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Full text of "The life and adventures of Black Hawk: with sketches of Keokuk, the Sac and Fox Indians, and the late Black Hawk war"

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ly/ieti i-a/lfil to ifuide a putieiU t/trout/h tin UIih-ks Ihf phifxivUni 
nhimld bf vtmsianUi/ a uafr/inuiit, and tt llienipftilM ouly ir/icn in-<^ii- 
nitf/ arUrg. 

A fjfXHl phyttirian in one iclio, fxtrhig puif dnign, hioWK when tn 
me t/tetn, Itou) Ut iwe Ihetn, and, eqvfUly inipoHant, when not to ttee (Itmi. 



A TEXT-BOOK 



OF 



PRACTICAL THERAPEUTICS, 

WITH ESFECIAL KEFEBKNXK TO THE. 

APPLICATION OF REMEDIAL MEASURES TO DISEASE 

JtttD THEIR 

EMPLOYMENT UPON A RATIONAL BASIS. 

BY 

HOBART AMORY HARE, M. D., B.Sc., 

rr.(>r»:xsoK or therapeutics ahi> mitkkia ^rt>ICA IN TBB JErPEMOH UT.MCJkt. coi.LECE op 

FHIL&DBLPHIl: PHVSICIAN TO THE JEFPERDOH MEDICAL COLLEGE HOSPITAL: ONE-TINE 

CUBICAL PBUFEBSOB OP DIMEASES OF CHILDREN IN THE DKIVERSITy OP PENNRYL- 

VINIA: LAFREATE nP THE ROVAL ACADEMY OP MEDICINE IK BELGIUM, 

OF THE MEDICAL SOCIETY OP LONDON; COBRraPOMDINO FELLOW OF 

THE SOCIEDAD ESPaSOLA t)E HIUIINE OP MADRID I AUTHOR 

OF "A TEXT-BOOK OP PRACTICAL DIAaNOSU," BTC. 

NISTH EDITION, ENLARGED, THOROUGHLY RETOED AND LiROaY RE-WRinEN. 
ILLUSTRATED WITH 106 ENGRAVINGS AND 4 COLORED PLATES. 




LEA BROTHERS & CO.. 

PHILADELPHIA AND NEW YORK. 



NkiMMtl wmt^aic t» Act of Congrew, In the yta.r lt)03, by 

LKJi BROTUBBS & UO.. 

tt Ak v>4kk<i >M i>t>w Ukniikn of CongieoB. All rights reserved. 



V>iA 



- * • 1 • • 






THie VOZ^trMK - 
IS DEDICATES TO 

Dr. J. WILLIAM WHITE, 

OP cuHiCAL BDUKRY » THi DinrsBBTrT OP p>iniiTi.vtiaA. 



KVIDENCE OF FRIENDfiHIP AND ESTBBH, 



THE AUTHOR 



3£032 



PREFACE TO THE NINTH EDITION. 



In the preparation of the first edition of this book the Autlior 
endeavored to present scientific facts and practieal therupeutic nieiisures 
in such a manner aa to render tlie former interesting and the latter 
rational. It ."cemed to him that the scientific investigator and the 
hetlside clinician, instead of being married were being divorced, and 
that a book was needed which would provide the practising physician 
not only with facts from the laboratory, which he might take advan- 
tage of at the bedside, but also with one whicli would provide concise 
inf(innati')n concerning the best nictbods of treating disease- 
In this ninth edition the Author has endeavored to make such 
rlinnges and additions as will render the work still more useful to 
the practitioner and student. Not only has he carefully reviseU all 
the text, but also included all new measures which seem useful, and in 
addition has added nearly one hundred illustrations, a large number 
of which show the actual npplication of tlie [iri)cedure described ; as, 
for example, the uses of cold water as a reuiedial agent, cupping, 
leoching, lavage, gavage, and the iisp of inhalations in the treatment 
of respiratory disorders. In uiany respects, therefore, the hook can 
be considered almost a new one upon a subject which is interesring 
to all practitioners of me<licine. 

I'm LA DELPHI A, N. \V. (!l>R. Sl-KfcK AND KlOHTEESTH STW. 

May, 1902. 



PREFACE TO THE EIGHTH EDITION. 



The call for eight editions of thin book, each of them larger 
th&D its predecessor, in less than ten years has afforded the author fre- 
quent opportunities for revision of the text ; and that tliese revinionH 
have increased its popularity is shown by the fact that the first 2000 
copies of the seventh edition were exhausted iritliin six weeks of 
the day of issue. In the present edition many therapeutic facts of 
value have been ailded, the general text carefully revised, and an 
effort made to render the book still more useful for quick reference on 
the part of the busy practitioner. In addition to this a large number 
of important new remedies which have stood ttie test of clinical expe- 
rience during the past two years have been added. In order that 
the physiological effects of drugs may be more readily understood, 
a number of illustrations showing those portions of the body upon 
which the drugs exercise their dominant influence have been intro- 
duced, and it is hoped that this feature will make the book still more 
valuable to students. 

Warm thanks are also due to the author's friends, Dr. George E. 
de Schweinitz, Professor of Ophthalmology in the Jefferson Medical 
College, for his carefid revision and rewriting of tlie sections devoted 
to the treatment of the common diseases of the eye; Dr. Edward Mar- 
tin. Clinical Professor of Gonito- Urinary Diseases in the University 
of Pennsylvania, for similar service in connection with the articles on 
antiseptics, gonorrhcea. and syphilis; and Dr. Barton Cooke Hirst, 
Professor of Obstetrics in the University of Pennsylvania, for the 
revision of the article on puerperal disorders. 

Philadelphia, 222 S. Fiftfk.sth St. 
April, 1900. 



PREFACE TO THE FIRST EDITION. 



The object of this book is to provide the pbysician or under- 
graduate student of medioine with a reliable guide in the atiidv of 
Therspentics. or the application of remedial meaaures for the cure 
of disease. It has been written because, in the belief of the author, 
most of the text-books on this subject treat of it as if the student were 
alreadv a skilled physician or experimental pharmacologist. As a 
conse^jHence, two classes of undergraduate readers exist. One finds 
that the mixture of science and empiricism is too difficult for him to 
fathom, and is hopeleRsly confused; the other simply learns the reme- 
dies and doses by heart, and gives drugs with little idea as to what 
they are to do. Further than this, the physician is often at a loss to 
dei;i«le when a remeily is indicated, even though his theoretical know- 
ledge of the subject be very thorough. Thus, he is told that ammo- 
nium chloride is a remedy in bronchitis, but the exact stage at which 
it i.« to be employed is often not stated ; or he knows that digitalis 
does good in cases of cardiac disease, but fails to recognize the fact 
that it is only when compensation is lacking that the drug is heeded. 
For this reason Part IV. has been written, not with the object of 
providing a rigid system for treating disease, but rather for the pur- 
pose of bringing together the best remedies, and of showing how and 
why they are given. 

Rational therapeutics at the present day does not consist in a 
knowledge of doses and the materia raedica. but exists as a complex 
art in which knowledge and its proper application, based on common- 
sense principles, go hand in hand. The treatment of '• symptoms as 
they arise " by the employment of remedies recommended by some 

eminent authority is a variety of empiricism whose existence has 

II 



12 PREFACE TO THE FIRST EDITtOS. 

depended largely on the fact that many physicians i>f the past have 
either been «o iguorant as to be led where a Writer willed, or so sloth- 
ful as to be willing to let others think for them. Scientific research 
ha^i ao largely ojiened up to every one the possibility of using drugs 
with a distinct idea of the reason for their employment that the 
writer has endeavored to bring together in a readable form the com- 
bined results of laboratory and bedside experience, thinking the time 
ripe for such a task. It is true that several other books give, in a 
more or less thorough manner, a rfinum^ of the physiological action 
of the drugs of which they treat, but in even the beat of them only 
the most trained student of pharmacology can discover the close rela- 
tionships which exist between the results reached by the physiologist 
on the one hand and the clinician on the other. The two parts of the 
study are usually so divorced by the prolonged mental effort neces- 
sitated by the arrangement of the text that the student either ignores 
the pliysiological action for the aectinns on therapeutics, or crams the 
former to pass an examination required by the teacher whose course 
he must follow. As a conseiiuenco, too many physicians regard 
pharmacology .«iraply as a species of mental training, or believe it to 
be a waste of time and energy. No one can think that the writer of 
this book will ever deny the value of original research or bedside 
experience, hut he does desire to weave science anil practice into so 
close a network that the foundations of experience may be cemented 
by the mortar of exact knowledge. In some instances, however, 
science and practice seem to be absolutely opposed, and only future 
research can ex|)lain the apparent contradiction. 

Throughout this book, in every part where drugs or diseases are 
considered, the writer has arranged the titles in alphabetical order, 
according to their English names. This has been done because it is 
desired to afford the reader a ready- reference book to which he may 
turn at short notice for desired information, for at present the state 
of pharmacology is so unsettled that a true classification is impossible. 
Thus, morphine may be classed by one writer as a nervous sedative, 
by another as a sleep- producer, by a third a^* a bitter substance, and 
by a fourth as a respiratory depressant. Bromide of pota-ssiiim can 



PREFACE TO THE FIRST EDITION- 18 

with equ&I propriety be called & spinal sedative or a cerebral seda- 
tive, or cafTeine be classed as a cerebral stimulaQt, a circulatory stim- 
ulant, or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopueia have been introduced; and with the same 
object in view, a dose-list of drugs, both official and unofficial, has 
been appended for ready reference. The subject of medical elec- 
tricity has heretofore commonly found a place in most text-books on 
therapeutics, but has been advisedly omitted in this instance, since 
electrical therapeutics has outgrown any work save one devoted to 
that subject alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their special- 
ties. Thus Dr. G. E. de Schweiiiitz has contributed the articles on 
the treatment of diseases of the eye; Dr. Edward Martin, those on 
the treatment of venereal diseases and on antisepsis; Dr. Barton C. 
Hirst, those on the treatment of diseases of the puerperal state. All 
of these articles enhance the value of the book to so great an extent 
that tbe author feels sure they will be sought out and read with 
interest. 

In addition to the general index, a copious and explanatory index 
uf diseases and remedies has been appended, wbicb will prove sug- 
gestive and valuable to practitioners, and for which the author is 
indebte<l to his friend and student, Mr. J. G. Clark. 

Phiuokuhia, 222 South Fifteentu Street. 
Sept., 189a 



CONTENTS. 



PART I. 

<iENEKAL THERAPEUTICAL CONSIDERATIONS 17 



PART II. 

DRl-fM 51 

PART III. 

Remedial MEABcmRft othkk than Drugs 4&'{ 

Fkedin'o THE Sii'K 609 

PART IV. 
IMkraspx S21 

Table op Ikwm op MEnrciXEs 777 

Index of Ukcgs and Remedial Meamureh 703 

Index of Diseahes and Uemedies 813 



15 



PART T. 
GENERAL THERAPEUTICAL CONSIDERATIONS. 



Bbforb enlering into a study of tbf^ nclion of drugs upon & livioa 
bodv. it 18 ncc<ssarv iliat the sludcnt sbuiitcl iioasc-Ms u clear itlea of 
what the word "iherapeniifs " QifiLUH. the rea*iiii why vm resorl lo 
drug». and, mure importaar ilian all, thnt he xhoiild grasp the limitn- 
tioDK which guvcru the ndmiiiistratinn uf remedieH. 

Two very footisb and unfounded ideas liave been put forward 
b^ certftia persons — one being, that medical thenipeutici^ is use- 
loss; and the other, that this branch of mi;dical kiionludgc U not 
advanciu)^ with bo j^rtsat » stride aa is palholwgy or surgery. The 
iodtviduaU who deride the use of drugs in ditteaee belong to one of 
two olftiMB ; either they have tiever tried them or have used the 
^dru^ ignomntly or wrongly. 

The statement that iheraiieutics i^ to-day less advajiced tlian are 
pathology and surgery is readily answered by a denial; for the thera- 
ptiuii«t is ftble to treat suoocs-ifiill v many diseases of whioh the pathol- 
ogtdl knows nothing, ikod is ol^liged to rest his Irealiiietit ou ouipiri- 
rcism simply ttecauso he cannot tell how his drugs uet if the pmliologist 
innot tell him in what the dineaao conidsts. Kheuiiiati^-m and syphilin 
are good examples of this very point. 

Ill regard to sureery, every one must recognise the extraordinary 
arlvances made in tliis brnncu of medical scienee. yet compurativcly 
fvw n-aliiic thai it is solely by the proper iisv of drugH that all its 
trinrnphs are possible. The definition of the word '■therapeulicsi" in 
Billings's Dictionary in; '" That bmncli of medical science which treats 
of the application of remedies to the cure or alleviation of diseafe" ; and 
practically the ti-rm ta aliiiont universally u.«ed toaignily iheeittptuymeiit 
of dnig9 for such purposes. The credit for the introduction of new 
ia4trumcDt« and operations may be accorded t<> surgcrv, but the dis- 
ivcrj of Dew drug^i must be accorded to therapeutics. We tind, then, 
titkt eth«r and clilorofortD began to revolutionize surgery sixty years 
i, and that oorrogiro sublimate and other drugs have revolutionixcd 
otice more witliin the lifetime uf every one who rcadd tliis bouk. 
Bcaine has changed ilic entire aspect of eye surgery and other minor 
kperation?^ tad has immediately averted an enormous amount of pain 
iid BulTenng which the surgeon could not mitigate, much lewt remove, 
tile abseDce of its influence. To the accusation of backwardtiesi 

17 



16 



OsyERAI. TRERAPEl 



I 



the tlierapetitUt can we)] replv by ankinj; tlie ('tiiini[iion of any otlier 
liranch of niri^ical sciiince lo put fomunl one discovcrr nhicb c([uaU 
tntipyrino nr acetunitid in powor lo relieve puin ; and Ust, but by ito 
means IcMAt, he caii poiiil U* lUosc triuraplis i*f modern tlirrapeiilirs — 
tbe use of ttuprarmml gland an a vawjconsirictwr, (if ibymiJ glnml for 
nyxcBdema, ami of antitoxin for <iiphtlieria. 

Tbe mnn wlio lioes not believp in the proper am of remedios for 
the cure of disease lacks the very keystone «f uic urcb upon whit;!i alt 
medioii inve^li^ation i^-stx. for tbi> nUiumto aim aii)I o)>ji>ct of all 
medical tbought ami efi^trt in the cure or allcriatioti of disease. Like 
every other thinj; retiiiiring a tboroiinli knowledge of iw cnniponent 
parU). uicth'ids of troatmoiU arc often iiiuvh tibufed by the careless and 
ignorani. but are a power for gooJ in tlio trains<l baud of tbe properly 
educated pbyHician. ^ 

Further tbnn this, therapeutics is the only unirenally uwhI part fl 

of medicine, for each and every branch raiifit resort lo it, and tlio 

'nost nkilfid i)pemli>r who fnila to tivat his cases mcdicinallv v-'nh 

C'|iial skill will have worse results thnii he who, though bnngling in 

bis surf'ury. yet \isvs dnigs iiiiflligcntly aftor hiH slufhin^c is finished. 

llonicc^ipalhy depends upon more than one reason for its exist- 
ence, tf infinite-oimnl doses are given, the patient is fiatifilied that 
be i» receivinj; medicine, and Xatiirf; often pi-odtict-a her most rajiid 
curex wheti left ahme. Afiaiti. tlie (•ntire baMis iifhuintvoputbic ihcnt- ^M 
pontics rest* not npun the study of the caiiaefi "f diheases. but upon ^| 
the Hvmptom.H uliich constantly present thenisplves. As a result of 
this, tD&uy minor symptutiiH are ri':lievud ii.nd the pationt's confidence 
is won. but nothing m done to control the pathological process icsvlf. 
No detail of dinf^noais or Ireatmeiit should be too nnall to attract tbo h 
attention of the ri>gular phvsiciiin. ^| 

The fir"t duty of tlic plijsuian when called lo a ctise of dliiCHS \a to 
reach a dia^nottis us lo the c:iiisl> of the ailment, ami not until be 
hoA formed a doRnite idea nn lo tlic condition which confronts bim 
should he prescribe any medicinal agent. In certain caseH wliere 
the syiuptoiu--< are severe or indicative of immediate dan<:er it may 
be necessary to give relief by the use of temporary remedies, not 
only to fljive life, hut to remove symptoms which, because of their 
severity, mask the case so that a diagiiottts is impossible. Thus a 
patient laay be found in collapse or in a state of fyncopo. Tbe 
cause of this state may be obscure, but the pitlse, heart-so undft, 
and respiratory action may indicate the need of immediate slimuln- 
tion. In another iuslanru aeoiiiKlu'; pain, as that due to a crlxis in 
locomotor ataxia, or reiiftt or hepatic colic, may i'0<.|ulre a bypodormio 
injertion of iiiorphinc an soon ua the physician assures himself that 
tbo |)aiu Complained of is genuine- In other in^tancei* the cusc may 
be so obscure that several days of careful study may he necessary to 
reach a correct diagnosis, and during this time palliative r«medics may 
be required. 

Before ordering a drug or method of treatment the physician should 
have a clear cuuoeptiou of what lie is trying to acromplisb. No 
remedy sbotild bo given unless there is a distinct indication (or its use. 



I 



QEXF.RAL TIIEnAVEUriCAL CoysiDERATIOXS. Ill 

The otd-fasbionecl "»hotj^in " prescrijitiftn, contniniiig nisuv ingrwli- 
ents, one or more of which Di)>:nt Lit tlic murk, i^huuld bo n'lipplnnteil 
bj th*" small-rnlilir^ riflp-liall sent with <)ir(?ct&L'!tri nt tbi' condition to 
bo relieved. Having ■k-cidcd upon tlio remedy itniitrated, the physi- 
cian must noxt di'ttTiiiiiii- ilie dose refiuirwf. This Uti<>r docisioii )8 
•ItnoRt a« inii)ortaiil bp the first, for very often an error in dosage 
vill raunu Giitiin' of tht> rt-nifdy. A Inrge ]iart of the lheru[ii>ii(ic 
nkill of the pbyi<ioian consists in fitting the dose to the uccd» of hie 
patient 

In the treatmoDt of a!) iorm* «f disease the phyiician niu«t never 
rorgri t])i> follow ing iiitluvDtiol factors iu the cumv. whicii arc often uf 
eroniiT itnportBiicc than the measures devoted to the treatment of tbe 
disease itself: 

1. Tlw maintenajicc of vital rcMStance by proper feeding. 

2. The eliuiitiatioti of eRctc tnBlerialii by the Itidiieys, bowels, 
and Mkin. 

8. The rclii'f of annoying symptomn which onp the puticnt's 

vitality and oHcn obseurc the true state of the syHtem, 
4. Thtilsuffiririit jdivi^ical and mental rent and sleep are obtained 
if |Kk*.<ili]i>. 

1. That the proper me of food in bitlli uciiteund chronic illness is of 
_ Bst inifioTtaiiue it* not onlv manilWt, but it Iiaa been prercd bj 
^MeniiGc iuvcntigalion that Inrk of f<^iod often prevents the flysteiD 
from fiucces«l\illT comhatini: the entranee and (rrowth of infoetitig 
micitj-orgmiiMns. The patit-nt wlio lias a greatly lowci-ed vital n-aist- 
snee not only (juffers from the cfTects of the parliculBr disease by which 
be huK been attarkcd, but not mrflr dies from the grrmth of other 
miero-organiiifn^ which find him a fair mark for their attnrks, thereby 
prrnlucinK whiit Flexner ba.* well culled "terminnl infections," and 
tfaiisiiig Osier to mv that *' n taan rarely die?i of the disease Frrnn which 
he i» suffering,' tnraning bt thin that thi)n<:li he ni«y be ill of a specific 
infeetion, other gemisi really produce ilie fatal iiUiue. Care in fee^ling 
ii thert^fore never to be ignored, and the varlon^s ways nf feeding and 
praparing fonda muet he cnrefully studied. {Hee I'art HI.) 

Z. It would seem hardlv neeeasory lo iiiHiist mi the importance of 
maintaining thi' active etitnination of impurities from the body were it 
HOC ihiii so little utlontion i^ |)aid by Home pliysicinnn In thrnc funrtions. 
[it all i»re<rlioi(e diseases the kidneya are required not onty to elimi- 
nate the ordinary waate products of the budy. which usually escape in 
ihitt vtav. hut in a^lditiim thi? ■nereaJ^ed wtiste produced by the fever 
and the |Mii«on? produced directly and indirectly by the growth of the 
invading micro-organiMins. It is cssentinl therefore that the [mtienl 
shall pa<w urine in Hullicient umoiinl to c»rry olT ihe--e Hnhslanrrs, and 
thiB result often may be attained by giving pleniy of watrr to drink 
and increasing diaresin by the use of nwect spirit of nitre and citrate, or 
■eetaie. of potnsaiiitn. Xor is it RifTictrnt lo Kee that the rpiantity of 
urine t» normal. E.^timnlioDs uf the urea t^hoidd be made in till serious 
cases, to determine whi-tberthenernnl eliminating function of the kidney 
ii active, for sniDclimr^ the How of urine is sufficient, bin the qnantiiy 
of nrinary solida i» far below what it ebould bo. Not rarely in diiieat», 



mk 



so 



(iENKRAr. THERAPEVTJCAL COXSWKnATlOyS. 



ur even in apparent health, the patient slates thai he \\a» hml bis biiwetti 
moved daily, and the pliyriciau is cuiilunt vttCh thifi repurt vvithoat 
mnkin;* any iii((uiriea aa lo the i)uaiiiilj of the (v<:v» or nht-'tlii-r the 
i|uaiitity is adequate in regard to the auiouut of food ingested. Even 
uheii the bowels are moved daily we may find after boiih* dava that there 
but bccu u partial r«tc»liOD of foecal inatt«r. so that ttic culoti bti- 
cumes fiUod with fwct». Someumen moderate dJarrhtra in an elfurt of 
nature to eliuinjite puisons, and is ta )>c regarded ae an aid to the 
patietil, and not arrested by ronslipatinj; remedies. It is also to he 
recalled thiit one of the fuLCtioiis of the liver ie tlie elimiuation and 
destruclioD of toxiL- material, aiitl therefore the ue« of a cholagogue 
not only unloads the bowel, but aitis the liver in one of it« most im- 
portant duties. An the slciii i!<aii iiiiporlaiit plimiiialing organ, itiniiRt 
he kept clean he fre'|uent wasliing, and if inactive it must be !-tian|- 
lateil to iiiereiiseil aciiviiy hy nihbing. niid in some ca^es by hot parks 
or Turkish bathi*. (See Heat.) 

3. It ix of iniportaiiL-e. »» already stated, that syitiptOQis which.] 
accompnny the pro^re^t! of various formfi of diHcases should be modi6e4] 
or reinoveil if iLcy bcfome sufficiently active to produce murh discom- 
fort or disturb the patient's rest. lleadncLe, backache, itching, wind 
colic, etc.. can often be entirely remcvcd by Hiui[ile uieaiis, and soiue-j 
times without the internal use of drugs. It ie. on the one hand, im-' 
portant lo .Tvoid uiuicccs^nry discomfort : and. on the other, care muit 
be taken tha-t in the use «f remedies tu relieve annoying symptonia 
we do not mask important diagnostic factom iu the case or lufluencs 
unfavorably the course of the uialudy. Thus in uppcndicitis it is wise, 
as a rule, not to give niiir|)hine to relieve the pain. aH it will i|uipl the 
patient 60 &H to leiid liiin and his att(.>Ddaiit« to regiird the condition as 
Bcttiitlly jiealed. when in reality the pathological process is rapidly 
progre^ing. Only when the pain ii agonising ougiit wc to give suffi- 
cient of the drug to allay the tx ccm of pain, and never enough to maak 
the real condition. It is of vitail importance that the physician be not 
content with the relief of synipiniiis alone, but thui he shall regard 
them ft" '^f little importance, while he searelie:* for and, having 
found. trie» to remedy the di^-aieed aiale itself. Thus it would be 
folly to treat the headache of ursemia and fail to treat the caiue 
producing it. 

Not infrequently cere U not taken to discover whether the 
patient hajj sufficient sleep or rest. It is perfectly true that if a 
sick man lies awake an hour ho i« apt to believe he hiw been awake 
all night; but. on the other hand, in severe illiiccseit pioloitged iictual 
wakefulness is a very exhaustinjr feature of the attack. Kvery one of 
eiperience has .leen ra.'ies rally-when apparently in n most serious state, 
and convalesce, when a good nleep ha..< been f^iven them by ih(^ aid of 
judiciously Ufted drtig^. If the patient is getting about the normal 
amount ofnleep in the twenty-four hours, hypuotica should be as muoL 
BTCNded ax if they were poisons. 



■4 



UODBS OF ADMiyiSTESINO DftUGS. 



SI 



MODES OF ACTION OF DBU(»S. 

OnigD act ID two vuyi, which are sometimes «ille<1 near &d(] 
reuiuii?, direct aiiJ indirect. The near, or direcl, actiun of a drug ia 
that intlnence which is felt bv the exercise of its effects dirocily upon 
ilie litotues niili whi<-h it r<iiui>i> in cnntact; the indiivirt, or remote, 
ihtluettcc i« that result which come* as a scquenpc ff its primary 
offfct. Aa ati illimtration of thix we tatty lake the local use of can- 
tbarides. The local, near, or direct effect of thiit is a blister; th« 
retiinle or indiivrt eff<>ct is ihe abiiorpiinn of exudations or the influ* 
•i-ni'ing of ioflBminuiorT proceesea. If pilocarpine is iiscd, its direct 
vir<'<:t h the jsAuatiii^ which eiuuea. while its Indirect effect is the 
relief of dropsv ihroiijih the removal of cxudatioQ bj the iacreased 
actioQ of the tikin, Halivarv glandi). and kiduevs. 



MODES OF ADMINISTBRINO DRUGS. 

DnigA may he adminiBtered for the purpose nf affecting the gen- 
(^rsl systvm in muxty waj.s but practically we employ only eight 
methods. iiA follows ; 

1. By the monlb or stomach : 

2. ity hy{)odermic injcctioa; 

3. By inhalation : 

4. By the rectum ; 

5. By iQUDctioD ; 

6. By fiimig;ition; 

7. By the endermic iDeihod. 

8. By kalaphorcsin. 
By &r the m<t«t usual maimer of admiiiisterinf^ drugs i« by way 

of the mouth, which is the nattirul nieanH of entrance into the body 
, ("»r foreign !mh«tane*a. Whenever medicines are used in thi.t way 
Ltbe physician ahoiild clearly bear in mind what the medicine is to do 
uftpr it is swallowed. Thns, if the drug ii< inlendeii to act directly 

ipoa the Htoiuach. it should not he ^vco after mvaK but some time 
[b«fore. «ioce the fod and jwslrii; juice may afterward «« cover the 

~n8tric macoiu membrane that the medicament cannot act upon it. 

rhua, in a case of chronic ga.<itric catarrh or gastric ulcer, the 

litratc of ailrcr which is used should always be given half an hour 
lor an hnor before meuls. On the other hand, if an ulcer or other 
[tronblc o\t<t in the small intestine, the {>itl should be given some time 
[after meaU. and. if a heavy meal is taken, three or four hourit after, 
pince under these circumstances the medicine is swept out into the 
Intewtine almost at once, without remaining any time in the stomach, 

rbere it may be chemically altered. Very often it is necessary to 
[give a uiediciue aooii after food iw taken, in order that it may not 
.•ct ID too powerful or concentrated a ma-nner upon the viscus which 
Mpct'ives It or iipoii the general system by reason of its rapid absorp- 
tioD in concentrated form. 

The general rule, however, may be laid down that alt mcdiclDes 



ds 



OEHERAL THKRAPkVTlCAL COXSlDfRATlOXS. 



are to be tak«n after rather tlmo before iiioal^ nnlpsft a looal ^nutrio 
dfcct or vi-r^' rapid ab»ni-|itiou i& dc«iri!cl. 

Next to tliv iidi- iif <Ini;;M by ibi" uioutli. 1/ far the moat popular 
method is their aduiiuiNtruliou h\ nicuiiii of the finipodcnnu' nairdff aud 
Bjringf. The In^ic nf this mtrthuil rests iipnii the absorptinn of all 
soluble PubeiaQceA from the siibcutaueoos tissues with great r&pidit.v. 
Any substance soluble etioiigh or ituifipeDdiible enough to jmss through 
a hypodermic needle without fonning &q obstruction mfty be employed, 
provided ii is not Hio irritutiiii; mid that it U "clean." 

The proper pliicw to give »iicb injectiont! are the forearm on the] 
extensor iiurfafe.' thn calf nf ibe leg, the biitloclc, or the bnmd of the I 
bncit — in other wnnU, nnv spot where the iia:*ue3 arc not dense andi 
uuvitddiiig. The skiu of ilie part, is Co be grnit]ied or piucbcd up] 
with the tlininti iinil foroRngor of the left hand and the needle sent 
well into tills rais(-d fold, prcfundjly abovr tlie finger and thtiinb. ho 
thnt the pressure of the fingers may prevent pain and hold the part 
steady- Thf ueedK' should !iluay» penetrate well into the luoi>e con- 
□eetive tissue, so that the lii[iiid iojceted may find lodgincai in the re- 
laxed and xpoiigy subciitaneniiit ti.^Hiii'^ without ML-paratiiig the akin from 

Fit.. 1. 



W.lli."! 1-1 ^iiiTii: «. (>> |....Ii null. ;ii>vHi.n Thfl 'kin hiivtnj! ln'i-n iti'Tlil^oil. l^■■ nrcn* U 
Uirn i'iieIx.--! iiil» iiit- >til>t-ulB]ii,*<'ii» tluU'-*. v il'owri )ii llii* lllii9lii>ll"ii. If Hit* tiOirU-iii 
In ^Id't) v>li> Oi<< [•sri'itriii, IJic ilin uf ilin |inii mln wtiU'li Lliv 1iU<'|'1It>ii It In !«■ ui\-'u l> lii 
twialEL-il I'l Kru^vliiE H U*l»i.v'i tim thuuili muil llniti-n -if Hit lr» Im^i-l t" «|i1 iu h*-|iIluK 

itH rother clo»- udh<sioii to the tiitnnes bvlow or from the liluod-vi-stwU 

supplying it, for if separation oecura abswH.* and » •iloiigh may result. 

The daiiyers from hypodermic injertions are eliicHy two. Fii^t: 

Tlie liecdtc may enter a vein, and the entire dose be carried at once, 

' HyiMHlermic ii^uctiun* !i>to Ihr niittfrior HHimt uf ih* fon-artu ofWn caiwe niiu-h 
)>alii ill' the hao'l hv irrilfitinfi l«n)|'inri1y llic tininohei oftbe nultal or ulnar tivrv» 




■ 



tn ma$tif, to tbr viul centres. Second: Th« solutioi) or Dcodle usml 
mty not be .ttrrilc, ntul an sh.<tcr?<H n-Htilr. The Brnt dnnger is to bo 
KToiJed by injprtinp intii parts not well siipyilic^l witli veiiid, nn<t the 
Becund by tlion>ugb]^' nnsliiug both syringe »(»\ iiul-cIIi' vriib Ntt^rilo 
vfxt^r th« inst&nc befort- tlioy are uscil, ptiifhing a fin« wire throuj*h 
the needle, and in smuic- casc?i by Koiiking tbc instrument in carbolixed 
oil. The solution injevied should be prepared by using freshly boiled 
watiT and adding thereto carbolic »cid in such proportion tlint onv- 
hnlfdrop is prMeiit in oai.<Ii injection if n solution i^ to )ic poruiaticnt. 
It i« cUimetl bv !<oun' ibat ibis iist of carbolic acid seriously binders 
absoqjtioti, and in caso^ of urgency tt ijbould not be it.«ed. Most 
pljyHicianx now ninke a solution for intmediate use by adding a Mnall 
tablet of tbi> roquirpd dnig to 20 mininiB of water at the moment it is 
needed. A third danger supposwl to txist by some person*, but prob- 
ably more rcaro-l than need be. i« tlie injection of air into a. rein with 
the mrdicamcnt. It in well tn nve that a11 air is expelled from the 
syringe bcfiro making the injection. Most hypodermic .lyringea bold 
frum tircuty tu thirty minims. 

When dnigH are piven by the r^rtftm^ wp employ them for three 
porpo«i\i : Firet, t« influence ihf general sydteni by tlieir ahNnrpiinn: 
wenndlv. to act bically iipmi any di^ca-^e whieb may be preseut in this 
puntcular locality or in tbc cidoti *. and, Rimllv. to di^tlod^c tiubxtniiecs 
or paraMfrji whicn it is desired In bring away. The word " eni'mn " 
i» IdOHely used to denote nil ihow injections, be their purpose what 
lliry msY. and is synonymous with '' rectal iujectiun " or the more 
tdd-faitbinni'd word "clyctcr." If nourishment i« being given, rbo 
injection i.s mllnl a "mitrient enema." Sometimes these injectioiut 
an" i-allfi) " Invcinents." 

in this mode of administration It is very neecs.sury that the physi- 
cian should use his medieaments in pruper bulk : and it may be laid 
down OS a ride that nn mure liqtiid slmuld be injecteil tlmu i^ nee^^a- 
»ary tu cnnvey the medicine nr f<)i)d. iinb-s-s the injeeliim is fnr :ho 
purpose "f emptying ibe bnwel uf ftentl matter iir uther muteriu1». or 
It to ileKire«l to (lisieiid ilie bi>wel iti order to overcome obsintction, or 
to iiillueuec the culuu bv drugs. 

The reasuu fur ihiti liea in the fact ilial any large bulk nf li(|uid 
MUt into the rectum ko ntiniulatefi lis walls by dintenlion aa to cause 
BpUMniidie (rnutractiou. with e-xpuUinn nf nil the i-eelal eontents, whteli 
in ju^t whil in needed vthea iiecal mutter ia to be removed, but the 
nppiiitile iif what is liesired wlieii ruleutiou of u remedy or fond is 
UVKciwury for absurption or loeal action. In rectal catarrh or ulcer 
two to four iiiinees of liiinid are usually sufficient in au adult (it 
accimplish any metlieiDal infltieiiee hiciilly nr by absorption, while at) 
a laxatii-e enema one lo two piuTs may be employed. 

In the UM' of injevtioiiB vv frcijuently Bnd that the rectum becomes 
irritable, and preiii|itly resints all eflort^s to forci* the entmnce of liipiids 
or solids. This li Ut be avoided by giving the injcetlon so gently that 
the bowel bils to recognize. a» it were, the entrance of liquid, and by 
ibirtHlucing a few drups of oil and luudanum in cudi injeetiou. 



• 



S4 



OF.SKRAL THERAPEUTICAL CONSrDERATIOSS. 



A l*rge Bmniint nf dislrcflit of^en foIlowB ctie gnidual accuma- 
latiuii of fietuil luoM^i's lu ttie coloa which are not pewted nith 
tbc daily tuoveuiotit nf cho lower bowel. These can readiljr be 
rumuTcd by liirgi- inje<:tit>ns of warm water or bjr the uee of inedi* 
Cttted li((uiil». 

A Terr important use of iqjections by the rectum ia in the trc&t- 
tnont of the variuiis causes of ince^linal otKitrnction. Wvre the great- 
vat eaution ishoiild be uxcrcistiU ihiit the iiijectiun be made with all 
[MDisible geutleuetu). and hIhwIv, the lii^uid bein;; tiMoued to rlribhie 
.into the bowel mtber than to force its waT> It ii^ dangt-rous tu use a 
rroatvr nresiiiiire ihan in giren hy a fniintaln syringe at the height of 
Two or Uiree feet, aa rupture of the ;)eri(oueal coat of the bowel may 
occur. Wbere a Xar^^v i|uaut)ty of wuler in used it dhouli) be caro- 
fullv warmed U> lUU" or a little tnorc. and it xr- well to add salt to it, 
So that it will repmaent the nnrmnl daline dtrength nf hbiod-serum. 
QftUDely, severi-teiilhs i>f iniu jier cent, (For uee of injections in 
special diseose-s see Pari IV.. and for £nlorocly»iB. Part HT.) 

Siippoai toriea are anotber nieana l>r wbicb we introduce mcdictncA 
into the bowel, either for loeal effect or to act after absorption of 
their contents upon the general system. 

When dru^M are> given hy inhnlaihn they are generally omplDyMl 
with tliR objiict of affectiup the respiratory tract aliiue. allhougb there 
are DoiH.bl<> exceptions to thi» in ether, chloroform, niironn oxide gas, 
and other volatile Buhntaticca. A»idc from unwwtbciie^. we find such 
remedial measures adopted as the inhaling of Kteani laileit with the 
drngfi employed, the re-spinny v? air loaded with the fumes nf the 
medicament, nr the inhalation of gase^i, and last, and inotti commonly 
resorted to of all, the use of the vaporiser, which, if properly made 
and employed, su minutely divides the liquid coutairitng the medicine 
tbat the inspired air carries it to the farthest bronchiole and pulmonary 
[Veaicle. (^'ee Part III.) Atomiied spriiya have also been found to 
Dssess Kfi^at pcHL-lraling power iu the treatment of iuflauituatious 
under the skin or mucous uiernbraues, as, for example, boils and 
cnrhunclea. 

As an example of rlie ndes governing the administration of drugs in 
thin manui-r ue find that eoiiipouud liucturo of benzoin may he taken 
bv inhaling the steam nrising from tiul uaier eonlniniiig it, but can- 
not be used in a fi»ray bccuunu it nccludc<« the fine point.-* of the ntnm- 
Uing tubes. In a similar manner we may inhale the smoke of bellu' 
duuna or ti ibacco-leaves to relieve aathnia. or the fumes of chloride 

Lof ammonium for bronchitis in its later stages. Funiigatinn with 
mercury, the ^ubliIned vapor being inhaled, is atso uttcful. Finally, 
ve find that oxygen is souietimes very useful, the gas being readily 
inhaled, with goocl results in proper cases. 
The " spray " or atomizer is made in two forms — one form of appa- 
ratus heing worked through the agency of oompri'b»ed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed -air attimiKcnt throw u spray Rnc enough to reach the 
deeper parts of the lungs, particularly if the air i.>i eompressed by the 



I 

I 



I 



JiODFS OF ADUiyiSTKRlSa O/iUOS. 



25 



k'vhirl) M) niinul4-lT divide tlio Iti^nHt tnedieatnont tbat it enters the 
Pdttwr paiiji of llie luiii^ verv reudily. 

The- inlinlntion nf nrnist nir is \'ery u^t-ful in bronehiris, and 
greailv ai'Ii* oilit-r remedial meitsiires, Srcam rany be ilisnigagcd iu 
tvtom bv means of a kettle of boiling vaccr or by |ilac-iiig [)iec«e 
>f unslakrd Jime in u |utn of wutcr. 

Inum-tioHM c-nii^ift in ilie nilihing into the nVin nf meJicliies gen- 

P«rallT of «n oilv or (nVy nntiir^, or wliic^li asKUine tbii; elinrucior 

lliniugh i-iiil>o<liii»-tiI will) oil or ful. Tbc tbree siibBtancen iikmI CDtn- 

mouly u3«il in lU'm wuv arv (.-od-liver uil. Dicreurin.1 oinrnienc, and 

indtQo niniiDetii. Thcv i«hnuld aJwitTH hv applied on soint part where 

I thi> ilerni in thin and woH attppliud wiih (tiibrutaiiixiHS Iviiipbatics, ns 

[iu titc axilla', ibu giroiDi). or tlio JuNidcs of ibe thigh». Otbcr sub- 

Mrtanww have boco uiid may be mcd by inunction ; biii ns thix method 

till necmsnriK n diHagreesblo snd dirtr ontv it is rurdy letiorled to 

|iiiil(«8 tbv stomiirh ia dimriUred or it m nL-ct^Mmrv to push tbc dnig 

into the system by erery pawlhle avenne of cntranc*. 

The rniirrmic method c-on^ti.tls in the npo tS a blister, by meaas of 
which Lbe fpidenn is raievd, wbf>ii a little morphine or other ulkuloid 
may be slippod under it nnd no abHorWd throngb the true Kkin. It 
in a painful metliod, alnioHt never to lie resorted In, baring been 
entirely supplanted by the hypodermic methoil of medication. 

Dru^ are aUo Bonietimea eaused to enter ibu body throiifrli the 
akin by placing them in plasters or pmiltices, or by the electrical 
process called catnpburesis. (Part IU.) 



■ 



Krmeilies are admiQistcrud in a niiinher of forms, biiteblefly as 
Xullona; 

AUHTRAnv are dry powdered extraelfi mixed with sugar uf milk 
antil tbuy are twice aa ftroiiji as ihe criido drue. Abstracts are no 
longer <i9it'iiil iu the Tnited Slates Pbn minropwm. 

AcfJTA, or vinegars, are flolutiona uf the active principles of drag! 

ia vinegar or dilute acntic acid. There are t\ro in the Lnited StatM 

Pharmacopeia {AciUitn OfH and Acetum SciHa) and three in the 

^T\il*h{Aftfumt'ttnthtirUli»,Avrtv.m lpfcafuanha',aiii\A<-ftiim SciUa-). 

Al.K,il^tItK are organic baae», forming «ilta with arid radicals, gen- 
»nllT occurring in crTst«lliiie form and ;ibMtraeted from crude drugs. 
They nearly nlwayit reprcaeiit the aetive principle of the drug. 

AqUjU. or waters, are ir>«ed as vehicles either for the dilution of 
tnmg medieinen or for the purpose of carrying taiutitc amounts of 
avoring materials. 

Cataplasm.'! are not ofTicioJ in tbc United StatCiS Pharmacopo-ia. 
Thev are Tirtually poultices made of linaccd-mcal or of bread-crumbs. 

(SjiATE'i are ointments conlaining wax to render them harder than 
Would ordinary fats. 

ClIABT^. or papers, consist of bibulouB paper soaJiod in a solution 
'f»f the drag which they are meant to carry. 




2« 



OESBRAL THERAPEVTlCAt COysiDfRATlOSS. 




CONFRCTIOXS ar« 0oinetiin«8 cnllnil otcctuaries or consenai. and are 
Boft pMtm whicb conluin ihv tirug mixvd nith t^ugar <tr huncr. 

Dkcoctions are aoluliouH of drupi ua<li' l>y builiiig aud iheo stra.it 
ing while hot. 

Ei.ix[R8 aT« diluted tinctures rendered pteiuaut to the tiuie by 
addition oF arumatic HulMtaac«4 and sugar. 

Ehi'Lastka, or plufiterti. urc iiiadp u[) of adh««iTe snlMtancen plaf 
upon a backing of clotb or leather aiid df-iigufd t'l adiii're to tbe skin, 
boiuj; 9'! applied for th<> ptirpnsi^ of lioldinf^ u iiiL-diciiial subi^tuncv in 
contAct witb the body. <>f acliii*; lu^ il protective, or of aiding in Ibe 
appntxitnatinn of the edgnit of a wmmd. ^| 

£ml'LSIOSH are liquid preparations whicb coneist of oily aabstaaeer' 
miDUtoly subdivided and held in auspenBiun usually br some gummy 
material mixed with water. 

ExTiiACT-< consiRt of the aolLble partH of plants reduced to a semi- 
aolid or solid condition bv evaporation ; the soluble cooatitaenta beiooH 
taken from the plant by water or alcohol. ^B 

FttriD ExTflACTB ore made in the same way as solid extracts, except 
chat they are not so completely evaporated. 

GlTCRRlTA. or glyceritfls, are solutions of varioua substances in 
glycerin — -the glycerin being useil as a vehicle. 

iNi'u^loyr arc uiadr by pouring boilin;; wat«r on the crude drug 
and allowing it to stand for a abort time until the water cools. afi< 
which the liquid ir fltr&ined. SomelimeB cold water is cmplcyed. 

LrsiMKNTri are made of nily Diibciiancieii of^en iDixed with powerful 
drugs to incn-asc their c£Bcicncy. 

Liquors are umially watery solutions of non-volatile drugs. 

Mi.\TfHK.^ are composed of two or more drugs or of a single dr 
partly disisolrod and purtly in su.>ipension. 

PiLI.!^ arc staall round uiaasvB which, us a gcneni) rule, should nt 
weigh more than three grains, tn order to avoid too great bullc. If3 
the material i» a heavy one. as much an five grains may be placed inj 
each pill. PillH may be without covering or ciatud with sugar or! 
gelatin l*> j)reservc thi-in and prevent the patient from tasting thcir^ 
Rontcnls. Sugar-coated pills (uu«l always bo fresh nnd ihe sugar-l 
coating pure. Gelatin is the beat coating for pills. Many pilU ai 
fraudulently coated with varnish ami iire itntoltible. 

SftRlTS are alcoholic solulioDs of volatile substancea. 

StMM'o.'ilToHri:.'! are small inassea made into a cono »hn]»o and', 
haviug for their basis cacao butter. They urc designed to carry into 
the rectum certain mediciQea for abikirpuun into thenyHtein or for locnl 
action. 

Syritpk are solutions of sugar or gummy substances in water. 
They are used as rehicles. 

TAiti.icrs. — Under thiN name manuf;tcturing phrirmncists and others 
prepare coinprosRcd pills or lozenges, generally of small eixtr. the mass 
being made to adhere by meuus of iu being subjected to great pre.i,iure 
by special machinery. Smaller tablete are used for carrying powerful 
drags for hypodermic use. Theae. however, are often only lightly 
preased, so u to render them easily .soluble. 



DOSAGE. 



27 



I 



TnrtrrDRRS arc 8i>!utio?i8of th<> active prinHpIeti of ilnigi in alooTioI 
in mixtures of i»!c«lii>! wul water. 
THlTiruiTttf arc? in:ule hv iiddin;^ 1" piT wnt. of tlie «i*live meili- 
dnp CO !'0 per rent nt iailk-sug;tr. These nrr Uicn camfullY ruliWd 
twetfaer oatil the twn uro iniimAtely mixed. Tritiirnle^i are very val- 
iluXte in the ndniiuistratiou uf medicines to utults or to children, 
eso trilunt^a are ofipo made into tablets., foricin^ what are known 
u'' Tablet Triturates." 

Tkoches, or Instengeo. are flat, hardened ma^ctt designed for faold- 
g nit'diciues iu tlie mouth, so that. Ihev may b« rIowIj- dixHiilvctl. 
tTcby afTccling ibo local mticoiis membrane 
OlSTMKNTf, »r imgiicuw, cftUBiat of the mixture of eome kind of 
ttv Bubstance with the tuotlieine which thev arc dosijjned to carrv. 
^ViNK^ are made in the same way as tincMirc» — »tr«ng wliitc wine 
being a»cd in rhe I'riiied Stateti. nnd .sherry or orange wine in Great 
in, in place of ordinary alcohol. 




DOSAaS. 

_ IB, unfortunately, no ahaotnlely fixed rule which can be 

apjdied to dotui^ic'. for Kwural reusf^lin. In the first jtlace, tlie indi- 
vidual may not be readily afTeeted by dru^i^, or ibe ditteat^e-pruoess 
rhicti 16 present may m* antagonize tbem ax tn render very large doKvs 
it^os»ory. Fnrlher than this, the npe nnd Rex of a patient have much 
■id with ihe rectilatiou i>f the ])rt>pur aiuuuiit vS a dru^ which we 
lav give. Finally, that ciiriuiix but fomuion condition of siii^cep- 
lability to various remedies, that we call iMoni/nn'nfi/. creep? in as an 
ijiortant factor in the dccisinn an tn (he dose which isboiild be given 
each caee. By far the nearest approach which we can make to 
isiiluie accuracy iu dosage in lo usedrug)* iwooniitig to the w«ii}ht of 
/»*■ patient, bnt tbic nielhod pwjteKscs the disadvauluges that we can- 
tnt alunys neigh nur paliimtii. and that the presence <if n large amount 
of fat or of drojN^y will iii:ik{' an iinkuowii iptanlity in our calculation 
to ibe true weight of the active jiarl of the individual. 
At present ne arc accunt'imed to be governed by a lint of dottes to 
^ren to nil adults within certain limilationtt. and which are varied 
lufficieutly to jjermit af great differcncefi in tht- effects (»blained. It 
iu this verv point thai the hhccpss of many a physician chiefly 
3\x\ for the H«e of a dose by " rule ol' thuiub " ie a* empirical antl 
icking in ihuiight as ii* n»c of a remedy, not because we have a deli- 
lile action for it to carry out, but boc&iiao it did Home one else good 
irho vi\» KiilTering from what appears to bare been a i>imilar attack. 
The dose must be varied to fit tlie case in the same manner that the 
lit of a cnat mii«I be varied to fit each individ[ial. 

There arn a number of aiipnixiuiaie riiles in regard to the tinaes 

_whicb are to be giren iu ireaiing the diseases of children, the best of 

rhich iA Young's rule. Thiij is ae follown: 

-Add V2. to the age antl divide by the age. Thus, if a child ia two 

~ old, we have ibe following, 'formula : 2 f 12 ^ 14 -»- 2 =7, or, 




s« 



GESEk.AL THERAPKVTW.iL COXSJ DERATIONS. 



ono-eevouth of the doso for an mliilt is the dose for a chiUl of two 
jcnrs. This rule is not a law, howovt-r, fur of narraitica children 
sliuaUl receive \txiS timti tbi») (one-lialf), aud uf purgalivus or laxatives 
more ibitu tliis (two or three timen). 

Wlion drays iire given bypodermically tlio dose should beoencmlly 
Duo-lialf to tiDf-riuurcer uf that givcu hy the mouth; and if any 
thought of idioRvncnuty cxj^t, tho dosi* should be smaller »tilt at tlie 
htart if powerful romndieB are to lie used. 

By the rectum the dtise whould hv twice the amount given by the 
mouth, uuleaa the drug he very powerful or capftble of very rapid 
ab>«orption. 

When ordering liquid medicine? in email amounts vc should always 
take paina to wrilc fur niinini.'^ riithor tlinn drops, for the ejje of a 
tlrnp viiries with the [inrticutiLr lii|uid with wJiich we arc dealing nud 
the shape of the mouth nf the vessel eoiuaJiiiiig it. This is well Hhuwn 
id the fuliuwiiig table, enmpilcd hy Kiuscy, and originally published 
in tbo Anti'rieaa Journal (^ I'harnuuy. 



4 

■ 

f 

I 



AcMna lobelliB 

AMInmopIl 

' Mtum Miifriilnirlc .... 
pM. •f'»iip 

_Dld.HCEllc.-lllulC ■ . . , 

■JicliJ, oirttollr. .....'., 

keM. ijdf'bn-iait} 

AcM. hjrdiatiilortc. . , . , 

A<>ld. bTdiofhlorte. dll. , . 

Acid, ultrle 

Acid. nllrlP. dilute . . . . 
AHd. nltruhyilrch^hlortc. , . 
Aoid. uhrutiyilnMlilotlo. dl- 

Add. phtiipli'irlp. .... 
Aeld. ■ulTiniiri'* 
Aeld.BuliitiuTlr.itllulc . . 
Aoid. ■uiiitiDTic, annnatie. - 
AquA oiuinanin ...... 

Al]U»<lMt1ll*U 

LlqtiAr (miUm. klaon 

Oltinn anUl 

01enroi>m]rfEdalj»UBi.r. . 

Olctun carl 

Otvumi^liFnnpiwIlI . . . . . 
Ol«ainc«roptiTl)l ' . 

OlFnm clnnununU 

oifiiTit ontonb 

okiim ciibKbM 

ItlVtllll MOllh'FlB 

OWiliu llciJcnRiic .... 
Ok'Uiu taviiictiitic . 
Oli^iint mrtnnnLjr 
Oltiuiit luiMilll* pip. . . . 

oiiiDtii Rifutbi* riridl*. , - 

OU'uiu mrrl»ilcw 

DtniiiiiorinBl 

Dlt'iim pJniirnla 

f.>l«i)ta roamarUi] 



t>TVfv<i from 



III 



aa 



ss 

M 

lAO 

u 

M 
u 

T6 

io« 

M 

M 
77 
84 
M 

n 

» 

W 
BB 
96 

ts 

•I 

m 
n 



%* 
a 

iM 
ii 
t* 
u 

'«i 

78 
77 
»« 

TO 
TO 

n ■ 

ta ' 
sn 

M 

to 
n 

M 
71 

n 
m 

83 

« 

M 

•n 



M 

«s 

92 
tOI 

W 
110 

Vi 

va 

62 
IM 
81 
03 

« 
«Z 

fiO 

u« 

M 
AI 

rt 

112 
7S 
ISft 

V3» 
1» 
113 

KM 

lai 
lis 

ISO 

las 

I3S 
132 

i%> 

1S8 
133 
113 
143 



01«i)ni tanArrll . . . 
Illi'iiiu U-ri'LlntblnM . 

^|llTlIU»SIIIin>>R. KT. . 

S|.1iHn« mlnT. cinup, 
Hliirlliiii .TtliiT iiltt, . 

f jiltHitb lil'riltiii- pip. 

Synipiii" •('ill.i ■■'imp. 
llntfufn ai'iiiiili . . 
Tlnclara iiuifri'llilie . 
TinfiiitK i).-iiiiiii>nn« 
TInctaia bciu-^tiit cq. 
Tlncmrn i^nniihU lad 
Tlnctur* oinlluiridi* 
Tlticiurncaplcl. . . 

Tlncliiru flleUnlla , . 
TlncrurH fi-rrl (filler. 
Tlnolura 1iyi)erjmii| 
TliK'liirti iiriJiiirB 
Tliii^turn i^ttli , . . , 
TliK'tjrs klii» . . . 
TlnctilM krntfujriB . 
Tlni'lura Uvnud. (to. 
Tini^ura loti#ll» . , 
TlnTtura inTrrbw . . 
Tlni'tvira nin'ln vninla* 
TIt»'Iii» 'j].!! .... 
Tliiiiiira fifill ramph. 
Tlnflum niill rtdoflnf. 
Tliiviura rhtl .... 
Tinpliira ■■iiiiiinarla 
TInc-tura ■Irainonll . 
TInriiini tolntani , 
Tlnetar* vprnlH vjrid. 
Vlnujn tticM^ . . 
Vlnum pi)k-hi<-l ntd. 
Vinum C'llrhtcl (cm. 
Vlaum vivJtie .... 
|Vlnun»pu . , ;. . 



IhvppodSam 



H 



If II 



110 

lOB 
» 

120 
M 

M 

ICW 

u» 

102 
M 
H 

]» 
118 

im 

M 
lU 

im 
ii« 

ii: 

112 

lis 

117 
117 
110 
V» 
111 
W 
M 

im 

M 
uo 
loa 
lan 

)I)H 
71 

fiS 
*8 

w 



01 

SD 
S 
7> 
W 

w 

H 

m 

UK 

at 
n 

M 
isn 

97 

m 
It 

n 

K 
9t 

100 
!» 
H 
TV 
96 

lOB 
V2 
M 

r» 

» 

M 

97 
M 
M 

Ti 
Tl 
W 

n 



us 

IH 
KB 
HO 
140 
M4 
lU 
113 
IM 
Ut 

ua 
w 

M 

U6 

Ml 
VU 
lib 

ua 
HT 
140 
W 

ua 
uo 
ui 
ua 
m 
lis 

va 

lU 

is 
i» 

lU 

va 

M 
06 
VK. 

va 

lOB 



I 



Do«e:i are abo urderetl in leadi>iH>iifii], dcHKorlspoonful. and table- 
spoonful quantities. SometiineB they are given by the wiuegliiiHtftil, 



WEIGHTS AND A/EASURHS. 



29 



meuiing by this tenn a sbcrry-t^Iassrul. Rouphly ostirantcd. » tea- 
ftpooDfuT ofjuttU a tluiJrachm (4.0). u degsorwpoonful two fluidrachms 
(8.0), aatl a tableepooiifnl hsIT a fliiitlouncc (lo.&j. As spoons and 



Fio. 2. 



Fiii. X 



Fio. 4. 




TUl 



tBLC 
SSCRTj 

rEA 



(Imduatcd UM'dli'luo k1mm>- 



winoglasfles vary ooneideratdv in capacity, it is always befit to iiac a 
graduated medicinn gta»«, Biich as arc nbown in FigK. 2, 8, ami 4. 



WEIGHTS AND MEASURES. 

There are two systerus of wvigLiMind nietifiuree employed in the 
UnitM States at the ppesont timt^ The one uiosi t-ominoiily employoti 
is the olil-lik''hionpd oystem of Apoiliecary weights fnr rfllid^s und tbe 
Wine, or Apothecarv, tDca»i)rci« for liquids. The newer and more 
accurate sy-item \» tuat wLicIi ii4 kiiuvrn as tbe M«iric:, or Decimal, 
^/.y^tpin nf weights and meimurcs, ami it i^ nuw nccogni^or) and rooom- 
mcndLil by ibf Pimrmacopouias of the United States, On-at Britain, 
Iveniiiiiiy. iiud Kniiiee. 

'I'hc dirij^ianH of Apothecary ireigbts ar« the pound, the ounce, 
tbe drachm. tJje noniple, ami the grain. The scruple. wbiL-b e(|u:il» 
20 grains, has dropped out of u»l\ chiefly bccim«e the scnipte mark 
when it is wTillen somewhat rtmeinhlet* thut of tbe drarbin. We 
niay my, tbtrcfore, that tht; A pothrcarj' weights ixmaist of n pound, 
n}iialliug 12 ooncM, or 9*5 draehniH, t>r -ITrtn grains ; tbn.1 ibc ounre 
rfprcsrnls K drftchms. or 480 grains ; and that ibc drachm wjtiaU Hd 
graiuff- Tbe abbreviation for tho word grain is **gr.**; forlbe drachm, 
3i f'>r tbe otiiico, S'- and tbe ])onni], lb. 

In the Wine, or Apotheeary. mfasHre tre have the ffallon. tbe pint, 
the tlnidoDnci'. the fluidrarhoi. and the minim. In each gallon there 
•re 8 pints. lUfi fliiiilniinoptt, 1l"l24 fliiidrnchnifi. find 6l,44i1 minimn. 
Ill each pint there are Iti QiiiJuuuceH. 1:28 (luldrachm?, and 76S0 
miiunm. In each onnco there an; S fluldrachms uml 48f> uiinimn. In 
each dracbm there are 60 minims. The ahbrcviutJun of the Latin 
word ■' minitnuni " or " tninim " is 11\ ; of the fliiidnicbni. f.^ ; of the 
fluiilr.nnce, fs; of a pint, or "oclarius, " 0" ; and of the gallon, or 
cuDgios, " Cong." 



OEyERAL TBF.RAPEVTWAL COSSJDKRATIOHS. 



Tbc Brilish IMinrmncopoein bns A<loptcil tlu> A^'oirdupoJD ;.ystein 
of woigliM. iitul tli«rebv \it,» a a^'Btem nlik'K dificrs ^oinewlial froDi 
the Apotliecurv" woightH of iho United Stati"* l'hnrmA(*op(pia. 
Tile AvoinlupwM pomiil n-priwiiti* IG ounces, ur "D'JO gruitis: tlie 
AvoinluiwiB oiiiiCff. 487.;') jfrains. Jt will be seen, thcrefort', tliat tlie 
A |)othcrarii' pound rniitaiiis 1240 gmiiiH less than the Avoinliipois 
pouni), hut llint the Apothecary ounce vciDtning 42^ groiiis more tlinti 
the Avoirdupoia ounce. ForlmiBtcly, Iiowcvcr, the grain, boili of the 
Apolbecnrj and Avoirdupois syetcms. is of identical value. So, ton, 
thr British I*harmaLiip<ria uurs what is known as thr Jinpi-rinl system 
of nirastiri'.i in plnce of tbe Wiiio measures user] in tin? I'nilcd Stutt«. 
Tliria. ilie liii)ic-rial f^aUon roprescrn.t 8 piirts. lliO fliiiiUuiiiccjfs liiSO 
fliii'lnicbins, atui 7<>,S00 niinitus; the Iinporiul piiii, 2l>fliiiilni]nei>H. I*i0 
fluiilracbuin. and HKOO minima ; und the lluidouiicu. S drachuin or 480 
minima Tbo fluidriti-hm equals liU miiiiitm. It uill lie seen, thcre- 
forp, tbal thp Inipflrial nifaj*nrp ilifiVi-n from the Witie nicusiirc chiefly 
ill havin;! 20 lliiirUiinccH in cutb pint, instead of l(i. So. two, tbe 
Vrei^hl of the Imporiiil Huidounci- cimtiiius tbe ^uuie iiuiiihor nf 
grains as tho Avoirdupoift uunue. nhieli 10 ltS.2 »rain)t Ics^g than the 
weight of the Ciiitfd Slatcn fluidouncv. which iit 4'*i5.7. These diffcr- 
eiictw beiwceri tbewei^lilN and Hn-asures used iu tlie United Stute^ and 
(Ireat Britain are, ibcfefore, i>f litile impcrtanre wlien we are employ- 
ing grains or iniiiiiDs. bnt they ijeeome of groat impnrtanre when we 
employ ounce*, ami uf still greater iiupurlaiice wlieii wc employ jiouudu 
or pint*. In tbe aierujje prescription, however, wliicb riircly exeeedn 
thrco or fonr ounre^s, the diU'erctice in ipiiintitieH in the I'nited Stales 
and Grent Britain are not of very great importance. 

The advunliigcs of the metric system over these incgulur syetems 
of weights ami itieusiire« lire the same iis thoi^o of the jb-eiuial sy^^teni 
of curn-iiey over t!u> English .systrni of poriniln. ^billiiigi'. and pen»T. 
The unit of nil enletibitiuns \» llie nii'tn-. whi<-h in the melrie system 
is ihe nriit of Ien[;tli. l*"rom this ih derived the unit of capacity, 
the litre, which is the cube of onEsienth of a metre; and from the 
lilrc is derived tlic unit of weight, the ;:ntuiuie, nhich is the one- 
ihoiir'Hiidtb part of llie weight of a litre ut distilled wnti-r at its maxi- 
mtim denaity. As a niattir of lael, tbe itietrie ^y!■^t-m is in. more 
diHiciilt to master than is the system of dollars and cents. The great 
difficulty is that the majority of pby-siciana having learne<I ihe doaes 
of variou!* prfiparation? in the .Vpoiliecary weight find il difficult to 
begin u^ing ihe metric -iystcui. and do not Ukc the trouble to conrcrt 
the .'Vpolbecary doses iuio this system. 

Iu tbe metcic flv^tcm wo have the gmmmc, which may be said to be 
tlteeiiuivaU-m of the dollar; tbederigramme, or one-tenth of a cranime. 
which represents the dime; the centigraiiinie, or onc-huii'lrertlh of a 
gramme, which represent? the cent : the milligramme, or the one- 
thouwindth of a grnmm*, which represents the mill. Above the 
gramme in ■'juimtiry we use what \* ktionn as tbe Di^kagramme. which 
corresponds to the gold eagte, or ten ilullnrs ; the ncct-ipi-virame, which 
eorrespouds to one hunilrcd dollar-; and the Kilogratume, which 
corresponds to one ibouHand dollaiv. 



I 



I 



we 



WEIGHTS AND MEASURES. 31 

When we come to the use of the metric system for flaids, we nse as 
the unit the cubic centimetre (cc.) in place of the gramme; a cubic 
centimetre representing 1 fluid gramme. 

When it is wished to convert grains into their metric equivalent, 
it must be remembered that 0.065, or 65 milligrammes, is the equiva- 
lent of 1 grain. Therefore, the following examples may be used : 

3 grains are equal to S X 0.065 = 0.195 gramme. 

60 grains " " " 60 x 0.065 = 3.9 grammes.* 

i grain is " " | of 0.065 = 0.0162 gramme. 

T^ grain is " " -^ of 0.0065 = 0.00065 gramme. 

To convert grammes into grains, instead of multiplying by 0.065, 
divide, thus: 

Gramme 0.12 is equal to 0.12 -•- 0.065 = 1.8 grains. 
Grammes 3.9 are " " 8.9 -*- 0.065 = 60 grains. 

Gramme 0.06 is " " 0.06 -+■ 0.065 - 0.9 grains. 
Gramme 0.0006 " " " 0.0006 -t- 0.065 = 0.0092 grain. 

When we wish to convert apothecaries' drachms into grammes, we 
multiply the number of drachms by 3.9, or more commonly, though 
less accurately, by 4.0. Thus: 

10 drachms X 4 =40 grammes, or, more accurately, 
10 drachms X 3.9 = 39 grammes. 

When grammes are to be converted into drachms, we divide the 
number of grammes by 3.9, or approximately 4.0. Thus: 

10 grammes ->- 3.9 = 2.56 drachms, or, less accurately, 
10 grammes -*- 4. = 2.6 drachms. 

When Apothecary ounces are converted, we multiply by 31.1 ; 
or, if grammes are to be converted into ounces, we divide by 31.1. 
Thus: 

2 ounces X by 31.1 = 62.2 grammes. 
40 grammes -*- by 31.1 = 1.25 ounces. 

m 

As accurate translation of apothecaries' weights into the metric 
ftvstom leaves a fractional quantity in almost every instance, and as 
the translation of the metric system into apothecaries' weiglits does 
likewise, the author has for the sake of presenting even figures, and 
ibcrcfore rendering the interchnnpe practicable, considered that ilie 
Apothecary ounce and the fluid ounce are uquiil to 30 grains or 30 
minims, although a more accurate estimate is 31.1. 

> Usually considered 4.0. 



32 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



TABLES OP RELATIVE WEIGHTS AND MEASURES IN THE 
METRIC AND APOTHECARIES' SYSTEMS. 

(See Oldberg'B MxuubI of Weights and Meunres.) 



MiLLIQBAlCUES IN QrAIKS. 



HUllgraiiiiiie. 
0.1 
0.2 
0.3 
0.4 
0.5 
0.6 
0.7 
0.8 
0.9 



Onln. 

affff 



HlUlgiKmiuei. 
1 

1.2 
1.6 
2 
3 
4 
5 
6 
7 



GniD. 

A 
A 



MUllKnuunws. 

8 

9 
10 
12 
16 
20 
30 
60 



Gnln. 
i 

i 
i 
i 
i 

i 
1 



Cbntjobahmes in Grains. 



CODtigrkmmM 
(or Cent.) 
1 
2 
8 
4 
- 



GrmfB. 

i 



CoDtlgnunmBS. 

(or Cant.) 

6 

7 

9 
10 
12 



Gnlaa. 
1 

H 
2 



CcDUsrammea 
{or Cent.) 


GnlD«. 


18 


= 


3 


25 


= 


4 


50 


= 


8 


75 


= 


12 


100 


= 


16 



Gbahhbs in Grains. 



Gmnmes. 
0.001 
0.010 
0.100 
0.250 
0.500 
0.760 
1 

1.60 
2 
3 
4 
5 
6 
7 
8 
9 
10 



Graiai. 

A 

i 

If 

4 
8 

12 

16 

24 

32 

48 

64 

80 

96 
112 
128 
144 
160 



UntDmM. 

11 

12 
13 
14 
16 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 



Graini. 
176 
192 
208 
224 
240 
256 
272 
288 
304 
320 
336 
352 
368 
3M 
400 
416 



Gmuiues. 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
50 
100 



(i rain I. 
432 
448 
464 
480 
496 
512 
528 
644 
560 
576 
592 
608 
624 
640 
800 

IflOO 



ABSORPTIOS OF ORVaS. 



33 



CESTIMferiUW {oh Fr,UIDORAMMB3> I3C U. 8. ApOTHECARIKs' 
FLflDRACUUe. 



Olltif 




U.S. 


Cuble 




U.S. 


Cnble 




US. 


CMLiBHni. 


FliUdnobnii, 


CauUuiUw. 


nuidiBcboia. 


Cntlnittraf. 


KluUndlilift 


1 


— 


I 


» 


= 


n 


16 


= 


4 


5 


^ 


* 


10 


= 


2} 


20 


= 


fi 


3 


= 


1 


II 


7= 


n 


24 


= 


S 


4 


E 


1 


12 


= 


3 


M 


=£ 


7 


fl 


» 


n 


IS 


= 


at 


»2 


=— 


8 


6 


a 


H 


H 


ss 


H 


48 


= 


12 


1 


— 


^ 


15 


= 


H 


64 


*< 


16 


« 


■= 


2 















ABSORPTION OF DRUGS. 

Tbeknnwieilgfioftlie rapidity nilh wliiclicvrlaiii drugs nroabiiorhed 
frt'in the various surfHces with nlich tliev comu in tvmtart is n? 
iiupnrlaiKV in nnler ihat we may Icimw wlien tn repeat the dose if 
the first amriiint dues nui prudnce ihc desired pffeet. The rapidity 
of ii)iaor)>ti()u depfijj« u]i«u a aiiinbt'i- uf fuctora. If iLo circutntioii 
is active, aljsorjition is active, but if it he depressed, absorption ia slow. 
TltBft, in a fxirson apparentlr drowned, iitisurptimi may not occur at 
all iiniil rile %iial fiincrions are reslnred. and repeated doHes given to 
the [uitient ntiile iincont<cit)U». actiuf; titgctlier, in the end poit^'m liim. 
This is often the case in deUritim tremens wbere hypoderraie inJL-c- 
titins of ini)r|diine are gii'en or when the driijz: in adminintered by 
ihi* nioiiili. In dropsy absorption is peculiarly slow, and the drag 
may remain in the tissues for days, only to be absurbed with (he exu- 
dation after severe piirpiition or profuse diurc^i^. or tupping. In 
^rnenl rlrojiitifii bypwdvnuiu medication is ncurly alvravH unitte ihaa 
uaeleKH. 

When the atoniach or bowel i» empty nbeorpiion tVom either is 
rapid, hut wliea tliey are full it is very stow. In iliis faer wc find the 
t«««ou for the popular idcfl that a gloss of whiskey wbcn a mao is 
hungry makes bim drunk, whereajt twice the (|UMnlity after dinner 
doe* not do »o. 

Drugs In ihe stomach nr bovet have no influence over the general 
»v»irin unless they are irritants. They only act when taken into th« 
bUmd »r lymphatics. 

Ki'««Qt stadies show that alcoholic solutions of drugs are more 

'ntpidly absorbed than are wnlery solulions or those made with gly- 

[ceriu or milk. 

When the stoniarl) is depressed and iw powers of ftiisor|}iion im- 

[|>«ir«<). the addition of some irntant ur stimuUnl, such as capsicum, 
lUl often aid iu tlie abiwrplioQ of an importatit drug. 

DURATION OP ACTION OP DRUGS. 

The duration of the action of drugs depends partly apoo their 
npidity of absorption, but chiefly upon the rapidity or slowness of 
their destruction in the hudy or their ellminatiou from it. Thus, 



34 



GENERAL TUEBAPEVTICAL COySIDEBATIONS. 



rolatile subaUaces, such a.s ether, cbloruforiu. uud ultrilc of Bmjrl. » 
nnlv for ft short time und are quii^klv uHiniiiated. whvreujt hmiuitle <»f 
potasitiiiiii unil iligituliB coulinue active during luany hours, and are 
Hlowly ctiminated, aa in Uio case of the former, or oxidiited, m in thai 
of the l&icer. Again, if curare Iei given hypoilermicAll^' it will cause 
pHniK'^is. but if inken by the stumach in inoderale amoiiat it will be 
[■limitmlcd bv tht.* kidiit^vs a^ rapidiv as it is absorbed, and produce 
in> offecta if tbc>»e ormius ar*j active. 

From studying the rapidity of the elimination of a drug we learn 
how oftpn to nrd«r n. do^e. Thus, digitalis may be given once, tirice, 
or ikricc a day. but carbiinnle of ummuQiuia every two or three hours. 

When lb*? physicirtn is not earefni iu the iiko of a drup which is 
ctiminaied slowly, it may suddnily develop so Hevere an effect as to 
eau^e aUrin, owinj; to the aceumulation of the poison in the body. 
This is called "cumulative action." 



COMBINATION OP DRUGS FOR JOINT EFFBOT. 

The ittudy of the pbyaiolugical action of drugs ha^ aided us very 
greatly in improving our therapeutic toeaMurea. Thus, we now know 
that chloral is a beart-depressant and cannot be used in very full 
dusos. or pushed to produce sleep in persistent insomnia, without 
grave danger ; whereas morphiuc. which also produces sleep, but docs 
not depre^ts the heart, but uoe» depress the respiration, am be com- 
bined with it, and tbe two acting together, each in smalt dose, pro- 
duce a heavy sleep, although so little chloral is present that the heart 
is safe, and so itniall an amount of morphino is used that the respira- 
tion doeit not aufTer. 

Another example of thU ib found in certain purgative pills where 
the purgative agent is a8i>iHied by hclliKlonna and nii'c vomica, the first 
of whicu relaxes muscular spa^m. whiti? the second acts as a tonic to 
the alimentary tract, tbe drugs combining to accomplish one result. 

Skill in the combination of drugs, nut only for increased physio- 
logical effect, but alito for tlic purpose of making their administration 
pleasant lo tbe taste, has much more to do with professional success 
than is generally supposed. This is particularly so iu regard to 
children, for parents dislike forcing incir children to tukc doses 
which they themselves regard a« horrible, und ihcy arc ever ready to 
beticTe that as long as a tncdicine tastoa good it is better than one 
whirb tastes otherwise. 

The meilical practitioner who prcicribei never no wisely and sppro- 
prialvly for a patient, but who is utterly regardte&ii as to his combina- 
tions of drugs so far as tasie is concornctl, will sooner or later see a 
more ignorant tuan take from htm that practice which his greater 
wisdom entitles him to, but which is driven from him by bis own 
errors in this mntter. 

While in some cnscii there is do alternative but to give a bad dose. 
in oihLTA a little thought and care will often avoid ofTending the taste 
of the patient. 



STRESaTH AXD RELIABtLPl-Y OP DRV08. 



35 



STRENGTH AND RBLIABILITT OP DRUGS. 

If a ccDHiia (Ti»ul(l !>(■ maiir of tliO!>e who die snixially frnai the use 
of drii^ wbiuli are impure nr nnelefl-i from W(*:ikHf'ss. [In- writer 
beliovet) that i\ mrm alarmiag array of figure? would be presented. 
For many yenn* iliJs was uunvoidablu Uiii great degree, either bpnause 
oar kuuwlc<]gc of (he active princtplcn of drugs and ihu methuds of 
isolating liivm wa^ delirient, nr bei'BiiR? tb(^ iimo t'oiitiinuod in their 
traunporliition by c<uiliu^ vetiu^l» or un th« bnckn of nn,tiTe!> frifiu the 
ruiiiiirie^ in which the natural products yielding the drugs were 
ftblainfd. permitted detcrioratiou to take place. At itresent these 
(]if!iei)ltie!i have been largely overcume. The trained iihaminpifit is 
lou);hl how to make an assay fi>r active prinriplrs in moat iif the valu- 
able ulknloidal drugs, and every pbysieian Kbould mnke camful iuves- 
tisation into the quality of all prpparalions which he employe. That 
chest- reuiLirka are not oul. of pluce will bo aeon by the f^ct that not 
long since an intimale friend of the writer bought from fjvc of the leud> 
ing druggists of Philadelphia mx on need of tiueture of mix vomiea 
which were stated to have been made according to the directions of 
the I'niled Stales PharmaPopn?ia. That madi' hy perhaps the lending 
druggist of the five eutituitied twice as much strychuitie tiiid bntciiiti 
u it should, and had twit-e a* much solid residue : ur, in other words, 
a pbyaician prescribing this tincture in full done would probably hav« 

Cni^tnaed bin patient and reported the case an one of anutiual KUHcepri- 
Uity to tlruga ! On the other hand, the author has recently »L^en a 
lioclure of nux rooiien which eoutaiuuil only a truce iif alkaloid, 
but h.id much inert ^olid residue. In neither in:=tani"e wiii^ the dru;;- 
gisi diAboncsl iateutioiiiilly, but one had usei] :i crinie drug Khieli 
wad iiDUAually rich in alkaloids, while the other had |MirehLi.->ed ntix 
vomiea ht^aoA which, by I'easun of immaturity, bad surroiinding)). or 
exposure to weather, were very poor in active ]u-inciplci4. All theae 
dmadraDtagei* may he avoided if physicians will insist that the drug- 
glBts who dispense the drugs they order shall either thrmsolves pre- 
iMTe assayed products, or piirrhase micli prodnct.t from any o7ie of ibo 
Urge manufacturing chemists whc put assayed goods on "the market. 
When ibis ia impaisible. the phvuician should employ the alkaloids 
in pill form, or, if eolution-^ are desirable, the alknIoi({ may be added 
lo olcohiil or water and given hy drops, as \9 the case with any ordinary 
UDCture. Digitalis, venitnim viride, and ergot arc pructically the only 
drugs of importance nf wliieh an assay c:inni)t be made : in the first :ind 
third the action nf the dnig does ni-.t depetid upon a nnglc active prin. 
eiple, but upou a number diflicult i if assay, and in the second ihe rola- 
lire proportions of jervine and vemtroidinc cannot be well ejilimated. 
All lirufis should bo physiologically tested when their chemiral assay 
is imiw^ible. X«t long tiinec Jtereral thousand pounds of ergot were 
found on being t<*8t«d phy^iologinvlly by one finii to be worlhlc&s; hut 
it was pitt on the market nevertheless, for certain niannfacitirers i|a not. 
Mnploy lhi# method of examination. Con.ttunt uncertainty i^ ii daiigor- 
ons »lenioni when we arc dealing with patientti who are dewperalely ill ; 
uiil ID iDKny caacn failure and di»;nuragomeDt may both be avoided 



38 OEyERAL THERAPHUTK.M COSStDKR.iTIOSS. 

if the plijslciao will sec to ii thut tli« <lmga wbivb be admioUlers are 
in good order and ciipaI>lo of doing what he recjuircs of them. A 
poor drug In the pliyniciaa is womo than a rusty knife to the surgeon ; 
for the injury in tlie one case Ja unknown, while in the other it caA be 
carefallj watched and guarded. 



IDIOSTWORASY. 

a 

This \» one nf (he moHt interesiing features of the study of the 
acliun uf drugs, It is a frequent cause of disappmiitrnent to both 
patieut and doctor, and an equally fretiueni cniti^e of excessive actioa 
frntn what the gibysiciuu hax thought to he u luodumte dui^u. No rulo 
Can be laid down fur the dint'overy of idiosyncrasy ill a given cohc, 
except that females, particularly of the hysterical type, are more 
subject to it than are males, although certain men often nreBrtit inarkeil 
evidences of lJii» tendency. Nu Lwiier illustration of idiusyncruay caji 
he adduced than (he ease which hero follows, nor than that of a friend 
of rhe author who cannot eat a strawberry without ciifferiDg from a 
violent attack of hives. 

The fii-HL cai^e in thai of a mnuun of thirty yeani, suflienu? from 
severe headache, who received an eighth of a grain of the hydro- 
chlorate of piliicar|)ine. hypodcrmically, every twenly ininril<;«, until 
nearly three-foiirtim uf a grain waii taken, without any evidence of its 
action cither Ju ;«aliv«.rv now or BMeat. But ihe tolerance of drugs 
did not stop here. Twenty drops uf tincture of eanuahi» indica Gverv 
four hours failing to relieve the pain, hnlf-grain pilU of the solid 
extract were onlered, two of which c<cininionly affect a grown tnnD 
must markedly. The extract had been proved lu be active lo oilier 
patients. In order to avoid any fatJuro in absorption the pilk were 
each cnt in half before they were given, and forthwiili adminintered, 
one every three hours, without any eifeet after ten had h^en taken. 
Twenty more of the pills from the same mauufaclurers. but from a 
different retailer, were now given, one every hour with the ezceptinn 
of a few irregularities in administration during the night, the entire 
twenty being swallowed between fimr o'clock one afternoon and two 
o'clock in the next afternoon. The thirty pill.ii (fifteen grains) were 
taken in less than forty-eight hours without proiiiipiiig a single phymo- 
logical sign of the slightest characicr. That the do»c» were really 
Bwallowed would seem to be undoubted, fur their administratiim was 

r^arriod out by a trained attendant, and their black color forbade their 
ipulsion from the muuth on the bed without attracting attonlioa. 

"The hypodermic injectiom* were given by the author, ami. as the nolii- 
tion was used as fast as it wa^ made, the patient must certainly have 
received all uf the pilocarpine. 

As there was daily an al'ternoon n»e of temperature amounting to 
aeveral degreea, qaimne bisiilphate was ordered in the dose uf tiftcen 
grains, to be given afl«r six powders of one-sixth of a grain of calomel 
hod hceu lakeu; thi^ nut only failed to cuutro] the fever, but also 
produced no buazing in the ear«. The writer was now inclined to 



4 

4 



JJSDlCATfOys, CONTRA tymCATrOyS, AKD DBFIMTlOm 37 

cnusitler all the svmptoms as bjrstcric&I, evco iDcluding the evening 
rise of tcmpcratUK. 

Twcniy-ruiir hnurs after tiie last ilose fif raniiabis in<Iica llic nlteiui- 
ant pave the patient, witliout orders, no less tlian sixty jirains of snii- 
pyrit) in sixteen hours -without an; physiological symptoms, suid, under 
ord*»i>, she took from forty to fifty grains of hisulphate of <|uiQine every 
d»Y for ibrvv days without any sign.* of cinchoniam. 

Wide experience han taught uh, huwovcr, that ncvcnil coiylilions 
act fairly votiatantly in regard to Aoine IditisyucrattieK. Oertaiti dift-: 
eased coudilioiu — guch m peritonitis or pain — allow large iosea of 
opium to be given, and iu lead-poisoning and pariilyitis patients may 
require cnormnun doses of active purgatives t« move the bowels. 

The eliwate in whirli the patient livcw, or lia» been uceUHteiueil l« 
live, reiidertf him mori- ur less 8»6ceplihle to cerluin remodiefl. Thus 
the Ea«t Indian r\iu» aniuok after eating ha.ohecJih nr r»nnahi.« indica, 
ur the Chinaman goen into n delightful dreuiulaiid from i>ui(>king< 
opiuiD, wheresw the Anglo-Saxon experiucewt no soch agreeable sen- 
natioDH. afl a general rule. SouthemorR generally require larger 
done* of pnrgRiives than Northernem, often because their livers are 
Dot a» active. 

The loiuwrament of an iudividual is also a highly important matrer 
to \tc considered. It ia a noturioue fact that phk-gUiatJc dark-skinned 
individuals usually yield to drugn le»ii readily than hlondes iind nen'Oua 
persont), more ejipeeially in rwpoct to the dnign which act on the ner- 
voiw nysiem. Nervous light-haired wompn Htand liellndiinna very 
badly as a general rule, while children will take large do^-e* often 
without discomfort. Opium is usually badly borne iiy ehildren. 

liuhit in another important factor governing idiosyncrasv- We all 
know how nipidly one beeomes accustomed to tobacco, and bow mor- 
phine kiitniu^n take euormouH amounts of their favorite drug without 
effect. 



INDICATIONS AND CONTRAINDICATIONS AND 
DEFINTTIONS. 

The indication for n dntg is any symptom or series of aymploms 
which we know the drug will relieve without causing at the same 
time nn evil effect to he fell by uther parts of the body. A conlrm- 
indie«lion isi any coexisting state or tendency which will be made so 
niach witrse by the drug as to forbid ila une. Thus, one might be 
temples] to give i|)tinine in meningitis for the fever, yet this would 
bo bml thcra[M!Ulie». since <[iiiniuo is coniraiudioated becauso it will 
iutensify lliu meuitigiiis. 

Abort\faeitHU form a class of drugs which, as such, ought never to 
be employed. If pregnancy is to be interfered with, the interruption 
ehoul'l be produced by itistrumcntal means, and then only after con- 
Bultnliun with another prietitioner to gel his views and protect one's 
self from possible legal diQiculticH. 



38 



GmrBftAt, TUKRAPF-VnCAL COSSTDERATtOHS. 



AUeratiwM are ladicaled where oell-growtli ta active to excess, but 
CQQtraiDdicatvd where ti^iie break-down is present, nr there exisu a 
tendency thereto. 

AnfBxthetieif are drugs used to produce la«k of 8eu»>alioQ. They 
a.Pe either local or general. Mwny of the local anseathctiM produce 
Itww nf sensation through bpiiurahing tli« piins bv ih*" cold th^'v pro- 
duce. (Vuciiiee '\* aii (.■xamjile of ii loc&l atitetithetic which causes 
ftoa^sthesia. hy a iljr>i-ct pariilyxuut aciiou uii the periphem] eensciy 
nerveH* The general an»\sthcticH nre taken by inhalation und net 
apon the higher cctitrt'ti in the brain. 

Amipfiroclmncs are remedies used to diiniuish sexual deaire. 

Antandu are eiuploved in cjiaea where, as ft result of morbid pro- 
censes, latrtic and hutyrir acids, or even hydrochloric acid, are found 
in abnormal i|iiantitieH in the fitoinHch. 

Aitl/tfimintica are those remedies which are used fertile purpose 
of remoriuB intestinal worms. 

AnitartnriticH i.i tlio name given tlioHC drugs which are employed 
for !hop«rpo.teof relipving inBamtnationx occurring in joints, whether 
these he in an acute or chronic condition of diReaAe. 

Atttih/tiialiifg are HRi?d to [ire%Mil excessive sweafing, either when 
it is I'lcal or general. Camphoric acid ie probably the best general 
uitihydrotic. 

Antiperifdire i» a term iipplic^d to dntgH or remedies employed for 
the prevention or cure of lualmrial poisoning. They are so named 
because they tend to break up the periodicity of the attacks, which 
periodicitv in a oharaeii-rislii; of such ditii-aues. 

Aniipnloijintirs are rfmcdies employed to prevent the progrewi of 
iaHammatory proeesiiofl. They are nt>ariy all contraindicaled in the 
presence of tissues possessing an impaired vitality through previous 
condiliouH of di!>ea^e. 

Aphroiilfini* are remedies uned to increase sexiuil desire and 
power. 

AittrtK^fntn are employed for the purpose of contracting or con- 
stringing tissueti. They act either by coagulation of albumin, by pre- 
cipitating albumin, or by making the tiiuiies more den.-ie by con- 
centration. Tbeorettcally. nil astriugeul» should be nuu-irritatingf 
bat practically they posHcfv" irritant properties, and are, in coase- 
quencc, eontraindieatcd in the presenceof very acute inflanuiiatious at 
ft rnle. Three of the mineral astrlngcuta, however, possess marked 
•■datiro properties in addition to their astringent power, and catr 
<fc.mforc rir mied freely in acute inHammations when locally applied 
1^1^ ^tt nitrate of silver, pubneetate or acetate of lead, and the gub- 

~N^Uaor subnitrate of bismuth. 

iMm are reiDedie.s designi'd to incroaae the activity of tlio 
liM metohrane of the ga.Htro-in,teHtinaI canal by incrciising its 
k. ThcT may be divided into simple bitters and complex bittera. 
■ feu deftcnd' upon their bitterness solely for their activity: the 
mk «iM» ia well represented by (|iiininB or strychnine, both of 
^an •xcci'dinglv hitter, but, in ,iddition to their local effect on 
ktcetioal mucous rocmbraiie, aut as stimulants to other por- 



I 

i 



4 



I 

J 



rNDicArrojfs, coyrnAiNDiCATioss, axd defixjtjoss. 

tion« of the organism. A good example iif a simple bitter in colnmbo. 
Many bittern conuin m much tannic acid that they are not geDcrally 
useful. »tid for tbtK rt- aixiD very i'ev cnti be iined with preparations or 
iron, eince a tantiate uf irun wuuld be formed. 

i'artUac iwdatifrn are drug^ wbicb decrease ihe force of ibe beart, 
and, as n c-la-iii, tbe nnioiint of b)ood expelled at each beat of the ven- 
tricles. They are indicated in arterial excitement, ciinlraindicateij 
in nrterial depression. 

Caniiat: gtimulantu arc dnigs which increase the force of the heart, 
thereby increasing the qnantiiy of blood expelled from ibc ventricles. 
Thi.s may be acoo[u|ili?hed by an iDcreuse iu the rapidity of iliu beats 
or by A greater output of blood at each contraction, the diastole being 
Ritfficicutly prolonged to uduiit of the ventricles being well Ulled. 
They are contraindicatod in the pret^ence of arterial exctlemeat, and 
indicalcil in arterial deiiression. 

t'arminalii'fii are remedies given for the pnrpoae of expelling flatns, 
particularly if there is n-asoQ to believe that the "wind" has arcu- 
tnolaleil because of iutei^tiiial torpidity. Many of the carminatives 
■re necessarily poHseiwed of irritant properties, and are therefore coii- 
Iraindicated in the prettencc oPIlatiilence due to intestinal ntonvaris- 
ing from inllamniuiioa. The best carminative h apiritiut icthcris com- 
posiliis. or Hoffmann')* Anodyne. 

CatUariiet. — ■Thc^c are drugs employed when a positive and 
decided action of the bowels in ilesired. Tbey occupy a position 
belncen the purges and ihe drastics. (See Purges and Drastics.) 
A good example of a cntbnrtic \« i^ennii when given in riill done. 

Oholagoiiaet tkTv uwd tuexortaxtiiiiulutit influL-iuH- over the flow of 
bile. Nitro-bydrochloric acid and mercury bichloride are perhaps 
the b«8t typc» of pure rholapngiies. while podophylhiii) and calomel 
rvpronenl the pIjiph of cholngogiien which increase inicBtinal ptriittaliiig 
in addition to t^limulating the Jlowof bile. Chuliii^guc» are. an a rule, 
contraindicatcd in the prcsooco of acute intlatuKatiou of tlie gall- 
biftdder or liver. 

Vaiinlrr-irritaniK are remedicB used to produce irritatiim at a spot 
distant from n painful or intlamcd urea, in order to relieve the di»ea!4ed 
[)ari« by retlvx action exerted through the nervniiB system upon the 
[Miiiiful nerve or dit<ordere(] capillary network. 

Jhmuh'f^iitt are substances used to protect any exposed parts of 
the body from irritation. 

DiaphorelieM produce an iuci'oased secretion from the sweat>glandH. 
They may be considered as inleTnat and exlcmal. The iuteruul are 
reprwenied by pilocarpine. whJL^b Hiimulates the 8wenl-glaiid.it llicm- 
M-lvw; the external are represented by the Turkish and Russian 
bailis, wlilch. by inrrea$ing bodily heat and dilating hlou J- vessels, 
ciU8v a profuse sweat. 

Diumtics are used to increase the flow of urine from the kidneyo. 
Tbey oot by stimulating the renal epithelium to greater acti^-ity, 
thert-bv increaaiug the excretion of both the watery and solid con- 
BtituentA of the urine; or they simply increase tiie watery constituents 
by increaaed blood-preHure io the kidney. 




40 



OENERAL TBERAPEUTICAL COySlDERATIONS. 



I 
I 



Tl is to be remembered that the vegetable ftalts of potABsiura and 
tbc litliiiim sultK JDcrcusD the solids in thu urine, Dot by oliiiiiilaling 
the secreting epitholiura of the kidnei,'. but b_v uoiting with iiii^ohilfl* 
material in the system, forming soluble compoiinds which are tbeoj 
readily elimlnaled. (See Eliminstorf.) Thev »re itidicaleil in con-' 
ditiomt of roiial iuactivity due either to ftmcUooal or organic causes. 
Irritating ditireties. such a& canthttHdea. for example, are couiraindi- 
cated in acute nephritis. Such a diuretic is only to be used where 
the kidneys are innctive through atony or prolonged chronic or »«b-| 
acute disciisc. 

Eiiminatora are drugs which, by Furming soluble compoumhi with] 
inscduble substances in the body, render them capable of being ex- 
creted by the excretory organs, «iich m the Bltin, Itidnpys. und bowel«. 

EmeUct arc drugs ueca lo produce romiting. They act centrally 
when, as is the case with upoiuorphine. they stimulate the vomiting 
centre, peripherally when they irritate the wnlls of the stomach. 
They are indicated when we wish to nnl»ad the dtmnach of unde- ^j 
siratile materials, or when we dceire to cause an increased flow of ^| 
tile from the gall-bladder, which le accorapliphed by the preissure^^ 
exerted upon this viecufi when tbc abd-'-minal walls and diaphragm 
contract in retching, Wbeu the ducts are mechanically obstructed 
by a gall-atone emetics are dangerous, as they may cause rupture 
of the gall-bladder. 

vSometimcs wo arc able by the iiso of emctica to rid the lungs and 
stomach «f mucus in bronchitis *>r gastric catarrh. 

The contraindications to emetica are cerebral congestion or menin- , 
gitis. gastrilis, gastric ulcer, advanced pregnancy, and hernia. 

EmmenagoqaeH arc remedies used to produce or increase the mcn-j 
Btrual flow, f hey are uf two clajtaes — direct and indiif ct. Thu direct 
are most of them irritants, and are seldom of njtich value : the indirect 
are used to overcome the morbid condition underlying the menstrual 
disorder, and are tbvrerore more rutiotinl. Thus iron and arsenic Diay 
be used with beuelicial result in amenorrhoe-^ due to atia^niia. 

£j:pectorantf ar^ cm|'lnyed when it is desirable to promote secretion 
or to get rid of weretion in the bronchial lubes. Thus, in the early 
stages of an acute bronchitis the niueous membrane is hypencraic 
and swollen, but dry and irritable. Ipecac and citrate of poi.ijtkinm 
form at this time a sed&iivc expectorant mixture, which, while allay- 
ing irritatinn, promotes secretion, and so relieves the engorged area. 
On the other hand, after the acute stage ia passed, there may be bo 
much atnny of the rauous glands thai the fsecretion is eitlier too 
acanty or too viscid to be wiughed up. Stimulant expectomnts, liieb 
•a chloride of ammonium, eucalyprus, and lerebene. are now to be 
employed. These latler drugs are contraindicated in the acute inflam- 
matory stage of the disease, as they would simply stimulate the irri- 
tated mucous membriino to greater irritation. 

ff^pnoticK are drugs used tn produce sleep. They may be divided 
into those which produce sleep and relieve pain, and those which have 
no analgesic power. The latter arc therefore not to be emploved in 
aleeplossness due to pain, and the former are ooDtraindicatecf whon 



\ 




JSCOMPA TIBTLITY. 



41 



paili is at>B«ut. Thus, chloral produces sleen if it be urdinarv fane- 
tional in»oninia; but if thu KlvcplcMliOM is aue to pain, opium is the 
(Irufc (<i be etnplnved. Chloral, in ordinary duecs. ib the purest hyp* 
notic [hut w« have. 

Mtf^iriati'-t aro drug* which prodiic« dilatation of the pupil or 
mTdrinsis. Coiiditinnft of the eye associated with increased intra- 
ocular lenitioa are oontraindications to mydriatics, as a rule. 

Myoliiii are dm^ which cau.ie contraction of the pupil or myosie. 
Thrr are best reprc««nted by eRcrinc. 

S^trtvut ttJativfs arc; iiiilioited and coDtraJndicated in a rereree 
DiBDuer to uervouti «iimulauu. 

yerrout atimuiatit^ are rnntraindicated in ucftous excitement, indi- 
cmted in neri'oiM deprei^Klnn. 

Oxjftaxi^n are drugs which increase the expoleive power of the 
nterine mu»cul»r ti»t«ue)>. 

HentUirvif are remcdici^ u.t«d to produce increased activity of the 

tj^neni] HVBlem or [wrta thereof thruiifch reflex iuflufiitta — that Is, 

ithey cause a determination of blood to one part, 1l«rcby relieving aa 

.engorged area. Thus, in cerebral congention or eiTiiRinn a vlgorouii 

purgative or cathartic may give relief by cxercisiot,' a deriralire 

effect. Hevulsives are closely ulliod to counlcr-irriliiut*. 

Jt-t-r-inrtt are drugs or measure* devoted to ibe repair and buUd- 
injr up of lis«iif.i in ihp body, and comprise holh (nmU and linigs, 
Roborant troaimont also includee hygienic surroundinp;!*, fieeb air, 
tight and healthful emplovmont. 

TVmiV^ are ui^ed to inereatw vital activity. They are indicated in 
iu<>tanc«4 of local or general systemii; deprpation, contniimiicated in 
cases "f iotlammation or excitation with excessive functional actinly. 
(See Bittern.) 

f'atoraotor depr^nanti are drags which dccroaee arterial prcMuro 
by au action on the ruomotor nervouft nviitpm rather than by an 
action on the heart. They act by relaxing the blood-vesseia. 

Vaiutmctor itimtilantM are drags which increase arterial pressure 
bT an action on the vasomotor Bystcm, thereby producing contraction 
'le blood* vessel 8. 



INCOMPATIBIIilTY. 

The chief value of a knowledge of chemistry or pharmacy to a 
practitioner of medicine ia (he avoidance of what is known aa an 
•' iiicoiiipatibililT. " or the placing in one predcription of two or more 
substances whicli will undergo chemical interchanges, decorapositions, 
iinrcipitatioiis. or cuuse the formalinn of explosive inixtiires. It is 
ttnpo^iMe to detail all the incomp.'itibilitie.'), and only the most dan- 
gerous and common iio(i.>iibilitie8 of erroi- can b'- (.•onKiiliTwd: 

1m. An acid should never bo eomliined wiiK (in nlkiili. 

itl. A »tr<Jtig acid should not bir iiilcted in any ijuuntlty tu a 
Hocture. The following prcucriptiou ia an illusti-ation of this: 




42 



OBNFRAh THFRAPAVnCAL COXSlIH-:R4TloyS. 



B.— P<i»w<li iudidl ■ . ._ ^■ 

Add! nitni-niciriatid kf. 

Tr. ciacboQw comp. 4|. ». f^iij- — M. 

B. — I'm u directed : « teanpooDful. 

In this ridiculous mixture the acii is incompatible with tht iodide 
of ]>otai«9iiiin. fonaJDC a chlnriile miil setting free ioiUne, and wimld 
alao oLauge part of uie aJcobol in tlie ti&cture into a.Q ether. 

8(1. Alkalies and neutrnl basa't should not be combined nilli the 
alkaluidal salta. 



li.— Sirvdinitwjiiilph gr.j. 

Potitmii intlitli . 3^. 

Ayr. safBDtiurilla: camp IjUj-— H. 

fill t. a. 



In this prescription ihe strychnine would be precipitated li,v the 
pottkssiiiHi sail, and the patient would get nearly all the Btrv'chniue in 
the hat duse. 

4th. Prtta<*iiiiin chlorate ehowld not be ordered to he ruhhM up 
with laiiiiii! atiid iiur any other orga^tiic substance cupaUe of uxidation, 
as it will explode. Pfrmangauate ufpotaaaimn is subject to the Hnroe 
rule. 

5th. Chlarale of pntasRtuni and ammomura chloride wh«u mixed 
togelhLT may lake fire. 

(iih. Iron is ini'oin|mlih1e with tannic acid, n.t it formi* a tiuinate of 
iron, or ink. Ai« all t\w wj^vtMf aj4triii;;eiilA coutaiu tannic acid, they 
should DuUD of them bo used with iron except etiirelta nnd coliimho. 

7lh. Tannif acid sboiild never be added to Koliitiona of alkaloidn. 

8th. Gum arable is not to be added tn solutions of iron, lead, or 
tlie miQcrul acidit. 

9th. Alcoholic solutions of camjihor and similar resinous subgtanccB 
are ineoinpalible with water. 

Idth. Fluid extrncts are incompatible with water, an the addition 
of water will precipitate ihem. 

11th. All Balla not acid but alkaline in reaction are decomposed 
by acids. 

!2th. .\^^ sails which are acid are decompnaed by alkalies. 

Iviih. AM vegetable acid ealts are altered by mineral acidn and are 
decomposed by alkalies. 

14tb. Iodine and the iodidcH should not be civen with alkaloids. 

lAlh. CorroHive sublimate, the salts of lead, iodide of potassium, 
and nitrate of silver should always be preacribed alono, except i& the 
followiug instances: 

(a) Corrosive sublimate may he given with potantium iodide, 

ainee it will throw down a precipitate which redi^.'^ol ves and forma 

a double nalt. 

(i) Nitrate of silver may he used with extract of opium or byoe- 

eyamus. 

ICtb. Syrup of aqtiill should not be given with the carhonste of 
ammonittm. av it contains acetic acid. Chloride of ammoiuum is not 
incompatible with it. 



i 




CLASSIFICATIOX OP VBVCS. 



43 



ITrh. Ch«rrT-lsarcl water should Dot be pr«ficrib«d with morphiDe, 
lit may form the poigouous cvauide of morphine. 

18th. Chloral ttDd CTUDidc of potassium soould never be pUred in 
the suae prefteription, as thev wiit decampoHe each other. »««^ttiii;; free 
bydroevanic acid, 

19th. Cocaine and borax when added together fomi an iiisolublo 
borate of cocaine. Borie acid and cocaine do not result in tbii 
formation. 

20th. Calomel and antipyrin arc incompatible, as are aim sweet 
spirit <A tillrc and atilipyriu. 

'I\»t. Waters cauuuLhe used in preparing saturated aolulionsof 
drugs, tu they are already loaded with the volatile substnnce. 

22d. Pepsin iind paact^atin sh'tiild not be used together, since 
the former can only act iu au acid and the latter in an alkaline 
metlimii, and the pancreatin i^i destroyed ty tlie acid gaalric digeativ© 
procuss. Further, one firmcut may neutnilir.e the other. 



CLASSIFICATION OP DRUOa 

Xa order that the Rtiident qibv gain a definite idea aa to the 
various actions of different rcuedieA the follovring list of druji;s is 
appended, which is of necessity somewhat arbitrnry, and h not 
intvndcd to he f!xhaustiv(\ for nmiiy remedies tnight be placed in 
M^viTuI rtaiciPK. The t-tidcavor has lx>L>b tuadcto place the heat or most 
|iiiwL-rri]l dm;; of ("ach claiki fir^t in the lit^t. It is to be reinembered 
that a Etrict phyaiolugical classiiication is impossible. 



L AtTBBATrVIB. 

I. M^rniry. 

% Th« lodidH oT potannm and lo- 

dium. 
& Todinc 
4. lodofurm. 
& lodoL 
9. Aracaia 
7. rw.liwr oil. 
R Colrhicnm. 
ft Ichtlt.vnI. 

10. Tintiiinnn. 

11. Mmraini, 
1£ Niirlein. 

tl. AKjw n iBTira. 

1. Kihor. 

2. Niimim oxide gaa 
a. fh\ontona. 

4. CDcaiae. 

5. RaraiiML 

6. Bniniiile <if rltiTl. 

7. Chloride of rthvl awl laelbjrl. 
fL. t>ml»l. 

9. Bmtnorarm. 
1(). <UTl>olic actd. 

11. Aniipyria. 

12. MeaUioL 



QI. Amtactdk 
1. Ammonia. 
£. Ekidiiim and im lalla. 
S. liquor potua- 

4. MagnouL 

5. Lime- 

I\'. ANTnEi.iiix'nai. 
Thow ihul nraiiMd tfiiaiiiBt itie roimd- 
worni Arv— 
I. Bault^nicii. 

5. Suifit'liiL. 

3. (-'lieni>|>(Hiitun. 

4. Amlnrnch. 

6. ^ianloninRte of Kodiiim. 



Those ii»ed ugaiiint 1b» t«(«-worm 

1. Pcllclicr'tnr. 

2. A3;iidium. 

1. I'omc^riLniLtv. 

5. I{tTi_v»-r«. 

6. KnTniila. 

7. Turpetilitte. 
S. Chlurorurm. 




44 



GBSERAL THERAPEUTICAL C0N81DEBATIOS8. 



Those used against the seat-worm, or 
or^uris Termicularis, are— 

1. Quassia. 

2. Turpentine. 

3. Tannic acid. 

4. Chloride of sodium. 
6. Vinegar. 

V. Amtiseptics. (See also Disinfect- 

ants.) 

1. Corrosive suhlimate in weak so- 

lutions. 

2. Carbolic acid in weak solutiooa. 

3. Peroxide of hydrogen. 

4. Creolin. 
6. Xi^sol. 

6, Boric acid. 

7. Permanganate of potaasium. 
6. Salicylic acid. 

9. Sulphate of iron. 

VI. Antipeuiodics or AltTIIUI^BULe. 

1. Cinchona. 

2. Eucalyptus. 

3. Warbui^B tincture. 

4. Arsenic. 

5. Methylene blue. 

VII. Ahtipyhetics. 

1. Anttpyrin. 

2. Acetanilid or antifebria. 

3. Phenacetin. 

4. Giiaiacol. 

5. Phenocoll. 

5. Quinine. 

7. Salicylic acid. 

8. Thallin. 

9. Carbolic acid. 
10. Kairin. 

VIII. Antispasmodics. 

1. Amyl nitrite. 

2. Chloral. 

3. Broniidee. 

4. Opium. 

6. Belladonna. 

6. Camplior. 

7. Hoflinann's anodyne. 

8. Asafcetida. 

9. Musk. 

10. Valerian. 

11. Monobromated camphor. 

12. Amber. 

13. Cimicifuga. 

14. Hops. 

IX. ASTRINOENIS. 
Vtgtfahle. : 

1. Tannic acid. 

2. Hicmaloxylon. 

3. Kino. 

4. Catechu. 
6. Rhatany or krameria. 

6. Rhus glabra. 

7. Geranium, * 



8. White oak. 

9. Blu^oak. 

10. Gallic acid. 

11. Roaa centifolia. 

12. Rosa gallica. 

All of these depend chiefly upon tannic 

acid for their active principle. 
JUinero/.- 

1. Sulphuric acid. 

2. Alum. 

3. Lead. 

4. Nitrate of nlver. 
b. Nitric add. 

6. Sulphate of copper. 

7. Bismuth. 

8. Sulphate of xinc. 

X. Cassuc Sedativxb. 

1. Aconite. 

2. Veralrum vlride and ilhnTniB 

3. Antimony. 

4. Hydrocyanic acid, 

5. Veratrum eabadilla. 

XI. Cardiac SmiuxAinrB. 

1. Digitalis. 

2. Strophanthus. 

3. Ammonia. 

4. Ether. 

6. Alcohol. 

6. Caffeine. 

7. Nuz vomica. 

8. Ignalia. 

9. Adonis vematis. 

10. Convallaria majalis. 

11. Sparteine. 

IZ Amyl nitrite (momentarily). 
13. Opium. 

XII. CotJNTES-lRRITANTB, 

Those counter-irritants that blister are 
called epispaatics. They are — 

1. Cantharides. 

2. Thapsia. 

3. Ammonia or chloroform when 

under a watch-glass. 

Those that redden or produce local 

liypersemia of the skin are — 

1. Mustard. 

2. Capsicum. 

3. Turpentine. 

4. Ammonia. 
6. Chloroform. 

6. Burgundy pitch. 

7. Canada pitch. 

8. Most of the spices. 

Under the name of EacHAROTtcs are 
grouped a number of substances 
capable of acting as destructive 
agents upon the soft tissues of the 
body. They are — 

1. Chromic acid. 

2. Nitric add. 



CLASSJFICATtOK OF DRUGS. 



45 



8. SnIpbiiriF add. 

r4. Niinia of mercury (mlutioa). 
h. Bromine 

0. Cknaic potuh, 
i. OuHiioMd*. 
8. Biimt aliiiu. 
S. ArvtKiuK add. 

10. (,'hUjfideof &inc. 

11. Vienna piuilc 

12. CanquoUi'ii putc. 

[Xill. Du paoRETits. 

The uuIt urns ;liitl v>^ know u dtract 
Klinuliuita to the slDiida aiv — 

1. Pilocarpus or JabonuHli 

The olli«n »r«— 

5. Hot ilr; and bol moist biiih». 
i. IXivcre puwder. 
fi. Alcabol (MrtJcuiKrly wheu faol)- 

6. Nilrgiw«tb«r. 

XIV. DtaivTAJcri. 

I. Pnix-reiUia. 

a. Pcp.in. 

3. K^vdiocliloricand. 

4- i>wnMc- 

fi. i-k|>«iiii 

DiMsncTAir™. 

1. Cnrr<i»ive eublimiit*. 

2. Chlotinc or ('lilurinut«il lime. 

3. Ftinnkldeh.vdG. 

4. C«rbnlioMKt. 

5. Chloride of dnc 

YXW. DiriiEntB. 

Those iliu inmnw! botli ihe Millib and 
. Ii<|uid catH>iiii«iii« aro probtbly — 

1. CaOUue. 

2. t^iiill. 
S. Cnnlliindn. 

4. Bocl-n. 

A. V«MC&bl« ulia or iwIUMiuin. 
ft. Lithium. 

7. Jnnipw. 

5. TiirptniiDc 

B. Cva ur»L 

10. {.Iiinmiililia. 

11. Uubeb. 
IS. Pondn bravH. 

13. lll<a(> 

Thcw whirh iix-mw the vBier? ooii' 
■duwDts of tlic urine without in- 
I irwlilg Um tolidt proponiunatclf 
mn— 

1. Dlgfudb. 

2. SUraw«lbv. 

XVn. KUMtXATIVBk 

1. Th» ioiiklM. 



2. Th« wlicjUuc 
8. The pesaiable saltc or potoaium 
nod Uie purKKtlra. 

4. Tho liltiiuni (uW 

5. JabnniDdi. 

6. Colt'hii^iiin (' prnhnbly). 

XVIII. EMMEKAarM^iriEK 
TtMvlimrt untuiSMgiiffueii are — 

1. Apiol. 

2. Rtnoiide of nianganeM. 

3. PermannDnLti uf [loiaawium. 
i. Cjtnilikndca. 
Sl Aloe*. 
8. Mvrrh. 

7. Kue. 
S. S«Tin«. 
ft Tawy. 

10. I'pnnyroTaL 

11. Guui&e. 

The inittrocl on — 

1. Iron. 

2. AnMMiic. 

8. Copper. 

4. Toiiiix in genenL 

3C1X. Kmeticd. 

The din;ct are repretcnleil bj — 
1. Apomorphinp. 

"i. Ipetiic (which iiiliolh (wntrt'C and 
pdrijihi'Dil). 

3. Tariai eiiielif (which is bnili 

criitrieaiul periplientlj. 

Tho periphoml ar»— 
1, Sulpliaiv of ttob 
3. MuMard. 

3. Alimi. 

4. Sulphnle at «opMr. 

5. Tiirpt^lh tuincnu. 

XX. ExrECTOBAKT*. 
15«diUive : 

1. Citrate or aoetat« of pnUtxinm. 
2/ Ipecac. 

3. Aitliiniinj'. 

4. LobtJlitt. 

TlauiW wlii<-)> not u tlimulnting expcc 
(c>r»ot« iH"*" — 

1. Ammoninm <Jilurid«> 

2. Apuutorphina. 

5. Crvuote. 

4. Ko«i]yi>ttii. 

6. Tar. 

6. Twobcne. 

7. T^rpioi' hydrate. 
*. Oil nf windal-KOod. 

9. tiiilphur. 

10. Griiit)«ll& robufiia. 
n. Garlic 
IS. tiquilL 



46 



OENERAl. THERAPEUTICAL C0NSWEBATIOS8. 



Bwidm thew we hav« mii vomic*, 
vbiuh irivrunMH cx|>einunUtnD by mimu- 
lating itiw ncrTuiw «yHt«in to cpiiKhimL 
ami tliUHVi|wlH the mucus. Opium ana 
ihv' liriiniidn (Irpi'tw the McrroiiH syaloiii 
and nlUj cough, uid M dccreua GXpecl«> 
Riliou. 

XXI. HrpxOTioi. 

1. Chh-ral, 

2. Britmida'i of [)ou«ium, Hodlnm, 

pic, 

3. Opium. 

4. SulphonaL 

5. Triimnl. 

6. Teironal. 

7. P&rnMeliyiJe. 

8. Chlorulote. 

9. Cklaral&Rtidff. 

10. Hypnal 

11. Hyuccinc \\n mniiia). 
Vl. I)uboi«inu (iit innniaV 

13, Cnnnabiii iudiea i in large doae). 

XXII. NERVOrslSEPATlVEa. 

1. Chlural. 

2. Opium I ill full duHxi). 

3. The broiniJfs and bydrobronaic 

avid. 

4. Ch!oroCi>rin. 
5^ Amyl nilril*. 

S NJiritceitf palABsiom and Bodium, 
Bud nittuxlyceriu. 

7. Ether. 

8. Bratnide of ethyl. 

9. Nlimiis oxide. 

10. Bromoform. 

11. Bellail(uma. 
IS. Aixipyria 

13. AcclnDilid. 

14. P!iPiiac4lin. 

15. C&la bar bean. 

Jfi. Hvdrwrvaiiic acid. 

17. Lobelia! 

18. Conlum. 

19. OnnabiifindicK. 

20. Snlpbonal, 

21. (^lun chloral. 
22 I>Brpid«hydo. 
23. t'unijihor. 

21. AloiiubruRi«t«d camphor. 

2S. Aaatetlda. 

2S. Amber. 

27. Ilofl^sana'a anodvM. 

23. Ciniicifuga. 

S». Mii>k. 

30. Valt-riao. 

31. lliiratiluai 

32. Ciui'ir. 

33. lIvpoaL 
SI, TohacTO. 

XXIII. Kekvodi 8TiKni.Avn. 
1. Nuz Toaicft. 

£ Ignatift. 



1 3. Cooa. 

4. Kohl. 
h. K'MSiaoK. 

XXIV. OsTTOciat 

1. l->got. 

2. Cuiioii-poot 

3. UatiLnjtainiiyilia, 

And indirect when in labor: 

1. Quiniiic 
-i. Kola. 

XXV. FtntoATim. 

1 . t.'wcura Mgrada. 

2. S(il}il>iir. 

3. Kbiiborb 
4 Frangiila. 

5. Oawia fiMulft. 
G. Emmy ui 110. 

7. MBgnatia. 

8. Muiina. 

9. Fraite. 

Cathartirt (mineral}^ 

1. MD([tUKiiim utilpbstff. 

2. Muinivxiuni citi-aie. 

3. Sodiiiiu ]j!io»jj|]hW. 
4- PnUiwimtii niul dmliiim tartr.ite. 
S, Sodium aiilphaie. 
C Mercury. 

Oa&w^ei (vegetftble) : 

1. Oulor oil. 

2. ^eona. 
8. Aloea 

4. Podophyllin. 

OaiharUet (hydragtigut!): 

1. EUceriiim, 

2. Jalap. 
& Colocyiilh 
4. CivitoD oil. 

b. (liUIllwge. 

3l Snimi&iiny. 
7. The nnlitic piirimiiwa, 
centraicd aoluiioni are i 

XXVI. Ta.vic8. 

I. ClDchone. 

3. Kit a vumica. 

3. CalumU. 

4. Aiwnii'. 

5. Phoaphenis. 
0. MtRury (in minute i 
7. Copper. 

8 Iron. 

9 il^dnichlorif at-id. 
10- Nitm-hyilrochloriv adiL 
II. Nitric acid. 
14 Phixpborit at'id- 

13, ConJnrunK'k' 

14. The vcgcUible biltcre in gounl. 



PRESCRIPTION WRITLVO. 



XXV U- YAaoMOToK DErusnAitn. 
I. AtnjI nilrili!. 

% NitroKl.Toenn and oUm-nilritca 
3. Veraimm viride 
A. Anliiuuuj. 
&. Aoonitc 
C Vcntnua albaiD- 
7- Vcralnnn HabodUU' 
8. Akohol (in ercwnr* dove*)- 
9l Jabonaili. •> 



XXVUr. VisoMOTon Snuui.ucn 
]. BeUndi)iu». 
% HyrwrnniuB. 

3. Digiulu 

4. Nux r tain in. 

5. Ergot- 

S- Stramvuium. 

7- CnlTciiic- 

8- Conviill&riii. 

9. Suprarenal gluul 



THE IMPOSTANCB OF DIETHTIO TREATMENT. 

MaDT phjaicians fail to pay projier attcntloQ tx> tbc regulation of the 
diet when treating Ihotw who are ill or " out of «orts. " Aa u uiatier of 
&ct. tie admiDisirauon of medicine often fails to produce good rraiilts 
iimply because the patient, bv persi-tting in the use of improper food and 
drink, is perpctuatiDj; the difficulty of which Le it) trying to get rid. 
There \a scarcely a case in which Bomo regulation or alterutiun of the 
diet will Boi be of advantage to the »ifk rnnn. (Seo Fombt for the Sick.) 
Farther than tliiis, failure to give diretrlions as to dit^t It apt to give 
ilie patient the idea that the physician i.'» careless, whoretis care in this 
respect will greatly cnhiinec his view of the doctor's ability to attend 
to important details of the ca«e. 



PRESCRIPTION WRITING. 

When a physician dinxte o patient how to regulate his diet, what 
exerei^e he in !'• take, and how iiiuiiv hours a day are i» be devoted 
to recreation and work, h« prescribe* for him «)uite ne mnch as when 
he n rites a prescription calling for one or nmre drugs which are to 
be dit^pensed by the druggist and swallowed by the individual who 
in ailing. N'everthelesa, the word *' prescription " is usually npplied 
to the piece of pa|ier on which is written the physician's ordrr to the 
drDg;:i*t. 

In writing prc^riptions pliysicisns usually employ Latin terma. 
There are several reasons for this. In tlie fimt place, it is a cut^tnm 
wbieh bas been followed »tnue the time when medical «:ii-uce was iu 
ita infoney, and medical men were wuut to write wbut they had to 
AAY in Latin. .Secondly, the botanical names of plants are usually in 
Latin: firvt, ln-cause seientifie men give them their name.>«. and, 
(urr4>nd. hecuuite not iufrL-[|tR-ntlv the English mime fi>r » plant in one 
pnrt of the country baa an entirely diftV -rent upjdiciition in another. 
TbuM. nearly ererj- State hna u liruj; called " Snake-root." yet in each 
tn^tancp a different plant mnv be m dehignated. Again, it is often 
advu^ble that a patient be Wpt in ignorance of the character of 
tli<> drng which he ia taking, )eft he attempt to une it without a 
pby»iciau 9 advice ou another occasion, and thereby do himself injury- 
Thua the physician might wish to give » patient a dose of cocii as a 
pt'werl'iil Dcrvou* stimulant, yet would fc;ir that it might be inken 
witboQt advice later oii, and do harm. By using the word " £ry- 



L 



48 



GKSERAl. THRRAPBVTWAl COSSlDERATtONS. 



tlirox^rlon " ttie druggUt knovra what to (liaprtist', but tbe psttent doea 
not recognise tbe term iiseJ and fails to remember it. 

All preAcriptioDH should be writti'n »n »htetH of paper on which 
are printed tbe phvaiciao's name, addreiw, aiiJ ofllce liourt. This 
iufurmutiaa la obviouslv necessary, and particularly is il uacful U> the 
dr^^^i)tt:, wlio may wisb to eommumciite with the physician in rase he 
thinkn that a puisonitus dose has bucu urdt-rcd by mi.-<tiike. Tbv Diimc 
ami iiddress (jf the piitiuat should bewiilteuou ibL-pn-scriptioii-blank. 
flo that the drii>;<;i))t ntny know where tho medicine is to he xcnt wbcti 
it is prepared. The prescription \a t» be accurately dated. 

Tliu lin<t symbol or mark placed on a preacnptiou- blank afler 
writing the name ortht- pstlent and his address is "^," which 8landB 
for " ilficipo." which u tUc second person singular of the impcrativo 
nrt-seiiL of the Latin verb *• Ueeipio," ineaHiiig " I take." Rwipc or 
H, tliereforc, says lo tbe druggist "Take thou" of vhatever Mub- 
stance.4 tbe physician desires. Ks ho is to take a given quantity of 
bia stock and plaoo it in the mi.'Ctui'e, the name of tiie drug is put tn 
tbe partitive genitive case. WLou. however, a pill or other finii-bed or 
eomplcte product ia oi'det'ed, m th:it not part <\X tbe stoek, bnt ibc 
wliole artiido in desired, the name of the uifdiciuf is placed in the 
actudfttive cuse. since it is tbe object of the verb. 

The nouns or niiraes of ilntgs belong to one nf the five Latin declen> 
Mons. &nd are most i^f them declinable. Those of tbe first dei'Iension 
end in tbe letter "a" in ibe nominative singular, and in '' k " in the 
genitive f^ingulnr, or "arum" in the gonitivo plural, except in the 
Lease of the word a.loe, tbe genitive singular of vbicb is aloos. Thus 
tlUftia iii tbe nominative, atj>i<if n the genitive singular, and ai/u^tru/n is 
llie genitive phinil. 

The nouDd of tho second declension cad cither in " as " if mascu- 
line," or •' urn " if neuter. Their genitive singular ends in " i " and 
the genitive plural in ''orum." There are several nouns of tliis de- 
clension which enil in ''on." like "hn-raiitoxylnn," which also end in 
"i" in the genitive .singular. Thus we fimi thnt S'/nijiun Is the 
nominative, Sgrupl tbe genitive singular, and Stfruporuin the gcD- 
ttive plural. 

In the third declension tho nouns end in a, c, i, o, j, c, I. in, r, ?. 
t, and X. Tbe genitive singular end-i in " is " and the genitive plnral 
ill "um." ThH.% .flther in the genitive is ^■Etheria. and the genitive 
plural .'Efhfrum. When the noun end* in "s" the gi^niiive take^ a 
" t " before tbe " is." Thus harmi is the nominative singular, bnratu 
the genitive singular, und bcrratum tbe genitive plural. 

ui the fonrth declension the masculine nonna end in '' us," and the 
neater nouns in " ii." The genitive singidnr of the ma.<ieiiline noun 
und^. us does tbe nominative, in " us." and tIjL- iieuivr iiouii like the 
Domrnativo ends in '*u," while tho genitive plural etids in '*uni." 
Tims HpiriluM. of which the nominative ntngulur ends in "us," is 
^<pirt(iui in the genitive singular, and npiritutim in the genitive pluraL 

In the fifth declension the nominative singidar ends in '*es," tbe 
genitive singular in '"i," and the genitive plural in "mm." Thui 
lies has as its genitive aingabu' rd, and as its genitive plural return. 



PRESCHtPTfoy WRlTISa. 40 

AJjectires uscU lo (jusUry iioims agree with them id gender, num- 
ber, and exw. 

After the in;;r(!Uifnt» unil their r|uniititica have been aigiiified the 
ph3>t(.-i%i] cxpitns^s hiM uislieH further, uiid wnieii the Mord " Miser," 
^'' Diix " ihe ingmlicnts. If the prescription a pat up iu Quid form, 
he next wrilt's i!ip niynfitura, and writwi the word Su/na, v»nMy 
altbrrviaied by A'ty.. which telU the druftjciat to write the direclioitf, 
■whifh follow in English, on the Ubel of the bottle. ' 

If the pret^;riptivQ consists In u powder and is to be put in papers, 
afiiT the wonl J/mcp, or tlie letter "M.." which stands for m»8w, the 
phy-ioian t'hh rt divU^ in cfiartuht No. rz. — that is, divide into 
iWL'orv «ina!l |»aperif or jiowders. If pills are dfsired. hi* writuM 
if. finHt (often written " ft.") ('« pUula ^'o. xz.—xliat is, make into 
tin pilb. 

Or Jiaf uni/uentum, let an ointment be mnde. 

Or thp icupenilive may be used by the euiployment of the word 
faf, a.^ /at; nuppotitonoH Kumero v. — that is, "Jlake thou 5 eup- 
pi«it«rif»." 

Ifciipsulea are de«nred, the dru^fri^t i^ directed to mix the injorredi- 
etits, and the phycieian adds tt ytme m caymlug A'o. j-Jt. — that is, 
mix and put into 20 enjMide^. 

A prescription is often ctjuiposvd of a Attm or the drug that in iao!>t 
inipartnnl. an a'ljvnint or tin' druj^ l"> iiid the basiti, a v'rrrp'-dvr to "vcr- 
nrnii- ftimiL' i-ftc'Ci wliich iw iindcMrahlc. and n iifiictc to pjvc ludlt ami 
to (-arry thi* at'livt- ^iuhslanr-c-'i into, the body. After the name of llio 
veliirle. which i^ also dei^igned to brinf; up the mixtiireto a even 
ijnaiitiiy^. we add the words quantum itufficil ad (u suifieient qaantiiy 
ip). iii-imlly abbreviated to " q. 5. ad," lo make the number of ounces 
de^iroi). 

A couiplete proscription may therefore be written a» follows: 

For Mr. John Jones, 

111 Blank Street, 

October U, 1901. 

t 

y^. — Bismiithi subnitrati« gr- xl. 

Creosoti- n^x. 

Sltpce el p<jne in capsula* Ko. xx. 
Signa. — Take one after eai:h meal. 

^.— Actdi Hulphuriei aroniatici f^. 

Extracti brematoxyli fluidi fiSiv. 

Bpirittu) ehlomformi f^. 

Syrupi ziogiberU q. s. ad f^iij- 

Misce. 
SignA. — Take 1 deMerT»|ioouful in water every three hoars. 

In the last prescription the sulphuric acid is the fiaiMjt, the ha'ina- 
loxylon and spirit of chloroform are the adjuvantt, and the syrup of 
j^ger is the rehicle. 
4 




Afctfia, U. S., Acackt Gwnmi, B. P., Gum Amljic orGiim Acncia, 
is a gummy exudate from tUe sleioit and branches «it' suinll Irue^ knuwn 
u Acaeia Senegal, and oth«r Acacias growinj; in Norlhcrn Africa auil 
in AiutraliH. As suld in the stores it consists of irregular eemi* 
transparent lumps, wliich arc cither smooth or angulnr, accnrding to 
■fflicthcr the aubittajice Iiiw bct'U iirt'strved iu iht; original beati^ or 
broken bv haodliDg. Ita color is eltglitly vell-iw <>i' nimnst white, 
both color and transparency depending largely on the aramint of the 
imparities by vhich it is contaminated- 
It 18 devwid of phvaiologiail action. 

Tb«rap«utlcfl. — Ac-acia is em|klHyed in m&dicino a» a local npplica- 
(iou I'p iuJLifueJ and irritaUd jrtiirtiuji ttirmfirniirn, |iiiilicnliirly »f ihw 
upper nir-pa5*agcs, and also when 'lissolvod in wattr in the form of a. 
drink whtrii the sauii- coudiiionii exist tu the miicr)ii!i membranes of the 
alimeatarrcaual and genito-unnary tract. In all theseetatesit is useful 
as a veliicle for more powerful rcinedicji. Made intn n ujui:ilage with 
fl^iBeed. to which liijuorice may lie added, it is largely employed to 
ln<wcn n hueking rowjh in children nr in iidiillt*. The linefeed should 
O"! be boiled, biit allowed to »tand on n. nioilerately warui part <if ibc 
" range," and the gum-arabic aolutiun added with a little teinnn-jiiiee 
for Qavoring purposes. Acacia is cLieliy used iu phannacv for miUving 
pilU. emulsiouK, and similar preparations, and is oili<^ial in the form 
of ihu mucilage of aeaeia (jVuci/uyo Acaeiir, I.'. S. ami B. P.) and 
the syrup of acacia {Srfrnptig Acacift, U. S.). the first eonlaiuing 340 
grms. of acacia and water cnoiicfa to mnke 100(1 grms., and tbo sec- 
Qiul 25 C.C. of the mucilage to 15 ac. of syrup. 



ACETANXLID, or ANTZFEBRIN. 

Aeetnniliditm V. S. and B. P., iraa first employed in medicine by 
Cabn and Hepp, and is a white cr\'sts!ltnp material only nlighlly hoI- 
able in water, but completely soluble in alohol and ether. Applied 
la the tonga«. it causes a burning sensation vrliich is very alight. It 
hafl teen known to ehemists for many years, and is made by the action 
of i;U<.-iul acetic acid upon aniline, forming SL-ctaniiid or phcnyl-acela- 
nuae. The word ani}febn}% is a regtatered name, and should be avoided 




DJtUGS. 



m 



* 



hy liic prof(!SA)on, cince ite emplo}i]ient obligee the druggist to oxe tbe 
acetanilid made by one firm iiHtoad of llic coiupouud luodi:: \>y otlier 
chemists who nre able to make the drug no uu ordJuiury cbt>mlcal com- 
pound, nnd do Dot cborge so bigb a pric« u do tbofic liolding control 
over tbe n-gistfred numc. 

Pbyaiological Aetioo. — Acctnnilid has been studied expcrinrDtallv 
o-od cliiiiciiU,v tu a vcrv gri-at cxtt'nt, aud fairly definite oulUuca of ^m 
itti suliuD bave boeu mupjted out. ^M 

NERVors Syi*TK-M. — On tlic nervouH j<y»tvin acclantHd has hven " 
fnund to act an a apdative, iLe sensory pnrlion of ihe nerves and xfiinal i 
curd partictilarly being quieted. After a poisonous dose general antes- ^M 
thcBJa comes on. with total loss uf reflex aclioD and with motor and V| 
scuHory paralysis. Tbc portiuna of tbc nerriiuB aystem involved in 
these changes are, primarily, the sensory side of ibe spinal cord and 
the sensory nerves, the raolor apparatua being least afferted. The 
muscles are not influenced by tbe poison, except indireclly. 

CiRCi'LATioN'. — Ou tbe circulatiun hcciiiuilid haci but little direct 
InflueDCO except when used in poisunoiis dosos. Applied to ibc frog'g 
hcurt, it at lin<)t aL-ccleratoM its brat and incrennea its forec, but noon 
cauHCii a weakening, ending with arrest in wide diastole. lI|>oa tlie 
higher animals ii causes, in toxic doae, an immediaie fall of arterial 
pressure with a diminution in the size of the piilNc-wave)t nnd all (he 
evidcDcvs of cardiac and circulatory dcpreiuiun. uotwilbi'lnDdiD;; tbc 
feet that death ensues frum resjiiratury failure. Tbe eauee uf this 
fall of blood-prcflaure is a direct deprct^aing action on the heart aaso- 
cialcd with failure of the vasomotor syatem, as asphyxia caiiees no 
rise iu prcsHUrc. 

In mtiiitiinal dcae acetanilid causes no circulatory cbaiiges of any 
moment in tbe healthy individual. Sometimes the pnlee-rato in in- 
creased, sometimes diiiiinuihed. The tendency is, howcTcr, toward 
deproasioo rathor than stimulation of the circulatioD. 

Blood. — The action of this drug upon the blood, when used in 
Urge doses, is more pronounced than ita iullucnco upon any other 
part of Jhe body, causing this tissue to beeouip bniwiiisb-rcd, dis 
creasing its oxygen-carrying power, and, finally, rcdiiciti-; tbe lia;ma- 
globin to methsmoglobin to a very eonsidernblc extent. The ques- 
tion as to the iikHueaco of ocetanilid upou the corpuscles is attU 
somewhat undecided, some observers decfanng that these bodies are 
disorganise^l. while others assert that they remain intact. Id mod- 
erately large poisonous du»es it may not aS*ecl the corpuscles, but if 
ita use in Urge amouQi be mniniaincd for some days, or a very large 
amount be n^cd at one lime, corjiuBOuIar destruction certainly occurs, 
free hremoglobin appearing in the urine in its characteristic forms. 
The normal alkalinity of tbc blood is decreased, and the urine hecomus 
dark and brownish in color, so that the blood-crystaU of Teichtnann 
may be found in iu In medicinal doses the blood shown no change 
tcxcept in cases where idiosyncraty is presenter tlie doses are unuBualTy 
[large. Under thcflc ciri.-umataDoe8 tbe blood in the arterial system 
becomes more blue than normal. 

UesPlHATlON. — N'o effect is produced upon this function by acetan- 




ACETASIUD, OR ASTIFEBRW. 



S3 






^ 



id when |;iven in modente dos«s. Wlien poisoDoue Aowi arc used 
the hreaihiiig at nnce becomes rapid tin<I ihrn impaired uiid labored. 
Large dnspjs pmdiip« dpath by paralysis of tht rcBpiriitory ct-ntros. 
TLt; cmi.'^f? id' itiv^v chaiigei^ are, priinaiily. tlie alieracions io tlio 
blood, nhicb so iiilluvnco oxygenation of the tissues »h m lead tlie 
iftpiratorT- centre to greater effort, while at the same time it iB begin- 
ning 10 b« directly dfipreued by tlie drujz itself^ so tt&t impairment of 
Its function iA soon msnifest. Bokai a^^ertA that the drug paralyzes 
the pc-riphenil motor nerves, ichichf if true, bringn fornaru a third 
Isctor in the respiratorv failure. 

Tkmpkkatl Kt:. — When givL-n in full modicinal doecs. acetanllid 
lowers the normal bodily temperature or else fails to produce uny 
rhauge. In poiMDoun da^en it produces a decreaw in teniiioniiure 
<)e[>«t)din^ on the amount employed, and may caufe coIlapt»e and 

ig:»r)t. On n. fevered temperature it aces as a powerful u.ud fairly 
eouBtttut antipyretic, lowering the lever by ilrcreimriff hfat-pro-hirfion 
uid inrreti»int) heat-ttit*iptitum, hent-prodiiction being the function 
iii<>«t affecteti' Whether the decreaae in Lcat-prodiicliau ie due to an 
loti'in on the heat-centres in the nervoun vystem. or upon other causes, 
j« tiot pwiiivfly kuowu. Some investigators have claimed that the 
&11 depends upon the partial reducljou of the hiemn^lubili of the 
bhwd. whereby k-t* oxygen is carried to the tissues and loss cumbus- 
lion en.iues. Thin seemii doubtful, in view of ihe fact that the most 
e«r«fitl spectroscopic examination of the blood fails to show any such 
chao)^ from the use of medicinal dogex. That the fall of tetnpera- 
re \* not dependent on the !)wcat produced 19 proved by the fact that 
temperature falla even if enough alro])iue be given to stop all 
iration. 
Kiunkv.". TissiK-WASTK. AND Urise. — Much LTontradictory evi- 
dence exinis in regard to the ehnwgea which occrir in these organs and 

' eir excretory produciA under the inHiiencc of aeelanilid, but most 
tttiserrers agree that the excretion of urea is increased, and it ia a 
fart that the more laborious researches which hiire been undcrtiiVen 
have reached a Bimilnr result (Lcpine, Chittenden, mid Tavlor). Lew 
oncertainty exists a« to ils intliteiice on tbc elimination of uric acid, 
which i* increased rather than dimiitifihed by the dmg. After cxce«- 

iTcly targe doi>c» the urine becomes ditrk from the presence of brokcn- 

' wn bluoi [-Coloring matter. 

Eliminattox. — The drug in eliminated by the Tcidnoys ns pnra- 
stnido-pbeDol sulpbitte. and isetitirely passed ntitof rite bndy io 11 hunt 
twenty-four h'^ur> 

AutUeptic Action. — The drug posgesses di«linct antiseptic powera, 
bat i» nnt ca[wfile -^i H'tiiii; aa a di-infcctant. {See Therapeutics.) 

Toxic ObaiMEes from Prolonged Use. — Although it hua bei'ii claimed 
that no untoward cffecls result from the prulungcd use of aeetanilid 
in large dntws, there cuii be 1:0 doubt that this is iintnie. I'ndcr these 
cinnimstanees cimgestioii of the liver, tidneyg, and spleen oeciirR, and 

~ the (luite bu poisonous, clots may be found in the cardiac cavities. 

> "Hj muHM (or hnldinii tn thn opinions atatcd caa be found ia my Boyliton Priis 
Smmj at BarraH Unt<m«itT, un .Amifiyrctio. 




S4 



DRUGS. 



Tbere may be bIho a progreBsive d«cr«8S« id the ntunlMr of the r«d 
blooci-corpusclos. 

Poisonins- — In lunn this drag in toxic ijuantity causes the. lipii to 
become blue, the face livid, cyanoMd, expMssionlces, or imxious. 
Tbe furi^bi'ud and cheeks bpcotu« covered by heads of ewcal. vhicb 
griiduaily extend over the rest of the body. The pulse is si>ft and 
com{>res!<i hie, but hIow. and finally very weatt. The reHpiintioDH become 
slow und shallow. 

Tbc treatment of a owe of" [luisoning by acetanilid should fnnsisl 
in »«pporfiii^ inensures, the tiso of fttimnliints, exlTonl beat, bella^ 
douuu lo maiiituiii blood-prciwure. strycbniue to aid ibe respiiution, 
and oxyK^'" iiilialalJons if iher are necn^ary lo combat eyiuiosis. 

Therapentica. — 'I'be eiiij)Ii»ymcnt of acetinJlid in fevens luiisl depend 
verv mufib npon the condition «f the pationt and the form of his dis- 
ease. The mere existence of a Ligb temperaiui^ cannot, correctly 
epeakiiig, be an indication for any pnrticulnr remedy. Tbo pbane of 
the diKcasc niuat ho recogni»:eil. and the i|ucslioii as lo whclhcr the 
fever which ia present is harmful muHt be duly weighed. (See Treat- 
ment of Fever, rnrt IV.) 

In typhoid fft'fr, though ihc drug po^Bcwe-i very decided anti- 
pyretic po^vcr, it often causes great depression and collapse, and in 
no way influencea for good the duration or general course of the 
dinease. 

For the sfime rcnsons the use of aoi>tnnilid in phlhitria is inud- 
visiblc, for, ulthou}Eh it greatly affwi* the huclic fever, it is very apt to 
caiL«€ collapflo, profuRR sweatinp. "nd depression. Tliuit the writer liiu 
repeatedly seen cases of phthieis in which the attempt to ctmtrol the 
fever bv thi«> dntg resulted in the KyinploinH juxt named ; and Kiese 
points out. «hat the author has al»o noted, iinnu'ly, Ibat in this dia- 
ease cyanosis is very apt to come on after the ii^e of the drug. 

In regard to the pmplfiynirnt of arrlanilid in nthrnir frverx. it ut 
onec become;* evident that a drug alwHlutely uimiiitefl to a ease of 
■Sthenic disease may. oo the other hand, agree wiih n sthenio-fever 
patient very well. In cooMqucnce of this, we find tbat the sweating 
pniduccd by ucelanitid is not «n marked or troublfsonie iii diseases of a 
dynamic type, and thiit, in eonaeiiuenee, it more rarely causes eoHapse: 
but even in tbiji claw of cases, and particularly in both variftii-s of 
pneumonia, the Hiu* of aeetanilid is rarely advisable. Indeed llie anti- 
pyretic use of this and simitar compounda is yearly bccouiiug lees 
and less. 

In mnch the same manner that antipyrin was found, somt time 
after its introdiielion, to he possessed of pain-relieving power, w aco- 
tanilid has been diftcovered to possniw similar properties — a discovery 
the credit of which must ho given to the Freneh investigator Lepine. 
Almost every form of nerve-pain neenis to indicate its employment. 
It baa been suoce&sfiily used in the crises of ataxia, the agonixing 
ilartings of ga*lraigia^ in cases of teialt'ca, and severe headacht* often 
vieM to its influence. A largo amount of experience baa proved it to 
he of value in epiU-pgy. 

The employment of aoetanilid in acute rheumatiitm may he Rtparatcil, 




ACETAXriW. Oa ASTTFEBRT}f. 



65 



tf df^red. into that devobed to the cure of the iliiwHiAO, with the relief 
of pnin, and the rodnction of pyrexia. There can be no doubt what- 
ever of the ahiliiy of thu drug to control the fever of ihin disease, 
»nd the question as to whether it lavombly inHut-rees the severity of 
the pain of the malady is to he answered vrrj' foriribly in the aftiniia- 
lire. (See Kheuiiiatisio, Part IV.) The dose for caM<9 of rhnwiatitm 
»bouId be 4 (0.2) to ^Riins (0.5) three limes a day. In »nbai-tiie 
rAeumatitm of the muscular typo aeetanilid will often give great relief. 

Acciaiiilld i;* of great value in the treatment of chancraUlfi when 
used in dry [wwder, and in the antiseptic drewting of wounds when 
luett alone or with ei{unl pana of borax. 

In many eases of oAjrfmafe vomiting, particularly that following 
lar^ical operations when nn anaesthetic has been used, acetanilid is a 
nstcM remedy. The drug is usually best given in the dose of 1 grain 
fO.OO) L-very half hour until 6 grains (0.5) arc taken ; and the follow- 
ing )iri:>MrriptiuD mav b« ufied in compressed tablcU pitl, or powder, 
pr^rferably the latter, in order to increaae the sedatire effect on the 
iich and steady the heart : 

B-— A..^nnili(li gr. »j(0.<)- 

Ciltein. citriLt 8^ i>l |C--I- 

Ctmphor. RMiDoltToniad ([r. vjI0l4). — M. 

FV in |>il. Tcl rhnii. Nil vi. 
8L-~WmIi down wiih m liulu wnlnr or rl*o diasolv* poirilar tn n dmcbm of 
branOv ; pout over ciackcd iw, aiiU ijiv* it IVoni a «pooD. 

Acetanilid haa even been recommended when applied locally as a 
bmnostalie in rfistaxa, and has been given internally with lutcwrtcd 
advantage in hiKntopttfait, 

Acetanihd very distinctly iiicrcasca the suscRptihility of a patient 
"to cold, and for this reason it should not be used for the relief of neur- 
algic or other pain before leaving the house in cold weather if it can 
be avoided. 

TTntoward effects are not very common if acetanilid be used with 

care- The writer has collecie'3 a nuinbi-r of ciwL'<i (thirty-eight) in which 

mifiivorablc signs appeared after its use, but untoward nctton was never 

iKwn luileas the dose givt-n was excessive for the (sise whieh received it. 

iTbe dose most commonly producing such symptoms was from 3 (0.15) 

Ito 10 grains (<).4!5). In only three instances of the series did death 

lOecnr — one from heart-clot and two from eicettive dosage. No tleaths 

'were reporU-d from moderate amounts, aliliough some of the cases were 

very aL-trniing. Vciy rarely symptoms of poisoning ^^y acetanilid. such 

as arr ilc>u~ribcd on p. o4. follow its now general use as a dusting powder 

lover W'iund.4 imd other breaks in the skin. 

Admioistration. — Acetanilid may he givpn in doses varying from 
(0.1) t>. 10 grains (0,G5). the last-named amount being iisitally far 
much. As ii is virtually insoluble in water, it shuutd always be 
lini8ier<-4l in wine or spirit, in which it will diis^olve, or in eapsulea 
or |tilU. The antipyretic eflect beginx to be felt about one hour after 
the drug is taken. When neuralgias are to be treated or similar 
forms of pain are pre.<«nt. monobronia.ied camphor, in the dose of \ 
a Brain (O.0S2), may be eombinod with acetanilid with advantnge. 
The preociiplion given above may be used, or the following : 



96 



DRvas. 



B. — AoriKiiilidi gr. xx (1.3). 

CunpIioT. moDobromtui gr. r ((XA.)— 11. 

Fl in jul, Nu. 3., 
%. — One cTcrj- twu houn. 

Tbis pill is not to be UMd if there is reason to brieve that msfked 
renal cODgealion or irritatioD is present. 



ACBTATB OP POTASSrUM. 

Pattuaii Acetat, V. S. and B. P.. is a neutral white salt of satino 
t8M(e. reudily ileliniifftrent and tmluble in water. It wan at one time 
rerr turgelr used in tlie trecttnu-nt of a<mte rheumatttrm in tbe "alka- 
line methou," as when it cntfint tlic blood it is cbangetl into an alkaline 
carbonate. It bas, however, been supplanted br the ealic.Tlate» in the 
treatment of mnnt iaae^ of rbeuinatism. The u08e should be from 1 
to 1 ounce (15.0-')0.'J( a dav. A combination of 10 grains (0.6ri) of 
the iodide of potosatuin and 30 grains (2.0) of the acetate ih useful in 
tutMcute rhfumaliam in Home inslmiccs. 

In hfpatie torpor acetate of puias^iutn is exceedingly useful, and 
aids in promoting the flow of bile as well &» that of the urine. It has 
been naed in the trpntment of the mo-called uric-acid dialhftit. and acta 
powerfully in renderiu;: uu acid urine alkatine. At one time it vas 
sappoBed to purifjr the bluod by aiding in the oxidation of efTeiO 
material. The dose of potanaii areffin is from 20 grains to 2 onncea 
(1.3-6'2.0), hut the latter dose is employed only when a pnr^tire 
effect ia desired, and other druf;^ nrr more suit-ibfe for tbis purpose. 

ACETIC ACIO. 

Acidum A-iVticum. 17. S. and B. P., na used in medicine, is »l 
clear liquid made up of 36 per cent, of glacial acetic acid and fi-t per 
cent, of water. an<i hs\A a ^wcctieh odor. It is obtained, from wood hj 
destractive distillation. 

Acetqm, or Vinegar, is practically a dilute acetic acid. 

Therap«iitilcs. — Acetic acid Im Aelaom iLted internnlly. Ae a pow- 
erful escharotic the glacial or absolute acetic aetd {Atridurn At'ffii-um 
QlaeinU, U- S. and B. P.) is used. It can be applied to tcartti and > 
other growthft, and to old »nrf» where the grnnulatioDS are profuse and 
alow to heal. The dilute acid [Acidum Acetifum Dilulum. ('. A', 
and B. P.) is UBod as a lotion in 7tii(ht-itu'f.ata and to arrest ^piit^rit 
and other small bscmorrhngcs. As a lotion to be widely employed 
it should be diluted one-iialf. Vinegar, or dilute acetic acid, ha.<< been 
uswl internally for the decrease of oi<-«((Vv. but is a hannftil and useless 
remeily, diiwrdering digestion and redncing the patient's strength. 

f^ometimm inhatution of vinrgar fiinies from a cloth >(:itura.ted with 
tbis liqrfid will control vomituuj after the use of an anresihetic. 

In the following mixture acetic acid has been used with aucoeu 
for the retnoral of vegetations about the external genitals : 

B.— Adil. •aliL7lic rt. xij (2.0). 

Add acrtit (SJ (30.0).— M, 

EL^Appljr with • I'MiiivlVhair bntsb. 

Very little ]>aia is caused by this appIicatioD. 



ACOrXB-ACOKlTE, OR UOSKSHOOH. 67 

Poiaoulng. — WTien nver-done* of acetic acid are taken fhc treat- 
ment ooDfiists in tlie use of large di>9e3 nf milk, alkal'mo li()uicls, Hiicb 
aa liiiii"-i*!iier, soap-water, etc., and the general nieiUiuivR a(lu|)ii'(l for 
the tn-atment of gastro-CDteritis. (Seo Cia.'Jtro-pnteriiia. I'art IV.) 

CoSTKAlSDlCATIoss. — Nursiog motliOMsliouIJ noi take frcelj- nf 
vinegar, as it ma; produce a troublesome diarrhoea id tUc nursling. 



ACOmB. 

Aooine ia a synllictic ftubstance introduced into opMhttlmic surgery 
SR a local ansesthetic and antiseptic. It is used in a 1 or 2 per cent 
oolation. 



ACONITE, or MONKSHOOD. 

The aconite of the U. S. P. and B. P. is derived entirely from the 
taberoos root of Aeonitufn NapeUwi. At one time the lenvcfi were 
official, but are «a no longer, ami for this reason the term "radix '* 18 
not to be emplored, a<i it i.4 n uselesta di.itiriction. 

Aconite is indij;enf>ua in ijormauy. France, and Switzerland, and 
is cultivated a-H a garduo-plani all over Siirope uuil America. The 
Tnot ia po fttrikin;;l>' like that of horHeradi^li an to b« readily ci'nfiii>ed 
wiih that article nf fiiinl. bin. 'Iorh not emit the punj^enl fiin)e.-< of ihe 
latter when it is Bcraped or broken. It U to be remembered, how- 
•rer, that it produces a disiinut feeling of beat in tbe moiilh when 
chewed. The a<;tive jmnciple upon which the therapeutical value of 
aconite would a)ipear to depend i.s aconitine. but there is reasonable 
doubt whether ihia can be relied upon aa completely a» the preparations 
of the crude drug: ibe aconitine of commeu'e, moreover, varies very 
Ujueh in strength, because some of it is amorphous and ioiptire, nhile 
uthrr sample? are very pure and crytttallino. Further than lhi.«, even 
ibc crystalline form is exceoditigly varialkle. In addition to nconitine, 
Danstan asserts that there are two amorphous ttlkalciids — namely, bens- 
ao(niin« and aconine. Aconitine is 200 times as toxic as ljcnw»conina 
and 2000 times as toxic ax ueoninc. 

Pbytioloflcal Action. — 'VVb^n aconite in placed on the tongue it 
produces ;i -<-iis»tion of tingling and burning which extends over the 
pharyngeal surface and into the f^lomach if the dnig i.<< gwallowed. 
Tills 19 due to ita primary irritant and xecondury benumbing action on 
tJie jieitfOTT nervc-eiui ings; of the mucous membrane. It *>tnetimw 
csuMs a i<«u<atioD of conKtrictioii in the fauces. 

NERVors SVSTRM. — In full medieinnl dose aconite doprf^wes the 
fuDcttoual activity of the perceptive ct-utres in the brain, tlie uenitoiy 
fide of the spinni cord, but chiefly depressea the peripheral ends of ilie 
aetisory nerves. Applied lo a mucontt membrane, it acts bs a locul an- 
eschetie. bttt i« too irritating for Ibis use iu the eye. On the motor 
portion of the body it exerts little Intluenco unlcsK given in large. 
poiaoniHit* doiws, when it paralyxes the motor tract of the spinul cord 
and the peripheral motor nerves. 



58 



DRUGS. 



Fib. 5. 



.0/ 



&f— tf 



B 



PuIf 
lifrt 



CiBCULAToav SiTSTEM. — WhcD ttoonite is given in moderBte medic- 
inal (lose it exercisieH no markcil effect on anv part of tho organism 
save the circuUtion, wliich bcconica souicwIiBt slower liy siimulaiioii of I 
the VAgii» centres and by the drug actiuc m & sedative to the heart- ' 
muaclc itself. The arterial pressure is sHghily decreased by ilie:*e doses, ^J 

rhietiy by the dciTctust^ in cardiac forcc^H 
If lorge doses are used, the pnl»e be- ^^ 
tomes still more feeble and bIok. and 
the arterial presaui-e falls from dcprea- 
hiim of the vaao-annor centre. When , 
R poisonous doi>e is given it cauMSl 
first a very marked fall in puUe-iato' 
:iiid iirt^'rinl pressure, preceded son)&- 
liuiea hy u miickt-ning due to a con- 
dition of weakne^ and abortive canliac 
action : this condition gra(lun.|]y passes 
into diastolic arrest of the heart, the 
ricscuit becoming paralyzed and refusing 
M respond lo stimuli. 

Ueppibation.^ — In moderate do«ee 
actmite <)uiels the respiratory mo¥fr- 
uients slightly, particularly if the 
breathing is 'hurried. In poisonoua] 
B, hyonrouMio doses ii parnlvBes the reapiratot^'j 
eetitrtis. and eo causes dealli. 

TK-MPKHATtRK. — Aconite acls as n 
distinct reducer of fever, probably b©. 
cause of increiiscd heat-radiation arising from relaxation of the capil-^ 
luries and impaired circulation. 

ABftiiKi'TioN AND ELIMINATION. — Aconite ia rapidly ahsiorbcd 
anil destroyed by oxidalimi. m that its effects flo not Ia*t for any 
length <if t line. The effect of aconite when gi vcn in u Urge medicinal 
do** lasts for aljiiiit three hour*. It usually iiicrcaHcs the urinary flow. 
FoiaoniiLc. — When aconite is takeu Liitcriially in exccHsive amount 
it causes tingling of the inueouii meinbraiK's wherever it touches tbeni, 
which iK'Dsutian finally auifiuutA to ecvvte burning. This soonuueet 
away, and is followed by a sense of tingling about the lips and finger- 
tips or all over the »kiu. At the same time tho patient focls relaxed ; ^m 
the piiUc at fint becomes weak and kIow, but later on may be rapid and ^^ 
running, so tliat it fleems a mere trickle under the finger; sweating more 
or Xgss marked is present, and fainting may ensue. Vomiting may occur, 
but id rare. The respimtiona now heeonic alow and sliallow, seeming to 
expand the tinig to the smallest po»iiblo extent conHistent vith life. ' 
The face is pallid ajid anxious. Consciousnees is preserved nnlese lost 

There may be oxophthalmu«, or tlii 
Tho sclerotic coat of the eye is palt 
excoKjive pallor. Clouii! lymvulaional 
occur. There may be marked anics-J 
The pupilii may be nonnnl, eortraeted, or di- 
lated Ui a wi'le degree. The temperature of the bodv is vcr>' low.ij 



A, Vaint n^ntre iIUouIiIim) hj aeonltv, 

(1«-prti(M.'(I. wlifrh RioVi pulM; 
vun-mMir centre drrmud, vhlclt 
lower* arUTlal Irtintcm ; a. mplni. 
lory miitro dcpri^w'il. 






through an attack of sync-opi-. 
eyes may he sunken and rlrill. 
and pearly-looking. There 
of unknown 



ongiu 
ihesia of the skm. 



IS 

someliiRCs 



ACOXJTK, OR MONKSHOOD, 



59 



TWtli m&T he frrndmil <ir suiltlen, ttie slif^bteet nioreuenc of the 
hodt Trlticli can throvr anv strain on the heart i<toppitig that orgui 
in tli^tolt!. 

TnB.\TMKHT OF Poisoxtso.— The psticDt ift (o be placed in a prone 
pcMitinn OR a h&l or boanl. with the fwi bi/lier than the licnd. in ortlcr 
to coofioe the circulation an far aa powible to the vital vcntrcM al the 
baae of the brain. Hot bottlm or brtckn are to be placed abuuc the 
bodj for tbe puriKxw of maintaintog the bodily beat. Emettrs are not 
to be givpn if the Rymptoins ar« 8eT*r«, as vmuiiiing may cause cariliac 
&ilart!. owiug to lh« nmscnlur effort involved, or tlui stoniafh may bo 
tn depressed that tbe einetics will not act. If vomiting; comes ou. it 
abnqld be into a towel, the patient not being allowed to raise his head. 
The stomach in to be washed ont by meani> of a stomach -pnmn or a 
siphou (nade of nibbi-r tubing. EtLer may be giveii hypoijerniically, 
ami followed by alcohol, and this again by digitalis. The ether act? at 
once, sad ImIz whib- tlie alcohol i» being absurbed, and the alcohol mip- 
port» thif heiut until the tUgiulis, whieb is the physiological antagonist 
of ai.-vDitc, but slow and prolonged in itoeffocti), aeoertt) itj^elf. Atropine, 
becau.<w of ita stimulating effect on the vaito-tnotor syBtem, may aUo be 
itM^. If the breuthing fails. artificiBl respiration is to be employed, or 
if tbe bean seeme about to cease in action, a wbifT of the nitrite of 
MBjl maj start it going again, but only a few drohs of the nitrite t-liould 
be aaed, as large amoants depreHi thin organ. Full hypodennic doses 
of BtTTchnine, sucb aa^Xo -^ {O.OiJ8-O.0U6) of a grain, may be given 
to ttimulate the rexpiration and heart. 

Untovard Eff«cta. — Aconite tuny cause in susceptible persons a 
rtsiculur. or vwn a pustular, eruption, or inntead intense itching of tbe 
skin may be developed. 

Therapeutics. — The employment of aconite in disease is one of the 
lDo*i univcrfaliy rocognixt-d procedures in medicine. It fulfils indi- 
catioiu which nothing else can, and lenda itjielf to the control of a 
large ntioiber of morbid processes, ite effects being uniformly cjcplain- 
ahlo by itN known physiological action. It !» used chit-ny for ila 
inliornre aa n cardiac and circulatory scdntive, for itt<i effecli} on tbe 
pt^nplienil sensory nervoud system. M in the romitiiii/ of jtrtffnanfff, 
and in those state; in whicli, through intlammation elsewhere, tbe 
nervnm system needs a sedative which will siniulLaneouHly reduce 
arterial tension. In the early etagea of all afute infiai/imatiwti aco-l 
nitfi is nf wjrvice. It may be applied locally over superficial nervc« 
in nruralgia in the form of an ointment (2 grains [0.1] to I drachm 

i 4.1)1. or n» the olcate of aconitine, 2 gniins [O.IJ of the oleate to 
(HI [6,"] of sweet oil). In the earlier Btages of (/''WOfrArt-i aconite 
in i>inall Aoits freifiiently repeatrd is n moAt valuable remedy, aud 
later in the diiease tends to prevent ehordee by its influence on the 
nerv<iH;« centres. It is iif*eful in froup, guhttii, aore throat, tevere 
i^J.h. i'f.ynrhiti*, nnd <i»lfiniii due to expojure, in their early Btages. 
Wbrii imjijirrAiiion fif mtimtruation fullows an exposure to cold, this 
drug, given with a hot drink and a hot sitx batli, will often rcRlure the 
i>onniil flow. In pi'rirttrtliiis it is valuable to allay the inflammation 
and qniet the excited heart, and it i» ali^o of great value in the earliest 



60 ^^^^ DSUQS. 

BtagoH of tt/ifiiie jmnttnonia if grcnt nrtcriiii cxcitonicnt is pr«wnt. 
Aconite is by Tar the be«l circiiliitoiyimd nervous iMMlative for cliildrcn 
suBt'ririji from stheiiiL* favore. jiariii-ularlv of tlie imtalive lype. Il 
iglit iidt tn lip tiKcil in ailynn-mir, nj^thnnlc affertionn. Aconite is use- 
loiia nnil hiirmfiil in prolongoil ocutc diseaseR, sadi u scarlet forer, if 
contstniitly employed. 

Tn [)orsonH who »uflcr frcnu asthma wbicli ia preMddd hy coryia 
iicuiiitc doca g<K)d If givi-n in the carlic-it ctages. 

In ntfrvouM fHtlj'itation of the heart and in the palpitntion of exrex- 
nirf. cardial' hinnrtri'vh^ aconite is very valunlito. In iniLny ca«^ of 
this clinraprer wiiere there is not only hypertrophy, but irregular inner- 
vation, the iikc of a pn-scription conluining aconite and digitalis proves 
of service, for tlie minute duees of digiiaUa stimulate the vagm; Dcrveg, 
ami the aconite ott only Hteadien the heart Ly its atiiiiulaiir efTecl on 
tlie vagu». hut aUo eounteracti the stiiDulant effect of the Jigiulia on 
the heart niuBcle : 

B.— Tine. amniL (J^ (2.0). 

Tine, diiciinl li^ (2.0). 

Tine, bcllndoniiv Llj. '■*■"'■ 

Tiiir. cuiiliui. Ltiini q. a. ad t^itj (9I).0},t-M. 

8. — Te(i»inKmful every "ix hour* 

In the epUtazii of full-blooded people aconite oHen affords great 
relief. 

Full doses of D«i|ue!iiner9 crvitdlline aconiiine are of i*a]ae in some 
■ t»seti of olsthmlf nfiirnlfpn, TIiiK crystaltiue salt is about 4 times 
rnncer than the amorphous variety. 

Aaniiiiistration. — As u general rule, small divided do^es of Ibe 
drug in ihe fnnu nf the IJuoture. ^ to A a minim (0.015-0.080) given 
every fifieen miiiuiea, vfill act better tbitn a full dose given at once, 
unleK'i the eoiidition of the patient recjiiireB very netive treatment. 

Preparationa. — Tinelure of aconite [Tincticra Acfitiiti. V. S. and 
B. P.) i» used in the dose of 1 to 5 minime (O,0t)-0.30) in water, re- 
peatcfi fivory hour if needed so often. A very usefid way of employ- 
ing it is in the form of tablet triturnle»i. The extract of aconite 
ihrtrnctum Armiiti. U. A'.) is given in the dose of -J to J of s grain 
(O.Ol.'i-O.OI.'i), while of the abstract (vrhtch is nu longer official) I 
Erain (0,06) is tmcd. The lluid extract (AV(racfK»i AconUi Fhtidum, 
U. S.) is given in the dose of 1 to 2 niinimH (0.05-0.1). Fleming's 
tincture ought never to be used. The active principle iironitine(yicti«»- 
Una, B. /*.) 19 not offieial in the U. »>'. P. Iw dose Js ^^j^ to ^J^ of a 

5 rain (0.i>0U3-0.0U0t>). but it ought never to bu used internally. The 
i. P. pre[jarylioU8 that are not official in the U. S. P. are : ueonitine 
{Aeonitina), aconite ointment {Unguf^tun* Acvnitina), and acwiite 
liniment [Linifncntttw Aconitt). 

ADONIS VERNALIB. 

From Adcme vcmalte, a plant indigenous in Europe and Asii. it 
derived a glucuaidv, Adouidin. When given to one of the nutnmaliii 
—•the dog, for instance — it cauMS on increase in licart-ferce and a 



I 



4 





AQARlCIH—ALCOnOt. 



ai 



of art«rial prassure. In the frog poisoBoua ftmoautH arrest the 

It in diMtuIe. 

Tlie indicBtinns for Uie use of adonin are all conditions of caiiliac 
failiirv. particulnrlv the preei-noe of cardiac dropsv. It is much infe- 
rior to dic;iialis aud taffi-ine. hui maj be emploveil wbeu iLesc fail, m 
it snmetiines xiicceeds under mch circmuslances'. Within the last few 
rears adonis verualii^ and bromides have been combined io the treat- 
^neat of rpilrpt^ with asserted sucness. 

The dose of adonidin is J to J of a grain (0.1)08-0.1)16) three times 
a daj : or 4 to 8 parts of the plant — all portiuuit of which are etoployod 
—m^y be added to 180 parl» of water, and of ibis iafuaion a half 
ounce (15.0) niaj be given every four honrs. 



AGARICIN. 

Affaric, or Tou«bwood. or Puuk, has been used in the Southnm 
t'niiMi States verv larf^ly in the done of T) gmitiK (0,3) evtrv few 
Itoum in ibe ireatmcDi of tbc night-tu'catu of iihttisia; aud urydWrm, 
ithf BiciihoHc extract of tbc drug, baa been ii-sed nilh verv exlraordi* 
oarr rc«nlts, under these circuoielaDcea, by certain (fermuu uuil 
ngliAh physicians, in the di^e of from 1 to 2 grains (O.OG-0,13) 
■T fire hours. Its pbvsiolopical action ie unknown, but it is sup- 
to act uj)on ilie nerte-tiUments in the »wfat-glundn. The 
Writer \t»» employed it fref^iienlly in varying dos«, and has never 
»e«*n any JecreaJie wbalever prodiieed by it in the gweaiif nf pbthisin. 
lalibftugh he ha? watched it m»*t closely, expecting to see jireat relief 
[fblluw \\A \\Ae. Sumelinit?4 ii^aricin causes uauiM.'a and diarrhocn,- 

ALCOHOL. 

Ethyl Alcohol (Alcohol fJthi/firum) in the only iilcohol used in 
icine. Some of the other iilrnhoU are uxeeedingly puiHoiiuus. 

Aoivlic alcohol i» futwl oil. 

Alcohol if) a liquid derived from the fcruuTiiation of xraruhes or 

•ufarv in the prci^cncc of beat. It is oHicial in four forms — nitiiicly, aa 
L^E-ftAfl/.f-.S'., containing 91 pir cent, hy weight of iho spirit imd y per 
[cent, of water; Alco/ivl Ah«olutui>t,i'. S.i\n.<i ft. /'..containing not mor« 
rihiili I [ter cent, by weight nf water; Alfohnl Demhrofum. eoataiuiDg 

92.6 (wr cent, by weight of alcohol ; aud Alfohoi DiUttum, U. S., 

or dilute alcohol, 41 per cent, by weight of spirit and the renmindcr 

water. The drug ie generally given in tho form of whiekeyor brandy. 

and when the word alcohol ia used in the saying. '* Give the pulicnt 

alcohol," one of tbcM two li<|uids ia always meant unlesa it in otber- 

wtiw Hated. 

Xutwithxtanding the almoat universal uae of alcohol aa a atimulant 

by tbc laity and the medical prufcuaioa, it cannot he detiied thst evi- 
Idence of scieolific character and weight is constantly being brought 
jforwanl that its dominant action '\» dcprewiant upon all parts of the 
(liody. It is claimed that under its intlueiice the total amount of work 

aceoinpluihcd in a given space of time is less than when it is not taken. 




DJtua& 



and that Hie iiuiolteniiig of the pulse un<]«r its iuflueaco is more 
apparent tlian real. On the one liaad, therefore, a Tast mays of evi- 
dence feeniA to exisit against the general emplovnicnt <jf almhol as a 
aliiuulaiit i while on the other clinical experience, loo [;reat to bu 
ignored, »taud» for the continued emplojnient of the drug. While the 
aiitlior is Ibrced to admit tliat the pharmarolo^ical evidence is strong, 
ho Ktil! deliberately allows the text nhicli follows to remain as in 
earlier editions, t<till employs alcoliol as a stimulant aa before, and fullr 
believes llmt itg ndwinititration irt often followed hy most beneficent 
results which otijcr ilruga will not produce. 

PliyaioloiiCid Action. — NEKVorg SvsTEM.^Al(!ohol act* 6rsl aa a 
powerful excitant, and afterward, when Riven in very full dose, as a 
most active dfprfssant and paralyianlof the nervous .sy.item. Locally 
apijlicd in ftuiill umouuts to the pvriphcral nerves, it excites them ut 
firtit and (jaralyxt-s them afterward. By tlie primary Htinjtilatioii of ■ 
tho brain it inorca^cB the rapidity, but not the depth, of thought. aud^H 
it inere&ses the rctlcx activity of ihu spinal 001*11, the muAoley, and ^V 
the Qcrvcs. In largo ioitsi it pruduceri lack of oo-ordiiiation by 
depression of the brain and lower nt-rvous syatcm. the loas of co-ordi- 
nation hein^ due largely l« impairment of sensation, so that the power 
of touch and the muscle .«en»e i* interfered with. This makes a 
dniiiken man fail lo recogniee thv an;;lL'j< or uneven surfaces of sur- 
runndiu;; objects, and tbe impaired mental puwer »ud di^urdored judg- 
ment, combined with tlie badly-acting motor and acnsory pathways, 
cause him to stumble and fall. 

CiRCCLATORV SysTBM. — Whcii alcoliol in jngoalcd. either by man 
or tlie lower aiiiioalti, it stirauUtes the beari-umsele aud increases the 
rapidity as well as the force of ita heat. According to Dogiol, tho 
increase in rate is partly due to atimulation of the accelurator nerves, 

but Castillo denies any such influence. 
Wood teaches tliiii ibc effect of alcohol 
is not through any action upon tbeae 
nerves, but upon the heart itftelf, and 
ia probably correct in hi.s belief. 
Along with the stimulation of the 
heart a rise bf arterial pressure en- 
sues, largely duo to increa.<w<d heart 
aetitiu and partly to vasomotor stimu- 
lation. In very large toxic doses 
alcohol depresses ami tinally paralyxes 
the heart and vasomotor aystem as 
well as tho nervous aj'stem. 

REtsfiRATtON. — llespiratioQ ia 
stimulated by »mall doses of alcohol 
and decroiseu, by large oncw. 

Tkmperatork. — Alcohol at no time 
JQcrea-Hes to anv extent tlie actual num- 
ber of heat-nnits in the body. It pro- 
duces a senoatioa of warmth, and wiirnui 
the extremities by causing the heart to pump hot blood from the 



Fia6. 



B 

D 



I 



i\^ 



J , Alcnhnl *tlmuUlM tfa« bcftTt miufle : 
B. Biiil iti« vftMitneior centtu in ih^i 




ALCOUOL. 



63 






centre of the body to the coM parte. If it be used in excess, tbe 
t^mperatare npully falls, owing primsril; to tbe iocreaso of heat-radia- 
liun produced by the excessive diatribation of heat just naucd, aad 
!tMxm<lari1v bv the dnpres-sion of viul power which is ciiii.<<eil liv a, too 
rapid destnivtioQ of the tissues of the body io the cftbrt induced by 
tiie drug. Cahiriiuclric:tl studiia hIiuw tliAt, wlule iiiorL* heat may bfl 
cn?atc<l under its influence, so much heat in didaipatod that the teiup«ra- 
mre nererthelws falls. 

BoutLT Metabulism. — The quautity of carbonic acid giveo off 
by t!if Wly uader the u«e of alci^liol is in moet instSDces increased, 
but it niny be deereased. The effect ou the abdorption of oxygen i« 
not known. Some ofmerveni have noteil an iiierease, some a decreaae, 
of such abMrption, and »ome no cliaDge at all when alcohol \s taken. 
Tpou the t^iviug off of nitrogenous substances it acts as a decided denres- 
aant, which seeoid to prove that it inhibits rapid tiMuo-ehuigeH ana ia » 
eoiuwrvator of vital power. It adihi force, but not tissue, to the body. 
KtlMiNATtos. — Alcohol is rapidly adrsorbt-d and rapidly destroyed 
liy or t>liiiiitiulL-d fruui the bndy. In inudiL-iriiil dosea it )9 largely " burnt 
up" ; but when taken in exce«s of the body's oxidising power it is 
eUininated by the brealfa and by the Kkin, kiuneys, and intestines. 

l>ia£STri)>". — .Alcohftl added in any amount to food in a test-tuhe 

eODlainiug digestive ferments retAnIs or inhibitfi digestion, hut in the 

•toiDacb. on the other hand, when used in moderation, it assieta the 

; for br reaMnti of its ii'rilntit and Alimulating i>iYiperti(M it 

tidacea tbe secretion of ati excet«s of tJie digestive juice. When exces- 

ive amoants are ingested it disorders digestion by inhibiting the action 

of tbe digestive ferments. 

Tb«np«utlcs. — The employment of alcohol in disea^ can here he 
only briefly alluded to, special mention of ita indications being named 
when ihe diseases in which it w iiued are (liscu»»eil. (See Part IV.) 
It* chief uses are as n mpidly-ucling stiujulnnt iu all forma of cardiac 
failure dne to xliock or to poisoutn. and a8 a )>YMtetuiL- support iiml stim- 
olut in low fevers and prolonged waiting di^usci. in old age, and in 
cooralencenco fmm acute discii.se. Id both crfjiipoua and ^ilarrbaJ 
poetimonia alcohol is useful, and particularly is tins true when these 
affections occur in chihlren. (See Fneumonia, Part IV.) 

Some addition;il conditions, to »t&te tbcci spccificiilly, in which 

cohol i^ iDflicnted are j'ttinting, make-bite, aur^/ical akack, and chronic 

n^umonia in its later stagey and excewive watting due Io prolonged 

ppuration. It ia aUo iweful in poLtoning by dcprcHsutit dnign, such 

a<( aeonile or antimony. 

Alcohol »lioiild never be given in the presence of circulatory excite* 
meat, but whenever the circulation faiU during the progress of an 
acute dueniw it ia u^^uful. In the pneumutim of childrt-ii. whether it 
be cronpoiis or catarrhal, brandy or whiskey is very useful in the dose 
of 5 t<* »jO minims (O.S-4.0) rvery two hours in a little water or niiik. 
'e'ec Admitii^tnitiou.) In exhau.tting fevers, suoh a^ typhoid or rif/'/iui>. 
ot finds it* true upefiilness. While il ia well to give alcuho! in 
casen of enteric fever fnim the begirming to the endof the attack, 
r the double purpose of aiding digcsiiou and of supporting the ajatem, 



$4 



D&UGS. 



ite adminifltratioD sfaoulcl not he a. mere malter of routino, t)Ui oliould 
be bu»c(l upon clear idtMU of ihu indications it is ailculutcd lo fallil. 
If tliu jmU« ia weak aud tlii! patient seeiiiH tu 1>e siukinu-. ur llie appe- 
tite ]» ittfling and adjrnamU h & pressing symploni, alcohol is indi- 
cated ; but if the pulse is good, and the paesaco of the patient throueh 
btK illne^ is not a Btunn,Y om>. alcuhol abuuld be excluded from the 
fiiek-room. Somelinies onliniiry wbiitkcy or brandv will in severe 
typhoid fever disorder the stomach. The physiciiD abotiM then em- 
plnv nn old brandy or vine which has acquirc^l an ai-oma which h 
ailU'd u " bou^urt," 

In pmiatent vomiting small doees of good brandy poured on 
cracked ice will oflen do much good. 

Alcohol is not only of service internally, hat it is aloo utieful cxtei^ 
Dally 118 a vrnsh or evaporating lotion over firtu'sts, iufiamed j'vinUi, 
and i»ou»d» of a concused chanict«?r. It nets as a cooling iind anti- 
Styptic drcxsin^. It \» also UMit'ul fur wnj^liing tlie ok in of iinalids. and 
"Bait ami whiskey" applied by rubbing is u good mixUiro to stimu- 
Ute the (tkin of imheallhy persons. 

Acute PoiBoning. — In advanced paiooiLing by nlcohal, with coma 
and t'jt^d n-liij^atiuii. external bent and b v pudt-imic injections uf digi- 
talis and strvelinino are iiidJo».(ed if the lioart or respiration seems lo 
be lit-iling. Heliadonun ftbould be ndtniiiiatorcd tu atimulate tbc vaeo- 
motor system if the skin ik relaxed and clammy, and c»unter>irrila- 
tion to the back of the neck is to be employed if any brain f«ynipli>U)8 
are prewing. The afier-treatment conxiefs in the use of KubslanccB 
Rtimulutiug to the ntumucli, such n» ammonia, spirit of Mindcrerutt, 
and s[»ee», unlesn there is gastri^r inflammation, when emollient saU- 
etanoea sbotdd be imed to quiet the irritation, if persistent vomiting 
comes on, it must be quieted by the patient swallowing piecen of ice, by 
aconite, cocaine, or uiinuCe doHca of ipecac. CounterHrritotion iJiuuld 
bo applied over tho belly. If the euiunctories are not acting freely, 
thorough purgation by jalap or elatcrium (4D grains (^.6) of jalap 
powder or \ of a grain (0.01) of eUtrrinm flhould be employed); or full 
doses of calomel f->IIowed by a ealine may be given if milder effects 
tro sought. For the morning romititiff of drunkards Fowler's eolation 
of aracuic is often a valuable remedy. 

In view of the frequency with which alcoholic and opium poinon- 
ing are confused, the following table is appended, which will be found 
iif value ill making u. differential diagntmin aa Lo the condition of tlio 
patient ; 

Alcoholism and Opium Poittining. 

Opiam rVnwninjr. 

1. Pupili ocKitracl«d. 
I'uIm S. It«tpir«[ion uul pul«« slow txiA (ulL 



AUaMum. 

1- PujiiLt nomal or diliilad. 
i. ItMpInttiiH) rmt)}' normal, 
rspifl, Mill Hnally f««l>l«. 

3. l''Bce iiiKv l)« |ial1i(L 

4. ^iii com, [wrhftjio moiia. 



ft. Puhe rapid, at Um sLroag, theu 
«ak. 



S. Face nifTuMMl aud (»iUHUod. 
A. Skia warmer llian in ulmhalic poi- 
•onine. 
0. Fu 



'uliw alow, UrtKifc, Mill Tuil till lale 
in [lOLMininR. 

There i> Eicuv«l]r mi* difrtrr«n<v u« to <<>ii9<Tioij»ueM in llic (wq i:onditii>ii«. 
tn nicdico-lcfnl cnnc* the miai stiuulil b« aarvd in hrnucticnlljr tioAvi Ti«>«ts fvr 
«ifti»iiMti''-n. 



I 



I 




ALCOHOL 



65 



Arttte AlrohnUam ami Apoplexy. 



AttnlieliMM. 

I. Pulnc mi'i<I,"Mn|"r«Twil>V ii'n! "'-■ilk. 
£ Sliiii tuuut. (.r rtUtinl nnd ixml. 

4. Pu|>IUMio:illr coulnuledorditatcil; 
gmmllv ail>it.tl. ' 

6. No li('iiti|>li-ttik. 

A. Bnntlun^ noi mi wi-rtorotu nor •» 
iwidwl In lipa. 

7. iio rucinl \M\ifj. 

5. I'tidOMK^uiaMweM mmy not l« com- 



Apopkiy. 

1. Fuke »pl to W Btruiif; snd «lo«. 

2. Skin hot or dt>-. 

4. PnpiU uuefiual. 

h. Iii-mipl>c4iia: ihk- nidti Inawil, ih* 
uihvr muiiiiitrii; niationlcK. 

(I. [{»fiLnilioi)»h-rtorutiH.tlti-II|nlM:*Iag 
inllnlM nil oni- Mi]e i>n i-xiiinilinn. 

7. Koclnl ))fiii^v. 

5. irnooiiBcinuitiii.'Mt ivnipivte. 



The latM-ll of klmtidl In lb« bnaili \t im gumit, iw nt'iiut nIcoiliullHtn 111117 buvs caused 
ilie ruiilure or * cvnfbnil faluorl vtsiel. 

Otaniiic Polunisg. or th« Alcohol Habit. — Ciironic poiaoning by 

■loobol rcAiills III vtTV ctiariicteri^lic cli:iii^(!S in llie ti»fim. As the 

lircr rw^ivc* ilic alcohol from the stomach dilutod ouly by tlie portnl 

bliMicl, it if ortcn aft'tTtpil vrry carlv. siml rirrliosi? of this orj^iin oomes 

DO with iu ac-conipanyinp f:a»tnc and nutritional iiyniptoiitii. Arentnl 

'>i»iurbn.nce» xve cutiimon, nixl neuritis may di-velup in it^ |Kiiiitul formH 

prtKJiHTo pimily«i.« or symptoms ro^cniblinj^ locomotor ataxia.' The 

TUnii-nt of I'liniiiio ulciitiolic jioiKOtiiiig iuiit tiv carried out in two wavt>: 

Mrst. hy I 111' isiiluiion of iht' jHiiioiit anil tin' compK'te witbdrnva.1 of the 

ImE at nnci' ; M'irnndly. by a lirtter plan. :t gniiliial tnporinjg-oB' in the 

ii>By nirHiiiui of till' spiric In ciiher instance isolation muat be abso- 

biu;. ami all siuuggliii;; of alooliul to or bj" the patient prerpntedl. The 

atlendanu niu«t hv ahooltiloty tnistworlhy. Carcftil ecnitiny &f bed- 

rlotbiv an<I cloiwlii will often bo rewanled by finding hiihlen wblskey- 

boltli!S. The (lepif«»«ion of iho pRticnt when rocovcrinp fnitu »lcolol- 

isiD tniiBl he met by the ui*it of niilnlioiiH brolliK. highly itca-Hiinnl in 

►r<ler to Ktimulitl^ iho stomach, by easily iligcfstotl or prcdi^ecled foods, 

111 by emnJI Josfs of luorpliino or coca if the patirnl he very weak 

id nved fluch aslimiiliu). Kourayfiti is an i>xc«c<lingly valuable and 

iDtntiou^ preparation under llic«e circumsiaiices. 

In tfap Mmitinent of the atonh atomash of tlruiilcarJg nothing doea 
eo «cU i%& the fullowing pill : 

B- — **l<"'n'«in, mpnri . tH,i(0,6B), 

l)li-i iiirviipliytli v^x (l>,65|. 

lIvdrurg.clit4M.init. er. xxil.S). 

Alow SocDiritw KT. zl t^^)- — ^ 

PL la |it). No. XX. 
S. — <)iw tliMv iiiii« a d.iy nftcr i'it liefore menlii. 

IftbiH pill fail^ to move the bouoln, aiialinejiurgative should be used. 
The following are the prinripnl points in the diffcrrntint diitgnosis of 

Ckr^nir AJcohfili»m and tfie General J^aml^xin of (lit; Insane. 
AMuAtMit. Paraie t>mentia. 



I. AltaHu) iilKincr, mikI more widclr 
vpirMed by inlrrrnli <if uinitv. 

1. Ihillriutit aay \it of aay cliantcler. 



1. Attacks atom proloiicrd. 

:!. iJcliriuia of i;niiidrar niure iiiftrlcod 
and liulitK"!' 



> Sw antlior'* "vii on ItiayaotU, Lm Brvttier» & Co., I'hiUdolpbia. 
S 




06 



t>BVO& 



3. Viaicnii aton: clttnctcrutic,Mi(lDn: 
otU. 

4. Tremar* eoofinMl to lieed and astoA. 
b. TromDnt removed br dote of alco- 
hol. 

6, Meaul symjitoms lempomrily re- 
□iov«><l, dr til niij nilc iinpitvvinl, by al- 
cohol. 

7. Treoiara oomr dilclLy in ibe uiom- 
int. 



JV<fK Dtvttntia. 
3. VImoiu oflco Dot eril, bat pleaawL 

i. TTcmot* toot* dimjced. 

&. Tram on mad* worw h; ftlcohot. 

6. Meiiul jitnlo uaUe wtinc by ■knbul. 



7. Traonan not nxiilnal tu t!ie monif 
ing- 



?%«•« u danifer of pneum/tnut from failure (if the right tide of lh4 
heart in gtiiticute atui chronic aleohalism, and fA« physician thould 
afu'iUfa he on the lookout for thi» comfiUeatior*. 

Adminiirtnition. — Bruiiilv and vrliiski'V are gctirriilly uscil ajtrapnllj' 
BCtiii^ sliiniildiity. Tliey uliowld be ex^lioite(^ in llip f'lnn hpst adnptcd 
to the work ihey arc inlciided lo [lerfurm. If iLu actiuu uiuat be 
instuntaneous. fl« in a. cjiso of faiiiliufi, thej shfiuM be cmploTOiI hct 
and eoncentratrd. jtn that the stmnArli hsw not tu warm t)i<! H(]iiid 
before absorption. They are to be iiB<>(i liyfuxlermicftlly if still more 
rapid actinn is re<]iiired. Ifadniiiiisteri'd to aid ilij^estion and eiipfiort 
the systfftn, ibon they slioiilil nlwnya be (/ii'cu with the food — never 
alone, and never couccnlrnti-d. Tbi-y may bo given as niilk-pnucb or 
08 eggnog, ilie lutier being the ** Jieavier" of the two so far as diges- 
tion IB concerned. In fevers of a typhoid type the dose of whisltey or 
brandy should bo for an odult from J to 2 oimcei»(l-VO-60.0) every 
three or four hotini. More than a pint in tnenty-fuur liours ia rarely 
recpiired, but this amrmnt often does great good and is not excessive 
if (he ])iiliont \t accustomed to its u»e and needs stitnnlation. When 
brandy or whiskey i» given to children, tho following rules u to 
dosage may be nHed an indicating the approximate proper dose : 5 to 
10 mininiB (O.S2-O.U;j) cverv four hours for a child of 1 month old; 
10 to 20 minims (0.05-1. ^W') for a child of '1 montha old: 2I> to ftO 
minima (1 .3-2.0) for a child of 8 monriis old ; »0 to 40 minimH (i'.0-2.6) 
for n child over 8 months old; 00 udiiitus 44.0) for a child over 4 
months old. In some caaes, however, it is well U\ iiae half these doeoa 
every two hoiir». In nil ca.tes the liniior nhoitld be dilutod with hot 
or cool water. Wine-whey is very light and useful, Mulle<l wine 
and chaui[)U^iic are partieularly useful in the treaCiUfiit i)f irritable 
stomach. {See Foods for the Sick.) (Jhampngne wlicn used as a 
medicinal !itimitlant iihoidd alwaVH be as devoid of sugar as poasibl 
that is, what is known as "extra dry" or "Brut." Gin is rarely 
employed as a stimulant, except when the kidneys are torpid. Stottt 
and porter are of value in wasting di«cajtes, in convalcscenee from 
acute di»ca."«c«. and for nursing women. 

Oontnindicattons. — All states of t'(>rebra! excitement, unless due 
to exhaustion. ncuti> inHanniuitions, the altroholic habit, apoplexr^ 
meningitis, aeute nephritl!i, aneurism, and advnni^ed nthernmu, coa- 
traindicale tbe use of alcohol, as does also the history of the alcoholio 
bnbit. 



« 



« 




ALUUM. 



67 



The official preparations of alcnhol arc nn fotlowB: 

Wbiskfv (•Spinliis I'rumenti, U, .V,) Hhiuiltl he at leaat three v«ara 
old, anil be DiHile, in America, from rye fur iiiodiciDnl [mrposes. 

Bnioil;^ (Sft^rit^ul ViniGalUci^ U. tS. and H. P.) ia obtaJnml bjtlie 
dtstiUatinD nf femieDted grapes or fruits, atid hLduIiI be frnm tliree to 
five vears old before use. 

Cnlogne-water {Spirit»» OeUrralwg) is used solely as a lotion and 
perfume. 

Ked. Wine( I'ctiuwi Ruhntm, V. A'.) is innde from grapes Dot deprived 
of their skins. White Wme ( Viuuiu Allmm.) Ja the fermented juice 
of grapes ilie nkins of wbieh have been reuovcd. 

Dilate A!c«lioI {Alcohol Dilutum, fj. S.), doodorimed alcohol 
{AUohol I}eodomtm», U. A".), pure alcohol (Alcoliol, If. S.). and abso- 
lute alcohol {AU-ohol Ahtotntiiiii, U. iS'. and It. /'.) are al»o otRcia). 

The mHjflfieial preparations are : 

Itnin, which u> made from the fermentation of molasseB. and con- 
[tains about 4't to 45 per cent, of alcohol. 

Gin i» made from ryti or barlcv. witli the addition of jmiipcr-bnrrics 
and hopA. (Good gin and the tSpirflu* Juniperi Compositus of the 
f'. .V. Fkitrm't<r<iptria are virtually identical laerapeiltically.) When 
diureeiH is re«jiiired and atony uf the kidneys is present, without 
ijatlniiiuitttion, ^n is a lucfii] mnliramrnt, prnvideil tliat n stimulant 
is iudieated. din is one of the aleohoUc drinktt must apt to produce 
cirrhoeui of the liver. 

Port Wine ( Vinnm Porteme) i« a fermeuteJ wine, to which pur© 
jtirit ia added to increaw ita streu^ lli. Jt is one of the strongest table 
rincs, and v useful ax n stimulant in convnleseence. 

Sheny f Vvium Xerii-uni) bufl about 30 per cent, of alcohol in it. 
It \A not offieial in the U. S. P. 

Beer ia made b; a elow fermentation, while ale is made by a more 
frapid fermentation at a higher hejit. Most of the beer in America 
eontaina about 4-6 per cent, of ukuhol. 

Porter resembles the other iiisll liquors closely, except that it 
eontains tnorc solids, dun to a £corcbing of tlio grain bj- a high 
beat. 

The B. P. preparation)! that are not official in the U. S. P. are 

ified spirit [Spiritm tieetifipatni), nherry ( IVm/m Xrri'-um). and 

\JHi*tura /ipirttut Vini GalUci, which \? a tiseful. pleasant, and nutri- 

|ti'>H» «timidnnt made by beating up the yolks of two ejigs with half 

\v\ ounce of sugar, and then adding four ouncca each of brandy aud 

cinnatuou-water. This is sometimes calk-d " egg-tlip." 

ALLIUU. 

G^iCy or Allium Satifum^ U. S-t it a etimulani to digestion, owing 

volatile oil it contains, which by its somewhat irritating proper- 

_ ascites the gaetric mucous membrane to increased secretion. In 

p£rMi$tent eolda. where the brnnchiHl tubes are particularly affected, a 

garlie pooltice. made by pounding the bulbs in a mortar, is a very 

[efficient though disagreeable remedy. If the skin in au^ case is too 




08 



DRUGS. 



(iflicaie to permit or the use of pounded garlic alone, it maj be mixed 
[•with ei^iinl parls of braii, una a regular poultice or plaster made 
tberenf. Kuipioyed in thiK t'ortn. Hlliuui is UKefiil if applied over tlir 
spine or feet in tite treatment of tlie cereh-al and tpiital ef^nv'atsioni 
of infanta; placcil nver the belly in cases of fftistro'tntt-stiiini ciUarrh, 
ir act^ nirioisl as wcLi jis a 9pit*o ]wiiliice. In llie treatment of oliildren 
wiili cAroHiccoWj* gurlie may be u^cd liuiled in milk, and the liquid 
^ivon as a drink, «a.ru] or eoUl ; or tlie nil of f^srlic lu&y be given lU 
emulsion lit tbu iloNe of 1 or 2 iitinima (0.0t)-0.12). It oii^lit not to 
be given during the febrile Rtnge, n» it i* sti mil la ling. Alliura-juice 
bus mL^o bfeii used iu tlie dtwe of ^ to 5 ilrojis (0.1-0.3). to relieve 
7ter^''ni6 vomilinif. Tbe dose of tlie svrnp [S^rupiia AfHi. I'. S.) for 
u cbild itf 1 driicbm (4.Q), but 4 drachm.<t (ITlU) majr be given to au 
adult. 

ALLSPICE. 

Allspice, iir Pimenfn ( (/. A', aud B. P.), is the nenrly ripe fruit of 
Pimenta vj^ciinilit. a tree of ibe Wf*l Indieji. It contains an official 
Tolutilc oil [Oit'U'/i J'lm'-ntiT. V. A'- and Jt. /*.). used for flavoring 
purpoaew. as a cuistitiieiit of itpice pbi)>teni. in diarrbtca uiixtures. or 
aa a eamtinative. It ■will aluo prevent the griping of purgative 
luedicinod. Tbe iUme nf tbe oil \s. 1 to •') minims |O.U(j-0.tiO). A(/na 
Pimentcf {B. P.) is given in tbe dose of 1 to 2 ounces (RO.O-tiO.O). 

ALMONDS. 

Almondi^ are official in tbe form of tbe bitter aImon<i8 (Amt/yilala 
Ani'tnul'. tS. and li. /*.|uiid ibe awcet ^['niutitXt {AviygtUtla Dulcin, 
L'. iS'. mid Ji. P.). Birter nluirmds develop bydrucyanic acid in the 
presence of water, by tbe reaction between tbe ninygdulin and water 
in tbe presence of ilie ernuUin contained in tbem ; tbia is not ttic 
ease with sweet almonds. 

Hweet almonds, when nibbed up iu a mortar with water, form a 
pleAMint-tastiug cinuUion uf nn ngreeable odor that is very uscfid m a 
vebieU; for rem«dii.'« having a diMa.greeablB t:uite. Almond bread baa 
been proposed ad a food for diabetics, owing to 1(8 containing virtually 
no srarcb ; but it IS requisite that tbe nils and iiaccbarine constituents 
of tbe almond shall first be removed. (See Foods for tbe Sick.) 

When half an ounce of »vri^>' almonds are rubied u|) uiih thirty 
grains of gum arabic and two dniclims of i!ugai*. to which is added 
gradually a half-pint nf dislilled water, the mixitirc being then 
Strnincd, an emoIHcnt and v^oothing dritik ia foruifd. whieb ia very 
useful in irriUUiaun of the tttumach and inUiriiiu-)! and of tbe air-ptu- 
tage» and pftarffnx. Tbe expressed or fixed oil of almonds in a uwful 
demiilreiit, and haf been recommended in Ibc cough of phthinit. given 
in tbe dose of a J drachm {'2.0) iu emuUJon. 

Bitler almomls give off un oil (O/rurn Amtfiida/tr Amar<r^ U. S.) 
which is exceedingly pojaonous. owiug in the prussie iieid which it 
rontains, and it in Haid that one drop will iill a eat. while »evcnteeo 
(Iropit have killed a man. 



I 
I 
I 



ALOKS. 



«« 



Bitter stmonils Are iiseil in allay irritnlile cotij;))!) nnil PiniilAr fltateo, 
but are not fr«i{iu'iilly eiu|»i'>ved, becsiits* otiicr ilnij.'ti are less diinget^ 
nus. more .^inhlc ant) iiixrt; nctivc ii8 rciit<>(lt.il ii;j;oiii!<. The eiiiulNinn 
of btllur alttixnil^ iMiiiitlr u> is tliutof snit-t iilmoiiii.'^. and iiiiiv be used 
iu leaspoonrui {\tyt,vs for ifao same pui-ptrnvs uiiil as u vcliicle in cou^fa 
mixtarcs. Hulli iimitUioriH aro iinefril an vcliideH in tlic trtatinont 
uf tfimorrhinii, u.< thcT iliiiiinisli tho burning on iirinatiun. Alinoiid 
(■iK'tl^iions. nbei) 1<k'»IIv itpjilied. are ttupposed Ui bo of value for tho 
iviniital tif frecMfs und »tinbiii-n. 

Tli« prvj>aratiou« of :«wL-ct iiliiixii'U urc : an ctuiilitiou (^Emulmtm 
{Aatj/t/rleiliT, C S.. nml Miftura Amtf^jthila, B. P.), daie \ lo 2 ounces 
(3'J.0-60.0>; a xvrap {Synipae Amy^/dala:, U. S.)t dose 2 drachms to 
2 nuoces tS.O-tjO.O) ; a cotnpomid pouder (Pufri'x Amjuplaltr Componi- 
lH», B. J'.), giveD iu the dose of 1 to 2 diarlims (4.0-S,0'); iind the 
oil {Otftiin Ami/ijJa/ir Kxpretnuiti. U. *S'.. and Ohuin Amygdaln., 
B. P.), ilie iii>so of wliicli ia 1 to >! drnclinia (4.')-l(i.0). A<ittix Amyg- 
xUUr Amnr(T{ U. S.) is prcparwl from ibc oil of bitter almouds. The 
ViAt is m 10 &} minims (2.0^.0). 



ALOES. 

AInefl, or Atariyt tho (T. S. P., is derived from Aloe Prrryi, or 

At'^r. tvru. In the V . S. V. of 1S90 tbo first is oallod Socotrinc aloes 

Al<f Socotrina, U. S. and B. P.), Ihe Kccaiid Barbadocs aloiw {Aloe 

ttirhaiienaia, U. 8. and B. P.), Aloes is tlie iii.>;pi.ssated or dried 

juice of the Iwivcrt of the plant. U ia also probably d<Tived from 

Evera] otber Rpccit>s than ihoNe jost named. A1o(?ji eontnint* an active 

riticiplt; kiiowD as aloin {Al'^inumt V. S. iiiid B. P.), wliicb is a 

r^talline ^iibslancp. As aloin t» generally hoM it tA, however, an 

aiuorpliou;! powdt-r of cxtrrmrly bitter tat^tc. 

Pbjrsloloclcal Action. — Lm-ally applied to tbe t()n;^iie. alnfH in a 
bitter of rather a pcrsisteot laate. ActordiuK to the studies of Kuther- 
fi»rd, the driii; int-rvautes very considerably the flow uf bilo in the dog, 
but in Qiau it trannot in any ccnue be refiunlMl as a medicamrnt for the 
pniduL-tion uf an increased biliary flow. RiitlierfnnlH doKex given to 
Uie ito>: amounted to as iinich aa sixty {;;raiiii4, equal to three or four 
drachnu id man. In the lower animals and in man a1oe« acts very 
slowly, requiring many houn for its iiifliionce to be distinctly felt, un- 
IcM iW doite be luxii; in amount. Iim i^hicf inHtieiieu In un tbe lower 
b*iwel (Ki^. 4). Aa much aa four drachms of aloes have been injected 
inln the veins of a horse without indurini; pnrpalinn, probably heeaujie 
lur drachms were Dot enough to affect the bowelt«. Aloes bait been 
endermioally, and when so employed is said to atrt thoroughly. It 
eliminatei] in the milk of nuTfting women, and will cause purgation 
an infant put to the breiMt of a patient taking it. If the doties b« 
lite lar^e (10 to 20 grains), the passages will be watery; but if tho 
lore moderate (2 or 3 grains), the atnolii will be thick oud 




Tberapentics. — AIot'» should be used only when a Homewhat slow 



70 



DRUOS. 



stitniilant to poristftllic movemonr h desire*!, and nprer where tlie 
object uf the jibysicinn in to rcliL-vf ci^ugestioDe bv <Io|fletioQ through 
the inl«8tirie. It ih a favorite remedy in cases of guhaciUa or chronic 
C^HBtipatiottt but it is dititinctlj harmful if continiietl for any tength 
of time. aM it seem!) to proiliice aconv of the bowel. Oning to its bit- 
ter properties it acts oe a tonic to th« slotnikch. nnd is oftt^n givon with 
iron to prnniow ihn atisorplioii of ibis inclal by KtimuUting the liver 
and by prevonting any (!oiwti|ialion which might ba produced by tbo 
cbulybeuttf. 

When taken in a larpe enough dose to produce a copious passajrc, 
alncs nparlv iiKavft prndnces a feeling r>f weight and fulncK* in iho 
region of tte rectum after the evacuation, mid the writer hm seen 
severe rectal catarrh produi-ed in this way. If given alone it is very 
apt to ]>rodiice griping, and il ought always to be combined witn 
other drugit wUusc tendency ia tu prevent intestinal spasm. 



( 



Fi«.7. 



\^. 



—A 



\ 



u 



A,Cb\et eJJcr^l nt Blocab cscrclnni on Inircrbawclorralaa. 

In canes of lupmnrrhnitls occurring in persons sufiering from gm- 
eral inuttcular re1a.iat.iun and utouy. aloes is «aid li> do great goad, 
but ii» ii.sc under these cireuuistaueeH is by no meane universal or 
gcnenilly accepted a» correct. For weak, antemic pemons leading 
sedeulary livee it may be cmiibined with toDies to relieve tbe eoiiffi- 
fiation f)o often a pressing aympioin in these cases. In amenorrhira 
dependent tip«n aumv of the »texual sysK^ni. or »nH.^mia, or constipa- 
tion, it is thought to Lave a specific emmrnugogiic iiiHucnce. Locally 
applied in the form of the glyeerole of aloea, it has been cniplovod 
in the healing of oA/ or nciv Ji»»nreg of mun/UB mnnlritueify and pvcn 
in b^d-aoren. The glycerols of aloes is to be made by evaporating 
four to eight part6 of tincture of aloes and gradually adding thirty 
parts of glycerin. 

Oontxaindica'tionB. — CooBtipation occurring in plethoric persons 
sliould not be treated bj aloes, and it shduld not be used if any 



ALVM. 



71 



N 



irriutioD or catarrh of tlie intestine is present. PrecQftut womvR 
nhoald use aloes most citrefullv, lest abortion be procured, uad if 
hepatic eonge^tion or itiflatntDntion is pi-esont it ought ni>l to be used. 
Fever U said to contraindiciLtt: the use uf uloeti, as (htrs nhn rectftl 
catarrb- 

Administratioa. — Aloes i» gcneralW given in a pill, eoDibincd vith 
spices and belladonna. (Sev <Viiij^ti|iaiion. t'arl lA',) The dose sboiiM 
be abtmt 1 to •> j(raiii« (U.OG-U.S) oft n laxalivi-. atul ID graltiK (U.5) aa 
a purge. The Aloe Puri^^ata, V. A'. /*.. nbuuld alnava be iined. The 
nfticiaJ preparations niosi cominoiilr empEoved »re the pill of aloes 
yUulip A}"--». r. .V. and H. P.). 2 grains; (0.T3) ench of aloes and 

ip; the pil! of aloes and myrrb (Piful(t Alvct el Ntfrrhtf, U.S. 

d B. P.). 2 grainH (0.12) of «Lcb (.■utisutueut : the pill of aloi^» aitd 

mastich {Pilulir Alorn ft Mitsthheti-, L<. iS'.). 2 grainr^ (0.13) of aloes, 

r the "Lady Webster dinner pilli" the pill of aloeK and iron 

Pituiee Alota H Prrri, U. .V. and li. P.), I grain (O.Ofi) of aloes and 

frrain (D.rtfii of dried eiilpliate of iron ; and ilip pill of aloes and 
attafirtida {i'i/ufft- Ahru et A«af(eliiitr:, U. .S'. ntid ft. P.), containing 

grains (l).2*i) of aloes, iuiiif<et ida. ami «oap. The doRL- of all these 
ia unv or two pills. Aloes i:* aUo nlhcial as Ejitractum Alars Aijue- 
»Km. dose I to 2 grainii (0.01-0.12). The lifpiid prepaniiions are the 

! tincture (TVKWutrrt AIih-h. (.', S. aiid li. /*,), dose 1 to 2 tluidrachtua 
W.O-JS.O): the tincture of idoai and myrrh (TiiiMunt AlurK et 
Sff/rrfiT, r. .v.).' dose 1 to 2 fluidmcbms (4.(l-8.Li). The U. P. 
preparations, braides those given, are the Dfroefum Ahi-t Commidium, 
doae \ tu 2 ounces (lo.O-ISO.O); and the Kxtrar-tuvt Aloet BaroatleTUtUj 
the doM of whicb ia 2 to li grains (0.1-04.) 



ALUM. 



Alum [Alumai. U. S. and B. P.) is the sulphate of alutninutn and 

potariKium in the ^'. iV. P., but in tlie B. /'. bntli it and the sulphate 

of aluminum and ammoitittm rrvstalliaed from a wntory solution are 

ofRcial. At preHL-ut much of the aluui of commerce is made in thn manu' 

faclure of coal-pa8 for illuminating purposes, and it is therefore very 

eht!Bp. It «M-cur« in ihe fiirm of uilahodral crvataU. and ha^i an a^trin- 

geol taste and aeid reaction. Afier the cry»ial« are expfwed to the 

^^Bir for aome lime they become covered with a white coaling. 

^H PliTBiological Action. — When alum ix brought in contact with s 

^^nnaoous membruuv it produces whileniug. constriction, and puckering 

^Bpf the part, and applied to the skin thickens and toiighen.<i it by 

^Vneana of ita a.^iringcut actiim. In i-ither case- it decreases secrclior 

^■and caanes onuiraciinn of the local hIuud-vcsK<U and eapillariea. 

' Large auMiints given for any length of time aecm to increaee secre- 

ttloo. 

Poiaraliif. — Very large amounts arc ncceasary to pruduCC death. 
in much as tiro ounces vtill not kill a sickly dog. This is largely 
Ine U< tlic fact that the vomiting nnd |)urging rid the animal of the 
' Suin«linics called Elixir I'ropricCatis. 



72 



DRUGS. 



ilriift, foi- if vomiting is prevented death rapidly on»iie« from gnstro 
I'liloritie. It^jectcd iDto the bloiid. alum pnxlucCH cinbutisni snitj 
tliromlinNis. 

Thdr&peuUcs. — Alum i^ uhl-(1 ul |iri--wiil iu u iiuuibRr of ditK-iMif., 
cliti'll^v as :i local agipticalioii. In ciist* uf unlinarv »ore throat npplt> 
cations of a etrouj; eolutiou (20 grains U> lli« ounce of water — ^1.8—1 
80.0) oil a swab wifl be fuuiid very useful. It waulil be of imicb eervioe' 
in [his condition were it liot Umt it pve^eses a iici<tructivc aclion on tlioi 
teeth. In hirmorrhaffp^ wheti llie linking blood- vt-sspla i!:iii be din%tlv 
reached, aluiti is a, rfmnrkublc lu-iuostatic. aiding in the an-eet of the 
bleeding iu ihi'L* wav* — iiaiiiul}'. b_v coagulating the allmmin, by cob* 
stringing ihe parts, and by eryelfl.1 lining when ajipHed in large amouula 
on lint, and thereby afrnrdiTig a iiiirtai-e tvhirti is rough and aids coagu- 
lation. In hemorrhage after tooth-extraction ita application i« a rcnr 
'Useful treiitnieiii. Dl-wtilvHd in water or aU-uhol. 2 grains to lliv uuncc 
(l).l to -iO.O), it makes nn (■xceedinglv efficient ((.[^plication for eponging 
in nu/hc-n/rtafg or localized uti'eaf im/ of the feel in hamb). In htrmop- 
Uim a fine sprar of a BCrong solution of alutn, ^0 gruiiu) to (he ounce 
(1.5-SO.O), may he etnploycd. iho iicccwity of the spmy being made 
ycry fin« being constantly borne in minj. This method may also be 
rejiorted In in lirfiichorrhofa or climnic hrnvc/iilig wilh i-xccwive seere- 
tion, and in chroni-: catarrh 'if thf phariptx and larynx. In incrcurial 
pti/altftti the drug may be nsed on a .iwab. loathing the parts affected 
with au idiiui suhition is said to be- an etficii>nt remedy in <:hilf>iaint, and 
even for pruritux vulvi^. As a viiginal wjish for fxce8i*ivc leuforrheta, 
in ihe strength o^ from 10 lo 20 grains to the nuuee (M.6o-1.3 to 30.0) 
of sraler. alum is of value. Some nbservem cliiiin good residts from its 
use ill tiiphdiTi't and dmisiUith. \\i fi-Uirn}nr tvimiHitiv the altim-stiek 
may be deeply in^-rted into ihu (lepre^sed follicles or applied lo the 
ewollcn surface of the gland. In tnitromng Uf-nail with graniilationa 
a piece of iwisu-d ab-torbeni cnttun wmkcd in siroiig alum Koluliuu and 
inserted under the edge of the Tiiiil will in niMt infltances dr> a great 
deal toward a cure. Dried alum {^Alitmiii f-'j-Muratum. i'. S, and JS. 
7*.) is useful aa a droseiug for i>'<i" ulrrr« and sorfs, and haw been 
highly reciuiimendtnl as an anjili-^'aUi'ii "jr nwvlffn tjmnx *herc ihey 
press upon and override a tooth, panieiilai'ly at the bafk of the jaw. 
The poiitsibllity uf it? exercising an evil ellect on the teclh shnuld nut 
be forgotten -whCD this treatment is roBorted r«, 

Inierniilly. alum has been used in lUnln-tt/,, jjastrnlffta, and t/i/wii- 
tertf of an acute and chrouio typfl. In h/nl coUc it ttceina to be of 
value in conjunction with uiorpuine to allay the pain. At one time 
alum wan largelv employed in tm^iiihratumt croup in emetic dowe for 
the dislodging of the membrane and for the astringent effect exer- 
cised as it was i^waLlowed ntid expelled. 

The emetic dose of powdered alum in a heaping leiutponuful for ft' 
child or a tablespoonfiil for an nilult. 

Alum may be used a« an autidnte in acute tead-poJuomnff. OB it iA 
a soluble sulphate and also an cuietic. 

Olj/rrrinvm AlumhuH (1 to h) is official in the B. P„ aod ia uaed 
as a local astringent applicaliou. 



4 




AMUOStA. 



73 



AMBBB. 

iwfWuHfM \» Jerivod rniin a fii-iMil n-sin Tntind in Prussift iiiid 
neniia. ami is iis<^l in ibe form «f tlie oil {Olrum- .Suceini), wliicli 
U roUcilr. i|iiii(- iiTilanl. unci nblained by deslniciive distillatittn from 
tbr dc[K4iit9 narned. 

TberapeuticB. — Oil of Anibei- is one of tho best remedies for prr- 
tuarnr hi'-cowjh that we have It n very useful a« u e(iunt«r-irrit«tit 
OTcr r/icumaU'r Joinlu. nnd has becti used io attimia, whonpinff cotter/'. 
and hi/gft'ri'i wifh good refiilts. In tbe brvni-hittM of mfatitf, with 
ii<M-vi}u-< disturliuuce. oil vf nniber in iho pvofiorlion «f 1 to 3 |iari9 
■•f (iliv« oil «m.liod to tbe biu-k and front of ihw cbust is of servieo. 
In aduils ftuaerin^ fmni acuff I'lrt/ngitU with im oxtcQ^iuU of tho 
in Ha nun lit ion into tbe bi-nnoliinl tubes full diutes of sudiutn bromide 
)iiii-n iiitiTmiUy, wiili ttiii* [»ro|jortioii of ainbtr oil and oliv* oil 
rublifd imo clie nwk and dies:, are very useful. Tbe dose iulerniilly 
is ^ to 6 miaiuut (0.1-0.4) giveu ia eiuubioit. 



AMMONIA (NH.). 



^^m Ammonia in a gas of a vcrj acrid, burning t«5te and s«Qration, 
^Beapmhle of proilucing ilratb very nipidly. wben inbaleil, by rca-wn of 
^Vtbi? inflaiLuiiilir-n of tliL- uit-|Ki88a^L-*i nnd' tlio fjKWni of tbe glottis wbicb 
f ensue. It ■»' iiiado in large uiuonnis in ihe manufacture of coal-gas. 
^^ FliTsloIogical Action.— \Yben ammonia comes in coutavt with the 
^■liniuBH of the body it acta as a. mn^t powerful irritant, rauHing ik red- 
^dfninc of tbe parts, f-illowcd. if the exp-.'suro be Ions «iio"(|,'li. by 
I'irmi (leaili iiiirl alutigliin^. If it be iidiali-d iis a gii». it may produce 
rapid dciillt by «pa«ni or CoWma of llie gluttia. aint if a »lTitiijr siiluliou 
of it 14 itwuilowtrd. ihf &aiuc acrideni may occur. Af'l^r more nioderalo 
tnbalationfl severe broncbitjs or pulmoQary ffidema may devclup. 

Nkuvodb SysrKM. — If aimoouia be iujttied into thw blood of 
animaLi, vioknt convulsions at once ensue wbivb ai'c largely totonic 
in tT|i(- und deju'iid ujKin u spinitl action of the drug, sinrc thev are 
n-ii .^topped by ilivii^iou of the itpinal con), m tbey would be if the con- 
vulsive movenieni-* bad their orij^in in llic brain. The druj^ iu iiiodtT- 
ate amorinb) act.i a? a :i|>innl oxtiituni, ini^ri'uMiu;; retlcx action and all 
ibe eifldeuc«s of spinal aciiviiy. If applii-.! iJirectly to a nerve, either 
motor or sensory, it [wiralyzM it, but If ihe drug be in very weak sola- 
tioD. it seenu to incniusc its fuiiclional activity. 

ClR<."tx.\.TlON. — Upon the circulation ammoniii acts as a powerful 
but Heeting :<tiinulani, incrftisiiig tbe pnW^-rate. jiulse-furce, nnd arterial 
pra w n re. The eau^c of the incri^'a.svd puUc>-r»Ie depcmb^ upon fltimuht- 
Cran of tlie ocicclerator nerves uf tbu iiuurt nnd of the heart itHnlf, wliile 
the laereaM in force is due to Ihe saiue cauHt>, lor Kinder and Sniniibiiry 
Ciiund llic stmi^h of the ventricles iniich inprwwe-i. The rii-e of jirto- 
nal pres-iurt* i-ij due to iho iner^aitcd amount of blood pumped into the 
art«rie* by the aliniulBtc<^l heart, ami probably by a 8liniubint action on 
the vaso-motor ei>ntre. altbou^b it i.-* ataieil bywrac autboritie* thitttbis 
is Dut so. Aa the dru^ acta ns a BlJiuulani on tbe respiratory centre, 



74 



DRUGS. 



wKicb is verj n««r the vaaomolor oentr*, it [irohttblj incrcssoe the 
fiiiioti»ii!il RL-tivilj^ uf hotli. If hy inemit; itf intra t-eiioua irgvction 
tJiu aniuiniiia rcoclius thv heart in Urge nmouiit in concentrated 
fonn, thin arson ceases to bent at once^ owing to paralysis of iu 
miiACiiIar walls. ^ 

Thk Bi.odh. — Tq uifMloraw amounts tbe drug has no effect on the^ 
blooti, but vilit'ii iiiJHcU^d ill paimnoiis ipiaiitities it causes th« blood to 
fail Ui i&kv ii|) lilt- oxvf^L'ii, aecortl lug to Fcltst and Killer. 

Respiratiox. — The injection of aunionia in modoran- ({unntiticsfl 
into the bluod caUKeN an accclcraiion of ibo rale of rpapiratiou due to^ 
ft stimuUlion of the respiratory centre, tbo rcapinibory inoT«mrnM 
becouiiuji not onlj more full, but'inore rapid. If the drug i& iohalMl^ 



Fia.S. 






AmranitU HtlmnlnU*; J.ihn knralrrat'^r nnrrni; H. Ilif- lti.'iLrt'niiii«.-li! Ili*l£aii<l »ui|ulcJi«ni | 
(rulHi?-nU- Hii<l Kirve- tl tlliuuUtc* tbc luc-mutoi cvntrr (' >nil ihu nijiirutor} cvutr* if. 

In »tnni\ ainniintK or Bwallowed, the same action is seen iu a lew4 degree, 
the chiiii>;cs Iwib in breathinf^ and circulation being partW dm; under 
such ciH'uiusciinces to a reflex irritation Irun^mitted along the sonaoty 
nerves. 

Ki.iMlMATloK. — Amtuoula wLeu taken into the body is so extremely 
fleeting in its action that (be <|iieHti(m a5 to it» escape from tlie nyxtcm 
is of interest. If lar^ie iitnoiintii are taken, it is parllv given off by 
the brefilb, but more of it i» burnt uj) In the system, atiu. accordiag to 
Bence Jouett, cliuiinaled as nitric acid by tendon of its being oxidized 
in the bodr. Home tbiuk that it it iu part vxcrclcd as urea. 

Therapeutics. — Aumonia i» employed fur four distinct purpuHe^ in 
medicine — niniieiy. as a circulatory and rcBpiratory Htimulaiit, an a 
counior-irritant, and n» an antacid. 

Tlic indicittiittis for the u^e of ammnnia in the Hrst class of cases 
are all furms of sudden cardiac failure where there is no time or 
ujiportuniiy to use the more stable uod elowly-actiiig drugs. Tbcso 



I 
I 




AitMOXIAC 



75 



iprgenc!es oecnr in mahe-poigoniiu}. in njfncofif from frif;ht or other 

hi*cV or intligefllioii, in auail^n fardiar faihirt' dnring the courBe of 

fi'verf} anr] iu [ineuniouin. &Dd tu all cuscid vrhcrv iu\i\'\ cikniiiic stiin- 

ilation lA n(>«<led. It is cluiiutKl, without ^treat jiutiGtKtioii, that aiunio- 

will mtl iu prvvfiiliiig htari-cht or tlirninboaiA in caiies of severe 
iKriborrhage auil iu pueumoiiia. In ihc most preBStng caAee it shoald 

injectDiI directJy into the rein of (he leg, so us to net more quicliljr. 
ioto thi! nulicutajipoiu) tissues, it is almost certain to innke a 
and if injected iiiio u win of tht' arm. it mny mich tbe heart 
ID ton comrentrnled fiirm and causv eurdiac dp|>r(.>!^sit)ii, Kin^^er hu» 
foand that the drug hue the extraorditmry {nmer of cituning a heart 
«to]>|wd or ileprcMsed by chlontform to rRtiirii to its beAting. 

In prolonged diseases tbe emptoyment of amuioiiin i^ nut purl icularly 
advisable, owing to its fitgaeioiis action, idtliougli it tg tnrgely u^icd. for 
thefrequeul adiuiuitilrtUton ucctMwiiily re<|iiirr<l is apt li> produce gastric 
difordiT. Soiiif pfiMius claim that ainuiuiaa in useful an a eed&tive in 
ilrunkmneti. bul this le doubtful. 

In yattrie tuidity due to fennent»tion, witli the derelopment of 
abnormal acid», ammonia is the most active rctnoity nc con employ, but 
^ia not to be given if acute irritation of the stomach exislii. 

Locally applied, strong ammunia-walcr mny be tieed to produce a 

blister by placing a few dro[M nn the skin under an inverted wntch- 

glasti. Ammoiiia-water may aUn be applied, often with great relief, 

to the jt/w^ »tu»ij hif intectt. The wateri! of Aiiiiuoniti ai-o used exter- 

,iially in stimulating liniincnlii, and hypoderniiniUy when the drug is 

given. The stronger water might not to be employed for the latter 
poriMwe. The aromatic spirit i» generally used internally iii the dose 
iif \ drarhm to 1 drachm (2,0— (.0), well diluted. Thia is alao the 
•doije of the ordinary spirit. 

AdndnUtratioo. — Ammonia is never employeil in medictoc as pure 
smuioDia ga», but in the form of .the stronger water [Atfua Ammonia 
Fortior. V. S. : JJfpwr Ammonur Forth, H. P.), ronlnining 2H per 
©cut, bywoightoflhegas, and the weaker water{.4}wa^Hj»io»iVe, r.S.; 
Lii/iior Amtnonitr, B. PX which should cuniuin about 10 per cent, 
by weight <>f the gaa. The spirit of ammonia {Sfiritun Ammoni<r, 
C. S.) in given in the dose of 30 tn tjO minims (2.0-4.0) iu water, 
and the aromatic spirit of ammonia {Spirittu AiniuonuP Aritmaliru», 
U. S. and /*. P.) in the do»e of 80 to tfO minima (2.0-4.0) in water. 
The Utter preparation is composed of carbonate of ammouiuiu. the 
oil* uf nutmeg. Icuion. and lavender, with nlcohnl and nmmonia-water. 
Spiriru* Amtnoiiiif Fftidus {B. P.) contains iL*iit'(Etidii and is u»ed in 
place of the aromatic Npirit. Ammonia liuimi-iit (Linlmentum Am- 
moiutf, i'. S. and B, P.) is used over tender joinu and muscles. 



AMMONIAC. 



Ammouiac (Ammoniavum, U. H. and B. P.) is a resinous gum 
ohtaiocd frotu iMrettui Ammoniaeum, and ia uaed very little in medi- 
cine at ihe present time. Internally ami externally it produces some 
trriutiou when brought in contact with the tiiwues, ajid may he uwjd 



76 DRua& 

mternnlly in the doeo of 10 to 30 grains (O.B5~2.0) in pills in 
of ehranie ftrunrhki* devoid iif ti\xy aciivf iiilliLunuatorv' prucu». ., 
is otBciBl in llii? form of tlie iilaster i)f amiiioaiuc; ami mercury (AVa- 
ptaxtruiH Amnumiiiri mm iifidriifffjfro, V. S. anil H. /*.)■ whicb iB 
used lu* n stimulant over onlarpetl plands. Finally, tlieiv to iJie einul- 
eion of nitituitnlac (£mu/«Mrit Amnwniai'i^ U. S., »nd Alii^Hia Ammo- 
iiififi, B. P). used in chronic broncLliis in the dose of a tnhlc^noon- 
fiil (lO.O). 

AMMONIUM (NH.). 

The fiillowing salts i>r aniuicmium are official, and are uaed for 
varifiws pur^xwes: 

Aoetate of Ammonium. 

Acetaltf of Ammonium ia UBed in medicine in the form of Ihe 
spirit of Mindererua (^Liifuor Ammomi Arctati*, IT. S. and R. P.y, 
dose 1 to 2 fluidraulims (4.0-8.0), for the pur|M»e of acting as ao 
antacitl in yatttrir ituiigegfion. and al»o as a mild dinpliorciic wliich is 
mfcrior Iw sWL-ct spirit of nitre. 

Benaoate of ArmnoDium. 

Benzoatc of Animoninni {Aimitunit litinoaii. IT. .9. and B. P.) is 

euipluveJ chiefly for its diuretic itiflnejiws, ivliifli depend entirely 

llipoD the benzoic ai-id present in the comiioiind. It should be kcpl 

'in well-slnppored bottles. As benzoic acid is eliminftted as hip[>aric 

acid and ainninnia wt nitric acid, rhiifi drug may he employed in eniies 

where the physician de.iirca to make the urine deciileilly acid: as. for 

example, in |>Btient8 siifferin;; fn)in catarrh of the hla,iiifr, when the 

nrino ia loaded nith p}ii»iphiitL's. Mhirh ikro diR'icd^'r'd bs- t)ii.i aeiiLulatioQ. 

^^XIio doM is IM ty 30 gi-uiiis (O.S-li.O), which should he dissolved in 

rater ot, better, administered in cucbets or eapsides. 

Bromide of Ammonium. 

Bnmiide of Ammonium (AiHmtinU BramuUtm, U. 8. aad B. P.) h 
really a cry!*tidline e&ll, hut i« geuendlv found in commerce as a nhile 
granular powder, whirh. when exponed I<> the aInio»phere, becomes 
elishtlv vtlt'-vvish. U 1^ readily dissolved in water. 

Physiological Action. — .\pplied to the mucous membrane of the 

mouth, the bromide of ammonium produces a salty tartlo. is markcdlv 

piinjient. and diaaolves readily in the oral secretions. If l-irge arnonnta 

are anallowed, it causes burning pain iu ihe belly and evidences of 

.gaslro^nterilia 

Nbrvoi's System.— The action of this drug upon this part of th« 
body is its most iuipurtant effect. Given to the lower aiiiuiali'. it pro- 
duces in froga total loss of rcllex activity, preceded, it in said, in some 
ca»e« by tetanic coDvulsions. although no auch motor disturbances may 
take place. Iu a series of studiet) undertaken by the writer to detci^ 



I 



1 
1 



nei^ M 



AKMOSWM. 



77 



ine the «xact e1fM>t of ihc drug it wss found thsl the spiDiil cord van 

ireeeed. bulli on IIk tiioUir unit ecnsorj xidcs, vrliilc the iutvob and 

iusvlvH tncapvd. TlivMe reHulis are iu aceord with iboso of other 

ivestijialore, who also found that the nerves are unaffected. Oa tho 

Brcbra] cortex it aci* iw a vcrr distinct wcdative. 

ClKCULATluN. — Uiiou ihc circuhktion bromide of ajnmonitim acts 

M a stimulaDt in small doses, but us a cardiac paralvKant if a large 

iiitmt corners ill contact with the- heart. In medicinal dnec it U 

lUiinctlir xtimutant to the circiilation. hut not Kufficieti il^' so lo render 

Tttlutthle as n cimilntorj Blimulant. tn iht- exclusion of other more 

iwerful preparations. 

TlierapenticB. — The bromide of ammonium may he uKrd in nearly 
rory inHiani'^ where hroinide of |)ntne«inin maj he employed, and 
p oa aea a ew the distinct advantagi- of hviti^ (cms dcpre^-oanl to th<- Kcn- 
ral «y*1em than the latier druj^. It is, however, more apt- to disoHer 
lie stomach even if given in moderate dn8e><. In rpitrfigtf it would 
i«m to W of an much vahie na the pninssium Halt, and may be eoni- 
^ucd with it ju ^oinc ko^w with :<ui.-c(:8t«. (See article on Epilepsy, 
irt IV.) According lo DaConta, the drug is of very distinct value 
(D rhrit'i'ittmn in tlie dose of HO In SO grain« (4.0-5.3) a day, well 
diluted uiih water, nlihoimh iti: manner of action in ihi^ di»ensc is 
" i.t known. Thtr ii!.i.al dow i(* 10 to 80 grains (0.65-2.0). It is 
vmpatible with spirit of nitrous ether. 

Carbonate of Ammonium. 

Carbnnslo of Ammonidm (Amnnmii ('arhonm, V. S. and H. /'.) 

ihnibu-tlly has ail action exactly like that ofihe Hqniil prepapatiiin-i 
ammi>nia. and la used either alune or with the chloride in iho 
ratmeni of l.ri-nfhitit, pariicnlarly when this dt»oai)e occurs in halncs 
id younj; children. Il is alao largely (;in|il«yed hy surgeoim in the 
Patment of children after a surgical openiliou to (iverconie the 
jiirntory and circulatory deprr-cHii'n produced by the ani^tithetic. 
dnee is 2 to 10 grains (0.1-0.6.'i) in syrup of acacia and water. 
Tt IB a rapidly -acting cardiac and renjiiratovy Htlniulanl. 



B. Ammonit mrlNMUt. Kr. xtrii] (3.0). 

Srru|t. nouin' . f^j <30.(tj. 

Aqr 



'«li«t. o. (.fcdftiij iSOO'i.— M. 

S^T«u|a>anful (4.0) every two liouni for a I'liild of nim; or four yuiiw. 

Chloride of Ammonium. 

The Chloride or Mnriate'of Ammonium (Ammonii Ckloriduvu U.S. 

id B. P.) ha.1 an entirely ititferent action and therapentic use from 

the rest of lhi.t group. Il p<>»»csse@ almost no iuHuence over the heart 

d r^jiiraiion. but doi-d eserfit^e a very i^tiniiihtnt effect on mucous 

Itmbrancs, increasing the secretion of mucus. The consideration of 

nue in dijwiwe« of the longs can he found in the arliclea on I*uun- 

miA and Broncbitid. Obloridc-of-ammonium fumes can bo obtained 

tim n few grains of the drug healed in an imn spoon over a gax-jct 

bv means of a set of thrco wosh-boulesj. In one of these is placed 





n W^^M DRVas. 

Htnmger water of &mniODi&, in tlie other muriatic &cid. B&ch of these 
is onneoted with % third bottle by meann of glai^ tubiD^. tbis bottle 
being partly filled with water, through which the fumeu in paBsing 
become purified and form the fumea of chloride of ammoniam. The 
drag mij kIsci be u.ted in a npniy from us atomiser. WIi«re it is 
desirable to mnintain the cft'ecCof the drug over ft long period of time, 
as in '•hronic bronchids, the following methwJ muy be followed, as 
ret'om in ended by M«w : A soup-plate ia plared upon tlie floor of the 
room, and fi-om 3 to 4 ouncr8(90-0-120.0)of sulphuric acid are placed 
in it, lnt'» a neighborin;]; saucer are pourod 2 ounces (60.0) of strong 
arninonia, and then about a tabkapoonful (15.0) of ordinary lablo- 
salt is gprinklod upon the ft(^id. In le.'ui than a minute the room 
becomes filled with denau funics of uaaccut chloride of animotiium, 
wliich can be readily luaintaiiied by renewed oliarging of liu' soup- 
place and saucer. In thin wuy the patient may be mudc to inhaJe 
chloride of Hmmonium fumes for a long period of time with very ad- 
vantngoous rosulis. Tliia is a parlivularly useful method in casee of 
feet id broiichittJi. 

Jhloride of ammnninm has !ie«n employed in intermitfeni frrrr, 
', htLf gone out of u<<e, and ha-t al^^o been used in vmralgian of th« 
ovarian type by Goodell and wthei-a. hi the treattuent of cfironie 
torpor of the liver and tuhamfi' fippiitUif. and even in cirrhotit and 
hepcUic ahacttn, it bus been thought of value. Many ctinicinnH have 
found it useful in the trealnioiil of llio gnatrie and i/iieatinat ratarrht 
of children of a very enhacutc type, and it is the louliiio treatniont 
fur all such eases whicti come under o!i»er%'fttion «i the hospital and 
elsewhere where the author hari charge. The dose ia 2 to If) grains 
(0.1-1.0), preferably given with liquorioe and water to mask the taste: 

}Sl. — Ammruiii chlorkli Sy (S.O). 

Fitrnrt. BJvryrtliia fl fT| (30.0). 

Aqnup (1ml <^. « ad (jilj (M.O).— M. 

8. — Teiu|KHJnful (4.0) L d. afWrroeBtn for acliilil of live lo ten jtmtk 

The chloride of ammonium may, howcTer, be given in compressed 
tablets provided a large draught of water or milk is taken simutta-' 
ncoiislv to protect the stomach. (See article on Bronchitis fot' other 
[iresc-npliomi.) 

(lillcspie asfierla that 10 grains (0.6.5) of chloride of ammonium 
given half an hour before meals gives pxtniordinarj relief in painful 
dgapeotia due to hyperacidity of the etoraaeh. 

Chloride of ammonium, in a lotion in the strength of! ounce (30.0) 
to 2 qiinris (2 litres) of water, ia an effieieut remedy for the derma- 
titix caused by jioison-ivy. 



Iodide of Ainmonitun. 

Iodide of Ammonium {Ammonii fodtdum, U. 8.) should be kept] 
ia dark, well-stoppered boltlps, and if deeply colored should not bo 
dispensed. It may be employed in the doiw of 2 to 5 grains (0.1-0. S) 
ia all cases where ifac iodide <>f pucassium is indicated, and seems 



Auri. yrrRrTE. 



7d 



I 



■h^rallve inflnences equal to thow* of that «ilt. It has been 
iiipn<le<i hR R loral nppliwition in cases uf enlarifcd totuUn in the 
TBI of a iwluti.>n of 30 gmhw (2.0) of the salt to [he huiipp (30.0) 
t glyceriiL pHriiculHrlv if struma is the cause of the ^-iiUrKftiiftit. 
.he applicaciuu ia U> hv iiniiJe oare a ilav with n swiib or euiiiel'ti- 
a.ir brash. It is nw!fssarv that thin Bolulion be uul exposed to the 
air or it will undergo ilecoQ) posit! on. 



Valerianate of ATTtm n Tiiiiyn i 



Valerifttiate of Amnioniiim (Ammnnii Vtilerianas. IT. 8.) i» the 

■alt of amniotiium cominonlv ttaod in the nerfous unrfnt of pregniiDt 

or bjTBteric'ul women, or lU the mrinif>aunc in the prnuliar m-rvoiis rlis- 

orders apt to oceur at that peI^utI. In poiaoHuuft dni**-.i it paralyzes 

I tbe spinal cord in the lower animals. It in Dsnally giveu in the forrn 

^_.of the elixir of rslerianate nf iimmoniiini. the dnec of nliich is n leo- 

^Mpoonful ui a deasertspuouful. ur it is cotahiucd with the bromides, 

^pvoder which eireumstancea it is niiich more efficacious. The doae of 

■ tlie salt ttm-ir is 10 to Vt graias (D.tiiVl.O). 

^V The sulphate of animoniiim is never used in medicine. The phoB> 
nliaie nf Rmmoniiini in employed in rheuinnli^in in tbo Aom of 10 to 
30 firaios (U.t>&-1.3). It is no Innjtcr oRicinl. 

The B. P. preparationH besides thojie already given are : Oralate 
of Amntonium^ Liquor Ammimn Citrat!*, duae •! to 6 fluiilruchiDS 



M 



AMYL NITRrrEI. 



I 



Amyl Nitrile (Ami/l JW/r/ji. U. S. and /I. P,) is a very volatile. 
Homewhal oily Ii<|ui(1 [rosstssin^ a peculiar penetrating pfttr-l i Ijh odor. 
ll IB made hr the action nf nitric rind nitroiis aciiU upon amylic nio 
hul. and ii not to he confoiimted with nitrate of amy), which has a 
different pbvKiological action and is never used medicinully. 

Nitrite of amyl should he proiecled from light, hesit, and fire. 

Pliyaiological Action.— When awullowrd or inhnled the diuj; pro- 
duce« staggering, fulness iti the head, roaring in tli« pars, 'dnskinefts 
of the face, ana finally utter muscular rcla^atiim, so itiin the animal 
or man falls to the ground. The heart beats very rapidly and forcibly, 
aad the respiration becomes gaspitig. 

NKRvors Systh.m. — Nitrite of amy] acw as the most rapid of all 
the nervous depressants and urdauveA known, except pmsetic acid. 
ExpertmfUis show that iu dnniinani action in on the motor side of 
the spin.-il cord. The motor cortex of the brain uu<I the motor nerves 
are only affected hy large amounti;. Upon the nervous apparatiiii of 
seasacion nitrite of aoayl baa no effect in medicinal amouotH, and can 
lever be used to relieve pain unless it he doe to spasni or tc angina 

I'lhs. The muscles are depressed by toxic aw^unt. 

CiRCCLATlDN. — ^Vhen nitrite of amy] is niie<l the pulse beeomcs 



80 



DRUGS. 



Fm.9. 



-'' 



S' 



NllrtU or tmrt ti^ 
PI4UMW tbf Rininr 
or i-riiMnl prraiii- 



exceediiiRly riipid. wliile the arterial twisioD progressirelj Alls. The 
iacresse in ptilac-ry-to is liuc to depresiiion of ino centric inhibitory 
appuraius (v-agus centres) of the Lean and to the 
sudiicn rchixstiou of the Ulood-vessels, by reason 
of nhich. the resistani^c being tukru uttit. the heart 
bcnlEi fnster. The fall of urtcnul pressure in due to 
df[irc5sion i>f llie Ta,ioniotr»r centres and ibe mus- 
ciilnr cont* «>t' the blood- veBBelst. In vorir smsill 
ninuunitt the drug Htimiilstcs the lieu rt- muscle 
(Keiehert), hut iu dominant aetion ia (hat of a 
(Ic'prcANint. 

The Bi.iiiin, — In medicinal dose iLis drug pro- 
duces a rhociilatc color of the nrleiiid blood, due to 
the change of oxvliirnuiglobin into iiielhiciDoglobin,, 
IJni.VK AXiJ 'Ei-imikatiox. — The urine some- 
times containK sii;tar after the use of ilu- uiirite of 
amyl. ami there is iiirnasod diure.'-is. The driig is 
eliminated very rapirily from the boily by the lurigs 
and kidneys. 

T^^Wl■EItATrlu■:. — If the niirtie of umyl be em- 
ploynl for any leiijrth of time, a most rcm&rkable 
fall in brMlity tempemture ensues, wlueh Is probalily 
due to diminished osidiklioii. but pns^ibly to soiue 
effeet oil the lieiil-<'entre'8 fruverninj; liear.prodiieiiou 
The vik-iciiliir ililatiition also tends to greatly aid in 
the fall of bodily beat proilric-pd hy the drug. 

Therapeutics. — Nitrite of aiuyl is used to rrlaj: grnrral er local 
iHUHful'ir iipttfmn, for the relawl.ioti of the sjhwui of r/tHepgi/ and for 
aborting art vn-iomiiiii lit, for the previMitiim 11111.I Mibjufjutiou <>{ jitn/e/i- 
nine *-oh(ti /«('"«» und t'-Unnm. iiiid fur llie lelief of iimjitin jiffturit, 
provided llie atlack i^ nccoiiijiutiii'd by liigli arterial tension. It may 
be used in f/imrperal lu-him/tsiii, but it is a dangvrguH remedy, hecau.'ie 
of its reluxution nf the utcnu) and the uoiiticfjuciit danger of |HKst- 
purtiim huraorrhage. In iti/xmiii'trrhtva with uterine »pasni it often 
gives great relief. NiCiile nf jiiuyl hits been used In cases of nca-airk- 
nuSM as a prnjihyliierie and enre with eousidenible siict^ess. In /•iiiiiutc 
J'niiiire from frifjht or aEia'slbi^lie.-^ umyl nitrite is often of great vnliie 
in single wbiflV. If it dooit not uet ul once under these cinniiii»>lane8, 
it y worse than ukcIcsh to punh it. It hnfl also hicn found of volufi 
in ii'iiiiopini/ foiufh. htrtfi\'ji»iini» ulriilirJuH^ tmthma. Bpiixmudic croup, 
and in/nntrir ronru/twnt. In mii/rninc with local vasomotor F^pa^im 
and true heininnopsia it is very useful. Tii iitrtjrlinhn- pnijuinhti/ and 
Irtttnit/i il mriMt be used helwi-iii ibe fl[ni«iii» or flse giviii hypuderuiio- 
ally. as the respiratory eruiup pre»eiil« iln iubalatioii. 

Adnii&istratioo. — '1 he drug may be given by plai-ing three to five 
dropK on a luuidlcprrhief and inb:iling the fumes, or it may be dropped 
uo Htigar ami tahea by the mouth in the t^iiuv quanlily. 

Il is imponniit to renioinber the fact tlmt the effects of ibo drug 
are wore severe for 11 ui<iiiK-ul after its use tliau during its iiihalatinu. 
Tb« [ihyaicinn xhould warn the [>atit>nt that the effect nf the drug 



k. 



AA'TJMOiVr. 



81 



fludd«D «nil atarmin?, and in nervous cases ithouIJ <llri>ct that (lie 
ihalulinn-i be maili) gently. n« a wry tuli inliiLiiitioii may produce 
~t{ileit8Atir seD^aCioui* of ciinliiw: failiin-. * 

Tilt* hrsx way fur (mIkmkh trj imo ibf> ilrtig i>i t(i Imv? it in pearU 
glaiw. eiicL liol'liug -i iniiiiins (lt,I,'»). One or mure uf llieac muv 
ciii.«bpii in rlie lniiiiikt.MTliier itnd the fiimeii inhalod. Souiu of tli« 
*arls raaelu by CAi'cIffis iiiMUiir»i.'Currr6 are uf aiivh ilijck. ulrung gliLW 
'lai tbc%- are diOicult to brfiik, uiid if h|-okeu arc apt to cut thv tin- 
era. These are, of course, to hv avoided. 

ANTHBAHOBIN. 

A&thrarobin, which was ui-i^iuully discovered by Liebcrmann, 

to |)088e»ii^ e<{ual \a1ui* vilib its ri>lulive chrvHarobin. ami tn be 

kpablc of actin;: am ctScaciouiily as ibis eubstancc in tbv tr«aliuenl 

iikin diMiiAL'H. It ]» a Vfllovriiili powder, T<jlerably siublu in a itrv 

|[ii<)?plit-r«, ti<>l tinliibjt; ID acida or Muti-r. but rcatiiEv i<<>ltibli- in dilute 

Ikalioi' 8>diiii<>ii or alcobol, at lirst iiiakiuj; a suiulion uf a brown 

:ilor. which, ns oxygen is taken up, pimseit to a greeti and finally to 

violet. 

TherapcnticAlly, aDthrarobin ba« been employed bv Roscnthnl and 

by Behrend. and iiioro ri-ii-iitly Kubner ban rot-ordeu his experionce 

ith it. employing it wilb ^imd rcftiihi^ in a 10 lo liU pot- cf-nt. solu- 

idU iu the variodiii forma of tonMurmin tm a WHsb. Kosi^nibal biiK used 

u psvriatis and pityriuiaa tenkulor and fierpen. and licbrend asscrta 

bat It i« often better iu its ©fftfPl* upon the sKin than chrysarobin, a« 

Inecs lci» iiittanimation and only rliricoh>r>« ibeskin fltightly. It 

Rpoasesttejt the additional value of making kci «ltglit a »taiu on the 

net) that it can be removed by washing. 

Aet'ording to nio^t mi[)ioriiie«. it i» best to keep the drug tn alco* 

kolic solutini). ami, if tbc bottle is well corkc-1, such a iuixlur« 

roiains good for a week. 



ANTIMONY. 

Antimony it.ielf is rarely used in nii-diciur. owing to its in^^oliibil- 

jtr, but is generally employed tis the tarlrate of antimony and )>otas> 

inOL, or Tartar Emetic (^Antim'jin'i et J^iifati»ii Tiirtras^ U. A'. ; Anti' 

TtHwi Turinrtiliim, H. P.), or in iho form of the sulphide (AHti- 

uu/V tSalpfiiiium. if. A'.); purified si)l[>bidu (Aatiiiwiiii Suffhidum 

Purifit^iilum. I'. S. : Anttmouiam J'n'ii/rnm J'tiriti^atuut. fi. f'.); and 

tiilphumied anlimony {AritiiiiiniiutH S'li^pJuirufuiu. I'. A', ami H. P.), 

u-tiines called K'-rw>t Mhi-fif. Tlie iai>t three drugs are %-ery 

irvly employcfL and are unreliable [iri'pnraliuus. alibougli some prac- 

lirionera use'kernie-.4 minei-al ati an alierstive circulatory dcprcesnnt 

id wnlrttive expi-etorant in ihe dose of I grain (0,01) every hour <»r 

•i>, A» an PHielic the diwe of Kernu't Jlintnit is 1 to 4 grains (D.OS— 

L8>. 

The oxide of nuliuiony (^AtitinioHii Ositlum, U. S. uud B. J'-) 
Tua part of the Pulria Antimvnialiii. 



82 



DRVOS. 



Tartar Emetic. 

Tartar Emetic (Antimonii et Poiasm Tartreu, If. S. ; Antimonium 
Tartaratum, B. P.) ia made by boiling the oxide of antimony with 
bitartrate of potasBium and water. Almoagh it is really crystalline, 
it is generally sold as a fine powder, owing to these crystals being 
easily pulverized. It is insoluble in absolute alcohol, but is soluble 
in ordinary water, and still more so in boiling water. In dilute alco- 
hol it is partly soluble. 

Fio.ia 




J, AnllinoDT deprenea the henrt-muac^le : B.anttmonjdepTeueB theperlphenl portlona of the 
Tssomotor iyscein In the blood-TeBHelc : C°tli'>oni' depreueB the vasomolcir centre; D, 
the leiplratory centre. 

Owing to its chemical constitution tartar emetic should never be 
given with either acids or alkalies, and all drugs containing tannic 
acid are also incompatible with it, owing to the fact that an insoluble 
tannate ia rapidly formed, which ia absorbed very slowly if at all. 
So complete ia the insolubility of the compound so formed that tan- 
nic acid is the best antidote to the drug that we possess. 

Fhrsiological Action. — Tartar emetic, when applied to mucous 
membranes, produces a burning sensation, and upon the skin it may 



AKTlMOaY. 



83 



rlbrce. 



I 



readily cnug« n 1arf>« nmniint of irritalkin if the part be di^liciile. If 
ko|H in cou(«cl with a nrncoua membrane, rerv distinct inflammatory 
occur, anrl if it b« applieil lo the skin fur any letigib of lime, 
.058, followed by ncno of a pustular cliiiract«r, appeare, which 
jfitnllf eii<U in ulceration mid ^lou^Liiiu; if the use of the drug '\*, per- 
sisted ID. L'tidcr thes« circntDstanccs the vilality of the parl£ ecetni 
!ilii4>rferpd with, and, a» a result, hesiling lakes place very »Iu»1y iiidved. 
. Kbbvocs Svstbm. — ADiimony is a dcpreswant to tho sensory «idc 
the spiual cuni and a [mralyxaut l<> all the »piiial I'L'titre:^. motor 
and sensory, in poiK^nous doB«. 

It ].« Btaifd that when an animal in under itx influence ncnHation 1o 
beat and &cid» is lost before the ordinary sonae of touch is deetroyed. 
The roQvul-iiong which Bometiinc* eo^iic after poisonous doses in th« 
lower animals are due to anivtnia of the bruin brought on by the cir- 
ciJatory dcprcjwiinn. Ringer and Mnrndl have prori-d antimony to 
be a motor-nerve and muBcIe poison. 

ClRCCLATiox. — The chief influence of antimony is exerted upon 
the circulation. In snanll dones it lower? the pulse-rate by a direct 
pression of the heart-muscle, and simultaueuusly decreases arterial 
tension by an action upon the peripheral portions of the x-asomotor 
system in tliu wallN of the hlood-vcxisels. but the vai«ninnt<ir intiucncefl 
maT be in part centric, and this <|Ue!«ci<>n must be considered hb mil 
iuaict!. The fall of arterial pre8»urc ia also due to failure of heart* 
With thfl Inwerinj; of the pul«e-rate there i» nearly alwa.ys a 
ponding decremx; in curdiac pnwer. 
When poisonous doses are employed, death onaues after great eii^ 
culatiirv and respiratory depretniioii. aa witi hv Mceii below. The heart 
is found aflvr lieath reluied and fliibby and utierlv dciiil to nil eltniuU, 
although in one of the lower nniirials. suih as ihi- fnig. if the dnsc has 
not been rery escessive and digital):^ ia freely employed, the heart may 
be made to beat a^^uin. In man, it is hardly necessary to »tale, the dig< 
italts mn«l be used early to render much service. The drug in {wison- 
ons do«c« is thought to depree^ the peripheral ends of the vagus nerves. 
Rk^pihation. — The drug has little or no effect tipon reepimtion 
except when given in Irthal dose-i. I'nder these circumBlances death 
is produced in three ways, all of them acting together. Priiuarily. 
the rt^piratory centre in the medulla is depressed, and the governing 
nerves of breathing, the piieumogasirics, are also rendered inactive; 
ieci>udBrily. the cardiac failure reailily causes pulmoiiitry cuDgevtion ; 
aiid. thirdly, the drug caustes such an outpouring »i liquid mucus into 
,liie bronchial tubes that the patient is drowned in hia own accretions, 
bich be is too weJik to expel 
Stomacii .\sd Ixtb?tise.^. — Antimony in toxic d«ees is a powcr- 
fal irritant U* these portions of lht> body. In full medicinal amounts 
it acts as ft slow but powerful emetic, producing much natitica. The 
Tomiiing is due to an aoiion on ibe vomiting centre in ilie nii>dulla 
Uid to u direct action on the stomavh itself. The drug '\i, therefore, 
a e^-ntric and iHiripberal emetic. 

Vcrv full awes prodace watery purging, attended with some grip- 
g anJ tenesmus. 




S4 ^W ^^^JOS. 

Ei.rMiRATiOX. — Anlimony escapes from the body in »1I the sccre- 
tirjtis. hiu l.ii'i^el}' bv the bowels. 7'l)c latter mrihoil <ir eliinitiBtioti He«tuK 
cliicfly 10 i'<'\lovi tHAaotmus ilosus, inti jiurgiug m uu vflbrt at ulimiaatioQ. 

Foisonlae. — wbtfn Uixic dmw of turlnr umellc are tak«u, ibe pul&e 
at fimt becotiipti Hli<i;lil]y wciLkci' niii] ttlowcr, llic skin h<>cnnir« niiiifit and 
rclnxpi]. n gf'iiom) Heiise nf rnlaxatlon eomett on. and simultaneously a 
Kt-iBKiLl Um of CL-vei-c iiiiiiaea mid f^RtilriD di!4lre:<9 appears. 

Fol1i)win<; tliiit (;otidirioii tinK-ut voiiiiiiii^ n^stTts itself. The 
ejuctfrd. niHSB ocmMiel!* <jf tl« crmtciits of ibo Mruimcli — mucus, bile, and 
watory lltiiiLi. and perhaps Idiiud. Piirgln}^ appears almatt »n varlii* 
us the voniitin):, and canaifts Urst of ibc Qortiial contents of the intes- 
tines, ihen mucus, then bate, and, very rarely, hlood. These signs 

FuklL 




•1, AnUaonj »UiiiuI>l«» tlio vomlUtiK centre : It. aDttmonr Irrltftloa th* ({wirlo n*«co«i 

mt-iDtiiauc. 

may rapidly pa.vi away and the iTharactcmtic peculiar " rirc-walcr " 
stnolii' (if anlimnnial pnisiming apptvir. Th« general condition of 
the patient is now most serious. The fare is pinched, livid, RJid cov- 
ered with n cftld sweat. The puUe i» mpid nnd shwltlc-like — to and 
fro — or lost at ihe wrist ; the urtt-riiil tcusiioi in ulmust nil. The res- 
pirutiond are fuint und ilultennj;. ntid mt «Ua]U)w a»> hardly to he wea 
or hrunl. (Iranips in the calves of the legs attack the patient, due 
to the ahstraetion of waler from the lisHues by the violent purging, 
and the leniperuture fnlN loner iiud lower us death approaches. The 
general ronditiuu \s iiuch that all the signu imiui to Ai^ialic cholera, 
anil untimoniul pi>ismiing cannot he separated frnm this di?r&«e dnrin 
ati epidemic wilhoiil a history of the case or a ebeiuieiil analysis o 
tliB ficcrelions, irbich ought alnaya to be preservefl.' 

' A "riw-mtflr" nnot is ono trliioli, on «tanding in a ^Itus, se|inratee into two \aj- 
■M, till! lower H'liilc anil t1tHViil«ii[, llie uiijn'r «'u.lLTy uni) uloi'xl I'ioiir, 

' Tliih i> u i^xhI iimxirionitv In oinir lliut ilii- Ms-ri-tioix tiiiil <>xrr-iti)iifi <if n penon 
ilying of any iminon ib.iiilil be iilmiil in a rlirmiriill,V-clcnii jnr cajinlilc of beinH ?*4lcd 
i>i;til. Thv wuiic rule of clritiillm-i4t ;i|ipIiiT< t" ilii- jiirb li<>Mini; •Ti'iin'' iti liir \»xtt- 
tu"ri<-m. The jaw sli^uld Ik n-miv, anil n" inU'i'iDiiiialv vcew:! uncd. They Bbould 
k wmIwI ai once, and kept m until clutnivil by tbv nutlioritiaf. 



AUTtMoar, 



SA 




Tbe irealinc-nt r>f aniinioninl |ini»'>ning cnnfliiitii in tlie internal biI- 
mioiiit ration tif lar;^e ariiuiinr^of tannic »cid, in tlic tise of the stumadi* 
I pump, ami in ihe msiriienunpi? of an aliaolmelv pmne itosiiion. Tlie 
^aUent ttlinuld vomit iiitu lnwvls nn<l not riLiM* ihf licatl fruiii tlii; 
ini] ; rhc head, indotnl, should generally bo platted hiwer ihiiii (lie 
External heut, alcohol, and di^ilalia should b« uitcd thotv 
,~.i;'hlT, and opiimi should W employed liypudoniiicallv to allay paiii 
ftnd irritntioD. unless the rc«ipimtions arc too foclle. If thi' upiuni 19 
greatly needt-d bociiuM* of pain, and ytst si^eins con train di(rated htxause 
of d«|)reMiou, it should be accompanied by strychnine to stimulate the 

trespimtory centre and overcome any depression pro<lii<red by the opium. 
yatty def:encralion of all organs tuny occur alter acutv uutimouial 
poisoning. 
Th«np«ntlC8. — Tartar emetic is employed for at least five separate 
pnrpfK^eH. the inoi^t lumal of wliieli i:^ an a i-irrulntuni tyteiWcr and teda- 
lirf. The indication!! for antimony as 11 eirciilalory depressant are not 
8*1 generally reeogiiiKed al prettent us iht-y were ut one lime, on account 
of the introduction of (ith«r drugs, SuIGl-c it to stale that all siatoH of 
tthenit^ infiammtttion with a bounding piil.se. high fever, and nvrnptoma 
showing the patient to be posMWh-ed of robanl eonHtiiiilion permit of its 
uoe. while all astlienic conditions most emphatiralty cnutraiudieate 
iu employment. In rlie treatment vX eoUh, in Un-nV forming dvufnaea, 
and lit allay iujia mmtilioti it is given in moderattt iIokc. It in iinefril 
in alhenic brimehitis aa an expeetorant. I'nder ihcuo eirriiinstj»nep.i 
il may be given in emetic doae: or. if emesis is not desiriible, minute 
Muouur« given hourly are of value, such as j^ of » grain (O.UUl) 
^^ every hour, or a if-aMpoonrnl of a .sitliiliim of 1 grain (<J.I).'i) to ^ a 
^B I)int (2''>0 cc.) every hour may be unimI. Tlii(> i^ a particularly »Hcful 
^B netboi) in chiltlren. as the solution is tasteless and it docs not pro* 
V doo<> DBiuea and voinitiDg.. 

It! the acute catarrh of children, which ofTcctrt tlic stomai^h and 
j^_ CQltre alimentary canal snd iit ssflociated with little fever, the use of 
^P the drug ia cstrcmi-ly valuable, and often fibori? an attack »heu given 
^^ in the same dose uk just ileKcribe^l. 

An an emetic ntitimotiy i^ filovv but fureiblf. It ought not to be 
osed in cases of poijioning I>y oiIrt drugM. uwing to it^ slowneeu. 

Before the ialroductiuu of uuieHlbctic.-^ emetic doBcswere employed 
to relax the muscles in reducing tliglucalmuH and frarturfii. 
^H Tmrtar emetic in haniiful if irritation of the eil.omacli is present or 
^f if kidney changi.-<( are ra])idly progi-ejising. If one good-tii^ed emetic 
' doee in not sutncii-nt to produce vomiling, it sluoild not be repealed, 
but some other emetic or llie slomaeh-pump be unt-d. li'dl anlimoiiial 
tpoirioniiiff oomplieate the cu!*e. The emetic dope must be large enough 
|t'> be oSectiru, or none at all nboidd be givon. Tf this rule is dis- 
Kbeypd, systemic changes come on with undesirable severity iu tlutse 
sre emesis fails lo occur because of small doses. 
itonnUr-irriUint nnlimo&y is employed in the form ofanoint- 
nent whenever a very sb.wly acting and prolonged counter-irritation 
!•> be maintained, as on llie back of the neck in epitepny or similar 
irunic slates, utd in old rnhrgements of the. jointn. 



86 



fiSVQS. 



Antimony acts well as m diaphoretic, but its oM ia uDitwiiTaHe, 
owing to il8 (liHagrrfubk- cffocla, such aa nausea and intestinal dis- 
turbji ii<;<_>. aii<l l)(><-a.iiKu oilier, niori- pK<it8Ant, drugs act etiuallj* well. 

Adminlatration. — TLe dome of tartur omotic when there ia an 
excited rirculiitioiii is jig to ^^j, of a f^rain (0.003-0.006) every three 
hours until an effect is obtained. As an emetic the dose is ^ to 1 
grain (11.0.3-fl.Oti). The wine of antimony ( I'inum Antimonii. V. S. : 
Vintim Anttmom'ale^ B. P.) contains only '2 grains of tartar emetic to 
each ounce, and may lie used in the dose of } to 1 drachm (2.0-4.0). 
or as an etneiicjn the dose of J to 1 oun^e (:i.0-30.0). The com- 
pound pill of antimony (/*i7m/.f Aittimomi Compctita, U. S., or 
Plumoicr's pill) is used as an nttcratire. and contains sulphurated anti- 
mony i a, grain (0. 03). calotm-l J a grain (0,03), guaiac 1 grain (0.06): 
the dose is one to three pills. 

The ointment of antimony i^llngtuntum Antimonii Tartaratt) is 
Qsed externally as a counter- irritant spread on a ra^ or piece of lint. 
Antimouiiit powder (J'u/rit Antimaniali*, U. S. and B. P.). or James's 
powder, coiitams oxide of antimony and phosphate of calcium, and is 
given oiTiisinnally as jin antipyretic in the trratment of rheumatitm 
and fever in the dose of 3 to 10 grains (0. 15-0.66) ; it is heel given 
in a pill. 

The compound «yriip of squill {Sffriipu)t Seilt^ Compoiiitu«,V'. S.), 
Otherwise known as " Co.ic'b hive syrup," contains three-foiirtha of 
a groin (0,04.'>) of tartar i-metie to the ounce. The dose is 20 (o 30 
mioims (1.3-2.0) for im ndiiU a.i » .sciialive, or from this amount to 1 
drachm (4.0) to a child as an emetic. 



I 

I 
I 

4 



AKTIPYEIN. 



Antipyrin is a derivative of coal-tar. its clicrmical name beitf^ 

IthenyldimL'thylpyraxuhin. It i« also culled Pheaazonitin i^it. J'.). 
X was diocovered by Ludwig Knorr in I8S4, and introduced into 
medicine by Kilehne. Aniipyrin h o while powder of a somewhat 
bitter tiutc. and is very soluble in water. lc»3 so iu ether, alcohol, 
and clilurufonu. 

When nnlipyrin is t;iren to a man in full medicinal amount, it 

fcuses :i sensation of buziinj; ;ind tightness of the head not unlike ihat 

reduced by <|Uinine. The bodily tcuipcrature, if normal, ii dvpre9at.-d 

fraction of a degree, but no othiT syniptoiua -xtv 111:111 ifcHied. If the 

^doee be quite largo, some blucocss of the lin$ and tinger-mtild appears, 

chilly HCtuialioii:! an; expericntx-d, und tinnlly a profile sweat breaks 

oat over the entire body, which is more severe if fever has previously 

existed. Ijarge doBes sometimes cause nausea atid vorniling. 

Physiological Action. — Nkrvoiij' Svstkm. — Wlit'O a lurjie poisonous 

%e ofanttpyrin i» given to one of the lower anim.'iiH, relaxation, utter 

< of reflex action, and total inability to move come on at once, and 

^death eiutics. Bomirwhat Kuialler doKps produce exceedin|<;Iy severe 

tetanic and epileptiform convuUtons, but eoi)scioi]!>ness so<jm» to be 

preserved. It has been proved that the chief cause of the convul* 



ASTSPYRtS. 



87 



h 



ajon 18 an nctjoD of the <lriig nn the lirain.' V«rv targo toxic doses, 
tterefofN", decrease reflex action, and hiuuHit ouca JncreBM it, though 
iii«ilictnal amuunt-i ccrtjiinl^- lessen ruflex ^iciivit^ to a iiotalile il«jtree. 
The eaaw of this fniliire of rofloxw U doprtowion of the sensory 
OerTM and the receptirt' wiitn.*!! of tht' spinal cord. MeJiciiial 
wnouats niusi, tliercforc, bo regarded as very distinct nfirvous Ae<t&- 
tires, KCtiag luiich inure activvlir »» thu nerrpji of HpnRntion than on 
thtwe of motion. iiiJMtt'd beneath the ekin or applied to a mucoua 
mt'inbrane, antipyrin is a powtrful local ;irift?»thelit, iho atiieatliesJa 
lafliing often for spvenil days. 

GiHCUUTios. — The fltwdies of a Tery large number of phamia- 
cotojiiets prove most cimclnsively tliat BiiiJ[iyriii ha^t no effect on the 
circulatinn of the hiirer auiuiaU in niodeiatt.* doses iinle^H these be so 
fre^foentlr repeated that cuuinlniive eifects ensue. Mutiy reliable 
clinical observers hav»> as-iertt^d that the drug (ii-prciwci! the cirt-ula- 
tton ill man in some cnHf>R, and nntipyrin iit L-i>rtainly not a cardiac 
viitniitaut. The w riier is confident, however, that aniipyrin is not so 
disiinctlv a cardiac depressant an soiue think. Large, poi»oDoii.<i dn^es 
lower blntxl-prrsfiiire, iiah^M convulaionit arc presi-ot. when the pressure 
rai.t«4l. The action of the drug on the circulaiiun is nevertheless a 
ery iinimporlaut part of its povrer, and in mortt cases is not to be 
wiftfiiderisl in the treatim-nt of ilisoasc unless the circiiktion is feeble. 
Ill tuauy of iho css(.-s where vaseidar depret^-^iuii and collapse have 
f»ll»tie«i iiH a&e it han been eiiipli^yod in e-veessive amounis, or the 
.11 io iMxlily temperature ha» caused the untowanl Hyioptotns. (8ee 
'ever and its Treatinent.) 

Blood. — No spectriwcopic changes in the blood follow the use of 
medicinal doAeit of a,nli]iyrin in the ordinary individual, hut in poi- 
aODons anioirurs it jinxlures niethteinoglobin. If the doses he toxic 
nr idiogyncni«y exists, cyanosis may come on. That the blood is not 
destru\eil bv suiall amounts is iirovcd bv the ab»encc of hicmatin in 
llie urine of persuns taking the drug. The corpimcleti eulfcr no 
c^uges except in rery pronounced poinonlng, when they are said to 
become crenatetl and shrivelled. 

R£3i'iK\riM.N. — Whfu uuiipyrin is given in lethal dones. death 
results fruiu failure of the re^tpirntory centre. Ordinary duues have 
no effect on this function, bnt large ones make tho breathing more 
rapid. 

TBHrEKATURE. — Id normal men and animals antipyrin in medi- 
ctoal dose mav be cmsidered ax wriK<tui eflV-et f-n fur as hodilv tempera- 
tare is concemc'l. In fmcri'd iinituaU it \i\\» been found to lower 
lempemtare bv decreajtiug heal-producliou and iiiereasiug lieat-diFisi- 
on. That it does not do ih,\» bv nn action on the blood sccni» 



^' 



ved by the fact that the blond in not afTecied by medicinal ainuunia. 

e -sweating duea not cause the fall, since it lakes place when no 
sweating occurs. It may. therefore, be eonsidered that the drug 
directly affects tho norvoutt lieat-mi-chauinm oi the body. 

KlONEVS, TissuB-WASTB, and ITrimk. — A large numller of studies 

' 8m anlboi'i Boylflon IMk Jukaj 4>f UarTard Univ«iiii7 on AnUpfrciica, Phil- 
pkia, ItWi. 




88 



DnVQS. 



made opon man nnd tlio lower animals hy competcnl invc«tigftt(>r 
liiivc liniuglil ahoiil verv coiisiiiuraWn Hclviiliccd ill our ktiDwItMlpf ofj 
llic iutluviicf itf aitli|>vnit upon tisisne-wajtlf. It i^ iiselesfl in hunico ■ 
ibis volume witt) a diwunsion nf their nietbtHU uuil results, which mav 
bo found ill the author's IJifsitif mh Antiptfreiirg. Sriflioc it to mt lbat> 
whilf nil observt'ns »rn not a^reeil as to llip efTectj" proJuofld. the deduo] 
liuiiff nppari-utl^v tw ht* draini arc (hat the Jrujj; dimiuishps the qusn- 
til)' of the m-itit* excreted, and also (lecieases ibe eliiuinxtlon of ihe, 
reaulto of uitnigunous ti.-«nii-mctiuD«rpbo3i8 — or, in other word*, a 
cODBervator of tbe tisanes of tbe body. 

Bum CATION. — Tb« eliiKimtioii wf antipyria gt*s oo very rapidly] 
indeed, and begins almost at once a^er it.s ingeiitiDn. Maragliniio and] 
BoihlcQ slatf that it uppeur^ in the uriim in tbree hours afti.-r it i»1 
tuken, so that ut the fourth Lour elimination Im at its lieigbl. allliou<:b.| 
it continues to be cUniinutcd for twenty-four or perhaps tbirtj-sixj 
lioum. Acconlliig to I'nvlinnw. part of the anttpyrin ingested il 
elitniiiafed by the salivary >;lands. 

Poisoning. — The treatnietii of poiMJiiini; by antipvrin cotuists il 
the adminii^lrntion of stiniulnitt^, tiic Qiainteniinec of noitily h4:'nt, the 
use of atropine to restori? tire tone of llie vascular sy^teiu, and. if 
cyanosis is al&rniin]tr. the ernpioymenl of oxygen inhalations. 

Antiseptic Pover. — .-Vnti pyrin exertH a very tlistinct antiMtptic 
action in iundl anioiintH, delays all formx of fermentation, and destroys' 
genns wberi it is present in \ar^v iiimntity. 

Therap«utic8. — Antipyriit i^; employed in medicine for two great 
purposes — namely, for thp reduction of fer<^r and the relief of jtain — 
but its employment na an antipyi-etie is now entirely surpas^^ed by its 
use as an anaij^esic. 

As an antipyretic, antipyrin shtnild be given in a few full doseaj 
rather than fi-eqiienl )<ni.ill ones, as a {»enenil rule, since if ibe fever 
is of any severity the latter merl^'d of administoring it will have no 
efiect. and tlie i'uni*Iani ilosiiig vill produce :i ^r:iiiiiiil tdiluration of tlio 
Bystoin without causing a fall of tviupcratiire. t>n tlie otbor band. toi>i 
large doses may depress the tempinMlure to n point below nnnuni imdj 
iiMWce collapse. In the article on Kevers (I'art IV.) tlae conditicu] 
tie indicated in which the dnig is best croployed, these being the 
Sthenic fevers as a rule, or instancci^ where exoc-ssive ontbnnsts of fercr 
neceAsitiite prrjiupl reduction of temperature. In excessively fiti/fi tent', 
perature in imeumonii it may prove of groat value, and in acariit ftver\ 
uid tmaltpaz antipyrin \a of servine in Rrmii* instances although in ' 
jmeumonia, aa a rule, the condition of tbe patient indicates the use of , 
cold to the chest as a local measure for the reduction uf congetttion orl 
cold sponging to relievo fever. (.See Pneuirnuiia.) Tbe u»w of th* 
cold applications is ulwayi^ to he preferred to anii)iyriii \n tlic reduc- 
tion of fever, vinee tbi'v are safer, mure retinbl^. and do not strain tbe 
kidneys, reduce tbe blnml, or dcprcfis the liead. in feeble patieiit.<«. (See ^^ 
Cold and Fever.) Wben cold water eannot be used, then antipyrin ^| 
may be employed. In jditbtsis antipyrin gciicrally iucrcaAi-s ibe sweat* ^^ 
ing, produces oppression, nnd either fails to act as an antipyretic or 
produces collapao by exercising loo grcjit an effeet. In Kunittrokf it, 



It 

i 

■ 

1 



<kf it^ 



ASTJPYRfS. 



89 



»: 



|U» 



fairli 



to tnencnce the tenipenituro, aud ought not to he 

U!H-d. 

Be iLe fever what il mnv, providod it be ossociatcd witli an\- dis- 
eased process, antipyrin is ttbs<i)mfly uacK-sa so far m any inlfnencc 
over toe coarw of tlic disease it«elf is coucerned. It is a remedy to 
be used in the treatmettl of tho symptom, noi for thu roinuval of the 
o»ow of the fever. 

As an aniilgft^ic unliprrin i« the peer of opium. Although the 
jter drug will relieve all forms of pain if it he piishe<i. it p'js'wsses 
uiativ liiMidraiita^cs mil foiitiil iik nntipyrin. Ii: decp<sejited jiains tiii« 
lo dueiLMi nf the orpLOSi of the body, in inflsmmiklions nnd siiiiilar di-t- 
rarbances. antipyno U u^eltfss. lu nturalyic ufiVi-tioiiH of all kinds it 
fin'I? its flphere, particularly if tho di*onlor bo rbpiiinulie, goMty, or due 
Dervoiiji ilepri'ssinn fWmi in-Tvmis cxhaimtioii ur disL-nwi-. I'mh-r the 
rirenni-^tanci's it is herit p<iiid>ini>d with cafiV'inc and a little hrnmide 
tassiutn. (See Neiiralgiii.) In r/iriniiijti»ni it will give relief in a 
irly large number of cMes, not only relieving the pain and fever if 
ihey be preM'iit. but alsu actimlly titiidil'viiig iht; diM-ose. Ii aeemst, 
bowever, to Jucreaiw tiwvaliiij; in »vut<; articular rluoimiiUHm. lsi;/out 
it is siaieil m have a spe^ilit curative effect ii|niii the di!«rA.sc over and 
abiire the relief of ihe pain but this is donhlfid. Its iisc in lii/xmrnor- 
Ao-it ban been recoiiiuieudi'd. hut its bcni-licitil iul1iii'ni.-e Jii ■'itch cases 
is doubtful. At one time it was thoiijrht that it* mt- wcmld relievo 
the paijit a/* /oAftr entirely, but thiri hnn. unfortunately, proved uulnie. 
It may. however, be tried, when the suffering Ir very severe, in the 
done of 15 ffraiiui {1.0). In ibe sc-vcrt- lunciiiutiii;; or ilarting pnins 
of hicomotor ataxia, and in tho larvngoni mid pustrie eriscs ci>m[)li- 
inj; tbid diseiwo, iiuripvrin i^ nii iiivuluiililf imd relialdn rt-nieily. 
nrtously enough, il ^cetu-'i to subdue acute attatrktf nf pain in po»trnor 
Immit, bul fail» fa contnd the slighter paiii^ and iiiiiHi'id»r tvritchJDgs 
mt'ti nil's se**n in ihia ilinna'to and in mi/i'lilur.. 
S^itnc eliuiciaiis have iisud aniipyrin nilb a.'^erted great .iuceiits it) 
■U* mtHilitii. In ^iieii in!^l:iii<*L'.<< ihLi di»ea^'.- often ik'|keii<U on a 
iQty diatht-iiiit, and can he mtII relieved by Milicylutes. Antipyrili 
.y be used hypoderuiiL-ally in tlie region of a /i^pi^rtfinnitive nerve as 
local amesthetic. The aiiPRtlhoam produced hy it lusts for several 
.ys, but tho pain immediately after the injection is severe. 
Atitipyriti is a vrry useful remedy in ef/ilrpaif. (Sou Epilepsy,) 
In u'hottpiuif euaijh autipyriri has more rrt'ijut>ntly givtn relief in llie 
writerV experience thau iiny olher reiuedy. It Hlmuhl bp given to a 
child of five yeara in th*^ dff*e of '1 prains (0.1) ovcrv Ibiir or hve hours, 
ihe patient being waUdtLnl for cyaiionis an<l the driig istiijiped i\» duou ns 
' is synaptom appojin^. Aniipyrin gi>itcr»lly decrciutos the frequeuey 
nUhcr than the w-vt-rity of the attack?* of cough. 

In malarial (/la^niffn nntipyrin ej-rlainly exnreises no antiperiodic 
inSiiciicA. altboii^li it iKintrolH ihe febrilt- paroxysin;^ I« a great extent. 
Yel, while this is the opinion of the ninjorttv of tbofio who have u«ec] 
. it canuot be said thiit every obi«erver hajt rent-bed similar vnnclu- 
£oU6r reports ca;<ie» where the resuhit obtaiiioil fnim its viae were 
'y, purlieuUrly in ihu tntenuittotit form of malarial poiwn- 




«0 



i>iiiro& 



mg. One cannot bplp thinking that frequently vhprc nntipTrin 
btH.'Q ropurt(.'tl us uftin;^ us un iLUtlpi-r iodic it bw simply lowered tb 
fever, and so weim^il lo afTuct the disease. 

In flfji.(.r cortfza thi; hiinptirary reliwf proiltined by npplyinfr cocaine 
to llie erigijrgtiii Si.'hii«i(li'i'iati membmnfl may be pmlonped inilefinitely 
by the use of a spray of antipyriTi in the strengih of 4 per cent. This 
proiiuces n siDartiiig son^ntion, whieli speedily pA.>iHe!> nw«y. The same 
trcutmuttt is of vuiuo in iufluiumatiaiis of thi: Uryux and pburyux. 
Should cocajue solutions not precede the sntipyrin, the priuiary irri- 
tant elTocta pen«i»t unleit» the strcni;tli of the solution of antipyrin is 
reduced to I or 2 per cent. It is alwiijs better to precede its U8C by 

COCIUIIO. 

Locally applied, ttntipyrin possesses rery distinct kcnnostatie pfop- 
erties, antl fnr this purpose may be ut^t'd in n 4 per cent, solution, eitlier 
in liquid or in a Rpray. Under these cin'umatanL'n; it seems to net not | 
by producing dotit, which are disadvantageous fruui the standpoint of 
antisepsis, but hy eunstringing the bleeding vessels. This hfewostatic 
property is very materially incrt'a»t;d if u wilutiim of tannic add is 
added to it, when it foriuK a glutinous pn?eipitate whieb controls the 
hemorrhage. The precipilaic is beat applied by tiieana of n ewab. ^J 

Antipyrin may be piven with cocaine in mppotitor^ to ebeck blced^H 
ing from hemurrlioida and relieve rectal pain. The cocbJqc mast hc^^ 
usetl to priM'oiit the antipyrin from CBUsin>^ puiii when the ^suppository 
IS fir^i; ititroilurt'il. ^H 

Untoward Effects. — Aside from the resultm of poisonous doses, a CCN^^ 
tain number of cases taking this drug present slight eyanosiis or duski- 
ness of till* hands and of the fiteo about the nose and lips: the fingers 
may be cold luid elaniiny. and the feet artt often very cold ; sweating is 
a very enniiiion svmpiom of the untoward influence of antipyrin, and 

f)rickin^ or tin^litj^; of the i^kin ii< not unconiUKirdy seen. By far the 
argest number nf iliese eases, however, suffer from disorders sfBoci- 
atod with lb<.- sk'iti. and crylbemHtous pnlehcA may he f^een every- 
where, more particularly on tlie bitiids and feet and about the face, 
arms, and chest. Occasionally pem}'higus-like spots appear, and 
often large bullae have been noted ns present- Elsewhere are pub- 
lished the statistics, collected from mcUical literature, of 121 cases 
of untouard effects exercised by atilipyrin. ' An analysis of tbeHO 
shows that females were much more tre(|uently affected than males, 
and that the most susceptible age was decidedly that of full adult lifo 
— namely, from thirty to forty years in both sexes. The dose caus- 
ing these effects was must commonlv a moderate one — from 10 to 15 
f rains (0.65-1.0). or even from 4 to 10 grains (0.2-0.0.5). This fact' 
olds goiid with regard to both wexes. The time of onset of the 
symptoms varied somewhat, according to whether the drug was given 
in one excewive dose or in frequently-repeated mtdh'inal dotes. In 
many tnstaucee the appearance of the symptoms was sudden rather 
than gradual. As a nilo, rbe duration of the symptoms did not 
exceed one to three houtti, three days being the lr>ngest time men-^H 
lioued. It is interesting to note, however, that of all rltese eases onlj^H 



>Seo autlior'H Boylston Pri» F^^y on Antipyretic*, Ph tin del phi*, 1891. 




A nnrnxts— a piol. 



91 




^Rini 



proret] fiital, anil in th«8« there wait anifile cause for deatb aside 
from any effect of the dru^. We can rest Qssured, therefnrp, in ordi- 
Dury cases ofdi^^nse that patirntj) exhilijtmg untnward elTectH nfnnti- 
.■nn are not in miy at-ute iliiri;;pi*. a.lTljuu^li the symptoms mnv he 
rijmrarily moat alarming. Typhoid fever SCTras, accorrling to the 
iiiitjc3 collected by tbo writer, to be the disease in which tbisuDex- 
d inttucocc manife:*!^ itself moiit frequently, bnt this may be due 
the fact (bai it if so coraraon a malmly and is so frequently treated 
meno.s of antipyretics. Brunlon is responsible for the stHteincnt 
at antiprrin is pnrticularlv prone to produce collapse in menstru- 
al ing Huuii-n. Faick has colleL-ted a large number of coses of antipy- 
t«in, and quotes Pusinelli as having seen vomiting often follow the 
of this drug. 

Aotipjrin very distinctly incroasea euBceptihility of patients to tok- 
_ coId» »nd ought not to bo enij>loyed by those who are forced to go 
t of doors in cold weather. 

▲dministratioa. — Ovring to the !<o]ubi1ity of untipvriii. it \» most 

ly given in a httlo water in n wineglass or spoon. If its slight 

tc is disLikiMl, it may be dissolved in any one of the ardinatir waters 

ill syrup of bitter orange-peel or some similar vehicle. Most per- 

>n» prefer to take it larith water. The antount which may be given at 

is 5 to 20 gminu (0.3-1.3), but 3 to 5 grains ((»..3) i« tlif best 

in tnoi>t Cities, at least until it m eccn hnvr well it it:; bnnie. 

Incompxtibles — When added to Hweet spirit of nitre, anlijiyrin in 

the course of a few moments produces a blue, changing to a dark- 

ereen, color, owing Iji the formation of iso-nitroso-nnlipyrin. which 

not poiwonous, hut whoii in the fwnii of a dry powder is readily 

iilized on exposure to slight heal. If this coIi>r in not formed, the 

irit of nitre lacks its nitrous ether, and is nurtUlcAS, »o that we have 

t only another ineompatibilily to remember, but n new means of 

testing the therapeutic value of all samples of ttwect apirit of nitre 

which may be dinpenseil by druggiatA. Antipyrin is aUo incompatible 

with the salts of iron, calomel, corrosive sublimate, and carbolic acid. 

i'ith BKlicvIate of sodium it fonns a pasty nia.ss ; with clilnral an oily 

uid. Bets-naphtol and tannic acid arc also incuiiipatiltte with it. 

'aunie acid and non-alcoholio .tolution!) of Itiunic ucid form au in- 

luble precipitate with antipyrin, as does also the tincture of iodine. 



ANTITOXIN. 
(SoG Part 111.) J 

APIOL. 

.■\pio! itself IS a camphoraccous body, derived from common parsley or 
'•'ftronftinum. As its melting-point is vervlow, it cannot be kept in 
slid form, and is always diMpensod in TA per cent, solution. So far as 

known to the author, no careful Htuily of its phyHiological action has 




BS 



bRtras. 



^wrer been miule, but tn-o French obitervei-s, Joret aoil Uomolle, mau' 
tliiii ill iiv<>ril<»ie il csuiiea ringing in the (>«T», intoxicfttion, and sexeK 
fniiiinl |]i'»ilarhe. 

Th«rapentlC8. — Originally introduced to oumbat malarial fewn, 
bvuniiKC of a fanci<.-(] reHcmbUnce in its toxic iictJnn U> ([uluint^. apiul 
lino nt la-sl foimd iu* tnie l<-vt>l an n n'mcilv in niifnorrinrfi. given in 
tbe dufttr of 2 to H niininit^ (O.l-f),.')) tbn-e limes ii <lii_v I'nr n wcrk 
lirfoi'e tilt? proper date for nK'nstruutiuu. It sbmild bo given, if poB- 
Hii>lv. in cu|»«ulca. owing to ittt bud t4tflte. It ie said not ti> poottcos 
ati^ abort! vt! iulluvnces, altJiougli it is on«ii laken wilb tbia ubjeot in.^ 
view. ■ 

Apiil « imponetl fponi France in CHpsule* coilliiiiiing Ji littlo I«ws^ 
tium 3 iniuiuis (0.15), ucd is uUu [ml up in eiift eliuttic Cii])Buli.-s iu tliis 
COUQtrj. 



APOCYNUM. 



iniujn H 



Apitri/num C'tt'inahinHm should not be oonfiised witb Apor-yjium 
An^r^fiin'r-fclium, wliicb hns few of its properties, but vtbicli is 
often wiiployi'd \>y iiiiatiLku for tbe r«al drug. When good effeois do 
not follow the use of the drug another sample slionid be tritnl. The 
r<?m(.'dj in overdose is capable of causing vomiting and purging through ^ 
giMtro-intei^tinal irritation, but in roe<licinnl dosa rar«l,T doed so. It ufl 
eroployed in medicine for the relief of carrfiVic ami renal dropai/ of the 
aubftcute or chronic typo, and is best givon in tbe form of the tincture 
or fluid estniot in the dospof '> lo 20 miniuiTi (O.^O-l.r)) of the former S 
or I to .'» miiiims(i).01-0.;lO|.)f (ho latter. Under itsinlluence profuse ^ 
diuresis occurs, and the* fluid Is removed so rapidly that the drug has 
been failed tho " vegetable trocar." 

Physiological KMidieH show thai the action of the drug on the lieart 
is iiitiiilur to ibac of digitalis, as it slows the pulse aad rai«M blood- 
presi^ure. 



APOMORPHINB. 

Aponoi^hiiio ii> an nrtilicial nlknlnid obtalni'd by the action o 
hjrdmchloric ai'id u[Hm niorphiiK- iu a soiiled lubt- to wliicli is spplifd' 
a higli heat. It is & whitit^h or gray powdor. ii!ndi> up of miuuie ery: 
taU. which rapidly undergo decomposition when espnwd to tlie air, 
Tbe drug should he kept iti dark bottloH well stoppered. A vei 
iniportuut point to remember is ihal snliilion^ rapidly dwompoiw, aO' 
if cmploved, lUKV produce poisonous syniplouis. Tlic drug onght t« be 
fn'?)hlv ilimolvcif each time it is u»ed. ff the »alt. impurta an etnemld- 
greeti cohir to 100 j^irlD of water when shaken ii few liuios, it should ho 
rejected, unlive it. i» found tliat lite wator nontniu!) irniall uiuounttt of 
aninioniii, which is aupfwHed tu be uelive in eauniiig »iich a ehnngo. 

According to Boyer and (.iiiinard, there are two kiml^ of aponior^ 
phiiic sold, Eaeh has a physiological effect different from tlie other. 
The m'Btallini' form, which is tbe one always to bo eiuploycrd. causux. in 
orerduse, irritaliuu, Hpasma, triomua, vertigo, and liyperi»Hlhesia ; wliile 



I 




APoifonrmsR 



93 



tbc amorptiouit (nerfr to hv u!>ed) entires collapse, liypotliorniin. gouerul 
wpiiknaag, foeblHic»i of the lioart nml ri'^pimtion, nn>l auicHtliMift. 

Phrsioloffical AcUon. — <>ul> oT tbe \tf»l siiidie!! of tbis <lnig \n that 
of Kvicliri'L nlio fuuiid tliut 111 puisonoiu) dosp^ it pro<IaceH (.'onvulaioUK, 
ui<l titinllv pumlvHiK, botli of wliicli are chiefly spinal in origin. 

Nebvods :<Yi*tem. — On the nervous contrc-s in the brain iipomor- 
kinc acts as ft atiiitulunt, but Ibfi coDvulsiaoit prnduMtl bjr poisouous 
av probahlv tipiniil. The luolor nnd sensory iiervw art' paralysed 
pobwiooiis dosL-s, Aiiil (!Vira tlio niuwdes lipmnip poisoned ami incHp- 
lie of eontnic-timi. Me^licinnl doHes Lave iio etTecl. 
CiRciiLATHi-v. — Apomnrpbine incrt-iises tbe nipidlty and force of 
the pa)»e and rniaea arterial preHHure, when given in moderate 
annuls, bv 8iiinid»ci(in of the aceeLerator nerves uitd tbu vumimntor 
lire. In l«rge doses it acts an a circulatory depressant. 

Kto. IS, 




A, Jl]wipbr^hiiiL> ■tltnitlatM vonltlni; centM in the medulla. 



Rbspir^tion. — After ordinary atnoiinte nn changes iii rcspimtion 
ir, but afWr poiRomiuH dmen the breathing becomen rapid and 
niUr. 

oailTINO. — Vomiting is prndiiced hy a direct action nf the drug 
m the vntnititig c-vntre iu ibe medulla, and not by «u action on tbe 
)tDa4:b. Apoinorphiii« is, iherofore. a ivpieal centric emetic. 
Tlier*p«itic8.— Ai>omorphiue i* ugvfiil in nearly nil ca-ws where an 
etnflK- may be employed, lit pnisoniiijr froiia olber drugs, ptirlicu- 
larly depre*i«intfi and narcotica, ire have little knowledge of ils safety, 
>Dt, iinlew! tbe stupor or circulatory change in very profound, tbe 
Irug may be used with care. In siilmeuie and ehr<inic uatarrh of the 
touiitch fitut (ttr-jniMiitfrM it may tie useful In pelting rid of the muciia 
cm*.-:<is. iind in non-emetic dote it is a useful remedy in icttte 
runirhUis when ii is necessary ro quiet Irritation and relieve exces-sive 
>ugb. or wlicn the socrction which ba? been poured out i« very scanty. 
taitc recently sm:ill non-ein«tic doses of ^ grain (0.002) have been 




Dsuas. 

ofi&l with asserted success in producing nervoas quiet in 
KTeiti'mtnt Btid ili-lirium Irfnieng. 

Vntoward Bffects. — Apomorpliine rerelv cuusea disagreeable effectA, 
but there ^re cs^ee on record in which it had product serious svinp- 
tomtt, even when given in ordinary doses. These sTiiipioni» hnvr con- 
aisted in dvprcssion nnd collapse. Ono-fiftoetith of n grain hut c-auKed 
death in a woman nliu Liid bruncliiti». hut was otufrwiso honlthT. 
I'roliably in these cft^es the amorphous rorm already nani4?d waa 
used. 

Administration. — The drug when used %» an emetic should nlvravs 
be given hvpod«rtaicaIly and lite K(iluti<m he freohly projtared. The 
cmelic dase ia about -^V ^'f' " grain ^O.OOc!), but a^'mucli ui ^ (O.OI) 
may be used in strong patients. The expectorant dose 18 A to A 
ofa grain (0.0015-0.003) by ihe raouth. No nausea i« usually fell. 
The drug nearly always acts badly in children, and it is better not 
to use it in thiK claKN of paiieots. The salt uiied i» Apomorpftin/e 
Hydrochhrat, V. A'., and Apomorphina: Ift/drot^hlorvlvm, li. P. An 
injection i^Injectio Apomoruhhice Hjfpodermu'o) — 1 grain (0,(15) di«- 
■oK-ed in 100 minime (6.0) of camphor-water — is official iu tlic 



AEISTOL. 
(See TuvMoL Iuuidk.) 




ASNICA. 

Arnica is a medicine derived from Arnica montana, a natire plant 
of iht> Wesi(>ni IJniled States uiid Europe. It holds a very bigh 
poflilion in domestic medicine as a local and internal remedy in tpraint 
and hrui»i't and in the treaimeiil of passive hi-mnrrhaget, amf^or- 
rkxa, and niiuilar statcjf. Two jiarta of the plant are official — the 
arnica-flowers (Aminp Floret. U. *S'.) and the root (^Arnica Badix^ 
U. .v., Amicar HhUoma, li. /*.). 

Pbr^ological Action. — When arnica is applied to a delicate alciOf 
it produtv." buruiiig and irritulinD. aud ovun citenaiTO skin IceiiHiB* 
According to the i^iudies of tlte uiitLur. it hIows tho pultte. raises the 
blood-prcK<<ure r^lighlly, and »tinuilate» the vagiix nerves. Toxic doses 
produce a rapid puliu* from pfiralyiii.1 of these nerves. 

AdmiiustratioD. — Arnica is rarely given internaily. If it is so 
lued, tile d<)se of the linclnre {Tinetura Arniop RadicU, U. S.) if 
15 to 30 minims (1.0—2.0), and tne same amonntof the tinclure of tlie 
flowers {Tinctura Amiae Florum, f'. iV.) may be employed. The 
solid (ErtrtH'tum Arni<:ff Jiadici*. V. *S".) and tlio fluid extrnct of the 
root (^Eztraetum Arnica Itadiei» Fluiduni, V. S.) are a.l»o official. The 
dose of these preparations is 3 to 6 grains (0.2-0.3) and 5 to 10 minim.* 
(0.3-0.6.5) regpectively. The planter (Kmptastrum Arnictr, U. iV.) is 
rery omful for external applications. 

J'be tiDctnre of arnica is the preparation usually applied to spmini 



AnsEsia 



95 



id bniisos. and the alcohol eoninuicil iu ihU pruparution aocompIifOicci 
luve part of tlie f^ii achieved. 
Tho only British preparation i» the tinotiirc {Tinfiiira Amie<^ 
vhich M given in the dose uf 30 minimH to 1 driLchm (2.0-4.0). 

ARSENIC. 

Anenic {Artrmcvm) ii«elf is never employed in medicine, but it 
Ls tu«d in the form of arseQous acid or the ar»ctiutea of sodium, 
pota^iiiu), or co|>|>er. 

Ar»etmufl ac-id {Acvium Art^nomm, U. S. ; Actdutn Arat'tiioeum., 
B. P.) is derivtnl from atRenic-beitring ores bv roii-iting ihera in a 
reverberatory furnace, when it rises in the form of a vapor which 
adhere* to the walls of the furnace, rrquiring a Hpcond suhli- 
mation, owing to the first depoi^it being quite ttupure. It is Holiibie 
in water, is without, odor, and when heated givea olF the .'^mell of 
gsrlir. 

Physiological Action. — The changes nrudnccd iu man by poiaonouH 
daws will be fonnd considered under (lie heading of Poisoning. 

Applied to the normal skin, arftenoun acid jiriiduccH tio change of 
any moment whatever, but if ihe surface bo bruken or a wound or 
sore exiAt. ilA action in very powerfid. nnil it dentroyfl the tis>9uea to a 
eomiiderable extent. For thi.>< reiisnn it hiui Wen employed ns n eauHtic 
by '* quacks " and to some extent by ret^'ilar ]j|iyeiciaut<. ihc luttcr 
tuing it to remove warts, condyloiaata. and similar growitiH, while the 
I former hare employed it chiefly a* a "cancer care, ' aaserting that it 
^_would take the disease "out by tlip nmtH." 
^^1 AlJ;?ORrr[o:f. — Arsenic in slenly absorbed. 

^^B NkrvoTiJ SvsTKSf. — When HmiiU amounts of arsenic are given to 
^^ifeoitaals, particularly those of the lower types a.^ repreeeuted by iho 
T fmg- retlex action i» lost ]onp before, or more riirely at ihe (^jinie time, 
that ToluutarT movement is put uaido. and. finally, ail »cntiutiiin to 
pain produced by heat and pinching totally ceitxes. It is therefore 
quite evident that the seneory nervous apparatiis is afreclcd, and 
experiments have proved that the sensory tract of the opinal cord is 
at bult. Cltimately, however, the motor system filao fails nnd com- 
p lete motor palsy eiuiies. Arsenic in poiifiiiioits iimuuiii actit ns a 
^^BepreSMDt poison to all protAiplnsm with which it may come in con- 
^^^act (Ringer and Murrell). In niedicirml amnuuts the dni^ itcts aa a 
nerrous excitant and 05 a stimulanl; to the trophic iiervoiis apparatus. 

CmccLATloN'. — In moderate .imoiinis arsenic ha.'s IJlile or no in- 

fluecce upon the circulation. Large doses cnntte marked decrease in 

the force aod frequency of the pulse, accompanied by a decided full iu 

arterial prosetife, and in the&e amounts it is to be regarded a.« a distinct 

cardiac depressant which deprfssL-s all tlic lurart's component parts, 

cb aa the ganglia, miisctc, nnd nerves. The fall of the arterial pres- 

re 18 dne to vasomotor deprrasion with rula.xuiion of the general 

.•Temel«, more especiallv those of the nbdominui cavttv. Accord* 

ig to LesBor^ small doHct^ canne it. to act a.s a cardiac stimulant, 

creasing the pals«Hrate. Arsenic is absorbed by the blood-vessels. 




08 



DRUOR 



Respiratio?!. — III 6inall amouDis amcnic rcrr distinctly st imululM 
the resjtiraton* centre. an<i Lwst'r asserts tliat .iiiiHll dueee ittimiilsle 
ch(^ peripIi4Tai vuiU nf iIk- vagi in ibc lutigs. tut that in toxic ()Uau- 
tities arsenic aets a« » [Miwerful re»)iiriilory depressant. J 

Et.lMiXATiKN. — Ai-M-iii*- cKCApen friiin tLe haiy tliicfly by the kid- 
neys, skin, and bowi'ls, but usiuitly litttw nol apfiear for (Vuiu fourieeii lo 
sixty liMiirrt after it<» iiifjestiuii in meilitinal ADumnt. In jioiaoning llic 
ptirying wliieli i.* prmluccd eiirrics nfT much of llie lirug, but after ine- 
dicinul uiuuunt.H i^Minr iruc'(» uf it iiiuy bv found in the Mitivuaud in tlic 
uiilk uf iiuriiiii); uuuiun. Tlii> writer has »yvu eulic proihiccd in infanta 
taking milk »t. the brcnKtx nf vroiufn who were rctx'iving Iirgt- doMS of 
Fowler's siilution. 

Tl!<srE-WASTU. — According Co Chitt«nden and Ciimmina, arsenic 
in inedicliiiil tiiiiount distinctly decreases ti^suc-cIinngeK. Lnr^e dfutes, 
huwiivt-r. j:rtnily riicrcjisc uilrogcntms luclaiuorplinsis. 

Therapeotlci. — Aiwenic is iiaed in elwrea, iu whicli it is ulmost s 
siiecific, acrino; in an iinklionn niiinncr. Small doses shmild be given 
ttt firsts and Inter mi rlic dnse sluMild be iixMviisi'd rii|)id1v. ns patients 
aooii get accuetomud lo the drug. Cases are on tecord, hovtcver, in 
wliicli ilip too rapid itierease of tbe ding in iriftdicinal cloKes has 
devclojied arsenical neuritis. As a tonic comtinod with Iron it is 
invaliia.ljtt! in vialarial itntPtHtii and rae/ieria. Iu afvntf of the muenu» 
membrane of the atonmeh and intestines it is exceedingly n»cfu]. And 
in ordlnarv antpinui and ilflnflftf, combined with a simple bitter ionic. 
It is invahuiblc. ArKenie offers the best vbance of saving cb8C» of /xt- 
niciitu* itmriiiiii. In /ruiuri/tfujiniii and fjxeuiitt-lt-uk<rmia arsenic is 
again tht- remedy, and it niiii^t be ooiiKtanlly given up to the point of 
intcilerance to be of vulue. In the latter diiteiue good results buve fol- 
loved its use vhen intrai^laDdular and introspleDic injoctionsof 4 mintms 
(0.2) of Fowler's ^^ulutinn v»«;re used, and any case of severe an^tnia 
where tbi- stoir,aeh is disordered may be treated by giving by ibe rec- 
mm iu starcb-natiT tbrc* limes tlic ordinary dose or By its use hypoder- 
mically in the proportion of 4 parts wnter to 1 of Fowler's solatioit. 
I'erbaps a bctUrr way of giving antcnic hypodermically, bwauftc it is 
IcM irritating, b by ibe use of eaeodvlaie of sodium. A substitute con- 
taining 0.25-0.-45 (4 to 7 grains) at cacndylatc of sodium, in 200 oc. 
(t! ouuccd) of water, may be u.^cd and given hvpodcrmieallj in the doM 
of 4 cc. (1 draclim) every oilier day. (Sec Sodium Caeodylato.) 

In tN'i/oWit arsenic acts as a prophylactic, as a cur^, and as an aid to 
conralescence. When the attacks of intcrfrnttt-ni /ercT are far apart 
arsenic is useful as an nntiporiodir, nuinine being williheUl for u^e dur- 
ing the attack itself. Arsenic \i of value, too, for the improvement ofdr- 
pravt'l muc<'Hi »wtnh'ani-« of the respiraton' trsicl, particularly in those 
f<er»on» wbn liavc not true tuberculosis, but vhlhisira( Imnimrirji ; that 
ia. individuals who continually have colds in the head, chest. Of 
ebewborc. 

No drug is so universally abused as i» arsenic in the treatment of 
skin disease: it should never hc^niplovcd in '-vrct" skin diseases; 
that is, ihofu: associated vith much proliferntion of new cells and Ibe 



J 



AnSEXJC 



97 



icxuilatioa of iwmini anil otbcr li<jui(lH. lu field of lutefulupss in in 
Itlie dr^, Meaty ukiii affeetio»«. 

jWliM-c tlie skill ifl nffpcied in iw k»«cr I&vcnt arwnir is iineleKS, antl 

Mild lip uMul only wliprp ihe epidonn is (liHpafiet) (Dulirinp). 

In p9vrian» nraciiii: at 6r»t iiiakv» tlic skin more i-eil aud seeininiilY 

nirse, but this pas8(« off uiid lUe iHiiease ^sX» well. This is imporuiut 

itu remvnihvr, as (ithorwiMc tlip drug nmv be Htojipec) jiist whi*n doing 

PxmphiyuM, liehtjt, und Irprn iill yield to lis influence in most 



ic«e. 



Id the treatment nfdiahfteg and pntritut vtiit'Of tfaedmg is said to 
\he uf value wlioii givun inlt-ruuUv. Id gouiif diabcUs tiie use uf tlie 
irbonata uf litliium aud tlie arecoate of Buditim is oAen of great 
ice. 

In Asthma, particularly whor* the mucous membranus are at 
'lault, arsenic is one of tho bvst rc-meiiici) ttiat wo hare, cither j^iveo 
ioi^rnally or Kmuknd in arsenic cigaretteH, nliich are to l>e uinde a« 
follows:' 

B. — Belladonnic folinrtim gt. xc^, 

HjrancTam. futinnim gr. xlv. 

StraiDonii fitlionini ^. itv. 

Ex(r«ct. a|iii gr. Iv. 

Tabaci gr. Ixxx. 

AqicB - Oj. — M. 

pLMl.etadde. 

Potaaii niiratin • • gt. dz. 

I>HmiU Brwiuus p. cvoxs. — M. 

' k to be wotted wiiii thu cumpcFutid, and ufkcr Axjing is to be lolUd op 
loked w ■ cigtuvttn. 

A more simple provctlure is to wet bibulouti paper in a aolu- 
Uuu of anenite itf potassium of tbo strength of 15 grains to tho 
>unc«. 

Id i-hronii- rhewnxaiiam arsenic is very valiialjlo in certain catieit, but 
oftm fails to be of service. lu ctttyen. in raiu^rurn oris. Bevt-re sore 
WtMil. and ehroNir mua} caUirrh it is to he craployod intcmftlly, nnd 
SKtntK caae$ i)f fity fever unilouhtcdly uffordit rolicf. The use «f 
ir^enic in all stagm af phlhigig ofivn ^ivpji the uiu>tt siirprisinj^rusulta. 
tfU' i-(i«tvrand ulcer, given in^'innll ainfiiinlflfreijiiently repeated, 
lie will (iflen do gimil hy ri'lieving the pain and checking tho 
rfMUitiii^;. It may be tried in the uomitiufi of jrrei/namy vilb 8<fme 
liance nf Muccess, and id often nf value in the rotnilim) uf hami-fed 
aMrf vrbo arc safferinf; from chronic gastric eutarrh. It i» also useful 
the mfirnuuj mmitiug of drunkards. In atonic dyxpe^isia asHocialed 
rith ehronie diarrhcea and iritb evidences of dyeenteri/ arsenic is of 
rvice, and in small amouiitx it ih very valuable in freijuentty repeated 
(riu **'" * g^io (_0.UOO(j) every hoar) in all fonns of ser&ns 
diarrliicra. 

For gattrie atony or torpidity the following prescription is ujsc- 
. but if irritation of the stomach is present it ^ould not he 
"ciaployed : 

I Pliiluldpliia II(Kpital l'lianaiioo]H«ia. 



9ft i}Ri'a& 

B.—Uq. ynximii unenitia 1^(3.0). 

Tr. nucts voniicjp fei 14.0). 

Aqnir q. ». ad fjiu I.9&.0).— M. 

&— TcaqMonTiil (10) L ^. in mux after mnls. 

Tn old pei'soiw wliose /eet becomt mcoUen and liot after prolonj 
standing, »D(1 who hare shortnttt of breath on exertion, areeaic 

good. jn""tipiilnrly if ihe t-aiiHe he cardiac feebleness, when iL incr 
le efnciiOTp- uf di;|^i(u,lid or strycliuiiic so gix-atlj ua to be gtiicrallj ind»*' 
CBttd wheu ihi'sf drugs are given. 

I.ocallv applicil to wartt aod other grontbfl of tliesbin for MTeral, 
days ill the forni of Kiejuor Amfniealin (B. P.) or Litfuor AfUii At 
tennai ( V. S.) or of Kuwler's »olutiun, il. cii'iises tbti gmvrtb lu drop otT^ 
or to become very muoh loosened. \Vh(>r« thcgrowlh is very hurd sud 
boray. ite surface should bo softened by thcapplicn-tion of liquor po- 
taasa before the om^iiit^al liquor in applied. The .tame treiitment may tie 
used for conit. and ^licylk- acid caa be employed iu a ^iiuiUr manner, 
but i» not dn efltcieiil. \S'here lurge growtlis wilhwide Hurfacv» are to 
be attacked tbe physician must use arsenic mcMt boldly or nut at all. 
The ilauger of absorption is only ewapetl when ihe drng in used so 
generously as to destroy the tissues before ibey van carry on any 
absorption of the poison. A very kige area should not Ijo treated at 
one tiue. Muritden rcoomincudcd the use of 1 ounce (ttU.O) each of 
aritenou.'i arid and powdered guiu ncaci;i to r> drachms (20.0) of vat 
as nil application to fftiih''U<imatou» gfitetht. A lees painful applic 
tion, because uf the anaesthesia caused by orthofonu, is as follows: 

B-— Onlwfom 3j (4,01. 

Add. nrvcootu ^ (4 0). 

Al«>[if.l fir /156.0). 

Aqiiv(tr*I.il)at. . f^T (ISajO). 

And Still another is as follows : 

B.— Act<l. arvcnoa gr. Irrr (R.O). 

Pulv. imGiff gr. }x%v (-'i.Ol. 

Ciwniu. hvilrochlnniL gr. xkx <~0). 

Glywrin.' m, «xi (iO). 

A<|iiir (leaillat q. a 

M. ft ]inHtr. 
8.— Apply kcnlly. 

The Marsden paito !>lioald be applied to the depth of about one- 
quarter of an inch, uvcrU[)piii;^ x\iv ed^^i-s of the sore, and then covered 
with patent lint. The nppliratipn i< continued from twenty four to 
fortv-eighl hours, and then a poultice is applied and ihi- slough re- 
moved after from fire to ten daya. 

Administration. — Children generally bear more anienic tlian adtilts, 
proportionafcly. and Kinger^tates that boys bear leiw ibnn girl.i. Th« 
drug should generally bfiiduiiniiilered after meals, a." ii is apt to irritate 
tic stomaidi if jjiven when ihii* viseus is empty. Whenever a |iatient 
is given arsenic, he shonld be cautioned to wateh for any puHinefiS 
about the eves, parliciilarly in the morning on arising, an<l for slight 
laxilT of ilie boweU and griping. These are signs that the drug 
should be stopped for a day or more. The swelling under the eyes 




BUT spiratl if the ii3P of tbe drug is peraisted id, ami finallj amount 
to geiipral aoAMrca. This is due at first to » celluIitiB, H.nil nfterwanl 
to » tnii; elTii»<iuu. (See I'atuwArJ KflVct«.) 

Tlie official pre|janitioD8 are: arsmiuus acid (AritJwt Araenoswm, 
V. S., Aci'iuiH Artt'nif'ifuin, B. I',), tlic ilosc "l" vrhich is :j^ to ^ 
t>r a grain ^0,OOl.'»-l).OO3); the noliilioii of the arseiiitL- of ncita«»ium 
{Liqm<ir Pi'taetti Artrnitu, i'. *V. ; Liqttor Ancnicality B. 7*.) or Fow- 
ler's solntioD, the iJose of whicb at first \» from I lo /> miniriiH (U.O.'i- 
0.3) io wat«r; the solution of arMoate of sodium {Lifuor iSWlii 
Arrenatu, V. S. nnJ B. P.), or Pearson's solution, tlie ilose of wLich 
V 1 to o miniiiu (0.0^0.3), and the solution of arsinous acid {Li'fuor 
Arufi ArMettuMi, V. A'.), the y\tme of wliicli in 1 to 5 iai!i(m.>i(O.IJ5-0.3). 
This i.4 more irritatiog to the ttomach than the other preparations. 
The iodide of arsenic etitcra into Donovan's sulittioii (Liquor Artenii 
rt Jfy.irar^ri loduU. U. S. and B. /*.). the do*e of nbich U 2 to 10 
minims (0.1-1}.G5). well diluted. Iodide of arwnic {Arnt^iii Imivlum, 
V. S. and B. P.) is given in ^^g grain (0.003) doses, and arst-nate of 
sodium {SoHii Argenas, I/. S. nnd B. P.) in the dose of ^ lo -^ of 
ap«i& (O.U02-0.(IOt>). Liquor Amcniei ffydroehlori<tu9 i^also oiGoial 
!■ the B. P. 

Ustairard Effect*. — If arsonie i« taken in full dote by a em- 
crptiblc person, it may cause a marked dt-naatitis. -n-ith :i Hensation of 
serere barninjc in the tkiii. PugtuUitioiu^ may iKCur. and Falck aeserts 
that an erysipelatomt •Hate may arLite. Almnst any t'orm of skin le^iioi) 
may follow its use imeraally or externally, but nearly all stow irrilu- 
tion of iht; true dkin. Ereti a scurlatiniform eruption followed by des- 
quamatiuDd may ensue. Io other cases the mueou^ mcinbruneH become 
ntSamed and rar^'za and diiutrders may develop. (See .VdminiHtration.) 

Acute Foisoning. — Arsenic if> a gn.'^tro-intc^tinat irritant, prodneing, 
whcu ukoii in poisonous doee, violent voiniiin); and pur^iug. niUi 
great pain in the oesopliapiis. stomach, and entire befly. TLo passages 
finally become watery and r«seiuhle "rice-water" ntools, but are to be 
aepAraied from tliose of cholera and antimonial poisonin;^ by the pr«>- 
enee of blood and, if neceHsary, by chemical ii.nat>'»i.s. The mucous 
m«mbruie it strippod olT the bowel and appmrs in .<<brt>d.« in the pa«> 
nglin Aery commonly about tbtr third day. if llie piitient survives go 
{sag, an intcniiissiou in the attack sppeartt, which will be folluwed by 
a retttru of all the symptoms, rsn iliat the pfaritician must not g^irc & 
fiiTonble pnogDusiii. lu thiii sympl^tu (remisfiion) the course of arxen- 
ical poi^uning resembles pbosphonis-poisoning and yellow fever. Death 
trfMicralty iKTum about the (oarth ors^ixih dav, ar>d on or about the 
third day a pec-ulinr akiu vniption i^«ni>i*tLmL-s ajipeure vihich may be of 
any character. In rare ca8«e siuldi-ii puiii, oolla|iso, and death may 
lakv place ailcr the ingestion rf the poison. Wideepvcad multiple 
DMiritia may he brought on. A tvpical change alnayx prt^seut iu acute 
poasonlog tiben the patient lives for any length of lime is fatty degtn- 
tratint of all the tismea. 

TnEATaENT op Acute PoiPONiita. — In uddition t^ washing cot 
the su>mach by the stomach-pump, a[)plyiiig extenial boat and Ktitn- 
BlaatB. the proper antitlotee ohould be at once employed, and Uic only 



100 



DRVOS. 



ones of anj value are the iVeelilj-precipitated hydrated 8««qaioxide of 
iron and mngnc^in. (S*o below.) T(h' first is lo he prepared by ih« 
precipitation of iron frutu one uf iu fluid prcpunitioiu uy the uite of nn 
alkali. Ammonia aijded to tli« tincture of the chloride of iron is effi- 
cacious, but tlio prmipitate has to be repeatedly washed to rid it of sii 
excess of thin irritunt. Magnesia is n better preeipitaiit, bernU9« it not 
only preripitateti the iron, but is an antidote iinetr. Mouael's solution 
and the sn^enllcd dinlyzed iron may bo employed in place uf llie tiiic- 
torc. hut Moiisel's suit i» ton irritating, iind dialyicd iron is »« readily 
proeipitn,ted tint it ueedc no alkali, but may be given pure. Magnesia 
is a useful antiiiote when \met\ alnne. 

TJiider the name Ft-rri Oriifum ffydratnm cum M-ijfneMin iho If. S. 
p. recognizes an antidote fur arsenic: thin iit orteii ciilli-d thc"a/i^»- 
dotum aiii'tiifi." The C^. S. J', directs that this antidote should be 
kept mi liuud fur inim[:diiite u^e in the following manner: Mix 18| 
fluidriicliius (50.0) of the oflicial solution of the ten^idphate of iron 
{/lii/uor Ferri TrrsiilphatU) with 4j ounces (100.0) of water, and keep 
tlie mixture in a well -stoppered bottle. Rub 150 grains (10.0) of 
ma^Mi-^^ia wiih u little water to a. Hniooth and thin mixture: transfer 
it to a buttle eutiitble of huhlin]; 3^ ounces (1000.0), anil Bll the bottle 
wit]) water. When tiie antidote is to be UBed, add the magnesia si^a ' 
tion eibmly to the iron solution and shnko together until a homogs 
nvuus ma»s results. (Sec Iron, Hydmled, Seatjuioxide of.) 

After tho \xm of the nntideu* emetics should be u>ied, upiuui aboulil 
be admini»tcrcd to allay irritation luid pain, and lar<;e ilniuglitA of 
water be givpn to flush the kidneys and dilute ilie poison. In the 
lati>r stages thu danger from uracuical poiaouiug arises from the chaiigcB^^ 
pTuduccd iu vital orgaiis. ^| 

Ohronic poisoning by ar»cnic shows it«elf in ^rcat irritation of the air-^^ 
passages, in iIjo development of nephritis, in pigmentation of the skin, 
and in nervous symptoms due Iu iufiiimmutiuii,'t uf the nerven, such aa^| 
patches uf anH3slhesia and loeuHzud li>ss of ujotor power. Tt>e«e^| 
aniesthetic ktcli are generally confined to the rxtremitict, and extend 
only to the first or the seond joint above. 5!i>metimes the multiple ^1 
neuritis caused by arsenic ^Ives rise to symploin^ which reeemblcthoso ^| 
of locoiiioioi" ataxia to a very coiifiiderable i-xtenl. In other rases the ^\ 
action <ia the »kin ii^ the more marked, and vurioiiH neutc iullammatory 
conditions are produced. .Arsenic ofien pniducfs asthma in thoHt 
exposed to it, by reason of the irritation it causett in the bronchial 
tabes. Chronic poisoning is to bo treated by withdmwal from tho; 
exposure and by the use of iodide of poiiusflium to aid in the elimi- 
nation of the arsenic. The spwia! symptoms are to be treated by 
the application of electricity, tonics, "ut-of-door life, and ^'ucli nieaa- 
nres as will improve the general condition of the patient. The pro- 
longed une of aracoic, according to dc Sohwcinitz, may prmiacei 
vitreous opacitiea. 



tie . 



I 




ASAFCETIDA. 

A9<if(tti(la, U. S., A»afcti<ia, B. P.. h a gum obtained hy inalilug 
nil incision into thv root of the F^rttiu fivtidn. It occurs in irregular 
maseea of b dftrk-yellow or reddish color, wbicli become still raoro 
real if exposed to tlio li^tit and air. Asafcccida in teara \a a term 
applied to tlie dnt^ wlicn it appcam in the shape of drt>p9 nr penrla, 
and ifl a form seldom seen. Ita odnr i<< iH^nptratiDf; and !<trong, and 
resembles tliai of ^rlic. When taken iuicrniUly it cattaes a sensa- 
tion of wanatb and nets as a attmulont and canaiuative Id the ali- 
meobtrv canul. 

TherajMuticB. — A^fcHtida is used in medicine as a carminative 
irhiub will particiilarlj afTect tbe lowrer bowel, and is useful in the 
iat/TMtinal i»iii-ji'»tion of old persons whtn oi^oeiaUHl with pititlence, 
and iu the flatulent colic of cnildrtn. In"the fonn of rottal iiijectiuna 
ii is of value for the relief of the tympaniten of children and iu that of 
adults daring typhoid fevrr. It is also used as a etimnlating expec- 
tof»Dl ill the later stages of hronchitU. In the nervous irritability of 
children it U often of service. 

AdmlniBtration. — Aoiifielida is (^iveii in pills of asafeelida (T^iVuffr 
Asafeetida; [.', S.). (if which two or thriw; may be taki:li, each one 
eontaininp Sgraino fO.II^) ; the emulsion or milk of aliafletida(/^Iffu^ 
ntmt A»<\Uftid(e. V- o.), the dose of wbioh is ^ to 1 ouuce (15.0-30.0); 
and the tincture {Tinrlura Atnfinidtf^ U. S. and B. J-"), ^ to 1 lluid- 
■iruchiii (2,() — 1,0), The mippwitories cnninin what is e()U(il to 40 
.ir>.|»ii (S.U) of thi' tineinre; and the pliwter of asflfajtidft [Kmjil/inlrum 
A'lijfittiflir) i.s used where a. faint coiiciter-irritiint mid antispasmodie 
i* tieetled. When infenliiial indiye»lion uud Jtdlv-lenee occur in old 
people the following pill is of service: 



fit, — KzL DDCts tODiiac 
£xl. koJa> .... 
AnfoiliilK . . . . 
Fl. in pit. No. IE. 
S. — One aight anil miirainy. 



. .gr.tiOJSO). 

. .gr.Tiaao. 

. .gr. zl(2II).— H. 



The B. P. preparation not official in the U. S. P. is PtMa GaU 
U-tni C-'tftpotiUt. eotnp<.<niHl of asafcetidu, gulhanum, and myrrh; dose 
6 to 15 grains ^0.32-1.0). 



ASPIDnjM. 

Atpidium, U. S., FiHx-ma9, B. J*., or Male Fern, the rhiaome of 
Jhyapterit FiUx-maa (or Atpidlxtm FitiX'mat^ B. P.), is employed in. 
oit4icin« t» a tn^niacidc or remedy against the tape-wcrm, and is a 
Terr eflicieol and valuable drug under such circuninduier^. being, per- 
bap*, the ninst reliable of all the vermifuges except pellotierin. \Vlien 
ODplored tli<> di recti on-':! and precauticins given in the article on Worms 
most be strictlv followed (Part IV.). 

Male fern taken in overdose is capable of producing poisoning, 
and according to Quivill caascs when taken in such a irritation of the 



102 



DRVQS. 



btru-Uitestinal mucous membrane and diarrhcen. If al)!iorbeil it acU 
on tlif ccntrul nervous system snd causes ptmilvaiB, collapse, aud dt-nlli. 
The form iind meiliod bv whicli it is oHuiiualea ure unkuown. It mar 
in overdui^t) ciiumr ulltumiQuria and glycosuria. To go bryood 1| 
drac1jm» of tlic uluurpsiii (0.0) ut a doi*e is dan^entiis. 

Adnunistration. — Male Tern is rarely, if over, uwd at pree«Dl in 
ila crude form, being ciL[iloycd most commuQiy hi this country in the 
form of tliu olcorcein (OUoreKina Anpidii^ V. *V.); dose ^ to 1 Quid-, 
drachm (2.0-4.D) in capBules, or as ({illows: 



ilv. iua«<i> - 9m IM>. 

Aq. (iMlillat. fS (82.0).— M. 



Piilv 



S. — TbIep <-Dtifc uiiiount after fucttn^ and follow id iwo hoars b;r a foil dOH • 
ftulphnK- or HiU|{iimiiiro. 

The dfise of the licjuid cx\Tacl{Extractum Filirin hiquhlum) of the 
B. P. i» 15 minims Ui 1 fluidraclim (1.0-^.0). 

Kataiuaya. und Okamoto, two Japanese invcgti gators, and Foulsaco, 
all Mate that r-astfir and other oJIn slinuld am W u»cd itftcr filix-mae ia 
givra. a.4 oiU iiMTPnxo tlic absorption of the active principle, and so pre- 
uispoae to tlie devulopmeut of poisoning. 



ASPIRIN. 



i 



Aspirin is auelyl -salicylic ncid, and occurs in wliite crystatliDC 
needles which melt at 135'' C. and disaotre in water up to tbe Ptreogth 
of 1 per cent. ]t is pjiaily dissolved in alkaline Huiflii. Owing to 
its chemical constitiuion, aspirin hii« been recently introduced into 
medicine aa a Hub6titut« for the ordinary itaHcylateii ; and an it is dift> 
Bolvcd and ahsorheil in the bnwel. as is aalol. it dues not irritate the 
Htnmacli. It is also not so disagreeable to the ta«lc as are most or the 
8alicylat« preparations, and it in claimed is less likely to cause tinnitus. 
The (lose of aspirin aa a remetly for acuU rftnttnaliam is 10 to 15 
gmius (0,(i5-l.(*) thre>c time? a day or ofUoer. It can also be employed 
as an inle^final nntigeptir. Aspirin may be given in cansid<>s or in 
pill-fnrm. Snnietiiues it m given in syrup of iicacia ana wutcr, tbc 
mixture beiog well stirrvd or ^haJccn boforo liie doao \» poured frou tba 
bottle. 



iin tna. I 



AZFIDARACH. 

Atedartufh is the bark of the MeUa Azedaraeh, or Pride of China, 
an it is jiometimcs called. It ia found in Syria, Pema, tbe uorlli of^^ 
India, and in the Southern United tStalea. ^H 

The berries have but little toxic power, and children may eat of ' 
diem largely without ill elTcct. but the bark \i puisunous when taken 
in overdose, and produces ttymptoms rc^tenibliug those of poianoing by 
spigcliaor bclladnnna. It i» ruiploycdaa a remedy against tbc r&iiM J- 
ij-orm. and sliouhl be given in decoction mude by builiug 2 unnces 
(60.0) of the drug in 1^ pinta (750 cc.) of wator until there onl 




BARIUM CHLORWE—BELLADONNA. 



tos 



reraaiiiB & pint (iiOO ee.) of liqnid. Of this, from 1 to 2 tahletipounfiils 
(lA.O-JJO.O) lire to be giren & child, and repuaied wvory two bours' 
until iho bowfis nrv opfoed. It has also becii usrd as n fluid extrfttrt 
prepared hy tbc ordiasrr meaao with aloolii^t, tu which vnxw. Trhito 
suj^r sbottld be added. Tho dose of this extract ib s tea£poonful(4.0), 
and it 19 not to be repeated. The decoction is tho best fonn in which 
to ose the drug. 



BARIUM CHLORIDE. 

Barium chloride eIovth the heart very greatly, eleadiee its rhythm, 
and at the same time increases the volume of blood thrown nut of 
the rentricle. It also incrcBMS blood-prewtiire, and Robert has. fi-oin 
a aeries of careful experiment*, concluded thnt it brings about this 
chanf^e by an aotiou on the muscular coats of the blood- vtasels. 

If large diwes are used in the imver iinimalfi. the heart sufl'ors »y*- 
mlic arr«*l from over-atimtilation. and the stroiigewt irritation i»f the 
'vaew tturreu fails to relax the fiVHtidic contraction. !StiU more inter- 
caOiig is ifae statement that this failure of ihe va^i to inhibit the 
heart is nut the rcault of paraly^nis «>f tbewe tierws, but is si«]i>3y due 
to the excess of CAnliac contractile piiwer. The slowinR of llii- |iuUe 
i* not due to iiihibiiory influence, but depends solely ujKin ibe )>timu- 
lation of the hearl-iniiscle, although it would seem prnbahip that the 
TaBomotor ftimulation. by iuci-casing the arterial resistance, may be 
at k'ost a betor in the redncti»n of the pnlso^rate. 

In m'Mt works on cbemietry barium ia stated to be an irritact 
poixnn, but to prndiiee ««eh evidences cf its presence the dtiJie given 
mw\ be exlremely litrge. aud luauy times greulcr than any amount 
aful for iiiiiliciDal purpni^iit. 

Therapeutics. — Barium chloride mav be n.tec] in all fonnn of rvr- 
(iiac ditfatf- in wbieli failure of tJie liearl-muHcIc is pretient. In the 
treatment of varii'ote iviw* it Is aaid to be of value, bf.lt when given 
intcniBJly and applied Incallv over the distended Te.wcl«. 

A poini wiirtiiy of reniaric \» the character of the pulse-wave pro- 
duced. While ile voltinie is increased, it does not give that ncnNitiim 
of tenBenesn to the finger that doen the pulne produced by digitalis, and' 
the pulse-wave eeema to be very considerably prolonged — a fact that the 
^hygmogmph also recordii. 

Arlmintrtratioo. — Tbc solution of barium chloride to be uHcd intei^ 
nslly ahould have tho strength of 5 grains to the ounce (0.13 : 30.0) 
of wat«r, sad of this 1 or 2 drachms (4.0-^.0) ure to bo given three 
ttmea a day. 

BBLIjADONNA. 

Belladonna is botanically known aa Atropa Bdhdonna, and ie 
ofSdal in the form of the root {Bflladonntr Radix, IT. ,S'. and li. P.) 
and Imvch {BflladoHnte FoUa. U. H. imd B. P.). Ita popular uumo 
ia "deadly nighlshade." The drug belongs to a very large class of 
planta. namely, the Sohnacne, which all have a aimilar physio- 
togical action. Belladonna containn an active principle in the form 



104 



DRUGS. 



of nn alkaloid known as atropine (Atropma, U. S. and B. P.), which 
b itiKolublo ill wutoi-. The sulphate of atropine (Atropmtt Sulpkaa, 
U. S. and R. J-".) iss^olulito, and is the salt comQioulT ii^ed. 

Physiological Effects. — [n oiikn, full medicitial dosci* prodace flush- 
ing of the face, redness and drynesa of the fauceK. dilated pupils. 
fK>DietIm&s All tfrvthcmnif.'us ixtsh over (be skin, rarely diplopia and 
dolirium. If the do«e be still larf^er. the delirium ItpcnmeA very 
marked, ami in nild n.nd lal kati re. Tho ptilne h rapid and wiry. Tho 
nish whieli uppears resemhlea that nf tirarlct fever, hut lacks ilie punc- 
tations. The ekin ma^ dcai^unmatc uflcr the Inpse of oeverat dujrs if 
the msh is severe. 

In children belladonna is usually Vnme verr well indeed. When 
bDlliLdotina iiaserta itself in children and in suBceptiblo adults tho res- 
piration is (laickened, the eyes become bright and the cheeks red, but 
lines of pallor reach from tho malar bones lo the angles oC tlie 
mouth, giving to the face a curious exprcaaivn. 
Absorption. — This dru^ is vt-ry rapidly absorbed. 
Nbrvoup Systkm. — Belladonna when given in medicinal amoant 
approaching llip toxic dose acts as a powerful exciiam of the brain, 
producing tidkative duliriuxu. Lucalty applied, il dcprus»us the peripb* 
erul Hanmjry nerves. 

When very lari^e do»M are given t« animalsv paralysis of the spinal 

cord comes on, followed by Iclanie HpaKnis, and finally by reeovery. 

The primary losa of power is due to puralyitis of the entire cord. 

and the awjond stalp, of eonvulsioiiii. to the escape of [he motor and 

raensory pathways from the paralysis before tht- inhibitory centres 

'recover. As a result, any periphond irrilatiou onuses violent explo- 

MDOa uf motor power.' Even in lar;rc medicinal do^e belkdouna may 

bo cunKldurvd as a depi'Oiisu.ul to the motor nerves aitd as a (|uieier to 

EtnBory nervc-filamenta. On voluntary masclou the drug has no effect, 

'Itat upon unstriped muaeleR It acts as a sedative and antipasmodir. ft 

distinctly Ie»sen!( retlex action. 

Circulation. — Belladonna •inickem^ the pulse by depre^ion of the 
peripheral vagi and by cumulating the t'nrdia{r niiiH(de tind the accele- 
rator nerve-s. [t produeea a rise of arterial pre»isure by stimulating tho 
TBtfomotor centre and by the increased heart-action which it causc-i. In 
[poisonoas doses it causes a fall of arterial prostiure due lo centric vaso- 
motor palay, and depn»«i«n nf the mnnciilar cnati^ of the blood-rebels, 
but ntrt to cardiac.- depression, as has been genemlly tanj,;ht, for Keiehcrt 
has proved that the drug is not a. heart-depressant uideas the dose is 
■imply overwhelming. Sometimes when belladouna h given the pulsa 
ibooomea slow, but in these ea«c» ttie slowing is due to tem]ioniry stim- 
ulation of the peripheral vagi or to momentary depreiution of the cardiao 
Intotor gan^itia. See Kigs. 13 antl 14. 

RespiiJation. — Atropine n a miraalant to the respiratory cenlw 

' If K Iiimiclr "imile, tnnvwi nmM hr tlw wriier in tearhinK, nmv hr tiB«l, tlw 
inliibilory tvilr** mnv bo i><|>r«M.<nt«<t l.y rt K'lKKi]iii(i.->l<rr nnd ih* iioHor mH •cnmiy 
ccDinv hr |wi. l«ov». Till' i-w^iw '.f i-)ilnr.>(.>riii in Uiu room piual^rsn i1k>iii all, iiiil, 
liiutllv, lii6 hofa tveorer hpfon l)H>ir tiiiwli^r ami gi> nff wt innnlii (oonvulaioiH) ; u 
lut til* auMW (iaUbitor; ceotrvet niMron^ ind onler, or IwalUi, U ralotod. 



I 

I 

I 



I 





A, jUMfitBC dcprexm lli« prrlptwral viuci anil mtlRiiiliilFi Ihv oFoclorator nerm C It rmlM* 
utorlal pmaun lij aliiuuUtiiiK ibe Tuiuiiiotur centre ir. 



iwtpiratinn it all, ami it w certainly infprior lo coiTce and otTTclinin* 
in llio treHtmetit of o[tiiim poisoning. In large dnM^x it in a ileprcR-smil 
auil paralTxant tn rt'»|i)mliiiii. and prmlTiws ilealli fmm rrspiratnry 
failure Ju« lo panilv>ii» uf the motor nerves supi)IyinK tlie rcsijiratory 
miuelpa, ati<l proluitily by tl(?[irc»sing tlie respiratory ccnirfn- 

Abdominai. CoNTBNTi^. — Bcllftdonna inorciuvs pcristalsi? by ilu- 
pressiDg the periplioral ciicIh uf ihc inhibitory filirest of ilic apIancLoic 
n«rvo^ and by dituinitabiiij; any lendeocy to'epatilti un the part of the 
iiiii.iciilar coat5 of the intestine. 

A'TioN OS JNKrKKTiiiN. — Tlio drug deoroa-ics all the speretions of 
the body except ilic urine, which is suiuetiuii'!t iucrt*KSi-d in umoimt 
uDilrr ii» Hw. Thp ilocreaiie of secretion is due to paralvsis of the 
peripheral nervc-B lament* supplying the secretory cells of tho 
glandH. 

BonilT HSAT. — When helladonna is need in larye iiiiiounts there 
in nearly alnayx a ri«e uf (L-iupeniture, wliicli in iliildii-n iiiiiy auiuuut 
t*i '.lie <ir two degrees. In advuuccd poisoning iho tcmponilure rap- 

EuiMntATION. — Atropine i^ eUminated by the kidneys and bowels 
with extraordinary rapidity, anj tbia la one of the rensons why death 
froto poisonous dose; of the drii^ in m rare. J. llarley a^i^erts that it 
w entirely eliminated in two hours, and Vlenriot titaten thai not a trace 
of it can be found in twenty-four hours, and thut it i? partly defttroye^l 
in the liver. In a auvpccted caM of |ioi8oning the urine of iLo patient 
may be dropped in the oyo of an animal, and, if atropine or belladonna 
ku bc«n taken, mydriaxis will result. 

Ettk. — *.h\ the eye belladonna proiiiiceif dilatation of the pupil by 
stimulatiug the a^iupatlietie nerve-fibres uf the iris aiid [)aralyxing 




106 



DRUGS. 



tii« oculomotor fibres peripherally, hot the douiiaant &ciioa of iL« 
drug 18 undouf»teclIy exercised upon the circular muscular fibres oT \\it 
iris, vfhicli are (iepressod (Jcasiijr). Litinuer bus rccenily asserted 
that tlilnUlioii is iitit (tut- tu 9yiii{iii.lUL*tic slimiiliitiuii, but •leMittiji'* 
con r1 IIS ions are gMierally aceepted as correct, although the teaching 
as tu the iufliiL-ricc of utropinp on the eye ha.** changed severnl timt--^ 
ill the last few yea,r9. Belladorma generally iDcr««»ea ialni-ocul&r 
lenBion. 

Poiaaning. — ^I'oisoiiiiig by atropine is an exceedingly common occor- 
rencr, but iU-iiih i.t rtircly prndiir^l by il, partly because its influence 
iH not very lictivoly exorcijte'l on vital pnrts and partly because it i» 
elimiuateJ by the kidneys alino^l as rapidly as it ia abHorb^tl Iroui thr 
stomach. Kecovcry hns occurred after ts much as I (jrain of atropine 
hail been taken by a rbild of three years. A»ide fratn the ^ynipt(int« 
uf mild pui>iaiiiiig detailed under the heading of pbvfiiologieal action, 
severe poiwiiiiiig is ch-Tiactcrizeil by d(«p sleep, preceded, it may be. 
by cunvuUiotis, violent delirium, blindne^^. and sometimes lo«a of 
speech. 

Thkatmext op Poisoninq. — Poiconinp by V>ellndonnn ih to be 
treated by emetics, the applicnlion of external hem if the patient goea 
into collapse, and the usn of strychnine if respiration fails. Opium 
may be employed in carefully gnided dos<a as the physiological niilag- 
oni«t ; but large doses areof doubtful service, partifuUrlv if the reapi- 
raliuu?! an- nnt in a salisfaclory state. 

Therapeutics. — l{e!lftd(>nnn is used to allay rrcfxmv secretion, to act 
aa an itntiitpaKmoJie. and to influence Uic circulatory apparatus when 
li>c(i( injUimmationv are beginning, particularly ia secretary glands, 
luid 10 act as a vasomotor stimulant (Kig. 14). In cartliac palpitation 
small doses of belladonna intcmnlly, or its exiernal use over the prrceor- 
diiiui in lliR fiirm of a plasler or oiutuieut. is very vuluiible. It i» our 
most useful vadomotor stimulant in coUapaf. Belladonna is of vnlue 
in Ki-wahjias and In the pains due to irritjitrd peripheral nerve.«. 

To cheek secretion in niffht-siu'eafiii it is one of the mo«t poveHiil 
remt'diiis wc liuve. and it is useful in excessive iJuipathic fiftyaU»m. as 
seen in children, or in thai due to niercuria]i?.ation. lu ftr&mijrftfiii 
of till- /erf and nthiT lucalizcd Hwcalings it i» useful, iind may bo 
employed loi-ally or taken iiitemally for their cure. It is the most 
efficaeiotis drug we bare fur ehrcking the wirch'on of milk in an 
inflamed hreflst, and under ihcse eircumslances it is to bo smeared 
over the gland in au oiutment. Belladouna may be used in HcrauM 
tliarrha'a, as it checks Ihe disorder by stimulation of the pplsnphnio 
vasomotor filaments of the inifutinal blood- veswl.*, which being inac- 
tive jiormit a transudation of liquid into the bowel. 

Trousacaii rceommouded a» a local remedy 1 to 2 grains (O-OJi- 
0.13) of the extract of belladonna -with 6 to 8 grains (O.SO-0.40) of 
tonnic ncid in leucorrhata dependent upon dineoDe of the uterine cer- 
vix. This should ho placed on a ple<Iget of cotton and applied to 
the affected part daily, being allowed to remain all day. Ringer 
tttatea that if pain is aUo present in thv^e cases the following injec- 
tion 18 of value: 



ItKlT^tDON.VA. 



107 



B.— >*(>JiiMntrtKiiMlli IS (*■<>)■ 

Tr U-llndontuc (pi 18.O). 

AqiKC dwi ii.i.miC^ (fiOO oc). — M. 

Tbis is to be iiik^ied iuto ibe vagina, tlie womaD first b«ing place*! oq 
ber back witli lier buttocks raised, bo tbat the drug may batbe ibe 
uterine c<'n'iit fWr nome Tnitmies- 

A-s an mitisjMusinodic, atropine is to be used in titrute. torticoUU, in- 
jwiod directly into lltc muscle itself. 30 as lo aut on its motor ucrve- 
bbn» ; it tDay be given in spasm of (he iiitcAtine witb cr<tmp» and tprip- 
mg. In erampi in the lege <ir*d iod^, eitlier a« a local application 
by means of liniments or wben cmplojed internally, it is of service. 

Piw. H. 



ruwwVi^ 



Wf 



n 



in 



IV 



mmitnxiatatptmmtt* fVAi «nil tnilito :2)^ In HI lUHMindii ; n. Pn-niiirflout-n'iJlTV t>ll<.<''nF|>lri(> 
t» H. pnW I>; It I. Tnu-Itit; Fuotliixnl, jifVMUiu, T<)i IV. Altu^iiiv haw 1iwii Jlivi'ii, rdl-iug 
ife« (trawiin: to UTr. jtubu sCi 

Id aathma of ibe 8(iasmodic tvpe bellwbinna is a sovereign renioily. 
pArticnUrlr if it be ccunbinod'with morpbiae. It maj- be used both 
M a propb^'tactic and as a cure durin;* the attack. Belloduuna-leaveB 
may i»p KntokeH by asthmatics, by rolling them into a cigarette or puc- 
linx them into a pipe. 

Tliis drug ifi nsed in •wftoopine/ i>Mtgk at all ages and in all »tagc«, 
bat it nau&t be given \n large amonnts in this disease to do any good. 

Id 9pa»m ^ thti sphincter ami, whether it be due to fsnure or 



other causT, bvlliwloiina iu tbc form of an ointmnit or sappo^itoiy 
JB of value. In uparm of the vrelhra and hlaiider tlie ^Inig intiv be 
used ink'ninlly »nd externally, and in the fonoev stale the oiniment 
sliuuli] be gmeai'oit along tlit* under surface of ibc penis every night. 
This tn-aiujt'ut is also UHcfui in chordce. In the rn/ti; resuliiiig Iruui 
the paswige of hepatic and renal ealfuU belladuunu in full <IoBe will 
very often give relief. Where urmarv mrontiitmcr depends ufion 
s\HLi,m nf the bladder belladonna should db used. (See Urinary Incon- 
tim-ncf.) In ilynni-norrh'ft in nervous women, with .spai^m of the 
cervix uteri, it ig uf very great vnlne applied as nn ointment or in n 
vaginnl suppository, nr whon givi;n by the uiouth. For the nrrvoiu 
eowfh of i'hildrfH and adulta belladonna ia one of (lie best remedies 
wf have. Id voii-»tip<ition it does good by depressing the inhibitory 
nervvdt of the inlciitino. It is also of value in larifngmmia stridiUu» 
and in hirt^wih. In npasmH from peripheral irrilAtinna bt-lhidonna in 
of value. In irith atropine is used m dilate the puidl nnd prevent 
adlu-^iuus. The solution to bo drupjied into the eye shuuhl eoniain 1 
lo 4 grains (^'i.OrtS-O iiti) of atnipiue sulphate to the oiiuce (3<).<1) of 
wntcr. Atropine Bnlpliate in atan used for the purpate of producing 
mydriaaU, before ophihalraosflopie examination, in Holutinna of the 
strength just given. It increases inlra-ocidar lent-ittn and is contra- 
indicated in glmicoma. When employed to act on the eirculation it 
is to bo uned in ahork and tuiUaf)tt from injury or in the coureo of 
severe disease. (See Shook.) During the jirogresB nf a ease nf 
pnritiniini'i. ffiphuid frrrr, or other neveiT di.sea.sc' hldhidonua should 
DO kept in the h<i»ao, and adminintered freely if collapse or rajiomotor 
reluxaii'iu suddenly a.weri.t itself. Particularly is this true in the 
fs^ti of pneumonia. Tlie vswcular system after the cri.-ii.t of this disea-ie 
will often be found much relaxed, and henrtnUniuUnia do not MfUi lodo 
much good. Tlie administration of atropine or belladonna will dry the 
leaking ttkin, and by iucreBung the vasomotor tono produce great im- 
provement, lu muatitid. or intlamumtion of the brea,st, even where pas 
is beginning to be I'oniied, belladonna, if pu:<hed, will give surprisingly 
giioii resulni if given iniernatly and applied loeully. Id acute v«rf 
thrr/'d. when ihc ))haryiix Laa a isewsation of rawness, while the local 
capillarieii ap[>eur iujeeted nnd red, belladonna is often of the greatest 
service if given in full do.se, almrting the "cold." In exophthalmic 
goitre hellndontui is thought to aet hy stimulating the eympathelle 
norvctt. and certainly givta relief ia some coal-s, particularly if combined 
with Fitrophanth U!« or digitalis. For the relief of local nen'e-pains it 
i» of value, and proliahlv ai^ts by (jMieting the irriluted ueive. It 
should ho npplii>d in these axst'n in the fonn of an ointment or plaster, 
and if the oiutmvnt ia used it should he well rubbed. int» the jtart 
affected. 

In headache occurring in young persons, oflen due to ocular ovtr^ 
work, xcith pain in the eycbatls and forehead and a Bcnsation as if the 
orbits were too small for the eyeballs, bellodonna It of service. In 
intfmogt^l m-uralffi'i or j}!eurodi/)iui liolladonns plasters may be applied 
to tlic spot where the pain is felt, with relief. 

Um of Atropine lo Poisonlnf. — Atropine is a phyniological antidote 



* 




to opmm. Calabar Lean or phyflosiigma. &nd jaboranili. In opium 
poisoning it acts as an uniktoic in all purts of tliv body except thf cjre. 
aad in jahurHmli puisoniiig the same facts hold tnns but in the fonner 
condition. althoii);h it has boon lar^Bly iispd, it \a no longer rrgardcd 
u a satisractory antidote ; and cafTeine and strychnine urv jircterallt. 
The condition of tbc pupil a not a guide as to the cfl'ect of atropitto 
in opiutn [MiiMining, because opiiiin nctn nentricully and nlropitif acts 
peripherally on the nerves fjoveniiiig the irie. Atropine »hould be 
■i^vd in aconite, antiiuony, and bydrocyuiiic acid poisoning fur it« 
sliniula.ting influence on the viiaoniotor system, tlio rtspiratorv ecntrc, 
sod the liexrt, and for the jiurixMe of titiiintaiiLitig the bodily heat, the 
(lisdipatioo uf which it retards by preventing vasomotor pal$y and 
contwijuent dilatation of the peripberul blood-vessels. 

Atropine is a valuable pbysio]i>^'ical antidote to poisonous musb- 
rooma, particularly the Amanita, an it is antagonistic to their potnon, 
moscarine. The doae Riven should bo larse. and if need be repeated. 

Admiuistration. — The dose of the eulpKaie of utropine (Atriipiv(r 
SulpJi.i», U. a. and B. P.) is ^ to ^^ (M.0(IU4-().I3U16) of n gi-ain. 
The ttloubolic extract {^Extravtum Belladonna Foluirum Alcukolicutu, 
v. S.) is given in J to + grain (D.O1-U.015) doscfi. and the tincture 
i^Tincturii liiUiiilomtir hoUorunty U. tS',, Thirlitru /iiHa'timii/r, H. /*.) 
in the d.ido of •') to 16 miniros (0.:i-I.O). Jlolh ttn!*e pri^panition.'* arc 
dcrivi'd from the leav«i. The fluid vxUvkrt {Kxtrtu-lum Bflhidouiiw 
UadiftM Fhixdum, U. S.) u given in 1- to il-minim {0.(J*j-i). 1:?) doFos, 
vhile the extract {^Exinictum Jielladoiintr Liyiiiiivm] of the Ji. P. is 
given in |- to 1-ininim (0.0t5-i>j05) doses. These pvepnnitionB arc 
iiurived from the rcHit. Belladonmi lininieiit (^Llvhumtm!' BtiUaduntifr. 
U. S. and B. P.), belladonna plasier {^Jimphietrum BfUaJ<inna\ V. <V. 
and li. /'.), and theointnieni:(C«^«(i(/Mm litiUuhivm^. V. S. and li. /'.) 
arc for external application. The pr^pn ration*? of t>ie B. P. nit •■■fticjai 
in the V. S. P. are Lii/uor Afrovma- Sulj'hatU. dropptil in the eye iu 
til© do«o of A to 1 minim (O.Oy-0.tM>) ; J.anifU-T Atroj-inft^. c^nh of 
which conliiins ^ A ^ j of a ^ain of atropine ; ar<l f'nijnmium Atrnpmir 
and Krfractum Btlladeruna: Alcokoh'cum, derived from the root, 
Sureut firlUidonme, B. P..\i fivv.ti \u 'i- to lo-iniiiiin (l(.3-1.lt) do&es. 
There arc iil*o a groon extract of belladonna. ofBcial in the £■ P. under 
the nnniv nf Kctractum BrJladonrnf \'irid>\ and a HUppository (.S'm^ 
p^iU/ria K^Hndonnct) which oontaJni* li grains of the extract. 

OontraitMllcafcloiia. — Recent experitnenis i^bow thnt belhidonnu tie- 
cT«w« gastric secrciion very considerably in some persons. It is 
hclter, therefore, not to administer it just l)t'forc or immediately after 
a meal, unlcsa it xa desired to reduce this sea-ctioo. 



BENZOIN AND BENZOIC ACID. 

Benzoin {B'ir?/»r»Mm, U. S. and B. P.) ia a rosinoiw hnlnam derived 
from the St^rax Btnzoin. which is a niilivc iif Sumutni, Borneo, and 
Java. Benzoic acid i« oblaiiu'd by the xuhlimHtinn of giiiii benzoin, 
or b prepared artificially, chiefly from toluol. The last method of 
|>n>parBti'>D is not to bo reoommcnded, ar the acid t<n tnnde often dia- 



no 



jfRuas. 



I 



I 



nr(l«rv the stomach niid leaves a (ti8ft<*ree!ib1c taetc in the mouth. It 
13 lienzmo acid which is generally useJ in medicine. 

Physiologteal Action. — Loyally applied iu co n«3Dtrat«l form, hen- 
ziiic aciil is nil JrriUiiit. and taken iritcriiallT in excessive amount it 
causes a apn^ntiiMi ut* vrai-mth und buriiiii<;. It ii^ etiroinnlcd :\^ hippuric 
ui-iil and lucron^etf ihc aci<lily (li* the- urine. It is an autiavptie antl 
gcTmit;i<k*. In pernors having un idioBynfrasy tu bptizuic aeid it is 
nut imcomtnon for urticum to follow the use of the drug. Sometitnee 
a papular or eryth^uialoiift eruption appears. 

Therap«atic8. — Benzoic acid is useful in the treotocnt of chronic 
i-ii»riih ftiih alkaline urine which is loadi-d with phosphates, and. 
CDiuhiucd Hilh cannaliiH indica. art!) vtoll in the later «tiigc-s of gnnor- 
rhnvi. Soiiucor «(«tc» that in a d<t.te of '2 or 3 dnn^hniK (8.0-12.0) 
a day it is n npt-cihc iu aeute rhifUmatiam, and thinks it ei{ual to Sati- 
cylio aeid. When these do«ea are to hi- usisd, thi> hvntoate of sodium 
^ould he employed, owing to itd soluhility. In lUrtUa lari/niiitis 
accompanied hy p'eat lioarsenesB the inhalation of steam lailen with 
coiapuutid tiiivturi' I'f lienxoiii h of the gn^atest service. A tahU- 
Hpoonful (1;>.0) of [Iiig tincture should be placed in a pitcher of hott- 
ing vater, the face tield over the liijuid, and a towel thrown over the 
lieail of the patient to retain the Hti>am. The drug cnnnot be used in 
nn alomixcr. aa il clo^s the "tipK.'' Taken internally, benxoic uctd 
i» iinoful as an expoclorant in chrunir brorichhit in tlie dose of 10 
grains (0.(J")) three time» a day. 

Administiatuni. — Tlie doRe of benzoic acid (Jicidum Hemmcttnt, 
U. S. and B. P.) is usually 10 Iu 40 grains (0.G5-2.G), but a drachm 
nay be given in capsule. The gum itaelf iu never ut^ed ujs huch. 
The tincture i^Tiitetartt Bemoini, U. A'.) is given in 'JU-miniin to 1- 
drachm (2.0-4.0) doscH, and the compound tincture {Tin^tura Ben' 
tiiini Compogita, U, S. and B. P.) is comimsc-d of bciiziiin. uloes. sto- 
r«x, balsam of Tolu, and alcohol, the dose of il being I 1o 2 fluid- 
draohma (4.0-d.O), The propuruttone official in the B. P., but not 
in the U. S, /*., are the troche (Trocltineut Acidi BemoiciJAuA 
Unguenium Oetacei. 

AdepH Bmioinattu (U. S.) and Bemoatti* {B. P.), or benzoated 
lard, is a non-rancid basis for many ointmcutd, notably that uf zinc. 

BISMUTH. 

BiBmutb in official as the subcarbonate {Bitmuthx Subcarbenaa, 
U. *S.), the Bubnitrate (Hixmiithi tSuhnilrtig. V. A', and B. P.), tie 
citrate {Bistniithi CUr'tg, If. A'.), and the bisoiutb and ammoiiiuiii 
citrate ( Ilisnuithi et Aminomi Citrax, U. »S'.). The fir.it and second are 
identical in their dose (o to 20 grains — 0.3-1.3) and action, and may 
be employed iutorchangt^ably. The third and fourth are more 
astringent and more irritating than the other two, and must be given 
in a Hmaller dose, which is :^ to 4 grains (0.1-0.2). 

Many years ago this drug was supposed to be capable of producing 
gaoitro-enteritia when giren iu large dow*, but this wm due to a ton- 
taminatiou by anienic. Bismuth may produce chronic poisaning aOer 
prolonged use on wounds or when iniemnlly administered in excessive 



I 




» 



do««s for some time. Ordinary doses are innocuous. As much od 4 
to o drachms a day may be given for a »liort time without harm. Tbo 
changM which CDeue when the drug i-^t abuixHl ar^i the foimation of 
blai^ skia;;hit in tlic uiuutb uiid gai^trti-inti-simul tmct. di-squuuialivc 
n«phnti4, and albuminuriu. The prc[)tiriLtioii6 of th« M. J', not official 
in ihp /, . .S". /*. aje the liitfuor liiamuthi et Amm.mi! Cityalts, dosp 
] to I ftuidrachm (2.0-4.ft), and the tmcli*' ( T'r'vAiViw fiismut/>i 
C'littpotUtu}, 2 graiua (0.1) in each. BUiutUhi t\trbvnfu. B. J*., is 
the tame n* the eubearWniitc of the i'. A'. P. Bi»ntitf>n OxiiSum, 
B. P., K given in the dose of i> to 21) grains (0,^1.^), 

PinviOLooicAL AcTtoN. — BiBraiith in thp form of the .lubnitrate 
and siiUcai'bonate is devoid of iiiiy cITccI u|>iin ilie jieiieral svi^tviu. and 
hwnlly applied externally, or when given int^nmlly, cxercigcs a mild 
airtrincent and pnttectivc inlluence upon inucoii!; tnembranea. 

TkerapeTitic8.~Bi!tmuth i^ ii.sed a.4 a mild nKtringcnt in large doaca 
to cover the surfaw of tnjtatned macnua iHemfrrttncn mid so to allay irri- 
tation. It is Ufteful in irritfftire vMniting iov this reason, anij in diar- 
rA'Ri of a Himllar type in whicti the stnolx are serous. If the passages 
an raatwHU, ca«tor oil should precede i>ismiith in order to rid the ali- 
mentary canal of the mucous secretion already poured out. It is very 
useful when combined with carbolic acid in froua dtarrfiteft, given in 
ntpKDle^ containing 10 grains (O.O.'t) of hisiniith KtihnitriLte ami 1 minim 
{'>.06) of citrbolic acid. It is also to be used as a slow and feeble 
snutcid. The BUmutht et Ammaiiif Citrat is verv astringenl. and 
sbouM be U8«l in chronic aerou» diarrhceat in the dose of o grains (O.^i) 
even- two or three houre. The other prepanitimiH of bismuth are 
iomlable, and they should not be given in water, but this prepanilion 
is Holuhle and mav be given in solution. Ui^mutb is of .iiprvice in 
a)i4ptp$ia when lactic and butyric acid fcrmentaiion i^ present with 
exomsive belching, and may be employed in tjnginiif/iti iiml ;iii»trlc 
uiwr and tfimfrith as a sedative and antringent, BiKmuth and am- 
monium citrate should never be cinploynl if a<:iite inHamiimtiou exiiita. 

When the satta of bismulh are u»ed fur any length of time, they 
MUM the ralnr of garlic to appear in tlic breath, which '\» due to the 
preoenee of lui exceedingly shglit trace of telliiriiim in the hiHinntli. 
The .■"tools are apt to become blai^k iimlor the influence nf liirttiiittb. and 
the tongue, if ftirred, may also be liiai-k about the centre when bismuth 
IS used. 

Where there is ehapping of the hands oi- checkH from exposure la 
culd or wet the futluvting prescripiioii \% useful : 

ft.^UiiontHlii oiibiiiinUu Jfiii (l'.:.0). 

Zinoi niwii* Sin (140). 

Lyo>podii gij (8,0).— M. 

8.— ApjJv ui UiD |«ne t i. d. 

Bismuth Benzoate. 

This i« a preparation which has hocn highly rneommended in Ger- 
many, and to suuie extent in ihiri country, within the la.>i[ few yean, 
in tliQ treaimeoc of cJumrrniil. fuder it« influence the ^orc heals itp 



L 



with grcut rapidity and Icuves a comparatively small cicatrix. It may 
atmi he iisBtl in ihu ti-eatuiont of all specific xnren aud for tlie ilreiiiiing 
of imlnleiit or Bloutjhittg ulcert. Bfuzoate of biemulL, wben properljf 
applioii, slinuld be prfcedud by &. careful witiiibing nf (lie diiieAsed sur* 
Puce with a very weak bicliloridc-of-incrciiry solmiim, uftor which the 
bixinuth is to be sprinkled nvnr the wound and the eiiiire surface cov- 
im^d with cottun. which should be held iu place by &a adhesive Btrip, 
The only disadvantage in ihLs dressing lies in the fact, that it ha.s to 
be changed nnce or twice in every twcaty-fnur bciur». Immediately 
after it is applied it may produce some tingling or huraitig, but this 
u> acver very aevere- 

Bismuth Salicylate. 

Salicylnto of Biitmiiih {Bhiiiuthi .V«A>y/*ijt, H. P.) h n, white, soft 
powder, iiinoluble in >*atcr. clcohol, ether, and cbUirolorni, but soluble 
in aeidH. It is tar^i-dy used by Eiome praciitiuiu'rs ai; an intetitiiial 
antiseptic in cafles in which there is diarrhtta due to fennenlatJon or 
putrefaction. It may lie giveti in powder, or, better Mdl, in capsules, 
in the dose of 8 to 1'j grains (0.2J>-1.0). 

Bimnuth Subffallato. 

Dermatxil. or the ^ribpallatc of bifmiuth, was first used by Heinz 
and Liebri'cht. It is a fine jelhiw powder which is unaffected by 
long exposure to light and air, is entirely odcrlcM. and is KUppoaed to 
contain f).^ per cent of oxide of bismuth. Its external uses are iden- 
tical with the nseH of iodofotiiij and it probably acts in much the 
same manner a* <loe.'' the hitter driiff — -namely, by so drying the 
woand that it lircomc« an nnfavnruble ^iti! for the growth of germs. 
As dermatcl im an nslringent. it cannot he emjilnyed in the treatment 
of indiilent ulcere, which need stimulatiim ruther than au aAiringeui 
influence, and it would seem probabU on ihcoretical grounds that it 
is Hoi to be compared lo i<id'iform in the treutnient of canen in which 
tubercular prneessett are goiui; on. 

There i-* no iluubt that iienual"l is less puisimoun than iodoform, 
but it must bir capable of pr()diicing some untoward effects if used 
)n■l^fnsely for any length of rime, since poiBoniiif? follows the pnn 
longed employment nf bi»imuih jireparations. as has been determiued 
by Balzer, Dalchi^, and ViJIejeao, for the Bymplomi* of which «ee the 
article on BiNmutb. 

I>eniiatid may be tried in cases of ekin diseafe in which there is 
mucji secretion. a» in weeping meman and nimilar sinter, either in 
the form of a diiiiling-powaor or in an ointment with va.«oline or lano- 
lin in iLo proportion of ^ to 1 drachm to the ounce (2.0-4.0: 80.0). 
Somctiino^ its efficiency can le much Jncrcajsed by the addition of n 
drachm f4.0) of oxide of zinc to the prescription pist given. 

D<>rmat/>1 ha.-" been oBfd with marked success in cases of punthHt J 

olUi« media as a dusting ])owder, and in other 8tat«« recfuiring ttiimlBr \ 

dijing and astringent effects. 



SlTAttTRATE OF POTA&SIU.V. 



113 



Int«rnalhr, it has been higlily rccommendt-d in cnsca of fcrme/tia- 
ttpe dyspermid iu tlio dose of 5 to 10 grains (0.^0.66), but its reel 
value ID tnift cifndition is us yot iindctcrmi acd. 



BITAETEATB OF POTASSIUM. 

Potaa*ii Sitartraa, U. S., Potaeaii Tartra^ Acidttt, B. P., is 8om«- 
called ■• cream of tnrtar " or atiid tarirate of ])Otaj«ium. It is n 
it< gritty powder vrhicli may occur in rhombic cryntnls. Owinf; to 
its Dtabilitv, it lia^ bvi>u Lbouglit ttifti it esc-aiies fW)m ihe body wiiiiout 
oxidation, and so to differ from llie otb«r potassium eults fonncd \>j 
Tegetabie acids. 

Ttaerapeotics. — Tlie bita-rtrate of potaMium is Ibo most dim-otic of 
the pntsK^ium salts, and is iise<l in riironlr nephriti* witli j:in nr coni- 

rnnd infusion of juniper. Tot tbe j)urpOM of removing rlrojiitt/. 
ounce (30.0) of ilie iuilt in added to a piut (•SOO cc.) of tlie infusion 
of jnnip«r'l>erriei^ and tbe entire fjuantity taken in divided doses id 
twcntv-four hour?*. In amtr renal lijWajtf tlit> drug Hliould be lunid 
without the junif-er. In large dosw — I ounce (15.0) — it actn as a 
watery purjie, t.iit is rarely so used. Wiierc the urine, m tkirfc and 
oA/i/frii?, tii!:irtniteof potas»«iiim \» a mefnl remedy to ueatralize it aud 
mke it clear and normal in appeurunce. 



BORA^ AND BORIC ACID. 

Borax (B. P.), or .SViAV Burag, V. S., may bt niado by tlie action 
of boracic or boric acid upon soda, but the drug na it u|i|»car» in cam- 
meroe Id AfDwrica ia derived wutin-ly from natural dt'pusits found on 
the 8bor«9 of lakes in CaUfurnia aud Neviida. The natuml jiroduct 
baa to be purifird before it W mnrketable. Itomx is Holiiblo in iweh'O 
time? ita neight of water. Both borax and boric aoid liuve Wen i^up- 

Eooed to act a8 ofEL'ient pcrmicidtts in strung solutions, but lliia bm< 
e«n pToved incorrect. They are antiseptics, liowcvcf. even in weak 
solutions. Upon the body borax has liltle eflect in any ihwu which I'.i 
given for a meilicinal offoct. It i* rapidly eliminati-'d and roiiders the 
urine alkaline, and it is toi) rapiilly absorbed from (he alimentarr 
canal to permit it to act a^ on iatcstinal antiseptic. Borie acid exercises 
eTen less effect upon the body than honix. 

la tlie form of a loti-rn boric acid has been need vith some buc- 
CC88 as a rutncdy for ery»ipehts. and it may be similarly employe*' in 
hum* and 9i-<ii'in. Borax may also be used as a (rarclo in niphh<-ria 
and in aphtkouM Htumntitui. etittcruiii nrlt. and yttntfnnoM* HomatitU, 
In the trentincijt of prtirilm ttni and fuh-a^ and in hravu'lroii* and 
firtid swe Uiiu/ it is of ffrciit value wlicn used a.t a wa«li. Btmng wdu- 
tioQR, locally applied, ore useful in tinfa tmnurant and linta tircinnia. 
Borax hia bpcn used very largply in the treatment of «ii7c/)*i;^. with 
aiserted succeaii in some oaaea, Ita employment is purely cmpiricni. 
Tlic dov ufled is from S to l-"- grain? (O.»-l.0). j^radually inorcitsed 
nntil it produces some diittiirbnnce in the alimontarv canal. As the 
s 



114 



DRUGS. 



tiuiEe in verv diHagreeable to most fwrnnns, the dng ehould bo used 
with liiiuorice, strong coffee, or syrup of bitter omogo: 



IJ. — ,S«lii iK-mlis . 5s 

EkI, jilvtyrrhit &. . . , , fi 

A'J11!>' 'l'*l. . - (|. K. Rd f^ 

S.— D«werie{x>onfiil {Hfi) \a MnMi Kfter each meal. 



(:5.0>. 



"5^ (30.0). 
(|. K. Rd isTJ ( 180.0}.— M. ' 



If larger doses th»ii \-y to 30 grains (1.0-2.0) a day are cuotinued 
afl«rtbccuuvuljioai4urv dccrciiecuiii tiumlicr. there arc two difficulties: 
Isl, lUat llu' guod fffe(rl JH rapidlv lost ; and, 2d, tliat iinlownrd nynip- 
totus, ^ucli afi QauBcit and diarrlioca, v,'itL emaciiitioii uud tlic furiua- 
tion of ft .icarliitiniil, eczemntous, op p&pulnr oruption. upjivur. A 
pcviiliurity of tlic last two eruptions u ui&t they an; distributed uroaad 
tlio Joints. 

Borax should not be ased with glycerio. as an acid reaction ia apt 
to occur. 

A vorv HUffuI vraxh for oral mul na»al mucous mciukranc:) is 
" Dobell's solution." which is compusyJ of — 

Acid, carljiiliu ... ([r. xxx (2.(1). 

tJtyi'crioi f^ \7.'La). 

Ai\\v piiiw , . . i Oi) vl lilfp). — M. 

Boric acid [AckiMiu lion'cuir., I'. S. and B. P.) is one of the most 
commonly used nubstuncca in cyc-waiilii»«. ciLlitT alone or \riili cotminc. 
When uhqA with cocuine or nther drugs it in employed t« prevent the 
dcnttuflion of the alkaloid or i;luco8i<!e. ats the case may be, by the 
gruivih of mould. Tliv following forniula may he employed: 

B-— Coealn. Iiydroctilor. . gr. if v»\ riij (O.^-V..^). 

Arid. Ixiric. rt- x vt-l xx |0,6ft-I.3j, 

.^>)IIwd(«l fs'j iW.O).— M. 

8.— To be UKcd by ilroppUig iuo the cjro. 

Tlte following makes a very nseful application for the skin of the 
face and hands to prereut ctiupptiig : 

a.-Add. boric SiaO). 

Cww albw XI H.O). 

Paraffini . . . . jii (S.0). 

01. ■mjgrUU'iliilc- Jjij (8,0j.— M. 

8. — Tn bo thoroughly' mixMl ikiut a]iplied nl^t anil mnrninf;. 

Boric acid may be given inlernally in e^»tit-i$ to render the urine 
acid, and in useful in the removal of /Vc-^/rji when applird hk a wash to 
the skin. In persmin liaring an iditisyiicrasy to boric acid a bullous 
eruption of the skin may follow its use. 

Borat«d lint iit mo^le by dipping lint into a baiting a&turatcd eola- 
tion of boric acid or borax. It malies a itimple, inexpensive bdIi- 
weptir surgical dressing, and eontains nearly one-half it* weight of 
the drug. A/fl Burndg, li. /*., ip noi official io the U. S. /*. It ia 
need u a locnl applieittion for tort mouth. 




Boroglifrrrin {dlyeerinittn AciJi Borici, B. P.) is aliquirt made bv 
mixirg "12 parts of buric ac:kl with 92 pnrw of jjlvcerin in n larred 
porcelain vajiiiiile 3tt n tcroperatiiro of not more tliim 302'^ F. The 
aci<i IS ndtle"! to the glycerin gmdually, with consunt siirrinj^. When 
tbo uiixturi* Iiu been rcduc«4 to the wei;:ht of U'O parts, it is poured 
on X Out tturfiioe wet slij^htly with petroleum, and on hnrdcning is eut 
into blocks, which should ho plarnd at once in a well-sloppcred bottle. 
When ii*ed fnr medicinnl pnrnosPH the plycurite of boroglycerin 
{Glyferituvi Btir->^hffrhti, V. .V.) itliould be employed, flhioh nrny 
be mndc hv adding 1 ounce (50.0) uf the bnroglvwriti in itolid form 
to I ounce (8*1.0) ofgWctrin and hciiting in a disli while fltirring. It 
is whible In water. Locally the glycerite of horoglycerin is used m. 
an aoti^epeic niid as a vehicle for carbrjlic acid. chri'Sftrobin, and the 
vegetable alliiiloids in the treatment of skin diseases, and in diseases 
of the eye, such as purulent ophthalmia. 



■ 



BROMIDES. 

Bromides of Potassiiim, Sodium, Lithitaa, Oalcinin, Gold, inck»l, 
Ammoniiua. Bbiontium, And EydrobKomk Add. 

Bromide of Potaaaiiim. 

Bromide of Potassium {P'4ami Bi-owJum, U. S. and B. P.) ia 

the most rommonly ii»ed and »n imporlant member of the group 
above Ram«l, anil wilt, therefore, \''f fpokon of hefore ihe others. 

It is preparwl by jirceipitating frcshty-iuadc linnnidt- of iron with 
pnr* carbonate of potasflinm. or by a proceiy nmre readily carried out 
and reoommended by the fi. P. It occuih in rnloilcss transp&roDt 
crystals, vbieh arc ittable in dry air, bnt ahflorb tnoistnrc in a dftrop 
atmosphere. Il is very soluble in water, hot le^ sn iu alcohol. This 
bromide has a ralty taste, and ia dittlinetty irritant to mucous inetn- 
braoce if Ictcally applied in enncentrnted foriD. A certain portion of 
Ha d^KSsant influence, particularly when it is givcu for long periods 
of time, depends upon the puta&siiim a^ much m upon the bromiDe, and 
for Ihi* rf^iLaon tlio aodinra salt ia preferable. 

Fhrslological Action. — Itrotnide of potatisium has an action upon 
(he auimal economy whii^h is rh-nrly defined and clopely follovFcd by 
all the other bromide sail.-*, so that what w nald in iImh pinrp eoncern- 
iiig im effects may bo taken m i*epre«onting the whole class of trouiides, 
enx-pt in ihe instances where aliglit differences exist, which will be 
pointed out under the various names of the respective salt*. 

Bromide of pota.'wium when taken internully iii full doses produces 
lirowBinesa, sleep, and a decrease in all the reflexes. (See Eflt'ota of 
Ptolonged Use.) 

Nkrvols Systkm. — The bromide of pntaitsium acts as a distinct 
depnenol to the motor and to the inteUectiial jMrtious of the cortex 



jml 



116 



J>SUO& 



cerebri. It slows the HevclopiAenb of thought and decreasea the excita- 
bility and power of tliR motor ceHs of the brain (Albertnni). Upon the 
spimil cord it acts a» a luiirkcd sedative, iiffectiu^ vliiefly tbe »eii)M>ry 
tnicta, iind cnn^ing thereby lo^s of reflex aeiion uml a (letrease in the 
abilitv to rccojioizt! pain. It al^^o di-preasfs, but I« u less extent, the 
niuior jiatbwivs in the cirj. Motltm is mainuiineil iiftvr jtecmuiiunn to 
pain and reHcxe^ arc loi<t. The dnif^ depre$«e: the periphet-ul parta 
of the urnsory nervRH, and under very large doses the motor nerves 
and niusclea are dimilarly involved. 



IK 



a> 



y 



a-- 



/J 



A, The bfonldes depm* Ihc motor Kreu and B, Intollcrtnal srou )□ tlic drain: C. Ihrr 
depriH thei«nMT)r iricl* tn the cyiln&l coti. i;. ibcr dc^prcu kCIcs bt'tlnn by drimuEne 
Uw MnMrj «cUt In tbv cunl (a). 



ClRctfLATIoN. — If the drag be injected in ordinary dose into the 
jagiilar vein, it causes at once n, fall of nrlt'riai pressure «nd [>ulst»- 
rale. The^e chniigcfl are due to a direct action of the bromine :in<l 
the potastiiiim upon tlie heart. When given to man in tiiernpeiilic 
di>i«eit by the uouth, its circulatory elfcct ia k> slight us iiot to be 
worthy of eonsi deration unless the dose is very large iind lepeuted. 

BBSPtBATtOH. — 'Id toxic doae bromide of pittaasiiitn in a depressant 
10 tlie respirutory centre. In mt-ilic-inal dose it doe<i not afltt't the 
'bnathing, except when the smonnt.s given are Inrge ami the drug per- 
WHtently adniinifttered, when ibc hreaihing beeomes slower. 

Dkikstion. — The broiuidca mny ilinorder the stomach by irriloting 
its mucous membrane or by !;o decreasing reflex action thai the proper 
Mvroliou of ga»tnc juice is retarded, vrith the remdt that digestion 
does not take place with nufHcient rapidity. For similar reasons tliey 
may cause constipation. The hydrouhlorio aoid of the gastric juioe 
sets free the bromine. 

lEMPERATURli. — No cffcct upoD this fuDCtion is noted unlcas Uio 



J 



BnOltlDSSi ^^^r 117 

dose be enormous: when tmeh x dote is given the bodily beat is pro- 
gressively diminisIieJ, the fall of temperature hein;; pi-obably iliie to the 
circulntnry and nervoiw depression produced, associated with the genera! 
iailare in xiia] power. 

Eluiixatiox. — Tlie drug escapes unchanged verv slouly with all 
the secretioos, and is found in the sweat, urines tear«, nemon, milk, and 
fffce*. 

Tiesae*vaale is decreased when the animal economy is under the 
inflarace of one of the bromiden. 

Ilierapeutics. — From what has brrn already sajil, it i.s evident that 
bromtdi; I'l' |iota.<»inni in » remedy to be devoted almost entirely Ut the 
ircainifnt of disonkTs of the nervous eystem, and iw nets are, there- 
fore, as various as the manifestations of perversion of nervuus aclion 
cmn l>e various. In a word, it may he i^aid that hrnniide of potasniutn 
ii to be u&eil wherever oper-rTciti^nteut <>/ nfrvium /irot.i/p!tixm in pres- 
ent, hot never where nervous symptoms are due to depression. 

In ■y>i7e/i*y, which, to the best of our knowledsje, is due lo explosive 
impulMid arising in the cerebral cortex, it \» one of tlie hwt drugs wo 
have if giveu in suHieiunt dose ; and iti all forms of minor spusm, due 
to heightened reflex activity, it is of servjee. Care tihould be iiped 
ID giving thiti drug in epili>p»y. that maniacal excitemrnt does not 
aupiihtui the attacks of epilepsy. (See Epilepsy, Part. IV.) In cases 
of tpiinminlif contrtii-liimt, in the treattnent of hysterical femaha, in 
nerveu* star(ingt and slant) at i^udden noiaes in adults and children, 
and in the nervous symptoras aeeompanying wfifnatii-ii and the mcwo- 
paitat the bromides will be found <>f givat value. The fwliowing )ire- 
seription was rpcommondcd very highly by Goodell,and will be found 
of service in the latter Hlate«: 

R.— Amaionii liromtdi JfU(S.O). 

Pouwii tramidi 5it |1B.0). 

S|ili> nmniriri. mnimsL Rvi iSS.O), 

Aqu* mmpbnrv q «. ad f^rj { 180.0). — M. 

8.— .\ deB«erUfH)onful (8.0) to m tables jioonful l Hi.O'i nvpry Tour hmire. 

In headache* due to uterine trouble the |iain is often felt at the top 
of the skull op at the back of the nook near the occiput. The cause 
of this trouble will sometimri' be found to be in the cervix utn-i, and 
nilicf under theac circum!ilanee.>> can only be obtained when the uterus 
is treated and the bromides ndmiiiisiered. 

In co>u'utgion» in children and adults, eombinod with chloral, bro- 
midos arc moat cffiirient, and sire nonictiines of service in iiif:ontinntrr 
of ttrinf due to vesical sps*m. In »eminai einimiUnii due to a morbid 
eicii*bility of the centres in the si>inal cord bromide of potassium ia 
one of the beet remcdi(.*s we hare, and in «<ilyrium nnd nymphomania 
it is of great scrvive. 

In cases where utidue irritabiUttf of the pharynx and larynx jirevunla 
examiaatioo of these parts, one or two ftil! dosei" w ill rendf-r an exami- 
nation e-asy of performance by decreu*ing the Incal rtlicx activity. 
Thi« ia a useful r>oinc to be remembered in rotation to the treatment 
of pharyngeal and laryngeal disease. 



^ 



Tn cMfiR of a/^itr iartfv«fitiM full dfiscH of the bronoidos (fiO to 120 
graiDs [-1.0-8.11] iL day) uri-'verj useful t« alla^' the pain auJ boarsencsa. 

The broinKles are found tn be of service id the lartfti^jeal erinen of 
locomotor ataxin, the cxplanaiion of rfiis fact ticin^ as follows: The 
adductor centre of the larynx in Hitiiatm] in the brain, and tlie abduc- 
tor centre in tite spinal cord. Tlic first cIusob the laryux. the second 
upena it. and in health tliey luiLiiiiain a patulous tubu by tbi>ir oppo- 
niltnii. In di^eiute the iipinal centre (the abductor or opener) fails, 
and the ndduclor in the brain being inionpoxril. produces closure of 
tbe tube wiili disu^Li-ou^ results. TLc bromide, by quieting reflex 
uctioD. as well as dvprc^iug Uio adductor coQtrQ in the cerebral cor- 
tex, ]>reventit this accident. 

In whanpiiuj fiiHifh with miieb mucoua exudation tlie drug \a rarely 
of bonclil. and bud better H'iI be used. In lari/nifiamue slriduiHS or 
any fiirm of Mpii^m dopouding upon local irritaiion tbo local trouble 
must, of course, be removed if posfible and tlie bromides given. In 
tfethinjf the dnig lony lie used to (lecrea.^e reflex iriitiition mid prevent 
couYulsiou8, aiiil it vill decri-ut!(j tbu Hiyht-e<'Vtamint) of cbiidreu — 
wliicli u often due lo bad dreams — to a very extraurdinary degree, 
oven if the dnsc Ic quite i^mall. Af a Mipori^e for tlie insane nml in 
tlie wmnifiia «if the overMtirked and that of nervous women the bro- 
mide of ]iolaijciuiu in of preat cerviee. but oufrht to be jsed M a tem- 
porary nieflsure only. (See Insoamio.) It may also be employed 
with good Tveultii in ritroniv atcuhoHfnt and morphivnianioj given in 
doses of 40 to 60 grains (2.6—4.0). In vit'ffrnwf and nfvratyia 
due to eye-strain or other nerve-strain, combined with caffeine the 
bromides are almost sperifics. The caffeine seems to sltmulatc 
tbc dcprc^jftvd nerve up to iht- iiuruial level, and the bromide to 
deaden ihe pereeptioii of the pain. The following \i a nio»t val> 
unblv remedy in tni)n'&i»e, and even in sick headache. It onght 
not to be ufted in bilious heathiclic, vliich will often b« made worse 
by it: 



V 



B.— Aoiipyrini . . . 

Otfl^xnn- cilrnW. 

i'oliMoii brnmidi 

Ft in chart Na ». 

B. — One iMwder aa iivcded. 



. gr. YX7 (l.«). 

. gr. z (0.86). 

. cr. xxT (l.«).--M. 



In the treatment ts( diftmrmrrhaea and menorrha^fia, particularly 
in young subjects, the bromides are aUo of service. (See Dr. Goodcirs 
proBcriplinn just given.) When the flow i.i too great at »ueb a period, 
the drug should bo begun a week bef»)ro ibo expected epoch, and kept 
up in the doee of 5 lo 10 grains (0.3-0.65) night and morning. Id 
eases where the epochs follow one another too closely the drug sbonld 
be used Continuously. After an apparent cure ousuea the tiromide 
abould be used for a few periods to avoid a rclajiBB. For ge-i-Kii-fm^gg 
the bromides are the bcrtt priipbylactica wc possess, and should bo 
used in the dose nf ft to 10 grains (U.ft-0.65) three times a day for 
several days before tb« patient eaild in order to quiet the vomiting 



BBOMritES. ^^^^ 119 

cvntre. Af^er Kea-ttickneiM begins tliey Hh<nil>] not be given in ordi* 
uury solution, but to au efferT<>sciDg dr&ugLt made as follows: 

B.— Acid rfirio. sii (8.0). 

AiiaxdM. r III (ISOO).— M. 

B.— PoimbU bromWi gi (4.0j. 

PoUwJI buarlMuiBtto SL^^-^'- 

KawAm. rjiv (120.0).— M. 

FtpoL 
8.— A UdlecpuonlVil {lft.0) of each or these aolulionB ahoatd \k nddetl to one anotber 
•ad Iwcn dnnng dterTumnLi;. 

Tbisjpr«8cription will also be found of value in the pereietent rom- 
iting of preifnancy i,nA in that following prolonged etherisation or 
Cilbcr et*t4». If tbc vomiting is evcwsive, Hip rinse ought to b« 
reduced to 2 t^aspouufula (8.0) uf i-acli sulution. ami be given every 
balf-hfiiir until half "f each mixture is taken or iho ]>atieut i» relieved. 
In cases whcri' thi» cannot he retainci u rectal injection of the follow- 
ing will he found of valtie : 

p.— S<rfij bromidi gr. ittFeljj (2.0-4.0). 

TinrL npii (leijd(>nU. ni xxx (.2.0). 

.Viwrmiijli Ilvj (1^0.0).— M. 

8.— To be ii|jci;i«(l t^uU; Into tlio nuiitj rectum uia rciaiiied as loug na fweaiblie. 

This metliod is the mosc reliable plan tbat can be followed. 

Bromide of potassium may be uoed lo prevent the development 
of symptoms of cinehjaiam. which often enaue after the use of quinine 
and salicvlic acid, and ii in said to prevent the nausea and deprtssiuu 
en apt to follow the u-w of opium. 

Adminiatration. — The cIo.<e nf hrnmide of pota.s!>iutn In from •'> to 
120 grains (0.3-8.0) u day. It should be given at l'>ng intervals, as 
it is slowly abaorhod and very slowly eliminated. Afier the pmie&t 
ii fully under ita intluence it« effects can bo maintained by smaller 
do»F4. The be»t way to order it is in a watery' sulutiou with a littlu 
syrup. 

TTaeof Bromides In Poisoning. — nroinidesare useful in all convul- 
sive attacks coiiseqaciit upon the ingestion of poisons, and they may 
be used lo iillny any nervous symptoms arLning from this cause, wbiuo 
arc of an excited natnre. 

Poleoninj. — Acute poisoning by the bromides is rare, but if half to 
one iiiinco is taken they produce a sense of warmth in the epigastrium, 
genfrr.il feehWnos". froiitiil headache, attipidlty. ajdiaitia. and atnnx'sia. 
The puluc-rate docrwwos 15 to :ili beatj> a minute; the pulse is irreg- 
ular and cnrnprewiible. Recovery takes place, as a i*u1e, unless pul* 
monary codema sets in. 

Sffects of Prolonsed Use, or Bromiam. — Afler the drug has been ntted 
for Sump liino in I:irgp dofiCit ncno iippcars about the fiice and extends 
over iho entire body: ihu breath bccomea foetid, the patient iliill. ex- 

Er«xsion1e8s. and heavy, remaining buried in slewp during nearly every 
our of the day. During tlii.<itime he can be aroused, but at once falls 



ISO 



DBVOS. 



to sleep ngnin. The w»lk biwonios wcnk and feeble, the movenipntB 
plow iind painltillv prolonjtcd- Tustc is lost and licariMg i» benumbed. 
Vfhile the inlfllectual facullit-Bof thehraiuanf ultiiuai in abeyinoe. Loss 
of sexual power in an enrly svinptnni. In olhrr ciises pvidrnccsoF mcii- 
tn! alu'rration ilevdop, the patient becoming irritaMo. mnro.ip, anil evi'ti 
bumiL-idiil. Sonictiirjcs. howcvL-r, vte find iiu-lancholia tind hallucina- 
tioiis, nnil ran-Iy ox»It«ii ideas.' In still others u itniigcrnnsS'nfrocative 
brMncbitie dcveloprt. ibn puticnt may become pmfoundly cachectic, or tbc 
condition may resemble typhoid Fever. The acme may be put uitide to 
some extent by th« ase of anKoic, and whoD the bromides &re given to 
women this dnij; inay be given sinmltaneoiiely to prevent the eruplion. 
A* Fuw1lt'» solution is compatible with ibt; bruiuidi- iu mAutiuii, if 
18 ibe best form of nrsenic to einpluy- As the aeiu* i& due to a torpid 
Btttto of the ?kin-glunds, il isalst) wtU in tbese omen to order r be patient 
to wash with warm water iiud ensiile snap every night, and afterward to 
dry the face by a good rubbing with k rough towel. Vvr^ hiw recently 
asserted that the mainiennnce of intestinal uiittiwp&i^ by the u»e uf 
oapbtol or salol will pri'voul tbc development of acne and digestive 
disorder when tbe bromides are given. 

O.ntraindication.^. — The bromides are contraindicated wherever 
there U general asthenia and feeblcnesn of the nervous system, aa, for 
example, in po»t-typhoidiil and po&t-pucrperal iDSunity. In senile 
sofVcning of tbc brain they are alno harmful. When the mucous 
membrane of the gMlro-iulesliuul trart is irritated, they do harm. 
When the patiuut is subject tv acne they should bu used with caution 
or uvoided. 



Bromide of Ammonium. 
(Se« AM-MOxri'M Biimmihe.) 

Bromide of Calcium. 

Caldnm Bromide (CaU'ii Brifmidum. U. A'.) was introdnced into 
medicine a» a nervous sedative and hypnotic, and wiut liiought at one 
time to be an eflieient ^ub.'ititiite for (he hrnmide of potassium. lis 
action OR the uervuuH syeitciu is virtually ideiilicnl with that of the 

Sotassium uaU. and it lia** been found to be Ihr le.s8 irritant and 
cpre.^Kant iban the latter. For some unknown reaaou it has never 
won the confidence of the profeaaion, but it may be given wilh very 
good results tn the dose of from 3<l to 90 grains ('2.U-6.0) a day, or 
oven more in cases which are not readily nlTncied by bromides. It 
may be employed in htfttvria and epilijtJfif and iti all the condl- 
lions iu which the other bromide unlXn arc indicated. Jl U some- 
times r>f value combined with tiie pntaHsium .salt, riincc under sueh 
eircam!itanee.4 better result.-^ are gained than if a single salt is 
employed. 

'8m Caltccttve Inv<aiifi:*ti<r>a bjftuthor in tbe mempmlifOiuMUof .Hn*\S,lS97i 
■bo article on Kptlop;-, Piirl IV. 



i 



B&OMwes. 



121 



Bromide of Qold. 

Tbf! Bromide of Gold hiui I>(;bii cmplnvcd in r.pllcpr^ liy » iitinilipr 
of clinicians wilb great kucccjui in tho iImmc nf from \ to ^ emiii 
(0.015-0.03) three times a day in pille. Fhyaiologioal Httidien bare 
proved that the drag is a dinwt sedative to the motor cells in the 
cortex cerebri. 

Bromide of Iiithinm. 

Brftiaide of Lithinm {Lithii Bromidum, V. S.). This salt ia nmch 
weaker itiao the other *&\i^. ntid must Ite ^irca in larger dose. Br. 
S. Weir Miwhell states that it ia of value in epilepsy after tho potas- 
siom salt fails. The dni<e in 3U to 90 grainn (2.(M>.(J) a day. 



Bromide of Nickel. 

This is a ;{reen salt quite irritant to the iitotnach. The author haa 
madc^ an pxpprimenta! study of the bnimide of nickpl, and found it 
practioilty idtmiici! with tho bromide of potn-isium in ]>hy.iiidii^icnl 
action. It should be j^ivcn well diluted or in an cITervt-scing draught, 
•a it is apt l« disorder the stomach if u»<!d iu contfentrated solution. 
The effervescing form nf the drug w made by mixing the siilt with 
bicarbonate of sodium and lartaric acid, mniHteiiing with alenbol, 
passing the moiat powder through a sieve, and then drying it in a 
warm closet. 

Bromide of Sodiam. 

Bromide of ?oditim (.SV>,/« Bn/riiiJum. U. .V. and B. P.). This 
aalt is to be used in every instance whore hmmide of potastiinm t-un 
be employed. Its dose is the same, although it in usserted to be n 
little weaker phygiologic&lly. grain for grain, than tht* putussium salt, 
lit 18 far Ic^ apt to disorder tho stomach, iind i» imt so generally 
depressant as is the bromide of pota»Kiiim. 

Bromide of Strontiiun. 

(See STito.\Tiuu.) 

Hydrobromio Acid. 

Tlydrobromic Acid is an extremely irritant preparation, but is 
tbought to b« U'SS apt te cause acne and other uutuwnrd ctTfcta than 
rthe otber bromides. It is only to be used in the form of the official 
'dilate acid {Ai't'tlum fIi/ilr»f>romieu'n JUlutuin, L', X and B. P.). and 
to be given iu the dose of from 1 drachm to ^ an ounce (4,0-1.1.0) 
well diluted with ewc«tened water. It is highly rccomtnended by 
de 8chweiiiita and others for keadachfn duo to eye-strain in nervous 
women. 

Bromide of BthyL 

(See Ktiiyl IIromide.) 




122 



D&VQ8, 



BBOMINE. 

Bromino {V. S.) is a dark-red Iii]iiiJ of an excessively punj^nt 
odor, likp tliat of cbloriiie. poastssing vt-ry extraordinary power as & 
oaiiittic when npplicd to iho tissHcs of the body. Ii i.< the most severe 
eamtio we posarss. and pcnctrati^ very deuply. It may bt* a|)[>lied ia 
ha»pitat tfangrtnt and otUt-r larj^e »lov^h» by mean^ of a j^lasa rod. 
Bromine should be kept in j^Iasd-^toppereJ bottles in n cool place. 

BBOMOFORM. 

Bromoform, or Tribromonicthane. is a clear, colorless liquid hiv- 
ing n peculiar ndnr and sweel laste. It is readily soluble in alcohol, 
but bli^btly H'i in wuti^r. Brnimiforiu. which in* to he used inedicinally, 
shinibl \>v jiroiocU'd frum Hunlighl »ud air, and must be free from 
in>lor aiul from avid. 

Tb«iapeatlcB. — Attlunigh br«mofi)nin has been found capable of 
[iroduciug annathetiiu >vheu |<iren hy inhaUtion, \l» cinploymen t in 
medicine is practically confined to ite trettiraent of ichonping cuugh, 
irben it is given internally in the dose of 2 to 5 minime (0.1-0.3) thrc« 
times :i day for rlie relief of the spasmodic cough. Bedford baa sug- 
geaied tin- followiikg tonuulu for its iutenia) use : 

U. — Eiromofonn ntlvj'il.O). 

Alcohel fsy laO). 

OlyMriu. fgxij (^5.0). 

Tiiiol. tainlBinrinii votnp q, «. «d fj^ij I W.O). — H. 

S.— Teaapounfol (4.D) U ri. in walor. 

This preacriplioi) should be put up by adding the ingredi«tiDi in the 
order namou. 

Bronidfonii imds to depre-wi the VMOtnotor system, but does not 
BOeiu to depivi*.^ the heart itself. Whilo it secnia to po^ec^ thorupvutic 
value, the large iiuuibiT of caxes reported in which it htu caused alarm- 
iug symptoms has prevented the author from employing it. 



BRYONIA, or BRYONT. 

This is a rwoedj very largely nsed liy irregular phy.ticiana, and i9 
prnhdhly too much i^niui'Ctl by rcpiit»b]e physicians, for it possesses 
very great power, and often roHcvcB condiiiune vhieb are obstinately 
persistent uniler other ircatmeiit. It is the root nf Jin/onia alba or 
tiriitmia dioifa { U. S.). The only oflicial preparation is the tincture 
(Thiftura Brt/oniiF, V. S.). The dose pf the powdired root is a 
(lra*tio piirgo i>" 1<* t^ 40 grains (O.fi-2.4). 

Physiological Actloo. — Iti overdoses bryouia acta a* a.liydnigogue 
cathartic! and gastro-intestinal irritant. On seroux membranes it 
fixerciscs an irritant influence, and may produce symptoms of menin- 
gitis when given in poi.i'>nnnfl do»o*i. In modemie dnnn'Si hryoiiin 
causes some lln^^hing of the fiice and neck and headache in :^u?eeptibU' 
persons. The drug needs studying fipom a pharmaeologieal point of 
view. 




BTROyjA, OB BRrONY^BUCBO. 

Tlierapeatics. — Ahtiou^li one of the oldest of reniedieM, br^ciaia Iiiu 
been givcD a uew iinpotde by the liomoeopoths, who employ it in a 
number of mffuclioits. In the ir^atmeni nf ilifrprpiiiii ilcpeixling u[>nn 
jjsatriti and iotcj^titial Atony or the abuse of nloohol <>r otlior .'timilar 
cansea bryonia often given relief. lis iiifliii-iici' is i-xertfil tliruti^h the 
irriUnt efTecla it produces, for by thiis means it stimulutcs or span tho 
atouic digestive glands to increased ncllvitv. For tills nwiion it btu 
been found particularly uacfal in children nlio sulfer from ccnstipatU/n 
resnltinj; from insuflieieut oecrt'liun rjii the piirt of iht' intesiiunl glaiids. 
When the pai«a;»cs are dry and frinbJcand rc**mbk' in ehiinictor ilutso 
of a (log, bryoiiia is of great value. The dnsi? for a child is uliout 
10 to 30 uiuiuts (O-ti-S-S-O). The drug hjia b«en prais^ed as a remedy 
ia tli« trtwtnu-'Ut of rhvumalism auil in pSourisy. but little is recorded 
u 10 ita real value in these diseases. In pfeu.ri»ij tcirfi fffugt'on drnstio 
doBOS have been aicd. hut the saline purgatives aru safer aud more 
efficacious reme<lies. 

AdminJBtratJOB. — The dose nf the tincture of bryonia (Tincinra 
Bryoniir, U. S) is from I to 2 Huidrachius (4.0-8,0) as a hixativc; 
but the M-called mother-tincture of the hoimcopatlis in perhaps thu 
beet preparation for ordinary use. The proper amount to be used in 
the troatment of a case of dyspeyisin in from h to 40 minims [O.^t^.4), 
tinle't'i the mucous membranes are very toiT>id, when this quantity may 
be iacreaiKML 



BUCHU. 

Bochu {TT. S.) is derived from Baro»ma hetullna, a plant of Africa. 
It contains a volatile oil, which is probably the active principle, and 
a bittAT extractive. It is official, under the name of linchu Folia, 
in the B. P. 

Tlierapentics. — Bitchu is used when it \% desired loalfect the mucous 
membnincs of the jrcnito-urinary tract which are chronically diseaacd, 
and particularly when these part-i are below their normal tone. It 
docs not increase the urinary flow to any great extent, but acta on the 
mucous membrane of the genito-nrinsry passagef* as n stimulant. It 
is employed in pyel^f-. rt/iitilig, nnd t'c*iiV<i/ irri(atioH of a chronic 
type. The following prescription is useful : 

R.— Piitawii I'itralu jiv (16.0). 

S|>t chlomffirmi f3iij(l2.0). 

Tihd. (liKiulis rnisi (2.0). 

InftM Uidiu ti. s. iulf.^vitj(2&(1.0V— M. 

& — Tw Ubl<s|ioonfuin (3*2.0) lliree Umw ■ dajr. Shake tlic botlk Mam using. 

If the urine is continnally highly acid, muddy, laden with snlts, 
and productive of incontinence by reason of the vesical irritntiun 
which it prodiicos, bitebu in the form of the fluid e.vtract. in tho doso 
of a teaapoonful (4.0) thrco timcn a day, eombined with an equal 
amnunt of sweet spirit of nitre and 20 gmins (1.3) fif acetate of 
pota^ium, will be of great eervice. For a child the dose of the Quid 



L 




124 



DRUGS. 



extract nhoiiM hv about ID to 30 miDims (0.6-2.0). If the vesical 
irritation is ncuu.', buubu is contraimJicated. 

Administration. — The flui<l uxtnicl {Ertractum B»fh\t Ffniduin, 
V. .Vj \< ihf milv olfiuittl prfparatit>ii, and il sliuuM lie iiIwa._V9 well 
ililiitcti Wf'iri; il la ;jiveii, in tlie close, ti> an adult, of 1 dracbiu f4.CI) 
three liDitw a day. The infusion is not officinl, but is miitlp liy adding 
1 ounce (JiO.O) of tlie leaves to a pint (500 cc.) of water. The <lf>se 
of this in * ounce (l-'J.O) to 1 ounce (SO.O). TIip official B. P. 
prepariitidni^ are ihH infusion i^Infaitunt Buchv). dose I t« 4 fluid- 
ounces (30.(1-120.(1), and llie tincture (TVnefMi'a fiufr/m), dose 1 to 2 
fluidrachuut (4.0-8.0). 

CACTUS ORANDIFLORTJS. 

nUs is n plant uf Mexico and tbe West Imiiea. There arc other 
iMdlM of CW^u«' posseesiog medicinal power, but tbc Cactut grandi- 
forui is the most active no lar as a medicinal effect upon the heart is 
concerned. 

Cactut cfrandiJlorH* is best given ia the form of the tinclurv or the 
fluid extract made from the green plant. 

Fhysiolojieal Actltm. — The drug lias licen studied by Myers snd 
Boitiet and Teiwiier, who have found that it cniises n distinct increase 
af arteriul prcM^iire. but does not slow the pulse, somehmes increasing 
it« r&pidity. Myers hati; uUo itbown that the dm;; is » stimuhint to 
the vsMOtnotor centres and lo the niotor gunglia of the heart-inunck. 
CnctiM crandiftonis also act^i as a stimulant rnther thnn n depressant 
to the "plii:!! coni. 

Therapenticit. — Caetiii^ grandiflorus ha« proved it*elf » good siih- 
Htitule for digitulia in certiiiti (liNeases of \\\c circulatnry appiirtitiis, 
Kuch as cardiac pnipitati&n and lefahwu. Il has also bccQ found 
very serviceable as a itmedy in cardiac failure the ruault of vahular 
ditfasf, but in all such cases scetns to act best when added to some 
tBore poncrful dnig. Huch a,^ digitali:>, an it lakes the pan of &n 
adjuvant. Cactut* also acts well in pome cases of anyiwi pcciorit. 

AdmitilstratioB. — Thedusc of the lincture of cactus is 2 to 8 miuinu 
(0.1-0.4) and of the lluid cttract 2 to 4 minims (0.1-0.2). 

ITntov&rd Effects. — U is cluiiucd that these du not occur, and that 
the drug never producwi a cumulative eSect. 



CAPPEA.' 

Caffeine (Cajfeitut, 17. S. and B. P.) in an alkaloid derived from 
the berric* of V'tffea Arabiea, which also coniain. upon roasting, an 
empyruumalie iiil. cafTeoI or caffeone. Caffeine is usually employed 
in medicine aw calTcine and the citrttcd caffeine {Vajfcina Citr'ata^ 
V. S. : CajffiW Oitras, B, P.). Cilraied caffeine is not regarded by 

' TliAilie, deriT«y) frr.ni Im, nff^ine. tho «rtir* prini'iplr nf oofTw, »iid titc nlliilold 
or piBiUM Troni Somfi .Vraerii'*, urv I'heriiicalty idmiii-al Mnrh f>f the cnltl<iii(. uf 
eomncroB ■< realtj (tieiae. «tlliriii([li it in ciiiinitHl t hxt pure ihcini' linu h r«irv difliKiU 
ptajrrioloeical actioa. 



cbemFsts as a elieniical componnd, but as a mixture of citric acid ftnd 
caflVino; therefore " citrate of caffeinu" is an inoomct term. It is 
6olul>l*> in 3 tiartA of water. If mon? water is added, it is partly prvcipi- 
Ut«d, }>ut ntten 25 parts arc added it is redissolved. IJi the L. >S'. J\ 
annilior officinl |>repanition of caffeine, (he Caffeina Citrata Bffcrre*' 
eena {Caffeina VUran Effcrvcacent, B. P.). has been introduced us an 
agre«able prffwralion for um in cases of tieaditclie, particularly if 
ooinbiQed witb one nf the bromides and autipyrin. The do^o is from 
1 to 4 dniclimn (4.0-lfi.O). 

The euipyrfumalic oil, of which there is about one-half to one t«a- 
ipoooful in each w«)l-iuiul« break fa'St-ciip of coffee, has no phy.iiolngica] 
«aiMtB. it is pcrbups tbc cau»u of the " biliousnees " eouictimes pro- 

Fw. 18. 




CUMtM dllUM bltMd-VMwIa of Ihc Malpishltn luft. Aod MlmulBtei th» KcreUiit epltliellun 
liuinic lhi> uHnlftr'-ii' liit>iili» 

duc«d by the babimal use of coffee, due to iho faulty digestion of this 
oil. »hi.-h isalso piTinc to disorder the liigertion if taken alone. 

Physiological Action. — .NKRVorri Sy.-*tem. — On rlit- iK-rvniw Rvstcn 

;C»ffviije atl« il* » rapidly-Hcting stiuiuUnt, cxfrtiii^ it* chief influence 

CMi the bniin iiuil i^piiiul cord. By ita cerebral effect it raiiKes increased 

rapidity of tliougbt. and by it« inUuence on the iipinal cord it increii»c!it 

reflex activity, and for this reason is .saitl to make people " ihtvous." 



136 



DJIUO& 



It is important to remember that it hu no effect on brain protoplasm 
except to stimulate it, luid iLut ultini»t(>ly a brain driven along by 
caffeine brcukM dowo bj tli« oouc«utmtioti of its energy for tbe time 
being in one efTort. 

OlRCPt-ATIoN. — Caffeine baa been supposed to increase tbe piiUc- 
nte and bluud- pressure by ^tiuiiilatiug tbu bL>art-muBclc. but fmrn 
recent studies in ih\s country and abrond it would &c«m probable that 
these cbaiiges are indireclly produced and due solely to its stimulating 
action on Inc nervous sysleui. Cliuically, it certainly seema to raise 
the blood-presi«ure in slmoal every iiiBUiiic« uhere it is used. 

Kidneys, Tibsue-waste, and' Elimination. — Caffeine incrcaws 
dinriBii.4 by raunirig ililatation of die renal ves.>u>]^ pnrticularly in tbe 
glomerales, and by prvv«nting ilie absorbtitt action of tbe tubules. It 
also exerts a direct stimulating influence on the secretory epithelium 
of the kidney, and therefore incr«aec« th« amount of solids as well ns 
of tbe Hquidd in the urine. Upon tiasue-waste the druK acts as a de- 
preesant, and is there-fore a conserrator of the tissues. It is oxidised 
and destroyed In the body. 

RBBPIRATIO^'. — Caffeine acts as a powerful stimulant to the r<«pira- 
tory centre. 

Therapeutics. — (laffoine is a valuable eaniiac gti'mulant and tonie 
am well as a rftial utimulant. It arfc* pqually well in rardiae and renal 
dropaien for this reason, and is an invaluable remedy in such ca^es. 
So useful is caffeine in cjisi-s of canfUie dm-dxe that it has largely sup- 
pltiutcd digitalis in the bands of some practitioners. lu acute renal 
inBiimmation it in cnntmindirated. hecnune all Htiinulantx are cnntnt> 
indicatcl when the part they inlluence is infiamed. In opittm-poison- 
iny, owing lo its stimulant effect on the respiratory ceuire. cafTeine Is 
very valuable. Under these circumstances it may be uiven by the 
mouth nr rectum in tin- form of strong black coffer;, wliidi will also aid 
in keeping the patient awoke and add heat to the body, which is often 
very cnld. A t-np of strong lilark coffee is often iiitefnl In relieving a 
paroxysm of asthma. In k^adafke due to nerve-strain caffeine com- 
biuvd with uniipyria and one of tbe bromides is of the greatest service. 
(.See Ncurulgiii.) 

Uuasted coffee is iwimetituca used to miwk the tojstc of disagreeable 
medicine. After jt is roasted and ground it may be employed as an 
ttntiseplic and deodornnt dressing for wounds when the common anti- 
septien arn iioi. nbtainiible. 

AdministratioD. — The onlinary dose of caffeine is 2 to 4 grains 
(0.1JJ.2). 

Vaffcina, f'. .V. and H. /'.. cannot he used hypodermically, owing 
to ita decomposition in the preseuoe of »aier. The following solutiott 
may, however, be U-ned hypodermically; tfaiirylale of aodium, 30 
parte; caffeine, 40 parts; and distilled watPT, fid parts; or, in other 
instances, the following preparation, recoiumcndod by lliicharil. may 
be employed: nenxoate of tiodium, 4.') grains; caffeine, 30 grains; 
di.itilled water, ~i> grninM. This mixture is to be beated, and 10 
miuiuiB (0.65) given at a dose. 



CAJUPUT OILr-CALCWX. 127 

Untoward Effects. — Caffeine oAen produeet h> inucli iiiRoinnia when 

5ivon IQ ra.T<.s '■!' cawliac disease that ite us* lias to bo tlis'-'ontinui-'i. 
f its US* \» persUled in, it maj prothice a condition of deliritim closelir 
kitubliof: tnnt of alcoholism ; and if too Inrge doses nre iHcd, or it is 
fi*(|uently ifjioated. it may cause a docrvase ia urinarv flow liy 
King j]>atftD of the reoal vchcU. The irritcr fau also eccu a marked 
rise of U-tn|>crn[uru fidlow itn am: in the danc of 1 grains (0.1) three 
lines a day. but this is very unusual. In certain potions the habiiual 
■M of coffee may cause insomnia, tremors, pidpitation, tinnitus auriiini, 
gastralgis, and eoiaciatioD. 

CAJUPUT OIL. 

Oil of Cajnjrat {Oltvm Ca^puti, U- S. and B. P.) in a volatile oil 
distilled from Mflatfiwa Lfucodmdron, a tree of the Molucca Islands. 
It ia a Mitnulaxit. and in large amouul^ an irriiaur, to mricoiiji mem* 
branes, but acts as an efficient eiirrnhxtHi-r und jutrnfUicidf in mod- 
erate amouDU. Ah a remedy for tinra tounuraitf and iwdiculi ii kIiouM 
he applied puiv to the part aflccted and nrtcd with caution, fur enjuput 
oil ie »uable of irritaling the skin. In ilinrr/ura of a serous tyi>e it 
is of iralue in the dose of 10 to 20 iniiuiiis (O.I).'i-1.80). {S«/l)iar- 
rfaira.) Spiritut Cajuputi is official in ihe B. P. : dose J to 1 fluid- 
dmhm (2.0-4.0). 



CALCIUM. 

Calcium is oflicial in a number uf forms, aod is to be distinctly 
Beparated in the miod of the student from calx or lime, which is an 
oxide of calcium. It i* never emploved as ralcinm, but as one of its 
■alts. Thc5« arc as follows: Bromide of calcium {dtlcii Bromidum, 
t'. A); precipitated carbonate of calcium {CalcU Carhatiat Pritcipi' 
tatut, IT- S- and B. P.) ; chloride ot* calcium [Caleii Cfilfyridtim, U. A'. 
and B. P.): hypophosphlle of calciian {Cafcn Ifi/pnfihoii}Jn». If. S. 
and B. P.) : and as i>rocipiiiited phntiphnte of calcium (C'it/ciV Pho»pk<tt 
Pnwcivitalwjf, 11. S- ; Citlvii I'kaspfumi, It. P.). Calcium sulphate is 
official in the B. P. 

All salta of calcium are incompatible with acids, 

The precipitated carbonate of calcium is used in the treatment of 
»frtiH9 iiiarrh'ia as an antarid, and as a hrnl jtmtrctiv in cuses of 
eh/tppf'f nkin or inti-rtrufo. particuSarly in young (.'hildren. When 
given internally the dose is fnim 10 to 80 ^ritiu^ (if,t>.v-i.(l), but bv 
far the l»eHt mctliod for its admini^lrntion is in the emplovment of 
chalk mixture {Sfisltira Cref^jt, U. S. and B. P.). which contains 
about 8U jirains of the chalk to each ounce (2.0-30.0) of liquid. The 
doffe «f Ihix mixture is from 1 drachm (+.0) for a yojing child to an 
ounce (30.0) f«ir an adult. In the treatment of cases of serous dittrrhaa 
chalk mixture is heel given in couibiiintiou with tinclurt* of kino or 
the oimpouud tincture of catechu and p&rej^onc, in some such form 
SB foUova: 



128 ^If^ DRUGSi 

B.-Tr. kino fSj (SiO). 

IV. cnlccliu cnmp ^ ((LO). 

MioLunv rreiir q.a ad ^vj (ISOlO).— tL 

S.^A deawTtspooDful yS-O} ctctj' (liroc houn* lill diarrhira ceane^ 

It 19 to be reroeraberetl that tlju cbullc niixtiirc acts verj slightly 
u aD BStriDgvDt, ond cbieil}' us au mitACii aud luoubatiical agcui In 
the ulicDfUiai-y cuaal. 

l*reci(iitated carbonate of calcium is the slowest antacid which w« 
pMseH.1. and for ihis reason in the rumcdy lo bo employed iii Mcidily 
of the inle.'itinc^. m it paaaeH tbroiif{b tliL> otonmcli to & vury great 
exti-ul uuL'haugod- (For the vurielies of diairbtca in which It is to 
bo iirtcd i^Q« nnioU- on ninrrhaia.J A.t an extf>r:inl application it is 
u»i-d ID tweatutif of the feet utid haiuU, and sou«timcft a& a dry dress- 
ing la nlfern. It may aUu h& used over banw. 

(jalcium cbbiridc, when ttikcn internally in large amount, tx:\» as aa 
intonHv gastro-iniL'stiual irriiaut, and luay produee death by this meaos. 
It ifl to b(; di;'tinctly sepanvted frona the chlminate or clibtridc >if Hme, 
with whieb it is smnplimt-s cnnfiisori, for the latter \» nothing more 
than hydrate nf litiic or slaked liu«, .cuntaiDiag 85 per cent, of chlo* 
rine, while cblnrido of calcium i? a bard, vitreous, friable subslanco, 
giviog off un odor of chlorine luid uttcrtv diffcrvut in its use, action, 
aud appi'aranee. 

Chloride of calcium is used id medicine by some physicianii in the 
tri'jiinit-ni of »rrifulou» enlftrifi'mr-titK of iftawh in the neck and else- 
vlicre, and is eviiii said to cause valviB cation and encysliug of (uher- 
cular nodult*. In cases where thfcient bonf-formation is evident it 
odf^n docs good, but the other sails of cakium, such as the lactophoa- 
|t)ial<», are better. Ln caM.'« where hoiU mature slowly a pnukic« 
made by juldiiig a noltition of cbloride of calcium to the mtww may 
bi' used to hu^ii'ii Kuppui'atioa. Tbe dose internally is •* to 30 
grains (l.>.3'2-2.0), b^st given in a solution made by adding water 
in the proportion of 1 draehm (4.0) to each .'J grains (0.;12) of tho 
drug. 

Another \i%» o? calcium chloride which Itt on^ always wortbv of trial 
is its employincnt in tlie treiumcnt of iUhmg. It should be given in 
tbe do«i? of 20 grains (l-'*^) three timeii a day to an adult, and may be 
prescribed as follows: 

a.— Cotcii tUoridi ■ - ■ - . Ju (8.0). 

Tincl. minintii flor n^'2Wt. 

Aoue chlorofnrrai q, e. iid ^vj {1S0.4}. — M. 

S.—Ono in 2 lablwpooiiafnla (16.-30,) three liuw a Any. 

Smaller doses may be iitwded if the stomach in irritable. These 
doges uwially produce some thirst, and they should be taken about one 
hour after a meal. 

Small doses of calcium chloride have also been used to increase tho 
onagalabiliiy of tlie blood in "bleederv/' and to prevent attacks of 
urticaria by an influence on the blood- plasma. It bbould not be given 
longer llmn four days, as after this time it decri*as<>« the coagulaoility 
of the blood. When used (he dose should be 1-0 to 30 grains (1.0-2.0), 



CAWWif. 



1» 



fo1tow«d by 5 (grains (0.35) every Iiour tilt 5 or 6 doiMw have boon talteu. 
Unforlunstcly, ».» already etatcii, it io n()t to disorder tlio stomacli. 

T]it> by|iu|)h()»!pl]iu< of calcium uiul the prer imitated phosjibalo of 
Cfttcium arc ueed for the treatment ol' Hcnjuloaia ur strumuui^ eUitcn 
and allied canditionii, Riich its rHchiti», generally in the furiu uf the 
SifTUpua Uffpt'phoapkitum, U. H., mid the iSj/mjiun Calcii I^ctopkoe- 
pkath, rr. S. and A P. 

The large amount of phnftpfaate of calcium in the bones and tissues 
renders it a useful drug when the body is fitnrved nf its proju'r pro- 
portions of saltjt, and its u»f has been found, in linimaU. to cau»o a 
great increase in booy growth, not only In the earthy, but aliio Jn the 
animal, cou^titucnta of the osaeouB tissues. The hypophuephitc haB 
a Minilnr eSi^. 

In ricketi and in fracture* where the bone is slow in uniting, and 
in some coats oTphthinui and tcroftda, the lac-to|)ho:4pbatca and hypo- 
phosphites arc of scrricc. 

It b worthy of note that these salts are of Jittlr value in tiibercii- 
loeia after it is really well developed. They do good chiefly in the so- 
called pre-tuhcrcular or hcginninjt stages of the disease ; aud the good 
effects of the so-called syrups of the liypophospbiten depend more upon 
the olhcr ingredients present in ttirm ihnn upon the calcium salt* tticy 
conrain. In d<nt<it ''trie^t parlieularly that occurrinj; in nurxinj^wuinen, 
and in fhe antfrnui of (hii* class uf patients, they are useful. 

The lactopliospiiates arc better than the hvp"phospli ites. as the 
latter arc probably chHii):ed into phoHpliatcs in the ntoniueh ns soon oft 
they enter that riHcus. The do«e of either the lautophosphates or tbft 
hypa'phitfiphiles is 10 i<i HO grains (0.6;>-2.fl) iliree times a day, or of 
ibe -iyrap^ j»gt named a teasp^iniifiil lo a tahlespnonfiil (4.0-l.'i.O). The 
difference betwet-n these salts ami pho.sphurti)«. both in llierapt-iitical 
effect nnd in physiologicjil netion, is to be elenrly borne in mind. Tho 
lactopboflphaies and liypophnsphittti are simply (lonvcnicnt mudis of 
admininteriug eaieium. pottu^iuni. or other auhstances, while phui^jihontA 
actfl afl a stimulant to hone-grnnth, and not hy its deposition in the bone. 
T'hosphoric aeid does not act any mnro like phnspbonis than does aul- 
phuric acid act like sulphur. 

Sulphate uf calcium \» not to be ciufouiideil witli calx sulphurata, 
ofUu wrongly lallud sulphide of rjiletusi. (Bcc Uoib and Cah.) 



Chalk. 

Chalk is a native calcium carbonate, cliiefly '>blftined from shells. 

I'reparc! cbiili (Crefa J'nr/jurftt/t, U. S. uml li. I'.) \s given in the 
r40K of 2" to i!i) grain* (l.;i-4."*). Dtlier preparaiionB are compomid 
efaalk powder (^J'uliiir t'rtttv {'oiiif>o»itu»,l'. S.), compoHed of prepared 
chalk, acacia, and sugar, and trjven in the duee of 1U to 60 grains (t'.t!5- 
4.0^. and troche* of ctialV {Vror/n'nci Cretir, U. A'.). Mvfluru CrrUv. 
ar Chalk Mixture, has been refen-od to on p. 1^7. Preparations 
uQiciat in ihc B. P., hut nut in ihe f/. S. P., arc amtnalic powder of 
chalk {Pulvix VreliB Ar<rmMii:u»), dcwe lU to (JO grains (0.6.J-4.0). and 
PuIvU Crriat Axtmatietu eum Opiu, iio«*e 10 to 00 grains (O.fJ.>-4.0). 



130 



DRVGS. 



CALUMBA. 

Catumba {Cfalufififp Itadiz, B. J'.). Colurabo. or Colunita, is tlie 
root of tbe JaUorhizn Palmala. Its* taste is bitter atid it» odor ia 
slightly aromatic. Two ulkaloiils are found in it. Wrbmne and coliiiii- 
biiie, and a tliird siihstaiirp known iis coluiobic acid. Caluraba is one 
of tho purest hittom ktiovrn. xa it di)<»t not contain tannic acid. 

Therarpeutics. — Ca-luinUa is one of llie he^i nlmiilf tonics that cati 
bo ii8i.-d, owing to its Incic of astringent effect and to its fainrablc 
action on uiucnun incinbramtt. 

In CH»vs of ffattrv-tntentiiiaf atony, parlicularlv tliiii following 
f«vrrs and »«imilar states, calumba will bo found of t<(>rvicc, and it i« 
a valuablo remedy in tho convalescent stages of Kununrr romplnini 
had teroua Jiarr/iu-nn. Tlic folloning prcncriptiuu of Pr. Guorge U. 
WonJ is very useful in ialntinti} ittntii/ when il is ut^swijited uitli 
flatulence, although its bulk is ili&advantagcDUS unil ils tu^te bilLvr: 

B> — I'alnnibw pnlv. SiwIIQ.O}. 

Zln)til*rii pulv X« 1 15. Oj. 

Mi-nnn-fol .'^ (4.0). 

Aqun> biilUeniia Oj (fiOOcr,)-— M. 

rt. 1(1 iuAuUQi. 
8.— A vrincKla-'xful t> '■ <I- 

Administration. — The fluid extract {Extractum Cnlumhte Ffulilum. 
U. A".) is given in the dose of l/i io 00 Tniniinj((l. 11-4.0) ; the tincture 
{Tmcium Ctilamlu¥. f. S. uiul ft. I'.), .lose 1 lo 4 (Inidraclims (4.0- 
16.0). The dose of the LiiriiKioii \lnfu*\im l^oiumhfr. It. P.) is J to 1 
fliildouiices (15.0-90.0). Liqtuyr Citlmnlxf CDiicentratus, B. /*., ia 
given in the dose of J to 1 drachm (2.0-4.(1). 

CALX. 

Calx [If. S. and B. I\) or Lime, or Oxide of Calcium, in an alka- 
line earth whicli ia incompatible with acids, nnnnniiini'ial niid inelaliic 
bues, bnmte!*, alkaline enrbonntes. ami nstrinccni ve);etiihlc infiifiions. 
It is prepared by burning pure while inurble, wysler-.Hhells, or the [jure^t 
calciuiij esrboiiaie. 

7bsnipeiiUc>. — Lime is used for llic jmrpose of anting iw an cjschar- 
otic particularly on old uhiT» and on hnirtf tfn^H-tfiif, It is never 
ffivcii internally except in the form of tlic hydrate or slnked lirac. 
An an esehariitic applicatiiDi lime ix uued in the uHieiiil caii><lic P/'Uima 
cum Calcgy if. iV. When given internally it ehnuld alwavH be used 
u Liquor Caha, U, S. and B. P., or lime-water, and nndcr tliefle 
circumstuDces it acti; as an antarul, a» nn aid to ike digestion of milk 
by preventing too rapid and solid cnagiilation of t)ie eaiieiu, and hy 
exciting an inereosed gastric secretion. It is also feebly afttringeot. 
Given to infiiniK and niiraing women, it is probably niilixed in tho 
body in tlie fomialion of biuie. It is uW of value in fJUii'tU-jt, in tho 
urir-ariii liinthpni*. and in the exe(«i*ive nawsr'u and vomithut very 
often seen In adult? and oliildren and due lo acidity i.f tlie stomju-h, 
Teaflpoonful do:«e» of milk and lime-water, ei^unl parts, irill oAea 



CAMPHOR. 



131 



be rctAine<I by sacb patienta wbrn tiotliing etfte vill retnnin in the 
■tomacb. 

The tluse uf limf-waU-r is 1 diaclim (4.") to 



1 



titmcL- «r even . 



ooncea (-iO.O-ttO.O). ExltTiiitlly Hp{)lied, liiuL'-ualcr is of value in 
tinea capita and similoi* xtstcs, and it is a enod application in btirmi, 
aft«r it \i uiixt-il witli eijital ])ariK of liiuieeu or nlive nil, furminp tlie 
hittimetttum Calci*, I', hi, and Jt. /',. orcaiT«n oil. As a local a|i|(ti- 
cHtinn in rni'mhranoun rroup and diphthiria liino-wftlcr Ihjis n high 
rL-pulalj-jn. and is btlieved lo dissolvi- tliL- mi-mlrauc, f^ul it does not 
compare in u»efuln«M «ith ptroxido of hrdrogen. It maj' be used as 
a fipra; or b v means of a swab. 

Lit/uor Calcin, or litue-watrr. in to be mailo by a(Wing n piece of 
■BsUkcd lime as lar^^e as a walnut to 2 quarts of Loiltd »nd filtered 
Iter in an eantien jar: after Ktirriof^ it thoroughly :illuw ii. lo sctilo, 
and poitr off ihv clear li'[uid iato a bottle. More water may tbctx be 
add^il to the lime until it iti all uned. 

Sulphurated lime {Calx Sulphtiraia, £'. -S. and Ii. /*.) is usefiil to 
check inflammation iiud hatitt-n »iippur»Tion: llic dns^ in ^^ to ^ of a 
grain (O.OOtJ-0.05). It i* of grcut value in acne fnoAul'im and all 
forms iif suppurntiim in the skin, Wht-re i«ul|»hiii-atL- of tiiiio is not 
obtainable and Biiccessive eropt af boili cnnstaiitU npptiir, it ir* often 
po)t<ibli; to relieve the patient by Ualiiiig eg^-sltells in iin ovt-n. pow- 
dering then), and then letting the patient e»t 1 dr&chra (4.0) or more 
of the powder each dtiy. 

The preparations of the B. P. tliat are not official in th« TT. S. art 
the ftacoharated Kolutiim of lime (Liijuor Catcu Stietrharalug). dose 15 
Uj 60 minims (1.0— l.Oi. and slaked litne (C'ahii liydra»), used in mak- 
ing difiVreni prcparacions. 

(For Calx Chlorato, see Chlorinated Lime.) 



CAMPHOR 

Cunphor (Cnmphora, TJ. S. and H. P.) U derived from the f^ltt- 
tutmomHm Camphora, which growe cbieSv iQ CbiLa and Japan. The 
camphor used in the dru^-atores 18 in reality i-eflned camphor, and is 
so ubiuined by repeated sublimation. It is a vulalik-, irritant »to*ir. 
opten. prudiieing a buniing lante and powit-ssin^ a pt'culiiir odor, 
poluble in IDOO partd of cold water and in 1 pan of >itrrinp alcohol. 
Camphor is sn volatile that if alluwtd to remain uxpiiSL>d to llii- air 
for nny length of time it rapidly h-sca its bulk and eventually disap- 
mars. It in an exceedingly conibuRtible sukitaiice. buniing nitli a 
natue and much smoke. It mav be white or pinkish in color. 

Pbyalological Action. — If talten in large amount, camphor pr*. 
dooM epileptiform convulsions, preceded by vertigo, roaring iti tbo 
ears, aud delirium. The pubte suou bccouii's rapid, feeble, and run- 
ning, and the E*kiu livid, cold, and covered with sweat. Great heat 
aud burning may be felt in the belly. au<L if the ])<ii!«nning be slnwr. 
4TidenccBof gUBtro-intvbtinal anrl renal iullamuiatiou euDue. In ttmall 
doses it acts as u etimidani ,^nd adds a seu»ation of warmth to the 



132 



pRuas. 



stom&cli, whilo the piilse mav become more rn-pid and str&agcr unJtir 
it*! iiiflupiice. At the siime time tliei-e is a H«(lation of rh* nt-nroua 
Byatein iiml n general fcolirig of uunit-ntiufiit. Id largo iiictiiciiml 
cli>so cain[>]i<)r is tbnujiltt liv svim; to act as a itcxual etimulaQt. aud Ity 
otbcr» a» a tsc-xiial suiUlivc, Tlit; ittimiilant effect is probably only 
product hy doses large eiiuuj;b to produw irritslioii of iLo geuito- 
arioary tract. The convulsionn following poisormua doHCH nre due to tlie 
actiun of the drug on the bntin. The dnig, although laTgcty do5troye<l 
in the body, is chiefly cliiniiialiMl by the Kidneys as canipljo-|;lyciiric 
acid, iiml iils-. oso«|r-8 hy the brrath and the pi'rspiraiion. 

Tliurapcutics. — Intersai. Uj^k. — Cuiiii>hor is employed for the 
purpose of acting aa a nerwus aedalire and antispannwdif in tlie treat- 
ment of nervous* women and oliildren, and aa a carminatifc in pcmoDft 
who suffer from mtcntinul fiaUiUxifc. It is of value is nervoiiR ij|y»^ 
Tnenifrrha-a and htmhtche, and !» hcit comUiiicd with one of the new 
aiial}^eti)c», KUi'h a^ unlipyriu and acolanilid {^iveii in taliU't-forni. As 
it i» virtually a volatile oil t^o far as it« phyRtubcical action is onii- 
cenied. it will bo found useful iti cholera and in cholera morbua and 
&1I forma of tfrou* diarrkixa, but rarely in niucoua diarrhoea, (i^ee 
Diajrhoea.) In chcrdee. combined with bromides and nimilar de- 
pruwants to the spinal cord, vuuiphor is of ;:rvat Fcrvice ili aouie 
cues, parti (.'id II riy late in the di8L>aso. In adytuimic fevrrx it Las 
been iise<i »» a diffnxildc i'timiilant by (iravcn and otlirr!> with {•rrat 
luccess. rjiniplior is a very uspftil remedy in cases of ^ndd-'U ntrvouM 
depreinon comia;; on in the course of acute or prolon^jcd exhauating 
diseases. It may he given by the mouth or. if the emergency is a prcBB- 
iitg one, by hypoderruic injection. Cndcr thetie ciroiiini'tnnccji it is beet 
given in tlie form of camphuraled nil in the ntrenglh nf ] part of ciiin- 
phor to i) of .*weet oil, wliieh la^t lihuidd be perfec'.ly sterile. The dose 
of this solution is 15 minims (1-0). When used in the nervous depr««- 
lioQ of phthisis, Alexander asserts lliat its couliiiuous injection 
may reitutt in ciimulHlive action and develop ihe syiupioins of mild 
camphor poisoning. In hif-nuifh it is of pvcat service, and in 
cardiac palpitittivn due to fiiDcLionuI irritability it i» fonnd to be 
of value. In rttpUfary hronfkilia and ■•'ttarrh of the air-passages it 
will be found useful in old nr atonic cases. In chronic nasal 
catarrh spirit.4 of caniphur when inhaled from the neck of A vial 
gives off* enough of the drug to start up secretion and tone up the 

rtrts. It ia also of value as u mouth-wath in persons who bnve ficCid 
realh. 
ram]thor may be inhaled or taken intcrnully in caaea of cold in 
the head, in the early stages, with great relief and a decided influence 
in aborting tho attACK. 'Che following formula may be employed : 

U.— Tdinplmrs- gr. (J iii.Vl\. 

Eit. bclladnnniv fl. nijw (0-IWl. 

(juininw Bul|)h , ..... gr. (j lt>.ia>.— M. 

Ft. UbcIlE No. z. 
6.— 4)iM every hour for four or Et« done*. 



■ 



After the attack i.t in full force this is oselecc, but tised earlv it will 



CAMtHOn MONOHJIOMAT£. 



133 



decjea»e ilio frontal headaehc and the mvezi«ff and rnnning at ibe 
DOM. In ("oryza from unknown causes willi iiiucli lachrymution and 
inocsB*ut sneezing, caniplmr will bd fuiitul of bem-til. It ninv Ik* snuffed 
up tbe nostril in a fine powder, or puwdert'J tanipliornmy bc'put in boil- 
ing water sod the funjes inhaled. The spirit vmv also be inbalod frotn a 
bantlkerchiff. 

External U^b. — ExturmtUv cumplior may be nsed as a stinjulant 
to hiiiolenl itorua and as a useful addition in tunull aTiioiint t<t the pre- 
cipitatet] carbonilc of calciuiu as a dusliuft-powcr iu inttrtruto. In 
the inrm of a liniment camphor is nsed uver injhtmtf'i Jointt from 
gprain* or rheunmliarit, unil iu myalyia aiul nfurafijia tu rclicvt; the 
psiii and sliflTumi.s. 

L'aniphorateil alcohol, t^piiit of camphor, h a. ujipfnl application for 
abortive pnrposeH when n!ii>il over hniit in their cnrh' iiin<;!e<:, if repented 
two or three tuaea a Aay fur a ffw niuuiutita al u titm-. FuIIowiitg thesi; 
applicnti<in«. th« skin should bo dried iind etiinphurateit oil upplicd. 
Kingcr and Tilt Wth refoinnxmd that Eau tic ('(dojrne. lyituriitcd with 
cauipbor, be rubbed into the head in the drowitini-** and hradachp. nf 
th* minopauif, an<l a lutJou of e«|iul pii.n.'i of ai|iiii iiuiiciciuia a.i>d spirit 
of camphor itnbbenl on the |niinfiil or hvperiesthe^ic spots at the lop of 
the head, »o otumwuly felt by ucrvotis wamen at the change of life or 
ilDriii*: iri(-ii''ini.-ilioii, will be fuuud to i;ive relief. 

Admlnifltration. — Camphor ie ufled inlernally in tie form of the 
Campbor-wHier {Ai/im Cumphvnr, t'. S. and B. P.). dose J to 2 fluid- 
ounvcs (I6.-6-1.); the spirit of camphor [.Sjnrifm Citntyhnrtc, U. S. 
anil B. J\). dose } a fluidrachm (2.0), or iu ihe form of the camphor 
itself, in piU, in the dose of 1 to 3 grains (O.Of.-O.l.'i) in each tiill. 

The best preparation for internal use is the spiril. or the fjuiu cam- 
phor itself may be (ziven. 

For external use we have, official, the camphor tinimenl (/jint- 
tnrnt'im Oamphorv, U. S. and B, P.) unJ the soap liniment, or Lint- 
mtnrum iSapontt, U. 8- and B. P., which is the milder of the two. 
Ccratum Camphors is also official. A ompoiind Tineiure of camphor 
(TVn^fMri Camp/iortp Oompanita). composed of otiinm. benzoic acid, 
camphor, antl oil of anise, is officinJ in the B. P., dose 15 miuims 
to 1 fluidrachm (1.0-4.0). This prepitmtiun is pmetiiraliv p(|uivalent 
to "paregoric" LinimentHtn- Vamphiini' At»i»'>uiatunt, li. /',, is 
oomposi*)! of ctimphor, rectifinl spirit, and stronger ammonia. 



CAMPHOR MONOBROMATH. 

Monobromated Camphor {{Jnmvhora moimbromata, U. S.) is iaad« 
bT beating together in a itealed tube camphor and bromine. It occurs 
in colorlesfl crystals or scalca. and has a mild taste resembling camphor. 
It is almost entirely insoluble in water, but is freely soluble in alcohol, 
rtber. and (.'bh>n)fi)rni. 

FhyaioloclcaJ Action. — Mouohrotuated camphor possesses powers 
partaking of the bromides ami of raraiihor. In the frog it causes losa 
of reilex action, motor jMilay and deatn by respiratory failure, and in 
warm-blooded animals violent convulsionsi, Cheyne-Stokes re.Hpi rations, 



1^ ^pi^ nnvos. 

niUBcular trptnblings, and VRaknass. The pulse ia at first more rapid 
thha normal, llicn slow and weak, (f&atU coming Id coma or dunng 
iho conviiUions, 

Therspeutiu. — •Monobromated ciimplinrwill generally bo found tnoat 
tiHiffitl tVir |iutu when combined nitb uiher dru/^R, particularly in /u/n- 
bayo, or llii- i>uiii diiu lo nervous disturbiiuve^. XJ" u&uJ m >'ii8tcrU-til 
/enuiteM. it will ofleti productf sleep, uud is of value lu tlioee wlio nre 
addicted to ()i<; alcubol-habit, a* it acts sa a hypnotic and nurrns 
the acoiuach. Like cuiuphor itHetf, it is a ga«tric irritunt. and 
should not be employed »Lerc ^aslritis exists. It has been used in 
tpermatorrhit'd with greiil suK-fetis. and in thlirium trfmfnii hae been 
found of bent-fit in cuhck v^licrc the gastric mucous membraDC is 
depressed aiid tbe ot^rvous twitt^binga are troublesome. In whoop' 
in^-<fOHi}h it may be tried, and it has even been nstd in -yhorea, fpi- 
tep»t/, and petit mal. In tlie nervouo depression and pains of epi- 
demic influenza monobromiitcd camphor has been largely used. (See 
Acetanilid.) 

AdminiHtration. — Thin dnig Hliutild never be used Iiypodunnieally, 
a» it is ioi> iiritatinj:;, bm administered in the do(>e of •'"> grains (^D.S'i!) 
three tiiiie.'i ii dnj in pill, or in an einulFiioii innde )>y diK.'^otvinz it in 
six liuicd itt) wei;;hl of expreiued oil of uliiiutids and then foriuiug an 
emuUiun with gum arubic water in the tjriuul uianner. 

CAMPHORIC ACID. 

Camphoric Acid is made by ilic oxidatinn wf camphor through the 
influenet? of aL-i<U. and is tbe btwt remedy for llie iiii/hl-nweatx of 
phthUis. In a large number of caie.-* nnfFering fmm nigbt-Hweats Llic 
author lia'' founil this drug to act very favorably indeed where other 
remedies failed, and he bo^ never seen it produce any disagreeable 
symptoms. 

It may be resorted to in the dose of from -0 to 30 grains (1,8-2.0), 
taken an liour or twti before the sweat is expected. Ia very obstinate 
ca»e>i as much as HO grair;^ (-1.0) ahuiild be given, but undt'r these cir- 
cum!4tanees it !«bou!d be «.<e(l in two separate dose* of ytl grains (2-0) 
eadi, two hours apart, in order to nvoia irritating tbf atomaeb. It is 
host given in cnpsiile or eiiehet, as it i^ insoluble in water, lu other 
iiidlaticcs cainpburie acid may be given in the following formula: 

B. — Aeiil. mnipliorlc Jiv 11.1,0). 

Alw'hol «ij (ftaot. 

Mucilftg. acBcItt tim |{H).0). 

I^r, »i)riiii|ii oDrtlciB q. (. nd f.^AfJ ( L8ti.O). — H. 

H.— DMMndfHwtifiil (S.U> \t> a tMblciipocaifiil <l&i.)) odg hour twfora swnt is 
expected. 

It in worthy of note that camphoric acid is posseaeed of little power, 
in the writer's experience, in case» of bromidroeis. 

CANNABIS INDICA. 

Indian Hemp {Cammbi* Jntiiea, U. S. and B. P.) is the flowering 
tops of the fetoulo plant ol Canuain* mtiva. It is [« be ilistlnctly 



4 



t 



I 



scparacoil from iIj« 8i»-call«l Aiuoricau, Anieritrau-rndian, or Canada. 
Iivmp, or Apwi/nunt Cfin»aiinitfi(. wbic)) is, in full doses, an inieD&e 
irritant and dnistic. 

The selvvliun of tfais drus^ is attended with pcHMtltar difficultly be- 
eaue of the fuel that onlr tlie non-fortilixeil fetnalo floner-i^pikeit are 
1»3MSS«<I of ihcrapcutir activity, the male spike-i and female flower- 
top9 which arp hearing seed being inert. At the sunie time the three 
varieties reeembic one another no cKfscly that wljcn rru^liud and jiiti- 
matitlv tnixeil in a bale it is practically impMBsiblefur even u drug expc^rt 
to tlistioguitdi tlic active from the inert. 

Miytloloclcal Action. — Cjiwu in fiil) dose to man, this drug causefl 
c.xbilaratiun and iittiirkn <>f inccKnant 1:iii<;liter arising from the Hlljrhteet 
cau-W. the [M^num sprminjj i'onviiUi?d with uierriinent ; in other Qiufen 
(he s«nfatii>n^ arc* di^a^^rveiiblu. tiiid even death mar soctii iniiuinfiit to 
the deraiifre*! iiiind. Sometime!* the Bomtatiun of very full bri-aihing 
oonM on. and the ;ialient thinkA he ifl ahont to bunt nith the inflation 
of his lunjpi. After thin deep sleep appearw, buling fur many huunt, 
evfu as much *» fourteen or fiftoen, without any intervals of wake- 
fnlneiw. One of the luimt oonwtant and prewiing symptoms in poison- 
ing in man is the ni»rkcil i«en^tioii of proloii^nlion of time, fo that 
miniitm «v«m like hours, and. in addition to t)ii», a peculiar srpiiraiinn 
of the mental pow<?r8 occurs, durinc which both hcn)i3r)hcre9 of the 
drain set-m tu tliink differently on Mil- same auhject. If the dodi- be 
vpry larjrc. the respirations are »lowe<l very consideraMy, lint no iknth 
from the nse of cannabis iiidira bv injin is on reconl. and ennnnou5 
amount;^ have been piven (n the lower ttniinaU witlioot caiisinp a leihal 
effect' Applteil t(» TiiiK-Hiia mrmlnanc, it aets ns a very severe irri- 
tant, and then an a local anpeathetic. bnt the primary effect is so 
[Miwerful a* to prevent U* applieaiinn to nim-oiiR inembrontM for the 
relief of pain. 

Therapeutics. — -Cannnbiii indica is une nf ilie best addiiioDH to 
e>ntigh mixtiires that we pogsess, as it (piiet^ iho tu-klitig in fhe. fhroat, 
•nd ypi doeii not constipate or dcprnut the aystem na dopH morphine. 
In advHi\(.-ed phthiniti it in Justifiable to keep the patient constantly in a 
alateof (juietunnifort by iwuse. For the relief of /I'u'n. partirnlnrly that 
dep<>nding on nervp.ili*iturbancp. hemp is rei-y valiiable. Before iho 
intrrHiiictionrfif atitipyrin and its ronjffners, lincture of gelwmiuni and 
the lincture or extract of rannubin indten were our be«t rj-iuediea In 
the treatment of m/i/rd/mr. The gelseniiiim in such cases should be 
given io fall dose, 2*) drops (1.3) of the tiD«t«re, and be followed by 
10 ifi 20 drop-t (O.Gri-l..:}) of the fluid extract of cannabis indica. it 
being known that Ike sample about to be used is netive. After this 
dose of geUeraiiim the patient Khonid bo carefully watched, lest he 
niffer from an exeeiixive influence of the drug, as siieh an amount 
mav produce great dcprcHsiou in susceptible pcreons. In true mii/raine 
with hemianopsia this treatment is often most oflTcctual in aborting 
the attack. The prevention of further attacks ia to be aKuined by 

I Tliv aiilhnr Kiu iiij«-iL-d lu miK.Ji n* H dnidintH of n llnid nclnirl, lunive in the 
■low uf 10 mininv tn man, into ihv juguliir vdn of n lODall clog wilbout producing 
<bath lur mu>j lioun. 



136 ^^HF bauGa. 

the one »f ^mn-lter Amounts of the cantiabia indicn. during tii« inter- 
vals, the gelsetnitim only being uscil at the aDM*t of the nyniptnm!!. In 
yartilxfgin atfitam oubimbis indk-u may ho aBec! to quiet the iremors, 
and in »patm nf tiie Madiirr, due to cTfiHiis or nervousness. It often 
givea great relief. In ttfriutf impntenff, not dependent tijmn organic 
ai.iease, it is said to be uf valuu conihiiied iviih i<trT<-liiiii)c nr mix 
vomica nnd ergot. 

In headaches at the monopsuBO carmahis imlira w ii»cful, and if the 
headaches are atittitoiaied with cuuslipaiion and anitMnia, iron and aloes 
should be given simultaneously. Where headaches are due to retinal 
ii»thetuipia a Tory nscful prescripUoQ, according lo dc Schweinitz, va 
08 foUorrs: 

(£.— Tr. mit^'ui romien ^(8.0). 

B.— I5clriap< il.D), in wnter, tvice <ir tlirice a day. 

The following prescription hu» hcco found to be rery efficient in the 
hands of the author in treating (fa*traigia and other fonns of Hbdomi' 
nal pain : 

li.— Tr. Mp«id r.?g (S.0>, 

Tr, iniinkbi* ind f;«i(lK.O]. 

Tr. opii dwtdomli fsi (31)0). 

.SjiL dilomfonnl f5j (3001. 

Sjit. Iflviirdiil, ojmp q,«. nrlf.^lv (120.0).— M. 

8. — Teanpoonful i -l.«i everv hmif uiilil jmlu is lelieTcd. 

In cases of ulerine Buhinrofitti'm. rhrtmie inff/tmmatien, and irrita- 
ttvit eatiuiLhis iudica is or;;if»l value, luid it lias been found oPiierrioe 
ill tHffrorrhfiifi/i and ifrrooun iind gfinjitiiiidff dyHwenorrffrn. Not nn\y 
doL'.s it relii-VL- the pniii, hut il seomH to set favorably upon the muit- 
cular fibres uf the utfruK. 

In acute and chronic Bright'* dieenee cannabis indica often allays 
the painful senRiilions over the renal ropinn, imil has been rceom- 
mcncied by some wiitera in the ni,-*e.- lu nhieli Moody urine '» preecnt. 
In i}(im>rrhuHi it i»> sutd to deereiu^e the discharge mid preveui c/iordee, 
BXid il has siippUnied liir um- of rnpailia and irohebH in some practi- 
tioners' h»nd». It should not he used in the early atagcs nf gonor» 
rhiva. but in the later or subacute stages. Tliere is some foundation 
for the belief ifaat in enmit doiief* it acts ns a tcrnftl flhntilanl. 

The adviintagen posst-.-'wd by nniniitii« irulica are that it does not 
constipat^^ nor esLUHe after- de])re>^iuii aud iiau>iea. On the eoutrarv. 
there is often au inerease ra.llier ihaii a deirea^e of the appetite under 
its inSaonce. In the Anglo-Saxon race the caunahiii indiea habit is 
practically unknown, but iu the East Indies when used to excesa it 
K»tn*'tinit<H causes niHiiiaeal in!>aiiiiy. from ^^l!iell the patient nearly 
always recovers after kohjc days, wceke. or month*. 

Admtnlfltratlon. — 'Die employnienr of this most valuable remedv is 
hfiridieiipprd iiy its frcnueni lack of power — a tiiiill which is largi-ly 
dependonl upon reasons already given. Only a pn?p»ration which lias 
been physiologically tested slioiild be used. The drug as prepared by 
Tarke, Dari» Jb Co. ha.-i proved etltcaeioit-t in the .luthor's liands for a 
nnmhor of years. The physician sliould always employ some pr<>para- 



lion knoffo hy liim to be uclivi; l>^- pcraouAl trini before coadcmaiiig 
the drug n» a failure ia ft given i-ase. 

Tho Hcwe of the solid cxlracl (Hjttractum Cannahii /«*>«, U. S. 
>n<l B. P.) i» from J to } gniiii (0.01 "i-<J.03). ilmt nf iliu fluid i-xiract 
(KxtradHfn Cannahit /i^die<e Fluidfim, U. S.) from 4 to 20 minims 



\ 




(O.tJ-l.iJ). ftliti ihat. of the tincture (^7\nrtum <Mnnabi» Indictf, (j. »S'. 
uil B. P.) from Id miaitas to 1 dracbm (1.0-4.0). 



CANTHAEIS. 

QnUhan* (U. S, and B, /'.), or " Spanish Fly." is really a bi-etlo, 
inovn aa th« Cantharimtnirtilorin. eikI an huch a{i]»earH wiib iridea- 
cent coverings or wing-abealhs of a blitish or greenish hue. Tho 
iiwects come chieHy from Spnin, liaty. and Sicily, nnd fnun tbo sonih- 
em pftrtA of Russia. Those from Russia arc suppoBt-'d to be tho bwt, 
Aocordiug to Leldy, the vesical in j; BuLHtaiioi' ia in ilic blood, the I'jrjis, 
and the iwcretions of the geuerativp appnrntiiA. 'I'hc blistering siib- 
•taocc contains eantharidin as an active principle, bnt cnniharidin ia 
not tucdic-inally employed. 

Phrstological Action. — r.i<R'nlly applied totheKJcin, caiilharidm causes 
irntatiuu and finiilly v<.<:>icntiuti. Tbcldister produced may be((uile large, 
and vuougb of the dru^ njuy be absorbed lo i-iiu«e fever uiid uitrvotm ex- 
citement. The inf^etttion of a. modtrriLlt; do-^u of (ruiitliiirLder' pniduceii a 
■ensation of warmth in the niomaeh and idighl Klimuhitinii of the getiito- 
urinary sy.item. partietilitrly the Uidnt-ya and tiriimry tnii:!?. Lurgv 
amounta produce great pin in ihe Itimbnr region, burning in itie blad- 
der and along the entire urrtlira, pri»pi»M. aguniziag vi-sieal tenesmus, 
widflRpreail aeute ncphritiK. bloody urine, iriiich is scanty at first, and 
finaUj »ippro*icd, with great irritation of the exiernni opening!* of the 
gwiild-uriniiry nppiirnin^. The iiirtnntraatory chfinge« whieli are pro- 
duced mar cause ploughing of xhv penis or of the lubiu in the female. 

VioloDt ^lriw?nteriti.i is nearly always a pressing eoudition. A 
diagnuetie aign of cantbaridal poinoning, when the beetles bnve hecQ 
swallowed, is the appearance of piecesof the iridescent wirrg-sheulhg 
or «oau in the votutt. Thirst is always n prominent symptom of 
poisonisg by eantharides. 

Therapeutics. — Canthnrides are em|doyed iniemally and extcmftllv. 
When giteu by the motitb the tinclnre It< used n» a uftri>ie stimulaut, 
to affect the uterine raucoita membrane and relieve amenorrhcea in 
caaes in which alony and deprcMion are the eaiiw of ihc nupjireiwion. 
Some persons teach that the tincture of canihuridcs w a valuable 
remedy in nmnll dosed in the Rpcnnd .xtage of acute ihtMiittitattlire 
tt/'j'hritig, but in the instances where the wriler has seen it nsi^d it 
ban made matters much won*e, ulthongli il is i^rippnserl to drrreasc iho 
quantity '>f iho albumin and blnod. In (he Inier slagei<, where the kid- 
ney* are relaxed and torpid or where uliuminuria comes on on the 
'■lightest exertion, tineturo of eanrhariiles in the dose of 1 minim (O.O.'i) 
Ihrei! times a day is of great st-rviec. 

In CBBCK of chronir parenehjfmaioiu »fphriti$, particularly where 




138 



DBVOS. 



nlo4jlioli!4iii irt the ciiuBO nftlK; dii^ntM^ Hiiil the kldneyfl arc innctirCt cut- 
tbaridul liliuture is verv useful. In jn/flitts and in chronic cyatilis it U 
of scrvk'f, ami it has bom rccomitiuinled very higfaly in drop dosos in 
irrilability of the bladder in women aud chUdreo. Id these cases the 
bWlder inuiit not be )n1Um<-d, but irritable from dcprceaion. The use 
of cuinhiiride* is of viibie in incontinenef. of Hrine- of a uiiiiur degree, 
OH that ociiiirrinj; in »»\i\v. trld^rh- or nervous rfU)aK>3 when eou;!bing, 
tmoezing. «r laujrliiri];, and nill oriou j^iven relief after many years of 
Ruffering. In rhorUrft in the linse of 1 raiium (IJ.OS) twice or thrice 
daily, it is sometinics of wrvit-e. For impotence defiending upon sexual 
excete Ringer i»s»rrlB that the nne of 10 lo 15 minims (0.(i5-l.U) of 
the tiuftiirt' of ciinlharides, wiih full do^es of the tincture of ibe chlo- 
ride of iron mill nux vomica, nill oflcu relievo tbv }iatie&t and eiinblo 
him to hepet (diildrcn. This dose of enntbaridcs tnusl be ^iren 
with caution. The dni{; has no true uphr<jdi»ia(; intlucncc except whcD 
given in s1mo«l toxic Ao*e. Id yttet of a rerr chronic type and in 
prottatorrhca it i» of Bcrvico. Dermatologists have u^cd eaiitiarides 
mternidly an a remedy in pturtaiii*, eczctiut^ liehen, and [/rurya, willi 
as9crte<] ^reut suceef<-H. I'he do»e sliould not be lari;e enough to irritate 
the Htomacii or kidney«. 

Exlernuliy, ■junlhat-idi-s arc u^cd in the production of blisti:r» for 
the |iurp08e of euuKiuj^ (lie ahsurpliou of iifTuKiunK or as a couiiltrr-irritaHl 
of some govcrity in ca«e8 of deep-seated infiammation*. (See Couuter- 
irritation.) Care should be taken that a nfiflieient amniini of the ilnig U 
not absorbed (o muse 8tnuij3;ury nnd renul ii-ritatiun. In reual con- 
(letlivitM and i»(iammati»iui the u>it> of rjinth:iridvs ii^ a cDuiiler-irritant 
U often coiLlruindicatcd bceuuse of this danger. Ilm:hnrd and others 
have reported raaes in which, without nny previous diaease of the 
kidney, a canthnridal blister ha.s produced viofent acute nephritic, with 
uremia llierefrom. In the proportion of 3 luiniin (0.05) of the tincture 
of canthurides to 4" ('^.0) of water il i^ *aid to be u very good appli- 
calion for f'tinm, but liow it acts i» iiul kni>wii. 

Administration. — The dose of the tincture { Tinrfura C(tnt}tari(it«. 
V. S. and li. J'.) ifi from 1 to 10 mininiB (D.O.i-ll.tiO). and it h the 
only preparation used internally. The cerate (C'tcrirfum CanlharidtM, 
U. •¥.) 18 used, spread upon h rag. to produce a blister, and the cerate 
of the extract, wliiob \t^ no l^'iificr official, ia u«*d for the piime pur- 
puMM and ill the mime mnnnt-r. The canthiiridal collodion {VulhuUum 
Van'h'iritiaUtm, f'. .V., CoifiMifum i'tricaur, ii. P.) is u uit-thod of 
applying the blister which is nioRt rIeanW, hut there is tuore daiiger 
of absorption of the drug if it is used. The collodion acts as a pro- 
tective to the part. J.u/uor /'Jpttpantifuti. B. P., ia employed a* a 
coiinler-irrilant. 

■■ Wnniiirig plaster" {Eniplastmm Piein Hant ha ri datum. U. S.) i» 
a mild counter-irritant jdaaier to be employed where a blister i? thought 
to be too scTcre. The prepiirations of the B. P., other than those 
named, mre Kmphiitrum VanthariiUt nnd ('nf/ufntum C^ittf/idn'-lit, 

The uiinfUcial plaster* of cauthariile^ made by several fimiR are 
the beitt preparations to use for the jiroduction of a b]i<)ter. In order 
to obtain a perfect effect the $kin should be washed thoroughly with 



CAPsicuif. 139 

aS^itld omier nml ilried with n towel, vrhicli ^tiould be rough enough 
to uroduvi: rvilitvniu^ of the cuticle Aficr this tht- »k'm sboulJ be- wet 
wiUi viuvgu", mid while w«l the hHKt«r jm to he apjilivJ. 

CAPSIOXJM. 

Captimm, V. S.. Cnpgiri Fructux, B. /*., or Cayenne Pepper, is 
tlie friiit of C'jptifum futliijiafum or Mtnimttm, a mtivo of tropical 
Afrira and of Central America. It occurs in lon^. oroid pods, which, 
when ripe, jire scarlet red and popses^^ a vorv hot. (jiirning taste. The 
itclive prinriple in c-apsirine. which i^ a dnvk-i'eildii>}i tiijtdd, which is 
a v.i|ati[.- ;ilV!i[<iid. 

Fhyaiological Action. — lineally applied to the skin or mucous 
roerobnine^, ca|Miiciitn caiiweH jjreat rednpsn, iind fiually, in the caM 
uf toucous uicuihranc-t, vesicniiuu. The alkaloid will uIhu |irr>diioB 
thew changes in the akin. When used intornftlly Tor auy leii;;th of 
time in exce.ts euptdcum will caane u chmtue or Hiihaciite ututtritis 
with |tain and discomfort over the liver and Htomaeh. It" single large 
doe«i are ii«ed renal irrilatimi and inKammaiicD en.^ue. wilL atraiigury 
sotl high-colurcl iirino- Taken inicrnatly, cn{)«ioiiin is said to act ue 
■ circuiatury ntiniiilnnt. 

Thfliapeittlcs. — In casefl of atont/ of the ttiowaeh dne to general 
dfbililtf, errors in diet, and alcoholism of the chnmic type enpf^ienm 
■a one of ihe ln-si remedies we have. When the patient is sufl'ering 
from di'u/c III ru holism the fiastric niiicyuj^ inetiil>i"aiif is often imi much 
irrilnleil lo permit of its iitte. but after the lapse of some days it may 
W found of hrnelit for the purpose of iricrea,''iir)r the dipealion. Aa » 
n-medy fi>r iiu6iirutr ahuholixm it is i|uire useful, since by itH stimu- 
lating f fffx'l uud hot fi-K'^al inn it often »itisftes, at lea.<nr tn oome degree, 
the craving for ali-ohol, 1 'nili-r thew eireumstaiiefs it should be used in 
(he dow'of :» tn I't minimi* (0.;HMUi;'i) of the tiiu-tnre every four or live 
Loun.oras ilieol»in>sin in pill in the dofieof i to I grain (U.03-0.05). 
The following prescription iiae heen found of great service in these 
casts : 

B.— Tr. rnwici fSy*- (laO). 

Tr. opii dt*>(Jr.rai f^y («.0), 

S|>l. nihir. oiif «i . ^iv(l8.0). 

Tr. Uvuidulwcniii)) ([. ». ad (^i" (^20.0). — U. 

&— -DemMtiipiinnful (tl.O) «Wrr (nur Or liva lioiin. 

Tn the fljtUthnt foHc nf old peranns and youuj; adulti* eapsimin 
will be found tmt only lo a«t as a cnrminalive. hut also to jirevenl the 
derelopraent of the ga». Tn low t'fvrii it hait been used as a diffusihlo 
Ktiiniilaiit. bill ii is of douhifitl value. It ia rather in the anorej-ia 
of col I valence iiee that en]>»ieiiiu acts most favorably. lu ehrovir 
ncjihriliM it i« of coiteidenihte Kervice, and it tends to cheek alhunii- 
nuria, hut it in tmly to he UHed in the chronic foniis and stages of 
reoal diseaae or in the trei&tinent of fuQctional torpidity of the kid- 
Dev. Tho tincture is to be stiven under these eirennit;tnnce>' in the 
d<m) (if 2'^ mitiiiiiH (1.8) or U-ss, but in simie cases whirli are very 
chroatc as luucb a£ 4U miuimti (2.136) may he used. lu mre throat and 



L 



t i m/Uf hxi lWi ib« iiactun> of capdicnm and glycerin, half and balf. 
ftrnn • Tvrr a»tn\ local applicatioo applit'd by mcAnn of « sw&b. 
Tfa« now pf«(«nittoit may oe used as a g&rgltj for reiaz*d uvuta and 
Mr* tirftt. 

Ca|H<>n)m mar be used u a gaatro-inlfwtinBl xtimiilnnt to aid in tlie 
abwrpiinn of oiher druj^. Applied cxteniftlly, capicutu acts as a 
coiintcr-iiriinni. pifxiiicing rednps* of the i^kin, but not a bliarpr in the 
unlitinrv inilividual. It is one of lliv b<«t uinlcmte coiint^T-irritatita 
which can be used, and it mftv bo cinpluyed by mtiirating blotting- 
paper, time and time again, in the tincturt! of rap»)(-[itii. ulbming it to 
drr between each dip. This paper should finally be plnooii when warm 
ati'il wrt civcr llic (lart, and beM elowly to tin- skin by a coiiiprpsa, 
C»f«icuui plasUT {Kiujilaftrum Ciipgt'ci, U. S.) is UKcfiil in hivihtujo 
and rhrHmaiinm when pbicwl ovt-r tlic uffVcted muscles, and in hraJache 
wfcee appliei) In tbu iia|)i> uf the neclc. The tinctiiiv i^ sometimes 
pwatrd iircr rAiV^/'t/riK whicli are unbroken. The fallovin): mrtbnd, 
prrsi by Kinger from Rbeims, is very efficacious in Ibis annuying 
afrction; 

" Make a strong tincture of capsicum-pod » by 8tee|iing ibom for 
wtrtnX days in » warm plivew in twice lleir wcigbt (»f rectili<;d Bpirila 
«r via*. DlMulve uum arabic in water tu nboat tbe cuusintence of 
Uiaclr Add to ibis an ctjiial qunniily of the tincture, stirring 
Mf^r with a ^mall bruNb nr u liirge ntniclVhair pencil unril tbey 
mil iaeorporated. The mixture will be cloudy nud <>pa<|uc. 



ttllC* Am Ci of aitlc er ti^iiie-paper ; give ibem, with llie brusb. ii goat 
rf tW aiixtnw: let tbcin dry. and tben ^'ive another. Let that dry, 
4M4 if tko Korface is iibiuiug. there ia enough of tlio peppered gum ; 
tf MA. £irr a tbird coat. Tbi? paper ebould be upplicd in the eame 
^M u oMrt-plaAicr to chilblains that arc not brokra and biirn» that 
W« Mt Ui»lert-d, and it will .'Speedily relievo the it'-hing and jwin. 
h Wfet like* a ehann and elTei.-t« » nijiiil curt-. The same ih true of 
tItMtflwml brniBce. It likewise allays rheumatic piling iu ifac jointa." 
tW «!«•* «f capsicum is 1 In 2 grains (IM>5-D.l) in powder, on 
ft. ' I pill. The dose of the tincture of capsicum {TiHctura Ctip- 

, > 4nd H. P.) is T) to 20 minima (0.tl;'i-l..'i), and of the ole^ 

Mwtt ktJfcwi U Wtf CVr/iiW. r. S.) } lo i niinini (O.*n.>-0.03). The 
4)f» gr itw fltid extract (Extrartum Caitgivi Flniiium, V. H.) 18 1 to 
ft«kijMMa» (t>.<>6-".l.'i). The plaster [Kmpia»hum Uaptict) is useful 
|m Mtwrmal aiiplioationH. An oioluieut {Unt/Hmtam C'aptia) is 
4Mld M Ikw »• f*- 



OABBOLIO AGID. 

tVM)» Acid (Aridum Carhotintm, U. S. and B. P.) is also 

''lipn-'t. I'honylic Alcohol, and Phenio Acid. Not only is 

bill iu addition it ia an alcohol of ihe [lecnliar group 

■iv )>lii'n'<ls, which are derived from coal-tar by a proce^ 

[ta acidity is, however, very feeble. 



Wi4 N«>*. \ u>d 



,1 ia *oM in neveml gnwles, N'». I being the purest. 
id i ore crystalline, while Nob. 8, 4, and a are impure. 



. 



1 whic 



CARBOLIC ACID. 141 

becBOM of the preHenco of crceylic icid aiid utlier frireign subiitHnrefi. 
<>iil_v No. 1 should be ordered when carbolic ifccid is to be pven bj 
the moulh. 

It hji8 a peculiar cbaracteriatic odor, and vflries in color according 
to itg method of preparatinn and piiritir- It Ih noliible in 20 per cent. 
of water, bat it is liquefird by the addition of fi per cent, of water. 
Carbolic acid flhould be kept in dark amber-colored, vrell-Rloppercd 
bottles. 

If tb« crystals be expnned to the air, they iinderxo lii^nefactinn, 
and in coiuoqiience the purest carbolic acid is npually proscriletl in 
miuim di:«es rather than in griLint>. It is sohible in nlcohoL ether, 
chlurufonn. >;iyeenn, aud luost oils. It uiiit\.'S tvjth nlkaliiie ba^es to 
furta giilu. carholiite^: hut these are vt-ry readily decomposed even by 
the feeble*! acid«, such as carbonic acid. 

flijriolocical Actloa. — Lueally applied to the nkiii. c-arUoHc acid 
produces nt tirht a lurning sensation, accompanied by a diffuno redden- 
ing of the surfiice. If the Holiiiion be stronp. the part at once becomes 
temporarily pBinfiil, then bleached and numb, so that tactile sensibility 
is destroyed. Api>Iied to mucous membranes, it causes similar chan);c8, 
btit to a more marked defjree. and may evt-n act as a moderately sever© 
caufltic of a superficial type. Owing to ibe coagulation of iilbuiiiin 
prorlured when it i« applied, it eaiiiiot cauterize the tiH^ueti very d(?eply, 

Nkkvoi.'s Sv.^tk.m. — Carbolic acid acts as a de[ireHSJint and piira* 
Irxaiit to the peripheral spnsory nerves when loraily apjdi.^d. Upon 
tlic hi^'hor centres in the brain the acid produces a couditinn of 
deprenwion and stupor. 

The convulsions which sonjetimes occur after toxic dti.sps have been 
taken are xpinal in origin, as ihey occur after dectinn of the spinal 
cord. The tnutor nerves escape almost uutuuehcd, as do also the 
muBclca. 

CntcL'tATiON. — Upon ibe circulation in the higher animals thedrng 
exereises a diiiltnct. depre.**ant inflaenee, stopping the henrl in diaittole 
in lethal dose, and panilyzing the vasomotor centre cvi-ii bt-fore the ear- 
iliae uuiM-le is affocied. Tbe^e ebanges follow only lethal ihsvs. i^tuull 
iiii-«iii'inal doses have no effect of any moment upon the cireiilalion. 

Kksi'IRatiok,- — After large dnse.'* tho breathing beeomc* more rapid 
and full. These changes, acconling to .r^alkowski mid others, are due to 
Riiinnlaiion of the respiratory centres and the peripheral vngj. Lethal 
doses altuoet invariably kilt by failure of renpiration due tu depn^sHion 
of the rMpimtory centres. 

TKMKKRATntR. — Carbolic arid acts as a feeble depressant lo nor- 
mnl bodily temperature evon when given in medicinal Aou; and also do- 
crvaeee the hoddy hc«t in fever. It lowers fever by djmitiibhing heat- 

Eruduction and iriereasitig heat-dissipation. This antipyretic power is 
ardly sufficient to permit of it*i use in dineiu^e I'ov this purpose. 
KtbXEVj^ AMI Elimisatiox. — When carbolic iicid is given in over- 
dose the kidneys may become so irrit^itcil that total urinary siii>prosflion 
may occur. When taken in large quuntity it entises the urine to becomo 
hrowni»h-hla«:k. This discolnration in due to an ediict nf carbolic acid 
which is not yet isolated, unU>s» ii be bydrochinon. Carbolic acid is 



142 



DJtVOSi 



pliminatofl in die urine as » ^ntphocirbolato of sorlinm nnd potaAiiiim 
iLiiil us <:Iyi;o-uron ic acid niiJ liviirachiiioli. Part ofit m burtit up in 
ihu Idnlv, 

It is to be (Ualinctlj uuilvr^luual that tliv <]ar)c tirinc of i:iu'b4>lic> 
aciil jioiHuiiing is not duo lo tlic prescnc* of lituod or Auy of ita 
«dui-l.s. 

Poisoning, Prolonged and Acute. — Ah the clianges produRod in tlie 
tiiuucA of tlie bod_v by aciile anil chronif iHimoiiin<; by carbolic acid are 
identioal, ibcy may be eonsitlered loyother. 

Carbiilic itcid is one of iLi- luiist di-iidly and mpidly-ivi^tiin; poiiions 
knou'ti. allb€m;^b thiA fact does not seem lo be ^enersUy ret'Ofinized. If 
a lar>!c Icthivl rlom be swalluvrcd by n man. be may drop d^xl from ita 
eflei^t* befoi'e be can ^o more tli:in n few fwi fruin the spnt where he Mood 
'when 'Iritikin^ tliv dm;;, or be niuy live n few houi*^. In t'u»c? wburo 
death bux occurred Huddenly fnnu l[ikin<; liiJM acid ibe direct cuir»i> bas 
been failure of respiration. It tlir jtiitient does not die at onee, all tbo 
eridoniN^ of ga^IrD-enleriiiH ennie on. Violent vomiting and purging 
may cusuv. and bitrnin^ pain in the entire abdomen is <i prominent 
svmptoni. Tlie slcin is wet with sweat, the face pinched and anxious. 
Coll«p«o, with u thrciidy. imperceptible pulse- and extreme dvBpatCB, 
miiy be pre»enl. Tbi* moutb and lip» luav not smell of the driiir. but 
tb» mucouf) nienibruue will be seen to be curru):tiled and i^iained black 
if impure arid \mn been taken, nr be wliitiiib if llie jDire rlrug Iihm be«n 
uaed. The eschar on the mucous meiubrane is a peculiar one, and is 
jwlhoirnnmonie of tbo poison, having a white centre surrrjiinded by a 
reddened mid iutbkiacd xouc. the centre doiuctimes becoming! dark brown 
or black. The jioBt-niorteni will show rhese HpoH In the le.Hoplia^is 
ftnd stomach, and cvea in ibe inte^line^- All the internal organs, m 
the brain, kidnuys. liver, and spleen, will be fonnd tilled wiib dark 
grumouti biftod, and on oponiny tht body the strong odor of the- a«id 
will be perceived. A ]ieculiar crouponii exudate iit MJinetiines fuund 
in the bronchial tubes, and tatty degeneration of n more or lose wide- 
uprrad lype nf'Hn follows rarbolic acid pni.soning. lisngerhans has 
noted thai ill some of these cum evidences of croupous pneumonia 
•xUt. A very coturiion symploiu Is huai'seiiena of ibe voice, due to an 
efleol im the larytix after the drug is abtiorbed, and not from its local 
inlluentx<. 

A Inrge number of cases arv on record in which subacute carbolic 
acid poittoiiiiii; liu!* been produced by its absorption from ;^ur^u.>al 
dre«»in;is, 'riie earliest signs of *uch an accident are ibc darktiicd. 
iimoky bne of the urine and a slight nervous unrest or cen'bnil di»- 
Hirbance, Wry often piiin in the lumbar ivj-ion indicates kidney etrain 
and Irritation. 'Die ilresssingii should be. of course, at once removed. 

TllHAT-MKNT i>v ror.''oviM!. — Thc chemical antidote to carbolic 
acid i« any miluble sulplmte. kiicIi a<. Kpsom ur (ilauber kbIIs. ivhicb 
fofiii iht<>d<i1ilr siilphn-carljohtiea. and which are prcferablt* to other 
Mibible Milplmles in that they aUo ncl a.** piiigalive.', if freely ii.'ird. and 
W> wacit out ibe bowel. The further trciittncnt con^is^t;! in ihc ndmin* 
iairalloii of uarm niiK-ilaxiixxis <lriiik». hot applicii lions lo the exlrenii- 
tie«, the liypmlerniic injection of cardiac and r(«pinilory ^tintulantu, 




CARBOLIC ACn>. 



143 



•s digitalis und strjchtiinc. morphini< to relieve pnin, ami the 
' ti9c of couiitt^r^irrilation over the abtlumeii. EiiiKici and the Rtoin»th- 
puup 6ti<>uld be QBcd if possible, but the former are generally uselcsa 
becaoise of the Rtate of the stomach. 

"Wbea earbolie acid hat bten trilled on the handt Ha effecfa can 

'^fte ofrrcOBU if the hands are immertrd at okm in tt6»ol«te aleohul. 

There is no satiirfsctorj vxpluQattuii of thi« very extraordinary effect. 

Alcnbol m»Y abu) be uited iiileriially as an antidote; but aw it caJinot 

[be taken in couctntratcd form, it? internal u?e is uol of much valuv in 

thin rondilion. 

Th«r»peiiti«. — IntonjallT carbolic acid is liltletwed, but, oeverthe- 
1 lass, has a viTjr tavonible t-ffect in t-crtaiti ntatea. In nenifiits romitintj 
[or in thill Oik- lo gajitric irritatinn the druj; does >;ond in i to '1 minim 
l(U.0;5-0.1li) ilmies by (lepressiug the sensorv nerves in ibe i^tomach. 

Ill dUirrfura di-pemling upon fer-mentfttion from 2 l<» 4 minim? 
|(0.HM).20) of llie acid do (^real good, |);irlic»hirlv if enmbinvd with 
^10 to *iO grains (D.65-1. 30) of biistnutb odmiuietcrcd in powder or 
ea{ieulv. 

In jianartttr aud tvfu'rculifgis »f the iun^f & spmy of lh« aoid in 
*er in the Btrenjitb of 5 w 15 minims (O.'^l.O) ro ihe ciince (IW.O) 
IT do some ("ood. and at least control tlie cimyh ami relievo the irri- 
ri'itx aii*\ tie klin;f in the ihrmit} (See Pait III.. Inhiilutiuui>.) ('rcosulc 
tj, howerer, generally preferred in these conditions at the present time. 
In diphhrrin, uht-rated tiore throat, and even in ontinnry uttmatitiM, 
carbolic aeid will be fonnd of vnlue when used in a spray or month- 
•Ktmh in the prti[ioriiun of 1 part to 75 imris of water; and in ordi- 
li.irr #■>« thfo'tt or that due lo sepsis in the (ftrciiptb ftf 1 pixrt to IIW 
vi water it will i>e found, nbrn applied nn a swab itr by a garble, to 
reliave the pnin and inHainmation. In the treatment -of hurpg carbol- 
izvd swwt oil in ilie proportion of 1 drachm (4.0) of the arid to each 
6 ounce* (IHO.O) makes one of the beat dre«*in}p that eiiii l^c used. 
By means of the local aIln.*stlle.^tn prnduL'i*d by llie iicid. minor opera- 
tions, such as i-^vrfion >•/ «« iiu/rotrinij toe-nail or opeiiiiij^ ii felov. 
uiwy be (MTformcd by applying the pure arid by mcanH of a brush to 
, tbi! line of the inetaion. Carbolic acid may he u»ed a» a biliun in iho 
' itching of jaundice in the proportion of lO grains {lt.65) of the acid 
to 2 drachms (8.0) of glycerin and '2 dmcbma (8.0) of water, or. 
fceller »till. 4 dracluus (15.0) of swet-t oil. In the fonii of iiiitiiutment 
Fu^bulie avid may be used in the strength of 10 iniiiim'4 to the ounco 
((J.lio: IlO.O)of a. simple cerate, panirularly in rawrw nf suhnrute eczema 
I Trbere tberp is a ereat amount of weeping. In ejLses i>f eczema with 
'much itching, and in pntritus and /tcA^u planum, the following oint- 
ment is nseful : 



a.— Mwitbol. . . . 
Acid, carhilic 
rtiK. tkijun^ ruoB 



. (rr. T (aSS). 
.Kt.3. (0.M1. 
. 3 l.TO.0).— M. 



' 'Tht; '("ay miinl l« a n-rr i\u.e viui^ ur il vtill iioi carrv the dniK far niiouKlt ili'wa 
inbi the lnnp< u> do ou* JECol* 




144 



DBUGS. 



In enlarged glanda vhtoli lta.ve not yet gone on to tuppuration 
)utru;;luiidiil:ir iiij^'tiuiu or cnrbuliu acid l>y tncnns of a liypodcrmia 
neetlle ar« nf vnlur in il large number of c&scs, tbc suluiiou used bving 
no TC*'iiki-r nr stronj|,'ir tliaii 2 per cont. ; 5 to 10 miiiiuiB (W.30-O.15) 
of tliis sulmiou arc stifticiuiit tor iiicli j^lamt. In tbc trt'stmciit of 
bufioen 10 miuiui!) (O.ijj ijf a »uhiliou oi" 8 grains (_0.5) to the ounce 
(30.0) uiay be injectpil into tlic ntteHing, the «kin being firat 
bennmbed by an ether spray. Tbig is a most siieceRj^fiil trentineiit. 
Tlie sainu tnratmeiit may be applied iu chronic xtfitotil^e uiiil n-))t<ute<l 
erery tliree davs. and t'oih aud ciirlmHclm may aUo be t^o tfLiiteil witJi 
great succoah if ttie mcasiiri^ bo used early enoiigli to abort Ibr trouble- 

Cnrbniie acid is rar<>ly iiiicd directly over leounih in <Ire»iingti at 
present iiuIc:<h tbe dreaniiig be one of airboliictl oil. Otber drugs 
or rigid a»epi^i<i bave Hupplanted it wb«u iiaed in thUway, but surgeons 
have rcliirneil tri itM f'inpb>\^ient a» ti ii»rful untisepliu wbcii u»vd in 
pure form to awab out open woiiridn tbiit are infeeted. Tbe use of tlie 
carboliiceil i^pray over noiiiid^ l\s^ bevn found lo do more hann tbaii 
gooi, and it ought never lo be employed, 

A$ tuIiMinfectant eurbulic acid ruiik^ among tlic poonat: 1 to S 
per e?nc. HMlniton^. however, kill inosi spores and genua. 

Untoward Effects. — Carbolic arid wbrii applied aa a dreaungi even 
in as weak a sirrnglh as .1 per cent., to a finger or toe may eaUF^e gan- 
grene of tbe piirt Pvveri! euoiigb to destroy it or tu require auputatinu. 
Snob 8treiigi)i« applied In Tlie skin of the trunk rarely produce evil 
effects, probably because ibe circulatiim i« nwl so completely cut off 
by tbe action of tbe drug on the blood-vessels. (See Plate 1.) 

Adminiatration. — Carbolio.ii:iJ ointment {i'ligufHtmn AeUH Citr- 
Afi/fW, i'. .S'. and ti. /*.) imd tlie glycerile ((V/f/C'-r/frt At'iitt Cnrhvliei, 
U, S.) lire tlif only olliciiil jtri-pumtions of airb<dif acid in tbc 
U. S\ y*. In tbe B. P. ibe following jirepiiniliniiH are oflieial : Acitlum 
VarhoHcum /.i'jurffictumt given in tbe doBc of 1 to - minims (0.0.5- 
0.10}; irltjci'rmuin Amfi Carboliei, Trochitm* Aeldi Carbolict, and 
iSupjuKi'toriuw AciJi Carbvtici. 

CARBON (OHABCOAIi). 

Oarba Liffni, U. X and B. P., or rharcoai, is prepared by tbe 
expoflure of soft wood to a red heat, air being prevented from coming 
in contart with Ibe w<H>d during tbe procena. <?barcoal when used 
for uiediciual purposes ^lioubl be a bbick, brittle, soruewhat Bhiny, 
porous sub8tanc(>, devoid of taste and odor, and completely insoluble 
in water. 

Therapeutlca. — Cbareonl is used externally jis ati ajipliealion to old 
norm or iihiiiffnt to act aa a droiiorant and <inti»eptu\ 'I'he»e tbinga 
it Bccompliiibej) by the nbnorptinn of nny liuiiids wbicli injiy be pnmcnt, 
thereby depriving geriiiin of a nidni*, iiiici by il^ distinct o^tidizing 
power. It may be applied in liiL- I'onii of ii dry powder nr in a poul- 
tice, wbicli is, bowerer, 60 uncleanly that other antiseptic dreasingn 
are belter. 

Tbe poultice {CtUaplanma CarhoHia), if used, sbould be maUe 



i 



PLATE I. 




CARBOLIC GANGRENE. 



Appearance of a Tinger four weeks after the appli- 
cation for twenty-four hours of a dilute solution of 
carbolic acid. The finger was wrapped in cloths which 
were saturated with the carbolic solution not stronger 
than five per cent. Amputation necessary. Inflamma- 
tory process at the base of the finger shown by the 
reddened tissues. (Harrington's case.) 



L 



in tlie following manner: Tnke cT pnvdorrd woocUch&rcoal ^ ounce 
(15.(1), braail-erumlis 2 niinoeB (60.0), linHt-oil meal 1^ niince» (45.U), 
anil add boilinj: waier 10 fliiiilouiu'i-s (8(>().0). Maci-rait' tlit- bruacl- 
crumbs anri mo«I for ten tnJDUtes over a fire, antl then etir in 
tbe charcoal to tlie pxtont of hulf the amount just nnmcd. Spread 
oat the poahice ao«l aprinkle the remnining hnJf of the charoou over 
its Burfiici;. and apply to the part affeccud white Lot. 

I&lomally. charfoal is used in powder in many eonditiong. and 
acts Terr well indeed iu cjiscs of so-ealled "jtowr gtomach" from 
which ertictaticinn of gas or 8our liiiuidii; tuke tilace. 

Tbc following prescription will also W fi.imd useful in the aionic 
or auliocuti- ijnttrie catarrh of persona who are careless in eating and 
who have much belching: 

B'— Oteorealn. m\»m gtt x rel ii (O.tiS-I.S). 

PaaoMtii) KT. xz<l.3). 



PulT.dodberii zt.x\(iMy 

Piil¥. rarfcon. Uipii gr. xl (2.65).— ML 

Fi in pil. No, XX. 
8,— One or Iwo t. d. 



fAi ordinary chan-oal is not always obtainuble. it may be ftubsti- 
tmed bv pieocs of vtrv thin toast hurnt tlirou;;b and through till they 
reecmbic charcoal. U the attaek is very severe and vomiting' eventu- 
ally cnHUcs. the ejecta will comniutily be found to be odorless and not 
Bonr, and the etouU will aloo be almoot odorless, though bluck. Jn 
frrmentMhst a«*i aii'd liiarrhfvag in adults this methntl of treatment 
isoftcn of Tsim;. till- prescription given above beiuft a vatuaLlo means 
of cure. When cdutrcoal is iistLl in iiny enndilion as.sneiiiT.pd wiih 
irriUtiou of Ihc ujucoiij' inciiibrunes nf tbo j:astro-inlostinat truel, it 
shonhl always be very finely pnlviTixed, Hnd if the stomach or LoweU 
•re iaHaroed' the capsicum must be excluded from the prescription. 

As a filter for impure water, charcoal, in mass or in powder, la one 
of the tnoat satisfactory substances we have. 



OABDAUOM. 

Cardamoni (Cartlamomum. V. S.) is the fniit of Hifttaria lit' 
j^t. and is a bitter tonic poBeesaing some aromatic properties. It 
ts useful iu ms^s of atony vf tht xdntuich and inmll iiife»riiie. par- 
ticularly if combined with a mineral acid or some other bitter tonic, 
such as gentian. Cardamom is olUcial in the B. I*, aa Cnrdamomi 
Stmirui, 

If ttte intestine is atonic and secretion is deficient, the following 
pTweription will be found of value: 



B.— Adii. nilriv-dil. . . . 
Tr. cardmnnmi comp. 



S(— DtnerlBpoonnil (8.0) nft*r each uical.' 



.... f 55 (4.0). 
. q. ». aJ f .5*i (180.0). 



• Wtiilr ib4> rule lli« «n iirid i* incompnLible wUh a lindure i* mil rpivigniwd in 
iHin tnixlurr. the (jtixiititini i>r adil Mid almliol »tv wi dl>i)n>]Kirit'>nHic ihm Dlhcr in 
•0/ anouu is not (IcTelnpail. 
10 



140 DRCGS. 

AdmlnistTallon. — Tbe uflficial preparations of oii'ilamiimB are the 
tiDcUire of carrtanioins (7'/fif;(Mr« Vardamomu (J. *S'.), dowc 1 to 3 
drachms (4.0-12.0); and the compound tiiiQXnve {Tinciura On«iamomi 
OtjmwtUa, U. S. tttitl H. P.), which in to be given in ihc sumc dose 
as tile tincture. This liiiciiirfl also coulains cochiueal. einnaninn, 
caraway, and glycerin. Cardamnm \s also a constilucot of the 
official ammatio powder {Pulvin Aromatietu, U. S.). 

CASCARA SAORADA. 

OiKcara Safjrada (iJ. P.) is the barit of tlif RhamuHt Pitrxhiana, 
t\ S„ plant prowiug in Cnliforniiu It in soinetimew called Cali- 
foniia buc-kihorii. to diNliiJL;tii^h it fmni oniiniiry buckthorn or Jthum- 
nu* f-'r("t<jtilii, which it clot^ely rwviubles in innny wavit, and which 
may li«' ii«i-(t Ks a Hiibslimte fur aiaairu ;<u}jrdda in auuie ca^ca. 

Therapeutics. — Oa^t-ara Buj:rud!i ought never to be used as a puige, 
but oidy ii- a laxativt.'. It i.i hy I'ar the best remedy we have when 
employed simpiv "> empty the bowel of fieeal matter in eases of eun- 
Hd'jMifiiiii, sinee it nut only |)i-rri)nii.s thi^ functk^n niUiont intestinal 
dl^t urban CO, but ytmiiliAncoui^ly net:* an n Ionic to the intestine, »nd 
so prevents the onstJpalion wliieh usmilly follows the use of all other 
dru^R ef its ela^s. 

Ciittcaru sii^nidfi is most coiniiiunly employed in this country in the 
fomi of the fluid cxtnict {Extrnftiiiii Ithnnini Piir^hianir Fiuidvm, 
U. S.. or Eriracliiin. CtiKixrtf Saijraihr Lufuiilttm, B. P.), in the doac 
of from lu to 20 niinini.=) (0.(>.'>-1.30) at niglit or moniinj; ^.nd night. 
If 20 iiiiniiuiT(1.3) fail to act. 30 iuin)inst(2.(l) may be used : hut if larger 
doseji nre re[|iiiretl, other drug^ shonld be employed aA fuljursnlji, as 
fluidrachm dotes of the fluid extract of cascara may lu-oduce irritation 
of the bowul, and enieritis or intestinal catarrh. flio objection to 
CHNcara s;ij:rin!a is il-i hitcer la^'ie. which may be partially overcome hy 
tile additiiiiial U!U> of (be .'^yrnpiii' .Aiirnntii, in tbe proportion of 1 lurt 
of the oiwcora extract lo 'Z jmi-ts of the ayrupof urangi'-peel. The 
Ji. P. Um a preparation, .SyrM/n« Vugranr Aromtiticus, which isgiveo 
ID the doi^c of 1 to i drachma (4.0-1 o.O). 

i^oiuu of ibu pn'panilionfi of ihi» drti^ are now made in an almost 
taatelrxs form, ftueli as '• Cjiseiira Cordial," an aromatic preparatioa 
useful for ebildrt-n wlio are coiislipated, or the non-bitter fluid ex- 
tract made by a promiiicnt Grui in this cainitry and railed " OnKcara 
Evucuuni," and used in the dose of 20 iuinimH(1.3). The eolid extract 
{Ezirtti'tittit Ctmeane .Sayra<lte) in officrial in ibe ft. /*., and is giren in 
the dose of 2 to 8 grams (O.I-0..J] in pill. 

CASSIA FlSTniiA. 

Casnla Fistula, U. S., in the fniit of Cnsnn Finhtla. or Forging 
Cassia, as il is sometimes called, and occurs in long, dark-brnwn pods 
contnining a dark pulp in each scf^niout. 'Y\m pnlji is the lu^eful part 
of ibc driif. and i.t oOicint in the H. P. afi <.'<ni«(fp Putpti. Cassia 
(latula ought never to be ased alone, ae it ja (uo apt to cause patct 



CASTOR OIL. ^^^^ 147 

-.-A griping, but it in officinlly present in the Cnnrcctinn of Spdub 
(Omfictia J^mmr. U. .V. iind B. A), anil may be given in tlie duse of 
4 draehm to 1 dracbtn (1!.4)~4.0) H.t a laxnti/e. or as mucb as ^ ouQC« 
(15.0) maj' be used if a purgative elTect is desired. 



CASTOR OIL. 

Cutor Oil {Oleum Jiin'nt, IT. S. and B. P.) is a fiietl oil derived 
by rxprcsflioD from the beans of Ririnag Cvmniunia, a plant of tbe 
rnited States and elsu'whtTe. but origitially derived from India. Jt 
contniti» an acrid Hubntaniv, ricini>li?ic acid. 

PliysioloKical Action. — The mnnner in wbirh csBtor nil purges is 
•omewbat iu doubt, but its aetirity pn)bnbly depeniltt upnn the pres- 
ence nf the acid ju8t named and the fact that it m an oil. 

A» is well known, oils — such as oltvo oil, for ctuinplt: — if given in 
oansideRible iiusntity. tend tn move tli*> bowoU, nnd tbi> ricinoleiu acid, 
wbidi i^ somewbat acrid, stimulates tbc t<uiiill and large ^ut, and 80 
develops peristaltic movement. According to 8ume writers, this acid is 
Dot Ht free until the oil i-* attacked by the pancreatic juice. That tlii^ 
add po«ef»e» purgative properties of itsi-lf »eeTn!» jmived bv ihr- fiiet 
thftt the oil will purge when it ia ruhbe<l in by tlie ■'kin, and that nurs- 
ing mothen on taking the oil diiuiuate the acid iu the tuitk Coimcb an 
extent that the suckling is pureed. According to tbe BtiidicB of 
Rutherford and Vignal, the oil Ti8« no effwt over bdiary secretion 
other than thai violent purgation indirectly JncrciLies the flow, and 
tbe researches of Xlesn have ahuwn that the nil iiots more rapidly in 
tbe small than in tbe large gut, and only prodticeti peristaUis by 
cominj4 In contact with the niiicoiis nn^mhrnne. 

Th^pentieB. — Castor oil is the blandest and moot unirritating 
purge we have, with the exception of tbe xntphaie of magnesium, 
which 1^ dcpletant and much more rapid in itseffeetA. While the Epsom 
Bait will act in one half tn one hour if the Hturaacb i» empty, cw«tor 
oil will generally act in four hours, or porbnps five. 

Castor oil is u»ed whenever irritant materitiU. aiich ax bad food, 
putrid flesh, or decaying or green » ejjetables. have been ealen, even 
if the inflatumtttion set up after them ia very active. If bard bodiea, 
inch as broken cberry-MtvneH. have been swallowed, castor oil is a lar 
better purge than sulphate of magnesium, as it is more gentle und 
Inbricateii the gut, thereby preveiiiing scrftjiinp and irrilution. Whet-e 
inucu^ ba^ accumulated in ihe bowel in cbildrctu and imist be gotten 
rid of before olhor treatment is resorted to, catttnr oil >«liniild be u.ted. 
I'revioua to parturition it has been largely used to relieve the howeU 
of f^cal matter, and is said by some practitioners to make tlie labor 
ea*ier than if any other purge is used. This i» doubtful. It is also 
employed In tbe roumtipatirrn following acute diiteaAeH and in that 
occurring in infants and children. 

Tbe disadvantages of castor oil lie in its taiste, ihe fact tbat It is 
oily, that it tends to pi-oduee bemorrholils if used constantlv, and 
finally that \Xa fre<|uent use, or even a single dose, is geuerally fol- 



148 



DRUOS. 



lowed hj more oWtinate constipation than existed before, so tliat tlie 
close must be rnpiHJy incrcjwcd in siae to bt- effcctivo. This \e one of 
tb(? rc-usous wJijf it is uKi-ful in irritative diarrhirag, for linving jtwept out 
tlie niiicuit and uflVjudiiij' matter it checks tbe movements of the boweU 
«IVri-ward. The purgative effect of castor oil is very mucli increased 
if a little bicnrboniite of sodium is given with it. 

Keccnt reporla show tliat souiit cases of severe neuralgic headache 
mny be cored by the use of smull daiiy dosw of castor oil. Hok it 
acta is not li uowu, urikss it iinlcMids the bowels and 80 prevents 
toxiemi'j, wbich, in turn, Ims caiuaed nervous irrilntion. 

Admtnutxatton. — Oastor oil is very uiucb more agi-eeablc (o the 
ta-ite if pure thnn if poorly prepared. It IS alao trae tliat too great 
purification reudc-rs it less active. 

The methods directed for tnlciTig etuttor oil a.re bs various u the 
Castes of individuuli«. lis odor may be covered by a drop or two of 
the oil of bitter nbnondii, but emiil>iions of the oil are not of any wr- 
vicc. save to interfere with it,'* efficiency. Soiui- take ibe oil in the 
foam of beer or porter, others in syrup of Harsajiarillu and soda- 
water, and still others in milk or cream. A good way to take it in 
to cat one or two strong so-ealled cream pRppermint drops, or even 
the crvHlalline peppermint drop*, swallow lliv oil from a spoon which 
is to be placed well back in the iiioulb, and immediately eat several 
other peppermints. This jilnn is imjiroved by usin^ the oil in tiiilk 
or water, so that the liquid earrii'M tlie oil down into the lo&opbajsus 
withoiil its touching the mncoiis niembrancs. It may also be taken 
iu highly Heiisnnoit beef-tea. Ringer recnmniends the following: ^ 
ounce (15.0) of oil. fresh »yrup of aeaciu 3 drachms (12.0). and dis- 
tilled water 5 draebms (20.0). (lavured with a little oil of lemon or 
peppermint. Wood ndvii^cn ibat it be mixed wilb glycerin, ei^ual 
parte, to which i» added a drnp or two of oil of gniillheria or oil of 
cinnamon, liy far the best vtay of udmiuiAtt^nng it is in 8011 capsules 
containing from J to 1 drachm (1.0-4,0). Most persons can swallow 
as much as a teoepoonful in capsule, and xevcrni capsules contjiiniog 
this ijuantity, or a smaller amount, may be given at. once tn complete 
the necessnry dose. The capsules should be dipped in water in order 
to render them slippery and so more easily swallowed. 

The doBc of cosbtr oil for an infant i« 1 to 2 fluitlraclm» (4.0-8,0), 
and for an adult -J- to 1 tlutdounce (ir».0-80.0). Often, however, small 
doses will act when it is desired to sweep out of the bowel foreign 
matter tlial is eniising dinrrhoen. 

Owing li> the fait tliat the oil will very freiiiiently produce griping, 
a few dropti of laudiinum shouhl be added lo it, or tincture o,f Wlla- 
donna may )>e iii'ed. if iheFe cniinot be employed, a drop of the oil 
of cinnamon iii e(|Ually useful for this purpose. 

Under tlie niniie of Mietura Olei Iticini the B. P. recognises a 
mixtoro of enstor oil made into an euiuUioo and given in the dos« of 
1 to 2 tiuidouncca (SO.O-tiO.U). 



CATBCna— CAUSTIC POTASH. M9 



CATECHU. 

Catechu {U. S,) is derived as an extract from Aeana Catechu. 
The catecliu of the fL S. P. is true catechu ; that of the li. /'. n in 
reality an extract of gambier. being derived from the leaves and Hlinoig 
of t'ncaria (iMuhier. Calechu deiteods for \Xs medicinal us*.' upon ibc 
aMriBgent properties wbieh it possesses. Itevond ihia power it baa 
DO particular value. 

It is of a dark-red color, han a nnuiewbut RucetiHb tantc, and is 
loaolulile, WVv. inont extracts, in wnter, 

Therapeutics. — Like nil the vegetable nstTingeDig, catv«hu is used as 
a remedj for diarrktfa. particularly that of the noroiia type or that io 
which the stools are of too fluid a consistency. If lar^re amnunts nf 
uiuru^ in the pa».'«agca sliow a ciLtarrhnl slate of (he honel, the mucus 
should he displaced by a purge of castor oil or sulphate of magnegiuni 
before the afilringeDt is used. 

Calcchn may or may nol be combined with opium in eases of diar- 
rbcea, but the fuUuniug prescription nill he found of service in mn.ny 
utBtaocas: 

For an oduli: 

B.— Tincl. cstediii Qiniponlt. f^'j "'''''^'- 

TTiict. oi^ii i:ain)iliDrabB ^n (filXOt. 

Mislunrcicur . , .. 4 .<..•■■ 1%] (VO.O).— U. 

8. — I>M»ertH|>oonfu) (8.0) every four Iionis IUI relieved. To lie nhftken before umng, 

la cases of avre throat irhfre the Hecrctlou ia excesalve aud the 
inflammation ftubacute -catechu tuay bo u»ed a!* a j^arj^Ie. 

In ca-Hif of tfionfj\f (fuma catechu is jionietiires uwjful as a moutli- 
wattb. If the powdered catechu in uited inteitiallv, the doKe i» 20 to 
30 grains (0.1-z.O). The doae of the Compound I'incturc of Catechu 
{Tincfura Cattehu Corrtfiotita. I'. .S'.) in 1 to 2 fluidrachtus (4.0-8.0). 
Its uuly uonHUiuent besides the catechu is cinuamifn. 'I'lie TrncheR 
of Catechu (Trocfiieni Vatfr/iu. f'. S. and li. P.) am to be employed 
ID sore throat, and arc to be held in the mouth. Tbey are uot gen* 
crallv used. 

'fhe oflicial pre|»aratioufl of the it. P.. hesidcR the oneK given, are : 
the tinctare {Titurtura OtOechu), duse 1 to 2 fluidracbma (4.0-S.O); and 
a compiiuud j^ofider (Puhwi Catechu Cwtpotilitt), composed of catechu, 
kino, and rbutanj. the doRC of vhich i;* t^O to 40 grains (1.3-2.6). 

CAUSTIC POTASH. 

Caqatio I^otash {Potnssa, fJ. S.: Potttxm Camtiea, B. P.) is a hard 
white Solid, which readiiy deli<[uesfC8 : it possonftoa great caustic power, 
and i» u^ in medicine for the purpose of burning away ffr'nvtfm or 
trulfrant ulcfrn. In umali cuUnfomi cnnerra it is applied to the spot 
for a uiiuutu or two after ibo protecting scab is rcmoveil. The parts 
are then poulticed for sevpral days, when the slough come." away. A 
pit!ci! of ilii- drug, if placed on the skin by mean:* of a pair of forceps, 
wilt at once soften and bum the tissues until it can reach no farther. 
The Burrounding skin should be protected by wax. suet, or oiK and a 



160 



DRVOS. 



piece of adtcsive plaftter with a hole for the growth should first be 
applied tn prevent artion on llip siirrouiiding Uealtliy tWues. The 
burn )iru<liiL-u<l by ciiu»ti<: potiifth it very painful, nnd cautcrizaCioD 
tliruu^h its iiiiltiouce shoubl iiol be pradisod if it c«n be avoidiKl, 
H'hpo tlin rButilir^ bnn nctfil ^iiiflicieiilly, it i» to be waslied off with 
vinegar or oilier ilibile aci'l m neniralixt' it. VJi'im* pitftc (Potnuta 
cum C^/«<, U. S.) t& ueed fur the same purpose as is cau&tic potush. 

CAUSTIC SODA. 

Caustic Soda (Soda, U. S. : iSvda Otntttf^, B,P.) is milder titan 
cniinitip potJisb, nnd it»i aetiuii is more readily controlled. It iihould 
be used ill the Miitie way and for the same purponca ua ii cauatic pot- 
ash, and ibtt surrounding .ikin ought l^i be protected by adhesive 
plaster and oil or ointment. 

The Roda must be kejil in wcll-slojipercd bottle* made of hard, 
strong glass. The »nly official preparation i>f caustic soda in the 
U. S. P. ii Liifiwr Soda, or solution of soda. 



CERIUM OXALATE. 

Cerium Oxalate {Cerit fh<iias,U. .S'. arid ft. P.) is awhite granular 
powder, permanent when expoxcd m the air, odorle.'ix and taatelosA, 
and insoluble in water and alcohol, but freely so in hydroehloric acid. 

Therapeutics. — 'It m often used instead of oreombined with binmutb 
ill the treatment of the vontitinu nf prcvnanct/ or that due to uterine 
disorders and displnceiuenis, and in some cases of .f/**fri{! ai'iilky. The 
duMs is from - to o gniinv (0.10-0,8), given in pill-form every four or 
five hours. 

CHENOPODimi. 

Clicnopodiiim ( U. S.) i» the fruit of the Cfienopodiiim ambTo»wid«a, 
or Auierie&n worinsccd. The seeds contain a volatile oil and have a 
disiibi't and rather disa^reeublo aromatic odor. These seeds, rubbed 
up into n powder, form witb a syrup an electuary which is a mixit 
efficient remedy against the atcarin lumbricoiden. or ruund-wartii, as it 
occurs in children. The d'»se of the powdered seeds is from 10 to 80 
graiuB (0.66-2.0). The bolter way of using cheoopodium is in tbe 
tbnn of the oil {Ohti'n Chejtapodiu V- «V.) in the doi^e of 10 minims 
(O.I>) to a child of five ymrs, either on sugar or in im emulsion m:ide 
of gum aracia. If the piitient is nhl enough, copsulci may be used. 
Tbe general dietetic measures adopted for the removal of worms should 
be insisted upon before the drug is giveD. (See lunicle on Worms.) 



OHIMAPHILA. 

Ckimaphila (27. S.), or l*i)>9issewa, is the leaves of Chimaph&a 
umbeltata, an evergreen found in America, Europe, and Asia. 



Cm&£TA-~CMLO&AL 



ISl 



n«np«iiUi!S. — Pipsisscwa i<t a itru^ employed in atmie rmal ecit- 
Jitiana^ particularly of the futircional I.vpt-. a^ n slimuliLliti^ diurvtic, 
which will bring into at-livitv llio serrcting Srtruciiirc of tut' kidney 
>nr] the raucoiui mt-mbrutic ul' tlii; p-iiilu-urtnary tract. It Ik a\m a 
\aaie to the mtouiac-h. F»r this reason it is ofu-ii pincfj in mixtures 
{n^eo to (Iropsictl pAiicnitt if ilcbility *ih1 anorcxin iiro prcM-nt. In 
iho trmtment of ulri^r* of tht- nkin uut! ti> stniniB it \n sniil tu be of 
wrvice, aiid il prub^ibly Iin8 aumv i^\^ii iilk-rative [lowt-r. Tlit- drug 
mmjr be used in ibi' form uf a deouciinn, wliicli is nut ijHif^inl, in ibo 
doM of 1 to -H fluid<mn«-s (;lO.l>-9tA0), and lu the liiiid i;xtract 

iExtraclum Chtmapkiia Fluidum, C. S.) iu the duut! of ^ to 1 dracliiu 
2.0-1.0). 

CHTRETA. 

Chireta (Chirata, U. S. and B. P.) \a the jilant Swertia Chirata, 
which i« » native of India. It ie » bitter tonic, pwsscssinjr a very 
distinct inSuenci- ns'er tlie liver, and, nnlikc many bitti^r tonics, in 
devoid of tannic acid. For tbiii rivifnon it may be u^od witii prenara- 
tioDS of iron. L'hiretn may be given in cast-;* of iwiiiitition iiiiil Amj 
of appftitf, psrricularly wlioro tlio lifvr i» U^t-fnii or if any tendency 
■ t« coHstipittiuu is pixyciit. although it is not directly laxative. When 
given in powder tbe doso I« 2'J grains [I. S); the done of the fluid 
vxtrsct {ErtrttHum CHiratft Fbiiiium, If. S.) is iH) minims to 1 
draclitn (2.0-4.0), while that of the tincture {Tiurliinr ChtMt^.U. A'. 
and B. P.) is 1 to 4 drachms (4.ft-](».0). The unofficial Hidid extract 
may be given in pill in the d«se of '2 in 4 grains (0.1-0.2). The doee 
of the infusion (/H/M»«ni i^iirattr, H. P.) isawijicgliissrul(;l2.0). Lirmor 
Ckiratet Conci-Hfraliw, B. P., is given in the dose of 1 dracUm (4.0). 



CHLORAL. 

Although the name Chloral is apfdied to the substance used In 
medicine, chloral itself is never so employed, hydrate of fhloi-al 
(Chlural Ui/dra*, B. P. ; ChlcTaU U. S.) being the real prepai-atiun. 
Chloral hydrate is a whit*, cryatatline budv. bm is id'ten sold in irreg- 
ular broken masses, which ure generally impnro. It shuuld bu ktrpt 
in lighi bottle.? in a coo!, dark place. 

Fhjilological Action. — When chloral \» applied to a mucous raem- 
br»Du it causes distinct reddening and burning pain, and liDaliy acute 
iafiamination. It \», therefore, a Incaj irrilant. Chloral arts in ihe 
body as chloral, and is ni>t broken up into formic acid aud chloro- 
form, as was taught ai one time. 

NEnvuts Sv-STKH. — In medicinal and toxic Uoee chloral produces 
sleep by quieting the iniellectiial ci-ntres in the train, at the .same 
tims depressing the motor tract of the spinal coi-d and the motor 
nenrea. In meflicinal amonntj« it does not decrease sensation, bat in 
Coxic dowe it does- Very often hypora'tLthosia of the skin results from 
imaJI dosea. Reflex action is decreased by its sedative influence on the 
motor poftiona of the spinal cord. 



152 



DSU03. 



CrRoiTr.ATroy.— A dose of 10 to 20 graiiu (0.65-1.20) in the hoalthj' 
adult rarply c»us«> any circuliitorv clian^, lut larger amounts pro- 
iliice » fall of arteriii! pressure atiij a slow, feeble, or soniet imes ■ rnpid- 
ruiiiiiii'; |)ul!if. liuf to a ilireri tlcjirp-'wioi] of tfie heart-musck', for 
chloral iti L<vcnIo!^o is a car'liac i>itrutYKiiiit. 

After tleaiti fruiu cblurnl tliebloud may be tbiind dark and grtimouS' 
looLiDg, with lite corpuectee broken down, but these <iiang«i) oooar 
only after ver^* large dnaes. 

Kkspiration. — In moderate amounts no respiratory effect is folt, 
but in toxic doses the breathing becomes slower aad slower snd mure 



E''io.l& 



Fin. 17. 



T^M^ 



^ 



/^ 



PuLsa 



Via. 19. 



D 



B 



Wto. V!.—A. chloni] CADneii ilnvp lir iiutL'tliiit tni^lleetiUil MUrci fo brRln 

Plu. If).— R. T^praara miilurrcnimLiKBl Itoclii iif i-unli C dejiRoM* tnuUir tmrni ; />,<lnc«nar 

dvnma tlia tnilie[n. 
I^<|. 16, — B, Dt^mwca heart miuplc. 

Fill- V>-—F. ItepreMo ihp rwrplTsiory ccnin. 



and ni»r« shallow, until it (rtops in death. When death is caused by 
ehlural it is [irinmrily due to rei<pimtot-y rnihirc, but there is an almost 
simultaneous arrest of the heart. 

Tkmi'bratuhk. — Chloral wnde to lower bodily hoal, and in large 
doses produofs u very niarlicd fnll of tcniprraturo. which dnc-n miurh 
toward causing death. itrunt'Ui lias f<mnii tliat atiiinali: will nurvive 
very l:irgc doses of thr dnij; if pxremal heat is supplied lii llieui. 
The fall of lerappnitiire is, at least in part, due to the failure of the 
circulation and to vascular dihitacion. 



Ktdskts, TiSsllB-WASTK. AM( KuMiSATION. — Chloral 18 elimi- 
nated by the kidneys in tho form of iin>-chloralic ncid Mid, if given 
in exce»«, as cliloral. PoLsotioiu Oosi-a irritati- tlicsv urgans. and way 
produce Moody urine, owing (o t)i« tiopliniiH which i» M!t up a» the 
ilniK p»s«M (brougli ihv renul strui-turc-H. After chlornl h ingested 
tbu urine uf u puiieut will ufleii rtact to FebliiigK tci>t for eUKar. 

Poisoning. — When a poitionous duae uf chloral U taken by luao. 
the |)rnion soon falls tuleep ami then »(ink8 into a deop couia. '] ho res- 
pinitions become at first iflow and lulioix-d. then siiiillnw and fcchlc. 
The pii[s)>, at 6n)i porhujt^ :l little slowed, 8oon beCDnies thready nnd 
xhuLtle-likt.-. and ifl finnlly luxt at tiie wnet. The fnct- it) nhile nnil livid, 
the forKheud and the hands covered with n void sucflt, nnd the piipilfi, 
which arc at lir^t contracted, iwua becoroe widely dilntcil. Abso- 
late musculiir rctsxiLtion 18 proeont. and it is ioipu^ible to arouse the 
patient. 

Trkatukkt of PoisoNtNo. — The physician Rlmnli! apply external 
heat and use emotjca in the early etsgt*«, or, if the caee is seen ton late 
for eineticit to act because of fvstemic dcpres^inn, lie should ui*e the 
Homacb-pump. This latter tneatis of removing tho drug from tho 
stomach is safer and more roliable. because the producliou of vomit- 
ixiff mar result in efforts which will ftrnin the heart. StrycUuiuc 
sboidd he jiiven in full doKn, ^q lo -^ of a jirain (0.003-11.006) to 
8tiiDiilat« renpiration, or atropine may be iifped for the fiiaue pnrp<>»e. 
The heart in to be Biipporlei] by lO-minim (O.fi.'j) dnse? of tincture of 
digitalis, given bypodcrniically every tweuty minutes utitil some eflet;l 

Fig. 21. 




gbo«ntliaefl)NH<if >llBfWll«Iijniiiliisl>ln>\>i]'iiR«>nr^Rii(t |iiiU?-r:irr>^liirh1i:ral |Hiit>>iilii|t mft^'i 

tfdlunI**lvWnGl ' tu I !}■■' i-n'uiEjr* i» wry t*'^ ly-vmit*- uf Ebi' tlta^c-L .-f u iur^^ cIimu' tit 
rhkinl: the blood.uTfuiitv ii <ii. In ll.aRcr itn liijiriliiii iT >ll£tlAll>>. ft l> ni, aikI fii III 
UU U;, whI tbt Individual yuUv Iwat U ftr Jiiv.n^.'t thitii I.trir-L. 

it noted ; and. w the digitnli^ in rather xlnw in itfl action, it may be 
pnrc«d«d \iy etlier and ammnnia or bmmly nr whinkey. The patient 




154 



i>svos. 



must not rai^e th« heai) to vomit, and the head shonld be placed oti a 
Idwit It^vvl iliiiu thv hceU to uid in maint&iDing ihe ciroiilHtion of blood 
in tlie vilal cciiin's at the bwfi: of ttur Sraiii. 

In ekronie ifahoitimi h\ cblural or lii traseit in which the patient haa 
uutoe to use the ilnig a;* a liabil the patiem suffers from weaknew. men- 
tal nitd phy^iiral, with smlrk'n f)ushin<;s(liii>to 7a«oinotor disorder, from 
patpittttiuii of tit- hcnrt, nml finnlly iwm pc-ttxhial eruptions, bed-sores, 
ulcHnitions, ao'l sluu^ilis. 

Therapeutics. — Otiloml in the pureat hypnotic that we have, and 
may ttirrfi'nre \>v used where niinple ncri'nu* in*nmrtia is present, but 
Dot wlti-n ffrfjtkta/ifift is lUit- to pujti. Uii'Ut sucii ciKUUi^toiiccA it 13 
to be employed iu the oombiualioii of 10 grains (0.65) of chloral with 
J^ of a grain (O.dl) of morphine, us a muc-h more powerful hypnotic 
effect IK pniduced by the combined action of the two dmgti than bj 
the uee uf either oiir of them alone. 

The follovbiiig prcsevipiion may be used: 

K.— Chlorali* gu «Ut (8.ft-15.0). 

Murpliipa- «iitph>tJs . . - - gT- ^ ^'^'J' 

Hyr. lactuunrii (.luberginr) .... fiii iCUwi. 

AtjiwileM. q.Liilf.;iij (Hd.O).— M, 

8l — ^Denerbipiiunrul (H.O), In water, at Iu, uad 3i II r. m. if uvconarv. 

lnteta»utanyl trtri/efiiiiini-pDminiiifj cManl isoneof iliebcsc remedies 
we have, as ildopres.se.'* tlie motor tract of the spinnt corit. lusucli acatw 
it :<ih<m1d he civeu iu :iO-griiiu (1.3) dvaes combined iviih W graiJiii (4.0) 
of broiniilu uf potassium. If the uoiivuUion prevents tieglutiiion or ia 
hroujjLt on by swiillowinj^, these remedies ishoidd lie used by iho rectum 
di>»8otved iii^uirch.winer; and if tbes(m.«iii expels them fivum the rcciiim, 
the piitiL'iit nhoiild be chtoriifuniicd luuy; enoujjh to allow the iiijeetion to 
he (^ivcii aiid absurbej. The same remedies iu Bmall iloses art) to he used 
in infrtiUiif cnMvu/niami a.nA in titfuntUc colic in the dose by tlio mouth 
tf A grain to 1 j;rnin (O.0.*i-0.0ti) of chloral to 2 grains (I). 1 ) of bromide 
ef polos^ium or eodium in a teuapooiiful uf pcppermiut-wuier and synip. 
In chona, fntrahjiii» atiUmi*. and dfUrinvt trrrnena chlonil i* of ^reai 
service, but inmst be givm cautifl«i«!y in the last-named cnnditiim, for 
fear it tuuy depreiw the heart, which is already liiswued by aleoholie ex- 
cess. I.'bbcs are on record in which chloral has canned sudden death from 
cardiac failure in the persons of alcnhobi!.'; with fatty heart — an awident 
t}ie liability to which is iiicn^tised by llie fui-t that owing to the addiction 
of the palient to a DaicuLie dru^ it reijuires larye do»es to produce sk'Cp, 
In urifmif ronvtilnion* chloral haa been highly cxtollc^d, but if any 
acute retud trouble i^ jireitent, it muHl not be uned, lest it irritate the 
kidoeytt. ]u puerperal c^irafsiong not dependent upon nephritis 20 
to 3(V grains (l.S-2.0) of the drug may be given, and rt'|>eated in one 
or two hours. 

/rii-fou^jfiH, norlurnai ppihpmf, and whoopinff cough are all indi- 
cations fur its u»r. but in adtliiua it rarely does good, and if pushed 
is dan;;orous to the heart. 

Uateward Effects. — C'hloral «4>metiiucft causes nausea, pui-ging. and 
vomiting by reuiiou of its irritant action. In gusceptible pensons doses 
of 10 to lA grains have produced marked redness of the cyc-s with 
Bvellinfz of the conjunctiva. Sometimes tlie last-named Hymptuma are 



I 




CBLOBALAiflDB. 



lU 



na\y prodnced «b«D an Ricoboltc beverage U tnken Mmult&tieously. 
In Hill oihor caAOi an trTttien))itoi», jMipiiInr, iirTicurin), vo^iculsr, or 
pei«chul i-niption iiikv ciiauc, tbc latter funus beinj^ sccii ah a niJe in 
eases «f chrwnic L-hldralisni. 

Admiitistr«tioti.-~<*)ilr)i-iil is best given ja ^vrtip of nrncia, ^imploj 

Snip, or wntvr. It gliuuli] be nlvave voll diliitpil. The jiynip of 
lor»l (Syruputi Chtoral. B. P.) is giv«ii in the dose of 1 fluidrtchm 
(4.0). The followjug proseripliou is usefa) in iLsotnnia: 



I 



B.— Chlor«Ii« Si ▼«! 3y t^-O-*")- 

I'olHKti bi«midi ^Ij I H.0). 

Svr. immi TirE^nhnio f » (30.01. 

a'i|IUb <j. ». wl f ^lij (90.0).— M. 

8-— Dc»-mpo»nfitl (6.0) ai hikIiL 

Sotnetinics cliluriil ciui bf well (^ivfii in junket \v uJJing it to a 
Hnnid renneti and then adding the reunot to th« milk. ($oq Junket, 
Pan III.) 

The qiie-Tition aa to the safe Joae at dilorni 13 one largfly pf>verned 
hy the su8ci-pill>iIilY of ihe paticiil. but tilnrmin^ syiiiptuniH have fol* 
lowed a dose of '6*^ j»rninfi, and death aft>_T from w to An yrains. 
Tbiitj graius iu tvrcuty-fuur lioura ia wrtainly ample in must cases. 

CHLORAL AMIDE. 

Chlnralamtile Is a emu pun ml very ifvently introduced into medi* 
cine, formed by the ndditino nf fonnatnide to anbydralL* of chlural, 
and i» & culurleset crystjillinc substance. f>olubIf in !f pnriA of water 
and IJ \j!xn» uf nlcobo]. lis ia*to is *li^htly bitter, hut not bitiof^ 
and it keepA wcil in watery Bobitimi without dcc-otupoaition. Its 
pbysiolcigical action is cbwely alliod to that of cbloml, except that it 
IS not quite so depreseinj; to the circulation. Upon thi- iiki'vous sya- 
tem it acts chiefly upon tlie brain and spinal cord, .iiid pntduc-cs sleep 
— a result to h« expected, i-int^u bi>t.b chloral and fiiri»u.iiiidc arc byp- 
DorieK. Tt i« Miid not to irritate iht* stomach and kidneys, but it 
probahly \» only 1dm irritant than chloral. 

Therapeutica. — Chloralamide may b« employed in medicioo when- 
ever chloral may be used. It is decidedly a nervous sfdativu. and in 
the wakefulness of nervout innimnUi '\a very usL-fiil. Sleep generally 
CDiiieii about thirty to forty-live minntes after it is taken. According 
to miHit of the rcport.s publiithrd »o far, the drug relieves pain »» well 
as produ«« Rlee|i, and is therefore distinct in ita actions fi-om cbkiral. 
In nruj-iilifiii it is very iiKoful. and it has heeii found of value in the 
pauu of tahfK damatit. The dose is 10 to 8(1 grain* (0.tij>-2,tt), which 
may be repeated in three or four hours, although the ."leep generally 
taats five to eight hours. The following formula may be tised for it9 
admitiiatratioa : 

fl,— t'liloraliimiflc gT. sll'S.6). 

Atlil. lijriinxthiorid dil til v (0.9). 

Synipi . /aii fltOt. 

.\4..R-.lwi fJQ (ftO.O}.— 31. 

5. — T&kc in iwo <k)M« in a Itltl* «at«r. 




166 



DRUGS. 



The late Professor Cliartcris cUimcil very cxtraorf)lnii.ry results 
io the tresttnent uf ufa-atchienit by the ane of etjual pHrti of rhloral- 
■luitlo and brutnide of potuesiuni. He gave it in tlie •lortu of 3i> <;ruius 
(2.0) witli an e<iual amount of the broioicle. It is necessary for the 
patient to t«kc a cholagoguc for two Jj»j» before starting on liis voyage, 
nrd as soon as he gets on hoard the sliip to take the dose named "n nn 
empty stomach, and at once to go to hoj and to sleep. If this la done, 
Charterift claimed that the patient will awake feeling bright and well. 
and rctuaiu ao for lie rest of the voyage. This cwmbination uuder the 
name <f " chtorobrom" has been also largeljr ««ed a-n a hypnotic in the 
treatment of the itiM/nnia due to melancholia and acute mauia. 

0SLORALO8B. 

Chluralose is a oompound made from anhydrints chloral and glu- 
coHe, 16 8uluhle in hot «St«r and aleuhul, and vm introtliire^l into 
medicine aa a Hafc hypnotic and Kiihatitute for chloral. Unfortu- 
nately it:^ ta'itc in ncriij, and to Rome persons nauHeoub;, particularly 
if taken in water. 

Physiological Action. —The physiological action is practically iden- 
tical with lliat of chloral, but much more mild if the researches of 
Musso are correct. Ita doiiiinanL effect is on the hnun, and full doses 
doprens liic spinal cord and Jieart. Poisonoua doses may produce 
lj.'cmfiglot>iMiiria. 

Therapeutics. — The indicationw for the drug are fuHctmial iMwm- 
nia, and the beginning dose is 2 to 7 grains (0.1-0.5), hut the smaller 
do**! should always be tried first, particulaily in women. Sleep fol- 
lows it^ iiige&iioii in about, half aii hour. 

The bf^st way to adminisler the drug is to give it iu capsttlea or 
cachets, and to follow it with a glass of water or milk. 

TJntoward ESect8. — 8onietinic8 cbEoralone proilucen diplopia. luuitcu- 
lar treiiioni., or cnnslnnt panning of the liandn over tbe head and face. 
If a habit in induced by it!> constant use, it ia a noteworthy fsk-t that 
it« power to produce sleep is decrea.'ied, while the uiitnwanil effects ara 
more likely to be marked. Iu nervous and tuberculous putientH it 
eomecituea causes teuuic or cataleptic syniploins with disturbed intel- 
lection. 



CHLORATE OF POTASSITTM. 

Chlorate of Pot4i«si«m [Pittasnit Chhrar, II. S. and B. P.) m a 
salt of jHitajwium differing entirely in Its physiological action IVnni all 
the other potassium 8alt«, and, with the exception of tlie cyanide of 
pota»<ium, i.i certainly the most poisonouM. Not only is it, when 
locftlly applied, an irritant to mucous membranes, but when it is 
absorbed into the blood it causes cbange.s of a serious character in 
this fluid, and produces acute nephritis if given in overdose. 

In dry form chlorate of potassium ought tbcvcr to be nibbed with 
organic -lubgtances in n mortar, as sn oxplr»«ion may occur. 

Physiological Action. — It "has been thought by some that chlorate 



J 



CHLOIiATS OF POTASSIJJif. 157 

of potassium Riiei up a large ^moutit of oxvgeu to the bodv. and iliat 
for ihis reasoD it would he of valiio in casoe of slow aspbvxiu., siicli 
u ruult from pnt-iiuioniu or phthisiH. It has even been recnnimended, 
to penotw croiuiiuj^ bijcb inouiitaiim wbure th« rariu- of ihi} air pro*' 
daced di»a^reeabl« rffccl^; but nothing is more abniirJ tban tbo 
belief ihat it gives up oxygen t« the body. Cbloraio of potasHiuui 
dots give off trJtycfii wbcn troa.teii with vury high beat, but not at 
the lemperature uf ibi- L»dy. Nearly aU of it eavapva from the body 
BDcbangcd. 

Wbco ovenbwcs of the cbloraie are taken, it pniduces Mickues^tof , 
tJie Btomxi-b, beaduche, pain iu the lojua n.ud belly, dyspnoea, cyano-^ 
bU, Wart- failure, and groat weakness. I'oJsnnnim do.H-R i-nuse the 
bloiyl to be of a chocolate color, this change being dno to the prodiic- 
uon of meths-moglobin. The blood- corpuscles arecrenaled and broken 
dowD, and after death the liver, kidnoye, and spleen are found soft- 
eavii and filKil Kitb brolcfn-down and diiuirjTjinixtrd blood. 

Tberapentica. — Chlorate of pota.wiiim is nsefid in nfMii/ttitt* and in 
mrrruTiai unTi' moiitli aH a iRouth-wash, or, giv4>n internally, in the 
following mixture: 

B.— foUMuichlontt. er. slvi|i(3.0). 

Tr. mvrrli fSss (2.0|. 

Eli«ifiali«»y« q. •, ad f.^iij (ftii.Oi. — M. 

A— T«M»pQ(mrii) lAO) vftry lire hoirn, or imc nn a moiiLli'Wtuih. 

Oving to the faut that ibe drug in eliminated by tbe saliva to a 
grent extent, the mucous membranes affected by HtoRiatiliH are con- 
stantly bathed by a solution of ibo chlorate when it is raken by ihe 
Btomsch. If auy irrit«.tion of the utoranch or kidneys exist the mtdi- 
eameot must bo utied «n a Hwab and none of it ewallovred. 

In diphtheria chlorate of po(A.s8iiira i« very comtnonly employed, 
bnt it« Qso vn exceedingly dangerous). Death in many ca^en nf diph- 
theria is due to the reoal irritation present, or. in other words, to an 
acuic nephritis, and this drag »imply iucrtiasos the Inflammatory pro* 
cess. If ibo cbloratu of |>()tuH»ium is employed in diphtheria it 
should bo used iu suluUou and applied by uveau^ of a 8wub. (See 
Dipbtbcrta.) 

Iu acute folUcttlar phartfngitit chlorate of potawuiim is a UA(>fnl 
gargle, tuid Wood rtiromuR-ndit thu use of a solution made by adding 
1 ounce (iiO.OJ of sumach- berrie*, \ ounce (lo.dj of chlorate of poms-, 
siutD, auu 1 pint (600 cc.) of bt^iliug water to rnch nihcr, und allowing^ 
them to j^immer for a few hours, wlit-n the mixture should be strained, 
cooled, and used aa a gargle. 

Tbe following io equally Kenrici>able : 

R.-I*oia»ii cliloMt aj (40), 

Ext. rlioii );liibfw 8. {\m (16.0). 

A<|ujrd«<t q. V. Djf.;iu (90.0).— M. 

S — Ta V« o^MaJ Io An rrjiinl <)iinntit]r of vniAt in n ^Inw vii'f iibi^ ilk ■ in"El' «t«I7 
l«» Itixin, nHor stirrin);. 

This prescription niakcs an abnminablo Ion king phnrmaceutical 
pr*p«rtitioii, but an exceedingly useful one. 



181 DRUGS. 

In titutt rtrtal catarrh -with mucouir diarrlictn and ipneoniDS » 
•olatioQ of ohiornte of potiupium in wsitjr, 20 grnino (1.3) to tli4> 
ounce, injt'cl*'*! iuio the uowi'l, vrill itflfu pniilua! u nire after oue or 
two iiiji.'('h.ins. Xot moro ilisiu 4 oiiucm ( 128.0) <<)ii>(ilil be «sod, and 
it otifrjii lo b« rtiinini'd for tweniv jninHr<'N, Ofiori il will l>e well to 
odd the saturated watery flolution of the chlorate lo ul c<|ual quautitj 
ftf (itarcli-w»t«r, iw tliu latu-r aids in allaying tlid lucai irritation. 
I'hia same uiethod cjin by udctI in the treatmem of hemorfhoidn. and a 
fiBW drups of iaudniium, if addeil 1u lIuH solution, will h« found of ^i>:it 
Mrric«. The tnvlio* {Tr<u-hiA.'i IW'Wi! C/i/ornth, C. .V. and /f. P.) 
uegircn in thi- dose uf 1 in <!, nu-h luzcn^^e niiiliiining 'j gmiii» (O.fi). 
Tlirv HIV intundt^ to bt> di»t<itv(<ij in tlip tiiniith to affect the oral 
■acnus Diembrane, btit if many are u^d tliey art- tifit to dinorder thv 
glo«a<rb by reason of the drug being swAlliiKed iu the Kalivii. 

CHLOEETONB. 

Tod^^ till- name cMoretoiie a siibsiatice. which ijt trichlor-lertiarv- 
Wt^^tlcohol, has reeenily lii'vii inirodiiced ixn a htfpm'tie and Hcrcous 
■ Jift 'i -r clo»dy allied in ico ukch to rhlnral. yet difloriug in the inipor- 
IMtl fiartieutars that il dries li»t depr(«.i the lieart or respiration unless 
piva in i'x«'*»9ive qiiiiniitie.t. niid rloc-. not irriiau- the sttnijach. but 
art» w ■ Mihilive to thi<i orgnn. For ihig rtUMiti it cun be ue«d with 
oiwid^ in rtiMtiVi'fiy due lu irrilatinn und in i/tiHtrir ctirciMoma to 
TvlhPTe |inin. tnreii in the daw «if 10 t(i lA graiiis (0.fio.-l,<J} before 
MltenutioD. it will ofien prevent, after-imnitinf/, and if vomiting lia« 
»ilrN4v bffg«n '%*■ a valuable nyent, for iis relitT. When used to |>re- 
TCW Mkir womilitti/. it should \te given ia |>n«dcr one hour beftire the 

Xk* nulhnr has also found il of value in relieving the pain of 

^Mi*w vfc^^ and nf gastrnff/ia. A:* jt in h.iili iiniefilhetie and anti- 

flWfXic. il can be ptufiluyvd a» an «|i]ilicnliou to hurus, tftiUh. and 

laiirtifi'ffif in 10 per cvnt. otnttnonl. nud toeal aniesthei>iA may be |iro- 

AiefJ by the siibcufJinfrtiiH injection of il in a 1 per cent, dilution of 

()|m^ \^ per (vnt. (ind >*!iler P.'i per cent. It may lie diii$<>lved tn 

Ul <■/ eh>rr« and iipplied on a cotton pledget uitli udvuuciige in easm 

uf tuirlrt^rHr It tnity be used lo benumb » painuil <i,'»tal nfrer by 

IMtxitt^ *U"*^ part< of ctlier and clilorctone and applyitig thi^t in the 

Mtil%. Pnmd«'rpfl chluretoiietiii.\pd with equal pariii of powdel^d boric 

v«l uwl tlwled over painful ufrn-a, hiinm. anil lacfratwnn nr tfoundw 

. . .1. »-(fi('ionl nntifieplio and pain-reliever, (.'hluretone and anti- 

n be pinred in a c^kp^ule in llie dose of H tn (> grainn eaeh 

iTi r'-Ktlr»itnfM ant] nfiunilffui pain. Tlie mistui-e of these 

> nvulla ill liquefaction, but this docs not interfere with 

I >-it|Mtutie eflieacy. 

\ Ml' iseflieient in dose« of from 10 to 20 ^tum (ft.R5-1.3). 

«ii4 ^i»i'n in siigar-cittted tablets of about 3 grains (O.lA) 



CnLOR!SATED U3IE. 



159 



CHLOBINATEID LIME. 

Chlorinated Lime (Vale ChloraUt, U. A'. ; t\tU Chbrinata, B. P.) 
is die hjdrale of lime, conuining 35 per ceoc. of clilorinc, provided 
It ia of offioiiil utrcDgth. It is an excecdiDglr irritottt substance 
because of (lie cUoriue which it cuntaius, and is Qev«r used inter- 
nal! r. 

• Much ttf ihe chlorinnled lime sold iit iineleMH, cronlainin); tno little | 
or Qij fr«e ciili>nDc. Good irblutiimii'd lime should he ao Udon witli 
the gas llial the fac« cannot he held iieur it without the pyog hvinj; 
sererely irritated. Tnlc^s the clilorjnc is present, the lime is of no 
Yalne, for the eoiployment ofchloniisl^^d lim* jw a diMinfeflaiit dcpemlal 
upon the notion oFtuis gas, the lime being used loerel}' as a vehicle aiid 
ti.iidizvr. tin: giui by itself heinn; ilifliciilt of application. 

Dies. — As a disinfeclant for privie.s, ilrnias, and sinks clilorinatcd 
limp ix one of the be*l, if not ilio biwl, »e pusao^-t. A ft-w noumU 
of it may be added every week to the coiiteuw of u. privy vault with 
great advantage, and a snlutiori of it may b<> uxt-d in all bfd-pau8 and 
urinals. Wbcii ihe pa^agot* of a patient having typbo'id fever ai*e to 
be recvived in a bed-pan, ;i phlorinatod-liniecuhition sh(>uld he [daccd 
in the re«»pucle beforchatid, so that ib^ fnjcal matter <ip nriue will 
fall at once into a disinfecting fluid. The snltition ^h^nIld he of the 
strength of 1 pound to 2 gallons. As it is one of the most powerful 
deodoriicrs. chlorioated lime should he placed liberally over nitd about 
decayiun animals, and in exhuming eorpxr!) wheels wrung out in a sohi* 
tiori malic as directed above will, if wrajiped about tbe body, be found 
of service to distroy 'be stanch. 

Water which ha.s becoujc foetid by stagnation mav be rendered 
drinliable by adding 1 to ^ ounces of the ehloriimted lime to everj 
%b galluns, and Atandiiig tlin nolution nnide for nnmo bourn until pre- 
cipitation and ez|u>i<ure to the air bav<> gone on for Home time. 

It ehould be remembered that chlorine fiinu-P will bleach many dyed 

'goods, and therefore thev cannot be usol on eolored fabrics. 

Chlorine gaa, in a diluted form, baa been used for the treulment of 
aphonia due to cold in cayea wher*; the u|»iiuniB pei'^ists for some 
tnnnlba. It can be obtained by allowing a few drofw nf hydrochloric 
acid tn fall upon chloride of lime or chloride of Kodium. 

Tfat! placing of chlorinated lime lu saucers about sinks and cloeela 
is Ttseles)<, as the amount of chlorine lihemled is very tilighi an com- 
parvil to the volume of air in the room. Where ihe chlorine is pres- 
eni in a suflSelenllv concentrated form to kill germs, it will also kill 
the occupant of the chamber. A deodorant effect may be obtained, 
bat a bad i<melU if it exiKis, even when overcome hy a greater one. 

tis not really gotten rid of. The official preparations of the B. I*, arc 

[XiifKor CaleU C'A/ori»ia?>P and Vapor Chtnri. 

CHLOBODYNE. 

Chlorodync is a pretwmtioti ixm-A to n very large extent for the 
treaiment of 9erou9 4iarrh^a9 i>r cram;** in the abdcmen. Its consti- 




190 DRUGS. 

tation varies cnmiileni'blj, but tlic fvrmulii moat cofflmooly osed is m 
follows : 

B-— Morphinw hydriM-iilor. |r. tUJ (0.5). 

Atiiiw (iatt. ?3» (iOI- 

Heat togeilier. and as tooa u iliu morphine ta djsolved and Uie liquid cooled, add 

Acitl. hrdnx-Iilur. dU t3» |&0). 

CSilotvrbriut f^iMCaO). 

Tr.oaonab. indiaB. faj (4.0). 

Ai'id. liTitiuryiutic^dil IfVsij (I.O). * 

Alcoliulii.. . . f3»(l«.0). 

Ol. nwDtli. pip«Ht. It^xy (1.0). 

Olecndiw npaici 11^(0.05).— M. 

8.— A u> 1A luininw (O.^i-I.C)) fnr on tiduli. In wu[«r, tvvrj two lioure for ibm 
(loN.>K. Moro lliaii tliis quantity i* dangaraiu. 

A formula clog«ly ullicd lo tlti« is used iii tab!el form -in repeated 
(losva. 



CHLOROFORM. 

riilorofftrm (f.Vtloroftirmum. V. S, and ii. /*.) was originally di«- 
covered by Guthrie (lliSl), of t^iukctt's Harbur, Kkw York, but fi«t 
brpuglit inlo iiifdiciiial use (lfi-17) by Sirop8on, of Edinburgh. Il U a 
cK''nr liquid wiib an exceedingly hot, burniag, sweetish (a«tc, of a rather 
a^rL't-ublc odor, and i-t very volatile in the presence of ordinary air. Its 
chemical name ie tricb lormetbuue. 

There are two kinds of chloroform— the purified (Chforaformum 
Purificatuitu (■'. S.) and the commercial chloroform {ChlorcfformutP 
Venaie). Chlorufnrin nhotild be kepi in a dark, cool place. 

If expo9«d to the lijiht for auy length of liiue, chlomform develops 
earhoriyl chloride, bydnichloric acid, und chlorine, which render il unfit 
for u»c. If the aciil i." present it will turn blue litmua red, and if 
chlorine in present it will form a while precipitate isith nitrat* of silver. 
Such decomposed chloroform mny be rectified by shaking the chloro- 
form wilh lalaked lime and filtering till the irritating products are gott«ti 
rid of. If impure beraiise of improper method« of manufacluro, aa 
oily odor will be left on the hand after evupuraiion tukos place. We 
find, therefore, thdt chloroform *it for use should bo absolutely trane- 
parent and eidorh-jw, neutral to tesl-papi-r, non-irritatiiig when inhaled, 
and should evupurale entirely, leaviu>; no- residue itr smell on a watch- 
g1a«A. U should have a specific gravity of from 1.41H lol.625. should 
form no precipitat<> with AgNO,. should not become brown when hcnted 
with caustic jioush. uJid only very faiully brown, if at all, when sliaken 
with concentrated HjSO,. The method of maiiufacturv of I'ictet, by 
wbii'h the chloroform is piiriC 
the purest artick'. In Aiiiei 
itrooklyii, is almost universally employed. 

Chloroform vapor in the jiresciiec of g!i>;-t1amc undergoes eertaio 
ohan^rcH which reauli in ihc development of noxioQ!) and irritating 
fumes, consifittiij^ principally of hydroehlnric acid and chlorin*, wbicS 
produce laryngf-at and bronchial irritjition. 

Physiological Action. — Locally applietl to the pkin, chloroform may 



irilic'd by cry^tatlixiLlion. probably gi%-e9 us 
ifrica the eliloroforni mude by S'juibh, ot 



produce some tinclin^ unil l>urtiiiic. even ir evaporation lie not inter- 
fcrctl Hith, If it lie ronfinfil iin<l<-r a wiitcii-glatvs on che »lciD, it ivill 
CAUMe a lilistcr and ad us n con nler- irritant. 

Wlien inliiilnl, cliloroPurui i>rti<IuiH-H n. genmlton of wanulb in the 
mouth and iltroat, n re4>liii;; of rolnxntion. nnd tiuatly iincon!iciousnesa. 
Tbc reapinlioiu; aru ut fir»l full and <Iit-]), Imt imnn bnroinr more 
npiil aad shallow. The pulse may he somewhat stronger uiid fuller 
for a fliort iiitt-rva!. pmlmdly beranse of intntnl excitemciit. but soon 
faiU in strcngih and bwonies more rapid. Tlie irrilaiion produced in 
the air-pa;<»u;:c.s l>y its itihulatiuii i.s vt-ry »lig!il. uiiil no primary nrrcHt 
i>t n-spiration etiiiU(». a» i» gi-nerally seen after t'tiiur is first ^ivt-n. 
Thr pupiU are at first slightly dilated, but are conirncted darinp aniefi- 
thesia. If tfie pupfh tlilatf liitriHtj the unr nf i-hloroform aj'trr thf 
'•vHtraciivH Juift n<un'-<i, dutujer in iminmcnt ami dvitfi nuij/ amhlfufy 
wfur. In JKuno persons llio first efleclit of chbjrufurm are violent 
9truggU». and there is danger in trying to ovrreomc tlu-M- ^tniegle^ 
W putthtng the drug verj" rapidly. Tlil.s struggling is particalarly 
ftpt to be met with in athluti-s and dniitltards. Total uiu»cular relaxa- 
tion fliould never be proiluced bv the drug. 

NsBVOUf- Syktem.— Clilorcforin first affects tbo brain, tlicu the 
wn«ory part of the spinal cnrd, then lht< molnr Inirt uf thf cord, then 
the ficniory paths of the medulla oblongaia, and finally the motor por- 
tion of ibtj nieilulht, theii-by produring death from failurp of the vaso- 
motor centre and of the reepiralory centre. uiili:*.s. a.* rarely occurs, the 
heart lias already ^iiccuinbeil to the drug. On the M>nsory and motor 
nerrM, vben loyally applied, it acl^ u» an irritant and luiictithetic. 
TpoD th(«e nerve-trunlcii, when taken by inhalation, it hu* little or no 
effect. 

{'tK<'ii..iTiijS ANH Rkspikatios. — Tlio effectc of rhlororomi upon 
these vital function; have been for mnnj vcari< a subject of hot dispute 
between various surgeona and phaiuuuologislii. On the one hand is 
the i^hool originallr led by Syme, of Edinburgh, which ha* asserted 
that di^th or danger from fhlomform l.iy in failure nf the n'spiralinn, 
and that this was the function to be watched while clilnrnf.irm was 
being used; on the other hand, (he sn-riilled Loniioii si-hool a.-i.^erlt'd 
that death «ri«'s fmin e^niiac fsihire nnd thnt the pulse is the thing (o 
be itatchcd during ttiL* use of ehloroforui. The number of clinical and 
Ifthonitory researvlien which have been carried nut to dcieniiine wbieh 
of these opinion? is correct has been very great, both in Knglond and 
in America, bnt it ha.'» only bopn within lln' !a.tt twenty years that 
the mopt competent i'ludio.'* have been uudcrlakc'n, of which the heat 
known in the serie** innde through the munificeiiee of Hi.-* High- 
ne««lhc NiMin of Hyderabiid in India, and known us the '• Iteporlsuf 
ibe Hyderabad Chtorofurm ('oiniui>^ionH Non. 1 and 2." The eonelu- 
eions of the first commission having been criltci.sed advcnrly bccarsc it 
ssBertrd that the cause of death was re,ipinUnry failure, a bBcoiid coin* 
mitoiou ««.■> formed, and, under a gnml of f'lO'H) from the Nisam. Sir 
Thotnas Rrnnlon of Lonilon wn-s .«ent out to ilireel the u^eond invesli* 
^tion. Although a tcucber of tlj<r theory ihat death froia chloroform 
is due to cardiac failure, tbie gentleuiaii returned to England converted 
It 



162 



DRUGS. 



to the idea that the cause of most of the fatal accidents under this drug 
is respiratory failure, and the conclusions of Commission No. 2 were 
once more criticised by numerous clinicians and pharmacologists in 
England and America. About this time H. C. Wood and the author 



Flo. 22. 




PiQ. 23. 




Fio. 24. 



B 





Fin. i].— vl. rliliiroform dcjirussi'!! thu VHBnmntor ronlre : H, (rhlororonn diliiU'n tbe heart nnd 

<li-)iressi'S il ; '', rlilnmliirm c1c]iroKSrB On: n-siilnitury pi-nlro. 
Flu. •£.- A, I'll Ion ifiiriu iirmlurfs miafllimiii liy ilfimsf-iiii; (Iil- pcrropllvc t-L-iitri's in llie brftin, 

Biitl liiUT ili'pri'sisi's Uii- /(, iniclli'i'liiHl cciitri'ii. Bini tiiiBllj- di^jin'i'iies tin- ('. motor centre. 
FiQ. ■H. — IK l>i'prcfls<.'e the sooaoTy patha in the spiiuil cord : E, llnaUy depresses motor tracti 

In thf eord. 



published a paper in which tlioy expressed their belief in the powerful 
depresHing effects produced by clilorofnnn upon the heart ; and Mac- 
Williams of tilaspiDw proved by experiment that chloroform without 
ilouht causes ctirdiac dilntatioo and cnfecblement. Shortly after this 



CITLOnOFORif. 

thf* author of lliis book was aake<l bv the ^^ovemniont of HU High- 
ness the Xir.»ni, through Colonel Edward Lnwric, the Hesidoncy Sur. 
gpoD. lo carnr ont a seriw of Htudiiai' ilejiigiicd if pussiblu tii n'tioiicile 
llie (wntradictory resulls rttaclifid by the Hydcrnbad ('ommisjiions lUid 
oiher invi>sii<rator*, .iiid fiiiiiiiUnncoiiBly (iHt^kt'lt nini Shore in Cam- 
bridjcc Univcvjiity, En-iUnd, were asked to do likewise. The result 
ksi) been to oonfirD) iu every way ttie rcsulu of all prorious studies in 
one respect — uauiely, th»' the primary action of chloroform oa the vital 
fiitiction.'t of cirrutation and respii-ation in ijreathf to dfpr^tn thr vtmo- 
nintiT 9i/ittem. thereby enii-ing an extniftrdinfiry fall of blood-prcssiirc. 
(lajikeH mid Shore. lc» bt; sure", awcrt that ana:>lbesjii can be produced by 
tddorofortn without causing thip fall, btit the author has never Iki'B able 
inilnwi^Fig. 17). They also believe that the fall is rbieHyarfSiiItuf t:ar- 
diae failure. With thi'a view the author disBcnts, because their experi- 
ments upon which these awertion.s nn? bawd were ton niniplex to eive 
practical rej?nlt-* ; and aocond, bfeause liiaowti HtmUesand tlinaeHi' others 
show the vasomolor system lo bo depressed, i'here ifl of eourse Home 
eardiao enfeeblement uud dilalalion, which add^ to the fall of prefSHure. 



''^v-^t^%f%'^, 



Fw. 26. 




''^r^'^^^'^^'Vw 



i.ii 'iiii-M--'- n !■■ I ■ , ... 1 F .Mi.i . M I M M I I nil Til n n t I 'ti I n r M i < mr i 

"■-■■-■"-■"■"""" " ■ " ' ■ ..]IH; r! I I I - I . I . I , 




""■■"'■ 



UJ-U-UJ-liJ 



■ ■' ' I ' ■' i ' I ■ I ' I i " I.I.I."... 



TnrlM itknrliiK ihe jiiiIm »nd blood .pmau re dciUTmil riy i-hlumltirm. KnMi Hie flill of 

t,i,_..i ,,...:,, „r, wTiii-h )HiHn* In the nrvfwr ItiiplnK itnil lioiTim.-ii nmrki-d In the imviihI trao- 

■ iiiv Ihi-wviih jml-y -I I'll" II In lln' (hinl IfN'rliiit, llliulnilliiE llit Ilnnl Ji.'l-n-»- 

1 -.ut ilfHK p.d Ihn bmn. Tliv nt|>lrHIl<>iG (■(.'iin-iriil .V, Init rlii- lu'iirl CMniiinit.d 

1.. ,- _. ; .[. t.l.»«l [.n'*»i)ri. fklli'il llr»l, thmi tin.. (.uIbc, then iliv fvtpitolluii.iiiiil ImI tif 

Alt with other discii.wion,* in medicine, the truth nf the <|ueation iw 
to whether chloroform causes deutb by rctpiratory failure oreardiae fail- 
ure lies. (18 it were. Iiallway between the two antaKontHtio fnrees; and, 
further than lhi<. the somewfaat stnrtliTig statement mav he made that 
it is ntit directly duo, in the inajoritv of ea!»r3. tn either of these criiiies. 
Dn the conlrary. Me rau^f nf lifitri fnnii r.hlorufonn in uKunfltf (•«*<»- 
motor tUf'Vutinn, whereby the nnerioleji allow (he blood t« paHU too 

' See TKtiiijtrulic fi'tsttir. ailol>er, 1894. 



mm 



freely into the gT«at ))Iood-vese«l areas which ar« found in Uie capillaries 
and veins, and &» a result the nian is suddenly hied inlu his own vesseU 
fis cfrcctuallv Hi* if into a bowl. When it is rcnicmhcrcd that the capil- 
liiry ui'lwoiK of the Lod,v will, with thf relaxed veins, liohl many time-s 
tht normal quantity of blood, and when it is remembered that we can 
inject salt solutions into the vcswelH to the extent of several limes ibe 
normal quantity of hlood without rinsing the blood-pnjssure, it n.t once 
becomes evident ihut [lie coiupleie vilscuIuj- relaxation caused bv chluii>- 
fonn result* in failure of all the vital funetions. not becatise the dr«j[ 
hiu.1 paralyxrd the heart «r respiratory eenire, but berause these parts 
aw (Icprivftd of blood by its sliij^nntion in the widely dilated enp)l1»rie9 
niid abdoniinnl veins. Keceni studit^ by Leonard Hill on The Pfiysi- 
"/«</;/ fi7id Pathologif of the Cerebral Cin-uhUon show that this is 
the case, for he asirrta thai when the blond i» no longer tlowiiig 
to the respiratory eentrea the heart is Htill bputitiR, bwausc its eoro- 
uary ttrt<!riea, being lower down, are more eii.sily supplied by the unalt 
b lood-stresm rceeived by the Iiwirt from Ibe veins. These studies arc 

Iirnved by the exjicrimeiilA of myself and uiy assistant. Dr. Thornton.' 
)y ever)* tracing of the Ilydenibad Commijisionn, and all other tmeinfifl 
wf biive ever «ceii. We luny conclude, therefore, that wliile chloroform 
witLout donbt nets as a powerful deprei^wini poisoii to ilie respiratory 
centre and llie brint in the aauie inttuner ain it parulyxct uU living pro- 
toplasm when applied in exeesf. lliiil when proj)erly j;iven by inhalation 
it piTtduros a death equivalent to that resulting from liemnrrhaije, which 
is a failure of tlie respiration nol so inueb from a dirwt depression of llie 
renpiratorv centre as from il.-< starvaiioii of blood : and while the lend- 
eiiey of the druj: \* to depress and dilate the heiirl, juut as it dilatoa 
the vessels of which the heart is merely a highly .ipepinlised part, the 
frtiliire in the piibe rests upon vaaomotor palsy, the patient beeoming 
pubeletus hee:ui!4e the heart has not any blood to pump. 

Let u^ see what evidence gupports this view : First, wo have the lab- 
oratory trai:inj:s nf many independent invenlipitoin extend injc over many 
years sind made in all parts of the world, all of which sbuw a fall of 
blood-preaaure. Among these may he named Itowiliteh and Minot of 
Boston, Coat*. H. ("'. Wood. Giusk'ell and Shore. Ibe Hyderabad Chlo- 
rot'orm romndssions, the ^tuditd of Wood and uivself in ISH',' .Tud 1890, 
and of nivsetf and ThornUtii in 18S'2 and IHHs. They are eoiiliniied 
by Hill, who has seen the abdominal veswels engorged with blood under 
enlorofnrm, the medulla almost bloodless, luid the benn aliW pumping 
though n-sp]raliiin Iiad eeiised. They are confirTucd by my ovrn experi- 
ment)), iu whieli I proved tlial even after the respimtion bad t^topped 
and the canitui wa» euipty, and tlir tlog apparently d«i,d. he eonld he 
resuscitated by visei'rul eoinpr«s«ioii uiid artificial respiration, and by 
inversiou, wliereby the blood left the dilated abdominal veins for tbo 
heitrt and brain. Again, if a needle was inserter) through the obe^t- 
wall, the lieart wa.** found to be beating, for the netnlle moved lo and 
fro ; and linully if the ehef^t wa« opened the hcnn could atill bv found 
besting feebly — dUated. it is true, but beating. 

So much for the lalxiralory evidcucf. What have we in clinical «vi- 
■ ntiTOfffUf. diutttf, (Mnbor, 1R93. 



lence? R<iaally positive prm>fe of \'nfi(»moti>r palsy, and none of <I«ith 
bcinji; purelr rain1in<T <ir respirator}'. For vpars Cliisliolni of Haltimore 
and latrr llowanl Kc-llv au'l a large nuuiU-r ti( others liiive used inver- 
fioQ with t:oiii|ir(i«ion uf tlie flonliug ribin in artificial i'e)>pit'&tion. ^liich 
hut forctHl tli€ blood into the clivnt and Raved life ognin and ncuiD. For 
TPare Ow literamivof notslioine tias iceiued willi rt-porls of death from 
cblorofonu wliiie llie [}itti<;iit was Btttin;; up ur half recumbent, becauee, 
ilic Mood-pntiiH being ilitaied, tbic posiiirc favorp'd anipniia of tbc vital 
ctnlrtti". Again, it bo* been proved tlial tlie best vswomotor stimn- 
lant — bi-ljadontia or iilropiue — j^iven liel^>rt' tlie rhloroforra is tisetl 
iDcrca£«8 tbt 8f»fctv of tbc ptiticnt, and th»c compression of the limbs 
br bandages t\<*en likewiMe. Finally, lUll \ui» siiowii iliat abdominal 
coiDpresston also aids resuscitation by sending tlie blood to llie heart. 
Od the ooDtniry, saline transfiif^ion, which would .t<;em to be iudlcatcd, 
in useless, beo&use the dilated blood-patiiw will roeeive all the saline 
for a long lime before they will overflow toward llie Lean, for as 
fut a« the fluid tlowg id they dilate. 

Thv author therefore thinlcs that while chloroform in its general 
deprettjing power depresses all vital functions, it is the question of 
blood •pressure which is moi^t iitijiurtaut in the healthy individual, 
although the heart may fuil if it bo damaged by disease before the 
drug is uKtd. Therufore iii tin; use of clilontfunii wt should always 
keep the head low. preceile the use of chloroform by atropine hypo- 
dermit-ally. bandage the limbs if the case is feeble or already blood- 
leM, and if ueee^^ary place compreftses on tbo belly and apply them 
deeply by pressure if Hiilure of iho circulation is devi-loped. 

The primary action of the cbloroforui it* to depres,* the blood-press- 
ure chietly by its vasomotor effect, socondly by it.-* cardiac effect, and 
finally, while the drug doe;* exercise a depresi^ant cfTcct on the respi- 
ratory ccHirc. the failure of this centrL* is chiefly due to aniemia. As. 
howe%Tr. an intact respirator}' centre meivns regular breathing, wo 
watrh thi.s function tn determine the dose of clilnroform actually 
inhaled, an<l bccnnse any variation in this function, as shown in 
irregular breathiui;, iiieuns that tlm chloruforin in disordering arterial 
teruion. Death from cbloroforni in a healthy orgnnii^m, then, is 
usually a vasomotor death, for an intact arterial system is as imjwr- 
tsnt tn vital function a^ an intact (■anliac apparatui^. 

BLOfft). — Upon the lilooil in the body clibiroform has little Of no 
effect when it in iiilialt-il. Shaken with chloroforta in n bowl the blood 
becoiuca ncnrlft in Imp. 

Tkmpkratikk. — ('hloroform when taken by inbaintion disttnetly 
lowera the bodily 1eiiipfratun\ probably by aiding in the dissijiaiion 
of bent and by itx aetiun on the nervous llIi^~hani)«ln of hcal-prnduetion. 

BlimiSaTiok takeii place by the lungn und by the kidney.s, and 
gOM on very rapidly, owing to ibe grent volatility of the drug. 

If large nmouuift arc cliiiiiimifd by the kidneys, these organs are 
apt to Itet-oine irritiited aiul inflamed. 

▲ntueptic Pvwor. — Chloroform, when it is added lo organic fluidsj 
prevents all cliiuigeti which depend upon the growth of mieru-orgati- 
moa. 



TherapeuticR. — Tlie fii'st and uiMt iiii|MrluDl use of cliloroforui is 
ttB ftn Miasiitholif, iinrt at this point wc cotne to a qiicslion wliicli lnw 
been for uiany yciiis a miitler of cotitpntinii lietweeii <lifl(>reiir. so^tiooii 
of the medit-al prufesaion — namely, aa to whctlipr it,s use is iliifig^mus. 
In tliB t^oiitliern and Western piirls of the Unik'd Suites cblorofortn b 
nearly lUwuyi' used, but in the EB8t«ra and NortLorn porlior* it is 
randy cmpluycd. Southcrncrit ccrtuinly seem to ukc cMorofurta 
better thun NurthprDers or those livin;; on tlie Atluntic coatit. It is 
impiwiblc tn go into apcncml discussion of this question here; suffice it 
to state that evoii the nio.*t i'litlni^iastic supporters of tlie \i»f of cliloro- 
fomi cuiifeas Unit it i.-i a luon* thiii);Lrous dru^ than t'llit^r if i-art-lw^sly 
uB*v], and, while llie advnntajics of clilorofonn are many, this one grciit 
diHadvaiiUi^c nYcr>ba<lows thim all,' The advanlagrs an^ — its more 
agreeable odor and the fart that it does not irritiite the air-pamapeB, 
owinp to ibc siiinll amount m-ceesary to cauee ana'^ittu^ia; the fart 
that it» UUP is kwg apt to be followed by nausea and voniiliiip; the 
rapidity of its actiim ; and the small bulk which hue to be carried by 
the aurgeou. Us dimtdvimtage m — the po«»ibility of its killit]g the 
patient. 

We come, then, to tli« all-imporlunt (juGstions: 

1. Tfl chloroform a safe aniesthetic? 

2. Are we ro wati-b the pnlse or respiration during tbe use of the 
diii^. and ^vhal are the .ligiis in the rc«piraUiry function indicative of 
dan;^iT lo the patient? 

a. What is the tnie niuae of death from (ihlomfonii ? 

4. Is dt^ath from chloroform jmiwiible wht-n it is properly adaiiu- 
ifitered ? 

5. fnder what ci re iimn lances in the xurgenn to use chloroform in 
prefercnw to (liu Ic^a dangerous anreslbetic, ether ? 

6. What is the bt*»l way "jf administering chlorofomi 'i 

To the lir«t queittion the annwer if. Yes fur tile luajorilv of cases. 

Erovided it is given by one who is skilled in its use. aiij not only 
UOW8 liovr to f^ive it, but how to detect mjpis of Uanji^er. It is not &o 
safi* as eiher at any time, other things being «<|Ual, and never safe in 
the- bunds of u tyro, 

To the second i^uestlon the answer is. Watch the respiration, 
because as soon aa enuuch chloroform ie used to endanger the circula- 
tion the respiration vrill show Home stgnH of abnormality, either in 
depth, shallowness, or irregularity. In other words, llie very eflect 
of the drug tuay be to cause such deep and rapid respitHtious thai an 
excest>iv« (jUUQtity of the drug is taken into the lungs and coulinues 
to be abswrbed even after the inhaler is withilrawn. 

Ae there is always a fall of b I vod- pressure under chloroform, it is 
difHcuIt to feel the radial or temporal i>ulse. and the respiratory cen- 
tre recognises the degree of arterial dcprcsfiion which its sister vaso- 
motor coutre has permitted by finding that its blnod-Bup|>ly is iiisuf* 
ficient. As respiration fails first, it should bo watched first. It is only 

' The inonaliiy IkiklvS imhki many l«tia of IhoiHiuiJii of caitr* in trkicli rhlnrnfurm 
ho* bc<n twoH i" nKoiit 1 in S'TO ( ( lurli l ; or •cpoNilnft u< ih'- 4vimhin«l ■lari'licti nf 
Jiilliartl Kiiil Orrnnbr, in ^Tll.TiiT ftditi)iittitruli<iii> there wvrv L'lJ <lcuili« 1 in 'MQS. 



• 



by wutciiiug tbe rirspinition tliat we ciin tell liow much vlilorofomi lUe 
pntient is g«tiiiij;. We do nut vrutt'b this functiou for dauger atoue, 
but ro tell u» of tbe dune. 

Kvery une U agreed that tbe patient taking chlomform nhoiilil 
liiivc: |>lvutr of fn.-»li nir. uud in India, to all intenit^ antl ]>ui'pofl«s, 
juitii-iiij^ un- o|)unit*.-<l du in ihu opt-ii air. at least lu com jiared lo tbe 
etoswl room* newssarv in America and Kuropc. Thh free 8iippl__v of 
ur is iinpurtiuit, nlii-ilKT wi; bidieve dtatb to bu iiiiminc<nl from ourdiau 
or respiratory failur«^; but thia aupply of airwatterfl little to the patient 
if he (Joes not breailic freely, nor does the ainoimt of r^blorofonn aniotint 
to augbt if it in not drawn into the ohcst. Tbe ilo.ic of chloroforin i» 
nrtl tlip amount nii [be inlmltfr. (till thv auiotint lulcen into tlio clifst, 
•nd, finally, the amount abeorbt-d by the blood-vos«ols. The rapidity 
■ud depth of reepinuory movements in, tbereforp, ax [.awrie asjwris, the 
entire k**y to the ftiluntion. We withdraw obiomform, iw Lawrle says, 
vfbeuever resptnitiou bttcoma* disturbwl in rbythiu or when struggling 
disturbs* it, because it is the first indication that the dntg'a aetiitn \» 
oDecrtain, and becAOse tbere is no telling tbe dosu wbit-b w absorbed. 
While watchinc the respimtion will not wnni us of ii mnldeti cardiac 
arrest in fatryneart plus chloroform depri'ssion, neither will the pnlse 

five ns siicb wamiii;;: nnd we are wmfident that tbe statement of the 
lyderabad Comiul"sion. that the rfttpiratiait thoulJ lie wutrhtil, is 
correct, for we believe, from a lorij* i*eries of obscrvntiiins, that grad- 
uoil cardiac failure never occun< wilhoat producing rea[»iralorv cbungea 
from tbe very fintt. In other words, we do iiol bclieVf tbiit in a 
iifolthif heart ebloroform can caiue serious rlisorder without, v» a, 
renult of beginninj* disorder, disturbing reflpimtion ; nnd, second, 
tiiat io the heoltby litMrt a iiuatitity of chloroform sufficient to disorder 
it will by ltd direct action iliKurder tbe roi^piralion. If, us an extra 
precaution, one a^Hintant wiitclies the pulse while the other walchc* 
the reapirat ion , very well, for though the respiration U the more 
imixjrlaot funiition to watch, the man watching the pulse might dift- 
oftver an irregularity which the aniesUieti xer may not sec repmduce^l 
in ibe respiratory action ; but aa divided attention generally means a 
flighting of both objects in view, Lavvrio is right in iu»isliu}{ on the 
pttUv beinjj; let alone. 

The answer Io Question 3 is that death is always due in the healthy 
person lo raeomotor failure accompaQied by respiratory dcprcssioti, 
the vascular relaxation beiri^ severe enough to cauee death, even if 
artififiul rcdpiratioii \a uh.-*! skilfully. 

Tile answer to Question 4 is. Yea. Tbe phviieiun li.xving a eaaeof 
benrt discMi* re4|uiriii;; nurgical interference, sliunld iilwiiyi^ lulvirie the 
(lad'ent of the danger of any nn.'psthetic, and he should remember, 
wbcther It in wi^e to toll the patient ur nut. tbuC unicatbe^ia ulway.-* 
means astep couard death, even iu tbe healtliieitt uf men. In the event 
of a death under chlorofnrm tlio physician is not to blame if he has tukcu 
proper preliminary precautions and given the chloroform properly. 
T<t Quei*tioii .5 we have several answers to make: 
1 Chlorofuru) uiav be used iu hot cUmacc-i (nbcu ether is inap- 




plicJiblc), whpfP II fi-ee citciiUtiim of air m<;rciuiM the safety of lb© 
[MitJcut. 

2. CblnrufoniL tnuv he used whcnc^'br u \»t^i! number of porsong 
are to tip mpidly ana'fit licit r.(-(l, iio that tht; fiur^rnti may piUMi on to 
otliei-s ami Bnv« h mnjority of liven, even it" l!ie itnig (Midangers a few, 
U8 on the battle-field, nhere only a simiU bulk itf snsethetics can be 
carried. 

3. Ita cmpliiynient ia indicated i» uattt^ of Bright'a diaeuo requir- 
inj^ the surgeon » attention, owing tu tlio faet tliat smeHthesis may be 
obtained willi so little clilnrofni-iu that the kidneys arc not irritated, 
whr-reas ether, hecaiise of the Inrgt' (pinniiiie-S ncccsiiavily used, wonid 
ii-ritaCe these orgtms. Quantity lor iiuunlity, ether is. of course, the 
less irritant of the two. 

4. In ra.ieA of aneiiriHiii or great athcrntim of the blood-vcEtseln, 
where the nhook of nn operation without nniestheiiiH would be a greater 
danger than the use of uu uriiesthetir, cLldrofuriii in to be emploved, 
since the greater siruggle^i cnu»ed by etht^r and ihu stiuiulaiing effect 
which it hiis on the rirciiliitinn and blood-prenHiire might eaufie vas- 
cular rupture. 

•5. In children or ndullt^ who already bave Lroncliilis, or who are 
known to bear ether badly, or. in other irords, have an idiosyncrasy 
to that drug, cblorofurui may be employed. 

Other iudicatiuiis fur the u»f nf flilon)funn in preference to ether 
are in the perf'o nuance ol* brain Wirgery. where ether is apt to pro- 
duce meningeal congestion by voniitiug. In jwrfontiitig traelieolwmy, 
if {hu uiinu is urgent und tht; clhcr produces reBpirotory irritatiou, 
chlurofunii may be lued with ailvantage. 

Chloroform inhalations have been recommended in exttetifive eharra 
and in purrpfntl roiiKuht'inrit. and are. of rour>e. of gri-nt nerviee In 
the rf'hi-fion t>f hernia, owing lo the iiumeuhir rchiAiiiion produced. 

Sometime!* « few whiffs will put « nervous patient to sleep, but itfi 
use as a liypiiotic ii^ very dutigeruua. aa it uiuy jirodiiee a habit, and 
the habit is apt to end fatally. 

Parturient women »eem able to take chloroform with more safety 
than other women. There are four important factors in inerea-iing 
the safety of chloroform in thiit v\&^ of cu^es : )&t. Les.^ chloroform is 
given than i» usual in surgical operations; :2d. The pregnancy ntny 
produce immunity by reason of tb»- slight eardiae hyporlropby pro- 
duced al this time ; Jid. The absence of frighu for the woman welcouHW 
the anicathettc; and 4th. The frequently recurring pains of labor so 
stimulate the va.<iomotor centre that the dominant action of chlomform 
— namely, vasotnolor deprcj-iion— is combated. 

In seyere rrfn'oviiiii <iiur/fi a fe»v dnipn of ctjlororonii miiy be 
poured on the hand of the attendant und the hand held before the 
child's face. While the child may at first dislike the u(h)r of ilie 
dmg, the relief given soon teaches the patient its value, and he will 
auk for it when he feels the attack coming on. If the aitack \» pro- 
longed and violent, this treatment must no u.'^od with caution, owing 
to the slraineit condition of the hL-art-tini^clc. which may be still 
ftirther depressed by the ft^e^^aent use of the dntg. The drug should 



CHLOROyoRU. 



139 



be poared on u cloth, but on tbe nurse's hand In this way too 
cli of it cannnt Itp given to tlir p&tJi-Qt at ont- timr. 
AKMl.vrsTRATinx. — When i^Llorororm in jrivfii. it stiuuld bo iwureii 
drop Ltv dru{i upon a. fuMed napkin or towvl. und tbc c]otb ;ilioukl 
th«ii b<- hold about three to six inches f'ram the inniiili mid iio«e, no 
that ibc va{>orniay be tliuruiighlv mixed witli ulr iti tbv |)ro]ii/rtiua 
of ;"i per cKnt. of vapor lo ;>.'» of air. The aJmiuistwiiou must be 
gradual, a-t " pusbin;; * iUf. aDn^ctbetii: ir* (huigtnoUF). 

Tbe wifesl method of ndministnuinn is by Imwrie's or Gsmnrrh'ti 
iiihator. b(.T»ui>ti ibi-^- provide- u free circulittion of air and the atleii- 
tioD uf the aiiKsibetizer is iiul distr:icl(.*d fmni the I'eupiratory move- 
meot bj the manipulation of compiiuatud apparatus. 



H*M 



Bunucb* Uilwlnr soil rhlnnitnmi bolik>. Tti» Inhalvt •■niwlMlii nf a wire tnatt o«Ter«d b^ a 

Tbe dangers of chlonjforiii >i^tn lo be uonnidorablv dncrpnspd hy 
the Muultanoous aduunistration of oxygen gas with llit; aiiii.'H'ibetic 
TB.por. (For the b('*t inelbodof using oiygen and cblorriforoi together, 
aee Oxygen, Imporiant.) 

The author largely agn^es with Tiawrie's publisbud personal con- 
duwons, which arc oa follows with sli[:ht modifications; 

1. The chloroform t^liuiild Iit> given on abnorbeiil cotton, Mtilelied 
in an opto wnt- or cup. 

'2. To ensure regular brenlhing. the patient, lying down, with 
evenrthing loose about the neck, lu-art. and abdomcu. should be niiidc 
lo blow into the oone, held nt a little diKliLiiee from the face. The 
right diatanee throughout the inhalation is the nearest which does not 
eauxe slrug^lin^ or elioking or holding of the brpath, 

S. The itdniini(tlrator'» »ole object while producitig aneesthesia is 
to keep the bn-athini: regular. As long as the breathing i* regidar 
tad the pativni im not compelled to ga^p in clUoToform at a>n abnormal 
rate, there ia comparatively Utile danger. 



170 



DRVGS. 



4. Trregulnrity of the bronthtng iu generally cuuscd by insufficient 
lir, wliicli uiukvs the patii-nt istruj^gK- ur choice or hciM his breath. 
Ttiere is liitip or im tfudency H> eiili(?r of thesL- utttrmaril pvonts if 
luilincnl air is given willi ihe thlorofonii. If they do occur, the cap 

Kio. 27. 



Ijmttfa collopullilv liiliulvr. mn'li' i>f fmiTKiriiill iiii'i'miriiMtrlnxi ci.^fi.-rt-il with miulln. Tlis 
I'hliiriifiiiiii iii«y Iw •tiMpivil ihn thv ■Idwf Ihi: Inhaler 

must he removal, und tlie patient allowed to take a breath uf fresh 
air btfore the admitiiatiation is proreeded with. 

•'}. I-'till .tniVNilieiaia if f-stlmaled by iinteii^iliTenesji of ihp rom«a.. 
It is aUo indicated by eterturou* bn-athing wr by reluxalioji of the 

Flo. 28. 



o 



Kmhno «.iii1 Snwiimir* m mil Una) inn uf Ijiwrd'*' liihiilpr. villi RailiRr renplnltOD-ludlmar 
•Itwhi'-I. Tl.i- liiiiFT lliiliiM l" "t wlillf felt, ihv ■■uU-r VMv t« uf li-oIhiT. TTir « h l-'^rv>r»nn 
XIuIlJ I>« pDuivfl luilli^r^tl thmnjiti ■■iubII li'ilc III Ihv Initbrr oil tlu> tupi'r tbe liibMlvr. 

musclm. nirpctly the c«>rnc« beconK"* inftcrwitivc or the bruiilhiiig 
becomes ttlvrturuus tin; in1ialn.ti')n should \>v stopped. The bn-atliin^ 
miiy become stertorous while the cornea is «till seosttive. The rule to 




Rtop tbn inlialBtion ahwilit. nutwittiRtnndinf^. ha rigidly enforced, ami 
il will lif ruuiu) tliaC tfa« cvriie» nlvrayfl bvfonios iiie«ii8itive niihiii ik 
low McuntLt nlWrwnrtl. 

Above all tbiuj^is il U uvc(»^ry tn ri.-uti[nbcT tbo tiict tlist a pvrson 
hAviii}; inken i^bloi-ufuim ttvoiity liuii't; bt^furi' tints uut ahuw be in uut 
in (lunger on takio<; it the twenty -It rst time, and it is nbo to be honw 
in tuinil thnt many of the !<U(]c]en ilt-atbs from ehlnrtiforni lutve ocourrt>'l 
iluriui; tbf Kr»t »ta}^e of ibc iolialatioti uf tbe drug, btfortr cuiisciuim- 
bl^s biM bwn liwr. anJ, tborePjro, when a.n accidt-nt wiis lpa*i expcctcil. 

hi o{)uratiotts a)>uul ibi* mouth clilfiri»f<priu iimj bo fnii»li)yBj by 
pacing a wifi cathclw ibnmph ilio U'jsc* aiiJ ihou by uk'iuis uf a 
haml-bulh attached to a small waah-bottlc of chb)roform or h\ means 
of a Jnnknr inhaler introduoing into the post-nmral spaces chloroform 
va|ior mixii) with air. 

It ia often a guud plan lo f\ve nlroiiine or euprarenul gland, pre- 
frrably lb*- former, before using chloroform, in order to avoid, if pw- 
siUc ramular relaxntlon. 

Pursons who are rubu^it and strung, und who £lrugglc viulcutlVi 
are lu greater danger from the use of chloroform iHun the sickly 
aud Weak, probably beaiuse the struggles cause verj- deep inbitlutiiviiH 
nfthi' dnip. eKb»uj«t the Ta*omot«r system, »Ir»iu the heart, and lend 
to dilate it« walls. 

The i|ne»tion h'M arUen a number of limea whether It is possible to 
tbbtwiforin a person who is asleep without hi* being wakened. This, 
hw boon decided by numeroua tests to be posBJble, particularly if tlie 
*lvvp he heavy. 

Chloroform, when tuken intenially by the mnuth. catisex a seiisa- 
tiou of warmth in the stomach and a h»l. burning taate aWul the lips 
and huccnl miu'oiis membrane. In overdose it can and ha)! prgduce<l 
death when takei) in tliis manner. Although rarciv n^i'-d in internal 
mnlicine, chloroform in the funn «f the spirit of ehlorofonn {Spirit at 
fJhtornUrmi, V. A'.) or water of chloroform {Af^U'i Chforof&rmi, t'. »S.) 
IK awfiil in cottgh mixtures, which are given toper^on?! having an irri- 
larive wngb. and in eases where. lhr<nigh nervmsness or other cause, 
tickling ill ibe throat or bronchial tubos ke^-ps tbe {mlii-iil continually 
in n (ftale i>f iinreiit. (See Bronchitis.) 

In i/antrir or iu/egtin>il fiatuietn'i' 1 nr !2 mloims (O.OG-O.IO) of 
p«re clilorofurm. or 1*1 w-iO 'minims (0,6-1.8) of the f--|>irit uf ehloro- 
fonn. will oficii give relief. The following prescription is very useful 
in nil forms of :thdominnl pain and i.4 bamilei<s in <^nliiinry dose: 

B-— Sl-t. .■I.l..ruf..ni,i r=w (15.0). 

SpL lBvaju]\il. (v.ni]> .|, K r^^iij (MI.O).— M. 

K— flpBM'rUjMxniriil IM.OI ill wutvr uvvrv iwiiHitir mimilttH fnr 4 (Iwm*. 

In the treatment of tiaroua diarrkcea the spirit of chloroform when 
oombincit with ontringrnla and opium is most useful, provided that the 
irritating ca'ise is first rpmoved. In T'-itnl or ff/mtir /-afif a few 
inhalarion!', not (sufficient lo disturb eouitcioii.4neft<<, will not iiiily gire 

ing ^pasin. Hypo- 
pure ciilorufurm, 



■ 



.U.I ■■■■•,. ■.■,.-, ■,.'. nil lilt. .V, I, » I.J itinir.ii.j ...^II.^i..iiilln.ill.TW, Wi 

temjMintry hut .-Muneiinies permanent relief by relnxin} 
dermic injections of 10 to 15 drops (O.0:i-l.O) of 



mt^ 



172 



DHUG& 



reaching down to a painful mnatie nerrr. have been recomiueitded hj 
BartLolow. This is a very painful treatmeiit, and may cati«« ii sltm^^h. 
Ruhhed on tlie cliesl in thi* form of chloroform llninioiit. ihi* drug will 
soniHitnos prevent anllnwitii' mUieka, Tut uhhifofurm iJii};ht not lu W* 
inhultd, excepl most cart-fully, in this diseast-. hecanse I'f iht' strained 
condition of iLc right tide vf th« heart. In drachm (4.0) doses chlwro- 
fonn IiaH hecn u»«ii lui a rt-mody for tajtcworin, hut ought never lo bo 
80 etnplyyed. 

When placed in liniments of n stimulating character chloroform is 
a very ii^t-fiit iippliciition lAcr muscles afffctod hy sni-enesH mid miff- 
ncttH, a.t in liindxiijo und ijuu(. and chlorofurui litiiiiH'nt may aW* he 
used over ifumliji'' ari'i* for its ]in>al aniesthetic effect, 

OoQtraindicatlons. — Chlnrofnrm if« not to he used in cast-.i of fatly 
heart or dJl;il.'^ti..n of the litiirt, in tho.»p with a known idioByncrjLsy, 
nor in so-railed lyn]|diuli(; person!! with overgrowth of lyrnjihoid tinHueA. 
aa, for example, adenoids. In the latter class it is pnrtieularly apt to 
cause suilden death. 

In the presence of valvulnr disease of the heart cldori>for«i niny t>e 
UBt'd with caution, although ether is far preferable. Given a chm of 
valvnlftT ditcfl«' that must he *iul)jecled to operation, ihp chances nrn 
bettcrpil with an nnirsthctic thjui without it. iis the |>uin and nieutal 
shock are worse fur the heart tlian is the anicslhetic. 



Fii; 2!i. 




dhowlnu ilic uTUiiiili ;i! ■-lIiU .i lIic ti'^'. >.ljLiuld J* htW tn pi^nall Iht viwjs paM»ai^ xf air 
ttiruucti till! uhiUU. liiia pmatuit inLMn Ibvcr'I^IoUla.uliU tllU Iht <ult |<alittc m>«a Utu 
lonsi'^' iSlartiri ■ml Uon-'s iiiriliaiil.t 

Untoward Effect and their Treatment. — Alarming cITc-cls produced 
Sy this drug are f:ir more upi t(.> ii|i)>L>ar in niuios than in feniulei; : the 
relative pn^portion being ahoiit t> to I. Snmrtimci^ during; the udminis- 
tration of chloroform the heart or respiration middenly cea^t>s. and in 
sonif cases thi:* change is preccdcil by a peculiar shade or cloud which 
pai^^sesuver the face of the piitient. but deiiih may come suddenly and 
without wnrniiig. If unlowjird eff'eetH appr-ar. tin- ann-wlhetie niuSt he at 
onci-willidruwn HndHrlificial respiration resorted to. InjeclinnK of ether 
and hot brandy t<hould be given beneath the skin, and the poles of a 



■ 




CHLOROFORM. 



173 



battery with a rapidly im*rr«plcil cmrL-nt «trr//( wer the bodif, but not 
held over the jjUrcnic nerve or diaphragni.' The jialiem must bu bcM 
hcAtl downward, bo thai the blood will flow to the brain, aa Leonard 



FiQ. 30. 



1>^ 



SImWIiw lluf [niT-nSii:! i<( llu' piiioui n- luIhiIi rl <>t K< II v , iiii<l iln' tLi>'il><iil nf ]Mrrl-iriiilii|( 
artlflnliil mjiinUi>Li iiiuultitiu.-iuiil). liii' klu^it m iA[.<iiiiii.<l liy iliuwlnu lu liiirtir tutu- 

and cbe author have sfaowo tlint tlit> chidT niusc uf <k-iiilL is vaso- 
}r rcUxatioii iriib accumulntioii of all the bluod lu tho ubtlominal 
vcwds. Bandagf}) should he ujipliecl to the limbs and c(iiui)rv:sHi<in by 

' VfTiiltt firw UmI-ImhiIch itive iii.v specifn: ilirwiiiMis fonceniiiiK llir iiruclicnl Hp(ilt> 
ctli'Ki nf ihc mrihiolti nhit'li nn: lo becmplnvtsl in Midi ctncrKfiinm, tlinu- 1 lint do no 
f(>rrr ilii) (i))>F)ciiui to a pnx«iliirr nt «Dc« dnnnvroiu ont! imprnrticnl ; fur thi^ dircc- 
(toiM imiinll; Kiren «rc. Uj plaw tbe pMilive jjola of the liallcrv on tli« plitpriio ii«rve 
M it croi"»» the anlcri'ir smknt- niiiw-li- ut tin' i^xit i>f iIr' nefk, Ibc t)tfiniti''c I'olc 
VitifC [■rr— *>1 iicninai ihc io««r nurpin nf (he fib* A m]>liilT-int*rruiii<<i (ijm'nl in 
Don l'> b« u-^yl with the ]>iirprMc of i-n.ituti{t rxiilRicliiviiof Inn tliii|ilii«jKm liy ih^ direct 
srtion nt tbii ^lotHrii-itv upiiii the nerve. Evvn ilienrfiicaJI; this u a |ioBHi)>1i- snurve 
(^ diTur^T, aiwl fin^imllr lh(r nrilcrr huii proved duriwT t» lie ever prci*eni iinitiT »ii<>)i 
trmtiiintt. Tlx? <.inli.io' inhibitory nerfw nin nn r!i»Hl_T In tliB |)lin-ni>- litir«?i», and 
n«|aHid 1^ rmdilv III rlii-irii-iil iiiiiiiilatiii>ii. tli:il it i" Imrd in iiiinifirit^ Imn ilii^r tail 
neajM MltmiilnliiMi if ii rtim-nl In- imil of niitlirii.-fil Ktivniflli Iii i-xrili- llin iilirrnic 
nervm nar by. liy |fr»rtii«l <'.\|i<'rirrifiil die wiiier Iiah prircd ihnl iiiliil>iti<iii of ilic 
liHin innv niA nnlv W iKKtiililT )in>UK)>l abiuil by lliin riifUiutl. lul l)inl il ji- ncftrly 
iiii|ii^bfr lo »Ti>i<l 'M.-li iiii I'lttcl if ihf phrt-nioi nrc to In.- iv-aL-hwl ait nil 




174 



DRUGS. 



tucuns of n bunilngc and tBrg<r toiaprcoft be cxerciMMl on the abdtiiuinal 
coiiietiu. uiid aciivv urtifii'ial rt!K|>!riilii>n nructieieil fur a long pt>rind nf 
tunc a^ tlic uiusi iiiipurtani iuctiiiurei> for tbc piLlicnt's relief. Kxltnuil 
lient .ihniilil hr applied. Alrtjpinp, niryc-hiiine. iiIkI iligitiili!' tiiav Ijt- uited 
to »timiilace tlic ti^art and rc-^pirutioti. Uf tbeso, ^tryoliiunt.- i^ tlic uiust 
vuliinble. (f^cc direction." under tlif articlt.' uu Etlicr.) Adrenalin 
chlorido givcD hypodcrioicnilv is bIso of value. 

rio. 31. 



HUM u Pig. SD, Fitt-pL [Ijai i!i.' i^Kii ijti;^ liljs Hit' i-.jiii|>T-^>'.-i I'-v;.'] fIk- air rnnn Ihc cb-cat. 

In some cases, wiUi tlif inovemenW of arlificial rcspiratioti an 
OBBJstBnt may grip the tip of the tongue with u pair of forccpe and draw 
it oat of llie inuulb mid upwan) from leii to fuurleen tiiiie» a miiiiitc, 
in onior lo HtimiilaU' the (iiiiiilirnjfm. (See Asphyxia. Purl IV., fitr 
dclnilcd (lirfctions for nrsiiwilatinii.) In ii rtTtuiii tmtidic;r of traM-s 
patients apparently dead fivnii chlnniform linvc Iwpri re.-iiisit'itatcd l»y 
rep«itt-d nJtn)irt-t,Hi»ii or inn.tNige of tito prwc^nliuTii. 

The mea»uri'« adopted for reeusoitation Mliaitid not bn stopped for 
at Icawt one hmjr. aa persons Jinvc recovcreil as long ft* lliis after au 
awidvnt fmm cldorofnnii. 

<>.<fb'rta^ lja'4 ruiind tliat very prolonged inlialationn of cldoroform 
in the lower nnininU produce widespread fatty ilegenomtion. 



Before closing th* cnnxiclenition of llip uw of chlnrnlnmi for nns>iu 
thetic purposed incDlion sbould be rnndi- of tic co-i-nllcd ADBcsthotic 
mixiiire^. Of ilieso llie A. C. E. is the bi'inl kiiuwii. It cijiihisth in u 
mixiure of 1 port »lcoboI («p. gr. .^38), '2 parts of chloioforiu (sp. gr. 
1.497), and 3 uaiin ctler (sp. gr. ."Sft). Billroth'H A. C. E. inislare U 
eoinpoeed of chloroform 3 parta, and etiicr ntul nk^ubol 1 pfirt «ach. 
The Vieniin mixturo consists in I pari of clilorofomi and Tiof elher, and 
the Bo-cttlled methylene mixture ia 30 per cent. mcthvUc alcohol and 
70 per c*ni. cliluruform. The ubject of all these iiiixtiirett is evidviit — 
namely, to get the an:c8thclie effect of the ether and chlorofomi without 
the ciirdiac am! respiratory effects of either, and the nlcnliol when 
Abided is to act as a stiuiiilunt. As the voUtihty of each ingredient 
varies, the mixiure h useless, for the fther evapor&ies first, and the 
ehtorofonn bext, and the alcohol la^t. The A. C. E. is popula-r in !Hng- 
tand. hut not ro in the Tnited StatL-x. 

The rapidity with which any drug, ivhich produce* nnjcsthesift 
\ty heinp inhaled, act'* is governed in part by itn boiling- or most 
rnpid evaporation-point. The higher thiit point the greater is ila 
mpidity of action and the more prolonged ita effeclfl. Thus wc find 
that in the ca«« of chloroff.rm, the evaporation-point of which is GTj* 
C an:e.itheAia speedily follows ittt adniiiiiiitrution in aiaall amounts 
and Innts for some time- Once in the rfysteni it m eliminated slowly, 
because the boilily liejit i» lesit than it--^ point of nK»st rapid evuporation. 
On the other hand, sulphuric ether boils iit 84*^ C, and fur thi» reation 
acts monr slowly and more tranwently. because for every breath of 
ether vapor which ia inhaled an e'lua] (luantity of ether in exhaled, 
since its evaporatioD-point is less than ihntnf the body. Schleich has 
found that if chloroform, «nlphuric other, !ind pi-tro1eiim ether are 
toixed, they form a Quid the eva[H>rutiuri<pi>i[it of nbich varies from 
fW° C to 42" C, aeeordirig to llie proportions of the ingre<lie»t8. 
By the nseof such n fluid for nniesthctic purpown wc avoid the ovcr- 
effecta of vhlorofonn when u»ed alone and tlie iteceimity of ufiing 
exeessire amouiitri of ether, and the patient speedily returns to con- 
finoiii^ne^? afler the inhalation eensos. Fiirtner ilisngroeable after- 
effects arc said to Iki not »o ouinnitin or BCvure as with a single drug. 
These so-called mixture!! of Schleiel) may be made iu three ways: 

No, 1 is cotnpofici) of: 

CliliMiifurni 15 partK. 

Petroleum vther - 16 " 

SD)pb[iric(4ber ISO " 

The boiling-point of this tnixtiire is SS** C. and as the lower the 
boiling-point the more transient the aniuiithpHia. it is to he employed 
in brief operative procedures of about twenty minutcit. About 1 ounce, 
or ;W gmmmes, will be reijiiired, given best in an onlinary ether cone. 
n)U<le of cardboard and a tuwi-t. About tliree ounces will be needed 
for a {Mfriod of one hour. If » more pniloiigt-^l and |)owerfid effect is 
desired, then one of the following mixtures is u»cd, No. 3 being 
naltirnlly more powcrfid than No. 2, becaune it» boiling-point is 
higher. 



176 ^^^V DBUO& 

Ko. 2: 

Chloroform -t-S p»rU. 

I'ctmleum ether, . . . . tft " 

Sulpliuriccdier. 160 " 

Tho boiling-point of this mixture is 45** G. 

No. y : 

L'hloruform .30 pirU. 

I'etraleum etber. . . If> '■ 

SuljiUuricclliM. 80 " 

The boiliug-jioiut of this mixture is 42" C. 

The pctrikli-um rtbrr hits mi Ji;tclcriaua cflcctfl, and seeing to modijir 
the effect iif the tiblorofonn and dilute tbe Hulphuriu other uithnut 
altering its penenil influence. Jt i« tn be remembered that only 
petroleum ctlicr, which boils (it 60* to 6.5" C, is (o be usifd. The 
vrdinur^' [iftrnlcum ether, ur hcusinc. uf tbe drugstores, wbicb boila 
at 56** C., is not suitable. 

Aside Trom tbe ilisagreeablc odor of the benzine, these mixtures 
are said to cniise \vf^ evitiioiiiI.s, lei^s iniicnuK secretion, and other disa- 
greeable cffetits thuii nov pingk* auiesthetie known and to b« »*fcr 
iu every way. 

Tbese mixturet! have not proved {Kipiilar in Ameriui, and nre being 
used li-ss and b-**s. 

Local Use aad Internal AdmimstratioD. — The official preparationsof 
chloroform nre n Miiiiriciit {J,iiii>iieiitum Chfornfunni, V. S. «nd B. P.V, 
a water {.^It/Kfl L'hl"rot'ormi,i'. ,S. ai.d /f. J'.), do^e A to 1^ oinices{l.'>.0— 
60.0); a upipii (SfUririin ChloroJ'ormi, U. S. jind H. I'.), the dose nl' which 
IB 20 minima to 1 lluidracbin (1.3-4.0); iuid uii eiiiuli^ion [Emaham 
CJiioroforwi. V. A'.), cumposcil of chloroform, gum tragacanth. oil of 
almondn, and water, jriven in tbe do»e of '2 to 4 tluidrachmK (8,0— 
15.0). The S. P. recognizes, beaides thoHe given, the Tinrtura Chio- 
roformi et Murp/iuue Vompottta, done 5 to 10 mininia (0.3-0.66). 



OHBOMIC ACID. 

Chromic Acid {Actdum Ohramittivi, U. S. and B. P,) n not a 
true acid, but an anhydride, and orciirs in the fonn of brillittnt red 
crvHtal.*, which are delit|iiC8eetit and pntwess a 8«ur, tnetallie taste. 
The acid should be kept in gju&a-aiupiiered bnllles. It should never 
be mixed with sweet spirit of nitre. Mvong alcohol, or glycerin, or 
any organic mutter, tut under thef4r cireiimslanreH it may explode. 

Thentpeutics. — Chromic aeid is used aolely an a csimtie for the 
reiiiuviil and destruction oiyrmrthx mt (fir nh'ii or mucous manhrane: 
When 11 limited area i» to he affected, a timnll erv«tal is plnced on the 
part to be cauterised; but if a laruer apuce is to be attacked, ami very 
severe action \» needed, the liuuiil resulting from ittt deli<|ueBcence pn 
exposure to tbe air umy be empmycd by means cif a glav< md. The .siir- 
rouiidiiip titsuen <<bonId ulMuys bi? proieeted by lard nr adhesive Birips. 

Dr. J. Wm. White bus recorded a dcntb front the application of 
thiii ftcid to a large number of I'ondylnnifila about the btiltoekts nnd 
Mjlia, Where toc drug has been, swallowed the patient ehould bo 



I 



CHRYSAROBIN—VIMIflFUQA. 177 

treated for gaBtro-eDteritis, ftad dilute alkalies imd lime-water be used, 
ui veil M emetics a.Dd dcmiilceDt drinks. 

ir a superfioiki action is desired, a solution contdinins 100 grains 
U) the nuQCL- (<!.ij : 32.0) uf ivuler i» sitlTicifnt. and for nuinll vrurl« and, 
similar growths tlii? solution will b« found Htrong enough. 

LtqKor Acidi (Jhromici, Ji. P., is composed of 1 part of acid to 3 
of water. 

CHRYSAHOBIN. 

Chrjmrobia {Chry9arobi»um, U. &', and If. J\) is a mixture of 
tlie proximate principle* derived frura a powder foun»[ in the wood of 
tbe tree AnJira Artiroto. wLlc-h was drijiiiiallv nacd for mediciiml 
purpose:^ iti Brazil, lu the Eiint Indies it is CMUfd " G^ou |)Owder." 
OhrTAarobia is sometimes misnamed cbrrsi)]ibaaic ucid, and is a vol- 
low, tftAtelcKS powder, soluble in suliitions of ulkiilies. in acid», and 
in ether. 

Therapeotics.— Cbrvsarobiu is given inlorunlly in the dose of ^ of 
a grain (tt.008) in i>itori-ut« and far-nitk- tfmtiM'» of the skin, but 
more cimmoul^ is emploved e.xterniillv in tlie form of the official 
ointment (/'«<;iK'ii(i*/n i-/iri/Mr-yf>inf, U. .V. and H. P.). which is too 
»tronff for direct use, and shoiilci be mixed with 4 or 5 [(arts of ben- 
eoated lard before application to the skin. Even vbcn so diluted 
chrvsarobin may cause great swelling and inflamniatinn of ibo skin, 
with di^s<{iiiim»(ii<n of the cuticle. J^hotild the unrfaw he broken, it 
may hv iibsorhed and cniise vomiting. A.s the drug stains ibe skin 
a dark-brown, it ougbt not to be used on the fufe. but should this acci- 
dent occur tbe discolomiion niny be removed by the application of a 
weak solution of chlorinateil lime. In pgori<'»l« the following may be 
employed after ihc patient has tiikcn u bath lu woften the scales; 
B.— Chri*«robini 3j (4.0>. 

fSZv,.} «q.a.,f...,l. 

CoiUidu .... fgij (60.0).— M. 

S.—Appl^' to ilie |>aft aflectH with n briuh. 

CIMICIFUQA. 

Cimieifuf}a (IT. A'.). — This ilriig is derived from Chm'cifuga Race- 
mom, otberwiitc known an hlai'^k oiihv]:;h or black fmake-ntot. It con- 
tains a resin and a V(daiilit oil. upon which its medti-inal powers are 
supposed to de|>end. The fluid extract and Cincture .'^bmild always be 
freslily prejiared from the fresh crude drug. It is ofRcial in the B. P. 
M L'tMififu-ffie Rhiioma. 

Phjaiological Action. — In very large doses cimii^ifuea panilyncs the 
sensory side of the npiual cord of the lower animaU. and iu consequence 
lowerH reflex artivity. It has no cfl'rcE on the n^TVts and nuwdes. 
On the circulation tit drug acts by depressing the lieart and vaeomotor 
aVBleu). I>falli is due lo resipiratory iirresl. In snjall d'jsr it in n 
feeble cardiac stimulant. When foil medicinal doses are given to man 
it nearly always pn»iiucc» frontal headache. Ila known physiological 
eSecta have no direct hearing upon it» U8c in mcdicinc- 

12 



n» 



DRV as. 



Thenpeutics. — Ciinicifugu is, nfter «i'«fnic, iJiv \>v*i rc-tucdv wi.' 
have for chorea, pa.rticul»rly if llii? {utieut is udierwiw iu c»>n*l benltli, 
but it bIiouM be useil nitL careful ulleatiou ta tlic itrjiulai-ity of ihi 
bowelft ami oftt-ii bu accuiu[iunifil lij inm. It is ulnn imlioiu-il wht>re 
there i^, in niUlitton to St. Vitas's dance, a rheunialic tvinletioj. In 
chronic f/rfinrhiliii it is ass^ried tn W of valiiR. niul in rhrtimiUiniH of ii 
subacute nr chronic type cimicifiigii tsometinKis gives relief. 

Ci'micifiipi lius Loeu liiglil^- pruiNcd in lite iri-aliiifnt of ufuraitfia, 
purtiuuUrly of the o»'ari)»n type, and in amenorrhaen, ttulm>'flution, 
unit IrniJrmfgti of the wojii/i. To women vrho stale ihRi tliejr cannot 
slu)) off s step without paining or hurting the uterus or ovaries cimi- 
cifuga ofton gives r«lu>f. tynmv wriitMn :L4Kert ibat it is an •.•fFicioitt 
hcnrt tonic in cases of /rtrti/ iind n-ritahlf /'fiirf who'll digitnlic fnils. 
Tlicrt' can Ir no doubt tliut it Is h powerful itterine ittimuluiit. uuil It 
oujfht to 1)0 used with t-are during prognuncy for fi'ar uf »borltoli. 
There are, however, somt- practitioners who miiinii-nd it« use for tlie 
prpvontion of llii*^ fleciilent. My rrnson of this power it may be 
employed iiiMt'Cud of ergot during hihor. antl is said to be betttr m 
aome caspn. bet'iuia*? it pru<iu«ed iioruiul. not touji! eontraetiona. As s 
matter of faoi, ii i.s littlo used for tliis piirpo»v. In itic trontnii'nt of 
hcitdanh.- nriTiing from overxtrainin^ of the eyra in Kludy einiirifuju;u is 
said to <l<i gixiil. 

The drug i» oflicia.1 a* the oxtrnct {Kr-trm^iMm Cimirffuya', IT, iS.), 
dow 1—") grains [0..'»-)l.y). the fluid extract {^rtrnrtum dmic^fuiitt 
Fluiiium, t'. .v., or KjtraciHin (Umiri/wjif LiifUiilum. ii. 7'.). ihe dijiw 
iif which is 10 to 30 minims (O.l!.>-2.0) or even 1 drachm (4.(1), and 
the tincluru ( Tinfturn iMminfuiffr^ If. S. and B. Jt\), the dose of 
wliicb in 1 to 2 drucinus {4.0-8.0). 

CINCHONA. 

Cin'-hoNi, iL .y., is » name applied to tbo bark of all the treea 
belonging tii the genus Cinchona, provided they contain as tnuch as 
'2.^i per cent, nf tho ulkaloid quinine, or >'> per wnt. of total alkabtids. 
There wre thirly-ouo species of this genus, but uiily a compiirativelj 
small niunbtT can be included in the list of rliose which contnin .'i per 
c«nt. of Eilkuloid. Thirse are tl»e ('iiit-hona Oalifiuyii, or t.'mr/iona 
fiara. wliich oontaina the mont ijuiiiine. the (.'incliona Cuiidaminetif 
Ciiichnnti Micraiuha. Cinchona Succiniba. or Omchotta Uuhra, U. S., 
Cinehonrt ttiih-a* Corfax, B. /*., ntid Cinchona Pituycnsi>>. The first 
is called yellow hiirk. the second pale bark, ibe fourth red bark. The 
alkaloids of the ijuinine scriesi derived I'roru these' hark w are (|iiiiiine or 
ipiiiiina, rininidinn or quinidina. and i|uiniciiic. vrhirli i<i an iirtilicial 
alkaloid. Of tbo cinchoiiine series we have ciiichonine. einfhguidiiie, 
and cinv:honicine. which tu.'^t i.'> also tin tirtificlal alkiiloid. Itetiidra 
Uiem- alkalrtidx we have prt«ont kiiiic iind kiiiovic acids and other inci^ 
u.ad useless substances. 

Aa i|uiniiie is the mimt important of the group, and ns its phynio- 
Ingicnl action is virlually identical with the rest, whiitever >s ■^xA 
hervafU'f in this article refers lo ijuinine, unless it is oiliei'wise stated. 



• 



CISCHOSA. 



179 



All th« alkftlouig nf ciiiphonn whioh hiivo Viw»n nampfJ aw not «nnloy«d 
OA \virv ulknlmilTt. but 11:4 .nullH fiinai.-il \iy uUiling ftutpLuric, hyilruclilurio, 
t»r other atiil to iticroii^u? their eulubiljtv. 

PliTstological AcUoQ. — When r^uinine i» tnken in overxloee it csusea 

ringing ill tlie enrs, ilizaincws. disurileni of tsisle dmi smoll, diHtiirbsnofl 

of vuion ill mini- fatv», and fiiltieA<4 iii the li<>ail. Doufiiei^M oRen nnmoff 

OD. Mid is gipticrnlly, wilh the roaring in t)ii> ears, the tnn.it }ire!«ing 

.symptom. Hosdnctie is nut uncoiuniuA. (See L'nloward EfTects.) 

Mbrvobs Systkm. — U(ioii tiio cer«ibritiii t|uiriiiu* iiels as o sliiuu- 
Iitnt, and fitiiiily as a cnngMtaiit. if giVMi in cxcewive do^e. If poi- 
Boiioiu duscs urc used, intense cerebral congestion ensues aJi'l finally 
anconscioasnetss comes on. On the spinnl cord of the lower animafa 
th<> dntg first riiii?«s » decrt^se in refipt action by stimnlnting 
S«tAclionow'» reflex iiiliibitory centre, nnd finally by ut-pree:*! iij; the 
spinfll cord and nervti!. The latter cliaoj^es oeciir only after iioiewi- 
otui dunes. 

ClRcitLATrox. — If qaininn, even in wmall nmniint, be injertefl into 
the jugular vein of a do^, no tliat it ^oet^ in couccutratod form to tha 
h«3rt, canliuc paralr^Is will result. If this does nut occur, the drug 
«mply <Ietrca*»» piil«c-forrc. puUe-rate. and arterial presviirB. When 
gireu to man in small nicdieinal do-te* by the month, the drug aeta aH a 
general stimulunl Ui the entire body, ami 30 XvhAa to ttuppoi-t the circu- 
iation, iiirreasing to a slight degree the piilse-nite iind blood-pressure. 
If the dose by the moulh be very large (15 grains), the puUc its 
depressed. Full doses in fever therefore act as vasonlar fteilati%'t«. 

Ul.oOD. — The bltHtd after poisonous dosai i.s more lougulable than 
Donnal, but in ntedii-innl anmnntK no rucIi effeet is pro<liieeil. llio 
effect of quinine <m the bhiuil-corpuscles is of grtai in(vTej<t. £vvu in 
full meilicinal dogL« it urnwts the diaiiedcKis of i1k> white cells from the 
cnpiltariirj by & direct action on tLe«e ccllis and if the drug he applied 
to the mesenlerv of a frog the celU already extruded cease their move- 
ment, but the intrara.'icuUr colls do not. On the other hand, if the 
nninine be given iiuernally in so stnalt n dcwe that the pro[Kirtion to 
ene blood is l:iO.<H)iJ. the white cells in the viuweU cirasi- to migrati?. 
but ihe onex in the surrounding Iissue» do not (Kinit, Hart!, Dis.'^el- 
horet). This is perhaps the explanation of the effects of fininine in 
acnte infl.-immationB. for it. arrests inflammatory e.<udation and allows 
the cximded celb to wander away from the dincaaed area. It \* stiitcii, 
however, that this is not the lase wilh all animals, Binz asueitM that 
in the proportion of 1 : ^f'.dOO i|tiinin« dimiiuHhe^ ihe number of white 
cells. Medicinal amoants gnidiially Increase the number of red hlond- 
corpu^eles very (naterially in man. It is said that quinine Inbibiltt 
the ojcygeD-b«triug powers of the red corpuscles, but this probably 
does not occur from medicinal doses. 

K&*PIRATrnx, — rpon respiration quinine acts a* u slight stiinulailt 
in Minall (ti>ses, but as a marked depressant in prtisonoua amount*, 
death being laost ronimnnly due in uniinalN to failure of re!«pirHtiuii if 
it be t&lcen by the Atomaob in lethal do»<-. 

TEMrEB.^TfBE. — Quiniiic lowers bodily lonipL-rature in healih very 
little if nt all, and in fevered giati'S its inthu-uec is governed by the 




180 



DRUGS. 



caug« of the fever. Thus in mularinl fevers quinine ie n tppv ptmifrful 
indirect ftiitipyretic. by reason nf its pppuUar pnners over thr infwtinn. 
anil not lit-cause it has. VlU^ direct intluence over heat production and 
dissipation. 

AitsoKi'TION. — Quinine i« absorber! from the stomnch, not from rlie 
intcdtinc. and it is precipiUted hy ihu nlkalinc JiiircH of tlir bnire). 
For lliis reiisoii it ahuiilil bf given in eai-hets, c-npnuli-s, ur powdent, 
rather than iii oomprcssed taMfls, bo that it may be nbsorbcd by the 
Btoniaeh before it reaches the jnteftine. If pills nre used, only those 
ivhicli hftTo been freshly mndc should be employed. 

KiDXEVs. Elimination, a.vd Tissie-w.^stk. — Quinine escapes 
from the body chiclly through the kidneys, nlthon^h some of it is 
destroyed by oxidstiiin in the liver find liwues. The proafM of 
excretion of ijutDiue i» by no tiieuns raiiid. to fnr n.'S the entire quno- 
thy lo be eliniinntfil is concfmed. \\hilo it may in ra.ro iu^Iauces 
bi- found in the urine in tiftecn niinuti^.« from the time it. is given, it 
doea not disHppcar from this secretion for about twenty-four hours. 
Iji the urine it is found a-s (luinine and *» dihydroxyl i|uinine. 

Upon tissue-waste iiuinine acts as a depressnnf and decreases the 
cliuiiuution of nitngvuouif muteriub. 

DiiiKS'TiVE Tract. — Quinine h:m a bitter taste in w small a pro- . 

portion as 1 : 10.000 of water. L'pon the stoniath it acts as u touic ^H 
and stilimlniit. but if >:iveu loo frequently or in large doses it may ^^M 
irritate thia viscu». Moderatt- dttses are slightly constipating in their 
cfTccts. and very larpe dnses may indiiee colicky i>ain. 

Poisoning and Untoward Effects. — Severe poisoning fi'om quinine 
verv rarely occurs except in persons who have an idiosyneraity to the 
drug. Itccently Hobcrtc hiis recorded tlic case of u votunn. ajfcd 
thirtv-six years, whts look .'i draehniB (^IVi graiuniei'l and survived. :ifter 
Buffcrin;: from deep conia. shallow brcathinp. «low pulse, abeolutc deaf- 
ness, and blindnciss. The loss of Right laatetl twn weeks, but the retinal 
changes peisisted for ^cveral months. Death from an overdose of 
quinine '\» exceedirijfly rare. The rut^es in vrliicli dvutli Iiuk followed 
it^ use iiri' iiK'-diral rnriof'itio''. Ilonchardat haf^ rccordMi t!uM:«t*ieof an 
adult inalp who died a.s a result of L-iking fn»m 4;') to (>j'» grains of the 
drug. Whether this was the real causeof Ucath is doubtful. Soallier 
qnotes Tarnier and Budin as asserting that enough quinine may be 
oliminated by the milk to produce death in a nuritling. This sccmii 
hanllv possit)le. 

" L'ntoward effects " in the best term with which to qualify the dis- 
agreeable -symplom-t which sometimes come on in persons having an 
idioevncrasy to the drug and who are in reality poiwned by email <lo«ea. 
In thi-se r-a.*c^ srtdden. coiniilete, but tenjpvM-ary blindnejis is ofUn met 
with. Dcil^cbweinitK hiui shown tliat in dogs quinine produceti in toxic 
doses coiif^triction of the retinal arteries, tbromhoeia ol the central vein 
of the rt'tinft. and permnnent opiie atrophy; and Holden iuw proved 
that llicre is degeueratiun of the nerve-fibrea and gunglion-cetl layers 
of the retina. In other inatunet'S complete desifncss asserts itself^ 
due to congestion of the middle <;sr, while .■<kin eruptions, generally 
of the nature of erythema, are not rarely seen. In other mstances 



CSNCHOHA. 



181 



pelecbial nnd veticuUr eruptions are dereloped, iLtid swelling of the 
game wiib a temlency for them lo bleed may appear (Scbulx). After 
lethal tlo!*««i hfiiiorrhage into tbc uiiddlo «ur may bu fuuiirl. and 
aevore «pistaxis miiT ensiit after go small a dose a£ 4 >;ru.iii» (0.^), 
The buzzitijT ill tliv cars can (jtfiierallv be put axide by tbo adruinia- 
tnuion of lU gmius (0.tJ6) of bromide of sodium combined with u 
little vrgot Karaniit»a.o has proved that quinine uia^ produce bemo> 
^lobinuria in penjons siiflc-riti^ from malarial poi^^jning, and apparently 
may even develoji biliittis rfmillvnt fever.' Irritability abuul the 
neck 'if till.' biiiddor may somctitncs be produced by (juiniiie. 

Therapeutics. — -The drug is cniplwyLff in nicdiciiif tu fuHil lUrec 
great offices, alliiouj'h its inHuence in otiicr directions is hardly less 
pOnerfol. These are as an (tiitiprn'odir nr iiniimaf anal, as an finti' 
pifrrtie, and aa a tonic pottse»ting peeuliar \'irtiiea. 

Far many years pbysicianH urcrc forced to employ this dnij: empiri- 
eaJIy, not kiiowiii/ the caUHs i»f the disease culled malaria, Wp now 
knoir thai the theory of Bin]!, offered af* long a^rj as ISIIT. is correct, 
aad that malaria \% due to the presence of a germ, ilie plattniodium 
walarioe, which was 6r8t accurately atudicd by Luvcran and named by 
Marcbiafax'a and Celit. Tliusf and otht-r investigators have fotmd that 
quinine acta a^ an active poiiKtn to tlie-«e germH. even in mi weak a solu- 
tion as 1 : 20.001). 

For the reasons given in the preceding paraj^rnph quinine is the 
best remedy wo have for malarial fever na a prophylaetir und cure. 
aad it Hfaoald bv given in dosei^ which are indicated by the rotate (if 
the patient. [See Malarial Fever.) If posnihle it sbmild always be 
preceded by a parge having an hepatic action. Tliitt preliminary 
trefttineni is panictilurly iniporlant in bUintis or remUtent fover. The 
dru^ should be given in Imnrly dtisrs. or in one or two large dDSCt* in 
such a way that its influence is fully felt, not only at the time of the 
expecte<l paroxysm. Inn about an hour or Thirty minutes before that 
time. If the paroxyitm is neitr nt hand, the drug should be given in 
mltitioi), bitter (hough it be, in iiciduliitcd \Mtter. If the ca^e be t<o 
far advanced aa tJie sweating xluge, it should be given neverlhclei^ to 
destroy the spores just set free. (Skc J tttcruiittcnt Fever.) 

An a pniphylactie against malaria the dnae of [[iiinine aliould be 2 
to 4 grains (0,1-0.2) or more three time» a day. 

In heiDorrliagic malarial fever qninine sometimes ^eems to do more 
hanu than good. Fudcr such ctrcumstauees the daitjjcr in using 
({Uiiiine consistH in iiTitatlng the engorged kidueyis afti^r the chill La4 
Uissed. tjuininc is not a hiem<')dtatic and only does good in malarial 
neniaturia by preventing; the paroxysm which prr>diice» the blondv 
urine. In benmturia occurring in person.-* bi'oken do"n in liealth 
from the reaultH of ehronic malarial infection r^uinine \». of no value 
UoliMS an exatninatiou of tlio blood reveaU the presence of parasites duo 
to a new infwrtion. To give ijuiniiie afier tlii« nyinploni ajipcarit ia 
to '*Iocfc the door after the borae is stolen '* nnless the para*itL-a are 
(bund in the blood. Indeeil, it would seem certain from the stuiliea 

' Sncnileclirp in rent i gat ion nf tllix >iiliji.vt I't the niilhor in Tl'fmjmUu: (iiarllt 
for Julj, 1S92; akn nrticlv io Stu- Yuii Mtdlml lirfvni, JHuuary 7, iH'i'J. 



182 



DRVG& 



of many phyt^iciari!) in Amerifa, (irppcc. ami Italy, thai tbc use ui 
auinine is ciipiiliU' of licvrlopin^ a hematuria.' (See llcnmuirin.) 
If. Iiowvvvr. an cMiuiiiitiliuit of tbi; bluod tevL-iiltt tljc luuliLnul jmnu^ite. 
iLe druj5 sliuuM lio frti'lv u»iril. 

In /if^riiiritiuv mufarinl _ftrn- ((uitiitic !=lioul<l Ijc given by thf mouih, 
by the rectum, luid hTpodennicnlly. :iml even inti-avenouslv, )u> iniirh 
an IJQ tu 70 grain:) (4.U— 4.6) beinj; used. 

Ill lnyiif ttiftie or muUtrinl vnifalyia quiuiiic of^eii actK must lue- 
fiilly, and tliis is alau true tii sumc casrs of orditiury nrn-f-paitt aot 
lU'jii'inlent upon a specrifiu diseajH?. 

F'-r ibe re^duclioii of the pyrexia of ty/'huit or tt/phoitl fifvrr uuiiiiiie 
will be found inferior to ihe new iintipyretic*. even wlieti giv4?u in very 
lurge dose, utid il oiiglil tu be uat-d vcrv rurcly, if at uU. for tliis purptuso. 
In all fevere il. will selduiii eaiiBe a full of ti'iupeniture before triMin or 
iti'ixy but will uid ill the fait very actively afier these cliiuige» have 
neciined. In tlinse ease--* of fever in vrbicli liii! use of i|niniiie \*- fol- 
Iowe<l by marked iiupruvomenl the ^'^od results are due either l*> il» 
specific Hiiliitiiikriul iiillueitce tir to itx sliiuuhilin^ influenee on thi^ 
general syi'teui. 

As a Uinic; ijuiriine aets not only a» u «iniple bitter. Init ;ilso HeemR to 
hove a direct effeot in inci en^inii the number of the red blood-corpusclee. 
The Innie diwe i>honUI he 1 to 2 grains (dJIiVy.!) three times a daj^. 

Quinine hnH been used to overcome uterine nu-tiia in weak woracn, 
but il i;- H fi'eble remedy. !Uid is lewi nml lee* resorted Hi by progressive 
obstetric i an •■*. (See Kola.) It will not of iiseif cause abortion, but 
in nervoiiti, Iiysierical women who have a tendency to abort, and lo 
whom il is nccewary to give full do^es of quinine (iaring pregnancy, 
it may be well lo combine some oedative, tu one of tlie bntmides or 
opinm, witli (he autiperiodic. 

In the Ubirr imeiimon!<t of rbildren (iiiinine i<bnul(l be u»ed in mip' 
positorie^ in tLc dose of - grains (O.I) three times a day. 

Acting on the basis that vhoren is due lo lack of inhibitory control 
of muscular niovcmenM, Woo.d biif urged the iisc of quinine iti large 
ilniies in thiH dlnea-sc a» a stliuiilHia to inliibitimi. Whether the good 
which BOinctiines follow ibis treatment ia duo to any specific effect of 
rhr ilnii; i» doubtful. 

In cases where prolonged TnfKtftl nr ph^aifal Btrain in to he undergone, 
quinine in the dose of 2 to 4 grains (0.1-0.2) will often prevent cibaus- 
tion miJ i-upport the system. 

The internal ii^ of <^uiiiinu i« also a wiiw proeedure in whoajtintf 
fouiffi, and the best do!M>. :tt'eordinjj to a eareful Marios of Rtudies by 
Karon, in 1 J gniins (0.07.1) to each year nf the ehibl's age, to be given 
at 6 A. M.. 2 I'. M.. and 10 p. m. 

A very miieh more iigrccablc iiifihod of purauing this trcnttnent ia 
whooping cough is lo give the patient tlie a«-culU*d quinine chocoInttA, 
which are inude of 1 grain (0.4t5) of tajinale of (juinine and chocolate. 
The taole of i|uinine in bucIi chocnlatof is senrrdy noticeable if they 
are well made, 

' St« enllertire invcfitigiilion of ihi^ mbjcrt by llic ■mlior in Tltfraptvtif OiuetU 
for July, HiWi; xIm anitltr iu A'w i'mi: HtdUal ll"vr<i, Jiiniiary ", \m\. 



CrSCHOSA. 



183 



Uiwrd in solution iti the ronu of n spmv by the alomixer, quinine is 
of nniloubicd service iu fphooj)ii»i/ muijfi, nml will olVon prevent tlie 
ftpn.'^ "if ilio clifipasf to «tiipr cliildix-t] if llit-y hv subji'irtuJ to its 
u*e. Thiii solution should contain from 1 to 'igiiiins (0.05-O.t) to the 
aiiiii-r (32JI) nml \>e iriuplin'cil every few hours. It is wvU to rciutin- 
ber tiiai quinine is not tanivd l>y the tip of ibi- lunguc. but is txateil by 
thi: hwk [mrlion. The tip of the atoiuizcr ^hoiiltl therefore bo «urrit?ii 
wvIE back of thu root of tliis orgitn, nii<l a 1 pur vvui. suluticin uf cocaine 
paiateil over the Jon»uni of the louyue in vuses wbtre the disagitca^ile 
tmstA of the (juiniae iit ubjei'tvd in vi-ry 8tror;;ly. Thi'' .'«i)1iiiioii of 
quinine OMd. by uenii" »r uii atouiixcr, in cf^f-U in tJic h^a<i und in 
faftlti *ort throat is often of seririce. High recta! injections uf 
iiuinine m the JiilreDxIli of I ; ^OUU arc useful in amaelic ligtt-nUrift us 
titis <Iru>; rle>troy.« ilie anifeba coli. 

Adnunistntioa. — When prc^fcribiDc r(nininc tho phyBiciiui should 
tiaplov the hyiirwlilorati.' (f^iiitiiji'f Iltfdriichh'ruis, V. S. ; Quinimr 
//y./(-trf*Wo'r((/M"i. B. J*.), !ie it ocntaiiw a high piTi-viiuifjo uf alka- 
loid *n«l is very Kohiblc. An iicid hydroohlDriilt.- (',""""'"■ flyiiro' 
eMorhhim A-'i-i'um) id iilso nflicial in the B. /'. The hydroclilorato 
of ijuinine U dITUIl^cr in ulk^tloid than the biHiilijIiHle t>f iiuiiiine 
(t^initKf BUttlpha*, U. >y,), wbicb is, bowtver. soluble in tht- pro- 
portion of about 1 tn 8 nf yraK^r The bydrobruiuatv of iiuiiiiiio 
( f^uinin'p W/dr(throm<t». U. A'.) re uuothcr useful salt, which is s<du- 
btr in the prij|t>rtion of 1 to 1 ''< of wattT. X\\c viiIi'rianu.:L' <if (|uiuiiiO 
{f^wninv Wilrrianat, U. S.) posseeses no piirticnhir valiit-. The 
nul[>bate of i|uininc (^Ufnt«nc iS'ulphat. I'. S. and It. PX the least 
soluble of all thfrne salt*, ih by KHstnm moat cunuiionly auininisteped. 
Thr uiinatc of rjiiinine i» a salt nul ho bitter its the oiher ttall:*. and in 
ve&ker in relnlivo alk!i!oi<lnl strength. One j^rain (U.O.'V) of the tan- 
nale e<|uats abom ] nf a ;j;nii[i (fJOlTi) tif |iiiii: ali%aluiit. The biwul- 

Iihale cfiunU ikbont <t and i)i(> siiipbule ^ of a grain of the pure- alkii- 
oid. TIic Jose of all the salts of <|uiiiini* viirit^ from 1 tn \ grains 
(0.05-0.15) aa a tonic, and from 4 t4t tJO grains ((».2ti— 1.0) for anti- 
raalarial purposes. 

The B. F. rceofinixes n pill of quinine, the Pihtfa t^urnintr ShI- 
I'iiatiHi a lirirtrire ( Tin-iunt ^^uhiituf). a ytihl' ( I'inum ^^iiiitinu-), niii 
*n nniiuoiiiaioi tinoture (r/n'-fuM QutHtna- Ammoniufa). 

In regard to tho administration of i|ntnine, it may be ftaiil tliat it 
'lUght never M bo given in solution if it can b« iivoidt^d, Lfoau^e of iu 
di-<Migreenl>le ta<ite. If it is given in Bolution. the litjuid idiould bo 
well aridiilatiil. as under tbcivc cireiiiiijitanws it will not tasiU- as biHer 
us whi-n a w«ikly acidulul4.-d solution in i,-nipb>yed. In adidts and rhil- 
drun quinine ehould he used preferably in small eapsules or in pills, 
whirh may be gelatin- or sugariouted. Another means for adults ia 
the u»« of eaehei«. If pilU or capsules are employed, care should be 
taken that the sugar is nut hanleuid by age. anil that the gelatin in 
Ihin. for if the pill or eapbulu e»eapca into tiie iiiiet^tiiie before- it is 
tI[N>olve<l lilt- quinine i« jm-cipitated and in not nb^orbcd. If therane is 
that uf a child too young lo take a pill, the drug may be given iu the 
following manner without lasting very disagreeably : 



184 ^pip^ DRUGS. 

B- — UniiiinfphrilrM'hlQr, ....... . sr. x«j (1.0). 

Exi ^IvcvVrhii. 11. . . . . i . . . ^ 14.0). 

Byruf.la.i'mitlieorL.^ fgij lUO.O).— M. 

B, — A ItNUjKKiiifiil L (I. lijr n cliild at three y«UK 

In some ca«e» (|uiiitni> t-liuculatf^i) may l>o used, but unless lliey are 
well made ibc urU'r-luj«ti- <A' uuinine is well luarkeil. When ihey are 
tued tADoate of quinine BlinuM always lie pliieed in them. In other 
c«wa quinine may be used in the suppository in tbe diwe of 2 lo 3 gniins 
(0.1-0.1 "»), care being tiikon that irrilatiou of tbe ri>ctum doe.i not ensoe. 
For sup py*i lories lie bcdl suit to employ id tbe hydnxldoraie. 

Fur bypuJurmic U8t" tbe by<l roc lil urate of ((iiininc should be uaed 
meet cotumotily, HA it lii doIuIIc in about 10 psrld of water, uud cud- 
lains more of tbe alknloid than tbe more soluble biflulpbatc of 
quizticc. It may be employed in tbe following manner: 

B. — QiiininvhyilronhlnrBi. gr vij (0.8), 

AqV.dwt.l- 1- (5" (2.0).-M. 

S.^Wurm Milolion btsfore iKing it, and do oat add acid. 

U- — Cinininw bydrochlonit g*- »» UO)- 

AIi-i>holi» n\,sv(1.0). 

Aigiwilust f.'^w iCUj.— M. 

8. — .\dil n few dfups of liydrocliloric acid to uniijiii-lc.' chsM^lotion Ixiforc usiag. 

If tbe bitiulphate iB iieed liyi>odeniiical]y, to lis solution sltoutd be 
added a little ttivlnric or gnlpburic acid to prevent pr(M;ipilation of the 
drug in the allcilinc juicicH of the rnnncetive tissues bpfore it can be 
Blis<)rbe<l. Tbe tartaric acid wimulil be prewnt in the proportion of 
about 1 grain (O.Oo) to each ft giaini^ (O.IJ) of tbe i^uinine. i^bould it 
be iiecessar.' lo use (lie siilpliate of quinine hy]iodeniiie«l!v, T* gniinH 
(O.Orj) rihould bf tidded to 1 ilrncbin (4.0) of «utor rnid sulpliurii: Htid 
added, drop by dro]», until ihi- salt is di»;olvfd. The bydrohrouiate of 
quinine, the solubility of whirli is about 1 to I'A of water, may also bo 
used hvi>odiiriiiicnlIy, ns may ulxo the liimiiriate of cjuinine and urea 
(Qiiuiimi- fiiiuitriaticti Otrlinwits), wbirb, huwever, is scarcely more 
than half iik ntnHij; in quinine it.s ibe other sftlls. 

The beet plat:e to give tbe bypudermic injection i8 in the buttock, 
between the trochanter and the tuberosity of the ischium. Injections 
into tbe calf of the leg arc very painful. 

In Italy. Baecelli Iir.« re.'sorted tn the intravenous injection of qui- 
nine in pn-iuing niat-s of luuluriiil infection. He employs the foUowmg 
solution for this puqiose: 

B.— t|iiiiiiiLii' |]vdri>cl>]orat gr. xr (l.OJ. 

Stxlii olilii'ridi (tr. xv (1.0). 

Aqim-ilral- (Sy* 10.0).— M. 

8.— TIiIb should be in]et:tc<i. after on niincc { 30.0) o( di»till<il wnlcr hns been nddod 
to iL Tiin suliiiion ^llmlld \>v Luiluxl uiiJ liltercd, ntid tiM-d whils nvnii. 

Aa quinine in a concentrated fortD is a powerful hcarl-deprcKsant, 
the drug should he injected cm/ ultinly indifed into a vein of the leg 
when intruvcuoua injections are employed. 



ctyyAMoy. 



isa 



Tlie alkstoiibi of citiciiunu other tlmn quinine whicli are commonly 
luteil >u metlicint' nre cinclioiiiditiu. cinvbuuiiie. t^uinidino, nnil tbc im- 
purt> niiK'itaiK'e i-liiRoiilinum. 

('nllen. Siiikter, ami T>r Brun have ftll found the sulphate of cio- 
cUomtime {C'inrhoitulina Sulphas, ff. S.) very uskM in mularia, and 
it is Iph* bitter and more solublv ibau w qiiiiiint?. Sinkler stiites that 
it doeK nut proJucL- ibeMvi^ru beatl-Hvniptoms caused \>y (|uinine. 

Tlie dose of ijuinidine sulphate {^unuWyfla'A'u/y/Aflii, f/. S.) is about 
twice that of ([uinine, as is also that of ciiichonine 6a\j>hate (Oinchi/tihia! 
ShMkik l'.S.)nnicixwhoni(\\ne sul^hat^ {Cmf/ionii/inii Sulplnia, I'.S.), 

CbiiioidinutD is u rcsinoui' ino!^ obtained in tbe prcparntion of the 
alkaloids ofeitielionu. and eoniuins amorpbnus ulbaloids. It poBResses 
distinct untipcrindic power, and was used freely when quiuirie was a 
venr eipeniiive drug. Its dose is three or four times tbat of (piinine. 

The li'juid preparation^ of cineliona nre the infiii<iuii [Iitfuaum Cin- 
choiuE, U. iV.), do«e a Kiiie;fla«sfid (S2.0) ; the tincture ( TinHura Cin- 
ehotMP, U. -S". ami B. P.), one or two teaspoonfids (4.0-8.0}; and tbo 
compound (Huxbam's) tinctiir« {Tincttint t'incfwntf Cumpagifa, U. S. 
and li. /*.), a ceAipoonfiil to a tnblospoonful (-l.it-15.0), lluxliam's 
tiuctnrc is a most efflicient and elegant bitter tonic in deliilitv and eon. 
valeseoncc from tow fevers. It is tSo weak in alkaloids to'be used iD 
malarial poiiioning. Under the name of elixir roborans, or Whytt'a 
liiicltire, a similar mixture is etnpit>yed for preeiselv tbe same purposM. 
'I'bc other li'inid pn-piinition is the flnid extract (EjiTiicttim CinchoruM 
flitidum, V. S., or Extractum Cinchona Lujtiiduni, It. /'.). dose 6 
to IS minims (0.;5-l.0). A solid exiiact {Ertrnrtuin Chchomr. U. S.) 
19 also officiiil, and is jriven in the du-Sf cif f> to 10 grains (11,3-0.65), 
The B. P. prep3ra!ii>n not ofTtcial in the L'. S. P. is the Jnt'ugiiin 
Vinrln'ito- A-i'lifiii, dost: I to '2 fliiidouiKfc (-iO.O-OU.O). 

Cootiamdicatiomi. — tjniniiie is enittniiniHrntcd in gastritt», cvKtitis, 
meniugitii*. epilepsv, cercbritirt, mitldle-car difteaae, locause it coagestB, 
irritates, or stimulates those ureas which are dii^eiised, and in tho^c cases 
which have an idiosynoroAy to it» action. 



CINNAMON. 

Cinttamon {Cinnatiiomum Ctimsia vd uaiyonicum vel zeylanicuirt, 

V. S., CS'nmtirumi (Wfrr. B. /*.) is the inner bark of n plant, a 

native of Ceylon or of the fpeciL>)> indigenous lo Ohitis. ft. contains 

a volatile oil and taouie acid. Itt overiloire the oil aetn as a. eoporilic 

and kilhi bv failure of refpimlion. 

Therapeutics. — Citmamon is used, a.-t an' all the drugs of ita eUifits 
for flavoring, il* a i-armhuttwe, and a« iin intestiuu) »limiilaiil iii Hn-ini» 
diarr/ttttu. It has the pecidiar power of atiitig as .i liiemot>latic in 
utrritte kencrrhniff where tbe flow is n«s;ing nml not nctive. thereby 
differing from tlie oilier volatile oils, with the exception nf that of 
erigenm. The oil of ciiinauiun is a powerful aniisefitic, which can be 
nscil in ilihite Konn in the dn-wiing of wounds and by injection in 
tfuHsirrhnM. .1. Cbalmen. Dat'oHla employs a Hpriiy of oil of citiuanion 
and bentoinol in tbc proportion of 1, 2. or 3 minims (0.O5-O.1O) of 



I 

i 



186 ^^^r r>Rvas. 

the oil Lu 1 uijiico (^(i.O) of 1>enzniRol, or it may be used by ii^'ection. 
It iweiiie to ii't tiost in the cnrly ntnsc of BonorrlicM,. 

Ciniiamii- iiciil, a ilfrivative of oil of ciddiliiiou. ia also us&l for the 
sani* piirpyflee; but its cliiyf tuiployiin^tit has been in the tn*ntnieiit of 
tuf'rrrufiiiiU. Tliis connists in irijirting hvpodcrmioally and intra- 
timseiiliirlj 2 minims (0.1) of tho acid, Tliis prtMiiuros biinung puin, 
which aoou ilisappcaps. The patient, however, feels fatigucij. lius 
vertigo and cerebrul coiigeation. (iraiUiailj tlie Afim i* iiivreoiwKl to 
l.'j minima (1.0), and after uBveral weeks the putitTit is said to cotijcli 
loss, ti> giiin in weight, and to improve in his phvsifjil wij^ns. The 
irciitinfiit 1^ si> painful tliat it ha.s not gained niniir frieml^ 

Administration. — '\'\\v dose of the oil {Olp.um (fiHunmnmi, f. S. 
nntl B. P.) \* 1 t() o ininiuit^ (O.OG-0.3) ; of tlie vriit^T {.Atfua Ohtna- 
tnomi, U. S. mid B, J*.). » wiui^glassfid (iiO.O) or I*** : of llie fpiric 
(Sf'triliiM rinuamnmu P. .S'. and B. /*.). A to HO miniinji (0.8-2.0); 
of llic timrtiarc ( Ttuftur/i (Sniutitiumi, V. S. and li. I'.), i Xn I di-arfim. 
I'tnler thi- name of /'wVcw Arntnaticuii^ V. .S'. ( i'ufri» Oiitiinummi 
C'lmpin'StuM, B. P.) Ti ranninfttive jinwdfr. consisting of einiiniiinn 
35 grains. iiutiiiejiH 15 jn'iiuis, eiirilunioins lit ;:nim». and giiipT lio 
gramt), i» otlieiiil. The B. P. preparation ducH not eontain uuiinef;. 
Ft is tiflefu! in the? treatment of the Datuh'nce of adiiltH and childivn. 
The larliT shiiuM take about 10 grains (0.().'>) at u done, an udalt 30 
grains (2.0). 



ornao acid. 



*l 



Citric Acid (Acidutn Ot'tricuiii, U. S, and B. P.) is chemicully idcn- 
ticul with the ueid of tlie lemon, but ha» not identical influences over 
the body with lemon-juicft. 

Not only does the leuinn owe ittt aeidity to thiM aeid. hut inoHt of 
the other edible fruits, such as strawheri'ies and raapberries, depend 
tipon it!* presence for iheir acidity. 

TherapeutlcB. — Citric uuid is used in aainy, or scorbutut, as a pro- 
phylariic and cure. Fur some unknown reason, pure lemon-iuice 
sc«mi9 to benefit these cases more thaii citric acid it«elf. and il is tDcr«- 
fore to be preferred to ibe latter whtnovcr it can bf had. In order 
to kwp lemon-Juice from decompoeition on Unp, voyages, it should be 
boiled, and poured while Lot into bottles imli! it nearly reaches to the 
cork; the remaining space is then tilled with a thin layer of sweet oil 
and the bottle corked and Mtood upright. Under these circitmslancea 
the juice may bo kept indefinitely. 

In Thi'-umnthm. either nntfc or rhronir, lemon-juice may be em- 

5 loved in the dose of 1 to 2 tnin('e,t (32,0-64.0) four tiniea a day. well 
iliited. or 2 drachms (8.0) of citric acid may be given. The acid is 
alut) of value in hepatic iiiadmti/ and ratarrhftt JauniU'V. {t>ec Citrato 
of PotoasLum.) 

The preparations containing citric acid are Syrtipue Aeidi Oitriei, 
U. S., Huecuii Liiiwnis, B. P., and ii'i/rupm Limonie, B. P. 



A 



(JLOVEa-CVCA AUD VOVdiyR 167 



OLOVBa 



CtoPM (Carj/ophifUug, U. S.; tjar^ophyllum^ B. P.) »ro the anox- 
nanilcd fltiwcnt ul ttic Ew/enia aroviattGit, n plant of tim EiiHt and 
West Indies. Ttiey ivossess an aromatic odor and llie |)ungcnt tostei 
of a ijpical spice. They contain n volatile oil (O/^-ww t'anfophi/ltifi 
V. S. and S. P.), which is yellow when fr«h, but very dark-color 
when oM- 

Therapeotica. — Clo^-es or th«ir oil are awd in in«dicin« for the pur- 
post of excrcieing a rarminativt'. influence. They are alfw employed 
as a Rtimulnnt nnd tonic to the stomach to prevent griping during an 
attack lif diarrfuni. ur tliat caii.<ed by purgatives, lu (u.'t ait u (lovurijiz 
agent, as a counter-irritAnt, and, finally, as a par<ieUicide aiid local 
anamtkftic. 

Tho oil of clove? possesses great power for coofl in mnny cases of 
puhtu>narjf ttUterculvxis. partly by \IA gt>rmicidal iDflueiire U[]on ibe 
Mcilliu. It should lie given in the <Iobc of 5 minims (0.3) in capsules , 
afUr food three or fniir limes a day, ami a )iy}>o«lermic injection itf liter- 
iliKcd 8weot oil, containing in each doso of 80 minims (-■**) ^> mininia 
(O.S) of the oil of clovcft, sbuuld be adiiiiniatered once a ilny. The 
injection should be giron into the fiubcntniieous tisi^uee of tho Hunk »r 
alMlomen. and is painful, but the decrease in the cough and cxpcutom- 
tion amply repays tlii- patient for the pain. 

Like all vi)larile oils, this oil ii an efficient local applinitinn for 
priii'ral«9 /'mAm and similar parasites. It may be used in tm'd'itohf-, 
because of iiit aniestbeiic pnwcrM. if placed on a pledget of cotlou in 
the cavity of the aching tooth. Id the treatment of iiti/tkp" or rnvs- 
eniar rhemnatitru oil of doves i^ often place<l in n linlmrnl for its 
oiMinter-irritant effect. Minntc doses of J to 1 minim (O.OS-d.Oli) of 
the oil it) a little w«iit will soineliniw amirol m-eitxipr rnwUing. In 
*dditii>n to the oil the H. J*, hais an official itifiiMton, Jitfuinnn Cary- 
ufihiflli, the dose oi" wbiidi in 1 tn i fluidiiunr.cs (yii.O-UO.O). 

In overdone it acta as a Hopiirifie, anil kills by failure of respiration 
and the production of marked gastro-enteritis. 

COCA AND COCArNE. 

Coca is official in the V. <S. P. as (!or:i, and aa Cocir Fofia iu the 
B. P. : but in the U. A'. P. of 188t> it was known as Ertfthroxylon. 
CWaine. ijoeaina {B. P.) (Cvcaina- Hifilrttrfif-'ruti. I'. S. ; (\)caiii'P 
//r/./r-i-'A/'frw/wm, £■ P.) in the alkaloid deriv('<l from KrythroTylcn 
Cofa. which i^t a shrub of I'erii and Bolivia. When cocaine \i heated 
with hydrochloric acid it i« sjilit up into several xubBtanpcp. amongst 
othem a ba."te colled ccgoniuc, which baa cnlirfly differnit powers from 
cocaine, and is perhaps responiiible for some of the evil eflecTjt whii^h 
have resulted fi-om poorly prepared cocaine. It is to be dictinctly 
nndoTStood that Erj-tbroxylon Cocii us not the same as chocoUto or 
Theobrfimn Cacao. 

Ptiysiological Action. — Coca and it« alkaloid cocaine, when taken 
intcnially, produce a Henitc of exhilaration and plen«ure. Uften the 



]8« 



DRUGS. 



Fiu. Si 



A.9«amrr narvn unrihlrlinB miirout 

invtiilitiuia if.wrili-'li l> A^l^l(lll■- 
litCl] by coralnc pmnlyiliii: tliR 
f-niU of IhiC HFTiior]' iii-rvv nl B. 



amount of nmscular and mental power is temporarily iQcrcaf>ed UQ<ler 
tbcir influence. When locallj applied to a mucous membrane, cocaine 
causes n blnnching followed bv niflrked congefllion. 

NKitvaL"5 SvsTKM.' — Tile ikiniiniint action of cocaine, when locallr 
applied to the peripheral eensory nerves, is tu parulyze them ( Fig. 325. 

When taken JLternally it 8tiiiiuUt«:ti the 
brain to an extraordinary dcgrev. but ox- 
erciacjt iio cfiucl upon the acnsory nerves. 
Sometimes its internal nse produces a de- 
crciwe of sensation, which Mosso believes 
to be due t« an intliiencc on the apinal 
cord. Thia effect i», however, very fee- 
ble. If the doee be a poieonoua one, con- 
TuUionK of cerebral origin ensue, and are 
bulb clonic and tetanic m type. 

The sensory nervea aa- paralyred by 
cnorinotts do^es both when the druz is 
directly Applied mid when it in tuKen 
internally. 

Upon the tuuacles. when lalten inter- 
nally, Mosso liaa proved the drug to be * 
direct stimulant, and it i» particularly 
active after starvation or fatifnie. Mus- 
cular power ia increased temporarily by 
cocaine. 

ClRClTLATEON. — Cocaine act.s as a atim- 
ulant to the heart and circulation in moderate amr^unts, but ita eS«Gt8 
are not marked oxcopC in poisonous dose. 

Rkhviuatiov. — The dnig new as a powerful respiratory stimulant, 
producing in liirgt* do^c « grnu iiicrt^ase in tlie riipidity of llie respira- 
toiT movements, but in poisonoun >ioso it kills by failure of rfspin- 
tion sAKociatrd with exhaustion rroni ihe iiccouipaiiTin^ cnnvulaionB, 

TBMPKUATrRB. — Cocninfl raifl&s bodily temperature to a very 
extraordinarv degree if given in overdose, this rise being dwp to an 
increase of 'heat- production (Kiiiehert). In moderate or tnedicinul 
amounts it hai^ ao effect. 

KlDXKVK, Ei.iMiNATiu.v, ANH TlssUH-w\sTE. — The drug is elimi- 
nated hv the kidneys, but ia chiefiv deatraycd by oxidation in the 
body, 'fhe (juantiiy of urine pjissutl is increased under its in&uenee, 
and the nitrngenouG elemeiiti^ eliminated in thia fluid are a little 
diiiiini.'ihed. 

Ete. — Owing to ita powerful action an a local aunesthctic, cocaine 
has been used largely in ilisoitues of the eye, and ii Is piirtieulnrly effi- 
caciuus in this urgau hccau»e of tlie delicacy of the conjunctiva., which 
it can readilv penetrate and »r> paralyse the peripheral ttensory nerve- 
ending». The initei^theBia comes on in fruu) one to five minutes after 
the i»e of the dnig, necording to the strength of the solution nsed. It 
t& accotupniiicJ hv very marked dilatation of the pupil, which KtilU-r 
EBSorta is due lo the fuel that the drug conKtrietn the hlood-veSseU of 
the iria but leavea the niui^cuiar fibres untouched. Uphthalmologij^ts, 



COCA AXt> POVAfSR 180 

boireTer, generallr a^hert that it Btiiiiulftlee the pfriplicral ciuls of tlir 
(pymjiathciic nerve. Xt is importimt to rcmcnuber tlml this diUiatHm, 
utilikt.- that jir'niuwil Iv iii if Jrial ic(f, kucIi oa atrij]iiiii-. is not accotn- 
jmntetl by imralysis wf seinmiinoJation. The drug (tors not cailRC a 
forcible myilria^it', anil is never used for Ihe prevention uf adhesions 
in iritiK iinleHfi combineil wiili atropine. 

TherapenticB, — Cocaine by ilroi;hloratu(CtfrrtiW ^^rfrorA/orrw, t'. A, 
and (Wai'nip h^drochhriiittm. B. P.) is ui^d ;i8 an nmt'Mtliotic in llic 
eye in the dose of from S to •'j or uinrc luiiiimF) of a 1 to a 4 per cent. 
Mlation. ITie strength of 2 and 3 p^r rent. I."* perhaps most cnmmonlv 
employed. It i» worth lenieinheriag that eucuine is e^iliihle in fats, 
■wherea.* its $a1ti4 are not. Ootiiino itself ehould therefore be used in 
aiucsihclic salves. 

The eondition.1 indicating its uBe in the eye are all operations of a 
painful character, he they wliat they may, and it ean also be uBe<l for 
the relief of pain when an aeittf mflavimation or fureign Ijiwly is caus- 

TLi* followinj; fornmla wfill be found uaeful in these states: 

E.— twaiuw liydivchlor. . ■ gr. Wy (D.KH. 

Acid, boric. %'• ^'^ 1 0,4(1'). 

Aquird«M. ^ (SO.O).— M. 

&. — I'm will) & droppvr in ih« crp ovvrv half hour until relieved. 

Cases of keniiili!) are recorded itt which cocaine hu» produced per- 
manent tfomcal opaciticit. and it may caufie dryness and roughctiing of 
the coraeal epithelium even in the normal eye. 

Cooaine is of^en used in H per cent, solution upon <-r^cked nipples 
just before nursing, 10 relieve pain. The drug uiu^it be carelully washed 
off before the baby is put to the breast, It is iisacrted, however, by 
Oticncl and Dusamaux that this treatment may permsnrnlly Ntnp the 
flow of milk. 

Owinp to the density of tlie iuucoldi lueiiibranes of ilie v«r;infl and 
ret'tntn. cocaine hae littl« effect upon them unle^ used in 10 per cent, 
.solution and profusely applied. In the month eot-aine may be iimkI 
in cnw* of ttomatitia where a spot is to be catiterixed. in /tlinri/»f/iti$, 
and in mreneum ami tiitderm-nn of tin' iiitm*. While it ;iives mufh 
temporary relief in /tharpu/ilh, th^ subscijuont effeet-i are often 
exceedingly disagreeable, the cooKestion lookin>c tuore ari;;rv nnd 
being more psinlnl than before, and the experience of the writer 
indicates that it will only act iu a cui-ative inunner if applied before 
the cu)>illarie)t become relaxed or paralyzed by the severity <jf ilio 
inrtammatory pr^icesc. In twi/zn and Artv/''''t''' a poivder con?'isling 
of cocaine, morphine, ami bismuth in the pn>porlii<n of 1 part each 
of the two alkaloids and o parts of the bii^miitb will often be of ser- 
vice if snuffed up iuio the nostrils. If cocaine be applied to a larini 
nenre-trunk, oniputAtiou of the Irihiitary limb may be perforiaed witu- 
oat pain, but »n large an amount of the drug must be used that there 
is great danger of poiscniug the }isticn(. 

Cocaine is generally URed at present in the place of ether in rasea 
rtKjuiring ampuMirm of thefingvn or in cases of minor surgery where 



tlic drug am be confined to tlic jisrt iniurcd. A tigbt cunl .tliouM 
\ki liQUiid antutid tlie hit^e of the Sh^lt sud » 4 to H per cent, solulion 
liijvvUil iiit'> tlie \>nrt, the ligature about th? bii«<> of the dl^it bt-ing 
iiwd to prevent lipmoiThago and the svsteniir absorption of tbe Hni;^. 
After the o|K'rotioii i^ concluded slitbt btfiiiurrbugc :«hr>uld bo ull««wl 
to ufcur. to Hweep out thi' drug iiuif llii-robi,' uvuid gystinulc uiudiciL- 
tioD. Not luiirc than ^ gruin of cucainc should be mjectt'd. ^Vhen 
nperution!* on a fn<>t or hniiil have lifrn done under cocaine anutHtbt^in, 
ij.ud hir^rcr Hiuouut» thiiu tbi^ hitve been UAed, tbe constricting bandage 
should V* ulhi»od tu rvitiaJu in place ."ome lime. )§ince the tit«8iie9 
destrov the ilriij;, so that wht-n the bunrlnge ig rcmorcd less is 
abw)rht'4]. (llriUcfier it at.) 

When A limb must be amputated under cocaine the main suppl^-- 
iii" nene In Tii he exposed by the aid of infiltration an:ej«thrKia (see 
beioiv), nnd then the norvo-tnmk i* to be anitsthctixed by the injec- 
tion into it8 sheath of so weak a Holiitiun of cocaine in uuruint saline 
fluid art 1 per cent. 

I'nder thenaraeof '■intf/(i'tifiti»r ono'iithcMia" Scbleich has introiluced 
a inctlto<l of destroying sensation in localized nreas which often gives 
good ri'stdta For luinur operations, lie injects into the ^kin. as siiper- 
iicially as possible, a sufficient nmount of u solution of cotnuion salt, 
cocaine, ami innrjihitie lo produce local csdema, and thereby pressure on 
the nerve-filaments, which are ulto depressed by the cold litiuid coming 
in cotitaci with them. Healso belioveji that tie local aiticiuia so caused 
uids in destroying seiisatiou. The iojection is given jio gently that a 
itort of wheal or ^cdetnatoux Kpnt ix proiluced where the tnciition i» to 
be made. A^ soon a? this Hpol is developed the needle is in»ert«d 
into its margin and carried under the akin further, and the injection 
is repeated. In this way the line of an extensive incision can he 
aiiiL-MlieltKcd pn)gn>s»ively. If ilcep Incinionn arc necessary, the injec- 
tions are given into the deeper tissues as well. The injections must 
always be made into the healthy skin, as if it is dtsejised a slougb may 
result. 8chleich a*serts that similar injections tinder the periosteum 
permit of oiicralions on the bunciii. The aitii»thL-sla will last twciity-eix 
minutes. I'ho solution is of three strengths, as follows: 

t 



Koliltliin t 11. ni, 

Cncainp hjrtlmi-hbridc , . . gr It (0.2). gryfO.!!. sr, 4 («.0I1. 

Uor|>hiiiG liy<lrochIuniJe - . bi". \ (O.OiVi. gr. j (0.02&). jtr. A (O.0O5). 

Sixliuin dili>rid«! tC. iv (0,21 gr. iv(0.2). ir. iv (0.2) 

ytcriliwddinlillwl "M«r. . . fslr (120.1». ^f (120,0). giv(iaO.O>. 



T<i each of these suhilioiiw .1 niinttiia of a 5 per cent, solution of cftr- 
Vtlic acid are adiled. The seaind nolittion is the one conmionly used, 
The finif is eni|il<)yed where iicuie inflainnmtinn is pri^ent. and the 
third whcrL- I'epeutcd inji-cli<in<< are necet*8»ry. (Sec Fig. 83.) 

This method of producing anicdtbrsinhns now been tried long enough 
to define it.» limits of uitefulnese. For siniill localised operntions it is 
very Riiti«factnry ; hut for long and deep incisions it js of little value, 
lis its effect* an- l"t' pujierficiul, nnd bec-aiiHc it in no wnv ilimiliisliea 
tbe fear and nicnlnl snlfering of the patient, in whom the enn«' loudness 
of the operation is wore« than the a*:tiial pain. There are, bowever, 



COCA AXD 0<)CAI\B. 



191 



r 



cfrtuiu c! rcmnstaiiciis in which il is to b« usc<l in mn-Jur surgery, 
Hitcb an tracbeutotiiv, ihu remuval of small superficial tutuiiro, iitnJ hi 
tlinsr patient-s who arr m pnifntinrlly ill 
thai it U JiingeruuB t« as« a general an»s- Pra- 88. 

ihetic »s, fur example, in iDtesunal per- 
foration in typhoiiJ fever, an operation a 
which hoa been iluiic eeveral tiiue» with ^ - 
ibia method. As the opL-ralion nrocueilH 
the ileeper tissuea arc auasthptizcn hy in- 
filtration if pcNviihlc, and are rue, not torn. 
»i (he Irariri;; prucluccit greiLt puiii. lircat 
care that the fluid iujectoil is sterile h 
DL-ccaimry. 

In fnmc inKtaniH« in which we are fear- 
ful of the prolonged effects of ether or 
ehloroform we can nee alternately ethyl 
chloride lircallv. ioSltratiou anwHtbcsia, 
and, finally, tliL* geiiL'ntl aua.'<«thetic when 
deeper tiasuca arc roachvtl and the radical 
portion of the operation U> be performed. 
Morphine m»v be given before the opera- 
tion ID unch instances to benumb the ner- 
roaa Rjstcm. 

When rikin-;;rafnii); is Ut be doiu'. «e 
may resort to the use of cocaine anfestbesia 
of the HkiD produoo<t by the aid of eata- 
phorcsU. (Sc< CataphorcsiB.) 

Within the Imi two yoar^ cocaine and eiicaiue have both been used 
to i)roduL'c amcslhesia of Urge areas of the lower portions of the Uody 
and limbs by tnjrcting them into the nubarachnoidoin cavity below the 
termination of the spinal cord by means of a long hypodermic needle, 
which is iintially introduced between ihe fourth and fif^li liinnbar rerie- 
hne. Ry this m^anii thccoeainc i^broughl in contact with the cord and 
its ucrvt-routs. and Hna-slh&siii in all the trihnlury piirls is prudnred. 
Th«.- operation is be*l perfimiicd with the patient in ibe sitting 
posture, very slightly bent forward. The skin nvir tin- lust Iniiibjir 
veiiebra is carefully sterilized and then infiltrated with Schleich's 
llnid. A long nfcdle la then inserted at the ^ideof the third or fourth 
lumbar rprtebra on a linn drawn between the iliac cre»t* acroB* the 
back. (Fig. 34.) It can be felt tu pass belwcen the bodie>i of the vertc- 
brip. (Fig. 35.) If there is no e8ea|>e of i^ubanidinoid lluid. the needle 
is not in the right place. .\s soon as this tluid appears the wyrinpe, 
already filled with a 2 per cent, cocaine iifllution, ih ullnched lo tiie 
ni-ci|le, and from 10 to \!i minims (O.liG-l.O) arc injected. Anaes- 
thesia \» develo[>ei) in frnm two to fifteen miniitoH. and laei? from one 
to five hour^. [t is needless tu point out that not only the ttkin. but 
needle, (he syringe, and the solution nhould be most earL-luily steriliiced 
before the operation. This method may be reiwirtcd t" in ;ill c-ttsen 
demandiag »|Mrration bebtw the area injetrled, and in cas4?> of labor, 
which 13 thereby rendered painleee^. Considerable fever, oervDUs and 



luillimilan KniiitiliL'iiin. The 
[><'>'r1l<i )■ liiii'Tloil nt <di'li mo. 
ceMiivv ixiiiilHH ituuibt.'rt'<t an- 
til tliv lhi# or aUKMlbWlB tl 

C<>Ull>lpt«. 



192 



DRUO& 



circulatorr disturbaace mav arise in tiuttccptibte p^reons; but M%rv 
asscrts that if jjj gmin (O.OOOS) of liyoacinp is given hypoUiTmically 
the^e itymptomn are preveitte'i. In the upinlon of tbc irritDr, thin 
pructioe will speedily oo stopped, aa it ia unsntisfiu-iory and ilan<:erous. 
A number of Joatlis- Iiavo followed it* ii*e. In HhIiii'}' statiiiiics tliere 
were H dratliH in 17UH opcratiuna. It would Ht-ciii, tiicrcfore, more 
dangerous than uldoroform. 

Fn;. :vi. 



Showliii; I !■ I III ■■■■;ui:tl"ii "t Ih? nccJlc br[»-«-i, ihi' lji--t i" - '■. ■ !■■ jn "luce 

EpItiHl niiiTitlii-ilK. Thr ■yrlnic !• BltHi'liLTl tn llic ijL'i-illr !■> ■•v. i<li' ii liiutilli' Alti't Ibv 
pmrnici*!! lirUi-vi* Ihal Xiw iit'cilk- |-<iiil t> In tliv ril>»'rH'-l>i|i-l<l ri-»r. Ili<- ijrlTiiEt la (Bkcii 
rilT llip Ufi'ilk- III unler lu mx' if nii^ luiiliniiiiiinl lliilrl ctiiiiiu IT li ilix-i. ilil* prniri 
ttiti th^ puni^Iiiiv hu bMii auMiicrriitlr rvrformol T\v- 'frlt^igv lllled with ttic fluid U 
tw InJtvMil Is tlii-u allMtvd to Itti tyrlnitv ao'l (liv LiOviiiua e>v«u. 

Internally, cot-aine ur the fluid i-'xtTact uf cota may lie used as a 
temporary piipptrtant and stimulant in low feven>, anil in cases 
where great physical «nd nioinal slratn iini«t be borne. lt« H5e lor 
any leiij-tli of tiinv is diin;;iTiiii8 niid liiinnfiil. Thoniijitoii line found 
cocaine itf very great vsliit- in t/fttow fivvr as » !>iitiiiilani for a sliort 
time and m an aiiti-enictic< la the tomitintf of pretpxancii and other 



COCA ASH <X>CAiyF. 



XM 



totam ofaicfMiee nnrjti* it in of great eeirioe by depratsiDg \he fcsstric 
Mnnrjr wervtm uid thereby doersutng Cbo imtebili^ Oif tbe stMnacii. 



Tm.3h. 






J.i^an bttiTMii iIm Uitrd Biul (ourUi lunbu-TerwtnwftirMitiuvbnddeMitDtocllaa 
(.qaliu-br'iari-ii;. it. An-a nTininniiiv lUcgOTWil h; 1\9fll*t, 

<^<WD« w otiiloobtcdW of iKfl-vioc in iJif ivj/i'wm AifAtV, but if largely 
ii»(<d •*m chiiQges ih* (Mli^iit from a eane of raorpliioiiiBfliB in a " eoea 
Evad." 

Tbe Atw uf the flnicl pjrtract iKxtrtu-tHm IW'f /Vfrfrftmi, f. A'., 
and JbCntrfum tWw Au/inWiim. /f. /*.) i^ from ^ to 1 ilrachm (2.ft- 
4.0): iliiil of «o«iinp. from ^^ tn ^ );niiii (O.OIS-O.OS). The olber 
ff. P. TtrepmrBttmi» nrc Ijttmelhr f'-Tf»m«F, each dink containing jV 
f^rain (O.fKlIZ) of «jo:iine IiyfirJtplilonHp. and I 'nfftmlitTii <%»rah}ir niifl 
inirftio ihr(uttte Uj/j/odrrmt'ca, given in the (lose of 1 to 5 miniine 
(H.iX'_0.»J. 

The fTK-(iin<" AwAif i.-! u cotKliti«>ii unfortnimtfly oft«n met wiA rincc 
tW introdtKtioii of tbe ■li'u^ iiiio ibL*i-ti))euiicfi. It ih ofWi coiiibiti»d 
witti ilie tnorpbin« bnlnt, ittitl wmc-tinmi lit ctn(doyc4 b« b vufofltitule 
for that omrhiil HLal«. 'l\« Hym[)lwBifl of the oiKrjime hfcbit fronnNt of 
narked kiM of fleffti, dieordpn* <>f the ("ircnJiilory !:<yptt'in, mental fitil- 
ure and MtwiofM, •nnetimeN i-ewmhlin^E tb(>!>f of rhronic almtiolifiin. 
OfWn baJlucioatioDS couic ou which ni-r ^envrally -A a lUiiafTe^ahle- type. 
The habit is iliiHcult to cure, for i-elap!«i>s an? freijuvut. Tlif nudiien 
withdrawal of cocsine from a patit-nt iua\ result in profound collujwBe. 

Xcconl'in^ tu Magtiiui, a palJittgnoaMinic .lyniptntn of climiiio or 
subaovte coeaine-iatoxtuuioD is a seoaatioQ of a crawling worm or hug 
undpr the skin. 

Untoward Eflaots.— Sotnttioics loss of spoeoli. UindlMS, naoieftMid 
vuuiiiug. 9;riia>fH'. and tuicoasciuumieiis ]i»ve fulluwdil tLe int«riial uu 
or local applivatioD of cocaine- Eplileptifomi oonvukionit have ako 
been noted, wbili: the cinuiiution and renpimcion have been iliiioi'deroil 
in prery pcoaible manntir. in miiny of llie>e catiai the urjjw passed 
aAer the poisoaua^ i^copiouji. very limpid. And cuuuins slbiuniu. Curi* 
u 




194 



DRUGS. 



ouslj enough. « I«rgr number of cases of severe poieoaing b»ve followed 
the injection of cocraine into tlie urelbra previous to name operation fbr 
tbc relief of clirotiic j^onorrhociL or strictuiv. 

Th« hypodermic injection of cocaio? lu* a siimulunt sometimea cauiies 
vomiting. 

The treatment uf ttie poiKonin^ consists in the use of ammonin, 
ooffe«, atrychnine. or ether and ak-ohol if the eyinploms are those of 
depressinn. If they are convnIsi%-e in type, then the tiTeamiKnt to bo 
instiluled \s idc-titic;^! with thut vf slrvchnuie-poisoDing (which see). 

Out of 2<0O ca»ea of accidental poisoning unsing from the medicituij 
use of the drug, but 13 proved fatal. 



CODEINE. 

Codtina, U. S- and fi. P., h an alkaloid derived from opiutn. and 
is often contain inatpd hy morphine. The .iiitphnte of codeine is gen- 
erally used, ax ic U more soluble thna codeine itself- In the H. P. 
codeine phottphnte (Codfinat Phogphag) U offioiiU. 

FbyslologicaJ Action.— Codeine rc.iendde« morphine very decidedly 
in its phyniulni^ieal notion, the thief difference ht-inj^ thai it possesses 
le.vt narcotizing power, but iii large Aiiioiinl more rea<lily prodm-ct 
lelaniiH and final pitraly»iH of the periidierul motor nerves in the lower 
animals (Dutt und Slockmaii). Ji dot-.s not arresl secretion iti the 
reapirntory and intestiunl tract, as docs morphine, and therefore ii 
less apt to cAuse uonstipiution. 

Therapeotict. — Codeine has been bi|;hly roeonimended in Franco 
as a nervou.0 ijuietant, and in lbi» eimntry in nrmitiJi vnUf/fi or in 
cases where the cough ia exceswive in hrimvhitfn and phthinia. In 
diahet<:x mcllitus some clinicians have found it of the greatest value, 
while others have been di^appoiuleil in its use. It should, however, 
always be tried in thin dimruHu. in the hopi; that it inny rxerctsr n 
favorable effeei. When given for cough it should be used in the 
dose of from J to ^ grainH (0.03-0.1'J) three or four limes a. day ; gen- 
erally placed in the syrup of wild-cherry bark. When given for 
diabetes the doae eliould be much hirjier, begmninj; sit 1 or 2 graitus 
{0.<t->-0.1), and rapidly ineveaiing it till the glyeoMiria is ditiiiiiished. 
HometimoH a« much an 2') or 30 grains (1.3-2.0) or rnvw may b« 
given daily. The /i. P. ri-cngnizes a syrup i^Syrujma Codeinte) given 
in the dooe of 1 to J drachniH (4.0-g.O). 



COD-XJVEB OIL. 

Ohum MorrhxiT, U. .V. and ft. /'.. sometimes called Ohiim Jeeorit 
AxeUi, is a fixed nit obtained from the fre^li livers of (he GaduM 
M<frrhua, or cod-fisb. There arc several species of cod from nlieh 
the oil is obtained other than the one named, but this is the chief 
source of supjdy. The oil i^ pule or dark uccording to its degree of 
freedom from foreign materials. Although the paler oils are gen- 
erally prescribed, ihero can he little doubi that the darker ones are 
more medicinally active. The mmt protntncnt inorganic conslituentB 




irotnine. and KulpuiirR' and pfaospuoric 
contains rooro or less of the Miliary snltH. 

Lnfoteti cxKl-livpr oil. ol>lainp<I from cod rauplit near the Luruton 

inds, 19 generally coniiidereil the |j«(tt for mitdicinal use. 

PltTsiologicBl Action. — Coil-Iivor >»] t\f]ivuth im n ntmiber of siib- 
ststiccii for itii |>eculisr cITect. The iodine rcrtninly exerts definite 
attcnuive powers, aail tlic oil svvm» pucuUarty u(lu]iti'ii to ilifccMtiou 
and sbsorptioD, for cod-liver oil pn);sea tlirou;;li muiual tueinWancti 
very readily, prolahly owing to ihe biliary sali.s cnntained in it. 

It aids in tho iiiain'fcniince of fcfidily temperature by it* oxidation, 
aod causes ik deposit of fat iu iIil' tiH.'<ue7i. *] he oil aleu seems to luflu- 
cnce the blood directly, for clinical obfervatioii «howts that anaemic 
purMina become healthy-looking iimler itn iise, and I'utlpr mid Brad- 
ford have found that this apparent improvement iR a phyRiologicnl 
fael. by the use of Mnlnsses's bloiKl-cdbtvitmiiiig appartiliis. the red 
eorpofcles b«in^ always increased. It has been proved by experiment 
that cod-liver oil i» more reiulily oxidised than atiy other oil. 

The belief Bmonji phyf»ieian!» that the effects of cod-liver oil are 
dependent upon i<ome peculiar combination of »ubstauee« ha^ shown 
ilMlf in the attempts of physiologiejil chemists to isolate the combina- 
tion. One rif the best results reached is the sn-rnlled "morrhiiol" 
of Chapoteau, who seems to have isolated a crystalline eiibttt&nce con- 
taining pha<>phorii!>. iodine, and liroiiiiiie : H tv /> gniins of tbi!< prepa- 
ration are Raid to represent 1 drjiebm of |]i«- pure oil, and it i* certainly 
of value as a niedicauieiit in most of iKe males in which we u&c the oil 
it#e]f. lu "coIiln" u'liich "bnn)t on " and are not readily gotten rid 
nf morrbiiol is lie^t given in cnpfiub! or pill. Tliirt substance Ih put on 
Ui« market in gelatin- coated pdLi or eapsuleii. It doeK not posHv&a 
the nutritive laluc of the oil it.'self. 

Tbenpentica. — Cod-liver oil is n&cful in thotie persons who have no 
tubercular lesion in lite lung or other tiesuce, but have mucoue mem- 
branes which are very susceptible to disease. This sialv bus been 
calle<l the pre'tubrratiar ttage of phthist*. ('od-liver oil pit.^st-K'en tin 
curative power in ca.icR of wftll-developed and rapid phtl]J»iK. und ilK 
admini?tt»tiuu in many cases 8erve.>« oidy to nau-<eat(' the pihtient or 
10 produce an oily diarrli(ca (hrough rnibireof digeslion. It does good 
in the early ntage of the diacaj^e in that it nets u:> a food peculiarly 
sniteil Ui a wasting malady, and its mild allevaiivo effects are also of 
value. It maintain:^ the patient'n ftretigih and general nutrition, and 
so favoraidy influeneeii the pulmonary lesion. In vlronic rheumatism 
the drug i* often of gieat Bcrviee, particubifly if the disease ie largely 
Diusctihir. Sirttmvti* thin irtiv-na dejiending for their existence not 
only upon aervfulotia. but nli>o upon anainr-'i. of\en yield to it^ tise. 
In en/i/ri/'-mejif of the hj»ijifiiitie yhttids, where they are not under- 
going acute active aupjturation. cod-liver oil given internally docs 
good. Tbtji ie a ptatemeni reouiring explanation. By acute active 
euppumtion is meant the early ivrtnatioa of pns or the molecular death 
of toe parts — not the slow formal ion characterized by no artivo change, 
bat represented by cold abscess or old sore?. If the auppurative 
procaai ii chronic, the oil doea good by maiiilaining the patient's 



L 



1 



IM 



DSO0& 



natritlon. In csmm of ttrumoti* opAtiialatia 4-o^-\\vct oil is nf great 
service. In mlvnticcf) KffjthiiiM <-oil-ljrcr nil i^ most useful, and in the 
early stages ofri'rkrfs ii ougbt aJinijfe in be employed. In uuMroMmus, 
when u8(.-d by irtuiicUtin or givvo iuu'rnallr if tli« stoottch will stand 
it, it in one ul'tlic Ui-»L ilrug:< »c iiavc. Jf a few gniina i>t' bilc-aalts. 
constBtin]; of ^lycttcbuiute uml taurucboliite of Hudmui. hu iidded to 
escb dmcbru of oil. it will }n: very rmdily absorbed, fmtii tbe aJcia 
vhen npftliod b^ nibbing, or wbeu taken intertially.* At tbe ^ircKeot 
liini- ca[»ulcs ol' L-i)d~liri*r uil. tn winch fass bfeii luided some bilt^^alt8 
to uid ill the abeorpliou urtbu ail, cm be obtaineii in ihit miu-ket. 

in Mr^atica aiid lu«tbaii<i iuiil ia iieuntiffta i:(Mi-Uvi.-r oil i:i of ecrvice. 
partirulurly if those (liMirileni are dependent upon vi«mja <>r an tto- 
povcrt^ed state of (be srstftn. In et*php»cma tij the ivuf/t it is said 
to be of great vuloe, and oenain writeri^ oomiuend it8 D.'^ in ffout. 
aitliiiDgk othcr.1 bare asserted tbat it ih of no vaJutf. Sometimo^ old 
pentoiiH, whittle digescioii ia oot disiirdered and vlio have no orgauic 
brain di)4ca»\ ooiofilaiii ii£ giddutetg. The best treatment for Uiu eoo- 
diiioi). in ni24iy enws, is ood-liver oil with smnll dowK of <|iiioine, or 
if ihvac fail wiuti uf ergot and oue of tbe bromldiM may be tucd. 

AdvilnlitratLon- — Owiu^ to its disH}tree»bU> tiuite and aniel) nont 
patiente rcb^l against Cakm^ ood-tiver oil; but this ciui. witb n little 
]>t^i->'isruucv. be readdy overcotne. so thai finally tbn ftatieiil may »ut 
objcL-l (o tiio remedy, but actnully like il. Tbih iit |iuiliuulai-ly 
true of youiiK children. The wjcrel of reaching ibij" mecJi-lo-b»- 
deslred stale lies iii tlie \av at limt of duMv »bicb may be dmppMl 
jQto a teiuifioon und tbe ttfxinn then penlly sulimcrged in a ftlam of 
loilk. Tbe oil fltwts off into tbe luitk lu a ^EitLiuU- iu the ceDtre of tbe 
tumbler, anil if ibe milk be rajiidiy ^J[ied down wiihouf the ml touch* 
iog the aiij<!3 cif ihf gluas, il will not be tiietcd. The br»t gidju must 
be large eaoufirb Iu include tbe oil. Tbe oil may bv taken uu a full 
atmuucb. bjut aa a ^ni-ral ruie il 18 best digested if taken about two 
or tbree litHirs after ineaJs. nbeii the guiric ennipnis are about to be 
f»Hsvd into tilt: KuudI bonrl. vberc tbe nil is di(;ffitt.Hl ; aud if it be ioi- 
tDediwtely followed hy a little pancreaiin. ii« di;<:*^'«tion vllt be uindi 
aided. OUirr modes of ingestion cunaiti in (Jic placing of t)ie nil in 
whUk4"y iir bnindy. in tbe uiuitter wbicb Jias been describeii witli uiilk. 
Tliit> method pa-'.sefHi-s the admntajire thai tbe ulcoliol by its attiuu- 
lating efl'iM::! »\n% very distinctly in the digestion nf ibe oil. SomUbow 
a pinch of salt placed lit the mouth before and after the oil ii> taken ai<U 
in ooTerinp iw taste and in ila ijij^eslion. (See Tudiowliou.) Oil of 
eufii-lyptus io tlie proportion of 1 J«> lOti of the cod-liver oil vUl cover tbe 
lairor's taiAe. but ninny persons diiJike the puenlyptuv ranre tlian tbecod- 
jiver oil. Tbe addition of ui equal <(Uantity of glycerin, with ^ to 1 

' Tlicsr "illi fnii|f he hniipht. »r nimlr ji.i fnllnw!! : Tn tilxnit .Iftfi cr nf ox-Rail In 
ad<)i:i) M-Mrly ifcricv tltM qiiiiiiUly •/ nnlinBrv alr«h"l,and tbe flii>k i-lirilu-n i^nniMElHf', 
All die niut-u'< ia u-'w |>rtN:iwttiti:d no'I Uit- BU|NirHntAul Uuid is tiluini. T'< lllv tiiuuta 
ifi uddid x Wkv ciiCT--* "1" nuli'l'iiHi- t>ttit'r. mid uflpr a linn' n (ilii-UT-likc iiuue formB 
*t tti^ Ixtlloni of ihi- vi-sK-l, wiiioli ■'linrlv bcr^tniM omtnlliiic. TImm? cmtAl* M» now 
filui«<l on a fillvr-iNii-nr mn<i wiichnd vhh n tnixUin- auidi- up of Mli«>r and akwb^ 
•qiul panx TIte lilb^^r-tiiHwr i» drk'l mn>l lti« itiibdanom tlien wen aw lb* laara- 
t^oUl* noil ^Jyi'i^ioliitv of Miditiiu I laving; mn'ruit;' rcmorf<l lliw *all* frvm the 
[laper, tbajr at^ nmAj for luc. 



COFtEB-COLCUtCVM. 



1*? 



OkUuiD (0.3-<^.06) of tb« oil of bilter aliBondi to eick doM^ is ofki-D of 
•errice. Syrup 9f bitl«r or»D^p«el i* one of tbe b«st eof era lo its 
tiutc. 'foBMlo ketchup lias also l)«cn invit wUIi irood rei^ultK. (^hew- 
iu^ & pieo* «f WmIivI bv-rrin<,' before wni itfter taking tK« oil i» of vnloe 
to dmrnte tbe iJWte >u aotni* truiis. 'Xlie oil ia nradlly taken in Mfte» 
>«[«« Mlding from J- to 1 dracbm (t. 0-4.0). Vet; few people are makw 
to swallow Mi«Ji capsules if tbese are tintt nuuk- slipperj b^ dipping 
tbcm ill water. 

Cwl-liver oil '» uioat readily digrated wbcn givvn is single nigktljr 
doMS aAer »4ipp«r at after a li};!ii rueal just befuri- fC**'>^)? ^ ^i^^- Alter 
a few daja it lauy W )>ivtrti after dinner, and in Uie cotir!« <:»f ii week 
after bn^bM. If iW pfai«tit iit rtiMi? inuueated by overdo.'u-s. it is 
alflMst inipcwvible to »ake tke stomach rettia tlic oiL If there is difi- 
evlty in di^wtiaiL, a drachm of ether aidu in its abHorption. or » drink 
lif vilii»liev or brittiily in»y be »»ed in!4te:ul. Oftnn a simple hitler, 
iMicb ait aiWm:rt»p(i«vnriil (H-O^of cnmpmtiMl tiiictrirv of mtrdnmoBi, uk«n. 
in water iiuaivdislvly ufttT ibe uil is awaltowL-d. aidit in Iim digtniiori. 

A largo nuiiibi-r of pr«pnr:itiuus of (.'uil-livur oil htk on the iiiJirkct 
in omulsion. pancrcsUscd, and puriticd tilt they are nearly tat^telcHH. 
Many of lbf> permanent or pn*fL>nt einuUionH ortntaio moru Ii-t>lnnd niain 
or acacia thai) oil. The pnncreutiKed enial«io«<» an: tbe lM«t >r the oil 
is present in siiffii>ient fjiinniity to An »wA. «« llie vorv fact of tbo 
oU botBg uitificially dig<.-»ted add» tu ita value anil inak«t it ptMsibtfe 
t4> pot mors oil into the einuUiou. Oil devoid of smeH is probably 
devoid of medicinal value, as all the pecHli»r properties hare be«n 
■■ purified" out of it. 

Quite rccL-utly it ban bpf» nuggceted that oo^-livcr oil be given by 
ibe rectum. » I'ldl iIohi- <>f p»ticreatdn being mixeil «ith it to iiicrrsso 
its a»aiDii lability. Simirtitnes creosote ii; plnred in thin injc-ctinii in 
5- to lO-minim (0.3i>-(I.G"i) doKea to prevent decomposition-ehniij^i'S 
ia tho oil and after absorption lo act as an cxpecturaoL 

COFFEE. 
(9« CAPFKrjra.) 



COLCHICUH. 

Colebieimi is tbe conn (Cofehici f'trrmtiiiy B. P. ; Colehwi Radix, 
U. 8.) ami fCftX {Unlrhiri .Semrn. U. S. : Cokkid Semina. B. P.) of 
tbe (i'ffflii-um A Iff iiirtnn/r, or Moidnw Saffron, a plani of Europe, 
OOOtauiiri^ an nlkahiid, colchicine, vrbich may be »till further cbuiiged 
into ooleliieeine. While ihc drog it official in tbe form of tbe seeds 
■ztd root, tbi; fnrmcr are rarely employed. 

PhTStolorlcal Action. — Colehictnn is a very powerftil drug,. a.nd 
when ItMSilly applied ia an irritant to the skin! Taken internally iii 
orenlrwe, it alflo severely irritntcs the gastro-iiitCKtiiuiI mucous mem- 
bra imv 

Acwmling to tbe stmlies of one of the writer's stmlenta — Dr. 
Ferrer y Loon — the drug haa liltle or no eFect when gircn id mod- 




erate dose on the nenrous »y»wm, circulsDon, respiration, or tom- 
peni[ur«. only producing cliaiigvj) id those parte wlicn given ip |K>i> 
s'juous (lo««8. Ill lull dosi'H it greally increases llio Oow of bil«, and 
mav cause bilious voiuitinj; and purging. Ja«obi aa^ertt) ttiat ile&tb is 
protliiced by rpspiniiory failiiri!, tbe bonrt continuing to beat for many 
luiiiutcs ttfttr reitpiration ceases. The vioU'iil ^i^tru-ciiteritis which is 
prf8«nt in coldiicum poisoning in iimn cenitimy has much to do with 
the usual fdtal result. 

TherapAHt^ics. — The employment of colchicuin in medicine centres 
around i\s U'ro in gout and .tiniilar stales, such as ckrfttic rheumadtm. 
Indeed, it im alinoiit a ^pecifii,- in ac-nte gout, provided that it be pushed 
until it causes slight griping or laxity of the buwvU. Colchicum does 
not seem to po^esa luiy marVed beneficial efiect in preventing iitlacks. 
Indeed, while it relieves one attack it often Eeoms to ha»t<>n the onset 
of the next. In atnttr. youl it is ii.suallr well to unload the bowels by 
a email dose of eotupound extract of colocynth, with some hyoMjamus 
added to it to stop griping. Thus 



ii. — KxL colocvntb. cQinp. . . 
Kri. Iiynwvomi .... 
Ft ifi liil No.'iv. 
8. — Oni* an *u»ii ns ttimLiKnci) \ij on «LUvk. 



. . gr. s T<^1 XX I0.9&-1.S}. 
. . gr. y (0.12).-M. 



I This pill is particularly needed if constipution be present and the 

I belly is hard, .\fler this has acted ibeeolchicnm iiiav bo j;iven. Thirty 

I to 40 minims (:i.U-2.6it) uf the wiiie of the root sljould lie given, and 

I 20 iniuimH more m twelve houre. In some cases of mihantt^ or ehronie 

I ^**vf of chrimir rhrumatitm iodide of pota^!<iiii[i hlioiild be nseil in 

L conjunction with the colchicum. The following may be onlered : 



>ii iodidl . > ;^ tcI ^ 19.0 vd 4.0]. 

xitclikiradicia fsim (6.0). 



Vim tI>tcllli.-( nuimiB ■■>■: 

Vinialb. q- «■ f.V'j (W6).— M. 

'rtibl«i|>u<]iiful U^0< threo dtnts a Aaj eXiKt [iicnln. ^hnkc well Iwfbra 



The use of colchicum in euch doscji ta to cause seven- purpalioD 
or eiuenis \» dangerous, and ought not lu be resorted to. Colchicine 
c^u be OMtd succes^fullv against gout in the dose of -f J-^; to ^ of a ):rain 
(O.l.UXJtJ-O.OIHii) ihrre' times a day. 

Polaoninc. — The symptoms of poisoaing by colchicum are nausea, 
griping, agony in llie belly, purging followed hy the passing nf thick 
mucus, with great and incrwising tenesmus, profuse salivalioa, col- 
lapKc. and death from exhuu-stion and ga»tri>-cnteritls. Bloody purg- 
ing )H almost never seen. The poisoning is one of the most painfuX 
slow, and hopeless poisonings known, and a man taking as much aa 
an ounce of the wine of the root or the seed is almost incviiably 
doomed to a terrible dea-ih. Tannic acid may he used as a partial 
chemical antidote, and tbo stomach washed out t)T the administration 
of emetics and the u.<ie nf the stomach-pump. Opium ia to be used 
to relieve the pain and irritation, and oils are to be given to soothe 
the inOained mucous membraoe. if collapse comes on, external heat 



and ^}uiuliiii(6 are to be used, fttid atropine may prove of service 
andrr ilii-»e rircuin«lniice$. 

AdmiBUtnttion. — Colcliicum uugbt hcvit Iv \>v u^ed in rab^taticv. 
bttt sbouid bv i-iU[iK>\€d iii tbi- form of wiut^' of ihc ruol ( I'hiuM Cot- 
chici liadirU, V. tV.) iti tlicdo.tcof 10 to liO niiiiims (f>.tj-1.2). nttliough 
if a marl^ «flVct is retiiiircd SO niiniiui« (-.0) may 1* used. Tbe 
extract {Exiruetum CoUhici Radicu, V. <S'.) i& }:ivfii in ttic dose of 
2 lo 3 graini (0.12-0.2). and llio' fluid extract {Kxtraitum Coh-hu-i 
Ho'/icig Ffufdum^ I'. S.) in ibc do»c of 2 l'> 4 niiuiius (0.1-0.3). 

Of tbv sewLt. tlip tincture (Tiiiflurti Calchict iSVwi/viiV. L'. S. and 
B. P.) is jiiven ill '■'if!- tn liO-mmim ('J.O-O.O) doses; the- wine ( I'mmn 
Ooifhifi Srminrt, U. S.) in llie samp ainnunis: and ibe fluid exiracl 
(JictrtictuiH C'plc/iici Srmmis FhiJutn. U. H.) in ihe dose of 2 to Tj 
minims (0.1-0.3). Tbi" fi. I*, preparations are T'imkhi Volchiri, dose 
10 to 30 luiDims (0.4$-!i!.0), and Eztrattum Colchui, dose ^ to 1 grain 
(0.015-0.05). 

Colchicine is given in piU in the dose of -^ to ^ grain (0.0006- 
0.001). 

COLLODION. 

CoHodium, U. S. and B. P.. in a solution of gun-cotton or pyrox* 
ylon in akobol and etlier, and is a clear, syrup-like fluid, smellins 
slroriirly "f eibcr. 

Thnspeiitin.^Colludion is used as an air-tight dressing for small 
trnun-ig and ahraainna and for rendering sinall dreminga waterproof. 
A difficulty in m uxe eon^ietti iu tlie coiilivetioii wliieb takes place -m 
it driM, nhicb draws and purkcnt tbe part stifticiently to uaiiNe not only 
■liscomfort, but acute pain. It sbould be applied with a camel's-liair 
linisb. 

In hoit». when ther nre bo^^iniiing in a fcmnll pustule or papule with 
BD inSiuni^l zone, colludmn pitintcd over tlie spot, except ai \is very 
centris will genorallv abort tlie mippuration. If the boil has burst, 
th)^ Ireatnient v, urtetew*; but if it \\«i< not. ibe puiiFibould not be liber- 
med. but albiwMl lo becmtir in.ipis-ntfd. By thi.« trentiot'nt and by 
the fn-ijuent application of u eoat or two the local trouble fvenlimlly 
dr^p|»ear^. Of courae, tliis rule applies only to certain cases, uiid if 
pait) I.-* cauE>fd by iLe retention of tnc pUM. it tnuft be evacuated with 
asli<>«ptir preeatiiions. In siualipox the flexible collodion luuy be 
umhI to prevent pitting. 

Id t/outif mJfavinitilioiiH of the fnintfl an application of collodion 
mixed with iodine, etiual parte, will ufli-u remove (be pain, ellbough 
at first the suffering may be increased by this Ireuluieut. 

Flexibile Collodion. 

Flexible Collodion (Colloiiitim FletiU, U. S. and B. P.) is made 
by adding Canada tarp«ntine 5 parts and castor oil 'i parts to 02 parts 
of ordinary collodion. It dot-s not contract or become hard, uud i.i 
gtnorallytoboprcferredtoordinary collodion in the dressing of wounds. 



I 



I 




2W ^^^V tfXCOSi 

Styptio Collodion. 

Slypuc CoUodion {Colludium UttfiUicmH. U. S.) eoBtUBii laanic 
aci4 uid is employed to eonlvol tmatt hrntorrhttgit. It u Mkdoai 
lued, aad iCH eaploymest ia^ dtrt^ wajr of vontroiliiig bleeding, 

CantharidBl CoUocboD. 

C«utlt»ritUI CuUuiiuu (Cclhiiium Omitiariiatnm, U. S.) hag b«ea 
ruferreii tu uitdur (Le bumJ uf Ciuitharides. C»Ui^iiiiua IVnennji, 
^. P., ta jdeatiuil witli tim prepturation, aud u luod for the tanM 
purpose. 

COLOCTNTH. 

Ot^O^fnthis. U, S., ia the fruit of the (Jitrullv* ColocmtkU, a plant 
at proeat largely grown in all parts of the world, ft coDlaimi iia 
altcal'tlJ. c«[orTiitImii', and a \v»m. Neillier of these ia ewr u.^ed in 
mi'diciixu. CiilocvDTh causes Itirgo wntery ei'acuatiQii!;. and tnav. in 
very large flose, produce CfttnJ gaHtro-enteritis. It i» official in the 
B. P. iiH <'nl-iri/nlhiiiin Palp*. 

Therapeutics. — Coluvrutu ia ncvur uaed alone, but alwaya im com- 
bioattuu with oih*r drugu of its clust att a fi^Jragogue eatkartie. 

In caKum of rhronii- drnpiiji and fur the relief of Mcroun rfi'itnonM 
ihiH drug iH ganerally given in the form of the cumpoiind axlraot of 
colocyntli (_Kj:tractu.m Vofuri/nthiJu CGmpij»itu.iM, l'. S, and B. i'.\ 
which contains lliO j^nan. of colueyulh, Mi\ gram, of panlied aliMs, 
140 grais. of ilio resin of snunmoay, 60 gnns. of canhunoia, «nd 140 
gruii. of soap. Id tho do^e of 6 tu SO grains (0.3-1.3) this acts as a 
powerful watery purge useful in dropsy. The cxtraut {ExtracUua 
Cttiocynthidi*, U. ^'.) ih giveu with other drugo in tlie div«« of 2 to 5 
grains (0.1:V0.;i) as a purge. Tho following ia a ujitful fonn ia which 
to admiiuetcr it ^^| 

IH-— Esmd. mImitmIl ft. zzs (2.4^ ^^H 

Exuwn^ brilMmnir K^ ij i^^Y ^^H 

HxtnicLiiU'cia vomicK ...... ■ gr. i) (0.1].— M. ^^H 

Ft. in pil. Ku. ^^^1 

CeUwyBth is one uf tlw principal togrediaats lu compound catluutio 
fullfl (Piluhp Cathtirticti' Cumpoiril/e, U. S.) Ea«h pil) eontuins: cow- 
ponna eilract of eotovynth, 1^ grains (0.09); extract uf jalap and 
caLmu«l, of «bc)i 1 graiu. ^0.0^); gnnb^ge, ^ p^in [<X()l5}i. Thit ptU 
is not to be UiMsil cuiMtautly. as it cvvutaalty nakea lh« howek« norc 
coniitipaced ihau before. Tho U. S. V. of 1890 iilso order* « pill 
{Piluio' i 'athariica- Vfgetahile%^ V. A'.) which contniun compound 
extratTt of ooloeyuth, extract of hyoseyanitui, extract of jalap, extract 
of leptandra, retain of podoptiyllin, and oil of peppermint. 'I'fais is 
given io tho dose trf 1 Co 2 pill**. 

The jirepiii-aitaaa of ibr £. P. not official iu lfa« V. S. P. aie : 
Piiula C»lvryiUkidi» CampowiiA, corapofled of coWicy»th-paIp. aloca^ 



cosD VRA noo—cosrcv. 



abi 



M»i»»oaj. «BiBbat« of potaHsimn, uDil oil of doves, dose 6 to lU 
gnns (0.3-1>.8d); FQuia Cotoetfitthidia et Jfi/rixegami. doae 5 to 10 

CONDURANQO. 

I 

Condurango is the lark of Com4uraitfio Blanco, a tree of C'niomliiai, 
SoBtk A«erks. Mtirtiadikle uad Westcott i>tiite it is the (imiolohtA 
Ctm*twtamif9. It una introdnccd into mciliL-iiie hi IS7^ us » <:urc of 
fiattric tmneer. snd «t one time had a f»rornblc wpuurion. W'c now 
knnv ibac. «■ fiir ns the luorbiil ^ontli is cunccriii-d, \ts nctien it* 
vkhtelem, bat then ia no Uoiiht tbnt it ilinitiii8h«i! thi> nt^vvnty of the 
fljrnptonM m aan^ cmw bj«x«Pi'i?iii;4 a fuvoralilc effect on the gii>trii' 
n i w«pa« nMwbwft. It aUo t«nd« to rcHovo the Hc<;vmjianyiiig gaiitric 
cstairh tliroagb its action an a hIodmcIuu. 

'Die biirlt is never nriplovMl »>t the bark, hut in tlio form of the 
fladil extract, iiom: 1 to ^ dracfaniH (4.0-£.()), ur the vrinc, dime | to 1 
oynee (l').ft-^.4). HoRtPtimeH it is gtvpti in the fariii of a ilecAoliun 
Eumle bv addio^ 1 ])an of the hnrk to 8 piirts of water, whicti 18 ^iven 
in tbe iio«r uf 1 lubU'SfHMjnfiil {'2M) three limos u day. Often it iBwiM 
tn odd Ui ihi- prcmrrtptioii a litth; bvdrocbloric acid to take llic plac« of 
ttir uaianit avid of the sioiuach. whieb is usually luvkiug in «ueb cu^c-s. 



OONIUM. 

Cotuum (U. S.) a tbe Icarej aud fruit of the Coniam maculatum. 
Tbc pIftDl growD ID Etuupu and tbe L'nited States, and contatne a 
liifiiid »lkalnid knovti *» eonine. This drug i^ oniciul in ihr li. P. 
as betaTockdemvea {Conii F^ii-t) aud heuloek-fi-uit {'.Wu Fru/rivti). 

Plirtiolo^cal Action. — rmiium in full niL-dii'Lual dirte frroiIuc<s » 
fircliM ol i-elaxaliuu and 1i)m o( muscular ]Kiv*er. and if tK- dwe be 
tmy bree it caurs fEiddinew. sta^gerii^, aod dUnrdervd vimon, wttii 
UikmttA tlic drctilatioD. 

Ukbvous System, — Coaitim depresses the motor uervep. and, if 
tho dose be extraordinarily large, tbc sensoi^ nerTe*!. Upon the 
apiuifcl cord it exerts a feeble deprc»»iikg iufluenec, but has uo poai- 
tire effpfft, wbdr rh<» fii«t that coneeion!:ac»9 contiftut'S alinoM up to 
diMtlj ?<hoM9 thai the iiiltllcctual portion of tht- fercbnun escupm it» 
iikflaeBc«. 

ClBCtHttUJOfi. — Tbe action of tie dru^ up^ tbe cirCBUtioo is 
depresMint. It causes at fin^t a fall of arterial preaeure, tben, if the 
dtioc be large, a rise, due to chc asphyxift cmiacd by uervo-niiififular 
fajlure uf tliu respiratory apparntiin. Finnllv, a con^tunl fall ofjiress- 
ure tukes place. 

Rh>:riittTlO!C is depressed, because of the paralytic iuHucnce of 
Uia drn^ ou the norve'tnibk:' ^upplyin^ the n-.'iptrttjvy Rin.icle-4. 

TlMnpeattca. — Coniaia holds an uniutportaAl niaco in the dro^-liM 
of to-day. It hae little value except in spaHna due to rrritatiom of a 
itfn'f~trMiik. vfbea it may be of setvicai fn npanw of eoitieal or 
HpifHil oni^in (jCiier drugs idinuld be nsed. k it ia eridenl tlinl cnnium 
ills rmlly no effect ia i^uietlDg the central nervouu pmtupla^ni, but 



I 




202 



DBVGS. 



Mily prevents th« ItDpubes which are sent out from uanifetitiog thetn- 
selves Id movemeRte of the muscles. The powdered teavee or other 

prepnrfttions may hp smeared over pnn|. 
Flo. 34. ticca to relieve tLe pain of iifrcr» and 

cancer*, and they certainly do good in 
' C such instances. 

1 AdmiidHtratioii. — TJie dose of the ■!■ 

/ coholie exlrai'l l^Kxtractum Conii, U.S.) 

is from ^ U* 1 grain (0.03-0.0«). and 
of lIiu liuid fxtratt (Ejtrucftim Comi 
FiuUhiiH. t'. S.) 2 to (! miiiinis (l).l- 
03). Tlie dose of the liiiettin- (Tine- 
Uira (.'onii, fi. P.) is lU li> SO iiuiiiiiis 
<0.6£-2.n). Outline i» a limiid alkaloid 
which should never Ih> usen. The do»e 
of tbc hvdrolirDTiiide of coiiiric is said by 
Hvlbitig tu l>e ^ to J^ a ^rain (O.Ul— 
0,03). The prejiiiralKin in the Ji. J*. 
inade from tlip leaves is Svfcut ^kmii-, 
dose 1 to 2 flu id rack m.s (4.0-8.0). 
Vapor Ctmit eonsists of the juice of 
hciulock (PueeuB Oiinii) ^ ounce (Itl.O), 
li(}Uor potas-iu 1 drueliiii (4.11), mid dis- 
tilled water 1 oimer (JO.O). 20 minimi* 
(1.2) of tliis niixtni^ are placed in hot 
'■^'"'Sw'SSr^^tTSIE''''''''''' w"ler in an inhaler, .ind «. employed 

for the relief of irrilnlivv coughs or 
spmniodiu udthma. Unguentitm Cortii Lo official in the B. P., and is 
used in yrurUut am. 

It is to be remcDibered that the variability of the dmig. so far as 
power is concerned, is very great — so great as to make Jl unreliable. 
For this rossott a small dose- should be given at first and the amount 
gradually increased. 

PoiaoniBg. — A proninent syniptom of poiBoning by conium is drop- 
ping of the eyelids (ptoslit). due to paralysin of the oculo-motor nervea, 
and staggering and inability to walk. Iw treatment consists in the 
use wf «ir_vehnine as a respiratory an<I nervnus stiiiitilanl. the em))loy- 
nicnt of external heat, ami the n»e <*f eardiac ytimulant^ if the circu- 
lation fails. The stomach is to be etnptied by emetics or the stomach- 
pump before ifae antidotes are used. 




CJONVALLABIA. 



■ This drug is derived from the rhisume aud root-stalk of Contvii- 

I laria TuaJ'ilis. It is employed in medicine ax a e-ardiac tonic to fulfil 

I the indica^iions vhich direct us in the use of digitalis. While hv no 

I means so valuaMo n drug as foxglove, it sometimes acts better in an 

K iuUividtial cvmc than the older remedy. The beurt is Dot groUlj 

k : 



COPAIBA. 



203 





slowed iiy it. liut the drug is particularity useful in caew oi arhylhmia 
and "eartji'ar hurrff." 

The dow of llie fluid uxlrai't (^Ejtractum drnt'tilhriit IlHidum, 
U. S.) \» from 4 to S minim* (0.i~0.5) three time* a day. The tinc- 
ture {Tittetura C»n''nUiiri(r) in given in the dnse nf .1 to 20 mitiiniN 
(0.3-1.3). CoDvaltatuariQ is a glucoside of conrallaria vhich has 
been used io the dose of ^ a graio (0.03) thre« litoes a dav. Some 
clJiticiaos tliiok it ought to be given but oQCc a day od account t>f 
a dauger of ciimulatire action. 



COPAIBA. 

Th« Copaiba uf the U. S. P. and B. P. is really the balRam or 
the oleorenin of Copa^ffra Latujulur^, and is a clear, tmnsparent 
liquid of oily conBistency, of a pale-yeilow color and a peculiai" odor. 
From it is ilit^tillcd an oil (O/fum Vopaib(r, U. «V. and B. P.) which ia 
of little value. 

Aa copaiba ia an oleofesin. the term " oleoresiD of co^^iaiba " is 
oRcn ttsod to distinguish it from the oil. 

TherajwuUcs. — Cupaiba i» used for the purpose of stiiuiilatitig the 
muroim niL>ia))nkiu>.>) of iht- gouito-iirinary tract, parti(?iilariy when iboy 
are depret^^ed afti.'v a period of itilliunniation. a.<i id the Inter slagPH of 
ffonerrhaw. In cases suffering from ekrcmic urt'thritin wilh luiaimia 
and debility the following prescription i^iunefiil. (See also Methylene* 
blue.) 

K.— C)Ieor«Mnii>(^o|Hiiba!. jj (4.0). 

Oimmiiu'cuktia' giL iv lO.Ztt). 

F«rri ei smmonii citmiiB gr. XX (L3).— H. 

Poiiv ia caiMLiIwi No, x. 
S. — Oqc t. i. d. ftder mcuK 

Copaiba is employed in wuhae-atf and ehronie hronehitigas a Btimu- 

it expoctorant. In the treiitmeut of sahacatc pffeiida, ey»(i(i». auA 
dytntt^ it '\t of value. In ilropg^ due to slow rcDal changes it will 
often be of wrricc as a reual Bttuiulant and diuretic. 

Admlnistratira. — Copaiba itiielt' U givi.>n in (he dose of 6 to 20 
tniiiitnfi (0.!t-1.:)) in e^pniilr or in eniulsioii. The nil of copaiba 
(Olfum Copiiibfp, I', S. and /t. P.) is given in cnptinle or emulsion, 
preferably in the former, in the dose of 10 to 20 miniuta (O.lJo— 1.3) 
two Ut four timea a day. Sometimes it is dropped on sugar uud m 
Mlmtiit<«tered. Mataa Copaibw, U.S., in made by rubbing up copuiba 
vith magnesia, but thLt is a useles.'i anil clumsy way of using it in the 
pill form. 

The drag is eliminated in the urine, and gives the teet for alhnrnin 
with nitric acid. 

In eomu cases it euui^cs urticaria, which soou disappears on the with- 
drawal uf the drug. 





lomi nr the metal 
M tb* 8«Iphnt«, whirt (ippwim m (w>min«rce iwi a ftlne. dtar. j»mne- 
what efTIoresu^ni sah. It is solubtp in 4 [larU of cold wat«r, 2 of 
boiltn;;; water, but i» ztot sohible in tieobol. 

Pl^iolofical Action. — Copper .tnliihnt^, wlien localW »ppli«(l to ft 
insoons mnnbraD^. atm m » powerfil a^miij^cnr, or on the rarrt«« 
of an ulci-r us a mild autl supt'ifkiiil mnstic. ^^liMi giv»fii in orer- 
<lo3C by the stomach it causes death bj violent gastro-euicritis and 
exhaustion. The .wymplonis dn not gpnerallv come nti i'nr an hour, 
aud consist in burning pain in tike slomach, u coppcri»h or metallic 
iKHte ill th? mtiuth. followed hj- voiniling of bluish tiijinds and glairy 
jnntm. With tb« vomiting, purging c*mM on, the pamages sr first 
CfltitsininR the CTmienrii nf (hi' intestine, iind finaHj mnrus and blm>d, 
ConvulmonH of an epileptiform character are prfaenf, and cowtimt 
»nd profu»t> salivation in not infie(jtient. After death fart? dt-gene- 
ratioQ of the liver and kldncvs hua been outiccd, and it is not at alt 
DQcummnn for janndire to uppfsr after the first iw«iiiy-fr>nr bonrs, 
if the patient Auvviveo m long. This j&undi^* is de|>eudei]t upon 
changes in the blood. Tie treatment of the noraontttg onsnts in 
the primary imc of th« ebcmt«al antidote, which is the ytNw prH9- 
tiate itf p'jtagitium. and the admtnistratinn of emtillicnt nr demulcent 
snbstances, such bm sweet oil and ■white of eggs, followed inaianily by 
emetics or the stomach-pnnip. If enesis and purgation are afreadjr 
active, emetics are vf course contraindicated. a.nd cuuuler-lrritatiOB 
is to be employed over the KtnmHtrh and intcHtiues in the iihupe of a 
muRtmnl phiatcr of noderute strr^ngth. and ufuiua given to nllny irrita- 
tiou and relieve pain. 

Chroiiii' cupper poiitouinc is alnioet never seen, nod, althou^ ibe 
metal !» widely used fur c»Toritig vanned green vi-geiuLIes, it seemn 
to be hiinnl«s» when ingBHted in tach uuall lunauutii. 

ThoiavAtitics. — iSul^MAte of eeppcr (Cupri SulphoB, U. S. and 
li. /'.), in the do»e of .^ to 7 g;rmiDfi (O.S— 0.4) may be iiKed us a rap* 
idly-acting rmeti^ which only urts upuu the sIuium^'Ii, uut tLe vuiuit- 
ing centre. A& it in irritutit, the eiuetic iluise ought not lu be i'«peaJed, 
but if eoiesis do«8 not occur the solpliaLe of unc or mnatiud ithauld 
be QAed to emp^ the Ktomacb. Indeed, it may be mid of sulpliuts of 
copper that it should never bo ^vea lui an eiai>tic if asy other emetic 
eaJi be found. Tboniton has proved in the Ijihonitory of Bxpori- 
luuiilkl Ther4|«vuti>:4 of the •TeSerMin ^Itdic*! CulU-^u tliiil iiu uatidotAl 
tlaw of copper >*ul|tLiae ji^wn to a dog poisoned wiih pluispluirtis iiiiiy 
produce di-utli before the phosphorus can cuum- o lellial result. The 
drag is Lhuretura a theoteticid but out a practical uittdute to phos- 
|ihoi-us. In pill form it ib sometimes given in diarrA^MS depeuding 
npon ulceration of the howal*. The dow ahouLil b« ^ lo 1 gnin 
(O.Olii-O.Dtf) cuiublLcd with opium. 

In soiue ata.tcw of the body, particularly in tkin (Ti»e(ut'» of thf lirg 
f!//>e and in persons with tittwrvuloi' temfeiu'tt'*, copper seemii to net 
like arsenic, and may be used in minute doites of jl^; of a grain (0.006J 



COTA RNTiTE-^CSEOSO TF.. 



306 



or loi ^hnB tinec b day wbfire arwaic is not weH liome. In hdirII 
dooas it is aaid fa> be • direct sdtDol&at to tli« tiatiiw. vai to increufr 
t})« finaness of tlie flasfa ftad 8lr«Dgtii »f riie oonuti mui. V'erj 
Tccenlly gir<«g eUisK for copper n* a remedy for aruvmh have been 
pot forwknj. pajticttimrly if it in eiiijiluvi'd »a tlitf vaeuitL* of ci>]iper, 
vhea the acQon of the aneiuc uid copper togethor produces a good 
effect. 

LookUt applied. Mitpfaate <£ copper is ueeful, in tlie solid form or 
in powder, in tite treatiDeiit of huioleiit ulnts, lo ehranic conjutw- 
ttrili* or in ».<«» of fdHtui tarsi — ^tliat is, tinea on the margin of the 
ejrrlid.^ — a (rr^tal nf litf siilpliatc nmv br drawn oyer illo diseased 
•|M>t; •fa weak sohition ofl to A f!:raitt9 (0.06-0.1^) lo the ounce (30.0) 
of wwler nay be droMed into the e^'e in tabariLtr rut^itrntiv^ttin. 

In rttaxtd mt* uo'oaL,ni a gnrglc, in the ^trongth nf 4 grains 
(Oj^ti) lo the oonae (90.0), it is oftvu cX nenricc. 



OOTABNINB. 

C-otaraiae is prepared from nftTc&tinc. oneof ihc niknloids of opinm, 
bat its physiolo^rul ^ect is rlmt'lv allimt to litit of liTdr!L>iliiiinf. 
Am^tA from fevdnietis. In tlie form of cotantiae liydroolil'jniie it 
fwB becH pl.'n!»^ on ttw mRflcpt as ■' Stirpticin." ami ihi;* is used as « 
reiue'lT forootin^ litHiorriiages. bb€L as mcnorrftuf/ia aii'l im^lrfrrha^ia, 
iind an a loral application in epfttaxU. It laa/ be p^fn in ike doKp 
of frMn J to 4 grains (0.0:M).S6) tliree times a Jav in pill, tablet, or 
f«ltsir. or in cnpHulp, or by the brpodenQic i^jriogc in ihc doae of 1 to 
2 gnias (©.0$-0.12). 



CRB060TB. 

Creoaow {Creonotunt, C. IS. and B. P). a» emploved in mediciae, 
■bottld alaaya be derived frou lh.e dtislructitL- dislilliLlit-u uf teecli- 
weod and be deslgiiaied "b«^cliwoud «.'re<>»uiB." Murb nf tbaC cold 
ie derived fruiu ci<al-t«r. atid i» (ar Ivnf itM'ful. Cbcuiicully. crctiaole 
iff almi^si idt-utical wiiL carbolic aviJ. Cliatoallv, it in vi-rv difiortitit. 
Bewbwood ereosote should be of a rcddisb-amber hue ani about &» 
thick u oliTc oiL Its pbyaiological action h almost idi'titical wiili 
that of carbolie acid, snd in poiRoning br crcototv (lis tanic untidutcs 
as are enployed in oariiolic-aad {oiaoniD)^— iiainriv, aolublo Hulplia.tL>H 
— ahoald be nsed. as ba-i been prr.vod in cxpfrimttAs by iho imtb'jr, 
< V ea «ot e ooataiaa 6lt per tran. of gau.ia«iol and 40 of i-rMxt* tmn crmsol. 
linaiaM)! in aniDrtiimw iiiie<l iii jiUm>? of crposote in tb« d*)&e of 1 to 2 
mininis (U.0l>-4).I3). ^Sec Unaiaool.) Creosote is a puwerlnl anti* 
Bvftie. 

Aoeonliiii; to tli« atodieaof finb«-t, «t«(»ote i* «4imitist«d ohieflj 
by the kidneys in the form of giiniacol sulpbito nnd (.i-eosol su1phal« 
of fOlaBliiaiB. Kitintnation drx.fi not po on vpry rnpidly, for tbi.i 
lavMtfapUar Aii not find it oomp1(44?d K>r ftboiit tvrpnty-otjfbt hours. 
A MBW aununt of ihe ilntg in eliminstrd by thf jongo. 



SOS ^^^r vRcos. 

Tberapentlcs. — During the jia^t few- years creosote has been largt-lv 
preacribwl in ptdmowirtf tttfiercith»i» an-i rhroiiir hnmt-ht'titi, nnrl some 
of the rcAultH readied by itsasv havt uuduubUill^y been ofviluc. (Sw 

artifli' oil TuljtrculoBiM.) It has 

Fin. 37. al^o been inhaled from sjKiD^es with 

great relief, and even lin.« been in- 

jtM;t«d into the luugs by w«y of the 

traelicH or iLrougli the ch(.>«t-wsll. 

1q the treatment of chronic iron- 

', ehitU creoiinte may be plnced in 

^ y boiliog water and inhaled in the 

IjV sicftiD. Under these rircuDi8Cauce« 

' it rcliereB the I'ctor of the breath, 

and this method ofien given more 

rapid relief than any other ueastire 

''^■HffiKlJT *«i*^/ '" ^^^ ti-eatment of ordinary »uh- 

acutc injUinmiatioH of tin- f'r*mchr. 
(Sl'b Iniialalioiis.) The bej^iniiing 
dose when the Jiii^ is given Inler- 
nallv is 2 to 5 minim? (0.1-0.8i>). 

It is nscless to attempt to cure 
pulmonary tuhereulo»is by the ad- 
ininiftratioii of creosote, und it^ 

T«<.'.inii«ivrra«.i.-«r«.rroi«i«iri!i^i«...nd chiftf value iu the diseade dejjends 

Willi *i».ii. i.-,i«<-.Kn h,.rk..rihi. ,-..«. 'ipon "* action as an expeciorani 
in. ■ HH.1.1K piiH't.t hi uiL- fr..iii of lilt in- affeetidj' favorablv the profuse bron- 

halloa. chial Ki-crction associated so often 

with the involvement of the Iiiiij; 

tissue!* by the tubercular process. Creosote does good, indirectly, by 

relieving thiti cuitiplii-ution : but it ia apt to (tii^)r(h>r the digi^tiun. It 

ought not to be employed in every cii}<e. Mnco it^ rolitc in relieving the 

bronchial disorder is far outneighed by the disturbance of digeation in 

many instances. If fever or hemuptyMs is present, tlie use of creosote 

is cojitraindicated. When it is desired In relieve profuse muco-puiH- 

IcDt ex jjecto ration crcopotc may be given in cajieulus or as follvtre : 

B.— CreowiU (bMcltn-ood) fsilj (12-0). 

Tincl. (TMiliM. comp flj (30,(1). 

SpL vini rectilirati r^viij (S'J-I.O), 

Vint Xi'rid Oij (1 litre).-M. 

8. — A tablc>poonfiil in a wincRlnairiil ( IS.O ■ M.0) of wnter tbrnv times n d«r. 

In Other cases the ereosote may be dropped into half a glass of milk 
and taken in this three times a dtiy. Olten a« much ao a drachm a 
day can bo given by gradually produeing lolerancc through ascending 
do5ej< ; and it lit worthy nf note that in most inatunccx Urge dusca are 
required if aatis&ctorr reaulls aro to bo obtained. (See article on 
Tuberculosis, Fart IV.) 

Inhalations of the drug often give relief in the advanced stapes of 
pLtbtaia. and dcereasc the eough. allay the laryngeal dryness, and aid 
expectoration. When creosote is given hy]Hid'erinioftlly in phthisis, it 
ma^ be given in the following formula : 



CBEOSOTE CARBOSATE. 



207 



B-— cpMwMi fgij (8.0). 

Olvi nmyitilAl. lidldo . . . _ . fgij (K.O).— W. 

8k — lOmioiiBi I0'<f5} U> be injeoud deeply iDtotimuei below Lite gi-upiila. 

Tbb methoit i» not to be emnlored except in rare coses. Indeed I 
have jet to ste a case in which its use seemed wise. 

In ihe treatment of gnhanitf lartfugitof a fine spray of 1 to 2 min- 
iois (0.05-0.1) of criN>«otp, 4 grain« (0.2) of menthol, and 1 ounce (32.0) 
of alhulene U of sorriee luteii several x'xuwf u rl;iy : or a mixture com- 
jKwed of creoeote 10 minims (O.fJ.")). cliloroform spirit 10 minims (0.65), 
And ulraliol 20 niinims (1-3) niav be pla(-(^d on t)ie spongv uf au inhaler 
Add inbaled. It i.i alM> cinimetf that wettin;; cloths with creojiote and 
hanging ihem in tbe air of a nursery will often be of preat xaliic in 
ifhotrphig '•otiifh. (Fop metlioda, »tee InhHlnliono. Part III.) 

SoiueiimtM creosote is given h_v eucm* in |KineroniiEed cod-ljver oil 
to rhildivii uith palmonurt/ or peritoneal tuJtereutomt, in tbc dose uf 
from •'> to \o niinim.s (n.ii-I.O). 

Cr«OMt« is s valuable rcino<ly id ciims of indigestion with fer- 
mentative changes is the gastric contents when tlicse arifie from the 
deficient digestion of meats or the tisu of^woels, w)i«n given in the dose 
of ^ to 2 minima (G.01i~0,l) after meals, prefcra.b]y in tablet iir capNiiIo. 
Applied ou a pledget of cotl<m tn ibe eavity of a tooth, ereonote ofleii 
relieves toothache oy virtue of its aniestbetic influence over peripheral 
iMuuory nerves. 

While ordinary medicinal doses of crcoemtc rarely uiuxc disagree- 
able symploms, exeept some disorder of the Ktomnch or bowelst when 
it is punhed in full doses, the phy.'^ieian who is ordering large nniounit< 
dioald be always on the Iciokotit for toxic Kymptom^. These consist in 
TCTtlgo. headache, and a tendeuty lo stujior. niid the uriiic iriuy hcctimt' 
BiDolcy in appearance, aa iii earbolie-aeid pulsonitig. If any of these 
ngns nf uvenliwiag appear, the drug must he reduced in ilrme or 
Slopped altogether. 

The preparationn of creosote Jirc Ariuu <7rfiwitu C. .V.. which is 
j^ven in the dose of 1 to .1 ttnidnichms (4.11-12.0) ; Mi»lurn (yeomti, 
B. P.. d<ise 1 to 2 fliiidoiinces (82.0-04.0); UnpucHtum Creogoti, B. P., 
for local application. 



CBEOBOTB CARBONATE. 

Creoaote carbonate, Bometimcs cjilled " Creosoinl." is n cnmbination 
of creoMte with carbonic acid. Over PO pur cent, wf itchssoIc car- 
hoDate is said to be ereo»uli>. It is a thick, oily fluid nf an umber 
color, with but litth; taste or odor, and is insoluble in wnter, dilute 
aloihol. and glycerin, hul in soluble in ft.j per cent, alcohol, in eilicr, 
ehloroforfi). and in cod-liver and olive oib. It w said tu be lesn irri- 
tating to ihe stomach than creo.wle. The drug is dissolved ami ab- 
ocrbcd chiefly in the intcistinc. The do^e of creosote carbonate is 
identical with that of creosote itself, and it is uxed an an expec- 
torant in puinu>nartf tubennhm and aa an inteitttnal iittUrcptic. 
il is li««t given in olive oil in capsules. (See also Giiaiarol, Car- 
honatfl of.) 



aoB 



Dsnati 



CREOUN. 

Creolin h s liquid crosol. s coal-mr product, pnBSC^ing; miirk^ 
antistatic but ctimpikmtivelT slight jkiIiioiiouk prnpi-rtic^. In ajipvar- 
amrt' it is a dark-browu fluid, ami is (lerivetl from soft ca«l. It in of 
the (xiiisi»t<iic_v of ?yrup. When added to water it fonna a white 
cloud nnd mixes thorougbljr. formiDg an emulsion op to 12 per c«nL 
of Uic drug. 

TkMapeQtlcs. — Cr»)liD is used u ad uutiscptic in the 1}'iDj;-in 
stfttc. as a Wfitfi for the hande, und for vtt^nal rrrigatunt. It cannot 
be UHed as a solution in which to |)1aee inKtrunientK, an it luaken so 
opai)ue a luixtiin- with water as lo prevent their being fleen when Ivinu 
at the liottom of ibodiiih. When uced lb a vaipuiLl douche it should 
be employed in the strength of 2 per cent. One of its prttpcrtics which 
ill of value is that it foniis a slippery coaling over the uiuteniaJ parts 
during; parturilion. In the truatnicnt of eiftiitu in the feninle. Turvio 
highlj' recommended it as a vesical wu»h in the strength of a 1 per ceiil. 
aolutiun. or. after the hluddi-r becomes ucrualomcil to its itac, in a 2 per 
cent, soluliou. Accoixliug to Krotzsebiuar aoil othe™, ii aolijtion of 
1 to 500, used witli a syringe, is useful in otorrhea, 1 to 100 in ruuut/ 
uicerm, and 1 to lOOO a-i a na.<:a1 iloiiehe in rhiHttit when tliere ii 
tuuob iltflvhurief' with the fonaution of cruets. Creolin hu8 bUk) bocn 
used A8 an injection in ihe proporliun of 5 jtartK in 1000 of water for 
J^ienlfrif ami fiUtig witli fiuccetW. 

\ii the eye Alt ha.<( used with ^ood remilts a 1 to 2 per cent, solution 
in the treatment of I'tepfiarifui, kcratitiM, and yh^^atimtlw ophihafmia. 

CBOTON CHLORAI.. 

Croton Chlorul. or Bvfftl Chloraf Ihidrat, B. P.. has a ph.vaio- 
locieal action ehwelv uMieil ta chloral itself, bnt if po»4e«se.i more nnij- 
gcsic power and is very nrnch less deprcwant to tlie heart and rircu- 
mlion. The dose for the production of sleep is the same as chloral, 
5 to 20 grnins (0.3-1.3) in svmp- 

Therapentica. — Ci-oton cfiloral is preferahle to chloral in sleeplesn- 
DCSS duo to pain. 

In fucint lUKvalgia and miyrainv it i» exceedinplv efficacious, par- 
ticularly if the fifth nerve be inTolred. In Atii<f'i<'fi>'s due lo i-i/f- 
Afrui'M. and in those associatoii nith sick ntumack, but uot due to 
nitric isdigeetioD or nervous debilit,Y, croton iihlorol ia of Mirice. 
Curiously enough, it i.s Talueleas iu toothache, hat dues good in tlic 
tuuraf;/in due to decayed teet/i. 

AdlDinistration. — Croton chloral should he used in nill form in the 
dose of o to 6 gniins (^i.2-fi.3j everv two Ikuivb nil the j^iin is 
rolicrcd or tdeep cornea on, or it may W given in snlutlon or fevrup 
of a«acia and vater, or water and cWocrin. It has Ixseu used id as 
krge a dose a.-i 60 grsiuit (4.0). but 20 lo SO groins (0.6&-2.0) ought 
to be the maximum dose as a general rule. 



• 



CROTON OIL—CVBKBS. 



S09 



CROTON OIL. 

Croton oil(0/rtim TiifUi. I'. S. : Otfum OrMonia, B. P.) is an 
excii*'iiiii;Iy in-itant »\\ ilurived fnnu Croton Tti/liutN, u Hmall tree uf 
India. The nil is fiale yellnw ami nf a complex cb«racter. Afjjilieii 
tn the ^kin for any Iciigili of time, it in uQ iiiloDBO irrittnt, producina 
Llistere or puamiM. 1 mitiim (O-OC). plnwJ on thr tongue with a 
mininmi (O.So) of sweet oil, acts as a violeut watpry purgy, iinil. owing 
tu tlir nnalliicHa of its dnsp, u is frcjiienlly employed to n-rHhr tlie 
UHfiiHM-iim^, aa in •••■r^ral ''ntufeMir.n. In dAirium it is nso'i fnr the 
tuutic piirpuse, ntul may be yivt'ii lo tuaniiics vriin are siiffering from »ii 
attack of cprebral cori;;<?stion or obstinate conii'lipBlion, owing to the 
nan11uL<S3 of its d«»c ami rapitlity of action. Tlie doae is 1 luiDini (O.Oti) 
placed on tfae tongue with sweet oil or given in cmiiliiion or in pill. 
It OD<:bt never to be iir^cd when llieTP im uiiy irritjillun uf the ^toumcli 
or bowels. An n eoiiTiter-irritiini it i*t jiitHictiiiien aprtlied ov«r a icri- 
iler oervc or to the chest in the trcmnieat of brtmrhitin, iu the pro- 
portion of h«ir-anci-hnH' with swecr oil. Thus applied, it may bo 
absorbed nud eausc purging. The treatment of poisoning by croton 
<»1 ifl ideuiical with that of giisiro-euteritis. (S«e Cia»lro-cnteritt8.) 
Ziinimfnt HiH ('rotonin \f s prepttrfili<m of the ft. J', which if emjiliiyoa 
u a couuler-irritant liniment for uprmm auil in muscular rheumatism. 



OUBEBS. 

Cnbebs (tt(Arft«, l^. S., and FrwtuK. B. P.) are the unripe fruit 
of PifMT Citbf(nt, a plant nf Java, They eoiisijii in wrinkled or rough 
blaek iMidica about the sine of small pcap, nnd have an aromatic, 
pungent laste, TJiey contain a volatile nil. I'libebic acid, and ewhebin. 
The drug should not be kept in powdered fonn. na it loses its powera, 
but sbonhl be powdered as needi-d. Oveidoses of cubobe cause gastro- 
intestinal and genitourinary iiifhiininaliou. 

Tbcrapentica. — Ctibebs are used in the advanced 8t»gM of ffonor- 
rhea where a tciideney to a chronic discharge ih present. Some sur- 
geons have uae<I thvui in the early Muges ax an abortive irealment, 
Imt tbis b a bad practice. In cvhl in tfif h<-<ul ihe powdered berriea 
mav h* snuffed np the mwiril, provided that ihi' stage of secretion is 
v«II established. TLiey ought not to be used hi-fore tbiit etoge. In 
the treatment of chron.it- or salntrule hronchitix the uleureMin of 
cnWbs is very n^eful in some ca-^ci (t*e Bri>rirhiii!'), and in the fnrm 
of eiibeh cigaretiea the dnig is much used lijs a remedy for hoarxcneita 
doe lo subacute laryngitin. 

Admlnisbatlon. — Cubeba may be given in powder in the dose of 
10 M ti() grains (0.t>5-4.i>), in the fluid extract {Ex(nt<'tum Vuhih<B 
Fliiithim. U. S.) 10 (0 :iO mininin (0.(i.*>-2.0). and in the form of the 
tiuclure {Tinctufii Cubthit, V. S. and B. P.) in tlit? dose of 10 miniine 
to 4 an ounce (0.6o : 16.0). 

The doee of (he olcorcsin (Okoretina Oubeha; U. S.) is 2 to 20 
minima (<i. 1-1 .A) three times a dav, and it may be given in cajwulea or 

14 



210 ^HiF DRU08. 

omulflion. The troclies of cubcba (TVacAwet Oububre, U. S.) are 
uspii for the reXiet nt pharynqitit of a chronic tvpc. The iloso of the 
oil [Oleum OuU-biV, U. S. MxA B. P.) is 5 to 20 laiaima (0.3-1.3). 



CUSSO. 

Otuw, U. S. and B. P., sometimes called Kouhho. is derived from 
Brafftra Antkfhnintu'a, n plant of Ab^rsKiQia. Id iJic V. if. P. of 
1880 it was culled Bmvcra. It contains u volatile oil, taouic acid, 
and kooBiD or r^eniiti. The drug ix ust'd ajEaiuitt iho tttju'-wnrm, anil 
IB most valuable as » veniiifiipo. also pofls(*fling Ihe ailvatitaj-e of 
safety. Il should be iiccd in an infiiHioii (^Infu*i/.m liritiifitt) in llip 
doHc of ^ an ounce (IG.O) of llic powdered Qowera to a pint (500 
ec.) of water, and be taken in the morning ou an empty stomach. 
(See Worms.) Kootiin may be used in the dose of 20 to -lO ^uiua 
(l.S-2..'i) in eapsuJo. The fluid extract {Exlractum Custo Huulum) is 
given in the done of \ an ounce (1I>.0), It has been said that the 
dni|r i8 apt to cn.ii»e abortiou in pregaant women, but this la not 
known to be a fact. 



CYANIDE OP POTASSnJM. 

Cyanide of PotaRsium (Pntasitii Ctfanidum, U. jV.) Is used in the 
ftamo way and for the same piirpoHc «» hyilrocyanio acid, (See 
Hydmcyanie Acid.) The dose is -^ to -^^ of a grain (O.OOSJ. 

The following prescriptions may he used in cafiett suffcnng from 
bronchitis or pkthi»i» accompanied with excessive cough: 

^.—V'*tu«A\ (^-smid ff ■ y ('^■1)- 

Alurjiltina- Ni]l|)li. - pf.J Hi.O.'il. 

Svr. pniiii viigiiiiuuB q. ■. ad l^'U (*0.0),^M. 

&»TuHii|HNinful (4.0) ii\n» in linj liinni n wty. 

Or lift follows : 

U.~PoUmu cranii). gr. IJttXl). 

Auiuii-ii, i4il..ridi Jij (fl-Of. 

Elix. mli«iv>. q. ■. ad Qpy (0a«).— H. 

6. — TM«[»intifiil (4.0J thrMi or Tmir llniw n day. 



DERMATOL. 

(See BiSMIjTU SuUliALLATK.) 



DIA8TA8E. 

The word diastase is applied to subatam^H found in certain of the 
dijieslive jiiias) of the animal hoily an<l present in procesaea couoected 
with the fermentation of grain, as, for example, in the iDanulactQre of 
alcoholic beverages. Whatever diastaae may be in one w;u»e, we recog- 



DIGITALIS. 



211 



Dixe dial it belongs to the tame clam ofenzTines as [wpsio luid pnocre^- 
tin, uid that it has the power of convcrtirg starch into sugar. Many 
prejKiratloiis of mail roiitain name iHaiitalic power, tmt there in iinly 
one preparttioD of ilisotiuio, which j^naaesjios nn othrr property save that 
of aiJing the digestion of the 8tarc1i<?9 — naiiU'lv. one prepared origin- 
ally by & JapftDcso investigator, Takuininc, and called from bis name 
*' Taks-diiuttasc." It i« uMcd to rellpve caaes of intiu/ettion of the 
starchy footU in the iIohq of 2 to S grains after meals, in tablets or 
capmlflB or in n Holiition. and is a tDost efficieot remedy. 
A very ttseful formula is ns follovs: 



R— Tiiltti(li»tsi« - 
(.'ufirt itneoiL . 
EilnLt. iiticis vomtiv 

Focm in ni|Hii1rn Nii. zx. 
Bl— Od« capBolc witb nicalc 



. gr. il7 (8.0). 
■ gr. I (0.01). 



Often a litlltt cnpsiRuiu lunr be nddcl to thiit prescriptioD, in the 
treatment of atonic dtftjiepna. with adviinlage. 



DIGIT ALI8. 

I>igitali$, U. S., ie the leave** of Ditiitah'gpurpurea, or Foxglove, of 
the aeoond year's growth. The leaves are Dflicin] in the B. P. as l^igi' 
talig Folia. It «intaJns a number of substances, iio diuele one uf 
wLich acta as do preparatloMH of the crude drug. lu utBur word^, 
all thwe compounds niii»t act together to produce therapeutic effecta 
similar to tlioae obtaioetl wheD digitalis leaves are given. Among 
tlte sabstancFj so far isolated frunt digitalis by chemists may be 
nainvd digitalin. digilalein. digituxiii, digilin, and digitnnin. SeverH.1 
of these arc probably compounda of the Mhcrs. r>igitalin, so called, 
occurs in two forms. iiinorjibniLi ami crystalline. The erystalline digi- 
talin (French^ is Ia.rgely digitoxin. whtlo the amorphoufi in composed 
of digitnnin, uigitalein, nnd digitalin. A purr tligitnliii htm, however, 
been isolated, which can now be obtained from Merck. Digitoxin nnd 
pare digilalin are the iwu most active [irinciples yet found. None of 
these mbstancc!^ should ho useil in incilieine to completely tnko the 
place of digitalis, but digittdiu may be u.-«ed fui a heart stimulant. 

We have already pointed out in the early part of thi.=t x-olnme the 
necBMJty of cmjdoyiug reliable drugs. In the instance of digitalia 
this U particularly important, because tbo ca«c8 in wlticb it Is used 
are o{\vn scriouM, and hecau^te digitalis vari(!s greatly In titrength. 
As a rale, the wild digitulis ii^ stronger than (he cultivatvd, and the 
English or (lerman disiitiilis is better ihan the American. Tlie prep- 
urstions of digitnlis lOiould tbereforo bo ohtiiined fri)ni u lirj"I-nito 
luiinufucturing phiinuaci.sl after they liuve been pliy^iolugicully ti-sted. 

Physiological Action. — Digitalis m apt to irritMe nincouM nieinbraneR 
which arc already slightly out of order, nud for thi» reason should not 
he given by the mouth in cases of gastritis ;iiid ulhud suites if it can be 
avoided. 

NKiivot," SVHTKM. — The action of digitnlist upon the nervous sys- 
tem is only manifcated wlicn poisouoiia duces ore used. Small toxic 




212 



DRVOS. 



doses decrease roflftx activity by stimulating Soteclienow'g refipx inliilj- 
itory centrea in iLo uicjulla. and finally by dcprcHj-iug i\w sjiiuu.! cord. 
Convulsioiu aro »:tiiiiL>tiuii'a ewu a^ u ri.>suU of ttio actiuii uf ilecuiujiuai- 
ttoQ products of digiulif^ — namely, toairtrsin aiid di^italreaiu. i'luulty, 
the motor nerve- truii kit themHelves &re depreHAed und the mtisdes are 
panilyzfcd. 

CinciTLATiOK. — rpoii iht' circtilutory syatom digitalis exerts iu chief 
influence. In. niodctratr or mcdi'ciiiftl ciniountt* it incrcaso»! tlio pidie- 
fbrce and arterial pressure, slows tlir pulse, and increases llip niiie of tlie 
pulee-wave. The incrcaj'e of puUc-force i& duo to a stinmhitiDp influ- 
ence exercised upon the cardiac fjanglia and tbe muscular fibres of the 

Tio. 38. 



l-^ 



\\ 



A 



A. D]KltK]l«(liinulaira Ui« tti^aH; i/. iilmuUio Ibu nKiii> ccnlRs : c. ■tlmuUlc«Ib<>wrIplwnl 
•n4la*rUio tKgl: l>, illtnuUlM lh« viuc4oolorcpa[re:£.allinu.l«tu UieWAlUorUiBDlMd- 
beftrt; th« rise of arterial pressm-o Is caiiBod by the increase in pulse- 
force and piiIse-Tolumc, and by a Hlimulntion of the vasontutor centre 
ami the mu-icnlar coats of the blood-vesaels, wliert-by n contraction occurs 
in the walls of the arteries and arterioles. The slow puWc is produced 
by stimulation of the pncumogjwtric centre and the peripheral emls of 
the raffus nerves. The iiicrcaaf in th« volume of the jiulsc is due to 
this intluenct! on the vagi, for, the pneumogu»lrie nerves hein;; stimu- 
lated, the diastole of the heart is ranrc full und coniplrte and occupies a 
greater length of time. The result of this delay in that iho ventriclex 



brcomrtlinroughlyiiistenilei).. intl on con trading drive out a much Urger 
wan* of blood ihroogh rhe aorui ihnn is normally si'iit out (FigiL 88 
and Z'J). This ls iui|)urtuiit to romeitiW-r wlicii uaiiig ttu^dru^ in iivart 
iii>-i'n>4* ui>d ullicr tttato^, WUilc- »<_• do not know tliiit (liu vii^t um the 
tnijibiu niTVt-s uf the heart, wc have a htrgc amount of rvidrnce 
ib favor uf such a viow, an<) it faii» long bt'f'ii thought that iligilalis 
uns not ouly a facart siimulant, hut a remedy thnt iacrcased the 
grijwlh of its tnus<'ulAr tisstic If the tropliio nerves of the heart iire 
iftiiotilated by digitalis, it beenmrM fVJdcnt thai it is a doubly uiseful 
remedy-' (S«© the article on " Heart Disease" in S'arl IV. of this 

Pio. ^9. 



1 


u 




^w\Jvfv^ 



Hi'-vincilKTlCrrlol iltitltaUaoii tile cin-iiutfifn (Aftet flchmli'ilvlnTK,» 1, Bff'iif ilIyllMlii 
uiu uM^I |jt«<d-|>mHiiM h£^ ixilu i\ In in uii-.itiitt. Jl. xtirt Ihn iiui iil •IIhiuiIIii; 
UcxI'imMiin \fi>. piitur ;; in id ««rL.iii'l> III \l\ri miithcr ili«o: bl'ioiliiruieure IM, 
IHUn? 'ji. IV. Artrraivitlivrdiiti': hloiMl-iin'uur* 3in, piiliut W, 



volume for a further exphiiiation of the influence of digjialis in 
inprnviDg tho niitritinn of the heJirt tnii^<-le.) 

When full medicinal doseAof digitali)) un- repeatedly given, or when 
poiaonoMB doses are ingested, the action of the heart become* exceed- 
upgly irrc;nihir. hobbling, and dicrotic. (Sit I'oiaoniiig.) What the 
j«r of ibis iiTogiiliipiiy if we do not Itnow. It is certainly not due to 
vrpaicnni*. for the caniinr beats, when they wciir. are in themselves 
mon* forcible than in hc;illh. The probable expUnnlion of ibis iicculiar 
cttrdinc irre;;ularity lies in u ilir^turbance of the eo-ui'diiiatiiig upparatu^t 
of the rarioiH parts of the heart muscle. By this the author doci not 
refer to the HO-i-alU-d cn-ordinating centre of Kroncrker and Schmev, 

' In Kn orinnnl siodv Uv llic Biitlmr he Ibonil thai wht-n ilix'tdti^ i« itivrn oui- 
linoaarij lor a long period <}i liiue iheir roulu c&rdioc hviHTlmpliviniieix-ndentJf o( 
Ml)- Talvulsr lealoa. Sve T/ientp<utk Oa^tt, V)vxm\iti.'l»!)7. 



wliivh prolmbly dutd not exist, but to tlie changes* which may take 
pla(;i> ill dio 9(3-eftlk'd " eoiilraoliim wave," which is found t« \xeia in 
tlu; iinrmiil In-art iil the grwit vciti!* niiJ pafBt-s from tliviii thruu^i tlie 
auri<TiiUr walU to the walU «f (he vunlricles. It ha« hcru fuuitil bj 
Wouhlritlge and by Tigersted: that if the auricle and vpntriclcs be 
aepftrated by a licittnre or clnin]), they stilt rontinue h<«iinR, hm no 
longer tlu 8i> ttytnihn^uously, or. in other words, the centres of each set 
of walls act iii<:lL']K>n'K>iit1y of the othei-a. Tht* irTfj»ul«r action of the 
bcort under digitatiii l« jirobably dependent upi>ti a di»a&t>uciation of 
.thi«c ceiitnwi: ami thii* theory is still further mbntantiated Ijy the 
experinientet of Hoy aiid Adauii, wbu have proved that indepeadeot 
contraclion of the varioiw pan* of the heart caii bo produced by sliin- 
ulatiou of the [loriphcral end of the cut viiguK, a part of tliv Dcrve 
which U stimulated by digitalis iu the large doKett which wc have been 
considering. In man we sotnetiines see this irregalar piiUo replaced 
by an ffxcfwdingly rapid pulse, whieh i.s shuttle-like in character; and 
■whetlier the puUc be invgular or mpid, the urteriul pressure is always 
low, owing, first. li> the imperfect action of the heart, and, second, to 
ft d«pres»loQ of the vasomotor centres and the luugcuUr coats of the 
blooo- vessels. The mpid puUe. wlmn it occurs, is probably due to u 
depression of the peripheral ends of the vngua nerves. 

In the frog digitali-s nitusrs. whrn given in full doses, systolio 
arre^tof the beart, hut in nitin (hcarrcKt ii in diastole. 

If a patient who has taken n nainoiinuK dose he siiddenlv raised up, 
he may drop dead, owin" to the uisturbauce of the com faction -wave in 
the heart prnduccd by tlic erect pottture. Under thcHC clrcuinatancea 
the heart beats so abortively that the circulation fails. 

Rkspiration. — l>igitali;ihss almost no effect on this function unless 
the amount bo poii;onouf, when retpiratioD is glowed. 

Temi'KRATITke. — I'pon the normal bodily tem[icrnlurc digitalis has 
little or tio effect in medicinal dose. In poisonous dose it lowers tcm- 
{>eratu.re. In fever the drug iteemH to cause a nligliL fall with some con- 
Btaoey, but it can rarely be nsed for any antipyretic influenre. High 
UmperatiiTfH prt-vent dii/ifoUs from shiin'n^ l/if iiiiJ«i\ because, aa 
proved by tirunton jind Ciwth, fever deproiwes the vngns centres in the 



medulla, iind also in uU probahilily, when the ti-uiiierature is very high, 
dx of tbe va^iitj. Tbl^ i^ an. important |ioJnt to D6 
remembered in the thorapeutie »«c of thin drug. 



the peripheral ends 



KiKNKVS, TrssDB-WAi'TK, AM> ELtMlNATtoN. — Digitalis hftS nlmoBt 
no effect upon the kidney stnictnre itself, and does not to any extent 
stimulate tlie renal epithelium. The nmse of the increiwed urinary flow 
produced by digitjilis in caae-s of cardiac drojisv dtpi-nds upon tliu 
removal of congestion of the kidneys and the increased arterial pres- 
Bure and impmvcd circitlation brought about by the drug. 

It is important to remember that digitalis, if given in overdose, maj 
cause n spa^m of the hlood-veasele of tlie kidney, and eo cauae suppres- 
sion of urine. This is mtualty followed by the development of cumula- 
tive cffccta. 

L'puu ii(>sue-waste lUgitalis xeems to have little effect, but there w 
still some discrepancy iti the reports as to the amount of area cast oS 



blOlTAUS. 



aodrr ita luc, some invMtigstors Baying It U increaeetl, others Utat it 
IB i1imtni»lieii. 

\Vc do not know how the druj; is eliminated. 3« '"hemists hiive 
never betrn atlt- io finil it in ttii? urine. It i» [irobutiW oxidixi'd in 
the brxlj. 

Foisoaing. — The slow, full pulse, followed by ibe huhblinj^, dicrotic, 
shnttle-like ral8«-bottt«, and the M\%ry, (umultUMUs cnidiac beat n^ninat 
the cfaesl-vrull. aflbrcl a couibiiiution uf syiiipiitni.« diiinirtcriHtic of the 
over-action of difntsHji. The pulse may be full wii*l slow when itie 
pattnit is Ivinp <Kihh, hut at nnce hctfuries irregular oii Lis t^itling ii|). 

As the poiiwiiing piv>}jpewc« vomitin;; may c«mt uii. exophtUaliuufi 
occurs, and a peculiar blm* pi>ai'liiit^<t of ibi* Mch'rutie eiiat of the eve 
w M>en. Cotiflciousnesa is generally prcBervcd nearly to the last. 
Deaih from digitaliN poinaning may be put off for days or occur in 
two hours or even lesa. Headache is often a severe Bymptom. 

TkkatmIvNT of PoiwtSENG. — Tauuic iitij \t, to be giveii as a chem- 
ico] Mitdole ; ctneticj? nn<i the r;li>ntach-pump are to be used, the former 
only whcu the drug has nnt yet Ik-c-ii absorbrd. for if the heart \» much 
aiTeeted etneilcri are dangerous. External heat '\s to be applied, particu- 
larly about 1 lie abdomen : the maiutenanceof a)iori/unial po!*ition iiiust 
be iii»iiit«(l upon and iimiiitaint^^d for several dayx u-fter aetiveRviiiptmns 
b^re passed by, fur smhleu death oti ailtiug up ha;* oeeurrud. The uxc 
of tincture of aconite, 'ah the physiological antidiite, may be reBurted to. 

Therapeutics. — Much uufLHtuuare luii'iniden'landiiig conceming the 
action of digitalis ha^ arisc-u, and, while somu call it a circulatory stim- 
olsnt. others think it a circulatory depressant. The first class hiise 
their bclirfon the signs of iuereajted arterial prewiureand cardiac powi»r, 
thi" oihora on the fact that it slows and steadies an irritable, rapidly- 
actiag heart, and they overlook the other signs. ItiijilaliH i» n ear- 
diiir MTtmulaat. ntut iiiit. a tifpri'Mtint. The quii-ting of irri tuhi 1 it.y by 
it 19 the ifuietnciis produced by the ilrink of whiskey or coffcu taken 
hy the piigilint before hu enters the ring, to oteady his nerves and 
make him iinn. If digitalis ia used to deeren^^e arterial tension, its 
do»e niOMl be dangerously hirge. (See Physiol ngiesil Action.) 

Di^talii i« of value In all CAseit of pardiae disease wliprc tbo con- 
dition is one in which the heart faiU to Jo its proper iimoutit of work. 
If simple hypertrophy or Kxcfsfivf coMipen»atury hypertropliy exists, 
it is harmful. It in of leiwi t»1iip in a,ortie regurgitation than in any 
other legion, heenuxe the prolongation of dia.-'tole alluwH greater oppor- 
tnoitv for the htood to fidl Ijuc\ into the ventricle, altliough in the 
aeconil stage of this ieaion, «lien tlie mitral orifice and valve arc 
brgitining to be affected, it is often very useful. In (niuio inatauecs 
of tuitral regurgitation the drug Ani's hariu by ovurdiMlending the 
auricle through ventricular bliiuulation, which ro»ult« in an incrcufle 
IB the regurgitant How, and we can never toll hpfore trying it which 
cuea will he no affected. In cases wliere the heart is irritnhle, pirljti- 
tatim prevent, and indigestiou not the canse of the trouble, digitalis 
i» of service. (See Heart UisniT.') It in nho useful in e-ardiuc 

' It {« abnlatoiir nc ca wary for ihv altiilviit {•! luru I'* (lie artii.-1r dii IK-tirl I'loeaM^ 
ani] 10 rc*il it emretMy, In orilcr U> Ditdcntantl tlic Dction <j( digitnli* in fliwox^ 



. 




SI 6 



DRUGS. 



liiUtatioa and utthouiii.— that cflDilition wliicti DaCosta calU a tired 
heart. 

In th« Bft'ond ntttifc of ftneumoma if the lieart is laborine nnd 
unahle to do its work propcrlv, digitalis is olU-ii invaluable {*(X riieu- 
inonia), nii<i tm a hwirt tonic liiirin^ tlie (.■ours»> of ejfiaii»tinyj'nfra, in 
small dusM. is of ijreat i-urvice. In ciriufi-xtioH of thu lung* in the 
tj'uhoid statu il will driwo out the Mood from the part coiigpstcd and 
relieve Htnji», unh^sa the t4>ni|iurature is so high thut it caiitiot net. 

In eardiat! Wfitlrni'SK from roUup»e, injury, pin»oninff, or g/ivrk digi- 
tulis is Iff aervti^f. parti culivrly in aronitt^ jiotBoniHt/, in which it is the 

{)hysiuloj»it^ul jinliiloie. ( twirifj; to the slownfjis of itii actioti it bIioiiUI, 
lowevpr. lit- juL'i'cdcd hy attiiiiniiia mid uIloIidI wlifre the need is 
§ resting. In niUHCurine iiuiHuniiig digitalis and atropine are llie iinti- 
otes. 

As ft iimrfti> dip;italis is most u.«eful vfhen the kiiineifn ntc cnn^e»tt^ 
nnd the circulation in a)ugi;i»!i fruin canlluc feubleiinw. Wlicii the renal 
FttriieturH iii di^ea^ed other drugs f^bould tiikc it? [jiaee. or it should he 
combined ivilh more active rfinn.! n'tnedipR, sueh as Buinill or naffeine, or 
in very chronif? coses of Icidiiey troiihln with compound spirit of jmiiper. 

As digilaliit acta very slowly fuid muinloinn its effect for a lou;i lime. 
it may bo given only once a day after its elTeets have been obtairivd, 
for tho purpose of continuing its influence. 

Often whi'n the patient has h^ error reeeivpd too much of the drug 
the finjj;er can scai-eely noti; iiiiy piil»e ut tlie wrifl, yet the enr wl)>-n 
placed nver the licnrt fnids it to he heating wildly, ns though it would 
hreak «ut of the chest. It is important that the weak pulse at the 
wrist he not taken as the only guide as to the :itute of the pntient fur 
tllii^ very rruKou. iiitd the phyHiciun t>huidd utwiiya :liihcuII the praeoor- 
diutn befiire reiiehing an opinion as to the action of digitalis. 

Vntoward Effects. — Digitalis sometimi's ciiu.'fe^ nnu»oa and indigealion 
by irritating the stmuuLdi. In chihlivu it is very apt lo produce marked 
irregularity of the pidse. When it \» given in full doses the patient 
should always be made to remain in bed and not allowed to sit up sud- 
denly, iM syiieope may occur. It is particularly important tliiit thi^ rule 
be enforeed if the patiutil desired to empty his bladder, for caet'ti are on 
record in which a jKitient has riwn Huddetily. empticil tiiu bluddcr, and 
fainted or even died in syncope- 

In some casei" a eumulaHvp aetirm occurs, which consists in a 
sudden developirient of the effects of the drug to an exev^ive 
degree, so thai Uie symptoins resemble those seen itflcr a poisonous 
doae hoe been taken. This is pnrliculnrly prone to occur irhen 
aseites or dropsy is remoTed by tupping af^er the drug has been taken 
for a long period. It is thought that the sudden withdrawal of prea- 
Bure upon the gri^t viUi-uUr trunk.« of the body-cavities causes th« 
absorption of the dmg with tlie juices of the ti^ucs where it has 
remained inactive. Such un accident also sometimes occurs when a 
fever cuds by crisis and digitalis has been given. It also inkes place 
whenever full doaes are given so fre((ueutly lu* to be in exces-s of elimi- 
nation, for the drug is Mowly climinalcd, and so rapidly aceiiuiulatea in 
the body, ('uinulative action is often preceded hyu scnntr passage of 




arine. A iIl-ci'l-atc iu the quaolity of tlie urine wLicn iligitalis ia being 
tued cliofiltl caiifto tlit* jili^'eicjuu Co stop iu adminiatniiioii or be most 
Qoutioiiit ill U.-^ iMiitiiiiiuiicc. 

ContxalndlcaUom. — Iu ciidw of marked atheroma of the blood-ves- 
selfl. in aneuri:^!!) »ntl H|ioplt>;^y di^ilaliH in a lUiiiicrouM drug, U'cuiiac it 
raises nnorUI prcwiire. and it if liecaiise of tins tft'ect lliiit it is bariuCul 
in thu ijrwcncc «f urtcnnl excitewcDt. In fittty degeneraitioa of iho 
htmn the rcmsiriiu)^ heitlthy uiuiH-ular fthn-n of this orc«n arr, it Ih 
trac. stiinalated b^r iho drag, but at thi- ttuuir tiiuc it also iucreases 
artpriiil li-tuioa to auch an extent aa to increase tbi- tabor of the 
failiri;; heart. 

AdmlnlstratioD. — Tlii> offii-ial preparations of di^'italiit nfc tho liiirl- 
are (Tinclurti IfitfiUtiio, I.'. <S'. and B. 1'.). dtuc •> to 2U niiuitiiii 
(0.32-1. S); thi- infusion {]nfu»uin iMfjilnlitt, V. S. and B. P.). \ to 4 
Oreclinu {:l.O-]().il) ; the lluid extract {Kj^tnu-tum Dii^itaUa FUtidunty 
V. S.), d«jM^' 1 tti 4 initiiui^ (0.(l;>-0.2) ; the oxtrnot {Krirai'ltitn IHtji- 
talia, I'. .V.I, J i<f a pmin ('J.'U5); mid thv pwvrdcred difriloli^ Icavoa 
{bitfitnlU Fnliii, B. P.), do«« 1 to 4 grains (O.fl,"»-0.2), gfiit-nillj given 
iu a pill. 

Soinp ehi>ii'L> should b» pxei^isod in thi> uw of the various prcpa- 
ratioDs inado from digitatiit leaves. bi'rcauHti the diffiircnt active iug^c- 
dienlN nf the dru)? jMtsspss difflV?roni flolubilitipH and exert different 
elfeclj* on the circulutioti. Tbu'* digitalin, digitoxin, and digitsleiii 
all act a« ponerfid xtiiiiiiluiitit to the ht'iirt inu:«c)e. Digitnlin iiho 
stiinulHl«!t the Viigiti^ pcripberatly and centrinaliy. .Alt three of the-sis 
Twse arterinl prewiure hv stimukting the vasomotor svKteiii poriiih* 
erallv and i-cntricnlly. Dlgitoniu. on the other hand, <iul-s rjut t>tiin- 
uliiii* ilif henrt musele, biit rather depresses it. It also depreswcs t!ic 
vo^iiK and tJiercLjr somenlmt aTitiLguniites the digitalin,' digitoxin, and 
digilalein. 

If Me now turn to a consideration of the solubilities of these prin- 
ciples, we can readily explain the different effeels [irodueod hv the 
infuaton and linvlnre or tluid exIrncU Dit;ltOTiiii irt noliihlc in nnUrr. 
M In digitalein; hut di<;it.%lin is only glij^htlv soliiblu and digitoxin \» 
acarcclr at all soluble in wulor. At< a result, thi; Ufe of tlic infosioa 
in a ra»e of henrt di^ea^e would not give llie jMtient tla- t:\ii\i- <l<?gi-ee 
of cwrdiftc power as the «**■ ftf the tincture, for not otily would the 
most powerful stiinnlant i>f all to the heart. va.-<oinotor system, and 
TBgi — ^namely, digitatiu — be pruxcnt in »uiaII amount, but in addi- 
tiuu the Urge prujiurtion of di;;itoiiin would antidote it. On the 
other liand.,digitoniu is ^puriugly soluble in alcohol, while di;;iia]iu 
and digitalein are readily Noluhle in it. dijjitoxin being sliglillv so. 
It would seem, therefore, that in the preiM^uce of a failing heart* and 
circulation tlie tinelnre and the Huid extract are the pre|mnitiou!i 
greatly to he preferred to the infusion. bccHUJc they contain Urge 
amuUBts of the active stimulant ingredientH. 

The reason that the infiiBion act*) ctGcietitly as a diuretic in some 

' Hy dli;liatiD, refemiKW it mwk- to Ihnt prvimred bv MiTi-k, utii] i«nirn>tiinoi railed 
ihdtRJtalin of Scliinieilrbcrii. ond oul the a mo rp 1 1 una 'form uf llomnllcnor tlie crys- 
lalliitc diEitBlin of NaiivcUe- 



218 



DBVO& 



caaca probnblj depends apon the fact that as it does i)ot l-odIuiu »o 
niiich (ligiUtlin it ts U'sh apt to cause spum of ihe rnnal vesfltiiU; 
but if tue he-art is feeble aud tliiTL- h reua) otwiu, tlu- tincturi.- is 
probablj the belter pre]iar»liou to ovt-rc-ome ibJB stale, because it b«tb 
aitU the he-art and by vontraeting the renal vcaselft overconiejt the 
i!t:i«iH. The u»v of digitaliii is innilvifijiblo. unless ve are sure that ve 
^et tliat made according (o the prucesti of Schuiiudelicrg, for thu other 
digiuilius iitiually sold iirt- wry utii-tTtnin. The iiifu!«ioti m far tnora 
iipt (o disorder tue stuuacli tbnii tho tiuidextmcl ortinclurr, bf^ause 
of tlie irritatiu^ digitmiiti, Tlie iltisp of digitalin, which ought not to 
be used aa a substitute lor di{;itali», i;* A of a grain (O.Wl). 

When (Itgilulis rniiuot be swiillowi-d it ran be gireu hvjioilenui- 
cally iit the form of thu tiucturu, or its ab&orptiim can be brought 
about bv the use of a poultice maxle by pluciitg some digitalis leaves 
ill » ^miill bag and eieepiug it in bot water. Th'e bag i» then placed 
over thf loins. This trt<HliiK>nt niu.sl he cjiutioiisly ciitplojcd t« avoid 
poisoning. 

Alieution has already bci-ii called to the neeeHSttj of using a prepa- 
ration vihieh hii» htcu ftubjocted to a physiological test by the niauu- 
facturer before it is placed on the mnrki't. Tlii>t is important because 
the crude drug rariea so grcAtly in strength that even the most careful 
piiarmacist camioi be wire tltat each lot of leaves is of equal medicinal 
atrcngib, and chemical analveis of its complex make-up i* practically 
iiiilKMsible. Often when a pnllelit has been taking an ordinary pivpa- 
ration of digitalis without gcod results the writer has seen the use of s 
physiologically tested and active preparation do mucb good. 

DltTBBTIN. 
(See SOOIO-SALIOYLATK OI' TUBOSKOMINK.) 

DORMIOL. 

This drug is closely related to chloral, being a compound of chloral 
and auiylcDC hydrate, luid occurs as a colorle-os fluid, tasting somewhat 
like camphor and being slightly pungent lo the oral nuicouB membrane. 
It is miscible with water, imil is mnrketwi in fil* per pent, wittery solu- 
lion, which is further diluted by 4 addJlimml parts of water when it is 
prescribed. It is used as a hypnotic, as its name indicates, and as a 
substitute fur chloral, but is probably not so powerful as a sleep-pro- 
ducer. Its doM ia 1 to 1 drachm (2.0-4.))) of the 10 per cent, solu- 
tion Just named, w-hich may be mixed with ejnip oi raspben-y. or 
water, to dilotc it if desired. 

DUBOISINB. 

DaboisiDC ia the alkaloid of the leaves of Ihihuinia myofiomiitrx, a 
plant of Australia. The crude drug is little used in mediciue. but 
duboisine sulpluic is used tu^ a my<lriutrc under the s^ame eoiidlrions a* 
is atropine, anil more largely still a,-* .-i hypnotic in intittiUff. inter- 
ebangeahly with hyost-ine. Thedojie of dnbnisine sulphate hvpcidermi- 
cally as hypnotic is B»o to ^ of a grikiu (0.0008-0.001). The clinical 



ELATSRWM. 



2ia 



experience so f»r ailduretl wouli] seem to indicate that it tends to de- 
crease uriuarv jMxrctioii and to disorder tlit digostion, pryduciug iit tbo 
same lime n sonpj Insto in the moulh, with exc(>fi!<iT<> drj-ness of the 
mucotts iijciijbrutius. Har<rl^ it c'aii8<» proruse salivution or sweating; in 
thoM who hare an Jdio^viicrEsy tu its ii»t-. In a large niiniher of inonne 
uid tiTStorical cufts \)v 'SUtwiyvX found \u ukc wa» followed b}' vom- 
i^ng m part of the food, hut the patients Hc^i-nied to have no naiteca. 
The ptilpKate ha« l>e#ii used with much asscrlc-d success in the treat- 
ment uf para/ifsi* affitaan. I'sniillj the dose \>y iht- iimiith for this pur- 
pose l)a« het-u rJo of a •;rain three times a day. Cividatl and Ginnolli 
Bssen that dtibuuiae is useful in eptkpftf, particularly in ita ps^xbio 
fbrais. 

ELATERIUM. 

Elatrrium. B. P., \» a sediment obtained from the juice of the 
Behallium f'UUeritim, or aqoirting cucumber, It appears in small, 
eaaily-broken, thin, gr»Yish-;^een flalcea. and has a bitter taste. Ela- 
«4?riwin is not official in tKe v. .V. P., but iw active principle; elaterin 
(^ElftUrinam, V. S. and B. P.), ia official. NotwitkataadiDg this fact, 
the crude druji is largely ased. 

FhjrtiioloKicakl AcUoa. — Elaterium ia a very dc<:id«d irritant to all 
macouH metn hrane.''. and e%'en to the fingers of tho.>^) who handle it. 
It« chit-f cIVect wht'n taken internally by man is to cause profn.->e 
wAtery stools, but for eouie unknown reason it rarely acts npoti 
animalx in thii* manner. 

Therapeutics. — Thi,-! drug in the best hydragopic purge which we 
hare, causing vury larf^v watery uassages. but not producing much 
pain when n^tsi in prvjpcr dose, ror this reason it is udofu) in the 
treatment of local nerotu rj^utilnna. ns in jtermtrililin and plcurisj/, and 
in drop»y atid atetlA-t or (icui-ral anasarca. It ouj^ht never to he used 
in cuea of marked exhaustion, and may be advantageously followed, 
aoon after it aot^ by alcoholie ^imnlnnt-'i. Fn unrTma with dropsy it 
10 thought to aid in the elimiualiou of the unemic poison by the 
bowel. In eere^al f'>n(ff»tion» or vffum'ons the drug will often be of 
aerricc by depleting the diseased ves-wls. 

In pouoning by elaterium thci Hymplnmn are those of violent ga-s- 
trr»-rnterit)H. and mu5t be treated accordingly. (See Giistro-eiitoritis.) 

AdministratioD. — The dose of elaterium is J of u grain (0.01), 
given ID a fresbly-miule pill. Elaterin is bpnt given in the dose of 
from ^ to y^ of a grain (0.002-0.004), as follows : 

B.— BUterinI .* p. iv (0.2). 

AlooWliH . fjiv (l-^.O).— U. 

CKawirc liy gentle beat. 
S. — Half R ilraoiim («ntajiw -^ gnXa 10.004), or oi)9 ^11 doM. 

The official preparnlion of elaterin. tlie aetive principle of elate- 
riliia, is TrUuratio Ehtterini, U. S. (elaterin 1, sngar of milk It), 
given in the dose of J to 1 grain (O.OS-0.0»j|. The Puhin Ktatfrini 
OvmpotitHt. B. P. (elaterin 1, sugar of milk 39), is given in the dvae 
of I to f» graina (0.05-0.82). 



I 



2S0 



DBVOS. 



Put. 40. 



BROOT. 

Krtfota, U. S. and B. P., is dorivftl from the spawn or mveGiium of 
tilt' fuiij;u« kiiuwii as iUavirapK purpura, wliich gi'riws in thv flower 
!iml ifplm-'cs the ^raiii in coinmon ryfl, or Seeale- eerfate. 

MaDV ao-cailed uctive principles havi- been iaolated by c-bewislA, 
and nampd cctioltc rn^iil, ergotio scid, sclcroiinic a4.'id, atid ergotin. 
Noue of tbeae rc'iiresent ilit; entire drug, tlie 
nc^ircst in its appnjacJi being ergotin, and 
orgntin is nut ilii iHolutuil prtriciple. but a oin- 
binutioii uf priuuiple;). Kutt-i'l loaobcd tbat 
tbcrc are three principles — namely-. iTgotiiiic 
ap\f\, c) mil title, and nplmooliiiic Ufid — and 
that corimtine is a triiu alk&lohl. Further, 
that it is upon tlii;^ cornuiinc and sphacclinio 
ociil that the ebief aetivity iiF the drug do- 
prttd^. TiLiirt't, on the i>lber hand. (Ienit<t> the 
existeiiec nf nirtiiitiTie aa an alkaloid. 

Phy«oIo6icalAction.—NKRVouK System. — 
Upon the iitTvuuH sydtcin cr^t cxcrcitics littJc, 
if any, offect. 

lUnci'r.ATiox. — Ergot when injected into 
the ciroulatinn caiistw a primary fall of arterial 
pressure, fulluweil by a ri»e. The doiiiinnut 
action i!> reproii<^'atPd iu the ri:$o. This rise is 
due to a stimulation of the vafornotor centreft, 
but the primar)' fall ij« (»U!>ed by its direct 
depressant effeet upon the heart- muscle, re 
suiting; from the direel contaet of the drug en 
maitfe with the heart, [f the di):<c be very 
large, the fall iif pressure i« never recoverwl 
from, and projjreseive paraly&is of the vaao- 
motor appanituft and heart oeours. When giver in mcdieiiml doses by 
the slom»ch the drug (;*iiaes a rise of arterial pri-ssurc, probably by an 
artion on the vasomotor centre and the muscuhir euata of the blood- 
vessels. 

Uterus aud UssTHiPKn Muscular Fibrk.— It hae been com- 
monly taufiht that the eontractione of the uterus productd by medicinal 
dos4w of ergot arixe from the fitimulatiu^ JiitlueuL-e of this drug upon 
the musculut* fibre.^ of thi.<( orpan : and while this ia probiibly the ease, 
it is also a fnet. a.« shonn by the careful Ktudies of Iletinneter. tiiat the 
dru^ cauitcs uierine eontractionB by stimulating the centres in the 
luuihur pnrtiou of the spinal con! wliirb contn:il this visciis. 

On the uteru^i erROt in full mcdiciual do»e cxf rts its influence not by 
increafiing th<- normal pains of lubor. but cuusing a tetanic, tonic, 
ntyieldiug ute^^nc bpasm which drives all before it. In verv small 
<loM»i it miiy assist the norma.) contraction.'* without causing them to 
lifcome tetanic. 

luyot ai-t-i us a Ktlinulant t(i all miauiped muscular fibres. 

Acute Poiftonlng, — The symptoms of overdosing from ergot, when 



• 



A, Rifot fUmnUtf* lli» ut«- 
rluit ceiiitvt III (lir »|itiMl 
in>nt, anil ft, t lit. riiiiii'irlai 
MiTtr ill tlir ul-nia Ilavlt 



ERGOT. 



221 



the elTwts are nlonly product?*!, arc unnietiines grenl riunger or CTiiving 
of ffoH, nt other time?' unii^ea anil vomitirii;;. If tin.- |)oi?i>iiiu^ ii" qwitu 
ppv«'re. ihert> nre ercat re8(Ieasac*«, hcadaclie, tloliriuiu, »nd coldiioaB 
of tlic suriiit'*' of ilic IhmIv. 

Chronic Pol80iiiii{. — Two fortuB of [loisuuiDf; fn>m tlie proloDgrd 
u«o of fTgoiizcti ryo lirrail ^tometinics occar. Oim is clinnictt'riBed by 
spNsinoilit: musrular iMntmclioTiR, the nther cniiNiKts in the fitriniLlioii 
of piujirfnoiin pl<ni;;lis. Ill the first of thc-sf foniiK it i;* not vtry un- 
coiuiniin for nitririct to (levolofi, ami it i» 8t«u-il thnt thv 8}iiuiiii» ^re 
due to the itillttL-iiCB of ouc of tile principle of urgot — n&mety, cornu- 
iine. 

Tberaiwtttics. — Ergot is eiTeu l» pariui-icnt women for tlie preven- 
tion or irre^I of jwitt-partum hemorrhayx. For tho prevention it should 
Ih> gir«u to tliL- noiuiiii by tht- mouth ju.->t aa tht; Lt'a<l of ihir cliiltl is 
about to slip orer the pvrinfum. nnil uut before, but in (he majority 
of iufitancri* its line in nee-.nc.s.s. W'hm iKltnini.'^tvreil U* slop a hunior- 
r)iag« a!mi<ly flowing, ihe ijiwen .ihoiihl he large, ii* much iis ! tn 2 
ilrachuu ll.lMj.O) uf the flui^l extinct i.r 1 Viiiegl^ii^ful (:j".il) of the 
«in« of ergot. The drug nhouhl produce it$ eBecm in abtuit liflcrn 
mioittcs, and nmy be repeated every lifleen tninntw till it nets. The 
action laUsaboatbulfun hour. Ergi>t ^thoiild litil begiveit in theeurly 
stMW of labor, but thia rule may, under eeriuin cundition;!, be niodi- 
fira. If alerine inmliii eoiiies mi in the course of » noriuni hibnr, 
vrhich cannot be overeouio by the use of coffee or kola, or other ner%-o- 
itiimnlant, a xmali riose of ergot may bu Ginplnyi^d. Siieh a sniall da-ic 
<l<>c* not ciiiii^c a eunstaiit Iclaiue uterine contraction, but simply luingit 
OQ thtf "'to-aml-fro" movements. Hv u "siitnll dn»c" the writer means 
from 5 to 'm minim* (0.;J5-l.:JJof t&e Huui e.xtrnct. Cuutkm uniat be 
itKed even with tliis iWe. 

If the birth-canal is obetructM. ergot iehould never be employed, 
aod. uulefla the oh uteri i.<i welt dilalea, fihnuld not be given in any 
dose. 

In |i<»t-[Kiitum bemorrliago of a severe character it may be well to 
give a siduiion of tiie sujueotif* extract of ergot hypoderrai cully. The 
extract should be ruld(e<l with the proper ntiiouni of water (piirtji 1 to 
A), aiid filtered through a line aseptic handkerchief to gel rid of foreign 
bwlits before it is injected,' 

When ergot is given care t^hould bo luken that tlie ulerine ciivity is 
clear of all elot-4 or phiceiital frugmcnta, lest tlic clunure nf the (i<4 uteri 
under the iutluence of the drug imprison these hurmriil mnterialii. 

Ace<»rding U> many obstetrician s. whose repultw Inive been eonfiritied 
Ipt a number of tf ccial i^tudie-s ergot in moderate dosei* very distinctly 
aids ia ovorcoming ftthiaroJudon of the nUrm, 

lu hernurrfrngc* from the funj/t imtl hdneys or other unapproach- 
able |Mirte ergot is thought by some to he veiy useful when given by 
the muQili, but it is probable that it nirely achieves any rtml good. 

' l'nd«r ihnnamiinf ' Krjcot Aiu'ptir'' ihai-f U <1i-pi'nm>i'l in ««xki1oni1 «u>Hli>eln^ 
iKiltsa mnpcnmtctl prepiirntiini of ercni I'-'r liyiiinli'miii:' u-ie. Fach liiilh iKiliUntitt 
llaM^ anil llw drag l> dritwi) iliivL'tlv ltr>iii it itili> ilin Hvniifii!. Thi> in n miMt iiM-fiil 
prcpintiiin. 




222 



DBUOS. 



. Particularly ia this the case in pulmonarj hemorrhage, since the vaso- 
motor nvKt^m prncticn-Uy ilons not exist in the pulmonary veaaeU. ami 
the inrrcaseil pressure causcit hy thf; Rr(p>t in the genural ay^tvtnic cir- 
culaliou ma^ increase the pulmanary leakage. The truth i^, that in piil* 
moDury hemorrhage very tittla real good can be obtained by iuterual 
meilioLtion. 

In ipittaxis, mmorrhftyia, and metrorrhagia, and in some casM of 
nt'ffftt'gweats, ergot is of service. In h^pogtatic, jmlmonary, luid other 
ctmt/estiona it \i UBcful, particularlv if employed with digitalis. 

Id JtfseHterirg with bloudystuola and in »«rou» diarrhaa ergot 8om^ 
times doE« ^ood. 

Some persnns sulfer frnm vertiffo a^sanciated with liyiwneatheaia of the 
scalp and headache. Relief can ol^en be obtained in such cases by the 
uw of 20 minims (1.3] of the fluid extract of orgot and 5 to 10 grains 
(0.35-0.G5) of bromiae of potaMium throe times a day. 

Ergot ha.H been used very largely in the treatment of iiU-rine fihroidM 
a^ an expulsive remedy and cure. It is only of value in those caftes 
where the growths are ju»t beneath the miiRous membrane. By the 
contraeiioiiBuf the uterine muscular ftbrciitfae blood-supply of the jCTowth 
is decrejised, the recurring hemorrhages cease. a.ud the tumor is finally 
expelled, having really sloughed out of its bed. Thin method is far 
interior to the knife, iiinl very painful and prntonged. Large growths 
uiDDot be 90 ireatcnl. Ergot in rtoinetimca useful in the treatment of 
hlufdiii'j hi-tnorrhaiiin. and it has heeu giren wiih success iu dialntes 
irmipidiui, when it i,'* well to combine with it the bromide of goclium. 

Adminlstratioa.— Brgut is official as the (tuid extract (AVtrarrMnt 
Ergotit; Fttiuium, I', i^., KiiTuHiim Ergottn Liifuiiinmt B. P.), doac 
4 to 1 rlrachni (2.0—1.0). The wine { I'tVum h'rgoi(r) is given in 
the dose of 4 to H drachmi^ (lt>. 0-30.0). Bonjcan'iii <-rgotin is made 
by a Sfieeial procet^. and it or llie solid extract cau be given hypoder- 
mically in the manner alroady described. The B. P. preparations are 
the -tolid extract [Eztractttm Ergottt), whicli w given in the dose of 
6 to 2<J grains (O.Sfi-l.S), and Infutium ErgoUs, 1 to 2 flnidounccs 
(30.0-(i4.0). lnjert.io Krifotup Htfpodemu'ca, B. P., \a given in ilic 
dow of 3 to 10 minims {o.l.'V-O.h'ii) hy subcutaneous injection. The 
B. P. iiliso recognizes an ammonia ted tincture of ergot (TVtwfuni 
Eryotir A>»m'.miata). Ergutin [^Eryotinum) is given in the dose df 
2toi>grainB((l.l-0.8:i). 

As ergot is a drug that varies greatly in its phTsiologieal activity in 
its crude state, and can not be chemically asMnyeil with advantage, the 
nliy.'iician should always use a preparation which has been physiolog- 
icfilly tested bv the manufacturer Iiofore it is placed on the market. 
This may ho done by studying its efPeet on the uterus nf n pregnant 
animal, or by giving it to aiiiuiaU and observing itH cCTei-'t on the calibre 
of the small veasels. If the drug is active, it causes stimulatioQ of tho 
muscular coats of the vessels; and if its use is persisted in. it finally 
ocelndes thom. Houghton has shown that an aetive ergot will caiixe 
gangrene of the rooater's comb if it is given eonslantly. Inert ergot 
will not do th\A. {See i'lat« V.) Much credit id due to llougbtoa for 
iiaving perfected this valuable pharmacological twt. 




Showing Shrivelling And Dry Gangrene oT Rooster's Comb pro- 
lIuc«(1 by lh« eciion or an active spc'clmen of Ergol on Ihe 
CapillBries, Iher-eby cuiiing off the Local Blood 
Supply. The c«nti-al figure shows ihe nor- 
mal comb. ^Aaer E. M. Houghion.) 



ETItES, 



223 



ERIGERON, or FLBABANB. 

Oil »f ErigeroD (Oleum Eriyerontib, U. S.) u a jvllowisli volatile 
oil of a ptfculiur. not ba<l. laatc. <.'1(i);<.>ly re&emblmg torpentiue, wliivli Is 
dutillcd {rum tho fre^h, Unwcring hfHi of Krigeron canadente. It is by 
fiir lilt' lipsl meilicinnl rfincdy which wc have far tho troatmcnt of paa- 
EiT« Hterine ovzitif/. or u "iiliuw," as it is soiuetiiucs called. 

In tpittaxis untl other liomorrhiu^os of moderHte ilp^rce it in finite 
useful. In somo iuataDCca it ia used id jiluce of cojmilia aud viiboba 
ID the lattT stages of gmtorrliara. It is besr given iu ca|)BuIe or ua 
augar in the daw of 10 to JIO minims (Q.iiii-2.{)) after meals, or oftcoor 
if needed. 

ERYTHROb TETRANITRATB. 
(See article on Xitkoolvcbrin.) 

ETHER. 

Sulphuric other is offit-ial ns ^fCther, U. S. and S. P., niul in the 
XT. S. rhnrnmcopoein of 1S8I) w«s oalloil .'Kthfir Ff'Ttiar. Pure* Ellioi" 
{Jilthrr pMnfii-fifHK. B. P.) ia (inicliailljr' fn'« from uluoliul and whIit. 
Ordinary (^tlier isiiot j;(>n(>nill\ \x»itt\ asuii;ji)».'!it)ic-tk>. but for tl)iMil»itnjL>- 
lioD fiF fwlft and for other phitrniaiTciitiriil piirjinsrs. Etiirr is niiuir hy 
till:' action nT sulphiirir ni^id on ctliylic alcohol, and ia sometimes mlled. 
in con)tequ*;Qcc, cth^'l oxide. Urainary ether cnnttiitia nbuitt 74 per 
Oeot. nf etliyl oxide and 18 per cent, of alcohol, with n little water. 
On the other hand, the stronf^er or official ether contains ubout 96 
per cent, of eihyl oxide and only 4 per rem. of nlcoliol. with water. 
Both preparations boil vrlien hehl tit a tcst-liibe if a pieci* (if brokrn 
glass ifl added to the litinid. The atrongcr ethL-r boils much more 
rigoroualy than the weaker onder those circiim»tanc-cti. 

Elher po*«es»e8 a iteculiar peiiotraiiug odor, a hot burning lasle, 
and is a colorless, volatile, and very inflammable licjuid. For this 
reason it lihonld never be held near a tire or light, and. ax its vapur 
b heavier thiui air. any lire in the room should bu abuve the patient, 
not below him. No (latDc should be held nearer to the ether th&n Sve 
feet. 

PhTsiological Action. — ^Tho action of ether on the nnlina] organism 
is very rapid and powerful, but temporary. Except for the rapidity of 
ita eifectif it is very much like that of alcohol. When applied lo the 
skin, it caoiies intfln^e cold by its evaporation, and may be used in the 
form of H spray to benumb or locally fi*eexe a part. 

Upon nucoos membranes ether .is a liquid or in vapor act«i as an 
irritant, and causes, when ita vupor ih fimt inhaled, great irritation of 
the fanees and respiratory tract, so tliat temporary arrest of respiration 
is not oDCoinnion. The face becomes .suffused and rfd :»nd the cojijunc- 
tira tnjeeted. Owing to thoiie conditions the paiienl otu-n in ro.^ricMs or 
or struggles to get his fticeaway fi-om the vapor, but a ntiige of <juiuC 
«aoa gueeeods this primary t^tage of ittruggling. During ihis ^leriod of 
qntnt the breathing is generally full iind deep and the pulse rapid but 



Hi 



DRUGS. 



-ip'tii:, T-ii- tin- nruliir n-flexw are at its beginning intact. Following 
■II- ■«uir' i ■^•-runil |ipri(Ki of restlessness or struggling comes on, in 
wji'!- r; n«ii>>iit nmT become absolutely uncontrollable except by 
Tiitc T— 1 filing, (shouting, cursing, or laughing ;iitil crying, may 
■(' n'':-..!!!"!!- -^ynijiTonis. and tbe intliviilual is pugilistic, caressing, or 
ii-;r'r.i'T"»»-i.. aiTording itiliis U'inperanient. If the drug is nowjiucbeil. 
L '■iniii:ii>i i>- mtiil ai.9i>sthe:<is is snon attained, and quictuile takes 
i.c iiiu-i '.- ihf smiirgles. This is tbc time for tbe operation to be 
■ni~i-i m.. iV if ii is attempted in tbe earlier stages the ."truggles of 
-rii- Mf- ft'L sTaure TtrcTint any operative procedures. (Sec Therapeutics. 
V'l -v J'. \i. Tifti T>r.*por to push the drug till tbe niu.scular relaxation 
«2- l: > V. coinph.ie tiaeciditv. as this endangers the respiration. 

SEl.V('r> System. — In producing its effects, ether acts Hrst on tbe 
bn'iii. theri rm ilie sensory tracts of the spinal cord, then on the motor 
tracts, then (ta tiio s^nsorv side of tbe medulla oblongata, and finally 
upon the tDou-fl- si^W of the medulla, and thereby produces death from 

Fia. 41. 





ntm iM><.liiiv< iiiiii>rtii>lH liv .l.'|>r»>iiii: (hi' porcpptlvc An.->K In thp brain A. Ijitor ft 
,*,>iuvw> 111-' iiilill.'iliiiil 'iriii-. i: i>il>l llii> imxiir an'n» l\ AftiT Uii» ihe senson' patlifv in 
1Wi|<Iim1 -'<'I>I oil' •lr|>ri'F»-<l I<, mtil liiiiiUv tlic m<il<ir trai-ts In llic tonl E. 

rwi»ir»1«'iv liiiliirc it'itiveii in excess. I'poii tbe nerve-trunks it exerts 
nn effivl itiilf-'S 11 is directly applied to them. Ether does not produce 
i«m'»tlie-.ia liv iiilliti'iicing the blo.>d. ooagubiting tbc protoplasm of tbc 
nor\oii-» ■.\-.ii-iii. or l>v any itibcr desinictive inlhieucc. It simply puts 
A^idti, t'nr llu- linn- ln'iiig. the vitnl functions uf the parts affected by it. 
Cnu'l t.ri'ii'N.- Ktlier is nnc of the most diffusible and rapidly act- 
)»ilt'(itdiii.- r.lmiuhints «hich tte]K>ssess, and is correspondingly liceting 
ilt ill etlirt^. I( iiiereiiscs tlie pnlsc-ratc and firce by stimulating the 
\am\\ iiuil Mil- luti'riiil pressure by increasing tbc activity of tbe vaso-' 
IHtttoi r.iiir.'.i In ii\crdoses it acts as a cardiac depressant, but only 
%ltiiii llii iiiii-iiini is vi-ry large. I'poii tlie blond, my collciigue, .1. 
tMttilnii-i-' ItiiCnsiii, has >li.<\vu thiit ctlier. when given by inlialation, 



ETHER. 



226 



I 



dwrosAw tlie hwmoglobiTi nelinoM of e«ch «orpuPcIe, although there is 
nn apfwrent increase in the nuinhcr of the L-nrpiincIeK thrmKel vch, par- 
ticuUrly in thntie persons who are already stunewliat anffiinic. 

Respiration. — As alroAily stuiet], when L-thor id first inhaled it 
often eau«-* an arrest of reapiratioii. Accordinji to Krptzst'lirMar, this 
is Auk to an imtiitiun Hfihc trifacial nerve, which cnusM a rellcx spasm 
of (be glottiB. and not tu irritation of the peripheral vngi in the luaes. 
Thia 15 only partly true, for ihe author has proved ihat section of tlie 
Togttii nene» prevents this occiirreiKv, ^o that both the vagal ami tri- 
geuiinul irrilulions are respoiiAibie for the arrest. 

lu pKtieiiti) under ether the morement nf ilie diaphnigm is an 
exceedingly interrsiing study, for hefore ilie condition known n» sur- 
gical anssthesis is developed, while there 13 still some rigitlity and 
the tlirtNit reflex is do) complelely abolialied, the coutractions of the 
diaphngin are frequently so violent llat uulesu the laryuffeal open- 
iag be absolutciy free the intercoHtnl ttpace^ are depve.«sed auJ the 
alMli>minal eonleuls thriiHt vioteully dunnward anil mitward. Juut so 
H'Hin. however, il» the chin is pulled forward »iid a. free accesa of air 
ia allowed, the nhdoniiiuil displacement, though it i» sTill present, in 
fiot au great, and the chest uiuveinetit is no lungt^r reverM-d. As tlie 
etber in pushed the respiration beeuuies purely llmraeie, the din- 
phmgtD DO longer taking part in the respiratory cycle, or becoming 
■o relaxed that it allovfi the che^t on cxpan'^iun to u^tpirute the 
abdonuoal viscera upward, as is shown hy the rrlractinn nf the hrlly- 
valla at a time vhen ihey should normally cxpHnd wilh the thorax 
ID ioapiration. Thi(« observation would seem In point to the fact ihut 
the primary stimulant action of ether upon rhe respiratory upparalua 
is particularly felt hy those centres which govern ihi- niovenienta of 
the diaphragm, and Ihut, aa this is the case, thottt ceutrL^s Inter on ara 
the firat to feel the jiuralyzing eflee-t of fitill larger uiuouiits uf tba 
drug. 

Tbeaa facta give ua, therefore, a daneer-aignal during the adminia- 
tration of etlicr. and the integiHty of tlic diapbragtnatie function, as 
reprBROnted by Ibo movetnont of the helty-walls. should be as caro- 
fhlly observed as are the thoruciu exeuniiouK, the ehnrtieter of the 
poise, or the condition of the pupil. The rule may thcn/fort' be laid 
dovtn that when the diaphragm eeaiies to act ana>sthe!iia bus Leen 
carried to its extreme legitiiuute limit, and that the use of an uD»>a- 
theljc aHor tbia time must bo carried on with the greatext care and 
watch fulncsa. 

The diaphragm is the firat part of the respiratory mecbaniam to 
yield to rcspiratnry paralysis. Id death from any cauee the progresa 
of failure of respiration will, in llie vaat majoiiiy of cases, be denoted 
by a failure »>n the part of the diapbtagni primarily, with compcDsu- 
tory excursions of the cht^l; and it i.H also to be noted thai as ibo 
cheat movemenis fail the accessory muscles of the neck come into 
piny. These musclea in time cease to act, the byoidean group Inae 
their point d'ajapui, the chest rcmnins tnotionk-ss, the lower jaw is 
dnijiped. and tbc scene is cti).'<i-d by u few gasps in which the muscles 
of the neck may be the chief factors. 

IB 




' 



Upon th« respimtory centre ether act» lu a powerfal stitnalant when 
iiKpf] ill ordinary umouiits; Ui ovcnioee it punil^iEcs tbis part of the 
nervoii>t eyatem. 

TivWPKKATrRK. — I*n»I(>nge<] ctlieriziition lowers the bodily lieat very 
grcntW- That of tlic »!(»}• may be lowered Home fl" F. iti aii hour if tht 
urug lie pushed, and ha greni u liill has been kDovrn aa 4° V. in man. 
Till' fail ix partly dwc to thu deprctasion of ibo nervniis system and the 
chilling nf the body and hing» by ttit' t'viipumtion of the dTug. 

Elimisatios. — Elher escapes frum the tody by the luugs and 
ki (lilt? vs. 

Untoward Effects. — Ether, while safer than chloroform, i» not ab«o- 
iult'ly dt-VMid of nil dui])CiTou» ufiVfts.' ^oiiiclilueH. when the dni;; is 
pushed Io<^ stroiiglv, dee[i eyaiiosiH wilh pulsatiuii of the juj^uliir veins 
shows deficient oxygenation of the blood and nirdiiic <listentio». In 
other, very ran*, instances Midden enrdiae failure has occurred or total 
Brrcst of respiration ensued. In nearly all eases of sudden death from 
elher j(i-ave kidney or heiin lettioiiti have been ]ne«eni, and have been 
found at the awtojwy. Rarely tbi: riau of arterial piv^sure which it pro- 
duces haft caused apoplexy. 

The treatment of accidents duriDg cthort&atioii consistft in the 
wiihdrawal of the elher. the use of artificial reapii-ation, and the 
placing of ihe body, if ihe face in pale, bead downward. On the 
other hand, if the face is tioslied iind cvanoiic it indieateii respiratory, 
not cardiac, failure, and thj« jiosiliou is not to be reaorted to. The 
phyitieinii slmuld alsu einplny hyprideruii« injeetiontj of strychnine. 
atropine, and digitalis, or. more rarely, an intravenous injection of 
ammonia, whieh i» more dangeroug, but better than the others in a 
presfling emergency because it is more rapid in ile action. Elher is 
often given hypndi>nairally nnder imeh circiimRtance^, and may occ^ 
)«ioiiully do goo<I, hut iln iim> i» a b:id practice, u^. if the heart or reapi- 
ration is already depressed by ether, the eioployinent of glill more of 
the drug !»injpiy makes uialters worse. The cases in wLicJi such a line 
of ireiitracnt is followed by good results are those in which the failure 
of respiration i'' not ditc to a salunition of ibe hody with ether, but lo 
Mphyxia produced by mechanical interference wiih ft-co breathing, as, 
for example, the presence of mucus in ihc air-pus,'*age.'* or a too close 
application of ibe towel to the face. In such cases the hypodermic 
injection of ether tansies so miicli local pain and irritation aa reflesly 
to call up reapiratory movements, as well as to directly Btimutate the 
respiratory centre to greater effort.' Alcohol ought not to be iiawl if 
the other drugs named can be obtained. becau.'<e alcohol is so nearly 
allied physiologically and chemically t<i elher. Frictions, hot appb- 
cation.«, and artificial tT>spiration should bo practised. (See article on 
Aaphyxi.i.) 

T^e diaphragm being the mnnt important muscle of re-spirution, the 

* T)ie mortalilv doe tu etIieriiAtioii is about 1 in 20,000 ; or. anwnlln!! i>i th« mm- 
biiwd *Ui[|sticx "f JnllUrd nod Onuftlv, id 40r,-Vi3 i-amt tlivrv were '2^> lieailra, or 1 io 
14,302. (Cr>Tii|iATf <'liInR»foriii.) 

* An c»nx'i(")^[i<;w in not noc««nrv U> Ili« cnrr^'ing ool of n fcHox Mtiuii, llii« ■• 
pcrieoily |»o«aiWe nnd prolmble. 



phyi>ici»n filionM seek to Htimuline it hy resorting to Laborde's rhythmic 
iraction of the tongue, which onri-si^CitiD rhythmically drawing this oi'gnn 
oatwani niiit upnanl fntiu tlii: niuuth ton tu rourtvcn times a niinute. 

Atr ether is at ha,iul, it tuuy he (hi^hcd on the cho^t a.n(l abilomcD to 
cmiiM; inspinitinti hy rcUpx aclion; in lieu of cold water, which wctfl 
the clothes miH tlocs not evBporittc rapidly. 

Id some casett grcAt nausciL nud vomiting follovrs the use of clhcr. 
This (»n gcnenilly be prwcnttxl by the avoidance if fon4l before the 
0))cnilion (»l-u ThcrapculicK), and by tin- udminintrutiuu of uruckcit icu 



l"iw, 42. 




[I nUu ilii-w> Iiiiw loitliia I be iotib 






tiimt' 



Thi" rtKiif llliptrai'.f limf imalon en llii ui 

II ■ I ■ ;iiill» fn-i- muTr 

l-i Kit 1 fiill (]vMrl|>tluii tec aTIIctc uti AsiiMyi'*' (Kroiii it 

rBW4ri'!> 'ly I'l. m nim iirxl liiuiiiittint.j 

anil small dn«eii of acvlauilide mid braiidy after ihv operaliun. (Ser 
VumitiD^O Thid oonditiou may al&o be aroidoil in lunny cat>ei« by 
fnTinn: oxygen gas with the Jinaesilieiic. (J^ce Oxygen. Iinjioruml.) 
Sererr bron<.'hiti? tnny occur in invulida and children after the inhaln- 
rinn Dfi-tlicr. iDid in iiiaiiy cMiV)< thi» is diiv more [o the L'xpoHuro iJiuii 
ihp drug. Pulmonary complit^'ntione, while possibly due to the direct 
eHVct nf the ethrr. an- probably cliieHy the result of the inspirnlion 
of particles of food, foul secretions from the mouth, and perhaps 
hlnod. into the lungs, the glottis being sntesthetize*! and unable to 
protect the lungs from the invasion of forei^i matter. Oreat clcanli- 
Diaa of the mouth in (.>S:(ential lifforc every operation, and care .-should 
be taken during and sf^er the operation that prnfune >«eeretion« ai*e not 
mRpiratPit. Total or partial anuria may develop after clhcrixaiioa, par- 



L 



228 



DRVGS. 



Fin.4& 



ticuUrl^ nfieK abdoiuinul operations. Ttiis is a. very dmigei-ous 8jiu[^ 
torn, wbioli cftu ^omi-tiiii(r< hv reniovod hj givinj; iiiti'uglyocrin and 
a l:irgi' n-irtu] inji-ction uF iiuniitLl niiiinv i^DlulicDi. It hu», liuwcvt^r, 
bpi'ii pruvtfd. bnth cxperirm-'iilally and cHuii'ally, that ellier is not 
cupftble, in the ordinary patifnt, of jjiodiH-ing niial dij*order of any 
monient iintesH ilip kidnojs are already diseased or the palient is soaked 
Tviili tbf dru<;, an PumetioK-s uvcurA wlicu it i» Ludly givi-o. W«ir 
fUBL-rlit i)i:ii Ptlier is not iluugeruuti ev«u in lliost' wltli iiiodtn'atcly ditu 
eased IcidncTG. Tlir use of ctlii^r iu dinbt'tir |iati<'iil^ m dangcroas; 
thr patiPiit oftflri never retrains const'inusni'.'w after its use. 

!Nol uii com moil ly iififr tlit- use of ellicr iii (he cns^e'^f aii old persoD 
or a cliild tti«> briiiicliiiil lubes n< (ill Kilb niiieii» ibiir rbere lii dniigor 
of the patient drovriiiiig in liia owii itccrctiwun. A full doacof utropinf, 
w'hi(-h eliecka BfcrPlion. given hypuilprrtiically. is ust>ful at such limM. 
Sometimes atlor an iinf&slbetic isj^iven llie pationt is formd to litve 
II moniiplegin. This is not due to the iinii^sllietii', biit to preBsiii-e exer- 
cised upon the u«rve supplying the pari during the operation. It is 
a trite prexsurt'-palav. 

ThempcntlM. — fitbcr '\>^ used cliicfly »* un imicitlelic bj means of 
inhalatiiin. iitw mi-thuil (.'onNints in iVmiiing a cone out of a towel 
and » piece of paper and idacing a email cponpe in iti" fnd. Upon 

thi» spoii)|»e (he cilicr in jiniired. and the 
Inr^'e open mcjiith of the cottc is pUeed 
over the fai'i'. If t)ii» be doiio suddenly, 
the sensation of suffocation is (generally 
BO great as to caiwe fripht and strug. 
glJDg. nhich is inodriEiible. The better 
way i* lu h'dd the conf hi Houiedl^tatice 
from the face. Jiud [gradually bring it 
nearer as ilic ^^fleeis of tlie ether are 
developed. After partial antci^tlie^iii hf 
&nuiued the c-uue sLouM be placed 
closely ovtT tlio face und tlic vapor be 
pushcil in as coiicfiiiratvd n fonn as 
possible, wlievMis wlit-n chloroform is 
used its vajior shnubl be well mixed with 
a great amount of air. Car*- should be 
taken that the elht-r Jo«* not gel into the eye* of the jiaiicnt. either 
in vapor or lifpud fonn. owing to the imtnlion ubi<rh it wilt set up. 
To prevent this a piece of thin muislin wet wilb water wdl he found 
of service if plaeed over the eyp«. A large number of etlier-inhaler!) 
■re eiiiployeti in preference to ibe lowel : ihe best is tlial known iii'llie 
" AHiy lidiftler." fitte-i witti a web of muslin. (See Fig. 48.) (For 
the asf. of oxygen with ether, see Oxygen.) 

When ether is to he given mo food ought to be allowed the patient 
for twelve hours preceding ita nse. in order to avoid vomiting during 
and after the operation. The fwtient slmuld not be albmitl In retain 
any tobacco or fnl^o lei-lh in the mouth, as either may ."lip into the 
larynx and i»ause deJith white the ann'sthetic is being given. 

Under the niinic of the A. C* K. mixture there is used a coin- 



-UIU IllTlllllT. 




f alcohol. cliloFororm. nml other, nhicli is properly but rarolv 
uacl iu America. (Scu Clilvroronn.) 

Etlipr niny tie iisod »:> a local aniesthelic in tin fttoniizer Hpray, ouiiig 
to tLe ceil J produced by its evaporation when it strikes the ukiii. Tims 
it is pinicularly iiitenil in cilics nliere tlioracfmlexts or pararentrmiM 
abdomintt is to be pcrfonuud. and also In cises of superficial near' 
aii/m, where th« boDuubiug of the nerve ofYen electa a perniasftit 
cure. 

Intnmally, bj the Htomach, ether in rery UHefiil in irolie, altlkoiigli 
for _/f<Tfu/''/i(-'' of adult« and cliildreD HofTiunnn's anodyne ia ti more 
»r(Iic'ii*nt rtaiedy. In i'iuwh of coUaptf ether ^iven by means of the 
hypodermic ni-vdlu or by the Ktuniacti is of ercat »crvice. particularly 
vhen c-ardiac action w very feeble, and it w 111 f^jve retii-f by irihalatlou 
in fwme of these cases more rapidly than the nitrite of atuyl. 

In hwconi/h a few inlialiLtiniis of ether will often stop the upaK- 
modic niovemc&t«, and other local muscular spa^iue can be relieved in 
this way. 

Large (lose« of ether j;iven by the month or hypodermics) ly hav« 
been highly recommended in the treatment of uraemia. They are 
most serviceable in the forms in vhich cardiac &Dd respiratory coin- 
plicatton^ are marked, 

Ether may b« u^cil by inhalation to prcdiire muscular relaxntion 
when the surueon desires to retlucu a utraui/uiad'd hernia by laxis. 

Id cases where cod-Uver oil cannot bo digested ether mflv be given 
ID 2ll-ininim (1.-10) dones in ice-water or capsule, either with the oil. or 
Home minuter after il is taken, to aid in iu eligestion and nb.'ioi'piion. 

Intamal Administration. — When used internally, ether should be 
given in ice-coKl water, nr, better still, in capsules, in ihe dose nf 30 
mioim.^ to ^ an mince {'l.ii : 1."».0|. If cold water is not used to dilute 
it, iK> groat is tho irritation of the faucea produced by tlie fumes of the 
drug that deglutition is impossible. 

The B. J'. rc(;o;»nizc« » spirit (.VynW/H* .-^fAww) given in the doe« 
of 1 to 2 drarlinis (4.0-S.O). 

OootrmiodicationK. — Ktlicr ahuuUl not be used by inhalation in bron- 
chitis or arnti- iiephrilis. because of itf irritant pr^iperlies ; in peri t«- 
nitiit or gu-^tntii, lie^-anse it is apt to iudiiee voiiiitirij; ; in aneurism or 
in ihe presence of iii;trked vasculiir athcruiuu. because jl may nipturo 
« blwMi-vensel by raising arteriiil pre^^ure, iiur in <liabi>te!i, IcHt it pro- 
iluire diabetic coma; and if anicmia in prc.»ent and an examiTintion of 
the blood shows that the hjemoglnbin is below M per cent, the use of 
ihc drug should be avoided if possible. 

ETHYL BROMIDB. 

Bromide of Rthyl is obtained l>y dintilling a mixture of aleohnl. 
sulphuric acid, and bromide of potawiiiim. and Is a colorless fluid of 
neuirul reaciioii, having a p!oft.*ant odni- resembling chloroform. It 
erapomteH with great rapidity, and any .iiimplc whiih does not do 
tbw is to be diseanled. I'oured on the linud, it !<bt)tild leave no fatty 
feeling. It should he n-uicmbercd that the dnig is decomposed by 
fanlight and when in contact with the air. In the presence of lamp- 



light the funiFs form broiual hydmie ami liroiiiine. Tim druy sboulJ 
ho krpt iti iliirk-gltLi4i bottles. The pliyiiicinn »houl<l di^tiiioMv 6cpn- 
rttCe ill liiB minil brotuitk' «f i-tliyl frum bniiuidc uf otbvU'iie. Tin- 
UtCiT i^ iivheuiicul ]irodiu'l poits^tt^iiig vitv ilan^fniitH prriperties. an<l 
tiliould never be iij^ed in tuciiirim'. Thi-re iit rcnsiin to believe cbat 
utifavorable tiympiotu^i follttw i!ii> u»e of broiDJclp of c-lti^M onlv vhcu 
tlif drug is iimpiirc ur i^ iiiiproperly ue«d. 

Physiological Action. — Accr>rtling to tlio isiudics of TlioTiitoii and 
Meixcll in tit* uutbor's Lubomt«iy at tlio .Icffci'soii Mediral Cnllegc. 
the (lomiiiuut Hctiuii of Ihf broinidt; of ethyl is «n the rpHpinuoiT. not on 
ihf riiTiilfttory, system. This eff'trct is ili'piesiaiit, but lbii« iiilliiL-tict.- is 
only m*t with nfteroxoossivo dosos. 'J'bc bloml-prfs^iiT* falls iindor its 
inlluvutiu tu a dliglit ilegree, ami the puW is sluwcil tbrnugh an influence 
probahlr exerciaed uri ibe inhibitory nervfjuH niechaniBin nf the heart. 

Tharapeutica. — Bniniitie nf I'thyl is a useful aiifeslbeiic for short 
opcrrttiinw, >iicli as opciiinj; boiU or nlkioosMefi, or for the relief of the 
|)!iin in uibur brief sur^iciil pri)t'i-ilurr:<, QriiiiiiQlly intnnluctrd inta 
gt'iivrni uso in this eouutry by Levis, it lia£ been fouud iinituiieii to 
major tiiirgicaJ cuwm. he'r^iiRe if <:nntinnrd for n Inng time it aerioitnly 
itepreKses the respiration, Brnmide nf ethyl ha.<t bepn finnil of th? 
greatest value by Montpintery, nf PhiliiiUOphia, as an anu'^lhetic in 
labor and for ininnr gynL'etilo<»ie«l i>p*Tiiiiornf in offiei' prnciice. Fie 
finds that the patient may be allowed to inhiile the drujt from a Haw- 
ley inhaler, for as noon as ishe has had enoufrli to produce iinK^slhesia 
the inhaler ilropei from her hand. The palJent is alwi more obedient 
to the pbyaician'K direetioni^, because of the fle<:-liiig iuHiienee of the 
drug, than when rhliimfonii or ether is Irikcn. iind post-partuin hcinor- 
rbaae through uterine relaxation i» not t^o apt lo occur. 

A very great advantage poBsc8.se«i hy bromide "f eihvl is the 
rapidity of ita action. A fovr whifi's are genernlly all llinl is needed 
10 cauac anicatheitiu. It rarely produces uiwigreeable eflccia, Oasca 
of Hudden dealb under its use are. however, on record, and in auine 
insloncea nervous Iwitchings, and even tetanic spaems. have been 
known to follow its em]doyinent. These tetanic svinptom« are, how- 
ever, fleeting and gi>nerally of little importttuw. JJaiicea and vomit- 
ing rarely follow its eniploymenl, bm it is aj.i tu leave an unpleasant 
gnrlic-lik'c caate In the mouth, and a aimilar odor of the breath is 
lre(]aently noted for several days after its use. 

Administration. — Bromide of ethyl should he administered for but 
a brief [leriod, but when tJiken should be inlmh'd freely. It esnnot 
he given earelc-sKly with jjood effei-t. If a. gtiod sample ia eiuploved, 
4.'> minims to H drnehnis (3.l>-12.l)) is a suffieieul iiinoiiiil lo induce 
aneesthefia. This ([unntity should be used at onee. instead of a<lded to 
the inhaler drop bv drop, as in the 5a«e of chloroform, and the elolli or 
inhaler Khould be Iiehl close to the mouth and not>e, iu5teaJ of at a little 
diotanoe, as ia often necessary with other ansestbetics. 



■ 



HTHTL CHLORIDE. 

Ethyl chloride is n liinid of a mmnu eilien-al odor, made hy llie 
action of hydrochloric acid upon cthylic alcohol. It is used, M is 



iMtbyl cliluride, fur the piirpo^ of producing antestbesia by freetiiif^ 
the part of tlio toily against whiclk ft ig brouglil in contact. ThU 
liijaid i* used not only n* a loral niiiirstkctic by virtue «f ila tVvuzing 
pni|i«rtie.4, but &Uu )ky hibuliitioii. It i» iiL-ct-ssary vthen it is given by 
inhalation, because of it.s ^roat xn [utility, that it i^hould reacb the 
paticDt in conocnirate'l form, and ngt h:ive un opportunity ta be di»- 
»i|>aled into t)ie surrounding ikir witliout first en l«i'- 
Kni. -M, ing ilio lungs. Far this reason it sboubl bi* used 

by tic aid «f u. nju.ik suc-b aa tbiit L-iniiloycd in the 
admiiiistratiuu of iiilruus uxide giis. Tbu niask 
sbould bo applied in niicb a way as to tigbtlv cover 

Fui.45. 



Tbr cap ttMctT'trt and 

nokli lii.U In the enil 
ur IfacctMi. 




^htiwliix use (it * tltm runuel aa aii Inbtler thr cUiyl ctaloride. 



ibe niwtf and uioutli, and tbe etbyl eliloride is tb(«ri proji'ded on to a 
comprcjw which is placed inside nf it. Where it h inipriAFtible to 
obtain an inhaler made for ibi.') piirposo, n tin or glaxx funnel may be 
used afl a ^ubstitnle. The bir^c end uf this may bi- placed over the 
tnoitth and mffic, ibe neek of ibo ftinnel cotJt:ii(iing nbgurKcni ention. 
Ihmiiizb the .'^uiatl einl of llii- funnct tlu? clilnride of etlivl ir* spra-ycd 
agaiiiKl tht' L-utlon. By the (.'art'Tul adapUition of the hniidA to the 
ludes of the funnel and the elieekn it \» pn»sib1c to make ihia a very 
elow- iuhsh-r. A good way to keep ethyl chloride is in the form of a 
^raduateil glaaa container s» conetnicted ihiit tlio dru^ is measured a» 
the Bpray is forced from it by the lieal of the hiuid. The drug i* plaeod 
upon the inurket for ibiii purpose in graduated yhiss votitaitjerit. under 
the name of 'Keleiie." Amesllte^m prtniuced by ibi^ itiotbod usuallvde- 
relops within s vtrv few moments, and it is t-lainietl that tht>re are very 
)4igDt changes in ifie pulse anil respiration under it* influence. 1 or 2 



L 



336 



DRVaS. 



upon tlif re^iratory centre ether ncU us a |>owerful stimiilitDt when 
used iu onlintLTv amounts; iD overJoBC it panljzes tbie part of the 
nervous system. 

TEMfEKATCliE. — PrciloDgeil etlipriiBtion lowers the bodily beat very 

ntiv- Tliat of the dog mav he lowered some 9* V. in nii hour if the 
J he pushed, und ha ^rvut u full bua hcL-u kunwn as 4° F. iu man. 
The full 18 partly due to the depre(t!<iuii of the tiervuu^ system und the 
chilling of the body and lungo by the- evaporation of the drug. 

EuMlXATioN. — Elber flscapes from the hody by the lunj^s and 
kidneys. 

Untoward Effects. — Ether, while safer than chloroform, is not nbiicc 
lutely devoid of nil dangerous effects.' Somtlimcs, when tbc drug is 
punlied toti Blroiigly, dyep <-\';itiuHiK with pulnation of ibf jugular veins 
BhovrR dclicient oxygenation of the blood and cardiac diitleation. Iti 
other, very rare. inntanwK niulden cardiac faihire has occurred or total 
arrc»t of reepirntioD ensued. In ne«rly all ea^es of sudden death frvio 
elbor grave kidney or heart lesiiins have been uiest-ni, and have been 
found at the autopsy. Rarely the rise of urtcriu! prewurc which it pro- 
duced han euuHed apoplexy. 

The Iroatmcnt of accidents during otbcnxation conaidts in the 
withdrawal of the ether, the um of artificial respiratioti, aud the 
placing of the body, if the face is pale, head downward. On the 
oilier hand, if the face is lliislieil and cyanotic it indicates respiratorv, 
not cardiac, fuihirc, and this position \a not to be resorted to. The 
phyaiciuu »huuld hImi einphty hypodermic injeetiona of strychnine, 
atropine, and digitalis, or, more rarely, aii intravenous injection of 
ammonia, which is more dangerous, but better than iho othem in n 
preying emergency because it in more rapid in it» ucliou. Elhcr \& 
often given liypndwrmicaUy under such circunt.*innce)*, and may occa- 
aionully do good, but itn iit>e is n bad pracLiLi*. an, if tlif hu'irl or rcKpi- 
ratinn is already depressed by i'llivr, iho l^iu pluyiuunt of still more of 
the ilnjg dimply makvs mattcre worse-. The nise« in vrhich &iich a line 
of trentmetit is followed by good r(!D»lL<4 are thoine ia which the failure 
of rctspiration h not due to a saturation of the body with ether, hut to 
aflphyxia produced by mechanical interference with free breathing, aa, 
for example, the prest-nce of mucus in the air-pa*pa^;t^s or a too close 
applicHiion of the towel to the face- In such cnseti the hypodermic 
injection of ether causes so much local pain and irritation na rcflcxiy 
to call up roapiraiory tnovcnients, as well aa lo directly stiraulate the 
respiratory centre to greater effort.' .Vlcohol ought not lo W used if 
thp other drugs tiatned can be obtained, because alcohol is so nearly 
alliird phyainlogtcully and chemicuily lo ether. Frivtiuui'. hoi appli- 
cations, ami srtiltcial respiraiiou should be practised. (See article on 
Asphyxia.) 

Tlie diaphragm being the most important muscle of respiration, the 

' The tUDrtalilr due tu olherizaiiou in alMUt I in ZOtOOO ; or, accordinp; t"th«ooiii- 
bined tiauslicscf Julliunl nnd Oniisti*', in 407,->S3 coeeq tti«r« vrvm '2^> iltntlus or 1 in 
16^02. ((,'<>iiii'i»ri> Clilciv.Wni. 1 

> A« coiiMiii>itfii«<a)> in not na^mwir; lo th« cwTjing uitl oT a rvHux iLcliun, tliio in 
|tvrf(!i.tl;r |KM»ibte kdU piuluible. 



ICTaER. 



227 



pb^eician should ^oeW in siimuliilu it bv resorting to Labordc's rhythmic 
inu-'tion of tlu< conguc. whioli o<iDai«l>< in rlirthniicnlly drawing ihin nrgHn 
oaLvnnl anJ unwar<l from tlie uinutii leu in limrttffii liiucs a. iiiinuto. 

Ai ether la ut tiainl. it luav he ilajthed on tlie obi'-st and abdomen to 
cau!ie inHpiriition by reflex nciion ; in lieu of cold water, whicb wets 
the clothes and docs not evaporate rupidly. 

Ill Homi' ciwt^ great nnuHfU and vomiting follows llic u«c of cilicr. 
TbiF can jjonorallj be pruvenied by ibo avoiiiance r.f food befotx* the 
opcmtion (see TherapentirR), and l>y the administration of trucked ice 



Fm. 42. 



rSii 



nu» flni"' n''i'tTjii'Tj 111 :\ 



Lj l-i Mirll.i illKl 111 ill 



<r ilii- tuiiKut- ■Irau'ii ihr (!pl&1nlU> ■wny ttom 

< .( II Ir II II Nil itif>i>'i. tinw liitllliB lh(" loniCII' 

■i-itniiir |..(--ui:.- iinil pcrmll thii<'|ili[l'>Ui* 

i;i|j11iii] ii-i iirlJi'lt- on AtuUriiit. il'rniii ■ 



lod Etaml\ dowR of ac<>taiiilid<> and brandy after the openition. (S&e 
Wtniting.) This condition may al^o b« avoided in many i-a»ct! by 
pviu;; oxygvii gas with the aiiw-tlielic, (See Oxygen. IiiipuFtant.) 
Severe bronchitin may occur in Jnviilitls and children after the inhala- 
tion of ether, mid in many rase:* iliifi i« due more to the expowire than 
the drTig. Pulmonary conipli'-ationi', while popsihly due to the direct 
sflTect of the ether, are probably ehi*fly the rei^nlt of the inspiration 
of particles of food, foul secrctioua from the mouth, mid perhupH 
bloDtl, into the lungit, lh« glotliH beiup ante^itiielized and unable to 
protect the tuDj^s from the invasion of forciffu matter. Great elcauli- 
«>■*» of the month U essential before every operation, and care shtmld 
be taken darinff and after the operation that profiHe Rpcretions are not 
iliapiratcd. Tota.1 or partial anuria may develop after etherization, par* 



234 



DRVQS. 



bowels, and luagH. The urine uiu.^' bavi- the uilor uf violetfi, lus it 
somcnmeB doeft nfter the iine nf oil of tiii-|»0DliQe. 

The oil 'jf fi[culyptii9 has cDeiderable antiseiJlic power. 

Thsrapeutlcs. — Eucaly[)lui* t» used in nin/aria) J'ercr where quinine 
cannot he had, nor be bonu- by the piitJrnt owing to idiosyncrasy. lu 
hronchidt, in iiii eimilniiin or in capsule, it in of great vsihie in the later 
6tuget> (see Bronchitis), since in it» elimination \>y the luii^ it acfai 
lovnlly upon the inflamed mucous meinhr»ne. and it in»y be Ufed in the 
Hubitcuto forma of tf(nwrrfi'i:a iu the su,uie luannvr. The fullowiag pre- 
scription will answer; 

K.— <Mvi«u(aIrpti Cti (^^l- 

OlMBinyKlalKduJc. ^ 14.0).— M. 

Ft ill Mimule No. x. 
8.— One t. d. aftor mi>al«. 

Oi] of t-ueiilyptu» is very useful in some forms of rheumatic head- 
ache or in headache dependent upon mnlurial fever. 

Kueafyvtot, U. S., U obtained from oil of eucalytuD, and is largely 
employed \>y rhiDologists and others in hitinos and utbcr nasal appli- 
cations It may bo used in soliitionK of fatty oiU, but in insoluble in 
nuicr. ulihuugh it is sulablc in alcubul and ether. 

Adminiiitration. — The fluid exlrael {IJxfractum Eumfi/pti Ftui'iutn, 
V. tV.) is j^iven in ihe dose of ID niiniin» (O.l!")) to 2 dranhmK (S.O), the 
oil {(fteum Kuealjfpti, U. S. and li. P.) in the dose of 5 minims (U.3ii). 
The dose of cucalyptol is 5 grains (0.82) in capsule. 

TVorhhPHg EwMlifpti Oummi and Un^nnttim Eucalypti are official 
in the B. P., but arc xcKioin used. 

BUDOXINB. 

.BudoriHe ie the bisniuih mh of noHophen. (See Nosophen.) 
It occnirs aa an odorless. tii*tplc»s, innoluble. red disii -brown powder, 
oontaininf; lees thiin tJO per cent, of iodine. Euduxinu in emjduyed in 
medicine as an mtfntiiuii tintitieptir and mitift'rinrnfatitH . It in a^ed 
in the diarrh'Ta* tif •■hiUirfii in the dose of 1 to /) grains (O.O-J-O.S), 
and jjivwi to adults for the aamc purpose id the dose of 6 to 20 
grains (n.:j— 1.3). The riiii^e of usL'fuliiesH of thiu drug is much the 
same ns biHtnuth in such coHen, exeept that it is les5 atitriTigent. but 
mure liiilisepltc imd aUemtik-e. Reeause of the laltor influenee it is 
indieated in suftm-uit c/ironu: catarrhal itijiammationa t^f the butPeh. 

KUONTMU8. 

Euontftiiua, V. S.. Euoni/mi Corffx, B. P., or Waboo, 18 the bark 
of Kuon^muu AtropurpuT^un, a luiiivc plant of the United States. 
It contain!* an aelive principle, Euonymin. B. P. As a laxative i(8 
aelinn J8 very slow and moderate, but it is thought to act particularly 
uii the lircr, and may he used when mild hepatic torpor is present. 

AdmlaUtratton.— The doBe of the solid exirnrt ( Krirartuin EuonyiHi, 
U.K. EilracUiiH Eitoui/nntStWuia)is-i to H) grains (0.15-0.65). Of 
euonymin the do«e ia h lo 1 grain (0.03-0.05). 



EUP.4r0JUUM~£iTarHAlMjy. 



236 



EUPATORItTM. 

£!u/>att>riitnt. U. .V., Thorougliwort or Buiitset. is llic leavt-i of rlie 
Hupatonum ptrfoUatum^ au Aiiicrtciin plant which is v«ry lar^nlv 
, tiaed M a simple bitter tonic and (lla|ilioreti« ic bousohold mediciDc. 
Tbe drug U generally given in hot iufneion in vaitcs uf arrritedwen' 
ttrufttten du« lo cold or in llic chill of nr^'mittent or intermittent fever. 
aai) bUo for anorfxi't and liehilitt). \x» tiiMte is verv disaprcpiilile, and 
ID the doee uf u piut (-^QQ cc.) of tlio citd infnsioQ it has lieon used na 
sn enielic. Tlie fluid cxtruft {Eitnu-tum lCn/>at»rii FluiJum, V. S.) 
is ^ven in the dose of ^^0 minims to 1 drnchu) {2.U-4.0). 



EUPHORBIA PILULIFERA. 

Thia herb is sometimes called ^nake-weed or CatVbair. and is a 
niitivt! uf AuMlrslia and the West Indies*, where, like fitramonium, it 
grows profusely f»8 a weed by the wdvuide. 

Physiological Action. — In loxic wmvs the drug ]ii]]» staaW am- 
maU by failure of the respiration niid eirctilation, these two viial 
fiuicttons being greatly affectfil by doses which exert no great influ- 
encc t>n the rest of tlie body, in full dose it may cause som« gastric 
irritation. 

Thecmpeutics. — Eujdiortjia pilulifera is one of the latest remedies 
introduced int'> mu'dicine for llie relipf and nire nf agthina. m which 
diac-»«u the results obtained, after other remedies fail, are very extra- 
ordinary if tbe report* of those who have given it a thorough trial 
can be acccfiied without rcacrvc. As vel we do not know the form 
of aeilima which iit most rL-lieved by its use, and its employment is 
parely empirical, It has aUo been highly praised in tbe treatment 

of rfiroiiir hr;»rhifit and fiiijilii/gi'mt. 

Administration. — Kuphorbin pilulifeni la lest given in the form of 
the fluid extract in the dose of iW uiiDtmii lo 1 drarlim (2.0-4.0). The 
decoction is made by adding a " handful nf ftalkt> with tbe leaves on 
ibem to 2 (iiiarts (2 litres) of boiling water, and boiling down to 1^ 
()aart« (1} litrcA)." Uf liiis docuction itic d^ec is a Email wiiieglaao- 
ful ^U4.0) tbree timeo a day. (.See Aiilbma.) 



EUPHTHAT.MTN. 

Etiphthalmin is a synthetic iilkaloid ii!i.ed ns an active nivdrintic. 
Il ]K}flae9eK< an i-ffect upon Ihcgenenil system very like tbut of atropine, 
tnil when firsi dropped into iht? cyo iiiuy vmi^v xli^ht salivutioii ibrougli 
irritation of the secretory filrt'S of the cliDnla tympani, which it rcBclies 
after abiiorption. The pupil under it« inHiience begin); tn dilute in from 
fifteen (o twenty minutes after a few drope: of s 2 io 10 per cent, solu- 
ticiB an instilled. The maximum ililiLtmion is reaehed in about an 
liour, and di5ap|H-ur< in about five lo eight hourd. Vinci ntatcs timt 
the mydriasis Ih due to paralysi?! of the oculomotor iierve-eiidiugs. and 
that the sympathetic ix not affected. 



23» 



Dnuos. 



BUROPHEN. 

Europhen is the result of (lie action of iodine on isobntylorlhn- 
Cro3ol ill ili*> prpspnce of an nlkiili, and n|)poHrs jls il fine vt'Ilow powder, 
soluhlv ill ak-ifliul. t.-L]i(-r, clilorofurtn, uail oiIh, but insotubte In water. 
I,t wn^ inlnitlucod l)L>i.-iiiise it wna hit\>e<3 timt i( iiii};ht prure a useful 
snbHtitiiie for iodoform. One ndvaiita^c clnimed for tt tti tliat it 
pAfts with its iodine vpry slowly, and so is not apt to produce 
lojcic symptoms iis rapidly as does iodoform. Fur ttiM very reason, 
bowcvur, it kfkfi ibo rt'trifdial power of ihe older drnj;. except in 
tiiOBC iiiRtanrcs in which ii drying powi-r is needed wliicli will 
keep tlio Vfoiiiid purfi by making it too dry to be favorable to the 
growth of gcrni^. When such an action la desired, ciiro^ihen po8- 
Bessf'a the addilional ndvantngc of being five liniL-s ns bulky as iodo- 
form. In the trcntmrnt of tnbcreuhma growtha cnrophcn has nlrcady 
proved itself very inferior to iodnform. Owing to itK stabiliiy. it fails 
to part iritli its i<idinc except in ibe preaence of nioicliire, »nd is use- 
lews in dry ekin diseases. It has been found UBefid in gcrofuiodrrm, 
nlctr of tiif. iege, and lupiu. Etiroplieti mu^ bo employed externally 
in a salve of the etrength of from .5 to lU per rent., or with olive nil 
or knoljn. It can also be added to flexile collndiun. The dnig do«8 
not poKBoHii the odor of iodoform, but experienec will probably prove 
it to bo more irritating than the latter drug. The inifvnal dose i» 1 
to 3 grain* (O.(l.^0.1o) in coses of nyjyhilix. Eiirophen is incompiK- 
ib]<> with metallic! o.Yide!t and llic preparatioiiH of mcrcriry. and also 
vith the .ttarch and zinc paste largely used by derma tolugiats. 

UXALOINE. 

This Bnbfltanco is really mothvl-aeetanilid, and closely rewmblea 
soetsmtid or antifebrin in its effects, [t is given for llie sanie pur- 
poses as is acetanilid and unlipyrine — namely, for the relief of pain 
in loeomotor attwia and other nervous afTcction!* — but never as an 
antipyretic. When used, oxaltiiio sbould be given night mid morning 
afi a rule, po that the dunci ahull not be near logeilier. The beginning 
dose should be from 'i to 4 grains (0.1-0.2), and not more tliau 15 
grains (1.0) t^hoaUl bo given in iwenty-four boiin*. It J.* slated by those 
who have u-ied the drug that fever contmtndicates its employment. 

The following prescript ions will be found applicable; 

B.— KKnIsini tfr. xixi2X)). 

Tincliincauraiii. diilcin rsg (8.0).— M. 

Fl. Id ami. n ntlilc 

Syr. numniii . rS** (Ift.O). 

Aqiiiv iiiicnlh, iiiperil. .... 9. ». nd f.^iv (121X0),— H. 
&— A tabUe|)ou>iful »igtit and uKirning. 



* 



^ 



Or, 



B.— ExalAini . . 
8tit. trumtinti , 
I't in Kil. el n(I<l« 
fif r. Hmjilida 



gr, XTX (2L0). 

r^Md^o).- M. 



Sjt. »iin])lida f 5) (Xi.O) 

Aiiiwilm (1- ».ail r^v (imO).— M. 

, — Tall loRpoon All nighi nnd mornint. 



FLAXSEED— FORWC ALbEHYDE. 



237 



PLAXSBBD. 

Flasecert or Linseeil (Linum,L'. S. atnl Ji. P j is IbeBted of Ziukm 
uMiratiitimum, or flax rrom uliit-li liii^n iu maJp: it was official in the 
S. P. an Lini •Si'miu'i. Thpsf Heeil.* cnntiiin nti oil Hnd a niticiiii>;c. 
llie first of nbich is Urgf'ly usetl in thearu, ami lli« Hccond is some- 
liowH rmploTed in meilicinc. The <iil {Olntm I.i'ni. (J. .V. anil B. P.) 
lA iilno asci) by physiciuiis iiml phiirniuoisls for vArivii!* piirpnsr.<t. 

Tberapeutlcs. — Flaxsoeil a.ct« as & (]riiiiili.*en( u* injhimiil mitcolu 
memhrm4e8, aud is uwil l»ryi'Iv in tbu ircsLtnii'iil ot aciitf eifxtitig, 
bronchUitf (/ntlrHin, nefihritiK. uiiJ fiiniliir MnH-s, in llic fitrm of flax- 
seed Ic*. Ttiis i« prepared liy mixing* loncilier S drachtn.'i (12.0) nf 
SaxHe«0, not ground, W ^rainR {"l.^'] of exlract of liquorice. 10 uunces 
(320.0J of bitilin;^ wsier. nnd ntlouiDg iho nilxtiiro im 8tnnd oqp to 
fimr bour» in a warm pla«i;. If iIk- iiii\turf i» ijoilud. thf *>i\ i« »fit 
fro« and makes i\w ilijm> di»&^rt;i>abl(^. Tbiit itifusiuti may now be 
mailL' more tableful ami imefnl by ibe addition of a little lenioii-jiiiL-o 
aud HUf>Ar and by (he placing of fr*im 1 in i dracbmti (^.O-IS.O) of 
gutn urubic in llic piluhvr containing it. If ibv cougli ik cxoomivq, 
a little {laregoriu inuy W ad(b>d. Liospeil oil i<( used KonielimeK aa 
a laxative in the dose of '1 onm^s (tH.O), and i» said to be of service 
nhvn HO given in ihe treatment of hemorrhoidit. 

FInxM-ed nital (/.*«< farimi) is cmptoyed universally when moist- 
eiiQil &« a UE^-ful poultice. 

Under the name of Carron oil an emulsion of lime-water and lin- 
seed oil. e4|ual [wrte, is tbe ^tandanl ajtplicntion for Umittii or rxtt-n- 
iht barns. 



FORMIC AT.n niMViiB! (FORMALDEHYDE). 

FonnaldehvdL' is iittcful to ['buck fjvi'»jnW J'etid sfi'ittinij bv virtue 
of il* aniiscpnc efffft and beL-:iii:-e it hardens niid contniciH tlie skin. 
The fsoliition iiMd may ho made by diluting the 40 per cent, rnm- 
murcial soliiti<in >ilth 4 to G pn-rt? uf water, or u^iiig Ktiforuiol <)ilut(.*d 
or [itire as a lotion. Koformol I'oncuiuti euciily[)ttif, gaultbiTiiL. nioiilhul. 
boric iu.-i<]. iind fornmld<-hydc-. and it* pUitMintrr to ii^c Ifiati the crude 
prt*|iarulioii. Diliiled in tbt pro|)orlioii of 1 lu 4 of watt-r. it loay be 
etaployed a." a lotion to the entiie body to check foUvfuaiV'e gteeats. 

Funnic aldehyde is a gnscouH body difliciilt of applicution because 
of itii pbyMcal ciiaractfriaLioe, but nevcrthelrstt po»Hc>ssing very great 
power iut a disiufeelant or germicide. It is prepared by Rubjei^ting 
methyl alrobol lo oxidation, and alinosl every instninu-nt-uiaker lius a 
dovieo whereby thi-i gas may he generated, and the nxmi Ibrtuerlv oecu- 
riiLvl by » sick portion thereby dii>iiifcctcd far more ofticaciuunly than ean 
be aceouplifthed by burning sulphur. The doors and windows of tlie 
room should be tightly abut during the proccs!« of diitinfection and for 
■evcral buunt after the furmuldehyde generator in exhau.«ted. As the 
ns in exceedingly irntstiug to the eyes and respiratory pa»ragei<. no out* 
wiould attempt to enter the room. After the diHinfetlion in euiiipluteil 
tbt roviu sbould be aired for »>uie hour», or, if it must be Uii>vd at once^ 



238 



DRUGS. 



it mftj be rendered c»pn.ble or liabitstion by spraying a 20 per cent, 
solution of aminoniib to ucnitnilizv the acid iitmoflphi-rc. The great ad- 
vantaj;e of fonnaldebyde for tliusepurpoara is the fact thnt it pcrnieateA 
evcrv nook and cranny, and yet does no injury to color-ed fubric:^. as 
does chlorine gas nnder similar circmnRtiinpesi. Such gencraton as 
bnvc bi-eii baoied can bo lini] for nbout t<Mir dollars. 

A solution of formic nldeliyile in the strength of 40 per cent, haa 
been wiildy UM>d of Utu fur disinfectant iind antide|)tic purposee.. For 
all these purposes it is usually diluted siiU further by the addition of 
water. A 1 per cent, wdulioii is usually quite active enough for sor- 
gicftl aniiwjpsis. ami in far les* [loisonous than ie the bichloride of mer- 
cury. A .Himilar perientage, or u Ultle stronger, may be used to pre- 
eervv pstholoj^iL-nl speeiniens, and it is stated that in llie pru|>ortioD of 
1 lo 82,0i>n it will pri-scrvf lailk for several days. Taken iutcronlly 
in small amounts, it does not poase** imy t.i»xic properties. 

Concentrateii undiluted foniialdehyde solution miiy be used for the 
purpose of cauleriKing Kyphilitic ftores. 

The aafcly, L-fticiuucy. and cheapness of formaldehyde gM a« a di*- 
infc-cranl. a.n<l of the sritution. render thiji agent a most valuable one. 
(Sec Disinfection.) 

Under the name of •' Glutol " we have a compound of formaldehyde 
and gelatin uaed as an antiseptic powder, which, drying the suirfaee of 
the wound nr ulrtT. ncaU it and n'udcrs it sterile. It is claimed lo be 
a particularly efficient dressing for bum«- 

QAT.T.TC ACID. 

Acidum GalUcum {U. S. and J?. P.) is usually prcitared from 
tannic scid. It occurs in nearly eoKirUws, long, needlu-lilie ciyHiats. 
which are soluble in lUO parta of cold water, 4 J [larts of alcohol, and 
3 pHrls iif boiling i»;iter. 

Physiological Action. — GoUie acid in an aatrtueent, but not a eoag- 
ulntd)- of blood. Loealty applied in bleeding, it m umeless. but given 
iniemally in hemorrhages vrbich cannot be acted upon by the ircct 
Ktfjil itpplicatiou of litnnic acid, it i» iliotighi to he iiM-ful tt* a liivmo- 
SIntic because il eontnicl!' the blood-vessels. It is elitniuntcd fituu the 
body by the kidneys us gallic acid. 

Therapeutics. — <inllic acid may be used with some eucceas in htrma- 
turtd, h(eiiiijptt/au. cvUiipuilivt tweaU, and in ekronie bronehitia with 
profu.-ie expectoratioD. 

IVtmliined nilJi opium, it is one of tlio btwi remedies in liialn-tea 
iwnuidii^, and is even u^'fiil in diabeftt mfllitux. 

In itlUnminuriit dejH-ndeni upon a relaxed, atonic sttite uf the kid- 
neys and in acute or chronic diarrhva gallic acid may he Uficd iritb 
advantage. In the form nf the ointment it is useful in the treatment 
of pt<*riaei$, and in the cure of uiecrn and Korfti which are actively 
discharging. A very unffiil iipplicatttm to rrtrniaf hemnrrhoidt i» 
equal partj of stniui'iuiuiu ointment and gallic acid. 

Adtolniatration. — liallic auid is giveu in ihe duse of 2 to 40 graiiu 
(U.l-*i.H) in pill or solalion. It oaght never to b« mtcd with any salt 



I 



i 



GA VlTiTERlA-aEL.'iEMWM. 



339 



of iron, a« it i» cbemicftllv incompatible. The prepftration uam) locally 
is iht' Uuguentum Aeidi Galliei. 

Nut«aU. 

Nat-palttt (Oalla, U. H. »utl B. P.) are the Kmall excrescences 
foand upon the oak (Qutreua luaitanxca) forme'l hy tLe ova of the Qy 
Oynifm QaUtr tituttirUy. Their sole value depends upon the tannic 
acid cobtaiued iu thoiu. and they are official in the form of the line- 
mre {Tinttura GalUr, C. S.). Ame J to 2 fluidraniiins (2.0-8.0). anil 
the oiDtiuCQt {Untfumtum Gallv, U. H. and B. P.). Ut>ftneiitum 
flatiiF rxim Opio in ollicial in the S. J*., and is uspd as aJi astringent 
aod sedative oiotment. 

OAULTHERIA. 

Wintergreen, or QauUhnrUt prucumben*, is an Anierlfan ever- 
_ HD containing a volatile oil. The oil poasesees a peculiar, exceed- 
ingljr penetrating odnr and a warm arnniatic taste. It in abcmt 96 
per cent, ealicvlate of methyl. .Snitri/l'^if ••/ Mt't/ii/l (MttJit/l •Stili- 
L'ttlali*. V. S.) IB an artificial pmduct made official in the last revision 
of the L-. S. P. 

FbTsiological Action. — Owing to the Urge nmuiint of .lalicvlate of 
mrthrl conr&inod in the oil, it« physiological action i& almost idetilical 
virli (hat of ftalioylic acid. 

Therapeatica. — Aside from its uoo as n flavoring mibstanco. nil of 
gaulthiTia inuj \ie ust-d in place of the ordinary salicylates in all 
form* of rhpumiiti»m in which they are tisoful. This oil {(Henm 
ttau/ffirrifr, C. .9.) ii> lio«t given in cnprnilfi" or eniillflion or dropped 
on a tf>u5pi)onful of HUgiir three limesailay afler iiu-a-ls. The dom- 
may he aw high tt» 100 minim.-^ (".(') a .lay. 1ml if fjO mininiF i+.O) 
three rimes a day <lo no good, pushing it fiirthrr is pra<rtically iihp- 
\vt». \cry feu patients can tiiku more than ^0 niiniine a day vritlioiit 
imflcring from a ditmnlered Momach. 

Lannois and Limonsin, of Lyon!-, linve highly rccommvinled 
the application of llila oil to aetiU: and chronif rheumtttic JfiritM. 
The nil IB placed on lint, and then the lint m vritpped iLroiiiid the part 
affected, evaporation being prevented liy applying a gulla-pereha covur- 
ing. They a«»ert that thi^ Ircatuieiit gives rapi<l relief, although they 
admit that afier it ibe Hkin may desquamate. 

The spirit of gaultheria (^pirtiu^ GauUhcri<e, U. S.) is given in 
tb« do0e of 10 to 20 minimM (0.65-1.8). 



OBLSEMIUM. 

Ofhemiiim. U. S-, and (feUfmii Hadir. B. P., or Yellow Ja.«mine, 
OS lued in medicine is the rhixoiiie of the Getaemtum »vmpert>iren4f, a 
climbiDg plant of the SoiitLcm I'aited Stales. It contains an alka- 
loid, gvUeuiiue. and geUeminic acid. 

PV8loh>slfial Action. — Neavoua Systkm. — Gclseraiurn paralyiea 



240 



DRL'QS. 



tlic Bpiool cord, parlicuUrl; on its seiiBory eide (?). although the motor 
side is certainly ultimately depreitsed. It does not iufliicnce the nerves' 
or DiuaclM except tliosc of the bead, on which it note m a paralyxaat, 
parti ell lai'Iy nfleciing tli« motor fibres. 

Circulation. — GeUemiiim ie a depressant to the circulation, act- 
ing particularly on the henrt. It paralyzes the vagtut and lowers t>lood 
pressure. 

Rksi'IBation. — Gelseinium kills by pandyilng the respirator)' cen- 
tres (Sanderson, Ringer, and Murrell). 

Tbmpkhaturk. — In overdose the drug lowers bodily heat yery 
markedly. 

Eve. — Gi'UemiucQ i* a mydriatic of cnnfiiderable power. L'a»5iii(i. 
when dropped into the eye, widi^ ililntalion of the pupil, a rfstilt due 
ttt paralyxis nf tlie ovulo-iiioLor nerve peripherally. 

TherapeuticB. — tietaoriiiTitn \» nwA in headache and mitfraine depend- 
ing on iiervuua Iroiibtes iir iiptiii rifi'-atyttm. It i» particularly uacrui 
in i-uiubiuatlou with euuuabi^ indiva. (See Cannabis ludica and 
Migraine.) 

in malarial feeer it is said to he of great dervice, bnt this is doubt- 
fuL In the early stagea o? pneumonia and phttrU^ it has been bigbljr 
spoken of by Bartkolow. 

OelMeiniiini han also been found of value in atthnia, whooping 
fQUf/h, /riri/ihjiiinni» utrirhihm. and nen'mu cfiigh. In Inrnlixcd muM- 
cu/iir upaeiH, 8iicb ti.-^ j'fcn in t<irlit:vUlK or ttfry-neck. and in epaumodic 
difttmnwrrhita, it in of eoiiJiidcra-hle ncrvifo. It miyhi not lo bo used 
if the synteni is already depre-ssed, but only in stbenir oises. 

When used hh ii mtfdn'afir. Tweedy reeommends geWniine ax etpiiil 
to atropine in effect, hut much nrnre tmRMent in its inSueiiee. He iisce 
a solution of 8 graiii!) of gelpeinine to the ounce (0,.'» : 32.0J of water, 
ini^tillcd. drop hv drop, iitio tlie eye fvery fifteen minutes for one 
buur. and then every hulf-liour for two hoiint. 

Poisoning. — The most prominent symptoms of gclseminni poison- 
ing are ptoMis and dropping of the Jaw. These are preceded by a 
sensation of languor, a desire to lie down, relaxation, and muscular 
weakneiis. GolKemiuin i«< ajit to cause loniporary internal squint, 
owing to it» purulyCanl uctiuu un the sixth jwir of cranial nerves. 
The puUe becomes rapid and feeble, the skin wel and cold, the face 
pinched and anxioua, the voice m lost in aphonia, and dealh entiues 
from centric respiratory failure and an almoKi sitnulraneouit cardiac 
arreat. Sensation in man is impaired very late in lie poiuoning. 

The treatment of the poiHuuiag conBiatA in the UHe of cardiac stimu- 
lantA, nuch a« ammonia and digitalis, the application of external heal, 
and the «mploynient of airopiuR and strychnine for the piirno.<e of 
fttiniuluting tht respiratory ecntre. EineticH and the ^lomocu-puuip 
are, of course, to he eiuploved if the patient is airong enough. 

Adminiitratiwi. — The nuid extract {KxlrafUtm (felaeaiii Ftuidxtm^ 
U. S.) is aivnn in the dose of 2 to '> minims (0.1l>-0.3.")). and the 
tincture ( 7i>(etura GtUemii, t'. .S'. and Ji. P.) 5 to 10 niitinii^ (0.0^ 
0,6fi), In some parts of the Tniled States physiciaus largely employ 
a very strong unolliciul tincture of gclsemium, tbo dote of wbicn ia 



i 



aEtlTTAX'^OERASnm^UlSGSR. 



341 



1 to 2 minima. Oelsemine may be nsed in the ioK orvU of a graiu 
(0.001). 

OBNTIAN. 

Otniiana, U. S., is tBe root of the Oenttana lutea, or Yellow 
(lontiai]. a EnrniKTiii pinnt. ItconiiLinxfrenlinnino and gpniisie acid, 
»n<i has a bitlvr tualc. Tl)i« drug is ufficiiU iu the B. f.iat GcatiaHsc 

Tbenpentics. — Gentian is one of the moat oflicaviouii bitter tonicH 
thai wv yufness. In iLe anorexia foUowiug ac-utt> iiii>eaKPjt ami in gout 
anti fiiiilari<2l i-'Mdiiinii with di/»j>i-p«iu it is of t*ervice. Combiiu'd with 
bicarbi>Datc of ituJiiini. it i* of great service in Uie Iretttnioiit of the 
«ubaeqte <ia*tric •!»<{ inffftinal catarrh of chililrcn. 

Adminlstratitaii. — 'I'he compautid tincture {^I'mctura (rentimue Com- 
powita, U. S. and B. P.) is given in tho doso of 1 in 2 drnolima (4.0- 
8.0), the fluid oxtrnci {Kjclraciam GentUxmr Fiuuliim. U. S.) in the 
du»e of 30 minituB to 1 drachm (^.0-4.0), iinil tliv bulid extrtiet (t'x- 
tractum lirnlittnte, /'. S. and Ji. J'.] in the dn»c of 1 to 8 gminii 
(0.05-0.40). InfuuHin iif/iti.wn f'fi7njui»itiim. H. P.. w given in the 
lioiM? of I to ti fliiidounc&t ("lii.O-lH.O). The eoiriponnd tinelnrp and 
compound infii^iioii arc e(iiii|)ONed of geniion. hiirer orange-peel, and 
cardan]on]t<. Thv fullovf irif! prracription Is &n excellent one for use in 
convalescence fWnii prolonwed fevers : 

B.-Acid. niifi>.lirJn«:lil«r. dU f.^j wl fslj (10-*0). 

Tr. niii-iii viiiiiinF fgi H-O). 

Tr. <«ri)aiiioini rufnp. fjij i(tO.O). 

Tr. KCiitiB-^iFc^-Dili c{. 1. ftd f jiv (ISO.Oi.— NL 

8. — TCMpoonfiil HM) in wnler after mmb. 



OBRA.NIUM. 

Gfranium^ U. S-, is the rhixomc of Gerftnium maetitatum. It 
OOntiuns tannic and gallic acids, and is useful as an lutringeitt in csacs 
of $frou» ^iiarrhaa. It \» not the common reii gernniiitu seen in 
flowcr-giirdtriw. 

In infantile diarrhoea geranium-root, boiled in milk in the propor. 
tion of one or two rootfl to the pint, will ii« found nf great nervice 
and in tttstelcM. The dose of the drug itself is 20 tit tiO grains (1.3- 
4.0), and that uf the flnid extract (A'j-lrar/uwf &era»ti Fluulutrnt 
U.S.)ila\ fluidrachm (2.U-4.0>. 



QmQ-EB. 

Ztttfjiber. U. S. and B, P.. is the rhizome of Zingiber oftdnah. a 
plant of nindofilan, Jamaica, «nd other Trouii'al connlric^. BLick 
ginger ii< tJic dried rhiznme wilh ilH burk. ^bilc while cinger has \V\i 
eoveriog reiuovi-d. It enntains a hui volatilo ail auu au arDUiatic 
resin, and is verr large!; used in donie.'^tic medicine a» a carminative 

10 



242 



DRUGS. 



and stomachic. Tn the treBtmcnt: of rmtnstmat crampn it is often 
givcu, iLud in |)iirticuUrlr usoful io tliose crftmps dtie to sopprea- 
Bion fpoui ex|)08ure to colil. Ginger ig oft^n combined wiih purgative 
medicines to slop priping and for it* plcnsnnt flavor. (_>f iXApXi it is 
deciiled!^- fuiistipuiiiig. aud wlien iwwl in Jiarrh(f*i mixtutL-e w of value 
other thun as. a flavoring addition to thp prcecnptioo. 

AdminlBtration. — Th» fluid i^xti-acl {hztractum ZiRfftherU Fltiidum, 
I'. S.) is tiivon in the dose of 10 to 30 miaiing (iJ.t>r)-2.0), wijII diluted; 
tlie liiicluri! (Tinrfmit Ziinjihrrin, L'. S. .itid H. /*.). done 20 miaiuis 
lo 2 drachms (l.3-J<.y) ; tiie SYritp {Siirnpu^ Zififfiherii, U. S. and 
B. P.), dnsc JtO iiiiTiiin» to '2 drachma ("i.l— M.i)); ihe oieoresin (f/lro- 
retina Zintfifxrio, C. .V.). dose J to 1 uiioiiu (').03-<',06). well diluted 
or in pill ; and the troolies(7'rocAMci Zingib^t, V. tS.) used aa stimu- 
lants to salivary secrttion. 

OLANDULAB TREATMENT. 

Within the past tvu yeurn phymicdogical investij^atioQH have indi- 
cntn) that several glands in the lioilj)- not onlv secrete suhstances in 
the bi>dy-cavitie!ii, but also pour out into the bloo<l~ or iyinph-ve^cU 
ferments or substances which perlunii definite ph^rsiological fuuclion-i 
in the 8}'Btero. Disease of these glnnds purvorts these fuiii-tiutiti, aud 
aeoonditr}' dlsurdrrs follow. Acting upon the discorerie^ jnst named, 
Some ptTwuis Lave attempted lo allow that nearly all of the organs of 
the body, be they glands or not. po8St's.s these functions. ULlil they 
have reached a redncdo ad abtttnium. On the other hmid, Home of 
tbo gluods are now used, when derived from the lower animals, for 
definite therupeutie purposes, aueh n.i the lliyroitl |u;land luid the Bupra- 
rfiiiil hodii-a. for cxniniilf. The use of llie ^liind» will hv I'ouud dis- 
cu^ed under their own Dume^, hut unirriperliini glands in iherapy, or 
thoM in regard to wliieli doubt existJt, arc included under thu genoml 
beading here given. 

The emplovment of lestictilar juice, or the dried gland itself, haa 
been prnrtiHally nhiindoned, but the Juice of the ornry swniH to posseKS 
cnnHidenihle powi-r. It has been ueed to combat the symptomb follow- 
ing doubk- oophuR-cioiuy uud those comnioii to tlje n)enop»n5e, and ahuj 
for aphrodiiiiiir pnrpo:>es. On the ground that rhlfiromu is due to a 
Itiulty internal Kecretion of the ovary, it bus been given in this condi- 
tion with aeserled goitd results, and nl-o in oittfomahicia., nrurnxMcfii'd, 
and lii/sfrriii. The dose if from 2 to 4 grains (**.liV0.20) a day. (See 
Ovarian Extract and Maiiitnary Gland.) 

The UKe of eer<>bi'iil mid >-jiiiiiil uxtraets has proved futile, as has 
aleo the use of hone-marrow, in ptrniciouif aufFutia. The pancreas 
has b<H>n u^ed in panerrafif ilitt/tetra, but its value is in doubt. The 
liver has been given in the dose of -i ounces {i'O.O) of fresh gland a 
day to eumbat the ili'lirium "f '•Irrhom'n. with ascerled good results 
(Carnot), ami liafi been thought to do good in alei^fiirlic cirrhotia teitk 
u'li'rttti, in that the heniorrhagi'H were arrested, ihfl delirium oeaxcd, 
and the patient generally iraprfivt-d. The same treatment haa been 
tried in diabetes. It is difficult to see how it can be of bcne6t. 



• 



GLYCERiy. 



34S 



TTliilo glaoilular tberajwutiCB f^jvpg promise of nkling us grnLtlif id 
tlie treatment of disease, and while for this rt-u^oD tlic cautious pbv* 
viciaa Bbould not opp(»(> ri-^ort to the use uf fEUndular extracts, lie 
sbould. nevertbolctx^ always atudy the physiological function of tbe 
platui to be cmplojcd in order that he may rench a clear Ulett of its 
reiaediul positihilitics. The oxtraordiDarr effects of some glands do 
not prove that all animal extracts are of value, nor docit the failure 
of others indicate that all are osctcM. 



GLYCERIN. 

Glyei-rinum, U. S. and li. /'., !? a lii|iiid tihiaiiied 1)t iIjc dpoora- 
tK)«itioo and dislillnlion of fats. It posscsges great power in absorb- 
mg water and of di««olving many iwbiiuiices. Even ' if pure it irri* 
tatea the ekin of snsceptible persona when applied locidly by its abaorp- 
tiou uf tratcr. and ul^eti causes a flight rvih. 

Physiological Action. — Injected into the circulation in Iarj:e amounts, 
glycerin causes* convutsionn. whith are due to its bygrowrnpic power. 

According to the clinicnl rcscarcht^ of Pavy, glycerin increases 

the polyuria vf diabetwt aluiu;'! one-half, and for tlii!) reason he tbiuks 

it is not to be employed in tbta c\&»a of ca^es as a substitute for 

■i^r. Othrr cliniriiins. tiowcvi-r. diaagrt-c with him and u»e it con- 

' iluitly for this puqvHf with iiAH>riv4l udvniilnge. 

Therapeutics.— Olycenn may bp eTiipIovrd as a swr«-lriiiiig agent 
in ihc f'>ftii <if liiabfUi'ii and in cases where sufrar cannin be iiscft. It 
Ym» abo been eiven as » taxalirc in 1- or i-drachui (4.(^1-8. ft) doSM by 
ihe moiilh, and in onema — I to 4 draclims (4.tt-lij.ft) with or without 
«{«»! parts of wu-ter. In some ca.«c.<t it may bt? ukimI id auppwilory 
in the official Suppo$itoria Gli/eerini. U. .V. and B. P. This latter 
method ia very siiccrspfiil in fhronic comtipntian. Itfl continued use 
by suppository may, however, result in roctal irritation. 

Af* an antiseptic it is used for iircdcrvinj; specimens and for keep< 
ing alkaloids in solution for hypoaonnie use. 

Id acHte eojyza, applied by a epray or brush to tbe nostrils, it is 
sunieiimes of service; fur thia purpose it »h'i)iilil be diluted four or 
five times with water. If used on the ekin, it should be diluted one- 
half with water. lu caUMt of impacted eerumen in tli« exieruul audi- 
tory caoal glycerin is often of doi'vice in eoficnlog ihc luatis. 

The U.HC9 of glycerin, other than those uientioite<l, are many. In 
the proportion of ^ixaX parts of glycerin and water it inukes a very 
oseful utunth-wu»Ii for the m-re and drif iiwu-lh of (ifphi'id fvvrr and f« 
tJie removal of fordei>. The same wa^h. with lemon-juice added to it, 
is very agreeable and will relieve the dry. glaxed tongue of advanced 

Owing lo the fact that, glycerin is hygroscopic, it may be n?ed as a 
4epletaiit on a pledget of coltoji in cuugoslioa of the uterine cervix, the 
iMOpflD being reucMcd daily. (Bee Boric Acid and Boroglycende.) 

For the prevention of In-d-icrm Kingcr recommcndji tho daily wash- 
ing and rnhbing uf the part likely to be nlfected, followed by the 



244 



DBtTGS. 



■pplication of glycerin and wftU-r, wilh a (Imir-eheet placed smoothly 
againit the patient to protoet tlio bedding. 

Olycorin aud vrliiakcy is u favorite Iioiii'phnld remedy for colds and 
eouffhg, lut is not very unefiil. Glycerile of sturcli {Gij/eeriiium 
AmtfU, U. A'. an<l B. P.] is used ua a protective ovki- pupcriiciiii irri- 
tations of the skin. Glyccritc of yolk of ogg (tf/yswiVMin I'itelli, 
U. S.) i» Used in making eniulsionH. 

A. vRry Hueful ointment for the application of medicinnl siihslani^es 
to the skin may be mu<tu by mixing cimstautiv in the (ircsence of heat 
1 part «f potain ataix-h and Ij pans nf pun- ^lyct-'riii. The result is 
a clear, irajiflparent, jelly-like siibattiiK-e which dooi! not doc^mpose, 
and hfls the ndvntiiogo of hnhlinjc; ilii> meilit-anienl uliicb it carries io 
solution rnthtr than by uiecliauiciil sua|icuai(iD. 

Th« B. P. preimrations of gljp-cerin are as follows: Glycerinum 
Aeidi C'arficlifi, Glij<vrinHm Ari'ji Taniii'}i, If/cerinttm AlummiMf 
Gl^ceriHum Acidi Itorici, Gfifcerinum Plumbi >Suiiacelatis. Gitfcerinum 
Tragacanth'^, Gh/cerinvm tiaracit, (l^lyrerinutn Peptint, Glt/eerinum 
Amyli, and UitgvLen(ut>t (Jfi/cerint Pluinhi' Sttburetath. 

GOLD. 

Gold itaolf is not official in the V. .S. J'harrncfopwia, but haa been 
recommendtid veiy hiphly by B^rtholow in rfinmir Uriyht'w dUfOxe in 
the form of the chloride of (-old and sodium {A-uri tt S^ii Chl'-ridum, 
U- A'.), The dose of lliis siibHiiince i» 'j',^ to -j^ of a grain (0,00;}- 
0.yi>U) once, twice, or thrice a day. The author has not found it of 
miirh value, (inld h.i.s also been Ntronply recomnn-nded for indite*- 
ti'fH vfilh epipaatric pain after eating when looeeness of the bowels is 
present, and it \t t>aid to at-t as a jtowerful sexual stiinulniit and to be 
of scn'ico in imyoltHi-e dependent upon inftbilily (o obtain mi erection 
or when there in deficient plandular aclion. It ha« alsfi been used in 
excessive tiortni-naj '•Dii^ninn* in niastnrhators, with asBerted great 
8Ui*cea9'. in over<hi»e» ilie 'Iriig causes gasiro-enleriiis. Magnider liaR 
recommended chloride of gold and Rodium in the treatment oi pertutini*. 



GBINDBLIA EOBUSTA. 

Grindelia, U. S., is an .\merican plant {Grindelia robwUii) cnii* 
Uining ft resin, n volatile oil, and an alkaloid. 

PhysioloKlcal Action. — Upon the lower animals and man this drug 
is not verv powerful iu iti^ action, but may causu. in 1arg«i doaes,, 
paraJyiiiK of the pcriphenil sensory ncn'cH, the »cn.vjrT centres in the' 
Rpinal cord, and iiually the motor centres and nerve-trunks. It .hIows 
ibv heurt by stiuiulatiog the ragi, and raises blood-preaaure by stimti- 
laling the vasomotor centre. 

Therapeutics. — (Irindelia rohuata is an exceedingly useful rcmetJy 
in eouii' ca<^eii of atthmn and iu broiichitia in its later stageu. It may 
he given in the dof>e of 20 to 60 mininin (l.Jl-4,0) of the fluid e.Ttrac( 
{ Kxfrtftiim ifrituidi'i' F/nidmn. V. S.), or by inlisliiig the riKiieit of 
burning gritideliu-leavcs, which have been preriously soakeJ in a solu- 



UAIAC—0 VAIACOL. 



346 




I tion of nitre, tlrJcd. nti'l kunied on n plate '^r rolled into a cigarette nnd 
'smoked. In chronic '■t/alidn it HtiiiiuluU'S tiiv bluddt-i' und is of grciit 

**rvice. Uv diluting it 1 to I'J with water it forms one of the hcst 

lotiotui that wc huve for the relief of the dermatilU produced by poison 

ivy or Hfiua ToxU-wlcmlron. 

Adnlnlxtnitioo. — The only prepsTation which i* official is the fluid 

*xtra>,t (£xtr<xctuin Grimleliie Flutdum^ V. S-), dose 20 to HO tniniraa 

(l.S-4.0). 

GUAIAO. 

Likhdid Vilte, or (htaiacvm o^inalc, a. West iDdian tree, is utied 
in tDediritif in two fmtnrt — nsiuply, as pnaiar wood {^fjunittri Luinuin. 
V. iS'. and li. P.), which i» in ru«{iiii<:H and enters into the compound 
Tun of 8ar8a|>aril1a. and gtialac re^in {Quitiaci Itesiim. I'. i>. and 
'. P.), or ffnaiac, which ia soluble in alcuhol, ether, and chloroform, 
bat ia insoluble in water. 

Therapeutica. — G^uaJac has been largel_y used in »v/i/n7(>, but is 
now rmvlv. if ever, so emplnveil. (liven in ncutf tnnniUitin in the 
dmee of ■SO^frainif in an vuiulsion uiude bv the u^e <jf wliilc uf egK< >t 
will iiften tSiOTl the disease. In riitumatitm it has boen largely used. 
The ammoniated tincture of ffuaiae is Aometimes employed in the 
treatmetit nf aorf thrmtt. imrticiilnrly if it be rheumatic in type, but 
18 a dii^a^reeable preparation to take into the mouth, and the atili- 
cylatcs raaj alwuvH b«- used in il» phiee. 

▲dmllilrtiatioii. — The tincture (TinHura Guaiaei, U. H.) is giTcn 

in tho doM of 5 lo 60 mininis (0.35-4.0), and the amnioniiited tincture 

(TVncfuri <}ua{aci Ammotiiatu. U. S. und B. P.) \s u»cd in tho same 

doee. preferably in milk. MUlura Ouaiaoi, B. P., is given in the 

'4oee of 1 t.> 2* fluidouncea (IJO.CMJO.O). Trovhitcui Quaiaci Hetinee 

official in the B. P. 



OUAIAOOL. 

Gaaiacol ig a lii|uid cou»litutin}£ from 60 to 90 per cent, of eren- 
'Bot«. It t» ohtuined by the dit^tillatinn of beechwood creosote, fol- 
lowed br a complieated process whirh it is not necwsjiry to dpsmbe. 
Ib other cases xuaiacol in ubiaiued frnm fceeehwitod creoBote bv pre- 
cipitation with barium hydrate. Much of the "absolute guaiiicol" 
of coDunerce is iiupuru. Chemically pure giiaiacol, obtained by llie 
DTOceaa last namiid. iu a light-colored fluid of an agrfcnble odor and 
Dlnble in Water in tlie proportion of 1 to 85 (Helbiug). It is easily 
~«oInbIe in alenhol and ether. 

Th«rapoutics. — Guaiacol has been largely used by Home practition- 
tn, chietly in Kiiropo, in tho treutiueut of tuhi-TmlcMiH m a sitb.Htitiite 
for creosote, becuuac it ia the principal ingredient of that drug, (Seo 
[CreoBote.) It waa thought by Gutimaun, Sommcrlnfidt, and othera 
that the good effect of creosote waa due to its destructive uetion on 
the bacilhix, ot that it so improved digestion a& tu invreiute the resist- 



946 



DRVOfi. 



ance of tbe patient to tbe spreMl of the diseaee. Kcceotly, Ho«Udi«r 
lUitl Reifcrt have aAsrrtcU tbat goniaonl and crconnte proiluco tbtHr 
good pffecis hv forming componnds with the toxincs or pdisonoas 
albuminoids funned b^* thie bftcilli. nliich are iheu elimiQaced from 
the boctv*. Tbe damL> rnlus govern tbe use of guaiRcol as gov«rQ the 
emplaytnont of crensnte. It is best given with brandy, wino. or olbcr 
Htcobolio drink, or in capsulai with *od-]iver or sweet oil. 5 or 10 
ininim:« (0.35-0.6.>) of giiaiacol nmy be adried to a pitcher of liot walcr 
and the vapor in)ial<>(l tljrpe or.f.Mir tiniei a day in cases of mtth'trute 
and cfiTonic i/roncfiitia. The dose by tbt; stomach is 6 to 20 minima 
(0.35-1,5). In atrute foUicu.Utr tonxillitU pure guaiucol may be eare- 
fully painted over the tonxilN with great udvaiilage. 



Cliniual obtiervatiouH pmve cunelusively that guaiucol possesses 
powerful <in<ip}/reiii: influencas. As pointed out by Sriolla in 1S'.(3, 
giiuiaeol when painted on the skin of a febrile patient causes a 



■ 



pronounced full of tciiiiwratiire, which begins *)ijn after tbe applica- 
tion is made, but ita not fully accomplished for from two to three 
hours. The application may hp madct Ui the i*kin of tlit; ahdunxTn. 
thijrhs, or chest, alioui 3U to 40 miniiiiK (2.0-2.6) buin^ used nitli » 
brush. When a Inll i-ficRl is rt;<|U!n-d. it is well to place an intpcr- 
meabio dre.H.4inj{ over thi^ pari paiult^d lo prevent evaporation und aid 
abaorption. These applicntions may he resorted to as often as is 
neconeary for the reduction of tbe fever, and, althniigb (he fall of 
temperature is aometiincs very rapid and very great — a* much aa 
7° F. in tM'o bourn — DaCootu haa never seen seriiMiB nervous ur car- 
diac symptoms prodiiwd. but other obaervers have noted such unt<i- 
ward rciiults. The temperature is very opt to speedily rise after the 
reduction, and this rise is ofien preceded by a chill. These uppli- 
cjiliona cannot supplant the cold halb, altbougb they uuduulitedly 
do reduce the temperature. The true sphere of usefulness to be 
juiHigned to guaiucol a.<< an anttpyrelie Reems to be tbat of a less 
valuable therapeutic measure thuu the bulb, and one eqnaUy power- 
ful and about us dangerous as are the uulipjretle drugs of coal-tar 
derivation. 

When Uiied externally in the fever of ivhercvlaaia ixs action \% very 
satisfactory, but the preaence of cavities conlraindicates it« use, It is 
snid. 

The .ittnlies of Stotzenbcrg show that if frequently and coiutanlly 
used guaia<'ol produces in febrile patients a tendency towanl depression. 
Thayer findfl that great ttneattng and depression generally ioUow its 
external uw in fevers. 

Probably future report.*! will develop the fact that in cases of rennl 
irrilatloD guaiacol will prnv(> haniiful. 

Qnaiacol li».<^ been used by painting it nn the affected part in tbe 
treatment of superficial neurnlgiaii. and in deep-sealed n^rve-vnint. *A 
in f<cinticn, it \a\» been ^iven hypoderiiii«.'ully in tbe dose of » minims 
in 10 minims of spirit of ehlorofonii deeply into the neighborhood of 
the painful nerve- 

If guaiacol is placed upon the skin by means of a small comprnn, 
which hii£ been wet with it and bound tightly to tbe part, local ansa- 



I 



dioift U rapidly •Icvelopetl. but if it is leH in plnc« too lonji, it may 
be att»iirbcil ID safficient am']unt to cuudc depression or s full of t«m- 
p«rature. 

Belficlil bip;bl7 recoiniuenJi» painting tlie scrotum with guaiiical IS 
niinims (1.0) snil gly<^erin 45 minims (S.l>) for unrhifU, or nn oiutment 
«f goniawl 1 driicliiii (4.0) tu 4 dracliuis (16.0) of lanolin may be 
rubbeil into iLu Hcrtiiuiu aud uppliud on lint. This should be applied 
every other day. 

A serious objection to tlie external line of guaiavol U iu dieagree- 
Abl« odur. 



OUAIACOL CARBONATE. 

Carbonate of gtuiiacnl it< n while, crystalline powder, consisting of 91 
per cent, of pare guaiiwot mid 9 per cent, of carbonic acid. This 
poirder t» in^oluhle iti water, neutml iii rcactinM. aud ia siud to be nitb- 
i>ut any irriiatitig vffvvl on tht^- slomiich. Taki'U by the healthy indi- 
ridanl, it i« drcomposcd ititti guaincol iitid ca.rboiiic iirid in the bowel, 
bat nut in the Rtouiach, and it is uN(>d for thitt reasfin, nit .saLnl ia, as an 
tutestiiial antiaeptic in the Yarioui? foiTiis of ftniicntative diarrhaa and 
hfphmd ffvrr. The ilriig is said to be jilovrly absorbed, but after ab- 
«orptiun i» rapidly eliuiuatcd. Ite therapentic appllRations in tuber- 
euloeis an- praeliL-ally identical witli those »f pure guiuacoi, save that 
it w more readily bonic hy the »tnTnach than the latter dni^. Giiataool 
otrbonalo may be given in capniile or pil!, or it may be giren in dry 
powder ou th« tongue iii the dose of 2 to 10 graine (0.10-0.G5). 
Vsaally in l^phoid f^ner the dose i» about 2 grains (0,10) every three 
boars, and in tHherntlngis of the luniig 5 grains (0.<{6) three tiinea a 



I 



day. 



H^BMATOXYLON. 



Iltrmatoxglon, U. S.. fftematoryli Lipntim, B. P., or Logwood, is 
tbe heart-wood of Hivmatvrt/ion citmpechian»m, u tree of the Atnor- 
ican tn»nic^. It cont-iins an active jirinciple. Laiinaioxylin. 

Therapeutics. — Ilicnisto.Yy]oD ie a wild astringent, very n»efnl in 
MfTuu* liinrrfitrag and in the diarrhoeas of yotmg children, as children 
do not dislike it, owing to itti agreeable toiite. (See article on Diar- 
rbira.). As it eolors the kiomIh and urine red, the nurse should be 
warned lest she be alarmed at the sight of what looks like blood on 
ibe diaper after the drug i» given to infants. If the urine is alka- 
line, the color may be violet or red. In leucarrhaxt its internal nse is 
of wrrvice. The extraet (^Krtrarfum Hirmatoxyli, V. S.) is given in 
the doscof 8 to 80 grains (O.tJ-2.0), and iJtcectum Jltemaloxi/li, li. J'., 
in the dose of 1 to '2 fluidouiaces (80.0-G0.0_|. An unofficial fluid 
extrvct is often to be found in the ehopfl. The dose of this is | Co 2 
Haidrachuu (2.0-8.0). (See article on Uiarrhoea.) 



I 





I 



fi. /'., Wiloli-haitel, or llamamrlij! i^irffintaiia, is h pUiit of ihv L'uJteil 
States, (iL-voitl of wj true neurc principle*, but )ioss(s.tiug cxtraonliimty 
roioeiiml [xiwcr. 

TherapcaUflB. — Hamanielia is to be employpil in relaxed sore throat 
rvHulliDj; in coiigt'Stion anil hyneririnia uftnn (>xpo»iir(; or vherp mild 
ciita.rrlial MHlf.4 are presetii. hiiiiilnrly, ««■ cmiiloy xi in uii iiiuiiiisvr, 
after atiackn of aeut« cor^fittt, lo lont:' up chf nugal uiucous mciiibmiie. 
Tlie i<truugtli of lIic Bolutimi should U; ;i" tu GU miiiims ( I .S— i.O) <.f tt« 
dlsiillficl vxtrael (o the ounce (SO.O) of water. Ilamainetin when taken 
intiTiially ia oficn very Hucre5tifitl in ihe treatmeni of uterine ooring 
from small l>1or>(l- vessels, seeniN co do good even in hirnuitrmenit 
and /i'fmuf'tt/ein, and will ^omt-tiuied arreal hatitaturia vrht-n all citlivr 
reineilic< fail. Applied Ly mt-aTis of i>Iu|]ih lo recent ^v/ ulcrrg, it acts 
Very tlior<iuj;lil\ mid rapidly relieves the angrydookins pkin F^un-aimdini; 
llie ulcer. Tlie limb kHouM be elevated and at rest wbile the trcai- 
Uieat is pursued. Iti bltediny from tAebladder it lu&y be itij«cl«d into 
tliiK viRCiis daily in tfac form of ibb dii^tined fluid extract. Taken 
internally and applied locally, it iu of value in the treatment of Ufcd- 
inil ;iii<l llie rio-(-al!ed hlinri pilft. (St'e lleiiiorrlioids.) 

Administratioa. — The one official preiitLriLtinn in the U. S. P. \» tli« 
Duid extract (^f^xtrmHiim Jlnirimni'h'iiin Ftuiifum, I'. S. : f.i'jTiiifum, 
B. P.). doBc 5 111 20 niinitim ((t.;t.V1.30). TIic dose of tlie distilled 
extract, whicVi is not oflicial and in a perfectly elesir fluid. i« frotn 30 
minims to 1 drachm (2.0 — 1.0), and tliih 'm much the he^^t prepaiation 
for incernul and external use. I'lifortuiialely. this prepnriilior of ihe 
flnig varic!^ wry iiiiieh both in odor and eOieucY. Sdiiil' of the pror 
prietnry prcparatioas of witeb-hiizel lire more active th:iii ibow ordi- 
narily dispensed in the drug-store. This ie due tu greater care in 
their preparation, and to the faet that they are hold in orif^inal 
packn;:cH without exposure to the air. The Jt. P. recognizcb a hoIu- 
tion. J.Hptor Hamainelklu, TinetHra UnmameUdiii, and Un<fHfVtum 
JlamaHttlidtM. 

HBROIN. 

Heroin is the diacetyl-acid-cBtcr of morphine, and is a white crys- 
talline powder without odor and of a slightly bitter t««to. It is used 
in medicine for the purpose of controlling escerwivt couf/h. I'nlikv 
tDor|)liinp. its effect on the rewpirntory cenire in stimulant rather than 
depivssjinr when it i,t ;:iveii in medicinal doses. I'tider it« inllucncc 
the respirations are uKuallv nli;;htly nloweii and dei>pe»ed. The dose 
i* ^ to t gniin (0.006-0.01) three limes u day. I.ar^'e di'ses do not 
act a* well &* small ones as a nde. It is said to he «f value in urtPtnie 
iliftpHva. The fact that it doea not stupefy the patient nor produce 
constipation is strongly in its favor. As heroin is Jusoliihle. the 
hvdnwhloridc of heroin i."t the preparation used for watery soliiliong ; 
or heroin itself may be di)»olved in water to which a little acetic acid 



ffoFfifJiVys .lyoorSE^noiocAfNE. 



249 



hiu been added. U may al.«o be giren in pill or powder nitb nhiif 
sugar. 

HOFFMANNS ANODYNE. 

Spintu* ,^tfifnii Compotitut, U. S. and B. P., coniiiiits of alco- 
bol. etber, and tlie livavy oil uf wine. The writer has experiitientallv 
fttndied very iboruugbly the action of tbi* 1a:^t-nnmed ingredieni. and 
Ends: 

Finit. That tbe belief in hravy nil of wine being the qnietiDg 
agent ia ilolFiiiaQii's anodyne la bllacious. 

Second. The calmative effects of tbia mixture depend largely on 
the etber, rather than <m the oil. 

Third. Il would seem pnihable that in Hoffmaun's anodyne w© 
poMcas an aj;ent in which there are linked toother Ihrce drugs of 
andoiibU'd tH>wer, each one of whirh surcensively niilKititHteji tbe 
ulber. stimulating tbc ey8t«m iu the order here named — vJE. ether, 
aJeobol. and tbe beavr oil of wine. 

Tb*isp«ntlcs. — Jlonmann's anodyne ta tbe best carmtQative that 
»!• notweiw for general use. and i.K nne of ilie best remedies fnr Mtnyultut 
or hiccough. I'bis effei^t ia accompli.'^) led by tbe alcohol and vtlier 
acting as irritants or gciiiiiilants to the siuuiaoh imd intestine, »o thai 
free peristaUts result.*. In itttffhyt peelr/ris this drug w often the b«Rt 
remedy we bare rluring the attack. In the enrdiac puljiii^tifn of 
t-has^f't-heirt or in that arising from indigestion and in the nausea and 
depression Aei-n after exoessive Aiiiukirig it i!4 also very useful 

MolTmann'^ jinodyne sKoutd always be given in capsule* or in cold 
water, preferably ite-iTihl, in order to prevent too rapid vohitilixatiori 
of tbe ether and on^iiucni difficulty in Hwallowin^ tbe Ii<(uid. 

The doie i.-* 1 lo 2 Jraclims (4.0-Jt.O) to an ailult. Tlie vapor of 
the eiber U so irritating that ttic drug id difficult of administration to 
very young i-bildroti. 

HOLOCAINB. 

Uolocaiite i« a synthetic substance allied to plietiacetine, which is 
almo^it insoluble in cold water, and which is then-fore commonly em- 
ployed in the form of the soluble bydrocbloridc. Thi^ salt is a white 
cnrsialline body, which is very stable when brought in contact with 
many agents, but ie readily decomposed by alkalies. Solutions of this 
preparation pouieNi distinct aniiseptir power, anri therefore do not re> 
ijnire boiling in order that they may be eierile. A.* thn drug when 
in solution graduallr loses iiJt aii»>Bthetic power, it abotild be freshly 
diwoJTed each time it is ncodcd. 

Holoaune ts u»ed ax a local ana,-slbetic fnr the eye in place of cocaine, 
luoally in tbe strength of 1 pnr cent. Its effects begin in about fifteen 
aeconds tn one minute, and la.st about five to fiflcen minutes. It does 
Bol dilate ihc pupil aii docjt cocaine, nor doe* it affect inlraoctilur ten- 
sion or roughen the corm^l epithelium, llolocuiiie ha^ not .tupplautcd 
cocaine, hni. for the reason just given, is iii^eful in cases re<(niring 
atiKwhefiia and yet st tbe wiine time Huff'ering frnni keratiU» or iritU. 



Dauos. 

Ic do«« not OMiM primAry iacbemtft or aecoiuUrj bypArttBU* of ilio 
mncoiii<> iiientbrane. 



HOMATBOPINB. 

Homatropine is in iirtiSciftl alkaloid obUkioed bj proloDfed act! 
gentle heftting of u aolutinn at e<jiiiva)ent qiinniide^ of tropinc' und 
tuliiic ftcid in liydrochtonr acid. The faydrobroniatc of honifttropioe 
(ffomalropiiitf Hyiirofirimtuhim. B. P.) is acrjri<uillitable aall of liora- 
atropine, soluble in 10 imrts --.r disiillca wat«r. The if. P. recognizes 
discs of bomntropitR- {Laviellce iltimatropinfp). 

Hvdrobromate of homstTopin©. properly applied by frequent iDstil- 
lations. 1)5 a reliable invdrialJc for the correcriim ufainmialies of refrac- 
tion in beftlthyeyw. *Experieuee in not at band 1** dotennJne it* value 
for this purpose in eyes iLflfecled with retiuul-dioroidal disturbance. 
Atropine and Iiyogcyamine are preferred under such circiimslauece, 
for the obvious reason that ibi'ir pro1<mged action is deiiirable a« a 
nctliod of treatment. The danger of eysleinic disturbance from hom- 
atropine is far removed, even when repeated instillalionK have been 
made, and ita temporary anion upon the pulse eatises no inconvenieuco 
U> the patient. Migbl hy|ier%iitin of the coujuncliva almoai invaria- 
bly folloTR its use, but irtie coujunctivilie, if it occars at all, must be 
excessively rare. Aceonling to the i«tii(Iie» of Dr. de Schweinitx and 
tliewriwr, the dnig has a phypiologiral aclion closely allied to that of 
atropine, from which it is derived. Hoinatropine niyilria$iH generally 
IasIs from thirty-six to forty-eight hotirs, that of hyoiicyaminc eight 
to nine days, and that of atropine ten to twelve days. For the pro- 
duction of ordinary inyiiria.iis the drug jihiiiild be used in solution of 
the utrmgih of I grains (0.20) to llie omiee i30.l)) of disrillod water, 
which is to be dr(ipped into the eye every five or ten minutes. Aa 
the drug is expensive, only a few drachms of tbe solution of the 
MTvogth nam<Ml xbould be ordered for u patient. 



HONEY. 

Honey, or yUU ^- S., is tbe saocbarine fluid deposited in combs 
ky ihe honey-bee, ur Apis mellijUfa. It in iiseil in mi-dicine lo Dover 
t£t taste uf Uiwigret-abie medicincji. WLcu it i» abfitracted from a 
(■Mticuiar variety of llowt-ra, it fn-ijueniiy lias rJie odor of the flnwop, 
mU *hen taken internally may even p^J<l^ce the physiological or iioi- 
MMiOus cAi-ctM of the plant from whicli it 'u galheretl. Tliis aceiJent 
. .'iiimonly in those parts of the country vttcre Ibo bees hav« 
-'« lo mountain taurt-I aud sttiiilar plants 
TWrapontlos. — Honey mixed with water is used as a vehielu in 

^j[lc» and til relieve couf/Ji and drj/nftg of tlur mouth nml faucifg. 
bi««i used a* a gargle it very dislinctly inereaaes the secretion of the 
WttCMM taptnbrniie, and so relieves the conge.«tioii. 

' YMlpla* b > jiKKJuct oblained bjf nplitilng uji alrofiinc into Itopine ud tropic 



I 



f?!ii 



Untinr the name of Oiymel the B. P. reoognizAS a. mixtare of 8 
parts of honey, 1 of acetic iic«l, and 1 of wftt«r. This is gc-ucriilly a»ed 
li) a vehicle for more active remedies in gurglus or evi>u fur cKjirrlorHnt 
niixti)re:<. Melift and strained honey, to which a iitimll jiro portion of 
glycerin is uildcU, is known op Mel Itcujiunititiun, fj. tV., and Mfl De- 
/ntralutH, B. P. There are also a honey of roses {Mfl Ii<i»<r, U. S.) 
ami a oonft-ction {Cin\fectio liosae, U. S.)y used as vehictit) fur other 
■Irugs. Mtt Boraeia, B. P., is used for the same parposcs and for 

The olijeution to the msq of hnnoy in vohieles for a<-tivc medicines 
iis the fact iha( it is apt to diitorder thv Hturuuch. 

HOPE'S CAMPHOR MtXTURE. 

Tfab is; n mixtine originally ninile nirh nitrous acid, bol iu§tly 
used at jirfseiil wilh uitriv ncid. owing to l]u- fuel that nitrou MM 
is ehuuged iutu aitric acid when water is added to it. The nitrous 
•cid i». however, more efiicatioue than nitric acid in the srn^us or 
cholMraie diarr/uetu which it is used to combat. The formula is as 
follows : 

B— Acidi nilroni M (4.0). 

Aiime nnii|ihara (X^'U (2r'i6.(>)- 

Fa lultk 

TiDcl. oj)ii . . Mt xi t!i«5}.— M. 

S. — Oae-fourtli of tliia ui water eveo three or four Tioius. 




HOPS. 

Ilumulu*, fT. S.. is die sli-ohiles of ordinary hops, or Ifumului 
Lupulut. Th<!se eontaiti a liquid volatile nlkn.loid, hipulinp, and a bitter 
principle, lopiilinic acid. Hops aru known under tht' name oi Lvyulus 
ID the B. P. Mudi confusion ha* ariseu in regard to the preparations 
of this drug, partly herant^e HumiiluK is the oflicial naiu« iu the 
I/. S. P. and Lupulud in the B. P. This confusion ha.s been incroBsed 
by the fact thai (he ulkfil<<iil of ho]i» is called tiipuline. while tho 
powder whieh is found on the strobiles i» calli-d lupuliu. Those 
preparations in the //. -S'. P. having the word '-hnnmluB" in their 
tinine are made from the hops thcinRelve.s, those with "luputin"iD 
their name from the powder of the strobiles. 

Therspeotdcs. — Hops are used as autigpaaviodieB and neivou* teda- 
tive* in ca«.f( of hyitteria imd nervouKur^s. In priapism, i-eKtKal trrUa- 
hility, and renal irnlatirm they are of service. Kten in ilpJlrium 
Iremcna they ttecm to be of value. For local application a hop poul- 
tice may he made hy placing (he powdered strobile.'* in the masa. and 
employed in this way they arc a favorite hoiut* ri-mt'dy fur IoluI pain' 
/ul injlammal wH». Hops havo been used in the form of a hop pillow 
in ncrvvue in«i/mnia, but the Honorilir. inHiKincc is largely imaginary 

drjtends OD the fumea O'f the alcohol with which tte piUow is 
oistenpd. 

Adminlalratioa. — The tincture {Tmctura^ITuimtU,U. S.) a given 




in the dow of S to 3 ounces (15.0-90.0). Lopulin {Luputinum, t/. S. 
ani] B. P.), which is the powder found od ihe strobiles of hops, is 
j;ivciii in thu doHO of 2 to 5 grains (0.1-0.85) or more; the oleorwin 
of lupulia (Olt^orfKi'na Lupuliju.U. S.\ is given in dosu of 10 lo 40 
miniitiH (D.li.Vti.f);'*) in capHulpH ; ana the fluid extract {f^tractum 
Lujiiihni Fhii.fum. r. 5J, in the dose of 30 to 120 minims (2.0-8.0). 

ununi Lujruff), doae 
[Tinctura Lupttlt)^ 



■•■■/■ 7 "■' ■ ""/' ' — ■■' "• "- •" ■-" ■"' 

Thi- iircfmrutioiisof the B. /'.are llie infusion (y}^»«u»j Lujrufi), doae 
1 to 2 fliiidounc<« (.^0.0-iiO.O); and the tincture {Tin 



I 



dtfsc i t« 2 lluidrachms (2.0-ti,0). 



HYDRASTIS. 

Ifydratti; U. S., or Hifiirntti* Jihhoma, B. P., in the rhisome 
of tiio Jif/dra^in Canadcunit, ^oinetimtM culled " Golden Seiil," con- 
taining two alkiiloids. 1<:iiijwu t%A hj'drasiiuo and berherine, aod. per- 
haps, xuuthopucviu. 

Physiological Action. — Wlien given tn one of the lower iiiiimiLU in 
poifioiKiua Josvs h>|-dra:iti!< mny cause spinal convul-Hionfi followed by 
paralvsin, acconUng to the iftinniily of hert.erine or h\dr»stine present. 
The lallcr is more convuhivc iti il» efffcta than the former. Vpon 
the circulation hydruatini', uhen injected into tie jugular vein, cituses 
a primary fi'H of urteriul pressure, succeeded by a decided rise, and 
the studies of <!erna liHVf jirnved ilial it i,i an active poistin. When 
given to man in medicinal amounts its effect on vital functions is very 
Blijihf indeed. 

Tlierap«TiUcs. — Uydmstis is of service in ehrmtic (fattro-intatinaf 
catiirrh, p.triicul.ir5y iIihI ffdliiwiug the ahtxne nf aUtihnl, and may be 
used aa a stomachic and tonic »fter malarial fever and similar deprose- 
in;; diseases. Wlierever iiieTiiliranes exiM in a condition of lowered 
tone thi.'? drug li in<iicatcd. Thus in ffllarrhal Jaundire of a subacute 
type, in utiritif calarrh. in leucorr/iifa depetident upon a relaxed state 
of the vagina, and in ffiranie jkjimI infiammationt and irritations it 
will be fouml nteful. 

Tincture of hydrasli? is said to possess a distinct antimatnrial 
Inflnence. bill thii* is dmibtfiil. 

One of the best rcmedtnl mcasurcB that we have in the later stages 
of fjnnorrhwii . when the acute pcrind htis passed, i> the local and 
internal use of liydraMtis. If it in used as an injection, •> grains (0.3) 
of the nommereial hydrasline to each ounce (30.0) of water ^linnhl be 
i-itiployed twice a dav- Uelfield hn.s highly recommended the follow- 
ing formula for uae in this disease prior to ihe tenlli day : 



sr. r (0.3). 



E-— Itydrertin. h]r<)rockt«ratb . ... ,.. . . , 

Pnilarir«I. ....... gt. v. (O.S). 

Olv**riii fTw (0.21. 

Ac(ii(c (lowilluL , q. K. ad T,^ (SO.ti/.—M. 

6L Piauidp «tUi M lint-wiiU'r injifclidii ontl iwc Taiir tn kii timn daily. 1vl1iii([ tli* 

p«tj«nt to retain it firp u> i«n ni inuteti eitcli lime. 



tThe following infusion will he fouod of service iti vaginal yonfrrheea 
&nd hiicoivhtea : Take i drachm of the powdered root and add it to 8 



ooaeM of boiling vktor; } to 1 ilrschm of tht fluid extract maj nbo 
be added to & pint uP vriiti-r ttiiil ii;<ed iis ti vrosli. 

▲dmlMiftratloD. — TIjc liui<l v\lraci {Uttractum Htfdraatix Jf'fiiidum, 
U* S.: Ltqniiium, li, /*.) may be given in the 6ow of 5 to <W minimN 
(0.30-2.r»), while the doae of the tincture (Ti»efura fIt(dra»tis,U. S. 
ami B. P.) is from 30 minims to 2 ilnicliiiis (2.f>-8.i)). The Qbj- 
reriinm ITydmtth, U. S., is used as a hcaliti); iipplic»Lion to mticouft 
lutMiihrant'.*. 

Mach doubt exJBtH as Ui the done tif hydras) i[i<>. This arises from 
tbe fiwt that two forms of it are sold. The most commonlj wen is 
m dark-brown maw which is very impure, and conlaintt berberiiie and 
other subatancos. Its dcwe is 3 to 10 graiua (0.15-0.65), The pure 
hydrastini*. a« uiado bj Mer«k, is givoo iu thi> d»s« of } to i grain 
(0.016—0.03). Iljdrafltinine hyd rochlnrate, an artilicinl alkaloid of 
uvdraatiDe. ha.s become official in the fT. S. J*, of 1890. 




HTDBOBROMIC ACID. 
(See Bhonide^.) 

HYDROCHLORIC ACH). 

Acitlttm Htfdrochhricum ( U. S. and B. P.) \tt a vicar, oolorlti88 
Ii(|iud. posAewiing an acid odor and lastu. devoid of iwtringency, but 
ia coQcentratcd form decideiUy caui>tic. It Bhinitd be kept io flark- 
colored boiik-s. In the streacth of two-icniL* rjf 1 per cenl. Jr is 
normallT present in the gastric juice, and aidfl the pepsin in the con- 
T«nioD of proleids into peptones and in the foriuatiun of pepiu from 
pepsinogen. 

TherapeaUca. — Hydrochloric acid is iudioitt-d only in certain foruis 
of indi,)--»iii>n. With nev methods of studying pnstrlc secretions we 
have learned that it in of vxliie in these caiim in which the ga.4tric 
accretion of HCl is deficient. Thui? it is given to aid digestion dur- 
ing and oAer fevers, when this acid is apt ti> he ub^^ent from llic <;iisiric 
jaice, particiiIoHy in tifphokl fmer. In cases oi tfnitrif cajurcr, when 
this acid is usually absent from the gastric secretion, and in the tick 
^nmtieli following nn alttobotii; debaucli, it ia "f great service. In 
9unic casus af irkrmiir i/(iMtric cnturrh with ilif(ittiti'}tt, in which there is 
atrophy of tbe gastric tiilmleiL, it sbould lie nsed freely. The dose of 
(he ddiite ariil (Aririum Ifj/iinicMoricum IHiutum.l/. S. and £. P.) is 
6 to 20 mininift (0.:l(;-1.8). 

A useful prescription in such case.t is the one that follovrs: 

8.— Acid, tivdmol.lorio. dil fTij (8.0). 

Ptp-in. <*>rdiii1 - . . . f "li (.30.6), 

Tinct. geotliD. onnip q. il iid f^iv (ISOlO).— M. 

& — Dw ni ttpognful iS.Qi in a lit[l« watrr wtih iik-hIk. 

Thin acid is combined with nitric acid to form ddutc nitro-hydro* 




254 



DRVtiS. 



chloric acid {Aridum NUrO'hydrovhiorioum Dilutwn, U. 8. aod B, P.), 
the doHe of which is 10 to ^0 miniinx (0.65-2.0); also the pnra Mid 
(Acridum Niiro'ht/Jrocftlorieum, U. <S'.), ilosc 1 to 6 miDiins(0.05-0.S5). 
Hydro(.'lilori(! acid cuuses. when taken in poiBonoiis doees, violent 
fjagtro-rntcritia and corrosion of the gaAtric walls, and iu action should 
ipe cotiibai«d by alknliea. sonp, oils, nnd vbite of egg, ud tbc uso of 
opium 10 relieve |)ain and imcatioa. 



BnfDBOCTANIC ACID. 

HTdrncTanic or Pniasic Acid Ja a traiit^parvnt, colorless, very volntil'C 
liquid. givii)f{ rise to v(>rtigo whnn mliulod in minute aroonali) and 
capable of producing deatti if the fumea be coQcentntt<;d. If the 
bottle containing llie pure drug be opened, it should be done where 
tbisru is sufficient Jruu;;bt belmcL-u »iuuo«8 to prevent aii; coDtauiinu- 
tioii of ibc almu>!^p1a>r<.' of the rootu by tbc ucid. 

I'un: bidrocjaiiic acid i» ni-rvcr used Ju lucditinc ; the forni employed 
iH the dilute iicid {Aridum H^drocyanietim DUutum, U. S. and B. /*.), 
which contains about 2 per cent, of t^e drug. It must be kept in dATk* 
tigbtly-stoppcrofl botilos. 

Physiolosical Action. — This id ociu of tJic must rupid (if not the most 
rapid) of tlie WtLal poisuDB, ouly biiiug approuclitid by carbolic arid and 
nitrobeiuiile in the vinlenne of itit cffcetrt. Owing to its volstitity, it is 
aljHorbed with great rapidity, .ind av\» upon the rpjipi ratorr centre and 
the heart, being i^linntiated almost immediately aOerward. Bccuu«e of 
its fleeting elara^^ter. the survival of a patient fwenty or thirty mio- 
iit«A after the ingestion of a poii^onoos dose is a favorable sign for hts 
recovery. 

The drug \» Kii active paralyzant and exerts a K-thol intliicuev over 
every part of the body, Tlie nervous system, hcarl. re< pi ration, brain, 
and all vital parts arc killed at once if much of it is prcHetit. 

Poiaonlos- — ^Vhen a lethal dose of hydrocyanitf arid is taken, death 
either comes at once, eo that the person drope dend Iu the floor vrith a 

FlQ. 46. 




MtM. 




Tnurinfiof iliBrlntbiiDiinT mipit«ltiiti" nfnn animal iitidBT thrlnfliicnrcof hjrilrrKTf"'*!*' < 
lAOrt ^liialrdc-bpri.) 1. NLnntil mi>ltBiioiw; II. Acid InhaM . Ill- Vliflcm dwp 
pIrallMia; IV. Arroiof rvipirallun. 



ga.'«n. is for a moiimnt fonviiUed. the face cyanotic, the eyes wide open, 
with ihe teeth tightly shut. nn<l the lips covered by a binndv froth, or 



HYDROCYAHIC AaO. 



2S5 



tbre» stages of poiKoning mar ensue if the dose has not bppn Urge eiiouf^li 
to result iu iutuitrdiate d«ftth, ovriii){ to \U slow absorption. Id iW 
first "f lliesi' slageii lliere are difficult reBjiii-Mtiuii. «Iyw cariliac action, 
nnil 'li8turb«>d ccrcbpatioa. Iu the second Ktugc, whii-h is convulsive, 
»e 6nil wild criwi, dilalvd [mpi!*. iin<-'nn»eiousiJC's,i. vomiting, ttpasiiKxlici 
oriftfttioD a&ii defecation, erection?! of t)io [tetiis. »ud ejiictiluli'mB of 
Memeti. In ilie third xtage tliere nre a»p}ivxia, coUaptte. and |)nra]T«i8, 
ending iti dencb. The h)oo<l i« found to be dark und venoug-lookiDg. 
Imt do«s not give tin- :4prciruiu bandit of <'vaiio-hremofrlobiii. 'riuruB 
))U)d« odIj &pp««r irbcii the dinig is sbakcQ with blood out»id« the 
ImhIt. 

'(he diAgDOStic signs of death f^>lll pmssic acid ar« the odor of the 
bodr, the wide-staring cjc. the clinched teeth covered wiili froth, and 
tho livid, cyan'^tited fac«. If the bodj be opened, the odor of hydro- 
c^ranic B4:id i:> Diurked, but ikiti rapidly passtit uway, owing to tlie vola- 
tilirv of iho ding. 

TIm- oiilv i>'H!*on pmdiiciiig s\mpt<nn» renenibling those yrhich harp 
jusl liecn d&tcribcd is nitrobcnxnle or usspmse «f tnirliane, which bsfi 
a. immewbat fimilnr iidor. hui itbich is, however, more permnnetit. the 
tMlur rrmaining in the opened body for hount. 

Tiierapeuttcs. — IlydrucvanitT acid ia uM-ful i» ca^e^ of gaetraUjia of 
purely nervous origin, ami in «onie eattug uf iierrown vorfn'tmif. and in 
irritahte Ktamaeh. whcrt-. owing to a hypcrH^sl bc-sia of the mucous uiein- 
brsoes, the taking uf food produces dixcotufort. 

Id irrilaMe cougkt, due to tickling in Ihc throat and bronchi, it is 
very extennivety used, and hag refioived high pnuHe by those beet 
(junlified lo judge. On the other bund, it haji been clnimeil thai owing 
to the extreme volatility of the drug it only acw for the tnoment, and 
tbat tt daw every ten or fifteen minutes in nerecvsary to produce any 
real effect. However this may be in theory, practically the acid oer- 
t»ialy di>e» aid in relieving cough. In tberie states the following pre- 
scription will be found of nervioe : 

B.-.4cW. bydjvcjui. dil f3j (■LOl, 

Strap- pruni virg. f.^iij (B6.0).— M. 

B- — TMiiMonfa] M.Oj ttvtj four or fi»* houn to no adult. 

In enteralgia ur neuralgia uf tJie iut«Htiues dilute pnuiAic acid ig 
often a very ueeful remedy. 

Externally, the drug is useful in prurUut and other forms of ilcJi- 
m</ "tin diMfonet, and the following formula will be found of service 
in pruriiu* vulvtr: 



ft.— Hjilni^. Hilot, rarrai. 

Acid, hjtdnieyanic. Hil fsj 



. jr. iM (n.OO). 

Anu. iijorw-vsiiic. riii fSj |4.0). 

.^qiununyf^ul. aiiiarw f.s^j (180.0},— M. 



8. — Poiartn ! Far eilemal ifK\ Apply to ili«! ItcbiiiK mirfucr witli a titnall rug. 

The same prescription may al!«o be employed in prutitns wftbout 
the bichloride, if so de^iired. The dose of dilute hydroc'vatiip acid is 
I tn i iiiinini.4 (0.0i>-0..3.''i). In eertain forni!* of irvilahh f/>vf/h inhnhi- 
tion» of the vapor {Vapor Aculi fftfdrofi/amct) are reconuuciided; 
tbift is prepared br adding 10 to 15 minims (0.65-1. U) of the dilnted 




2S6 



DRUGS. 



BCtd to 1 fliiidrachm (4.0) of wntcr. nlitcli IH Ibcii placed m o suitable 
apparatus, from wbicJi ia inhaled tlie vapm* that arises. 



HYDROGEN PEROXIDB. 

Pproxide of Hyflrogi-n is a clear, odorle**, syrupy flnid of a 
Bpecifin gravity of 1.4(>2, paK^emiing a harxb. bitter ta»t«. It ia 
readily soluble in water, imd it« cht^mical formula, in HjO,. Pure 
peroxide of hydroj;eD i» never u^d in medicine, but in eolutioDs 
of varying strength. The ordinary solution, a-ii found iu tbe shopa 
and ttint now ofiicial (^-lyinr Ifjfdmrjrnu Vioridi. V. S., Liffuor 
Hydroi/enii Pvroi-iili, S. P.), is abuut 3 per cent. or. as it is gen- 
erally called, a 10-vnluine fioliitiwn. Thie term. " 10 volume*." sig- 
nifips that it eati yield 10 volume!) of araitiible oxygen: and it is 
upon this vicld i>f oxygen tliat ite activity dependa. Tbe specific 
jjravityof t^iis oflirial Sidrition is 1.006 to \'0V2 at .'j!t'. Tho rpaetion 
is aoid, but tliis i^ due to a small iimuimt of iicid addi'd lo ibe eoluliitu 
to present' it. The uAlviul noliitioii of peroxide of hydmiien. while 
the most stable ibal can be prepared, is nevertheless reuiUlT deterio- 
rated by exposure to lieat, Kiinlight. or prolonged shaking. If placed 
in an absolutely clean. 3iQ»otb gtas9 vessel, it may be concentrated for 
immediate use by eic[Hii»inj; it to a lemperalure of 140° F. ; but 
exposure to a icraperatmc- above this point may result in its decompo- 
sition with explosive viulence. Praciically. ibis means of concentra- 
tion is not coDvenient for tbo practitioner, and tbe ordinary official 
solution fulfih all or<linary requirenients unless it has deteriorated by 
age. The grcnt difficulty in (tic nse of the solution of tbe peroxide 
is its litibility to undergo eb^iige uuil become pruiMtoilly wurtbless. 
Wallian states that as a rough test for the value of a given solution* 
few crysiaJ!' of pcnuaii^analc of pfttaM.titiin may be ]ilai;cd in a test- 
tube, and 1 or 2 drachms (4.V-K.0) of the soluiion added. Tbo vio- 
lence of the resulting eflervescenue is in direct ratio to il£ value as 
a remedial agHUt. 

TherapentiCB. — The moat valuable use of the peroKide-of- hydrogen 
solution ill medicinu ]» iu the ireiiimeui of diphthi-ria. So far as we 
know, it is the best application for tbe destruction and removal of iLo 
fiilse membrane. There in uo injury to the norriml lissfuca, nor is there 
the danger of poisoning which somelinies follow? the use of such drugs 
an carbolic acid. Applied to the false monibrane. there is at once an 
active efferv««ccnce with some local tindiu)' of the part. The mcu- 
bratie can afierwanl be removed in slireds. Tbe solution should 
<bc applied by moans of a i>wab or spray, hut if the latter is it^ed a 
glasH aroiuizer must be employed, as tlie peroxide ie decomposed by 
coming in contact with metals. Peroxide of liydntgen is also a very 
valiiablp nppliealion for ea*es oT follicular tuniiiHirix with jirofuse exu- 
dation, to cleanse the parts prior to the use of guaiacot. (.Sep (.iuaiacol,) 

In the treuttnuDt of ahtee*t-CfiFltlpii. tiihcmilar or septic in char- 
acter, the peroxide of hydrogen is a very valuable application, and 
its use will often decide the presenre of ptis. ^inee when it meel)^ with 
this material active effervescence ensues; but euro must be txcrcisod 



HYOSVYAUCS. 



257 



that free vcni is allowed for the gas tlint if> givoD oflT, w ifcoutiiied it 
will forcf ilic septic maU'rUt ibto Ibc euri-uuadiiig licnltLy tituu(?a. 
Similarly, it i^ a raluablv pre|mratiou for cIcAUsing uleeri and malig- 
nant (ffoirth* which have ulcerated. 

Thp employment nt the pcrnxiUe inlomallv, wjih the idea that it 
win yitid oxygen to tlie body iu ca«a iu whicli this ctm in lai-king in 
the blood, li fulilv. Even if tlie ojcygeii futcrcu lh« hluod. th« 
niuuunt disctigaged from a poBsiblo dose would be too uasll to be of 
value. 

lljdro^cQ peroxide ia a useful n^nt for the removal of powder- 
ataint in recent cases. 

It is staled thut the appIic':ation of this liquid to the spot alTvcted 
by s homel'x tthiff will give iiisiaut relief: and applied by means of 
an atoroiacr it lb the best fluid to aid in the p-tinlet» removal <tf adhf- 
aire ttnpt. The part i>r the strip next tn ihe skin should he spmyed 
afi it >» gnidiially jiulK-d ufT. It i:^ ubo a»vd un plo^ter-uf- Paris dri's»- 
ing* to M>ftL-ii the njutciial su ihnt it can be cut >tith a kiiifu or sliL-ura. 

V^heri- tbi.- peroxide is used a« a gurgle it may product; pain through 
it« atlaekiug cavities in the teeth or the mrlullic- subslancoj; with which 
they are filled. 

Taken internally, the peroxide of hydrogen is not poi6onout<. The 
internal dose of tlio Arju-i I/f/dr'^yfiii IHori<li of the 6"^ H. P- is 
friiiit 1 lo 4 drachms (4.0-16,6), well djlutt^l with water, and taken 
fmm a porceiaii*. not a metal, cup ar spoon. It posicsses no dietincl 
value in iotemal medicnlion. 



HYOSCYAMUS. 

/iTmi(j), V. .9.. or Ilenliatie, is a jilaut of the Northern Hnitcd 
'and Europe. The leaves {^ITyosfyami folia, B. /■*.) only are 
nsvd. aud frum tbciu an; obtained ivru alkaloids— one known an hyas- 
cjmmine. the other as IiyaioJne. The first hiw practically the same 
pbvfliol'igiral action aa atropine, save that it is much more sedative in 
it» effects on the nervous system. (See Rclladoniia.) The second is 
quiu- difTfrent iu it? influence over the body. Tli« only marked differ- 
BDce in the action of liyosoyiLmino and ittrupine ia in the iDydria»;i» pro- 
duced by each. While thm of atropine la.«itH, in man, from twelve to 
fourteen daytt. bjoseyamine genemlly remniuK for only seven to nine 
dajs. Hotoetinies the development of mydriasis is preceded by violent 
'■'peui iu the eye due to a mititp of the eiliary muscle. If so, the driij* 
IDUBC be poshed to overcome llie spasm. The Htren^lh of the solution 
to be twed i« 2 grainft (0.1) to the ounce (-30.0), Owing lo tbo pre«eiiee 
of bTDMine in hyuflcyomus. it is more quieting and depreiwiag to ibe 
IMTvou^ i^yst^-m than is belladonna. 

Tberapeatiet. — Hvoscynmus is used in ©very condition indicating 
tbe employment of beltadonniL; or, in other wonls, wherever local 

nm or -irten'tl rflaxaUcn exists or where pain is due to ipa»m. 
IS been particularly recommended in ii'-reoHn cough, in ichoopiitg 
cough, and in co/f>, and probably it better in its influences in tbeae 
Btat(M than is belladonna. Iu eombination with nitrate of silver the 
17 



2N 



DRUGS. 



extract may be awl with nlvaiitagc in chronie geulrh ratarrh and 
gattric utcrr. In urinary ineontm^nce due to irrititbU- bladdtr it is 
very sei-vicoftblc, and paiticuliirly ia this true of liiie nfTeoiion in chil- 
dren and old persons, provideil that the urine w firwl rradtri-d normul 
by tlie use of acidifyinj; drugs or bj- the use ofalkaliniKiiig drugs if iL 
is ;ibiiariiia!iy acid. 

Administratiaii. — The drug itaelf is officiftl in four forms and as 
hyatcvaiuiiiu sulpliuiv Aud }tyilrohrnmiLti>. Tbu doau uf tbc liiicturo 
{Tinctitra ffyosMmmi, U. .S'-'und H. P.) in 80 ujiiiims to 1 dracbm 
(2.0-4.(1); the alcobalic extract {Kxtractum Iltfimyami, V. .V., uid 
Viridf. B. P.), dose J to 1 grain (0.02-t).O5) ; the iilkaloid (%o»-^a- 
JW/W Sul/ifiitM. Ij. S. and /t. /*., vel Ilt/Jrubromnes /'. ii.\ do^e 
Jj l« ^ of ft grain (ll.OOl-O.OOiri); nnd (lie lluid fXU-act {Ertraeinm 
HyiiBcifatui Ftuidtim, U. S.), dose a to JtQ minims (0.:ir>-2.0). The 
B. P. preparation, besides those ji;iv«n. is the juico (A'ucctw Hgoa- 
eyanti), dose ^ minims to 1 lliiidmchm (2.0-4.0). 

Hyoecine. 

This is oue of tlio nlkuluids derired from hyoscyaiaua. and is & 
tbiclc. syrupy aiknioid which forms u crystuHiuo salt with an acid. It 
is n piiwcri'ul URrt'uus sedative in mimv immcm. Much if not all the bo- 
calk>d liyosi'iro cif the stores is in roality Beopuluiiiiue, derived from 
St'fii'"li<i 'lU'f'pfi'li-H, 

Physiological Action. — Ilyontcine qniets the cerebrum and producea 
deep sleep in a certain rlaa-t uf putifntn. In the loner animiiU or in 
nian it may I'au^e sleep or wild dt'Hriuui. It cunseK In^ts of reflex 
action iu ovcrJiisL', which is due to (IcpreK^iiin of ibe epinn.1 cord and 
not of the inTve-trunks. rpt)n the ciri-ulntion it has little eflTw't, bnt 
it id Worthy of note thai it influences the va^^ua nerves, as dyes atpipitie, 
fitiniid.iting th^'in at firet, but finitlly dppre«»ing tliein. ullbouj^h the 
floutrary has been asserted. In any event, tbc circulatoiy effect is 
a minor one. In iJiaes where hyoscine hiw acted in exeess, or where 
an overdose ha« been ^iven. pilocarpine may be used as a pbyBiolof;ical 
antidote in full dcHes if the heart is Mimnd. 

Tliftrapentica. — Hyoscine is of value a* a Jtyfrwlic in a very limited 
class of Ka-Hes, and in thin chics jfeiierallv aeta most favoraVdy. These 
casna consist of tIio.te who, from ncuu^ mania, hysteria, or similar cause, 
suffer from insomniu, and perhaps Htru^le violently against proper 
control or rcfuac to swallow or retain food. 

Tbc drug may be ^iven lo .srich persons hypodennicallT, in tbft 
dose of yjd to ^(j of a grain (O.(>006), or by tho mouth in 'the dose 
of T^ to -X of a grain (H.OOOH). The facM that ii possesses no 
iBAto ind IS small in bulk renders it readily employed. In eome 
persons it utterly fails even in this particular tvpe of eaaea.' In 
delirium tremens it may cause evidences of cerebral cotijjestioo and 
ChevDe-Stokcs breathing. .Some patients are not cjiiieted by the 

' The wiiipr hw g^vm one-iMiih of n irrnin of Xlcivh't liyofcchw in iippniy-fmir 
Itoura. itbiniuiug li team two diArnDl mil rpliible (ourn]*, witlioiii jirmluci.ig al«ep, 
■lihougli ih« iwjiinuivas were aiuch ijuicken«d, 



nypyAL-icHTH yol. 



259 



ilmg, bnt pace up s.nd down in n wmwanc condition until iu action 
woAni off. In tie opinion of tlio writer tlif iipi'liL-nbility of the drug 
ia wry limited indoed, uud iintunard cBVctH ui<.' coinmuii. 

H voscino 18 of great value in noiiic oayt?!) of »/irrmalorrhtea and »mw- 
turnat rmiMUivii if given m the dose of yj^ grain (O.OOOH) at Tu'dtiuie. 

Tlie drug is contraindicaled in tlic »«ro tbroBt of searlot fever, aa 
it tnsj cause a »ensatioD of |)harjngeft] cuDstrictioD. In \ lie inaomnia 
of hitnrt iii»fiuf with n('rvouBnt>*s it will came sleep, but muy also 
product' d«itb i»_v n-spiratory failiin- or cardiac arrest, and it is to bo 
reDi«mben.-d ibui tbc druj; will pniduce asllima rather ilian ri-lieve it. 
The bmithing in some pei?tonA niaj Uecoiue utidcr itn influence croupy 
or raHping. 

Hyutfcine U un unvcrtuin remedy iu ncrvouH allectious, snmetiiucs 
ftctJQg very well, at othern prodiieing very alarming xyiuptomH in 
oerebration, cireularion. and respiration. 

Hyoaeine is official in the form of Il^nteinf Iludr^lrr-minle {Huot- 
cince Hydrohromat, U. S.) and in the Ji. P. as llyoacinf. Hijdrohro- 
mide [UjfoKinee tij/drobromidum). 

S7FNAL. 

Tbc cbemicat name of this substance is monochloml-antipyrino, 
sod it is, a@ its ntnae indicatos, a coniijound of ehlnrnl and nnlim-rine. 
, Tbere is also a dichlnral-iintipyriiie. nliich cuuiainft muTC chlura]. Tlie 
compoand in etuploycd in tr^aiitig tb()»e piitieuls who ■mSht from puin 
tuid iuMtmuin comuiued, tbe aatipyrine relieving the jiain and tbo 
cblorul prodiiciug sloop. Opium is the only drug known wbicli can 
be relied npnn to act in thin doiililc manner, and the di»udvautage.t of 
ihttt mcdiramf'nt nr*" oft4'n «(> prominent as to prevenl its uhe. The 
drug has bi-en us<'d in jicuni/gic tuHuinuin. hut fur some reason has not 
prored %» popular a* wa» expcercil wlu-n it was iniri>dnced. Thi> flnse 
w from 5 lo JiO graina (0.3.*)-I.:l). best given with ciuiple ayiup and 
water or with symp of orange-peel, or it may be used a« follows : 

B^HypBal gr. XT(I.ft). 

tliartreuw m («.0). 

Ktillcd water t^\USi\.—VL 

8.— T1>e entire amount to be taken in one doee. 



ICHTHYOL. 

The 5ubatancc sold in the shopn and employed in medicine under 
the name of ichthyol is really a salt fnrined hy the bibutje acid, 
iohtbyo- sulphuric or sulpho-ichthyolic acid with ammonium. In other 
worda, it ia ammonium it-hthvol. which in a itenii-mjlid snbNtance. The 
ichthyo-sulphuric acid itself is derived from a crude oil. which in turu 
is obtained by destructive distilbition from a depwit of fossil fish found 
in the Tyrol Jlotintains. When combined with sodium, forming sodium 
ichthyol, a more solid substaocc than ammonium icbthyol is furun-d. 
which nn be employed if it is desired to use the drug in pill form. 



360 



VHUG^, 



Both the aiDDMQiam and sodium ichthyol coniain abont 10 per cent. 
of siilphiir, nnd it is largely upon thi!« that their iberapeutic nctivitT 
dcpenas. They ftfe both ftolunle in water, ind have n dnrk-browij. 
tiirry appiramucu. Their disagrt-cablc odor dcpt-iid^ ujiou uti iudt-ptkra hlv 
volatile oil. 

Therapeutic*. — Iclithyol id without doubt one of the most remark- ^ 
able Kubslancca introduv«d for medicinal purpoftM within ibc IsM fev ^f 
\ear^, both because of its curious origin and itt) iberapeutic ru.lue in a ^^ 
Wgc viiriety of uilmcnt*. In the nuthor'g hande it hits proved ntoat 
eflic-aciuus iu thu trcalineiit of the iniltuned arena in acute articuUn- 
rfint'tiatism. ^V!it>ii vewi in tbi^ disooHe an ointment composed aa fol- 
lows is to be sitieart-d over the ioflanieil pari, and cLen spread on lint, 
vbich is vrnppcd tiboiit the limb. This usually relieves the pain and 
tenderness of the part to a great extent. The aanie application, accom* 
paiiieil by rubbing; or applying maiigage to the joint, is of value for tbe 
pain and slifTuess met villi after the acute miuiift;station of the disevM 
oas passed by : 

B.— lohihjftl. 3»[15.0). 

Vl duuticlle ini- Ev TCl XXX (lj&-3:ft). 

Aaiiiinvpl Unolini Jj (:«l.O). — M. 

The same prescription is aUo llm best external treatment of «y- 
sipdiu iliat we have. The skin shouUl he rarefully and gently 
washed, and llu'n anointed with the ointment iuid covered by tint 
smeared with Ihia aiuLuicut. If the disease be in the skin of the face, 
holes are to be cut in the lint fur the mouth. iio»e, and eyes, tchtliyol 
\a also a very userul dni;; in cbe trcntmetit of cfiroiiir nlcin tlUfate* 
associated with atony and iiLdunvtion of the deeper Inversi of the skin, 
ench as arm:, fciema, ami even (ujiujh and ktlnitt in ihuir chronic i 
Rtageo. It is always better to u^e iemhyol in ointment furm, but wm«| 
praciilioners bnve employr^d it by piiiutJng it uu in wntt-ry Milutioa 
with a eainers-hiiir brush. In ffoHl-hiUn^ ehilbUtitm. and in Imrnaii 
is of service, and Agriew reootninended it highly when rubbed into 
iymphadiT fii/itrfftiiicnrx. Iclilhyol h«8 prnved remarkably efticacioui 
in rcmf>vin!5 fteri-utfriiti: and other pi-lvic tXH'laliitni when need as 
salve with pelvic massage or in a vugiiial t^uppotiiKjry. 

¥oT acute spr^infi, and for the removal of the swelling following 
such injurieft. its influence ii extraordinary if it be well rubbed into 
the part nflVctcd. 

Iu gtivure ea«e^ of cracked nipples, with much induralion, an oint'] 
ment of ichthyol, 1 <lni<tbni to 4 (4.f)-lG.M) uf liiiiuliu, will prove of 
value, but it must hi' wipc-d nf[ bL-forc eiieli nursing or ihe ciiild willj 
not take the breast. Oflen the odnr remniiis and prevcnti* nursing. 

The dtwe of iclithyol internally is 1 to 10 grains (O.OJi-O.ttS), given 
in pill. 

lehthyol is a very useful remedv for the treatment o^ Jtettd otctna. 
(See Nasal Catarrh. Atrophic Part IV.) 

IODIDES OP AMMONIUM AND ETHYl*. 
(S«e AMMo.Ntt;3i and Kthvl Iodide.) 



IODIDE OF POTASSWit, 



361 



IODIDE OP POTASSrUM. 

The pliTdiological eflVi'W of iotlitie of pt*t»t.siiiiri (fotn^at't lodidwtn, 
U- S. ariA B. J'.i an oiitir»ly conipurtiblo to ttiosp of iodine itself 
(see liiiliiic). 1ml ii is cmjiinifc*! for BciiUL-wliat dill'crtriiL jmrpuses, is 
less irritani, morf rendJly Kiveii, anil fierbu]i6 more rouiiily ulisorb«d. 
Wbeo it is given in very lar^e tioflps nr for ik long period of time, tli« 
fstit (hat the polss^ium hose is a ilepraiKniit poison is to be retaembered, 
mad it in wt-ti tu u^' iotliJi.' of soilium iiii^U-ii<l. 

Pbysioloclcal Action. — Circulatios. — t'[wii this pan of the sys- 
hMU wlii-ii ill lirAltii ioiliilc of pntjissium produces (^li'ci^U dilTrrinr: rt-ry 
sliglitlr, if «t all. from tboAO chu!<«<I Ly fHtlaMHiuiu ib4i>lf. Smalt 
aoiDiiut^ raise tlie blood-pressure, ami lar;;;e quantities lower itfl'revot^t 
■ti<l Hirn^t). bill if fttheromn of the Mood-vctiAels he present with liigh 
artfTial tciiHiim in aiv^dciaCiuii witli it. iodidv of [lotuifiti itni oete uh a vulii- 
abW n'lnfdv m rediiciii^ llm vascular Hpafitn. It lliert'fuiu lowers art*v 
rial preosure. 

Abwrptiok an'F> Ei.iM[KATloN.^Iailiile of polniiiiium ih Tcry 
npitllj ubsorbcd and eliminated, appearing in the urine, nccording to 
IMdx. iu thirteen iaiuut«8 after it is inge»t«d, and tlic daily nmoiint 
excreted equals about 80 per cent, of tl* dose taken. Souit- of the 
drug tends co aceuuiulHte iu the tody. It ]n evideni. therefore, that 
in the use of iodide of pota8^i^nl vte fli<tuld give il frifly and fre- 
quently at fir»t until the re-iiduiil aiiiounl has re-Jilied itti limit, nhen 
smaller doses may be given, and giveu less frequeotly, for the purpose 
of maintaining tbo iodine inflaence. Tbat i» to sny, the drag should 
be given u|> to the point of tolerunci-, whatever ihnt may be, and then 
a Binailer dose will be Buflicieiit to uiaiiitaiu its itilluouee by replaeiug 
thi^ albuminoid compour<lti of iodine tm they are slowly cHiainiitcd. Un 
the other hand, if the iodide is being given for the purpo-ie of elimi- 
naling »ome poison, as lend, forexatnplc, here the doae cannot be greatly 
'decreased, because in addition to the ordinary quantity eliminated 
p« portion is passed out sk a double t^olnbln ioilide I'f Itiad. This 
fbporet.ical deduelion seemA to 6nd Hiippnrt in the fnet that after ihc 
BTpbilo^rapber naclies the full effect of the dru;^ he often cuta tlie 
dose down to what he calls the " tonic dose." and so maint&itis the 
coastuit alterative ciTt-ct without disordering the functions of the 
Ijr. If be docs not do this, the drug accttmulntes and cnuncs 
Vnic iodine cachexia, a ^tate whieb it is iiitportunt to nvoid in 
le disen.ie.'t. likeRyphilii), which depend f<)r their relief so larguly on 
maintenance of greut vitality in the patient. All tnicc^ nf the 
iodine in the urine disappear four or live days after the lost do»e is 
adniiuistvred (Elhers). 

nwrapeDtics. — The medicinal uses of iodide of polag-^iuni mar be 
divided into thrco great divisions, <iw;b of whieh is important. It is 
abo employed for many conditions nut ineluded in tliese el:u<tes : 

1. SVPHII-I?. — The use of iodide of potasflittiii in Bvphilis is recog- 
nized a* a part of all treatment for it.s relief. KLiewhere Dr. Martin 
bas, ia his excellent article (we Syphili.<), treated of thi.i queatton, 
aad it is only necessary to call uttention to the fact that Cbe drug 



263 



DRUGS. 



does mercury. 



is generally well borne in Urge amniints hy aHvnnr^d syphilitics, 
although tilis is not alwiiys the coat:. The term " thcrii|H'utic t«t" 
18 :ipp[ii>d by one emiaeiit Ii^aolier tu si^iiify a elute of lhi> synem 
produced by sypbiliii in wLicb a diHgnositt may be iDadc by the fact 
that large iloses of die indiile are bwme ntttiout incwiivetiienw. Tbis 
reeifitance tloes not always prove the presence of ftypbilift, uor does the 
absence of this re^ustance prove the absence of ihis (iiHease. Persons 
having hercditar)- asthma, eout, rheumatism, or eotnc similar diathetic 
inalaily ufliii ri<»i!^t the iodlue, and, oit the other hand, suiiit.' syphiliiiiii 
arc affected with " iodism " after very small dose*. In treating syphilis 
the drug should bo uiied in the ilnse of 1 (* ^ains (0.(i.>) three limes s ^j 
day, and thi? amount gradually iucreaaed & grain a d^y u&til symp^^l 
toni9 of ■' iorli^m " occur. ^^ 

The quantity borne often amounte to from ICO to 200 grains 
(6.0-13.0) a dav. and n^ much iu< 400 grainA may be taken by mido 
persons. The beat way to use the iodide of potiwsiuni is to order for 
tlic piilirnt a N.ttur.ited solution of the drug, which cnntnins in each 
drop about I grain, and at tbn »anic time a bottle of the compound 
aynip of sarsapurilln. To ii lable^pouuful ut'the latter tile patieni is 
to add the ioilidt )<oUuton, beginning with 10 minima (0.65) three times 
a iIbt, and inervasiug a minim rvcry twinty-four hours. 

The iodide auKt more slowly a^i an aiitisyphilittc than 

In U'rtiarfi rtfjihiliH the rodide i^ invnlmilile. 

In nirrou* nyjfhUiii. be ita iiianifi<Ktnti'm.'< wlinl ibcv tnav, iodide of 
potassium is the standard reinetly. being ftuppliiiiled liy merrury only 
when it is iieri-ssary to break down a gntwtb whose exintence is a daily 
menace to the patieut's life, as, for example, a brain'tumor which muses 
pressure near vital areii.i. It is not curalive in sclerotic |io.sl-.*v[>bililto 
changes nor i[i toconjotor utjixia due to syphilid, except in the earlicAt 
atageja, bcL-atiKe destroyed evi\» eaniiol be re^^'ored. but it eun be used 
to arrest further aJvuncc of the dinease. It may greatly improve th 
patient's i-ondition by preserving cells not as yet entirely destroyed. 

The therapeiiiic effect of tlii)* drug ii« much increused if hot vapor 
baths are used i^imultaneouitlr with \t» iniernal ndniiniatrmion. 

2. Mkhllic I'oirfuxiNt). — Owing to the fairi. that iodide of potas- 
sium roriTi-s iioluble double Balls with all the metulx ill the tif»ue!i in 
chrunlc poisoning, thereby aiding in their elimination, it nbould always 
be empIoyi>il in ehronie lend, nine, nrsenir, or mereiirial poiKoning. 

^. ANTinilKDMATIc. — lodldc of potussiuin is best i«uiled, not to 
acute articular rfieti ntittiim; when the joints are very hot and 
painful, hut lo the serondary or Mibaciile types, when the joints 
are large and the ease "hnngn on" — now bcttfr. now worse. It act>* 
best, under these circunistamx'S, if combined with wine of cok-hicnm- 
rO't. (See Kfaeumatism-) It is also to be tried iu iaaiica, htmhntfo, 
and rheumati'' iteuralgia, and it may be employed in cfircnic plfurtau, 
pmeftriiilh, and h4ffhorrpha.hi* to raiise abMirptioii of the fluids. In 
tlies^e conditions, however, it (lOen fails and rnnnot be relied upon. 

In tn*«Furhm. particulnrlv that of the anrtn, the drug otWn does 
good, but tie value rc»l(t largely U]^u[l the caiifc of the disease. If 
it is due to syphilis, the aneuriitn) may speedily c«as« to grow 







lOD/DE OF POTASSmSf. 



^3 



* 



iJer its itiSncnce, and tlict {«iD, HWL'lIiug, ftiid pulsation grudiiolly 
decrease. 

In lufAnia iodide of jK)tiuwium in TuluabU' if tlir diMiLM: id uf tbe 
pure broncliiiil ij-po. but il (ni(;lit nut to hv *tm\i\tiyvil if tlie cause i« 
a»oci»ted with gsalric irritation or indigestion, a;' it nii»li<-s tlic condi- 
tion of the fttotnacti wonnc. In brotwhilis and mtfutinnl rultirrh wlicre 
thecouditiou ofthvuiui-uus □lembruucti i;« scmi-vliroiiic. und not reiievod. 
hy chlurid^uf ammonium, iodidu uf [ictu^ium sliould be ii»ed. If the 
bntnvbtliK ih cbronic and the eecretinn profimt" (broricbi>rrh<fia), iodide 
of pa>t»ti»iiiift will in»tiv it worse. The dose for an «diilt in nil theso, 
inBtnnces i»lii>nld be iilout 3 to ■> grains (M.l.^-U.SO) three tiroes n dny, 
fur small JuwH tt-ud to iucreiifie atiTelion far more than large ones, 
vbich often seem to decrease it. In pulmonoTjf cmphytetna iodide' 
of potiuuium is oflen of great value. 

In chronie inttrgtitia! tuj'hriita small dos«« (5 grains (0.82) t. i. d.) 
ar« tliuuglii by Home to c-li<^ck the diMeaae. but il is to be remembered 
that the drug toaj pro'luce iinionArd symptoms if the kidueys do not 
eliminate it, no that, if u.H-d at nil, it iniLtt be given with great rare. 
If the drug is well borne in chronic parfnfh/matous tiefhnti», it will 
cauite an extraordinary increaw in the uriiiarj' flow, and will often 
relieve very rapidly any dropsy which may be preeent. 

in /ir"Hchoc'l>^ the I'mjiloyment nf iodide of p»ta.vslum inlemally 
ftDd tincture of iodine cxccmuUy \a the best treatment wc can use, and 
in aruff rvriftft. or " ddd in iho ht-ad," 1') grain*" (fl.ltS) taken at the 
bcgioning of the trouble will often abort the mtack. 

In hfimtie cirrhonh, in iL'^ early stages, the iodide oilen does good 
in arresting the overgrowth of connective tissue, and in arteriotclrrom 
or ti(Ai-ry/«(i of the blood-vesselc it is of great t«ervice. Thus in the 
Utter oomiiiions n combination <vf ioilido of sodinm or jM>ia*sinm with 
& tittle digiliilis will relluve vaKCuIur nponm mid Mippttrl a fei^blc bmrt. 

A vepk- important use of iodide of pota«.!iiura is for the removal of 
rntiiryrptenlM of (he crrvieitl ijfauih and tlinse oiTurrinp In other parts 
of thf* body. In the later Mage-'' of prtftimonia the iodidt^ are n.-<efiil 
tn aid in the absorptinn of any exudates, hut they ure cuiilruindicnted 
in phtlii^JH. except in the fibroid form and in those eaiH'rt wbioli nro 
depen'ti-nt upon <ty|i)iili:< as an underlying dvscriutia, att tbey nid in 
the breaking down of the lung. 

Untoward Effects. — In ^ome pentonH, after thi* une of the iodide, 
oorrsci corned un, ho that the edges of tlie cyolida becnmn reddened an»i 
the uose runs con.stantly ; uud it is a curious faet that snial! doses 
are more apt to prodneo sueb a result than large ones. This is fol- 
lowed, if the drug is [tuKhed. by the more poflitive signs of " iodism " 
■polcen of under Iodine. 

In other ca«e» acne breaks ont on the face and disorders of diges- 
tion and oMtric irritability come on. The acne can nearly always be 
prevented by giving arsenic at tie same time with the iodide. In 
Home rawes petecbtal nuthes break out on the legs, while in others 
l^rcat luentat and physical dcpnrs?«ii>n iippen-rn, so that lisiiesane.i8 or 
nirlnncholia may develop. Somelimeti iodide of potassium causes 
durrhoea. 



264 



DRVas. 



In peraonH susceptible to io<li<Ie of potnesiam coro should be exer- 
cised irn«n it is 6r»t U'.lmlni.'ik-ri-il \vti siidtli-n utid dani^t-tvuii oedeiita 
of ihe glotlis occur. EUiiur Utix tvpurtfO n ciiiip In whlob J(->»th ilui* to 
this CAU?« followed the ndmiiiiMtratiun of ^0 f^niius of the iotli'lo of 
potvoiuui. Multiple lieinorrliages from lh« skin ami luucoiui meiiilirui« 
occurred. 

If bnll;p or lilelifi follow tlif ii^t- uf ibp iiiJidoi or other rashes 
appear, it i^i said that atropiuu vrill afford relief. 

Sou^ciiuca the iodide of umrantilum or iodide of radiam will be 
Itonie when the iodide of potaeainni will not. 

Administration. — The iorlide of potagsium. owing to its exceed- 
iiiKly disagreeable taste, should be given with the componnd ixnp 
of xui^apfirillft. aa already destrihed, with fluid extract of 1 itj uorice, iir 
in tnilk. Large amounts of those vehicles are to he used. A gooil 
yiu.y to give it i» tn add the drug t<» one of the liquid pepBins. ami then 
to add thi? to warm milk, as in the directions for the preparations of 
junket given in Part III. The curd largul^ cov(?ns iIil* taj-ie of the 
drug. The dose usually varies from 5 to tJU grains (0,3:J— 1.0) three 
times .1 day. aim in) in;; to the rondilion ofthe piitient. It is best given 
an hour after meale, »o ttmt it will not (lisvrder digestion hy irri- 
tating the ntomach or interfere with the action of the gastric juice. 

One nf the best ways to take the drug is in eapawle, but if this is 
done H drink of milk or watrror nthrr fluid should pn-ccdo or folloir 
it, in order to prevent the drug from coming in contact with the 
Htomtirli in ironcentraled foriii. The preparations of the iixiide of 
p<itnH»iun) are — I'tiffuentum I'o(a»tii loflidi, U. iS'. and B. P-, and the 
liiiiiuL'iit {Linimcntnm Potasfii lodidi nim Saptnie, B. P.). The 
former should always he frishly prepwcd. 



< 



IODIDE OP SODItTM. 

S>ydii Jotildumt U. S. and B. P., is used in the same doaes and for 
the Kixnv- purposes as the indlde nf poiiusium. and in lens irritniit thai) 
the Utter salt-, as well aa \ee« dcpve^.'iant to the general system. 

IODINE. 

ToJum, IT. S. oikI B. P.t ia a □oii-niulallic clcuvnt found largely 
in seawt'i'd and in uiiutTal lodates and iodides. It is noluhle in ether 
and alcfhol, but !>lightly »o in water, and pooaeseea ui acrid, burning 
ta.<)te and n nciitrnl reaction. 

Pliysiolosical Action. — The physiological action of iodine, to far tu 
its altentire powers are concerned, is absolutely unknown. Applied 
to the skin, it stain.* it yelhjw. brown, or black according to ihc free- 
dom uf its applicaiiiui. and it at^ts Mitliout pain if the olkin is intact. 
If very largi' iiiuounti* are used, it pruducos vesication. Upon mucous 
membranes iodine acts as » powerful irritant. OerniniQ-Si^e believed 
it to be a stimulant to ihv Qutritivv procceses of the body and to the 
circulatoi^ syHtom, and he wnK certainly correct in regatx) b* the influ* 
euce it exercises over nutrition. 

Ab!!1oki*ti(in jtNt) Elimination.— The drug is rapidly absorbed. 



4 




lODIh'K. 



^^ 



i« bo4ly clii<!lly tbroiigli the ki<lii<>ye. tlie sLin. tlie ealU 
ry glaudit. uiifl i( evfo appearR in the milk nf niirsin;; wumon to sucli 
i-xtviii thiLi tbt> nursing inrnnt tnny be aff«et«<i by ioilitun and suffer 
»m gAKtro-ititestiiial ili»turbaiii;i' in consequence of inci-stinf; lU 

Thesviiiptum); of acut« ))oisoniriu liv i'lilioo arc tliose 
nleritifl. sunh as (wven; pain in the a:.soi»liiigii», floitinch, 
() stiilnincn, iiccoinpiinicd by violent voniiliii^ uiid (lui^iiig. An t-nrly 
lupUioi in tbo pL'rj«istfii 1 strong melallic ta^te in tbo nioutli. viitb 
niarkcilly tncrcaM.-i] «»l>vsCioD. Tlio puW bpc(ini(>s rapiil, ninning, and 
feeble, the face ik-alhly pal«. totiil srre^t of urinni-v Docrelion takes 
place ihroiigh n-unl irrit^tliun, iinil deiith ncciirR l>y lailiire of rcspirs- 
tion. which ijt nctioinpunioil by lo^ of all viul fiowcr. 

If the poisonin}; \« not muwiy L>auu);h to mu»v iloatb at once, n 
fatal result is, nevcrtheltsa, rractn?<l after a few days by reason of 
the severe gajitro-enteriti» and the widespread fatty degeneration of the 
tisntes which iodine produces. 

Tbtf treiitintnt of ihe poisoniwf^ coiiMiftlJt in the u«e of Urge amountit 
of starch in any of it* forms as the antidote, the eniploymt-nl of 
rmetius and (he ntnmach-pmnp. the application of hear, to the body 
iind cxtremilicd, and, Gn»llr, the einplc>yuit.-iit of hypudenuie injeviiotis 
of alcohol, digitalis, and atropine or strychiiiuo for tliv pur|)OH» of 
aintaining the strength of the circulatorv and re'piratory syatems. 
Untoward Effects. — Under the name ul "iodisni" the profession 
iaes ft state of the body hrmiglit on by the prolonj^ed aud 
cessivc une of io<titi(> in any of it^ forms. The eailie:<ic notable 
i9 of thii< slate arc a peculiar metallic tuf^te iu the uiouth, par- 
leularly before breakfast, slight lendeniewi of the le(>th and gums, 
increase of salivary secretion, a little niorniDg nausea and u lack of 
appetite for breakfa.4t, and perliajH eoine cor^'za or evirlviioe of gastric 
irritation. Aenc- rosiwea often comefl on Tcry early during the nso of 
fall dos«s ef iodine. If the drug is continued, all tht-se symptoiim 
become more marked and the corys* becomes intense. Headache 
under tile frontal bone and sore throat often appear, and the piistn* 
lar and bleb-Hke changes in the skin go on to active Ruppiiration. 
Fomctimes Urge boils appear or purpuni hfemorrbugicu (iodic purpura) 
inos on. Slight eatarrlial fever nmy develop. 
In other nutes the nervous syntetu chiefly suffers. Twitchings of 
'en, neuralgic fains in the trunk nnd exireinitie.*, and wut^itin^i! 
e testicles, mamnue. and all other tissues o<-cur iig the result of 
'pbic disturbances, .\nicmia amouniing in an actual ca<-lie.xiu is 
mmnnly produced. Iioss of vision ami jmrulysis mnv ensue in 
treme caaes. Sonllier asserts tlntt albuniinurln may be cfeveloped in 
ildren af^er tincture of iodine hiis been applied to the t^kiii. by reasoD 
its abaorption and irritation of the kiilnvyi*. 
TherapeaUcB. — In all cus4's where the gliindiiUr system is in a mate 
of chronic perverted functional ftctivicy. sis in those disenacs uesociHie^l 
with disomer of the processes of ntiirition. and often inrlmled under 
the singlr name of arn'ofuiotln, iodine is of service. In eiilartj^iint 
•'/ 'lif l^'tph-ijlamh it ia, In its rariotw forms, one of tin; best rt-uiedies 
we poneaa, but it ought not to be employed in those caeca irhcre rapid 





DItVOS. 



chnnge^ ar« going on in tbe glatii], meh as the formation of ptu, stnea] 
under ibe^ circuiiiBinnces it vrill increase the sise of the sloug' 
N'vitlirr will it benefit ttio gUndulnr enlargements of Hodgkin's 
i)iM<nN<> iir IvuijitiutiL- It'ukicmin. Tlio <Irug ought ncrer to be u»ed in 
ni{iij jthlliisia, because it xend^i to <li8intogratc the tissucg, and tlits tg 
imHriaflv wliiit the iliscase is doing. In tiip excecditiglj cliruuic fi»rm 
i>f |MibH'>nftrv diswis* knnwii as jibroi-l fhlhimii iodine may often be 
umh) with udvuiilugo. When iulialeil in fiinies it mav be of service 
aa a slimtitant to the muooiu nicinbrnnc», l>at \a ncv4>r of VRliie in 
plilbisis !«o far a» cnmbattiig the true jmtholugioat chniigu ia coif 
tiornod. Tti countries where ffmlrr is very [ircvuk'nt iwlino niuks U 
a miwi L'flieitint reuieity, but it must be used vrilh aintion, and in case 
of cxophthnlmic goitre it i« probably hnrmful in iliat the hyper- 
trophiwl ghinil probably produce* some of its symplotus by extreiing 
too mueli iodine. In cystii.- i>r vascular ealargeinenC of tbe thyroid 
ghuid it is valueless but in aim|ile overgrowth of the connective 
ti^tte of iho gland loilino ii* of riorne value. Snmetinieii it is iiijeeled 
by mciina of ii hy|iodcnaic needle inlu the gUiid. The usual done is 
10 to 15 miiiimx (0.(!.>-1.0J every seuond or third day till twenty or 
more injection^ have been nse(i. Meltunr utaUr* that while tJuB treat- 
ment is Koineliine.4 elTicH<:iou3, it iti not by any meaaa devoid of danger, 
for lit \cxii thirty deaths have re-^idicd fi-om it. 

In efiroru> Ainw iIm^>«u^ iodine applied about tho sffcctiMl joiDt in^ 
the form of the oinunt-ut diluted oHe-hulf with lard, or in the par* 
tiliclnre, will he found of norvioi?, and if atuEuiia exUts the syrup of 
the iodide of iron sb-uhl be given internally. 

The oihoi" use* of iodine eictcrnally «ro many and important. As 
a b1»w comitor-irritiiiit. which doo'i not produce pain if properly em- 
ployed. It IS particiitarly usofnl in childrL»u. and may be employed in one 
to ihree roHf, and no more, applied by nif^ann of ii camers-hnir brush. 

The proper way to U-ie the tincture of iodine an a local connter- 
irritaut for adults is tu give ono goad black coat at oiiu fitting, and ^^ 
not to repeat it until tho akin bait desf] uaiuaU'^d and beeume well tv-^H 
Bi'wed. If iodine ii* appViwI after de»r|iiftmatioii of the skin Las begun, ^i 
ii will nause agoni/inji hurtling pain, wliit-h nnihing will relievo exwpl 
the reinoviil of the iodine by the use of colugne-n ater, iiteohn]. whiskey, 
or gin. The application of any of these ]ii[uiiU e»use« such an in- 
crease in tbe pain iM to be almost uselcts afWr tbe nkin in broken. 
Th« best siduiion for its removal '\» one of iodide of potafwinra, 
which should he followed by ii Blarrh poultice. A good rule to follow, 
ia iievur to caiiite paiu by the u^e of iodine, an tho drug acta equally ^^H 
well if apidied in eiich a way ns to nvoid !<iiflcriug. ^^| 

A stronger »nd more netive prop»riition of iodine in solution for 
oxternnl use is that recently suggivtted by Elsberg. TIiiH preparation 
is of 20 per c«nt. strength, whcreaH tbe ordinary tincture in abont 10 
per cent. Jt i» c^nnpoacd of iodine, lO drachms (20.0); alcohol and 
ether, of esuh. 10 draehmH (40,0). Ono or two eoat« of thin solution 
painltid upon tlic skin will produce as much effect a^ «evi-i-al of the 
ordinary tincture, and as it dries very rapidly it do«a not wiil the 
clothiag. 




rontsK. 



m 



^ 



Iodine to tho form of the titictiii*(? is applied as n couater-irritanc , 
poiol tv tilt; skill of thu cbcst iu plrurirtf. lotli to nbort an sttiuik uid ' 
to aid in aUsurptiuri of the fluiil »ft<-r it 'i» jmauvA uut into thv clieHl. Iu 
haratsin;/ irnlatuv •■<'H;fh it may puinted over the suiiraclaviciilar 
«pac«(. ftiid it will nometimeK l<>K<t«n the scHTelion in rhronif bronehith 
if used in tliis way. In chronic rhcumatitrm uiTcctiiig tbi! .joints aud 
mu8c1e9 it does good nhen locally apjilied. Ofleu in iynofitin tliv 
local application of iodine causes increased swelling for fiouic daya.. 
Tbia should uot caiwc uluriu. fur iillinialely the swplliHg ilf-creaaes 
very gnntly, and the eases in Trhick this occurs are gcn<>rally the 
best friHii u prognostic point of view. 

Id llic course of phthinU ovcry now and theu a "spOl" in the 
chm will beeutnt' "Bore," probably due Iti a Htuited area of pltfurisy, 
and under these cireamstances tiocttire of iodine locuJly applied will 
give relief. In lupus the linrtur« may be painted nmimd llie edges, 
of the growth, ana even over its surface, witii tlio object of retarding'' 
its spread. In rtiifl'laina an iipplicjition of iodine ointment gives the 
grcalest relivf if diluted one-hiilf with bird, nrd its ueo is probably ibo 
most vfiieacious uii-asure at our dispoaal. In certain individual wlio 
have "pain* tn the chent" iodine ointment may do good if rubbed 
in over the ufleetcd Hpot, As h«s been pointed ont by others, iodine 
doe« ^ood if inuiieiilar teuderut-sii i» pnwent. while it faibi if ji/eurn- 
litfnia or intrri-oMf<if Hfurnk/in i.« the eaiise of the .suffering. The Int- 
ler troablps should he removed by the i)se of belhid^mna. In tfrtain 
forms of xlcin diseases, mieh aj* tinea ti<v*uran» m\(\ vircinntn. tincture 
of iodine may be applied with a L'aniet'u-hair brush, and even the 
entire ncalp may be painted. A better way i)» tn apply it Ui liift'nrpnt 
•potflesch day. When .rifitipelaa is present, the tinetiirt'inay bo painted 
nrounJ the i-d^-es of the iiiraniniBlion in order to prevent iiJi spread- 
In old persions or those in middle life rrirai-lion of thf tjumit frdiu 
the teeth MUictiracK come» on. and dentietit recommend for this dis- 
order the use. by nn-iiiis of a camL't's-hair bruvh. of u watery »ulutiuD 
of iwline of the sirengtii of 1 grain tn the ounce (_".0.1: -w,0), to be 
fnlloweil at once by a thorough rinsing of the mimtb with pure wiitcr. 
In htfiirorrlc ludtne in ilie form of tbe tincture is the he.-^t drug for 
efTeciint; a peniianoni euro that wi- have. The sac should tirst be 
eniptie-1 by iho ii!<e of a inxiar nnd cuniitu, and the iodine ahjnt; or 
mixe'l with glycerin injected with a isjringe. and tlien allowed lo 
enwpe. As the pain produced by thin injection is most utroeionn, 
the patient iihoiild Brst be put under the inUuence of ether or other 
auttAthetic. 

[nJiM'tions of iodine have been made into various seroas cavities for 
tbc relief of cbroiiii: inlluintnatory proceiwea. This is &oiuciitBe« fol- 
lovred by bod symptoms, and after the injection of tiiieture of iodine 
into the pleural cavity in bydro'horax aymptoms of poisoning liare 
come nn in some cjises 'be most eomnion eonipllciilinn being eon- 
vulsitms. These are cpile])tifonn iu character uiid are followed by 
coma 'ir collapi^. 

In (firipffi-ma ft solution of iodine 6 grains (0.30), iodide of potav* 
aiom 6 gruns (0.30), and water 1 pint (ADO cc.) may be used daily 



268 



DRUGS. 



* 



ae an irrigating fluid witit good results; Lut tbU practice is d 
entirely devoid of danger, as too rnach of ike iodine may W absorbed 
or the irritBtion [irocTuced in tlie chest by its injection maj oaoge 
reflex and severe uervoiis sym|)toni9. lodororin i^ better. 

Tlic tincture of iodine niaj he used, ticconliii;; to Ricgpr. as au 
iiibnlutiun with signal benefit in the foltotring three iniitanceN: 

1. In the chrouic forms of plithisi-; [titirnid lung). When the 
expectoration ia abundant and when the couj^h ia trDubti-aomc, ilii 
inhalation, nwd both night and morning, nill generally lessen the 
expectoration and allay the cougli. 

2. In childrtMi six to ten yvarti of age, wbo sft9r meats, or. inde- 
pendently of them, itn exposure ti> Oflii, are seized with h'sarsont-M. a 
fioante. hollnw cniigh and some wbepting at thp ehest. This afTcetion, 
involving the larynx, ti-achea, ami larger bronchial tubea. and often 
proving very obstinate, is apt lo return and to pemiat a considerabta 
time. 

S. Some persona Hufler « ith itching of (he note, of tlie inner eaotbiu 
of one or both eyea. tueezing, i-unmng at the note of a watery llwid. 
weeping of the eyen. and Mfi-fiT frnntaf firadarhrK : and rhew* patienia 
of vftrioua agc« arc greatly troubled, often for many vcare. with daily 
altacltH of tliia ebaracler. laatiiig. it may be. several hours. Iodine 
iuhulod ■>flcn removea tbi« affection at once, lessening ihc beadacbe 
and dJMrharge fnitn thp nnstrils. Itn eflect is raont marked in respect 
tL> the ilching. 

UiiiL'rr gencrallv adopts tbe fiilloniug simple, bandy, cleanly, and 
(■ffcctiial pIftD of innalaiion : lleitt well a jug capable >if buhling about 
2 piut;t. by rinsing »ilb boiling water, then partly lill wiib boiling 
water, into which pour 20 to 30 minims (1.3-2,0) of the lincturp of 
Liodine, then direct the patient to put bin face over tbt- luuuth of the 
■jog and breathe the iodized Ht«im, covering the head to prevent the 
escape of the vapor. This inlialation nboidd be nso<l nii:hl and morn- 
ing for live tninntea or a little longer. (ieca»ionnlly nn excess of 
iodinn will temporarily produce a sensation of non-ncMt in the cheat 
and throAt, accompanied with rednesii of the conjunctiva, running 
from the nose, and pain in the hejid, 

In some casM of ficuYc eonixn much relief may be obtained by snifT- 
ing tbe fumM of tincture of iodine from a bottle, as In the uae of 
"amelUiig salu." The beat of the hand is sufficient to disengage the 
TOpnr in proper quantity. 

Ajdniniatration. — Iodine is never UBed in solid fonii, and it bas 
been Imight that the tincture ( Tinrtitm lodi, U. .V. and B. P.) should 
not \k- given internally, on the ground that it is precipitated in tbe 
stomac-b. Wbcibcr this be true or false, it is a fact that the tincliire 
hns recently been lurguly used rn the fiimitinf ttf jfei^nmifif and after 
ansMtheiies with very good rciiulls. The doiw is .*► to 10 miniiii9{n.36- 
0.<55), well diluted, lender the nume of Lugol's solution (7,('/i(">* /orit 
Computitiui, V. S.) iodine in freqaenlly used internally; the dncw it) h 
to 10 niiiiim^ (O.S-t-O.O.^), in water. LitfWfT lodi forii9, B. P., is 
used H-s a liniment or local application. 

Vnguentum lodi, U. S, and B. P.^ is osed locally over enlarged 



IODOFORM. 



269 



glamiii. In ihe ca«o of chiWron or adulta who liavo dolicntfl flfein* rite 
(lintnt'Dt sbodM be diluteJ one- half with lard. This ointiueul slioulii 

ContTaindJcatioiu. — Iodine is conlraindicntcd in rcnnl difteaseA, 
exr^'pt in Biuall dow*, during the proj^ross of acute iiifl»tninnlion, nnd 
.whenever tiwaes ore rapidly undergoing a brraking-down prix-esfl. 



IODOFORM. 

Iodoform (ToJo/ormKm, U. S. and li. P.) oeenrg in small saffron- 
. . i>l(>red crjBlitU which ](o»3eKS a powerful churucteri»tiv, pcnctnuint; 
odor and strong tii^^te. It im soluhle in ali-ohol. olhi^r. chlurofurm, 
iK-nzo). and in fixed »i>d volatile oils, but i» insoluble in water. 

PhTsiologlcal Action. — The effecUi of iodororm upon the circulation. 
r(-ftpir»iiuu. and other vital functions are very .*Iiglit Kp'hen tlie drug is 
uM-d an a. surgical dres»iiig in ordinary auiutintii or when it in givin by 
the Riuuih in average doM-ii. It act« ss an anesthetic upim mucous 
meuibranfii. and jiroducfs those changes which vre are wont, for want 
of ft better term, to call "alterative." in the tifisites with which it 
cornea in contact. Iwloform in eliminated in the urine att iodine or aa 
alkaliue iodides chiefly iotlido of sodium. The drug also eecapes by 
the ftalivH ».-> an alkaline iodide. 

Poisoning. — If applied to an absorbing surface in easceptible indi- 

riduuLi. irMloforra iimy cnuw general svrttcroic poisoning. This jiuison- 

ig uiay )>e uiild, in which vase we have n eeiieral ff idin); of iimlaiKe. 

rith nausea and ihe perception of variou-s odors wltidi are in reality not 

pr(!»en(. Thor« may be headache and vomiting, if the ^yetem in still 

more impressed by the drug. thcsA symptoms nre followed by rarcbral 

pxcitetuent, iosotnuia, Iom of niemon.', loss of ap|H'tite, and a rapid 

Dulne. In very grave rswea convnhtive niovemenls iin<l maiii-inil dclir- 

iR], alternntin^j with eninn, may be the dominant syuiptoms. The 

'ptllse is small and rapid, nnd there in often retention of urine or liiciua- 

turia- Ixieblich attserti that the mental excitement cannot be ([uieted 

by Durcolit.'^s. If deuth occurs, the heart and rcapiratiou fail Himultane- 

ously. In aildition to the fnlty degeneration which such pnieoning pro- 

ducen in all the vital orgiiiu. tlierc is aumetinie» found an oDdematous 

condiiion of the pia mater or a low-grade leptomeningitis. Thene 

inrmptonis seem to occur more commonly in the aged. In tiic graver 

eaMS the onset of the poisoning \e apt to be Huddeii, though from 

twentv-four hours to several days it^imlly elapse between the njipli- 

. Bstiuu of the dnig and the onset of ibe symptoms of poisoning. 

ThkatMKVT of the poiiKining by iudofurm cun?i»t.s according to Soul- 

[lier, in (he adminii^tration of bicarbonate of sodium to tinire with llie 

}dine and so aid in itA elimination ; the u&c of aU-ohidic !!limularits to 

ipport the i*vstem ; the employment of diuretlcii. and wrappitig the 

tticnt in hot blanket? to encourage free sweating, eo relieving the 

itidneys. Kocher advises valine transfusion in Kiieh ca.>trii. 

Untoward Effects. — It in not to be forgotten tliat iiHlofurm when 
appli.'d Its a dr(!ssing may produce teK4 viok-ui synipiouis than those just 
described, and capable, becaus« of their aberrant character, of eeriously 




270 ^^^ DBVQ& 

luiatoading tbo pbjsician. ThiM a sicarlfttinal rasb nifty deTcLop vriUi 

fevor. mafiuHV, an<l nervous ilmcurhanco^. 

Th«iBi«utlM. — loilop.riB is Ufvii cLicflv a? a atirgicnl dreesing, b«l 
18 Iv iiii iiiiaHH as pnpiiUr for lliii" purpusc as it wfts ul one lime. It 
is uiitiiioiitk-, but nut gvrmiciUal. Genn» tnay lie found in powdered 
iuilufurui, iiik) will even griiw iii it. When used Inoallv. ihe dnig doM 
good by iiliHurtiiiig the liquids of tlie vuund, aud tliert-bj rt'taoving ihc 
nidus fur germ-growtli. and wlien applied lu large moist surfaces givw 
off free iodine and acts aa well as a proU-ctivc. There can be no doubt 
that imlnfijrni when applied to a nouiid does gcxtd, not by deetroying 
the liactorifi dircctlv or iodiroctly. but by inducing uticuiical chaiigrai 
in lliuir toxiiieit. 

!n fyvhllitie $9rea the following dressing wilt be found of great 
service: Iodoform. 20 grains (1.8); oil of eucalyptus, ^ flnidounce 
(16.0); or a powder of iodoform } an ooQce (16.0), camphor 76 

? rains (5.0), and essence of roae^ 2 drojm (0.1). may he employed, 
n cczeina. with tingling and itching, tb« following application will 
give relief (Ringer) : 

K.— loJofornii in'-(T(0-2J. 

Olci L'tunlyjitl hcj M.O). 

P»lr>.!»li S(*2.0),— M, 

&— Apply lacallj'. 

Intornally. iodoform is used in tertiary sifphilU in all its fonns in 
le dose of from 1 to 5 gruius (0,05-0.35). Bartholow recommends 
It most highly in catarrhal jaundice and in the early stages oihcpatie 
cirrhoM. 

lite influence of iodoform upon ihc tubercle bacitltis i« very great, 
and il ik now hugely used in tht^ treatment of tubercular JUrase vf the 
joint* ami yltara; The pus is allowed lo escape under antiseptic pre- 
cautions ; tile caviiy is washed out wiih warm boric-arid or carbolic-acid 
Bolutious of low strenj;th, niiJ from 1 to C drachms (4.0-24.0) of oii 
emulsion of iodoform and slcrilixed sweet oil are injected and allowed 
to remain. The strength of the iodoform-uml-oil emulsion should 
utiunlly he 10 per cent. Should the abscess-cavity fail to heal after 
these injections have been repeateil every fen duy« for some time, il 
mu«t be reopene«l, scraped, and injected again or packed with iodoform 
gauic. The iodoform also promotes healine through its alterative influ- 
ence, which uidit in the absorption of the innammatory exudate. Should 
tubereiilur glanda he prcsout, injcctiaos may be made iitio them even if 
pus haH not formed. 

Ustid by iiit-jitia of a powder- blower, iodoform will often relieve the 
hoAivt'iie^ and discomfort o^ larifnijinl phthitiM^ but it must be pulver- 
ixcd moat minutely. Sometimes a spray may be uied, which should 
consist of spiriLi of turpentine and sweet oil. half-and-half, and contain 
2 grains (0.10) of iodoform to each ounce (32.0). This mixture may 
also be usetl in chronic bronchial cntarrh to lexsen the nnugh and fixtid 
discharge. lu the gaHv stages of phthisis several clinician;! claim to 
have reached very good results by tlie daily hypodermic injection into 
the back of 30 minime (2.0) of a 1 ; 100 solution of iodoform in oil of 



lODOI^IPFX'A CUA }IBA. 



271 



, bat this Ircatmont has not gcn«rally found favor, in Uiis 
For ftgttre of the anus and im'tatt-if hf-m^rrhoidf 5 grnins (0,35) 



of ilHlttff 



onn 



a suppofliiory may be plnccil in tlif rL-etutn. a.tul after it 



ba^ remaiaeil Oiere a few minuted Hoft'catioii may lio liml without pain. 
The paiti fwllowiug operutiuns on tin- tciiiiili! |)i>nmttim may also b»; lam-h 
relieveil in tliig uiaiiiiiT. In thi> feiifstnua <\^ ehoUra infantum au injee- 






fantum au injee- 
tion (if 1 ouiifc(32.0)of sweet oil with 5 grains (0,85) of iodoform will 
give ^teat rvlicf if u«eil aftpp or hofofw ctnitfpoclvsis. 

AdBunistration. — The oiutiueut of ioitoforiii ( VutfuvHtum loilofurmt, 

U. &'. and B. J'.) IS uaeful when ap[)li(!(l over ftstid soreo. It shuuld 

ways he frei^lily tuadv. The dnig itself may he given in 1-to n-grain 

".05-0,35) doses three times a day. The RupposildHtM {Supjuaitfiria 

lotloj'urmt) are official in llie H. /'. ; Cinli itni' i-uiituin^ 3 grniua (0.15) 

of iodofurm. (See alw Xunuphen, Kurophcu, and Arii^iol.) 



lODOL. 



^0 TtiK i« a dark, dirty-y*llowish-Iookinjf povrJer, Holublpin alcnhol, 
' ether, and oila, but only slightly no in water. Its nst'i: in mi-dicine 
are identical with iLtoMr of ioduforni, uiul it pcs^e^teH the advantage 
of keing not bo penetrating in odor as the latter ^Irug. 

In tuixrrular hiry}iifiU» the very finely [lowdercd drug may be 
bhiwn into the larynx nittiont disagrc«nhle rcM]li»- tiTid with a favnr- 
able cITeet on the di.<ic-a.si- pruress. <Vriia has fnunil imhil nf n-ry 
great st^rvice in diahrU-n when given internally, in the dose of from 2 
to i^ grains (0.1-0.8) three titnctt a duy, nni) it in eiiirl lo be of vahje in 
^rtiary typhilU in tbo same ()i)tintity. 

A very uw-ful aiiti-sepiic drcsying for small vtmnds and ubnuIooB 
made by adding 1 par! of i'ldul to 1" jKirta of "?ihcp imd G uf gun- 
tdii. ihcreby pre|i!iriii^' nn iridi)l rnllodion. 

IngidU reof»minendn the fol!«iiving prwcription in ra-tes of cpefwa 
ir obnutioDs of the upper lip and itustriln : 

B— Add. carbolic TP^v 10.3). 

CH. fOMB ni,T (tl.3). 

lodol gr. «v(i.tt5). 

Udolin. .?as(15.0),— iJ. 



IPECACUANHA. 

inhOyV. iSm or Ipecacuanhas Radix, B. P.. or Ipw»c. is 

je mot nf frphaifiin Ipei-nruanha (J'stfcfiulriii Jptrnruatihu. /i. P.), 
aoiall i<bnib >jt' Bratit, It contains an alkaloid, emetine, mid ipceuc- 
nanhie acid. 

PbTttological Action.— I.ot-a I ly applied to tniicotis irieiuhraneit. ipe- 
cac acff :ii nn irritant. :ind if applied for a long pcrind to the Fikin 
)i¥iduc«s ve-*icie8 and irrii»ti"n. Voi^' iiiinuti^ dt>.'0,» have little nntice- 
ttle efieet, bnl large onei* produec nausea, rehtxatiun, vomirmg. Tree 
eliou into the bronchial tubeit, and a profuso flow of jmlivn. The- 



273 



DRVOS. 



emesis is due both to ibo irritntioD of ibe slomach auil to an effect 
upon thp vomiting oouire in ilie ineiiiilln (Fi^. 47). Tte drug acts as 
n Jcpifwsiiit to the Hpimil con! (IWiolici), mid it. also dcpresM-;* ibc* 
licurt if givi'ii in trirce doNeH and rt'taincd liv the xioinach long onoiigh 
for it Ui l>c ab^irbod. ]]iecAo ih eliiiDUiitciI bv tlie kidneys, the gu»- 
tru-iiitestinnl inucoiik me-mbraDu, and the »kiu (fiitis). 

Fio. 47. 




J. Vomitins ««iitn- in m«dalU itlmnlAtoil hj iiwcar: B, nerrtm tn mnooni ncmttnm »rttiiB< 

arh irrUAti^d by l[WC*c. 

If etnotino is givi-n in Ictbul dusc to one of the lower autiiiAl».deatb 
is due to failure vf reKpii-ation. 

Tltcrapcutics. — tjiefiic i» used a« an *;nirtic where u fairly rapid 
acliiui is rf(|tiiicd. It lit purtieiilarlv u»efiil in ea»e» wberu lliv Moin> 
act) of a cbibl ie tivcrloadt^d with food. In fruBva of poisoniDg it is 
hardly nclire 'or rapid «iU)Ugb us an emetic, and ih nor. as good as 
Diusttinl or .Hiilpbuie nf xinc. In babies and young cliibirfii an attack 
of brutifhitU often eauaes digesliie disorders, by i^eason of llie mucus 
coughed up from tbe luugs being at once i>wallowcd inMead of lipil 
out of tlie liiomb. Ill lhe«e t-ases tbf stomach may be relievwl and 
the state of the luugs improved by the lue of an emetic do&e of 
Hynip of ipecae. 2 io i\ dtacbius (^.^1— 12.0). Often if ibe dose be not 
large enough to produce emosia it will purge the child and remove the 
mitcu^ by tbt^ bouel. 

In 8(.mc eai^es of obstinate vomiting small doB(» af ipecac will act 
8< a tuoMt nuceesiiful cure, provided that tbe roniiliiig \* due not to 
inflamrnation and excitement, but to depression. The iiTitant effect 
of the ipecac slintuiiites the deiiresAed stomach to a normal tone. 
The proper do«*c of ipecac for loi'- purpoic is ^ to 4 a grain (0.016- 
0.08) or le«e evt-ry h»lr-iioiir until 6ve or xiji Aa^-i are tuteu. 

In some caKca of tlie rontifitig of ufi-finnni^ it w very useful, in 
otbcrs il utterly failw. 1 minim (".(lii) tif tbe wine or J to J grain 
(0.014-0.016) of tho jiowder^'d ipecir, repeated every balf-liour for six 
or Borcn dones, is all that i^bauld be u»ed. In tbe morntng tnmtkinff of 



IPECACVA SUA. ^^^F 373 

ilmnJbirda ipecac is of scrrkv, but it is not so good a runed^ »b are 
rmall amuunu of ar»enic or hvilruclilorie aoi<l. 

Iiwcac b also Haiti to posju-ra markrtl orvtncir firoperii«», Mnilar to 
quioiDe, wlien jtireii in stnall Amen., 1M to 16 minimA (0.6.S-I.0), nf 
tne witM* evf rir two or three hours. 

In true aeutt dytetttery ipecno i» one of the best remedits »c poe- 
seas. Wbeu tbe pusages arc Urge and bloody and the dtMiue is 
tnnli^Hnt, as it o<-«iir8 in the tropics. i[>e^-ac shuold be j^iven in tbe 
follnwiDg matincr: The powilercil ipecac \* to Ik* nthnini-'-tpreil in tJic 
dofu? of 30 graitiK (2.0) with deoitorixt-d latidaniim. vhicU U U'^dl to 
dwrrease the tendency to vomit. AIwoIiKl' rent is L-sseutiul for suc- 
ces*. Finally a profuse gray, muchy »tool \% passed. The piifttiige of 
this stool is a most favorable pmgno»tic sijjrn, and \ls non-appcnniiivc 
is equally sij'QificaDt of fiulure. Counterirri Cation tH to be applietl tu 
the belly, and stimiiliLnls fre^-ly n-sed to avoid great depr<ti»ioi]. In 
e/uils-mie dtttrrhiFiH iimi fhoUra marh'tt ipecw 1» often of great scrrioe 
in the dose of 'i grdinsn (0.2) every two lioiint. 

Xo le«s a person than Trousseau adK(>rtGd that ipecac wag a hmno- 
mtatie, and it Is suid to be a moHt iifTrtiive remedy in ttinnll dtntes in 
lunnapt^nt, and in all hemorrbageit uhieh are cnpillary in ebaracter. 

Ipecac may Ije need in the early stages of hnmrhitiit, to act as » 
ardatire to tbe inflamed mucous menifimm.' and to promote accretion. 
L'nder these circumstona* it xn beat combined with citmle of [lota*- 
aitin. (See Uronchitis.) 

Ringer and Murrell have fmind that inhaling ipecac spray is \eTY 
naefiil in f^kronia Hfinter rnayh or hroH'-bith, pariiciilnrly when lliere 
is proeent sfaortneM of breath. Tbi; pure wine miiy (w u.tcd in * 
«)»ray Bppnratus or be diluted one-half wilh water. While the throat 
B»r aecm tempomrily worse, the Khortne-U of breath rapiilly deereasea 
■na a great improvRraent takM place in the notigb. In onler to pnv 
rent the wine which colleets in ilie mouth fruiu Being .swalloweil, and 
naiwea and lomiting thereby induoeil. ilic patient sniwild be direcMMl 
to ria.se hi;» luouth thoroitgnly every few minutes. The inhalaEJnn 
should not last at linit over cbreu ur four niiniitea. and, nntil it is 
known huw well tbe patient will bear tbe application, ihe wine Ahnubl 
he diluted twice or tlirii-e with water smd ali-iitiol. mjuuI part*. 

It is staled thai powdered ipecac made itilo u pa^tt- and tmieiired on 
the akin will greatlj relieve the pain and ttwelling produced by the 
ttittift of beet. 

AdinlnistnittoD. — Thesyrup(iSjyru/niJi Ijifucuanhof. U. <S'.) is given 
Id the d<^$e of } to 1 drachm (^.0-4.0) a» an cipeclorant, or in (he 
Bamc diMte uan emetic loan infant. Thewinef I inum /pfi-afwni/iiv. 
B. P.) is given in the same d<we an the syrup, ilnd tbe fluid extnwt 
iExlrartUM Iprrrarmtnlnf FIniiluM, I'. S.; nstritrtuin I^trracuHuHir 
Liiptulam, B. P.) in the dow of 30 tntnin>i> (U.O) ]i« an oricrie to nn 
adult. The troohi'* {Trifhi^i'i lf>rraemtnh<ir. !'. S. hikI B. P.) eon- 
tain V of a cnin (0.iH*>) each, 'ffoi-hlfi Moi-f<hi>itr ff Tf^'cvunnh^, 
t'. ,S. and B. J'., encb of « liicli cnntuitut ^ of a grain (U.OOi) uf mor- 
phine und jlj of a grain (O.niJti) of ipeeae. aro nse<l in >oi» throat, dia- 
tnlretl in the tnouth. Hover's powder (/*«'ci« Ipfcairuanhir ft Opii, 
18 



■iii 



S74 



VRvas. 



V. S. : P]^m Ipeeo'swinhn' C^mpceitut, B. P.) is given in the d< 
A to 1o grains (U.35-1.UJ. Il contsins 1 part (y.Uo) of opium, 1 pi 
(0.05) of ipcMC, nni 8 parts (0.4) of sugar of milk. (See Opium,) 

Emi;linn may hv glTt-n in tbu ditSf of -j^ to J ^raiii ((I.OOtJ-O.OI 2) 
M an emetic, but is very rn-rcly so otnployoil 

Tlie Itriiiali prcnnratioHs :Lrc tlic pill of Ipecac mid sijuill (PiVu/t^ 
Tpfiacu-rnhtF rum Sfitla. H. P.). which ia given Jti tlie dos« of 5 lo 10 
grain* (0.35-0.6i"i). and ilie vinegar of ipecac [^AcHum ipecacuanha-, B. 
P.), vbich i« given io the do«c of ■"» lo 30 miniiDS (0.3-2.0), and used 
a» expectoi-antfl. 

IRON. 

Tron {Ferrum, U. 8. and B. P.) is a metal which is ased both as H 
mnlirinc and ii food — n food bi-cuuHi.' il fonn* part of the body when 
taken into the organism and i^ lUL'd Iiy ihi* «;,'tiiv»> in the matkiiig of 
blood. The number of itA oflicial miIIh and compounds le far in cxccm 
of tho need.4 of prac:tifrxl phyHiciatiii, and half the preparationi arej 
nirulv. if t'v«r. used. 

Phyfliologlca.! Action. — Iron ha» little or liu elfect upon the 8y8tpio| 
when ^iven in a single ih'i^c. hut rep(<«ted doeen cause an ibercatfc iaj 
the numbpr of red Ijlood-eoi-niificW, and idethora. or an increase 
the quantity and quality of the lilood. Much disi-u^^ion has arisen ajl 
to whether iron when piven as a drug In the form of one of the inorganic 
saltit in absorbed. Om,- theory Iiuk \>cv\\. that only tht- urganit iron of 
the ftjod is abHurhed. and tliat nivl.illic iron when given freely allows 
thi« absorption to f;o on both by atiiinihiting the bowel and by enter- 
ing into cnmbinnlion with the 8ulphuri>ttfd hydrogen In the interline, 
thus permitting the organic iron lo eecapo into the system. That both 
fbnns of iron are abnorhed and eliminaled is now certain. (For a 
discuBsion of i^ouie of theee viewH see article on AneeuiiA.) If, however, [ 
iron is pireti in esvessivc dns;(«i. much of il reniainx unahsorhod, ia> 
changed into the (sulphide of iron in the bowels, and c«cmpee with the] 
fecM. Careful Htiidieiii have ebown that the iron, when onoe ahsorhod, | 
eecapee from the body very alowly. and that its pathway of escape is 
not by the bile or in the urine, but by the wallu of the intestine which 
excrete it, so thai it tuay be recovered from the fieccd. It hiu< bevbJ 
asserted that it \% never retpii»e<l from the body, but this i^ untrue. 
Whether it acts us a stimulant to blood-man ufaolure or dimply $upplit'4 
tlie glands with blood-making material we do not know, but the latter. 
is probably the correct view. Iron causes oxidation to go on mor 
rapidly by reason of its ppcniiar power of convening oxygen into 
ozone, ana in this manner acts a& a atimuJaiit to nutritioD and bodily 
activity. 

Ilic preparations of iron consist in the soluble and insoluble salta 
or forms. Of ibej^e the in.<<nhible ari! better than the soluble, bemuse 
ncurlv all the soluble salts of iron arc precipitated by the gastric juice 
and nave to he xlonly rodisi^ol ved. Nearly nil iron preparations are 
Capable of acting as more or less powerful astringents, and so arc apt 
to cau-ie constipatinn and to disorder digeiiiou if given in large i\^iM'm. 
The most astringent of all of these preparationa ar« Monsel's salt (ih«| 



JROH. 



275 



Ftrri Suhtulphat, U. S., B. P.) •nd tJie milphiitc (Ferri Sulphat, 
V. S. and B. P.). Clodclv foUowing these in ustringcncj an; the am- 
monio- rerrit: alum, (Ferri et Amnwi\ii Sttlphaa^ If. ^ audthe chloride 
of inm (ferri i'/iloridum). The lenst aj*tringent preparations are 
QuBvenneK iron, or iron by hydmgcn [Ferrum Redartum, V. S. uu\ 
B. /'.), nnil carbonate of iron (Fern Carionas SaccfifiratHg. P. S. anil 
B. P.), and Basfaam's Mixture [Liqmtr Ferri et Ammonii Ai^^tatfa, 
U. S,\, aaJ the citratcji, tartrates, und the lactate and pho»phato of 
iron. 

TharaiKiitics. — The chief indications for the admint3tra|ioii of iron 
are ihate formH of aneemia (see Anicmia) chsnict«risi(od by a decrease in 
the normal quaotilT of hiciuoglobin iu tJic blood an determined by the 
tiH^tnoglobinometer, ns. for exnmplf*. ebhirorti^. Itn chief cnntrnindiLiw 
tion is plethora. When ust-d iu siniill J(K*e (J t<) J gmin — ().01*>-*),oy) 
ii is quite a^ efficsciouH an in large amomit^i, and k'X^ apt to dii^order the 
stomach, hut the doses given in \\\\n article arc the ehuisii-jil ones 
usually prescribed by nbyidcian-t. In Rome casva of an:L>raia of a semi- 
pernicious type large aoscs of iran are really needeil, probably because 
the system is deranged in such a ninniier tbnt an excessive Inns or 
elimiuntinn of iron is con-tui iil ly present. Large do^ra coiij)>en^te for 
chi« IvakiLgi? and afford the i|uantity needed fur physiological piir|iose«. 
It slinold not he used iu< a ionic unless? fonie dirccl indicntlon for it» 
onployment ia pr«.<ieni, and nn dnifr is Rinre abu>i{!d in this respect than 
in>D. As every prc|>nrutioii puisi>efi»cs souii; peculiarity, the use of each 
will be coDSidered wparately. 



Ammonto-ferrio Alum. 

Am monifv- ferric Alum {Fcrri ,t Aminonii ^idphas, U. S.) is often 
giveu in cikMrs oi' itl'inic teucrirrh'Fii n^ffor.iatcd willi c!ilorollcii-nth;ncie3 
in the dom of 2 to •'> gminR (0.1-0.3i!). It i» quite a«iringent, and 
should not be given in coses of ga»tric irritability, as it is not auitcd to 
imeb a condition. 

Aromalio Mixture of Iron. 

The Aromatic Mixture of Iron {.Wstura Frrri Aromalica) cvin- 
MirM #0 little iron that it ^honM not he administered in ensis where 
a very marked chalyhL-ntc iiillufiicc is do.-^ired : it is, Iiowl-vlt, a tisfful 
tonic for cMe» of debility and slight O'lii^niM following long illnesses, 
given in the dose of 1 ti» "J tluidounce.i (."S'l.lMJO.O) after mt'als. Aro- 
inalie mixture of iron c'>nt.iin9 cinchona-bark, cnlumba, cloves, iron, 
cumpoiirvd tioclure of canlaiuoia^ tincture ofoiaiigc-peel. »nd pepper- 
mi nt-water. 

* ArBenate of Iron. 

Arsenate of Iron (Ferri Am/rnas, fi. P.) is used in the dose of 
-jlf to ^ grain in anicmic Huhject'i who are sHfFering from the dry, 
scaly forms of skin dist^a-'^e which indiciiio the usl- of arsenic, (See 
"Lr*enic.) Il is also of value in the iiiift'mia of chronic diarrhfra, as 
iron and axMenic are useful, not only for the anxmia, but for the 
rol of the iotestiuul diJ^order. 





276 ^^V DRV08. 

Baeham'e Mixture. 

• 

Under tbe nnme of Basham's Mixture {Liquor Fern a Ai 
Arriatu. If. S.) a vtry useful nrnl elegiint |)re|nrH.t ion of iron is 
cmijloTed. It !!• piirticulnrl^' iiM'ful in the <in<Tmia of acute <ini/ chronir 
uttri-Krht/inatou* iii'ii/iririx. um it alnu acts aa an efiick'nl iltiirelic and 
uiaphorocic. It is made up as follovra : 

'Hnrliirc cif okIarid« of iroo SjNUtii 

DilTiW luwtic Mdd 8 " 

Sniritfif MinilsnuTM 90 " 

Klixtr of oruige ID " 

Syrup , IS " 

WWM- » '■ 

The dose ia (rom 1 to 8 dnchme (4.0-32.0), vol! dilated. 

Bromide of &on. 

Bromide of Iron (Ferri Bromidum) is fiiid hy DsCosta to be ose- 
ful in anarmla, when tliiei stare is ae^ocinlfd witli chorea, in the dose 
of 5 to 20 gnvitie (0.3-&-l.y) givcu in 9_vriip. In oilier orrYoim dia- 
eases ncconip&ni^il hy niuvuiiu imd iii»Liiiiiiiii tlie ^yrup of llie liromide 
of iron {S;frujnt* Ferri Brovtidi) is useful in the dose of i to 1 iluiil- 
ilraclitn (i. 0—4.0), hiil ils Hptlaiiv*? prnpRrlies are not sufficK'ntlv itmrked 
to rvmler it of much value in overcoming true inaomDia unless it ia 
fortiliod by one of the other bromides. 

Oocodylaie of IrcHi. ■ 

Under the namt.' of cut-udyliiii* uf imii s compound ha^ been 
introduced which iit givmi in L>:uM.>!t uf aiKrmiu. \n which th<* hii^mo- 
glohin and the crnrpiincleH arc lacking, fincc hy tJiiit oiraoA wi- obtain 
the effVct of both iron and arsenic. The s:itt mar he givt-n by the 
Miuuth in tho dui<e of ^ lo 1 gniiu <0.(|]i)-l).Oi:) three times a day, in 
Mtlutiou. or ill urgeiil ca;«es in the doso of ^ to | grain (0.f)0K-fl.016) 
by the hy[iodcrmic necdlu three times a day. It is nc-scrted hy Gilbert 
and TurebouUe! that this in nut productive of local ur renal irritatiou, 
and in the ailaminuria of tuberculuatt may even be beneficial. 

Carbona-to of Iron. 

The Carbonate of Iron {Ferri t'arbonan Saeckaratut. U. S. and 
B. P.) is vcrv fligblly iiatriiigciil. and may be used in pill form under 
Ihc niinio of' PiUie Ferri Carlvnatia. I . .V. {Pilttl<r Ferri, B. P.), 
Bomeiime-i called " Blaud's jiill," or in Griffith'* pill, which also eon- 
tains myrrtj. The dose is about 3 grains (O.lo). This preparation 
of iron is largelv used fur the TroBtmenl of itmcHcrrhtfu dependent 
upon amt-miii. Indor the name of Mi«tvr>i Ferri ('«n/«i»»''J, i'. S. 
and B. P.. or Griffith"* mixture, we have n liquid prepamlinn used 
f-ribe same purpoee* as the pills jntt nntricd, in the diw nf I to 2 
taUcnpoonfuU (l<>.0-^0.0). iV>iJ>iri Ferri Carbomttit, U. S., 9am^\ 



I 




Tincture of the CliIorid« of Iron (Tinetura Ferri ChlnruU, U. A'.; 
Tinrfuro Frrri Perckluniii, If. P.), often cilIIciJ Tincture of the 
Murmie of Iron, is ono of the best anA inottt iiReful propnrations of 
injti thai we tinvv. It if lliu ruoel diuri-tic iirejjuniliun uf Iron. This 
diiirt-tic elfect iluv»i not d(.>|ieiid upon tlie pi-i-sotiLV nf a tnuriiilic other, 
AM iukA hcreiofori.- Utvn taught, eiiico it iB not pni°mit. antl in lianl to 
pr«jUire exf«|>r lliiTe is an exfesa of chlorine. Arrnniirig 1o resi-iirclica 
of L>r. 8. Weir Mitchell, the onW eUicr |jrc8*nt is iiiimuft ellicr, and 
this in devoid of power and in snrnll qiiiiDTiiy, As chloride of iron 
ittK-lf \i diunriic. it is pn^ablT ujion this thul llu- dtiircBis proAntied 
\ty it dvjtetula. Thi* diwe uf tui' chlonde uf iivjii i Fi-rri Chtoritlnm, 
C .V.) if 1 to -H grains (0.0t;~i|.I8), 'J'inrture of the clil-)ri.i<' of iron 
is I'onsidored n siHfitii" in rrifgtj>i-la»^ nnd should be given in very full 
do9e and firequeiillv rejwatpd IF it is to be of any SL-rvice. (Sec Ery- 
sipelas.) Kl minimi' (li.<!>^), wfll dilulvd. vvcrv hour »re cot too much 
if tli« )tt«>aiiK-li yf llic pfttii-nf doctt not rebel. In rhronir Itright'i 
dtMroMr it id of value and d»-n.>(i!it>6 the albimiiuuria. In aturmia it 
ia u.ocfiil. ;ind owinf? lo its acid ij* ji doiililv effective roiiic. In cases 
of clijrlit Hnirmia in which very ^rfat iirtcrinl pret^jviire exists l*r. 
MilclicU luw^ II pnn-ly milk diet, nad aii ounce of au old tiiictnrc uf 
iron io the twenty-fonr hmirs, While lie recojinizes the fat't tliat inin 
pTcp^httions are penernlly .tiipjiTOed to rai.T hlnml-prc^Hiirc, he aaserta 
that in this instance the blnnd-pressHrc is loweied. The dose of 
Litfuor F'TTTt i'hlurhli, J'. S.y is 4 to !'► iiiinini.'«(0.2-l),G-'i). It is rarely 
utted inieninlly. but chiefly a?* Jin Ji-lriri;;ern of gieut power. LiijuoT 
Ferri Chlrtrili i» idcnti^tl willi lA-juor Fcrri J\rrfili/riJi, B. P. 
Tinrtura Frrri Prrcfiioruii. B. P.. is uaed internally in the dose of 
IM to 20 minims nXti-VLS). 

Ae a tncal application tincture of the chloride of iron is useful in 
diphthrria and memhraHotiK croup, and even in toHtilUtia. In cuch 
of thme uiitadit.t lur^ doses of the tinclure internally, with couni«r- 
irritntiou over the neck, are most useful. When used internally it 
nhuahl tw well diluted with water and tnlten through a gla»i tube to 
prjt«ct the teeth. The strong solution of pcrchloride of iron {Ligu<>r 
Ferri Perchioridi Fortit, B. P.) is a powerful styptic. 

Oitratee and Tartratee of Iron. 

The four citrates of iron arc .soluble in wiitcr and v(Ty useful for 
this reaaoii, becanae they are readily added to liquid preacnptioue, and 
ure also of value becwufte ihey are very slightly irritant kiu\ asLrin- 
Mit and do not disorder the iiliinentary cnnnl. Ft-rri Citritu, V. .V., 
id Ferri ft Amatoitii CUrtui. U. S. and B. P., occur in garnit-red .scalej' 
ind ar« given in the don* of S •rrains (0.85). The ooluiion of the 
citrate of iron {Liquor Ferri Vitratia, U. A'.) is given in the doBe of 



278 



DRCGS. 



10 rainiins(0.65). Tbc Ferri et Quinintt C'itraa, B.P., und the Ferrp 
et StryetmiiKf Citraa, U. S., mre UBualW given iu ihu doso of 5 to 
15 grains (0.35-1.0) and I U> 8 grains (O'O.'i-O.ir.). rcepwlively. The 
new ol9icial Ferri et QmnintF LHtrat SohihitU, V. S., is given in the 
doBc of 1 to 2 gi-aiii» {0.0,V0.10). 

liefitiltH thv>ie cilraU's ihi-rv arv thiv« tsrtretee — (/Vim e/ Ammunii . 
TaTlratt If. A',, ami Frrri et Patasnii 7^artrati, //. .S'., iinJ Fcrrum Ta 
taratitm, B. P., all given in the dose of .'* grains (O.SS). 



Dialysed Iron. 

DinJjned iron [Ferrum Dialytatiim) is & very feeble preparation 
of iruti. Isiokiii^ ill »«[rinj;eiii!y, easily precipitated from the solution 
in i^hich it occiira. but nt one time largely used in ana-mia by poidp 
practitionern. The dose is 10 to 20 mininiH (0.3^1,3) in water three 
times a day. Soiiietiiiu-s river-water, if it contains niucli inor[»anic otj 
orfinnii.' iiidttt-r, will prceipitiiic it. Owing to the in^tahility 
diuly/ed iix>ii, it may bu uaetl without auy further ]>n;[i«ratiou as 
uuttitute to linsenic. 



Hydrated SeBquioxide of Iron. 

HydrateJ Sestniioxide of Iron [Ferri Oxidtim Hydratutn, TT, 5.) 
the antidote to itr»enir. but lobe«l1it-a«iou» it uuHt be freality prcf 
It in to be made by precipitating any liquid preparaiiuii of iron by 
ttm addition of an nlkali, such ns ammonia, or by the athlition of mag- 
nesia. The resulting pn-cipltatc is the untidote. and the supcnmlaut 
li(|uiJ is to he poured ulf. If ammonia is used, the precipitate must 
be wuihed with water Hevcral tiniia to get rid of the alkali, which will 
render ihe antidote too irrilant to be avalhtwed if it is allowod ro 
remain with the precipitate. Magneaia in an antidote in itiHilf. and 
iihonhl be preferred under all eircunistanco!*. The antidote should be 
given iu exce:^, and na tuucli as a pint of the iron f^()lutii>u .<^iuuld t)C 
precipitated. The magUL^ta xbuulrl he freely added, as too much of it 
cannot he given. The antidote to arsenic iB official h» Ferri &xidum 
Jltfdraium nun Maffumia.TT. S. In the Pruswinn I'barmacopoeia thu 
is knonn va the Authlotum Amcnici. (See Arsenic, Poisoning hy^ 
for oflicial motliod of preparing antidote.) 

Iodide of Iron. 

Tho Syrup of the Iodide of Iron {S^rupu* Ferri lodidi, U. 3. and 
Jt. P.) is'ft transparent liquid of a sweet, iron-like taste. It should 
contain no free iodine, and if a sample of it strikes a blue color with" 
Btarch it should be discarded. It is largely used in ana-mia associated 
with aerafMlotit and tttnima. and is useful in the fczmta of young 
ehtldrcn nhen chi!< i» dependent upon Inck of vitality or anietnia. 
The dose to a child of two years i;^ ^ to 8 minima (l.l-O.l.'i), well 
diluted, and to an adult :1U to 4(1 minims (2.(t-'2.ti.>) in water, to be^ 
taken through a glastt tube to protect tho tc^th. 




Tfao sacvbanted iotliile of iron {Ferri lodidutn Saccharatuta, U. S.) 
is osetl in pltce of the -iii'nip in the iIome* of 2 to ij grain.* (0.1— 0.,t). 
The official pilb (PUuia Ffrri JwliJi, f'. ^,) e^cb ouiitaiii ^ of b groin 
(0.01) of rwliicipil irun bihI ^ of a. grain (0.075) of iodine, ana are 
giv«n in thu doeo of ouu to ibruu pills. 

Bubeulphate of Iron, or Monsel's Salt. 

MoutH-'lH SuliiUoii (/.I'YUor I^'erri Sniiaalyhtifis. I/. S., lAtfuor Ferri 
J'fraulp/iatig, It. /-*.) ia someliiue;* wrongly called the Soliition of the 
iVrsulphiiio *>f Iron, unci is onv of rhc most prtwerful mtyptica or 
hicttKPSlatJca that we have. It in ncvfi- to be cmpli»y<Ml when- a 
hemorrhage is to he aitacki'd tlrou-'h the uireiiluiiou. liut only wiiou 
tile aolation can come in direct contact nitb tin; bleeding spot. The 
abjection to \ta me in the luml, blBck, nnd dirty clot which it foriiis 
on oomin;; in conlact with blootl. In hitmi'iitynU Mun^ers solution 
should be uwhI in fine spray eoiisistin}' of from 1(1 to tiD iiiinims (0.*i5- 
4.0) to thf ounce of dintillcd water. In utcrlm- hrmorrhatie from nny 
cnuM the dilution miiy he half-iind-half, iir if the hemarrharfe he from 
a jHtfyptia or the cervix uleri the pure solution .'^houhl ber nscd, loc^ally 
applied. In Haae-hU>otI Monwl's »olutioa miiy be cniphiyed diluted 
'.•tic-hulf or pure; but it» use ia not to hu cum mended, Ik^husc of tlie 
hnrd, black clot vrbich in fontiei) and the ttiiL'omfortable smiButiuusand 
pftin produL'cd in the niLsal cbaniljcr-'t. i'lii^giiig the nonlrilF!, and if 
ticed be the paiterior nare.«, with pledgets of cotton is geiierallv eufli- 
eiently efbciu-ious. 

Fur the iatexlintil hemorrhai/e occurrinj; during or after tvpboid 
ferer MoomI'a whition hii;^ been given, hut ought not to he so 
eniployvd, us it is deeompospil in the Kiniiiach bi-frire it n'ni'he;* the 
inteetine. In its .stead Mnu.-*er3 sjilt {Fi-rri SaUiufphnu) Mhoidd bu 
gireu in pills of -t grains (0.1.'>) oacli. the pills beiii-; inade hard 
enough to escape into the intestine before the Hlouiach diiutolvc!) ihiin. 
One, twu, or tliree pilU may be given, and repeated in an hour 
in prceaing cases. II(tma(imf*i» due to bleeding in the atomach may 
be treated by !t*ininiin ((1.1.1) dosefl of the smlution in a liltlc walor. 
It sbyuld he remcmtcred, however, that the drug \m irritating if frc- 
ijnently i-eijeated. 

In Um»iUUi» and yhari/ngitU a most efficient application is pure 
MnnKel'ii solniion applied by Tnnms of a pledget of cotton or camel's' 
bnir brash, or equal parts of the solution and glycerin may be used. 
Tbiff applic:ition h ofleu as pMiitful us it iit efiicii^ni, :ind care luiisl b« 
exercised that an exce»* of th.- fluid be not xirc«-nt, as it iniiv drop 
down and irritate the larynx. In iliphthrria tbiHniethud nf treatment 
ii often of great service, , 

The antidote to iMoti»erft solution is common loap. 

Oxalate of Iron. 

Oxalate of Eron {Fi-rri OraJaii) is given in the dose of 2 to 8 
grainn (0.1-0.1t>). It po»;iies»cs no advantages peculiar to itself. 



AM 



DRUGS, 



Phoephatod of Iron. 

Tliere nre two plinttpfintee of irmi — Fcrri Phi'>}tha» SalvhUu, f. .¥., 
ftr Ferri J'fuiipkat, B, J'., mid Ferrt P>fropho»phaB S^luhifit. l.\ S. 
PLa-iplinto of imn itself is VRrj* insolubiB aiiil w rarely uw^l- Tlie of- 
ficial foniw arc. Lowcvcr, tjuitf »"jluble. and useful in the dow of '2 fo 
5 f^illS (0.1-0.35). Syrnjmn Frrri Photf^hatix. B. P., lii given IQ 
tlie dose of 1 tiuidrachm (4.0). Pln>si>hntc of iron is otir of the in- 

5redif>nt!i of tlie Ftjnip of iron, <]ainine. sad atryclinint' {Stfr*i<u» 
'rtm', QwMfttt et '.'^rifhttina Pho*ph(ttttm, I'. A". ; Sjfruj:»u9 fr 
Phot/ifiath cum Qvinina*et Strychvina, B. /*.). which m gi 
the doac of I fluidr&ctini (4.0). 



Reduced Iron. 

Quftvenne's Imn (Ferritin lUtfuctutit, U. S., and Ftrri Rrriafium, 

B. P.) is an iron-gray or roiidi-'h iifni-dcr which ia fref|nenlly uihiltrratfrd 
with lurajjltUcl;. If tt ia jmri-. il .'•lioiiM hiirn in sparku nhcii dmppcd 
into a. flame ; Iml if luiiipblack is prcsonl iliin will not oRciir, It KhoiiM 
nlw jidd no pulpliim-ttird hyilrogim un adding sulphuric acid lo it. It 
is totitcloes, and may he ciVf^u lo chlMi'oti for thi)< reason in |nlU or 
gum-drftp3, or'^lafinl ineidv of small cbucolate crcama, or in tne form 
of troches (Trochi'iici Fern Hafacti. B. P.). each I'l^enge containing 
1 gruin (0.05) of the rcdiicet] iron. It i» ufcd solely in oaicuia, and 
is one uf the least Hstrlngent of the iron prepiiratioiis. 

Lactate of Iron. 

Tho Lactutt: of Iron (Ftrri Lai-tag.V. S.) is soluble in 48 parts 
of water, and i« given in the d«.«e of ij grainn fO.32). It in usH Pjr i 
the 8sni« purpueed un the otli^T ]>i'0)>iirAtions of iron. Lactate of iroQj 
is one of tne ingredients of .S^ru/jMJt Hyftvphoephitum ntm Ferro, V. S-A 
die do80 of which ia ^ to 1 lltiidrachin (:i.<J-4.0). 



i 

« 



Sulphate of Iron. 



Solpluit« of IroD {Ferri Hutphan, U. S. and B. P.) is ased inter- 
unity in the ilosw* of .1 grains (0.3.1) in pilt (orm in rftrvnic tiiarrfnea 
with nwrrmwi. ExternftllT. in a solution of the streti^ll of ■'i to 25 
graiuH to the ouuoo (O.Sm— l.(tn ; 1J2.0). it in used as an asU-ingeot 
lotion. Two other forms of tho sulphate arc also employed — namely, 
the dried (Frrri Sulptmt Er^ircatm^V. S. and B. P.) and the grwin-' 
lattfd (Ferri S»Upha$ t^tnttlatm, V. A'.), each of -which is ^vcd in tlie i 



do8« of 3 grains (0.18). 



VaJerlaoate of Iron. 

raleriaoate of Iron (Fti-ri \'tih-riinas,U. S.") \a .sometimes 
hgtteria with anvminy given in tlie do**); of 1 grain (O.OK) or uioru. 
pusDctsBCit a rory feeble influencti as a nervous sedatire. 



JjiLAP. 



S«] 



I 



Winee of Iron. 

Tfce Biller Wine of Iron { Vinum Ferri Amantm, V. S.") \« usefiil 
a bin«rtuuic in anamia in both cbildron uu<i atlulte, amt niiiv be ad- 

tage()ii5ly accompanied with c(>cl-liT<>r oil. It tit givrn in ti du^e of 
1 to 2 flaHlraflims (4.0-8,0) or more. This wine in cnrnpowd of soliibl* 
citraie of iixtn and <iiiinin«, tincture of sweet oraDgc-|)ecl. ayrup, and 
atroDitrT vliite wine. 

Wint" of tlic Citnitc of Iron, or Vinum Ferri Oitratit, U. S. and 
S. P., is eomponed of the citrate of iranAend animoniiim, tincttire of 
nroct oranctvprcl. syrup, and stronger wKite wine. The dose is identi- 
cal with that of chi! bitt4>r wine, una it in u^ied for tJio samv pnrpows. 



The plaster of iron {Kmplantrum Ferri), official in the U. S., is 
epared from the bydraled oxide of irOD. 
The folloving nropHrulion of iron ie also offieini : Liquor Ferri 
AcetatiSt If. S. and B. P.. dose 15 niininiH to 1 fliiidraflim (1.0-4.0). 



Uotovard Effects of Iron. — Iron !» apt to cttunc giiAlric dititrciK* and 
froQULl bvadavbc iu perwiiiJt who are Kiixci-ptihU' to it^ nm: Kvcu niie 
lieme will raime tlii» triiuhle in s^noe- pei'Hone. In ninny in^Tiinrrn tlir 
frunial liradache will lie found tn \>« duo to the cunRtipntinn which 
lue been brunght on by the iron. &tid will bv reliL-veil if utild hixa- 
live or parages are itsetl. The state of the boMelit kIiumIiI always be 
inquired into when iron in being n»ed, and luxaUvrt^ givrn whenever 
const ifiatinn is present and iron in being administtired. In rheuiiiatio 
acid gouty persons frontnl ht-adnclice are a cotnuiou fyiiiploni iftht-n iron 
^tven. and purgatives will not genemlly give relief. Gairud iind 
laig hare Ahown that iron deimu'ivi the diminution of uric nctd, and 
iry tliiuk lliis may afcoiiiil for the production of lieadacbB in the 
s^ of rheumatic patieniH iimlcr iti^ tuHueiK^c. SomctimiH »a1t« of 
produce vcHJcnt irritntirni nnd :i constnnt desire to urinate, e%U!<ing 
■Qeus to form in abtiomiul aiufuiit in the bladder. Id children its 
may reHult iu nocturnal lucontiDence of urine. 



falapa 



^(?. 



JALAP. 

Jalap {-fftiApa. U. S. and B. P.) Ix the tuberous root of Tpamma 
(ipvmirrt Purifd. B. p.), a niitive of Mexico. It cuntuiii!* t«o 
ins, jalapin and q^nvolvulin, neither of which ia u<ied iti uiedlctne 
tiAelf. though both of them enter tiitu tlie Ilenin of dahip of the 
T. .V. p. Tn overdose jalftp or iU resin causes vomiting and purg- 
ing, with g»<>lrii-entLTiti!t. 

Tbantpeuttcs — italiip ic iwil in nii'dieiiic us n hydrn^giie purge to 
lurlievt- •Ir-fifif of luiy origin. It luay be iiaed to di-pletc in nisea of 
\eMeral pletlu/rii with eerehrnl eimijfgtion. atid owing Im its tiu;telf?»>s- 
neiw IH » u»ieful active cathartic in children if given in the proper iloi« 
— nutnely, I to 2 gmin^ (0. 0-V-0. 1 0) in 1 an ounce (l.'J.O) of Hyrup of 
rhubarh. Comhiued with calomel, it is preferred to all other pui^ce 



282 



DJtVOS, 



bj some practitioDi'T?, pitrticiilnrl^- if the liver in lorpiil. Jalap iu large 
(luac'S iiiiiat bo uattl witli cnutioii In persons wlio ivve feelilc, and it is 
ooutrniiiiIi»iii-i) ill i-ases suflV-riug from gasTric or intestinal irritntinn. 

AdmimEtratioD. — Jalap may br glvrn in tbr form of tbc compound 
powder {Puh-rg .falaptr ('^rmfiomtng, I'. iV. and B. P.), dose 15 to 40 
giaitis (1.0-i!.G5), wbich in ci)iii|iuseil of 8o )»rtfl of jalap and 66 
parts of bitarlmle i>r p<itas>!t[i»i ; niid llie rosin [Iteaina -falapcp, ^ 
U. H. and li. P.). (hm for an adult 2 to 4 graioa (0.1-0,2). Owing] 
to the HDiall Bixe (if rlio d[kEi<> iif the renin and its lack of taste, tkia 
prepa,rAl i^in is to be pteferred fitr cbildrrn in tbe dose of ^ to } a 
crnin (O.IJlG-0.03). The iiiiciiirc {Thit-tura Jalaptr. H. P.) is given 
in the dose nf J tn 1 Hnidnirbm {:i.(M.O): tlif extract (Kjrtrnvtum 
JalapiF, U. S. and B. P.) tn uaed in the dose of 5 to 15 graitis 
(a85-1.0). 



JEQUIRITT. 

This 19 a plant known as Abru* pre<^atonu$, the seeds of which 
are poisoiKHi!* wbfii applied In a wound. An active principle, abriu, 
is cotupoitcd of pariigli>1)idiD and a-|>hyt«IbnmoHe, Thich closely ro»ein- 
blt! »n like- venom in iheir ai-tinn. Jei|iiintv i^ never used internallj 
in medicine in tliin country. An infusion of the powdered seeds, 
made hj adding! \ a drucbui tn !lii ounce (2.0 : S2.0) uf water at 140° 
F. miiy be pniiili'd with a brii-^h on the ioiiide of the eyelids in casea 
of chronic i/ntnultir coitjum-tlvifu, in order to produce an acute diph- 
theritic iiilUiiiiniitioii which will mo change tbe chronic prooc^ present 
as to permit of a riire. If an excessive action u developed, it may 
be controlled by hot coinpreS!<e« made of very dilute aolutioos of cor> 
rteive sublimate. Tbe solution of tbc drug undergoes decoin position 
wilb great nipidity, ii-nd should be frcHlily prepiired each lime it is lucd, 
or 4 to M gruins (0.2-0..')) nf tiorit- arid .''hniild be ailded to preserve it. 
The drug in a powerful canliiic depre-innnt poison when injected into the 
circulation. Whether ibe seeds produce poisoning when swallowed is 
d<Mibtftil, some asseriing that ihey cause giwtro-enterilis. others that 
they ore burndcM. IVohaltly much dcpciioit on tbc activity of iligcs- 
tiou and ahitorplion at tbe liioe of ingestion. 



JUNIPER. 

JumperuM is the fruit or berrv of Juniptrv* communiay an ever- 
green of Northern Kuropc and America. It contains a volatile oil 
and an ainorph<}iiii principle, jiiuiperin. 

Physiological Action. — Juniper iict» 9a a gastric Htimiilant and 
tunic, iia u. mild diaphoretic if combined with alcohol, and as a 
marked stimulating, exciting diuretic. It escapes from the body by 
the kidneys. 

Tberapeutiea. — Juniper is valuable ati a stimulant tu the genito- 
urinary tract whenever it is depressed or chronically diseaAed, as in 



KAMALA^KJyO. 



£83 



chronic pytlitit. H^Ariii9,aai chrvnie etttarrh of ihe bladder. lu tv/n- 
ffeMion of fht kidn.i'i/$, particularly tLal due to feeble clrcuUtioo, if 
not soooiupaiiicd by active roDul cbunees, it rclicrcs thuse oi^aiis aud 
diias uway with alhumimiria. LWl after an uttark of acute Urujht'n 
dineaer when reaction Ims set in ami tbe secretiDg ei-itheliuna of iLe 
kiiiii<>y h uionic, it is of value ; but carL> sboiild be lakeo that all in- 
fl«iim>ation has pawed by or it will tniikc tbo paiicnt worse. In tlic 
Utur Mtu£i£« of scarlet fever, iii wliicli tbc rcnui cundition corrt-Mpuiida 
to that jUBt described, juniper is also useful. In old persons a sensa- 
tioH iif tcfight acnma the famliar rrg'itin in often (quickly remoi'pd by 
tbc ude of juniper if the kidncyi* nrc inactive. 

AdJiInlstntioQ.— Juiii[>i?r Is U!>ed in till- form of lb« conipound 
spirit {Sjnrilu* •funipfri (.'f/ntpuMtut, L'. A'.). CTOposed of llio oiln of 
juniper, caraway, and foniid. ciimbine'l ftiih nlrolinl and water, in 
the do«e of I to 4 dmchtnH (4.(1-16.0). Gin ta virtually idotittcal 
w itii tlie compound spirit. The infusion of juniper is made by adding 
an o«ntv> (ilO.O) of iho bcrrien to a pint (J n litro) of boiling wafer una 
ullnwing it to Htand in a warm pluci- for an b<mr. Tht- cutin; iguiintity 
ia to be taken in tventy-four bunr^. Thiu infusion is 'ifien couiliineil 
with an oiinre (JJl.O) of acetate of pnliiKsinnt or of the hitartvaLe of 
potaMium in ihp trmtment of dropsy. Tlie Fpirit {Spirilv* •fumpfri, 
V. S. and Ji. P.) is given in the dose of Stt ininim<) to 1 drucbni (2.0- 
4.i>), The oil (tfti-um Juuiperi, U. S. and £. J'.) is ui^ed in ibo doiw 
of 1 to 4 minin)» (0.00-0.3). 

gAMAT.A 

Kamala. tJ. S., or Rottlera. as it U sometiinea called. 18 tli« gll 
aod haira from llie cappuks of Mallotua p}nlif>pu-n»i», a plant of 
Abyioiinin. India. China, and Aastrnlia. It coiitiuns an active prin- 
ciple, rottlerin. which id not official. Given in the dose of 1 to *J 
dracliiuK (4.0-8.0). kaninla acts us a drastic purge Hnd n.i a remedy 
for fat/ewt>rmt and is fotnctimcs a«ed for the removal of ilie a^earig 
lumbncviido!*. It «honl<l hi- adininiHtercd in syrup in which is placed 
some liyoscyanins lo prevent griping, and the dope is to bo repeated inj 
eight hours if no effect i.i proilnced. (See Wonna.) 



KAOLIN. 

"Kaolin (Kaolinian, B. /*.) is a soft white powder, a dceoiuposition- 
produci of luiuerjl deposits eoulaimng fcld«pju-. It is used e.\tonially 
aa a dliBtiug powder in eczema. 

EINO. 

Kino {B. p.) is the inspissated Juice of the Plerocarpv* Manupium, 
a till tree of India. It contains kino-tannie acid, and is used as an 
aflirinjpjnt in the trenlment of Kfr/mt diijrrh'va. It is official in tbe 
f'ifui of the tincture (Tiurttun Kino, C S. and B. P.). and is given 
in the dose of 1 llui<Imchni (4.0). Kino inny l>e used as a gargJe in 




imuas. 



J 



tore tAroat and for relaxation of thp undo. TTnder the lutne of Com- 
pound Powder of Kino {J'uft'i* Kite VumjMnituf. B, /'.) an efficient 
and plcaxaot intiiliarrhtra powder is nnsfA, Tbis pow(i<*r \n not nflicial 
ID tbe V. 8, P. The formula for ntcli povdcr is 15 (jmiimfl.O) «f 
pondert^l kino, 4 (0.2) of powdered cinti^tmon. and I (0.05) of pow- 
liereJ opium. 

KOLA. 

T!iL*< drug i» the aat of Kola fl<T«in«Mrf<i, t tree groniog iu certain 
piirt8 of Africa. Thi- iiuL dt.-pi*iid8 for it» diii'f iiifdiciiial m-tivitr 
opoQ (be caficiue which it couUins. In addition to this alkaloid it 
contains Aituit* thvohniuiiiie and kulatannic acid, uhich latter ingredi- 
ent may explain the good reaulto which Lave foUowed the nee of^koU 
in case* of ilinrrhcea. 

Phydologleal Action. — The phygiologicnl ftction of kola is. a« fnras 
■we know, nt-arl^' idt'iiticxl with its nt-ar relative* coffee and coca. 

TheiavettUes. — In cases of feeBfe heart aspociateil with flrucral delnl- 
itif kola often proves a valnnhle utimulaiit to the heart and general sx»- 
tnn, as w*ll as to the kidneys. It has also been uwd with a^icrtcl 
success ia $ea-»ichir9ii and to AoUer dninken persons. ahhou;;h the 
latter power i« to he doubted. Its age will «oioetitttoi« reliere nVi 
id vruralgir hfodaehr. KeccnlK a lar^c nmnh<'r of semi-proprielarir 
rtiole^ have been introduced to the Uitv nith tbe statetneiil that lh<.'T 
increase niiiitcular strength. Kxcept for their teni]irtrsnf .•ttiiniilalin^ 
powfcr tLcv un.' uselcsis for this purpose. The drug is, however, of 
vstiie in ca-^eM of uterint: Inertia aiiring labiir in the dose ul' 30 mtaiuis 
to 2 drachms CJ.ii— S,0( of the fluid exinuri. 

Admlniatration. — Kola \» not olliciii). It may be given id the form 
of the Huid I'Straei ^^EJ■^ra''tu^n Kultr Fluidum). dose 10 to 50 
minims ('Kl!*>-^.*l], nr in an elixir. A verj iiM-ftil prepat-ntion, known 
M the t'onipoumi KU.tir of Kola ( ft7(>/r flW« ihmftoti/a}. vonU'tM 
kola, coca, and guarana. and may he given in the dose uf '1 dmchnis 
(9.0). Thii) forms a u-^eful tonic in some ease.4 of debility, particularly 
if arsenic is added to it. Thus: 



J 



Kli^. k-'tlip (iiiti|i4uiiui - 
5.— DeiMiUf oniifnl {^0) after niMlfl. 



Qiv. (130.0). 



I 



LANOUN. 

Lanolin, which is nrnciically the Adept Lantr Ift/drfinu ^of the 
r^. S. and li. P.. i» n fat derived from the wwd of the common uheep. 
nod is a whitish i^iilsisnce of jwculiar stability, very difficult of 
iponi&catioQ, and incapable of becoming rancid, (tnna states thai 
aintacuts of acids, hydrogen peroxide, and -xher substiuices may be 
madehy it. One };reai ohjecriou to lauolin ia m stickinoaa. which ia 
avoided by addinc oQe-third of va»eliD«. LanoUu ie stipposed to 
possess very remarkable neneiraiing powem when applied to tbe skin 
to coacH wticro much infiltration is prownt. particularly if it is com- 



X 



LEAD, 



286 



In^ nkb resorein nr sone similar modicameni. la itiiolf it has 
liitle cumtivv [jnwer. ami ifl but little bettor tliao lard, auct. ur aujr 
iiiimi)n fni ilk a huAis. for oinMn<>ntit. la some caaes, which axe rare, 
will cause irritaliou of the eluu. 




LEAD. 

Pluml'um, or Load, is n motal poesessiag more or less power over 
theorgBuism «ccordiog to tbo salcii which sro utuploycil. It is Dot 

Ccinl a« l«ad itself. 
PhTsiolofflcal Action.— Lead, in one of iU eolullt- salts, if applied 
a mucouM membnioe. by reaMiu of its aslriiigvtii ellect. proiluoen a 
bLaochitig which is particukrlj noticofrble whi-rc the rt;diiL-its of infiaoi- 
^nmlioD bus prfvioiisly ht-L-ii prpsent. It haw little effect when piven in 
|ft Hngle doee. except by an indirect influence over tlic circula.tion, 
nervoiLH system, or respiration. (For a de.scriptioo of the effects of 
^Jead in orerdows see " Poisoning," below.) 

^fc The Dio8t irritiint nnd poinoDou^ of the voluble snltH in the nitrate, 
^%o next the flubacetate, and the lea«t poisonoaa of the soluble salts is 
the acctuttr. 

The insolnhle a»\ts rarely cauoc acute poisoning, but freiiuently 

prodnce chronic pliimbisra. 

^m Acute Poisoning. — When the acet»t« of lend i« (nkon in poiMinnuK 

"toounls, it pn>dm^«< a sweet mptaliir tftwlp in the inoutii. followed hy 

lin in the epigimtnum and the vomiting of wliire. loilky-ltioking 

jiiidft or white curds mixe<l wilh food. The wliitp colur is iliii* to the 

brc^cDce of chloride of lead formed by the acid of tlic gantrio juice. 

The pain rapidly iucreufiea in severity, and diarrlioca due to ga.4lro- 
iteritia may be »et up, or, in other caues, obiitiuate eonHtipation is 
ent. The passages are generally black, this color being due to the 
?nee nf the sniphide of Tend. At thesanie tiin^' ttii- pulse hee'^nies 
Ipid. tenite. uud cord-like, but ufter u tiinL* wi-uk anil cuiiiprcs»i))le. 
'Tlie face is anxious and palo or livid. The thirst is excessive, ajid 
crainpK in the calves of the legs or niusmliir tvfitchings may ensue. It 
is aaid tliat the characteristic blue Hue on the gums may occur in acute 
poisoning, hut this is rarely if ever seen. If coma comes on in the 
course of acute lead poisoning, death is nlmoet certain. 

Tlu- irt-utiucnt consists in the wtc of the chemical nntidotc. a aol- 
nhlc Hulpbatt-. iu large ((uantitV; in the admini-xtration of (■miiiics, and 
the twe of the stomach-pump if the vomiting produced hy the drug is 
not anffieirnt (o rid the stomach of all the poison. Tho best soluble 
sulphalCA to employ are EpAom and Glauber salts, bccuuse they are 
always at hand, arc readily soluble, and. in exce»M. act as purges 
which will wash out thp intestinal canal, lint ap)dicationci should be 

» applied to the belly and feet, and the pain and irritation which are 
pre^^nt should be relieved hy opium. 

Chronic Poiioniug. — Chronic lead poii^oning is rarely pt-oduoed by 
L- sniuldc saita of Icail, nearly always being due to the inMiliibli- i<alt&. 
be •lymptoms of chronic lea'l poitkiuiug. or pliimbism. are as various as 




286 



DRUOS. 



it is possible to find variety in [hesigns of diMoseof ercrj kind. Tlicro 
iii DO train of syniptoing wtiieli iiiny nut occur, and tlie oeourrence of 
rare, urtoiiiiiIoiiK i>viiiptDitiM iti a given i-ase Ahonld at once bring to 
the niiuil of ttiv pbyitii^iuo tbi> tliouglit of lend pt>i<i'>ning or fiypUili^. 
Chronic poisoning oociirn in paiorers. miiniif'ftctiirerB of lead fi&fls. aud 
every one who is largt'Iv tbrown in nuitiici with the metal in the arts. 
It (it-curH from the u&u of bair-tlyes vvutuiuint; the ncetnlc of icad, 
frum (iriukiiiji wuU-r whieb has passed tlirougli new lead pipe, and 
even from the biting of Kilk threads loaded with lead lo increase (heir 
weight. Chromate of lend has Wph nsi-d tn color 8pong(^cake when 
eggt> were thought too dear, and liut< kilted tuaity persons. Millcra 
who have filled the holes in grindstones with lead have caused «id«- 
spreail epideiiiice nf what has been called " dry vholcriL," and many 

iierKons hare siifToreil from lead poiKoning from eating apple-butter 
:ept in jan^ glazed with lead. 

One of the mo-tt prninlnent, bnt h\ no meann the moat conntant, 
symptoms of chronic pluQibi»iu is bitat'eral ivrist-drop, due to palsT 
of rfie extensor iiiiisfle!' of the forearm. Tho short extensor of the 
thumb gunerally escape-* the drug's influence, as doe» a,\M the »um- 
nutur loiigii:!. SometimeH internal mjuiiit arises from paralysis of the 
external rectus niuaclefl by the lead. Another rery common »ymptom 
is colic centering around ihenmhilicnx and radiating through tne belly 
and loins. Obstinate conacipiitioiL often accompanies lhe».' symptoms, 
and the fmcvs. when passed, are white and clay -colored, owing lo a 
deficient sectretloo of bile. 

During an attack of lead colic the arterial tension is increased vorr 
markedly, the tongue is coated and whitish, and the bowelfl are obstj- 
nately confined. 
. If these early warnings are diaregurdcd and the cipoBOre to the 
lead is continued, eerehral »yniploms may come on. the result of 
enciphalopathia tatitrnma, or suturnine cet^britie. Saturnine epi- 
lepsy is not very rare. If corivuUiuns come on, death generally 
ensues. The convulsions in #omc ca»c« arc not due to a cerebral 
eflect of the lead, bat to ummia due to the renal changes which it 
has caused. 

Kcnal disease is very commonly produced by lcn<l. nnd it is not 
uneoromon for chronic contraeieil kidney to be found at the autopsy 
of a suflTcrcr from chronic lend poisoning. If a patient wit-h chronic 
lead pnisoning have a urine with a persistent low specific gravity, the 
prognosis 1.4 grave, i\s evidencing advancetl kidney involvement. 

Asthma due to the inhalation of lead-dust is anmetimes met with. 

The raott im/xirtant confnnirtorff eiudaicc of rfimnir had poiitonmg 

it a blut Unf on theffumtjutt teherf thi-y join thf tfrih. Its absence is 

,D0t n negative sign, however, as poisoned persons clcnnly In respect lo 

their mouths oHen do not have it. Marked esehcxia or nnicmia is 

commonly seen in chronic lead poisoning. 

.\fter prolonged lend-nmsnning the nerve-trunks are found atro- 
phied, aim finally changed into filirous cords. Anterior iruliumyetitis 
may be prL«enl, but true locomotor ataxia is rarely caused. If niaxic 
symptoms exist, they are most probably dependent on pscudo-tabee 



LB AD. 



287 



tm 

I 



^ b^ & plumliic matliple nearitin. nnd can he Hcparatcd frntn 
truv lobes dorwis hy the absence of sevtrul of the important true 
tabeiiv sympwius — ancti as slow onsn, the Argyll- RoTiertstin pnpil, otc. 
— wUile tbe pro8*DCO of murkcd wnstiag an<l loss of power, and gomo- 
titnes tendemewt over the iien'e-trutikM. poinf* to neuritis. 

In sonic cases trophic changes in the joiitis fimie, and plumbic 

nt i» not nir«lv seen, nr ev^n lead arlhralgift, with depo^lis uf iirntfji 

ihi» joiaii This coadition is due to tlip fact, pointed out by Gar- 

■1 aiid llaig. that load funnK iiipiuhihlt^ i^ills wilb tine add. 

Lead escapes frotu the body in the urine, thi' fivct-^. and all the 

setretioti*. ft iji chJeflj- eiiminat.ed by tlip liver in tlio bile. 

Treatment op Chroxic Poisonino. — The treatmeni concista id 
three olastted of reniediul mcnsurcit: Ist, the remnval of the cause; 
2d, the removal of the poi^ou in the body; and, '6d, the treatment of 
the lesionn pro<hiced by the pnitinn. 

Ill lead ct^lic hei'atic purgea. such as jalap and calomel, combine)] 
with opinni to prevent pain, are indicated, and nliim and npiiim or 
morphioo ar« said to be almost apcciScs, the sinni in 2-grain doBcs, 
the olhent in full amounta. In many iroscd purf;v& fail lu mora tho 
b-jvreU of a person sufferiog from chrrmio lead poisoninf;, and suceeed 
only when mrtrpbine is given t« overcome ihe intestinal inhibition 
prwJuced by the irritation caused by the load. 

In the cerebral inliummaiiuu of lf;ail-poisoiiing a hli.ster to the back 
of the ncok, revulsives, and a piiocttrpiue sweat may bp. resorted to. 

To aid iti the eli in in at ton of the lead, imlide nf poCa-^itiiu. which 
Ibrma double soluble salts in the tisyiios with the metal, is to be used, 
10 t»i 20 grain* (O.B5-l.y) three rimes a day. 

If progresiiive parnlviiis is present. Wood insista on tlie iitie of 
largp doses of 3trycliniue nt the :*ame time that the iodide ia given. 
The stry<-hnine should not. of course, be given in the »iino mixture as 
tbe io«]idc, 08 it ia ineumpatible. . 

Electricity should b« u»ed ss a remedy to restore lost function. If 
the farodie current makes tliR miisf.Ies contract, it should he eraplnyed, 
and, if nnt, llie galvanic current should be U-scd. Curiously enough, 
partial voluntary power aometiuies returns before the muscles will react 
at all to electricity. 

It ie said thab hatha of sulphurct of notaaeium do good in chronic 
pluinhism./iorfloDiices (160.0) uf t)iosalc to each bath, which is to be 
Itiven in a wooden tub. The patient should aftervranU be well soaped, 
then ihorouglily rinsed off. and rubbed down with a rnugli towel. 

At! the salts of lead are used for different purposes, the therapeu- 
of each one will b« lakeu up iteparately. 



Aoetata of Lead. 

Acetate of Lead (Plnmhi Aceim. U. ,S. aud B. P.). or Sugar of 
1, baa a eweet, nslhngent taste, nnd is soluble in water, although 
tho aolulioQ formed is slightly luilky in appearanre. 

TlmapeatiCB. — Aectato of lead may be ii.=ed, and is largeljr 
iplnycd, ID the fnllowing pill in the treatment of tcrout diarrhaea: 






2S8 ^^^ D&VGS. 

B-— PIiiniUwttteL fr. z) rtiSB), 

Pulf. upii ......gr. X laittj. 

Ciinipbum gr. zl ^2^}.— If. 

Fi, In jiil No. XX. 
Si— Ont' evenr fimr bnun. 

This pill muy nW he givrn in cneeB of dtfwnterf. 

TlJe iicetntL* of It-ail iu prujwrtioii of 1-8 grains (O.Oti-0.5) to the 
ounce of water luaj he usud uk an iiiji'cttoo for ffoaorrhiea. 

Lvaii iiuctatK is nlsn a uiteful nppliration for tbr (/ermotcfis prodaced 
by pninon ivv. as this "inig prccipiiuu-s tlit* Btieky, non-volatile oil of 
Uliu? tuxicodKUilroii, rtffDttj BtuJicd by Viaff. Tlic HCt-tute of K'lul 
slioiild Itc (iii!«ul\'etl iu alcoliu) in tlie proportion uf half a fcrmia tu tLe 
Ounvc (O.Wi-iHi.i)) ami used a.s a wat>h. After thiH> tiie- iiiMained part« 
should be treated by cuolin;^ applirntionj*, but ointnirau arc not to be 
usod, u^ tlioy di^?^>lvv llu' poifsouoiid oil utid Minrad the irritation. 

AdminiBtiatioD. — 'rht< 1i. /'. recngnixex ilie fnllowiag preparations 
of lead Acetate: PihtUt Plmnbi i-um Ojm'v, dw»e 3 to ti ^nun.* (0.1- 
0.3); Suppotiriiri'ii Plumb! Coinpimta. each Kuppoxitury conlainiini; 1 
grain (0.06) of opium to 3 grains (0.18) of lead acetate; and an oint- 
meot ( IfntfHtntum Plumii Aeetatui). 

Carbonate of Load 

Carbonate of Lead (Pfittnbi Cnrhonaii, I', S. and B. /*.). or White 
Lead, ia in^oltiblc. and is used us a coatioff or dreuiog for burn*, 
tcafiis, or uhrT» when rubbed up with linneea or other oil. or in ihe 
form of the ointtnent ( Cnffuenium Plumbi Carhonatit, V. A", and 
B. P.). If a Midi^ vnrTacc i^ covered with this oinltuenL, il may 
cause lead pnisonin;; by abaorption. 

Carbniiaie of lead may be ancd m the treutmcnt of ntnium in the 
following prescription : 

B.— PtumW <»rl>oii»t. 3j (-tOV 

Pitiv. nmvli S [*0)- 

X^ngwrnt. nqnm nm^ . 1} '32.0). 

Olci oliTip t^ij (8.0).— M. 

S.— Api)l>' 10 the inflftin«d bUo. 

Iodide of Lead. 

Iodi<ic of Lead {Phtmhi JodUlum, U. S. and B. P.) is oeoasion- 
ally fuiploywl iu medicine; the do»e is J lo 2 grains (0.03-0.1), 
Emplaati'um Pfumbi Todtdi, B. P., and ifngiLWtutn Phimhi I»didi, 
U. S. and li. P., are used as external astringent and alterative appli- 
cations, but are rarely useful. 

Llqaor Plumbt SubacetatiB. 

TAuiutr Phiiuhi StihacctatiH. U. S., and Lufm>r Plumbt Sub- 
arrtatu Forti», B. /*., or GouUrd's Extract, is u coloring liqatd, 
much used externally, when tliliited with laudaiiuiu. for ttpram*. 
bruinctt, and local inllan)mati<.<ns, under the name of " lead-water anil 



LEPTAXDRA. 



S89 



Uudatium." "L. and h.," a» it is ofion cnTled in Ute hospitals, is a 
Diwfu) nppiicntirin in tlie drrmatiti* pi'Oiiii(?cii W poison ivy. The 
pmfmrliuu »ltuu1(l be 4 parts of llie uiiJiltitf<I Ifml-wuler. ililulvil with 
Uj {lurts of tiiib-r, lu 1 i>f lauilaiiuui, but ttiiti is varied b» ilie inflani- 
tnacion or pain i* tlie inoiv s*ver«. Tfic official Iiq«or is hUd official 
in a dilute solution [ItUfUor Plumbi Suimfetntia IHIutui, U- H. and 
S. -P.). and nn such in too weak for ordinarv uhc. allhougti it is l'oid- 
Dionly emplorc'l. The Bln>Q^ solution should be used in tlit> HM'«>ti(;tli 
of from 1 lo 4 ounces (30.ii-l'20.'t) lo tKo pint (500 cc.) of wat<-r. 
This solution should never he omployed if the fWn is hmlten, »fl 
absorjition inuy occur, and. wlmt in moru itnportiiiit >til). the drug pre- 
vents h«nling by constringinp nn-l vtliitcning the od^c^ of iho wound- 
If MHnc Drcad-cnimlts be KUturated with the solution juKt named 
and applied to an inflnmed Brif^er. a feian ean often be abortpd In the 

.early stages. The official ilih)l<> solution id ]|!^'^llt itt* a lulion in fczfnut 
rbtch itches and tingles ntut ia not drv in ehnriu'tor. It H)tould be 
applied ODce or twice a dav. iiiid it it* well tu follow the iippli<.'tition of 
lead with a weaL sulphur bath or ulkfLline waf^b. (See Ecit-uia.) 

Lead-water ix alno upcful in vrurilus pudciiUi. The ceratt; {CWa- 
him Plumbi Svtin-fitatis, U. A.), the liuintent (Lhiimfntiim Plvmbi 
Suiitteetaitfi), and the glycerin (Gigvfrinwn I'iumfii SHhavftntitt IJ. /'.} 

.nay be a»ed for the lutine purposeM a» the Croulard's extract. 

Iiitliarge. 

Litharge (Plumbi Oxidum, U. S. and B. P.) \» used for the prcp- 
KratiOQ of lead plaster {Emplastntm Plumhi. U. -.V. and ii. P.). some- 
times Galled " Diachylon." and tht» is in turn eranloTed for the manii* 
GMtore of resin planter (-fi'"!/'/a»?''w"e ReeiaiTy h. .S'. and B. P.). Tt 
iji aliw ntied in the proparalion i>f ibe solution of Rubacetuie of lead. 

IJebm rwomraended forocMrf'np of thefcHati ii[i]dicatioii of eiiual 
parts of lead plaster and linseed oil, applied ou linen and wrapped 
■ro<ind the feet every thinl day. 

Nitrate of Lead. 

Nitrate of Lead {Plumhi Nitra»^ U. S.) is never used intcrnallv, 
but as a powder, in ibr treainieat of casea of om/rhia mafuinc and lu 
the fonnation of Ledoyeti's disiiifeetin;; Holution. The latter diB- 
colors the paint in water-closeta, di.iso!vea the solder in drain-pipes. 
Mid is not a good preparation for general use. 



LEPTANDRA. 

The medicinnl portion of Vn^finim uirginica '\* the rhizome and 
rootlet, from which are made the official exlrai^l of leplnndra {Extrac- 
turn Lrfitanilrv. V. S.) and \\\r.- fluid fxtrnel {Kxtraeltim hcptaiidrce 
Fluutum. V. S.). The doM* of the former ix from 1 bo IS grains 
(0.06-0.5) and of the Ouid extniet .0 to 40 mininiR (0.3-2.()). 
IS 



290 



pitves. 



Physiologic*! Action. — ycry few «xperinoeDts have Wcii made 
to the action of thin remeily, timl the onljr oneH «f importance arel 
Ihoec of Riithorfonl and Vignnl. u-ho fniinfl* that it [>09j>o«m« a mod- 
erate influeriff ill iucrL'a^iug the How of hik-. In ovi'itluee it cauBce 
violent piir^riiig. i 

Therapeutics. — In the ofHclaJ prepnrntiotis of lejitaiidrii, whicli arOl 
nnt ns Bctive os i» tho frosh drug, w? hivTC excellent sabslitntcs for 
caloiuci, Acroiiliiig to iiiu.ii^- rliiii^'inns. Tliuse who have used leptan- 
dni nUrt boliovf It ro ho of tlic grciitt'si valne in the indigestion nf the 
inlrstina) type aoiuetimes called '"duodena] atonv." {fiev also l*nilo- 
iihvltiiiO 1 1^« fotlowine pill is & tiood inothod of usinit the dnic m 



jinyUiii.) 
these i:ic»es: 



B.— Ext diiniK . gr. xx (l.S). 

Est kputndn gr. xz 1,1.3).— M. 

Fl- in pU. No. X. 
6. — Ono piU after racb meal. 

I'nder the name of leptandrin we have an impure rosin which is 
given in the dose of 2 to 5 grainB (0.1-0.3). An alkaloid of doublful 
existence is called Icptandriuo. 



LBVUIiOSB. 

TjevnloHe !.<< » monoEiaccaride liviet'tfr than oane-eogar. and if pare 
free from glucose. It is ii.'^ed in nu'dicinc s« a snbstJtate for sugar in 
the (liotvtic trfutmrtit of iiinbHrn, and ik ahnurbvd a^ leviiloi^e and then 
oompk'Iely oxidixed in the hody. Levulose may be takon by diabetic 
patient)^ in th<^ doFie of 1 to 2 ounces a day withont injury in man/ i 
in.slnnpefi, and tends to promote nulntion. One firm places il on the ' 
markut under the name of " Diabetin." 

LIPANIN. 

Lipanin is nn Artificially prepared mi-tture devised by von MerioK 
Bit u .-^uhHtitiilc for cod-liYcr oil. and entiitiittK in 6 parta nf oleic acid 
added ti> I0(* parts of olive oil. The adinntageif po.tsns,ied by it are 
its lack of disagreeable odor and casie and its ready eiintUification 
and digestibility. The coniinencing do»e n 1 dmelim (4.0) which 
may be increased to 4 dracliui;^ (IG.V). This mi.\turc hao been found 
of value in mout of liie waHtiiig digoaae* in which cod-liver oil is cm- 
ployed, and in the opinion of von Mcring it« eflicncy id grcAtly increaacd 
if the hv[H>[i[ioiipliites of lime ami midiuni are used ut the same time iiti 
the dose of lU grains (O.rt.i) three limei* a day. Iodine or ouo of its 
compouuib may aW be given if it is dei^ired to exert an nlierativa , 
influence. 



LIQUORICE. 

Liijnoriee {(rli/f^rhiaa, U. S., and Giyifrrhho' fiadir, B. P.) ii 
the root of Ol^cjfrrhiza tflahra. a plunt of Southern Europe and Am*. 



JjqVOR POTASS^-LITHWM. 



SM 



[t is used to inrroftge accretion in the mouth in the fnmi of a nnltd 
extract, and nkcii <listfnlv«d in natcr to forai » vt-Kick Torotlier Ani^s, 
jwriicuUrJv if iKpv have a <ti>a^rc»rable (aolt-. The powdered xoJid 
extract \» a very mil'l nnd uAcfiil lux&cive. 

AdniinlstiatioD. — Tlie solid extract (^(j-flc/nm Glyrifrrhizrr. U.S. 
and Ji. J'.) is used iu a do^c (LU,Ywhi:r« from 5 to L2*> ^aius (0,35- 
8.0). The pure exinci {Exfrartnm Giifryrfhint Purui». t*. 5.) is 
ii^ct] in the tn&iO quantitici^ as theordinnrv extract. Tho flniit t^xtract 
( Krtnicfum Qh/cyrrhizfr Flnidiim. V. iV.) or the H(jtiid extract ( h'ltrac- 
tttm Gli/rtfrrhiza: Liquiiittm, B. P.) in unt-d in ]■ to S-dnichui (4.0-8.0) 
di^oen. Under the nume «f Bn)wn Mixture or " Cotu|)ot!Dd Lii|Uonce 
Mixture" a very efficient expectorant fioliition is official (UlUtura 
(flyifrrhizfe Compoxita. V. S.), whirh mntninH as it.") moNl Important 
ingredients 12 j^arls of parejtoric. ti imrln \>( wine of antiinoDj, and 
S parts of RW«?<'I spirit of nitre. TliP dosR of Brown Mixliirp Ir 1 to 4 
drachma {4.0-16.0). Pulvif iJ^y-^yrritizir- CQmunfi'iv*, V. S. and B. 
/*., or com|K>nnd licorice powder, cuniains. arcording to the i'. iS. P., 
IK per cent, i>f ^enna, 23.6 per cent, of lii^iiorioe, 4 per cent, of oil of 
fennel. 8 per wnt. of waaheii sulpliur, und 50 per ceul. of sugar. Ac- 
cording to the S. P., it (should (^ontnin 2 imrl? of ^onna, 2 of lifjuoricc- 
rout. 1 of fcnnd-fruit. I of ^KuMiiiied sulpliur, and of sugar tJ parte. 
Tlic dose is 1 tu 4 dmchiiiH (4.0—10.0). It in lurjjely used its iiu 
effirtent laxative after childldrth and in casi^s wliit^h Ntiffcr from 
coaatijvatiiin rhictiy due lo th^j iniu.-tivil? eonseiiucnt upim being 
in hed. The iTvche$ {Trocfiinct Glt/fyrrliiz(F et (tint, I \ S.) cautmn 
grain (0,008) of opium and 2 jjrains (O.I) of extract nf Itfjtiorice. 
Hnitlly wi" havi" (Jlyi^i/rrhizhrum Anivwniirttim. U. S., which is the 
te«t principle of lii|iiiiriec r«'iKlcred soliihle and easily tasted liy the 
addition of nuiuionia. Tin* doM- uf ihb prcpanitlon is 5 to 16 grains 

^^lic ab 



ID 



LIQUOR POTASS.<B. 



mi: 



Liyu<yr P(4a9»<f, U- A', and B. P„ is a solution of potas»a contain- 
g about 5 per cent, of ptilusHiuin hydrate, and ia a clear, odorlesa 
i(|nid of cathitic taste and strongly utkuliue rL-ueiioii. It is u»ied in 
medicine na an antaeid and for the purpooe of decreasing the addity 
the urine. 

Id castw of intfruiviiii) toe-nasl it ia often used to soften the nail 
ior to packing with cotton or partial evulsion. Its dose is 5 to 30 
tniDimi* (0.35-2.0) well diluliid vrith warter. 



LITHIUM. 

Lithium ia utted in several formA, Int ita mils may be divided into 

En ctai^(.t4 — thofte which art at lithium and thQ.«e whirli act nn the 

eids fortuiD}; them. In the fn-st class «e ha.vc (Li; curbr^iiute (/•tMii 

rrioim*. l^. .V. and B. P.). dose 2 lo 10 grains (0,1-0. 65). thocitrate 

4thii Oitrat, U. S. and Ji. P.), dose 6 to 20 (jraine (0.:i-1.3), and 



292 



DJIVG& 



the cfivrvcisccat citrato {Litfiii Gilrat EfferveoctiUi U. S. and li. P.), 
An*p 1 to 4 (Imcliran (4.0-16.0). Tn the Bwionci cliiw we fiinJ the 
beti3i(jiite [Lithii limzom. U. S.). dose h to rtO graius ((1. 8-2.0); 
Lithii BrouiUliim. U. S.. dom- 10 l» 40 }'rain» (0.65-2.65), and 
Lithii Sali.-ylus, U. .S'., dose 10 to .'JU grains (0 65-2.0). 

The carbimate and citrate are luod in yoiit and rhruiuatoiil arthrita 
for the purpotte of etiteriii^ into cuinbi nation with tha uriu acid JD Ihr 
body lo form snhihle iiraU-s aiul piwciit drposiut in tht JoiiiW. Tber 
havK heon saiil lu dissolve eafculi. but this in untrue, though they 
are iMi>il when it \» desired Iq render the urine alkaline. Haig has 
pointed out tlut although litbia fonui' »ilti> with uric acid in the 
Icsl^Iuhc, in the hodv it bos n greai«*r aflinicy Tor the aind sodtutn jihiui- 
phatc in the blouJ. and practically leaves the uric acid to ilMlf. 
This is au important jjDint. since it proves that the large aaionnl of 
water generally taken «iih lithis hfis mori> to do with rclieTing 
gout thiin li;ui the lilhiii. The carbonate is nut soluble in nater. 
and should hv j:ivtii in capsule or froshly-niade pill, bnl the citrate U 
Bohihle. The i:tUi.T iimy i>o Hia.de from the fonner hy taking oO grains 
{3 ^) of the cnrbonate, i>0 grains (6.0) of cry sttal lined citrio acid, and 
wiirm ilisiitled water 1 fluidounce (30.0). Theaeid i<hniild hedi»»olred 
first, (itid the carl'onate adJe<l to th« solution. The solution fbnnld 
then be kept ht>t until efiV'rve-scence ceases. 

In ciisos ff 'ilahftet dcj^ending upon a gouty taint reniarkabtc 

results are said to bt- ubtuined from the u^ie of the citrate or carlioniile 

of lithium and ftrsenic. The tlo^e should be Jj of a grain (0.002) of 

[arsenile of sodium »nd 1 grains (0.65] of the litbiuta salt three tines 

a day. 

It is worthy of note that in some cases eitrate of lithium vrill di»> 
order the stoninclt and jiroduce voniitinj; ; and overdoses produce gvtt- 
end relaxation of the system with a sense uf feebleness. 

(For the iiec of other salts of lithium sec the articlce on the Dro- 
Uiides. Salicylic Acid, and Benxoic .-Veld.) 

(See also article on Mineral Springs.) 



LOBELIA. 

Lobelia, V. S. and B. P., is the leaves and tops of Lobefi'i inJlatOt 
a common weed of the United States. It contnins an alkalnid, tobe- 
line. »»■! lobellc acid. 

Physiological Action. — When taken in overdnae lobelia causes eme- 
ftis. intense |nv-.^tration, a fcvhle pulse, pale skin, livid face, muscular 
relaxation, and a culd sweat. \ iulent purgiiij: maybe present. It 
, ia said to paralyze the motor ncrve-trunkrf, and it causes a fall of 
»rt«rial ]ires*ure. followed by a rise, the latter change being due to 
the a^iphyxia which it finally prodnce^*. l.'ltimately it pai-alyxes the 
respiratory centre and tlic ])eripheral vugi. The treatment of the 
i;poisi>ning is to administer opium to stop irritation nnd vomiting, 
to give alcohol and aiainonia tu support the heart, and iho us« of 
•external heat. 

Therapeutica. — liobclia is used chiefly us an antiagthmatic, and has 




LYCETOL—LYSOL. 



293 



been e<|mitly praWd and condeinnvd by eminent autboritien. The 
r«t3on ft-r this Hm in the fact thai it is cenerallv useless in atthmti 
ai)K-«s jiiven in almoxt poii^onous do«e. AVood tenciicn that it sliould 
r»rclv if evor be u*i-<l, booausc of it* pnisonou.* «fl>cts even in dosea 
medi<;iiiiillT active. wLIIk Syiliiey Ringer «iy9 that the drug i« urro 
neou&Ij thought to be duDgcrouu. In •utkitia both (if the ga-stric and 
bmnchiAl fnrin lobelin is uiidoiiUedly nf acrvivc. In botiiu c.aAo> it 
liiiLo as aigoally a? it succeeds in <)lhei's. If the asthma h due to or 
waociftird viih cardiac di!>«:i^i-. lobt-lia should nevi-r be employed. 
The lir >g should be taken in the du9C of ^ n drnchm (2.0) lo 1 ilracbin 
l4.U) iif the tinctiire at the HrslJtigii of an atlJii:k, or in lO-miuiui (0.65) 
dosea every fifteen minutes until distinct nausea oecurs or relief is 
obtaiDed. If the heart is feeble, its ii8e h cmitrnindiraied. 

In afrtniV ••onutipiitif'ti with great dryness of the ftecoa lO minims 
(0.(j5> of the tim-iurc of lobdJH at bedtiuR- urc often of service, 
particularly if it la eombinod with cascara sagra^la. {Jiee Cascara 
ftagrmlii.) 

Administratiffl]. — Ijobelin i-* given in the foma of the tincture ( TVno- 
turn J.ob*:lia; U. S.), in the dose of 10 to 30 minims (O.lJo-'J.O). or I 
ift 2 drachms (4.0-K.O) as an emetic. The vint-gar {Aeefmn hoMif) 
ja no longer ollicial. but ia given in tJie dose of 2(1 to 8U minims (l.tiiV- 
i.fl). and the fluid extract {Krtrnfinm f.nMite FiHuJum, U. S.) in 
ibe di««; of 1 lo o minims (l).O6-0.!i'"i), or iis an einetie \n the dose of" 
Xb tuiiiims (1-0). 

Ill thit form of the infusion lobelia i:t useful i\a \ lotion in tlit^ treut- 
meut of the iti-nnutiilH produced by poison ivj-. The proportion used 
should be ftn oimoe (''(1.0) t/.i the pint (^ litre) of water. 

The preparation of the B. P. is Timtttra LobttuF .Kthi-rta, dose 
10 to 30 minim» (0.6r*-2.0). 

, LYOETOL. 

(See FiPKKAiiNK.) 



LTCOPODIUM. 



I 



Lyeopodium, U. S., is & pale-yellow powder derived from I^co- 
jxnUitm clavaUim, a »peeieH of nicBa. It is used by piiftnuacists ns a 
povder iu which to roll pills, and by physician.'* and nuntea to prevent 
the intertrigo or chapping »/ the *kin of infants and adults. 



LYSOL. 

This is a preparation made by dissolving in fat and saponifrine 
with •Icohiil thai part of tar oil which boil.s bclwi-cn liJO* and ^1)0^ 
C-, and is a brownish, clear, Mly fluid. emcUinfr p"mewbat like creo- 
sote. It in UAed for ilie »nme Hiiti^ieptic piirpoaes as creolin (itee ('reo- 
lin), bat p(]f»eAies the advantage nf forming a clear, soapy lluid wlii4i 
mixed with water, in which iuittrumeuts can be acl-h. If small instru- 
tnenu are osod, the 84>lutioii is so aoapy that it rcndcrsj tbem too slippery 



294 



VBUQ3. 



for ready uac. Ttioae who have umviI lyiol claim that it does not affect 
tlie tikiii of the operator's haml« except to rendtT it soft sud flexible. 
Esppriinnil nhows it to be possessed of mftrkod antiseptic power, and 
it is far It^t poisonoui? tlian carbolic acid, t'sed upon mucous mem- 
biuues. a solution of lysni should not be stronji^r than 2 per cent. 

MAQNESIA. 

Magnesia is the oxide of ii;a);nchium. nmde by expoHin;.' tlie Mr- 

Imiintc of ma>;JiL-^!uiu to a red lieat. It 10 used in tiic form of the 

light majtiiesiik (Maijne»ia Lnm, B. P.) bk & diistiiipi-powder. Tlie 

.troches [Trfii'hittri M<t<rrni'la-) vb.c\\ wnlain 3 grain* (O-Oirj). Moj/- 

letia Piinderona is official in thw B. P. 

Magnesia is an antidote tn nTvuiiic. and when pmployed to pPMip- 
itate a Roluble preparation of imn it forms the Anttdx^tam Amemin 
{Ferri O^idam Hydratum cum Mat/netta, V. A'.)- 

It is iuiporlnui that the student should not coufuse magnesia and 
magncsiiiin. The finit is the oxide of Ihc second, an<l is somelimw 
called ealdned mapiejiia or "Iluabaud's Majiiiettia. " Magnesia is of 
little vulue in iiiterniil medicine except as a feeble antacid. Magnesia 
and the carbonat43 of magnesium may be used interctmiigeably. 

MAGNESrOM. 

Magnesium is a metal never used as such, hut always in the form 
of eno of its sali«, which arc- ihc sulphate, citrate, carbonate, and 
Hulphilc. The sulphite m a naturnl salt found in nea-nater and io 
caves or in the water coming from the latter. The citrate and car- 
bonate are derived from the »ul|ihiiie. The carbonate is iofioluble id 
vatcr and alcohol. The others arc gohible. 




Ma^esium Carbonate. 

The Oarboniitc of Magnctiura {yfagnrtii Carhonat, U. tS'.)is official 
in the form of llie hcsivv and light powiler {M'tffn^m Carbonftn Pqh- 
d'-ro«U9 uiid I.cri». B. P.). and lliese two suKstnm-rs do not differ in 
respect to their efT&ctii. The light luagnettiiim is never given internaltr, 
bcmuae of it« hulk, but it is uaed as a diislitK powder in intrrtriffff, 
and ill the form of white cubes nihhed on tne skin to prevent ex- 
cessive pcrspinttioQ aud as u o»<iuielic. The heavy ma^m-^iiim is 
Uriod as an anlnrid, and is not, a>4 hiM been thought bv «ome, in 
any »eii?c a laxative, iw it p«sae."weH no such power. When the etom- 
ach or iiitvMtiiies contain muuh acid from fermentative chnngeH, these 
acids may. however, unite with the mugnesiuin and form a slighlly 
laxative salt. 

Is tick hfadaehen due to great gantric acidity carbonate of magne- 
iium is often of service. The dnsp of the carbonate is from .1 to 60 
grains (0.3-4.0) It should not be used constantly, as there \b daug«r 
thai it will accumulate in the intestines. 

Liquor Matpiftii Ctirbonatia, B. P., is given In the doM of 1 to 
2 ounces (SO.0^0.0) as a laxative. 



Maffneeium Citrate. 

The Citrate of JIiif-iK-^ium (J/ui/n <■»/(' tVf/-cw) la a much more irri- 
tating purg« tliau {lie »iilpli;ite. but it i» more ugreeaMe to the taste. 
It i* ufficioi iu two foria*. 'Hiv wf wIiifL is tin.- solution {Li'fuvr Mag- 
neKJi C'itratis. L'. .S'.). wbicli it vtfvrwucvui ami sLoitlil never bt- used 
Dtiic6« frusblv prepared. It is made hy a^I'linj; licarboiiali.- oT potM- 
Hium to u. Nvrujiy snlutioii of tliu citriitc of tna.^ncs:um coiilaiiiing an 
excoBS of acid, and corking tbc bottle ttghtW, tbc cork bi'liiv tied 
flown nitli X Htron^ ronl. Care hHouIiI bi' taken that tlie bottle is & 
strong oue. tm the tlevelopnicnt of lAr;;« aiiioiint.>< of cnrboiiic tit.-iil ^iis 
mav burst it if it be weak. Tbo dose ia Liilf to one bottle, wbicli 
c<>iitaius about V2 ouncei^ (:}4K> cc). It st* too irritutiug tu be usvfi 
nliere iuflmuuiatiou uf the allnieutary canal vxiBts, but is UK«ful iu 
the Ireatment of sick and bilioua headache. 

The Crmnulatwl Citrate {Mat/netil Clfra* Efferveteeiit, V. S.) is 
\e«e ngreeaMe to take than the solution juxl named. It should be 
dissolve"! iu water, about 1 to •! drachms (li'i.O— 4.5.0) of the salt beitiu; 
nied in each dose, and swallowed while the solution in eflTervoscing. It 
nust be kept in bottler tightly curkeii. 

MagneBium Sulphate. 

Sulphate of Magnetitiiui (Mriifninii .SWfifuis, U. S. and .B. P.) is a 
white granular |K>wder of neutral reucliori and salt^ liiBte. and is sol- 
uble iti water. It in generally kiionn a.s ''Kiiltt^," although in Kome 
|mrtit of the country this term also includes the tiilphate of Hodiiim and 
•■ Hochelle Mils." " 

According tr> the ttludies of Hay and others, yulpbate ol magneuium 
is a. purge by reason of ita absirnriion of water from the inteetinal 
bItKK|.\-e!M<els. All Nlrnng saline solutions above the strength of 7 
per 1000 abstract liijuids from the tissues when brought in coutact 
with theta. The rocolleetioti of these fuct« readily luakes clc^ar the 
mode of action of mogncniiiu] »ulpliate. Whenever a thorough pur- 
gative action in rei|uired — that iH. wliere deplRtioii of tlu" intestine or 
abporptinn of exudatioue i» to be attained — the lutignesiuiii ehoiild k« 
given iu coiicentrak'd form, so as lo make its solution a^ of high a 
IHirceutage a:^ pD9.-*ible. 

Magne#iuni sulphate lusy be given by enema with the double 
purpiMH! of unloading the bowels and acting as a depletant. The 
beM mixture for this pur[i<>N« seems to be tbnt of Watkiii^ — ^namely, 
2 oimces (tJ4.0> of luaguesiuui. 1 ounce (32.0) of glycerin, uud 4 
iiune«« (128.0) of water, 

Iu ca*vs of Jrvj/»t/ tbc ukc of concentrated solutions is pa.rticularly 
nuct-jisarv if free watery evaciintions are desired, and from 1 to 2 
ounces should be given before brenkfa^t or on an empty .stuuiaeli in im 
tittle water an will disiolve the *ah. (See Dropsy.) (Jeiierally it is 
better to give this quantity divided into Hmall doecH every liftccn 
miiiutea (ill it is all taken. 

in tHteritin and p^ritonUU the use of magnesium ia widely recog- 
niied 8K a proper measure for its depletant effects, and it is claimed 



296 



DRVOa. 



to bci better than ipecac ia ibe treauneiil of trofiical dt/aettterjf. 
Wlu-u uivd fur the fiLtU-r purpose it should be ffiven in dracbin (4.0) 
driM's or a saiuraUMl xutulion with 10 to 1:'i drnji^ (0.65-1.0) of nrotOBtic 
Balpburic- acid everj two hours. Tlie sulpliBlc itt nut irriutiti^, aud 
Diuy lie given freely wben influniiiiniioii oxists. (See Peritonitis.) 

It Ibrm^ ft Urgo part of moKt of ibc Dutanil purgative waters. 

8oiuvliiiii« sevt'n? attBcks nf rpnal pain will occur in niidille-«pe<l 
periioaa wbo have freuucLt attacks of gravel, ao'l tbe urine will be 
found to contain oct»ric(tral cry^itals of calcium oxalate. A uxcfnl 
trfutmciit \a to give i t« 1 drnchiu (2.'>-4.(.') of iiiagnii^iuiii eulpbate 
witli i''|Uiil p»rtM of citrate of potmyfium twice or lliriw u dav. iu watt-r, 
for a c'iiit<ider«ble period of time- 

Tlic ft. I*, coiitiiiiiii an ollieini nropnration cHltpd .Viiffjieitii Sttlphim 
Effene^crnt. wliicli ia gruiiulatt'O, and is given iu tlie dof* of 4 to 8 
dracliius (lli.O-3iJ.O). 

MAMMARY GLAND. 

Tbe extract of msmman- plainl of llie common sbfep has recent^ 
conK- into genenil nse in the treatment of njwcs nf suhinfi/lufinn of thf 
iittTUM and for tlio piirjjose of arrti^iiug metrarrhigia or other forms 
of loM of blood from xhv iileniji. It ticeriiit U\ exercise a gtx)d effect 
iijum tlir bleeding ntid prowtli of miuiv uterine, fibraidti, but oaiinot, of 
ctnirne, cure the condition. Tlie doao of extract «f niHniuinrv f'liind is 
/"» grains tbree times a day. or, if hemorrhage is free, iiw rnncli as (i doses 
-B dav i"«y I"' used. ((verdo«e« ffiusc cardiac pftlpirntinn, but moder- 
atf flnpes aeera to fjivombly affect geiienil nutrition. Bleeding from 
goft. fibroids i:* not do f&vurulily affected by its use as thai froiu hard 
fibroids. 



UANOANESE. 

Hiingnnnm. or Mangane-ie, is oificial in tbe fj. S. Pharmaropceta 
in tbi- t'unii of tlie black oxide (Maii;jarti Divxidum) and tbe 9ul- 
phalo {Mangani Salphnt). The first of these, under tbe name 
binuxidc of manganese, liae bot:n higblv praised in ameuorrkiea 
dependent upon functional disturbance und aniemia. The do»e is S 
to h grains (0.10-0.3) three times a dav. in pill form, and the drag 
fiboutd be tak«n for a few davn before the expected or proper date for 
menstruation. Tbe sulphate is rarely if ever employed, but may be 
tried in malarial jnitndiri'. The dose is I to 2 grains (0.05-0.1). 

MANNA. 

Afmiui, U. S., IB the concrete Mcobnrinc exudation of JViieniiM 
Or*Mf, a tree of Europe. It occurs in niundisb tnaatwa of varying 
■iac looking 9omewbat like a gray-colored gum arabic. It hait a 
gBWt taste and odor. Sometimes the ta.ste is a litlte bitter. 

B. — Manna is the most feeble of the laxallx-ea, and 

sli^t flnlulencu lU anmu pernons. In children fed by the 

ii tlx m<ittt fre([Uent dUonlers is oh»tmaU cotuaipatvm^ and 



}fA TRICARIA—MERCVR Y. 



297 



T iia relief I m 2 ilniohnia {4.0-8.0'^ of the swwt Taricty of iiiuuna 
muv bi> dissolred in the milk of each bottle. Wlien gi%'CQ to older 
childrut] <ir adults, nuLuna im alwaj'^ cnmbineil wllh nthcr m«ro [inwirr- 
fiil drugs, cbic&v '<• cover iheir taste. It may bp cnmbiiii'iJ with 
aclvauisge with rhubarb and Benna, and it entci-s into the official 
Jnfutuin Hennn ConwQsitunu V. H., tlic dueo of which is from 1 to 4 
fluitbunces (30.0-1 20.0). 

H MATBICABIA. 

^f Mcrtrieana, V. S., German Cbaoiotuilc, coniiislj tu the flowcr-h,eadfl 
oT Matricaria Chamomiita, a KunijifJin pliuit. pr>.<uieiHiiti^ mild bitter tiniJc 
properties when given in moderate do^e. In larger amounts it acts aa 
an r.metir and anthelmintic. In the form of an infiDdon of the strength 
of 1 to 2 ounces to tlic pint (;JO.<)-60.0: j litre) it has been largely 
used » a diaphoretic, tua, in huuiU dosw. tu prevtiut calic in teetkiug 
vhildreu. 



MENTHOL. 
See Pbppbkmiht.) 



MERC UROL. 



kiirol is a (•hemiL'al compimnd of mercury and nuelein, ami 
1 active germicidal power over pyogenic orj^anistns. It ia 
said to bo particularly destructive to the gonocucciis and to bo of value 
in both (/r,Hoirhata mid f)utitirihiri.il uphthalinia. It does not eoagulato 
albuiuiu nor act as an irritant, and is n-adily aolubte in water. In 
' making the nolntion it should be placed on thesurface of the flnid, as it 
! diatolves best in thifi way. The xolutinn for gonorrhrea »hould bo of 
the strength of } to I per cent. In very obrttinatu cases m atrotig a 
solution as 2 per eenl. may bo needed- It ia best given by injection 
into the urethra in normal ^alt solution. 



I 



MERCURY. 



Hydnirgyi-utH, U, S. and B. I'.. Mercury or Quicksilver, is a 
heavy fluid metal of a [>eculiar color and a]ipi-nnincc. An melatlic 
laerttury it i.« u«ed in medicine in the tbriu of tht- omtment. the planter, 
gray powder, antl blue masa and the iimiffieial gray oil. 

Plurtiolofical Action. — When mermiry is taken into the body in one 
of its insolubto mid luibl prt^'pnnitioii.s. it niuy eiLuse no evident-e of its 
PTMence until by fn?ipient and o.xci-Hstve ilo^igt! ihu Hy^teiu in geiiemi 
begiDS to feel ltd irilliieiice. Thfl tir.'^t evidences of thi.! are to be found 
in the moQtb. and cunxict in lendernesH of the teeth when tlie jiiva aro 
Knnly and ijuicklv closed, ffctiil hronth. »puugiuct» of the {rums, 
which finally may bleed at the slightest touch, swotliug of the lutigue, 
»D<1, mojHi up'mineut of all, t-xcesMvn nalivntton, a eomlilioii some- 
timeK cille'I ptyali!>m. If the use of the dnij: is persisted in, all 
eae Byiaptoms grow worse. Eczema, anil finally sloughs of the chin 



298 



DRVQS. 



and cIiHt dovelop u the result of the constant dribbling of xaliva' 
and tlic direct ilcjircssing effect of llic drug ou the lissues. Tbc teeth 
drop nul, the inaxilkr^' bout'S iindiTfio uocrosi*. and amid a general 
ineltin;; down and decompoaitioii of the liiunied tlio patient dies. The I 
blniid 1." affected, iinil becniim: vrrr thin, Suid. and potir in it» corpc 
cuUr i-lemcnts. Thfse symptoms cn^uc on the u-se of uiercury lo 
cuntltiued ovepdusca, and rarely fultow exposure to the drirg in the 
processes of tiic art*. In tht- arts — us. for in*tancf. in tiie njaking of 
looking-glasses — workmen ari* ofti-n aff«^cted by vnrioua (raitm of tiyiD|>- 
tonis varying very widely in their course. In eome cases the nervous 
gyxteiu beconiott chiefly affecied. Trfiiirtra of*&H mrtti atise. paralysis 
ogitaiis is devi'lijped. and the rcstilta of peripheml neuritis ensue; 
but it is worthy of iiou> thni the ocular tuuscV« are rarely iurolved 
in luercui'iid tremor, while in di^iM^rminated sc1ero«iii nystagmus if not 
rare. Similarly ihe tremors of inerrurini pni^ionin)^ oft^-n aflVct the 
bend and neck' ikionc. while in paralysis aKiinns thi» is rarely the 
case. Oliort^n of^en comes on in chruuJc merenrinl puiitouin);, and the 
occurrence of choreic movcmcat* in an adult should oaui^e in'iuiry a* to 
any possible exposure to mrrcnry. In otht-r cast-s hrownixh discolor- 
ation of tbc skiu, resetubliiig Addison's disease, appears. Jtliodncss, 
desfuees. aenmry di^tturbauces, nuchas hyperse^tbesiaand aDtesthesiu, 
may be developed, and localized wasting of muscle* or groups of muscles 
may assert itnelf In Htill other cilsch thubloud bL-comcsimpaveri!ihed 
and luercuri&l cachexia i9 developed. 

It i» worthy of note that ehihlrrn under three years are rarely sali- ' 
vated by the uije of mervui-y, but tlits is no reason for tising thi$ drug 
carelessly in thi^ clam of caitex, since tho other cLanj^ in the orgim* 
ism iioroVtbelesa occur. 

Ani'ORPTiON AXD Ei.iMr NATION-— The rapidity of absorption and 
elimination of meKury depends to a very great extent on tlie variety 
of it which is given. The drug in some fiiruaa is jto insoluble that 
very great delay in its elimination must often encne bL-cituse it is 
slowly absorbed. Several opininn-t are held a,s to the form in which 
mercurv i>t absorbed. It is n.«iianT taught in Fran<re that the 
theory of Miahl is correct: this is, that tho niereuriat preparations 
are lrnn»formed in the stomach and intestine into the bichloride, 
wbirh in twrn unites with llic sodium rhioride in thp blood and 
cironlfttea a-n n double clilori*!^ of mercury and bocUuiu. In tier- 
many it ix taught tLat it Ibrin.s an alhuminate of mercurv and no 
eirctilatcs (Henoch's theory), or that it forms a chlora-atbuminate 
{Voit's theory). All these theories ii.<4 to its absorption are opeu 
to grave criticism. As to the elimination of mercury, it is known 
to escape aa an albuminate by every excretion of the body — the urine, 
feces, swe&t, toars, milk, and saliva. Altera sin^ledo<t« the ilrug begins 
to be eliminated in about two hours according to Rya.>von. an<l it is 
entirely gotten rid of in twerty-fuur hours. If, however, the daiwi are 
repeated it gradually accumulates in the body, and is so slowly elimi-l 
nated as to remain for almo^it indefinite periods of time, and 15 found 
deposited in all the organs. In otlit-r words, the doi*es of mercury 
ordinarily given are always large enough to produce cumulative. 



MKRCURY 



299 



^ffect8. Thill* wliili- Biilzcrami Klmupku ngri--« wiLii Bynssoii m id 
he rapiditv of pliininatiun uf :i xiii^le tioKu, tlii'y fiml rrwiii nii expori- 
loQtuI »tu<ly tiiiit the amount oT mcrciiry whicti van Ik- riiminnteil by 
ihti kidneys fnr tn»ny nook.>i <nhou tlie hmiv ik satiiratM with the 
Ini^ '}K only oiit-'.Hlxti.-ODth of u ^uia a iluy. It iscviileiit, therefon;, 
titnt after » full merouriul cffti-I is |)rodiici<(l it is welt to r)ocreesi>, ns 
Id lutist HTpbilugr»pLers, the dose of iiR-rcitry and givK crnly enuugh 
maintaju thu effect. It h also (•rid^rit tbut the plan uf using 
ilide of polasiiiiiiu ctitt noM* am) n;;iim to a.id in the eliniitiatioit of 
lip r(>si>ti|[il iiicrt'im' i-i ailvisahlc. 

Th«rapcutlc<. — 'I'hc i'tuploynx^nt of incTvury in medicine ccDtrcA 

Kroniitl four gn-al puiiils — vii. ; lot. its valiii? in i^ftphllU and kiiidrt'd 

ites ; 2d, ita use as a puftje ; Sd, it« pow«r as an antUeptic and <}crm- 

it: and 4th. its action a^i an antiphlotfintu- : the finit and loiirth 

'^points are fulfilled by all the inercurr milts more or less perfectlv, the 

Hxroud dblv by blue tniL&s aud t'JilrtDiel, the third by ibi' bicbloriue and 

biniodide of mercury. 

Kii. 4'(. 









"S: 



■ ft* eifmiirtil nimlmiluii*. Thin Inini- it idh<1v •<€ wliw iptiiu. itnil t«Mmbl«<llHiMtMy 
iHiiip uf inlDrn*. Ihrrvbjr Kuunlltiii uvaivul tUiliKn txI'IoI-iIIK ••! Iti<- aU-nholIc viipnf* 

Ab as A)meypmi.lTlc. — In »ypfiilis mercury is to be given, not 

Secau:*e ihe patient is in this nr that stage of tb« diaeaae. but because 

llthy C'tiidilions prencni call for its etiiploymeiil. Many wrilL-r* have 

LjiiaiHleii that it ought oiily to hn employed in the seeoiidary f4l»g«-», 

»nd, while this is, as a genoral rule, correi't, certain conditions may 

[rail for U at any time. 

Of «ll the preparations of mercury userl in the troatiiient of Jiyphilin, 



DRUGS. 



the protoiodide ia the moat popular, and deservedly- "fco. (See article oa, 
Sjpliiliii.) 

Mercury is often administerod br means of Aiinigatiotis or 'mliala- 
tioDR boili for ibe removal of lucal and gcnernJ Aj^tihilitic flisorclem. 
Thfi best apparatus for either purpose is one devised' oy Bumslead, and 
it is both simple iind inexpensive. It consUls of a alieet-irou cup *o 
bwit ttiat the bottom of tne vessel, instead of being flat, project* up- 
wanl into tlie ceritrw of llir cup, tbcrcby formiug a raised wntre wiih 
a little ditcb about it. The top of this projection is flattened, and on 
its apex is placed the calomel which i» to be sublimed. The sur- 
rminding ditch is then filled with hot water, and the cup placed over 
au alcuuol tlauie, which diauugagea the vapor of tlie calomel and 
water. (See Fig, 48.) 

When inlialatinnit are ii»ed the face should he held Home six or 
eight irchea nwny fri>m the cup to permit the fumes to pass through 
the air. Tudtir these circumatauce!* tbe ijiiaalit^v of calomel u»ih1 
should not exceed 4 or 5 grains (0.3). and the mmith should be rinsed 
out to prevent mercurial NtomatitiH unles.4 a Incnl actinn on the buccal 
miicoufi mcmbnine \s dpKired. Not more than eight or ten innpira- 
tJons should be Taken at one sitting. 

[f general fiiiiiigntions arc to be praetised, the pntieni places (he 
lamp and cup with 30 griiinM (2.0) of calomel on it under a chair, on 
which he wita wrapped in a heavy blanket, and enbjecis himself not 
onlj to ib«ie fume-t, but to a honie-macle Russian bath, which relaxes 
bis skin and aids absorption. (See Fig. 49.) 

We lieliere that the nltironte conclusion nf the profei^ion in regard 
to the hypodermic injection of mercurials in fvphiliii will certainly be 
identical with that governing tliiti use nf (juiniue lu uialari:il fever. 
There can be no doubt that a certain uumber of inntnuceii do ari»c in 
■which, bj reason of severe infectiou, susceptibility of the patient, or 
inability to take mercury by the ordinary means, hypodermic injec- 
tions are ahuolutely necewiary. In the sjinie way that we give qui- 
nine by the mouth, the rectum, and hypodei'mically in pernicious 
mnliirial fever, no do we give mercury by the nioutli, by inunctions, 
bv cublimation. ond by the byjHKlcrmic needle in mulignaul syphilid 
The reasons for believing tlial bypodt-riuic injections of mercurials 
are not to be resorted to m the routine treatment of syphilis are acT- 
eral. In the 6r>t place, all fonus of hypodermic medicniion pa<»csa 
j^diaadTantages not posKcssed by the use of drugs by the mouth. There 
always dnnger of entering a vein, of proinicing au abacesa, or of 
cau-'<ing lociil pnin. When murcuriaU are so employed, the danger 
of abscess, of pMin, or of mibler inflammatory nianife^iations is 
greatly increased, and the presence of an indurated >ip()l whore the 
EypiKlerniic injection hi^s but-n given proves that it \f not the best 
form of mediealivn iu syphilis. Uf the mercurial preparations which 
may be a'lmini.stered bypodormically in syphilis, tlie two which snr- 
pa«a all others are undoubtedly the hicnh.rido of mercury, in the 
dose of ^ grain, dissolved in 10 or \») minims of distilled water. eviTV 
second or ibinl day, or gray oil {0!ruin C'lnn-e-um), which was lir!<t 



XBRCURY. 



301 

(See Gray Oil, noder 



infndtiMd teto medieino by Lang of Vienna. 

Mcrcunr.) 

In all cases the injection ehouUi be pivenelowlv nnd dpoply into some 
portion of the bod; in which the tissues arc luosv, tt» the buttuck or the 



Fia. ■»». 



/ 



A pitttnt prapiuHl f>T the um -^r mcieiirial BiibHcnjidnti* A bl4Dk«t havit^M '^^n [>inn<'4 
UcbilT arouiKl tlir nMk after tlir |«nciic Ix ^ttlI1(>l■ll, the rtitnlntCuT *litjw:t ct hin rti-I ib 
puHn under hU Plisir aiid tlm cnlnini'l plni'pil im tlu' I'fiiiml dltc nx itiou n In )hi' iIIiih 
Intltriit. WiiMT k» 111 Ihtt Ultlc ililrlt ori'iMT)*! it <4n>t 411 filcohol l^iiip unclpr It, T\k |HLIfOrl1 
tliuiilit iH-'XiYvna nil). warm Imili uvtorrlinnil tDrloDitvnnil prcpKri'lhn*klnlbrat»iir|itli>n 

broad of the bnck. and thi: skin of tho purt where ibc injection is tn he 
inii«L« should be carefully vroshcii attd etcriiized by the use of f|;reen 
suAp and Alcohol. 

The intravonoin injection of bichloride of mercury has been proved 
fto dangcroMii in* to be prnperlv considered unjustifiable. 

it 18 10 bo roc»ll<^l thnt the herpes Hecn in advanced evpbilitjce ia 
tuunlly made wnrse by mrreury. AIbo, that hftniafhe diie to sypliilis, 
if due to ft cerebral jrrowtli, in benefited by merenry; while ihal due 
Ui anipmia and debility complicating sypbilift ia increased hy the use of 
Uiv drug. 



3(V2 



DJtrns. 



As A PfRflK. — The emjdovment nf mercury »» i» purge i»r liii[iiiiv«| 
baritif; a itpeciil action on the liver ia consranflr resorteJ ro. The iwoj 
pre pxnit inns used are \i\n« mam hikI criloiitel. lint, the latter Ik morej 
activf. TIh'V both c'fiiiflc soft at watery stools, according tn the dose in' 
whirh tlie^v ore given, but ttio liluc muss is ntrety, if ever, lucd except 
for the pruluction of a laxative offect. 

Muc-li diHCua^iou liiui arbeii tts to whether uiereurv aflevtH the liver, 
mill wlu-rher the peculiar p-eenish or I) rowtiiali -yellow stools produced 
by it lire tlup to the presence of bile or niercnry. 

If there \* one point tinnly tixcti io tW mind <>r the average 
|)ractiliuuer uf iiiei^IiL'iuo. it is llini. the mild cliluridc of mercury 
incrca««]« the t|imnlitr of bile tn tho intestiU'O. If sticb a believer 
ia iiuufitionoJ bm to nhcthcr this iiiRrt'ascil amonni of biliary lluid 
iH due to a true increase in )tut-i*eli<>n nr »im|)ly tn an incrcatie in 
the flow of bile fmiii the gall-blndder. he will either state ihat be 
\9 iitinblc l» iinswor the ijiiciitioi] nr ibai he believe* thai it is nn' 
increaaed .sfcrcliim. 

Pmctitialiy, ilie pouitioa of ibe pmfessiou in general in regard W] 
tbe pnrgative inlliient^o of i;alr>iiir1 \f. that the drug exennnea a stim-) 
ulating efTeet U|i(m the biliary ju;lan<). C'nrefnl experimentatiDii npnn 
the lower uuiiiiaiti by several coitigjeieril observers, and rarefnl sludit-s 
made by jibvyidlojiicHl eheitiists. fail, however. lo give i« very niuelii 
light upon this subject. It i.s held Liy »nme that enbmiel never aeuj 
aa ealoinel, but i« eimvertt'd by tlie hydnu^hlorie acid (if the piaALrioj 
Juice into oorro'iiiive subliniale. and tliat ibis drug iheQ stimulates tbol 
liver to inereaaed aeiivilv- 

()u the utber liuud, tbe lust chemical inveatijiBtinns nhow piK^ittveW 
that the feeble acidity 4)f the jjjatilrie juice and the lempernture to 
wbirb the cnUimel is expnsed aie not favorable In ibe cimversion of a 
Hilllicicnt quantity of cnbunol into porrnsive fiihiimute in neeoinil for 
any bepatic iuflneucc. Tbua il wa8 found by Rntbcrford aiid Vignol, 
in tbelr well-knnwn series of stndie!> upon rbe influence of drug* ui>on 
tLi! Secretion of bile, that if 5 graine {^.'i'i) of calomel are subjected,! 
at ll'tO" F-. for 3<vvente»'n hours to tbe action of" normal gastric jilica,| 
not inure tbau ^'.^ of a gruiu oi mcrctinc cbloridv )■■< ]>r"duuod. As 
caluiuel iloee uot remain iu the humnit stomach for more tbari a day 
at tbe utmuirt, und gcDcrally but a very few hours, it is not likely that 
ail much M ^ of a grain of mercuric chloride ia pnidiiced from llioj 
ttioderately larjje dwe of 5 grains (0.32). 

Ill contradiction of this. fiuLdieiin, Winkler, and others assert tliat 
no conversion ivbalevcr take* pUce at ibe teiupeniturc of tbe body,,] 
and Jaetiner» later sliidies Kiipjifirt this view. 

The other theory as to tbe change which takes place in calomel 
prior to its action upon tbe liver is ihat it escapes into the intestine,.! 
where it is decomposed and the grav oxide of mercury precipitated,' 
which may. however, be held in urdiilion by any faily niateriaU. uhich, 
bMllg mixed with alknlino Itqiiidit. practicullvfonnKonjiR. It \» TtioTighl 
by \Vnod and iithers that this is tlie more probable n-siilt. parlicularlyi 
in view of titt! fact tliat ciilomet acts more like blue uiai^ than ei>r>l 



rnfiivo gnblimate. Further than thin, rhtse opinions are contiiinod bv 
tbv fuel. Mith vrliivb ull of tis urc fainilinr, ihat the hrjiatic inllucncc 
of oil'imel is much nun'e ]umti\v\\ asaeited it" at ihe same lime nmM 
doatrt) of the l>icai'l>oaoie uf siiUitim Hre aijiniiiii<lered. Under thtso 
ci rciimstnnres the hicarhnnate of itrriliiim naturttllv JiiiiinisheK, losomo 
CJtti'nl at least, the acidity of the gu-xtric conlenli?, and aUn <lircclljr 
or indirectly tends to incrvaute tlie atkalinily uf the cunteiilH of the 
ilutideitiim. 

Afi if to increajte the complexity nf the problem, the stiidies nf 
Rutherford and Visual seem, to prove conclusivfly thai in the dog;, 
at le««t. inemirir chloride lias a direct etimuluiit effect iipuu the 
hepatic ci'lU; whcrcuA, enloinrl, wliili> prothicing purgation by increas- 
ing the iiei'retiun nf the inieHtinal glandti. in no way iiicreaKeN the true 
seeretiun of bile: and thin nviild t<eeni Ui indicate thai, after all, the 
influenre of cahtniel Tipon the liver is due to « very minute pnvlion 
of it tx-iiig chuii^vd intti eorrnKivc titibliniale. l'n>hal)ly the truth of 
ibf matter i*. that »e liave x» yel no detiniie •icientifle exphiiiutioii nf 
b'>w Calomel really does set. ]t i^iay be tlist the »ulution of theprobltm 
livN in the he|mtie influence exereitied by tlie presence of ininnte i|iian- 
liti«« of Corrosive ^nblimate. and lliv pin'gulive (.'ffeot produced by that 
portion of the calomel nlireh 1ih?i not been coinericd into the strong 
ch|..rido •.fmcrcnry. Tllii^ is rendered the more Ulivlyin view .-f tlie 
Cict that the corrosive Huhliinate lias hei-n fuund a feehle inLeatinul 
fttimulant. while the eatomel Imt^ been found to prmluee active ptirj;a- 
tiin in dogx. iriihout producing an increase in biliary How. when th« 
drng hM been introduced into tie duvJeuuni. 

ft li»)t been sugji;eNled. too. that calomel imelf may stimulate the 
bile-expellinfi; mechanism, while the minute jiortion of eorri'f'ive itub- 
Ittnate increa-ies the secretion of llie liquid ; and. again, tlial hy means 
of the pnrgativc effect that it produces certHin substances which have 
be«n in the inte»tiue are iiamwiiately removed, and, a» a consequence, 
a doprcsMinl inHiieuce upon the hepatic cells no longer c:cist8. 

Quite a number of physicianrt linve siuilled the enectof the vnrioofl 
so-eiilled ehidagogue drugs H]ion ihe fl"W of bile in human beings wlw 
bare had biliary fistula. IVrhups llie bisl ntuiiiea are lliuat- of PfalT 
and Italch, and more recently those of JokIiii. upon v^ouieu nlib biliary 
fistula. Calomel and the bichloride of mercury seemed invariably in 
tbcw eaiicA tn decrease rather than increase the biliary flow. O.Y-galt 
WM the only drug which did increase it. 

This iiubjpct aUo ]» of intereit to flic practical pliysieian in rula- 
tion to the administration of cidomel tn comjircsi't'd tablets or other 
preparations when mixed with what might liecallcil oxcipienl-i. riitler 
thtsy? circtinusianc&s if oue of the excipients is bicarbonate of sodium. 
the tnbtet iifter a time almotft always undergoes a change and becomes 
of a gmy udor. Those who h^ivc used pills or tablets of calomel wbioh 
hiire btiJii kept for a long period of time seem to be uuiversallv in 
accord with the staiemeni tliat they have lost the hepatic efTcf^t which 
a re<;enily prepared powder always possesses. Thus it him lie^iji frp- 
<|uetilly found tbat no biliary ttow occurs under the use of stale tublela, 



3M ^^^B VRUO& 

vlicreiis free bilivus purgiug fuUuws the adminUtratton of frcehljr 
prepared powderB. 

Calouel aud blut> maes are largely used iti the condition kDono ae 
hifiouxnfHA, and iitidinibtedlv give relief. (See HilioiiBiieiw.) If lh« 
tongue i-^ lieavilv coated, tlio breatlj fuul. ihc c-onjutictivn & little 
ii:ti-rold, and lu'ndiiclio is [ireKotil, uiii' uf tlit-m ^tmiild tie fiuploytHl. 
In yftiiilttfttt mafiirinl fever the use of t'liiiill rep«itc»l do>ic« of ciilouicl 
will often ttriiig relief from tjjc voniiting. nitd it i«luiul(l alwiirs be 
gi%'en in the treatmoiil of malarial dismice before ({uinine ip used if a 
thoroiigli fictioii of tlioaiitiperiodic is re<^u)red. »8 it aids in the absorp- 
tion of the drug. 

As .1 Disinfectant. — The disinfectant and germicidal power of 
bichloride of mercury and of the bitiiodide is very well c«tabli8lie<l by 
clinical experience and experimental investigation. The RtrengtU of 
tho bichloride in solution for antiseptic purpoftee may varv from I to 
2000 to 1 to :;i(l.l)00 of wiuer. and fur diwinfeclanl ubc from 1 to 504J 
to 1 to 10(10. (See Adtiscpticf^.) 

In u.<iing the bichlnride nf mercury an an antiiieptic it \» neccNuary 
to add n few grains of tiirtiu-ic acid to the solutiun (a prevent iL4 unit- 
jng with the albmniD of the tis.'^ues to (brni an in.<«oliihle and uHcleu 
albuminate' The same ia true of the use of mercury biniodide. 

As AN AsTtPIiLooiSTIc. — The antiplil(»gislic or anti-inHHiiimatoiy 
action of mercury i» very marked in(U'C<i, but its eniploynieiil is abso- 
lutely limited nuder these circnm.'ntJince.'ii to one vnriety of inflamma- 
tion — namely, the Btlienic or dynamic form. In inttauimation arising 
during the course of some exhausting disciLHe merL-ury i» not only coii- 
traindicaied, but harmful. Thus*, if a man in health iu strieken with 
pleurisy or fifritointig or i}irtihi;/iti» or any acute inflammation of a 
serous menibrnne, be the canse what it may, tlie exudate jioured ont 
will probably be iibriiious. and capable of undergoing oiganixalion, 
thereby causing adluwions of the pleural i»urfaoe». of the intestines, or 
of tlie meninges of the brain. On the other hand, if a muu be taken 
with pleiiri-ty or meningitis during the eourae of phthiKia or typhoid 
fever, the exudate is often serons and large in fpiantitv. It U in the 
first (swc that incrcnry should be n.ied tn prevent iho fibrinous exudate 
or to miike it scruua. In the aeoond iuatauoo it will d« harm Ly increao- 
i»g the exudation. 

When mereury in given an an antiphlogiistic, opium in often combined 
with it to rx>)ieve the pain and irritation and to prevent purging. In 
mentri(ji<ig uriiiiug from head injuries tliis is a routine treatment, and 
niav lie carried oul by the use of powders* containing J- gniin (0.015) 
of caltiuiel und ) gruin (0,015) uf powdered opium every hour till 1 or 
1} graius (O.Ci-O.DT) uf each are taken. 1 he Bimutianeoiui use nf 
the ict^liag to the hejid and perfect i^uiet will often bring relief very 
rapidly. 

Mercury is abo the best remedy in tthfnie endocarditu, und should 
he given in fidl dose. The biehloridu may be used tn small doeai iu 
place of Ihc Qhlouiel, and iloitf not, of coui'm-. produce tlio same tend- 
ency to laxity of the buweU. Ou tlte other hand, it oileu aeema to be 
less eflic-aeiout^. 



MKRCVRY. ^^^P 305 

^fercnrj in myofardHu and perirtarililiii is also oT service, and 
CH^rtiiinly cx«-rts iliAtinct mcilicimil power in the early stagM or 
»i il>hthfria. allliou<;h sitire the introductioii of sntitoxia its UM in 
dijiht)ieri& is vorv limited. (Sec Diplithcrio.) 

One of llio b<.'8t Nujrs tu t^mpl'iy nil of tbe v!iriiiti!< fornix uf mer- 
cury is in tbe forro of triturates, which ina.y be prepared by triturating 
10 parts of the drug with 90 parts of mifk-siigiLr. The minute siib- 
diTuioQ of the medicomcDt aids in its efficiency, bc«atiae oS it« more 
rtLNwly absorption. 

LcAviug the j^enoml subject of mercury, ve may now consider each 
individual preparation. 

Ammoniated Mercury. 

White Precipitate, or AiuiaouJaied Mercury of the strength of 10 
per cent, with iard {Hijdrarjftfnim Ammotiiatum, U. S. and It. P.), is 
Dfted in an oinimeiil ( l'n;/ufntum ITt/drargyri Amnwniati. I', S. and 
B. P.^ iu vuriuuA i^kiii nflcctiim:^. nhrn u i^tiiuiihtliii^ application 19 
needed, ok. for exaiti[)le, in pmnain'ii niiJ chrvnw liril eezema. \t ii* also 
BomBtimo) empUiyml hi* a parafliticidu in oai«c?i of tint^. TLc otScial 
oiiiUnitDt should jjencnilly he diluted vilh lard, as it itt far tuo strong 
and will ofteu induce a dt-riiiutitia if used undiluted. 

In ottgnn, ulieiher ityphiliiic or not. Trou^eau ha« recooimeDded the 
ctQployiUL'Ut of tlie followinf; powder its a SDuff; 

B. — nydram^rri ammf^niati ...... ,yr. iv(0.21. 

Pulv. narcliur. alh .^dfi.*).— M. 

8.— To be Ufed a* a mull', aAcr thoroughlj' Uowins the nocv. 

The red preripitAte may be used innland of the whilo. Tbe treat- 
tnrat removes ihe stench iind may cure the nonipUint. It. may, bow- 
ever, irritate the mucoiiJi membrane, in which caw it should be ui^ed in 
tbe strength of 2 ^raiim to the ^ ounce (0.1 : 15.0). Amoioniated 
mercury is never used iiir(>rually. 

Bichloiide of Mercury. 

The Bi(!blorid« uf Mercury, or tVtrruwive Sublimate (flvdrargt/ri 
Vhhridum Cvrroiitum, f. iS. : JlifUniryifri PercldvruUnn, If. I'.), as 
it is called, is an exceedingly poisonous and irritating subataiice when 
token tutemaUy in cvuoen tinted form. 

Taken intoriinlly. it causes violeni ]>ain in the stomach, vomiting, 
purging of ruu-'us. bU>od. and the contents of the intwtinc, ollopse, 
syncope, and death. If Uiken in fioisonoUH amount, the patimt sliotdd 
IJe made to swallow larpe t|iiantitic« of the antidote, white of egc, Ihe 
stomach should be nu«hed out with tlie stomach .pump. he«t idiould 
be applied about tbe body, and the proper etiniuUnt!* be given if 
the pulae or respiration fail. If death dois not occur at once, the 
parient generally lias a protrncled convalescence or else dies from the 
orgaiiic changes produced in the gasl.m.inie?«linal tnitrt, such iis strict- 
area, nIoughR, destruction of ihe peptic glands, and iik-era lions. 

The bichloride of mercury is an exceedingly useful preparation 
SO 



DRUGS. 



of racrcur; for bypodennic injection in ^phtUt, aod M better tbau 
. catornel for this purpiHte. Ahnut ^ gmin (0.012) nii y be iojecied 
deeply ami g«QtIy into the collitlar lutaucs every two vt three days. 
Wbt-'u ibu iiijectiou^ are tnaJe the fjreatest iKi*sible clentitincjw sbuuld 
be oblaincd. The iiicdlc should W uaupttc und tbv batid^ of the 
operator well disitifet-lwl. The besl pUei- i'nc ibe iujectiwu is in die 
gtutetil regLuu ur betwueo ilie flboulder-bladeji. 

Mercury bicbluride. aside frrmi its antiseptic nse (see Anli»cptic»), 
is of great value vrhuii givrti irLlernuUy. uot iinlv in sypbilis, but in 
other stutf-H nut atmociuled wiih aitv such depraved Dondition. as iaJ 
Ghronic BrirfkCti duieagf. In tlif/fittfria. it may be used lu [>rovcnti 
fibriDous oxudatioD as readily ait calomel (see l>i|ihtberia), aiid iii tou- 
aitUliB, where th« inBatutnati'iD ia severe, it u vftea used nitb great^ 
service. 

Id flmall amounts — that is. in ^ Ut -^ of a gnirt (0.0015-0.0017)^ 
three rime* a lUy — [he bicliloride is one of ihe b«<t rvint-iIieA whicli we 
l)oes(.-'»s for ibc- treuttiiclit of lUu^iiiia depending;, u|>oD a deficient liain-| 
W-r uf bluud-L-L'llx. If the aiiKMiiin im eyphililio in ori)^iii, it is, of coanterj 
pceiiliarly useful. 

Bielilorido of niereiiry is of value in iniiinte dn«e« of ykn ^^ *■ grain 
(0.0U')3) for tbiT ill-»iiitdliug green slyola of immmfr dtarrh^a* in 
adultvi uiid L-bildren, atul it baa been recommended thai a .»n1ntinn 
l>e made nf ^ a grain (O.08) in 5 ounces (150.0) of water, and a tea-J 
spoonful given every hour until relief is ohtJiincd. The waivr usedf 
in making the solution should be distilled, and it may be veil to add 
to it a little ta.rta.ric acid lo prevent precipitation of llio bichloride by 
organic ina>tler whii'^h iniiy have gotten into the water. Thin treat- 
ment h( particularly nHofiil in mucau* liirij-rhn-r/ jn nhich blood and 
miieuH are l.ht)roii;;1ily nii-xt-d. Patients in tlic di(<|)i'nMtrie? 'iHcn vpcuk i 
of these passages jis i^oniaining " cornipiirjn." .^JuI oiIrt-i ibiiik they! 
consist nf " lump* -if ilenb," owing to tho niJiiHe<t of blond and mueiiti. ' 
Whether the diaeiuu bt- acute* nr rhnmic, ihu biehlnridc, used in thej 
wayjuflt dettcnbed, will b^ fauud of aerrioe. In i/t/nenirri/ taid tin 
diarr/iepa ttf adidcs the same treatment may be resorted Ut. using 2 
teaapoonfals of the solution instead nf 1. It is hardly nec««nrv to add 
that the grt'a.tt'Hi can? uiiist be bcMtowt-d ii|>on the diet imd cl»tbing.J 
The autbur has Irf^aied a child suffering fnHii persisifnt diarrbcca foi 
monlliA with varying Hnrces."*. only tn succeed when, it "being foimdj 
tbat lhL> ahdnmen was exposed lo the air, the mother was forced 
apply and keep ou the child n ilannel binder. 

In some casl-!; in whieb .in ubttinatf s_t//>/ii!otierm is preseui j an 
ounce (l.'t.O) nf rnrrnsive .Miblimnle and 1 oiiii<-c ('(O,!)) of rhtonde of 
aiumfiniiitn may l>^ added to a irnnn biitli, which should ho lakon 
every few dwya. ^ a giuiu (0.03) of the bichloride nf mercury in d , 
ounces (180.0) nf vraier is said to lie moat efficient as an injection in-^ 
ffleel, if UBwl cvcrj- thnxi or four liour.t. (See Oononhcea.) 

In ail iMran'tif affectinnn of th^ skin a solution of 2 grains (0.1)1 
of bichloride to the ounce (30,0) of water may he j«0|i|H-d un the pairi 
three times n day. A solution of perchloridc of mcrctiry {Llijuor 
/iffJntrffffri Perchloridi) in (dficial in tlie B. P.; it M pre|mro(l by 



• 



aiTdinji ^ grain (O.ftS) of the percliloride of mercury to 1 ouncf (30.0) 
of wnler, wiili J gmin (U.OS) i»f aiDmonium ciilon'de to hold it in solu- 
lion. 

(For iliv antiseptic iisea of the bicbluinde of meK-nry see Antise|>ttcft 
aud Dumft-'ctanU.) 

Binlodide of Mercury. 

Mercury Blniodidc (^Uydraryyri loduUim Itubntm, U. S. and B.P.") 
19 a brigbt-rcd powder, posseseiD^ in-iratinj; powers equal to or above 
tbuso of the bichloride, and causing Hympionis when tnkcn in nvcr- 
diwe. cl«»wly rest-mbling those profjiiced by ihp Initcr drug. Owing 
to ilie fonnatioo of the mIi. it i» thought lu he purticularly useful in 
the later stages of »yphili». The dose is jiji- to -ji^ of a. grain (O.Ofi;i- 
0.006), (See Syphilis.) An ointment ( VnqnmUtm Jftfiharf/yri ladidi 
Jtubri, 6. P.) iH iincfril asi an application la goitre and obttiaate akin 
dUfotri. 

At one time it wnx thought that btniodide of mercury wn» a better 
antiiicptic thun iho biclitoride, but rc'crnt rc»eurche'5 have proved that 
tbia is Dot a fact. 

Black Woah. 

Black Wa«h {Lotto Ihidrarifffri Aiffra, If. P.) i? made by adding 
1 drachm of cahHud to a pint (4,0: ^ litiv) of liuic-wntcr. It l.t uspd 
na a stimulant application for irashing ttfi'liiUtU' *ore» and woHniU and 
in Turiuus fonua of fczrma. 

Blue Maes. 

Blue Maiw (M'lMH Ifi/dran/ffri, U, S. ; Pilufa Htiilrargt/fi, B. P,) 
is iDade by nibbing tip m4>tnllip merciirv *iih linuorice and other 
excipicnls,'»nd \» often culled Blue J'ili* Each gmio of the maas 
contains J grain (0.02) of mcu-urv. and it may h« gircn in the dose 
(if from \ to 20 grains (0.03-l.y| for the same laxative piirpow?* for 
which we u»e calomel. Blue majw is rarely ui*c<i to produce nystciuio 
efftfcle. 

Calomel. 

Calotnol (-ffyi^rdiT^^i^i-i <^/ortW(f m Mite.U. S.: Ihfilrartfifri Subchlo' 
ridHin, H. P.), or the Mild Chloride of Merirury, is un iuBoInble «alt 
whieh is. ni'vi»rihele!(<i. frt-fly absorbed. 

('aloinid when need as il lB.\arivo purge should Iw given in the dose 
of J t«j J grain (it.Ol-O.O;!) every hii-lf-hour or every fiftccmuiniites until 
1 or tl grains (O.O.'i-O.I) arc taken, oa it will often act as eflicieiitly in 
this way as if 10 gr»in!i (0.t!fi) aro given at one doMr, and there is no 
danjccr of producing ptvalism. Tbo reason that auiall do«os are &B 
efficient as large ones lies in ihu fact thai only the calomel whicb ia 
chBiige^l into tlic gray o.vi-Je ic iictive, and, Ail the amount of ulkaliue 
juiceinilie inlusline is Bmiili. only a minor part of n large dfificof 
calnrael act*, the major portion e-^ciiping uncliangi'd. Tlii-t is the 
reason that bicarbonate of sodium is addi'd tu calomel jiowders, 10 aid 
ibe iiiteiliunl juice in the redaction of l!ic salt. While lUi» stale- 



308 



MBBCVRY. 



ment m true of the tt5e of calomel in temperato ctimntefl, it does not 
Iiol'l good in hot climaies, where much larger diwwt. aioountiug to 10 
(O.diJ) or ovt-n 20 grains (1.3) iirc often given to affect ihe flow of bile, 
till- lK>|uitic glaud liuiug madt- turjud bj lieat. If piimntion does not 
occur after ii full doHtt of calomel, a. flnlino purf;c must ov given at the 
rnil of thp twenty-fuur Iioum, nnJ ibis must always hv u^«^l if lorge 
doac^ of the caerounal arc einpluyed, to aroid poesiblo mercurinlizftCion. 

Mercury id the form of culomol ha* been used hypodcrmieallv in 
the tri-atiiK'tit of Kifphilii, being held in Holution by il luucilagc. lJe«t 
nf ail, bowpver, in the eniplnyineiit of L-tdondi? of sodium in water with 
tbe calnmel, in tlie proportion of •'i juirta each t-i 50 purtfl of water. 
It slujiild be inje<?t<'d deeply into tlie li»«iies, not, iminediiitoly under- 
ouHtli the tikiu, the greatest clounlini-ss being ncctawnry to avoid 
absce»8L>:<. The bt'Hl ])la>w for tbeso iiijwtions is in the fob! of tho 
butlrtcks, but elowcbing, tetanus, an<l even gangrene, have fallowed ita 
employmt-nt in ihis way. (See iilso tSalJcylnie of Mercriry and 
Bichloride nf Mercury.) 

In lii/ni-ntfrt/ of the ai-ute fiinn cnbitnol and ipecac are raluable 
remedies. (Sec- Dysentery and Ipecac,) TlieritUiaiel slioubl be given 
in aiuall dortfs. repeated every boor or half-hour until a favorable 
change in the number and character of ilie stoyU appears. Calomel 
is not tn be used if great ei^t)ieni:i conipllcales ilie dii^ease. 

In chiMron wlm .seem constantly " under the weather " and never 
quit« well, whn have jhifuli-nn', Jo'tiii Iiyettth, and itl-«Tni'flinjf, /matt/ 
ttoott, calomel ofiwi gives great relief iti tJie do?e of X of a grain 
(0.0i>3) every balf-bonr [lutil fnur [loses are taken, tuis treatmeot 
being immiied every fourth or fifth looming. 

In jauinli'-r due to exposure tn) cold and to nligbt bepntic conges- 
tion J of a grain (O.Ul) of caloiocl every half-hour until 1 grain 
(0.06) ii* taken will often bring relief. 

Calomel is generully prescribed in conjunction nith nngar of milk, 
while sugar, or bicarboiiatv of Aodium. which are added lo invrea^o 
the bulk and wieldinewi of the powder, and, in the carte of llie hitter 
ingretlieiit. toiuLTease iti aetivity. Owing to its lack of ta*tie. t-aluuiel 
it! uHeiL placed on the tongue in children, and fur thia vlas.* of pntienta 
white augur is lo he u.ied in ^iiiall ijuantity. as the other vehicles aro 
l<4« agreeable. The uio^t agreeable form of administration is by mean^ 
of tritanites. 

It ii important to remember that calomel, when u$ed as an anti- 
syphilitic, pmdiices .salivaiinti very mueh earlier than the other nier- 
cnriald. 

Someume-i calomel is of value when dusted into the eye in cmum 

of uhl'(<''i^»ul'"' t'onjitwto-ltl» whieh are clnimoiis. This practice 

iniiiit n«t be resorted m if imtlne or todide.1 are being taken inters 

nallv. aM the ioditie in climinaTed by the tears and fortnn a compound 

«liich bum« the conjunctiva. 

A, Tcrv important use of calomel, and one whieh has been brou|[ht 
forwatd very recently as new, hut which is really many yenrs old. Ih 

lU niap\oT»eilt in r/r*>y»fy aa a dinretie, either alono or combined with 

i^jjU, «; digitalis, or with opium to prevent purging. '^'— ^ — =~ 



I 



I 



The dose is 



IfTBCCRT. 



309 



I 



'smtll, tbont I grain (O.Oo) tltrice a day. and if a diuretic influence 
e not aMcrt itself in forlv-i-ight liours it sliould not be coutiiiufd. 
-How ciitoincl scu Id {iroduce th» iucruai^cd uriuur}- flow under tlivxe 
circumatauves we do not If now. {Some sup|)Oj9e llial it aids the ab8or[>- 
tioD of li<|iiid frr>ni drnpsicnl tiKSiiai. a.nd »o increaiies urinary sraru- 
ttoD : others think that it !>tiintdates the renal epithelium to greater 
activity. The latl«r seeuiit iLi* \va»l jiruhuhle of the two. but neither 
theory h&a been proved correct. althi>u;;b cx|)crinic»lation siipporta 
the view first nameil. The full urinary cirisct of the drug i.i nut felt 
till the Mcond or third day of itn ufie. and speedily pasaos away, par- 
ticularly as purging is oflen induced very early, Still another use 
of calomel i» in Ufphoid fever, in which dtacusc it has been higLlr 
recommended iu nmaU repealed doKeK. particularly if coiistipiLtiou 10 
present. In the opinion of the author this is disadvantaj^eoua as a 
routine niejisiire anrl entirely uncalled for, although in the very early 
stages Df the di»-usf. Mhcu the howeU ure coDtiuvd uud the tongue 
coated, a dose of 1 grain (0.05) ia fourth* with a little bicarbonate 
of sodium 15 useful. 

Sydney Itinger has called attention to the fact that in conittipa- 
tion or in " bUioatneit " podophvllin does more good than calomel, 
providetl that lh« stools are <litrk in color, whereas if the same vigns 
are preseot, but the stools light and clayey in color, cnlomol i» moro 
efGcient. The author has proved the correctne^t of this asitertitin 80 
fre<inenlly ihat he is convinced of its truth- 
Calomel has been recommended in the condition of anorexia and 
depreMioQ following acute di)<ea:ses, and when tbc tongue is covered 
by a thick yellow coat it is the remi'dy for the ga«Ini-iHte«tinal tor- 
por always present. While purgative doses of calomel certainly are 
of value, the use of freshly- prepared nitro-muriatic acid is, liowever, 
highly pn>ferahlc to the incrcurittl .salt in many ^uclt iimtanccs. Both 
of ihww drugs should not be given siuniitaneouHly. because tliev are 
incompatible- 
Calomel is of^en given in small doses to "settle the atnmnch." 
Sometimes it will act in this way, but in other cases it will seem to 
incrvaj^v the iiauKcjL snd liring on vomiting. This is true of btilh 
aitiilts and cbildi-en, and it is_ impossible to tell beforehand which will 
occur. Itinger a.<sert« that in a pecnliar form of vomiting occurring 
in very young children, which comes on immediat^^Iy after the food is 
ewatlowed, the rt^jeuiion of milk being forcible, and perhaps ao suddi'U 
that it is not even curdled, and which in uoi accompanied by muth 
etmiuiiic. fulomi:! will i>rten give relief when all other remedies fail. 
It Khuuld not ho resorted to until Rome eiiilcnces of wasting occur, as 
thitt action <if iho ntoinarh in many children only rids lliat organ of 
thai part of the milk which is in excess, and i« a purely pliysiological 
reffurgilation. The calumet may he given in the done of -^ of a 
grain (i').O0.'i) every hour, or. if preferred, gray powder in tie dose 
uf ^ of a grain (0,02) every hour for three doses is e<|ually efficient 
iu uieae cumoi. 

Calomel in a fine powder will often remove *y/>Ai7(Vu- tovdnhnnata 
if doHled over them for some time, and an ointment made of 1 drachm 



310 



VRVOS. 



(4.0) of colomd to 1 ounce (31,0) of lunl is wry uacful in prttHttu 
ani. 

Tbe B. P. coiita'ms a pill mass of ca]f>me1, calleii PHula Bifdrar^i/ri 
SuhcMcrldi ('••niffifiin. which contain'* aniitnonjr, gnaiac resin. ouJ 
cait4)r oil.. Il« J<i»c is 2-8 gruius (0.1-0.5). 

Calomel oinliiieiit ( f'tif/nenlHm Ffrjrhar;/f/ri .Vi(AcA/oi-tif(, B, P.) M 
oftcti useful ill tbe trenltneot uf t«uiall ]mtchca of eci«ia&, or the Ibl- 
lowing |ire8cri})l]uii ma^' be given for its use: 

B-— Uj-amrp. chlop. mit gf. nI (2.6.^1. 

MognciOw <«.rboimtis P- ^^ iS.65). 

Un^unt. iu[uu kmb ^ ISUiO).— U. 



? 




Gray OU. 

Gray Oil {OJntvi Clnrrruni) is prppiin-d a» fullowfl: 2 ilriiolimfi 
8.0) (il lanolin iiro rrilibinl u]i «ilh sulRciwnt clilorufonii lo viuutnity it, 
.'lie ruLbing |iiMces.s ii< L-tnitinued until niot^i i^f the clilorofnmi is 
oviijioruTcil, iiuii whiio the iiiixtiirc is i^till in a fluid Ktate tneiatlic 
mercury, in ilmiMc tbe ainiiunt of lauuliii, 4 ilmcliiuts (15.0). is atltli'd 
and ihetriiumtion continiti'il. By iLiia uiyans an oiniuniDt of mercury 
JB left which ennnlfl 2 pnria of mercury and 1 of lanolin. This is 
soHiclimei* callt-d Strong (irnj Oinimonl, For hypodermic injcciion 
3 purtK uf thi^ gray oititcufnt art; added to 1 port of olive oil. or jt may 
be si ill furiliL'r diluted b^' uddiiig ulive oil in thv proportion of h&If- 
&nd-half. Of this mixture 1 to '2 ntinims (0.0&-U.1) may bu ii^ected, 
every second or third day. f 

By miiiiK pnurlitiouem this preparation is conaidcred ttiuch belf«r 
llian uuy otht^r for livpudermiu u»u lu tt^yphills. 



* 



Mercury with Ohalk. 

Mercury willi Clialk { ITifilnirififniiH rum i^reta, U. S. and B. P.), 
or Gray Powder, b elighlly purgative, but is chiefly employee! in the 
treatment of infantiie xifphili*, as it will not freely piirne. It is com- 
posed of 38 purls •jf iiiercurv. 1^ purli' of «ugur of mitk. and o*) parts 
of prepared chalk. The dose is 1 to lU j;raina (0.00-0.C5). ChiU 
drttn buffering from ay^phiUtic nutraamua seem fitirly to fatten on it. 
This preparation is nleo of service in tlie syphilis of adulK ami may 
be employed whenever the lit.\ativc cffeol of mercury is not desired- ^^ 

Id the treatiuL'iit of int\t»(tU dinrrhaa witli watery, colorless stools ^H 
containing undigested food gray powder in small doses is oft«n very ^* 
usefd. 

Mercury Ointment. 

The Ointment of Mcrem-y, Mercurial Ointment {Ifngu^ntum 
Iftfdrarffi/rK V. .S*. Rtid H. P.). sometimes called Klue Ointment, is 
made by rulibing up ineirury with snet and Inrd untd the mercury is 
extiii'^uiisht-d. or. iti oilier words, until the ^jluhulea of mercury cannot 
be »vvu with » magnifying power of ten diumeters. 

The oinimuut of mercury m used externally in certain skin affec- 




MERCURY. 



an 






lions and for the piirpose ur inlliicncing the gi<acral Hystcm in casea 
where the drug cnunot woU be lakcii by the mouth. In iifphilia 
wLi.-re II mercarinl cfTuct is to bo n^ached thcninimcni in sm^ll atuouDU 
^liuiiM be thon>iigh!v rulit<pil into the ^kiii in variou)* piiriji of the 
body — one Bvrninp in the lett gruiii. ilie ul-aI in the right groin, the 
uexi evening in the left nxilla, and the fourth (evening in tliv right 
axilla, beginning tm the fifth evening in the left gmin once more. 
This avoids hicsl irritstinii of the tikin by meanH of Ion freqnent 
applications, |>]ace8 the drug on spots where it is readily absorbed, 
and very rapidly iafliienccs ihe system of the patient. In infantile 
Bifphilia tbia method may Iw employed, or ii flannel hinder rovrrod 
with the ointment may be placed nboiit the belly. The elothe? xhnuld 
Dot be changed too frequently, as their eaturation with the ding aids 
in producing llie impression upon the 8yf>tem, and the wearing of an 
onuvrshiri ttaturated with the uinlineiil uftcr u few dnyn' wear itt a 
ery valuable, though aomewliat diity, method of producing mercu- 
rialiftation. 

The nintnient of tnerenry is sometimes rubbed into the skin over 
entanied jflandt. 

L'nder the name of Oleatc of Mercury (Oleatitm }Tjfdrarffifri,U.S. ; 
J/ffdrartfi/ri OUas, It. /'.) a very elKcirnt and more aitreeable appli- 
eation thnn tho ointnK'nt is u»*d in itx pinee or mill further diluted 
willi bird, when it bL-comes tlie Ui'<itirntuiii ffifirnTiuffi OUntin, B. /'. 
It is made from the yellow oxide of mercury. (Sei' Oxides of Mercury.) 

For pedieulu* pubis, or in any case where pavsKites, stich as the 
idea or louse, infest the region of the genilnls or nny spot covered by 
a hairy growth. mi;rcurial ointment may be uned as u ix-mcdv. owing 
to ila Ifibal inltiieiiee over theHe troublesome pcsls. Care aliould be 
taken that il does not cause ealivatiftn of the patient, and it must not 
be allowed to remain on the parts, bm be wiped off in the courBe of 

hour or two or less. The fullowing worda from the pen of Dr. 
Jus&pb Leidv are suflieiontly iutervHting to demsiid a place at ibia 
juncture: " We may hei^ say that if it is once iJtiderHtitoel thai, all 
in^ecis, including lice, nrc destrnyed quickly by ihe application of 
any fi\ed or voluiilc oil. physicians will &ee there is no uece^ity of 
employing remedie» uf a noxions eharacter to the patient. The fat 
of mercnriat ointment ts probablv more active tlian the mercury 
iUeir. 

jAnimentttin Ilyilrari/f/ri, H. /*.. ami Emplatlram llfidriir;;ifri, 
tr. S. ami h. /'., are used for the some piirposoR a.'; is llie niiiliiioiit 
of mcreurv. The pliislur ii^ made with olive oil, resin, and lead plafi- 
ler insteau of ordinary suet or lard. 



Nitrate of Mercury. 

The Solution of Mercuric Nitrate [Liquor ITydrargyri Nitratit, 

'. .v., and Li'juor JTifdrnrffifri Nitrnti* Acidu*, Tt. P.), Acid Nitrate 

if Mercury, is nii exccciliugly active. [K-iit-tintiug cauntic, no nipid in 

B efTecU that il hcciih to drop through the tissues. It may beem- 

oyed for the removal of epithdiomata nnti /nn/r wartt, and should 



w. 



lu 



DRUOS. 



bo ftpplied by means of a ^asa xoA. This trratment may also bej 
rcaorted to with advantage iti Itipuis until the surface of the growth it 
level with the i>kin. The surroutidiu}; parts Kbould be protected by 
tard or oil. Aa this trcatnient ia rerj painful, the epot may b« fini 
COCaioiied and afterward covered with flexible collodion. 

Citrine Ihnlincut [i'ltf/urnfUM JltfJrart/jfri jViYj-dfi*. U- S- aod 
li. P.) in u»e<l as a xtiiiiulatiiig apnlicaiiun in vases of chronic ikin 
(/iWa«t'ii of the scalp aud trunk. It is too strong for onlitiarj UM, 
and ebould be diluted one^bslf or lef)9 with lard according to tbe »tim> 
ulnliug cHcct rctiuired; the dilute ointment is official in tbe B. P. as 
VnffuentU7u Hyarnryj/ri Nitrntis Dilutum. 

Ondes of Mercury. 

The Ti'lbm and Hcd Oxide of Mercury {Hydrargyri OxidumA 
Fltrmn, V. a. und H. P. and Sydrarffffri Oriiium JiubrHin, V. S.\ 
and H. PX Iteil Precipitate, are used larjii'ly as a dreiviing for jrypA* 
ilitif torff ython dilntc-d ahmii onL'-Lalf witlicbalk nr other [towrUer. 
If unt'd pure, tliey iirc sjtucwbut rauslic. l''rotii the veliow oxide iS'^H 
made the OlcalP nf Mercury {^(Vfilum ffi/'lritrffj/ri, I . .S".). whieh il^V 
used for the sanii- purpose iw ordinary mereurial ointment. 

In intfatitml and tjnafrif inJitifation. uilh foul belching and very ^^ 
itl-amelling stools wbii-h are due lo intestinal acpwis, the yolliiw oxida^H 
is sometimes given in the doAe of j^ to 5*0 of a grain (0.001-0.0012) 
in a triturate. 

Hed Precipitate Ointment ( L'nifufnluiu Ifi/ilntrffifri Oruii HmM. 
l\ S, and B. P.) and the Ointment of the Yellow (>jiidc(i''n(/it*^n/«ffl 
HyHrargyri Oruli Flttn^ U. S, and B. P.) are largely nse*!, diluted 
one-half with hird, for chronic Mcnty tkin affcctioni, in "Itsiinote con- 
Junctifiti*, and in granuUir iida and ttyeg. (See Styes.) i'hoy abould 
always be freshly prepared. 



Protiodide of Mercury. 

Mercury Protiodide {fJtfiirargifri lo-iitiam Flfiviim, U, S.) is much 
more mild than the bJiiiodide. and is given for exactly the same pur- 
poses. It i« very UMcfiil in chronic Itrif/fit.'M diaeatr. It ib to be 
remembered as the best mereurial preparation foronliuury cases of 
mfphiiia. (See Syphilis. Fart IV.) Tbe duse ia ^ 10 ^ of a grain 
(0.01-0.010) three times a day. 

Salicylate of Mercury. 

Salicylate of Mercury is a drug which liaa come into qnite general 
nsa aince the introdiic^tiou of the bypodiTniic mt-tliud of atlmitiistcr- 
iDg raeryjury In syphilis. It ia to be suspended ia parafGn oil in tbe 
proportion of 22 grains (1.5) of the salicylate of mercury to 3 
draclnus (12.0) of cfac oil, and before it is used tbe bottle must be 
well »hnken in order that the insoluble mercury may not remain at 
tbe bottom. It is of great importance tbat the needle aud tiyniige 




MKTUYL BLUE. 



313 



h&U be thcroughl^ cleansed af^er cncli injection, ai* tlie insoluble 

ig readily clogs tlie instrument. At first I minim (O.Oo) ol' tliv 

'mixture just nnuied slioiiM ln^ injefie<l ileejily inlo \\iv ^liiU-al i't';;iiLi» 

ev*rv fourttt dav, and this miiy b« iiicronstd to every stc-vod day if no 

M^steiuic evidences of tlie actitm of the drug appear. 



r 

■ nnmr 



Yellow Sulphate of Mercury. 



I 



HydrarffTfrt Suhnuiphnt Flai'ftv, C. ^., has "heen used under tlic 
namr nf Tnrppth Minfni) ns an crrliine in rhronif ophthalmia and 
klm) ax u prompt emetic in croup. It is u qnick and oertaia emetic. 
atid. it is claimed, dues not priHlii(!« dopre.'winn, hut the wnter nniild 
reconimend great care in its use. The dose for a two-year-old duld 
is 2 to 5 grains (O.l-O.So), repeated in Hnoen niinute.st if Qcceagary> 

If as much ad 5 i;rniiix (U.3.*j) hon hwn given, and emMia does 
Dot fulloH'. other emcticH ur the stouiach-putup must lie used to pre- 
vent gaatro-iotestinal irritatioD. 

Yellow Wash. 

Tellow Wash [Lotto IT^drarq^ Fiava, B. P.) is made by adding 
") grains (2.0) of corrosive HuUimatc to a pint {J litre) of lime-water. 

1.1 U!>ed for llic »ime purpose.'! a* the Daek wu»li already iiieiitioued, 
it ia much more stimulating in it>) intltietice. 

lAcompatiblas. — Bichloride of mercury should never be given with 
tti\ other :iii liiitiUice except iodide of potastiium and ehluride nf ammo- 
Dium. as it td incompatihlc- with uluiost every other dru^. With th« 
iodide of potassium it luuy be used, because the precipiiate formed Is 
at once redissolved and the rcwlting mixture is highly alterative- 

OatnmpI Khiiiild never he ^liveti with iodides ur hruiuides. tilid hydro- 
chloric acid may convert it into the bichloride if the acid is prceont in 
aay amount. It is also incompatible with antipyrin. 



METHYL BLUE. 



Methyl Blue or Methyl Violet is an aniline iye often sold under 
the name of Pyoktaniii. When used medicinally, it must ha perfectly 
pure and deprived of itn iiMiai rontaminating matter, arsetiic. which if 
ptntent cauaeH local irritation of the part to whioli it is applied. Pyok- 
lanin Ka« introduced to pri>fe^.-«iijna1 notice under this name by Still* 
ing as no antiseptic, hut careful study h»^ jn-oved it to hoof very 
fitrble jwjuer o»cr the gmwth of geniif. In all cuiiditioua of the eye 
in «hieb autDieplic loiiuiiti are iiidjcatod pyuktjinin hiut been Htated Ut 
be of value, but clHjwhere in eur;;ery it is practically usele.s't as an 
antitieptic. Even in the eve it pos^et^^os, according It) dc Scbwciuitz, 
a very limited range of uBefulriesa, Iwing no better iban the older 
antiftCpticK, except in diflcaHC^ of the luebrviual appiiratus. The fact 
that pyoklauin stains everything it loiiclicK U a great disadvantage in 
itc uae. It may be tried in tUphuritit, eesema of ike ryelidt, coit' 



314 



DBOQS. 



junctivifia. boUl sitnpto and phWct«nulftr. and in the treatment of 
corneal nicer. W1tt*ii m uiujilojrea it should liv applied in the strrugtb 
of I to low of M liter. 

It ithoiiM be remembered tbnt nny pure ojiiline dye mav be used 
in place of pjoktania. Tliue some payaiciana have UBod yellow pyok- 
tniiiu or sunnine. 

Methyl blue and similar aniline substances are largely employed by 
some [)cnionfl in the treatiueiit of malignant neoplatmt. The solution 
(1 to 61)0 of water) should be filtered through hot iisibt*to«* lo render it 
sterile, and every iintiseptie precaution win-fully silberud to in giving 
the injection. The dnso is J tn 3 drachms (2.0-i;i.(>) of this solution 
evei"y other day or every third day, and the inje<^tion is to be gircn 
either into the growth itwif if ir U large, or just nt its Hide, in llie 
heallhy tiwueit, if it is !*mall. To<i much should not be injected into 
one spot, leat it caoae a Kloiijih. This treatuieut does not euro Ibe 
dineiLH^. U relieve:* pain anil ^o (|uiet5 the patient, and in rare caa« 
glopH the growth of llie tumor. If the gnjwth nlougha, com|)lele anti- 
septic dressing h iioccttsury. An antiseptic pyoktaiiiD-gauae dre^ag 
should ulwuys bo used while tbe treatment is going on. 




METHYL CHLORIDE. 

Methyl Chloride is a. CMlvrless y^w. eaaily li.|iiclied under pressure. 
with all wdor resL'iubliiig ilmt uf elher and chloroform, Hi»ed lo produce 
local amvKthesia. whieU it doett by nbaorbiug a lurgc amount of heat 
an pnsfting from the liijuid tn the volatile state mi it ittrikeH the skin. 
It la usniiTly kept In u ^uiull iltt^ik whii.-h Lu» ile end fused into a Rue 
poinl. This is broken off. und the heat of the hand volatilizes the 
drii^, which i» tlien forct-'d out of the tiu^k in a line apnty. The 
nnzxle shniild be hcbi ten to twelve incheH from the part to be frozen. 
The ^kin of the part to be au».'s.t hell zed should be wai^hed with soap 
and ether lo remove all fatty substanee^ before the spray is used. 

I'ndcr iheso circumslimcfs the- akin bcfomcs pule in s few sccoihIa, 
and afterward perfcetly white ami parebmeut-like iu appearance. 
lio>rjLl anjpstlicfiia is now eonipleie. and minor surgical operaliona, 
imeh H« opening boils or nbseeases, caii be performed without )>ain. 
The !<pray ifhoiild nut be conliiuied more than two to four minutes. 00 
local dettth of the ti)^ii(->s muy nwult. A greiil udviiiiluge of the aprav 
of niolhyl over Ihni of ether ia ita filigbt intlaniniubility and rapidity 
of action. Melliyl chloride Ih tn bi> distinctly -teparntetl from melbvl- 
ene chloride. The lirst \h luonochtormelhane, the second dichlurmv* 
thane. 

BtETHTLBNB BLUB. 

Methylene Blue is to bo distinctly M-puratcd in the mind of the 
siuilent from iimtliyl blue, which is practically what is known by the 
traile nmiip '• Pyoklanin." 

Methylene blue him been employed in the treatment of maHgntnt 
ffrotcths and in malarial fevt-r* with uwicrleil succeed, although its suc- 
epHiifiil line in the lirst group of cosom is decidedly problomiitlcal. When 
tisod in tho treatment of mrcotna luid caitcn-, from ^ to ti grains (U.03— 



METHYLESK CHLORIDK. 315 

0.12) ID wstery solution are iiijevt«d iliiilv or on nltoroaie days directly 

ml'} lilt] grovrtU. The tiooplaMii, it \» naiil, <;[;aHu.-i to ^row, xlinuks, 

k^aml coiut'ji awiiy, leaving a fiiirly hitallliy i^ Ion filing surfaw?. Tins 

Ltreutioi-Qt xh ?o uiiuertAiii ttiut it shuul^I ouly W trivd ia luop^rable 

Anil in t)ii8 cl»S4 of patiimts ila local uso ofwn seems to relieve 

paio MwX cliuck lliu fetnr. 

Id malarial fever of the intermittent typo mntliylcnp blue tteems 
\o pueecss very dtMinct curative powci's. It is not so jxiBerful as 
quinine by any means, but has il8 chief sphere of usefiilne^H in 
patients nha cannot take quinine or wltere <]uiuiuc hua btx-n (ried 
niisucces^ fully. ThU antimalariul iutltii-uce \* A\w to iis 'K-struction 
of the /f/annWium malarvv^ but its adminiHtration muf\ W-gin from 
B«Teo lo t«ti hours before tbe expected interniittent parosyKm nnd 
be oODtiDued after tbe attacks huve cc^itteU and for some little time 
after the physician fails in finil tlie niicro-orjpinifim in the blood, il8 
reUpJtc:* arc couimou. Particularly jjood resulfc I'lTin to follow the 
use of methylene blue in cLildren suffering fnim lusUria. ITntowanl 
ejmptoma from \\st use aro not common, but wheL they do occur con- 
sist in lilight vertigo, nauiiea, and some ntrnngury. The urine is 
».lwaV9 blue from the elimiiin-tion of the drug through the kidiieyit. 
Recenily Levy husemjduyed methylene blue in the doMeof fnim 1 
2 grains (0.1)5-0.1) four limes a day in tlic treatment of miijraine. 
[t is to be fjiven in cap-iiilo ivitli kola. He HtnteK that a.i niiurb as I'*) 
rains (1.0) may be given in a diV with saf ty. 

Methylene blue oa8 been highly commonded hy Horwit): in the 
"^atmcnt of ibo earlier staged oi gonorrhtta, iiti it sbortcas the couree 
>f the disease. He suggents the follnning formula: 

Metlivleiie blue 2 Krniti* (0l13>. 

Oil of Nin«Ulwo<xI 8 " io.;>). 

01«Hrt«iii of (topftiU 3 " (0.^]. 

Oil of cJnnamaa 1 minim (0.06.) 

To be made io one capsule, three of which arc to ho taken each day. 

Injected into a muscli; in tliu dose of 1 grain in ID minima of water, 
methylene blue is used to test the activity of the eliminat'u-e futicthji 
of thr h'dnrt/. In health it should appear in the urine jii fifteen to 
thirty intnutes, and pcrsi:*t tor thirty-six hours. 

The ordinary doae in the treulmetit of malaria !a 2 to 4 grains 
(0.l-".2) every fonr hours to adults, or 1 lo :i grains (0.05-O.lJ to 
Bbildrell of five rcan. preferably given in capaiile. 



METHYLENE CHLORIDB. 

Melhyleni? Chloride i» made from chloroform or bv the action of 
:bliiriue ou iQ:irah>giis, ami in a colurlcw linuiii a-Meiuhliiig i:hlorotijrm 
In odor. It is readily deeompoHeil by light, which process may bo 
lindered by the aihlition of a little iib.tolute alcohol. 

ThsT^iea'tics. — Thisi drii^ \* employed n» an nnn-sthetic in a manner 
like chloroform, nnd was iutrodiiee^I as a safe substitute for ihat druf>;, 
ibat it is of duublful sufetv and i« little used. It has been used as a 



316 



DRVOS. 



^ray for lli4> pnjductuin ut local an%-slli«sia. As stated undur Metby) 
Ciiloridc. it is nut lo be confijuuded with that drug. 

In Engluiid, under the tiume of iiieth^lcnu chloride or taeibylene, 
a mixture of ethyl vlliur and meltiyleiic cbluriJo hns bi-fii widely 
eiii)iliiyed by jiijiulatiuiu ThiH prcjiaraliuu is, of course, to be distin- 
guished from tnie methylene chloride. The amouot of thif- mixtare 
U)>od lo produce nmesthesia ik 1 to :^ ilrachins (4.0-8.0) for minor bikI 
8 to C drachma (12.0-24.0) for major opcrationa. The terui "inotbyl- 
ene chluride " Iiaii al»o beeii upplied to a mixture of clUoroform and 
methyl chloride. 

MUSE. 

Music {Mitgrhug, IT. A', and It. P.) is obtained rrom the prepulitl 
foUiclea of the Monehaa moaithiferus or tna^k deer of Thibet, and is a 
i Btibstance po»:^e89iQg the moat remarkable penetrating powers, so far as 
odor is conc^emod. Very little of the musk for sale in the shops is 
pure, aud tuost of it ig tiut luu^k at all. \t» price varies very greatly, 
but if Hold for lens thau twenty-five eeuts a grain it is probably worth- 
lew or impure. 

Therapentica.. — For some iinknoft'n reason tnusk acts as a diffusible 
stiiuuluiit uiid sujipurld the system. It b also uu antispasmodic and 
nervous aodittive. In all lowfevfr» where the strength of the fffltient 
is fast ebliing away and the ntrvoiis symptoinii arc those of the most 
ndvHiK-od depreH<<inn, reetal iujot!tt»nit of munk in starch-wnter should 
\ic employed. The do»e should be 5 to 10 grains (O.S.'i-O.tii'i). Ttia 
drug m of value where eithei' ttt'n^oua ea-^tt-im^nt or H^rt'oiu eollapM 
in pre5etit, but is not to he employed until it i.n absolutely needra to 
carry the patient past a crisiR. If frequently employed, it loses iu 
power and the e.tpense is a necrdless one. 

Mn.«l; is one of the be«t roiiioditw in iihgtinaU hieeougli. 

The dose of the tincture {Tiurfura .l/oscAi, f'. »V.) is 40 minims 
to 1 druebm (:^.0-4.0), and of mii»k it.^clf 5 to 10 grains (0.32-0.36). 



i 



MUSTARD. 

Mustard is ofiicial iu the form of ,Sinafm iifAa, t* S., and Sinapia 
Allftt Scmiiia^ li. /*., or whitx* miiBturtl, derived from the eceds of 
lini/aimi alL'i, iirid .Siiiniiif nigra. I'. S.. and Si/tiijn> Nif/rw Seniinn^ 
H. P., or black mustard, derived from the seeds of Hr»*sica tngnt. 
Both of these eoulain an Jrritaut oil (Oleum Sinitpiti I'olatile. t'. S. 
and ft. P.) as their chief active wnatituciit. 

TberapenticB. — Muatard is often u-ed in the form of mustard flour 
na an ejn(ti{' when j'tin'cd np in water in the proportion of 2 table- 
jipf-oiisffil 1'> n gla)i9 of water. Jt ig nbo employed as a t-ounter-irritant 
and as ii cundimenl. If jiixen in excessive duse, it will cause violent 
gastritis, and chronie gastritin is often set up by its constant ni* in 
excess. It"* internal use is cMintra indicated during the exiatence of 
aentc gmstntie ami nil states of jiBstro-intoiitinal irritation. 

When used as a counter-irritant muetard ia applied to nlifiVd 



MYRRH. 



m 



pain ofeofie dne to fiatuhnee ami aeutc infinmmaiwn of the abdomiual 
and llioracic Tisccni. diat liue to nnc*<-ul<tr rhruiiiatiiin, infinmed jtnutx^ 
ami ttrunil'/in, atul it iii:Ly he npplicO at tho napn of the neck in rases 
«f hrttilffhr unil lerr.hral cvniffKlioA, Wlieii K{i]ilieil lo t]it; j«kiu of an 
urtliii»ry tDdividual. it will produce a hnd burn if left on more tban a 
few niiniiteA. aiid ii i^ltoiiM iiv mixt-d with mLcat flour in tbi; propor- 
tion of balf-nnJ-balf wht^n uslhI upon perxonM baviD^ tender skins. 
Cbililreu geut-nilly will nol ti>l<?ralc more tban one-fourth mustard. 
The planter should bo mado h^' mixing muf^tJinl flour and wljent flour 

ktogetliitr and ibcii muiHtoniiig ttio luixcj Hours with wanu natc-r or 

r-wiirm vinejiar, or a Unle brandy luay be uai»d. 

The Bcaid or burn produced by mnstard is peculiar in its alowncsa 
to heal nnd in the faet that it is lomler and r«ddi>ned for diiyH. Ofton 
it produL-i'8 a pcrmoiRirit stain oflhv itkiii. If tliu buniin^ of the mus- 
tard beeomM oxcvsAive. it ^houbl ho treated bv upplyiu<^ a pii^ce of 
liDt soakfJ in lime-wator and olivo oil, hiiir-und-hn!t', or olive oil uluuc 
maj he used. 

The oil of muatard is very irritant, and iiluioi^t epispastic in ita 
«ffecta. It in sometimes giv«D in tL« treatment of the atunicttomnckof 
dntnkardi4 iu thcdoMrof^j^to i a luiniiu (O.'lllJ-O.iJ^). Charta SmapU^ 
V. a. and H. P., or mustard- jtapers, are sometimLy cuIlM xiimpiifma, 
nnd lbe«i' aflford a ready mt.'an» i>f applying this couutc-r-in'itunt. 
Tlirv arp BPnerally very «irong, and one or two liiyers of tbin and 
nioutuDvd Tiaen should be placed between the dkiu and the eiDupiMii to 
prevent too creat nn «etinn, (See rounter-irritution.) Tht* compound 
ItnioieQt (Ijitiimeiitum Sin^jiU Comff/tfturn, U. S. ; Linhiutitwi' Siiit- 
piji H. /'.) in ciimposfd of the oil nf muHlard, riistor oil, exiracf nf 
iu<.-xereuu}, antl alcoliol. The lueEcrcum is omitted in the British prL-jta- 
ration, which 18 twice as strong iu mustard oil as the C. 5./*. prcpamtioa. 



MYRRH. 



EMyrrha, U. S. and B. P., is a euia-resin obtained from Com- 
miphora Mtfrrha, a tree of Arabia. It occurs in dark-colored tears, 
ftnd contains nn active prineiple, luyrrltin. 
TliarapenticB. — Myrrh, iu luediclnal umouut, \a a ^tinmlimt Ui the 
cirenlaiion and to the uterine and the broncbial mucoua membranes. 
In amenorrhan due to functioniil inactivity or aniemia, '■ Iron and 
roTirh ■* ia a standard remedy. 
The tincture of myrrh, diluted one-half, is useful in ulecratnl tore 
tkroul ta a garfrte, and iJie pnre tincture is ^onictimc-s applied with a 
_ smHll bnii>h or by the end of the 11ugt?r H> */'f"i,'/.'/ "r ttinU-r ^um*. 

Id Iniforrhfpa depending upon uterine trouble and in chr^tiic 
ctfttilin uiyrrh ia often of w;rvice. S>raetime8 ii enters into expec- 
torant mixtures" given in the taier xta/f/n f,f hr/in'-hiti». The dose of 
the tincTnrc (7V»r(iiir<» Mt/rrhte. V. S. and H. P.)h 10 to 30 iiiinims. 
(n.6'i-2.(y). It alao enters into the componitinn of PHultv Ahr^ et 
Mtfrrh(r. V. S. and B. P., dose two lo five pills, and Tiiiciura 
Aloe» et MynrhtPj V. S.^ the doae of which is 1 to 2 fiuidrsohms 
(4.0-8.0). 



318 



DRUnA 



NAFHTHALUT, or KAPHTALBNE. 

J^apht?ifili»um, U. .?., i« a coal-tar clerirativp owurring in color-! 
less cnicA'like ci'YscaU. possessing a peculiar flnifH, niid soluble ial 
alcohol lo H'ltne s\\^\i i>xii>iit. Ht'l))inf: HtatPH that napljlhaliii whtn 
pure is colorless anil wiihiml action im inniht litmiis-pai>cr. ll shoiiM 
also iJt«solve in concenlnilod sitlpLiirie aciil wiiliniii color when gcnily 
wanned. After it in tukt^n for imtav time, vr uvuii after llic iiral iiv»v, 
the patient will xtaie that when lie beluhos the pia has the fimell and 
tuetc of burning nihber, 

Th<> drug pnsne»Re» distinct nnliseptic power, and for tbiR roannnJ 
hufi been emplovcd in ix-rtuiti gitatric and iotHlinul di.'-e]i»e» a^si?- 
ciaiod nilh rormi'iitative ubangt'ii or dependent upuu uleenitiou and 
or^funiv Icmioiik. iv-ftet-id diarrhoM it mar be given as a dcodoruati 
and (Ture. 

Wlien f^Iren lo children, tut in auiinntr diarrkcea, iLe dof>e eboiild'^ 
Jje J 'o I piiiin (0,01-0.015) every two or four hours, but ndiiliv may 
lake as mac'b a^ it to 10 grains (O.SS-0.65). More than ihie will dis* 
ordor itio stomach. The drug sliould bo given in powder, with euj^r, 
or in cajisule. It haft not hccti ts widely employed as. vas expected 
when it lirHt came before the prureMiun. and certainly often faiU to 
do ficood. 

In r.iX» and rabbits na|ihih»lin, when administered contiuuously for^ 
fe considerable period of time, produces cataract. 



NAPHTOIi. 

NaphioL V. .9.. and NapltthoJ, B. P.. is oHen called Bota-naiAtol, 
and is gODorally H.rlificially prepared from napbtbuliD. It is u&ed 
externally in nntinpiptic dre«>sings. Inti-rnally it in an excellent 
remedy for fi«*trtr frnnenhtti'ut and fl'itnti-nrf. as it acts m an active 
nnti^ipptir. It i8 irl^i iiii>riil in fieltd diarrlieeo of the serous type. 
The dose is 2 to 6 j;rHiu!> (".15-O.rJ) in capsule or cbcbct. 

Bftn-naphtol-htMiitith, nr Or/ihof, is a nenlral. (idorless, and tasteleM [ 
powder designed to combine the sedative effects of bii>mutli with tlie. 
antiseptic properties of belii-naphtol. It is used in cases u>^ trroum and 
fennenlatii'c diarrh-ita in adults i|i the dose of Ti to Ifi ^jrains (0.3-1.0) 
and in infants in the du.^e of 2 to 5 grains (0.1-O.li) every few hours 
in c&psule. 

limnmaphtol is used as a siibstitiite forbeta^naphtol m fmnerttatir^ 
difapt^psia. The dose is about 10 grains (0.6d) three tiniM a day, and 
it is beat given in cachel 

NABGOL. 

Nargol is a chcuiiefll compound of silver and nacleinic acid, which 
is readilv snhible in water, and posse^ties a more [leuelrating power 
and more hutting eBcct!' than nther silver prcp.n rat ions. It is not |)re- 
eipitated by coming in contact with aUmmiiuiidti. and it doe^ not 
undergo chuugc when boiled. Nargol contains about 10 p«r cent..! 



XITB.ITR OF POTA&srVif—yiTRATK OF SILVKIl. 



31H 



4>r nieCallic silver, which ia more rhfin tfaut c»iititliiL>(t iu the otiicr 
< organic silror compoiimls now obUiina.blc by [tliyeit^inaH. 

Therapeutics. — Nargol i* cniplojfctl in tl»> trcatnuint of ponorrhim 
in tlie f'tnii Iff iiijeciitttu in the strengthof O.^rv to 1 per rent. ; although 
in chronic ca.«es tlie strength inaj bo increa»c*d iiji to 6 per ct-iit. It 
dedirovs the gonococcus siml seems to pcnctnitc into ihc crypts iiinl 
ilccper-lying ti&tucA, and is Maid to prodnce little or no pain if not iu 
loo slrorifz iiolutioti, It diininiithed the di9char}*e quite ritpidlj. 

Ih oplithnlinologists it is employed in ihe eye in thf sliTnetli of 
5 per rrni. in tlic treiitinenl of the vari.-.iia itiJtfJimiKirinns of f/f toil' 
jtiHflitti, but is not aufTicicntly stnitiu for ntai-a uf gmiiuliLr coujuni:- 
tivitis. It 18, however, a very valuable drug in gonorrhcenl fiphth^t- 
milt anil in nphthabnin wonatoriini. It ha-s abo hern rmplnyed in 
ifAnorrhval rvtflinilin, and ns a silver ointracnt in the stn-ngth of ii or 
10 |R'r ccui. wilU co^ujoliuc or hitioliu ujKiri nHpiiurtittiui nlffn and 
hum*. It does not po8«i>e.« any odor, nnrl tlicrefore lia." ii gn'iit 
. ndvaulagn orrr iodnt'orm unil similar sutiataucca which hurc been 
used in this manuer. 

NITRATE OP POTASSIUM. 

Xitre {Pfitnmi Xitrun, U. S. and B. P.), or SaJtpetrc!, occitrt in 
long ueedledikt^ crystMU aud lia» a sharp, saline lasce. Sal pnini-lla 
M faltpetre melted and run into mouUb, 

Next to the chlorate of potassiuin. this is the moHt poisonous of the 
atassium mIis, and produces whon taken in overdose flvrnptoms of 
violent ga^lTii-i'Dteritia. While it doeii tiut affect the hloud, it is more 
irritant thnn tbo chlorate.- 

Nitrate of potnsaitim In rarely employed at praieut, and has been 
Ti>ry properly [lut aside as Inferior to the barmletui vegetable potas- 
sium salts (tbe citrate, acelftte. nnd bitartrate). If useu in rhetimO' 
timi, the dn?e should bo 1 ounce (32.0) in .i pint (A litre) of barley- 
water or syrup of ncucia und water, U* he. taken in divided doses of a 
Tahlespoonful every three hours. Nitrato-of-potaiwium papers ((.'Adi-frt 
J*oltusii yitradg, V. S.) arc miulc by dipping unsized p7tper in a 
tlution of the drug of flie strength of 2(1 paiiit of the salt to SIJ 
parta of dittlilled nater 'I'hey are rolled iuto cijiun^tteit and ainokcd 
by anthmntii-it, or burned in a ]iari lAid the fuiiieii arising from thetn 
Linhuled. Their efficacy luuy bo incrca-Mid in cases wlierp the respira- 
'fcjry tuucoud lueiuhraue is irritable by dipping them in compounil lino- 
tnre of benzoin and exposing to the air long enough to dry. They 
i^hoiiM then be prnt<^ctod from the air until ut-od. 

Tbe paper luied should be moderately thin bibulous paper. 



NiraATB OP SILVER. 

• Nilrato of Silver {^Artfenti Nitrftt, U, 8. and B. P.) v* a heavy 
crytitallinc aalt of silver readily soluble in il:^ own weight of water. 

It M official as the pure nitrate {Afffenti ?i'itrai, C .V. and I/. PA 
and as th« aticksor fused rolls [Ari/entt Nitras /'k»m«, U. S.), or lunar 



DRUGS. 



cntulic. The Utter ar« never ust^il in mc^icins internally, onlj th 
crrstaU being employed. Applied to the tissues of th« body or ottiT 
t!ub.-<tuiici». nitriiU'r of iiilvcr cnutu-8 a brown and Guallj % black etai% 
wliicb i<t iluL* l4i tln^ formation of nii uxideuf silver. 

Physiological Action. — Nitnit« of Hilvor is one o{ the few ostria* 
gent stibstauc-i's wliifli ;iiv apiilifiible to inflamed uiuomim invinbraiiea, 
■a it ia, witb leaJ, bit^umtli. and sine, one of tbe few dru^o of this 
claa* wliicli is not irritant as well a.* astringent. Lor^Uy upptietl, it 
adu in pure furiu *s u powerful caustic, whJcb is. Iiuwever, vcrv 
miperficial In its effectj*, m iLl- drug coagulntes ibe albumin with wLict 
it oaies ia contact and thereby forms a coat which protects the tisiUds 
beneath. 

Tb« uclioD of the drug apon th« circulation, rcspiratioD. aod simit&r 
vital fuDctiuns is only partly known, and has no relation to its era- 
pluvmciit iu mcdiciito. 

riitrateof wiver i-i elimina-ted from the NVRtera very slowly indeed. 

Poisoning. — Aimcwt immediately after the ingestion of a poisonous 
dose iif iiiiraie of silver violent pain in the belly, with Tomitine and 
purging, comes on. At the same time evidences of widespread ga9- 
tru-tfnteritts develop. The abdomin.al wsIIa are ktiotteil and bard, 
and perhaps scaphoid. The face ia anxious and livid and covered 
with a Rweat. When the vomiting occurs the cjecta are seen lo bft 
brown or blackish, or even white and curdy. The lips arc stained 
white, but iht-y rapidly becume brown, then llack. In mime ca*iw the 
nervous syrnpconw aro severe and convulsions with deliriam may occur. 
The convnli-ions nr« epileptiform. Death ensues either from gascro* 
enteritis or from ctntric rcspimtory failure, accompanied by a profos* 
exudation of tJi^uid tiiucus intu the brou4:hial tubes. 

The treatment cmoistd in the iu$e of common ealt. which id the 
chemiuid antidote, the employment of opium and oils lo allny irrita- 
lioD, and in the ingestion of large draughts of milk and of soap and 
wafer for ihe piir]iosc uf diluting the poison and protecting ibe mucous 
membranes of the rcsophngns and stomnch from the action of the irri- 
tant. The Ixxlily heat n)u»t be maintained. 

Chronic Poisoning. — This i^ a fonn of poisoning quite fre<|nently 
Been. The numt. prominent symptom is the pale niatc-blue color of 
the skin, which causes the individual to be livid and douh-hke in 
appearuuoe. 

Argyria, as chronic silver poisoning is called, is caused bj tli« 
continued emphiyinent of the drug until it irt depiisite*) in ttio tiiwuM. 
It iH then found in every part of the body. The firsi Higns of dis- 
ciiloriLlioii can generally be fie«;n in a darkening of die conjunctiva 
over the sclerotic coat of the eye or in a dark line on the inner part 
uf tlic lips. 

The treatment of argyria is not hopeful so far as the color of the 
i>kin is coneorned. but tuc discoloration may be slightly modified in 
some cii»e» by the use of iodide of potaatium to aid in the diminution 
of tile silver. 

Tberapeutict. — Internnlly this salt is used as a cuit for gawtrin uher, 
and it is certainly the best remedy wc pottsesa if combined with exirs 



I 



SJTRATE OP aiLVEB. 



321 



of hjrfMcyamtu) or npitim and given in pill form. In elroni^ ^antriff 
eatarrh and <ja«triti/i nitrate of silver is very iiBcfuI wht-n tin- patient 
is iroaMed witL sour eruclatiouw or vihen vomiting occuru after wealH. 
When ii'fe^l in these stales it »liniil<l lie given in J- tn J-gitun (0.01— 
0.16) (l(»«e<, hnJf tu one hour before each meal, in onVer tVint the 
BioniHch tuaif be expoHed to its eflcctfi and not he protected b^ 
foo«i. 

In intfttmitl uleentlinn llic drrij; lias lict-n liigRlv rreomni ended by 
Dr. P«'p[>or, nnd under tlic-se circuiuiilnnefH tiiiuuld be given in Iiard 
tir kcratin-ciiateii pilla. in order that it iiitiy escape tlirou^ti tlie ftoni- 
ach trithuui being chemically ehangcd. In uUfralion of the etr/'um 
and rrrtam and in arute and chrvnu: dynetitcry the disease uiuy be at- 
tacked by rectal or colonic iujectiooB of uiti-att! of silver. If the oiecum 
is inTolrvd, the solution xn\i»t be given in inr^c iimintily in cinler to 
reneli the jMirt ufTW^Ied. but if the rcetiim \* di.'H'axeil, the nninnnt of 
]t<)uid iiijeirunl aliuuld not exceed 4 otmces, the huwel in either ouso 
being wuhed out beforelmnd by wiurm water to rid it uf fweeu;. Soap 
und water uiil Halt ;ind wati-r niu^t not Iir lined for tluA purpoM, nb 
the iioaj) or Halt which remains in the bowel will prevent the »ilver Bslt 
frvm KCiing. The t*trengtli of the solution employed should be 1 
dnivbrn lo 3 pinl« (4.(J : 1.0O1) ee.) uf water in oiei-al trouble. anr| 3 
gmiiiit (".18) tt» t-ath 4 ounctrs <]2''.Ui in recttil tn>uLIe. If the Utter 
condition is very ubHtinate and chronic, the strength may be increased 
to Scraina (O.-t) lo each 4 ounces (I'20.0). 

Vrhenever nitnite-of.«ilvcr iujeclione are uboiI in this w^ay, a solu- 
tion of Mtli and waur should be made, n-udy for use. nnd injected if 
>Uie action i^ too sevei-e or as stton i» it is thought that tlic drug has 
acted with F^ufficient tborouglinetia. 

Nitralfl of silver was at one time thought to ho of value in latnral 
mnA votiarior apituil ecteruna, bill nirvly tlo4-« good. 

Nitrate of silver ha:; been largely used in epiyp«if and chorea, but 
id now Fcldnui HO rniployrd, and doea little jrood in moflt caBc». 

l>r. \Villiam Pepper thought highly nf tlie eontinual adminiBtralicn 
of nitrate of silver in pill form in the dose of Jl to J grain (0.01— 
It.Ol.^) through the entire atliu-k of (ijpJitjiel Jh'er. and believed that 
it greatly mmlilied the itercrity of the diHcase. 

Externally, nitrate of silver is used for many purposes, and will 
often prevent the jnlfini/ of awflt-pojr if on the fourth or fifth day the 
vpsieled are jiunctureii by a needle dipped in a icnlntlon of nitrate of 
siWcr in the .■•trength of 20 grains (l-'J) 'o the <iiiiic« (30.0) of water, 
flthers «iinply paint the t^kin over the eruption with a solution of 
5 to 10 grains (0.-S:M).tj5) U) tliu ounce (30.0). cluiuiing tliat this 
method is etjuully effective and preventJi inlluiumatiou and iiu[>- 
puratloD. 

Higginhottnm has highly recommended the use of nitrate «f wlver 
upon er;fiii}h-la(vwi irijiaiiuH(\ti'm». but the practice Ih not often resorted 
t<>. and is now ifupplitiited by h<-Tler uieasureit. (See Bryeipelas.) In 
other inHamiQfltions of a superficial chai-acter nitrate of silver is of 
great value. Painted in strong solution over thcfcrotum In the early 
[vttges of erchiiiji or epidt'li/mitis^ it will often relieve the pain and 
n 



ssa 



J}RUO& 



flwclling. and frlnnn may soroetitneH be aboited by ils «arly applicmtion 
iu eonLfntrntfi*! acilutian over tho siirtbce of llic fing^-r. 

In all iiiflammnliiin!! of the jthaniux. tnryiis. J\iurrs. nnil motitk 
Solutions of ailver nitrate art' to be used in varviup mretip;lli. Some- 
times after slight exposure to cold or iliinipiir.'M ihf posterior wall tif 
the pharynx suddenly becomes sore and raw, I'coling 11.1 if the niacoiiH 
membrane had been sciiiified. A soliitioo of uiirale of silver will 
relieve iliis. and if It is employed in the strength of 60 grains (4.D) 
t'j the ounce (HO.O) nf water, tlio application will l>e more efficaciotia 
and lesK painful than if weaker fiidiilinn<i are omfiloyed. 

Id iitrifMijval phthiiiU n H^ray uneil from an n.loinizor in tlio strength 
of \ tfl 2' grains (0.08-0.1) to the ounce (80.0) of water may do good 
servioc. 

In whooping eutiyli Kinger recommends lli« use of a spray in lh« 
strength given above for the purpiwe iif rrlicving the eoiigb iu ita vio- 
lence and fre<itieney and of olitaining a good nignt'a reat. The appti- 
calions aboulu be umde when tlje stomach ifl empty, an they are apt to 
bring on retching. TLe end of the atomiser mnst be within the 
mouth or the skin of the face will be Blaiued. 

in the later »<ubacute stngoii of qanorrhtra. an injection of nitmte 
of silver of llie strengili of gr. ^ (O.O'Jfi) to 3 ounces (I'U.O) of water 
is very iiaefu). (See (ionorrhcea, I'art IV.) 

In uterine ukei-aliuii und in U-arvrr/uni when the cervix is boggy 
and tendoi-. ilie up{jlii'iitiun nf the solid uitnittMif-Kilver stick is of 
service. Its use is often followed by iieaiiacke about ihc vertex, and 
thin in turn is to be relieved by 10-graiu (0.05) dosefl of the broioidos. 

In prurituM putlemii vel ani anil nuli^r a noliitinn of 4 to (i grains 
(0.2.5-0.4i>) u> the ounce (;in.i)) should be painted with a eaniel'i^-hair 
brush over llu* parts to relievf the itching. The npplieaticm is to he 
made from iwd lu fuur times a day. 

Bed-imivii may be aborted if, as soon as tho skiu reddens, a »utu* 
tion of nitrate of silver of the strength , of ifl> jrain* [1.3) to the ounce 
(30.0) is applieil with a brush to the [Mirt. 'Xh\s measure often fails in 
pftmlytiett for obvious reii^oiis, 

BfiiU which begin in a nmnll limited pKpiile with a surrounding 
artja of inllnmmutiun may mmetimea be aborted by painting a strong 
ijolution of thi.s s:ilt around them. 

In gramdnr IhU, vtrnjuvetiviti*. and eimilar nfteetions about the eye 
nitrate of silver in sticK foi'm or in solution is largely and suceen- 
fullv employed, (See C-onjtinetivitis.) 

When it is di«ir<ti to remove nilrate-of-silver i!tiiin.H, they »hoald 
be washed with a solution mode of eyanide of potaasium 2\ drachms 
(10.0), iodine \Ts grains (1.0), and water 8 ounce$ (90.0); or dissolve 16 
gra]nii(1.0) corrosive sublimate in 7 ounce!) (200.0) of boiled water, 
add about 4>'> grains (!)-0) of cooking salt (a scant tcasjMMinful) just 
before uKing, lay the stained iTmt>_>ria.ls in it for about five luinntes, and 
tlien wajih them twn or three timi^n. 

Administration. — The dose of nitrate of silver is ( to ^ "f a grain 
(O.Ol-O.Olo) in pill form. Mitigafetl caustic, or diluted nitrate of 
%i\\GT {Argt'nti Xitrng liiiufa*, if. .S. ; Argenti Nitr»> JfitiffatM, 



SITRIC ACTD. 



32a 



S. B.), is composed of ot]ual paru of nitra.t« of nlrer ani] potasiinm 
niiratc. aud is used lut niiiiUl ciiuatic. 

Tho *irti;; wlifii {jiven cuDtmuoualy itboulil W disron firmed for two 
weeks at tiic ctiii of the oighlh wecJi, as il is «n slowly elliniriatoi as \o 
•rruniulale in the bodj and coufle nrgyrin, ltiit«I-owiri ami Soullior ns- 
eert thnt tlie smultest aggregate amount uii record wLicIi has pruiluciMl 
argrria is 1 ounce. 

NITRIC AOm. 

Xitric Acid {Aciihtm ^Titrmtm, L'. .S'. and B. 7'.), tlic stTongest 
Bnd most corronivc of the minora! acicU used in modioinp. is n clear 
liquid, becouiiug slightly yeltow vitli age. It should bt; kqit in durk, 

PLyHiological Action. — Nitnc acid act«, wlirn in pure form, upon 
tlie lisHut'H of liic boily a-i a iiLWirliil i-iuistic. AppliwI fii llifl niui'oun 
ntefuhmiie^^, yri'll diluted, ii ariw ii^ uii irriiutil or iistriiiKeiit, anil ulicn 
taken internally it exerts u tdiuiidutin^ inthienve over the t^ecrolorj 
ghwds of the stomach ntul !«tuiill iulcttstiiics. It does not t4-ud tn relax 
thv liowpbi, a.<< does nitrn-liydrovliiloric itcid. Continuoil for n long 
iriod of lime in anmll iltvirs, it Is »aid to ctiuso nutiif Milivattou anu 
of the teeth. Nilrie acid (.-ougulutce alluniia. 

FofBoninc. — Whrii tiitriu u-cid in Ukcu iii coucemiulvd form it pro- 
ilucea a nide-Hpreiid j(nalro-enit'ritis. grea-t paiu ill the mouth. (CMoph- 
agu9, and nbdomeu. and finally deatli, from the intlammation induced 
or from oolU[u>«. If the patient siirvivc)<i the uciite Htnget^, he may 
die from MWomUry chnnfrx in the stoiuiich and howcla, such us alriu- 
tnre or destniclion of the peplic luhuli?(*. Thf slaia made by llio aeid 
alioiit ibe niuuth and ctolheii iis deep lent on -yellow, Kcnal irritation 
is iifieo a severe symptom, and the ]iiyi»age)i from tho bowels and the 
urine may ho blwidy. 

The antidotoa are any alkali of a mild ty]H3. as magiieuiuia, chalk, 
or wbitewaoh from the walls i>f the room, the use of oiU and opium to 
relievo irritation, and ihe proper mniiiionanoo of bodily beai. 

Therapeutics. — Nitrii; arid in used uxfernally in iinidiciric as a 
caustic for cha/n'rea and chancroith, the surrounding tissueit being 
protected by nits or ointments. 

It may also be need on warta, in cases of pnnirme to destroy the 
tiMUus, and ou plmt/ttlciiic aieera. Whenever ibe add i« to he applied 
for »yich puriMWce, a fiuliitioQ of soap and water should he at hand to 
neutralize itn eflecia ad Kor)n as it li»» acted deeply enough. Nitric 
arid is also asod extorniilly in a dilute form, -^i tn Hi) minimit (i>,3,'>- 
S.0) to che ounce (31K0}, m a slimuliint and ai^tritigfut to indolent 

Tnt^Tnatly. nitric a^'ld is used 11? a tonic ni.d astrinpent. In the 
nTattr-<iriil Mdlh^itU when oxaluria is present, nitric at^ld will give 
relief when nitro-muriatie aeid <"annot l)c obtained, allhou^li the lu,tter 
^^^ in prefer able. When *mnll vJ'erii exist in the ■iioiilh or xtojtmftlis is 
^^Mreoent, '4 miniin» (0.25) of iiitrie acid at a do'^e, in iviiter, will often 
^^■ne of "ervire. but It should he taken through a tube lo proieet the teeth. 
I In gastric indiyv»tion m which, ((omctime« after a meol, andige^ted 



3S4 



l>RVO& 



food regurgitsti^s into the mouth, a few drops of nitric acid given in 
water iilter meals will oftco give rvlicf. lu intcgUtial Jt/tft-jtuia 
camiiij; un soiui? Uuiirs after uiL>aK aud in wliich not urilv di»i(;oiiifort 
but jiaiu may be fi*lt in the Lypocloiidrium, nitric aci<i witb some 
bilt«r tonic is most rllicient. and it will nflcii euro tbe grren diarrhna 
of oliildrvu, purliciiUrly tliat uiL't witb in ^utumor, bringing nliout thcst* 
■Gauges nut ou\y by \la astriugetii pouer. but ulso hy itK stimtila-ting 
effect on tho intciitiuul glaiida. C<>nibincd with itom« ginrd (x-jisin, it 
will give rt'lief in tlie ehrouir tJuii-rhifa of clilldren aHsociated will 
lieniirtf, and in wbich the stooh may be pasty or watery and at tbe 
sauif time tll-inuelliiig. 

RitigtT rccuiumcnd» the cniplorurnt of nitric acid in the treat- 
ment of /»i7fii. The strong acid should be UKe<l. xnd »imply u>uch*d 
to one or two points, not e*ept over ibc whole surface. Tbe pain is 
very .slight, nr none at all may bo felt. A slough residis, nnd finally 
comes uwar. leaving a cicntrix whicL as il contracts diuitui&bes ihe 
size of the pile. 

Tbe eatuc autbrir also statics that a lotion of dilute ntlric acid in 
tile pniportion of l to 1 drachm (2.<>— 4.0) to a pint (rjOO cc.) of ■nratpr 
is of service in ble^finn iumorrhoiih, arresting tbe bk-eding, cen- 
striiigiug the \HiV\%. aud relieving the sens&tion of weight nnd fulness 
80 often a pressing syiuptoni. 

The d'we of dilute nitric acid (Acidum NUrietuu iHlutum. U. S. 
and B. P.) is :i to l-'> minims ((1.25-1.0). well dilnt«d, and taken 
through a tube to protect the teeth. 

An exceedingly strong preparation, Acidwn NUrieum Fumon*i i» 
official in the U. P. 



NTTRITE OP POTASSIUM. 

Kitn'te of Piitastium is a salt used largely in modem medicine to 
take the place of nitrite of amyU but it po^c»scs greater etability, and 
i», therefore, moitt permanent in ita eflects. It in uBed for the relief 
of angina pectorit or heart-pang, in the treatment of gattralgia, and 
even in epihpsy. Tbe dose is from 3 to 5 grains (0,25-0.8), although 
much larger doec* have been employed. These lorger do«w are, how- 
ever, not devoid of dianger. Nitrite of potassium is elitnioated by the 
lungs and by the kidneys as a nitrate. (See Nitro-glycerin.) 



Oobalto-nitrite of PotsfiBium. 

This preparation hH.s been siigg(;.sted aud tried nucceKtfiilly na a anb- 
atitule for uie nitrite of potasttinm. As it is a more stable componod, 
it is IcfM rapidly broken up in the system, and no cxercisctt a more pro- 
longed influence. For this reason it does nut act so vigorously or 
suddenly, vbirb is a great a<lvnntage in some coeeB- It use is iden- 
tical with that of the r&u of ilio tiiiriic group. The do»e of cobalto- 
□itrito of potasaiuui is J grain (0.08) every three hours. 



IflTRlTE OF SODtUM-yiTBO-OLYCEniy. 



S26 



NITRITE OP SODIDM. 

Sodium nitrite (.VorfiV yitris, B. /',) \a used for tlio same purpoErt 
r*B nitrite of iwtuasium in thr diwc «f I n> 2 grains (0.0"»-0.1) giveo in 
pill or cacbet. 

NITRO-GLTCERIN. 

Kitrd-glvceriu, aomt'tiuiiTt nilL-d [ritiitriii or glouoic, is a com- 
pound vhich, in its pure scste, it) u«eU lai-j;i>ly as au explosive, buC it 
is cQipIovcd in incdivinc iii a dilute form iu« a useful drug in those 
inxtancpfi where a sonipwlmt rapid and powerful effect is to bo cxerclned 
ovDr the va.sciiUr systvm. " As its influence lasts but a abort tinio, it 
Kbniild h« Given every three or four lioiirs. Its physiolojjical aolion is 
lideDti<al wiLb that of tbc other nitntN, siicli lis tht; amyl nitrite {whicb 
'■ee). except tbat it in not do violent or tiig»ci"i]<i as tho bitter nor so 
persisttuiit ill its eiTert-i ns tlio niiritt-s of noibuiii und poUSnitliii. Tbc 
do:io i« 1 to 2 iiiiiiiniK (O.Oti— IM^) of a 1 per cent, nohitioii in a little 
water or iu a pill, and no niort- tbun tbis miiy bw wiijdoyi'id uC one dose 
uiiIma tbv patient tuke^ tlie reuii-<ly tor a. a<ms'ul(frj.h\v period of time, 
«bcaiifi niucb as 6l' niiniin» may be iidiiiinii^liTcd. Often ^uod rt'sultx 
are obtained onlv by giving ascending dotieit. It ix m)teuortby tbat 
kj)atietit4 Ripidly become iiumuuo tu the dru^, and Keadiog has 
»rded a case iti which, after m year of treatiiieni, 1 dracbni (4.0) 
of a 10 ner cent. stilutJon was titkoii daily with good effect. IK V. 
Siewart owt also re|K)rted wimilar eases. Tbe drug is largely eui- 
ploved in artt/ina prctoris (ace I'art IV.), und soiuetinies in epilt:p»tf 
anil chorea and in (/(i»tmli/m. DuCobUi and uihei> have highly 
ciuuicodcd ibis drug in tbc trentment of vhrouie parntchjttiiatoui 
nef/firitu. a« it very uiMtincllv decreiutett the escape uf nlbiimin from 
the kidneys. Iti ii%Ur»(Uiitl nfphritii, with cardiac disturbance ro- 
iltiog from the renal rhange^, in which there Is a marked inereii^e 
iirterial pressure, ?q thitC auscultation reveuU at the eecoud right 
kl cartilage an at^centuuled second sound duo to tbe furcible 
losnre of the aortic leaflet*!, nitro-glycerin often products s good 
Tect by reducing the pressure and relieving the heart of striiin. 
This uM of the drug is its mo-st important applii'atiori. (See article 
on Heart DiAcune, in Part IV.) It is ulten iiit:ii;k!i of angina pecioris 
to be accompanii-d or preceded hy murlced vu.«cular i>pa.-im that 
^nitn>•glyce^in is chiefly indicated. Jn cii»e» of tuthma depL'udeui 
npon s|m^in and cDgorgcmont of tbe mucoiu membrAnes of the 
broncbiul tubes it '\a very serviceable. Iliiinphreys asserts that nitro- 
fflyrcrin i* a most viiluable drug in rnntitinri of oil kinds, except 
itat of pregnancy and peritonitis. Given in the done id" ^J-jj (jrain 
(U.OOfiB) hy|)<>dermieiilly with morphine it prevents tlie nfter-nitiisi-a 
ufiually produceil by opialett. Nitn*- glycerin usiially causes a con- 
siderable inereaAc in iiriniiry flow by reason of the relaxation of the 
reoal hlund-vesxcts whi»-|i it produce-f^ particularly in Bowman's capsule. 
The wnterv sobiliun used in iiiedirine is too weak To be explosive. 
TablcLi of uitn>-gWcerin ITafi.'Jfo' TViuftnut, B. P.) each contain 
rl, of a grain (O.UOOti). The U. S. P. of 1890 iniroduccd a i^piriim 



326 



dhuos. 



Qionoini, vliicb i3 an alcobolic solution of glonoin. It sboald be 
.kept ill lightly-atoppered tins, ncvpr In glass, anil be stmetl in a cool 
place, away from ctent. Its cxplnBircneas is in direct ratio to the 
eraparation of its alcubul. Tin- iIiml' of the spirit is tlie !>aiu« a» tlj»t 
of lh« watenr noliition — namely, 1 to :! minims (0.)i.'>-0.1). LiifUfr 
TriHitn'ni, B. /'., ix pmcticaitv identiual with the sjiiril juM uoiuriJ. 
and is giv«n in the snmc dose. 

ERYTHROL TETRANITRATS. 

ThU ia a wbite crj-Btallinp subatance, rioIuWe in iilcobol. but in- 
solnble in water. It is explosive on (wrrtission or tritoration. and 
\» emplrtvcd in tbi* pUco prnitro-trlycerin for tbp purp<ise8 just naiui'd. 
It \a not as mi«ful. howt-vcr. It« doee is ^ to J grain (0.015-0.03), 
giv«Q in solution or in tablets. 

NITRO-HYDROOHLOBIC ACID. 

Nitm-hydrochloric Acid [Aetiium Nilro-htfcirochloricum> V. S.) is a 
li(|uid giving nff a distinct ciuor, and jiosm^Mii of a very caustic p«iwer, 
tttaining tbi? tiei<(u«d nf t)io body a light yellow. It is official tti the 
fonii of llio dilitlo acid {Additm Nitro-hifiiraekltfnciim IHtututH,C .S. 
and £. P.). in which form it is uM^>t(«s vxcfpl av an ordinary acid. 
When TO wish ti> u«o iho add for its (►wn pi;culiur effects, tin- iiffioiil 
dilute acid ou;;lit always lu be xupplanted by llie freolily-mixed strong 
acid and be of nn orange color. U this cannot be obtained, the physi- 
cian should prepare the compound for himself by adding 4 parts of 
medicmulW pure nitric acid to 16 parts of hydrochloric acid, and 
nllowiug tile niixturt to stand iu au oji«-n botlU' iiiilit llw fuiues are no 
longer given off in pxcvs;^. when it iuut«t be ti^dilly corked and kept 
in a dark place. This acid ought to be freshly jirepared every few 

Poi«onlii£. — The symploma eaused by poisonous dost-s ore those of 
violent gastro-cntcritis vilh vomiting and purging of bloody tnaterialfl. 
Death mav otrcur from jM-rforation of the alimenian,' oannl. fmra inflam- 
mation of the iibdotainal vi^eera. and from destruction of t ho peptic 
tubules or constriction!" of tht- tesopliagus or bowel. The treatment 
coikSist« in the asv of alkalie», such as magnti»iutD. lime, nliitewasib. 
Boap. and oiK with opium to allay irritation. The use of eiternal heat 
to prevent collapse is also to be resorted to. 

Therapentio. — Xitro-bydrochloric acid is nn invaluable remedy in 
many cases of in<li(/f«tmi arising either in the stomach or bowclf, oa 
it acta as a tonic and Klimuhint Co li^erretion. I'pon the biliary flow 
its action is (|uite marked, and it may even cause bilious purging if 
administered in fiili dose-i for some days. It is therefore largely iiwd 
in hepatic torpor, cither acntc or chronic, and in the early stages of 
hepatic n'rrfiom'K sbouhl always be rcsoried to. In the cAroHiV heyatitu 
of hot climatefn it is exceedingly nficful, but it is not to be etnptoy(.-d in 
acute sthenic hepatitiK, aj< it Ik a Htimnhint to the liver, which, under 
these conditions, nee*!? quieting. AVhcn nscd in t'ArOTi»> fi^patitit it 
should be given in full dose and jinshed to it« physiological limit, as 



^•rT^iOVs oxit>F.. 



327 



I 



ATidcnccd hy tbc 1>ilioas purjrinj; produred or hy iugns of gsittro-int«»- 
ttDal iminlion. 

A u-teful mMiUot>»l rnr»ns for ohtaining the lieneficia! effects of 
lilts ai'id is to iii*e il by n)<-tiii<i of the fool-batli or gcnonil bulli. As 
used b; Johti.<u>n in India, tlie ucid for tbia buih i:* pix-parcil hy bIowIj 
and mrefulty ndding Wgothcr 2 part» of tiitric ai;i«l. 3 [mris of liydro- 
cblurio acid, luid afWi' fnvnly mjniitn< mixing RarcfuUy with chrt4t.< dis- 
liUed water A parts. Fur tue general I>nth (in a nonden tiib) take 5 
pailfiila of Tiat«r, 64 fluidouncci) (2 litres r) of the arid mixture, and 
enoiigb hiiiliB" water to raise the temperature to 98°. Keep the 
{latieut ill iLl- (rath twenty iiiiniiteii. Thun rub him thoroughly witL 
warm towels and platiit him in a dry, wartn bed. For the foot-bath 
add 6 ouncea (180.0) of the acid tn 2 gollons (7 litres) of water at 
9H°. and Imthe the thighs and calre;! of the legs for twenty niiniil«fl 
with a »]ion;;« wet with the nii.xtare. Thie is a very useful treatmL'Ut, 
accordiuff to Stills, for caiten of nlaihvlic hepatic torpor. If in either 
case the skin becomes irritated less acid is to be u»ed. 

In ordinary so-called hifii,\i»neii». which in not bilioijiim'^a. but 
inte-iitinal indige!*tion, this acid is often of j^reat service. (See Indi- 
gestion and ItittousneKH.) [t in aUo of valuf iti hentrric diarr/ifa 
where the dywnttry roi^ults from defective secretory action on the 
]>art of the glands wliirU pour out the proper fiiiids for ilijre<tioii. 

Another very imporiimt aciion of iiitronyarochloric aeid is the re- 
inettial iiilltieiice itext-ri." in oasej" siifferiiij; from '>rohiriit. partirnlarly 
if this be ass-cinted with melancholia or jtrcat doprwiion n\' spirits. 

AdminlstratloD. — The strong frnshly-mixed arid should be j-iven 
t*>tbe adult ill thi- dose of 1 to :JTnitiim3(0.06-'>. 18) throe tiinetta day, 
widl dilHii>d. and t:iken through a tube, after ineal<<i. If rhc paiient in 
inlf-tlisrenl. he should be ordered ^ ounce (l->.0} of the pnre acid and 
tfdd how to drop il. If he is not, the physician must order it partly 
or eniircly diluted in the prescription, and in so sniall an atnouat 
that it will be renewed before it loseii any of its power. Warning 
ftliould be KiveD of its effects on any clothof! with wbich it may cotn« 
in contact, and care should be taken that the bottle is ludd some dis- 
touce away from the fate when the cork is withdrawn, as the ucid, jf 
it is fresh, may spurt ont and burn the eyes and face. 



NITROUS OXIDB. 

Nitrous oxide or nitrogen njonoxide \» iromotitnoH called protoxide 
of nllrof^cn or ■' laughing eas." Its power of relieving pain was first 
recognized by Sir Humphrey Davy about one hundred yean* ago. 
.\* with ether, so with iiitron* oxide, itM first tise as a surgical anns- 
tBetio wan by on .Auiericnn. Horace Well;', a dentist. 

This gas It obtained by a complicated process which requires tha 
use of sueh cnmbereorne apparatus tlial its manufacture is out of the 
question for the ordinary practitioner of medicine, while the fact that 
sevenil largo firms prepare the gas and sell it in cylinders r«adv for use 
nndors it« pre|>aration on a small scale aiineeeMarjr. The gas is devoid 



328 



DRUGS. 



of oilor, but poftieB8«tt a sli^htlir sweet Ca.<)t«. [t may be k«pt in gase- 
ons ibrni or liquefied and allowed to become gaseous us it i* lued. 

FhTuolo^cal Action. — Owing to tbe syinplotus tiuni«tiiii«i produced 
in pnticnt.4 inhaling this gsts, it \\m receivt'd tbe popular diuu« of 
"laughiii}^ K**-" but a cunditiou uf liilarity is ra-reij wwn when tlie 
inbalfttioD)' urc full snd deep, and only cotiiee on in tbe tnajoriiv of 
ciutrs wbrrc ibr pis l» tnken in ^mfkll nnioimiH or verv dowlv. ^^ ben 
osed properly, the patient is directed to lake long, deep inspirations 
from the tube plaeed in tbe uioulb. lb« nose being beld wi that ibe tios- 
trils are cloi«e(l. Under these circumstances the face becomep for a 
moiuent fluishcd, thpn of n deadly pallor, and finally the juvf drops if 
the ffPeut is very great. At this titne aiiw^theaia is complete (ind the 
operation is to be rapidly performed. Uwiu;; to tbe fact that wbeii pure 
it is devoid of" irritant pryporties. this gas can be tided when ether and 
ohloroform are coiitraimlicatcd. 

According to i^oinc careful studies upon tb« action of tliii* chs 
(Kemp), it hns no direct effect on the lieart and vuaumotar Hy»tviu. But 
indirectly it eau.^ea a, rise of arti-rial preAsnre by tbe i^ligbt aiipbyxi>i 
which is |ir"diieeil. The iiHtentlK-siii n»ay be due in part to the 
non-ovygcnaiion of the blood during the time the gnti ir in ibis fluid, 
but tbe ga.^ pruduoca uua»)tbe9iu aside fniui any sueb inHuetiee by u 
direct acliun ou the cerebral cortex. It is a euriituM fact that the 
cnnj iineti vnl reflex ia often preHirved alVcr general aim-RlheKJa is 
preitent. It baa been thought tbiit the u.-tc of ibiH dnig produces 
letopiirary glycoauria. but n-cenl studies ivnder thia doubtful, lo iiay 
tbe least. U'litTe permanent glycosuria baa been produced t-ome 
injury to tbe vascular Byetem in the region of the rlinbetit: centre in 
the floor of the fourth ventricle lias in all prahability occurnd. 
Nitrous oxide gas *beu iubuled very rarely produces any disagree- 
able HlhT-elfecl«, «ive » little lif>bt-beaded sensation or dinxiQcss fur 
a few IiHurs, 

TheraueutiCB. — >'itrous oxide is a useful auivtilbetic in all minor 
opcnLtioiiH, siieli as npeniug an abhcei^s, boil, or felon, or even ampu- 
tating a thiiuib. It is us(.hI by nmny surgeons at the present time 
for tbe pur[)()&e of beginning an Hiiie^ihi^<lu> which ia to ne continued 
by ethi't' or ebluroform. The ga»< jiOitscMes two diiiad vantages, the 
first >if whiL'b is its brevity nf amion : llie other, ibe difiiculty iu 
carrying it frou [daet.' to plai-n. It possesses a great advantage in 
Almost absolute safety, very few deaths Laving been caused by it 
directly. It is the Mifc-it of all aniv«thetic«, not oven excepting 
cocaine, which latter drug bu.-' largely isupplaiited ihc gas for umuy 
minor surgical operati<jus. When teeth arc to be extracted, a [dug 
or cork is plaeed brtneen the jaws before the gas is given, to keep 
them apart. The <-(>rL should always \*n attached to a .string, so that 
if it slip» into tbe back part of the mouth it can be withdrawn befor« 
it chokes the pniient. 

Oxygen ga« may be utimbiuvd with, nitrous oxtJc gne with as grcut 
advantage as with the vapor of I'ther or cblorofomi. allhnugb its QM 
may delay to ft slight extent tbe cleve]o)iiiieQt of anieiithe»ia. The fol- 
lowing ebisses-of [tersons, aeenrding to Hewitt, do better witli the mix- 



tfOSOPHEX—XCClED/. 



329 



tore of oxygen •tul nitrous oxk)« ihati with tlic nitrous oxide alone: 
1. CbiUrcn (wliu witb uttruun oxidi- ulouc an: liubli; to itit-onvenicnt 
Jsctitulioii); '2. Aiia>mic ami ilubiiitatod [laiieulH, who, like cbiMrcn, 
(juickly uxfailtit miD^ciitar contniclions, and, in ititdiiitiii In tbitk, reuiain 
but a very abort time und4>r the inHiioiice of nitroiui oxido aloni*; ^, 
AiiY one wbo bua [ircvioiiHly oxbibitL-<l grunt Hu»(.'(.-|)tibilily to nitruiui 
oxide per »e (such ^iiticnls arc difficult aubJL-etu tu iiia.ii:i^<.' in danlsl 
practice bcciuiHe of tbc abort perimt oriivaibibleiuiic^iliraiii); 4. I'litii-nM 
wbo, under nitroii» oxide a.loni>, bnvo experienced bi^lily n nphvi^niit 
aenMtiuus : 5. PuticnU* Yfrj'advuiitT<l in VL-urs; it. I'atieiits willi very 
Iftfgo torwtU; 7. pHti«iit3 Huffpnuj; from lit-iirt or Uinj; afTectioiia. 

Oontrauidications. — Tbe jjas nii^jbc noi to be given to tliose wbo 
'are advamni in yi-iirs or bftve al^K'lMtlla^>Il!» blood-vi'iwoli'. since tbe 
rise of arterial pressure cuiisei^ufiit upon ibc nspbyxia laay ruptnro 
a cerebral blood-re^sel uud ibet%by causL- uii apoplexy. 

NOSOPHEN. 

plien is a .«Hbstsnce obtained by tbe action of iodine on solu- 
I pbeiiulpbtulem, &ud m a ligbt iiopulpablc powder, witljouc 
tMte or odor, and of a yellow iali -gray eolor. It ia said to contain (il.T 
i»r cent, of iodine, ^nsopben i.s itisnliible in nearly all sotrents, but 
E)s solable in alkaline snlutinn-i, and wLib nlkalieN ii f'lrms RallJi. The 
'bkh of tbi.H sub8tanc(> are prsctlcitUy idouiicul witb tliusc of iiKlofonu 
tliat it excrciiwis a favorable effect on ti(«ui's by reiiBun of its iodine 
^ id drying properties, its bulk is four tiraew greater than an equal 
wngitt of iodoform. Wben osed m nn anci)>eptie on Horea it t>bould be 
brought directly in contact wiib tbe livinj; tissue, mid not dimply upplied 
to the pu9 nr scab eovering ihv part. As it will i^riitid a bi^di Iit-at, it 
can be slerilijitn] by t^xpomtre up lo 220^ F. nitliout decomposition. Ita 
lack of odor is a great udvimiage in its use. 



NUCLEIN. 

The animal body lias several methodn of protecting it.self from the 
LKttack» of iofcctiDX micro-orguiisms. Oue of tbese is by plinguey tosis, 
'Of the devouring of the germs by tlie cells of tbe body ; ttie ouier is by 
the proteetire or eermicidal inttucDCC of tbe blood-^^nim. It bos been 
proved that tbe Tatter p<jvtfr dependo upon the prestencc iu the blooil 
of certain protcid-like bodies rich in phosphorus, which can aUo be de- 
rived from cell-nuclei and other sources, such us yejust-cells and many 
^Miioial tissues, ^uvlein ia a weakly acid body coDipot>ed of nucleic 
arid and soiui- fonn uf proletd matter, and it not only iiRTi-asi-s the 
germicidal power of the blood-serum when it i» given to man nr one 
of the lower animalft. but in addition it caintes u great iticreiute of leu- 
cocrtosis, which of eonrne aids in phagocytosis and probably results in 
the production of still more nuclein fi-om the leucocytes. 

Naclein, n* placed upon the murkot. is manufactured, ust. a rule, Irom 
It i& prepared in many difTercut ways and muL-h of it is unreli* 
able md possesses none of the ohanictcristic« of true ntftlcin. Very 



330 



DRVOS. 



recently Chittenden of Yale rnirerfiity has utatjsed the v&rions nn- 
clcin {>reparatitins on lh« in&rket; bdiI liv finds a proparaliou called 
''nnrlcin etftmlnrd " (o contuin no pliojpfaorus, nod, as phos|)hunis is a 
prumiiii'iii ouiuittuont iir iiii(-li<ln, hi- «iys it ■'sccni.i olivinus lliat tlip 
solution contains no nuclein." " Protonuclein," another proiiaralion 
of this characier. contained 1.25 per ccuc. of phw^phoras. and iliercfore 
contains in all probability nticlein. iind the improrcd niiclcin wlution 
of Parke. Davis k C<i.. wliifli is a 1 p[*r cent, solution of pure liucU-inic 
acid from yeast, contained tJ per cent, of phosphoms, "vbich would 
imply tlic prt-scnce of even more than 1 per cenl. of such a nncleic 
acid ' (Chittenden). It is cTidotit, ihoTcfore, that this prepamtion of 
niiclcin is a good one to me iu teitting thi« laethml of ireatmuut. 

Therapentlca. — Nuolein i« used with asserted great success in the 
treatment of tlie ordinary tonus (if pttlmonartf tvherruiosit ami for 
aeptwmuia. Tbdoroiically it sltould prove useful in eombating any 
infcutioua pructw*. 

AdministratiOQ. — The proper way to nse tlie niiolctn Boliition jnat 
nanii-d i.H In ^ivc 10 1o tiO rciuiuis (*l.f]5— 1.0) liypodermically once, 
twice, or iliric* a day under earofnl aiitiHL>ptic prcoautions ; or tfl giv* a 
Iwutpoourul H-U) in a wiiiegla.'uiifiil of watiiron an empty stomach ilirici: 
during the day and at hed-limc. (.'aphides which contain '2 grains 
(IMiJ) of niirlcinic acid may alflo he lu^ed. 

Contraiodications. — Tlie nuclrins dhoiild not he j*iven for a long 
period of litiic ro >;outY per^oiLS*. thcM' patients usually have uric-acia 
troubles under their ui!c, us nuclein i« an antecodcnt of uric add. 



NUTMEG. 

Jfffrutiea, V. S. and B. J'., or Nutmi*g, ie (he kernel of the seed 
of Mifriiitira fr<t(fr»n*, an Eaat atiil TiVc«t Indian plant, mace being 
the ontaide covering of the same. Nutmeg is a soporific and nervous 
sedative. e^crciMng a peculiar inllucnco over the cerebrum. It is 
also usc'd as a fiai'oring Bubt(taae« in somQifacicnt inixinres, nod is of 
value in pri»criptiona for tvraas diarrhoea. The oil {Oleum Hgrit- 
tuNF, V. S- and Ji. P.) is givfn in iho dose of 1 to 'i uiiDitns (0.05- 
0,1^), The splril or esj^cnce (.V/ymV«» Mtfrtdica, U, »V.) is used in 
the dose of 1 lo :i fliiidrnvhms (4-0-K.O). 

Sevenil insiiincfs of poiHoninp; by uutmeg are reported; a pcver« 
cnae l>y Or. Reading, of Wiioclbnry. X. .1. 1'hc symptoms closely re- 
Bonihle tha'te produced by cxcoRsive doses of cannabis Indica. 



NUX VOMICA. 

Xox Vomica ( U. S. and Tt. P.) is the stcds or beans of the ."^trtf^ft 
N'M A'tLT't'omka, au East Indiun lrv«. It contains two alkaloids, 
atrvchninc and hrucine, and depends largely for its medicinal power 
Ml the former. For ihin rea-von the statementa made in rrgard to the 
(divftiolittfical action of strychnine may practically he woHidcrcd as 
applivahlu to the «uiire drug. 



FicM. 



Physiological Action. — Whfti «tr^-clkDtnc m given tu man or tbe 
lan«r nniijtuU in f'liil ini>ilicinnl dow it iiicreiist-H reflex nctivitj, re«- 
piniiiirv rate, [itiNr- turw. arl«riiil press- 
arv, tilt" aciiiiv of yiiifll, vistion, iiiiil iK'ur- 
iii'^. and cau<M-:4 "ciicrul syttlcmiR irritHp 
liou or excitoiueril. 

Keiivops System. — On tt« uervoiw 
aysietn etrjcboin« excrU itn chief luflu- 
eoce- It exril4?» the spinal cord iti its 
DKvior tr»ci9, and probably increases tbe 
roccptivc iictivity nf ibe sensory cviuri-a. 
It hIm has Mine !^bgtit inttiicrico in ia- 
cnawing thu cmiiiuftive power o( the 
tnol/ir and aensury uer\'e». 

In wvenio?* strychnine proiliiccs spi- 
nal or t«tunic convuLiionii bv iin netion 
ex«rtetl on tbi^ npiniii cunl. When enor- 
IU01I3 (lo84!«i are given iutrarenouslT. total 
puntlyMS, rr«L'inbliiig thai riLiineil by ctl- 
ran>. preceded t)ie ci>nv*il.iion>i. nnd if 
artiScinl re.'<pirali<>n it* mM ii^i'd ilie ani- 
mat die* fnint fnilure of rt«piniiion. If 
death takes pluee fmm the efi'i-cts of the 
dnig. tbe iiiutur nerves are t'ouiid to be 
depres&ed, partly as tbe result of the 
{nisoDooft action of ibe stryclinine, and 
partly as tlie rennlt of the exbuu:«tioii of 
the nerve-truukM i)y tbe eouvukinjr im- 
pabes which ihey have cnrriefl |Fig. iiO). 

OrRctii,A7H"i\. — Nhx vmniea increases 
the force of the pulse-beat and the puL»v 
rate by » siiniiiluliun of tbe beart-iittiscle 
and its gunglto. while tbe ri»c of arterial 

EreMure which it cauKefi is due lu stimu- 
ttion of the vawmolor ttentrc. If very 
poiaoQuus diravi are injected intravenouMly. a f:iU uf arterial presuira 
oocnre itutead of a ri^. which is due to vatiuniotor deprei>«i4D and 
panilyitiii. 

RBi^piration. — Strychnine is on« of the tnost constant and pow- 
erfal stiiuulauts to the respimtoiTr centre that we have, and it not only 
iDcre»^c» the rate, but »ho the rpspiratory capacity. 

Tkmpkkxhre. — Ordinary dodps have no effect npon temperature. 
but jKiiaonoaa doses may raise it by reasoii of the convulsions. 

E1.IMIKATI0.V. — Strychuiue is eliminated from the body hr the 
kidncyft a3 strychnine and strychnic acid. Most of ir is nxiilized and 
diwtroyed by the liver. 

PotooDlng. — When a poisonoug dose of strrcbnin© in taken, it act« 
either suddenly or gradually. If Hiiddenly. the ni&n or animal may 
he, without any premnmiidn, thn>wti several feet and become rigid 
by contraction of bis muttcloti. If ibc onset is gradual, wime stiffness 




J, Vox T(>tii1i?a jilhiiulM<-» lh<- inuiiir 
inti'U 111 !li<' tiilnsl rrinl iiiiil 1<> n 
•llljlil r\[i'!ii ltll^ ri'-iVi-truiil!'! , 71, 
in lai);i'. [«tl.<»noii!> <I>nrii li ilu- 
prtsmi tlic nrnlur tirfvi* i-liiu- In 

tivrru-lrunlu. 



• 



at lh« back of the ne«k and nneaey starttngs mtty pT«c«<l« the gen- 
eral nerve-storm. 

Tho convulsions aro tetanic, or, in other wonla, tonic, and the 
boJy i.i (linmti iutu opiatUoluiius ; tltat id. rrsting on the head and 
heels at each con\-u!sion. Uarely the trunk is ivfintci sidcwise or the 
flpxion of the body i-i fiirward ^prapmslhotonos). The L-yc» arc open 
and fixed, the comers of iho mouth drawn hack into r»irM* s<trdonuru$^ 
mid respiration duriug a ^t-vurc couvuUion i» inipoA^ible, owing tu 
the re«pir«tory mu<)c]e!> being in a utaty of tetanic ngiditv. 

The slighteflt noise, draught of air, or touch may cause n cimrul- 
gion or convulsion afc«r coDvuhsion, because the sentsory iiopnlHe, 
reaching the spinal curd, cau8(»i a spasmodic motor impulse to be sent 
out to the muscles. 

The convulsions are not ahiMilutely continuous, hut iierloda of utter 
or partial relaxation occur, during which the patient breaihea easily. 
The cnimp-liku couiraetious of ibe muscles are exceedingly painful, 
and tho patiout eithf^r dies of cramp asphyxia — that 1%, Through tail* 
urc of rt'flpiralinn becauHe bis chcat-mu-scica arc lucked in spasm— 
or, much luure rarely, fruni exhaustion. Reicliert haw shown that 
it reijuireH live hundred times the ordinarily fatal dose of etrych- 
nine to eaune d^'aili in anLRial-t if artifieial n^piration is properly 
niaintnined. The a/erage fatal dose for iin aduh Is 1.} to l| grains 
(u, 10-0.1:,'}. Heath liii« occurred from \ a grain (ft.l);^) anJ recovery 
lifter sniillo«iiig 11' gniiiis (1.2.')). 

Treatment of Foisoning. — The attendant should give at once, if do 
Hyniptomn have yet appeare<l, inbalatiomt of nitrite of auiyl, and mcan- 
vrhile employ the stomach-ptimp, U8iu>; the uJtnte U> prevent any con- 
vulsive lendeuuies durin" the operation. Draughts of water contain- 
ing tannic acid, a* the clicoiieal antidoie, aro to be aihiiini!»tercd, and 
after the .stuiuaeh is wa.shud out 60 grains (4.0) of bromide of [MJtas- 
sium and 'XO grains (I-'l) of chlond in solution are to ho given. 
Thaw are the physiological antidote.'!, for the bromide of poliLssiuoi 
(Wpre-ises the 9eri.sory tr&ets of the spinal cord, and the chloral ileptyswes 
the motor tract;!. If the eonvublons prevent swallowing, the {xatient 
must bo chloroformed with care, and the physiological antidoT« given 
in starch-watrr by the rectum, inii.tcidar i-eUxntion being nutinlained 
by the anaesthetic until the drugs are absorbed. Kther cannot be used 
as a relaxant, as it ia too irritant and too slow. Nitrite of arayl is 
o physiological antidote, but it is usolexd if a complete convmsive 
attack is present, aa it cannot be inhaled if the cht>st 1.1 imniovuble. 
Neither can any other relaxant, such as chloroform, bo used under 
these circumstances. These drugs should be gently given hclween iLo 
paroxysms. If relaxation does not oe&iir, the nitrite of nniyl nbonld 
he injected hypoderuiically. 

While a llijht touch may produce a spasm, it is said that a firm, 
hard gnuip of the limb often relieves the pain of the cramp. Sensa- 
tion and oonnciniiHn(>>« nre preserve<l in stryelininc potsoninfi; unlcsiH 
the asphyxia ohtiimt^ tlii-iii. 

DllTerentlal DlagnonlK. — The convulsions of strychnine potsiininc: 
do not resemble epilepsy, because they arc so distinctly tonic and 



ijL'ver clonic. From tetanus etrj-cbnin© poisoning is to be separated 
br the fact that in tetanus tho Unclcing of thi^ javrs coraes lirai. wliile 
in .ttrrchnino poisoning it comes last. The con\iil9iotig of tctanu9 
rarelj, if ever, comjtletelv relax, while those of strvcLuiuu do tiuve 
perioiU of roUxatiuQ. Tu«re Is s different hislorv ni vsieh case — in 
one perbapfl uf an injury, aa of a n^il nin intn tbo foot ; in tii« other, 
of a (lose uf fmiHon haring been KwallovrecL 

The differenlial diagnosis of strychnine poisoning from hvslerical 
eoQviilsirtng in more ditficuh. The convulsions are rarel^y sn pprslst- 
cutly (ouic in Iirsleriji, and the peculiar cspreswion of thi; hyRtLTicttl 
face i» oflen seen in such eaxetj. The history of the patient, if abtaiu- 
able, will throw much light on the caee and aid Tery materially in the 
Bepai^tion of the two eonditionH. wliile the jieruliar v»riiiiinnR in 
cutaneous sensibility, »u«h o.» areas of typereesthcsia iinj anaeittlietiiiu, 
which are m characteristic of hysteria, may render the iliagnosis pes* 
sibk-. 

An the treatment of all these states h virtually IdirnLical, the 
employment of the meadure^ just sugj^eslcd may be resorted to in 
each imtlnnre, ami the diagnosis made afterward. 

Th«r»p«irtl«. — Niix vomica, or its chief alkaloid strychnine, is 
nscd for several pnrnoses in medicine. Owing to its bitter character- 
istics it may be employed ft* n simple bitter tonic or as one especially 
infiiieucing the uervoiiM system. It may also be used as a respiratory, 
cardiac, and ocular stimulant. 

In outes of funHioital nervous atony, or depreseinn, strychninft 
doM good, bat in organic disease of the ncrvou8 i^yetvut, if ui«cd during 
ihe period of acute infiauimatioii, as soon afVer an iL|.riipli.'.ty (ir in acute 
infantile palsy, it iit diotinctly harmful. Snme persons who have 
suffrrcii from apoplexy can never take the drug without a sjiosm com- 
ing en in the paralyzed part or parts, probably through irritation of 
the pmbahly degenerated pyramidal tracts. In acute or subacute 
Dpuntis strychnine ought never to bo a?ed, as the nerves are iilrenily 
inllaineil. and are not tu he still further irrilutcd by the employment of 
nerve exeilants. In pr'.'i/r*-»»ivi- /wirf /xi/tr^ lar;;e doees of stryolinine 
should be runslantly used to stop the process of the diHrase, iodide 
of polassium ah)o being employed to cause the ctiminatinn of the lead. 

In amauroris dependent upon the excessive use uf tobacco or aico 
hoi strychnine is almost a specific, and in eye-strain resulting from 
lOsuflGciency of the ocular musL-lc* it docs great good, curing the iusuf- 
Bcieney and improving the general condition of the muscles. Accord- 
ing lo de SchweinitB, the patient should uae ascendins doses of ihe 
tinetnre of nux vomica, beginning witii '6 miiums (H.l/ij three tima^ a 
day, tkud increase the amount ^ minims (H.l) a day until distinct 
physiological effects are produced. Sometimej^ (tU minima (4.(1) miiy 
be lakfn in twenty-four houre. Keccnt cxperimenta made i>y the 
author indicate that conhtantly increasing d'lses, instead of decreasing 
the person's suaceplibility to the drug, acliiaity increjiec it, so that a 
moderate dose produces greater effects after gome days of use than 
& full dosv d<H.-H at the start. 

in pneumonia and all other acute diseases in which sudden collapse 



id liable to occor strrchnine U of the grentent wrri™ a,l ilip time of 
lic«l. On«a it will pull lh« pntJcnt out of a ciriking attack vrtiich 
swms ttnain to end in <i«ilK. It slioulil W nwil frwly I»v Uie livpo- 
dcrtnio n<.i.*'ll<'. iiini i* often aiilfil in proiliioing its giuni efiwts liy ttie 
■ildilicin of jj^ Id jf^ ;iraiii (O.(lt)04-0.000tj) of atropine to eacli injec- 
tJon. {Sec Viieumotiiii and fsliock.) 

The author il(»iirpa to protest most emphatii^ill; ugaiost the common 

{irnctice of tlie ilaj. which cynijisis in llic use of strychnine m « circu- 
«Corv ttiimutant ihntiigli prnlongcd f^xhaihsting iliricff5. It is cKscutifillv 
A whip to the flaftginjr heart, to he used at a crisis, but not foutiiiii«f 
i for da^.s, CaKcs iirt- consiantlv ^ieeri in inhich the persisttnl use of 

Ihe dnijt in ferer pi^ducts a rapid running pulw and grent nenfoiiR 
' irriTniion and prolonpalion of tho fchrilr iiiovrmt-nt. 

Th*-i"c \» no 'Imp Icnnwn which is so aiiliilota] to llu- tlFeds of ov*r- 
doscsof chlwruforui as is strvrhninc. In ca-ses of siiddt-n arcidenl, with 
arrest nf the luvirt or rewpiitiiion ihmng the use of this ana'sthftic the 
phy.fician .thoiilii give a hj pudt-rintc iujtwtion of ^^j grain (O.OlKi) of 
strychnine as n |Kiwerfiil, mjiiilly-aciing rnrdtac and respiratory stiimn- 
Innt, which Jomi way W repfatcd in Ivn miuutvs if uo t- HVct is produced. 
Strychnine is a very valuable remedy in xariftcal ahoek, and is abetter 
antidote to opium than in belladonna. 

In liynpii'V^i from anv caii!ie, fiich n:^ ihurt of old pcnuiiis !<ulTering 
frotn winUr c</a<jh or oronchorrfiwit. in nnp/iffgi-rui, fihthims, iii)d in 
nhurlNfi* of brcatli. t^trvL-huine i»i uf j^t'i'vic^'. aud it i« a valiiahti» drug 
fur the treatment o£ opmm-p<ti»o»in</, because it prc^rvea the reflexes 
and Kiimiilates tho rcsjiiratory centre. 

ta at/mt/ of the buwrU ctr^chnine i^ of iicrricc. and it i» to he added 
to ]iur^ttv(.' pills to avoid tlieir dtprewiiiiji alter-efl'ocl oii the iiiU'slint'S. 

In casrji of hitaipfrijiti, Mrychnine may he used to keep up the 
nutrition of the limlm which are parolyzed ; but if the paralvsi* be due 
to disease of the trophic cells in the s|iiniil oord. it uuee little j^ood 
except to stimulate tho reniaiuiu^ cclli! to j^'ater eflurt. 

Accordiu^E to llinjjrr. «i<-k hrfiHarhrti, due to rrrors in diet ftsd 
wilhoiti miiL-h nniisea, can he put aside for the day hy the um' of 1 
minim {D.ll.l) of the tincture of nitx voniiru in n teii^poonful (4.0) of 
water every five «r ten minuter nittil \i) inininii^ (O.li.'i) are talteii. 

Strychnine poswssea no curative properties in chronic akoholititn. 
Owing to itA powerful .>ttintulaut prupertie.>i it may temporarily hntoe 
the TiervouB system, but its pmlonfied use i.i danjreroun. It should 
bo employed temporarily only lo rninhat great dopressirin nf the iiyijtem. 

Untoward Effects. — Care rihould be exercised in giving plrychninc 
to children, .is lliey are more suscfpliblc to the drug than are adultK. 
The proper beginning dose of slryclmine by the month for a child of 
6ve or six ytars is not mort- lliati j^ grain (O.OOOtj). In Ronio casea 
of exhauijting discaiKr the prolonged use of full doses of flrychDinc may 
produce a talkative delirium with great pecTiiahneM). and. if the drug is 
c>intinued. this condition m;iv pft>« into a statr of temporary insanity, 
ftninton assertji that nnx vmniea nmy indutre malarial HiilU in thoM 
prcdiripoiied to them. Ileaisoti-seris tlmt atr^chtiine acts more power- 
fully when given by the reotuni than by the tirouth. This is d^'UhlfnU 



L 



OPfVU. 



335 



1 






AdmfailitraUioa. — The extract of niix vomica {Kxlrarttnu Niu-i» 
Vf>m!r4i>. ('. ,V. anii li. /*.) is given in the ileis* of | to | of b. graitt 
O.Ol-O.Oltit; the flniil exirairt ( Kj-trarlum aVucu Vomieir FfuiJum, 
'. .V, ,• Extrfftum Xwit t'omt'er Li/jui<IiiM, H. I'.), in the tlose of 1 
to 5 minima (11.05-0.3): ihe tiiictan- (T^nrturit ym-ix I'lmttw, C S. 
ami B. /'.), in the doso of 5 to SO niiniius (O.:i-2.0). .Stryehrtimt 
Sulphaw, U. S., and Strychnine IlTdrochloride {B. P.) are given 
hypO'lennlcalW in the dose of ^ lo -^ of a (rf'" (*'-0n;;_0.<H)3). and 
ht the mouth in the wime amount*. In ra.*iefl «f severe f>nrt:ica) shock 
miieh a« 1 prain fO.mfi) ninv he used I lyjxidemi it-ally. The B. /*. 
L-o;;DixtrN a ^uliilion (/./^itt/r Stryrhtiiiur Ilydrochlvritli); iluse, 2 to 
8 miatnis (0.1-0.5). 

OPTOM. 



^P Opium (C. S. and £. P.) ia ihe Juii-e or milky exudation appear* 
^pwif; f^n the surface of the unripo enpeule^ of whit*> [M>ppy or Papavtr 
»"mn(frrum, a native plant of Asia, now grown in muny other partii of 
^Lk world. 

^B Good opinm, according to the U. S, P., should contain at lea^t 9 per 

^^«nt. of crystalline mor|itiiiio. but lh« powdortd opium {f'uhijt O/iii. V. 

IS^) should contain nut losg thnu 13or more than lopLTeeiit.ofniorphiDe. 

^K The chemienl composition of thi.>< drug is yer^' complex, no tcss thnn 

^Bftvcntceu alkaloids liiivin^ huen obtuiued fmin it, the ttiosl iuiportuul 

af whiL'h are morphine, eudeine. itarcutiue. thebuini'. niLFceine, f)n)>uver- 

ine. pwuilomorpmnv, and laudHnint;. It aUo uuntoins uecunic acid 

and nieconinc. 

Pbytiological Action. — llje nctiuii of L'piuni U]ion nmn and tlie lower 
a niinalb v.-iiii-s with the dej^ree of intellijienee or cerebral development. 
^^b qaiet^ the hrain and exeitcs the r^pinal cord. 

^B rfEBVOtrs SviTEM. — Tile doiiiinunt nciion of (ipiuru upon man is to 

^Brodurc nervous sedaiioii in funitll doses and ."Icep when -/wen in larger 

^^VRonntn. Some^inle!^ however, in peniOTiR who are neeuslniiied lo its 

iLMi, it prodnce.s a iitale of renllct^ inaouinia or i]iiiel, Wiikefiil npathT< 

When given l*> frogs it often prwluee*! lelanie convulsion?, owing lu ita 

primary eltranlaut effect on the ispinni i-ord. In dogs it increaACH the 

reflt>xe!t and produces dn)wsine!w. and in luan sleep. If, however, the 

^_fi|tti«nt be » mctuber of one of the lowur ruc«e or u youii;; child. 

^^■0 spinal irritation may be as manifest a» the eerehral relation. If 

^^irge doses are civen, tdccp in produced in all animals, and both tlic 

hrain and »piual cord arc depif^ed. The mensi^ry nervea are also 

markedly benumbed, atid the motor ucrvee may finally be rendered 

inactive. 

ClBcl'i-ATirix. — i^niall therapeutic dows of opium have no effect 
^upnn the eiroiilation. but large ones hIow ihe pube, increase its forcf, 
^■Uid slightly rrnite arterial pressure. 

The sloM'ing of the puUe depeuilit upon Mimulation of the pncumo 
gutnc nerves pehphcraily nnd contriniily : the increase in puUe-foree 
rtats upon the stimularion of iht- heiLrt-muscIe and ilM ganglia; tlie rise 
~ pressure i« due ehiofiy lo the iiiL'reuM'd heart-aelion. 
AftcT poisonouR dosen the pulse becomes rapid and feeble, due to 



JtRVas. 



of Uie ruoinotor oeotre aod tlie heart, aud tbe gnduall; 

RtmuTidS. — Id very minute doMB ojiiuin it u fwMc stimulaot, 
•rat InM Dui a ilepre»»iiil, 10 the fuMstioB of reapjnittuti. lu over- 
Am il booeof tbc iuo:<t povrctTuI paralvsnnta of the rt^piratorj cen- 
um ia 1^ in«dnlln uMotigata, caiuitig ilealh bjr this ariinn. 

TuirKRdTCRE. — 'f he bodily temperature is raised sli^llj by fall 
J o a w uid lowered bjr poiiionous amounU of opium. 

TiSsrE- Waste. — Opium actsasa prcvonlive to tissue- waste, dccn«8- 
iDfTibvi'limination of uri>u aiidoibcr n-^ullsuf uitntgrnoii^ hre»k-dowi). 

KuuiNATIoN. — Tlie 4ini(j aicapes from the body, if given in ejecew, 
«» moq)hiiif, by wny of ibe intrsliiie» xnd kidneys but must of it is 
d(«troT^l by r>xidiitioii in tbe liver ond (issitos. KxpC'fimcnte mule 
by Ak »ad T«iiber show thst morpbim- is cbiefly cliininalrd by the 
stomach, and tbni if this viseus U fr4<([ueniiy wajibed out duriDj; a case 
of poisoning, rccoTcn>' i» much aidnd. as by thi$ ineans reab9or])tiQn is 
prevenlod. 

Pui'iL. — Opium contracts tbc pupils by a centric stimulation of 

FiQ. M. 





prffduoM «>mr> t>r (leprMniiiff ilti> iiii^llfctunl rvnlrra or ih« brain, and 0. nlwv 
p&Ui b7 depnailDs lliu [«rc«i>(lv* mnlro* In Ifac bnla. 



the ocnio-motor uerrcfl, and perhajiit bydopression of the sympatbetic 
fibres. 

Stomach. IxTSSxr-VES, a\ii Sfxhbtion. — Opium 'depresses ibe 
motor activity of tbe stomacb and intc^itinc^ and produces constjpa^ 
linn. It does thi.s by slimulatiug the ejdancbaic inbibitory fibres of 
tbtt inlestiue and thereby preventing jieristal.titi. in very large doses 
it increases perislalsis by panilyxiug tbese fibres. 

Opium checks every secretion in tbo body except tliat of the 

skin. 

Acnte Poisoning. — When opium is taken by man in overdose it 
causixs diYiw!4iuL>-t?i. dfcp sleep, full breAlhing, a slow, full pulse, a 
warm, dryekin, contract^ pupils, and plea-sant — or, more commonly, 
in tbe Anglo-Saxon ra^«, disugrt-cablc — dn-amit or no drcjims at alt. 

Precfiling this peridd tlicro miiy bo a brief one during which the 
person feels wilf-salisficd and contente<I. The duration of this agrcft- 
able seusatiou only lasts a short time, and if the dose is Urge d<tea 
not ricmtr or at nnce passes off. It has been called the first stage, 
while the more marked symptoms Jtiat described have been grouped 
itilo a so-called second stage. 



OPWM. 



337 



During tbc sleep of the second Ktagc the patient niHif he roiiacd b^f 
KhoDtiuj; in hi?; ear or hy rioleni slinking, lint i^inks ))iu<k into slutnber 
at yn\^-c on hffing left alone. 

Many ot'ilic Miitplijims rc^cnibk* tkurie uf L*un<!<!«tiou of tho braio- 
Tb« face ie suffuM-d and rc<Uli.ni'<i. ami wjay l>e tinnlly dislinctiv cj-aii- 
litic. The breathing may he putliag uud sttTturouri. Whi-u the 
patient is awakened be breathea more rapidly, and for this reason the 
ciiiKkinesui of the fncc disappears iind tho normal hue return?. DcfLth 
never occur* in the second olaxc of opium poisoning from the poisim 
alouL', but if a complicating diitoasn is present dBatu may take place 
at this time. 

Tho tliird or fatal filace emergen ffora the second by « process so 
gradii&l that no abrupt liue of scpariitinn can bo nutCiL Thi* faeo 
bocomos at first luoro cyanotic, tiien pale and livid; the r»epirntioii»<, 
which have been eight to Im to tiic niitiiiic, are now only four or five, 
anil finally Rtich prolonged pauses o(;<-ur tlmt nil hope of annther re^^ 
piration is lost by the attendant. While ihu elnw brenthin;; is at first 
deep, it rapidly becomes shallow, and muscular re1a.Yatiou is present 
to the grciitwl degree. The skin, previously dry, is wet with the 
sweat of death, the patient is so 'Uiiply nart'otiKeii thnt nothing pnn 
arouse biin. and he dies from ri-spimlory failure, although' thi- heart 
may cease iilinosi Kimultaiieuusly from thi' asplivxia. The pupils do not 
dilate in the tbinl stage, except in the relaxation of death. 

TitE.iTMENT OP A'cm;te Poisoning. — After employing the usual 
inetliods resorletl to for the purpo.*o of unloading; ihc stomach, and 
after giving pormanganalo of potassium or tuniiio acid, preferably tho 
finrmcr. as the rhrmical imfidote. the patient should receive one or 
two enps of strong Mack coffee, hot and conrentmted. The heat in 
the liquid is useful in mainiaiutnjj: hoilily IciEiiii*raIrn-e. ninl ihe caf- 
feine siimnlales the respiratory centre and keeps tho luiin awake. 
Coffee should b^ used even before any symptoms cuinu on, in order to 
put them off if possible, ff atrychuiue is at hand and the re«pinition8 
ure beconjing very slow, ^'j^ t« ^ of u gmin (t'.Od.^-fl.OOtJ) should be 
given bypodermicallv. Strychiiiiie is luuch better than atropine nx ati 
antidote to opium, and shouhl lie ^veu hypodcniueully in lull iWjm:, 
repeated freifui-tillv enough to keep the nervous system of the patient 
active and redpitaliun intact. The jiupil is no ^uideas to the action of 
atropine in opium poisonin-;. as the action of these two drugs (opium 
&Qd utropiuc) on ibc eve is not directlv antagonistic. 

AlciwoUc stimulantti may he calk'd for. and ammonia as a cardiao 
and respiratory stimulant muy bo resorted to. 

In the third stage heat slumltl be upplicd to the tmnk and oxtrem- 
itics. 

Mncb eropfaasts ba^ been placed on kee|Mng the patient awake, 
and it bafi be«Q tbougkt that the cause of death was the deep sleep. 
Tkia is not «o. The man roust be ke^it nwake in order that ho will 
BupplciDcnt the efforts of bis depressed respiratory centres by volun- 
tary breathing. If bo sleeps, he forgets to breathe, and .tieep niean.i 
death for tbia riMWon, and not because sleep in itself produces death. 

Besides the uh« of the hot strong coffee, the patient may be kept 
■3» 



DJtCGS. 



avnkkc b;>- ltid]iox bim >vitli Bwitclius or by keeping lum walking up 
and down between two attendants. Bitth of the!i« uipaj^iivest nre rep- 
rebeneible If un^r'tbing better can be dune — tbe Srsl nictbvd because it 
CUV6I-8 tlte patient witb cuts and bruiser, ibe second litwause it mav 
aid in tbc production of death bv cxhuuetion. If an ordinary niea- 
ifal faradic battery is at band, llie full force of ibe current may be 
allowed to come iu contact with tbe skin from two small pole^ wet 
with salt water, or, better Btill. tbe dry or wire electric bruui sbMuld 
be awcjit over the budy while tbe nc^utivc jiolc is held iu the band of 
tbe patient ur pr^jweil agaiiiat bin <>kin. This causes tbe tniMt exqai- 
eile pain iu tbc normal individiitil. but if tbe brush is kept moTiug 
will not caiiHe any bruises or dixcoloration. (See Asphyxia.) Arti- 
ficial respiration may be resorted to. 

As already pointed out when discuwing tbe elimination of opium, 
tbft dose ifl eliminnlcd into the stomach from tbe blood-veosels and tlien 
reabsorbed. Fretjueiit washing uut of tbe stomai-b !» therefore sdvis- 
able in iroalinf; ciwra of [wistining, 

Objonic Poiioning. — Morphine or opium when taken constantly 
gener&teH a babit. The person — or morphinc-habitni^, as he ii> srnnio- 
times called— nlepends for a comforlablL- existence on the drug, and 
day br day increases his dose until the nio»i extraordinary nnionnis 
are taken by the stouiaob or by ninins of tbe hypodermic needle. If 
the drug is withbubl, a train of .Kytuptoraa typifying; depression or 
esbniiHtion rn:*iie». The riiil.'»e is scarcely to be felt, horrible mental 
dcpressi'm aud melancholia come on, the mixcruble uiuu or woinaa 
wring* bis or her handn. and begs, srreams, bowln, or yells for mor- 
pbioe, only to break down and cry on being refused the customaiT 
dosK Diarrhten of a serous type and most violent iu ebaracter. with 
cramps in the muscles, may a»*rt itself, and must be controllt-d by 
astringents mid an active line uf treatment wa far as poKsible free 
from opium. (See Diarj-boca.) 

A charaelerisiic symptom of chronic upium-entitig h (be develop- 
ment oftb^ most clever lying in previously truthful persons, la the 
same breath that the patient begs the physician to cure him. br will 
lie to obtuin tbe drug iu a ciirroptitious manner, and may even ba»e 
the drug ill his luoulb lit the moment be spejiks. it will often be 
found hidden iu tbc scams of the cloibing in small packnge^, and the 
nurse miwt be abwilutelj reliable, above bribery, and forever on the 
watch lest the drug be obtaiued by Fmuggling. Any sudden improve- 
meut ou the partof ihe putient should bi;place<I to tbe credit of more 
morphine, not to professional skill. 

Treatment. — The best way to treat such caaes is to "taper off" 
the daiW dose, and to decreaiie by a sixtb or a fourth tbe total cns< 
ternary amount in each twcniy-rour hours. The sudden Pom|)lete 
withdrawal of the drug is an unnecessarily severe measure, and its 
withdrawal in a slower manner than that nnmcd is simply prolonging 
the treatment beyond rcssonabLe limits. t'ocaine has been used to 
dde over tbe crisi.n af^er the withdrawal of morphine, bur too fre- 
quently the patient uasseii from ojiium to the t^'orainv, and tiually tu 
tne alcohol habit, all of wbicb are eijually bad. If tbe circuUtion 



OPIUM. 



339 



Osgn, (li;tilHlis and irtryclinine tnaj be (•iveii and tli« rttiiiaining sjmp- 
totas treated fts common sense indicates. 

SonieLinie^ paregoric lit taken in excess, and tlie writer lian SM-n und 
treated a oa^e in whinh over a pint of pamgori<! was tnken flvery day. 

When a motlier is an opiurD-e»Ier. the new-fcoru chiM often suffePS 
from colUpso on the second or third day after its birth, owing to iho 
lock of iut cttslomarr doao of opium. 

Ttaerapentlcs. — Opium is used for the relief of five great conditions, 
vbicli will Ih.' »p<jki'n tf ttriatim, the minor OHrs of the drug being 
pousidored aHeruard. These arc pain, inMjmiiia, inflammation and 
irritation, over-aecretion, and systemic strain. 

Pais. — Opium is the best remedy that we poaae^s for the relief 
of all forms of pain, except in thouc iuHtmitea when ncurnti/ia exiist^ 
when antipyrin and itti fellow-fiinpounda exceed it in medicinal value 
bccnuie they have no nrnrkerl nfter-effevtii. Et i» lo be remembered, 
however, that no dnijj lin-i yet been diueovered which e(|«iftls its pain* 
relieving power in this or aiiy other puiiiful aflectioii. lu one form of 
pain npiiim is not to be employed — namely, that arif-iiij; from cerebral 
€fjnyeitivn and cerchritia. for it is distinctly contraindicated in tlicae 
affectioos. ad it makes them worse. In acute or traumatic mi'nintfiHa, 
howerer. opium is of great service, eitlier alone or combined with 
merenry in sthenic cases. In the trentmcnt of eases of rftial and 
hepatic colic aftM)ciat4.'d with Bpasiti, and in dynmenorrhira, bella- 
donna' and opium given together will relieve the Bpa&in and pain, and 
jet »o counteract each other elsewhere in the body as to be devoid of 
tnarlcod effect upon other organs. Usnally in these severely painful 
affections it its best to give morijhine and atropiiiu bypoderniically. 
Persons sriiffering from severe palu will alwayti hear larger iiuiountM of 
opium than individuals wiihnut pain. - 

For the relief of I'lViA-wf pain physicians of experience usually 
employ morphine bypodermically aa the rnoai rapid und effective 
means of giving relief. If thi<) in not posf^ible. the morphine uhould 
be given by the month in a little hot vtatt-r with or witliout wliiskry 
or brandy added to it; or deodoriai'd liueiure nf opium may be given 
in the imroe manner. If neither the hypndeTinic needle nui- the 
draught cati be resorted to, then the drug is best given in the form 
of the fluid extract, or tincture, by tbc rectum, being first mixed wilb 
»ome warm Htarch- water. If the pain is chiefly in tiie pelvic viscera, 
the reetui admin istratioit of the drug in alwaya advisable by injection 
or by suppository. 

VVhrn the pain in due to viclrni mcintica or to muscular tpasm it Is 
best relieved by injecting the morphine directly into the subcutaneous 
IJMues over the aff'eeted part. In other iuKtancetf local (luin due to 
tnperftrial inflammatinr. may be relieved by eompreMu>s wet with 
Uudariuni and lead-MUtcr. 

To patioulA who are prone to frequent attacks of pain opium must 
be given with the greatest caution, as the "opiuui-bubit ' is easily 
prod u cod. 

IltsoUNIA. — Opiuta, wbiU capable of producing dleep in almost 
•very case in which it u given, save iu those persons who by reason 



rfHB 



340 ^^^F DRvna. 

of idiosyocrasj arc made wakeful by it, is only to b« ased in \Xiom 
insDmec-K wlu>r«.' lhi> ^lopplessnesa is due lo pain. If conslanilv a^ed 
for ihe rcHi^f of insomuis ur paiu. (iitupiiiiu babit ie rujiiill; contructcd, 
and for tLis reascHi the um- uf tbi-i druj^ nbuuld be alterunti'd witti 
chloral, cannabis indica, and otber soporific drugs. 

In some canes cliloral and morpbine, wbcn given in small Ao$m in 
comb illation, will so act upuu tbe [>raiu us to produce alvep. 

Tlitut, iu the following prescripliun. tbe dose uf botb active ingredi- 
ents ie mucb Kiualk-i' tbun vould be needed if either one wa« iisixl 
aloue, yet tbe reBult muglit by tlieir iwe — namely, sleep — is readily 
produi;ed : 

B.— MoqihiniFtfulpli. - .gt. y (0.10). 

Cblnmli* 7A (1.0). 

Sypopi Rj (S2.0). 

AqundtM. q, ■. i^ (M,0).— M. 

S.— t)«sMirtiit<(Kiiirul (8.0) at aine r. IL, and; \t Deeded, again at t«n or clevco 
o'clock. 

Id the pfrtittent insomnia of typhoid fcvtr, troupou* ptumiu^nui, 
and all uniic discustw in wbicb iii-rvous cxbauHtinn is due lo lack of 
sleep, a hypodermic injection of morphine vill sometime^ produce most 
excflleni rcstilLs. but tlie proper use of cold bathing is to be preferred 
for this purpnse if it can be employed. (Sec Cold, Part Itl.) 

IsPLAMMATros AXR Ibhitation. — opium srcniH to poswcsa some 
influence over inRammation ivhicb we cannot expbiin, and both' small 
and large doses are particularly valuable in inRainniation of seroiim 
membranes, such as pcrUti/tititty w>;«i«yiV(*, and p^ricarditi). In 
pcritcmitis opium ban been thought to be very u.seful. but (iravc 
doubt* are now entertained as to its value. (See tbe article oo Veri- 
tnniti.4 in Part IV.) It allays tlie nervous excitement and congh 
following furmnpti^m, and the intonse unrcjtt caused by Hefting nkin 
di»aiiifs. im, for exuujjile, tbe Irrilatiun of »jiuiU-por. 

SoinetimoM inteu!i<- irnintion or intlftnimntinn produces ho ^reat an 
effect u[K)n unctlripud iuu.«<-ulur fibres us to cjiuise t«pa»ni or piir»ly.^is, as 
in retention efvrini\cya(iti».av tbeeonscipation fulloHing iiitUiumation 
of tbe bowel-H due to the ingestion of irritating fooda; under these cir- 
cuinntanced tbi* i>mployinHnl of opium is iiidiratL>d, and is usintUy veri" 
successful. In irriintiir rouiihn morpbinc given in «ympof wild-clierry 
bark docs j^oixi in the dose of -^V 'o 1*11 *'^ " gniin (0.00.'>), 

In some caitca of irritable. cou;ih. due to a tickliug sensation in the 
larynx much rebef can be bad by inhaling tbe steam arising from % 
cup of boiling water in which has been place*! a dnicbni or tiro of pare- 
goric. 

Whenever n cmt^h is in cxces? — that is. prealer than is nec«*ary to 
free tbe lung fruui nlu<.■lll^ — morphine may be given in small doseii. If 
the luiijj'S contain more rfi.les after its use than before, it« uw must bo 
atoppe^l, n« the incre-asc in the number of rftlea indicates au iucreaae in 
the accnmulution of mucuH. 

In tbe Ireiitnient of ttranfiury due lo cyMlHi», and in rfettii inflam- 
mation, providctl they are nr>t at-ute, and aftt-r (iperatiun on tie pelvic 
organa, suppositories of the Hirength of ^ or ^ of a grain ((1.016-0.03) 



I 



PLATE III. 



nuiTz 



s ± k ; 



T ; 






~s 



ChBTt showing the errect or opium in a case or inab«te« in«l- 
lllu*. On Ihe day or adml»»lon the paiient was placed on a Mil 
hou«o dlel. The quantily or urine and fluid Ingested at once 
Inop0a««d. He then xvns pinced on a resii>ieted diet whieh 
cauftdd a rail in the urine and Huids ingeBi&d but no decrease in 
■uoar. Opium was now given and the sugar fell at once (see 
graen line). Later on the hoUse diet was resumed but the 
opium held the eugar In check. Note how the Huids increased 
on the 28th or May and how they fell when the opium ^wns 
^•ne^ved and Increased. The ohan 8ho^A;8 hoMV the restricted 
riloi governed the urlnar*y flow and how the opium was need* 
to eonirol the melliiurla. 




OPIUM. 



341 



n 



of tbe w«t«ry extract of opium are very usefnl. In exeemve v/>mit- 
ing from aiiv caus*. excvpt it be from a previnus iliwo uf opium, 
nn cufinft of di'odorizofi limdamini ^0 minim» (2.0) and slaiTh-waicr 
4 outlet'^ (liO.O), witb 40 grains (2.6) uf bromide of nodimn, will be 
fband of T»lu*. {See Vomiting, Part IV.) 

In mMtculoT rhrum'ttium uud Bimitur states, and when a " cold " 
bn9 been taken, opium it) tbe foriu of Ilovor's powdor in (lii? dose of 
6 lo 10 grains (0.31-U.I>JJ) will often produc-e ii ciire. piirticulArly if 
emplovca in poinbinnlion «itb Iioi drinks ami u Lot fixn-biiih. Cnm- 
pbor can ofli-n be added to the Dotcfb powder witli adrnntnge. (Sae 
Corvia. I'art IV.} 

For sprains and bmi'»e-a lead-water- uud^lnudaiium is one of the beet 
ppIicalianB. (See Artit-le on Lwid.) If llie skin is broken, the lau- 
dannni may be u»ei) nhme to ivlievr piiin, and, by ks nlrohol. will act 
iL« an anti.«e]iti<r. (Ipium is aUo it rnteful drii^ in l)j» Ireatment of inter- 
nal And cxl«ni»i 6uritit In relieve the jiain and irritation. 

OVER-SKC'RETKiN. — In gtrou» iliarrhcpa, dialnten iimjudiiK, and mel- 
lituM, and in tlie Ircaluient of ovcr-secrction on the pari of all senre- 
tinjE sorfaeett except the iikiu, opium may be used. 

It is said lo decrease the amount of urine before decreasing the 
amnant of the sugar in tliabete.'s. However this may be, the employ- 
ment of opium or morphine or codeine in dinhi-lep ip a very valuable 
form of treatment. The doses should be rapidly incrensod, xi the 
effect IK only obtained by ascending amounts, and <liubetic patients 
0eeni peciiliaHy immniie to the nervonn tnfliienee nf lhi» drug and 
its alkaloids. Morphine is, therapeutically, the more powerful of the 
two alkaloids, bnt crude opium is mort' poMerfnl for pood in this 
aflvction than either. None of thctn. probably, cure the didonee, but 
so modify it as to m^ike life bearable and ha]>py, for (he sugar is 
decreased in many caees and tho scDflc of excessive hunfi;er, thirst, 
and neni'ons irritability t» put a.tide. Itching of the skin is also re- 
Iieteil in this class of patients by its nse. (r>ee Plate, and also article 
on Diabetes Part IV.) The sinMen withdrawal of opium frorri a ca«e 
of diabetes mity procifiitate diabetic coma. 

Opium should nut be used to arrefit an attack of nnicnu* diarrhoea 
nntil al^er the muetis which is already present in the bowel had been 
Hwept out of the intestinal canal by a dn.«e of ca^itor oil or magnesium 
autphate. Mintite doses of ^^^ to j^g of a grain (0.001) of morphine 

Siven hypodermically wiH :4oiuetimes rhec^k aummer diarrhmi iu cbil- 
ren at once- (f^cc article on Diarrhoea,) 
Morphine in UHe<l to rcliove puiu riithei- than opium, beeauKe it doe.^ 
not caiiw so much eoiiiitipntion, but opium is better to check diurrhcen. 
Paregoric is particularly useful in diarrhira because it contains a 
olatilc oil and camphor. 
Systemic Strain. — In prolonged strain upon tho system, aa in 
physical or nervouR efTort, or more frefjuentlT in old nge to 
out the cares of the reujuiiiing years of life nod decrease worry, 
ium is usefid, but its u^e in young persons is most dangerous, M it is 
moat cerlaiin to produce the opium habit. In astficiuc /i-vcrs opium 
is thought to be aupportive, but its use is apt to eaii^c io manv other 





342 ^^^» DRVas. 

conditions. bucIi as (<onstipAtion, itimroxiit. or menial JcprMoion, thftt 
aleoliot ia luiicli beltur for this purjiose. In verj Advanced phthitin it 
18 ofron jiistifiiible to give enough optnm to kwp the patient free from 
pitiii ami iliflcomfort for the retnaJning hours of liis lift*, but can.- mu»t 
ix) tukoiL liiat the dose dues not intorfero wilh his brcatbinj; and so 
ka»t<-ii donth. 

In heart ditpaae, particularly of the mitral valves, the patient ean 
ofttn breslhe i'«flily only when awake, slArlin^ up when he falls 
asleep nnd popping fur hi-cath. tt is ststed bv Bomo wriieni that 
iiiorphinc will rclifve this stJit<! und pi-nuit stocp. but that it will 
not be of svrvico in iiortic diso&se. While thjo uiuv he partly true, 
the drug will often give great relief in all fornix of cardiac dytfmeea, 
and ouglit alwuyit to be tried with rautian. »Ichitugh it is oontraiiidi- 
cated if the heart has under^'one fiilty degeneration. Care should be 
taken that the first ilose is .snmll. ha in unme instances il increaws the 
discomfort. The relief obtintu-d i? »u|>|H>jed to be due to cardiac stim- 
ulation by the drii^. mid. while this ix no doiibi correct, the other car- 
diac stimulants, sach as digitalis, will often fail when morphine suc- 
ceeds. The presence of cyanosis unci lividily in said to be no con- 
trnindication to the hypodcnnic use of morphine under theee circum- 
stances, provided the dnsn is not iinrfasoimbly large, and prrtvidetl 
ibos.? signs are purely circulatory in origin. If they depend upon 
[iiilrti'uiiirv »Tcdfina or dift'iise bronchitis, it is uusufe. The tlrug .■'boiild 
Up wivnn livpodermically for this purpose in the dose of about ^ gmin 
(O.Olfi). 

Opium and morphine, particularly the latter, have been freely 
Riveu to produce nuiet In patient* with tirtrmie ctmruUt'ona. The 
practice is a dangerous one and should not be resorted t« a« a rule, &9 
thf impaired slate of the kidneys prevents the proper elimination of 
the drug. 

AdministratloQ. — Recent studieit upon the action of opium and it« 
alkaloid)! )«b(>w that it acts in an inhibitory manner upon castric diges- 
tion and absorption, decreasing the amount of hydrochloric ociu id 
the gaatric juice. Kor this reason, unless ihoro is an excess of acid 
prc-sent in the slonmcli. il is well nut Lo give opium ur morphine at 
merd-times, but some time after. 

Opium iwelf is »«ed in the form of the powder (Pulvffi Opii, U. S.) 
in the dose of from \ to 1 grain (0.016— O-OH). The nolic) preparations 
are the deodorized opium {Opiuni iJeodoratitm. U. S,), which is de- 
prived of ita imrcutitie, duse } to 1 grain (0.03—0.05); the pills of 
ojiiiim {Piltthr (^pii, I'. .S'.), each rnntaining 1 grain (0.05); and the 
■watery extract (/Crtraetum Opii, U. S. and R, P.). dose ^ lo | a grain 
(0.01&-0.03). Of ihe liquid preparatiouB we have ijaregoric ( '/'iMt-hira 
Opii (^mpfiorata. U. S. ; Tinetura Cmnp/iortp vomponita. B. /*.), 
done 1 drachm lo 1 tablcspoonful (4.0-lu.r») ; laudanum {Tinctura 



Opii, U. A', and Jt. P.). doae 10 to 80 minims (0.66-2.D): the deodo- 
rixcd tincture (Tiuftura Opii Ptvdoroti. L'. .V.), dose 10 to W ininiiiia 
(0.6-2.0); tho l'inu»i Opii. t'. S., or, as it is sometimes called, 
bydenbaui's Iiaudnnum — dose 10 to 80 minima (O.G<'r-2.0t; and 
Acetum Opii, U..S., or Black Drop, done 10 to 30 miuitus (0.65-2.0). 




OPWJL ^^^^ 343 

As nil thp liqnid propnratioiiEi nf npium in the U. S. P. iir« of 10 
per coiiL. slreri;j|tti, e.xci-pt purc-^oric, wliicti is uliuut 2 gmtiid u> the 
mjiia*. tlie lioi^' of si) »i tliooi ('xocpt paregoric U ideutit^xl. This is 
a f»cl to he rtnicuiht-roti hy stmivnts. 

Under the iiumu of Uover'a Powder (/'u/m Ipeeacuanlur rt Opn, 
U. S. ; J'ulru lprcnfitanii(f- Vunxpatiiu*, li. P.)>a powder containing 
1 part of [>">wflerpfl opiiiin, 1 pwrt of poipdercd ipecac, and X pnrte of 
sugar of uiilk, m Inr^i-I^ usvil. The (]o!<e is 5 to 10 grains (O.3-0.G.5). 
It is tiiore cflicmious if ^cpunitml into titlhs mid taken in ilivitk'd (Iukob. 
The tincture of ijiennc and o|ii!im (Tim-ttira J/tfi-aruanhce ft Ojiiij 
tL S.) in given in the dose of !t to Wi niininiR {0.3-1.0). 

Tho pre}Ukraliaoa of opinui oflicinl in the B. J\, other than those 
■IrMilj natDL'il. are Kifrat-rum tf/iit Litjvidvvi, dose 4 to 2l^ minims 
(0.3-1.3); J'tiirU Ofiii Vfimpftituii. compoeed of opium, pcppt-r, (liiijjor, 
cara«r»y-truit. and tnipnciuiih, dosn 2 to .I griiina(0.1-1l.3o) ; Tinetara 
pit Anim"tiiiitfi. dosc ^ to 1 drnchiii (2.1)— 4.<t). Pibihi Saponin Vom- 
otita, B. P., is purt^lv n prpparsititm of opiniii. It is somrtime-s neccR- 
irjr to gii'e this drug to patient* without tlieir knowledge, and it may 
bfe prvacribed in thi.swfty, the piilient not learning from the preseripCioD 
the nature of ilie metticine. The dose is 2 to 4 graiim (0.1-0.2). 

The B. P. also recognises a liniment (Unimentum Ojyii) and a 
pliLSll-r iKfii/'t'.tntnti'i Opii) for lociil application. 

Uatowiurd Effects. — -When opium ik given to Home persona it pro- 
dui-cv for Bumc hour^ nmrtced wakefulness followed by elccp, luia id 
many patients pn>diicos aftt-r its primary influence great nausea, and 
Mimctiintf? vomiting. The mental d(<pro«$ion may be simply over- 
whelming, and the very fjiei of having to drag out existence is a curse. 
Bt far tnc moot ofTvctive un'ide of preventing these very distrecssing 
eHectfi of opium or iljt derivatives is to administer with this drug about 
jhv g"'" °'^ nitroglycerin. One of the chief cftii8o#, however, of the 
nausea nrodm-ed by the iiNe of opium or morphine is the change in tlie 
body of morphine into oxy-diinorpliine, which is eliminated irito the 
stomach and tliere realisorbe<l, and then induce.** these serondary effects. 
It is al»o ft fact that the^c symptoms can be largely done nway v-jth by 
ihv use of 20 grains (IS) of bromide of potassium, which muHt he taken 
at the same lime as the opiate, and by employing the preparations of 
opium largely devoid of narcotine. such as the deudunzcd tincture or 
deodorized opium itself. Whenever it is possible these prepsrationa 
»hould be lined to the exolu^sion of the others, Haig is responsible for 
the assertion that, as opium froea the blood of urir acid by CJiusing its 
" Itention in the JiHsues of the body, the pleasant cflV-cts are »i produced, 
sd that, the retention being ciimnlative, no sooner docs the effect of 
the opinio pass ofT than the uric acid is set free in the blood, and as :i 
result depression ensues. Ho states ibnt if salicylates are given with 
the opium tho retention doos not occur, and the unpleasant serjudic aro 
much UKxIitied or prevontwl. After the untoward symptoms come oa 
coffee and atiniulaiits may be used with advantage to overcome them- 
In siHiio jM-rsone ilie use of opium is followed by itching of the skio or 
by ibc development of an erythematous rash which ui&y go on to 
desqiuiDitioD. 



I 



344 ^HJ^ DRVas. 

Cliildrcn bosr opium butlly. uiid Mine ciiililrcn are xerj touch more 
susceptibiv tbnii otbertt tu iu iiillu(>tice. 

One-Rigblb gmiii of inorpbiiic hnR caiiscil (Icaili in an ailult when 
givpti bypoJemiitTnllv, prnbnbly bE>('iiii^ it. eiitert^d a vein. Sometimes 
tiie <lrii^ causes culfapA«, or in oLher caace au vruptiun upon the skin 
of ibe body. 

Thu UAC of repealed donen nf tnnr^iliine for severnl days often aeta up 
ob-stiuate vomiting, due prnbably to the change of the drag into oxy- 
di morphine or apoiuorphine. 

Codeine. 
(See p. 194.) 

Morphine. 

Marphina, U. S. and B. /*., i« the rhiof alkftloid of opium, but 
owiiip to itH insnhibility in niri>ly UHed, being generally given in the 
forui of tlie sidphatc. 

Sulphate of Morpbint- {^Morphhup Sulphan, V . S.) is given in 
the dost; of i to J prain (0.(lf.l8-t'.0:i). either by the inuuth or liy|Mi- 
dermicslly. BeAides thv. sulphntc of morphine we hare the ucetate 
{Morpkincf AcrtiiH. V. S. and D. P.). Ihe muriate {Mvryhhut lly- 
drorhhrag, U. S., and JTi/ifroehion'iium, R. P.), nnd the tanrate 
i^Mi/Tphino! Tartrat. B. J'.), all givvii iti ibe dose of J to ^ gruib 
(u.008-(J.03). In the U. S. Phariuat-oimjiu of 1870 a soiutioM of 
morphine wiis olGcial. rullt'd T.i'fuvr Morphmtf Suljtiiitt{» {B. P.). dose 
1 to 2 drachms (4,0-8.0) : hnl it is no longer official and lihoiild not be 
callr<] for. Magcndic'it »i)lutiou of morphine la aixtoon timi-s a« etrong 
a-t lliis liijuor just named (10 grains lo tlie ounce), and JK sIru not 
official. The words " Lifjuor Morphinte Sulphatis*' will often cause 
Ma-iondie's f^olution to be dispensml in New York Stale, and care 
should be taken that iwisoniiig docs not result. Pulvu Merphhitt 
CompoBttaa, U. S., or TullyV Powder, is given in the doee of 10 
grains (0.tJ5). It containo sulphate of morphine, camphor, licorice, 
and precipilated caleium rarbonate. It in u.ied to break up fvrmitig 
colds and as a uervoua «^ativ«. Tracbee of morphine and ipecac 
(TVot'hif/'i ^forphin^p el Tjtecacuanlur. U. S.) are given one or two aC 
a time for irriMion of thf phrtrtjtir. 

The foHuwiug additional preparations of morphine are official in the 
B. P.i Liquor Morphin<F Hi/drocfiloridi, Lv/uor Morphtnw Tartrati$, 
dose 10 to 40 minims (Q.6<>~'i.iMj) : TinHura Chlorofermi H Morphina 
Vompoaita, dose 6 to ID minims (O.35-0.6.'j); Suppotituria J/orpAiwi*, 
RBch siippositi>ry conlaiiiintr + jirain fO.Ol") of morphine; Trochi*ru* 
Morf'iiiptF and" Tro<-iiisru« Morphino' cf J pfcai-uanhir, each loeeiig* 
containing ^ of a grain (0.0(121 of morphine, done 1 to 4. Lit/Uor 
Aforphuiar M-etatit is given in 2')- to 4II.minim {2.fi5) dosea. Jnjectw 
itorphuiiT Hi//Hidrnnir4i. B. P.. contiiinn 1 grain (0.fl.>) of the tartrate 
of niorpbine in each 22 miniiDs (1.4> "f wnt^r. Tin dose is 1 lo fi 
minimK (0.0r,-0.2y 

IncompatlhUa. — Morphine is incompatible with potassium pernian- 



I 



ORTiroFOBM^OX-OALL. 345 



j^tite and -with tannic or j^tlic acid or astrinf^enl Bolutions containing 
thcin, wilii Alkalies, t^iicli aa poIaAHium, Hniliiiin, aii<I amiiKiniuin, but 
with llio cliloritlo of nmmoniiim it in not inr<iinpatil)lp. With 
of cblorifiv of iron it forius u dtvj>-rv«l fuiur (mvcoiiic acid). 



tincture 



ORTHOPORM. 

Orthoform a a colorless, bulky, OflorlcK". and taaU'less powdor whirh 
is slightlir soluble in water. It is used as a local a)»esthetic and anti- 
septic dressing (iyr tTaaif tpouxeiii and 6um», and is said to b« uon-l^>xie, 
but this i-t an error. It may bf applied in powder nr ointment. The 
latter is naually of tbe strenfttb of 2 drachms to ilip ounce of Iniiolin 
(8.0—80.0). RrtMiq asecrls that it is capable even in weak <iintiiii?nt8 of 
caujiing |*r«.-at irritation of tb? skin, an<i Kpsteiti has fousd it capable of 
producuig jwisouiug if given by tlie luoutfi. 

OVARIAN EXTRACT. 

The ovarian gland, in tbe foriu »f tlm dried gland mubstance or iu 
tLat of an extract made from it, litu* been useo for the relief of the 
norrous and Qntritional disturbuucea '»f the nicn</pavai-, whether llicy 
be tlie re!>alt ofagc or uf opL-rativv removal of chese bodlen. It is Kuid 
to be tno!>t effieacioud in tiioi^c- itietauces in whicb the ovaries Lave been 
remoTeii from young wompn. .\s rhe use of tbe ovarian extract in 
m^djcinul doi«es eci'ind to be Lnruilcs^, it may be given for a loog time 
iritbout danf;er. The beginning iWe Rliould b^ 2 to 4 gruinit (0.1-0.2) 
a day, and this bo gradually increased until eome effect U produced or 
it nrovee itseir uiteleiw. Tbe biwt inetbod of giving it is in conipreHicd 
tiiblvtM or in aip»ulei». J'rutossional opinion ae to it» value is very ^^ 
coutnulictory. ^^M 

■ OX-OAL.L. ^H 

Inapiflsaled Ox-gall (Fef liovi*, U. S.) is, u ita name implies, dried 
ox-bile, derived from tbe gall-bladder of the common ox ( liof TVrttrtis), 
It ia u«ed iu metliciiie fur the piir|>ose of relieving ccrluin form^ of 
tndigcslion which depend upon detlcienl secretion of bite or which occur 
in person* who (ligest fats with difficulty. Iu full doses it is apt to 
cmusc some l(M)B«ncwi of the bovcels. and it may be given witli the object 
of producing thifl condition. When it is uiied tbe fact should be 
remembereil ibat bile prevents the gastric juice from iicting upon pro- 
teid nr albuminous ou bsinnces, sbriTclIing them up. iind in iiddition 
BO alters the gastric lii)uids ns to decrease their digestive power. We 
know, therefore, that this drug mii^t be adrniniictored some hours aftei 
lueala. as a nile, or. in other vrords. when ga.*tric digestion is ended 
and intevtina) activity is beginning. Tbe dow of ini^ptHsatcd ox-g«ll, 
vhich i-x dried by cvapomtion fn>m 100 to \h parw. i,i A to IJi grains 
(0.35-1.0). Purified (>x-gnll (/'*■/ Jim-)'n rvrifie'tfuni. U. S. ; Fet 
Jiofinnm I'uritiratHm, It, i',) in given in the «imc dose ii« the inspis- 
sated bile. It is made by evaporating H parts of pure ox-gall to 1 
part, and then adding to this part an equal amount of alcohol, which 




M& ^^^V DRVGS. 

coDHtilncnts are raixod tlioronghly. and aft«r atandiof; ttceDty-fonr 
hours the cloar liquid is d«cuiiU-d and the residue is evaporated tu a 
cousisUQcy capallo of funnitig a pilL 

OXIDE OP zmo. 

Commi^rcial Oxido of Zinc (Zinci Ozidum VettaU) is Dot n»ed io 
meilit-iiif. but in iho |)unrR>d furm is largoly omploved id the ehapp 
of Zim-ri (hi<ium, f. *S', and Ji. /'., which is iliauluolc in watvr. Id 
thn form of the oxido-nf-zinc nintment ( T'ntfuentum Zmei OriJi, U. S. 
and B. J'.) this drufi affords one of the most goncrally ased appiic*- 
lifiiis ill the treatment of n/cin tltn-axet, burn*, and noret. 

In all 9tatci) where the surface «f the ekin is dry it is contraindi- 
ea1«d, hill wlier« the eruption is moist tl is ui^efiil. In ihe treatment 
of the chloatma of j>regnancg the following prtecription is of service : 

K.— i^inrl oiiitt f[T. jij (i>.2}. 

ilrdrarg. &[umuniiU. gr.j (OXM), 

0U\ ihwhtitoK gm» (]0.0). 

OIci ricini j^fl^O)- 

KwwnL TOKO, gtt. Z (&&&).— M. 

S. — Apply to tli« face night and TDomlng. 

Tn eeaema with many vesicles use — 

H.— Pulv. camphonc 5»(2.l)). 

hiU. tini*. nsidi ^1^(12.0). 

Glvoerini «L xl (2.«5l. 

AriiitiKlinnuiinxli ^(30.0). — M. 

B.— Apiplr to ihc part triihoiil oifacr trcatmmt or imcede it by povckred bi>- 
mulh. 

Under the name of Unna'i* Dressing (compnspil of gelatin 4 partB, 
wuItT 10 |iurltt. glvcftiii 10 jiBi'ts, and xtnc oxide 4 |)art8) is u useful ap- 
pliinitiun fur uleen and i-oxvuiaidii)> putches on the \vf^ or arms. Il i^i par- 
ticnliuly iiiiefiil for leg Hher». The gtdutin and culd vater art- put in a 
ba«in river n fire and a solution maile; then ihi* glyeerin is added, and 
then the oxide of Jtiuc is slowly added, with constant Blirriiig. Aft#r 
the mixture is ooiiiplete it is poured into a can and allowed to eool, 
when it is reudr fur use. Thid applti'iilioii derreaM» swelling and ift 
soothing and mippuriiiig. It i» applied lis follows : The part alTuctud is 
well washed wiih water and Hoap. and then with alcnhol. The paint 
having been wanned and melted, a large three-inch palnt-hrtiNh \» uwd 
to apply a coiiting to thi.' liitib all uroiiiid the ulcer, and over this & 
single layer of gaiixe i-i iLppliod. Tlie j»inizc bandage ahouM l»o two 
iiitrlic* wiilr. The buiidii;r(.- iimibI be laid on evenly and the ulcer cov- 
ered by II |Ktd of ah>i(>rljeii t eotton. After une laver Ih applied it it) cut 
and another lutat of paint applied over it. Then another layer of guuxo 
and another nf paint are used, until !!everal layent are in plaee. tt la 
be«t to begin ul the loea and work up lowai^l the knee. All psrid 
should be etjimlty well covered. Finally tlie entire dressing in eovered 
by a cotton roller bandage, which is removed in twenty-four hours, 
leaving what looks like a wliit-e nihljer dreeing on the limb. If ilie 
lit|iiid from the ulcer oosos ibrough the dressing proftiscly, a window ia 
to be cut over the ulcer, aJid it can be locally treai«d hj utringentti or 



OXYGEX. 



347 



ether inOMure*. The patient slioiJd keep the Uinh eWratcal for a day 
or two, but can tlien walk vrith &r more oomi'ort than if n nibber aup- 
portiug bandage is used. 

In |>owder«d form Eilic oxide is asefiil in the treattnoiit of intertrigo 
a,xn\ (or fot^uni^tivitin. Mixed with bisiniitb siibniimte uml pi'tmiu, it 
\A lureely U3«d by Mme practitioners in llie trcaUucni of tlie summer 
diarrnvea of iiifiLDts or adults. 

In ibc nitjht-ttreatt of debility or of phikmn oxido of aino in the 
following forniula lias bueii liighly recommended, but tlio prt-iscription 
probably depends largely for its action on the wcoiid iugrediont: 



^.—'/itv-i oiidi . 

EiInicL hellBduniue . . . 
Ft. ill fill. No. I. 
8.— On» kl niifhi bcforr |[ning to bed. 



. . -gr. «xx (2.0). 
- - .gr.iytftiB.)— M. 



Bartbolow rccommonds tbo oxide of sine for cases of mthma and 
vshooping couyh, given to an adult in the luBUuor just indicftted. 



OXYGEN. 

The lEiis Oxygen ie now widely used in raedicnl and Bur^i«»lpi«tioe 
in three ways, a.^ followii: By the inlmlation of tbe g&« itselr (Vora a 
cylinder in whii-b it m compressed until 40 gallons occupy a very small 
space; by drinking oxygen-wnler, which in distilled water iMturated 
with ttic gus: and liiiiillv. by the u^e of i be dioxide or peroxide of 
hydrogen, which h applieti locally to diseased surfsces. (See Uydrogen 
Peroxide.) 

Inhalations of oxygen are imcfiil in the second nnd third Btogea 
of pneumonia where um palieiit seemii about to die from deficient aera- 
tion of lW bluod, with n-flulting hetirl-dii^U'tition. Tlu^y are also of 
value in adranccd iron^hitis, particularly that of old pcn^otii;, and fur 
the TBNUseitatiun of pernoiw a-Hphyxiated by coa(-ga.i (Iliirp nnd Martin). 
In phthmt and otber exhauftttnj; diseases oxygen will allay dyspntea 
and oppreiiiiinn. Oxygen inhalation.'* are also of service in the treat- 
aent of HHtemia iu all it« fonua and give relief even iu pemichv* 
imtrmia and in tf.uktrmui. Often a mixture of oxygen gas fiO parts 
and nitrous oxide gas 40 partc> is used as a sciiuulunt intinlation and 
nervous swlativc. 

The clinical reaatts which hare so far been obtained from the admin- 
iatrotion of ether anil rtdoroform vapor when combined wilh oxygen 
gas aeeoi to prore beyond all doubt that the oxygen dcereasos the dan- 
ger of the auflulbetic anil to a large uxteut obviates thL- lUflirullies 
which fturr^iund thd adnaini^tnition of these drugfs, and mo«t of the 
iiiitDward L-ffet-L^ which wc art; accuslnmrti to meet with a,* a cnn.'te- 
quence of tUeir use. T]iu«, when o.xygen is given with ether, vomit- 
ing w less frequently mrt with, excessive pallor i* nirely seen, and 
[io»t-operative dcpretmion ii<>ema to be largely avoideil. 

As a general nile, however, it liaa been ine cusIotu of pbysicicans 
and wirgi?f>ns who have empb>yed oxygen giu* in combination with ether 
ur chlorufuriti. to place tbe aiiiv.-<thetic in a viasle-bottle and then to 
allow the oxygen gu« to putss tbrou<jli it iu such a way that the patient 




received in the inhaler a mixture of anesthetic vapor and oxygen, the 
mixture being luiidc hr the passage of the oxygea gas through the 
liquid auKsthetic lu tiie bottle. An erident uiimdrantage of this 
arrangvQient is that the quantity of aiue«thi'tic which is %'olatilizcd 
can rinly he in direct proportion to the volume of oxygen gun which is 
forced itirough the vruah-bottle, and therefore with every increase id the 
quiiDclty of vapor which the patient receives he muet also receive ao 
ioorcased (juimcity of oxygen. It has been claimed, too, by those vho 
bare empluvi^d the ether aud oxygen cunibination mo»i rrei[uently, that ■ 
in a Jarge proportion of cases a greater length of time is rcijuired 
ftir ihi- uiiii-sthciiiEiug uf ibi- patient, and tliut in some ca.<K.-s it Heema 
altnoet impossible to get tl>e patient under the direct influence of the 
drug. Til is didiculty lies in the funt that a» noon afl n large quantity of 
oxygon gas is used to convey a large quantity of nnicflthotic vapor to 
thf lun^, the patient rapidly passes into a condition which is culled by 
phyaiologi-it!* apnoja. The rcepiraton,- centre is no longer irritated by 
the nonnal propnrtian.<t of carbonic arid in the hloQiT and therefore 
aeniht out feeble respiratory impulse^t ; and as the patient doex not 
bre»thc a» rapidly or as deeply as before, the result is that very amall 
'}]iantitie)« of the anicstbotic are lalfcn into the body. 

Tbc apjiaratun which the writer hn» einiiloyeii with luiccees, and 
wbtrb he rtupgtslH an a Huh.tflitute for the one heretofore employed, con- 
sists of a somewhat funnel-sliiiped piece of leather having a greater 
diameter in one direetion thnii in another, itiuy vhieh i? nitcd ax on 
inner liniiij^ a piece of soft felt or Kpoiigio-pilirie almost a quarter of 
an inch thick. In the under surface of the leather cuue is inserted a 
small metal iiihc. and at the opening of this lube a Hmall hole i^ cut in 
thespongifi-piline. Tlieciber is ilien poured upon ibe spongio-piline in 
the cone, iu the a]>cx of wliich is placfd some absurbeiit cotton. The 
oxygen entert; the I'one bv meaus of a rubber lube attached to tbc metal 
untnincc whicti ba.s been mentioned. By this arrangement several objoctA 
areaeconipli.-4)ied. IntheHrst place the supply of oxygen can he delivered 
to tlie pntieiit in varying quantities without altering the amount of 
anii'sthctie which is being given. In the second place, any quantity of 
ana-sthetie can be employed without ncccaaarily increasing the oxvgen. 
Thirdly, the leather cone prevents the rapid evaporation of ether from 
the outer side of the epongio-piline. And fourth, the spongio-pilinc. being 
much more poroux than an ordinary towel, will retain a large quantity of 
etbcr in liquid form when this drug is poured upon it. Finally, if desireil. 
the taaine appiinitus; can he used for the administration of eblomfonn by 
removing tlir metal cap on the amaller end of tbr cone as in this way 
the patiput wilt receive not only lhoatia>stbelie vu|H)r and iheuxygen, hut 
aUo fresh air through the end of tho cone, in auch quantitief> at> the phy- 
sician deems Ki.se. In these casea it is hettt to use the attachment knoira 
as the Krohiie and Se^emann "respiration-indicator," which contiats 
of a small feather on a pivot which moves to and fro with the motiona 
of respiration, thereby providing the physician with a gauge u to the 
rapidity and force of the re-npinttory movements. The soft fdt is very 
cheap, and a fresh piece can be used for each patient. 

In ouncluaioD, tlie writer cannot condemn too strongly the metltod 



PAXCRKATiy ASD PANCRKATIC EXTRACTS. 



349 



of employing chtoroibrm vapor znd oxygen by paning the ozygeu 
directlj ^rougb the chlorofonu wilbout too free administration of air 
IB ailditiuu, for, after all, air is vrtiat we ore intended to lireallie, and 
not oxyguQ ga» alone, althaugb it may be advantageouii at times to add 
an increased quantity of oxygen to the air. 

Still more severe condomnaiion should be directed toward the attach- 
ineut which i» placed ou HOue of the Junker inbalent. and which oon- 
iiiU of ft small rubber bag whioh, instead of acting an a reservoir of 
fresh aoiEsthetic vapor and oxvgen, \» inflated and colIap!<ed by the 
expiration and the inspiration of the patient, who does nol retjcive even 
freah oxygen and anic»thetic viipnr, miicb Icsn freHJt air, but, im the 
contrary, inhaler again and again air, oxygen, and vapor wbieh are 
loaded with the impurities of fr«({aciit expfratory efforts. 

(For the directiona for uaing oxygon with nitrous oxide as an anieB- 
theiic sec the artiele un Nitrous Oxido') 

rPANORBATIN AND PANOREATIO EXTRACTS. 
Under these naoiea a iiumhur of linus now sell an extract £rom tlio 
pancwotic gland or juicy, and the U. S. P. recognixea such a product 
ander the name of Pancreattnwn. It contains, or should contain, tlie 
four pancreatic ferments — trypsin, which dig««tfl nroteids (meat, eggs, 
etc.); 5teapsiu, which splits up and ciuulBifiea tuc fats; atuylopsin, 
which has dinstalic power (that is, converts srurch into sugar), and 
finally a milk-curdling ferment, 
A preparation equally uiteful with the commercial pancreatin may 
be made t>T the physician in the following tnunner: 
Take the p:increas of a pig which has been killed nboia six hours 
o-ftcr ft full meal, the organ being therefore active, and, after chopping 
it up Rne, add to it four times its weight uf dilute alcohol and allow 
it to slnnd for twelve hours. Decant or filter off the alcohol, and 
give the filtrate in the doee of 1 to 2 draehtuj (4.0-8.0). Or. better 
still, aa followg: Wasb and chop up tine a fresh panereatt. and allow 
the gland to soak in alcohol (absolute) twenty-four to forty •eight hrjurs. 
.\fier this sqaceKc out the alcohol and add to the gland ten tiinoo its 
uvight of glyccriQ. This must stand forty-eight hours and then b« 
filtered, and be used in dotufD of 3U minima (-•'3) ^'^ each glaas of milk. 
(For the use of poncrcatin in ariidcial liigestion see the article on Pop- 
touijed Fowis in Part HI.) 

Fancreatin, as prepared for the market, is a dry powder, given in 
the dose of 2 to '20 gniins (0.1—1.3) after nieaU or during ihcm. 

Pancreatin should usuuily be prescribed with bicarbonate of sodium 
to aid it in its digi-stive action. Il is indi^yited in all cases nf {itnUric 
diarrhtea and in many caiKS nf di-lii'ii-iii digestion. Pancreatin, or the 
powdered pancreax, may also lie frttly used in those cdses of '{i'lhfieit 
mtllittu in which the disease depends upou u lesion of tLc pancrratic 
gland, AS carcinoma or atrophy fruui other eaut>e. 

Some doubt baa been cast upon the usefulness of the employment 
of pancreatin in TochIh unlesR this ferment wan allowed to act upon the 



I 



■ 




SBO -^^gm- DRUGS. 

aliment before it waa iiwalloweci hy the palieDt, on Uie ground tliat 
IMtQcrcntiD is destroyed