphurata ...
i
Parturltltlon. Bandaga ..
Chloml
1144
, SS3
Chestnut
Ch loroform
Corrosive-sublimate Injecttont
Cotton -root bark
»4l
619
497
Chloral
'-•
Chloralamldc
Chloretone
Electricity
Ergot
Ml
4S0
Chloroform ,
Coclllana
■
Ipecac
592
Cochineal
' '
Leonurui
S99
Codein*
Mercury
Sift
Codllver-oll ,,.
Vlsciim
999
ColliosoDia
Pediculosis. Bentln ......
Mt
Conlutn ••
Betanaphthol
Cevadllla
M)
,,., 796
Creosote
*^
nipteryn •■ .■•■
Chaulmoogra-oll
,.., ,.,.. Iff
Dronera .. .. •■•.••••■■
Cloves
tu
KrRot ■....
Coccu 1 ua ••■>. ..
ttl
Kthyl Iodide
Creolln
404
ICuphinln ,,„
lyotophaa
tD?
Formaldehyde
Nfercurlc cleat*
«7
Oarilc ,..,,
Mercury
634
Oelsemlum *.
Plcrotoxln
750
Oold
Rosemary ,,.
798
OrtrdHta
• ••■•»{
Stavesacra .....••••«.,,
, 849
Hydrooyanie acld ■.
-
Sulphur ..!•>.>•
,,.. 972
Hyoocyamus
....:;
Veratrlne
ftlS
Intilln _ .
i
■ i
^L 1240 H^B
^^^^ PvrtUBBln imnt'ih todlDO
^H Ipecuruiiuhu
^H Juiimit'ii dogwood
^^1 lirn^ ntiittittt
CLINICAL
rAOR
577
&82
743
7S4
PbttrynKltla iront'tl). Pbytotacca ..
PInua C&nadensts
Pomegranate
PoCasBiufu chlorate
PAOS
7^
739
4M
7«i
^H Titnnli Ill
60S
Rhus sldbra
Silver nltraiu
Sodluui beatoate
Tmitilc ucld
79«
229
..J8S. ttf
H LobalU
t-J%
526
^1 Monobromntod camntaor
■ Muek
^^fe Mnphthil*'Mii III
SOX
834
610
Tar
74fi 1
Tragacanth
903
^B ^Urlrl m^tA
3S
Turpeotlne
Xantboxyltim
Zinc aoiolodol ..... .......
tt4
9»
gl7
^^H nnliint 1
... 6M. 891
^H Ouabain
^M Oxyratnptior „„„,...
^H IVtmloum . . ,•
^^m PhenacotlD
8SA
, 6ft7
,-, 7M
,. 712
Pblrxmasla Dolens. Cottoo
497
Hamamclla
5M
lt*v
Potasalum oxalata
1U7
7«9
^H PtfritTl
Ill
^H PIlTll* Il1*ld
,,.,...... 132
Quinine
Pboaphatlo Calrull. N'ltrlc arid ....
PhoBpbaturla. GlyctTDphoapbates .
llfxamt^thylcnamlnr - ..
I.acttc arid
3fi0
135
738
5to
m
^H Pllfwnrjiln**
.......... 736
H PulMtllla .,.
^H Potuitsluin hrotnld* ,.
m
178
^.. 7«5
^^1 ^i^Hnlnr > ■ • ■ ,
35B
I'rntropin
Phoiophoblft. Cocaine
Pbysoatigmlne
us
sn
T3I '
^^B H-inri^ln . 1 ,
........ . 782
^^1 RrnrtH ,
gas
^H f?'Wirr nItmtiT i ,,
.... us
Tonga ^..
Pbthlitla. Ao«tphen«ddlB
Codllver-oll
90S
712
.1.. 86)
^^■^^ PfiliitTn hrninilA i ■■ i
. 381
^^^^H
. . WT
^^^H
tu
CrtHisotr ^.
441
^^^^^ Bimphanlhiia
, , K*
Croton-oll ..._.-....,. ..
fTt
^^M Qulphiii-
in, 8T8
Kthyl Iodide
5?>
^H Sulphurous add
^H Ti-rpln hydrvte ...............
143
nr
EucalyptMit ^
EucalypLua
4SI
4St
^H Ti^Mf rUim 1,1 1 ,
SSR
Fortnaldf*byd«
Geranium
«os
w:
^m Thirrmi^l
KM
■ T^rmr , ,
90b
Guaiacol
41!
^B Thymus iw>rpy||uin
^H Trlfi>lhiiii
Ml
903
Iodine
571
Iodoform ........................
i&k
^H Tuaaul
^H V«lor1iin
^m Wild oborry
^^f Wild thy mi
Til
91!
T7S
Mii
iT»
12S
«91
14«
»)
I7.»
fv4t
iss
3'>)i
8«l
103
IM
3t3
381
sn
.,^ ^ SB
lodol
.. «♦
.. <7»
....««7. «U
... K8
lodoph^'n
ItH»rac
Koumlas
Lycopns
^^^H Phaj(>HSit<n« Hydroffvn dioxld**
^^^V Iodoform
^P Iroa
H sunt Mid ....
^m Opium
^H Tannic add
H, PhuryDtfltls. Ao«UftlUd»
V Alrohol
^H Alpbaoaphtbol
^^1 Alum
Mercury
on of candal-wood .
Opium
potassium eltratC'
787
tellurate
Saiopben
Salicylic a4^d
Stiver nitrate
Sirychnfne
Terebene
^H B<>lladonnK .,.«.4,....
H Bvlanapbtbol ...
H FV.r,,. n....1
■
TolypTiin
Plcm«t)t patches. Trichloraetde M«i. .. 14il^
Ptlriiatlff rhlftrfa« . j . IM ^
Glycerin ..1...
... .. 4«
■ Csta^htt
^^ OmvId*
Oil of calopat
Qfllllala
" 1
- *^i^m
m 1
_ im J
-48^1
i«3^^
. 38& 1
. tm J
.Cl J
.. «s 1
**1 1
•■c I
RewrUB
Trler«*>t
PltrHasis Rubn. CUan tanctttUi*
PttTTiaala Versicolor. 49m ftoat T
Ptaceau. DfMsae oL PoCaaalvB d
PteciM. Bsbaiile. Pbenol
Pleartey. Attwlle
AnUpyrte
AaplratiM
Baadtoc*
BryMta
Ctetbarla
CUoraUmii*
rhlorttlttrm
im
^1 rw*t«^.«if
..,. CT3
^^^^ r^trlr
431
^^^K Krfotia
«7
,. 4SS
^^^^V X****"*
cn
^r Oalaacia
« «»
UT
.,-, in
B Olrrarin
^H OnalAT M ,
8IS
1 gSSBJf.::::::::::::::::;
us
. Mi
urn
sn
fViMtlaiB
1 ^^.::-:-:-::::
^^^ tTM **.
CffafjM nil
Batfl
^^^H M^*W^
Oi
^^ 0M»
cb;
ItjfclaiN MM
^^_^^^^^^^^^^B
1
•
i
Fleurliy [ront'^). lofllnc
CLINICAI
pAoa
670
Pneumonia {ront'd). SaltcyUc fteld.134
S&lophen
1
PASS
136, 137
StH
lodol
562
Kaolin
320
Sattffutnarla
Sa&^lnarlDe
807
,..,. 808
LiinUQi . ...*............•....
601
MaKDCBla ..■•...■>..•>..•■•..(
611
Senega
Berpentaiia i... .......
Silver nitrate
8J5
828
22»
Malaktn ....,
616
Mercury
Olive-oU
Opium , ■•■■•>>•
6»
666
689. 6M
Sodium crcsotate
..... 120
salicylate »..••.•
H2
Potafislum Iodide
gulnine
Sailcyltc acid
676
a&»
12S
Strontium Iodide •...•...>.•
$S4
Tartar emetic
228
Tea
298
Squill
8U
Tolypyrin
733
Siroollum Iodide
8M
Turpentine
.883, 888
lactate
864
Veralrum
Pneumonia, CaUrrbal. Amraoolum cl
Idc
Tartar emetic ,.
,,.,^ 222
Veratrloe
913
PK'Urodyiila. BvlladoDoa ■•••■■
236
Araeulc
:: |H
Caotbarls ,,,,
110
Caulopbyllum ,.
Crfsotato o( sodium *,*••••
OriiidellB
Hydrtodlc acid
lis
Chloral brdrale
ConflDe ,....
.....333
316
MuatanS
;:;;:i;;.:;ffi
Turpentine ..........»..»»..,.
Vt*ratrlne . . ,
.*.. 333
. *. .. 918
lodliie
. ... 509
Salicylic acid .
135
PnouiuoDia. Acetphpoetldla .<.
7ia
Hodlum paracreeolate
Polytrichia. Sodium ethylate
Polyuria. (See DUxbtteit jHStpiAmt.)
Pott's Dlscaae. Gualacol
Potassium silicate
417
835
«4
829
Acet&nilide
S9
Aconite
na
Alcohol t.
176
AmiDDn la
192
AmmoDium carbonate
1S3
Suspension
1166
chloride
If 4
Priapism. Bromides
276
Antlputumococclc seruin •••
.. 216
Lupullu , ,.
61 J
Antlpyrlo
718
Veratrum
916
Asaprol
296
Proctitis. Alphanaphtbol
.... 644
Belladonna
266, 268
Copaiba
tan
OenxanlUd .,,,,
360
Prolapsed Bowel. Compound sine atea*
rate HM
Dlood-letting
1 1 45
Caffeine
187 ZSS
Brgot
447
Calcium chloride
291
Nu'-sall
Mux vomica
.... 480
65J
Camphor
.......... 303
Cantharls
310
Proslat*. Hypertrophy of. Antlpyrla.
Pichl
Prostate. Irritable. Trltlcum ........
Alum .' .....,,
TI8
.... 463
906
187
Chloral
......... 33t
Chloroform .j. .........
........... 313
Coclllaua
382
Cold
,. 1117
ProstatiUa Antlpyrin
721
baths
1048
Bromidea -,.,.
..... 2T7
Coo line ....,4.........
3»5
Capsicum
,... 314
Cocvallarla majalla
3»6
Coro-alllc
,,.. 614
Creosote cartHinate
416
Fnblana Imbricata .................
.... 463
Dlcltolla
434
Ichtbyol «*
.... 661
T)lKttOXlD
4Z4
Iodoform
.... 668
Diuretin
B»l
Salol
.... 608
Ether
.. .... 160
Thuja
... 8N
BucatyptUB ,,.,
. ... 464
Proslatorrhasa. Atropine sulphate ...
Camphor
Capsicum
Colllnsonia
.... 863
.... 808
.... 813
.... 389
ap|9«>mlum
;,,,, 4%
Gualacol i..
Heat
Heroine
414
1114
609
Iron *>(..
.... 473
Ice
un
Juniper ..*......••■■
.... 689
Iodine
.«■>.. .CTV. S7J
Turpentine <■
"''SH
Kaolin
390
cataplasm ,
LactopbeniD i
Load acetate
WO
714
764
Betnnaphthol , .....,««.
BoroRlycerlde • .
Chloral . ....
.... 333
LInum ..,..(*.
...^. toi
Oelsemlum .. . ............*..■
.... 486
Mercury
Mooesia
Musk
388
C9I
Iodoform ... .1.1
.... 568
1 lOSfinhan
.... 609
Reeorbln *
.... 198
Nitroglycerin ,
489
Sodlum-sulpbate-thlophen .
Tar
PruriUs. (See Pnnriithetia .)
Pseudoleukipmld. Iron
Roentgen rnTS ... . . .
.... 894
.... 746
... 473
.1131
... 89
«... 163
.... 644
.... 188
Nuclein
317
Oil of ftandaUwood
670
OllTC-Oll
.., 664
Opiam
Oxycc'n
880
,.1006
Paorlaals. AretanlUde
Adeps lanee
Alphanaphtbol
Alumna] ...................... .
Paraldehyde
Phenacetln
701
719
PhenocoU
715
Phospborua
799
Anthrarobln
Antlmouy • ...t
Arlsiot
.... 331
.... 333
.... 897
Phyaoatlsma
Pilocarpus
Potassium Iodide .»«« «..
nitrate ..•..«...»,««
Quebracho ■ **.>>ii
• Quinine
:::::::::: S
W8
.......... 788
349
999
Arsenic .,., ,...,
Betnnapbtttol .»
Cantharls
-m
Carbolic acid •.•.....
.... loS
d
1242
OLINIOAL INDSX.
PAoa
Psoriuls (cont'd), C«reTl«toe m
CbauImoogra-oU 32S
Cbrynrobin 349
Cocaine 374
Copaiba 398
Copper 424
Creosote 406
Blecampane 565
Bugallol 776
Buropben 461
Formalin 603
Pucus Teslculosua 479
GallacetopbeQone 776
Ourjun 503
Outta percba 341
Hydrocotyle 543
Hydroxylamln bydrocbloride 22L
Ichthyol 560
I«>*oI 661
Lappa 690
Liquor gutta percbse 442
Mweage .10I8
Mercuroua oleate 123
JJercunr 628'. 52S
Myrtol 037
Napbtalan 039
Napbtbaiene 039
on of cade ' 057
of cajuput * 057
Petroleum 700
Pbenol 208
Pyraloxln .,'.,[. 776
Potaeslum iodide 575
Pyrogallol ". 770
Resorcln 733
San d , '.'.'.'.'.'.'.'.'. 830
Soap 813
Sodium cacodylate '/.'..'.'.'.'.'.'." 105
etbylate 830
Ballcylate "',[ 342
Strontium Iodide ^
lactate 854
Strophantbus brq
Sulphur i ! ! 871
Tar ' " ' fJK
Tbllanln ..; ......"" 893
Thymol "" oqq
Thyroid extract .*...'.'!.".",*!'!.'!' 207
Turpentine 884. 885
Zinc etearate 850
Piychoses. Cbloralamlde '.'.'.'.'.".' 330
Ergot 460
Ptyallsm. Alcohol 175
Alum " 185
Belladonna 269
BeUnapbtboI '. on
Bismuth ■ 288
Cocaine " " ' 370
Myrrh ::: 030
Pilocarpine 73-,
Potassium chlorate '.'..'" 7fi7
PyoktanlD 031
Puerperal Fever. (See Septicamia.)
Pulmonary CEdema. (See (Edema of the
Lungs.)
Pulp Irritation. Jamaica dogrwood 743
Pulpitis. Thymol 900
Pttpura. Alum ■.. 188
Calcium chloride , 294
Digitalis 434
Ergot 449
Gallic acid 117
Hamamelia 606
Iron 473
Nux vomica 0^
Potassium chlorate 769
nitrate 707
Strontium Iodide 854
Sulphuric acid 140
Sulphurous add 142
Turpentine 885
Pyaemia. Creosote 410
Potaaslum permanganate 020
Quinine 300
PAOB
Pysemia iconVd). Salicylic add 134
PyeliUs. Bucbu tn
Cantbaris 31«
Capsicum 314
Copaiba IM
Com-silk C14
Pabiana imbrlcata 40
Oallio acid 117
Cfbid and sodium chloride 244
Orlndella SM
Hamamelts S0»
Hezamethylenamlue 509
Juniper £88
Mansanlta 6Z1
Myrtol C7
Parelra 708
Salol 802
Sandal-wood oil <70
Sulphur 871
Turpentine 88S
Uva ursi 91*
Pyelonephritis. Eucalyptus 4w
Oalllc acid U7
Ichthyol S50
Liquor potassa 7&
Pyorrhcoa Alveolarts. Europhen 461
Pyrozone SI
Pyrosis. Cerium nitrate 33
Kino fi«
Magnesium carbonate OS
Manganese C1>
Pepsin 706
Quinsy. (See TonHlUtU.)
Rachitis. Calcium 292
Calcium phosphate 296. 737
(3odllver-oll 9m
Goto 4<e
Diet 1«2
Iron 473
Lime-water 290
Phosphoric acid ISt
Phosphorus 736
Potassium bromide 27R
Ranula. Chromic trloxide 113
Eattlesnake-btte. Calmette's aerum 21**
Potassium nitrate 766
Nitroglycerin 4S9
Slsyrtncbtum SC
Rectum. Fissure of. Ltnum 6'>t
Magnesium sulphate <i^
Sulphur 873
Rectum, Inflammation of. Alpbaoapbtbol. 644
Lanolin 15S
LInum 691
Nut-galls 4i9
Potassium chlorate 768
Rectum, Painful Affections of. Opium M
Rectum. Prolapsus of. Silver nitrate 239
Ergot 44;
Renal Dlseaaea. Antlpyrtn SM
Belladonna 258
Bilberry $•*
Boido rs
<3orn-Bllk «<
Fablana Imbrlcata 4«3
Puchsin 47^
Juniper !<Af
Koumiss SM
Lycopodium 6l*>
Magnesia 613
Oleander 654
Pilocarpine 7"5
Scoparlus 33*
Strontium lactate &4
Sugar of milk ^W
Retention of urlae. Oicalne 379
Com-sIlk 614
Strychnine *S0
Retina. Congestion of. Ergot 44T
Retina. Detachment of. Mercury ^^
Pilocarpine 73S
Retinal Asthenopia. Cannabis IndIca snT
OLINIOAL INDEX.
PAGE
ReUnttls. Albuminuric. Gold 24S
Rheumatic Gout (See ArthritU. Bheumatoitl.)
RbcumatlBm. Absinthium 86
AcetanlUde 89
Acetic acid 91
Acetone 90
Acetpbencttdln 712
Acidulous waters 1062
Aconite MS. 160
Aconltlne 149
Agftthin 167
Alumnol 18fl
Ammonia 19S
Ammonium bromide 279
Analgen 328
Antlpyrln 718
Arnica S3S
Aaaprol 236
Ascleplaa £36
Aaplrin 240
Atneroflperma moschata 816
Bandage 11«
Balhs 1048
Benianllid 260
BenalD 261
BoWo 272
Bryonia 282
Caffeine 287
Cannabis Indlca 807
Caulophyllum S22
Cbekan 316
Cbloral SSS
Chioralamlde SSO
Chloral-caffeine 836
Chloroform ..,.> 841
Cimicifuga 3S0
Collodion 389
Coniutn ', , 384
Cowberry 910
Cresotate ot solium , 420
Crocus , 430
Croton-oll 672
DtglUllB 436
Dulcamara 440
Elder 806
Electricity 966
Bmbelia rlbes 443
Bpbedra vulgaris , 444
Eupborin 459
Formates 116
Frankllnlsra ......966. 971
(ialhnnnm , 479
Gauliherla , 481
Gualac 501
Oualacol 412
Gynocardlc acid 326
Heat 1114
Hot and cold applications 1114
Hydrlodlc acid 118
Illlclura GU
Iodine 677
Lanolin 152
I>appa 696
Laurel W7
Lemon 60O
Light 1128
Lithium salicylate 606
soEOiodol 847
Lycopodlum 610
Masnolla 614
Malaklne * 616
Manaca ,.... 617
Matrlcsrla €28
Methyl aallcyUU 482
Myrtstlca €3S
Oil or cajuput 668
Oil or pine 486
Opium 186
Ovlfrrrin 476
Feppermlnt-oU ..* 9K
Petroleum «,. 708
Phenaoetln < 712
Phenocoll 715
Phytolacca 783
Rbeumatlam (cont'd). Pilocarpine ..
Plpcjratln
Potaaslum bicarbonate j
bromide .'..
carbonate a
PIpslsscwa i
Pisoldla *
Pyoktanin 1
Quinine •
Radium
Rhus toxicodendron
Roacmary
SalocoU
Salinapbthol
Sallpyrin
Savlno
Soap liniment
Sodium poracresotate
phosphate
salicylate
Solomon's seal
Splgella
SUtic electricity
Stramonium i
Strontium Iodide •»
lactate
nitrate
salicylate
Sulphur
Teucrium ,
Thymol ,
Tolypyrln .,
Trlmctbylamlo hydrochlorate ...
Turpentine 1
Veratrlne
Xanthoxylum
Zinc cyanide
Rheumatism. Acute. Absorbent cot
Acetphenetldln 1
Ammonium bromide
Antlnervln »*«..••*
Antlpyrln
Arnica ,
Asaprol , 1
Aspirin ,
Beneolc Acid i
Camphoric add
CantharlB
Chamomile t
Chloral cafTeioe
Delpblnlne ..t
Digitalis ,
Formic acid i
Hydrlodlc add •;
Euphoria .* .;
Ichihyol «
Iron .;
Lactopbenin i
Lemon-Juice ....»i
Mercury ;
Methylene bichloride
Manaca
Opium 1
Phonacetm
PbenocoU t
Potassium bicarbonate
iodide
nitrate
permanganate
Quebracho 4,1
Salacetol ••.
Salldn
Salicylic add
Sallpyrin
Salol »
Balopben i
Sodium acetate
bpntoato 1
ereeotate
salicylate
■ulphoeallcylate
Spirit or nitrous ether
Thymol
Tolyaal
1244
CUBICAL INDEX.
pAoa
RheumatlHm, Acute (eonVd).
Trlmethjlamln hydrochloride 906
Veratnim 914
Zinc oxide 923
Rbeum&tlsm, Chronic. AletrlB 178
Amber 861
Anentc 98
Arnica 233
Ammonia Itnlment 192
ABparasln 237
Belladonna 2&4
Buchu 283
Capsicum 313
Chenr-laurel 697
Cowberry 910
Conlum 394
Gtmlclfuca 350
Cochlearla 382
CodllTer-oll 660
<:olchlcum 387
Eupborln 439
Qalbanum 480
Hamamells 505
Jamaica dogwood 743
Iiemon-Julce 600
Lithium 606
bltartrate 146
Manganese sulphate 618
Menthol
Mesereum 633
Opium 686, 689
Petroleum 708
Pilocarpine 738
Potassium dichromate 114
Iodide 7K
■Quinine 361
Rubidium iodide 794
Rosemary 793
Salaeetol 806
Salicylate of soda 8i2
Salicylic add 136
Salophen 804
Sarsaparilla 815
Senega 825
Serpentarla 828
Stmingla 851
Stramonium 852
Strontium Iodide 854
Sulphur 872
Tolysal 419
Teucrlum 888
Thermol 893
Thuja 895
Turpentine 886
Rheumatism, OonorrhoMt. Ichthyol 551
Iron 471
Mercury 524
Phenacetin 712
Potassium Iodide 674
Rubidium 794
Sodium salicylate 135
Rheumatism. Muscular. Amyl Talerlanate 200
Aconltlne ointment 149
Amy] Talerlanate 200
Colchicine 387
E^phedra 444
Buphorin 459
Faradism 969
Lithium 605
Manaca 617
Methylene-blue 629
Opium 686
Pilocarpine 73?
Salaeetol 805
Salicylic acid 135
Solanlne 440
Strontium Iodide 834
Tartar emetic 223
Tolysal 419
Rhinitis. Alumnol 188
AriBtol 897
Camphor-menthol 301
Compound ilnc stearate 850
Creosote 407
Frankenla 478
Rhinitis iconfdh Noaophsa 5»*
Osone 1«S*
Pyrotone 2^1
Sanguinaria ^''
Sodium soiolodol m;
Soiotodol U'
Rhino-pharyngltls. Artstol «C
Sosolodol MT
Rhlnosclertoma. Roentgen ray li^i
Rhus Poisoning. Alum-curd W*
Ammonium chloride IM
Artstol *^
Bromine r74
Chestnut-leaTes Z>
Cocaine XT.
Dobeirs solution l'<
Eun^hen «•
Oelsemlum 4V*
Qrindella Vf*
Ipecacuanha vc
Labarraque's solution ^*T
Lime-water Sft
Llndera-bark «-■>
Lobelia *:
Mercury jCI
Oak-bark TTT
Phenol 1 *
Plantain T<:
Sassafras-bark S'4
Serpentarta KH
Sodium bicarbonate 0(
cblorinated «*.":
sulphite 79'.
Zinc oxide 7^1
Rickets. (See RwMtU.)
Ringworm. (See rines Trifoph0t(ma.\
Rosacea. Alphanaphthol *44
Arlstot ilM
Bismuth oleate ItT
Chrysarobin U9
Coca 3711
Compound sine stearate <*'
Electricity »1
Ergot 44T
Brgotln ..., 447
Buropheu Hi
Hamamells 54
Iron oleate 177
Losophan *•
Mercury SJ«
Oil of cajuput 657
Reaoroln 7sl
Sulphur jn
Thiol an
Ballratlon. Alcohol IT>
Belladonna 2S9
Bismuth acs
(See Ptwali0m.)
Salplogo^OTarlUs. Sallcin 799
Sarclnae Ventrlcull. Calcium chloride.... SM
Creosote 4«
Eucalyptus 4S5
Quinine '. 3»
Sodium thlosulphlte 837
Sarcoma. Arsenic 99
Erysipelas serum tit
Formaldehyde tOS
Mercury SSS
Roentgen rays 1123
SatyrtaMs. Dulcamara 449
Scabies. Balsam of Peru 246
Bensln 2*1
Betanapbtbol 64«
Carbollsed oil l«i»
Cevadilla 796
Chaulmoogra-H>ll SS
Chlorine »47
Copper sulphate 424
Creolln «••
Budermol S78
Hydroxy lamln bydrocblortde 221
Kamala «»•
Losophan •■*
Manganese dioxide <U
■ Scabies iconVd). Mercury
H^^ Nftphtalan
CLINICAI
PAOG
B2a
639
,,.. n?
- INDEX
Sciatica (conl'd). Otmlclfusa ,
Colchicine ,
" 1245
PAOB
, 860 '
: 387 \
Colocynth
Croton-ol!
ElfctricUy ...
Ethpr ,
898
872 '
970.974 ,
160 1
^^^^^H Dr.l cnlAiirn
708
^^^^^H Dln(vi4nvln
..,,....,, 710
^^^^H D»>«.«liir« p»»<«i.nu»H«*k
:.;..;.;;.«!
ttS
,...,..„.... 459
^^^^V
IM
GaulLherIa
4«2
^^^^^V Oiitrinn
787
GlycoropboapbateB
Quslacol
, 72H
418
^^^^H
ns
^^^H Sodium tlilosulphlLe
^^^H Storajt
887
860
171
Hydrochloric add
120
Jamaica docvood
, 74a
Light
1U8
^^^H Sulpburouji acid
^^^ Tnr
^M Scalda. Acctanillde
1«
745
SB
Liquid air
Mamage
Nervr-Btretching
Opium
Plchl
U19
1006
116S
690
468
^fc^^ Oalpinliiln , ,
386
^^^^H
«8
^^^H Jamaira dogvood
748
Pilocarpine
738
Potaflfllum todlda
: . 578
^^^^^^^■T PI n nt nl n
.......... 7€7
1131
^^^^^^BBodlum bicarbonate
886
801
Salicylic acid
Sallpyrlnc
Strontium Iodide
m
, 722
, 854
^^^^^^^ Wl.*.4.»_#l«,.r
806
■ Whtte-load paint
^fc^^ Rrjirlnfinn AfPtnnlllrtp
764
89
872
Sumbul
Turpentine
876
_ . WK
^^^K AllantbUB Klanduloaa
168
184
Sclerema Neonatorum. Reoorbto — 198
SclerltlB. Colchicine 88T
^^^H Ammontum acetate
W3
193
Scleroderma. Iodine . ..... ..
, 672
^^^H Antlnvftn
718
Lanolin ..<
,..,. 163
^^^H AntlatPMptfwnMKlM uiftttM
218
Mercury
520
^^^H Ar>Anln
M
Reaorbin
19ft
^^H AaplrlD
S40
Sclerosis. Spinal. Gold
, 198
^^^^ nallAflnnnn
2&S
Sclerotitis Copaiba
..I.......... 400
^^^^ "•tsnnphth'fl
642
Turpentine
S86
^B Calx Bulpburata
293
Scorbutus Alcohol .......<
175
^1 ''^p*I'*Min ,, ,
313
Armoracla ,
238
H ^nrNrlli' iifid
lOB
Citric acid
, 116
■ Codllver-oil
;;::;::::: iS
Cocblearla
, 382
V Chloral
3M
Elder
806
CblortDe
Cold doucha
Creoaote , ,
847
1018
410
EucalvDtua
164
Garlic
Horseradish
179
^ 283
CrocuB
480
Lemon -Juice
.,,., 000
niKltttlls
436
Light
Monesla
Onion
1123
638
, 179
EucalyptUB
Gaultherta
Qualacol
Hydrochloric add
Hydrogen dioxide
Lfactophenin
466
488
418
180
349
714
Oranxf*
24S
Pellltory
Rumi'x ...<
773
, 79B
Turpentine ,
885
Lanolin
Lard
163
151
Winter's bark
918
Scorplon-stlng. Aconlto .......
Cocaine ^ .• ..>•.■••.
160
, 872
Menthol
Mercury
626
627
Scrofula AInuB . .,.■•«..*
,„, 180
Muatard
831
Araenic Iodide
, 98
OlWe-oU
665
Barium chloride
Calcium phosphate .........
Call sulphuratn ..■.<
, 2^7
898
„,, 298
Phenol »,
, 103
Phoephorue .,,,
PotaBBlum cblorlda
786
768
Cbalybcate waters
Chaulmoogra-oll ..-..
1068
, 885
permanganate ,..,.,
as
Quinine •..4*t«i««.«.
......8S0. 680
Codl 1 ver-oU
68a
Reiorcin *........
7g3
.Compound syrup red cIotct
» 903
Salicylic add
136
194
Salopben .>.>..«
San^lnarla
Serpentarla
8M
807
ns
Copper sulphate 484
Creoaote ....414
calcium hydrocblorpbosphaie 4t8
Cuprobvmol ..,»^.... 476
Elgon 441
Gallium 4I»
Sodium bensoate
868
Sulphur
,, HTl
Sulphurous add
141
Thallln
889
Hetlnntbcmum ,,
Hyilno'lli' odd .<
Hydrorotyle «.«•
606
U8
6a
Toly pyrin ,
TSJ
Sciatica. AcetanlUde
88
Actual cautery
1118
Iodine
677
Arupunrture
1199
lodlpin
680
Antlpyrln
T19
lodof ono >
B8. 660
Aaaprol
;.::.;:;:: JS
lodol ^
:....;... 7?;; Si
Atropine .•*....«
Bonianllld
868
...,,.»„. 860
Iron ....>
474
475
Brain and spinal extracts ...
206
oleaU
Keflr ,
.0 187 J
691 1
Carbon divulphlde
SIB
^^^^^ pfiif«rii!-'^iifff*lne ,.,
., 886
Koumiss *..>.*i
691 1
^^K Chloroform
841
Lead Iodide <.........••■••
TM 1
1246
CLINICAL INDEX
PAOB
ScrofuU (eofU'i). Light lUS
ManacA 61S
Manganese 61*
Meniepermum 624
Mercury 520
Boxoiodol 647
Moneela 633
Oxygen 1086
Phosphoric acid 131
Phytolacca 738
Potaaslum chlorate 769
Rumex *. 795
Soap 813
Boapwort 779
Strntngia 861
Byrupus calclt lactophosphatls 296
Teucrtum 888
Thloslnamln 894
Walnut 688
Xaothtum 919
Zlttmann's decoction 816
Scrofuloderma. Arlstol 897
Chaulmoogra-oil 325
Europhen 460
Hydriodio acid 118
Massage 1006
Mercuric oleate 128
Strontium iodide 864
Scurry. (See BcorbuUu.)
Seasickness. Aoetanllide 89
Amyl nitrite 199
Bromides 278
Chamomile-oil 220
Chloral 334
Chloretone 337
Chlorobrom 330
Chloroform 342
Cinnamon 867
Cocaine 376
Creosote 408
Hyoscyamlno 547
Kola 692
Opium 692
Resorcln 783
Sulphonmethane 863
Beborrhout. Alphanaphtbol 644
Alumnol 188
Arsenum oleate 127
BeUnaphtbol 640
Borax 103
Calcium 291
Cocaine 876
Ergot 447
Europhen .464
Oreen soap 813
Hamamelts 6(»
Hydrastis 640
Iron oleate 128
Lead 755
Massage 1006
Mercury 521
Petroleum 708
Sulphur 873
Tannic acid 144
Seminal Emissions. Cantbarls Sll
Benlltty. Alcohol 176
Brain extract 205
Cannabis Indica 806
CaDtharts 811
Chloralformamido 330
Dubolsia 488
Gold 248
Spermln 206
Septlcsmia. Alcohol 177
Argentum Cred« -. ta
Carbolic acid 109,111
CreoUn 404
Formaldehyde .' 603
Hydrogen dtoxfde 249
Injection of normal salt solution 1150 •
Iodine trichloride 689
Lactophenln 718
Mercury 619
Oxygen 1<^
Phenol 109, HI
PAOB
Bepticamla (oont'd). FhenolsulphODAte. . . lU
Pilocarpine 2!
Potassium permanganatu O*
Resorcln jS
Quinine 861
SallcyUte of sod& 186
Silver »
Sodium bensoate 861
Sewer-gas Poisoning. Ammonia tji
Oxygen ™
Shock. Alcohol IW
Aqua ammonia 1>6
Atropine sulphate 2S9
Digitalis 485
Injection of normal salt solution 841
Morphine 6>
Oxygen IM
Strychnine «•
Turpentine 8(6
Warburg's tincture >0
Sick Headache. (See Miifra4me.) _^
Singultus. Chloral »
(See Biecouffh.) ^
Slnuse& Aluminum oleate 1^
Bensoln 268
Camphorated naphthol 641
Chlorine 846
Clnchonlne lodosulphate 8tZ
Creolin »
Creosote *■
BIgon 25
Formalin •"
Hydrogen dioxide **
Nitric add IJ
Potaaslum chlorate <v
Sulphuric acid 149
Skin Disease, Chronic. Alnus Ij;
Arnica 5?
Cantharls JJJ
Chaulmoogra-oll g
Clnchonlne lodosulphate w
CodllTer-oll S
Compound syrup red clover *»
Copaiba »J
Bmbella ribes J«
HTdrocotyle 5g
Ichthyol gj
Ledum 5*[
Mercury >I}
Phytolacca 2
Pilocarpus ™
SarsaparlUa JJJ
Boapwort JJJ
Tar ''•
Skin Diseases. Acacia ,87
Adeps lansB 1»
Althna U;
Anthrarobin «J
Arsenic _2
Barberry Jg
Baths llj
Bismuth oleate l*^
Boric acid JJ
Camphor JJ
Cascara amarga *g
Chamomile 2
Chlmaphlla E
Croton-oil «2
Cydonium «»
Ephedra ***
Eigon «}
Bthyl-sulphurlc sold MJ
Galvanism JJf
Olycerlte of starch JJJ
Outta-percha j*
Hydriodlc acid ■ JJJ
Hydrochloric acid 1*9
Hydroxylamln hydrochloride St
Ichthyol gj
Ichthalbln S
Iodine ••^' WJ
Iron 661. <]»
Krestn JH
Lanolin W
CtimCAL INDEX
FA.OB
SklD Dleeases {cont'd). Lard ....#...»-;... 1S2
L*end aubaoetate <..... 753
M EBsaKe 1 V06
Nitric add 125
Oil or cajuput 65-^
Oil or cbaraomlle 220
Oleander 666
OlJve-oU 6«4
Opium 6S7
Ozone 1081
Ptiosphorua T2S
Potasalum 19o
dlthlocarbonate 7(U
PrlDoa 770
Quinine aoi
Rtiua glabra TN
RoeDtgt*n rays 1131
' ReUooI 7»
t Rumex ...• 7K
SUlllDgla «n
txirollum 008
Soap 813
StratuoDlum 83t
SulpfaorlDlc add 141
Syrupua calcl lactopboapbatla 296
Vltellus 918
XaDtboxylum 920
Skin Dlaeaaea, ParaaUlc. Alcohol 174
BcUoapbthol 040
Cacodyhc add 106
Chromic trioxide 118
Chrysarobln 840
Cevadllla 105
Cocculus 381
Euphoria 469
Hydroxylamla hydrochloride 331
Ledum ...., 503
Mercuric oleate U8
Mercury '. S33
Myrtol 037
Roentsen rays ..,. 1131
Sosoiodol 847
Stnvesnrrc 849
Sulpburoua add 14t
Tricresol 416
Skin Dia«aeea, Scaly. Araeotc 97
Cantbarta Sll
Codllrer-oU 600
Creosote 406
Dulcamara 440
Euroben 3&0
Hydrocotyle ....*■ &43
Tar 74."1
Xanthlum 91!i
Skin. Fibromata of. Blectrlolty 913
FormaUn , » 600
Smatl-pox. (See Variola.)
Snake-bite. Alcohol 177
Ammonia .60, ISS
Aotlvenene 318
Aqua ammonliB 192
Dandase .,... 1144
Ccdron SS3
Chromic trioxide 118
OlWe-oU 66S
Parelrn 703
Potaaelum perroanffanate 630
Strychnine 661
SneealnK. Periodical. Arsenic 97
Potassium Iodide 573
SomnambullBm. Chloraloao 336
8or« Mouth of Chlldroo. Potassium
chlorate 767
Sores, Veneral. Nitric acid 12&
Opium 637
SIlYer nitrate 828
Spasm, Hysterical. Ether 100
Spasm, Intrstlnal. Myrlatica 616
Spaam. Muscular. Ethyl carbaroata ...... 164
Oelsemlum 484
Heat 1114
Phenol 110
PhyaostlRma 731
Bulphonmethane r. 863
Spaam, Muscular {cont'd). Uretbune
Spasmodic Disorders. Ailantbus ...
Belladoona
Electricity
Calcium sulphite
Ethyl Iodide
Spermatorrhoea. Atropine sulphate.
Camphoric add
Cannabis Indlca **.*i
Colllnsonla ..*k*4.*..
Coru-amut
CorauUn
Damlana
Dlglulla
Electricity
Ergot
Gold
Hyoacine
Iron
Lupulln ,
Monobromated camphor ,
Potassium bromide
Sail gu inarla ,
Stryeholne
Turpeiillne
Spina Dlflda. Collodion
Iodine
Spinal Cord, Hypcrnmla of. Ergot.
Spinal IrrlUtlon. Testicular extract
Spine, Curvature of. Nux vomica .
Suspension
Spleen. Enlarged. (See Enlarged 8t
Statua EpllepUcus. Amyl nitrite..
Spongy Gums. Alnus
Catechu
Cetraria
Coc blearla •
Oumblr ..,......»,
Myrrh
Rhus glabra
Serpentaria
Sprain. Alcohol
Ammonia liniment
Arnica
Calendula
Cold
Hamamella
Irblhyol
Kaolin
Lead-water and alcohol
Laudanum
Naphthalene
Ontiim ,,,
Origanum
I'''troU*um .-,,...
Rhus toxicodendron
Rosemary ...,
Salicylic acid
Solomon's seal
Stramonium
Staphyloma. Cocaine
Status Bpileptlcua. Amyl nltrlta. .«
Pilocarpine
Stiff Neck. Static electricity
Stings of Insects. (See Hltrt f$n4 8
Stomach and Dowel Disorders
Grvtritiit and Enlcritia.)
Stomach, Ollatatlon of. Croton-oll
Iron
Paps in
Physosttgma
Stomach. Diseases of. Cannabis ti
Condurango
Hops
Pepvin
Phofiphoric add
Strontium bromide ,
Zinc cyanide
Stomatitis. Alcohol ,
Dorax
Copper sulphate
Eucalyptus )•>>*>
Hydrastis
Hydrogen dioxide
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sis
"^ PAOB
Tabes Dorsatta. (See Locomotor Altuia,)
Tachycardia. CoronUIa 401
Tnpe-worm. Allaotbua glaodulosa 168
Throat and Alr-Pssaages (cont'd).
Eucalyptus
rostrata ••••
1249
PAoa
Cub«b. 4131
454
465
Euphoria .........'
489
226
Gallic acid
iw
838
Glycerin
498
109
Glycerlte of tannic acid
498
W
Gold
348
:::::; S
Hops
Quaiac
6U
591
4S4
■ CreoHn
■ Creosote
■ CroCoD-oU
W CUBHO »-
4W
410
ss
'iodine ..,..
571
Kino
591
Kramcria
595
Mango ,
621
Rrnhplin rllwa
» MS
Mangostona •
C60
Marrublum
622
Kamala
589
Mel ro8»
... • ^i
Male fern •
S38
Mercury
Mlcrocldln
Myrlca
....582, 681
oa
935
5K
6S3
OB
Myrrh
638
Oil uf pumUlo plae
IV'llctlerine
896
498
Pellltory
778
Petroleum
708
Pepo .*••*••*■•(•••■•••■••>••••••
704
PUcnol ^, ...,,
no
Phenol ■
109
Pomegranate •
488
Pomesraoate .■ ■■ ••■•■••■■•■•••• >*
408
Sulphur
Sulphurous acid
Potassium chlorate lose&go ...
878
148
TM
Quicliie ■••***■•■••
ISO
SallcvLIc acid
119
Savlne >....• ••••■
797
Salol
999
Scatnmoiiv ...> •••.>
817
Sage
...... .. 806
Strontium lactate *..t>
856
Serpoutarla , ,,
8S8
Thyrnol .
800
Soda, chlorinated ..,,,
.... 838
Turpt'utlne . . .. •..•
985
Sodium chlorate • «...
.... 8S7
Tectb. CarlouB. Boric acid
ForiuatlD ...••
108
003
aalleylate
848
Styrone
Tannigen
861
879
Hydrogen dioxide
249
Mastic
622
White-oak bark
777
Oil of cloves
ilH
Xylene
930
Teeth. Discolored. Hydrogen dioxide 2«
Py rozone 149
Cocaine *.*.•« - S72
Thrombosis. Aqua ammonia ....
Thrush. Copper sulphate ........
194
424
CreoHn
404
Kcsorcln
.... 788
fiucalne
Music
461
1187
Salicylic acid
134
Tic Douloureux. Asaprol
Atropine
8tt
Orthororm
Ob
Penloi
704
Convallarla majalls
Galvanism
259
965 1
Teething. * IrrltabllUy of. Mercury
chalk
With
636
Gelscmlum ,
489 ^H
SulpbonmetUone
861
Olyctrophosphatea
Sir.inionlum
:::::::;: tS ■
858 ^H
Tendo-vaglnltte. Alcohol
175
TenpsmuB. Electricity
Saw-palmetto
>77
796
Tinea Favosa. (See Fnruti.)
Tinea TrlchophyUna. Acetlo odd
ArlBtol . ,
:::::••• iS
Tetanui. Acetanlllde
89
Amyl nitrite »
199
Betanaobthol
. .. 949
Antitoxin
ais
Carbolic acid . .. ...........
• 111
Antlpyrln
798
('||§h^Y..f|||( ^,
sot
Blood-serum
218
Cbromio trloxtdft ... *.... .
111
Bromides
175
Coccutus M. .. .. >
S81
Cannabis Indlcft
807
Copper oleate
128 424
Carbolic acid
....89, UO
Croton-oU
....... 678
Chloral
884
Crystalline ...,,
399
Conllne
896
Cresol
417
Ethyl carbamate
OalTanlim ...••*••...
104
977
Hydrochloric acid
U9
Iodine .,.,,
. t 669
Oetiemlum
484
lodol
.. 681 BTt
Lobelloe
609
Kamala
U9
Magnesium sulphate
Mercury •
8U
588
Lanolin ...,,
158
Losopban ,
flOi
Morphine
698
Manganese dloxlda
Mercury ,
'.. 619 ^M
Paraldehyde ,,,*.
701
Phenol ,
....89. 110
Naphtjuan
OH of cajuput ,
;:;:.r:: S ■
.... . 887
PbysosUgmlne
[m
Solanum CaroUneoss
TTrettaan
9M
101
Pepper
749
Plcrotoxln
7W|
Zinc lulphatp
924
Potassium permanganate ....
919
Affections of Alnua ........ IM
PyraloKin .,,..,
779
ResorclQ
,, 788
Salicylic acid
Sangulnorla
Savlne
Sliver Ditrate
aublaroloe
Sulphur
SulDtauroua add
181
88r
m
819
081
m ^
Altb»a
184
Rsndage
llil
Belladonna >••■•■
8S8
804
Carbolic acid •
119
Copper anipiiatw
424
^^1
cumcu. ix0£x
^^H Tuberculosis {cont'd). Codeine .
^^V CodliviT-oil
^^ Cold
u ColUnsooia
r ConTBllarls maiAllB
Copper sulphate
Coto > t • .
CLINICAL
PAOB
ass
660
::::::::::'yi
3M
424
40S
INDEX ^^^^^"
TuberculoiU (cont'd). Prrldln ...
■
Roentxen raya ................
::::.:": wT"
Salicylic icld
Sallcln
SqIoI
134. 136
799
808. 808
Salophen .. ...■■.■■.•■■■■■■■■
804
Creosote
4M
Saw -palmetto
796
calcium bydrochlorophospbftte 418
carbonute *tt
Silver iiltrate ■
BSl
Sodium beu£oate
S6S» 889
BUlpborlcluntrd
Cupric serum
las
43S
176
birarbonate
BUlpbortclnate ■
Sparteine ,
138
821
Diet
1062
Sriernim hydrochloraU
Strontium Iodide ,
206
8S4
Dlouln
437
Drosfra ....,
Elgon «
Eriodlctyon ...••
441
461
Styracol ,
416
Sulphur >
, 873
Sulphuretted Injections
Sumbul
Syrup, ealcli lactophosphatla .
Syrup hydrlodic acid <
56
876
Ethyl lodida
166
Bucalyptt'Ol
466
Eucalyptus ,,,
454
Euphorbia pilullfera
458
Taooalbtn ;.
flSi^H
Formaldehyde «....■ i
:;;:;;:;:;;«
Tannic acid ,
lo^H
Formates ,
1J6
TanDopIn ,
oS^H
Gaseous enomata
Olycerlo
Qold and sodium chloride ..
»
4N
,,,. 144
Tar <
•^3^H
Terebene ,
aS^^I
Thallln
JgH^I
Qrlndelia
BOO
Thloeol
^^^H
Ouaiscol
......4.... 4U
Thymol
^^^H
cacodylate
carbon s te
dl-iodlde
100
414
415
TofvDvrln . .
•i3^H
TrunBfUBloD
TrltlcuzD
' '^'"^mV
Gualalln „.,..
416
Tuborrultn ,
bm ^^
Oeranfum ..,,,. ,
467
Vitellus 918
Wild cherry 771
XtTfiform 820
Zinc chloride 984
Tuberculoflli of the Skin. Sodium cacody-
late 106
TuberculoalB ol the Tongue. Lactic acid. 128
Tympanites. Aaafetlda 886
AsplraUon .-. U48
Caator Mfl
HcIenlD
554
Hydrobromfc acid
119
Hydrochloric acid
121
Hydrotherapy
104S
Hypophosphltes
Iodine
718
B77
trichloride
579
lodlpiu
590
Iodoform
..658. SS9. 671
lodol
542
MasffAge , ., Li i
1006
Ipecacuaaba
5«3
TyphllUB. Aristol
MO
IroD ,.,
471
Typhoid CondltfooB. tSee Fever, TVpAold.)
Ulcerated Gumn. Myrrh 636
riceratlon, Bplthellnl. Nickel oleate 128
Ulcpratlon. Uterine. Kupborla 459
Nitric ftcld - I2i
Jamaica dogwood
K^'dr
', i.... 591
KDumisa
594
Lactic add
Lactophenln
Lead acctata
123
718
754
Zioc oleate .....•.•••.■•.>■*.•
129
Light ♦...►
, 1128
86
LiPDla
008
Arftanllldf*
88
LycopUB
flO
^... 81
Malaklo
Menthol
MothylPDe-blue
616
6r
6»
Acetpheoetldln • . . » .
718
Alcohol
AInuB
Alphanapblhol ..>•.■....*•• ...
:::::::::: II
Morrnuol
Mullein ,.,.
Muftf-artoe ,.
«6
166
Alumlnstcd copper
486
127
Myrrbolln
;;;:::::;:: B7
Alumnol ••.>*■•■•■•
188
Myriol
Nervine ',.,,
en
601
ArlBtol ...k.
894
,.„ 128
Maoull-oll
. ,. . i. 668
Arsenum oleata ...............
., 187
Nuclein
117
Balaam of Peru
Baptlsla 4
BelladODna «..
Beniln *•■•
846
»47
on of pine
666
Orexlne
, 884
Oxygen
1016
Oconlaed oxygen .,
1081
Bensoic acid .....■..■..•
268
Papatn
,. on
,.,, 264
Paraldehyde
Peppermint
Pepsin , ,.
itiiiii"!! 166
B''tanaphlhol ■•.■•
, 544
Bluuiuth ,
261
264
Petroleum »-.,.
TOO
loretl n • •»
409
Pht'noroll , ,
., 716
261
Phenol ,...,
, no. lU
subcBllata
.. .1.;.. 271
Potassium caotbarldau .....
chlorate
HI
768
Boric acid «
a..*.. . . 101
Iiromoform ...
....... 880
citrate
.,.,, 718
Broniol .■■*.>■■■>•■•«
,. 281
cyanide ..•>.,•••*.
786
Ciilclum chloride ....
284
Iodide ,.,
,..„ (TB
Camohor .....
...... SOI
nitrate ...»•
787
C am D bora ted naohthol
L Pyokunlo
681
■
:!'ii";;iSlta
J
H mecn icmr4}. Cn«tc »otMk .
^1 SfliL.?"*^
GUXICAl
PXGK
7C
2»2
Sli
, INDEX ^^^^^^^
UlMVB tftmfMi Strunontn . .......
rxoM
ttt
8«rtmeM
9tri«M
Buipfcofliiiiirml mhti
.... CIC
....an
^^^K ^^t.^^t
XS
^^^^H fTr*Tr**n
.....Stf. »4T
^^H CMwpfciBOl
^^H GbroMe trtoxMe
^^^^H OacteBA
«T
Ul
357
SalptaBrmu add
Ttanlc acid
.... I«
.Ml. IM
.... im
Tax
^^^^H Ctnckoalaa loAom^hait
XX
TUoTocv
Tknia
.... m
. iK
^^H Coca
^^H CocWcuU
tm
ThTWv) ladMa
ThcklBrw«cle aelA -
.... Ui
^^^^^^H '*'^*"*xTund il&c wttuTtim
wt
Trtlottw
ftff
^^^^^B r'r.n ■! m
IM
T»nifDl . ... .
^^H Co^te
^^^H capper oleate
^^^H satphatc
tfi
«7
Tttxpcatta*
TaaMlBC*
■"'S
VibQrvvm pmatfollviM .............
.... m
Wlutr-omk tek
X-rmfv ........'....4... •«....
— . T7T
^^^H CTMMOca
^^^H HrktaarvK ...p
4M
441
YfUMi , , ,.,,,.,,. , .
Ml
4<3
Ziac cUorlde
^^^^^1 ■^■■lii'iiiia
fn
Bii»ulu4al
1 ■ ac
^^^H Baphbrla
........ 4H
4a»
Cltirrv, OoTBCftl. HotocmlMt
M«iiu| .......••••
ProktaalB
Salot gmnmt
Ulcvn. iDtFatlmaL Pratafoi
;:nS
'!!! TIP
^^^B
in
^^^^^1 "■"«*"—
«ST
^^^H aw«..^«ii.
#9
MS
TurpeoUar
^^^H Uydrutis
^^^^B "rdracf Aoxtde
Mt
t<9
Clcrra of X«co» MembrvMa. lo«o« M
Clc«r« of Rcrtua or Ansa. Ha— mrtw . Sift
Papain 09
IVinwr «!•
^^m ■Js;:r'™ "™"
sn
Soil
^^^H ff.,.A»i
5(1
Silver sdtnte
SB 1
^^^^H InilnBM^thol
M3
CocinariBatK. Mcvthol ,-.
^m'
^^^H ».w.M «i^».
IM
Cmnia. Blood*lctUac •••• --.
..■ JMK
^^^H
s>l
Bromide*
- -. SB
■ i^
SH
m
Caffeioe
:.;: S
Crotoo-oll
.... tR
^^^^^H ..[**.»«
. . 7H
BtatieriB - ,*,. ..
• • 4tt
^^^^^H
s»i
Utbiooi beoaoBtc
. ... Ml
^^^^^B LiDnm
f0t
HaffnralnB anlplMSr ..,,
fa
^^^H fi,|«i^ .k.
Ill*
Xephrta .'
Opivn
PllocBrptne -,...,....-....
.... tm
. •■. MB
UP
^^^H Lorrtia
^^^H Loaopbma
•»
«»
us
TrBDsfaaloa of Mood
V M
^^^^^1 m£»r,f-nw^
.....iM. »«7
S«il BoIttUon
.. . dci
^^^H Wl*»^.<«t«
... . Si
Water ,.
....ipa
^^^^H u.r«...-i.
en
Xeroform ., ., .
^^^H M^.-rK
SIT
Urrlliral IrrltaUoo. AeottlU
... m
^^^H w*^^i
en
BeniJOtc acid
^^^m
<n
Bromldeo
.... xrr
^^^m mn.:^i »t^..
i»
Damlana , , ,, ,,, ^
...I IS
^^^H MM. »IA
us
UrrthntU. Artatta
^^^B
4ao
Ar^ooin ...-.,......-,.,...
^tt
^^^^^H
OS. Ml
Bucha
^tt
^^^^^B nrfhAfni-n*
•i
Germsfaaa
" tff
^^^^^1 '^^TTT***
liM
Hg«Bmethy*maMt—
Mercury .,-...,.,
"," at
^^^H i>.|>«i»
nt
^^^H n^^.
7(6
P*r*lr»
55
^^^H PtiraACTtiB ,
713
PbeoooBlrt .....-,....,.....,,
.;.; S'
^^^H l>K««fA^»<« »^A
UJ
sace :::::;::::::::::;
^^H PbftolaMa
7W
siiv*r n'tr»tr
^M
^^H Pratarsol
^^^^^^H rotsasliiiii bromide •..•••....•■
^^^^^" Dwnuuicuiatf!
TIf
t74
<u
VroUt>pUi
.... 9t$
Z4nc aocolodol .-
UricAdd DtatbeslB. 'utkte *mK».'."."
Kltrtc acid
PIpetMlB
Crtna, ScBBtT- Secrettoa ot. SpUlt «(
trooa cllicT
....Mr
"" IS
.... 741
■1-
.... Ml
^^B »s:3r" ■■
„ 770
CM
^^m A^i.1. "
73J
^^B B*dioth«np7
na
780
Vrticaiia Ac^uillldA
.... M
^^^^1 ll*M«p<Hn
7tt
Acetic add ..-,.
.... •*
^^^H l>*«^w^*.^l
TSt
Alvninol . .. • ...*•
IM
^^^H Rbna sUbra
7»0
tw
Aaimoola ....•...•
.... Ml
Antipyrta
Araratc
.... TM
.... M
^^^H SuiKalXLAria
»T
su
Belladonna
... MP
^^^H a^^^n*
7JT
BnisglB
.." m
^^^^H ■•^Tim ><.l^a
m
nf*u na nil r Iwri
. • . CM
^^^^H AltT^r nlt->>ttta
.. . m. Tir
Tforav . . ...
m
^^^H KA.4lnm ••K«U»*
B3S
Carbotic add .-
.... MB
^^H tt^.!
\m
Cliloral
Coca „
Orralard'a ^iMna
:.;.5
....Ml
.... MB
.. TM
§17
^^^1 ■•.....^f
-..*.. 41>
^^H «».»««
SM
^^H Urticaria (cont'd). Ichthrol
^^^H MrnthnI
F
OLINIOAI
PAOB
661
en
. IKDBX
Variola (conCd). Nitric aold
1
PAoa
12$
, ftdo
^^^^H Plirnnl i 1 1 i
108
Phenol
, 107
^^^^H PtlftfnmitT
718
Pheoolsulphonates ■•■.■■•*•
Ill
^^^^H TMrntnliim tr'IMr
678
PfTtnnsltira permanganate ..■■•.•••
, 618
^^H Peruvian balBam
146
78J
Quinine .■......■«.(•■..■
,..,,. 268
Salicylic acid
188
^^^V nnllrrllr nrlrl
IM
Sliver nitrate
328
■ Sulphurous add 142
1 Vinegar M
■ Uterine Caoal. Inflammation of. Iodine.. $78
^^K Tannic add Itt
^^B Vterlne Hsmorrhage. (S«e iletrorrlujffia
^^H and Hmorrhaffia.)
m Uterine Inertia. Cold UI7
■ Ergot 449
■ Ipecacuanha SBS
■ Strychnine CSS
■ Qulnint) 3$l
1 Uterine Neck, Eroalona of. Europhen 410
Uterine Palna. Chloral 3JJ
Utero-ovarlan ConKettlon. Gold 244
UUrus, Atrophy of. Saw-palmetto 79<
Utt>rus. Congestion of. Olycerln 492
Uterus. DlavAses of. Mercury B22
Uterus, Fibroma of. Bromldea 378
Jamaica dogwood 74S
PoUsslum Iodide 678
<7teruB. Ulcerated Cancer. Calcium car-
bide 2»S
Olycerlte of tatmln 1*4
Zinc oleato iM
Stodium b<?nzoale ...................
361
Sulphur . . .■■..■.•..*.•••■■•■■
871
Sulphurous acid
Viburnum
Xcrof arm
Xylene
Venereal Sores. Iodine trichloride ..
Silver nitrate
Venesection. Bandage
Vertigo. Camphor
142
M7
920
920
B79
220
1144
302
IfiK
Gold sa
Pbysostlgmloe 731
PIcrotoxIn S81
Vitr4H>us Humor, Opacities In. Pilocar-
pine 738
Vomiting. Acfltanllide M
Acetone ,
90
Bfllndonna ,,,.,.,
,,.... 268
Cali'lum chloride ..•
294
Calumba
207
Caotbarls ,
JIO
Carbolic acid
C<?rlum oxalate
Cblorobrom
109
322
330
UtdU. Relaxed. ColUnaonla
Popper
Myrrh
"Vaginismus. Belladonna
Cocaine
388
740
837
3S4
378
Chloroform
842
Cinnamon
387
Cloves , . » .
..... 318
Cocaine *...*.,
». . . . 378
Colllnsonla
388
Copper arsenite
... . 425
Vaginitis. Tampbor
Betnnapbthol
Chlorim*
200
8a
847
Eucalyptus
Garlic
454
179
Hydrof^yanlc acid
Hydrotherapy
122
. . 1048
Compound line stearate
CoppfT aulphate
860
4Sf
Ingluvln
Ipecacuanha A
B63
682
Eucalyptus
466
Orlndella
49S
l>actlc acid
Lime-water
Hasneiria
Mercury
Nitroglycerin
Nux vomica
m
2»2
612
626
489
, 662
Hydrastis
Hydrogen dioxide
Icbthargan
640
BO
SBS
Ichthyol
66X
lodol
Bit
Kava-kara ,
Lysol
...*,. 681
*...., 810
6.'.7
Opium
Pancreatin
Papain ,
693
698
898
Mercury ,
..,,,, 627
Metbyleno-blue
,..,.. 818
Petroleum •
. .... 708
Pepsin
. . 708
Pot&Mlum silicate
8SP
Phenol
PIcrotoxIn
Podophyllum
100
S9T
758
Retlnol
780
Sodium fluoride
841
Zinc soxolodol
848
PotosBium dlcbromate
bromide
Qulnlno
Rectal allmentatloo
784
276
8«0
1164
Varicocele. Bandages
Collodion
1144
810
Ergotln
440
HamamcllB
Varicose Veins. BandacM
Barium chloride
Chloral
608
1144
148
. , 2X8
Roscrcln
781
Salicylic acid
Beidlltz powder
Serpeotarta ,
135
840
828
BrgoUn
Harosmells
440
.. .. M
Sliver nitrate .
229
Sodium tbiosulphate
Strontium bromide . ,.
83S
863
Phytolacca ,
.... 783
Variola. Alcohol
178
Valerianic ether
183
Ammonium carbonate
194
Vinegar
Vocal Cords. Paralyals of. Strychnli
Vomiting of Pregnancy. Aconite
Arsenic
Bellsdonna
91
ce... O-M
150
08
..266. 268
270
278
298
822
842
An tipyrln
Carbolic acid
Carron oil
Cocaine
71H
107
. .107. 291
...... 277
Collodion
888
Blsmutb
Bromides
Calcium phosphate
Cerium oxalate
Chloroform ■
. Bcblnacea
m Ether
441
180
1 Outta pcrcha ....»
...... 841
■ Hydrocblorlo add
120
■ Iodine 4.
171
Cocaine . ■..■.••.■.•■.■.*.■.•«•
278
■ lodol
...... Itt
Copper aulptaats ...................
424
^^^ U.»,n^^^ ^^ff,.
!::.!. EM
Creosote
407
^^^h Xeroary
..ST. 628
Electricity
877
1254
CLINICAL INDEX
PAOE
VomlUn* of Prcffuaacr icont'iS), Gentian. 4K«
Glycerin «3
HydroBttB MO
llyilrated calcium phosphate tK
Hydrocyaulc aold US
Inxluvin .• 561
""oalno .BTJ, 677
pccocuAsba 682
■^ SM
$12
rlA
nxYomlea 66i
pDplum * <9Z
Or«xloe Cd&
omUD eM
*_ 706
Bln« 440
' SUTPsacre S50
Vibuniura pruoKollum ...« fl6
Vulvitis. Alum U6
Bctantphibol 641
Camphor 300
CoxDpound eIqg itearat* 860
Phenol 103
Warti. AccUc acid 61
ArMnle 100
ArBCDUQi oleate » Itl
Castaew>nut Ml
Caustic potash TO
Cbelidoatum SZ6
I Chromic trloxjde lU
Copper oteate US
Crratalllne 390
I Electricity 912
I Hjrdrorhtorlc acid .....>. UO
Mercury S24
Mullein 916
NllPlc acid ,.,., U6
Oil of rue M»
Papain 999
Potaulum dichromatt Tt4
SaUcyltc acid A. IS«
SaTine t9T
Scdum acre « 899
Sodium ethylata B6
Thuja , 896
Trichloracetic acid 146
Else chloride 921
Wboop)ng-coii«h . (Se« fii >wfa.>
Vteva. Alialnthlgm 89
Aloaa ISX
Asadarach Z45
Bttanaptathol AU
Denaln 911
Blamath aulphlta 272
OarteUc acid Ill
227
. «Z7
. 4a
. 494
. 1T9
. 9«T
.1191
fO
PAOS
Worms (ro»rd). Salicylic acid U8
Santonin 8Q9
SactonlDoxtme Sll
Scammony S17
Senna 886
Sodium chlorlda 837
Spt^Ua Mi
Stavesacre 8lO
Styrcno 999
Tannic add lO
Thuja •»
Thymol 900
Turpentine • 899
Wounds. Absorbent cotton 07
Aceianlltdc 99
Alcohol nr
Alpbanaphthol 844
Aluminum acetloo-tartarleam I99
Alumnol tt9
Ammonia 194
Anlodol SI9
Balsam of Pern 999
Benxtn 291
Benzoic add 991
Betanaphthol tfO
Boric acid > U^ XM
Boroglycerlde 199
Bismuth 999
oxylodlde 199
subsallate SU
Bromol XI
Calcium chloride 8M
Camphoid • 9H
Camphor , 999
Camphorated naphtbol .»»••••.• §81
Cartmllc acid Wt
Carbollied oil JMw «9«
Cf'droD ....•«.... 998
Chloral 8H
Chlorine 9l9
Cinnamon , •...«
Collinsonia .- ....*,.... 9i
Collodion 889
Compound sine atcttrM* fl9
Corrosive rablUnata ■§
Court-plaster ■§
Creolia 98t
CreH>l Of
DModotonn „....*..... 986
Ecbinace* OH
Blgoo -■- m, 989
EocalyptUB 8lS
Buphorin 49
Bvroplkm
INinaalia
HydrDbrooilc arid
Hydrochloric actd .
Hydrocea dtoxi4r
HamamelLa
Hetealn
Hya&eroaica
. TTO
OLIKICiX INDEX
1255
PAQB
Wounds (wmtdi. PjrokUnln 630
Quinine 357
Resoroln 783
Reaorcinol 1S2
Salol 800
SUver-folI 228
nitrate 228
Sodium tetraborate 101
Soxolodol 847
Styracol 416
Styrone 861
Bulpbamlnol 862
Sulphurous acid 141
Symphytum 876
Tar ; 746
Thloform 272
Tblophen dt-iodlde 8»4
PAQB
Wounds (eonl'tf). Tricresol 416
Trtfollum 908
Trillium 908
Xeroform 920
Yeaet 764
ZlDC chloride 923
subgallate 923
Wrinkles. LonoUn 153
Wrist-drop. Strychnine 654
Blectriclty 977
(See also LM4-poi$9ntn0,)
Writer's Cramp. Electricity 977
Massage 1006
MeUllotherapy UU
physostlgma ...» — 781
Strychnine ^ 654
Wryneck, Spasmodic. Centum 896
!
LANE MEDICAL LIBRARY
This book should be returned on or before
the date last stamped below.
U121 Shoemaker, J.V. 98104
S55 A practical treatise
1906 on materia medica and
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