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CORNELL  UNIVERSITY. 


THE 

BostxteU  p.  Movant  Cibrarg 

THE  GIFT  OF 

ROSWELL  p.  FLOWER 

FOR  THE  USE  OF 

THE   N.    Y.    STATE   VETERINARY   COLLEGE. 

1897 


CORNELL  UNIVERSITY  LIBRARY 


'Ml 


Cornell  University 
Library 


The  original  of  tiiis  book  is  in 
tine  Cornell  University  Library. 

There  are  no  known  copyright  restrictions  in 
the  United  States  on  the  use  of  the  text. 


http://www.archive.org/details/cu31924104225861 


REFERENCE-BOOK  OF 

PRACTICAL 
THERAPEUTICS 


BY   VARIOUS   AUTHORS 


Edited  by    FRANK    P.    FOSTER,   M.  D. 

EDITOR  OF  THE  NEW   YORK    MEDICAL  JOURNAL  AND   OF 
FOSTER'S   ENCYCLOPEDIC   MEDICAL   DICTIONARY 


IN   TWO  VOLUMES 
VOL.  II 


NEW    YORK 

D.     APPLETON     AND     COMPANY 

1897 


Copyright,  1897, 
By  D.  APPLETON  AND  COMPANY. 


M  0  3  S" 


LIST  OF  CONTRIBUTOES  TO  VOLUME  II. 


Samuel  Treat  Armstrong,  M.  D.,  Ph.  D..  late 
Visiting  Physician  to  the  Harlem,  Willard 
Parker,  anci  Riverside  Hospitals ;  ex-Passed 
Assistant  Sure;eon,  U.  S.  Marine-Hospital 
Service,  New  York. 

Samuel  M.  Brickner,  A.  M.,  M.  D.,  New 
York. 

Edward  Benmet  Bronson,  M.  D.,  Professor  of 
Dermatology,  New  York  Polyclinic ;  Visiting 
Physician  to  the  City  Hospital ;  Consulting 
Physician  to  the  Babies'  Hospital,  New  York. 

William  B.  Coley,  M.  D.,  Assistant  Surgeon 
to  the  Hospital  lor  the  Ruptured  and  Crip- 
pled ;  Attending  Surgeon  to  the  New  York 
Cancer  Hospital  and  to  the  Post-graduate 
Hospital,  New  York. 

Floyd  M.  Crandall.  M.  D.,  Adjunct  Professor 
of  Diseases  of  Children,  New  York  Poly- 
clinic ;  Consulting  Physician  to  the  Infants' 
and  Children's  Hospital,  New  York. 

Jeremiah  T.  Eskeidob,  M.  D.,  Professor  of 
Nervous  and  Mental  Diseases  and.  Medical 
Jurisprudence,  Colorado  School  of  Medicine, 
Medical  Department  of  the  University  of 
Colorado,  Denver. 

Matthias  Lancktox  Foster,  M.  D.,  Assistant 
Surgeon  to  the  Manhattan  Bye  and  Ear 
Hospital,  New  York. 

Aepad  a.  Gerstee,  M.  D.,  Visiting  Surgeon  to 
the  Mt.  Sinai  and  German  Hospitals,  New 
York. 

Henry  A.  Griffin,  M.  D.,  Assistant  Physician 
to  the  Roosevelt  Hospital  (out-patient  de- 
partment) :  Attending  Physician  to  the  Ran- 
dall's Island  Hospitals,  New  York. 

Charles  Jewett,  A.  M.,  M.  D.,  So.  D.,  Profes- 
sor of  Obstetrics  and  Diseases  of  Children, 
Long  Island  College  Hospital ;  Obstetrician 
to  the  Long  Island  College  Hospital ;  Con- 
sulting Obstetrician  to  the  Kings  County 
Hospital ;  Consulting  Gynaecologist  to  the 
Bushwick  Hospital,  Brooklyn. 

Howard  Lilienthal,  M.  D.,  Lecturer  on  Sur- 
gery, New  York  Polyclinic ;  Assistant  At- 
tending Surgeon  to  Mt.  Sinai  Hospital,  New 
York. 


Russell  H.  Nevins,  M.  D.,  Stamford,  Connec- 
ticut. 

Austin  O'Malley,  M.  D.,  Ph.  D.,  LL.  D.,  late 
Medical  Sanitary  Inspector  and  Bacteriolo- 
gist of  the  District  of  Columbia,  Washing- 
ton. 

George  L.  Peabody,  A.  M.,  M.  D.,  Professor 
of  Materia  Medica  and  Therapeutics,  Col- 
lege of  Physicians  and  Surgeons  (Medical 
Department  of  Columbia  University);  Vis- 
iting Physician  to  the  New  York  Hospi- 
tal and  to  the  Roosevelt  Hospital,  New 
York. 

Frederick  Peterson,  M.  D.,  Chief  of  Clinic, 
Department  of  Neurology,  Vanderbilt  Clin- 
ic, College  of  Physicians  and  Surgeons  (Medi- 
cal Department  of  Columbia  University) ; 
Neurologist  to  the  City  Hospital;  Patholo- 
gist to  the  New  York  City  Insane  Asylums, 

..  New  York. 

Samuel  0.  L.  Potter.  A.M.,  M.D.,  M.R  C.P.L.; 
Professor  of  Principles  and  Practice  of  Medi- 
cine and  Clinical  Medicine  in  the  College  of 
Physicians  and  Surgeons  of  San  Francisco ; 
late  Visiting  Physician  to  St.  Luke's  Hos- 
pital, San  Francisco. 

Charles  Rice,  Ph.  D.,  Phar.  D.,  Chemist  of  the 
Department  of  Public  Charities,  care  of 
Bellevue  Hospital,  New  York;  Chairman  of 
the  Committee  of  Revision  and  Publication 
of  the  Pharmacopoeia  of  the  United  States 
of  America  (1890-1900),  New  York. 

Solomon  Solis-Cohen,  M.  D.,  Professor  of 
Clinical  Medicine  and  Therapeutics,  Phila- 
delphia Polyclinic ;  Lecturer  on  Clinical 
Medicine,  Jefferson  Medical  College ;  Physi- 
cian to  the  Philadelphia  and  Rush  Hospitals, 
etc.,  Philadelphia. 

James  T.  Whittaker,  M.  D.,  Professor  of  the , 
Theory  and  Practice  of  Medicine  and  Clin- 
ical Medicine,  Medical  College  of  Ohio,  Cin- 
cinnati. 


HANDBOOK  OF  THERAPEUTICS. 


NAPBLLTNE 
NAPHTHALENE 


NAPELLINE.— This  alkaloid,  C.HstNO, 
(0H)4,  obtained  from  Aconitum  napellus,  is 
almost  identical  with  aconitine  in  action,  but 
not  quite  so  powerful.  The  dose  is  from  ^  to 
J  of  a  grain.    (See  Aconitine.) 

NAPHTHALENE,  naphtalene,  naphta- 
lin,  naphtalinum  (U.  S.  Ph.),  naphthalin, 
naphthalinum  (Ger.  Ph.),  is  a  hydrocarbon  ob- 
tained from  coal-tar.  It  occurs  in  transparent 
plates,  without  colour,  of  strong  and  peculiar 
odour  and  a  burning,  aromatic  taste.  It  vola- 
tilizes slowly  when  exposed.  It  is  insoluble  in 
water,  but  when  boiled  with  water  imparts  to 
it  a  faint  odour  and  taste.  It  is  soluble  in  al- 
cohol.    Its  formula  is  CioHs. 

The  action  of  naphthalene  is  that  of  an  an- 
tUeplic  and  antiparasitie.  Locally,  it  is  stim- 
ulant,  and,  though  small  doses  may  have  a 
beneficial  stomachic  effect,  large  ones  may 
cause  gastric  disorder.  It  is  thought  that  when 
it  is  given  by  the  mouth  it  passes  into  the  intes- 
tines with  little  or  no  change,  and  there  exerts 
its  antiseptic  power.  To  some  degree  the  rem- 
edy is  absorbed,  but  its  absorption  is  slight  in 
man,  though  its  continued  administration  to 
animals  is  productive  of  cataract.  It  is  elimi- 
nated by  the  lungs  and  kidneys,  but  principally 
in  the  f;eces.  In  passing  through  the  kidneys, 
naphthalene  may  cause  irritation  of  those  or- 
gans, and  in  renal  diseases,  therefore,  its  use 
should  be  cautious. 

The  external  use  of  naphthalene  in  thera- 
peutics is  small.  It  is  occasionally  used  as  an 
antiseptic  in  the  treatment  of  wounds.  It  has 
been  employed  as  a  substitute  for  iodoform  in 
chronic  abscess,  a  solution  consisting  of  3 
drachms  of  naphthalene,  2  oz.  of  alcohol,  and 
4  oz.  of  hot  water  being  employed.  Unless  it 
is  warmed,  crystallization  will  occur  in  the 
solution.  It  is  said  to  bo  valuable,  too,  as  a 
dressing  for  ulcers.  As  an  antiparasitic  naphtha- 
lene is  valuable,  especially  in  scabies.  Its  ex- 
tensive application,  however,  is  said  to  have 
been  the  cause  of  nephritis.  The  popular  use 
of  it,  under  the  name  of  "  tar  camphor,"  for 
the  destruction  of  moths  is  well  known. 

The  internal  use  of  naphthalene  is  chiefly 
for  intestinal  antisepsis.  Among  the  condi- 
tions benefited  by  it  are  diarrhoeas,  especially 
if  fermentative  or  putrefactive,  dysentery,  and 


typhoid  fever.  The  beneficial  action  is  not  in- 
variable, however,  and  the  remedy  is  often  dis- 
appointing. Roundworms  are  said  to  be  re- 
moved by  the  action  of  naphthalene,  and  for 
seat  worms  an  injection  may  be  made  which 
contains  from  15  to  30  grains  of  the  drug  and 
from  2  to  3  oz.  of  olive  oil. 

[Dr.  A.  Schmitz  (Jahrb.  f.  Kinderheilk. ; 
litv.  internat.  de  med.  et  de  chir.  prat.,  Apr. 
25,  1895)  describes  his  method  of  using  naph- 
thalene in  cases  of  intestinal  worms  in  chil- 
dren :  After  having  purged  the  patients  several 
times  he  prescribes  capsules  each  containing 
from  2-J^  to  6^  grains  or  more  of  naphthalene, 
according  to  the  age  of  the  child.  Four  of 
these  capsules  are  taken  during  the  day. 
Eight  days  afterward  the  same  dose  is  re- 
peated, and  after  a  second  interval  of  fourteen 
days  a  third  dose  is  taken.  In  some  rare  cases, 
he  says,  a  fourth  dose  may  have  to  be  given. 
The  naphthalene  should  not  be  given  imme- 
diately after  meals,  and  oily  or  fatty  food 
should  be  avoided,  in  order  not  to  cause  de- 
composition of  the  drug  in  the  digestive  canal 
and  thus  hinder  its  action.  If  it  causes  consti- 
pation a  purgative  should  be  given.  In  forty- 
six  cases  in  which  this  treatment  was  used, 
twenty-six  children  were  completely  cured.  In 
twenty  other  cases  the  results  were  less  favour- 
able; the  symptoms  were  ameliorated,  but 
there  was  no  definitive  cure.  In  three  of  the 
cases  the  return  of  the  symptoms  was  so  long 
delayed  that  they  were  thought  to  be  cases  of 
reinfection.  In  cases  where  success  is  doubt- 
ful Dr.  Schmitz  recommends  repeating  the 
treatment  after  an  interval  of  several  weeks,  as 
the  organism  of  children  tolerates  repeated 
doses  of  naphthalene  very  well.  In  one  case 
only  it  caused  strangury,  but  the  symptoms 
were  slight  and  transitory.  The  action  of 
naphthalene,  says  Dr.  Schmitz,  is  always  more 
certain  than  that  of  santonin,  and  it  is  much 
less  toxic] 

Naphthalene  is  beneficial  in  pyelitis  and 
cystitis  by  its  action  to  lessen  urinary  fer- 
mentation. It  may  bo  efficient  in  bronchor- 
rhaea  and  foetid  bronchitis,  and  has  been 
recommended  for  whooping-cough. 

The  dose  of  naphthalene  is  from  2  to  8 
grains,  and  it  is  best  administered  in  tablets  or 
in  capsules. — Henry  A.  Gkiffin. 


NAPHTHOL 
NARCOTICS 


NAPHTHOL,  naphtholum  (Ger.  Ph.),  naph- 
tol  (U.  S.  Ph.),  isonaphthol,  beta-naphthol. 
beta-naphtol,  $-naphthol,  is  a  phenol  occurring 
in  coal-tar.  It  is  generally  prepared  from 
naphthalene.  It  occurs  in  colourless  or  buif- 
coloured  crystalline  plates  or  a  white  or 
yellowish  powder.  Its  odour  is  faint  and  re- 
sembles that  of  phenol ;  its  taste  is  pungent.  It 
is  permanent  in  the  air  and,  though  only 
slightly  soluble  in  water,  is  freely  soluble  in 
alcohol.  Its  formula  is  CioH, OH.  Though  beta- 
naphthol  alone  is  meant  when  the  term  naph- 
thol  is  used,  there  is  another  naphthol  which  is 
equally  entitled  to  that  distinction.  This  is 
known  as  alpha-naphthol.  Its  physical  proper- 
ties in  the  main  are  those  of  beta-naphthol, 
but  it  is  more  irritant  than  that  remedy,  though 
said  to  be  less  toxic.  The  physiological  action 
of  naphthol  is  practically  that  of  naphtha- 
lene, and,  though  it  is  certainly  capable  of 
poisoning,  experimental  death  in  animals  hav- 
ing resulted  from  paralysis  of  respiration,  the 
toxic  dose  for  man  would  necessarily  be  very 
large.  As  an  antiseptic,  naphthol  is  said  to  be 
five  times  as  strong  as  carbolic  acid,  but  its 
insolubility  in  water,  though  of  value  in  that 
it  renders  less  the  liability  to  poisoning  from 
absorption,  is  an  obstacle  to  its  usefulness. 

As  a  local  remedy,  naphthol  is  useful  in  a 
variety  of  ailments,  and  is  employed  in  oint- 
ments and  alcoholic  solutions  which  usually 
range  in  strength  from  3  to  10  percent.  If 
applied  pure  to  the  siiin,  naphthol  causes  a 
brown  discoloration  and,  subsequently,  des- 
quamation. It  has  been  used  for  the  relief  of 
psoriasis,  but  is  generally  inferior  to  chrysa- 
robin  and  pyrogallio  acid,  though  often  a 
desirable  substitute  for  them.  A  10-  or  12-per- 
cent, ointment  is  suitable  for  the  purpose, 
but  if  used  extensively  may  cause  poison- 
ing, the  symptoms  being  similar  to  those 
of  carbolic-acid  poisoning  and  preceded  by 
cloudy  discolouration  of  the  urine.  In  scabies 
an  ointment  containing  from  5  to  10  per  cent, 
of  naphthol,  with  or  without  sulphur,  is  effec- 
tual. It  should  be  applied  nightly  for  about 
a  week.  Tinea  circinata  is  relieved  in  the 
same  way,  as  are  other  vegetable-parasitic  skin 
diseases.  Foul  ulcers  also  are  said  to  receive 
benefit  from  an  application  of  naphthol.  A 
solution  containing  5  parts  of  naphthol,  100  of 
alcohol,  and  10  of  glycerin  is  highly  spoken  of 
as  a  remedy  in  hyperidrosis.  In  chronic  sup- 
purations of  the  ear  naphthol  may  be  used  by 
insufflation.  In  all  conditions  where  it  is  lo- 
cally applied  naphthol  has  the  advantages  of 
being  colourless  and  nearly  odourless. 

The  internal  use  of  naphthol  is  very  like 
that  of  naphthalene.  It  is  serviceable  in  gastric 
fermentalisn,  particularly  if  there  is  also  dila- 
tation of  the  stomach.  In  diarrhoeas  and  in 
dysentery  it  is  often  of  much  service,  and  the 
abdominal  symptoms  of  typhoid  fever  are  in 
many  cases  much  ameliorated  by  its  use,  with 
the  subsequent  improvement  of  the  constitu- 
tional symptoms.  Its  continued  use,  however, 
is  occasionally  the  cause  of  gastric  disturbance. 
Naphthol  has  been  much  praised  in  the  treat- 
ment of  cholera,  both  as  a  prophylactic  and  in 
the  early  days  of  the  disease.     Epidemic  in- 


fluenza also  is  said  to  be  favourably  affected 
by  its  use.  It  is  a  desirable  vermifuge  against 
ascarides. 

The  dose  of  naphthol  is  ordinarily  between 
2  and  5  grains,  but  much  larger  amounts  may 
safely  be  administered.  In  fact,  many  authori- 
ties regard  doses  of  15  grains  as  by  no  means 
excessive.  It  is  preferably  given  in  capsules. 
It  may  be  given  in  keratin-coated  pills  when 
its  intestinal  action  is  specially  desired. 

A  preparation  called  camphorated  naphthol 
is  sometimes  employed.  It  is  a  clear  brown 
liquid  composed  of  1  part  of  beta-naphthol  and 
2  parts  of  camphor.  It  has  been  recommended 
as  an  application  for  tuberculous  ulceration  of 
the  tongue  and,  mixed  with  vaseline,  has  been 
employed  in  ozoena. 

[In  regard  to  the  value  of  camphorated 
naphthol  in  the  treatment  of  tuberculosis, 
somewhat  contradictory  observations  have  been 
recorded.  Spillmann  (Rev.  mid.  de  I'Est.,  Nov., 
1894;  Iiei\  mens,  des  mat.  de  I'enfance,  Nov., 
1895)  reports  the  case  of  a  child,  thirteen  years 
old,  which  showed  all  the  symptoms  of  ad- 
vanced pleuro-pulmonary  tuberculosis,  and  had 
tuberculous  peritonitis  with  ascites.  The  gen- 
eral condition  was  bad,  and  the  temperature 
varied  from  100-2°  to  103°  P.  in  the  morning, 
and  from  102'1°  to  103°  in  the  evening.  After 
the  abdomen  had  been  punctured  and  36^  oz. 
of  ascitic  liquid  been  drawn  off,  150  grains  of 
a  solution  of  camphorated  naphthol  was  in- 
jected into  the  peritoniEum.  This  was  well 
borne,  but  during  the  following  month  the 
fever  and  the  pulmonary  symptoms  seemed  to 
become  more  intense.  About  five  weeks  later, 
however,  the  fever  disappeared,  the  appetite 
returned,  the  bowels  became  regular,  and  the 
pulmonary  symptoms  ceased.  When  last  seen 
by  the  author,  the  child  seemed  completely 
transformed.  The  abdomen  was  elastic  and 
not  painful ;  the  digestive  functions  were  nor- 
mal ;  percussion  and  auscultation  did  not  re- 
veal any  trace  of  the  pulmonary  lesions,  and 
the  child  was  considered  completely  cured. 

On  the  other  hand,  Netter  (Rev.  mens,  des 
mal.  de  I'enfance,  Nov.,  1895)  relates  the  his- 
tories of  three  cases  in  which  this  treatment 
was  employed.  In  the  first  two  cases  the  re- 
sults obtained  were  not  convincing  either  for 
or  against  the  method.  In  the  third  case, 
however,  it  was  different.  The  patient  was  a 
child,  seven  years  old,  and  a  diagnosis  of  tu- 
berculous peritonitis  was  made.  M.  Netter 
was  rather  inclined  to  think  that  there  was 
cirrhosis  complicated  by  peritonitis.  However, 
on  the  advice  of  a  hospital  surgeon,  the  treat- 
ment with  camphorated  naphthol  was  adopted. 
After  a  puncture  had  been  made  through  which 
more  than  a  hundred  ounces  of  liquid  flowed, 
about  75  grains  of  camphorated  naphthol  were 
injected  into  the  peritoneal  cavity.  No  symp- 
toms immediately  followed  this  injection",  but 
at  the  end  of  half  an  hour  agitation  and  con- 
vulsions supervened,  which  did  not  yield  to 
treatment,  and  in  a  few  hours  death  occurred. 
At  the  autopsy  it  was  proved  that  the  patient 
had  suffered  from  hypertrophic  cirrhosis,  with 
acute  generalized  peritonitis  which  had  mani- 
festly been  caused  by  the  injection  of  naphthol. 


NAPHTHOL 
NARCOTICS 


In  view  of  this  fact,  while  admitting  that  the 
healthy  peritonasum  does  not  act  in  the  pres- 
ence of  naphthol  like  the  tuberculous  peri- 
tonaeum, M.  Netter  states  that  he  is  unwilling 
to  employ  this  treatment  in  tuberculous  peri- 
tonitis.] 

Hydronaphthol  is  very  similar  to  beta-naph- 
thol.  In  fact,  the  commercial  preparation, 
though  of  unknown  composition,  yields  beta- 
naphthol  when  purified  by  reorystallization. 
Theoretically,  hydronaphthol  is  beta-naphthol 
in  which  1  atom  of  hydrogen  (H)  has  been  re- 
placed by  hydroxyl  (OH).  It  occurs  in  phar- 
macy as  a  crystalline  powder  of  grayish-white 
colour  and  a  slight  odour  resembling  that  of 
iodine.  Its  uses  are  those  of  beta-naphthol, 
but  it  is  said  to  have  a  lesser  toxicity  than  that 
drug.  It  has  been  thought  of  special  value  in 
cholera  and  typhoid  fever.  The  dose  is  the 
same  as  that  of  beta-naphthol. 

Bemonaphthol,  or  benzoyl-naphthol,  is  a  white 
crystalline  powder  without  taste  and  with  but 
a  slight  odour.  It  is  practically  insoluble  in 
water,  but  is  soluble  in  alcohol.  Chemically, 
tiie  drug  is  the  benzoate  of  beta-naphthol 
(C10H7O,  CvHsO),  and  in  the  intestines  a  sep- 
aration into  its  components  is  believed  to  take 
place,  the  benzoic  acid  being  then  eliminated 
by  the  kidneys  and  acting  as  a  diuretic,  while 
the  beta-naphthol  remains  in  the  intestines  to 
act  as  an  antiseptic.  It  is  chiefly  employed 
as  a  gastric  and  intestinal  antiseptic  and  is 
useful  in  the  conditions  in  which  naphthol  is 
given.  The  dose  is  from  4  to  8  grains,  but 
small  and  frequently  repeated  doses  are  the 
most  serviceable. 

[Dr.  S.  Solis-Cohen  (Med.  News,  July  28, 
1894)  speaks  highly  of  the  use  of  benzonaph- 
thol  in  conjunction  with  bismuth  salicylate  in 
the  treatment  of  summer  diarrhoea.  After  the 
alimentary  canal  has  been  cleansed  of  irritat- 
ing matter  by  the  most  available  means,  which 
may  be,  he  says,  according  to  circumstances, 
lavage  of  the  stomach,  irrigation  of  the  bowel, 
or  the  administration  of  a  purge,  usually  calo- 
mel or  a  mixture  of  castor  oil  and  spiced  syrup 
of  rhubarb  (equal  parts);  and  after  the  diet 
has  been  duly  regulated  he  has  observed  very 
satisfactory  results  from  the  administration  of 
the  following  combination : 
Benzonaphthol,  ) 
Bismuth  salicylate,  >■  each. . .  5  grains. 
Dover's  powder,        ) 

In  capsule,  cachet,  or  powder. 

To  an  adult  1  capsule  is  given  every  three 
hours,  or  as  often  as  may  be  necessary.  It 
is  rarely  needful  to  exceed  4  doses  in  the 
twenty-four  hours.  To  children  the  same 
preparation  may  be  given  in  reduced  doses ; 
thus,  to  a  child  of  two  years  Dr.  Solis-Cohen 
gives : 

E=Sc°y'iate,}-*---«^--' 

Dover's  powder |  grain. 

In  the  mildest  cases  benzonaphthol  alone 
has  proved  efficient,  and  in  many  cases  the 
opium  is  unnecessary ;  but,  as  a  rule,  the  com- 
bination of  the  three  ingredients  in  the  pro- 
portions stated  he  has  found  more  promptly 


efficacious  than  any  other  routine  treatment 
that  he  has  used.] — Henry  A.  Griffin. 

NARCEINE.— See  under  Opium. 

IfABiCOTICS  are  drugs  which  lessen  the 
relationship  of  the  individual  to  the  external 
world.  Their  action  is  very  complex,  depress- 
ing the  sensory  nervous  system  from  its  pe- 
ripheral nerve-endings  to  the  perceptive 
centres,  influencing  also  the  motor  side  of 
the  nervous  system,  and  disturbing  the  sen- 
sory, motor,  and  metabolic  functions  of  most 
of  the  viscera.  At  flrst  more  or  less  excitant 
to  the  higher  brain  and  stimulant  to  the  mind 
and  to  all  the  bodily  functions,  they  at  the 
same  time  blunt  the  perception  of  external  im- 
pressions and  bodily  sensations,  and  to  a  greater 
or  lesser  extent  substitute  ideas  for  sensations. 
This  stage  of  their  action  is  usually  a  pleasant 
one,  and  is  accompanied  by  feelings  of  high 
nervous  tension  and  followed  by  a  disposition 
to  repose  of  the  body.  Their  next  stage  is  one 
of  profound  sleep  characterized  by  increasing 
stupor,  and,  if  the  dose  has  been  sufficient,  is 
followed  by  coma,  insensibility,  and  finally 
death  by  paralysis  of  the  medullary  centres 
which  govern  the  functions  of  organic  life. 
An  autopsy  shows  nothing  but  great  conges- 
tion of  the  brain,  spinal  cord,  lungs,  heart,  and 
great  vessels.  Narcotics  and  stimulants  are 
closely  related,  alcohol  and  opium  being  good 
illustrations,  in  the  different  stages  of  their 
action,  of  stimulant  followed  by  narcotic  ef- 
fects. Such  agents,  in  proper  medicinal  doses, 
give  us  the  power  of  lowering  morbidly  acute 
perception,  of  relieving  pain  and  allaying 
irritation,  nervous  agitation,  and  spasm,  of  in- 
ducing sleep,  and  of  regulating  the  vital  func- 
tions by  rest — all  of  which  are  means  of  great 
therapeutical  value.  It  is  for  these  effects,  and 
not  for  their  full  narcotic  action,  that  they 
are  employed  in  medicine.  (See  the  subtitle 
Narco-hypnotics,  under  the  title  Hypnotics.) 

Narcotics  operate  medicinally  in  smallerdoses 
than  almost  any  other  drugs,  and  their  effects 
vary  considerably  with  the  size  of  the  dose; 
under  the  smaller  doses  stimulation  predomi- 
nates, under  the  larger  narcotic  sedation  pre- 
vails. Their  action  is  much  more  intense  upon 
young  persons  than  on  adults,  and  to  a  greater 
degree  than  can  be  accounted  for  by  the  mere 
difference  of  age.  They  lose  their  effect  by 
repeated  administration,  unless  the  dose  is 
constantly  increased,  in  which  respect  they 
agree  with  all  agents  acting  directly  upon  the 
nervous  system.  If  taken  continuously  for 
any  length  of  time  they  are  prone  to  induce  a 
drug  habit,  and  this  is  especially  true  of  opium 
and  chloral.  The  principal  members  of  the 
narcotic  group  are  briefly  described  below, 
their  action  in  other  respects  being  detailed 
under  their  respective  titles  throughout  the 
work. 

Opium,  and  its  chief  alkaloid,  morphine, 
are  typical  narcotics,  as  also  the  most  potent 
and  reliable.  They  are  especially  valuable  as 
medicines,  for  of  all  the  members  of  the  class, 
they  possess  the  most  powerful  anodyne  action, 
enabling  them  to  relieve  pain  in  doses  which 
do  not  cause  sleep.    There  are  few  indications 


NAREGAMIA  ALATA 

NBJRVINES 


for  the  use  of  narcotics  which  can  not  be  filled 
by  opium  alone ;  the  principal  exceptions  are 
delirium  tremens,  in  which  chloral  is  more 
efficient  and  safer,  and  neuralgic  affections, 
spasmodic  action  generally,  and  the  relaxation 
of  the  sphincter  muscles,  in  which  belladonna 
and  stramonium  are  more  serviceable.  Opium 
does  not  produce  so  much  early  excitement  as 
alcohol  does,  though  its  stimulant  stage  is  well 
marked,  may  be  maintained  by  the  admin- 
istration of  small  doses  at  proper  intervals, 
and  is  apparently  due  to  alterations  in  the 
relative  functions  of  diif  eren  t  parts  of  the  brain. 
After  a  full  medicinal  dose  (from  1  to  3  grains) 
the  excitant  stage  is  of  shorter  duration,  and 
sleep  soon  comes  on,  during  which  external 
impressions  are  made  with  difficulty  upon  the 
peripheral  nerves  or  on  the  organs  of  sense,  are 
slowly  and  imperfectly  conducted,  and  are  im- 
perfectly perceived  by  the  cerebrum.  After  a 
narcotic  dose  (3  grains  or  more)  the  excitant 
stage  is  very  short ;  sleep  rapidly  ensues,  be- 
comes deeper  and  deeper,  and  passes  into  coma, 
from  which  the  patient  can  no  longer  be 
aroused,  the  strongest  external  impressions 
having  no  influence  upon  him.  This  uncon- 
scious condition  is  accompanied  by  great  de- 
pression of  the  medullary  centres  governing 
respiration  and  circulation,  the  breathing  being 
slow  and  shallow,  the  pulse  slow  and  full,  be- 
coming very  feeble  towards  the  end,  the  pupils 
minutely  contracted,  and  the  body  bathed  in  a 
cold  sweat.  Death  occurs  by  asphyxia,  respira- 
tion ceasing  before  the  heart  stops.  Opium  has 
no  effect  in  muscular  contractility,  and  com- 
paratively slight  influence  on  the  motor  nerves, 
but  it  has  a  marked  paralyzing  action  on  the 
sensory  nerves,  on  the  conductivity  and  reflex 
function  of  the  spinal  cord,  and  on  the  cere- 
bral and  medullary  centres. 

Alcohol  is  primarily  an  excitant,  then  an 
intoxicant,  and  finally  a  narcotic.  It  first 
stimulates  the  cerebral  circulation,  and  then 
proceeds  to  paralyze  the  several  parts  of  the 
brain  in  the  inverse  order  of  their  develop- 
ment. This  order  varies  in  different  individ- 
uals, but  in  all,  the  powers  of  judgment  and 
self-restraint  are  the  first  to  be  impaired,  as 
they  are  the  last  to  be  completely  developed. 
Imagination  and  memory  fail  next  in  some 
cases,  while  the  emotions  become  prominent ; 
and  on  this  follows  disturbance  of  the  power  of 
co-ordination,  and  soon  paresis  thereof.  In 
others  the  latter  is  impaired  to  a  marked  de- 
gree before  the  mental  faculties  are  much 
affected;  the  speech  becomes  thick,  and  the 
gait  is  staggering  and  uncertain.  At  this 
stage  reflex  action  still  persists,  but  afterwards 
becomes  diminished  and  then  abolished.  Final- 
ly, paralysis  of  the  respiratory  centre  occurs. 
The  action  of  alcohol  exemplifies  three  great 
laws  of  drug  action,  viz. :  1.  That  all  stimula- 
tion reacts  into  depression.  3.  That  most  agents 
which  at  first  stimulate  the  nerve-centres  after- 
wards depress  and  finally  paralyze  them.  3. 
That  when  drugs  so  affect  the  functions  of  the 
body  progressively  they  do  so  in  the  inverse 
order  of  their  development,  the  highest  and 
latest  developed  function  being  affected  first, 
the  lowest  and  oldest  last. 


Ether,  chloroform,  and  the  other  general 
anaesthetics  have  much  the  same  effects  as 
alcohol. 

Chloral  hydrate  in  a  large  dose  (45  grains) 
causes  a  deep  sleep  without  preliminary  ex- 
citement usually,  which  sleep  may  pass  into 
coma,  with  slow  respiration,  slow  and  weak 
pulse,  lowered  temperature,  relaxation  of  the 
muscular  system,  and  diminished  sensibility 
and  reflex  action.  By  a  toxic  dose  (a  drachm 
or  more)  all  these  symptoms  are  intensified, 
the  coma  is  profound,  the  pulse  is  weak  and 
thready,  the  pupils  are  contracted  at  first,  but 
dilated  afterwards,  the  temperature  is  greatly 
lowered,  and  the  patient  gradually  sinks  into 
death,  paralyzed  and  anaesthetized.  Death 
usually  occurs  by  paralysis  of  the  respiratory 
centre,  but  in  many  cases  the  cardiac  action  is 
simultaneously  arrested;  and  fatal  syncope 
may  occur  in  any  case,  the  heart  stopping  in 
diastole  from  paralysis  of  the  cardiac  ganglia. 
Bromal  hydrate  acts  in  the  same  way,  but 
is  poisonous  in  smaller  doses,  and  has  a  more 
powerful  paralyzing  action  on  the  heart. 

Butyl-chloral  hydrate  (croton-chloral) 
also  acts  in  like  manner,  but  much  less  potent- 
ly than  chloral.  The  principal  symptoms  pi-o- 
duced  by  large  doses  are  deep  sleep,  aniesthesia 
of  the  fifth  nerve,  and  death  by  arrest  of  respi- 
ration ;  but  very  large  doses  paralyze  the  heart. 
Belladonna  and  its  principal  alkaloid,  atro- 
pine, also  its  congeners  stramonium  and  hyos- 
cyamus,  produce  active  delirium  at  first,  the 
patient  having  a  constant  desire  to  speak,  to 
move  about,  or  to  be  doing  something,  while 
at  the  same  time  he  feels  great  languor ;  this 
effect  is  due  to  the  combined  stimulation  of 
the  cerebral  and  spinal  nerve-centres  and  the 
paralyzing  action  on  the  peripheral  ends  of  the 
motor  nerves  which  is  decidedly  produced  by 
these  agents.  Atropine  is  one  of  the  most 
powerful  of  the  alkaloids  in  proportion  to  its 
dose,  a  seven-hundred-thousandth  of  a  grain 
affecting  the  pupil  (Donders),  and  a  two-hun- 
dredth of  a  grain  producing  marked  physio- 
logical effects.  Although  antagonistic  to 
morphine  in  most  of  its  earlier  actions,  its 
final  result  is  narcotism  and  death  by  paralysis 
of  respiration.  Hyoscyamus  is  much  feebler 
than  belladonna,  but  has  a  similar  action,  and 
has  been  used  as  a  substitute  for  opium  in 
children  and  where  it  is  desirable  to  avoid  tlie 
constipating  action  of  opium  on  the  bowels. 
Its  derivative  alkaloid,  hyoscine,  is  a  powerful 
depressant  of  the  respiration  in  full  doses,  and 
efficiently  hypnotic  and  calmative,  after  a  pre- 
liminary stage  of  excitant  action,  in  doses  of 
rit)  of  a  grain,  hypodermically. 

Cannabis  indica  is  primarily  a  producer  of 
delirium,  and,  though  its  secondary  action  is 
of  a  decided  narcotic  character,  the  drug  is 
not  dangerous  to  life,  no  case  of  death  thereby 
having  ever  been  known.  Some  of  the  phe- 
nomena experienced  under  its  influence  are  of 
unique  character— namely,  a  sense  of  double 
consciousness  and  a  semi-cataleptic  state,  be- 
sides which  it  produces  a  considerable  degree 
of  ansesthesia  and  confusion  of  thought  as  an 
after-affect.  The  dose  necessary  to  produce  its 
full  action  varies  according  to  the  activity  of 


NAREGAMIA  ALATA 
NERVINES 


the  preparation  and  individual  susceptibility 
to  it,  but  may  be  placed  at  from  10  to  20  grains 
of  a  good  alcoholic  extract.  It  loses  much  of 
its  power  by  repetition. 

Humulus  (hops)  and  lupulin,  its  glandular 
powder,  are  feebly  narcotic  in  action,  produc- 
ing such  effects  only  in  large  doses  of  active 
preparations,  2  fl.  drachms  and  upwards  of  the 
fluid  extract  of  the  former,  or  a  drachm  and 
more  of  the  oleoresin  of  the  latter.  Neither 
drug  is  capable  of  producing  the  extreme  stage 
of  narcotism. 

Lactucarium  (lettuce)  was  considered  high- 
ly soporific  and  narcotic  by  the  ancients,  and 
such  qualities  were  again  ascribed  to  it  in  the 
present  century  by  JJr.  Coxe,  of  Philadelphia, 
and  others.  It  is  now  looked  upon  as  a  very 
feeble  member  of  the  class,  if  possessing  nar- 
cotic power  at  all.  The  fresh  juice  of  the  wild 
plant  was  referred  to  by  Dioscorides  as  nearly 
equal  in  power  to  opium  ;  but  there  is  no  case 
on  record  of  poisoning,  or  any  symptoms  ap- 
proaching it,  from  any  quantity  of  the  modern 
preparations  ever  administered. 

Carbolic  acid  is  a  rapid  and  powerful  nar- 
cotic poison,  the  symptoms  developing  almost 
immediately  after  its  ingestion,  and  death  may 
occur  in  a  very  few  minutes.  The  minimum 
fatal  dose  is  not  determined,  but  i  an  oz.  has 
frequently  caused  death,  which  occurs  in  most 
cases  by  paralysis  of  respiration,  in  a  few  by 
paralysis  of  the  heart,  and  is  preceded  by 
paralysis  of  motion  and  sensation,  coma,  con- 
tracted pupils,  and  abolished  reflexes. 

Oil  of  turpentine  in  a  large  dose  (from  ^  to 
1  fl.  oz.)  is  a  powerful  narcotic  and  excitant 
of  delirium,  producing  primary  symptoms  of 
cerebral  intoxication  not  unlike  those  of  alco- 
hol, followed  by  paralysis  of  sensation  and 
abolished  reflexes,  death  occurring  in  coma  or 
convulsions,  or  both.  In  the  few  fatal  cases  of 
turpentine  poisoning  on  record  the  drug  acted 
evidently  through  the  nervous  system,  as  but 
slight  organic  traces  of  its  irritant  action  were 
found.  The  oils  of  eucalyptus,  rue,  savine, 
tansy,  and  wormwood  have  a  similar  narcotic 
action  in  large  doses,  being  powerfully  de- 
pressing to  the  brain,  medulla  oblongata,  and 
spinal  cord,  abolishing  sensation  and  reflex  ac- 
tion, and  causing  death  by  paralysis  of  respira- 
tion. 

Hydrocyanic  acid  produces  the  symptoms 
of  rapid  asphyxia,  and  causes  death  by  cardiac 
paralysis  in  the  instantaneously  fatal  cases,  by 
paralysis  of  the  respiratory  centre  in  those 
which  occur  more  slowly.  In  the  latter,  after 
a  convulsive  stage,  there  are  coma,  complete 
loss  of  sensation,  paralysis  of  the  voluntary 
muscles,  an  almost  imperceptible  pulss,  and 
slow,  weak  respiration — the  phenomena  of  nar- 
cotic poisoning. 

Carbonic  acid,  nitrous  oxide,  carburet- 
ted  hydrogen,  and  sulphuretted  hydro- 
gen gases  produce  symptoms  of  general 
narcosis,  and  cause  death  by  asphyxia  from 
paralysis  of  the  respiratory  centre. 

Samuel  0.  L.  Pottbe. 

NAKEG-AMIA  ALATA,  or  Ooa  ipecacu- 
anha, is  an  East  Indian  meliaceous  shrub  said 


to  contain  an  oil,  wax,  and  the  alkaloid  narega- 
mine.  The  root  is  said  to  be  emetic  and  chola- 
gogue,  and  to  have  been  found  efficient  as  a 
remedy  in  indigestion,  rheumatism,  and  ca- 
tarrhal affections.  The  powder  is  given  in 
daily  amounts  of  16  grains. 

NATRIUM.— See  Sodium. 

NECTANDEiA.— See  under  Bebeerine. 

NERItriyr. — Several  species  of  this  echitide- 
ous  genus  of  shrubs  are  reputed  to  have  medici- 
nal properties.  Merium  antidysentericum  is  the 
same  as  Wrightia  (or  Holarrhena)  antidysen- 
terica  {q.  v.).  Nerium  odoratum  (or  odorum), 
the  kunarel,  or  sweet-scented  oleander,  of  the 
Bast  Indies,  contains  two  non-nitrogenous  glu- 
cosides,  neriodorin  and  neriodorein.  Nerium 
oleander,  the  common  oleander,  contains  two 
alkaloids — oleandrine,  bitter  and  very  poison- 
ous, and  pseudocurarine,  tasteless  and  non- 
poisonous — also  two  glucosides,  nerianthin  (an 
inert  substance  resembling  digitalin  chem- 
ically) and  neriin,  which,  according  to  Schmie- 
deberg,  seems  to  be  identical  with  digitalein 
and  to  have  the  same  action  as  that  principle 
upon  the  heart,  causing  cessation  of  its  action 
in  systole.  Oleander  is  an  active  narcotico- 
acrid  poison.  It  should  not  be  used  where 
there  is  irritation  of  the  alimentary  canal,  and 
the  therapeutic  employment  of  it  should  al- 
ways be  very  cautious.  It  is  used  as  a  cardiac 
tonic,  and  its  prolonged  use  is  said  to  reduce 
the  frequency  of  the  paroxysms  of  epilepsy. 
There  are  no  official  preparations  of  oleander. 
The  fresh  leaves  of  the  Italian  plant  are  pre- 
ferred in  pharmacy.  A  tincture  made  witli  1 
part  of  the  leaves  to  5  parts  of  alcohol  may  be 
given  in  daily  amounts  of  from  5  to  10  drops. 

NERVINES.— The  nervines  include  those 
medicines  that  are  supposed  to  have  a  special 
action  on  nerve  tissue.  There  are  but  few 
agents  that  act  as  sedatives  or  stimulants  to 
the  nervous  system  in  virtue  of  their  primary 
effect  on  nervous  matter.  Some  medicaments 
quiet  nervous  irritability  on  account  of  the 
anodyne  influences  which  they  exert.  Among 
these  may  be  mentioned  opium,  morphine, 
codeine,  chloroform,  ether,  cannabis  indica, 
belladonna,  antipyrine,  acetanilide,  phenace- 
tine,  croton  chloral,  Hoffman's  anodyne,  ure- 
thane,  and  many  others ;  some  produce  a  similar 
result  on  account  of  their  effect  in  producing 
hypnosis,  among  which  may  be  mentioned  sul- 
phonal,  chloral,  paraldehyde,  hypnol,  somnal, 
amylene  hydrate,  tetronal,  trional,  chloralose, 
hydrobromide  of  hyoscine,  and  numerous  oth- 
ers belonging  to  this  group ;  some  act  as  stimu- 
lants or  sedatives,  largely  through  their  effect 
on  the  circulation,  and  foremost  among  these 
are  the  organic  and  inorganic  nitrites  and 
nitroglycerin  ;  others  have  a  special  influence 
on  the  nervous  system  from  their  apparent 
depressive  action  on  the  vaso-motor  nerves, 
cimicifuga  and  calabar  bean  being  the  princi- 
pal ones. 

The  nervines  to  which  I  shall  briefly  refer  in 
this  article  are  few  in  number,  and  consist  of 
asafoetida,  the  bromides,  hydrobromic  acid, 
camphor;  monobromated  camphor,  amber, 
musk,  valerian,  hops,  sumbul,  and  strychnine. 


KERVOUS  SUBSTANCES 
NITRIC  ACID 


Some  of  these  act  as  stimulants,  some  as  seda- 
tives, and  some  as  stimulants  with  a  sedative 
influence  on  the  nervous  system,  while  others 
apparently  influence  the  nervous  system  by 
their  tonic  action.  The  bromides  constitute 
the  purest  type  of  nervous  sedatives.  Valerian, 
hops,  and  amber  are  usually  considered  among 
the  pure  nerve  sedatives,  but  it  is  evident  to 
any  one  who  has  carefully  studied  the  influ- 
ence of  these  medicaments  in  quieting  nerv- 
ous disturbances  that  part  of  their  effect  is 
due  to  a  tonic  influence.  Asafoetida  is  usually 
classed  as  a  stimulant,  but  it  is  capable  of 
acting  as  a  sedative  in  conditions  of  excessive 
nervous  irritability.  Strychnine  and  sumbul 
exert  their  quieting  effects  on  the  nervous  sys- 
tem in  appropriate  doses,  indirectly  through 
their  tonic  effect.  The  rest-cure  and  forms  of 
liydrotherapy  are  the  best-known  non-medici- 
nal means  for  allaying  nervous  irritability. 

Bromides. — When  a  purely  sedative  effect 
of  the  bromides  is  desired  they  should  be 
given  in  10-grain  doses,  well  diluted  with  water, 
after  each  meal,  and  about  double  this  quantity 
may  with  advantage  be  administered  at  bed- 
time. The  indications  for  their  use  in  this 
manner  are  found  in  nervousness  from  irrita- 
tion of  the  sexual  organs,  from  worry,  cerebral 
overwork,  and  prolonged  mental  strain.  Bro- 
mide of  sodium  seems  to  act  better  as  a  pure 
nerve  sedative  than  most  of  the  other  bro- 
mides. Hydrobromic  acid  is  more  acceptable 
to  the  stomach  of  some  patients  than  the 
sodium  salt,  but  its  influence  in  producing 
sedation  is  usually  less  apparent. 

Asafoetida. — According  to  my  experience, 
the  nervine  that  stands  pre-eminently  first  in 
allaying  nervous  irritability,  especially  in  those 
hysterically  inclined,  is  asafoetida.  It  appar- 
ently acts  as  a  tonic  and  stimulant,  and  at  the 
same  time  has  a  soothing  effect  in  enabling  the 
patient  to  suppress  excessive  nervous  mani- 
festations. It  has  long  been  to  me  in  the 
treatment  of  over-functional  nervous  mani- 
festations what  cannabis  indfca  has  proved  to 
be  in  the  treatment  of  various  forms  of  head- 
ache and  conditions  of  hyperalgesia.  The  only 
objection  to  its  more  frequent  use  is  its  exces- 
sively offensive  odour.  I  hope  to  see  the  time 
when  some  enterprising  manufacturing  chem- 
ist will  be  able  to  extract  a  principle  from  asa- 
foetida that  will  contain  its  virtues  but  not  its 
odour.  To  obtain  the  best  effect  from  this 
drug,  it  must  be  given  in  large  doses.  Of  the 
gum  resin,  3  or  4  pills  containing  3  grains 
each  should  be  given  three  or  four  times  daily, 
but  most  stomachs  soon  rebel  against  these 
large  doses.  When  a  speedy  action  of  asa- 
foetida is  desired,  from  1  to  2  teaspoonfuls  of 
the  tincture,  in  water,  may  be  administered  by 
the  stomach,  or  a  tablespoonful  by  the  rectum, 
in  warm  milk  or  water.  The  drug  acts  in  re- 
lieving nervousness,  both  by  its  stimulating 
effects  upon  the  brain  and  by  its  lessening  in- 
testinal flatulence. 

Camphor  is  employed  on  account  of  its  sup- 
posed sedative  action  in  nervous  manifesta- 
tions in  women  and  children,  and  for  its 
apparent  stimulating  effect  in  the  depressive 
stages  of  the  low  fevers.    It  has  seemed  to  me 


to  be  an  agent  of  uncertain  value  when  used 
alone  for  its  sedative  action  on  the  nervous 
system,  but  its  influence  is  undoubted  in  the 
treatment  of  headaches  and  nervousness  from 
dysmenorrhoea,  when  it  is  combined  with  some 
of  the  analgetics,  such  as  phenacetine  or  acet- 
anilide.  Monobromated  camphor  combines  the 
effects  of  the  camphor  and  the  bromides,  but 
this  is  too  feeble  when  used  in  non-irritating 
doses  to  produce  a  very  decided  sedative  effect 
on  the  nervous  system.  Its  best  effects  are 
obtained  when  combined  with  phenacetine  or 
acetanilide  and  cannabis  indica.  Camphorated 
oil  (1  part  of  camphor  to  9  parts  of  aseptic 
sweet  oil)  is  a  prompt  and  powerful  stimulant, 
given  hypodermically,  in  cases  of  sudden  pros- 
tration. The  dose  for  this  purpose  is  15  minims. 
When  camphor  is  given  in  combination  with 
an  analgetic,  the  dose  need  not  exceed  from  1  to 
2  grains,  and  monobromated  camphor  may  be 
administered  in  about  the  same  doses  when  used 
in  combination  with  an  analgetic ;  but  when 
it  is  employed  alone,  two  or  three  times  these 
quantities  will  be  necessary  to  obtain  appre- 
ciable effects.  Both  pure  camphor  and  the 
monobromated,  in  large  doses,  are  gastric  irri- 
tants, and  should  not  be  given  to  persons  suf- 
fering from  gastritis. 

Valerian  is  a  less  reliable  agent  for  the 
relief  of  most  forms  of  functional  nervous 
manifestations  tha,n  asafoetida,  but  in  some 
cases  it  seems  to  be  superior  to  the  latter  drug. 
It  is  not  always  possible  to  determine  without 
a  trial  which  will  better  meet  the  indications 
in  a  given  case,  but  I  have  thought  that  vale- 
rian is  more  indicated  in  nervousness  and  hys- 
terical manifestations  due  to  loss  of  sleep  and 
prostration  following  prolonged  perioUs  of 
uncertainty  and  intense  anxiety.  The  best 
form  for  administration  under  such  circum- 
stances is  the  elixir  of  the  valerianate  of  am- 
monium in  teaspoonful  doses  every  hour  or 
two  until  relief  from  the  nervous  strain  is  ob- 
tained. A  hypnotic  or  a  small  dose  of  mor- 
phine increases  the  good  effects  of  the  valerian. 
V'alerian  in  combination  with  small  quantities 
of  morphine  acts  well  in  the  treatment  of  de- 
lirium tremens. 

Hops,  amber,  and  m.usk  may  be  classed 
among  the  nervines,  but  their  value  as  nerve 
sedatives  or  stimulants  is  slight,  except  to 
meet  special  indications.  Hops,  in  the  form 
of  the  hop  pillow,  have  been  popularly  used 
to  overcome  nervousness  and  induce  sleep,  but 
their  influence  is  rather  questionable.  Lupu- 
lin  (the  powder  of  the  strobiles  of  the  hops), 
in  doses  of  from  3  to  5  grains,  seems  to  do  good 
in  allaying  nervousness  from  irritation  of  the 
urethra,  bladder,  or  kidneys.  The  oil  of  am- 
ber, given  in  emulsion  in  from  2-  to  5-minim 
doses,  often  promptly  relieves  hiccough  of  func- 
tional nervous  origin.  Musk  acts  as  a  tempo- 
rary, but  as  an  effective  and  prompt,  stimulant 
in  cases  of  sudden  nervous  depression.  It  also 
quiets  nervous  excitement  occurring  in  de- 
pressed states  of  the  nervous  system,  and  is 
said  to  be  quite  effective  in  relieving  obstinate 
hiccough  under  such  circumstances.  The  dose 
of  the  powder  is  from  5  to  10  grains,  by  the 
mouth,  in  pill,  and  from  10  to  16  grains,  by 


NERVOUS  SUBSTANCES 
NITRIC   ACID 


the  rectum,  in  starch  water ;  that  of  the  tinc- 
ture from  -i  to  1  teaspoonful.  The  only  occa- 
sion for  resorting  to  this  expensive  medicine 
is  in  cases  of  great  nervous  depression,  when 
tiding  the  patient  over  for  a  few  hours  offers 
a  "fighting  chance"  for  life.  The  cost  of  the 
pure  drug  is  from  twenty  to  twenty-live  cents 
a  grain. 

Stryclmine  and  sumbul  may  be  classed 
among  the  nervines  from  their  special  tonic 
action  on  the  nervous  system.  Strychnine  in 
small  doses  has  a  happy  effect  in  allaying  nerv- 
ousness and  in  enabling  the  patient  to  suppress 
undue  nervous  manifestations  in  cases  of  the 
functional  neuroses.  It  is  an  invaluable  agent 
in  the  treatment  of  delirium  tremens.  Sum- 
bul,  while  less  efficient  than  strychnine  as  a 
nerve  tonic,  is  a  medicine  of  considerable  im- 
portance. The  indications  for  its  use  in  the 
functional  neuroses  are  about  the  same  as  those 
for  the  use  of  strychnine,  with  which  it  may 
be  advantageously  combined  in  pill  or  capsule. 
It  often  seems  to  act  well  in  the  unrest  of 
chronic  nerve  exhaustion  and  in  the  treatment 
of  delirium  tremens.  Of  the  tincture,  the 
usual  dose  is  from  1  to  4  teaspoonf uls ;  of  the 
extract,  from  1  to  3  grains ;  and  of  the  pow- 
dered root,  from  10  to  40  grains. 

Jeremiah  T.  Eskbidge. 

NERVOUS  SUBSTANCES.— See  under 
Akimal  Extracts  and  Juices. 

NEUBODfN.  —  This  is  a  German  trade 
name  for  acetylparaoxyphenylurethane, 
p  rr  ^  OCO.CHa 

^«^'<-NH.C0.0CaH5' 
introduced  into  medicine  in  1893  by  J.  von 
Mering,  of  Halle,  as  an  antipyretic  and  anal- 
getic. Lippi  (Policlinico,  Feb.  15,  1895 ;  Jour, 
of  the  Am.  Med.  Assoc,  Aug.  17,  1895)  has 
experimented  with  neurodin  on  persons  free 
from  pain,  in  order  to  ascertain  the  limits  of 
tolerance  of  the  drug  and  the  toxic  effects 
which  might  be  caused  by  it ;  also  on  persons 
suffering  from  pain  of  various  kinds,  either  in 
the  form  of  neuralgia,  or  as  symptomatic  of 
organic  lesions.  He  thus  treated  four  cases  of 
sciatica ;  one  case  of  slight  attacks  of  angina 
pectoris  in  a  patient  with  atheroma  of  the 
aorta ;  one  case  of  intestinal  pain  caused  by  ma- 
lignant growth  of  the  retroperitoneal  glands ; 
one  case  of  neuralgia  in  a  person  suffering 
from  polyneuritis;  one  case  of  brachial  neu- 
ralgia in  a  neurotic  subject ;  one  case  of  gas- 
tric pain  caused  by  epithelioma  of  the  gall 
bladder ;  one  case  of  headache  in  a  neurotic 
person  who  was  the  subject  of  a  neuralgia 
simulating  polyneuritis;  one  case  of  neuralgia 
of  the  bladder  and  stomach  in  a  patient  suf- 
fering from  cancer  of  the  liver;  one  case  of 
muscular  pains,  probably  rheumatic,  in  a  tu- 
berculous subject ;  and  one  case  of  pains  in 
the  arms  symptomatic  of  spinal  irritation.  He 
found  neurodin  to  have  the  property  of  sooth- 
ing and  even  abolishing  pain,  whether  neural- 
gic in  character  or  symptomatic  of  an  organic 
affection ;  its  action,  however,  he  considers  un- 
certain and  notably  inferior  to  that  of  other 
similar  remedies,  such  as  phenacetine  and  anti- 
pyrine. 


Neurodin  may  be  given  in  wafers,  in  doses 
of  from  7  to  25  grams.  It  is  said  not  to  be 
poisonous,  although  in  large  doses  it  has  been 
known  to  cause  diarrhoea. 

NICOTIANA,  NICOTINE.— See  Tobac- 


NITRATES.— See  under  Nitric  acid. 

NITBiE. — See  Potassium  nitrate. 

NITEIC  ACID,  acidvm  nitricum  (U.  S. 
Ph.,  Br.  Ph.,  Ger.  Ph.),  HNOa,  should  be  a 
colourless  'fluid,  but  has  usually  a  yellowish 
tinge,  emits  white  or  grayish  fumes  when  ex- 
posed to  the  air,  has  a  very  powerful  oxidizing 
action  upon  nearly  all  substances,  and  hence  is 
an  active  caustic.  When  it  comes  in  contact 
with  organic  matter  it  imparts  to  it  a  yellow 
stain  not  easily  removed.  This  property  is 
valuable  in  assisting  in  a  diagnosis  of  the 
cause  in  cases  of  poisoning  by  acids,  as  the 
mouth  and  lips  are  usually  of  a  yellower  dark- 
brown  colour.  It  is  not  often  that  accidental 
or  intentional  poisoning  with  it  occurs,  as  the 
irritating  vapours  given  off  by  it,  except  when 
freely  diluted,  prevent  its  being  mistaken  for 
other  fluids.  The  treatment  differs  in  no  way 
from  that  appropriate  for  poisoning  with  the 
other  acids,  but  must  be  undertaken  promptly. 
As  a  caustic,  it  is  more  largely  used  than  almost 
any  of  the  other  acids,  being  easy  to  control  and 
yet  sufBciently  active  to  meet  the  conditions  of 
nearly  all  cases  in  which  a  corrosive  effect  is  de- 
sired. It  may  be  applied  with  a  stick,  a  pledget 
of  cotton,  or  a  glass  rod  or  brush,  and  its  action 
limited  by  greasing  the  parts  around  the  point 
of  application.  Weak  alkaline  solutions  may 
be  used  to  check  its  action  when  this  has  been 
carried  as  far  as  is  desired.  Freely  bleeding 
hcemorrhoids,  when  of  small  size,  may  usually 
be  cured  by  the  free  use  of  this  acid.  It  is 
applied  through  an  anal  speculum,  and  almost 
immediately  after  its  application  a  considerable 
amount  of  any  vegetable  oil  should  be  injected 
to  prevent  any  extension  of  its  action  to  the 
healthy  tissues.  Chronic  cervical  endometritis, 
all  forms  of  intra-uterine  granulations,  and 
small  fibroid  tumours  may  be  benefited  by  its 
application,  the  cervix  being  thoroughly  di- 
lated so  as  to  allow  of  free  access  to  the  in- 
terior of  the  uterus  and  as  clear  a  view  of  it 
as  possible.  It  may  also  be  used  to  arrest 
hmmorrhage  from  the  mucous  membrane  of 
the  uterus  after  operations  for  the  removal  of 
polypi  and  other  small  foreign  growths.  For 
phagedcenic  ulcers,  chancroids,  cancrum  oris, 
and  hospital  gangrene  it  is  the  most  manage- 
able escharotic  in  use,  although  for  the  last- 
named  condition  bromine  is  to  be  preferred. 
Warts  and  condylomatous  growths  may  be  re- 
moved by  its  aid,  and  in  conditions  such  as 
cancer,  where  an  operation  is  inadmissible,  it 
may  be  used  as  a  palliative.  A  2-per-cent. 
aqueous  solution  may  be  employed  as  a  stim- 
ulant application  to  unhealthy  ulcerations  and 
to  bathe  irritated  and  bleeding  hcemorrhoids. 
In  chronic  cystitis  anA  phosphatic  deposits  in 
the  bladder  it  may  be  used,  as  a  vesical  in- 
jection, in  the  proportion  of  1  part  to  500  parts 
of  water.    Baths  containing  about  1  fl.  oz.  to 


NITRIC  ACID 


8 


the  gallon  of  water  are  sometimes  employed  in 
the  ti'eatment  of  cirrhosis  and  other  chronic 
affections  of  the  liver,  but,  while  they  are  of 
advantage,  it  is  doubtful  whether  the  effect  of 
the  acid  is  anything  more  than  that  of  an  irri- 
tant   of    the    skin.     Pediluvia   of    the    same 
strength  often  relieve  the  itching  of  chilblains. 
When  taken  internally  for  any  considerable 
period,  nitric  acid  has  an  effect  upon  the  gums 
resembling  that  of  mercury  and  its  salts,  but 
this  is  probably  due  to  its  local  action  rather 
than  to  a  constitutional  one.     This  condition 
should  be  an  indication  that  its  use  is  to  be 
suspended  for  a  while.     Nitric  acid  may  some- 
times be  substituted  for  hydrochloric  acid  when 
the  latter  seems  to  be  without  avail  in  the  con- 
ditions for  which  it  is  appropriate.     Oxaluria, 
dyspepsia  with  phosphalic  urine,  summer  and 
colliquative  diarrhoea,  lithcBmia,  chronic  bron- 
chitis, and  hoarseness  are  all  conditions  in 
which  it  may  be  expected  to  be  of  use..    Al- 
though it  has  been  recommended  in  the  treat- 
ment of  intermittent  fever,  it  is  hardly  to  be 
rfelied  upon  by  itself,  but  is  in  many  instances 
a  valuable   adjuvant   to   quinine,  particular- 
ly when   there  are  signs  of  hepatic  engorge- 
ment.   There  would  seem  to  be  little  doubt 
that    it  is  of  some  value   in  the  treatment 
of  chronic  diseases  of  the  liver,  but  nitro- 
hydroohloric  acid  is  more  effective.    Whooping- 
cough,  after  the  catarrhal  symptoms  have  dis- 
appeared, is  often  benefited  by  it.    In  intestinal 
indigestion  it  is  to  be  preferred  to  hydrochloric 
acid  when  diarrhoea  exists,  but  when  it  is  ab- 
sent the  latter  acid  is  more  useful.    A  number 
of  cures  of  constitutional  syphilis  treated  with 
this  acid  alone  have  been  reported,  but,  as  the 
starvation  method  has  usually  been  conjoined, 
it  is  more  than  probable  that  it  assisted,  as  it 
will  in  the   ordinary  methods,   rather    than 
acted  as  a  specific. 

From  5  to  10  drops  of  the  undiluted  acid,  in 
from  3  to  4  oz.  of  water,  may  be  given  three 
times  .daily,  or  even  oftener,  the  usual  pre- 
cautions, such  as  must  be  observed  in  the  use 
of  the  mineral  acids,  being  taken.  The  acid  of 
commerce,  acidum  nitricum  crudum  (Ger.  Ph.), 
is  hardly  suitable  for  internal  use,  as  it  may 
contain  impurities  derived  from  materials  em- 
ployed in  its  manufacture,  but  it  may  be  used 
externally  with  entire  propriety.  The  diluted 
acid,  acidum  nitricum  dilutum,  of  the  Br.  Ph., 
contains  a  little  more  than  17  per  cent,  of  the 
strong  acid,  while  that  of  the  P.  S.  Ph.  con- 
tains but  10  per  cent.  The  dose  of  the  former 
is  from  10  to  30  drops ;  that  of  the  latter  from 
15  to  40  drops,  freely  diluted  with  water. 

[Fuming  nitric  acid,  acidum  nitricum  fu- 
mans  (Ger.  Ph.),  contains  nitrous  acid  and 
emits  a  brownish  vapour  copiously.  It  is  pre- 
ferred by  some  practitioners  as  a  caustic] 

The  strong  acid  is  very  largely  used  m  de- 
termining the  presence  of  albumin  in  the 
urine.  It  may  be  used  by  placing  a  small 
quantity  in  a  test  tube  and  adding  cautiously 
an  equal  bulk  of  urine,  or  by  allowing  the  acid 
to  trickle  down  the  side  of  a  tube  into  which 
the  urine  has  been  previously  introduced,  care 
being  observed  in  each  case  that  the  two  do 
not  mingle  but  remain  in  distinct  layers.    If 


the  manipulation  has  been  proper  and  albumin 
is  present,  a  white  ring  or  disc  of  the  latter 
will  be  observed  at  the  point  of  contact  of  the 
two  layers,  or  the  acid  may  be  added  drop  by 
drop  to  an  indifferent  amount  of  urine  in  a 
test  tube  to  the  upper  portion  of  which  heat 
has  been  applied.  If  albumin  is  present  and 
has  not  been  previously  coagulated  by  the  heat, 
which  it  will  not  have  been  if  the  urine  is  al- 
kaline, a  white  precipitate  or  cloudiness  is 
formed.  It  must  be  remembered,  however, 
that  heat  will  cause  a  precipitate  of  phosphates 
under  certain  conditions,  but  this  is  redissolved 
by  the  acid,  which,  on  the  other  hand,  has  no 
effect  upon  the  coagulated  albumin. 

[Some  of  the  salts  of  nitric  acid,  notably 
certain  organic  nitrates,  appear  to  have  thera- 
peutical properties  that  call  for  some  consider- 
ation under  this  heading,  principally  in  the 
light  of  Dr.  J.  B.  Bradbury's  investigations  of 
the  vaso-dilator  action  of  methyl  nitrate,  glycol 
(ethylene)  dinitrate,  glycerol  trinitrate  (nitro- 
glycerin), erythrol  tetranitrate,  arabinol  penta- 
nitrate,  and  niannitol  hexanitrate,  as  set  forth 
by  him  in  a  Bradshaw  Lecture  delivered  before 
the  Royal  College  of  Physicians  of  London 
and  published  in  the  Lancet  and  in  the  British 
Medical  Journal  for  November  16,  1895.  All 
these  organic  nitrates,  says  Dr.  Bradbury, 
dilate  the  blood-vessels,  but  their  activity  varies 
within  wide  limits,  and  the  variation  appears 
to  be  due  to  their  different  solubilities  and  lia- 
bility to  decomposition.  Methyl  nitrate — the 
most  soluble  compound — has  a  comparatively 
slight  vaso-dilating  effect.  On  the  other  hand, 
glycol  dinitrate — the  least  stable — ^has  a  power- 
ful action  closely  resembling  that  of  nitroglyc- 
erin. Its  effect,  however,  is  more  transient.  The 
erythrol  and  mannitol  nitrates  and  the  nitro- 
sugars,  being  less  soluble  than  the  other  com- 
pounds, have  a  correspondingly  weaker  effect, 
but  their  action  is  more  prolonged.  In  individ- 
ual cases  slight  differences  in  the  extent  and 
duration  of  action  of  these  bodies  are  noticed, 
says  Dr.  Bradbury,  and  occasionally  persons  are 
met  with  comparatively  insusceptible  to  their 
influence.  Thus,  in  some  eases  of  advanced 
heart  disease  where  the  artery  presents  a  feel- 
ing of  fulness,  but  yet  remains  easily  com- 
pressible (the  "  virtual  tension  "  of  Broadbent), 
vaso-dilators  have  often  little  effect.  In  these 
cases  the  arteries,  like  the  heart,  have  lost  their 
normal  tone,  are  considerably  dilated,  and, 
though  possessing  a  sense  of  fulness  and,  on 
superficial  examination,  of  resistance,  are  vet 
arteries  of  low  tension.  Coupling  with  this 
fact  the  tendency  to  fibrous-tissue  formation 
in  the  various  oVgans  in  this  condition,  the 
author  finds  some  explanation  of  the  compara- 
tive irresponsiveness  of  these  cases. 

In  some  cases  of  not  far  advanced  Bright's 
disease  in  which  the  tension  is  very  high,  and 
is  evidently  due  to  causes  existent  in  the  blood, 
a  comparatively  large  dose  of  nitroglycerin  or 
one  of  its  allies  is  necessary  to  produce  any 
marked  reduction  of  tension.  "  But,"  says 
Dr.  Bradbury,  "  apart  from  such  pathological 
conditions,  we  now  and  then  come  across  indi- 
viduals who  can  bear  large  doses  of  these  drugs 
with  impunity.    Even  in  animals  there  seems 


9 


NITRIC  ACID 


to  be  considerable  variation  of  susceptibility  to 
the  action  of  vessel-dilating  drugs,  and  par- 
ticularly of  the  organic  nitrates.  The  reason 
is  not  always  clear.  Habitual  use  tends  to 
diminish  their  action,  but  this  is  obviously  not 
the  explanation  in  many  cases.  With  the  solid 
nitrates  the  amount  of  food  in  the  alimentary 
canal  at  the  time  of  administration,  as  well  as 
its  reaction,  will  have. an  important  influence 
in  determining  the  amount  of  drug  dissolved, 
and  therefore  absorbed.  It  may  be  that  under 
the  influence  of  the  alkaline  juices  of  the  in- 
testines these  nitrates  are  converted  into  ni- 
trites (for  example,  sodium  nitrite),  but  I  am 
rather  inclined  to  believe  that  this  change,  if 
it  occurs  at  all,  takes  place  in  the  blood  or  in 
the  cells  which  form  the  walls  of  the  blood- 
vessels." At  the  time  of  his  lecture  Dr.  Brad- 
bury knew  of  only  one  case — that  of  a  man 
suffering  from,  dilated  heart,  the  result  of  alco- 
holism, in  which  these  drugs  had  failed  to  have 
any  distinct  effect. 

"  The  action  of  organic  nitrates  upon  other 
organs,"  he  continues,  "  is  of  little  practical 
importance.  Upon  the  heart  the  direct  effect 
of  these  compounds  is  very  slight.  Indirectly, 
owing  to  the  diminished  work  consequent  on 
dilatation  of  the  blood-vessels,  increased  rapid- 
ity and  sometimes  palpitation  (especially  after 
glycol  and  glycerol  nitrates)  are  noticed.  Cer- 
tain nervous  effects  have  been  attributed  to 
nitroglycerin,  but  none  have,  as  yet,  followed 
the  administration  of  the  solid  organic  nitrates. 
The  effect  upon  the  urinary  excretion  is  prac- 
ticiiily  nil.  These  bodies,  as  far  as  they  have 
been  investigated,  are  not  diuretic.  As  ordi- 
narily administered,  the  organic  nitrates  pos- 
sess no  cumulative  action.  The  continued  use 
of  nitroglycerin  produces  a  lessened  suscepti- 
bility to  its  effects,  but  this  has  not  yet  been 
noticed  after  the  administration  of  the  ery- 
throl  and  mannitol  compounds." 

Reviewing  the  action  of  these  compounds 
upon  the  vascular  system  in  regard  to  their 
practical  application  to  the  treatment  of  dis- 
ease. Dr.  Bradbury  thinks  we  may,  for  the 
present  at  least,  discard  methyl  nitrate  as 
being  the  least  likely  to  prove  of  clinical 
value.  Glycol  dinitrate,  again,  is  so  similar  in 
action  to  nitroglycerin  and,  at  the  same  time, 
so  much  more  expensive,  that  it  also  is  not 
likely  to  enter  into  our  stock  of  remedies. 
The  longer-acting  nitrates,  however,  may  prove 
of  value. 

Dr.  Bradbury  continued  as  follows :  "  From 
the  pharmacological  action  of  these  two  ni- 
trates, it  would  seem  that  the  chief  indication 
for  their  use  is  a  condition  in  which  the  heart 
is  labouring  under  increased  work  imposed 
upon  it  by  contracted  arteries.  As  life  ad- 
vances, the  hitherto  elastic  vessels  become  con- 
verted into  more  or  less  rigid  tubes,  the  fibrous 
adventitia  is  thickened,  and  fibrous  tissue 
replaces,  to  a  greater  or  less  extent,  the  muscu- 
lar and  elastic  tissue  of  the  middle  coat.  As  a 
result,  increased  work  is  put  upon  the  heart, 
and  hypertrophy  results.  Sooner  or  later, 
however,  central  or  peripheral  degeneration 
occurs;  either  the  heart  fails  from  the  increased 
strain  put  upon  it  on  the  one  hand,  or  causes 


rupture  of  a  vessel  from  excessive  power  on 
the  other.  In  disease  the  normal  evolution 
may  be  compressed  into  a  much  shorter  space 
of  time ;  thickened  arteries  and  hypertrophied 
hearts  may  be  found  comparatively  early  in 
life ;  and  the  final  results  may  be  the  same.  If 
by  any  means  we  can  dilate  the  vessels  we  di- 
minish the  work  of  the  heart  and  the  pressure 
upon  each  unit  of  area  of  the  arteiy,  and  thus 
in  both  ways  avert  the  tendency  to  death. 
Our  difBculty  hitherto  has  been,  not  so  much 
to  reduce  arterial  tension  when  desired  as  to 
keep  the  tension  steadily  below  a  certain  level. 
Botn  nitroglycerin  and  sodium  nitrite  have 
been  used  for  this  purpose,  but  their  adminis- 
tration is  attended  with  some  inconvenience. 
As  we  have  seen,  these  drugs  have  compara- 
tively little  action  after  two  hours,  and  it 
would  therefore  be  necessary  to  give  them  at 
least  every  two  hours  to  produce  continuous 
low  tension.  Even  then  there  would  be  con- 
siderable variation  in  the  arterial  pressure. 
By  the  substances  I  have  described  the  tension 
is  not  brought  so  low,  but  the  reduction  is  of 
longer  duration  and  the  pressure  is  less  liable 
to  fluctuation.  They  are  also,  as  far  as  I  am 
aware,  free  from  poisonous  properties,  a  qual- 
ity readily  explained  by  their  slight  solubility." 
In  cardiac  pain,  Under  which  name  he  in- 
cludes all  forms  of  pain  accompanying  dis- 
eases of  the  heart  or  vessels,  and  adopts  it  in 
preference  to  angina  pectoris.  Dr.  Bradbury 
thinks  that  obvious  increase  of  tension  is  not 
always  present.  In  a  heart  weakened  by  dis- 
ease, he  remarks,  a  very  slight  increase  of  re- 
sistance may  prove  too  much  for  the  heart  to 
overcome.  This  slight  increase  may  be  due  to 
a  general  effect  almost  inappreciable  in  any 
one  artery,  or  to  an  effect  localized  in  one  or 
more  areas.  Of  greater  significance  is  the  fact 
that  vaso-dilators  do  not  always  relieve  angina- 
like pains,  especially  if  these  occur  in  cases  of 
far-advanced  heart  disease  with  a  low-tension 
pulse.  In  such  cases  morphine  is  of  much 
greater  value. 

■  It  is  only,  he  says,  by  keeping  arterial  pres- 
sure below  its  normal  level  that  the  solid  ' 
organic  nitrates  can  be  of  service  in  the  pre- 
vention of  a  seizure.  "  When  an  attack  has 
come  on,"  he  says,  "  it  is  necessary  to  resort 
to  more  quickly  acting  drugs,  and  in  cases  of 
a  sudden  and  severe  nature  inhalation  of  the 
fatty  nitrites  is  advisable.  For  cases  in  which 
the  pain  is  less  severe  and  of  longer  duration 
the  administration  of  nitroglycerin  or  sodium 
nitrite  is  perhaps  more  beneficial,  But  if  we 
can  prevent  the  advent  of  these  attacks,  a  great 
stride  ahead  will  have  been  made.  Much  may 
be  done  by  the  exhibition  of  purgatives  and 
attention  to  the  general  health,  but  in  the  ma- 
jority of  instances  something  more  is  needed. 
This  something  is,  I  believe,  a  vaso-dilator. 
Hitherto  nitroglycerin  and  sodium  nitrite  have 
been  the  drugs  mainly  used ;  but  their  evanes- 
cent and  varying  action  render  them  unsuit- 
able. Nevertheless,  I  have  seen  cases  in  which 
the  continuous  administration  both  of  nitro- 
glycerin and  sodium  nitrite  seemed  to  prevent 
the  occurrence  of  anginal  attacks,  and  other 
physicians  have  reported  similar  results.    In 


NITRITES 


10 


many  of  these  oases,  however,  attacks  occasion- 
ally developed,  and  it  is  quite  possible  that 
longer  acting  remedies,  such  as  erythrol  ni- 
trate, might  have  prevented  them  altogether." 
In  regard  to  chronic  Bright's  disease.  Dr. 
Bradbury  says :  "  The  most  important  change, 
and  the  one  which  affects  us  most  closely,  is 
the  arterial  thickening  attending  Bright's  dis- 
ease. This  leads  to  hypertrophy  of  the  heart, 
and  both  combined  to  a  high-tension  pulse. 
Sooner  or  later,  if  the  patient  does  not  succumb 
to  urajmia  or  some  intercurrent  disease,  the  in- 
creased vascular  strain  begins  to  tell  either 
upon  the  heart  or  on  the  vessels,  often  on  both. 
Either  the  symptoms  of  heart  failure  develop 
or  attacks  of  apoplexy  occur.  Previous  to 
such  terminations,  headache,  mental  inapti- 
tude, weariness,  and  similar  symptoms  are  not 
uncommon,  and  sometimes  these  may  be  no- 
ticed, with  a  high-tension  pulse,  where  no 
other  direct  evidence  of  renal  disease  exists. 
In  all  such  cases  the  longer  acting  vaso-dila- 
tors  are  often  beneficial.  1  do  not  wish  to  con- 
vey the  impression  that  I  regard  the  thickened 
condition  of  the  arteries  as  the  primary  cause 
of  the  high  tension  of  Bright's  disease.  This, 
I  believe,  is  due  in  the  first  instance  to  an  im- 
pure condition  of  the  blood,  and  the  correct 
treatment  under  the  circumstances  is  to  rid 
the  blood  as  far  as  possible  of  this  impurity. 
Once,  however,  the  fibroid  and  muscular  thick- 
ening in  the  arteries  is  produced  it  becomes  a 
danger  in  itself.  It  is  a  condition  we  can  not 
cure,  and  our  treatment  must  therefore  be 
symptomatic.  By  keeping  down  the  arterial 
pressure  in  such  conditions  we  may  not  only 
alleviate  unpleasant  symptoms,  but  may  also 
prevent  the  onset  of  such  disastrous  conditions 
as  cerebral  hiemorrhage.  The  fibroid  thicken- 
ing of  the  blood-vessels  does  not  annul  the 
action  of  these  nitrates,  though  it  diminishes 
to  some  extent  their  power."  Tracings  were 
shown,  one  series  of  which  had  been  taken 
from  a  man  in  advanced  Bright's  disease ;  the 
other  from  a  man  who  had  had  slight  attacks 
of  cerebral  haemorrhage.  With  regard  to  the 
action  of  these  drugs  upon  the  kidney  disease 
itself,  the  author  did  not  expect  any  beneficial 
action.  "They  are  not  diuretic,"  he  said,  "at 
the  same  time  they  are  not  irritant  to  the  kid- 
neys, and,  given  even  in  acute  inflammatory 
conditions  of  these  organs,  are  not  likely  to 
produce  ill  effects." 

In  cases  of  aneurysm — meaning  those  com- 
ing under  the  care  of  the  physician — Dr.  Brad- 
bury says  It  is  very  necessary  to  keep  the 
circulatory  system  as  far  as  possible  in  a  state 
of  physiolofjical  rest.  This  is  best  accom- 
plished by  dilating  the  peripheral  arteries,  and 
for  this  purpose  iodide  of  potassium  has  for 
some  time  been  the  drug  most  in  vogue. 
Without  detracting  in  the  least  from  the 
value  of  potassium  iodide  in  this  condition,  he 
thinks  that  the  nitrate  of  erythrol  or  of  man- 
nitol  will  accomplish  this  end  better,  and  will 
give  more  satisfactory  results,  in  cases  not  of 
syphilitic  origin.  The  pain  which  accom- 
panies aneai-ysm  is  not  often  relieved  by  vaso- 
dilators, and  therefore  he  does  not  expect  any 
benefit  from  the  nitrates  in  such  cases. 


Of  other  conditions  connected  with  the  con- 
traction of  blood-vessels,  Raynaud's  disease, 
says  Dr.  Bradbury,  is  one  that  has  been  suc- 
cessfully treated  with  nitroglycerin.  If  vaso- 
dilators are  of  value  in  this  condition,  it_  seems 
to  him  that  erythrol  nitrate,  as  tending  to 
keep  up  a  more  constant  dilatation,  would  be 
of  greater  value. 

With  regard  to  respiratory  conditions,  he 
does  not  expect  any  beneficial  efllects  from 
these  bodies.  In  various  forms  of  dyspnoea 
(uraemic,  asthmatic,  and  bronchitic)  nitroglyc- 
erin and  the  nitrites  are  sometimes  of  value, 
he  remarks,  but  they  often  fail  to  relieve. 
Seeing,  then,  that  the  action  of  these  compara- 
tively powerful  vaso-dilators  is  not  very  dis- 
tinct, he  says,  we  should  not  expect  the  less 
powerful  drugs  mentioned  to  exercise  much 
influence.  They  may  prove  of  prophylactic 
value  in  the  dyspnoea  occurring  in  Bright's 
disease,  for  example,  but  beyond  that  it  would 
be  useless  to  hazard  conjectures.  In  cases  of 
chronic  hronchitis,  however,  and  in  other  con- 
ditions where  the  dyspnoea  is  of  cardiac  origin, 
amelioration  might  be  obtained  from  these 
compounds,  he  thinks.  In  such  cases  the  weak 
heart  is  unable  to  drive  the  blood  with  suffi- 
cient power  along  the  arteries;  stagnation 
therefore  occurs  in  the  veins,  and  the  pulmo- 
nary system  is  often  the  first  to  suffer.  Thus 
aeration  is  limited  by  the  pulmonary  lesions 
on  the  one  hand  and  the  cardiac  on  the  other. 
By  dilating  the  vessels  and  thus  relieving  the 
heart,  the  circulation  becomes  more  eiRcient 
and  the  blood  is  better  aerated ;  but  under 
such  conditions  digitalis  is  usually  of  much 
greater  benefit.  He  mentions  that  disappear- 
ance of  the  headache  occurring  in  a  chronic 
bronchitic,  with  full,  rather  tense  pulse,  fol- 
lowed the  administration  of  erythrol  nitrate. 

It  is  very  probable,  he  thinks,  that  anmmic 
headaches  occurring  in  patients  with  a  high- 
tension  pulse  may  be  relieved  by  this  drug, 
but  his  observations  on  this  condition  have 
been  confined  to  those  with  a  low-tension 
pulse,  and  the  results  have  been  somewhat 
conflicting. 

Although  nitroglycerin  has  been  given  in 
many  nervous  affections.  Dr.  Bradbury  does 
not  think  much  beneflt  will  follow  the  use  of 
erythrol  or  mannitol  nitrate  in  these  diseases. 
Migraine  and  neuralgia,  he  remarks,  are  often 
accompanied  by  reflex  contraction  of  the 
blood-vessels,  atid  the  use  of  vaso-dilators  has 
sometimes  proved  curative.  The  solid  organic 
nitrates,  however,  are,  he  says,  much  too  slow 
in  action  to  be  of  beneflt.  though  it  is  possible 
they  may  prevent  attacks  of  migraine  if  ad- 
ministered continuously.  The  drugs  might 
also  be  used  by  those  who  believe  in  the  value 
of  nitroglycerin  in  epi7eps2/,  hut  as  he  has  rarely 
used  this  drug  in  this  affection,  his  experience 
on  this  point  is  limited.  Other  nervous  dis- 
eases—  epileptic  vertigo,  cerebral  congestion, 
tetanus,  etc. — in  which  nitroglycerin  has  been 
used  are  not  likely,  he  thinks,  to  yield  to  treat- 
ment with  the  nitrates. 

The  dose  of  the  solid  organic  nitrates,  ac- 
cording to  Dr.  Bradbury,  may  be  taken  as  1 
grain;   more  may  be  given  if  it  is  thought 


11 


NITRITES 


necessary,  but  usually  this  amount  will  suf&oe. 
They  may  be  taken  in  the  form  of  pills  or 
tablets  or  in  alcoholic  solution.  The  last 
method  he  prefers.  A  solution  of  erythrol  ni- 
trate in  the  strength  of  1  in  60  may  be  made, 
and  1  fl.  drachm  may  be  taken  in  an  ounce  of 
water  when  necessary.  Mannitol  nitrate,  he 
says,  is  not  quite  so  soluble,  but  a  1-per-cent. 
alcoholic  solution  can  be  prepared,  of  which 
H  or  2  fl.  drachms  may  be  taken  in  water. 
The  additions  thus  made  are  stable  and  free 
from  irritating  properties. 

He  knows  of  no  evil  effects  having  followed 
the  administration  of  these  drugs,  but  he  adds 
that  his  investigation  of  them  is  not  yet  com- 
plete.]— Russell  H.  Nevins. 

NITRITES. — The  compounds  known  as 
the  nitrites  have  become  quite  numerous.  They 
may  be  divided  into  two  groups — the  inorganic 
and  the  organic.  Those  constituting  the  former 
group  are  less  numerous  than  those  of  the  lat- 
ter. The  nitrites  of  sodium,  barium,  calcium, 
potassium,  and  strontium  are  the  principal 
ones  whose  bases  are  of  mineral  origin.  The 
organic  nitrites  whose  properties  have  been 
most  extensively  studied  are  compounds  of 
methyl,  ethyl,  propyl,  butyl,  and  amyl.  From 
these  we  have  the  primary,  iso-primary,  sec- 
ondary, and  tertiary  nitrites.  "The  primary 
nitrites,  both  normal  and  iso-primary,  differ 
from  tlie  secondary  and  tertiary  compounds  in 
containing  nitroxyl  joined  to  a  methylene 
group  (CHj),  and  all  these  primary  compounds 
therefore  contain  the  complex  (CH2NO2)  united 
with  the  different  alkyl  radicles.  In  the  sec- 
ondary nitrites  one  atom  of  hydrogen  in  this 
group  is  replaced  by  methyl,  (CHs)CH(CHs) 
KOj,  while  in  the  tertiary  nitrites  both  the  hy- 
drogen atoms  are  replaced  by  methyl,  and  these 
bodies  therefore  contain  the  group  C(CH3)2 
NOs.  If  the  radicle  takes  the  place  of  hydro- 
gen in  one  of  the  methylene  groups,  but  not  in 
that  which  is  atl ached   to    nitroxy],  the  iso- 

Brimary  butyl  nitrite  is  formed"  (Cash  and 
lunstan,  Phil.  Trans,  of  thr,  liny.  Soc.  of 
London,  vol.  clxxxiv  [1893],  R,  pp.  505-639). 
Thus,  of  butyl  we  find  normal  (primary),  iso- 
primary,  secondary,  and  tertiary  nitrites.  Ni- 
troglycerin is  sometimes  erroneously  regarded 
as  a  nitrite.  It  is  a  trinitrite  of  glyceryl. 
(See  Nitroglycerin.) 

The  influence  of  the  nitrites  on  the  general 
circulation  is  to  lower  the  arterial  tension  and 
increase  the  rapidity  of  the  pulse,  with  flush- 
ing of  the  face,  the  neck,  and  the  upper  por- 
tion of  the  chest,  especially  pronounced  from 
the  influence  of  the  amyl  nitrites.  The  dilata- 
tion of  the  capillaries  of  the  skin  over  the  other 
portions  of  the  body  is  not  often  very  marked. 
It  has  been  demonstrated  that  the  arterioles  of 
the  lungs  dilate  from  the  influence  of  these 
agents,  thus  pointing  to  their  usefulness  in 
relieving  a  distended  right  heart.  The  lowered 
arterial  tension  is  mainly  due  to  the  direct 
effects  of  the  nitrites  in  paralyzing  the  circu- 
lar muscular  fibres  of  the  arterioles,  and  the 
increased  rapidity  of  the  heart's  action  proba- 
bly results  from  their  depressing  influence  on 
the  inhibitory  nerve  of  the  heart  and  the  im- 
45 


pression  made  upon  the  cardiac  muscle  by  the 
sudden  dilatation  of  the  arterioles.  According 
to  the  observations  of  Professor  Cash  and  Pro- 
fessor Dunstan,  the  nitrites  named  below  ac- 
celerate the  pulse  in  the  following  order,  the 
strongest  being  named  first :  Tertiary  amyl 
nitrite,  a-amyl  nitrite,  ;8-amyl  nitrite,  tertiary 
butyl  nitrite,  isobutyl  nitrite,  secondary  butyl 
nitrite,  butyl  nitrite,  secondary  propyl  nitrite, 
primary  propyl  nitrite,  ethyl  nitrite,  and  methyl 
nitrite.  The  pulse  begins  to  show  some  accel- 
eration at  the  end  of  five  seconds  after  inhaling 
a  few  drops  of  amyl  nitrite,  attains  the  great- 
est frequency  about  the  end  of  the  35th  second, 
when  it  begins  gradually  to  decline,  and  reaches 
normal  at  the  end  of  the  70th  to  the  90th  sec- 
ond. The  average  greatest  fi'equency  from 
moderate  doses  of  the  amyl-nitrite  prepara- 
tions is  from  30  to  40  beats  a  minute.  The 
primary  butyl  nitrite  causes  about  75  per  cent, 
of  the- pulse  acceleration  found  to  follow  amyl 
nitrite.  The  greatest  frequency  of  the  pulse  is 
reached  between  25  and  28  seconds  after  begin- 
ning the  inhalation,  and  the  return  to  normal 
is  a  few  seconds  (3  to  5)  sooner  than  follows  after 
inhaling  amyl  nitrite.  Isobutyl  and  secondary 
butyl  nitrites  increase  the  pulse  a  little  more 
than  primary  butyl  nitrite.  Isobutyl  nitrite 
causes  about  82  per  cent,  and  the  secondary 
about  80  per  cent,  of  that  found  to  follow  the 
inhalation  of  an  equal  quantity  of  amyl  nitrite. 
The  pulse  after  each  returns  to  normal  a  few 
seconds  sooner  than  after  amyl  nitrite.  Pri- 
mary propyl  nitrite  accelerates  the  pulse  about 
62  per  cent,  and  the  secondary  about  76  per 
cent,  of  what  results  from  an  equal  dose  of 
amyl  nitrite.  The  acceleration  and  reduction 
of  the  pulse  are  effected  in  a  shorter  time  than 
from  amyl  nitrite.  Bthyl  nitrite  increases  the 
pulse-rate  only  10  or  15  beats  a  minute.  The 
maximum  influence  on  the  pulse  is  reached 
about  25  or  80  seconds  after  inhalation  is  be- 
gun, but  complete  reduction  does  not  take 
place  until  at  the  end  of  the  60th  or  70th  sec-' 
ond,  when  the  pulse  shows  a  tendency  to  fall 
below  normal  (Cash  and  Dunstan).  Professor 
Leech's  experiments  (Brit.  Med.  Jour.,  July  1, 
1893,  p.  6)  show  a  slower  action  of  ethyl  nitrite 
than  that  observed  by  Cash  and  Dunstan.  So- 
dium nitrite  acts  much  more  slowly  than  the 
group  of  organic  nitrites,  and  its  influence  is 
much  more  prolonged. 

There  is  no  positive  evidence  of  the  nitrites 
having  a  direct  stimulating  effect  upon  the 
heart.  In  large  doses  they  all  lessen  the 
strength  of  the  cardiac  systole,  and  especially 
is  this  effect  well  marked  after  large  doses  of 
sodium  and  ethyl  nitrite.  Leech,  in  compar- 
ing the  influence  of  the  nitrites  with  that  of 
alcohol,  says :  "  On  the  whole,  it  seems  to  me 
we  must  accord  to  the  nitrites  in  small  doses 
a  certain  degree  of  that  kind  of  stimulating 
power  which  we  attribute  to  alcohol,  but  it  is 
exercised  much  more  quickly,  passes  away 
more  rapidly,  and  is  far  more  readily  followed 
by  decreased  cardiac  power  than  is  alcohol." 
By  relieving  the  distended  right  heart  of  blood 
and  depressing  the  cardiac  inhibitory  centres 
the  nitrites  act  as  indirect  cardiac  stimulants. 
Irregular  action  of  -the  heart  may  result  from 


NITROBENZENE 


13 


large  doses  of  the  nitrites,  and  slight  irregu- 
larity is  said  to  be  common  after  the  inhala- 
tion of  amyl,  isobutyl,  and  propyl  nitrites. 
The  recorded  observations  of  a  number  of  cli- 
nicians are  to  the  effect  that  previous  irregular 
action  of  the  heart  is  no  bar  to  the  adminis- 
tration of  the  nitrites,  and  that  when  such 
irregularity  exists  it  is  frequently  lessened, 
sometimes  made  to  disappear,  and  rarely  in- 
creased by  appropriate  doses. 

Reduction  of  the  Blond-pressure. — Reduc- 
tion of  the  blood-pressure  is  usually  well 
marked  after  the  administration  of  the  nitrites. 
According  to  Cash  and  Dunstan,  the  organic 
nitrites  may  be  arranged  as  follows,  the  nu- 
merals representing  the  relative  strength  of 
each  in  reducing  the  blood-pressure :  The  ter- 
tiary nitrites— butyl  (9),  amyl  (6) ;  the  second- 
ary—propyl  (10),  butyl  (8);  the  primary — 
iso-butyl  (7),  amyl  (5),  methyl  (4),  butyl  (3), 
ethyl  (2),  and  propyl  (1). 

Respiration. — Very  small  quantities  of  the 
nitrite  do  not  perceptibly  affect  respiration; 
medicinal  doses  increas'i  the  number  of  respi- 
rations to  the  minute,  the  increase  amounting 
in  the  case  of  the  primary  amyl  nitrite  to  5  or 
9,  and  occasionally  to  12  respirations  over  the 
normal.  Repeated  inhalations  without  a  long 
interval  cause  distinct  slowing  of  the  respira- 
tion. Toxic  doses  paralyze  respiration  before 
the  heart  ceases  to  beat.  Leech  believes  that 
small  medicinal  quantities  of  the  nitrites  stim- 
ulate the  respiratory  centre.  When  these 
agents  exert  a  depressing  effect  on  the  respira- 
tory centre  it  is  probably  through  their  influ- 
ence on  the  blood,  which  becomes  dark,  and 
even  chocolate-coloured,  before  death,  from  in- 
terference with  hiemic  respiration. 

Stomach  and  Bowels. — The  effect  of  the 
nitrites  on  the  gastro-intestinal  raucous  mem- 
brane varies  in  different  individuals.  Many 
experience  no  inconvenience  when  the  nitrites 
are  administered  in  medicinal  doses  beyond 
emanations  of  nitrous  gas  in  small  quantities, 
especially  following  the  ingestion  of  sodium 
and  ethyl  nitrites,  while  to  others  they  act  as 
gastric  irritants,  causing  sickness  and  diar- 
rhoea. Leech  thinks  that  when  inhalation  of 
the  nitrites  causes  gastro-intestinal  disturb- 
ance it  is  due  to  their  excretion  by  the  stomach 
and  bowels. 

Kidneys — Dilatation  of  the  vessels  of  the 
kidneys  results  from  the  administration  of  the 
nitrites,  and  an  increased  flow  of  urine  takes 
place  in  some  cases,  but  experimental  observa- 
tions seem  to  show  that  they  are  rather  unre- 
liable diuretics.  Atkinson  found  in  carefully 
conducted  experiments  on  lower  animals  that 
small  doses  of  nitrite  of  sodium  either  did  not 
affect  the  flow  of  urine  at  all,  or  slightly  dimin- 
ished or  increased  it.  Leech's  experimental 
observations  on  twelve  persons  free  from  fever, 
cardiac  or  kidney  disease,  to  each  of  whom 
he  gave  3  grains  of  nitrite  of  sodium  thrice  daily 
for  a  week,  showed  the  urine  increased  in  quan- 
tity in  seven  and  decreased  in  five.  In  only  one 
of  the  seven  was  the  urine  markedly  increased, 
amounting  in  this  one  to  317'731  c.  c.  (7  fl.  oz.) 
daily  {Brit.  Med.  Jour.,  July  1,  1898,  p.  7). 
The  excretion  of  urea  and  that  of  uric  acid 


seem  to  be  unaffected  by  the  use  of  the  nitrites.' 
It  should  be  remembered,  as  Leech  reminds  us, 
that,  although  the  nitrites  do  not  materially 
affect  the  action  of  the  kidneys  in  health,  it 
does  not  follow  that  they  are  inert  in  certain 
pathological  states  of  these  organs. 

Temperature. — Small  quantities  of  the  ni- 
trites, given  to  persons  in  health,  do  not  mate- 
rially affect  the  temperature,  but  in  toxic  doses 
they  lower  it  considerably. 

Perspiration. — Most  nitrites,  when  given  in 
sufficiently  large  doses  to  dilate  the  vessels  of 
the  surface  of  the  body,  will  increase  the  per- 
spiration temporarily.  Both  sodium  and  ethyl 
nitrite  possess  this  power  in  conditions  favour- 
able for  their  action.  The  latter,  in  the  form 
of  spirit  of  nitrous  ether,  given  in  doses  of  ^ 
a  fl.  oz.  in  hot  drinks,  is  the  most  reliable,  but 
little  effect  may  be  expected  from  it  when  given 
in  doses  varying  from  10  to  15  minims.  The 
condition  most  favourable  for  the  diaphoretic 
action  of  the  nitrites  is  a  febrile  condition  fol- 
lowing exposure  to  cold. 

The  Nervous  System. — The  nitrites  in  ordi- 
nary medicinal  doses  do  not  seem  to  depress 
the  nerve-centres  or  nerves,  but  in  large  thera- 
peutic and  toxic  doses  they  lessen  cerebral  ac- 
tivity, giving  rise  to  heaviness  and  apathy, 
and  sometimes  even  to  stupor  or  unconscious- 
ness after  inhalations  of  large  quantities  of  the 
vapour  of  nitrous  ether  or  nitrite  of  amyl. 
Leech  is  confident  that  no  narcotic  effect  need 
be  feared  from  the  use  of  the  nitrites  in  me- 
dicinal doses,  and  observes  that  "  the  sense  of 
distention  and  throbbing  in  the  head,  the  diz- 
ziness, and  the  headache  felt  by  some  after 
amyl,  ethyl,  or  sodium  nitrite  are  manifestly 
due  to  circulatory  changes  ;  but  the  prolonged 
headache,  which  does  not  always  come  on  im- 
mediately, but  may  last  'for  twelve  hours  or 
more  after  some  nitrites  have  been  taken,  is 
probably  not  due  to  the  same  cause.  It  is  most 
frequent  after  amyl  and  isobutyl  compounds. 
I  have  felt  it  myself  after  both,  and  also  after 
propyl  compounds,  but  not  after  ethyl  nitrite 
or  sodinm  nitrite.  I  am  inclined  to  think 
it  is  caused  by  the  alcohol  radicles,  and  not  by 
the  nitrite  element,  for  other  amyl,  Isobutyl, 
and  propyl  compounds  produce  the  same  kind 
of  long-lasting  headache."  The  convulsions 
that  sometimes  occur  in  the  lower  animals  and 
the  slight  muscular  twitching  that  has  been  oc- 
casionally observed  in  man,  after  taking  large 
doses  of  one  of  the  nitrites,  especially  the  amyl 
nitrite,  are  thought  to  be  of  cerebral  origin  and 
due  to  the  asphyxiating  infiuence  of  the  poison. 
All  observers  seem  agreed  that  the  entire  ab- 
sence of  any  serious  or  fatal  brain  disturbance 
following  large  doses  of  the  nitrites  makes  the 
unpleasant  cerebral  symptoms  no  bar  to  their 
administration  in  medicinal  doses.  Motor  con- 
duction and  the  reflex  activity  of  the  spinal 
cord  are  depressed  after  toxic  quantities  of  the 
nitrites  in  the  lower  animals,  and  probably  also 
in  man,  even  after  very  large  medicinal  doses, 
but  other  symptoms  than  spinal  are  so  promi- 
nent after  using  these  agents  in  man  that  it  is 
almost  impossible  to  determine  satisfactorily 
their  effects  on  the  functions  of  the  cord.  The 
activity  of  the  motor  nerves  is  undoubtedly 


13 


NITROBENZENE 


lessened,  but  not  out  of  proportion  to  the  irri- 
tability of  the  muscles.  The  sensory  nerves  do 
not  seem  to  be  directly  afEected,  and  the  relief 
of  pain  which  sometimes  follows  the  use  of  the 
nitrites  is  due  to  their  influence  on  the  circu- 
lation. 

Therapeutic  Uses  of  the  Nitrites. — The 
carefully  conducted  experiments  of  Professor 
Reicherl  {Am.  Jour,  of  the  Med.  Sci.,  July, 
1880,  p.  158)  show  that  the  physiological  effects 
of  the  alkaline  nitrites,  especially  of  sodium  and 
potassium,  are  almost  identical  with  those  of 
amyl  nitrite,  except  that  they  are  much  slower 
in  "their  action  and  more  permanent  in  their 
efEects.  The  investigations  of  Cash  and  Dun- 
stan  (/.  c.)  demonstrated  a  marked  similarity  be- 
tween the  effects  of  amyl  nitrite  and  the  other 
organic  nitrites.  And,  finally,  the  admirable 
clinical  observations  of  Professor  Leech  (Brit. 
Med.  Jour.,  vols,  i  and  ii,  1893),  as  well  as  the 
experience  of  various  clinicians,  enable  us  to 
conclude  that  the  therapeutic  indications  whose 
value  has  been  determined  are  nearly  the  same, 
and  the  choice  of  the  nitrite  to  be  employed  in 
a  given  case  will  depend  largely  upon  the  ra- 
pidity of  action  and  the  permanence  of  the 
effects  desired  from  a  nitrite,  modified  by  the 
unpleasant  symptoms  which  are  more  likely  to 
follow  the  use  of  certain  nitrites  than  of  oth- 
ers. The  reader  is  referred  to  the  article  on 
Amyl  nitrite  for  the  general  therapeutic  in- 
dications of  the  nitrites. 

[Petrone  {Riforma  med.,  Aug.  31,  1895 ;  Brit. 
31ed.  Jour.  [Bpiiome],  Nov.  33,  1895),  having 
found  that  rabbits  that  had  been  inoculated 
subdurally  with  rabies  had  their  period  of  sur- 
vival doubled  by  subcutaneous  injections  of 
sodium  nitrite,  tried  the  same  treatment  in  two 
cases  of  syphilis  with  good  results.  The  first 
case  was  that  of  a  man  suffering  from  marked 
malarial  cachexia  and  enlarged  spleen,  who 
contracted  syphilis  in  December,  1893.  Dur- 
ing the  early  manifestations  he  took  mercury 
and  iodide  of  potassium,  but  as  soon  as  the 
symptoms  disappeared  he  ceased  taking  medi- 
cine. In  March,  1894,  he  suffered  from  marked 
nocturnal  osteocopic  pains,  periostitis  of  the 
skull  and  tibia,  and  an  abundant  papulo- 
pustular  syphilide.  From  5  to  10  grains  of 
sodium  nitrite,  rapidly  increased  to  50  grains, 
were  injected  daily  in  two  doses.  The  noctur- 
nal pains  were  relieved  on  the  second  day,  and 
the  rash  and  periostitis  gradually  disappeared, 
so  that  at  the  end  of  a  month  the  patient  was 
able  to  work  and  in  much  better  health  in  every 
way.  The  second  case  was  that  of  a  woman, 
aged  twenty-two,  suffering  from  hereditary 
syphilis,  which  had  first  developed  ten  years 
before,  and  been  treated  with  potassium  iodide 
and  mercury.  In  April,  1895,  she  presented 
loss  of  bony  substance  over  an  area  equal  in 
size  to  a  5-franc  piece  on  the  right  frontal  bone 
and  on  the  left  parietal,  confiuent  ulcerating 
gummata  on  the  back,  gummata  on  the  thigh, 
and  very  extensive  ulceration  of  the  leg.  The 
daily  injection  of  50  grains  of  sodium  nitrite 
in  two  doses  was  practised,  and  the  ulcers  were 
merely  cleansed  with  boric-acid  solution.  After 
twenty-six  days  the  sores  were  almost  all  healed. 
The  treatment  was  then  interrupted  for  a  few 


days  by  an  attack  of  acute  bronchitis.  On  the 
resumption  of,  the  injections  the  patient  was 
cured  in  ten  days  more  and  her  general  health 
much  improved.  No  local  troubles  or  general 
symptoms  followed  the  injections.  The  solu- 
tions, says  the  author,  should  not  be  more  con- 
centrated than  3  or  3  per  cent.] 

Some  of  the  Ifitrites  Compared. — Headache 
is  more  common  after  the  amyl,  isobutyl,  and 
propyl  compounds,  and  least  frequent  after  the 
nitrites  of  sodium  and  ethyl.  The  pulse  is 
most  accelerated  by  the  amyl  nitrites,  but  so- 
dium and  ethyl  nitrites  cause  only  slight  in- 
creased action.  Gastric  irritation  occasionally 
follows  the  use  of  nitrites  of  sodium,  potas- 
sium, and  ethyl.  When  rapidity  of  action  is 
desired,  nitrite  of  amyl  is  to  be  preferred  to 
all  the  other  nitrites,  but  if  a  more  prolonged 
influence  of  a  nitrite  is  the  object,  nitrite  of 
sodium  is  preferable.  Cash  found  isobutyl 
and  secondary  propyl  compounds  most  active 
in  lowering  blood-pressure,  and  Leech  thinks 
that  isobutyl  nitrite  is  more  reliable  for  the 
relief  of  anginal  pain  than  the  official  amyl 
nitrite.  In  cases  where  it  is  desirable  to  in- 
crease the  flow  of  urine  temporarily,  ethyl  ni- 
trite or  the  spirit  of  nitrous  ether  is  fairly 
efiBcient,  if  given  in  sufficiently  large  quanti- 
ties. 

Dose  and  Administration. — Half  a  fl.  oz.  of 
spirit  of  nitrous  ether,  or  1  fl.  drachm  of  the 
2'5-per-cent.  solution  of  the  nitrite  of  ethyl, 
should  be  given  to  an  adult.  The  former  con- 
tains, when  pure,  from  3'5  to  2-75  per  cent,  of 
nitrite  of  ethyl.  It  should  not  be  mixed  with 
water  except  in  combination  with  an  alkaline 
solution,  such  as  the  acetate  of  ammonium  or 
potassium,  until  just  before  administration,  as  it 
rapidly  deteriorates  after  water  has  been  added. 
The  nitrite  of  ethyl  is  soluble  in  absolute  alco- 
hol, and  must  not  be  mixed  with  water  until  the 
time  of  its  administration.  Of  the  two  alka- 
line preparations  (of  sodium  and  potassium)  of 
which  most  is  known,  the  nitrite  of  sodium  is 
most  commonly  employed  when  a  prolonged 
effect  of  a  nitrite  is  desired.  The  sodium  and 
potassium  nitrites  may  be  given  in  doses  vary- 
ing from  1  to  5  grains.  Two  grains  is  the 
ordinary  dose  to  begin  with,  but  it  is  always 
safe  to  begin  with  the  minimum  dose  of  a 
medicine  that  is  sometimes  followed  by  un- 
pleasant symptoms,  and  increase  the  quantity 
after  the  susceptibility  of  the  patient  is  ascer- 
tained. The  nitrite  of  sodium  or  potassium 
may  be  given  in  water.  When  it  is  desirable 
to  administer  a  nitrite  hypodermically,  a  solu- 
tion of  nitroglycerin,  which  acts  like  a  nitrite, 
is  to  be  preferred  to  the  nitrite  of  sodium  or 
potassium.    (See  Nitroglycerin.) 

Jeremiah  T.  Eskridge. 

NITROBENZENE,  or  nitrolenzol,  C.Hs 
NOa,  oil  of  mirbane,  artificial  oil  of  bitter 
almonds,  is  an  oily  liquid  that  has  an  odour 
resembling  that  of  bitter  almonds,  and  a  very 
sweet  taste.  It  is  produced  by  the  action  of 
strong  nitric  acid  on  benzol,  the  resulting  prod- 
uct being  washed  with  water. 

If  nitrobenzene  is  injected  into  the  blood- 
I  vessels  of  a  rabbit,  death  with  convulsions  en- 


NITROGEX 
NITEOGLYOERIN 


14 


sues  in  a  few  seconds.  Administered  internally 
to  an  animal,  it  produces  unconsciousness,  epi- 
leptoid  spasms,  in  some  animals  glycosuria,  and 
sometimes  death  in  consequence  of  paralysis 
of  the  motor-centres  of  the  nervous  system. 

The  inhalation  of  the  fumes  of  nitrobenzene 
produces  in  man  headache,  muscular  weakness, 
drowsiness,  mental  disturbance,  and  a  blue 
colour  of  the  face.  Taken  internally,  the  drug 
is  absorbed  more  or  less  slowly,  and,  in  addi- 
tion to  the  foregoing  symptoms,  the  entire 
body  acquires  the  bluish  colour,  the  pupils  are 
dilated,  the  respiration  is  rapid,  shallow,  and 
irregular,  the  pulse  is  rapid  and  thready,  soon 
becoming  imperceptible,  the  muscles  are  com- 
pletely relaxed,  and  consciousness  is  lost.  Fif- 
teen drops  have  caused  death. 

Nitrobenzene  has  no  therapeutic  uses,  but  is 
employed  in  manufactures.  In  case  of  poison- 
ing with  it,  apomorphine  or  some  other  emetic 
should  be  administered  at  once  so  as  to  empty 
the  stomach,  which  should  be  washed  out  by 
means  of  a  stomach-pump  or  stomach-tube; 
hypodermic  injections  of  strychnine  should  be 
administered  as  may  be  necessary ;  the  bodily 
temperature  should  be  maintained  with  hot- 
water  bottles  or  bags  ;  and  massage  and  arti- 
ficial respiration  should  be  used  if  necessary. 
Samuel  T.  Armsteosg. 

NITROCrEN,  nitrogenium,  or  azote. — This 
gas  is  disengaged  freely  from  certain  mineral 
waters,  such  as  those  of  Lippspringe  and  the 
Ottilien-Quelle  at  Paderborn.  According  to 
Dr.  I.  Burney  Yeo  (Manual  of  liedical  Treat- 
ment, Philadelphia,  1893),  the  gases  that  those 
waters  give  off  contain  respectively  83'25  and 
97  per  cent,  of  nitrogen.  Great  improvement 
of  the  general-  symptoms  in  cases  of  pulmonary 
tuberculosis,  says  Dr.  Yeo,  is  stated  to  follow 
the  inhalation  of  this  gas,  which  is  conducted 
with  the  aid  of  a  special  apparatus :  the  sleep 
is  said  to  become  calm,  the  appetite  to  increase, 
the  night  sweats  to  diminish,  the  diarrhoea,  if 
there  has  been  any,  to  be  allayed,  and  the  pul- 
monary capacity,  the  weight,  and,  except  in 
desperate  cases,  the  bodily  strength  and  ac- 
tivity to  be  increased.  But  the  fever  has  been 
reported  as  variously  influenced.  Treutler 
(Oertel's  Respiratory  Therapeutics,  Yeo's  trans- 
lation) says :  "  In  slighter  cases  it  soon  dis- 
appeared, in  others  it  was  sometimes  even 
exaggerated  for  the  first  week  or  two,  after- 
ward diminishing  somewhat  rapidly  or  ceas- 
ing altogether,  while  in  hopeless  cases  it  was 
unaffected." 

Dr.  Yeo  refers  to  Oertel's  book  for  a  full 
description  of  the  mode  of  conducting  the  in- 
halations, and  makes  the  following  quotation 
from  his  translation  of  it :  "  It  is  difficult  as  yet 
to  express  a  decided  opinion  on  the  influence 
of  nitrogen  inhalations  on  chronic  pulmonary 
infiltrations,  as  we  have  not  nearly  sufficient 
observations  on  the  subject  to  exclude  com- 
pletely all  the  casualties  which  always  occur 
in  the  treatment  of  pathological  processes 
running  so  varied  a  course,  and  to  be  able  to 
separate  the  influence  of  the  various  other 
agents  which  come  into  operation.  For  the 
present  it  behooves  us  to  give  a  fair  trial  of 


nitrogen  inhalations  in  th  e  treatment  of  chrome 
pneumonia  and  its  products." 

On  the  other  hand,  Rhoden,  of  Lippspringe 
(cited  by  Yen),  is  inclined  to  attribute  the 
good  effects  of  the  treatment  to  the  moist  cli- 
mate, the  inhalation  of  vapour  of  water,  and 
the  drinking  of  a  great  amount  of  warm  water 
containing  a  considerable  quantity  of  calcium 
salts,  together  with  a  little  sodium  sulphate, 
the  patient  fasting. 

ITITROG-LYCERIN,  an  organic  nitrate, 
glyceryl  trinitrate,  03H5(ON02)3,  is  an  explo- 
sive compound,  and  to  obviate  the  prejudice 
that  some  patients  might  therefore  have  against 
its  use,  it  has  been  employed  under  the  names 
of  trinitrin  and  glonoin.  It  is  an  agent  of  con- 
siderable importance  and  is  principally  used  in 
medicine  when  it  is  desirable  to  make  a  rapid 
and  powerful  effect  upon  the  vascular  appa- 
ratus by_dilating  the  arterioles.  It  occupies  a 
place  between  amyl  nitrite  and  sodium  nitrite, 
being  less  rapid  in  its  action  and  more  per- 
manent in  its  effects  than  the  former,  but 
expending  its  influence  on  the  vascular  sys- 
tem more  quickly  than  the  latter,  although 
the  headache  which  is  very  common  after  a 
large  dose  of  nitroglycerin  persists  much  longer 
than  one  produced  by  sodium  nitrite. 

The  effects  of  nitroglycerin  are  first  expe- 
rienced by  the  patient  in  from  a  few  seconds 
to  one  or  two  minutes  after  the  drug  has  been 
administered.  In  small  doses,  yet  large  enough 
to  be  appreciable,  these  consist  of  full  and 
throbbing  sensations  in  the  head  and  slight 
dizziness,  followed,  in  some  instances,  by  head- 
ache. Larger  medicinal  doses  give  rise  to  sud- 
denly developed  dizziness,  full,  throbbing,  and 
constricting  feelings  in  the  head,  amounting 
frequently  to  decided  headache;  a  choking 
sensation  in  the  throat,  at  times  nausea,  faint- 
ness,  rapid  action  of  the  heart,  lessened  arterial 
pressure,  dilatation  of  the  arterioles,  followed 
by  languor,  and.  according  to  Bartholow,  some- 
times pams  in  the  stomach.  In  still  larger,  or 
lethal  doses,  the  effects  are  rapidly  developed 
and  very  pronounced,  amounting  to  an  ex- 
treme degree  of  languor  and  muscular  relaxa- 
tion, weak  and  rapid  action  of  the  heart,  small, 
feeble,  or  imperceptible  pulse,  cold,  clammy 
perspiration,  and  even  unconsciousness.  The 
effects  of  nitroglycerin  are  most  rapidly  de- 
veloped when  it  is  administered  in  alcoholic 
solution. 

On  account  of  the  variable  susceptibility 
exhibited  by  different  persons  to  the  influ- 
ence of  this  medicament,  considerable  care  is 
required  that  the  initial  dose  should  not  be 
larger  than  is  necessary  to  produce  the  desired 
results.  One  minim  of  a  1-per-cent.  alcoholic 
solution  has  produced  insensibility,  and  3 
minims  have  been  followed  by  loss  of  conscious- 
ness and  absence  of  the  pulse  at  the  wrists  (II. 
C.  Wood,  Therapeutics  and  Materia  Medica, 
6th  ed.,  p.  390).  I  have  observed  unpleasant 
effects  to  follow  the  use  of  yU  of  a  grain.  On 
the  other  hand,  some  persons  experience  no 
disagreeable  symptoms  after  taking  2  or  3 
minims  of  a  1-per-cent.  solution.  Persons  soon 
become   accustomed    to    increasing  doses  of 


15 


NITROGEN 
NITROGLYCERIN 


nitroglycerin.  Dr.  Murrell  gave  10  minims 
eight  times  daily,  the  only  effect  being  to  re- 
lieve anginal  pain  and  cause  some  headache 
(Croonian  Lectures.  Brit.  Med.  Jour.,  July  8, 
1893,  p.  57).  Bartholow  thinks  that  women 
and  persons  of  feeble  constitution  are  more 
susceptible  to  the  druf;  under  consideration 
than  the  robust  {Materia  Medica  and  Ttiera- 
peutics,  8th  ed.,  p.  G(iT).  Like  nitrite  of  amy], 
nitroglycerin,  in  toxic  doses,  causes  the  blood 
to  assume  a  chocolate  colour,  owing,  no  doubt, 
to  its  power  of  interfering  with  hifimic  respira- 
tion. 

Death  may  be  produced  by  large  doses  of 
nitroglycerin,  and  such  a  result  is  apparently 
due  to  paralysis  of  the  muscles  of  respiration; 
but  if  ordinary  care  is  used  in  the  employment; 
of  this  powerful  agent,  nothing  further  than 
slight  inconvenience  will  be  encountered  in 
those  who  are  the  most  susceptible  to  its  influ- 
ence. Even  when  unconsciousness  has  been 
produced  by  its  too  free  use,  recovery  has  taken 
place  without  an  untoward  symptom  beyond 
headache  that  persisted  for  some  hours. 

Dose  and  administration. — It  is  always 
safer  to  begin  with  a  small  dose  in  persons 
whose  susceptibility  to  the  influence  of  nitro- 
glycerin is  unknown,  and  rapidly  increase  the 
quantity  until  slight  inconvenience  is  experi- 
enced by  the  patient,  or  the  desired  results  are 
obtained.  The  initial  dose  for  weak  and  ner- 
vous persons  should  not  exceed  jjj-  or  T[h^  of  ^ 
grain,  and  if  no  appreciable  effects  are  experi- 
enced the  same  quantity  may  be  repeated  in 
ten  minutes.  If  still  no  effects  are  observed, 
the  dose  may  be  doubled  and  repeated  as  often 
as  is  found  necessary.  There  are  two  solutions 
of  nitroglycerin  in  use — the  alcoholic,  spiritus 
glonoini  (U.  S.  Ph.),  and  the  aqueous.  They  are 
both  1-per-cent.  solutions.  The  alcoholic  solu- 
tion is  more  reliable  than  the  aqueous,  but  the 
disadvantage  of  it  is  that  it  becomes  explosive 
in  proportion  to  the  amount  of  evaporation  that 
has  talcen  place  of  the  alcohol  holding  it  in 
solution.  Hare  recommends  that  it  should  be 
kept  in  tightly  stoppered  tins,  in  a  cool  place. 
The  dose  to  begin  with  of  either  of  these  solu- 
tions should  not  exceed  J  a  minim  in  persons 
whose  susceptibility  to  nitroglycerin  is  not 
known.  Tablets  and  pellets  of  nitroglycerin  are 
made  by  manufacturing  chemists.  The  amount 
of  nitroglycerin  contained  in  them  varies  from 
jirff  to  yi^  of  a  grain.  1  have  known  the 
weaker  ones  to  cause  unpleasant  symptoms. 

[The  British  official  tablets,  tabeUm  nitrogly- 
eerini(Jir.  Ph.),  are  tablets  of  chocolate,  each 
containing  xhn  oi  a  grain  of  pure  nitroglyc- 
erin.] 

To  Dr.  Murrell,  of  London,  belongs  the 
credit  of  having  first  employed  nitroglycerin 
for  the  relief  of  spasmodic  attacks  of  angina 
pectoris.  It  seems  to  lessen  or  cut  short  the 
precordial  pain  and  distress  by  suddenly  dilat- 
ing the  arterioles,  especially  of  the  pulmonary 
circulation,  and  thus  relieving  the  distended 
cavities  of  the  heart.  When  great  promptness 
of  action  is  required,  inhalations  of  amyl  ni- 
trite should  be  given  for  its  temporary  effect, 
followed  by  nitroglycerin  for  its  more  perma- 
nent influence.    As  soon  as  the  susceptibility 


of  the  patient  to  the  influence  of  this  drug  is 
ascertained  it  must  be  pushed  to  the  point  of 
tolerance.  Larger  doses  are  required  in  this 
disease  than  in  almost  any  other  spasmodic 
affection.  Leech  (Brit.  Med.  Jour.,  July  15, 
1893,  p.  109)  states  that  he  has  had  to  gradually 
raise  the  dose  to  30  minims,  and  a  larger  dose 
is  frequently  required. 

The  nitrites  generally,  and  nitroglycerin  es- 
pecially, are  useful  in  cardiac  dyspnoea,  both 
of  puljponary  and  of  cardiac  origin.  In  cases 
in  which  the  heart  is  weak  or  fatty,  it  is 
thought  care  should  be  exercised  lest  damage 
to  the  heart  result,  but,  on  the  whole,  the 
weight  of  testimony  is  in  favour  of  the  use  of 
this  agent,  even  under  such  circumstances. 

Some  eases  of  spasmodic  asthma  are  bene- 
fited by  ni  troglycerin,  but  in  this  affection,  as  in 
angina  pectoris,  the  less  the  structural  changes 
that  have  taken  place,  the  better  the  effects  of 
the  nitrites;  therefore  it  is  in  the  early  stages 
of  these  diseases  that  most  may  be  expected 
from  the  use  of  any  of  the  nitrite  group. 

It  is  well  known  that  the  arterial  tension  is 
increased  in  Bright's  disease,  and,  as  nitroglyc- 
erin lessens  this,  it,  as  well  as  the  other  ni- 
trites, has  been  employed  with,  as  is  alleged, 
more  or  less  advantage  to  the  patient  (Bar- 
tholow, Robson,  et  al.). 

Nitroglycerin  has  been  employed  with  some 
success  in  hiccough,  whooping-cough,  laryngis- 
mus stridulus,  tetanus,  seasickness,  reflex  vom- 
iting,'gastralgia,  sixiA  hepatic  and  renal  colic. 
It  is  not  so  effectnal  in  preventing  an  attack 
of  epilepsy  as  amyl  nitrite.  In  migraine 
attended  with  blanching  of  the  face,  and  in 
neuralgia  of  the  trigeminal  nerve  due  to  in- 
suffieient  blood  supply  to  the  affected  nerve  ni- 
troglycerin acts  promptly  in  cutting  short  an 
attack.  Headaches  due  to  anamia  of  the  train 
are  relieved  by  this  agent.  Bartholow  speaks 
highly  of  the  use  of  nitroglycerin  in  the  cure 
of  ancemia.  The  cold  stage  of  intermittent 
fever  may  be  aborted- by  any  of  the  promptly- 
acting  nitrites.  Gowers  recommends  the  use 
of  nitroglycerin  thrice  daily  in  persons  who  are 
subject  to  migrainous  headaches,  given  during 
the  interval  of  the  attack  for  the  purpose  of 
increasing  the  blood  supply  of  the  brain. 

[Nitroglycerin  has  recently  been  found  a 
very  potent  remedy  in  sciatica.  A  Russian 
physician.  Dr.  Milkhalkine  (Semaine  mid.  ; 
Lyon  med.,  Feb.  24,  1895),  reports  three  cases 
of  persistent  sciatica  that  had  been  absolutely 
rebellious  to  the  action  of  antipyrine,  of  acet- 
anilide,  of  chloral  hydrate,  of  the  bromides,  and 
of  other  analogous  drugs,  as  well  as  to  the  em- 
ployment of  I'evulsives.  Under  the  influence 
of  nitroglycerin  two  of  the  patients  were  radi- 
cally cured  of  their  sciatica,  and  in  the  third 
case  it  produced  a  considerable  amelioration. 
It  was  administered  sometimes  in  a  1-per-eent. 
alcoholic  solution,  of  which  three  drops  a  day 
were  taken,  sometimes  under  the  form  of  the 
following  mixture  : 

A  1-per-cent.  alcoholic  solution  of  nitroglyc- 
erin, 75  grains ; 

Tincture  of  capsicum,  113  grains  ; 

Distilled  peppermint-water,  235  grains. 

S.  :  From  5  to  10  drops  three  times  a  day. 


NITEOHYDROCHLORIC  ACID 
NITROUS  OXIDE 


16 


Dr.  William  C.  Krauss,  of  Buffalo  (N.  Y. 
Med.  Jour.,  Feb.  29,  1896),  before  he  had  seen 
Milkhalkine's  report,  and  having  only  a  vague 
knowledge  that  Lawrence  had  recommended 
the  use  of  nitroglycerin  in  the  treatment  of 
sciatica,  treated  seven  cases  with  the  drug,  using 
it  indiscriminately  in  all  his  cases  of  sciatic 
pain.  Dr.  Krauss  reports  that  all  these  seven  pa- 
tients received  decided  benefit  from  the  very 
beginning  of  this  mode  of  treatment.  In  the 
acute  cases  they  recovered  in  from  ten  days  to 
a  month ;  in  the  chronic  cases  they  improved 
notably  and  gained  daily.  Just  how  to  explain 
the  action  of  ,this  drug  on  sciatic  disturbances, 
says  Dr.  Krauss,  is  extremely  difficult;  to  say 
that  it  has  the  eflfeet  of  dilating  the  arterioles 
of  tJie  nerve  sheaths,  affording  more  nourish- 
ment to  the  nerve,  might  answer  in  cases  of  neu- 
ralgic sciatica,  but  would  hardly  be  accepted 
for  neuritic  sciatica.  The  action  in  these  lat- 
ter cases  can  be  explained  in  no  satisfactoiy 
way,  and  therefore  had  better  be  left  unex- 
plained. The  only  discomforts  arising  from 
the  use  of  the  drug  noted  by  Dr.  Krauss  were 
congestive  headaches  and  flushing  of  the  face 
sometimes  following  the  first  dose  of  the  medi- 
cine, while  in  other  cases  they  did  not  supervene 
until  the  maximum  doses  were  administered. 
To  counteract  these  effects,  he  says,  the  bro- 
mides may  be  used,  thus  robbing  the  nitroglyc- 
erin of  all  the  physiological  effects  where  they 
are  not  wanted,  and  allowing  them  to  proceed 
without  hindrance  in  those  places  where  they 
are  desired. 

Dr.  Krauss  adds :  "  I  do  not  wish  to  convey 
the  idea  that  nitroglycerin  will  cure  every  case 
of  sciatica — far  from  it ;  but  if  it  cures  50  per 
cent,  of  all  cases  in  a  period  of  from  one  to 
three  weeks,  it  will  be  doing  what  no  other 
drug  or  measure  has  heretofore  done.  If  after 
a  period  of  administration  of  ten  days  no  per- 
ceptible effects  have  been  obtained,  it  should 
be  abandoned  and  kept  in  store  for  the  nest 
case.  The  treatment  of  anaemic  conditions, 
diatheses,  and  local  causes,  such  as  pressure — 
these,  perhaps,  provoking  and  setting  up  the 
sciatic  pain — must,  of  course,  be  considered 
and  carried  out  in  conjunction  with  the  special 
treatment.  Prom  my  experience  I  should  ad- 
vise beginning  the  treating  sciatica  with  nitro- 
glycerin, and  only  after  its  inability  to  cure  is 
apparent  falling  back  upon  the  other  drugs 
and  measures  with  which  we  are  all  ac- 
quainted." 

Dr.  G.  Lindsay  TurnbuU  (Lancet,  Feb.  8, 
1896),  who  records  a  case  of  the  successful  use 
of  nitroglycerin  in  the  treatment  of  gallstone 
colic,  suggests  its  use  when  morphine  is  not 
well  borne.] — Jeremiah  T.  Eskridge. 

NITBOHYDROCHLORIC  ACID,  or  ni- 

tromuriatic  acid,  aqua  regia,  acidum  nitro- 
hydrochloricum  (U.  S.  Ph.),  contains  18  parts  of 
nitric  acid  and  82  of  hydrochloric  acid,  is  of 
an  orange-yellow  colour,  and  is  highly  cor- 
rosive, but  is  somewhat  unstable,  and  should 
be  freshly  prepared  to  be  of  the  highest  thera- 
peutic value.  Although  strongly  escharotic, 
it  is  never  employed  as  a  caustic,  and  possesses 
no  advantage  over  nitric  acid.    In  the  propor- 


tion of  1  fl.  oz.  to  the  gallon  of  warm  water  it 
is  often  used  for  sponging  cachectic  children 
that  have  a  dry,  wrinkled  skin,  white  pasty 
stools,  and  an  inclination  to  gseophagia.     A 
somewhat  stronger  solution — from  2  to  8  fl.  oz. 
of  the  acid  to  the  gallon  of  watei- — is  very  ser- 
viceable in  the  treatment  of  jaundice  due  to 
duodenitis  or  malaria ;  it  is  used  for  sponging 
the  surface  of  the  body  and  as  a  pediluvium, 
or  a  general  bath  in  it  may  be  taken.     Nearly 
all  chronic,  but  not  the  acute,  diseases  of  the 
liver  are  beneflted  by  the   constant   wearing 
of  a  broad  bandage  moistened  in  a  solution 
of  this  strength  and  covered  with  oiled  silk, 
over  the  region  of  the  liver.     The  efficacy  of 
the  external  application  of  this  acid  is  usually 
increased  by  its  simultaneous  internal  admin- 
istration.    Dysentery,  jaundice,  smA  dropsy  of 
hepatic  origin,  especially  in  persons  residing 
in  hot  climates,  are  also  generally  alleviated  by 
a  continued  use  of  it.     In  constitutional  syph- 
ilis it  is  more  useful  than  niti'ic  acid,  particu- 
larly after  a  long  course  of  potassium  iodide 
and   mercury.      It   may  be  used  in    place  of 
nitric  acid  in  the  various  digestive  disorders, 
lithcemia,  etc.,  and  often  is  more  efficient,  but 
no  rule  can  be  given  for  the  selection  of  the 
cases  in  which  it  would  be  the  more  appro- 
priate.    In   xanthelasma,  acne,  and  all  cuta- 
neous  affections    due    to  or    aggravated    by 
digestive  disturbances   it  is  a  highly  useful 
adjuvant  to  anv  special  treatment  which  may 
he  indicated.    It  is  advisfed  that  it  should  not 
be  combined  with  alcoholic  solutions,  as  suf- 
ficient gas  may  be  given  off  to  cause  an  ex- 
plosion.    The  dose  is  from  3  to  6  drops,  well 
diluted,  three  times  daily.     The  dilute  acid, 
acidum  nitrohydrochloricum   dilutiim   (D.  S. 
Ph.,  Br.  Ph.),  is  of  about  one  third  the  strength 
of  the  undiluted,  and  may  be  given  in  doses 
of  from  10  to  20  drops,  biit  is  not  very  reli- 
able, as  the  reaction  between  the  diluted  acids 
used  in  its  preparation  is  very  different  from 
that  which  occurs  when  the  undiluted  acids 
are  mixed. — Russell  H.  Nevins, 

NITROUS  OXIDE,  laughing  ga.i,  pro- 
toxide of  nitrogen,  or  nitrogen  monoxide,  is  a 
colourless,  transparent  gas  of  the  specific  grav- 
ity of  1-537  and  of  neutral  reaction.  It  has  a 
sweetish  odour  and  scarcely  any  taste.  It  is 
made  by  careful  heating  of  nitrate  of  ammo- 
nium, NHjNOa,  which  splits  up  into  water 
and  nitrous-oxide  gas,  N,0.  To  be  freed  from 
any  trace  of  acid  or  nitric  oxide,  the  gas 
should  be  passed  through  a  solution  of  hydrate 
of  potassium  and  a  solution  of  ferrous  sul- 
phate, and  should  be  held  over  water  in  a  jar 
for  at  least  twenty-four  hours.  Xitrous-oxido 
gas  supports  combustion  almost  as  well  as 
oxygen.  By  pi'essure,  a  colourless  liquid  may 
be  made  of  the  gas,  and  further  pressure  will 
cause  its  solidification.  Water  will  take  up 
almost  its  own  bulk  of  nitrous-oxide  gas. 

Priestley  discovered  the  gas,  but  Sir  Hum- 
phrey Davy  was  the  first  to  discover  its  aiias- 
thetic  properties.  It  was  his  belief  that  it 
could  be  substituted  for  oxygen  in  inspired 
air  ;  but  this  has  since  been  proved  false  by  the 
researches  of  Hermann  and  of  Amory  [N.  T. 


17 


NITROHYDROCHLORIC  ACID 
NITROUS  OXIDE 


Med.  Jour.,  Aug.,  18T0).  Davy  did  not  carry 
his  experiments  far  enough,  however,  to  realize 
the  possibility  of  the  use  of  nitrous-oxide  gas 
for  surgical  purposes.  Mr.  Colton,  now  an 
aged  man  living  in  New  York,  was  demon- 
strating the  anaesthetic  properties  of  the  gas 
in  one  of  his  public  exhibitions  in  which  per- 
sons under  its  influence  seemed  to  feel  no 
sensibility  to  pain,  when  the  notion  was  seized 
by  Horace  Wells,  a  dentist  of  Hartford,  Conn., 
to  use  the  substance  for  the  painless  extrac- 
tion of  teeth.  Dr.  Wells  made  an  unsuccessful 
effort  in  1844  to  induce  the  medical  profession 
to  adopt  nitrous  oxide  as  a  general  surgical 
ansesthetic,  but  his  attempt  failed.  It  was  not 
until  1863  that  it  came  fully  into  vogue  among 
dentists.  Since  that  time  it  has  been  used  for 
ansBsthetic  purposes  on  a  gigantic  scale  all  over 
the  civilized  world. 

For  our  knowledge  of  the  physiological  ac- 
tion of  nitrous  oxide  we  are  indebted  princi- 
pally to  Hermann  (Arch.  f.  Anat.  u.  Physiol., 
18G4),  Amory  {loc.  cit.),  and  Zuntz  (Pflilger's 
Archiv,  Bd.  17, 1878,  i  and  ii).  Though  there 
is  a  difference  in  the  methods  employed  by 
these  observers,  their  results  are  almost  iden- 
tical. Arterial  blood  shaken  up  witli  nitrous- 
oxide  gas  becomes  dark,  .and  venous  blood 
remains  dark.  Inhaled  pure,  the  gas  pro- 
duces a  feeling  of  sufEocation  and  at  the  same 
time  of  stimulation.  The  gas  is,  therefore, 
not  respirable  in  the  true  sense  of  the  word, 
for  it  does  not  give  up  its  oxygen  to  the  blood. 
All  observers  are  agreed  that  asphyxia  is  pro- 
duced by  this  strong  molecular  cohesion,  de- 
priving the  blood  temporarily  of  a  suflScient 
supply  of  oxygen.  The  ansesthetic  properties  of 
the  gas  lie  in  close  connection  with  its  as- 
phyxiating tendencies. 

On  inhalation  of  nitrous-oxide  gas,  there  is 
first  noticed  a  stimulation  of  the  entire  system, 
as  in  alcoholic  intoxication.  The  entire  body 
tingles,  and  the  keenness  of  the  senses  is  ac- 
centuated. The  pulse  becomes  fuller  and  more 
rapid,  and  the  respirations  are  increased  in 
frequency  and  are  shallow.  Consciousness  is 
maintained  up  to  this  point,  and  the  subject 
answers  questions  rationally.  The  face  is  pale. 
If  the  administration  of  the  gas  is  continued, 
the  face  and  visible  conjunctivEe  become  deeply 
cyanosed,  and  the  breathing  grows  stertorous. 
Consciousness  disappears  and  anEesthesia  of 
the  senses  follows,  sensation  and  muscular 
power  being  the  last  to  disappear.  Unless  the 
use  of  the  anaesthetic  is  continued,  the  aboli- 
tion of  sensation  lasts  but  a  minute  or  two, 
the  patient  recovering  from  the  influence  of 
the  narcotic  as  soon  as  oxygen  is  inhaled. 
Rhythmic  muscular  movements,  twitchings, 
or  rigidity  may  manifest  themselves  during 
the  anaesthesia ;  or,  on  recovery,  there  may  be 
erotic  symptoms  or  hysterical  conduct. 

During  the  second  period  of  ansesthesia, 
■when  the  face  is  dark  and  the  pulse  scarcely 
perceptible,  it  is  well  to  guard  against  the  pos- 
sibility of  complete  asphyxia  or  the  appearance 
of  convulsions  by  giving  the  patient  a  few 
whiffs  of  atmospheric  air.  During  the  period 
of  insensibility,  dilatation  of  the  pupil,  im- 
peded respiration,  irregularity  of  the  heart, 


and  diminished  pulse-rate  are  often  seen. 
Warner  {Lancet,  June  17,  1883,  p.  985)  reports 
that  he  has  seen  coma,  hemiplegia,  catalepsy, 
hysteria,  and  clonic  convulsions  follow  the  use 
of  laughing  gas.  Cardiac  disturbances  are 
not  rarely  witnessed,  and  an  interesting  case 
is  recorded  by  Ottley  {Lancet,  Jan.  30,  1883). 
Lafout  has  observed  a  transient  albuminuria 
and  glycosuria  following  the  inhalation  of 
nitrous-oxide  gas  {University  Med.  Mag.,  vol. 
ii,  p.  348).  The  great  majority  of  people  may 
be  narcotized  without  any  disagreeable  occur- 
rences. Occasionally,  however,  persons  are 
met  with  who  complain  of  an  "  anxious  feel- 
ing" about  the  breast — something  like  that 
witnessed  in  pseudo-angina  pectoris.  Some- 
times the  psychical  effects  of  the  gas  are 
disagreeable  rather  than  pleasing,  and  the 
occasional  slight  convulsions  already  noted 
indicate  an  irritation  of  the  cerebral  cortex. 
Long-continued  anaesthesia  with  this  gas  may 
be  followed  by  a  venous  condition  of  the  arte- 
rial blood;  due  to  the  deprivation  of  oxygen 
from  the  haemoglobin  of  the  red  blood-cells. 

Erotic  excitation  is  not  uncommonly  ob- 
served after  nitrous  oxide  anaesthesia.  The 
same  precaution  of  having  a  third  responsible 
person  present  during  the  narcosis  of  females 
should  be  observed  as  in  ether  ansesthesia. 
Vomiting  and  nausea  practically  never  occur 
in  the  use  of  this  gas.  Minor  operations 
under  its  influence  can  therefore  be  under- 
taken without  consideration  of  a  previous 
meal. 

Recovery  from  the  infTuence  of  nitrous  oxide 
is  marked  by  a  slight  mental  dulness,  which 
rapidly  disappears.  The  face  and  visible  mu- 
cous membranes  return  to  their  normal  colour, 
and  within  a  minute  or  a  minute  and  a  half 
the  patient  is  entirely  conscious.  He  may 
laugh  or  cry  for  a  few  minutes,  or  may  remain 
very  solemn  in  his  demeanour. 

That  nitrous  oxide  is  the  safest  of  the  three 
great  anaesthetics  is  axiomatic.  Deaths  after 
or  during  its  use  are  exti-emely  rare.  Thus, 
Darin,  making  a  statistical  comparison,  gives 
these  figures :  Chloroform,  one  death  out  of 
3,873  anaesthesias ;  ether,  one  out  of  33,303  ; 
and  nitrous-oxide  gas,  one  out  of  100,000  {Brit. 
Med.  Jour.,  Jan  84,  1885).  The  present  writer 
has  been  able  to  find  but  eighteen  cases  of 
death  from  nitrous-oxide,  one  of  these  being 
an  unrecorded  instance.  The  gas  is  used,  un- 
doubtedly, hundreds  of  thousands  of  times  an- 
nually, and  report  is  certain  to  be  made  of  a 
fatal  result  in  its  administration.  Evidence  is 
almost  unanimous  that  it  is  the  safest  of  the 
general  anassthetics. 

liolden  has  pointed  out  that  inhalation  of  the 
gas  may  be  followed  by  haemorrhagic  tendency, 
and  that  its  employment  is  always  attended 
with  pulmonary  engorgement.  He  regards 
nitrous  oxide,  therefore,  as  contra-indicated  in 
pulmonary  disease,  particularly  when  there 
has  been  a  hfemoptysis,  and  in  haemophiliacs 
(Kappeler,  Anmsthetica,  Stuttgart,  1880). 

Nitrous-oxide  gas  has  its  greatest  use  among 
dentists  in  the  extraction,  of  teeth  and  their 
roots.  Among  surgeons  it  has  gained  wider 
and  wider  favour  during  the  last  decade  for 


NOSOPHENB 
NUCLEINS 


18 


use  in  minor  operations  of  short  duration.  Un- 
fortunately, its  physiological  action  is  so  su- 
preme that  it  will  not  admit  of  prolonged 
employment.  It  is  called  into  requisition  for 
the  opening  of  abscesses,  tenotomies,  and  the  re- 
daction of  dislocations  and  fractures.  Barton 
recommended  it  highly  for  the  last-mentioned 
purposes,  because  of  its  safety  and  the  qui..'k 
muscular  relaxation  it  produces  (Phila.  Med. 
Times,  vol.  xvi,  p.  108).  It  can  be  satisfactorily 
used  in  operating  an  ingrown  toe  nail  and  in 
circumcision.  In  fact,  in  any  surgical  pro- 
cedure which  requires  only  a  short  anaesthesia, 
nitrous-oxide  gas  has  its  distinct  indication. 
More  extensive  operations  than  those  indicated 
have  been  performed  with  the  use  of  nitrous 
oxide.  Carnoohan,  in  England,  removed  a 
woman's  breast,  giving  the  patient  alternate 
inhalations  of  the  gas  and  of  atmospheric  air. 
The  late  Dr.  J.  Marion  Sims  extirpated  an 
abdominal  tumour  with  a  nitrous-oxide  anaes- 
thesia lasting  twenty  minutes. 

The  use  of  the  gas  in  labour  has  naturally 
been  tried.  Zweifel  and  Doderlein,  of  Erlan- 
gen,  made  a  thorough  research  in  regard  to  it 
(quoted  in  Brit.  Med.  Jour.,  Nov.  7,  1885), 
and  found  that  it  did  not  retard  labour  in  the 
later  stages,  as  chloroform  does.  Sensation  is 
benumbed,  but  the  patient  remains  conscious. 
This  obtundity  of  pain  lasts  long  enough  to 
suture  a  ruptured  perinmum.  NH;rous-oxide 
gas  could  be  introduced  into  private  obstetrical 
practice  only  under  peculiarly  favourable  cir- 
cumstances; and,  indeed,  so  rare  is  a  death 
from  chloroform  during  confinement  that  the 
obstetrical  use  of  laughing  gas  will  probably 
always  remain  restricted  to  maternity  hospitals. 
No  great  advantage  seems  to  accrue  from  mix- 
ing it  with  oxygen  in  the  proportion  of  4  to  1, 
as  has  been  proposed. 

At  the  present  day  English  surgeons  fre- 
quently begin  an  ether  narcosis  by  rendering 
the  patient  unconscious  with  nitrous-oxide  gas. 
By  this  means  the  primary  disagreeable  effects 
of  ether  are  obviated. 

The  gas  may  be  administered  in  two  ways. 
Both  methods  require,  besides  the  iron  reser- 
voir, a  caoutchouc  bag  connected  by  rubber 
tubes  with  the  reservoir  on  one  side  and  with 
a  mouthpiece  on  the  other.  This  mouthpiece 
is  furnished  with  a  valve  opening  outward, 
allowing  the  expired  air  to  escape.  With  each 
inspiration  the  valve  closes,  permitting  only 
pure  gas  to  enter  the  lungs.  A  lever-like  ar- 
rangement renders  it  possible  to  administer  gas 
and  atmospheric  air  at  the  same  time.  In  the 
first  method,  pure  rjitrous  oxide  is  given  for 
inhalation  for  from  one  to  two  minutes,  fol- 
lowed by  an  occasional  whiff  of  atmospheric 
air.  The  second  manner  of  inducing  anaesthe- 
sia is  characterized  by  permitting  the  simul- 
taneous inhalation  of  the  gas  and  air.  The 
latter  requires  a  longer  time  to  accomplish  the 
purpose,  and  the  narcosis  is  more  difficult  to 
produce.  The  method  first  described  is  the  one 
in  most  common  use.  The  only  objection  to 
the  apparatus  above  defined  is  that  an  ap- 
preciable quantity  of  gas  is  lost.  To  overcome 
this  loss,  an  apparatus  has  been  devised  for 
institutions  where  much  gas  is  used  in  which 


the  expired  air  is  returned  to  the  reservoir  after 
being  passed  through  limewater  to  rid  it  of  its 
contained  carbonic-acid  gas. 

The  advantages  of  nitrous-oxide  gas  as  an 
anaesthetic  may  be  said  to  be :  1.  The  rapidity 
of  its  action.  3  Its  comparative  and  prac- 
tically absolute  safety.  S.  The  rapid  return  to 
consciousness  and  sensation.  4.  The  almost 
total  absence  of  disagreeable  sequelae.  Among 
its  disadvantages  are  its  unfitness  for  prolonged 
operations  and  the  difficulty  of  transporting 
the  necessary  apparatus  for  its  use. 

Blake  and  Hamilton  {Med.  Record,  Jan.  31, 
1880)  have  recommended  inhalations  of  ni- 
trous-oxide gas  in  cases  of  melancholia  and 
nervous  exhaustion,  as  a  hypnotic  and  stimu- 
lant. Its  use  in  this  coTinection  has  entirely 
disappeared.  Dr.  George  J.  Ziegler  (Researches 
on  the  Medical  Properties  and  Application  of 
Nitrous  Oxide,  Philadelphia,  1865)  has  also 
urged  the  employment  of  the  gas  in  small 
quantities  in  "  permanent  chemico-organic,  ar- 
terial, nervous,  and  cerebral  changes,"  and  as 
a  "general  stimulant"  in  all  asthenic  diseases. 
These  suggestions  undoubtedly  rested  upon  the 
belief,  now  known  to  be  false,  that  the  oxygen 
of  the  gas  was  given  up  to  the  blood. 

JS'itrous-oxide  water  is  water  impregnated 
with  nitrous  oxide  under  pressure.  This  was 
known  as  "  Searle's  patent  oxygenous  aerated 
water,"  and  about  fifteen  years  ago  had  a  large 
sale  as  a  diuretic,  stimulant,  and  alterative. 
Serullas  employed  it  in  Asiatic  cholera.  It 
possesses  merely  a  historic  interest. 

[In  the  Medical  Record  for  May  11, 1895,  Dr. 
Charles  G.  Pease  treats  of  the  use  of  nitrous- 
oxide  gas  as  an  anfesthetic  in  prolonged  opera- 
tions. As  anaesthesia,  he  says,  may  be  prolonged 
with  the  gas  up  to  one,  two,  three,  and  four 
hours,  with  so  much  greater  safety  to  the  pa- 
tient than  with  other  anaesthetics,  and  with  no 
unpleasant  sequelae,  it  must  surely  come  into 
more  general  use.  fie  admits  that  he  finds  it 
far  more  tiring  to  administer  gas  than  to  ad- 
minister the  other  aniEsthetics,  but  that,  he 
says,  should  have  no  weight,  in  view  of  the 
great  advantages  to  the  patient.  Dr.  Pease 
has  devised  a  portable  outfit  consisting  of  small 
cylinders  containing  100  gallons  of  gas  each 
(condensed)  with  a  convenient  case  for  carry- 
ing them,  a  gas-bag,  tubing,  and  an  inhaler, 
with  valves  to  admit  air  and  shut  off  gas,  and 
mce  versa.  The  gas,  he  says,  should  never  be 
administered  to  an  alcoholic  patient,  and  alco- 
hol should  not  be  allowed  prior  to  the  admin- 
istration, as  the  patient  is  very  apt  to  become 
unmanageable. 

At  a  meeting  of  the  New  York  Surgical  So- 
ciety held  on  November  37,  1895  (Annals  of 
Swg.,  Feb.,  1896),  Dr.  Francis  H.  Markoe  pre- 
sented the  subject  of  the  use  of  oxvgen  in  con- 
nection with  that  of  nitrous  oxide  and  ether 
(see  under  Oxygen).]— Samuel  M.  Beickner. 

NOSOPHENE,  or  tetraiodphenolphthalein, 

(CeHJ,.OH),.C<g«^^^^'   has  recently  been 

proposed  as  a  substitute  for  iodoform.  It  is  a 
yellowish  powder,  odourless  and  tasteless,  in- 
soluble in  water,  moderately  soluble  in  ether 


19 


NOSOPHENE 
NUCLEINS 


and  chloroform,  and  soluble  with  difficulty  in 
alcohol.  It  has  the  characters  of  a  weak  acid, 
and  forms  stable  salts  with  bases  (see  Antino- 
siNE  and  BuDoxiNB,  in  the  Supplement).  It 
is  said  to  contain  60  per  cent,  of  iodine.  Sei- 
fert  (Wien.  klin.  Woch..  Mar.  21,  1895;  Brit. 
Med.  Jour.,  Apr.  13,  1895),  who  seems  to  have 
introduced  nosophene  into  use,  says  that  it  is 
absolutely  non-poisonous,  and  that  it  does  not 
part  with  iodine  when  taken  into  the  organ- 
ism. He  has  found  it  specially  adapted,  owing 
to  its  insolubility  and  lack  of  odour,  to  the 
after-treatment  in  cases  of  operations  on  the 
nares.  He  continues  his  report  as  follows: 
As  an  insufflation  applied  after  the  cautery 
(chemical  or  galvanic)  it  prevents  suppuration 
and  the  formation  of  adiiesions ;  in  rhmitis 
sicca  it  causes  no  irritation  and  no  secretion; 
in  rhinitis  with  excessive  secretion  it  dimin- 
ishes the  secretion  and  cures  the  inflammation 
quicker  than  bismuth,  aristol,  europhene,  or 
sodium  sozoiodolate ;  it  appears  to  shorten  the 
course  of  rhinitis  acuta;  in  a  case  of  nasal 
diphtheria  in  which  it  was  used  the  membrane 
disappeared  in  four  days ;  six  cases  of  halan- 
oposthitis  were  cured  in  three  days ;  in  cases 
of  soft  chancre  it  was  equal  to  europhene,  if 
precautions  were  taken  to  prevent  its  forming 
a  crust  and  retaining  the  secretion  by  first  cau- 
terizing the  sore  with  liquor  ferri ;  in  hard 
chancre  the  number  of  cases  treated  was  too 
small  to  warrant  him  in  forming  any  opinion. 
A  case  of  traumatic  weeping  eczema,  he  adds, 
was  cui'ed  in  a  remarkably  short  time  by  the 
application  of  nosophene  in  powder. 

A  10-per-cent.  nosophene  gauze  has  been 
-  found  by  von  Noorden  (Milnch.  med.  Woch., 
1895,  No.  23 :  Otrlbl.  f.  Chir.,  July  27,  1895) 
quite  as  efficient  as  iodoform  gauze  for  tam- 
pons. 

NTJCIiEINS. — The  nuoleinic  compounds 
are  not  of  recent  discovei'y.  They  were  studied 
chemically  as  early  as  1831  by  Braconnot,  by 
Tuevene  in  1838.  by  Schlossberger  in  1844.  by 
Mitscherlioh  in  1845,  and  by  Bechamp  in  1865, 
but  no  special  value  was  attached  to  these  sub- 
stances. In  1874  Miescher  made  an  important 
contribution  to  our  knowledge  of  the  nucleins, 
and  to  him  belongs  the  credit  of  giving  them 
their  name  and  first  appreciating  their  physio- 
logical properties.  Horhaozewski  showed  the 
relation  of  the  nucleins  to  the  formation  of 
uric  acid.  Vaughan.  aided  by  Dr.  J.  McClin- 
tock  and  Dr.  Novy,  demonstrated  that  some  of 
the  nucleins  had  germicidal  properties,*  and, 
continuing  his  experiments,  with  the  assistance 
of  Dr.  McClintock.  he  reached  the  important 
conclusion  that  the  germicidal  properties  of 
blood-serum  were  due  to  the  presence  of  nu- 
cleins in  it.f     Through  the   careful    experi- 

*  Dr.  John  Aulde  (If.  Y.  Med.  .fovr.,  Sept.  29,  1894, 
p.  .392)  states  that  in  1879  Kossel  demonstrated  that 
the  nucleins  possessed  germicidal  properties.  Pro- 
fessor Vaup:han,  in  answer  to  my  inquiries  concerning 
the  discovery  of  the  erermicidal  properties  of  the 
nucleins.  says :  "The  first  paper  on  the  germicidal 
action  of  the  nucleins  from  this  laboratory  was  pub- 
lished in  Mav,  1893.  Kossel's  paper  was  published  in 
FebruaiT,  1894." 

+  For  brief  references  to  the  principal  literature 
relating  to  the  history  and  discovery  or  the  nucleins 


mental  investigations  of  Professor  Vaughan 
and  his  assistants,  and  the  clinical  observations 
of  Vaughan  and  Dr.  John  Aulde,  of  Philadel- 
phia, the  nucleins,  as  therapeutic  agents,  have 
attracted  considerable  attention  in  this  coun- 
try. 

Professor  Vaughan  {Jour,  of  the  Am.  Med. 
Assoc,  June  3,  1894)  says:  "Physiologically, 
nucleins  may  be  said  to  form  the  chief  chem- 
ical constituents  of  the  living  parts  of  cells. 
Speaking  broadly,  we  may  say  that  the  nuclein 
is  that  constituent  of  the  cell  by  virtue  of 
which  this  histologic  unit  grows,  develops,  and 
reproduces  itself.  It  is  the  function  of  the 
nuclein  of  the  cell  to  utilize  the  pabulum 
within  its  reach.  It  must  be  evident  that 
those  tissues  most  abounding  in  cellular  ele- 
ments contain  relatively  the  largest  amounts 
of  nuclein.  It  must  also  be  seen  that  it  is  by 
virtue  of  their  nuclein  that  the  cells  of  various 
organs  and  organisms  possess  and  manifest 
their  individual  peculiarities.  We  should 
therefore  expect  to  find  that  the  nuclein  of  the 
yeast  cell  is  not  identical  with  that  of  the 
Bacillus  tuberculosis,  and  that  the  nuclein  of 
the  spleen  differs  from  that  of  the  thyreoid 
gland.  The  number  of  kinds  of  nuclein  is 
limited  only  by  the  varieties  of  cells.  Nuclein 
is  the  chemical  basis  of  that  part  of  the  cell 
designated  by  the  histologist  as  the  nucleus, 
sometimes  called  chromatin  on  account  of  the 
readiness  with  which  it  absorbs  and  holds 
colouring  agents.  It  is  the  nuclein  of  the  bac- 
terium which  takes  up  and  retains  the  stains, 
and  it  is  on  account  of  this  fact  that  the 
nuclein  of  the  Bacillus  tuberculosis  differs 
from  that  of  other  bacilli  that  we  are  able  to 
distinguish  the  former  from  the  latter  by  its 
tinctorial  properties.  Differences  in  reaction 
with  staining  reagents,  so  plainly  seen  under 
the  microscope,  are  only  outward  manifesta- 
tions of  less  apparent  and  more  important  dif- 
ferences in  chemical  composition. 

"  Chemically,  the  nucleins  are  complex  pro- 
teid  bodies  characterized  especially  by  the  large 
amount  of  phosphorus  they  contain.  The 
phosphorus  exists  in  the  form  of  nucleinic 
acid,  which  is  combined  with  a  highly  complex 
basic  substance.  So  far  as  we  know  at  present, 
the  nucleinic  acid  of  all  nucleins  is  the  same, 
yet  the  basic  part  differs  in  the  various  nu- 
cleins. This  basic  substance  yields,  as  decom- 
position products,  one  or  more  of  the  so-called 
xanthine  bodies,  adenine,  guanine,  sarkine,  and 
xanthine.  Some  nucleins  yield  only  adenine, 
and  these  may  be  designated  as  adenyl  nucleinic 
acids.  Those  which  furnish  xanthine  most 
abundantly  may  be  called  xanthyl  nucleinic 
acids.  Generally  speaking,  the  nucleins  are 
insoluble  in  dilute  acids  and  soluble  in  dilute 
alkalies.  They  resi.st  peptic  digestion,  and  in 
this  way  may  be  separated  from  most  other 
proteid  bodies. 

"  Certain  substances  which  are  histologically 
and  functionally  nucleins  do  not  yield  any 
xanthine  base    as   a  decomposition  product. 


and  their  properties,  the  reader  is  referred  to  the  able 
articles  by  Professor  Vaughan,  Med.  News,  Dec.  33, 
1893,  and  Jour,  of  the  Am.  Med.  Assoc,  June  2, 1894. 


KUCLEINS 


30 


These  are  now  called  paranueleins.  Some  of 
these  are  the  antecedents  of  true  nuclelns. 
Thus  the  yolk  of  the  egg  contains  a  para- 
nuoleln,  which  may  be  isolated  by  removing 
the  accompanying  proteids  by  peptic  digestion. 
This  substance  does  not  yield  any  xanthine 
base,  but  during  the  process  of  incubation  it 
develops  into  a  true  nuclein. 

"  Some  nucleins  are  combined  with  albumins, 
forming  compounds  known  as  nucleo-albu- 
rains.  When  one  of  these  bodies  is  submitted 
to  peptic  digestion,  the  albumin  is  converted 
into  a  peptone,  and  the  nuclein  forms  an  in- 
soluble precipitate.  The  casein  of  milk  is  a 
nucleo-albumin,  the  albumin  of  which  is  pep- 
tonized by  gastric  digestion." 

The  nucleins  may  be  obtained  from  various 
sources — from  yeast,  casein,  the  nuclei  of  blood- 
and  pus-corpuscles,  the  liver,  the  spleen,  bone- 
marrow,  the  thyreoid  gland,  the  thymus  gland, 
the  spermatozooids  of  various  animals,  the  tes- 
ticles, the  yolk  of  hen's  eggs,  the  brain,  or  any 
gland,  organ,  or  structure  containing  numer- 
ous cell  elements. 

[Hainmarsten  {Zfschr.  f.  physiol.  chemie, 
xix;  JSf.  Y.  Med.  Jour.,  Aug.  25,  1894)  has 
recommended  the  following  classification  of 
nucleins  and  nucleo-com  pounds  : 

Nuclein,  to  designate,  after  Kossel,  such 
phosphorus-containing  substances  as  remain 
in  the  peptic  digestion  of  complex  proteids, 
which  further  are  compounds  of  albuminous 
substances  with  nucleic  acid  and  yield  xan- 
thine-like  bases  by  decomposition. 

Paranudein,  to  include,  after  Kossel,  nu- 
clein-like  bodies  which  are  formed  in  peptic 
digestion  of  simple  albuminous  substances,  but 
which  do  not  yield  nuclein  bases.  Since  these 
substances  differ  much  among  themselves,  and 
are  only  similar  in  that  they  resemble  nucleins 
in  certain  particulars,  Hammarsten  suggests 
that  they  be  called  pseudonucleins. 

Nudeoalbiimiri,  to  include  only  phosphorus- 
containing  simple  albuminous  substances,  such, 
for  example,  as  casein,  which  are  not  compound 
proteids,  and  by  peptic  digestion  yield  pseudo- 
nucleins. 

Nixcleoproteids,  to  include  all  complex  pro- 
teids which  by  peptic  digestion  yield,  beside 
simple  proteids,  true  nucleins,  and  give  by 
more  profound  decomposition  nuclein  bases. 
To  this  class  belongs  a  compound  which  Ham- 
marsten has  discovered  in  the  pancreas  and 
calls  the  pancreatic  nucleoproteid.  It  is  made 
up  not  only  of  nuclein  in  combination  with 
an  albuminous  substance,  but  contains  some 
third  part,  perhaps  animal  gum,  which,  by 
heating  with  dilute  acids,  yields  a  reducing 
body.  Hammarsten  is  unable  to  state  the  ex- 
act nature  of  this  reducing  substance,  though 
the  evidence  favours  the  view  that  it  belongs 
to  the  penta-glucoses. 

Chittenden  {N.  Y.  Med.  Jour.,  Apr.  11,  1896) 
sees  little  to  be  gained  by  attaching  any  special 
significance  to  the  terras  nucleoalbumin  and 
nucleoproteid,  and  thinks  that  Hammarsten's 
suggestion,  if  followed,  would  "only  lead  to 
increased  confusion  and  probable  misinterpre- 
tation." Concerning  the  chemistry  of  the  nu- 
cleins, Professor  Chittenden  says : 


"  On  the  basis  of  our  present  knowledge,  we 
may  perhaps  make  a  division  of  nuclein  bodies 
into  the  following  groups  : 

"  1.  Nucleic  acids,  bodies  rich  in  phosphorus, 
which  contain  no  proteid  matter,  and  yield  on 
decomposition  only  phosphoric  acid,  nuclein 
bases,  and  sometimes  carbohydrate  bodies. 
They  may  occur  free  in  some  animal  cells,  as  in 
spermatozooids,  but  are  more  generally  united 
with  more  or  less  proteid  matter.  To  this 
group  may  be  added  paranucleic  acid,  which, 
however,  must  have  a  widely  different  consti- 
tution, in  that  it  does  not  yield  any  nuclein 
base  on  decomposition. 

"  3.  True  nucleins,  such  as  are  present  in 
cell  nuclei,  either  as  such  or  joined  to  proteid 
matter  as  a  part  of  more  complex  molecules 
(nuoleoproteids),  containing  variable  amounts 
as  well  as  variable  kinds  of  nucleic  acids,  and 
yielding  by  decomposition  proteid  matter,  nu- 
clein bases,  and  phosphoric  acid. 

"  3.  Paranueleins,  obtainable  especially  from 
nucleoproteids  with  a  low  content  of  phos- 
phorus, such  as  are  present  in  the  cytoplasm 
of  the  cell,  in  egg  yolk,  and  in  milk.  Para- 
nueleins yield  on  decomposition  proteid  mat- 
ter and  phosphoric  acid,  but  little  or  no  nuclein 
bases — i.  e.,  they  are  compounds  of  proteid 
matter  with  a  small  amount  of  paranucleic 
acid. 

"  4.  jSlucleoproteids  or  nucleoalbumins,  phos- 
phorus-containing proteids,  widely  distributed 
through  all  animal  cells,  and  which  by  pepsin- 
acid  digestion  yield  soluble  proteid  products 
and  true  nuclein,  the  latter  giving  on  further 
decomposition  nuclein  bases. 

"  5,  Paranucleoproteids,  phosphorus-contain- 
ing proteids,  which  by  digestion  with  pepsin 
acid  yield  insoluble  paranudein,  together  with 
soluble  proteoses  and  peptones 

"  Unquestionably,  the  members  of  these  dif- 
ferent groups  range  into  each  other  by  almost 
insensible  gradations.  Further,  many  of  the 
nucleoproteids,  with  a  low  content  of  phos- 
phorus, are  hard  to  distinguish  from  true 
globulins,  and  frequently  it  is  only  by  a  de- 
termination of  the  presence  or  absence  of  phos- 
phorus that  a  definite  conclusion  as  to  the  true 
nature  of  the  body  can  be  reached. 

"  The  properties  and  general  characteristics 
of  the  nucleoproteids  and  nucleins  depend,  as 
has  been  stated,  mainly  upon  the  amount  and 
character  of  the  nucleic  acid  united  to  the  pro- 
teid matter.  Further,  in  the  majority  of  the 
tissues  of  the  body  nuoleoproteids  with  some 
paranucleoproteids  are  mainly  met  with,  these 
bodies  being  especially  abundant  in  the  caryo- 
plasm  and  cytoplasm  of  the  cells,  nucleins  and 
free  nucleic  acids  being  less  abundant.  From 
all  nucleoproteids,  however,  nuclein  and  nu- 
cleic acid  can  be  prepared  by  proper  methods 
of  treatment.  The  larger  the  proportion  of 
nucleic  acid  in  the  nucleoproteid  or  nuclein 
the  more  acid  its  character,  and  the  chief  dif- 
ference between  a  nuclein  and  a  nucleoproteid 
is  found  in  the  proportion  of  nucleic  acid  to 
the  proteid  matter.  Hence,  digestion  of  a 
nucleoproteid  with  gastric  juice  naturally  gives 
rise  to  a  nuclein,  since  the  proteolytic  action 
of  the  digestive  enzyme  results  in  a  solution  of 


21 


NUCLEINS 


the  superfluous  proteid  matter.  Variations  in 
the  amount  of  nucleic  acid  and  proteid  matter 
in  a  nucleoproteid  obviously  affect  the  ordi- 
nary reactions  of  the  body,  notably  its  solu- 
bility, etc.  Nuoleoproteids  and  nucleins  rich 
in  phosphorus  are  more  likely  to  be  found  as- 
sociated with  the  nuclei  of  cells,  while  nuoleo- 
proteids with  a  small  amount  of  phosphorus 
are  more  abundant  in  the  cytoplasm. 

"  If  we  examine  the  composition  of  a  few  of 
the  nucleoproteids  and  nucleins  that  have  been 
separated  from  different  tissues  and  organs, 
we  gain  a  very  clear  idea  of  the  great  variation 
in  the  proportion  of  nucleic  acid  and  proteid 
matter  in  these  compound  bodies.  Thus,  the 
peculiar  nucleoproteid  separated  by  Hammar- 
sten  from  the  pancreas  contains  4'48  per  cent, 
of  phosphorus ;  the  nuclein  of  yeast  cells  Kos- 
sel  found  to  contain  about  619  per  cent,  of 
phosphorus :  the  nuclein  of  egg  yolk,  according 
to  Bunge,  contains  5'19  per  cent,  of  phospho- 
rus ;  the  peculiar  nucleoproteid  (nucleohiston) 
separated  by  Lilienfeld  from  the  nucleus  of 
lymphocytes  contains  3'03  per  cent,  of  phos- 
phorus ;  while  in  the  cytoplasm  of  leucocytes 
from  the  thymus  and  lymph  glands  the  same 
investigator  found  only  0'43  per  cent,  of  phos- 
phorus. Probably  the  great  majority  of  the 
organs  of  the  body  contain  nucleoproteids  with 
a  comparatively  small  percentage  of  phospho- 
rus. The  nucleoproteid  obtained  from  red 
marrow  by  Halliburton  and  Forrest,  however, 
contains  1'6  per  cent,  of  this  element,  and 
from  the  liver  a  nucleoproteid  has  been  sepa- 
rated with  1'45  per  cent,  of  phosphorus.  Prom 
the  brain  a  nucleoproteid  has  been  obtained 
with  0-5  per  cent,  of  phosphorus,  while  iA  the 
kidney  there  is  present  a  nucleoproteid  with 
only  0-37  per  cent,  of  phosphorus." 

Professor  Chittenden  says,  in  regard  to  cer- 
tain nuclein  products  in  the  market :  "  In  some 
cases  the  method  of  manufacture  has  apparent- 
ly had  for  its  object  the  separation  of  a  pure 
nuclein  or  nucleic  acid,  freed  so  far  as  possible 
from  all  other  cell  or  tissue  constituents,  as  in 
the '  nuclein  solution,  standard,  formula  of  Dr. 
John  Aulde,'  which  is  '  made  from  thyreoid 
and  thymus  glands,'  and  in  the  'improved 
nuclein  solution '  manufactured  by  Parhe, 
Davis,  &  Co.,  which  is  stated  to  be  a  '  pui-e 
nueleinic  acid  from  yeast.'  In  the  preparation 
known  as  ' protonuclein,'  on  the  other  hand, 
the  process  of  manufacture  is  stated  to  consist 
'  in  the  mechanical  separation  of  the  cellularly 
active  constituents '  of  various  lymphoid  struc- 
tures and  glands,  the  product  presumably  con- 
sisting of  the  entire  contents  of  the  cells,  and 
hence  composed  not  only  of  the  nucleins  and 
nuoleoproteids  naturally  present  there,  but  also 
of  considerable  other  material  belonging  to  the 
substance  of  the  cells. 

"Taking  the  amount  of  phosphorus  con- 
tained in  these  products  as  an  index  of  the 
proportion  of  nucleoproteid  or  nucleic  acid 
present,  we  may  draw  some  inferences  as  to 
the  character  of  these  pharmaceutical  prepa- 
rations. A  sample  of  '  nuclein  solution,  stand- 
ard,' recently  analyzed  by  the  writer,  failed  to 
show  any  phosphorus  whatever,  from  which 
the  conciusion  seems  obvious  that  the  solution 


contains  no  nuclein.  '  Tablets  of  nuclein  solu- 
tion '  made  by  the  same  manufacturer  likewise 
failed  to  show  any  appreciable  amount  of 
phosphorus. 

"  A  sample  of  '  protonuclein  special ' — a  dry 
powder — recently  analyzed,  contained  1"25  per 
cent,  of  phosphorus,  an  amount  of  phosphorus 
which  accords  with  the  view  that  the  prepara- 
tion represents  a  mixture  of  cell  nucleoproteids 
with  other  cell  material.  Nearly  two  thirds  of 
this  phosphorus  belongs  to  matter  soluble  on 
addition  of  water — i.  e.,  to  nucleoproteids  which 
dissolve  in  the  water  or  in  the  dilute  saline 
solution  which  results  on  the  addition  of  water. 
'  Protonuclein  powder,'  which  is  presumably  a 
dilution  of  the  preceding  preparation  with  milk 
sugar,  was  found  to  contain  0'23  per  cent,  of 
phosphorus. 

"  The  '  improved  nuclein  solution,'  manufac- 
tured by  Parke,  Davis.  &  Co.,  is  stated  to  be  a 
one-per-cent.  solution  of  pure  nucleic  acid  from 
yeast,  containing  six  per  cent,  of  phosphorus. 
A  sample  of  this  solution  recently  analyzed 
was  found  to  contain  0'078  per  cent,  of  phos- 
phorus, which  would  imply  the  presence  of 
even  more  than  one  per  cent,  of  such  a  nucleic 
acid.  From  the  solution  the  nucleic  acid  itself 
can  be  partially  separated  by  precipitation  with 
a  little  dilute  hydrochloric  acid  and  the  addi- 
tion of  alcohol.  A  sample  of  the  acid  so  pre- 
cipitated and  dried  was  found  on  analysis  to 
contain  5"71  per  cent,  of  phosphorus,  so  that  it 
is  evident  that  a  very  pure  nucleic  acid,  and 
one  with  a  high  content  of  phosphorus,  can  be 
separated  and  made  available  in  fluid  form. 
In  this  '  nuclein  solution,'  therefore,  we  have 
pure  nucleic  acid  isolated  by  chemical  methods 
from  its  natural  combination  with  the  proteid 
matters  of  the  yeast  cell,  and  held  in  solution 
by  the  action  of  a  weak  alkali.  In  '  protonu- 
clein,' on  the  other  hand,  we  have  the  nucleo- 
proteids and  nucleins  of  various  gland  cells 
without  chemical  separation  from  the  other 
cell  constituents.  It  is  therefore  obviously  not 
a  pure  nuclein,  which,  indeed,  it  does  not  pur- 
port to  be,  but  rather  a  product  containing  all 
the  cellular  elements  characteristic  of  the  tis- 
sues from  which  it  is  derived."] 

Manner  of  extracting  the  Nucleins. — In  the 
Medical  News  for  May  20,  1893,  p.  537,  Pro- 
fessor Vaughan  gives  the  details  of  his  process 
of  extracting  the  nuclein  of  the  thyreoid  gland, 
and  also  one  foi'  obtaining  the  nuclein  of  the 
yeast  cells.  Slight  modifications  of  these 
processes  are  found  described  in  the  American 
Therapist,  vol.  ii,  p.  79.  In  the  case  of  ex- 
tracting yeast  nuclein,  cells  from  a  pure  cul- 
ture of  yeast  are  washed  with  sterilized  water 
by  decantation,  then  placed  in  a  5-per-cent. 
solution  of  potassium  hydrate  and  filtered. 
The  filtrate  is  rendered  feebly  acid  by  hydro- 
chloric acid,  and  the  proteids  are  thrown  down 
by  adding  96-per-cent.  alcohol.  Vaughan  rec- 
ommends that  the  filtrate  should  be  washed 
with  alcohol  until  the  supernatant  fluid  re- 
mains colourless.  Two  methods  may  now  be 
followed ;  one  is  to  dissolve  the  filtrate  in  a 
very  dilute  potassium-hydrate  solution  (0-25  to 
0'50  per  cent.) ;  the  other,  and  apparently  the 
better  way,  is  to  digest  out  the  other  proteids 


NUCLBINS 


33 


than  those  of  nuclein  from  the  alcoholic  fil- 
trate by  means  of  hydrochloric  acid  and  pep- 
sin, very  similar  to  the  manner  of  procedure 
in  extracting  the  animal  nucleins.  The  nuclein 
of  the  testicle,  of  the  thyreoid  gland,  or  of 
almost  any  other  animal  substance  is  obtained 
by  finely  cutting  or  crushing  the  gland  or 
substance  from  which  the  nuclein  is  to  be 
separated,  making  an  extract  of  this  by  means 
oE  equal  parts  of  absolute  alcohol  and  ether. 
The  extract  is  then  placed  in  0-2-per-cent. 
hydrochloric-acid  solution  with  pepsin,  and 
kept  in  an  incubator  at  40°  C.  (103°  P.)  for 
two  days,  the  digestive  fluid  being  decanted 
and  renewed  several  times.  The  digestive 
process  is  kept  up  until  the  fluid  fails  to  re- 
spond to  the  biuret  test  for  peptones.  The 
undigested  portion,  which  contains  the  nuclein, 
Is  washed  on  filter  paper  first  by  pouring  a 
0'3-per-cent.  solution  of  hydrochloric  acid  over 
it  and  then  alcohol.  What  still  remains  is 
dissolved  in  a  0'5-per-eent.  solution  of  potas- 
sium hydrate  and  filtered  through  a  Chamber- 
land  filter  without  pressure.  The  nuclein 
solutions,  as  thus  made  according  to  Vaughan's 
process,  were  found  to  be  alkaline  and  too 
irritating  for  hj'podermic  administration.  Both 
Vaughan  and  Aulde  profess  to  have  adopted 
processes  by  which  a  purely  neutral  and  non- 
irritating  nuclein  .solution  is  obtainable. 

Germicidal  Properties  of  the  Nucleins^— 
The  experimental  observations  of  Lewis  and 
Cunningham  (1873),  of  Traube  and  Gschiedlen 
(1874),  of  Podor,  of  Wysokowicz,  of  Grohraann 
and  Schmidt,  of  Nuttall  and  Pliigge  (1888),  of 
Nissen  and  Pliigge,  and  of  Behring,  all  proved 
conclusively  the  germicidal  properties  of  blood. 
Buchner,  in  1890,  aided  by  Viot,  Littmann, 
and  Orthenberger,  made  a  valuable  contribu- 
tion to  our  knowledge  of  the  germicidal  prop- 
erties of  blood,  and  came  to  the  conclusion 
that  the  germicidal  properties  reside  in  the 
blood  serum  and  was  an  albuminous  const!  tuent. 
The  experiments  of  Halliburton,  Hankin,  Bit- 
ter, Christmas,  Emmerich,  Tsuboi,  Steinmetz, 
and  Low  seem  to  justify  the  conclusion  that "  it 
is  possible,  but  highly  improbable,  that  the  ger- 
micidal substance  is  not  the  serum-albumin,  but 
some  substance  that  is  precipitated  along  with 
this  by  alcohol  and  other  agents."  Professor 
Vaughan  {Med.  News,  Dec.  23,  1893)  extracted 
a  nuclein  from  the  serum  of  blood  taken  from 
dogs  and  rabbits,  and  demonstrated  by  a  num- 
ber of  experiments  that  the  nuclein  possessed 
germicidal  properties. 

In  the  Journal  of  the  American  Medical 
Association  for  June  3,  1894,  a  number  of  ex- 
periments by  Vaughan  are  recorded  which  seem 
to  demonstrate  quite  conclusively  that  certain 
animals,  at  least,  may  be  rendered  proof  against 
diseases  most  fatal  to  them  by  first  treating 
them  with  hypodermic  injections  of  nuclein. 
The  diplococcus  of  pneumonia  was  injected  into 
rabbits.  This  germ  in  its  virulent  form  is  said 
to  be  practically  always  fatal  to  rabbits,  death 
taking  place  on  the  second  or  third  day.  A 
2-per-cent.  yeast-nuolein  solution  was  used, 
and  of  this  1  c.  c.  (about  15  minims)  was  given 
hypodermically  every  day  or  every  alternate 
day  for  a  number  of  days  prior  to  injecting 


the  diplococcus  of  pneumonia.  It  was  found 
that  the  longer  the  nuclein  treatment  was  con- 
tinued, the  more  frequently  the  injections  were 
made ;  and  the  sooner  the  germ  was  injected 
after  daily  treatments  with  the  nuclein  were 
stopped,  the  greater  the  immunity  of  the  ani- 
mal to  the  poison. 

The  next  step  in  Vaughan's  investigations 
was  to  determine  whether  the  immunity  se- 
cured by  the  use  of  a  nuclein  was  due  to  the 
direct  germicidal  action  of  the  nuclein  or  to 
its  stimulating  "efEect  on  some  organ  whose 
duty  it  is  to  protect  the  body  against  bacterial 
invasion."  Eight  rabbits  received  each  3  c.  c. 
(about  30  minims)  of  the  nuclein  solution  in- 
tra-abdominally  immediately  after  having 
been  inoculated  with  0'3  o.  c.  (3  minims)  of  a 
virulent  culture  of  the  diplococcus  of  pneu- 
monia. At  the  same  time  two  control  rabbits 
were  inoculated  with  the  same  amounts  of 
the  virulent  culture.  Two  days  later  all  the 
animals  were  dead,  and  an  examination  showed 
that  they  had  all  died  from  the  effects  of  the 
germ.  Prom  these  results  Vaughan  concluded 
that  immunity  was  not  secured  by  the  germi- 
cidal action  of  the  nuclein,  but  by  its  stimulat- 
ing efllect  upon  some  organ.  His  attempts  to 
render  guinea-pigs  proof  against  tuberculosis 
have  been  more  or  less  contradictory  and 
unsatisfactory,  but  his  recent  experimental  in- 
vestigations seem  to  demonstrate  quite  conclu- 
sively that  rabbits  may  be  rendered  proof 
against  tuberculosis  by  previous  treatment 
with  yeast  nucleinic  acid  (Med.  News,  Dec.  15, 
1894,  p.  657). 

Therapy. ^KxuAam  therapy  is  as  yet  in  an 
early  experimental  stage,  and  many  of  the 
beneficial  results  alleged  to  have  been  obtained 
from  the  use  of  nucleins  have  not  come  to  us 
surrounded  with  sufficiently  accurate  and  sci- 
entific observations  to  enable  us  to  accept  them 
unqualifiedly.  Theoretically,  nothing  could 
be  more  fascinating  than  the  contemplation  of 
the  possibilities  of  the  nucleins  in  the  preven- 
tion and  cure  of  disease,  but  experience  and 
common  sense  teach  us  to  wait,  watch,  and 
observe  practical  results. 

According  to  Metchnikoff's  phagocytic 
theory,  the  white  corpuscles  of  the  blood  are 
the  natural  defenders  against  bacterial  inva- 
sion. Dr.  Huber,  working  under  the  direction 
of  Vaughan,  maintains  that  subcutaneous  in- 
jections of  nuclein  increase  the  white  blood- 
corpuscles.*  Vaughan  has  demonstrated  that 
the  nucleins  possess  germicidal  properties. 
He  is  convinced,  however,  that  a  nuclein,  when 
introduced  into  the  system  for  the  purpose  of 
rendering  the  subject  proof  against  the  inva- 
sion of  germs,  or  that  of  destroying  them 
when  they  have  already  found  a  lodgment  in 
the  system,  does  not  act  directly  as  a  germi- 
cide, but  as  a  substance  which  stimulates  '•  the 
activity  of  those  organs  whose  function  it  is  to 
protect  the  body  against "  bacterial  invasion. 
He  makes  the  following  condensed  statements,   - 


•  Dr.  William  S.  Carter,  of  Philadelphia,  in  a  series 
ot  elaborate  investigations  on  the  subject  of  leuoooy- 
tosis,  concluded  that  injections  ot  nucleins  did  not 
cause  any  distinct  increase  in  the  number  of  leuco- 
cytes {.Vnivers.  Med.  Mag.,  Dec,  1894,  p.  18S). 


23 


NUULEINS 


based  on  his  own  investigations  and  those  of 
his  coworkers :  "  1.  The  subcutaneous  injec- 
tion of  a  nuclein  increases  the  number  of 
white  blood-corpuscles.  2.  This  increase  oc- 
curs in  both  healthy  and  tuberculous  persons. 
3.  With  like  quantities  of  nuclein  injected,  the 
increase  varies  with  the  person.  It  may  be 
slight  and  it  may  be  threetold.  4.  This  in- 
crease occurs  principally  in  the  polynuclear 
cells.  It  is  evident,  as  a  rule,  as  soon  as  the 
third  hour  after  treatment  and  generally  dis- 
appears after  the  forty-eighth  hour  "  (Jour,  of 
the  Am.  Med.  Assoc,  June  3,  1894,  p.  831). 

Prom  the  investigations  of  Professor 
Vaughan  and  others,  the  nucleins  seem  to  be 
indicated  as  germicides  in  topical  applications 
in  certain  diseased  conditions  of  the  mucous 
membranes  and  skin,  in  the  prevention  and 
probably  in  the  cure  of  diseases  of  bacterial 
origin,  and  in  atonic  conditions,  especially  of 
the  nervous  system. 

I^evention  of  Diseases  by  the  Use  of  the 
Nucleins. — So  far,  about  the  only  definite  and 
positive  experiments  which  have  been  under- 
taken to  determine  the  "immunizing"  effects 
of  the  nucleins  against  disease  are  those  of 
Vaughan  and  his  assistants,  and  these  were 
performed  principally  upon  rabbits  and  guinea- 
pigs.  It  was  found  that  these  animals,  under 
certain  conditions,  on  receiving  nuclein,  be- 
came proof  against  violent  cultures  of  the 
diplococcus  of  pneumonia.  Prom  these  ex- 
periments the  following  conclusions  were 
drawn  by  Vaughan  :  '•  1.  Rabbits  and  guinea- 
pigs  may  be  protected  against  virulent  cultures 
of  the  diplococcus  of  pneumonia  by  previous 
treatment  with  hypodermic  injections  of  a 
yeast  nuclein.  3.  The  immunity  thus  secured 
is  not  due  to  the  action  of  the  nuclein.  as  a 
germicide,  directly.  3.  The  process  of  secur- 
ing this  immunity  is  an  educational  one,  and 
most  probably  depends  upon  the  stimulating 
effect  of  the  nuclein  upon  some  organ  whose 
function  it  is  to  protect  the  body  against  bac- 
terial invasion.  4.  The  longer  the  nuclein 
injections  are  continued  and  the  more  fre- 
quently they  are  administered,  the  more  com- 
plete is  the  immunity  which  is  secured.  5.  In 
order  to  obtain  this  immunity,  the  inoculation 
with  the  germ  must  follow  soon  after  the  last 
treatment  with  the  nuclein."  The  attempts  to 
render  guinea-pigs  proof  against  the  bacillus 
of  tuberculosis  by  previous  injections  of  nuclein 
have  not  been  satisfactory.  It  was  found  by 
Vaughan  that,  while  a  nuclein  solution  in  cul- 
ture tubes  containing  the  bacillus  of  tuber- 
culosis usually  destroyed  the  virulency  of  the 
germ,  such  a  result  did  not  invariably  take 
place.*  Against  the  germs  of  what  diseases 
the  human  subject  may  be  protected  by  the 
use  of  the  nucleins  has  not  been  determined. 
It  seems  probable  that,  if  it  were  possible  to 
make  man  proof  against  the  germs  of  disease, 
the  immunity  at  most  would  be  of  short  dura- 
tion, and  consequently  of  uncertain  value. 

*  Professor  Vauglian  has  almost  invariably  suc- 
ceeded in  renderinp:  rabbits  proof  against  injections 
of  cultures  of  the  bacillus  of  tuberculosis  {Med.  News. 
Dec.  15, 1894,  p.  657).  The  length  of  the  immunity  has 
not  been  determined  yet. 


The  Germicidal  Value  of  Nucleins  in  the 
Treatment  of  Disease. — It  seems  to  be  evident, 
from  the  experiments  of  Vaughan,  that  it  is 
only  in  cases  where  the  nucleins  can  be  brought 
in  direct  contact  with  diseased  surfaces  that 
we  may  expect  much  effect  from  the  direct 
germicidal  action  of  these  agents.  Such 
opportunities  for  the  use  of  the  nucleins  are 
afforded  in  affections  of  the  buccal  and  naso- 
pharyngeal mucous  membrane  and  in  indolent 
ulcers  of  the  skin.  They  have  been  employed 
in  the  treatment  of  diphtheria  due  to  the 
Klebs-Lofller  bacillus,  pharyngitis  due  to  the 
streptococcus  of  diphtheria,  follicular  pharyn- 
gitis, amygdalitis,hay-f ever  (autumnal  catarrh), 
and  in  one  case  of  indolent  ulcer  on  the  leg, 
reported  by  Vaughan. 

Diphtheria. — Dr.  J.  Mount  Bleyer,  of  New 
York,  in  the  American  Therapist  for  Novem- 
ber 15,  1894,  p.  113,  reports  four  cases  of 
diphtheria,  due  to  the  Klebs-LOffler  bacillus, 
treated  by  means  of  the  nucleins  with  marked 
benefit,  as  shown  by  the  decline  of  temperature 
on  tlie  second  day  after  beginning  with  the 
nucleins,  without  a  tendency  to  recurrence  of 
fever  after  it  had  declined,  and  by  loosening 
and  discharge  of  the  membrane.  No  unpleas- 
ant effects  were  observed  from  the  nuclein, 
which  was  given  hypodermically  in  doses  vary- 
ing from  t'ij-  to  J  of  a  minim  of  the  standard 
solution  every  three  hours.  Dr.  John  Aulde 
(N.  Y.  Med.  Jour.,  Sept.  39, 1894,  p.  896)  states  : 
"In  quite  a  large  number  of  cases  where  the 
symptoms  pointed  to  diphtheria  as  the  true 
condition,  1  have  found  nuclein  solutions  most 
eificacious,  the  false  membrane,  angina,  ano- 
rexia, and  restlessness  all  disappearing  in  lefs 
than  twenty-four  hours;  and,  although  some 
fever  remains  for  a  day  or  two,  if  seen  early  in 
the  attack,  the  most  forbidding  symptoms 
promptly  yield  to  this  form  of  medication. 
He  prefers  giving  the  medicine  by  the  mouth 
to  children,  as  it  is  tasteless,  and  they  take  it 
readily  either  in  the  form  of  tablets  or  solution. 
Dr.  J.  L.  Porteous,  in  a  recent  report  of  nine 
cases  of  diphtheria  due  to  the  Klebs-LOfBer 
bacillus,  states  that  he  used  nuclein  in  four, 
with  a  fatal  result  in  two  of  the  four.  In  the 
two  cases  which  terminated  favourably  the 
nuclein  seemed  to  exert  a  direct  beneficial 
influence  on  the  progress  of  the  disease.  In 
the  two  cases  which  resulted  in  death  the  false 
membrane  appeared  to  yield  to  the  nuclein, 
but  in  one,  profound  blood  changes  with  great 
depression,  and  in  the  other,  kidney  complica- 
tion, seemed  to  decide  the  fatal  issue. 

The  Streptococcus  Diphtheria. — Dr.  Victor 
C.  Vaughan  (Jour,  of  the  Am.  Med.  Assoc,  June 
2.  1894,  p.  831)  reports  four  cases  of  the  strep- 
tococcus diphtheria  treated  by  yeast  nuclein. 
In  one  the  patient  was  too  young  to  gargle, 
and  a  spray  composed  of  equal  parts  of  a  3- 
per-cent.  solution  of  yeast  nuclein  and  salt 
solution,  sterilized,  was  thrown  into  the  nose 
and  pharynx  by  means  of  an  atomizer  every 
three  or  four  hours.  In  the  three  other  cases 
the  patients  were  able  to  gargle,  and  the  same 
solution  used  for  the  first  case  was  employed 
by  this  method  for  these,  with  more  prompt 
and  decided  effect  than  was  obtained  from  the 


NUTGALLS 
NUTMEU 


24 


spray.  In  all  there  were  a  rapid  fall  of  tem- 
perature, disappearance  of  the  membrane,  and 
a  speedy  return  of  the  affected  parts  to  a 
normal  condition. 

Amygdalitis  and  Pharyngitis. — Dr.  John 
Aulde  has  reported  favourable  results  from 
the  nuoleins  in  these  afieotions.  Professor 
Vaujjhan  gives  twelve  cases  of  membranous 
amygdalitis  rapidly  cured  by  a  gargle  com- 
posed of  equal  parts  of  a  2-per-cent.  solution 
of  yeast  nuclein  and  salt  solution. 

Indolent  Ulcer. — Vaughan  (ihid.)  reports  the 
case  of  a  printer,  forty  years  old,  who  had  been 
under  treatment  for  an  ulcer  of  the  leg  for 
more  than  a  year.  The  ulcer  measured  an  inch 
and  a  quarter  in  length  by  half  an  inch  at  its 
widest  part  and  showed  no  tendency  to  heal. 
When  nuclein  was  resorted  to,  all  other  agents 
were  discontinued.  Injections  of  80  minims 
of  a  3-per-cent.  solution  of  yeast  nuclein  were 
made  into  the  tissues  around  the  ulcer  on  eight 
different  occasions,  with  the  effect  of  causing 
a  rapid  healing  of  the  ulcer.  "  The  injections 
caused  a  burning  sensation  at  the  time,  but 
immediately  after  each  treatment  the  patient 
walked  half  a  mile  to  his  work  and  stood  at 
his  case  each  working  day  of  the  week." 

If  the  nucleins  stimulate  the  metabolic  proc- 
esses of  the  body,  as  they  are  supposed  to  do, 
it  is  evident  that  when  they  are  used  for  their 
germicidal  action,  as  in  the  above-mentioned 
cases,  they  also  stimulate  the  nutritive  func- 
tions and  especially  those  organs  concerned  in 
the  elaboration  of  material  for  protecting  the 
body  against  the  invasion  of  germs. 

Tuberculosis. — Vaughan,  in  his  able  paper 
entitled  The  Nucleins  and  Nuclein  Therapy 
{ibid.),  says :  "  I  have  been  using  nuclein  in  the 
treatment  of  tuberculosis  in  man  since  May  1, 
1893.  At  first  I  employed  only  yeast  nuclein, 
but  now  I  am  using  spleen  nuclein  in  some 
cases.  When  sufficient  evidence  has  been  ob- 
tained either  to  reject  or  recommend  the  treat- 
ment, the  results  will  be  communicated  to  the 
profession.  I  may  say,  however,  that  only  in 
initial  cases  may  we  expect  any  benefit,  and 
even  in  regard  to  these  I  must  have  more 
abundant  material  and  a  longer  experience  be- 
fore I  can  speak  with  any  certainty  "  (June  3, 
1894).  In  his  recent  article  (Treatment  of 
Tuberculosis  with  Yeast  Nuclein,  Med.  News, 
Dec.  15  and  23,  1894,  pp.  657  and  675)  he  gives 
us  the  results  of  his  further  experience  with 
the  yeast  nuclein  in  the  treatment  of  tubercu- 
losis. After  a  careful  study  of  the  twenty-four 
cases  of  which  he  has  given  a  detailed  report, 
I  am  forced  to  the  conclusion  that  the  results 
have  not  been  very  gratifying,  and  no  one  ap- 
preciates this  more  keenly  than  Professor 
Vaughan  himself,  who  shows  all  through  his 
reports  the  unfavourable  as  well  as  the  favour- 
able symptoms  experienced  by  his  patients, 
exhibiting  a  state  of  mind  so  essential  to  the 
scientific  observer,  and  especially  to  the  clin- 
ician and  experimental  investigator.  The  best 
results  were  obtained  by  Vaughan  in  the  local 
treatment  of  tuberculosis  of  the  bladder,  and 
the  next  in  the  early  stage  of  pulmonary  tu- 
berculosis before  the  general  health  had  been 
seriously  involved,  and  prior  to  secondary  in- 


fection of  other  portions  of  the  body.  In  ad- 
vanced oases  the  nucleins  seemed  to  have 
nothing  more  than  a  tonic  or  stimulating 
effect.  Dr.  Heniy  Sewall,  of  Denver,  has 
employed  hypodermic  injections  of  nuclein, 
obtained  from  Professor  Vaughan,  in  twelve 
cases  of  pulmonary  tuberculosis,  but  he  is  un- 
able to  draw  any  definite  conclusions  from  this 
method  of  treatment  further  than  that "  cough 
and  general  symptoms  are,  in  some  cases, 
quickly  improved,"  and  adds:  "Taking  the 
vital  condition  as  a  whole,  without, reference 
to  particular  features,  the  nuclein  treatment  of 
tuberculosis  is  followed  by  such  encouraging 
results  as  to  warrant  for  it  a  thorough  test." 
The  few  other  cases  of  tuberculosis  for  which 
nuclein  has  been  employed  have  not  afforded 
flattering  results. 

The  experiments  of  Vaughan  and  McClin- 
tock,  while  they  demonstrated  the  germicidal 
properties  of  nuoleins,  showed  quite  conclu- 
sively that  in  the  treatment  of  disease  with 
whose  germs  the  nucleins  could  not  be  brought 
in  direct  contact  but  little  dependence  could 
be  placed  upon  their  germicidal  properties.  It 
is  probable  that  the  nucleins  may  prove  to  be 
valuable  agents  in  stimulating  the  vital  forces' 
of  the  human  organism  in  the  early  stages  of 
pulmonary  tuberculosis,  and  may  thus  aid  in 
deciding  the  battle  in  favour  of  the  unfortu- 
nate sufferer.  Which  one  of  the  numerous 
nuoleins  is  the  most  potent  for  this  purpose, 
or  whether  a  combination  of  several  (which 
is  very  probable)  will  prove  more  ,  powerful, 
observation  may  enable  the  clinical  investiga- 
tor to  decide. 

[In  the  American  Lancet  for  January,  1895, 
Dr.  Charles  W.  Hitchcock,  of  Detroit,  gives 
the  history  of  a  case  of  Mp-foint  disease  in 
which  great  improvement  followed  the  sys- 
tematic use  of  nuclein  (Parke,  Davis,  &  Go's) 
hypodermically  every  second  day.  The  pa- 
tient ultimately  recovered,  and  Dr.  Hitchcock 
attributes  the  result  ■'  very  largely,  if  not  en- 
tirely, to  the  long  and  persistent  use  of  nu- 
clein."] 

Pneumonia,  Pleurisy,  and  Bronchitis. — The 
nucleins  have  been  employed  in  the  treatment 
of  these  diseases  more  for  their  supposed 
stimulating  effect  on  the  blood-making  glands 
and  excretory  organs  than  for  their  antago- 
nism to  the  diseased  processes  directly.  Ger- 
main See  states  that  he  has  obtained  good 
effects  from  the  use  of  spleen  nuclein  in  the 
treatment  of  certain  cases  of  pneumonia  and 
pleurisy.  Dr.  John  Aulde  has  observed  marked 
improvement  to  follow  the  use  of  the  nucleins 
in  chronic  bronchitis  and  naso-pharyngeal  ca- 
tarrh. Dr.  Aulde  also  speaks  highly  of  the 
therapeutic  effects  of  nuclein  in  the  treatment 
of  hay-fever  {Am.  Therapist,^  Aug.,  1894,  p. 
35).  Cases  of  malarial  toxcsrnia  and  of  chronic 
and  recurrent  inalarial  disease  have  yielded 
quite  promptly  to  the  nuclein  treatment  in  the 
experience  of  Dr.  Aulde.  The  same  writer  re- 
ports numerous  cases  of  influenza,  anmmia  and 
general  debility,  one  of  chronic  eczema,  and 
one  of  night  sweats  successfully  treated  by 
means  of  the  nuoleins.  He  also  records  one 
case  of  chronic  Bright's  disease  in  which  the 


25 


NUTGALLS 
NUTMEG 


patient  was  made  more  comfortable  by  the  use 
of  the  nuoleins. 

There  is  danger  of  the  eager  and  enthusias- 
tic becoming  too  sanguine  over  the  real  and 
supposed  results  from  the  use  of  the  nucleins, 
but  if  these  agents  possess  one  half  the  virtues 
alleged  for  them  as  stimulators  of  the  various 
organs  of  the  body,  they  will  find  a  perma- 
nent and  useful  place  in  therapeutics,  and  in 
no  class  of  cases  will  they  be  more  welcome 
than  in  those  of  general  dehiliiy  and  neuras- 
thenia.* 

[Dr.  Charles  P.  Knapp,  of  Wyoming,  Pa. 
(^V.  Y.  Med.  Jour.,  Apr.  13,  1895),  reports  the 
beneficial  action  of  nuclein  in  cases  of  amyg- 
dalitis, malarial  disease,  scarlet  fever,  tuber- 
culous adenitis,  and  diphtherial] 

Dose  and  Administration. — Prof.  Vaiighan 
believes  the  pure  nucleins  to  be  wholly  free 
from  poisonous  properties,  and  says  that  he 
has  injected  subcutaneously  in  man  46'653 
grammes  (1^  oz.)  of  a  2-per-cent.  solution 
of  yeast  nuclein  at  one  time  without  harm 
other  than  the  temporary  irritation  caused 
by  the  large  volume  o£  fluid  injected.  He 
has  administered  by  the  mouth  from  186'608 
to  248'824  grammes  (from  6  to  8  oz.)  of 
the  same  solution  during  twenty-four  hours 
without  ill  effect.  It  must  be  borne  in  mind 
that  a  much  smaller  quantity,  from  15  to  60 
grains  of  the  2-per-oent.  solution,  given  hypo- 
dermically,  may  cause  in  some  persons  a  rise  of 
temperature  of  from  two  to  four  degrees.  The 
average  dose  for  an  adult  is  about  00205  cubic 
centimetre  (J  of  a  minim)  of  the  standard  so- 
lution, or  1  cubic  centimetre  of  a  2-per-cent. 
solution,  given  every  two,  three,  or  four  hours, 
according  to  indications.  Usually  one  third 
of  this  quantity  is  given  to  children  under  five 
years  of  age.  The  solution,  diluted  with  a  few 
drops  of  water,  may  be  placed  on  the  tongue 
and  allowed  to  be  absorbed  without  swallow- 
ing, but  there  'seems  to  be  no  necessity  for 
this  precaution,  as  the  nucleins  are  probably 
not  affected  by  the  gastric  secretions.  A  con- 
venient method  of  administration  is  in  the 
tablet  form.  Heretofore  there  has  been  a  pref- 
erence for  introducing  the  nuoleins  into  the 
system  by  the  hypodermic  method,  but  I  am 
not  aware  that  any  comparative  studies  have 
been  made  regarding  the  relative  value  of 
these  methods  of  administering  the  nucleins. 
When  the  hypodermic  method  is  resorted  to, 
thorough  aseptic  precautions  must  be  ob- 
served. 

[Dr.  William  Jacobsohn,  of  New  York  (Med. 
Record,  May  4,  1895),  ascribes  to  nuclein 
whatever  eflSciency  the  diphtheria  antitoxines 
and  other  cognate  remedies  may  have.  In  a 
subsequent  article  (N.  Y.  Med.  Jour.,  July  30, 
1895)  he  reports  cases  of  scarlet  fever,  measles, 
diphtheria,  and  follicular  amygdalitis  treated 
with  nuclein. 


*  I  have  used  1,500  niielein  tablets,  prepared  by 
Charles  Leedom,  of  PhUadel{)hia,  each  containing 
^  of  standard  nuclein  solution,  and  solutions  of 
nucleins  made  by  Parke,  Davis  &  Co.  and  by  Leedom, 
principally  cases  of  nervous  exhaustion,  but  so  far  I 
have  been  unable  to  attribute  much  benefit  to  the 
use  of  the  nucleins. 


"Believing,"  says  Dr.  Jacobsohn,  "that  the 
body  must  contain  the  antitoxine  which  de- 
stroys the  microbes  and  its  poisons,  and  that 
this  antitoxine  must  bo  nuclein,  I  have  made 
an  injection  of  this  substance  whenever  the 
person  has  been  exposed  to  a  communicable 
disease.  I  have  found  that  diphtheria,  mea- 
sles, and  scarlatina,  the  only  diseases  in  which 
I  have  made  the  experiments  up  to  this  writ- 
ing, can  be  prevented  by  a  timely  injection  of 
nuclein.  It  occurs  to  my  mind  that  the  other 
communicable  diseases  may  likewise  be  pre- 
vented. The  persons  receiving  the  injections 
have  been  those  directly  exposed  and  living  in 
the  same  apartments  with  the  patients.  No 
quarantine  was  used;  the  dose  given  was  5 
minims  of  nuclein  solution."] 

Jeremiah  T.  Eskridge. 

NUTGALLS.— See  Galls. 

NUTMEG,  myristica  (U.  S.  Ph.,  Br.  Ph.), 
semen  myristicm  (Ger.  Ph.),  is  the  dried  seed 
of  Myristica  fragrans  deprived  of  its  testa. 
The  nutmeg  tree  is  a  native  of  the  Moluc- 
cas and  neighbouring  islands,  but  it  is  now 
generally  cultivated  in  the  East  and  West  In- 
dies. The  nuts  contain  starch,  fixed  oil  or  fat, 
albuminoids,  and  a  volatile  oil.  The  dose  of 
the  powdered  nutmeg  is  from  5  to  20  grains. 

Nutmeg  butter,  or  concrete  oil  of  nutmeg, 
oleum  myristiccB  expressum  (Br.  Ph.),  is  made 
by  bruising  nutmegs,  exposing  them  to  steam, 
and  compressing  them  between  heated  plates 
or  rollers.  It  is  a  solid,  soft,  yellowish,  unctu- 
ous substance  that  has  the  characteristic  odour 
and  taste  of  nutmeg,  and  is  composed  of  a  true 
fat,  myristin,  CaHB(OCi4H270)s,  which  yields 
myristie  acid,  C14HJ8O5,  on  saponification. 

Volatile  oil  of  nutmeg,  oleum  myristicce  (U. 
S.  Ph.,  Br.  Ph.),  is  a  limpid,  straw-coloured 
liquid  possessing  a  pungent  taste  and  the 
odour  of  nutmeg.  It  is  obtained  from  powd  ered 
nutmeg  by  distillation  with  water.  The  dose 
is  from  1  to  5  minims. 

Essence,  or  spirit,  of  nutmeg,  spiritus  myris- 
tica (U.  S.  Ph.,  Br.  Ph.),  is  a  5-per-cent.  solu- 
tion of  the  volatile  oil  in  alcohol.  It  is  used 
for  flavouring.  The  dose  is  from  ^  to  2  fl. 
drachms. 

Nutmeg  possesses  aromatic,  carminative, 
and  some  narcotic  properties.  In  large  doses 
it  has  produced  in  man  frontal  headache,  ver- 
tigo, delirium,  and  stupor.  Injected  into  the 
circulation  of  the  lower  animals,  the  oil  causes 
slowness  of  respiration,  loss  of  reflex  activity, 
and  profound  sleep;  it  has  but  a  moderate 
sedative  influence  on  the  heart. 

The  volatile  oil  is  a  rubefacient,  and  may  be 
applied  in  rheumatism  and  neuralgia.  Pow- 
dered nutmeg  may  be  applied  in  a  poultice  to 
relieve  colic  in  infants,  and  as  a  mild  rubefa- 
cient. Internally,  nutmeg  may  be  used  as  a 
carminative  and  anodyne  in  gastralgia,  en- 
teralgia,  nausea,  and  enteritis.  It  is  a  spice 
that  is  generally  used  in  flavouring  desserts 
and  farinaceous  foods. 

[Poisoning  is  occasionally  produced  by  the 
ingestion  of  large  quantities  of  nutmeg,  the 
symptoms  culminating  in  collapse  in  severe 
cases,  although  no  fatal  result  is  recorded. 


NUX  VOMICA 


26 


The  treatment  should  include  the  application 
of  warmth  and  the  use  of  cardiac  stimulants.] 
Samuel  T.  Akmstrong. 

NUX  VOMICA  (U.  S.  Ph.,  Br.  Ph.),  semen 
strychni  (Ger.  Ph.),  poison  nut,  Quaker  but- 
ton, is  the  seed  of  ISitrtichnos  Nux  vomica,  a 
tree  of  the  LogaidacecB,  growing  in  India, 
Cochin-China,  and  neighbouring  countries. 
All  parts  of  the  tree  are  bitter  and  poisonous. 
The  seeds  contain  the  alkaloids  strychnine  and 
hrucine  (see  below)  in  combination  with  iga- 
suric  (strychnic)  acid,  also  the  glucoside  log- 
anin,  a  yellow  colouring  matter,  a  concrete 
oil,  gum,  starch,  wax,  and  earthy  phosphates. 

Strychnine,  sirychmna  (U.  S.  Ph.,  Br.  Ph.), 
strychninum  (Ger.  Ph.),  CjiHjjISraOj,  which  is 
also  obtainable  from  other  plants  of  the 
lioganiacem,  notably  Strychnos  Ignaiii  {Igna- 
tia  amara),  occurs  in  colourless  crystals  or  as 
a  white,  crystalline  powder,  permanent  in  the 
air,  of  alkaline  reaction,  odourless,  but  of  an 
intensely  bitter  taste  perceptible  in  a  highly  di- 
lute solution  (1  in  700,000).  It  is  soluble  in 
6,700  parts  of  cold  water,  in  2,500  of  boiling 
water,  in  110  of  alcohol,  and  in  7  of  chloro- 
form ;  it  is  almost  insoluble  in  ether.  On  ac- 
count of  its  insolubility  the  alkaloid  itself  is 
rarely  prescribed.  The  dose  is  from  bV  to  ^ 
of  a  grain,  but  after  tolerance  is  attained  much 
larger  doses  may  be  safely  used. 

Strychnine  sulphate,  strychnines  sulphas 
(U.  S.  Ph.),  (C,jH,2NjOj)jH2S044-5H20,  occurs 
as  colourless,  prismatic  crystals,  ef&orescent  in 
dry  air,  odourless,  of  an  intensely  bitter  taste 
perceptible  in  a  l-to-700,000  solution,  of  neu- 
tral reaction,  soluble  in  50  parts  of  water,  in 
109  of  alcohol,  and  in  2  of  boiling  water,  but  is 
almost  insoluble  in  ether.  It  contains  75  per 
cent,  of  strychnine.  The  dose  is  from  ^-  to  iV 
of  a  grain. 

Strychnine  nitrate,  strychninum  nitriciim 
(Ger.  Ph.),  GjJIjjN.O^.HNOs,  forms  colourless 
needles  of  a  silky  lustre  and  very  bitter  taste, 
soluble  in  90  parts  of  cold  water,  in  3  of  boil- 
ing water,  in  70  of  alcohol,  and  in  26  of  glyc- 
cerin,  but  is  insoluble  in  ether.  It  contains 
84  per  cent,  of  strychnine,  and  is  preferred  to 
the  sulphate  for  hypodermic  use,  being. less 
irritant.  The  dose  is  from  jV  to  I'j  of  a  grain. 
The  Ger.  Ph.  gives  the  maximum  single  dose  as 
^  of  a  grain ;  the  daily  maximum  as  J  of  a  grain. 
Strychnine  arsenite,  CaiHjjNaOj.AsaOs  (un- 
official), forms  white  cubical  crystals,  almost 
efflorescent  in  air,  completely  decomposed  by 
heat,  of  a  bitter  and  metallic  taste,  soluble  in 
35  parts  of  cold  water,  in  10  of  boiling  water, 
also  in  alcohol,  less  so  in  ether.  The  dose  is 
from  jV  to  jS'  of  1  grain,  but,  as  it  is  highly 
toxic,  the  initial  dose  should  never  exceed  the 
minimum  given. 

[Strychnine  hydrochloride,  or  hydrochlorate, 
2(Cj,H,2Nj0j  HCl).8Hj0,  is  used  in  medicine  in 
the  form  of  liquor  strychnince  hydrochloratis 
(Br.  Ph.),  which  is  a  solution  of' the  strength 
of  about  1  part  in  100.  The  dose  is  from  5  to 
10  minims.] 

The  acetate,  hydriodide,  and  hydrobromide 
are  prepared  by  the  chemists,  but  offer  no  ad- 
vantage over  the  above-named  salts. 


Strychnine  is  one  of  thealkaloids  -which  dis- 
solve (as  its  salts  do  also)  without  colour  in 
concentrated  sulphuric  acid,  but,  on  adding  to 
the  solution  some  deoxidizing  substance,  a  play 
of  colours  results,  lead  peroxide  producing  a 
beautiful  blue,  passing  into  violet,  then  red, 
and  finally  yellow  (Marchand).  A  minute 
quantity  of  potassium  bichromate  produces 
similar  results  (Otto),  while  oeroso-ceric  oxide 
causes  a  blue  changing  to  violet,  and  then  to  a 
permanent  cherry-red.  If  these  tests  are  care- 
fully applied,  as  minute  a  quantity  as  1  in 
900,000  of  the  solution  may  be  detected  (Wen- 
zell). 

Brucine,  CjaHssNjO*  (unofficial),  occurs  in 
colourless  prisms, pearly  flakes  or  masses,  bitter, 
soluble  in  850  parts  of  water,  very  soluble  in 
alcohol  (1  in  1|).  It  is  with  difficulty  separated 
from  strychnine,  in  many  samples  of  which  it 
occurs  as  an  impurity.  The  dose  is  from  iVto 
^  of  a  grain. 

Brucine  is  detected  by  the  red  colour  which 
it  yields  with  nitric  acid.  Neither  nitric  nor 
sulphuric  acid  colours  strychnine,  unless  bru- 
cine is  present  as  an  impurity,  a  test  which 
distinguishes  this  alkaloid  from  several  others. 
Brucine  does  not  decompose  iodic  acid,  and  is 
thereby  distinguished  from  morphine. 

The  incompatibles  are  bromides,  chlorides, 
and  iodides  in  the  same  solution,  the  strych- 
nine being  precipitated  as  a  hydrobromide, 
etc.  Solutions  of  strychnine  salts  are  decom- 
posed by  the  alkalies  and  their  carbonates, 
and  by  tannic  (tiot  by  gallic)  acid,  but  are  not 
affected  by  ferric  salts.  Oils  and  fats  retard 
their  absorption. 

Physiological  Action.— The  action  of 
nux  vomica  is  that  of  its  principal  alkaloid, 
strychnine.  Externally,  the  latter  is  a  very 
powerful  antiseptic,  but  too  poisonous  for  safe 
use.  In  concentrated  solution,  hypodermical- 
ly,  it  has  a  decided  irritant  action  on  the  tissues. 
Internally,  in  small  doses,  its  bitter  quality 
makes  it  a  good  stomachic  tonic.  Increasing 
the  vascularity  of  the  gastric  mucous  mem- 
brane and  promoting  the  secretion  of  gastric 
juice,  also  of  the  pancreatic  and  biliary  secre- 
tions, it  aids  digestion  and  sharpens  the  appe- 
tite, but,  like  other  bitter  tonics,  it  deranges 
digestion  when  used  excessively  or  for  a  long 
time.  It  directly  stimulates  the  "muscular  coat 
of  the  intestines,  increasing  peristalsis  and 
acting  as  a  purgative  ;  but  restrains  the  faecal 
discharges  when  their  frequency  is  due  to 
atony  of  the  bowel.  It  stimulates  the  motor 
nerve-cells  of  the  spinal  cord,  the  cardiac 
motor  ganglia,  the  respiratory  and  vaso-motor 
centres  in  the  medulla,  contracting  the  arteri- 
oles all  over  the  body  (though  by  full  doses 
they  are  relaxed),  and  the  excitability  of  the 
sensory  nerves  and  their  terminal  elements. 
The  result  is  that  respiration  is  deepened  and 
quickened,  the  action  of  the  heart  is  increased 
and  the  blood-pressure  raised,  the  field  of 
vision  is  enlarged,  the  sight  and  hearing  are 
sharpened,  and  the  sense  of  touch  is  rendered 
more  acute,  but  the  cerebral  convolutions  are 
not  aflfected.  Excreted  chiefly  in  the  urine,  it 
causes  increased  frequency  of  urination,  and 
in  excess  produces  spasm  of  the  neck  of  the 


27 


NUX  VOMICA 


bladder.  It  probably  excites  uterine  contrac- 
tion, but  undoubtedly  promotes  menstruation, 
disposes  to  sexuality,  and  provokes  erections  of 
the  penis. 

The  most  marked  feature  of  the  action  of 
strychnine  is  the  great  increase  which  it  causes 
in  the  reflex  excitability  of  the  spinal  cord  and 
other  reflex  centres,  such  as  the  vaso-motor 
and  respiratory  centres  in  the  medulla.  When 
the  dose  is  large  this  increase  is  so  great  as  to 
induce  convulsions  and  cause  death  by  as- 
phyxia. After  a  full  dose  (-^  of  a  grain)  the 
pupils  become  dilated,  the  limbs  take  on  jerk- 
ing movements,  respiration  becomes  spas- 
modic and  the  lower  jaw  stiff,  a  sensation  of 
cerebral  tension  may  be  felt,  and  sudden  shud- 
dering and  anxiety  follow,  the  face  taking  on 
an  unmeaning  smile  (risus  sardonicus).  A 
toxic  dose  (from  i  to  3  grains)  produces  power- 
ful and  characteristic  convulsions  of  a  tetanic 
character.  Within  an  hour  after  its  adminis- 
tration, sometimes  after  only  a  few  minutes, 
the  patient  feels  a  sudden  sense  of  suffocation 
and  dyspnoea,  the  head  and  limbs  begin  to 
shudder  and  jerk,  the  latter  are  suddenly 
stretched  out  rigidly  with  hands  clenched  and 
feet  arched,  then  the  head  is  bent  backward 
and  at  last  the  whole  body  becomes  stiffly 
arched,  resting  on  the  head  and  the  heels,  the 
belly  hard  and  tense,  the  chest  fixed,  and 
breathing  all  but  arrested.  In  the  height  of 
the  spasm  the  face  is  dusky  and  congested,  and 
the  eyeballs  project.  Nearly  all  the  muscles 
of  the  body  are  affected,  the  contraction  of 
those  of  the  face  causing  a  risus  sardonicus, 
but  the  jaw  muscles  are  not  seriously  affected 
until  near  the  end,  and  never  so  powerfully  as 
in  tetanus.  The  pulse  is  very  rapid,  and  the 
temperature  of  the  body  is  above  normal,  but 
the  intellect  remainsunclouded,  and  the  patient 
often  expresses  a  sense  of  impending  dissolu- 
tion. After  the  paroxysm  has  lasted  a  minute 
or  two  it  usually  relaxes  for  a  time.  In  the 
interval  the  patient  suffers  from  soreness  of 
the  muscles,  feels  exhausted,  and  sweats  pro- 
fusely, but  before  long  becomes  aware  that  the 
spasm  is  returning,  and  cries  out  for  some  one 
to  hold  him  or  to  rub  his  limbs.  The  convul- 
sions rapidly  increase  in  severity,  a  breath  of 
wind,  the  slightest  noise,  even  a  bright  light, 
being  sufficient  to  bring  them  on  ;  and  in  one 
the  patient  may  jerk  himself  out  of  the  bed. 
At  last  the  respiration  stops  in  the  middle  of 
a  fit,  and  the  heart  soon  after  ceases  to  beat. 
Death  occurs,  after  two  or  three  hours  at  most, 
by  exhaustion  and  asphyxia  from  tetanic 
fixation  of  the  muscles  of  respiration,  con- 
sciousness being  preserved  until  carbonic-acid 
narcosis  sets  in. 

Strychnine  exalts  all  the  functions  of  the 
spinal  cord — reflex,  motor,  vaso-motor,  and 
sensory,  the  latter  being  the  least  affected.  It 
has  a  selective  action  on  the  large  multipolar 
ganglia  in  the  anterior  columns,  which  it  first 
stimulates  and  finally  paralyzes  by  over-stimu- 
lation, in  this  respect  ilhistrating  the  rule  that 
small  and  large  doses  of  an  active  agent  act 
antagonistically  to  each  other.  A  massive 
dose  seems  to  destroy  the  spinal  and  medullary 
functions  as  by  a  single  blow.  The  spasms  of 
46 


strychnine  may  be  distinguished  from  those  of 
tetanus  by  their  intermittency,  the  latter  being 
constant,  also  by  the  meaningless  smile,  the 
less-marked  trismus,  the  absence  of  a  wound, 
and  the  rapid  course  of  the  symptoms,  which 
all  point  to  strychnine  poisoning.  Thebaine, 
the  tetanizing  alkaloid  of  opium,  is  also  a 
spinal  exaltant,  and  acts  much  the  same  as 
strychnine. 

Strychnine  does  not  directly  affect  the 
muscular  tissue,  the  motor  nerve-trunks  or 
nerve-endings,  or  the  cerebral  con  volutions.  Oc- 
casionally, however,  large  medicinal  doses  cause 
a  greatly  heightened  sensibility  of  the  optic 
and  auditory  nerves,  so  that  brilliant  lights  and 
loud  sounds  produce  painful  impressions  ;  and 
in  a  few  cases  there  is  a  true  cerebral  intoxica- 
tion, resembling  a  slight  degree  of  drunkenness. 
It  probably  affects  all  the  nervous  centres  in 
some  degree,  the  sensory,  however,  much  less 
than  the  motor  and  vaso-motor  ones. 

Strychnine  is  to  some  extent  oxidized  and 
destroyed  in  the  body,  and  the  remainder  is 
eliminated  by  the  urinary,  salivary,  and  cu- 
taneous channels.  As  it  contracts  the  renal 
arteries,  it  hinders  its  own  excretion  by  the 
kidneys,  and,  being  rapidly  absorbed,  it  may 
accumulate  in  the  system  if  even  a  small  dose 
is  frequently  repeated  and  continuously  ad- 
ministered. It  is  much  more  poisonous  when 
injected  into  the  rectum  than  when  swallowed. 

The  fatal  dose  is  placed  by  Taylor  at  from 
-}  to  2  grains  for  an  adult,  but  recovery  has 
taken  place  after  larger  doses — even  7  and  8 
grains — cases  probably  of  imperfectabsorption, 
due,  perhaps,  to  the  presence  of  fat  or  tannin 
in  the  food  in  the  stomach.  A  child,  aged  two 
years  and  a  half,  died  in  four  hours  from  a  dose 
of  iV  of  a  grain.  After  death  from  strychnine 
poisoning  cadaveric  rigidity  is  marked,  with 
opisthotonos,  clenched  hands,  and  arms  flexed 
across  the  chest,  and  the  muscular  rigidity 
may  persist  for  several  months  after  death. 
The  face  is  usually  pale,  but  sometimes  livid, 
the  internal  organs  are  gorged  with  dark  blood, 
and  the  bladder  is  usually  contracted.  The 
cause  of  death  is  primarily  asphyxia,  produced 
by  rigidity  of  the  muscles  of  respiration  with 
possible  factors  in  spasm  of  the  heart  or  ex- 
haustion thereof. 

On  animals  strychnine  acts  as  it  does  on  man, 
but  in  different  degrees ;  birds,  guinea-pigs, 
and  perhaps  monkeys  are  comparatively  in- 
susceptible to  it,  while  ruminant  animals  are 
less  easily  affected  than  other  quadrupeds,  at 
least  when  it  is  given  by  the  mouth,  and  cats 
resist  it  singularly.  Very  minute  portions  in 
the  soil  will  destroy  the  life  of  growing  plants. 

There  is  "no  very  reliable  chemical  antidote, 
unless  potassium  permanganate  should  prove 
to  be  one,  having  been  taken  recently  in  large 
dose  after  the  ingestion  of  f  of  a  grain  of  strych- 
nine, without  any  symptom  of  strychnine 
poisoning  resulting  (Pahr).  Tannic  acid  is  the 
usual  antidote,  forming  the  tannate ;  another 
is  iodine  in  dilute  solution,  or  a  soluble  iodide. 
Animal  charcoal  should  be  given  freely,  also 
fats  and  oils,  to  retard  absorption.  Evacuation 
of  the  stomach  should  follow  the  administra- 
tion of  any  antidote,  and  the  bladder  should 


NUX  VOMICA 


28 


be  emptied  frequently,  to  prevent  reabsorp- 
tion. 

Chloral,  which  is  by  far  the  most  reliable  of 
the  antagonists,  should  be  given  as  soon  as 
possible,  30  grains  at  once,  with  or  without 
potassium  bromide,  and  repeated  in  doses  of 
29  grains  at  hourly  intervals  as  long  as  reflex 
exaltation  continues.  Quiet,  as  perfect  as 
possible,  is  an  antagonistic  measure  of  great 
value.  Ice  should  be  applied  to  the  spine, 
and  artificial  respiration  practised  when  pos- 
sible. Hydrastinine  hydrochloride,  given  hy- 
podermically  in  the  amount  of  a  grain,  has 
been  successful.  Nicotine  has  proved  efficient 
in  many  cases,  also  tobacco  by  enema.  Chloro- 
form or  arnyl  nitrite,  by  inhalation,  may  be 
used  to  procure  muscular  relaxation.  Physos- 
tigma  is  antagonistic,  but  dangerous.  Cham- 
omile oil  subdues  reflex  excitability  in  frogs 
poisoned  by  strychnine.  Veratrum  viride  has 
cured  a  bad  case ;  a  fluid  drachm  of  the  tinc- 
ture was  given  at  once,  followed  by  S  drops 
every  ten  minutes  (Ringer).  Valerian  miti- 
gates the  spasms.  Curare,  in  doses  of  J  of  a 
grain  hypodermioally,  is  warmly  recommended, 
but  its  value  is  doubtful.  Potassium  bromide 
is  antagonistic,  but  too  slow  of  action  to  be  of 
service. 

Strychnine  is  antaijonistic  to  chloral,  phy- 
sostigmine,  and  morphine,  and  may  be  used  as 
a  respiratory  stimulant  in  poisoning  by  any  of 
those  drugs  and  in  narcotic  poisoning  when 
respiration  is  failing. 

Therapeutics. — Nux  vomica  has  a  wide 
range  of  therapeutic  efB  cacy,  though  chiefly  em- 
ployed as  a  stomachic  tonic  and  a  stimulant  of 
the  cardiac,  respiratory,  and  other  nerve-centres. 
When  some  degree  of  its  physiological  action 
is  desired,  the  salts  of  strychnine  are  preferred 
for  administration,  more  accurate  dosing  being 
thereby  attained,  as  the  proportion  of  this 
alkaloid  in  nux-vomioa  preparations  varies 
greatly.  The  tincture,  in  doses  of  5  minims, 
is  an  excellent  remedy  for  flatulent  dyspepsia 
and.  flatulency  of  any  kind,  also  for  pyrosis  and 
gastric  catarrh,  especially  in  drunkards,  and  is 
often  efficient  in  the  moi-ning  vomiting  of  dip- 
somaniacs and  the  vomiting  of  pregnancy.  In 
the  vomiting  of  phthisis  strychnine  is  one  of 
the  best  agents.  The  extract  is  much  used  in 
laxative  pills  for  habitual  constipation,  with 
the  object  of  increasing  peristalsis,  and  in 
either  constipation  or  diarrhoea  due  to  atony 
of  the  bowels  the  tincture,  in  10-minim  doses, 
may  be  given  with  good  results.  In  the  con- 
dition clinically  known  as  "  torpid  liver," 
wherein  the  stools  are  of  a  pale  colour  and  an 
offensive  odour,  showing  the  absence  of  bile, 
the  tongue  is  coaled  with  ^  thick  fur,  and  the 
patient  complains  of  headache,  lassitude,  ano- 
rexia, and  a  bad  taste  in  the  mouth,  small 
doses  of  strychnine  (^  of  a  grain)  twice  or 
thrice  daily  will  often  act  as  well  as  a  mercu- 
rial, restoring  bile  to  the  stools  and  correcting 
the  other  symptoms.  Epidemic  diarrhcea  and 
dysentery  are  frequently  controlled  by  it,  and 
in  anosmia  and  chlorosis  it  is  an  invaluable 
remedy,  with  iron  and  quinine.  As  an  ad- 
junct to  the  latter  in  intermittents  it  is  gen- 
erally useful,  and  has  proved  of  decided  service 


in  tremors  and  ataxic  movements  of  various 
kinds  (but  not  in  locomotor  ataxia),  also  in 
chorea,  epilepsy,  and  idiopathic  tetanus. 
Strychnine  is  highly  efficient  in  many  forms 
of  neuralgia,  especially  the  visceral  (hepatal- 
gia,  gastralgia,  etc.),  also  in  infraorbital  and 
other  neuralgice  accompanying  anaemia  and 
general  debility,  in  all  of  which  very  small 
doses  (yiir  of  a  grain)  should  be  employed. 
Headaches  are  often  controlled  by  nux  vomica, 
especially  the  sick  headache  of  gastric  origin, 
in  which  a  minim  of  the  tincture  every  ten 
minutes  frequently  gives  marked  relief;  and 
doses  of  10  minims  before  each  meal  will  prevent 
frontal  headache  in  many  persons  liable  there- 
to. A  sense  of  heat  and  weight  on  the  top  of 
the  head,  accompanied  or  not  by  flatulence, 
and  occurring  usually  in  women  at  the  cli- 
macteric, will  often  yield  to  the  tincture  in 
doses  of  5  minims  before  each  meal. 

Nux  vomica  is  a  most  efficient  remedy 
against  impending  cardiac  failure  from  al- 
most any  cause.  Even  with  the  pulse  im- 
perceptible, the  extremities  cold,  and  death 
apparently  imminent,  the  administration  of  a 
drop  of  the  tincture  every  five  minutes  has 
frequently  given  renewed  strength  to  the  car- 
diac contractions  after  five  or  six  doses,  ini- 
tiating an  improvement  which  resulted  in 
eventual  recovery.  It  is  an  excellent  remedy 
for  coughs,  even  for  those  of  phthisis,  pneumo- 
nia, bronchitis,  or  emphysema,  but  is  particu- 
larly efficient  in  coughs  of  neurotic  origin, 
such  as  periodical  cough,  night  cough,  and  the 
paroxysmal  laryngeal  cough  without  lung  or 
bronchial  symptoms,  but  characterized  by  a 
persistent  tickling  sensation  in  the  throat.  In 
all  these,  drop  doses  of  the  tincture  frequently 
repeated  are  much  more  serviceable  than 
larger  doses  at  longer  intervals.  In  bronchial 
asthma  and  that  of  neurotic  origin — in  the 
dyspnoea  of  pulmonary  affections,  and  that 
with  palpitation  of  the  heart  in  hysterical  sub- 
jects— in  irregular  cardiac  action  and  ooerac- 
tion  of  the  heart,  in  functional  anmsthesia, 
hypochondriasis,abdomi7ialcramps,the  nervous 
movements  accompanying  pregnancy,  cold  hands 
and  feet  due  to  languid  capillary  circulation, 
prolapsus  ani  and  urinary  incontinence  in 
children,  a,ni  paralysis  of  the  bladder  in  old 
people,  small  doses  of  strychnine  or  nux  vomica 
frequently  repeated  are  remarkably  beneficial. 
In  many  of  these  affections  the  therapeutic 
action  of  the  drug  is  unmistakably  antispas- 
modic, illustrating  the  opposite  effect  of  large 
and  small  doses  of  an  active  agent,  a  thorough- 
ly established  fact  in  many  cases,  though  not 
of  universal  application. 

Local  paralyses  of  various  forms  are  well 
treated  by  the  hypodermic  injection  of  strych- 
nine into  the  substance  of  the  affected  muscles, 
and  diphtheritic  paralyses  are  almost  invari- 
ably cured  by  its  internal  administration.  It 
may  be  useful  in  hemiplegia  when  degenera- 
tion has  not  set  in,  and  when  the  paralyzed 
muscles  are  completely  relaxed ;  but  it  is  of  no 
avail  in  recent  cases  or  when  electrical  con- 
tractility is  lost.  Its  too  early  use  in  cerebral 
paralyses,  especially  when  due  to  haemorrhage, 
may  ilo  serious  harm ;  and  in  the  early  stages 


29 


NUX  VOMICA 


of  organic  spinal  lesions  it  may  be  decidedly 
injurious,  particularly  if  given  in  large  doses. 
It  should  never  be  used  in  spinal  paralysis 
when  there  are  symptoms  of  congestion  or  in- 
flammation of  either  the  cord  or  its  mem- 
branes. In  hysterical  paralysis  and  that 
caused  by  lead  it  is  decidedly  beneficial,  and 
is  highly  efficient  in  that  form  which  is  limited 
to  one  or  two  groups  of  muscles,  especially  in- 
fantile paralysis  of  long  standing,  even  when 
the  atrophic  process  has  gone  so  far  as  to 
greatly  impair  the  electrical  sensibility.  Mr. . 
Barwell  employed  in  such  cases  a  3-per-cent. 
solution  of  the  hydrochloride  by  injection  into 
the  substance  of  the  paralyzed  muscles,  giving 
as  much  as  -J  of  a  grain  at  a  dose  in  some 
cases,  with  remarkable  success  and  without 
the  occurrence  of  a  swingle  accident,  either  in 
his  experience  or  in  that  of  others  subsequent- 
ly (Phillips).  Tlie  safety  of  this  injection  is 
explained  by  the  concentration  of  the  solution 
employed,  which,  being  highly  irritant,  sets  up 
a  circumscribed  inflammation,  inclosing  the 
poison  and  localizing  its  action.  A  much 
smaller  dose  in  weaker  solution,  given  hypo- 
dermically,  would  prove  toxic.  Strychnine 
is  very  useful  in  cases  of  nervous  impairment 
of  the'  sight,  especially  in  amblyopia  from  lead, 
tobacco,  or  alcohol,  and  atrophy  of  the  optic 
nerve,  also  in  that  due  to  functional  disorders 
of  the  retina  without  apparent  lesion,  and  in 
muscular  asthenopia.  In  these  affections  it 
may  be  used  internally,  but  is  usually  em- 
ployed by  injection  into  the  tissues  around  the 
temple,  beginning  with  -^  of  a  grain,  and 
gradually  increasing  the  dose  up  to  ^  or  j  of  a 
grain.  Improvement  may  not  be  apparent  un- 
til the  larger  doses  are  reached. 

[Strychnine  is  sometimes  employed  to  reme- 
dy.de/ccj!jre«imne  contractions  during  labour. 
For  this  purpose  the  dose  should  be  small; 
otherwise,  there  is  danger  of  poisoning  the 
foetus.  A  Russian  physician.  Dr.  AbrajanofE 
(Jour,  russe  d' accoucheur,  et  de  gynecol.,  1895  ; 
Presse  medicale,  Feb.  5,  1896),  having  given  to 
a  woman  in  labour  a  subcutaneous  injection  of 
0-015  of  a  grain  of  the  nitrate,  found  that  no 
sooner  had  he  cut  the  umbilical  cord,  when  the 
expulsive  stage  was  over,  than  the  child  was 
attacked  with  opisthotonos  and  rigidity  of  the 
limbs,  but  the  convulsion  lasted  only  half  a 
minute,  and  does  not  seem  to  have  been  re- 
peated.] 

A  form  of  amblyopia  termed  by  M.  Sous 
(Jow.  de  med.  de  Bordeaux)  "  insolation "  of 
the  eyes  has  been  successfully  treated  by  him 
with  temporal  injections  of  strychnine.  The 
patient,  a  naval  officer,  had  exposed  his  eyes 
for  a  rather  long  time  to  a  very  bright  light 
while  taking  observations  in  mid-ocean  at  noon. 
Shortly  afterward  he  noticed  a  marked  trouble 
with  his  eyes,  and  in  two  months  the  visual 
acuity  was  O'l  with  central  scotoma.  The  am- 
blyopia was  not  of  toxic  origin.  The  affection 
made  no  progress  after  the  first  two  months, 
and  it  might  be  considered  as  having  been 
arrested,  leaving  only  a  certain  inertia  of  the 
retina.  Four  drops  of  a  solution  of  1  part  of 
strychnine  sulphate  in  300  parts  of  distilled 
water  were  injected  in  the  left  temporal  region 


on  the  first  day,  and  on  the  second  day  the 
same  quantity  was  injected  in  the  right  tem- 
poral region.  After  the  second  injection  the 
scotoma  disappeared  and  the  visual  acuity 
rose.  The  injections  were  made  alternately  in 
each  temple  once  a  day,  and  they  did  not 
cause  any  pain.  The  sight  rapidly  became 
ameliorated,  for  after  the  eighth  injection,  the 
treatment  having  lasted  for  eight  days,  the 
visual  acuity  became  normal.] 

In  acute  and  chronic  alcoholism  strychnine 
is  undoubtedly  of  great  service.  In  small 
doses  it  is  signally  effective  for  the  morning 
vomiting  and  dyspepsia  of  drunkards,  for  the 
tremor  of  chronic  dipsomaniacs,  in  the  form- 
ing stage  of  delirium  tremens,  and  in  the  de- 
pression due  to  enforced  abstinence  from 
alcohol.  Hypodermieal  ly,  in  doses  of  from  ^ 
to  ^0"  of  a  grain  of  the  nitrate,  three  or  four 
times  daily  for  a  week,  and  less  frequently  for 
two  weeks  longer,  it  removes  the  craving  for 
stimulants,  counteracts  the  vaso-motor  paralysis 
to  which  most  of  the  injurious  effects  of  alco- 
hol are  due,  and  is  probably  in  other  respects 
a  true  antagonist  to  the  action  of  that  nar- 
cotic poison  on  the  human  organism.  The 
published  reports  of  its  efficacy  in  dipsomania', 
by  Luton,  Dujardin-Beaumetz,  Portugaloff, 
and  others,  have  been  fully  confirmed  by  re- 
cent observers,  so  that  strychnine  is  now  the 
acknowledged  remedy  for  inebriety  and  the 
efficient  constituent  of  the  numerous  "  cures  " 
therefor  so  widely  advertised  in  the  religious 
and  secular  press. 

Strychnine  arsenite  possesses  strong  antipe- 
riodic  power,  and  may  prove  an  efficient  rem- 
edy for  any  intermittent  disease  rebellious  to 
the  infiuence  of  quinine.  As  it  is  highly  toxic, 
the  minimum  dose  should  be  given  at  first, 
and  its  effects  carefully  watched. 

Brucine  was  formerly  supposed  to  have  an 
action  analogous  to  that  of  strychnine,  though 
weaker.  The  error  arose  from  the  fact  that 
both  alkaloids  usually  occur  in  commej'oial 
samples  of  the  former  one.  Dr.  Mays  has, 
however,  shown  that  pure  brucine  acts  more 
like  cocaine,  being  a  powerful  local  anaesthetic 
in  5-  to  10-per-cent.  solutions  on  mucous  mem- 
branes, and  in  a  20-per-cent.  solution  on  the 
skin.  In  the  latter  strength  it  has  been  em- 
ployed with  satisfaction  for  chronic  pruritus, 
and  in  a  weaker  solution  (5-per-cent.)  for  in- 
flammations about  the  external  ear,  in  which 
Dr.  Burnett  alleges  for  it  more  satisfactory  ac- 
tion than  is  obtained  with  cocaine. 

Methyl- brucine  and  methyl-strychnine,  like 
methyl-thebaine,  do  not  affect  the  spinal  cen- 
tres, but  paralyze  the  end-organs  of  the  motor 
nerves,  like  curare,  and  may  be  used  as  antago- 
nists in  strychnine  poisoning. 

[Much  attention  has  lately  been  paid  in  Aus- 
tralia and  in  India  to  the  use  of  Strychnine 
as  a  remedy  for  snake  poisoning.  Dr.  August 
Mueller,  of  Yaokandandah,  has  been  a  promi- 
nent advocate  of  its  efficacy.  In  1893  Dr. 
Mueller  published  a  pamphlet  on  the  subject  in 
which  he  upheld  the  theory  that  snake  venom 
acted  by  depressing  and  more  or  less  suspend- 
ing the  function  of  the  motor-nerve  centres, 
and  urged  the  use  of  strychnine  hypodermically 


OAK  BARK 
OILS 


30 


in  sufficient  quantity  to  overcome  the  influence 
of  the  venom.  For  many  months  before  the 
issue  of  that  publication  Dr.  Mueller  had  re- 
peatedly published  accounts  of  cases  observed 
by  himself  and  others  tending  to  show  the 
life-saving  properties  of  large  doses  of  strych- 
nine in  snake  poisoning,  and  several  other 
physicians  had  confirmed  his  observations. 
So  much  vogue  did  Dr.  Mueller's  views  obtain, 
and  so  many  venomous  snakes  are  tliere  in 
Australia,  that  the  instrument-makers  of  Syd- 
ney set  to  work  to  provide  medical  practitioners 
with  specially  designed  "  snakebite  antidote 
pocket-eases."  In  the  literature  of  the  subject 
that  has  since  arisen  much  has  been  published 
in  criticism  of  Dr.  Mueller's  ideas,  and  the 
reported  recoveries  with  which  he  supports 
them  have  been  "  explained  away  "  with  one 
supposition  after  another,  so  that  it  can  not 
yet  be  affirmed  positively  that  strychnine  is  a 
remedy  to  be  fully  relied  on  in  cases  of  snake- 
bite ;  nevertheless,  it  should  be  tried  for  want 
of  a  better  one,  although  the  large  doses  said 
to  be  necessary  call  for  the  utmost  caution. 
In  one  case,  that  of  a  girl,  twelve  years  old, 
jV  of  a  grain  was  injected  twice  within  ten 
minutes ;  in  another,  that  of  a  person  that  had 
been  bitten  by  a  tiger  snake,  ten  injections  of 
"iV  of  a  grain  each  were  given. 

A  reciprocal  antagonism  has  been  supposed 
to  exist  between  strychnine  and  serpent  venom, 
and  thus  has  been  explained  the  survival  of 
persons  so  dosed  with  strychnine,  and  not  only 
their  survival,  but  also  their  freedom  from 
symptoms  of  strychnine  poisoning.  So  far  as 
the  poison  of  the  cobra  is  concerned,  the  va- 
lidity of  this  theory — indeed,  the  soundness  of 
the  strychnine  treatment  of  cobra  poisoning — 
,  has  been  rendered  very  doubtful,  to  say  the 
least,  by  Surgeon-Lieutenant  R.  H.  Elliot,  of 
Madras  {Trans,  of  the  South  Indian  Branch 
of  the  Brit.  Med.  Assoc,  Oct.,  1895),  who  has 
subjected  the  matter  to  careful  experimental 
investigation.  Dr.  Elliot  describes  a  number 
of  antidotal  experiments  made  with  strych- 
nine in  cases  of  cobra  poisoning,  and  says 
that  out  of  the  whole  number,  thirty-three, 
he  has  not  one  single  case  of  recovery  to 
record ;  that  in  no  case  did  the  strychnine 
save  life.  Much,  he  says,  must  be  allowed 
for  the  individual  idiosyncrasies  of  animals, 
nevertheless  he  thinks  that,  given  an  ani- 
mal with  a  poisonous  dose  of  cobra  poison, 
the  subcutaneous  injection  of  strychnine 
often  hastens  death  very  noticeably,  while 
it  can  not  be  said  to  retard  it  materially. 
It  would  seem,  he  says,  that  death  may  be 
hastened  by  the  strychnine  in  two  ways:  1. 
By  its  increasing  the  force  and  speed  of  the 
circulation,  thus  aiding  the  diffusion  of  the 
virus.  2.  By  the  exhausting  reaction  which 
strychnine  undoubtedly  produces  on  the  nerv- 
ous centres.  The  author  adds  that  he  be- 
lieves that  the  supposed  antidotal  action  of 
strychnine  in  cobra  poisoning  is  a  delusion  and 
a  myth.  On  comparing  the  strychnine  check 
experiments  with  the  antidotal  experiments, 
he  says,  the  following  facts  will  be  observed : 
1.  That  symptoms  of  strychnine  poisoning 
manifest  themselves  as  early  after  the  injection 


of  strychnine  in  the  one  case  as  in  the  other. 
3.  That  in  the  early  stages  the  convulsions  of 
strychnine  are  as  violent  in  the  one  case  as  in 
the  other.  3.  That  in  the  later  stages  animals 
die  from  cobra  poison  with  typical  symptoms, 
and  yet  the  least  touch  evokes  an  undoubted 
strychnine  tremor  in  the  animal  up  to  within 
a  minute  of  death.  An  intermediate  stage  oc- 
curs in  which  the  victim  starts  on  the  least 
touch  or  sound,  but  does  not  respond  with  a 
convulsion.  4.  That  under  the  influence  of  a 
poisonous  dose  of  strychnine  the  animal  dies  as 
surely  when  fully  under  the  influence  of  cobra 
poison  as  it  does  when  no  such  poison  has  been 
given.  5.  That  in  some  cases  strychnine  ad- 
ministered in  physiological  doses  seems  ac- 
tually to  determine  at  once  the  impending  fatal 
issue.  That  in  an  animal  poisoned  with  cobra 
virus  strychnine  may  produce  a  temporary 
stimulation,  and  so  may  give  rise  to  a  falla- 
cious appearance  of  improvement.] 

The  dose  of  nux  vomica  in  substance,  a 
form  in  which  it  is  rarely  used,  is  -J  a  grain, 
and  not  more  than  3  grains  should  be  given  in 
the  course  of  twenty-four  hours.  The  dose  of 
the  extract,  extractum  nucis  vomicm  (U.  S.  Ph., 
Br.  Ph.),  extractum  strychni  (Ger.  Ph.),  is 
from  ^  to  J  of  a  grain,  and  not  more  than  3 
grains  should  be  given  in  a  day.  The  dose  of 
the  fluid  extract,  extractum  nucis  vomicm  flui- 
dum  (D.  S.  Ph.),  is  from  1  to  5  minims.  The 
dose  of  the  tincture,  tinctura  nucis  vomiccB 
(U.  S.  Ph.,  Br.  Ph.),  tinctura  strychni  (Ger. 
Ph.),  is  from  5  to  20  minims.  The  British  so- 
lution of  strychnine  hydrochloride,  liquor 
strychnines  hydrochloratis  (Br.  Ph.),  is  made 
with  1  part  of  strychnine,  3  fl.  parts  of  diluted 
hydrochloric  acid,  24  fl.  parts  of  rectified  spirit, 
and  73  fl.  parts  of  distilled  water ;  the  dose  is 
from  1  to  5  minims. — Samuel  0.  L.  Pottee. 


OAK  BARE,  quercus  cortex  (Br.  Ph.),  cor- 
tex quercus  (Ger.  Ph.),  is  the  dried  bark  of  the 
smaller  branches  and  young  stems  of  Quercus 
Robur.  The  Br.  Ph.  demands  that  the  collec- 
tion shall  take  place  in  the  spring,  and  shall 
be  made  from  trees  which  grow  in  Britain. 
The  drug  as  found  in  pharmacy  is  in  quills 
which  are  covered  externally  with  a  corky 
layer  of  grayish  colour,  and  which  internally 
are  brownish  and  longitudinally  striated.  It 
has  little  or  no  odour,  but  its  taste  is  very 
astringent.  White-oak  bark,  quercus  alia  (U. 
S.  Ph.),  is  the  bark  of  Quercus  alba,  an  oak 
which  grows  in  the  United  States,  and  closely 
resembles  the  oik  of  Great  Britain.  It  occurs 
in  nearly  flat  pieces,  which  have  been  deprived 
of  the  corky  layer ;  its  colour  is  pale  brown,  it 
has  a  faint  odour  like  that  of  tan,  and  its  taste 
is  highly  astringent.  In  the  shops  it  is  kept 
as  a  coarse,  fibrous  powder.  Among  the  con- 
stituents of  oak  bark  are  tannic  acid,  gallic 
acid,  and  extractive.  The  tannin  is  the  im- 
portant ingredient.  It  is  of  the  variety  known 
as  quercitatmic  acid.  It  varies  much  in 
amount  according  to  a  number  of  circum- 
stances, among  them  the  part  of  the  tree  from 
which  the  bark  is  obtained  and  the  season 


31 


OAK  BARK 

OILS 


■when  it  is  gathered.  It  is  especially  abundant 
in  the  young  bark,  and  the  bark  contains  fai' 
more  of  it  in  the  spring  than  at  other  seasons. 
The  requirements  of  the  Br.  Ph.  are  thus  ex- 
plained. A  bitter  principle  called  quercin  is 
also  found  in  oak  bai-k. 

Oak  bark  is  highly  astringent  and  somewhat 
corroborant  by  virtue  of  its  bitterness.  It  is 
ordinarily  employed  in  the  form  of  decoction, 
decoctum  guercus  (Br.  Ph.).  This  is  composed 
of  li  oz.  of  bruised  oak  bark  and  1  imperial 
pint  of  distilled  water.  These  are  boiled  for 
ten  minutes,  strained,  and  sufficient  distilled 
water  is  added  through  the  strainer  to  main- 
tain the  quantity  at  1  pint.  The  dose  is  from 
1  to  2  fl.  oz.  It  may  be  given  in  those  diar- 
rhoeal  conditions  in  which  astringents  are  not 
contra-indicated,  but  it  is  far  more  commonly 
used  as  an  external  remedy.  It  may  be  em- 
ployed as  an  injection  in  leucorrhma,  as  an 
enema  in  hcemorrhoids,  as  a  wash  in  prolapsus 
ani.  and  as  a  gargle  in  relaxation  of  the  fauces 
and  uvula.  It  has  even  been  thought  bene- 
ficial as  a  bath,  especially  for  use  in  children, 
in  such  conditions  as  marasmus  and  chronic 
diarrhosa.  As  a  local  application,  too,  it  is 
beneficial  in  flabby  ulcerations  and  hyperi- 
drosis.  I 

Black-oak  bark  is  the  bark  of  Quercus  tinc- 
toria.  Its  properties  are  similar  to  those  of 
the  barks  already  described,  but  it  contains  a 
colouring  matter,  quercitrin,  which  is  soluble 
in  boiling  water  and  turns  it  brown.  A  de- 
coction of  black-oak  bark  is  therefore  objec- 
tionable because  of  its  staining  qualities,  and 
is  seldom  used. — Heney  A.  Griffin. 

OATMEAIi. — This  is  chiefly  used  as  an 
article  of  diet,  being  nutritious  and  easily 
digested  by  most  persons  who  have  passed  the 
age  of  infancy.  It  is  slightly  laxative,  and  is 
therefore  a  particularly  appropriate  food  for 
individuals  affected  with  chronic  constipation. 
It  is  thought,  however,  to  have  a  tendency  to 
add  to  the  irritation  of  the  skin  in  cases  of 
eczema,  and  to  aggravate  the  disease.  Oat- 
meal gruel  is  a  suitable  article  of  food  in  the 
early  days  of  convalescence  from  inflammatory 
and  febrile  diseases. 

ODOITTIITE. — This  name  has  been  applied 
to  various  dentifrices  and  antodontalgic  prep- 
arations. According  to  Geissler  and  MoUer 
{Real-Encyclop.  d.  ges.  Pharm.),  English  odon- 
tine  is  composed  of 

Camphor 5  parts ; 

Alcohol 10     " 

Chloroform 30     " 

Or  of 

Oil  of  cajuput 2  parts ; 

Oil  of  cloves,     )       ,  3     « 

Oil  of  juniper,  p^''''"-     "* 
Ether '. 24     " 

These  are  for  use  in  cases  of  toothache.  A 
bit  of  cotton  moistened  with  either  of  them  is 
to  be  inserted  into  the  cleansed  cavity  of  the 
tooth  in  cases  of  caries. 

ODONTODOL.— This  is  a  name  given  in 
Italy  to  a  new  preparation  which  is  much 


vaunted  in  the  treatment  of  toothache.    The 
formula  is  as  follows : 

Cocaine  hydrochloride,  )       i,  i  ^ 

Oil  of  cherry-laurel,       ]  ^'^^'^  ■■•■     ^^  S^-'' 

Tincture  of  arnica 150  " 

Solution  of  ammonium  acetate. . .  300   " 

If  the  pain  is  caused  by  caries,  a  piece  of 
cotton  saturated  with  the  liquid  is  put  into 
the  cavity  of  the  tooth ;  if  it  is  caused  by 
inflammation  of  the  pulp,  the  mouth  should 
be  washed  out  with  odontodol  diluted  with 
twice  its  bulk  of  warm  linseed  •  tea.  If  the 
pain  extends  to  the  entire  jaw,  the  painful 
surface  should  be  thoroughly  rubbed  with 
several  drops  of  odontodol,  after  rinsing  the 
mouth  with  the  solution.  Care  should  be 
taken  not  to  swallow  any  of  the  odontodol. 

OILS. — These  are  liquids  or  solids,  generally 
of  a  greasy  or  fatty  character,  often  distin- 
guished by  a  peculiar  odour,  more  or  less  vis- 
cosity, insolubility  in  water,  and  affinity  for  the 
most  volatile  solvents.  These  bodies  occur  in  the 
three  kingdoms  of  Nature,  but  vary  so  much  in 
their  properties  that  no  general  definition  can 
apply  to  them  all.  In  fact,  the  word  "  oil "  is 
merely  a  conventional  term  which  is  often  mis- 
applied to  substances  entirely  foreign  to  the 
group  of  true  oils. 

Oils  are  most  conveniently  divided  into  three 
classes — namely,  mineral,  fixed,  and  volatile 
oils,  though  these  terms,  when  strictly  inter- 
preted, partly  overlap  each  other.  However, 
custom  has  drawn  the  limits  of  each  so  sharply 
that  there  is  no  probability  of  any  confusion 
arising. 

Mineral  oils  are  usually  hydrocarbons  de- 
rived from  the  carboniferous  deposits  of  former 
geological  ages,  the  most  familiar  representa- 
tive of  which  is  petroleum.  This  is  itself  a 
most  complex  body,  but  it  interests  us  here 
only  so  far  as  its  oily  character  or  its  oily  con- 
stituents are  concerned.  Crude  petroleum  con- 
tains a  number  of  substances  which  are  very 
volatile  and  the  removal  of  which  causes  the 
residue  to  assume  more  and  more  an  "  oily 
character."  This  is  particularly  shown  by  the 
fact  that  when  a  portion  of  this  residue  is 
dropped  on  blotting  paper  the  oily  stain  re- 
mains for  a  long  time.  Mineral  oils  are  all 
more  or  less  volatile,  the  boiling  point  increas- 
ing with  their  density.  Their  chief  character- 
istic is  that  they  can  not  be  saponified. 

Mineral  oils  or  fats — the  latter  term  being 
applied  to  those  of  a  more  or  less  solid  consist- 
ence— are  largely  employed  in  medicine,  par- 
ticularly as  vehicles  for  remedial  agents. 
Very  carefully  purified  fractions  of  American 
or  Russian  petroleum  (liquid  vaseline,  albo- 
lene.  etc.) — entirely  free  from  odour  or  taste — 
are  used,  for  instance,  in  spraying  the  throat 
or  nasal  passages.  The  unctuous  residue,  left 
on  distilling  off  the  more  volatile  fractions 
from  petroleum,  when  properly  purified,  is 
extensively  used  as  an  ointment  or  ointment 
base  under  the  name  of  petrolatum,  or  vaseline, 
and  crude  petroleum  itself  is  still  in  consider- 
able use  for  embrocations,  particularly  in  do- 
mestic practice.     It  also  constitutes   one  of 


OINTMENTS 
OLEIC  ACID 


32 


the  most  eiHoient  parasiticides  when  freely  ap- 
plied to  the  infested  parts. 

Fixed  oils  are  derived  from  the  animal  and 
vegetable  kingdoms.  These  bodies  are  usually 
compound  ethers  (esters)  of  glyceryl  and  one 
or  more  of  the  so-called  fatty  acids.  The  most 
commonly  occurring  fatty  acids  are  stearic, 
palmitic,  and  oleic.  The  more  oleic  acid  an 
oil  contains,  the  more  fluid  it  is  at  the  ordi- 
nary temperature,  and  the  less  liable  it  is  to 
congeal  when  cooled.  The  preponderance  of 
palmitic,  and  still  more  so  of  stearic  acid, 
causes  the  oil  to  be  semisolid  or  solid.  When 
fixed  oils  are  heated  with  water  and  an  alkali, 
the  fatty  acids  combine  with  the  latter,  and 
the  glyceryl,  CsHb,  is  converted  into  glyc- 
erin, CaH5(6H)3,  a  portion  of  the  water  being 
consumed  in  the  reaction.  This  is  called  sa- 
ponification. When  a  portion  of  a  fixed  oil  is 
dropped  on  blotting  paper  it  leaves  a  greasy 
stain  which  does  not  evaporate  when  heat  is 
applied. 

Volatile  oils  are  derived  almost  exclusively 
from  the  vegetable  kingdom.  They  may  be 
subdivided  into  hydrocarbon  oils,  oxygenated, 
sulphuretted,  and  nitrogenated  oils.  The  hy- 
drocarbon oils,  or  terpenes,  mostly  have  the 
composition  CioHio.  Oil  of  turpentine  (recti- 
fied) is  a  type  of  this  class.  Among  the  oxy- 
genated oils  there  are  many  possessing  a  highly 
aromatic  odour,  which  is  chiefly  due  to  the 
oxygenated  constituent.  Most  of  them  are  not 
simple  bodies,  but  consist  of  several,  one  of 
which  is  very  often  a  terpene,  and  this  is 
usually  not  the  bearer  of  the  odour.  Exam- 
ples of  oxygenated  oils  are  oil  of  cinnamon, 
cloves,  peppermint,  wintergreen,  etc.  The  sul- 
phuretted oils  contain  sulphur,  and  possess  a 
pungent,  disagreeable  odour  and  taste.  Exam- 
ples are  oil  of  garlic  and  oil  of  mustard.  In  the 
case  of  mustard  the  volatile  oil  does  not  pre- 
exist in  the  plant,  but  is  formed  by  the  action 
of  water  on  the  constituents.  Nitrogenated 
oils  are  those  which  contain  the  group  CN, 
cyanogen.  Such  are  oil  of  bitter  almonds,  oil 
of  peach-kernels,  etc.  In  these  the  cyanogen 
compound  is  likewise  formed  only  after  the 
kernels  have  been  macerated  with  water. 

Fixed  oils  are  obtained  either  by  melting 
or  heating  the  substances  containing  them  or 
by  pressure,  with  or  without  heat.  Volatile  oils 
may  all  be  obtained  by  distillation,  usually  in 
a  current  of  steam,  which  enables  them  to  be 
volatilized  at  a  temperature  far  below  their 
own  boiling  points.  Some  of  them  may  also 
be  extracted  by  mechanical  means,  in  the  cold, 
such,  for  instance,  as  the  oils  of  orange,  lemon, 
and  bergamot,  which  are  thus  obtained  of  a 
much  finer  flavour  than  would  be  possible  by 
distillation. — Charles  Rice. 

OINTMENTS.— These  are  fatty  prepara- 
tions, softer  than  cerates,  and  intended,  as  a 
rule,  to  be  applied  by  inunction.  Some  of 
them,  however,  are  preferably  spread  on  some 
fabric  and  applied  in  this  manner.  They  con- 
sist either  altogether  of  fatty,  or  a  combination 
of  fatty,  resinous,  .waxy  substances,  etc. ;  or 
else  of  a  mixture  of  these  with  some  active 
medicinal  ingredient. 


Ointments  of  a  compound  nature  are  made 
either  by  melting  the  ingredients  together  or 
by  incorporating  them  mechanically;  in  one 
case  (unguentum  hydrargyri  nitratis)  also  by 
the  aid  of  a  chemical  reaction.  In  combining 
the  ingredients  of  an  ointment  by  fusion,  as 
low  a  degree  of  heat  should  be  used  as  will 
accomplish  the  object,  and,  unless  the  con- 
stituents are  by  nature  perfectly  and  homo- 
geneously diffusible  into  each  other  (such  as 
oils  with  lard  or  suet,  resin  with  lard,  etc.),  the 
mixture  must  be  stirred  while  cooling,  to  pre- 
vent the  separation  of  one  or  another  of  the 
ingredients.  When  a  solid  insoluble  in  the 
fatty  base  is  to  be  incorporated  it  should  be  in 
the  state  of  finest  powder.  This  should  first 
be  rubbed  with  a  small  portion  of  the  oint- 
ment base  until  a  perfectly  smooth  paste  is 
formed,  after  which  the  remainder  of  the  base 
may  be  incorporated.  When  solid  extracts 
(for  instance,  extract  of  belladonna  or  of 
stramonium)  are  to  be  mixed  with  an  oint- 
ment base,  they  should  first  be  rendered  semi- 
fluid by  trituration  with  water  or  diluted 
alcohol,  as  the  case  may  require. 

On  a  small  scale,  ointments  are  best  prepared 
by  trituration  or  rubbing  on  a  mai'ble  slab  or 
glass  plate  with  a  flexible  spatula  or  an  oint- 
ment trowel,  since  the  degree  of  homogeneity 
and  the  absence  of  gritty  particles  can  be  best 
seen  when  the  ointment  is  spread  and  drawn 
to  and  fro  in  thin  layers  across  the  surface. 
Mortars  are  not  so  suitable,  since  only  a  small 
portion  of  the  mass  will  be  acted  on  by  the 
face  of  the  pestle  at  a  time,  while  the  re- 
mainder will  be  forced  up  on  the  sides  of  the 
mortar  and  the  stem  of  the  pestle.  Very 
smooth  ointments  may  be  produced  by  em- 
ploying a  mechanical  mill,  such  as  that  used 
by  manufacturers  of  paints  and  colours.  For 
operations  on  a  small  scale,  one  of  the  best  oint- 
ment mills  is  that  made  by  Liebau,  of  Chemnitz, 
Germany. 

The  ointment  bases  most  generally  in  use 
are  lard,  mixtures  of  a  bland  oil  with  wax, 
spermaceti,  resin,  etc.,  mixtures  of  suet  and 
lard,  etc.,  wool-fat  in  its  various  forms,  and 
unctuous  substances  derived  from  petroleum. 
These  bases  must  Vie  perfectly  bland  and  neu- 
tral— that  is,  free  from  fatty  acids  (the  cause  of 
raticidity)  and  other  irritating  constituents. 
It  is  customary  to  impregnate  lard  and  other 
fatty  substances  used  in  ointments  with  certain 
preservative  agents,  usually  benzoin,  to  pre- 
vent or  retard  the  change  which  produces  the 
rancidity. 

Sometimes  the  bland  ointment  base  is  used 
by  itself  for  inunction,  the  object  being  merely 
to  exclude  the  air  from  the  skin,  without 
using  any  specific  medication.  Usually,  how- 
ever, ointments  are  mixtures  of  fatty  bases 
with  medicinal  substances  which  are  intended 
either  to  act  purely  topically^that  is,  on  the 
surface  to  which  they  are  applied  ;  or  topically 
and  f)hysiologicalIy — that  is,  by  absorption  into 
the  circulation. 

The  more  affinity  an  ointment  base  exhibits 
toward  water,  the  more  easily  will  it  be  ab- 
sorbed by  the  skin ;  and  the  more  it  repels 
water,  the  less  probably  wDl  it  be  absorbed. 


33 


OINTMENTS 
OLEIC  ACID 


The  hydrocarbon  fats  (petrolatum,  vaseline, 
etc.)  belong  to  the  latter  class.  Wool-fat 
(which  consists  chieiJy  of  the  cholesterin  ether 
of  glyceryl)  in  any  of  its  commercial  forms, 
such  as  lanolin,  adeps  lanffl  hydrosus,  etc.,  is 
the  best  representative  of  the  former.  Indeed, 
lanolin  is  so  readily  absorbed  by  the  skin  that 
an  insoluble  substance,  such  as  zinc  oxide,  with 
which  it  is  mixed,  is  apt  to  remain  as  a  dry 
crust  on  the  skin  some  time  after  the  oint- 
ment has  been  applied.  By  combining  wool- 
fat  with  other  fats  in  proper  proportion  its 
rate  of  absorption  may  be  retarded  at  will. 

Professor  tJnna  has  introduced  a  method  of 
applying  ointments  to  the  skin  in  the  form  of 
soft  plasters,  termed  "  ointn.ent-muUs  "  {Sal- 
ben-mull),  that  is  an  absorbent  fabric  (absorb- 
ent gauze)  on  which  the  ointment  is  spread 
under  certain  precautions.  These  mulls  may 
be  prepared  in  the  following  manner : 

A  piece  of  parchment  paper  larger  than  the 
piece  of  gauze  or  mull  is  wet  and  spread  upon 
a  level  surface,  and  all  superfluous  water 
wiped  off.  The  piece  of  absorbent  fabric 
(mull)  is  now  fastened  upon  it  with  pins  or 
tacks,  and  the  ointment,  which  must  be  but 
slightly  warm,  is  spread  upon  it  as  uniformly 
as  possible  with  a  flat  brush  at  least  three 
inches  in  breadth.  The  surface  is  then 
smoothed  rapidly  by  means  of  an  elastic  spat- 
ula which  is  immersed  in  hot  water,  quickly 
wiped,  and  drawn  across  the  ointment.  It  is 
best  to  put  several  spatulas  at  once  into  the 
hot  water,  so  as  to  lose  no  time  after  the  first 
one  has  cooled.  When  the  ointment  has  been 
smoothly  spread,  one  edge  of  the  fabric  is  at- 
tached to  a  straight  stick,  and  the  whole  piece 
detached  from  the  paper,  covered  with  paraf- 
fin, and  hung  up  for  a  few  hours  in  a  cool 
place,  when  it  may  be  rolled  up.  For  use,  a 
suitable  piece  is  out  off.  applied  to  the  affected 
part,  covered  with  paraffin  paper,  and  secured 
by  a  bandage  or  otherwise. — Charles  Rice. 

OLEANDEE..— See  under  Neriom. 

OLEATES.— See  under  Oleic  acid. 

OLEIC  ACID.— Pure  oleic  acid,  when  fresh, 
is  a  colourless  liquid  of  an  oily  consistence, 
without  odour  or  taste,  and  possessing,  in  al- 
coholic solution,  a  neutral  reaction.  It  is  very 
easily  oxidized  when  exposed  to  the  air,  turns 
brown,  and  acquires  an  acid  reaction  and  a  ran- 
cid odour.  When  cooled,  it  congeals  to  a  white 
crystalline  mass  which  becomes  liquid  again 
at  57°  P.  This  substance  is  of  interest  rather 
to  the  chemist  than  to  the  physician  or  phar- 
macist, yet  it  is  the  chief  constituent  of  the 
commercial  oleic  acid,  which  is  used  in  medi- 
cine. 

■The  oleic  acid  of  the  pharmacopoeias,  aci- 
dum  oleicwm,  is  obtained  in  the  process  of  de- 
composing fats,  as  carried  out  in  various 
technical  operations  (such  as  the  manufacture 
of  stearic  acid,  candles,  etc.).  It  is  the  acid 
derivative  of  olein,  a  widely  distributed  fatty 
ether  of  glyceryl,  which  is  fluid  at  ordinary 
temperatures,  and  the  presence  of  which  in  a 
mixture  of  fats  causes  the  latter  to  be  more 
fluid  than  would  otherwise  be  the  case.  The 
liquid  removed  by  pressure  from  stearic  acid, 


in  candle-works,  is  technically  called  red  oil, 
is  of  a  deep  red-brown  colour,  and  has  a  pe- 
culiar, disagreeable,  fatty  odour.  It  contains, 
besides  real  oleic  acid,  a  considerable  quantity 
of  stearic  acid  and  often  some  of  the  interme- 
diate fatty  acid  (such  as  raargaric).  To  free 
it  as  far  as  possible  from  these,  it  is  carefully 
cooled  to  about  39°  P.,  so  as  to  cause  the  ste- 
aric and  margaric  acids  to  solidify ;  the  mix- 
ture is  then  subjected  to  gradually  increasing 
pressure  in  suitable  bags,  and  the  liquid  por- 
tion repeatedly  treated  in  the  same  manner 
until  there  is  no  longer  any  sign  of  congela- 
tion on  cooling  the  liquid. 

Oleic  acid  of  a  lighter  tint,  and  more  easily 
freed  from  the  solid  fatty  acids,  may  be  ob- 
tained by  decomposing  an  olive-oil  soap  (Gas- 
tile  soap)  by  sulphuric  acid,  treating  the 
separated  fatty  acids  by  cold  and  pressure,  as 
just  described,  and  washing  the  liquid  residue 
with  warm  water.  It  may  be  obtained  in  a 
still  purer  condition  by  combining  the  product 
thus  obtained  with  oxide  of  lead,  dissolving 
the  warm  oleate  of  lead  in  10  parts  of  benzin, 
and  decomposing  this  solution  by  diluted  hy- 
drochloric acid.  On  evaporating  the  benzin, 
the  oleic  acid  will  be  left  behind. 

It  is  stated  that  commercial  oleic  acid  is 
very  commonly  adulterated  with  linoleic  acid 
(from  linseed  oil),  which  has  different  proper- 
ties. The  presence  of  even  1  per  cent,  of  this 
may  be  detected  by  treating  the  saponified  oil 
with  permanganate  of  potassium,  which  con- 
verts oleic  into  azaleinic  acid,  while  linoleic  is 
converted  into  sativic  acid.  On  decomposing 
the  soap  with  a  mineral  acid,  and  treating  the 
separated  fatty  acids  with  ethei',  the  azaleinic 
acid  will  dissolve,  but  the  sativic  will  not. 

Oleic  acid  is  used  in  medicine  only  as  a  ve- 
hicle or  solvent  of  certain  remedies.  Some  of 
these  are  intended  to  be  absorbed,  while  others 
are  not.  The  vehicle  itself,  however — that  is, 
the  oleic  acid — is  quite  easily  absorbed  by  the 
skin,  much  more  so  than  a  neutral  fat. 

Oleic  acid  is  a  good  solvent  of  alkaloids  and 
of  many  metallic  oxides,  such  as  oxide  of  mer- 
cury, copper,  zinc,  etc.  On  triturating  these 
substances  with  some  of  the  oleic  acid  so  as  to 
bring  every  particle  in  contact  with  the  liquid, 
and  then  macerating  or  digesting  for  some 
time,  complete  solution  may  be  effected.  In 
preparing  the  so-called  "  oleates  "  in  this  man- 
ner, the  intention  is  to  have  an  excess  of  oleic 
acid  present  in  which  the  real  chemical  com- 
pound, the  true  oleate,  is  kept  in  solution  or 
with  which  it  is  mixed.  The  oleates,  prepared 
in  this  manner,  which  are  in  more  than  ephem- 
eral use  are  the  following : 

Oleatum  hydrargyri  (U.  S.  Ph.),  made  by 
dissolving  30  parts  of  oxide  of  mercury  in  80 
of  oleic  acid.  For  use,  this  is  often  diluted 
with  oleic  acid,  so  as  to  reduce  the  percentage 
of  oxide  of  mercury  to  15,  10,  or  5  per  cent.,  or 
even  less. 

Oleatum  verairinm  (U.  S.  Ph.),  which  con- 
tains 2  per  cent,  of  veratrine. 

Oleatum  zinci  (unofBcial),  of  5,  10,  and  more 
per  cent. 

Oleatum  atropine  (unofBcial),  of  1,  3,  or 
more  per  cent. 


OLEORESINS 
OPIUM 


34 


Oleate  of  aconitine  was  at  one  time  praised 
as  a  very  efficient  agent  in  neuralgia,  but  has 
been  found  too  risky  for  general  use. 

True  oleates  may"  be  prepared  by  double  de- 
composition between  the  solution  of  an  oleic- 
acid  soap  and  the  solution  of  a  metallic  salt. 
The  resulting  precipitate,  for  instance,  oleate 
of  lead,  of  copper,  of  bismuth,  etc.,  when  thor- 
oughly washed  and  dried,  is  usually  in  the 
form  of  a  dry,  hard  mass  or  in  dry  powder. 
These  oleates  are  either  used,  by  themselves, 
as  dressings,  or  are  combined  with  fatty  bases, 
and  applied  as  ointments. — Charles  Rice. 

OIiEOKESIITS.  —  As  the  name  implies, 
these  are  compounds  of  oils  and  resins.  The 
word  "oil  "  in  this  connection  is  to  be  taken 
in  the  sense  of  "  volatile  oil."  In  pharmacy 
the  term  is  applied  to  preparations  made  from 
vegetable  drugs  containing  an  essential  oil 
ancl  a  resin  which  are  medicinally  active,  more 
particularly  such  as  are  of  a  pungent,  spicy 
character. 

Oleoresins  may  be  prepared  by  various  vola- 
tile menstrua,  such  as  benzin,  ether,  chloro- 
form, etc.,  but  ether  is  the  one  usually 
employed,  as  it  is  the  easiest  to  be  removed  from 
the  product  without  leaving  its  own  taste  be- 
hind. 0  wing  to  the  volatility  of  the  menstruum, 
it  is  preferable  to  employ  some  form  of  appa- 
ratus which  will  prevent  too  great  a  loss  of 
ether  by  evaporation.  This  is  best  accom- 
plished by  connecting  the  percolator  in  which 
the  exhaustion  of  the  drug  by  ether  is  effected 
air-tight  with  the  receiver,  establishing  a  com- 
munication between  the  air-spaces  of  the  two 
vessels  by  a  separate  connection  (tubing).  As 
fast  as  the  ether  percolates  through  the  drug 
and  drops,  loaded  with  dissolved  matters,  into 
the  receiving  vessel  below,  the  air  displaced  in 
the  latter  is  transferred  to  the  percolator.  In 
the  manufacture  of  oleoresins  on  a  large  scale 
special  precautions  are  taken,  by  means  of 
suitable  condensers,  to  diminish  the  loss  of 
ether  to  a  minimum. 

The  oleoresins  which  are  official  in  the  U.  S. 
Ph.  are  the  following : 

Oleoresina  aspidii,  formerly  called  oleo- 
resina  filicis  (oleoresin  of  aspidium  or  male 
fern ;  very  commonly  called  simply  "  oil  of 
male  fern  ").  This  is  prepared  by  exhausting 
the  green  parts  of  the  rhizome  of  male  fern, 
previously  powdered,  with  ether.  From  the 
percolate  the  greater  part  of  the  ether  is  re- 
moved by  distillation  on  a  steam-bath,  and  the 
residue  is  then  exposed  to  the  air  until  the  re- 
maining ether  has  evaporated. 

This  oleoresin  has  the  peculiar  property  of 
gradually  depositing  a  granular-crystalline 
precipitate  which  consists  of  filicic  acid,  the 
most  active  principle  contained  in  the  drug. 
Ignorant  pharmacists  are  apt  to  regard  this  as 
an  inert  matter,  such  as  will  often  form  in 
tinctures  containing  pectin  bodies,  and  they  are 
anxious  to  get  rid  of  it  by  filtration  or  other- 
wise. In  the  present  case  the  sediment  should 
be  carefully  incorporated  with  the  liquid  por- 
tion before  any  of  the  oleoresin  is  removed  for 
use. 

Oleoresina  capsici,  oleoresin  of  capsicum,  is 


prepared  in  the  same  manner.  When  the 
ether  is  finally  evaporated  a  considerable 
amount  of  a  waxy  substance  will  be  found 
mingled  with  the  liquid  oleoresin.  In  order 
to  get  rid  of  this,  it  is  best  not  to  evap- 
orate until  all  traces  of  ether  vapour  are 
gone,  as  the  mixture  will  then  usually  be  too 
thick  to  be  strained.  If  it  is  strained  while 
yet  just  sufficiently  liquid,  the  waxy  constitu- 
ent may  be  completely  separated. 

Oleoresin  of  capsicum  is  the  most  concen- 
trated pharmaceutical  preparation  of  the  drug, 
and  must  be  employed  with  caution.  It  is 
used  externally,  spread  in  a  thin  layer  upon 
adhesive  plaster  as  a  rubefacient.  For  internal 
use  it  must  be  largely  diluted  with  other  sub- 
stances. 

Of  the  other  official  oleoresins,  that  of  cubeb 
is  employed  in  making  troches  or  pastils  of 
cubeb.  The  remaining  ones — viz.,  those  of 
lupulin,  pepper,  and  ginger — are  but  little  in 
use. — Charles  Rice. 

OLEUM  CADINTJM  (U.  S.  Ph.)— Oil  of 
cade  (see  under  Tar). 

OIiIBAN"D'M,  or  frankincense,  thus  ameri- 
canum  (Br.  Ph.),  is  a  gum-resin  which  enters 
largely  into  the  composition  of  incense,  on  ac- 
count of  its  yielding,  when  burning,  a  fragrant 
odour.  In  medicine  it  has  essentially  the  same 
effects  upon  the  respiratory  mucous  membranes 
as  the  other  gum-resins  and  may  be  substituted 
for  balsam  of  Peru  and  balsam  of  Tolu  in  the 
treatment  of  bronchitis,  etc.  The  fumes  aris- 
ing from  its  slow  combustion  or  those  furnished 
by  exposing  it  to  heat  are  recommended  in 
chronic  bronchitis  and  laryngitis,  on  account  of 
their  slight  stimulant  effects.  Combined  with 
charcoal,  saltpetre,  and  a  little  gum,  it  forms 
pastils  which  are  sometimes  burned  to  disguise 
unpleasant  odours  in  sick-rooms,  etc.  The  dose 
of  olibanum  ranges  from  15  to  60  grains,  and 
it  is  recommended  to  combine  with  it  a  little 
soap,  which  is  believed  to  add  to  its  activity. 
Russell  H.  Nevins. 

OLIVE  OIL,  or  sweet  oil,  oleum  olivce 
(U.  S.  Ph.,  Br.  Ph.),  oleum  olivarum  (Ger.  Ph.), 
is  a  bland  oil  obtained  by  expression  from 
the  fruit  of  the  Olea  europcea,  a  native  of  the 
countries  bordering  upon  the  Mediterranean 
but  cultivated  in  nearly  all  the  semi-tropical 
countries  of  the  world.  It  is  almost  entirely 
without  odour,  has  a  sweetish  taste,  and  is 
yellow  or  greenish-yellow  in  colour,  the  oil  of 
the  latter  colour  being  the  most  delicate  and 
highly  prized,  but  rarely  met  with  outside  of 
the  regions  in  which  it  is  produced.  Varieties 
less  commonly  met  with  are  dark-coloured  and 
are  used  almost  exclusively  in  the  manufacture 
of  soap,  plasters,  etc.  When  exposed  to  the  ac- 
tion of  the  air  and  light,  olive  oil  rapidly  be- 
comes rancid,  assumes  a  darker  colour,  and 
acquires  an  unpleasant  taste  and  odour.  After 
its  exposure  to  a  temperature  slightly  below 
that  of  freezing  it  solidifies  into  a  mass  of 
about  the  consistence  of  soft  butter,  and  at 
slightly  higher  temperatures  is  apt  to  become 
turbid  on  account  of  the  separation  of  small 
particles  of  palmatin  and  stearin.    This  con- 


35 


OLEORESIKS 
OPIUM 


dition  often  leads  to  the  suspicion  that  the 
sample  has  been  sophisticated,  but  slight  agi- 
tation and  warmth  will  cause  the  oil  to  be- 
come perfectly  clear.  When  kept  in  tightly 
closed  vessels  it  will  remain  sweet  for  long 
periods ;  but  when  once  exposed  to  the  air  it 
should  be  used  at  once  or  kept  in  a  very  cool 
place,  such  as  a  refrigerator.  It  is  more  than 
probable  that  little  of  the  olive  oil  consumed 
outside  of  the  countries  in  which  it  is  made  is 
free  from  adulteration,  but  the  only  important 
adulterant  and  the  one  most  commonly  em- 
ployed is  cotton-seed  oil,  and,  provided  the 
latter  is  pure  and  sweet,  the  principal  objec- 
tion which  can  be  urged  against  the  sale  of 
the  sophisticated  article  is  that  it  is  a  fraud 
upon  the  consumer.  Prom  nearly  every  stand- 
point cotton-seed  oil  is  as  desirable  as  olive  oil, 
but  lacks  in  a  measure  the  delicate  flavour  of 
the  finer  grades  of  the  latter. 

Olive  oil  is  largely  used  in  pharmacy  in  the 
preparation  of  liniments,  cerates,  and  oint- 
ments, but  has  been  almost  entirely  replaced 
in  the  U.  S.  Ph.  by  cotton-seed  oil,  which  is 
equally  useful  and  much  cheaper.  For  the 
preparation  of  salads  olive  oil,  or  what  is  com- 
monly so  termed,  is  oftener  used  than  cot- 
ton-seed oil ;  but  for  all  other  purposes  in 
cooking  it  is  no  better,  although  more  expen- 
sive. For  inunction  and  for  the  protection  of 
raw  surfaces  it  is  less  suitable  than  cacao  but- 
ter or  vaseline,  as  it  becomes  rancid  very  quick- 
ly and  the  fatty  acids  developed  are  irritating 
to  the  skin.  In  all  icasting  diseases  it  forms 
a  valuable  addition  to  the  food,  as  it  may  be 
incorporated  into  salads  of  various  kinds  and 
will  not  usually  be  regarded  by  the  patients  as 
a  necessary  element  in  their  treatment.  In 
conditions  in  which  a  fatty  food  is  imperative- 
ly demanded  cod-liver  oil  is  to  be  preferred, 
for  the  reasons  mentioned  under  that  head. 
Like  nearly  all  fatty  bodies,  olive  oil  is  laxative 
and  may  be  used  as  such  in  doses  of  from  1  to 
2  fi.  oz.,  but  it  is  not  very  efficient  and  its  use 
is  almost  limited  to  children  and  infants.  It 
may  be  added  in  almost  any  proportions  to 
enemata  when  there  are  large  accumulations 
of  hard  fceees  in  the  rectum,  but,  while  it  un- 
doubtedly softens  them,  it  is  not  so  efficient  as 
linseed  oil,  which  has  in  addition  an  irritant 
effect  upon  the  rectum.  As  large  amounts  as 
can  be  taken  without  exciting  nausea  are  re- 
puted to  increase  the  quantity  and  fluidity  of 
the  bile,  and  consequently  to  be  of  use  for  the 
relief  of  biliary  calculi. 

[The  olive-oil  treatment  of  liliary  colic  is 
regarded  by  some  physicians  as  one  of  very 
great  efficiency ;  others  consider  it  of  no  value. 
The  question  must  be  regarded  as  still  unset- 
tled. Professor  Comberaale,  of  Lille  {Bull, 
med.  du  Nord,  July,  1893 ;  Oaz.  med.  de  Paris, 
Sept.  33,  1893),  who  seems  to  have  no  doubt  of 
its  value,  finds  a  similitude  between  biliary 
colic  and  lead  colic ;  hence  he  has  been  led  to 
try  large  doses  of  the  oil  in  the  treatment  of 
painters'  colic.  He  reports  four  cases  of  its 
successful  employment,  and  thinks  it  is  in 
some  respects  superior  to  other  remedies  for 
this  form  of  plumbism.] 

Russell  H.  Nevins. 


OPITIM. — It  is,  of  course,  impossible  to  de- 
tail all  of  the  countless  therapeutic  applica- 
tions of  opium.  It  will  therefore  be  the  aim 
of  the  writer  to  deal  with  the  general  princi- 
ples which  underlie  the  use  of  this  drug  rather 
than  to  summarize  all  the  detailed  uses  to 
which  it  might  be  applied.  In  the  first  place, 
its  power  to  support  life  as  a  substitute  for 
food  is  of  great  value,  as  is  also  its  power  to 
contribute  to  the  support  of  the  body  as  an 
auxiliary  to  food.  Millions  of  well-to-do,  sober, 
and  industrious  Orientals  take  their  opium 
daily  as  the  European  takes  his  wine — as  a  sort 
of  supplementary  food.  This  they  do  with  no 
more  thought  of  dissipation  than  we  have  in 
smoking  a  cigar,  and  oftentimes  with  less 
damage.  Taken  in  this  way,  indeed,  it  seems 
to  entail  no  evil  consequences,  and  it  does  not 
cause  narcosis. 

In  this  country  there  seems  to  be  an  increas- 
ing number  of  those  who  take  opium  as  most 
do  alcohol,  simply  to  remove  fatigue  or  to  add 
to  a  too  slender  food  allowance.  The  food- 
power  of  opium  is  certainly  great,  and  in  cir- 
cumstances of  privation  it  has  been  shown  to 
exist  for  horses  as  well  as  for  men.  It  is  not 
intended  to  intimate  that  opium  is  in  any  sense 
a  tissue-builder,  but  merely  that  it  serves  the 
clinical  purpose  of  making  the  lack  of  food 
less  disastrous.  It  is  of  controlling  importance 
that  one  should  bear  in  mind  the  danger  of 
forming  the  opium-habit  by  any  avoidable  use 
of  the  drug,  but  it  is  only  fair  to  admit  that 
great  benefit  has  followed  its  use  in  cases  of 
profound  enfeebtement  due  to  deprivation  of 
food,  or  loss  of  sleep,  or  fatigue  from  excessive 
exertion.  In  such  conditions  food  and  rest 
would  be  the  natural  restoratives  to  apply, 
but  without  question  recovery  is  more  rapid  if 
small  amounts  of  opium  are  given,  or  perhaps 
preferably  small  doses  of  morphine,  such  as 
a  fifteenth  or  a  tenth  of  a  grain.  The  only  ob- 
vious effect  of  such  doses  is  a  general  addition 
to  the  patient's  comfort  and  to  his  power  of 
repair.  It  is  extremely  important  that  large 
doses  be  not  given.  The  slightest  develop- 
ment of  narcosis,  being  followed,  as  it  invaria- 
bly is,  by  reaction,  would  be  very  harmful. 

Another  illustration  of  its  restorative  power 
is  in  prostration  from  severe  hemorrhage.  It 
is  within  the  experience  of  many  surgeons  and 
obstetricians  that  after  severe  hfemorrhage 
opium  in  full  doses  seems  to  sustain  life  until 
food  can  be  assimilated  in  a  way  superior  even 
to  alcohol.  Under  these  circumstances  both 
these  agents  are  well  borne  and  in  large  doses, 
and  seem  to  cause  no  other  effect  tlian  the 
removal  of  certain  grave  symptoms,  such  as 
rapidity  and  feebleness  of  the  heart,  restless- 
ness, delirium,  wakefulness,  etc.  Of  the  two, 
opium  is  the  more  useful  in  this  condition. 

It  is  impossible  to  say  what  the  exact  doses 
should  be ;  it  should  be  given  in  small  amounts 
and  at  frequent  intervals  until  it  produces  the 
desired  effect, but  it  is  very  important  to  avoid 
narcotism.  The  modus  operandi  is  entirely 
unknown,  but  it  is  known  that  the  induction 
of  narcotism  is  fraught  with  great  danger. 

In  hmmoptysis  which  is  at  all  profuse  opium 
is  of  value,  as  it  Is  in  all  cases  of  severe  haem- 


OPIUM 


36 


orrhage,  but  it  is  of  special  value  in  small 
bleedings  with  nagging  cough  which  seems  to 
keep  up  the  bleeding.  The  use  of  opium  dimin- 
ishes the  cough,  and  this  is  often  followed  by 
cessation  of  the  bleeding.  It  is  far  more  use- 
ful in  this  condition  than  all  the  real  and 
imaginary  styptics. 

In  the  hectic  fever  of  phthisis  it  often  gives 
great  comfort  by  relieving  the  irritating  cough 
that  is  so  distressing. 

In  hcemorrhage  from  a  typhoid  ulcer  it  is  of 
great  value,  not  only  on  the  general  principles 
above  enunciated,  but  because  it  allays  the 
patient's  apprehension  and  puts  him  at  rest, 
and  thiis  tends  to  immobilize  the  bleeding 
point.  By  this  means  the  danger  of  a  recur- 
rence of  the  bleeding  is  reduced  to  a  minimum. 
In  the  irritable  festlessness  due  to  prostra- 
tion of  prolonged  and  enfeebling  diseases,  such 
as  protracted  fever  or  suppuration,  its  effects 
are  often  highly  beneficial.  In  this  condition 
only  small  doses  are  required,  and  unless  there 
is  some  oontra-indication,  it  is  best  adminis- 
tered subeutaneously. 

Who  does  not  recognise  the  condition  ?  A 
feeble,  rapid  pulse,  great  general  weakness  and 
depression  associated  with  delirium,  muscular 
tremors,  picking  at  the  bedclothes,  a  dry, 
brown,  shaky  tongue — these  are  its  prominent 
symptoms,  and  among  them  stand  out  con- 
spicuously wakefulness  and  delirium.  The 
administration  of  from  a  tenth  to  a  quarter  of 
a  grain  of  morphine  subeutaneously  will  often 
be  followed  by  a  calm,  quiet,  restful  sleep, 
after  which  great  improvement  in  the  general 
condition  may  be  observed. 

If  diarrhcea  is  excessive  in  typhoid  fever, 
and  especially  if  it  is  associated  witli  delirium, 
we  have  a  dtjuble  indication  for  the  adminis- 
tration of  the  agent. 

It  is  a  fact,  so  far  as  I  am  aware,  without 
e.xceptions  that  there  is  absolutely  no  danger  of 
engendering  the  opium  habit  by  its  use  in  this 
latter  condition ;  and,  incidentally,  the  same 
may  be  said  with  regard  to  alcohol.  Indeed, 
these  two  agents  are  usually  to  be  used  jointly 
in  these  conditions,  and  such  use  is  likely  to 
produce  better  results  than  the  use  of  either 
alone. 

Although  the  above-mentioned  small  doses 
will  usually  be  sufficient,  the  therapeutist 
must  never  forget  that  he  is  using  opium  here 
to  accomplish  a  definite  effect,  and  that  this 
necessarily  implies  a  somewhat  indefinite  dose. 
It  must  be  given  in  divided  doses  until  it 
produces  the  effect  that  is  sought. 

It  is  extremely  important  here  again  not  to 
narcotize  the  patient. 

In  collapse  due  to  cholera  it  has  been  found 
very  beneficial.  Here,  of  course,  opium  per  os 
would  be  useless,  because  of  the  greatly  di- 
minished absorption  that  takes  place.  Its 
trial  in  this  condition  seems  to  have  been  care- 
fully undertaken  in  the  British  Seamen's 
Hospital  at  Constantinople.  A  dose  varyi  ng  be- 
tween a  quarter  and  half  a  grain  was  followed 
in  numerous  instances  by  a  quiet  sleep,  after 
which  recovery  usually  took  place.  Occasion- 
ally the  same  patient  needed  to  have  this  dose 
repeated  two  or  three  times.    There  has  been 


a  disposition  to  elevate  this  to  the  height  of  a 
method  of  treating  cholera — a  contention  for 
it  which  is  absurd.  That  certain  symptoms  of 
the  stage  of  collapse  may  be  benefited  by  it 
may  well  be  allowed. 

It  is  in  heart  disease  that  opium  achieves  its 
most  significant  modern  victory. 
.  In  speaking  of  the  general  subject  I  have 
used  the  words  opium  and  morphine  inter- 
changeably, but  I  should  like  to  be  understood 
as  havinga  decided  preference  for  morphine, 
as  a  rule,  and  as  using  this  by  subcutaneous 
injection  in  the  absence  of  contra-indieation. 

The  recommendation  to  use  morphine  in 
heart  disease  came  from  England,  it  is  a 
singularly  apt  illustration  of  the  great  benefit 
to  be  obtained  from  an  accurate  clinical  knowl- 
edge of  the  action  of  the  agent  which  no 
amount  of  laboratory  study  or  research  could 
have  rendered  possible;  and,  moreover,  it  isan 
illustration  of  the  value  of  the  subcutaneous 
injection  of  this  alkaloid  which  can  not  be  re- 
placed by  mouth  administration  of  the  same 
alkaloid  or  of  opium.  Opium  given  by  the 
stomach  is  not  suitable  in  the  distress  of  most 
forms  of  heart  disease. 

It  is  especially  in  late  stages  of  mitral  ste- 
nosis and  mitral  insufficiency  that  morphine, 
given  subeutaneously,  accomplishes  such  happy 
effects.  Here  we  see  all  the  appearances  of 
general  venous  congestion.  It  begins,  of  course, 
in  the  lungs  and  extends  thence  to  the  entire 
body,  manifesting  itself  by  cyanosis,  pallor, 
and  dropsy.  The  heart  may  be  unduly  active, 
even  tumultuous  in  its  effort  to  overcome  the 
mechanical  impediment  to  the  circulation,  and 
the  patient  may  be  slowly  suffocating  in  con- 
sequence of  the  inability  of  the  blood  to  convey 
the  needed  oxygen  to  "the  tissues.  Anything 
at  all  approaching  narcosis  would  further  ag- 
gravate the  existing  congestion  and  general 
distress.  But  a  non-narcotic  dose  of  morphine, 
given  subeutaneously,  has  a  totally  different 
effect.  An  eighth  of  a  grain  or  double  that 
amount  seems  to  restore  the  disturbed  balance 
in  the  circulation,  and  most  of  the  distressing 
symptoms  are  thus  ameliorated.  The  face  be- 
comes less  turgid,  the  expression  calmer,  the 
precordial  distress  disappears,  the  pulmonary 
congestion  abates,  the  heart  becomes  more 
tranquil  and  regular,  and  the  patient  may 
enjoy  the  refreshing  influence  of  a  tranquH 
sleep. 

The  effect  is  certainly  better  in  mitral  than 
in  aortic  disease,  and  yet  in  parallel  cases  of 
aortic  disease  we  need  not  fear  to  use  it  in  the 
same  way. 

In  angina  pectoris,  if  the  pain  is  severe,  it 
will  sometimes  yield  to  no  other  treatment, 
although  it  is  proper  first  to  try  the  arterial 
dilators  in  this  condition.  In  some  of  these 
cases  it  seems  to  exercise  a  lasting  influence 
over  the  symptoms.  In  old  cases  of  this  dis- 
tressing condition  the  severe  paroxysms  of 
pain  are  not  always  associated  with  arterial 
spasm  and  increased  arterial  tension,  and  in 
such  cases  the  use  of  the  nitrites  is  not  indi- 
cated. 

In  another  form  of  dyspnma  it  will  often 
serve  an  exceedingly  useful  purpose.    In  con- 


37 


OPIUM 


ditions  of  laryngeal  stenosis  caused  by  inflam- 
matory swelling,  by  croup,  or  by  diphtheria,  it 
will  often  cause  a  veiy  marked  subsidence  of 
the  dyspncBa  and  its  attendant  distress.  For 
a  child  a  year  old  doses  of  two  drops  of  the 
deodorized  tincture,  for  older  children  larger 
doses,  up  to  five  drops,  given  two,  three,  or 
more  times  a  day,  have  often  been  followed  by 
an  amelioration  of  the  dyspnoea  with  all  its 
attendant  symptoms  of  distress.  In  some  cases 
this  treatment  will  replace  operative  procedure ; 
in  others  it  will  enable  one  to  postpone  an 
operation.     Even  this  is  often  a  great  gain. 

In  diabetes  codeine  aTid  morphine  will  some- 
times exercise  a  controlling  influence  over  the 
amount  of  urine,  as  well  as  over  the  sugar  per- 
centage, and  many  of  the  much  more  distress- 
ing symptoms  of  this  grave  malady.  Neither 
of  these  alkaloids  should  be  administered  in 
narcotizing  doses  for  this  purpose,  and  one 
need  entertain  no  hope  of  being  able  to  cure 
the  disease  by  this  means. 

For  the  cure  of  pain  opium  is  without  a 
rival.  In  general,  it  is  better  administered  sub- 
cutaneously  for  this  purpose.  It  is  not  neces- 
sary to  narcotize  a  patient  in  order  to  cure  his 
pain ;  in  fact,  the  relief  of  pain  is  exceedingly 
common  even  without  the  production  of  sleep 
at  all. 

It  is  of  great  importance  to  give  the  small- 
est dose  that  will  accomplish  the  purpose,  for 
many  reasons.  Anything  resembling  narcosis 
is  very  objectionable  on  numerous  accounts, 
but  particularly  because  it  is  likely  to  be  fol- 
lowed by  a  condition  of  depression  which 
makes  one  distinctly  less  able  to  endure  pain.  If 
large  doses  are  used  there  is  much  more  danger 
of  establishing  the  opium-habit.  To  relieve 
pain  the  doses  to  begin  with  should  be  from  a 
fifteenth  to  a  sixth  of  a  grain  of  morphine.  If 
the  pain  is  due  to  a  chronic  condition  or  to  one 
that  is  to  recur  frequently,  it  is  exceedingly  de- 
sirable not  to  use  opium  in  its  relief  at  all,  of 
course ;  but  in  the  pains  of  acute  conditions, 
such  as  acute  inflammations,  it  is  of  immense 
value. 

Once  in  a  great  while  a  case  may  occur  in 
which  it  will  be  necessary  to  narcotize  a  pa- 
tient in  order  to  relieve  his  pain.  This  is  true 
occasionally  in  the  pain  due  to  ulcerations  of 
malignant  disease  involving  sensitive  nerves, 
as  it  also  is  in  some  of  the  painful  conditions 
due  to  pressure,  as  by  brain  tumours,  aneu- 
rysms, and  the  like.  In  these  conditions  the 
dose  must  be  indefinite,  but  it  is  to  be  dis- 
tinctly borne  in  mind  that  in  giving  large 
doses  one  is  surely  approaching  the  end  of  the 
usefulness  of  the  drug. 

It  is  of  inestimable  value  where  death  is  in- 
evitable and  imminent,  to  relieve  pain  and  rest- 
lessness. The  latter  condition  may  be  purely 
reflex,  and  the  patient  may  be  unconscious  of 
it ;  but  it  may  be  so  distressing  to  his  family 
that  one  is  justified  in  controlling  it  by  a  small 
dose  of  morphine,  administered  by  preference 
suboutaneously. 

As  a  means  of  inducing  sleep  in  many  con- 
ditions of  delirium  it  is  without  a  rival.  To 
do  this  it  is  not  necessary,  nor  is  it  proper,  to 
narcotize  the  patient.    It  is  largely  the  unjus- 


tifiable production  of  narcosis  that  formerly 
was  in  vogue  that  led  to  the  disuse  of  this 
agent  in  all  cases  of  delirium  tremens.  Sleep 
is  recognised  as  essential  to  the  cure  of  this 
condition,  and  it  the  pulse  justifies  its  uso 
chloral  is  certainly  better;  or  if  one  can  ac- 
complish the  purpose  with  any  of  the  modern 
hypnotics  it  is  certainly  better  not  to  use  mor- 
phine. Moreover,  if  the  delirium  is  very  ac- 
tive it  will  not  be  controlled  by  a  small  dose  of 
morphine ;  but  occasionally  cases  of  chronic 
alcohol  poisoning  occur,  with  great  depravity 
of  nutrition,  anaemia,  emaciation,  and  such 
feebleness  of  the  heart's  action  as  not  to  allow 
of  the  administration  of  chloral — cases  with 
persistent,  uncontrollable  insomnia  and  mild 
delirium.  Sometimes,  after  trying  the  safe 
hypnotics  in  vain,  one  is  driven  to  administer 
morphine  subcutaneously  in  this  condition. 
A  sixth,  a  quarter,  a  third  of  a  grain  will 
sometimes  succeed  when  other  agents  have 
failed.  In  general,  in  delirium  tremens  it  is 
not  so  good  as  other  agents. 

In  raving  mania,  with  active  circulation, 
small  doses  will  not  produce  sleep,  and  large 
doses  are  not  well  borne.  But,  combined  with 
hyoscine  hydrobromide  and  given  subcutane- 
ously, morphine  is  of  great  utility  in  this  con- 
dition. 

In  the  milder  delirium  of  nervous  exhaustion 
in  the  acute  fevers  small  doses  will  often  sup- 
plement in  an  admirable  way  the  supporting 
and  stimulating  treatment  that  is  most  appro- 
priate, as  has  been  already  stated. 

In  melancholia  a  few  small  doses  are  often 
most  serviceable,  as  they  also  are  in  wakeful- 
ness and  delirium  from  anssmia  of  the  brain 
after  severe  hiemorrhages. 

The  same  distinction  must  be  di-awn  in  re- 
gard to  dyspnoea.  In  dyspncea  from  respii-a- 
tory  disease  opium  narcosis  would  be  likely  to 
aggravate  the  condition,  but  that  is  no  reason 
why  a  small  dose  should  not  be  administered 
in  ironchitis,  ,0V  pneumonia,  or  pleurisy  associ- 
ated with  wakefulness  from  incessant  cough 
or  from  pain.  Indeed,  in  these  conditions 
such  treatment  is  often  highly  beneficial. 

Its  use  has  been  properly  abandoned  as  un- 
justifiable in  tetanus,  epilepsy,  and  chorea.  The 
same  is  true  of  hiccough  and  asthma. 

In  obstinate  vomiting  it  is  often  of  great 
value. 

Bright's  disease  in  general  and  urcemic  con- 
vulsions in  particular  were  formerly  regarded 
as  absolute  contra-indications  to  the  use  of 
opium  in  any  form.  Although  other  agents 
are,  without  doubt,  better  in  general,  still  it  is 
true  that  small  doses  of  morphine  will  often 
act  as  a  useful  adjunct  in  the  treatment  of 
uremic  convulsions.  No  other  agent  with 
which  I  am  familiar  is  so  useful  in  the  dyspnoea 
which  is  associated  with  the  ursemic  condition. 

In  the  treatment  of  cough  it  is  in  general 
not  a  desirable  agent. 

It  is  of  great  value,  associated  with  rest,  as  a 
means  of  averting  abortion  if  that  accident  is 
susceptible  of  being  averted  in  any  given  case. 

In  some  forms  of  inflammation  it  seems 
capable  of  opposing  the  morbid  process  in  an 
unknown  way.     Many  people  can  abort  an 


OPIUM 


38 


acute  catarrhal  attack  by  taking  a  small  dose 
of  opium  and  facilitating  perspiration. 

In  peritonitis  it  is  often  proper  to  push  it 
to  the  verge  of  the  production  of  narcotism. 
A  useful  measure  of  the  dose  is  given  by  the 
respirations,  which,  in  this  condition,  may  be 
reduced  to  the  frequency  of  twelve  a  minute. 

As  a  means  of  repressing  intestinal  secretion 
small  doses  are  of  great  value  in  the  treatment 
of  diarrhosa,  if  that  is  not  kept  up  by  the 
presence  of  irritants  in  the  intestine. 

In  dysentery  it  is  used  symptomatically  to 
relieve  the  pain  and  tenesmus.  To  cure  the 
disease  the  modern  local  treatment  is  of  in- 
comparably greater  value. 

[There  are  some  persons  who  bear  opium 
badly  under  ordinary  circumstances;  they  are 
narcotized  by  comparatively  small  doses,  or 
they  suffer  from  cardiac  weakness  soon  after 
taking  the  drug,  or  they  experience  in  an  ex- 
aggerated degree  the  unpleasant  after-effects 
that  are  not  uncommon.  This  is  due,  no  doubt, 
to  idiosyncrasy  in  the  great  majority  of  in- 
stances, but  there  seems  reason  to  attribute  it 
to  hysteria  in  some  cases.  Nevertheless,  mor- 
phine has  been  recommended  for  the  cure  of 
hysterical  anorexia.  M.  Dubois  (Progr.  med., 
Feb.  23,  1896 ;  iV.  Y.  Med.  Jour.,  March  14, 
1896)  reports  three  cases  in  which  he  used  it 
subcutaneous!  y  with  success  after  all  other 
treatment  had  failed.  He  says  that,  if  the 
morphine  is  well  tolerated,  no  inconvenience 
will  arise  from  the  employment  of  three  injec- 
tions a  day,  each  containing  i  a  grain  of  mor- 
)hine  hydrochloride,  at  intervals  of  four  hours. 
(I.  Dubois  insists  upon  the  following  points: 
1.  The  injections  should  be  given  each  day  at 
the  same  hour,  and  food  should  be  given  half 
an  hour  after  the  injections,  with  or  without 
forced  feeding.  2.  The  patient  must  be  assured 
that  the  food  will  be  retained  and  will  cause  no 
pain.  If  this  treatment,  both  physical  and 
psychical,  he  says,  is  well  directed,  in  less  than 
three  months  a  rebellious  anoi-exia  may  be 
cured.  The  strength  of  the  solution  is  dimin- 
ished from  week  to  week  until  a  final  cessation 
of  the  use  of  the  morphine  is  attained.] 

A  minute  dose  of  atropine,  a  hundredth  of  a 
grain  or  less,  seems  often  to  add  to  the  useful 
effects  of  a  small  dose  of  morphine  and  to 
diminish  its  unpleasant  effects.  It  must  not 
be  forgotten  that  among  the  effects  which  it  is 
likely  to  control  is  the  sweating,  and  therefore 
atropine  should  not  be  given  if  this  is  desired. 

Of  the  preparations  of  opium  itself  the  best  to 
use  are  the  deodorized  preparations  of  the  phar- 
macopoeia. Those  made  from  the  crude  drug 
should  be  abandoned,  as  causing  needless  sub- 
sequent discomfort  to  the  patient.  With  de- 
odorized opium,  the  deodorized  tincture,  and 
the  tincture  of  ipecac  and  opium,  practically 
we  have  all  the  preparations  that  are  neces- 
sary, if  we  except  paregoric,  which  for  the  ad- 
ministration of  minute  doses  is  of  distinct 
value.  (See  Pareqoeic.)  Laudanum  is  espe- 
cially objectionable  and  should  never  be  used. 

[In  an  article  on  the  therapeutic  abuse  of 
opium  {Jour,  of  the  Am.  Med.  Assoc.,  Jan.  25, 
1896),  Dr.  Q.  Walter  Barr,  of  Keokuk,  Iowa, 
remarks  that,  while  our  knowledge  of  pathol- 


s] 


ogy  and  physiological  action  has  long  since 
tiassed  the  point  of  the  treatment  of  symp- 
toms, yet  we  still  cling  to  this  one  drug  which 
does  most  of  its  work  in  relieving  symptoms 
only,  but  must  always  be  a  potent  agent  for 
therapeutic  good.  Chemically  and  physio- 
logically, he  continues,  opium  is  perhaps  the 
most  complex  drug  in  the  pharmacopoeia.  It 
contains  a  large  number  of  active  principles 
which  have  been  isolated,  and  a  number  more 
that  are  probably  present  in  the  crude  drug, 
although  it  is  maintained  that  they  are  merely 
products  of  chemical  manipulation.  It  may 
also  contain  some  that  have  not  yet  been  iden- 
tified as  cheraipal  entities  by  laboratory  re- 
search. It  seems  a  little  strange,  says  Dr. 
Barr,  that,  with  the  present  tendency  to  pre- 
scribe the  use  of  the  drugs  uncombined  with 
others,  so  many  active  principles  should  be  so 
often  prescribed  at  once  under  the  title  of 
opium.  That  the  combination  of  so  many 
principles  has,  by  virtue  of  the  correlation  of 
physiological  forces,  a  dynamic  action  of  its 
own,  is  obvious  :  that  this  action,  he  says,  can 
not  be  prognosticated  with  much  certainty  is 
proved  by  the  large  number  of  eases  of  alleged 
idiosyncrasy.  That  opium  is  of  great  thera- 
peutic value  is  maintained  at  the  outset ;  that  it 
is  overrated  is  also  contended. 

When  the  natural  polypharmacy  of  opium 
itself  is  avoided,  says  the  author,  its  most  ac- 
tive constituent,  morphine,  is  nearly  always 
resorted  to.  The  effects  of  morphine  upon  the 
secretions,  upon  metamorphosis,  and  upon  the 
disposal  of  waste  products  are  exactly  what  is 
not  desired  in  most  cases  of  disease.  Yet  mor- 
phine is  usually  chosen  to  produce  certain  ef- 
fects upon  the  nervous  system  without  regard 
to  its  energetic  action  in  other  directions.  Dr. 
Barr  regards  codeine  as  for  many  purposes 
preferable  to  morphine.  He  is  thoroughly 
satisfied  that  it  does  not  produce  bad  habits, 
even  in  highly  sensitive  neurotics,  and  that  it 
acts  with  little  energy  upon  the  digestive  tract 
and  the  heart.  As  a  cardiac  stimalant,  mor- 
phine, he  says,  acts  quickly  and  energetically, 
but  the  after-depression  which  always  comes 
after  its  use  may  be  avoided  by  using  strych- 
nine, nitroglycerin,  caffeine,  digitalis,  or  even 
atropine,  in  the  proper  dose.  To  use  opium  or 
morphine  for  a  condition  of  nervous  excita- 
tion and  exalted  reflexes  is,  in  many  cases,  says 
Dr.  Barr,  like  stunning  a  refractory  patient 
with  a  club.  Valerian,  hyoscyamus,  and  the 
bromides  will,  he  thinks,  generally  give  better 
therapeutic  results  of  greater  permanence,  and 
with  less  risk. 

It  is  in  those  diseases  of  the  digestive  tract 
which  are  commonest  in  summer,  says  Dr. 
Barr,  that  opium  does  the  most  harm.  Close 
observation,  he  says,  must  drive  the  physician 
to  the  conclusion  that  very  rarely  indeed  is 
opium  indicated  in  the  treatment  of  diarrhoea. 
This  affection  usually  needs  some  drug  which 
increases  the  excretory  functions,  and  thus 
drives  out  of  the  body  something  which,  by  its 
presence,  is  producing  the  flux  from  the  bowel. 
Opium  temporarily  relieves  the  chief  symp- 
tom at  once,  and  when  its  influence  has  sub- 
sided and  the  disease  still  persists  the  condition 


39 


OPIUM 


is  called  a  relapse  or  a  new  attack.  Dr.  Barr 
admits  tiiat  opium  has  a  real  value  therapeu- 
tically in  certain  inflammations,  in  great  pain, 
in  rare  forms  of  diarrhcea,  as  a  splint  for  the 
intestines,  and  in  some  other  conditions. 

The  usual  dose  of  opium,  cither  in  its  crude 
form  or  in  powder,  opii  pulvis  (U.  S.  Ph.),  for 
an  adult  is  1  grain,  and  the  maximum  under 
ordinary  circumstances  is  3  grains  ;  not  more 
than  7  grains  should  be  given  in  the  course  of 
twenty-four  hours.  Young  children  are  singu- 
larly susceptible  to  opium,  and  the  dose,  it  the 
drug  is  to  be  used  at  all  for  infants  should  be 
minute.  Dr.  Samuel  0.  L.  Potter  (Handb.  of 
Mat.  Med.,  Pharm.,  and  Therap.)  reminds  us 
that  a  single  minim  of  laudanum  has  killed  a 
child  a  day  old,  and  that  a  medicinal  dose 
given  to  a  nursing  mother  has  proved  fatal  to 
her  infant.  The  dose  of  opium  for  a  child  a 
year  old  should  not  exceed  ^-^  of  a  grain,  and 
even  this  should  be  given  with  caution.  If 
opium  is  given  to  children  less  than  a  year  old, 
some  dilute  preparation,  such  as  paregoric, 
should  be  selected,  and  great  caution  observed 
that  the  dose  directed  is  so  small  at  iirst  as  to 
contain  but  an  infinitesimal  amount  of  opium  ; 
indeed,  in  the  case  of  very  young  infants  it  is 
safer  not  to  use  opium.  The  aged,  too,  are 
very  susceptible  to  opium,  and  with  them  the 
ordinary  doses  should  be  materially  reduced. 
Besides  these  considerations  of  age,  idiosyn- 
crasy should  not  be  forgotten  ;  there  are  some 
persons  in  whom  even  a  small  dose  of  opium 
or  morphine  produces  alarming  depression, 
and  so  it  is  apt  to  do  in  the  case  of  hysterica] 
women.  Hence,  in  prescribing  opium  for  a 
given  individual  for  the  first  time,  it  is  prudent 
to  order  only  very  small  doses,  and,  as  a  gen- 
eral rule,  somewhat  smaller  doses  should  be 
prescribed  for  women  than  for  men.  The 
doses  of  opium  and  those  of  its  United  States, 
British,  and  German  official  preparations  that 
are  given  internally  are  as  follows : 


Ph.,  Br.  Ph.),  is  occasionally  employed  as  an 
anodyne  plaster.  Care  should  be  taken  that 
it  be  not  applied  over  a  part  denuded  of  epi- 
dermis. The  same  is  to  be  said  of  opium  lini- 
ment, linimentum  opii  (Br.  Ph.).  For  the 
imguentum  gallm  cum  opio  (Br.  Ph.),  see  under 
Galls.  Sydenham's  laudanum,  vinum  opii 
compositum  (Pr.  Cod.),  is  practically  the  same 
as  vinvm  opii.  For  lead-and-opium  wash,  see 
under  Lead,  p.  577. 

Morphine,  morpMna  (U.  S.  Ph.).  and  its 
salts — the  acetate,  morpMnmacetas  (U.  S.  Ph., 
Br.  Ph.),  the  hydrochloride,  morphince  hydro- 
Moras  (U.  S.'Ph.,  Br.  Ph.),  morphinvm  hy- 
droMoricum  (Ger.  Ph.),  and  the  sulphate, 
morphinm  sulphas  (U.  S.  Ph..  Br.  Ph.) — are 
practically  of  the  same  strength.  The  proper 
initial  dose  is  from  J  to  J  of  a  grain. 

A  fl.  drachm  of  iirjedio  morphince  hypoder- 
mica  (Br.  Ph.)  contains  4^-  grains  of  acetate  of 
morphine  (formed  from  the  hydrochloride  by 
the  action  of  the  acetic  acid  used  in  its  prepara- 
tion). The  dose,  by  subcutaneous  injection,  is 
from  1  to  5  minims.  The  dose  of  liquor  mor- 
phinm acetatis  (Br.  Ph.),  by  the  mouth,  is  from 
10  to  60  minims. 

The  dose  of  liquor  morphince  hydrochloratis 
(Br.  Ph.),  by  the  mouth,  is  from  10  to  60  min- 
ims. The  trochisci  morphince  (Br.  Ph.)  con- 
tain each  -^  ot  a.  grain  of  the  hydrochloride. 
Prom  1  to  6  lozenges  may  be  given  at  a  dose. 
The  trochisci  morphince  et  ipecacuanhce  of  the 
U.  S.  Ph.  contain  the  sulphate ;  those  of  the 
Br.  Ph.,  the  hydrochloride.  From  1  to  6  may 
be  given  at  a  dose.  The  suppositoria  mor- 
phince of  the  Br.  Ph.  contain  each  ^  a  grain  of 
the  hydrochloride.  The  suppositoria  mor- 
phinm cum  sapone  (Br.  Ph.)  contain  the  same 
amount  of  the  morphine  salt  along  with  glyc- 
erine of  starch,  powdered  starch,  and  curd  soap. 

The  dose  of  pulivs  morphinm  compositus 
(U.  S.  Ph.),eontaming  the  sulphate,  is  from  7  to 
10  grains.    A  solution  of  sulphate  of  morphine 


For  an  adult. 


For  a  chilli  a  year  old. 


Acetum  opii  (U.  S.  Ph.) 

Covfeciio  opii  (Br.  Ph.) 

Exlractum  opii  (U.  S.  Ph.,  Br.  Ph.) 

"    (Ger.Ph.) 

"  "    liquidwm  (Br.  Ph.) 

Opii  ptdms  (U.  S.  Ph.)  ) 

Opium  (U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.)  V 

Opium  deocforatum  (U.  S.  Ph.)  ) 

FHulce  opii  (U.  S.  Ph.) 

Pulvis  ipecaeuan/iw  et  opii  (U.  S.  Ph  )  I       Dover's  powder . . . . 
"  "  opiatus  (Ger.  Ph.)  f "   ■""  i" 

"      (ypii  compositus  (Br.  Ph.),  which  is  not  Dover's  powder  . 

Tinctura  opii  (U.  S.  Ph.,  Br.  Ph.) 

"  "    ammoniata(JiT.Ph.) 

"  "    benzoica  (Ger.  Fh.) 

"  "    camphorata  (U.  S.  Ph.) 

"  "    (Tocate  (Ger.  Ph.) 

"  "    cleodoratiiV.  8.  Ph.) 

'*  "    simplex  (Ger.  Ph.) 

"        ipecaeuanJuz  et  opii  (U.  S.  Ph.) 

Trochisci  glyeyrrhioB  et  opii  (U.  S.  Ph.)  I 

opiJCBr.  Ph.)  i 

Timm  opii  (U.  S.  Ph.,  Br.  Ph.) 


10  to  IB  drops. 
5  "  20  grains. 

i  grain. 

1      •' 
10  "  40  minims. 

1  grain. 

1  pill. 
10  grains. 

2  "    5      " 

5  "  40  minims. 

i  "    1  fl.  dr. 
200  minims. 

1  "    4  fl.  dr. 
20  minims. 

B  "    4 

12       " 
10        " 

1  lozenge. 

10  minims. 


J  to   ^  drop. 
I  "    I  grain. 

A     " 

A     " 
5        H  minim. 

sV  grain. 

Not  to  be  used. 

i  grain. 
Ate   J     " 
J  "    1  minim. 

1  "    2  minims. 

6 

2  "    8 

I  minim. 
4  "   1     " 
J     " 
i     " 
Not  to  be  used. 
5  minim. 


The  enema  opii  of  the  Br.  Ph.  consists  of  -J 
a  fl.  drachm  of  laudanum  and  3  fl.  oz.  of  mu- 
cilage of  starch,  the  whole  to  be  administered 
at  once  by  injection  into  the  rectum.  The 
official  opium  plaster,  emplastrum  opii  (U.  S. 


containing  16  grains  to  the  fl.  oz.,  commonly 
known  as  Magendie's  solution  of  morphine, 
was  formerly  official,  and  is  still  much  used. 
The  dose,  by  subcutaneous  injection,  is  from  3 
to  7  minims. 


OPIUM 


40 


Another  salt  of  morphine,  the  biraeoonate, 
figures  in  the  liquor  morphi7iCB  bimeconatis  of 
the  Br.  Ph.,  the  dose  of  which,  by  the  mouth, 
is  from  5  to  40  minims. 

The  dose  of  codeine,  codeina  (U.  S.  Ph.,  Br. 
Ph.),  is  from  j-  to  1-J  grain  ;  that  of  the  phos- 
phate, codeinum  phosphoricum  (Ger.  Ph.),  is 
the  same.  Not  more  than  7  grains  of  codeine 
should  be  given  in  the  course  of  twenty-four 
hours  (cf.  Codeine).] 

Toxicology. — In  its  toxioological  relations 
opium  is  of  great  practical  importance,  be- 
cause it  is  one  of  the  commonest  of  all  the 
poisons  and  is  everywhere  easily  accessible. 
Moreover,  its  poisonous  properties  are  well 
known  to  the  laity.  Thus,  either  under  its 
own  form  or  in  the  form  of  a  morphine  salt, 
it  is  a  frequent  cause  of  death,  both  by  murder 
and  by  suicide. 

It  is  said  by  Taylor  to  have  been  the  cause 
of  five  hundred  and  forty  deaths  in  England  in 
five  years. 

The  fatal  dose  of  opium  can  hardly  be  defi- 
nitely stated — i.  e.,  the  smallest  fatal  dose. 
Even  large  doses  produce  very  uncertain  ef- 
fects under  different  eiroumstanees.  Thus,  a 
large  dose  may  be  promptly  vomited  and  may 
in  this  way  fail  to  be  absorbed ;  or  following 
the  ingestion  of  a  large  dose  and  the  absorp- 
tion of  a  certain  amount  of  it,  one  effect  of  the 
drug  then  may  be  to  retard  the  absorption  of 
the  rest,  and  in  this  way  the  total  effect  of 
the  large  dose  may  be  less  than  would  have 
been  expected. 

Individual  susceptibility  to  the  poisonous 
efllects  of  opium  diilers,  as  is  the  case  also  with 
regard  to  its  therapeutic  efEects.  Thus,  two 
persons  of  similar  weight  and  health  may  be 
poisoned  to  very  different  extents  by  the  same 
dose ;  and,  again,  of  two  persons  who  may 
seem  to  present  the  same  degree  of  poisoning. 
the  same  depth  of  coma,  etc.,  one  will  die  and 
the  other  get  well  under  exactly  similar  con- 
ditions as  to  treatment. 

This  latter  observation  is  equally  true  in 
disease:  it  is  often  impossible  to  say  why  one 
man  dies  and  another  does  not  in  conditions 
of  acute  disease. 

Besides  these  causes  of  uncertainty  as  to  a 
minimum  fatal  dose,  treatment  becomes  a  dis- 
turbing element  in  determining  this  point,  for 
it  may  in  any  given  case  modify  the  natural 
course  of  the  symptoms  and  prevent  a  fatal 
issue. 

Probably  the  smallest  fatal  dose  of  which 
we  have  satisfactory  knowledge  is  2-J  grains 
of  the  extract,  which  may  be  said  to  be  the 
equivalent  of  4  or  5  grains  of  opium.  One, 
3,  and  3,  drachms  of  laudanum  have  killed, 
and  4  an  ounce  of  the  latter  preparation  has 
often  proved  fatal. 

It  is  stated,  even  in  recent  editions  of  good 
text-books,  that  cases  have  occurred  in  which 
the  subcutaneous  administration  of  so  small 
an  amount  as  ^  of  a  grain  of  a  morphine 
salt  has  caused  death.  These  cases  are  alluded 
to  briefly,  in  edition  after  edition,  quoted  by 
author  after  author,  without  any  one  appar- 
ently giving  himself  the  trouble  to  trace 
them  to  their  origin  and  ascertain  whether 


they  are  well  observed  and  well  recorded,  and 
especially  whether  all  possibility  of  other  con- 
tributing factors  has  been  excluded  in  assign- 
ing the  causes  of  death. 

It  is  probably  true  that  -J-  a  grain  of  a  mor- 
phine salt  has  caused  death ;  it  is  probably 
untrue  that  any  smaller  quantity  has  done  so. 
On  the  other  hand,  recovery  has  occurred, 
without  vomiting,  after  the  ingestion  of  55 
grains  of  opium,  and  after  6  ounces  of  lau- 
danum, which  contained  285  grains. 

In  two  cases  recovery  is  known  to  have  oc- 
curred from  8  ounces  of  laudanum,  although 
the  patients  were  untreated  for  hours. 

Infants  are  easily  poisoned,  and  indeed  a 
large  pei'centage  of  opium  deaths  is  contrib- 
uted by  children  under  five  years  of  age.  One 
explanation  offered  of  this  fact  is  that  in  child- 
hood the  brain  is  proportionately  larger  than 
in  adult  life  and  that,  as  opium  probably  acts 
only  upon  the  central  nervous  system,  it  thus 
can  operate  more  powerfully  upon  children. 

It  i.s  stated  on  excellent  authority  that  the 
death  of  a  child  four  years  of  age  was  caused 
by  a  single  grain  of  Dover's  powder.  It  is 
perhaps  not  unlikely  that  this  preparation 
may  be  sometimes  carelessly  compounded,  so 
that  the  ingredients  are  unevenly  mixed  and 
the  opium  percentage  in  a  given  specimen  may 
thus  be  higher  than  we  suppose.  It  would 
perhaps  be  safer  not  to  give  this  preparation 
to  children  at  all. 

Of  the  numerous  children  whose  deaths  have 
been  traced  to  minute  quantities  of  opium,  it 
can  be  said  that  we  have  no  testimony  as  to 
the  excellence  of  the  preparation  which  was 
used,  and  often  none  as  to  the  diseased  condi- 
tion of  the  patient  which  caused  the  adminis- 
tration of  the  drug.  In  a  child  nine  months 
old  four  drops  of  laudanum  are  said  to  have 
caused  death. 

Infants  a  few  days  old  are  said  to  have  been 
killed  by  two  drops  and  even  by  a  single  drop 
of  laudanum  ;  but  in  this  latter  case  we  are 
informed  that  the  bottle  had  been  left  un- 
corked, and  its  contents  had  presumably  be- 
come concentrated  by  evaporation. 

The  nearest  approach  to  a  vanishing  quan- 
tity as  the  cause  of  death  with  which  I  am 
familiar  is  found  in  a  case  recorded  by  Taylor, 
that  of  an  infant  four  weeks  of  age  who  is 
said  to,  have  been  killed  by  3|  minims  of  pare- 
goric which  ought  to  have  contained  only 
about  ^  of  a  grain  of  opium. 

It  is  well  to  bear  in  mind  that  under  treat- 
ment children  have  often  recovered  from  large 
doses.  Thus  a  child  nine  months  of  age  re- 
covered after  swallowing  2  drachms  of  lau- 
danum, a  quantity  that  has  often  killed  an 
adult. 

It  is  probably  safe  to  say  that,  if  a  healthy 
adult  who  is  not  accustomed  to  opium  shoulil 
take  4  grains  of  opium  or  a  grain  of  a  mor- 
phine salt,  he  should  be  carefully  watched, 
and  if  necessary  carefully  treated,"  as  having 
taken  a  quantity  which  is  on  the  border  line  of 
possibly  fatal  dosing. 

Symptoms  of  Poisoning.  —  Overpowering 
drowsmess  is  one  of  the  early  symptoms.  It 
IS  often  possible    before    the   poisoning  has 


41 


OPIUM 


become  very  profound  to  bring  about  an  in- 
stantaneous change  from  deep  sleep  to  full 
wakefulness  by  arousing  the  patient  rather 
forcibly,  but,  left  to  himself  again,  he  relapses 
into  his  former  condition. 

Contraction  of  the  pupils  is  seen  in  the 
drowsy  stage.  If  the  patient  is  kept  awake  by 
external  irritation,  he  is  likely  to  become  con- 
scious of  dryness  of  the  throat  and  thirst. 
There  is  a  distinct  disposition  to  perspire. 
The  pulse,  which  is  accelerated  by  a  small 
dose  of  opium  and  also  during  the  earlier 
symptoms  following  a  large  dose,  becomes 
rather  slow  and  full  as  symptoms  of.poisoning 
deepen. 

Respiration  becomes  steadily  diminished  in 
frequency  as  the  poison  proceeds. 

Before  consciousness  is  lost,  complaint  is 
often  made  of  a  sense  of  fulness  of  the  head, 
beginning  at  the  nape  of  the  neck. 

In  some  cases  there  is  an  early  development 
of  mental  excitement,  with  more  or  less  con- 
fusion of  idpas,  and  at  the  same  time  a  sense 
of  general  heat  which  may  be  almost  insup- 
portable may  precede  the  sweating. 

During  this  initial  stage  nausea  and  even 
vomiting  may  occur. 

The  sleep  soon  deepens  into  a  semi-coma  or 
deep  stupor  from  which  the  patient  can  still 
be  aroused,  but  with  difficulty,  and  if  he  is 
aroused  he  very  speedily  becomes  again  un- 
conscious on  being  left  to  himself. 

The  face  is  often  congested,  the  skin  gener- 
ally more  or  less  anEesthetie,  and  itching  at  the 
nose  becomes  in  some  oases  a  very  prominent 
symptom. 

All  these  symptoms  may  pass  off  without 
treatment  if  the  dose  has  not  been  very  large. 
In  case  the  dose  was  actually  a  poisonous  one, 
and  especially  if  the  stomach  was  empty  and 
the  preparation  a  soluble  one,  this  condition 
may  come  on  rapidly,  and  there  may  be  an 
intensification  of  many  of  the  symptoms. 
There  is  profound  stupor,  with  complete  mus- 
cular relaxation  and  absolute  ansesthesia.  All 
the  nerve-centres  seem  to  be  overwhelmed — 
the  medulla  oblongata  alone  continuing  to 
perform  its  function  sufficiently  for  the  main- 
tenance of  life,  but  in  a  very  imperfect  manner. 

An  evidence  of  centric  impairment  is  seen  in 
the  facts  that  emetics  are  of  no  avail  and  that 
mustard  fails  to  redden  the  skin. 

After  the  stupor  has  lasted  for  a  few  hours 
with  these  symptoms,  if  the  patient  is  not 
treated,  or  if  treatment  is  unsuccessful,  respi- 
ration becomes  slower  and  shallower,  and  the 
heart's  action,  which  was  full  and  slow,  be- 
comes rapid  and  feeble.  As  this  change  takes 
place  the  venous  congestion  of  the  face,  which 
was  caused  by  impairment  of  respiration  with- 
out much  impairment  of  heart  power,  gives 
place  to  a  ghastly  pallor  ;  the  skin,  which  was 
previously  warm,  becomes  cold  and  the  sweat- 
ing continues. 

The  pupils  have  become  tightly  and  uni- 
formly contracted  and  not  responsive. 

Death  is  caused  by  apnoea,  commonly  in 
from  six  to  twelve  hours  after  taking  the  fatal 
dose.  Convulsions  may  precede  death,  and 
may  be  said  to  be  not  uncommon  in  children. 


If  the  poisoning  is  not  fatal,  recovery  takes 
place  gradually  and  is  attended  by  great  pros- 
tration, languor,  listlessness,  disordered  diges- 
tion, and  very  often  nausea  and  vomiting, 
anorexia,  constipation,  relaxed  skin,  headache, 
and  sometimes  dysuria. 

Such  may  be  said  to  be  about  the  usual  clin- 
ical picture  from  toxic  doses  of  opium  and 
morphine,  but  it  must  be  admitted  that  cases 
occur  in  which  the  effect  of  idiosyncrasy  or  of 
habit  will  be  seen  to  modify  greatly  the  course 
of  the  symptoms. 

Of  the  symptoms  of  poisoning,  certain  ones 
may  be  said  to  be  alarming  and  to  indicate 
the  necessity  for  immediate  and  active  treat- 
ment. One  of  them  is  coma  so  deep  that  the 
patient  can  not  be  aroused,  accompanied  or  not 
by  stertorous  breathing.  The  face  may  be 
pale  and  ghastly  it  the  pulse  has  become  feeble, 
instead  of  being  suffused  and  livid,  as  it  prob- 
ably was  at  an  earlier  period  in  the  same  case. 
This  pallor  is  an  indication  that  the  heart 
power  is  failing,  and  is  a  direct  suggestion  of 
the  need  of  treatment  to  be  addressed  to  that 
organ.  At  the  same  time  the  pulse  will  be 
rapid  and  feeble,  instead  of  slow"  and  full,  as 
it  is  early  in  the  onset  of  symptoms  of  poison- 
ing. 

Another  alarming  symptom  is  great  decrease 
in  the  number  of  respirations  (below  ten  to  the 
minute),  and  the  respiratory  act  is  likely  to  be 
accompanied  by  tracheal  rales.  There  are  apt 
to  be  noted  dropping  of  the  lower  jaw  as  an 
indication  of  muscular  relaxation,  complete 
relaxation  of  the  sphincter  ani,  and  almost 
always,  preceding  death,  dilatation  of  the  pre- 
viously contracted  pupils. 

The  diagnosis  of  opium  poisoning  would 
thus  seem  to  be  easy ;  but  excellent  authorities 
believe  it  to  be  impossible  without  a  history  of 
the  taking  of  the  drug.  In  other  words,  they 
believe  that  the  diagnosis  may  be  impossible  if 
one  has  the  symptoms  only  to  guide  him. 

Cases  certainly  bear  much  resemblance  to 
some  cases  of  uraemia  and  to  some  cases  of 
alcohol  poisoning,  and  still  more  to  apoplexy. 
Indeed,  hsemorrhage  into  the  pons  Varolii  pro- 
duces all  the  symptoms  of  opium  poisoning, 
including  extreme  and  it  may  be  equal  con- 
traction of  the  pupils.  In  all  these  conditions 
there  may  be  coma,  stertorous  breathing,  slow 
respiration  and  pulse,  and  a  congested  face. 
In  opium  poisoning  we  see  contracted  pupils, 
in  alcohol  poisoning  dilated  pupils,  in  apoplexy 
often  unequal  pupils,  except  in  haemorrhage 
into  the  pons.  Moreover,  ineq^uality  of  the 
pupils  is  said  to  have  occurred  m  opium  poi- 
soning, and,  if  atropine  has  been  previously 
applied  locally — as  it  may  well  be  in  criminal 
cases  with  intent  to  deceive — the  resulting 
mixture  of  symptoms  may  be  extremely  con- 
fusing. 

Unilateral  paralysis  with  an  hypertrophied 
heart  or  with  valvular  disease  would  point  to 
brain  lesion  as  the  cause  of  the  coma. 

The  history  of  the  case  is  of  course  the  chief 
aid  to  diagnosis. 

The  presence  of  albumin  and  casts  in  the 
urine  would  point  to  uraemia,  but  would  not 
necessarily  exclude  opium ;  moreover,  it  must 


OPIUM 


42 


be  borne  in  mind  that  there  is  ample  clinical 
evidence  that  the  urine  may  promptly  become 
highly  albuminous  in  ordinary  apoplexy  or 
even  in  cases  of  traumatic  intracranial  hasraor- 
rhage,  although  the  kidneys  may  have  been 
previously  healthy. 

The  smell  of  alcohol  in  the  breath  or  of  the 
various  ethers  that  occur  in  spirits  may  be 
misleading,  for  the  patient  may  have  taken 
both  these  poisons  in  overdoses.  The  smell 
of  opium  might  be  a  help,  but  there  is  no 
odour  to  morphine. 

The  detection  of  morphine  in  the  urine 
might  help  greatly,  but  in  ordinary  eases  it  is 
not  practicable  to  resort  to  this  aid  to  diag- 
nosis. 

Erection  of  the  penis  is  an  unusual  symptom, 
but  when  it  occurs  in  coma  it  points  to  opium 
poisoning. 

The  time  of  the  onset  of  cerebral  symptoms 
varies  considerably  even  in  fatal  cases,  and 
this  has  an  important  bearing  on  jurispru- 
dence. The  patient  may  be  able  to  perform 
intelligent  acts  two  or  three  hours  after  swal- 
lowing a  fatal  dose,  but  generally  symptoms 
begin  in  from  half  an  hour  to  an  hour.  The 
length  of  time  that  elapses  before  the  devel- 
opment of  symptoms  depends  upon  the  rapidi- 
ty with  which  the  toxic  dose  has  been  absorbed, 
and  this  is  dependent  upon  the  form  in  which 
it  is  taken,  whether  fluid  or  solid,  and  upon 
the  condition  of  the  stomach  as  to  its  being 
empty  or  not  when  the  poison  is  taken. 

Even  after  hours  of  absolute  stupor  the  pa- 
tient may  sometimes  be  aroused  and  become 
rational,  and  ultimately  relapse  into  coma  and 
die  in  spite  of  energetic  treatment. 

A  case  is  recorded  in  which  an  ounce  and  a 
half  of  laudanum  was  taken.  After  more  than 
nine  hours  of  coma  the  patient  rallied,  his  face 
became  natural,  his  pulse  grew  steady,  his  pow- 
er of  swallowing  returned,  he  recognised  the 
bystanders,  and  in  a  thick  voice  gave  an  ac- 
count of  the  accident.  This  state  lasted  sev- 
eral minutes.  He  then  relapsed  into  profound 
coma  and  died  after  the  lapse  of  about  five 
hours. 

I  have  been  roundly  abused  by  a  patient 
whose  life  I  was  trying  to  save  by  the  usual 
means  of  treatment  because  they  were  disturb- 
ing to  him,  and  he  preferred  to  be  left  to  him- 
self in  his  enjoyment  of  the  effects  of  the 
poison ;  and,  in  spite  of  my  persistence  with 
ample  assistance  to  relieve  me,  I  have  seen  him 
relapse  into  a  condition  of  coma  and  die  from 
gradual  failure  of  heart  power,  although  we 
kept  him  breathing  regularly.  Although 
death  generally  occurs  in  from  six  to  twelve 
hours,  in  rare  cases  it  has  taken  place  in  five, 
three,  two  hours,  and  in  one  case  in  three 
quarters  of  an  hour.  In  this  latter  instance  a 
soldier  had  swallowed  an  ounce  of  laudanum 
and  died  in  convulsions. 

On  the  other  hand,  death  is  sometimes  post- 
poned, usually  by  the  effects  of  treatment, 
from  fifteen  to  twenty-four  hours.  Generally, 
it  may  be  said  that  if  patients  survive  twelve 
hours  and  recover  from  the  stupor  they  ulti- 
mately get  well,  but  this  is  not  always  the 
case.    In  case  of  recovery  it  may  be  several 


days  before  all  the  symptoms   have    disap- 
peared. 

Prom  what  has  been  said  it  may  be  inferred 
that  the  prognosis  in  any  given  case  is  ex- 
ceedingly difficult  to  make  with  certainty,  and 
it  may  often  be  impossible ;  and  from  this  the 
logical  inference  is  that,  no  matter  how  grave 
the  symptoms  are,  treatment  should  never  be 
suspended  until  the  heart  has  ceased  to  beat. 

Treatment. — If  the  patient  is  seen  early 
enough  to  justify  the  hope  that  some  of  the 
poison  may  still  be  in  the  stomach,  that  vis- 
cus  should  be  emptied.  If  the  symptoms  are 
not  already  very  pronounced  it  is  safe  enough 
to  administer  an  emetic.  For  this  purpose 
mustard  followed  by  copious  draughts  of  warm 
water  is  perhaps  the  best.  Apomorphine  may 
be  given  subcutaneously  if  the  coma  is  not 
profound ;  but  if  it  is,  the  inference  is  justified 
that  the  vomiting  centre  is  not  likely  to  re- 
spond to  any  emetic,  and,  furthermore,  when 
it  has  failed  to  act  under  these  circumstances, 
apomorphine  has  seemed  to  aggravate  an  ex- 
isting condition  of  collapse.  The  irritant  emet- 
ics should  not  be  administered  if  there  seems 
any  likelihood  that  they  may  not  operate,  un- 
less there  is  the  means  at  hand  of  removing 
them  from  the  stomach  in  case  of  their  failure 
to  act.  This  means  is  the  stomach-pump  or  gas- 
tric siphon ;  and,  if  this  is  at  hand,  it  is  far 
better  to  use  it  at  once  than  it  is  to  depend 
upon  any  emetic.  On  the  whole,  it  is  better, 
in  cases  in  which  one  may  be  in  doubt  as  to 
the  existence  of  the  poison  in  the  stomach,  to 
give  the  patient  the  benefit  of  that  doubt  and 
wash  out  his  stomach.  It  is  well,  if  possible,  to 
have  the  washings  tested  until  they  no  longer 
respond  to  tests  for  morphine  before  feeling 
that  this  procedure  may  be  discontinued.  But 
it  should  be  borne  in  mind  that  solid  opium 
may  remain  in  the  stomach  in  spite  of  the 
most  energetic  and  persistent  lavage. 

It  has  been  maintained  of  late  that  symp- 
toms of  jjoisoning  may  be  aggravated  by  the 
reabsorptior.  of  morphine  which  has  been 
once  excreted  by  the  gastric  mucous  membrane, 
and  that  therefore  one  single  emptying  of  the 
stomach  may  not  be  sufficient  in  a  given  case. 
On  that  account,  perhaps,  it  is  well  to  lay 
stress  upon  the  fact  that  has  already  been 
mentioned  of  the  desirability  of  continuing  the 
process  of  lavage  as  long  as'the  stomach-wash- 
ings  respond  to  the  chemical  tests  for  mor- 
phine. 

This  proceeding  must  not  be  undertaken  if 
the  respiration  is  clearly  failing;  then  the 
most  imperative  duty  is  to  attend  to  that  func- 
tion, and  neglect  everything  else  that  might 
interfere  with  it.  It  is  plain  that  the  most 
important  thing  to  do  is  to  keep  the  patient 
breathing.  As  an  aid  to  this  end  it  is  impor- 
tant, if  possible,  to  keep  him  awake.  If  he  he- 
comes  comatose  he  ceases  absolutely  to  render 
voluntary  assistance  in  the  matter  "of  respira- 
tion, but  if  he  is  kept  awake  he  not  only 
breathes  because  he  feels  the  instinctive  neces- 
sity which  impels  him  in  health,  but  he  can 
also  be  made  to  inspire  deeply  at  command. 

Of  the  numerous  chemical  antidotes,  none 
is  avaUable  after  the  poison  has  been  absorbed, 


43 


OPIUM 


and,  unless  it  has  been  impossible  to  empty 
the  stomach,  none  can  be  said  to  be  indicated. 

Tannin  is  perhaps  the  best  of  them,  and  it 
may  be  administered  in  the  form  of  a  vege- 
table infusion,  as  in  the  shape  of  a  cup  of 
strong  tea.  It  forms  a  compound  with  the 
morphine  which  is  temporarily  insoluble,  al- 
though it  would  be  likely  to  undergo  slow 
solution  and  absorption  if  it  were  allowed  to 
remain  in  the  alimentary  canal. 

Coffee  tends  to  diminish  somewhat  the  be- 
numbing effects  of  opium,  and  is  useful  as  a 
means  of  preventing  the  onset  of  coma  and'  of 
lessening  the  severity  and  the  duration  of 
coma  which  may  already  have  come  about. 
Coffee  may  be  administered  by  the  stomach  or 
by  the  rectum,  or  by  both. 

If  it  is  possible  to  cause  the  patient  to 
walk  about  between  two  attendants,  this  may 
act  as  an  external  irritant  to  the  extent  of  pre- 
venting the  supervention  of  coma.  A  similar 
service  is  sometimes  rendered  by  any  effi- 
cient and  equally  harmless  external  irritation. 
Shaking  the  patient,  beating  him  gently  with 
a  towel  or  with  a  slipper  or  a  bundle  of 
twigs  is  often  resorted  to.  These  proceedings 
all  liave  the  object  of  keeping  the  patient 
awake,  which  has  already  been  shown  to  be 
important  in  itself. 

As  a  stimulant  to  respiration,  cold  affusions 
to  the  chest  or  the  nape  of  the  neck  are  of  de- 
cided value.  It  is  important  to  avoid  chilling 
the  patient's  surface  too  severely,  and  on  this 
account  it  is  preferable  to  use  alternate  hot 
and  cold  affusions. 

Tliese  and  all  other  means  that  are  used 
must  be  intelligently  employed.  Care  must  be 
taken  not  to  exhaust  the  patient  by  too  ener- 
getic treatment,  and  therefore  the  frequency 
and  force  of  the  pulse  must  be  closely  watched 
and  any  indications  for  treatment  by  stimulants 
carefully  observed. 

The  great  importance  of  keeping  up  the 
respiration  has  been  alluded  to,  and  certain 
means  to  that  end  have  been  mentioned.  In 
case  the  coma  is  pronounced  and  the  respira- 
tion failing,  artificial  help  to  accomplish  this 
purpose  must  be  resorted  to.  The  application 
of  the  faradaic  current  to  the  region  of  the 
phrenic  nerves  in  the  neck,  or  the  application 
of  an  electrode  over  the  ensiform  cartilage  and 
the  other  over  the  phi'enics,  seems  occasionally 
to  cause  contraction  of  the  diaphragm,  al- 
though, upon  the  whole,  this  is  likely  to  be  a 
disappointing  procedure.  The  current  need 
not  be  strong,  and  certainly  no  stronger  than 
the  operator  can  himself  bear  without  pain. 

Artificial  respiration  is  a  more  troublesome 
but  a  much  more  efficient  means  of  accom- 
plishing this  end,  and  it  should  be  performed 
with  every  precaution  to  insure  the  potency  of 
the  air-passages,  such  as  drawing  the  tongue 
forward,  etc.  It  should  not  be  too  frequent- 
ly repeated,  eighteen  times  a  minute  being 
about  as  often  as  is  desirable.  The  use  of 
atropine  in  opium  poisoning  depends  largely 
upon  its  effect  upon  the  respiratory  centre. 
The  subject  of  this  use  of  atropine  is  so  impor- 
tant and  so  generally  misunderstood  that  it  is 
proper  to  lay  stress  upon  it.  It  is  largely  used 
47 


as  the  physiological  antagonist  to  opium  in 
spite  of  the  fact  that  it  is  not,  properly  speak- 
ing, such  an  agent.  Indeed  there  is  much  dif- 
ference of  opinion  as  to  its  possessing  any 
efficacy  at  all  in  opium  poisoning,  although 
the  weight  of  opinion  is  strongly  in  favour  of 
its  usefulness  within  certain  limits. 

Atropine  is  not  in  any  proper  sense  a  phys- 
iological opponent  of  opium — i.  e.,  the  two 
drugs  are  not  possessed  of  the  power  of  causing 
exactly  opposite  effects,  nor  are  their  effects 
mutually  abrogated  by  the  employment  of 
suitable  doses.  Atropine  in  part  opposes  and 
in  part  enhances  the  action  of  opium,  as  it 
does  with  regard  to  certain  other  drugs  whose 
actions  are  complex.  Thus,  in  relation  to  cala- 
labar  bean,  atropine  opposes  the  action  of  cala- 
bar upon  the  pupil,  upon  the  spinal  cord,  and 
upon  the  respiratory  centre,  but  it  enhances 
the  effect  of  the  other  poison  upon  the  motor 
nerves  and  upon  peristaltic  activity. 

Equally  mixed  are  the  relations  between  at- 
ropine and  morphine.  They  are  synergic  in 
many  of  their  effects,  as  in  their  production  of 
motor-nerve  palsy,  sensory  aneesthesia,  spinal 
irritation,  and  cerebral  disturbance.  Even 
with  regard  to  those  organs  which  they  affect 
very  differently  in  small  doses — namely,  the 
heart  and  lungs — even  here  in  large  doses  they 
become  synergic,  and  poisoning  by  one  of 
them  may  be  'aggravated  in  regard  to  the 
heart  and  the  respiration  by  adding  the  poi- 
sonous effects  of  the  other. 

It  is  important,  therefore,  to  lose  sight  of  the 
oft-quoted  idea  of  one  of  these  drugs  being  an 
opponent  to  the  other.  This  idea  leads  to  the 
false  conclusion  that  the  effects  of  a  large 
dose  of  one  of  them  may  be  neutralized  by  a 
properly  adjusted  large  dose  of  the  other. 
Practice  founded  upon  this  theory  would  be 
likely  to  kill  patients  by  the  combined  effects 
of  the  two  poisons. 

The  real  question  to  be  an.swered  is  this:  Is 
atropine  useful  in  opium  poisoning?  It  cer- 
tainly is  of  great  value,  exactly  as  drugs  are  of 
value  in  treating  disease.  The  effects  of  opium 
poisoning  are  to  be  regarded  as  a  disease  from 
which  the  patient  is  suffering.  As  is  the  case 
with  many  other  acute  diseases,  it  may  be 
curable  if  it  is  not  too  severe,  or  it  may  be 
so  severe  as  to  prove  fatal  in  spite  of  intelli- 
gent treatment.  But  for  the  intelligent  treat- 
ment of  the  condition  it  is  important  to  get 
rid  of  the  idea  that  we  have  an  ajjent  which 
will  act  as  a  chemical  or  even  as  a  physio- 
logical antidote  to  opium  after  it  has  been  ab- 
sorbed and  has  reached  the  nerve-centres. 

Atropine  is  both  a  medicine  and  a  poison,  as 
opium  is.  Certain  of  its  medicinal  powers 
happen  to  have  a  curative  influence  over  some 
of  the  more  formidable  symptoms  of  the  opium 
disease.  Hence,  properly  used  in  that  condi- 
tion, it  may  do  much  good,  and  may  even  be 
the  principal  means  of  saving  life  ;  but  it  may 
fail  in  too  severe  a  case  to  influence  these 
symptoms  to  the  patient's  benefit.  Its  poison- 
ous effects  are  of  a  kind  parallel  with  the  worst 
symptoms  of  opium  poisoning,  and  hence  are 
especially  to  be  avoided  in  that  condition. 

How,  then,  is  it  that  atropine  does  good  ?  It 


OPIUM 


44 


is  often  answered  that  it  will  dilate  the  pu- 
pils which  have  been  contracted  by  opium; 
but  that  symptom  of  opium  poisoning  does  not 
kill,  and  it  matters  little  to  a  man  whether  he 
dies  with  a  small  pupil  or  a  big  one.  More- 
over, the  effect  of  atropine  upon  the  pupil  is 
of  no  use  as  a  guide,  even  in  the  matter  of 
dose.  Opium  contracts  the  pupil  by  a  centric 
influence;  atropine,  while  not  opposing  this 
centric  influence  in  the  least,  dilates  the  pupil 
by  its  power  over  the  periphery. 

The  valuable  and  indeed  the  essential  point 
is  that  atropine  directly  irritates  the  respira- 
tory centre,  which  has  been  more  or  less  com- 
pletely paralyzed  by  opium,  and  thus  averts 
asphyxia;  it  sometimes  actually  restores  the 
frequency  and  depth  of  the  respirations.  J3e- 
sides  this,  it  enables  the  heart  to  overcome  the 
difficulties  which  the  opium  has  imposed  upon 
it ;  it  accelerates  the  pulse  and  increases  the 
arterial  tension,  and  thus  relieves  the  condition 
of  congestion  of  important  organs  which  opium 
has  brought  about. 

As  to  doses  of  atropine  much  difference  of 
opinion  exists.  In  opium  poisoning  there  is 
a  greatly  increased  tolerance  of  belladonna. 
Doses  of  the  plant  or  its  alkaloid  which  wonld 
be  likely  to  be  fatal  under  ordinary  circum- 
stances have  been  freely  and  safely  given. 
Under  conditions  of  profound  physiological 
disturbance  there  is  in  general  an  unusual  tol- 
erance established  of  many  powerful  drugs. 
Thus,  opium  is  borne  in  enormous  doses  in 
tetanus  and  after  profuse  hasmorrhage.  It  is 
best  to  administer  atropine  subcutaneously. 
It  is  almost  impossible  to  define  the  doses 
sharply,  but  in  general  we  must  expect  to  give 
large  quantities.  We  are  guided  in  this  respect 
by  the  physiological  effect,  and  to  this  end  we 
must  watch  especially  the  clinical  results  upon 
the  respiration  and  pulse.  If  the  respirations 
rise  to  a  frequency  of  ten  a  minute,  probably 
no  further  administration  of  atropine  is  neces- 
sary. If  the  pulse  increases  in  frequency  and 
diminishes  in  force  under  its  influence,  too 
much  has  been  given.  The  state  of  the  pupils, 
as  we  have  seen,  is  absolutely  valueless  as  a 
clinical  guide,  having  no  relation  whatever  to 
the  antagonism  between  the  two  poisons  which 
is  really  of  value. 

No  direct  effect  upon  the  condition  of  coma 
is  to  be  expected — unless,  indeed,  the  atropine 
is  given  in  poisonous  doses,  when  it  will  deepen 
the  coma  due  to  morphine. 

It  is  a  matter  requiring  great  nicety  of  judg- 
ment to  determine  when  to  give  atropine  and 
how  much  to  give.  It  is  perhaps  as  good  a 
plan  as  any  to  give  it  in  every  case  in  which 
the  respirations  are  failing,  and  to  continue  to 
give  it  in  small  doses  until  distinct  improve- 
ment in  this  function  has  taken  place.  Prom 
a  twenty-fifth  to  a  fortieth  of  a  grain  may  be 
given,  to  begin  with,  subcutaneously ;  and 
every  twenty  minutes  the  smaller  of  these 
doses  may  be  repeated  until  three  or  four 
doses  have  been  given,  unless  earlier  improve- 
ment in  the  patient's  condition  renders  such 
repetition  unnecessary.  If  the  condition  of  res- 
piration is  improving,  give  no  more  atropine 
while  the  improvement  lasts.    It  must  never 


be  forgotten  that  it  is  possible  by  overdosing  to 
add  the  coma  of  atropine  to  the  coma  of  mor- 
phine. 

Very  large  doses  of  atropine  have  been  given 
without  injury  to  the  patient.  In  bad  cases  a 
grain  has  been  given  at  a  dose,  or  a  half  grain, 
repeated  in  an  hour.  Doses  of  a  quarter  and  a 
third  of  a  grain  have  often  been  given.  It  is 
far  better  to  give  smaller  doses  and  repeat 
them  at  short  intervals. 

It  is  important  to  emphasize  the  fact  that 
cases  which  were  apparently  desperate  have 
ended  in  recovery  under  active  and  intelligent 
treatment.  I  have  several  times  seen  patients 
recover  whose  respirations  were  as  infrequent 
as  four  in  the  minute. 

Within  the  last  few  years  much  has  been 
written  of  potassium  permanganate  as  an  anti- 
dote to  morphine ;  and  thei-e  is  reason  to  be- 
lieve that,  if  the  two  agents  are  placed  in  the 
stomach  together,  the  former  may  oxidize  the 
latter  and  alter  it  chemically  so  as  to  interfere 
with  its  action.  But  there  seems  at  present 
no  good  reason  to  believe  that  the  permanga- 
nates can  affect  the  course  of  the  poisoning 
after  the  morphine  has  been  absorbed  into  the 
circulation. 

Chronic  Opium  Poisoning. — Chronic  poi- 
soning, or  "opium  eating,"  is  a  very  common 
vice  in  the  East,  and  is  probably  becoming  of 
more  frequent  occurrence  here.  In  China  it 
has  long  been  a  national  evil  and  has  more 
than  once  necessitated  legislation,  and  led  to 
foreign  warfare,  without,  however,  any  real 
tendency  toward  its  suppression.  Thus,  in  a 
town  of  a  million  and  a  quarter  inhabitants 
nearly  eight  thousand  pounds  of  opium  are 
consumed  a  month.  Formerly  it  was  taken 
either  by  the  stomach  or  by  inhalation,  as  in 
smoking,  but  of  late  years  the  worst  victims 
of  this  drug  that  we  see  here  are  those  who 
have  learned  to  take  it  subcutaneously. 

In  the  Bast  there  is  open  and  deliberate  in- 
dulgence in  opium  as  a  matter  of  luxury,  just 
as  there  is  in  regard  to  whisky  and  tobacco 
with  us.  Mohammedans  use  opium  largely 
because  the  Koran  forbids  the  use  of  alcohol. 
With  us  and  in  Europe  a  large  majority  of  the 
victims  of  this  habit  have  acquired  it  as  the 
result  of  having  to  use  the  drug  for  medicinal 
purposes — or,  in  other  words,  they  owe  their 
misfortune  directly  or  indirectly  to  some  doc- 
tor. Deliberate  indulgence  in  opium  and  de- 
liberate formation  of  the  habit  of  indulgence 
in  it  are  comparatively  rare  with  us,  although 
perhaps  less  rare  than  they  were  a  generation 
ago,  before  we  had  learned  opium  smoking 
from  our  Chinese  immigrants. 

These  facts  should  make  us  extremely  cau- 
tious in  recommending  or  administering  mor- 
phine, especially  subcutaneously. 

It  should  never  be  forgotten  that,  if  it  is 
once  acquired,  the  habit  of  taking  morphine 
subcutaneously  is  harder  to  bi-eak  than  any 
other  of  the  opium  habits.  Like  all  habits 
which  depend  upon  self-indulgence,  it  most 
easily  fastens  itself  upon  people  of  weak  and 
vacillating  character,  especially  upon  sufferers 
from  insomnia  or  from  chronic  pain.  These 
reasons  should  prevent  our  using  this  drug  in 


45 


OPIUM 


the  treatment  of  chronic  disease  if  it  is  possi- 
ble to  avoid  it. 

In  general,  the  effect  of  chronic  opium  tak- 
ing may  be  said  to  be  an  interference  with 
digestion,  followed  by  malnutrition,  ansemia, 
emaciation,  and  later  failure  or  perversion  of 
power — physical,  menial,  moral — and,  if  the 
habit  is  continued  and  increasing  doses  are 
taken,  as  is  usually  the  case,  comparatively 
early  death. 

In  aggravated  cases  the  patients  are  emaci- 
ated and  shrivelled,  with  a  sub-icteric  hue,  and 
are  apt  to  suffer  from  a  variety  of  nervous 
symptoms.  They  are  feeble  in  mind  and  char- 
acter as  in  body.  They  complain  of  vertigo, 
headache,  insomnia,  and  neuralgia;  they  are 
fanciful  and  discontented,  peevish  and  irrita- 
ble. They  manifest  failure  of  memory,  intelli- 
gence, energy,  and  will ;  and  they  are  especially 
prone  to  be  untruthful  about  their  opium  in- 
dulgence. 

Taking  it  by  the  stomach  is  especially  likely 
to  disorder  digestion,  while  those  who  take  it 
by  injection  or  by  smoking  are  likely  to  be 
able  to  do  so  without  as  much  impairment  of 
appetite  or  digestion. 

Those  who  indulge  in  opium  commonly  take 
but  little  interest  in  the  parallel  vices,  namely, 
those  of  alcohol  and  tobacco ;  but  exceptionally 
an  opium  eater  of  more  than  common  energy 
is  found  who  unites  the  three  forms  of  indul- 
gence. Of  late,  too,  a  combination  between 
opium  and  cocaine  has  been  repeatedly  made 
and  with  the  most  disastrous  results.  Combi- 
nations between  opium  and  the  other  hypnot- 
ics are  becoming  very  common. 

In  spite  of  the  gravity  of  this  vice  in  its  ulti- 
mate effects,  which  I  have  endeavoured  not  to 
exaggerate,  it  is  only  fair  to  admit  that  a  per- 
sistent moderate  indulgence  in  opium  or  mor- 
phine by  people  of  regular  habits  and  good 
general  surroundings  has  often  been  shown  to 
be  possible  without  impairment  of  health.  As 
has  been  said  elsewhere,  in  the  East  millions 
of  thrifty,  well-to-do  people  use  opium  daily  as 
the  European  does  his  wine,  and  with  no  more 
thought  of  excess.  Such  moderation  in  opium 
indulgence  seems  hardly  possible  with  us,  or, 
at  all  events,  it  may  be  said  to  be  unusual. 

Opium  seems  to  have  the  same  tendency  to 
repress  secretion  when  taken  chronically  as 
when  taken  occasionally.  Chronic  opium-eat- 
ers show  this  in  the  diminished  functional  ac- 
tivity of  the  sebaceous  and  mammary  glands, 
as  also  of  the  ovary,  testicles,  and  intestines. 
Men  are  usually  rendered  impotent,  and  women 
are  apt  to  cease  to  ovulate  during  the  con- 
tinuance of  the  habit.  These  functions  are  re- 
stored if  the  patients  are  cured. 

The  amounts  which  different  people  consume 
vary  very  greatly.  It  is  not  infrequent  to  find 
the  daily  allowance  as  low  as  two  grains  or  as 
high  as  sixty. 

Among  those  who  use  morphine  subcutane- 
ously,  occasionally  an  intermittent  fever  de- 
velops whose  paroxysms  are  less  regular  than 
those  of  malarial  fever.  It  may,  however,  in 
any  given  case,  easily  lead  to  a  false  conclu- 
sion. The  absence  of  malarial  organisms  and 
the  impotence  of  quinine  in  checking  it  serve, 


however,  to  establish  the  diagnosis.  As  in  true 
malarial  fever,  neuralgia  is  a  common  symp- 
tom also  of  this  form  of  intermittent. 

The  prognosis  of  the  opium-habit  is  very 
unfavourable  as  regards  permanent  cure ;  and 
it  is  extremely  difficult  to  treat  the  individual 
attacks,  if  one  may  so  call  them.  In  general,  it 
may  be  said  to  be  more  difficult  to  treat  in 
proportion  to  its  duration  as  a  habit.  More- 
over, if  the  patient  suffers  from  any  chronic 
painful  condition  he  seems  to  be  really  de- 
pendent upon  the  drug.  Again,  if  he  is  of 
weak  will-power  and  prone  to  yield  to  a  de- 
sire for  stimulants,  or  if  he  is  in  general  self- 
indulgent,  it  may  be  impossible  to  treat  him 
with  success. 

Treatment  may  be  said  to  be  possible  in 
three  ways.  Either  the  drug  may  be  withheld 
at  once  absolutely,  or  it  may  be  withdrawn 
rapidly,  or  it  may  be  gradually  withdrawn. 
The  exact  method  to  be  followed  must  be  de- 
termined for  each  case,  and  it  must  depend 
upon  the  patient's  general  condition,  the  size 
of  the  doses,  the  number  of  doses  that  he 
takes  in  a  day,  and  the  original  cause  of  the 
habit. 

If  he  is  in  the  habit  of  taking  a  few  grains 
of  morphine  a  day,  not  more  than  six  or  eight 
days  should  be  consumed  in  withdrawing  the 
drug  completely.  If  he  is  habituated  to  large 
amounts — 20  or  30  grains  a  day — probably 
twelve  or  fourteen  days  should  be  occupied  in 
withdrawing  the  drug. 

The  very  slow  withdrawal — spoken  of  as 
"  the  tapering-off "  process — is  not  a  good  one, 
and  is  not  likely  to  be  as  well  borne  as  the  quick- 
er method,  or,  as  it  has  been  called,  the  "  rapid 
withdrawal." 

The  sudden  withdrawal  of  the  drug — and  by 
this  I  mean  the  immediate  and  forcible  cessa- 
tion of  the  habit — is  not  a  safe  means  of  treat- 
ment in  many  cases.  Active  maniacal  delirium 
m;iy  he  caused  by  such  a  method,  and  very  se- 
rious, threatening,  even  fatal  prostration  may 
ensue.  Doubtless  with  some  few  patients 
whose  general  nutrition  is  not  much  impaired, 
whose  habit  is  not  inveterate,  and  whose  daily 
allowance  is  small,  this  method  may  be  the  best 
one  to  follow. 

Gastric  disturbance,  manifesting  itself  by 
anorexia  or  nausea  or  vomiting,  may  occur  un- 
der any  system  of  withdrawal ;  and  so  also 
may  a  rather  profuse  and  watery  diarrhoea. 

The  more  frequent  the  antecedent  relapses, 
the  more  difficult  is  the  cure. 

Patients  who  have  tried  all  three  methods 
are  said  uniformly  to  prefer  the  method  by 
rapid  withdrawal  as  being  productive  of  the 
least  pain  and  distress  to  them. 

They  are  all  apt  to  be  untruthful  as  to  the 
daily  amounts  to  which  they  are  accustomed, 
both  to  excite  surprise  in  their  attendants  and 
to  enable  them  to  secure  large  doses  in  the 
course  of  their  treatment.  Before  putting 
themselves  under  treatment  they  are  apt  to 
prime  themselves  with  large  doses.  However 
intelligent  and  apparently  in  earnest  they  are, 
they  are  apt  to  conceal  a  supply  about  them 
and  deliberately  deceive  the  doctor  while  they 
appear  to  be  improving.    Before  seriously  be- 


OPODELDOC 
OSMIO  ACID 


46 


ginning  treatment  a  patient  must  be  removed 
from  his  usual  surroundiugs  and  contact  witli 
his  friends,  for  even  these  may  also  be  party 
to  the  deceits  that  are  so  often  practised.  The 
patient's  clothing  should  Lie  searched  if  any 
suspicion  arises  as  to  his  honesty  of  purpose, 
lie  should  be  surrounded  by  good,  trusty,  in- 
corruptible attendants  who  should  not  be  di- 
rectly in  his  pay.  Daugerous  weal^ness, 
amounting  even  to  collapse,  may  ensue,  so  that 
treatment  may  have  to  be  suspended. 

The  general  treatment  should  be  supporting, 
and  stimulating  if  necessary. 

I  have  known  the  use  of  antipyrine  inter- 
nally to  serve  a  useful  purpose  in  calming  a 
patient  during  the  withdrawal  of  morphiue. 
Its  taste  is  suggestive  of  that  of  morphine, 
and  in  some  cases  may  lead  to  the  belief  that 
morphine  is  being  received. 

In  general,  they  are  weaned  from  morphine 
in  two  weeks,  but  during  this  time  they  may 
suflEer  from  insomnia,  neuralgia,  nausea,  vomit- 
ing, diarrhcEa,  and  other  symptoms  of  general 
systemic  derangement.  The  diarrhoea  usually 
requires  no  treatment;  the  other  conditions 
are  to  be  treated  upon  general  principles. 

It  is  a  good  plan  to  give  up  the  night  dose 
last  of  all.  Great  assistance  is  derived  from 
the  modern  hypnotics,  such  as  siilphonal,  trio- 
nal,  araylene  hydrate,  and  others. 

Of  all  the  drugs  upon  which  reliance  is 
placed  as  a  means  of  making  the  treatment 
less  distressing  to  the  patient,  cocaine  is  per- 
haps the  least  desirable  to  use.  It  is  extremely 
easy  to  engender  a  fondness  for  this  alkaloii 
in  these  patients,  and  the  combined  cocaine 
and  morphine  habits  are  incomparably  worse 
than  the  morphine  habit  alone. 

The  market  is  flooded  with  so-called  opium 
antidotes.  Most  of  them  are  solutions  of  mor- 
phine in  disguise.  The  patient  is  easily  de- 
ceived by  them,  because,  while  apparently 
abstaining  from  liis  di-ug,  he  feels  pretty  well, 
and  does  not  miss  it.  All  this  time  he  may  be 
taking  more  than  he  has  been  accustomed  to 
take. 

Of  twenty  "opium-habit  cures,"  including 
all  the  principal  "cures"  advertised  through- 
out the  country  examined  in  1885-86  by  the 
State  Analyst  of  iVIassachusetts,  all  but  one 
contained  morphine.  This  one  was  called  a 
"  double  chloride  of  gold,"  and,  while  it  did  not 
contain  morphine,  it  did  not  contain  even  the 
minutest  trace  of  gold,  and  would  have  been 
quite  as  worthless  if  it  had. 

One  plan  of  treatment  which  has  been  re- 
cently advocated  can  hardly  be  taken  serious- 
ly. It  is  that  by  which  codeine  is  substituted 
for  morphine ;  and  it  is  about  as  reasonable  as 
it  would  be  to  attempt  to  cure  a  man  of  a 
fondness  for  whisky  by  giving  him  brandy  in 
place  of  it.  (See  also  Paregoric  and  under 
Hypnotios.)— Geoeqe  L.  Peabody. 

OPODELDOC.  —  This  is  a  camphorated 
soap  liniment,  Knimentum  saponalo-camphora- 
tum  (see  under  Soap). 

ORANGES.— See  Aurantium. 

ORCHITIC  EXTRACT.— See  Animal  ex- 
tracts AND  JUICES, 


OREXINE  HYDROCHLORIDE,  phe- 
nyldikydrochinazoline  hydrochloride, 

^'^'j  CH,NC,nj-ICl, 
is  a  complex  derivative  ot  quinoline  that  was 
introduced  as  a  proprietary  remedy  in  18H0.   It 
occurs  in  colourless,  odourless,  lustrous  crystals 
that  have  a  bitter,  pungent  taste. 

Originally  Penzoldt  recommended  the  sub- 
stance as  an  active  stomachic  that  increased 
the  appetite  and  exercised  a  tonic  influence  on 
the  digestive  organs ;  but  subsequent  investi- 
gation showed  that  it  neither  promoted  nor  re- 
tarded digestiim,  and  that  it  exercised  no 
influence  over  the  peptonization  of  albumin. 

It  was  recommended  for  anorexia  associated 
with  aniEmia,  chronic  gastric  catarrh,  neuras- 
thenia, tuberculosis,  and  some  neuroses.  A 
number  of  physicians  have  reported  that  its 
administration  produced  eupepsia,  while  others, 
including  the  writer,  have  not  observed  any 
benefit  following  its  use.  In  doses  exceeding 
0  grains  it  has  caused  nausea,  vomiting,  colic, 
and  vertigo.  The  dose  is  from  1  to  3  grains, 
in  a  wafer,  several  hours  before  each  meal. 
Samuel  T.  Armstrong. 

ORGANIC  EXTRACTS,  ORGANO- 
THERAPY.— See    Animal    estbacts    and 

JUICES. 

ORIGANUM. — Origanum  vulgare,  the  wild 
marjoram,  was  formerly  official,  and  was  es- 
teemed as  a  diaphoretic  and  emmenagogue. 
It  has  now  fallen  into  almost  complete  disuse. 

ORPHOL. — This  is  the  copyrighted  name 
of  a  compound  said  to  contain  26-5  per  cent,  of 
/3-nai)hthol  and  73o  per  cent,  of  bismuth.  Dr. 
E.  Chaumier,  of  Tours  (Tlierap.  Woch.,  Dec.  1, 
1895),  describes  it  as  an  efficient  substitute  for 
^-naphthol  as  an  internal  antiseptic  and  as  be- 
ing free  from  the  ofllensive  odour  and  burning 
taste  of  ;8-naphthol.  He  states  that  he  has 
used  it  chiefly  in  the  diarrhmal  diseases  of 
children,  and  has  found  it  more  satisfactory 
than  other  remedies  of  its  class.  Chaumier 
alleges  that  it  is  absolutely  harmless  and  may 
be  given  to  an  infant  a  month  old  to  the 
amount  of  from  30  to  45  grains  in  the  course 
of  twenty-four  hours,  and  to  older  children  to 
the  amount  of  from  45  to  75  grains.  The 
powder  may  be  given  in  milk,  syrup,  or  honey. 

ORRIS  ROOT,  rhizoma  iridis  (Ger.  Ph.), 
is  the  rhizome  of  Iris  germanica.  Iris  pallida, 
and  Iris  florentina.  The  last-named  plant, 
which  is  the  commonest  source,  grows  in 
southern  Europe,  particularly  in  Italy,  whence 
by  far  the  largest  amounts  are  exported.  The 
root  as  found  in  pharmacy  is  denuded  of  its 
epidermis  and  is  rough,  knotted,  and  irregular. 
Its  odour  is  faint,  peculiar,  and  agreeable;  its 
taste  is  bitter  and  slightlv  acrid.  It  contains 
gum,  extractive,  resin,  fixed  oil,  volatile  oil, 
and  vegetable  fibre. 

In  large  doses  orris  root  is  a  gastro-intestinal 
irritant  and  competent  to  cause  vomiting  and 
purgation.  In  fact,  it  was  at  one  time  con- 
siderably used  as  a  cathartic  and  an  emetic. 
It  is  also  said  to  be  possessed  of  a  considerable 
diuretic  power.  At  the  present  time  it  has  no 
use  save  to  disguise  an  ofiensive  breath  and  to 


47 


OPODELDOC 
OSMIC   ACID 


provide  an  agreeable  addition  to  tooth  pow- 
ders. It  is  said  to  be  employed  in  Prance  in 
making  issne  peas,  its  odour,  its  slight  acridity, 
and  its  swelling  by  the  absorption  of  moisture 
rendering  it  suitable,  for  the  purpose.  (See 
under  Iris.) — Henry  A.  Griffin. 

ORTHINE,  otherwise  called  orthohydra- 
zine-paraoicybenzoic  acid,  seems  to  be  an  arti- 
ficial alkaloid.  The  hydrochloride,  a  white 
powder  soluble  in  water,  is  said  to  be  a  very 
powerful  antipyretic  in  daily  amounts  of  from 
4  to  8  grains.  Its  use  can  not  be  recommended 
until  further  observaiions  regarding  it  have' 
been  published. 

OBTHOCHLOROPHENOL.— See  under 
Chlokopuesols. 

ORYZA  SATIVA.— See  Rice. 

OSMIC  ACID.— The  substance  which  is 
commonly  known  as  osmic  acid  is  osmium 
tetroxide  (OSO4),  a  perosmio  acid.  Of  true 
osmic  acid  (II3OSO4),  in  the  free  state,  nothing 
seems  to  be  known.  Perosmic  acid  is  a  vola- 
tile, odouroiis,  crystalline  substance,  and  is  made 
by  the  action  of  liydroehloric  acid  on  osmium 
or  its  lower  oxides.  It  is  readily  soluble  in  al- 
cohol and  in  ether,  and  dissolves  slowly,  but 
completely,  in  water.  The  aqueous  solution  is 
at  first  colourless,  but  on  exposure  to  light  it 
darkens  and  soon  becomes  black,  the  black 
osmic  hydrate,  the  tetrahydroxide,  Os(OH)4, 
being  formed.  It  is  a  powerful  deoxidizing 
agent,  and  very  irritating  to  living  tissues, 
even  when  diluted  with  several  parts  of  water. 
When  the  acid  is  brought  in  contact  with  the 
skin  it  produces  a  severe  and  painful  eruption. 
The  vapour  of  osmic  (perosmio)  acid  acts  as  a 
violent  irritant  to  mucous  membranes,  and 
when  it  is  inadvertently  inhaled  the  eyes, 
nose,  larynx,  and  lungs  suffer.  In  small 
quantities  it  causes  increased  lacrymation, 
coughing,  and  difficulty  in  breathing,  and  in 
excessive  amounts  it  will  cause  death.  The 
poisonous  properties  of  osmic  acid  will  be  ap- 
preciated if  we  accept  Deville's  statement  that 
'•  osmium  is  the  most  deadly  poison  known,  a 
thousandth  part  of  a  grain,  diffused  through 
100  cubic  yards  of  air,  being  sufficient  to  poi- 
son all  persons  inhaling  it :  and  no  antidote 
tor  it  is  known  "  (Foster's  EncyelopcBdic  Med- 
ical Dictionary).  The  eyes  seem  to  suffer 
greatly  from  exposure  to  the  vapour  of  osmic 
acid,  a  severe  and  distressing  conjunctivitis 
resulting,  and  it  is  thought  that  vision  may  be 
permanently  impaired  by  the  deposition  of 
metallic  osmium  on  the  cornea.  Barnell  gives 
the  symptoms  of  chronic  osmic-acid  poisoning 
in  his  own  person.  He  made  about  two  hun- 
dred experiments  with  the  acid  on  animals, 
and  as  a  result  of  prolonged  exposure  experi 
enced  "  a  feeling  of  weight  and  a  sensation  of 
cold  in  the  back  extending  to  the  loins,  pain  In 
the  region  of  the  groins  and  testicles,  swelling 
of  the  inguinal  glands,  loss  of  appetite,  and 
malaise.  These  symptoms  slowly  disappeared 
when  exposure  was  discontinued"  (Reference 
Handbook  of  the  Medical  Sciences,  art.  Per- 
osmic Acid).  Raymond (/Vo^r^s  medical,  June 
27,  1874)  reports  a  case  of  apparently  acute 
poisoning  from  osmic  acid.    The  chief  symp- 


toms were  inflammation  of  the  eyes,  a  cutane- 
ous eruption,  indigestion,  diarrhoea,  and  severe 
headache,  and  finally  pneumonia,  which  ap- 
peared to  be  the  immediate  cause  of  death. 
At  the  autopsy  the  stomach  was  found  the 
seat  of  considerable  inflammatory  reaction 
along  its  greater  curvature.  A  chemical  analy- 
sis revealed  no  traces  of  osmium  (ibid.). 

Claus  has  recommended  careful  inhalations 
of  hydrogen  sulphide  as  an  antidote  to  poison- 
ing from  the  vapour  of  osmic  add,  but,  as  the 
antidote  is  a  violent  poison,  "the  remedy  may 
be  worse  than  the  disease  "  unless  great  pre- 
caution is  exercised  in  its  use. 

Osmic  Acid  as  a  Hardening'  and  Stain- 
ing Agent. — A  1-per-cent.  solution  of  this 
acid  kills  the  lower  foi'ms  of  animal  and  vege- 
table life  almost  instantly  without  distorting, 
them,  and  hardens  and  preserves  the  tissues ; 
it  is  thus  a  valuable  agent  to  the  microscopist 
in  certain  lines  of  investigation.  By  its  select- 
ive action  on  certain  tissues,  and  its  power  of 
turning  fat  black,  it  is  a  staining  agent  much 
prized  in  studying  fatty  degeneration  in  neu- 
ritis. The  inconveniences  experienced  in  the 
use  of  osmic  acid  in  microscopy  are  its  expen- 
siveness  and  the  readiness  with  which  it  dete- 
riorates on  exposure  to  light. 

Therapeutics. — Wildermuth,  in  1884,  em- 
ployed osmic  add  in  the  treatment  of  epilepsy. 
It  was  given  in  the  form  of  a  pill  containing 
-^i  of  a  grain,  and  repeated  until  the  daily 
quantity  amounted  to  j  of  a  grain.  Stekonlis 
has  alleged  great  success  from  injections  of 
15  minims  of  a  1-per-cent.  solution  of  osmic 
acid  deep  into  the  region  close  to  the  sciatic 
nerve  in  obstinate  cases  of  sciatica.  At  first 
the  injections  were  made  daily;  later,  every 
three  or  four  days  (V.  S.  Dispensatory).  Dr. 
Schapiro  (Lancet,  Aug.  13, 1887)  confirmed  the 
value  of  the  remedy  in  the  treatment  of  sci- 
atica. He  used  5  minims  of  a  solution  com- 
posed of  1  part  of  osmic  add,  40  parts  of 
glycerin,  and  60  parts  of  water.  Solis-Cohen, 
of  Philadelphia  (Med.  News,  April  6,  1889),  has 
reported  the  cure  of  an  obstinate  case  of  sci- 
atica by  injections  of  a  1-per-cent.  solution 
of  osmlo  acid.  The  injections  were  made  near 
the  nerve,  two  or  three  times  a  week ;  the  dose 
varied  from  10  to  20  minims,  and  the  treat- 
ment was  continued  about  three  weeks.  Seelig- 
niilUer,  in  1887  and  1888,  reported  the  use  of 
1  to  10-per-cent.  solutions  in  the  treatment  of 
intercostal  neuralgia.  The  injections  were 
made  deep  into  the  muscles  along  the  spine, 
and  gave  sharp  pain  at  first,  followed  later  by 
relief.  Grinevitski,  in  1888,  advised  for  mMsc«- 
lar  rheumatism  injections  of  from  8  to  20 
minims  of  a  1-per-cent.  solution  of  the  acid, 
thrown  deep  into  the  parenchyma  of  the  af- 
fected muscle  (Ann.  of  the  Univ.  Med.  Sci., 
vol.  V,  A-114,  1889).  Dr.  Carl  Schroder  em- 
ployed the  acid  in  pill  form  in  eight  cases  of 
epilepsy.  The  daily  quantity  was  about  ^  of  a 
grain.  Two  of  the  patients  showed  some  im- 
provement, and  the  six  others  appeared  to 
derive  no  benefit  from  the  treatment  (Med. 
Annual,  1891,  p.  199).  Auerbach  has  employed 
parenchymatous  injections  of  osmic  acid  with 
alleged  success  in  the  destruction  of  morbid 


OSMIUM  HYDROXIDE 
OXYGEN 


48 


growths  (Jour,  of  Laryngol.  and  RTiinol.,  June, 
1891).  Dr.  Burton  W.  Swayze  {Med.  Summary, 
Dae,  1893)  reports  three  cases  of  sciatica  favour- 
ably influenced  by  daily  injections  of  a  1-per- 
eent.  solution  of  osmic  acid. 

The  use  of  osmic  acid  as  a  therapeutic  agent, 
has  not  been  very  extensive,  as  the  references 
just  mentioned  seem  to  be  the  principal  ones 
relating  to  its  employment  in  therapeutics. 
The  results  obtained  from  it  in  epilepsy  have 
not  been  gratifying,  but  in  certain  cases  of  ob- 
stinate and  intractable  neuritis  and  muscular 
rheumatism,  in  which  a  local  stimulant  is 
needed  deep  in  the  affected  tissues,  a  weak 
solution  of  osmic  acid  seems  to  meet  the  indi- 
cations. The  solution  first  recommended  by 
Schapiro,  consisting  of  1  part  of  osmic  acid,  40 
•parts  of  glycerin,  and  60  parts  of  water,  is 
probably  the  best.  It  will  rarely  occur  that  a 
stronger  solution  than  one  of  1  per  cent,  will 
be  necessary,  although  a  10-per-cent.  solution 
has  been  injected  (SeeligmuUer).  This  seems 
to  be  unnecessarily  strong,  and  might  set  up  a 
violent  inflammation.  The  quantity  of  the 
weaker  solution,  to  begin  with,  should  not,  as 
a  rule,  exceed  5  minims,  but  this  may  be 
gradually  increased,  as  tolerance  is  estab- 
lished, to  three  or  four,  or  even  five  times  this 
amount.  It  seems  safer  not  to  employ  the 
injections  oftener  than  every  second  day,  but 
the  severity  and  duration  of  the  reaction  fol- 
lowing each  injection  will  form  the  best  guide 
for  the  frequency  of  subsequent  injections. 
An  injection  should  not  be  repeated  until  all 
tenderness  and  soreness  from  the  previous  in- 
jection have  passed  away. 

Jeremiah  T.  Eskridqe. 

OSMIUM  HYDROXIDE,  OSMIUM 
TETSOXIDE. — See  Osmic  acid. 

OUABAIN  is  a  crystalline  gluooside, 
CsgllteOiz-l-VHjO,  obtained  from  an  Abys- 
sinian arrow-poisou  which  is  a  concentrated 
extract  of  the  wood  of  Acocanthera  ouabaio,  an 
apocynaceous  tree.  Ouabain  is  said  to  be 
identical  with  strophanthin.  It  is  white,  in- 
odorous, slightly  bitter,  soluble  readily  in  al- 
cohol and  in  boiling  water,  and  slightly  soluble 
in  co-Id  water.  Ouabain  is  a  powerful  cardiac 
and  respiratory  poison.  According  to  Rondeau 
and  Gleg  (cited  by  Booquillon-Limousin),  0'031 
of  a  grain  will  kill  a  dog  weighing  twenty-six 
pounds  in  a  few  minutes.  In  minute  doses, 
never  reaching  to  daily  amounts  of  more  than 
0"015  of  a  grain,  it  has  been  given  to  children 
aEEected  with  whooping-cough,  and  a  favoura- 
ble action  has  been  noted ;  but  it  is  too  violent 
a  poison  to  be  recommended  as  a  remedy  for 
this  disease. 

OVARINE. — An  extract  prepared  from 
the  ovary  (see  under  Animal  extracts  and 

JUICES). 

OVI  ALBUMEN,  OVI  VITELLUS.— 

See  under  Eggs. 

OXALIC  ACID.— This  crystalline  acid, 
CaH204H-2Ii20,  is  a  violent  caustic  and  corro- 
sive poison,  so  violent,  indeed,  that  a  case  of 
fatal  poisoning  with  sorrel,  which  owes  its  sour 
taste  to  potassium  oxalate,  has  been  recorded 


(Hosp  Qaz.,Zmii,  1886:  U.  S.  Dispensatory, 
17th  ed.,  p.  1707).  The  minimum  fatal  dose, 
according'  to  Taylor,  is  a  drachm.  Swallowed 
dry  or  in  strong' solution,  oxalic  acid  immedi- 
ately gives  rise  to  horrible  pain  in  the  stomach 
and  oesophagus,  accompanied  by  retching.  It 
does  its  work  speedily,  and  the  corrosive  symp- 
toms soon  give  place  to  fatal  collapse.  When 
diluted  so  as  to  show  no  corrosive  action,  the 
acid  is  still  highly  poisonous,  acting  as  a  para- 
lyzer  of  the  heart. 

The  treatment  of  oxalic-acid  poisoning  is 
that  of  poisoning  with  the  other  corrosive 
acids  (see  vol.  i,  page  6).  As  this  acid  and 
some  of  its  salts  (known  as  "salt  of  sorrel" 
and  "  salt  of  lemon  ")  are  extensively  used  as 
cleansing  agents  and  to  remove  ink  stains, 
iron-rust  stains,  etc.,  and  as  the  acid  crys- 
tals are  exceedingly  apt  to  be  mistaken  for 
those  of  Epsom  salts,  oxalic-acid  poisoning 
is  of  frequent  occurrence.  The  treatment 
must  be  prompt  and  assiduous.  After  wash- 
ing out  the  stomach  with  a  siphon,  or  empty- 
ing the  organ  by  means  of  an  emetic  it  no 
siphon  is  at  hand,  chalk  or  magnesia,  mixed 
with  water,  should  be  given  freely.  If  neither 
of  these  is  readily  to  be  obtained,  lime,  in  the 
form  of  scrapings  from  a  plastered  wall,  may 
be  used.  Afterward  white  of  egg,  milk,  or 
some  like  bland  substance  maybe  employed  as 
in  poisoning  with  other  corrosives. 

For  the  toxic  paralysis  of  the  heart  which 
results  from  the  ingestion  of  solutions  of  oxalic 
acid  too  weak  to  be  caustic,  cardiac  stimulants, 
such  as  digitalis,  may  be  given,  but  there  seems 
to  be  little  hope  of  their  proving  efflcient,  in 
view  of  the  radical  destruction  worked  by  the 
poison  on  the  functional  capabilities  of  nerve 
and  muscle.  This  is  well  illustrated  in  an  arti- 
cle on  The  Action  of  Oxalate  Solutions  on 
Nerve  and  Muscle  Irritability  and  Rigor  Mor- 
tis, by  Professor  W.  H.  Howell,  of  the  Johns 
Hopkins  University  (Jour,  of  Physiol.,  vol.  xvi, 
1894,  p.  476).  In  the  action  of  oxalate  solu- 
tions upon  muscle  and  nerve,  Professor  Howell 
says,  there  are  certain  points  of  resemblance 
which  may  be  mentioned.  In  each,  the  irrita- 
bility is  quickly  destroyed,  but  the  tissue  does 
not  at  once  entirely  lose  the  structure  charac- 
teristics of  organized  matter.  This  is  made 
probable  by  the  fact  that  the  nerve-fibre  still 
shows  a  demarcation  current,  and  the  muscle- 
fibre  is  still  capable  of  undergoing  rigor  mor- 
tis. The  action  of  the  oxalates,  however,  ac- 
celerates in  each  case  the  disorganization  of 
the  living  structure  of  the  tissue ;  rigor  sets  in 
more  rapidly  in  the  muscle,  and  the  demarca- 
tion current  disappears  more  quickly  in  the 
nerve.  He  thinks  the  important  fact  brought 
out  in  his  experiments  is  that  the  action  of 
oxalate  solutions  upon  skeletal  muscle  may  be 
carried  far  enough  to  completely  destroy  its 
irritability  toward  electrical  stimulation  with- 
out injuring  or,  at  least,  destroying  its  prop- 
erty of  entering  into  the  conditions  of  rigor 
mortis. 

Oxalic  acid  is  little  if  nt  all  used  in  thera- 
peutics. In  1886  a  committee  of  the  Paris  So- 
ciety of  Therapeutics  reported  on  a  paper  in 
which  M.  Poulet  had  proposed  its  use  in  asth- 


49 


OSMIUM  HYDROXIDE 
OXYGEN 


ma,  in  daily  amounts  of  30  grains,  dissolved  in 
about  5  fl.  oz.  of  vehicle.  As  this  dose  was 
considered  dangerous,  the  committee  reported 
adversely  on  the  paper  (Gaz.  hebdom.  de  med. 
et  de  chir..  May  7,  1880).  Very  soon  an  article 
by  M.  Poulet  appeared  in  which  he  advocated 
the  use  of  the  acid  as  an  emmenagogue  and  as 
a,  remedy  for  dysmenorrhcea  (Gaz.  hebdom.  de 
med.  et  de  chir..  May  14,  1886).  He  recom- 
mended the  following  formula : 

Oxalic  acid 2  parts ; 

Warm  water 200     " 

Syrup  of  bitter-orange  peel 60     " 

A  teaspoonful  to  be  taken  every  hour. 
At  the  meeting  of  the  Society  of  Therapeu- 
tics succeeding  the  one  at  which  the  report  on 
M.  Poulet's  paper  on  the  use  of  the  acid  in 
asthma  had  been  received,  M.  Rougon  (Gaz. 
hebdom.  de  med.  et  de  chir..  May  21,  1886), 
who  had  made  the  report,  reviewed  the  subject 
of  the  advisability  of  admitting  oxalic  acid 
into  the  list  of  substances  to  be  used  medici- 
nally. He  spoke  of  its  having  been  employed 
with  favourable  results  as  a  palliative  in  eases 
of  strangulated  hernia,  but,  in  view  of  its  tox- 
icity, 45  grains  of  potafsium  binoxalate  ("salt 
of  sorrel  ")  having  killed  a  person  fifteen  years 
old,  he  thought  it  unsafe  to  employ  in  the 
doses  recommended  by  M.  Poulet.  As  a  mat- 
ter of  fact,  oxalic  ueid  has  not  come  into  use 
in  medicine,  although  oxalate  of  cerium  (see 
under  Cerium)  is  a  recognised  remedy. 

OXALIS, — Oxalis  acetosella,  or  common 
sorrel,  has  been  used  in  infusion  as  a  cooling 
drink.  As  it  contains  potassium  binoxalate, 
a  violent  poison  (see  Oxalic  acid),  its  immod- 
erate use,  either  as  a  medicine  or  as  an  ingredi- 
ent of  salads,  etc.,  is  not  wholly  free  from 
danger. 

OX-BILE,  OX-GALL,  fel  hovis  (U.  S. 
Ph.),  fel  tauri,  is  the  fresh  bile  of  Bos  Taurus, 
the  ox.  It  is  a  green  or  brownish-green,  vis- 
cid liquid  of  disagreeable  odour  and  bitter, 
nauseous  taste.  Its  composition  is  not  entirely 
known,  for  biliary  chemistry  has  thus  far 
proved  defiant  of  solution,  but  it  contains 
what  are  known  as  bile  salts  and  bile  pigments, 
as  well  as  cholesterin,  urea,  fats,  mucus,  and 
some  inorganic  salts.  Crude  ox-gall  is  not 
employed  in  medicine. 

Purified  ox-gall,  jel  bovis  purificatum  (U.  S. 
Ph.),  fel  boviimm  purificatum  (Br.  Ph.),  is 
fresh  ox-gall  purified  by  filtration  with  the  aid 
of  alcohol  and  evaporated  to  a  pilular  con- 
sistence. It  is  a  yellowish-green  mass  of  pe- 
culiar odour  and  bitter  and  sweetish  taste.  It 
is  freely  soluble  in  water  and  in  alcohol. 

Ox-gall  has  the  physiological  properties  of 
bile;  that  is,  when  in  the  intestine,  it  aids  in 
the  absorption  of  fats  and  peptones,  it  dimin- 
ishes putrefaction,  and  it  stimulates  peristal- 
sis. For  these  purposes  it  has  been  given  in 
ailments  in  which  biliary  secretion  is  thought 
to  be  deficient.  It  may  thus  be  serviceable  in 
habitual  constipation,  in  intestinal  dyspepsia, 
and  in  malnutrition  from  inability  to  properly 
digest  fatty  foods,  and  it  may  be  combined 
with  cod-liver  oil  to  aid  in  its  assimilation.  It 
is  not  a  remedy  which  is  extensively  employed, 


for  it  is  not  effective  as  compared  with  others, 
and  it  must  be  confessed  that  even  if  it  were 
effective  its  use  would  not  be  altogether  ra- 
tional, for  certainly  it  would  serve  to  palliate 
rather  than  to  cure.  Ox-gall  has  the  serious 
disadvantage,  too,  of  interfering  with  gastric 
digestion.  If  it  is  used,  therefore,  it  should  be 
at  a  time  sufficiently  remote  from  the  taking 
of  food,  and  it  is  well  to  administer  it  in  a  cap- 
sule. The  dose  of  purified  ox-gall  is  from  5  to 
10  grains. 

[Ox-gall  enemata  have  been  thought  to  be  of 
value  as  a  solvent  of  hardened  fsecal  masses  in 
cases  of  f cecal  impaction.  The  enemata  should 
be  large  and  should  be  retained  by  the  patient 
for  a  considerable  length  of  time.] 

Henry  A.  Griffin. 

OXTCtBN  is  a  chemical  element.  It  is  the 
most  active  of  electro-negative  substances. 
Under  ordinary  terrestrial  conditions  free  oxy- 
gen assumes  the  gaseous  state,  but  under  great 
pressure,  combined  with  extreme  cold,  may  be 
liquefied  and  even  solidified.  Oxygen  gas  is 
colourless,  tasteless,  and  odourless.  Its  den- 
sity is  a  little  greater  than  that  of  air,  being 
1'10563.  The  density  of  liquid  oxygen  at 
—140°  C,  under  a  pressure  of  530  atmospheres, 
is  0'9787 — that  is  to  say,  a  little  less  than  that 
of  water.  At  0°  C,  under  a  pressure  of  0'76 
metre,  a  litre  of  air  weighs  1'2930  gramme. 
Under  the  same  conditions  of  tempei'ature 
and  pressure  a  litre  of  oxygen  weighs  1"4298 
gramme.  Oxygen  is  but  slightly  soluble  in 
water,  which  at  ordinary  temperatures  will 
take  up  about  4'6  per  cent,  of  its  volume. 

Biological  Relations. — Oxygen  is  sepa- 
rated from  carbon  dioxide  in  the  atmosphere 
by  plants,  which  retain  the  carbon  and  give  off 
oxygen,  animals  complementarily  absorbing 
oxygen  and  giving  off  carbon  dioxide.  Physio- 
logically, it  is  thus  of  the  greatest  importance, 
its  free  supply  to  the  respiratory  organs  being 
absolutely  essential  to  the  maintenance  of  life. 
Entering  the  alveoli  of  the  lungs  by  way  of 
the  bronchi,  trachea,  larynx,  mouth,  and  nos- 
trils, it  unites  with  the  haemoglobin  of  the 
blood  to  form  oxy-haemoglobin,  carbon  dioxide 
being  given  off  at  the  same  time.  This  change, 
effected  in  the  capillaries  of  the  lungs,  marks 
the  conversion  of  dark,  or  venous,  into  bright, 
or  arterial,  blood.  The  volumes  of  oxygen 
and  of  carbon  dioxide  absorbed  and  given  off 
respectively  are  proportional,  being  dependent 
upon  the  chemical  and  physical  relations  of 
the  two  gases.  By  the  blood,  oxygen  is  given 
up  in  part  to  the  cruder  products  of  digestion, 
but  more  largely  to  the  fixed  tissues  by  which 
it  is  made  use  of  in  the  development  of  energy, 
combining  with  their  constituents  to  form  a 
number  of  products — nutrient,  functional,  and 
excretory.  The  final  results  of  vital  oxidation 
are  chiefly  carbon  dioxide  and  water,  although 
certain  quantities  of  urea,  uric  acid,  and  other 
products  of  the  oxidation  of  food  and  tissue 
are  excreted  without  further  reduction.  While 
the  whole  subject  is  still  obscure  and  in  dis- 
pute, it  seems  to  be  reasonably  demonstrated 
that  some  of  the  toxic  metabolins  giving  rise 
to  symptoms  of  disease  are  the  results  of  im- 


OXYGEN 


50 


perfect  oxidation.  It  is  estimated  that  about 
one  fifth  of  the  oxygen  contained  in  atmos- 
pheric air,  as  ordinarily  inhaled,  is  absorbed 
into  the  blood,  combining  with  the  haemoglobin, 
the  four  other  fifths  being  returned  to  the  at- 
mosphere in  the  expired  breath. 

Hedical'  History. — Attempts  to  use  oxy- 
gen in  therapeutics  were  made  by  Priestley, 
its  discoverer,  and  by  his  contemporaries,  of 
whom  Beddoes  has  contributed  observations 
of  the  greatest  value  to  medicine.  Prom 
Priestley's  day  to'  the  present,  oxygen  has  been 
much  abused  by  eharlautry  and  by  honest  ig- 
norance. The  name  has  a  decided  hold  upon 
the  imagination,  and  sufEerers  and  hypochon- 
driacs are  ready  to  welcome  it  as  a  Eemedy  for 
every  imagined  and  imaginable  ill.  The  facts 
that  the  inhalation  of  oxygen  produces  a  tem- 
porary exhilaration  in  almost  every  instance, 
and  that  certain  cases,  both  of  chronic  and  of 
acute  affections,  are  really  benefited  by  such 
inhalation,  render  it  easier  for  pretenders  to 
deceive  their  clients,  and  for  physicians,  igno- 
rant of  the  true  field  of  usefulne'ss  of  the  rem- 
edy and  of  its  limitations  and  dangers,  to 
deceive  themselves. 

Preparation  and  Administration. — 
Oxygen  may  be  extemporaneously  prepared 
for  medical  use  in  many  ways,  for  the  details 
of  which  chemical  treatises  may  be  consulted. 
The  best  is  by  gently  heating  in  a  suitable  re- 
tort a  mixture  of  4  or  5  parts  of  potassium  chlo- 
rate and  1  part  of  manganese  dioxide.  Purity 
of  the  ingredients  is  essential,  not  only  to 
avoid  contamination  of  the  product,  but  to 
prevent  accident  in  the  preparation.  The  gas 
as  evolved  should  be  passed  through  three 
wash-bottles  containing  water,  and  to  the  first 
of  them  should  be  added  about  i  per  cent, 
of  potassium  hy- 
droxide, and  to 
the  second  about 
i  per  cent,  of  sil- 
ver nitrate  to  ab- 
sorb any  free  acid  or  chlo- 
ri  rie  that  might  be  given  off. 
The  last  washing  snould  be 
with  pure  water.  The  ap- 
paratus designed  by  Ur. 
Wallian  is  the  best  in  the 
American  market.  The 
gas  may  be  collected  in  a 
suitable  gasometer  and 
kept  for  a  short  time,  or 
in  rubber  bags  and  used 
promptly.  Another  method 
of  preparing  it,  which  has 
come  into  vogue  within  re- 
cent years,  since  pure  hy- 
drogen dioxide  has  been 
more  readily  obtained  in 
the  shops,  is  to  allow  a  solu- 
tion of  potassium  perman- 
ganate, 8  grains  to  the 
ounce,  to  drip  slowly  into  a 
solution  of  hydrogen  di- 
oxide contained  in  a  Woolf 
bottle  or  other  suitable  re- 
ceptacle futnished  with  two  openings  for  the 
ingress  and  egress  tubes,  the  latter,  to  which 


the  mouthpiece  is  attached,  not  being  allowed 
to  pass  more  than  about  an  inch  below  the 
stopper.  A  plan  even  more  convenient  is  to 
introduce  into  a  long-necked  flask  of  about  4 
07..  capacity,  stopped  with  rubber  and  furnished 
with  an  air-tube  and  mouthpiece  (see  figure),  2 
oz.  of  the  official  solution  of  hydrogen  dioxide, 
and  pour  upon  it  an  equal  quantity  of  boiling 
water.  To  this  should  then  be  added  half  a 
teaspoonful  of  washing  soda  (sodium  carbonate) 
as  free  from  lumps  as  possible.  Oxygen  will 
be  disengaged  and  bubble  slowly  through  the 
fiuid. 

Sir  Benjamin  Ward  Richardson  believes 
what  he  terms  '•  ethereal  oxygen  "  to  be  one  of 
the  most  useful  of  his  many  contributions  to 
our  resources.  In  a  two-necked  Woolf  bottle, 
one  neck  of  which  is  furnished  with  a  delivery 
tube  and  a  valved  mouthpiece,  he  places  2  oz. 
or  more  of  "  ozonic  ether  "  (which  is  a  30-vol- 
ume  solution  of  hydrogen  dioxide  in  ether), 
pours  through  a  funnel  in  the  other  opening 
1  oz.  of  a  solution  of  potassium  permanganate 
(8  grains  to  the  ouncej,  and  then  corks  that 
opening  while  the  patient  inhales  ether  and 
oxygen  through  the  mouthpiece  (AscUpiad, 
vol.  ix,  1892,  p.  167).  He  has  also  shown  the 
usefulness  of  oxygen  as  a  carrier  of  other  va- 
pours than  ether,  such  as  ethylene,  chloroform, 
methylene,  methylal,  amyl  nitrite,  ammonia, 
iodine,  bromine,  benzoin,  turpentine,  and  vola- 
tile oils.  The  oxygen  may  be  freshly  evolved 
from  hydrogen  dioxide  in  a  flask  containing 
the  volatile  substance  on  or  in  the  dioxide 
solution,  or  a  gentle  current  of  oxygen  from 
any  convenient  reservoir  may  be  passed 
through  the  medicated  solution  into  the  in- 
haler. When  water  is  not  admissible,  the 
volatile  substance — say  iodine  or  turpentine — 
is  placed  in  a  good-sized  flask  with  a  double 
neck,  and  the  oxygen  simply  flows  over  it  on 
its  way  to  the  inhaler.  Another  method  is  to 
charge  an  elastic  receiver  with  oxygen  that 
has  passed  over  the  volatile  medicament,  and 
to  have  the  patient  inhale  directly  from  this  a 
fixed  quantity.  Clover's  (chloroform)  inhaling 
bag  and  the  cellulite  valved  mouthpiece  of 
Richardson  are  the  best  for  use  in  this  man- 
ner. A  convenient  method  for  the  adminis- 
tration of  oxygen  much  in  vogue  at  the 
present  day  is  to  store  the  pure  gas  (prepared 
from  potassium  chlorate  and  manganese  di- 
oxide, or  from  atmospheric  air,  and  properly 
washed),  or  oxygen  mixed  with  nitrogen  mon- 
oxide in  various  proportions,  in  stout  metal 
cylinders  under  greater  or  less  pressure,  ac- 
cording to  the  size  of  the  cylinder  in  which  it 
is  desired  to  hold  the  given  volume.  Under  a 
pressure  of  1,800  lbs.  to  the  square  inch,  40 
gallons  may  be  stored  in  a  cylinder  3  inches  by 
12JS  inches,  weighing  11  pounds.  It  will  have  ii 
purity  of  95  to  96  per  cent.,  being  diluted  by 
the  small  quantity  of  air  in  the  cylinder.  Pi;om 
the  cylinder  the  gas  may  be  drawn  into  rubber 
balloons  and  inhaled  (passing  through  water 
in  a  wash-bottle  on  its  way  to  the  mouthpiece), 
or  the  wash-bottle  may  be  attached  by  tubing 
directly  to  the  cylinder.  A  special  apparatus 
for  the  administration  of  oxygen  by  rectal  in- 
jection (or  insufftation)  has  been  devised.    The 


51 


OXYGEN 


writer  has  had  no  experience  with  this  method 
of  administration. 

Physiological  Effects.  — Inhaled  undi- 
luted, oxygen  causes  subjectively  a  sensation 
of  warmth  in  the  mouth  and  air-passages,  and 
there  seem  to  be  lightness  and  ease  in  respira- 
tion, sometimes  in  mental  processes  likewise. 
Objectively,  there  is  acceleration  of  the  pulse 
with  increased  hardness,  indicating  a  rise  of 
blood-pressure  from  increased  force  of  the 
cardiac  action.  Warmth  of  the  cutaneous 
surface  is  usually  observed.  The  visible  mu- 
cous membranes,  sometimes  the  cheeks  as  well, 
are  heightened  in  their  red  colour.  Sometimes 
there  is  increased  moisture  of  the  skin.  The 
respirations  are  usually  increased  in  frequency 
at  first,  but  subsequently  the  depth  increases 
and  the  number  diminishes.  If  the  inhalation 
is  continued  for  too  long  a  time,  violent  men- 
tal and  physical  excitement,  with  rise  of  tem- 
perature, may  be  produced.  This  is  marked  in 
small  animals,  such  as  the  mouse,  guinea-pig, 
cat,  and  dog  kept  in  an  atmosphere  of  undi- 
luted oxygen.  In  such  animals  death  may  oc- 
cur in  a  few  hours  and  all  the  viscera  be  found 
congested  or  inflamed.  Sucti  effects  are  not 
common  in  human  beings  inhaling  oxygen  for 
medicinal  periods,  except  in  the  case  of  sub- 
jects of  pulmonary  tuberculosis,  in  whom  in- 
creased inflammation  and  febrile  movement 
may  result  from  the  inhalation  of  oxygen,  as 
was  long  ago  pointed  out  byBeddoes.  In  the 
researches  of  Sir  B.  W.  Richardson  (Asdepiad, 
vol.  iv,  1887,  pp.  71  and  172)  concerning  the 
effects  of  oxygen  upon  lower  animals,  the 
process  of  manufacture  of  the  oxygen  used 
seemed  to  make  a  difference,  probably  due  to 
the  admixture  of  ozone  in  some  cases.  Tem- 
perature exerted  a  marked  influence,  oxygen 
at  20°  or  125°  F.  becoming  practically  a  nar- 
cotic poison.  The  range  of  temperature  most 
favourable  to  life  was  from  55°  to  90°  P.  Be- 
tween these  temperatures  and  the  extremes  be- 
fore noted  an  anaesthetic  effect  was  produced. 
The  degree  of  concentration  of  oxygen  in 
the  factitious  atmosphere  was  also  found  to 
modify  the  effect.  Life  could  be  sustained 
longer  in  an  unchanged  atmosphere  of  diluted 
oxygen  than  in  the  pure  gas,  t  he  most  favour- 
able mixture  being  that  found  in  ordinary 
air,  one  part  of  oxygen  to  four  parts  of  ni- 
trogen. Important  differences  were  noted  in 
the  reactions  to  oxygen  of  cold-blooded  and 
of  warm-blooded  animals,  the  former  being 
little  affected,  while  among  the  latter  dif- 
ferences of  effect  in  different  species  were  ob- 
served, the  rabbit,  for  example,  resisting  the 
pyretic  and  phlogistic  influences.  Perhaps 
the  most  striking  result  obtained  by  Richard- 
son is  that  dependent  upon  the  difference  in 
the  effect  of  breathing  a  still  atmosphere  of 
pure  oxygen  and  that  of  breathing  pure  oxy- 
gen in  current.  In  the  former  case,  after  tfie 
stage  of  excitement,  narcosis  and  death  ensue 
in  the  course  of  a  few  hours ;  in  the  latter  case 
the  animal  continues  to  live  for  days.  That 
this  is  not  due  to  accumulations  of  carbon  di- 
oxide is  proved  by  making  provision  to  absorb 
it ;  and  even  when  all  other  products  of  respi- 
ration are  removed,  the  oxygen  that  has  been 


breathed  and  rebreathed  for  some  time,  while 
still  able  to  support  combustion,  is  unable  to 
support  life.  "  Devitalizing  oxygen  "  may,  how- 
ever, be  made  "  vitalizing  "  again  by  the  effect 
of  an  electric  discharge  (ef.  Ozoke).  These 
facts  indicate  a  source  of  danger  in  crowding 
and  lack  of  ventilation  apart  from  those  com- 
monly recognised. 

The  physiological  effects  described  are  usu- 
ally transient,  but  after  repeated  inhalations 
certain  permanent  effects  begin  to  be  mani- 
fest in  addition.  There  are  increase  of  appe- 
tite and  increased  ingestion  of  food,  with 
consequent  gain  in  weight.  The  number  of 
red  corpuscles  in  the  blood  and  the  relative 
as  well  as  the  absolute  haemoglobin  percentage 
are  augmented.  The  excretion  of  uric  acid 
diminishes  and  that  of  urea  probably  increases ; 
observations  upon  the  urinary  excretion  are, 
however,  conflicting. 

Jipplied  to  the  unbroken  skin,  oxygen  is 
practically  without  effect,  perhaps  increasing 
the  exhalation  of  carbon  dioxide.  When,  how- 
ever, the  gas  is  allowed  to  come  in  contact 
with  wounds  or  ulcerated  surfaces,  it  produces 
immediate  and  painful  irritation,  accompanied 
with  increased  redness  and  abundant  liquid 
exudation ;  granulations  increase,  and,  if  the 
process  is  too  long  continued,  become  ecchy- 
motic  and  lose  their  tendency  to  cicatrize. 
Oxygen  may  be  introduced  beneath  the  skin, 
in  the  form  of  gas  or  held  in  loose  combina- 
tion as  hydrogen  dioxide,  without  danger.  As 
hydrogen  dioxide,  it  may  be  injected  into  the 
pulmonary  tissues  through  the  chest  wall,  and 
it  is  said  that  with  caution  oxygen  gas  may 
safely  be  injected  into  the  veins.  It  has  been 
passed  into  the  stomach  through  a  suitable 
tube.  However  introduced,  it  is  readily  ab- 
sorbed, and  produces  its  effects  primarily  upon 
the  tissues  and  blood  locally,  secondarily  upon 
the  organism  as  a  whole. 

Upon  pathological  conditions  certain  specific 
effects  liave  been  alleged  for  oxygen  ;  thus  its 
inhalation  has  been  said  to  diminish  the  pro- 
duction of  sugar  in  diabetes  and  to  liave 
proved  capable  of  averting  diabetic  coma  by 
the  oxidation  of  products  tliat  would  other- 
wise form  diacetic  and  oxybutyric  acids. 

Therapeutics. — Oxygen  may  be  applied  to 
the  skin  or  mucous  covering  of  the  body,  or 
introduced  into  the  blood  by  way  of  the  lungs'. 
Solution  of  hydrogen  dioxide  (g.  v.),  given  by 
the  stomach,  or  with  due  caution  subcutane- 
ously,  has  also  been  supposed  to  yield  oxygen 
to  the  blood.  It  has  been  used  as  a  stimulat- 
ing application  to  indolent  ulcers,  and  has  been 
said  to  promote  their  repair.  It  has  also  been 
used  in  cases  of  infected  wounds,  and  especially 
when  there  have  been  sloughing  and  gangrene, 
for  the  purpose  of  destroying  foul  odours  and 
preventing  putrefaction.  The  eharcoal-and- 
oxalic-acid  poultice  is  supposed  to  be  of  ad- 
vantage by  virtue  of  the  oxygen  which  it 
slowly  gives  off.  Hydrogen  dioxide  is  also 
supposed  to  owe  much  of  its  undoubted 
therapeutic  value  to  the  fact  that  upon  being 
brought  into  contact  with  decomposing  or- 
ganic matter,  with  pus  and  other  morbid 
products,  it    liberates  oxygen  in  the  active 


OXYGEN 


52 


(nascent)  state.  Day  {Australian  Med.  Jour- 
nal, July,  1878,  p.  183)  prepares  dressings  by 
saturating  cotton  with  terebinthinate  oils  and 
exposing  them  to  the  air,  hydrogen  dioxide 
being  thus  generated.  A  useful  formula  is 
the  following:  Very  old  turpentine,  1  part; 
benzine,  7  parts ;  oil  of  verbena,  5  drops  to  the 
ounce.  Eucalyptus  oil  is  also  useful :  1  part  of 
eucalyptus  to  4  of  benzine  makes  a  good  disin- 
fecting mixture,  readily  yielding  its  oxygen. 

[Stoker  (Med.  Press  and  Circular,  Apr.  17, 
1895 ;  Therap.  Gaz.,  Aug.,  1895)  states  that  in 
the  local  treatment  of  wounds  and  ulcers  the 
oxygen  may  be  diluted  with  pure  air,  accord- 
ing to  the  requirements  of  each  case.  It  is  not 
necessary  that  an  absolute  vacuum  should  be 
brought  about.  When  the  treatment  is  to  be 
applied  to  the  extremities  it  is  necessary  to 
have  rubber  bags  of  the  simplest  construction. 
If  to  the  knee,  for  instance,  what  is  required  is 
an  oval  rubber  receptacle  open  at  both  ends, 
larger  at  one  end  than  at  the  other.  The 
lower  or  smaller  end  of  the  bag  embraces  the 
limb  below  the  knee  and  the  upper  or  larger 
end  embraces  the  limb  above  the  knee.  When 
this  rubber  receptacle  is  used  it  is  not  neces- 
sary to  have  a  continuous  stream.  The  bag 
should  be  filled  and  the  tap  turned  off.  and 
after  five  or  six  hours  it  should  be  filled  again. 
Such  bags  may  be  made  to  include  any  part  of 
the  body.  The  method  of  procedure  is  as  fol- 
lows :  First  the  wound  is  washed,  then  the 
rubber  cap  is  placed  so  as  to  embrace  the  part. 
The  bag  is  then  filled  with  oxygen  diluted 
with  air.  Pure  oxygen  causes  a  great  deal  of 
pain,  but  some  patients  stand  it  well.  A  50- 
per-cent.  mixture  is  commonly  employed,  di- 
luted with  purified  air ;  this  is  passed  through 
two  wash-buttles  before  entering  the  gas-bag, 
the  first  containing  liraewater,  and  the  sec- 
ond a  strong  solution  of  Condy's  fluid ;  then 
the  oxygen  is  passed  into  it  out  of  a  cylinder. 
When  the  bag  is  to  be  refilled  it  is  connected 
with  the  receptacle  by  a  small  tube,  the  tap  is 
turned  partially  on,  and  the  oxygen-container 
is  refilled  as  often  as  is  necessary.  There  is 
usually  immediate  relief  from  pain.  For  the 
first  twelve  hours  the  micro-organisms  do  not 
differ  in  number  or  character,  but  after  that 
the  discharge  diminishes  and  the  germs  show 
remarkable  changes.  In  one  of  Stoker's  cases, 
in  addition  to  lesions  in  other  parts  of  the 
body,  there  was  a  tuberculous  ulcer  on  the 
back  of  the  hand,  involving  nearly  all  the 
dorsal  surface.  Other  cases  were  of  tubercu- 
lous disease  of  the  tibia,  of  tuberculous  syno- 
vitis, and  of  syphilitic  rupia  of  the  head.J 

By  inhalation  oxygen  is  used  either  pure  or 
diluted  with  air  or  with  nitrogen  monoxide 
in  various  proportions.  Its  principal  employ- 
ment in  the  hands  of  educated  physicians  has, 
unfortunately,  been  in  the  treatment  of  pul- 
monary tuberculosis,  in  which  disease  it  is 
rarely  useful  and  usually  harmful.  This  fact, 
first  pointed  out  by  Beddoes,  was  independ- 
ently observed  by  Fourcroy,  and  has  been 
confirmed  by  the  studies  of  J.  Solis-Colien 
(Inhalation,  etc.  2d  ed.,  Philadelphia,  1870,  p.  77) 
and  by  those  of  the  writer.  It  should  not  be 
understood,  however,  that  the  inhalation  of 


oxygen  is  at  all  times  and  under  all  circum- 
stances to  be  avoided  in  the  treatment  of 
pidmonarv  tuberculosis.  Under  certain  cir- 
cumstances it  has  considerable  palliative 
value;  but  it  should  be  distinctly  recognised 
that  it  is  palliative  only,  to  be  used  for  tempo- 
rary purposes,  and  for  short  periods  as  a 
stimulant,  or  to  relieve  dyspnoea.  The  com- 
bination of  one  third  oxygen  and  two  thirds 
nitrogen  monoxide  is  usually  the  best  for  em- 
ployment in  this  manner,  as  the  nitrous  oxide 
diminishes  the  untoward  activity  of  the  oxy- 
gen. Toward  the  end  of  life  in  pulmonary 
tuberculosis  oxygen  assists  in  smoothing  the 
passage  to  the 'grave.  It  is  of  use  in  hypo- 
chondriasis  and  neurasthenia  as  a  stimulating 
agent,  and  especially  in  cases  of  neurotic  dys- 
pepsia attended  with  perverted  gastric  secre- 
tion. In  chronic  gastric  and  gastro-inteslinal 
catarrh  oxygen  given  by  inhalation  and  ap- 
plied locally  through  a  stomach-tube,  oxygen- 
ated water,  and  hydrogen-dioxide  solution  have 
been  used  with  benefit.  Oxygen  is  a  useful 
palliative  in  gastric  carcinoma.  It  sometimes 
relieves  the  insomnia  due  to  auto-intoxication, 
and  especially  when  this  is  remotely  due  to 
mental  fatigue.  It  is  of  benefit  in  rhachitis, 
in  the  scrofulosis  of  children,  in  debilitated 
states,  in  gout,  and  in  diabetes.  As  a  pallia- 
tive in  asthma  during  the  attack  it  is  of  ser- 
vice, though  not  often  successful  in  cutting 
short  a  paroxysm.  In  chlorosis  and  the  ancB- 
mias,  even  in  pernicious  anmmia  and  in  leucoe- 
mia,  it  is  of  distinct  service.  In  acute  lobar 
pneumonia  it  has  often  saved  life.  The  ad- 
ministration of  oxygen  in  this  affection  is  ra- 
tional, because  the  diminutioii  in  lung  surface 
requires  a  concentration  of  respiratory  pabu- 
lum. Nascent  or  at  least  recently  prepared 
oxygen  is  preferable  because  it  exerts  antisep- 
tic, powers.  Resort  to  oxygen  should  not  be 
postponed  until  the  patient  is  moribund.  The 
inhalations  should  be  regular  and  continuous, 
not  sporadic  and  spasmodic;  and  should  the 
patient  be  unconscious  or  unable  to  assist,  the 
delivery  nozzle  should  be  inserted  into  the  nos- 
tril and  the  gas  allowed  to  flow  in  a  continuous 
current  at  a  gentle  rate. 

In  acute  obstructive  diseases  of  the  air-pas- 
sages, such  as  croup  and  laryngeal  diphtheria, 
before  or  after  intubation  or  tracheotomy,  in 
the  capillary  bronchitis  of  children,  in  the 
catarrhal  pneumonia  of  the  aged,  and  in 
acute  diseases  attended  with  prostration  or  col- 
lapse, such  as  cholera  asiatica,  cholera  in- 
fantum, severe  cases  of  measles  and  scarlatina, 
the  terminal  stages  of  typhoid  fever  and  puer- 
peral and  other  forms  of  sepsis,  inhalations  of 
oxygen  will  always  afford  comfort  and  prolong 
life,  and  may  sometimes  greatly  assist  recov- 
ery. In  connection  with  artificial  respiration 
oxygen  is  a  potent  agent  in  the  treatment  of 
asphyxia.  In  toxic  narcoses,  especially  those 
brought  about  by  carbon  dioxide,  coal  gas, 
opium,  belladonna  and  its  congeners,  chloral, 
ether,  chloroform,  and  similar  agents,  if  re- 
sorted to  in  time  and  used  persistently,  it  may 
save  life. 

[The  value  of  oxygen  in  coma  has  been  well 
illustrated   by  Dr.  Charles  J.  Macalister,  of 


53 


OXYGEN 


Liverpool  {Clinical  SJcetches,  Jan.,  1896 ;  JV.  Y. 
Med.  Jour.,  Feb.  15,  1896),  who  describes  two 
cases.  Tlie  first  case  was  that  of  a  man,  thirty- 
nine  years  old,  who  had  pains  in  his  limbs,  se- 
vere headache,  and  frequent  vomiting,  which 
had  been  attributed  to  a  series  of  exposures  to 
cold  and  wet.  He  had  an  alcoholic  appear- 
ance. The  urine  was  diminished  in  amount, 
and  contained  more  than  aquarter  of  albumin. 
The  temperature  was  normal.  Two  days  after 
he  entered  the  hospital  he  seemed  drowsy  and 
complained  of  spots  fl.oating  before  his  eyes. 
The  respiration  was  hurried  and  the  pulse  was 
83.  There  was  severe  frontal  headache,  with 
some  vomiting;  the  bowels  moved  freely.  In 
the  afternoon  the  patient  became  delirious, 
and  later  on  be  was  found  to  be  absolutely 
blind.  The  temperature  was  100'8°  F. ;  the 
pupils  were  very  much  contracted,  with  no 
reaction  to  light;  there  were  no  muscular 
twitchings.  Early  in  the  evening  he  became 
somi-comatose ;  the  breathing  was  loud  and 
iHtertorous,  and  the  lips,  the  nose,  and  the  ex- 
tremities were  somewhat  cyanosed.  The  tem- 
perature was  101°  P.  Two  hours  later  he  was 
in  a  profound  coma ;  his  eyes  were  open  and 
the  pupils  were  contracted  to  pin-points ;  the 
muscles  were  relaxed,  the  extremities  were 
cyanosed,  the  mouth  was  closed,  and  the  heart 
beat  tumultuously.  The  pulse  was  118  ;  there 
was  oedema  of  the  extremities.  The  patient 
was  insensitive  to  pain  and  was  apparently 
under  the  influence  of  some  poison  which  in- 
terfered with  oxidation..  Dr.  Maealister  ad- 
ministered oxygen  freely,  pure  oxygen  through 
one  nostril  and  air  through  the  other.  The 
results  were  very  striking,  for  the  face  and  the 
lips  rapidly  became  less  cyanosed,  and  in  ten 
minutes  the  patient  tried  to  push  the  tube 
from  his  nose.  The  pulse  was  at  once  reduced 
from  118  to  96.  The  respirations  became 
slower  and  freer  from  stertor,  and  the  pupils 
were  less  contracted ;  the  corneae  were  sensi- 
tive. Later  on  the  patient  turned  voluntarily 
on  to  his  side,  but  no  replies  could  be  elicited 
to  questions.  A  cupping-glass  was  then  ap- 
plied over  the  loin,  and  the  pain  effectually 
aroused  him.  He  sat  up  in  bed  and  became 
so  violent  that  assistance  was  necessary  to  re- 
strain him,  although  he  took  no  notice  of  any 
questions  put  to  him  and  made  no  attempt  to 
speak.  He  presently  relapsed  into  a  drowsy 
condition,  for  which  the  administration  of  the 
oxygen  was  repeated,  and  ten  minutes  later  he 
sat  up  and  asked  for  a  drink.  There  was  no 
return  of  unconsciousness,  although  two  days 
later  there  was  a  threatening  of  it,  which 
was  averted  by  the  oxygen.  In  twenty-four 
hours  the  urine  measured  108  ounces,  and 
contained  an  eighth  of  albumin,  with  hya- 
line and  granular  casts ;  the  specific  gravity 
was  I'OOS.  Pour  days  later  the  patient  was 
able  to  see;  the  ophthalmoscope  showed  small 
haemorrhages,  especially  in  the  left  fundus.  A 
few  days  afterward  the  headache  disappeared 
and  the  albumin  rapidly  subsided.  A  week 
later  the  man  left  the  hospital  perfectly  well. 
The  second  case  was  one  of  morphine  poison- 
ing, and  the  cure  seemed  to  have  been  acceler- 
ated by  the  use  of  oxygen.] 


The  most  recent  advance  in  the  therapeutic 
use  of  oxygen  is  the  application  in  surgical 
aniBsthesia  of  Sir  B.  W.  Richardson's  sugges- 
tions as  to  the  use  of  oxygen  as  a  menstruum 
for  ether  and  chloroform.  Cole,  of  New  York 
{Med.  Record,  Oct.  16,  1895),  seems  to  have 
been  the  first  to  put  the  plan  into  actual  opera- 
tion. The  writer  has  adapted  the  ordinary 
face-mask  of  his  compressed-air  apparatus  to 
this  purpose  by  the  addition  of  an  expiration 
valve.  Prom  a  cylinder  of  compressed  oxygen 
the  gas  is  passed  through  a  wash-bottle  con- 
taining the  anesthetic  into  the  mask.  By  this 
plan,  which  has  been  adopted  in  the  service  of 
Dr.  T.  S.  K.  Morton  at  the  Philadelphia  Poly- 
clinic Hospital,  anaBsthesia  is  produced  with- 
out sufEooation  or  struggling,  may  be  prolonged 
with  less  ether  and  continued  with  less  cyanosis 
and  less  danger,  and  recovery  (which  is  aided 
by  the  inhalation  of  pure  oxygen)  is  more 
rapid  and  without  distress. 

[At  a  meeting  of  the  New  York  Surgical  So- 
ciety held  on  November  27,  1895  {Annals  of 
Surgery,  Feb.,  1896),  Dr.  Francis  H.  Markoe 
read  a  paper  on  the  use  of  oxygen  with  ether 
for  anaesthesia.  He  said  that  the  use  of  oxy- 
gen prevented  the  cyanosis  that  was  so  com- 
mon when  ether  alone  was  employed ;  and 
that  if  anaesthesia  was  induced  by  oxygenated 
nitrous  oxide  it  could  be  most  satisfactorily 
and  safely  prolonged  with  oxygenated  ether. 
It  had  been  suggested  also  that  chloroform 
anaesthesia  might  be  made  safer  with  oxygen. 

In  the  discussion  which  followed  the  read- 
ing of  Dr.  Markoe's  paper.  Dr.  Robert  Abbe 
said  that,  so  far  as  his  limited  experience  with 
the  method  went,  it  seemed  to  show  that  it  pos- 
sessed advantages.  That  there  was  a  gain  in  ox- 
idation during  etherization  could  not  be  ques- 
tioned. The  patient's  complexion  was  pink- 
er, the  blood  in  the  wound  was  more  arterial, 
the  minute  arteries  seemed  to  spurt  more,  but 
the  blood  clotted  quickly,  so  that  there  was  no 
greater  haemorrhage.  Its  use  had  been  attend- 
ed by  less  secretion  of  saliva  and  a  less  abun- 
dant production  of  mucus  in  the  bronchi  than 
where  ether  alone  had  been  employed.  The 
patients  had   experienced  less  nausea  subse- 

?uently,  and  the  effects  had  been  pleasanter. 
n  a  case  of  mitral  lesion  which  had  caused 
much  anxiety,  the  patient  had  borne  the  anaes- 
thesia and  a  long  operation  very  well,  and  had 
experienced  no  nausea. 

Dr.  B.  Farquhar  Curtis  said  he  had  tried 
the  method  in  about  ten  cases,  and  must  say 
that  he  had  not  witnessed  much  improve- 
ment over  older  methods.  There  had  been 
cyanosis  in  some  of  his  cases,  whereas  he  had 
supposed  that  cyanosis  was  the  principal  dis- 
agreeable symptom  which  could  be  prevented 
by  the  use  of  oxygen.  The  stage  of  excite- 
ment had  been  quite  prolonged  in  some  of  his 
cases,  and  there  had  been  nothing  in  the  his- 
tory of  the  patient  to  account  for  it.  In  some 
cases  he  had  observed  want  of  efficient  anaes- 
thesia, and  he  suspected  that  it  was  due  to  the 
diminished  quantity  of  ether  inhaled  when  ad- 
ministered in  this  way.  The  effects  on  the 
blood  seemed  to  be  about  as  described  by  Dr. 
Markoe,  but  perhaps  this  advantage  also  was 


OXYMELS 
OXYTOCICS 


54 


due  to  the  fact  that  the  patient  got  less  ether. 
In  a  case  in  which  he  had  kept  the  patient 
waiting  about  two  weeks  to  get  rid  of  a  bron- 
chitis before  submitting  to  some  trivial  opera- 
tion, it  had  been  noticeable  that  there  was  ab- 
solutely no  irritation  of  the  bronchi  after  the 
operation,  although  there  had  been  rales  only 
two  or  three  days  before.  He  would  warn  the 
profession  against  the  use  of  oxygen  with  ni- 
trous oxide.  He  had  tried  it  experimentally 
over  and  over  again,  and  had  found  that  the 
oxygen  had  no  effect  whatever,  except  in  di- 
minishing the  aniBsthetic  influence  of  the  ni- 
trous oxide. 

Dr.  W.  W.  Van  Arsdale  agreed  with  Dr. 
Markoe  that  the  ideal  ana3sthesia  of  the  future 
would  probably  begin  with  nitrous  oxide  and 
be  continued  with  etber.  He  had  used  this 
form  in  private  practice  for  two  years,  and  had 
been  fortunate  in  having  an  experienced  ad- 
ministrator assist  him.  By  giving  pure  nitrous 
oxide  and  afterward  substituting  plain  ether 
the  patient  could  be  placed  remarkably,  alarm- 
ingly quickly  under  anaesthesia,  sometimes  in 
half  a  minute,  and  without  any  disagreeable 
sensations  or  period  of  excitement,  and  with- 
out any  of  the  after-eifects  following  the  use 
of  ether  alone.  He  had  had  no  experience 
with  the  use  of  ether  mixed  with  oxygen.  It 
impressed  him  as  a  step  in  the  right  direction, 
but  he  feared  that  clinically  it  would  meet 
with  some  objection.  More  ether  had  to  be 
given,  which  was  not  a  desideratum ;  if  there 
were  less  cyanosis,  that  would  be  an  advantage 
in  itself. 

Dr.  Howard  Lilienthal  had  used  nitrous  ox- 
ide at  the  beginning  of  aniEsthesia  and  had 
been  almost  alarmed  at  the  rapidity  with  which 
the  patient  became  aniesthetized.  A  method 
which  would  do  away  with  cyanosis  would  rob 
us  of  one  of  the  danger  signals.  He  added 
that  this  mixture  of  oxygen  and  ether  was 
probably  highly  inflammable,  if  not  explosive, 
and  therefore  should  be  used  with  extra  pre- 
caution. 

Dr.  Andrew  J.  McCosh  had  used  the  com- 
bination of  oxygen  and  ether  in  eight  or  ten 
cases,  and  had  found  the  chief  objection  to  lie 
in  the  fact  that  it  was  difficult  to  bring  the 
patient  under  the  influence  of  the  ansesthetio, 
and  relaxation  had  not  been  complete.  During 
the  greater  part  of  the  time  before  unconscious- 
ness the  patient  was  in  a  jolly  mood.  There 
was  an  absence  of  the  distress  which  ether 
usually  caused,  there  was  no  cyanosis,  and  the 
blood  was  well  aerated.  Some  years  ago  the 
method  had  been  extensively  employed,  the 
tube  conveying  the  oxygen  passing  into  a  cone 
made  of  paper  and  a  towel,  but  after  having 
been  used  in  fifty  or  sixty  cases  the  method 
had  been  abandoned.  Regarding  the  combina- 
tion of  nitrous  oxide  and  ether,  it  was  rather 
troublesome,  and,  unless  the  ansesthetizer  was 
a  man  of  experience,  the  patient  was  apt  to  re- 
gain consciousness  when  the  change  was  made 
from  nitrous  oxide  to  ether. 

Dr.  Markoe  believed  with  Dr.  Van  Arsdale 
that  the  future  method  would  be  to  induce 
anaesthesia  with  nitrous  oxide,  but  he  thought 
it  would  be  modified  with  oxygen. 


Dr.  I.  N.  De  Hart,  of  Brooklyn  (Boston  Med. 
and  Surg.  Jour ,  April  16,  1896),  who  has  re- 
ported a  number  of  cases  in  which  he  has  used 
oxygen  in  conjunction  with  an  ana3sthetic, 
says  that  pure  oxygen  should  not  be  used  with 
ether,  on  accountof  its  tendency  to  counteract 
the  anaesthetization  or  make  it  a  very  slow  pro- 
cess ;  but  it  may  be  used  with  chloroform.  He 
has  found  that  oxygen  diluted  with  33  per 
cent,  of  nitrous  monoxide  or  atmospheric  air 
is  the  best  form  of  gas  to  be  used  in  producing 
anaesthesia,  with  either  ether  or  chloroform, 
during  surgical  operations. 

The  amount  of  oxygen  used  during  the 
operations  which  he  reports  averaged  about  a 
gallon  a  minute  during  the  etherization,  and 
afterward  it  was  given  with  less  pressure  dur- 
ing the  operation.  The  amount  of  ether  con- 
sumed by  an  adult  averaged  about  4  ounces 
an  hour,  and  he  presumes  it  would  require 
about  half  that  quantity  for  a  child.  Of  chlo- 
roform, from  2-^  to  3  drachms  an  hour  were 
used.  Of  the  A.  C.  E.  mixture  about  4  ounces 
were  used  in  an  hour  and  forty  minutes  in  one 
case.  In  another  case  only  8  ounces  of  ether 
were  consumed  in  two  hours  and  a  half.  The 
longest  time  required  to  produce  complete 
anaesthesia  with  ether  and  oxygen  gas  (diluted) 
was  fourteen  minutes ;  the  shortest  time  with 
the  same  anassthetic,  seven  minutes.  With 
pure  oxygen  etherization  with  ether  requires 
from  twenty  to  twenty-five  minutes,  and  then 
it  will  sometimes  require  the  giving  of  ether 
with  a  cone  and  dispensing  with  oxygen  gas 
for  two  or  three  minutes.  With  chloroform 
and  oxygen  gas  (diluted)  the  results  are  far 
more  satisfactory,  and  anajsthetization  is  very 
rapid,  usually  requiring  about  two  or  three 
minutes.] — Solomon  Solis-Cohen. 

OXYMELS. — These  are  mixtures  contain- 
ing honey  and  some  dilute  acid,  used  mostly 
for  their  agreeable  flavour.  The  oxymel  of  the 
Br,  Ph.  is  composed  of  8  parts  of  clarified 
honey  and  1  fl.  part  each  of  acetic  acid  and 
distilled  water.  It  may  be  used  as  a  refriger- 
a7it  in  doses  of  from  1  to  2  fl.  drachms. 

OXTNAPHTHOIC  ACID,  CHeO,, 
formed  by  the  reaction  of  an  alkaline  com- 
pound of  o-naphthol  on  carbon  dioxide  under 
pressure  at  a  high  temperature,  is  a  colourless 
crystalline  substance  hardly  soluble  in  water, 
but  fairly  soluble  in  alcohol,  in  ether,  and  in 
oils.  It  is  poisonous  and  is  not  used  internally, 
but  has  been  proposed  as  a  topical  antiseptic. 

OXYaUINASEPTOL.  —  See  Diaphthe- 

RIN. 

OXYSPAE.TEINE.— This  derivative  of 
sparteine  has  been  found  by  Langlois  and 
Maurange  (Gaz.  med.  de  Paris.  Aug.  24,  1895) 
more  active  than  sparteine  as  a  cardiac  stimu- 
lant. The  dose  of  the  hydrochloride,  admin- 
istered subcutaneously,  is  from  ^  to  J  of  a 
grain. 

OXYTOCICS.— This  term,  in  the  broadest 
sense,  includes  all  measures  which  hasten  par- 
turition by  increasing  the  strength  of  the 
expellent  forces,  especially  of  the  uterine  con- 
tractions.    Such  agents  are  also  sometimes 


55 


OXYMELS 
OXYTOCICS 


designated  as  eobolic,  ocytocio,  ocyodinic,  or 
oxytoceous  agents. 

The  unstriped  muscular  fibres  of  the  uterus 
are  apparently  capable  of  rhythmical  contrac- 
tion independently  ot  the  action  of  the  general 
nervous  system.  Yet  at  the  same  time  they  are 
under  the  control  of  nerve-centres  in  the  spinal 
cord  and  the  brain.  The  spinal  centre  is  situ- 
ated in  the  lumbar  portion  of  the  cord,  and  the 
uterine  contractions  go  on  normally  after  the 
cord  has  been  divided  above  the  lumbar  region. 
This  lumbar  centre  may  act  independently  of 
the  cerebral  centre,  or  may  be  excited  by  it. 
The  mode  of  action  of  ecbolics  is  not  yet  fully 
understood.  While  their  effects  are  in  the 
main  due  to  stimulation  of  nerve-centres,  some 
of  them  also  possess  to  some  extent  the  power 
of  directly  causing  contraction  of  the  uterine 
muscle  fibres. 

Under  the  foregoing  definition  there  are  two 
classes  of  ecbolic  measures,  medicinal  and  me- 
chanical. Of  drugs,  there  is  a  long  list  which 
have  been  credited  with  the  power  of  stimu- 
lating the  uterine  contractions  during  labour. 
Chief  among  these  are  ergot,  hydrastis,  cimiei- 
fuga,  thuja,  mistletoe,  ustilago  maidis,  borax, 
Cottonwood,  savine,  rue,  tansy,  wormwood, 
apiol,  yew,  pennyroyal,  black  hellebore,  quinine, 
sugar,  digitalis,  squill,  laburnum,  grains  of 
paradise,  guaiacum,  salicylate  of  sodium,  oil  of 
amber,  pilocarpine,  belladonna,  phosphorus, 
strychnine,  broom-fern,  lignum  vitiE.  hoar- 
hound,  chamomile,  mugwort,  cantharides, 
juniper,  juice  of  bamboo,  milk  hedge  and  other 
euphoriaceous  plants,  chiretta,  carrot  seeds, 
sassafras,  arsenic,  corrosive  sublimate,  cyanide 
of  potassium,  sulphate  of  copper,  drastic  ca- 
thartics, and  the  inhalation  of  carbonic  oxide, 
of  illuminating  gas,  or  of  the  vapour  of  carbon 
disulphide.  Most  of  these  drugs  exert  but  a 
feeble  influence  upon  the  uterine  contractions, 
and  are  of  no  practical  importance  as  oxytocics. 
A  few  deserve  special  mention. 

Ergpot  is  an  agent  of  undoubted  power  as  a 
uterine  excito-motor.  It  intensifies  the  uterine 
contractions  when  they  are  already  established, 
and  is  capable  of  exciting  them  primarily  in 
the  gravid  uterus.  In  large  doses  it  produces 
a  tonic  contraction  of  the  uterus.  The  inter- 
vals between  the  contractions  are  nearly  or 
quite  obliterated,  the  organ  remaining  in  a 
state  of  spastic  rigidity.  Under  smaller  doses 
the  action  of  the  uterine  muscles  is  intermit- 
tent, but  the  relaxation  is  not  so  complete  as 
in  spontaneous  labour.  In  very  small  quanti- 
ties (10  minims  of  the  fluid  extract)  the  effect 
is  to  produce  contractions  very  closely  resem- 
bling those  of  natural  labour.  The  pains  are 
rendered  more  frequent  and  more  energetic. 
The  use  of  ergot,  however,  for  the  purpose  of 
accelerating  labour  is  generally  condemned  by 
obstetric  authorities.  The  nearly  continuous 
contraction  of  the  uterus  under  full  doses  of 
the  drug  interferes  with  the  utero-plaoental 
circulation  and  is  frequently  fatal  to  the  child. 
Violent  ergotic  contractions  are  dangerous  to 
the  mother  as  well,  exposing  her  to  the  risk  of 
uterine  rupture.  While  ergot  ia  very  small 
doses  may  no  doubt  be  given  to  advantage  in 
inertia  uteri,  it  is  usually  inferior  to  other 


means  and  the  practice  is  seldom  to  be  recom- 
mended. 

Hydrastis  canadensis  is  a  powerful  ec- 
bolic. Its  action  is  believed  to  be  of  centric 
origin,  since  it  ceases  on  section  of  the  uterine 
nerves.  The  dose  of  the  fluid  extract  is  from 
5  minims  to  ^  fl.  oz.  Bydrastine,  the  domi- 
nant principle  of  hydrastis,  may  be  substituted 
for  the  drug  itself.  The  dose  is  from  |  to  J  of 
a  grain.  Jiydrastinine  is  an  artificial  alkaloid 
produced  by  acting  on  hydrastine  with  oxidiz- 
ing agents.  It  is  an  active  oxytocic.  In  full 
doses,  like  ergot,  it  produces  violent  uterine 
tetanus.     (See  vol.  i,  p.  475.) 

Q,uinine  has  the  power  to  intensify  con- 
tractions of  the  uterus  already  established  ; 
possibly  in  some  cases  that  of  originating 
them.  Probably  it  acts  more  by  rousing  the 
general  nervous  system  than  by  its  direct  ef- 
fect on  the  uterus.  However  that  may  be,  the 
writer  has  seen  abundant  evidence  of  its  value 
in  stimulating  the  flagging  pains  of  labour. 
A  single  dose  of  10  grains  usually  suffices. 

Sugar  has  recently  been  added  to  the  list  of 
ecbolic  agents.  It  is  given  in  doses  of  about 
an  ounce  dissolved  in  water.  Its  effect  on  the 
pains  is  manifest  in  from  twenty-five  to  forty- 
five  minutes.  Rarely  is  a  second  dose  required. 
The  contractions  induced  by  sugar  are  said  to 
be  of  the  usual  normal  character. 

Cotton  Boot. — The  fiuid  extract  of  cotton 
root  exerts  a  pronounced  oxytocic  infiuenee. 
It  is  open  to  substantially  the  same  objection 
as  ergot.  The  dose  of  the  fluid  extract  is  -J  fl. 
drachm. 

Cimicifuga  has  been  employed  as  a  uterine 
stimulant  during  labour.  It  produces  normal, 
not  tonic,  contractions.  The  fluid  extract  is 
the  best  preparation.  It  is  given  in  doses  of 
from  -|  to  1  fl.  drachm  three  or  four  times 
dailj'.  Of  the  tincture,  from  1  to  2  fl.  drachms 
may  be  given  with  the  same  frequency. 

Electricity  is  one  of  the  most  reliable  ec- 
bolics. The  faradaic  or  the  interrupted  gal- 
vanic current  is  used.  To  avoid  injury  to  the 
fcetus,  the  current  must  not  be  too  strong,  and 
it  should  not  be  passed  directly  through  the 
child's  head.  One  electrode  may  be  applied  to 
the  sacro-lumbar  region  and  the  other  over  the 
middle  of  the  abdomen.  The  current  should 
be  mild  at  first  and  increased  gradually,  to 
guard  against  over-stimulation  and  consequent 
destruction  of  the  electro-muscular  contractili- 
ty. Bach  application  may  last  from  five  to 
thirty  minutes. 

Before  the  escape  of  the  waters  the  introduc- 
tion of  an  aseptic  English  bougie  between  the 
foetal  membranes  and  the  uterine  wall  may  be 
practised  for  accelerating  labour,  as  it  is  for 
inducing  it. 

Glycerin,  injected  between  the  ovum  and 
the  uterus,  has  recently  been  much  employed 
for  the  induction  of  labour.  It  is  most  effect- 
ive when  carried  high  up  into  the  uterus,  and 
retained  for  a  time  by  the  aid  of  the  latero- 
prone  posture.  It  is  believed  to  act  partly  as 
a  direct  irritant  and  partly  by  the  separation 
of  the  membranes  and  by  its  osmotic  effect. 
Labour  is  in  most  cases  promptly  established. 
In  numerous  recorded  cases,  however,  the  in- 


OYSTER  SHELL 
OZONE 


56 


tra-uterine  injection  of  glycerin  has  been  fol- 
lowed by  haemoglobinuria,  with  evidence  of 
glomerulo-nephi-itis  and  even  of  interstitial 
hepatitis.  Pelzer,  by  whom  the  method  was 
introduced,  still  regards  it  as  a  safe  procedure 
provided  the  quantity  of  glycerin  injected  does 
not  exceed  half  an  ounce. 

The  alternate  use  of  hot  and  of  cold  appli- 
cations to  the  abdomen  during  labour  is  a 
powerful  stimulant  of  uterine  contractions.  In 
the  iirst  stage  of  labour  standing  or  wallcing, 
and  in  the  second  sitting  erect,  are  useful  pos- 
tural measures.  A  serai- recumbent  or  a  squat- 
ting posture  favours  the  expulsive  efiEorts. 
Hot  rectal  or  vaginal  douches  increase  the 
strength  and  frequency  of  the  pains.  Mam- 
mary irritation  is  a  well-known  reflex  stimu- 
lant of  uterine  contractions. 

It  is  especially  necessary  in  slow  labours  that 
the  bladder  and  the  rectum  be  kept  empty. 
\Vhen  these  viscera  are  distended  the  uterine 
efforts  are  partially  inhibited.  Misdirection  of 
the  uterine  axis  should  be  corrected.  A  firm 
abdominal  hinder  is  frequently  a  material  help 
during  the  second  stage  of  labour,  especially  in 
relaxed  conditions  of  the  abdominal  walls. 
While  it  does  not  increase  the  energy  of  the 
uterine  contractions,  it  adds  to  their  efficacy 
by  furnishing  a  point  d'appui  for  the  intra-ab- 
dominal pressure. — Chakles  Jewett. 

OYSTER    SHELL. — See  Testa   fumpa- 

RATA. 

OZOITE. — Chemistry. — Ozone  is  allotropic 
oxygen.  Its  molecule  contains  three  atoms  in- 
stead of  the  two  atoms  forming  the  molecule 
of  ordinary  oxygen.  Its  formula  is  written  as 
Oa,  or  sometimes  as  O2O.  It  combines  energet- 
ically at  ordinary  temperatures  witn  nearly  all 
oxidizable  substances.  Moisture  favours  its 
action.  In  forming  combinations  it  yields 
the  additional  atom  of  oxygen,  the  remaining 
atoms  resuming  the  ordinary  form  of  O2.  This 
residue  of  uncombined  oxygen  occupies  the 
same  volume  as  the  original  ozone,  which  was 
therefore  condensed.  The  density  of  ozone 
has  been  experimentally  shown  to  be  24,  or 
half  as  much  again  as  that  of  oxygen,  and  its 
mol.cular  weight  48,  or  three  times  that  of 
oxygen.  It  has  been  separated  from  oxygen 
only  in  minute  quantities,  and  in  medicine 
ozonized  air  is  the  agent  ordinarily  employed 
to  produce  the  effects  of  ozone.  As  a  rule,  50 
per  cent,  is  the  highest  proportion  of  ozone  that 
can  be  obtained  in  mixture  with  oxygen,  and 
readily  available  apparatus  produce  much  less. 
Heated  to  300°  C.  (572=  P.)— some  say  250°  C. 
(482°F.)  —  ozone  reverts  to  the  condition  of 
ordinary  oxygen  with  corresponding  expansion 
in  volume.  It  may  be  liquefied  by  cold  and 
powerful  pressure  (from  150  to  125  atmos- 
pheres). Liquid  ozone  has  a  blue  colour,  it 
boils  at  106°  C.  (222-8°  P.)— some  say  159°  C. 
(286'2°  P.) — and,  if  it  is  inclosed  in  a  glass 
tube,  changes  to  blue  gas,  which  may  again  be 
liquefied  by  cooling. 

Preparation  and  Properties.  —  Schon- 
bein,  in  1839,  proved  that  the  characteristic 
phosphorus-like  odour  accompanying  electric 
discharges  was  due  to  a  gas  developed  in  and 


from  the  air  by  the  chemical  effect  of  the  dis- 
charge, and  on  account  of  its  odour  he  gave 
to  this  new  gas,  afterward  shown  to  be  modi- 
fied oxygen,  the  name  by  which  it  is  now  known. 
The  best  means  of  preparing  ozone  in  large 
quantities  is  to  pass  air  or  oxygen  through  a 
narrow  dielectric  space  between  two  parallel 
conductors,  as  by  means  of  a  Siemens's  induc- 
tion tube  or  some  similar  device  connected 
with  a  Holtz  electric  machine  or  a  powerful 
Euhmkorff  coil,  the  silent  discharge  being 
more  effective  than  the  spark.  Houzeau's  ap- 
paratus consists  of  a  glass  tube  about  0-1  of 
a  millimetre  in  calibre  and  from  40  to  45 
centimetres  in  length,  containing  a  stout  plat- 
inum filament,  and  wrapped  around  with  a 
spiral  of  some  good  conducting  material,  such 
as  copper  wire.  One  of  the  rheophores  of  the 
induction  coil  is  connected  with  the  platinum 
wire,  the  other  with  the  copper  spiral.  The 
current  of  pure,  dry  oxygen  gas  is  allowed  to 
pass  through  the  tube  at  the  rate  of  a  litre  an 
hour.  The  quantity  of  ozone  produced  is  the 
greater  the  lower  the  temperature,  about  50  per 
cent,  of  the  oxygen  being  converted  into  ozone 
at  —88°.  An  effective  machine  based  upon 
this  principle  but  much  improved  in  detail 
has  been  placed  on  the  American  market  and 
has  been  described  by  Dr.  W.  J.  Morton  in  the 
New  York  Medical  Journal  for  June  23  and 
30,  1894.  The  output  of  the  machine  is  meas- 
ured in  milligrammes  of  ozone  per  minute,  and 
the  dosage  regulated  accordingly.  To  remove 
irritating  and  deleterious  nitrogen  compounds 
the  ozonized  air  is  passed  through  a  wash  bottle 
containing  a  solution  of  caustic  alkali  (.sodium 
hydroxide  or  potassium  hydroxide).  When 
pure  oxygen  has  been  ozonized  this  procedure 
is  obviously  needless.  As  ozone  is  always  formed 
in  greater  or  less  quantity  when  oxygen  is  lib- 
erated or  takes  part  in  a  reaction,  especially  if 
the  evolution  of  heat  is  prevented,  various 
chemical  processes  of  production  are  available. 
Thus,  several  pieces  of  stick  phosphorus  may 
be  placed  in  a  large  fiask  and  half  covered  with 
water;  after  some  hours  the  flask  will  contain 
considerable  ozone.  A  current  of  oxygen  may 
be  conducted  over  moistened  phosphorus  in  a 
glass  tube.  Barium  dioxide  or  potassium  per- 
manganate or  a  mixture  of  potassinm  perman- 
ganate and  oxalic  acid  may  be  gradually  added 
in  small  portions  to  cold  sulphuric  acid.  Ozone 
may  be  allowed  to  diffuse  through  the  air  of 
an  apartment,  or  (mixed  with  air  or  oxygen) 
may  be  collected  over  water  in  glass  vessels. 
It  can  not  be  collected  in  rubber,  as  it  qviiokly 
destroy?  organic  substances.  It  is  soluble  in 
pure  water  in  the  proportion  of  8'81  per  cent., 
the  larger  part,  however,  being  converted  by 
the  water  into  oxygen  without  the  formation 
of  hydrogen  dioxide.  It  is  soluble  in  oils,  some 
of  them  taking  up  as  much  as  25  volumes  per 
cent. 

Essential  oils  and  terebinthinates  absorb 
ozone  readily;  they  will  also  absorb  oxygen 
from  the  air  and  convert  it  into  ozone,  becom- 
ing rich  in  ozone  with  long  exposure.  Ozone 
exists  in  moderate  and  variable  quantity  in  the 
atmosphere.  According  to  some  authorities,  it 
is  the  form  in  which  oxygen  exists  in  the  blood 


57 


OYSTER  SHELL 
OZONE 


combined  with  the  hsemoglobin,  bnt  this  opin- 
ion must  be  said  to  lacls;  demonstration.  It  is 
supposed  that  the  ozone  of  the  atmosphere 
arises  in  great  part  from  the  slow  oxidation 
of  organic  matters  in  a  state  of  decomposition. 
If  the  combination  takes  place  with  elevation 
of  temperature,  the  ozone  formed  is  immedi- 
ately broken  up. 

Thunderstorms  and  silent  electric  discharges 
in  the  atmosphere,  the  evaporation  of  water, 
especially  of  salt  water,  and  the  respiration  of 
plants,  especially  ConifercB^  are  among  the 
other  sources  of  ozone  in  Nature.  Its  presence 
may  be  detected  by  the  blue  coloration  which 
it  brings  about  in  tincture  of  guaiac,  the  decol- 
orization  of  indigo,  or  the  liberation  of  iodine 
from  combination  in  potassium  iodide,  as  dem- 
onstrated by  the  blue  reaction  of  starch  paper. 

One  source  of  fallacy  in  observation  is  the 
fact  that  most  of  the  agents  employed  to  detect 
atmospheric  ozone  react  similarly  to  hydrogen 
dioxide,  but,  allowing  for  this,  the  production 
of  ozone  in  Nature  must  be  extensive,  and  its 
destruction  almost  equally  so.  It  is  the  great 
natural  purifier,  attacking  energetically  putre- 
fying materials  and  converting  deleterious  into 
harmless  products,  nitrous  and  nitric  acids, 
water,  hydrogen  dioxide,  and  carbon  dioxide. 
Sehonbein  showed  that  one  part  of  ozone  in 
3,240,000  of  air  was  sufficient  to  destroy  the 
odour  of  decay  in  a  vessel  of  60  litres  (about 
127  pints)  in  which  had  been  placed  for  one 
minute  120  grammes  (about  4  oz.)  of  putrid 
meat,  and  later  observers  have  abundantly 
demonstrated  its  deodorizing  properties.  (Fox, 
Ozone  and  Antozone,  London,  1873.)  Under 
ordinary  conditions,  it  does  not,  however,  de- 
stroy bacteria,  moisture  of  the  ozone  and  its 
prolonged  contact  in  quantity  with  the  germs 
being  necessary,  while  the  presence  of  lifeless 
organic  matter  retards  or  prevents  the  action 
cf  ozone  on  the  living  matter.* 

"Various  diseases  have  been  attributed  to  the 
increase  of  ozone  in  the  atmosphere,  especially 
pneumonia  and  influenza.  It  is  unquestionable 
that  ozone,  if  respired  in  appreciable  quantity, 
will  excite  catarrhal  inflammation  of  the  re- 
spiratory tract,  and  that  at  times  its  presence 
in  the  atmosphere,  in  notable  quantities,  is  co- 
incident with  an  epidemic  of  pulmonary  in- 
flammation or  with  la  grippe.  On  the  other 
hand,  both  of  these  diseases  have  been  found 
to  be  epidemic  at  times  when  the  ozone  of  the 
atmosphere  was  at  a  minimum.  Diminution 
of  atmospheric  ozone  has  been  found  to  be  co- 
incident with  epidemics  of  cholera.  This  loss 
of  ozone  has  by  some  been  placed  among  the 
causative  factors  of  the  epidemic,  and  by  others 
referred  to  the  increased  destruction  of  ozone 
by  the  germs. 

Physiological  Effects. — The  evidence  as 
to  the  action  of  ozone  upon  man  and  animals 
is  confused  and  contradictory.f  Albumin  is 
rendered  incoagulable  by  acids  or  boiling  after 
exposure  to  ozone.  Blood  out  of  the  body  be- 
comes dark,  then  black,  when  ozone  is  passed 

*  Ohlmtiller.  Ueber  die  Einwirkung  des  Ozons  auf 
Bakterien.  Arbeiten  auft  dem  kaiserlichen  Gesund- 
heitsamte,  viii,  1,  Berlin,  1892. 

t  For  extensive  bibliography,  see  Morton,  loc.  cit. 


through  it,  finally  becoming  a  clear  fluid  with- 
out albumin,  a  gas  not  analyzed  being  given 
off.  Hiemoglobin,  like  vegetable  protoplasm, 
if  brought  in  contact  with  ether  or  terebinthi- 
nate  oils  which  have  absorbed  ozone,  will  at 
once  cause  the  latter  to  give  up  their  ozone. 
It  has  also  been  demonstrated  that  red  blood- 
cells  (or  haBmoglobin)  can  transform  the  oxygen 
of  the  air  into  ozone  by  coiilact,  even  afterthey 
have  become  saturated  with  carbon  monoxide, 
which  prevents  them  from  absorbing  oxygen, 
the  action  being  comparable  to  that  of  the 
platinum  sponge.  It  has  been  supposed  that 
the  blood  transforms  into  ozone  the  oxygen 
which  it  absorbs,  and  that  the  same  effect  is 
produced  within  the  blood  by  tissue  oxidation 
without  elevation  of  bodily  heat.  Binz,  how- 
ever, by  agitating  ozone  with  a  solution  of 
albumin  and  guaiac,  with  the  result  that  the 
guaiac  was  not  discoloured,  while  the  albumin 
was  transformed,  proved  that  free  ozone  could 
not  exist  in  the  blood  serum,  though  the  oxygen 
of  oxyhjemoglobin  might  be  yielded  up  as 
ozone  under  some  circumstances.  The  quan- 
tity of  ozone  ordinarily  contained  in  the  air 
is  about  1  part  in  450,000  by  weight,  1  in 
700,000  by  volume,  at  about  20  metres  above 
the  earth.  This  quantity,  absorbed  during 
respiration,  plays  the  part  of  a  useful  stimu- 
lant ;  and  to  the  absence  of  ozone  from  the 
atmosphere  has  been  attributed  the  torpor  and 
malaise  which  occur,  especially  in  nervous 
women,  at  certain  times — particularly  in  hot, 
moist  weather  and  before  the  approach  of 
thunderstorms.  The  fact  that  these  symptoms 
frequently  disappear  after  the  storm  is  attrib- 
uted to  the  generation  of  atmospheric  ozone  by  , 
the  electric  discharges.  In  large  quantities, 
however,  ozone  is  irritating  to  the  air-passages 
and  destructive  to  the  blood.  Birds,  which 
live  in  the  atmospheric  regions  ordinarily 
richest  in  ozone,  are  the  least  affected  by  its 
toxic  action  ;  however,  in  sufficient  concentra- 
tion (1  in  2,0()0}  it  may  prove  toxic  even  to  birds, 
causing  not  only  violent  pulmonary  inflamma- 
tion, with  catai'rhal  discharges  from  the  mu- 
cous membranes  in  genera],  as  in  the  case  of 
any  other  irritating  gas.  but  coagulation  of  the 
blood,  proving  almost  immediately  fatal.  As 
the  passage  of  ozone  through  coagulated  blood 
outside  of  the  body  restores  its  fluidity,  the 
coagulation  of  the  blood  which  follows  ozone 
poisoning  has  been  attributed  not  to  a  direct 
fibrinogenetic  influence,  but  to  a  destructive 
influence  upon  the  lung  epithelium  and  even 
the  red  cells,  interfering  with  the  discharge  of 
carbon  dioxide,  which  therefore  accumulates 
in  the  organism,  and  may  give  rise  to  all  the 
toxic  symptoms.  There  is  depression  of  the 
heart  and  nervous  system,  due  partially  to  the 
destructive  action  of  ozone  upon  the  albumin 
of  their  tissues,  partially  to  carbon  dioxide 
poisoning,  and  partially  to  reflex  irritation 
from  the  air-passages.  In  moderate  doses  by 
inhalation  or  by  internal  use  in  water  or  in  oil, 
ozone  acts  as  a  local  antiseptic  and  under  some 
circumstances  as  a  stimulant  to  metabolic  pro- 
cesses, and  hence  to  nutrition  in  general.  A 
regenerative  influence  upon  the  red  blood-cells 
has  been  attributed  to  it. 


PALMETTO  WINE 
PAPAW 


58 


Therapeutics. — In  therapeutio  applications, 
ozone  has  thus  far  been  demonstrated  to  have 
but  a  limited  field  of  usefulness.  Its  bacteri- 
cidal properties  are  not  available  in  treatment, 
tiiough  its  deodorizing  and  disinfectant  powers 
are  useful  in  preventive  medicine.  Thus,  it 
should  be  evolved  in  quantities  in  public  halls 
after  the  presence  of  crowds,  and  in  small 
quantities  during  their  occupany.  In  croup, 
diphtheria,  whooping-cough,  scarlet  fever, 
small-pox,  cholera,  and  similar  infectioiis,  if 
the  sick-room  can  be  charged  with  ozone  in 
moderate  quantity  the  patients  will  do  better 
and  contagion  will  be  minimized.  This  is  the 
probable  usefulness  of  the  evolution  of  vapours 
of  turpentine,  eucalyptus,  and  the  lilce.  To 
disinfect  the  sick-room  after  contagious  dis- 
eases, ozone  evolved  in  the  largest  possible 
quantity  is  more  efficacious  than  sulphurous 
fumigations  or  other  ordinary  means.  The 
presence  of  moisture  retards  the  conversion  of 
oxygen  into  ozone,  but  assists  the  process  of 
disinfection  after  the  ozone  has  been  produced. 
By  direct  inhalation,  ozone,  largely  diluted, 
may  be  employed  with  caution.  Statements  as 
to  doses  are  quite  discrepant  in  form  and  sub- 
stance. French  observers  speak  of  -jV  milli- 
gramme of  ozone  to  the  litre  of  air.  Morton 
recommends  45  to  70  milligrammes  of  ozone  a 
minute  in  nasal  cases,  and  but  1  milligramme  a 
minute  in  chronic  bronchitis.  Ransome,  how- 
ever, states  that  his  tuberculous  patients  in- 
haled for  ten  or  fifteen  minutes  oxygen  of 
which  9  per  cent,  had  been  electrified  into 
ozone.  Yet  a  mixture  containing  10  parts  of 
ozone  in  one  hundred  has  proved  fatal  to  large 
animals. 

By  inhalation,  ozone  has  been  used  by  com- 
petent observers  with  apparent  good  effect  in 
diphtheria,*  in  cholera,  in  chronic  nasal  ca- 
tarrh, bronchitis,  asthma,  and  emphysema,  in 
gout  and  diabetes,  in  pernicious  anosmia,  and 
other  diseases  of  the  blood.  In  ozmna  it  may 
prove  of  great  benefit  not  only  as  a  deodor- 
izer, but  as  a  stimulant  to  the  nasal  mu- 
cous membrane,  increasing  watery  secretion 
and  facilitating  the  reproduction  of  healthy 
epithelium.  Caille  has  thought  ozone  inhala- 
tions beneficial  in  early  pulmonary  tuberculo- 
sis, while  Ransome  (Med.  Chronicle,  viii,  1888, 
p.  37;  X,  1889,  p.  97)  observed  great  ameliora- 
tion in  advanced  cases  of  pulmonary  phthisis, 
especially  improved  appetite  ami  sleeping  pow- 
er, and  consequent  gain  in  weight. 

Mr.  J.  C.  Dittrich  has  recently  introduced 
preparations  of  ozone  dissolved  in  water  (with 
the  addition  of  2-5  per  cent,  of  sodium  hypo- 
phosphite)  in  various  vegetable  and  ethereal 
oils  and  in  cod-liver  oil.  These  preparations, 
unfortunately,  have  proprietary  names  at- 
tached. Doubtless  they  will  be  found  useful 
as  gastric  and  intestinal  antiseptics,  as  stimu- 
lants to  the  circulation,  respiration,  and  diges- 
tion, and  if  the  ozone  escapes  destruction  in 
the  stomach,  as  a  means  of  increasing  oxidiza- 
tion in  asthma,  in  gout,  in  diabetes,  and  other 
affections. 

[The  results  of  the  examination  of  twenty- 


*  Vide  CaiU6,  Archives  of  Paediatrics,  Aug.,  1893. 


two  cases  of  whooping-cough  treated  exclusively 
with  inhalations  of  ozone  have  convinced 
Labbe  and  Oudin  {Progr.  med.,  July  20,  1895) 
that  the  use  of  ozone  produces  an  immediate 
amelioration.  The  spasms  of  coughing  are 
rapidly  modified,  not  only  in  frequency,  but 
also  in  intensity  and  duration.  The  respiratory 
troubles,  the  cyanosis,  and  the  vomiting  almost 
entirely  disappear.  The  general  condition, 
says  M.  Labbe,  naturally  feels  this  favourable 
modification  ;  the  children  recover  their  spirits, 
their  appetite,  and  their  former  healthy  ap- 
pearance. None  of  M.  Labbe's  patients  were 
attacked  with  the  broncho-pulmonary  compli- 
cations which  are  so  often  observed  in  this  dis- 
ease. The  authors  think  that  in  whooping- 
cough  ozone  seems  to  have  a  special  antiseptic 
action.] 

It  is  quite  possible  that  some  of  the  good 
effects  observed  in  cases  of  chronic  malnutri- 
tion of  various  kinds  treated  with  Pranklinio 
electricity  are  to  be  attributed  to  the  ozone  de- 
veloped during  the  application.  The  whole 
subject  is  still  in  too  much  uncertainty  to  war- 
rant positive  statements.  It  should,  however, 
receive  greater  attention  from  clinicians. 

Solomon  Solis-Cohen. 


PALMETTO  WINE.— According  to  Dr. 
Ira  W.  Porter,  of  Sanford,  Florida  (South.  Med. 
Record,  Aug.,  1895),  the  raw  palmetto  of  the 
Southern  States  seems  to  have  a  medicinal 
action  on  mucous  surfaces,  and  has  been  used 
with  good  results  in  bronchitis,  laryngitis, 
follicular  pharyngitis,  amygdalitis,  awA  gonor- 
rhoea; also  to  promote  the  growth  of  the 
mammae  and  to  act  as  a  tonic  and  fattening 
agent.  Palmetto  wine  seems  to  be  a  wine 
made  from  the  juice  of  Florida  oranges  im- 
bued with  palmetto  in  some  manner  that  Dr. 
Porter  does  not  describe.  He  states  that  he 
has  prescribed  it  with  success  in  a  case  of 
nervous  impotence.  The  dose  is  not  men- 
tioned. 

PAMBOTANO.  —  This  is  the  Mexican 
shrub  Anneslea  grandiflora.  Bocquillon  has 
isolated  a  glucoside  from  it.  Its  active  prin- 
ciples are  said  to  be  soluble  in  water  and  in 
alcohol.  Morales  and  Labato  have  found  it  an 
efficient  remedy  in  malarial  diseases.  Crespin, 
of  Algiers  (Bull.  gen.  de  iherap.,  Aug.  15, 1895), 
reports  that  he  has  found  it  effective  in  many 
cases  in  which  other  remedies,  including  qui- 
nine, had  failed,  especially  of  the  quotidian 
and  simple  continued  forms,  also  those  of 
chronic  malarial  poisoning;  but  in  malarial 
neuralgia  and  in  bilious  and  pernicious  cases 
it  appears  to  exert  no  decided  remedial  action. 
Pambotano  is  said  to  be  an  appetizer  and 
stomachic  tonic  of  the  first  rank.  Valude,  who 
reports  that  he  has  used  it  with  success  in 
various  non-malarial  febrile  affections,  such  as 
typhoid  fever,  influenza,  and  t\\e  fever  of  tuber- 
culosis, recommends  the  administration  of  a 
decoction  of  about  17  drachms  of  the  root- 
bark  as  a  single  dose.  Pambotano  is  said  to 
be  perfectly  harmless. 


59 


PALMETTO  WINE 
PAPAW 


PANCREATIC  EMULSION.  —  More 
than  thiiiy  years  ago  Dr.  Horace  Dobell,  ot 
London  (On  luberculosis  ;  its  JfJalure,  Cause, 
and  Treatment.  With  Notes  on  Pancreatic 
Juice,  2d  ed.,  London,  1866),  suggested  the 
hypothesis  that  tubercalusis  was  due  to  de- 
fective action  of  the  pancreas.  A  sudden,  al- 
most complete  or  total  suspension  of  normal 
pancreatic  secretion  accounted,  to  his  mind, 
for  acute  tuberculosis;  a  less  complete  sus- 
pension or  perversion  of  the  function  of  the 
pancreas  led  to  chronic  tuberculosis ;  and  inter- 
mittent pancreatic  derangement  of  either  sort 
was  at  the  bottom  of  recurrent  tuberculosis. 
Acting  on  this  theory,  odd  as  it  now  seems,  Dr. 
Dobell  set  about  treating  consumptives  with 
various  preparations  of  the  pancreatic  secretion 
of  the  pig,  and  finally  settled  on  an  emulsion  of 
beef  fat  and  pancreatic  juice.  This  pancreatic 
emulsion,  in  the  form  in  which  it  was  at  last 
put  upon  the  market,  resembled  lard  in  ap- 
pearance. Although  repulsive  to  some  pa- 
tients, it  was  readily  tolerated  by  some  others 
who  could  not  take  cod-liver  oil.  While  we 
can  not  look  upon  it  as  in  any  sense  a  cure 
for  consumption,  it  is  undoubtedly  a  nutrient 
of  great  value,  especially  suited  to  persons 
whose  power  of  digesting  fat  is  weak.  About 
an  ounce  ot  the  emulsion,  thoroughly  mixed 
with  a  pint  of  milk,  may  be  given  daily. 

PANCBEATIC  EXTRACT.— See  Pan- 
CREATiN  and  under  Animal  extracts  and 
JUICES,  page  80, 

PANCREATIN,  pancreatinum  (U.  S.  Ph.), 
extract  of  pancreas,  paricreatic  extract,  is  de- 
fined in  the  Pharmacopoeia  as  a  mixture  of 
the  enzymes  existing  in  the  pancreas  of  warm- 
blooded animals.  It  is  usually  obtained  from 
the  fresh  pancreas  of  the  hog.  It  sometimes 
occurs  in  yellowish,  brittle  scales,  but  more 
commonly  as  a  yellowish-white,  amorphous 
powder  without  odour  or  having  a  peculiar 
faint  odour  and  a  faint  meat-like  taste.  It  is 
almost  completely  soluble  in  water,  but  in- 
soluble in  alcohol.  The  ferments  found  in 
pancreatin  are  those  of  the  pancreatic  juice, 
and  are  at  least  three  in  number:  trypsin, 
which  converts  albumins  into  peptones  ;  pty- 
alin,  an  emulsive  ferment;  and  aniylopsin, 
which  converts  starch  into  dextrin  and 
sugar.  It  also  has  faint  milk-curdling  prop- 
erties, due  probably  to  a  ferment.  The  pan- 
creatic ferment  acts  in  alkaline  or  neutral 
solution.  An  acid  destroys  its  activity.  Its 
chief  digestive  action  is  exercised  upon  the 
pvoteids  and  starches.  It  converts  the  former 
into  peptones  and  certain  minor  products 
through  the  agency  of  the  trypsin.  The 
pancreatic  juice  is  the  chief  agent  for  the 
digestion  of  starch,  which  it  converts  into 
glucose.  Pancreatic  digestion  of  proteids  dif- 
fers materially  from  peptic  digestion.  The 
pancreatic  ferment,  in  an  alkaline  medium, 
acts  chiefly  on  fibrin,  which  it  corrodes  away, 
forming  leucine,  tyrosine,  hemipeptone,  and 
several  other  less  important  products.  The 
peptic  ferment,  in  an  acid  medium,  acts  best 
on  albumin,  which  swells  before  it  is  dissolved. 
The  products  of  this  digestion  are  peptones, 
48 


albumose,  and  syntonin.  Five  grains  of  good 
commercial  extract  of  pancreas  will  digest  a 
pint  of  milk  rendered  alkaline  by  bicarbonate 
of  sodium.  Pancreatic  extract  acts  upon 
starch  paste  with  great  rapidity,  5  grains  being 
sufficient  to  almost  immediately  con\ert  100 
grains  of  starch  into  sugar. 

Pancreatin  is  chiefly  used  in  medicine  for 
the  purpose  of  pi'edigesling  food.  This  sub- 
ject is  fully  considered  in  the  article  on  Ali- 
mentation, to  which  1  he  reader  is  referred. 
It  is  not  infrequently  given  in  capsules  or 
tablets,  in  doses  of  from  3  to  5  grains.  The 
utility  of  the  preparation  thus  employed  is 
doubtful,  as  its  activity  is  probably  at  once 
destroyed  by  the  acid  secretion  of  the  stomach. 
It  is  best  administered  from  two  to'four  hours 
after  meals.  For  the  purpose  of  making  so- 
called  peptonized  foods  it  is  an  agent  of  the 
utmost  value  in  the  nourishment  of  patients 
seriously  ill  or  sufi'ering  from  impaired  diges- 
tion. The  pancreatic  ferment,  trypsin,  is  used 
for  a  variety  of  purposes  for  which  the  extract 
is  not  employed,  and  is  considered  in  its  proper 
place. 

[Of.  Pancreatic  extract,  under  Animal  ex- 
tracts AND  JUICES,  vol.  i,  page  80.] 

Floyd  M.  Crandall. 
PANSY. — See  Viola  tricolor. 
PAPAIN,   PAPAIVA.— See  under  Pa- 
paw. 
PAPAVER.— See  Poppy. 
PAPAW,  papain,  papaiva,  papayotin,  or 
papoid,  is  a  ferment  prepared  from  the  juice 
of  the  papaw  tree  of  South  America  and  the 
West  Indies.     It  is  obtained  by  incising  the 
half-ripe  fi'uit  of  Carica  papaya.    A  white, 
milky  juice  exudes,  which  on  drying  forms  a 
white  amorphous  or  slightly  granular  powder 
which  has  a  slightly  astringent  but  not  acrid 
taste.    This  powder  contains  a  ferment  which 
has  not  as  yet  been  obtained  in  a  state  of  ab- 
solute purity.    It  is  freely  soluble  in  water  and 
in  glycerin,  but  is  precipitated  by  alcohol  and 
the  tinctures,  acetate  of  lead,  tannic  acid,  and 
nitric  acid. 

Papain  is  a  proteolytic  agent  of  decided 
power.  It  resembles  in  its  action  trypsin  more 
closely  than  either  of  the  other  natural  digest- 
ive ferments,  its  final  product  being  leucine. 
Like  trypsin,  it  acts  in  an  alkaline  or  neutral 
medium,  but  unlike  trypsin,  it  acts  also  in  a 
slightly  acid  medium.  Its  action  is  arrested 
but  not  wholly  destroyed  by  hydrochloric  acid. 
It  has  been  said  that  it  is  not  a  true  ferment, 
but  rather  a  solvent.  Sharpe  affirms  that  its 
action  is  that  of  hydration.  This  view  is  not 
generally  held  by  more  recent  observers.  It 
is  maintained  by  Woodbury  that  it  has  a  slight 
effect  in  converting  starch  into  maltose.  This 
action  has  not  been  observed  by  others.  Its 
action  is  not  interfered  with  by  the  ordinary 
antiseptics. 

Although  its  digestive  power  is  great,  its 
action  has  probably  been  somewhat  overesti- 
mated. A  feature  of  great  importance  is  the 
fact  that  it  is  active  in  both  acid  and  alkaline 
media,  and  may  be  administered  in  hydro- 
chloric acid  or  in  an  alkaline  mixture.    It  is 


PARA-ACETPHENETIDINE 
PARALDEHYDE 


60 


employed  in  the  various  conditions  in  whicli 
pepsin  is  indicated — namely,  in  forms  of  dys- 
pepsia resulting  from  deficiency  of  gastric 
juice.  It  is  especially  efficient  in  those  forms 
of  gastric  catarrh  which  are  marked  by  an  ex- 
cessive secretion  of  mucus,  a  condition  espe- 
cially common  in  chronic  alcoholism.  In  such 
conditions  it  should  be  given  before  meals,  as 
it  seems  to  have  the  power  to  a  certain  degree 
of  removing  the  unhealthy  mucus.  Another 
dose  may  be  given  after  the  meal.  As  is  the 
case  with  pepsin,  its  good  effects  are  frequently 
transient,  and  no  curative  results  follow  its 
use:  In  these  conditions  the  dose  varies  from 
1  to  5  grains;  3  or  3  grains  are  frequently  as 
efficacious  as  larger  amounts.  It  may  be  ad- 
ministered in  capsules,  powder,  solution,  or 
compressed  tablets.  The  last-mentioned  form 
is  the  one  most  commonly  employed.  It  is 
very  unstable,  and  in  solution  with  plain  water 
,  quickly  decomposes.  If  the  solution  is  ren- 
dered slightly  acid  or  alkaline  it  does  not  de- 
compose so  readily.  A  solution  containing 
glycerin  keeps  indefinitely.  As  the  ferment  is 
more  active  in  concentrated  solution,  it  should 
not  be  given  largely  diluted,  and  but  small 
quantities  of  water  should  be  taken  by  the 
patient  with  his  meals.  In  dilatation  of  the 
stomach,  where  a  dry  diet  is  used,  papain  acts 
especially  well.  The  treatment  of  digestive 
disorders  by  digestive  ferments  is,  as  a  rule, 
unsatisfactory.  The  applications  of  papain 
would  seem  to  be  more  extensive,  however, 
than  those  of  pepsin  or  pancreatin,  as  it  can 
be  combined  with  a  much  larger  number  of 
drugs.  Its  use  may  therefore  be  added  for  its- 
temporary  effect  to  other  treatment  designed 
to  cure  the  diseased  condition. 

Papain  has  the  undoubted  power  of  de- 
stroying intestinal  parasites.  It  is  effectually 
used  for  the  removal  of  roundworms  and  tape- 
worms. In  large  doses  it  seems  to  have  a  toxic 
effect  on  the  worm.  In  smaller  and  repeated 
doses  it  seems  to  be  efficacious  through  its 
power  of  digesting  albuminous  substances.  It 
is  used  most  successfully  in  doses  of  from  3  to 
3  drachms,  which  should  be  given  in  the  morn- 
ing, the  patient  having  been  prepared  with  the 
same  care  as  should  be  exercised  when  other 
tseniatuges  are  employed.  It  is  wise  to  com- 
bine it  with  bicarbonate  of  sodium,  to  neutral- 
ize somewhat  the  acids  of  the  stomach  so  that 
the  drug  may  act  most  effectually. 

The  use  of  papain  for  dissolving  the  mem- 
brane of  diphtheria  has  been  vigorously  advo- 
cated by  Jacobi.  He  applies  to  the  membrane 
a  solution  of  papain  in  glycerin,  one  part  to 
four.  The  solvent  power  of  the  solution  thus 
applied  is  undoubted,  and  in  many  oases  its 
good  effects  are  equally  clear.  It  has  not,  on 
the  whole,  however,  proved  so  efficacious  as  to 
have  maintained  its  position  as  an  efficient  and 
satisfactory  remedy  in  diphtheria.  At  the 
present  time  it  is  but  little  used.  It  is  em- 
ployed in  surgery  in  the  same  manner  as  tryp- 
sin. As  a  dusting  powder,  it  has  been  used 
with  bicarbonate  of  sodium  in  the  proportion 
of  five  parts  to  one,  or  with  equal  parts  of  boric 
acid.  As  a  paste  for  unhealthy  sores  or  slov-gh- 
ing  tissue,  a  drachm  of  papain  may  be  thor- 


oughly mixed  with  3  drachms  of  glycerin  or 
with  boroglyceride.  For  injection  into  cavi- 
ties or  sinuses,  a  drachm  may  be  dissolved  in 
3  drachms  of  glycerin  and  6  drachms  of  water. 

[According  to  Dr.  Cerna,  papoid  has  been 
recommended  for  dissolving  accumulations  of 
cerumen  in  the  ear ;  it  has  been  used  with  de- 
cided success  in  the  treatment  of  fissure  of  the 
tongue  after  the  failure  of  other  applications, 
such  as  iodoform,  chromic  acid,  and  nitrate  of 
silver ;  and  it  has  been  employed  advantage- 
ously in  the  treatment  of  syphilitic  ulcerations 
of  tlie  tongue. 

Dr.  J.  F.  Barbour  (Notes  on  New  Remedies, 
Jan.,  1894;  Am.  Jour,  of  the  Med.  Sci.,  Apr., 
1894)  reports  a  case  of  ulcer  of  the  stomach  in 
which  papain  relieved  the  symptoms,  including 
that  o£  pain,  which  did  not  return  when  the 
employment  of  the  remedy  was  discontinued, 
after  it  had  been  given  for  three  weeks. 

Mittra  (Med.  Reporter,  Jan.,  1894;  N.  Y. 
Med.  Jour.,  June  9,  1894)  uses  papaw  juice  in- 
ternally, usually  in  doses  of  10  drops.  He 
thinks  it  a  gastnc  sedative  of  great  power,  as 
is  seen  in  the  magical  relief  obtained  from  it 
in  certain  forms  of  gastric  irritation  and 
vomiting.  He  regards  it  as  a  valuable  antacid 
also,  more  trustworthy  than  sodium  bicarbon- 
ate. Locally,  it  may  be  used  as  a  solvent  of 
small  polypous,  warty,  and  other  growths.'] 
Floyd  M.  Cra]sdall. 

PARA  -  ACETPHENETIDINE.  —  See 
Phenacetine. 
PARABBOMACETANILIDE.— SeeAN- 

TISEPSIN. 

PAUACHLOROPHENOL,  PABA- 

CHLOBFHENOL.  —  See    under    Chloro- 

PHENOLS. 

PABACOTOIN,  PABACOTOINIC 

ACID. — See  under  Coro  bark. 

PARACRESALOL,       FARACRESOL 

SALICYLATE,  C6H4.0H,COO,C6H,.Cns,  is 
a  crystalline  compound  resembling  salol  in 
its  medicinal  virtues,  and  said  to  be  particu- 
larly efficient  as  an  intestinal  antiseptic.  It 
is  insoluble  in  water.  From  3  to  30  grains 
may  be  given  in  the  course  of  twenty-four 
hours,  preferably  in  wafers. 

PARAFFIN. — The  name  paraffin  was  ap- 
plied, in  1830,  by  Reichenbach  to  a  substance 
which  he  isolated  from  the  products  of  the 
dry  distillation  of  wood,  as  well  as  from  ani- 
mal tar  and  coal-tar.  This  substance  proved 
to  be  so  indifferent  toward  energetic  chemic.il 
reagents  that  he  based  its  Tiew  name  on  this 
property  (parMw  =  but  slightly,  a^nis  =  re- 
lated; combinable).  During  the  next  decade 
various  attempts  were  made  to  produce  this 
substance  on  a  large  scale,  for  Keichenbarh 
had  already  pointed  out  its  prospective  useful- 
ness as  an  illuminating  agent ;  but  it  was  not 
until  1850  that  marketable  amounts  of  it  were 
produced  in  England.  Since  then  the  produc- 
tion of  paraffin  has  become  very  extensive  in 
various  parts  of  the  world,  most  of  the  ma- 
terial being  used  for  candles. 

At  present  paraffin  is  obtained  chiefly  dur- 
ing the  distillation  of  brown  coal  (lignite),  turf, 


61 


PARA-ACETPHENETIDINE 
PARALDEHYDE 


petroleum,  or  ozokerite.  After  the  lighter  or 
lower-boiling  fractions,  so  far  as  they  are  pres- 
ent, have  been  driven  over,  the  distillate  be- 
comes heavier  and  more  viscid,  until  the 
temperature  of  about  265°  C.  is  reached,  when 
the  so-called  paraffin  oil  begins  to  pass  ovei-. 
As  the  temperature  increases  this  carries  over 
a  substance  practically  identical  with  it  in 
chemical  composition  but  capable  of  being 
separated  from  it  in  a  solid  condition  by 
cooling.  The  crude  distillate  is  treated  with 
strong  sulphuric  acid,  which  chars  the  accom- 
panying resinous  matters,  the  sulphuric  acid 
is  removed,  and  the  residue,  after  being 
washed,  is  again  distilled.  The  first  fraction 
is  liquid,  and  is  added  to  the  liquid  paraffin 
oils ;  the  remainder  of  the  distillate  constitutes 
the  paraffin,  which  is  set  aside  in  suitable  ves- 
sels to  crystallize.  The  crude  solidified  parai- 
fin  is  next  subjected  to  centrifugal  action  to 
remove  from  it  any  liquid  paratHn  that  may 
still  adhere  to  it,  and  is  then  treated  with  the 
lightest  benzin  to  dissolve  out  the  remainder 
of  the  adhering  impurities.  As  the  benzin 
dissolves  also  a  small  portion  of  the  paraffin,  it 
is  subsequently  subjected  to  special  processes 
to  recover  the  latter.  Finally,  the  remaining 
paraffin  is  melted  and  steamed  to  remove  the 
odour  of  benzin,  and  then  pressed  into  cakes. 

Commercial  paraflfin  is  colourless  when  liquid, 
white  and  translucent  when  solid ;  the  softer 
kinds  are  white  and  opaque.  It  becomes 
readily  plastic  when  warmed.  When  heated 
to  100°  C.  it  begins  to  volatilize.  At  about 
350°  C.  it  begins  to  boil  with  partial  decompo- 
sition. 

Paraffin  is  often  used  as  a  substitute  for  wax : 
in  this  case  the  high-melting  varieties  should 
be  chosen.  When  it  is  combined  with  ordi- 
nary fats  it  is  very  apt  to  separate  during  the 
process  of  cooling.  It  is,  therefore,  not  a  good 
constituent  of  ointments. 

The  use  of  paraffin  as  a  coating  for  pills,  or 
as  an  ingredient  in  pill-masses  for  potassium 
permanganate,  silver  nitrate,  etc.,  which  has 
been  repeatedly  advocated,  is  not  to  be  recom- 
mended, as  the  paraffin  is  absolutely  insoluble 
in  the  juices  of  the  digestive  organs. 

[Hard  paraffin,  paraffinum  durum  (Br.  Ph.), 
parafflmim  solidum  (Ger.  Ph.),  is  paraffin  wax. 
The  Br.  Ph.  prescribes  its  use  in  various  oint- 
ments. Soft  paraffin,  paraffinum  molle  (Br. 
Ph.).  is  vaseline,  the  petrolatum,  of  the  U.  S.  Ph. 
Liquid  paraffin,  paraffinum  Uquidum  (Ger. 
Ph.),  is  liquid  vaseline.]^— Charles  Rice. 

FARAFOB.M,  or  triformol.  a  polymer  of 
formaldehyde,  is  a  white  crystalline  substance 
almost  insoluble  in  water.  The  name  para- 
form  seems  to  have  been  given  to  it  by  Dr. 
Hans  Aronson,  who  introduced  it  as  an  anti- 
septic at  a  meeting  of  the  Berlin  Verein  fur 
innere  Medicin  held  on  March  5,  1894  i.Berl. 
Min.  Woch.,  Sept.  24,  1894).  It  is  chiefly  as 
an  internal  antiseptic  that  Aronson  advocates 
the  use  of  this  substance.  His  experiments 
show  that  in  germicidal  power  it  far  exceeds 
•salol,  benzonaphthol,  iodoform,  aristol,  bis- 
muth-tribromphenol.  and  naphthalin.and  that 
it  somewhat  excels  y3-naphthol ;  this  extraor- 


dinary efficiency  he  attributes  to  its  giving  ofl 
vapours  of  formaldehyde,  for  it  is  not  neces- 
sary to  place  it  in  actual  contact  with  the 
geims  to  secure  their  inactivity.  Paraform 
appears  to  be  almost  if  not  quite  free  from 
poisonous  properties;  Aronson  himself  took 
75  grains  of  it  in  the  course  of  twenty-four 
hours.  Aronson  likens  the  physiological  ac- 
tion of  paraform  to  that  of  calomel ;  in  various 
animals  and  in  man,  large  doses  (in  man  one 
or  two  doses  of  30  grains)  give  rise  to  diar- 
rhoea. Aronson  says  that  it  destroys  not  only 
bacteria,  but  also  their  poisonous  products ; 
guinea-pigs  he  has  found  able  to  take  with  im- 
punity large  quantities  of  a  highly  poisonous 
diphtheria  culture  in  bouillon,  provided  para- 
form is  added  to  it  in  the  proportion  of  1  to 
500.  At  the  time  of  his  report  he  had  used  it 
with  good  results,  in  twenty  cases  of  cholera 
infardum,  in  the  initial  stage,  in  doses  of  from 
J  of  a  grain  to  l-J  grain  every  two  hours.  He 
recommended  that  it  be  tested  also  in  the  in- 
cipient stage  of  typhoid  fever  and  cholera  in 
adults.  The  dose  for  adults  is  from  5  to  15 
grains,  three  times  a  day,  preferably  in  cap- 
sules. When  paraform  is  given  subcutane- 
ously,  formaldehyde  passes  into  the  urine ; 
when  it  is  given  by  the  mouth,  however,  this 
does  not  occur.  Paraform,  applied  pure  to 
raw  surfaces,  is  highly  irritant,  and  for  use  on 
u-ounds  and  ulcers,  therefore,  it  should  be  di- 
luted with  dermatol  or  tale.  Ointments  are 
not  suitable  for  diluting  paraform,  according 
to  Blaschko,  for  the  fat  contained  in  them  in- 
terferes with  the  liberation  of  fumes  from  the 
drug. 

PARALDEHYDE, jjaraMeAyA/TO  (U.  S. 
Ph.,  Ger.  Ph.),  CeHjOs,  is  a  polymeric  modifi- 
cation of  aldehyde.  As  found  in  the  shops, 
above  a  temperature  of  from  40°  to  53°  P.,  it  is  a 
colourless  liquid,  having  a  peculiar,  unpleasant, 
ethereal  odour  and  a  pungent,  disagreeable 
taste.  It  is  very  soluble  in  alcohol,  and  dis- 
solves in  about  8  parts  of  cool  water,  but  less 
readily  in  hot  water.  It  has  been  principally 
used  as  a  hypnotic,  but  in  appropriate  doses  it 
is  also  sedative,  depressant,  antispasmodic,  and 
diuretic.  Its  administration  in  large  doses  is 
followed  not  only  by  an  increased  flow  of  the 
watery  constituents  of  the  urine,  but  also  by  a 
marked  increase  in  the  elimination  of  urea.  In 
producing  sleep  paraldehyde  acts  very  much 
like  chloral,  with  the  important  difference  that 
it  has  less  depressing  effect  upon  the  heart.  It 
is  supposed  to  produce  sleep  by  its  action  on 
the  brain.  When  given  in  poisonous  doses  to 
the  lower  animals,  it  lessens  reflex  action, 
paralyzes  the  spinal  cord,  and  arrests  respira- 
tion before  the  heart  ceases  to  beat.  In  suffi- 
ciently large  doses  it  depresses  or  paralyzes 
the  vaso-motor  centres  so  that  dilatation  of 
the  arterioles  takes  place.  Decreased  arterial 
pressure,  slight  diaphoresis,  and  increased 
peristalsis  result  from  the  full  effects  of  this 
agent. 

Poisoning  from  Paraldehyde. — Thomas 
MacKenzie,  of  Douglas,  England  (Brit.  Med. 
Jour..  Dec.  12,  1891),  records  an  interesting 
and  instructive  case  of  poisoning  from  paralde- 


PARASITICIDES 
PASTES 


62 


hyde  in  a  woman  who  took  by  mistake  3J  oz. 
The  drug  was  taken  at  11  p.  M.,  and  the  patient 
was  not  found  until  the  next  morning,  when 
she  was  in  a  deep  stupor  and  limp,  like  a  per- 
son deeply  under  the  influence  of  chloroform, 
with  a  strong  odour  of  paraldehyde  on  the 
breath,  face  slightly  flushed,  pupils  moderately 
contracted  and  quite  insensitive  to  light,  pulse 
120,  respirations  40.  A  complete  recovery  took 
place.  Notwithstanding  every  means  was  used 
to  arouse  her,  it  was  forty-one  hours  from  the 
time  the  drug  was  taken  before  she  was  able 
to  understand  and  reply  to  simple  questions. 
This  remarkable  case  seems  to  indicate  the 
harmlessness  of.  paraldehyde  when  employed 
in  therapeutic  doses,  provided  there  is  no  con- 
tra-indication  to  its  use. 

The  Paraldehyde  Habit. — It  was  thought 
that  the  very  disagreeable  taste  and  odour  of 
paraldehyde  would  be  sufficient  to  prevent  a 
craving  or  habit  being  contracted  for  it,  but 
experience  has  taught  us  our  mistake.  Several 
cases  of  the  paraldehyde  habit  are  on  record, 
and  the  results,  mental  and  physical,  have  usu- 
ally been  disastrous  where  the  habit  has  been 
continued  a  great  length  of  time.  Dr.  Fred- 
erick Peterson,  of  New  York  (Med.  Record, 
Dec.  10,  1893),  records  an  apparent  exception. 
A  woman  took  ounce  doses  nightly  for  months 
and  grew  fat,  without  apparently  suEEering  any 
bad  efEects.  It  is  probable  that  if  such  cases 
are  watched  evil  efEects  will  manifest  them- 
selves, as  fatty  degeneration  of  the  liver  has 
been  experimentally  produced  in  animals  by 
the  use  of  large  quantities  of  paraldehyde. 
One  of  the  most  remarkable  cases  on  record  of 
the  paraldehyde  habit  is  one  recently  published 
by  Mr.  Prank  Ashby  Elkins  (Quart.  Jour,  of 
Inebriety,  Oct.,  1894,  p.  333),  in  which  the  pa- 
tient had  been  accustomed  to  take  16  oz.  of 
the  drug  a  week.  The  patient  rapidly  became 
emaciated,  and  presented  great  cardiac  and 
general  muscular  weakness  and- subsequently 
delusions  of  persecution,  with  mental  failure. 
A  complete  recovery  took  place  in  three 
mouths  under  restraint  and  appropriate  treat- 
ment. Symptoms  very  similar  to  those  of 
chronic  alcoholism  are  likely  to  follow  large 
doses  of  paraldehyde  continuously  employed 
for  a  considerable  length  of  time.  KraEEt- 
Ebing  has  observed  epileptoid  convulsions  to 
follow  the  prolonged  and  extravagant  use  of 
this  drug. 

Therapy.— T\\a,t  paraldehyde  in  a  large  pro- 
portion of  cases  is  an  efficient  hypnotic  no  one 
who  has  given  it  a  fair  trial  doubts.  In  these 
days,  when  the  agents  by  which  sleep  may  be 
produced  are  so  numerous,  the  physician  often 
finds  himself  puzzled  in  trying  to  decide  which 
one  to  select  for  an  individual  case  or  a  par- 
ticular class  of  cases.  The  large  dose  of  paral- 
dehyde, from  60  to  120  minims,  required  to 
produce  sleep,  and  its  repulsive  odour  and  dis- 
agreeable taste,  should  decide  against  this 
drug  when  another  equally  efficient  and  harm- 
less and  more  agreeable  to  the  patient  can  be 
obtained.  The  drug  under  consideration 
seems  to  be  a  respiratory  depressant,  and  I 
feel  inclined  to  indorse  Dr.  W.  H.  Flint's  con- 
clusions :   •'  It  is  contra-indicated  in  cases  of 


cyanosis  with  depression  of  the  respiratory 
centres,  as  in  the  advanced  stages  of  emphy- 
sema and  cardiac  dilatation"  (Therap.  Qaz., 
Jan.  1.5,  1890).     The  same  writer  believes  that 
paraldehyde  is  contra-indicated  in  most  cases 
of  insomnia  attended  with  much  physical  or 
mental  depression.     KrafEt-Ebing  has  found  it 
a  most  remarkable  hypnotic  in  the  ileeplessness 
of  insanity.     Dr.  Leech,  of  England,  regards 
it  as  the  best  hypnotic  for  continuous  use,  and 
Dr.  Clouston  favours  it  as  one  of  the  best  when 
the  insomnia  is  marked  and  intractable.     My 
rule  in  the  use  ot  hypnotics  is  never  to  employ 
any  one  continuously  for  a  prolonged  period, 
but  to  alternate  them,  from  time  to  time  and 
sometimes  to  give  two  or  more  in  combination, 
never  letting  the  patient  know  what  drug  he 
is  talcing.     The  three  hypnotics  on  which  I 
mainly  rely  are  sulphonal,  trional,  and  chlo- 
ralatnide.     In  some  cases  I  have  found  paral- 
dehyde to  act  better  than  any  of  the  three  just 
mentioned.     I  have   found  headache,  vertigo, 
nausea,   and   sometimes   one    or    two  watery 
evacuations  from   the   bowels  to   follow  full 
doses  ot  paraldehyde.     The  cases  of  insomnia 
in  which  this  hypnotic  seems  to  have  the  best 
effect  are   those  attended   with   mental    and 
nervous  excitement.     In  the  early  stage  of  de- 
lirium tremens  it  sometimes  afEords  prolonged 
and  refreshing  sleep.     I  have  never  used  it  to 
overcome  the  insomnia  of  chronic  alcoholics. 

[Dr.  B.  D.  Evans,  of  the  Morris  Plains  Hos- 
pital, Morristown,  N.  J.,  an  institution  for  the 
insane  (quoted  in  Ephemeris  of  Mat.  Med., 
etc.,  Jan.,  1896),  says  that,  although  this  drug 
is  established  as  a  valuable  and  reliable  hyp- 
notic, however,  there  are  two  serious  objections 
to  it ;  first,  that  it  gives  to  patients  when 
swallowing  it  the  sensation  of  smothering  or 
strangling,  and  second,  its  slow  elimination 
through  the  lungs,  leaving  some  patients 
drowsy  and  all  patients  with  its  strong  odour 
for  six  or  eight  hours  after  its  sleep-producing 
eEEeets  have  passed  away,  but  withal  it  may  be 
relied  upon  to  give  in  a  case  of  almost  any 
form  of  insomnia  from  four  to  six  hours  of  re- 
freshing sleep,  when  administered  in  doses  of 
from  1  to  3  fl.  drachms  in  equal  parts  of  whis- 
ky and  syrup  of  orange.  In  the  sleeplessnens 
of  chronic  alcoholism-,  alcoholic  mania,  deli- 
rium tremens,  and  "  chronic  disturbers,"  says 
Dr.  Evans,  this  drug  has  no  superior  as  a  hyp- 
notic. In  many  of  the  acute  forms  of  insanity 
it  acts  very  gratefully,  but  occasionally  it 
fails.  It  does  not  disturb  the  appetite,  and 
does  not  depress  the  heart's  action.] 

Dr.  A.  B.  Cook  has  found  paraldehyde  ser- 
viceable in  asthma,  puerperal  convulsions,  and 
cough  {Ann.  of  the  Unip.  Med.  Sci..  v,  A-115, 
1889).  In  twelve  cases  of  spasmodic  asthma, 
some  of  which  had  been  submitted  to  the 
usual  forms  of  treatment.  Dr.  William  Mackie 
succeeded  in  causing  the  disappearance  of  the 
spasm  in  a  short  time  by  the  administration  of 
paraldehyde  in  doses  of  ^  a  draclim,  repeated 
every  half  hour  until  the  eifeet  was  produced. 
The  author  never  was  obliged  to  give  more 
than  three  doses;  often  one  sufficed  (ibid.. 
V,  A-66,  1894). 
[In  the  British  Medical  Journal  for  March 


63 


PARASITICIDES 
PASTES 


21, 1896,  Mr.  Frederick  P.  Hearder  states  that 
lie  has  used  paraldehyde,  with  good  effect,  in 
about  thirty  cases  of  asthma,  iiicliidiiig  ordi- 
nary spasmodic  asthma,  asthma  with  epilepsy, 
with  heart  disease,  with  renal  disease,  and 
with  chronic  bronchitis,  and  in  two  cases  of 
asthma  with  pneumonia.  In  the  majority  of 
the  cases,  he  says,  relief  was  rapid  and  com- 
plete, and  in  the  remainder  the  distress  was 
lessened.  The  dose  employed  was  from  45  to 
60  minims,  and  one  dose  was  usually  siiHioient ; 
a  few  patients,  however,  needed  a  further  dose 
of  from  30  to  45  minims  an  hour  or  so.later. 
Using  these  doses,  Mr.  Hearder  has  never  ob- 
served any  untoward  action  of  the  drug,  but, 
on  the  contrary,  the  breathing  has  gradually 
become  easy  and  normal,  the  pulse  been  stead- 
ied and  strengthened,  and  the  patient  fallen 
into  a  comfortable  sleep.  A  point  in  dispens- 
ing, says  Mr.  Hearder,  is  that  the  addition  of  a 
few  drops  of  alcohol  renders  paraldehyde  per- 
fectly miscible  with  water ;  any  flavouring  tinc- 
ture can  be  used  for  this  purpose.] 

Humphrey  has  found  paraldehyde  an  excel- 
lent remedy  in  Gheyne-Stokes  respiration  asso- 
ciated with  broncho-pnsumvnia.  Ignatieff  and 
Tohervinsky  have  obtained  good  effects  from 
the  use  of  paraldehyde  in  the  treatment  of 
tetanus.  About  150  minims  were  given  daily, 
either  by  the  mouth  or  by  the  rectum  {Year 
Book  of  Treatment,  1892,  p.  112). 

Dose  and  Administration. — The  dose  to  pro- 
duce sleep  should  be  from  |  to  1^  drachm.  It 
is  better,  as  a  rule,  to  begin  with  the  smaller 
dose  and  repeat  it  every  hour  or  two  until 
sleep  results.  Small  doses  rarely  have  much 
effect  in  overcoming  obstinate  insomnia.  I 
have  found  the  elixir  of  Curagoa,  to  which 
some  alcohol  may  be  added  with  advantage,  an 
excellent  menstruum.  (See  also  under  Hyp- 
notics, vol.  i,  p.  509). 

Jeremiah  T.  Bskridgb. 

PAIl.A.SITICIDES.^See  Antiparasitics 
and  Anthblminthics. 

PARATALOID.— See  Tuberculin. 

FAB1EGOB.IC,  tinctura  opii  camphorata 
(U.  S.  Ph.),  camphorated  tincture  of  opium,  is 
virtually  an  elixir  containing  opium,  benzoic 
acid,  oil  of  anise,  camphor,  and  glycerin  in 
diluted  alcohol.  It  contains  somewhat  less 
than  a  grain  of  opium  in  each  half  ounce.  It 
is  therefore  the  weakest  official  preparation  of 
opium,  and  is  especially  adapted  to  use  where 
a  very  small  dose  of  that  drug  is  desired.  It 
is  largely  used  where  opium  is  indicated  in  dis- 
eases of  children,  as  the  dose  can  be  very  readily 
graduated.  The  camphor  renders  it  especially 
serviceable  in  diarrlicea.  In  this  disease  it  is 
used  in  enormous  quantities,  as  it  is  one  of 
the  commonest  ingredients  of  diarrhoea  mix- 
tures. It  is  a  serious  error,  however,  to  add  it 
to  a  mixture  which  is  to  be  given  at  short  in- 
tervals. The  younger  the  patient  the  more 
serious  does  this  error  become.  If  it  is  thus 
given  in  sufficient  quantities  to  produce  ap- 
preciable results,  it  is  difficult  to  avoid  narco- 
tism after  a  few  doses.  It  is  far  safer  and  the 
results  are  more  satisfactory  to  administer  it 
entirely  alone  at  sufficient  intervals  to  allow 


the  effect  of  one  dose  to  subside  before  another 
is  given.  The  diarrhoea  mixture  can  thus  be 
given  as  frequently  as  it  is  indicated  by  the 
symptoms.  Paregoric  is  also  a  frequent  in- 
gredient of  cough  mixtures.  One  of  its  chief 
effects  when  thus  used  is  to  destroy  the  ap- 
petite and  disturb  the  digestion.  The  same 
rule  as  to  frequency  of  administration  applies 
here  as  in  diarrhcea.  The  dose  must  be  grad- 
uated according  to  the  dose  of  opium  desired. 
This  varies  so  greatly  that  no  positive  rules  can 
be  given.  As  a  rule,  a  minim  for  each  month 
of  a  baby's  age  jnay  be  given  as  an  initial  dose. 
It  should  be  remembered  that  paregoric,  being 
an  alcoholic  solution,  drops  at  least  2  drops 
to  the  minim.  Twice  as  many  drops,  there- 
fore, should  be  given  as  minims.  Paregoric  is 
a  preparation  rarely  used  by  persons  addicted 
to  the  opium  habit.  In  the  few  cases  which 
have  come  under  the  writer's  observation  in 
which  it  was  used  the  results  have  been  espe- 
cially disastrous.  The  raw  alcohol  and  per- 
haps the  camphor  have  seemed  to  increase 
materially  the  bad  effects  of  the  opium.  (See 
Opium.) — Floyd  M.  Crandall. 

FAKEIB.A  (U.  S.  Ph.),  pareirw  radix  (Br. 
Ph.),  is  the  root  of  Chondodendron  tmnentosum, 
a  menisperraaceous  climbing  plant  indigenous 
to  tropical  America.  It  is  chiefly  used  in  the 
treatment  of  chronic  cystitis.  The  dose  of  the 
decoction,  decoctum  pareirce  (Br.  Ph.),  is  from 
1  to  2  fi.  oz. ;  that  of  the  extract,  extractum 
pareirce  (Br.  Ph.),  from  10  to  30  grains :  and 
that  of  the  fluid  extract,  or  liquid  extract,  ex- 
tractum pareirm  fluidum  (U.  S.  Ph.),  extractum 
pareirce,  liquidum  (Br.  Ph.),  from  -J  to  1  fl. 
drachm. 

FABIIiLA,  YELLOW.— See  Menisper- 

MUM. 

PARIS  GEEBN.— See  under  Arsenic. 

PABODYNE.— See  Antipyrine. 

PARSLEY. — See  Petroselinum  and  Apiol. 

PARTHENICINE.— Dr.  Ulrici,  a  Cuban 
physician  {Brit.  Med.  Jour.,  June  16,  1888 ; 
N.  Y.  Med.  Jour.,  Oct.  13,  1888),  has  experi- 
mented with  this  alkaloid,  obtained  from  the 
leaves  and  flowers  of  Parthenium  HysterophO' 
rus,  a  West  Indian  plant.  Parthenicine  is 
described  as  crystalline,  intensely  bitter,  and 
poisonous  to  animals.  It  is  said  ,  to  be  anti- 
pyretic, antiperiodic,  and  analgetic.  It  has 
been  given  in  daily  amounts  of  15  grains. 
Possibly  this  alkaloid  is  identical  with^aj-Me- 
nine,  obtained  fi-om  the  same  plant. 

PARTHENINE.— This  alkaloid,  possibly 
the  same  as  parthenicine,  is  obtained  from 
Parthenium  Bysterophorus.  It  has  been  used 
as  a  remedy  for  malarial  fever  and  neuralgia, 
in  doses  of  from  7  to  10  grains. 

PASTES. — These  are  plastic,  cohesive,  and 
adhesive  mixtures,  for  internal  or  external  use, 
according  to  the  nature  of  the  ingredients,  and 
intended  to  be  only  slowly  dissolved,  or  to 
exert  a  continuous  slow  action. 

The  "pastes"  for  internal  use  have  prac- 
tically ceased  to  be  an  object  of  the  apotheca- 
ry's art,  belonging  rather  to  the  sphere  of  the 
confectioner.    And  yet  many  medicines  might 


PASTILLES 
PELLBTIERINB 


64 


with  great  propriety  be  incorporated  with  such 
"  pastes " — for  instance,  with  those  of  marsh 
mallow,  jujube,  etc. — and  administered  in  this 
manner. 

Pastes  for  external  use  are  mostly  intended 
to  act  as  escharotics.  Those  more  or  less  in 
use  at  the  present  time  are  the  following; : 

C'anguoin's  Paste. — Rub  300  grains  of  fused 
zinc  chloride  to  a  powder,  and  make  a  paste 
with  1  fl.  drachm  of  alcohol.  Then  add  430 
grains  of  flour,  using  strong  pressure  with  the 
pestle.  When  the  paste  is  homogeneous,  roll 
it  into  strips  about  i  of  an  inch  thick,  allow 
them  to  stand  exposed  for  a  few  hours,  then 
transfer  them  to  well-closed  bottles. 

Latour's  Paste. — Dissolve  300  grains  of  fused 
zinc  chloride  and  600  grains  of  zinc  nitrate  m 
1  fl.  oz.  of  water,  allow  the  solution  to  coo],  and 
incorporate  600  grains  of  flour.  Roll  the  mass 
into  strips  about  i  of  an  inch  thick,  and  keep 
them  in  well-closed  bottles. 

Smith's  Paste. — Deprive  crystallized  zinc 
sulphate  of  its  water  by  the  heat  of  a  water- 
bath,  then  transfer  the  powder  to  a  crucible 
and  keep  it  at  a  low  red  heat  for  a  short  time. 
'Transfer  the  powder  while  hot  to  small  glass- 
stoppered  phials,  which  should  be  made  abso- 
lutely air-tight  with  wax  or  parafBn.  When 
the  paste  is  required,  open  one  of  the  phials 
and  mix  the  contents  by  means  of  a  glass  rod 
with  enough  concentrated  sulphuric  acid  to 
produce  a  plastic  paste.  (Recommended  and 
used  as  an  escharotio  in  cancer  by  Dr.  Stephen 
Smith.) 

Similar  pastes  are  those  known  under  the 
names  of  Michel,  Rust,  Velpeau,  and  Ricord, 
in  which  the  anhydrous  zinc  sulphate  is  re- 
placed by  powdered  asbestos,  saffron,  licorice 
root,  and  charcoal,  respectively. 

Vietma  Paste. — This  is  prepared  from  the 
oSicial  potassa  cum  caZce,  consisting  of  equal 
parts  by  weight  of  caustic  potassa  and  quick- 
lime, rubbed  together  in  a  warm  mortar  so  as 
to  form  a  fine  powder,  which  must  be  kept  in 
well-stoppered  bottles.  For  use  it  is  made  into 
a  paste  with  alcohol. 

Of  non-esoharotic  pastes,  the  following  de- 
serve mention : 

Lassar's  NapMhol  Paste. 

Beta^naphthol 10  parts ; 

Precipitated  sulphur 50      " 

laS'l-'^ ''      " 

Lassar's  liesorcin  Paste. 
(1.  Strong.) 

Resorcin,     J 

Zinc  oxide,  >  each 20  parts; 

Starch,         ) 

Liquid  paraffin 40      " 

(3.  Weak.) 

Resorcin 10  parts ; 

Zinc  oxide,  )       .  „>      ., 

Starch,         \  ^^'^^ ■^^ 

Liquid  paraffin 40      " 

Unna's  Lead  Paste. 

¥?S\^^-^ 30  parts; 

Rice  starch 10      " 

Vinegar 60     " 


Unna's  Zinc  Paste. 

i^?ch°"''''h-h ^^P-ts; 

Vaseline 50      " 

Charles  Rice. 

PASTILLES,  PASTILS,  are  small  cones 
or  tapers  prepared  from  an  aromatic  mass 
which,  when  dry,  can  be  made  to  burn  slowly 
at  a  glow,  and  thereby  cause  the  odorous 
substances  to  be  diffused  through  the  room. 
Their  preparation  on  the  small  scale  is  best 
carried  on  in  this  wny:  The  ingredients, 
well  mixed  to  a  tenacious  but  pliable  mass, 
are  rolled  out  on  a  board  or  on  the  pill-ma- 
chine into  uniform  cylinders  of  a  diameter 
of  about  J  or  J  of  an  inch,  which  are  out  into 
pieces  of  equal  length  and  shaped  into  small 
cones.  They  are  then  diied  at  a  gentle  heat. 
The  following  formula  is  recommended,  but 
this  may  be  modified  in  many  ways  to  produce 
different  odours : 

Med  Pastils. — Moisten  725  parts  of  red 
Saunders,  in  No.  50  powder,  with  a  solution  of 
75  parts  of  potassium  nitrate  in  1,000  of  water, 
and  dry  the  mixture.  The  object  of  this  is  to 
impregnate  the  powdered  wood  uniformly  with 
the  saltpetre.  Pre[)are  a  mixture  of  50  parts 
of  tincture  of  benzoin,  30  of  balsam  of  Peru, 
40  of  balsam  of  Tolu,  40  of  storax,  2  of  oil  of 
sandalwood,  and  ^  part  of  cumarin,  and  if  ne- 
cessary add  to  it  just  enough  alcohol  to  render 
it  homogeneous  and  capable  of  being  [loured. 
Having  mixed  the  powdered  red  saunders 
with  30  parts  of  powdered  tragacanth,  incor- 
porate with  it  the  odorous  mixture  thoroughly, 
and  finally  work  into  it  enough  mucilage  of 
tragacanth,  containing  2  per  cent,  of  potassium 
nitrate,  to  obtain  a  pliable  dough,  which  is  to 
be  rolled  out  and  formed  as  above  directed. 
Before  the  pastils  are  quite  dry  they  may  be 
painted  with  a  thin  coating  of  some  liquid 
metallic  bronze,  to  give  them  a  handsome  ap- 
pearance. 

Pastils  not  only  are  useful  for  diffusing  a 
pleasant  aroma,  but  may  also  be  made  the  me- 
dium of  impregnating  the  air  with  medicinal 
vapours.  Some  examples  (partly  after  Diete- 
rich)  will  show  how  this  may  be  done : 

Carbolic-acid  Pastils. — Mix  830  parts  of 
charcoal,  in  No.  50  powder,  with,  a  solution  of 
50  parts  of  potassium  nitrate  in  1,000  parts  of 
water,  and  dry  the  mixture.  Next  mix  it  with 
30  parts  of  powdered  tragacanth,  and  then  in- 
corporate with  it  thoroughly  100  parts  of  car- 
bolic acid  and  1  part  of  oil  of  wintergreen,  and 
finally  work  into  it  enough  mucilage  of  traga- 
canth (containing  2  per  cent,  of  saltpetre)  to 
give  the  mass  the  proper  consistence. 

Crcsol  Pastils. — These  are  made  like  the  pre- 
ceding, except  that  100  parts  of  cresol  (oresylic 
acid)  are  taken  in  place  of  the  carbolic  acid. 

Creosote  Pastils. — These  may  be  made  with 
50  parts  of  creosote. 

Tar  Pastils  inay  be  made  to  contain  from  50 
to  100  parts  of  tar. 

Chloride-nf-ammonium  Pastils. — Six  hun- 
dred and  fifty  parts  of  powdered  charcoal  are 
moistened  with  a  solution  of  250  parts  of  am- 
monium chloride,  75  of  potassium  nitrate,  5  of 


65 


PASTILLES 
PELLETIERIjSE 


sugar,  and  ^  part  of  oumarin  in  700  parts  of 
water,  and  then  dried.  The  powder  is  mixed 
with  20  parts  of  powdered  tragacanth,  and 
the  mixture  made  into  a  mass  with  mucilage 
of  tragacanth  (containing  2  per  cent,  of  salt- 
petre). Lastly,  10  drops  each  of  balsam  of 
Peru  and  oil  of  rose  are  incorporated,  and  the 
mass  is  formed  in  the  usual  manner.  Diete- 
rioh  recommends  giving  them  a  coating  of  sil- 
yer-bronze. 

lodide-of-ammonium  Pastils.  —  These  are 
made  like  the  preceding,  the  quantities  of  the 
first  three  ingredients  being  825  parts  of  char- 
coal, 100  parts  of  ammonium  iodide,  and  50  of 
potassium  nitrate. 

Iodine  Pastils. — Eight  hundred  and  eighty- 
five  parts  of  powdered  charcoal,  40  of  potas- 
sium nitrate,  5  of  sugar,  and  20  of  powdered 
tragacanth  are  combined  as  described  in  the 
preceding  formula.  To  the  mixture  is  added 
a  solution  of  50  parts  of  iodine  and  ^^  part  of 
nerolin  (the  synthetic  perfume)  in  200  parts  of 
ether ;  the  whole  is  spread  out  and  exposed  to 
the  air  for  a  few  minutes,  and  then  it  is  formed 
into  a  mass  with  mucilage  of  tragacanth. 
When  the  pastils  have  been  formed  they  must 
be  dried  without  heat.  To  prevent  further 
loss  of  iodine  as  far  as  possible,  they  should  be 
covered  with  a  coat  of  benzoin  by  several  times 
applying  a  tincture  of  benzoin  of  double 
strength.  When  they  are  perfectly  dry,  they 
must  be  kept  in  glass-stoppered  vessels  in  a 
cool  place. — Charles  Kice. 

PATTIililNIA.— See  Guaeaka. 

PEANUTS.— See  Arachis. 

PEAT  is  a  kind  of  carbonaceous  earth 
found  beneath  the  surface  and  composed 
principally  of  vegetable  roots  and  fibres  in 
various  stages  of  decomposition.  It  is  pro- 
duced under  several  different  conditions  of 
climate  and  topography,  but  usually  in 
swampy  or  marshy  places  or  where  the  atmos- 
phere is  for  a  considerable  portion  of  the  year 
foggy.  It  is  abundant  in  northern  Europe, 
Scotland,  Ireland,  and  India,  and  in  some 
parts  of  the  L^nited  States.  The  principal 
vegetables  which  by  their  decomposition  form 
peat  are  the  different  varieties  of  moss  called 
Sphagnum  and — especially  in  India — wild  rice. 
It  is  probable  that  peat  is  a  product  of  one 
stage  in  the  formation  of  coal,  and,  indeed,  it 
is  in  some  countries  extensively  used,  when 
dried,  as  fuel. 

Peat  is  usually  of  a  dark  or  blackish  colour ; 
it  is  spongy  and  in  its  more  superficial  layers 
contains  much  water.  Its  reaction  is  acid, 
due  to  the  presence  of  humio,  phosphoric,  and 
sulphuric  acids.  When  dried,  peat  is  a  light, 
very  absorbent  material  which — because  of 
these  properties  as  well  as  by  a  supposed  anti- 
septic quality,  due,  perhaps,  to  its  acid  constitu- 
ents— has  been  deemed  suitable  as  a  dressing 
for  wounds.  Like  dry  earth  and  charcoal,  it 
causes  the  disappearance  of  foul  odours  and 
improves  the  appearance  of  granulations. 
When  used  for  these  purposes,  the  peat  should 
be  dusted  upon  the  wound  quite  thick,  and 
should  be  often  renewed.  It  has  been  highly 
recommended  in  foul-smelling  ulcers  and  in 


gangrene.  Peat  may  also  be  used  as  an  ordi- 
nary wet  or  dry  surgical  dressing,  when  it  will 
be  found  convenient  to  have  it  sewed  into  bags 
of  cheese  cloth  made  in  various  sizes.  It  is 
supposed  to  have  a  special  virtue  as  a  wet 
dressing  or  poultice.  It  has  been  the  practice 
since  the  beginning  of  the  antiseptic  era  to 
moisten  the  wet  peat  dressing  with  one  or 
another  of  the  well-known  antiseptic  lotions, 
such  as  bichloride-of-mercury  or  carbolic-acid 
solution.  The  peat  then,  of  course,  has  little 
or  nothing  to  commend  it  over  the  more  usual 
dressings.  Still,  in  an  emergency,  such  as  may 
exist  in  time  of  war  where  for  one  reason  or 
another  the  ordinary  gauzes,  etc.,  may  be  un- 
obtainable, if  the  country  is  one  where  peat 
abounds  it  may  be  found  useful. 

Another  use  for  it  exists  in  certain  parts  of 
Europe  and  Africa — namely,  as  an  immersion 
medium  or  kind  of  bath  for  the  entire  body. 
The  peat  for  this  purpose  has  such  a  large  ad- 
mixture of  water  that  it  becomes  a  kind  of 
thin  mud  or  slime.    (See  Baths.) 

White  peat  is  the  name  of  a  very  finely 
powdered  silicious  earth  formed  from  extinct 
varieties  of  diatoms.  This  is  not,  properly 
speaking,  a  true  variety  of  peat,  but  is  soriie- 
thing  quite  different.  It  is  silicious,  not 
carbonaceous;  it  will  not  burn,  but  may  be 
sterilized  by  heat.  It  has  in  itself  no  antisep- 
tic qualities.  White  peat  in  bulk  is  used  as  a 
filter,  and  it  is  also  used  in  the  manufacture  of 
dynamite.  Arpad  G-.  Gerster. 

Howard  Lilienthal. 

PECTORALS.— See  Expectorants. 

PEDILXJVIUM.— The  foot-bath  (see  un- 
der Baths,  vol.  i,  p.  169). 

PELLETIEBINE,  the  active  alkaloid  of 
pomegranate,  is,  on  account  of  the  small  bulk 
of  the  dose  required,  the  most  elegant  icenia- 
cide  known,  but  is  hardly  suited  for  gen- 
eral use,  on  account  of  its  relatively  high 
cost.  In  appropriate  doses  it  appears  to  be 
without  any  marked  effect  upon  the  gen- 
eral economy,  but  in  unduly  large  amounts 
it  may  give  rise  to  vertigo,  diplopia,  and 
muscular  weakness,  and  in  some  instances 
it  has  been  known  to  cause  temporary  paraly- 
sis of  the  voluntary  muscles.  It  is  never  used 
in  its  basic  state,  but  either  as  the  sulphate  or 
the  tannate,  the  latter  being  regarded  as  the 
most  effective.  From  -J-  to  1  grain  may  be 
given  in  the  morning  after  the  preliminary 
treatment  given  in  the  article  on  Anthel- 
MiNTHios  has  been  followed  out.  It  is  usually 
followed  by  no  general  symptoms  except 
perhaps  a  slight  feeling  of  giddiness,  •  but 
may  excite  nausea  and  vomiting.  As  a  rule, 
it  may  be  depended  upon  to  purge,  but 
if  it  fails  to  do  so  within  two  or  three 
hours  a  cathartic  must  be  administered. 
The  proprietary  preparation  known  as  "  Tan- 
ret's  pelletierine  "  is  very  largely  used  instead 
of  the  tannate  and  appears  to  be  entirely  free 
from  objection.  Pelletierine  and  its  salts  have 
been  employed  in  the  treatment  of  paralysis 
of  the  third  and  fourth  cranial  nerves,  and 
with  reported  good  results. 

The  bark  and  stem  of  the  root  of  Pimica 


PELLITORY 
PENTAL 


66 


granatum,  or  pomegranate,  granatum  (U.  S. 
Ph.),  granati  radicis  cortex  (Br.  Ph.),  cortex 
granati  (Ger.  Ph.),  may  be  substituted  for 
pelletierine,  of  which  they  are  the  source,  but, 
on  account  of  the  considerable  bulk  necessary 
to  constitute  a  proper  dose,  the  crude  drug  is 
open  to  objection  and,  besides,  is  rather  more 
apt  to  cause  nausea  and  vomiting.  The  pow- 
dered drug  may  be  given  in  doses  of  -|  oz.,  but 
a  decoction  made  by  soaking  3  oz.  for  twenty- 
four  hours  in  a  quart  of  water  and  afterward 
reducing  it  to  oue  half  its  bulk  by  boiling  is 
preferable.  The  whole  amount  may  be  taken 
at  once,  but  it  is  more  usual  to  administer  it 
in  divided  doses  at  such  intervals  as  may  seem 
appropriate  in  individual  cases. 

[There  is  an  official  decoction,  decoctum 
granati  radicis  (Br.  Ph.),  the  dose  of  which 
is  from  2  to  4  fl.  oz.]. 

The  rind  of  the  fruit  and  the  flowers  also  are 
said  to  have  the  same  properties  as  the  bark. 
They  may  be  given  in  doses  of  from  30  to  30 
grains.  The  rind  is  also  astringent,  and  is 
sometimes  used  in  the  treatment  of  diarrhoea. 
(Of.  Anthelminthics). — Russell  H.  Nevins. 

PELLITORY.— See  Pyrethrum. 

FEIf  OILS,  also  called  bougies,  are  small  cy- 
lindrical rods  about  -^t;  to  J  of  an  inch  in  diam- 
eter and  from  about  8  to  6  inches  long,  pointed 
at  one  end,  and  weighing  from  15  to  30  grains. 
They  are  intended  to  be  introduced  into  cav- 
ities requiring  this  form,  such  as  the  urethra, 
sinuses,  etc.  They  may  be  formed  either  by 
hand  or  by  rolling  on  a  pill- tile  or  board,  or  they 
may  be  made  by  pouring  the  melted  mixture 
into  glass  tubes  previously  oiled  inside,  and 
then  pushing  the  pencils  out  by  means  of  a 
suitable  glass  rod.  They  may  be  made  of 
cacao  butter  or  of  gelatin.  Those  made  of 
cacao  butter  are  apt  to  be  very  brittle  and 
to  break  I  easily.  Those  made  of  gelatin  are 
preferable.  For  the  latter,  the  following 
method  may  be  employed :  Soak  10  oz.  of  the 
best  gelatin  in  water  until  it  has  become  soft;, 
pour  off  the  excess  of  water,  melt  the  softened 
gelatin,  add  16  oz.  of  glycerin,  and  heat  the 
mixture  on  a  water-bath,  constantly  stirring,  for 
about  an  hour.  Then  incorporate  or  dissolve 
in  it  the  medicinal  ingredient,  being  care- 
ful to  keep  the  mass  well  stirred  if  the  reme- 
dial agent  is  insoluble  in  the  mixture,  and 
pour  it  into  suitable  glass  moulds  previously 
coated  on  the  inside  with  oil  or  soap  liniment. 
When  the  mass  has  set,  push  it  out  by  means 
of  a  rod  and  cut  the  pencil  into  sections  of 
suitable  length.  As  glass  tubes  are  usually 
slightly  tapering,  it  is  well  tf  remember  that 
the  pencils  should  be  pushed  out  at  the  wider 
end. — Charles  Rice. 

PENNYBOYAL.— See  Hedeoma. 

PENTAL,  tHmethylethylene,  /3-isoamylene, 
CbHio,  an  isomer  of  amylene,  is  a  colourless 
and  very  inflammable  liquid  which  boils  at 
1004°  P.,  and,  though  volatile,  is  not  decom- 
posed on  exposure  to  light  or  air.  Its  odour 
is  strong  aijd  pungent  and  has  been  thought 
to  resemble  that  of  mustard.  Pental  is  insol- 
uble in  water,  but  with  alcohol,  ether,  and 
chloroform  it  is  misoible  in  all  proportions. 


The  physiological  action  of  pental  is  in  par- 
ticular that  of  a  general  ancesthetic  of  rapidly 
developed  but  transient  effect.  Prom  its  in- 
halation there  results,  usually  within  two  or 
three  minutes,  loss  of  sensibility  without  abso- 
lute loss  of  consciousness,  so  that  the  command 
to  open  the  mouth  or  perform  some  similar 
action  may  be  complied  with.  A  persistence  in 
the  administration  ot  the  drug,  however,  results 
in  narcosis.  The  unconsciousness  produced 
by  penfal  is  brief,  unless  the  administration  is 
continued,  its  duration  seldom  exceeding  four 
minutes.  The  return  to  consciousness  is  rapid 
and  is  apt  to  be  followed  by  a  brief  period  of 
analgesia,  during  which  operative  procedures 
may  sometimes  be  continued.  The  inhalation 
of  pental  is  but  slightly  irritating  to  the  respir- 
atory tract,  and  excitement  is  seldom  an  ac- 
companiment of  its  use,  but  occasionally  there 
may  be  observed  laughter,  delirium,  and  slight 
convulsive  movements.  During  the  period  of 
narcosis  the  pupils  are  usually  widely  dilated. 
The  corneal  reflex  is  late  to  disappear.  Sali- 
vation is  unusual,  and  muscular  relaxation 
is  generally  absent.  Upon  the  patient's  re- 
covering some  dizziness  and  unsteadiness  of 
gait  are  apt  to  occur,  but  as  a  rule  they 
disappear  rapidly.  It  has  been  said  that  there 
are  no  undesirable  sequels  of  pental  amesthe- 
sia,  but  this  is  certainly  a  mistake,  for  there 
are  credible  accounts  of  excitability,  tremors, 
difficulty  of  speech,  headache,  erythematous 
eruptions,  and  even  convulsive  movements. 
Albumin,  casts,  and  blood  cells  have  been 
found  present  in  the  urine  after  its  use.  That 
pental  anassthesia  may  be  safely  conducted  is 
no  doubt  true,  but  that  it  is  a  safe  anaesthetic 
is  questionable,  to  say  the  least.  Temporary 
cessation  of  respiration  with  cyanosis  is  not 
infrequent  during  its  administration,  and 
Cheyne-Stokes  respiration  has  also  been  ob- 
served. Moreover,  the  circulation  has  in  some 
cases  been  much  depressed,  and  death  has  un- 
doubtedly been  produced  by  it.  These  things, 
indeed,  are  scarcely  to  be  wondered  at,  since 
experiments  upon  animals  would  seem  to  indi- 
cate that  pental  is  a  circulatory  and  respira- 
tory depressant  of  considerable  vigour. 

Pental  may  be  administered  for  anaesthesia 
in  the  same  manner  as  chloroform.  For  a 
brief  effect  it  may  simply  be  dropped  upon  a 
cloth,  but  many  prefer  to  employ  an  inhaler 
for  the  purpose.  Junker's  in  particular  being 
thought  desirable.  The  use  of  pental  for  pro- 
longed anaesthesia  seems  hazardous,  but  it 
has  certainly  been  used  thus  with  success. 
The  amount  of  the  remedy  necessary  to  pro- 
duce anaesthesia  is  usually  from  1  to  3  drachms. 
It  is  said  that  some  few  individuals  are  in- 
susceptible to  its  action. 

The  operations  suited  to  pental  aufesthesia 
are  those  that  are  brief,  such  as  the  extraction 
of  teeth  and  the  opening  of  abscesses.  It  has 
been  particularly  recommended  for  producing 
anaesthesia  in  children.  Pental  maybe  used 
as  a  local  anmsihetic  in  the  form  of  a  spray. 

[The  Lancet  for  January  4,  1896,  after  men- 
tioning Wood  and  Cerna's  experiments  on  the 
physiological  action  of  pental.  and  their  conse- 
quent warning  that  it  was  a  dangerous  cardiac 


67 


PELLITORY 
PENTAL 


depressant,  says :  "  Riith,  as  late  as  1894,  came 
to  the  opposite  coticlusion,  asserting  pental  to 
he  a  safer  agent  than  chloroform  and  possess- 
ing many  advantages  over  ordinary  laughing- 
gas.  It  has  not,  however,  been  extensively 
employed,  except  in  dental  practice.  Mr. 
Constant,  after  experience  of  some  hundreds 
of  cases,  was  satisfied  with  its  action,  but  did 
not  speak  very  enthusiastically  about  it.  In 
1893  a  death  was  reported  as  having  occurred 
during  the  employment  of  pental,  but  the  evi- 
dence, so  far  as  could  be  elicited,  did  not  con- 
clusively prove  that  the  an»sthetic  was  to 
blame  in  the  case.  In  all  these  observers' 
hands  the  danger,  such  as  was  admitted,  ap- 
pears to  have  been  that  incurred  by  heart  fail- 
ure, although  Riith  has  expressly  stated  that 
respiration  fails  before  the  heart's  action 
ceases.  In  the  following  case  the  patient  was 
a  woman  aged  twenty-three.  She  attended  at 
the  Dental  Hospital  in  Devonshire  Street,  Chorl- 
ton-on-Medlock,  for  the  purpose  of  having 
several  teeth  extracted.  She  was  examined 
by  the  medical  attendant  who  administers 
anaesthetics  at  that  hospital,  and  was,  in  his 
opinion,  in  a  fit  state  to  undergo  the  operation 
and  to  take  pental.  This  he  administered, 
and  she  rapidly  passed  under  its  influence. 
After  the  extraction  of  five  teeth  her  respira- 
tion ceased,  and  none  of  the  means  adopted 
to  restore  her  succeeded.  The  dental  student 
who  had  operated  stated  that  there  was  no 
particular  difficulty  in  the  operation.  Pental 
had  been  used  by  the  ana!sthetist  for  many 
patients,  and  he  stated  that  he  had  never  pre- 
viously met  with  any  difHeulty  or  danger.  We 
are  not  told  whether  the  patient  was  at  the 
moment  of  extracting  the  fifth  tooth  resuming 
consciousness.  If  so,  possibly  the  mechanism 
of  death  was  similar  to  what  so  often  occurs 
under  chloroform.  On  the  other  hand,  Hol- 
lander in  his  first  paper  spoke  of  his  patients 
being  analgesic  rather  than  unconscious,  as  if 
there  were  no  danger  of  reflex  shock  under 
this  anffisthetic.  This,  of  course,  is  a  point  of 
great  importance.  At  present  pental  is  on  its 
trial,  and  the  fullest  information  concerning 
the  action  of  the  drug  is  desirable ;  every  acci- 
dent should  be  most  carefully  reported  to  see 
how  far  we  can  trust  the  favourable  opinions  so 
freely  uttered  about  this  substance,  and  how 
far  Professor  Wood  is  correct  in  his  warning 
that 'pental  will  probably  prove  a  most  dan- 
gerous anaesthetic' " 

Dr.  Prince  Stallard,  in  a  paper  read  before 
the  London  Societv  of  Anjesthetists  (Lancet, 
March  14,  1896 ;  M.  Y.  Med.  Jour.,  April  4, 
1896),  said  that  at  the  ordinary  temperature  of 
a  room  pental  was  so  volatile  that  it  was  ne- 
cessary to  administer  it  by  the  closed  method, 
with  the  admission  of  as  little  air  as  possible. 
If  it  was  dropped  on  to  a  piece  of  lint,  as  was 
usual  with  chloroform,  a  large  quantity  was 
required.  In  a  hundred  and  forty-eight  cases 
Clover's  portable  ether  inhaler  had  been  used. 
Two  drachms  of  pental  were  poured  into  the 
reservoir,  the  indicator  was  placed  at  0,  and 
the  patient  was  encouraged  to  fill  the  small 
bag  with  his  expirations;  the  indicator  was 
then  turned  rapidly  but  evenly  to  3;  rarely 


was  it  necessary  to  turn  to  P.  Pental  was 
thus  given  more  rapidly  than  was  advisable 
with  ether,  and  attention  had  been  directed  to 
the  absence  of  coughing,  struggling,  and  fight- 
ing for  breath,  so  characteristic  of  the  latter 
drug  when  given  alone  without  the  previous 
use  of  nitrous  oxide  gas.  No  restriction  had 
been  placed  on  the  patients  with  regard  to  diet, 
and  m  only  one  ease  had  there  been  after- 
vomiting.  I'he  clothing  should  be  quite  loose 
around  the  throat  and  abdomen  so  that  the 
thoracic  and  abdominal  movements  could  be 
quite  free.  All  the  administrations  had  taken 
place  at  about  10  a.m.  In  all  the  cases  the 
patients  had  been  seated  in  a  dental  chair,  the 
head  having  been  placed  in  an  easy  position 
midway  between  flexion  and  superextension. 
The  horizontal  posture,  said  Dr.  Stallard,  would 
be  much  safer,  as  signs  of  cardiac  failure  had 
not  infrequently  occurred  in  the  cases  cited,  for 
pental,  in  this  respect,  resembled  chloroform. 
When  this  drug  was  inhaled  the  pulse  was  at 
first  quickened,  also  the  breathing,  and  then 
the  pulse  became  fuller  and  bounding,  with 
dilatation  of  the  capillaries  of  the  face,  which 
was  evinced  by  extreme  flushing,  similar  to 
that  observed  when  nitrite  of  amyl  was  in- 
haled; swallowing  movements  were  observed, 
but  never  any  coughing  or  struggling ;  scream- 
ing might  occur,  and  dreams  of  a  pleasant  na- 
ture were  frequently  experienced.  Spasms, 
tonic  and  clonic,  were  occasionally  present  in 
the  arms  or  in  the  legs.  The  lid  reflex  was 
usually  present  unless  the  anaesthesia  was  deep; 
when  the  patient  was  deeply  under  the  influ- 
ence of  the  drug  the  pupils  were  dilated  and 
the  eyeballs  turned  upward  under  the  upper 
lids,  and,  in  some  cases,  the  conjunctival  ves- 
sels were  prominent  and  congested ;  the  arm 
when  raised  dropped  helplessly  to  the  side. 
At  the  height  of  anaesthesia  the  pulse  became 
small,  and  might  be  running.  'There  was  no 
cyanosis  or  duskiness  of  the  features,  and  ster- 
tor  was  very  rare.  Micturition  and  defecation 
had  never  been  observed.  Opisthotonos  and 
twitohings  of  muscles  had  been  noted  in  a  few 
cases,  the  patients  having  generally  been  tran- 
quil. The  breathing  could  hardly  be  heard  ; 
this,  said  the  author,  constituted  one  of  the 
dangers,  and,  in  this  respect,  pental  again  re- 
sembled chloroform.  Recovery  was  extremely 
rapid,  and  was  not  followed  by  any  stupor  or 
drowsiness.  As  a  rule,  there  were  no  after- 
effects; the  patients  felt  quite  well  three 
minutes  after  the  removal  of  the  face-piece, 
and  were  able  to  walk  out  of  the  house.  One 
case  only  of  vomiting  had  occurred  and  three 
or  four  of  nausea ;  slight  headache  had  been 
noted  in  a  few  cases,  but  this  had  rapidly 
passed  off.  The  average  time  required  to  pro- 
duce anaesthesia  had  been  fifty-six  seconds,  and 
the  average  anaesthesia  obtained  had  lasted  for 
seventy-six  seconds.  The  preansesthetic  stage 
had  varied  from  thirty  to  one  hundred  and 
twenty  seconds  and  the  atiaesthetio  period  from 
twenty-five  to  two  hundred  and  ten  seconds. 
The  advantages  maintained  for  pental,  said 
Dr.  Stallard,  were :  1.  Longer  anaesthesia  than 
nitrous  oxide  gas  yielded.  2.  Simple  appa- 
ratus.   3.  No  struggling,  coughing,  or  dislike 


PENTANE 
PEPTOMANGAN 


68 


to  the  drug.  4.  The  small  amount  required, 
which  averaged  2  drachms.  5.  Rapid  recov- 
ery. 6.  The  absence  of  after-effects.  The  dis- 
advantages -were:  1.  The  insidiousness  of  its 
action — an  overdose  could  easily  be  admin- 
istered. 3.  Xoiseless  and  shallow  breathing. 
3.  Screaming.  4.  The  sudden  cessation  of 
respiration.     5.  Sudden  cardiac  failure. 

Dr.  Stallard  said  that  he  had  frequently 
known  decomposition  of  the  drug  to  occur. 
With  regard  to  albuminuria,  he  had  examined 
the  urine  in  twenty-five  cases  after  its  ad- 
ministration and  found  no  albumin,  but  it 
must  be  remembered  that  all  his  cases  had 
been  short  ones  and  the  effect  would  not  last 
long  enough  to  injure  the  kidney.  The  fall  of 
blood-pressure  was  marked.  VVith  regard  to 
the  length  of  ansesthesia  obtained,  he  was  of 
opinion  that  there  was  a  marked  personal  fac- 
tor in  many  cases.]— Henry  A.  Gkiffin. 

PENTANE.— See  Amyl  hydride. 

PEPO  (U.  S.  Ph.)  consists  of  the  seeds  of 
the  common  field  pumpkin.  It  has  been  very 
extensively  employed  as  a  tcBiiiafuge,  and  in 
many  eases  with  gratifying  results.  Two 
ounces  constitute  an  average  dose.  The  seeds 
are  bruised  in  a  mortar  or  crushed  in  a  coffee 
or  spice  mill  and  made  with  water  into  a  sort 
of  emulsion,  the  covering,  or  husk,  being  sep- 
arated by  passing  the  mixture  through  a  coarse 
sieve,  although  it  has  been  advised  that  they 
also  should  be  taken.  The  only  drawback  to 
its  use  is  the  considerable  bulk  of  a  dose, 
which  may  excite  nausea  in  certain  cases.  If 
failure  follows  the  first  dose,  it  may  be  re- 
peated daily  as  long  as  the  individual  is  will- 
ing. It  is  best  taken  in  the  morning,  after 
the  precautions  mentioned  in  the  article  on 
Anthelminthics  have  been  observed,  and  it 
should  be  followed  by  a  laxative.  No  harm 
has  ever  followed  the  use  of  this  remedy,  and 
little  seems  to  be  known  of  the  active  agent  in 
it.  Fowls  which  have  eaten  the  seeds  and  the 
soft  portion  of  the  fruit  enveloping  them  are 
said  to  be  affected  with  giddiness  and  a  form 
of  intoxication.  An  oil,  an  aloholic  fluid  ex- 
tract, and  a  resin  are  prepared  which  seem  to 
vary  considerably,  as  both  successes  and  fail- 
ures have  been  reported  as  following  their  em- 
ployment. The  fleshy  portion  of  the  pumpkin 
has  also  been  used,  but  it  seems  to  be  less 
efficient  than  the  seeds. — Russell  H.  N  evens. 

PEPPER,  BLACK.— See  Piper  nigeum. 

PEPPER,  CAYENNE.— See  Capsicum. 

PEPPERMINT. — See  Mentha  piperita. 

PEPSIN  (Br.  Ph.),  pepsinum  (U.  S.  Ph., 
Ger.  Ph.). — What  is  known  under  this  name  is 
by  no  means  the  pure  gastric  ferment,  a  body 
having  the  property  of  converting  proteids 
into  peptones,  but  is  a  mixture  of  that  sub- 
stance and  various  bodies  derived  from  the 
mucous  membrane  of  the  pig's  stomach,  from 
which  it  is  prepared.  These  latter  are  insep- 
arable from  the  true  pepsin  and  are  present 
in  varying  proportions,  depending  upon  the 
care  with  which  the  processes  of  manufacture 
have  been  conducted.  The  purest  samples  oc- 
cur as  a  yellowish-white  or  white  powder,  either 


amorphous  or  somewhat  grainy  or  scaly.  They 
have  a  slight  acid  or  saline  taste  and  should 
be  free  from  any  unpleasant  odour. 

Pepsin  is  soluble  in  100  parts  of  water,  but 
the  addition  of  small  amounts  of  hydrochloric 
acid  renders  it  soluble  in  less  than  half  that 
quantity. 

Many  samples,  while  agreeing  in  appearance 
with  those  known  to  be  active,  are  entirely  in- 
ert, having  deteriorated  by  keeping  or  having 
always  been  destitute  of  the  slightest  pepto- 
nizing powers  in  consequence  of  lack  of  care  in 
their  manufacture. 

The  (J.  S.  Ph.  calls  for  a  pepsin  which  will 
completely  digest — that  is,  render  soluble — at 
least  3,000  times  its  own  weight  of  the  finely 
divided  white  of  a  hard-boiled  egg  when 
combined  with  1,000  times  its  weight  of  a  2-per- 
cent, solution  of  hydrochloric  acid  and  main- 
tained for  six  hours  at  a  temperature  of  not 
less  than  100-4°  or  more  than  104°  F.,  the  ves- 
sel in  which  it  is  contained  being  gently  agi- 
tated every  fifteen  minutes.  At  the  end  of 
the  given  time  little  or  no  residue  should  be 
observed,  but  a  few  thin  flakes  of  the  coagu- 
lated albumen  need  hardly  be  regarded.  The 
Br.  Ph.  requires  that  it  shall  dissolve  50  times 
its  own  weight  of  finely  sifted  coagulated  albu- 
men in  thirty  minutes  when  combined  with  a 
solution  of  5  minims  of  hydrochloric  acid  in  1 
oz.  of  distilled  water  and  subjected  to  a  tem- 
perature of  154°  F. 

For  practical  purposes  the  latter  test  is  the 
most  readily  applied,  and  is  one  which  should 
be  made  in  all  cases  save  when  the  most  satis- 
factory evidence  is  presented  as  to  the  activity 
of  the  sample  to  be  prescribed. 

In  accordance  with  the  variations  in  the 
methods  of  preparation,  three  varieties  of  pep- 
sin are  found — one  form  entirely  soluble  in 
water,  another  soluble  in  slightly  acidulated 
water,  and  a  third  insoluble  in  either. 

There  is  but  little  difference  in  the  activity 
of  these  varieties,  but  the  insoluble  variety  is 
the  most  permanent  and  is  but  little  liable  to 
decomposition.  The  soluble  specimens,  when 
dissolved  in  water,  are  apt  to  spoil  rapidly, 
and  their  solutions,  when  possessed  of  any  un- 
pleasant odour,  are  unfit  to  use.  The  addi- 
tion of  not  over  20  per  cent,  of  alcohol  renders 
these  solutions  fairly  permanent,  although  the 
activity  of  the  pepsin  is  somewhat  impaired. 

What  is  known  as  "crystal  pepsin"  is 
practically  the  substance  obtained  by  the  self- 
digestion  of  the  gastric  mucous  membrane  of 
various  animals,  which  is  dried  in  thin  scales 
and  sifted  so  as  to  give  it  a  crystalline  ap- 
pearance. It  is  usually  quite  active,  but  is  not 
superior  to  the  varieties  prepared  in  the  ordi- 
nary ways.  No  matter  what  precautions  are 
exercised  in  the  preparation  of  pepsin,  it  is 
undoubtedly  true  that  there  is  a  great  dif- 
ference in  the  activity  of  the  different  lots 
turned  out  by  the  samemanfacturers,  and  often 
that  made  by  those  of  indifferent  reputation  is 
entirely  inert.  Consequently  it  is  of  the  high- 
est importance  that  a  reliable  brand  should  be 
selected. 

Unfortunately,  nearly  everv  drug  is  incom- 
patible with  this  substance,  the  most  notable 


69 


PENTANB 
PEPTOMANGAN 


exoeptinns  being  codeine,  bismuth  subnitrate 
(which  retards  but  does  not  diminish  its  activ- 
ity), strychnine,  nux  vomica,  lactate  of  iron, 
and  lactic  and  hydrochloric  acids.  To  obtain 
its  maximum  effects,  it  should  be  used  in  con- 
nection with  either  of  the  two  last  named,  and 
nux  vomica  or  strychnine  may  be  advanta- 
geously added  when  a  stomachic  tonic  appears 
to  be  indicated.  Codeine  or  the  bismuth  salt 
may  be  added  when  gastralgia  is  a  prominent 
symptom,  and  the  latter  when  diarrhoea  is 
present.  Of  the  numerous  vehicles  for  the 
preservation  and  administration  of  pepsin, 
glycerin  is  by  far  the  best,  and  there  is  little 
reason  for  the  employment  of  any  other,  al- 
though milk  sugar  is  unobjectionable  except 
when  its  presence  in  the  stomach  would  be 
injurious.  Saccharin  has  been  suggested  as  a 
diluent,  but  there  would  seem  to  be  no  particu- 
lar advantage  in  its  employment.  It  is  well, 
however,  to  note  its  perfect  compatibility,  as 
the  simultaneous  administration  of  the  two 
might  be  convenient  in  diabetes. 

As  pepsin  is  only  active  in  neutral  or  acid 
solutions,  alkalies  of  any  kind  should  not  be 
administered  with  it  or  for  some  time  after  it 
has  been  taken.  Exactly  what  takes  place 
when  it  is  combined  with  pancreatin  is  not 
well  understood,  but  theory  indicates  that, 
as  the  one  requires  an  acid  medium  to  bring 
oiit  its  full  effect,  and  the  other  an  alkali,  little 
benefit  would  be  gained  from  their  mixture. 
A  number  of  preparations  exist  in  which  the 
two  are  found  and  from  which  good  results 
have  undoubtedly  been  derived,  but  there 
seems  to  be  reason  to  believe  that  either  the 
pepsin  or  the  pancreatin  alone  would  have 
been  as  effectual. 

As  a  rule,  it  is  best  to  administer  pepsin 
shortly  after  eating  and  before  the  food  passes 
from  the  stomach  into  the  intestines.  In  ad- 
dition to  its  peptonizing  effect  upon  proteids 
it  appears  to  act  as  a  stimulant  of  the  mucous 
membrane  of  the  stomach,  thereby  increasing 
the  natural  secretions  of  that  organ,  and  by 
some  it  is  maintained  that  its  beneficial  action 
depends  more  upon  the  latter  property  than 
upon  the  former.  The  doses  ordinarily  given 
are  inadequate,  and  many  of  the  failures  im- 
puted to  it  are  undoubtedly  due  to  this  fact.  It 
is  safe  to  say  that  in  conditions  where  it  is  ur- 
gently demanded  not  less  than  30  grains  of  the 
average  article  should  be  administered. 

The  conditions  in  which  pepsin  is  indicated 
are  dyspepsia,  with  a  sense  of  weight  in  the 
stomach  after  eating  and  eructations,  vomiting 
of  undigested  food,  lienteric  diarrhma,  espe- 
cially in  children,  the  indigestion  of  phthisis, 
mucous  gastritis,  atonic  dyspepsia,  and  cancer 
and  ulcer  of  the  stomach.  It  is  also  very  use- 
ful in  the  convalescence  from  acute  diseases 
and  in  infants  after  weaning  until  the  stomach 
has  become  accustomed  to  its  new  conditions. 
In  some  obscure  cases  of  indigestion  it  may  be 
necessary  to  adopt  the  procedure  of  testing 
the  secretion  of  the  stomach  before  it  can  be 
determined  that  there  is  a  deficiency  in  the 
secretion  of  pepsin.  This  is  performed  by  ob- 
taining a  specimen  of  the  gastric  fluid  by  a 
stomach-bucket  or  an  oesophageal  tube.    After 


careful  straining,  the  specimen  is  divided  into 
four  equal  parts,  to  one  of  which  pepsin  is 
added,  to  another  pepsin  and  hydrochloric  acid, 
to  the  third  hydrochloric  acid  alone,  while  to 
the  fourth  nothing  is  added.  To  each  por- 
tion an  equal  bulk  of  coagulated  albumen  is 
added  and  the  solvent  effect  of  each  is  noted, 
the  temperature  of  all  of  them  being  main- 
tained a  trifle  over  100°  P.  In  this  way  it  can 
easily  be  determined  whether  the  gastric  Juice 
is  normal  or  whether  pepsin  or  hydrochloric 
acid  or  both  are  lacking.  The  procedure  is 
one  which  is  rather  unpleasant  to  the  person 
from  whom  the  specimen  is  obtained,  and  is 
only  indicated  in  aggravated  conditions. 

A  peptonized  milk  may  be  prepared,  which 
may  be  used  as  a  nutrient  enema  or  for  intro- 
duction into  the  stomach  through  the  oesopha- 
gus or  a  fistula,  by  digesting  1  oz.  of  milk  for  an 
hour  at  a  temperature  of  100°  F.  with  5  grains 
of  pepsin  and  4  drops  of  hydrochloric  acid. 
The  product  should  be  clear,  and  must  be  neu- 
tralized with  a  small  amount  of  sodium  car- 
bonate. Meat  and  other  albuminoids  may 
also  be  treated  in  the  same  manner,  but  they 
are  not  very  palatable  and  are  hardly  to  be 
used  except  in  desperate  cases  or  in  the  same 
manner  as  the  peptonized  milk. 

For  the  removal  of  the  exudation  of  diph- 
theria, solutions  of  pepsin  are  sprayed  into 
the  throat,  and  often  very  great  temporary  re- 
lief is  obtained,  the  effect,  however,  being 
purely  local,  so  that  the  general  constitutional 
treatment  is  not  to  be  neglected.  Similar  so- 
lutions may  be  applied  to  unhealthy  suppurat- 
ing surfaces  with  a  view  to  dissolving  the 
superficial  morbid  tissues. 

Saccharated  pepsin,  pepsinum  saccharatnm 
(U.  S.  Ph.).  contains  1  part  of  pepsin  to  9 
parts  of  milk  sugar.  Unless  that  diluent  is 
objectionable,  it  may  be  used  in  nearly  all 
cases  in  which  pepsin  is  indicated. 

In  conclusion,  it  may  be  stated  that  the 
greatest  care  should  be  taken  that  the  purest 
possible  brand  is  dispensed,  and  all  tablets, 
troches,  etc.,  are  to  be  rejected.  Nearly  all  of 
the  elixirs  and  wines  are  inert,  although,  as 
already  stated,  a  weak  wine  is  entirely  com- 
patible with  pepsin.  The  best  vehicle  is  glyc- 
erin, and  in  all  cases,  except  those  of  infants, 
lactic  or  hydrochloric  acid  should  be  given 
simultaneously. — Bussell  H.  Kevins. 

PEPTOMANGAN, '  liquor  mangano-ferri 
peptonatus,  is  a  liquid  peptone  preparation 
containing  iron,  manganese,  and  a  small  per- 
centage of  alcohol.  Each  half  ounce  contains 
the  equivalent  of  3  grains  of  metallic  iron  and 
1  grain  of  metallic  manganese.  It  is  essen- 
tially a  drug  in  its  characteristics  and  in  no 
sense  a  food.  It  occurs  as  a  transparent,  dark 
sherry-red  liquid,  of  a  slight  agreeable  odour 
and  taste.  It  is  neutral  in  reaction,  non- 
astringent,  and  miscible  with  water,  milk,  or 
any  wine  fi'ee  from  tannic  acid.  It  is  used 
especially  in  the  ancemia  of  rhachitis,  chloro- 
sis, and  phthisis.  Von  Ruck  reports  its  use 
in  two  series  of  cases  of  pulmonary  tubercu- 
losis. In  the  first  series  of  twelve  cases,  with 
a  single  exception,  after  the  use  of  this  drug 


PEPTONIZED  MILK 
PHENACETINE 


70 


the  hiEmoglobin  increased  materially.  The 
smallest  amount  of  increase  was  3  per  cent., 
the  largest  46  per  cent.,  while  the  red  blood- 
corpuscles  showed  in  different  patients  an  in- 
crease ranging  from  83,000  to  1,990,000.  Each 
of  these  patients  had  been  receiving  the  ordi- 
nary iron  mixture  previously,  but  had  gained 
comparatively  little  in  either  hajuioglobin  or 
corpuscles.  JEspecjally  good  results  have  also 
been  reported  in  chlorosis  and  rhachitis.  It  is 
believed  that  in  certain  forms  of  anaemia  man- 
ganese as  well  as  iron  is  of  material  advantage, 
as  it  is  fully  demonstrated  ithat  this  element 
occurs  in  the  blood.  The  dose  of  peptoman- 
gan  is  a  tablespoonful  three  or  four  times  a 
day.  It  may  be  given  alone,  as  it  is  not  un- 
palatable. It  may  be  diluted,  if  desired,  with 
milk  or  water,  or  may  be  administered  in  any 
sweet  wine  free  from  tannic  acid. 

[Dr.  Hugo  Summa,  of  St.  Louis  {N.  Y.  Med. 
Jour.,  Feb.  9,  1895),  who  has  used  Grude's  pep- 
tomangan  extensively  in  doses  varying  from  a 
teaspoontul  to  a  tablespoonful,  in  sherry  or 
milk,  three  times  a  day,  an  hour  after  meals, 
reports  excellent  results  in  chlorosis  and  ance- 
mia.  Dr.  Summa  lays  stress  on  the  fact  that 
this  preparation  does  not  give  rise  to  constipa- 
tion.]— Ployd  M.  Cbandall. 

PEPTONIZED  MILK.— See  under  Milk. 

PEBMANGANATES.  —  Potassium  per- 
manganate, potassii  permanganas  (U.  S.  Ph., 
Br.  Ph.),  kalium  permanganicum  (Ger.  Ph.),  is 
a  highly  oxidized  salt,  and,  parting  with  its 
oxygen  with  great  i-eadiness,  is  of  considerable 
value  as  a  deodorizer  and  disinfectant,  but  its 
relatively  high  cost  and  the  property  it  pos- 
sesses of  imparting  a  red  stain,  removable  by 
oxalic  acid,  prevent  its  extensive  employment. 
It  may  be  advantageously  used  to  disinfect  or 
deodorize  ulcerating  surfaces  from  which  of- 
fensive odours  ai-e  given  off,  as  in  hospital 
gangrene,  carbuncles,  etc.,  and  as  an  injection 
in  otorrlicea,  ozaina,  or  leucorrhma.  Its  effects, 
however,  are  rather  transient  and  it  must  be 
used  oftener.  than  the  other  disinfectants  em- 
ployed in  the  conaitions  mentioned.  Solutions 
of  1  grain  in  1  oz.  of  water  are  often  employed 
to  overcome  the  axillary  odours  and  those 
arising  from  sweaty  feet,  also  as  a  tooth-wash. 

The  ordinary  strength  of  a  solution  for  ap- 
plication to  wounds,  etc.,  is  from  5  to  10  grains 
to  the  ounce  of  water.  Stronger  solutions  act 
as  stimulants,  and  are  often  employed  upon 
raw  surfaces  where  a  stimulating  effect  is  de- 
sired. Occasionally  the  finely  powdered  salt 
is  sprinkled  upon  unhealthy  wounds,  etc.,  with 
the  result  of  obtaining  a  mild  esoharotic  effect. 

Co7idy's  fluid,  or  solution,  is  an  aqueous  so- 
lution of  this  salt  to  which  aluminium  sulphate 
is  added  under  the  belief  that  it  greatly  pro- 
motes the  oxidizing  effect  of  the  permanganate. 
It  may  be  employed  for  the  same  purposes  as 
an  extemporaneous  solution. 

Internally,  the  permanganate  has  been  used 
in  the  treatment  of  scarlet  fever  and  of  diph- 
theria, the  throat  being  sprayed  or  swabbed 
with  a  1-per-cent.  solution.  It  has  also  been 
employed  in  all  the  so-called  zymotic  d  seases, 
especially  erysipelas,  puerperal  fever,  and  sep- 


ticmmia,  but  its  efficacy  in  these  affections  is 
denied  by  many.  In  the  treatment  of  the 
bites  of  poisonous  reptiles  and  rabid  aitimals 
it  was  long  ago  brought  forward  as  almost  a 
specific,  but  the  evidence  for  and  against  its 
employment  is  rather  conflicting,  so  that  it 
would  be  wise  neither  to  trust  to  it  alone  nor 
to  neglect  it  if  it  is  at  hand,  the  wounds  at  the 
same  time  being  washed  out  with  a  4-  or  5-per- 
cent, solution. 

In  delayed  or  arrested  menstruation,  espe- 
cially in  young  women  and  those  affected  with 
ancBmia,\t,  appears  to  ,be  of  considerable  value. 
Prom  1  to  2  grains  are  to  be  given  three  times 
a  day,  and  the  doses  are  to  be  continued  for 
two  or  three  days  after  the  establishment  of 
the  flow.  It  is  also  said  to  assist  in  the  re- 
moval of  fatty  tissue,  and  has  been  vaunted  as 
a  cure  for  obesity.  In  some  forms  oi  flatulence, 
especially  that  occurring  in  the  obese  it  has 
been  used  with  good  effects,  and  by  some  is 
esteemed  highly  in  lithiasis,  in  which  it  seems 
to  be  more  effectual  when  inclosed  in  capsules 
which  do  not  dissolve  until  they  enter  the  in- 
testines. 

It  is  of  importance  that  potassium  perman- 
ganate should  not  be  combined  either  in  solu- 
tion or  in  substance  with  organic  matters,  as  it 
is  rapidly  reduced  in  their  presence,  and  spon- 
taneous combustion  is  said  to  have  sometimes 
occurred.  When  it  is  administered  in  the  pill 
form,  which  is  by  far  the  best  form  for  its 
use,  kaolin  and  vaseline  are  the  best  excipients, 
or  it  may  be  compressed  into  pills.  The  usual 
dose  is  1  grain,  although  the  size  of  the  dose 
may  be  as  large  as  4  grains  without  any  ill 
results.  The  liquor  potassii  permanganatis 
(Br.  Ph.)  is  a  solution  of  4  grains  to  the  ounce 
of  distilled  water.  It  may  be  given  in  doses 
of  from  3  to  4  fl.  drachms.  AH  solutions  and 
the  salt  itself  should  be  kept  in  tightly  closed 
receptacles  and  in  a  dark  place. 

[Kor  further  information  concerning  potas- 
sium permanganate,  see  under  Manganese, 
vol.  i,  pages  596  and  597,  and  under  Opium, 
vol.  ii,  page  44.] — Russell  H.  Nevins. 

PEBOSMIC  ACID.— See  Osmic  acid. 

PEBOXIDE  OF  HYDROGEN.  —  See 
Hydrogen  dioxide. 

PETBOLATUM.— See  Vaseline. 

PETBOLEXJM,  or  the  mineral  oil  which 
occurs  in  many  parts  of  the  world,  varies  in 
colour  from  a  light  green  or  red  to  black,  and 
has  a  distinctive  odour  which  in  certain  varie- 
ties is  highly  offensive  on  account  of  the  pres- 
ence of  numerous  sulphur  and  phosphorus 
compounds.  It  is  more  largely  used  in  the 
arts  than  in  medicine,  but  enjoys  some  repute, 
more  especially  in  domestic  medicine,  as  a 
local  application  in  the  treatment  of  rheuma- 
tism, pulmonary  affections,  chilblains,  and 
other  conditions  in  which  a  moderate  decree 
of  irritation  of  the  skin  is  desired.  Combined 
with  oil  of  turpentine,  linseed  oil,  and  the  oils 
of  amber  and  juniper,  it  constitutes  "  British 
oil,"  a  rubefacient  liniment,  more  eraploved  in 
veterinary  medicine  than  in  practice  on  the 
human  subject.  Under  the  name  of  '■  Seneca  " 
oil  it  was  at  one  time  regarded  as  a  specific  in 


71 


PEPTONIZED  MILK 
PHENACETINE 


phthisis,  but  beyond  producing  a  slight  expec- 
torant effect  it  is  of  little  value. 

Tapeworms  are  said  to  have  been  expelled 
by  doses  of  from  20  to  40  drops  given  tliree 
times  a  day.  Petroleum  has  been  substituted 
for  vaseline  in  the  treatment  of  psoriasis,  and 
may  be  used  in  the  treatment  of  scabies.  It  is 
somewhat  antiseptic,  but  is  rather  too  oflEen- 
sive  to  be  used  except  upon  animals.  I.i 
poultry  houses  and  dovecotes  it  is  probably 
the  best  agent  that  can  be  found  for  the  de- 
struction of  insects,  the  woodwork,  etc.,  being 
painted  with  it  from  time  to  time. 

Refined  petroleum,  or  kerosene  (g.  v.).  is  highly 
esteemed  by  many  ignorant  persons  as  a  uni- 
versal remedy,  but  is  probably  without  any  ef- 
fective therapeutic  action  except  as  an  irritant 
of  the  skin. — Russell  H.  Nevins. 

PETROSELINUM:,  or  parsley,  Apium 
Petroselinum,  is  largely  used  for  culinary  pur- 
poses, and  from  a  medical  standpoint  is  chiefly 
interesting  on  account  of  its  being  the  source 
of  apiol,  which  possesses  all  the  virtues  as- 
sumed to  exist  in  the  plant,  and  is  to  be  pre- 
ferred on  account  of  its  smaller  bulk.  The 
fresh  root  is  reputed  to  be  laxative  and  diu- 
retic, and  the  herb  itself  antiperiodic.  The 
seeds  are  thought  to  be  antiperiodic  and  em- 
menagogue,  and  play  a  more  or  less  important 
part  in  domestic  medicine.  They  are  probably 
more  active  than  any  other  part  of  the  plant. 
They  may  be  given  in  doses  of  half  a  teaspoon- 
ful.    (Cf.  Apiol.) 

[Fresh  parsley,  steeped  in  vinegar  and  eaten 
immediately  after  eating  onions,  is  useful  in 
removing  the  ofEensive  odour  of  the  breath.] 
Russell  H.  Nevins. 

PHELLANDBIXIM.— The  fruit  of  Phel- 
landritim  aquaticum,  the  water-hemlock,  was 
formerly  official  in  various  pharmacopoeias, 
and  was  esteemed  a  useful  sedative  in  the 
treatment  of  cough,  al.so  tonic  and  stomachic. 
From  .5  to  8  grains  may  be  given  three  times  a 
day,  and  the  dose  may  be  gradually  increased 
to  15  grains.  In  large  doses,  the  drug  is  said 
to  be  a  narcotic  poison. 

PHENACEIIXE,  phtnacetinum  (Ger.  Ph.), 
was  first  prepared  by  Hinsberg,  chemist  of  the 
colourfactories  of  Bayer  &  Co.,  in  Elberfeld,  and 
was  first  subjected  to  trial  by  this  author,  with 
Kast  and  Freiberg,,  in  1887.  Soon  afterward  its 
value  as  an  antipyretic  was  demonstrated  at 
Bamberger's  clinic   in  Vietma.     Phenacetine, 

OP  TT 
C,H4  (^jTfT/n fT  pQv  '^  *"■"  acetyl  compound  of 

phenetidine — that  is,  of  the  ethyl  ether  of  para- 
midophenol.  Its  composition  is  thus  analogous 
to  that  of  acetanilide.  It  is  a  colourless  or 
slightly  reddish. odourless,  and  tasteless  powder, 
sparingly  soluble  in  water,  somewhat  more 
soluble  in  glycerin,  and  readily  soluble  in  alco- 
hol, especially  hot  alcohol.  It  is  insoluble  in 
acid  or  alkaline  fluids,  hence  in  the  acid  gas- 
tric juice  and  in  the  extract  of  pancreas.  It  is 
demonstrated  in  the  urine  by  the  red  colour 
produced  by  liquor  ferri  sesquichloridi  and  by 
the  green  colour  produced  by  sulphate  of  cop- 
per. 
It  has  no  effect  upon  the  temperature  in 


health,   but  a  remarkable  antipyretic  effect, 
even  in  small  doses,  in  fever. 

From  Muhnert's  comparative  tests  it  was 
found  that  14  grains  of  phenacetine  lowei'ed 
the  temperature  more  than  15^  grains  of  anti- 
pyrine,  quinine,  or  kairin,  and  more  than  3'1 
grains  of  thalline.  It  is  less  apt  to  be  followed 
by  perspiration  thati  thalline  and  acetanilide, 
by  ringing  in  the  ears  than  the  salicylates,  by 
dizziness  than  quinine,  and  by  chills  than  acet- 
anilide. 

In  summing  up  the  evidence,  it  is  found 
that  phenacetine,  while  as  prompt  and  efficient 
as  any  of  the  antipyretics,  is  the  safest  of  all  of 
them.  After  a  dose  of  15. grains  the  tempera- 
ture falls  rapidly,  reaching  its  lowest  point  in 
about  three  hours,  and  remains  low  for  from 
eight  to  ten  hours,  when  it  again  rises  some- 
what, with  the  appearance  of  an  abundant 
perspiration.  Too  great  depression  is  followed 
by  chilly  sensations,  attended  occasionally,  es- 
pecially in  certain  subjects,  with  a  feeling  of 
weakness,  sometimes  of  faintness,  due  to  heart 
failure.  Small  doses  are,  however,  unaccom- 
panied with  evil  effects  of  any  kind.  Any 
sinking  sensations  may  be  speedily  combated 
by  alcohol,  as  by  a  glass  of  wine  or  a  drink  of 
whisky,  and  anything  like  excessive  sweating 
may  be  prevented  or  controlled  by  the  use  of 
atropine.  Phenacetine  is  a  powerful  analgetic, 
and,  notwithstanding  its  insolubility,  begins 
to  act  in  twenty  minutes.  And  although  it 
may  by  no  means  be  compared  with  morphine 
in  the  relief  of  pain,  it  has  a  more  distinct 
anodyne  influence  than  antipyrine  or  acetani- 
lide in  the  various  neuralgias,  and  is  especially 
valuable  in  the  treatment  of  any  ordinary 
headache,  of  migraine,  gastralgia,  sciatica, 
neuritis,  and  of  the  insomnia  of  diseases  of 
the  uterus,  floating  kidney,  exhaustion  from 
overwork,  etc.  (Cohn).  A  small  dose,  say  5 
grains,  of  phenacetine,  taken  at  bedtime,  may 
have  a  very  soothing  effect  in  allaying  the 
anxieties  and  hyperjEsthetic  states  which  pre- 
vent sleep. 

Unplea.sant  after-effects  are  at  times  due  to 
unconverted  paraphenetidine,  which  is  poison- 
ous in  small  dose.  This  substance  acts  espe- 
cially upon  the  kidneys,  causing  nephritis  with 
albuminuria.  The  presence  of  this  impurity 
may  be  detected  by  the  following  test :  If  38 
grains  of  chloral  hydrate  are  melted  in  a  small 
test-tube  in  a  water-bath  with  7f-  grains  of 
perfectly  pure  phenacetine,  the  solution  will 
remain  absolutely  colourless  upon  shaking  for 
at  least  five  minutes,  but  after  that  time  will 
assume  a  rose-red  colour.  If  any  parapheneti- 
dine is  present,  the  solution  becomes  coloured 
in  two  or  three  minutes  to  a  more  or  less  in- 
tense violet.  Phenacetine  is  much  less  toxic. 
It  seldom  or  never  produces  chill,  cyanosis,  or 
collapse.  It  very  rarely  causes  nausea  or  other 
disturbance  of  digestion. 

Phenacetine  is  considered  by  most  authori- 
ties as  an  ideal  antipyretic.  It  should  be  given 
in  doses  of  from  5  to  10  grains,  never  more  than 
15  grains.  For  children,  the  dose  ranges  from 
3  to  4  grains,  with  5  grains  for  the  maximum. 

[There  is  some  difference  of  opinion  as  to 
the  efficiency  of  phenacetine  as  an  antipyretic 


PHBNATES 
PHENYLACETAMIDB 


72 


and  as  to  the  non-ocourrence  of  ill  efEeets  from 
its  use.  For  example,  an  editorial  writer  in 
the  British  Medical  Journal  for  Dec.  23, 1894, 
says,  with  regard  to  the  impression  that  phen- 
acetine  does  not  produce  evil  eifects,  that  it 
has  been  "  somewhat  justified  by  experience  "  ; 
nevertheless,  he  goes  on  to  say,  we  may  meet 
with  unpleasant  and  profuse  diaphoresis,  ren- 
dering its  habitual  use  in  phthisis  and  typhoid 
fever  undesirable.  Collapse  and  exhaustion 
are  not  unknown  even  after  moderate  doses, 
while  palpitation  and  oppression  of  breathing 
followed  by  nausea  and  vomiting  have  also 
been  observed.  Cutaneous  eruptions,  chiefly 
urticarial,  prevail  with  a  frequency  scarcely 
inferior  to  that  observed  in  the  employment  of 
antipyrine,  and  cyanosis  of  the  face,  due  to 
changes  in  the  hsemoglobin,  may  be  seen  in  a 
similar  degree.  The  usefulness  of  phenacetine 
as  an  antipyretic  remains  small,  he  continues,  as 
its  power  in  that  respect  is  not  equal  to  that  of 
the  others,  except  when  it  is  employed  in  doses 
that  very  often  give  rise  to  toxic  symptoms. 

Kronig  (Berlin.  Uin.  Woch.,  Nov.  18,  1895; 
University  3Ied.  Magazine,  March,  1896)  has 
related  a  fatal  case  of  poisoning  with  phena- 
cetine. The  subject  was  a  boy,  aged  seven- 
teen, who  presented  the  general  appearance  of 
sepsis.  He  was  the  subject  of  a  chronic  sup- 
purative otitis  media.  The  general  condition, 
however,  indicated  some  profound  alteration 
in  the  blood,  such  as  is  not  seen  in  cases  of 
sepsis.  An  examination  of  the  blood  revealed 
the  red  cells  in  various  stages  of  dissolution. 
Even  the  apparently  healthy  cells  showed  con- 
siderable changes  in  age  and  shape.  Thus 
there  was  reason  to  suspect  the  presence  of 
some  blood-poison.  The  history  was  that  three 
weeks  before  his  admission  the  patient  had 
been  given  by  his  physician  five  powders  of 
phenacetine,  each  containing  15  grains  of  the 
drug,  with  the  direction  that  not  more  than 
two  should  be  taken  in  the  day.  Within  three 
weeks  he  had  taken  four  of  these  powders 
without  much  improvement  in  his  condition. 
One  evening  he  took  another  powder,  and  in 
the  night  he  was  seized  with  vomiting.  On 
the  following  day  he  had  headache,  vomiting, 
and  diarrhoea.  He  was  somewhat  cyanotic. 
His  urine  was  of  a  chocolate  colour,  and  sub- 
sequently contained  blood.  The  cyanosis  in- 
creased, and  he  died  in  two  days,  within  three 
days  after  taking  the  last  powder.  The  appear- 
ances resembled  those  of  chlorate-of-potassium 
poisoning.  In  the  discussion  Prankel,  Pur- 
binger,  and  Gerhardt,  all  strongly  emphasized 
the  importance  of  giving  small  doses  of  drugs 
like  phenacetine  in  the  first  instance. 

Phenacetine  has  been  much  used  in  the  early 
fever  of  influenza  as  an  antipyretic  and  as  an 
analgetic  in  migraine,  rhenmatism,  and  vari- 
ous forms  of  neuralgia.  Bocquillon-Limousin 
gives  the  following  formula  for  its  external 
use  in  acute  rheumatism,  which  he  attributes 
to  Taylor : 

5  Phenacetine 90  grains; 

Lanolin 300      " 

Olive  oil,  a  sufficient  quantity. 
Mix  for  an  ointment  to  be  rubbed  gently  on 
the  painful  parts.] — James  T.  Whittakeb. 


PHENATES. — Salts  of  carbolic  acid  (see 
Caebolio  acid). 

FHENAZONE. — See  Antipyrine. 

PHENEDINE. — See  Phenacetine. 

PHENIC  ACID. — See  Carbolic  acid. 

FHENIDINE,  or  paraacetphenetidine,  ac- 
cording to  Cerna,  has  been  considei'ed  superior 
to  antipyrine  as  an  analfjetic.  He  gives  the 
dose  as  15  grains.  Phenidine  seems  to  be  one 
of  the  drugs  that  should  not  be  used  in  prac- 
tice, unless  with  the  greatest  caution,  until 
more  is  known  of  its  properties. 

PHEIfOCOIiL,  or  amidophenacetine,  is 
produced  by  the  action  of  glycocoU,  which  is 
an  amidoacetic  acid,  upon  phenacetine.  Phe- 
nocoU  is  a  white  crystalline  powder,  soluble  in 
water  in  the  proportion  of  1  to  16  parts.  It 
reduces  fever  much  more  rapidly  than  phenac- 
etine, and  by  diminution  of  heat  production 
without  affecting  the  radiation  of  heat.  Phe- 
noeoll  hydrochloride  is  given  in  doses  of  from 
5  to  15  grains.  It  has  no  unpleasant  after- 
effects, excepting  occasionally  profuse  perspi- 
ration. But  the  remedy  must  be  used  with 
caution  in  cases  of  great  prostration,  as  it  may 
produce,  in  exhausted  states,  dyspnoea,  cyano- 
sis, and  heart  failure. 

[The  formula  of  phenocoll  has  been  stated 

to  be  C.H4<jjBf  0^  cH^jjH^.  The  hydrochlo- 
ride is  the  form  in  which  it  has  been  used  most, 
but  an  acetate,  a  salicylate,  and  a  carbonate 
have  been  employed.  It  has  been  used  as  an 
antipyretic  in  the  fever  of  phthisical  subjects 
and  other  febrile  conditions,  particularly  that 
of  influenza,  and  as  an  analgetic  in  acute  ar- 
ticular rheumatism  and  in  neuralgia. 

Vargas,  of  Barcelona  (Therap.  Woch.,  Jan. 
5,  1896),  employed  phenocoll  in  the  treatment 
of  whooping-cough  in  forty-two  cases  during 
the  period  from  February,  1894,  to  June,  1895, 
and  he  declares  that  it  is  far  superior  to  any 
other  remedy  for  that  disease  that  he  has  ever 
tried.  In  every  one  of  his  forty- two  cases  its 
effect  was  shown  within  the  first  twelve  hours, 
although  in  many  of  them  the  frequency  of  the 
paroxysms  was  not  reduced  until  the  next  day. 
Even  in  children  of  a  very  tender  age  he  has 
not  observed  any  untoward  action  of  the  drug. 
He  gives  the  hydrochloride  in  daily  amounts  of 
from  1  to  30  grains,  according  to  the  patient's 
age ;  he  has  always  used  it  -dissolved  in  water 
to  which  sugar  or  gum  arable  has  been  added. 
He  remarks  that  it  is  absorbed  very  rapidly 
and  eliminated  promptly.  He  thinks  that  the 
efficiency  of  phenocoll  hydrochloride  in  whoop- 
ing-coug  his  not  due  to  its  antibacterial  action, 
but  to  its  acting  as  a  sedative. 

Albertoni,  of  Bologna,  has  found  phenocoll 
an  efficient  remedy  in  malarial  fevers.^ 

James  T.  Whittaker. 

PHENOCOLL       SALICYLATE.  —  See 

Saloooll. 

PHENOL,  in  its  chemical  sense,  is  a  class 
name  applied  to  benzene  derivatives  in  which 
one  or  more  atoms  of  hydrogen  in  the  nucleus 
have  been  replaced  by  a  corresponding  number 
of  molecules  of  the  compound  radicle  hy- 
droxyl,  OH.    Thus  there  are  monatomic,  di- 


7S 


PHENATES 
PHENYLACETAMIDE 


atomic,  triatomic,  tetratomic,  pentatomic,  and 
hexatomio  phenols.  There  is  derived  from  ben- 
zene but  one  monatomic  phenol,  carbolic  acid, 
and  it  is  to  this  that  the  name  phenol  is  given  in 
pharmacy.  (See  Carbolic  acid.)  Prom  these 
facts  it  has  come  about  that  various  remedial 
combinations  into  which  carbolic  acid  or  an- 
other phenol  enters,  as  well  as  certain  drugs 
which  are  truly  phenols,  have  borne  a  part  or 
the  whole  of  the  name  phenol  as  significant  in 
some  degree  of  their  composition.  The  number 
of  these  combinations  is  very  large ;  a  few  of 
them  are  ofBoial,  some  are  of  recognised  scien- 
tific status  and  worth,  and  more  of  them  are 
proprietary.  It  would  scarcely  be  possible,  even 
were  it  desirable,  to  consider  these  last  exten- 
sively, and  as  for  the  second  class,  they  are,  for 
the  greater  part,  considered  elsewhere  in  this 
work.  I  shall  therefore  limit  the  consideration 
here  to  the  few  which  bear  the  name  phenol 
entire  and  are  in  common  employment. 

Camphorated  phenol  is  a  mixture  of  1 
part  of  carbolic  acid  and  2  parts  of  camphor, 
which,  after  standing  for  some  hours,  is  puri- 
fied by  washing  with  water.  It  is  a  liquid  of 
a  reddish-yellow  colour  with  the  odour  of 
camphor.  It  is  insoluble  in  water,  but  soluble 
in  alcohol  and  in  ether.  It  is  recommended 
by  Bufalini,  who  believes  that  the  camphor 
diminishes' the  caustic  action  of  the  cardolic 
acid  without  otherwise  lessening  its  effective- 
ness. Its  use  is  for  external  application  and 
similar  to  that  of  carbolic  acid. 

[Dr.  Thomas  A.  Elder,  of  Aurora,  Illinois  (iV. 
Y.  Med.  Jour.,  Apr.  28, 1894),  has  used  a  "  car- 
bolate-of-camphor "  ointment,  consisting  of  1 
part  of  crystallized  carbolic  acid,  3  parts  of 
camphor,  and  from  3  to  5  parts  of  vaseline, 
applied  externally,  in  the  treatment  of  small- 
pox, and  reports  that  it  relieved  the  itching  at 
once  and  made  the  patients  comfortable.] 

Iodized  phenol,  phenol  wdatum.  iodized 
carbolic  acid,  acidum  carholieumiodatum  (Nat. 
Form.),  is  a  mixture  composed  of  20  parts  of 
iodine,  76  of  carbolic  acid,  and  4  of  glycerin. 
It  should  be  kept  in  a  dark  place  and  in  glass- 
stoppered  bottles. 

Another  preparation  which  bears  the  name 
of  iodized  phenol  was  suggested  by  Dr.  Robert 
Battey  (Am.  FracL,  Feb.,  1877)  for  use  as  a 
uterine  caustic.  It  is  prepared  by  slightly  heat- 
ing 1  oz.  of  carbolic  acid  with  |  oz.  of  iodine. 
It  may  be  diluted  with  glycerin  if  necessary. 
A  similar  preparation  containing  4  grains  each 
of  iodine  and  carbolic  acid  dissolved  in  10 
drachms  of  glycerin  is  sometimes  known  as 
iodated  phenol.     (Cf.  Annidalin.) 

Phenol  sodique  is  a  French  proprietary 
preparation,  but  the  name  is  used  as  a  syn- 
onym for  solution  of  carbolate  of  sodium, 
liquor  sodii  earbolatis  (Nat.  Form.),  a  solution 
of  30  parts  of  crystallized  carbolic  acid  and  2 
parts  of  soda  in  28  parts  of  water.  It  should 
be  prepared  fresh  when  needed.  It  is  anti- 
septic and  sedative,  and,  diluted  with  water, 
may  be  applied  on  lint  as  a  dressing  for  abra- 
sions and  wounds. — Henry  A.  Griffin. 

PHENOSALYL.— This  is  a  French  pro- 
prietary mixture  of  various  antiseptics  based 


on  Bouchard's  idea  that  a  mixture  of  such 
drugs  has  a  heightened  antiseptic  action  with- 
out a  corresponding  increase  of  poisonous 
properties.  Phenosalyl  is  said  to  be  composed 
of  9  parts  of  carbolic  acid,  1  part  of  salicylic 
acid,  2  parts  of  lactic  acid,  tV  of  a  part  of 
menthol,  and  -J-  a  part  each  of  eucalyptol  and 
oil  of  gaultheria,  dissolved  in  glycerin  (in  what 
amount  is  not  stated).  The  foregoing  is  the 
formula  given  by  Soulier  (Memento  formulaire 
des  medicaments  nouveaux) ;  Blanc  (Rev.  de 
therap.  med.-chir.,  March  15,  1893)  mentions 
the  same  ingredients,  except  the  oil  of  gaul- 
theria, but  does  not  give  the  proportions ;  and 
a  writer  in  the  Wiener  medizinische  Wochen- 
schrift  for  June  10,  1893,  says  that  benzoic 
acid  is  one  of  the  constituents.  The  Squibbs 
(Ephemeris,  etc.,  Jan.,  1894)  say  that  the  active 
ingredients  are  dissolved  in  four  times  their 
volume  of  glycerin. 

Phenosalyl  is  a  colourless,  syrupy  liquid  which 
becomes  brownish  if  much  exposed  to  light. 
On  this  account  it  should  be  kept  in  blue  bot- 
tles. It  is  soluble  in  water  in  the  proportion 
of  7  per  cent.  As  compared  with  a  numbei' 
of  other  well-known  antiseptics,  phenosalyl 
acts  as  a  germicide  in  very  weak  solutions. 
Duloroy  (cited  by  Blanc)  found  that  cultures 
of  various  micro-organisms  were  sterilized  by 
a  minute's  contact  with  it  in  the  following  pro- 
portions : 

The  cholera  spirillum  by  a  l-to-1,000  solution. 

The  Bacillus  anthracis  by  a  3-to-l,000  solu- 
tion. 

The  pneumonia  coccus  by  a  4-to-lOO  solu- 
tion. 

The  Bacillus  pyocyameus  by  a  4-to-lOO  solu- 
tion. 

The  Bacillus  typhi  dbdominalis  by  a  5-to- 
1,000  solution. 

The  Bacillus  diphthericB  by  a  5-to-l,000  solu- 
tion. 

The  Bacillus  tuberculosis  by  a  4-to- 1,000 
solution. 

The  Staphyloccus  pyogenes  by  a  7-to-l,000 
solution. 

For  sterilizing  instruments,  a  3-per-cent.  so- 
lution is  employed.  A  1-per-eent.  solution  has 
been  found  efficient  as  an  injection  in  cases  of 
vaginal  and  uterine  catarrh  and  in  gonorrhoea. 
Phenosalyl  is  not  much  inferior  to  corrosive 
sublimate  as  a  germicide,  and  it  has  the  great 
advantage  of  being  far  less  poisonous;  but,  as 
Blanc  says,  there  is  nothing  to  hinder  the  prac- 
titioner from  making  similar  mixtures  of 
antiseptics  for  himself,  varying  the  formula 
according  to  the  case.  In  strong  solution  in 
glycerin,  phenosalyl  is  a  caustic.  In  5-per- 
cent, solution  its  application  to  the  interior  of 
the  uterus,  after  curetting,  has  been  found 
very  efficient  in  cases  of  septic  fever  due  to 
retained  portions  of  the  placenta. 

PHENYLACETAMIDE.— See  Acetani- 
LIDE.  An  ammoniated  phenylacetamide  known 
by  the  trade  name  of  ammonal.  It  has  a  strong 
smell  of  ammonia,  and  is  said  to  be  at  once 
antipyretic,  analgetic,  and  stimulant.  It  has 
been  used  chiefly  in  the  treatment  of  rheu- 
matism, neuralgia,  and  the  sequel(B  of  alco- 


PHENYLAMINE 
PHOSPHORUS 


74 


hoUc  excess.  The  presence  of  ammonia  in  a 
more  or  less  free  state  is  said  to  give  it  the  ad- 
ditional properties  ot  an  expectorant,  a  diu- 
retic, and  an  antacid.  Ammonol,  according 
to  the  Lancet,  is  also  prepared  in  the  form  of 
salicylate,  bromide,  and  iithiate. 

PHEUYLAMINE.— See  Aniline. 

PHENYL  FOBMAMIDE.— See    Foem- 

ANILIDE. 

PHENYIiHYDBAZIlIE,  CeHsN,.  is  an 
oily  liquid  without  colour,  but  of  a  faintly 
aromatic  odour.  It  is  crystallizable  on  cool- 
ing;. It  is  not  used  as  a  remedy,  but  is  the 
basis  of  a  very  delicate  test — Fischer's  test — for 
the  detection  of  sugar  in  urine.  The  test  de- 
pends upon  the  union  of  phenylhydrazine  hy- 
drochloride with  grape  sugar  to  form  a  highly 
characteristic  crystalline  substance  caMedphe- 
ni/lglucosazone.  It  is  applied  as  follows :  ''  To 
25  cubic  centimetres  of  suspected  urine  add  1 
gramme  of  phenylhydrazine  hydrochloride, 
0-75  gramme  of  sodium  acetate,  and  10  cubic 
centimetres  of  distilled  water  in  a  capsule. 
The  capsule  should  be  placed  in  a  water-bath 
and  warmed  at  least  an  hour,  then  removed 
and  allowed  to  cool ;  and  if  sugar  be  present 
even  in  minute  quantity,  there  forms  a  yellow- 
ish deposit,  which  may  appear  amorphous  to 
the  nalced  eye,  but  which,  when  examined 
under  the  microscope,  is  seen  to  contain  line, 
bright-yellow,  needle-like  crystals,  either  single 
or  in  stan—phenylgliicosazone — which  melt  at 
204°  C.  The  presence  of  small  or  large  yellow 
scales  or  powerfully  refracting  brown  spherules 
must  not  be  taken  for  evidences  of  sugar,  as 
only  the  bright-yellow,  needle-like  crystals  are 
conclusive"  (Purdy,  Practical  Uranalysisand 
Urinary  Diagnosis,  3d  ed.).  Tiiis  test  is  ex- 
ceedingly sensitive — more  so,  indeed,  than 
either  the  Pehling  test  or  that  by  fermentation. 
It  has  also  the  pronounced  advantage  over  the 
Fehling  test  of  not  responding  to  a  number  of 
urinary  ingredients,  such  as  uric  acid,  hippuric 
acid,  creatinin,  and  pyrocatechin  when  in  ex- 
cess. It  will,  it  is  true,  yield  yellow  needle- 
shaped  crystals  with  urine  containing  gly- 
couronie  acid  and  pentose,  but  the  former  will 
often  disappear  on  stopping  the  medication, 
to  which  its  presence  is  often  due.  Aside 
from  this,  however,  glycouronic  acid  and  pen- 
tose are  seldom  present  in  the  urine  in  amounts 
sufficient  to  give  the  reaction.  The  phenylhy- 
drazine test,  therefore,  is  one  of  the  utmost 
reliability  and  delicacy,  though  the  manipula- 
tions it  involves  (the  determination  of  the 
melting  point  of  the  crystals  should  be  in- 
cluded in  testing)  render  it  somewhat  trouble- 
some. Attempts  to  modify  and  to  simplify 
the  test  have  been  njade,  but  these  modifica- 
tions can  not  be  said  to  be  free  from  objec- 
tion.s.  Because  of  the  irritating  property  of 
phenylhydrazine  hydrochloride,  its  manipula- 
tion should  be  attended  with  much  care. 

Henry  A.  Griffin. 
PHENYL  HYDBIDE.— See  Benzene. 
PHENYL  SALICYLATE.— See  Salol. 
PHENYLUaETHANE.  —  See    Eupho- 


PHLEBOTOMY.  —  See  Bloodletting. 
For  hepatic  phlebotomy,  see  under  Aspiration, 
vol.  i,  page  151. 

PHLOBiIBZIN,  phlorizin,  or  phlorrhizin, 
is  a  crystalline  glucoside,  CaiH240iox2H30, 
obtained  from  the  bark  of  the  apple  tree,  the 
plum  tree  and  some  other  fruit  trees,  occurring 
in  silky  needles,  of  a  sweetish  taste  and  a  bit- 
ter after-taste,  soluble  in  hot  water  and  in 
alcohol.  It  has  been  used  to  some  extent  as 
an  antipyretic  and  antiperiodic  in  malarial 
fevers,  in  daily  amounts  of  from  15  to  30  grains. 
Large  doses  produce  temporary  glycosuria, 
the  so-called  artificial  diabetes;  given  to  ani- 
mals to  the  amount  of  8  grains  for  each  2y  lb. 
of  the  animal's  weight,  it  causes  this  result. 

PHOSPHATES. — See  under  Phosphorus. 

.  PHOSPHEBGOT.— This. name  has  been 
applied  to  an  exhilarating  mixture  of  ergot 
and  sodium  phosphate  (see  under  Ergot). 

PHOSPHIDES,  PHOSPHITES.  —  See 

under  Phosphorus. 

PHOSPHO- ALBUMIN,  otherwise  called 
dioleyllecithin.  a  preparation  that  has  been  a 
good  deal  used  in  the  Western  States,  is  said 
to  be  '•  not  secret,  patented,  or  copyrighted." 
It  purports  to  be  an  extract  made  from  the 
testicles,  spinal  cords,  and  brains  of  young 
bulls,  and  to  contain  lecithins,  spermine,  phos- 
phorized  albumins,  and  nuclein.  It  is  used 
internally  as  a  tonic  and  reconsttuctive,  espe- 
cially in  the  various  forms  of  neurasthenia, 
in  anmmia,  and  in  phthisis.  Dr.  S.  V.  Cleven- 
ger,  of  Chicago,  has  found  it  of  great  service 
also  in  the  circulatory  derangements  of  the  cli- 
macteric. It  may  be  given  in  doses  of  a  table- 
spoonful,  after  eating,  from  once  to  three  times 
a  day. 

PHOSPHOBUS  (U.  S.  Ph.,  Br.  Ph.,  Ger. 
Ph.)  is  a  non-metallic  element  obtained  chiefly 
from  bones.  It  is  a  waxlike  substance  at  the 
ordinary  temperature,  translucent  and  nearly 
colourless.  Its  surface  may  become  red  or  black 
upon  Itmg  keeping.  Its  odour  and  its  taste 
are  characteristic,  but  tasting  it,  unless  it  is 
greatly  diluted,  is  highly  dangerous.  Upon 
exposure  to  air,  phosphorus  gives  off  white 
fumes  which  are  luminous  in  the  dark  :  if  the 
exposure  is  prolonged,  it  takes  fire  spontane- 
ously. For  this  reason  it  is  kept  under  water 
and  in  strong,  carefully  closed  vessels,  and 
protected  from  heat  and  light.  Although 
phosphorus  yields'  its  odour  and  its  taste  to 
water,  it  is  practically  insoluble  in  it.  It  is 
somewhat  soluble  in  absolute  alcohol,  more 
soluble  in  absolute  ether,  still  more  soluble  (in 
about  50  parts)  in  any  fatty  oil,  and  very 
soluble  in  chloroform.  "  Besides  the  ordinary 
form  in  which  phosphorus  appears,  there  are 
several  allotropic  forms.  Of  these,  the  most 
important  are  white  phosphorus,  black  phos- 
phorus, and  red  phosphorus.  White  phos- 
phorus is  produced  when  phosphorus  is  long 
kept  in  ordinary  water,  being  a  sort  ot  incrus- 
tatjion  formed  upon  the  surface  of  the  mass. 
It  is  said  to  be  due  to  erosion  of  the  phosphorus 
by  the  free  oxygen  the  water  contains.  It 
does  not  appear  upon  phosphorus  which  is  ex- 


75 


PHENYL  AMINE 
PHOSPHORUS 


posed  to  water  containing  no  air.  Slack  phos- 
phorus results  from  a  peculiarity  in  tlie  mode 
of  cooling  liquid  phosphorus.  Neither  white 
nor  black  phosphorus  is  employed  in  medicine. 
Red  phosphorus,  also  called  am,orplwus  phos- 
phorus, is  formed  when  phosphorus  is  exposed 
for  some  time  to  a  heat  of  between  419°  and 
483°  P.  without  contact  with  air.  It  is  a 
hard,  brittle  solid,  and,  though  it  is  decom- 
posed upon  long  exposure  to  air,  the  necessary 
exposure  is  so  long  as  to  make  red  phosphorus 
for  all  practical  purposes  permanent.  Because 
of  this  it  is  a  far  safer  thing  to  handle  and  to 
transport  than  ordinary  phosphorus,  but  its 
greatest  recommendation  lies  in  the  fact  that 
when  pure  it  is  entirely  non-poisonous.  It  is 
said  to  have  the  same  systemic  action  as  the 
vitreous  form  of  phosphorus  and  to  be  free 
from  irritant  properties.  For  these  reasons, 
and  because  it  is  almost  devoid  of  taste  and 
odour,  it  would  seem  a  desirable  form  in  which 
to  administer  phosphorus,  and,  indeed,  its  use 
has  been  strongly  urged.  It  is,  nevertheless, 
little  employed  in  medicine. 

Although  the  belief  that  phosphorus  is  a 
diffusible  general  stimulant  is  scarcely  enter- 
tained at  the  present  time,  it  certainly  is  tonic 
and  nutrient  to  the  tissues  in  general  and  to 
the  nerve-centres  in  particular.  It  is  a  con- 
stituent of  many  of  the  tissues,  and  therefore 
its  medicinal  employment  is  rational.  Further- 
more, its  use  in  disorders  of  the  nerve-centres 
is  often  followed  by  the  most  gratifying  re- 
sults, and  direct  experiment  upon  animals  has 
shown  that  from  its  administration  there  fol- 
low a  thickening  of  the  spongy  tissue  of  bones 
and  a  greater  compactness  of  the  dense  por- 
tions, bony  deposits,  too,  taking  place  inside 
the  shafts  of  the  long  bones  even  to  complete 
■  obliteration  of  the  cavity  within.  As  to  the 
form  iu  which  phosphorus  acts,  when  absorbed, 
opinions  differ,  but  there  is  much  reason  in 
support  of  the  belief  tliat  it  acts  in  its  elemen- 
tary form  and  not  in  combination.  From  the 
administration  of  small  doses  of  phosphorus 
no  immediate  symptoms  are  observed.  When 
the  doses  are  slightly  increased,  however,  there 
follows  slight  gastric  warmth,  and  doses  larger 
still  cause  burning  pain  in  the  epigastrium, 
perhaps  with  some  tenderness.  The  continued 
use  of  phosphorus  may  cause  severe  dyspeptic 
symptoms,  and  phosphorous  eructations  may 
be  a  disagreeable  occurrence.  The  evidences 
of  its  beneficial  action  are  seen  in  an  increase  of 
functional  activity  throughout  the  body ;  secre- 
tion is  augmented,  mental  and  bodily  vigour 
arc  enhanced,  and  nutrition  is  improved. 

Poisoning  with  Phosphorus. — When  a  poi- 
sonous dose  of  phosphorus  has  been  taken,  the 
toxic  symptoms  do  not  appear  at  once,  for 
time  is  required  for  the  drug  to  undergo  solu- 
tion and  oxidation.  The  duration  of  this 
period  will  depend  largely  upon  the  form  in 
which  the  poison  has  been  administered,  being 
shorter  when  it  has  been  given  in  oily  solution 
and  longer  when  it  has  been  taken  in  sub- 
stance (match-heads  are  a  frequent  means  of 
self-destruction).  After  an  interval  which  may 
vary  from  one  to  twelve  hours  there  occur 
prostration,  nausea,  vomiting,  and  epigastric 
49 


pain  and  tenderness.  The  vomitus  is  of  food, 
mucus,  and  bile,  and  for  some  time  smells 
strongly  of  phosphorus  and  is  luminous  in  the 
dark.  The  vomiting  may  be  persistent  through- 
out the  duration  of  the  condition,  but  not  in- 
frequently it  disappears  on  the  second  or  third 
day,  to  return  later.  The  abdominal  tender- 
ness, however,  remains  and  generally  spreads, 
being  particularly  severe  in  the  hepatic  area. 
The  temperature  is  generally  elevated,  thirst 
is  excessive,  the  tongue  is  furred,  and  prostra- 
tion is  marked.  The  condition  of  the  bowels 
is  variable ;  in  some  cases  the  movements  are 
normal,  but  diarrhoea  may  be  present  or,  on 
the  other  hand,  constipation.  The  stools  in 
some  cases,  like  the  vomitus,  are  luminous. 
Later  on,  the  movements  are  clay-coloured  and 
sometimes  bloody.  At  any  time  between  the 
second  and  the  fifth  day  jaundice  appears  and 
rapidly  grows  worse,  and  from  now  on  the 
symptoms  observed  are  the  same  as  those  of 
acute  yellow  atrophy  of  the  liver.  The  mental 
condition,  up  to  this  time  one  of  restlessness 
and  anxiety,  now  becomes  much  disturbed. 
Delirium  appears,  varying  in  type  and  severity ; 
afterwards  stupor  supervenes,  then  coma,  end- 
ing in  death.  Spasmodic  muscular  contractions 
are  common,  also  tremors,  sometimes  paralysis, 
and  occasionally  general  convulsions.  The  fever 
is  variable  and  irregular,  but  not  infrequently 
the  temperature  becomes  subnormal  before 
death.  Vomiting  returns  with  the  jaundice 
and  is  severe,  and  the  vomited  matter  now 
contains  blood  or  more  commonly  matter  re- 
sembling coffee  grounds.  The  urine  is  di- 
minished in  quantity  and  is  high-coloured, 
containing  both  biliary  acids  and  bile  pigment. 
It  is  albuminous  and  often  contains  glucose, 
leucine,  and  tyrosine.  Sarcolactic  acid  is  gen- 
erally present.  The  urine  in  some  cases  is 
suppressed.  As  in  malignant  jaundice,  the 
liver  is  at  first  increased  in  size,  but  later,  pro- 
vided life  is  sufficiently  long  maintained,  it 
rapidly  becomes  atrophied. 

Deviations  from  the  usual  symptomatology 
of  poisoning  by  phosphorus  are  not  rare.  Ex- 
ceptionally death  may  occur  within  twenty- 
four  hours,  and  from  collapse.  Under  these 
circumstances  jaundice  does  not  occur  and  the 
symptoms  are  not  typical.  Death  may  take 
place  at  a  later  time,  even  without  the  appear- 
ance of  jaundice.  In  women  there  may  occur 
metrorrhagia.  The  duration  of  the  larger 
number  of  cases  is  days,  it  may  be  weeks,  and 
if  recovery  follows,  it  is  slow  and  tedious.  The 
post-mortem  changes  observed  in  persons  dead 
of  acute  phosphorus  poisoning  are  fatty  de- 
generation of  most  of  the  soft  parts,  especially 
the  liver,  the  stomach,  the  intestines,  and  the 
kidneys.  The  liver  varies  in  size  according  to 
the  period  at  which  death  has  taken  place.  It 
is  often  large,  softened,  and  light-coloured  or 
mottled.  The  hepatic  cells  are  infiltrated  with 
fat  globules ;  in  the  later  stages  they  are  bi-oken 
down.  There  is  catarrhal  inflammation  of  the 
bile  ducts.  The  kidneys  undergo  acute  de- 
generation, the  renal  epithelium  being  infil- 
trated and  then  broken  down.  The  mucous 
membrane  of  the  stomach  and  intestines  is 
thickened  and  grayish.    The  epithelial  cells  are 


PHOSPHOEUS 


76 


infiltrated  with  oil  globules  and  granular  mat- 
ter, or  are  destroyed.  The  heart  muscle  is  not 
uncommonly  the  seat  of  fatty  degeneration,  as 
the  voluntary  muscles  and,  in  fact,  almost  any 
of  the  soft  parts  may  be.  Hemorrhages  and 
eochymoses  may  be  found  in  various  parts  of 
the  body,  and  the  blood  is  dark  and  fluid. 

The  treatment  of  acute  phosphorus  poison- 
ing must  be  instituted  early  if  success  is  to 
follow,  for  when  the  poison  is  once  absorbed 
no  remedies  will  directly  counteract  its  effect. 
In  all  cases  the  first  remedy  which  should  be 
employed  is  sulphate  of  copper,  for  not  only 
is  it  emetic,  and  therefore  will  cause  elimina- 
tion, but  it  is  also  a  chemical  antidote.  It 
should  be  given  in  dilute  solution,  in  the  dose 
of  3  grains,  and  repeated  every  five  minutes 
until  vomiting  occurs.  It  is  recommended  by 
some  that,  following  emesis,  the  use  of  copper 
sulphate  should  be  continued  in  doses  of  iV  of  a 
grain  at  intervals  of  twenty  minutes.  Most 
authorities  prefer  to  administer  turpentine 
after  emesis  has  been  brought  about  by  the 
copper  salt.  It  is  not  the  ordinary  turpen- 
tine which  is  thus  useful,  for  that  is  of  no 
effect,  but  the  acid  French  turpentine-,  which 
with  phosphorus  forms  a  soft  crystalline  mass 
called  turpentine-phosphoric  acid,  which  is 
harmless.  Magnesia,  too,  should  be  adminis- 
tered, or  the  sulphate  or  citrate  of  magnesium, 
in  order  that  the  bowels  may  be  rapidly  and 
effectively  opened  and  elimination  be  thus 
promoted.  Potassium  permanganate  is  pre- 
ferred by  some  to  turpentine.  It  may  either 
be  given  by  the  mouth  or,  in  a  l-to-1,000  so- 
lution, may  be  used  to  wash  the  stomach.  A 
pint  of  thii  solution  has  been  used  with  suc- 
cess half  an  hour  after  the  poison  had  been 
taken.  Oils  are  to  be  avoided  in  all  cases,  be- 
cause of  the  solubility  of  phosphorus  in  oil. 
Further  than  this  the  treatment  must  be  symp- 
tomatic, anodynes  and  stimulants  being  g'ener- 
allv  demanded. 

[Dr.  B.  Q.  Thornton,  of  the  laboratory  of 
therapeutics  of  the  Jefferson  Medical  College, 
Philadelphia  {Therap.  Oaz.,  January,  1893), 
from  his  experiments  in  the  laboratory,  con- 
cludes that  permanganate  of  potassium  is  the 
best  antidote.  It  must  be  used,  he  says,  before 
the  poison  has  become  absorbed,  and  must  be 
well  diluted  (in  a  -J-  to  a  1-per-cent.  solution),  or 
vomiting  will  result  before  the  desired  chem- 
ical reaction  has  taken  place  in  the  stomach. 
It  must  be  given  in  excess,  as  considerable  per- 
manganate is  reduced  by  the  organic  sub- 
stances in  the  stomach.  While  sulphate  of 
copper  and  phosphorus  are  chemically  incom- 
patible, and  reaction  occurs  instantly  when 
they  are  brought  into  contact,  they  decidedly 
complicate  a  case  of  phosphorus  poisoning, 
says  Dr.  Thornton,  by  causing  severe  gastro- 
enteritis. Any  substance  intended  to  act  as  a 
chemical  antidote  in  the  stomach,  he  remarks, 
must  be  given  in  excess,  so  that  it  may  come 
in  contact  with  all  the  poisonous  material ;  but 
with  sulphate  of  copper,  whether  given  in  ex- 
cess or  in  the  same  chemical  proportions 
required  to  make  the  change,  violent  gastro- 
intestinal inflammation  results.  In  all  his 
experimental  oases  of  phosphorus  poisoning 


in  which  sulphate  of  copper  was  used  as  an 
antidote  death  resulted,  although  the  animal 
to  which  the  solution  of  peroxide  of  hydrogen 
was  administered  recovered  after  poisoning  by 
phosphorus.  Unchanged  phosphorus  was  vom- 
ited and  passed  by  the  bowels  by  this  animal, 
and  severe  gastro-enteritis  resulted.  Peroxide 
of  hydrogen.  Dr.  Thornton  thinks,  is  too  slow 
in  oxidizing  the  phosphorus,  and  too  irritating 
to  the  digestive  tract  to  be  a  valuable  anti- 
dote. Dr.  Thornton  says  that,  inasmuch  as 
the  old  French  oil  of  turpentine  can  not  be 
obtained  in  this  market,  it  should  cease  to  be 
considered  as  a  practical  antidote.^ 

Besides  the  acute  phosphorus  poisoning  there 
is  observed  a  chronic  form  of  poisoning  by  this 
element.  It  is  not  from  its  internal  use  that 
this  variety  of  poisoning  proceeds,  but  from 
the  continued  inhalation  of  phosphorus  in 
vapour,  to  which  workers  in  certain  manufacr 
tures,  especially  of  matches,  are  exposed. 
From  this  exposure  there  result  symptoms 
due  to  irritation  of  the  respiratory  and  the  di- 
gestive mucous  membranes.  Cough  is  gener- 
ally present,  and  not  infrequently  there  are 
anorexia,  dyspeptic  symptoms,  constipation, 
and  debility.  Impotence  and  paralysis  have 
been  observed.  The  most  remarkable  phe- 
nomenon in  these  cases,  however,  is  necrosis  of 
the  maxillary  bones,  the  inferior  maxilla  in 
particular.  The  severity  and  extent  of  this 
necrosis  are  variable,  but  the  curious  fact  about 
it  is  that  unless  the  teeth  are  carious  the 
necrosis  does  not  take  place,  access  of  the  poi- 
son to  the  maxillae  being  prevented.  The 
surest  treatment  of  the  chronic  form  of  phos- 
phorus poisoning  lies  in  withdrawal  from  the 
contaminated  atmosphere,  but  it  is  said  that 
workers  in  phosphorus  may  prevent  injury 
from  the  vaporized  element  by  suspending  . 
bottles  of  oil  of  turpentine  about  their  necks, 
that  the  well-known  antagonism  between  the 
vapours  of  turpentine  and  of  phosphorus  may 
be  brought  into  play.  This  expedient  may  be 
successful,  but,  though  it  may  prevent  phos- 
phorus poisoning,  it  is  difficul  t  to  see  how  injury 
from  the  inhalation  of  vaporized  turpentine 
can  be  assured. 

The  therapeutics  of  phosphorus  is  indicated 
by  its  physiological  action;  malnutrition  of 
nerve  and  bony  structures  constitutes  the  chief 
field  of  its  usefulness.  In  cerebral  atony '  and 
mental  enfeeblement  its  action  is  often  excel- 
lent, and  even  if  the  symptom  is  a  result  of 
organic  changes  in  the  brain  phosphorus  is  not 
always  useless.  Indeed,  in  cerebral  endarteri- 
tis, in  cerebral  softening,  and  in  paralysis  of 
cerebral  origin  it  may  be  serviceable,  though 
certainly  as  much  is  not  to  be  expected  of  it 
as  in  conditions  which  are  purely  functional 
disturbances.  Insomnia  as  an  evidence  of  cere- 
bral ancemia  and  malnutrition  is  often  effect- 
ively removed  by  phosphorus.  Mania  and 
melancholia  are  thought  by  some  to  be  bene- 
fited by  it,  and  even  paralysis  agitans  may 
thus  be  aided.  In  neuralgias  of  the  asthenic 
type  the  remedy  may  sometimes  be  serviceable, 
and  it  is  maintained  that  improvement  may 
follow  its  use  in  locomotor  ataxia  and  spinal 
sclerosis.  No  doubt  can  exist  of  its  great  value 


77 


PHOSPHORUS 


in  impotence  of  a  functional  nature,  and  the  ac- 
tivity it  possesses  over  the  genital  function  is 
witnessed  in  the  priapism  which  so  often  is  a 
symptom  of  its  toxic  action.  In  rickets  phos- 
phorus is  widely  used  and  highly  esteemed, 
and,  though  it  would  appear  to  the  writer  that 
calcium  laetophosphate  is  its  superior,  both  in 
theory  and  in  practice,  yet  many  place  more 
dependence  upon  phosphorus  for  the  cure  of 
ricliets  than  upon  any  other  drug.  In  osteo- 
malacia its  value  is  similar.  By  some,  phos- 
phorus is  thought  effective  in  pernicious 
anmmia  and  in  pseudo-leuccemia,  but  no  great 
constancy  of  action  can  be  expected  of  it  in 
these  conditions.  In  certain  skin  diseases 
phosphorus  has  been  thought  of  benefit,  nota- 
bly in  chronic  eczema,  psoriasis,  acne,  lupus, 
and  Inputs  erythematosus.  Indeed,  the  treat- 
ment of  lupus  erythematosus  by  phosphorus,  as 
taught  by  Bulkley,  is  one  of  much  excellence. 
This  plan  of  treatment  requires  the  use  of  full 
doses  for  a  considerable  time.  Thompson's 
solution  is  preferred  by  Bulkley,  because  of  its 
being  less  likely  to  cause  gastric  and  hepatic 
disturbance  than  oily  solutions  or  pills.  Be- 
ginning with  a  dose  of  15  drops,  added  to 
water  quickly  and  quickly  taken,  three  times 
a  day  and  after  eating,  the  dose  is  gradually 
increased  until  40  or  45  drops  are  taken.  Ex- 
ceptionally the  dose  may  even  reach  60  drops. 
Careful  observation  is  required  throughout  the 
course  of  treatment,  and  on  the  appearance  of 
digestive  disturbance  the  use  of  the  drug  is 
stopped  and  a  remedy  adapted  to  the  digestive 
state — nitric  aoid,  for  example,  or,  if  there  is 
constipation,  a  pill  of  blue  mass,  colocynth, 
and  ipecac — is  substituted  until  the  condition 
of  the  digestion  becomes  normal,  when  the  use 
of  phosphorus  is  resumed.  With  careful  ob- 
servation and  the  precautions  described,  the 
use  of  phosphorus  may  safely  be  continued  for 
months,  and  from  its  use  in  lupus  erythemato- 
sus much  benefit  may  be  expected. 

So  far  as  the  use  of  phosphorus  in  general  is 
concerned,  it  is  certainly  a  remedy  which  is  to 
be  used  with  the  utmost  care,  and,  provided 
its  use  is  to  be  long  continued,  frequent  obser- 
vation of  the  patient  is  necessary.  It  should 
seldom  be  long  given  in  large  doses,  because  of 
the  danger  of  its  causing  fatty  degeneration 
when  so  used  and  because,  as  a  rule,  small 
doses  are  as  effective  as  large  ones.  It  should 
not  be  given  in  diseases  in  which  the  lesions  are 
acute  and  inflammatory,  and,  finally,  it  should 
under  no  circumstances  be  given  in  substance. 

The  preparations  of  phosphorus  are  not  nu- 
merous. Phosphorated  oil,  oleum phosphoratum 
(U.  S.  Ph.,  Br.  Ph.),  is  a  l-per-cent.  solution  of 
phosphorus  in  expressed  oil  of  almond.  Ether 
in  small  amount  is  added  to  the  U.  S.  prepara- 
tion to  aid  in  preservation  and  to  render  the 
taste  more  agreeable.  The  dose  is  from  3  to  5 
minims,  and  it  may  be  administered  either  in 
emulsion  or  in  a  capsule.  Pills  of  phosphorus, 
pilulcB  phosphori  (IT.  S.  Ph.),  and  the  phosphor- 
us pill,  pilula  phosphori  (Br.  Ph.),  are  consider- 
ably employed.  Each  pill  prepared  according 
to  the  formula  of  the  U.  S.  Ph.  contains  about 
yoTT  of  a  grain  of  phosphorus,  while  the  pill 
mass  of  the  Br.  Ph.  contains  -^  of  a  grain  of 


phosphorus  in  3  grains.  Of  this  the  dose  is 
from  1  to  3  grains,  the  equivalent  of  from  ^^ 
to  ^f  oi  &  grain  of  phosphoi'us.  Spirit  of 
phosphorus,  spiritus  phosphori  (U.  S.  Ph.), 
tincture  of  phosphorus,  is  a  solution  of  phos- 
phorus in  absolute  alcohol.  Each  drachm  con- 
tains about  (V  of  a  grain  of  phosphorus.  It  is 
seldom  employed  save  in  making  elixir  of  phos- 
phorus, elixir  phosphori  (U.  S.  Ph.),  which 
contains  210  parts  of  spirit  of  phosphorus,  3  of 
oil  of  anise,  550  of  glycerin,  and  enough  aro- 
matic elixir  to  make  1,000  parts.  The  dose  is 
from  20  to  40  minims.  There  is  also  employed 
a  solution  of  phosphorus  proposed  by  J.  Ash- 
burton  Thompson,  to  which  reference  has 
already  been  made.  This  is  composed  of  1 
grain  of  phosphorus  dissolved  in  5  fl.  drachms 
of  absolute  alcohol  by  gentle  heat  and,  added 
to  it,  a  warmed  mixture  composed  of  l^-  fi.  oz. 
of  glycerin,  2  fl.  drachms  of  alcohol,  and  40 
minims  of  spirit  of  peppermint.  Of  this  solu- 
tion 1  fl.  drachm  will  contain  -^g  of  a  grain  of 
phosphorus. 

FnospMdes  are  direct  combinations  of 
phosphorus  with  other  elements  or  radicles. 
But  one  phosphide  is  in  common  use.  This  is 
zinc  phosphide,  zinci  phosphidum.  (U.  S.  Ph.), 
a  dark-gray  powder  or  dark  crystalline  frag- 
ments of  metallic  lustre.  It  has  an  odour  and 
a  taste  which  resemble  those  of  phosphorus. 
When  exposed  to  the  air  it  emits  phosphorous 
vapour.  It  is  insoluble  in  water  and  m  alco- 
hol. It  is  soluble  in  diluted  hydrochloric  or 
sulphuric  acid,  hydrogen  phosphide  being 
evolved.  Its  formula  is  ZuaPa.  The  physio- 
logical action  and  the  therapeutic  effects  of 
zinc  phosphide  are  those  of  phosphorus,  for 
which  drug  it  may  be  used  as  a  substitute. 
The  dose  is  ^  of  a  grain. 

Phosphites  are  salts  of  phosphorous  acid. 
None  are  official. 

Phosphoric  acid  is  a  name  equally  ap- 
plicable to  three  acids — orfhophosphoric  acid, 
H aFO i,  pyrophosphoric  acid,  H4PJO7,  and  me- 
taphospfioric  acid,  HPOs.  By  general  consent, 
it  is  the  first  of  these  which  is  meant  when  the 
unqualified  term  phosphoric  acid  is  employed, 
and  orthophosphoric  acid  alone  is  official. 

Strong  solutions  of  phosphoric  acid  are  lo- 
cally irritating  and  stimulating,  but  they  are 
seldom  applied,. for  they  possess  no  advantage 
over  other  stimulant  remedies.  A  10-per-oent. 
solution  in  distilled  water,  however,  is  said  to 
be  an  effective  application  to  chronic  ulcers 
when  applied  several  times  a  day  on  lint.  In 
weak  solution  phosphoric  acid  is  frequently 
given  internally  as  a  tonic  and  refrigerant. 
That  it  is  stomachic  and  aids  digestion  seems 
proved,  but  that  it  possesses  any  other  remedial 
value  is  questionable,  to  say  the  least ;  it  cer- 
tainly has  none  of  the  systemic  effects  of  phos- 
phorus, and  therefore  for  alterative  action, 
save  as  alteration  may  follow  improved  diges- 
tion, it  is  inert.  Notwithstanding  this,  phos- 
phoric acid  has  been  recommended  for  a 
variety  of  ailments,  among  them  hysteria,  leu- 
corrhcea,  sexual  debility,  chronic  bone  diseases, 
and  diabetes.  It  has  been  thought  to  prevent 
phosphaturia,  and  indeed  it  may  do  so  if  indi- 
gestion is  the  cause,  for  in  some  cases  of  dys- 


PHOTOXYLIN 
PHCJLLUAH 


78 


pepsia  its  curative  power  is  considerable.  Tiie 
diluted  acid  is  a  desirable  remedy  in  many 
varieties  of  fever,  not  because  it  exerts  any 
curative  influence  upon  the  disease  processes,  as 
a  rule,  but  because  of  its  effect  upon  digestion 
and  because,  when  added  to  water,  it  makes 
an  agreeable  refrigerant  drink  by  virtue  of  its 
sour  taste.  Although  the  diluted  acid  is  not 
actively  irritant  and  is  not  astringent,  its  too 
liberal  administration  will  cause  digestive  de- 
rangement similar  in  character  to  that  which 
results  from  over-use  of  the  vegetable  acids. 
Several  solutions  of  phosphoric  acid  are  official. 
The  strongest  solution  is  known  in  this  coun- 
try as  phosphoric  acid,  aeidum  phosphoricum 
(U.  S.  Ph.).  This  contains  not  less  than  S5  per 
cent,  by  weight  of  absolute  orthophosphoric 
acid  and  not  more  than  15  per  cent,  of  water.  It 
is  a  colourless  and  odourless  liquid  of  a  strong- 
ly acid  taste.  This  preparation  is  seldom  used 
medicinally,  though  it  may  be  given  in  doses 
of  from  2  to  5  minims  largely  diluted.  Con- 
centrated phosphoric  acid,  aeidum  phosphori- 
cum concentratum  (Br.  Ph.),  in  spite  of  what 
its  name  might  suggest,  is  a  weaker  solution 
than  the  one  previously  mentioned.  It  con- 
tains "  phosphoric  acid,  H3PO4.  with  33'7  per 
cent,  of  water  "  (Br.  Ph.).  The  dose  is  from  2  to 
5  minims,  given  largely  diluted.  Another  so- 
lution, yet  weaker,  is  also  known  as  phosphoric 
acid,  aeidum  phosphoricum  (Ger.  Ph.).  It  con- 
tains 25  per  cent,  of  the  acid.  The  preparation 
which  is  generally  employed  is  known  as  di- 
luted phosphoric  acid,  aeidum  phosphoricum 
dilutum  (U.  S.  Ph.,  Br.  Ph.).  The  preparation 
of  the  U.  S.  Ph.  contains  10  per  cent,  by 
weight  of  absolute  orthophosphoric  acid;  the 
British  preparation  contains  13'8  per  cent, 
by  weight.  The  dose  of  either  is  from  10  to 
30  minims,  given  freely  diluted. 

Under  the  name  aeidum  phosphoricum  gla- 
ciale  (glacial  phosphoric  acid)  there  was  for- 
merly recognised  by  the  U.  S.  Ph.  a  solid 
metaphosphorie  acid,  HPO3.  It  is  a  white, 
uncrystallizable  solid  without  odour,  but  of  a 
very  acid  taste.  It  is  deliquescent,  soluble  in 
water,  and  soluble  also  in  alcohol.  Glacial 
phosphoric  acid  was  official  solely  for  pharma- 
ceutical purposes,  and  was  dismissed  because 
of  its  almost  invariable  impurity. 

Ph.ospb.ates  are  salts  of  the  phosphoric 
acids,  and  particularly  of  orthophosphoric 
acid.  The  phosphates  which  are  of  the  most 
importance  medicinally  are  those  of  ammo- 
nium, calcium,  iron,  potassium,  and  sodium  ; 
though  other  phosphates  have  been  employed, 
they  are  active  rather  because  of  their  basic 
than  of  their  acid  constituents. 

Ammonium  phosphate,  phosphate  of  am- 
monium (often  improperly  called  phosphate  of 
ammonia),  ammonii  phosphas  (Br.  Ph.),  occurs 
in  colourless,  translucent  crystals,  without 
odour  and  of  a  cooling,  saline  taste.  It  is  free- 
ly soluble  in  water,  but  insoluble  in  alcohol. 
When  exposed  to  dry  air  it  loses  ammonia. 
Its  formula  is  (NH4)2HP04.  Though  other 
ammonium  phosphates  are  found  in  commerce, 
this  salt  alone  is  official.  The  dose  is  from  5 
to  30  grains.  It  has  been  thought  valuable  in 
the  uric-acid  condition,  the  soluble  ammonium 


urate  and  sodium  phosphate  being  produced 
by  its  combination  with  sodium  urate.  It  has 
also  been  recommended  in  rheumatism,  and  is 
employed  at  times  as  a  diaphoretic.  It  is  to  be 
given  dissolved  in  a  moderate  amount  of  water. 
Calcium  phosphate,  caleii  phosphas  prcecipi- 
tatus  (U.  S.  Ph.),  caleii  phosphas  (Br.  Ph.), 
calcium  phosphoricum  (Ger.  Ph.),  precipitated 
calcium  phosphate,  phosphate  of  calcium,  im- 
properly called  phosphate  of  lime,  Ca3(P04)!,,  is 
a  light,  white,  amorphous  powder  without 
odour  or  taste.  It  is  insoluble  in  water  and  in 
alcohol,  and  is  permanent  in  the  air.  It  is 
dissolved  by  hydrochloric  and  nitric  acids. 
Although  calcium  phosphate  is  insoluble  in 
water,  it  is  absorbed  from  the  stomach  in 
small  amount  because  of  the  acids  present  in 
the  gastric  juice.  There  is  no  advantage  in 
giving  the  salt  in  large  doses,  because  the  gas- 
tric acids  are  competent  to  dissolve  and  cause 
the  absorption  of  small  quantities'"  only.  The 
combination  of  calcium  phosphate  with  lactic 
acid,  however,  is  more  soluble  in  water,  and 
therefore  the  preparation  known  as  syrup  of 
calcium  lactophosphate,  syrupus  caleii  lacto- 
phosphatis  (IT.  S.  Ph.),  is  an  admirable  means 
of  administering  calcium  phosphate.  The  im- 
portance of  calcium  phosphate  in  the  animal 
economy  is  evident  when  it  is  known  that 
there  is  no  tissue  of  the  body  which  does  not 
normally  contain  it,  and  though  it  is  most 
abundant  in  bone,  it  is  equally  essential  to  the 
health  of  the  other  structures  also,  for  experi- 
ments have  shown  that  animals  fed  upon  food 
which  lacks  it  will  suffer  with  rhaohitis  or 
become  wasted  and  enfeebled.  Its  medicinal 
employment  therefore  becomes  rational  in  all 
conditions  in  which  the  quantity  of  the  salt  in 
the  tissues  is  deficient.  Of  such  conditions 
rickets  and  osteomalacia  offer  the  best  exam- 
ples, though  if  it  is  true  that  in  tuberculosis 
the  phosphoric  waste  is  increased,  as  shown  by 
a  larger  quantity  of  earthy  phosphates  in  the 
urine,  without  a  correspondingly  increased  in- 
take, tuberculous  conditions  are  not  less  appro- 
priately so  treated.  The  treatment  of  rickets 
by  the  use  of  calcium  phosphate  is  as  effective 
as  it  is  rational,  and  in  osteomalacia  as  well  as 
in  delayed  union  after  fracture  the  remedy  is 
to  be  recommended.  As  to  its  value  in  tuber- 
culosis, the  proof  is  less  convincing,  though 
many  esteem  it  highly  in  chronic  phthisis  and 
other  tuberculous  conditions.  It  would  seem 
to  be  more  generally  effective,  however,  in  the 
debility  of  children  and  young  people,  which 
suggests  and  may  precede  actual  tuberculosis, 
than  in  the  fully  developed  disease.  The  drug 
has  been  recommended  also  as  an  alterative  in 
late  syphilitic  manifestations.  The  dose  of 
calcium  phosphate  is  from  10  to  30  grains. 
Syrupof  calcium  lactophosphate,  syrupus  caleii 
laetophosphatis  (U.  S.  Ph.),  is  composed  of  25 
parts  of  precipitated  calcium  carbonate,  60  of 
lactic  acid,  36  of  phosphoric  acid,  25  of  orange- 
flower  water,  700  of  sugar,  and  a  sufficient 
quantity  of  water  to  make  1,000  parts.  The 
dose  is  from  2  to  4  fl.  drachms.  There  is  some- 
times employed  a  non-official  combination 
known  as  "chemical  food,"  compound  syrup 
of  the  phosphates,  syrupus  phosphatum  com- 


•yg 


PHOTOXYLIN 
PHULLUAH 


positus  (Nat.  Form.).  This  is  composed  of  256 
grains  of  precipitated  calcium  carbonate,  128 
grains  of  iron  pliosphate,  128  grains  of  ammo- 
nium phosphate,  32  grains  of  potassium  bicar- 
bonate, 33  grains  of  sodium  bicarbonate,  1 
Troy  oz.  of  citric  acid,  1  fl.  oz.  of  glycerin,  2  fl. 
oz.  of  50-per-cent.  phosphoric  acid,  2  fl.  oz.  of 
orange-flower  water,  120  minims  of  tincture  of 
cudbear,  8  Troy  oz.  of  sugar,  and  enough  water 
to  make  16  fl.  oz.  The  dose  is  from  1  to  2  fl. 
drachms. 

Jron  phosphate. — See  under  Iron. 

Potassium  phosphate,  phosphate  of  potas- 
sium, KsHP04,  is  a  white,  amorphous  salt 
which  is  deliquescent  upon  exposure.  Its  use 
is  similar  to  that  of  calcium  phosphate,  the 
salt  being  used  as  an  alterative  in  various 
forms  of  tuberculosis.  The  dose  is  from  10  to 
30  grains,  given  dissolved  in  water. 

Sodium  phosphate,  phosphate  of  sodium, 
soda  phosphas  (U.  S.  Ph.,  Br.  Ph.),  natrium 
phosphoricum  (Ger.  Ph.),  sodium  orthophos- 
phate,  NaiHP04  +  I2H2O,  is  sometimes  called 
phosphate  of  soda.  It  occurs  in  large,  colour- 
less crystals  which  are  without  odour,  but  of 
a  cooling,  saline  taste.  It  is  efflorescent  in  the 
air.  It  is  soluble  in  water,  but  insoluble  in 
alcohol.  Sodium  phosphate  is  a  normal  in- 
gredient of  the  blood,  and  when  administered 
in  sufficient  amount  increases  the  alkalinity  of 
that  fluid.  In  small  doses  it  is  believed  to 
possess  alterative  powers,  and  may  be  given  in 
the  same  variety  of  eases  in  which  calcium 
phosphate  is  useful.  In  moderate  doses  it  is 
stimulant  to  thebiliary  function,  and  therefore 
may  be  administered  in  cases  in  which  biliary 
production  is  insufficient.  Among  those  in 
which  it  is  most  useful  are  catarrhal  jaundice, 
hepatic  torpor,  intestinal  dyspepsia,  and  diar- 
rhoea with  olay-ooloured  movements.  Its  power 
of  promoting  hepatic  activity  seems  especially 
pronounced  in  children,  and  because  of  its  not 
disagreeable  taste  the  remedy  is  one  which  is 
well  suited  for  use  in  the  young.  As  to  the 
value  of  sodium  phosphate  in  lithcemic  condi- 
tions, it  seems  evident  that  many  patients  are 
benefited  by  it,  though  many,  too,  seem  but 
little  relieved.  In  doses  of  1  oz.  sodium  phos- 
phate is  laxative,  but  it  is  seldom  used  for  this 
purpose.  The  drug  is  of  much  usefulness  in 
preventing  biliary  inspissation  and  the  forma- 
tion of  biliary  calculi.  Indeed,  it  is  a  more 
efficient  remedy  in  this  field  than  any  other. 
It  should  be  given  for  this  purpose  in  moderate 
doses,  and  its  use  should  be  long  continued. 
Upon  calculi  which  are  already  formed  the 
remedy  has  no  influence.  For  children,  the 
dose  of  sodium  phosphate  is  from  3  to  10 
grains,  and  it  may  advantageously  be  given  to 
them  in  milk  or  other  food.  For  adults,  the 
usual  dose  is  from  20  to  40  grains,  though  much 
larger  doses  may  be  given.  For  its  constitu- 
tional effects  it  should  be  given  after  meals. 
(See  also  Sodium  phosphate.) 

Sodium  pyrophosphate,  sodii  pyrophosphas 
(U.  S.  Ph.),  is  prepared  by  heating  sodium 
phosphate  to  redness,  dissolving  in  water,  fil- 
tering, and  crystallizing.  It  appears  as  colour- 
less, transparent  crystals  or  as  a  crystalline 
powder.    It  has  no  odour,  but  a  cooling,  saline, 


and  somewhat  alkaline  taste.  It  is  permanent 
in  cool  air  and  efflorescent  in  warm  air.  It  is 
soluble  in  water,  but  insoluble  in  alcohol.  Its 
formula  is  Na4P20T  -I-  lOHjO.  Though  the  ac- 
tion of  sodium  pyrophosphate  is  probably  that 
of  sodium  phosphate,  the  salt  is  one  which  is 
little  used  medicinally.  It  is  used  in  pharmacy, 
however,  in  making  ferric  pyrophosphate. 

Henry  A.  Griffin. 

PHOTOXYLIN,     PHOTOXYLON,    or 

trinitrocellulose,  is  a  substance  analogous  to 
gun  cotton,  but  made  from  wood  pulp.  A 
form  of  collodion  made  by  dissolving  it  in  a 
mixture  of  ether  and  alcohol  has  been  em- 
ployed for  embedding  objects  of  which  sections 
are  to  be  made  for  microscopical  examination, 
also  to  some  extent  in  surgery  as  a  substitute 
for  ordinary  collodion. 

PHTJLLtTAH.— In  the  Indian  Medical 
Record  for  Nov.  16,  1893,  Mr.  E.  C.  Beddell, 
W.  M.  0.,  says  that  this  is  an  oily  substance 
obtained  from  a  plant  that  grows  wild  on  the 
hills  about  Nani  Tal.  In  its  fresh  state  it  re- 
sembles small  white  balls  of  about  the  size  of 
areca  nuts.  When  kept  for  some  time  in  its 
liquid  form  it  becomes  of  a  dirty-brown  colour. 
It  is  largely  used  among  the  tribes  of  the  hills 
for  the  cure  of  frostbites  and  chilblains.  Mr. 
Beddell  has  found  the  topical  use  of  phulluah 
very  beneficial  in  rheumatism,  sprains,  sciatica, 
and  chilblains,  and  he  is  inclined  to  think  that 
it  would  do  good  service  in  cases  of  gout,  but 
as  yet  he  has  not  had  the  opportunity  of  giving 
it  a  trial.  Its  action  seems  to  him  to  be  stim- 
ulant, emollient,  powerfully  anodyne,  and  an- 
tiseptic. It  is  best  to  heat  "the  crude  drug  and 
then  use  it  like  an  ordinary  liniment  by  friction. 

He  relates  the  case  of  a  Hindoo,  forty-two 
years  old,  who  in  his  youth  had  been  a  sepoy 
in  a  rajah's  service  and  had  received  a  sword 
wound  and  two  bullet  wounds.  The  scars  of 
these  wounds  were  still  to  be  seen,  but  their 
situation  could  in  no  way  account  for  a, paraly- 
sis of  which  he  was  the  subject.  He  had 
always  enjoyed  good  health  and  had  never  had 
a  head  injury,  a  sunstroke,  or  a  fit  of  any 
kind.  His  story  of  his  paralysis  was  as  fol- 
lows :  One  night  he  had  gone  to  sleep  perfectly 
well,  and  the  next  morning  been  found  insen- 
sible. On  recovering  consciousness,  he  had 
found  himself  in  a  hemiplegic  condition.  For 
fifty-four  days  thereafter  he  had  been  unable 
to  walk  and  had  had  great  difficulty  in  swal- 
lowing. He  had  gradually  recovered  to  some 
extent.  On  inspection,  Mr.  Beddell  found  the 
man's  right  side  paralyzed.  His  sensibility 
was  partially  affected ;  he  could  not  tell  ac- 
curately the  situation  of  a  part  touched. 
There  was  a  slight  trace  of  sensation  in  the 
occipito-frontalis,  the  right  masseter,  the  bi- 
ceps, and  the  triceps,  but  it  was  quite  lost  in 
the  right  trapezius,  the  rectus,  the  vastus  in- 
ternus,  and  the  hamstring  muscles.  The  pa- 
tient could  lift  his  hand  to  an  angle  of  about 
forty-five  degrees.  The  usual  routine  treatment 
could  not  be  carried  out  for  want  of  proper  medi- 
cines and  appliances,  and  Mr.  Beddell  was  there- 
fore obliged  to  adopt  such  measures  as  were 
within  the  patient's  means.    His  bowels  were 


PHYSIOLOGICAL  ACTION  OP  DRUGS 
PHYTOLACCA  80 


cleared  out  with  calomel,  and  it  was  ordered 
that  a  liniment  of  8  oz.  of  phuUuah,  2  oz.  of 
oil  of  turpentine,  and  4  oz.  of  rum  should  be 
rubbed  into  the  affected  parts  three  times  a 
day.  Continued  friction  with  this  liniment, 
together  with  steady  massage,  caused  a  re- 
markable improvement,  and  the  patient  was 
able  to  lift  a  weight  of  3f  lbs.  with  the  para- 
lyzed hand  after  a  month  of  this  treatment. 
Mr.  Beddell  is  inclined  to  attribute  the  fa- 
vourable result  to  phuUuah  and  massage. 

PHYSIOLOGICAIi  ACTIOBT  OF 
DRUGS. — The  present  scientifio  use  of  cura- 
tive agents  is  a  product  of  evolution  not  yet 
finished.  It  has  developed  from  the  pure  ern- 
piricism  of  the  ancients  and  the  pseudo-sci- 
ence of  the  scholastics.  The  Egyptians,  Ro- 
mans, and  Greeks  had  a  materia  medica  which 
was  based  on  experience :  a  patient  received 
some  drug  or  some  form  of  drug  which  was 
known  to  have  benefited  some  other  patient 
with  similar  "  surface-play  of  disease."  The 
Greeks  and  Romans  increased  their  list  of 
drugs  by  placing  votive  tablets  in  the  tem- 
ples on  which  were  inscribed  the  names  of 
useful  remedies  with  their  indications.  The 
Egyptians  are  said  by  Strabo  to  have  displayed 
their  sick  ones  in  the  open  market  place,  that 
all  who  had  suffered  in  similar  manner  might 
offer  suggestions. 

In  the  Middle  Ages  this  empiricism  was  dis- 
regarded. Signatures  largely  took  the  place 
of  tried  remedies.  These  consisted  of  natural 
objects  which  were  believed  to  have  medicinal 
properties  bestowed  upon  them  by  the  stars. 
Thus,  the  hedge-turnip,  having  some  resem- 
blance to  a  swollen  foot,  was  considered  a  cer- 
tain cure  for  dropsy ;  the  eyes  on  the  peacock's 
tail,  resembling  a  nipple  and  its  areola,  were 
considered  specific  for  diseases  of  the  breast 
in  women.  In  the  lungwort,  ov  pulmonaria.  a 
plant  which  looks  faintly  like  a  tuberculous 
lung,  the  scholastics  believed  they  had  an  in- 
fallible cure  for  phthisis.  Similar  instances 
could  be  multiplied  did  not  space  forbid.  So 
late  as  at  the  end  of  the  eighteenth  century  the 
London  Fharmacopmia  contained  crab's  eggs, 
coral,  earthworms,  and  the  excrement  of  many 
vertebrate  animals  in  its  list  of  curative  agents. 

To  the  great  Magendie  is  due  the  credit  of 
having  made  thfe  first  scientific  endeavour  to 
use  drugs  in  disease  in  accordance  with  their 
physiological  action  in  health.  His  first  ex- 
periment was  on  the  upas,  the  active  princi- 
ple of  which  is  strychnine,  and  his  deductions 
were  followed  by  clinical  use  of  the  alkaloid, 
derived,  however,  from  the  nux-vomioa  plant, 
since  that  was  more  accessible  and  cheaper 
than  upas.  In  the  same  way,  after  the  dis- 
covery of  chloral,  in  1830,  by  Liebig,  it  was 
regarded  as  a  chemical  curiosity  until  Lie- 
breich,  in  1860,  showed,  after  experiment,  its 
narcotic  influence.  Magendie  was  followed  by 
a  host  of  clinical  and  chemical  experimenters 
who  have  raised  the  treatment  of  disease  by 
drugs  from  the  most  absurd  position  to  a  com- 
paratively rational  basis ;  for,  although  at  the 
present  day  we  use  some  drags  empirically, 
such  as  quinine  in  malarial  disease  and  mer- 


cury in  syphilis,  there  exist  good  reasons  and 
substantial  indications  for  the  administration 
of  most  of  our  remedial  agents. 

The  effect  of  a  drug  introduced  into  the  sys- 
tem is  regarded  as  direct,  local,  or  primary,  or 
as  indirect,  remote,  or  secondary,  according  as 
its  influence  is  exerted  upon  the  site  of  appli- 
cation or  upon  some  other  organ  or  part 
through  the  nervous  system  or  the  circulation. 
The  relation  of  effect  to  the  dose  varies  with 
the  quantity  of  the  drug  taken  ;  and  this  rela- 
tion changes  in  a  manner  depending  upon  the 
interaction  of  different  parts  of  the  body  and 
upon  the  difl:erent  effects  the  medicament  ex- 
ercises upon  individual  cells  or  tissues  or 
organs.  A  very  large  and  a  very  small  quan- 
tity may  thus  produce  the  same  symptoms, 
while  an  average  dose  may  cause  a  different 
effect.  Lauder  Brunton  (Text-book  of  Phar- 
macology, Therapeutics,  and  Materia  Medica, 
Philadelphia,  1885)  states  that  the  quan- 
tity entering  the  system  or  coming  into  con- 
tact with  its  tissues  must  depend  upon  the 
quantity  actually  given,  its  relation  to  the 
bodily  weight,  its  rapidity  of  absorption  and 
excretion,  the  rate  of  absorption  by  the  tis- 
sues, and  the  condition  of  the  circulation  in 
various  parts  of  the  body  which  determine  the 
quantity  of  the  drug  carried  to  each.  The 
dose  of  a  drug,  therefore,  varies  in  proportion 
to  the  amount  already  in  the  system.  If  a 
drug  is  not  rapidly  excreted  or  dissolves  very 
slowly,  as  strychnine  does,  it  may  remain  in 
the  body  for  a  considerable  time  and  finally 
show  the  effect  of  an  accumulated  dose.  This 
is  known  as  cumulative  action.  Physiological 
experiment  has  determined  that  bodily  weight 
and  dose  are  proportionate  to  each  other. 
Children,  for  this  reason,  receive  in  practice 
smaller  doses  than  adults. 

It  has  been  demonstrated,  likewise  by  ex- 
periment, that  in  the  administration  of  drugs 
the  quickest  possible  effect  is  obtained  by  their 
injection  into  a  blood-vessel ;  that  the  subcu- 
taneous introduction  of  a  drug  offers  the  next 
most  rapid  transfer  of  effect ;  that  a  medica- 
ment administered  by  the  mouth  requires  for 
the  exertion  of  the  same  influence  a  larger 
dose ;  and  that  drugs  introduced  into  the  rec- 
tum require  to  be  used  in  still  larger  quanti- 
ties and  for  a  greater  length  of  time  to  produce 
their  effect.  Absorption  after  subcutaneous 
injection  is  quickest  in  the  most  vascular 
areas,  which  are.  in  order  of  rapidity  of  as- 
similation, the  temples,  the  breast,  and  the 
inner  surfaces  of  the  arms  and  legs.  The 
serous  membranes  absorb  more  quickly  than 
the  intercellular  tissues,  and  these  more  rap- 
idly than  mucous  membranes. 

The  human  body  is  so  complex  and  the 
inter-relations  of  its  parts  are  so  difficult  to  com- 
prehend that  it  is  little  wonder  that  the  physi- 
ological action  of  drugs  in  health  is  masked 
by  disease.  The  well-known  excitement  follow- 
ing the  administration  of  opium  in  delirium, 
for  instance,  is  a  good  example.  Other  influ- 
ences modify  the  effects  of  drugs  when  given 
in  the  determined  physiological  do.se.  'Thu.s. 
drugs  in  soluble  form  exert  their  influence 
more  quickly  than  solid  substances ;  an  empty 


81 


PHYSIOLOGICAL  ACTION  OP  DRUGS 
PHYTOLACCA 


stomach  facilitates  their  introduction  into  the 
system,  but  they  affect  the  viscus  locally  as 
well ;  the  surrounding  temperature  and  the 
temperature  of  the  individual  modify  the  ac- 
tion of  a  drug;  a  warm  climate  seems  to 
increase  narcotic  influence ;  the  time  of  day 
determines  modifications  which  depend  upon 
lowered  or  heightened  Titality.  Tolerance, 
idiosyncrasy,  and  habit  are  powerful  factors 
in  the  determination  of  doses;  quantities  of 
opium  and  arsenic,  for  example,  may  be  taken 
by  persons  addicted  to  these  drugs  which 
would  speedily  prove  poisonous  to  a  stranger 
to  them.  Emotions  play  a  considerable  role 
in  affecting  the  action  of  drugs;  the  firm 
assurance  that  a  substance  will  exert  a  cer- 
tain influence  may  induce  the  desired  result, 
though  the  dose  may  be  a  minimal  physio- 
logical one  or  though  the  drug  may  not  be 
given  at  all. 

To  determine  the  effects  of  drugs  upon  the 
human  system,  experiments  are  carried  out  in 
various  ways.  Some  animal  of  simpler  consti- 
tution is  chosen  and  deductions  are  made  by 
analogy,  allowing  for  differences  in  bodily 
weight ;  or  a  drug  is  applied  to  some  part  of 
a  more  complex  animal  body  separated  from 
the  rest,  being  prevented  from  reaching  other 
parts  of  the  body  at  the  same  time ;  or  arti- 
ficial changes  are  produced  in  the  relations  of 
the  various  parts  of  the  body,  as  by  dividing 
the  pneumogastric  nerves,  and  the  effect  of 
drugs  is  noted  on  isolated  organs  or  parts  of 
the  body  (Lauder  Brunton,  loc.  cit.).  By  sub- 
sequent careful  experimentation  upon  the 
human  body,  eliminating  such  errors  as  are 
manifest  by  the  differences  in  anatomical 
structure,  exact  physiological  knowledge  is 
easily  attained. — Samuel  M.  Bkickner. 

PHYSOSTIGMA  (IT.  S.  Ph.).  physostigma- 
tis  semen  (Br.  Phi.),  the  ordeal  bean  of  Calabar, 
has  been  considered,  so  far  as  its  therapeutical 
properties  are  concerned,  in  the  article  on  Es- 
ERINE,  which  is  another  name  for  physostig- 
mine,  and  in  the  article  on  Motor  depressants 
(vol.  i,  page  644).  It  may  be  added  here  that 
Dr.  Giovanni  {II  Morgagni,  1895,  No.  7;  Dtsch. 
Med.-Ztg..  November  18, 1895)  reports  the  suc- 
cessful treatment  of  three  cases  of  hcematuria 
with  Calabar  bean.  One  was  a  case  of  so-called 
essential  hematuria  in  which  six  months  of 
treatment  had  been  ineffectual.  Extract  of 
physostigma  was  prescribed,  and  in  a  few  days 
the  hsematuria  ceased,  to  come  on  again  when 
the  use  of  the  remedy  was  continued,  and  to 
subside  definitively  on  its  resumption.  In  the 
two'  other  cases  the  hiematuria  accompanied 
cancer  of  the  kidney  in  one  and  Pott's  disease 
in  the  other ;  in  both  instances  it  yielded  to 
the  remedy.  The  dose  of  physostigma  in 
powder  is  from  1  to  4  grains ;  that  of  the  ex- 
tract, extractum  physostigmatis  (U.  S.  Ph.,  Br. 
Ph.),  is  from  -jV  to  i  of  a  grain ;  that  of  the 
tincture,  tinctura  physostigmatis  (U.  S.  Ph.), 
is  from  20  to  40  minims. 

PHYSOSTIGMIITE,  physostigmina  (Br. 
Ph.),  is  the  same  as  eserine  {q.  v.).  The  official 
discs  of  physostigraine,  lamellce  physostigmince 
(Br.  Ph.),  contain  each  about  •n)Vff  of  a  grain  of 


the  alkaloid.  The  sulphate,  physostigmincs 
sulphas  (U.  S.  Ph.),  physostigminum  sulfuri- 
cum  (Ger.  Ph.),  and  the  salicylate,  physostig- 
minum salicylicum  (Ger.  Ph.),  are  also  in  use 
(see  under  Eserine). 

PHYTOLACCA,  or  po^e.— Both  the  root 
and  the  berries  of  Phytolacca  decandra  are  of- 
ficial in  the  U.  S.  Ph.,  being  denominated  re- 
spectively phytolaccce  radix  and  phytolaccm 
fructus.  The  root  is  the  more  active.  The  leaves 
of  the  plant  possess  the  same  properties,  but  to 
a  much  less  marked  degree.  It  is  a  narcotic 
emeto-cathartic,  and  the  accidental  ingestion 
of  the  berries  has  been  followed  by  fatal  results, 
death  being  due  usually  to  paralysis  of  the  res- 
piration. Itschief  useinmedicineisinthe  treat- 
ment of  mammitis, over  which  it  appears  to  have 
more  eflEect  than  any  other  drug  we  possess. 
It  should  be  applied  in  the  shape  of  the  non- 
ofdoial  solid  extract  spread  upon  cloth  which 
must  cover  the  entire  breast  save  the  nipple, 
which,  it  is  hardly  necessary  to  state,  must  be 
thoroughly  cleansed  before  an  infant  is  allowed 
to  suck.  At  the  same  time  it  is  recommended 
to  administer  it  internally.  It  is  maintained 
that  in  inflammation  of  the  lymphatic  glands 
suppuration  may  be  prevented  by  its  applica- 
tion to  them  in  the  same  manner  as  to  the 
breasts.  Varicose  and  other  ulcers  of  the  leg 
and  chronic  eczema  are  said  to  be  benefited  by 
a  similar  method  of  application,  but  there  is 
considerable  doubt  as  to  whether  there  is  any 
specific  effect  in  this  direction  upon  the  part 
of  the  Phytolacca,  and  whether  in  the  reported 
cures  the  use  of  any  simple  ointment  would 
not  have  been  as  effectual.  In  chronic  rheu- 
matism it  has  long  been  held  to  be  of  value, 
and  in  obstinate  cases  it  is  worthy  of  a  trial. 
Also  alterative  properties  are  ascribed  to  it,  and 
granular  conjunctivitis  is  said  to  be  cured  by 
it,  but  the  evidence  in  this  latter  case  is  very 
shadowy.  Although  it  is  emetic,  there  is 
nothing  to  recommend  its  selection  in  prefer- 
ence to  the  more  easily  found  and  less  depress- 
ing agents.  The  U.  S.  Ph.  orders  a  fluid 
extract,  extractum  phytolaccm  radicis  fluidum, 
the  dose  of  which  is  from  1  to  5  minims. 

[Dr.  Goodman  (S.  Carolina  Med.  Jour.,  April 
20, 1895  ;  Therap.  Qaz.,  August,  1895)  says  that 
the  green  leaves  of  the  plant  possess  a  property 
which  alone  would  entitle  it  to  rank  among 
the  most  valuable  remedies  of  the  materia 
medica — that  of  destroying  epithelioma.  The 
method  of  using  the  remedy  is  to  bruise  the 
green  leaves  to  a  pulpy  mass ;  collect  the  ex- 
pressed juice  in  a  shallow  receptacle,  such  as  a 
plate ;  allow  it  to  evaporate  to  a  thick,  pasty 
consistence ;  spread  a  portion  of  this  on  a  piece 
of  silk  or  other  suitable  cloth,  and  apply  to  the 
morbid  growth.  The  plaster  should  be  removed 
and  the  part  washed  twice  daily.  The  remedy 
causes  severe  pain.  It  has  a  selective  action 
for  the  morbid  tissue;  follows  out  all  the  ir- 
regularities of  the  epithelioma;  causes,  as  it 
were,  its  liquefaction  and  removal,  and  then 
acts  as  a  cicatrizant  for  the  open  sore.  As  soon 
as  all  the  morbid  tissue  is  destroyed,  a  bed  of 
cicatricial  tisstre  begins  to  spread  from  the 
periphery,  and  as  this  occurs  the  plaster  should 


Picm 

PICROTOXIX 


82 


be  out  smaller  each  day,  so  as  to  conform  to 
tlie  size  and  shape  of  the  surface  to  be  covered 
by  it.  Under  this  treatment  Dr.  G-oodraan  has 
seen  large  epitheliomatous  masses  destroyed  in 
a  few  weeks,  and  nothing  but  a  faint  scar  left 
at  the  place  occupied  by  the  growth.  In  no 
case  was  there  a  recurrence  at  the  original 
site.  Unlike  other  remedies,  he  says,  it  may 
be  used  fearlessly,  does  not  endanger  the  pa- 
tient, combines  within  itself  a  caustic  action 
and  a  healing  property,  and  requires  to  be  used 
in  the  same  manner  from  beginning  to  end. 

The  alkaloid  phytolaonine  is  a  cardiac  and 
respiratory  poison;  its  antagonist  is  atropine 
(see  vol.  i,  p.  88).] — Russell  H.  Kevins. 

PICHI  is  the  Chilean  name  for  Fabiana 
imbricata,  a  shrub  or  small  tree  of  South 
America.  It  belongs  to  the  order  SolanacecB, 
the  suborder  Gurvembrim,  and  the  tribe  Nico- 
fianecB.  It  is  usually  found  growing  in  dry, 
sandy  places,  especially  on  the  tops  of  the  hills, 
where  there  is  little  other  vegetation.  It  reaches 
a  height  of  from  15  to  18  feet.  The  larger 
branches  are  covered  with  a  thin,  smoothish, 
somewhat  warty,  brownish-gray  bark,  which 
adheres  firmly  to  the  yellowish,  tough  wood. 
The  upper  twigs  are  crowded  together,  form- 
ing plumelike  sprays,  and  are  covered  with 
bluish  or  greenish-gray  leaves,  which  are  broad- 
ly ovate,  blunt-pointed,  thick,  sessile,  closely 
imbricated,  and  about  a  line  in  length.  All 
the  tender  parts  are  covered  with  a  resinous 
coating,  which  is  a  striking  peculiarity  of  the 
plant.  The  same  resin  exists  also  to  some  ex- 
tent in  the  wood,  especially  of  the  smaller 
branches,  and  abundantly  in  the  bark.  In 
the  second  year  each  of  the  terminal  branch- 
lets  bears  a  solitary  flower  having  a  tubular 
white  and  purplish  corolla  from  -j  to  J  of  an 
inch  long  and  of  four  times  the  length  of  the 
calyx.  The  frnit  is  a  two-celled  and  two-valved 
capsule  containing  usually  four  flattened,  ob- 
long, brown  seeds  with  a  roughened  orustaceous 
testa. 

The  leaves  and  twigs  yield  a  crystalline  fluo- 
rescent substance  that  resembles  tesculin,  and 
is  supposed  to  be  a  glucoside,  together  with 
paviin  and  fraxin,  besides  a  resin  and  an  essen- 
tial oil.  According  to  Lyons,  there  is  also  a 
bitter  alkaloid  named  by  him  fabianine,  which 
is  said  to  form  crystalline  salts,  but  other  ob- 
servers have  failed  to  identify  this  substance. 
It  is  believed  that  the  active  principles  of  the 
plant  reside  in  the  fluorescent  glucoside  as  well 
as  in  the  resin  and  the  essential  oil. 

The  drug  was  first  brought  into  notice  in 
this  country  by  Dr.  Henry  H.  Rusby  {Therap. 
Q-az.,  December,  1885),  who  obtained  his  in- 
formation originally  from  Dr.  Ramirez,  of  Val- 
paraiso. In  Chile  the  drug  had  been  much 
employed  in  the  treatment  of  urinary  diseases, 
particularly  when  there  was  irritation  from  the 
presence  of  gravel  or  calculi.  It  is  said  to  act 
as  a  sedative  to  the  irritable  raucous  membrane 
of  the  urinary  tract,  modifying  the  secretions 
and  subduing  the  pain.  It  is  believed  also  that 
it  aids  in  the  expulsion  of  calculi.  There  have 
been  numerous  reports  of  its  successful  em- 
ployment in  this  class  of  affections.    Accord- 


ing to  Limousin  (Bull,  et  mem.  de  la  Soc.  de 
therap.,  April  14,  1886),  it  is  probable  that  the 
resin  disintegrates  the  calculi  by  dissolving  the 
mucus  that  keeps  the  particles  together,  thus 
facilitating  their  expulsion,  but  it  is  not  proba- 
ble that  there  is  any  solvent  action  on  the  cal- 
culus itself. 

In  cystitis,  both  chronic  and  acute,  whether 
accompanied  or  not  with  the  arthritic  diathesis, 
its  successful  employment  following  the  failure 
of  other  remedies  has  often  been  reported.  In 
prostato-cystitis  following  gonorrhoea  it  has 
also  been  used  with  most  favourable  results. 

Mr.  Reginald  H  arrisim  (Bost.  Med.  and  Surg. 
Jour. ;  Med.  Age.  1891,  p.  154)  reports  that  he 
"  has  used  pichi  during  four  years  in  the  form 
of  a  fluid  extract,  in  drachm  doses,  with  con- 
siderable benefit.  In  renal  colic  and  the  pass- 
ing of  calculi  through  the  kidneys  and  along 
the  ureters,  attended  with  hcemaiuria.  though 
not  exercising  any  solvent  power,  it  seems,  by 
its  action  on  the  tissues,  in  some  way  to  favour 
the  escape  of  the  stone,  and  thus  suppress 
bleeding ;  it  has  been  found  useful  also  in  the 
haemorrhage  which  frequently  accompanies 
cancer  of  the  bladder.  The  sedative  action  of 
the  drug  on  the  raucous  membrane  of  the 
bladder  has  proved  beneficial  in  many  instan- 
ces of  irritability  connected  with  a  large  pros- 
tate. After  the  bladder  has  been  properly 
cleansed  by  irrigation  and  disinfected  it  has 
been  frequently  found  that  the  calls  to  urinate 
were  far  less  urgent  when  the  pichi  was  used." 
Where  organic  disease  of  the  kidneys  exists 
the  drug  is  generally  regarded  as  contra-indi- 
cated, as  other  terebinthinate  remedies  are. 
But  where  reyial  hmmorrhage  is  a  marked  symp- 
tom, even  though  organic  disease  is  present,  it 
has  been  maintained  that  the  drug  exerts  a 
beneficial  effect. 

In  hepatic  diseases  the  drug  is  said  to  have 
been  used  with  benefit,  the  effect  being  due 
probably  either  to  its  action  on  the  stomach  as 
a  bitter  tonic,  or  to  the  diuretic  action  which 
it  possesses,  rather  than  to  anv  direct  chola- 
gogue  effect. 

Pichi  is  usually  administored  in  the  form  of 
a  flhid  extract,  of  which  the  dose  is  from  10  to 
40  minims.  It  is  not  miscible  with  water  un- 
less the  solution  is  made  alkaline.  The  best 
vehicle  is  glycerin.  A  solid  extract  and  a  pow- 
dered extract  are  also  .prepared,  which  may  be 
given  in  doses  of  from  3  to  10  grains.  Limou- 
sin recommends  a  decoction  of  the  pichi  wood. 
All  ounce  of  the  coarsely  powdered  twigs  is 
boiled  in  2  pints  of  water,  and  this  quantity  is 
taken,  divided  into  four  equal  portions,  during 
the  twenty-four  hours.  Salines  should  not  be 
combined  with  pichi,  as  they  cause  the  separa- 
tion of  the  resin  in  dense  curds. 

Edward  Bennet  Bronson. 

PICB^NA  EXCELSA.— See  Quassia. 

PICRIC  ACID,  or  trinitrophenol,  is  formed 
by  the  action  of  nitric  acid  on  phenol,  benzoin, 
silk,  indigo,  salicylic  acid,  leather,  and  many 
other  substances.  Its  formula  is  CaH,(No,)sOH 
=Co(Nos,H,NojH,No20H).  It  occurs  in  yellow, 
shining  crystals  or  scales,  fuses  at  352-5°  F., 
and  explodes  if  subjected  to  higher  heat.    The 


83 


PICHI 
PICROTOXIN 


salts  of  the  acid  explode  on  percussion.  Picric 
acid  is  freely  soluble  in  water,  the  solution 
having  a  strong  yellow  colour.  The  acid  has 
an  exceedingly  bitter  taste. 

Taken  internally,  picric  acid  stains  the  skin 
and  visible  mucous  membrane  a  decided  yel- 
low, and  the  urine  shows  distinct  traces  of  the 
acid.  Its  action  in  large  doses  is  toxic.  Erb 
has  shown  that  by  it  the  red  corpuscles  of  the 
blood  are  destroyed  and  a  leuooeytosis  is  pro- 
duced. The  colour  of  the  blood  becomes  dirty 
brown  (Die  Pikrinmure,  Wilrzburg,,  1865). 

Though  there  is  practically  no  therapeutic 
value  in  the  internal  use  of  picric  acid,  it  has 
been  recommended,  in  the  form  of  ammonium 
pierate,  in  the  treatment  of  malarial  diseases. 
Thus,  Clark,  an  army  surgeon  of  East  India, 
alleged  it  to  be  so  valuable  "in  the  treatment  of 
thousands  of  cases  of  malarial  fever  that  he  no 
longer  employed  quinine  {Lancet,  1887,  i).  In 
the  hands  of  others  it  has  not  been  so  efficient. 
As  a  remedy  for  trichiniasis  picric  acid  at  one 
time  was  in  favour.  Direct  experiment,  how- 
ever, has  proved  that  it  is  powerless  in  (his 
infection.  It  is  equally  useless  as  an  anthel- 
mmthic,  and  there  is  no  evidence  that  it  pos- 
sesses the  tonic  properties  which  have  been 
alleged  for  it. 

Locally,  picric  acid  has  been  employed  by 
Cheron  as  a  caustic  and  antiseptic  after  curet- 
ting the  uterus  for  fungous  e7iaomeiritis  (cited 
in  Med.  News,  June  11,  1887,  p.  659).  For  this 
purpose  he  recommends  a  solution  of  1  to  300 
in  water.  In  a  solution  of  6  parts  to  1,000  of 
water  it  has  been  praised  in  the  treatment  of 
eczema,  erysipelas,  and  lympliangeitis  (Lancet, 
April  6,  1889,  p.  703).  In  Ihe  same  proportion 
it  has  been  used  for  fissured  nipples,  and  as  a 
local  application  in  impetiginous  eczema  after 
removal  of  the  crusts  by  oil. 

[The  Medical  Record  for  November  33, 1895, 
credits  the  Medical  Times  and  Hospital  Ga- 
zette with  the  following:  '•  French  surgeons 
have  recently  been  using  a  solution  of  picric 
acid  for  the  first  treatment  of  hums ;  and  it 
has  been  found  that  the  pain  which  is  caused 
by  the  burning  of  the  skin  can  be  almost 
immediately  alleviated,  or  altogether  removed, 
by  painting  the  affected  surface  with  a  strong 
solution  of  picric  acid.  It  is  stated  that  the 
remedy  lias  proved  to  be  quite  harmless,  and 
that  the  yellow  stains  which  are  caused  by  its 
application  can  be  easily  washed  out  with  boric 
acid.  The  general  verdict  of  those  who  have 
employed  the  remedy  is  that  it  has  greatly 
lessened  suffering,  and  has  therefore  probably 
saved  life,  while  it  would  appear  that  even 
severe  cases  thus  treated  have  recovered  more 
speedily  and  completely  than  would  have  been 
the  case  under  other  forms  of  treatment.  It 
would  therefore  be  well,  presuming  that  ex- 
perience of  the  remedy  in  this  country  gives 
identical  results,  if  the  medical  officers  of  fac- 
tories or  workshops,  where  accidents  like  burn- 
ing or  scalding  are  common  occurrences,  would 
direct  that  solutions  of  the  acid  should  be  kept 
at  hand,  and  explain  the  method  of  its  appli- 
cation to  the  workers."] 

In  an  aqueous  solution  of  15  grains  to  an 
ounce  of  water,  picric  acid  is  used  for  the 


detection  of  albumin  in  urine.  It  is  a  delicate 
test,  but  as  mucin,  peptones,  and  potassium 
salts  are  also  precipitated  by  picric  acid,  it  is 
not  absolutely  reliable.  As  a  test  for  sugar  in 
urine,  picric  acid  occupies  an  inferior  place. 

In  pathological  and  histological  work,  picric 
acid  is  used  for  fixing  and  staining  specimens, 
either  in  bulk  or  after  section.  It  is  also  em- 
ployed in  combination  for  the  decalcification 
of  bones  and  teeth.  For  these  purposes  a  sat- 
urated aqueous  solution  is  prepared. 

Samuel  M.  Brickner. 

FICROIi. — Darzens  and  Dubois  (Ripert.  de 
pharm.,  iv ;  Fharm.  Jour,  and  Trans.,  October 
29, 1892)  have  given  this  name  to  an  iodine  deriv- 
ative of  resorcinmonosul  phonic  acid  the  potas- 

OH 
C 

slum  salt  of  which  has  the  formula  rrp  f    I  (-.nn 

C 
SosK 
The  salts  of  this  iodized  acid  are  said  to  be 
powerfully  antiseptic,  but  not  very  poisonous. 
The  potassium  salt  is  soluble  in  5  I'arts  of 
water,  and  is  soluble  also  in  alcohol,  in  glyc- 
erin, in  ether,  and  in  alkalies.  It  contains  53 
per  cent,  of  iodine.  Until  more  is  known  of 
its  action,  picrol  should  be  used  with  caution. 

PICROTOXIN,  picrotoxinum  (U.  S.  Ph.), 
is  a  neutral  principle  obtained  from  the  seed 
of  Anamirta  paniculata,  a  climbing  shrub 
growing  in  India.  It  occurs  in  colourless, 
shining  crystals  or  in  a  crystalline  powder 
without  odour  but  of  a  very  bitter  taste.  It  is 
permanent  in  the  air,  and,  though  only  mod- 
erately soluble  in  cold  water,  is  more  soluble 
in  boiling  water  and  freely  soluble  in  alcohol. 
It  is  soluble  also  in  alkaline  solutions  and  in 
acids.  Its  formula  is  C3oH340i3.  Picrotoxin, 
because  of  its  bitterness,  is  stomachic,  and  it  is 
said  to  be  added  to  malt  liquors  that  it  may 
increase  both  their  bitterness  and  their  intoxi- 
cating properties.  When  taken  in  small  doses, 
picrotoxin  causes  increase  of  the  saliva  and 
probably  of  the  other  digestive  juices  as  well ; 
moreover,  it  stimulates  peristalsis,  and  by  its 
use  the  movements  are  rendered  large  and  soft. 
The  drug  is  absorbed  not  only  from  the  stom- 
ach but  also  from  denuded  areas,  and  there- 
fore its  external  application  should  be  cautious. 
It  is  eliminated  chiefly  by  the  kidneys. 

Picrotoxin,  when  given  in  sufficient  amount, 
is  a  violent  poison,  producing  grave  nervous 
disturbances.  In  poisoning,  the  main  symp- 
toms are  general  convulsions,  which  are  both 
tonic  and  clonic.  In  fact,  the  combination  of 
clonic  and  tonic  attacks  is  thought  to  be 
highly  characteristic  of  poisoning  by  picro- 
toxin. It  is  said,  too,  that  the  clonic  seizures 
often  appear  highly  co-ordinated,  and  that 
various  perfected  movements  are  gone  through 
with,  such  as  the  motions  of  walking  and 
eating.  During  the  convulsive  periods  the 
heart's  action  is  rapid,  but  in  the  intervals  the 
pulse  is  slow  and  the  arterial  tension  is  raised. 
During  the  convulsions  the  breathing,  too,  is 
accelerated,  but  between  them  it  is  said  to  be 
slow  and  shallow.    At  times  there  is  spasmodic 


PILEA   PUMILA 
PILOCARPINE 


84 


arrest  of  respiration.  In  some  oases  the  pupils 
are  at  first  contracted  and  subsequently  dilated, 
but  these  phenomena  are  not  constant.  The 
mental  condition  varies ;  frequently  it  is  a  dull 
sort  of  intoxication.  Dizziness,  tremblings, 
inco-ordination,  and  stupor  are  observed,  and 
finally  coma.  The  sequence  of  the  phenomena 
of  picrotoxin  poisoning,  the  tonic  convulsion 
followed  by  the  clonic  seizure  and  this  by  the 
period  of  exhaustion,  stupor,  and  even  coma, 
bears  some  resemblance  to  the  usual  epileptic 
attack.  In  many  cases  of  poisoning  vomiting 
is  a  symptom.  As  to  the  causation  of  these 
phenomena  opinions  differ,  but  it  seems  prob- 
able that  the  convulsive  seizures  are  due  to 
stimulation  of  the  motor  centres  of  the  me- 
dulla oblongata  and  the  spinal  cord.  Reflex 
activity  is  said  to  be  diminished  after  the  con- 
vulsive attacks,  and  this  has  been  attributed  to 
exhaustion  of  the  motor  centres,  for  from  the 
administration  of  small  doses  there  is  observed 
increase  of  reflex  action  from  stimulation  of 
these  centres.  The  action  of  picrotoxin  to 
increase  blood-pressure  is  due  to  direct  stimu- 
lation ot  the  vaso-motor  centres,  while  its 
action  to  cause  slowing  of  the  heart  is  thought 
to  be  due  both  to  stimulation  of  the  inhibitory 
nerves  and  to  a-  direct  action  upon  the  heart 
muscle.  In  fatal  cases  the  heart  stops  in 
diastole.  In  cases  of  poisoning  by  picrotoxin 
the  stomach  should  be  emptied  if  the  drug  has 
been  taken  by  the  mouth  and  the  case  is  seen 
sufficiently  early.  Further  than  this  the  treat- 
ment is  symptomatic  and  supporting. 

The  dangerous  quality  of  picrotoxin  is  out 
of  all  proportion  to  its  usefulness,  and  the 
remedy,  though  recommended  for  various 
morbid  conditions,  is  neither  popular  nor  in- 
valuable. Its  chief  employment  is  for  the 
relief  of  colliquative  sweating,  especially  the 
night  sweating  of  tuberculosis,  but,  though  it 
is  certainly  efficient  in  many  cases,  it  is  not 
more  so  than  many  other  remedies,  although 
the  anthidrotio  effect  from  picrotoxin  is  said 
to  last  for  several  days,  and  therefore  to  make 
frequent  administration  unnecessary.  In 
epilepsy,  in  chorea,  and  in  paralysis  agitans 
picrotoxin  has  been  thought  valuable,  but  it  is 
seldom  employed  for  their  relief.  It  has  also 
been  recommended  in  various  paralyses,  nota- 
bly in  those  ot  the  sphincters.  Picrotoxin  is 
antiparasitic,  and  has  been  applied  in  oint- 
ment for  the  relief  of  various  parasitic  dis- 
eases of  the  skin.  Such  a  use  of  the  remedy  is 
not  to  be  recommended,  for  it  is  no  more  effi- 
cient than  many  another,  and  the  danger  of 
its  absorption  is  great.  The  dose  of  picrotoxin 
is  from  fou  to  -gV  of  a  grain. 

Henry  A.  Geiffin. 

PILEA  PUMILA.— See  Uktica  pumila. 

PILIGANINE. — See  under  Ltcopodium. 

FILLS. — Pills  are  small  round  or  ovoid 
masses  composed  of  one  or  more  medicinal 
agents  and  usually  containing  some  binding 
substance  to  prevent  them  from  becoming 
brittle  or  losing  their  shape.  They  are  one  of 
the  oldest  forms  in  which  medicines  have  been 
administered,  and,  if  carefully  prepared,  con- 
stitute one  of  the  most  convenient  for  the 


administration  of  medicines  by  individual 
doses. 

Properly  made,  pills  should  be  as  small  as 
the  nature  and  amount  of  their  constituents 
will  permit,  should  be  sufficiently  cohesive  to 
admit  of  free  handling  without  crumbling  to 
pieces,  and  should  be  readily  dissolved  or  dis- 
integrated in  the  contents  of  the  stomach  or  of 
the  intestines,  according  to  their  destination. 

Pills  are  either  coated  or  uncoated.  As  a 
rule,  uncoated  pills  are  the  surest  to  produce 
the  desired  effects  if  they  are  to  act  from  the 
stomach.  Nevertheless,  the  art  of  coating  pills 
has  now  attained  to  such  perfection,  and  most 
of  the  coatings  used  are  so  readily  soluble,  that 
the  objections  formerly  raised  against  all  coat- 
ings are  no  longer  justified.  The  manufacture 
of  pills  is  now  carried  on  by  many  houses  on  a 
very  large  scale,  and  the  public  as  vi^ell  as  the 
medical  profession  have  become  so  well  ac- 
quainted with  the  peculiar  features  or  merits 
of  the  various  kinds  found  in  the  market  (su- 
gar-coated, gelatin-coated,  "soluble,"  "fria- 
ble," etc.)  that  the  larger  proportion  of  the  pills 
dispensed  by  the  apothecary  is  the  product  of 
the  large  manufacturers. 

To  prepare  a  proper  pill-mass  it  is  neces- 
sary to  possess  a  knowledge  of  the  nature  and 
properties  of  the  ingredients.  Unless  it  is  spe- 
cially intended  otherwise  (as  in  pilula  ferri 
carbonatis),  the  mixture  must  be  made  so  that 
none  of  the  ingredients  will  decompose  any  of 
the  others  or  render  the  production  of  a  well- 
shaped,  cohesive,  and  soluble  pill  difficult  or 
impossible.  Except  in  the  case  of  certain  ex- 
tracts or  standard  pill-masses  (such  as  massa 
copuibcB  and  massa  hydrargyri),  which  may  be 
formed  into  pills  without  the  intervention  of  a 
supporting  agent,  most  pills  require,  in  addi- 
tion to  the  medicinal  constituent,  a  binding 
substance,  called  excipient,  such  as  honey,  mo- 
lasses, syrup,  mucilage,  glycerin,  some  aqueous 
or  alcoholic  extract,  or  the  like.  The  choice  of 
the  proper  excipient  is  often  left  to  the  discre- 
tion of  the  dispenser,  the  prescriber  having 
omitted  it.  As  a  rule,  it  is  a  safer  plan  for  the 
physician  to  leave  the  choice  of  the  excipient 
for  pills  not  already  containing  some  tenacious 
ingredient  to  the  pharmacist,  unless  the  phy- 
sician himself  is  versed  in  the  apothecary's  art. 

The  first  point  to  be  observed  in  making  a 
pill-mass  is  to  see  that  all  the  ingredients,  with 
the  exception  of  the  excipient,  where  this  may 
for  the  time  being  be  kept  out,  are  in  the  finest 
possible  subdivision  and  thoroughly  mixed. 
This  is  particularly  necessary  in  the  case  of 
pills  which  are  to  contain  minute  doses  of  po- 
tent remedies,  such  as  ^^r  of  a  grain  of  aconi- 
tine,  ^  of  a  grain  of  atropine,  etc.  Next,  the 
excipient  is  to  be  incorporated,  first  with  a 
small  portion  of  the  mass,  then  gradually  with 
the  remainder,  and  the  whole  systematically 
worked  about,  folded  and  refolded  over  itself, 
again  worked  about,  etc.,  until  the  mass  is  per- 
fectly uniform  and  of  the  proper  plasticity. 
It  is  then  rolled  out  and  cut  into  the  required 
number  of  pieces,  and  the  latter  are  given  their 
proper  shape  either  by  the  pill  machine  or  with 
the  fingers. 

Soft  extracts  and  semi-fluid  or  deliquescent 


85 


PILEA  PUMILA 
PlLOCAEPli^E 


ingredients  usually  require  the  addition  of  a 
small  amount  of  a  fibrous  powder  (such  as 
powdered  licorice  root,  powdered  gentian, 
powdered  marsh  mallow,  etc.)  to  give  to  the 
pill  the  requisite  firmness  and  stability.  More- 
over, if  a  pill  contains  deliquescent  substances, 
it  is  best  to  give  it  some  coating.  Indeed, 
when  such  pills  are  to  be  kept,  a  coating  be- 
comes indispensable. 

Inorganic  salts  containing  water  of  crystalli- 
zation should  first  be  dried  before  they  are 
made  into  pills. 

If  "the  constituents  of  a  pill  consist  of  non- 
adhesive  powders,  one  of  the  above-mentioned 
excipients  should  be  used.  Neither  gum  arable 
nor  tragacanth,  however,  is  a  good  pill  excipi- 
ent  unless  used  in  very  small  quantity,  since 
they  are  apt  to  render  the  pills  very  hard  and 
often  nearly  insoluble.  If  either  of  these  is  to 
be  used,  a  little  glycerin  should  be  added. 

Among  the  most  generally  applicable  ex- 
cipients the  following  two  deserve  special  men- 
tion : 

TJpharn's  Excipient. 

Powdered  acacia 1  drachm ; 

Powdered  tragacanth 2  drachms  ; 

Glucose  (white) 5  drachms  ; 

Glycerin 3  oz. 

Remington's  Excipient. 

Powdered  acacia 90  grains ; 

Benzoic  acid 1  grain  ; 

Glucose  (white) 4  av.  oz ; 

Glycerin 1  av.  oz. 

Coating  of  Fills. — Originally,  pills  were 
coated  to  mask  their  taste  or  odour,  or  to  pre- 
vent them  from  change  by  exposure  to  air. 
Mowadays  it  is  customary,  on  the  part  of 
manufacturers,  to  coat  all  pills,  not  because  all 
of  them  require  it  (opium  or  quinine  pills  will 
keep  uneoated  just  as  well),  but  to  put  upon 
them,  as  it  were,  the  trade-mark  of  their  manu- 
facture. So  long  as  the  coating  is  readily  solu- 
ble, no  objection  can  be  made  to  this  practice. 

The  silvering  and  gilding  of  pills  have  al- 
most gone  out  of  date.  The  coating  is  of  no 
practical  value,  since  it  is  but  rarely  so  applied 
as  to  form  an  efiicient  protection  to  the  con- 
stituents. 

Pills  containing  readily  oxidizable  matters, 
such  as  phosphorus,  phosphides,  and  ferrous 
iodide  or  bromide,  or  deliquescent  salts,  require 
some  kind  of  coating.  One  of  the  most  efficient 
is  a  coat  of  balsam  of  Tolu  or  benzoin  or  mastic. 
After  the  pills  have  been  formed  they  are  placed 
in  a  flat-bottomed  capsule  into  which  a  little 
of  an  ethereal  solution  of  balsam  of  Tolu  is 
poured.  After  being  rotated  in  this  for  some 
time  they  are  removed  and  allowed  to  dry. 
If  necessary,  the  process  may  he  repeated.  The 
ethereal  solution  is  directed  by  the  Pharmaco- 
poeia to  be  prepared  from  10  parts  of  balsam  of 
Tolu  and  15  parts  of  ether. 

Sugar-coating,  which  is  the  method  least  to 
be  recommended,  can  be  carried  on  successfully 
only  on  a  large  scale. 

Gelatin-coating  can  be  carried  on  easily  on 
any  scale.  The  coating  solution  is  prepared  by 
dissolving  4  parts  of  the  best  gelatin  (French, 


"gold  brand")  and  1  part  of  the  clearest  and 
purest  gum  arable  (sometimes  together  with 
about  J  of  a  part  of  boric  acid)  in  40  parts  of 
water  by  the  aid  of  heat.  On  cooling,  this 
liquid  becomes  a  jelly,  and  may  be  used  in  por- 
tions as  wanted. 

When  the  pills  have  been  formed,  they  must 
be  dried  on  the  outside  and  freed  from  any  ad- 
hering powder.  They  are  now  picked  up  on 
the  ends  of  needles  and  dipped  into  the  melted 
gelatin  solution.  After  being  withdrawn,  they 
are  held  for  a  moment  to  allow  the  superfluous 
gelatin  to  collect  in  the  form  of  a  drop  which 
is  removed  by  touching  the  surface  of  the  gela- 
tin solution,  and  the  frame  in  which  the  pins 
are  fastened  is  rotated  so  as  to  cause  the  coat- 
ing to  distribute  itself  evenly.  When  the  coat- 
ing is  set,  the  small  hole  made  by  the  pin  is 
coated  separately.  On  a  large  scale  the  coat- 
ing is  performed  on  machines  which  act  almost 
entirely  automatically. 

Keratin  or  Salol  Coating. — Sometimes  it  is 
intended  that  a  pill  shall  pass  through  the 
stomach  unaltered,  reserving  its  action  until 
it  arrives  in  the  duodenum.  In  this  case  it  is 
coated  either  with  keratin  or  with  salol.  As  to 
keratin,  see  under  this  title.  To  coat  pills  with 
salol,  prepare  them  as  for  gelatin  coating,  im- 
pale them  on  pins,  and  dip  them  into  salol 
melted  on  a  water-bath  in  a  small,  deep  cap- 
sule. The  coating  hardens  almost  as  soon  as 
the  pills  are  removed  from  the  melted  mass. 
The  pin-holes  are  afterward  closed  by  applying 
a  little  of  the  salol  with  a  brush  or  rod.  A  salol 
coating  may  be  applied  over  a  gelatin  coating, 
thus  rendering  it  possible  to  use  ready-made 
pills  for  this  purpose. — Chakles  Rice. 

PILOCAKPINE.— This  alkaloid,  CnH.e 
NsOa,  was  considered  to  some  extent  in  the 
article  on  Jaborandi,  which  the  reader  may 
consult  in  connection  with  this  one.  The  hy- 
drochloride, pilocarpines  hydrochloras  (U.  S. 
Ph.),  pilocarpinum  hydrochloricum  (Ger.  Ph.), 
and  the  mtraXe,  pilocarpince  nitras  (Br.  Ph.), 
are  oificial. 

A  Hungarian  physician.  Dr.  Sziklai,  is  a 
strenuous  advocate  of  the  use  of  pilocarpine  as 
a  preventive  of  diphtheria,  pseudo-diphtheritic 
affections,  and  croup,  also  in  the  treatment  of 
all  stages  of  croupous  pneumonia.  He  urges 
the  employment  of  pilocarpine  more  particu- 
larly in  families  where  one  case  of  diphtheria 
has  already  appeared.  He  believes  that  it  may 
actually  prevent  the  formation  of  false  mem- 
branes. As  a  safe  prophylactic  he  advises  a 
1-per-cent.  solution  to  be  given  in  10-drop 
doses  three  times  a  day.  For  infants  less  than 
a  year  old  half  this  quantity  is  suificient.  He 
has  never  observed  any  untoward  effects  from 
pilocarpine,  and  believes  its  use  in  diphtheria 
will  yet  come  to  be  regarded  in  the  same  way 
that  quinine  is  looked  upon  in  malarial  dis- 
ease.   (Med.  Record,  January  18,  1896.) 

Sziklai's  belief  in  the  prophylactic  and  cura- 
tive powers  of  pilocarpine  has  led  him  to  the 
length  of  saying  that  it  exerts  a  mechanical  ' 
effect  by  the  profuse  secretion  which  it  gives 
rise  to,  so  that  undermining,  loosening,  and 
separation  of  the    croupous  or    diphtheritic 


PILOCARPUS 

PINE  PKEPARATIONS 


86 


membrane  result ;  and  in  addition  a  chemical 
effect  whereby  the  transudate  is  deprived  of 
its  fibrin,  so  that  there  can  be  no  further  for- 
mation of  false  membrane.  He  says,  further- 
more (cited  by  Glass,  Ctrlhl.  f.  d.  ges.  Therap., 
October,  1895 ;  Therap.  Gaz.',  November,  1895), 
that  pilocarpine  is  a  specific  against  croup  in 
the  broadest  sense  of  the  word,  and  therefore 
against  all  croupous  diseases — conjunctivitis, 
rhinitis,  croupous  pneumonia,  etc. ;  that  its 
action  is  immediate,  so  that  recovery  fi-om 
pneumonia  occurs  in  two  or  three  days  ;  that 
not  only  is  the  duration  of  the  disease  consid- 
erably shortened  by  it,  but  also  the  mortality 
brought  down  to  nothing;  that  in  appro- 
priate cases,  if  administered  early  enough,  the 
remedy  has  a  preventive  action ;  and  that  it 
can  be  given  in  twice  the  official  dose  without 
any  injurious  results  whatever. 

Glass  has  tested  this  treatment  in  eighteen 
cases  of  pneumonia,  u.'ing  the  remedy  only  in 
the  developed  and  undoubted  oases.  Follow- 
ing the  example  of  Sziklai,  he  added  the 
pilocarpine  to  an  infusion  of  ipecac,  and  in 
cases  which  required  energetic  treatment  pilo- 
carpine was  given  subcutaneously.  In  part 
of  the  cases  an  infusion  of  jaborandi  leaves 
was  employed,  without  his  being  able  to  de- 
tect any  essential  difference  in  the  action  of 
the  two  remedies.  As  a  rule,  he  combined 
with  this  medication  corresponding  doses  of 
strophanthus  or  digitalis.  He  began  with 
single  doses  of  from  |  to  J  of  a  grain  of 
pilocarpine,  and  in  no  case  exceeded  the  maxi- 
mum dose.  Usually  in  half  an  hour  or  more 
after  the  administration  of  the  remedy  there 
occurred  profuse  salivation,  then  great  perspi- 
ration, redness  of  the  face,  a  full  pulse,  with 
s'ight  increase  in  its  frequency,  lively  action 
of  the  heart,  and  expectoration  of  a  slightly 
hsemorrhagic,  foamy  material.  Examination 
of  the  lungs  showed  numerous  small  and  mid- 
dle-sized moist  rales  throughout  the  whole 
extent  of  both  lungs,  although  before  the  em- 
ployment of  pilocarpine  no  catarrhal  symp- 
toms of  any  kind  had  been  detected. 

After  analyzing  his  own  cases  at  considerable 
length,  Glass  concludes  that  the  administra- 
tion of  pilocarpine  in  doses  of  from  -f  to  J  of  a 
grain,  which  induce  noticeable  symptoms  of 
collapse,  results  in  some  cases  in  a  strikingly 
rapid  extension  of  the  pneumonic  process.  A 
pronounced  cure  in  acute  pneumonias  he  did 
not  observe.  On  these  grounds,  he  thinks,  the 
employment  of  the  remedy  in  such  cases  of 
pneumonia  does  not  seem  justified.  Espe- 
cially, he  remarks,  is  this  the  case  in  private 
practice,  where  uninterrupted  observation  of 
patients  can  not  be  carried  out.  In  addition, 
he  concludes  that  in  delayed  resolution  the 
remedy  may,  in  the  doses  above  named,  given 
two  or  three  times  a  day,  be  administered  for 
five  or  six  days  in  succession  without  decided 
bad  symptoms  being  produced  by  it.  In  this 
stage  the  remedy  may  effect  a  pretty  rapid  so- 
lution, yet  it  fails  in  some  cases.  Heart  weak- 
ness here  also,  he  says,  contra-indioates  the 
employment  of  pilocarpine. 

On  the  other  hand,  in  pneumonia  due  to 
influenza,  Poulet  (Nouv.  rem.,  November  24,, 


1895;  Brit.  Med.  Jour.,  December  28,  1895 
{Epitome])  has  met  with  very  good  results  from 
the  use  of  pilocarpine.  During  an  epidemic 
which  prevailed  in  the  neighbourhood  of 
Plancher-les-Mines  in  February,  1895.  and 
attacked  more  than  1,000  out  of  a  population 
of  from  3,000  to  4.000,  he  treated  108  eases  of 
influenza  in  which  pneumonia  and  broncho- 
pneumonia were  formidable  complications 
with  pilocarpine,  with  only  four  deaths.  He 
gave  the  drug  in  daily  amounts  of  f  of  a 
grain,  except  in  the  case  of  children,  to  whom 
a  proportionally  smaller  amount  was  given. 
The  treatment  generally  lasted  two  days,  in 
only  a  few  cases  three  days.  It  was  elficient 
in  several  cases  of  persons  over  seventy  years 
of  age.  It  was  far  less  effective,  however,  in 
pneumonia  complicating  whooping-cough  in 
children. 

Pilocarpine  phenylhydroxide,  CnHieNjOa. 
OH.CeHii,  which,  according  to  Dr.  Henry  A. 
Mott.  consists  of  53'93  per  cent,  of  pilocarpine 
and  46-08  per  cent,  of  phenol,  forms  0-0188 
per  cent,  of  Dr.  Cyrus  Edson's  "  aseptolin," 
which  has  lately  been  vaunted  as  a  remedy  for 
tuberculosis,  but  has  not  yet  been  sufficiently 
tested  in  practice  to  admit  of  a  judgment  be- 
ing' rendered  as  to  its  efficacy.  (Med.  Record, 
February  8.  1896.) 

In  the  article  on  Jaboeandi  the  use  of  that 
drug  in  urcemia  is  treated  of.  It  may  be 
added  here  that  H.  Molliere  has  recently  called 
attention  to  the  use  of  external  applications  of 
pilocarpine  in  the  treatment  of  acute  and 
chronic  nephritis  (Ann.  d.  mat.  d.  organ,  geni- 
to-urin.,  January,  1895 ;  N.  Y.  Med,.  Jour.,  Feb- 
ruary 9,  1895).  He  has  used  frictions,  espe- 
cially of  the  trunk,  with  an  ointment  composed 
of  3  oz.  of  white  vaseline  and  from  f  to  IJ  grain 
of  pilocarpine  nitrate.  A  very  large  dose  of  the 
remedy,  he  says,  causes  disagreeable  cutaneous 
eruptions,  which  may  make  it  necessary  to  in- 
terrupt the  treatment.  The  region  is  covered 
with  a  thick  layer  of  cotton  wool  and  a  piece 
of  waxed  linen,  which  is  not  to  be  taken  off 
until  the  wool  is  completely  wet  with  perspira- 
tion, when  it  is  replaced  at  the  end  of  a  few 
hours.  In  patients  who  are  subjected  to  a 
milk  diet,  as  well  as  in  those  who  take  other 
forms  of  nourishment,  he  says,  the  results  are 
very  nearly  the  same :  a  rapid  recovery  in 
acute  nephritis  and  a  marked  amelioration  in 
the  chronic  form. 

M.  Molliere  calls  attention  to  the  sudorific 
action  of  pilocarpine,  which  is  manifested  by 
a  continued  abundant  sweat,  and  he  adds  that 
a  concomitant  diuresis  is  accomplished  through 
the  medium  of  the  nervous  system.  In  this 
way,  he  says,  medicaments  which  act  directly 
on  the  kidneys  after  being  absorbed  by  the 
stomach,  which  they  soon  irritate  and  disorder, 
may  be  avoided.  External  applications  of 
pilocarpine,  says  M.  Molliere,  do  not  directly 
influence  either  the  kidneys  or  the  stomach, 
and  the  revulsive  and  derivative  action  on  the 
skin  facilitates  the  elimination  of  the  toxines 
and  at  the  same  time  relieves  the  congestion 
of  the  kidneys.  Furthermore,  the  diuretic  ac- 
tion of  pilocarpine  is  added  to  that  of  the 
milk,  and,  by  the  sweating  it  provokes,  the 


87 


PILOCARPUS 
PINE  PREPARATIONS 


drug  moderates  the  exaggerated  action,  if 
there  is  any,  which  may  end  by  irritating  the 
kidney  itself.  In  the  beginning  of  conva- 
lescence, he  says,  when  the  oedema  has  disap- 
peared and  the  albuminuria  diminished,  it  is 
well  to  have  this  indirect  diuretic  action.  The 
physiological  action  of  pilocarpine  applied  by 
friction,  says  M.  Molliere,  seems  to  be  purely 
local.;  the  medicament  is  not  absorbed,  and  it 
is  impossible  to  find  any  trace  of  it  in  the 
urine.  With  regard  to  diuresis,  it  may  be  ex- 
plained by  the  effects  which  are  obtained  in  ex- 
ternal applications  of  certain  other  alkaloids.  In 
the  same  manner  that  sparteine,  when  applied 
to  the  skin,  produces  a  lowering  of  the  central 
temperature,  so  pilocarpine  may  give  rise  to  a 
medullary  reflex  causing  dilatation  of  the 
blood-vessels  of  the  kidney. 

In  a  subsequent  communication  (Coneours 
mid.)  M.  Molliere  says  that  the  pilocarpine 
treatment  should  not  be  suspended  except  in 
cases  where  the  patients  are  too  weak.  Then 
it  is  to  be  interrupted  for  forty-eight  hours, 
after  which  it  may  be  continued,  but  with  an 
ointment  containing  only  one  half  the  original 
quantity  of  nitrate  of  pilocarpine.  With  re- 
gard to  the  quantity  of  ointment  to  be  used  at 
each  application,  it  varies,  according  to  the 
size  of  the  patient,  from  300  to  600  grains. 
The  amount  indicated  in  the  formula  generally 
suffices  for  three  or  four  applications. 

Pilocarpine  has  been  employed  with  some 
success  in  the  treatment  of  labyrinthine  ver- 
tigo, or  Meniere's  disease. 

Three  cases  were  treated  by  Labit  in  Moure's 
clinic  in  Bordeaux  (Rev.  de  laryngol.,  d'otol. 
et  de  rhin.,  September  1,  1894;  Brit.  Med. 
Jour.,  September  29,  1894  [Epitome]).  They 
occurred  in  a  governess  aged  sixty-eight, 
a  stoker  aged  forty-nine,  and  a  female  cook 
aged  twenty-eight.  The  first  had  previously 
been  affected  with  sclerotic  catarrh  of  both 
middle  ears :  the  others  were  quite  free  from 
any  atiral  disease  of  the  kind,  but  were,  from 
the  nature  of  their  occupations,  exposed  to 
extreme  heat.  In  all  there  were  the  typical 
symptoms — noises,  vertigo,  nausea  or  vomit- 
ing, and  deafness  to  osseous  as  well  as  to  aerial 
sound  vibrations.  In  the  second  case  one  ear 
only  was  affected.  The  first  patient  received 
fifteen  injections  of  from  ^ij-  to  ^  of  a  grain, 
the  second  thirteen  of  from  -j^  to  ^  of  a  grain, 
and  the  third  eight  of  from  ^  to  i  of  a  grain, 
continued  and  increased.  In  all  the  cases  the 
vertigo  disappeared,  the  noises  diminished,  and 
the  hearing  was  to  a  certain  extent  restored. 
The  writer  compares  the  absorption  produced 
to  that  observed  in  pleural  and  peritoneal  effu- 
sions under  the  action  of  pilocarpine.  Success, 
he  says,  depends  upon  the  correctness  of  the 
diagnosis  and  the  early  adoption  of  the  treat- 
ment. 

PILOCARPtJS. — See  Jaborandi  and  Pi- 

LOOABPINE. 

PIMENTA  (U.  S.  Ph.,  Br.  Ph  ),  or  allspice, 
is  the  dried  fruit  of  Pimenta  officinalis,  a 
myrtaoeous  tree  of  tropical  America.  It  is 
mildly  aromatic  and  astringent,  and  is  partic- 
ularly useful  in  flatulence.    The  dose  of  pi- 


menta in  powder  is  from  10  to  40  grains  ;  that 
of  the  volatile  oil,  oleum  pimentm  (IT.  S.  Ph., 
Br.  Ph.),  from  1  to  4  minims.  Distilled  water 
of  pimenta,  aqua  pinientcB  (Br.  Ph.),  may  be 
used  freely  as  an  aromatic  vehicle. 

PIMPEBBTEIi,  PIMPINELLA,  radix 
pimpinellm  (Qer.  Ph.),  or  saxifrage,  is  the  root 
of  Pimpinella  Saxifraga  and  Pimpinella 
magna,  iimbelliferous  European  plants.  It 
was  formerly  in  repute  as  a  remedy  lor  chronic 
catarrh,  amenorrhoea,  asthma,  etc.,  being  con- 
sidered diaphoretic,  diuretic,  and  stomachic. 
The  dose  of  the  tincture,  tinctura  pimpinellm 
(Wer.  Ph.),  is  from  30  to  30  drops,  to  be  taken 
on  sugar.     (Cf.  Anagallis.) 

PINE  FBEPARATIONS  have  a  consid- 
erable popularity  and  a  somewhat  extended 
employment.  Pew  of  them  are  officially  recog- 
nised, for  whatever  medicinal  virtue  they  possess 
seems  unquestionably  to  be  due  to  the  turpen- 
tines which  they  contain.  (See  Tdkpentine.) 
Pine  in  various  forms  occupies  a  high  position 
in  popular  esteem,  however,  and  residence  in 
or  near  pine  forests  and  even  pine-leaf  baths 
are  reputed,  on  grounds  which,  if  not  of  accu- 
rately determined  value,  are  seemingly  not 
unreasonable,  as  curative  of  catarrhal  and  cu- 
taneous affections  of  a  chronic  type.  In  pre- 
paring a  pine  bath  it  is  usual  to  add  to  water 
a  decoction  or  a  distillate  of  pine  needles,  the 
amount  added  being  regulated  by  circum- 
stances. The  baths  may  be  taken  hot  or  cold. 
In  the  diseases  mentioned,  as  well  as  in  rheu- 
matic and  gouty  complaints,  they  may  not  be 
altogether  ineffectual.  They  are  considerably 
employed  at  certain  of  the  health  resorts  of 
Germany  and  Austria,  where  the  "  pine  cure  " 
is  practised.  A  preparation  known  as  fir-wool 
extract  (extracium  pini  silvestris),  obtained 
from  pine  leaves,  is  also  used  in  preparing 
these  baths.  It  is  a  syrupy  liquid  of  a  dark- 
brown  colour  and  has  a  faint  odour  of  pine. 
It  is  soluble  in  water,  and,  added  to  warm 
water  in  the  proportion  of  from  2  to  4  oz.  to 
30  gallons,  is  used  in  the  treatment  cf  rheuma- 
tism. Woollen  clothing  is  sometimes  impreg- 
nated with  the  volatile  oil  derived  from  pine 
leaves,  and  is  thought  to  be  beneficial  when 
worn  by  those  suffering  from  rheumatic  com- 
plaints. The  cotton  wool  so  medicated  is  sold 
in  sheets  under  the  name  of  "  fir  wool "  or  "  fir- 
wool  wadding." 

Pir-wool  oil.  oleum  pini  silvestris  (Br.  Ph.), 
is  a  volatile  oil  distilled  from  the  fresh  leaves 
of  Pinus  silvestris,  Scotch  pine,  or  Scotch 
fir.  It  has  little  or  no  colour,  an  odour  of 
pine  leaves,  and  a  pungent  but  not  unpleasant 
taste.  It  is  used  in  the  preparation  of  fir 
wool,  as  already  stated,  may  be  rubbed  on  for 
the  relief  of  various  rheumatic  pains,  and  may 
be  used  in  the  prejjaration  of  the  pine  bath,  a 
drachm  or  more  being  added  to  the  necessary 
quantity  of  warm  water.  Inhalation  of  fir-wool 
oil,  vapor  olei  pini  silvestris  (Br.  Ph.),  consists 
of  40  minims  of  fir-wool  oil  rubbed  up  with  20 
grains  of  light  magnesium  carbonate,  with 
sufficient  water  added  to  produce  1  fl.  oz.  Of 
this,  1  fl.  drachm  is  placed,  with  half  a  pint  of 
cold  water  and  half  a  pint  of  boiling  water,  in 


PINKROOT 
PIPERAZINB 


88 


an  apparatus  so  arranged  that  air  taay  pass 
through  the  solution  and  be  inhaled.  Thus 
inhaled,  the  preparation  is  useful  as  a  mild 
stimulant  in  chronic  laryngitis. 

The  volatile  oil  derived  from  Firms  pumilio 
(oleum  pini  pumilionis)  is  used  in  the  same 
way,  and  is  thought  to  be  even  more  agreeable 
in  odour  and  taste.  It  is  known  under  the 
names  of  "  pinol,"  "  pumiline,"  and  Krummholz 
oil.  Soaps,  pastiles,  and  other  preparations 
are  medicated  with  it.  An  extract  derived 
from  this  source  is  also  used  for  baths. 

Various  proprietary  remedies  containing  pine 
preparations  are  sold  in  Prance.  Of  these,  pin 
d'Autriche  (essence  de  Mack)  has  as  its  impor- 
tant ingredient  the  oil  of  Pinus  pumilio.  It 
is  used  by  inhalation  and  rubbing,  and  is  suit- 
able for  catarrhal  conditions  of  the  upper  re- 
spiratory passages  and  for  rheumatism.  Pin 
maritime  (pastilles  Brachat),  another  French 
preparation,  contains  lactucarium,  codeine,  and 
pine.     It  is  used  in  bronchitis. 

From  pine  wood  there  is  prepared  what  is 
known  as  sanitary  wood  wool,  or  wood-wool 
wadding.  This  is  the  finely  divided  wood 
made  antiseptic  with  corrosive  sublimate.  It 
is  considerably  employed  as  an  absorbent  dress- 
ing and  to  make  various  toilet  conveniences, 
pads  for  receivinsr  menstrual  and  vaginal  dis- 
charges, absorbent  mattresses,  etc. 

Henet  a.  Qripfin. 

PINKBOOT.— See  Spiqelia. 

PINOL. — See  under  Pine  preparations. 

PINUS  CANADENSIS,  or  Abies  cana- 
densis, the  hemlock  spruce  of  the  United 
States  and  Canada,  furnishes  pix  canadensis 
(g.  v.),  or  Canada  balsam.  An  unofficial  ex- 
tract has  been  used  to  some  extent  as  an 
astringent  and  mild  local  stimulant  in  leucor- 
rhcea. 

PINUS  SILVESTHIS  (or  sylvestris).— 
See  under  Pine  preparations. 

PINUS  STBOBUS.— The  bark  of  this 
tree,  the  American  white  pine,  is  extensively 
used  in  many  parts  of  the  United  States  as  an 
expectorant,  in  the  form  of  a  syrup.  This 
syrup  is  made  by  different  manufacturing 
pharmacists  according  to  processes  of  their 
own,  so  that  the  product  varies  somewhat. 
The  last  edition  of  the  National  Formulary 
gives  a  formula  which,  it  is  to  be  hoped,  will 
henceforth  be  followed  by  the  pharmacists. 
This  is  the  formula : 
White  pine  bark  (Pinus  Stro- 

*M«) 75  grammes; 

Wild  cherry  bark 75         " 

Spikenard  root 10         " 

Balm  of  Gilead  buds 10         " 

Sanguinaria  root 8         " 

Sassafras  bark 7         " 

Morphine  sulphate 0'5      " 

Chloroform. 6     c.  cm.  ■ 

Sugar 750  gramme's. 

Alcohol 

Water 

Syrup  (U.  S.    Ph.),  of  each  a 

sufficient   quantity  to   make 

1,000  cubic  centimetres. 


Reduce  the  vegetable  drugs  to  a  moderately 
coarse  (No.  40)  powder,  moisten  the  powder 
with  a  menstruum  composed  of  1  volume  of 
alcohol  and  3  volumes  of  water,  and  macerate 
for  twelve  hours.  Then  percolate  with  the 
same  menstruum  until  500  cubic  centimetres 
of  tincture  have  been  obtained,  in  which  dis- 
solve the  sugar  and  the  morphine  sulphate; 
lastly,  add  the  chloroform  and  sufficient  syrup 
to  make  1,000  cubic  centimetres,  and  strain. 

The  dose  of  this  preparation,  which  is  termed 
syrupus  pini  strobi  compositus,  is  from  1  11. 
drachm  to  -J  fl.  oz.  The  syrup  is  a  modifica- 
tion of  one  recommended  by  Mr.  Robert  S. 
Sherwin  in  the  American  Journal  of  Phar- 
macy for  May,  1896. 

PIPER.— See  Piper  nigrum. 

PIPEBAZIDINE,    PIPERAZINE,  or 

diethylenediamine,  is  obtained  by  the  action 
of  ammonia  upon  ethylene  bromide  or  ethylene 
chloride.  It  occurs  in  colourless  crystals  of 
little  or  no  odour  and  a  faint  saline  taste.  It 
is  deliquescent  and  freely  soluble  in  water,  the 
aqueous  solution  being  alkaline  in  reaction. 
The  formula  of  piperazine  is  CiHjoNa. 

The  remedy  was  introduced  into  medical 
practice  because  laboratory  experiments  had 
shown  it  to  be  a  powerful  solvent  of  uric  acid 
and  because  it  was  hoped  that  it  might  be 
available  in  causing  increased  elimination 
of  uric  acid  from  the  body.  From  these  labo- 
ratory experiments  we  learn  that  piperazine 
forms  with  uric  acid  a  neutral  and  very  soluble 
salt,  piperazine  urate,  and  even  if  the  uric  acid 
is  present  in  excess  this  salt  onlv  is  produced. 
As  compared  with  lithium  carbonate,  we  learn 
that  piperazine  will  render  soluble  twelve  times 
as  much  uric  acid,  and  that  piperazine  urate  is 
seven  times  as  soluble  in  water  as  lithium  urate 
is.  The  power  of  piperazine  to  cause  the  solu- 
tion of  uric  acid  in  the  laboratory  is  manifes- 
ted not  only  upon  granular  uric  acid,  but  also 
upon  the  hardest  of  uric-acid  calculi;  and  even 
if  the  calculi  are  not  formed  purely  of  uric 
acid,  piperazine  may  cause  their  disintegra- 
tion by  acting  upon  the  uric  acid  which  they 
do  contain. 

The  physiological  action  of  piperazine,  so 
far  as  it  has  been  studied,  seems  not  very  de- 
cided. The  drug  is  not  irritant  and  ordinarily 
is  not  toxic,  though  hallucinations,  tremors, 
and  spasmodic  movements  are  said  to  have  fol- 
lowed the  use  of  large  doses,  while  headache 
and  vomiting  have  also  been  reported  as  sequels. 
The  circulation  and  respiration  seem  little  af- 
fected by  piperazine,  and  digestion  is  not  in- 
terfered with.  Although  it  is  possible  that 
the  remedy  is  partially  oxidized  within  the 
body,  it  IS  mainly  eliminated  by  the  kidneys, 
unchanged  and  in  combination  with  uric  acid. 
The  urine  is  said  to  be  much  increased  in 
amount  sometimes  under  the  influence  of 
piperazine,  and  some  have  even  regarded  the 
drug  as  a  diuretic  of  sufficient  activity  to  be 
useful  m  dropsies.  This  diuretic  action  of 
piperazine,  however,  is  not  reliable.  The 
amount  of  urea  eliminated  by  the  urine  is  said 
to  be  increased  under  the  influence  of  pipera- 
zine, while  the  amount  of  uric  acid  is  lessened, 


89 


PINKROOT 
PIPERAZINK 


and  from  this  it  is  inferred  that  piperazine 
acts  to  make  oxidation  more  complete.  These 
results  have  not  been  invariably  observed, 
however,  and  some  have  found  the  elimination 
of  urea  and  uric  acid  to  be  unchanged  by  it. 

Piperazine  has  been  used  in  a  variety  of  dis- 
orders which,  with  moi-e  or  less  correctness, 
are  thought  to  result  from  uric-acid  accumu- 
lation. The  results  observed  in  these  dis- 
orders have  been  contradictory,  and  latterly 
more  suspicion  has  existed  as  to  the  value  of 
the  drug  than  was  to  be  observed  when  first 
it  was  introduced.  Gout  in  all  its  forms  and 
manifestations  is  treated  with  piperazine,  and 
in  some  cases  with  success.  Rheumatism, 
too,  is  so  treated,  though  scarcely  effectively. 
Uric-acid  calculi  and  gravel  may  perhaps  be 
prevented  from  further  increasing  by  the  use 
of  piperazine,  but  that  their  diminution  is 
thus  accomplished  is  to  be  doubted.  In  cystic 
irritation,  either  from  uric-acid  calculus  or 
from  highly-concentrated  urine,  attempts  have 
been  made  at  relief,  not  only  by  the  internal 
use  of  the  drug,  but  also  by  the  vesical  injec- 
tion of  a  1-per-eent.  solution,  and  in  the  latter 
condition  some  success  has  followed  the  prac- 
tice. In  lumbago  piperazine  has  been  inject- 
ed suboutaneously  in  a  2-per-cent.  solution. 
Though  this  procedure  is  painful,  it  is  said 
that  abscess  seldom  results.  Similar  injections 
have  been  made  in  the  neighbourhood  of  gouty 
joints,  and  some,  with  much  faith,  make  exter- 
nal applications  of  piperazine  in  solution  for  a 
similar  purpose,  hiabetes  is  said  sometimes 
to  receive  benefit  from  the  use  of  piperazine, 
and  when,  as  is  frequently  the  case,  glycosuria 
is  present  in  the  gouty,  an  improvement  under 
the  use  of  this  agent  might  not  seem  surpris- 
ing. 

The  daily  dose  of  piperazine  is  usually  15 
grains,  and  it  is  recommended  that  this  amount 
be  dissolved  in  water  (a  pint  to  a  quart)  each 
day,  and  that  this  solution  be  drunk  at  inter- 
vals. Larger  doses  may  be  given  with  safety, 
and  30  grains  a  day  is  with  many  the  usual 
dose.  Owing  to  its  hygroscopic  properties, 
piperazine  is  most  satisfactorily  administered 
in  solution. 

There  are  a  number  of  preparations  of  piper- 
azine. Granular  effervescent  piperazine  con- 
tains 5  grains  in  a  drachm.  The  dose  is  1 
drachm.  Granular  effervescent  piperazine 
with  phenoeoU  contains  5  grains  of  each  in  a 
drachm.  The  dose  is  1  drachm.  Aerated  pi- 
perazine water  'contains  15  grains  in  each 
bottle.  A  bottle  may  be  taken  daily,  and  the 
aerated  water  is  to  some  a  pleasanter  vehicle 
than  ordinary  water.  Tablets  of  piperazine 
are  also  prepared  for  the  sake  of  convenience 
in  making  the  daily  solution.  Each  tablet 
contains  15  grains. 

It  must  be  confessed  that  the  expectations 
which  were  formed  of  piperazine  when  first 
the  remedy  was  introduced  have  not  been 
realized  ;  and  though  in  some  few  cases  of  uric- 
acid  accumulation  its  administration  may  be 
attended  with  success,  this  is  perhaps  due  rather 
to  its  alkaline  reaction  and  possibly  to  its 
favouring  the  conversion  of  uric  acid  into  urea 
by  oxidation  than  to  any  power  it  has  to  act 


as  a  solvent  of  uric  acid.  In  this  connection 
the  results  of  some  recently  conducted  experi- 
ments are  instructive.  Bohland  (Therap.  Mo- 
nats.,  May,  1894)  administered  piperazine  in  a 
case  of  leucaemia  in  which  the  urine  deposited  a 
uric-acid  sediment.  The  remedy  was  given  in 
large  doses  and  its  use  was  continued  for  a 
long  time,  but  not  the  slightest  alteration  was 
observed  in  the  amount  of  uric  acid  eliminated. 
Schmidt,  Bresenthal,  and  Levison  have  experi- 
mented upon  healthy  individijals  with  a  simi- 
lar result,  and  their  conclusion  is  that  the  drug 
is  useless  to  prevent  the  enlargement  or  to  cause 
the  solution  of  uric-acid  concretions.  Finally, 
though  it  is  conceded  that  the  solution  of  uric 
acid  by  piperazine  is  easily  accomplished  in 
the  laboratory,  it  seems  evident  that  the  labo- 
ratory conditions  can  not  be  duplicated  within 
the  body.  Bearing  upon  these  facts  are  the 
much-quoted  conclusions  of  Sharp  and  the 
more  recent  ones  of  Fawcett.  Gordon  Sharp 
(Brit.  Med.  Jow.,  June  16,  1&94)  concludes: 
1.  Piperazine  is  not  wholly  oxidized  in  the  body, 
and  may  be  detected  in  the  urine  of  those  to 
whom  it  is  administered.  3.  Solutions  of  1 
per  cent,  in  normal  urine,  when  kept  in  con- 
tact with  a  fragment  of  uric-acid  calculus  at 
a  temperature  of  103'3°  P.  for  a  given  time, 
have  the  property  of  dissolving  it  to  a  great 
extent.  3.  The  stronger  the  solution  of  pipera- 
zine in  the  urine  the  earlier  does  the  solvent 
action  begin,  though  the  rate  of  solution  is  not 
so  decidedly  faster  than  with  the  weaker  solu- 
tion as  might  be  expected.  4.  The  solvent 
action  of  piperazine  is  greater  than  that  of 
other  substances  employed  for  the  same  pur- 
pose, such  as  borax,  lithium  citrate,  sodium 
carbonate,  and  potassium  citrate.  5.  Pipera- 
zine in  weak  and  strong  solutions  converts  the 
undissolved  portion  of  the  calculus  into  a  soft 
granular  or  pulpy  material. 

Sharp,  however,  has  shown  that  from  the 
daily  administration  of  30  grains  of  piperazine 
there  are  eliminated  unoxidized,  by  the  urine, 
but  5  grains.  This  would  mean  a  urinary  so- 
lution of  about  0'02  per  cent.  The  solutions 
which  Sharp  used  in  his  experiments  were  far 
stronger  than  this,  and  were  such  as  could  by 
no  possibility  be  obtained  by  the  clinical  use 
of  the  drug.  Fawcett  has  called  attention  to 
these  facts  and  has  gone  so  far  as  to  prove  that 
even  l-to-1,000  solutions  of  piperazine  in  urine 
are  inert,  and  therefore  we  are  forced  to  the 
conclusion  that  the  clinical  employment  of 
piperazine  as  a  uric-acid  solvent  of  any  impor- 
tance is  unreasonable. 

[Dr.  John  McKinlock,  of  Chicago  {N.  Y. 
Med.  Jour.,  Aug.  18,  1894),  reports  four  cases 
of  renal  colic  in  which  he  used  piperazine  with 
very  satisfactory  results.  He  used  large  doses, 
in  one  case  as  much  as  2  drachms  in  the  course 
of  the  first  day. 

A  case  oi  poisoning  with  piperazine  has  been 
reported  by  Dr.  Charles  H.  P.  Slaughter,  of 
Philadelphia  (3Ied.  News,  March  14,  1896). 
Dr.  Slaughter  had  prescribed  three  powders, 
each  to  contain  30  grains  of  piperazine,  for  a 
woman,  thirty-two  years  old,  who  had  great 
acidity  of  the  urine.  Each  of  the  powders 
was  to  be  dissolved  in  a  pint  of  water  and 


PTPERTDINE 
PIX  LIQUIDA 


90 


taken  in  the  course  of  twenty-four  hours,  but 
the  woman  took  the  20  grains  all  at  once,  dis- 
solved in  a  pint  of  water.  It  seems  to  have 
been  three  or  four  hours  after  this  that  Dr. 
Slaughter  was  called  to  see  her.  He  found  her 
greatly  cyanosed  and  semi-comatose,  and  it  was 
necessary  to  arouse  her  to  obtain  any  reply  to 
inquiries.  Her  pupils  were  minutely  contract- 
ed, the  pulse  50,  and  the  temperature  97'4°  F. 
The  respirations  were  very  much  depressed  and 
a  low  muttering  delirium  prevailed.  The  tips 
of  the  fingers  and  the  lips  were  cyanotic,  and 
on  her  attempting  to  walk,  complete  loss  of  the 
power  of  motion  was  observed  in  both  lower 
limbs,  while  sensation  was  well  preserved.  The 
symptoms  are  said  by  Dr.  Slaughter  to  have 
been  most  alarming.  He  administered  cardiac 
and  respiratory  stimulants,  using  at  the  same 
time  external  heat  and  elevating  the  lower 
limbs.  The  woman  also  received  a  high  stimu- 
lating rectal  injection  and  was  catheterized. 
It  was  only  after  several  hours  of  treatment, 
persistently  administered,  that  reaction  oc- 
curred. On  the  next  day  Dr.  Slaughter  visited 
her  and  found  the  loss  of  motion  returning  and 
also  a  marked  hypostatic  congestion  of  both 
lungs.  Upon  the  sixth  day  the  paraplegia  had 
vanished,  and  the  woman  finally  made  a  com- 
plete recovery.  The  paralysis  was  treated  with 
large  doses  of  strychnine  and  with  massage.] 
Henry  A.  Griffin. 

PIPERIDINE,  C5H11N.  an  alkaloid,  is  a 
colourless  liquid  having  an  odour  of  ammonia 
and  pepper.  It  is  obtained  by  the  decomposi- 
tion of  piperin.  It  is  readily  soluble  in  water 
and  in  alcohol.  Dr.  Arthur  R.  Cushny,  of  the 
University  of  Michigan  (Exper.  Med.,  Jan., 
1896),  has  experimented  extensively  with  pi- 
peridine,  but  thus  far  there  are  no  accounts  of 
its  having  been  used  in  medicine.  Dr.  Cushny 
and  others  have  found  that  its  toxic  properties 
resemble  those  of  curare  and  ooniine,  but  are 
much  feebler. 

PIPERIN,  PIPERINE.  —  Piperine,  as 
this  principle  should  be  termed  if  it  is  an  al- 
kaloid, bears  the  name  piperinum  in  the  U.  S. 
Ph.,  indicating  that  it  is  considered  to  be  a 
neutral  principle.  The  U.  S.  Ph.  of  1880,  how- 
ever, had  described  it  as  a  "  principle  of  fee- 
bly alkaloidal  power,"  and  the  authors  of  the 
United  States  Dispensatory  seem  justified  in  re- 
marking that  "  this  should  have  been  retained 
at  least  until  it  had  been  proved  beyond  ques- 
tion that  this  description  was  incorrect."  Pi- 
perine  has  been  regarded  as  a  compound  of 
piperidine  and  piperinic  acid,  having  the  for- 
mula      /0\pT, 

C  Hs  \0^ 

""■CH  =  CH  -  CH  =  CH  -  CO.CsHioN. 

It  is  obtained  from  the  fruit  of  Piper  nigrum, 
or  black  pepper.  It  is  a  tasteless  crystalline 
substance,  insoluble  in  cold  water,  soluble  in 
alcohol,  in  ether,  and  in  chloroform.  It  has 
been  used  to  some  extent  as  an  antiperiodic  in 
malarial  affections.  The  dose  is  from  1  to  5 
grains,  which  may  conveniently  be  given  in  the 
form  of  a  pill. 

PIPER  NIGRUM  (Br.  Ph.),  piper  (U.  S. 
Ph.),  black  pepper,  is  the  dried  unripe  fruit  of 


Piper  nigrum,  the  pepper  vine  of  various  tropi- 
cal countries,  mostly  Asiatic.  It  is  used  chiefly 
as  a  condiment,  but  occasionally  also  as  a  car- 
minative and  as  a  remedy  for  malarial  affec- 
tions. 

Pepper  is  the  chief  ingredient  of  Ward's 
paste,  a  compound  formerly  much  used  in  the 
treatment  of  hmmorrhoids.  An  old  official 
equivalent  of  Ward's  paste,  that  of  the  Lond. 
Ph.,  was  made  after  the  following  formula: 
5  Powdered  black  pepper,  )j^  ^  ^ 
Powdered  elecampane,    p"^^"--   ^  t""-^' 

Powdered  fennel 3  parts ; 

Honey,  (       ,  „     „ 

Sugar,  p^'=" '' 

Prom  1  to  2  drachms  of  this  paste  may  be 
taken  three  times  a  day.  The  ordinary  ground 
black  pepper  of  the  table  is  a  very  efficient 
hmmostatic  in  cases  of  -imall  wounds.  The  dry 
powder  should  be  applied  copiously.  It  acts 
mechanically  and  does  not  give  rise  to  the 
slightest  pain.  The  dose  of  pepper  for  inter- 
nal administration  is  from  10  to  20  grains. 
Oleoresin  of  pepper,  oleoresina  piperis  (U.  S. 
Ph.),  may  be  given  in  doses  of  from  -i  to  1 
minim,  in  a  pill.  The  dose  of  confection  of 
pepper,  confectio  piperis  (Br.  Ph.),  is  from  1  to 
2  drachms. 

PIPERONAIi,  called  by  perfumers  helio- 
tropin,  is  a  crystalline  substance  obtained  by 
the  oxidation  of  piperinic  acid  and  having  the 


formula 


.OvCHj 
O.H.Os  =  CaHs^O-^^ 

C<H- 


It  has  been  proposed  as  an  antipyretic  and 
antiseptic,  but  has  not  been  much  employed. 
The  dose  is  15  grains. 

PIPSISSEWA.— See  Chimaphila. 

PISCIDIA,  Jamaica  dogwood,  is  the  bark 
of  the  root  of  Piscidia  erythrina,  a  tree  grow- 
ing in  the  West  Indies.  'The  bark  is  imported 
in  small  pieces,  which  have  a  heavy,  narcotic 
odour  when  broken,  and  a  bitter,  acrid  taste. 
The  active  principle  of  the  bark  is  as  yet  un- 
determined, though  it  contains  oil,  tannin,  res- 
ins, and  a  peculiar  colourless,  crystallizable 
substance — a  neutral  principle,  called  piscidin. 
This  is  soluble  in  alcohol,  but  is  insoluble  in 
water.  The  physiological  action  of  piscidia 
has  not  been  sufficiently  studied,  but,  so  far  as 
may  at  present  be  judged,  it  appears  to  be  pos- 
sessed of  soporific  and  anodyne  powers,  but  to 
be  far  weaker  in  action  than  opium.  It  pos- 
sesses the  advantage,  however,  of  causing  no 
unpleasant  after-eflfects  and  no  injurious  in- 
fluence upon  digestion.  Piscidia  is  said  to  di- 
minish reflex  irritability,  to  cause  dilatation  of 
the  pupil,  to  increase  the  salivary  flow  and  the 
cutaneous  secretion,  to  cause  slowing  of  the 
heart  and  increased  arterial  tension  from  stim- 
ulation of  the  vaso-motor  centre,  and,  finally, 
to  cause  lowered  blood-pressure  from  cardiac 
weakening.  It  may,  it  is  said,  cause  tetanic 
spasms  from  irritation  of  the  spinal  centres, 
and,  if  given  in  sufBcient  amount,  may  pro- 
duce death  from  respiratory  or  cardiac  paraly- 
sis. 

The  analgetic  power  of  piscidia  seems  a  local 


91 


PIPERIDINE 
PIX  LIQUIDA 


one  as  well  as  constitutional,  and  it  may  be 
applied  with  benefit  in  such  painful  conditions 
as  toothache,  burns,  scalds,  and  hemorrhoids. 
Internally,  piseidia  maybe  used  as  a  substitute 
for  opium  in  cases  in  which  that  drug  is  not 
well  borne.    It  is  said  to  be  especially  suitable, 
therefore,  for  use  in  the  young  and  the  aged, 
and    it    is    probably   less   disturbing   to    the 
digestion.     That  it  is  entirely  inactive  upon 
digestion  would  seem,  however,  to  be  disproved 
by  the  case  reported  by  H.  C.  Wood,  in  which 
nausea  and  gastric  distress  followed  its  em- 
ployment, without  any  narcotic  effect  what- 
ever.    Piseidia  mav  be  given  to  cause  sleep,  to 
diminish  nervous  irritability,  to  lessen  reflex 
action  and  spasm,  and  to  relieve  pain.     Neu- 
ralgias of  various  sorts  are  often  favourably 
affected  by  piseidia,  though  its  beneficial  ac- 
tion is  not  invariable,  and,  in  cases  of  great 
severity,  it  is  apt  to  fail.     If  we  are  to  believe 
its  advocates,  there  is  no  form  of  pain  in  which 
piseidia  is  not  eflicient,  and,  indeed,  in  many 
cases  it  is  productive  of  much  relief,  but  in 
many  cases  it  fails.    In  spasmodic  dysmenor- 
rhcea  it  acts  both  as  an  antispasmodic  and  as 
an  anodyne,  and  often  appears  to  be  of  benefit. 
In  the  same  way  it  may  be  efficient  in  quieting 
the  pains  of  abortion.    As  an  antispasmodic, 
it  has  been  said   to  cause   relief  in  asthma, 
whooping-cough,  and  even  chorea,  but  its  seda- 
tive action  is  especially  valuable  in  quieting 
the  irritable  cough  which  accompanies  bron- 
chitis and  phthisis.     It  has  the  advantage,  too, 
of  not  interfering  with  expectoration.     In  in- 
somnia of  various  sorts  piseidia  is  often  effi- 
cient ;  though  in  severe  cases  of  this  symptom, 
such  as  are  witnessed  in  alcoholics,  it  may  fail, 
it  is  said,  on  the  other  hand,  to  be  very  useful 
in  pure  nervous  insomnia,  and  also  to  be  highly 
efficient  in  the  relief  of  hysterical  states  in 
general. 

Several  preparations  of  piseidia  are  to  be 
obtained,  but  the  most  reliable  is  the  fluid  ex- 
tract. Ot  this  the  dose  is  from  -J  to  1  fl. 
drachm,  which  may  be  cautiously  increased  if 
necessary. — Heney  A.  Griffin. 

PISTACIA  LENTISCUS.— This  anacar- 
diaeeous  tree,  growing  on  the  shores  of  the 
Mediterranean,  is  the  source  of  mastic  {g.  v.). 

PITCH. — See  Pix  burgundica,  Pix  cana- 
densis, Pix  LIQUIDA,  and  Tar. 
PITUITARY -BODY    EXTRACT.— In 

the  article  on  Animal  extracts  and  juices  it 
was  stated  (vol.  i,  page  81)  that  this  extract 
had  been  recommended  in  the  treatment  of 
acromegaly.  Marinesco  (Semaine  med.,  Nov. 
13, 1805  ;  Brit.  Med.  Jour.,  Dec.  7,  189.^,  Upito- 
me)  has  since  reported  three  cases  of  that 
disease  in  which  he  gave  the  pituitary  body  in 
substance.  In  two  of  the  cases  the  patients,  a 
woman  aged  fifty-three  and  a  man  of  fifliy- 
four,  were  examples  of  the  massive  type  of  the 
disease  ;  the  third,  a  woman  aged  about  thirty, 
was  an  example  of  the  giant  type.  Under  the 
treatment  the  headache,  which  in  the  "  mass- 
ive" cases  was  extremely  violent,  diminished 
considerably  in  intensity,  but  the  remedy  had 
no  effect  on  the  neuralgic  pains  in  the  limbs. 
The  general  condition  was  improved,  but 
50 


Marinesco  could  not  detect  the  slightest  dimi- 
nution in  the  size  of  the  affected  extremities. 
The  most  definite  objective  effect  of  the  treat- 
ment was  increased  diuresis.  Without  denying 
that  suggestion  may  have  had  some  part  in  the 
matter,  Marinesco  believes  that  the  treatment 
had  some  action,  either  on  the  pituitary  tu- 
mour or  on  the  encephalic  circulation.  He 
states  that  both  Mane  and  he  believe  that 
acromegaly  depends  on  perverted  function  of 
the  pituitary  body,  but  they  reject  Tamburini 
and  Massalongo's  hypothesis  that  the  hyper- 
trophy of  acromegaly  is  a  result  of  pituitary 
supersecretion.  In  certain  cases  post-mortem 
examination  has  shown  that  the  pituitary 
body  had  undergone  a  heterogeneous  transfor- 
mation, the  gland  cells  having  been  replaced 
by  elements  of  a  different  kind,  incapable  of 
supplying  the  normal  secretion  of  the  gland. 

PIX  BTJBGTTNDICA  (U.  S.  Ph.,  Br.  Ph.), 
or  Burgundy  pitch,  is  the  resinous  exudate  of 
a  variety  of  pine.  It  is  soft  and  adhesive  at 
the  temperature  of  the  body.  Spread  upon 
leather,  etc.,  it  is  used  as  a  rubefacient  plaster 
in  chronic  rheumatism,  pulmonary  affections, 
etc.,  in  which  mild  and  long-continued  coun- 
ter-irritation is  desired.  tJmplastrum  picis 
burgundicce  (U.  S.  Ph.),  Burgundy  pitch  plas- 
ter, is  used  as  above  stated.  Emplastrum  pi- 
cis (Br.  Ph.),  pitch  plaster,  is  essentially  the 
same. 

[Emplastrum  picis  cantharidatum  (U.  S. 
Ph.),  cantharidal  pitch  plaster,  is  a  compound 
of  8  parts  of  cerate  of  eantharides  and  100  of 
Burgundy  pitch.  It  is  somewhat  more  active 
than  ordinary  pitch  plaster,  and  is  used  for 
the  same  purposes.] — Russell  H.  Nevins. 

PIX  CANADENSIS,  or  the  resin  of  the 
common  American  hemlock,  has  been  em- 
ployed in  the  same  manner  and  for  the  same 
purposes  as  Burgundy  pitch,  but  is  less  suit- 
able on  account  of  its  lower  melting  point  and 
consequent  lack  of  adhesiveness  at  the  temper- 
ature of  the  body. — Eussell  H.  Nevins. 

PIX  liiaUIDA  (U.  S.  Ph.,  Br.  Ph.,  Ger. 
Ph.),  or  common  tar,  is  a  black,  tenacious, 
semifluid  substance  obtained  from  various  spe- 
cies of  pine.  In  some  respects  it  is  similar  in 
its  action  to  turpentine,  than  which,  however, 
it  is  more  useful  in  the  treatment  of  pulmo- 
nary affections.  In  winter  cough,  given  in  the 
pill  form  in  2-grain  doses  three  times  a  day, 
it  usually  diminishes  the  expectoration  and 
reduces  the  frequency  of  the  paroxysms  of 
coughing.  Chronic  bronchitis  also  is  bene- 
fited by  its  administration  in  this  manner,  but 
the  ordinary  tar  water  is  probably  as  effectual 
and  is  more  easily  obtained.  The  inhalation 
of  the  steam  arising  from  hot  tar  water,  or  the 
vapour  given  off  from  heated  tar,  is  more  or 
less  useful  in  allaying  the  cough  of  all  pulmo- 
nary affections,  but  it  has  no  curative  effect  in 
phthisis,  as  was  held  at  one  time.  Though 
possessed  of  slight  diuretic  properties,  it  is 
rarely  used  as  a  diuretic,  for  it  has  no  advan- 
tages over  the  other  diuretics. 

Syrup  of  tar,  syrupus  picis  liquidce  (U.  S. 
Ph.),  is  regarded  by  some  as  being  less  irritat- 
ing than  either  tar  itself  or  tar  water.    It  has 


PIXOL 
PODOPHYLLIN 


93 


all  the  active  properties  of  tar,  and  may  be 
given  in  doses  of  from  1  to  3  fl.  drachms.  Tar 
water,  aqua  picis  (Ger.  Ph.),  may  be  prepared 
extemporaneously  by  allowing  4  parts  of  water 
and  1  part  of  tar  to  stand  for  twenty-four 
hours,  and  decanting  off  the  water,  which  is 
the  portion  used,  at  the  end  of  that  period. 
It  may  be  given  almost  ad  libitum,  and  some- 
times is  useful,  when  injected  into  the  bladder, 
in  allaying  the  irritation  of  chronic  cystitis. 

Saccharated  tar  contains  about  4  per  cent, 
of  tar,  is  freely  soluble  in  water,  and  may  be 
substituted  for  the  syrup.  A  mixture  of  tar 
and  charcoal  readily  allows  of  the  solution  of 
the  tar  in  water,  which  may  also  be  vaporized 
when  sprinkled  upon  any  hot  surface. 

Externally,  tar  is  stimulant  and  is  very 
largely  employed  in  the  treatment  of  tinea 
capitis,  psoriasis,  lepra,  and  some  of  the  scaly 
forms  of  eczema. 

In  these  affections  it  may  be  painted  upon 
the  affected  surface  or  applied  in  the  shape  of 
a  soap,  an  ointment,  or  the  unofficial  liquor 
picis  alkalinua.  This  latter  contains  2  parts 
of  tar,  1  part  of  caustic  potash,  and  5  parts  of 
water.  When  dried  upon  the  skin  it  is  only 
slightly  sticky.  Tar  soaps  are  unofficial  and 
vary  considerably  in  strength,  etc.,  so  that  it  is 
important  that  a  well-known  brand  should  be 
selected. 

Tar  ointment,  unguentum  picis  liquidcc,  con- 
tains, according  to  the  U.  S.  Ph.,  50  per  cent. 
of  tar ;  that  of  the  Br.  Ph.  consists  of  5  parts 
of  tar  and  2  of  yellow  wax.  The  British  oint- 
ment is  therefore  considerably  the  stronger. 
(Cf.  Tar.) — Russell  H.  Nevins. 

FIXOL. — This  name  has  been  given  to  a 
disinfectant  made  with  tar,  soft  soap,  and 
caustic  potash.  Dr.  Doukalsky,  physician  at 
the  military  hospital  at  Keltzy,  is  cited  in  the 
Province  medicate  for  November  17,  1894,  as 
saying  that  painting  with  a  watery  solution  of 
pixol  of  from  10  to  13  per  cent.,  repeated  two 
or  three  times  a  day,  is  an  excellent  means  of 
treating  acute  dermatitis  produced  by  the  too 
energetic  employment  of  ointments  for  the 
itch,  mercurial  frictions,  and  other  medicinal 
applications.  Under  the  influence  of  pixol  the 
itching  becomes  less  intense  almost  immediate- 
ly, and  the  inflammatory  symptoms  disappear 
in  a  few  days.  These  paintings  give  equally 
good  results  in  the  treatment  of  psoriasis, 
simple  chancres,  and  wounds  resulting  from 
opening  virulerit  buboes. 

PLACEBOS.— For  some  reason  the  use  of 
placebos,  or  preparations  made  of  inert  sub- 
stances or  those  nearly  so,  appears  to  have  in 
a  measure  been  abandoned,  but  there  are,  with- 
out doubt,  conditions  in  which  they  may  play 
a  useful  part.  These  cases  may  be  roughly 
divided  into  two  classes,  the  one  including 
those  in  which  the  desires  and  notional  ideas 
of  the  patient  are  to  be  gratified,  and  the  other 
those  in  which  it  seems  wise  to  gratify  the 
wishes  of  the  patient,  friends,  and  attendants, 
and  to  assure  them  that  something  is  being 
done.  In  the  first  class  it  is  desirable  that  the 
preparation  employed  should  be  sapid,  but  in 
the  latter  this  is  of  little  moment  and  it  is 


often  better  that  it  should  be  without  taste. 
It  is  also  of  advantage  that  in  the  first  class  the 
sympathies  of  the  patient  should  be  aroused, 
the  expected  action  of  the  remedy  explained 
in  detail,  and  the  most  minute  directions  given 
as  to 'the  time,  manner,  etc.,  of  taking  it,  add- 
ing, if  possible,  an  air  of  mystery.  As  the 
persons  for  whom  this  class  of  remedies  is  ap- 
plicable are  impressible,  it  is  wise  to  call  that 
trait  into  play.  For  adults,  probably  as  good 
as  anything  would  be  the  infusion  of  hops  or 
that  of  quassia,  which  are  certainly  harmless 
enough  and  yet  can  not  be  called  insipid.  The 
time-honoured  bread-pill  may  be  used  if  desired, 
or  one  of  extract  of  licorice  if  one  having  an 
odour  and  colour  seems  preferable.  Often, 
especially  among  the  ignorant,  patients  may 
insist  upon  something  having  a  moderate 
physiological  effect ;  for  them  the  rhubarb- 
and-soda  mixture  is  very  appropriate  and  cer- 
tainly is  nasty  enough  not  to  lead  one  to  acquire 
the  habit  of  abusing  it.  Small  amounts  of 
potassiumbromide.  aromatic  spirit  of  ammonia, 
or  compound  tincture  of  lavender  may  be  use- 
ful in  the  case  of  hysterical  women  and  girls. 
When  the  hypodermic  use  of  morphine  has 
been  practised  for  a  considerable  period  and 
patients  call  for  it  at  certain  regular  intervals, 
distilled  water  in  which  an  inert  disc  or  tablet 
is  dissolved  in  their  presence  will  usually  assist 
very  materially  in  dispensing  with  the  mor- 
phine. 

In  acute  cases,  when  it  seems  desirable  to 
employ  medication  for  the  purpose  of  allay- 
ing the  anxieties  of  the  friends  and  others,  the 
patient  being  indifferent,  it  is  best  to  make  use 
of  some  preparation  entirely  or  nearly  tasteless, 
which  should  be  supplied  by  the  medical  at- 
tendant rather  than  the  apothecary,  and  be 
as  easy  of  administration  as  possible.  Plain 
water  or  that  to  which  a  slight  taste  and  colour 
have  been  imparted  by  gentian,  or  something 
similar,  may  be  employed,  a  drop  or  two  of 
glycerin  placed  upon  the  tongue  at  regular 
intervals,  or  some  such  simple  procedure  as 
sponging  undertaken,  but  caution  must  be 
observed  in  critical  cases,  where  all  that  can  be 
done  is  to  await  developments,  not  to  unduly 
disturb  the  patient.  For  children,  almost  any 
preparation  of  an  agreeable  odour  and  taste, 
such  as  syrup  of  raspberry,  is  appropriate,  ex- 
cept in  the  febriculse  of  childhood,  calling  for 
no  particular  treatment,  when  sweet  spirit  of 
nitre  is  preferable,  as  it  is  held  in  high  esteem 
by  the  laity  in  such  conditions,  and  in  small 
doses  is  entirely  harmless  and  may  probably 
render  the  patient  slightly  more  comfortable. 
For  infants  probably  nothing  is  so  safe  or  de- 
sirable as  fractional  doses  of  pepsin. 

Russell  H.  Nevins. 
PLASTERS.— These  are  compounds  of 
various  fusible  solids  of  a  melting  point  higher 
than  that  of  the  human  body,  being  brittle 
when  cold,  but  rendered  adhesive  by  the 
warmth  of  the  body,  and  usually  the  bearers 
of  some  medicament. 

Plasters  may  be  divided  into  plaster-masses 
and  into  spread  plasters. 

In  the  preparation  of  plaster-masses  the  heat 
employed  should  not  be  greater  than  is  neees- 


93 


PIXOIj 
PODOPHYLLIN 


sary  to  produce  a  homogeneous  mixture,  more 
particularly  if  a  medicinal  substance  contain- 
ing readily  perishable  active  principles  is  to 
be  added,  such  as  extract  of  belladonna. 

Owing  to  the  introduction  of  the  rubber 
base  for  plasters,  it  is  but  seldom  that  the 
apothecary  is  called  upon  at  the  present  time 
to  prepare  a  plaster  except  for  blistering  pur- 
poses, in  which  case  he  spreads  the  ceratum 
cantharidis  on  a  suitable  fabric.  Practically, 
all  other  plasters  are  now  prepared  on  the 
manufacturing  scale,  and  most  of  them  with  a 
base  consisting  in  part  of  rubber. 

The  composition  of  the  rubber  plaster  base 
is  stated  to  be,  approximately,  India  rubber,  2 
parts;  Burgundy  pitch,  1  part;  olibanum,  1 
part.  The  rubber  has  to  undergo  protracted 
treatment  in  washers  and  crushers  before  it  is 
clean  and  pliable  enough  to  be  worked  up  with 
the  other  ingredients.  The  mass  is  then  mixed 
with  the  medicinal  agent  in  proper  proportion 
and  spread  upon  muslin  by  special  machinery. 
To  enable  the  perspiration  of  the  skin  to  escape 
from  underneath  a  plaster,  it  has  become  cus- 
tomary to  make  it  "  porous  " — that  is,  to  per- 
forate it  with  numerous  small  holes,  for  which 
special  machines  are  used  by  the  manufacturers. 
On  hand-made  plasters  this  may  be  done  by  a 
small  apparatus  devised  by  Professor  Reming- 
ton, being  a  small  revolv'able  wheel  carrying 
two  rows  of  punches  on  its  circumference. 

Competition  has  caused  a  considerable 
amount  of  practically  worthless  rubber  plas- 
ters to  make  their  appearance  on  the  market. 
It  is  therefore  best  to  specify  the  maker's  name 
when  ordering  these.  The  large  houses,  whose 
names  are  well  known,  carefully  control  the 
quality  of  their  output  in  their  own  interest. 
Chables  Rice. 

PLASTER  or  PARIS.— Only  plaster 
from  which  most  of  the  water  has  been  driven 
off  bv  means  of  heat,  calcii  sulphas  exsiccatus 
(U.  S.  Ph.),  calcii  sulphas  (Br.  Ph.),  calcium 
siilfuricum  nstum  (  Ger.  Ph.),  is  recognised. 
If  it  can  not  be  readily  obtained  freshly  pre- 
pared, it  must  be  kept  in  well-closed  bottles. 
Besides  its  uses  in  surgery  and  for  making 
casts,  which  do  not  come  within  the  scope  of 
this  work,  plaster  of  Paris  applied  in  paste  to 
a  tu7nour.  for  example,  sometimes  acts  well  as 
a  placebo  in  the  case  of  an  ignorant  and  timid 
patient.  The  process  of  taking  a  cast  of  the 
tumour  is  apt  to  be  interpreted  by  such  a  per- 
son as  a  therapeutic  procedure,  and  may  cheer 
and  sustain  him  during  the  few  days  for  which 
it  may  be  wise  to  postpone  a  surgical  opera- 
ation. 

PLETTSISY  ROOT.— See  Asclepias  tu- 

BEROSA. 

PLUMBTJM.- See  Lead. 

PNEUMATIC  CABINET,  PNETT- 
MATIC  CHAMBER.  PNEUMATIC 
CUIRASS,  PNEUMATIC  DIFFER- 
ENTIATION, PNEUMATIC  TUB.— See 
under  AiE.  condensed  or  rarefied  (vol.  1, 
pages  18,  19,  20,  and  21). 

PODOPHYLLIN,  podophylHnum  (Ger. 
Ph.),  is  a  name  which  is  improperly  applied  to 


the  resin  of  podophyllum,  resina  podophylH 
(U.  S.  Ph.),  podophylH  resina  (Br.  Ph.),  and  its 
use  should  theretore  be  abandoned. 

Resin  of  podophyllum  is  an  amorphous 
powder  which  varies  in  colour  from  grayish 
white  to  greenish  yellow.  It  has  a  faint  but 
peculiar  odour  and  a  peculiar  and  bitter  taste. 
It  is  permanent  in  the  air,  but  becomes  darker 
at  temperatures  above  95°  P.  It  is  freely  solu- 
ble in  alcohol  and  partially  soluble  in  ether. 
It  is  composed  of  two  resins  ;  one  is  soluble  in 
alcohol  and  in  ether,  the  other  only  in  alcohol. 
As  to  the  relative  powers  of  these  two,  opin- 
ions differ,  but  there  seems  reason  to  believe 
that  the  resin  soluble  in  ether  represents  the 
greater  part  if  not  the  whole  of  the  mixture's 
activity. 

The  action  of  resin  of  podophyllum,  when 
given  by  the  mouth  and  in  medicinal  doses,  is 
to  increase  the  intestinal  secretions  and  cause 
catharsis ;  in  some  cases  it  produces  nausea  and 
occasionally  vomiting.  It  is  somewhat  slow  in 
its  action ;  from  six  to  ten  hours  usually  elapse 
before  purgation  begins.  The  movements  it 
causes  are  usually  large  and  fluid.  The  action 
of  resin  of  podophyllum,  when  given  uncom- 
bined,  is  somewhat  severe,  and  griping  is  gen- 
erally an  accompaniment,  but  in  combination 
with  an  antispasmodic,  like  belladonna  or 
hyoscyaraus,  the  remedy  is  usually  not  un- 
pleasant. The  action  of  the  resin  upon  the 
hepatic  function  is  pronounced,  the  production 
of  bile  being  directly  stimulated  by  it,  as  the 
much-quoted  experiments  of  Rutherford  have 
shown.  It  is  certainly  proved  that  the  action 
of  resin  of  podophyllum  follows  its  absorption, 
for  catharsis  has  resulted  from  its  hypodermic 
administration  to  animals,  and  its  application 
to  an  ulcerated  surface  has  had  a  similar  re- 
sult. That  the  drug  has  any  constitutional 
effect  is  improbable. 

In  large  doses  the  remedy  is  poisonous  ;  the 
symptoms  observed  have  been  vomiting,  ex- 
cessive purging,  violent  abdominal  pain,  and 
collapse.  Convulsions  have  also  been  noted 
in  podophyllum  poisoning.  The  treatment  in 
cases  of  such  poisoning  must  be  symptomatic 
and  sustaining ;  opium,  of  course,  is  generally 
required. 

Constipation,  whether  occasional  or  habit- 
ual, may  well  be  treated  with  podophyllum. 
For  the  latter  state  the  drug  is  more  suitable 
in  cases  in  which  the  constipation  is  depend- 
ent upon  deficiency  of  hepatic  or  intestinal 
secretion  than  in  those  where  muscular  atony 
is  the  cause,  though  even  in  that  condition 
the  remedy  is  not  without  effect.  From  its 
cholagogue  power,  resin  of  podophyllum  is 
useful  in  a  variety  of  hepatic  disorders,  among 
them  functional  disturbances  of  the  liver,  por- 
tal congestion,  and  catarrhal  Jaundice.  The 
familiar  "  bilious  attack  "  may  be  benefited  by 
a  podophyllum  purgation,  and  in  malarial 
infection  the  digestive  disturbances  may  be  re- 
lieved by  it  as  they  are  by  calomel.  Podophyl- 
luni  was  formerly  thought  to  diminish  arterial 
excitement  and  lessen  cough  when  given  in 
small  and  repeated  doses.  It  was  thus  used  in 
hmmoptysis  and  respiratory  catarrhs,  but  it 
can  not  be  said  that  the  value  of  the  treatment 


PODOPHYLLOTOXIN 
POTASSIUM  CARBONATES 


94 


is  evident.  The  remedy  is  seldom  gi  veil  alone, 
but  is  frequently  employed  in  combination 
■with  other  cathartic  drugs,  as  in  the  vegetable 
cathartic  pill  (see  Cathartics),  and  with  in- 
testinal antispasmodics.  The  dose  ot  the 
resin  as  a  purge  is  from  ^  to  i  of  a  grain  ;  as  a 
laxative,  from  tV  to  ^  of  a  grain.  It  is  usually 
administered  in  pill. — Heney  A.  Griffin. 

PODOPHYLLOTOXIN,— This  principle, 
CjsHjiO  +  OSHsHi,  obtained  from  Fuduphyllum 
peliaium,  is  said  to  have  the  therapeutical 
properties  of  resin  of  podophyllum;  it  is  so 
violent  a  poison,  however,  that  its  use  as  a 
medicine  is  not  to  be  recommended. 

PODOPHYLLUM  (U.  S.  Ph.)  is  the  rhi- 
zome and  roots  of  Podophyllum peltatum,  or  the 
May  apple,  a  berberideous  herb  indigenous  to 
the  United  States.  The  therapeutical  proper- 
ties of  podophyllum  are  those  of  the  resin, 
resina  podopliytli  (U.  S.  Ph.),  podophylli  resina 
(Br.  Ph.),  podophyllinum  (Ger.  Ph.) ;  (or  an  ac- 
count of  them  the  reader  is  referred  to  the 
article  on  Podophtllin.  The  other  ofBcial 
preparations  of  podophyllum  are  the  follow- 
ing :  The  extract,  extractum  podophylli  (U. 
S.  Ph.),  the  dose  of  which  is  from  1  to  3 
grains;  the  fluid  extract,  extractum  podo- 
phylli fluidum  (U.  S.  Ph.),  the  dose  of  which 
is  from  5  to  15  minims  ;  and  the  tincture,  tine- 
tura podophylli  (Br.  Ph.),  the  dose  of  which  is 
from  15  minims  to  1  fl.  drachm.  These  prepa- 
rations are  hardly  ever  employed,  and  it  may 
be  said  that  the  powdered  root  itself  is  practi- 
cally never  administered;  the  resin  (podophyl- 
lin)  is  the  form  in  which  the  remedy  is  almost 
invariably  used. 

POISONS. — See  Antidotes  and  Antago- 
nists, also  the  articles  on  the  individual  poi- 
sons. 

POKEBERIIY,  POKEBOOT.— See  Phy- 
tolacca. 

POLYGALA.— See  Senega. 

POLYGONUM  BISTORTA.— See  Bis- 
tort. 

POLYGONUM  HYDROPIPEB.— This 
plant,  the  water-pepper,  or  Persicaria  urens, 
has  been  studied  by  Dr.  C.  J.  Rademaker  (Am. 
Joiir.  of  Pharm.,  November,  1871),  who  says  he 
has  frequently  known  it  to  be  used,  in  the  form 
of  a  tincture  or  a  fluid  extract,  in  amenorrhrea 
and  "other  uterine  disorders"  with  very  satis- 
factory results.  Dr.  Rademaker  concluded 
that  the  medicinal  properties  of  the  plant  re- 
sided mainly  in  an  acid  that  he  found  in  it, 
which  he  named  polygonic  acid.  Dr.  Cerna 
states  that  the  preparation  generally  used  is  a 
fluid  extract,  of  which  the  dose  is  i'rom  15  to 
30  minims. 

POLYPOBUS  FOMENTABIUS.— ^(/(i- 
ricus  chirurgorum  (see  under  Agaric). 

POLYSOLVES,  or  solvines,  are  sulphori- 
cinates  of  alkalies.  When  dissolved  in  water, 
they  enable  the  water  to  mix  with  various 
substances  that  ordinarily  are  not  misoible 
with  it. 

POMEGRANATE,  granali  radicis  cortex 
(Br.  Ph.). — See  under  Pelleiierine, 


POMMADES. — See  Ointments. 

POPLAR. — See  Populus. 

POPPY. — Poppy  heads,  papaveris  capaulcB 
CBr.  Ph.),  fructus  papaveris  immaturi  (Ger. 
Ph.),  are  the  dried  capsules  of  Papaver  somnife- 
rum.  Those  of  the  Br.  Ph.  are  grown  in  Brit- 
ain. They  contain  a  very  small  and  varying 
amount  of  opium  and  are  very  uncertain  in 
their  action.  They  are  employed  for  the  relief 
oi  pain,  etc.,  in  an  emulsion  for  external  use, 
an  official  decoction,  decoctum  papaveris  (Br. 
Ph.),  an  extract,  extractum  papaveris  (Br.  Ph.), 
and  a  syrup,  syrupus  papaveris  (Br.  Ph.),  sir- 
upus  papaveris  (Ger.  Ph.).  The  decoction  is 
employed  topically  as  an  anodyne.  The  dose 
of  the  extract  is  from  3  to  5  grains,  and  that 
of  the  syrup  is  from  ^  to  1  fl.  drachm.  There 
is  little  to  recommend  the  use  of  these  prepara- 
tions, as  their  composition  is  extremely  uncer- 
tain and  they  possess  no  ad  vantages  over  the 
preparations  of  opium  and  its  alkaloids.  A 
bland  oil  is  made  from  the  seeds  which  is 
employed  as  an  illuminant  and  as  a  food  in 
many  parts  of  the  world. 

Syrup  of  red  poppy,  syrupus  rhoeados  (Br. 
Ph.),  is  an  inert  preparation,  valued  solely  on 
account  of  its  bright-red  colour,  used  as  a 
vehicle  in  cough  mixtures,  etc. 

Russell  H.  Nevins. 

POPULUS. — Several  species  of  poplar,  a 
genus  of  salicineous  trees,  have  been  more  or 
less  used  in  medicine,  and  the  black  poplar, 
Populus  nigra,  indigenous  to  Europe,  was 
formerly  official.  The  buds  are  balsamic,  and 
are  occasionally  used  in  the  preparation  of 
pectorals.  The  recently  dried  buds  are  an  in- 
gredient of  poplar  ointment,  pomatum  popu- 
leum  (Fr.  Cod.),  onguent  populeum.  pommade  de 
bourgeon  de  peuplier,  which  is  used  to  some  ex- 
tent in  Europe  as  an  anodyne.  Poplar  buds  are 
said  to  contain  a  principle  that  preserves  oint- 
ments to  which  it  is  added  from  becoming 
rancid.  The  bark  of  Populus  tremula,  which 
contains  salicin,  and  that  of  Populus  tremu- 
loides,  the  American  aspen,  are  tonic  and 
antiperiodic,  and  have  been  employed  with 
success  in  the  treatment  of  malarial  fevers. 

Populin.a,  glucoside  having  the  composition 
CaoHajOe  +  2H3O,  is  found,  along  with  salicin, 
in  the  bark  and  leaves  of  Populus  tremula, 
Populus  alba,  and  Populus  grmca ;  it  has  also 
been  made  synthetically.  It  is  used  as  an  an- 
tipyretic in  doses  of  from  3  to  4  grains. 

POTASH,  POTASSA  (U.  S.  Ph.),  PO- 
TASSA  CAUSTICA  (Br.  Ph.),  potassium 
hydrate,  or  caustic  potash,  is  a  highly  corrosive 
substance  used  in  medicine  as  a  caustic  (cf. 
Caustics),  in  the  preparation  of  a  number  of 
potassium  salts,  and  very  largely  in  the  arts  in 
the  manufacture  of  soap,  etc.  In  common 
with  the  carbonates  and  organic  salts  of  potas- 
sium, potash  has  a  decided  action  in  rendering 
the  fluids  of  the  body  alkaline,  and  these  com- 
pounds are  very  extensively  employed  in  the 
treatment  of  rheumatism,  gout,  the  uric-acid 
diathesis,  and  other  conditions  in  which  alka- 
linity of  the  urine  is  desirable.  They  also 
may  be  employed  to  correct  undue  acidity  of 
the  stomach,  but  are  inferior  for  this  purpose 


95 


PODOPHYLLOTOXIN 
POTASSIUM  CARBONATES 


to  soda  and  the  sodium  salts.  Solution  of 
potash,  liquor  potasses  (U.  S.  Ph.,  Br.  Ph.), 
liquor  kali  caustici  (Ger.  Ph.),  contains  about 
()  per  cent,  of  the  anhydrous  potassa,  and  is 
the  only  preparation  which  can  be  used  with 
safety  for  internal  administration.  It  is  less 
useful,  however,  than  the  potassium  carbon- 
ates or  citrates,  and  is  rarely  dispensed  for 
internal  use.  It  may  be  given  in  doses  of  from 
15  to  60  minims,  largely  diluted  with  water. 
Bxternally,  it  is  employed,  when  diluted,  in 
cutaneous  affections  characterized  by  acid 
secretions,  to  remove  crusts,  etc.  Without 
there  seeming  to  be  any  rational  explanation 
of  its  mode  of  action,  the  undiluted  solution, 
painted  every  hour  or  two  upon  a  felon  during 
its  early  stages,  will  without  doubt  in  many 
instances  abort  it.  In  household  practice  a 
poultice  containing  a  considerable  quantity  of 
unleached  wood  ashes  is  used  for  the  same 
purpose,  and  with  good  results,  which  are  due 
to  the  potash  contained  in  the  ashes. 

[In  the  employment  of  potash  as  a  caustic, 
the  pencil,  or  stick,  of  fused  potassa,  kali  caus- 
ticum  fusum  (Ger.  Ph.),  potassa  fusa,  may  be 
moistened  and  rubbed  on  the  skin,  the  sur- 
rounding parts  being  protected  by  being 
covered  with  adhesive  plaster.  It  should  be 
remembered  that  the  eschar  is  apt  to  be  larger 
than  the  area  to  which  the  caustic  has  been 
applied.  Potassa  cum  calce  (U.  S.  Ph.),  or 
Vienna  caustic,  is  treated  of  in  the  article  on 
Caustics  (see  vol.  i,  page  228).  The  liquor 
potassm  effervescens  of  the  Br.  Ph.  is  really 
not  a' solution  of  potash,  but  of  potassium  bi- 
carbonate in  carbonic-acid  water  ;  it  probably 
owes  its  official  name  to  the  same  conven- 
tionality that  leads  us  to  speak  familiarly  of 
sodium  bicarbonate  as  "  soda."  The  solution 
is  a  very  weak  antacid  and  gastric  stimulant. 
It  may  be  taken  freely.  For  potassa  sulphurata, 
see  under  Sulphue.] — Russell  H.  Kevins. 

POTASSIUM  ACETATE,  potassii  acetas 
(U.  S.  Ph.,  Br.  Ph.),  kalium  aceticum  (Ger.  Ph.), 
is  quite  eilectual  in  rendering  the  fluids  of  the 
body  alkaline ;  it  is  also  diuretic,  and  in  mod- 
erately large  doses  laxative,  although  it  is 
rarely  employed  to  act  on  the  bowels,  as  it  is 
rather  more  disagreeable  to  the  taste  than  most 
of  the  other  salines.  It  may  be  employed  in  the 
treatment  of  acute  rheumatism  by  the  alkaline 
method  (cf.  Alkalies),  from  -J-  to  1  oz.  being 
given  during  each  twenty-four  hours,  but  the 
bicarbonate  is  less  unpleasant  and  just  as  effi- 
cacious. As  might  be  assumed,  it  is  useful  in 
the  uric-acid  diathesis  and  in  the  various  cuta- 
neous affections  assumed  to  depend  upon  that 
state.  It  will  be  found,  however,  that  the  bitar- 
trate  is  rather  more  efficient  and  less  unpleas- 
ant than  this  salt,  and  is,  as  a  rule,  preferable. 
As  a  diuretic,  potassium  acetate  may  be  given 
in  doses  of  from  20  to  60  grains,  and  as  a  ca- 
thartic in  quantities  up  to  \  oz.,  well  diluted, 
as  it  may  otherwise  give  rise  to  gastric  distress 
and  irritation. — Kussell  H.  Nevins. 

POTASSIUM  AND  SODIUM  TAR- 
TRATE.— See  under  Potassium  tartrates. 

POTASSIUM  BICARBONATE.  —  See 
under  Potassium  caebonates. 


POTASSIUM  BICHROMATE,  potassii 
bichromas  (U.  S.  Ph.,  Br.  Ph.),  kulium  dichro- 
micum  (Ger.  Ph.),  is  a  very  irritating  and  caustic 
salt,  not  very  extensively  employed  in  medi- 
cine. In  saturated  solutions  it  may  be  em- 
ployed to  remove  warts,  corns,  and  other 
morbid  growths  of  moderate  size.  In  a  1-per- 
cent, solution  it  is  astringent  and  more  or  less 
of  a  deodorizer,  but  is  rarely  used  except  when 
it  happens  to  be  the  only  body  of  that  nature 
at  hand.  A  fluid  for  use  in  zinc-and-oarbon 
batteries  may  be  made  of  6  oz.  of  this  salt,  6 
fl.  oz.  of  commercial  sulphuric  acid,  and  48  oz. 
of  cold  water,  but  as  a  rule  sodium  bichromate 
is  employed,  as  it  is  much  cheaper  and  more 
soluble  in  the  water.  Mailer's  fluid,  used  for 
the  preservation  of  anatomical  specimens,  eon- 
tains  from  2  to  3  parts  of  this  salt,  1  part  of 
sodium  sulphate,  and  100  parts  of  water.  In 
poisonous  doses,  the  effects  of  potassium  bichro- 
mate vary  little  from  those  of  other  caustic 
bodies,  severe  irritation  of  the  alimentary  ca- 
nal, pain,  coma,  collapse,  etc.,  being  the  most 
prominent  symptoms.  Magnesia,  soap,  and 
the  alkaline  carbonates  are  the  proper  anti- 
dotes. It  is  largely  employed  in  the  arts,  and 
the  dust  and  vapour  arising  from  it  and  its  so- 
lutions often  cause  ulceration  of  the  mucous 
membrane  of  the  nose. — Russell  H.  Nevins. 

POTASSIUM  BISULPHATE.— See  un- 
der Potassium  sulphates. 

POTASSIUM  BITARTRATE.— See  un- 
der Potassium  tartrates. 

POTASSIUM  BROMIDE,  potassii  bro- 
midum  (U.  S.  Ph.,  Br.  Ph.),  kalium  bromatum 
(Ger.  Ph.). — See  under  Bromides  and  under 
Motor  depressants  (vol.  i,  page  644). 

POTASSIUM  CARBONATES.— Potas- 
sium carbonate,  potassii  carbonas  (U.  S.  Ph., 
Br.  Ph.)  kalium  carbonicnm  (Ger.  Ph.),  is,  in 
large  quantities,  highly  corrosive,  and  may 
give  rise  to  the  same  effects  as  those  of  caustic 
potash.  It  is  employed  as  an  antilithic,  as  an 
antacid,  and  in  the  treatmient  of  acute  rheu- 
matism (cf.  Alkalies).  Being  very  soluble  in 
water,  it  is  a  very  appropriate  salt  to  use  when 
the  constitutional  effects  of  potash  are  de- 
sired. It  may  be  given  in  doses  of  from  10  to 
30  grains  in  very  dilute  solution,  and  is  also 
added  to  water  to  form  an  alkaline  bath,  about 
10  oz.  being  used  for  each  bath.  For  the  re- 
moval of  crusts,  etc.,  in  various  cutaneous  af- 
fections, it  may  be  substituted  for  sodium 
carbonate  when  a  more  energetic  action  is  de- 
sii'ed. 

Potassium  bicarbonate,  potassii  hicar- 
bonas  (U.  S.  Ph.,  Br.  Ph.),  kalium  bicarboni- 
cum  (Ger.  Ph.),  differs  but  little  in  its  effects 
from  the  carbonate  and  is  adapted  to  the 
same  purposes,  except  when  the  evolution  of 
considerable  amounts  of  carbonic-acid  gas  in 
the  stomach  is  undesirable.  When  it  is  added 
to  lemon-juice  or  a  solution  of  citric  acid  mod- 
erate effervescence  takes  place,  and  a  citrate  is 
formed  which  is  identical  in  its  effects  with 
the  official  salt.  The  bicarbonate  may  be  used 
in  doses  of  from  30  to  60  grains. 

Russell  H.  Netins. 


POTASSIUM   CHLORATE 
POTASSIUM  IODIDE 


96 


POTASSITJM  CHLORATE,  poiassii 
Moras  (U.  S.  Ph.,  Br.  Ph.),  halium  chloricum 
(Ger.  Ph.),  is  very  largely  used  in  the  treat- 
ment of  all  forms  of  stomatitis,  salivation  due 
to  mercury  or  its  salts,  sore  throat,  hoarseness, 
and  pharyngitis.  It  is  popularly  supposed  to 
be  entirely  harmless,  but,  as  a  matter  of  fact, 
it  is  a  powerful  depressor  of  the  heart's  action, 
and,  passing  unchanged  out  of  the  body  by  the 
urine,  acts  as  a  strong  irritant  to  the  kidneys, 
and  in  large  quantities  is  more  or  less  corro- 
sive. In  the  treatment  of  the  affections  men- 
tioned it  mav  be  used  in  solutions  having  a 
strength  of  from  1  to  2  per  cent.,  or  in  the 
shape  of  troches,  one  form  of.  which  is  official 
in  the  Br.  and  U.  S.  Ph's  under  the  title  of 
trochisci  potassii  chloratis.  Prom  1  to  6  loz- 
enges are  allowed  to  dissolve  slowly  in  the 
mouth.  If  potassium  chlorate  is  given  at  the 
same  time  with  mercurials,  it  is  probable  that 
salivation  will  be  less  apt  to  occur  than  if  it 
were  omitted.  Externally,  it  has  been  em- 
ployed as  an  application  to  unhealthy  ulcers, 
etc.,  either  in  the  shape  of  the  powder  or  in 
saturated  solutions. 

In  scarlet  fever  and  diphtheria  its  local  ac- 
tion upon  the  throat  may  be  slightly  beneficial, 
but  it  should  be  used  as  a  gargle  or  applied 
with  a  brush  or  swab,  and  as  little  as  possible 
allowed  to  enter  the  stomach,  as  its  effects 
upon  the  liidneys  render  it  particularly  dan- 
gerous in  these  diseases. .  It  should  never  be 
combined  with  sulphur,  sugar,  or  any  substance 
containing  considerable  amounts  of  oxygen, 
as  an  explosion  would  be  pretty  sure  to  result 
if  the  proper  conditions  of  heat,  etc.,  existed. 
The  ordinary  dose  of  this  salt  is  5  grains,  but 
double  that  quantity  may  be  given  with  safety. 
Provided  the  troches  do  not  contain  more  than 
5  grains,  which  is  practically  the  strength  of 
the  official  variety,  and  they  are  allowed  to  dis- 
solve slowly  in  the  mouth,  there  is  little  or  no 
danger  of  an  overdose,  even  if  they  are  em- 
ployed almost  continuously. 

[Dr.  Duraontpallier  recently  stated  before 
the  Paris  Academy  of  Medicine  {Presse  med., 
March  18,  1896;  N.  Y.  Med.  Jour.,  April  11, 
1896)  that  he  had  had  occasion  to  employ  this 
drug  in  three  cases  of  tumours  of  the  gitms  and 
of  the  tongue,  the  aspect  and  progress  of  which 
had  presented  a  certain  gravity.  One  patient 
had  been  operated  on  for  epithelioma  of  the 
right  lateral  border  of  the  tongue,  and  during 
his  convalescence  a  recurrent  nodule  was  dis- 
covered near  the  cicatrix.  Cauterization  with 
silver  nitrate  was  practised  three  times  at  in- 
tervals of  several  days,  but  the  epithelial  nodule 
increased.  At  this  time  M,  Dumontpallier  saw 
the  patient  and  made  an  examination  of  the 
tumour,  which  had  developed  rapidly,  and 
found  that  it  was  situated  on  the  right  border 
of  the  tongue,  about  five  centimetres  from  the 
end  of  the  organ.  In  size  and  shape  it  was 
like  a  large  bean,  and  papillomatous  in  appear- 
ance. It  was  sessile  and  adherent,  and  it  had 
caused  much  annoyance  and  pain  on  mastica- 
tion. There  was  no  submaxillary  adenopathy. 
The  avithor  prescribed  potassium  chlorate  as 
a  local  application  in  the  form  of  powder, 
which  was  to  be  applied  six  times  a  day.    At 


the  same  time  a  solution  of  60  grains  of  the 
potassium  salt  in  4|  ounces  of  water  was  to  be 
given  in  doses  of  a  tablespoonful  every  four 
hours.  In  this  way,  said  the  author,  the  tumour 
was  kept  under  the  constant  influence  of  the 
drug,  as  it  was  freely  eliminated  by  the  saliva. 
This  treatment  had  been  continued  regularly 
for  six  weeks,  and  at  the  end  of  that  time  the 
tumour  had  been  reduced  to  half  of  its  original 
size,  and  three  weeks  later  there  existed  only 
two  small  protuberances,  which  were  not  pain- 
ful. About  two  months  afterward  M.  Dumont- 
pallier saw  the  patient  again,  and  found  only 
three  whitish,  shining  cicatricial  bands  corre- 
sponding to  the  course  of  the  operative  wound. 
At  the  time  of  the  report  the  recovery  was 
complete. 

M.  Dumontpallier  said  that  the  favourable 
results  had  certainly  been  due  to  the  use  of  the 
potassium  chlorate,  and  that  its  elimination 
by  the  salivary  secretion  had  acted  continually 
on  the  diseased  surface.  He  recommended  this 
drug  in  cases  of  tumour  of  the  mouth,  in  which 
the  diagnosis  was  often  doubtful,  and  thought 
it  ought  to  be  given  a  trial  before  resorting  to 
a  cutting  operation.  In  order,  he  said,  to  bring 
about  good  results  from  this  treatment,  it 
should  be  continued  for  two  or  three  months; 
it  was  also  absolutely  necessary  to  be  assured 
of  the  functional  regularity  of  the  kidneys, 
which,  with  the  salivary  glands,  were  the  prin- 
cipal organs  of  its  elimination.  It  was  also 
prudent  to  ascertain  if  the  condition  of  the 
teeth  was  not  a  cause  of  irritation  to  the  af- 
fected surface,  and  to  institute  the  proper 
treatment.] — Russell  H.  Nevins. 

POTASSIUM     CHLOBOCHBOMATE, 

on  the  addition  of  hydrochloric  acid,  evolves 
chlorine  and  may  be  employed  as  a  source  of 
that  gas, — Russell  H.  Nevins. 

POTASSIUM  CITRATE,  potassii  citras 
(U.  S.  Ph.,  Br.  Ph.),  is  decomposed  during  the 
process  of  absorption,  the  bicarbonate  result- 
ing. Like  all  the  organic  salts  of  the  alkaline 
bases,  it  has  diuretic,  diaphoretic,  laxative,  and 
refrigerant  properties,  and  also  renders  the 
fluids  of  the  body  alkaline  and  corrects  the 
tendency  to  the  formation  of  uric  acid.  It  is 
very  useful  in  the  milder  fevers,  such  as  that  of 
measles,  scarlet  fever,  etc.,  on  account  of  its  re- 
frigerant and  diaphoretic  properties,  and  its 
action  may  be  furthered  by  the  addition 
appropriate  amounts  of  tincture  of  aoo 
root.  Acute  rheumatism,  when  not  of  a 
severe  type,  may  be  treated  by  it  with  enu. 
propriety  (of.  Alkalies),  and  in  the  uric-acid 
diathesis  it  is  to  be  preferred  to  other  alkaline 
organic  salts.  The  usual  dose  as  a  refrigerant, 
etc.,  is  from  20  to  30  grains,  and  during  twen- 
ty-four hours  as  much  as  an  ounce  may  be  ad- 
ministered without  ill-effect.  It  may  be  given- 
either  in  plain  water  or  in  water  to  which  lem- 
on-juice has  been  added.  More  agreeable  and 
ecjually  efficient  is  the  solution  of  potassium 
citrate,  liquor  potassii  citratis  (U.  S.  Ph.),  or 
neutral  or  saline  mixture,  which  contains  a 
small  amount  of  carbonic-acid  gas  and  may  be 
given  in  doses  of  -J-  a  fl.  oz.  The  old  mixture 
of  citrate  of  potassium,  mistura  potassii  citra- 


97 


POTASSIUM   CHLORATE 
POTASSIUM   IODIDE 


tis  (U.  S.  Ph.,  1880),  differed  trom  this  solution 
in  being  prepared  with  lemon-juice  instead  of 
citric  acid,  and  was  of  a  rather  more  agreeable 
flavour.  Almost  identical  with  it  is  an  extem- 
poraneous preparation  made  by  dissolving 
15  grains  of  potassium  carbonate  in  i  oz.  of 
water  and  adding  it  to  1  fl.  oz.  of  a  mixture  of 
equal  parts  of  lemon-juice  and  water.  Pro- 
vided the  lemon-juice  is  of  the  average  compo- 
sition, brisk  effervescence  should  occur,  but 
often  a  rather  larger  amount  of  the  juice  is 
necessary.  An  effervescent  granular  citrate, 
potassii  citras  effervescens  (U.  S.  Ph.),  is  a  con- 
venient form  in  which  to  employ  this  salt.  It 
may  be  given  in  doses  of  1  or  3  teaspoonfuls 
dissolved  in  a  large  amount  of  water. 

Russell  H.  Nevins. 

POTASSIUM    COBALTONITBITE.  — 

See  under  Cobalt  (vol.  i,  page  273). 

POTASSIUM    CYANIDES.  —  For    the 

cyanide  and  the  ferrocyanide,  see  under  Cyan- 
ogen (vol.  i,  pages  323  and  323). 
POTASSIUM    HYDRATE.  —  See     Po- 

TASSA. 

POTASSIUM    HYPOPHOSPHITE.  — 

See  under  Phosphorus. 


POTASSIUM  IODIDE,  KI,  potassii  io- 
didum  (U.  S.  Ph.,  Br.  Ph.),  kalium  jodaium 
(Ger.  Ph.),  when  pure,  is  in  the  form  of  colour- 
less cubical  crystals  of  a  somewhat  unctuous 
feel,  of  a  soapy,  saline  taste  and  a  bitter  after- 
taste, freely  soluble  in  water. 

The  therapeutic  properties  of  potassium  io- 
dide are  almost  identical  with  those  of  iodine, 
except  that  they  do  not  include  the  irritant 
topical  action  of  iodine  (see  vol.  i.  page  535). 
It  is  chiefly  used  in  the  .treatment  of  so-called 
tertiary  syphilis — that  is  to  say,  syphilis  in  the 
stage  of  gummata  and  degenerations  of  tissue, 
of  deep  ulcerations,  and  of  affections  of  the 
nervous  system,  the  blood-vessels,  the  internal 
organs,  and  the  bones ;  in  short,  of  syphilis 
that  has  passed  the  period  of  swollen  lymphatic 
glands,  superficial  cutaneous  eruptions,  mucous 
patches,  osteooopic  pains,  and  alopecia.  In  or- 
dinary cases  of  syphilis,  if  the  patient  is  under 
treatment  from  the  outset  and  if  he  is  a  person 
of  good  general  health,  properly  nourished,  in 
good  hygienic  surroundings,  and  of  good  hab- 
its, careful  treatment  with  small  doses  of  mer- 
cury, prolonged  for  a  period  of  about  two 
years,  may  often  prove  all  that  is  necessary  to 
prevent  further  manifestations  of  the  disease. 
If  they  do  occur,  they  are  commonly  of  a  kind 
to  be  remedied  rather  by  the  use  of  iodine  than 
by  the  further  employment  of  mercury.  It  is 
then  that  iodide  of  potassium  becomes  the  chief 
remedy  at  our  command.  It  may  at  first  be 
given  in  doses  of  5  grains,  which  may  be  in- 
creased gradually  to  8,  10,  or  15  grains,  three 
times  a  day.  It  should  be  given  in  dilute  solu- 
tion, with  the  addition  of  articles  to  palliate  its 
taste  and  to  mitigate  any  untoward  effect  it 
may  have  on  the  stomach.  The  official  com- 
pound syrup  of  sarsaparilla  is  a  favourite  ve- 
hicle for  potassium  iodide  ;  its  agreeable  taste 
commends  it,  and,  in  addition,  most  patients 
have  faith  in  sarsaparilla  as  a  remedy,  so  that 


when  they  are  taking  it  they  have  the  moral 
support  of  feeling  that  they  are  doing  the  right 
thing. 

In  the  treatment  of  syphilis,  the  use  of 
iodide  of  potassium  often  requires  to  be  pro- 
tracted, and  ordinarily  it  is  well  borne  by  the 
system.  There  are  some  persons,  however, 
who,  by  virtue  of  idiosyncrasy,  are  affected 
with  iodism.  This  forni  of  iodine  poisoning 
is  considered  in  the  article  on  Iodine  (vol.  i, 
page  535).  The  opinion  has  been  expressed 
that  iodism  occurs  far  less  readily  in  syphilit- 
ics  than  in  persons  free  from  syphilis,  and,  in 
accordance  with  this  opinion,  the  administra- 
tion of  potassium  iodide  in  comparatively  large 
doses,  to  the  amount  of  60  grains  a  day,  has 
been  recommended  as  a  diagnostic  test  in 
cases  in  which  the  syphilitic  nature  of  the  dis- 
ease is  questionable — it  has  been  said  that  if 
iodism  does  not  occur,  the  disease  may  be  con- 
sidered to  be  syphilis.  But  this  idea  seems  to 
be  erroneous ;  the  great  majority  of  competent 
observers  who  have  had  ample  opportunities 
of  studying  the  treatment  of  syphilis  maintain 
that  iodism  is  quite  as  likely  to  take  place  in 
syphilitics  as  in  other  persons,  and  that  there- 
fore the  so-called  "  therapeutic  test "  is  of  no 
practical  value.  Dr.  George  Cohen  (Lancet, 
July  13,  1895),  having  remarked  the  similarity 
of  the  phenomena  of  iodism  in  patients  who 
were  taking  potassium  iodide  to  those  pro- 
duced by  the  inhalation  of  free  iodine,  and  re- 
flecting on  the  observed  fact  that  iodide  of  po- 
tassium containing  free  iodine  as  an  impurity 
oftener  causes  catarrh  than  the  pure  iodide 
does,  concludes  that  iodism  is  due  either  to 
iodine  being  secreted  by  the  salivary  glands,  or 
to  the  circumstance  that  iodide  of  potassium 
is  broken  up  in  the  mouth  after  its  secretion, 
and  iodine  liberated.  Hence,  he  reasons,  there 
is  a  chance  of  preventing  the  continuance  of 
iodism  by  diminishing  the  salivary  secretion, 
and  he  reports  his  having  been  able  to  stop 
the  catarrh  in  three  well-marked  cases  by  add- 
ing to  the  mixture  that  the  patients  were 
taking  tincture  of  belladonna  to  the  amount 
of  10  minims  for  each  dose  (10  grains)  of  the 
iodide.  Iodism  is  not  always  a  mere  matter 
of  catarrh,  cutaneous  eruptions,  and  a  few 
other  inconvenient  occurrences ;  in  rare  in- 
stances so  pronounced  is  the  idiosyncrasy  that 
acute  iodine  poisoning  results.  Dr.  J.  William 
White,  of  Philadelphia  (Therap.  Oaz.,  Decem- 
ber, 1888),  cites  the  record,  by  Dr.  Mackenzie,  of 
a  case  in  which  a  fatal  result  followed  the  ad- 
ministration of  a  single  dose  of  2-J-  grains  of 
potassium  iodide  to  a  syphilitic  child.  The 
remedy,  therefore,  should  always  be  used  with 
great  caution  at  first,  until  it  has  been  ascer- 
tained that  the  patient  is  not  unduly  suscep- 
tible to  its  toxic  action. 

Potassium  iodide,  as  has  already  been  said, 
is  more  particularly  serviceable  in  the  late 
manifestations  of  syphilis.  Some  physicians 
have  supposed  that  its  remedial  action  was  in 
great  part  that  of  ridding  the  system  of  a  poison 
— namely,  mercury— that,  having  been  given  as 
a  remedy  for  syphilis,  had  accumulated  in  the 
system.  Far  from  admitting  the  truth  of  this 
explanation,  that  excellent  observer,  Dr.  Robert 


POTASSIUM  NITRATE 
POTASSIUM  SULPHATES 


98 


W.  Taylor,  says  in  his  Pathology  and  Tnat- 
ment  of  Venereal  Diseases  :  "  Iodide  of  potas- 
sium, administered  during  or  after  a  mercurial 
course,  lessens  at  once  the  quantity  of  mercury 
eliminated  daily.  The  practical  conclusion  to 
be  drawn  from  these  observations  is  that  the 
iodide  is  not  useful  in  mercurial  poisoning, 
but,  on  the  contrary,  may  be  harmful.  My 
own  experience  in  the  treatment  of  mercurial 
stomatitis  has  convinced  me  that  no  benefit 
whatever  results  from  the  administration  of 
iodide  of  potassium.  Clinically,  however,  it  is 
very  frequently  found  that,  the  long-continued 
use  of  mercury  having  failed  to  give  relief  or 
having  produced  a  cachectic  condition,  the  sub- 
stitution of  iodide  of  potassium  is  followed  by 
involution  of  the  symptoms  and  improvement 
of  the  health.  This  fact,  however,  does  not 
warrant  the  conclusion  that  the  auspicious  re- 
sult was  due  to  any  effect  produced  by  the 
iodide  upon  mercury  supposed  to  be  stored  up 
in  the  system." 

While  potassium  iodide  by  itself  is  more 
suited  to  the  treatment  of  the  late  manifesta- 
tions of  syphilis  than  to  that  of  the  early  ones, 
its  association  with  mercury,  in  what  is  called 
the  "  mixed  treatment,"  is  very  serviceable  at 
a  comparatively  early  period — toward  the  end 
of  the  first  year,  if  not  before.  Dr.  Taylor 
thinks.  In  his  masterly  work,  already  quoted 
from,  he  gives  the  followinp;  formulae  for  this 
conjoint  of  mercury  and  iodide  of  potassium : 

5  Mercury  biniodide 1  to  2  grains; 

Potassium  iodide ^  to  1  oz. ; 

Syrup  of  orange  peel . .  3  fl.  oz. ; 

Water 1  oz. 

M.  S. :  A  teaspoontul  three  times  a  day,  an 
hour  after  eating,  in  a  wineglassful  of  water. 

5  Corrosive  sublimate .  1,  2,  or  3  grains ; 
Potassium  iodide. . .  ^,1,  or  1|  oz. ; 
Compound    tincture 

of  cinchona 2J  il.  oz. ; 

Water J  oz. 

M.  To  be  taken  in  the  same  manner  as  the 
preceding  mixture. 

It  is  in  syphilis  affecting  the  central  nervous 
system  and  giving  rise  to  grave  symptoms  that 
iodide  of  potassium  assumes  its  greatest  im- 
portance as  a  remedy.  "  The  effect  of  opium 
upon  pain,"  says  Dr.  Edward  L.  Keyes  {Sur- 
gical Diseases  of  the  Genito-urinary  Organs, 
-including  Syphilis),  "  is  not  more  wonderful 
or  more  striking  than  that  of  the  iodide  of  po- 
tassium upon  the  nervous  manifestations  due 
to  syphilis."  It  often  has  to  be  used  in  very 
large  doses  for  a  comparatively  short  time.  It 
is  generally  given  in  such  cases  in  the  form  of 
a  saturated  solution  in  water,  each  drop  of 
which  contains  a  grain  of  the  drug.  Dr.  B. 
Sachs  (Morrow's  System  of  Genito-urinary 
Diseases.  Syphilology,  and  Dermatology)  pre- 
fers sodium  iodide,  on  account  of  the  unfa- 
vourable action  of  the  long-continued  use  of 
the  potassium  salt  on  the  heart.  He  advises 
beginning  with  10  drops  of  the  saturated  solu- 
tion, given  three  times  a  day,  in  some  alkaline 
water,  long  enough  before  meals  to  insure  its 
complete  absorption  before  anything  else  is 
taken  into  the, stomach.    According  to  the  pa- 


tient's condition,  he  would  increase  the  doses 
by  from  2  to  5  drops  daily,  until  from  100  to 
150  drops  are  taken  three  times  a  day,  or  until 
the  improvement  that  has  set  in  shows  that  no 
further  increase  of  the  dose  is  required.  If  no 
improvement  has  taken  place  when  these  large 
doses  are  reached,  he  says,  it  is  well  to  suspend 
this  form  of  treatment  for  a  time,  but  he  adds 
that  another  attempt  should  be  made  in  exact- 
ly the  same  way,  with  small  doses  gradually 
increased.  He  declares  that  again  and  again 
he  has  seen  these  renewed  attempts  finally 
bring  about  a  decided  change  for  the  better  in 
the  patient's  symptoms.  But  Dr.  Sachs,  Dr. 
Keyes,  and  Dr.  Taylor  all  insist  on  the  value 
of  mercury  also  in  these  cases.  "  Could  we 
decide  witli  certainty  in  a  given  case  that  the 
lesion  was  purely  gummy,"  says  Dr.  Keyes, 
"  the  iodide  alone  would  be  all-sufficient,  but, 
as  more  or  less  pachymeningitis  and  arterial 
disease  may  be  inferred  to  exist  in  most  cases, 
it  is  better  to  adopt  for  nervous  syphilis  a 
mixed  treatment,  with  the  iodide  largely  in 
excess."  It  is  hardly  necessary  to  say  that 
when  the  iodide  is  being  given  in  large  and 
progressively  increasing  doses,  and  mercury  is 
used  at  the  same  time,  the  two  drugs  should 
not  be  associated  in  one  solution,  for  the  doses 
of  the  mercurial  are  not  to  be  increased. 

Other  grave  conditions  in  which  potassium 
iodide  is  of  notable  service,  when  given  in  large 
doses,  are  chronic  lead  poisoning  and  internal 
aneurysm.  Dr.  Bartholow,  of  Philadelphia 
{Practical  Treatise  on  Materia  Medica  and 
Therapeutics),  says  he  knows  of  several  in- 
stances in  which  great  benefit  was  derived  from 
it  in  aneurysm,  and  one  case  certainly  in  which 
a  cure  apparently  resulted.  The  dose  in  such 
cases  may  range  from  15  to  30  grains;  in 
chronic  lead  poisoning,  from  15  to  60  grains. 
Chronic  poisoning  with  mercury  or  copper  may 
be  treated  in  the  same  way.  These  metallic 
poisons  stored  up  in  the  system  are  rendered 
soluble  by  the  iodide  on  its  coming  in  contact 
with  them,  so  that  they  are  eliminated. 

Potassium  iodide  in  the  ordinary  doses  is  often 
of  decided  service  in  the  treatment  of  chronic 
rheumatism,  chronic  bronchitis,  inflammatory 
exudates,  enlargements  of  various  orga^is,  ar- 
teriosclerosis, the  early  stage  of  cirrhosis,  and 
the  beginning  of  Bright' s  disease. 

Bicente  (Jour,  de  din.  et  de  thSrap.  infan- 
tiUs,  March  22,  1894),  having  successfully 
treated  with  the  iodide  a  child  suffering  from 
the  acute  broncho-pneumonia  of  measles,  of 
a  suffocating  character,  which  threatened  to 
prove  fatal  speedily,  reflected  that,  although 
he  had  ordered  the  iodide  because  the  child's 
father  gave  a  history  of  syphilis,  it  might  have 
acted  by  virtue  of  some  other  than  its  anti- 
syphilitic  property.  He  therefore  resolved  to 
try  it  in  other  cases.  The  result,  he  declares, 
has  been  the  same  in  a  large  number  of  cases. 
He  says  he  has  had  failures,  but  they  have 
seemed  to  him  to  be  in  cases  of  tuberculous 
disease.  He  has  therefore  arrived  at  the  fol- 
lowing conclusions:  1.  In  the  simple  forms, 
where  there  is  no  tuberculosis,  the  efficiency  of 
the  remedy  may  be  counted  upon.  2.  If  there 
is  no  improvement  in  the  course  of  a  few  days 


99 


POTASSIUM   NITRATE 
POTASSIUM  SULPHATES 


its  employment  should  be  given  up  and  the 
existence  of  tuberculosis  inferred.  He  gives 
the  iodide  in  daily  amounts  of  from  3  to  13 
grains,  according  to  the  patient's  age.  At  the 
same  time  he  uses  one  or  more  blisters.  The 
patient's  strength  should,  be  kept  up  by  means 
of  grog,  bouillon,  and  milk.  The  caution  is 
given  that  if  after  the  child  has  shown  decided 
amelioration,  tremulousness  and  dryness  of  the 
mouth  are  observed,  iodism  is  to  be  feared. 

In  veterinary  practice,  iodide  of  potassium 
has  been  used  successfully  as  a  remedy  for 
actinomycosis.  It  was  first  employed  in  this 
disease  in  Holland,  but  has  since  been  used  in 
a  number  of  cases  in  the  human  subject  in 
Prance.  The  results  have  been  so  good  that 
M.  Netter  (cited  in  Uiiio7i  med.,  August  23, 
1894)  affirms  that  the  iodide  is  a  remedy  which 
assures  recovery.  The  dose  need  not  be  very 
large;  M.  Netter  gives  90  gi'ains  a  day  at  the 
beginning,  but  rapidly  reduces  the  amount  to 
45  or  even  to  30  grains. 

Iodide  of  potassium  is  sometimes  very  effi- 
cient in  spasmodic  asthma,  especially,  as  Dr. 
Bartholow  states,  when  the  seizures  are  reflex. 
In  the  various  manifestations  of  the  morbid 
constitutional  condition  called  scrofula,  espe- 
cially in  chronic  enlargements  of  the  lymphatic 
glands,  the  iodides  are  more  or  less  efficient. 
In  such  cases  it  is  well  to  employ  arsenic  or 
iron  at  the  same  time,  and  in  many  instances 
cod-liver  oil. 

As  a  topical  application,  potassium  iodide 
is  credited  with  some  efficiency  as  a  sorbe- 
facient.  It  is  usually  employed  in  the  form  of 
an  ointment,  unguentum  potassii  iodidi  (U.  S. 
Ph.,  Br.  Ph.),  unguentum  kalii  jodati  (Ger. 
Ph.).  The  American  preparation  contains  a 
little  sodium  hyposulphite ;  the  British,  a  little 
potassium  carbonate;  and  the  German,  a 
minute  amount  of  sodium  thiosulphate.  A 
liniment,  linimentum  potassii  iodidi  cum 
sapone  (Br.  Ph.).  is  sometimes  used. 

POTASSIUM  NITRATE,  potassii  nitras 
(U.  S.  Ph.,  Br.  Ph.),  kalium  nitricum  (Ger. 
Ph.),  nitre,  or  saltpetre,  was  used  formerly 
much  more  extensively  than  it  is  at  present  as 
a  diuretic  and  diaphoretic.  Safer  and  more 
efficient  remedies  have  led  to  the  discontinu- 
ance of  the  use  of  nitre  to  any  considerable 
extent,  save  in  veterinary  medicine.  The  dose 
is  from  10  to  30  grains.  In  concentrated  solu- 
tions it  acts  as  a  gastro-intestinal  irritant,  and 
numerous  deaths  have  resulted  from  its  acci- 
dental ingestion.  There  is  no  chemical  or 
physiological  antidote  for  it,  and  the  treatment 
of  such  cases  must  be  conducted  upon  general 
principles.  In  asthma,  the  fumes  given  off 
during  its  combustion  are  often  of  great  benefit, 
but  to  distinguish  the  cases  in  which  it  may 
prove  useful  is  impossible.  It  is  employed  in 
the  shape  of  blotting  paper,  impregnated  with 
a  saturated  solution  of  nitre  and  dried,  which 
is  ignited  in  a  close  chamber,  and  the  fumes 
arising  are  inhaled.  This  procedure  is  entirely 
safe  and  should  be  carried  out  during  a  parox- 
ysm. 

[Potassium  nitrate  has  recently  been  recom- 
mended as  a  topical  application  in  the  treat- 
ment of  bums.    M.  Poggi  (cited  in  Eev.  med., 


February  16,  1896)  says  it  has  given  excellent 
results  in  all  kinds  of  burns  of  whatever  de- 
gree. It  is  used  in  the  form  of  baths,  or  in  that 
of  compresses  wet  with  a  saturated  solution. 
According  to  M.  Poggi,  the  nitrate  acts  especial- 
ly as  a  refrigerant.  As  it  becomes  dissolved  in 
the  water  it  produces  a  notable  lowering  of  the 
temperature  of  the  liquid  of  from  5°  to  9°  F. 
If  a  burned  hand  or  foot  is  plunged  into  a 
basin  of  water  to  which  a  few  spoonfuls  of  the 
nitrate  have  been  added,  the  pain  ceases  rapid- 
ly ;  if  the  water  becomes  slightly  heated,  the 
pain  returns,  but  it  is  allayed  as  soon  as  a 
fresh  quantity  of  the  salt  is  added.  This  bath, 
which  is  prolonged  to  from  two  to  three  hours, 
may  bring  about  the  definitive  disappearance 
of  the  pain  and  even  prevent  the  production  of 
blisters.  The  application  of  the  compresses 
also  exercises  the  same  influence.  By  this 
means,  he  says,  the  pain  is  allayed  and  cica- 
trization takes  place  without  delay.] 

Russell  H.  Nevins. 

POTASSIITM:  NITKITE.  —  See  under 
Nitrites. 

POTASSIUM  OXALATES.— See  under 
Oxalic  acid. 

POTASSIUM     PERMANGANATE.— 

See  under  Permanganates  and  under  Manga- 
nese (vol.  i,  pages  596  and  597). 

POTASSIUM  PHOSPHATE  resembles 
sodium  phosphate  in  its  action  and  has  been 
employed  to  some  extent  for  the  same  pur- 
poses, in  doses  of  from  10  to  30  grains,  but 
appears  to  be  somewhat  inferior  to  the  sodium 
salt.    (Of.  Phosphoric  acid.) 

Russell  H.  Nevins. 

POTASSIUM  SILICATE,  or  soluble  glass, 
was  at  one  time  employed  internally  in  the 
treatment  of  gout  and  rheumatism,  but  at  the 
present  time  it  is  used  only  in  the  preparation 
of  immovable  bandages.     (Cf.  Silicates.) 

Russell  H.  Nevins. 

POTASSIUM  SULPHATES.— Potas- 
sium bisulph.ate,  potassii  bisulphas,  may  be 
regarded  as  a  saline  cathartic,  but  is  hardly 
so  desirable  as  the  other  members  of  that 
group.  It  has  a  very  bitter  a.nd  acid  taste, 
and  may  have  an  injurious  effect  upon  the 
teeth.  An  ordinary  dose  is  about  IJ  oz.  When 
it  is  added  to  a  solution  of  sodium  bicarbonate, 
brisk  effervescence  occurs,  and  a  mixture  of 
sodium  and  potassium  sulphates  will  result, 
but  there  is  no  special  advantage  in  their  com- 
bined employment  as  cathartics  over  that  of 
either  one  by  itself. 

Potassium  sulphate,  potassii  sulphas 
(U.  S.  Ph.,  Br.  Ph.),  kalium  sulfuricum  (Ger. 
Ph.),  is  a  gentle  cathartic,  causing  little  pain 
or  griping  and  producing  watery  stools.  It  is 
assumed  to  act  beneficially  when  suppression 
of  the  milk  is  desired,  and  is  often  gi^en  in 
fevers  and  after  delivery.  The  usual  laxative 
dose  is  from  20  to  80  grains ;  larger  quantities, 
up  to  -J  an  oz.,  will  act  more  energetically.  It 
is  best  given  with  large  amounts  of  water,  as 
in  concentrated  solutions  it  will  act  as  an  irri- 
tant of  the  alimentary  canal. 

Russell  H.  Nevins. 


POTASSIUM  SULPHITE 
POULTICES 


100 


POTASSIUM  SULPHITE  has  essential- 
ly the  same  effects  as  the  other  sulphites,  but 
in  a  less  marked  degree.  It  may  be  used  in 
the  same  doses  and  for  the  same  purposes  as 
sodium  sulphite. — Russell  H.  Nevins. 

POTASSIUM  SUIiPHOCYANATE  has 
been  suggested  as  a  substitute  for  hydrocyanic 
acid  and  the  cyanides. — Russell  H.  Kevins. 

POTASSIUM  TABTBATES.— Potas- 
sium bitartrate,  cream  of  tartar,  potassii 
bitartras  (U.  S.  Ph.),  potassii  tartras  acida 
(Br.  Ph.),  has  an  agreeable  subacid  flavour 
and  is  actively  diuretic,  causing  the  flow^  of 
large  amounts  of  urine  of  low  specific  gravity, 
and  also  cathartic,  acting  as  an  aperient  or 
hydragogue,  according  as  the  dose  is  small  or 
large.  In  dropsy  due  to  acute  nephritis  or  val- 
vular disease  of  the  heart  this  salt  is  probably 
as  effectual  a  diuretic  as  any  other  drug,  and  its 
use  is  practically  free  from  danger.  It  is  best 
given  in  the  shape  of  "  cream-of-tartar  lemon- 
ade," which  is  simply  an  ordinary  lemonade  with 
any  desired  amount  of  the  salt  added,  which 
should  previously  have  been  dissolved  in  hot 
water.  Potus  imperialis  is  a  solution  of  J  an 
oz.  of  cream  of  tartar  in  3  pints  of  water, 
sweetened  and  flavoured  with  lemon  peel. 
Cream-of-tartar  whey  is  the  whey  strained 
from  milk  to  which  the  salt  has  been  added. 

In  the  fehriculcB  of  childhood  these  prepara- 
tions are  quite  useful,  acting  as  refrigerants. 
Combined  with  sulphur,  jalap,  or  senna,  cream 
of  tartar  prevents  griping  and  adds  to  the  ac- 
tivity of  those  drugs.  As  a  cathartic  it  may 
be  employed  under  the  same  conditions  as  the 
other  salines,  but  is  not  quite  so  good  as  some 
of  them.  The  dose  as  an  aperient  is  from  1 
to  2  drachms ;  as  a  hydragogue,  from  -^  to  1 
oz. ;  and  as  a  diuretic,  1  drachm,  several  times 
a  day,  in  a  considerable  bulk  of  water.  It  is 
very  largely  employed  to  set  free  the  carbonic- 
acid  gas  of  sodium  bicarbonate  used  for  aerat- 
ing bread,  etc.,  and  entei-s  into  the  composition 
of  the  so-called  baking  powders.  It  is  largely 
adulterated,  and  it  is  best  to  purchase  the  crys- 
tals rather  than  the  powder. 

Potassium  tartrate,  potassii  tartras  (Br. 
Ph.),  kalium  tartaricum  (tier.  Ph.),  is  a  laxative 
and  purgative,  operating  with  little  pain  and 
causing  watery  stools.  The  dose  as  a  laxative 
Is  1  drachm,  and  as  a  purgative  1  oz.  It  is  not 
often  used. 

Potassium  and  sodium  tartrate,  potassii 
et  sodii  tartras  (U.  S.  Ph.),  soda  tartarata  (Br. 
Ph.),  tartarus  natronatus  (Ger.  Ph.),  or  Rochelle 
salt,  is  a  typical  saline  cathartic,  and  is  prob- 
ably the  least  disagreeable  of  that  group  to  the 
taste.  Usually  |  an  oz.  will  constitute  a  pur- 
gative dose,  but  in  an  adult  double  that  amount 
may  be  employed  without  inconvenience.  In 
Seidlitz  powders  it  is  the  portion  contained  in 
the  blue  or  other-coloured  paper.  In  doses  of 
from  30  to  40  grains  it  is  without  cathartic 
effect,  and  may  be  employed  to  induce  an  alka- 
line effect. upon  the  system,  as  in  acute  rheu- 
matism.   (Cf.  Alkalies.) 

Russell  H.  Nevins. 

POTASSIUM  TEIiliUBATE  has  been 
employed  as  an  anthidrotic,  especially  ia  the 


night  sweats  of  phthisis,  in  doses  of  from  -}„  to 
^  of  a  grain. — Russell  H.  Kevins. 

POTIO  MVERI  (Ger.  Ph.)  is  an  efferves- 
cent draught  made  by  adding  9  parts  of  sodium 
carbonate,  in  small  crystals,  to  a  solution  of 
4  parts  of  citric  acid  in'l90  parts  of  water.  It 
should  be  freshly  prepared  when  it  is  to  be 
used.  Owing  to  the  carbonic  acid  that  is  set 
free  by  the  action  of  the  citric  acid  on  the 
sodium  carbonate,  this  solution  has  a  refresh- 
ing and  slightly  stimulant  action  on  the  mouth, 
throat,  and  stomach ;  in  addition  to  that,  it 
acts  as  an  alkaline  remedy  (see  Alkalies).  It 
may  be  taken  freely.  The  analogous  liquor 
sodii  citratis  of  the  Nat.  Form,  is  made  by 
dissolving  150  grains  of  citric  acid  in  16  oz.  of 
water,  contained  in  a  bottle,  and  gradually 
adding  190  grains  of  sodium  bicarbonate,  the 
solution  of  which  is  to  be  hastened  by  shaking 
the  bottle,  which  should  be  stopped  securely 
at  once. 

POULTICES,  cataplasms,  cataplasmata, 
"  are  moist  substances  intended  for  external 
application,  of  such  a  consistence  as  to  accom- 
modate themselves  accurately  to  the  surface  to 
which  they  are  applied,  without  being  so  liquid 
as  to  spread  over  the  neighbouring  parts  or  so 
tenacious  as  to  adhere  firmly  to  the  skin" 
(U.  S.  Disp.).  They  are  almost  invariably  ap- 
plied hot.  Although  poultices  may  be  made 
to  exert  a  variety  of  medicinal  actions  by  the 
incorporation  in  them  of  various  drugs — mus- 
tard, for  example — the  non-medicinal  or  ordi- 
nary poultice  is  made  of  a  substance  which  has 
no  activity  beyond  that  of  warmth  and  mois- 
ture. A  number  of  bland  materials  are  em- 
ployed in  making  poultices,  and  especially 
flaxseed,  but  I  shall  defer  the  consideration  of 
these  ingredients  until  I  come  to  speak  of  the 
several  kinds  of  poultices,  at  the  end  of  this 
article.  Poultices,  like  fomentations,  afford  a 
convenient  means  of  evoking  the  remedial 
powers  of  moist  heat  when  locally  applied ; 
they  differ  from  them,  however,  in  the  posses- 
sion of  a  more  prolonged  action. 

The  application  of  a  poultice  is  followed  by 
effects  which  vary  with  the  local  conditions. 
If  the  part  is  normal,  there  will  be  produced 
an  increase  of  the  cutaneous  vascularity,  the 
skin  becoming  reddened,  relaxed,  and  slightly 
swollen  perhaps.  If  pain  has  been  present,  it 
will  probably  have  been  relieved,  the  relaxing 
and  soothing  power  of  the  moist  heat  having 
served  to  remove  pressure  from  the  sensory 
nerve  filaments.  If  there  is  beginning  inftam^- 
mation  in  the  part,  a  poultice  may  serve  to 
check  it  by  diminishing  the  local  tension  and 
relieving  the  vascular  stasis.  That  this  power 
resides  in  poulticing  is  undeniable,  but  the 
effect  is  certainly  not  invariable,  and  the  ap- 
plication of  continuous  cold  is,  both  in  theory 
and  in  practice,  a  far  safer  and  more  efficient 
procedure,  for,  by  virtue  of  its  warmth  and  its 
moisture,  the  poultice  may  furnish  exactly  the 
conditions  suitable  for  the  development  of  the 
micro-organisms  which  are  so  often  present, 
and  thus  be  a  direct  cause  of  the  increase  of 
the  inflammation.  That  the  conditions  might 
be  different  if  continuous  heat  were  furnished 


101 


POTASSIUM  SULPHITE 
POULTICES 


by  poultices  is  possible,  indeed,  likely,  but  it  is 
not  continuous  heat  they  furnish,  but  rather 
■warmth.  The  action  of  warmth  upon  acute 
superficial  inflammation,  and  especially  the 
action  of  moist  warmth,  is  undesirable,  and 
since  we  can  not,  by  poulticing  at  least,  main- 
tain that  constant  and  sufficient  degree  of  heat 
required  to  restrain  superficial  inflammation 
and  the  activity  of  micro-organisms,  it  is  better 
in  such  oases  to  employ  the  more  constant  and 
more  manageable  as  well  as  the  less  injurious 
inhibiting  influence  of  cold.  With  deep  in- 
flammations the  case  is  different,  however,  for 
then  it  is  not  direct  warmth  and  moisture 
■which  render  poultices  eSicaoious,  but  that 
unexplained  power  they  possess,  in  common 
with  so  many  other  applications,  which  is 
known  as  that  of  counter-irritation. 

If  superficial  inflammation  is  well  established 
and  exudation,  emigration,  and  pus  production 
have  begun,  the  application  of  a  poultice  will, 
indeed,  promote  and  hasten  the  process  and 
favour  the  extrusion  of  the  inflammatory  ma- 
terial by  softening  the  tissues  which  cover  it ; 
but,  though  it  will  favour  "  pointing  "  and  the 
external  escape  of  pus,  and  though  it  may  tend 
to  limit  and  circumscribe  the  inflammation,  it 
will,  on  the  other  hand,  frequently  promote 
the  wide  diffusion  of  the  inflammation  and 
be  the  cause  of  irreparable  harm.  Especially 
is  this  the  case  when  the  inflammation  is  not 
cutaneous,  but  is  subcutaneous  and  situated  in 
loose  cellular  tissue  or  in  the  neighbourhood  of 
tendinous  sheaths.  It  is  in  such  oases  as  these 
that  the  employment  of  poulticing  in  domestic 
practice  becomes  so  dangerous,  and  the  wide- 
spread popularity  of  the  practice  and  the  gen- 
eral belief  in  its  harmlessness  are  responsible 
for  many  a  grave  misfortune.  To  this  the 
experience  of  every  surgeon  will  bear  testi- 
mony. If  applied  to  a  sluggishly  granulating 
surface,  a  poultice  is  said  to  hasten  its  healing. 
No  doubt  it  may,  but  equally  without  doubt  it 
may  convert  that  surface  into  the  best  of  cul- 
ture media,  to  the  benefit  of  the  micro-organ- 
ism and  the  injury  of  the  individual.  Poulticing 
in  such  cases  is  certainly  not  comparable  to 
antiseptic  treatment,  and  poultices,  apart  from 
their  lack  of  antisepsis,  are  not  even  possessed 
of  asepsis,  but  may  be  the  means  of  introduc- 
ing infection  into  abraded  surfaces.  The  di- 
rect application  of  poultices  to  wounds,  whether 
granulating  or  not,  should  therefore  be  for- 
bidden. The  prolonged  application  of  poul- 
tices is  highly  injurious  to  the  tissues.  Under 
the  continued  influence  of  warmth  and  mois- 
ture they  become  pale,  flabby,  relaxed,  and 
swollen.  Their  vitality  is  greatly  impaired, 
small  fni-uncles  frequently  appear  upon  the 
skin  affected,  and  it  is  said  that  sloughing  is 
not  an  impossible  result.  The  prompt  removal 
of  the  poultice  is,  of  course,  indicated  upon  the 
appearance  of  these  atonic  conditions,  and  it 
may  be  that  stimulant  applications  will  be  re- 
quired to  hasten  the  return  of  the  part  to  a 
healthy  state. 

Apart  from  the  purely  local  effects  of  poul- 
tices, they  are  possessed  of  considerable  power 
as  counter-irritants.  In  spite  of  all  the  efforts 
which  have  been  made  to  solve  it,  it  must  be 


confessed  that  we  are  as  much  as  ever  in  the 
dark  as  to  the  mechanics  of  counter-irritation. 
How  the  counter-irritant  effect  of  poultices  is 
brought  about  is  unknown,  but  it  is  certain 
that  they  have  an  influence  over  deep-seated 
inflammations  which  is  pronounced  ;ind,  in- 
deed, is  their  most  valuable  remedial  property. 
It.is  in  inflammatory  conditions  of  the  viscera 
and  of  the  serous  and  mucous  membranes  of 
the  thoracic  and  abdominal  cavities  that  the 
good  effects  of  poulticing  are  most  striking 
and  the  ill  effects  most  unusual.  That  poul- 
tices used  for  counter-irritant  purposes  are 
usually  rendered  more  vigorous  in  action  by 
the  addition  of  rubefacient  remedies  to  them 
is  true,  but  the  addition  is  not  essential,  for 
even  without  it  the  poultice  is  in  itself  a  coun- 
ter-irritant of  considerable  activity.  It  may 
be  that  a  constitutional  influence  will  result 
from  the  abuse  of  poulticing  if  it  is  extensive, 
and  general  relaxation  and  atony,  with  circu- 
latory enfeeblement,  may  be  attributable  to  it. 
The  therapeutics  of  poulticing  will  have 
been  inferred  from  what  has  already  been  said. 
In  neuralgic  pain  it  may  be  an  efficient  means 
of  relief,  but  as  its  efficiency  in  these  cases  is 
probably  dependent  upon  a  counter-irritant 
action,  the  addition  of  rubefacients  is  common, 
and  the  use  of  the  simple  emollient  poultice  is 
unusual.  As  a  means  of  softening  cutaneous 
incrustations  preliminary  to  their  removal,  the 
emollient  poultice  of  flaxseed  is  in  frequent 
employment.  Eczematous  incrustations  in.  par- 
ticular are  so  treated.  In  superficial  inflam- 
mations the  use  of  poulticing  should  be  cautious 
in  the  extreme,  and  the  dangers  which  have 
already  been  stated  should  ever  be  borne  in 
mind.  In  acute  congestive  and  inflammatory 
conditions  of  deep-seated  structures  lies  the 
chief  utility  of  poulticing.  Thus  pleurisy,  peri- 
carditis, and  bronchitis  may  well  be  treated. 
Pneumonia  may  be  treated  in  the  same  way, 
though  it  is  doubtful  whether  anything  more 
will  be  obtained  from  poulticing  than  a  bene- 
ficial action  upon  the  pleurisy  and  the  bron- 
chitis which  are  present,  for  it  is  not  likely  that 
the  procedure  will  exert  any  influence  upon 
the  consolidation.  The  effect  of  poulticing  in 
pneumonia  is  not  a  subject  upon  which  all 
physicians  are  agreed ;  many  think  it  distinctly 
prejudicial  to  recovery.  In  all  thoracic,  and 
indeed  in  abdominal,  conditions,  too,  the  effect 
of  poulticing  is  more  apparent  when  the  pa- 
rietes  are  thin.  In  children,  therefore,  as  a 
rule,  poulticing  is  a  more  vigorous  remedy 
than  in  adults.  In  acute  abdominal  congestions 
and  inflammations  the  use  of  cataplasms  is 
of  much  beneflt.  Intestinal  and  hepatic  in- 
flammations may  thus  be  relieved,  and  even 
peritonitis  is  favourably  influenced.  In  all 
these  conditions  the  poultices  should  be  of 
ample  dimensions,  and  in  case  the  abdominal 
disease  is  general,  the  application  should  be 
made  to  cover  the  abdomen  completely.  In 
general  peritonitis  the  cataplasm  should  be 
made  as  light  as  possible,  on  account  of  the  ex- 
treme tenderness  which  is  present  as  a  rule.  In 
pelvic  peritonitis  a,nA  localized  abdominal  m- 
flammaiions  this  precaution,  as  a  rule,  is  not 
so  requisite.    Lumbago  and  other  myalgias  are 


POWDERS 


103 


benefited  by  poulticing,  no  doubt,  but  the  sina- 
pism is  usually  a  far  more  suitable  applica- 
tion. Lumbar  poulticing  for  the  relief  of  renal 
congestion  and  oouseqaeat  suppression  of  urine 
is  a  procedure  of  great  value.  The  use  of 
poultices  in  articular  inflammation  is  not  to  be 
recommended,  as  a  rule,  save  of  that  known  as 
the  "  dry  poultice,"  which  consists  of  a  wrap- 
ping in  cotton  with  an  outer  covering  of  rubber 
tissue  or  similar  material  to  retain  the  heat. 
This  form  of  application  may,  indeed,  be  bene- 
ficial, but  the  emollient  poultice  of  flaxseed  is 
apt  to  promote  articular  exudation  and  to 
favour  the  production  of  pus,  perhaps  to  the 
permanent  injury  of  the  joint.  A  service 
which  poultices  are  sometimes  called  upon  to 
render  is  to  promote  the  specific  action  of 
medicinal  applications.  To  this  end  the  remedy 
may  be  sprinkled  upon  the  surface  of  the  poul- 
tice, as  is  frequently  done  with  laudanum,  or 
the  medicament  may  be,  applied  to  the  skin 
and  the  poultice  superimposed  upon  it.  Thus 
belladonna  is  used,  and  for  the  relief  of  pain- 
ful and  inflammatory  conditions  Ringer  rec- 
ommends the  application  of  a  mixture  of  equal 
parts  of  extract  of  belladonna  and  glycerin 
beneath  the  poultice.  Mo  doubt  this  procedure 
is  efficient,  but  the  application  of  belladonna 
to  the  skin  must  always  be  carefully  made,  for 
absorption  sufficient  to  cause  pronounced  and 
even  dangerous  effects  is  always  a  possibility, 
especially  when  the  area  of  application  is  ex- 
tensive or  the  skin  broken,  and  doubtless,  too, 
absorption  would  be  more  active  under  the  in- 
fluence of  warmth  and  moisture. 

Certain  general  rules  apply  to  the  employ- 
ment of  poultices.  The  poultice  should  be 
applied  as  hot  as  may  well  be  borne.  The  de- 
termination of  this  temperature  may  be  left  to 
the  patient  himself  in  case  he  is  in  possession 
of  his  normal  faculties.  If  he  is  insensible, 
however,  or  if  his  general  or  local  sensibilities 
are  blunted,  the  attendant  must  determine  the 
■safe  and  proper  temperature  of  the  poultice  by 
applying  it  to  a  part  of  his  own  skin  which 
is  sufficiently  sensitive.  A  neglect  of  this  pre- 
caution may  result  in  dangerous  blistering  or 
burning.  One  of  the  chief  disadvantages  of 
poulticing  is  the  fact  that  the  application  so 
soon  cools  and  thus  loses  its  efficiency.  To 
prevent  this  tendency,  so  far  as. is  possible, 
a  beat-retaining  substance  should  always  be 
placed  over  the  poultice.  Cotton  may  be  suf- 
ficient for  this  purpose,  flannel  may  also  be 
used,  but  a  more  reliable  substance  is  oiled 
silk.  Notwithstanding  these  precautions,  the 
heat  of  poultices  is  soon  lost,  and  it  becomes 
necessary  to  renew  them  frequently.  The  fre- 
quency with  which  this  should  be  done  will 
vary,  of  course,  with  the  rapidity  of  cooling, 
and  this  in  turn  will  vary  with  many  circum- 
stances. An  interval  of  two  hours,  however, 
may  be  said  to  represent  the  average  time  of 
utility  of  poultices.  In  changing  the  poultice, 
it  should  be  seen  to  that  the  skin  is  not  left 
unprotected  even  for  the  shortest  time,  for  in 
its  relaxed  and  hyperaamic  condition  it  is  ex- 
tremelv  sensitive  to  the  injurious  influence  of 
cold.  "For  the  same  reason,  the  skin  should  be 
carefully  protected  after  the  use  of  poulticing 


has  been  suspended.  Poultices  may  dry  and 
adhere  to  the  skin  if  left  too  long  upon  it; 
they  may  also  cause  a  considerable  amount  of 
irritation.  To  prevent  such  occurrences,  it  is 
well  to  smear  the  area  of  aiiplication  with 
vaseline,  or  glycerin  may  be  used  in  its  stead. 
The  size  of  poultices  should  always  be  gen- 
erous, for  no  harm  will  result  from  the  use 
of  large  rather  than  small  ones,  save  when  the 
treatment  is  long  persisted  in,  and  in  many 
cases,  especially  when  poultices  are  employed 
as  counter-irritants  in  thoracic  and  abdominal 
inflammations,  the  beneficial  results  are  in 
proportion  to  the  amplitude  of  the  applica- 
tion. For  this  reason,  in  such  conditions  as 
bronchitis  and  pneumonia,  especially  in  chil- 
dren, in  whom  it  is  difficult  to  maintain  the 
proper  position  of  the  poultice,  there  is  used 
what  is  known  as  the  poultice-jacket.  This  is 
a  sleeveless  jacket  of  muslin  which  is  made  of 
two  layers  of  the  cloth  sewed  together  at  the 
edges.  Thus,  it  is  practically  a  bag  in  which 
the  poultice  material  (flaxseed,  usually,  mixed 
with  hot  water)  is  placed,  sagging  of  the  poul- 
tice being  prevented  by  the  insertion  of  quilt- 
ing stitches  here  and  there,  and  apposition  to 
the  body  being  obtained  by  tapes  which  fasten 
the  jacket  together  in  front  as  well  as  over  the 
shoulders. 

Indications  and  oontra-indications  are  sel- 
dom to  be  accepted  unreservedly,  for  all  cases 
are  subject  to  alteration  by  circumstances.  As 
a  general  statement,  in  the  case  of  poultices, 
however,  it  may  be  said  that  they  are  indicated 
as  mild  counter-irritants  in  acute  congestive 
and  inflammatory  conditions  of  the  thorax  and 
abdomen,  and  are  strongly  contra-indicated  in 
all  superficial  congestions  and  acute  inflamma- 
tions where  pus  formation  is  a  possibility. 

The  Flaxseed,  or  Linseed,  Poultice, 
cataplasma  lini  (Br.  Ph.),  is  a  mixture  of  lin- 
seed meal  with  boiling  water.  The  official  di- 
rections for  making  it  require  3  parts  of  the 
former  .and  5  fluid  parts  of  the  latter.  These 
are  gradually  mixed,  with  constant  stirring. 
In  practice  no  such  accuracy  of  measurement 
is  required,  and  it  is  sufficient  to  combine  the 
ingredients  in  such  proportions  that  a  pulta- 
ceous  mass,  neither  too  fluid  nor,  on  the  other 
hand,  too  stifi,  shall  result.  Linseed  is  more 
used  for  poultice-making  than  any  other  ma- 
terial, for  its  oily  and  mucilaginous  constitu- 
ents make  it  thoroughly  useful  and,  because  of 
its  cheapness,  it  is  generally  obtainable.  In 
making  the  poultice,  it  should  be  seen  to  that 
all  the  ingredients  and  apparatus  employed 
are  warmed,  else  the  poultice  when  completed 
will  be  but  warm  instead  of  being  hot.  A 
bowl  having  been  warmed,  there  is  poured 
into  it  a  sufficient  amount  of  hot  water,  and  to 
this  there  is  added  flaxseed  meal,  little  by  lit- 
tle, with  constant  stirring,  until  a  smooth  and 
sufficiently  consistent  dough  results.  This  is 
quickly  spread  upon  a  thin  cloth  which  is  of 
sufficient  size  to  permit  of  being  turned  up 
about  the  edges  of  the  mass  and  made  to  cover 
its  back.  The  cloth  having  been  adjusted  and 
fastened,  the  poultice  is  ready  for  application. 
The  thickness  with  which  the  poultice  material 
is  spread  will  vary  between  half  an  inch  and 


103 


POWDERS 


an  inch,  the  former  thickness  being  more  suit- 
able -where  lightness  is  required,  and  the  lat- 
ter advantageous  because  it  longer  retains  the 
heat. 

Bread  Poultices  are  frequently  employed 
in  the  same  oases  in  which  linseed  poultices 
are  used.  They  are  made' preferably  from  stale 
bread  thoroughly  disintegrated  and  rubbed  up 
with  hot  water.  Instead  of  hot  water,  hot 
milk  may  be  employed,  the  "  bread-and-milk  " 
poultice  being  the  result.  The  disadvantages 
of  all  bread  poultices  are  that  they  cool  quick- 
ly, dry  quickly,  crumble,  and  are  apt  to  become 
sour. 

Indian-meal  Poultices  are  prepared  from 
Indian  (maize)  -corn  meal  in  the  same  manner 
as  flaxseed  poultices  are.  They  are  popularly 
supposed  to  retain  their  heat  for  a  longer  time 
than  flaxseed  poultices,  and  in  this  opinion 
Dr.  H.  C.  Wood  concurs. 

Bran  Poultices  are  serviceable  because  of 
their  lightness.  Their  preparation  and  their 
uses  are  the  same  as  those  of  the  poultices  al- 
ready mentioned. 

Poultices  are  prepared  also  from  oatmeal, 
from  slippery  elm,  from  mashed  potato,  from 
carrots  boiled  and  mashed,  and  from  starch. 

The  Charcoal  Poultice  is  prepared  by  add- 
ing powdered  charcoal  to  the  ordinary  flaxseed 
poultice  or  by  dusting  it  upon  the  surface  of 
the  poultice,  or  by  doing  both.  The  official 
poultice,  cataplasma  carbonis  (Br.  Ph.),  con- 
sists of  1  part  of  powdered  wood  charcoal,  4 
parts  of  bread  crumb,  3  parts  of  linseed  meal, 
and  20  fluid  parts  of  boiling  water.  The  bread 
is  macerated  in  the  water  for  ten  minutes  near 
the  fire  and  then  mixed,  and  the  linseed  meal 
is  gradually  added,  with  constant  stirring. 
With  this  there  is  mixed  one  half  of  the  char- 
coal, and  the  remainder  is  sprinkled  upon  the 
surface  of  the  poultice. ,  The  charcoal  poultice 
is  thought  a  suitable  application  to  offensive 
ulcers^  but  another  method  of  applying  the 
charcoal  is  to  be  preferred  (see  Chaecoal),  and 
of  the  objections  to  poulticing  ulcers  enough 
has  been  said. 

The  Yeast  Poultice  is  misused  in  the  same 
way.  It  may  be  made  by  smeai'ing  warm  yeast 
on  the  surface  of  a  bread  poultice.  The  offi- 
cial yeast  poultice,  however,  cataplasma  fer- 
menti  (Br.  Ph.),  is  practically  nothing  more 
than  rising  dough  ;  it  is  composed  of  3  fluid 
parts  of  beer  yeast,  7  parts  of  wheat  flour,  and 
3  fluid  parts  of  water  heated  to  100°  F.  The 
yeast  is  mixed  with  the  water,  the  flour  is 
stirred  in,  and  the  mass  is  placed  near  the  fire 
until  it  rises. 

An  lodide-of-Starch  Poultice  has  been 
recommended  to  cleanse  unhealthy  and  slough- 
ing ulcers.  A  jelly  is  made  by  the  combination 
of  2  oz.  of  starch  and  0  oz.  of  boiling  water, 
and  to  this  is  added,  before  cooling  takes  place, 
■J  oz.  of  liquor  iodi  (Br.  Ph.).  This  mixture  is 
spread  upon  cloth  and  applied  cold. 

The  Blustard  Poultice  is  made  by  the  ad- 
dition to  the  flaxseed  poultice  of  mustard  in 
amounts  which  vary  with  the  rubefacient  im- 
pression which  is  desired.  As  a  counter-irritant 
for  the  relief  of  deep  inflammat ionfi.  it  is  an  ap- 
plication of  much  value.    The  official  mustard 


poultice,  cataplasma  sinapis  (Br.  Ph.),  con- 
tains 2-J-  oz.  "  or  a  suSiciency "  of  powdered 
mustard,  2^  oz.  of  linseed  meal,  and  a  suffi- 
ciency of  boiling  water  and  of  lukewarm  water. 
The  mustard  is  mixed  with  from  2  to  3  oz.  of 
lukewarm  water,  the  linseed  meal  is  mixed 
with  from  6  to  8  oz.  of  boiling  water,  and  the 
two  mixtures  are  united  by  stirring. 

The  Chlorine  Poultice,  cataplasma  sodce 
cMorinatm  (Br.  Ph.),  contains  1  fl.  part  of  solu- 
tion of  chlorinated  soda,  3  parts  of  linseed 
meal,  and  4  fl.  parts  of  boiling  water.  The 
linseed  meal  is  gradually  mixed  with  the  water 
and  the  solution  of  chlorinated  soda  is  stirred 
in.  This  poultice  is  designed  for  the  destruc- 
tion of  offensive  gaseous  emanations  from  un- 
healthy sores.  Chlorinated  lime  mav  be  used 
in  the  same  way.  The  use  of  poulticing  in 
such  cases  is  usually  highly  undesirable. 

Yarious  medicinal  additions  are  made  to 
poultices  for  the  object  of  thus  obtaining  the 
specific  local  effect  of  certain  drugs.  Of  such 
additions,  save  rubefacients,  it  may  be  said 
that  in  general  they  are  unwise,  the  applica- 
tion of  active  medicinal  agents  being  more 
suitably  practised  by  the  use  of  ointments, 
plasters,  and  similar  means.  Opium,  however, 
generally  in  the  form  of  laudanum,  may  be 
sprinkled  upon  a  poultice  when  relief  of  pain 
is  an  urgent  necessity,  but  a  hypodermic  in- 
jection of  morphine  is  more  accurate  and  re- 
liable and  much  to  be  preferred.  A  hemlock 
poultice,  cataplasma  conii  (Br.  Ph.),  is  some- 
times employed  (see  CoKium). 

As  a  substitute  for  the  ordinary  emollient 
poultice,  there  is  sometimes  employed  a  ma- 
terial known  as  spongiopiline.  This  is  a  heavy 
fabric  upon  one  side  of  which  sponge,  in  very 
small  pieces,  is  felted  in  and  the  surface  then 
shredded  so  as  to  form  a  nap,  while  the  other 
side  is  covered  with  a  layer  of  rubber.  If  the 
sponge  side  is  moistened  and  the  material  is 
applied,  we  have  present  all  the  elements  of  a 
poultice,  for  both  the  heat  and  the  moisture 
are  retained  by  the  rubber  backing,  though  it 
must  be  confessed  that  cooling  soon  takes 
place.  Spongiopiline  is  little  used  at  the  pres- 
ent time. — Henby  A.  Gkiffin. 

POWDEKS. — In  a  pharmacopoeial  sense,  a 
"  powder  "  is  a  medicine  or  mixture  of  medi- 
cines directed  to  be  kept  on  hand  or  to  be  put 
up  in  a  certain  form  ready  for  dispensing. 
When  powders  are  prescribed  ex  tempore,  re- 
gard should  be  had  to  the  nature  of  the  sub- 
stances composing  them  and  to  the  purpose 
for  which  they  are  intended.  If  they  are  com- 
posed of  several  ingredients,  and  intended  for 
internal  use,  they  should  be  in  a  state  of  fine 
division  and  intimately  mixed.  If  one  or 
more  of  the  ingredients  is  an  unusually  potent 
substance — for  instance,  arsenous  acid — the 
greatest  care  must  be  taken  to  insure  its  uni- 
form distribution  through  the  mass. 

If  a  compound  powder  is  intended  for  ex- 
ternal use,  as  for  oiisting  wounds,  it  is  prefer- 
able not  to  mix  it  by  trituration,  since  this  is 
apt  to  render  it  too  compact,  but  to  mix  it  on 
paper  with  a  spatula,  and  then  to  pass  it  re- 
peatedly through  a  sieve. 


PRESCRIPTIONS 
PRUNUS  VIRGINIANA 


104 


When  a  powder  is  prescribed  which  is  apt  to 
deliquesce,  it  should  be  dispensed  in  glass,  or, 
if  the  case  admits  of  it,  in  paraffin  paper. 

Sometimes  potassium  chlorate  or  hypophos- 
phite  is  ordered  in  powder  in  combination  with 
sugar  or  with  tannic  acid  or  some  other  or- 
ganic substance.  If  these  were  triturated  to- 
gether in  a  mortar,  a  dangerous  explosion 
would  be  apt  to  result.  The  ingredients 
should  therefore  be  powdered  separately,  and 
then  carefully  mixed,  without  trituration,  on 
a  sheet  of  paper. 

Occasionally  substances  are  prescribed  to- 
gether with  the  intention  of  having  them 
dispensed  as  a  powder,  although  they  do  not  per- 
mit of  this.  For  instance,  if  chloral  is  rubbed 
with  camphor  a  liquid  will  result.  The  same 
happens  when  antlpyrine  is  triturated  with 
chloral,  naphthol,  sodium  salicylate,  etc.  Ace- 
tate of  lead  and  sulphate  of  zinc  are  often  pre- 
scribed together.  On  triturating  them  a  white 
paste  will  form,  due  to  the  separation  of  water 
from  the  zinc  sulphate  and  the  simultaneous 
formation  of  sulphate  of  lead. 

A  very  convenient  way  of  administering 
powders,  if  they  are  not  too  large,  is  by  means 
of  empty  capsules  or  in  wafers.  (See  Wafers. 
Cf.  Insufflatiox.) — Charles  Rice. 

PRESCRIPTION'S  are  written  orders  from 
the  physician  to  the  pharmacist,  instructing 
him  to  dispense  a  remedy  or  a  combination  of 
remedies  in  such  amount  or  proportion  as  the 
physician  may  see  fit,  and  generally  including 
the  written  directions  which  the  pharmacist  is 
to  place  upon  the  receptacle  which  contains  the 
medicament  when  it  is  dispensed.  The  form 
which  a  prescription  should  follow  is  too  well 
known  to  require  description  in  such  a  work  as 
this.  The  language  in  which  prescriptions  are 
written  may,  with  propriety,  be  the  vernacular, 
but,  since  certain  advantages  pertain  to  the 
use  of  Latin,  that  is  the  language  most  com- 
monly employed.  These  advantages  are  the 
fact  that  Latin  is  recognised  as  the  language  of 
science  the  world  over,  so  that  a  prescription 

groperly  written  in  Latin  may  be  compre- 
ended  and  properly  dispensed  by  a  pharma- 
cist, whatever  his  nationality;  the  fact  that 
Latin  names  are  constant  and  definite,  while 
vernacular  names  have  various  applications 
and  are  subject  to  change ;  and  the  fact  that 
Latin  affords  a  means  of  prescribing  without 
the  patient's  knowing  the  nature  of  the  drugs 
he  is  to  receive.  That  this  last  advantage  is 
not  a  great  one  is  perhaps  true  in  the  ease  of 
the  more  highly  educated  patient,  but  with  the 
multitude  it  is  certainly  effective,  and  that  the 
patient  should  in  many  oases  be  ignorant  of 
the  nature  of  his  medicine  is  almost  self-evi- 
dent. The  directions  for  the  patient  which 
the  compounder  is  to  place  upon  the  receptacle 
in  which  the  medicine  is  dispensed  are  usually 
written  in  the  vernacular,  since  no  advantage, 
as  a  rule,  would  result  from  having  them  in 
Latin.  The  directions  to  the  compounder, 
however,  are  usually  written  in  Latin. 

So  far  as  the  writing  of  prescriptions  is  con- 
cerned, it  is  a  thing  which  ought  to  be  per- 
formed with   much  care  and  tlioughtfulness. 


That  the  writing  should  be  legible  might  go 
without  saying,  but  in  this  respect  the  physi- 
cian is  often  culpable.  Abbreviation,  too,  is  a 
serious  fault  in  prescription-writing,  and  often 
dangerous  in  a  high  degree.  Many  drug  names 
may  be  safely  abbreviated,  but  others  when 
abbreviated  become  ambiguous  and  easily  eon- 
founded,  so  that  it  will  be  far  safer,  and,  cer- 
tainly, more  elegant,  if  the  prescription  is 
written  in  words  which  are  entire.  Of  danger- 
ous abbreviations  many  examples  might  be 
cited — for  instance :  "  acid,  hydroc.  dil.,"  which 
might  be  interpreted  as  meaning  either  acidum 
hydrochloricum  dilutum  or  acidum  hydro-, 
cyanicum  dilutum,  remedies  certainly  of  wide- 
ly different  potentialities.  To  give  a  -list  of 
such  abbreviations  which  should  have  any 
claim  to  completeness  would  require  too  much 
space,  but  a  very  satisfactory  list  of  examples 
may  be  found  in  Thornton's  Dose-Book  and 
Manual  of  Prescription  Writing.  That  seri- 
ous mistakes  are  so  seldom  attributable  to  il- 
legible writing  and  abbreviation  is  not  so  much 
to  be  credited  to  the  physician  as  to  the  phar- 
macist, whose  duty  it  is  to  obtain  elucidation 
from  the  prescriber  whenever  ambiguity  or 
uncertainty  is  aroused  by  a  prescription.  It 
is  perhaps  the  knowledge  that  the  prescription 
will  be  critically  scanned  by  the  pharmacist 
that  makes  the  physician  less  careful  than  he 
should  be.  Such  carelessness,  however,  should 
be  severely  reprehended,  for  a  mistake  may 
escape  the  eye  of  the  pharmacist  as  it  has  es- 
caped that  of  the  physician,  and  then  both  be- 
come blameworthy.  The  condition  is  the  same 
with  incompatibility.  So  far  as  chemical  in- 
compatibility is  concerned,  the  pharmacist  is 
no  doubt  more  expert  than  the  physician,  but 
to  the  practitioner  of  any  experience  it  is  cer- 
tainly discreditable  that  he  should  prescribe 
remedies  in  combination  which  are  chemically 
antagonistic;  of  physiological  antagonism  he 
should  be  by  far  the  better  judge  than  the 
pharmacist,  and  should  know  to  what  degree  a 
therapeutical  incompatibility  may  exist  in  his 
prescriptions.  To  some  degree,  physiological 
and  therapeutical  antagonism  is  often  sought 
for  by  the  prescriber,  that  one  remedy  may 
diminish  or  correct  the  over-activity  of  the 
principal  agent  in  the  prescription,  "but  this 
antagonism  is  intended  and  is  not  the  com- 
plete antagonism  which  is,  as  it  were,  antido- 
tal. Of  solubilities,  the  prescriber  should  be 
well  informed,  that  unsightly  medicine  shall 
be  avoided  so  far  as  is  possible.  It  must  not  be 
forgotten,  too,  that  a  precipitate  or  sediment 
may  be  taken  with  the  last  doses  in  the  bottle, 
and  thus  make  them  dangerous  overdoses,  and 
this  perhaps  in  spite  of  the  direction  to  "  shake 
well  before  taking."  The  success  of  a  practi- 
tioner often  depends  upon  little  things,  and 
among  them  the  prescribing  of  medicines  of 
good  appearance,  which  are,  so  far  as  possible, 
agreeable  to  the  smell  and  taste,  is  not  the  least. 
The  prescription  should,  as  a  rule,  call  only 
for  such  quantities  of  medicine  as  will  be  re- 
quired by  the  patient  during  a  very  limited 
time,  for.  renewals  are  generally  easily  obtained. 
On  the  other  hand,  it  is  absurd  to  prescribe  a 
large  quantity  of  medicine  from  which  but  a 


105 


PRESCRIPTION'S 
PRUNUS  VIRGINIANA 


small  amount  can  be  consumed ;  moreover,  the 
habit  which  many  j)eople  have  of  retaining 
and  storing  up  their  unemptied  bottles  of 
medicine  is  both  foolish  and  dangerous,  for 
deterioration  as  well  as  concentration  may 
occur,  to  the  injury  of  the  patient  who  may 
eventually  partake  of  his  stock  rather  than 
have  a  new  supply  compoimded.  The  question 
of  repeatedly  dispensing  medicines  on  one  pre- 
scription is  one  which  must  be  borne  in  mind 
by  the  physician.  Many  prescriptions  are  in- 
tended only  for  brief  employment  and  may 
contain  ingredients  whose  continued  use  would 
be  undesirable.  Under  these  circumstances 
the  prescriber  should  write  upon  his  prescrip- 
tion "  Not  to  be  repeated,"  or  words  to  a  simi- 
lar efEeot,  for  it  is  second  nature  to  the  patient 
to  indefinitely  renew  the  supply  and  continue 
to  use  the  medicine  which  affects  him  favour- 
ably or  pleasantly,  without  thought  or  knowl- 
edge as  to  consequences.  Of  no  prescriptions 
is  this  truer  than  of  those  which  contain  ano- 
dynes and  hypnotics.  As  to  doses,  it  is  self- 
evident  that  the  prescriber  should  exercise 
great  care.  The  pharmacist,  it  is  true,  stands 
between  him  and  the  patient,  but  that  should 
not  in  the  least  lessen  his  responsibility,  and 
carelessness  in  dose  determination  and  pre- 
scription may  mean  loss  of  life  or  loss  of  repu- 
tation, perhaps  both.  In  some  cases  doses  of 
unusual  size  are  made  necessary  by  unusual 
circumstances,  and  various  plans  have  been 
proposed  by  which  the  prescriber  may  inform 
the  dispenser  of  the  correctness  of  the  unusual 
amount.  Such  is  the  drawing  of  a  heavy  line 
beneath  the  quantity  and  the  remedy,  the  ex- 
pression of  the  quantity  both  in  the  Roman 
and  in  the  Arabic  characters  or  in  the  English 
and  metric  systems,  the  addition  of  an  ex- 
clamation mark  (!)  after  the  dose,  or  the  inser- 
tion of  the  letters  Q.  R.  {qua/ntum  rectum). 
None  of  these  is  in  general  employment,  how- 
ever, and  it  generally  happens  in  such  a  case 
that  a  question  from  the  dispenser  and  an  an- 
swer by  the  prescriber  are  gone  through  with. 
In  the  determination  of  doses  the  physician  will 
be  governed  by  many  circumstances,  but  these 
have  been  presented  elsewhere  (see  Doses).  In 
ordering  quantities,  nevertheless,  it  must  ever 
be  borne  in  mind  that  measures  of  accuracy  are 
demanded  in  prescriptions ;  drops,  teaspoon- 
fuls,  tablespoonfuls,  and  wineglasstuls  may  be 
allowed  in  the  directions  to  the  patients,  be- 
cause of  the  previously  considered  and  reck- 
oned latitude  of  doses,  but  no  such  measures 
should  occur  in  the  body  of  the  prescription. 

In  writing  a  prescription  the  active  agent  or 
agents  should  first  be  selected.  This  portion 
of  the  prescription  is  known  as  the  basis.  The 
basis  should  include  as  few  remedies  as  may 
be,  and  it  a  single  remedy  will  serve,  so  much 
the  better.  If  several  different  effects  are  to 
be  accomplished,  it  is  far  better  to  prescribe  a 
corresponding  number  of  individual  remedies 
than  the  same  number  in  combination,  for  re- 
sults may  then  be  more  perfectly  judged  of 
and  conclusions  drawn.  Two  and  even  more 
remedies,  however,  may  unite  to  do  a  work 
which  one  alone  will  do  but  imperfectly ;  for 
this  reason  arsenic  and  iron  are  often  combined. 


Under  these  circumstances  the  several  ingre- 
dients may  wisely  be  mixed  and  given 
together,  but  the  piling  together  of  many 
remedies,  in  the  hope  that,  if  one  does  not 
relieve,  one  of  the  others  may,  is  unscientific 
guesswork,  and  a  prescription  so  constructed 
has  well  been  dubbed  "  shotgun."  To  aid  in 
the  action  of  the  basis  there  may  be  incorpo- 
rated what  is  known  as  an  adjuvant.  The  aid 
may  be  chemical,  such  as  the  effecting  of  solu- 
tion, or  it  may  be  physiological  and  promote 
the  remedial  effect.  Thus,  calomel  will  pro- 
mote the  diuretic  effect  of  digitalis.  Diminn- 
tion  of  a  disagreeable  or  undesired  effect  of 
the  basis  may  be  obtained  by  the  addition  of 
another  remedy  to  it.  This  is  known  as  the 
corrigent,  and  an  example  is  had  in  the  dimi- 
nution or  the  abolition  of  griping  which  results 
from  the  use  of  some  of  the  resinous  purgatives 
by  the  addition  to  them  of  an  antispasmodic 
or  an  aromatic.  Finally,  the  excipient,  or 
vehicle,  in  case  the  medicine  ordered  is  liquid 
and  intended  for  internal  use,  may  be  so 
sweetened  or  flavoured  as  to  make  the  prepara- 
tion more  acceptable  both  to  the  palate  and  to 
the  stomach.  This  flavouring  and  sweetening 
are  not  always  necessary,  but  will  be  deter- 
mined by  the  nature  of  the  drugs  employed. 
In  solid  preparations  the  taste  of  the  excipient 
is,  of  course,  of  less  importance.  Medicinal 
prescriptions,  therefore,  may  consist  of  a  basis, 
an  adjuvant,  a  corrigent,  and  a  vehicle.  Con- 
cerning the  substances  so  used  information 
will  be  found  in  other  parts  of  this  work,  and 
special  preparations,  such  as  emulsions,  pills, 
etc.,  are  elsewhere  considered. 

The  ownership  of  the  prescription  is  a  much 
discussed  matter — moi'e  discussed,  indeed,  than 
the  question  would  seem  to  deserve.  The  de- 
cision is  even  yet  not  finally  reached,  but  the 
custom  of  the  majority  of  pharmacists  is  to 
retain  the  original  prescription  as  evidence  in 
case  of  subsequent  dispute,  while  they  give 
copies  of  it  (copies  having  no  legal  status)  to 
those  concerned. — Henry  A.  Griffin. 

PBOPYLAHINE.— SeeTRiMETHTLAMiNE. 

PBOTONTJCLEIN.— See  under  Nuoleins 
(vol.  ii,  page  21). 

PmrNES. — The  fruit  of  Prunus  domesHca 
is  official  as  prunum  (U.  S.  Ph.,  Br.  Ph.).  It 
enters  into  the  composition  of  confection  of 
senna.  Stewed  prunes,  taken  at  meals  like 
other  sweets,  are  often  efficaoious  in  overcom- 
ing constipation,  provided  it  is  of  a  mild  de- 
gree. 

PBUNTJM.— See  Prunes. 

PRTJNTJS  VIRGINIANA  (U.  S.  Ph.)  is 
the  bark  of  the  wild  cherry  tree  of  North 
America,  Prunus  serotina.  It  is  tonic  and  mild- 
ly astringent,  and  is  popularly  regarded  as  an 
efficient  pectoral  and  sedative  ;  on  this  account 
it  is  much  employed  to  allay  cough  and,  by 
reason  of  its  agreeable  flavour,  is  a  favourite 
addition  to  cough  mixtures.  The  infusion,  in- 
fusum  pruni  virginianm  (U.  S.  Ph.),  is  occa- 
sionally employed  as  an  astringent  lotion.  It 
may  be  given  internally  in  doses  of  from  2  to 
3  fl.  oz.,  three  or  four  times  a  day.    The  dose 


PRUSSIC  ACID 
PULSATILLA 


106 


of  the  fluid  extract,  extractum  pruni  virginia- 
nmfluidum  (U.  S.  Ph.),  is  from  20  to  40  drops ; 
that  of  the  syrup,  sympus  pruni  virginianm 
(U.  S.  Ph.),  is  from  1  to  2  fl.  drachms.  The 
fluid  extract  and  the  syrup  are  much  em- 
ployed for  imparting  a  pleasing  flavour  to  in- 
sipid liquid  medicines. 

PRUSSIC  ACID.— See  Hydrocyanic  acid. 

PSEUDACONITINE  is  an  alkaloid  ob- 
tained from  Aconilum  ferox,  Indian  aconite. 
It  is  a  crystalline  substance,  and  from  it  crys- 
talline salts  may,  with  difficulty,  be  obtained. 
Pseudaconitine  melts  at  about  220°  P.  If  de- 
hydrated, it  produces  apopseudaconitine,  and 
from  its  saponification  there  is  obtained  pseud- 
aconine.  It  is  said  to  be  related  to  the  alka- 
loids narceine,  narcotine,  and  oxynarcotine, 
which  are  derived  from  opium.  The  formula 
of  pseudaconitine  is  CjbHisNOij.  It  is  some- 
times erroneously  called  aconitine. 

The  physiological  action  of  pseudaconitine 
is  similar  to  tliat  of  aconitine  (see  Aconitine). 
Though  the  relative  potency  of  the  two  alka- 
loids has  not  been  finally  determined,  pseud- 
aconitine is  certainly  violently  poisonous. 
Pseudaconitine  is  not  used  medicinally,  and  as 
yet  we  are  but  ill  informed  of  its  properties. 
Perhaps  like  Aconitum  ferox,  from  which  it  is 
derived,  it  differs  from  the  alkaloid  of  Aconi- 
tum napellus  in  being  more  of  a  diuretic  and 
less  of  a  diaphoretic. — Henry  A.  Griffin. 

PTEROCAK.PTTS.— -See  Sandalwood. 

PTISANS.— See  Drinks. 

PTYALAGOGUES.— See  Sialagogues. 

PTYALIIT.— This  amylolytic  constituent 
of  the  saliva  is  in  the  market  in  the  shape  of  a 
yellowish  powder,  also  in  the  form  of  a  solu- 
tion in  glycerin.  It  has  been  used  to  some  ex- 
tent as  a  remedy  for  that  form  of  dyspepua  in 
which  starchy  articles  of  food  are  particularly 
difticult  of  digestion.  The  dose  is  from  10  to 
30  grains.  Mixed  with  pepsin,  forming  Merck's 
"  ptyalin-pepsin,"  it  may  have  a  wider  range 
in  the  treatment  of  dyspepsia. 

PTYCHOTIS  AJOWAN.— See  Ammi. 

PULSATILLA  (H.  S.  Ph.)  is  the  herb, 
collected  soon  after  flowering,  of  Anemone 
Palsatilla  and  of  Anemone  pratensis  (pasque- 
flower, meadow  anemone),  small  herbal  plants 
of  the  RanunculacecE.  The  flrst  is  a  very 
common  plant  in  England,  northern  Europe, 
and  Siberia  ;  the  second,  also  called  Pulsatilla 
nigricans,  inhabits  southern  Europe.  A  third 
species,  Anemone  patens,  var.  nuttalliana,  in- 
habits the  United  States.  The  herb  should  be 
carefully  preserved,  and  not  kept  longer  than 
a  year  ;  even  the  drying  of  it  is  said  to  impair 
its  medicinal  value  and  render  it  unreliable. 
The  dose  of  the  herb  is  from  1  to  5  grains. 

The  Pulsatilla  plants,  when  fresh  and  dis- 
tilled with  water,  yield  a  distillate  from  which 
ether  extracts  an  acrid,  yellow  oil.  This  oil, 
in  the  presence  of  water,  is  gradually  con- 
verted into  anemonin  and  anemonie  acid. 
Anemonin,  or  Pulsatilla  camphor,  CisHijOo, 
the  active  principle  of  the  plant,  is  crystalli- 
zable  and  very  volatile,  soluble  in  chloroform 
and  in  hot  alcohol,  almost  insoluble  in  water 


and  in  ether.  The  dose  is  from  ^  to  -J  a  grain; 
in  pill ;  much  larger  doses,  !•}  grain,  may  be 
taken  without  inconvenience  (Vigier);  doses 
of  2  grains  produce  no  physiological  symptoms 
in  man  (Olarus,  Schroff) ;  9  grains  have  proved 
fatal  to  rabbits  in  three  or  four  hours  (Warns). 
It  is  very  unstable.  Anemonie  acid,  C16H14O7, 
obtained  from  anemonin  by  the  action  of  al- 
kalies, is  a  white,  crystalline,  tasteless  powder, 
apparently  inert. 

The  herb  alone  is  official  in  the  United 
States.  The  dose  is  from  1  to  5  grains.  A 
tincture  may  be  prepared  according  to  the  offi- 
cial fornmla  for  tinctures  of  fresh  herbs  {tinc- 
turcB  herbarum  recentium)  by  using  1  part  of 
the  freshly-gathered  herb,  bruised  and  crushed, 
and  2  parts  of  alcohol.  The  dose  is  from  -^ 
to  5  minims,  several  times  a  day.  The  im- 
ported German  homoeopathic  tincture,  made 
with  equal  parts  of  the  expressed  juice  and  of 
alcohol,  is  an  efficient  preparation,  but  tinc- 
tures or  fluid  extracts  made  from  the  im- 
ported dried  plant  are  not  trustworthy.  The 
Ger.  Ph.  formerly  had  an  extract,  to  be  given 
in  doses  of  from  -J  to  3  grains,  but  it  was  unre- 
liable ;  and  the  Fr.  Cod.  has  an  alcoholate, 
which  is  practically  a  strong  tincture,  made 
from  the  fresh  herb. 

Locally  used,  Pulsatilla  is  powerfully  irri- 
tant—the oil  vesicates  the  skin,  and  the  fresh 
juice  causes  tingling  and  burning  sensations 
in  the  part  to  which  it  is  applied.  It  may  ex- 
cite a  violent  dermatitis,  with  a, vesicular  or 
pustular  eruption  ;  and  inflammation  and  even 
gangrene  of  the  entire  limb  has  followed  the 
application  of  the  bruised  root  to  the  calf  of 
the  leg  for  rheumatism.  Inhalation  of  the 
dust  has  produced  itching  of  the  eyes,  colic, 
vomiting,  and  diarrhoea ;  the  fresh  herb,  swal- 
lowed, may  cause  severe  irritation  of  the  gas- 
tro-intestinal  mucous  membrane.  On  the 
tongue,  the  fresh  juice  gives  rise  to  tingling 
and  burning  followed  by  numbness — symp- 
toms caused  also  by  aconite.  Internally  ad- 
ministered, it  is  diuretic,  diaphoretic,  and 
emmenagogue,  and  acts  as  a  cardiac  and  vas- 
cular sedative,  lowering  the  action  of  the  heart, 
the  arterial  tension,  and  the  bodily  tempera- 
ture. In  overdoses  it  strongly  affects  the  mu- 
cous membranes,  giving  rise  to  nausea  and 
vomiting,  slimy  diarrhoea,  bloody  urine,  pro- 
fuse and  offensive  sweats,  ooryza,  and  cough, 
also  vesicular  and  pustular  eruptions  on  the 
skin,  and  peculiar  pains  in  and  dimness  of  the 
eyes  (Dierbach,  Dietz,  Clarus).  It  acts  by  con- 
trolling irritability  and  overactivity  of  the 
ganglionic  nervous  system,  and  has  no  title, 
except  indirectly,  to  be  classed  with  hellebore 
and  aconite  as  a  vascular  sedative  (Shapter). 
Large  doses  paralyze  the  spinal  cord  and  the 
niedulla  oblongata  (Clarus).  Its  primary  ac- 
tion is  that  of  a  spinal  irritant ;  its  secondary 
results  are  exhaustion  and  general  paralysis 
(TuUy).  It  is  a  paralyzer  of  motility  and  sen- 
sibility (Bartholow).  The  homoeopathic  writ- 
ers credit  it  with  speciflc  influence  on  the 
synovial  membranes,  the  veins,  the  ears,  and 
the  generative  organs  of  both  sexes  (Hughes). 
The  pharmacology  of  the  drug  is  yet  to  be  ac- 
curately worked  out. 


107 


PRUSSIC  ACID 
PULSATILLA 


The  action  of  anemonin  has  been  studied  by 
Heyer,  Ciarus,  and  others,  chiefly  on  rabbits, 
since  its  discovery,  in  1771,  by  Stoi-clc.  Applied 
to  the  conjunctiva,  it  caused  slight  inflamma- 
tion; on  the  liuman  tongue  it  left  a  slight 
burning  sensation.  Melted,  its  vapour  pro- 
duced intense  inflammation  of  the  eyes,  and 
caused  pricking  in  the  tongue,  followed  by 
numbness  and  white  patches.  The  symptoms 
following  its  internal  administration  in  fatal 
dose  were  a  slow  and  feeble  pulse,  slow  respira- 
tion, lowered  bodily  temperature,  frequent 
diarrhoea,  paralysis  of  first  the  hind  and  then 
the  fore  legs,  dyspnoea,  mydriasis  succeeded 
finally  by  meiosis,  stupor,  and  death  without 
convulsions.  The  absence  of  convulsions  is 
thought  to  be  due  to  a  paralyzing  action  of 
anemonin  on  the  cerebral  motor  centres,  as  in 
poisoning  by  extract  of  Pulsatilla  they  are  al- 
ways present.  The  autopsy  showed  congestion 
and  oedema  of  the  lungs  and  marked  hyperse- 
mia  of  the  cerebral  and  spinal  membranes, 
especially  in  the  vicinity  of  the  medulla  oblon- 
gata. The  heart  walls  were  relaxed,  and  its 
cavities  and  the  great  vessels  were  filled  with 
dark,  clotted  blood,  while  the  blood  elsewhere 
was  fluid.  The  liver,  spleen,  kidneys,  and  other 
abdominal  viscera  were  found  healthy. 

Antagonists  and  Incompatibles. — Alcohol, 
opium,  and  digitalis  are  its  physiological  an- 
tagonists. Tannic  acid,  the  caustic  alkalies, 
and  the  metallic  salts  are  chemically  incompat- 
ible with  preparations  containing  Pulsatilla  or 
anemonin. 

Therapeutics. — The  medical  history  of  Pul- 
satilla ascribes  to  it  somewhat  of  the  character 
of  a  panacea,  so  numerous  and  diverse  are  the 
affections  reported  to  have  been  cured  with  it. 
The  ancient  writers  credited  different  species 
of  anemone  with  many  medicinal  virtues,  but 
the  modern  use  of  this  drug  dates  from  the 
time  of  Baron  StOrck  and  his  contemporaries 
(1770  to  1800),  who  highly  praised  Pulsatilla 
nigricans  as  an  efficient  remedy  for  corneal 
opacities,  cataract,  paralysis,  rheumatism, 
amenorrhoea,  melancholia,  secondary  syphilis, 
old  ulcers,  and  scaly  skin  diseases.  Later  thera- 
peutists differ  widely  as  to  its  medicinal  value, 
some  finding  no  efficacy  in  it  and  others  giving 
it  extravagant  praise.  In  acute  catarrhal 
affections  of  mucous  membranes  it  has  been 
very  efGcient,  particularly  in  rhinitis  and  con- 
junctivitis, the  early  stage  of  purulent  ophthal- 
mia in  children,  and  gonorrhoeal  ophthalmia, 
also  in  subacute  and  chronic  bronchitis  of  deli- 
cate persons  accompanied  with  much  mucous 
expectoration,  and  in  chronic  catarrh  of  the 
bladder.  It  is  used  with  benefit  in  chronic 
nasal  catarrh  with  a  thick  though  bland  dis- 
charge, and  even  when  the  discharge  is  offen- 
sive; also  in  acute  and  subacute  inflammations 
of  the  middle  ear  and  of  the  external  auditory 
canal,  so  often  seen  in  children,  where  the  lin- 
ing membrane  is  red  and  swollen,  with  severe 
pain,  and  later  on  a  thin,  acrid  discharge  ap- 
pears, often  bloody  and  soon  becoming  puri- 
forin.  In  these  affections  medium  doses  (from 
5  to  10  minims  of  the  tincture)  ai'e  given  inter- 
nally every  four  hours  to  adults;  also  from  1 
to  2  fl.  drachms  in  from  4  to  6  oz.  of  warm 
51 


water  maybe  applied  as  a  lotion  to  parts  which 
are  accessible.  A  similar  use  of  this  remedy 
has  proved  of  benefit  in  many  cutaneous  affec- 
tions, especially  eczematous  eruptions,  syphi- 
lides,  and  indolent  ulcers. 

In  acute  and  chronic  dyspepsia,  characterized 
by  gastric  catarrh  or  subacute  gastritis  with  a 
white-coated  tongue,  no  taste  or  a  greasy  one 
in  the  mouth,  nausea,  flatulence,  heartburn, 
sick  headache,  anorexia,  depression,  diarrhoea, 
etc.,  Pulsatilla  proves  a  very  efficient  remedy  in 
5-drop  doses  of  the  tincture  every  four  hours. 
It  does  good  service  also  in  intestinal  catarrhs, 
shown  by  passive,  mucous  diari'hcea  with  little 
pain,  and  frequently  seen  in  the  febrile  affec- 
tions of  childhood,  especially  in  measles, 
mumps,  varicella,  and  remittent  fever. 

On  the  generative  organs  of  both  sexes  Pul- 
satilla is  generally  credit  ed  with  a  specific  ac- 
tion, both  physiologically  and  therapeutically. 
Epididymitis  and  orchitis  have  been  often 
controlled  and  entirely  dissipated  within  a  few 
days  by  very  small  doses,  a  few  drops  of  the 
tincture  in  a  glass  of  water,  of  which  a  tea- 
spoonful  is  given  every  two  hours  (Piffard, 
Sturgis).  In  more,  than  twenty-four  cases  of 
acute  uncomplicated  epididymitis,  doses  of  2 
drops  every  two  hours  gave  immediate  relief, 
the  patients  not  being  confined  to  bed,  but 
wearing  a  suspensory  bandage  (Borcherin). 
Doses  of  5  drops  aggravated  this  disorder,  while 
those  of  i-'ei  minim  every  three  hours  proved 
curative  (Piffard).  In  functional  amenorrhoea, 
scanty  or  delayed  menstruation,  and  in  sup- 
pression of  the  menses  tcora  fright  or  chill,  in 
oophoritis,  and  in  simple  mucous  leucorrhcea 
with  pains  in  the  back  and  nervous  depression, 
it  has  been  found  an  excellent  remedy.  Dys- 
menorrhoea  has  been  removed  in  several  cases 
by  2-drop  doses  of  the  tincture  thrice  daily  for 
several  days  before  the  menstrual  epoch  (Pif- 
fard). Extravagant  opinions  of  its  virtues  in 
the  puerperal  state  and  during  parturition  are 
promulgated  by  homoeopathic  authorities,  who 
even  credit  it  with  the  power  of  rectifying  false 
presentations  in  labour  by  causing  spontaneous 
version  of  the  child  and  bringing  the  head  to 
present. 

Besides  catarrhal  affections  of  the  ocular 
mucous  membrane,  already  mentioned,  Pulsa- 
tilla has  a  remedial  power  in  certain  affections 
of  the  eyelids.  It  is  believed  to  blight  a  stye 
when  given  internally,  though  not  to  prevent 
its  recurrence.  In  recent  blepharophthalmia, 
the  lacrymation  and  Meibomian  secretion  be- 
ing profuse,  it  is  an  efficient  remedy,  and  is 
said  to  stop  twitching  of  the  lids  accompanied 
by  dazzling  of  the  sight.  It  has  been  efficiently 
employed  in  the  earache  of  children  and  in  re- 
cent catarrhal  deafness,  also  in  acute  cerebral 
and  spinal  meningitis,  eclampsia  from  various 
causes,  asthma,  subacute  rheumatism  of  the 
small  joints,  acute  rheumatic  gout,  left-sided 
clavus,  hemicrania,  and  inframammary  pain. 
Deniau  used  it  with  benefit  in  Several  nervous 
affections,  and  concludes  that  it  is  a  direct  sed- 
ative of  nervous  irritability,  but  only  indirectly 
a  vascular  sedative.  Tucker  found  it  to  be  es- 
pecially serviceable  for  nervous  headache  pro- 
duced by  overtaxing  the  mind.    An  extract  of 


PtTMILINE 
PYRBTHRUM 


108 


the  root  has  proved  eflBoieht  against  tapeworm. 
Coughs  which  are  loose  by  day  but  dry  and 
tickling  on  lying  down  at  night  are  greatly 
benefited  by  small  doses  of  the  tincture  fre- 
quently repeated ;  and  anemonin,  in  doses  of 
i  to  1  grain,  has  been  found  extremely  useful 
in  whooping-cough  and  other  irritative  coughs. 
Samuel  0.  L.  Pottek. 

PTTMILINE. — See  under  Pine  prepara- 
tions (vol.  ii,  page  88). 

PUMPKIN  SEED.— See  Pepo. 

PtJNICA,  PXTNICINE.— See  Pelletier- 

INE. 

PUNK. — See  under  Agaric. 
PURGATIVES.— See  Cathartics. 

PUSTUIiANTS.— See  under  Counter- 
irritants. 

PYOCTANINE  is  a  name  applied  to  two 
distinct  aniline  dyes  which  possess  antiseptic 
properties.  One,  known  also  as  methyl  violet 
or  methyl  blue,  may  be  a  tetramethyl,  a  penta- 
methyl,  or  a  hexamethyl  pararosaniline,  or 
perhaps  a  mixture  of  methyl  pararosanilines  in 
various  proportions.  Arsenic  is  frequently 
present  as  an  impurity.  The  other  variety, 
the  yellow,  is  one  of  a  group  of  aniline  dyes 
known  as  auramines.  It  is  said  to  be  free 
from  arsenic.  The  blue  pyootanine  is  consid- 
ered the  more  powerful,  is  the  one  employed 
in  general  surgery,  and  is  the  variety  usually 
referred  to  when  the  word  pyoctanine  is  used 
without  a  qualifying  adjective.  Yellow  pyoc- 
tanine is  principally  used  in  ophthalmic  prac- 
tice. 

Pyoctanine  occurs  in  the  form  of  paste  or 
crystals,  of  the  colours  indicated,  and  is  odour- 
less. According  to  the  bacteriological  experi- 
ments of  Fessler  and  of  Troje,  it  would  seem  to 
be  a  germicide,  although  these  observers  differ 
very  materially  in  regard  to  its  power.  Fessler 
maintained  that  pyogenic  micro-organisms 
were  destroyed  in  fifteen  minutes  by  exposure 
to  a  l-to-1,000  solution,  while  Troje  found  that 
those  micro-organisms  were  not  certainly  de- 
stroyed after  twelve  hours  of  such  exposure. 
Pyoctanine  does  not  coagulate  albumin. 

According  to  Combermale,  pyoctanine  has, 
when  given  internally,  two  principal  actions, 
one  local  and  strongly  irritant,  the  other 
characterized  by  sedation  of  both  motor  and 
sensory  nerves.  It  occasionally,  though  not 
frequently,  causes  gastro-intestinal  irritation, 
it  is  rapidly  absorbed  into  the  circulation,  and 
it  is  excreted  by  the  kidneys,  upon  which  it 
acts  as  an  irritant.  Soon  after  the  administra- 
tion of  a  dose  the  drug  appears  in  the  urine, 
which  it  renders  at  first  bright  green  in  col- 
our, after  two  hours  dark  green,  and  after  four 
hours  dark  blue.  If  the  dose  is  repeated  two 
or  three  times  a  day,  the  urine  becomes  steril- 
ized and  will  resist  putrefaction  for  two  or 
three  weeks.  The  sedative,  or  rather  analgetic, 
property  of  the  drug  has  been  demonstrated, 
so  far  as  demonstration  is  possible  of  the  prop- 
erties of  a  drug  of  uncertain  composition,  and 
two  theories  have  been  advanced  to  account 
for  it — one,  that  it  depends  upon  an  elective 
affinity  of  the  drug  for  the  axis-cylinder  of  the 


nerve ;  the  other,  that  a  condition  of  meths 
moglobinaeraia  is  produced  and  that,  as  a  see 
ondary  result  of  this,  nervous  irritability  i: 
diminished. 

Pyoctanine  is  said  to  have  affected  the  hear 
so  as  to  cause  intermittence  of  the  pulsations 
but  such  an  effect  has  not  generally  been  nO' 
ticed.  The  toxic  symptoms  deduced  by  Orlofl 
from  his  experiments  on  dogs  and  horses  arf 
dilatation  of  the  pupils,  severe  salivation,  mus- 
cular tremor,  and  vomiting.  Fortunately,  wt 
have  few  data  in  regard  to  these  symptoms  ir 
addition  to  those  obtained  by  such  experi- 
ments. 

Pyoctanine  is  principally  and  best  known  as 
an  antiseptic  dressing.  The  surgical  world 
was  electrified  by  the  announcement  of  Still- 
ing, of  Strassburg,  that  he  had  discovered  ar 
ideal  germicide,  superior  in  power  to  bichloride 
of  mercury,  free  from  noxious  properties,  and 
capable  of  penetrating  the  tissues  of  the  body 
and  destroying  pathogenic  micro-organisms 
embedded  therein.  The  new  drug  was  imme- 
diately put  to  use  in  all  branches  of  surgery, 
and  before  long  very  contradictory  reports  of 
its  action  appeared.  Such  acute  observers  in 
ophthalmic  and  aural  work  as  Cheatham, 
Gould,  and  Galezowski  were  warm  in  its 
praise,  while  others  found  no  benefit  from  its 
use,  and  some  even  condemned  it  as  harmful. 
The  same  was  true  of  the  reports  of  its  use  in 
general  surgery,  in  cases  of  malignant  tumours, 
as  well  as  in  general  medicine,  and  the  drug 
was  thus  shown  to  be  unreliable.  The  cause 
of  this  unreliability  was  explained  by  Lieb- 
reich  in  1890,  when  he  demonstrated  that  the 
composition  of  pyoctanine  was  uncertain. 

The  presence  of  pathogenic  micro-organisms 
may  be  said  to  be  the  one  general  indication 
for  this  drug,  but  excellent  results  have  been 
obtained  in  diseases  not  supposed  or  not  known 
to  be  dependent  upon  such  a  cause.  Thus  the 
number  of  pathological  conditions  in  which 
much  improvement  has  been  noted  includes 
almost  all  of  those  accompanied  by  a  purulent 
discharge.  In  suppurating  womtds  and  chronic 
ulcers,  in  conjunctivitis  and  dacryocystitis,  in 
furuncles  and  otorrhcea,  in  gonorrhoea  and 
cystitis,  its  use  has  been  highly  extolled. 
Good  results  have  also  been  obtained  in  her- 
petic ulcers  of  the  cornea,  in  trachoma,  the 
dependence  of  which  upon  a  micro-organi.«m 
is  probable,  but  not  yet  definitely  determined, 
and  in  clearing  up  certain  corneal  opacities. 

A  case  of  idiopathic  ptyalism  which  had  re- 
sisted other  treatment  has  been  reported  by 
Heiman  as  promptly  cured  by  the  local  appli- 
cation twice  daily  to  the  mucous  membrane  of 
the  mouth  of  a  0-1-per-oent.  solution. 

The  injection  of  pyoctanine  into  the  sub- 
stance of  malignant  neoplasms  has  been  iit- 
tended  with  the  same  contradictory  results 
which  have  already  been  noted.  In  several 
cases  malignant  growths  have  been  alleged  to 
have  been  cured,  and  in  other  cases  marked 
retrogression  obtained. 

HSring  found  that  in  diphtheria  a  3-per- 
cent, solution,  applied  two  or  three  times  a 
day,  destroyed  the  false  membrane  and  dimin- 
ished pain  and  fever  without  giving  rise  to 


109 


PUMILINE 
PYRBTHRUM 


toxic  symptoms,  but,  unfortunately,  such  good 
results  can  not  always  be  thus  obtained. 

In  phthisis  pulmonalis  injections  of  a  solu- 
tion have  been  made  into  cavities  in  the  lungs 
with  benefit.  The  temperature  has  been  re- 
duced and  the  bacilli  have  disappeared  from 
the  sputum.  The  danger  in  this  treatmeiit 
lies  in  the  injurious  efEect  upon  the  kidney. 

Pyoctanine  has  been  given  internally  in 
doses  of  f rom  -i  to  3  4  grains,  three,  four,  or  five 
times  a  day,  in  malarial  fever,  gonorrhoea,  acute 
and  chronic  nephritis,  pleurisy,  adenitis,  endo- 
metritis, typhoid  fever,  and  malignant  neo- 
plasms. The  oases  of  malarial  disease  in  which 
this  drug  seems  to  be  indicated  are  those  which 
have  resisted  other  treatment.  According  to 
Thayer,  in  the  majority  of  such  cases  which  he 
treated  in  this  manner  the  plasmodia  disap- 
peared from  the  blood  after  a  fe^r  days,  and 
but  rarely  could  be  found  after  three  weeks. 
It  is  quite  possible  that  this  valuable  antiplas- 
modiac  power  is  due,  not  to  the  pyoctanine 
itself,  but  to  the  arsenic  which  is  frequently 
present.  When  given  alone,  pyoctanine  is  apt 
to  produce  strangury,  but  this  can  be  prevented 
by  combining  it  with  nutmeg.  In  acute  ne-, 
phritisii  is  said  to  have  quadrupled  the  amount 
of  urine,  and  to  have  caused  the  disappearance 
of  casts  and  of  the  cardiac  and  pulmonary 
symptoms  together  with  the  accompanying 
oedema.  Its  use  in  a  few  cases  of  leucocythcemia 
has  resulted  in  a  diminution  of  the  number  of 
leucocytes,  but  in  some  of  the  cases  the  num- 
ber of  the  red  blood-corpuscles  has  seemed  also 
to  have  been  diminislied. 

It  is  commonly  used  in  solutions,  which  varv 
in  strength  from  1  to  2,000  to  1  to  100.  It 
should  be  borne  in  mind  that  these  solutions 
are  unstable,  and  Stilling's  directions  should 
be  carefully  followed.  A  solution,  when  made, 
should  be  filtered,  kept  in  dark  glass  bottles, 
and  renewed  every  eight  days.  Possibly  some 
of  the  failures  which  have  occurred  have  been 
due  to  neglect  of  one  or  more  of  these  pre- 
cautions. The  pure  drug  may  be  used  as  a 
powder,  but  usually  when  it  is  desired  to  use 
it  in  this  way  it  is  best  to  dilute  it  with  some 
inert  substance  like  talc,  to  a  strength  of  from 
0-1  to  2  per  cent.  The  paste  may  be  moulded 
into  pencils,  either  large  or  small,  which  may 
be  applied  directly  to  the  diseased  tissue. 
Ointments  from  2  to  10  per  cent,  in  strength 
are  useful  in  some  cases. 

A  strong  objection  to  the  use  of  pyoctanine 
is  that  it  will  stain  the  skin  or  any  clothing 
with  which  it  comes  in  contact  a  deep  purple 
colour.  This  stain  may,  however,  be  removed 
by  means  of  dilute  hydrochloric  or  nitric  acid, 
alcohol,  or  cologne  water. 

Matthias  Lanckton  Foster. 

PYRANTIITE.— According  to  the  Chem- 
ische  Zeitung  (cited  in  the  Pharm.  Rev.,  March, 
1896),  this  substance,  first  prepared  by  Piutti, 
is  a  succinic-acid  derivative  of  phenacetine,  a 
colourless  crystalline  body  of  the  formula 
CH,-CO 

I  >N— CHi— OCjHt.     It    is    said    to 

CHj— CO 
have  been  used  in  several  of  the  Italian  uni- 


versity clinics  as  an  antipyretic  and  in  the 
treatment  of  acute  rheumatism,  in  daily 
amounts  of  from  15  to  45  grains.  The  usual 
statement  is  made  that  no  bad  effects  have 
been  noticed  from  its  use,  but  prudence  seems 
to  dictate  that  we  should  refrain  from  employ- 
ing it  in  practice  until  we  have  further  infor- 
mation concerning  its  action. 

PYBAZINE,    PYK.AZOL,    PYBAZO- 

LINE,  PYRAZOLONE.— These  derivatives 
of  pyrrol  have  had  various  formulas  assigned 
to  them.  According  to  A.  H.  Allen  (Fharm. 
Jour,  and  Trans.,  1890 ;  Am.  Jour,  of  Pharm., 
1892),  they  are  as  follows  : 

PymMHNJ;Nj^Ca     [_ 

(  N  ■  CH     ) 
P2/m2oZme,HN|;cH^CH,[. 

Pyrazolone,  w\-l^^^-^_\. 

These  substances  have  been  proposed  as  anti- 
pyretics, but  Dr.  Cerna  says  of  pyrazol  that  it 
lacks  antipyretic  properties,  but  has  been  used 
as  a  diuretic.  He  gives'  the  dose  as  from  15 
to  30  grains.  It  is  doubtful  if  any  of  these 
compounds  will  take  a  lasting  place  among 
remedies ;  certainly  they  can  not  now  be  said 
to  have  got  beyond  the  "experimental  stage. 

PYRETHBUM  (U.  S.  Ph.).  pyrethri  radix 
(Br.  Ph.),  or  pellitory,  is  the  root  of  Anacyclus 
Pyrethrum.  It  is  of  little  importance  from  a 
medical  standpoint.  When  chewed,  it  acts  as 
a  sialagogue  and  stimulant  of  the  mucous 
membrane  of  the  mouth,  and  has  been  em- 
ployed in  headache,  toothache,  paralysis  of  the 
tongue,  and  relaxation  of  the  soft  palate. 
From  20  to  60  grains  may  be  used.  In  the 
shape  of  a  tincture,  tinctura  pryethri  (U.  S. 
Ph.,  Br.  Ph.),  it  is  employed  by  dentists  to  re- 
lieve toothache  and  to  add  a  local  stimulating 
effect  to  tooth  washes. 

The  flowers  of  Pyrethrum  Parthenium  are 
often  substituted  for  chamomile  flowers,  and 
apparently  with  as  good  results. 

Pyrethrum  carneum  and  Pyrethrum  roseum 
furnish  the  Persian  or  Caucasian  insect  pow- 
der of  commerce,  and  Pyrethrum  cineraricefo- 
lium,  the  Dalmatian  variety,  which  is  rather 
more  active  than  the  others.  It  occurs  as  a 
yellow  or  yellowish-brown  powder,  and  is  the 
most  valuable  insecticide  known,  as  itis  without 
any  poisonous  effects  upon  man  or  the  higher 
animals,  at  least  in  the  quantities  commonly 
employed.  It  is  not  very  rapid  in  its  action, 
first  stupefying  or  intoxicating  the  insects 
which  come  in  contact  with  it,  but  death  ordi- 
narily follows  in  a  short  time.  Upon  the  eggs 
it  appears  to  have  but  little  effect,  and  on  that 
account  is  less  efficient  than  mercurials  for 
tha  destruction  of  bedbugs  and  roaches.  Upon 
ants  it  seems  to  have  rather  less  effect  than 
upon  the  other  insect  pests  of  the  household. 
It  is  of  importance  that  it  should  be  as  widely 
disseminated  as  possible,  and  for  this  purpose 
a  bellows  is  a  very  convenient  appliance.  One 
specially  adapted  for  the  purpose  may  be  found 
nearly  everywhere.    In  beds  infested  with  bugs 


PYRETINE 
PYKOZONE 


110 


the  powder  may  be  scattered  over  the  bedding 
as  a  temporary  measure,  and  rarely  causes  any 
inconvenience  beyond  in  some  instances  a 
slight  and  temporary  irritation  of  the  skin.  A 
small  quantity  sprinkled  on  hot  coals  will  clear 
a  room  of  flies  or  mosquitoes,  and  it  is  proba- 
ble that  for  sovei-al  hours  the  entrance  of  others 
will  be  prevented.  Pastils  are  made,  contain- 
ing small  quantities  of  nitre,  whicb  may  be 
employed  in  the  same  manner.  In  kitchens 
and  other  places  where  flies  are  abundant  it 
may  be  scattered  around  at  night,  the  apart- 
ment being  tightly  closed  until  morning,  with 
the  result  of  killing  all  there  are  present.  A 
solution  of  from  30  to  30  grains  in  half  a  gal- 
lon of  water  is  very  suitable  for  spraying  upon 
plants  infested  with  insects,  but  its  expense 
renders  its  range  of  usefulness  rather  limited. 
A  20-per-cent.  alcoholic  tincture,  diluted  as  de- 
sired and  applied  to  the  body,  is  very  effectual 
in  keeping  fleas,  etc.,  from  remaining  upon  the 
person.  Dogs,  cats,  and  other  animals  infested 
with  fleas  may  be  relieved  of  them  by  a  thor- 
ough dusting,  but  it  is  wise  to  select  some 
spot  remote  from  the  dwelling  to  do  this  in, 
and  if  possible  a  sandy  spot  .upon  which  the 
sun  shines  brightly  is  the  best,  as  the  dry  heat 
insures  the  death  of  the  insects ;  as  a  matter  of 
fact  they  are  unable  to  endure  exposure  to  the 
naked  rays  of  the  sun.  Fowls  may  be  treated 
in  the  same  manner,  being  held  head  down- 
ward in  a  barrel  and  the  powder  sifted  among 
their  feathers.  Poultry  houses,  pigeon  lofts, 
etc.,  may  be  freed  of  vermin  by  its  liberal  and 
frequent  employment.  It  is  hardly  necessary 
to  specify  every  purpose  to  which  it  may  be 
applied,  but  in  addition  to  the  foregoing  it 
may  be  employed  in  cabinets  for  furs  and 
woollen  fabrics,  and  in  almost  every  place 
where  insects  destructive  to  such  objects  are 
found.  The  recently  introduced  buffalo  bug, 
which  is  so  destructive  to  carpets  and  rugs, 
appears  to  be  but  little  affected  by  it.  Carbon 
bisulphide,  naphtha,  and  similar  petroleum 
products  are  almost  the  only  agent  effective 
for  their  destruction.  It  is  of  great  importance 
that  insect  powder  should  be  fresh,  as  it  loses 
its  virtues  on  keeping.  Much  of  it  is  inert 
and  worthless. — Russell  H.  Nevins. 

PYRETINE,  an  American  proprietary  an- 
tipyretic  and  analgetic,  is  said  to  be  a  mixture 
o±  acetanilide,  caffeine,  calcium  carbonate,  and 
sodium  bicarbonate.  It  has  not  come  into 
general  use. 

PYRIDINE  is  a  basic  substance  obtained 
from  bone  oil,  coal  tar,  naphtha,  and  other 
organic  materials  by  distillation.  It  also  oc- 
curs in  tobacco  smoke,  a  fact  which  has  led 
some  observers  to  credit  it  with  the  remedial 
action  tobacco  smoking  has  in  asthma.  When 
pure,  it  is  a  colourless,  volatile  liquid  with  a 
powerful  and  persistent  empyreumatio  odour 
and  a  pungent  taste.  It  is  freely  miscible  with 
water,  alcohol,  ether,  chloroform,  and  fatty 
oils.  Its  formula  is  CoHaN.  With  acids  pyri- 
dine forms  crystallizable  but  imstable  salts. 

Although  the  physiological  action  of  pyridine 
has  not  been  exhaustively  studied,  it  would 
seem  that  it  is  an  agent  of  most  vigorous 


action.  Locally  applied,  it  is  antiseptic.  Given 
in  small  doses,  according  to  De  Renzi,  it  stimu- 
lates cardiac  action  and  raises  the  blood- 
pressure.  This  action  on  the  blood-pressure, 
however,  is  denied,  and  many  maintain  that 
the  blood-pressure  is  lessened  by  it.  Inhaled,  it 
diminishes  bronchial  spasm  when  that  is  pres- 
ent, and  experiments  upon  animals  show  that 
it  quiets  irritability  of  the  respiratory  centre. 
In  large  doses,  however,  the  drug  is  actively 
poisonous,  causing  cyanosis  and  muscular 
feebleness  and  paralysis  from  action  upon  the 
motor  centres  and  nerves.  Death  may  result 
from  respiratory  paralysis. 

The  chief  therapeutical  employment  of  py- 
i-idine  is  in  the  relief  of  bronchial  asthma. 
The  treatment  was  introduced  by  Germain 
See.  A  drachm  of  the  drug  is  exposed  in  a 
saucer  in  a  small  room,  the  patient  remaining 
in  the  room  and  inhaling  the  pyridine-charged 
atmosphere  for  a  period  of  from  fifteen  to 
thirty  minutes  several  times  a  day.  Although 
the  treatment  is  exceedingly  disagreeable,  be- 
cause of  the  offensive  odour  of  the  drug,  it  is 
said  that  much  relief  follows  its  use,  the  respi- 
rations becoming  free  and  the  disease  often 
subsiding  after  a  number  of  exposures  to  the 
treatment  have  been  endured.  Instead  of  in- 
haling pyridine  thus,  a  solution  containing 
from  5  to  20  drops  in  3  oz.  of  water  may  be 
respired  by  atomization,  or  a  few  drops  may 
be  directly  inhaled.  Angina  pectoris  is  said 
to  be  benefited  by  the  internal  use  of  pyri- 
dine, from  5  to  10  minims  being  taken  daily 
and  the  dose  gradually  increased  until  25 
minims  are  taken  in  a  day.  In  cardiac  en- 
feehlement  it  is  said  to  exercise  a  beneficial 
effect,  and  has  even  been  thought  a  substitute 
for  digitalis.  The  antiseptic  action  of  pyridine 
may  be  made  use  of  in  the  treatment  of  gonor- 
rhcea,  an  injection  of  a  watery  solution  (1  to 
300,  or  even  stronger)  being  employed. 

Henky  a.  Griffin. 

PYROACETIC  ETHER  or  SPIRIT.— 

See  Acetone. 

PYRODINE.— See  Htdbacetin. 

PYROGALLIC  ACID,  PYROGALLOL 
(U.  S.  Ph.),  PYROGALLOLtTM  (Ger.  Ph.), 
is  a  trihydroxylbenzol  with  the  formula 
CbHoOs.  When  gallic  acid  is  heated  to  subli- 
mation it  is  decomposed  and  carbonic  acid  and 
pyrogallol  are  formed.  The  latter  substance 
occurs  in  long,  flattened,  prismatic  or  needle- 
like crystals,  very  light  in  weight,  of  a  pearly 
colour,  bitter  to  the  taste,  soluble  in  from  2i 
to  3  parts  of  water  and  also  in  alcohol  and  in 
ether.  It  fuses  at  339°  F.  and  boils  at  410° 
F.  It  is  a  strong  reducing  agent.  A  watery 
solution  of  it,  with  soda  or  potash,  as  well  as 
the  moistened  crystals  themselves,  becomes 
soon  of  a  reddish  or  dark-brown  colour  from 
oxidation,  and  it  readily  reduces  the  salts  of 
mercury,  silver,  gold,  and  platinum.  Pyro- 
gallic  acid  is  largely  used  in  connection  with 
nitrate  of  silver  in  photography,  and  also  in  the 
compositions  of  hair  dyes  and  marking  inks. 
To  its  property  as  a  reducing  agent  are  chiefly 
ascribed  also  its  therapeutic  effect^.  Pyro- 
gallic  acid  had  seldom,  if  ever,  been  employed 


Ill 


PYRETINE 
PYROZONE 


in  medicine  prior  to  1878,  when  Jariseh  first 
introduced  it  as  a  remedy  for  certain  cutaneous 
diseases.  The  diseases  for  which  he  especially 
recommended  it  were  psoriasis  and  lupus,  but 
it  has  also  been  found  of  more  or  less  value  in 
parasitic  diseases,  such  as  eczema  marginatum, 
in  epithelioma,  and  in  simple  chancre  otphage- 


In  psoriasis  it  is  generally  admitted  to  be  of 
considerable  value  when  applied  locally.  ■  It 
acts  with  less  energy  upon  the.  disease  than 
chrysarobin,  which  in  many  respects  it  resem- 
bles, but  is  more  energetic  in  its  action  than 
tarry  preparations.  It  is  odourless  and  but 
slightly  irritating  to  the  skin  (rarely  causing 
the  dermatitis  that  so  often  follows  applica- 
tions of  chrysarobin).  It  is  often  preferable  to 
chrysarobin  where  the  skin  does  not  tolerate 
the  latter,  as  upon  the  face,  or  in  individuals 
with  unusually  vulnerable  or  sensitive  skins. 
It  does,  however,  cause  irritation  at  times,  pro- 
ducing considerable  pruritus  and  occasionally 
follicular  papules  or  pustules,  which  may  re- 
quire a  temporary  suspension  of  its  use.  It 
stains  the  skin  and  clothing  only  slightly  less 
than  chrysarobin.  A  more  serious  objection 
to  its  use  when  incautiously  employed,  so  as  to 
permit  considerable  absorption,  lies  in  the  fact 
that  it  may  give  rise  to  grave  toxic  efEects. 
Attention  was  first  called  to  this  danger  by 
Neisser,  who  reported  a  case  of  fatal  intoxica- 
tion following  inunctions  of  one  half  the  body 
with  a  10-per-cent.  ointment,  the  surface  hav- 
ing afterward  been  covered  by  gutta-percha 
tissue  and  a  bandage.  The  symptoms  began 
in  two  hours  after,  with  rigors,  diarrhoea,  vom- 
iting, and  strangury.  The  next  day  the  urine 
was  very  dark-coloured  from  the  presence  of 
haemoglobin;  all  the  symptoms  became  aggra- 
vated, with  apathy,  dyspnoea,  exaggerated  re- 
flexes and  collapse,  followed  by  death  two  days 
later.  The  cause  of  death  was  stated  to  be 
decomposition  of  the  blood  with  hfemoglobinu- 
ria  and  nephritis  hsemoglobinurica.  Though 
pyrogallic  acid  is  a  more  dangerous  remedy 
than  chrysarobin  to  the  general  economy,  when 
applied  to  limited  areas  thereis  probably  little  to 
fear  from  it.  It  would  be  especially  objection- 
able in  a  ease  of  psoriasis  attended  with  much 
excoriation  or  eczema,  or  in  that  form  which 
approaches  the  character  of  an  exfoliative 
dermatitis.  The  mode  of  its  employment  in 
psoriasis  is  similar  to  that  of  chrysarobin.  A 
10-  to  15-per-cent.  ointment  is  thoroughly 
rubbed  into  the  affected  areas.  The  ointment 
is  preferable  to  preparations  with  traumatioin 
.or  gelatin,  as  well  as  to  plasters.  On  the  first 
indication  of  gastro-intestiual  disturbance, 
strangury,  or  smoky  urine,  the  remedy  should  be 
at  once  discontinued.  In  case  of  decided  toxic 
symptoms  Neisser  recommends  subcutaneous 
injections  of  ether,  alcoholics  frequently  re- 
peated, energetic  stimulation  of  the  surface, 
and  the  inhalation  of  oxygen. 

In  lupus  pyrogallic  acid  has  pro  ved  Itself  a 
remedy  of  no  little  value.  It  is  especially 
suited  to  the  more  superficial  forms.  It  acts 
on  continued  application  as  a  mild  escharotic, 
and,  while  it  has  but  little  effect  upon  the  epi- 
dermis, it  has  a   selective   action   upon  the 


diseased  subepidermal  tissue,  in  this  respect 
resembling  the  action  of  the  arsenical  pastes. 
The  rapidity  of  its  action  is  increased  when 
the  epidermis  is  intact  by  first  applying  a 
moderately  strong  solution  of  caustic  potash. 
An  ointment  of  the  strength  of  from  10  to  20 
per  cent,  is  applied  on  lint  and  covered  with 
a  piece  of  gutta-percha  tissue,  which  may  bo 
made  to  adhere  to  the  surrounding  skin  by 
moistening  its  edges  with  chloroform.  The 
applications  are  renewed  daily  and  continued 
for  from  two  to  seven  days  or  until  the  lupus 
patch  has  become  converted  into  a  gray  pul- 
taceous  mass,  when  the  pyrogallic  acid  is 
replaced  by  an  ointment  of  iodoform  or  the 
emplastrum  hydrargyri.  This  treatment  is 
repeated  at  intervals  so  long  as  any  lupus  tu- 
bercles are  apparent.  The  scars  left  are  smooth 
and  supple.  IBesnier  uses  a  satui'ated  solution 
of  pyrogallic  acid  in  ether,  which  is  brushed 
over  the  lupus  patch  and  covered  in  with 
traumaticin.  repeating  the  applications  as  above 
described.  Brocq  prefers  a  solution  of  pyio- 
gallic  acid  with  salicylic  acid  (10  per  cent,  of 
each)  in  collodion. 

Epithelioma  of  the  skin  has  been  treated 
successfully  with  pyrogallic  acid  employed  ac- 
cording to  the  same  methods  as  those  recom- 
mended for  lupus. 

In  chancrous  ulcerations  Vidal  has  found 
this  remedy  eflScaeious.  For  simple  chancre  he 
used  a  salve  consisting  of  1  part  of  pyrogallic 
acid  in  4  parts  of  lard  or  vaseline,  and  for 
phayedcena  a  powder  composed  of  pyrogallic 
acid  and  starch  in  the  proportion  of  one  to 
four. — Edward  Bennet  Beonson. 

PYEOGLYCERIN.— See  Nitroglycerin. 

PYEOLIGNEOTJS    ACID.— This    is    an 

impure  acetic  acid,  obtained  by  the  destructive 
distillation  of  wood.  It  is  the  source  of  the 
acetic  acid  of  commerce  and  of  the  pure  acetic 
acid  of  the  pharinacopoeias.  Crude  pyroligne- 
ous  acid,  acetum  pyrolignosum  crudum  ((9er. 
Ph.),  and  the  rectified  acid,  acetum  pyroligno- 
sum rectificatum  (Ger.  Ph).,  are  used  topically 
for  the  same  purposes  as  acetic  acid(}.  v.). 

PYBOXYLIIT  (Br.  Ph.),  pyroxylinum 
(TJ.  S.  Ph.),  or  gun  cotton,  is  official  only  be- 
cause it  is  used  in  the  preparation  of  collodion. 

PYROZONE. — This  name  was  at  first  ap- 
plied by  an  American  firm  of  manufacturing 
pharmacists,  Messrs.  McKesson  and  Robbins, 
of  New  York,  to  a  thick  syrupy  liquid  consist- 
ing of  pure  hydrogen  dioxide,  from  the  fact 
that  when  a  fluffy  fabric  of  silk  or  the  like  was 
saturated  with  the  liquid  and  warmed  slightly 
it  took  fire  and  burned  "furiously,  as  sub- 
stances do  in  oxygen,  presumably  producing 
both  fire  and  ozone  "  (Coblehtz). 

Pure  pyrozone  speedily  undergoes  decompo- 
sition ;  hence  it  is  furnished  in  solutions  of 
certain  standard  strengths.  The  S-per-cent. 
solution  in  water  corresponds  in  strength  to 
the  aqua  hydrogenii  dioxidi  of  the  IT.  S.  Ph., 
and  is  said  to  be  purer  and  more  stable  than 
that  preparation ;  also  to  admit  of  concentra- 
tion by  evaporation  without  appreciable  loss  of 
hydrogen  dioxide.    The  use  of  this  solution  is 


QUASSIA 
QUININE 


112 


the  same  as  that  of  hydrogen  dioxide  (see  vol. 
i,  page  503). 

The  5-per-cent.  solution  in  ether  and  the  S5- 
per-cent.  solution  in  ether  have  been  found  to 
be  exceedingly  &&c\eni  stimulating  and  caustic 
applieations,  particularly  valuable  in  checking 
suppuration,  notably  that  of  pyorrhcea  alveo- 
laris. 


QUASSIA  (TJ.  S.  Ph.),  quassicB  lignum  (Br. 
Ph.),  lignum  quassice  (Ger.  Ph.),  is  the  wood  of 
Picmna  (Quassia)  excelsa,  a  tropical  and  semi- 
tropical  tree.  It  is  a  simple  bitter  tome  which 
appears  to  have  no  injurious  effects  upon  the 
economy  unless  it  is  talien  in  enormous  doses, 
when  it  acts  as  an  irritant  of  the  mucous  mem- 
brane of  the  stomach  and  as  a  uauseant.  It  is 
a  very  useful  bitter  in  all  cases  of  la^ck  of  ap- 
petite and  atony  of  the  stomach,  and  is  particu- 
larly applicable  in  malarial  afEections  in  which 
a  stomachic  is  desirable.  Its  action  depends 
upon  a  principle,  quassiin,  or  quassin,  which 
■may  be  substituted  for  the  drug  or  its  preparar 
tions  in  doses  of  -J-  a  grain.  The  wood  readily 
•imparts  its  properties  to  cold  water,  and  cups 
■are  made  of  it  in  which  water  is  allowed  to 
•stand  for  two  or  three  hours,  or  until  it  becomes 
distinctly  bitter,  and  then  drank.  This  method 
■  of  administering  it  used  to  be  quite  common 
•and  is  a  very  useful  one,  as  the  cups  retain 
their  properties  for  a  long  time  and  are  always 
ready  for  use.  The  extract,  extractum  guassics 
(U.  S.  Ph.,  Br.  Ph.),  may  be  given  in  doses  of 
from  1  to  2  grains.  It  is  perhaps  to  be  pre- 
ferred to  the  other  preparations  because,  bulk 
for  bulk,  it  contains  a  larger  amount  of  the 
bitter-tonic  principle  than  any  of  them.  The 
fluid  extract,  extractum  quassice  fluidum  (U.  S. 
Ph.),  is  also  a  powerful  preparation ;  it  is  used 
in  5-  to  10-drop  doses.  The  infusion,  infusum 
quassice  (Br.  Ph.).  possesses  all  the  properties 
of  the  drug,  but  is  somewhat  objectionable  on 
account  of  the  bulk  of  the  dose,  from  1  to  2  fl. 
oz.  The  tincture,  tinctura  quassice  (U.  S.  Ph., 
Br.  Ph.),  is  used  oftener  as  an  ingredient  of 
tonic  mixtures  than  by  itself ;,  it  may  be  given 
in  doses  of  from  1  to  2  fl.  drachms. 

An  infusion  of  2  oz.  of  quassia  in  a  pint  of 
boiling  water,  when  of  the  proper  temperature, 
is  used  as  an  enema  for  causing  the  expulsion 
of  ascarides,  and  is  very  efficient.  The  same 
eilect  is  said  to  be  produced  when  quassia  is 
administered  by  the  mouth,  but  the  enema  is 
much  surer.  By  macerating  10  parts  of  the 
wood  in  50  of  water  for  twenty-four  hours  and 
adding  enough  sugar  or  molasses  to  make  the 
strained  infusion  somewhat  syrupy,  a  mixture 
is  formed  which  is  very  effectual  as  a,  fly-poison. 
It  may  be  exposed  on  a  plate,  or  on  cloth  or 
paper  soaked  in  it  and  hung  up.  It  is  perfect- 
ly harmless. — Russell  H.  Nevins. 

QXTEBB.ACHO,  aspidosperma  (XJ.  S.  Ph.), 
is-  the  bark  of  Aspidosperma  Quebracho,  or 
quebracho  bianco,  so  named  from  the  light 


colour  of  its  wood.  The  bark  employed  is  col- 
lected from  old  trees  after  the  corky  layer  is 
well  developed.  The  first  detailed  description 
of  the  drug  came  from  Penzoldt,  who  asserted 
that  by  its  use  some  forms  of  dyspnoea  depend- 
ing upon  •  disturbances  of  the  circulatory  or 
respiratory  apparatus  could  be  diminished  or 
entirely  removed.  He  maintained  that  no 
deleterious  effects  were  produced  on  other  or- 
gans by  its  administration.  Although  the 
drug  has  a  disagreeable  taste,  and  occasionally 
causes  nausea  or  diaphoresis,  or  salivation  after 
its  ingestion,  there  seemed  to  him  to  be  no 
lowering  of  the  pulse-rate  accompanying  the 
diminished  respiratory  frequency  {Die  Wir- 
kungen  Quebrachodrogin,  Erlangen,  1881). 
Penzoldt  believes  that  quebracho  acts  by  in- 
creasing the  power  of  the  haemoglobin  to  take 
up  oxygen,  but  he  found  that  when  it  was 
given  in  an  overdose  the  oxygen  was  retained 
in  the  blood  and  metabolism  was  diminished. 

Five  alkaloids  have  been  derived  from  que- 
bracho :  aspidospermatine,  which  is  believed 
to  hold  the  active  principles  of  all  the  other 
alkaloids ;  aspidosam-ine,  quebrachine,  hypo- 
quebrachine  and  quebrachamine.  Of  these, 
quebrachine  is  the  one  most  frequently  em- 
ployed. Aspidospermine,  an  impure  mixture 
of  the  alkaloids,  is  sold  in  the  market  as  a  fluid 
extract  and  as  a  solid  extract.  The  dose  of 
the  former  is  from  i^  to  •J  a  fl.  drachm  ;  that  of 
the  latter,  from  1  to  3  grains.  Penzoldt  rec- 
ommends quebracho  in  asthma  accompanied 
by  emphysema,  even  in  the  presence  of  pleurisy 
or  bronchitis.  He  praises  it,  also,  in  bronchial 
asthma  and  in  all  cases  of  dyspncea  arising 
from,  cardiac  disturbances,  in  which  compensa- 
tion is  well  established.  In  dyspnoea,  however, 
due  simply  to  a  weakly-acting,  diseased  heart, 
it  is  not  recommended,  since  it  lacks  the  in- 
fluence of  digitalis  upon  the  ventricles.  Flint 
gave  quebracho  cordial  praise  in  all  cases  of 
dyspnoea,  particularly  when  this  symptom  was 
caused  by  mitral  insufficiency.  In  the  absence 
of  other  organic  disease,  he  used  quebracho  for 
the  symptom  dyspnoea  {Med.  News  and  Ab- 
stract, May,  1881,  p.  273).  The  drug  has  been 
employed,  also,  for  the  relief  of  urwmic  dysp- 
noea, but  it  is  to  be  doubted  if  it  is  as  valuable 
in  this  emergency  as  other  remedies ;  as  a  stom- 
achic tonic,  it  formerly  enjoyed  some  repute. 
After  prolonged  use,  quebracho  seems  to  cause 
some  disturbance  of  the  sympathetic  nervous 
system. 

Like  many  other  drugs,  quebracho  has  been 
recommended  for  the  protection  and  stimula- 
tion of  wounds ;  it  has  been  superseded,  of 
course,  by  other  substances. 

The  dose  of  the  fluid  extract,  extractum 
aspidospermatis  fluidum  {U.  S.  Ph.),  is  from  15 
mmiras  to  1  fl.  drachm.  The  non  official 
preparations  of  quebracho  are  a  tincture  and  a 
wine.  The  dose  of  the  former  is  from  10  to  20 
drops  ;  that  of  the  latter,  from  J  to  1  fl.  drachm. 

Quebrachine,  one  of  the  most  active  of  the 
alkaloids  of  quebracho,  has  been  used  instead 
of  the  original  drug.  It  appears  in  the  mar- 
ket as  the  hydrochloride  and  the  sulphate,  of 
which  the  dose  is  from  1  to  3  grains. 

Samuel  M.  Brickner. 


113 


QUASSIA 
QUININE 


QXniBCUS. — See  Oak  bark  and  Acorns. 

QTTICKLIME. — See  under  Lime  (vol.  i,  p. 
583). 

axnCKSILVEB..— See  Mercury. 

QTJILLAIA,  quillaja  (U.  S.  Ph.),  cortex 
mdllaim  (Ger.  Ph.),  or  soap  bark,  is  the  inner 
bark  of  Quillaia  Saponaria,  a  rosaceous  tree 
indigenous  to  Chile  and  Peru,  and  cultivated 
in  northern  India.  It  contains  saponin,  Cio 
HsoOio,  by  virtue  of  which  it  has  the  property 
of  producing  a  froth  when  rubbed  in  the 
presence  of  water.  It  has  been  used  topically 
to  some  extent  as  a  detergent.  The  use  of  the 
powder  as  a  sternutatory  has  been  suggested. 

Kobert  (GtrlU.  f.  Iclin.  Med.,  July  25,  1885) 
has  recommended  quillaia  as  an  expectormit. 
He  says  that  it  is  five  times  as  rich  as  senega 
in  saponin,  which  he  regards  as  its  active  prin- 
ciple ;  that  it  is  rich  in  sugar  also,  and  is  free 
from  the  substance  to  which  the  bad  taste  of 
senega  is  due ;  that  patients  tolerate  it  better 
than  senega;  that  it  seldom  gives  rise  to 
vomiting  and  diarrhoea ;  and  that  it  has  a  de- 
cided expectorant  action.  Kobert  used  a  de- 
coction of  the  strength  of  5  parts  of  quillaia  to 
200  of  water,  in  tablespoonful  doses  for  adults 
and  in  teaspoonful  doses  for  children.  These 
statements  having  been  confirmed  by  Gold- 
schmidt,  Maslovsky  (Russh.  Med.,  1886,  No.  36 ; 
Therap.  Oaz.,  May,  1887)  employed  it  in 
twelve  cases,  using  the  preparation  recom- 
mended by  Kobert,  with  the  addition  of  syrup. 
Two  of  the  patients  had  pulmonary  emphy- 
sema, one  had  interstitial  pneumonia  with 
bronchiectasis,  four  had  pulmonary  iuhercv^ 
losis,  one  had  pleuropneumonia,  three  had 
croupous  pnettmonia,  and  one  had  syphilitic 
stenosis  of  the  right  bronchus.  Maslovsky  con- 
cluded from  his  observation  of  its  action  in 
these  cases  that  quillaia  did  not  irritate  the 
gastro-intestinal  tract :  that  it  increased  the 
discharge  of  sputa ;  that  it  soothed  cough  ;  and 
that,  on  the  whole,  it  was  preferable  to  senega 
as  an  expectorant,  although  it  might  give  rise 
to  an  attack  of  haemoptysis  if  there  was  a 
tendency  to  that  accident,  in  which  case  it  was 
contra-indicated,  and  although  in  some  cases 
of  phthisis  it  might  intensify  the  cough  without 
facilitating  expectoration.  The  tincture,  tinc- 
tnra  quillajoe  (U.  S.  Ph.),  is  used  almost  wholly 
as  an  emulsifying  agent ;  it  may  be  given  in- 
tpi'nally  in  doses  of  from  5  to  35  minims. 
Powdered  quillaia.  mixed  with  sugar,  may  be 
given  in  doses  of  from  1  to  6  grains.  It 
should  be  borne  in  mind  that  saponin  is  de- 
cidedly poisonous,  acting  as  a  paralyzer  to  the 
centrnl  nervous  system,  and  that  some  caution 
is  therefore  necessary  in  the  employment  of 
quillaia. 

aUILLAIN.— See  Saponin. 
Q.TJINALGENE.— See  Analgene  and  Ben- 

ZANALGENE. 

ainNASEPTOL.— See  Diaphthol. 

aUINCE-SEED.— See  Ctdonium. 

CtTTIIfETTTM.  —  This  preparation  is  de- 
scribed as  a  mixture  of  other  cinchona  al- 
kaloids than  quinine  in  which  cinchonidine 
predominates.     It  is  soluble  in  water.    It  has 


been  recommended,  in  doses  of  from  1  to  8 
grains,  as  an  antiperiodic  m  malarial  affec- 
tions. 

aUINIDINE.— This  is  an  alkaloid  occa- 
sionally found  in  cinchona  bark.  It  is  isomeric 
with  quinine.  The  alkaloid  itself  and  the  bi- 
sulphate,  the  citrate,  the  dihydrobromide,  the 
hydrochloride,  the  sulphate,  and  the  tannate 
have  been  employed.  The  sulphate,  quini- 
dince  sulphas  (U.  S.  Ph.),  may  be  given  in 
doses  half  as  large  again  as  those  of  quinine, 
and  for  the  same  purposes.  It  is  very  bitter. 
The  tannate  is  almost  tasteless.  It  does  not 
appear  that  quinidine  has  any  advantages  over 
quinine. 

QTTININE  is  the  principal  alkaloid  of  the 
bark  of  the  trees  Cinchona  flava.  Cinchona 
pallida,  and  Cinchona  rubra.  To  be  accepted 
by  the  U.  S.  Ph.,  the  barks  must  contain  at 
least  5  per  cent,  of  the  total  alkaloids  and  at 
least  2-.5  per  cent,  of  quinine.  Associated  with 
many  other  alkaloids,  quinine  exists  in  greatest 
abundance  in  the  bark  of  Cinchona  flava  (yel- 
low cinchona).  It  is  isomeric  with  quinidine 
and  quinicine,  the  latter  an  artificial  compound. 
Quinine  was  first  separated  and  identified  in 
1820,  although  the  bark  had  been  in  use  in  Eu- 
rope for  nearly  two  centuries,  and  in  South 
America  from  time  immemorial.  From  a  solu- 
tion of  its  salts,  quinine  may  be  precipitated  as  a 
crystalline  hydrate  by  an  alkali ;  after  subse- 
quent dehydration,  the  alkaloid  appears  as  a 
white,  opaque  crystalline  mass.  It  is  of  an  in- 
tensely bitter  taste,  and  is  but  sparingly  soluble 
in  water,  although  it  dissolves  freely  in  alco- 
hol, in  ether,  in  benzol,  and  in  chloroform.  To 
distinguish  quinine  from  salicin,  the  former 
may  be  dissolved  in  concentrated  sulphuric 
acid  with  the  production  of  only  a  faint  yel- 
low colour.  Heated  highly  on  platinum  foil, 
quinine  burns  entirely,  leaving  no  ash. 

The  salts  of  quinine  in  solution  have  a  beau- 
tiful blue  fluorescence.  They  divert  the  polar- 
ized ray  to  the  left.  The  salts  vary  as  to  their 
solubility.  Thus  the  sulphate  is  but  sparingly 
soluble  in  water,  whereas  the  bisulphate  and 
the  hydrobromide  and  hydrochloride  dissolve 
easily  in  water.  This  becomes  of  importance 
in  the  administration  of  the  drug. 

Although  the  bark  of  the  cinchona  trees  was 
introduced  into  Europe  early  in  the  seven- 
teenth century  by  the  Countess  Chinchon,  who 
had  been  cured  of  an  intermittent  fever  by  its 
use  in  Peru,  the  influence  of  the  Church  was 
sufficiently  strong  to  prevent  its  general  use. 
And  it  was  not  until  Jesuit  missionaries  later 
brought  quantities  of  the  bark  to  the  conti- 
nent that  its  use,  dictated  by  popular  demand 
because  of  the  cures  it  produced,  overcame 
priestly  prejudice.  It  has  since  then  become 
one  of  the  world's  staple  articles  of  commerce — 
so  much  so  that  when  the  South  American 
supply  threatened  to  run  short,  successful 
transplantation  was  resorted  to.  As  a  physio- 
logical study  of  the  drug,  this  extract  from  the 
Thesaurus  novus  experientice  medicm  aureus 
(Basel,  1704)  will  prove  of  interest  and  most  of  it 
will  bear  the  light  of  the  present  day :  "  On  ac- 
count of  its  bitter  taste,  it  is  also  known  as 


QUININE 


114 


'  earth-gall.'  Supreme  virtues  exist  in  it  when 
used  in  liver,  spleen,  and  joint  diseases,  jaundice, 
and  dropsy ;  for  which  purposes  a  powder 
[made  from  it]  is  mixed  with  anise-seeds  and 
drunk  in  beer  and  wine.  It  induces  the  men- 
strual flow  and  restores  a  lost  appetite.  It 
rids  the  body  admirably  of  pin-worms,  if  an 
infusion  of  it  is  spread  on  a  cloth  over  the 
abdomen  ....  It  is  valuable  above  all  in 
the  treatment  of  tertian  and  quartan  fever." 
Though  old  Helmont,  the  compiler,  placed  the 
most  important  indication  of  the  drug, last  in 
his  category,  one  can  see  that  the  indications 
which  call  ior  quinine  have  not  varied  much 
in  the  last  two  hundred  years.  The  alkaloid 
and  its  salts  are  used  to-day  for  many  phases 
of  disease  for  which  there  is  no  more  primary 
indication  than  in  the  ancient  medical  tale  of 
our  fathers.  Rheumatism  and  typhoid  fever 
were  formerly  the  diseases  cured  specifically  by 
quinine ;  and  there  are  still  many  physicians 
who  regard  it  as  more  than  valuable  in  these 
ailments.  Its  efficacy  in  intermittent  fevers  is 
classical,  however,  and  even  fiction  has  helped 
to  establish  its  permanency,  as  in  Twenty 
■Thousand  Leagues  under  the  Sea. 

In  their  physiological  action,  the  alkaloid 
and  its  salts  are  so  nearly  identical  that  they 
will  be  considered  together,  only  such  pecul- 
iarities of  each  as  recommend  it  for  particular 
uses  being  specified.  An  enumeration  of  the 
ofBcinal  salts  follows :  Quinina  (U.  S.  Ph.),  qui- 
nine (Br.  Ph.),  is  the  alkaloid  proper.  Its  recog- 
nised salts  are  :  quinince  bisulphas  (U.  S.  Ph.), 
acid  quinine  sulphate  (Br.  Ph.),  quinines  hydro- 
bromas  (U.  S.  Ph.),  quininm  hydrochloras  (U.  S. 
Ph.,  Br.  Ph.),  chininum  hydrochhricum  (Ger. 
Ph.),  quinines  sulphas  (U.  S.  Ph.,  Br.  Ph.),  chi- 
ninum sulfuricum  (Ger.  Ph.),  quinince  valeri- 
anas  (U.  S.  Ph.),  and  chininum  tannicum  (Ger. 
Ph.).  In  the  U.  S.  Ph.  there  is  also  an  officinal 
double  salt,  the  citrate  of  iron  and  quinine, /er«' 
et  quinines  citras  (U.  S.  Ph.,  Br.  Ph.),  chininum 
ferro-citricum  (Ger.  Ph.),  which  contains  13  per 
cent,  of  quinine.  Among  other  numerous  salts 
of  the  alkaloid  that  have  been  praised  for  some 
virtue  or  other  are  the  arsenite,  the  hydro- 
chloride with  urea,  the  lactate,  and  the  acetate. 
The  bichloride  of  quinine  is  another  salt  but 
recently  added  to  the  long  list  of  those  that 
have  been  compounded  for  some  special  pur- 
pose. 

In  general,  it  may  be  stated  that  the  effects 
of  quinine,  as  manifested  upon  the  body  and 
its  organs,  depend  upon  the  dose.  Whereas 
small  doses  are  stimulating  and  tonic  in  their 
influence,  large  doses  administered  to  the  same 
individual  are  sedative  and  depressing.  Par- 
ticularly is  this  true  of  the  circulatory  and 
nervous  systems,  which  respond  well  and 
quickly  to  the  action  of  the  drug.  The  various 
peculiar  manifestations  observed  in  the  organs 
of  special  sense,  in  the  cerebrum,  in  the  skin, 
and  in  the  internal  organs  may  be  summed  up 
in  the  universal  harbour  of  medical  refuge — 
personal  idiosyncrasy.  Yet,  though  it  is  un- 
questionable that  some  individuals  are  more 
susceptible  to  the  subtleties  of  this  than  to  those 
of  other  alkaloids,  it  should  never  be  forgotten 
by  the  physician  that  quinine  is  not  an  indif- 


ferent drug  which  can  be  administered  regard- 
less of  dose  and  of  the  personal  element. 
While  it  would  be  perfectly  safe,  for  example, 
to  administer  from  6  to  10  grains  of  quinine 
to  an  otherwise  healthy  woman  who  was  at  the 
same  time  pregnant  and  suffering  from  mala- 
rial disease,  it  would  probably  induce  an  abor- 
tion or  miscarriage  in  a  woman  with  intermittent 
fever  whose  general  condition  was  deteriorated 
by  excessive  work  and  worry.  Again,  a  man 
who  required  a  stimulant  tonic  might  do  very 
well  on  a  pill  or  a  mixture  containing  quinine, 
or  he  might  show  such  decided  personal  suscep- 
tibility to  the  drug  that  its  withdrawal  would 
be  imperative.  The  personal  element,  then,  is 
as  important  in  the  administration  of  the 
cinchona  alkaloid  and  its  salts  as  it  is  in  that 
of  any  othor  drug  which  produces  pronounced 
effects.  In  respect  to  the  differences  mani- 
fested by  different  alkaloids  of  cinchona,  cin- 
ohonine  seems  no  less  inert  than  quinine,  but 
its  action  is  not  so  prolonged  or  so  intense. 

The  symptoms  of  the  condition  known  as 
cinchonism  appear  after  the  use  of  either,  but 
in  the  case  of  cinchonine  the  familiar  buzzing 
in  the  ears  is  not  so  early  a  phenomenon,  but 
an  intense  frontal  dnlness  accompanied  by 
praecordial  distress,  subsultus  tendinum,  and 
faintness  with  other  severe  nervous  manifesta- 
tions, appear.  Indeed,  it  would  seem  that  it 
requires  a  smaller  dose  of  cinchonine  to  pro- 
duce a  physiological  effect  than  of  quinine. 

The  causation  of  cinchonism  has  been  a 
puzzle  to  physiologists.  Of  its  existence,  how- 
ever, there  is  daily  proof.  There  are  few  indi- 
viduals who  have  taken  quinine  in  moderate 
doses  for  any  length  of  time  who  have  not  ex- 
perienced some  of  the  phenomena  which  mark 
its  presence.  Therapeutic  doses  of  quinine  (5 
to  10  grains)  produce  the  flrst  symptoms. 
These  are,  usually,  a  buzzing  or  ringing,  a  feel- 
ing of  fulness  or  heaviness  or  both  in  the  head, 
and  there  may  be  partial  deafness.  If  the 
drug  is  withdrawn,  these  symptoms  disappear 
spontaneously.  Should  its  use  be  continued  or 
larger  doses  given,  there  is  an  exaggeration 
of  the  symptoms  mentioned,  with  those  of 
cerebral  congestion.  The  deafness  becomes 
almost  complete,  if  not  absolutely  so  ;  an  amau- 
rosis is  developed  which  may  well  be  called 
toxic ;  the  face  is  flushed,  and  there  are  de- 
cided giddiness  and  an  intense  feeling  of  dis- 
tention in  the  head.  An  ataxic  gait  may 
accompany  the  other  functional  disturbances. 
After  the  administration  of  more  than  a  physio- 
logical dose,  pronounced  symptoms  of  poison- 
ing show  themselves  in  rapid  succession.  At 
first  there  is  a  heaviness  in  the  head,  with 
tinnitus  aurium  ;  then  there  are  confused  and 
disturbed  trains  of  thought,  followed  often  by 
delirium.  If  the  dose  has  been  sufficiently 
large,  loss  of  consciousness,  complete  deafness, 
and  blindness  ensue.  The  sensibility  of  the 
skin  disappears,  and  the  limbs  are  powerless. 
Intense  paresis,  sometimes  paralysis,  follows. 
The  respiratory  movements  are  "not  free,  and 
death  may  take  place  in  coma  or  in  delirium, 
usually  with  symptoms  of  asphyxia.  The  treat- 
ment of  such  poisoning  is  direct  and  indirect. 
If  the  patient  is  seen  sufiBciently  early,  gastric 


115 


QUININE 


lavage  may  be  employed.  If  the  systemic 
symptoms  are  already  very  pronounced,  treat- 
ment must  be  directed  toward  them.  The 
subcutaneous  use  of  cardiac  and  respiratory 
stimulants  is  indicated,  and  all  measures  which 
tend  to  restore  the  flagging  heart  and  circula- 
tion should  be  resorted  to.  Lesser  degrees  of 
poisoning  by  quinine  evoke  similar  but  not  so 
mtense  symptoms,  the  difference  being  in  de- 
gree only.  The  toxic  dose  is  difficult  to  esti- 
mate ;  44  grains  given  in  divided  doses  in  fifty 
hours  have  caused  death,  and  12  grains  are 
recorded  as  having  caused  amaurosis.  In  this, 
as  in  the  therapeutic  effect  to  be  obtained, 
personal  idiosyncrasy  plays  an  important  r61e. 

The  deafness  frequently  following  the  use  of 
quinine  usually  vanishes  on  the  withdrawal  of 
the  drug.  The  blindness,  however,  may  be 
permanent,  but  is  frequently  only  temporary. 
Von  Graefe,  Gruening,  and  Knapp  have  re- 
ported cases  of  permanent  blindness,  and  there 
are  many  cases  recorded  of  temporary  loss  of 
vision.  If  a  patient  recovers  from  quinine 
poisoning,  he  is  likely  to  have  great  muscular 
weakness  for  some  days.  The  other  symptoms 
gradually  subside,  with  the  exceptions  above 
noted. 

The  influence  of  quinine  upon  the  cerebrum, 
the  spinal  cord,  and  the  organs  of  special  sense 
can  in  part  be  determined  by  a  consideration 
of  the  phenomena  of  cinchonism.  Other  con- 
siderations, however,  require  a  somewhat  more 
detailed  investigation  into  the  action  of  the 
drug  upon  the  various  organs  of  the  body. 
When  quinine  is  given  in  small  doses  (6  to 
8  grains),  the  tone  and  elasticity  of  the  cerebral 
vessels  are  enhanced,  which  would  probably 
account  for  the  observation  of  Brown-Sequard 
that  quinine  increases  the  number  of  epi- 
leptic seizures.  The  disturbances  of  sight 
and  hearing  after  the  administration  of  the 
drug  are  believed  to  be  due  to  a  direct  or  indi- 
rect congestion  of  the  peripheral  sense  organs, 
as  animals  poisoned  by  quinine  are  found  to 
have  great  congestion  of  the  middle  ear  and 
labyrinth.  So  severe  may  this  congestion  be- 
come and  under  such  pressure  may  it  exist 
that  serous  or  even  bloody  exudation  ensues. 
In  a  series  of  experiments  to  determine  the 
lesionin  quinine  blindness,  DeSchweinitz(OpA- 
thal.  Rev.,  February,  1891)  found  that  the  oph- 
thalmoscopic picture  in  dogs  was  similar  to  that 
seen  in  human  beings  with  quinine  amaurosis, 
blurring  of  the  edges  of  the  optic  discs,  and  in 
one  case  obliteration  of  the  vessels  of  the  optic 
disc.  In  all,  the  pupils  were  immovably  di- 
lated. In  one  case  there  was  a  decided  dilata- 
tion of  the  blood-vessels,  the  central  vein 
being  plugged  with  a  clot,  and  white  thrombi 
filled  the  smaller  veins.  In  the  corneas  were 
found  dilatation  of  the  circuracellular  lymph 
spaces,  and  degeneration  of  the  protoplasm  of 
•the  cell.  Proof  seems  to  exist  that  the  action 
of  quinine  upon  the  cortical  centres  is  a  stimu- 
lant one.  Thus  persons  who  have  been  in  the 
habit  of  taking  the  drug  for  some  time  seem 
to  feel  less  energetic  and  less  active  after  its 
withdrawal. 

Although  the  influence  of  quinine  upon  the 
spinal  cord  and  the  peripheral  nerves  m  man 


has  not  been  scientifically  demonstrated,  it  is 
well  known  that  in  lower  animals  it  produces, 
in  small  doses,  lessening  of  reflex  activity  and, 
in  larger  doses,  paresis  of  the  reflex  centres, 
which  is  usually  permanent.  It  would  seem 
that  similar  influences  are  produced  upon  the 
central  and  peripheral  systems  of  man,  for  re- 
flex disturbances  whose  origin  may  be  in  the 
cord  or  in  the  cortex  are  inhibited  by  the  judi- 
cious use  of  quinine.  It  is  true  that  this  result 
may  be  called  forth  by  a  stimulation  of  the 
inhibitory  centres,  but  the  influence  of  toxic 
doses  upon  the  gait,  producing  as  they  do 
ataxic  movements,  would  seem  to  imply  an 
impairment  of  the  reflex  arc.  The  safest  state- 
ment that  can  be  made  in  the  light  of  our 
present  knowledge  is  probably  that  upon  the 
spinal  cord  quinine  has  the  same  general  effect 
as  upon  the  body  at  large  ;  in  small  doses  it  is 
stimulant ;  in  larger,  still  therapeutic  doses,  it 
has  a  sedative  effect. 

Upon  the  stomach  and  intestines  quinine 
acts,  in  small  or  moderate  doses,  as  a  simple 
bitter.  Gastric  digestion  and  the  production 
of  gastric  juice  seem  to  be  favoured  by  its  ad- 
ministration. Given  for  a  long  period  of  time, 
it  is  apt,  however,  to  bring  about  a  catarrhal 
gastritis,  and,  when  administered  in  too  concen- 
trated a  form,  it  is  very  irritating  to  the  gastric 
mucous  membrane.  Nausea  and  even  vomiting 
sometimes  follow  its  introduction  into  the  stom- 
ach. A  constipating  efl'ect  is  sometimes  ob- 
served after  the  early  use  of  the  drug,  which  is 
subsequently  superseded  by  diarihoea.  These 
effects  are  undoubtedly  local,  due  to  liberation 
of  the  tannic  acid  which  is  innate  in  the  alka- 
loid. When  introduced  into  the  rectum  in 
somewhat  larger  doses  than  usual,  quinine 
produces  its  physiological  efi'ects  upon  the 
organism ;  but  frequently  it  is  so  irritating 
to  the  rectal  mucous  membrane  that  it  can  not 
be  administered  in  this  manner.  Its  absorp- 
tion from  the  alimentary  tract  is  hastened  by 
previous  purgation,  and  in  this  instance  the 
catharsis  is  best  accomplished  by  mild  meas- 
ures, hydragogues  and  cholagogues  being  con- 
tra-indicated. 

That  quinine  is  readily  dissolved  by  acids 
and  precipitated  by  alkalies  is  well  known. 
Thus  the  acid  gastric  juice  renders  it  suitable 
to  be  absorbed  from  the  intestinal  mucous 
membrane,  while  the  intestinal  juices  are  apt 
to  cause  its  precipitation.  It  has  been  shown 
that  when  a  quinine  salt  passes  unchanged 
into  the  intestine  it  is  removed  from  the  body 
with  the  fasces  in  the  form  of  insoluble  com- 
pounds. It  would  naturally  be  supposed,  there- 
fore, that  the  alkaline  blood  would  also  cause 
its  precipitation :  but  it  is  known  that  the 
gases  of  the  blood,  in  some  chemical  manner, 
hold  the  quinine  in  solution.  The  alkaloid, 
however,  is  not  deprived  by  this  suspension 
of  its  power  upon  the  blood-cells.  It  is  dif- 
ficult to  arrive  at  a  satisfactory  conclusion  as 
to  its  effect  upon  the  white  corpuscles;  some 
experimenters  declare  that  leucocytosis  follows 
its  use,  while  others  say  that  the  white  cells 
are  diminished  in  number.  If  it  is  true,  as  is 
alleged  for  it,  that  quinine  has  a  phagocytic 
action,  enabling  it  to  decrease  suppuration,  it 


QUININE 


116 


would  seem  likely  that  those  who  favour  the 
view  of  leucocytosis  are  correct.  Upon  the 
red  cells  it  is  probable  that  the  effect  is  to 
diminish  their  number  to  a  slight  degree, 
though  the  form  of  the  red  cells,  according  to 
the  greater  number  of  observers,  remains  un- 
changed. That  the  quinine  solution,  through 
its  ability  to  modify  or  even  destroy  proto- 
plasmic structure,  profoundly  influences  the 
contents  of  the  blood-cells,  is  not  in  doubt. 
By  the  use  of  the  drug  the  coagulability  of  the 
blood  is  diminished,  and  diapedesis  and  emi- 
gration— a  "  paralysis  of  the  leucocytes  " — are 
embarrassed.  An  effect  upon  the  hjemoglobin 
seems  to  be  a  diminution  in  its  oxygen-carry- 
ing properties. 

The  fall  in  blood-pressure  after  the  admin- 
istration of  quinine  is  due,  unquestionably,  to 
two  causes :  1.  To  a  dilatation  of  the  periph- 
eral capillaries  and  smaller  arteries.  2.  To  a 
diminution  in  the  force  of  the  heart-beat.  The 
former  effect  may  be  a  local  one,  but  it  is 
more  probably  due  to  a  slight  paresis  of  the 
vaso-inhibitory  centre.  The  action  upon  the 
heart  is  caused  by  the  influence  of  the  drug 
upon  the  heart  muscle  or  its  resident  gan- 
glia. The  pulse,  naturally,  shows  variations 
which  correspond  to  the  degree  of  these 
changes,  which,  in  the  use  of  therapeutic 
doses,  are  gradually  brought  about.  Poisonous 
doses  succeed  in  paralyzing  the  heart  muscle 
after  having  tirst  rendered  its  beat  very  rapid 
with  much  diminished  force.  Small,  tonic 
doses  of  quinine  act  as  a  stimulant  to  the  cir- 
culatory as  to  the  nervous  system. 

After  its  absorption  into  the  blood  and  when 
it  is  not  excreted  in  the  faeces,  quinine  is 
eliminated  principally  through  the  kidneys. 
It  can  be  found  in  the  urine  shortly  after  its 
introduction  into  the  system,  though  it  takes 
some  hours  for  the  total  quantity  to  be  ex- 
creted. A  peculiar  effect  on  the  urine  is  the 
decrease  in  nitrogenous  elements  excreted. 
Experimental  evidence  leads  to  the  belief  that 
it  is  not  due  to  diminished  excretion,  but  to  a 
lessening  of  metabolic  changes  in  the  body,  in- 
volving the  destruction  of  proteid  elements. 
During  its  passage  through  the  genito-urinary 
tract,  quinine  may  cause  renal  or  vesical  irri- 
tation with  albuminuria,  hasmoglobinuria,  or 
cystitis.  Increased  frequency  of  micturition 
and  retention  of  urine  have  been  observed ; 
and  occasionally  erotic  excitement  has  been 
manifested.  Large  doses  of  quinine,  however, 
may  allay  vesical  irritation  or  tenesmus. 

The  primary  effect  of  moderate  doses  upon 
the  respiration  is  stimulant.  The  rate  of 
breathing  is  increased,  but  the  respiratory 
movements  are  not  materially  deepened.  Toxic 
doses  call  forth  dyspnoea  with  stertorous,  em- 
barrassed breathing.  Death  may  ensue  from 
asphyxia,  as  described  above.  This  is  undoubt- 
edly due  to  central  action. 

'the  reduction  in  the  size  of  the  spleen  sub- 
sequent to  the  administration  of  quinine  in 
malarial  disease  is  due  to  the  elimination  of 
the  disease.  But  experimental  observers  have 
recorded  the  fact  that  the  spleen  in  lower  ani- 
mals has  shrunk  in  size  and  its  capsule  has  be- 
come  loosened  and  its  parenchyma  tougher 


after  the  administration  of  quinine.  Be  this 
as  it  may,  it  is  probably  true  that  the  dimin- 
ished spleen,  not  only  in  malarial  disease,  but 
also  in  other  infective  processes,  is  due  to  the 
victory  over  the  disease  rather  than  to  any  spe- 
cific action  on  the  organ. 

A  variety  of  opinions  have  been  expressed  as 
to  the  influence  of  quinine  upon  the  gravid 
uterus.  The  statements  that  follow  are,  how- 
ever, the  best  teaching  of  the  profession  at  the 
present  time.  An  otherwise  healthy  pregnant 
woman  suffering  from  malarial  disease  may 
take  quinine  with  safety  to  her  offspring.  A 
debilitated,  overwrought,  highly  nervous  preg- 
nant woman  under  the  influence  of  malarial 
poison  may  miscarry  whether  she  is  given 
quinine  or  not ;  but  in  precisely  these  eases 
in  which  malaria  may  induce  abortion  or  mis- 
carriage the  judicious  use  of  quinine  may  pre- 
vent the  mishap.  When  dystocia  arises  from 
exhaustion  of  the  mother,  generous  doses  of 
quinine,  by  their  stimulation  to  the  uterine 
muscles,  frequently  are  of  service.  Mental  en- 
couragement is  of  value,  however,  by  inducing 
the  patient  to  believe  that  the  drug  will  have 
the  action  desired.  Atkinson  (Am.  Jour,  of  the 
Med.  Sci.,  February,  1890)  concludes  that  qui- 
nine occasionally  has  an  oxytocic  action  if  there 
is  an  idiosyncrasy,  and  he  advocates  its  use  in 
prolonged  laboursYii\h  exhaustion  of  the  mother 
or  threatened  uterine  inertia.  In  this  position 
he  is  indorsed  by  the  bulk  of  the  profession. 

The  local  action  of  quinine  demands  some 
consideration.  Applied  to  the  skin  denuded 
of  its  epidermis,  quinine  and  its  salts,  in  powder 
or  in  solution,  are  active  irritants.  Upon  an 
intact  skin  little  or  no  irritating  influence 
is  perceived,  but  upon  mucous  membranes  a 
distinct  irritating  and  stimulant  effect  is  ob- 
served. This  is  particularly  marked  in  some 
individuals  who  can  not  take  the  drug  by  the 
mouth  or  by  the  rectum.  The  prolonged  in- 
ternal administration  of  quinine,  or  even,  in 
isolated  cases,  a  single  dose,  has  called  forth 
eruptions.  These  may  assume  any  character, 
from  a  mere  erythematous  blush  to  papules 
and  vesicles.  Allen  (Med.  Record,  January  26, 
1895)  has  reported  a  case  in  which  the  eruption 
was  like  that  of  scarlet  fever,  becoming  suc- 
cessively urticarial,  oedematous,  and  bulbous, 
leaving  an  excoriated  surface.  After  a  quinine 
eruption  there  is  frequently  an  exfoliation  of 
the  skin.  These  instances  are  undoubtedly  to 
be  accounted  for  by  the  marked  idiosyncrasy 
manifested  by  some  persons  against  the  drug. 

The  antiseptic  action  of  quinine  has  long 
been  recognised.  A  solution  of  1  part  to  300 
will  preserve  organic  foods  for  a  great  length 
of  time,  and  in  a  similar  proportion  quinine 
will  check  alcoholic  fermentation  in  saccharine 
substances.  Upon  the  higher  and  more  viru- 
lent forms  of  bacteria  its  action  is  decidedly 
less  powerful,  although  in  the  early  antiseptic 
period  it  was  used  in  a  spray  instead  of  car- 
bolic acid.  It  is  principally  upon  fungi  that 
its  antiseptic  influence  is  strongest. 

The  antipyretic  action  of  quinine  has  never 
been  satisfactorily  explained.  Wood  does  not 
believe  that  it  is  due  alone  to  the  diminished 
oxygen-carrying  function  of  the  blood,  but 


117 


QUININE 


rather  to  the  drug's  influence  upon  the  spe- 
cialized nervous  tissues  of  the  body — in  other 
words,  the  heat  centre.  Upon  a  normal  bodily 
temperature  quinine  exerts  but  a  feeble,  if  any, 
antipyretic  action.  But  in  febrile  conditions 
of  any  kind,  or  at  least  of  most  kinds,  the  ther- 
mometer shows  a  marked  fall  after  its  admin- 
istration. Quinine  is  not  a  universal  remedy 
for  all  febrile  diseases,  though  its  enormously 
wide  clinical  and  therapeutical  application 
would  lead  one  to  believe  that  it  was  a  specific 
lor  almost  all  diseases  in  which  there  was  an 
abnormal  rise  of  temperature. 

The  first  important  therapeutic  application 
of  quinine  is  in  the  various  forms  of  malarial 
disease.  In  this  disease  it  is  a  specific.  Al- 
though other  antiperiodics  have  been  tried,  and 
although  many  other  alkaloids  have  been 
vaunted  as  curing  or  aborting  an  attack,  qui- 
nine stands  forth  pre-eminent  in  its  ability  to 
prevent,  cure,  or  abort  the  various  forms  of 
malarial  intoxication.  Consideration  must  be 
extended  in  three  directions  in  its  application 
in  malarial  disease:  1.  Its  prophylactic  use. 
2.  Its  curative  use.  3.  Its  specific  action  on 
the  Plasmodium  malariw. 

Laveran's  work  has  received  such  almost 
unanimous  recognition  and  acceptance  that  for 
the  purposes  of  this  article  it  will  be  assumed 
that  his  discovery  of  the  malarial  parasite  is  uni- 
versally believed.  The  clinical  evidence  of  the 
value  of  quinine  in  malarial  affections  is  only 
strengthened  by  the  adoption  of  the  view  of  the 
Plasmodium  as  the  jetiological  factor — and  the 
sole  one — in  the  causation  of  this  group  of 
diseases.  In  the  classical  report  on  The  Ma- 
larial Fevers  of  Baltimore  (Johns  Sophins 
Sosp.  Rep.,  1895)  it  is  stated,  in  the  too  brief 
chapter  on  the  action  of  quinine,  that  the  best 
time  to  attack  the  malarial  organism  is  during 
the  period  of  segmentation.  In  the  tertian 
type  of  the  disease  this  can  be  best  accom- 
plished by  giving  one  moderate  dose  just 
before  the  expected  paroxysm,  so  that  the  qui- 
nine salt  shall  be  in  solution  in  the  blood  at 
the  time  of  division.  Blood  examinations 
made  immediately  after  the  paroxysm  show 
that  entire  groups  of  the  Plasmodium  disap- 
pear. It  is  found  that  in  the  intervening 
stages — in  which  the  parasite  is  in  the  endo- 
glohular  stage — quinine,  administered  in  a 
single  dose,  has  little  effect  upon  the  further 
development  of  the  organism.  In  mild  tertian 
cases  a  moderate  dose,  given  from  ten  to  twelve 
hours  before  an  expected  paroxysm,  may  avert 
the  chill,  but  it  is  more  efiioacious  if  given 
nearer  the  time  of  the  expected  attack.  In 
tertian  and  quartan  cases  treated  with  quinine 
the  Plasmodium  disappears  from  the  blood 
within  the  first  four  days.  In  the  quotidian 
type,  if  the  patient  is  energetically  cinchonized, 
it  may  disappear  even  sooner.  It  is  not  known 
in  what  manner  quinine  is  antagonistic  to  the 
specific  organism  which  produces  malarial  dis- 
ease, but  it  is  probably  by  some  direct  influence 
which  destroys  its  vitality.  Certain  it  is,  that  in 
addition  to  the  clinical  history  of  nearly  three 
hundred  years  to  substantiate  the  title  of  cin- 
chona as  a  specific  in  intermittent  fever,  we 
have  the  direct  evidence  that  quinine  attacks 


the  cause.  We  have  every  right,  therefore,  to 
regard  quinine  as  a  specific  antiperiodio  (and 
antipyretic,  incidentally)  in  the  various  mani- 
festations of  malarial  disease. 

Two  recognised  plans  are  followed  in  the 
treatment  of  intermittent  fever  with  quinine. 
The  first  is  the  daily  administration  of  a  dose 
sulfioiently  large  to  control  the  paroxysms. 
The  second  consists  in  giving  the  drug  imme- 
diately after  a  paroxysm,  on  the  supposition 
that  the  Plasmodium  malaricB  yields  most 
easily  at  that  time.  Either  plan  may  be  fol- 
lowed, and  both  will  give  good  results.  But 
one  thing  is  essential :  the  patient  under  treat- 
ment must  receive  his  physiological  dose  of 
quinine — he  must  be  cinchonized.  By  the  for- 
mer plan  the  patient  will  receive  daily  from 
15  to  30  grains  of  quinine,  given  in  divided 
doses;  less  than  4  grains  in  one  dose  it  is  use- 
less to  give  to  an  adult,  since  that  quantity 
produces  no  appreciable  effect.  In  the  so- 
called  pernicious  cases  it  is  necessary,  or  it 
may  become  necessary,  to  increase  the  amount 
of  quinine,  for,  to  cure  these  cases,  the  patient 
must  be  fully  under  the  influence  of  the  drug, 
not  only  during  the  paroxysms,  but  during  the 
intervals  of  the  disease  as  well.  When  the 
symptoms  are  becoming  less  marked,  the  dose 
may  be  gradually  diminished ;  but  the  drug 
should  not  be  wholly  withdrawn  until  some 
weeks  have  elapsed.  The  second  plan  involves 
the  giving  of  from  15  to  25  grains  of  quinine, 
as  the  temperature  falls  in  the  first  paroxysm 
observed.  This  is  said  to  be  sufficient  to  avert 
the  second  attack ;  but  if  slight  symptoms 
should  show  themselves,  the  administration  of 
a  second  dose  of  10  or  15  grains  is  usually  suf- 
ficient to  control  the  disease.  No  further  dose 
need  be  given  until  the  seventh  day,  when  from 
15  to  35  grains  are  again  given.  Usually  this 
suflices ;  but  if  a  tendency  to  relapse  is  noticed, 
or  if  some  of  the  milder  symptoms  of  malarial 
infection  present  themselves,  full  doses  of  qui- 
nine must  again  be  resorted  to. 

Sometimes  a  paroxysm  seems  to  be  best 
averted  by  giving  quinine  prior  to  a  paroxysm, 
and,  although  some  prefer  giving  divided  doses, 
it  seems  more  rational  to  give  one  or  two  large 
doses,  for  it  would  appear  that  small  doses 
are  able  oidy  to  retard  the  development  of  the 
Plasmodium  malarim,  while  larger  ones  are 
able  to  destroy  the  micro-organism.  Pour 
hours  is  the  shortest  time  in  which  a  moderate 
dose  (10  grains)  of  quinine  can  enter  the  blood 
in  solution ;  hence  the  best  time  for  giving  the 
drug  previous  to  an  attack  is  from  five  to  six 
hours.  A  dose  of  15  grains  will  maintain  its 
action  in  the  body  for  from  four  to  five  hours, 
while  a  dose  of  from  5  to  8  grains  will  exer- 
cise its  influence  for  from  two  to  three  hours. 
Doses  in  other  amounts  act  for  lengths  of  time 
corresponding  to  their  quantity.  As  pointed 
out  above,  it  is  necessary  for  a  patient  to  be 
cinchonized  for  the  drug  to  be  of  the  greatest 
value  in  overcoming  the  malarial  infection. 
Otherwise  the  disease  may  linger  and  be  pro- 
tracted over  many  months,  or  relapses  may  oc- 
cur. Free  purgation  is  essential  during  the 
administration  of  a  quinine  salt.  This  may  be 
accomplished  by  mercurials,  by  vegetable  ca: 


QUININE 


118 


thartics,  or,  in  the  case  of  the  pernicious  forms, 
by  diuretics. 

The  so-called  "  Jimmorrhagic  "  form  of  ma- 
larial fever  demands  einchonism  at  once.  For 
this  purpose,  the  administration  of  the  alka- 
loid is  much  the  same  as  in  the  ordinary  inter- 
mittent type  of  the  disease.  From  15  to  20 
grains  may  be  given  in  one  or  in  divided  doses. 
For  the  condition  known  as  malarial  cachexia 
quinine  is  valuable ;  but  after  a  long  period  of 
its  administration,  if  a  cure  or  relief  does  not 
follow,  other  drugs,  such  as  arsenic,  may  be 
employed.  The  cachexia  is  dependent,  indeed, 
not  only  upon  malarial  infection,  but  also  on 
some  tissue  changes,  and  it  is  probable  that 
not  all  eases  can  be  cured.  But  even  in  this 
symptom-complex,  quinine,  in  doses  of  5  or  6 
grains  daily,  has  well-marked  curative  effects 
more  frequently  than  not. 

To  refer  briefly  again  to  the  pernicious  va- 
riety of  malarial  infection,  it  is  usually  not 
sufficient  to  administer  quinine  alone.  The 
grave  phenomena  presenting  themselves  on  the 
part  of  the  nervous  system,  the  intestines,  the 
lungs,  and  the  kidneys  render  symptomatic 
treatment  necessary  as  well.  If,  indeed,  the 
gastric  symptoms  are  pronounced,  resort  must 
be  had  to  the  giving  of  quinine  by  the  rectum 
or  hypodermically.  Like  all  other  drugs,  qui- 
nine given  suboutaneously  acts  more  promptly 
than  when  administered  by  the  mouth  or  by  the 
rectum;  but  in  this  form  of  malarial  disease  the 
choice  must  rest  upon  the  conditions  present. 

In  the  treatment  of  remittent  fever  quinine 
is  indicated.  Its  results  are  not  always  so 
gratifying  as  in  intermittent  fever,  but  it  is 
frequently  curative.  Quinine  has  probably  an 
antipyretic  effect  in  remittent  fever  when  given 
at  its  height,  and  there  seems  to  be  no  theo- 
retical objection  to  administering  it  at  this 
time.  Many  observers  prefer  to  give  the  drug, 
however,  as  soon  as  the  remission  appears. 
Using  drugs  other  than  quinine  with  ther- 
molytic  action  to  reduce  the  fever,  or  resort- 
ing to  the  full  bath.  Quinine  frequently, 
however,  succeeds  in  lowering  the  temperature 
and  then  exerts  its  speoiflo  action  upon  the 
micro-organism  of  the  disease.  No  symptoms 
which  may  arise  during  a  remittent  fever  are 
contra-indications  to  the  use  of  the  cinchona 
alkaloid.  Should  a  severe  gastritis  arise,  the 
drug  may  be  given  in  solution  or  suppository 
by  the  rectum  or  suboutaneously,  as  in  the  per- 
nicious type  of  the  disease.  In  remittent  fever, 
from  20  to  50  grains  may  be  given  in  twenty- 
four  hours,  in  one  or  in  divided  doses.  (For 
the  selection  of  quinine  salts  for  hypodermic 
administration,  see  page  131.) 

There  are  some  forms  of  what  are  called 
"  masked  intermittent "  fever  which  seem  to  be 
benefited  by  quinine.  These  ailments  rnanifest 
themselves  by  the  periodical  appearance  of 
certain  functional  disturbances  without  accom- 
panying chill  or  fever.  Intermittent  neuralgia, 
very  frequently  of  the  trigeminal  type,  though 
it  may  appear  in  any  of  the  plexuses  or  their 
branches,  yields  readily  to  quinine  in  sufficient 
doses.  Sometimes, '  though  not  usually,  the 
attack  is  of  long  duration,  and  the  drug  must 
be  given  for  a  considerable  period  of  time.    At 


the  time  of  the  onset  a  dose  of  from  15  to  35 
grains  may  be  given,  which  will  usually  relieve 
the  symptoms.  After  the  abatement  of  the 
attack,  5  grains,  thrice  daily,  may  be  adminis- 
tered for  a  few  days.  Other  phenomena  have 
been  described  as  occurring  periodically,  and 
have  been  attributed  to  malarial  poisoning; 
but  although  they  have  seemed  to  yield  to 
quinine,  according  to  their  reporters,  the  cases 
have  not  had  the  appearance  of  having  been 
■  accurately  and  acutely  observed.  They  embrace 
such  functional  disturbances  as  intermittent 
haemorrhages,  oedema,  convulsions,  and  paraly- 
sis, and  should  probably  be  classified  under 
other  groups  of  disease  than  the  malarial.  How- 
ever, if  any  such  symptoms  arise  after  an  attack 
of  malarial  disease  of  any  type,  and  are  inter- 
mittent in  character,  there  can  appear  no  valid 
objection  to  thorough  dosing  with  quinine. 
There  are  other  forms  of  neuralgia  which, 
though  intermittent,  are  not  periodic  in  char- 
acter, that  yield  gracefully  to  quinine  given 
for  a  few  times.  They  can  not,  however,  be 
supposed  to  be  due  to  malaria,  for  any  effect 
the  quinine  may  have  is  soon  lost. 

When  a  patient  suffers  from  intermittent 
malarial  fever,  or  any  of  its  forms,  or  from 
remittent  fever,  or  from  any  of  the  intermit- 
tent forms  of  disease  which  appear  to  be 
dependent  upon  the  invasion  of  the  specific 
parasite  of  the  disease,  he  should  be  removed 
from  the  locality  at  once  if  it  is  known  to  be 
malarial.  The  mere  administration  of  quinine, 
though  curative  in  a  single  attack,  will  not 
prevent  recurrence  if  re-infection  is  possible. 
Pernicious  cases,  indeed,  follow  frequently  upon 
one  or  more  mild  attacks.  Prophylaxis  against 
the  disease  is  possible,  however,  by  the  judicious 
use  of  quinine.  The  effect  of  the  drug  need 
not  be  carried  to  the  extent  of  einchonism  for 
this  purpose.  From  3  to  5  or  even  8  grains 
may  be  given  twice  daily.  It  does  not  always 
succeed  in  preventing  acquisition  of  the  dis- 
ease, but  even  in  dreaded  malarial  tropical 
countries  it  has  succeeded  in  keeping  the  dis- 
ease aloof.  When,  after  prophylactic  treatment, 
malarial  poisoning  does  make  its  appearance, 
it  is  altogether  likely  that  it  is  less  severe  than 
it  would  have  been  had  not  such  treatment 
been  instituted.  The  experience  of  the  British 
army  in  India  in  preventing  a  spread  of  the 
disease  among  the  soldiers  may  be  taken  as  a 
good  example  of  the  value  of  the  prophylactic 
use  of  cjuinine. 

Quinine  has  been  recommended  at  various 
times  for  all  the  acute  infectious  diseases.  In 
acute  articular  rheumatism  it  was  used  two 
hundred  years  ago,  and  was  thought  to  be 
specific.  Probably  this  belief  rested  upon  its 
antipyretic  power.  At  the  present  day  it  is 
used  by  some  clinicians,  not  as  a  specific,  but 
as  a  tonic,  in  doses  of  from  1  to  2  grains  thrice 
daily  during  the  convalescent  stage.  In  typhus 
fever  it  is  still  used  at  the  present  day,  and  is 
believed  not  so  much  to  exert  any  specific  ac- 
tion on  the  course  of  the  disease  as  to  give 
tone  to  the  organism  during  the  critical  stage. 
The  well-known  Huxham's  tincture  is  used  in 
this  connection.  As  a  curative  agent  in  typhus 
it  is,  of  course,  worthless ;  but,  together  with 


119 


QUININE 


other  tonics  and  stimulants,  it  may  help  to 
tide  the  patient  over  his  crisis. 

In  typhoid  fever  it  is  also  no  specific,  of 
course,  although  it  has  had  wide  use  as  an  anti- 
pyretic. Striimpell  is  doubtful  if  the  quinine 
salts,  by  their  mere  reduction  of  temperature, 
have  any  favourable  influence  upon  the  course 
of  the  disease.  That  they  do  sometimes  reduce 
the  temperature  2°  or  j}°  P.  is  unquestioned, 
and  in  cases  in  which  the  bath  treatment  is 
contra-indicated  (see  Hydriatics)  quinine  may 
be  used  as  an  adjuvant  in  the  treatment  of 
typhoid  fever.  It  must  not  be  forgotten,  how- 
ever, that  by  its  irritant  action  on  mucous 
membranes  it  may  injure  the  intestine  which 
is  the  seat  of  the  disease,  and  make  a  perfora- 
tion possible.  For  the  purpose  of  reducing 
temperature  it  may  be  used  in  doses  of  from 
15  to  25  giains,  given  at  once.  Of  more 
value  is  it  in  small  doses  during  convalescence 
as  a  tonic,  both  gastric  and  general.  It  may 
then  be  given  either  in  pill  or  in  substance. 
A  very  good  formula  for  a  tonic  containing 
quinine  is : 

3  Quinine  sulphate 1  grain  ; 

Dried  sulphate  of  iron 1      " 

Arsenious  acid ^^    " 

Mix  and  make  one  pill.  One  such  pill  to  be 
taken  thrice  daily. 

Or, 

5  Quinine  sulphate 1  grain ; 

Cried  sulphate  of  iron 2  grains ; 

Extract  of  nux  vomica -J  grain. 

Mix  and  make  one  pill.  One  such  pill  to  be 
taken,  thrice  daily,  before  m«als. 

These  combinations  may,  of  course,  be  modi- 
fled  in  many  ways ;  but  the  drugs,  combined 
as  in  the  two  formulas  given,  have  virtues  as 
tonics  of  a  high  order. 

Quinine  has  been  lauded  in  the  treatment  of 
puerperal  fever,  small-pox,  scarlatina,  and  ery- 
sipelas, as  well  as  in  that  of  diphtheria.  It 
has  been  given  in  these  affections  in  the  be- 
lief that  it  exerted  some  speciflo  action  on  the 
poison  of  each  disease.  This  is  absolutely 
without  foundation  of  proof.  So  far  as  its 
antipyretic  action  goes,  it  may  relieve  the  pa- 
tient of  some  of  the  symptoms  of  pyrexia,  if 
administered  iu  sufliciently  large  doses;  but 
aside  from  this  and  from  its  tonic  action,  com- 
mon to  it  in  all  forms  of  disease,  there  is  no 
proof  that  it  has  any  action  which  should  de- 
mand its  use.  Prophylaxis  in  the  first  men- 
tioned is  of  more  importance  than  treatment, 
and  for  the  other  diseases  of  the  group  there 
is  much  to  be  hoped  for  in  recent  observations 
and  investigations.  Even  in  cholera  quinine 
has  been  advocated  on  the  ground  that  the 
difficulty  of  absorption  from  the  intestines  in 
this  disease  favours  the  antiseptic  action  of  the 
drug  on  the  comma  bacillus.  It  is  well  known, 
though,  that  the  antiseptic  action  of  the  cin- 
chona alkaloid  is  too  weak  to  exert  any  such 
eileot  on  a  bacillus  of  such  virulence.  In 
doses  of  from  20  to  40  grains  it  may  help  to 
combat  the  high  fever  of  cholera,'  and  its 
supporting  action  may  also  be  brought  into 
play  with  a  favourable  result  should  recovery 
ensue. 


For  many  years  the  quinine  treatment  of 
pneumonia  was  a  recognised  form  of  treatment 
in  New  York.  It  does  reduce  the  temperature 
in  pneumonia,  with  a  coincident  falling  of  the 
pulse.  Its  use  is  not  to  be  commended,  for  its 
indiscriminate  employment  may  be  productive 
of  cardiac  depression  and  failure.  Certainly 
in  the  doses  recommended  in  former  years,  20 
to  40  grains  in  one  dose,  it  would  be  feared  by 
many  practitioners  for  its  tintoward  influence 
upon  the  heart.  Here,  as  in  most  of  the  febrile 
diseases,  its  tonic  influence  is  valuable  when 
convalescence  has  been  established.  It  has 
been  maintained  that,  if  given  early  in  pneu- 
monia, as  in  follicular  amygdalitis  and  inflam- 
mations of  serous  surfaces,  it  will  modify  the 
course  of  the  disease.  Indeed,  one  observer 
has  alleged  that  the  pneumonic  process  is  less 
severe,  that  the  cerebral,  respiratory,  and  cir- 
culatory phenomena  are  less  grave,  if  quinine 
is  given  in  large  doses  early  in  the  disease.  It 
may  cause,  if  given  in  a  large  dose,  anorexia, 
nausea,  and  vomiting,  and  even  cardiac  weak- 
ness— symptoms  which  should  be  avoided  or. 
guarded  against  in  pneumonia,  of  all  diseases. 

In  some  of  the  diseases  of  the  respiratory 
tract  quinine  has  had  extended  use.  Like  so 
many  other  dnigs,  it  has  been  recommended  in 
the  treatment  of  pertussis.  In  doses  of  from 
5  to  10  grains  twice  a  day  (the  doses  for  infants 
are,  of  course,  correspondingly  smaller)  it  is 
said  to  diminish  the  frequency  and  severity  of 
the  attacks.  It  should  be  given  early  in  the 
disease,  if  at  all.  Laubinger  {Jahrb.  f.  Kin- 
derheilkunde,  xxxix,  2,  3)  urges  the  subcutane- 
ous use  of  the  dihydrochloride  of  quinine  in 
cases  in  which  the  symptoms  demand  instant 
relief.  In  asthma  good  results  have  been 
alleged  from  the  use  of  quinine  in  diminishing 
the  spasmodic  attacks.  The  same  has  been 
asserted  for  it  in  laryngismus  stridulus.  More 
eflScacious  methods  of  treatment,  however,  are 
at  our  command.  The  hectic  fever  oi  phthisis 
may  be  reduced  by  the  use  of  quinine,  and  it 
may  be  used  as  a  tonic  in  chronic  phthisis 
when  there  are  anorexia  and  general  weakness. 
As  a  gentle  stimulant  in  chronic  bronchitis, 
quinine  may  form  part  of  a  mixture  or  pill. 
A  very  good  formula  for  this  use  is : 

5  Extract  of  belladonna 1  grain  ; 

Extract  of  opium 2  grains ; 

Extract  of  nux  vomica 3      " 

Powder  of  ipecac 4      " 

Quinine   hydrochloride,    or 

sulphate 5      " 

Mix  and  make  20  pills.  One  pill  to  be  taken 
four  times  daily. 

In  acute  coryza  and  hay-fever,  spraying  the 
nostrils  with  an  aqueous  solution  of  from  \  to 
iV  per  cent,  has  been  reported  to  have  cured 
cases.  •  Or  the  quinine  may  be  in  the  form  of 
a  snuff  in  a  mixture  containing  bismuth  or 
salicylate  of  sodium.  The  internal  administra- 
tion of  5  grains,  three  times  daily,  is  advised 
in  connection  with  the  spray.  In  influema 
it  is  doubtful  if  quinine,  locally  or  internally, 
is  of  great  utility.  In  the  albuminuria  of 
scarlatina,  quinine,  combined  with  tincture  of 
chloride  of  iron,  is  said  to  be  efficacious ;  but, 


QUININE 


120 


like  many  other  reoomraendations  of  quinine, 
this  assertion  rests  on  very  little  evidence. 

For  other  internal  and  functional  diseases, 
quinine  has  been  praised.  In  the  treatment 
of  insolation,  Binz  (Bed.  klin.  Wochensclir., 
1895,  No.  29)  recommends  the  hypodermic  ad- 
ministration of  the  bichloride  of  quinine.  He 
says  that  at  least  3J  grains  should  be  injected 
at  one  time,  and  this  dose  may  be  repeated  in 
one  hour  if  necessary.  He  alleges  good  results. 
Quinine  in  doses  of  from  3  to  8  grains  relieves 
many  of  the  chronic  cases  of  headache  which 
are  the  bete  noire  of  the  physician.  Taken  at 
night  in  one  dose,  in  black  coffee,  for  five 
nights,  it  has  accomplished  a  cure  of  migraine 
which  lasted  for  five  months.  In  cases  of 
leucaemia  quinine  has  been  tried  on  account  of 
its  supposed  effect  in  reducing  the  size  of  the 
spleen,  but  it  has  no  curative  effect  on  the 
disease.  Hosier,  quoted  in  Strilmpell's  Text- 
booJc  of  Medicine,  reported  good  results  from 
its  use.  The  drug  has  been  tried  in  diabetes, 
on  theoretical  grounds,  but  it  is  valueless  as  a 
curative  agent. 

In  the  treatment  of  a  few  of  the  parasitic 
skin  diseases,  quinine,  in  a  o-per-cent.  ointment, 
has  been  found  valuable.  In  some  forms  of 
pityriasis  and  tinea  it  has  been  found  effica- 
cious. Given  in  doses  of  from  5  to  10  grains 
previous  to  the  passing  of  a  sound  into  the 
male  urethra,  it  will  prevent  the  remarkable 
rise  of  temperature  known  as  urethral  fever. 
Moreover,  after  this  temperature — sometimes 
reaching  106°  P. — has  made  its  appearance, 
quinine  will  quickly  reduce  it.  The  writer 
can  not  refrain  from  adding  that  he  has  always 
regarded  this  phenomenon  as  directly  due  to  a 
surgically  unclean  instrument.  In  the  treat- 
ment of  gonorrhoea,  cystitis,  and  growths  at  the 
neck  of  the  bladder,  injections  of  quinine,  of  a 
strength  of  from  3  to  3  grains  to  an  ounce, 
are  said  to  be  curative  and  to  relieve  the  tenes- 
mus which  frequently  accompanies  these  con- 
ditions. There  are,  however,  better  means  of 
combating  these  ailments.  Rectal  injections 
of  a  similar  strength  are  of  value  in  treating 
an  ammhie  dysentery  whose  seat  is  low  in  the 
intestinal  canal. 

On  the  nervous  system  quinine  has  decided 
effects,  and  has  been  used  in  various  functional 
and  organic  nervous  diseases.  The  pains  of 
locomotor  ataxia  sometimes  yield  to  the  alka- 
loid of  cinchona,  though,  of  course,  the  anal- 
getic effect  is  due  entirely  to  the  sedative 
influence  of  the  drug  upon  the  peripheral 
nerves.  Charcot's  classical  recommendation 
of  quinine  in  Meniere's  disease  deserves  the 
place  it  holds,  for  cases  of  cure  are  certain, 
and  in  some  instances  permanent.  For  this 
purpose,  from  8  to  15  grains  are  taken  daily 
in  divided  doses  for  a  month.  As  mentioned 
above,  malarial  neuralgias  yield  to  quinine 
in  large  doses  (15  to  35  grains)  it  taken  at  once. 
And  in  the  so-called  "  idiopathic  "  eases  oineu- 
ralgia  of  the  trigeminal  <2/pe,qumine,  pushed  to 
the  point  of  cinohonism,  brings  frequent  relief. 
Sciatica  yields  less  often  to  the  influence  of 
quinine.  As  a  tonic,  quinine  is  indicated  in 
neurasthenia,  in  the  combination  of  the  formula 
given  above.    The  drug  has  been  used  in  steno- 


cardia to  prevent  a  recurrence  of  the  paroxysm, 
but  its  use  is  purely  tentative.  In  the  so-called 
hydrops articulorum intermittens,  a  vnre  trophic 
disturbance,  quinine  may  be  used  for  its  anti- 
periodic  effect. 

As  hinted  at  above,  quinine  is  of  use  during 
labour  when  the  mother  has  become  exhausted 
and  uterine  inertia  is  threatened.  (See  also 
under  Oxytocics,  vol.  ii,  page  55).  Initial 
abortifacient  power  does  not  reside  in  the 
drug.  For  the  purpose  of  aiding  uterine  ac- 
tion, it  may  be  given  in  doses  of  from  5  to  10 
grains  every  hour  or  in  a  single  dose  of  15  or 
30  grains.  In  cases  of  hmmaturia,  even  if  not 
of  malarial  origin,  quinine  is  often  serviceable, 
particularly  in  those  instances  in  which  the 
attacks  are  paroxysmal.  When  inunctions  of 
mercury  are  given  in  severe  cases  of  syphilis, 
the  simultaneous  administration  of  from  15  to 
30  grains  of  quinine  daily  will  prevent  stoma- 
titis and  will  help  to  cure  cases  which  do  not 
seem  to  yield  to  inunctions  alone.  (Dymnicki, 
Monatshft.  f.  praU.  Dermat.,  1889,  No.  39.) 

Qninine  lias  some  reputation  as  a  tonic  and 
stimulating  drug  in  prolonged  suppuration  in 
any  part  of  the  body.  It  may  be  given  in- 
ternally or  applied  locally  as  an  irrigating 
fluid.  Thus,  in  oases  of  empyema  of  long 
standing,  in  which  there  are  discharging  si- 
nuses, it  mav  be  injected  into  the  cavity  in  a 
strength  of  from  4  to  5  grains  to  an  "ounce. 
Internally,  it  should  be  administered  in  the 
usual  tonic  dose.  For  pruritus  ani  or  vulvce, 
a  strong  solution  of  quinine  is  recommended 
for  topical  application.  Ophthalmic  surgeons 
use  quinine  in  acute  glaucoma  and  blennorrhagic 
ophthalmia  with  variable  results.  In  some 
cases  of  glaucoma  the  pain  seems  to  be  dimin- 
ished by  the  use  of  the  drug. 

[Dr.  George  Reich-Hollender,  of  Seattle 
(Arch,  of  Ophthal.,  xxiii,  1  and  3),  used  a  qui- 
nine lotion  experimentally  in  an  obstinate  case 
of  gonorrhmal  ophthalmia,  and  found  that 
after  the  third  day  the  discharge  became  in- 
nocuous, and  within  two  weeks  not  a  vestige 
of  the  inflammation  remained.  By  making 
cultures  he  satisfied  himself  that  the  gonococ- 
cus  of  Neisser  was  destroyed  by  a  solution  of 
quinine.  He  considers  that  the  best  way  to 
employ  quinine  is  in  a  solution  containing 
hydrochloric  acid.  He  believes  it  to  be  a 
specific  in  the  ravages  of  the  gonococcus.  He 
makes  a  solution  of  8  parts  of  quinine,  8  of 
dilute  hydrochloric  acid,  and  720  of  distilled 
water,  and  applies  it  every  hour.] 

Knapp  has  recently  used  quinine  in  the 
chorea  of  children  with  good  effect.  It  does 
not  cure  all  cases,  however.  He  does  not  con- 
sider the  action  of  the  drug  to  be  due  to  its 
stimulation  of  the  inhibitory  motor  functions 
of  the  spinal  cord,  but  to  some  influence  upon 
the  toxines  of  the  disease  (Boston  Med.  and 
Surg.  Rep.,  February  38,  1895).  Good  results 
are  also  alleged  for  the  use  of  the  alkaloid  in 
nocturnal  enuresis,  especially  in  nervous  chil- 
dren in  whom  the  inhibitoryfunction  seems  to 
be  disturbed.  Four  grains,  three  or  four  times 
daily,  are  given  for  this  purpose. 

Finally,  quinine  in  solution  may  be  applied 
to  unhealthy  granulating  wounds,  or  to  slowly- 


131 


QUININE 


healing  ulcers.  So  many  better  topical  appli- 
cations are  to  be  found,  however,  that  it  is 
scarcely  worth  while  to  discuss  the  use  of 
quinine  as  a  surgical  aid. 

The  onntra-indications  to  the  use  of  quinine 
are  inflammation  of  the  middle  ear — because 
of  the  congestion  quinine  produces  in  the  mid- 
dle ear  and  labyrinth — and  acute  inflammatory 
processes  of  the  gastro-intestinal  canal,  for 
reasons  already  stated.  Very  rarely  the  influ- 
ence of  quinine  upon  the  genito-urinary  tract  is 
irritating,  so  in  acute  processes  in  this  region 
the  use  of  quinine  might  be  contra-indicated. 

Each  of  the  salts  of  quinine  has  uses  to 
which  it  is  particularly  adapted.  The  sulphate 
and  the  bisulphate  are  used  for  similar  pur- 
poses, for  internal  administration,  and  for 
rectal  use.  For  hypodermic  use  the  bisulphate, 
the  hydrobromide,  and  the  hydrochloride  are 
preferred  on  account  of  their  solubility  in 
water.  The  bichloride  and  the  hydrochloride 
with  urea  are  also  capable  of  use  by  subcu- 
taneous injection.  The  administration  of  qui- 
nine varies  with  circumstances  and  with 
individuals.  The  intensely  bitter  taste  of  the 
alkaloid  and  its  salts  renders  it  necessary  to 
disguise  their  taste.  Quinine  itself  is  rarely 
employed,  the  sulphate  being  the  most  com- 
monly used  of  the  salts.  It  must  be  mentioned 
that  the  sulphate  frequently  varies  in  its  sta- 
bility and  in  its  effects.  In  two  cases  simul- 
taneously observed  by  the  writer,  suspected 
malarial  infection  was  treated  with  the  sulphate 
of  quinine.  After  several  weeks  of  its  admin- 
istration with  no  improvement,  the  hydrochlo- 
ride of  quinine  was  given,  and  a  cure  resulted 
within  a  week.  A  point  in  the  administration 
of  quinine  is  the  fact  that  children  excrete 
quinine  more  rapidly  than  adults ;  but  from 
the  experiments  of  Oui  it  is  no  longer  believed 
that  suckling  children  suffer  a  cinohonic  effect 
from  the  milk  of  their  mothers. 

Quinine  may  be  administered  by  the  mouth, 
by  the  rectum — in  suppository  or  by  enema — 
hypoderraically,  or  dermically.  The  taste  of 
quinine  may  be  disguised  by  giving  it  in  wafers, 
which  is  perhaps  the  most  desirable  method. 
It  may  be  given  in  the  form  of  pills,  which 
may  be  coated  to  obscure  the  bitter  taste. 
Mineral  acids  should  follow  the  administration 
of  the  sulphate  in  order  to  facilitate  the  solu- 
tion of  the  salt  in  the  stomach.  Either  the 
sulphate  or  the  bisulphate  is  better  tolerated 
by  the  stomach  if  given  in  a  solution  of  potas- 
sium tartrate.  The  albuminate  of  quinine  is 
said  to  be  acceptable  to  a  sensitive  stomach ; 
but  it  is  soluble  in  water  only  when  hydro- 
chloric acid  has  been  added.  If  a  rapid  result 
is  desired,  a  solution  of  the  salt  should  be 
given,  and  to  accomplish  this  most  satisfac- 
torily the  bisulphate  is  usually  employed. 
After  its  solution  in  water,  aromatic  sulphuric 
acid  should  be  added,  one  drop  for  each  grain 
of  the  drug.  The  tablets  of  the  quinine  salts 
in  the  market  are  not  to  be  too  cordiallv  com- 
mended, for  they  are  apt  to  defy  solution. 
Tablets  of  tannate  of  quinine,  in  the  form  of 
chocolate  lozenges,  are  sold  in  the  shops,  each 
tablet  containing  1  grain  of  the  drug.  These 
are  especially  desirable  for  use  among  children, 


as  the  chocolate  completely  disguises  the  taste 
of  the  salt. 

[A  simple  and  very  effective  way  of  masking 
the  bitterness  of  quinine  was  taught  some 
years  ago  by  Dr.  A.  Jaoobi.  The  quinine  is  to 
be  mixed  in  a  tablespoon  with  enough  strong 
black  coffee,  cold,  to  almost  fill  the  spoon.  The 
quinine  does  not  wholly  dissolve,  but  it  gives 
the  coffee  the  colour  of  cafe  au  lait.  In  this 
way  most  persons  can  take  quinine  without 
tasting  it.] 

Suppositories  containing  quinine  are  apt  to 
irritate  the  rectum,  and  enemata  are  not  always 
retained.  However,  when  the  administration 
of  the  drug  by  the  mouth  is  not  feasible,  and 
when  it  is  desired  to  secure  a  local  effect  upon 
the  lower  bowel,  it  is  Justifiable  to  give  it  by 
the  rectum.  Potassium  iodide  is  chemictlly 
incompatible  with  the  quinine  salts  and  should 
never  be  given  in  combination  by  the  rectum, 
since  iodine  is  set  free.  For  hypodermic  use, 
as  brought  out  above,  the  hydrochloride,  bi- 
sulphate, and  hydrobromide  are  to  be  chosen, 
because  of  their  easy  solubility.  The  first  is 
soluble  in  34  parts  of  water,  the  second  in  10 
parts,  and  the  last  in  54  parts.  It  is  alleged 
for  the  hydrochloride  that  it  is  cheap,  that  its 
injection  is  free  from  pain,  and  that  it  does  not 
produce  an  abscess  at  the  site  of  introduction. 
The  same  statements  are  made  for  the  bichlo- 
ride and  the  compound  salt  of  the  hydrochlo- 
ride with  urea.  The  hydrochloride,  however, 
according  to  Briquet,  is  not  stable.  Except  in 
an  emergency,  as  in  insolation,  or  when  an  im- 
mediate effect  is  desired,  it  is  not  necessary  to 
resort  to  the  hypodermic  needle  to  secure  the 
effect  of  quinine.  The  possibility  of  producing 
an  abscess  by  the  use  of  an  unclean  needle 
must  not  be  overlooked. 

The  dermic  method  of  administration  may 
be  resorted  to  in  children ;  but  it  has  been 
shown  that,  although  some  of  the  quinine  ap- 
pears in  the  urine  shortly  after  its  dermic 
application,  the  greater  part  of  the  drug  does 
not  enter  the  blood.  This  method,  then,  is 
practically  valueless. 

The  dose  of  quinine  and  its  salts  is  elastic. 
It  may  be  given  for  tonic  effect  in  doses  of  ^  a 
grain ;  or,  to  produce  cinchonism,  the  dose  may 
be  as  high  as  75  grains.  No  set  rule  can,  there- 
fore, be  laid  down.  The  hydrochloride  is  given 
in  doses  of  about  J  less  than  the  sulphate.  The 
dose  of  the  valerianate  is  from  1  to  2  grains. 
The  doses  of  the  other  salts  are  the  same  as 
those  of  the  sulphate,  which  varies  with  indi- 
vidual cases  and  with  the  diseases  for  which  it 
is  given.    (Cf.  Cinchona.) 

[An  oiRcial  wine  of  quinine,  vinum  quinines 
(Br.  Ph.),  contains  a  grain  of  the  sulphate  in 
each  fl.  oz.  It  is  given  in  doses  of  from  -J  to  1 
fl.  oz. 

Dr.  Erskine  B.  Fullerton,  of  Columbus,  Ohio, 
professor  of  materia  medica  and  therapeutics 
in  Starling  Medical  College  (N.  Y.  Med.  Jour., 
August  18,  1894),  urges  the  use  of  quinine  in 
Asiatic  cholera.  He  recognises  that  it  has 
often  been  tried  and  found  to  fail,  but  this  he 
attributes  to  its  having  been  given  in  an  im- 
proper manner.  Ten  grains,  in  powder,  he 
says,  diffused  through  a  small    quantity  of 


QTJINOIDINE 
KECONSTITUENTS 


122 


water,  or  in  acid  solution,  at  hourly  intervals, 
until  20  to  40  grains  have  been  given,  after- 
ward pro  re  nata,  should  be  the  ordinary  in- 
structions; the  same  dose  at  half-hourly 
intervals  for  a  sufficient  time  in  collapsed  or 
in  foudroyanf  cases ;  smaller  doses,  perhaps,  at 
longer  intervals  in  choleraic  diarrhoea.  There 
should  certainly  be  retained,  of  other  treat- 
ment, adds  Dr.  FuUerton,  appliances  for  the 
restoration  of  heat ;  saline  hypodermoclyses  to 
supply  lacking  sernm  to  the  blood;  morphine 
hypodermics  to  allay  pain  and  cramps,  with 
enteroclyses  of  quinine  where,  as  past  experi- 
ence shows  rarely  to  have  been  the  case,  the 
remedy  is  vomited ;  and  in  the  sequent  enteritis 
or  otherwise  persistent  diarrhcea,  calomel  in 
small  doses  should  not  be  lost  sight  of.  That 
by  so  treating  our  patients,  says  Br.  FuUerton, 
we  may  hope  tor  a  mortality  among  collapsed 
and  collapsing  patients  of  about  14  to  35 
per  cent,  only;  that  by  earlier  administra- 
tion of  the  remedy,  instead  of  the  use  of 
other  agents  that  have  heretofore  permit- 
ted so  many  cases  to  run  on  into  collapse 
and  death,  we  may  reduce  the  mortality  In 
such  cases  to  2  to  5  per  cent,  only,  seems  a  fair 
assumption  for  the  best  of  reasons — i.  e.,  it 
should  be  so,  and  so  far  it  always  has  been  so.] 
Samuel  M.  Bbickneb. 

aTTINOIDINE.— See  Quinidine. 

aTTIlTOLINE,  an  oily  alkaline  liquid, 
CjHtN,  obtained  by  distilling  quinine  with  a 
caustic  alkali,  is  colourless  when  pure.  It  has 
a  disagreeable  odour  somewhat  suggestive  of 
bitter  almonds,  and  is  acrid  and  bitter  to  the 
taste.  It  is  but  slightly  soluble  in  cold  water, 
but  dissolves  more  readily  in  hot  water.  It 
mixes  in  all  proportions  with  alcohol,  with 
ether,  and  with  the  essential  oils.  It  has  been 
employed  as  an  antiseptic  in  a  5-per-cent.  so- 
lution in  equal  parts  of  water  and  alcohol. 

ftTTIITOSOL,  a  German  proprietary  prep- 
aration, is  described  by  the  manufacturers  as  a 
neutral  compound  of  oxyquinoline  which,  when 
used,  gives  up  oxyquinoline  in  a  nascent  state 
and  consequently  of  great  efficiency  as  an  anti- 
septic. R.  Kossmann  (Ctrlbl.  f.  G^ynakol.,  De- 
cember 28,  1895),  states  that  trials  of  it  made  at 
the  Munich  Hygienic  Institute  go  to  show  that 
it  is  relatively  so  non-poisonous  that  a  dose  of 
45  grains,  given  to  a  rabbit,  does  not  injure  the 
animal,  while  a  l-to-40,000  solution  prevents 
the  development  of  cultures  of  the  Staphy- 
lococcus pyogenes  aureus.  For  several  months, 
he  says,  it  has  entirely  supplanted  corrosive 
sublimate  and  carbolic  acid  in  his  practice,  and 
he  has  seen  absolutely  no  toxic  effects  due  to 
it.  or  any  irritation,  even  eczema,  when  it  has 
been  insufflated  in  powder  into  suppurating 
wounds.  He  further  states  that  it  does  not 
injure  the  skin,  even  in  so  strong  a  solution  as 
that  of  1  to  500,  applied  repeatedly;  it  does 
give  the  hands  a  yellowish  tint,  but  this  may 
be  removed  by  washing  with  pure  water.  It 
is  free  from  any  unpleasant  odour.  Kossmann 
thinks  it  would  prove  a  safe  and  efficient  anti- 
septic in  the  hands  of  midwives.  Solutions  of 
it  should  be  of  the  same  strength  as  those  of 


corrosive  sublimate.     It  may  be  had  in  the 
form  of  tablets  which  are  readily  soluble. 

On  the  other  hand,  Ahlfeld,  Vahle,  and  "W'itte 
(Ctrlbl.  f.   Gynak.,  February  29,  1896)  report 
discouraging  results  as  to  its  efficiency  as  an 
antiseptic  and  as  to  its  being  non-poisonous. 
Ahlfeld  and  Vahle  found  that  even  so  strong  a 
solution  as  one  of  3  per  cent,  could  not  be 
altogether  relied  on.     Eight  grains  of  quinosol, 
injected  subcutaneously    into  a  rabbit,   they 
report,  killed  the  animal  in  eighteen  hours  ;  its 
blood  was  found  to  be  very  dark-coloured,  and 
all  the  organs  were  dusky,  especially  the  kid- 
neys.    Witte  makes  quinosol  the  text  for  some 
very  forcible  remarks  about  the  quest  for  new 
antiseptics.   In  corrosive  sublimate,  in  carbolic 
acid,  and  in  lysol,  he  says,  we  have  antiseptics 
that  have  been  tried  thoroughly ;  years  of  ob- 
servation have  taught  us  the  bright  and  the 
shady  side  of  their  action.     The  case  for  quino- 
sol, he  holds,  has  by  no  means  been  made  out. 
As  to  Kossmann's  experience  in  the  employ- 
ment of  the  drug  for  a  number  of  months 
without  the  occurrence  of  a  single  case  of  in- 
fection from  a  wound  or  any  appearance  of 
poisoning  whatever,  even  so  slight  as  eczema, 
he  doubts  if  these  results  are  to  be  ascribed  to 
the  quinosol.     His  own,  he   says,  have  been 
quite  as  good  when   he  used  only  a  steiile 
physiological  solution  of  common  salt.     Fur- 
thermore,  he  argues,  even  if  it  is  true  that 
traumatic  cavities,  suppurating  and  yielding 
a  foetid  secretion,  may  be  favourably  affected 
by  quinosol,  the  fact  is  of  little  consequence, 
for  the  thing  to  do  is  to  remove  the  putrefying 
masses  and  use  drainage,  and  it  makes  no' dif- 
ference whether  this  or  that  antiseptic  is  em- 
ployed, or,  indeed,  only  sterile  water.     As  to 
the  statement  that  quinosol,  even  in  substance, 
is  in  no  wise  iratating  to  wounds,  his  own  ex- 

ferience,  he  says,  has  been  to  the  contrary, 
n  two  instances  he  has  applied  quinosol  in 
substance  to  the  cavities  left  after  the  removal 
of  glands,  and  each  time  -uch  intense  burning 
pain  set  in  that  the  ]>atient  begged  to  have  it 
taken  out.  Although  he  himself  has  not  ob- 
served symptoms  of  poisoning  from  quinosol, 
he  insists  that  we  can  not  be  sure  thev  will  not 
occur.  A  minor  objection  to  quinosol  is  the 
fact  that  it  stains  the  skin  and  the  instruments, 
but  the  stain  can  be  removed  without  much 
trouble. 

Quinosol  is  particularly  unsuitable  for  vagi- 
nal irrigation  during  labour,  says  Dr.  Witte, 
for  it  is  highly  astringent,  so  that,  it  would  rob 
the  vagina  of  its  lubricity  and  make  it  rough 
and  unyielding,  as  corrosive  sublimate  does. 

aXJINaTJINA.— See  Cixoho.xa. 


RATANHIA.— See  Keameria. 

BECONSTITTJENTS  are  remedies  which 
promote  reconstitution  or  reconstruction. 
They  include  a  variety  of  therapeutic  means 
of  which  only  a  part  axe  medicinal.  Among 
the  reconstituents  are  diet,  exercise,  climatic 
influences,  travel,  bathing,  and  personal  hy- 


123 


QUINOIDINE 
RECOI^STITUENTS 


giene,  as  well  as  alterative,  stomachic,  and 
tonic  medicines.  These,  for  the  greater  part, 
are  considered  elsewhere  in  this  work,  and  it 
therefore  remains  but  to  point  out  their  special 
actions  as  reoonstituents. 

The  action  of  food  as  a  reconstituent  is  pro- 
nounced, and  curable  debility  of  any  kind 
■yields  more  quickly  to  it  than  to  anything  else. 
The  most  striking  example  of  its  powers  is 
observed  in  the  convalescence  which  follows 
acute  disease.  The  reconstituent  power,  how- 
ever, does  not  reside  in  all  varieties  of  food 
to  the  same  degree ;  indeed,  from  their  indi- 
gestibility,  certain  of  the  richer  foods  not  only 
fail  at  reconstitution  when  given  in  debility, 
but  are  even  productive  of  debility  if  given 
excessively  in  a  state  of  health.  Fats  are,  as  a 
class,  our  most  useful  reconstructive  foods,  for 
they  combine  with  easy  digestibility  a  maximum 
power  to  nourish,  milk,  of  course,  offering  the 
best  example  of  this  action,  and  tuberculosis 
the  condition  in  which  its  benefits  are  most 
striking.  Nitrogenous  foods  rank  second  to 
fats  in  reconstituent  value,  being  both  more 
difficult  of  digestion  and,  as  a  rule,  less  nourish- 
ing, while  carbohydrates  come  last,  though 
they  are  certainly  nourishing  and  in  many 
cases  highly  to  be  recommended.  As  in  health, 
so  also  in  debility,  no  exclusive  diet  is  ordi- 
narily to  be  advocated,  but  instead  such  a 
judicious  mixture  and  combination  of  nitro- 
genous, fatty,  and  carbohydrate  foods  as  ex- 
perience has  shown  to  be  most  useful.  In 
some  cases  of  debility  a  positive  distaste  for 
food  has  to  be  combated ;  the  patient,  if  left 
to  himself,  would  not  consume  a  sufficient 
amount  of  food  to  maintain  his  nutrition.  If 
this  is  the  case  there  is  often  much  benefit  to 
be  had  from  forced  feeding,  or  garage.  Cer- 
tain beverages  may  be  regarded  as  indirectly 
reconstituent  by  virtue  of  the  stimulating  and 
sustaining  power  they  exert  over  nerve  func- 
tion, especially  that  of  digestion,  and  by  virtue 
of  their  action  to  lessen  tissue  waste.  Those 
which  contain  alcohol  or  caffeine  are  undoubt- 
edly thus  active,  while  some  few  drinks  are 
directly  reconstituent  because  of  the  food  value 
of  some  of  their  ingredients. 

That  a  judicious  amount  of  exercise  is  recon- 
stituent needs  proof  no  more  than  that  over- 
work is  debilitating.  Under  its  influence 
tissue  metamorphosis  is  made  more  active,  and 
elimination  of  waste  products  is  increased. 
Digestion  and  absorption  are  in  their  turn 
augmented  and,  provided  the  food  given  in 
response  to  this  demand  is  of  the  proper  and 
nutritious  sort,  reconstruction  takes  place.  It 
is  not  every  exercise  which  performs  this  re- 
constructive duty,  for  if  excessive  in  amount 
or  violent  in  its  nature,  it  may  have  quite  the 
opposite  effect — namely,  to  exhaust  and  depress. 
Exercise  in  the  open  air,  too,  is  much  to  be  pre- 
ferred to  exercise  within  doors,  though  the 
latter  is  not  inefficient.  In  some  cases  where 
debility  is  extreme,  active  exercise  is  an  impos- 
sibility, and  then  we  may  usefully  employ 
massage  and  passive  motion  until,  with  return- 
ing vigour,  the  ability  to  take  active  exercise 
returns. 

The  influence  of  climate  upon  debility  is 
53 


great,  and  no  more  convincing  proof  of  this 
is  needed  than  the  rapidity  of  convalescence 
which  takes  place  when  a  change  of  air  is 
sought,  as  compared  with  the  relative  slowness 
of  recovery  at  home.  That  the  different  at- 
mospheric conditions  deserve  some  credit  for 
this  usefulness  is  no  doubt  true,  but  they  cer- 
tainly do  not  deserve  it  all,  for,  as  in  the  case 
of  treatment  by  mineral  waters  at  the  spring 
from  which  they  are  obtained,  a  number  of 
factoi'S  must  necessarily  enter  into  the  effect 
upon  the  patient.  Of  these  factors  the  most 
important,  besides  atmospheric  conditions,  are 
change  of  scene  and  surroundings,  relief  from 
the  cares  of  home  or  of  business  life,  change 
of  diet  and  occupation,  change  of  hours,  rest 
and  repose,  and,  finally,  a  mental  condition  of 
hopefulness  and  expectation  of  benefit  to  be 
derived  which  in  itself  will  favour  recovery. 
That  convalescence  and  debility  in  general 
should  receive  the  benefits  which  change  of 
residence  will  give  needs  no  argument,  but 
some  cases  are  wrongfully  treated  thus.  Of  all 
conditions  so  mistreated,  tuberculosis  offers  the 
most  striking  example,  and  we  every  day  see 
patients  sent  from  home  that  they  may  obtain 
the  supposed  benefits  which  change  of  climate 
can  give,  when  it  is  quite  evident  that  recovery, 
or  even  improvement,  is  impossible,  and  that 
deprivation  of  home  surroundings  and  of  home 
comforts  to  them  means  positive  harm.  The 
hopeless  kinds  and  degrees  of  debility,  there- 
fore, should,  as  a  rule,  receive  treatment  at 
home.  As  to  the  climate  which  should  be 
sought  in  cases  suitable  for  climatic  treatment, 
there  are  no  hard  and  fast  rules.  In  many 
cases  it  is  change  that  is  the  important  factor 
rather  than  atmospheric  conditions,  and  then 
almost  any  climate  will  be  suitable,  provided 
the  element  of  change  is  present.  In  other 
cases  the  proper  climate  must  be  sought  by  ex- 
periment, and  therefore  the  patient  must  go 
from  place  to  place  until  he  finds  a  locality  in 
which  he  eats,  sleeps,  and  feels  well.  In  cer- 
tain diseases,  however,  one  rather  expects  re- 
covery to  be  promoted  by  special  atmospheric 
conditions ;  thus,  persons  with  catarrhal  dis- 
eases, as  a  rule,  are  relieved  by  atmospheres 
which  are  relatively  warm  and  dry  ;  those  with 
renal  diseases  also  are  generally  improved  by 
the  same  sort  of  climate ;  while  those  with 
nervous  diseases,  as  a  rule,  are  benefited  by  a 
warm  and  soothing  air,  and  injured  by  one 
which  is  changeable  in  temperature  and  hu- 
midity, and,  as  a  rule,  by  sea  air.  Patients 
with  pulmonary  tuberculosis  are  susceptible  of 
improvement  by  a  variety  of  climates,  the  chief 
determining  elements  being  the  purity  of  the 
atmosphere,  the  relative  absence  of  moisture, 
and  freedom  from  sudden  changes.  Further 
than  these,  the  exact  locality  will  be  deter- 
mined by  the  degree  of  debility  which  is  pres- 
ent ;  those  who  are  much  enfeebled  it  is  well 
to  send  to  warm  climates,  while  those  whose 
vigour  is  preserved  do  well  in  the  dry  and  cold 
mountain  atmospheres,  and  for  others  still 
the  suitable  place  must  be  sought  by  travel. 
In  all  tuberculous  cases,  however,  the  main 
requisite  seems  to  be  a  continued  out-of-door 
life. 


RECTAL  MEDICATION 
RESORCIN 


124 


Travel  as  a  reoonstituent  agent  may  be  of 
much  benefit,  and  on  the  other  hand  may  be 
productive  of  great  harm ;  the  determination 
of  the  question  rests  upon  the  amount  of  vigour 
which  the  patient  possesses  and  his  ability  to 
■withstand  fatigue.  Certainly  nothing  could 
be  more  foolish  than  to  hurriedly  and  continu- 
ously drag  an  enfeebled  man  from  place  to 
place  and  expect  him  to  grow  strong.  Not 
only  must  the  strength  of  the  patient  be  con- 
sulted, but  also  the  mode  of  travel,  for,  though 
an  invalid  might  well  be  able  to  travel  in  the 
luxury  of  a  yacht  or  a  private  car,  he  would  be 
no  fit  occupant  for  the  springless  wagon  or 
the  saddle.  In  mental  exhaustion  from  over- 
work travel  is  certainly  at  its  best,  provided 
anxiety  can  also  be  left  behind,  and  in  many 
another  disturbance  it  may  be  of  the  greatest 
benefit,  but  in  prescribing  it  one  must  care- 
fully consider  many  things,  especially  the 
patient's  physical  ability,  the  circumstances  of 
the  journey  as  regards  comfort,  the  importance 
of  the  duties  and  interests  he  leaves  behind,  the 
itinerary,  and  the  amount  of  benefit  which  it 
is  possible  for  him  to  derive  from  his  journey- 
ings. 

The  observance  of  hygienic  rules  is  highly 
reoonstituent.  This  is  scarcely  the  place  to 
impress  the  importance  of  regularity  in  all 
which  pertains  to  our  physiological  life,  as 
concerns  eating,  sleeping,  exercise,  the  evacua- 
tions, and  bathing.  The  rules  which  should 
govern  these  matters  are  well  known,  and  it  is 
equally  well  known  how  violation  of  them  may 
result  in  a  debility  which  will  return  only  when 
the  violation  ceases.  As  a  reoonstituent  in 
convalescence  and  asthenia,  generally,  the  cold 
hath  deserves  a  particular  mention,  for  its 
tonic  power  over  nervous  energy  is  very  great. 
Whether  the  cold  bath  should  take  the  form 
of  sponging,  of  showering,  or  of  the  plunge 
will  vary  with  circumstances,  and  for  detailed 
information  the  reader  is  referred  to  the  article 
on  Baths. 

So  far  as  reoonstituent  drugs  are  concerned, 
it  might  seem  that  they  were  sufficiently  de- 
scribed as  tonics,  but  reconstituents  would 
appear  to  be  the  larger  class,  including  not 
only  tonics,  but  also  bitters  and  alteratives. 
Alteratives  certainly  possess  a  great  infiuenc3 
in  certain  cases  of  debility ;  an  example  of  this 
action  is  seen  in  the  ancemia  of  syphilis,  where 
other  reconstituents  are  of  little  or  no  effect 
unless  mercury  or  an  iodide  is  simultaneously 
administered.  It  is  doubtless  true  that  in 
such  conditions  the  alterative  acts  in  a  comple- 
mentary capacity  to  the  other  reoonstituent, 
and  it  is  perhaps  more  exact,  therefore,  to  re- 
gard alteratives  as  reconstituents  rath-er  by 
indirect  than  by  direct  action.  Bitters  pro- 
mote reconstitution  by  their  action  upon  di- 
gestion, for  the  appetite  and  the.  assimilative 
power  become  so  much  enhanced  under  their 
influence  that  larger  amounts  of  food  are  taken 
and  absorbed,  to  the  end  that  general  nutrition 
is  much  improved.  It  is  for  this  reason  that 
bitters  are  so  generally  employed  in  debilitated 
states,  and  in  the  convalescence  from  acute 
disease  the  use  of  the  bitter  remedies,  like 
quassia,  caluraba,  and  gentian,    has    become 


almost  a  routine.  As  reconstituents,  the  bit- 
ters act  indirectly  by  virtue  of  their  influence 
upon  digestion  ;  the  tonic  remedies  act  thus  as 
well,  for  stomachic  and  digestive  virtues  reside 
in  most  of  them,  but  they  act  more  upon  the 
body  generally,  though,  again,  digestion  plays 
a  part,  for  bodily  invigoration  includes  digest- 
ive improvement,  and  from  digestive  improve- 
ment the  genei-al  health  is  increased.  The 
chief  primary  action  of  the  tonics  as  recon- 
stituents is  upon  the  body  generally,  and  thus 
iron,  arsenic,  and  strychnine  become  of  so  much 
service  in  debility.  Finally,  we  must  class 
cod-liver  oil  as  in  the  highest  degree  reeon- 
stituent,  though  the  manner  by  which  it  acts 
is  not  clear.  It  is  credited,  as  we  know,  with 
alterative,  tonic,  and  nutritious  qualities  by 
any  or  all  of  which  it  might  be  reoonstituent. 
Henkt  a.  Gbiffin. 

RECTAL  MEDICATION.  —  See  under 
Cacao-butter. 

RED  POPPY.— See  Rhceas. 

RED  SATJlfDERS.— See  Sandal- Wood. 

REFRIGERANTS  are  agents  which  effect 
cooling,  either  of  the  body  generally  or  of  a 
part.  Strictly  speaking,  no  reason  exists  why 
the  name  refrigerant  should  not  be  held  syn- 
onymous with  antipyretic ;  it  has,  however, 
come  to  have  the  signification  of  producing 
sensations  of  cold,  rather  than  of  actually  re- 
ducing the  temperature  of  the  body. 

Clinically,  refrigerants  have  two  uses.  The 
first  concerns  their  employment  as  cooling 
beverages,  which  are  often  so  grateful  to  pa- 
tients suilering  from  fever,  and  are  eflfective 
rather  by  quenching  thirst  than  by  appreciably 
reducing  the  fever.  As  refrigerant  drinks, 
there  may  be  used  ice  water,  carbonated  waters, 
lemonade,  or  water  slightly  acidulated  with 
an  acid,  especially  diluted  phosphoric  acid. 
Naturally,  these  drinks  are  more  effective 
if  used  cold,  and.  with  due  regard  for  the 
amount  of  the  acids  they  may  contain,  they 
may  be  taken  freely,  the  sole  eontra-indication 
to  their  generous  employment  being  gastric 
disturbance,  either  present  or  impending. 
Should  gastric  disturbance  be  present,  the 
proper  refrigerant  will  be  either  cracked  ice  or 
iced  water  given  cautiously,  tentatively,  in 
small  quantities  and  at  infrequent  intervals. 
The  second  clinical  use  of  refrigerants  is  for 
the  production  of  local  and,  especially,  cutane- 
ous cold  for  the  purpose  of  diminishing  local 
congestion  and  inflammation  or  of  causing 
anassthesia.  As  refrigerant  applications  u:'n- 
ful  in  local  inflammations  may  be  cited  cold 
water,  cold  air,  and  especially  evaporaling 
lotions.  The  production  by  cold  of  local  anaes- 
thesia sufficient  for  the  performance  of  minor 
surgical  operations,  such  as  the  opening  of 
abscesses,  may  be  brought  about  by  the  appli- 
cation of  ice  to  the  part ;  but  there  are  certain 
obvious  disadvantages  connected  with  this 
practice  which  do  not  apply  to  the  spraying  of 
very  volatile  liquids  upon  the  area  for  opera- 
tion, the  rapid  evaporation  which  takes  place 
insuring  the  necessary  degree  of  cold.  A  num- 
ber of  these  liquids  are  in  use;  particularly 
serviceable  are  rhigolene,  ethyl  chloride,  and 


125 


RECTAL  MEDICATION 
RESORCIN 


ether.  The  Use  of  such  remedies  must  be  cau- 
tious, however,  because  of  their  inflammable 
and  even  explosive  nature. 

The  terra  refrigerant  is  used  by  some  writers 
to  further  describe  the  action  of  other  remedies. 
Thus,  refrigerant  diuretics  are  those  which  act 
as  general  sedatives  and  render  irritating  urine 
bland.  This  class,  naturally,  consists  mainly 
of  alkalies  and  their  salts,  and  the  term  re- 
frigerant used  in  this  connection  would  seem 
to  be  more  suggestive  than  exact.  Refrigerant 
diaphoretics,  too,  are  spoken  of,  the  term  ap- 
plying to  drugs  which  promote  perspiration  by 
reducing  circulatory  excitement  and  are  espe- 
cially useful  in  fever.  Such  are  aconite  and 
veratrum  viride. — Henry  A.  Griffin. 

RELAXANTS  are  remedies  which  lessen 
the  tension  of  body  tissues.  The  power  to  re- 
lax resides  in  many  agents ;  relaxation  of  the 
skin  is  produced  by  diaphoretics,  of  the  intes- 
tines by  various  cathartics,  of  the  blood-vessels 
by  vascular  sedatives,  and  of  the  body  gener-  I 
ally  by  nauseantsand  emetics,  as  well  as  by  the 
hot-air  bath,  the  prolonged  warm-water  bath, 
and  remedies  which  debilitate.  All  these  might 
properly  be  termed  relaxants,  and,  indeed,  the 
name  not  infrequently  is  employed  as  signifying 
laxative,  but  clinically  the  term  is  oftener  used 
in  describing  remedies  which  produce  relaxa- 
tion in  the  skin  to  which  they  are  directly  ap- 
plied and  in  the  tissues  immediately  beneath  it. 

Of  relaxant  remedies,  poultices  offer  a  good 
example,  together  with  other  and  similar  ap- 
plications to  the  surface  of  the  body  which 
are  active  by  virtue  of  their  heat  and  moisture. 
Of  similar  effect,  though  by  a  different  mode 
of  action,  are  fatty  substances,  which  when 
locally  applied  are  productive  of  softening  and 
relaxation,  an  action  which  is  constantly  made 
useful  in  the  application  of  ointments. 

The  therapeutics  of  relaxants  will  have  been 
inferred  from  what  has  already  been  said,  and 
though  for  the  relief  of  cutaneous  and  subcu- 
taneous tension  poulticing  was  so  constantly 
practised  formerly,  it  is  now  but  little  esteemed, 
for  fear  of  the  injury  which  poultices  may  do, 
but  the  softening  action  of  fatty  sub.stances  is 
constantly  evoked  in  conditions  in  which  the 
skin  has  become  indurated,  dried,  or  inflamed. 
Henry  A.  Griffin. 

RESINA  (U.  S.  Ph.,  Br.  Ph.).— See  Rosin. 

RBSINS. — These  are  fieculiar  principles, 
profusely  distributed  through  the  vegetable 
kingdom  and  almost  entirely  oonflned  to  it. 
They  are  mostly  uncrystallizable  solids,  fusible 
but  not  volatile,  insoluble  in  water,  but  soluble 
in  one  or  more  of  the  more  volatile  solvents, 
such  as  alcohol,  ether,  chloroform,  benzin,  etc. 
They  are  also  soluble  in  volatile  and  fixed  oils. 
Most  of  them  have  an  acid  character,  which 
enables  them  to  combine  with  alkalies  to  form 
so-called  "  resin-soaps,"  compounds  which  are 
soluble  in  water,  and  from  which  the  resin  may 
again  be  separated  by  acids.  The  nature  of 
the  resins  is,  as  yet,  not  fully  understood,  but 
most  of  them  are  evidently  oxidation  products 
of  certain  hydrocarbons,  such  as  terpenes, 
which  are  the  chief  constituents  of  most  vola- 
tile oils.    What  are  ordinarily  called  "  resins," 


either  in  the  classification  of  drugs  or  in 
pharmacy,  are  in  most  cases  not  pure,  homo- 
geneous, chemical  individuals,  but  more  or  less 
complex  mixtures. 

Resins  are  most  conveniently  divided  into 
"  natural "  and  "  pharmaceutical "  resins. 
Natural  resins  are  often  accompanied,  in  their 
commercial  form,  by  other  proximate  prin- 
ciples, which  modify  their  properties  to  some 
extent  and  have  induced  pharmacologists  to 
classify  them  in  different  ways.  Pluckiger's 
classification,  which  appears  the  most  natural, 
is  as  follows : 

1.  Resins  mixed  with  gum  (true  gum-resins) : 
gamboge. 

3.  Resins  mixed  with  gum  and  volatile  oil  : 
myrrh,  olibanum,  asafoetida,  galbanum,  and 
ammoniacura. 

3.  Resins  mixed  with  notable  amounts  of 
volatile  oil :  turpentine  (and  its  varieties,  such 
as  Burgundy  pitch,  etc.),  elemi,  copaiba,  and 
gurjun  oil.  In  the  case  of  the  two  latter,  the 
substance  remaining  after  the  removal  of  the 
volatile  oil  is  a  true  resin.  They  are  often  (but 
incorrectly)  called  balsams. 

4.  Resins  proper :  common  rosin  (colophony), 
amber,  sandarac,  damar,  Botany-Bay  resin  (red 
and  yellow  acaroid  resin),  dragon's  blood, 
guaiac  resin,  mastic,  shellac,  and  benzoin.  The 
latter,  however,  does  not  properly  belong  here, 
as  it  contains  other  constituents,  such  as  vola- 
tile acids. 

Pharmaceutical  resins  are  the  following, 
which  are  ofHcial  in  the  U.  S.  Ph. : 

a.  Resina  copaibce,  prepared  by  distilling 
off  the  volatile  oil  from  balsam  of  copaiba. 

b.  Resina  jalapce,  prepared  by  exhausting 
jalap  with  alcohol,  concentrating  the  tincture, 
and  precipitating  the  resin  by  water. 

c  Resina  podophylli,  prepared  like  the  pre- 
ceding, except  that  the  water  is  acidulated  with 
hydrochloric  acid.  Of  all  the  official  resins, 
this  is  the  most  complex  in  its  composition. 

d.  Resina  scammonii,  prepared  like  resina 
Jalapfe. — Charles  Rice. 

RESINOL.— See  Rosinol. 

RESOL. — This  is  a  German  proprietary 
disinfectant  resembling  creolin,  said  to  be 
made  by  saponifying  100  parts  of  wood  tar 
with  20  parts  of  caustic  potash  and  adding  20 
of  methyl  alcohol.  It  seems  to  have  been 
used  but  little,  if  at  all,  clinically. 

RESOLVENTS. — See  Sorbefacients. 

RESORBIN. — This  is  a  German  ointment 
basis  said  to  be  made  from  very  pure  oil  of 
sweet  almonds,  wax,  gelatin,  soap,  and  water. 
It  mixes  freely  with  all  fatty  bodies,  and  facili- 
tates the  penetration  of  drugs  incorporated 
with  it  through  the  epidermis. 

RESORCIN,  resorcinum  (U.  S.  Ph.,  Ger. 
Ph.),  resorcinol,  or  metadihydroxybenzene,  Co 
HeOa,  is  a  diatomic  phenol  prepared  by  melting 
a  gum-resin  with  caustic  potash  or  soda.  It 
forms  colourless  or  slightly  reddish  acicular 
crystals  of  a  peculiar  but  faint  odour,  a  dis- 
agreeable sweetish  taste,  and  a  pungent  after- 
taste. It  grows  reddish  or  brownish  on 
exposure,  and  should  be  kept  in  dark  amber- 
coloured  bottles.   It  is  readily  soluble  in  water, 


EEST-CURB 


126 


in  alcohol,  and  in  ether.  Applied  to  mucous 
membranes,  resorcin  in  strong  solutions  is  irri- 
tating and  may  give  rise  to  inHiimmation. 
Taken  internally  in  .  poisonous  doses,  it  pro- 
duces tremor,  convulsions,  unconsciousness, 
and  paralysis  of  the  heart  and  of  the  respira- 
tion. 

In  full  medicinal  doses  (from  15  to  30  grains 
in  twenty-four  hours),  resorcin  acts  as  an  anti- 
pyretic and  intestinal  antiseptic,  but  it  is  not 
so  eligible  as  several  other  drugs,  inasmuch 
as  its  action  is  apt  to  be  accompanied  by  lan- 
guor, nausea,  and  sweating. 

It  is  chiefly  as  a  topical  application  that 
resorcin  has  been  found  useful.  Its  action 
is  antiseptic  and  germicidal.  It  may  be  used 
in  solutions  or  ointments  of  from  1  to  10  per 
cent.,  or  even  greater  strength.  Tbusemployed, 
it  has  proved  serviceable  in  a  great  number  of 
morbid  conditions.  In  diphtheria  it  is  a  valu- 
able topical  remedy,  also  in  various  inflamma- 
tory skin  diseases,  such  as  erysipelas,  herpes, 
acute  and  chronic  eczema,  lupus  erythematosus, 
and  psoriasis  ;  in  purulent  and  ulcerative  affec- 
tions of  the  mouth,  the  throat,  the  nose,  the  ear, 
etc. ;  and  in  gonorrhoea,  leucorrhcea,  and  chan- 
croids. 

Dr.  Moncorvo,  of  Rio  Janeiro,  proceeding 
on  the  theory  that  whooping-cough  is  due  to  a 
microbe,  has  employed  resorcin  in  that  disease 
with  great  success.  He  sprays  the  larynx  with 
a  1-per-cent.  solution. 

Dr.  C.  Boeck.  of  Christiania  (cited  in  the 
Rev.  internal,  de  med.  et  de  chir.  prat.,  No- 
vember 10,  1895),  has  found  that  resorcin  is 
very  efHoacious  against  chilblains,  especially 
when  the  drug  is  associated  with  iohthyol  and 
tannin  according  to  the  following  formula  : 

Resorcin, 

Ichthyol, 

Tannin,  each 30  parts ; 

Water 150      " 

This  mixture  must  be  thoroughly  shaken  be- 
fore it  is  used.  The  affected  parts  should  be 
painted  with  it  every  night,  and,  after  the  first 
layer  is  applied,  it  forms  in  a  few  minutes  a 
dry,  glazed  surface.  Under  the  influence  of 
resorcin  the,  skin  becomes  shrivelled,  and  the 
chilblains,  as  well  as  the  extensive  oedematous 
tumefaction  of  the  fingers  and  of  the  hand,  dis- 
appear rapidly.  However,  this  mixture,  in  spite 
of  its  great  efficacy,  presents  certain  inconven- 
iences which  may  restrict  its  employment.  It 
stains  the  skin,  and  the  region  to  which  it  is 
applied  will  remain  black  for  from  one  to  two 
weeks  after  the  cessation  of  the  treatment. 
Sometimes  the  mixture  is  not  well  tolerated  by 
subjects  who  have  a  very  delicate  skin,  in 
which  it  produces  cracks.  Finally,  it  cannot 
be  employed  in  cases  o£  ulcerated  chilblains. 
The  following  formula,  which,  says  Dr.  Boeck, 
is  less  efficacious  than  the  preceding  one,  may 
be  employed  if  the  patient's  work  is  such  that 
he  can  not  use  a  substance  which  blackens  his 
hands : 

Resorcin 60  parts ; 

Gum  arable 38  grains ; 

Water 115  parts  ; 

Talcum  powder 15     " 


This  mixture  should  be  applied  every  night 
to  the  ailected  parts. 

Dr.  Leo  Leistikow  (Ilonatsh.  f.  praki.  Der- 
matol, October  1, 1894)  reports  great  success  in 
the  treatment  of  leucoplakia  with  resorcin.  He 
uses  the  following  paste  : 

Resorcin 6  parts; 

Siliceous  earth 3     " 

Lard 1  part. 

With  a  thin  layer  of  cotton  wound  round 
the  pointed  end  of  a  stick,  this  paste  is  to  be 
smeared  over  the  patches  several  times  a  day, 
especially  after  eating  and  before  going  to  bed. 
In  from'  eight  to  fourteen  days  the  opaline 
patches  begin  to  shrink  and  the  mucous  mem- 
brane becomes  thin  and  rosy.  It  is  now  very 
sensitive,  so  that  smoking  and  eating  qiquant 
articles  of  food  should  be  avoided  and  the 
mouth  rinsed  frequently  with  peppermint 
water  to  which  borax  has  been  added.  The 
hyperferaia  caused  by  the  resorcin  may  be 
overcome  in  three  or  four  days  by  applications 
of  balsam  of  Peru. 

REST-CXTIIE.— Rest  is  one  of  the  oldest 
forms  of  treatment  in  medical  history.  Doubt- 
less it  was  the  chief  remedy  in  prehistoric 
times,  for  that  matter,  because  Nature  herself 
has  always  insisted  upon  it,  even  to  the  extent 
of  inflicting  many  a  twinge  of  pain  on  such  as 
disobeyed  her  precepts.  One  of  the  most  in- 
structive books  ever  written  on  the  scientific 
aspects  of  rest  is  that  of  John  Hilton,  who,  some 
twenty  years  ago,  collected  in  one  volume,  en- 
titled Rest  ana  Pain,  a  series  of  lectures  de- 
livered in  the  years  1860.  1861,  and  1862.  In 
this  book  he  points  out  the  value  of  rest  as  a 
curative  agent.  In  one  place  he  says :  "  So  inti- 
mate is  the  association  between  rest  and  growth 
as  to  make  them  appear,  on  a  superficial  view, 
to  stand  to  each  other  in  the  relation  of  cause 
and  effect."  In  another,  in  relation  to  the  in- 
crease in  weight  caused  by  rest,  he  says  :  "  The 
value  of  rest  in  fostering  the  production  of  that 
highly  organized  animal  tissue  which  forms  so 
large  a  portion  of  our  staple  food  is  well  known 
to  the  stock-keeper  and  grazier."  And  thus  he 
goes  on  to  explain  how  rest  is  the  great  agent 
in  growth  and  also  in  repair,  which  is  but  a 
repetition  of  the  processes  of  growth.  Hilton 
applied  the  principles  of  rest  chiefly  to  surgical 
disorders,  but  the  principles  are  in  reality  ap- 
plicable to  many  other  conditions  of  disease. 
This  is  especially  true  of  some  disorders  of  the 
nervous  system,  and  the  phrase  "  rest-cure " 
as  employed  nowadays  refers  more  particularly 
to  a  method  of  treatment  in  vogue  in  this  class 
of  cases,  of  which  Dr.  S.  Weir  Mitchell,  of 
Philadelphia,  may  be  considered  the  first  and 
chief  exponent.  In  1875  he  published  a  brief 
chapter  in  Seguin's  series  of  American  Clin- 
ical Lectures,  entitled  Rest  in  the  Treatment 
of  Nervous  Disease,  and  he  subsequently  ex- 
panded his  ideas  in  a  small  volume  with  the 
title  Fat  and  Blood.  He  made  use  of  the  treat- 
ment in  cases  of  neurasthenia  and  hysteria. 
Nowadays  we  apply  the  rest  treatment  to  many 
varieties  of  nervous  disorder. 

The  essential  feature  of  the  treatment  is 
rest.     This  promotes  growth  of  tissue    and 


127 


REST-CURE 


repair  of  waste.  To  hasten  the  attainment  of 
these  ends,  overfeeding  with  easily  digested 
foods  is  required.  A  part  of  the  principle  of 
true  rest  and  repose  is  seclusion.  In  order  to 
counterbalance  any  ill  effects  due  to  prolonged 
rest  in  bed,  and  to  assist  in  tissue  metabolism, 
massage  and  the  exercise  of  muscles  by  faradi- 
zation are  made  adjuncts  to  .the  treatment. 
Hydrotherapy  is  frequently  employed  as  an 
adjuvant. 

With  this  original  principle  of  rest  as  one 
of  Nature's  remedial  processes  in  view,  Dr. 
Mitchell  evolved  the  system  of  therapy  known 
as  the  rest-cure,  which,  as  we  have  seen,  con- 
sists in  brief  of  rest,  particular  diet,  artificial 
exercise,  and  isolation. 

Rest. — Usually  what  is  meant  by  rest  in  the 
rest-cure  is  absolute  rest  in  bed  for  a  consider- 
able period  of  time — from  six  weeks,  to  two 
months.  At  first,  for  several  weeks,  the  patient 
is  not  allowed  to  sit  up,  read,  write,  or  use  the 
hands  in  any  way,  except  to  clean  the  teeth. 
In  many  eases  even  the  bladder  and  bowels  are 
to  be  evacuated  in  the  recumbent  posture; 
when  the  bed  is  to  be  made  up,  the  patient  is 
lifted  to  a  sofa  and  back  again :  and  he  is  to 
be  fed  by  the  nurse.  But  not  all  cases  require 
such  absolute  rest,  and  the  amount  of  rest  will 
vary  with  the  needs  of  each  patient  as  viewed 
by  his  physician,  from  absolute  rest  through 
every  degree  of  "  partial  "  rest-cure.  Thus, 
there  are  patients  who  are  permitted  to  feed 
themselves,  to  get  up  for  stools,  to  read,  to  sew, 
or  to  write  a  little,  and  others,  again,  who  may 
pursue  their  vocations  within  certain  hours, 
being  required  merely  to  add  some  hours  to 
their  rest  by  going  to  bed  early  and  rising  late. 

Diet. — The  aim  in  dieting  the  patient  is  to 
insure  easy  digestion  and  the  assimilation  of 
considerable  quantities  of  nourishment.  Milk 
constitutes,  therefore,  the  major  part  of  his 
food,  and  it  is  given  every  two  hours  generally, 
at  first  in  small  quantities,  for  some  days  (4  fl. 
oz.),  and  gradually  increased  until  at  the  end 
of  a  week  or  ten  days  he  takes  from  8  to  13  oz. 
every  two  hours.  When  ordinary  milk  is  not 
well  borne,  it  may  be  diluted  with  carbonated 
waters  or  peptonized,  or  some  digestible  sub- 
stitutes employed,  such  as  kumyss,  matzoon, 
or  somal.  At  the  end  of  a  few  days  a  little 
stale  bread  and  butter  may  be  given  twice  and 
subsequently  thrice  daily ;  later  on,  a  soft- 
boiled  egg  may  be  added,  and  finally  a  chop 
or  steak  at  noontime  and  boiled  rice  at  supper- 
time. 

The  stimulant  drinks  (tea.  coffee,  cocoa,  etc.) 
are  not  given,  nor  are  beef  tea,  broths,  soups, 
and  the  like,  because  the  former  are  needless 
and  the  latter  not  especially  nutritious. 

Massage. — In  order  to  overcome  the  disad- 
vantages of  lack  of  exercise,  the  muscles  of  the 
entire  body  are  kneaded  by  a  masseur  or  mas- 
seuse (preferably  the  nurse)  for  from  fifteen 
minutes  to  an  hour  in  the  evening.  This 
should  be  begun  in  persons  unaccustomed  to 
it  by  gentle  ^enrage  for  but  a  .short  period  of 
time,  and  the  duration  of  the  massage  gradu- 
ally increased.  Playfair  advises  its  continu- 
ance for  as  long  as  three  hours,  but  this  is 
undoubtedly  extreme. 


Electiicity. — The  object  of  the  use  of  electric- 
ity is  the  same  as  that  of  employing  massage — 
to  effect  tissue  metabolism  by  passive  exercise 
of  the  muscles.  The  current  should  be  that  of 
the  faradaic  battery.  General  faradization  of 
all  the  muscles  of  the  body  is  given,  either  by 
the  nurse  or  by  the  physician,  each  muscle 
being  sought  out  and  contracted  a  certain 
number  of  times  at  each  seance.  It  is  well  not 
to  begin  at  once  with  electricity,  and  when  it 
is  used  to  use  very  feeble  currents  at  first,  in 
order  not  to  disturb  or  irritate  the  patient  un- 
duly at  the  outset.  This  is  particularly  needful 
when  patients  are  sensitive  and  unaccustomed 
to  the  current.  Besides  exercising  the  muscles, 
there  is  probably  a  certain  amount  of  "  refresh- 
ing effect"  in  electricity,  and  its  suggestive 
value  is  obvious. 

Isolation. — The  seclusion  of  the  patient  is 
naturally  an  inherent  part  of  the  theory  of  the 
rest-cure.  In  some  cases  it  must  be  so  rigid 
that  no  one  sees  the  patient  but  the  physician 
and  nurse,  and  letters  and  news  of  the  day  are 
excluded  from  the  sick-room.  In  others  some 
relaxation  of  this  rule  may  be  made,  but  the 
physician  must  be  very  judicious  in  such  ex- 
ceptions. The  patient  may  be  isolated  in  his 
own  home,  but  in  perhaps  the  majority  of  cases 
for  which  the  rest-cure  is  adopted  a  complete 
change  of  environment  is  productive  of  better 
results. 

Such  is,  in  succinct  form,  the  idea  of  the 
rest-cure,  slightly  modified  in  minor  details 
from  its  original  conception  by  the  experience 
of  the  writer.  In  many  instances  hydrothera- 
peutic  measures  may  be  added  for  their  sooth- 
ing, tonic,  or  stimulating  effects  on  the  nervous 
system,  as  indicated  by  the  symptoms  of  indi- 
vidual patients.  Drugs  are  given  as  required 
to  meet  special  manifestations. 

It  is  well  to  ascertain  the  weight  of  the  pa- 
tient from  time  to  time  during  the  course  of 
treatment,  when  possible,  and  where  this  is  not 
practicable  the  effects  of  the  method  may  be 
judged  by  the  appearance  of  the  face,  limbs, 
and  trunk.  The  duration  of  the  treatment  will 
naturally  vary  with  different  cases.  The  rest- 
cure  is  not  terminated  suddenly,  but  in  every 
instance  there  is  to  be  a  gradual  relaxation  in 
the  regulations  of  treatment  above  described. 
It  is  of  great  advantage  to  write  down  specifi- 
cally, for  the  instruction  of  the  nurse  and  for 
the  discipline  of  the  patient,  the  duties  for  each 
hour  of  the  day,  the  times  for  food,  massage, 
electricity,  recreation,  hydrotherapy,  and  so 
on.  It  will  be  found  that  the  personality  of 
the  physician  and  nurse  will  have  much  to  do 
with  the  results  of  this  treatment. 

As  to  the  nature  of  the  disorders  apt  to  be 
benefited  by  rest-cure  in  its  absolute  or  modi- 
fied forms,  they  are  of  many  kinds.  They  are, 
taken  somewhat  in  the  order  of  their  appropri- 
ateness, such  diseases  as  neurasthenia,  hysteria, 
exhaustion  from  any  form  of  nervous  or  mfntal 
disease,  chorea,  acute  mania,  melancholia, 
exophthalmic  goitre,  epilepsy,  and  hypochondri- 
asis. But  it  must  be  remembered  that  there 
are  exceptions  in  all  classes  of  cases  above 
enumerated.  All  neurasthenics,  hysterical  sub- 
jects, and  other  victims  of  nervous  disorders 


RESTORATIVES 
RHUBARB 


128 


are  not  by  any  means  to  be  put  under  such 
treatment.  The  rest-cure  may  be  the  very 
worst  kind  of  therapy  for  some  patients.  The 
pliysieian  must  exercise  great  judgment  and 
discretion  in  selecting  patients  adapted  for  a 
course  of  seclusion,  absolute  repose,  and  over- 
feeding.— Frederick  Peterson. 

RESTORATIVES  may  be  regarded  as 
measures  or  remedies  to  be  employed  when 
there  is  loss  of  consciousness,  or  temporary 
flagging  of  the  vital  powers,  or  when  the  con- 
dition popularly  known  as  suspended  anima- 
tion exists,  as  after  prolonged  submersion  in 
water.  The  loss  of  consciousness  observed  in 
fainting  is  the  form  oftenest  met  with  and 
■usually  demands  but  little  beyond  a  recumbent 
posture  with  tlie  head  lower  than  the  rest  of 
the  body,  a  procedure  which  usually  results  in 
a  speedy  recovery;  but  in  the  cases  where  the 
return  to  consciousness  is  slow,  the  inhalation 
of  the  fumes  of  ammonia,  which  may  be  pro- 
vided extemporaneously  by  burning  close  to 
the  patient's  face  two  or  three  feathers  ob- 
tained from  a  pillow,  or  the  internal  adminis- 
tration of  the  same.  laraore  pronounced  eases 
it  may  be  desirable  to  administer  alcohol,  apply 
counter-irritation  over  the  heart,  or  even  pass 
a  ligature  around  one  or  more  of  the  person's 
limbs,  so  as  to  turn  the  blood  current  toward 
the  brain ;  firmly  grasping  the  ankles  or  wrists 
may  be  sufficient;  but,  whatever  is  done,  the 
utmost  gentleness  must  be  observed,  lest  too 
violent  a  shook  be  inflicted  upon  the  tempo- 
rarily weakened  heart.  It  may  be  stated  that 
in  this  condition  and  others  in  which  alcohol 
appears  to  be  indicated,  the  smallest  amount 
possible  consistent  with  the  end  in  view — viz.. 
stimulation  of  the  heart's  action — should  be 
administered,  as  often  too  large  a  quantity 
will  overstimulate,  and  shortly  the  condition 
may  be  worse  than  in  the  beginning.  There- 
fore it  is  best  to  measure  the  dose  by  drops 
rather  than  by  drachms,  and  when  unconscious- 
ness is  profound  to  instil  it  into  the  mouth 
by  means  of  a  dropper  and  trust  to  its  absorp- 
tion by  the  oral  mucous  membrane,  and  of 
that  of  its  vapour  by  the  lungs  rather  than  by 
the  stomach.  Moreover,  when  considerable 
quantities  are  given  and  none  of  the  fluid  en- 
ters thelarynxa — a  quite  possible  accident — the 
stomach  is  rarely  in  a  condition  to  absorb,  and 
when  no  appreciable  effect  upon  the  pulse  is 
observed,  more  is  apt  to  be  given  and  thus  a 
dose  almost  lethal  in  its  effects  is  in  the  stomach 
ready  for  absorption  as  soon  as  the  circulation 
is  quickened.  A  few  drops  of  sulphuric  ether 
may  be  dropped  between  the  lips  or  inhaled, 
or,  as  well  as  alcohol,  employed  hypoderraie- 
ally.  Whatever  method  is  employed,  it  is 
much  wiser  to  administer  only  enough  to 
cause  a  moderate  strengthening  of  the  action 
of  the  heart,  and  to  repeat  the  dose  at  short 
intervals  rather  than  to  arouse  the  organ  to 
vigorous  action  by  a  full  dose. 

In  addition  to  fainting,  the  principal  con- 
ditions in  which  heart  stimulation  is  desirable 
are  asphyxiation  from  submersion  in  water  and 
exposure  to  illuminating  gas  or  carbonic  oxide 
or  dioxide  in  excavations,  breweries,  etc.     Un- 


necessary movements  of  the  person  are  to  be 
avoided,  and,  as  a  rule,  it  is  much  better  to 
adopt  the  measures  needed  as  near  as  possible 
to  the  seat  of  the  accident,  unless  the  weather 
is  too  inclement,  rather  than  convey  the  pa- 
tient to  a  more  convenient  locality.  This  is 
especially  important  in  drowning,  and  the  neg- 
lect of  this  precaution  has  led  to  many  deaths 
which  could  have  been  prevented  if  the  efforts 
at  resuscitation  had  been  undertaken  imme- 
diately after  the  taking  of  the  person  from  the 
water.  In  conditions  that  are  not  serious,  all 
that  may  be  necessary  will  be  dashing  cold 
water  upon  the  face  and  exposure  of  the  chest 
to  the  cold  air,  but  chilling  of  the  entire  body 
is  to  be  avoided.  In  the  asphyxia  of  the  new- 
born, immersion  in  a  cold  bath  or  cold-wa- 
ter effusions  usually  excite  the  respiratory 
movements.  When  the  depression  of  the  vital 
powers  is  great,  faradization  over  the  heart 
will  usually  strengthen  its  action,  while  the 
same  application  made  to  the  back,  over  the 
lower  portion  of  the  lung,  should  stimulate  the 
respiratory  movements.  Dry  heat  to  the  sur- 
face is  a  most  efficient  stimulant  of  both  the 
chest  and  the  lungs,  and  may  be  applied  by 
bottles,  etc.,  filled  with  hot  water,  or,  when 
practicable,  by  a  general  hot-air  bath.  In  ap- 
plying heated  objects  directly  to  the  body  cau- 
tion must  be  observed  that  the  indifference  of 
the  patient  may  not  prevent  his  appreciating 
too  high  a  temperature,  and  thus  troublesome 
burns  be  caused.  Friction  of  the  surface  of 
the  body  with  the  hand,  flannel,  etc.,  is  also 
useful ;  but  when  there  is  marked  depression 
the  person  should  be  protected  by  a  blanket. 
In  the  asphyxia  resulting  from  the  inhalation 
of  illuminating  gas  or  of  carbonic  oxide  or  di- 
oxide, ammonia  appears  to  be  rather  more 
serviceable  than  alcohol,  and  is  the  agent  ordi- 
narily kept  at  hand  in  gas  works,  etc.  To  restore 
consciousness  in  alcoholic  or  opium  coma  a 
mustard  plaster  may  be  applied  to  the  nape  of 
the  neck,  but  should  not  be  allowed  to  remain 
in  position  long,  lest  too  great  irritation  be  set 
up  and  sloughing  result. 

Among  the  less  active  restoratives  may  be 
included  hot  soups,  tea,  coffee,  milk,  and  cocoa, 
which  should  be  given  in  moderate  amounts, 
as  during  periods  of  depression  or  fatigue  the 
stomach  is  apt  to  reject  too  large  quantities  of 
fluids. — Russell  H.  Nevixs. 

RETINOL.— See  Rosinol. 

RETRO JECTIONS.  — See  under  Injec- 
tions. 

RHAIJININ. — This  name  has  been  ap- 
plied to  several  glucosides  found  in  various 
species  of  Rhammis.  also  to  an  American  con- 
centrated preparation  of  Rhamnus pnrshiana, 
said  to  be  made  in  the  same  way  that  podo- 
phyllin  is. 

RHAMNOXANTHIN.— See  under 

Frangbla. 

RHAMNUS  FRANGULA.— See  Fran- 

GULA. 

RHAMNUS  PURSHIANA  (U.  S.  Ph.), 
rhamni  purshianm  cortex  (Br.  Ph.),  cascara,  or 
cascara  sagrada,  is  the  bark  of  the  Califomian 


139 


RESTORATIVES 
RHUBARB 


buckthorn,  a  bush  indigenous  to  the  Pacific 
slope,  which  has  recently  been  introduced  into 
the  pharmacopoeias.  Its  ellects  are  cathartic, 
and  it  is  especially  indicated  in  cases  of 
chronic  constipation.  It  acts  without  purging, 
is  said  to  irritate  hsemorrhoids,  and  in  large 
doses  sometimes  has  the  efiect  of  a  powerful 
gastro-intestinal  irritant.  Preparations  made 
from  the  freshly  gathered  bark  are  somewhat 
apt  to  gripe,  but  if  it  has  been  kept  for  about 
two  years  this  tendency  disappears.  In  ad- 
dition to  its  cathartic  effects,  it  is  slightly 
tonic  to  the  intestinal  mucous  membrane,  and 
tends  to  correct  the  constipation  for  which  it 
was  given. 

The  fluid  extract,  extraetum  rliamni  pursli- 
iancefluidum  (U.  S.  Ph.),  is  the  best  preparation, 
and,  as  a  rule,  is  most  effectual  when  given  in 
about  dnuihm  doses  at  bedtime,  although  some 
advise  from  10  to  30  drops  night  and  morning, 
gradually  increased  to  30  drops  if  necessary. 
The  analogous  British  preparation,  the  liquid 
extract,  extraetum,  cascarcc  sagradce  liquidum 
(Br.  Ph.),  may  be  given  in  doses  of  from  |  to  2 
t\.  drachms.  The  dose  of  the  extract,  extrae- 
tum casearcs,  sagradm  (Br.  Ph.),  is  from  3  to  8 
grains.  Nursing  infants  are  apt  to  be  affected 
by  this  drug  when  it  is  taken  by  the  mother. 

Cascara  amarga,  or  Honduras  bark,  is  a 
drug  having  the  same  properties  as  quassia, 
but  it  is  not  often  used,  and  is  noted  here  only 
on  account  of  the  confusion  sometimes  caused 
by  the  similarity  of  names. 

Russell  H.  Nevins. 

RHATANHIA,  RHATANY.— See  Kra- 

MKRIA. 

BHEI  RADIX  (Br.  Ph.),  RHEUM  (U.  S. 
Ph.). — See  Rhubarb. 

RHEUMIN. — See  Chrysophanic  acid. 

RHIGOLENE  is  a  very  volatile  and  in- 
flammable fluid  obtained  in  the  distillation  of 
petroleum.  Probably,  like  nearly  all  similar 
products,  it  is  a  mixture  of  a  number  of  close- 
ly allied  bodies,  and  not  of  any  definite  chemical 
composition.  It  is  used  in  surgery  to  produce 
local  ancesthesia.  or,  rather,  freezing  of  parts,  a 
spray  from  an  ordinary  hand  atomizer  being  pro- 
jected upon  the  part  to  be  affected.  Its  great 
volatility  renders  it  the  most  effective  agent  for 
the  purpose,  and  also  requires  its  being  kept 
in  well-stoppered  bottles  in  a  cool  place.  The 
application  of  the  spray  is  to  be  continued  un- 
til the  part  upon  which  it  is  directed  has  be- 
come blanched  and  insensible  to  the  touch. 
The  procedure  is  one  which  may  often  be  use- 
fid  for  the  painless  extraction  of  teeth  and 
the  incision  into  boils,  abscesses,  felons,  etc., 
but,  it  the  action  of  the  cold  extends  beyond 
the  skin,  more  or  less  sloughing  of  the  parts 
will  occur.  The  chief  advantages  attendant 
upon  this  method  are  the  ease  with  which  it 
can  be  carried  out  and  the  portability  of  the 
apparatus,  but  whenever  it  is  practicable  the 
use  of  nitrous-oxide  gas  is  much  to  be  pre- 
ferred when  minor  surgical  operations  are  to 
be  performed.  Rhigolene  is  unsafe  to  use  in 
the  vicinity  of  lights,  and  if  considerable 
amounts  are  needed,  thorough  ventilation  is 
necessary,  as,  when  combined  with  air  in  cer- 


tain proportions,  its  vapour  is  highly  infiam- 
mable. 

An  ointment  containing  16  parts  of  rhigo- 
lene and  1  part  each  of  camphor  and  sperma- 
ceti has  been  recommended  in  the  treatment 
of  burns ;  it  is  spread  or  daubed  on  cotton, 
which  is  applied  over  the  affected  part. 

Russell  fl.  Nevins. 

RHODALLINE. — See  Thiosinamine. 

RHODEOKRHETIN.  —  See    Convolvu- 

LIN. 

RHCEADOS  PETALA  (Br.  Ph.),  RHCE- 
AS. — The  fresh  petals  of  the  red  poppy.  Pa- 
paver  Rhrnas,  and  preparations  made  from 
them,  especially  the  syrup  of  poppies,  syrupus 
rhaeados  (Br.  Ph.),  were  formerly  much  used 
as  a  mild  anodyne  and  soporific,  particularly 
for  children.  The  dose  of  the  syrup  is  1  fl. 
drachm.  It  is  now  prescribed  chiefly  to  im- 
part a  pleasing  colour  to  mixtures  in  which, 
such  as  cough  mixtures,  a  feeble  anodyne  is 
unobjectionable. 

RHUBARB,  rheum  (TJ.  S.  Ph.),  rhei  radix 
(Br.  Ph.),  radix  rhei  (Ger.  Ph.),  is  the  root  of 
various  species  of  Rheum.  The  0.  S.  Ph.  and 
the  Ger.  Ph.  name  Rheum  officinale  only,  but 
the  Br.  Ph.  recognises  the  root  as  derived 
from  Rheum  palmatum.  Rheum  officinale, 
"  and  probably  other  species."  The  plants  of 
this  genus  are  native  to  Asia.  Though  certain 
varieties  are  cultivated  elsewhere,  medicinal 
rhubarb  is  chiefly  obtained  from  China  and 
Tartary.  The  root,  having  been  dug  up,  is 
cleaned,  divested  of  its  cortex,  cut  into  pieces 
of  convenient  size,  perforated,  and  strung  upon 
cords.  In  this  state  it  is  dried  by  exposure 
either  to  artificial  heat  or  to  the  sun,  some- 
times both.  Much  obscurity  surrounds  the 
precise  origin  and  preparation  of  the  Asiatic 
root,  but  in  commerce  two  sorts  are  recog- 
nised, the  Chinese  and  the  European.  Chinese, 
or  India,  rhubarb  is  the  one  most  esteemed 
medicinally.  It  occurs  in  irregularly  cylin- 
drical or  conical,  flattened  pieces  which  are 
generally  perforated.  The  object  of  the  per- 
foration has  already  been  alluded  to.  The 
surface  of  the  pieces  is  covered  with  a  light 
yellowish-brown  powder,  and  is  frequently 
wrinkled.  Beneath  the  powder  the  colour  of 
the  root  is  reddish-brown  and  mottled  with 
lighter  hues.  The  root  is  hard  and  dense,  its 
odour  is  aromatic  and  peculiar,  and  its  taste 
bitter  and  somewhat  astringent.  When  chewed, 
the  root  is  gritty  to  the  teeth  and  stains  the 
saliva  yellow.  European  rhubarb,  though  of 
considerable  medicinal  activity,  is  not  compar- 
able in  worth  with  the  Chinese  variety.  At 
the  present  time  it  is  little  exported,  and  is 
used  probably  as  an  adulterant  of  the  Asiatic 
drug.  The  plant  has  been  cultivated  in  sev- 
eral parts  of  Europe,  especially  in  England 
and  Prance,  but  less  now  than  formerly.  A 
variety  of  rhubarb  known  as  Russian,  or 
Turkey,  rhubarb  was  formerly  exported,  but  is 
no  longer  to  be  had.  Its  exact  origin  is  un- 
known. 

The  chemistry  of  rhubarb  is  not  completely 
determined  as  yet.  The  Asiatic  root  contains 
extractive,  sugar,  starch,  pectin,  lignin,  and 


RHUS 


130 


inorganic  salts.  It  contains  also  tannic  acid 
of  the  variety  known  as  rheotannic  acid ; 
calcium  oxalate,  which  occurs  in  crystals  in 
large  amount,  and  accounts  for  the  grittiness 
of  the  drug  when  chewed  ;  and  several  colour- 
ing matters,  among  them  chrysophanio  acid. 
The  existence  of  chrysophanio  acid  in  rhubarb, 
however,  has  been  denied,  and  it  is  stated  that 
it  occurs  only  when  chrysophan,  a  glucoside 
which  the  drug  is  said  to  contain,  is  decom- 
posed under  the  influence  of  moisture,  and  a 
supposititious  ferment.  A  crystalline  sub- 
stance termed  emodin  is  also  described  as  pres- 
ent in  the  root.  The  medicinal  power  of 
rhubarb  is  thought  to  reside  rather  in  the  com- 
bination of  constituents  than  in  an  active  prin- 
ciple ;  certainly  no  active  purgative  principle 
has  been  isolated.  The  European  varieties  of 
rhubarb  contain  more  tannin  and  more  starch 
than  the  Asiatic,  but  far  less  calcium  oxalate ; 
they  therefore  lack  much  of  the  grittiness  of 
the  Asiatic  drug  on  being  chewed. 

In  small  doses,  rhubarb  is  bitter  and  sto- 
machic, acting  decidedly  to  increase  digestive 
vigour.  In  larger  doses  it  is  purgative,  causing 
loose  faecal  evacuations,  but,  owing  to  its  tan- 
nin, rhubarb  is  secondarily  astringent  and 
even  constipating,  a  circumstance  which  con- 
tributes much  to  its  medicinal  value.  The 
purgation  from  rhubarb  has  been  attributed 
rather  to  its  action  upon  peristalsis  than  upon 
intestinal  secretion,  though  it  is .  apparently 
proved  that  the  drug  is  actively  cholagogue. 
Occasionally  it  causes  griping.  The  urine 
shows  that  a  part  of  the  drug  at  least  is  ab- 
sorbed, for  under  its  influence  the  colour  of 
the  urine  becomes  more  deeply  yellow.  The 
milk  of  a  nursing  woman  is  apt  to  be  made  yel- 
low it  rhubarb  is  taken,  and  is  said  sometimes 
to  exercise  a  laxative  influence  upon  the  child. 

The  therapeutic  value  of  rhubarb  is  chiefly 
manifested  in  atonic  dyspepsia,  where  it  is  ac- 
tive because  of  its  stomachic  properties,  and 
also  valuable  from  its  influence  upon  the  con- 
stipation which  is  generally  present.  In  such 
cases  the  administration  of  rhubarb  before 
eating,  and  especially  in  combination  with  an 
alkali  like  sodium  bicarbonate,  is  highly  bene- 
ficial, a  fact  which  would  seem  to  have  abun- 
dant confirmation  in  the  extensive  use  of  the 
familiar  "rhubarb-and-soda  mixture  "for  these 
purposes.  Habitual  constipation  may  be  treated 
with  rhubarb  with  benefit,  for,  though  it  is 
indeed  secondarily  astringent  in  its  action,  it 
is  not  injuriously  so,  and  its  strengthening 
properties  more  than  compensate  for  its  astrin- 
gency.  Its  mildness  of  action  makes  rhubarb 
a  valuable  purge  for  the  enfeebled,  and  for  the 
same  reason  it  is  practically  worthless  where 
revulsion  or  depletion  is  required.  In  diar- 
rhoea  of  the  subacute  rather  than  of  the  acute 
variety,  rhubarb  is  often  of  much  benefit,  serv- 
ing to  remove  irritating  materials  from  the  in- 
testines as  well  as  to  exert  upon  them  an 
astringent  and  a  strengthening  influence.  In 
functional  disturbance  of  the  liver  in  which 
biliary  production  is  deficient,  rhubarb  is  an 
excellent  remedy.  The  drug  is  sometimes 
used  in  combination  with  another  purgative, 
that    mutual   increase    of    activity   may  oc- 


cur. Thus,  rhubarb  and  blue  mass  may  be 
given  together  when  hepatic  stimulation  and 
bilious  evacuation  are  desired,  while  rhubarb 
and  aloes  make  an  excellent  cathartic  combi- 
nation for  those  who  are  habitually  consti- 
pated, provided,  as  is  always  the  case  in 
chronic  constipation,  curative  hygiene  is  not 
neglected.  Rhubarb  is  but  little  employed 
topically,  but  it  has  at  times  been  applied  to 
unheatthy  ulcerations  in  powder  with  sup- 
posed benefit. 

The  dose  of  rhubarb  as  a  stomachic  is  from 
2  to  5  grains ;  as  a  purgative,  from  20  to  30 
grains.  Its  use  in  substance  is  uncommon, 
though  those  who  suffer  habitually  from  con- 
stipation may  find  benefit  in  chewing  small 
pieces  of  the  root  from  time  to  time.  As  a 
stomachic,  rhubarb  is  most  frequently  given  in 
a  mixture ;  as  a  purgative  it  may  be  given  in 
a  pill  with  soap.  Of  European  rhubarb  the 
dose  will  vary  between  two  and  three  times 
that  of  the  Asiatic  variety.  The  preparations 
of  rhubarb  are  numerous.  Extract  of  rhubarb, 
extractum  rhei  (U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.), 
is  a  mass  of  pilular  consistence  obtained  by 
macerating  and  percolating  powdered  rhu- 
barb with  alcohol  and  water  and  evaporating 
the  percolate.  The  dose  is  from  5  to  10  grains. 
Compound  extract  of  rhubarb,  extractum  rhei 
compositum  (Ger.  Ph.),  contains  6  parts  of  ex- 
tract of  rhubarb,  3  parts  of  extract  of  aloes,  1 
part  of  resin  of  jalap,  and  4  parts  of  medicinal 
soap.  The  dose  is  from  2  to  5  grains.  Fluid 
extract  of  rhubarb,  extractum  rhei  Huidum 
(U.  S.  Ph.),  is  given  in  doses  of  from  5  to  10 
minims  as  a  laxative,  and  from  20  to  30  min- 
ims as  a  purgative.  Infusion  of  rhubarb,  in- 
fusum  rhei  (Br.  Ph.),  is  composed  of  1  part  of 
thinly  sliced  rhubarb  infused  in  a  covered  ves- 
sel for  half  an  hour  with  40  fl.  parts  of  boiling 
distilled  water,  and  the  liquid  strained.  The 
laxative  dose  is  from  1  to  3  fl.  oz.,  and  it  may 
be  repeated  every  three  or  four  hours  until  it 
operates.  It  is  incompatible  with  the  stronger 
acids  and  with  solutions  of  metallic  salts. 
Pills  of  rhubarb,  pilulm  rhei  (U.  S.  Ph.),  con- 
tain 30  parts  of  powdered  rhubarb  and  6  parts  of 
powdered  soap  mixed  with  a  sufficient  quanti- 
ty of  water.  Each  pill  contains  3  grains  of 
rhubarb.  Compound  pills  of  rhubarb,  pilulce 
rhei  compositce  (U.  S.  Ph.),  and  the  compound 
rhubarb  pill,  pilula  rhei  composita  (Br.  Ph.), 
according  to  the  U.  S.  Ph.,  are  composed  of  13 
parts  of  powdered  rhubarb,  10  of  purified 
aloes.  6  of  myrrh,  -J-  of  oil  of  peppermint,  with 
a  sufiiciency  of  water;  those  of  the  Br.  I'h. 
contain  6  parts  of  powdered  rhubarb,  4J  of 
Socotrine  aloes,  3  of  myrrh,  3  of  hard  soap,  ^ 
of  oil  of  peppermint,  3  of  glycerin,  and  6  of 
treacle.  The  dose  of  the  Americaii  prepara- 
tion as  a  laxative  is  from  3  to  4  pills ;  of  i  he 
British  preparation,  from  5  to  10  grains.  Cora- 
pound  powder  of  rhubarb,  puhtis  rhei  composi- 
ius  (U.  S.  Ph.,  Br.  Ph.),  pulvis  magnesim  cum 
rheo  (Ger.  Ph.),  Gregory's  powder,  according  to 
the  U.  S.  Ph.,  contains  35  parts  of  rhubarb  in 
powder,  65  of  magnesia,  and  10  of  ginger ;  ac- 
cording to  the  Br.  Ph.,  3  parts  of  powdered 
rhubarb,  6  of  light  magnesia,  and  1  of  pow- 
dered ginger ;  according  to  the  Ger.  Ph.,  13 


131 


RHUS 


parts  of  magnesium  carbornate,  8  of  oleosac- 
charum of  fennel,  and  3  of  powdered  rhubarb. 
The  powder  is  laxative  and  antacid.  The  dose 
is  from  -J  to  1  drachm.  Syrup  of  rhubarb,  syr- 
upus  rliei  (U.  S.  Ph.,  Br.  Ph.),  sirupus  rhei 
(&er.  Ph.),  according  to  the  U.  S.  Ph.,  con- 
tains 100  parts  of  fluid  extract  of  rhubarb, 
4  of  spirit  of  cinnamon,  10  of  potassium 
carbonate,  50  of  glycerin,  50  of  water,  and 
enough  syrup  to  make  1,000.  It  is  a  mild 
cathartic  of  much  value  for  infants.  The  dose 
for  an  infant  is  1  fl.  drachm.  The  British  syr- 
up consists  of  8  fl.  oz.  of  rectified  spirit  mixed 
with  34  fl.  oz.  of  distilled  water  and  percolated 
through  2  oz.  each  of  powdered  rhubarb  and 
powdered  coriander,  and  afterward  evapo- 
rated to  14  fl.  oz.  and  filtered,  with  the  final 
addition  to  it  of  34  oz.  of  refined  sugar.  The 
adult  dose  is  from  1  to  4  fl.  drachms.  Aro- 
matic syrup  of  rhubarb,  syrupus  rhei  aromat- 
icus  (U.  S.  Ph.),  contains  15  parts  of  aromatic 
tincture  of  rhubarb  and  85  of  syrup.  It  is  an 
excellent  laxative  in  diarrhoea!  conditions  of 
infants  ;  for  adults  it  is  too  feeble.  The  dose 
for  an  infant  is  1  fl.  drachm,  repeated  every 
two  or  three  hours  until  the  movements  im- 
prove. Tincture  of  rhubarb,  hncfura  rhei 
(U.  S.  Ph.,  Br.  Ph.),  tinctiira  rhei  aquosa  (Ger. 
Ph.),  according  to  the  U.  S.  Ph.,  is  made  with 
100  parts  of  rhubarb,  20  of  cardamom,  100  of 
glycerin,  and  a  sufficient  quantity  each  of  al- 
cohol and  water  to  make  1.000.  The  dose  is 
from  1  to  3  fl.  drachms.  The  British  tincture 
is  made  with  2  oz.  of  rhubarb,  i  oz.  of  carda- 
mom seeds,  J  oz.  of  coriander  fruit,  i  oz.  of 
saffron,  and  1  pint  of  proof  spirit.  The  Ger- 
man tincture  is  made  with  10  parts  of  rhu- 
barb, 1  of  borax,  1  of  sodium  carbonate,  90 
of  water,  15  of  cinnamon  water,  and  9  of  alco- 
hol. The  dose  as  a  stomachic  is  from  1  to  2  fl. 
drachms  ;  the  purgative  dose  is  from  4  to  8  fl. 
drachms.  Vinous  tincture  of  rhubarb,  tinctura 
rhei  vinosa  (Ger.  Ph.),  is  made  with  8  parts  of 
rhubarb,  2  of  orange  peel,  1  of  cardamom,  and 
100  of  sherry  wine.  The  doses  are  a  little  larg- 
er than  those  of  the  tinctures  previously  men- 
tioned. Aromatic  tincture  of  rhubarb,  tinctura 
rhei  aromatica  (U.  S.  Ph.),  is  made  with  30  parts 
of  rhubarb,  4  of  cassia  cinnamon,  4  of  cloves,  3 
of  nutmeg,  10  of  glycerin,  and  of  alcohol,  water, 
and  diluted  alcohol,  each  a  quantity  suflHoient 
to  make  100.  The  adult  dose  is  from  ^  to  1  fl. 
drachm.  It  is  used  in  making  aromatic  syrup 
of  rhubarb.  Sweet  tincture  of  rhubarb,  tinc- 
tura rhei  dulcis  (U.  S.  Ph.),  is  made  with  10 
parts  of  rhubarb,  4  of  licorice,  4  of  anise,  1  of 
cardamom,  10  of  glycerin,  and  of  alcohol,  water, 
and  diluted  alcohol  each  a  sufiicient  quantity 
to  make  100  parts.  The  dose  is  from  3  to  3  fl. 
drachms.  Wine  of  rhubarb,  vinum  rhei  (Br. 
Ph.),  is  made  by  macerating  1^  oz.  of  pow- 
dered rhubarb  and  60  grains  of  powdered  ca- 
nella  bark  with  1  pint  of  sherry  for  seven  days, 
straining,  filtering,  and  adding  suiBoient  sher- 
ry to  make  1  piirt.  The  dose  is  from  1  to  2  fl. 
drachms.  There  is  occasionally  used  for  diar- 
rhoeal  conditions  what  is  known  as  torrefied 
rhubarb.  This  is  rhubarb  from  which  the 
purgative  principles  have  been  driven  off  by 
heating,  the  astringent  property  remaining. 


[The  dose  of  rhubarb-and-soda  mixture,  mis- 
tura  rhei  et  sodce  (U.  S.  Ph.).  is  from  -J  to  1  fl. 
drachm  for  infants,  and  from  3  to  4  fl.  drachms 
for  adults.  A  more  convenient  form  of  rhu- 
barb and  sodium  bicarbonate  is  that  of  the  un- 
official compressed  tablets,  from  one  to  six  of 
which  may  be  taken  in  the  course  of  twenty- 
four  honrs.] — Henry  A.  Geiffin. 

BHTTS. — This  is  a  genus  of  anacardiaceous 
trees  and  shrubs.  Several  of  the  species  are 
poisonous,  and  medicinal  virtues  have  been 
ascribed  to  some  of  them. 

Rhus  aromatica. — The  root-bark  of  this 
North  American  shrub,  the  sweet  sumach,  is 
diuretic,  and  is  reputed  to  have  a  stimulating 
action  on  the  muscular  tissue  of  the  bladder, 
the  uterus,  and  the  large  intestine.  It  has 
been  used  with  considerable  success  in  inconti- 
nence of  urine  from  vesical  atony,  in  vesical 
haimaturia,  in  metrorrhagia  due  to  fibroid 
tumours  of  the  uterus,  and  in  haemorrhage  from 
the  rectum.  The  powder  may  be  given  in 
daily  amounts  of  from  15  to  45  grains.  There 
is  an  unoifioial  fluid  extract  of  which  from  10 
to  30  drops  may  be  given  daily. 

Rhus  diversiloba,  the  hiedra,  or  yeara,  or 
poison  oak,  of  the  Pacific  coast  of  the  United 
States,  is  similar  in  its  poisonous  action  to 
Rhus  Toxicodendron,  which  it  resembles  in  ap- 
pearance also.  According  to  Dr.  Colbert  A. 
Garfield  (Am.  Jour,  of  Pharm.,  September^ 
1860),  a  remedy  which  is  invariably  efficient 
in  poisoning  with  Shus  diversiloba  is  grin- 
delia  (either  Orindelia  hirsutula  or  Grin- 
delia  robusta).  '•  The  mode  of  using  it,"  says 
Dr.  Canfield,  "  is  as  follows :  One  may  bruise 
the  fresh  herb  and  apply  it  by  rubbing  over 
the  parts  affected,  or,  boiling  it  in  a  covered 
vessel,  make  a  strong  decoction  of  the  fresh  or 
dried  herb  with  which  to  wash  the  poisoned 
surfaces.  Its  remedial  properties  appear  to  be 
contained  chiefly  in  the  resin  or  balsamlike 
juice  of  the  plant,  which  is  particularly  abun- 
dant on  the  surface.  One  application  is  some- 
times sufficient  for  a  cure,  but  if  the  disease 
has  been  of  long  duration,  several  days  will 
elapse  before  relief  is  obtained."  Probably  the 
fluid  extract  of  grindelia  will  be  found  equally 
serviceable  and  more  convenient  as  a  remedy 
for  this  distressing  form  of  poisoning. 

Rhus  glabra  (U.  S.  Ph.).— The  berries  of 
this  shrub,  the  smooth  sumach,  or  upland 
sumach,  indigenous  to  the  United  States  and 
Canada,  which  are  edible,  are  sour,  astringent, 
and  refrigerant.  The  fluid  extract,  extractum 
rhois  glabrm  fluidum  (U.  S.  Ph.),  diluted,  forms 
an  agreeable  vehicle  for  gargles  in  various 
forms  of  sore  throat. 

Rhus  pumila,  or  dwarf-sumach,  a  small 
shrub  found  in  North  Carolina,  is  said  to  be 
the  most  poisonous  species. 

Rhus  radicans. — This  is  a  climbing  vari- 
ety of  Mhus  Toxicodendron,  known  as  poison 
ivy.  Its  poisonous  effects  are  the  same  as  those 
of  Hhus  Toxicodendron. 

Rhus  Toxicodendron.— Under  this  name, 
the  fresh  leaves  of  Jihus  radicans,  which  is  a 
variety  of  Rhus  Toxicodeiidron,  are  ofiflcial  in  the 
U.  S.  Ph.    The  poison  oak,  or  poison  ivy,  is  a 


RHUS 


133 


familiar  plant  of  the  fields,  woods,  and  road- 
sides of  southern  Canada  and  of  the  United 
States.  Its  trifoliolate  leaves  serve  readily  to 
distinguish  this  poisonous  plant,  the  "three- 
leaved  ivy,"  from  the  harmless  Virginian 
creeper  (Ampelopsis  quinquefolia)  with  which 
it  might  otherwise  be  confounded. 

To  most  persons,  Rhus  Toxicodendron  is  a 
violent  poison.     Handling  the  plant  or  gentle 
contact  with  it — even,  in  the  case  of  some  in- 
dividuals, exposure  to  the  emanations  from  it, 
without    any    contact   with    it    whatever — is 
enough  to  cause  the  cutaneous  form  of  rhus 
poisoning  to  ensue  within  a  few  hours,  in  the 
form  of  an   intense  -dermatitis.     In   rare  in- 
stances the  entire  skin  is  affected,  but  usually 
the  effects  of  the   poison  are  shown  only  on 
those  parts  Co  which  the  plant  was  originally 
applied  or  on  those  also  to  which  the  milky 
juice  (some  say,  too.  the  contents  of  the  vesi- 
cles incident  to  the  inflammatory  process)  may 
be  transferred  by  the  patient's  fingers.    The 
face  and  the  hands  are  the  commonest  seats  of 
the  cutaneous  inflammation.     In  its  character, 
it  may  range  from  a  mere  reddening  of  the 
skin  through  the  phases  of  papular  and  vesicu- 
lar lesions  up  to  a  condition  of  redness,  swell- 
ing, and  vesication   that  constitutes  a  close 
counterfeit  of  genuine  erysipelas.     Whatever 
form  the  poisoning  takes,  it  is  always  accom- 
panied  by  distressing  itching  and  burning. 
Desquamation  usually  closes  the  progress  of 
the  affection,  which  generally   begins  to  de- 
cline within  two  or  three  days,  and  almost  al- 
ways in  the  course  of  a  week.    In  severe  cases, 
where  the  dermatitis  is  widespread,  there  may 
be  a  moderate  degree  of  fever  for  a  short  time. 
There  are  some  persons  to  whom  Rhus  Toxi- 
codendron is  not  poisonous ;  they  can  handle 
the  plant  and  rub  its  milky  juice  on  their  skin 
without  suffering  any  unpleasant  effect.     In 
some  others,  on  the  contrary,  troublesome  se- 
quel* follow  upon  the  regular  course  of  the 
poisoning,  such  as  protracted  eczema  and  re- 
current crops  of  boils.     Moreover,  there  is  on 
record  indubitable  testimony  going  to  show 
that,  with  a  few  individuals,  one  attack  ot  rhus 
poisoning  entails  upon  the  victim  one  or  more 
annual  recurrences  at  about  the  same  time  in  the 
year  without  any  fresh  exposure  to  the  plant. 
Thus,  Mr.  E.  G.  Lodeman  {Garden  and  Forest, 
cited  in  Am.  Jour,  of  Fharm.,  January,  1895), 
writing  of  his  personal  experience  with  this 
plant,  states  that  the  symptoms  of  poisoning  re- 
appeared for  six  years  consecutively,  at  about 
the  same  time  of  the  year  as  that  in  which  he 
had  been  poisoned,  without  his  having  been 
again  exposed  to  the  plant.     An  attack  of  ty- 
phoid fever  occurred  in  the  seventh  year,  and 
for  several  years  afterward  he  escaped  the  affec- 
tion.    Thinking  himself  then  exempt  from  the 
influence  of  the  poison,  he  rubbed  a  leaf  of  the 
plant  on  the  back  of  his  hand,  and  again  for 
several  years  symptoms  of  poisoning  recurred 
at  the  same  time  of  the  year. 

The  treatment  of  this  cutaneous  form  of  rhus 
poisoning  consists  in  the  administration  of  cool- 
ing drinks  and  the  topical  application  of  sooth- 
ing remedies.  The  patient  should  always  be 
cautioned  against  handling  the  affected  parts, 


for  fear  of  transferring  some  of  the  poisonous 
principle  to  other  portions  of  the  skin.  The  well- 
knovvn  lead-and-opium  wash  (.see  under  Lead, 
vol.  i,  page  577)  is  very  soothing:  cloths  wet 
with  it  maybe  kept  constantly  applied,  except 
to  the  eyes.  This,  however,  has  little  if  any  cura- 
tive action,  but  is  only  palliative.  The  fluid 
extract  of  serpentaria  has  been  highly  recom- 
mended as  both  a  soothing  and  a  curative  ap- 
plication. It  is  highly  probable,  in  view  of 
Dr.  Canfield's  experience  with  the  use  of  griu- 
delia  in  cases  of  poisoning  with  Rhus  diversi- 
loba  (mentioned  in  the  section  on  that  species), 
that  the  fluid  extract  of  grindelia  will  be  found 
of  substantial  service  in  Rhus- Toxicodendron 
poisoning.  Weak  solutions  of  carbolic  acid 
have  sometimes  proved  efficacious.  Mr.  George 
M.  Beringer  {Am.  Jour,  of  Pharm.,  Jan.,  1895) 
has  found  hot  soda  baths  efiioacious,  but  for  a 
topical  application  he  prefers  the  following 
lotion : 

]^  Granular  sodium  sulphite. .   1  drachm  ; 

Glycerin ^  fl.  oz. ; 

Camphor  water,  enough  to 

make   4  fl.  oz. 

M. 

Mr.  Beringer  states  that  he  has  seemed  to 
have  good  results  from  washing  his  face  and 
hands  with  a  solution  of  hydrogen  dioxide  as 
a  preventive  measure. 

The  bastard  nettle,  dead  nettle,  rich  weed, 
cool  weed,  or  silver  weed,  XJrtica  (or  Pilea)  pu- 
mila,  which  grows  in  damp,  shady  woods  and 
occasionally  along  the  roadsides,  has  been  used 
for  a  number  of  summers  by  Dr.  James  Stokes, 
of  Philadelphia  {Med.  and  'Surg.  Reporter,  No- 
vember 2, 1867),  in  cases  of  rhus  poisoning,  and 
always,  he  says,  with  decided  beneflt,  some- 
times when  other  remedies  have  proved  slow 
or  almost  inoperative.  If  possible,  he  obtains 
full-grown  plants,  strips  off  the  leaves,  bruises 
the  stems,  and  applies  the  juice  directly  to 
the  affected  parts.  The  coating  is  to  be  re- 
newed when  it  has  become  dry.  In  many 
cases,  says  Dr.  Stokes,  a  complete  cure  is  ef- 
fected by  one  or  two  thorough  applications. 

Dr.  Blackwell,  of  Philadelphia  {Charlotte 
3Ied.  Jour.,  cited  in  Indian  Lancet,  April  16, 
1896),  urges  the  use  of  europhene,  in  an  oint- 
ment of  from  10  to  30  per  cent.,  or  that  of  a 
dusting  powder  of  from  35  to  50  per  cent,  with 
talcum,  in  the  treatment  of  rhus  poisoning. 

Cases  of  poisoning  from  the  internal  use  of 
Rhus  Toxicodendron  are  rare.  In  the  Ameri- 
can Journal  of  the  Medical  Sciences  for  April, 
1866,  Dr.  J.  W.  Moorman,  of  Hardinsburg,  Ken- 
tucky, relates  two  cases,  communicated  to  him 
by  a  professional  friend,  of  poisoning  from  eat- 
ing the  berries.  The  subjects  were  children, 
one  six  and  the  other  eight  years  old.  The 
quantity  eaten  (whether  by  each  or  by  both 
together  is  not  stated)  was  nearly  a  pint.  In 
a  few  hours  the  children  became"  drowsy  and 
stupid,  and  in  a  short  time  they  began  to 
vomit,  flrst  the  partially  digested  fruit,  after- 
ward a  thick,  tenacious  fluid  of  a  wine-colour. 
Then  convulsions  of  different  parts  of  the  body 
followed,  accompanied  by  slight  delirium.  The 
breathing  was  hurried ;  the  pulse  was  at  flrst 


133 


RHUS 


full  and  strong  but  slow,  afterward  small, 
frequent,  and  compressible;  and  the  pupils 
were  dilated.  Warm  water  was  given  to  pro- 
mote vomiting,  and  afterward  a  Inrge  quantity 
of  sodium  carbonate  [bicarbonate  ?],  dissolved 
in  water,  under  the  belief  that  it  was  an  anti- 
dote. Both  the  children  recovered,  but  the 
younger  one's  convalescence  was  very  slow. 

Three  oases  of  poisoning  with  the  root  have 
been  recorded  by  Dr.  J.'iines  Stokes  (loe.  cit.). 
Pour  children  gathered  what  they  supposed  to 
be  sassafras  roots,  and  made  a  tea  from  them 
which  they  drank.  One  of  them,  a  boy,  twelve 
years  old,  broke  out  with  a  rash  resembling 
that  of  measles;  his  face,  neck,  and  throat 
were  swollen,  his  eyes  were  sufEused  and 
watery,  his  voice  was  husky,  he  had  a  dry, 
hoarse  cough,  there  was  soreness  of  his  throat, 
with  intense  burning  extending  to  the  stomach, 
he  had  high  fever,  his  tongue  was  coated,  his 
urine  was  high-coloured,  scanty,  and  irritating, 
there  was  intolerable  itching  of  the  skin,  there 
were  nervous  twitchings,  and  at  times  his  mind 
was  wandering.  He  had  then  been  ailing  for 
a  week,  with  catarrh  and  general  indisposition. 
The  scarlet  appearance  of  the  eruption  on  the 
face,  with  incipient  vesication,  and  a  crescentic 
arrangement  of  the  rash  on  the  body,  together 
with  the  fever  and  catarrhal  sym  ptoms,  led  Dr. 
Stokes  to  a  reluctant  diagnosis  of  measles.  He 
ordered  small  doses  of  magnesium  sulphate, 
a  tablespoonful  of  neutral  mixture  every  two 
hours,  demulcent  drinks,  and  a  farinaceous 
diet.  On  his  next  visit  he  found  the  oedema 
more  diffused,  extending  to  the  hands  and 
feet ;  the  eyelids  were  closed,  their  connective 
tissue  was  filled  with  serous  fluid,  and  they 
seemed  ready  to  burst;  and  the  prepuce  was 
so  swollen  as  to  cause  difficulty  in  urinating. 
All  resemblance  to  measles  had  disappeared. 
At  his  next  visit.  Dr.  Stokes  found  two  others 
of  the  children,  girls  fifteen  and  seventeen 
years  old  respectively,  affected  with  the  poison. 
It  was  then  that  he  learned  of  the  tea  they  had 
made  ;  among  the  roots  they  shovred  him  were 
some  that  he  recognised  as  those  of  Rhus 
Ihxicodendron.  The  fourth  child,  a  boy,  being 
insusceptible,  did  not  suffer.  Lead  water  was 
now  applied  to  the  affected  skin,  and  small 
doses  of  saline  purgatives  were  given.  All  the 
patients  recovered.  The  time  that  intervened 
between  the  tea-drinking  and  the  onset  of  the 
symptoms  is  not  mentioned. 

Therapeutics. — Rhus  Toxicodendron  was  for- 
merly official  in  several  of  the  pharmacopoeias, 
but  it  is  now  recognised  only  in  the  U.  S.  Ph., 
which,  strangely  enough,  gives  no  preparation 
of  it.  The  first  edition  of  the  Ger.  Ph.  au- 
thorized a  tincture,  tinctura  toxicodendri, 
made  by  macerating  5  parts  of  the  fresh  leaves 
in  6  parts  of  alcohol.  Dr.  John  Aulde,  of 
Philadelphia,  who  has  made  two  important 
contributions  to  the  literature  of  the  therapeu- 
tic use  of  the  drug — one  published  in  the  Medi- 
cal Neics  for  April  20,  1889,  and  the  other  in 
the  Therapeutic  Gazette  for  October  15, 1889 — 
makes  a  tincture  according  to  the  directions 
given  in  the  U.  S.  Ph.  for  making  tinctures 
from  fresh  herbs,  using  50  parts  of  the  fresh 
leaves  and  100  parts  of  alcohol.    This  strong 


tincture,  the  dose  of  which  he  finds  does  not 
exceed  -J  drop,  he  dilutes  with  nine  times  its 
bulk  of  diluted  alcohol,  and  the  dose  of  this 
weaker  tincture  is  5  drops. 

Dr.  Aulde  cites  Dr.  Phillips  as  stating  that 
rhus  was  first  brought  to  the  notice  of  the  pro- 
fession by  Dr.  Dufresnoy,  of  Valenciennes,  in 
1798,  and  that  in  ISiifi  it  was  recognised  in  the 
London  Pharmacopoeia.  Dr.  Phillips  recom- 
mended it,  both  taken  internally  and  employed 
topically,  in  various  subacute  and  chronic  rheu- 
matic affections  of  fibrous  tissues.  Dr.  Whitla 
and  Dr.  Brunton,  says  Dr.  Aulde,  have  recom- 
mended it  in  incontinence  of  urine.  In  his 
first  publication  (Med.  News,  April  20,  1889) 
Dr.  Aulde  gives  the  condensed  histories  of 
seven  cases  in  which  he  used  rhus.  Three  of 
them  were  examples  of  various  forms  of  sub- 
acute and  chronic  rhetimati.im,  one  was  a  case 
of  sciatica,  one  was  a  case  of  cramps  in  the  legs 
occurring  at  night,  and  two  were  cases  of  vari- 
cose veins.  He  suggests  some  occult  relation- 
ship letween  rheumatism  and  the  varicose 
state  of  the  veins  that  gives  rise  to  pain.  In 
all  these  seven  cases  the  employment  of  the 
remedy  was  promptly  followed  by  the  most 
satisfactory  results. 

In  his  second  article  (Therap.  Oaz,,  October 
15, 1889)  Dr.  Aulde  reports  his  continued  satis- 
factory employment  of  rhus  in  various  manifes- 
tations of  chronic  rheumatism.  "  I  do  not 
think  it  would  be  of  great  benefit  in  acute  at- 
tacks," he  says,  "and  my  experience  does  not 
justify  the  statement  that  it  can  be  depended 
upon  invariably  for  relief "  in  chronic  cases. 
In  this  article  Dr.  Aulde  gives  extracts  from 
reports  that  have  been  made  to  him  by  other 
physicians,  as  follows :  Dr.  B.  W.  Allen,  of 
Jernigan,  Alabama,  says  he  considers  the  reme- 
dy of  value  in  neuralgia.  Dr.  T.  C.  Fcnton, 
of  Streator,  Illinois,  mentions  a  case  of  acute 
rheumatism  in  which  four  doses  of  the  drug 
took  away  all  the  pain,  but  failed  to  do  aw.iy 
with  the  stiffness  ;  a  case  of  "  rheumatism  of 
the  thigh,  extending  to  the  knee,"  in  which 
six  days'  use  of  the  remedy  gave  no  relief ;  a 
case  of  neuralgia  of  the  face  in  a  woman  of  a 
nervous  temperament,  seven  months  advanced 
in  pregnancy,  in  which  also  no  effect  was  pi'o- 
duced ;  and  a  severe  case  of  sciatica  which  was 
cured  with  five  doses.  Dr.  J.  B.  Laidley,  of 
Oarraichaels,  Pennsylvania,  reports  a  case  of 
severe  recurrent  sciatica  in  an  aged  clergyman 
who  was  a  sufferer  from  chronic  cystitis.  De- 
cided benefit  seemed  to  be  derived  from  the 
use  of  rhus.  Dr.  H.  A.  Mobley.  of  Byromville, 
Georgia,  reports  a  case  of  sciatica  in  which  the 
beneficial  action  of  I'hus  was  doubtful,  and  one 
of  "  articular  rheumatism  "  in  a  weak,  anasmio 
lad,  in  which  the  remedy  acted  most  satisfac- 
torily. Dr.  B.  Powell,  of  Houston,  Texas,  who 
had  himself  been  for  years  a  sufferer  from 
rheumatism  and  hcemorrhoids,  found  the  use 
of  the  remedy  very  beneficial  as  to  both  ail- 
ments. He  began  its  use  in  a  spirit  of  scepti- 
cism, but  he  says,  with  regard  to  his  rheumatism : 
"  In  three  days  I  began  to  feel  better  than  I 
had  done  for  months,"  and  concerning  his 
haemorrhoids :  "  While  taking  the  rhus  I  was 
entirely  free  from  all  rectal  annoyances.    Im- 


RICE 
RUBBER 


134 


mediately,  however,  upon  stopping  the  medi- 
cine the  piles  returned."  Dr.  J.  Richard 
Taylor,  of  Charleston,  has  found  the  drug 
very  efficient  in  subacute  and  chronic  mus- 
cular rheumatism,  always  tolerated  by  delicate 
stomachs,  but  not  quite  so  prompt  as  sodium 
salicylate.  He  says,  however,  that  its  action 
is  very  rapid  in  relieving  muscular  soreness  due 
to  hysterical  convulsions.  Dr.  J.  W.  Welch, 
of  New  Hope,  Missouri,  reports  its  satisfactory 
employment  in  a  case  of  rheumatism  and,  to 
a  lesser  degree,  in  one  of  sciatica.  Dr.  J.  B. 
Whitehead,  of  Lovingston,  Virginia,  reports 
the  cure  of  a  case  of  sciatica  with  rhus,  also  the 
apparent  failure  of  the  drug  in  a  ease  of  chronic 
rheumatism  and  neuralgia.  In  this  case,  he 
remarks,  the  patient  thought,  from  the  small 
size  of  the  dose,  that  the  medicine  was  very 
dangerous,  and  so  did  not  talie  it  as  she  should 
have  done. 

In  the  course  of  his  comments  on  these  re- 
ports Dr.  Aulde  says  :  "  Dr.  Powell  speaks  very 
highly  of  the  value  of  rhus  in  connection  with 
the  pain  and  annoyance  attending  the  presence 
of  hiemorrhoids,  all  of  which  I  can  fully  in- 
dorse. It  is  truly  wonderful  how  quickly  local 
irritations  of  this  character  and  varicose  veins 
are  subdued,  and  my  observations  incline  me 
to  consider  favourablv  the  use  of  some  drug  in 
connection  with  the  rhus  which  will  favour  a 
more  active  discharge  of  tlie  functions  of  the 
lower  bowel,  from  the  fact  that  hiEmorrhoids 
and  constipation  often  go  together.  Pew  phy- 
sicians would  be  willing,  however,  to  say  that 
there  was  any  relation  existing  between  rheuma- 
tism and  hfemorrhoids,  or  between  rheumatism 
and  varicose  veins  ;  but  it  seems  to  me  that  a 
relationship  can  be  inferred,  if  not  demon- 
strated, from  the  results  which  attend  the  ex- 
hibition of  certain  remedies.  Knowing  that 
cascara  sagrada  has  been  highly  extolled  for 
the  relief  of  rheumatism,  and  knowing,  further, 
that  it  acts  mildly  as  a  laxative,  and  is  thus 
calculated  to  reduce  the  congestion  of  the  pelvic 
organs,  including  the  rectum,  I  have  made  a 
combination  of  the  rhus  with  cascara  sagrada 
cordial  with  the  happiest  effects." 

Rhus  venenata. — This  species,  the  swamp 
sumach,  is  reputed  to  give  rise  to  severer  poi- 
soning than  that  caused  by  Rhus  Toxicoden- 
dron.    The  treatment  is  the  same. 

Kh.us  vemicifera. — This  is  the  plant  from 
which  Japanese  lacquer  is  made.  According  to 
Mr.  Beringer  (Joe.  cif.),  Mr.  D.  P.  Penhallow 
reports  serious  poisoning  resulting  from  stir- 
ring and  smelling  the  lacquer.  He  says  that 
after  a  few  experiences  it  was  always  possible 
for  him  to  ascertain  whenever  he  came  into  an 
atmosphere  charged  with  the  poison.  This 
was  manifested  by  a  well-defined  acid  taste  in 
the  mouth  and  a  slight,  somewhat  acute  pain 
directly  between  the  eyes,  which  were  invari- 
ably symptoms  of  the  results  to  follow.  The 
Japanese,  he  says,  employ  the  flesh  and  juices 
of  a  fresh  giant  crab,  the  Alacroclieira  Kmmp- 
feri,  and  apply  it  freely  to  the  poisoned  parts. 

KICIE. — Rice  is  the  grain  of  Oriza  ■'<aiiva,  a 
grass  deri%'ed  originally  from  India.  It  is  now 
largely  produced  in  the  Southern  United  States 


and  in  southern  Europe.  It  contains  a  larger 
proportion  of  starch  than  any  of  the  other 
cereals  and  a  smaller  proportion  of  proteid,  fat, 
and  mineral  matter.  Its  composition,  accord- 
ing to  Bauer,  is  as  follows :  Proteids,  7"81 ; 
fat,  0-69;  starch,  76'40;  cellulose,  0-78;  ash, 
0-09 ;  water,  13-83.  According  to  Gautier's 
analysis,  it  contains  78'1  per  cent,  of  carbohy- 
drates, while  others  have  placed  the  portion  of 
them  as  high  as  80  per  cent.  It  is  therefore 
the  simplest  in  its  composition  of  all  the 
cereals,  and  is  one  of  the  most  digestible  of 
vegetable  foods.  But  one  hour  is  required  for 
the  digestion  of  boiled  rice.  Its  nutritive 
value  is  less  than  that  of  wheat  and  the  other 
cereals.  It  is  unirritating,  and  is  often  tolerated 
by  the  stomach  when  other  vegetable  food  will 
not  be  retained.  It  is  therefore  well  adapted 
for  the  nourishment  of  invalids.  The  addition 
of  milk  or  cream  renders  it  more  nutritious  by 
supplying  the  elements  which  are  lacking  in 
the  rice.  Rice  water  is  considerably  used  as  a 
demulcent  drink.  It  is  prepared  by  boiling 
whole  rice  in  water  and  straining  ofi!  the  clear 
liquid. — Floyd  31.  Ckandall. 

mCINTTS.— The  leaves  of  the  eastor-oil 
plant  {Hicinus  communis)  have  by  some  writers 
been  credited  with  galactogenic  properties. 
The  method  usually  recommended  for  their 
employment  is  as  follows  :  The  breasts  are  first 
bathed  for  fifteen  or  twenty  minutes  with  a 
decoction  of  the  fresh  leaves.  A  fomentation 
of  the  boiled  leaves  is  then  applied  to  the 
breasts  and  allowed  to  remain  till  they  are  dry. 
If  the  desired  result  is  not  accomplished  within 
a  few  hours,  the  process  is  repeated.  The  ex- 
tract of  the  leaves,  smeared  over  the  breast  and 
covered  with  a  common  poultice,  has  been  used 
instead  of  the  leaves  themselves.  Routh  rec- 
ommends the  internal  administration  of  a  de- 
coction of  the  leaves  and  stalks  of  ricinus  as  a 
galactagogue.  He  says  that  its  effects  are 
frequently  immediate,  yet  in  some  cases  are 
not  observed  for  several  days.  On  ceasing  its 
use  the  secretion  is  liable  to  again  become 
scanty  or  even  to  stop  altogether.  In  modern 
obstetric  practice  the  castor-oil  plant  is  seldom 
or  never  employed  as  a  galactogenic  agent. 
(Cf.  Castok  oil.) — Charles  Jewett. 

ROSA  CANINA,  KOSA  CENTIFO- 
LIA,  ROSA  DAMASCEN A,  ROSA  GAIi- 
lilCA.— See  Rose. 

ROSANILINE  HYDROCHLORIDE, 
ROSEINE.— See  Fuchsi.xe. 

ROSE.— The  fruit  of  the  dog-rose  (Rosa 
canina),  known  as  hips,  rosm  canines  frucUis 
(Br.  Ph.),  beaten  to  a  pulp  and  deprived  of  its 
seeds,  is  employed  in  the  preparation  of  con- 
fection of  hips,  confectio  rosm  canince  (Br.  Ph.), 
which  is  used  in  making  pill  masses. 

The  hundred-leaved  rose  (Rosa  centi folia)  is 
the  species  of  which  the  petals,  rosa  ceniifnlia 
(U.  S.  Ph.),  ros(B  centifolim  pefala  (Br.  Ph.), 
Jflores  roscB  (Ger.  Ph.),  are  used  in  the  prepara- 
tion of  compound  syrup  of  sarsaparilla,  syrupvs 
sarsaparillm  compositus  (XJ.  S.  Ph.),  rose  water, 
aqua  roscB  (Br.  Ph..  Ger.  Ph.),  oil  of  roses, 
oleum  roscB  (Ger.  Ph.),  and  honey  of  roses, 
mel  rosatum  (Ger.  Ph.). 


135 


RICE 
RUBBER 


The  damask  rose,  Rosa  damascena,  furnishes 
the  oil,  or  attar,  of  roses,  oleum  roscB  (U.  S.  Ph.), 
which  is  used  in  the  preparation  of  a  strong 
rose  water,  aqua  roscB  Jortior  (U.  S.  Ph.).  This 
diluted  with  distilled  water,  forms  ordinary 
rose  water,  aqua  rosea  (U.  S.  Ph.),  which  enters 
into  the  composition  of  rose  ointment  or  cold 
cream,  unguentum  aguce  rosm  (U.  S.  Ph.).  Of 
the  official  rose  waters,  that  of  the  U.  S.  Ph.  is 
the  most  elegant.  It  is  employed  as  a  flavour 
in  cooking,  as  a  perfume,  and  as  a  vehicle  for 
coUyria.  Collyria  made  with  rose  water  are 
less  irritating  to  the  eyes,  other  things  being 
equal,  than  those  made  with  plain  water. 

The  red  rose,  Bosa  gallica,  is  the  variety  the 
petals  of  which,  rosa  gallica  (U.  S.  Ph.),  rosx 
galliccB  petala  (Br.  Ph.),  are  used  in  the  prepara- 
tion of  confection  of  rose.s,  confectio  rosm  (U.  S. 
Ph.),  confectio  rosm  gallicce  (Br.  Ph.),  acid  in- 
fusion of  roses,  infusum  rosm  acidum  (Br.  Ph.). 
fluid  extract  of  roses,  extractum  rosm  fluidum 
(U.  S.  Ph.),  honey  of  roses,  mel  rosm  (U.  S.  Ph.), 
and  syrup  of  roses,  syrupus  rosm  (U.  S.  Ph.), 
syrupus  rosm  gallicm  (Br.  Ph.).  The  petals  of 
the  red  rose  were  formerly  used  as  a  tonic  and 
astringent,  but  are  now  chiefly  employed  to 
impart  an  agreeable  odour    and    flavour  to 

E reparations  to  which  astringenoy  is  no  draw- 
ack. — Russell  H.  Nevins. 

BOSEMART.— The  volatile  oil  of  rose- 
mary (Rosmarinus  officinalis),  the  oleum  rosma- 
rini  of  the  pharmacopoeias,  acts  topically  as  a 
rubefacient,  and  is  added  to  rubefacient  prep- 
arations on  account  of  its  agreeable  odour. 
Given  internally,  in  doses  of  from  1  to  4  minims, 
on  sugar  or  diluted  with  hot  water,  it  is  car- 
minative. The  dose  of  spirit  of  rosemary, 
spiritus  rosmarini  (Br.  Ph.),  is  from  ^  to  1  fl. 
drachm.  The  compound  ointment  of  rose- 
mary, unguentum  rosmarini  eompositum  (Ger. 
Ph.),  which  contains  1  part  each  of  oil  of  rose- 
mary and  oil  of  juniper,  3  parts  each  of  yellow 
wax  and  oil  of  nutmeg,  8  parts  of  mutton 
suet,  and  16  parts  of  lard,  is  useful  as  a  mild 
stimulant  to  indolent  ulcers. 

ROSIN,  or  colophony,  resina  (TJ.  S.  Ph.,  Br. 
Ph.),  colophonium  (Ger.  Ph.).  is  the  resinous 
residue  left  after  the  volatile  oil  is  distilled  off 
from  turpentine.  It  is  employed  in  the  form 
of  ointments  and  plasters  for  its  topical  stimu- 
lating effect.  The  official  preparations  are  a 
cerate,  ceratum  resinm  (U.  S.  Ph.),  a  plaster, 
emplastrum  resinm  (IT.  S.  Ph.,  Br.  Ph.),  com- 
monly called  adhesive  plaster,  and  an  ointment, 
unguentum  resinm  (Br.  Ph.).  The  cerate,  which 
is  known  also  as  iasilicon  ointment,  is  much 
employed  as  a  dressing  for  indolent  ulcers, 
especially  those  following  burns. 

BOSINOIi,  resinol,  or  rhetinol,  CsaHu,  is  a 
thickish  yellow  oil  obtained  by  the  dry  dis- 
tillation of  Burgundy  pitch.  It  dissolves  salol, 
camphor,  cocaine,  codeine,  chrysarobin,  balsam 
of  Peru,  creosote,  iodol,  phosphorus,  oil  of  cade, 
and  carbolic  acid,  and  mixes  readily  with  other 
oils.  It  does  not  become  rancid  and  does  not 
irritate  the  skin.  It  is  an  antiseptic,  and  has 
been  employed  topically,  undiluted,  in  the 
treatment  of  vaginal  and  uterine  catarrh, 
hmmorrhoids,  foul  ulcers,  and  pruritus. 


BOSMARINTJS.— See  Rosemaky. 
ROTTLERA.— See  Kamjvla. 

RtTBBER,  elastica  (U.  S.  Ph.).  This,  as 
met  with  ordinarily,  occurs  in  three  colours, 
black,  white,  and  red,  the  exact  shade  of  each 
depending  upon  the  mtthods  employed  in  its 
manufacture,  and  upon  the  diluent  always 
found  except  in  the  purest  varieties,  which, 
however,  are  suitable  only  for  articles  m  which 
great  elasticity  and  flexibility  are  necessary. 
As  a  rule,  the  ordinary  specimens  of  manufac- 
tured rubber  contain  carbon,  zinc  oxide,  and 
lead  carbonate  or  antimony  sulphide  in  vary- 
ing proportions ;  in  some  instances  the  per- 
centage may  run  as  high  as  sixty.  In  the 
cheaper  rubber  dolls,  etc.,  zinc  oxide  is  the 
diluent,  but  it  is  so  evenly  distributed  through 
the  rubber  that  even  if  particles  of  the  toy 
reach  the  stomach  no  ill  results  are  apt  to 
follow.  The  same  may  be  said  of  the  antimony 
sulphide  which  is  employed  to  give  a  reddish 
colour  to  rubber.  According  to  the  amount  of 
sulphur  employed  and  the  degree  of  heat  and 
pressure  to  which  rubber  is  subjected,  it  ap- 
proaches glass  in  hardness,  or  may  be  as  soft 
and  flexible  as  kid.  From  the  hard  variety,  er 
"  vulcanite,"  are  made  drainage-tubes,  bougies, 
pessaries,  syringes,  basins,  etc..  and  similar  ob- 
jects which  it  is  desirable  to  cleanse  easily  and 
which  should  be  non-absorbent.  It  is  also  a 
poor  conductor  of  heat,  and  on  that  account  is 
preferable  to  metals  for  the  nozzles  of  douche- 
bags,  syringes,  etc.,  which  are  used  to  inject 
hot  fluids  into  the  vagina  and  other  cavities. 

From  the  softer  variety,  often  termed  pure 
rubber,  are  made  catheters,  bougies,  drainage- 
tubes,  and  other  objects  for  introduction  into 
small  canals,  etc.,  the  interior  of  which  might 
be  bruised  or  lacerated  by  a  hard  material  and 
which  are  tortuous  and  not  easily  followed  by 
a  rigid  instrument. 

The  uses  of  rubber  tubing  are  almost  with- 
out number.  It  occurs  in  many  forms,  varying 
from  a  white  colour  to  a  dead  black  ;  the  former 
is  but  little  elastic  and  rapidly  deteriorates,  while 
the  latter  is  of  such  consistence  as  to  barely 
maintain  its  tubular  form  and  will  retain  its 
properties  for  years.  The  heavy  white  variety 
is  employed  as  a  tourniquet  in  siirgieal  opera- 
tions and  may  be  substituted  with  advantage 
for  a  cord  to  encircle  a  part  to  cheek  hmmor- 
rhage  or  prevent  the  absorption  of  the  poison 
introduced  by  the  bites  of  venomous  snakes  or 
rabid  animals.  Care  must  be  exercised  that 
too  great  pressure  is  not  exerted,  as  paralysis 
of  the  motor  or  sensory  nerves  may  follow. 
Solid  cords  or  bands  may  be  employed  in  place 
of  the  tubing  for  the  above-mentioned  pur- 
poses and  also  to  encircle  the  bases  of  small 
morbid  growths,  such  as  hmmorrhoids,  with 
the  view  of  causing  a  stasis  of  the  circulation 
and  a  resulting  .shrinkage  of  their  bulk  or  even 
gangrene.  Fistula  of  the  anus  and  fistulas  in 
other  localities,  when  an  operation  will  not  be 
submitted  to,  may  be  treated  by  passing  a  cord 
or  strip  of  rubber,  called  an  elastic  ligature, 
through  the  tract  and  tying  it  upon  the  sur- 
face, the  tension  being  increased  each  day  until 
the  tissues  are  cut  through.    If  the  surfaces 


RUBEFACIENTS 
SACCHARIN 


136 


are  not  fibrous  and  indurated,  success  usually 
follows  this  method,  but  it  is  rather  tedious 
and  troublesome,  and  is  hardly  to  be  under- 
taken unless  there  is  good  reason  for  avoiding 
an  operation. 

Sheet  rubber  is  usually  of  about  the  thick- 
ness of  blotting  paper  and  should  be  of  con- 
siderable elasticity,  as  its  uses  largely  depend 
upon  that  property.  It  may  be  employed  to 
exert  moderate  pressure  upon  varicose  veins, 
small  aneurysms,  and  old  intractable  ulcers, 
especially  of  the  leg ;  in  the  place  of  elastic 
webbing,  to  sustain  iveak  and  injured  joints 
and  to  expedite  the  absorption  of  effusions 
in  injuries  to  joints  and  to  expel  the  blood 
from  limbs  preparatory  to  operations.  In  this 
last  case  it  should  be  applied  from  the  distal 
end  of  the  member  toward  the  central,  and 
need  not  remain  in  position  longer  than  a  few 
seconds,  care  being  observed  that  it  is  applied 
in  such  manner  that  only  very  moderate  pres- 
sure is  exerted.  Before  its  removal,  two  or 
three  turns  of  tubing  should  be  applied  a 
short  distance  above  its  upper  boundary  and 
allowed  to  remain  until  the  operation  has  been 
concluded  and  all  bleeding  vessels  have  been 
ligated.  This  method  is  hardly  applicable 
■when  pus  cavities  or  abscesses  exist,  as  there 
might  be  some  danger  of  pus  absorption.  Nar- 
row strips  may  be  substituted  for  adhesive 
plaster  in  the  treatment  of  varicocele  and  hydro- 
cele, but  too  great  pressure  is  to  be  avoided. 
One  point  which  must  be  borne  in  mind  in  the 
use  of  elastic  bandages  over  any  considerable 
extent  of  surface  is  the  liability  to  the  occur- 
rence of  more  or  less  severe  headache,  which 
may  often  prevent  their  employment. 

Elastic  webbing  or  heavy  cloth  containing  fine 
rubber  cords  is  rather  stiffer  and  less  manage- 
able than  sheet  rubber.  It  absorbs  fluids  and 
loses  its  elasticity  in  a  shorter  time,  but  may 
be  employed  for  the  same  purposes.  Combined 
with  silk  and  other  fibre,  rubber  constitutes 
the  cloth  from  which  elastic  stockings,  anklets, 
etc.,  are  made,  which  are  employed  to  exert 
moderate  pressure  over  varicose  veins  and 
tipon  joints  into  which  there  is  effusion  or 
which  have  sustained  injuries.  When  used  for 
any  of  these  purposes,  it  is  rarely  that  they 
should  not  be  removed  during  the  sleeping 
hours  and  the  parts  that  have  been  covered  by 
them  rubbed  with  the  bare  hand,  as  otherwise 
the  nutrition  of  the  tissues  will  be  impaired. 
In  joint  affections  these  bandages  should  be 
used  with  great  caution,  for  if  they  are  worn 
too  long  the  vitality  of  the  joint  is  lowered  and 
in  some  instances  its  usefulness  has  been  en- 
tirely destroyed.  Bandages  for  the  support  of 
the  abdomen  in  pregnancy  and  in  the  obese  are 
often  worn  and  without  any  evil  results. 

Rubber  tissue,  or  rubber  in  very  thin  sheets, 
when  applied  to  the  surface  of  the  body,  tends 
to  keep  it  warm  and  moist,  and  is  employed  in 
the  treatment  of  eczema  and  psoriasis,  to  pro- 
tect burns,  to  relieve  the  pain  of  rheumatic 
joints,  to  cover  poultices,  and  as  a  protective 
and  covering  in  surgical  practice.  Several 
thicknesses  wound  over  a  corn  will  soften  it  in 
the  course  of  two  or  three  days  so  that  it  may 
easily  be  picked  out.     Wherever  two  surfaces 


of  rubber  tissue  come  together,  the  application 
of  a  piece  of  warm  metal  will  cause  them  to 
adhere  and  thus  an  air-tight  and  water-tight 
covering  may  be  made.  A  proprietary  ad- 
hesive plaster  is  also  made  from  rubber  which 
the  heat  of  the  body  renders  adherent. 

The  uses  of  the  various  appliances,  such  as 
hot-water  bags,  etc.,  which  are  made  from  rub- 
ber are  so  familiar  that  they  need  little  more 
than  passing  mention.  They  are  simply  con- 
venient vehicles  for  the  application  of  heat  and 
cold. 

Rubber  sheeting  is  largely  employed  as  a 
protective  of  the  bedclothing,  etc.,  in  childbed, 
in  affections  in  which  there  are  offensive  dis- 
charges, in  fevers  when  baths,  etc.,  are  given, 
and  in  a  host  of  other  conditions  that  occur 
during  illness.  It,  however,  should  never  be 
allowed  to  come  in  direct  contact  with  the 
person,  but  a  sheet  or  blanket  must  be  inter- 
posed. 

Condoms  maybe  used  for  small  ice  bags,  and 
are  very  convenient  in  small  contusions,  affec- 
tions of  the  eye,  etc.,  where  the  application  of 
cold  is  indicated. 

To  preserve  rubber  articles  they  should  be 
kept  in  a  cool  nnd  moderately  moist  place,  two 
surfaces  should  never  come  together,  and,  if 
possible,  a  little  French  chalk  should  be  dusted 
upon  them. 

[Soft  rubber  is  very  much  injured  by  pro- 
longed contact  with  fatty  matters.  When  any 
such  material  has  lodged  on  the  rubber,  it 
should  be  washed  off  with  ammonia  water,  and 
it  is  well  to  keep  small  articles  of  soft  rubber 
immersed  in  ammonia  water  when  they  are  not 
in  use.] — Russell  H.  Netins. 

BUBEFACIEIfTS.— See  under  Countee- 

IRRITAMTS. 

RtTBIDirM.— The  salts  of  this  metal  bear 
a  close  resemblance  to  those  of  cassiura  and 
those  of  potassium.  The  iodide,  Rbl,  has 
been  recommended  as  a  substitute  for  potas- 
sium iodide  in  cases  in  which  the  potassium 
salt  is  taken  only  with  great  repugnance  or  in 
which  it  deranges  the  digestion.  Rubidium 
may  be  given  in  doses  of  from  5  to  15  grains, 
three  times  a  day,  in  syphilis  and  in  other"  affec- 
tions for  which  the  iodides  are  employed.  Top- 
ically, a  solution  of  1  part  in  20  parts  of 
distilled  water  has  been  used  as  a  lotion  for 
mucous  surfaces. 

A  double  bromide  of  rubidium  and  ammo- 
nium, NHs.RbBrj,  has  been  recommended  as 
a  remedy  for  epilepsy,  to  be  given  in  daily 
amounts  of  from  1  to  2  drachms.  It  is  readily 
soluble  in  water. 

RUBUS. — This  genus  of  rosaceous  shrubs 
includes  the  blackberry,  raspberry,  dewberry, 
etc.  The  rubns  of  the  U .  S.  Ph.  is  the  root  bark 
of  Rubus  villosus,  the  blackberry,  which  is 
mildly  astringent,  and  is  erhployed  in  atonic 
diarrhoea.  The  dose  of  the  powder  is  from  20 
to  30  grains ;  that  of  the  fluid  extract,  extractum 
rubi  fluidum  (U.  S.  Ph.),  is  from  20  to  30  min- 
ims ;  that  of  the  syrup,  syrupus  rubi  (U.  S.  Ph.), 
is  from  1  to  4  fl.  drachms. 

Rubus  idoius  (U.  S.  Ph.),  the  raspberry,  is 
employed   in   the  form   of  a  refrigerant  and 


137 


ETJBEPACIENTS 
SACCHARIN 


flavouring  syrup,  syrupus  rubi  idcei  (U.  S.  Ph.), 
sirupus  rubi  idcei  (Ger.  Ph.). 

HUE  (Ruta  graveolens)  is  a  perennial  herba- 
ceous plant  of  southern  Europe  and  the  Levant. 
The  leaves  chiefly  are  used  in  medicine.  As 
their  quality  is  impaired  by  drying,  the  oil, 
oleum  rutm  (Br.  Ph.),  is  the  only  preparation 
commonly  used.  It  is  a  colourless  or  greenish- 
yellow  liquid  of  a  characteristic  aromatic  odour, 
a  pungent,  bitterish,  disagreeable  taste,  and 
neutral  reaction.  It  is  soluble  in  an  equal 
weight  of  alcohol.  When  applied  to  the  skin,  it 
causes  heat  and  irritation,  and  may  even  pro- 
duce vesication.  Its  physiological  actions  are 
similar  to  those  of  savins.  It  is  employed  for 
much  the  same  purposes  as  savine  and  tansy. 
It  is  used  chiefly  in  amenorrhcea,  hysteria,  and 
epilepsy.  It  is  especially  indicated  in  ovarian 
and  uterine  atony.  In  ordinary  doses,  it  pro- 
duces a  sensation  of  warmth  in  the  stomach, 
and  is  followed  by  slightly  increased  action  of 
the  heart.  In  toxic  doses,  it  produces  violent 
gastro-intestinal  symptoms,  which  are  followed 
by  prostration,  strangury,  and,  in  extreme  cases, 
convulsions.  Owing  to  its  disagreeable  taste 
and  its  uncertainty  of  action,  it  is  now  but 
little  used  in  medicine,  other  drugs  having 
almost  completely  usurped  its  place.  The  dose 
of  the  oil  is  from  3  to  5  drops. 

Floyd  M.  Cbandall. 

RTJM  is  an  alcoholic  liquor  obtained  by  the 
distillation  of  molasses,  skimmings  from  cane- 
sugar  kettles,  and  other  by-products  of  sugar 
manufactories  after  having  undergone  fermen- 
tation. When  fresh  it  is  nearly  colourless,  but 
various  shades,  varying  from  a  deep  claret  to  a 
pale  straw,  are  imparted  to  it  from  the  casks  in 
which  it  is  stored.  Two  varieties  are  found, 
the  one  being  made  from  molasses  and  the 
other  from  kettle  skimmings,  etc.,  which  come 
respectively  under  the  general  heads  of  New 
England,  or  Medford,  and  Jamaica.  Of  the 
latter,  many  varieties  are  found,  named  Santa 
Cruz,  Barbadoes,  etc.;  according  to  the  points 
of  manufacture,  but  they  differ  in  little  but 
name,  and  ard  as  a  rule  dark-coloured,  while 
the  Jledford  variety  is  straw-coloured.  Usu- 
ally an  unadulterated  specimen  will  contain 
about  50  per  cent,  by  volume  of  alcohol  and  be 
of  a  peculiar  rank  taste  which  is  objectionable 
to  many,  but,  as  a  rule,  the  disgust  it  excites 
at  first  is  soon  overcome.  Of  all  spirits,  rum 
is  by  far  the  most  easily  obtained  free  from 
adulteration,  contains  less  fusel  oil  and  other 
deleterious  bodies  than  whisky,  and  is,  in  ad- 
dition, much  cheaper.  It  is  .usually  easily 
digested,  and  appears  to  be  less  apt  to  under- 
go the  acetous  fermentation  in  the  stomach 
than  other  spirits.  It  may  be  administered  in 
the  same  manner  as  other  alcoholics,  but  seems 
to  be  better  relished  when  taken  with  consider- 
able milk. 

Pineapple  rum  is  rum  to  which  cut  pine- 
api^le  has  been  added  in  the  casks  and  allowed 
to  remain  for  several  months.  It  has  a  slight 
flavour  and  odour  of  that  fruit.  Rum-shrub 
is  sweetened  rum,  flavoured  with  the  essential 
oils  of  lemon  and  orange,  to  which  lemon-  or 
orange-juice  or  tartaric  acid  is  added  to  suit 


the  taste.  By  soaking  the  common  black 
wild  cherry  for  several  weeks  in  an  equal  bulk 
of  the  spirit,  what  is  known  as  cherry  rum  is 
made,  which  is  very  palatable  to  many  per- 
sons, but  ranks  rather  as  a  liqueur  than  as  a 
plain  spirit,  and  is  rather  severe  upon  the 
stomach  unless  taken  in  small  amounts. 

Russell  H.  Nevins. 

RXTMEX  (U.  S.  Ph.)  is  the  root  of  Sumex 
crispus,  the  yellow  dock,  and  of  some  other 
species  of  Rumex.  It  is  moderately  astringent 
and  stomachic.  It  is  hardly  used  now,  except  in 
domestic  practice.  The  fluid  extract,  extrac- 
tum  rumicis  fluidum  (U.  S.  Ph.),  may  be  given 
in  teaspoonful  doses. 

RUTA  GRAVEOLENS.— See  Rue. 

RYE. — Rye  flour,  the  flour  of  the  grain  of 
Secale  cereale,  is  much  employed  in  making 
bread,  particularly  in  continental  Europe. 
When  sound,  it  is  wholesome  and  nutritious, 
but  cases  of  poisoning  have  sometimes  oc- 
curred from  meal  made  from  ergoted  rye  (see 
Eesot).  Rye  mush  is  occasionally  employed 
as  a  laxative  article  of  diet  in  cases  of  habitual 
constipation.  The  dry  flour,  dusted  on  to  the 
skin,  has  a  soothing  effect  in  eases  of  burets  to 
the  degree  of  rubefaction,  and  in  acute  dry 
eczema  and  erysipelas. 


SABADILLA  (Br.  Ph.),  or  eevadilla,  is  the 
dried  ripe  seeds  of  Schcenocaulon  officinale.  It 
is  now  used  only  as  a  soui'ce  of  veratrine. 

SABBATIA. — One  species  of  this  Amer- 
ican genus  of  gentianaceous  plants,  Sabbat ia 
anguLaris,  was  formerly  official.  Together  with 
Sabbatia  paniculata,  it  was  used  as  a  bitter 
tonic  and  appetizer  and  as  a  remedy  for  mala- 
rial fevers.  An  infusion  of  3  parts  of  the 
plant  in  10  of  water  may  be  given  in  daily 
amounts  of  from  1  to  2  fl.  oz. 

SABINA.— See  Savine. 

SACCHARIN,  gluside,  gluaidum  (Br.  Ph.), 
or  neo-saccharin,  is  a  derivative  of  coal  tar  and 
is  two  hundred  times  as  sweet  as  cane  sugar, 
for  which  it  has  been  proposed  as  a  substitute 
in  conditions  in  which  the  latter  is  contra- 
indicated.  It  may  apparently  be  used  as  a 
sweetener  of  food  for  indefinite  periods  without 
ill  results,  and  is  excreted  unchanged  in  the 
urine.  It  appears  also  to  have  acid  properties 
and  unites  with  the  bitter  alkaloids,  such  as 
quinine,  strychnine,  etc.,  to  form  bodies,  pos- 
sibly salts,  which  are  in  a  measure  destitute  of 
the  bitter  properties  of  the  bases,  of  which 
they  contain  on  an  average  about  CO  per  cent. 
In  addition,  it  is  antiseptic,  but  to  no  marked 
degree.  Solutions  of  it  have  been  employed 
to  some  extent  as  injections  in  the  treatment 
of  purulent  nffecfions  of  the  ear,  and  a  -J-per- 
cent.  alcoholic  solution  is  useful  as  a  wash  in 
aphthous  sore  month.  In  large  amounts  it 
retards  gastric  and  intestinal  digestion,  but 
proper  doses  are  regarded  as  having  no  such 
effect.  As  it  is  very  insoluble  in  water,  3  parts 
may  be  combined  with  3  of  sodium  bicarbonate, 


SACCHARUM 
SALICIN 


138 


forming  what  is  known  as  "soluble  gluside''  or 
"  soluble  saccharin,"  or  "  sodium  saccharinate," 
which  is  readily  soluble  in  water.  As  might  be 
expected,  it  is  largely  substituted  for  sugar  in 
the  diet  of  persons  suffering  from  diabetes  mel- 
litus,  to  sweeten  tea,  coffee,  etc.,  and  to  overcome 
the  insipidity  of  the  various  breads  made  from 
gluten.  While,  of  course,  it  does  not  overcome 
the  natural  physiological  craving  for  sugar,  it 
unquestionably  is  of  decided  value.  It  may  also 
be  employed  in  the  treatment  of  obesity  and  in- 
digestion, both  gastric  and  intestinal,  where  it 
is  evident  that  saccharine  and  starchy  foods  ex- 
cite and  aggravate  the  trouble,  and,  being  com- 
patible with  pepsin,  it  may  be  administered 
simultaneously  with  that  substance.  Lemon- 
ade may  be  sweetened  with  it  when  sugar  would 
be  objectionable.  It  can  not,  however,  be 
regarded  as  a  true  physiological  substitute  for 
sugar,  or  substituted  for  it  in  cooking,  as  it  is 
powerless  to  supply  to  the  system  the  carbon 
contained  in  sugar.  The  daily  amount  of 
saccharin  which  may  be  given  without  inter- 
fering with  digestion  is  about  20  grains,  com- 
bined with  the  food. — Russell  H.  Hevins. 

SACCHARTJM.— See  Sugar. 

SACCHARTTM  LACTIS.— See  Sugar  of 

MILK. 

SAFrBON. — This  drug,  the  crocus  of  the 
pharmacopceias,  is  almost  disused,  and  it  is 
said  that  it  is  to  be  omitted  from  the  next  edi- 
tion of  the  Br.  Ph.  Saffron  is  slightly  carmi- 
native,  but  is  chiefly  used  to  impart  a  pleasing 
colour  to  mixtures.  The  tincture,  tinctura 
croci  (U.  S.  Ph.,  Br.  Ph.),  may  be  given  in 
doses  of  from  1  to  3  fl.  drachms. 

SAFBOIi. — This  oily  liquid,  which  readily 
crystallizes  and  is  called  also  shihimol,  has  the 
same  chemical  constitution,  according  to  Heff- 
ter  (Arch.  f.  exp.  Path.  u.  Pharm.,  xxxv,  4,  5, 
1895 ;  Fortschr.  d.  Med.,  March  1,  1896),  as  al- 
lylpyrocatechin  methylene  ether, 

/CH,  — CH  =  CH, 

It  constitutes  90  per  cent,  of  the  ethereal  oil 
distilled  from  sassafras  root,  and  is  said  to  be 
present  in  a  great  variety  of  lauraceous  and 
monimiaceous  plants.  It  smells  like  sas'iafras 
oil.  On  oxidation  it  is  converted  into  pipero- 
nylic  acid.  This  change  takes  place  to  some 
extent  after  its  ingestion,  but  for  the  most  part 
it  is  exhaled  unchanged  from  the  lungs  in  the 
form  of  vapour.  Safrol  does  not  irritate  a 
part  to  which  it  is  applied,  but  it  is  highly 
poisonous,  lowering  the  blood-pressure,  abol- 
ishing the  reflexes,  and  causing  stupor.  The 
subacute  form  of  safrol  poisoning  closely 
resembles  phosphorus  poisoning,  especially 
in  being  accompanied  by  fatty  degeneration 
of  many  of  the  internal  organs,  notably  the 
liver  and  the  kidneys,  with  pronounced  jaun- 
dice. The  fatal  dose,  in  experiments  on  ani- 
mals, has  been  found  to  be  15  grains  for  each 
kilogramme  (about  3'3  pounds)  when  admin- 
istered by  the  mouth  or  subcutaneously,  and  3 
grains  when  injected  into  a  vein.  Safrol  has 
been  employed  to  a  limited  extent  as  a  stom- 
achic and  carminative,  in  doses  of  from  -J  to  1 


grain.  The  crystallized  form,  known  as  sassa- 
fras camphor,  has  the  same  effect  as  thymol 
exerts  when  applied  topically  for  the  relief  of 
neuralgia. 

SAGE. — See  Salvia. 

SAGO  is  a  starch  derived  from  several  spe- 
cies of  palms,  especially  Metroxylon  Sagu,  a 
native  of  Ceram,  Borneo,  Sumatra,  and  other 
islands  of  the  Indian  Archipelago.  In  some 
of  these  regions  sago  is  the  chief  article  of  food. 
The  stems  are  cut  from  the  tree  and  split  open, 
and  the  starch  is  removed  from  the  centre. 
This  pith  is  placed  in  receptacles  having  _a 
sieve-like  bottom,  and  the  cellular  tissue  is 
entirely  washed  away.  The  starch  is  reduced 
to  a  thick,  moist  mass,  and  rubbed  through 
sieves.  It  is  thus  formed  into  grains  and  is 
then  dried,  and  finally  polished  in  rollers  by 
friction.  It  appears  in  the  shops  in  round 
grannies,  usually  opaque  and  white,  with  serai- 
translucent  spots.  This  is  known  as  pearl  sago. 
It  also  appears  in  other  forms.  Coarse  granu- 
lated sago  from  India  is  sometimes  called  tapi- 
oca, a  term  which  is  properly  applied  to  another 
substance.  Sago  is  not  wholly  soluble  in  hot 
water,  but  swells,  forming  a  light,  nutritious 
food  very  easy  of  digestion.  It  has  no  medici- 
nal properties,  and  is  used  solely  as  a  food. 
The  method  of  preparing  it  is  practically  the 
same  as  that  of  the  other  forms  of  simple 
starch. — Floyd  M.  Crakdall. 

SAIiACETOL,  or  salicylacetol,  or  acetol- 
salicylic  ether, 

yOll 

\C00.CH,C0.CH3, 
is  obtained,  according  to  Bourget  and  Barbey 
{Therap.  Monatsh.,  December,  1893  ;  Nouveaux 
remedes,  March  8, 1894),  by  heating  monochlor- 
acetone  with  salicylate  of  sodium.  It  crystallizes 
in  the  form  of  scales  or  brilliant  needles.  It 
is  slightly  soluble  in  hot  or  cold  water,  and 
dissolves  in  hot  alcohol,  in  ether,  in  carbon 
sulphide,  in  chloroform,  in  benzol,  etc.  It  has 
a  slightly  bitter  taste,  and  melts  at  160°  F. 
Shaken  up  with  an  alkaline  liqilid,  for  exam- 
ple, a  0'6-per-cent.  solution  of  canstic  soda,  it 
is  dissolved  and  saponified — that  is,  it  becomes 
split  up  into  its  component  parts. 

Passing  into  the  intestine,  it  becomes  split 
up  into  acetol  and  salicylic  acid.  The  latter 
is  rapidly  resorbed.  the  urine  showing  traces 
of  it  in  a  quarter  of  an  hour  after  the  admin- 
istration of  15  grains  of  salacetol.  Castor  oil 
accelerates  the  absorption  of  salacetol.  When 
it  is  given  in  the  form  of  a  powder,  in  a  dose 
of  30  grains,  from  8  to  9  grains  of  salicylic  acid 
are  found  in  the  urine  twenty-four  hours  after- 
ward, but  if  it  is  given  dissolved  in  about  an 
ounce  of  castor  oil,  at  the  end  of  twenty-four 
hours  from  12  to  13  grains  are  found.  The 
causes  of  this  increase  of  the  rapidity  of  ab- 
sorption are,  on  the  one  hand,  the  slightly  irri- 
tating action  of  castor  oil,  which  gives  rise  to 
a  more  abundant  secretion  of  the  intestinal 
juice,  consequently  splitting  up  the  salacetol 
in  a  more  energetic  manner,  and,  on  the  other 
hand,  its  rendering  the  intestinal  peristalsis 
more  active. 


139 


SACCHARUM 
SALICIN 


The  absorption  of  salacetol  through  the  skin 
depends  upon  the  substance  in  which  it  is  in- 
corporatea.  Salacetolized  yaseline  is  not  ab- 
sorbed at  all,  while  salicylic  acid  may  be  found 
in  the  urine  in  from  three  to  four  hours  after 
friction  with  salacetolized  lard.  Salacetolized 
lard  with  10  per  cent,  of  oil  of  turpentine,  and 
a  solution  of  salacetol  and  chloroform  in  which 
lard  and  a  small  quantity  of  lanolin  have  been 
incorporated,  are  also  completely  absorbed. 

Salacetol  is  recommended  as  an  intestinal 
antiseptic.  Given  in  daily  amounts  of  from 
30  to  45  grains,  dissolved  in  castor  oil,  it 
has  produced  good  results  in  choleraic  diar- 
rhoea. The  intestine  is  disinfected  as  early  as 
the  third  day.  If  the  diarrhoea  continues,  the 
same  dose  is  repeated.  At  the  beginning  of 
the  third  day  salacetol  alone  is  prescribed. 
Children  can  take  1^  grain  for  each  year  of 
their  age. 

In  acute  articular  rheumatism  the  adminis- 
tration of  30  grains  is  followed  in  two  or  three 
hours  by  a  falling  of  the  temperature  and 
lessening  of  tlie  pain.  If  this  dose  is  repeated 
from  two  to  four  times  a  day,  the  temperature 
becomes  normal,  and  convalescence  sets  in  as 
early  as  on  the  fourth  or  fifth  day.  The  fol- 
lowing ointment  is  recommended  by  Bourget 
and  Barbey  for  the  affected  joints : 

Salicylic  acid. 
Oil  of  turpentine. 

Lanolin,  each 150  grains ; 

Lard 1,500      " 

Salacetol  is  given  internally  at  the  same 
time,  in  doses  of  15  grains,  morning  and  even- 
ing. They  have  obtained  excellent  results  with 
this  treatment.  Muscular  and  chronic  rheu- 
matism also  have  been  treated  successfully 
with  salacetol.  and  favourable  results  have 
been  observed  in  cases  of  Mliary  lithiasis  from 
the  use  of  this  drug  dissolved  in  castor  oil. 
In  these  oases  30  grains  of  salacetol,  dissolved 
in  almond  oil  or  (especially  in  winter)  in  cod- 
liver  oil,  were  given  every  day  for  three  or  four 
weeks.  They  think  that  salacetol  may  replace 
with  advantage  all  other  salicylized  prepara- 
tions, and  they  recommend  its  employment 
especially  for  children. 

SALACTOL,  or  salahtol,  is  a  German  pro- 
prietary mixture  of  sodium  salicylate,  sodium 
lactate,  and  a  10-per-cent.  solution  of  hydrogen 
dioxide.  It  was  introduced  by  Walle  (Dtsch. 
Med.-Ztg.,  November  15, 1894 ;  Brit.  Med.  Jour., 
December  15, 1894),  who  reported  fifty-two  cases 
of  diphtheria,  of  all  grades  of  severity,  treated 
successfully  by  carefully  and  systematically 
pencilling  the  affected  parts  of  the  throat  with 
the  mixture  every  four  hours.  Diluted  with 
its  own  bulk  of  water,  it  was  employed  also  by 
Walle  as  a  gargle  and  in  the  form  of  spray. 

SALAZOLON.— See  Salipyrine. 

SAIiEP,  tuhera  salep  (Ger.  Ph.),  is  the  dried 
tubers  of  various  Oriental  and  German  orchids, 
such  as  Orchis  mascula.  Orchis  militaris,  Or- 
chis Morio,  Orchis  ustulata,  Anacamptis  pyra- 
midalis,  and  Platanthera  bifolia.  According 
to  Dragendorff,  salep  contains  48  per  cent,  of 
mucilage,  27  per  cent,  of  starch,  1  per  cent,  of 
53 


sugar,  and  5  per  cent,  of  albumin.  It  is  demul- 
cent and  nutrient.  The  mucilage,  mucilago 
salep  (Ger.  Ph.),  is  made  by  shaking  1  part  o  £ 
salep,  in  moderately  fine  powder,  in  a  bottle 
with  10  parts  of  water,  and  adding  90  parts 
of  boiling  water.  It  should  be  prepared  ex- 
temporaneously as  it  is  wanted. 

SALEBATTJS. — Potassium  or  sodium  bi- 
carbonate (see  under  Potassium  carbonates.) 

SALICIN,  salicinum  (U.  S.  Ph.,  Br.  Ph.), 
is  a  neutral  principle,  derived  from  the  bark  of 
the  willow  tree,  principally  Salix  alba  and 
Salix  Helix,  and  from  the  bark,  leaves,  and 
flowers  of  Popifte  tiemula.  Although  it  had 
been  previously  described,  it  was  first  iden- 
tified by  Leroux  in  1880.  Its  graphic  form- 
ula is  CisHisOt,  and  it  may  be  synthetical- 
ly prepared.  Salicin  is  not  hygroscopic,  re- 
maining permanent  on  exposure  to  air.  It 
occurs,  when  it  is  pure,  in  two  forms,  as 
colourless,  flat  plates  or  rhombic  prisms,  or  as 
white,  shining  scales  or  needles.  Its  reaction 
in  solution  is  neutral.  It  has  a  very  bitter 
taste,  which  remains  in  the  mouth  for  some 
time  after  its  administration,  but  a  solution  is 
inodorous.  At  59°  P.  salicin  readily  dissolves 
in  28  parts  of  water.  It  is  also  soluble  in 
ether,  in  chloroform,  in  benzene,  and  in  alka- 
line fluids.  The  melting  point  of  salicin  is 
388'4°  F.  Salicin  burns  without  an  ash,  by 
which  test  its  freedom  from  mineral  impuri- 
ties may  be  ascertained.  Salicin  is  a  glucoside, 
and  its  difference  from  alkaloids,  also  the  ab- 
sence of  alkaloids,  may  be  demonstrated  by  the 
test  of  the  U.  S.  Ph.,  which  demands  that  a 
small  portion  of  salicin  be  heated  in  a  test  tube 
until  it  assumes  a  brown  colour ;  a  few  cubic 
centimetres  of  water  and  a  drop  of  a  solu- 
tion of  ferric  chloride  are  then  added.  A 
violet  colour  is  then  taken  by  the  solution. 
The  aqueous  solution  must  not  be  precipi- 
tated by  tannic  or  picric  acids. 

Upon  the  temperature  of  the  body  in  health, 
salicin  exerts  no  influence.  Given  in  fever, 
however,  it  has  a  thermolytic  action  which  cor- 
responds to  that  of  salicylic  acid,  although  it 
is  much  slower.  In  full  medicinal  doses,  its 
administration  is  followed  by  a  dull,  apathetic 
expression  of  the  countenance  and  by  flushing 
of  the  face  on  the  slightest  irritation  or  ex- 
citement. Less  constantly,  temporary  deaf- 
ness, tinnitus  aurium,  and  frontal  headache 
supervene.  A  tremor  of  the  hands  and  a  rapid 
increase  in  the  respiratory  rate  have  sometimes 
been  observed.  After  very  large  doses,  more 
serious  phenomena  present  themselves.  There 
are  severe  headache,  muscular  weakness,  tremor 
of  the  extremities,  and  mental  irritability.  The 
voice  may  become  husky,  and  the  movements 
of  respiration  are  augmented  in  number  with- 
out the  appearance  of  dyspnoea.  Salicin  in 
such  doses  may  cause  enfeeblement  of  the 
heart's  beat,  with  a  pulse  which  corresponds 
to  the  rapidity  of  the  respiration.  The  pulse 
may  intermit.  Like  salicylic  acid,  salicin  has 
provoked  ha?morrhages.  Binetocatharsis  may 
follow  an  overdose,  and,  after  its  long-con- 
tinued use,  a  gastric  catarrh  may  supervene. 
It  produces  sweating,  rendering  this  secretion 


SALICYLAGBTOL 
SALICYLIC  ACID 


140 


alkaline  or  neutral.  Salioin  is  excreted  by  the 
kidneys,  appearing  in  the  urine  iu  from  fifteen 
to  thirty  minutes  after  its  ingestion.  The 
elimination  of  the  drug  is  very  slow,  however, 
as  traces  of  salicylic  acid  have  been  found  in 
the  urine  sixty  hours  after  the  administration 
of  a  single  dose.  In  the  urine  it  appears  as 
salicin,  salicylic  acid,  salicyluric  acid,  and  sali- 
genin. 

Lederer,  of  Munich  (cited  in  I^.  T.  Med. 
Jour.,  April  11,  1896).  and  Attfield  (Chemistry, 
Qeneral,  Medical,  and  Pharmaceutical,  Phila- 
delphia, 1883),  maintain  that  salioin  consists 
of  saligenin  and  glucose,  into  which  it  splits 
up  in  the  system,  saligenin  being  the  active 
principle.  Senator,  however  (Lancet,  July  17, 
1879),  records  his  belief,  based  on  experiment, 
that  salioin  is  converted  into  salicylic  acid  in 
the  blood.  0ntil  this  conversion  takes  place, 
the  influence  of  salicylic  acid — which  Senator 
believes  is  the  action  of  salioin — must  be  re- 
tarded. This  observation  corresponds  with  the 
clinical  phenomena  which  are  manifested  after 
the  administration  of  salicin  and  with  the 
findings  in  the  urine  following  ingestion  of  the 
drug.  Arguing  from  this  standpoint  also, 
Haig  logically  asks  why  salicin  should  be 
administered  when  it  depends  upon  its  trans- 
formation into  salicylic  acid  for  what  favour- 
able action  it  exerts  (Med.-chirurg.  Trans., 
London,  1890,  p.  287).  He  urges  that  the 
compounds  of  salicin  and  salicylic  acid  exert 
a  curative  power  in  rheumatic  affections  which 
is  directly  proportional  to  their  power  of  elimi- 
nating uric  acid  from  the  system,  and  that 
they  cure  these  diseases  solely  by  effecting 
this  elimination.  Assuming  his  position  to  be 
correct,  he  sees  no  reason  why  salicin  should 
be  preferred  to  salicylic  acid  or  its  compounds. 
These  propositions  have  been  almost  universal- 
ly accepted  by  therapeutists,  and  at  the  present 
day  it  may  be  safely  said  that  salicin  is  not 
largely  used  as  a  substitute  for  salicylic  acid, 
although  as  an  analgetic  and  antirrheumatio  it 
still  finds  some  employment. 

Therapeutically,  salicin  has  been  urged  by 
various  writers  for  a  vast  multiplicity  of  ail- 
ments. Its  first  and  most  important  employ- 
ment was  in  acute  articular  rheumatism.  The 
results  obtained  were  not  encouraging,  and 
even  its  most  ardent  advocates  have  long  ago 
abandoned  its  administration  for  this  com- 
plaint. Its  action  was  so  much  slower  than 
that  of  the  compounds  of  salicylic  acid  that  it 
could  not  compete  with  the  latter,  although 
the  accompanying  fever  was  reduced  and  the 
arthritic  pain  diminished  if  the  use  of  the 
drug  was  continued  long  enough.  In  fact, 
some  writers  maintain  that  in  a  week's  time  a 
.patient  suffering  from  this  disease  will  feel  as 
well  under  treatment  with  salicin  as  under  the 
more  generally  approved  method  of  treatment. 
In  chronic  articular  rheumatism,  in  gout,  and 
in  those  cases  of  arthritic  pai^i  which  may  or 
may  not  depend  on  a  uric-acid  diathesis,  some 
successful  results  seem  to  have  been  attained  by 
the  employment  of  salicin.  In  all  the  acute  in- 
flammatory processes  for  which  salicylates  are 
given  salicin  has  been  tried  with  varying 
In  doses  of  from  20  to  30  grains 


salicin  is  said  to  abort  an  acute  coryza  and  to 
mitigate  the  symptoms  of  hay  fever.  In  the 
same  doses,  it  is  said  to  exert  a  favourable  in- 
fluence upon  influenza  when  taken  early  in 
the  disease.  Salioin  has  been  employed  in 
pneumonia  as  an  antipyretic  and  in  pleurisy 
as  an  analgetic,  with  results  that  have  not  led 
to  its  general  adoption  in  the  treatment  of 
these  conditions.  As  a  local  application  to  the 
diseased  surfaces  in  diphtheria  it  is  useless. 
In  catarrhal  jaundice  salicin  is  said  to  abate 
the  symptoms.  If  this  is  true,  it  is  probably 
due  to  the  diuretic  action  of  the  drug. 

Salicin  was  early  in  its  care'er  recommended 
as  a  specific  for  the  intermittent  fevers,  but  it  is 
not  to  be  compared  with  the  cinchona  alkaloids 
in  these  diseases.  As  a  substitute  for  quinine 
it  need  not  be  considered.  Yet,  in  cases  of 
intermittent  neuralgia,  when  quinine  seems  to 
be  ineffectual  in  relieving  the  pain,  salicin 
sometimes  accomplishes  this  result  in  doses  of 
from  20  to  40  grains.  This  is  undoubtedly 
due  to  its  unquestioned  analgetic  action,  for 
in  other  neuralgic  affections,  including  lum- 
bago, salicin  exerts  at  times  a  marked  influence 
for  good.  The  many  other  therapeutic  recom- 
mendations for  salicin  need  not  be  considered 
here,  since  their  worthlessness  has  already  con- 
signed them  to  oblivion. 

The  dose  of  salioin  for  an  adult  is  from  10 
to  40  grains.  It  may  be  given  in  wafer,  in 
simple  flavoured  solution,  or  in  pill  form.  The 
fact  that  no  unpleasant  symptoms  have  been 
recorded  after  its  use  in  medicinal  doses  renders 
it,  at  least,  a  safe  agent.  (Cf.  Salicylic  acid 
and  the  salicylates). 

Samuel  M.  Bmokkeb. 

SALICYLACETOL.— See  Salaoetol. 
SALICYLALDEHYDE    -    METHYL- 
PHENYLHYDRAZINE.— See  Agathin. 

SALICYXAMIDE  is  a  derivative  of  me- 
thyl salicylate  obtained  by  the  chemical  action 
of  concentrated  ammonia.  The  ammonia  may 
be  added  to  the  oil  of  gaultheria,  which  con- 
sists principally  of  methyl  salicylate.  When 
obtained  pure,  salioylamide  appears  in  thin, 
colourless,  transparent  plates.  It  dissolves, 
readily  in  250  parts  of  water,  and  is  solu- 
ble in  smaller  quantities  of  alcohol,  ether,  or 
chloroform.    Its  melting  point  is  292-0°  P.    Its 

graphic  formula  is  CeH.,  -j  qqjjjj  .     Salicyl- 

amide  was  first  prepared  by  Limprioht  (Anna- 
len  d.  Chemie  u.  Pharmacie,  xcviii). 

Administered  in  toxic  doses,  salioylamide 
causes,  in  lower  animals,  a  paralysis  of  motor 
nerves  and  of  the  spinal  and  brain  centres. 
Upon  the  muscular  system,  in  poisonous  doses, 
it  also  produces  complete  loss  of  function. 
Although  the  reflexes  are  not  destroyed,  sali- 
oylamide evokes  a  delay  in  their  action  and 
diminishes  their  force.  This  action  is  proljably 
due  to  a  diffusion  of  the  reflex  impulse  through- 
out the  cord.  Nesbitt  (Therap.  Gaz.,  October, 
1891),  who  has  made  a  careful  study  of  the 
drug,  believes  that  poisonous  doses  diminish 
spinal  conductivity.  In  this  way  he  accounts 
for  the  diminution  in  peripheral  pain  which  is 
seen  after  its  administration.    Given  in  mod- 


141 


SALIC  FLACETOL 
SALICYLIC  ACID 


erate  doses,  salieylamWehas  no  effect  upon  the 
heart  or  pulse,  the  blood-pressure  remaining 
stable.  Upon  respiration,  the  drug  seems  to 
have  no  deleterious  effect,  even  in  large  doses. 

In  a  solution  of  1  to  500,  salioylamide  seems 
to  have  considerable  miHseptic  power.  In  this 
strength  it  prevents  the  development  of  bacilli 
and  of  micrococci,  although  ^lesbitt  {loc.  cit.) 
does  not  mention  the  species  of  bacteria  ex- 
perimented with.  In  very  dilute  solution  it 
destroys  the  motile  power  of  the  amoeba, 
though  movements  return  if  the  amoeba  is 
washed  in  clear  water.  The  same  effect  is 
noted  on  the  leucocyte.  The  coagulability  of 
albumin  is  diminished  by  the  presence  of  sali- 
oylamide. 

Therapeutically,  salioylamide  has  not  had 
the  career  as  a  substitute  for  salicylic  acid 
which  it  was  at  one  time  believed  it  would 
have.  Nesbitt  alleged  for  it  that  it  was  safer 
than  salicylic  acid  for  general  use,  since  it 
contained  an  amidogen  radicle,  and  Lauder 
Brunton  has  stated  that  synthetic  compounds 
with  this  radicle  as  a  component  part  are  stimu- 
lant in  character.  This  matter,  however,  has 
not  been  further  studied.  Salioylamide  is  more 
easily  soluble  than  salicylic  acid,  and  is  taste- 
less— elements  in  its  favour  for  medicinal  use. 
Its  analgetic  influence  is  said  to  be  marked, 
and  as  an  antirrheumatio  and  antipyretic  it  has 
had  limited  employment..  The  dose  varies 
from  3  to  1.5  grains,  the  former  for  uses  in 
rheumatic  processes,  the  latter  as  a  thermolyiic 
agent  and  antineuralgic.  Nesbitt  has  reported 
four  cases  of  acute  amygdalitis  which  were 
apparently  cured  in  twenty-four  hours  by  the 
use  of  salicylamide.  In  acute  articular  rheu- 
matism he  also  met  with  successful  results.  In 
cases  of  visceral  pain,  such  as  ovarian  neural- 
gia, and  in  neuralgias  of  peripheral  nerves, 
the  same  writer  has  reported  beneficial  results 
from  the  use  of  salicylamide.  Its  value  in 
fevers  has  not  been  determined,  since  no  clinical 
reference  is  made  to  the  drug  as  an  antipy- 
retic in  the  literature  of  the  subject. 

Samuel  M.  Bbickner. 

SALICYLIC  ACID  AND  THE  SALI- 
CYLATES.— Salicylic  acid,  acidum  salicyli- 
cum  (U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.),  is  an  organic 
acid  existing  naturally  in  combination  as  sali- 
cylate of  methyl.  Salicylous  acid  was  discov- 
ered in  1834  by  Pagenstecher,  who  found  it  as 
salioyi  aldehyde.  Three  years  later,  Piria  and 
Bttling  obtained  salicylic  acid  from  the  prod- 
uct of  Pagenstecher's  discovery  by  combining 
it  with  oxidizing  agents.  It  was  Procter  who 
found  that  the  salicylic  acid  could  be  derived 
from  the  plant  wintergreen  (Gaultheria  pro- 
cumbens),  which  contains  it  in  very  large  quan- 
tities as  methyl  salicylate.  The  process  of  its 
preparation  was  very  expensive,  however,  until 
Kolbe,  in  1874,  showed  that  salicylic  acid  could 
be  manufactured  cheaply  from  carbolic  acid 
by  means  of  the  elements  of  carbonic-acid  gas. 
According  to  this  process,  the  carbolic  acid  is 
first  mixed  with  caustic  soda  in  molecular  pro- 
portions and  dried.  The  resulting  acid  car- 
bolate  of  sodium,  heated,  is  saturated  with 
carbonic-acid  gas ;  every  pair  of  molecules  of 


the  carbolate  then  affords  one  of  regenerated 
carbolic  acid,  which  distils  away,  and  one  of 
normal  carbolate  of  sodium,  which  is  con- 
verted into  sodium  salicylate  by  absorption  of 
the  gas.  By  the  action  of  hydrochloric  acid, 
the  latter  furnishes  salicylic  acid  which  may 
be  purified  by  alcohol  or  ether. 

Many  plants  furnish  salicylic  acid,  but  the 
•  process  of  obtaining  it  naturally  is  too  expen- 
sive to  render  it  useful  in  commerce.  It  was 
only  after  Kolbe's  discovery  that  the  drug  was 
taken  up  by  the  medical  profession.  It  occurs 
in  small,  acicular,  white  crystals,  is  odourless, 
and  has  a  sweetish,  acrid,  acidulous  taste.  Its 
formula  is  represented  by  IIaCTH40a.  Water 
at  212°  F.  dissolves  79-15  parts  of  the  acid. 
Its  solubility  is  increased  by  addition  of  the 
phosphates,  citrates,  and  acetates  of  the  alka- 
lies and  borax.  The  fixed  oils,  ether,  and 
chloroform  also  dissolve  salicylic  acid.  Glyc- 
erin, on  being  warmed,  dissolves  4  grains  of 
the  acid  to  a  drachm.  Pure  salicylic  acid 
should  be  free  from  the  odour  of  phenol.  When 
salicylic  acid  is  heated  on  platinum  foil  it 
should  leave  no  ash,  a  proof  of  its  freedom 
from  mineral  contamination. 

The  closeness  to  cinchonism  of  the  symptoms 
induced  by  salicylic  acid  in  doses  sufficient  to 
exert  any  infiuence  has  led  to  some  therapeutic 
errors.  Its  first  manifestations  are  fulness  of 
the  head,  with  tinnitus  aurium,  buzzing,  hum- 
ming, whistling,  or  knocking  sensations  in  the 
ears.  Larger  doses  induce  headache,  with  a 
sense  of  distress,  and  visual  disturbances 
amounting  even  to  temporary  blindness.  The 
hearing  may  simply  be  dulled,  or  a  partial 
deafness  may  be  evoked.  Mental  dulness  and 
apathy  supervene,  and  the  gait  becomes  uncer- 
tain. Delirium  may  appear  and  respiratory 
disturbances  have  been  reported,  consisting  of 
a  deepening  of  the  respiratory  movements  and 
an  increase  in  their  rapidity.  Sometimes  ex- 
treme dyspncea  is  added.  Sweating  is  evoked 
and  becomes  very  free.  The  heart  grows 
tumultuous  in  its  action  and  may  be  feeble  in 
its  beat.  The  temperature  may  remain  or  may 
sink  below  normal.  Toxic  doses  may  produce 
nephritis  with  vesical  irritation.  If  the  kid- 
neys are  sound,  salicylic  acid,  even  in  poison- 
ous doses,  may  not  affect  them ;  but  albumin 
and  even  blood  may  pass  off  in  the  urine. 

Salicylic  acid  is  an  irritant  to  the  mucous 
membranes,  producing  a  feeling  of  rawness. 
It  is  frequently  the  cause  of  nausea  and  vom- 
iting when  given  uncombined,  and  catharsis 
or  diarrhoea  may  occur.  Urticarial  and  ex- 
anthem-like  eruptions  have  appeared  upon  the 
skin  after  even  small  doses  of  the  drug. 

The  action  of  salicylic  acid  and  its  sodium 
salt  are  practically  identical,  and  will  be  con- 
sidered together.  The  symptoms  thus  far  de- 
scribed are  attributable  to  either  drug.  When 
it  is  given  in  poisonous  doses,  all  the  manifes- 
tations of  the  larger  doses  are  exaggerated. 
Delirium  may  appear,  either  of  maniacal  or 
melancholic  type.  Hallucinations,  often  in  the 
shape  of  visions  of  animals,  may  come  on,  or 
there  may  be  a  tendency  to  drowsiness.  Death 
may  occur  suddenly  or  accompanied  by  con- 
vulsions and  extreme  dyspnoea. 


SALICYLIC  ACID 


143 


Salicylic  acid  in  moderate  doses  does  not 
materially  afEect  the  blood-pressure,  but  large 
doses  cause  a  depression,  not  only  in  the  pres- 
sure but  in  the  cardiac  beat.  The  drug  has  a 
cumulative  action,  and  it  is  possible  that  the 
heart  weakness  sometimes  observed  after  a 
long-continued  use  of  the  salicylates  may  be 
due  to  this  fact.  Upon  the  peripheral  nervous 
system  the  action  is  not  definitely  determined, 
but  upon  the  central  nervous  organism  its  in- 
fluence is  above  detailed.  Upon  the  respiration 
the  effect  of  moderate  doses  is  an  acceleration 
and  deepening.  When  toxic  doses  have  been 
administered,  death  ensues  either  with  intense 
asphyxia  or  by  sudden  depression  of  the  res- 
piratory centre. 

Upon  fever,  salicylic  acid  has  a  decided  an- 
tipyretic action.  Especially  in  the  fever  of 
acute  articular  rheumatism  does  it  exert  almost 
a  specific  action.  The  fall  is  accompanied  by 
profuse  sweating,  which  may  appear  within  a 
short  time  after  the  ingestion  of  the  drug. 
This  sweating  is  apt  to  be  very  exhausting,  and 
it  is  quite  probable  that  the  lessening  of  the 
force  of  the  heart's  beat  may  be  dependent 
upon  the  fall  of  temperature.  The  temper- 
ature reaches  its  minimum  in  about  six  hours 
— sometimes  in  less  time — and,  if  it  rises, 
will  return  to  a  level  not  so  high  as  it  had 
reached  before,  quite  rapidly. 

Pulmonary  haemorrhage  and  epistaxis  have 
been  reported  to  follow  the  use  of  salicylic 
acid.  Although  the  oxytocic  power  of  the 
salicylates  is  in  doubt,  there  is  no  question  that 
they  have  caused  abortion  and  provoked  uter- 
ine haemorrhage.  Whether  or  not  they  increase 
the  menstrual  flow  has  not  been  determined. 

Absorption  of  the  salicylates  takes  place 
very  rapidly  from  the  intestines,  where  it  is 
probable  that  salicylic  acid  is  converted  into 
a  salt.  Although  it  escapes  chiefly  through 
the  kidneys,  salicylic  acid  does  not  appear  as 
such  in  the  urine,  but  in  the  form  of  salicylates 
and  salicyluric  acid.  The  green  colour  of  the 
urine  after  the  use  of  salicylic  acid  or  its  de- 
rivatives is  due  to  the  presence  of  indican  or 
of  pyrooatechin,  the  latter  possibly  derived 
from  the  acid.  The  drug  is  absorbed  through 
the  skin  and  can  be  detected  in  the  form  of 
one  of  its  compounds  within  a  few  minutes 
after  inunction.  It  has  been  found  in  the 
saliva,  in  the  serum  of  blisters,  and  in  the  sweat, 
but  never  as  salicylic  acid.  The  urine  may  be 
diminished  in  quantity,  though  it  is  usually 
increased.  Moderate  doses  do  not  affect  a 
Found  kidney  or  bladder,  but,  as  previously 
pointed  out,  hfematuria  or  albuminuria  may 
follow  the  use  of  salicylic  acid.  Reporters 
differ  as  to  the  elimination  of  urea  and  uric 
acid.  Germain  See  observed  no  change  in  the 
nitrogenous  elements  in  the  urine  after  the 
use  of  the  drug,  either  in  disease  or  in  health. 
Other  observers  have  found  a  great  increase 
in  the  solid  matter  excreted  in  the  urine.  Ac- 
cording to  Haig,  the  curative  virtues  of  sali- 
cylic acid  and  its  compounds  in  acute  articular 
rheumatism  depend  upon  the  amount  of  uric 
acid  they  are  capable  of  eliminating  from  the 
organism  ;  as  a  matter  of  fact,  the  manner  in. 
which  these  agents  are  of  benefit  is  ill  under- 


stood even  at  the  present  day.  The  question 
of  uric -acid  secretion  being  enhanced  by  sali- 
cylic acid  is  still  sub  judice. 

Therapeutically,  salicylic  acid  and  its  deriva- 
tives are  useful  as  antipyretics,  analgetics,  and 
antiseptics.  As  an  antipyretic,  the  mode  of 
action  of  the  salicylates  is  not  determined,  but 
it  is  true  that  they  have  a  pronounced  thermo- 
lytic  power.  They  are  very  decided  in  their 
effects,  and  the  decrease  in  temperature  is  quite 
lasting.  A  fall  irom  103°  to  98°  F.  in  rheu- 
matic fever  is  not  unusual.  There  are  many 
cases  of  hyperpyrexia  in  rheumatic  conditions 
which  the  salicyl  compounds  fail  to  relieve, 
however,  and,  indeed,  an  instance  is  recorded 
in  which  sodium  salicylate  sent  a  temperature  of 
101°  to  107°  F.,  although  it  is  altogether  likely 
that  this  was  a  coincidence.  The  discovery  of 
other  and  more  valuable  antipyretics,  including 
the  cold  bath,  has  led  to  the  abandonment  of 
salicylic  acid  as  an  antipyretic  in  almost  all 
diseases  except  those  of  rheumatic  origin  or 
affiliation. 

As  analgetics,  the  salicyl  compounds  have 
some  just  reputation.  In  sciatica  and  neural- 
gias of  various  types  they  sometimes  produce 
decidedly  beneficial  effects.  The  pains  of  loco- 
motor ataxia  and  of  peripheral  neuritis  may 
sometimes  be  controlled  by  the  use  of  salicylic 
acid  or  its  sodium  salt.  The  discomforts  of 
muscular  rheumatism  are  sometimes  relieved 
by  moderate  doses.  Oonorrhmal  rheumatism 
does  not  seem  to  be  influenced  by  the  agents 
under  consideration,  although  they  are  usually 
given,  and  although  some  observers  have  re- 
ported beneficial  results. 

The  introduction  of  salicylic  acid  to  the  med- 
ical profession  was  due  to  "the  discovery  of  its 
antiseptic  properties.  A  small  percentage 
(from  0-3  to  0-4  per  cent.)  is  sufficientlv  strong 
to  kill  bacteria  in  culture.  One  part  "to  3,000 
will  prevent  putrefaction  in  urine,  and  solu- 
tions of  organic  materials  can  be  indefinitely- 
maintained  intact  by  the  addition  of  salicylic 
acid  or  sodium  salicylate.  These  agents,  in 
small  percentage,  are  able  to  check  amylaceous 
and  proteid  digestion.  Salicylic  acid  was  used 
for  a  long  time  for  the  pre'servation  of  food 
stuffs,  beers,  and  wines,  but  in  1881  its  use 
was  forbidden  by  the  French  Government  after 
it  was  proved  that  its  continued  and  prolonged 
ingestion  might  be  dangerous  or  serious.  This 
antiseptic  power  has  been  employed  in  the 
preservation  of  inorganic  solutions  as  well. 
In  surgery,  salicylic  acid  has  never  had  much 
employment.  It  causes  steel  instruments  to 
corrode,  and  is  not  agreeable  for  use  in  and 
about  wounds.  Salicylic-acid  cotton,  contain- 
ing 3  and  10  per  cent,  of  the  acid,  is  raanufac- 
tured  for  dressings  to  apply  next  to  a  wound. 

When  it  is  desired  to  use  salicylic  acid  and 
not  one  of  its  salts,  it  may  be  given  as  such  or 
in  the  form  of  oil  of  gaultheria  (see  Gaul- 
THERiA).  Eminent  authorities  agree  that  in 
acute  articular  rheumatism  there  is  no  drug 
the  empirical  employment  of  which  has  met 
with  such  universal  favour.  It  certainly  re- 
duces the  pulse-rate  and  fever,  although  the 
disease  itself  may  not  be  eradicated.  (For  a 
brief  discussion  of  its  use,  see  under  Sodium 


143 


SALICYLIC  ACID 


salicylate,  in  this  article).  In  chronic  articular 
rheumatism,  salicylic  acid  seems  to  be  useless. 
In  the  treatment  of  rheumatic  irido-chorioid- 
itis  and  sclerotitis  it  is  valuable  in  doses  of  15 
grains  four  times  daily.  In  gout  it  frequently 
arrests  paroxysms  of  attacks  and  prevents  re- 
lapses, at  the  same  time  favouring  the  absorp- 
tion of  deposits  of  tophi.  There  is  no  evidence 
to  prove  that,  in  the  treatment  of  intermittent 
fevers  or  of  the  acute  infectious  diseases,  it  is 
of  the  least  value.  Success  has  been  alleged 
for  the  drug  in  relapsing  fever,  but  this  state- 
ment rests  upon  slender  testimony.  In  acute 
inflammatory  processes  it  may  be  used  as  an 
antipyretic,  but  it  is  very  doubtful  if  it  arrests 
their  course.  Of  very  meagre  value  is  it  in  the 
treatment  of  diphtheria.  It  is  probably  little 
better  or  little  worse  than  other  drugs  in 
aphfhcB,  or  thrush.  In  dysentery,  enemata  of 
salicylic  acid  in  a  strength  of  1  to  300  are  said 
to  lessen  the  frequency  of  the  stools  and  to 
destroy  their  fcetor.  In  gastric  catarrh  and 
intestinal  flatulence,  salicylic  acid  may  decrease 
the  formation  of  gas.  The  drug  has  been  em- 
ployed for  the  expulsion  of  Tcenia  solium,  in 
doses  of  12  grains,  following  the  administration 
of  castor  oil  upon  a  fasting  stomach. 

The  respiratory  tract  has  had  its  share  of 
experiments  by  the  use  of  salicylic  acid.  The 
drug  has  been  given  by  inhalation  to  destroy 
the  odour  of  foetid  bronchitis  and  gangrene  of 
the  lung  ;  and  in  phthisis  it  has  been  employed 
to  reduce  the  fever.  On  none  of  these  ailments 
does  it  exert  any  curative  influence.  Acute 
coryza  and  hay-fever  are  alleged  to  have  their 
symptoms  mitigated  by  the  use  of  the  drug. 
Small  doses  are  said  to  have  cured  oases  of 
diabetes,  but  this  may  well  be  doubted.  The 
pains  of  herpes  zoster  and  of  swollen  Joints  in 
purpura  hemorrhagica  are  said  to  be  relieved 
by  the  use  of  salicylic  acid. 

Locally,  this  agent  has  a  host  of  applications. 
It  has  been  employed  with  varying  results  in 
hyperidrosis  of  the  feet  and  hands,  in  psoriasis, 
and  for  the  removal  of  corns  and  warts.  For 
this  last  purpose  the  plaster-mull  of  Unna  is 
really  valuable.  This  consists  of  a  mixture  of 
from  30  to  50  parts  of  salicylic  acid  and  from 
5  to  10  parts  of  creosote  spread  upon  gutta- 
percha. For  the  destruction  of  parasites, 
salicylic  acid  is  of  value  in  a  strength  of  1  to 
500.  In  eczema  and  intertrigo  excellent  re- 
sults are  attained  with  a  4-per-cent.  ointment. 
Chronic  urticaria  has  been  cured  by  the  in- 
gestion of  30  grains  thrice  daily.  As  a  styptic 
in  slight  hcemorrhages,  in  erosions  of  the  cervix 
uteri,  in  carcinoma  of  the  uterus,  and  in 
metrorrhagia  not  dependent  on  some  gross 
lesion,  tampons  moistened  with  a  solution  of 
salicylic  acid  are  valuable.  A  salicylate  of  iron 
has  been  vaunted  as  a  styptic  agent,  but  is 
rarely  used.  A  nasal  douche  of  salicylic  acid 
of  a  strength  of  1  to  1,000  is  palliative  in 
chronic  ozmna.  Salicylic  acid  has  some  virtue 
as  a  deodorizer,  but  in  this  respect  it  is  an 
infi'rior  agent. 

The  dose  of  salicylic  acid  varies  with  the 
purpose  for  which  it  is  given.  A  drachm  in 
twenty-four  hours,  in  divided  doses,  in  acute 
articular  rheumatism,  represents  the  average 


administration.  It  is  frequently  given  in  larger 
doses.  It  may  be  administered  in  wafers,  in 
simple  solution,  or  in  some  flavouring  vehicle. 

[The  official  salicylic-acid  ointment,  unguen- 
tum  acidi  salicylici  (Br.  Ph.),  contains  1  part  of 
the  acid,  18  parts  of  soft  paraffin,  and  9  parts 
of  hard  paraffin. 

A  form  of  chronic  salicylic-acid  poisoning 
manifested  by  a  congested,  swollen,  and  oede- 
matous  state  of  the  mucous  membrane  of  the 
air-passages  sometimes  occurs  among  workmen 
employed  In  manufactories  in  which  they  are 
exposed  to  inhalation  of  the  acid,  especially,  as 
it  appears,  of  the  amorphous  form.  Dr.  Lud- 
wig  Ebstein  ( Wiener  klin.  Wochenschrift, 
March  13,  1896 ;  iV.  Y.  Med.  Jour.,  March  88, 
1896)  relates  the  case  of  a  man,  sixty  years  old, 
a  maker  of  preserves,  who  for  two  years  had 
suffered  with  a  tormenting  cough,  by  day  as 
well  as  by  night,  accompanied  by  difficult 
expectoration  of  a  very  thick,  gray  mucus.  In 
April,  1895,  his  condition  had  become  so  ag- 
gravated that  there  was  often  dyspncea  in  the 
daytime,  the  cough  had  increased  in  intensity, 
and  every  night  he  was  suddenly  awakened 
with  a  feeling  of  suffocation,  so  that  he  had  to 
resort  to  the  inhalation  of  steam,  whereby  he 
was  enabled  to  cough  up  with  difficulty  a 
scanty,  thick  secretion,  and  the  dyspnoea  was 
rendered  more  tolerable.  Up  to  the  middle  of 
September,  when  Dr.  Ebstein  first  saw  him, 
the  symptoms  had  kept  on  increasing,  and  a 
sense  of  dryness  had  been  added  to  them.  The 
whole  nasal  mucous  membrane  was  then  of  a 
dusky-red  colour,  with  a  very  scanty  secretion, 
and  the  nasopharynx  showed  the  same  appear- 
ances. The  pillars  of  the  fauces  appeared  as 
inflamed  swellings  which  were  thrown  into 
horizontal  folds  when  swallowing  movements 
were  executed.  The  upper  part  of  the  larynx 
showed  nothing-  abnormal  beyond  moderate 
inflammatory  redness  and  swelling,  but  the 
vocal  cords  showed  a  striking  change  in  the 
neighbourhood  of  the  vocal  processes — on  the 
upper  surface  of  each  cord,  projecting  beyond 
its  border,  there  was  an  oedematous,  tumour- 
like  swelling,  and  the  two  cords  "  smacked  " 
perceptibly  on  phonation.  The  trachea,  which 
was  readily  visible  to  a  considerable  depth, 
showed  a  uniform  swelling  of  the  mucous 
membrane,  which  was  of  a  deep-red  hue  and 
covered  here  and  there  with  thick,  gray  secre- 
tion. The  swelling  was  so  great  as  to  produce 
a  notable  stenosis,  reducing  the  calibre  to  the 
size  of  one's  little  finger.  There  was  manifest 
stridor  with  each  inspiratory  and  expiratory 
movement,  and  both  these  movements  were 
prolonged.  There  were  dry,  piping  murmurs 
in  all  parts  of  the  chest.  The  diagnosis  arrived 
at  was  that  of  bronchitis  sicca  with  slight  em- 
physema. The  swelling  of  the  tracheal  mucous 
membrane  was  somewhat  reduced  by  five  days' 
inhalations  of  a  spray  of  a  weak  solution  of 
sulphate  of  zinc,  but  expectorants  had  no  effect 
on  the  thick  bronchial  secretion.  Inhalations 
of  atomized  solutions  of  sodium  bicarbonate, 
sodium  chloride,  etc.,  served  only  to  increase 
the  sensation  of  dryness.  Finally,  iodide  of 
potassium  was  prescribed,  as  recommended  by 
Cantani,  and  proved  to  be  most  efficacious; 


SALICYLIC  ACID 


144 


the  secretion  became  thinner  and  the  swelling 
of  the  tracheal  mucous  membrane  grew  mani- 
festly less.  At  the  end  of  four  weeks  the  man 
was  entirely  free  from  his  troubles.  But  in 
five  days  after  his  returning  to  his  work  he 
had  a  relapse,  and  then  for  the  first  time  it 
came  out  tliat  he  was  in  the  habit  of  handling 
salicylic  acid  in  his  occupation.  A  resumption 
of  the  treatment  accomplished  a  cure  again  in 
the  course  of  three  weeks.  Then  the  nnu  gave 
up  the  use  of  salicylic  acid,  and  he  had  no 
farther  return  of  the  trouble.  Although  he 
had  employed  the  acid  for  years,  it  is  note- 
worthy, says  Dr.  Ebstein,  that  the  pronounced 
aggravation  of  his  symptoms  had  followed 
close  upon  his  giving  up  the  use  of  the  crystal- 
line acid  and  using  the  amorphous  form  in- 
stead. 

Dr.  H.  Radcliffe  Crocker  (Lancet,  June  8, 
1895 ;  Internat.  Med.  Magazine,  August,  1895) 
says  that  he  first  prescribed  the  salicylates  in 
a  case  of  psoriasis  accompanied  by  symptoms 
of  amygdalitis,  and  the  improvement  in  the 
appearance  of  the  patches  from  week  to  week 
was  very  remarkable.  Since  then  he  has  given 
the  salicylates  an  extensive  trial,  with  the  re- 
sults in  many  instances  equally  striking  and 
conclusive,  especially  in  cases  of  psoriasis  gut- 
tata of  extensive  and  recent  development,  the 
very  form  unsuited  for  the  employment  of 
either  thyreoid  extract  or  arsenic.  Under  the 
influence  of  the  drug  he  has  observed  a  dimi- 
nution of  the  hypera?mia,  the  scales  being  no 
longer  formed  abundantly,  while  the  old  crusts 
became  easily  detached,  leaving  a  pale-red  sur- 
face which  became  smoother  from  week  to 
week.  Should  the  drug  produce  any  gastro- 
intestinal irritation,  he  says,  an  aggravation  of 
the  psoriasis  may  result,  requiring  the  admin- 
istration of  an  alkaline  sedative  for  a  few  days, 
when  the  salicylates  may  be  given  again  in 
smaller  doses.  He  reports  also  much  success 
in  the  salicylate  treatment  of  the  various  forms 
of  erythema  multiforme,  and  also  in  erythema 
nodosum,  and  mentions  one  case  o£  lupus  ery- 
thematosus in  which  striking  improvement 
followed  its  employment.  He  sums  up  as  fol- 
lows :  Salicylate  of  sodium  and  probably 
salicin  and  its  derivatives  are  of  great  value  in 
psoriasis,  especially  during  the  period  of  active 
development,  and  in  hypersemic  cases  which 
are  unsuitable,  as  a  rule,  for  either  arsenic  or 
thyreoid  extract.  They  are  useful  in  all  forms 
of  the  disease,  except,  perhaps,  in  old  chronic 
patches,  but  their  administration  must  be  tem- 
porarily stopped  if  they  give  rise  to  any  dys- 
peptic symptoms. 

In  the  Therapeutic  Gazette  for  April  15, 
1896,  Dr.  J.  Abbott  Cantrell  reports  upon 
about  ten  years'  experience  of  his  in  the  use  of 
salicylic  acid  in  skin  diseases  at  the  Phila- 
delphia Polyclinic  and  College  for  Graduates  in 
Medicine.  In  the  topical  employment  of  the 
drug  he  uses  ointments  of  a  strength  of  from 
3  to  15  per  cent.,  made  with  either  vaseline  or 
lanolin,  sometimes  together  with  zinc  oxide; 
or  washes  of  from  2-  to  30-per-cent.  solutions 
in  water  or  in  an  emulsion  with  a  small 
amount  of  mucilage  of  acacia ;  or  plasters 
ranging  in  strength  from  10  to  25  per  cent. 


In  erythematous  eczema  the  treatment  gave 
excellent  results  when  the  disease  was  confined 
to  a  small  single  area,  especially  in  cases  that 
were  rather  subacute  ;  but  where  the  eruption 
was  more  or  less  general  or  the  inflammation 
was  high,  it  was  not  thought  advisable  to 
resort  to  it.  In  papular  eczema  the  drug  was 
used  only  where  there  had  been  a  coalescence 
of  the  lesions,  such  as  is  often  seen  on  the  legs, 
and  then  only  when  the  condition  was  more  or 
less  chronic.  If  the  inflammation  was  acute 
or  the  lesions  were  rather  scattered  in  iri-egular 
patches,  the  treatment  did  not  have  the  same 
good  effect.  In  vesicular  and  pustular  ecze- 
ma, weak  ointments  produced  excellent  results. 
Salic^ylic  acid,  however,  gave  much  better  re- 
sults in  eczema  rubrum  and  squamous  eczema, 
also  in  eczema  with  considerable  Assuring. 
The  good  results  were  most  noticeable  in  cases 
of  long  standing,  especially  those  in  which 
there  was  much  infiltration  and  thickening. 

Desquamative  eruptions  yielded  rapidly  to 
the  use  of  salicylic  acid  in  some  instances. 
Pityriasis  capitis  in  which  desquamation  was 
the  marked  symptom  behaved  exceedingly  well 
under  the  use  of  a  solution  in  water.  Ichthy- 
osis of  the  mild  varieties  was  benefited  by  oint- 
ments. In  psoriasis  possibly  the  best  effects 
were  seen,  but  only  so  far  as  the  removal  of 
the  scales  was  concerned,  as  the  entire  curative 
results  depended  upon  the  internal  administra- 
tion of  suitable  remedies.  Dermatitis  exfolia- 
tiva as  a  distinct  disease  or  where  it  followed 
upon  a  psoriasis  was  much  benefited  by  the 
use  of  salicylic  acid  in  the  ointment  form. 
Pityriasis  rubra  improved  under  the  use  of 
mild  ointments. 

liingworm  of  the  body  [tinea  circinata)  was 
cured  with  a  mild  ointment,  but  ringworm  of 
the  beard  (sycosis)  and  of  the  scalp  (tinea  ton- 
surans) did  not  yield  so  quickly  to  the  action 
of  the  drug. 

Favus  yielded  to  about  the  same  extent  as 
to  other  remedies,  but  if  any  good-  did  result 
from  the  use  of  salicylic  acid  it  was  only  from 
the  stronger  ointments. 

Pigmentary  affections  were  not  affected  so 
quickly  as  by  other  remedies.  Chloasma 
yielded  only  to  a  slight  extent,  but  lentigo  was 
cured  in  the  majority  of  instances  when  treat- 
ed with  strong  applications. 

Affections  of  the  sweat  glands,  both  hyperi- 
drosis  and  dysidrosis  with  occlusion  of  the  fol- 
licular openings  and  the  formation  of  vesicles 
at  these  orifices,  were  benefited  greatly  by  the 
application  of  either  an  ointment  or  a  "solution 
of  salicylic  acid.  It  acted  as  a  stimulant  to 
the  glandular  structures,  promoted  a  proper 
secretion,  and  prevented  the  formation  of  le- 
sions at  the  follicular  openings,  as  well  as 
removing  the  su  m  mi  t  from  the  vesicular  lesions 
that  had  formed  and  allowing  the  blocked  fol- 
licles to  be  emptied  of  their  contents. 

Inflammatory  conditions  of  the  sebaceous 
glands  improved  under  the  application  of  sali- 
cylic acid,  both  in  ointment  and  in  solution  ; 
papular  acne  was  benefited  greatly,  especially 
where  induration  was  a  marked  feature,  and 
pustular  acne  was  subdued  by  its  judicious 
use.    Seborrhcea  occurring  either  on  the  scalp, 


145 


SALICYLIC  ACID 


on  the  chest,  or  around  the  nasal  orifices,  was 
cured  by  the  use  of  an  ointment. 

Corns  were  softened  so  that  they  were  easily 
removed  with  the  curette  or  with  the  finger 
alone.  Warts  also  shared  this  softening  proc- 
ess, and  after  removal  by  the  curette  did  not 
return. 

Epithelioma,  after  the  removal  of  the  crusts, 
was  removed  by  the  action  of  salicylic  acid  in 
the  stronger  ointments,  but  where  these  new 
growths  had  progressed  for  some  time  the  drug 
did  not  have  the  same  effect. 

In  impetigo  contagiosa  the  remedy  acted 
favourably.  Rhus  poisoning  was  greatly  and 
quickly  relieved,  while  the  eczema  constantly 
seen  after  this  condition  was  entirely  removed. 

Both  syphilitic  and  non-syphilitic  ulcera- 
tions were  benefited  by  the  action  of  this  drug, 
and  in  a  short  time  it  could  be  seen  that  the 
bases  of  the  ulcers  were  healing.  During  the 
treatment  of  the  syphilitic  ulcers  internal  medi- 
cation and  other  proper  measures  were  associ- 
ated with  the  use  of  the  acid. 

Eemarkably  good  results  followed  the  em- 
ployment of  the  acid  also  in  lupus  erythema- 
tosus of  the  face,  lichen  cestivus  occurring 
upon  the  trunk,  and  molluscum  contagiosum 
after  the  removal  of  the  summits  of  the  little 
grayish-white  bodies.  In  urticaria  there  was 
much  relief  from  itching,  but  internal  and 
other  treatment  was  adopted  at  the  same  time. 
JS/ail  deformities,  especially  of  the  hypertrophic 
varieties,  were  improved,  and  particularly 
where  the  condition  was  caused  by  an  eczema- 
tous  process. 

Dr.  Fafiourse  {Province  med..  May  18,  1895  ; 
N.  Y.  Med.  Jour.,  June  15,  1895)  reports  the 
successful  employment  of  salicylic  acid  in 
seven  cases  of  can  cer  of  the  uterus.  He  used  a 
5-per-cent.  solution  of  the  acid  in  alcohol  in 
the  following  manner:  The  patients  received 
previously  vaginal  antiseptic  iniections  from 
two  to  three  times  a  day,  one  of  these  injec- 
tions always  preceding  those  of  salicylic  acid. 
From  one  to  four  cubic  centimetres  of  the  solu- 
tion were  injected  into  the  vaginal  portion  of 
the  neck  of  the  uterus  in  five  or  six  places  in 
the  affected  region.  The  vaginal  portion  was 
then  dried  with  tampons  of  cotton  and  dusted 
with  iodoform,  and  the  vagina  was  packed 
with  two  or  three  tampons  of  cotton  satu- 
rated with  a  mixture  of  glycerin  and  iodoform. 
The  patients  were  then  p\it  to  bed  and  ordered 
to  remain  there  during  the  day  without  mov- 
ing ;  in  the  evening  (or  on  the  following  morn- 
ing if  there  was  abundant  haemorrhage)  the 
tampons  were  withdrawn  and  a  vaginal  injec- 
tion was  given. 

The  first  injections  were  usually  followed  by 
a  rather  profuse  haemorrhage,  but  the  more 
frequent  the  injections  the  less  abundant  the 
haemorrhage.  In  the  majority  of  cases  the  in- 
jections are  painful,  but  the  pain  disappears 
very  rapidly,  and  there  are  no  secondary  un- 
favourable symptoms  of  any  kind.  The  injec- 
tions are  repeated  more  or  less  often,  according 
to  the  gravity  of  the  case  and  to  the  inten- 
sity of  the  patient's  suffering. 

Dr.  Fafiousse  says  that  the  results  of  these 
injections  are  the  almost  complete  cessation  of 


metrorrhagia,  disappearance  of  the  leucorrhoea, 
diminution  of  the  pain,  amelioration  of  the 
general  condition,  and  arrest  of  the  progress 
of  the  disease.  It  will  be  seen  then,  he  adds, 
that  the  injections  of  salicylic  acid  are  superior 
to  all  other  means  of  treatment  proposed  for 
"  inoperable"  caneer.J 

Borosalicylic  acid,  acidum  boro-salicyli- 
cum,  is  a  white,  crystalline  powder,  quite  solu- 
ble, of  a  very  bitter  taste,  and  of  decidedly 
antiseptic  properties. 

Ammonium  salicylate  is  sometimes  used 
as  a  substitute  for  salicylic  acid.  It  has  a 
sweet  taste,  and  is  readily  soluble. 

Antipyrine  salicylate. — See  Saliptrine. 

Beta-naphthol  salicylate  {betol-tiaph- 
thalol)  occurs  in  white  shining  crystals,  is 
odourless  and  tasteless,  and  is  soluble  in  hot 
alcohol,  though  not  in  water.  It  is  occasion- 
ally used  instead  of  salol,  as  it  yields  naphthol 
instead  of  phenol  to  the  intestines  by  its  split- 
ting. It  does  not  give  up  its  component  parts 
I'eadily,  however,  and  contains  less  salicylic 
acid  than  salol.  It  has  been  used  in  acute  ar- 
ticular rheumatism  and  in  cystitis  with  am- 
moniaeal  fermentation.  It  may  be  used  in 
the  form  of  suppositories  or  bougies,  as  butter 
of  cacao  dissolves  a  quarter  of  its  weight  of 
the  salt. 

Bismuth,  salicylate  is  a  soft,  white  powder, 
soluble  only  in  acids.  It  is  a  local  antiseptic, 
and  is  used  in  chronic  intestinal  catarrh  and 
in  cholera  infantum.  The  dose  for  an  adult  is 
from  10  to  20  grains,  eveiy  eight  hours.  It 
prevents  putrefaction  in  the  stomach,  and  may 
be  given  in  combination  with  strychnine  when 
gastric  digestion  is  impaired  by  fermentative 
processes.  Wagner  (Am.  Jour,  of  Pharm.,  May, 
1886)  maintained  that  this  salt  was  a  cardiac 
stimulant. 

Cinchonidine  salicylate  may  be  used  in 
the  absence  of  quinine  as  an  antiperiodic.  It 
is  inferior  to  the  other  preparations  of  the  al- 
kaloids of  cinchona.  In  chronic  and  subacute 
articular  rheumatism  it  has  been  used  in  doses 
of  from  15  to  20  grains  daily. 

Calcium  salicylate  appears  in  the  form  of  a 
white,  crystalline  powder,  tasteless,  odourless 
and  freely  soluble  in  dilute  acetic  and  mineral 
acids,sparingly  soluble  in  water.  Ithasbeen  em- 
ployed in  the  diarrhceas  of  children,  in  doses 
of  from  7  to  24  grains.  Locally,  in  solution,  its 
beneficial  use  in  chancres  and  syphilitic  ulcers 
has  been  recorded. 

Guaiacol  salicylate  is  a  chemical  analogue 
of  salol.  It  is  a  white  crystalline  powder  and, 
like  most  of  the  salicylates,  is  odourless  and 
tasteless.  The  dose,  for  purposes  similar  to 
those  for  which  salol  is  employed,  is  from  15 
to  150  grains  daily. 

Lithium,  salicylate  is  a  white,  deliquescent 
powder,  of  a  sweetish  taste.  It  is  very  soluble 
in  water  and  in  alcohol.  The  supposed  advan- 
tage of  the  lithium  base  probably  proceeds 
from  the  belief  that  it  will  act  as  an  elimina- 
tive  agent  toward  uric  acid.  It  is  useful  as  a 
substitute  for  the  sodium  salt  in  acute  articular 
rheumatism  and  in  pyrexia.  Its  dose  is  from 
6  to  15  grains,  to  be  repeated  until  physiological 
effects  are  produced. 


SALICYLIDENB  PARAPHEKETIDIXE 
SALIPYRINE  146 


Mercuric  salicylate  is  a  white,  amorphous 
powder,  rarely  used. 

[Methjrl  salicylate  is  the  chief  constituent 
of  oil  of  wintorgreen  (see  Gaulthekia). 

NapMhol  oalicylate. — See  Betol.] 

Phenyl  salicylate  is  salol  {q.  v.). 

Physostigmine  salicylate,  or  eserine 
salicylate,  appears  in  colourless,  glossy  crystals 
or  needles,  and  has  a  slightly  acid  reaction.  It 
is  very  sparingly  soluble  in  water,  but  may  be 
employed  hypodermically  in  doses  of  from  ^V 
to  tV  of  a  grain.  It  is  occasionally  used  in 
dysentery  and  diarrhoeas.  In  a  solution  of 
alcohol  and  water  it  may  be  used  to  cause 
meiosis  by  instillation  into  the  eyes. 

Potassium  salicylate  has  been  used  as  a 
substitute  for  the  sodium  salt  in  rheumatism, 
but  is  inferior  to  it  in  action. 

Sodium  diiodosalicylate,  in  doses  of  from 
30  to  40  grains,  has  been  used  as  an  antipyretic 
and  analgetic.  It  has  a  sedative  influence  upon 
a  tumultuous,  irregular  heart.  Locally,  it  has 
been  used  as  an  antiseptic  in  parasitic  diseases 
of  the  skin. 

Sodium  dithiosalicylate  is  a  more  power- 
ful antiseptic  than  the  salicylate.  It  has  been 
given  in  acu'.e  articular  rheumatism,  and  is 
said  not  to  produce  the  disagreeable  aural 
symptoms  caused  by  the  salt  more  commonly 
used.  The  dose  is  from  3  to  30  grains,  given 
morning  and  evening. 

Sodium  salicylate,  sodii  salicylas  (U.  S. 
Ph.,  Br.  Ph.),  natrium  salicylicum  {Ger.  Ph.),  is 
the  most  widely  used  of  the  salts  of  salicylic 
acid.  It  is  obtained  by  the  action  of  salicylic  acid 
on  the  carbonate  of  sodium  or  on  sodium  hy- 
drate. It  is  an  amorphous,  inodorous  powder, 
with  a  sweetish,  saline  taste.  It  remains  per- 
manent in  the  air  and  is  very  easily  soluble  in 
water  and  in  glycerin.  An  aqueous  solution 
of  the  salt  reddens  blue  litmus  paper.  It 
is    incompatible    with   antipyrine  (see    Sali- 

PYRINE). 

The  ready  solubility  of  sodium  salicylate 
makes  it  preferable  for  therapeutic  use  to  the 
other  salts  of  salicylic  acid.  It  is  not  severely 
irritating  to  mucous  membranes,  although  it  fre- 
quently causes  nausea  and  vomiting  in  medici- 
nal doses.  A  drachm  taken  daily  for  six  weeks 
has  produced  pronounced  mental  symptoms  of 
an  unfavourable  character,  which,  however, 
disappeared  after  the  drug  had  been  with- 
drawn. Some  persons  are  particularly  suscep- 
tible to  its  influence,  and  the  manifestation  of 
disagreeable  phenomena  must  be  a  signal  for 
the  suspension  of  its  employment.  In  general, 
its  physiological  action,  absorption,  and  elimi- 
nation are  similar  to.  those  of  salicylic  acid. 
Cutaneous  eruptions,  collapse,  and  delirium 
have  appeared  after  an  overdose. 

Its  influence  on  the  course  of  acute  articular 
rheumatism  is  similar  to  that  of  salicylic  acid. 
Because  of  its  more  agreeable  qualities,  it  is 
largely  used  in  preference  to  its  acid.  Although 
sodium  salicylate  does  not  show  in  every  case 
remarkably  good  results  in  the  abatement  of 
fever  and  reduction  of  pain,  the  great  majority 
of  oases  yield  to  its  influence.  So  universal  is 
this  beneficent  showing  that  failure  of  the  drug 
is  apt  to  impugn  the  diagnosis.     Most,  but  not 


all,  arthritic  pains  do  not  yield  to  the  drug, 
and  this  is  particularly  true  of  the  gonorrhceal 
and  pyaemic  joint  affections,  as  well  as  of  ot;her 
uniarticular  arthritic  lesions.  In  acute  articu- 
lar rheumatism,  however,  sodium  salicylate 
should  be  first  tried,  and  its  influence  ob- 
served. Hood  (Lancet,  February  18,  1888) 
thus  characterizes  the  influence  of  the  salt 
upon  acute  rheumatism :  It  relieves  pain  and 
reduces  fever,  but  renders  the  patient  subject 
to  relapses  ;  it  does  not  affect  the  frequency  of 
cardiac  complications  [on  this  point  authorities 
differ];  it  does  not  prevent  hyperpyrexia;  it 
does  not  modify  the  mortality  rate.  It  is  most 
efficient,  he  concludes,  in  combination  with  an 
alkali  treatment.  This  summary  probably 
represents  the  opinion  of  those  most  qualified 
to  judge  in  the  matter;  and,  since  salicylic 
acid  or  its  sodium  salt  is  in  daily  use  the  world 
over,  there  can  be  no  question  as  to  its  great 
value  and  almost  specific  influence  in  acute 
articular  rheumatism. 

The  dose  of  sodium  salicylate  in  this  affec- 
tion varies  according  to  different  writers.  It 
may  be  given  in  amounts  of  from  15  grains 
every  four  hours  to  single  large  doses  of  a 
drachm.  As  a  general  rule,  not  more  than  3  or 
3|  drachms  should  be  given  in  twenty-four 
hours.  When  it  is  given  in  divided  doses,  the 
doses  must  "overlap"  each  other,  as  it  were, 
in  order  that  the  continuous  effect  of  the  drug 
may  be  secured.  As  it  takes  from  four  to  six 
hours  for  sodium'  salicylate  to  influence  the 
organism,  the  dose  should  be  repeated  within 
this  time.  It  may  be  given  in  simple  solution 
in  peppermint  water  or,  to  disguise  its  disagree- 
able taste,  in  some  syrup  or  licorice  prepara- 
tion. Usually  its  benign  influence  is  manifested 
in  from  fifteen  to  thirty  hours. 

Sodium  salicylate  has  been  widely  used  in 
acute  follicular  amygdalitis  supposed  to  be 
rheumatic  in  origin,  in  the  same  doses  as  in 
rheumatism.  In  facial  neuralgia  and  dysmen- 
orrhoea  it  relieves  pain.  In  the  treatment  of 
migraine  and  pertussis  it  is  said  to  mitigate  the 
symptoms ;  but  in  these  ailments  its  nauseating 
tendency  should  render  its  use  cautious.  In 
rheumatic  iritis,  as  well  as  in  iritides  of  gonor- 
rhceal and  other  origin,  and  in  acute  glaucoma, 
it  is  analgetic  and  hastens  recovery.  It  has 
been  widely  recommended  in  dry  pleurisy  and 
pleurisy  with  effusion,  and  in  neuralgic  affec- 
tions of  peripheral  nerves.  Robinson  (Am. 
Jour,  of  the  Med.  Sci.,  November,  1895)  rec- 
ommends the  sodium  salt  or  salicylic  acid  in 
cases  of  cough  dependent  upon  enlargement  of 
the  lingual  tonsil.  As  an  antacid  and  anti- 
septic agent,  sodium  salicylate  has  been  praised 
in  the  treatment  of  cholera  infantum  and  other 
diarrhoeas  the  origin  of  which  is  infection. 
The  use  of  the  drug  is  contra-indicated  in  the 
presence  of  albuminuria,  because  of  its  irritant 
action  on  the  kidneys.  The  salicylate  of  so- 
dium has  been  used  in  almost  all  the  acute 
infectious  diseases  with  results  that  are  not 
encouraging.  In  exophthalmic  goitre  Chilret 
(Rev.  generate  d' Ophthalmol.,  1895,  No.  1)  pro- 
fessed to  have  accomplished  cures  in  four  cases 
by  the  administration  of  75  grains  of  sodium 
salicylate  daily. 


SALICYLIDENE  PARAPHENETIDINE 
147  SALIPYRINE 


Strontium  salicylate  has  been  used  by- 
Wood  ( Univ.  Med.  Mag.,  vii,  4)  in  doses  of  from 
15  to  20  grains  daily  as  an  anUzymotic  and 
antiseptic  in  flatulent  dyspepsia  and  fermen- 
tative changes  in  the  intestines,  with  good 
results.  In  small  doses  it  acts  as  a  bitter. 
The  disagreeable  effects  of  the  other  salicylates 
seem  not  to  be  evoked  by  ordinary  doses.  In 
svbacute  and  muscular  rheumatism  beneficial 
efiects  have  been  obtained.  The  drug  may  be 
given  in  solution  or  in  capsules. 

Samuel  M.  Brickneb. 

SALICYLIDENE     PARAPnENETI- 

DINE.— See  Malakin. 

SALIGENIN,  or  salicyl  alcohol,  CtHsOj, 
has  been  used  by  Dr.  L.  Lederer,  of  Munich 
(ikuncTi.  med.  Woch.,  1895,  No.  7 ;  Dtsch.  Med.- 
Zlg.,  March  13,  1896),  who  says  that  salioin 
consists  of  saligenin  and  glucose,  into  which  it 
splits  up  in  the  system,  and  that  saligenin  is 
the  active  principle.  Saligenin  has  been  tested 
in  cases  of  acute  rheumatism,  and  has  been 
found  a  very  efficient  remedy.  It  is  speedy 
and  sure  in  its  action,  and  thus  far  it  has  been 
observed  to  be  free  from  unpleasant  eflEeots. 
Dr.  Lederer  gives  the  histories  of  eight  cases 
of  acute  articular  inflammation  in  which  sali- 
genin was  used,  and  says  that  in  such  cases,  no 
matter  whether  they  are  of  a  rheumatic  or  of  a 
gouty  nature,  the  inflammation  is  promptly 
brought  to  an  end.  The  unpleasant  effects  of 
salicylic  acid,  such  as  the  siekish-sweet  taste, 
ringing  in  the  ears,  disturbed  digestion,  blue- 
ness  of  the  lips,  etc.,  are  not  experienced,  and 
the  sweating  is  hardly  noteworthy.  According 
to  the  severity  of  the  case.  Dr.  Lederer  orders 
from  7  to  15  grains  of  saligenin,  in  the  form  of 
powder,  to  be  taken  every  hour  or  every  two 
hours.  As  saligenin  dissolves  readily  in  alka- 
line juices.  Dr.  Lederer  thinks  it  would  prove 
highly  serviceable  in  such  other  diseases  as 
typhoid  fever,  cholera,  influenza,  malarial 
fevers,  dysentery,  etc.,  in  which  salicin  has  been 
employed. 

SALINAPHTHOL.— See  Betol. 

SALINES,  in  the  therapeutic  sense,  are 
remedies  which  have  the  nature  of  salts,  espe- 
cially salts  of  the  alkalies,  and  which  are  used 
either  as  cathartics  or  as  diuretics.  The  more 
exact  terms  saline  cathartic  and  saline  diuretic 
are  to  be  preferred  to  the  unqualified  name 
saline,  though  its  use  or  that  of  its  popular 
synonym,  "  salts,"  ordiiiarily  with  the  cathartic 
significance,  is  frequent.  The  saline  cathartics 
in  common  use  are  magnesium  sulphate,  so- 
dium sulphate,  magnesium  citrate,  sodium 
phosphate,  and  potassium  and  sodium  tartrate, 
with  their  modifications,  solution  of  magne- 
sium citrate  and  seidlitz  powder.  The  activity 
of  the  saline  cathartics  depends  upon  their 
power  to  increase  intestinal  secretion,  for  upon 
peristalsis  they  probably  exert  no  greater  in- 
fluence than  would  be  explained  by  the  pres- 
ence of  the  fluids  thus  poured  out  in  the 
intestines.  Experiment  has  demonstrated  that 
the  strength  of  the  solution  of  a  saline  cathar- 
tic as  it  exists  in  the  intestine  within  two  hours 
after  the  administration  of  the  salt  is  5  or  6 
per  cent.    If  the  salt  has  been  given  in  greater 


dilution  than  this,  water  has  been  absorbed 
from  it  until  this  strength  has  been  reached  ; 
if  in  greater  concentration,  the  tissues  have 
yielded  their  fluids  to  dilute  it  to  the  necessary 
degree.  The  inference  is  therefore  clear  that 
saline  cathartics,  to  produce  serous  depletion, 
should  be  given  in  concentration,  while  if 
promptness  of  action  is  sought  for,  a  solution 
of  about  5  per  cent,  strength  will  be  more  effi- 
cacious. If  for  any  reason  purgation  does  not 
follow  the  use  of  a  saline  cathartic,  absorption 
of  the  remedy  will  take  place,  with  the  result 
that  a  considerable  diuresis  will  often  be  pro- 
duced by  it.  The  evacuations  caused  by  saline 
cathartics  are  invariably  watery. 

The  saline  cathartics  are  used  where  large 
fluid  evacuations  are  required.  In  acute  in- 
flammations they  are  antiphlogistic;  in  con- 
gestive and  dropsical  conditions  they  are  active 
as  hydragogues  ;  in  abdominal  inflammations, 
such  as  appendicitis,  they  are  of  great  value, 
not  only  because  of  antiphlogosis  but  be- 
cause of  the  intestinal  depletion  they  cause 
with  little  increase  in  peristaltic  action.  Sa- 
line cathartics  are  often  excellent  haemostat- 
ics, especially  in  abdominal  hemorrhage,  for 
they  lower  blood-pressure  in  the  affected 
area  and  thus  produce  relief.  In  hemor- 
rhages due  to  hepatic  obstruction  they  are 
particularly  beneficial,  in  a  manner  similar 
to  that  in  which  they  relieve  the  ascites  of 
hepatic  cirrhosis — that  is,  by  portal  depletion. 
In  the  plethoric,  the  daily  administration  of 
salines  is  highly  to  be  recommended,  especially 
if  constipation  is  present,  as  is  so  frequently 
the  case.  In  acid  conditions,  such  as  rheuma- 
tism and  gout,  the  salines  are  of  much  service, 
both  by  their  power  to  aid  elimination  and 
probably  by  an  antacid  effect  as  well. 

Saline  diuretics  include  a  number  of  the  al- 
kalin  e  salts,  and,  as  has  already  been  said,  the 
saline  cathartics  will  often  act  as  diuretics  if 
for  any  reason  catharsis  does  not  follow  their 
use.  The  converse  of  this  is  sometimes  true 
also,  and  saline  diuretics,  such  as  potassium 
acetate,  may  cause  catharsis  in  some  subjects 
without  producing  diuresis.  The  most  active 
of  the  saline  diuretics  are  the  salts  of  lithium 
and  potassium,  though  some  of  the  sodium 
salts  are  not  deficient  in  this  respect.  Many 
of  the  saline  diuretics  are  antacid  by  virtue  of 
their  chemical  nature,  and  so  act  to  alkalinize 
the  urine  and  to  exert  the  constitutional  power 
of  antacids.  Of  the  saline  diuretics,  the  most 
important  are  potassium  acetate,  potassium 
citrate,  potassium  tartrate,  potassium  bitar- 
trate,  lithium  carbonate,  lithium  citrate,  solu- 
tion of  ammonium  acetate,  and  sodium  acetate. 
Henry  A.  GRiFrm. 

SALIPYRINE  is  a  combination  of  sali- 
cylic acid  and  antipyrine,  intended  to  obviate 
the  deliquescence  which  takes  place  on  the 
mixture  of  antipyrine  and  any  of  the  salts  of 
salicylic  acid.  It  contains  42-3  parts  of  salicylic 
acid  and  57-7  parts  of  antipyrine.  It  is  a  white, 
coarsely  crystalline  powder  without  odour. 
Its  formula  is  given  as  CuHijNjO.CHeOa. 
The  powder  is  not  hygroscopic.  It  dissolves 
very  sparingly  in  water,  more  freely  in  alcohol. 


SALITHYMOIi 
SALOL 


148 


Prom  an  alcoholic  solution,  salipyrine  sepa- 
rates in  hexagonal  crystals. 

Taken  into  the  mouth  as  such,  salipyrine 
imparts  a  rough  sensation  to  the  tongue.  Like 
all  the  synthetic  antipyretics,  it  produces,  in 
moderate  doses,  a  copious  perspiration  during 
defervescence.  But  little  discomfort  attends 
this  exudation,  exhaustion  not  being  so  pro- 
nounced as  in  the  thermolysis  called  forth  by 
antipyrine  alone.  The  minimum  temperature 
after  a  dose  of  salipyrine  is  reached  in  from 
three  to  four  hours,  when  it  slowly  rises  again, 
reaching  the  original  mark  in  from  four  to  iive 
hours.  Chirone  maintains  that,  while  the  cen- 
tral temperature  is  reduced  by  the  drug,  the 
peripheral  temperature  rises.  As  is  the  case 
under  the  action  of  quinine  and  that  of  most 
of  the  antipyretics,  the  pulse  falls  with  the 
temperature,  but  with  apparently  no  diminu- 
tion in  the  foi-ce  of  the  cardiac  beat.  In 
febrile  diseases  with  a  continuously  high  tem- 
perature, the  action  of  salipyrine  as  an  antipy- 
retic seems  less  eiflcient  than  in  the  intermittent 
types  of  fever.  Normal  temperature  is  not 
affected  by  the  drug. 

The  influence  of  salipyrine  upon  the  nervous 
system  has  not  yet  been  carefully  worked  out. 
Upon  the  lower  animals  it  produces  an  increase 
in  reflex  excitability  which  is  temporary.  Even 
in  large  doses  it  seems  to  have  no  deleterious 
effect  upon  the  central  nervous  system.  Upon 
the  heart  the  depressing  influence  of  antipy- 
rine appears  to  be  lost.  Although  salipyrine 
is  not  a  cardiac  stimulant,  it  does  not  induce 
weakness  of  the  cardiac  beat.  Its  effect  upon 
the  pulse  has  not  been  determined,  but,  al- 
though it  decreases  the  number  of  beats,  there 
is  no  record  of  weakness  produced  by  it.  Sali- 
pyrine is  said  to  produce  a  hypnotic  effect  if 
taken  in  large  doses,  and  it  has  been  alleged 
for  it  that  it  is  calming  in  its  influence  upon 
an  excited  and  irritable  nervous  system.  An 
aphrodisiac  effect  is  noted  in  some  persons 
after  taking  the  drug. 

Experimenters  and  observers  differ  in  their 
statements  as  to  the  influence  of  the  drug  upon 
the  gastric  mucous  membrane.  Although  anti- 
pyrine and  salicylic  acid  may  either  of  them 
provoke  nausea  and  vomiting,  some  therapeu- 
tists maintain  that  salipyrine  does  not  evoke 
this  action.  Others,  and  among  them  the 
writer,  have  secji  nausea  follow  the  use  of  the 
drug,  but  actual  vomiting  has  not  occurred. 
In  one  case  the  nausea  continued  for  over 
eight  hours. 

Toxic  effects  of  salipyrine  have  not  been  re- 
corded, although  some  large  doses  have  been 
taken  accidentally.  In  one  instance  3  J  drachms 
were  administered  within  four  hours  and  a  half 
without  any  injurious  sequelae  being  observed. 
The  drug  has  been  too  little  studied  for  a 
complete  account  of  its  physiological  action  to 
be  given ;  but,  so  far  as  it  has  been  investigated, 
it  appears  to  be  safe  in  ordinary  doses. 

The  main  uses  of  salipyrine  may  be  classified 
under  two  heads:  antipyretic  and  analgetic. 
As  a  thermolytic  agent,  it  is,  as  stated  above,  of 
more  use  in  fevers  of  an  intermittent  type  than 
in  those  with  a  continuously  high  tempera- 
ture.   In  typhoid  fever  it  will  reduce  the  tem- 


perature, but  it  requires  a  dose  larger  than  the 
usual  antipyretic  one  to  accomplish  this  result, 
and  the  effect  is  not  so  prolonged  or  so  deep  as 
that  of  other  antipyretic  agents.  In  intermit- 
tent fevers  of  any  kind,  however,  it  is  safe  to 
give  salipyrine  for  thermolytic  purposes,  as  it 
does  not  depress  the  heart's' action  and  reduces 
an  abnormally  high  temperature  from  two  to 
three  degrees  P.  The  larger  the  dose,  the  more 
pronounced  is  the  thermolysis,  and  the  longer 
does  its  action  continue.  The  temperature 
slowly  rises  after  the  minimum  has  been 
reached,  reaching  the  same  degree  as  that  at 
which  the  drug  was  given  in  from  three  to 
five  hours.  Salipyrine  has  been  recommended 
as  an  antipyretic  in  those  cases  particularly  in 
which  collapse  or  cardiac  depression  is  feared. 
Naturally,  in  those  instances  in  which  a  febrile 
movement  is  dependent  upon  malarial  infec- 
tion, salipyrine  is  interior  to  quinine;  and  in 
the  infectious  diseases  and  the  exanthemata, 
when  an  antipyretic  may  or  may  not  be  indi- 
cated, the  continuous  high  fever  is  a  contra- 
indication to  its  use.  It  is  doubtful  if  it  will 
ever  be  able  to  supplant  some  of  the  more  im- 
portant antipyretics  or  the  cold  bath,  safe  as 
its  action  on  the  heart  is  alleged  to  be. 

The  mode  of  action  of  salipyrine  as  an  anti- 
pyretic has  not  been  established ;  but  it  is 
probably  central,  either  by  direct  action  upon 
the  heat  centre  or  by  influencing  the  vaso-motor 
centre. 

Salipyrine  has  been  recommended  in  the 
treatment  of  acute  and  chronic  articular  rheu- 
matism. In  the  former,  not  only  does  the 
agent  act  as  an  antipyretic,  but  it  is  alleged  for 
it  that  it  has  a  specific  action  upon  the  inflamed 
joints.  Active  movements  of  the  Joints,  it  is 
said,  are  possible  without  pain,  and  passive  mo- 
tions can  be  performed  with  less  distress  to 
the  patient.  Sometimes  2  drachms,  given  in 
divided  doses,  seem  to  alleviate  all  symptoms, 
while  in  other  cases  the  administration  of  the 
drug  has  to  be  continued  for  a  varying  period. 
In  the  chronic  form  of  articular  rheumatism, 
salipyrine  may  be  given  instead  of  the  salicy- 
late of  sodium ;  but  here  the  drug  must  be 
administered  for  several  days  before  improve- 
ment is  manifested,  and  Hennig  (Deutsche 
med.  Woch.,  1891,  Nos.  35  et  seg.)  has  been 
obliged  to  administer  it  for  months  in  some 
cases  in  order  to  maintain  a  standard  of  well- 
being.  The  arthritic  pains  of  gout  are  said  to 
be  diminished  by  the  use  of  salipyrine. 

In  the  treatment  of  neuralgias  of  various 
kinds  salipyrine  has  been  tried,  like  most  other 
drugs  which  have  the  least  analgetic  action. 
Its  action  in  this  form  of  ailment  really  seems 
to  be  what  is  alleged  for  it — antineuralgic. 
Unquestionably  this  influence  is  due  to  the 
salicylic  acid  contained  in  it,  although  in  part 
to  the  antipyrine,  closely  united  chemically  as 
the  two  substances  are.  It  is  most  efficacious 
in  facial  neuralgia  of  the  trigeminal  type, 
although  good  reports  of  its  use  have  been 
recorded  in  neuralgic  affections  of  the  sacral 
and  lumbar  plexuses.  In  myalgia  it  is  also 
recommended  by  Hennig,  who  says  that  mus- 
cular movements  and  the  pain  were  favourably 
impressed.    Salipyrine  has  been  used  in  cepha- 


149 


SALITHYMOL 
SALOL 


lalgias;  but  in  cases  of  migraine  it  is  probably 
not  wise  to  administer  it,  on  account  of  the 
nausea  it  may  produce. 

Salipyrine  is  vaunted  as  a  particularly  ef- 
ficient drug  in  influenza,  not  only  cutting  short 
incipient  forms,  but  acting  favourably  upon 
the  disease  when  it  has  already  been  estab- 
lished. Writers  upon  this  therapeutic  use  of 
the  drug  allege  that  the  pains  incident  to  the 
affection  are  lessened,  particularly  the  muscu- 
lar pains  and  the  headache.  Sleep  is  procured 
by  the  administration  of  salipyrine,  and  the 
patient's  general  well-being  is  furthered.  Upon 
the  bronchial  disturbances  which  are  usually 
part  of  the  disease  this  medicament  has  no 
favourable  action. 

In  cases  of  metrorrhagia  and  menorrhagia 
salipyrine  has  been  praised  as  being  preferable 
to  ergot  (Orthraann,  Deutsche  klin.  Woeh., 
1895,  No.  7).  It  has  a  favourable  influence  in 
those  cases  of  profuse  menstruation  which  are 
dependent  upon  the  climacteric  and  in  patients 
in  whom  marked  pathological  changes  can  not 
be  demonstrated.  The  nature  of  this  action, 
whether  oxytocic  or  dependent  upon  some 
hicmic  changes,  has  not  been  determined.  It 
is  safe,  however,  not  to  place  too  much  reliance 
upon  uncorroborated  evidence  of  this  nature 
as  to  the  influence  of  drugs  which  have  been  in 
the  market  for  only  a  short  time.  Proof  exists 
that  salipyrine  is  quite  efficient  in  allaying  the 
symptoms  of  fever  and  pain,  and,  through  one 
of  its  component  parts,  those  of  the  rheumatic 
affections.  Benefit  from  its  use  is  alleged  to 
have  been  obtained  in  a  great  variety  of  other 
conditions,  but  the  testimony  of  one  observer 
is  not  sufficiently  strong  to  induce  one  to 
throw  aside  older  and  well-tried  medicines. 
A  longer  time  must  elapse  before  a  correct 
judgment  as  to  the  virtues  of  salipyrine  can 
be  given. 

The  dose  of  salipyrine  varies  with  the  con- 
dition for  which  it  is  administered.  When 
given  as  an  antipyretic,  an  average  dose  is 
from  15  to  30  grains,  depending  upon  the 
height  of  the  temperature.  The  larger  the 
dose,  the  more  permanent  and  stronger  the 
thermolysis.  For  acute  articular  rheumatism, 
15  grains  may  be  given  at  hourly  intervals 
until  3  drachms  have  been  taken.  The  chronic 
forms  of  rheumatism  require  larger  and  longer 
continued  doses.  For  neura.lgia,  15  grains  is 
an  average  dose,  though  8  grains  may  accom- 
plish the  same  result.  In  the  treatment  of  in- 
fluenza, 15  grains,  three  times  daily,  is  an 
average  dose  which  seems  to  accomplish  the 
purpose  of  its  administration.  Salipyrine  may 
be  given  in  the  form  of  powder,  in  wafers,  or  in 
capsules,  or  it  may  be  taken  in  a  mixture  con- 
taining glycerin  to  hold  it  in  suspension. 

Samuel  M.  Briokneb. 

SALITHYMOL,  described  as  a  thymol 
ester  of  salicylic  acid, 

occurring  as  a  sweetish  crystalline  powder,  in- 
soluble in  water,  but  readily  soluble  in  alcohol 
and  in  ether,  has  been  recommended  as  an 
antiseptic,  but  it  is  advisable  not  to  make  use 


of  it  in  practice  until  further  reports  of  expe- 
rience with  it  have  been  made. 

SALIVIN.— See  Ptyalin. 

SALIX. — Several  species  of  willow  have 
been  used  in  medicine.  The  bark  of  the  white 
willow,  Salix  alba,  was  formerly  official.  It  is 
Utter  and  feebly  tonic.  The  catkins,  leaves, 
and  shoots  of  the  weeping  willow,  Salix  baby- 
lonica,  are  also  tonic  and  have  been  reputed  an- 
thelminthic.  The  bark  of  the  North  American 
black  willow,  or  pussy  willow,  isalix  nigra,  es- 
pecially the  root-bark,  is  also  a  bitter  tonic. 
It  is  said  also  to  be  a  powerful  antaphrodisiac 
and  sedative  to  the  sexual  organs,  to  be  pre- 
ferred to  the  bromides,  for  the  reason  that  it 
has  no  depressing  effect,  in  spermatorrhma, 
prostaiorrhcea,  ovarian  hyperaisthesia,  dysmen- 
orrhcea,  and  uterine  neuralgia.  As  it  is  not 
recognised  in  the  pharmacopoeias,  there  are  no 
official  preparations ;  an  English  firm,  how- 
ever, Messrs.  Christy  &  Co.,  of  London,  make 
a  fluid  extract  (said  to  have  a  rough  and  very 
persistent  astringent  taste)  the  dose  of  which 
is  from  -J  to  1  fl.  drachm,  and  a  cordial  (known 
as  salix  nigra  cordial)  which  may  be  given  in 
doses  of  from  2  to  4  fl.  drachms  {Brit.  Med. 
Jour.,  March  24,  1888).  All  the  species  con- 
tain salicin  (q.  v.). 

SALOCOLL. — This  is  the  trade  name  of 
phenocoll  salicylate.  It  is  used  in  doses  of 
from  10  to  15  grains  for  the  same  purposes  as 
phenocoll. 

SALOL  (U.  S.  Ph.),  salolum  (Ger.  Ph.), 
CbHsCtIIsOs,  is  a  salicylic  phenol  ether,  and 
probably  not,  as  is  commonly  stated,  a  true 
salicylate  of  phenol.  It  consists  of  60  parts  of 
salicylic  acid  and  40  of  carbolic  acid.  It  oc- 
curs as  a  white  powder  having  a  crystalline 
structure  with  a  faint  odour  resembling  that 
of  carbolic  acid,  but  without  taste.  It  is  to- 
tally insoluble  in  water,  but  freely  soluble  in 
alcohol,  in  ether,  and  in  the  fixed  and  volatile 
oils. 

Locally,  it  acts  as  an  antiseptic,  like  iodo- 
form, in  preventing  the  growth  of  bacteria, 
but  not  destroying  them  when  present.  It  is 
commonly  believed  that  when  salol  is  taken 
internally  it  is  not  digested  by  the  gastric 
juice.  While  there  seems  to  be  doubt  as  to 
the  truth  of  this  assertion,  it  is  a  fact  that  it  is 
chiefly  acted  upon  by  the  pancreatic  juice. 
Irritation  of  the  stomach  is  very  rarely  ob- 
served, which  would  seem  to  show  that  no  car- 
bolic acid  is  liberated  in  that  organ.  Its 
therapeutic  value  seems  to  depend  upon  the 
fact  that  in  the  intestinal  canal  it  is  decom- 
posed into  its  constituent  elements — salicylic 
acid  and  carbolic  acid.  It  is  excreted  by  the 
kidneys.  When  large  doses  are  given,  the 
urine  assumes  the  same  dark,  smoky  hue  which 
appears  when  carbolicacidis  being  administered. 
Salol  has  been  proved  to  have  a  decided  disin- 
fecting power  upon  the  urine.  In  large  doses 
it  has  a  very  marked  antipyretic  action,  which  ' 
occurs  suddenly  from  fifteen  to  twenty  minutes 
after  the  drug  has  been  given,  and  "is  accom- 
panied by  profuse  sweating;  Unlike  what  oc- 
curs after  the  use  of  many  other  antipyretics, 
the  rise  of  temperature  at  the  end  oi  the  pe- 


SALOPHENB 


150 


riod  of  apyrexia  is  not  marked  by  a  rigour.  Sa- 
id possesses  also  decided  analgetic  properties. 
They  are  most  marked  in  cases  of  pain  which 
are  due  to  rheumatism. 

A  review  of  the  physiological  properties  of 
salol  furnishes  a  key  to  its  therapeutic  uses. 
It  was  first  introduced  as  a  substitute  for  sali- 
cylic acid  and  the  salicylates.  Its  advantages 
over  these  drugs  are  its  tastelessness,  the  ease 
of  its  administration,  and  its  freedom  from 
causing  unpleasant  symptoms.  It  unquestion- 
ably has  a  most  decided  power  over  the  pain 
and  fever  of  rheumatism.  It  does  not  prevent 
cardiac  complications,  and,  unless  its  use  is 
continued  after  the  symptoms  are  relieved,  re- 
lapses are  apt  to  follow.  In  that  large  class  of 
diseases  designated  by  such  names  as  muscular 
rheumatism,  myalgia,  and  lumbago,  which  are 
marked  by  more  or  less  acute  and  localized 
pain  or  by  vague  and  uncertain  pains  and  sore- 
ness of  the  muscles,  salol  is  a  most  valuable 
remedy,  but,  after  full  trial,  it  does  not  seem 
to  be  regarded  by  the  best  observers  as  equal 
to  salicylate  of  sodium  in  acute  rheumatism. 

In  migraine,  the  various  forms  of  neuritis, 
and  the  pains  of  locomotor  ataxia,  salol  some- 
times shows  a  remarkable  power  of  affording 
relief. 

In  intestinal  catarrh,  especially  when  the 
duodenum  is  involved,  in  catarrh  of  the  bile 
ducts,  and  m  jaundice,  salol  has  been  found  to 
be  a  remedy  of  decided  value.  It  is  alleged 
that  in  hepatic  catarrh  with  a  tendency  to  in- 
spissation  of  the  bile,  it  also  acts  most  effi- 
ciently by  rendering  the  bile  more  fluid,  and 
thus  dissolving  hardened  masses.  In  diar- 
rhma,  especially  the  so-called  summer  diar- 
rhoeas of  children,  salol  has  come  to  be  largely 
used  arid  sometimes  proves  of  the  greatest 
value.  When  the  stools  are  foetid  and  of  bad 
odour,  the  use  of  salol  in  the  treatment  has  a 
most  satisfactory  effect,  the  drug  acting  ap- 
parently as  an  antiseptic.  It  may  be  added  to 
the  regular  bismuth  or  other  diarrhoea  mix- 
ture. 

In  diseases  of  the  urinary  tract  salol  has 
proved  to  be  a  drug  of  the  utmost  value.  This 
would  readily  be  inferred  from  the  fact  that  it 
is  excreted  by  the  kidneys.  In  pyelitis,  cysti- 
tis, or  urethritis  it  may  be  given  with  great 
advantage,  as  it  does  much  to  render  the  urine 
antiseptic  and  unirritating.  Its  value  in  these 
conditions  is  almost  universally  conceded  by 
authorities  upon  genito-urinary  diseases. 

Salol  has  been  a  favourite  drug  in  the  treat- 
ment of  simple  influenza  and  of  the  grippe. 
As  commonly  combined  with  phenacetine  or 
acetanilide,  it  has  a  marked  effect  in  relieving 
the  pains  and  discomforts  of  these  disorders. 

KecentJy  salol  has  been  considerably  used  as 
an  antiseptic  dressing  for  sores  and  ulcers.  It 
is  sometimes  used  as  a  dusting  powder  in- 
stead of  iodoform,  its  lack  of  odour  making  it 
far  more  agreeable  than  that  preparation.  It 
is  also  sometimes  mixed  with  oil,  balsam,  or 
ointment. 

The  dose  of  salol  varies  greatly  with  the  case 
and  with  the  purpose  for  which  it  is  used.  In 
rheumatism  and  as  an  antipyretic  the  dose 
ranges  from  15  to  30  grains,  but  it  has  been 


given  in  doses  of  60  grains.  In  so-called  mus- 
cular rheumatism,  in  influenza,  and  in  ipi- 
graine  it  is  given  in  doses  of  from  4  to  8  grains 
from  three  to  five  times  a  day.  In  cystitis  5 
grains  are  commonly  given  every  three  to  six 
hours.  In  diarrhoea  5  grains  are  usually 
given,  children  of  one  year  receiving  1  or  2 
grains. 

[Colombini  (Riforma  medica  :  3ied.  Record, 
February  15,  1896)  has  found  salol  dissolved  in 
liquid  vaseline  a  very  useful  and  unirritating 
antiseptic  application  for  ulcers.  Reynier 
{Jour,  des  praticiens,  April  4,  1896 ;  N,  Y. 
Med.  Jour.,  April  25,  1896)  has  employed  salol 
as  an  antiseptic  dressing  after  operations  for 
tuberculous  disease  of  bone.  This  dressing 
consists  of  salol  liquefied  at  a  temperature  of 
104°  P.  and  mixed  with  naphthol,  aristol,  and 
iodoform.  After  trephining  of  the  bone  and 
cleansing  of  the  tuberculous  region,  the  cavity 
is  filled  with  the  melted  salol,  and  a  complete 
and  aseptic  occlusion  is  obtained.  Further- 
more, union  by  first  intention  of  the  sub-adja- 
cent skin  may  be  effected  with  this  method  of 
closure,  which  is  similar  to  plugging  of  the  teeth. 
M.  Reynier  states  that  he  has  operated  on  six 
patients  and  employed  this  dressing,  with  the 
result  that  he  has  obtained  a  rapid  recovery  in 
a  few  days  after  filling  the  osseous  cavity  with 
this  antiseptic  mixture,  and  that  immediate 
union  of  the  skin  and  the  subcutaneous  con- 
nective tissue  has  taken  place. 

A  mixture  of  salol  and  antipyrine  has  proved 
a  very  eEficient  application  in  the  treatment  of 
uterine  hmmorrhage.  Berman  {Allg.  Wiener 
med.  Ztg.,  1895,  ISfo.  35;  Ctrlbl.  f.  Gyn&k., 
March  15,  1896)  gives  the  following  account  of 
Labadie-Lagrave's  method  of  using  it :  Equal 
quantities  of  the  two  drugs  are  heated  together 
in  a  test  tube  over  a  lamp  until  a  deep-brown 
mixture  forms.  As  soon  as  this  has  cooled 
sufficiently,  a  film  of  cotton  on  an  applicator 
is  dipped  into  it  and  passed  into  the  uterine 
cavity.  This  is  done  two  or  three  times  in 
succession.  The  procedure  is  said  to  be  pain- 
less and  not  to  be  followed  by  unpleasant 
effects.  It  is  said  also  that  a  second  resort  to 
it  is  rarely  necessary.  Labadie-Lagrave  has 
been  using  it  since  the  year  1893,  and  with  bet- 
ter results  than  with  any  other  method.  In 
cases  of  fungous  endometritis  the  application 
should  be  made  after  curetting.  It  is  not  only 
hffimostatio,  but  also  antiseptic,  and  tends  to 
prevent  a  relapse. 

Camphorated  Salol. — In  a  report  on  derma- 
tology. Dr.  John  T.  Bowen,  of  Boston  (Boston 
Med.  and  Surg.  Jour.,  September  19,  1895),  re- 
marks that  Elsenberg  has  used  this  prepara- 
tion in  various  cutaneous  affections  for  two 
years,  and  has  found  it  of  special  value  in  fur- 
uncles  and  carbuncles.  It  is  prepared  by 
moistening  1  part  of  camphor  with  a  few  drops 
of  alcohol,  and  rubbing  this  in  a  porcelain 
mortar  with  1'4  part  of  salol  until  a  trans- 
parent liquid  is  obtained.  When  the  liquid 
has  been  apfilied  from  twelve  to  twenty-four 
hours  the  pain  diminishes;  the  redness  and  in- 
flammation of  the  adjoining  parts  disappear, 
and  the  tumour  becomes  progressively  smaller, 
without  the  formation  of  pus.    As  a  rule,  the 


151 


SALOPHENE 


secretion  obtained  from  the  vesicle  at  the  point 
of  the  furuncle  yields  a  pure  culture  of  the 
Staphylococcus  aureus  on  nutrient  media,  as 
do  also  bits  of  the  infiltrated  tissue.  After 
camphorated  salol  has  been  used  for  twenty- 
four  hours,  no  such  cultures  can  be  obtained. 
When  suppuration  has  already  taken  place  in 
the  furuncle,  and  after  the  slough  has  been  re- 
moved, the  pain  and  hyperiemia  may  be  much 
lessened  and  the  suppuration  diminished  by 
the  application  of  the  camphorated  salol.  The 
healing  process  then  advances  quickly,  a  slight 
discoloration,  and  some  infiltration  being  felt 
only  for  a  short  time.  The  method  of  using 
the  drug  is  to  lay  bare  the  point  of  the  fur- 
uncle, or,  in  the  case  of  carbuncle,  to  make 
several  moderately  deep  incisions,  in  order  to 
facilitate  the  penetration  of  the  mixture  into 
the  infiltration  ;  afterward  the  lesion  and  the 
surrounding  hypersEinic  parts  are  covered  with 
cotton  compresses  soaked  in  camphorated  sa- 
lol, and  an  impermeable  covering  is  placed  over 
it.] — Floyd  M.  Ceandall. 

SALOPHENE,  or  salophen,  is  chemically 
a  salicylate  of  amidophenol.  It  is  a  derivative 
of  salol  and  contains  50'9  per  cent,  of  salicylic 
acid.  It  occurs  as  a  white,  odourless,  tasteless 
powder,  composed  of  small  white  lamellar 
crystals.  It  is  not  soluble  in  water,  but  is  very 
soluble  in  alcohol  and  in  ether  or  an  alkaline 
solution.  It  is  not  official. 
.  It  is  employed  as  a  substitute  for  salol  and 
salicylic  acid,  its  chief  advantage  over  salicylic 
acid  being  that  it  is  unirritating  and  tasteless, 
and  is  said  not  to  be  depressing.  It  is  indi- 
cated in  the  same  conditions  which  would 
suggest  the  use  of  the  salicylates.  In  acute 
muscular  rheumatism  it  is  alleged  to  have 
been  used  with  extremely  good  results.  It 
may  be  given  for  considerable  periods  of  time 
without  causing  nausea,  loss  of  appetite,  tin- 
nitus, or  other  unpleasant  effects  that  are 
frequently  observed  from  the  use  of  salicylic 
acid  and  its  derivatives.  In  chronic  rheuma- 
tism it  is  less  efficient  than  in  the  acute  form. 
It  is  given  with  good  results  in  migraine  and 
various  neuralgic  affection^.  Like  salol,  it  has 
been  used  as  an  intestinal  antiseptic.  It  has 
been  recently  lauded  as  efficient  in  relieving 
the  neuralgic  pains  and  headache  of  influenza. 
For  this  disease  it  is  usually  combined  with 

Ehenacetine.  At  the  present  writing  the  drug 
as  not  been  sufficiently  tested  to  warrant 
dogmatic  statements  as  to  its  true  value.  It 
is  administered  in  the  'form  of  tablet  or  pill, 
or  may  be  given  dry  on  the  tongue.  The  dose 
ranges  from  5  to  20  grains,  which  may  be  given 
from  three  to  six  times  a  day.  The  maximum 
daily  amount  should  not  be  over  1|  drachm. 

[Salophene  seems  to  have  been  introduced 
into  practice  by  Dr.  Paul  Guttmann  {Berliner 
l-lin.  Woeh.,  1891,  No.  52).  Dr.  William  H. 
Flint  (iV.  T.  Med.  Jour.,  July  30,  1892)  gives  a 
summary  of  Dr.  Guttmann's  article,  together 
with  the  following  formula, 

COO       Icoch;'  ^^^"^^  '^  '''''  '''- 

signed  to  the  drug  by  Dr.  Siebel,  of  the  Elber- 
feld  Chemical  Works.    Prom  the  fact  that  in 


the  system  salophene  was  split  up  into  sodium 
salicylate  and  acetyl  paraamidophenol.  Dr. 
Guttmann  inferred  that  it  would  be  useful  in 
the  treatment  of  rheumatism.  In  his  article 
he  reported  his  experience  with  it  in  four  cases 
of  acute  rheumatism  and  in  a  number  of  cases 
of  the  chronic  form  of  the  disease.  He  found 
that,  to  obtain  the  best  results,  as  much  as  CO 
grains  had  to  be  given  in  the  course  of  twenty- 
four  hours,  that  this  amount  might  be  in- 
creased with  advantage  to  90  grains,  and  that 
these  doses  must  be  given  daily  until  the  sub- 
sidence of  the  symptoms,  when  they  might  be 
somewhat  reduced.  Dr.  Flint  reports  six  cases 
of  acute  rheumatism  treated  in  the  Presbyterian 
Hospital,  New  York,  with  15-grain  doses  of 
salophene  eve:-y  three  hours  and  10-grain  doses 
of  sodium  bicarbonate  three  times  a  day.  In 
all  but  one  of  these  cases  the  pain  was  quite 
relieved,  the  redness  dispelled,  and  the  tem- 
perature reduced  to  the  normal  point  on  the 
second  or  third  day  of  treatment.  The  excep- 
tional case  was  that  of  a  poor  woman,  in  need 
of  an  asylum,  who  may  have  exaggerated  the 
intensity  of  her  pain  in  order  to  prolong  her 
sojourn  in  the  hospital.  In  none  of  the  cases 
was  the  heart's  action  at  all  weakened  or  the 
digestion  impaired  by  the  remedy.  In  chronic 
rheumatic  arthritis  Dr.  Flint  has  met  with 
very  poor  results  in  the  main  from  the  use  of 
salophene. 

In  the  New  York  Medical  Journal  for  May 
25,  1895,  Dr.  Bertram  H.  Waters  reports  twen- 
ty-five cases  of  acute  rheumatism  treated  with 
salophene  in  Dr.  Andrew  H.  Smith's  service  in 
the  Presbyterian  Hospital,  New  York.  In 
almost  every  case  improvement  was  rapidly 
effected,  and  the  average  length  of  time  for 
reduction  of  fever  was  six  days,  as  against 
eight  days  for  oil  of  wintergreen  and  nine  days 
for  sodium  salicylate.  No  complication  more 
serious  than  the  extension  of  the  process  to 
other  joints  was  observed.  The  average  length 
of  hospital  treatment  was,  under  salophene, 
eighteen  days;  under  oil  of  wintergreen  and 
sodium  salicylate,  each,  twenty-five  days  ap- 
proximately. These  periods  include  the  after- 
treatment  with  iron  and  tonics.  In  no  cases 
were  gastric,  renal,  or  constitutional  disturb- 
ances observed. 

Dr.  Harry  S.  Pearse,  of  Albany  (N.  Y.  Med. 
Jour.,  March  14,  1896),  reports  fourteen  cases 
of  acute  rheumatism  treated  with  salophene  in 
Bellevue  Hospital,  New  York,  in  the  services 
of  Dr.  Dana,  Dr.  Fowler,  and  Dr.  Lambert. 
Dr.  Pearse's  remarks  are  to  much  the  same 
purpose  as  Dr.  D.  B.  Hardenbergh's,  in  a  pre- 
vious report  of  the  cases  treated  in  the  same 
wards  (Med.  Record,  July  29, 1893).  Dr.  Pearse 
says  that,  according  to  Dr.  Whipman  (Report 
of  the  Collective  Investigation  Committee  of  the 
-British  Medical  Association),  in  the  treatment 
of  a  hundred  and  seventy-three  cases  with  the 
salicylates,  the  average  duration  of  fever  was 
8'65  days.  In  a  hundred  and  ninety  eases  col- 
lected by  Wardner  the  average  was  5'5  days ;  in 
a  hundred  and  fifty-six  oases  by  Owen,  3'66  days ; 
in  fifty-five  cases,  according  to  Howard,  in  Pep- 
per's .52/«<e?re  of  Medicine,  7'25  days;  in  ten  by 
Hardenbergh,  6'1 1  days,  treated  exclusively  with 


SALT.  COMMON 
SANDERS-WOOD 


153 


salophene.  According  to  Whipman,  in  a  hun- 
dred and  sixty-seven  cases  treated  with  the 
salicylates  the  average  duration  of  the  whole 
attack  was  19-03  days ;  ten  by  Hardenbergh,  who 
used  salophene,  gave  an  average  of  ten  days. 
In  Dr.  Pearse's  own  oases  the  average  was  10'2o 
days.  This  conclusion  is  perhaps  valueless,  he 
adds,  because  of  the  necessity  of  transferring 
some  of  the  patients  to  another  hospital  in 
early  convalescence  to  make  room  for  incoming 
patients.  The  average  daily  amount  given  was 
U  drachm  in  15-grain  doses  every  four  hours. 
This  could  be  continued  indefinitely  with  no 
untoward  effects.  One  patient  took  15  grains 
every  four  hours  during  the  day  for  a  month. 
With  each  15  grains  of  salophene,  15  or  20 
grains  of  bicarbonate  of  sodium  were  com- 
bined, as  advised  by  Flint  in  the  salicylate 
treatment,  for  the  reason  that  there  is  less 
probability  of  cardiac  complications  in  the 
alkaline  treatment  than  in  any  other.  There 
were  no  symptoms  of  gastric  irritation,  cardiac 
depression,  or  renal  or  cerebral  involvement  in 
any  one  of  the  salophene  cases  which  could  be 
attributed  directly  to  salophene. 

Dr.  Pearse  gives  some  data,  prepared  by  Dr. 
Charles  Rice,  the  chemist  to  the  Department 
of  Public  Charities,  from  which  it  appears  that 
from  the  year  1893  to  1895  the  amount  of  sali- 
cylic acid  employed  in  Bellevue  Hospital  rose 
from  93  to  170  pounds,  that  of  oil  of  winter- 
green  rose  from  18  to  23  pounds,  that  of  sodi- 
um salicylate  declined  from  88  to  60  pounds, 
and  that  of  salophene  rose  from  8  to  430 
ounces.  The  employment  of  salophene  in  the 
hospital,  he  says,  has  been  confined  pretty 
closely  to  cases  of  acute  rheumatism,  and  the 
increase  in  the  amount  of  the  drug  consumed 
seems  to  bear  testimony  to  its  growing  favour. 
Dr.  Richard  Drews,  of  Hamburg  (Ctrlbl,  f. 
innere  Med.,  November  23, 1895),  has  observed 
such  good  effects  of  the  use  of  salophene  in 
the  treatment  of  the  nervous  form  of  influ- 
enza that  he  does  not  hesitate  to  declare  the 
drug  a  specific  for  that  variety  of  the  disease. 
In  the  case  of  adults  severely  and  suddenly  at- 
tacked he  gives  30  grains  and  then  15  grains 
every  two  or  three  hours  until  from  75  to  90 
grains  have  been  taken  in  the  course  of  twen- 
ty-four hours;  if  the  symptoms  are  of  little 
intensity,  or  if  the  patient  is  a  weak  person,  es- 
pecially a  woman,  doses  of  from  8  to  13  grains 
every  two  or  three  hours  are  often  suflicient  to 
speedily  allay  the  various  neuralgic  pains  and 
to  cure  the  attack  entirely  in  two  or  three  days. 
To  children  he  gives  from  5  to  8  grains  at  a 
dose,  according  to  the  age — from  60  to  75 
grains  ia  twenty-four  hours.] 

Floyd  M.  Ceandall. 

SAIiT,  COMMON.— Sodium  chloride.   See 
under  Sodium. 

SALT,     CABLSBAD,    ARTIFICIAL, 

sal  carolinum  factitium  (Ger.  Ph.),  is  a  dry 
white  powder  consisting  of  32  parts  of  dried 
sodium  sulphate,  1  part  of  potassium  sulphate, 
9  parts  of  sodium  chloride,  and  18  parts  of  so- 
dium bicarbonate.  Ninety  grains  of  it,  dis- 
solved in  a  quart  of  water,  form  a  solution 
closely  resembling  the  natural  Carlsbad  water. 


Artificial  effervescent  Carlsbad  salt,  sal  caro- 
linum factitium  efervescens  (N.  F.),  is  made 
by  triturating  together  330  parts  of  artificial 
Carlsbad  salt,  630  of  sodium  bicarbonate,  560  of 
tartaric  acid,  and  390  of  sugar,  all  previously 
well  dried  and  in  fine  powder.  About  87 
grains  of  this  powder,  dissolved  in  6  oz.  of  wa- 
ter, correspond  to  the  essential  ingredients  of 
Sprudel  water.     (See  Waters,  Mineral.) 

SALT,  EPSOM. — See  Magnesium  sulphate, 
vol.  i,  page  593. 

SALT,  MONSELL'S.— Iron  subsulphate 
(see  vol.  i,  page  549). 

SALTPETRE. — See  Potassium  kitrate. 

SALT,  BOCHELLE. — See  Potassium  and 
sodium  tartrate,  under  Potassium  tartrates. 

SALTTBRINE. — This  fanciful  name  seems 
to  have  been  given  to  two  different  things,  one 
of  which  is  a  French  preparation  containing 
salicylic  acid,  used  for  preserving  articles  of 
food,  and  the  other  a  Swedish  patented  medic- 
ament consisting  of  2  parts  of  acetic  acid,  35 
of  acetic  ether,  50  of  alcohol,  and  33  of  water. 
Diluted  with  from  two  to  six  times  its  bulk  of 
water,  this  Swedish  preparation  has  been  rec- 
ommended as  an  antiseptic  and  hcemostatic, 
and  as  an  application  for  bruises,  for  muscular 
rheumatism,  and  for  certain  inflammatory  skin 
diseases.    It  has  not  come  into  use  in  America. 

SALUMIITE. — This  is  a  trade  name  for 
aluminum  salicylate,  used  as  an  astringent,  es- 
pecially by  insuflBation,  in  dry  catarrh  of  the 
nose  and  pharynx  and  in  oziena.  It  is  insolu- 
ble in  water. 

SALVES. — See  Ointments. 

SALVIA  (U.  S.  Ph.),  folia  salvim  (Ger. 
Ph.). — This  drug  consists  of  the  leaves  of  Sal- 
via officinalis,  or  common  garden  sage.  It  is 
stomachic,  aromatic,  and  slightly  tonic,  and 
has  been  used  in  the  treatment  of  atonic  dys- 
pepsia, in  doses  of  from  20  to  30  grains.  The 
volatile  oil,  which  in  overdoses  is  poisonous, 
causing  epileptoid  convulsions,  may  be  given 
in  doses  of  from  1  to  2  drops,  on  sugar,  three 
or  four  times  a  day. 

SAL  VOLATILE.— See  Ammonium  car- 
bonate. 

SAMBUCTTS.— The  samhucus  of  the  U.  S. 
Ph.  is  the  flowers  of  Sambucus  canadensis,  or 
American  elder,  which  is  closely  allied  to  the 
European  elder,  Sambucus  nigra,  that  fur- 
nishes sambuci  flores  (Br.  Ph.),  or  ilores  sam- 
buci  (Ger.  Ph.).  Elder  is  diaphoretic,  diuretic, 
and  febrifuge,  but  is  now  little  used  in  medi- 
cine. The  powdered  drug  may  be  given  in 
doses  of  3  drachms ;  the  distilled  water,  elder- 
flower  water,  agua  sambuci  (Br.  Ph.),  in  doses 
of  a  tablespoonful. 

SANDAL-WOOD.— Two  kinds  of  wood 
are  known  as  sandal-wood,  or  sannders — the 
white  or  yellow  sannders  {Santalum  album) 
and  the  red  sannders  (Santalum  rubrum).  The 
former  only  is  of  much  importance  in  medi- 
cine, chiefly  on  account  of  the  fragrant  oil  it 
contains.  The  red  sannders,  santalum  rubrum 
(U.  S.  Ph.),  pterocarpi  lignum  (Br.  Ph.),  is  em- 
ployed as  a  colouring  agent  in  certain  pharma- 


153 


SALT,  COMMON 
SANDERS-WOOD 


cal  preparations,  such  as  Tindura  lavandulcB 
composita,  and  is  also  sometimes  used  in  tootii 
powders.  It  is  the  wood  of  Pterocarpus  santa- 
linus,  indigenous  to  India,  especially  in  the 
Madras  Presidency,  and  is  cultivated  in  south- 
ern India.  In  the  shops  the  wood  is  found  in 
chips  or  in  a  coarse  irregular  powder  of  a 
brownish-red  colour,  nearly  inodorous,  and 
having  a  scarcely  perceptible  astringent  taste. 
It  imparts  its  red  colour  to  alcohol,  but  not  to 
■water. 

Santalum,  album  belongs  to  the  order  San- 
talacecB.  It  is  a  small  tree  growing  in  East 
India  and  in  some  of  the  islands  of  the  Indian 
Archipelago.  Three  varieties  of  sandal-wood 
are  distinguished  in  commerce  as  East  Indian, 
Macassan,  and  West  Indian.  The  first  is  the 
wood  iSantaliim  album,  the  second  is  probably 
that  of  some  other  species  of  santalum,  and  the 
third  is  a  wood  imported  from  Puerto  Cabello 
in  Venezuela.  Bucida  capitata,  a  combreta- 
ceous  plant,  is  also  known  in  the  West  Indies 
as  sandal-wood,  but  is  quite  distinct  in  the 
odour,  both  of  the  wood  and  of  the  oil,  from 
true  sandal-wood.  In  India,  where  in  certain 
sections  the  production  is  under  government 
control,  the  trees  are  felled  after  they  have 
attained  an  age  of  twenty  or  thirty  years  and 
are  allowed  to  remain  on  the  ground  for  sev- 
eral months,  till  the  white  ants  have  eaten 
away  the  sapwood,  which  is  valueless,  leaving 
the  fragrant  heart-wood  untouched.  The 
trunks  are  then  sawed  into  billets  from  3  to  3J 
feet  long.  The  best,  or  "  yellow,"  wood,  which 
is  the  richest  in  oil,  comes  from  trees  that  have 
grown  slowly  in  dry  and  rocky  soils,  which  are 
favourable  to  the  development  of  the  duramen. 
Its  colour  is  yellowish  brown.  The  "  white  " 
wood  is  from  trees  that  have  grown  more  rap- 
idly in  alluvial  lands.  It  is  inferior  in  quality 
to  the  yellow.  Sandal-wood  is  hard  and  heavy, 
splits  easily,  and  when  cut  transversely  shows  a 
somewhat  waxy  lustre  with  irregular  concen- 
tric zones  alternately  lighter  and  darker  in 
colour.  When  rubbed  or  rasped  it  emits  an 
agreeable  odour  "  suggestive  of  rose,  musk,  and 
lemon."  To  the  taste  it  is  aromatic,  bitterish, 
and  slightly  acrid. 

The  oil,  oleum  santali  (U.  S.  Ph.,  Br.  Ph.),  is 
obtained  by  distillation,  usually,  from  chips  of 
the  wood  and  from  its  roots.  It  is  a  thick  oil 
of  a  light  amber  colour  and  has  the  character- 
istic odour  of  the  wood.  The  taste  is  at  first 
sweet,  later  sharp  and  bitter.  It  is  insoluble 
in  water  but  imparts  its  odour  to  it.  It  dis- 
solves in  alcohol  and  in  ether.  It  is  very  often 
adulterated  with  copaiba  and  castor  oil. 

Although  in  ancient  times  it  was  employed 
medicinally  by  the  Arabs  and  Hindus,  san- 
dal-wood oil  has  been  used  in  modern  times 
only  since  a  comparatively  recent  date.  In 
1865  Henderson,  of  Glasgow,  introduced  its 
use  into  Great  Britain  as  a  remedy  for  gonor- 
rhwa,  and  it  is  for  this  disease  that  it  is  now 
chiefly  employed.  Its  therapeutic  properties 
are  those  of  the  balsamic  and  terebmtninate 
remedies  generally,  and  are  chiefly  shown  in 
controlling  excessive  secretions  from  the  mu- 
cous membranes.  When  taken  internally  it  is 
eliminated  by  the  respiratory  and  urinary  or- 


gans, as  is  shown  by  the  odour,  which  is  also 
sometimes  perceptible  in  the  transpiration 
from  the  skin.  It  causes  no  cutaneous  erup- 
tions, unlike  copaiba,  and  is  less  apt  to  pro- 
duce gastric  or  intestinal  disturbance  than  the 
latter  remedy.  It  is  believed  to  have  some 
stimulant  effect  on  the  organs  of  digestion. 
To  some  patients,  however,  the  taste  is  so  ob- 
jectionable that  its  use  can  not  be  long  con- 
tinued. 

In  gonorrhoea  it  was  at  first  vaunted  as  a 
remedy  in  every  way  superior  to  copaiba.  It 
was  recommended  to  be  used  early  in  the  dis- 
ease and  was  supposed  to  be  capable  of  arrest- 
ing the  discharge  in  a  few  days.  Some  have 
maintained  that  it  acted  by  rendering  the  af- 
fected mucous  membrane  aseptic.  The  gen- 
eral opinion  now  is  that,  while  it  is  more  apt 
to  be  tolerated  than  copaiba,  it  is  no  more  eifi- 
oacious  in  gonorrhoea  than  the  latter.  Indeed, 
many  regard  both  copaiba  and  cubeb  as  slightly 
more  efficacious  than  sandal-wood  oil.  As  re- 
gards the  period  of  the  disease  at  which  its  use 
is  indicated,  the  same  rule  applies  to  this  drug 
as  to  the  otlier  balsamics.  It  should  never  be 
administered  until  after  the  acute  manifesta- 
tions of  the  disease  have  passed. 

In  bronchial  affections  its  use  was  suggested 
from  the  fact  of  its  elimination  through  the 
organs  of  respiration.  In  bronchitis  with  abun- 
dant secretion  and  in  asthma  it  is  said  to  be  a 
remedy  of  considerable  value. 

In  diarrhoea  due  to  a  persistent  catarrhal 
state  of  the  intestinal  mucous  membrane  it  has 
also  been  recommended. 

The  oil  is  best  administered  in  capsules  con- 
taining usually  from  5  to  10  drops.  In  gonor- 
rhoea the  dose  is  from  10  to  20  drops  three 
times  a  day.  In  the  liquid  form  the  taste  is 
best  disguised  by  cinnamon,  as  in  the  follow- 
ing: 

5  Oil  of  sandal- wood -J  fl.  oz. ; 

Dilute  alcohol 2^     " 

Oil  of  cinnamon 25  minims. 

Sig. :  1  or  2  teaspoonf  uls  two  or  three  times 
a  day. 

Often  it  is  combined  with  copaiba,  with 
oleoresin  of  cubeb,  or  with  matico.  The  fol- 
lowing is  recommended  as  "  a  peculiarly  effect- 
ive combination,"  though  sometimes  disturbuig 
to  the  stomach : 

5  Balsam  of  copaiba,  )       ,         i  fl  n7  • 
Sandal-wood  oil,      f  ^^°^-  •■  *  "•  °2  , 

Liquor  potassse 6  fl.  drachms ; 

Syrup  of  orange  peel 2  fl.  oz ; 

Water,  enough  to  make 4  fl.  oz. 

M.  S. :  A  teaspoonful  three  or  four  times  a 
day  in  a  wineglass  of  water. 

Edward  Bennet  Beonson. 

SANDABAC  is  a  resinous  body  derived 
from  Callitris  quadrivalvis,  a  tropical  and 
semitropical  evergreen,  formerly  used  in  medi- 
cine and  in  pharmacy  in  the  preparation  of 
plasters  and  ointments.  It  is  of  little  medic- 
inal importance  and  is  employed  chiefly  in  the 
arts,  in  the  preparation  of  varnishes,  etc. 

SANDERS-WOOD.— See  Sandal-wood. 


SANGUINAL 
SAPONARIA 


154 


SANGTJIITAL.  —  This  is  a  proprietary 
preparation  made  by  defibriiiating  fresh  bul- 
lock's blood  and  evaporating  it  to  a  pilular  con- 
sistence. Dr.  Otto  Dornbluth,  of  Rostock 
(Dtsch.  Med.-Ztg.,  January  16, 1896 ;  N.  Y.  Med. 
Jour.,  February  8,  1896),  gives  his  experience 
with  a  preparation  called  sanguinal,  made  by  a 
Cologne  firm  of  apothecaries,  who  say  that  it  is 
composed  of  46  per  cent,  of  the  salts  normally 
found  in  the  blood,  44  per  cent,  of  muscle  albu- 
min, and  10  per  cent,  of  haemoglobin,  and 
therefore  corresponds  almost  perfectly  to  nor- 
mal blood  in  composition.  Dr.  Dornbluth 
says  that,  although  he  has  not  lost  confidence 
in  the  old  inorganic  preparations  of  iron,  he 
often  observes  eases  of  debility  with  nervous 
symptoms  manifestly  due  to  a  defective  consti- 
tution of  the  blood  in  which  those  preparations 
of  iron  fail  altogether  or  at  least  do  far  less 
good  than  in  chlorosis.  In  many  such  cases 
he  has  found  that  the  effects  of  sanguinal  were 
surprising ;  in  numerous  cases,  ranging  from 
the  slightest  nervousness  up  to  the  severest 
forms  of  neurasthenia,  in  which  the  previous 
use  of  all  sorts  of  preparations  of  iron  had 
been  unavailing,  the  use  of  sanguinal  speedily 
brought  about  an  improved  condition,  mani- 
fested by  a  blooming  appearance,  a  decided 
feeling  of  well-being,  and  a  good  appetite. 
The  dose  of  sanguinal  he  gives  as  three  pills, 
three  times  a  day,  preferably  taken  before 
meals.  He  does  not  state  how  much  sanguinal 
each  pill  contains,  so  it  may  be  presumed  that 
the  drug  is  in  the  German  market  in  the  form 
of  pills  of  a  certain  weight. 

SANGUINARIA  (U.  S.  Ph.),  or  blood- 
root,  the  rhizome  of  Sanguinaria  canadensis, 
for  a  long  time  has  played  an  important  part 
in  domestic  and  irregular  practice,  but  it  was 
not  until  within  a  relatively  recent  period  that 
its  value  was  fully  recognised  by  regular  prac- 
titioners. In  small  doses,  it  increases  the  se- 
cretions of  the  liver  and  intestines  and  acts  as 
an  emmenagogue  and  stimulant  expectorant; 
in  larger  doses,  it  is  em,etic,  and  in  improper 
amounts  it  is  a  depressant  narcotic.  It  also 
may  be  regarded  as  alterative,  and  may  be  ad- 
vantageously employed  in  scrofula,  syphilis, 
and  other  conditions  in  which  such  a  remedy 
is  indicated.  Externally,  it  and  its  prepara- 
tions are  stimulant  and  escharotic,  and  may  be 
employed  to  stimulate  unhealthy  surfaces  and 
to  destroy  exuberant  granulations,  but  for 
these  purposes  it  is  ordinarily  not  so  conven- 
ient as  other  agents.  In  all  forms  of  gastro- 
duodenal  catarrh  and  the  jaundice  due  to  it, 
sanguinaria  is  very  useful,  as  well  on  account 
of  its  specific  effect  upon  the  liver  and  intes- 
tines as  by  its  action  as  a  slight  stimulant  of 
the  gastric  mucous  membrane. 

Amenorrhcaa  of  an  atonic  nature,  in  which 
the  pelvic  organs  appear  to  be  anajmio  rather 
than  congested,  or  that  of  chlorotic  girls,  may 
be  advantageously  treated  with  it,  but  it  is 
better  to  use  aloes  or  iron  or  both  at  the  same 
time,  as  such  a  combination  appears  to  be 
rather  more  active  than  any  one  of  the  drugs 
by  itself. 

[In  addition  to  its  emmenagogue  properties, 


sanguinaria  is  said  to  be  decidedly  abortifa- 
cient;  therefore  it  should  be  employed  only 
with  great  caution  in  pregnant  women.] 

Increasing,  as  it  appears  to,  the  amount  of 
blood  circulating  through  the  pelvic  organs,  it 
has  been  suggested  as  an  aphrodisiac  when  the 
erections  are  feeble  and  diurnal  pollution  ex- 
ists, and  its  employment  has  been  followed  in 
many  cases  with  sufficiently  good  results  to 
warrant  its  trial  in  such  forms  of  impotence. 
As  a  stimulant  expectorant,  with  slight  nause- 
ating effects,  it  is  very  useful  in  the  later  stages 
of  acute  bronchitis,  and  in  some  cases  of  asth- 
ma it  appears  to  be  of  value.  Chronic  nasal 
catarrh  is  sometimes  improved  by  the  insuifia- 
tion  of  small  quantities  of  the  powder  con- 
joined with  the  internal  administration  of  one 
or  another  of  the  preparations  of  sanguinaria. 

Although  it  is  emetic,  its  use  to  produce 
vomiting  should  be  avoided,  as  it  is  very  de- 
pressing and  apt  to  excite  more  or  less  irrita- 
tion of  the  gastric  mucous  membrane. 

All  the  properties  of  the  official  sanguinaria 
are  contained  in  an  unofficial  alkaloid,  san- 
guinarine.  Nitrate  of  sanguinarine  may  be 
given  as  an  emmenagogue,  aphrodisiac,  expec- 
torant, or  alterative  in  doses  of  ^  of  a  grain,  or 
as  an  emetic  in  doses  of  J  of  a  grain.  The  dose 
of  the  tincture,  tinctura  sanginarice.  (U.  S. 
Ph.),  is  from  30  to  60  minims ;  that  of  the  fluid 
extract,  extractum  sanguinarice  fluidum  (U.  S. 
Ph.),  is  from  3  to  5  minims.  The  dose  of  the 
drug  itself  is  from  1  to  5  grains,  but  the  pow- 
der is  rarely  employed.  A  weak  decoction  has 
been  used  as  a  gargle  in  sore  throat,  particu- 
larly in  that  of  scarlet  fever. 

Russell  H.  Nevixs. 

SANGUINARINE.— See  under  Sakguin- 

AKIA. 

SANGUIS.— See  Blood. 

SANOPORM.— Dr.  Alfred  Arnheim,  of 
Berlin  (Allg.  med.  Gtrlztg.,  1896,  No.  37 ;  Disch. 
Med.-Ztg.,  May  14,  1896;  N.  Y.  Med.  Jour., 
May  30, 1896),  says  that  sanoform  was  brought 
into  notice  by  Courant  and  Gallinek  in  1895, 
and  has  been  experimented  with  by  Lohn- 
stein.  Chemically,  it  is  said  to  be  a  diiodo- 
salicylic-acid  methyl  ether  having  the  formula 

/COOCH3 
CsHs^OH  .    It  contains  63-7  per  cent,  of 

iodine  and  occurs  in  white  needles  that  are 
entirely  odourless  and  tasteless.  It  is  moder- 
ately soluble  in  alcohol  and  readily  soluble  in 
ether  and  in  vaseline,  so  that  it  is  suitable  for 
use  in  medicating  gauze,  collodion,  and  vase- 
line. Its  melting  point  is  above  the  tempera- 
ture required  for  sterilizing  gauze.  It  is  said 
to  be  not  at  all  poisonous.  The  author  men- 
tions its  having  been  used  as  a  substitute  for 
iodoform,  in  seventy-two  cases,  consisting  of 
twenty-two  of  soft  chancre,  twenty  of  hard 
chancre  (sometimes  together  with  mercurial 
treatment,  sometimes  before  it),  six  of  bubo, 
sixteen  of  phimosis,  three  of  wounds  from  the 
excision  of  ulcers,  and  five  of  paronychia  or 
the  after-treatment  of  open  abscesses.  The 
pure  powder  was  dusted  on  to  the  ulcerous 
surfaces,  and  after  the  suppuration  had  been 


155 


SANGUINAL 
SAPONARIA 


checked  a  10-per-cent.  ointment  was  applied. 
The  same  course  was  followed  in  the  treatment 
of  fresh  wounds.  In  general,  the  improvement 
was  comparatively  rapid.  In  a  few  of  the  cases 
of  soft  chancre,  and  especially  in  almost  all  of 
those  in  which  the  prepuce  had  to  be  out,  the 
rapidity  of  the  healing  process  was  striking. 
There  were  instances,  however,  in  which  the 
morbid  condition  followed  its  usual  course  of 
two,  three,  or  four  weeks.  Sanoform,  says  Dr. 
Arnheim,  is  inferior  to  iodoform  as  a.  healing 
agent,  but  has  the  advantages  of  its  freedom 
from  odour  and  its  perfectly  non-poisonous 
character.  It  is  not  more  expensive  than  iodo- 
form. It  is  madri  at  the  Hochst  dye-works  for- 
merly known  as  Meister,  Lucius,  &  Briining's. 

SANTAIiUM  RUBBXTM  (U.  S.  Ph.), 
SANTAL-WOOD.— See  Sandal- wood. 

SANTONICA  (U.  S.  Ph.,  Br.  Ph.),  or  Le- 
vant wormseed,  is  the  dried  unexpanded  flow- 
er heads  of  Artemisia  pauciflora.  Flores  cinm 
(Ger.  Ph.)  are  the  flower  heads  of  a  Turkestan 
variety  of  Artemisia  maritima.  Both  san- 
tonica  axid  flores  cinae,  were  formerly  employed 
in  doses  of  from  10  to  30  grains  in  the  treat- 
ment of  ascarides,  but  they  have  now  been 
superseded  by  their  active  principle.  Santonin, 
the  Santoninum  of  the  pharmacopoeias,  on  ac- 
count of  the  smaller  dose  necessary  and  its 
definite  composition. 

Santonin  occurs  in  flattened  crystals,  nor- 
mally colourless,  but  yellowish  after  exposure 
to  the  light  and  air,  and  practically  insoluble 
in  the  ordinary  menstrua.  It  is  best  adminis- 
tered combined  with  sugar.  Ordinarily  it  im- 
parts an  orange  hue  to  the  urine,  and  large, 
but  not  necessarily  dangerous,  doses  may  give 
rise  to  headache  and  slight  dizziness,  and  affect 
the  vision  so  that  objects  appear  yellowish  or 
greenish.  In  overdoses  it  may  cause  vertigo, 
tetanoid  spasms,  vomiting,  cold  sweats,  chill- 
ing of  the  surface  of  the  body,  loss  of  con- 
sciousness, and  failure  of  the  respiration.  No 
special  rules  for  the  treatment  of  cases  of  poi- 
soning can  be  laid  down,  as  there  is  no  physi- 
ological antidote  to  its  action,  and  urgent 
symptoms  must  be  combated  on  general  prin- 
ciples. 

To  obtain  the  maximum  efliciency  of  this 
remedy  against  the  Ascaris  lumbricoides,  it  is 
desirable  to  combine  it  with  castor  oil  or  to 
administer  the  latter  shortly  after  its  use.  Not 
so  desirable,  but  yet  fairly  useful,  an  adjuvant 
is  calomel  in  ordinary  cathartic  doses.  The 
commonest  form  of  its  administration  is  that 
of  a  troche.  The  trochischi  santonini  of  the 
V.  S.  Ph.  contain  i  a  grain  each  of  santonin, 
while  those  of  the  Br.  Ph.  are  of  double  that 
strength,  and  those  of  the  Ger.  Ph.  contain 
each  only  J  of  a  grain.  In  whatever  form  it  is 
employed,  the  dose  must  be  given  in  the  morn- 
ing after  the  precautions  noted  in  the  article  on 
Anthelminthics  have  been  observed,  and  fol- 
lowed by  a  cathartic,  unless  it  has  been  given 
combined  with  one.  Under  ordinary  circum- 
stances it  is  proper  to  repeat  the  dose  for  three 
successive  mornings.  If  it  is  so  desired,  a 
troche  may  be  given  to  young  children  three 
or  four  times  a  day,  and  usually  there  is  little 
54 


difficulty  in  inducing  them  to  eat  it.  Supposi- 
tories containing  from  2  to  3  grains  of  san- 
tonin are  sometimes  used  in  the  treatment  of 
threadworms,  but  are  not  so  efficient  as  other 
measures.  In  tobacco  amaurosis  and  other 
functional  forms  of  amaurosis  santonin  has 
been  employed  with  reported  good  results,  also 
in  amenorrhcea  of  the  aoEemic  type.  Nocturnal 
incontinence  of  urine  in  children  has  been  re- 
lieved by  small  doses  when  other  remedies  had 
failed,  but  the  cases  in  which  it  will  prove  use- 
ful can  not  be  distinguished  from  those  in 
which  it  will  fail.  The  usual  dose  for  an  adult 
is  from  3  to  4  grains,  and  for  a  young  child 
from  J  to  -J-  a  grain. 

Sodium  santoninate  has  been  employed  for 
the  same  purposes  as  santonin,  but  is  improper 
to  use,  as  it  is  soluble  and  readily  absorbed. 
Moreover,  considering  the  ease  with  which 
santonin  may  be  administered,  there  is  little 
or  no  reason  why  more  dangerous  prepara- 
tions should  be  employed.  Gingerbread,  bis- 
cuits and  similar  articles  may  have  santonin 
incorporated  with  them  if  it  is  desired,  but 
they  are  not  to  be  recommended  except  in  the 
case  of  very  young  children  to  whom  it  is  dif- 
ficult to  administer  medicine. 

The  roundworms  so  common  among  dogs 
may  be  expelled  by  2-  to  3-grain  doses,  which 
can  be  mixed  with  the  food  or  administered 
in  a  bolus. — Russell  H.  Nevins. 

SANTONIN. — See  under  Santonioa. 

SANTONINOXIME,  CsH.bO^.NOH,  is 
obtained  by  treating  5  parts  of  santonin  with 
4  parts  of  hydroxylammonium  chloride  and 
50  parts  of  90-per-cent.  alcohol,  with  the  addi- 
tion of  from  3  to  4  parts  of  calcium  carbonate, 
boiling  for  six  or  seven  hours,  and  adding  to 
the  mixture  from  4  to  5  times  its  bulk  of  water 
heated  almost  to  boiling,  whereupon  the  san- 
toninoxime  separates  in  the  form  of  white 
needles.  It  is  insoluble  in  ordinary  menstrua. 
It  has  been  recommended  as  a  substitute  for 
santonin  as  an  anthelminthic,  on  the  ground 
that  it  does  not  give  rise  to  poisoning.  It  re- 
quires to  be  given  in  larger  amounts  than  san- 
tonin— f  of  a  grain  for  children  two  or  three 
years  old,  li  grain  for  those  between  three  and 
six  years  old,  2  grains  for  those  between  six 
and  nine  years  old,  and  5  grains  for  adults,  di- 
vided into  two  doses  to  be  taken  an  hour  or 
two  apart  and  followed  by  a  cathartic. 

SAPO.— See  Soap. 

SAPOCABBOIj.— This  is  a  German  pro- 
prietary mixture  of  crude  carbolic  acid  and 
potash  soap,  a  brownish-yellow  syrupy  liquid, 
analogous  to  creolin  and  used  for  the  same 
purposes. 

SAPOLANOLIN.— This  is  Stern's  name 
for  a  mixture  of  2  parts  of  sapo  kalinus  (Ger. 
Ph.),  and  from  2  to  2^  parts  of  anhydrous  lano- 
lin, recommended  as  a  suitable  basis  for  oint- 
ments to  contain  any  drug  except  salicylic  acid. 

SAPONABIA. — Saponaria  officinalis,  or 
soapwort,  owes  whatever  medicinal  properties 
it  possesses  to  the  presence  of  saponin,  a  very 
powerful  paralyzer  of  the  voluntary  and  invol- 
untary muscles.    It  has  been  tried  as  a  local 


SAPONIN 
SCAMMONY 


156 


anmsthetic  and  as  an  antipyretic,  but  with  no 
good  results.  The  root  of  the  plant  has  been 
assumed  to  have  the  same  alterative  properties 
as  sarsaparilla,  but  is  not  held  in  high  esteem, 
and  there  would  seem  to  be  no  good  reasons 
for  its  employment.  The  powdered  root  may 
be  given  in  doses  of  from  \  to  1|  draohm  three 
times  a  day.     (See  Saponin.) 

KussELL  H.  Nevins. 

SAPONIIT. — This  substance,  first  discov- 
ered in  Saponaria  officinalis,  has  been  sup- 
posed to  be  a  glucoside,  but  it  is  doubtful  if  it 
is  in  reality  a  definite  chemical  principle. 
Substances  closely  resembling  the  saponin  of 
soapwort  have  been  found  in  a  g;reat  number 
of  plants.  Saponin  is  highly  poisonous,  act- 
ing as  a  paralyzer  of  the  heart  and,  if -intro- 
duced into  the  blood  unchanged,  causing  the 
death  of  the  corpuscles ;  fortunately,  it  is  very 
difiBcult  of  absorption  from  the  alimentary 
canal.  It  should  not  be  used  in  medicine.  Its 
paralyzing  action  on  the  heart  is  said  to  be  an- 
tagonized by  digitalis. 

SAFO  VIBIBIS. — Green  soap  (see  under 
Soap). 

SAFBOL, — This  mixture  of  phenol,  cresols, 
and  various  other  constituents  is  an  oily,  tarry 
liquid  having  the  odour  of  carbolic  acid.  It 
was  introduced  as  a  disinfectant,  but  does  not 
seem  to  have  come  into  general  use. 

SARRACEITIA  PURPUREA,  a  North 
American  nymphfeaceous  herb  known  as  side- 
saddle plant,  is  now  but  little  used  in  medi- 
cine. It  is  diaphoretic,  diuretic,  and  sto- 
machic in  its  effects,  and  is  employed  to  some 
extent  as  a  remedy  for  atonic  dyspepsia.  A 
tincture,  of  the  strength  of  1  part  of  the  rhi- 
zome to  8  parts  of  alcohol,  may  be  given  in 
teaspoonf  ul  doses  three  times  a  day. 

SARSA. — See  Sarsaparilla. 

SARSAPARILLA  (U.  S.  Ph.),  sarsce  ra- 
dix (Br.  Ph.),  radix  sarsapariltm  (Ger.  Ph.),  is 
the  root  of  Smilax  officinalis  (Br.  Ph  )  and  of 
several  other  species  of  the  same  genus  (CJ.  S. 
Ph.).  At  one  time  it  had  a  high  reputation  in 
the  treatment  of  syphilis,  rheumatism,  scrof- 
ulous affections,  and  a  number  of  diseases  of 
the  slcin,  but  at  the  present  time  is  rarely  era- 
ployed  save  in  the  tertiary  stage  of  the  first- 
named  disease,  and  even  in  that  it  is  not  held 
in  high  esteem.  It  probably  possesses  slight 
tonic  and  alterative  properties,  and  is  highly 
regarded  by  the  laity  as  a  "  blood-puriiier," 
to  be  taken  during  the  spring  months,  and  it 
certainly  possesses  the  merit  of  being  entirely 
harmless.  After  a  long-continued  course  of 
mercury  in  syphilis  it  appears  to  assist  in  re- 
storing the  system  to  its  normal  condition. 
The  smoke  furnished  by  its  slow  combustion 
is  said  to  mitigate  the  violence  of  an  attack 
of  asthma,  but,  as  the  smoke  from  many  prac- 
tically inert  substances  has  a  similar  effect, 
there  is  presumably  no  specific  action  in  this 
case. 

A  simple  decoction,  decoctum  sarsm  (Br.  Ph.), 
may  be  given  in  almost  any  quantities.  The 
compound  decoction,  decoctum  sarsaparillce 
compositum  (U.  S.  Ph.,  Ger.  Ph.),  decoctum  sar- 


sce compositum  (Br.  Ph.),  varies  somewhat  in 
composition  according  to  the  different  phar- 
macopceias.  It  may  be  given  in  doses  of  from 
4  to  6  fl.  oz.  as  often  as  desired,  and  appears 
to  be  slightly  sudorific  and  to  render  those 
who  are  taking  it  liable  to  catch  cold,  so  it  is 
well  to  advise  against  undue  exposure  during 
its  use.  The  decoction  of  Zittmann,  decoc- 
tum Zittmanni,  contains  a  small  amount  of 
senna,  together  with  several  raoi-e  or  less  inert 
substances,  and  is  a  very  popular  German  rem- 
edy. It  is  often  combined  with  mercurials  in 
the  treatment  of  syphilis.  The  fluid  extract, 
extractum  sarSaparillm  fluidum  (U.  S.  Ph.),  or 
liquid  extract,  extractum  sarsce  liguidum  (Br. 
Ph.),  can  be  combined  with  other  remedies 
rather  more  conveniently  than  a  decoction. 
The  dose  of  the  British  liquid  extract  is  from 
3  to  4  fl.  drachms ;  that  of  the  U.  S.  fluid  ex- 
tract is  from  20  to  60  minims. 

The  compound  fluid  extract,  extractum  sar- 
saparillcB  compositum  (U.  S.  Ph.),  is  practically 
a  condensation  of  the  compound  decoction, 
and  is  given  in  doses  of  from  20  to  60  minims. 
The  compound  syrup,  syrupus  sarsaparillce 
compositum  (U.  S.  Ph.),  is  given  in  doses  of  -J  a 
fl.  oz.,  and  is  often  made  the  vehicle  for  the 
administration  of  corrosive  sublimate,  but  im- 
properly, as  precipitation  of  the  mercurial  is 
apt  to  result. — Russell  H.  Nevins. 

SASSAFRAS.— The  sassafras  of  the  U. 
S.  Ph.  is  the  bark  of  the  root  of  Sassafras 
variifolium ;  the  sassafras  radix  of  the  Br. 
Ph.  and  the  lignum  sassafras  of  the  Ger.  Ph. 
are  the  chips  or  shavings  of  the  root  of  Sassa- 
fras officinale.  As  there  is  only  one  species, 
Salisbury's  species  name  variifolium,  adopted 
in  the  U.  S.  Ph.,  does  not  indicate  that  the 
plant  that  is  official  in  the  United  States  is 
different  from  that  which  is  recognised  in 
Europe.  The  pith  also  is  official  as  sassafras 
medulla  (U.  S.  Ph.).  The  bark  of  the  root  alone 
is  medicinal ;  the  wood  is  inert.  The  root-bark 
of  sassafras  is  highly  fragrant  and  of  an  agree- 
able aromatic  taste.  It  is  slightly  stimulant 
and  astringent.  Sassafras  is  used  almost  en- 
tirely to  impart  an  agreeable  flavour  to  mix- 
tures and  to  the  beverage  popularly  known  as 
"  root  beer."  The  fresh  leaves  of  the  sassafras 
tree  are  slightly  aromatic.  If  chewed,  they  are 
highly  efficient  in  allaying  thirst  when  water 
can  not  be  obtained.  A  mucilage,  mucilago 
sassafras  medullcB  (U.  S.  Ph.),  made  from  the 
pith,  may  be  taken  freely  as  a  demulcent  in 
painful  affections  of  the  mouth  and  throat. 
The  volatile  oil,  oleum  sassafras  (U.  S.  Ph.),  is 
used  almost  entirely  for  flavouring  purposes, 
but  it  may  be  given  as  a  carminative  in  flatu- 
lent colic,  in  doses  of  from  3  to  10  drops,  on 
sugar.  In  overdoses  it  is  decidedly  poisonous. 
It  contains  safrol. 

SASSY-BARK— See  under  Eeythroph- 

LCEINE. 

SAUNDERS.— See  Sandal-Wood. 

SAVINE,  sabina  (U.  S.  Ph.),  is  the  fresh 
and  dried  twigs  and  leaves  of  Juiiiperus  Sabina. 
an  evergreen  shrub,  from  three  to  fifteen  feet 
high,  which  grows  in  the  northern  United 
States  and  in  Europe.     It  is  frequently  adul- 


157 


SAPONIN 
SCAMMONY 


terated  with  red  cedar  (Juniperus  virginiana), 
■which  it  closely  resembles.  Oil  of  saviiie,  oleum 
sabinm  (U.  S.  Ph.,  Br.  Ph.),  a  volatile  oil- ob- 
tained by  distillation,  is  its  most  important 
medicinal  ingredient. 

Savine  has  an  exceedingly  unpleasant  odour 
and  a  pungent  and  acrid  taste.  After  the  in- 
gestion of  large  doses,  the  characteristic  odour 
of  the  drug  is  given  ofE  in  the  breath  and  is 
pronounced  in  the  perspiration  and  the  urine. 
Applied  to  the  skin,  the  oil  acts  as  a  rubefacient 
and  a  vesicant.  Taken  internally  in  small 
doses,  its  principal  effects  are  a  more  rapid  ac- 
tion of  the  heart,  increased  arterial  tension, 
followed  by  relaxation,  and  more  abundant 
cutaneous,  bronchial,  and  renal  excretions.  It 
also  stimulates  the  circulation  in  the  pelvic 
organs  and  increases  the  menstrual  flow.  In 
toxic  doses  it  produces  violent  gastro-intes- 
tinal  irritation,  strangury,  and  hematuria. 

Savine  has  been  used  as  an  abortifaeient,  as 
an  emmenagogue,  as  an  anthelminthic,  and  in 
the  treatment  of  chronic  gout.  Used  in  quan- 
tities sufficient  to  produce  abortion,  it  is  an 
extremely  dangerous  agent.  As  an  emmena- 
gogue, Pereira  regards  it  as  one  of  the  incst 
active  of  the  materia  medica.  Direct  emraena- 
gogues  like  savine,  however,  are  now  seldom 
employed.  The  drug  is  said  to  be  useful  in 
the  treatment  of  atonic  menorrhagia. 

Of  the  dried  tops,  the  dose  is  from  10  to  15 
grains  or  more  ;  of  the  oil,  from  1  to  5  minims, 
best  given  in  emulsion  or  in  capsules.  The 
dose  of  the  fluid  extract,  extractum  sabince 
fluidum  (U.  S.  Ph.),  is  from  5  to  15  minims ; 
that  of  the  tincture,  tinclura  sabinm  (Br.  Ph.), 
from  20  minims  to  1  ii.  drachm.  The  ointment, 
unguentum  sabinm  (Br.  Ph.),  was  formerly  used 
externally  as  an  irritant. — Charles  Jewett. 

SAXOIi. — This  name  has  been  given  to  a 
"  very  pure  petroleum  in  a  liquid  state  "  which 
"  seems  to  facilitate  the  absorption  of  any 
medicinal  matter  which  may  be  mixed  with 
it."  So  it  is  stated  in  Clinical  Sketches  for 
August,  1895.  It  does  not  seem  to  have  been 
used  much. 

SAXOLINE.— See  Vaseline. 

SCAMMONY,  scammonium  (U.  S.  Ph.,  Br. 
Ph.),  is  a  gum-resinous  exudation  from  the 
living  root  of  Convolvulus  Scammonia,  a  plant 
native  to  Syria  and  neighbouring  localities. 
The  drug  occurs  in  irregular  pieces  or  flattened, 
circular  cakes  of  a  grayish  colour,  a  peculiar 
odour,  and  a  slightly  acrid  taste.  It  is  brittle, 
and  the  broken  surface  is  shining  and  some- 
what porous.  Its  powder  is  light  gray.  The 
scammony  of  the  market  is  seldom  absolutely 
pare,  and  absolutely  pure  scammony,  virgin 
scammony.  as  it  is  called,  is  difficult  to  obtain. 
The  so-called  scammony  in  shells  was  formerly 
to  be  had,  and  represented  the  drug  in  its 
purity.  The  peculiar  name  of  the  product  was 
given  to  it  because  it  was  contained  in  the 
shells  in  which  the  exudation  had  been  collect- 
ed and  dried.  Factitious  scammony  is  often 
substituted  for  the  genuine  scammony.  It 
is  compounded  of  various  resinous  and  other 
substances.  Its  manufacture  is  done  especially 
in  southern  France.     The  active  principle  of 


scammony  is  a  resin  which  occurs  in  the  pure 
drug  in  quantities  which  vary  from  80  to  90 
per  cent.  This  resin  is  identical  yvith  j'alapin, 
the  resin  of  Ipomoea  orizabensis,  or  male 
jalap.  Besides  the  resin,  scammony  contains 
gum  and  extractive.  The  quantity  of  the 
resin  which  scammony  contains  is  so  variable, 
and  adulteration  is  so  often  practised,  that 
the  resin  should  always  be  employed  in  prefer- 
ence to  the  crude  drug.  Resin  of  scammony, 
resina scammonii  (U.  S.  Ph.),  scammonim  resina 
(Br.  Ph.),  occurs  in  yellowish  or  brownish,  brit- 
tle pieces,  or  in  a  yellowish-white  or  grayish 
powder.  Its  odour  and  taste,  though  slight, 
are  peculiar.  It  is  freely  soluble  in  alcohol. 
Although  the  U.  S.  Ph.  directs  that  resin  of 
scammony  shall  be  prepared  from  scammony, 
the  Br.  Ph.  provides  that  it  may  be  prepared  _ 
not  only  thus,  but  also  from  dried  scammony' 
root,  scam,moni(B  radix  (Br.  Ph.),  which  is  made 
official  for  this  purpose. 

Scammony  and  its  resin  are  cathartics  of 
much  vigour  and  even  severity  of  action,  and 
because  of  this  they  are  seldom  administered 
save  in  combination  with  less  powerful  cathartic 
remedies  whose  activity  they  serve  to  enhance 
and  by  which  their  own  violent  properties  are 
made  less.  The  griping  which  scammony 
causes  may  be  of  great  intensity.  The  action 
of  scammony  is  similar  to  that  of  jalap,  but  it 
has  a  more  drastic  effect.  Scammony  is  useful 
in  cases  requiring  a  thorough  and  vigorous 
intestinal  evacuation  ;  it  is  suitable,  therefore, 
in  obstinate  constipation  in  the  early  days  of 
inflammatory  and  febrile  diseases,  and  some- 
times to  aid  in  the  dissipation  of  dropsical 
effusions.  It  is  contra-indicated  in  intestinal 
inflammation.  Scammony  may  be  given  in 
emulsion,  griping  being  mitigated  by  the  addi- 
tion of  an  aromatic.  The  dose  of  the  pure 
drug  is  from  5  to  15  grains.  Kesin  of  scam- 
mony is  to  be  preferred  to  scammony  itself, 
because  of  its  constancy  of  strength.  The  dose 
of  the  resin  is  from  4  to  8  grains,  and  it  is 
conveniently  given  emulsified  with  milk.  A 
similar  emulsion  has  official  recognition,  for 
scammony  mixture,  mistura  scammonii  (Br. 
Ph.),  is  composed  of  1  part  of  powdered  scam- 
mony triturated  with  146  parts  of  milk  until  a 
uniform  emulsion  is  obtained.  This  mixture 
must  be  prepared  fresh  when  needed.  The 
dose  is  from  1  to  3  fl.  oz.  Confection  of  scam- 
mony, confectio  scammonii  (Br.  Ph.),  contains 
48  parts  of  powdered  resin  of  scammony,  24 
parts  of  powdered  ginger,  3  parts  of  oil  of 
caraway,  1  .part  of  oil  of  cloves,  48  parts  of 
syrup,  and  24  parts  of  clarified  honey.  The 
dose  is  from  10  to  30  grains.  Compound  scam- 
mony pill,  pitula  scammonii  composita  (Br. 
Ph.),  is  composed  of  1  part  each  of  resin  of 
scammony,  resin  of  jalap,  powdered  curd  soap, 
and  strong  tincture  of  ginger,  and  2  parts  of 
rectified  spirit,  mixed  and  reduced  by  evapora- 
tion to  a  pilular  consistence.  The  dose  is  from 
5  to  15  grains.  Compound  powder  of  scam- 
mony, pulvis  scammonii  compositus  (Br.  Ph.), 
contains  4  parts  of  powdered  resin  of  scam- 
mony, 3  parts  of  powdered  jalap,  and  1  part  of 
powdered  ginger.  The  dose  is  from  10  to  20 
grains. — Heney  A.  Griffin. 


SCARIFICATION 
SCUTELLARIA 


158 


SCARIFICATION  is  the  production  of 
small  incisions.  The  object  of  the  practice  is 
the  relief  of  local  congestion  spaA  inflammalion. 
By  scarification  of  inflamed  tissues  the  con- 
gestion is  lessened  by  direct  abstraction  of 
blood  from  the  engorged  vessels,  effused  mat- 
ters are  permitted  to  escape,  and  painful  and 
perhaps  dangerous  tension  is  removed  from 
the  affected  part.  The  treatment  of  localized 
inflammations  of  the  skin  and  mucous  mem- 
branes by  early  incision  is  a  surgical  rather 
than  a  medical  affair,  of  which  information 
must  be  sought  in  surgical  works,  but  the  more 
minute  incisions  to  which  the  name  scarifica- 
tion is  properly  confined,  though  certainly 
surgical  and  differing  from  other  incisions 
only  in  degree,  may  not  inaptly  be  briefly  con- 
sidered here.  The  condition  in  which  scarifi- 
cation is  of  most  momentous  importance  is 
oedema  of  the  glottis,  but  it  is  frequently  bene- 
ficial in' acute  inflammation  of  tlie  tonsils  and 
may  be  required  in  conjunctivitis  wtien  conges- 
tion and  swelling  are  extreme.  In  the  first- 
named  condition  care  must  of  course  be  had 
to  avoid  cutting  the  tongue,  which  is  best 
accomplished  by  protecting  the  blade  of  the 
knife,  all  save  the  tip,  with  rubber  plaster  or  a 
similar  material.  In  some  cases  scarification 
of  the  uterine  cervix  is  of  benefit.  Scarifica- 
tion has  also  been  done  for  the  relief  of  subcu- 
taneous dropsy,  but  it  is  to  be  avoided  as  a 
rule,  because  of  the  danger  of  infection  and 
the  slowness  with  which  such  wounds  heal.  If 
the  necessity  for  relief  is  urgent,  multiple  punc- 
tures are,  as  a  rule,  far  preferable  in  such  cases. 
Whenever  scarification  is  performed  it  must, 
of  course,  be  with  all  aseptic  precautions,  and 
in  the  case  of  cutaneous  scarification  the  sub- 
sequent application  of  an  antiseptic  dressing  is 
often  a  necessity.  Scarification  as  an  adjunct 
to  cupping  was  formerly  much  practised. 

Henry  A.  Griffin. 

SCILLA. — See  Squill. 
SCILLAIIT,  SCILIilN,  SCILLIPICMN, 
SCIIililTIN,    SCIIiLITOXIN.— Little    is 

known  of  these  substances  obtained  from  XJr- 
ginea  Scilla.  Scitlain  is  described  as  a  col- 
ourless or  yellowish  glucoside  said  to  be 
diuretic.  According  to  Dr.  Cerna,  soillain 
may  be  given  in  single  doses  of  ^  of  a  grain, 
and  in  daily  amounts  of  from  ^  to  f  of  a  grain. 
Scillin,  according  to  Merck,  is  a  light-yellow 
crystalline  glucoside.  Husemanu  has  found  it 
inert.  Scillipicrin  is  a  yellowish-white  prin- 
ciple, very  bitter,  and  freely  soluble  in  water. 
It  has  been  found  to  be  diuretic,  and  has  been 
recommended  in  the  treatment  of  dropsy,  em- 
ployed subcutaneously  in  the  dose  of  from  i 
to  1  grain,  once  a  day.  Scillitin  is  said  to 
have  the  same  medicinal  action  as  scillipicrin, 
and  in  smaller  doses,  from  ^  to  ^  a  grain. 
Seillitoxin  also  is  diuretic  in  doses  of  from  jV 
to  -^  of  a  grain,  and  not  more  than  f  of  a 
grain  should  be  given  in  the  course  of  twenty- 
four  hours.  In  the  present  state  of  our  knowl- 
edge of  their  properties,  it  is  advisable  not  to 
use  any  of  these  substances  in  practice. 

SCLEROTIC  ACID. — This  substance,  C, 
n,aNO»,  obtained  from  the  sclerotium  of  Cla- 


viceps  purpurea  (see  Ergot),  seems  to  differ  m 
medicinal  properties,  and  probably  in  chem- 
ical composition  also,  according  to  the  method 
of  its  preparation.  Uragendorfs  sclerotic 
acid,  according  to  Merck,  is  the  ergotic  acid 
of  Zweifel  and  the  impure  ergotic  acid  of  Ko- 
bert,  a  cinnamon-brown,  hygroscopic  powder, 
odourless  and  tasteless,  having  the  h(Bmostatic 
properties  of  ergot,  but  not  its  ecbolic  power. 
It  has  been  recommended  in  the  treatment  of 
epilepsy  and  internal  haimorrliages.  It  may 
be  given  by  the  mouth  or  subcutaneously,  in 
amounts  not  exceeding  5  grains  a  day.  Pod- 
wyssotzki's  sclerotic  acid  is  described  by  Merck 
as  a  light-brown  powder  having  both  the 
Jmmostatic  and  ecbolic  properties  of  ergot.  It 
may  be  given  in  doses  of  i  a  grain,  to  the  ex- 
tent of  5  grains  in  twenty-four  hours. 

SCOPARII  CACTJMINA  (Br.  Ph.).— See 

SCOPARIUS. 

SCOPARIN,  CaiHjjOio,  obtained  from  Cy- 
tisus  Scoparius  (see  Scoparius),  is  a  brownish 
crystalline  powder.  It  has  been  thought  to  be 
the  active  diuretic  and  catliartic  principle  of 
scoparius,  but  its  medicinal  properties  are  not 
yet  well  enough  known  to  warrant  its  em- 
ployment in  practice. 

SCOPARIUS  (U.  S.  Ph.),  scoparii  cacu- 
mina  (Br.  Ph.),  are  the  official  names  for 
broom-tops,  the  tops  of  Gytisus  Scoparius,  in- 
digenous to  Europe  and  cultivated  in  North 
America.  Scoparius  is  diuretic  and  cathartic  ; 
in  large  doses  it  is  also  emetic,  but  should 
never  be  used  in  such  amounts.  Scoparius  is 
used  mostly  in  the  treatment  of  dropsy.  The 
decoction,  decoctum  scoparii  (Br.  Ph.),  may  be 
given  in  doses  of  from  3  to  4  fl.  oz.  The  dose  of 
the  fluid  extract,  extractum  scoparii  fluidum 
(U.  S.  Ph.),  is  from  20  to  40  minims:  that  of 
the  expressed  juice,  succus  scoparii  (Br.  Ph.), 
is  from  1  to  2  fl.  drachms.  Scoparius  contains 
sparteine  {q.  v.). 

SCOPOLAMINE,  C^H^NO,,  is  an  alka- 
loid obtained  from  the  roots  of  the  various 
species  of  the  solanaceous  genus  Scopolia, 
principally  Scopolia  atropoides  and  Scopolia 
japonica.  It  is  also  found  in  small  quantities 
in  the  roots  of  Atropa  Belladonna,  in  the  seeds 
of  Datura  Stramonium,  and  in  Duboisia  myo- 
poroides.  It  occurs  in  permanent  transparent 
crystals,  stated  to  be  isomeric  with  cocaine, 
atropine,  and  other  members  of  the  tropeine 
series,  which  melt  into  a  colourless  liquid  at  a 
temperature  of  59°  C.  (138-2°  P.),  and  is  de- 
composed by  baryta  into  a  crystalline  base 
called  scopoline  and  atropic  acid. 

The  pure  alkaloid  is  insoluble  and  is  not 
employed  in  medicine,  but  is  represented  bv  the 
hydrobromide.  This  salt  can  be  distinguished 
with  difficulty  from  the  hydrobromide  of  hyos- 
cine.  and  the  opinion  has  been  advanced  that 
the  latter  drug,  as  found  in  commerce,  consists 
largely  of  scopolamine  hydrobromide.  While 
this  is  certainly  not  true  of  all  the  hydro- 
bromide of  hyosoine  on  the  market,  the  close 
resemblance  of  these  drugs  may  perhaps  occa- 
sionally cause  one  to  be  mistaken  or  substi- 
tuted for  the  other. 


159 


SCARIFICATION 
SCUTELLARIA 


Another  salt,  the  hydrochloride,  is  met  with 
in  glassy  crystals  3  cm.  long  by  3  cm.  broad. 

SufiRcient  data  have  not  yet  been  accumu- 
lated to  enable  us  to  speak  positively  in  re- 
gard to  the  physiological  action  of  the  drug. 
In  many  ways  it  closely  resembles  that  of 
atropine,  but  is  much  more  prompt  and  rapid 
and  passes  away  more  quickly.  It  has  been 
principally  observed  in  the  results  of  instilla- 
tions of  solutions  into  the  conjunctival  sac. 
From  1  to  5  drops  of  a  O'l  to  0'2-per-cent.  solu- 
tion, thus  instilled,  will  produce  a  maximum 
dilatation  of  the  pupil  in  from  ten  to  sixty  min- 
utes, and  paralysis  of  the  ciliary  muscle  proceeds 
pari  passu  with  the  pupillary  enlargement. 
This  mydriatic  eflfect  gradually  passes  away, 
and  disappears  in  from  five  to  eight  days.  An 
effect  upon  the  heart  usually  becomes  manifest 
within  a  quarter  of  an  hour  after  such  an  in- 
stillation, the  pulse  becoming  soft  and  com- 
pressible, while  the  rate  is  usually  lessened, 
sometimes  to  a  very  marked  degree,  but  is 
occasionally  increased  or  becomes  irregular. 

Toxic  symptoms  have  not  infrequently  been 
observed.  These,  as  they  appear  in  different 
degrees  of  severity,  may  be  given  as  dryness 
of  the  throat,  muscular  weakness,  dizziness, 
nausea,  restlessness  or  sleepiness,  occasionally 
flushing  of  the  face,  diliriura.  very  rapid  and 
weak  pulse,  convulsive  action  of  the  muscles 
of  the  extremities,  and  paresis  of  the  pharyn- 
geal muscles.  No  fatal  case  has  yet  been  re- 
ported. The  severest  case  I  know  of  occurred 
in  my  clinic  at  the  Manhattan  Eye  and  Ear 
Hospital  while  it  was  under  the  care  of  Dr. 
Kendall.  Four  instillations  of  a  drop  eacli  of 
a  0-3-per-cent.  solution  of  scopolamine  hydro- 
bromide  were  made  into  each  eye  of  a  young 
labouring  man,  at  intervals  of  ten  minutes. 
Fifteen  minutes  later,  toxic  symptoms  ap- 
peared and  increased  in  severity  lor  half  an 
hour.  First  appeared  dizziness,  dryness  of  the 
throat,  nausea  and  attemps  to  vomit,  flushing 
of  the  face  which  increased  to  mild  cyanosis, 
decrease  in  strength  of  the  pulse  and  increase 
in  its  rapidity  until  it  was  over  160  a  minute, 
wild  diliriuni.  convulsive  action  of  the  muscles 
of  the  extremities,  and  paresis  of  the  pharyn- 
geal muscles.  Under  treatment  with  mor- 
phine and  whisky  these  symptoms  began  to 
abate  in  two  hours.  Nausea  and  dizziness  per- 
sisted for  a  day. 

Scopolamine  is  employed  principally  as  a 
mydriatic  in  ophthalmology,  for  the  purpose 
of  determining  the  refraction.  On  account  of 
its  rapid  action,  it  would  be  very  desirable  if 
there  were  less  danger  of  its  producing  toxic 
effects.  A  single  drop  of  a  0'2-per-cent.  solu- 
tion is  often  sufficient  to  produce  the  desired 
result,  and  a  stronger  solution  than  this  should 
never  be  used.  Solutions  of  less  than  half  this 
strength  do  not  seem  to  be  reliable.  The  dan- 
ger of  poisoning  is  greatly  lessened  if  not  com- 
pletely avoided  by  occlusion  of  the  canaliculi 
by  means  of  pressure  while  the  drug  is  being 
employed. 

In  pathological  cases,  such  as  inflammations 
of  the  iris  and  cornea,  scopolamine  does  not 
seem  to  possess  any  marked  advantage  over 
atropine,  while  the  greater  tendency  to  poison- 


ing forms  a  positive  disadvantage.  Occasion- 
ally it  is  of  use  in  an  attempt  to  tear  away 
posterior  synechice,  or  when  tor  other  reasons 
a  sharp  effect  is  wanted,  on  account  of  the 
more  rapid  action  of  this  drug. 

[Dr.  Charles  A.  Oliver,  of  Philadelphia,  in 
a  paper  read  before  the  Section  in  Ophthalmol- 
ogy of  the  College  of  Physicians  (N.  Y.  Med. 
Jour.,  March  31,  1896),  said  that  among  quick 
and  active  measures,  which  were  so  necessary 
in  incipient  oases  of  plastic  iritis  and  during 
the  early  stages  of  inflammatory  reaction, 
scopolamine  hydrobromide  was  very  impor- 
tant; but  where  prolonged  treatment  was 
necessa,ry,  as  in  many  cases  of  the  chronic 
form  of  the  disease  with  subacute  exacerba- 
tions, the  good  effect  did  not  seem  to  be  lasting. 
For  these  reasons  he  had  learned  empirically 
to  depend  upon  the  drug  where  prompt  action 
was  necessary,  but  where  more  permanent  ef- 
fects were  desired  he  used  it  alternately  with 
atropine.  Prom  the  doses  in  which  he  had 
employed  the  drug,  he  had  never  seen  any 
symptoms  of  poisoning,  although  in  several  of 
the  cases  in  which  he  had  used  it  freely  there 
had  been,  at  times,  giddiness,  inco-ordinalion 
of  movement,  and  drowsiness.  In  regard  to 
the  question  of  intraocular  tension,  he  intended 
to  perform  a  series  of  experimental  researches 
and  to  make  a  relative  study  of  the  other 
mydriatics  with  which  the  drug  had  usually 
been  thought  to  be  associated  or,  in  fact,  consid- 
ered identical. 

Dr.  William  Murrell  (Ann.  of  Ophthal.  and 
Otol.,  October,  1895)  thinks  that  a  0'1-per-oent. 
solution  of  scopolamine  hydrochloride  is  abso- 
lutely positive  in  controlling  the  accommoda- 
tion, that  in  this  strength  it  is  non-toxic,  and 
that  it  is  the  least  troublesome  of  the  mydri- 
atics. 

According  to  two  Russian  physicians,  Dr. 
W.  W.  Olderogge  and  Dr.  N.  A.  Jurmann 
{Vratch,  1895.  No.  50  ;  JTierap.  Woch.,  January 
12,  1896),  find  that  scopolamine  hydrobromide 
is  of  great  value  as  a  hypnotic  in  the  insomnia 
of  the  insane.  Administered  subcutaneously, 
in  doses  varying  from  O'OOS  to  0-015  of  a  grain, 
it  induced  in  the  majority  of  the  subjects  a 
sleep  which  lasted  from  three  to  ten  hours. 
On  awakening,  the  patients  appeared  much 
calmer  than  before  the  administration  of  the 
drug.  This  effect  was  especially  pronounced 
in  maniacs,  but  it  was  not  so  marked  in  acute 
lypemania.  In  chronic  insanity  also  its  hyp- 
notic action  was  manifest.  In  delirium  tre- 
mens, however,  it  had  no  hypnotic  action 
whatever.] — Matthias  Lanckton  Foster. 

SCOPOLEINE,  SCOPOLENINE.— This 
is  a  poisonous  alkaloid  obtained  by  Eykman  in 
the  root  of  Scopolia  japonica,  or  "  roto,"  or 
"  Japanese  belladonna."  Scopoleine  is  said  to 
be  a  powerful  mydriatic. 

SCUBVY-GRASS.— See  Cochleaeia. 

SCUTELLARIA  (U.  S.  Ph.),  is  the  herb 
Scutellaria  laterifolia.  or  skullcap,  which  has 
been  employed  in  medicine,  but  appears  to  be 
practically  inert.  Several  other  species  of  the 
same  genus  are  found  in  the  United  States  and 
are  credited  with  bitter  and  tonic  properties 


SEA-TANGLE 
SENECIO 


160 


The  fluid  extract,  extraclum  scutellaricEfluidum 
(IT.  S.  Ph.),  may  be  given  in  doses  of  a  fl. 
drachm.  ScnieUarin  is  a  precipitate  from  an 
aleohoiio  tincture.  It  may  be  given  in  doses 
of  from  1  to  4  grains. — Russell  H.  Nevins. 

SEA-TANGrliE.— See  Laminaeia. 

SEBUM  OVILE  (Ger.  Ph.).— Mutton  tal- 
low (see  Pats  and  Tallow).  Sebum  salicyl- 
atum  (Ger.  Ph.)  is  an  ointment  consisting  of 
2  parts  of  salicylic  acid  and  98  of  mutton  tal- 
low. 

SECALE  CEBEALE.— See  Eye. 

SECALE  COBNUTXJM  (Ger.  Ph.).— See 
Bkgot. 

SEDATINE. — See  Antipymnb. 

SEDATIVES  are  agents  employed  to  pro- 
duce a  calm  and  quiet  condition  of  mind  and 
body,  or  of  some  portion  of  the  body.  This  is 
accomplished  in  morbid  conditions  by  reducing 
the  excessive  action  of  the  organ  or  organs  in- 
volved, thus  lessening  functional  activity,  de- 
pressing motility,  and  diminishing  pain.  They 
are  naturally  divided  into  several  classes  in 
accordance  with  their  action  on  the  morbid 
conditions  in  which  they  are  employed. 

General  sedatives  are  used  to  produce  seda- 
tion of  the  entire  system.  They  include  rest, 
warm  baths,  narcotics,  anodynes,  and  hyp- 
notics. These,  as  well  as  the  individual  drugs, 
are  extensively  considered  under  their  own 
heads,  so  a  detailed  account  of  each  here  is  not 
necessary.  The  most  important  and  frequently 
applicable  general  sedative  is  rest,  by  which  is 
meant  a  removal  of  the  body  from  any  exciting 
or  irritating  surroundings  to  such  as  conduce  to 
restoration  of  the  equilibrium  of  its  disordered 
functions.  This  may  with  propriety  include 
the  rest  obtained  by  a  change  of  scene  and 
occupation,  but  it  is  generally  used  in  the  more 
limited  sense  of  cessation  from  voluntary  effort 
and  relaxation  of  the  muscular  tissues.  The 
latter  is  usually  best  effected  by  placing  the 
body  in  a  recumbent  posture  in  a  quiet  room 
with  surroundings  which  predispose  to  sleep, 
or  functional  rest  of  the  whole  system.  In 
conditions  of  general  excitement  the  ingestion 
of  food  into  the  stomach  has  a  decidedly  seda- 
tive effect.  A  warm  bath  induces  muscular 
relaxation,  promotes  sedation  of  the  entire  sys- 
tem, and  is  a  valuable  adjunct  in  the  produc- 
tion of  rest. 

The  drugs  which  belong  to  this  class  act 
principally  through  the  nervous  system,  and 
have  been  on  that  account  classed  by  some 
writers  as  nervous  sedatives.  Opium,  with 
most  of  its  alkaloids,  particularly  morphine, 
also  chloral  and  the  bromides,  are  the  most 
important  members. 

Local  sedatives  are  employed  to  lessen  nerv- 
ous and  vascular  excitement  of  a  distinct  por- 
tion of  the  body  and  to  relieve  local  irritation, 
pain,  or  inflammation.  Their  effect  is  due  in 
part  to  their  action  on  the  vessels  and  tissues, 
and  in  part  to  their  action  on  the  tei'rainal 
filaments  of  the  nerves  which  supply  the  por- 
tion of  the  body  affected.  As  usually  em- 
ployed, this  term  is  held  to  apply  to  agents 
which  act  upon  the  skin  and  the  accessible 


mucous  membranes,  and  does  not  include  those 
which  act  upon  certain  of  the  internal  organs. 
The  most  prominent  agents  which  belong  to 
this  class  are  cold,  in  the  form  of  ice,  a  spray, 
or  an  evaporating  lotion  ;  heat,  either  moist  or 
dry  ;  aconite  ;  belladonna ;  the  essential  oils  ; 
opium;  alcohol;  chloroform;  acetate  of  lead; 
and  cocaine. 

Gastric  sedatives  are  employed  to  relieve  ir- 
ritability of  the  stomach  shown  by  pain,  nau- 
sea, and  vomiting.  They  may  act  either  (a) 
mechanically,  by  covering  the  irritated  mem- 
brane with  a  bland  coating,  by  diluting  the  ir- 
ritating fluid  in  the  stomach  and  so  rendering 
it  innocuous,  or  by  distending  the  stomach  suf- 
flciently  to  allow  the  irritated  mucous  mem- 
brane to  be  bathed  with  a  bland  fluid ;  (V)  by 
inducing  a  contraction  of  the  local  blood-ves- 
sels so  as  to  relieve  the  surcharged  mncous 
membrane ;  (c)  by  a  direct  effect  on  the  nervous 
centre  which  controls  the  action  of  the  stom- 
ach ;  (d)  by  neutralizing  hyperacidity  of  the 
gastric  fluid ;  or  (e)  in  the  manner  of  a  coun- 
ter-irritant when  applied  to  the  integument  of 
the  epigastrium. 

Bismuth  and  oxalate  of  cerium  are  perhaps 
the  most  commonly  employed  mechanical  local 
sedatives.  When  there  is  a  persistent  attempt 
to  vomit  and  the  stomach  contains  only  a  small 
amount  of  acrid  fluid,  as  after  a  debauch  or 
etherization,  a  large  draught  of  warm  water, 
milk,  or  other  bland  fluid  will  frequently  con- 
trol it  at  once. 

The  most  powerful  local  gastric  sedative  is 
probably  ice  swallowed  in  small  pieces.  This 
acts  doubtless  by  both  the  anassthetic  action  of 
the  cold  upon  the  terminal  nerve  filaments  and 
by  inducing  a  contraction  of  the  local  blood- 
vessels. Alum,  nitrate  of  silver,  and  other  as- 
tringents likewise  act  upon  the  blood-vessels  of 
the  mucous  membrane  and  relieve  its  conges- 
tion. 

It  is  difiBcult  to  determine  how  far  the  effect 
of  the  narcotics,  hydrocyanic  acid,  carbolic 
acid,  and  creosote  is  due  to  their  anresthetic 
action  on  the  local  nerves,  and  how  far  to  their 
action  on  the  nervous  centre,  but  it  is  gener- 
ally admitted  that  it  is  due  largely  to  the  latter. 

Alkalies,  such  as  bicarbonate  of  sodium,  are 
frequently  effectual  by  neutralizing  the  hyper- 
acidity of  the  gastric  contents  which  is  acting 
as  an  irritant. 

Counter-irritation  in  the  form  of  heat  or  a 
mustard  poultice  applied  to  the  epigastrium  is 
a  well-known  and  effective  gastric  sedative 
which  should  not  be  forgotten.  It  is  more 
fully  described  elsewhere. 

Spinal  sedatives  reduce  the  functional  ac- 
tivity of  the  spinal  cord  and  quiet  its  abnormal 
excitability,  either  by  a  direct  action  upon  the 
nerve  cells  or  indirectly  by  an  action  upon  the 
circulation  of  the  blood'  through  the  cord. 
Their  use  is  indicated  in  conditions  of  irrita- 
tion or  congestion  of  the  spinal  cord.  The 
principal  ones  are  gelsemium,  physostigma,  lo- 
belia, conium,  hydrocyanic  acid,  and  bromide 
and  nitrate  of  potassium.  In  the  administra- 
tion of  these  drugs  the  fact  should  always  be 
remembered  that  an  overdose  may  abrogate, 
for  a  time  at  least,  the  functions  of  the  spinal 


161 


SEA-TANGLE 
SBNECIO 


cord.  Counter-irritation  in  the  form  of  the 
electric  brush  or  the  actual  cautery  along  the 
spinal  column  is  also  an  eflRcient  sedative. 

Circulatory  sedatives  are  substances  which 
reduce  the  circulation,  either  by  diminishing 
the  calibre  of  the  blood-vessels  or  by  rendering 
the  cardiac  action  slower  and  less  forcible. 
Those  which  act  to  contract  the  calibre  of  the 
vessels  are  employed  mainly  to  check  haemor- 
rhage and  to  cut  short  local  inflammation. 
Cold,  by  its  primary  action,  best  obtained  by 
means  of  the  application  of  ice  or  of  iced  cloths 
very  frequently  changed,  and  heat,  by  its  sec- 
ondary action,  are  very  powerful  agents  for 
this  purpose.  Ergot,  digitalis,  haraamelis, 
opium,  salts  of  lead,  zinc,  and  barium,  cocaine, 
antipyrine,  and  hydrastis  are  examples  of  the 
drugs  which  belong  to  this  class. 

The  circulatory  sedatives  which  render  the 
cardiac  action  slower  and  less  forcible  are  use- 
ful in  sthenic  fevers  and  inflammations.  The 
principal  ones  are  aconite,  veratrum  viride,  an- 
timonial  compounds,  pilocarpine,  gelsemium, 
and  senega,  with  its  alkaloid,  saponin.  These 
all  depress  the  cardiac  motor  ganglia,  the  car- 
diac muscles,  or  both,  while  muscarine  and 
pilocarpine  stimulate  also  the  inhibitory  gan- 
glia. Digitalis  frequently  acts  as  a  cardiac  sed- 
ative by  stimulation  of  the  vagus  centre  and 
of  the  cardiac  muscle,  as  it  thus  slows  the 
rate  and  regulates  the  rhythm  of  the  heart 
beats. 

Pulmonary  sedatives  are  substances  which 
are  employed  to  relieve  dyspnoea  or  to  allay 
cough.  They  may  be  divided  into  drugs  which 
mechanically  protect  the  alfected  membrane 
from  further  irritation,  those  which  tend  to 
remove  the  exciting  irritant,  those  which  di- 
rectly allay  the  irritability  of  the  respiratory 
centre,  and  those  which  act  on  the  terminal 
fibres  of  the  respiratory  nerves  in  the  bronchi 
and  lungs; 

Licorice,  mucilage,  jujube  paste,  linseed  tea, 
and  other  like  remedies  cover  the  back  of  the 
throat  with  a  mucilaginous  coating  and  me- 
chanically relieve  a  cough  when  it  depends  on 
congestion  of  the  pharynx  and  trachea.  Drugs 
which  diminish  congestion  of  the  respiratory 
passages  and  so  lessen  irritation  have  been 
considered  under  expectorants.  Most  of  the 
pulmonary  sedatives  either  act  upon  the  re- 
.spiratory  centre  or  obtund  the  excitability  of 
the  terminal  nerve  filaraents,  but  in  many 
cases  it  is  not  yet  determined  whether  a  drug 
acts  in  one  way  or  the  other.  Thus,  while 
opium  undoubtedly  acts  principally  if  not 
wholly  upon  the  centre,  belladonna  and  stra- 
monium seem  to  act  both  upon  the  centre  and 
upon  the  terminal  filaments.  The  vapour  of 
certain  drugs,  such  as  conium,  hydrocyanic 
acid,  stramonium,  and  tobacco,  seems  to  have 
a  local  sedative  action,  and  to  diminish  local 
spasm  of  the  bronchioles. 

Urinary  sedatives  render  the  trine  bland, 
lessen  irritability  of  the  bladder,  and  relieve 
pain  and  the  desire  to  micturate.  When  ad- 
ministered internally,  they  act  through  the 
medium  of  the  urine  upon  the  whole  extent  of 
the  urinary  tract.  (See  Antiblennorrhagics.) 
Matthias  Lanckton  Postee. 


SEIDLITZ  POWDERS.  —  The  Seidlitz 
powder,  pulvis  effervescens  compositus  (U.  S. 
Ph.),  pulois  sodm  tartaratm  effervescens  (Br. 
P'h.).pulvis  aerophorus  laxans  (Ger.  Ph.),  varies 
but  little  in  its  composition  according  to  the 
diflferent  pharmacopccias.  That  of  the  U.  S. 
Ph.  is  an  intimate  mixture  of  about  38  grains 
of  sodium  bicarbonate  and  about  118  grains  of 
potassium  and  sodium  tartrate  (Rochelle  salt), 
together  with  a  separate  powder  of  about  35 
grains  of  tartaric  acid  in  fine  powder.  The 
two  powders  are  directed  to  be  kept  done  up 
in  papers  of  different  colours ;  ordinarily  these 
are  blue  and  white,  the  blue  for  the  mixture  of 
Rochelle  salt  and  sodium  bicarbonate  and  the 
white  for  the  tartaric  acid.  The  powders 
should  be  kept  strictly  dry  until  they  are  to  be 
used,  when  the  contents  of  the  white  paper  are 
to  be  dissolved  in  half  a  glass  of  water  and 
those  of  the  blue  paper  in  another  glass  about 
half  full  of  water.  The  two  solutions  are  then 
to  be  mixed,  when  brisk  effervescence  takes 
place,  owing  to  the  action  of  the  tartaric  acid 
on  the  sodium  bicarbonate,  whereby  carbonic 
acid  is  set  free.  The  mixture  is  to  be  swallowed 
while  it  is  still  foaming,  for  it  is  then  not  un- 
pleasant to  the  taste,  and,  moreover,  the  action 
of  the  carbonic  acid  on  the  stomach  is  that  of 
an  agreeable  stimulant  and  often  serves  to 
check  nausea.  The  main  action  of  the  Seidlitz 
powder,  however,  is  that  of  a  laxative  and  diu- 
retic. It  is  most  commonly  used  to  overcome 
temporary  constipation.  Its  laxative  action 
may  be  decidedly  heightened  by  using  hot 
water  in  making  the  solutions,  which  may  be 
flavoured  with  sugar,  lemon-juice,  or  some 
syrup.  One  powder  (i.  e.,  the  combination  of 
a  blue-paper  covered  and  a  white-paper  covered 
powder)  is  the  ordinary  dose. 

SELENIUM. — This  element,  which  in  its 
chemical  relations  is  closely  analogous  to  sul- 
phur, resembles  that  substance  also  in  medici- 
nal properties,  but  is  more  energetic,  so  that 
it  should  not  be  employed  internally  until 
more  is  known  about  it.  As  an  external  appli- 
cation. Dr.  Demontporeelet  and  Dr.  Fere  (cited 
in  Med.  and  Surg.  Reporter,  July  7, 1894)  have 
found  that  in  certain  skin  diseases  amorphous 
selenium  yields  much  better  results  than  sul- 
phur does.  They  used  an  ointment  made  ac- 
cording to  the  following  formula  : 
5  Amorphous  precipitated  selenium. .  30  gr. ; 

Vaseline 1  oz. 

M. 

SENECIN. — This  is  a  resinlike  substance 
prepared  by  precipitating  a  tincture  of  Senecio 
vulgaris  with  water.  It  is  employed  by  the 
eclectics  in  amenorrhoea,  dysmenorrhosa,  jaun- 
dice, and  hmmoptysis,  in  doses  of  from  1  to  3 
grains.  It  must  not  be  confounded  with  sene- 
cine. 

SEKTECIITE. — Under  this  name  a  proprie- 
tary elixir  of  Senecio  Jacohoea  is  used  as  an 
emmenagogue. 

SENECIO. — Two  species  of  this  genus  of 
the  Compositm,  tribe  Senecionidece,  have  been 
used  in  medicine.  Dr.  H.  S.  Purdon,  of  Bel- 
fast,  Ireland    (Practitioner,   January,   1882), 


SENEGA 
SERUM 


163 


speaks  well  of  Seneeio  Jaeolcea,  the  common 
ragweed,  in  the  treatment  of  pruritus  and  of 
jaundice,  with  which  itching  is  often  connect- 
ed. He  recommends  a  Belfast  preparation 
termed  siiccus  senecionis  jacohmcB,  the  dose  of 
which  is  from  1  fl.  drachm,  to  1  fl.  oz.,  to  be 
taken  early  in  the  morning,  with  or  without  a 
teaspoonful  of  sulphur.  Senecio  vulgaris,  the 
common  groundsel,  was  formerly  employed  as 
an  anthelminfhic,  and  has  of  late  been  em- 
ployed with  success  in  the  treatment  of  amen- 
orrhma  and  dysmenorrhcua  not  dependent  on 
lesions  of  the  uterus  or  its  annexa.  It  has 
also  been  nsed  in  hcBrnoptysis  and  epilepsy. 

SENEGA   (U.  S.  Ph.),   senegm  radix  (Br. 
Ph.),  radix  senegm  (Ger.  Ph.),  is  the  root  of 
Polygala  Senega,  a  polygaleous  plant  indige- 
nous to  nearly  all  parts  of  the  United  States 
east  of  the   Rocky  Mountains.     It  contains 
senogin  (saponin),  a  fixed  oil,  a  resin,  and  a 
small  amount  of  a  volatile  oil  composed  of 
valerianic  ether  and  methyl  salicylate.     It  is 
chiefly  employed  as  a  stimulating  expectorant 
in   bronchitis  after  the  subsidence  of    acute 
symptoms  and  in  the  stage  of  resolution  of 
pneumonia.    It  was  originally  thought  to  be  a 
remedy  for  the  bite  of  the  rattlesnake,  whence 
its  common  name  of  senega,  or  seneka,  snake- 
root.    It  is  contra-indicated  in  cases  of  gastric 
or  intestinal  disturbance,  and  its  use  should 
not  be  long  continued.     The  dose  of  the  powder 
is  from  10  to  20  grains ;  that  of  the  fluid  ex- 
tract, extractum  senegce  fluidum  (U.  S.  Ph.), 
from  1  to  5  minims;  that  of  the  infusion,  in- 
fusum  senegce  (Br.  Ph.),  from  1  to  2  fl.  oz. ; 
that  of  the  tincture,  tinciura  seneg(B  (Br.  Ph.), 
from  1  to  2  fl.  drachms ;  and  that  of  the  syrup, 
syrupus senegce  (U.  S.  Ph.),  sirupus  senegce  (Ger. 
Ph.),  from  1  to  2  fl.  drachms. 
SENEGIN.— See  Saponin. 
SENEKA.— See  Senega. 
SENNA.— Under  this  name  the  U.  S.  Ph. 
includes  the  leaflets  of  Cassia  acutifolia  and 
those  of  Cassia  angustifolia ;  the  Br.  Ph.  des- 
ignates the  dried  leaflets  of  the  first  named 
species  as  senna  alexandrina  and  those  of  the 
other  species  as  senna  indica;   the  Ger.  Ph. 
recognises  the  leaflets  of  both  as  folia  senncB. 
Of  all  purgatives,  senna  is  perhaps  the  one 
most  commonly  employed  for  the  simple  pur- 
pose of  overcoming  constipation.     The  leaves 
lose  their  cathartic  properties  to  a  very  great 
extent  if  they  are  kept  for  a  long  time,  and 
they  do  not  yield  them  readily  to  alcohol,  so 
that  alcoholic  preparations  of  "the  drug  are  in 
general  to  be  avoided.    Senna  acts  simply  by 
increasing  peristalsis,  producing  soft  but  not 
watery  evacuations.     With  some  persons  it  is 
apt  to  cause  griping,  and  in  most  cases  it  will 
do  so  if  given  in  doses  rather  larger  than  are 
needed.     It  usually  operates  in  from  five  to 
seven  hours.     Pronounced  gastric  or  intestinal 
inflammation  is  the  only  contra-indication  to 
its  use.     The  dose  of  good  senna  in  powder  is 
from  15  to  30  grains,  but  it  is  seldom  ordered 
in  that  form.     The  compound  infusion,  infu- 
sum  senncB  compositum  (U.  S.  Ph.,  Ger.  Ph.), 
may  be  given  in  doses  of  from  J  to  3  fl.  oz. 
The  dose  of  the  fluid  extract,  extractum  sennce 


^_ m  (U.  S.  Ph.),  is  from  J  tol  fl.  drachm; 

that  of  the  tincture,  tinctura  sennm  (Br.  Ph.), 
is  from  1  to  4  fl.  drachms.  The  dose  of  the 
syrupus  sennce  of  the  U.  S.  Ph.  is  from  2  to  4 
fl.  drachms  ;  that  of  the  syrupus  sennce  of  the 
Br.  Ph.  and  of  the  sirupus  sennce  of  the  Ger. 
Ph.  is  from  1  to  4  fl.  drachms.  Confections 
and  electuaries  are  held  in  high  favour  among 
the  preparations  of  senna.  The  confectio  sennce 
of  the  U.  S.  Ph.  is  made  with  100  parts  of  pow- 
dered senna,  160  of  bruised  cassia  fistula,  100 
of  tamarind  pulp,  70  of  sliced  prunes,  120  of 
bruised  figs,  555  of  powdered  sugar,  5  of  oil  of 
coriander,  and  enough  water  to  make  1,000. 
The  dose  is  from  1  to  2  drachms.  In  addition 
to  the  ingredients  mentioned,  the  confectio 
sennai  of  the  Br.  Ph.  contains  extract  of  licor- 
ice ;  the  dose  is  the  same  as  that  of  the  U.  S. 
preparation.  The  electuarium  e  senna  of  the 
Ger.  Ph.  is  made  from  1  part  of  powdered  sen- 
na, 4  parts  of  syrup,  and  5  parts  of  tamarind 
pulp  ;  the  dose  is  from  2  to  4  drachms.  The 
compound  mixture  of  senna,  or  black  draught, 
mistura  sennce  composita  (Br.  Ph.),  is  made 
with  4  parts  of  magnesium  sulphate,  1  fl.  part 
of  liquid  extract  of  licorice,  2J  fl.  parts  of 
tincture  of  senna,  IJ  fl.  part  of  compound 
tincture  of  cardamom,  and  15  fl.  parts  of  infu- 
sion of  senna.  The  dose  is  from  1  to  1^  fl.  oz. 
Senna  is  the  chief  purgative  ingredient  of  the 
compound  licorice  powder  (see  vol.  i,  page  581). 

SEPTENTRIONALINE.— According  to 

Professor  Virgil  Coblentz  {Newer  Remedies, 
New  York,  1896),  this  is  an  alkaloid  obtained 
from  Aconitum  septentrionale,  which  has  been 
recommended  (in  doses  not  stated)  in  the  treat- 
ment of  strychnine  poisoning,  tetanus,  and 
rabies. 

SEaUARDINE.— This  name  has  been 
given  to  two  different  medicinal  substances : 
1.  The  sterilized  testicle  extract  recommended 
by  the  late  Dr.  Brown-S^quard  (see  Animal 
EXTRACTS  AND  JUICES).  2.  A  mixture  of  vari- 
ous glycerophosphates  proposed  as  a  substitute 
for  testicle  juice. 

SEBO-THEBAPY.— See  Serum  theeapt. 

SEE.PENTAEIA  (U.  S.  Ph.),  serpentarice. 
rhizoma  (Br.  Ph.),  Virginia  snakeroot,  accord- 
ing to  the  U.  S.  Ph.,  is  the  dried  rhizome  and 
rootlets  of  Aristolochia  Serpentaria  and  Aris- 
tolochia  reticulata.  The  Br.  Ph.  recognises 
only  the  first  of  these  two  plants.  Serpentaria 
is  a  mild  tonic  and  is  occasionally  used  as  a 
remedy  for  intermittent  fever,  given  during  the 
chill,  in  a  dose  of  from  8  to  20  grains  ;  also  in 
dyspepsia.  The  dose  of  the  infusion,  infusum 
serpentaria)  (Br.  Ph.),  is  from  1  to  2  fl.  oz. ; 
that  of  the  tincture,  tinctura  serpentarice 
(U.  S.  Ph.,  Br.  Ph.),  from  i  to  2  fl.  drachms ; 
that  of  the  fluid  extract,  extractum  serpentarice 
flmdum  (U.  S.  Ph.),  from  15  to  30  minims. 

SEBPYI-LUM,  herha  serpylK  (Ger.  Ph.). 
—Wild  thyme  (see  under  Thyme). 

SEBTJM.— This  constituent  of  the  blood 
seems,  even  in  its  normal  condition— that  is  to 
say,  when  its  constitution  has  not  been  modi- 
fied by  the  action  of  any  toxine— to  be  possessed 
of  an  antitoxic  power,  and  probably  this  assists 


163 


SENEGA 
SERUM. 


in  the  prophylactic  and  curative  action  of  the 
antitoxine  treatment.  Indeed,  the  normal 
serum  of  certain  animals  has  been  used  with 
alleged  benefit  in  the  treatment  of  disease. 
For  its  use  in  cancer,  see  under  Serum  teeat- 
MENT.  In  the  Medical  Record  for  July  11, 
1896,  Dr.  J.  A.  Dunwody,  of  Cripple  Creek, 
Colorado,  reports  four  cases  of  pulmonary 
tuberculosis,  including  that  of  himself,  in 
which  subcutaneous  injections  of  horse  serum 
were  used.  In  three  of  them  much  benefit 
seemed  to  ensue.  Dr.  Dunwody  gives  the  fol- 
lowing account  of  his  own  case :  He  was  at- 
tacked when  he  was  thirty  years  old.  On  July 
26,  1895,  a  physical  examination  showed  the 
upper  two  thirds  of  the  left  lung  to  be  infil- 
trated ;  numerous  moist  rales  could  be  heard 
throughout  this  portion,  and  there  was  expec- 
toration of  a  muco-purulent  character,  about 
two  ounces  during  the  twenty-four  hours.  His 
weight  was  a  hundred  and  twenty-five  pounds. 
Micro.scopic  examination  showed  tubercle 
bacilli.  The  range  of  temperature  was  from 
99°  to  100°  P.,  and  this  continued  until  August 
2d,  when  he  was  attacked  with  acute  pleurisy 
on  the  left  side,  which  confined  him  to  bed  lor 
ten  days.  The  temperature  ranged  then  from 
100°  to  102-5°  for  a  week,  after  which  time  it 
was  from  99°  to  100°  until  September  18th, 
when  it  became  98"5°  P.  The  injections  of 
serum  were  begun  on  July  26,  1895,  with 
10  millimetres  and  rapidly  inci'eased  to  45 
millimetres,  and  were  then  reduced  to  30 
millimetres,  which  quantity  was  maintained 
continuously,  notwithstanding  the  attack  of 
pleurisy,  until  December  24th,  at  which  time 
a  small  abscess  was  produced,  owing  to  the 
want  of  proper  care  by  the  physician  giving 
the  injection.  His  weight  at  this  time  had  in- 
creased to  a  hundred  and  forty-three  pounds ; 
the  expectoration  had  nearly  ceased  so  that 
there  was  not  enough  for  microscopical  exami- 
nation. Physical  examination  revealed  the 
absence  of  all  rales ;  there  was  clear  vesicular 
respiration  throughout  the  affected  portion  of 
the  lung,  though  it  was  somewhat  weak  in 
character.  The  right  lung  was  not  affected  at 
all.  On  March  24,  1896,  he  was  attacked  with 
influenza,  and  during  the  time  it  lasted  his 
weight  was  reduced  to  a  hundred  and  thirty- 
four  pounds  and  the  cough  returned  for  a 
short  while,  with  loss  of  appetite,  etc.  On 
April  13th  he  resumed  the  daily  injection  of 
80  millimetres  of  serum,  with  a  resulting  in- 
crease of  weight  of  two  pounds  and  the  cessa- 
tion of  the  cough  at  the  time  of  the  report, 
April  23d.  He  adds :  "  I  have  used  no  other 
treatment  at  all — the  injections  of  serum  alone. 
This  point  in  my  case  proves  conclusively  the 
great  mistake  of  stopping  the  use  of  the  serum 
too  soon,  or  before  the  lung  tissue  has  been 
restored  to  its  full  strength  and  vitality." 

Dr.  0.  Reinaoh,  of  Munich  (Munchener  w,ed. 
Woch.,  May  5,  1896),  reports  on  the  use  of 
cow's  serum  in  the  summer  diarrhoea  of  chil- 
dren. In  fifteen  cases  of  cholera  infantum  he 
employed  subcutaneous  injections  of  the  serum- 
in  doses  of  from  10  to  30  cubic  centimetres. 
Pour  of  the  patients  died ;  two  had  a  concom- 
itant broncho-pneumonia,  and  _two  a  follicular 


gastro-enteritis  of  long  standing.  The  efEect 
of  the  injections  manifested  itself  ordinarily 
in  from  six  to  eight  hours  after  the  adminis- 
tration of  the  serum,  and  from  that  time  the 
temperature  gradually  rose,  the  extremities 
became  warm,  the  cyanosis  gave  place  to  a 
rosy  tint  of  the  skin,  and  the  diarrhoea  was 
arrested.  This  condition  generally  continued 
on  the  following  day,  and  recovery  usually 
occurred  after  one  injection  only.  In  some 
cases,  however,  a  second  injection  was  neces- 
sary in  order  to  maintain  the  good  results 
which  were  obtained  by  the  first  one.  Besides 
these  injections,  rice  water  was  given.  The 
author  states  that,  from  a  nutritive  point  of 
view,  twenty  cubic  centimetres  of  assimilable 
serum  are  equivalent  to  five  ounces  of  cow's 
milk,  or  to  an  ounce  and  a  half  of  the  mother's 
milk.  At  the  time  of  making  the  report,  Dr. 
Reinach  was  continuing  the  serum  treatment, 
but  was  using  horse  serum. 

Antistreptococcic  serum.  —  See  under 
Serum  treatment. 

Artificial  serum  was  used  as  long  ago  as 
in  1855  by  the  late  Dr.  Edmond  R.  Peaslee  in 
the  performance  of  ovariotomy.  It  was  com- 
posed of  4  drachms  of  sodium  chloride,  6 
drachms  of  white  of  egg,  and  4  pints  of  water. 
"  It  is  intended,"  says  Dr.  Peaslee,  "  to  imitate 
the  natural  secretion  of  the  peritoneum,  and  is 
kept  at  a  blood-heat,  and  used  to  thoroughly 
moisten  the  operator's  hands  before  they  are 
introduced  into  the  peritoneal  cavity." 

M.  Mengus  {Independance  medicale,  July  22, 
1896 ;  Revue  internationale  de  medecine  et  de 
chirurgie,  September  10, 1896)  relates  a  case  of 
hydrocele  of  the  tunica  vaginalis  testis  that  had 
relapsed  after  the  employment  of  an  injection 
of  tincture  of  iodine.  It  was  cured  by  inject- 
ing a  boiled  and  filtered  0-7-per-cent.  solution 
of  sodium  chloride  at  the  temperature  of  104° 
P.  He  relates  also  a  case  of  ascites  in  a  patient 
with  heart  disease.  Paracentesis  had  had  to 
be  performed  six  times  in  the  course  of  five 
months,  and  the  man  was  becoming  cachectic. 
The  seventh  puncture  was  followed  by  the  in- 
jection of  about  a  quart  of  the  same  solution 
at  the  same  temperature.  After  massage,  about 
three  quarters  of  the  amount  was  withdrawn. 
The  patient  regained  his  general  health,  and  at 
the  time  of  the  report,  three  months  afterward, 
no  further  effusion  had  taken  place. 

Internally,  artificial  serum  has  been  used  as 
a  tonic,  especially  in  cases  of  neurasthenia,  and 
as  a  restorative  in  cases  of  acute  anwmia  from 
hcemorrhage ;  it  is  injected  subcutaneously  or 
into  a  vein  by  infusion  (see  under  Transfu- 
sion). The  following  is  Sir  Benjamin  Ward 
Richardson's  formula : 

White  of  egg 1  oz. ; 

Sodium  chloride 1  drachm  ; 

Sodium  phosphate 20  grains ; 

Clarified  animal  fat 1  oz. ; 

Glycerin 2  oz. ; 

Water,  enough  to  make  a  pint. 

Hayem's  formula  is  as  follows : 

Sodium  sulphate 10  parts ; 

Pure  sodium  chloride 5       " 

Sterilized  distilled  water...  1,000  " 


SERUM 


164 


This  solution,  heated  to  the  normal  tempera- 
ture of  the  blood,  is  injected  into  the  internal 
saphenous  vein,  to  the  amount  of  2  quarts,  in 
cases  of  Asiatic  cholera, 

Huchard's  formula  is  as  follows  : 

Pure  carbolic  acid 7J  grains ; 

Sodium  chloride 30      " 

Sodium  sulphate 60      " 

Sodium  phosphate 130      " 

Distilled  water 35  drachms. 

Thirty  minims  of  Huchard's  solution  are  in- 
jected subcutaneously  three  times  a  week. 

Cheron's  solution  is  prepared  according  to 
the  following  formula : 

Pure  carbolic  acid 15  grains ; 

Sodium  chloride 30      " 

Sodium  sulphate 120      " 

Sodium  phosphate 60      " 

Distilled  water 35  drachms. 

In  cases  of  neurasthenia  of  moderate  severi- 
ty, from  75  to  150  minims  of  Cheron's  solution 
are  injected  subcutaneously,  behind  the  tro- 
chanter major,  every  second  or  third  day ;  in 
grave  cases,  every  day. 

At  a  meeting  of  the  Paris  Academy  of  Medi- 
cine held  on  June  30,  1896  {Gazette  hebdoma- 
daire  de  medecine  et  de  chirargie,  July  2, 1896), 
several  speakers  mentioned  the  good  effects  of 
subcutaneous  and  intravenous  injections  of 
artificial  serum  in  septiccemia  after  operations, 
in  anmmia,  and  in  shock.  The  discussion  shows 
how  unsettled  professional  opinion  is  as  to  the 
precise  value  of  injections  of  artificial  serum 
and  on  the  question  of  their  being  dangerous 
when  thrown  into  a  vein,  but,  on  the  whole,  as 
M.  Pean  puts  it,  there  was  general  agreement 
as  to  the  usefulness  of  subcutaneous  injections 
and  the  precaution  with  which  intravenous  in- 
jections should  be  administered. 

M.  Pozzi  made  a  report  on  M.  Duret's  work 
in  regard  to  the  treatment  of  septicmmia  fol- 
lowing operations  by  means  of  these  injections. 
He  showed  that  the  practice  was  widespread  in 
the  hospitals  of  Paris,  and  said  he  had  con- 
cluded that  this  method  of  treatment  was 
sometimes  very  eflicacious,  and  one  to  be  rec- 
ommended. He  gave  the  preference  to  subcu- 
taneous injections  of  a  solution  of  sea  salt  in 
the  proportion  of  seven  to  a  thousand.  These 
injections,  he  said,  favoured  phagocytosis  and 
diuresis,  which  exerted  a  favourable  influence 
in  certain  forms  of  septiojemia  and  prevented 
a  fatal  result.  M.  Championniere  had  also  ob- 
tained good  results  in  the  treatment  of  anmmia 
*  and  shock,  but  not  in  septicEemia.  He  was  in- 
clined to  doubt  some  of  the  statements  that 
had  been  made,  and  he  thought  intravenous 
injections  were  not  harmless,  and  that,  at  the 
present  day,  there  was  danger  of  the  method 
being  abused.  M.  Dumontpallier  thought  that 
injections  of  ether  were  suifioient,  and  said  he 
would  not  allow  any  surgeon  to  practice  intra- 
venous injections  on  him.  M.  Pinard  stated 
that  he  had  seen  recovery  follow  subcutaneous 
injections  in  seventeen  women  whose  condition 
had  been  such  that,  before  the  employment  of 
this  method,  death  would  probably  have  re- 
sulted. M.  Tarnier  also  had  obtained  good 
results  in  oases  in  which  by  the  old  method  of 


treatment  death  would  certainly  have  resulted. 
M.  Reclus  stated  that  he  had  experimei^ted  with 
intravenous  injections  on  a  boy  who  had  rabies. 
The  treatment  had  not  been  begun  until  two 
weeks  after  the  boy  had  been  bitten,  but  an  in- 
jection of  nearly  5  ounces  had  seemed  to  quiet 
the  patient,  who  died,  however,  two  hours  later. 

Subsequently,  at  a  meeting  of  the  Societe  de 
biologic  (Journal  des  praticiens,  July  25, 1896), 
M.  Bosc  and  M.  Vedel  presented  the  following 
conclusions :  1.  Large  intravenous  injections 
of  a  simple  saline  solution  are  not  toxic,  in 
spite  of  their  quantity  and  the  rapidity  with 
which  they  are  given — from  45  to  83  cubic 
centimetre's  a  minute.  3.  The  physiological 
effects  of  these  large  injections  are  not  in  pro- 
portion to  the  temperature  of  the  solution  and 
the  rapidity  with  which  the  injection  is  made. 
3.  These  injections  produce  an  abundant  di- 
uresis, which  occurs  half  an  hour  after  the 
solution  has  been  injected ;  there  is  no  eleva- 
tion of  the  blood-pressure,  and  there  is  no 
albuminuria ;  but  there  is  acceleration  of  the 
heart  with  an  elevation  of  the  central  and  pe- 
ripheral temperature  which  resembles  that  of 
fever.  4.  A  0'7-per-cent.  solution  of  sodium 
chloride  is  preferable  to  a  0'5-per-cent.  solution. 
5.  Large  intravenous  injections  of  compound 
saline  solution  (chloride  and  sulphate  of  so- 
dium) are  deprived  of  their  harmful  effects  under 
the  same  conditions  as  those  of  the  simple  sa- 
line solution.  6.  There  is  no  difference  between 
the  effects  of  these  two  solutions.  7.  The  addi- 
tion of  sodium  sulphate  to  the  sodium  chloride 
does  not  seem  to  be  useful ;  it  seems  rather  to 
be  prejudicial  to  globular  preservation,  accord- 
ing to  Mayet.  8.  During  a  series  of  injections 
each  individual  injection  has  the  same  effects  ; 
they  are  equally  harmless.  9.  Pasting  animals 
appear  to  be  more  susceptible  than  others  to 
large  intravenous  injections,  but,  in  spite  of  the 
appearance  of  grave  symptoms  during  the  ad- 
ministration of  the  injections,  even  apparent 
death,  the  animals  rapidly  return  to  their  normal 
condition.  10.  The  simple  saline  solution  seems 
to  be  the  preferable  solution  for  intravenous  in- 
jections ;  it  produces  the  minimum  of  harmful 
effects  and  the  maximum  of  physiological  effects. 

In  addition  to  its  restorative  action  in  shock 
and  acute  anmmia  from  loss  of  blood,  artificial 
serum  has  been  thought  to  act  as  a  haemostatic. 

Dr.  L.  Le  Clerc  {JSemaine  mAdicale ;  Sevue 
internationale  de  medecine  et  de  chirurgie, 
June  10, 1896)  relates  the  case  of  a  woman  who 
lost  a  great  deal  of  blood  during  her  third 
pregnancy  and  with  its  termination  in  abor- 
tion. Neither  curetting  of  the  uterus  with 
subsequent  tamponing  nor  the  use  of  drugs 
served  to  cheek  the  haemorrhage,  and  her  con- 
dition became  critical,  as  was  shown  by  her 
shallow  breathing  and  the  im perceptibility  of 
her  pulse.  In  this  emergency  the  author  in- 
jected about  40  cubic  centimetres  of  artificial 
serum  (a  solution  of  1|  drachm  of  sodium 
chloride  and  3  drachms  of  sodium  sulphate  in 
a  quart  of  distilled  water)  into  the  basilic  vein 
and,  in  addition,  rather  more  than  8  oz.  of  the 
same  solution  under  the  skin  of  the  thigh.  The 
activity  of  the  heart  and  of  the  respiration  was 
soon  regained,  the  uterine  hsBmorrnage  ceasec? 


165 


SERUM 


definitively,  and  the  patient  recovered  with 
striking  rapidity.  The  author  accounts  for 
the  hffimostatic  efEect  of  the  inieetions  by  their 
stimulant  action  on  the  vaso-constrictor  nerves. 
M.  Andre  Claisse  {Gazette  medicate  de  Paris, 
September  26,  1896 ;  New  York  Medical  Jour- 
nal, October  31,  1896)  also  has  used  artificial 
serum  in  acute  anaemia  from  heemorrhage,  in 
the  form  of  one  of  the  following  solutions : 

1.  Distilled  water 31  ounces ; 

Sodium  chloride 105  grains. 

2.  Distilled  water 31  ounces ; 

Sodium  chloride,  )       t,     inc 
Sodium  sulphate,  [  «^°^-  ^^^  grams. 

The  solution  should  be  clear  and  without  any 
foreign  substance ;  it  may  be  sterilized  by  being 
submitted  to  a  temperature  of  348°  P.  or  to  a 
boiling  of  twenty  minutes'  duration.  It  should 
be  injected  at  the  temperature  of  the  body,  and, 
as  it  loses  several  degrees  during  manipulation, 
it  should  be  kept  in  a  funnel  at  a  temperature 
of  about  104°.    (See  also  under  Transfusion.) 

M.  Sapelier  (Revue  internationale  de  medecijie 
et  de  chiruryie,  August  10, 1896)  recommends 
injections  of  artificial  serum  in  exanthematous 
typhus.  He  says  they  may  be  employed  for 
patients  of  all  ages  and  conditions  at  any  stage 
of  the  disease.  High  fever  is  the  best  indica- 
tion for  the  employment  of  the  serum  in  typhus, 
and  the  liquid  should  be  at  a  temperature  of 
86°  F.  at  least.  The  advantage  of  this  treat- 
ment over  that  with  cold  baths,  says  M.  Sape- 
lier, lies  in  a  direct  lowering  of  the  temperature 
which  lasts  from  twelve  to  fourteen  hours  on 
an  average.  In  regard  to  the  efEect  on  the  urine, 
it  is  so  striking,  he  says,  that  one  may  tell  by  the 
urine  alone  whether  the  patient  is  undergoing 
the  serum  treatment  or  not.  In  those  who  are 
under  any  other  treatment  the  urine  is  scanty, 
and  all  the  scantier  in  the  graver  cases,  dark- 
coloured,  cloudy,  very  dense,  and  albuminous, 
with  a  considerable  diminution  of  the  amount 
of  urea  excreted,  and  it  is  not  until  late  in  the 
disease  that  there  are  critical  discharges  of 
clear,  limpid  urine  free  from  albumin,  but  still 
charged  with  toxic  products.  On  the  other 
hand,  under  the  serum  treatment  he  has  seen 
the  urine,  from  the  very  beginning  of  the 
course,  passed  in  quantities  as  great  as  from 
four  to  five  quarts  in  twenty-four  hours  and 
clear  and  limpid,  and  that  in  spite  of  the  fact 
that  for  half  the  day  the  temperature  was  ele- 
vated ;  moreover,  the  excretion  of  urea  was  far 
different  in  amount  from  that  seen  in  cases 
treated  on  the  old  plan,  the  albumin  rapidly 
diminished  and  soon  disappeared  altogether, 
and  the  toxines  were  readily  and  rapidly  elimi- 
nated, indeed,  as  fast  as  they  were  produced, 
so  that  the  patients  were  the  better  able  to  re- 
sist the  disease,  and  consequently  the  deaths 
were  fewer.  In  twelve  grave  cases  subjected 
to  the  serum  treatment,  in  ten  of  which  the 
patients  were  aged — a  fact  that  was  much 
against  the  chance  of  their  recovery — a  fatal 
result  occurred  in  only  six,  so  that  it  is  upon 
grave  cases  alone  that  M.  Sapelier  grounds  his 
statement  as  to  the  reduction  of  the  mortality 
from  eighty-five  in  the  aged  and  eighty  as  the 
average  of  the  epidemic  of  1893  to  fifty. 


Dr.  Bassi  (Qazzetta  degli  ospedali,  June  6, 
1896  ;  British  Medical  Journal,  July  18,  1896) 
reports  six  cases  of  severe  acute  pneumonia 
treated  after  the  method  of  Galvagni — that  is, 
by  intravenous  injections  of  a  solution  of 
chloride  and  bicarbonate  of  sodium.  In  each 
case  the  pneumonia  was  double  and  of  a  grave 
type ;  of  the  six  patients,  five  recovered  and 
one  died,  and  at  the  necropsy  double  broncho- 
pneumonia, right  lobar  pneumonia,  and  acute 
nephritis  in  addition  to  an  old  chronic  ne- 
phritis, also  some  mitral  stenosis  were  found. 
With  regard  to  the  other  cases,  the  author  be- 
lieves the  treatment  was  of  material  service. 
The  best  time  to  give  the  injections,  he  thinks, 
is  about  a  day  before  the  expected  crisis,  or 
when  the  pulse  becomes  intermittent,  or,  in 
fact,  upon  any  grave  alteration  in  the  condi- 
tion of  the  patient.  A  small  preliminary 
bleeding  is  useful.  Whether  the  treatment 
acts  by  preventing  coagulation  of  the  blood, 
by  oxygenating  (through  the  incision)  the  ve- 
nous walls  and  acting  in  a  reflex  way  on  the 
circulation,  or  in  some  less-known  manner,  the 
author  is  unable  to  say,  but,  from  his  clinical 
experience  in  its  use,  he  feels  justified  in 
strongly  recommending  it  for  further  trial. 
In  a  footnote  he  refers  to  two  other  cases  in 
which  it  was  tried  by  him  with  success. 

Dr.  Brodier  (Medecine  moderne,  June  18, 
1896 ;  Therapeutic  Gazette,  November,  1896) 
reports  the  case  of  a  patient,  aged  thirty-one 
years,  who  was  brought  to  the  hospital  suffer- 
ing from  asphyxia  due  to  inhalation  of  oxide 
of  carbon  during  the  previous  night.  He  was 
comatose,  and  the  reflexes  were  lost.  Alto- 
gether his  condition  was  exceedingly  grave, 
the  respirations  being  44  a  minute  and  the 
inspirations  short  and  abrupt,  while  the  expi- 
rations were  prolonged.  The  stertor  was  in- 
tense, and  finally  the  respirations  became  53  a 
minute.  There  was  nystagmus,  the  pulse  was 
rapid  and  feeble,  and  the  temperature  was 
normal.  The  condition  of  the  patient  was  so 
grave  that  any  therapeutic  measures  were  con- 
sidered useless,  but  nevertheless  inhalations  of 
oxygen  and  injections  of  ether  were  given. 
After  six  hours  he  was  no  better,  the  coma 
persisted,  and  the  respirations,  while  less  rapid, 
were  still  stertorous ;  nystagmus  was  still 
present.  Under  these  circumstances  a  quart 
of  artificial  salt  solution  was  injected,  at  a 
temperature  a  little  above  that  of  the  body, 
into  the  median  cephalic  vein,  the  operation 
lasting  twenty  minutes.  A  quarter  of  an  hour 
afterward  the  patient  was  seized  with  a  vio- 
lent chill,  and  twice  vomited  bilious-looking 
material,  and  at  the  same  time  broke  out  into 
an  abundant  sweat.  Two  hours  afterward,  as 
the  symptoms  did  not  improve,  another  injec- 
tion of  saline  solution  was  given.  On  cathe- 
terism,  nearly  a  pint  of  clear  liquid,  which 
contained  a  small  quantity  of  albumin  and 
sugar,  was  obtained.  In  four  hours  after  the 
man  was  brought  into  the  hospital  the  trismus 
had  ceased,  the  respirations  were  calm  and 
regular,  and  catheterism  obtained  nearly  a 
quart  of  urine.  The  patient  returned  to  con- 
sciousness, and  complained  of  violent  frontal 
headache  and  great  anorexia.    The  retentioQ 


SERUM  LACTIS 
SERUM  TREATMENT 


166 


of  urine  persisted,  and  there  were  fibrillary 
twitchings  in  the  lower  extremities.  The  gly- 
cosuria did  not  continue,  but  the  albuminuria 
lasted  for  eight  days.  The  patient  left  the 
hospital  completely  cured  in  twelve  days  after 
his  entrance.  Brodier  alludes  to  the  experi- 
ments of  Mororaarco  in  1893,  which  were  made 
after  the  proposal  of  Kuhne,  that  saline  injec- 
tions should  be  used  in  all  forms  of  grave 
poisoning,  and  adds  that  cases  have  been  re- 
ported by  Schreiber,  Bergmann,  and  Praent- 
zel,  of  the  advantage  of  this  method  of 
treatment. 

Cf.  Sodium  phosphate,  under  Phosphokus 
(vol.  ii,  page  79). 

SEBUM  LACTIS.— See  Whet. 

SEKTJM  PASTE. — According  to  Profes- 
sor Coblentz  {Newer  Remedies,  New  Vork, 
1896),  this  is  fresh  serum  from  ox  blood,  thor- 
oughly mixed  with  35  per  cent,  of  zinc  oxide 
and  sterilized  at  a  temperature  of  158°  P.  in  a 
thermostat.  "  When  painted  over  denuded  or 
diseased  surfaces,"  he  says,  "  it  dries  readily, 
leaving  a  film  which  may  be  readily  removed 
by  washing  with  water." 

SERUM  POWDER.— Professor  Coblentz 
(op.  cit.)  says  that  this  is  a  mixture  of  fresh  ox- 
blood  serum  and  35  per  cent,  of  zinc  oxide 
spread  on  glass  plates  and  dried,  then  finely 
powdered,  and  sterilized  at  a  temperature  of 
313'  P.  It  has  been  recommended  as  an  anti- 
septic dusting  powder  to  be  used  alone  or 
mixed  with  some  other  antiseptic. 

SERUM  SUBLIMATE.— This  is  dried 
blood  serum  containing  10  per  cent,  of  corro- 
sive sublimate,  used  in  the  preparation  of  an- 
tiseptic gauze. 

SERUM  THERAPY,  SERUM  TREAT- 
MENT.— The  meaning  of  the  terms  toxine, 
antitoxine,  and  therapy  with  immunized  se- 
rum is  best  understood  by  consideration  of  the 
present  state  of  the  question  of  immunity  and 
the  very  practical  deductions  therefrom. 

We  know  that  there  are  certain  diseases, 
such  as  anthrax,  diphtheria,  and  others,  which 
are  caused  by  specific  micro-organisms.  Each 
of  these  micro-organisms  gives  off  a  special 
toxine.  The  anthrax  bacillus  and  the  diph- 
theria bacillus,  for  example,  do  not  them- 
selves produce  the  effects  we  group  under 
the  titles  anthrax  and  diphtheria ;  the  toxines 
thrown  off  by  the  bacilli  are  the  immediate 
causes  of  these  diseases.  When  a  man  has 
received  the  toxine  of  a  pathogenic  bacterium 
into  his  body  the  physician  does  not  attack 
the  disease  directly ;  he  sustains  the  patient 
until  the  human  organism  has  itself  produced 
'an  antidote  for  the  poison — an  antitoxine  for 
the  toxine.  When  the  antitoxine  has  been 
made  in  quantity  sufficient  to  offset  the 
amount  of  toxine  in  the  system,  recovery 
begins.  Immense  labour  has  been  expended 
in  isolating  various  toxines,  but  the  present  re- 
sults are  very  unsatisfactory.  Hardly  anything 
has  been  ascertained  in  regard  to  antitoxines, 
except  that  they  exist.  Leaving  the  bacte- 
rium in  a  culture  medium,  or  filtering  it  out, 
we  can   precipitate  a  substance  which  gives 


the  reactions  of  albumose  and  of  an  organic 
acid  or  alkali— this  is,  the  toxine.  Beyond 
this,  and  the  fact  that  some,  at  least,  are  en- 
zvmes,  little  is  known.  That  these  precipitated 
substances  are  really  the  specific  toxines  of  the 
bacteria  from  which  they  are  derived,  we  prove 
by  the  effects,  also  specific,  which  they  pro- 
duce upon  animals  inoculated  with  them. 

When  a  human  being  or  one  of  the  lower 
animals  has  enough  antitoxine  in  his  or  its 
blood  serum  to  neutralize  that  quantity  of  the 
toxine  of  a  pathogenic  bacterium  which,  if  not 
controlled,  would  cause  disease  or  death,  the 
man  or  animal  is  said  to  be  "  immune  "  against 
the  poison  of  that  micro-organism.  In  our 
knowledge  of  immunity,  we  are  still  in  the 
stage  of  theory — rather  in  that  stage  where 
there  are  almost  as  many  theories  as  there  are 
writers  upon  the  subject.  Buchner  held  the 
"  theory  of  the  bactericidal  power  of  body  hu- 
mours "  to  explain  recovery  and  immunity.  He 
supposed  that  the  blood  plasma,  the  liquid  of 
exudates,  and  other  body  humours  killed  bacte- 
ria, and  that  afterward  the  leucocytes  removed 
the  dead  micro-organisms.  He  himself  gave 
no  facts  to  prove  his  assertions.  In  1894  he 
modified  his  theory,  and  said  that  the  leuco- 
cytes gathered  in  inflammation  produced  alex- 
mes  which  destroyed  bacteria.  This  seems  to 
be  substantially  the  theory  advanced  by  Han- 
kin,  Kanthack,  and  Hardy,  except  that  they 
maintained  that  the  alexines  were  produced  by 
eosinophile  leucocytes,  an  assertion  refuted  by 
Mesnil.  Chauveau,  in  1880,  formulated  the 
'■retention  theory  " — i.e.,  the  theory  that  im- 
munity exists  by  virtue  of  some  bacterial  prod- 
uct retained  or  deposited  in  the  tissues.  In 
the  same  year  Pasteur  proposed  the  "exhaus- 
tion theory" — that  immunity  is  an  effect 
caused  by  abstraction  from  the  tissues  of  the 
specific  pabulum  of  a  micro-organism.  Both 
these  hypotheses  are  untenable.  The  theory 
most  widely  accepted  at  present  to  explain  im- 
munity is  called  the  "theory  of  cell  excita- 
tion." The  toxine  of  the  bacterium  stimulates 
the  body  cells  to  the  production  of  an  antitox- 
ine. It  seems  to  be  established  that  phagocyto- 
sis, first  indicated  by  Sternberg  and  four  years 
later  developed  by  Metchnikoff,  to  some  extent 
assists  in  the  removal  of  bacteria,  but  prob- 
ably the  presence  of  the  antitoxine  enables  the 
animal  organism  to  eject  the  foreign  substances 
by  means  more  general  than  phagocytosis. 

Immunity  is  acquired  naturally  or  artifi- 
cially. Natural  immunity  is  seen  after  con- 
valescence from  a  bacterial  disease.  Artificial 
immunity  is  produced  by  injecting  into  the 
animal's  body  at  intervals  graded  quantities  of 
a  medium  holding  in  solution  the  toxine  of  a 
bacterium.  The  medium  is  usually  freed  from 
the  micro-organism  itself  by  filtration.  At 
first  a  certain  small  quantity  of  this  toxine,  of 
known  strength,  unmixed  with  any  attenuating 
chemical,  is  injected  into  the  animal,  or  the 
toxine  is  attenuated  with  a  drug — say,  iodine 
trichloride — and,  in  both  methods,  it  is  left  in 
the  circulation  for  a  number  of  days.  In  get- 
ting diphtheria  antitoxine  Roux  does  not  at- 
tenuate with  drugs,  and  the  Germans  also  have 
abandoned  this  method.    The  small  quantity 


167 


SERUM   LACTIS 
SERUM  TREATMENT 


first  injected  does  not  usually  cause  the  animal 
serious  inconvenience,  but  it  is  large  enough  to 
excite  the  body  cells  into  the  foi-mation  of  an 
amount  of  antitoxine  sufficient  to  neutralize 
the  toxine  placed  in  the  circulation.  At  the 
second  injection  a  larger  quantity  of  toxine  is 
given.  The  antitoxine  already  formed  neu- 
tralizes this  larger  quantity  in  part,  and  the 
freshly  stimulated  cells  again  make  more  anti- 
toxine to  neutralize  the  remainder  of  the  tox- 
ine. Thus  the  process  goes  on  until  there  is 
enough  antitoxine  in  the  circulating  serum  to 
render  harmless  a  lethal  dose  of  the  poison. 
The  animal  is  then  said  to  be  "immune." 

"  Immunized  "serum  from  this  animal  may 
be  injected  into  the  circulation  of  another 
animal  suffering  from  the  specific  disease  natu- 
rally produced  by  the  toxine  used  in  the  im- 
munization, and  this  second  animal  is  almost 
immediately  rendered  "  immune,"  not  being 
obliged  to  slowly  build  up  the  antitoxine. 
Behring  calls  the  state  of  the  first  animal 
"  active  artificial  immunity,"  that  of  the  sec- 
ond, "passive  artificial  immunity." 

There  is  immunization,  or  partial  immuniza- 
tion, which  may  be  called  indirect,  as  when 
the  virns  of  vaccinia  "  immunizes  "  wholly  or 
in  part  against  variola,  or  erysipelas  counter- 
acts the  poison  of  infectious  pneumonia,  an 
effect  which  seems  to  have  happened  in  some 
cases.  In  vaccinia  and  variola  no  specific  mi- 
cro-organism has  been  demonstrated,  and  it  is 
not  yet  established  whether  direct  immuniza- 
tion against  the  latter  disease  is  possible,  but 
the  serum  from  calves  which  have  for  a  time 
been  subjected  to  the  action  of  vaccinia  virus 
has  been  tried  upon  small-pox  patients, by  Dr. 
J.  J.  Kinyoun,  of  the  Marine-Hospital  Service. 
The  experimentation  up  to  the  present  time 
has  been  limited  to  very  few  cases,  but  the 
results  obtained  have  been  remarkable.  C'al- 
mette.  of  Paris,  has  also  applied  with  success 
the  principles  of  direct  immunization  to  pro- 
tect animals  against  the  venom  of  the  cobra. 
He  is  now  working  with  the  venom  of  the 
American  rattlesnake,  a  poison  remarkably 
similar  to  the  toxine  of  diphtheria,  and  he 
will  probably  succeed.  Serum  "immunized" 
against  snake  venom  must  be  applied  within 
an  hour  or  two  after  the  bite,  and  this  neces- 
sity will  limit  its  practical  value.  Pasteur's 
immunization  against  rabies  and  anthrax  are 
applications  of  like  principles  ;  the  body  cells 
are  supposed  to  be  stimulated  to  form  antitox- 
ines.  but  in  these  two  cases  a  mild  attack  of 
the  disease  itself  is  induced,  and  the  toxine 
and  antitoxine  are  evolved  simultaneously  in 
the  animal  organism.  Sanarelli  has  studied 
the  immunization  of  animals  against  the  vib- 
rio of  Metchnikoff,  and  he  and  others  have 
worked  in  the  same  way  with  the  bacillus  of 
typhoid  fever.  G-.  and  P.  Klemperer.  Issaef, 
and  Poa  have  experimented  with  the  diplo- 
coccns  of  pneumonia,  and  Pfeiffer,  Wasser- 
mann,  and  Sobernheim  with  cholera.  George 
P.  Nnttall,  an  American,  first  demonstrated 
that  the  bactericidal  virtue  in  the  animal  or- 
ganism lay  in  the  blood  serum.  Two  years 
later  Behring  and  Kitasato  rendered  animals 
"immune"  to  tetanus,  and  at  the  same  time 


Ogata  and  Jasuhara  discovered  that  there  ex- 
isted something  in  the  serum  of  animals  "im- 
mune "  to  anthrax  which  would  protect  other 
animals.  Thus  the  methods  of  immunization 
have  grown  more  perfect  until  the  results  are 
astonishing.  A  detailed  account  of  the  process 
followed  in  immunization  against  diphtheria 
will  be  given  here,  because  this  is  almost  perfect- 
ly elaborated  and  it  is  the  most  valuable  in  its 
application.  These  details  will  make  clear 
what  a  process  of  immunization  signifies. 

To  Behring  should  be  given  the  honour  of 
first  elaborating  a  method  for  immunizing  ani- 
mals against  diphtheria.  Roux's  method, 
which  has  essential  differences,  is  more  prac- 
tical. The  immunizing  serum  is  obtained  in 
about  three  months  by  the  French  method, 
whereas  with  the  (lerman  methods  from  six  to 
eight  months  are  requii'ed.  Dr.  J.  J.  Kinyoun, 
passed  assistant  surgeon  in  the  United  States 
Marine-Hospital  Service,  published  a  remark- 
able paper  in  the  Abstract  of  Sanitary  Reports 
(No.  51,  vol.  ix,  December  21,  1894)  giving  a 
complete  account  of  the  German  and  French 
methods  of  immunizing  against  diphtheria,  and 
the  results  obtained.  This  knowledge  was  pro- 
cured directly  from  Professor  Roux,  Professor 
Behring,  and  Dr.  Aronson.  and  the  paper,  to- 
gether with  information  given  by  Dr.  Kinyoun 
personally,  will  be  used  in  describing  the  manu- 
facture and  employment  of  the  serum. 

The  animal  now  chosen  for  immunization, 
after  trial  of  many  others,  is  the  horse.  A 
horse  should  not  be  more  than  nine  years  of 
age,  and  it  should  be  constitutionally  sound. 
If  it  has  defects  which  are  merely  local,  these 
do  not  lessen  its  worth.  A  high-bred  horse 
does  not  bear  the  injections  well.  During 
the  process  of  the  immunization  the  animal 
needs  gentle  exercise,  but  it  must  not  be  put 
to  work,  and  this  holds  true  while  the  state  of 
immunization  is  kept  up. 

When  a  horse  has  been  selected,  mallein  is 
injected  to  test  for  latent  glanders.  The  tem- 
perature is  taken  in  the  rectum  every  two 
hours  for  two  days,  and  it  there  is  no  elevation 
of  the  bodily  heat,  no  oedema,  anorexia,  or 
sluggishness,  the  animal  is  considered  free 
from  glanders.  Professor  Klebs,  in  a  recent 
article  in  an  American  medical  journal,  says 
the  mallein  test  is  not  reliable,  especially  in 
latent  cases  of  glanders.  De  Schweinitz,  of 
Washington,  in  a  series  of  1,000  cases,  found  it 
somewhat  unsatisfactory  in  only  two.  It  is  es- 
pecially valuable  in  latent  cases,  and,  even  if  it 
were  not  reliable,  the  serum  is  filtered  before 
it  is  used  upon  the  human  subject,  and  there 
is  no  danger  of  transmitting  glanders.  After 
the  mallein  test  the  horse  is  permitted  to  rest 
for  a  day  or  two,  and  then  an  injection  of  tu- 
berculin is  given  to  test  for  tuberculosis.  The 
temperature  is  taken,  and  the  general  condi- 
tion is  noted  as  during  the  mallein  test.  After 
another  period  of  rest,  a  day  or  two,  the  hypo- 
dermic or  intravenous  injections  of  the  diph- 
theria toxine  are  begun.  The  German  serum 
is  as  good  as  the  French,  but  the  German 
methods  of  preparing  it  are  so  slow  that  only 
the  French  method  will  be  given  here. 

The  preparation  of  the  toxine  is  one  of  the 


SERUM  TREATMENT 


168 


most  arduous  stages  in  the  process.  A  flask 
containing  alkaline  1-per-cent.  peptone  broth 
is  inoculated  with  a  looped  needle  from  a  cul- 
ture of  diphtheria  bacilli  strong  enough  to 
kill  a  500-gramme  guinea-pig  in  at  least  thir- 


FiG.  1.— A  Fembaeh  flask. 

ty-six  hours.  The  flask  is  left  in  the  thermo- 
stat for  twenty-four  hours  at  36°  C.  (96-8°  F.), 
that  the  bacilli  may  begin  to  multiply.  This 
stock  growth  is  then  used  to  inoculate  broth 
in  Pernbach  flasks,  in  which  the  toxine  is  to  be 
formed.  The  Pernbach  flask  (a.  Pig.  1)  has  a 
neck,  a  foot  in  length,  constricted  to  hold  a 
cotton  stopper,  and  the  flat-bottomed  body  is 
four  inches  high  and  eight  inches  in  diameter ; 
one  inch  from  the  bottom  there  is  a  three-inch 
tube  inserted,  which  is  also  constricted  for  a 
ootton  plug.  It  is  an  improvement  to  have 
this  side-tube  bent  at  a  right  angle  to  prevent 


are  left  in  the  thermostat  twenty- four  hours  at 
37°  C.  (98-0°  P.),  that  the  growth  may  begin. 
Then  rubber  tubing  is  passed  through  holes  in 
the  thermostat  and  connects  the  side-tabe  of 
the  Fernbach  flask  with  an  ordinary  water  vac- 
uum-pump. A  wash-bottle  is  joined  to  the 
neck  of  the  flask.  The  vacuum-pump  draws  a 
current  of  air  through  the  wash-bottle  and 
over  the  surface  of  the  culture  medium.  This 
process  is  continued  uninterruptedly  for  three 
weeks,  the  thermostat  always  at  a  temperature 
of  37°  C.  (98-6°  P.).  The  wash-bottle  prevents 
evaporation  of  the  bouillon.  Dr.  Pernbach, 
assistant  to  Professor  Duclaux,  discovered  that 
a  current  of  air  favoured  the  growth  of  the 
diphtheria  bacillus,  possibly  by  removing  in- 
hibitory volatile  products 
and  by  supplying  oxygen. 
If  bacteria  are  placed  under 
circumstances  unfavour- 
able to  growth  they  give 
off  but  little  toxine,  but 
when  the  medium  and  gases 
are  supplied  adequately, 
these  micro-organisms  take 
on  a  rapid  growth  which  ends  in  prolifera- 
tion and  abundant  production  of  toxine.  At 
the  end  of  three  or  four  weeks  the  bouillon 
in  the  Pernbach  flasks  contains  masses  of  par- 
tially or  wholly  disintegrated  bacilli  and  it  is 
thoroughly  impregnated  with  toxine. 


FiQ.  3.— A  Martin  toxine  bottle. 

The  cultures  in  the  Pernbach  flasks  are 
next  filtered.  A  sixty-degree  500-c.  cm.  cop- 
per funnel,  containing  filter  paper,  is  attached 
to  a  Chamberland  bacteriological  filter  (Pig.  8). 
These  are  joined  by  rubber  tubing  to  a  globu- 

\_H_^  .  „  1^  lar  flask.     The  flask  has  a  filling  tube  at  the 

I  j\    J— — ■ —  (|«         /feisv^  bottom  and  a  tube  at  the  top  which 

X^g^^  ^^^^P^^*==— *    is  to  be  connected  with  the  water 

^^  vacuum-pump.    At  the  side  of  the 

Fia.  2.— A  Chamberland  bacteriological  filter.  ^^^^  Va&n  is  a  sealed  tube  which 

may  be  broken  open  when  the  con- 
tents of  the  flask  are  to  be  drawn  off  into 
the  cotton-stopped  250-c.  cm.  storage  bot- 
tles (a,  Pig.  3),  which  also  have  sealed  side- 
tubes. 
Everything    being  sterile,    the    culture    is 


spilling  of  the  culture.  The  Pernbach  flasks 
are  filled  up  to  near  the  side-tube  with  alka- 
line peptone  bouillon  and  sterilized  in  steam ; 
after  this  they  are  inoculated,  each  with  about 
40  c.  cm.  of  the  stock  growth  of  bacilli,  and 


169 


SERUM  TREATMENT 


poured  from  the  Fernbach  flask  into  the  filter 
and  the  vacuum-pump  rapidly  aspirates  the 
toxine  in  solution  over  to  the  globular  flask, 
leaving  all  the  bacilli  behind.  When  the  globu- 
lar flask  is  full,  the  drainage-tube  at  the  side 
is  nipped  and  the  toxine  drawn  into  the  ster- 
ile storage  bottles.  The  virulence  of  the  toxine 
is  then  tested,  and  if  O'l  c.  cm.  will  kill  a  500- 
gramme  guinea-pig  within  twenty-four  hours 
the  toxine  is  considered  most  suitable  for  effect- 
ing immunization. 

The  horse,  which  has  already  been  tested  for 
glanders  and  tuberculosis,  is  prepared  for  in- 
oculation by  having  a  spot  of  about  the  size  of 
a  man's  palm  on  the  shoulder  clipped  bare  of 
hair  and  disinfected.  The  toxine  is  carried  in 
a  Martin  toxine  bottle  (Pig.  3).  This  is  a  bot- 
tle arranged  like  a  wash-bottle.  The  air-vent 
is  stopped  with  cotton  and  the  tube  that  runs 
into  the  toxine  solution,  and  through  which 
the  toxine  is  sucked  into  the  injection  syringe, 
ends  in  a  small  rubber  tube  which  fits  the 
nozzle  of  this  syringe.  There  is  a  pinch-cock 
on  the  rubber,  and,  of  course,  the  entire  appa- 
ratus is  sterile.  The  Germans  use  the  Koch 
injection  syringe.  The  Roux  syringe  has  a 
glass  barrel  with  rubber  washers  and  metal 
fittings,  and  the  piston-head  is  shaped  like  a 
spool,  the  flanges  of 
■which  are  rubber  and 
the  body  of  which  is 
metal  (Pig.  4).  This  pis- 
ton fits  snugly,  and  it 
can  easily  be  kept  clean. 
It  is  lubricated  with 
sterile  talc.  The  needles 
Fi3. 4.-A  Roux  syringe.  ^^^  °^  platino-iridium,  a 
composition  nearly  as 
rigid  and  elastic  as  steel,  and  one  which  may 
be  sterilized  in  the  flame. 

Por  the  first  injection  0'5  e.  cm.  of  toxine  is 
given.  This  toxine  is  not  attenuated  with  any 
drug,  and  it  is  selected  from  a  specimen  O'l  c. 
cm.  of  which  will  kill  a  500-grarame  guinea- 
pig  in  twenty-four  hours.  The  injections  are 
always  made  under  the  skin,  not  into  a  muscle. 
The  horse's  temperature  is  taken  in  the  rectum 
twice  a  day ;  its  respiration  must  be  watched, 
and  signs  of  oedema,  anorexia,  or  any  abnormal 
condition  are  noted.  On  some  horses  even  the 
initial  injection  has  a  bad  general  effect,  and 
usually  there  is  considerable  local  and  general 
reaction — oedema  and  inflammation  at  the  spot 
of  injection,  and  a  rise  of  one  or  two  degrees 
C.  in  temperature.  There  may  be  anorexia, 
also  muscular  spasm  or  twitching.  On  the 
eighth  day  1  c.  cm.  is  given,  and  on  the  four- 
teenth day  1'5  c.  cm.  If  the  horse  should  be- 
come very  ill  after  any  of  these  doses,  a  small 
quantity  of  Gram's  solution  is  added  to  the 
toxine  (1  part  of  Gram's  solution  to  2  parts  of 
toxine)  to  attenuate  it  before  injection.  After 
the  second  dose,  the  animal  usually  bears  the 
toxine  with  little  or  no  discomfort.  It  is 
impossible  to  give  a  universal  rule  for  the 
quantity  used  and  the  intervals  to  be  observed 
in  the  injections.  The  general  and  local  reac- 
tions must  always  be  considered,  and  a  new 
injection  should  not  be  attempted  till  these 
subside.    A  general  plan,  subject  to  consider- 


able change,  of  course,  might  be  presented  as 
follows : 

Pirst  day,  0'5  c.  cm. 

Eighth  day,  1  c.  cm. 

Fourteenth  day,  1-5  c.  cm. 

Twentieth  day,  3  c.  cm. 

Twenty-eighth  day,  3  c.  cm. 

Thirty-third  day,  5  c.  cm. 

Thirty-eighth  day,  8  c.  cm. 

Forty-third  day,  10  c.  cm. 

Forty-seventh  day,  20  e.  cm. 

Pifty-flrst  day,  30  c.  cm. 

Fifty-sixth  day,  50  c.  cm. 

Sixty-second  day,  50  c.  cm. 

Sixty-eighth  day,  60  c.  cm. 

Seventy-fourth  day,  100  c.  cm. 

Eightieth  day,  250  c.  cm. 

Eighty-eighth  day,  250  c.  cm. 

Usually,  after  two  months  the  toxine  causes 
only  local  cedema,  which  may  be  very  large, 
but  this  subsides  within  a  day  or  two.  Near 
the  end  of  the  third  month  the  horse's  serum 
is  fit  for  use.  Blood  is  drawn  from  the  jugu- 
lar vein  by  means  of  a  trocar  and  cannula.  The 
trocar  should  be  about  8  inches  in  length, 
its  cannula  about  5  inches  long  and  nearly  -^g 
of  an  inch  in  diameter.  The  cannula  has  a 
stopcock  on  it  which  is  used  when  the  slow  in- 
travenous method  of  injecting  the  toxine  is 
followed.  A  short  metal  tube,  which  fits  into 
the  cannula  after  the  trocar  has  been  with- 
drawn, is  fastened  to  a  rubber  tube  a  foot  and 
a  half  in  length  ;  and  into  the  other  end  of  the 
rubber  tube  is  inserted  a  glass  tube  about  4 
inches  long.  Wide-mouthed  2,500-o.  cm. bottles 
are  used  to  catch  the  blood.  A  piece  of  paper 
is  tied  over  the  mouth  of  each  bottle  and  a 
paper  hood  is  placed  upon  this.  The  trocar 
and  tubes  are  sterilized,  and  then  kept  in  a  5- 
per-eent.  carbolic-acid  solution.  The  blood 
bottles  are  sterilized  separately.  A  spot  over  the 
horse's  jugular  vein  is  clipped  bare  of  hair,  the 
animal  is  blindfolded,  and  a  twitch  is  put  upon 
its  upper  lip.  The  bared  spot  is  disinfected 
with  a  5-per-cent.  carbolic-acid  solution.  A 
cut  is  made  through  the  skin,  the  jugular  is 
compressed  by  the  hand  to  make  it  prominent, 
then  the  trocar  is  pushed  into  the  vein,  the 
point  downward.  An  assistant  removes  the 
paper  hood  on  the  blood  bottle,  leaving  the 
paper  cover,  through  which  he  plunges  the 
glass  end-tube.  Then  the  trocar  is  withdrawn 
and  the  rubber  tube  is  attached  to  the  cannula. 
From  6  to  8  litres  (nearly  2  gallons)  of  blood 
are  drawn  from  a  horse  at  one  bleeding.  The 
blood  is  allowed  to  coagulate,  and  then  the  bot- 
tles are  put  into  an  ice-chest.  Within  twenty- 
four  hours  the  serum  will  have  separated,  and 
from  21  to  3  litres  are  obtained  from  the  6 
litres  of  blood.  This  serum  is  drawn  off  with 
sterile  Pasteur  filling  pipettes  and  put  into 
storage  bottles.  It  may  be  first  run  through  a 
Chamberland  filter.  To  kill  any  organisms 
which  may  have  dropped  into  it,  a  bit  of  gum 
camphor  is  put  into  each  storage  bottle.  The 
camphor  is  first  lighted  to  sterilize  its  surface, 
the  flame  is  extinguished,  and  the  piece  is 
dropped  into  the  serum.  The  serum  will  keep 
for  two  or  three  months  without  deterioration, 
if  not  exposed  to  light  or  variations  of  tern- 


SERUM  TREATMENT 


170 


perature.  It  may  be  desiccated  in  vacuo,  but 
it  then  loses  strength,  and  it  causes  irritation 
when  injected  subcutaneously. 

After  the  serum  is  separated  from  the  coagu- 
lum  its  strength  is  tested,  and  this  test  must 
be  repeated  after  each  bleeding.  The  French 
choose  a  young  guinea-pig,  as  near  500  grammes 
in  weight  as  possible,  and  weigh  it.  They  inject 
1  c.  cm.  of  the  serum  Just  obtained  from  the 
horse,  and  twelve  hours  later  0'3  c.  cm.  of  a 
toxine  which,  if  uncontrolled,  would  in  such  a 
dose  kill  a  guinea-pig  of  this  weight  in  at  least 
thirty  hours.  If  the  serum  is  strong  enough  in 
antitoxine  for  use  upon  the  human  subject, 
there  will  be  no  constitutional  effect  or  local 
cedema  observable  in  the  guinea-pig ;  if  the 
serum  is  too  weak,  there  will  be  at  least  oedema 
at  the  point  of  inoculation  within  twenty-four 
hours.  In  the  latter  event  another  guinea-pig 
must  be  used  and  a  larger  quantity  of  the 
serum  given,  and  so  on,  until  the  specimen  of 
serum  is  standardized  for  dose.  If  it  is  very 
weak  it  is  rejected. 

A  horse  may  be  kept  "  immune  "  indefinitely 
by  fresh  doses  of  toxine — 25  to  40  c.  cm.  every 
other  day,  and  a  200-c.  cm.  dose  about  three 
days  before  bleeding.  If  the  toxine  injections 
are  discontinued,  the  horse  reverts  to  its  origi- 
nal susceptibility.  About  6  litres  of  blood  may 
lie  drawn  from  the  "immune"  horse  every 
three  weeks,  giving  nearly  seventy-five  doses 
of  immunizing  serum  from  the  first  bleeding, 
one  hundred  from  the  second,  and  one  hun- 
dred and  twenty-five  from  the  third. 

The  serum  is  administered  to  diphtheria 
patients  subcutaneously  with  a  Roux  syringe 
ol"  30-c.  cm.  capacity.  This  syringe  is  made 
like  the  instrument  used  for  giving  the  injec- 
tions to  the  horse.  Between  the  needle  and 
the  barrel  there  is  a  rubber  tube  about  5  inches 
in  length,  which  permits  considerable  move- 
ment without  pain  on  the  part  of  the  patient ; 
it  also  enables  the  physician  to  inject  the  serum 
with  more  security.  The  syringe-barrel  is 
opened  and  the  entire  instrument  is  boiled  for 
five  minutes  to  sterilize  it ;  after  it  is  cool  it  is 
filled  with  the  serum.  The  skin  over  the 
eighth  and  ninth  costo-chondral  junctures  is 
disinfected  with,  say,  a  l-to-1,000  bichloride- 
of-mercury  solution,  and  the  needle  is  stuck 
under  the  skin,  not  into  a  muscle.  The  point 
of  the  needle  should  be  directed  toward  the 
physician,  to  prevent  dislodgment  during  the 
injection.  The  syringe  is  held  against  the 
palm,  while  the  needle  is  pushed  through  the 
skin  by  the  thumb  and  forefinger.  The  dose 
is  slowly  injected,  little  or  no  pain  is  caused, 
and  the  swelling  at  the  place  of  injection  soon 
disappears.  After  the  injection  a  bit  of  ab- 
sorbent cotton  is  laid  upon  the  puncture.  In 
slight  cases  of  diphtheria,  or  in  the  early  stages 
of  the  disease,  usually  one  dose  of  20  c.  cm.  is 
enough,  but  in  severe  eases,  where  there  is 
mixed  infection,  several  doses  may  be  required, 
as  will  be  explained  below.  When  the  serum 
is  used  as  a  preventive,  5  o.  cm.  are  given  to 
children  under  ten  years  of  age  and  10  c.  cm. 
to  older  children.  It  will  protect  for  probably 
six  weeks.  In  all  cases  of  suspected  diphtheria, 
even   before  the  bacteriological  diagnosis  is 


made,  the  physician  should  immediately  inject 
20  c.  cm.  of  the  serum.  If  the  child  is  over 
fifteen  years  of  age,  give  from  30  to  40  c.  cm. 
in  two  injections,  one  on  the  left  side  and  one 
on  the  right.  The  only  possible  ill  effect  will 
be  a  slight  urticaria,  if  in  from  fourteen  to 
twenty-four  hours  later  the  bacteriological  ex- 
amination proves  the  case  to  be  diphtheria,  no 
time  will  have  been  lost.  The  earlier  in  the 
disease  the  serum  is  injected,  the  better  the 
chance  for  cure.  Of  course,  a  bacteriological 
diagnosis  of  diphtheria  is  the  only  diagnosis. 
Whether  the  German  or  French  serum  is  used, 
there  seems  to  be  a  reactionary  rise  of  about 
one  degree  in  temperature  when  the  diphtheria 
bacillus  is  present. 

[Some  deaths  have  been  attributed  to  the 
use  of  diphtheria  antitoxine,  and  doubts  have 
been  entertained  as  to  whether  those  deaths 
were  attributable  to  the  action  of  the  serum 
itself  or  to  some  other  cause.  The  question 
has  been  investigated  experimentally  by  Dr. 
A.  Seibert  and  Dr.  P.  Schwyzer,  of  New  York 
{New  York  Medical  Journal,  May  30,  1896). 
Their  conclusions  are  as  follows  : 

"  1.  Antitoxic  serum  does  not  seem  to  be 
capable  of  causing  threatening  symptoms  and 
speedy  death,  even  when  brought  quickly  into 
the  blood  current  in  very  large  doses. 

"  2.  The  carbolic  acid  used  in  preserving  the 
antidiphtheric  serum  must  be  in  such  a  weak 
solution  as  to  be  entirely  unable  to  cause  the 
characteristic  carbolic  convulsions  produced 
in  every  one  of  our  second  series  of  experi- 
ments. The  absence  of  these  convulsions  in 
the  cases  of  sudden  death  in  patients,  the  en- 
tirely different  group  of  symptoms  reported 
in  them,  and  the  fact  that  guinea-pigs  and 
rabbits  will  survive  even  very  large  'and  con- 
centrated doses  of  carbolic  acid  injected  into 
a  vein,  lead  us  to  discard  the  possibility  of  this 
drug  having  caused  the  reported  deaths. 

"3.  Even  very  small  quantities  of  air  will 
cause  severe  disturbances  and  ultimate  cessa- 
tion of  breathing  in  every  animal  experimented 
upon.  These  disturbances  are  entirely  analo- 
gous to  the  symptoms  reported  as  preceding 
the.  sudden  deaths  after  antitoxine  injections. 
Air  is  found  alongside  of  the  fl.uid  in  every 
syringe  used  for  hypodermic  injections,  and 
being  pressed  under  the  skin  with  the  fluid 
may  readily  come  in  contact  with  a  punctured 
cutaneous  vein  and  so  may  enter  the  blood- 
vessel and  the  right  heart,  even  before  the 
serum  has  been  absorbed. 

"  In  view  of  these  facts  and  of  our  experi- 
ments, we  here  express  our  firm  opinion  that 
the  sudden  deaths  reported  after  antitoxine 
injections  were  caused  by  injected  air  and  not 
by  the  antidiphtheric  serum." 

The  American  Piediatric  Society  has  lately 
made  a  collective  investigation  into  the  use  of 
antitoxine  in  the  treatment  of  diphtheria  in 
private  practice.  It  was  conducted  by  a  com- 
mittee consisting  of  Dr.  L.  Emmett  Holt,  Dr. 
William  P.  Northrup,  Dr.  Joseph  O'Dwyer,  and 
Dr.  Samuel  S.  Adams.  In  the  committee's  re- 
port, presented  before  the  meeting  in  Montreal 
on  May  26,  1896  (New  York  Medical  Journal, 
July  4,  1896),  it  is  stated  that  only  three  cases, 


171 


SERUM  TREATMENT 


■in  a  total  of  3,628,  could  by  any  possibility  be 
classed  as  "oases  in  which  unfavourable  syinp- 
touis  were,  might  have  been,  or  were  believed 
to  have  been  due  to  antitoxine  injections." 

The  first  case  was  that  of  a  girl,  sixteen 
years  old,  in  good  condition,  who  had  tonsillar 
diphtheria.  The  diagnosis  was  confirmed  by 
culture.  She  was  injected  on  the  first  day 
with  10  c.  cm.  of  Beh  ring's  serum,  and  died  in 
convulsions  ten  minutes  later. 

The  second  case  was  that  of  a  fairly  healthy 
boy,  two  years  and  a  half  old,  who  bad  the 
membrane  on  the  tonsils,  on  the  pharynx,  and 
in  the  nose.  The  diagnosis  was  confirmed  by 
culture.  He  was  injected  on  the  morning  of 
the  fourth  day  with  10  c.  cm.  (1,000  units)  of 
the  New  York  health  board  serum.  His  tem- 
perature at  the  time  of  the  injection  was 
100"4°  F. ;  there  was  no  sepsis,  and  the  child 
was  apparently  not  very  sick ;  the  urine  was 
free  from  albumin.  He  was  distinctly  worse 
after  the  injection ;  in  ten  hours  the  tempera- 
ture rose  to  103°  F.,  the  urine  became  albumi- 
nous, the  throat  cleared  off  rapidly,  but 
marked  prostration  and  great  anajmia,  with 
irregular  fluctuating  temperature,  continued, 
and  death  from  exhaustion  with  heart  failure 
took  place  in  four  days  after  the  use  of  the 
serum. 

The  third  case  was  that  of  a  boy,  three 
years  and  a  half  old,  who  had  been  ill  for  two 
days.  The  diagnosis  was  confirmed  by  cul- 
ture. The  membrane  was  on  the  tonsils  and 
in  the  nose.  Two  injections  of  New  York 
health  board  serum  were  given.  "A  rapid 
nephritis  developed  after  the  second  injection, 
causing  coma,  convulsions,  and  death  twenty 
hours  after  the  second  injection."  In  re- 
sponse to  an  inquiry  by  the  committee  for  fur- 
ther particulars,  the  following  was  received 
from  the  physician  :  "  The  case  seemed  a  mild 
one,  but  the  injection  was  given  one  afternoon 
and  repeated  the  following  afternoon,  about 
fifteen  hundred  units  in  all.  The  urine  up  to 
that  time  had  not  been  examined.  About 
fourteen  or  sixteen  hours  after  the  second  in- 
jection unfavourable  symptoms  began  to  de- 
velop pointing  to  infection  of  the  kidneys. 
The  urine  was  found  to  be  loaded  with  albu- 
min. My  impression  at  the  time  was  that  the 
antitoxine  either  produced,  hastened,  or  inten- 
sified nephritis,  thereby  causing  the  fatal  ter- 
mination." 

The  committee's  comments  on  these  three 
fatal  cases  are  as  follows :  "  Case  I  is  wholly 
unexplained.  In  Case  11  the  query  arises.  Did 
this  sudden  change  hinge  upon  the  injection 
of  the  serum,  or  was  it  one  of  those  unex- 
plained abrupt  changes  for  the  worse  in  a  case 
apparently  progressing  favourably  so  often 
observed  in  diphtheria?  As  regards  Case  III, 
it  will  be  seen  from  the  letter  that  the  evi- 
dence is  not  at  all  conclusive.  All  details 
available  are  given,  and  the  reader  may  draw 
his  own  conclusions." 

Certain  secondary  accidents  are  occasionally 
observed  to  follow  the  use  of  the  antidiphthe- 
ritic  serum.  They  are  commonly  limited  to 
an  urticarial  rash  and  slight  feverishness  com- 
ing on  within  two  or  three  days.  They  are 
55 


thought  to  be  due  to  the  serum  itself,  and  not 
to  the  antitoxine  contained  in  it.  According 
to  Dr.  Sevestre  (Bulhtin  de  la  Societe  medica/e 
des  hopUaux,  1896,  Nos.  4  and  5 ;  British 
Medical  Journal,  April  4,  1896),  one  some- 
times sees  about  the  thirteenth  or  fourteenth 
day  after  the  injection  a  polymorphous  erup- 
tion like  that  of  measles  or  scarlet  fever,  more 
or  less  generalized,  a  reappearance  of  the 
urticaria,  great  constitutional  disturbance, 
vomiting,  excitement,  delirium,  insomnia,  al- 
buminuria, muscular  and  articular  pains,  in- 
flammation of  the  glands,  and  more  rarely  an 
erysipelatous  erythema  at  the  site  of  the  in- 

i'ection  or  elsewhere.  These  phenomena,  says 
)r.  Sevestre,  may  be  limited  to  a  slight  erup- 
tion, with  a  few  transitory  articular  pains,  or 
even  to  a  passing  feverish  attack  only  recog- 
nisable by  the  typical  date  (always  between 
the  eleventh  and  fifteenth  days)  of  its  occur- 
rence, which  shows  that  the  injection  is  the 
determining  cause.  As  these  accidents  never 
appear  in  cases  of  pure  diphtheria  treated  by 
serum,  are  very  analogous  to  those  produced 
by  streptococci  apart  from  serum  therapy,  and 
are  always  associated  with  the  presence  of 
virulent  streptococci  in  the  mouth  or  pharynx, 
their  gravity,  moreover,  seeming  to  agree  with 
the  virulence  of  the  cultures  of  the  bacteria, 
they  may  properly  be  attributed,  says  Sevestre, 
to  the  action  of  the  streptococcus.  They  are 
seldom  very  serious,  though  sometimes  alarm- 
ing, and  they  last  four  or  five  days.  If  a  pa- 
tient is  seen  at  the  beginning  of  a  slight  sore 
throat  the  case  should  be  carefully  watched 
till  the  result  of  the  Bacteriological  examina- 
tion is  known,  and  if  numerous  streptococci 
are  found  with  no  LofBer's  bacilli,  one 
should  abstain  from  injecting  serum ;  if  only 
that  short  bacillus  which  is  not  pathogno- 
monic of  diphtheria  is  found,  one  may  hesi- 
tate about  doing  so ;  but  if  the  case  is  one  of 
pure  diphtheria  or,  even  apart  from  bacterio- 
logical examination,  is  serious  or  involves  the 
larynx,  there  should  be  no  delay;  it  will  be  a 
great  advantage  to  have  conquered  one  source 
of  infection. 

In  the  discussion,  Dr.  Hutinel,  admitting 
the  great  resemblance  of  these  accidents  to 
those  of  streptococci  infection,  said  he  had 
found  them  where  no  streptococci  were  pres- 
ent. They  were,  he  said,  worse  in  children 
with  large  and  chronically  inflamed  tonsils  ;  he 
looked  upon  serum  therapy  as  not  to  be  adopted 
in  children  so  affected,  or  in  scarlatina,  unless 
the  diphtheria  was  characterized  by  long  and 
numerous  LofHer's  bacilli.  Dr.  Le  Gendre  had 
seen  serious  accidents  eleven  davs  after  the 
injection  in  a  child  in  whom  the  short  bacillus 
was  associated,  not  with  streptococci,  but  with 
staphylococci.  Thibierge  had  reported  a  simi- 
lar case  (Revue  des  maladies  de  I'enfance,  1895). 
The  short  bacillus  was  not  indubitably  specific, 
and  local  treatment  was  better  in  such  cases. 
Dr.  Chantemesse,  in  twenty  cases,  had  found 
that  rectal  injections  of  serum  were  well  re- 
tained and  readily  absorbed,  were  as  efficacious 
in  the  same  doses  as  when  used  hypodermically, 
and  caused  no  accidentsj 
One  of  the  greatest  difficulties  that  will  beset 


SERUM  TREATMENT 


172 


the  advance  of  serum  therapy  is  the  unskilled 
application  of  the  immunizing  serum.  Local 
treatment  should  not  be  abandoned,  because 
the  associated  bacteria,  especially  the  pyogenic, 
may  kill  the  patient  after  the  diphtheria  bacil- 
lus has  been  removed.  No  caustic  should  be 
applied  to  cause  traumatism,  and  carbolic  acid, 
and  especially  bichloride  of  mercury,  work  only 
bad  effects  when  combined  with  the  serum. 
The  throat  and  nose  should  be  sprayed  or 
washed  thrice  daily  with  boric-acid  solution  or 
with  a  mixture  of  Sfl.  oz.  of  Labarraque's  so- 
lution in  a  quart  of  water,  to  destroy  the  asso- 
ciated bacteria  and  the  remaining  diphtheria 
bacilli.  The  diphtheria  bacillus  remains  in  the 
mouth  after  the  artificial  immunizationas  long 
as  it  does  after  natural  convalescence.  It  is  well 
to  remember  that  if  no  tongue-depressor  is 
used  a  spray  does  not  reach  a  child's  throat. 
The  patient  must  be  well  nourished,  unless 
marked  albuminuria  indicates  a  milk  diet.  It 
is  a  common  error  to  discontinue  the  use  of 
antiseptic  mouth-washes  soon  after  the  mem- 
brane disappears.  They  should  be  used  until 
the  microscope  proves  that  no  more  pathogenic 
bacteria  remain. 

While  using  the  serum  we  must  keep  ac- 
count (1)  of  the  temperature,  (2)  of  the  pulse, 
(3)  of  the  respiration,  (4)  of  the  presence  or  ab- 
sence of  albuminuria,  and  we  must  know  (5) 
whether  we  are  dealing  with  simple  diphtheria 
or  with  diphtheria  complicated  with  other  bac- 
teria, especially  with  the  streptococcus  or 
staphylococcus  of  pus,  or  with  both  of  these 
micro-organisms.  If  within  from  twelve  to 
twenty-four  hours  after  the  initial  injection 
the  temperature,  pulse,  or  respiration  in- 
creases, or  if  noticeable  albuminuria  shows,  a 
full,  half,  or  quarter  dose  must  be  given,  in 
keeping  with  the  severity  or  multiplicity  of 
these  symptoms.  Where  there  are  pus  germs 
mixed  with  the  Klebs-Loiller  bacillus  it  may 
be  necessary  to  inject  as  many  as  80  c.  cm.  of 
the  French  serum,  in  divided  doses,  accord- 
ing to  the  persistence  of  the  symptoms.  Kossel 
has  found  that  where  there  is  mixed  infection 
it  is  well  to  give  strong  serum  or  larger  doses 
of  a  weaker  serum  in  order  to  desti-oy  the 
diphtheria  toxine  quickly,  and  thus  enable  the 
patient  to  better  contend  with  the  pya3mia. 

In  simple  diphtheritic  laryngitis,  where 
tracheotomy  is  indicated,  the  noses  of  the 
serum  must  be  somewhat  larger  than  for  mere 
faucial  diphtheria,  and  proportionally  larger 
where  there  is  a  complication  with  pyogenic 
bacteria  in  a  case  needing  tracheotomy."  Anti- 
sepsis in  the  operation  and  treatment  of  trache- 
otomy should  be  perfect,  because  it  is  a  serious 
evil  to  add  pyaemia  to  diphtheria.  If  intuba- 
tion were  studied,  especially  in  conjunction 
with  serum  therapy,  tracheotomy  could  be 
avoided  frequently  where  at  present  it  seems 
to  be  necessary.  Almost  without  exception, 
surgeons  indifferently  choose  tracheotomy  or 
intubation  as  if  there  were  no  special  indica- 
tions for  either.  The  only  real  reason  that 
prevents  intubation  from  entirely  replacing 
tracheotomy  in  hospital  practice  is  that,  unfor- 
tunately, the  intubation  tube  will  nearly  always 
cause  tissue  erosion.    The  difficulty  in  intu- 


bating and  the  greater  difficulty  in  extubating 
are  surmountable.     These  operations  are  easier 
to  perform  upon  the  living  subject  than  upon 
the  cadaver,  but  no  one  should  attempt  them 
unless  he  is  able  to  do  them  with  the  utmost 
gentleness  within  five  seconds  after  a  child  is 
in  position.      If  an   O'Dwyer  tube  is  left  in 
contact  with  normal  throat  tissues  for  a  while, 
no  erosion  is  caused,  but  the  result  is  very 
different  when  we  have  to   deal  with   soggy 
diphtheritic    tissues.     The    head,    point,   and 
bulging  part  of  the  shank  of  the  tube  all  erode 
the  glottis  and  trachea,  and  excite  a  cicatricial 
stenosis  which  only  too  often  becomes  perma- 
nent, especially  when  the  clumsy  European  in- 
struments are   used.     It  is  a  great  error  to 
leave  the  tube  in  the  throat  longer  than  four- 
teen hours  at  any  one  time.     Children  not  in- 
frequently recover  after  the  tube  has  been  in 
position  for  days,  but  they  are  the  exceptions, 
and  this  very  practice  has  thrown  the  operation 
into  disrepute.     Take  out  the  tube  after  from 
twelve  to  fourteen  hours.    l*e  child  may  never 
need  it  again,  or  it  may  choke  within  five  min- 
utes.    If  it  chokes,  put  back  the  tube.     After  a 
few  trials  of  twelve  hours'  duration  with  per- 
sisting closure  of  the  throat  after  removal  of 
the  tube,  tracheotomy  should  be  done.     While 
the  tube  is  out  the  physician  must  stay  with  the 
patient.     This  obligation  prevents  the  use  of 
intubation  in  private  practice  unless  the  physi- 
cian is  willing  to  take  the  faint  chance  of  "the 
patient's  escaping  erosion  and  stenosis  after 
the  tube  has  been  left  in  for  days. 

If  a  child  under  two  years  'of  age  is  intu- 
bated, a  serious  tissue  erosion  will  follow  almost 
as  the  rule,  unless  the  child  is  unusually  large 
and  robust.  When  the  membrane  is  in  the 
trachea,  not  only  is  intubation  apt  to  push 
down  the  membrane,  but  erosion  readily  forms. 
Very  severe  diphtheritic  croup  with  associated 
bacteria  indicates  tracheotomy  in  preference  to 
intubation  even  though  the  wound  infection  be 
taken  into  consideration.  In  diphtheritic  ste- 
nosis, where  the  cough  is  "  dry  "  and  the  mem- 
brane firm,  intubation  does  not  succeed  so 
often  as  tracheotomy. 

In  using  the  German  serums  it  should  be  re- 
membered that  Behring's  antitoxic  serum  is 
sent  out  in  three  grades  of  strength.  "  No.  2  " 
is  the  grade  usually  emploved,  and  this  has 
about  double  the  strength  of  the  French  serum. 
Aronson's  serum  is  about  as  strong  as  Behr- 
ing's "  No.  2."  Ten  c.  em.  of  the  German  serum 
IS  the  average  dose. 

[It  appears  from  the  American  Pa-liatrie 
Society's  collective  investigation  that  the  prep- 
arations chiefly  used  in  the  United  States  may 
be  enumerated  in  the  order  of  the  frequency 
with  which  they  are  employed  as  follows  ■  That 
furnished  by  the  New  York  board  of  health 
Behring's,  Gibier's,  Mulford's,  Aronson's,  and 
Rouxs.] 

There  is  no  injurious  effect  upon  the  kid- 
neys of  patients  upon  whom  the  serum  has 
been  used,  and  the  same  is  true  for  the  lower 
animals.  Roux  says  that  before  the  use  of  im- 
munizing serum  two  thirds  of  the  cases  of 
diphtheria  showed  albuminuria ;  after  treat- 
ment with  the  serum  fewer  than  one  half  show 


173 


SERUM  TREATMENT 


albuminuria,  and  pneumonia  and  paralysis  as 
consequences  of  the  disease  are  much  more  in- 
frequent. 

The  results  are  more  than  encouraging.  If 
there  are  no  associated  bacteria,  from  20  to  50 
c.  cm.  of  the  serum  will  cure  from  98  to  99  per 
cent,  of  the  cases.  As  our  knowledge  of  the  use 
of  the  serum  increases,  the  mortality  lessens. 
Prom  1889  to  1894  iu  Paris  the  mortality  of 
the  tracheotomy  osises  was  fully  85  per  cent. ; 
now  less  than  47  per  cent,  of  these  patients 
die,  and  the  need  for  tracheotomy  itself  is  not 
so  often  felt.  The  average  mortality  for  all 
cases  in  Berlin,  outside  the  tracheotomy  cases, 
is  down  to  14  per  cent,  at  present. 

[There  are  still  a  few  physicians  who  deny 
the  eCBcacy  of  the  antitoxine  treatment  of 
diphtheria.  It  seems  to  be  abundantly  proved, 
however.  In  the  report  of  the  American  Psedi- 
atric  Society's  collective  investigation,  already 
mentioned,  it  is  stated  that  the  circular  letter 
which  the  committee  had  sent  out  called  for 
information  upon  the  following  points :  The 
patient's  age ;  the  previous  condition ;  the 
duration  of  the  disease  when  the  first  injection 
was  made;  the  number  of  injections;  the  ex- 
tent of  the  membrane  on  the  tonsils,  in  the 
nose,  on  the  pharynx,  and  in  the  larynx ; 
whether  or  not  the  diagnosis  was  confirmed  by 
culture ;  complications  or  sequeliE — viz.,  pneu- 
monia, nephritis,  sepsis,  and  paralysis ;  the  re- 
sult ;  and  remarks,  including  statements  as  to 
other  treatment  employed,  the  preparation  of 
antitoxine  used,  and  the  general  impression 
drawn  from  the  cases. 

Reports  were  returned  from  615  different 
physicians  of  3,628  cases.  Of  these,  S44  cases 
were  excluded  from  the  statistical  tables. 
They  were  cases  in  which  the  disease  was  said 
to  have  been  confined  to  the  tonsils  and  the 
diagnosis  not  confirmed  by  culture,  so  that 
they  were  open  to  question.  A  few  cases  were 
reported  in  such  doubtful  terms  as  to  leave 
the  diagnosis  uncertain.  The  figures  given 
were  therefore  made  up  from  oases  in  which 
the  diagnosis  was  confirmed  by  culture  (em- 
bracing about  two  thirds  of  the  whole  number) 
and  others  giving  pretty  clear  evidence  of 
diphtheria,  either  in  the  fact  that  they  had 
been  contracted  from  other  undoubted  cases  or 
in  the  membrane  having  invaded  other  parts 
besides  the  tonsils,  such  as  the  palate,  pharynx, 
nose,  or  larynx.  "  It  is  possible,"  says  the  re- 
port, "that  among  the  latter  we  have  admit- 
ted some  streptococcus  cases,  but  the  number 
of  such  is  certainly  very  small."  There  were 
left  of  these  cases  3,384  for  analysis.  They 
were  observed  in  the  practice  of  613  physicians 
from  114  cities  and  towns,  in  15  different  States, 
the  District  of  Columbia,  and  the  Dominion  of 
Canada. 

The  report  continues :  "  In  the  general  opin- 
ion of  the  reporters  the  type  of  diphtheria  dur- 
ing the  past  year  has  not  differed  materially 
from  that  seen  in  previous  years,  so  that  it  has 
been  average  diphtheria  which  has  been  treat- 
ed. If  there  is  any  difference  in  the  severity 
of  the  cases  included  in  these  reports  from 
those  of  average  diphtheria,  it  is  that  they  em- 
brace a  rather  larger  proportion  of  very  bad 


cases  than  are  usually  brought  together  in 
statistics.  The  cases,  according  to  the  extent 
of  the  membrane,  are  grouped  as  follows :  In 
593  the  tonsils  alone  were  involved.  In  1,397 
the  tonsils  and  pharynx,  the  tonsils  and  nose, 
the  pharynx  and  nose,  or  all  three  were  affect- 
ed. In  1,256  cases  the  larynx  was  affected 
either  alone  or  with  the  tonsils,  pharynx,  and 
nose,  one  or  all.  In  many  instances  the  state- 
ment is  made  by  the  reporters  that  tlie  serum 
was  resorted  to  only  when  the  condition  of  the 
patient  had  become  alarmingly  worse  under 
ordinary  methods  of  treatment.  This  is  shown 
by  the  unusually  large  number  of  cases  in 
which  injections  were  made  late  in  the  dis- 
ease. Again,  many  physicians,  being  as  yet  in 
some  dread  of  the  unfavourable  effects  of  the 
serum,  have  hesitated  to  use  it  in  mild  cases 
and  have  given  it  only  in  those  which  from 
the  onset  gave  evidence  of  being  of  a  severe 
type.  The  expense  of  the  serum  has  unques- 
tionably deterred  many  from  employing  it  in 
mild  cases.  These  facts,  it  is  believed,  will 
more  than  outweigh  the  bias  of  any  antitoxine 
enthusiasts  by  including  many  mild  cases 
which  would  have  ended  in  recovery  under 
any  treatment.  It  will,  however,  be  remem- 
bered that  tonsillar  cases  not  confirmed  by 
culture  have  not  been  included." 

In  addition  to  the  material  which  came  to 
the  committee  in  response  to  the  circular,  it 
had  placed  at  its  disposal  reports  of  942  cases 
treated  in  the  patients'  homes  in  the  tene- 
ments of  New  York.  Of  these,  856  were  treat- 
ed with  antitoxine  by  the  corps  of  inspectors 
of  the  New  York  health  board.  In  them  the 
diagnosis  of  diphtheria  was  confirmed  by  cul- 
ture in  every  case.  They  were  of  a  more  than 
ordinarily  severe  type,  485,  or  more  than  50 
per  cent.,  of  the  patients  being  reported  as  be- 
ing in  bad  condition  at  the  time  of  injection  ; 
to  mild  cases  the  inspectors  were  not  often 
called.  Further,  an  unusually  large  number 
of  them  (38  per  cent.)  received  the  injection 
on  or  after  the  fourth  day  of  the  disease.  In 
182  of  those  cases  only  the  tonsils  were  affect- 
ed ;  in  466  the  tonsils  with  the  pharynx  or  nose, 
the  pharynx  and  nose,  or  all  three ;  in  294  the 
larynx  was  invaded  either  with  or  without  dis- 
ease of  the  tonsils,  nose,  or  pharynx. 

The  committee  received  also  a  partial  re- 
port upon  1,468  cases  treated  in  the  patients' 
homes  in  Chicago  by  a  corps  of  inspectors  of 
the  health  department.  It  was  the  custom  in 
Chicago  to  send  an  inspector  to  every  tene- 
ment-house case  reported,  and  to  administer 
the  serum  unless  it  was  declined  by  the  parents. 
These  cases  were  therefore  treated  much  ear- 
lier and  the  results  were  correspondingly  bet- 
ter than  were  obtained  in  New  'I'ork,  although 
the  serum  used  was  the  same  in  both  cities — 
viz..  that  of  the  New  York  health  board. 

The  grand  total  amounted  to  5,794  cases 
with  713  deaths,  or  a  mortality  of  12-3  per  cent., 
including  every  case  returned  ;  but  the  reports 
showed  that  in  318  cases  the  patients  were 
moribund  at  the  time  of  injection  or  died 
within  twenty-four  hours  of  the  first  injection. 
Should  these  be  excluded,"  says  the  report, 
"  there  would  remain  5,576  cases  (in  which  the 


SERUM   TREATMENT 


174 


serum  may  be  said  to  have  had  a  chance)  with 
a  mortality  of  8-8  per  cent." 

In  the  4,120  cases  of  injection  during  the 
first  three  days  there  were  803  deaths — a  mor- 
tality of  7'8  per  cent.,  including  every  case  re- 
turned. The  report  continues :  "  If  from  these 
we  deduct  the  cases  in  which  the  patients  wei'c 
moribund  at  the  time  of  injection,  or  died 
within  twenty-four  hours,  we  have  4,013  cases, 
with  a  mortality  of  4-8  per  cent.  Behring's 
original  contention,  that  if  patients  were  in- 
jected on  the  first  or  second  day  the  mortality 
would  not  be  5  per  cent.,  is  more  than  sub- 
stantiated by  these  figures.  The  good  results 
obtained  in  third-day  injections  were  a  great 
surprise  to  your  committee.  But  after  three 
days  have  passed  the  mortality  rises  rapidly, 
and  does  not  differ  materially  from  that  of  or- 
timary  diphtheria  statistics.  Our  figures  em- 
phasize the  statement,  so  often  made,  that 
relatively  little  benefit  is  seen  from  antitoxine 
after  three  days ;  however,  it  must  be  said  that 
striking  improvement  has  in  some  cases  been 
seen  even  when  the  serum  has  been  injected  as 
late  as  the  fifth  or  sixth  day.  The  duration  of 
the  disease,  therefore,  is  no  contra-indication  to 
its  use." 

In  the  3,384  cases  reported  to  the  commit- 
tee, the  larynx  was  stated  to  have  been  in- 
volved in  1,256  oases,  or  37'5  per  cent.,  a 
proportion  somewhat  higher  than  usual,  and 
partly  explained  by  the  fact  that  several  phy- 
sicians sent  in  the  reports  of  their  laryngeal 
cases  only.  In  691,  or  a  little  more  than  iialf 
the  number,  no  operation  was  done,  and  in 
this  group  there  were  128  deaths.  In  forty- 
eight  of  them  laryngeal  obstruction  was  the 
cause  of  the  fatal  issue.  In  the  eight  remain- 
ing fatal  cases  the  patients  died  of  other  com- 
plications, and  not  from  the  laryngeal  disease. 
In  the  563  cases,  therefore,  or  16'9  per  cent,  of 
the  whole  number,  there  was  clinical  evidence 
that  the  larynx  was  involved,  and  yet  recovery 
took  place  without  an  operation.  In  many  of 
these  cases  the  symptoms  of  stenosis  were  se- 
vere, and  yet  disappeared  after  injection  with- 
out intubation.  No  one  feature  of  the  cases 
of  diphtheria  treated  with  antitoxine,  says  the 
report,  has  excited  more  surprise  among  the 
physicians  who  have  reported  them  than  the 
prompt  arrest,  by  the  timely  administration  of 
the  serum,  of  membrane  which  was  rapidly 
spreading  downward  below  the  larynx.  In 
the  operative  cases  the  same  remarkable  effects 
of  the  antitoxine  were  noticeable.  Operations 
were  done  in  565  cases,  or  in  16-7  per  cent,  of 
the  entire  number  reported.  Intubation  was 
performed  533  times  with  138  deaths,  or  a 
mortality  of  35-9  per  cent.  Among  the  cases 
were  nine  in  which  a  secondary  tracheotomy 
was  done,  with  seven  deaths.  In  thirty-two 
tracheotomy  only  was  done,  with  twelve 
deaths,  a  mortality  of  37'4  per  cent.  In  the 
565  operative  cases,  sixty-six  patients  either 
were  moribund  at  the  time  of  operation  or 
died  within  twenty-four  hours  after  injec- 
tion. Should  these  be  deducted,  says  the  re- 
port, there  remain  499  cases  of  operation  by 
intubation  or  tracheotomy,  with  84  deaths,  a 
mortality  of  16-9  per  cent.    In  the  2,819  cases 


in  which  an  operation  was  not  performed  there 
were  312  deaths,  a  mortality  of  11-3  per  cent. 
Deducting  the  moribund,  or  those  that  died 
within  tvventy-four  horus  after  injection,  the 
total  mortality  of  all  non-operative  cases  was 
9-12  per  cent. 

Tlie  antidiphtheritic  serum  has  been  admm- 
istered  by -the  mouth  with  success.  Dr.  De 
Miniois  (Oazzetta  degli  ospedali,  July  19, 1896  ; 
British  Medical  Journal,  August  15,  1896),  on 
an  occasion  when  his  hypodermic  syringe  was 
out  of  order,  determined  to  try  the  effect  of 
antidiphtheria  serum  when  given  by  the  mouth. 
The  result  was  eminently  satisfactory.  Since 
that  time  he  has  treated  four  otlier  cases  in  a 
similar  manner.  In  each  case  the  effect  was 
quite  as  good  as  if  the  serum  had  been  given 
hypodermically,  and  no  evil  results  followed — 
no  gastric  disturbance,  no  skin  eruption,  and  no 
joint  or  renal  affection.  Before  deciding  as  to 
the  dose  required,  the  author  thinks  further 
experience  desirable.  In  the  five  cases  the  dose 
given  was  the  same  as  would  have  been  given 
hypodermically.  The  serum,  which  has  no 
unpleasant  taste,  was  administered  in  iced  milk 
or  pure. 

Roux's  antidiphtheritic  serum  has  been  em- 
ployed in  the  treatment  of  malarial  fever  by 
Dr.  Alcide  Treille  (Oazette  medicale  de  Nantes, 
September  12,  1896;  New  York  Medical  Jour- 
nal, October  24,  1896),  who  relates  the  histories 
of  two  cases  in  which  he  employed  it  with  the 
following  results :  1.  In  both  cases  the  intense 
violent  chill  was  completely  suppressed  after 
an  injection  of  the  serum,  which  was  employed 
with  the  first  patient  in  the  beginning  of  the 
eleventh  attack,  and  with  the  second  patient  in 
the  beginning  of  the  thirteenth  attack.  2.  The 
attaclis  were  not  modified  in  any  way  by  the  in- 
jections ;  the  serum  did  not  increase  or  diminish 
the  tern  perature  or  t  he  duration  of  the  paroxysm, 
and  only  the  chill  that  would  have  next  followed 
the  injection  was  suppressed.  3.  In  both  pa- 
tients the  injection  produced  a  veritable  crisis 
twenty-four  hours  afterward,  which  manifested 
itself  in  the  first  patient  by  diarrhoea  and  in 
the  second  by  a  profuse  sweating  which  was 
quite  unusual  and  produced  apyrexia  for  a 
day.  4.  There  was  no  eruption,  abscess,  or 
superadded  fever.  5.  In  the  first  patient  not 
only  did  the  serum  suppress  the  chill,  but,  from 
the  beginning  of  the  attack  which  followed  the 
injection,  all  the  stages  were  atteiraated.  After 
the  fifth  attack  a  spontaneous  apyrexia  oc- 
curred which  lasted  for  five  days ;  two  more 
attacks  then  occurred  which  were  followed  by 
continuous  apyrexia.  Hence  Treille  concludes 
that  the  injection  led  to  recovery.  6.  In  the 
second  patient,  who  was  young  and  in  the  full 
vigour  of  his  life,  the  first  injection  led  to  the 
suppression  of  the  chill,  but  it  did  not  modify 
the  attack.  A  second  injection  did  not  lead  to 
other  results  than  those  obtained  in  the  first 
case. 

Preparations  of  quinine,  says  the  author,  must 
be  employed.  A  daily  dose  of'4  grains  for  eleven 
days  is  necessary  in  order  to  produce  the  first 
apyrexia.  Afterward  2i  grains  are  sufficient. 
The  author  states  that,  as  he  obtained  abso- 
lutely similar  results  in  another  series  of  cases 


175 


SERUM  TREATMENT 


of  quartan  fever  with  equally  small  doses  of 
quinine,  he  is  not  able  to  say  that  the  serura 
facilitated  the  action  of  the  quinine  in  the 
second  patient  to  whom  he  had  been  obliged 
to  give  it. 

The  use  of  serura  containing  an  antitoxine 
is  not  confined  to  the  treatment  of  diphtheria. 
Animals  have  been  rendered  proof  against  the 
diseases  caused  by  various  species  of  strepto- 
coccus, and  their  serum  used  to  prevent  or 
cure  such  diseases  in  man,  including  the  strep- 
tococcus infection  complicating  diphtheria  and 
that  which  gives  rise  to  erysipelas.  Dr.  Gibier, 
of  the  New  York  Pasteur  Institute,  following 
the  example  of  Dr.  Marmorek,  of  Paris,  pre- 
pares what  he  terras  a  "  double,''  or  "  dual," 
antitoxine.  This  is  held  to  be  efficacious 
against  both  diphtheria  and  the  streptococcus 
complication  of  that  disease.  In  ordinary  oases 
a  dose  of  15  c.  era.  is  injected,  preferably  into 
the  lateral  part  of  the  abdominal  wall,  and 
after  twelve  hours  10  c.  cm.  more  are  injected  ; 
in  severe  cases  25  c.  cm.  are  injected  at  first, 
and  the  same  quantity  again  within  twenty- 
four  hours.  Antistreptococcus  serum,  accord- 
ing to  Dr.  G.  W.  Van  Sehaick  (N.  Y.  Therap. 
Rev.,  1895,  No.  3),  has  been  used  successfully 
also  in  puerperal  fever,  erysipelas,  and  •phleg- 
mons following  infection  in  operations. 

In  the  British  Medical  Journal  for  October 
31,  1896,  Dr.  John  D.  Williams,  of  Cardiflf,  re- 
ports six  severe  cases  of  puerperal  septicmmia 
treated  with  antistreptococcus  serum.  Only 
one  of  them  proved  fatal.  The  serum  used  in 
one  of  the  cases,  which  was  among  those  of 
recovery,  was  obtained  from  the  Paris  Pasteur 
Institute;  that  employed  in  the  other  cases 
came  from  the  British  Institute  of  Preventive 
Medicine.  Remarking  on  his  own  cases  and 
eight  others  which  he  finds  recorded.  Dr.  Will- 
iams says  that  two  of  the  fourteen  cases  ended 
fatally.  Eight  of  the  patients  were  primipa- 
rous  women,  varying  in  age  from  twenty-two 
to  thirty  years.  One  was  a  case  of  abortion, 
and  one  was  that  of  a  multiparous  woman  with 
a  rickety  pelvis.  In  Vinay's  cases  no  informa- 
tion is  given  as  to  age,  character  of  labour, 
and  the  number  of  pregnancies.  Excluding 
his  cases,  says  Dr.  Williams,  we  have  left  ten 
in  which  there  is  a  definite  record  of  the  pa- 
tient's state  before  and  after  the  use  of  the 
serum.  The  labour  was  instrumental  in  six 
cases,  lingering  in  one,  and  normal  in  two.  In 
all  the  placenta  came  away  easily  and  com- 
pletely. Information  as  to  the  integrity  of  the 
perinaeum  is  furnished  in  seven  cases :  it  was 
torn  but  not  sutured  in  four,  torn  and  sutured 
in  two,  and  uninjured  in  one.  In  six  cases  the 
lochia  were  scanty  and  suppressed  in  two. 
The  reaction  of  the  vaginal  discharge  was 
ascertained  in  three  cases.  Once  it  was  found 
acid  and  twice  alkaline.  Dr.  Williams  says 
that  his  investigations  into  the  reaction  of  the 
vaginal  discharges  in  cases  of  puerperal  septi- 
CEemia  during  past  years  seem  to  indicate  that 
an  alkaline  reaction  most  frequently  accom- 
panies septic  intoxication,  saprreraia,  and  an 
acid  reaction,  septic  infection — septicaemia. 
With  the  former  reaction  the  lochia  were 
usually  found  free  and  foetid,  and  with  the 


latter  scanty  or  suppressed.  In  the  ten  cases 
referred  to,  sympton)s  of  the  disease  set  in 
frojn  within  a  few  hours  of  labour  to  the 
eighth  day.  The  use  of  constitutional  agents, 
combined  with  local  and  instrumental  treat- 
ment, was  tried  in  all  the  cases  before  the 
serum  injections  were  resorted  to,  for  a  period 
varying  from  two  to  fifteen  days.  The  earliest 
day  after  labour  on  which  the  serum  was  used 
was  the  fifth  day,  and  the  latest  the  nineteenth 
day. 

The  serum  was  not  injected  in  a  single  case 
without  a  previous  thorough  trial  of  the  usual 
constitutional  and  local  remedies.  The  state 
of  the  pelvic  organs  was  ascertained  in  nine 
cases,  and  with  two  exceptions,  where  there 
was  uterine  tenderness,  they  were  found  to  be 
normal.  The  cases  were  characterized  by 
severe  febrile  symptoms,  and  in  some  there 
were  diarrhoea  and  vomiting.  It  must,  of 
course,  be  admitted,  says  Dr.  Williams,  that 
puerperal  infection  may  be  independent  of 
streptococci,  but  the  conjunction  of  certain 
symptoms — rigours,  high  fever,  and  a  rapid 
breaking  up  of  the  general  condition — permit 
us  to  affirm  a  probability  in  favour  of  infec- 
tion due  to  streptococci.  Certainty  is  only  to 
be  obtained  by  a  bacteriological  examination. 

Following  each  injection,  says  Dr.  Williams, 
the  previously  hot,  dry,  and  inactive  skin 
passed  into  a  state  of  moisture  and  active 
perspiration,  the  parched  lips  and  dry  tongue 
became  moistened,  suppressed  lochia  and  lacta- 
tion reappeared,  delirium,  insomnia,  and  rest- 
lessness passed  off  into  a  refreshing  sleep, 
from  which  the  patient  awoke  feeling  better 
in  body  and  clearer  in  mind.  Headache  and 
mental  torpor  were  usually  dispelled,  but  ex- 
ceptionally the  headache  remained  for  hours, 
the  patient  otherwise  feeling  much  relieved. 
The  headache,  which  was  described  as  "pe- 
culiar," was  sometimes  frontal  and  sometimes 
occipital.  In  three  cases,  however,  no  benefit 
resulted  from  the  injections.  Vinay,  says  Dr. 
Williams,  believes  tlie  injections  to  be  more 
effective  and  more  immediate  in  their  action 
when  they  are  made  early  and  at  the  time  of 
the  evening  when  there  is  a  spontaneous  rise 
in  the  temperattire.  Local  treatment,  curet- 
tage, and  antiseptic  washings  are  not  to  be 
neglected. 

In  all  the  cases  analyzed  by  Dr.  Williams, 
with  the  exception  of  three,  the  degree  of  tem- 
perature and  the  frequency  of  the  pulse  were 
reduced  after  each  dose  of  serum.  The  reduc- 
tion of  temperature  and  decrease  of  frequency 
of  the  pulse  were  effected  in  from  six  to 
twenty-four  hours.  The  temperature  in  one 
case  fell  from  104°  to  102°  in  six  hours  after 
10  cubic  centimetres  of  the  serum  (from  the 
Pasteur  Institute),  but  it  rose  to  103°  eighteen 
hours  later.  A  second  dose  of  20  cubic  centi- 
metres reduced  it  to  normal  in  ten  hours,  and 
it  remained  so.  In  one  case  the  temperature 
followed  an  exceptional  course.  After  a  single 
dose  of  35  cubic  centimetres  (Ruffer's  serum) 
the  temperature  fell  from  104'4°  to  104°  in  six 
hours.  At  the  twelfth  hour  (midnight)  it  rose 
to  105°,  but  at  the  eighteenth  hour  it  fell  to 
102°,  and  at  the  twenty-fourth  hour  to  99'2°, 


SERUM  TREATMENT 


176 


and  remained  under  100°  from  this  time  on- 
ward. This  was  the  only  instance  in  which  a 
rise  was  observed  after  an  injection.  In  three 
.  cases  the  temperature  fell  to  normal  in  twenty- 
four  hours.  The  pulse  rate  varied  with  the 
temperature. 

In  Dr.    Williams's  fatal  case    the    patient 
received  a  daily  injection  of  30  cubic  centi- 
metres for  three   consecutive  days,  with   no 
observed  benefit.     She  died  on  the  fourteenth 
day,   the  fever  remaining   high   to  the   last. 
With  regard  to  this,  case.  Dr.  Williams  says  he 
can  not  help  feeling  that  if  it  was  a  case  of 
strepto-infection,  and  a  larger  initial  dose  had 
been   administered,   a  different  result  might 
perhaps  have  been  obtained,  but  if,  of  course, 
it  was  one  of  staphylo-infection  no  benefit  was 
to  be  expected.     This,  he  remarks,  shows  the 
supreme  importance  of  a  bacteriological  diag- 
nosis.   Gaulard's  fatal  case,  however,  stands  in 
a  different  light.     Here  a  bacteriological  ex- 
amination had  been  made,  and  the  case  un- 
doubtedly  proved   to  be  a  true  example  of 
strepto-infection — streptoraycosis.     A  dose  of 
10  cubic  centimetres  of  serum  (Marmorelt's) 
■was  injected  on  the  fourth,  fifth,  sixth,  and 
.-seventh  day  after  confinement,  and  by  it  the 
'temperature  was  reduced   to  normal   on  the 
.ninth  day.     On  the  evening  of  this  day,  how- 
■  ever,  the  patient  was  seized  with  bilious  vom- 
dting  and  meteorism.     The  next  day  she  was 
much  worse,  had  uncontrollable  vomiting,  and 
ibecame  semicomatose ;  she  died  on  the  eleventh 
day,  the  temperature  remaining  low  to  the 
end.     The  serura  was  effective  in  reducing  the 
temperature,  yet  the  patient  died   two  days 
later  during    convalescence.      Gaulard,   after 
the  post-mortem  examination,  attributed   her 
death  to  the  use  of  too  much  serum.     The 
total   amount    injected  was  40    cubic  centi- 
metres, spread  over  four  days.     In  view  of  his 
own  experience,  Dr.  Williams  can  not  agree 
with  him,  as  in  one  case  he  injected  60  cubic 
centimetres  (British   Institute)  during    three 
days,  and  Kennedy  used  85  cubic  centimetres 
in  two  days,  and  both  patients  recovered. 

There  may,  of  course,  says  Dr.  Williams,  be 
a  difference  in  the  strength  of  the  fluids  used. 
This  emphasizes  the  desirability  of  bacteriolo 
gists'  adopting  a  uniform  system  of  standardiz- 
ing their  serum.  An  erythematous  rash  appeared 
on  the  chest,  abdomen,  and  extremities  in  two 
cases.  It  was  of  a  fleeting  character,  and  dis- 
appeared in  the  course  of  a  few  days  without 
calling  for  any  treatment.  Patchy  pneumonia 
of  the  base  of  each  lung  complicated  one  case. 
The  first  and  second  injections  of  30  cubic 
centimetres  were  made  on  the  eighth  and 
twelfth  days  respectively.  The  temperature 
fell  after  each.  On  the  seventeenth  day  there 
were  signs  and  symptoms  of  pneumonia.  Dur- 
ing this  attack  the  temperature  ran  a  fluctuat- 
ing and  an  exceptionally  high  course,  being 
106°  on  the  twenty-first  and  108°  on  the 
twenty-third  day.  The  patient's  physician 
looked  upon  the  serum  with  suspicion,  and 
feared  it  was  the  cause  of  the  pneumonia.  The 
serum  used  was  supplied  by  Dr.  Ruffer.  Is  it 
possible,  asks  Dr.  Williams,  that  the  serum, 
owing  to  dofeoti.ve  filtering  or  something  else, 


contained  living  streptococci  ?  Might  a  serum 
containing  living  germs,  or  might  the  antitox- 
ine  found  in  an  efficiently  filtered  and  germ- 
free  serum,  give  rise  to  patchy  pneumonia  in  a 
puerperal  patient  with  a  decided  phthisical 
family  history? 

In  the  cases  reviewed  by  Dr.  Williams  the 
serum  was  administered  by  subcutaneous  in- 
jection into  the  areolar  tissue  of  the  abdominal 
wall  ;  to  avoid  septic  troubles,  the  skin  was 
washed  with  Johnston's  antiseptic  ethereal 
solution  of  soap,  and  then  for  two  minutes 
with  perchloride-of-mercury  lotion  (1  in  1,000), 
and  finally  dusted  with  borio-acid  powder. 
The  syringe  used  was  Debove's,  of  the  capacity 
of  10  cubic  centimetres.  It  was  taken  to  pieces 
and  placed  in  a  pie  dish,  which  was  boiled  in  a 
clean  saucepan  for  fifteen  minutes  at  the  pa- 
tient's iiome.  Ten  cubic  centimetres  were 
injected  into  each  puncture,  three  such  punc- 
tures being  made  for  a  dose.  In  no  instance 
was  there  local  trouble. 

The  question  of  a  maximal  dose  beyond 
which  it  is  unsafe  to  go  Dr.  Williams  regards 
as  not  yet  settled,  and  he  adds  that  supplies 
of  serum  derived  from  different  sources  or 
from  the  same  source  at  different  times  are 
not  guaranteed  to  be  of  the  same  uniform 
strength.  He  thinks  it  desirable  that  a  uni- 
form system  of  standardizing  should  be 
adopted  by  bacteriologists,  and  says  that 
when  this  is  accomplished  clinical  observers 
will  be  better  able  to  agree  as  to  what  the 
maximal  and  submaximal  doses  should  be. 
At  present  the  practitioner  has  to  rely  for 
guidance  upon  the  instructions  which  accom- 
pany each  supply,  and  these  vary  with  their 
source. 

In  regard  to  the  cases  in  which  this  treat- 
ment is  suitable.  Dr.  Williams  remarks  that 
puerperal  infection  may  be  independent  of 
streptococci.  According  to  Bulloch,  recent 
research  shows  that  a  puerperal  fever  may  be 
set  up  by  the  gonocooous,  the  Bacillus  coli  com- 
munis, the  Talamon-Praenkel  coccus,  and  the 
staphylococcus.  In  the  majority  of  instances, 
however,  puerperal  fever  means  infection  of 
the  genital  canal,  and  ultimately  of  the  whole 
system,  with  the  Streptococcus  pyogenes.  There 
is  produced  a  septicaemia— using  the  term  in 
the  sense  in  which  it  was  originally  employed 
by  Koch— namely,  a  condition  o'f  microbic 
blood  infection  where  the  microbes  multiply 
in  the  blood  and  cause  a  rapidly  fatal  disease. 
The  microbe  at  work  most  commonly  is  the 
Streptococcus  pyogenes,  and  the  type  of  infec- 
tion or  septicEemia  induced  is  called  puerperal 
strepto-infection  or  streptoseptioaamia,  or,  in 
the  language  of  the  bacteriologist,  streptomy- 
cosis.  It  is  in  this  class  of  cases  only  that  the 
antistreptococcic  serum  is  of  value,  the  serum 
is  specific  a.gainst  the  streptococcus  only,  and 
attempts  to  cure  with  it  staphylosepticjEmja  or 
infection  caused  by  any  other  germ  will  not  be 
successful.  The  symptoms  found  in  cases  of 
severe  puerperal  septicasmia  point  to  a  strepto- 
mfection,  but  in  the  absence  of  a  bacterio- 
logical examination  one  can  not  be  certain 
The.  strepto-infection  is  at  first  essentially  a 
local  disease;  it  is  later  that  it  become.'!  a 


177 


SERUM  TREATMENT 


blood  infection.  Therefore  local  treatment, 
antiseptic  douches,  and  curetting  can  not  be 
dispensed  with,  but  must  be  carried  out  in 
conjunction  with  the  serum  treatment,  which 
comes  into  play  when  the  germs  have  passed 
into  the  general  circulation  by  annulling  their 
action  and  toxine  and  obviating  the  organic 
degenerations  which  are  beyond  our  control. 

The  serum  treatment  of  forms  of  septicaemia 
and  suppuration  due  to  other  micro-organisms 
than  the  streptococcus  is  still  in  the  experi- 
mental stage. 

In  the  British  Medical  Journal  for  July  4, 
1896,  Mr.  Charles  A.  Ballance  and  Mr.  Francis 
U.  Abbott,  of  St.  Thomas's  Hospital,  London, 
report  a  case  of  acute  hmmorrhagic  septicemia 
occurring  in  a  physician,  thirty  years  old,  who 
pricked  his  thumb  in  making  a  post-mortem 
examination  in  a  case  of  suppurative  perito- 
nitis at  1.45  p.  M.  on  Monday,  June  8th.  At  7 
p.  M.  the  thumb  began  to  throb,  during  the 
evening  this  throbbing  increased  to  burning 
pain,  and  between  9  and  10  the  red  lines  of 
lymph-duct  inflammation  had  extended  as  far 
as  the  axilla,  and  the  glands  in  that  region 
were  enlarged.  At  4  A.  M.  on  June  9th  pain 
and  tension  of  the  pad  of  the  thumb  were 
so  great  that  nitrous-oxide  gas  was  given  and 
an  incision  made.  Previous  to  this  vomiting 
had  occurred,  and  there  had  been  several  shiv- 
ering fits.  The  temperature  at  7.30  a.  m.  was 
103°  F. 

At  9.30  A.  M.  he  was  seen  by  one  of  the  au- 
thors. 'J'he  whole  body  was  covered  with  a 
scarlet  septic  erythema,  the  face  was  puify, 
and  the  eyes  were  suffused.  The  patient  com- 
plained of  severe  shooting  pains  up  the  arm, 
and  in  the  intervals  of  pain  was  listless  and 
drowsy;  the  temperature  was  high  and  the 
pulse  rapid  and  soft.  It  was  arranged  at  once 
to  take  him  as  soon  as  possible  to  the  hospital, 
where  he  was  admitted  about  3  P.  m. 

The  condition  gradually  grew  worse,  and  on 
the  evening  of  the  following  day  (June  10th) 
the  temperature  was  104'7°  and  the  pulse  150, 
soft,  feeble,  irregular  at  times,  and  "  running." 
The  rash  was  very  brilliant,  and  hsemorrhagic 
in  places.  All  day  drowsiness  had  been  a 
marked  feature ;  the  respiration  was  more 
rapid  than  normal,  and  occasionally  jerky. 
Nourishment  was  taken  with  difficulty.  There 
was  soreness  of  the  throat,  which  was  of  a 
brilliant  red  colour.  During  the  day  vomiting 
occurred  several  times,  and  also  slight  bleeding 
from  the  nose.  Coughing,  too,  was  trouble- 
some, and  he  hawked  up  blood-stained  mucus 
from  the  pharynx.  There  was  no  swelling  of 
the  thumb,  and  no  discharge  of  pus  from  the 
incision,  but  there  was  great  pain  and  tender- 
ness along  the  forearm  and  arm,  though  with- 
out obvious  swelling  or  oedema.  The  axillary 
glands  were  large  and  tender.  The  red  lines 
were  obscured  by  the  rash,  but  the  hard  lymph 
cords  could  be  felt.  There  was  frontal  head- 
ache, and  the  mind  was  clouded.  The  tongue 
had  gradually  become  coated  and  dry,  and  was 
passing  into  a  typhoid  condition.  There  was 
slight  albuminuria. 

At  midnight  (June  lOth-llth)  3-5  e.  em.  of 
antistreptococcus  serum  (Burroughs  and  Well- 


come) were  injected.  This  was  repeated  every 
four  hours.  Six  hours  after  the  first  injection 
(6  a.  M.,  June  11th)  certain  indications  of  im- 
provement were  manifest : 

1.  The  mind  was  clear  and  the  headache 
had  disappeared. 

2.  The  respiration  was  regular  and  less  rapid. 

3.  The  pulse  was  slower. 

4.  The  tongue  was  moist  along  the  edges.- 
On  June  11th  the  temperature  was  continu- 
ously 104°  F.  Cold  sponging,  which  was  done 
several  times,  had  no  real  effect.  The  tongue 
continued  to  clean,  but  a  smart  attack  of  epis- 
taxis  occurred.  The  rash  was  still  as  bright, 
and  the  blotchy  subcutaneous  haemorrhages 
were  more  evident.  Toward  evening,  after  the 
epistaxis  occurred,  the  pulse  became  much  more 
rapid  and  weak,  and  gave  rise  to  much  anxiety. 
Strychnine  and  digitalis  were  ordered  every 
four  hours. 

During  the  night  the  temperature  dropped, 
but  much  pain  and  some  swelling  were  noticed 
in  the  ball  of  the  thumb,  and  there  was  tender- 
ness above  the  wrist  on  the  radial  side,  with 
slight  oedema.  Notwithstanding  the  bad  night, 
the  general  condition  was  better. 

On  June  12th  the  skin  was  moist,  and  the 
tongue  was  steadily  cleaning  from  the  edge, 
leaving  a  marked  pink,  moist  surface,  such  as 
is  seen  on  the  throat  in  diphtheria  when  the 
membrane  clears  under  the  use  of  antitoxine. 
Chloroform  was  given,  and  an  incision  into  the 
thenar  eminence,  opening  the  sheath  of  the 
tendon,  was  made  ;  also  one  over  the  first  pha- 
lanx of  the  thumb.  The  parts,  though  swollen 
and  tense,  contained  no  visible  pus.  At  mid- 
day the  dose  of  antitoxine  was  doubled,  7  c.  cm. 
being  injected  every  four  hours. 

No  further  incisions  were  necessary,  the 
swelling  and  oedema  above  the  wrist  gradually 
disappeared,  and  the  incisions  all  began  to  heal 
without  any  visible  discharge  of  pus.  The 
rash  did  not  disappear  entirely  until  June 
16th. 

The  use  of  the  antitoxic  serum  appears  to 
the  authors  to  have  produced  the  following  ef- 
fects : 

1.  The  mind  became  clear  notwithstanding 
the  high  fever. 

3.  The  frontal  headache  ceased. 

3.  The  tongue  began  to  clean  and  become 
moist  from  the  edge  until  it  was  clean,  moist, 
and  of  a  peculiar  pink  colour  all  over. 

4.  The  pulse  became  slower  and  of  better 
quality. 

5.  The  respiration  was  slower  and  never 
jerky  afterward. 

6.  The  skin,  which  was  dry  and  burning,  be- 
came moist,  and  sweating  occurred. 

7.  The  wounds  healed  without  suppuration, 
and  the  threatened  inflammation  of  the  great 
synovial  sac  under  the  anterior  annular  liga- 
ment subsided. 

Every  care  was  taken  to  asepticize  the  syr- 
inge used  for  the  injection,  to  cleanse  the  skin 
at  the  site  of  injection,  and  to  maintain  the 
sterility  of  the  serum  by  keeping  it  in  ice,  and 
using  other  obvious  precautions.  The  in- 
jections were  given  into  the  loin  and  abdominal 
wall.    Notwithstanding  the  large  number  of. 


SBRDM  TREATMENT 


178 


injections  (twenty-eight  in  all,  eight  of  3'5  c.  cm. 
and  twenty  of  7  c.  cm.),  no  local  reaction  oc- 
curred at  all  except  a  fleeting  urticaria  limited 
to  the  site  of  injection,  which  was  noticed 
once  or  twice,  and  did  not  produce  any  incon- 
venience. 

The  recovery,  the  authors  add,  would  seem 
to  encourage  the  employment  of  the  anti- 
streptococcus  serum  in  many  other  serious 
surgical  conditions.  Among  many  others,  the 
following  occur  to  them :  Fracture  of  the 
skull  with  risk  of  suppurative  meningitis, 
acute  necrosis,  acute  septicemia  or  pymmia 
from  any  cause,  rapidly  spreading  gangrene  or 
cellulitis,  erysipelas,  general  suppurative  peri- 
tonitis, and  the  septic  complications  of  middle- 
ear  disease. 

With  regard  to  the  dose,  they  would  be  in- 
clined to  begin  by  injecting  a  large  one — say  20 
c.  cm. — and  then  to  give  a- smaller  dose — say  7 
c.  cm.  every  four  hours.  After  most  of  the  in- 
jections given  in  the  case  related,  the  temper- 
ature temporarily  dropped,  but  soon  rose  again, 
and  they  fancy  that  it  is  of  great  importance 
to  give  the  injections  frequently. 

In  the  Lancet  for  October  17, 1896,  there  is  a 
report  of  a  case  of  ulcerative  endocarditis,  by 
Dr.  Harrington  Sainsbury,  in  which  the  anti- 
streptococcus  serum  was  employed  with  suc- 
cess. Dr.  Sainsbury  refers,  however,  to  another 
case  that  had  come  under  his  care  in  which 
the  serum  failed  to  arrest  the  disease  or,  ap- 
parently, to  have  any  beneficial  efEect. 

Scarlet  fever  has  to  some  extent  been  sub- 
jected to  the  serum  treatment.  M.  Roger 
(Presse  medicate,  August  26,  1896)  gives  an  ac- 
count of  a  case  in  which  the  symptoms  seemed 
to  point  to  a  rapidly  fatal  termination,  so  that 
he  resolved  to  make  a  trial  for  the  serum  treat- 
ment. The  preparation  for  this  occupied  an 
hour,  during  which  time  the  patient's  condi- 
tion became  worse,  and  death  seemed  im- 
minent. At  eleven  o'clock  in  the  morning 
phlebotomy  was  practised  on  the  patient,  and 
afterward  80  cubic  centimetres  of  deflbrinated 
blood  which  was  taken  from  a  patient  conva- 
lescent from  scarlatina  were  injected  under 
the  skin  of  the  abdomen.  Five  hours  later  the 
patient  was  sleeping  quietly  and  breathing 
easily.  When  he  awoke  and  moved,  the  respira- 
tion changed  and  became  of  the  Cheyne-Stokes 
type ;  the  pulse  was  120  and  feeble ;  the  tongue 
was  moist ;  the  temperature,  however,  remained 
high  and  no  urine  was  passed.  A  bath  of  82° 
E.  was  then  given  and  the  temperature  began 
to  fall.  Three  hours  later  12^  oz.  of  saline 
solution  were  injected  subcutaneously  and  in 
an  hour  urine  was  passed.  Two  hours  later 
the  patient  was  sleeping  quietly:  the  pulse 
was  100,  and  the  respiration  25.  On  the  fol- 
lowing day  the  patient  was  completely  changed ; 
he  felt  better  and  asked  for  food;  his  tongue 
was  raw  but  moist ;  the  eruption  was  pale,  ex- 
cept on  the  legs,  where  it  was  still  very  pro- 
nounced ;  the  pulse  was  80,  feeble  but  regular  ; 
and  the  respiration  was  22.  During  the  twelve 
hours  following  the  last  injection  the  patient 
passed  1,100  cubic  centimetres  of  urine,  which 
was  of  a  dark-red  colour,  but  it  contained  no 
albumin.      The  temperature  during  the  day 


ranged  about  100-2°  P.,  and  on  the  following 
day  it  became  normal.  For  several  days  after- 
ward nothing  special  was  noted,  and  the  infec- 
tion terminated  rapidly.  M.  Roger  says  that 
he  has  never  seen  such  a  rapid  recovery  follow 
in  such  a  grave  case  of  scarlatina. 

Defervescence  was  rapid  instead  of  being 
progressive,  as  is  usually  the  case,  and  the  dis- 
ease terminated  suddenly.  This,  M.  Roger 
thinks,  is  one  of  the  best  arguments  in  favour 
of  the  serum  treatment. 

The  antidiphtheritic  serum  also  has  been  used 
in  the  treatment  of  malignant  scarlet  fever. 
M.  Fourrier  (Gazette  hebdomadaire  de  mede- 
cine  et  de  chirurgie,  August  27, 1896),  used  this 
serum  in  the  case  of  a  young  child  who  showed 
an  angina  during  the  course  of  grave  scarlet 
fever.  The  case  was  almost  hopeless  at  the 
moment  the  treatment  was  begun,  but  from 
the  first  injection  the  coma  into  which  the 
child  had  sunk  disappeared  and  the  subsequent 
injections  led  to  a  rapid  recovery.  Since  then 
M.  Fourrier  has  employed  this  treatment  in  five 
similar  oases,  with  the  most  successful  results, 
and  he  recommends  it  in  all  grave  cases  of 
scarlatina. 

Marmorek's  antistreptoooccus  serum,  too, 
has  been  employed  in  the  treatment  of  scarlet 
fever.  M.  Josias  (Semaine  medicate.  May  20, 
1896;  Bn7isA.  MedicalJournal,  Augusts,  1896), 
bearing  in  mind  the  fact  that  most  of  the  com- 
plications of  scarlet  fever  are  due  to  infection 
with  the  streptococcus,  treated  some  cases  with 
antistreptococcic  serum.  In  the  first  period 
forty-nine  children  were  treated  with  an  aver- 
age dose  of  5  cubic  centimetres  of  the  serum 
obtained  by  Nocard  from  a  sheep.  Except 
urticaria,  no  bad  symptoms  were  observed.  In 
the  second  period  ninety-six  children  were 
treated  with  an  average  dose  of  10  cubic  centi- 
metres of  the  serum,  some,  however,  receiving 
as  much  as  90  cubic  centimetres.  This  serum 
was  obtained  from  a  horse,  and  was  much  more 
active  than  that  from  the  sheep.  Streptococcic 
abscesses  at  the  seat  of  inoculation  occurred 
in  four,  lymphangeitis  in  eight,  polymorphic 
eruptions  in  ten,  and  purpura  in  seven  cases. 
As  a  result  of  this  treatment  Josias  thinks 
pseudo-membranous  angina,  unaccompanied  by 
suppurating  glands,  improve  more  quickly 
than  usual.  It  had  no  effect,  however,  on  sup- 
puration, even  though  due  to  the  sti-eptococ- 
cus,  and  none  on  albuminuria,  the  temperature, 
or  the  general  course  of  the  disease.  The 
mortality  in  cases  treated  without  serum  was 
5'81  per  cent,;  in  those  treated  with  serum 
from  the  sheep,  2-08  per  cent. ;  and  in  those 
treated  with  serum  from  the  horse,  5-31  per 
cent.  Thus  the  lowest  mortality  was  observed 
in  those  treated  with  the  serum  obtained  from 
the  sheep,  which  was  the  least  active  of  the 
two. 

Dr.  Weisbeckor  {Zeitschrift  fur  klinische 
Medicin,  1896,  Nos.  3  and  4;  therapeutische 
Wochenschrift,  June  28,  1896 ;  Journal  of  the 
American  Iledical  Association,  August  8, 
1896)  has  experimented  with  serum  from  pa- 
tients recovering  from  measles,  with  which  he 
injected  others  in  the  incubatory  stage.  He 
considers  the  results  quite  satisfactory,  as  the 


179 


SERUM  TREATMENT 


incipient  disease  was  much  modified,  and  cases 
of  measles  with  pneumonia  were  cured. 

The  serum  treatment  of  small-pox  has  been 
shown  to  be  rational  and  eflSoient,  but  as  a 
preventive  it  is  not  likely  to  supplant  vaccina- 
tion. Dr.  A.  Beclere  (Presse  midioale,  August 
12,  1896  ;  New  York  Medical  Journal,  Septem- 
ber 5,  1806)  gives  a  brief  account  of  nineteen 
cases  which  came  under  his  observation  in  the 
liospitals  of  Paris  and  of  Marseilles.  Among 
the  adults  the  total  quantity  of  serum  which 
was  injected  under  the  skin  varied  from  a  pint 
to  a  pint  and  a  half,  and  twice  it  even  exceed- 
ed this  quantity.  Young  children  received 
doses  of  from  3  fl.  oz.  to  half  a  pint,  accord- 
ing to  their  weight.  In  adults  it  was  often 
very  difficult  to  inject  more  than  a  fiftieth  of 
their  weight ;  in  some  emaciated  subjects  M. 
Beclere  was  able  to  inject  a  thirty-third  of 
their  weight,  but  he  never  exceeded  this  dose. 
These  enormous  quantities  of  serum,  which 
were  introduced  into  the  subcutaneous  cellular 
tissue,  were  rather  rapidly  absorbed  and  did  not 
provoke  any  accidents  except  the  appearance, 
in  certain  cases,  from  six  to  ten  days  after  the 
injection,  of  a  morbilitorm  exanthem  which 
was  sometimes  accompanied  by  urticarial  ele- 
vations ;  ordinarily  it  was  rather  pale,  rarely 
generalized,  nearly  always  apyretic,  and  always 
of  short  duration ;  there  were  no  general  trou- 
bles. The  serum  of  heifers,  whether  they  have 
been  vaccinated  or  not,  says  M.  Beclere,  is  gen- 
erally better  tolerated  by  the  human  organism 
than  horse  serum. 

The  treatment  of  tuberculosis  by  the  use  of 
serum  prepared  on  the  principles  that  govern 
the  production  of  the  diphtheria  antitoxine 
has  proved  successful  in  a  number  of  in- 
stances. Professor  E.  Maragliano,  of  Genoa, 
has  obtained  from  the  dog,  the  ass,  and  the 
horse  a  serum  which  he  presumes  to  contain 
a  tubercle  antitoxine.  He  gives,  a  summary 
(Gazzetta  medica  Lomharrla,  April  20,  1896; 
British  Medical  Journal,  May  16,  1896)  of  the 
results  observed  in  his  own  practice  and  in 
that  of  his  colleagues  and  other  practitioners 
who  have  reported  to  him.  The  statistics  in- 
clude all  the  cases  of  which  he  has  knowledge 
up  to  February  15,  1896.  The  total  number 
of  cases  is  412.  These  are  subdivided  as  fol- 
lows: 1.  Destructive  bronchopneumonia  with 
cavities,  93  ;  7  patients  were  apparently  cured, 
35  were  notably  improved,  and  34  were  un- 
changed, while  in  17  the  disease  went  steadily 
on  to  a  fatal  issue.  2.  Destructive  broncho- 
pneumonia without  demonstrable  cavity,  and 
with  microbic  associations  (that  is,  mixed  in- 
fection), 85;  9  patients  were  apparently  cured, 
45  were  improved,  24  were  unaffected,  and  7 
died.  3.  Diffuse  febrile  bronchopneumonia, 
with  or  without  destructive  processes,  104;  7 
patients  were  apparently  cured,  55  were  im- 
proved, 32  were  not  affected,  and  10  died.  4. 
Diffuse  non-febrile  bronchopneumonia  with  or 
without  destructive  processes,  43  ;  2  patients 
were  apparently  cured,  31  were  improved,  and 
10  were  not  affected.  5.  Circumscribed  febrile 
bronchopneumonia,  54;  20  patients  were  ap- 
parently cured,  31  were  improved,  and  3  were 
unchanged.      C.     Circumscribed     non-febrile 


bronchopneumonia,  33  ;  22  patients  were  ap- 
parently cured,  9  were  improved,  and  2  were 
not  affected.  The  author  explains  that  when 
he  speaks  of  "  cure "  he  means  only  the  com- 
plete disappearance  of  every  symptom  of  the 
disease  for  the  time ;  he  declines  to  commit 
himself  to  any  statement  as  to  the  permanence 
of  this  state  of  things.  The  number  of 
"  cures  "  varies  according  to  the  severity  of 
the  disease  when  treatment  is  begun.  In 
the  cases  here  summarized  the  proportion 
of  "  cures"  in  ihe  cases  with  cavities  was  7'76 
per  cent.  The  proportion  rises  through  in- 
termediate forms  till  in  cases  of  circum- 
scribed non-febrile  tuberculosis  in  which  the 
treatment  has  been  fully  carried. out  it  reaches 
almost  100  per  cent.  In  98'30  per  cent,  of  the 
cases  included  in  the  statistics  all  the  ordinary 
methods  of  treatment  had  been  tried  in  vain. 
Maragliano  sums  up  as  follows  :  1.  The  reme- 
dy has  been  proved  to  be  quite  innocuous.  2. 
It  has  caused  subsidence  of  fever.  3.  It  has 
had  a  modifying  influence  on  local  morbid 
processes.  4.  It  has  caused  the  bacilli  con- 
tained in  the  sputum  to  diminish  in  number 
or  to  disappear.  5.  It  has  brought  about  no- 
table increase  of  weight.  6.  Jt  has  had  a 
beneficial  effect,  more  or  less  markrd  accord- 
ing to  the  gravity  of  the  disease,  in  91-75  per 
cent,  of  the  cases.  7.  It  has  cured,  or  put  on 
the  way  to  cure,  nearly  all  the  patients  with 
circumscribed  non-febrile  forms  of  the  disease. 
8.  It  has  cured  even  cases  in  which  cavities 
had  formed.  9.  It  may  be  used  with  advan- 
tage in  all  forms  of  tuberculosis.  Maragliano 
at  first  recommended  that  treatment  should  be 
begun  with  the  injection  of  2  c.  cm.  of  the 
serum  every  two  days,  and  then  after  ten  days 
the  same  amount  every  day,  and  after  ten  days 
more  daily  injections  of  2  c.  cm.  Further  ex- 
perience has  convinced  him  that  equally  good 
effects  can  be  obtained  with  smaller  doses,  and 
he  now  recommends  that  1  c.  cm.  of  the  serum 
should  be  injected  systematically  every  two 
days.  In  cases  of  suboontinuous  fever,  with 
persistent  high  temperature,  however,  5  and 
even  10  c.  era.  may  be  injected  in  one  dose, 
and  repeated  after  from  five  to  eight  days, 
and  so  on,  when  after  two  or  three  days  an  ap- 
preciable depression  of  the  thermic  curve  is 
noted. 

It  appears  from  an  important  article  by  Dr. 
Zaeslein,  of  Genoa  {Deutsche  Medizinal-Zei- 
tung,  July  27,  1896  ;  New  York  Medical  Jour- 
nal, August  15,  1896),  that  Koch's  tuberculin, 
although  it  has  proved  a  failure  as  a  curative 
agent,  does  lead  to  a  formation  of  antitoxine, 
but  it  is  not  known  that  sufficient  antitoxine 
to  f  rove  curative  can  be  produced  by  the  use 
of  safe  doses.  The  employment  of  tuberculin 
as  a  therapeutic  measure  having,  therefore 
been  practically  renounced,  some  experiment- 
ers, especially  Riohet  and  Hericourt,  sought  to 
cure  tuberculosis  by  injecting  the  normal 
serum  of  such  animals  as  the  goat  and  the 
dog,  which  are  naturally  almost  completely 
proof  against  the  disease ;  but  the  results  were 
not  very  encouraging. 

Then  animals  were  treated  with  tuberculous 
matter,  in  order  to  engender  large  amounts  of 


SERUM  TREATMENT 


180 


antitoxines  in  their  blood.  For  that  purpose 
Maragliano  used  cultures  of  the  tubercle  ba- 
cillus, but  without  living  bacilli  ;  Behring, 
Wernicke,  Knorr,  and  Niemann  employed 
tuberculin ;  Babes  and  Broca  made  use  of  the 
bacilli  of  the  tuberculosis  of  birds,  human 
tuberculin,  and  dead  or  attenuated  cultures  of 
the  human  bacillus;  and  Paquin  used  cultures 
from  tuberculosis.  The  serum  of  animals 
systematically  treated  with  any  of  these  mate- 
rials, says  Zaeslein,  annuls  the  action  of  tuber- 
culin ;  Maragliano  first  announced  this  with 
regard  to  his  product  in  August,  1895.  Wer- 
nicke, Knorr,  and  Niemann  employed  only 
those  culture  products  that  resist  heat,  but 
Maragliano  uses  also  those  that  are  destroyed 
by  heat,  and  Zaeslein  thinks  it  probable  that 
this  is  of  great  advantage.  Babes  and  Paquin 
have  had  some  good  results,  but  there  are  no 
statistics  to  compare  with  Maragliano's,  which 
now  include  four  hundred  and  fifty  cases. 
The  use  of  his  serum,  says  Zaeslein,  has 
passed  the  experimental  stage,  and  may  safe- 
ly be  received  into  practical  therapeutics,  for 
the  dose  in  antitoxic  units  is  adjustable  and 
calculated  for  long  periods  and  the  use  of 
the  remedy  rests  on  adequate  clinical  obser- 
vation. 

For  the  inoculation  of  animals,  Maragliano 
uses  the  filtrate  of  cultures  that  have  been 
heated,  as  well  as  that  of  those  that  have  not 
been  heated.  The  first-mentioned  are  pre- 
pared by  steaming  highly  virulent  pure  cul- 
tures at  a  temperature  of  213°  F.  for  three  or 
four  days,  and  then  treating  them  in  the  same 
way  as  for  producing  Koch's  tuberculin;  in 
the  preparation  of  the  last-mentioned,  the 
cultures  are  filtered  through  a  Chamberland 
filter  at  the  ordinary  temperature,  and  then 
placed  in  a  vacuum  with  the  temperature 
never  above  80°  P.  The  first  product  contains 
all  the  toxic  elements  that  resist  heat — i.  e., 
the  bacterial  proteins,  or  tuberculins ;  in  the 
second  there  are  the  toxalbumins,  which  do 
not  bear  heat,  and  tuberculins  also,  for  in  all 
cultures  there  are  fragments  of  bacilli  which 
doubtless  contribute  tuberculins  to  a  solution. 
Now,  as  it  is  known  that  not  all  cultures  are 
equally  toxic,  an  unchanging  toxic  unit  has  to 
be  established,  in  order  that  the  animals  may 
be  inoculated  uniformly.  This  is  accom- 
plished by  greater  or  less  concentration  of  the 
filtrates,  and  the  unit  consists  of  a  weight 
sufficient  to  kill  a  healthy  guinea-pig  of  a  cer- 
tain weight ;  in  this  case  the  two  filtrates  are 
concentrated  to  such  a  degree  that  a  cubic 
centimetre  will  contain  a  hundred  toxic  units 
— i.  e.,  a  cubic  centimetre  for  each  1,500  grains 
of  the  guinea-pig's  weight  will  be  required  to 
kill  the  animal.  In  the  inoculations  three 
parts  of  the  heated  and  one  part  of  the  un- 
heated  filtrate  are  employed,  the  operator 
beginning  with  3  milligrammes  for  each  kilo- 
gramme of  the  animal's  weight,  and  increasing 
the  dose  regularly  by  1  milligramme  daily 
until  it  reaches  from  40  to  50  milligrammes, 
at  which  it  is  to  remain.  Dogs,  assee,  and 
horses  are  emploj'ed,  and  ordinarily  the  inocu- 
lations are  continued  for  six  months.  The 
animal  will    then  withstand  large   doses  of 


virulent  cultures,  even  by  intravenous  injec- 
tion. Before  blood  is  drawn  from  the  animal 
there  is  a  pause  of  three  or  four  weeks,  m 
order  to  make  sure  that  the  serum  contains  no 
residue  of  the  poisonous  substances  that  have 
been  injected.  The  serum  is  separated  and 
treated  according  to  the  ordinary  method. 

The  physiological  action  of  the  serum  on 
man  is  as"  follows :  In  a  healthy  person  the 
curative  serum  as  such  has  no  eflfect  on  the 
temperature;  however,  like  any  other  animal 
serum,  even  that  of  animals  that  have  not 
been  inoculated,  in  certain  individuals  it  may, 
especially  if  used  in  large  doses,  cause  a  rise  of 
temperature,  but  the  fact  of  its  coming  from 
an  inoculated  animal  has  nothing  to  do  with 
this.  It  has  no  direct  influence  on  the  circula- 
tion ;  when,  however,  a  tuberculous  patient's 
general  condition  improves  after  a  series  of 
injections,  the  pulse  grows  correspondingly 
slower  and  fuller.  There  is  often  a  striking 
increase  in  the  number  of  leucocytes  in  the 
blood ;  in  tuberculous  persons  the  number  of 
the  red  corpuscles  and  the  amount  of  haemo- 
globin also  are  increased  in  proportion  to  the 
improvement  of  the  general  condition.  In 
general,  there  is  no  perceptible  effect  on  the 
urine,  but  when  a  large  dose,  as  much  as  10 
cubic  centimetres,  is  given  at  one  time,  tempo- 
rary peptonuria  may  occur,  but  never  glyco- 
suria or  albuminuria.  The  appetite  is  almost 
always  increased,  also  the  weight ;  if  the  loss 
of  flesh  has  been  only  slight,  there  will  be  but 
little  increase,  but  in  very  emaciated  persons 
the  gain  will  be  striking,  amounting  in  some 
instances  to  as  much  as  30  pounds. 

Zaeslein  then  proceeds  to  the  effects  of  the 
treatment  on  the  manifestations  of  the  disease, 
considering  first  those  that  are  local.  The 
chief  effect  elicited  by  auscultation,  he  says,  is 
a  diminution  and  final  disappearance  of  the 
rales,  which  means  a  drying  up  of  the  de- 
posits, beginning  with  those  that  are  recent 
and  slowly  extending  to  the  older  ones.  Sub- 
sequently the  areas  of  dulness  diminish  or  dis- 
appear. These  effects  occur  even  in  cases  in 
which  no  other  measure  has  been  of  any  avail 
and  whether  or  not  there  is  fever  and  whether 
or  not  heredity  is  playing  a  part.  Now  and 
then  a  tendency  toward  cure  is  perceptible 
within  a  few  days,  and  usually  in  the  course 
of  a  month,  if  the  process  is  not  too  far  ad- 
vanced and  not  too  many  other  bacilli  are 
present.  Slight  fever  usually  disappears  slow- 
ly when  the  treatment  is  carried  out  according 
to  Maragliano's  directions;  high  fever  may 
abate  and,  if  the  progress  of  the  case  is  to  be 
favourable,  subside  entirely.  Very  high  fever 
and  the  subcontinuous  fever  which  occurs  in 
the  final  stage  may  be  reduced  or  overcome  if 
large  doses  of  the  serum  are  employed — from 
5  to  10  cubic  centimetres  every  fifth,  sixth,  or 
seventh  day,  but  only  for  two  or  three  days ; 
this  effect  is  not  constant  and  generally  not 
lasting. 

A  tolerably  constant  effect  is  a  gain  in 
weight,  even  if  the  fever  continues.  Mara- 
gliano says:  "The  patient  gains  weight  because 
he  eats  more,  it  is  true,  but  it  is  because  the 
serum  treatment  enables  him  to  eat  more." 


181 


SERUM  TREATMENT 


As  the  other  symptoms  are  ameliorated,  the 
number  of  tuViercle  bacilli  in  the  sputa  be- 
comes reduced,  slowly  of  course  in  severe 
eases ;  finally  they  disappear  entirely  and  not 
merely  for  the  time  being,  provided  the  treat- 
ment is  energetic  and  continued  long  enough. 
As  regards  the  general  condition,  many  pa- 
tients say  that  they  feel  stronger  after  the  first 
few  injections,  and  they  are  inclined  to  do 
some  work,  which  for  a  long  time  had  been 
impossible  for  them  ;  but  this,  of  course,  is 
only  a  subjective  phenomenon.  After  further 
treatment  the  whole  scene  changes — there  is  a 
sharp  appetite,  the  patients  take  long  walks 
without  exertion  or  fatigue,  and  they  do  not 
get  out  of  breath.  Moreover,  their  sleep  is 
long  and  restful. 

As  regards  the  different  forms  and  stages 
of  the  disease,  Maragliano  divides  all  cases  of 
pulmonary  tuberculosis  into  two  great  groups 
— those  in  which  Koch's  bacillus  is  the  only 
micro-organism,  or  almost  the  only  one,  found 
in  the  spiita,  and  those  in  which  there  is  an 
abundance  of  other  microbes,  such  as  strepto- 
cocci, staphylococci,  and  the  diplocoecus  of 
pneumonia,  constituting  what  he  calls  "mi- 
crobial associations."  In  these  latter  cases 
the  cure,  although  not  impossible,  is  difficult 
and  protracted;  they  are  the  ones  in  which 
the  old  remedies  must  not  be  neglected  on  ac- 
count of  the  serum  treatment.  Besides  the 
question  of  which  of  these  two  great  divisions 
the  case  belongs  in,  one  has  to  take  into  ac- 
count four  other  considerations:  The  "quali- 
ty "  of  the  disease  (whether  there  is  only 
catarrh  or  infiltration,  whether  the  infiltra- 
tion is  compact  or  disseminated,  whether  there 
is  a  tendency  to  caseation  or  to  cirrhosis,  and 
whether  or  not  there  are  cavities) ;  its  "  quan- 
tity" (the  amount  of  tissue  diseased);  its  in- 
tensity; and  the  patient's  general  condition. 
All  these  data  are  of  importance  in  the  prog- 
nosis. 

Maragliano's  statistics  relate  to  four  hun- 
dred and  forty-five  cases,  including  the  eightj- 
two  that  he  reported  in  August,  1895,  before 
the  Societe  fran§aise  de  medecine  interne, 
those  recorded  or  reported  to  him  by  other 
Italian  physicians,  and  a  few  contributed  from 
France  and  Austria.  When  Maragliano  speaks 
of  a  cure,  he  means  a  "  provisional  cure," 
manifested  by  the  disappearance  of  all  sub- 
jective symptoms  and  all  physical  signs  except 
dulness  on  percussion.  The  cases  are  divided 
into  six  groups  as  follows : 

1.  Patients  with  destructive  ironchopneumo- 
nia  and  cavities,  105. 

Cured 8 

Improved 37 

Not  affected 37 

Grew  worse 33 

Eighty-two  of  these  patients  had  fever.  It 
disappeared  in  twenty-nine,  was  reduced  in 
sixteen,  and  remained  stationary  in  thirty- 
seven.  The  local  signs  disappeared  in  twenty, 
were  mitigated  in  thirty,  and  were  unchanged 
in  forty-eight.  The  weight  increased  in  forty- 
three  cases,  remained  stationary  in  twenty-six, 
and  decreased  in  seven. 


2.  Patients  with  destructive  bronchopneu- 
monia, without  recognisable  cavities,  with 
"  mierobian  associations,"  85. 

Cured 9 

Improved 45 

Not  affected 24 

Grew  worse 7 

The  fever  disappeared  in  forty,  abated  in 
eleven,  and  remained  the  same  in  twenty-one. 
The  local  signs  disappeared  in  fifteen,  were 
improved  in  forty,  and  remained  unaffected  in 
twenty-one.  Forty-three  gained  flesh,  four 
lost  weight,  and  in  twenty-two  there  was  no 
change  of  weight. 

3.  Patients  with  diffuse  febrile  pneumonia, 
with  or  without  a  destructive  character,  120. 

Cured 11 

Improved 01 

Not  affected 35 

Grew  worse 13 

The  fever  disappeared  in  sixty,  grew  less  in 
twenty-two,  remained  the  same  in  twenty-nine, 
and  increased  in  eight.  The  local  signs  van- 
ished in  twenty-four,  were  improved  in  fifty- 
one,  remained  stationary  in  twenty-nine,  and 
were  aggravated  in  twelve.  Forty-eight  gained 
flesh,  eight  lost,  and  in  twenty-two  there  was 
no  change. 

4.  Patients  with  diffuse  non-febrile  broncho- 
pneumonia, with  or  without  destruction,  47. 

Cured 3 

Improved 83 

Not  affected 11 

Grew  worse 1 

The  local  signs  disappeared  in  eleven,  re- 
mained the  same  in  thirteen,  and  were  im- 
proved in  twenty-two.  The  weight  increased 
in  twenty-four  and  was  unchanged  in  twelve. 

5.  Patients  with  circumscribed  febrile  bron- 
chopneumonia, 54. 

Cured 30 

Improved 31 

Not  affected 3 

The  fever  disappeared  in  forty-seven,  was 
unchanged  in  four,  and  was  aggravated  in  one. 
The  local  signs  disappeared  in  twenty-five, 
were  improved  in  twenty-five,  remained  the 
same  in  three,  and  were  intensified  in  one. 
Forty-four  gained  in  weight  and  in  four  there 
was  no  change. 

6.  Patients  with  circumscribed  apyretic 
bronchopneumonia,  34. 

Cured 23 

Improved 10 

Not  affected 2 

The  local  signs  disappeared  in  twenty-three, 
were  improved  in  eight,  and  were  unchanged 
in  two.  The  weight  increased  in  twenty-seven 
and  was  not  affected  in  one.  It  is  explained 
that  the  omission  of  some  of  the  data  in  the 
foregoing  statistics  was  due  to  defective  his- 
tories having  been  sent  in  some  instances. 

To  summarize  the  results,  the  fever  disap- 
peared in  176  out  of  333  cases — in  55  per  cent. 


SBRDM   TREATMENT 


183 


of  cases  of  bronchopneumonia  with  "  microbian 
associations,"  in  33  per  cent,  of  those  of  cavi- 
ties, in  48  per  cent,  of  those  of  diffuse  broncho- 
pneumonia, and  in  86  per  cent,  of  those  of 
circumscribed  bronchopneumonia.  The  local 
signs  disappeared  in  27  per  cent.,  were  im- 
proved in  41  per  cent.,  were  unchanged  in  30 
per  cent.,  and  were  aggravated  in  6  per  cent. 
[so  the  account  says,  bat  these  numbers  added 
together  make  104 ;  consequently  there  has 
been  a  slip  of  the  pen].  There  was  an  increase 
of  weight  in  57  per  cent.  The  tubercle  bacilli 
disappeared  in  43-2  per  cent,  (in  54  per  cent,  of 
the  febrile  bronchopneumonias  and  in  88  per 
cent,  of  the  non-febrile  circumscribed  broncho- 
pneumonias). 

As  a  general  thing,  a  cubic  centimetre  of  the 
serum  was  administered  subcutaneously  every 
other  day,  and  the  temperature  was  carefully 
observed.  Inasmuch  as  a  few  persons  are  sen- 
sitive even  to  this  dose,  half  a  cubic  centimetre 
may  be  given  to  begin  with.  Such  individuals 
may  be  recognised  by  their  showing  a  febrile 
reaction  on  the  injection  of  3  cubic  centimetres 
of  a  physiological  salt  solution.  In  the  great 
majority  of  instances  there  was  neither  a  rise 
of  temperature  nor  any  other  disturbance,  even 
when  the  treatment  was  continued  for  many 
months.  When  a  rise  of  temperature  occurred 
the  treatment  was  suspended  until  it  fell,  but 
even  in  such  cases  a  definitive  apyrexia  oc- 
curred in  time.  When  the  treatment,  thus 
employed,  failed  to  affect  patients  who  had 
high  fever  and  were  in  bad  general  condition, 
from  5  to  10  cubic  centimetres  of  the  serum 
were  given  every  fifth  day ;  when  three  or  four 
such  injections  had  been  given  without  avail, 
it  was  thought  useless  to  continue  with  them, 
and  the  ordinary  plan  of  using  small  doses  was 
resumed. 

The  use  of  the  serum  should  be  continued 
until  a  cure  results,  then  two  injections  a  week 
should  be  given  for  two  months,  and  after  that 
one  injection  a  week  for  a  year.  The  side  of 
the  chest  and  the  back  are  the  preferable  parts 
for  the  injections.  They  are  no  more  painful 
than  injections  of  morphine ;  occasionally  a 
little  swelling  occurs,  but  it  subsides  in  a  few 
Anjs,  rarely  there  is  urticaria,  and  no  other 
accidents  are  observed.  The  serum  is  described 
as  clear  and  free  from  flocculi  and  sediment. 
Not  until  it  has  been  kept  for  a  long  time  does 
it  become  turbid,  and  then  it  had  better  be 
discarded,  although  the  flocculi  seem  to  con- 
sist only  of  precipitated  albumin. 

Br.  Cattaneo  {Cfazzetta  degli  ospedali,  March 
14, 1896 ;  British  Medical  Journal,  August  15, 
1896)  gives  an  account  of  two  cases  of  infantile 
tuberculosis  treated  with  Maragliano's  serum. 
He  first  points  out  the  advantages  offered  by 
tubercle  in  children  for  the  observation  of 
this  method,  presenting  as  they  often  do  local 
lesions  which  tend  readily  to  infect  other  tis- 
sues, and  thjis  forming  what  may  be  termed 
test  cases.  In  each  of  the  cases  which  he  re- 
cords the  patient  was  kept  under  observation 
for  twenty  days  previous  to  the  beginning  of 
the  treatment,  and  during  the  whole  of  this 
time,  as  also  during  that  of  the  treatment,  the 
following  amount  of  food  was  given:  Bread, 


100  grammes ;  rioe,  150  grammes ;  broth,  350 
grammes ;  meat,  80  grammes ;  two  eggs ;  red 
wine,  100  grammes;  Marsala  wine,  100  grammes; 
milk,  200  grammes.  The  first  patient  was  a 
girl,  aged  three  years,  whose  father  had  died 
of  pulmonary  tuberculosis  and  two  brothers  of 
pulmonary  disease,  probably  tuberculous.  She 
was  poorly  developed  and  had  flaccid  muscles, 
dry  skin,  enlarged  glands,  enlargement  of  the 
liver  and  spleen,  40  per  cent,  hieraoglobin, 
4,624,000  red  blood-corpuscles,  evening  tem- 
perature with  maximum  103-3°  F.,body  weight 
7-55  kilogrammes.  The  treatment  consisted  of 
fifty  injections  in  all,  at  first  on  alternate  days, 
then,  being  well  borne,  every  day.  In  the 
first  fortnight  there  was  a  rapid  improvement 
in  the  general  condition  and  appetite,  and 
the  child  was  more  brisk  and  playful.  The 
hemoglobin  was  55  per  cent.,  the  red  blood- 
corpuscles  were  4,830,000,  and  there  was  a  de- 
crease in  the  number  of  white  blood-corpuscles. 
At  the  end  of  the  treatment  there  was  no 
cough,  the  liver  was  reduced  in  size,  the  spleen 
did  not  protrude  from  under  the  ribs,  and  the 
glands  were  smaller.  The  hEemoglobin  was  55 
per  cent.,  the  red  blood- corpuscles  numbered 
4,584,000,  there  was  no  fever,  the  weight  of  the 
body  was  8  kilogrammes,  the  general  condition 
was  good,  also  the  appetite,  and  the  patient 
was  active  and  playful. 

The  second  patient  was  a  girl  aged  five  years. 
Her  family  history  was  negative :  dentition 
had  been  late,  and  she  had  had  intestinal  dis- 
turbances, and  a  slight  discharge  from  the 
ear.  She  had  some  cough,  dyspnoea,  and  occa- 
sional pyrexia ;  no  improvement  had  resulted 
from  general  treatment.  At  the  time  when 
the  serum  treatment  was  begun  the  child  was 
miserable  in  appearance,  wasted,  with  the  mus- 
cles fiaccid,  the  mucosae  pallid,  the  skin  dry 
and  scaly,  the  glands  enlarged,  breathing  harsh 
at  each  apex,  with  sibilant  rales,  moist  rales 
lower  down ;  the  abdomen  tumid,  and  the  liver 
and  spleen  below  the  costal  margin,  the  latter 
slightly.  The  hemoglobin  was  50  per  cent. ; 
the  red  blood-corpuscles  numbered  3,000,000 ; 
there  was  indicanuria,  but  no  pyrexia;  the 
child  weighed  11-75  kilogrammes.  The  treat- 
ment included  fifty  injections.  During  the 
first  fortnight  there  was  some  improvement  in 
the  general  condition  and  appetite,  with  dimi- 
nution of  both  dry  and  moist  sounds  and 
cough.  The  hemoglobin  was  65  per  cent.,  and 
the  red  blood-oorpusoles  numbered  4,000,000. 
In  the  last  three  weeks  of  the  treatment  there 
was  very  slight  pyrexia  due  to  some  slight 
local  suppuration  at  the  seat  of  injection,  which 
subsided  on  the  discharge  of  some  pus.  At  the 
end  of  the  treatment  there  was  great  diminu- 
tion in  the  dry  sounds,  no  moist  being  heard, 
with  a  decrease  in  the  size  of  the  glands :  the 
hemoglobin  was  60  per  cent. ;  the  red  blood- 
corpuscles  numbered  3,634,000;  there  was  no 
fever;  the  weight  was  11-8  kilogrammes;  the 
general  condition  was  good ;  the  appetite  was 
fair  ;  and  the  child  was  cheerful.  The  writer 
looks  upon  these  cases  as  very  instructive, 
showing  as  they  do  considerable  improvement 
in  the  tuberculous  condition,  with  marked 
change  for  the  better  in  the  general  state  of 


183 


SERUM  TREATMENT 


tVie  patient's  health.  They  are  also  of  im- 
portance in  showing  the  h'armlessness  of  the 
treatment.  As  these  patients  were  both  young 
and  delicate  children  they  would  be  expected 
to  exhibit  whatever  bad  effects  might  accrue 
from  the  method.  The  result  was,  however, 
only  a  slight  local  suppuration  in  one,  and 
even  that  was  practically  insignificant  in  its 
effect. 

Favourable  results  from  the  use  of  Maragli- 
ano's  treatment  have  been  reported  by  Regnier, 
Fasano,  De  Renzi,  Casarini.  and  others.  Fasano 
(cited  in  the  Archirio  internazionale  di  medi- 
cina  e  cMrurgia,  1896 ;  J^ew  York  Medical 
Journal,  October  31,  1896)  employed  Maragli- 
ano's  serum  in  the  treatment  of  pulmonary 
phthisis  in  the  hospital  of  Sainte-Marie  de  la 
Paix.  The  patients  were  carefully  watched  by 
him  every  day  and  all  forms  of  phthisis  thor- 
oughly studied.  Maragliano's  method  was 
rigorously  carried  out  in  regard  to  the  diet, 
the  doses,  and  the  time  of  injection,  and  the 
results  obtained  led  the  author  to  the  follow- 
ing conclusions:  1.  The  serum  is  absolutely 
harmless  and  does  not  provoke  lesions  of  the 
renal  organs.  2.  In  certain  subjects  there  are 
some  cutaneous  manifestations,  but  they  dis- 
appear rapidly.  3.  Occasionally  the  serum 
produces  engorgement  of  the  ganglia  near  the 
seat  of  injection,  but  this  may  be  avoided  by  a 
rigorous  antisepsis  during  tlae  procedure.  4. 
The  serum  has  certainly  an  antithermic  power, 
which  varies  with  the  temperature  and  the 
amount  of  serum  injected ;  the  lower  the  tem- 
perature the  smaller  should  the  dose  be ;  when 
the  temperature  is  higher  the  dose  must  be  in- 
creased ;  a  thermic  lowering  is  obtained  with  5 
cubic  centimetres,  but  the  fever  does  not  en- 
tirely disappear  until  after  from  twenty-five  to 
forty  injections  have  been  given,  according  to 
the  individual.  5.  The  serum  diminishes  re- 
spiratory action  and  the  freqiienoe  of  the  pulse, 
as  it  causes  a  moderated  action  of  certain  nerv- 
ous centres.  6.  It  increases  the  weight,  the 
dynamometric  strength,  and  the  appetite  from 
thebeginningof  the  treatment.  7.  It  increases 
respiratory  power  and  invariably  diminishes 
the  sweats,  and  in  certain  cases  causes  their 
complete  disappearance.  8.  The  direct  changes 
of  the  bacilli  take  place  slowly  in  the  expecto- 
ration ;  in  the  pure  forms — that  is  to  say,  with- 
out microbian  associations — the  disappearance 
and  the  diminution  of  the  bacilli  are  more 
prompt,  and  when  this  condition  occurs  it  is 
invariably  maintained,  and  it  is  dependent 
upon  not  only  the  quantity  of  serum  injected, 
but  the  duration  of  the  treatment.  9.  The 
daily  quantity  of  the  expectoration  constantly 
dimiiiishes.  10.  In  the  forms  in  which  rales 
prevail  there  is  a  drying  of  the  bronchopneu- 
monic  centre  and  finally  a  disappearance  of  the 
rales.  11.  The  serum  may  be  considered  as  a 
remedy  for  the  local  symptomatic  processes  in 
the  extensive  forms  with  fusion,  cavities,  and  a 
high  temperature,  or  as  a  curative  in  limited 
and  initial  forms.  Dr.  Fasano  thinks  that  this 
serum  is  a  remedy  that  all  physicians  should 
employ,  especially  in  the  beginning,  when  the 
results  are  more  certain,  as  it  prevents  the 
spread  of  the  disease. 


Dr.  Paul  Paquin,  of  St.  Louis,  who  has 
made  a  close  study  of  the  serum  treatment  of 
tuberculous  disease,  using  a  serum  of  his  own 
preparation,  has  reported  a  number  of  cases  in 
which  patients  affected  with  various  forms  of 
the  disease  have  been  either  cured  or  notably 
improved.  In  a  recent  article  (ISlew  York 
Medical  Journal,  October  24,  1896)  he  states 
that  up  to  September  1,  1896,  he  has  received 
reports,  tabulated  more  or  less  accurately,  of 
two  hundred  and  twenty-five  cases.  He  has, 
indeed,  reports  tonching  on  more  than  four 
times  that  number  which  are  not  written  so  as 
to  be  available  to  make  an  absolutely  reliable 
digest  of  them  at  the  time  of  his  writing. 
There  are  among  them  a  number  of  records  of 
improvements  and  some  of  alleged  recoveries. 

The  details  of  conditions  and  results  of  the 
two  hundred  and  twenty-six  cases  are  as  fol- 
lows, foreign  classification  being  employed  to 
make  comparisons  of  American  and  foreign 
work  more  intelligible : 

No.  of 
Pulmonary  tuberculosis  :  cases. 

Class  1.  DestructiTc  bronchopneumonia 
and   cavities 37 

Class  2.  Destructive  bronchopneumonia, 
without  recognisable  cavities 66 

Class  3.  With  diffuse  febrile  pneumonia, 
with  or  without  a  destructive  process.     19 

Class  4.  With  diffuse  non-febrile  broncho- 
pneumonia, with  or  without  destructive 
cavities 19 

Class  5.  With  circumscribed  febrile  bron- 
chopneumonia       35 

Class  6.  With  circumscribed  apyretic 
bronchopneumonia 18 

Diagnosis  not  reported  clear  enough  for 
classification 32 

Hip- joint  tuberculosis 2 

Laryngeal  tuberculosis 2 

Ovarian  tuberculosis 1 

236 

In  every  one  of  these  cases  the  diagnosis 
was  verified  microscopically.  During  the  treat- 
ment of  these  two  hundred  and  twenty-six 
cases  the  following  conditions  obtained  : 

Effect  of  serum  on  fever :  Subsided,  60  ;  re- 
duced, 56  ;  stationary,  26 ;  not  recorded,  84. 

Effect  of  serum,  on  night  sweats :  Subsided, 
69  :  unchanged,  17 ;  not  recorded,  140. 

Effect  of  serum  on  weight :  Increased,  125; 
unchanged,  15 ;  decreased,  27 ;  not  recorded, 
59. 

Effect  of  serum  on  strength  :  Increased,  154; 
unchanged,  9 ;  decreased,  24 ;  not  recorded, 
39. 

Effect  of  serum  on  appetite  :  Increased,  114 ; 
unchanged,  15 ;  decreased,  31  ;  not  recorded 
66. 

Effect  of  serum  on  local  signs :  Disappeared, 
46 ;  mitigated,  58 ;  unchanged,  29 ;  not  re- 
corded, 94. 

Effect  of  serum  on  tuiercle  iacilli :  Disap- 
peared, 40;  reduced,  103;  altered,  7;  not  re- 
corded, 76. 

Effect  of  serum  on  general  well-heing,  exclu- 
sive of  the  40  cures :  Improved,  145 ;  un- 
changed, 9  ;  not  recorded,  33. 


SERUM  TREATMENT 


184 


Number  of  recoveries  that  seem  complete 

and  permanent 40 

Number  of  apparent  recoveries  with  exist- 
ing lesions  in  statu  quo 3 

Number  of  improved  capable  of  perform- 
ing usual  duties 41 

Number  of  improved  to  a  lesser  degree. . .     69 

Number  of  deaths  reported 32 

Number  of  cases  disappeared  from  observa- 
tion or  under  various  treatments 41 

226 

As  to  the  pulmonary  cases,  the  extent,  stage, 
and  importance  of  the  conditions  at  the  begin- 
ning of  treatment  were  as  follows  : 

Cases  in 


In  Class  1  there  were. 
"      ■'     2     •' 
"      "     3     " 
"       "      4      " 

"       "      5      " 


advanced  stage. 
20 
33 
12 
9 
12 

r 


Cases  in 
early  stage. 
3 
6 
0 
0 
3 
1 


Not  classified  accurately  enough  for  satisfactory  de- 
scription of  the  stage 115 

These  ranged  between  the  first  and  third 
stages,  and  belonged  to  various  classes. 

Now,  it  is  needless  to  add,  says  Dr.  Paquin, 
that  many  physicians  who  have  used  serum 
have  not  reported.  It  should  be  remembered, 
also,  that  from  eighty  to  ninety-five  per  cent, 
of  the  patients  who  have  so  far  consented  to 
use  serum  are  in  the  third  and  last  stages  of 
the  disease,  and  therefore  by  no  means  fair 
tests  of  the  value  of  the  serum  in  earlier  and 
purer  cases  of  tuberculosis.  Nothing,  he  adds, 
can  cure  the  vast  majority  of  advanced  eases. 
His  own  cases  were  treated  exchisively  with 
serum,  and  the  reports  given  cover  only  those 
of  which  he  is  reliably  informed  and  the  diag- 
nosis of  which  was  trustworthy.  It  is  obvious, 
he  says,  that  if  we  would  give  tuberculous  pa- 
tients all  the  chances  possible  of  recovery,  we 
must  begin  their  treatment  at  the  earliest  pos- 
sible moment,  when  the  first  slight  symptoms 
appear,  instead  of  depending  exclusively  on 
drugs  and  climate  until  it  is  too  late  for  the 
help  of  organic  and  pacific  treatment. 

Maragliano's  tubercle-antitoxine  serum  has 
been  employed  in  the  treatment  of  lupus. 
Terrill  {Oazzetta  degli  ospedali.  July  12,  1896: 
Therapeutische  Wochenschrift,  August  9, 
1896)  used  it  on  two  young  subjects,  one  of 
whom  had  lupus  of  the  foot  and  the  other 
lupus  of  the  hand.  The  first  one  received,  in 
all,  107  cubic  centimetres  of  the  serum  (at  first 
1  cubic  centimetre  every  second  day,  then  5 
cubic  centimetres  every  third  day);  the  second 
got  25  cubic  centimetres  (5  every  third  day), 
and  was  also  treated  topically  with  the  serum. 
In  each  case  the  result  was  very  gratifying,  al- 
though a  perfect  cure  did  not  tal<e  place.  The 
infiltration  subsided  and  the  joints  became 
movable.  The  local  application  of  the  serum 
was  founded  on  its  direct  destructive  action 
on  the  bacillus,  as  was  shown  by  the  healing 
of  a  tuberculous  anal  fistula  after  local  injec- 
tions of  it. 

Dr.  Juan  de  Dios  Carrasquilla,  of  Bogotd, 
has  used  a  serum  prepared  by  himself  in  the 


treatment  of  leprosy.  His  concliisions  (iVeW 
York  Medical  Journal,  January  18,  18yb)  are 
as  follows : 

1  The  serum  treatment  overcomes  tlie  an- 
ajst'hesia  more  or  less  rapidly,  in  proportion  to 
the  extent  and  gravity  of  the  lesions  of  the 
peripheral  nerves.  3.  It  decolourizes  the  mac- 
ules without  obliterating  them  entirely ;  they 
become  the  seat  of  abundant  desquamation. 

3.  It  causes  oedema  to  disappear  rapidly  in 
some  cases,  slowlv  in  others ;  the  skin  retracts, 
becomes  wrinkled,  and  finally  returns  to  its 
normal  state  when  the  oedema  has  subsided. 

4.  The  tubercles  become  flattened  and  softened 
and  disappear,  either  by  absorption,  by  desqua- 
mation, or  by  suppuration,  leaving  marks  to 
show  their  situation.  5.  After  suppurating 
abundantly,  the  ulcers  heal  with  marvellous 
rapidity  and  leave  the  skin  sound.  6.  The 
scars  of  old  suppurative  lepromata  become  pale 
and  tend  to  assume  a  level  with  the  surround- 
ing skin.  7.  The  ulcerated  mucous  mem- 
branes cicatrize  rapidly,  become  decolourized 
like  the  cutaneous  macules,  and  regain  their 
sensibility,  while  the  tubercles  disappear.  8. 
With  the  disappearance  of  the  cedema  and  the 
tubercles  and  with  the  fading  of  the  stains  the 
countenance  grows  thin  and  loses  its  leonine 
aspect  entirely.  9.  The  appetite  is  recovered, 
together  with"  the  capability  of  sleeping,  there 
is  cheerfulness,  content  replacing  the  previous 
profound  depression,  and  lost  hope  is  regained. 
10.  Prom  the  first  serum  injection  adminis- 
tered to  the  patient  the  morbific  action  of  the 
Bacillus  leprcB  ceases,  and  no  new  manifesta- 
tion of  the  disease  shows  itself.  This  the 
author  has  invariably  witnessed  in  the  fifteen 
cases  that  he  has  treated. 

In  a  subsequent  communication  to  the  Na- 
tional Academy  of  Medicine  of  Bogotd  (New 
York  Medical  Journal,  August  22,  1896)  Dr. 
Carrasquilla  describes  his  method  of  obtaining 
the  anti-leprous  serum  and  his  mode  of  em- 
ploying it.  He  first  bleeds  a  leper,  choosing 
an  "adult  whose  general  condition  is  fairly 
good.  The  blood  drawn  varies  in  amount 
from  100  to  250  cubic  centimetres.  It  is  re- 
ceived into  a  sterilized  vessel  and  carefully 
covered,  kept  away  from  the  light,  and,  above 
all,  kept  perfectly  quiet.  In  from  twelve  to 
twenty-four  hours  the  superficial  layer  of 
serum,  that  only  which  is  perfectly  limpid,  is 
removed  with  a  pipette.  If  it  has  to  be  kept  for 
some  time  before  it  is  to  be  used,  it  is  passed 
through  a  layer  of  powdered  camphor  con- 
tained between  two  layers  of  cotton  to  preserve 
it,  and  it  is  kept  away  from  light  and  heat. 
Thus  prepared,  the  serum  is  injected  into  an 
animal  that  is  refractory  to  leprosy,  prefer- 
ably a  healthy  young  horse  in  good  condition. 
Roux's  method  of  procedure  is  employed.  In 
regard  to  this  operation,  says  Dr.  Carrasquilla, 
there  are  two  points  that  are  of  the  greatest 
importance  and  at  the  same  time  difficult  to 
determine — the  amount  of  serum  to  be  in- 
jected at  one  time  and  the  interval  that  should 
be  allowed  to  elapse  between  the  injections. 
His  experience  leads  him  to  think  that  45 
cubic  centimetres  is  the  proper  medium  dose, 
given  at  intervals  of  ten  days.    The  horse  is 


185 


SERUM  TREATMENT 


bled  in  from  five  to  ten  days  after  the  last  in- 
jection, preferably  from  the  jugular  vein.  The 
Nocard-Roux  process  is  followed  for  obtaining 
aseptic  horse  serum,  and  it  is  treated  in  exact- 
ly the  same  way  as  the  human  serum.  Tlie 
dose  of  the  serum  for  use  on  the  human  sub- 
ject is  from  1  to  5  cubic  centimetres,  according 
to  the  strength  of  the  serum,  the  constitution, 
age,  and  other  circumstances  of  the  patient, 
the  period  of  the  disease,  etc.,. given  subcuta- 
neously.  The  locality  to  be  preferred  for  the 
injection  is  that  bounded  by  the  iliac  crest 
and  a  transverse  line  passing  just  beneath  the 
trochanteric  fossa,  or,  better  still,  just  to  the 
outer  side  of  the  trochanter  major.  Great  care 
must  be  taken  to  make  sure  that  the  serum  has 
not  undergone  any  septic  change.  A  full  day 
should  intervene  between  the  injections.  Feb- 
rile reaction  follows  in  all  cases,  and  the  in- 
jection should  not  be  repeated  until  this  has 
subsided. 

Others,  such  as  Professor  Kitasato,  of  Japan, 
have  tried  the  serum  treatment  of  leprosy,  but 
it  must  be  said  that  thus  far  its  curative  power 
has  not  been  satisfactorily  demonstrated. 

In  the  treatment  of  cancer,  Dr.  S.  Arloing 
and  Dr.  J.  Courmont  (Province  medicale.  May 
23, 1896 ;  New  Yorh  Medical  Journal,  June  18, 
1896)  have  employed  both  the  normal  serum  of 
the  ass  and  that  of  the  same  animal  "  immu- 
nized "  by  inoculation  with  epithelioma  juice. 
Their  conclusions  are  as  follows:  1.  Injections 
of  the  serum  of  asses  which  have  been  inocu- 
lated with  epithelioma  juice  given  in  the  region 
of  malignant  tumours  are  not  alone  capable  of 
causing  the  disappearance  of  these  tumours  or 
even  of  preventing  the  generalization  and  the 
fatal  issue  of  the  disease.  3.  They  may  be 
useful  in  bringing  about  a  diminution  in  the 
size  of  the  tumour  for  a  short  time,  probably 
by  a  retrogression  of  the  peripheral  inflamma- 
tory zone.  This  action  may  be  the  origin  of 
a  temporary  cure,  if  not  of  a  definitive  one,  by 
making  it  possible  to  operate  on  a  tumour 
which  was  "  inoperable  "  before  the  injections. 
More  frequently  it  causes  the  disappearance, 
for  a  short  time,  of  the  symptoms  of  compres- 
sion, such  as  pain  and  oedema.  The  general 
evolution  of  the  disease  will  sometimes  be  ar- 
rested for  several  weeks.  3.  Ass's  serum  thus 
prepared  appears  to  contain  toxic  substances 
which  do  not  exist  in  the  normal  serum.  These 
substances  accumulate  in  the  organism,  so  that 
at  a  given  moment  they  cause  symptoms  of 
reaction  (in  the  cancerous  at  least),  such  as 
oedema,  purpura,  various  eruptions,  etc.,  near 
the  punctures  or  even  at  a  distance.  These 
symptoms  appear  after  the  fifth  injection,  and 
they  disappear  in  a  few  hours  or  days.  They 
are  frequently  accompanied  by  general  symp- 
toms, such  as  a  rise  in  temperature,  anorexia, 
insomnia,  etc.  At  the  fifteenth  injection  the 
patients  refused  to  have  the  treatment  con- 
tinued. 4.  With  the  normal  serum  of  the  ass, 
the  same  diminution  in  the  size  of  the  tumours 
is  obtained,  but  the  reactionary  symptoms 
which  follow  the  injections  of  the  "immun- 
ized "  serum  are  never  observed.  5.  Subcu- 
taneous injections  of  serum  may  be  given  in 
the  region  of  "  inoperable  "  tumours  if,  by  so 


doing,  it  makes  an  operation  possible  by  free- 
ing the  neighbouring  parts,  or  when  the  tu- 
mours are  accompanied  by  pain  or  oedema  due 
to  compression.  The  normal  cerum  of  the  ass 
is  preferable  to  the  "  immunized  "  serum. 

At  a  meeting  of  the  Congres  franjais  de  me- 
deoine  interne  [Gazette  mSdicale  de  Paris,  Au- 
gust 29,  1896;  New  York  Hedical  Journal, 
September  26,  1896)  M.  Dubois  stated  that  he 
had  introduced  fragments  of  cancers  taken 
from  human  subjects  into  the  cellular  tissue  of 
animals  and  had  obtained  several  tumours,  the 
largest  of  which  weighed  between  17  and  18 
ounces.  The  serum  of  these  inoculated  ani- 
mals was  then  employed  in  three  cases  of  can- 
cer. In  the  first  case  there  was  non-ulcerative 
cancer  of  the  breast  in  which  the  treatment 
led  to  an  almost  complete  recovery  after  a  pe- 
riod of  forty-five  days.  The  second  case  was 
one  of  epithelioma  of  the  face,  which  subsided 
in  thirty-nine  days.  In  each  ease  from  2  to  5 
cubic  centimetres  of  the  serum  had  been  in- 
jected in  the  region  of  the  tumour  every  three 
days,  and  a  few  drops  of  alcohol  with  a  very 
small  quantity  of  iodine  had  been  injected 
around  the  tumour  in  the  second  case.  The 
third  case  was  one  of  relapsing  epithelioma  of 
the  upper  lip,  which  was  very  much  ulcerated 
and  highly  inflamed,  and  after  twenty-three 
days  of  the  treatment  the  progress  of  the  tu- 
mour seemed  to  have  been  arrested,  but  it  pre- 
sented no  tendency  to  complete  recovery. 
From  these  facts  M.  Dubois  concluded  that 
the  serum  of  animals  inoculated  with  cancer- 
ous elements  seemed  to  cure  cancer  by  fibrous 
transformation.  Its  action  was  ranch  more 
certain,  he  said,  when  it  was  employed  in  the 
beginning  of  the  disease.  He  thought  its  em- 
ployment presented  no  dangers,  except  in  cases 
of  extensive  lesions. 

M.  Bard  stated  that  he  did  not  believe  that 
the  tumours  which  were  obtained  in  the  ani- 
mals by  inoculation  were  of  a  really  cancerous 
nature ;  he  thought  that  they  were  simply  of 
an  inflammatory  sort  and  not  true  neoplasms. 
The  local  reaction  produced  in  the  animals  did 
not  prove  that  they  had  been  influenced  by  the 
inoculated  cancerous  elements.  Furtliermore, 
he  thought  that  the  alcohol  and  iodine  which 
had  been  employed  in  the  second  case  might 
have  had  a  local  action  which  diminished  that 
of  the  serum.  Moreover,  serum  injections  in 
the  region  of  a  tumour  caused,  in  some  cases, 
a  local  inflammation  which  was  sometimes  use- 
ful ;  therefore  he  did  not  consider  M.  Dubois's 
experiments  conclusive. 

Dr.  J.  Swiatecki  [Przeglad  Chirurgiezny,  iii, 
2,  1896  ;  British  Medical  Journal,  October  17, 
1896)  reports  a  case  of  cancer  in  which  serum 
prepared  by  the  method  of  Richet  and  Heri- 
oourt  was  used.  The  patient  was  a  woman, 
aged  forty,  with  a  recurrent  cancer  of  the 
breast.  Portions  of  the  tumour  were  removed 
and  inoculated  on  two  difl'erent  occasions  in  a 
dog.  Serum  was  afterward  taken  from  this 
dog  and  injected  in  the  pectoral  region  of  the 
patient,  where  the  tissues  were  hard  and  infil- 
trated, although  the  wound  of  the  second 
operation,  which  had  been  skin-grafted  by 
Thiersch's  method,  was  healing  well.    After 


SERUM  TREATMENT 


186 


four  injections  of  1  cubic  centimetre  each  of 
serum  the  skin  over  ttie  mass  was  less  tense, 
the  arm  was  less  swollen,  and  one  of  the  en- 
larged supraclavicular  glands  looked  smaller 
and  was  distinctly  less  hard.     After  two  fur- 
ther injections  of  serum  an  abscess  formed  un- 
der the  skin  above  the  tumour,  and  an  attack 
of  erysipelas  of  the  arm,  with  somewhat  high 
temperature,     occurred.     The     abscess     was 
opened,  giving  issue  to  a  large  amount  of  pus 
and  debris,  the  products  of  necrosis  of  the  tu- 
mour.    The  temperature  then  fell,  and  it  was 
found  that  the  tumour  had  almost  disappeared 
and  the  glands  above  the  clavicle  had  shrunk 
almost  to  half  their  former  size ;  the  patient 
was  very  weak,  but  felt  well.     Some  days  later 
considerable   haemorrhages    occurred,   and  at 
the  spot  which  was  the  source  of  bleeding  a 
cancerous  ulcer  with  exuberant  red  granula- 
tions was  discovered.     The  swelling  over  the 
great  pectoral  became  as  large  as  a  woman's 
breast  and  adhered  strongly  to  the  ribs,  ex- 
tending in  the  form  of  hard  infiltration  into 
the  axilla;  nodnles  developed  in  the  subcuta- 
neous tissue  of  the  epigastric  region,  and  new 
glandular  enlargements  formed  in  the  supra- 
clavicular fossa  and  in  the  opposite  axilla. 
The  patient  was  greatly  emaciated  and  in  a 
very  feeble  condition ;   the  author,  therefore, 
had  recourse  again  to  the  serum,  and  after 
three  injections  of  1  cubic  centimetre  each  the 
ulcer,  which  had  attained  the  size  of  a  florin, 
rapidly  diminished  by  one  third.     After  eight 
consecutive  injections  it  had  completely  cica- 
trized.    The  principal  tumour  had  diminished 
to  half  its  former  size,  and  the  other  nodules 
had  also  become  smaller;  the  patient  looked 
better  and  was  stronger. 

According  to  Dr.  John  Ruhrah,  of  Balti- 
more {Medical  New/!,  November  21,  1896),  Ri- 
chet  and  Hericourt's  anticarcinomatous  serum 
is  made  as  follows :  An  osteosarcoma  is  thor- 
oughly rubbed  up  with  water  in  a  mortar,  and 
then  strained  through  a  cloth.  This  was  in- 
jected into  dogs  and  a  donkey,  and  after  about 
ten  days  they  were  bled.  The  serum  was  ob- 
tained in  the  usual  manner.  In  April,  1895, 
Richet  and  Hericourt  reported  the  results  of 
their  labours  to  the  French  Academy  of  Sci- 
ences. They  had  used  the  serum  in  two  cases 
successfully,  one  being  a  recurrent  costal  osteo- 
sarcoma of  about  the  size  of  an  orange.  After 
forty  days  of  treatment  with  3  cubic  centime- 
tres of  serum  a  day,  the  growth  had  been  ab- 
sorbed, as  had  almost  all  of  the  cicatricial  tis- 
sue. The  second  case  was  one  of  a  tumour  of 
the  stomach,  of  about  the  same  size,  which  also 
disappeared  under  treatment. 

Subsequently,  in  October,  189.5,  says  Dr. 
Ruhrah,  the  same  authors  reported  the  follow- 
ing results  after  having  used  their  serum  in  a 
large  number  of  cases :  There  is  a  diminution 
of  pain  and  the  cancerous  ulcers  dry  up,  as- 
sume a  healthy,  granular  appearance,  and  in 
some  cases  attempt  to  cicatrize.  There  is  also 
a  decrease  in  the  size  of  the  growth  and  of  the 
enlarged  lymphatic  glands,  and  the  evolution 
of  the  case  seems  to  be  delayed.  Unfortunate- 
ly, after  about  two  months  of  improvement, 
■which  takes  place  in  four  fifths  of  the  oases, 


the  disease  breaks  out  afresh ;  new  foci  form 
and  death  ensues. 

Dr.  Ruhrah  mentions  a  case  of  his  own  in 
which  he  used  this  serum  with  the  same  result. 
It  is  evident  that  we  have  not  yet  in  the  serum 
treatment  a  remedy  on  which  we  may  rely  in  the 
treatment  of  cancer,  but  it  is  to  be  hoped  that 
before  long  it  may  be  so  perfected  as  to  become 
a  trustworthy  resource. 

Dr.  Ludwlk  Rekowski  (Gazeta  lekarska; 
Deutsche  Medizinal-Zeitung,  November  12, 
1896)  has  treated  cancer  with  the  serum  of 
animals  that  has  been  subjected  to  a  course  of 
injections  of  sodium  arsenite.  Traces  of  ar- 
senic were  found  in  this  anticarcinomatous 
serum.  It  was  used  on  two  patients  with  cancer 
of  the  face,  10  cubic  centimetres  being  injected 
subcutaneously  twice  a  week  for  six  weeks, 
and  at  the  end  of  that  time  the  author  was 
satisfied  that  the  patients'  general  condition 
had  improved  notably.  What  the  ultimate 
results  were  is  not  stated. 

The  same  gentleman  has  pursued  a  similar 
plan  in  the  production  of  a  serum  for  the 
treatment  of  syphilis,  using  mercury  salicylate 
on  the  animals.  In  the  antisyphilitic  serum 
thus  produced  traces  of  mercury  could  be  de- 
tected by  means  of  chemical  tests.  It  was  in- 
jected into  patients  with  tertiary  syphilis  in 
doses  of  10  cubic  centimetres  every  third  day, 
and  the  results  are  represented  as  astonishing; 
as  soon  as  after  the  third  or  fourth  injection 
the  gummatous  lesions  began  to  disappear  and 
soon  vanished  completely. 

Professor  Boeck,  of  Christiania  (Arehiv  fur 
Dermatologie  und  Syphilis,  xxxv,  3;  Wiener 
medizinische  Blatter,  July  30, 1896).  has  experi- 
mented with  the  serum  treatment  of  syphilis, 
using  the  fluid  removed  from  the  tunica 
vaginalis  in  cases  of  hydrocele  in  syphilitic 
men.  He  comes  to  the  following  conclusions : 
1.  The  symptoms  of  the  primary  period  are 
more  rapid  in  their  invohition  than  under  the 
expectant  treatment.  2.  The  secondary  symp- 
toms are  somewhat  delayed.  3.  They  "are  de- 
cidedly mitigated,  so  that  the  rash  is  hardly 
noticeable  and  the  affections  of  the  mucous 
membranes  are  strikingly  slight.  4.  The  general 
condition  is  speedily  improved.  5.  The  stage 
of  secondary  eruption  is  shortened.  6.  The 
treatment  is  the  more  effective  the  earlier  it  is 
begun.  7.  Serum  from  a  person  in  the  tertiary 
stage  is  more  efficient  than  that  from  a  person 
in  the  secondary  stage.  Although,  on  the 
whole,  the  serum  treatment  is  not  so  effective 
as  the  use  of  mercury  and  iodine,  it  is  deserv- 
ing of  further  trial  and  may  be  regarded  as  a 
useful  auxiliary. 

_  Tommasoli  (Giornale  italiano  delle  malat- 
he  veneree  e  della  pelle  ;  Fortschritte  der  Med- 
icin,  September  1,  1896:  New  York  Medical 
Journal,  September  26,  1896),  who  was  among 
the  first  to  treat  syphilis  with  serum  and 
analogous  agents,  divides  his  most  recent  ex- 
periments into  three  series.  In  the  first,  by  a 
method  which  he  calls  hydropotherapy,  he  used 
the  ascitic  fluid  of  a  person  affected  with 
syphilitic  disease  of  the  liver.  This  he  em- 
ployed upon  seven  patients  in  the  secondary 
stage,  most  of  whom  had  had  no  previous  specific 


187 


SERUM  TREATMENT 


treatment.  The  smallest  number  of  injections 
given  in  any  one  case  was  eight,  and  the  larg- 
est'thirty-seven,  in  periods  ranging  from  ten 
to  fifty-seven  days,  and  the  total  amount  in- 
jected varied  from  68  to  350  cubic  centimetres. 
The  largest  single  dose  was  18  cubic  centi- 
metres. The  fluid  was  obtained  with  all  antisep- 
tic precautions,  and  used  either  fresh  or  after 
being  kept  in  sterilized  vessels  with  the  addi- 
tion of  a  few  drops  of  chloroform.  The  fluid 
was  injected  into  the  buttocks,  and  no  serious 
mishap  occurred  in  any  case.  In  most  of  the 
patients,  soon  after  the  injection,  there  fol- 
lowed indisposition,  headache,  giddiness,  etc., 
but  they  always  subsided  speedily;  in  some 
there  was  a  slight  elevation  of  temperature ;  in 
several  the  temperature  rose  and  the  weight 
increased  during  the  treatment.  No  albumin 
was  ever  found  in  the  urine.  As  to  the  effect 
on  the  disease,  all  that  can  be  said  with  cer- 
tainty is  that  no  new  symptoms  made  their 
appearance  during  the  course  of  injections. 

In  the  second  method,  or  galactotherapy,  he 
used  the  milk  of  two  women  who  had  secondary 
syphilis,  latent  in  one  of  them.  After  proper 
cleansing  of  the  nipples,  the  milk  was  pressed 
out  and  injected  immediately  into  the  muscles 
of  the  buttock.  Out  of  seven  patients  treated 
by  this  method,  one  had  gummatous  syphilis, 
but  all  the  others  were  in  the  secondary  stage. 
The  number  of  injections  varied  from  three  to 
thirteen,  and  the  total  amount  injected  into 
any  one  patient  ranged  from  30  to  100  cubic 
centimetres.  Two  of  the  patients  in  the  sec- 
ondary stage  were  decidedly  improved ;  the 
others  showed  no  change.  The  method  was 
based  on  the  observation  that  in  other  infec- 
tious diseases,  such  as  tetanus  and  diphtheria, 
the  antitoxines  pass  into  the  milk. 

In  the  third  method,  termed  myelotherapy, 
he  employed  large  quantities  of  the  spinal 
cord  of  the  ox.  He  had  previously  seen  syph- 
ilitics  relieved  of  malaise  and  osteocopic  pains 
by  eating  freely  of  ox  marrow  without  specific 
treatment.  In  all,  nine  patients  were  treated 
in  this  way.  Six  of  them  had  severe  headache 
and  pains  in  the  bones  and  joints ;  two  of  the 
six  had  before  been  treated  with  the  ascitic 
fluid ;  the  four  others  had  had  no  treatment. 
The  three  remaining  patients  showed  fresh 
lesions  of  the  skin  and  mucous  membranes. 
The  fresh  spinal  cord  of  the  ox  was  given 
either  in  the  form  of  balls  having  powdered 
licorice  incorporated  in  them  or  in  that  of  an 
emulsion  with  milk.  The  smallest  amount 
given  in  twenty-four  hours  was  300  grains, 
and  the  largest  was  1,500  grains.  None  of  the 
three  patients  with  fresh  cutaneous  manifesta- 
tions showed  any  improvement.  Of  the  six 
others,  only  three  were  kept  under  observation 
for  a  considerable  length  of  time;  at  the  end 
of  ten  days  they  were  all  relieved  of  severe 
sufferings  and  felt  perfectly  well.  Of  course, 
this  method  of  treating  the  disease  can  not 
properly  be  called  serum  treatment ;  neverthe- 
less, it  is  interesting  in  this  connection. 

Normal  serum  has  been   employed  in  the 

treatment    of    syphilis,    but    Dr.   A.   Lourier 

(Journal  des  maladies  cutanees  et  syphilitiques, 

July,  1896 ;  British  Medical  Journal,  Septem- 

50 


ber  26,  1896),  who  has  experimented  with  the 
serum  of  healthy  horses,  has  found  it  abso- 
lutely useless. 

The  serum  treatment  of  Asiatic  cholera  has 
been  studied  experimentally  by  Lazarus,  Metch- 
nikoff,  Roux,  Ransom,  and  others,  and  clin- 
ically by  the  Japanese  physicians  under  the 
supervision  of  Professor  Kitasato.  Dr.  Na- 
kawaga  (British  Medical  Journal,  July  18, 
1896)  gives  the  following  abstract  of  Kitasato's 
report  of  December  6,  1895 : 

"  The  inoculations  for  obtaining  the  anti- 
toxic sei'um  were  begun  in  May,  1895,  with 
cholera  bacteria  isolated  from  one  of  the  ear- 
liest cases  in  the  last  epidemic.  At  the  time 
the  serum  treatment  was  begun  at  Hiroo 
Cholera  Hospital  (August  6,  1895)  the  supply 
of  the  serum  was  therefore  very  limited,  and 
what  was  used  for  injection  in  the  beginning 
was  not  all  of  the  desired  strength.  Neverthe- 
less, some  of  the  animals  had  already  attained 
quite  a  considerable  degree  of  immunity,  and 
the  efficiency  of  the  serum  of  such  animals  is 
seen  in  the  following  experiments : 

"  1.  Without  entering  into  details  of  the 
experiments,  it  may  be  stated  that  for  guinea- 
pigs  0-02  milligramme  (0-0002  cubic  centi- 
metre) was  sufficient  to  protect  against  the 
inoculation  of  several  times  the  fatal  do.se  of 
cholera  culture — the  serum  and  the  virus  being 
injected  into  the  peritoneal  cavity  simultane- 
ously. The  guinea-pigs  used  in  this  as  well  as 
in  all  experiments  mentioned  in  the  report 
weighed  from  two  hundred  to  three  hundred 
grammes. 

"  2.  If  the  serum  is  injected  subcutaneously, 
the  quantity  required  to  obtain  similar  results 
was  found  to  be  considerably  larger  (0'02  cubic 
centimetre). 

"3.  To  determine  the  antitoxic  property  of 
the  serum,  using  the  word  antitoxic  in  the 
strict  sense,  experiments  were  made  with  the 
toxine  obtained  by  warming  the  twenty-day- 
old  cholera  bouillon  culture  for  twenty  minutes, 
at  the  temperature  of  131"  P.  The  bouillon 
culture  thus  sterilized  (the  so-called  '  toxine  ') 
was  found  to  be  fatal  to  guinea-pigs  in  the 
dose  of  1'5  cubic  centimetre  when  injected  into 
the  peritoneal  cavity.  The  antitoxic  serum 
was  found  to  neutralize  the  effect  of  2  cubic 
centimetres  of  sterilized  bouillon  when  injected 
simultaneously  into  the  peritoneal  cavity  in  the 
dose  of  0-2  cubic  centimetre. 

"  Experiments  for  ascertaining  the  curative 
action  of  the  serum  were  carried  on  in  this 
wise :  A  number  of  guinea-pigs  were  inocu- 
lated with  several  times  the  fatal  dose  of  the 
virus,  so  that  the  untreated  animals  died  with- 
in twenty  hours  after  such  inoculation.  At 
the  expiration  of  each  successive  hour  injec- 
tions were  made  in  some  of  the  animals,  and  it 
was  shown  that  those  treated  not  later  than 
seven  hours  after  the  inoculation  of  the  virus 
were  cured,  while  those  in  which  the  injections 
were  made  after  the  lapse  of  seven  hours  could 
not  be  saved  by  the  serum.  In  other  words,  if 
injected  during  the  first  third  of  the  entire 
course  of  the  disease  (thus  experimentally  pro- 
duced) the  serum  can  be  considered  curative. 

"  Two  hundred  and  seventy  patients  suffer- 


SERUM  TREATMENT 


188 


ing  from  cholera  -were  admitted  into  the  Hiroo 
Hospital,  Tokio,  from  August  6  to  November 
10,  1895,  and  a  hundred  and  thirty-eight  died. 
Rate  of  mortality,  51'1  per  cent. 

"  Antioholera  serum  was  employed  in  a  hun- 
dred and  ninety-three  cases  only,  owing  to  the 
fact  that  the  supply  of  serum  was  inadequate 
to  allow  it  to  be  used  in  all  cases. 

"  The  rate  of  mortality  among  Japanese  in 
nearly  all  the  previous  epidemics,  as  well  as 
that  of  the  last  epidemic,  has  always  been 
about  70  percent.  Without  claiming  to  draw, 
from  a  number  relatively  so  small,  the  final 
conclusion  that  the  serum  treatment  was  at- 
tended with  the  reduction  of  20  per  cent,  in 
the  mortality  statistics,  it  is  evident  at  least 
that  the  result  of  the  new  therapy  was  not  an 
unfavourable  one.  Moreover,  there  is  reason 
to  believe  that  with  a  sufficient  supply  of  very 
efficient  serum  the  rate  of  mortality  can  still 
be  lowered. 

"  Subsidiary  results  of  serum  injections  are 
similar  to  those  of  diphtheria  antitoxine : 
1.  IJrtioaria  (very  common).  3.  Arthralgia 
(observed  in  eighteen  cases  only).  3.  Myalgia 
(observed  in  six  cases  only). 

"Obviously  there  must  be  difference  in  the 
prognosis  of  each  case  according  to  the  time 
which  elapsed  before  the  patient  came  under 
treatment. 

"Three  cases  of  cholera  were  observed  in 
children  under  two  years  of  age.  A  bacteri- 
ological examination,  microscopical  as  well  as 
cultural,  was  made  in  every  case." 

Serums  for  the  protection  of  animals  against 
hog  cholera  and  swine  plague  have  been  ob- 
tained by  Dr.  Theobald  Smith,  Dr.  Moore,  and 
Dr.  de  Schweinitz,  of  the  Bureau  of  Animal 
Industry  {New  York  Medical  Journal,  Sep- 
tember 5,  1896),  by  the  use  of  products  of  the 
Bacillus  coli  communis. 

The  serum  treatment  ot  typhoid,  fever  has 
hardly  yet  passed  the  stage  of  laboratory  in- 
vestigation, and  therefore  requires  no  further 
mention  here. 

In  the  Indian  Medical  Record  for  August 
16,  1896,  there  is  an  editorial  article  embody- 
ing a  sketch  of  the  serum  treatment' of  rabies, 
both  preventive  and  curative,  in  which  it  is 
stated  that  Tizzoni  and  Centanni  have  suc- 
ceeded in  obtaining  a  most  powerful  antira- 
bietic  serum.  This  serum  is  furnished  by 
sheep,  which  during  twenty  days  are  submit- 
ted to  inoculations  with  the  attenuated  nervous 
tissue  of  rabid  animals  in  the  proportion  of 
0'75  gramme  to  each  kilogramme  of  weight  ot 
the  animal  treated.  They  declare  that  one  in- 
jection of  their  serum  gives  almost  immediate 
immunity.  As  a  preventive,  they  say,  a  drop 
and  a  half  of  the  serum  is  sufficient  to  protect 
an  animal  3  kilogrammes  in  weight  inoculated 
an  hour  afterward  with  virus  from  the  dog. 
As  a  curative  means,  the  subcutaneous  inocu- 
lation of  a  cubic  centimetre  is  said  to  suffice, 
even  eight  hours  after  direct  infection.  This 
serum,  they  also  say,  can  be  dried  and  kept  in 
bottles  away  from  the  light,  and,  so  kept,  will 
remain  powerful  for  a  considerable  time.  Roger 
{loc.  cit.)  thinks  that  the  use  of  this  serum 
should  be  preferred  to  that  of  the  Pasteur  treat- 


ment in  cases  in  which  it  is  necessary  to  act 
promptlv,  and  he  adds  that  since  1891  Babes 
has  successfully  employed  the  serum  treatment 
of  persons  bitten  by  rabid  wolves.  (See  vol.  i, 
pages  82  and  84.) 

Certain  nervous  and  mental  diseases  have 
been  subjected  to  serum  treatment.  At  the 
recent  French  Congress  of  Internal  Medicine 
(Semaine  medicale.  August  19,  1896;  Brihsh 
Medical  Journal.  October  34, 1896)  Mairet  and 
Vires  reported  that  they  had  injected  serum 
taken  from  a  patient  cured  of  mania  into  two 
women  suffering  from  acute  mania.  In  one  of 
them  each  injection  was  followed  by  the  onset 
of  marked  drowsiness ;  the  agitation  after- 
ward became  as  great  as  before.  In  the  other 
case  twenty  similar  injections  were  given,  the 
dose  being  5  cubic  centimetres.  Each  injec- 
tion was  followed  by  a  feeling  of  drunkenness, 
buzzing  in  the  ears,  and  heavy,  deep  sleep. 
Distinct  improvement,  physical  as  well  as  in- 
tellectual, was  the  result  of  a  first  series  of 
these  injections ;  then  the  agitation  became  as 
bad  as  before.  A  second  series  of  injections 
in  doses  of  30  cubic  centimetres  in  the  twenty- 
four  hours  was  given.  Similar  symptoms  fol- 
lowed the  injections,  but  the  improvement 
which  resulted  from  them  persisted,  and  finally 
the  patient  was  completely  cured.  The  authors 
admit  that  this  result,  which  so  far  stands 
alone,  may  be  nothing  more  than  a  coinci- 
dence ;  possibly  also  it  might  be  explained  by 
the  improvement  in  nutrition  brought  about 
by  the  injections.  Nevertheless,  they  think 
the  hypnotic  properties  of  the  serum  to  be 
noteworthy. 

According  to  information  received  by  the 
French  Colonial  Minister,  says  the  Allge- 
meine  Wiener  Medizinal-Zeitiing  (cited  in  the 
Deutsche  Medizinal-Zeitung  for  October  o, 
1896),  Dr.  Yersin,  the  discoverer  of  the  plague 
bacillus,  has  established  a  bacteriological  labo- 
ratory in  Uha-Trang,  on  the  coast  of  Annam, 
for  the  study  of  the  serum  treatment  of  the 
plague,  and  has  taken  the  opportunity  afforded 
by  this  year's  outbreak  of  the  disease  in  and 
about  Hong-Kong  to  make  a  practical  test  of 
the  elTioiency  of  serum  obtained  from  horses. 
The  account  is  that  he  has  employed  the  treat- 
ment in  twenty-five  cases  of  bubonic  plague, 
twenty-three  of  which  have  been  cured. 

The  serum  treatment  of  snake-tite  has  been 
made  the  subject  of  special  study  by  Dr.  A. 
Calmette,  of  the  Pasteur  Institute  in  Lille.  Dr. 
Calmette  (British  Medical  Journal,  October  10, 
1896:  New  York  Medical  Journal,  October  "1, 
1896)  says  that  the  venoms  of  different  species 
of  snake  produce  physiological  phenomena 
which  are  in  general  alike.  The  only  differ- 
ence is  in  the  local  action  of  these  venoms,  and 
it  is  possible  to  separate  artificially  the  sulv 
stanoes  which  produce  the  local  phenomena 
from  those  which  cause  bulbar  intoxication. 
This  dissociation  can  be  effected  by  means  of 
heat.  If  any  venom  in  solution  in  water  is 
subjected  to  a  heat  of  185°  P.  for  fifteen 
minutes,  the  albumin  contained  in  it  coagu- 
lates, and  the  thermogenic  substances  are  de- 
stroyed, while  the  toxicity  of  the  venom  itself 
is  in  no  way  affected.     M.  Phisalix  and  M. 


189 


SERUM  TREATMENT 


Bertrand  had  previously  demonstrated  this 
fact  as  refjarded  tlie  venom  of  the  French 
viper.  After  heating  to  185°  P.,  and  after 
filtration,  all  venoms  produce  the  same  effects, 
whether  they  are  taken  from  viperine  or  from 
colubrine  snakes.  They  differ  only  in  the  in- 
equality of  their  toxic  activity.  All  are  equally 
destroyed  by  alkaline  hypochlorites  and  by 
chloride  of  gold — substances  which  the  author 
suggested  (particularly  hypochlorite  of  calcium 
in  l-in-60  solution)  for  local  use  in  preventing 
the  absorption  of  venoms. 

Quito  recently  M.  Phisalix,  assistant  in  the 
Paris  Museum,  announced  that  he  had  suc- 
ceeded in  isolating  a  "  vaccine  "  substance  by 
filtering  venom  through  a  Chamberland  filter. 
The  animals  in  which  this  experimenter  in- 
oculated filtered  venom  did  not  die,  and  were 
found  to  be  "  vaccinated  "  against  the  inocula- 
tion of  a  fatal  dose  of  unfiltered  venom.  The 
author  has  repeated  these  experiments  with 
the  greatest  possible  care,  but  the  results  which 
he  has  obtained  are  very  different.  When  a 
solution  of  normal  venom  is  filtered  through 
Chamberland's  apparatus  much  of  it  is  held 
back  by  the  porcelain,  exactly  as  is  the  case 
with  the  microbial  toxines.  As  a  matter  of 
fact,  the  lethal  dose  of  filtered  venom  is  two 
and  a  half  times  that  of  unfiltered  venom.  But 
if,  before  filtration,  care  is  taken  to  precipitate 
the  albumin  in  the  venom  by  means  of  heat, 
it  is  found  that  the  porcelain  holds  back 
scarcely  any  of  the  toxic  substance.  Animals 
are  killed  by  the  same  doses  of  the  solution  be- 
fore and  after  filtration.  It  follows,  then,  that 
it  non-dealbuminized  venom  is  less  toxic  after 
filtration  than  before,  this  must  be  due  to  the 
fact  that  the  albumin  adheres  to  the  porous 
wall  of  the  filter,  and  forms  an  actual  dia- 
lyzing  membrane  through  which  the  venom  can 
pass  only  with  the  utmost  difficulty.  If  this 
albuminous  venom  is  filtered  anew  it  will  be 
found  that  the  liquid  which  passes  through  the 
filter  is  much  less  toxic. 

Animals  which  have  survived  filtered  venom 
can  tolerate  some  three  days  later  a  minimal 
mortal  dose  of  venom  without  dying.  They 
begin  to  be  '•  vaccinated,"  just  like  those  into 
which  a  dose  of  normal  venom  less  than  the 
mortal  has  been  injected.  In  the  author's 
opinion,  therefore,  there  is  no  need  to  sup- 
pose that  by  heat  or  by  filtration  of  venom 
there  is,  as  Phisalix  and  Bertrand  suppose, 
a  dissociation  of  two  substances — the  one 
toxic,  the  other  antitoxic — which  are  found 
together  in  normal  venom.  This  hypothesis 
appears  to  him  to  be  in  no  way  justified,  and 
it  is  absolutely  certain  that  if  venom  the  tox- 
icity of  which  has  been  reduced  by  heat  or  by 
filtration  is  injected  into  an  animal  in  a  quantity 
sufficient  to  kill  it,  the  course  of  events  will  be 
precisely  the  same  as  if  it  had  received  the 
dose  of  normal  venom  slightly  inferior  to  that 
which  would  have  caused  death.  In  both  cases 
and  in  the  same  time  the  animal  acquires  by 
this  inoculation  resisting  power,  which  enables 
it,  even  after  several  days,  to  tolerate  with  im- 
punity a  quantity  of  venom  sufficient  to  kill 
other  animals  of  the  same  weight. 
The  serum  of  animals  "  vaccinated  "  against 


a  very  active  kind  of  venom,  as,  for  instance, 
that  of  the  cobra  di  capello,  is  perfectly  anti- 
toxic in  respect  of  the  venom  of  all  other  kinds 
of  serpents,  and  even,  says  the  author,  as  he 
recently  proved,  in  respect  of  that  of  scorpions. 
Dr.  Caimette  insists  upon  this  statement  be- 
cause it  has  recently  been  contested  by  Dr. 
Cunningham,  and  he  states  that  he  is  ready  to 
repeat  before  a  commission  the  experiments 
which  he  has  made  many  times  on  this  sub- 
ject. 

The  best  method  of  "vaccination  "  in  large 
animals  which  are  to  produce  antivenomous 
serum  consists  in  injecting  into  them  at  first 
increasing  quantities  of  the  venom  of  the  cobra 
di  capello  mixed  with  decreasing  quantities  of 
a  l-in-60  solution. 

All  the  observations  in  which  the  kind  of 
serpent  has  not  been  determined  must  there- 
fore be  regarded  as  doubtful.  He  has  pub- 
lished a  most  conclusive  case  relating  to  an 
Annamite  who  was  bitten  in  the  hand  by  a 
cobra  di  capello  at  the  bacteriological  labora- 
tory of  Saigon,  who  was  cured  by  a  single  in- 
jection of  ten  cubic  centimetres  of  serum. 

It  is  proved  conclusively,  theiefore,  con- 
tinues Dr.  Caimette,  both  by  experiment  upon 
animals  and  by  the  applications  which  have 
already  been  made  in  man,  that  we  possess  in 
antivenomous  serum  a  specific  remedy  which 
is  most  efficacious  in  cases  of  venomous  bites. 

In  the  British  Medical  Journal  for  Novem- 
■  ber  21,  1896,  Surgeon-Major  S.  J.  Eennie  gives 
the  following  account  of  one  of  the  first  cases 
of  snake-bite  treated  in  India  with  Professor 
Calmette's  antivenene  serum  :  "Abont6.30  p.m., 
on  September  21st,  a  Hindu  boy,  aged  eleven, 
son  of  a  groom,  was  drawing  water  from  a 
well,  and  in  returning  accidentally  stepped  on 
a  snake,  which  bit  him  on  the  right  foot,  the 
foot  being  bare  at  the  time.  Two  men  were 
with  him  who  both  saw  the  snake,  but  were 
unable  to  kill  it  before  it  disappeared  in  the 
grass.  They  promptly  bound  the  end  of  a 
pugaree  tightly  round  the  boy's  leg,  and,  pick- 
ing him  up,  ran  with  him  to  my  quarters. 
Not  more  than  three  minutes  elapsed  from  the 
time  he  was  bitten  until  I  saw  him.  The  typi- 
cal imprint  of  a  snake-bite,  with  its  two  deep 
fang  punctures  and  the  crescentic  row  of  small 
teeth  marks  between,  was  clearly  seen  on  the 
inner  side  of  the  right  foot.  It  being  '  the 
hour  at  which  men  most  do  congregate  at  the 
club,'  no  fewer  than  five  medical  officers  were 
on  the  spot  in  a  few  moments.  I  at  once  in- 
jected 8  cubic  centimetres  of  Calmette's  anti- 
venene serum  into  the  subcutaneous  cellular 
tissue  of  his  abdomen.  At  the  same  time 
Surgeon  -  Ma  jor  Birt,  A.  M.  S.,  treated  the 
wounds  and  their  immediate  neighbourhood 
with  a  hypodermic  solution  of  permanganate 
of  potassium,  after  which  they  were  carefully 
washed  and  dressed.  The  case  was  then  placed 
under  observation  and  seen  from  time  to  time 
during  the  evening,  but  the  patient  never  had 
a  bad  symptom,  and  is  now  running  about  as 
well  as  ever  he  was," 

The  snake  was  not  killed,  and  therefore, 
says  Mr.  Rennie,  there  might  be  an  element  of 
doubt  as  to  the  nature  of  its  species.    The 


SESAME  OIL 
SILVER 


190 


reptile,  however,  was  clearly  seen  by  both  men 
who  were  with  the  boy,  who  gave  an  accurate 
description  of  it,  and  recognised  it  as  a  krait 
{Bimgarus  ccBruleus).  that  most  deadly  and 
dangerous  Indian  snake.  The  characteristics 
also  of  the  wounds  were  clearly  those  of  a  bite 
from  a  snake  with  fangs.  Mr.  Rennie's  own 
personal  observation  led  him  at  once  unhesi- 
tatingly to  conclude  that  the  injuries  were 
caused  by  a  poisonous  snake,  and  in  this  he 
was  borne  out  by  the  unanimous  opinion  of 
the  five  medical  ofRcers  by  whom  the  case  was 
seen,  several  of  them  of  long  and  varied  expe- 
rience in  India.  Taking  all  these  points  into 
consideration  there  can,  he  thinks,  be  little 
doubt  that  the  boy  was  bitten,  and  bitten 
savagely  and  deeply,  by  a  krait,  a  bite  from 
which  under  ordinary  circumstances  is  neces- 
sarily fatal. 

According  to  Roger  {loc.  cif.),  Marchoux  has 
obtained  from  the  sheep  a  serum  of  which 
from  10  to  12  cubic  centimetres,  injected  into 
an  animal  on  the  day  after  its  inoculation  with 
anthrax,  will  prevent  its  death,  and  he  thinks 
it  likely  to  prove  no  less  efficient  in  cases  of 
malignant  pustule. 

The  Klemperers,  says  Roger  (loc.  cit.),  were 
the  first  to  employ  serum  treatment  in  pneu- 
monia. Of  thirty-nine  cases  treated  by  them 
and  others,  thirty  were  very  decidedly  miti- 
gated, and  in  twenty-one  the  crisis  occurred 
within  one  or  two  days.] 

(See  also  under  Animal  exteacts  and  juices, 
vol.  i,  pages  83,  84,  and  85 ;  also  Antitoxines.) 
Austin  O'Malley. 

SESAME  OIL,  oleum  sesami  (U.  S.  Ph.), 
is  the  expressed  oil  of  Sesamum  indicum.  used 
for  the  same  purposes  as  olive  oil.  Dr.  R. 
Stiive,  of  Professor  von  Noorden's  division  of 
the  Municipal  Hospital  in  Frankfort  on  the 
Main  (Gentralblatt  fur  die  gesammte  Therapie, 
June.  1896 ;  New  York  Medical  Journal,  Au- 
gust 1,  1896),  after  experimenting  with  sesame 
oil,  reports  on  its  use  as  a  substitute  for  cod-liver 
oil.  He  employed  it  in  all  kinds  of  oases,  several 
hundred  in  number,  in  which  cod-liver  oil  was 
indicated.  The  patients  were.of  all  ages,  from 
six  months  upward  to  old  age,  but  the  major- 
ity of  them  were  children  between  four  and 
fifteen  years  old  weakened  by  acute  infectious 
disease  or  by  scrofula.  As  a  rule,  the  amount 
of  sesame  oil  given  daily  was  from  two  to 
three  tablespoonfuls,  but  in  many  cases  it  was 
twice  as  large.  On  account  of  its  absolute  lack 
of  odour  and  its  almost  entire  tastelessness,  it 
was  seldom  necessary  to  use  anything  in  the 
way  of  a  flavour;  a  swallow  of  coffee  or  of 
cognac  or  a  bit  of  bread  was  always  sufficient. 
Many  patients  objected  to  the  taste  at  first, 
but  their  repugnance  was  soon  over. 

The  oil  was  particularly  well  borne  gener- 
ally, but  it  disagreed  with  a  few  persons,  caus- 
ing palpitation  and  nausea  or  vomiting  in  some 
and  diarrhcEa  in  others,  so  that  its  use  had  to 
be  discontinued.  On  the  whole,  the  author  re- 
gards it  as  one  of  the  best  borne  and  most 
easily  digested  of  fats.  It  will  often  agree,  he 
says,  in  cases  in  which  cod-liver  oil  is  contra^ 
indicated,  such  as  those  of  phthisis  with  ob- 


stinate diarrhaa,  which  sesame  oil  aggravates 
only  in  very  few  instances  and  mitigates  in  the 
majority  by  improving  the  patients'  general 
condition.  Not  less  favourable  was  its  action  in 
cases  of  chronic  intestinal  catarrh  with  habit- 
ual constipation  and  overproduction  of  mucus 
in  the  lower  portion  of  the  intestinal  tract. 

The  oil  was  strikingly  well  borne  in  cases  of 
disease  of  the  stomach.  Emaciated  persons 
with  gastric  catarrh,  excessive  acidity,  ulcer 
of  the  stomach,  or  nervous  dyspepsia  took  daily 
from  1  to  2  ounces  of  sesame  oil  without  expe- 
riencing any  ill  effect.  In  other  patients  with 
sensitive  digestive  organs  the  oil  was  well 
borne;  above  all,  in  those  with  acute  fevers. 
Patients  with  febrile  pleurisy,  septic  fever,  and 
especially  typhoid  fever,  even  children,  bore 
the  oil  well.  In  some  cases  it  was  used  by 
subcutaneous  injection,  in  doses  of  from  15  to 
100  cubic  centimetres. 

Administered  as  a  nutrient  enema,  sesame 
oil  was  not  found  to  give  good  results ;  it  would 
remain  in  the  rectum  for  from  twelve  to  twenty- 
four  hours  and  then  be  expelled.  The  author 
thinks  it  would  act  better  as  a  substitute  for 
olive  oil  in  the  cnemata  treatment  of  habitual 
constipation ;  it  is  at  least,  he  says,  quite  as 
good  as  olive  oil  for  this  purpose.  Only  the 
finest  and  purest  sesame  oil  is  suitable  for 
medicinal  use.  The  author  has  had  the  best 
results  with  an  oil  furnished  by  the  firm  of 
Speyer  &  Grund,  of  Frankfort. 

SEVTJM  (U.  S.  Ph.),  SEVTJM  PRiEPA- 

EATTJM:  (Br.  Ph.).— Mutton  tallow  (see  Fats 
and  Tallow). 

SHIKIMOL.— See  Safrol. 

SIALAGOGXTES  are  substances  which  in- 
crease the  flow  of  saliva.  They  may  not  be 
employed  for  this  specific  purpose,  and  may 
effect  this  salivation  as  an  incident  of  their 
administration.  Therapeutic  indications  may 
demand  the  use  of  such  drugs,  however,  such 
as  great  dryness  of  mouth  or  fauces,  or  they 
may  be  used  to  diminish  congestion  in  the 
neighbourhood  of  the  salivary  glands  or  for 
the  relief  of  pain  in  and  about  the  mouth 
which  is  dependent  upon  hypersemia  of  the 
parts.  Public  speakers  and  singers  find  it  ad- 
vantageous, at  times,  to  employ  a  substance 
which  will  increase  the  salivary  secretion  ;  and 
after  exhaustive  efforts  on  the  platform  or 
stage,  a  sialagogue  will  frequently  combat  with 
success  the  hoarseness  which  follows. 

Sialagogues  act  in  two  ways.  They  either 
stimulate  the  salivary  glands  directly  or,  after 
passing  into  the  circulation,  influence  the  se- 
creting cells  of  the  glands  to  abnormal  activity. 
The  former  group  may  act  mechanically  or  in 
a  reflex  way  upon  the  chorda  tympani  or  the 
sympathetic  nerves;  the  latter  group  depend 
for  their  power  upon  their  stimulating  action 
upon  the  peripheral  ends  of  the  secretory 
nerves  in  the  glands.  A  flow  of  saliva  pro- 
duced in  a  reflex  way  after  the  ingestion  of  a 
sialagogue  may  be  caused  by  a  number  of  other 
circumstances  which  stimulate  salivary  secre- 
tion—for example,  pregnancy,  the  odour,  sight, 
or  recollection  of  savoury  food,  the  influence 
of  emotions  or  the  thought  of  saliva. 


191 


SESAME  OIL 
SILVER 


The  class  of  drug:s  under  consideration  may 
be  roughly  divided  into  two  classes,  the  classi- 
fication depending  upon  the  mode  of  action. 
Topical  siahigogues  are  those  which  have  a  di- 
rect action  upon  the  secreting  glands  or  evoke 
such  action  in  a  reflex  way  by  the  production 
of  a  hypersBmia  in  the  vessels  supplying  the 
glandular  structures.  Under  this  group  may 
be  placed  the  mineral  and  vegetable  acids  and 
their  salts,  alkalies,  ether,  chloroform,  mustard, 
horseradish,  ginger,  pyrethrum,  megereon,  to- 
bacco, eubeb,  and  rhubarb.  Ordinary  chewing 
gum  accomplishes  the  same  purpose,  but  does 
so  mechanically,  as  any  foreign  body  in  the 
mouth  might  do.  Slippery-elm  bark,  ulmus 
(U.  S.  Ph..  Br.  Ph.),  is  also  a  pleasant  siala- 
gogue.  Cubeb  in  the  form  of  tablets  or  in  that 
of  the  berries  themselves  is  frequently  used  for 
keeping  the  articulatory  organs  moist  during  a 
public  effort.  Pyrethrum  is  probably  the  most 
frequently  employed  sialagogue  for  therapeutic 
purposes  in  relaxation  of  the  uvula,  toothache, 
and  congestive  conditions  in  and  about  the 
mouth. 

General  sialagogues  are  substances  which 
prodaoe  the  salivary  flow  by  stimulation  of 
efferent  secretory  nerves  or  their  end  plates. 
Such  are  jaborandi,  the  compounds  of  io- 
dine, mercury  and  its  compounds,  muscarine, 
and  physostigmine.  Some  nauseants,  like 
tartar  emetic,  produce  a  flow  of  saliva  by 
stimulation  of  the  glands  through  the  pneu- 
mogastric  nerve.  Jaborandi  (and  its  alka- 
loid, pilocarpine),  nicotine,  physostigmine  and 
muscarine  excite  salivation  experimentally  by 
subcutaneous  injection  af  tei'  the  severing  of  all 
nerves  leading  to  the  secretory  glands ;  it  is 
possible,  therefore,  that  their  action  is  partly 
central  as  well  as  upon  the  peripheral  ends  of 
the  secretory  nerves.  Mercury,  in  all  proba- 
bility, has  a  twofold  action  in  calling  forth  an 
increased  flow  of  saliva :  it  influences  the  gland 
structures  and  exerts  its  influence  in  a  reflex 
manner.  Mercurial  salivation  is  rarely  evoked 
for  therapeutic  purposes,  since  it  may  become 
too  intense.  During  the  prolonged  ingestion 
ot  potassium  iodide  the  drug  is  usually  to  be 
found  in  the  saliva  and  may  easily  produce 
salivation. — Samuel  M.  Bricknee. 

SILICA. — In  his  Treatise  on  the  Materia 
Medica  and  Tlierapeutics  of  the  Skin.  Dr. 
Henry  G.  Piffard,  of  New  York,  mentions 
Battye's  employment  of  finely  powdered  silica 
in  grain  doses  for  relieving  the  pain  of  cancer, 
and  says  that  he  himself  has  used  triturations 
of  silica,  and  has  twice  seen  small  lupous 
ulcerations  heal  during  its  employment.  He 
refers  also  to  Ellinger's  recommendation  of 
the  use  of  fine  sand  rubbed  on  the  skin  in  the 
treatment  of  ephelis,  chromophytosis,  acne  ro- 
sacea, and  chronic  eczema. 

Silica  hydrata,  or  hydrated  silica,  is  a  jelly- 
like  mass  prepared  for  Dr.  Piffard  according 
to  a  process  devised  by  Dr.  Charles  Rice,  the 
chemist  of  the  New  York  Department  of  Public 
Charities.  Dr.  Piffard  has  used  this  mass  as  a 
dressing  for  chancroids,  buboes,  and  other  sup- 
purating surfaces,  and  he  is  satisfied  that  it 
exerts  a  decided  control  over  profuse  suppura- 


tion. "The  bubo  or  other  lesion  under  treat- 
ment," he  says,  "should  be  thoroughly  packed 
with  the  silica,  and  the  dressing  renewed  once 
or  twice  a  day.  As  soon  a?  healthy  action  is 
established,  its  use  should  be  discontinued." 
Dr.  Piffard's  book  was  published  in  1881 ;  since 
then,  few  if  any  trials  of  silica  as  a  remedy 
appear  to  have  been  reported.  Now  (May  23, 
1896),  in  a  note  to  the  editor  of  this  work,  Dr. 
Piffard  says :  "  I  have  nothing  to  add  to  my 
account  of  silica  hydrata,  except  to  caution 
against  its  too  profuse  or  prolonged  use.  It 
will  check  suppuration  more  quickly  than  any- 
thing I  know  of,  but,  if  used  too  long,  devitalizes 
the  tissues  and  results  in  extensive  sloughing." 

SIIilCATES.  —  A  solution  of  potassium 
silicate  or  of  sodium  silicate,  liquor  sodii  sili- 
catis(\J.  S.  Ph.).  "soluble glass,"  occurs  as  a 
syrupy  liquid,  which  is  employed  for  making 
rigid  bandages  or  splints  for  use  in  fractures, 
etc.,  where  an  easily  removable  appliance  is 
desired.  It  is  applied  with  a  brush  to  an  or- 
dinary roller  bandage  in  the  same  manner  as 
starch,  dextrin,  etc.,  and  ordinarily  becomes 
sufficiently  rigid  to  allow  of  considerable  strain 
to  be  exerted  upon  it  in  the  course  of  four  or 
five  hours.  When  it  is  desired  to  remove  it, 
the  application  of  hot  water  will  soften  it 
sufficiently  to  permit  of  the  bandage  being  un- 
rolled. Potassmra  silicate  and  the  correspond- 
ing sodium  salt,  sodium  silicate,  have  been 
employed  internally  to  produce  the  constitu- 
tional effects  of  their  bases  and  also  a.*  astrin- 
gents and  antise,  tics,  but  have  no  particular 
virtues  as  such. 

Magnesium  silicate,  or  meerschaum,  when 
powdered,  has  essentially  the  same  properties  as 
bismuth  carbonate  and  subnitrate,  and  may  be 
substituted  for  them. — Russell  H.  Nevins. 

SIIiVEBr,  argentum,  argenium  purificatum 
(Br.  Ph.),  in  its  metallic  state,  is  considered 
inert,  and  its  internal  administration  is  limited 
to  its  occasional  use  in  the  form  of  silver  leaf, 
argentum  foliafum  (Ger.  Ph.),  as  a  coating  for 
pills,  but  as  a  material  for  certain  surgical 
purposes  it  is  very  valuable.  Its  flexibility 
and  toughness  render  it  indispensable  for 
probes  and  directors.  Cannulas  and  styles 
used  to  prevent  the  closure  of  artificial  open- 
ings in  the  soft  tissues,  as  after  operations  on 
the  lacrymal  passage,  or  to  restore  the  lumen 
of  an  occluded  external  auditory  meatus,  are 
preferably  made  of  silver  because  it  is  smooth, 
non-irritating,  non-corrosive  in  the  secretions 
of  the  body,  and  not  readily  broken.  Silver 
wire  has  been  used  very  extensively  for  sutures, 
especially  in  certain  gynseoological  operations, 
but  it  is  being  superseded  for  this  purpose  to  a 
large  extent  by  other  materials.  Other  in- 
struments which  are  frequently  or  occasionally 
made  of  silver,  either  pure  or  sterling,  are  ap- 
plicators, cannulas,  catheters,  ear  specula.  Eu- 
stachian catheters,  and  tracheotomy  tubes. 
Silver  is  used  to  some  extent  for  spectacle 
frames,  but  is  much  inferior  to  gold  alloyed  to 
a  proper  hardness.  Its  use  has  been  advocated 
in  the  manufacture  of  trusses,  because  it  keeps 
bright,  is  not  affected  by  the  perspiration,  and 
will  not  soon  wear  out. 


SILVER 


192 


[Metallic  silver  has  recently  been  credited 
with  antiseptic  virtues.  Crede  {Deutsche  Med- 
izinal-Zeitung,  March  2G,  1896)  has  satisfied 
himself  that,  when  brought  into  contact  with 
colonies  of  schizomycetes,  it  kills  them  with- 
out exerting  any  unfavourable  action  on  the 
animal  tissues.  He  Siiys  that  aseptic  wounds 
coated  with  silver  foil  remain  aseptic  for  weeks 
at  a  time,  and  heal  better  than  with  any  other 
dressing.  Instead  of  silver  foil,  he  has  lately 
employed  a  dressing  material  in  the  fabric  of 
which  metallic  silver  is  intimately  blended  in 
such  a  manner  as  to  admit  of  its  being  cut  or 
torn  into  a;:v  shape  desired.  There  is  also  a 
dressing  in  the  form  of  a  mull  containing 
powdered  silver  that  may  with  advantage  be 
substituted  for  iodoform  gauze  in  packing  deep 
wounds.] 

A  large  number  of  salts  of  silver  are  known 
in  chemistry,  but  very  few  are  used  in  medi- 
cine. Those  official  in  the  U.  S.  Ph.  are  the 
cyanide,  iodide,  nitrate,  and  oxide.  With 
the  exception  of  the  cyanide,  which  is  used 
for  pharmaceutical  purposes  only,  all  these 
salts  resemble  each  other  closely  in  their  ac- 
tion, varying  principally  according  to  their 
solubility.  All  should  be  protected  from  the 
light,  because  in  the  presence  of  organic  matter, 
even  in  the  small  quantity  present  in  the  air, 
light  induces  their  decomposition.  The  nitrate 
is  the  raogt  soluble  and  is  used  very  extensively, 
while  the  others  are  seldom  employed.  The 
soluble  silver  salts  are  very  considerably  used 
in  staining  sections  made  for  microscopic 
examination,  on  account  of  their  strong  affini- 
ty for  the  cement  which  unites  epithelial  or 
endothelial  cells.  They  also  unite  with  albu- 
min to  form  albuminates,  which  are  soluble  in 
the  digestive  fluids,  but  it  is  not  certain  that 
this  is  the  form  in  which  silver  is  absorbed 
into  the  system.  According  to  Frasohetti,  a 
reduction  of  the  salts  takes  place  in  the  stom- 
ach, afterward  in  the  intestinal  canal,  tending 
to  the  separation  of  the  metal.  The  same 
writer  says  that  silver  finds  its  way  to  the 
organs  o£  the  body  through  the  lymphatic 
passages.  In  medicinal  doses,  a  soluble  salt  of 
silver  acts  as  a  tonic  to  the  nervous  system, 
causes  certain  changes  in  the  blood,  and  in- 
creases tissue  change  and  the  secretion  of  bile  ; 
in  larger  doses  it  depresses  the  heart,  reduces 
the  temperature,  and  causes  embarrassment  of 
the  respiration ;  in  an  overdose  it  acts  on  the 
central  nervous  system  to  produce  tetanic  con- 
vulsions or  paralysis. 

The  prolonged  internal  use  of  any  of  the 
soluble  salts  of  silver  will  occasion  chronic 
silver  poisoning,  known  as  argyria.  The  first 
sign  of  this  condition  is  the  appearance  of  a 
slate-coloured  line  along  the  gums,  associated 
with  some  inflammatory  swelling.  Subse- 
quently grayish  patches  appear  on  various 
parts  of  the  skin  and  mucous  membranes,  and 
spread  until  the  whole  integument  has  become 
dingy  or  slate-coloured  No  organ  of  the  body, 
save  the  parenchymatous  cells  and  the  epithe- 
lium, is  excepted  from  this  pigmentation, 
which  is  due  to  the  deposit  of  silver,  either 
in  its  metallic  state,  or  as  an  oxide,  or  as  some 
organic  compound.    Although  several  months 


of  ingestion  of  silver  elapse  before  the  dis- 
coloration can  be  seen,  the  deposit  of  the  metal 
probablv  takes  place  proportionally  from  the 
first  dose.  As  a  rule,  argyria  does  not  produce 
any  serious  eifect  upon  the  health  of  man,  but 
some  wrirers  ascribe  to  it  gastro-intestinal  ca- 
tarrh, faulty  assimilation,  fatty  degeneration 
of  the  heart,  liver,  and  kidneys,  and  changes  in 
the  blood.  Such  associated  conditions  form  a 
part  of  argyria  in  the  lower  animals,  and  their 
occasional  appearance  in  man  is  not  a  matter 
of  surprise.  It  is  not  improbable  that  in  all 
cases  a  certain,  though  not  serious,  degree  of 
derangement  of  nutrition  is  present. 

A  local  argyria.  or  argyrosis,  may  be  caused 
by  the  frequent  topical  application  of  a  soluble 
silver  salt  for  a  considerable  length  of  time. 
Thus,  the  conjunctiva  is  not  infrequently  seen 
to  be  discoloured  from  the  prolonged  use  of 
nitrate  of  silver.  A  few  cases  have  been  re- 
ported in  which  general  argyria  has  resulted 
from  the  topical  use  of  silver,  usually  in  the 
mouth  or  throat. 

The  elimination  of  silver  from  the  body  is 
accomplished  very  slowly  and  in  a  manner 
which  is  not  known.  It  is  generally  supposed 
to  be  removed  in  the  albuminous  secretions, 
such  as  the  bOe,  and,  as  it  has  been  detected  in 
the  urine,  it  is  possible  that  it  may  be  elimi- 
nated by  the  kidneys  to  a  very  slight  extent. 
Frasche'tti  denies  that  it  is  eliminated  by  either 
the  kidneys  or  the  intestines.  At  best,  the 
process  of  elimination  is  very  slow  and  the  dis- 
coloration of  the  skin  and  mucous  membranes 
in  argyria  may  be  considered  permanent,  al- 
though a  few  cases  have  been  reported  in  which 
it  disappeared  after  long  courses  of  treatment 
with  iodide  of  potassium. 

In  order  to  avoid  the  unpleasant  production 
of  argyria  in  any  case  where  the  internal  use  of 
silver  is  indicated,  its  administration  should 
not  be  continued  longer  than  from  six  to  eight 
weeks,  and  then  the  use  of  the  drug  should  be 
stopped  and  the  patient  given  a  thorough 
course  of  purgatives,  diuretics,  and  baths. 
The  iodide  of  potassium  may  be  given  with 
the  silver  to  expedite  its  elimination,  and  the 
patient  may  be  frequently  sponged  off  with  a 
solution  of  hyposulphite  of  sodium. 

Silver  nitrate,  argenti  nitras  (U.  S.  Ph., 
Br.  Ph.),  argentum  niiricum  (Ger.  Ph.),  is  by 
far  the  most  important  of  the  silver  salts, 
viewed  from  a  medical  standpoint.  It  is  de- 
scribed in  the  U.  S.  Ph.  as  occurring  in  "  col- 
ourless, transparent,  tabular,  rhombic  crystals, 
becoming  gray  or  grayish-black  on  exposure 
to  light  in  the  presence  of  organic  matter, 
odourless,  having  a  bitter,  caustic,  and  strong- 
ly metallic  taste  and  a  neutral  reaction.  It  is 
soluble  in  0-8  part  of  water  and  in  36  parts  of 
alcohol  at  15°  C.  (59°  F.),  in  0-1  part  of  boiling 
water  and  5  parts  of  boiling  alcohol.  When 
heated  to  about  200°  C.  (392°  P.)  the  salt  fuses 
to  a  faintly  yellow  liquid,  which,  on  cooling, 
congeals  to  a  purely  white,  crystalline  mass. 
At  a  higher  temperature  the  salt  is  gradually 
decomposed  with  evolution  of  nitrous  vapours. 
It  should  be  kept  in  dark,  amber-coloured 
phials,  protected  from  the  light." 

If  hydrochloric  acid  or  a  soluble  chloride  is 


193 


SILVER 


added  to  a  solution  of  nitrate  of  silver,  a  white, 
curdy  precipitate  is  formed  which  is  soluble  in 
ammonia.  If  a  small  piece  of  the  crystal  is 
heated  on  charcoal  by  means  of  a  blowpipe,  it 
melts  and  then  deflagrates,  leaving  behind  a 
dull  metallic  coating. 

For  topical  purposes,  it  is  fused  and  moulded 
into  pencils,  of  which  two  strengths  are  of- 
ficial in  the  U.  S.  Ph.,  the  lunar  caustic  and  the 
mitigated  caustic.  The  moulded  silver  nitrate, 
or  lunar  caustic,  argenti  nitras  fusus  (U.  S. 
Ph.),  is  made  by  melting  the  crystals  with  4 
per  cent,  of  hydi-ochloric  acid  and  casting  in 
suitable  moulds  to  form  "  a  white,  hard  solid, 
generally  in  the  form  of  pencils  or  cones,  of  a 
fibrous  fracture,  becoming  gray  or  grayish- 
black  on  exposure  to  the  light  in  the  presence 
of  organic  matter,  odourless  and  having  a 
bitter,  caustic,  and  strongly  metallic  taste." 
This  conversion  of  a  small  portion  of  the 
nitrate  into  chloride  of  silver  is  for  the  purpose 
of  giving  a  certain  degree  of  toughness  to  the 
pencils,  which,  when  made  of  the  pure  nitrate, 
are  very  brittle. 

The  mitigated  caustic,  argenti  nitras  dilutus 
(U.  S.  Ph.),  argenti  et  potassii  nitras  (Br.  Ph.), 
argenlum  nitrieum  cum  kalio  nitrico  (Ger.  Ph.), 
is  composed  of  1  part  nitrate  of  silver  and  2 
parts  nitrate  of  potassium  melted  together  and 
cast  in  moulds.  The  pencils  closely  resemble 
those  of  lunar  caustic,  but  have  a  finely  granu- 
lar instead  of  a  fibrous  fracture.  Both  forms 
are  stimulant,  astringent,  and  mildly  caustic 
in  their  action,  but  the  mitigated  is  much 
weaker,  and  is  to  be  used  where  a  gentle  effect 
Is  desired.  The  moulded  nitrate  may  cause 
sloughing  or  ulceration  if  used  too  energetic- 
ally. Both  forms  should  be  kept  and  used  in 
a  protective  covering,  such  as  a  porte-caus- 
tique. 

The  nitrate  is  the  most  freely  soluble  of  the 
silver  salts.  It  has  a  strong  affinity  for  albu- 
min, with  which  it  unites  to  form  an  albu- 
minate. Locally  applied,  it  causes  a  very 
marked  contraction  of  the  blood-vessels,  and  is 
in  consequence  an  efiieient  hmmostatic.  In 
weak  solutions  it  is  an  astringent,  and  when 
applied  to  a  mucous  membrane  it  whitens  the 
surface  by  uniting  with  the  albumin.  In 
stronger  solutions  it  is  an  irritant  and  acts  as 
a  superficial  caustic  by  coagulating  the  albu- 
min of  the  tissues  to  which  it  is  applied  and 
destroying  their  vitality.  At  the  same  time 
this  change  results  in  a  dense  layer  which  pre- 
vents further  penetration  of  the  salt  into  the 
tissue  and  so  limits  its  caustic  action.  The 
albuminous  coating  thus  formed  is  at  first 
white,  but  under  the  influence  of  light  soon 
becomes  black.  This  decomposition  of  nitrate 
of  silver  which  takes  place  under  the  influ- 
ence of  light  in  the  presence  of  organic  matter 
is  made  use  of  in  the  manufacture  of  indelible 
ink,  but  is  a  frequent  source  of  annoyance  to  a 
surgeon  on  account  of  the  accidental  stains  on 
his  hands  and  clothing.  The  writer  has  for 
several  years  been  accustomed  to  bathe  his 
hands  with  a  solution  of  salt  and  water  imme- 
diately after  the  use  of  this  drug,  and  has 
found  it  very  satisfactory  to  prevent  the  ap- 
pearance of  stains  upon  them.    It  must  be 


used  before  the  chemical  reaction  has  taken 
place,  which  fortunately  is  not  rapid,  in  order 
that  the  silver  present  may  be  changed  into 
the  insoluble  chloride.  After  the  black  stains 
have  appeared,  and  while  they  are  still  re- 
cent, they  may  be  removed  by  washing  with 
a  solution  of  cyanide  of  potassium.  A  num- 
ber of  preparations  have  been  recommended 
for  this  purpose,  two  of  which  are  the  follow- 
ing: 

5  Potassium  cyanide 9  parts ; 

Iodine 1  part ; 

Water 96  parts. 

M. 

5  Corrosive   sublimate 10  parts; 

Ammonium  chloride 10  parts  ; 

Distilled  water 80  parts. 

M. 
When  the  stains  are  older,  an  efficient  method 
of  removal  is  to  rub  them  with  a  mixture  of 
iodine  and  ammonia,  and  while  the  part  is 
still  wet  wash  it  thoroughly  with  water.  The 
vessel  in  which  this  preparation  has  been  made 
must  also  be  washed  without  delay,  because 
the  compound  produced  when  the  mixture  is 
allowed  to  dry  is  apt  to  explode  upon  slight 
agitation. 

Nitrate  of  silver,  given  internally  in  small 
doses,  is  said  to  stimulate  the  heart,  promote 
nutrition,  and  act  as  a  nerve  tonic.  Large 
doses  produce  violent  gastro-enteritis,  throm- 
bosis of  the  gastric  veins,  and  ulceration  of 
the  mucous  membrane  of  the  stomach.  It 
also  causes  centric  impairment  of  the  nervous 
system  with  loss  of  the  power  of  co-ordina- 
tion, paralysis,  convulsions,  coma,  disturbances 
(and  finally  paralysis)  of  respiration,  from 
which  death  results.  The  lethal  dose  is  not 
certain.  The  antidote  is  chloride  of  sodium 
in  large  quantities.  Vomiting  should  then  be 
induced  at  once,  as  the  chloride  of  silver  is 
soluble  in  solutions  of  chloride  of  sodium  and 
in  the  digestive  fluids,  or,  if  possible,  a  very 
soft  stomach-tube  should  be  introduced  and 
the  stomach  very  thoroughly  washed  out  with 
salt  and  water.  The  same  precautions  must 
be  observed  in  the  tiseof  the  stomach-pump  in 
these  cases  as  in  cases  of  poisoning  with  other 
corrosive  agents.  If  the  stomach  can  not  be 
washed  out,  large  draughts  of  salt  and  water 
must  be  taken  and  vomited,  and  this  repeated 
until  no  silver  remains.  The  stomach  should 
then  be  filled  with  milk  and  the  bowels  moved 
with  oil. 

For  internal  use,  the  crystals  should  always 
be  prescribed,  and  the  long  list  of  chemical  in- 
compatibles  be  borne  in  mind  when  choosing 
an  excipient.  This  list  includes  all  soluble 
chlorides,  most  of  the  mineral  acids  and  their 
salts,  alkalies  and  their  carbonates,  and  or- 
ganic material.  In  spite  of  the  most  careful 
choice  of  an  excipient,  it  is  doubtful  if  the 
drug  ever  reaches  the  stomach  as  nitrate  of 
silver,  and  if  it  does  it  is  probably  changed 
immediately  upon  its  arrival.  The  usual  dose 
is  from  ^  to  ^  a  grain,  three  times  a  day. 

The  internal  use  of  nitrate  of  silver  is  almost 
confined  at  present  to  affections  of  the  gastro- 
intestinal tract.    Probably  on  account  of  its 


SILVER 


194 


astringent  action  it  is  sometimes  very  useful 
in  cases  of  irritable  stomach,  to  allav  persist- 
ent vomiting,  in  chronic  gastric  catarrh,  and  in 
gastric  ulcer.  When  given  for  stomach  trou- 
ble, it  should  be  administered  when  the  viscus 
is  empty. 

[Forlanini's  method  of  treating  chronic  gas- 
tritis by  irrigating  the  stomach  with  a  solution 
of  silver  nitrate  has  been  employed  in  twenty 
cases  by  Reale  (Riforma  medica,  iv,  1895,  No. 
37;  Deutsche  llediziiml-Zeitung,  April  13. 
1896),  who  reports  that  in  eleven  of  them  the 
influence  of  the  treatment  on  the  chemistry  of 
the  stomach  was  investigated.  Of  the  eleven 
patients,  nine  had'  chronic  catarrh,  mostly  ac- 
companied with  a  reduction  of  the  amount  of 
hydrochloric  acid  in  the  gastric  juice;  in  one 
of  them  abnormal  fermentation  was  enormous. 
In  one  of  the  patients,  who  had  been  assumed 
to  have  chronic  gastric  catarrh,  cancerous  steno- 
sis of  the  pylorus  was  found  after  death. 

At  first  the  irrigations  were  performed  with 
a  solution  of  about  3f  grains  of  silver  nitrate 
in  a  little  over  5  drachms  of  water.  The 
strength  of  the  solution  was  gradually  in- 
creased, but  not  to  exceed  23  grains  to  the 
amount  of  water  mentioned.  The  best  results 
were  obtained  with  these  doses,  which  were 
rather  large  as  compared  with  those  recom- 
mended by  Porlanini.  Immediately  after  the 
use  of  the  silver  nitrate  the  stomach  was  irri- 
gated with  a  solution  of  from  three  to  five  per 
cent,  of  common  salt. 

The  results  were  as  follows:  The  first  thing 
observed  was  a  heightened  motor  activity  of 
the  stomach,  as  was  shown  by  the  amount  of 
decrease  in  the  contents  of  the  organ  in  the 
course  of  an  hour  after  a  test  meal.  This  was 
accompanied  by  an  increase  in  the  secretion  of 
hydrochloric  acid.  In  all  cases  the  vomiting 
was  checked  speedily  and  permanently  and  the 
general  nutrition  was  promoted,  for  the  pa- 
tients gained  in  weight  and  in  muscular 
power.] 

Silver  nitrate  is  also  at  times  of  value  in 
chronic  inflammation  of  the  small  and  of  the 
large  intestine,  particularly  when  associated 
with  ulceration.  In  ulcers  of  the  rectum  situ- 
ated so  as  to  admit  of  its  local  application  it  is 
of  especially  good  service.  It  has  been  said  to 
give  relief  to  pain  in  catan-h  of  the  biliary 
ducts  and  to  assist  in  restoring  the  functional 
activity  of  the  liver.  It  has  also  been  recom- 
mended in  cholera  infantum  after  the  acuter 
symptoms  have  abated,  and  it  has  done  good 
service  in  some  epidemics  of  acute  dysentery. 
Formerly  it  was  used  as  a  nervine  tonic  in  epi- 
lepsy, but  has  been  superseded  by  other  rem- 
edies which  are  less'  objectionable  and  more 
efficacious.  Its  use  in  spinal  sclerosis,  labio- 
glosso-laryngeal  paralysis,  and  other  similar 
diseases  has  not  been  marked  with  much  suc- 
cess, but  it  is  said  to  be  one  of  the  few  rem- 
edies which  are  ever  of  any  service  in  tabes 
dorsalis. 

[Dr.  William  Murray,  of  London  (Lancet, 
September  21,  1895),  says  that,  as  regards  the 
treatment  of  epilepsy,  it  is  evident  that  our 
efforts  must  be  directed  to  the  removal  or  pre- 
vention of  the  tendency  to  an  explosive  dis- 


charge in  the  nervous  and  muscular  systems. 
Without  attempting  to  explain,  he  says,  how 
this  inhibited  state  of  the  nerve  centres  is 
brought  about  by  several  remedies,  some  of 
them  do  their  work  by  preventing  this  explo- 
sive union  of  atoms  or  molecules.  One  of  these 
remedies— nitrate  of  silver— offers  a  fair  field 
for  study  in  this  direction.  Some  years  before, 
he  says,  he  expressed  the  opinion  that  a  deposit 
of  silver  in  some  form,  probably  chloride,  in 
the  molecules  or  subniolecules  of  the  nerve 
cells  and  fibres  so  altered  the  polarity— that  is. 
the  explosive  tendency— of  the  molecules  as  to 
arrest  the  epileptic  discharge.  Dr.  Gowers,  he 
says,  gives  a  mental  picture  of  what  actually 
takes  place  in  the  action  of  the  nervous  and 
muscular  tissues  when  force  is  set  free.  He 
points  out  that  the  susceptibility  to  nervous 
and  muscular  action  needs  but  the  influence 
of  a  stimulus  to  bring  about  a  manifestation 
of  the  latent  energy  in  these  tissues,  and  that 
an  increase  of  susceptibility  or  of  stimulus  may 
evoke  an  epileptic  explosion.  The  inference 
is,  says  Dr.  Murray,  that  a  remedy  which  is 
deposited  in  the  tissues  may  by  its  chemical  in- 
ertia interfere  by  its  presence  with  the  minute 
motion  or  chemical  activity  of  adjacent  atoms 
and  thus  prevent  their  explosive  union.  Ex- 
perience has  taught  us  two  remarkable  things, 
he  says :  First,  that  nitrate  of  silver  will  cure 
epilepsy  where  th"  bromides  have  utterly 
failed ;  secondly,  that  a  patient  who  has  sub- 
jected himself  to  a  course  of  silver  that  has 
produced  a  deposit  secures  a  remarkable  im- 
munity from  a  number  of  minor  nervous  ail- 
ments. This  latter  effect,  he  says,  throws  a 
great  deal  of  light  upon  the  subject  and  cor- 
roborates the  view  that  the  silver  blunts  the 
polarity  of  the  nerve  centres  and  renders  them 
stable  and  less  easily  disturbed  by  outward  in- 
fluences. In  confirmation  of  these  statements 
and  in  pi-oof  of  the  power  of  nitrate  of  silver 
to  cure  epilepsy,  he  relates  a  few  cases. 

With  regard  to  the  effect  of  nitrate  of  sil- 
ver in  minor  ailments,  he  says,  there  is  no 
more  striking  illustration  of  it  than  in  those 
cases  of  weah,  irritable  stomach  which  are 
characterized  by  intense  depression  of  spirits, 
apprehensions,  and  failure  of  pluck  or  courage. 
In  these  eases  a  remarkable  change  takes  place 
both  in  the  functions  of  the  stomach  and  in 
the  tone  of  the  nerve  centres  of  emotion.  To 
get  the  best  results  in  these  stomach  cases,  the 
nitrate  should  be  dissolved  in  distilled  water 
and  taken  on  an  empty  stomach.  Dr.  ?Iurray 
thinks  that  a  distinct  local  effect  on  tlie  mu- 
cous membrane,  as  well  as  the  more  remote 
effect  on  the  nerve  centres,  by  giving  it  in  this 
form,  is  produced.] 

The  local  uses  of  nitrate  of  silver,  which  are 
the  more  important,  depend  on  its  antiseptic, 
hasmostatie,  astringent,  and  caustic  properties. 
As  an  antiseptic,  it  has  proved  an  efficient  pro- 
phylactic measure  against  ophthalmia  neona- 
torum, when  used  in  a  manner  suggested  by 
Crede,  by  instilling  a  drop  of  a  1-  or  2-per-cent. 
solution  into  each  eye  of  a  newborn  infant. 
Bad  results  do  not  frequently  occur  from  this 
rather  heroic  means  of  prophylaxis,  but  Pome- 
roy  has  reported  a  case  in  which  persistent 


195 


SILVER 


ha5morrhage  froin  the  conjunctiva  was  excited 
by  it.  It  is  preferable  to  restrict  the  use  of 
this  method  to  those  cases  in  which  the  mother 
is  known  to  have  a  blennorrhoeal  discharge, 
and  in  other  cases  to  thoroughly  cleanse  the 
eyes  of  the  child  with  a  solution  of  bichloride 
of  mercury,  boric  acid,  or  common  salt. 

In  ophthalmia  neonatorum,  when  the  dis- 
charge is  distinctly  purulent,  a  solution  of  ni- 
trate of  silver  from  1  to  3  per  cent,  in  strength 
should  be  applied  daily  to  the  conjunctiva. 
When  the  discharge  is  very  profuse,  partic- 
ularly if  the  gonooocoi  are  abundant,  the  2- 
per-cent.  solution  will  not  be  too  strong.  A 
very  important  part  of  the  treatment  of  this 
disease  is  to  keep  the  eyes  carefully  and  con- 
tinuously cleansed. 

In  the  puriUent  conjunctivitis  of  adults, 
after  the  tense  conjunctiva  has  become  soft 
and  velvety,  the  lids  should  be  everted  daily, 
the  conjunctiva  cleansed  and  then  dried  with 
absorbent  cotton,  and  a  solution  of  nitrate  of 
silver  brushed  over  the  surface  with  cotton  on 
an  applicator.  The  strength  of  the  solution 
may  vary  from  1  to  4  per  cent.,  but  a  2-per- 
cent, solntion  is  perhaps  the  most  commonly 
employed.  After  this  application  the  excess 
of  nitrate  should  be  removed,  either  by  wash- 
ing the  conjunctiva  with  warm  waler,  or  by 
neutralization  with  salt  and  water.  When  the 
cornea  is  intact,  solutions  ^  to  -J-  of  1  per  cent. 
in  strength  may  be  occasionally  dropped  into 
the  conjunctival  sac.  Care  must  be  exercised 
in  all  cases  in  which  nitrate  of  silver  is  used  in 
diseases  of  the  eye  that  it  shall  not  come  in 
contact  with  an  inflamed  cornea,  as  it  is  then 
not  well  borne  and  may  cause  a  permanent 
opacity  from  a  deposit  of  silver.  Milder  meth- 
ods of  treatment  have  almost  superseded  the 
use  of  silver  in  catarrhal  conjunctivitis,  except 
in  some  chronic  cases. 

In  trachoma  the  application  of  silver  nitrate 
is  one  of  the  oldest  methods  of  treatment,  and 
still  has  its  pronounced  advocates,  though 
other  methods  have  been  largely  adopted,  and 
it  can  no  longer  be  said  to  be  the  favourite. 
The  mitigated  stick  presents  the  advantages  of 
being  capable  of  a  localized  application  and  of 
being  at  the  same  time  more  efficient  than 
solutions.  The  latter  are  used  in  strengths 
varying  from  1  to  4  per  cent.,  according  to  the 
condition  of  the  conjunctiva. 

Otherwise  intractable  eases  of  dacryocystitis 
are  not  infrequently  quickly  cured  by  the  injec- 
tion of  a  few  drops  of  a  solution  of  this  drug 
into  the  lacrymal  duct,  but  such  a  practice  is 
not  to  be  commended  as  a  routine  ti-eatment. 

In  obstinate  cases  of  blepharitis  marginalis  a 
good  result  is  sometijnes  obtained  by  removing 
all  the  eyelashes  and  scabs  and  then  applying 
the  fused  caustic  to  the  margins  of  the  lids. 

The  eczematous  eruptions  on  the  lids  which 
not  infrequently  accompany  strumous  eye  af- 
fections may  often  be  benefited  by  the  appli- 
cation of  a  moderately  weak  solution. 

In  chronic  purulent  inflammation  of  the 
middle  ear  nitrate  of  silver  is  one  of  the  most 
valuable  agents  at  our  command.  It  has  been 
used  in  solutions  varying  in  strength  from  J-  of  1 
per  cent,  to  saturation,  dependent  upon  the 


conditions  present  in  the  ear  and  the  experi- 
ence and  Judgment  of  the  surgeon.  The  audi- 
tory canal  should  be  thoroughly  cleansed  and 
dried,  and  the  application  then  introduced 
either  directly  into  the  middle  ear,  by  means 
of  a  syringe  made  for  this  purpose,  through 
the  perforation  in  the  tympanic  membrane,  or 
by  means  of  cotton  on  an  applicator,  or  by 
dropping  it  into  the  external  meatus.  A  very 
neat  method  of  making  applications  is  to  fuse 
a  small  quantity  of  the  mitigated  or  of  the 
moxilded  caustic  on  the  end  of  a  silver  probe 
or  applicator,  to  which  it  adheres  very  firmly, 
and  so  carry  it  to  the  desired  spot.  Aural 
polypi  are  sometimes  successfully  treated  with 
solutions  of  from  6  to  20  per  cent. 

Weak  solutions  are  frequently  useful  in  ecze- 
ma of  the  external  ear  and  in  external  otitis. 
Silver  nitrate  has  also  been  recommended  for 
chronic  inflammation  of  the  mucous  membrane 
lining  the  Eustachian  tube,  but  it  is  seldom 
used.  It  has  also  been  alleged  to  abort  aural 
furuncles  when  applied  in  the  first  stage,  and 
to  relieve  pruritus  of  the  external  auditory 
meatus. 

In  the  local  treatment  of  diseases  of  the  nose 
and  throat,  nitrate  of  silver,  though  occasion- 
ally useful  should  be  employed  with  care,  as 
it  may  be  decidedly  harmful.  It  is  an  excel- 
lent hEemostatic,  and  will  often  check  an  epis- 
taxis  dependent  on  an  ulcer  of  the  nasal 
mucous  membrane.  Ulcers  on  the  nasal  smp- 
tum  are  quite  common,  as  results  of  both 
mechanical  irritation  and  disease,  and  a  very 
good  treatment  for  them  is  to  thoroughly 
cleanse  their  surfaces  and  then  apply  an  8-  to 
12-per-cent.  solution.  This  promotes  healing 
by  its  astringent  and  stimulant  action,  but 
such  an  application  should  not  be  made  too 
frequently. 

The  vascular  granulations  which  often  occur 
after  operations  in  the  nose  are  advantageous- 
ly treated  by  touching  them  with  the  moulded 
nitrate  or  with  a  strong  solution  in  the  same 
manner  as  exuberant,  granulations  are  treated 
elsewhere  in  the  body. 

In  acute  coryza  a  powder  made  by  triturat- 
ing nitrate  of  silver  with  some  inert  substance 
will  relieve  the  immediate  symptoms  by  means 
of  its  astringent  action. 

In  chronic  inflammation  of  the  nasal  mu- 
cous membrane  nitrate  of  silver,  though  not 
generally  useful,  is  occasionally  of  decided 
value.  In  an  old  case  of  atrophic  rhinitis,  or 
ozcena,  after  the  scabs  have  been  removed  and 
the  mucous  membrane  has  been  thoroughly 
cleansed,  an  application  of  a  moderately  strong 
solution  is  sometimes  of  benefit,  but  these 
cases  have  to  be  carefully  selected.  Fissures 
of  the  lips  and  tongue,  mucous  patches,  and 
ulcers  of  the  mouth  respond  well  to  this  treat- 
ment. It  is  of  doubtful  value  in  chronic 
pharyngitis  or  naso-pharyngitis,  but  it  is  occa- 
sionally useful  to  abort  an  acute  attack.  Its 
use  on  adenoids  in  the  naso-pharynx  is  to  be 
deprecated,  as  it  does  no  good  and  is  apt  to 
cause  considerable  pain. 

A  threatened  attack  of  amygdalitis  may 
perhaps  sometimes  be  aborted  by  the  appli- 
cation of  a  strong  solution,  but  when  it  fails 


SILVER 


196 


its  irritant  action  increases  the  severity  of  the 
inflammation.  Diphtheria  and  membranous 
croup  are  not  usually  benefited  by  the  local 
use  of  this  drug.  It  exerts  no  influence  toward 
the  removal  of  recent  exudations,  and  is  apt  to 
irritate  and  increase  the  trouble  present.  It 
should  never  be  used  in  infancy. 

In  chronic  and  subacute  laryngitis  the  ap- 
plication of  a  solution  of  nitrate  of  silver  is 
sometimes  very  etfective.  The  strength  used 
varies  from  0-1  to  12  per  cent.,  according  to  the 
conditions  present.  It  should  be  very  care- 
fully applied  to  the  affected  portion  after 
clea'nsin.^:  wit;h  an  alkali  and  anaesthetizing 
with  cocaine.  But  there  is  great  danger  of 
provoking  a  severe  laryngeal  spasm  in  making 
such  an  application,'  and  two  precautions 
should  always  be  taken — to  avoid  touching  the 
epiglottis,  and  not  to  use  any  excess  of  the 
fluid.  In  the  treatment  of  laryngeal  ulcers 
this  drug  is  efficient,  but  it  is  of  little  use  in 
laryngeal  phthisis.  Sponging  the  throat  with 
a  solution  of  moderate  strength  is  said  to  give 
a  decided  amount  of  relief  in  whooping-cotigh, 
but  the  primary  effect  is  a  violent  paroxysm 
of  coughing. 

In  making  applications  to  the  mucous  mem- 
brane of  the  mouth  and  throat,  the  danger  of 
fracture  of  the  brittle  stick  of  caustic,  of  the 
broken  portion  being  swallowed,  and  of  conse- 
quent acute  poisoning  must  be  remembered 
and  guarded  against.  A  good  plan  is  not  to 
use  the  official  pencils,  but  to  fu.se  a  small  por- 
tion on  a  silver  probe,  in  the  manner  already 
mentioned,  which  may  be  used  without  danger 
of  any  portion  becoming  detached.  It  should 
also  be  borne  in  mind  that  cases  of  general 
argyria  have  been  reported  as  resulting  from 
the  prolonged  topical  use  of  nitrate  of  silver  in 
the  mouth  and  throat. 

In  general  surgery,  the  moulded  nitrate  is 
largely  used  to  cut  down  exuberant  granula- 
tions in  suppurating  wounds,  and  to  stimulate 
indolent  ulcers  to  repair.  It  should  be  freely 
applied  in  the  former  case,  but  in  the  latter 
the  surface  should  be  only  gently  touched.  A 
good  plan  is  to  trace  a  line  with  the  caustic  on 
the  surface  of  the  ulcer,  parallel  with  and  a 
little  distance  from  the  margin  of  the  integu- 
ment, and  to  repeat  this  every  day  or  two  as 
this  margin  creeps  inward. 

In  punctured  wounds  and  dog  bites  it  is  irri- 
tant and  should  never  be  used.  It  has  no 
effect  whatever  as  a  preventive  of  rabies.  In 
the  treatment  of  fissured  nipples  the  mitigated 
caustic  is  sometimes  very  useful. 

In  some  inflammatory  conditions  it  is  em- 
ployed as  a  counter-irritant,  but  is  little,  if 
any,  more  eflicient  than  tincture  of  iodine. 

in  genito-urinary  surgery,  nitrate  of  silver 
is  an  old,  tried,  and  valued  remedy  for  gonor- 
rhcea,  to  be  applied  to  the  urethi-a  during  the 
course  of  the  disease.  In  the  early  stage  it  is 
used  to  abort  the  inflammation,  a  treatment 
which  has  strong  advocates  and  equally  strong 
opponents.  One  point  should  be  seriously  con- 
sidered before  trying  the  abortive  treatment  in 
any  case — it  it  fails  to  cut  the  inflammation 
short,  it  will  probably  aggravate  it  consider- 
ably.   It  is  also  frequently  a  useful  remedy 


in  gleet,  prostalorrhcea,  balano posthitis,  hcemct- 
turia,  and  chronic  cystitis. 

Cordier  recommended  and  reported  excellent 
results  from  the  injection  of  a  2-per-cent.  solu- 
tion into  the  substance  of  buboes  in  their  early 
stage.  Indolent  sinuses  which  result  from  bu- 
boes, or  from  abscesses  elsewhere  in  the  body, 
may  be  stimulated  to  healing  with  a  strong 
solution  or  the  moulded  caustic.  It  is  some- 
times applied  also  to  venereal  sores. 

Formerly  it  was  used  much  more  than  at 
present  for  cervical  endometritis  and  erosions 
of  the  OS  uteri. 

Cysts  and  hydroceles  may  also  be  cured  by 
the  injection  of  a  solution  after  evacuation  of 
the  contents.  An  adhesive  inflammation  is 
set  up  which  obliterates  the  sac.  Other  meth- 
ods of  treatment  are  usually  preferred,  how- 
ever. 

A  2-per-cent.  solution,  painted  on  the  skin 
when  it  is  red  but  not  yet  broken,  hardens  the 
epidermis  and  is  frequently  efficient  to  prevent 
the  formation  of  bedsores. 

In  erysipelas,  the  method  of  treatment  sug- 
gested by  3Ir.  Higginbottom  in  1828  is  said  to 
be  very  successful  when  the  directions  laid 
down  by  him  are  properly  observed,  but  at  the 
present  time  other  methods  are  largely  em- 
ployed. His  directions  are :  "  The  affected 
part  should  be  well  washed  with  soap  and  wa- 
ter, then  with  water  alone,  to  remove  every 
particle  of  the  soap,  as  the  soap  would  decom- 
pose the  nitrate  of  silver ;  then  to  be  wiped 
dry  with  a  soft  towel.  The  concentrated  solu- 
tion of  four  scruples  of  the  nitrate  of  silver  to 
four  drachms  of  distilled  water  is  then  to  be 
applied  two  or  three  times  on  the  inflamed 
surface  and  beyond  it,  on  the  healthy  skin,  to 
the  extent  of  two  or  three  inches."  He  main- 
tained that  if  the  inflammation  should  spread 
it  would  be  less  severe,  and  might  eventually 
be  checked  by  repeated  applications. 

In  diseases  of  the  skin  nitrate  of  silver  is 
used  to  destroy  parasitic  fungi,  to  cause  exfo- 
liation of  the  epidermis,  or  for  a  stimulant 
effect.  As  a  caustic  for  destroying  outgrowths 
of  the  skin,  such  as  warts  and  molluscum  con- 
tagiosum,  it  is  inferior  to  several  other  caustics. 
It  is  useful  in  some  forms  of  eczema,  relieves 
the  itch  ing  in  prurigo  and  lichen,  and  is  said 
to  prevent  pitting  in  sraall-pox.  Its  use  has 
also  been  recommended  in  lupus,  psoriasis, 
erythema,  and  ringworms. 

Silver  cyanide,  argenti  cyanidum  (F.  S. 
Ph.),  has  no  medical  use.  and  is  official  simply 
for  the  pharmaceutical  purpose  of  the  manu- 
facture of  hydrocyanic  acid.  The  toxicology 
of  this  salt  is  that  of  hydrocyanic  acid  rather 
than  of  silver. 

Silver  iodide,  a;-,(7f)i!'/ i'o(?i'(7H?)i  {U.  S.  Ph.), 
is  described  as  a  heavy,  amorphous,  light- 
yellowish  powder,  unaltered  by  light  if  p'lire, 
but  generally  becoming  somewhat  greenish- 
yellow,  without  odour  or  taste,  and  insoluble 
in  water,  in  alcohol,  in  diluted  acids,  or  in  solu- 
tions of  carbonate  of  ammonium,  soluble  in 
about  2.500  parts  of  stronger  water  of  ammonia. 

This  salt  was  introduced  into  medicine  in 
the  hope  that  thus  silver  could  be  used  for  in- 
ternal medication  without  danger  of  discolora- 


197 


SILVER 


tion  of  the  skin,  but  it  hns  failed  to  realize 
this  hope.  It  has  been  used  in  gastric  itoubies, 
dysmenorrhma,  and  epilepsy  in  doses  of  from  1 
to  2  grains  for  adults  and  i  to  J  of  a  grain  for 
children.  It  has  been  used  for  trachoma,  but 
its  use  has  never  received  much  favour. 

Silver  oxide,  argenti  oxiditm  (U.  S.  Ph.,  Br. 
Ph.),  is  a  heavy,  dark,  brownish-black  powder, 
liable  to  reduction  by  exposure  to  light,  odour- 
less, having  a  metallic  taste,  and  imparting  an 
alkaline  reaction  to  water,  in  which  it  is  very 
slightly  soluble.  It  is  insoluble  in  alcohol. 
This  salt  is  easily  decomposed  and  parts  read- 
ily with  its  oxygen,  hence  it  must  not  be  tritu- 
rated with  oxidizable  materials.  A  case  is 
recorded  in  which  pills  of  oxide  of  silver,  hy- 
drochloride of  morphine,  and  extract  of  gen- 
tian exploded  violently  in  the  pocket  of  a 
patient.  When  29  grains  are  heated  to  red- 
ness the  oxygen  passes  away  and  leaves  27 
grains  of  metallic  silver.  It  is  the  least  irri- 
tating of  the  oflioial  salts  of  silver,  and  does 
not  discolour  the  skin  so  promptly  as  the  ni- 
trate, although  eventually  the  result  is  the 
same. 

It  allays  irritability  of  the  stomach  and 
tends  to  check  vomiting  even  in  severe  gastri- 
tis, and  may  serve  to  control  diarrAffia  depend- 
ent on  reflex  nervous  irritation.  It  has  been 
used  with  more  or  less  success  in  gastric  neu- 
ralgia, irritable  dyspepsia,  pyrosis,  gastric 
and  pulmonary  hemorrhages,  dysmenorrhea, 
and  various  other  uterine  complaints,  and  also 
to  check  profuse  sweating.  The  usual  dose  is 
from  i  to  2  grains,  in  pill  or  capsule. 

For  external  application  to  venereal  sores 
and  to  the  urethra  in  gonorrhoea,  an  ointment 
has  been  used  composed  of  5  or  10  grains  to 
the  drachm  of  lard. 

Silver  and  sodium  hyposulphite. — This 
non-official  salt  of  silver  is  used  to  some  ex- 
tent in  medicine.  It  is  very  soluble  in  water, 
does  not  coagulate  albumin,  and  may  be  given 
either  by  the  stomach  or  hypodermically.  It 
was  first  introduced  for  use  in  diseases  of  the 
throat  as  -being  superior  to  the  nitrate  in  that 
it  was  more  agreeable  to  the  taste,  and  did  not 
stain  the  skin  or  the  clothing.  It  has  also 
been  used  to  some  extent  in  locomotor  ataxia. 
The  dose  to  be  given  by  the  stomach  is  from  f 
to  3  grains ;  hypodermically,  from  J  to  |  of  a 
grain  during  the  day. 

Argonin  is  the  name  given  to  a  combina- 
tion of  silver  with  casein  introduced  by  Roh- 
mann  and  Liebrecht.  The  amount  of  silver 
contained  in  it  seems  a  little  doubtful,  as  state- 
ments are  made  which  indicate  that  it  contains 
from  iV  to  }  as  much  as  is  present  in  the  same 
weight  of  the  nitrate.  It  is  soluble  in  water, 
non-irntant,  and  not  precipitated  by  chloride 
of  sodium  from  its  solution.  In  the  conjunc- 
tival sac  it  is  no  more  irritating  than  water, 
but  it  is  said  to  produce  good  effects  in  puru- 
lent and  catarrhal  conjunctivitis.  It  is  also 
said  to  be  antagonistic  to  the  gonococeus.  and 
is  at  the  present  time  being  recommended  as  a 
useful  remedy  in  gonorrhoea.  It  does  not  stain 
the  hands,  linen,  or  clothing,  and  is  asserted 
to  show  its  antiseptic  properties  even  in  the 
presence  of  albuminous  fluids. 


[Silver  lactate. — Crede  (loc.  cit.)  says  that 
numerous  experiments  have  shown  that  silver 
forms  a  lactate  with  the  lactic  acid  produced 
in  the  metabolism  of  the  micro-organisms,  and 
that  this  compound  kills  them.  Therefore  it 
occurred  to  him  to  make  direct  use  of  silver 
lactate,  instead  of  silver  in  the  metallic  state, 
as  an  antiseptic.  This  preparation,  known  by 
the  trade  name  of  actol  or  ahtol,  he  thinks  ful- 
fills all  the  requirements  of  an  antiseptic  bet- 
ter than  any  other.  He  has  given  as  much  as 
15  grains  of  it  subcutaneously  without  the  least 
ill  effect ;  there  was  only  a  slight  burning  pain 
at  the  site  of  the  injection,  lasting  for  but  a 
few  minutes.  Silver  lactate,  he  says,  forms  no 
insoluble  compounds  with  the  alkaline  secre- 
tion of  a  wound  or  with  tissue  juice,  as,  for 
example,  corrosive  sublimate  does,  but  only 
soluble  ones,  which  gradually  permeate  the 
tissues  and  thus  extend  their  action  to  some 
distance  from  the  surface. 

In  a  subsequent  article  (Centralblatt  fUr 
Chirurgie,  October  24,  1896 :  JS'ew  York  Med- 
ical Journal,  November  21,  1886)  Crede  sums 
up  his  method  of  treating  wounds  as  follows  : 
Whether  they  are  to  be  closed  or  to  remain 
open,  he  covers  them  with  silver  gauze  and 
dusts  itrol  (silver  citrate)  over  any  punctures 
that  may  be  found.  This  gauze,  containing 
metallic  silver  in  a  state  of  the  very  finest  di- 
vision, he  says  is  absolutely  unirritating  and 
may  be  sterilized,  but  he  does  not  consider 
that  necessary.  It  becomes  antiseptic  as  soon 
as  morbific  germs  attack  the  wound,  for  the 
lactic  acid  which  the  germs  produce  unites 
with  the  silver  to  form  the  lactate.  He 
cleanses  the  wounds  with  soap  and  water  and 
a  brush,  applies  ether  to  the  surrounding 
parts,  and  rinses  the  whole  with  boiled  water. 
If  portions  of  tissue  are  almost  completely 
separated,  he  removes  them,  but  leaves  large 
undermined  flaps  alone,  also  all  fissures, 
opened  joints,  etc.,  and  powders  the  surface 
of  the  wound  lightly  with  itrol.  If  inflamma- 
tion has  already  set  in,  he  employs  a  water 
dressing  for  a  few  days  ;  if  not,  he  applies  the 
silver  gauze,  lays  cotton  over  it,  and  puts  the 
injnred  limb  at  rest  in  a  secure  attitude.  If 
the  dressing  becomes  partially  soiled  by  (he 
oozing  of  blood  and  serum,  he  seeks  to  pro- 
mote drying  by  putting  on  more  cotton,  more 
for  the  sake  of  appearances  than  for  anything 
else.  If  the  discharge  is  very  great,  he  renews 
the  upper  layers  of  the  dressing.  He  does  not 
dread  the  access  of  air  to  the  wound,  so  great 
is  his  trust  in  the  protection  afforded  against 
infection.  If  morbific  germs  have  been  forced 
into  the  recesses  of  the  wound,  they  can  not 
give  rise  to  anything  worse  than  an  abscess. 

For  gargles. mouth-washes, and  thelike, actol 
(silver  lactate)  or  itrol  (silver  citrate)  may  be  used 
in  the  proportion  of  1  to  4,000  or  from  that 
down  to  8,000,  although  stronger  solutions  do 
not  irritate.  These  silver  salts  stain  the  skin, 
but  the  stains  are  readily  removed  with  a  so- 
lution of  1  part  of  corrosive  sublimate  and  25 
parts  of  sodium  chloride  in  2,000  parts  of 
water.  In  surgical  infections,  actol  may  be 
used  subcutaneously.  In  erysipelas,  the 
amount  to  be  given  daily  ranges  from  7  to 


SfMULO 
SOAP 


198 


22  grains,  but  the  solution  should  not  be 
stronger  than  one  to  two  hundred,  otherwise 
coagula  of  albumin  will  form  and  stop  the 
remedy  from  getting  into  the  circulation. 

Silver  citrate  seems  to  be  quite  as  efficient 
an  antiseptic  as  the  lactate,  and  to  be  free  from 
some  minor  disadv-antages  attributed  by  Crede 
to  the  lactate.  The  citrate  has  the  trade  name 
of  itrol.  Crede  says  that  it  is  a  perfectly  harm- 
less antiseptic  and  an  excellent  dusting  pow- 
der for  wounds.  In  the  course  of  four  months 
he  has  treated  many  hundreds  of  wounds  with 
it,  and  with  never  the  least  untoward  effect. 

Dr.  Oscar  Werler  (Berliner  klinische  Wo- 
chenschrift,  1896,  No.  37 ;  New  York  Medical 
Journal,  October  3,  1896)  states  that  in  the 
course  of  about  six  weeks,  in  private  and  public 
practice,  he  has  used  silver  citrate  in  at  least  fifty 
cases  of  acute  or  chronic  gonorrhoea,  in  three 
of  gonorrhoeal  urethritis  in  women,  in  gonor- 
rhceal  inflammation  of  the  vulvo-vaginal  gland, 
and  in  a  few  cases  of  chronic  cystitis,  with 
very  favourable  results.  It  is  used  as  an  in- 
jection in  the  ordinary  way,  also  in  irrigations 
according  to  Diday's  method  and  by  a  modifi- 
cation of  Janet's  procedure  consisting  in  wash- 
ing the  entire  urethra  with  a  lukewarm  solution 
of  the  silver  salt  by  means  of  a  large  syringe. 
In  acute  gonorrhcea  he  prescribes  at  the  outset 
a  very  weak  solution,  one  of  1  to  8,000,  and 
gradually  increases  the  strength.  The  injec- 
tions may  be  used  four  times  a  day.  The  solu- 
tion should  be  kept  in  a  yellow  bottle.  It  is 
important  that  it  should  be  resorted  to  with- 
out loss  of  time,  before  the  gonococci  have 
penetrated  deep  into  the  mucous  membrane. 
Even  in  very  weak  solutions,  silver  citrate  is 
an  energetic  antiseptic,  disinfectant,  and  germi- 
cide. He  sums  up  as  follows :  Itrol  has  an 
intense  gonococcus-destroying  action;  it  is 
readily  borne  by  the  urethral  mucous  mem- 
brane, and  causes  no  noteworthy  irritation  or 
increase  of  the  inflammation;  its  action  is 
deep-reaching,  but  without  injury  to  the 
mucous  membrane;  it  therefore  meets  all  the 
re  juirements  of  an  efiicient  remedy  for  gonor- 
rhoea.]— Matthias  Lanokton  Foster. 

SIMULO.— This  is  the  fruit  of  a  species  of 
Capparis  (said  by  some  to  be  Capparis  cori- 
acea;  by  others,  Capparis  oleoides)  grovring  in 
Peru  and  Bolivia.  It  has  been  recommended 
as  a  remedy  for  epilepsy,  but  experience  has 
shown  that  it  exerts  only  a  palliative  effect  in- 
ferior to  that  of  the  bromides,  and  its  employ- 
ment is  now  practically  restricted  to  cases  in 
which  the  use  of  the  bromides  is  objectionable. 
The  dose  is  3  grains,  six  times  a  day,  in  the 
form  of  pills.  A  tincture  is  prepared,  and  of 
that  the  dose  is  from  1  to  4  fl.  drachms,  three 
times  a  day. 

SINAPIS,  SINAPISMS.— See  Mustard. 

SKULLCAP.— See  Scutellaria. 

SLAKED  LIME.— See  under  Calx  and 
Lime. 

SLIPPERY  ELM.— See  Ulmus. 

SMILACIN,  sarsaparillin,  salseparin,  pa- 
rillin,  or  pariglin.  is  a  glucoside  of  the  saponin 
group  obtained  from  Smilax  officinalis.    It 


crystallizes  in  fine  white  needles  which  are 
soluble  in  water  and  in  alcohol.  It  has  been 
supposed  to  be  the  active  principle  of  sarsapa- 
rilla,  but  Robert  has  found  it  inert. 

SMILASIN. — This  is  a  gummy  substance 
obtained  by  precipitating  a  tincture  oi  Smilax 
Sarsaparilla  with  water.  It  must  not  be  con- 
founded with  smilacin. 

SMILAX. — Several  species  of  this  genus, 
particularly  Smilax  officinalis,  yield  the  sarsa- 
parilla of  the  pharmacopoeias. 

SNAKEBOOT.— See  Serpbntaeia. 

SOAP  is  a  chemical  compound  lesulting 
from  the  union  of  fatty  acids,  such  as  stearic, 
palmitic,  margaric,  and  oleic  acids,  with  the 
alkalies  soda,  potash,  or  ammonia.  The  com- 
position of  soaps  is  analogous  to  that  of  the 
so-called  "  plasters,"  in  which  a  fatty  acid  is 
united  with  a  basic  metallic  oxide,  such  as 
lime,  magnesia,  lead,  or  zinc,  but  they  differ  in 
that,  while  true  soaps  are  soluble  in  water,  the 
plasters  are  insoluble.  It  was  formerly  sup- 
posed that  soap  was  simply  a  binary  compound 
of  fat  and,  alkali,  but  all  fats  and  fatty  oils  are 
mixtures  of  glycerides  with  some  fatty  acid. 
Thus,  under  favourable  conditions,  glycerin, 
C3Hb(OH)3,  and  palmitic  acid,  3(CjaH3iOa)H, 
become  palmitin,  C'aHslCieHaiOj)?!,  and  water 
3Ha0.  In  the  formation  of  a  soda  soap  the 
decomposition  is  as  follows: 

CsHjCCbHsiOJs  -I-      3Xa0H 

Palmitin.  Soda  hydrate. 

=  3NaCi,H3i02  -I-     C3Hs(0H)3 
Soap.  Glycerin. 

Soaps  are  characterized  by  greasiness  to  the 
touch,  an  alkaline  reaction,  and  an  acrid  taste. 
They  are  readily  soluble  in  water,  and  the  solu- 
tion, when  agitated,  forms  a  tenacious  froth  or 
"lather."  Dissolved  in  small  proportions  of  hot 
water,  they  form  homogeneous  slimes  which 
on  cooling  set  into  jellies  or  more  or  less  con- 
sistent pastes.  Among  thp  fatty  substances 
used  in  the  formation  of  soap  are  beef,  sheep, 
and  horse  fat,  lard,  marrow,  and  butter,  from 
the  animal  kingdom,  together  with  palm,  olive, 
castor,  and  cocoanut  oils  and  cacao  butter  from 
the  vegetable  kingdom. 

Drying  oils  yield  softer  soaps  than  non-dry- 
ing oils,  and,  of  the  latter,  those  that  contain 
a  large  proportion  of  olein  are  softer  and  more 
soluble  than  those  richer  in  stearin  or  palmi- 
tin. But  the  hardness  or  softness  of  the  soap 
depends  more  especially  on  the  alkali.  A  soda 
soap,  which  is  the  one  commonly  used  for  toi- 
lette purposes,  however  large  the  proportion  of 
oleic  acid,  is  always  '■  hard,"  while  the  potash 
soap  is  almost  invariably  soft,  even  though 
made  with  the  more  solid  fatty  acids.  They 
differ  also  in  their  behaviour  on  the  addition  of 
common  salt  to  their  solutions.  When  the  salt 
is  added  in  a  certain  proportion  to  a  solution 
of  soda  soap,  the  soap  is  at  once  precipitated, 
while  the  same  reagent  added  to  a  pota.«h  soap 
in  solution  causes  a  double  decomposition  with 
the  formation  of  a  soda  soap  plus  chloride  of 
potassium. 

Resin  is  a  common  ingredient  of  many  soaps. 
Its   complex    acids  (chiefly  abietic)  combine 


199 


SiMULO 
SOAP 


with  the  soda  or  potash,  though  it  is  not  by  a 
process  of  true  saponification.  It  occui'S  more 
particularly  in  the  so-called  "yellow"  soaps, 
which  sometimes  contain  resin  in  as  large  a 
proportion  as  40  per  cent,  or  more. 

In  the  manufacture,  both  of  soda  and  of  pot- 
ash soaps,  the  fatty  matters  are  first  melted 
and  the  lye  is  gradually  added  to  the  boiling 
mixture  till  it  becomes  clear,  when  that  mix- 
ture is  known  as  "  soapsize,"  and,  so  far  as  the 
potash  soap  is  concerned,  this  is  practically  the 
end  of  the  process.  But  to  make  the  "curd 
soap,"  "which  is  only  practicable  with  soda  lye, 
the  fluid  mixture  which  contains  an  excess  of 
alkali  and  glycerin  is  subjected  to  the  "  salting- 
out  "  process.  When  salt  or  brine  is  added, 
the  soap  collects  in  a  granular  condition  at  the 
top,  while  the  uncombined  lye  and  glycerin 
gradually  sink  to  the  bottom  and  are  drained 
off.  After  still  further  refining,  the  soap  is 
finally  exposed  in  wooden  frames,  when  it 
slowly  cools  and  solidifies. 

The  JlJarseilles,  or  Castile,  soap  is  made  from 
olive  oil  and  soda.  When  the  hot  solution  is 
allowed  to  cool  and  solidify  quickly,  the  im- 
purity and  colouring  matters  are  uniformly 
diiiused,  and  the  soap  is  afterward  white  or 
grayish  white.  But  it  the  process  of  cooling 
and  solidifying  is  prolonged,  a  segregation 
takes  place  of  the  stearate  and  palmitate,  on 
the  one  hand,  and  the  oleate,  on  the  other. 
The  latter  solidifying  more  slowly  than  the 
others,  tends  to  form  into  translucent  veins 
into  which  the  greater  part  of  the  colouring 
matter  is  drawn.  In  this  way  is  produced  the 
"  mottled  "  or  "  marbled  "  soap.  Formerly 
this  mottling  was  esteemed  as  a  guarantee  of 
freedom  from  excess  of  water  or  from  adulter- 
ation, but.  inasmuch  as  the  same  effect  can  be 
produced  by  artificially  working-in  colouring 
matters  while  the  soap  is  solidifying,  it  is  no 
longer  necessarily  an  evidence  of  purity. 

Marine  soap  is  made  from  soda  and  cocoa- 
nut  oil.  This  oil  is  peculiar  in  its  behaviour 
as  regards  saponification.  It  does  not  form 
emulsions  with  weak  alkalies,  as  other  oils  and 
fats  do,  even  when  subjected  to  long  boiling, 
but  with  strong  alkaline  solutions  it  saponifies 
very  readily,  even  without  heal,  and,  without 
the  separation  of  any  under-lye,  forms  a  soap 
of  very  hard  consistence,  though  containing  a 
large  proportion  of  water.  Moreover,  it  is  not 
insoluble  in  salt  solutions,  as  curd  soaps  are, 
and  therefore  forms  a  lather  with  sea  water, 
with  which  it  can  be  used  for  washing  pur- 
poses. 

Transparent  soaps  are  made  by  dissolving 
ordinary  soap  in  strong  alcohol  and  distilling 
ofi  the  greater  portion  of  the  alcohol  till  the 
residue  forms  a  thick,  translucent  jelly  which 
is  afterward  poured  into  moulds  and  allowed 
to  harden. 

The  perfuming  of  soap  is  effected  either  by 
some  cheap  perfume,  which  is  not  affected  by 
alkalies  or  heat,  being  stirred  into  the  soap  be- 
fore it  has  cooled,  or,  in  the  fine  soaps,  by  the 
cold  method,  which  consists  in  kneading  the 
essential  oil  into  the  solid  soap,  which  is  first 
shaved  down  into  thin  slices  and  afterward 
moulded  into  cakes  by  pressure. 


Glycerin  soap  is  made  by  combining  a  hard 
soap  with  glycerin  in  about  equal  parts  while 
the  soap  is  in  the  melted  state.  If  the  glycerin 
is  in  excess,  a  fluid  soap  results  which  usually 
has  feeble  lathering  qualities. 

Liquid  glycerin  soaps  made  from  potash, 
however,  yield  an  abundant,  tenacious  lather. 
That  made  by  Sarg,  of  Vienna,  was  especially 
commended  by  Hebra. 

Green  soap,  sapo  viridis,  sapo  mollis  (U.  S. 
Ph.,  Br.  Ph.),  sapo  kalinus  (Gr.  Ph.),  is  "  soft " 
soap  and  made  with  potash  and  fat  or  a  fatty 
oil.  The  common  commercial  variety  is  made 
from  fish  oil.  According  to  the  Ger.  Ph.,  lin- 
seed oil  is  used  ;  100  parts  of  this  are  gradu- 
ally added  to  135  parts  of  a  heated  solution  of 
potassa.  The  heat  is  continued  for  thirty 
minutes,  then  25  parts  of  alcohol  are  added, 
and  as  soon  as  the  mixture  has  become  uni- 
form, 200  parts  of  water  are  gradually  added 
and  the  mixture  is  heated  until  the  mass  be- 
comes translucent  and  will  dissolve  in  hot 
water  without  any  oil  separating.  It  is  then 
evaporated  to  150  parts.  A  potash-olive-oil 
soap,  used  largely  in  the  manufacture  of  silks, 
said  to  be  a  pure  preparation,  has  been  intro- 
duced as  a  medicinal  agent  by  Mr.  F.  Bagoe,  a 
New  York  pharmacist. 

Green  soap,  when  properly  prepared,  is  of  a 
greenish  or  brownish-yellow  colour,  of  uniform 
soft  unctuous  consistence,  free  from  granula- 
tion and  rancid  odour,  and  completely  soluble 
in  water  and  in  alcohol.  It  should  not  con- 
tain over  40  per  cent,  of  water,  but,  as  it  is 
hygroscopic,  a  larger  proportion  than  that  is 
usually  present.  A  tincture  of  green  soap,  the 
tpinius  saponains  kalinus  of  Hebra,  is  much 
used  in  medicine  ;  2  parts  of  the  soap  are  dis- 
solved in  1  part  of  alcohol  and,  alter  filter- 
ing, the  solution  is  perfumed  with  spirit  of 
lavender.     Unna's  formula  is  the  following  : 

Green  soap 100  parts  ; 

95-per  cent,  alcohol 150  parts  ; 

Oil  of  lavender \  part. 

This  tincture  forms  perfect  solutions  with 
chloroform,  oil  of  turpentine,  tar,  petroleum 
ether,  benzine,  and  ether,  in  equal  proportions, 
and  with  carbon  disnlphide  in  the  proportion 
of  5  to  1  at  ordinary  temperatures  or  of  5  to 
2  at  the  temperature  of  the  body. 

Medicinal  Soaps  and  their  Uses. — Both  hard 
and  soft  soaps  are  employed  medicinally.  For 
internal  use,  hard,  or  curd,  soap  is  employed  as 
a  menstruum  for  making  pills  or  as  a  solvent 
for  resinous  medicines  whose  action  it  assists 
somewhat  because  of  its  slightly  alkaline  and 
antacid  effect.  Soapsuds  are  a  convenient  and 
valuable  antidote  to  acid  poisons,  when 
promptly  and  freely  administered,  and  are  also 
useful  as  a  local  application  for  injuries  of  the 
surface  by  acids  or  by  phosphorus.  They  are 
much  used  too  in  laxative  enemata. 

But  it  is  in  its  external  applications  that 
soap  is  chiefly  useful  in  medicine.  Its  thera- 
peutic uses  in  the  treatment  of  the  skin  are 
manifold.  Because  ot  its  detergent  effect,  re- 
moving as  it  does  foul  secretions  and  impuri- 
ties that  often  harbour  parasites  and  noxious 
germs,  it  is  most  valuable  as  a  prophylactic 


SOAPBARK 
SODA  CAUSTICA 


200 


against  disease.  When  vigorously  applied  it 
has  a  stimulant  eflfeet  that  is  often  useful.  It 
shares  with  alkaline  remedies  generally  the 
property  of  modifying  and  allaying  catarrhal 
inflammation,  particularly  when  subacute  or 
chronic,  and  in  still  larger  degree  because  in 
the  employment  of  soap  the  alkali  is  carried 
to  the  deeper  portions  of  the  epidermis.  In 
some  forms  of  chronic  eczema,  besides  being 
aniicatarrhal,  it  is  decidedly  an  antienes- 
matic.  This  is  partly  due  to  the  keratolytic 
action  of  soap.  By  softening  down  and  remov- 
ing the  horny  or  scaly  covering  that  conceals 
the  vesicles,  it  enables  the  alkali  in  solution  to 
come  directly  in  contact  with  the  seat  of  dis- 
ease. This  "  keratolytic  effect  is  useful  in 
various  cutaneous  affections  associated  with 
excessive  accumulation  or  growths  of  the  cor- 
neous layer  of  the  epidermis,  such  as  ichthy- 
osis, lichen  planus,  psoriasis,  and  squamous 
eczema.  For  this  purpose  the  potash  or  green 
soap  is  preferable  to  the  soda  soaps.  The 
green  soap  is  often  added  to  ointments  for  sca- 
bies for  the  same  purpose.  Further  than  this, 
soap  has  considerable  germicide  power  which 
renders  it  useful  in  various  pai-asitic  diseases  of 
the  skin,  such  as  ringworm  and  chromophytosis, 
or  where  sohizomycetie  parasites  are  present. 
In  the  treatment  of  chronic  eczema,  which  is 
often  parasitic,  .soap  frictions  are  especially 
valuable.  Hebra's  method  of  treating  eczema 
rubrum  sen  squamosum  of  the  leg  by  thorough 
scrubbing  with  green  soap  is  still  esteemed  as 
one  of  the  very  best  for  this  form  of  disease. 

Inveterate  psoriasis  was  treated  by  Hebra 
with  green  soap  in  the  following  manner :  The 
entire  affected  surface  was  smeared  with  the 
soap,  which  was  allowed  to  remain  on,  and  the 
inunctions  were  repeated  twice  a  day  for  from 
six  to  eight  days,  during  which  time  the  pa- 
tient was  kept  in  bed  enveloped  in  woollen 
blankets.  Besides  the  general  applications 
once  a  day,  a  certain  section  of  the  diseased 
skin  was  treated  more  energetically,  the  part 
being  rubbed  with  the  soap  hard  enough  to 
cause  some  bleeding,  a  different  section  being 
treated  in  this  way  each  day  till  the  whole 
affected  surface  had  been  gone  over.  At  the 
end  of  this  course  of  treatment,  which  varied 
in,  duration  according  to  the  severity  of  the 
disease  as  well  as  the  tolerance  of  the  patient, 
the  skin  underwent  free  desquamation,  the 
epidermis  peeling  off  in  lamellar  scales,  dur- 
ing which  time  or  for  three  or  four  days  after 
stopping  the  inunctions  the  patient  was  kejit 
in  the  same  blankets  and  a  bath  was  not  per- 
mitted till  desquamation  was  nearly  accom- 
plished. When  the  disease  was  limited  to 
special  areas,  these  alone  were  subjected  to  the 
soap  inunctions  without  putting  the  patient  to 
bed,  or  else  the  soap  was  applied  as  a  salve. 
Diseases  due  to  filamentous  parasites  as  well  as 
some  forms  of  chronic  eczema  were  also  treated 
in  this  way.  For  the  hairy  scalp  the  tincture 
of  soap  is  better  suited. 

As  a  vehicle  for  the  external  application  of 
various  remedies  soap  is  coming  more  and  more 
into  use.  It  is  said  to  be  more  readily  ab- 
sorbed by  the  skin  than  either  water  or  fats  by 
themselves,  and  for  this  reason  should  be  a 


better  exoipient  for  drugs  administered  ender- 
mically.  Most  of  the  medicinal  soaps  sold  are 
not  sufficiently  under  medical  control,  and 
their  composition  is  for  the  most  part  uncer- 
tain and  unreliable;  while,  on  the  other  hand, 
the  technical  difficulties  in  the  manufacture 
of  soap  are  such  that  neither  the  physician  nor 
the  pharmacist,  as  a  rule,  is  competent  to  deal 
with  them. 

With  soft  soaps  the  difficulties  are  less  than 
with  hard  soaps.  Thus,  with  ordinary  green 
soap  many  substances  may  be  combined  in  an 
impromptu  prescription.  Oberlander  ( Viertel- 
jahrsch.  f.  Derm.  u.  Syph.,  1883)  recommended 
a  mercurial  soap  to  be  used  in  place  of  mer- 
curial ointment  for  inunctions.  It  consisted 
of  3  parts  of  green  soap  with  1  part  of  mer- 
cury, combined  with  a  small  quantity  of  glyc- 
erin and  perfumed  with  oil  of  lavender. 
Unna  (Monatsh.  f.  prakt.  Derm.,  1886),  under 
the  name  of  Salbenseife  (sapo  unguinosus).  has 
described  a  potash  soap  made  with  lard  instead 
of  oil,  to  which  5  per  cent,  of  lard  was  after- 
ward added  in  excess,  making  a  superfatted 
soap.  With  this  he  made  soaps  containing 
mercury,  iodide  of  potassium,  ichthyol,  and 
ichthyol  with  tar.  The  mercurial  soap  differs 
from  Oberlander's  chiefly  in  its  excess  of  fat ; 
1  part  of  mercury,  having  been  extinguished 
with  ^  part  of  official  mercurial  ointment,  was 
incorporated  with  3  parts  of  the  superfatted 
soap.  The  potassiuhi-iodide  soap  consisted  of 
9  parts  of  the  superfatted  soap  with  1  part  of 
potassium  iodide  and  a  little  water.  Ichthyol 
(sulphichthyolate  of  ammonium)  was  combined 
with  the  soap  in  the  ratio  of  from  -J  to  5  parts 
of  the  former  to  10  of  the  latter. 

Following  suggestions  of  Unna  (Ueber 
medizinische  Seifen,  Volkmann's  Sammlung 
klinischer  Yortrage,  No.  253),  Eichhoff  has 
succeeded  in  making  a  large  number  of  hard 
soaps  containing  many  of  the  remedies  com- 
monly used  in  dermatology,  and  they  are  now 
on  the  market.  The  formula  for"  the  soap 
which  is  the  basis  of  them  all  is  as  follows : 

Finest  beef  tallow 59-3  parts ; 

Olive  oil 7'4 

Soda  lye,      /   qoo  -d^ a   (  22-2 


Potash  lye, 


38°  Beaum^ 


111 
100 


(Dermatologische  Studien,  2.  Reihe,  1.  Heft, 
1889.) 

The  following  are  some  of  the  substances 
successfully  incorporated  with  this  soap  :  Res- 
orcin  (3  to  H  per  cent.),  salicylic  acid  (3  to  5 
per  cent.),  salol  (5  per  cent.),  ichthyol  (6  per 
cent.,  combined  usually  with  2  per  cent,  of 
salicylic  acid),  menthol  (.'5  per  cent.),  thymol 
(0-2  per  cent.,  called  children's  soap),  sulphur 
(5  per  cent.,  combined  with  5  per  cent,  of  cam- 
phor and  3  per  cent,  of  balsam  of  Peru),  pine- 
needle  oil  (10  per  cent.),  tar  (3  per  cent.,  with 
3  per  cent,  of  ichthyol),  aristol  (3  per  cent.), 
iodoform  (5  per  cent.),  creolin  (5  per  cent.),  and 
corrosive  sublimate  (i  to  1  per  cent.).  These 
soaps  all  contain  the  fatty  acids  in  exces." — 
i.  e.,  are  superfatted.  In  some  cases  it  has  been 
found  necessary  to  acidulate  the  soap,  as  in 
the  resorcin  soap,  to  prevent  decomposition  of 


201 


SOAPBARK 
SODA  CAUSTICA 


the  incorporated  drug.  For  this  purpose  sali- 
cylic acid  was  first  used.  It  has  since  been 
found,  however,  that  a  resorcin  soap  can  be 
made  vvitliout  the  salicylic  acid,  merely  by  ex- 
cess of  fatty  matter.  This  is  effected  by  adding 
to  the  original  formula  a  mixture  of  3  parts  of 
lanolin  and  3  parts  of  olive  oil  in  the  ratio  of 
5  per  cent,  to  the  whole  mass.  Indeed,  all  the 
soaps  are  now  made  with  this  modification. 
They  lather  well,  they  are  agreeable  to  the 
skin,  and  the  lanolin  is  supposed  to  increase 
their  absorbent  effect.  They  are  used  (1)  by 
simple  washing,  as  with  any  ordinary  soap,  the 
lather  being  rinsed  off  with  water,  (3)  by  rub- 
bing the  lather  well  in  with  fiannel  cloths  till 
the  part  is  dry,  (3)  by  allowing  the  lather  to 
dry  on  gradually,  or  (4)  by  retaining  it  in  a 
moist  condition  on  the  surface  by  means  of 
impermeable  dressings. 

Buzz!  (JJermatologische  Studien,  2.  Reihe,  6. 
Heft,  1891)  takes  exception  to  Bichhoff's  plan 
of  making  only  a  superfatted  soap,  on  the 
ground  that  thereby  the  keratolytic  action  of 
the  soap,  which  in  many  diseases  of  the  skin  is 
a  desideratum,  is  largely  sacrificed.  Moreover, 
he  maintains  that  the  soda  used  in  the  hard 
soap  is  often  apt  to  cause  decomposition  of  the 
incorporated  medicaments.  Thus,  in  the  case 
of  salicylic  acid,  if  it  combines  with  the  soda, 
as  it  is  apt  to  do,  it  becomes  inert,  and  though 
a  certain  portion  may  be  left  free  and  uncom- 
bined  in  the  soap,  as  soon  as  water  is  added 
the  liberated  soda  would  combine  with  this 
also.  Buzzi,  in  association  with  the  pharma- 
cist Keysser,  of  Hanover,  has  described  methods 
for  making  three  kinds  of  medicinal  soaps — 
viz.,  neutral,  alkaline,  and  superfatted — and 
each  of  these  is  made  both  in  the  form  of  a 
liquid  and  in  that  of  a  soft  soap.  To  obtain 
the  pure  fatty  acids,  a  soda  soap  is  first  made 
with  olive  oil.  Then  with  dilute  sulphuric 
acid  this  is  decomposed,  with  separation  of  the 
fatty  acids  as  a  white  flooculent  sediment.  The 
sediment  is  washed  with  distilled  water  until 
the  filtered  liquid  is  quite  neutral.  The  fatty 
acids  thus  obtained  are  next  treated  with  liquor 

Eotassa3,  and  by  the  addition  altern  tely  of  al- 
ali  and  fatty  acid  the  product  is  made  abso- 
lutely neutral.  To  prevent  thickening,  a  smoll 
quantity  of  pure  glycerin  is  added.  This  neu- 
tral fluid  soap  forms  the  basis  for  all  the  others. 
Prom  this  a  "  snft "  soap  is  made  by  evapora- 
tion over  the  water  bath  to  a  salve  consistence 
(sapo  unguinosus,  Keysser).  The  alkaline  fluid 
soap  is  made  by  adding  4  per  cent,  of  carbon- 
ate of  potassium  to  the  finid  neutral  soap. 
With  the  addition  of  oil  of  rose  it  makes  a 
good  toilet  soap,  useful  for  acne  or  where  scales 
or  crusts  are  to  be  removed.  When  the  car- 
bonate of  potassium  is  added  to  the  thickened 
soap  it  forms  the  soft,  alkaline  soap  (sapo  un- 
guinosus cum  alkali).  The  superfatted  fluid 
soap  contains  from  3  to  4  per  cent,  of  lanolin, 
and  the  superfatted  soft  soap  10  per  cent,  of 
lanolin  {sapo  unguinosus  cum  lanoUno).  These 
fundamental  soaps  are  combined  with  a  great 
number  of  medicaments,  a  fluid  or  soft,  neu- 
tral, alkaline,  or  superfatted  one  being  chosen 
as  the  base  according  to  the  special  indications. 
The  medicinal  ingredients  embrace  most  of 


those  contained  in  the  superfatted  soaps  of 
Eichhoff.  The  corrosive-sublimate  soap  is 
made  by  first  dissolving  1  part  each  of  sub- 
limate and  oleic  acid  in  3  parts  of  alcohol,  and 
mixing  this  solution  with  95  parts  of  the  neu- 
tral soap.  It  is  said  to  be  a  very  stable  prep- 
aration. A  marble  soap  is  made  by  adding  5 
parts  of  marble  in  very  fine  powder  to  95  parts 
of  the  alkaline  soap,  and  is  employed  as  a 
keratolytic  agent. 

[White  Castile  soap  is  official  as  sapo  (U.  S. 
Ph.)  and  sapo  durus  (Br.  Ph.);  soft  soap,  as 
sapo  mollis  (U.  S.  Ph.,  Br.  Ph.),  and  sapo  kali- 
nus  (Ger.  Ph.),  also,  in  the  crude  form,  as  sapo 
kalinus  venalis  (Ger.  Ph.).  The  medicinal 
soap,  sapo  medicatus.  of  the  Ger.  Ph.  is  a 
soda-lard-olive-oil  soap  containing  13  parts 
of  alcohol,  35  parts  of  common  salt,  and  3 
parts  of  crude  sodium  carbonate  in  540  parts 
of  the  soap.  The  spiritus  saponatus  of  the 
Ger.  Ph.  is  a  potash-olive-oil  soap  used  as 
a  stimulating  embrocation.  A  soap,  sapo 
animalis  (Br.  Ph.),  made  with  soda  and  a 
purified  animal  fat  consisting  principally  of 
stearin  enters  into  the  composition  of  the 
emplastrum  resinm,  emplastrum  saponis,  em- 
plastrum  saponis  fuscum,  extractum  colocyn- 
fhidis  composifum,  linimentum  potassii  iodidi 
cum  sapone,  pilula  phosphori,  pilula  scammo- 
nii  composita,  suppositoria  acidi  carlolici 
cum  sapone,  suppositoria  acidi  tannici  cum 
sapone,  smA  suppositoria  morpTiince  cum  sapone 
of  the  Br.  Ph.  The  compound  pill  of  soap, 
pilula  saponis  composita  (Br.  Ph.),  is  really  an 
opium  pill  in  which  opium  is  incorporated  with 
four  times  its  weight  of  powdered  hard  soap 
and  a  snflHciency  of  glycerin  ;  the  dose  is  from 
3  to  5  grains.  Soap  liniment,  or  opodeldoc,  in 
its  various  forms,  such  as  linimentum  saponis 
(U.  S.  Ph.,  Br.  Ph.),  spiritus  saponato-cam- 
phoratus  (Ger.  Ph.),  and  linimentum  saponato- 
camphoratum  (Ger.  Ph.),  is  a  mild  stimulating 
liniment.  The  liniment  of  soft  soap,  or  tinc- 
ture of  green  soap,  linimentum  saponis  mollis 
(U.  S.  Ph.),  is  employed  in  dermatology  for  the 
same  purposes  as  green  soap  itself.  Soap  plas- 
ter, emplastrum  saponis  (U,  S.  Ph.,  Br.  Ph.), 
emplastrum  saponatum  (Ger.  Ph.),  is  employed 
as  a  discutient.  Brown  soap  plaster,  emplas- 
trum saponis  fuscum  (Br.  Ph.),  is  really  a  cerate. 

Soapsuds  form  an  excellent  lubricant  for 
the  fingers  in  making  vaginal  and  rectal  ex- 
aminations, and  scraping  the  surface  of  a  wet 
piece  of  soap  with  the  nail  of  the  examining 
finger  until  the  space  beneath  the  free  border 
of  the  nail  is  filled  with  soap  is  a  ready  means 
of  preventing  the  lodgment  of  fscal  matter  in 
that  situation  in  rectal  examinations.  The 
use  of  a  soap  suppository  in  the  constipation 
of  infants  is  a  well-known  domestic  expedient, 
harmless  and  usually  efficient.] 

Edward  Bennet  Beonson. 

SOAPBARK.— See  Qhillaia. 

SOAPWORT.  —  See  Saponaria  and  Sap- 

ONINE. 

SOCAIiOIN.— See  under  Aloin. 

SODA  (U.  S.  Ph.),  SODA  CAUSTICA  (Br. 

Ph.),  caustic  soda,  sodium  hydrate,  or  hydrox- 
ide, is  little  used  save  for  the  preparation  of 


SODA  TARTARATA 

bODIUM  AND  MAGNESIUM  TARTRATE  203 


some  of  the  sodium  salts  and  as  a  caustic  when 
a  moderate  and  slow  action  is  desired.  Its  gen- 
eral effect  is  that  of  potassa.  Combined  with 
equal  parts  of  caustic  lime,  it  constitutes  "  Lon- 
don paste,"  a  preparation  resembling  "  Vienna 
paste,"  but  less  active,  and  not  giving  rise 
to  so  much  pain. 

Liquor  socles  (U.  S.  Ph.,  Br.  Ph.),  liquor  natn 
caustici  (Grer.  Ph.),  may  be  given  as  an  antacid 
in  doses  of  from  2  to  5  minims,  well  diluted 
with  water.— RassELL  H.  Nevins. 

SODA  TABTABATA  (Br.  Ph.).— See  Po- 
tassium and  sodium  tartrate,  under  Potassium 

TARTRATES. 

SODIO  -  THEOBBOMIITE  SALICYL- 
ATE.—This  double  salicylate  of  sodium  and 
theobromine  was  proposed  by  Gram  in  1890  as 
a  means  by  which  the  diuretic  action  of  theo- 
bromine could  be  obtained  without  its  unde- 
sirable effects,  and  it  was  introduced  as  a 
proprietary  medicine  under  the  name  of  diur 
retin. 

Authorities  differ  in  opinion  in  regard  to 
whether  it  is  a  definite  compound  or  simply  a 
mixture  of  sodium,  theobromine,  and  salicylic 
acid.  According  to  the  National  Dispensatory, 
it  is  "  obtained  by  mixing  aqueous  solutions  of 
equal  molecules  of  sodium,  theobromine,  and 
salicylic  acid  and  evaporating  to  dryness;  a 
definite  compound  appears  to  be  formed  con- 
taining theoretically  49-7  per  cent,  of  theo- 
bromine and  38'1  per  cent,  of  salicylic  acid. 
It  occurs  as  a  white  powder,  odourless,  of  a 
saline,  alkaline  taste,  and  soluble  in  one  half 
its  weight  of  warm  water,  the  solution  re- 
maining perfect  on  cooling.  It  should  be  pre- 
served in  well-stoppered  bottles,  as  it  is  readily 
affected  by  the  air,  theobromine  separating 
by  action  of  carbon  dioxide." 

The  physiological  action  of  sodio-theobro- 
raine  salicylate  is  not  yet  thoroughly  under- 
stood, and  only  an  approximate  idea  can  be 
obtained  from  a  collation  of  the  opinions  of 
recent  writers  on  the  subject,  opinions  which 
do  not  all  agree.  When  the  body  is  in  a 
healthy  condition  this  drug  will  produce  little 
or  no  diuretic  effect,  but  in  certain  conditions 
of  disease  associated  with  dropsy  it  causes  very 
pronounced  diuresis. 

From  the  reports  of  the  experiments  of  Sa- 
bashnikoff  and  Cohnstein  we  learn  that,  when 
given  to  the  lower  animals,  this  drug  certainly 
does  not  raise  the  arterial  blood-pressure,  but 
rather  tends  to  lower  it,  that  the  respiration  is 
quickened,  that  large  doses  at  first  slow  the 
heart,  then  make  it  rapid  and  finally  irregular, 
and  that  death  occurs  from  simultaneous  ar- 
rest of  the  respiration  and  the  heart  in  diastole. 
Both  observers  believe  that  it  acts  as  a  di- 
rect stimulant  on  the  renal  epithelium.  Ac- 
cording to  Sabashnikoff,  the  temperature  was 
invariably  raised,  unless  the  administration  of 
the  drug  was  preceded  by  a  high  division  of 
the  spinal  cord,  which  would  indicate  that  the 
drug  exercises  a  stimulating  influence  on  the 
cerebral  thermic  centres.  The  same  observer 
noted  that  the  drug  acted  as  a  sialagogue. 

In  those  diseased  conditions  in  which  sodio- 
theobromine  salicylate  has  an  efficient  action  it 


is  noticeable  that  it  strengthens  a  weak  heart 
and  corrects  arrhythmia.  Clmical  observers 
disagree  as  to  whether  this  effect  is  due  to  a 
direct  action  on  the  heart  or  not,  and  quite  a 
large  proportion  of  them  consider  that  it  is 
produced  secondarily  by  the  increase  of  diu- 
resis, the  diminution  of  the  oedema,  and  the 
consequent  removal  of  obstacles  to  be  over- 
come by  the  heart.  In  view  of  the  results  of 
the  experiments  on  the  lower  animals  just 
referred  to,  it  is  probable  that  the  heart  is  pri- 
marily slightly  stimulated  by  the  drug,  but 
that  the  greater  part  of  the  stimulant  effect  is 
secondary  in  its  nature. 

The  effect  of  sodio-theobromine  salicylate 
upon  the  arterial  blood-pressure  is  at  most 
very  slight.  Pawinski  considers  that  it  in- 
creases the  blood-pressure  by  exciting  the  vaso- 
motor centres,  but  other  observers  do  not  agree 
with  him,  and  he  is  probably  mistaken. 

Occasionally  a  rise  of  temperature  is  noticed 
after  the  administration  of  this  drug,  but  this 
is  by  no  means  constant,  and  when  it  occurs  it 
may  possibly  be  due  to  nervous  initation. 

Upon  the  gastro-intestinal  tract  it  is  apt  to 
act  as  an  irritant,  and  as  such  may  produce  re- 
sults which  vary  from  simple  loss  of  appetite 
to  severe  vomiting  and  diarrhoea.  One  writer 
says  that  it  may  increase  the  appetite. 

Upon  the  kidneys  sodio-theobromine  sali- 
cylate seems  to  act  powerfully,  in  a  non-irri- 
tating manner,  to  increase  both  the  solid  and 
the  watery  constituents  of  the  urine  in  the 
diseases  iii  which  it  is  indicated,  but  whether 
its  action  is  upon  the  excretory  epithelium  or 
upon  the  parenchyma  is  not  yet  decided.  Prob- 
ably it  is  directly  on  the  epithelium.  The 
diuretic  effect  begins  usually  within  twenty- 
four  hours,  and  reaches  its  maximum  from  the 
third  to  the  fifth  day.  The  daily  quantity  of 
urine  excreted  increases  threefold  or  fourfold, 
and  sometimes  to  an  excessive  degree — ten  or 
twelve  quarts  of  urine  passed  in  twenty-four 
hours  have  been  reported  as  resulting  from 
the  employment  of  this  drug.  Exudations  of 
a  non-inflammatory  character  are  then  readily 
absorbed,  and  the  diuresis  lessens  as  the  oedema 
disappears.  This  diuretic  effect  certainly  can 
not  be  obtained  if  the  excretory  epithelium  is 
degenerated. 

Certain  annoying  nervous  symptoms,  such 
as  headache,  vertigo,  tinnitus  aurium,  palpi- 
tation of  the  heart,  and  somnolence  or  insom- 
nia sometimes  result  from  its  use,  and  in  rare 
instances  it  causes  a  cutaneous  eruption.  No 
cumulative  action  has  been  observed. 

The  therapeutic  power  of  sodio-theobromine 
salicylate  seems  to  be  almost  limited  to  cases 
of  dropsical  effusion  dependent  on  disease  of 
the  renal  or  circulatory  apparatus.  In  addi- 
tion it  is  useful  in  some  ca.'^es  of  serous  effusion 
resulting  from  inflammation  of  serous  mem- 
branes. After  digitalis,  strophanthus,  caffeine, 
and  calomel  have  failed  to  reduce  dropsy  of 
cardiac  origin,  sodio-theobromine  salicylate 
will  frequently  succeed.  It  seems  to  be  of 
equal  efficacy  in  all  forms  of  valvular  disease, 
aortic  as  well  as  mitral,  to  promote  diuresis 
and  absorption  of  dropsical  effusions  and  to 
strengthen  and  regulate  the  cardiac  action. 


SODIUM  TARTARATA 
203  SODIUM  AND  MAGNESIUM  TARTRATE 


Here  is  to  be  noted  the  diflerenoe  between  its 
action  and  that  of  such  a  direct  cardiac  stimu- 
lant as  digitalis,  which  is  almost  always  contra- 
indicated  in  aortic  disease.  In  cases  of  dropsy 
due  to  mitral  insufficiency  digitalis  should  be 
used  to  promote  compensation,  and  then,  if 
sodio-theobromine  salicylate  is  employed  in 
addition,  the  removal  of  the  ascitic  fluid  is  ac- 
celerated. But  it  is  not  only  in  cardiac  weak- 
ness due  to  valvular  disease  that  this  drug 
shows  its  power.  In  dropsy  dependent  on 
disease  of  the  heart  muscle  itself  it  seems  to  be 
equally  efficient.  Some  observers  say  it  is  more 
efficient  in  myocarditis ;  others,  that  its  best 
results  are  obtained  in  valvular  heart  disease. 
Still,  though  it  usually  acts  so  powerfully,  it 
must  be  admitted  that  it  does  not  always 
diminish  anasarca  of  cardiac  origin.  Whether 
this  may  be  due  to  individual  idiosyncrasy,  or 
to  changes  in  the  renal  epithelium,  or  to 
something  else,  has  not  yet  been  determined. 

In  other  diseases  of  the  general  circulatory 
system  accompanied  by  ascites,  such  a.s  peri- 
carditis, aneurysm,  and  arteriosclerosis,  excel- 
lent results  are  sometimes  to  be  obtained,  but 
the  action  is  uncertain. 

In  ascites  of  renal  origin  the  drug  is  fre- 
quently of  great  benefit.  When  interstitial 
nephritis  has  resulted  in  cardiac  trouble  and 
general  di'opsy  this  drug  is  perhaps  more  effi- 
cacious than  any  other.  Regarding  its  value 
in  acute  nephritis  opinions  differ.  Some  rec- 
ommend it  highly,  others  advise  against  its 
use.  It  seems  to  be  valuable  for  the  purpose  of 
removing  excessive  dropsy  in  the  acute  nephri- 
tis of  scarlatina  after  the  first  acute  stage, 
particularly  in  childhood.  In  chronic  nephri- 
tis, unless  the  epithelium  has  undergone  de- 
generative changes,  it  is  usually  beneficial.  In 
renal  troubles  due  to  arteriosclerosis  and  com- 
plicated by  heart  disease  Masius  did  not  obtain 
any  marked  diuretic  effect  with  it,  but  noted 
that  the  amount  of  albumin  excreted  during 
twenty-four  hours  was  lessened. 

To  remove  pleuritic  effusions  or  other  in- 
flammatory local  accumulations  of  serum  this 
drug  is  at  times  ujse^il,  but  i^'lless  reliable  than 
in  anasarca  from  circulatory  or  renal  disease. 

In  cirrhosis  of  the  liver  and  obstruction  of 
the  portal  circulation  from  any  cause  it  is  use- 
less for  the  purpose  of  reducing  the  ascites, 
though  it  sometimes  increases  the  daily  quan- 
tity of  urine.  It  is  o£  no  value  in  dropsy  de- 
pendent on  tuberculous  inflammation.  ' 

A  suggestion  once  made  that  sodio-theobro- 
mine salicylate  might  avert  urethral  fever  has 
been  negatived  by  the  same  writer. 

Sodio-theobromine  salicylate  is  not  official. 
The  ordinary  dose  for  an  adult  is  from  10  to  30 
grains,  frequently  repeated.  From  1  to  3 
drachms  may  be  given  in  twenty-four  hours. 
If  diuresis  is  not  increased  within  six  days  its 
use  should  be  stopped  and  other  treatment  em- 
ployed. In  cardiac  disease  it  is  well  to  alter- 
nate it  with  cardiac  tonics. 

Acids  and  acid  vegetable  juices  are  chemic- 
ally incompatible  with  it.  It  should  never  be 
prescribed  in  powders,  on  account  of  the  change 
which  results  from  exposure  to  the  air,  or  in 
syrups,  or  in  combination  with  other  drugs, 
57 


because  of  its  great  tendency  to  decomposition. 
It  is  best  given  in  plain  or  aromatic  water,  but 
when  the  disagreeable  taste  causes  serious  ob- 
jection it  may  be  given  in  pills  or  capsules. 
Hypodermic  injections  of  it  are  said  by  one 
writer  to  be  always  followed  by  local  abscesses. 

When  prescribing  this  drug  it  is  sometimes 
well  to  remember  that  if  it  is  sold  under  its 
chemical  name  of  sodio-theobromine  salicylate 
it  costs  much  less  than  under  its  proprietary 
name  of  diuretin. 

[Sir  Benjamin  Ward  Richardson  (Hospital, 
March  3,  1894)  reports  a  case  of  renal  dropsy 
in  which  sodio-theobromine  salicylate  failed  to 
keep  up  free  diuresis  and  induced  systemic 
symptoms  like  those  that  are  apt  to  follow  the 
administration  of  sodium  salicylate  or  salicylic 
acid,  but  without  the  deafness  or  noises  in  the 
head  occasionally  consequent  on  the  action  of 
those  drugs  when  it  is  carried  to  a  toxic  de- 
gree. That  the  action  was  not  cumulative,  he 
says,  was  shown  by  the  fact  that  the  symp- 
toms quickly  ceased  when  the  use  of  the  drug 
was  discontinued. 

The  Squibbs  {Ephemeris,  etc.,  1895)  cite  Dr. 
B.  Main's  reminder  that  sodio-theobromine 
salicylate  should  not  be  administered  to  chil- 
dren less  than  eighteen  months  old,  because  in 
young  infants  it  is  prone  to  produce  digestive 
disturbances  and  gastro-intestinal  irritation. 

Dr.  Louis  Vintras,  of  the  French  Hospital  in 
London  (Lancet,  April  25,  1896),  remarks  that 
in  considering  the  value  of  a  therapeutical 
agent  of  this  kind  it  is  not  the  ultimate  termi- 
nation of  the  case  which  should  form  the  basis 
of  judgment,  but  its  effect  on  an  individual 
symptom.  Sodio-theobromine  salicylate,  he 
says,  can  not  be  a  specific  in  any  disease,  and  its 
action  can  be  exerted  only  for  the  relief  of  a 
distressing  complication.  Reviewing  the  re- 
sults of  its  use  in  some  cases  reported  in  his 
article,  he  says  it  appears  that  when  the  kidney 
affection  is  primary  and  well  established^ — that 
is,  when  the  deep  parts  of  the  organ  are  af- 
fected, as  in  the  parenchymatous  form  of  acute 
nephritis — and  when  there  is  much  albumin  in 
the  urine,  diuretin  is  of  little  or  no  value,  while 
in  cases  in  which  the  kidney  trouble  is  second- 
ary to  morbid  lesions  in  other  organs,  and  the 
epithelial  layer  of  the  urinary  tubules  is  the 
seat  of  disease,  this  diuretic  is  a  valuable  thera- 
peutical agent.]— Matthias  Lanckton  Foster. 

SODIUM  ACETATE,  sodii  acetas  (U.  S. 
Ph.),  natrium  aceticum  (Ger.  Ph.),  is  sometimes 
substituted  for  potassium  acetate  as  a  diuretic, 
but  it  is  less  eligible  in  rheumatic  and  gouty 
affections,  as  its  action  in  increasing  the  alka- 
linity of  the  fluids  is  much  feebler.  It  may  be 
given  in  doses  of  from  20  to  60  grains. — Rus- 
sell H.  Nevins. 

SODIUM  AND  CAFFEINE  SULPHO- 
NATE. — See  Stmphorol. 

SODIUM  AND  MAGNESIUM  BOBO- 
CITBATE. — This  compound  has  been  used  to 
some  extent  as  a  remedy  for  urinary  lithiasis, 
in  doses  of  from  5  to  30  grains. 

SODIUM  AND  MAGNESIUM  TAR- 
TRATE may  be  used  as  a  cathartic  in  doses 
of  from  2  to  4  drachms. 


SODIUM   ARSENATE 
SODIUM  BICAKBONATE 


204 


SODIUM  ARSENATE,  SODIUM  AR- 
SENIATE,  sodii  arsenas  (U.  S.  Ph.),  sodii 
arsenias  (Br.  Ph.),  is  used  in  medicine  in  the 
form  of  Pearson's  solution  (see  under  Arsenic, 
vol.  i,  page  146). 

SODIUM  AUaOCHLOmDE.— Chloride 
of  gold  and  sodium  (see  under  Gold). 

SODIUM  BENZOATE,  sodii  benzoas(U.S. 
Ph.),  has  been  employed  in  lithcBmia  andrheuma- 
tism  for  the  purpose  of  freeing  the  system  of  uric 
acid,  but  it  is  hardly  so  efficient  as  the  more 
commonly  employed  remedies.  As  much  as  2 
drachms  may  be  administered  during  twenty- 
four  hours,  but  the  size  of  each  single  dose 
should  not  exceed  15  or  20  grains. 

The  borobenzoate  is  a  somewhat  similar 
preparation.  It  may  be  given  in  doses  of  from 
10  to  15  grains. — Russell  H.  Nev[XS. 

SODIUM  BIBOBATE.— See  Borax. 

SODIUM  BICARBONATE,  sodii  biear- 
bonas  (U.  S.  Ph.,  Br.  Ph.).  natrium  bicarboni- 
cum  (Ger.  Ph.),  the  "  baking  soda "  of  the 
household,  is  more  freely  used  to  correct  acid- 
ity of  the  stomach  than  any  other  alkaline  salt, 
on  account  of  its  non-irritating  properties 
and  its  relative  freedom  from  disagreeable 
taste  (cf.  Alkalies).  It  is  also  useful  in  the 
acid  diarrhoea  of  childreii ;  from  10  to  20 
grains,  given  three  times  a  day,  will  often  de- 
crease the  amount  of  sugar  in  the  urine  in  dia- 
betes ;  and  saturated  solutions  relieve  the  pain 
and  irritation  of  superficial  burns,  and  also 
allay  the  irritation  set  up  by  the  stings  of  bees, 
wasps,  etc.  When  it  is  taken  in  drachm  doses 
and  followed  by  an  equal  bulk  of  tartaric  acid, 
effervescence  takes  place  in  the  stomach,  and 
expulsion  of  its  contents  rapidly  follows.  In 
intestinal  intussusception  the  two  substances 
have  been  injected  separately  into  the  large  in- 
testine for  the  purpose  of  correcting  the  invag- 
ination by  the  pressure  of  the  gas  evolved.  The 
usual  dose  is  from  10  to  20  grains. 

[Dr.  Or.  Linossier  (Jour,  des  praticiens,  April 
11,  1896;  JVew  York  Ifedical  Journal,  May  2, 
1896)  says  that  sodium  bicarbonate  is  servicea- 
ble in  deficiency  of  hydrochloric  acid  in  the 
gastric  Juice  only  when  this  affection  is  not  due 
to  a  profound  alteration  in  the  glands.  The 
essential  condition  of  its  action  is  that  the  mu- 
cous membrane  should  be  still  excitable.  The 
amount  of  the  dose  also  is  very  important;  a 
very  small  dose  produces  an  insufficient  exci- 
tation, and  with  too  large  a  dose  the  excitation 
produced  is  only  enough  to  neutralize  the  alka- 
linity provoked  by  the  ingestion  of  the  medi- 
cament. A  medium  dose  .should  be  employed, 
so  that  after  a  slight  alkalinity  the  gastric 
contents  may  acquire  an  acidity  greater  than 
that  usually  present.  It  is  impossible,  he  says, 
to  give  an  idea  in  figures  of  small,  medium,  or 
large  doses,  for,  in  reality,  the  amount  can  not 
be  absolutely  determined ;  it  is  relative  only 
to  the  gastric  condition  ascertained.  He  ex- 
plains the  relation  between  the  gastric  acidity 
and  the  proper  dose  by  saying  that  the  sensi- 
tiveness to  the  action  of  this  drug  is  in  inverse 
ratio  to  the  richness  of  the  gastric  secretion  in 
hydrochloric  acid.  The  doses  should  be  re- 
duced in  proportion  as  the  deficiency  of  the 


acid  becomes  more  marked.  If  it  is  very  in- 
tense, not  more  than  8  grains  should  be  given. 
If  the  deficiency  is  moderate,  the  dose  may  be 
increased  to  15,  SO,  or  even  45  grains.  He 
thinks,  however,  that  there  are  some  incon- 
veniences in  regard  to  the  remote  action  of  the 
drug  if  patients  suffering  with  this  affection 
are  subjected  to  the  habitual  use  of  large 
doses,  and  that  it  is  better  to  employ  doses  not 
exceeding  30  grains. 

It  is  better  to  give  it  before  meals,  so  that 
alkaline  saturation  may  take  place  before  the 
food  enters  the  stomactf,  when  it  comes  imme- 
diately in  contact  with  the  mucous  membrane 
which  is  in  a  complete  condition  of  secretory 
excitation.  The  larger  the  dose  the  longer 
should  the  interval  be  before  eating ;  a  quarter 
of  an  hour  is  sufficient  tor  a  dose  of  8  grains, 
but  an  hour  is  necessary  for  large  doses.  It 
is  difficult,  says  M.  Linossier,  to  lay  down  ab- 
solute rules  in  this  respect,  but  we  may  be 
guided  by  the  subjective  symptoms.  The  in- 
gestion of  this  drug  by  dyspeptic  patients 
when  fasting  is  followed  by  a  feeling  of  satiety 
analogous  to  that  caused  by  a  very  light  meal ; 
this  sensation  gives  place  subsequently  to  a 
feeling  of  hunger.  If  the  ingestion  of  food  is 
deferred,  and  the  excited  mucous  membrane 
continues  to  secrete,  the  patient  experiences  a 
sensation  of  tearing  which  occasionally  pro- 
duces pain.  These  symptoms  are  not  always 
very  distinct,  but  when  they  are  present  they 
are  an  excellent  guide.  Sodium  bicarbonate 
should  be  given  at  such  a  time  that  the  hour  for 
the  meal  shall  coincide  with  the  feelingof  hun- 
ger. The  employment  of  this  drug  should  not  be 
too  prolonged ;  a  period  of  from  two  to  three 
weeks  with  intervals  of  rest  is  sufficient. 
This,  says  M.  Linossier.  is  the  surest  means  of 
obtaining  a  remote  exciting  action,  .and  there 
is  no  danger  of  giving  rise  to  depression. 

In  cases  of  excess  of  hydrochloric  acid,  he 
says,  the  alkaline  action  of  the  drug  may  sup- 
press the  cause  of  the  pain  and  uneasiness, 
which  are  due  to  the  contact  of  the  raucous 
membrane  with  a  veiy  acid  liquid.  It  may  be 
doubted,  he  says,  whether  the  exciting  physio- 
logical action  is  not  too  much  for  a  stomach 
already  greatly  excited  ;  this  action,  however, 
is  not  a  contra-indieation  to  the  use  of  the 
drug,  provided  it  is  administered  in  such  a  way 
as  to  prevent  any  ill  effects.  For  this,  it  is  suffi- 
cient to  give  the  sodium  in  divided  doses  dur- 
ing the  course  ol  digestion,  each  dose  being 
too  small  to  cause  complete  saturation  of  the 
gastric  contents;  there  is  then  no  violent  exci- 
tation. The  ingestion  of  each  dose,  moreover, 
destroys  the  effect  of  the  preceding  one, in  sat- 
urating the  acid  which  is  secreted  anew.  The 
doses  may  vary  from  15  to  30  grains,  accord- 
ing to  the  intensity  of  the  excess  of  acid.  The 
first  dose  should  be  given  before  the  probable 
appearance  of  the  pain ;  this  is  easy  to  deter- 
mine, as  the  majority  of  patients  are  attacked 
at  an  invariable  time  before  eating.  The  suc- 
ceeding doses  may  be  given  every  hour  or,  if 
necessary,  every  half  hour  until  digestion  is 
finished.  M.  Linossier  urges  the  necessity  of 
prescribing  the  drug  before  the  appearance  of 
the  pain,  as  it  is  generally  easier  to  prevent  it 


205 


SODIUM   ARSENATE 
SODIUM  BICAKBUNATK 


than  it  is  to  allay  it  when  it  has  become  estab- 
lished. 

The  tolerance  displayed  by  the  organism  for 
this  drug  is,  says  the  author,  remarkable,  and 
the  inconveniences  of  large  doses  are  few  as 
compared  to  their  advantages.  The  following 
prescription  is  often  made  use  of  by  M.  Linos- 
sier 

IJ  Sodium  bicarbonate 300  grains  ; 

Calcined  magnesia 75      " 

Bismuth  subnitrate 30     " 

M. 

This  quantity  may  be  divided  into  twelve 
or  twenty-flve  capsules,  according  to  the  in- 
tensity of  the  acidity,  and  the  proportion  of 
magnesia  and  that  of  bismuth  subnitrate  may 
be  varied  in  accordance  with  the  intestinal 
functions. 

The  remote  action  of  sodium  bicarbonate, 
says  M.  Linossier,  is  shown  by  the  excitation 
and  afterward  by  the  depression  of  the  secre- 
tion. Tiie  period  of  excitation  is  very  distinct 
in  many  patients  treated  with  this  drug,  and 
after  a  few  days  the  original  doses,  which  suf- 
ficed to  allay  the  pain,  become  too  weak  to 
saturate  the  overacidity.  and  they  must  be  in- 
creased gradually.  The  depression  is  theoret- 
ically the  result  of  an  intense  and  prolonged 
treatment,  and  it  occurs  in  patients  in  whom  ex- 
cessive acidity  is  not  very  marked.  After  a  cer- 
tain time  the  dose  may  be  diminished  by  degrees 
and  finally  suppressed.  In  severe  acidity,  es- 
pecially if  it  is  accompanied  by  oversecretion, 
the  sensitiveness  to  the  action  of  this  drug  is 
greatly  diminished,  and  frequently  only  apallia- 
tive  effect  is  obtained. 

As  regards  the  use  of  large  doses  of  sodium 
bicarbonate,  at  a  recent  meeting  of  the  Na- 
tional Society  of  Medicine  of  Lyons  {Lyon 
medical,  June  88,  1896)  M.  Tournier  related 
the  case  of  a  woman  who  suffered  from  an  ex- 
cess of  hydrochloric  acid  in  the  gastric  juice. 
She  had  been  treated  with  instillations  of  sil- 
ver nitrate  and  with  nutritive  enemata,  but 
without  beneficial  results.  A  course  of  sodium 
bicarbonate  was  then  prescribed  and  begun 
with  amounts  of  from  180  to  325  grains  a  day. 
No  relief  having  been  obtained,  the  quantity 
was  increased  to  375  grains,  but  this  amount 
also  proved  insufficient,  and  no  real  relief  was 
felt  until  she  reached  the  amount  of  750  grains 
a  day.  Even  this  was  increased,  and  without 
M.  Tourniers  knowledge  the  patient  took,  dur- 
ing a  period  of  a  month,  from  3  to  2|  oz.  a  day 
in  doses  of  45  grains  every  fifteen  minutes,  in 
milk.  During  this  time,  said  M.  Tournier, 
there  had  been  no  disturbance  of  any  kind 
and  no  ana?mia,  and  her  weight  had  increased 
three  kilogrammes.  The  urine  was  abundant 
and  presented  a  feeble  alkaline  reaction.  The 
intestinal  functions  were  normal. 

JI.  Lcpine  thought  that,  in  order  to  tolerate 
such  large  doses  of  sodium  bicarbonate,  there 
must  be  a  special  receptivity,  a  pathological 
condition  with  exaggerated  acidity  which 
should  neutralize  a  part  of  the  sodium.  Large 
doses  were  incompatible  with  a  normal  condi- 
tion, and  it  would  be  dangerous  to  give  them 
to  a  healthy  person. 


In  the  Medical  Record  for  January  18, 1896, 
Dr.  L.  Duncan  Bulkley  gives  his  experience 
in  the  treatment  of  coryza  with  sodium  bicar- 
bonate. He  says  he  has  used  the  drug  for  this 
purpose  for  over  two  years  among  his  patients, 
in  his  family,  and  among  his  friends  and  ac- 
quaintances, and  is  well  satisfied  of  its  value. 

Recognising  that  all  individuals  are  not 
equally  "subject  to  colds,"  and  also  that  the 
same  individual  may  exhibit  a  stronger  tend- 
ency to  them  at  one  time  than  at  another,  he 
had  long  felt  that  the  susceptibility  to  this 
affection  depended  upon  some  state  or  condi- 
tion of  the  system,  commonly  present  or  occa- 
sionally developed.  Observation  had  convinced' 
him  also  that  while  it  was  not  persons  with  a 
marked  gouty  diathesis  or  in  an  active  gouty 
state  that  were  mainly  subject  to  colds,  these 
latter  were  more  frequently  seen  in  those  suf- 
fering with  minor  forms  of  acidity,  and  in 
those  in  whom  it  had  developed  quickly.  It 
therefore  occurred  to  him  that  the  slight  relief 
he  had  experienced  from  a  cold  had  been  the 
result  of  his  having  taken  sodium  bicarbonate 
to  neutralize  acidity  of  the  stomach. 

He  thinks  it  important  that  the  remedy 
should  be  taken  just  right,  and  a  definite  plan 
carried  out  thoroughly,  for  he  has  never  seen 
any  effective  results  from  a  desultory  use  of  it. 
For  an  adult  of  medium  size  and  weight,  from 
30  to  30  grains  of  the  bicarbonate  are  given  in 
3  or  3  ounces  of  water,  every  half  hour,  for 
three  doses,  and  a  fourth  dose  is  given  at  the 
expiration  of  an  hour  from  the  last  one.  From 
two  to  four  hours  are  then  allowed  to  elapse,  to 
see  the  effect,  and  the  four  doses  are  repeated 
if  it  seems  to  be  necessary,  as  is  frequently 
the  case.  After  from  two  to  four  hours  more, 
the  same  course  may  be  taken  again,  although 
this  is  not  often  necessary,  if  the  treatment  has 
been  begun  early  in  the  course  of  the  cold. 
He  has  known  the  doses  to  be  repeated  four 
times,  with  final  good  result. 

The  me1;hod  is  applicable  more  especially  to 
the  early  stage  of  a  cold.  To  be  promptly 
effective,  it  should  be  begun  with  the  earliest 
indications  of  coryza  and  sneezing,  and  his 
experience  has  rarely  failed  to  break  it  up, 
even  in  persons  much  inclined  to  colds.  After 
the  second  or  third  day  it  acts  less  promptly, 
and  more  frequent  repetitions  are  needed,  but 
he  has  seen  very  good  results  even  much  later 
in  the  trouble. 

In  influenza  it  is  less  efficacious,  but  is  often 
of  service.  In  these  cases  Dr.  Bulkley  pre- 
scribes from  5  to  10  grains  of  phenacetine,  with 
from  10  to  20  grains  of  sodium  bicarbonate, 
and  directs  the  powders  to  be  taken  with  hot 
water,  every  two  hours,  continuously  for  a 
day  or  two.  He  has  had  a  large  number  of 
very  striking  instances  of  the  benefit  of  this 
plan  of  treatment ;  in  some  cases  it  was  be- 
gun several  days  after  the  onset  of  the  dis- 
ease, and  in  one  instance  after  it  had  lasted 
about  four  weeks.  In  the  latter  case  the 
almost  immediate  relief  to  many  distressing 
symptoms — headache,  cough,  malaise,  etc.,— 
was  very  striking.  The  patient,  a  remark- 
ably intelligent  gentleman,  aged  forty-five,  had 
been  under  varied  treatment  for  the  entire 


SODIUM  BISULPHITE 
SODIUM  PHOSPHATE 


206 


time.  In  regard  to  such  a  frequent  repetition 
of  doses  of  from  30  to  30  grains,  he  has  never 
seen  cause  to  regret  it,  and  has  never  linown 
of  any  later  ill  effects  from  it. 

Lozenges  of  sodium  bicarbonate,  trochisci 
soda  bicarbonaiis  (U.  S.  Ph.,  Br.  Ph.),  contain 
each  3  grains  (U.  S.  Ph.)  or  5  grains  (Br.  Ph.) 
of  the  bicarbonate.  The  U.  S.  troches  are 
slightly  aromatic,  containing  a  little  nutmeg. 
From  1  to  10  of  the  American  and  from  1  to  6 
Of  the  British  troches  may  be  given  at  a  dose.] 
Russell  H.  Nevins. 

SODIUM  BISULPHITE.  —  See  under 
Sulphurous  acid. 

SODIUM  BORA.TE.— See  Borax. 

SODIUM  BROMIDE.— See  under  Bro- 
mides. 

SODIUM  CANTHARIDATE  has  been 
used  to  some  extent  in  the  same  way  as  potas- 
sium cantharidate  in  the  treatment  of  pul- 
monary tuberculosis  (see  under  Cantharides 
and  Cantharidio  acid). 

SODIUM  CAE.BOLATE  has  been  recom- 
mended as  an  intestinal  antiseptic  in  diarrhosa, 
dysentery,  and  typhoid  fever,  given  in  doses  of 
from  3  to  10  grains.  The  sulphocarbolate  has 
been  more  employed  in  these  affections.  So- 
dium carbolale  has  been  used  also  as  an  ex- 
ternal antiseptic  (see  Phenol  sodique,  under 
Phenol). 

SODIUM  CARBONATE,  sodii  carbonas 
(U.  S.  Ph.,  Br.  Ph.),  natrium  carbonicum  (Ger. 
Ph.),  sal  soda  or  washing  soda  of  commerce, 
iiatrium  carbonicum  crudum  (Ger.  Ph.),  is  not 
much  employed  internally  in  medicine,  as  the 
bicarbonate  possesses  all  of  its  useful  proper- 
ties and  is  less  irritating  and  of  a  more  agree- 
able taste.  Externally,  it  is  used  in  nearly  all 
conditions  in  which  it  is  desirable  to  soften  or 
remove  scaly  or  scabby  accumulations  upon  the 
skin,  as  in  certain  forms  of  eczema,  plica  polo- 
nica,  etc.  It  may  be  given  in  10-grain  doses, 
but  in  overdoses  is  corrosive. 

Mild  sodium  carbonate,  sodii  carbonas  exsic- 
catus  (U.  S.  Ph.),  sodii  carbonas  exsiccata  (Br. 
Ph.),  natrium  carbonicum  siccum  (Ger.  Ph.),  is 
sodium  carbonate  deprived  of  its  water  of  crys- 
tallization. It  does  not  differ  in  its  properties 
from  the  crystallized  form,  and  is  given  in  5- 
grain  doses,  usually  in  the  pill  form. 

Russell  H.  Nevins. 

SODIUM  CETRABATE,  a  salt  of  cetrario 
acid,  soluble  in  water,  is  said  to  act  as  a  tonic 
when  given  in  doses  of  from  3  to  15  grains,  but 
the  clinical  reports  on  its  employment  are  at 
present  not  such  as  to  warrant  positive  state- 
ments with  regard  to  it. 

SODIUM  CHLORATE,  sodii  chloras 
(U.  S.  Ph.),  has  essentially  the  same  properties 
and  uses  as  the  corresponding  potassium  salt, 
and  may  be  substituted  for  it  in  doses  of  from 
5  to  15  grains. 

[In  the  palliative  treatment  of  cancer  of  the 
uterus  Boucher,  of  Rouen,  according  to  the 
Therapeutische  Wochenschrift  for  August  16, 
1896,  prescribes  the  following : 


5  Sodium  chlorate 3  parts ; 

Distilled  water 10     " 

Syrup  of  orange  flowers 3     " 

M.  At  first  two  "spoonfuls"  (whether  tea- 
spoonfuls  or  tablespooiifuls  is  not  stated) 
are  to  be  taken  in  twenty-four  hours,  and 
the  daily  amount  is  to  be  increased  gradu- 
ally to  eight  ■'  spoonfuls." 
The  following  powder  is  applied  on  intra- 
cervical  tampons : 

B  Sodium  chlorate,        )  ^f  ^^^^         g        ^^ 
Bismuth  snbnitrate,  j  '^ 

Iodoform 1  part. 

M. 

In  addition,  the  vagina  is  irrigated  daily 
with  a  solution  of  150  grains  of  sodium  chlo- 
rate in  a  quart  of  boiled  water.  It  is  said  that 
this  treatment  often  prolongs  life  for  a  year 
and  makes  it  reasonably  tolerablej 

Russell  H.  Nevins. 
SODIUM  CHLORIDE,  sodii  chloridum 
(U.  S.  Ph.,  Br.  Ph.),  natrium  chloratum  (Ger. 
Ph.),  or  common  salt,  while  it  does  not  play  a  . 
very  important  part  in  medicine,  may  be  of 
considerable  value  as  a  substitute  for  more  ac- 
tive remedies.  A  tablespoonful,  dissolved  in 
a  tumblerful  of  cold  water  and  swallowed  be- 
fore breakfast,  will  usually  act  as  a  catUitrtic. 
and  double  that  amount,  in  a  similar  bulk  of 
warm  water,  is  one  of  the  most  readily  ob- 
tained and  prompt  emetics  and  one  that  is 
rarely  followed  by  depression.  A  teaspoonful, 
taken  dry,  is  a  useful  hmmostatic  in  epistaxis 
and  other  capillary  hcBmorrhages.  In  inter- 
mittent fever,  3-drachm  doses,  given  every  two 
hours  during  the  intermissions,  is  said  to  be 
useful,  especially  when  combined  with  lemon- 
juice  or  lime-juice.  Added  to  water  in  the  pro- 
portion of  i  of  a  pound  to  the  gallon,  salt  forms 
a  solution  of  approximately  the  same  specific 
gravity  as  sea  water,  and  maybe  used  for  general 
or  local  baths,  being  particularly  useful  for  a 
foot-bath  after  prolonged  exercise.  A  number 
of  preparations  termed  "sea  salt"  are  on  the 
market,  which  purport  to  be  the  residue  left  upon 
evaporating  sea  water,  and  to  be  of  greater  value 
for  preparing  baths,  etc..  than  the  purer  articles, 
but  it  is  probable  that  there  is  no  special  virtue 
in  them.  A  teaspoonful  of  salt,  dissolved  in  a 
pint  of  water,  may  be  used  as  a  gargle  in  nasal 
catarrh  and  pharyngitis.  It  is  also  sometimes 
added  to  enemata  to  increase  their  irritant 
effect. 

[The  value  of  sodium  chloride  in  the  form  of 
the  so-called  "physiological  salt  solution"  will 
be  found  set  forth  in  the  section  on  Infusion 
of  the  article  on  Transfusion. 

Mr.  P.  J.  Reilly,  M.  R.  0.  S.  (British  Medical 
Journal,  November  33,  1895),  says  that  for  sev- 
eral years  he  has  used  common  salt  as  a  remedy 
for  ringworm.  Children,  he  says,  who  are  suffer- 
ing from  tinea  tonsurans  are  sent  to  the  seaside 
and  almost  invariably  improve  in  the  salt  air. 
This  improvement  has  hitherto  been  ascribed 
to  the  general  favouring  influence  of  the  open- 
air  life  and  improved  hygienic  conditions  under 
which  children  live  at  the  seaside.  But,  he 
asks,  when  we  remember  the  fact  that  the  nir 
near  the  sea  is  impregnated  with  minute  par- 


207 


SODIUM  BISULPHITE 
SODIUM  PHOSPHATE 


tides  of  sea  water  containing  in  solution  as  it 
does  a  large  proportion  of  sodium  chloride, 
may  we  not  reasonably  ascribe  the  disappear- 
ance of  the  skin  disease  to  this  circumstance? 
This  fact,  he  says,  arrested  his  attention  and 
led  him  to  think  that  common  salt  might 
prove  a  valuable  remedy  in  ringworm.  Ac- 
cordingly, he  prepared  a  solution  and  used  it 
in  the  next  three  cases  which  he  was  called 
upon  to  treat,  applying  it  to  the  diseased  scalp 
every  night  for  five  nights  and  washing  it  oft 
on  the  following  morning  with  10-per-cent. 
boric-acid  soap.  In  less  than  four  weeks  a 
cure  was  eflEected  in  each  case.  Mr.  Reilly  does 
not  mention  the  strength  of  the  solution  em- 
ployed by  him,  but  presumably  it  was  a  strong 
one.] — Russell  H.  Nevins. 

SODIUM  CHOLEATE.— Under  this  name 
a  purified  preparation  of  ox-gall  is  furnished 
by  Merck.  It  is  described  as  a  yellowish-white 
powder,  to  be  given  in  doses  of  from  5  to  10 
grains.    (See  Ox-gall.) 

SODIUM  CITRATE  resembles  the  other 
alkaline  citi'ates  in  being  laxative,  diuretic, 
and  refrigerant.  Not  usually  being  met  with 
in  the  shops,  it  is  prepared  extemporaneously 
by  adding  sodium  bicarbonate  to  lemon-iuice 
or  a  solution  of  citric  acid.  This  combination 
effervesces  quickly  and  quite  actively,  and, 
unless  a  sufficiently  large  vessel  is  employed,  is 
apt  to  foam  over.  Prom  5  to  10  drachms  of 
soda  neutralized  with  citric  acid  will 'consti- 
tute a  cathartic  dose  of  this  preparation. 

RussELt  H.  Nevins. 

SODIUM  CITKO-TABTRATE.— Effer- 
vescent citro-tartrate  of  sodium,  Hodii  citro-tar- 
tras  effervescens  (Br.  Ph.),  is  a  granulated  mix- 
ture of  17  parts  of  sodium  bicarbonate,  9  of 
tartaric  acid,  6  of  citric  acid,  and  5  of  sugar. 
It  has  the  same  laxative,  diuretic,  and  refrig- 
erant properties  as  sodium  citrate.  The  dose 
is  from  1  to  3  drachms,  dissolved  in  water  and 
taken  while  it  is  foaming. 

SODIUM  DIIODOPARAPHENOL- 
SULPHONATE.  —  See    Sodium    sozoiodo- 

LATB. 

SODIUM  DIIODOSALICYLATE.— See 

under  Diiodosalicylio  acid. 

SODIUM  DITHIOSALICYLATE.— See 

under  Dithiosalioylic  acid. 

SODIUM  ETHYIiATE,  or  caustic  alco- 
hol, is  a  preparation  sometimes  used  as  a  caus- 
tic, its  alcoholic  or  aqueous  solution  being 
applied  with  a  glass  rod  to  the  parts  to  be 
affected.  Its  action  is  reputed  to  be  painless 
and  of  special  value  for  the  destruction  of 
warts,  naevi.  small  condylomata,  and  similar 
growths.  Solutions  of  the  strength  of  30  per 
cent.,  especially  those  made  with  olive  oil,  are 
often  useful  for  inunction  in  psoriasis. 

Liquor  sodii  ethylatis  (Br.  Ph.)  is  a  20-per- 
cent, alcoholic  solution  of  this  salt. 

Russell  H.  Kevins. 

SODIUM     ETHYLSULPH  ATE.  —  See 

Sodium  sulpBovInate. 

SODIUM  FLUORIDE.— See  Fluokide. 


SODIUM  FLUOSILICATE.— See  Sodi- 
um SILICOFLUORIDE. 

SODIUM  FORMATE,  NaCHO^-l-H^O, 
occurs  in  white  deliquescent  crystals  that  are 
soluble  in  water  and  in  glycerin.  Its  subcuta- 
neous employment,  in  quantities  of  from  J  to  1 
grain,  at  intervals  of  from  a  week  to  ten  days, 
has  been  reported  to  be  of  benefit  in  the  treat- 
ment of  tuberculous  diseases. 

SODIUM       GLYCERINOBORATE.  — 

This  glyoerite  of  borax,  prepared  by  Merck 
from  40 -parts  of  borax  and  60  of  glycerin,  with 
the  aid  of  heat,  is  described  as  a  translucent, 
brittle,  and  very  hygroscopic  mass  soluble  in 
water.  Its  uses  are  the  same  as  those  of  the 
glyceritum  boroglycerini  (see  under  Boric 
ACID,  vol.  i,  page  191). 

SODIUM      HYPOPHOSPHITE.  —  See 

under  Hypophosphites  (vol.  i,  page  519). 

SODIUM  HYPOSULPHITE.— See  un- 
der Hyposulphites  (vol.  i,  page  519). 

SODIUM  IODIDE,  sodii  iodidum  (U.  S. 
Ph.,  Br.  Ph.),  natrium  jodatum  (Ger.  Ph.),  is 
employed  for  the  same  purposes  as  potassium 
iodide.  It  may  be  given  in  doses  of  from  5  to 
60  grains. 

SODIUM  LACTATE,  NaCH.Os,  is  a 
thick,  syrupy  liquid.  It  may  be  given  as  a 
hypnotic  in  cases  of  insomnia,  in  doses  of  from 
3  to  4  drachms.    (See  Lactic  acid.) 

SODIUM  NITRATE,  sodii  nitras  (U.  S. 
Ph.,  Br.  Ph.),  natrium  nitricum  (Ger.  Ph.),  or 
cubic  nitre,  has  properties  somewhat  similar  to 
those  of  the  corresponding  potassium  salt.  It 
is  oftener  employed  in  veterinary  medicine  as 
a  diuretic  than  in  the  treatment  of  the  human 
subject,  although  it  has  been  recommended  in 
dysentery,  in  drachm  doses,  freely  diluted, 
every  three  hours. 

SODIUM  NITRITE.  — See  under  Ni- 
trites (vol.  ii,  page  13). 

SODIUM  PARACRESOTATE,  C,H,Na 
O3,  according  to  Merck,  is  a  fine  microcrystal- 
line  powder,  of  a  bitter  taste,  soluble  in  24 
parts  of  warm  water.  It  is  said  to  be  antipy- 
retic, antiseptic,  and  analgetic.  Dr.  Cerna 
says  that  it  has  been  used  with  success  in  the 
treatment  of  rheumatism,  catarrhal  pneumo- 
nia, typhoid  fever,  and  gastro-intestinal  disor- 
ders in  general,  and  is  well  borne  by  the 
stomach.  He  adds  that  it  is  said  to  be  partic- 
ularly suitable  for  children.  The  dose  is  from 
1  to  20  grains. 

SODIUM  PHENOLSULPHONATE.— 
Sodium   sulphocarbolate  (see  under  Sulpho- 

CAEBOLATES). 

SODIUM  PHOSPHATE,  sodii  phosphaa 
(U.  S.  Ph.,  Br.  Ph.),  natrium  phosphoricum 
(Ger.  Ph.),  is  hardly  suitable  for  producing  the 
constitutional  effects  of  either  its  base  or  its 
acid,  and  is  almost  exclusively  used  as  a  laxa- 
tive and  cholagogiie.  the  latter  action  being 
pretty  clearly  established.  It  is  freely  soluble 
and  of  a  not  unpleasant  taste,  and  is  partic- 
ularly adapted  for  children,  to  whom  it  may 
be  given  dissolved  in  milk.  Also  tolerance  of 
it  is  not  established  speedily,  and  it  may  be 


SODIUM   PYROPHOSPHATE 

SOLANUM   CAKOLIKENSE 


308 


given  for  months  without  any  ill  effiects  fol- 
lowing.     For  children   who   pass   pasty  and 
pale-ooloured  stools,  exhibiting   at  the  same 
time  the  symptoms  of  malnutrition,  there  is 
probably  nothing  so  useful  as  10-grain  doses 
of  sodium  phosphate  three  times  daily.     Ordi- 
nary sick  headache  may  also  be  greatly  alle- 
viated by  doses  of  from  20  to  30  grains  three 
times  a  day,  after  eating,  taken  for  a  week  or 
so,  and  the  course  repeated  after  an  intermis- 
sion of  the  same  length  of  time,  due  atten- 
tion being  paid  to  the  diet.     An  attack  may 
also  be  aborted  by  two  or  three   full  doses, 
from  1  to  2  oz.,  taken  as  soon  as  the  premoni- 
tory symptoms  are  noticed.     In  gastro-duode- 
nal  catarrh  and  the  jaundice  dependent  upon 
it,  it  usually  works  well,  and  it  is  very  useful 
in  the  epidemic  jaundice  of  warm  climates  not 
dependent  upon  organic  disease  of  the  liver. 
The  tendency  to  the  formation  of  biliary  cal- 
culi is  also  somewhat  lessened  under  its  per- 
sistent administration,  but  after  their  formation 
it  is  doubtful  if  it  is  of  benefit.     In  sclerosis 
of  the  liver  it  is  worthy  of  a  fair  trial,  for, 
if  it  has  no  curative  effect,  it  renders  the  con- 
dition of  the  patient  much  more  tolerable.     In 
the  obese  and  diabetic  in  whom  there  may  be 
a  troublesome  succession  of  hoils  or  carbun- 
cles it  often  effects  a  cure,  and  the  same  may 
be  said  of  those  cases  in  which  no  clearly  de- 
fined dyscrasia  exists.     In  lithmmia  it  is  usu- 
ally of  value  in  preventing  to  a  great  extent 
the  occurrence  of  the  headache  which  appears 
to  depend  upon  faulty  intestinal  digestion  or 
upon  fermentation  of  the  contents  of  the  in- 
testines.   It  is  not  maintained  that  there  is 
anything  actually  specific  in  the  action  of  this 
salt,  but  that  whatever  benefits  follow  its  em- 
ployment are  due  to  its  property  of  restoring 
to  its  normal  condition  the  upper  portion  of 
the  intestinal  canal  and  stimulating  the  flow 
of  the  bile. 

As  a  laxative,  from  1  to  3  oz.  may  be  giv- 
en, but  when  the  use  of  the  salt  is  to  be 
protracted  not  over  a  drachm,  three  times  a 
day,  is  advisable.  For  children  10  grains  will 
usually  be  a  sufficient  dose.  The  effervescent 
phosphate  of  sodium,  sodii  phosphas  effer- 
vescens,  of  the  Br.  Ph.  (additions)  contains, 
besides  the  phosphate,  small  amounts  of  spdi- 
um  citrate  and  tartrate,  and  is  consequently 
slightly  diuretic.  It  may  be  given  in  doses  of 
i  oz.  dissolved  in  a  tumblerful  of  water. 

[The  Province  medicale  for  October  17, 1896, 
contains  an  abstract  of  an  article  from  the 
Journal  de  medecine  de  Paris  for  September 
37,  18S)6,  in  which  the  writer  remarks  that  a 
0'1-per-cent.  solution  of  sodium  phosphate  in 
sterilized  water  is  proper  to  employ  in  subcu- 
taneous injections.  After  the  usual  antiseptic 
precautions  are  taken,  the  injections  are  prac- 
tised in  the  retrotrochanteric  groove.  These 
injections  have  been  employed  in  tabes  dor- 
salis,  hemiplegia,  neurasthenia,  and  progressive 
myopathic  paralysis.  In  locomotor  ataxia  the 
darting  pains  and  the  troubles  of  motility  are 
considerably  diminished.  Also  in  other  affec- 
tions marked  amelioration  is  produced.  Some- 
times this  salt  has  a  direct  action  on  the 
nervous  system ;  the  organism  seems  to  experi- 


ence a  functional  overactivity,  and  it  produces 
symptoms  of  intolerance.  On  the  whole,  says 
the  writer,  it  may  be  said :  1.  That  sodium 
phosphate  exerts  an  action  on  the  organism 
which  is  due  to  the  exciting  influence  which  it 
produces  on  the  central  nervous  system.  2. 
That  if  the  injections  are  carefully  adminis- 
tered hypodermically,  the  solution  does  not 
give  rise  to  any  local  reaction.  3.  That  the 
therapeutic  value  in  locomotor  ataxia,  in  neu- 
rasthenia, in  hemiplegia,  and  in  progressive 
myopathic  paralysis  is  worthy  of  consideration. 
4.  That  the  hypodermic  injections  should  be 
carefully  watched  in  order  to  prevent  the  ap- 
pearance of  the  symptoms  of  intolerance  which 
are  often  produced.] 

(Cf.  Sodium  phosphate,  under  Phosphoeus, 
vol.  ii,  page  79.)— Russell  H.  Neviks. 

SODIUM      PYHOPHOSPHATE.  —  See 

under  Phosphorus  (vol.  ii,  page  79). 

SODIUM   SACCHABINATE.— See  un- 
der SACCHARrN. 

SODIUM  SALICYLATE.— See  under 
Salicylic  acid. 

SODIUM  SANTONINATE.— See  under 
Santonica. 

SODIUM  SILICATE.— See  under  Sili- 
cates. 

SODIUM      SILICOELUOBIDE.  —  This 

compound  has  been  recommended  for  use  like 
fluorol  {g.  v.).  Sufficiently  definite  reports  of 
its  action  are  not  yet  at  hand  to  warrant  its 
recommendation  here. 

SODIUM  SOZOIODOLATE,  NaOCJI, 
IsOHSOs  +  2H20,  is  furnished  bv  Merck  in  the 
form  of  colourless  acieular  crystals  soluble  in 
U  parts  of  water.  It  is  said  to  be  antiseptic 
and  antipyretic.  The  powder,  blown  into  the 
nose  to  the  amount  of  3  grains  daily,  has  been 
reported  to  be  efficacious  in  the  treatment  of 
whooping-cough.  Dr.  Cerna  remarks  that  it  is 
considered  superior  to  iodoform  as  an  applica- 
tion to  syphilitic  ulcers,  and  serviceable  in 
nasal  catarrh.  Internally,  as  an  intestinal 
antiseptic,  it  may  be  given  in  daily  amounts 
of  from  5  to  30  grains.  Its  internal  adminis- 
tration is  said  to  have  proved  serviceable  in 


SODIUM  SULPHATE,  sodii  sulphas 
(U.  S.  Ph.,  Br.  Ph.),  natrium  sulfuricum  (Ger. 
Ph.),  Glauber's  salt,  is  used  to  some  extent  as 
&  laxative  in  doses  of  from  3  drachms  to  1  oz., 
dissolved  in  water,  in  eases  of  constipation 
and  sluggishness  of  the  liver.  The  dried  sul- 
phate, natrium  sulfuricum  siccum  (Ger.  Ph.), 
IS  considered  preferable  to  the  crystalline  salt 
as  an  ingredient  of  powders  compounded  in 
imitation  of  the  salts  of  natural  mineral  wa- 
ters, 

SODIUM  SULPHITE.— See  under  Sul- 
phurous acid. 

SODIUM  SULPHOBENZOATE,  sodii 
sutphohenzoas.ha.s  been  recommended  as  an 
antiseptic.  It  may  be  emploved  in  a  1-per- 
cent, aqueous  solution.— Russell  H.  Nevins 

SODIUM  SULPHOCARBOLATE.  - 
See  under  Sulphocarbolates. 


209 


SODIUM  PYROPHOSPHATE 
SOLANUM  CAROLINENSE 


SODnXM  STTLPHOLEATE.— Dr.  George 
n.  Fox  {Journal  of  Cutaneous  and  Genito-uri- 
nary  Diseases,  May,  1890)  remarks  that  when 
sulphuric  acid  is  added  slowly  to  any  fixed  oil 
or  fat  at  a  low  temperature,  the  oleic  acid  is 
transformed  into  sulpholeic,  or  sulpholeinic, 
acid.  A  soda  soap  made  with  a  fat  so  treated — 
sodmm  sulpholeate  or,  if  castor  oil  is  used,  so- 
dium sulphoricinoleate — is  a  mass  resembling 
vaseline  in  appearance  and  consistence,  and 
Dr.  Fox  has  found  it  an  excellent  base  for 
ointments  for  the  reasons  that  it  mixes  readily 
with  water,  that  it  is  absorbed  rapidly  by  the 
skin,  and  that  it  dissolves  a  great  number  of 
medicinal  substances  used  topically  in  the 
treatment  of  skin  diseases. 

SODITJM  STJLPHOMETHYLATE  is 
cathartic  in  -J-oz.  doses,  but  has  not  met  with 
any  great  favour. — Russell  H.  Nevins. 

SODIUM  SULPHOBICINATE,  SODI- 
UM SULPHORICINOLEATE.— See  un- 
der Sodium  sulpholeate. 

SODIUM  SULPHOVINATE,  or  ethyl 
sulphate,  is  an  unstable  and  rather  expensive 
salt,  with  an  agreeabl  e  taste.  In  doses  of  from  4 
to  5  drachms  it  produces  free  catharsis  without 
any  pain,  and  when  it  can  be  procured  fresh 
and  expense  is  no  object,  it  is  very  desirable 
for  use  in  children. — Russell  H.  Nevins. 

SODIUM  TAKTRATE.  —  This  salt  is 
purgative  and  diuretic  in  doses  of  from  i  to  1 
oz.  It  is  free  from  the  bitter  taste  of  some  of 
the  other  saline  cathartics.  For  potassium 
and  sodium  tartrate  (Rochelle  salt),  see  under 
Potassium  taktrates. 

The  effervescent  citrotartrate  of  sodium, 
sodii  citrotartras  effervescens  (Br.  Ph.),  is  a 
granular  effervescent  salt  which  is  mildly  laxa- 
tive and  refrigerant,  and  may  be  employed  in 
the  febriculcB  and  to  relieve  nausea.  It  may 
be  given  in  doses  of  from  1  to  2  drachms  dis- 
solved in  water  and  drank  while  effervescing. 
Russell  H.  Nevins. 

SODIUM  TAUROCHOLATE.— See  So- 
dium CHOLEATE. 

SODIUM  TELLURATE  has  been  used 
to  some  extent  as  an  anthidrotic  in  the  night- 
sweats  of  phthisis  and  other  exhausting  dis- 
eases. It  is  soluble  in  water.  The  dose  is 
from  }  to  J  of  a  grain. 

SODIUM  TETRABORATE.— According 
to  Professor  Coblentz,  this  compound  consists 
of  equal  parts  of  boric  acid  and  sodium  bibor- 
ate.  It  dissolves  readily  in  water  and  is  used 
as  an  antiseptic,  usually  in  a  16-per-cent.  solu- 
tion. 

SODIUM  THIOPHENE  -  SULPHO- 
NATE  is  described  by  Professor  Coblentz  as 
a  white  crystalline  powder  of  an  unpleasant 
odour,  soluble  in  water,  and  containing  33  per 
cent,  of  sulphur.  In  the  form  of  an  ointment 
of  from  5  to  10  per  cent.,  also  in  that  of  a 
dusting-powder,  it  has  fjeen  used  in  the  treat- 
ment of  prurigo  and  some  other  skin  diseases. 

SODIUM  THIOSULPHATE,  natrium 
thiosulfuricum  (Ger.  Ph.),  is  the  same  as  so- 
dium hyposulphite.  (See  under  Hyposulphites, 
vol.  1,  page  519.) 


SODIUM  TUMENOL  SULPHONATE. 

— See  under  Tumenol. 

SODIUM  VALERIANATE.— The  vir- 
tues of  this  salt  are  those  of  valerian.  (See 
Valekian  and  Valerianic  acid.) 


SO  J  A  HISPID  A,  or  Glycine  hispida,  or 
Glycine  Soja,  is  a  Japanese  leguminous  plant 
from  the  seeds,  or  beans,  of  which  a  sauce 
known  as  soy  is  prepared.  The  plant  has  been 
acclimatized  in  India,  China,  and  Austria.  In 
France  there  are  to  be  had  bread,  cakes,  and 
biscuits  made  from  the  beans,  which  have  been 
recommended  as  articles  of  food  for  persons 
affected  with  diabetes,  on  account  of  their 
comparative  freedom  from  starch. 

SOLANIN. — This  principle,  which  should 
not  be  confounded  with  the  alkaloid  solanine, 
is  found  in  various  species  of  Solanum.  Ac- 
cording to  Professor  Coblentz,  its  formula  is 
C42H87NO1B.  It  is  a  bitter,  crystalline  sub- 
stance insoluble  in  water.  It  has  been  used  to 
some  extent  as  an  analgetic  in  cases  of  neural- 
gia, in  doses  of  from  J  to  1  grain. 

SOLANINE. — See  under  Dulcamara. 

SOLANUM  CAROLINENSE.— This  is 
the  American  horse-nettle,  or  bull-nettle,  a 
weed  that  grows  abundantly  in  the  Atlantic 
States.  The  juice  of  the  berries,  succus  solani, 
and  a  fluid  extract  prepared  from  them  have 
been  used  as  a  remedy  in  various  convulsive 
affections,  such  as  chorea,  puerperal  eclampsia, 
and  especially  epilepsy.  It  has  even  been  em- 
ployed in  tetanus.  According  to  Dr.  Charles 
S.  Potts,  of  the  University  of  Pennsylvania 
(Therapeutic  Gazette,  December,  1895),  and  Dr. 
C.  F.  Barber  {Journal  of  the  American  Medi- 
cal Association,  December  14,  1895),  the  first 
published  report  of  the  use  of  this  drug  in 
epilepsy  was  made  by  Dr.  J.  L.  Napier,  of  Blen- 
heim, South  Carolina,  in  the  Iledical  World  in 
1889.  Dr.  Napier  had.  obtained  his  knowledge 
of  it  from  the  negroes,  who  used  it  as  a  domes- 
tic remedy  for  convulsions. 

Dr.  E.  1i.  Bondurant,  of  the  Alabama  Insane 
Hospital  at  Tuscaloosa  {Medical  News,  March 
30, 1895).  reports  eleven  cases  among  the  inmates 
of  the  institution,  in  none  of  which  was  any 
favourable  effect  produced.  He  adds,  however, 
that  insane  epileptics  doubtless  have  the  dis- 
ease in  its  most  unfavourable  form.  He  used 
Parke,  Davis,  &  Co.'s  fiuid  extract,  in  doses  of 
from  -j  to  1  fl.  drachm,  three  times  a  day.  On 
the  other  hand,  a  writer  in  the  Medical  Re- 
porter, of  Calcutta,  for  July  1,  1895,  says  that 
he  has  used  the  same  fluid  extract  in  doses  of 
from  10  to  15  drops,  three  times  a  day,  after 
meals,  and  feels  encouraged  as  to  its  thera- 
peutic powers,  although  the  number  of  cases 
in  which  he  has  prescribed  it  is  not  large 
enough  to  warrant  him  in  positive  statements. 
He  cites  an  article  published  in  the  Indiana 
Medical  Journal  for  November,  1894,  by  Dr. 
Allison  Maxwell,  of  Indianapolis,  who  coA- 
cludes,  from  his  own  use  of  the  drug  and  from 
that  of  several  other  observers,  that  it  "  materi- 
ally controls  epileptic  seizures  and  is  worthy 
of  considerable  confidence." 

Dr.   Potts  {loc.  cit.)  gives  the  histories  of 


SOLANUM   DULCAMARA 
SOLVENTS 


210 


seventeen  cases  and  gives  his  conclusions  as 
follows :  , 

"  1.  That  the  drug  has  a  decided  influence 
for  good  upon  the  epileptic  paroxysm.  2. 
That  this  influence  is  probably  not  so  great  or 
so  sure  as  that  obtained  by  the  use  of  antipy- 
rine  and  the  bromide  salts,  or  even  of  the 
mixed  bromides.  3.  That  in  those  cases  in 
which  it  is  of  service  it  relieves  the  paroxysms 
without  causing  other  unpleasant  symptoms, 
such  as  are  sometimes  caused  by  the  use  of 
large  doses  of  the  bromides.  4.  That  the  dose 
ordinarily  recommended  (10  to  15  drops  of  the 
fluid  extract)  is  too  small,  and  that  as  much  as 
a  teaspoonful  or  more  four  times  daily  is  often 
needed  to  secure  results." 

Dr.  Barber  {loc.  cit.)  has  of  late  employed 
the  fluid  extract  in  doses  of  from  J  a  fl.  drachm 
to  i  a  fl.  oz.  The  ages  of  the  patients  ranged 
from  eight  to  fifty  years,  and  the  cases  com- 
prised those  of  epilepsy  with  idiocy,  epilepsy 
with  insanity,  epilepsy  with  grand  mal  and 
petit  mal,  and  epilepsy  from  traumatism. 
Among  them  were  those  of  five  girls  and  three 
boys.  The  girls,  who  had  been  having  epilep- 
tic attacks  every  day,  did  well  for  three  weeks, 
having  no  convulsions,  but  at  the  end  of  that 
time  the  convulsions  returned  and  the  patients 
relapsed  into  their  former  condition.  The 
dose  was  pushed,  but  no  improvement  was 
noted,  and  the  treatment  was  abandoned.  The 
boys  had  a  mild  outbreak  of  convulsions  fol- 
lowed by  an  interval  of  rest  for  about  a  week, 
when  they  gradually  relapsed  into  their  former 
epileptic  state.  Among  the  epileptics  who  were 
the  subjects  of  grand  mal  Dr.  Barber  had 
about  the  same  results  as  with  the  male  epilep- 
tic idiots,  save  that  the  period  of  improvement 
continued  longer  and  the  relapse  was  more 
gradual.  Ten  who  were  under  the  influence 
of  the  drug  did  not  have  a  convulsion  for 
twenty-nine  days.  Then  a  patient  who  was  in 
the  habit  of  having  from  three  to  six  seizures 
a  week  had  an  attack  so  mild  that  he  was 
not  obliged  to  lie  down.  This  patient  was 
mentally  much  brighter  than  ho  had  been  for 
some  time  before,  and  was  capable  of  doing 
light  work  about  the  ward.  He  still  had  his 
epileptic  attacks,  but  they  were  milder  in  form 
than  previously. 

Dr.  Barber  does  not  regard  solanum  as  an 
efficient  substitute  for  the  bromides,  but  he 
thinks  it  preferable  to  borax.  He  says  it  un- 
questionably has  an  influence  over  the  disease, 
but  only  a  mild  one  ;  it  controls  it  sufficiently 
to  warrant  its  use  for  a  time  to  relieve  the  pa- 
tients of  the  depression  due  to  the  bromide 
treatment. 

Dr.  E.  Q.  Thornton,  demonstrator  of  thera- 
peutics in  the  Jefferson  Medical  College  ( TAera- 
peutic  Gazette,  November,  1896),  has  experi- 
mented with  a  soft  extract  made  by  Parke, 
Davis,  &  Co.  He  was  unable  to  detect  any 
effect  on  dogs,  rabbits,  guinea-pigs,  or  pigeons, 
but  he  says  that  when  the  soft  extract  is  in- 
jected hypodermically  into  the  posterior  lymph 
space  of  the  frog  in  doses  of  about  3  milli- 
grammes to  the  gramme  weight  of  the  batra- 
chian,  respiration  becomes  gradually  slower  and 
laboured,  then  gradually  returns  to  the  nor- 


mal in  about  three  hours  as  the  effect  of  the 
drug  passes  off.  If  the  drug  is  given  in  toxic 
doses  the  respiration  becomes  slow,  shallow, 
and  irregular,  and  death  results  from  respira- 
tory failure.  Dr.  Thornton  was  somewhat 
surprised  to  find  that  Solanum  carolinense,  a 
plant  belonging  to  the  same  natural  order  as 
belladonna  and  hyoscyaraus,  had  no  effect  upon 
the  circulation. 

The  effect  upon  the  nervous  system  he  found 
most  marked,  depressing  the  cerebrum  and 
powerfully  stimulating  the  spinal  cord.  After 
receiving  an  injection  of  the  drug  into  the  pos- 
terior lymph  space,  the  frog,  he  says,  becomes 
quiet  and  apparently  stupefied,  and  retains 
the  normal  posture,  but  if  irritated  it  will 
make  very  long  leaps,  alighting  usually  upon 
its  belly,  although  frequently  upon  its  back, 
with  its'  fore  and  hind  legs  extended  in  tetanic 
spasms,  the  hind  limbs  being  more  decidedly 
affected  than  the  fore  limbs.  The  limbs  are 
thrown  into  spastic  extension  each  time  the 
animal  hops  or  attempts  to  hop,  and  these 
spasms  last  about  from  ten  to  thirty  seconds. 
Sharp  jars,  a  sharp  tap,  and  pin-pricks  bring 
on  the  spasms,  although  they  are  not  then 
nearly  so  marked  as  when  the  animal  leaps  or 
attempts  to  leap.  Division  of  the  spinal  cord 
does  not  prevent  the  spasms.  The  frog  recov- 
ers from  the  condition  of  spasm  in  from  three 
to  five  hours  if  the  dose  has  not  been  so  large 
as  to  be  lethal.  Lethal  doses  are  preceded  by 
the  condition  above  related,  but  finally  depres- 
sion or  exhaustion  takes  the  place  of  excitement 
or  stimulation,  and  the  animal  lies  limp,  fail- 
ing to  respond  to  any  stimulus. 

In  the  experiments  the  respiration  became 
laboured  and  slower  after  the  drug  had  been 
administered,  and  when  large  doses  were  given 
the  breathing  ceased  before  the  heart  stopped. 

SOLANUM  DTJIiCAMARA.— See  Dul- 
camara. 

SOLANUM  PANICULATUM.  —  The 
root  of  this  Brazilian  shrub  is  used  by  the  physi- 
cians of  Brazil  as  a  purgative  and  deohstruent  in 
diseases  of  the  litter  and  of  the  spleeti,  also  as  a 
tonic  and  as  a  remedy  for  catarrh  of  the  blad- 
der. Elsewhere  than  in  South  America  it  has 
not  yet  passed  the  experimental  stage  of  medici- 
nal employment.  Robert  has  found  it  inert, 
but  Michaelis,  who  has  given  16  drops  of  a  fluid 
extract  three  times  a  day,  thinks  it  is  undoubt- 
edly stomachic  and  useful  in  biliary  colic  and 
in  chronic  dyspepsia.  (Medirinisch- chirur- 
gisches  Central -Blatt.  April  24,  1896;  New 
York  Medical  Journal,  May  16,  1896.) 

SOLIDAGO. — Solidago  odora  (or  odoratd). 
the  sweet-scented  golden-rod  of  the  United 
States  and  Canada,  was  formerly  official.  The 
leaves  are  aromatic  and  carminative  and,  when 
given  in  a  hot  infusion,  diaphoretic. 

The  common  golden-rod,  Solidago  virga  au- 
rea,  Solidago  vulgaris,  also  was  formerly  used 
in  medicine.  It  has  lately  {Therapeutische 
Wochenschrift,  May  10, 1896)  been  recommend- 
ed anew  in  the  form  of  Rademacher's  tincture, 
in  doses  of  30  drops  several  times  a  day,  as  a 
diuretic.  The  writer  gives  the  following  for- 
mula: 


311 


SOLANUM   DULCAMARA 
S0LVE2S'TS 


5  Fresh  infusion  of  digitalis 150  parts; 

Rademacher'stinetureof solidago.   20      " 

Syrup  of  orange  peel 30      " 

M.  S. :  A  teaspoonf  ul  to  be  taken  every  two 
hours. 
SOLPHINOL.  —  Professor  Coblentz  de- 
scribes this  as  an  antiseptic  mixture  of  borax, 
boric  acid,  and  alkaline  sulphites.  According 
to  Dr.  Cerna,  it  is  soluble  in  10  parts  of  water 
and  in  20  of  glycerin,  and  is  said  to  be  an 
efficient  antiseptic  in  the  treatment  of  wounds, 
in  a  solution  of  from  2  to  10  per  cent.  It 
must  not  be  confounded  with  sulphonal. 

SOLTJTOL. — This  is  an  alkaline  solution  of 
sodium  cresylate  in  an  excess  of  cresol,  con- 
taining 15  per  cent,  of  free  cresols.  It  is 
an  antiseptic  used  chiefly  for  preserving 
corpses  and  disinfecting  bedclothes,  excreta, 
privies,  etc. 

SOLVENTS.— A  solvent,  as  understood  in 
pharmacy  or  chemistry,  is  a  substance,  usually 
a  liquid,  which  is  capable  of  dissolving  another 
substance  (gas,  liquid,  or  solid)  without  alter- 
ing the  nature  of  the  latter.  While  nitric  acid, 
for  instance,  will  dissolve  copper,  or  acetic  acid 
chalk,  neither  of  these  liquids  is  a  true  solvent 
of  the  respective  substance,  since  the  latter  no 
longer  exists  as  such  in  the  solution. 

The  principal  solvents  employed  are  either 
non-volatile  or  volatilized  with  difficulty,  such 
as  glycerin,  paraffin  oil,  solution  of  soda  or 
potassa,  limewater,  etc. ;  or  else  more  or  less 
volatile,  such  as  water,  methyl  alcohol  (or 
wood-spirit),  ethyl  alcohol  (ordinary  alcohol), 
amyl  alcohol  (fusel  oil),  acetone,  acetic  acid 
(glacial  or  of  other  strength),  ether,  acetic 
ether,  chloroform,  carbon  disulphide,  petro- 
leum ether  (benzin),  benzol  (from  coal-tar),  so- 
lution of  ammonia,  etc. 

Only  a  few  of  these  solvents  are  suitable  for 
retaining  medicinal  substances  in  solution 
when  it  is  desired  to  administer  the  latter  in 
a  liquid  form.  Water  is,  of  course,  under  all 
circumstances  the  most  harmless  and  prefer- 
able, but  it  fails  to  dissolve  or  to  keep  in  solu- 
tion many  bodies,  such  as  resins,  oils,  balsams, 
and  various  other  proximate  principles.  In 
these  cases  a  menstruum  or  solvent  must  be 
selected  which  will  approach  the  aqueous  state 
as  far  as  practicable.  That  is  to  say,  if  it  is 
found  that  a  certain  substance  is  readily  soluble 
— for  instance,  in  a  mixture  of  1  part  of  alcohol 
and  2  parts  of  water — the  alcoholic  percentage 
should  not  be  increased  iinless.  perhaps,  for 
preservative  reasons,  because  the  physician 
does  not  wish  to  complicate  the  medicinal  ac- 
tion of  the  drug  with  the  special  effects  of 
the  menstruum  itself.  In  some  cases  the  em- 
ployment of  a  pure  volatile,  non-aqueons 
menstruum  is  unavoidable.  Then  it  becomes 
necessary  to  combine  or  to  disguise  the  solu- 
tion in  such  a  manner  that  the  secondary  ef- 
fects of  the  solvent  are  obtnnded.  For  instance, 
a  solution  of  phosphorus  in  absolute  alcohol  is 
very  disagreeable  to  take.  If,  however,  it  is 
suitably  combined  with  aromatic  elixir,  its 
harshness  and  disagreeable  taste  are  entirely 
removed. 

The  solvents  mostly  used  for  pharmaceutical 


preparations  from  crude  vegetable  drugs  are 
water  and  alcohol,  either  separately  or  in  com- 
bination, often  with  the  addition  of  glycerin, 
and  sometimes  of  water  of  ammonia  or  of 
acetic  acid.  The  latter  two  are  solvents  in  so 
far  as  they  combine  with  certain  insoluble  ac- 
tive principles  and  convert  them  into  soluble 
compounds,  from  which  the  free  principles 
themselves  can  at  any  time  be  again  separated 
in  their  original  state  by  neutralizing  the  al- 
kali or  the  acid,  as  the  case  may  be. 

After  a  drug  has  been  exhausted  by  a  vola- 
tile solvent  it  is  often  desirable  to  concentrate 
the  solution.  If  the  solvent  is  valuable,  and  a 
gentle  heat  can  not  injure  the  preparation,  the 
latter  is  subjected  to  distillation  at  as  low  a 
temperature  as  possible,  so  that  the  volatile 
solvent  may  be  recovered  as  far  as  practicable. 

Some  of  the  solvents  mentioned  above  have 
so  little  affinity  for  each  other  that,  when  they 
are  mixed  by  agitation,  they  will  speedily  sepa- 
rate again,  and  in  most  cases  will  not' retain 
more  than  traces  of  each  other  in  solution. 
This  fact  enables  the  chemist  to  transfer  a 
substance  from  one  solvent  to  another.  It  is 
particularly  made  use  of  for  the  separation 
of  alkaloids,  certain  organic  acids,  and  some 
other  proximate  principles.  For  instance,  if 
some  tincture  of  nux  vomica  is  mixed  with 
enough  dilute  ammonia  water  to  set  free  all 
the  alkaloids  (though  the  latter  may  still  re- 
main in  solution)  and  the  mixture  is  then 
shaken  with  chloroform,  the  latter  will  take 
up  part  of  the  alcohol  present  and  all  of  the 
alkaloids,  together  with  some  colouring  mat- 
ter. On  now  shaking  this  chloroform,  after 
separating  it,  with  pure  water,  the  latter  will 
abstract  the  alcohol  and  nearly  all  the  colour- 
ing matter.  The  chloroform  will  still  retain 
the  alkaloids.  If  it  is  now  shaken  with  some 
dilute  aqueous  acid,  the  latter  will  search  out 
the  alkaloid,  combine  with  it,  and  transfer  the 
alkaloidal  salt,  which  is  not  soluble  in  chloro- 
form, to  the  aqueous  layer.  From  this  the 
alkaloid  may  again  be  extracted,  after  the 
addition  of  an  alkali,  by  chloroform,  ether,  or 
any  other  volatile  menstruum  capable  of  dis- 
solving it,  and  not  misoible  with  water.  This 
method  of  extraction  is  known  as  the  process 
of  "  extraction  by  immiscible  solvents." 

Water,  either  cold  or  hot,  is  the  solvent  most 
generally  employed,  and,  when  it  alone  suffices, 
is  always  to  be  preferred  for  medicinal  com- 
pounds." It  is  to  be  regretted  that  the  method 
of  administering  many  vegetable  drugs  by  in- 
fusion or  decoction  has  almost  gone  out  of  use. 
In  many  cases  it  might  have  been  retained 
with  advantage.  Infusion  of  digitalis  has 
survived  because  it  is  well  known  to  possess 
properties  which  are  not  inherent  in  any  prepa- 
ration of  digitalis  made  with  the  intervention 
of  alcohol. 

Alcohol  is  the  solvent  next  in  importance. 
There  are  many  important  constituents  of 
drugs  which  are  insoluble  in  water,  and  require 
another  solvent,  such  as  alcohol,  ether,  chloro- 
form, etc.  But  of  all  these  volatile  solvents 
none  is  so  free  from  objectionable  features  as 
alcohol.  Wherever  there  are  essential  oils, 
resins,  alkaloids,  or  certain  gluoosides  to  be  ex- 


SOLVEOL 
SOKBBFACIBNTS 


213 


traoted  and  kept  in  solution,  alcohol  usually 
forms  at  least  a  part  of  the  menstruum.  It 
does  not  dissolve  gams,  albumin,  starch,  lig- 
nin,  etc.,  most  of  which  substances  are  inert 
medicinally.  Alcohol  is  also  often  added  to 
preparations,  not  so  much  for  its  solvent  as 
for  its  preservative  powers. 

The  attempt  has  at  various  times  been  made 
to  banish  alcohol  altogether  from  medicinal  or 
pharmaceutical  preparations,  in  compliance 
with  the  demand  of  ignorant  fanatics,  who  are 
unable  to  discriminate  between  the  usefulness 
and  uselessness  of  some  product  of  nature,  and 
who,  therefore,  have  erroneous  ideas  regarding 
its  use  or  abuse.  Up  to  the  present  time  no 
liquid  has  been  found,  which  is  not  itself  more 
or  less  of  the  nature  of  alcohol,  which  would  be 
able  to  take  its  place  as  a  solvent.  It  is  not 
impossible  that  such  a  liquid  or  combination 
of  liquids  may  in  the  future  be  discovered. 
An  important  step  in  this  direction  has  been 
made  by  Dr.  Edward  R.  Squibb,  of  Brooklyn, 
who  has  succeeded  in  extracting  drugs,  pre- 
viously held  to  be  assailable  by  alcohol  only,  by 
means  of  acetic  acid.  It  will  require  extended 
experiments,  however,  to  ascertain  whether 
this  process  will  furnish  preparations  in  every 
respect  suitable  as  medicines. 

Olycerin  is  an  impoitant  solvent  as  well  as 
preservative.  Owing  to  its  viscid  nature,  it  is 
not  often  used  alone  as  a  solvent,  but  usually  in 
combination  with  alcohol  or  water,  or  both. 
It  dissolves  many  inorganic  compounds,  nearly 
all  substances  soluble  in  water,  and  many  solu- 
ble in  alcohol. 

Ether  is  more  restricted  in  its  solvent  power. 
It  dissolves  nearly  all  oils,  most  resins,  and 
many  alkaloids  and  neutral  principles.  In 
combination  with  alcohol,  it  dissolves  gun-cot- 
ton, the  resulting  product  being  collodion. 
As  it  possesses  valuable  therapeutic  properties 
of  its  own,  it  is  used  as  a  partial  solvent  in 
such  preparations  as  ethereal  tincture  of  lo- 
belia, ethereal  tincture  of  acetate  of  iron,  etc. 

Chloroform  is  still  more  restricted,  so  far  as 
medicines  are  concerned.  It  is  made  use  of 
to  dissolve  phosphorus  for  the  purpose  of  mak- 
ing phosphorus  pills :  also  for  preparing  a 
solution  of  gutta-percha  as  a  coating  to 
abraded  surfaces. 

Bemin,  benzol,  carbon  disulphide,  acetone, 
amyl  alcohol,  methyl  alcohol,  oils,  and  many 
other  liquids  are  exceedingly  useful  as  solvents 
for  chemical  and  technical  purposes,  but  are 
unsuited  for  most  medicines. 

Alkalies  and  acids  are  also  very  efficient  sol- 
vents, but  in  most  cases  they  enter  into  combi- 
nation with  the  substance  dissolved,  and  are 
therefore,  under  those  circumstances,  not  true 
solvents. — Charles  Rice. 

SOLVEOL. — This  is  a  neutral  concentrated 
solution  of  cresylic  acid  with  sodium  oresotate. 
It  contains  10  per  cent,  of  free  cresols.  It  is 
a  dark-coloured  liquid,  readily  raiscible  with 
water  and  having  a  not  unpleasant  odour  sug- 
gestive of  carbolic  acid.  It  is  a  good  antiseptic 
in  solutions  of  from  O'l  to  0'5  per  cent.  It  has 
the  advantage  over  oreolin  of  not  clinging  to 
the  hands  or  instruments  in  gummy  masses. 


SOLVINES.— See  Polysolves. 

SOMATOSE,  a  German  proprietary  meat 
preparation,  seems  to  consist  substantially  of 
about  equal  parts  of  deutero-alburaose  and 
hetero-albumcse,  with  traces  of  peptone  (Lan- 
cet, February  3,  1895).  It  is  a  pale  yellowish 
powder,  readily  soluble  in  water,  and  having 
the  nutritive  value  of  six  times  its  weight  of 
beef.  It  is  employed  as  a  food  in  amounts  of 
from  -J-  to  1  oz.,  in  milk,  cocoa,  or  soup  (Cob- 
lentz),  chiefly  in  eases  of  impaired  digestion. 
Dr.  Hans  Taube,  of  Madrid  (Wiener  Minische 
Rundschau,  December  29,  1895;  New  York 
Medical  Journal,  January  35, 1896),  gives  brief 
histories  of  a  case  of  ulcer  of  the  stomach  and 
one  of  cancer  of  the  stomach  in  which  he  has 
observed  great  benefit  from  the  use  of  somatose. 
The  patient  with  ulcer  was  fully  restored  to 
health,  and  the  subject  of  cancer  was  much 
benefited.  Dr.  Taube  states  also  that  he  has 
used  somatose  with  advantage  in  chlorosis, 
anaemia,  phthisis,  typhus,  pericarditis,  neu- 
rasthenia, the  mercurial  cachexia,  and  agalac- 
tia. Its  effect,  he  says,  was  particularly 
striking  in  the  case  of  mercurial  cachexia. 

Dr.  Gerdes  and  Dr.  Susewind  (Deutsche 
Aerzte-Zeitung,  October  15,  1895;  New  York 
Medical  Journal,  January  4,  1896)  have  found 
somatose  of  special  utility  in  irritation  of  the 
gastro-intestinal  mucous  membrane.  They  cite 
a  case  of  severe  gastro-enteritis  in  which  all  other 
liquid  foods  given  in  larger  quantities  had  been 
vomited,  while  the  employment  of  a  strong  so- 
lution of  somatose  (a  heaping  teaspoonfiil  to 
three  tablespoonf  uls  of  water)  not  only  tided  the 
patient  over  a  critical  period  of  fourteen  days, 
but  exerted  a  very  favourable  influence  upon 
his  strength.  Although  the  somatose  solution 
was  administered,  at  first  three  times,  then 
four  or  five  times  daily,  for  a  period  of  four- 
teen days,  the  patient  never  manifested  repug- 
nance, and  even  during  the  stage  of  convales- 
cence relished  its  addition  to  soups  or  other 
foods.  As  an  element  in  the  ordinary  diet  of 
anmmic  and  nervous  persons  it  proved  of  great 
value,  being  well  borne  and  perfectly  assimi- 
lated for  a  long  time.  In  the  cases  observed 
by  the  authors  an  increase  of  strength  occurred 
within  a  comparatively  short  time,  and  in 
chlorosis  a  rapid  disappearance  of  the  men- 
strual disturbances,  headache,  vertigo,  etc., 
was  noted.  In  some  instances  after  the  use  of 
somatose  a  remarkable  improvement  took 
place  in  the  digestion,  and  all  the  pa,tienls  expe- 
rienced an  increase  of  appetite  which  persisted 
after  the  discontinuance  of  its  use.  In  the 
above-mentioned  solution  somatose,  in  the  au- 
thors' opinion,  seems  pre-eminently  indicated 
as  a  nutriment  in  cancer  of  the  stomach  and 
cesophagvs,  where  only  small  quantities  of 
food  can  be  ingested,  or  after  gastrostomy, 
since  its  ready  assimilability  precludes  the  oc- 
currence of  digestive  disturbances. 

SOMNAL,  Cn.jCl.OsN,  or 

/OCJit 
CCI3  —  C-H  ,  is  a  German  patented 

^MH.COOCaHo 
preparation  termed  also  efhylated  chloralure- 
thane,  a  clear,  colourless  liquid  of  a  pungent 


213 


SOLVEOL 
SORBBPACIENTIS 


taste.  It  is  used  as  a  hypnotic.  M.  Mar- 
amlon  de  Montyel  {Annates  medico-psycho- 
logiques,  August,  1893 ;  Fresse  medicale,  March 
23,  1895)  recommends  its  employment  in  acute 
melancholia.  Not  only  has  it  produced  sleep, 
in  his  experience,  but  even  recovery  after  three 
or  four  weeks  of  its  daily  employment  in 
amounts  of  from  75  to  105  grains.  In  other 
subjects,  he  says,  somnal  provokes  a  certain 
degree  of  intoxication  before  sleep  comes  on, 
agreeable  dreams  during  sleep,  and  a  slight 
excitation  and  gaiety  on  awakening. 

Khmelewsky  has  found  that  there  is  a  very 
marked  amelioration  in  cases  of  melancholia. 
He  also  says  that  in  healthy  subjects  doses  of 
from  38  to  45  grains  give  rise,  at  first,  to  a 
slight  intoxication;  but  in  half  an  hour  after 
its  administration  sleep  follows,  although  it  is 
often  interrupted.  From  45  to  60  grains  pro- 
duce very  profound  sleep.  On  awakening, 
there  is  no  disagreeable  sensation,  as  is  the 
case  when  trional  or  sulphonal  is  used.  Khme- 
lewsky has  not  observed  any  particular  gaiety 
or  excitement  in  the  patients,  as  M.  Marandon 
de  Montyel  had  alleged.  In  melancholia,  as 
well  as  in  simple  insomnia,  he  says,  somnal  al- 
ways acts  better  than  any  other  hypnotic,  for 
not  only  does  it  induce  an  agreeable  and  pro- 
found sleep,  but  it  is  not  accompanied  by 
disagreeable  subjective  symptoms  on  awaken- 
ing ;  it  causes  no  depression,  as  sulphonal  and 
trional  do  ;  it  does  not  give  rise  to  the  motor 
troubles  so  frequently  seen  after  the  use  of 
chloralose;  and  it  never  produces  cardio-pul- 
monary  accidents.  It  is  only  in  cases  of  gas- 
tro-intestinal  disorders  that  the  use  of  somnal 
is  contra-indicated,  as  it  may  aggravate  dys- 
pepsia and  diarrhoea. 

The  usual  hypnotic  dose  of  somnal  is  from 
15  to  30  minims,  well  diluted. 

SOPOUIFICS.— See  Hypnotics. 

SOUBEPACIENTS  are  agents  which  pro- 
mote absorption.  They  may  be  divided  into 
two  classes :  First,  those  which  assist  the 
lymphatics  in  the  removal  of  morbid  or  in- 
flammatory products ;  and.  second,  those  which 
promote  the  imbibition  of  nutritive  or  medic- 
inal material  into  the  system,  either  by  stimu- 
lation of  the  lymphatics  or  by  furnishing 
excipients  for  less  readily  absorbable  materials. 

The  first  class  is  very  large,  and  includes 
drugs  of  very  diverse  action,  but  as  the  great 
majority  have  already  been  considered,  grouped 
under  headings  which  denominate  their  mode 
of  action,  such  as  cathartics,  counter-irritants, 
diaphoretics,  diuretics,  etc..  the  present  ar- 
ticle will  be  devoted  to  those  agents  whose 
sorbefacient  power  has  been  empirically  deter- 
mined, while  we  are  still  ignorant  of  the  man- 
ner in  which  that  power  is  exercised.  These 
agents  promote  the  absorption  of  morbid  prod- 
ucts, and  this  fact  furnishes  a  basis  upon  which 
to  group  them,  but  this  common  factor  or 
result  is  not  the  most  prominent  feature  of  the 
action  of  each  one,  and  it  is  not  likely  that  it 
is  attained  in  the  same  way  by  the  diflEerent 
members  of  the  group.  They  alter  morbid 
processes  of  nutrition  in  an  unknown  manner, 
and  are  therefore  known  as  alteratives ;  they 


also  possess  the  power  of  causing  the  disinte- 
gration of  pathological  products  and  of  pro- 
moting the  absorption  of  the  debris,  whence 
they  have  been  termed  discutients  or  resolv- 
ents. 

The  absorption  of  an  inflammatory  product 
may  sometimes  be  hastened  by  inducing  a 
modification  of  the  surrounding  circulatory 
conditions,  thus  assisting  the  efforts  of  the 
lymphatics  to  remove  an  abnormal  deposit  by 
overcoming  an  obstruction  to  their  action. 
For  example,  in  parametritis  the  sluggish 
local  circulation  is  stimulated  to  a  healthier 
activity  by  the  use  of  vaginal  douches  of  hot 
water,  which  enable  the  lymphatics  to  resume 
a  more  normal  activity,  and  to  commence  the 
removal  of  the  inflammatory  exudation.  A 
similar  but  briefer  effect  is  produced  by  the 
use  of  cold  instead  of  hot  water,  and  in  some 
conditions  the  alternate  use  of  heat  and  cold 
may  be  the  most  efficient  means  for  relieving 
the  inflammatory  stasis.  In  plastic  iritis, 
the  writer  is  convinced,  the  systematic  use  of 
applications  of  hot  water  to  the  eye  is  of  ma- 
terial value  in  promoting  the  resolution  and 
absorption  of  the  exudate,  and  in  influencing 
the  course  of  the  disease,  even  when  not  indi- 
cated by  pain.  The  absorption  of  hypopyon 
may  also  be  hastened  by  the  use  of  hot  water, 
and  reparative  action  may  sometimes  be  in- 
duced in  an  ulcer  of  the  cornea  by  the  same 
means. 

The  principal  drugs  which  facilitate  the  .ab- 
sorption of  morbid  products  are  mercury  and 
iodine,  particularly  m  the  form  of  the  iodides. 
We  know  that  for  a  great  many  years  these 
drugs  have  been  employed  to  cause  the  dis- 
appearance of  certain  inflammatory  deposits 
which  have  proved  not  amenable  to  other,  pos- 
sibly better  understood,  lines  of  treatment, 
and  that,  in  spite  of  an  immense  amount  of 
study  which  has  been  devoted  to  them,  we  are 
as  ignorant  as  our  fathers  were  of  their  modes 
of  action. 

The  systemic  action  of  mercury  has  been 
already  thoroughly  discussed.  We  know  that 
it  is  very  complex  ;  that  the  drug  increases  the 
activity  of  glandular  structures  and  augments 
the  quantity  of  almost  every  secretion  ;  that  it 
tends  to  induce  solution  of  imperfectly  organ- 
ized structures,  particulai'ly  when  they  are  the 
results  of  inflammation ;  and  that  this  solvent 
power  is  most  strongly  exhibited  when  the 
morbid  product  is  the  result  of  syphilis.  At 
the  same  time  observation  teaches  us  that  mer- 
cury is  not  equally  efficacious  in  all  the  forms 
or  stages  of  syphilis,  but  that  certain  products 
of  syphilitic  inflammation  are  move  amenable 
to  the  iodides,  while  still  others  respond  more 
quickly  to  the  combined  use  of  the  two  drugs. 
Mercury  does  not  confine  its  action  to  neo- 
plasms of  syphilitic  origin,  but  promotes  to  a 
greater  or  lesser  degree  the  elimination  of 
other  imperfectly  organized  tissues  from  the 
system.  Prom  these  facts  we  deduce  the  con- 
elusion  that  in  some  manner  mercury  acts  to 
break  down  newly  formed  tissue  which  is  lack- 
ing in  certain  qualities  of  organization,  and 
to  reduce  it  to  a  detritus  which  can  be  carried 
away  by  the  lymphatics.    At  the  same  time  it 


SORBINOSE 
SOZOIODOL 


214 


probably  increases  the  activity  of  the  lym- 
phatics themselves,  and  by  stimulation  of  the 
glandular  system  hastens  the  work  of  elimina- 
tion. 

Iodine  is  a  general  excitant  of  the  vital  ac- 
tions, especially  of  the  lymphatic  and  gland- 
ular system.  Its  principal  use  is  perhaps  as  a 
counter-irritant,  and  as  snch  it  is  not  infre- 
quently used  over  the  site  of  inflammatory 
effusions  or  deposits.  The  result  is  not  entire- 
ly due  to  its  counter-irritant  action,  because 
some  portion  of  the  drug  is  absorbed  and  aids 
in  the  elimination  of  the  morbid  product. 
Administered  internally,  it  seems  to  find  its 
greatest  elTicacy  in  reducing  glandular  en- 
largements, such  as  goUre  and  enlarged  and 
indurated  liver,  spleen,  mammce,  or  testes.  It 
is  also  useful  in  promoting  the  absorption  of 
inflammatory  effusions  in  the  great  lymphatic 
spaces,  such  as'the  pleural  and  peritoneal  cav- 
ities. When  administered  in  the  form  of  the 
iodides,  it  shows  a  distinct  eliminative  power 
over  certain  neoplasms,  particularly  young 
connective-tissue  growths  of  syphilitic  origin 
which  do  not  respond  well  to  the  influence  of 
mercury. 

Although  we  can  not  explain  its  modus 
operandi  any  better  than  we  can  that  of  mer- 
cury, there  is  reason  to  believe  that  it  is  not 
the  same.  It  is  probable  that  the  principal 
feature  of  its  action  is  to  stimulate  the  entire 
lymphatic  system  and  so  encourage  the  ab- 
sorption of  certain  imperfectly  organized  newly 
formed  tissue.  It  does  not  possess  the  power 
of  modifying  the  local  circulation,  and  does 
not  materially  affect  the  lymphatics  of  a  part 
which  is  in  a  state  of  vascular  congestion  from 
either  active  or  passive  inflammation,  but  when 
the  circulatory  obstruction  has  been  removed 
it  assists  the  lymphatics  in  their  effort  to  re- 
move the  products  of  the  inflammation  and 
restore  the  tissues  to  their  normal  condition. 
Thus  the  sorbefacient  power  of  iodine  is  seen 
to  be  in  all  probability  greater  than  that  of 
mercury,  but  it  is  not  the  only  one  which  it 
possesses.  The  study  of  the  results  produced 
by  its  use  reveals  evidence  that  it  also  has  a 
power  to  cause  disintegration  of  certain  exu- 
dates and  neoplastic  tissues,  and  that  these 
tissues  differ  from  those  which  are  broken 
down  by  the  action  of  mercury.  It  is  effective 
In  some  cases  where  mercury  is  not,  and  again 
may  fail  where  the  other  will  succeed.  The 
use  of  the  two  drugs  combined  is  frequently 
of  greater  efficiency  than  that  of  either  alone, 
as  is  demonstrated  in  certain  syphilitic  con- 
ditions as  well  as  in  non-syphilitic  affections 
of  the  skin  which  originate  in  excess  of  nutri- 
tion. If  to  these  two  drugs  we  add  arsenic, 
and  form  what  is  known  as  Donovan's  solution, 
we  obtain  the  combined  action  of  three  agents, 
each  of  which  acts  apparently  in  a  different 
way  to  destroy  neoplastic  tissue,  while  two 
exert  a  sorbefacient  action,  thus  forming  a 
very  powerful  means  for  the  removal  of  such 
growths. 

Atrophy  of  the  raammjie  and  of  the  testicles 
has  been  ascribed  to  iodine,  but,  if  authentic, 
such  eases  ai-e  very  rare.  No  drugs  of  which 
we  have  knowledge  can  break  down  or  cause 


the  lymphatics  to  absorb  hypertrophies  of  nor- 
mal tissue  or  the  products  of  slow,  progressive 
parenchymatous  inflammation.  Neither  the 
connective  tissue  which  distorts  the  valves  of 
the  heart  in  endocarditis  nor  that  which  is 
present  in  spinal  sclerosis  can  be  removed  by 
these  means.  A  low  grade  of  organization 
is  necessary  for  such  removal  of  tissue. 

In  cases  of  chronic  poisoning  with  lead  or 
mercury  the  elimination  of  these  drugs  is 
powerfully  aided  by  the  iodides,  which  con- 
vert the  deposited  nietal  into  soluble  combina- 
tions and  hasten  their  excretion. 

In  addition  to  these  two  principal  drugs  a 
few  other  alteratives  of  minor  importance 
should  be  mentioned,  although  it  has  not  been 
satisfactorily  determined  that  they  have  any 
marked  sorbefacient  power. 

Sarsaparilla  and  guaiacum  have  popular 
reputations  as  alteratives,  and  some  practition- 
ers consider  them  useful  as  adjuvants  to  mer- 
cury in  promoting  the  absorption  of  certain 
pathological  products.  On  the  contrary,  other 
practitioners  declare  themselves  doubtful,  not 
only  in  regard  to  these  drugs'  possessing  sorbe- 
facient powers,  but  in  regard  to  their  having 
any  medicinal  virtua  whatever. 

If  any  stimulation  of  the  lymphatic  system 
is  produced  by  iodoform  and  iodol,  it  is  prob- 
ably referable  to  the  iodine  which  enters  into 
their  composition,  but  the  effect  of  iodoform 
upon  the  general  system  is  so  different  from 
that  produced  by  iodine  as  to  cause  a  reasonable 
doubt  in  regard  to  the  production  of  such 
stimulation. 

Ichthyol  has  been  recommended  as  "  a  local 
alterative  and  an  anodyne  resolvent"  in  cer- 
tain skin  diseases.  Possibly  its  effect  upon 
these  morbid  conditions  is  due  to  stimulation 
of  the  lymphatics,  but  too  little  is  known  of  its 
action  upon  the  general  system  to  permit  of  an 
authoritative  statement  whether  this  is  or  is 
not  a  correct  theory. 

Occasionally  other  drugs  produce  effects 
which  are  difficult  of  explanation  in  any  other 
way  than  that  they  promote  absorption.  Thus, 
the  application  of  nitrate  of  silver,  sulphate  of 
copper,  and  other  remedies  to  trachoma  in- 
duces an  absorption  of  the  trachomatous  tissue 
which  can  hardly  be  satisfactorily  explained 
by  their  caustic  or  astringent  effect. 

The  sorbefacients  of  the  second  class  are 
agents  by  means  of  which  the  imbibition  of 
nutritive  or  medicinal  material  into  th&  system 
is  aided  or  determined,  through  the  skin  or 
mucous  membrane,  exclusive  of  the  processes 
of  digestion.  They  may  be  divided  into  two 
sets — those  which  mechanically  promote  ab- 
sorption and  those  which  serve  as  menstrua  to 
conduct  drugs  more  readily  to  the  lymphatics. 
The  hot-water  bath  and  the  vapour  hath  are 
possibly  the  most  important  of  the  first  class. 
By  them  the  surface  of  the  skin  is  cleansed 
from  extraneous  substances,  the  pores  are  di- 
lated, and  the  tissues  are  relaxed,  while  the 
circulation  and  the  activity  of  the  lymphatics 
are  increased,  rendering  absorption  more  read- 
ily accomplished.  This  method  of  medication 
is  largely  used  in  sulphur  and  mercurial  baths 
as  well  as  in  those  containing  other  drugs. 


315 


SORBINOSE 
SOZOIODOL 


Massage  stimulates  the  circulation  by  the 
compression  of  the  small  blood-vessels  with 
the  muscular  tissue  and  skin  of  the  part  op- 
erated on,  and  determines  a  more  active  circu- 
lation and  therefore  increased  activity  on  the 
part  of  the  lymphatics.  At  the  same  time  the 
medicament  is  mechanically  pressed  into  the 
pores  of  the  skin  and  into  close  propinquity  to 
the  lymphatics,  thus  rendering  its  absorption 
easier  and  greater  in  amount.  The  combined 
use  of  the  bath,  massage,  and  an  oily  excipient 
for  the  drug  is  a  very  efficient  method  of  secur- 
ing rapid  absorption  through  the  integument. 
Superficial  irritation  of  the  skin  may  be  pro- 
duced by  the  application  of  certain  counter- 
irritants,  such  as  heat,  hot  water,  and  mustard, 
and  after  their  removal,  if  absorbable  medica- 
ments are  applied,  they  will  be  taken  up  by 
the  lymphatics  more  readily  than  usual,  on 
account  of  their  stimulation  by  the  locally  in- 
creased circulation. 

The  absorption  of  certain  drugs,  such  as 
cocaine  or  aconite,  through  the  skin  may  be 
accomplished  by  mea,ns  of  the  galvanic  current . 
The  positive  electrode  is  moistened  with  a  solu- 
tion of  the  drug  which  it  is  desired  shall  pass 
through  the  skin,  applied  to  the  place  where 
the  action  is  desired,  and,  placing  the  negative 
electrode  elsewhere  on  the  body,  a  moderate 
current  is  turned  on.  The  drugs  can  be  car- 
ried deeper  into  the  tissues  by  increasing  the 
porosity  of  the  skin  with  very  fine  needles,  but 
the  punctures  must  be  very  fine,  not  large 
enough  to  be  visible  to  the  naked  eye.  Accord- 
ing to  Dr.  Corning,  the  periosteum  of  the 
bones  of  the  arm  can  be  thus  ansesthetized 
with  cocaine.  (See  also  under  Electricity, 
vol.  i,  p.  361.) 

The  remaining  set  of  sorbefacients,  which  act 
as  excipients  for  less  readily  absorbed  materi- 
als, consists  mainly  of  fatty  and  oily  substances 
of  which  ointments  and  similar  preparations 
are  made.  Lanolin,  cacao  butter,  and  oleic 
acid  possess  peculiarly  efficient  powers  of  pene- 
trating through  the  skin,  and  deserve  special 
mention.  The  oleates  are  solutions  of  certain 
drugs  as  bases  in  oleic,  acid.  They  penetrate 
the  skin  much  mor-e  readily  than  the  corre- 
sponding ointments,  and  thus  introduce  the 
drugs  they  contain  more  quickly  into  the  gen- 
eral circulation.  The  principal  objection  to 
their  use  is  that  they  are  apt  to  be  irritating 
and,  when  applied  with  friction,  may  even 
cause  pustulation  of  the  skin.  Lanolin  pene- 
trates the  skin  probably  the  most  rapidly  of 
all  oils  or  fatty  substances,  and  at  the  same 
time  is  non-irritating  and  can  be  with  advan- 
tage applied  with  friction.  For  these  reasons 
lanolin  is  the  best  excipient  of  this  class  when 
rapid  absorption  of  a  certain  drug  is  desired. 
Oleum  theobromse,  or  cacao  butter,  penetrates 
the  skin  nearly  as  well  and  is  used  in  the 
manufacture  of  cosmetics,  as  it  is  a  fine  emol- 
lient and  does  not  leave  a  greasy  appearance. 
Although  solid  at  the  usual  temperature  of  the 
air,  it  melts  at  from  86°  to  95°  P.,  below  the 
temperature  of  the  body.  On  account  of  its 
usual  consistence,  low  melting  point,  and  great 
absorbability,  it  is  an  almost  ideal  substance 
for  the  manufacture  of  suppositories,  for  which 


it  is  mainly  used.  It  dissolves  in  the  cavity  of 
the  body  in  which  it  is  placed  and  penetrates 
the  mucous  membrane,  carrying  with  it  a  por- 
tion at  least  of  the  medicament  with  which  it 
has  been  charged. 

Matthias  Lanckton  Fostek. 

SORBINOSE.     See  under  Sugar. 

SORREL.— See  Oxalis. 

SOY,  SOYA  BEAN.— See  Soja  hispida. 

SOZAL,  or  aluminum  paraphenylsulpho- 
nate  (C6H4(0H)S02)sAl,  is  an  astringent  and 
antiseptic  crystalline  powder  soluble  in  water, 
in  glycerin,  and  in  alcohol.  It  is  used  in  a 
1-per-cent.  solution  as  a  wash  for  suppurating 
surfaces  and  as  an  injection  in  cystitis  and 
tuberculous  abscesses. 

SOZOIODOL,  sozoiodolic  acid,  or  diiodo- 
paraphenolsulphonic  acid.  CoHjIj(OH)SOsH, 
is  a  crystalline  body  readily  soluble  in  water, 
in  alcohol,  and  in  glycerin.  Sozoiodolic  acid, 
mercury  sozoiodolate,  potassium  sozoiodolate, 
sodium  sozoiodolate,  and  zinc  sozoiodolate  are 
used  as  antiseptics.  In  dispensing,  sodium 
sozoiodolate  is  furnished  when  "sozoiodol"  is 
prescribed  without  qualification. 

Mercury  sozoiodolate,  or  sozoiodol-mer- 
cury,  CeHsIj.SOa.O.Hg,  is  an  orange-yellow 
powder  soluble  in  salt  water.  It  contains  41 
per  cent,  of  iodine.  It  is  used  topically  in 
parasitic  shin  diseases  and  in  syphilitic  ulcere, 
in  an  ointment  of  the  strength  of  from  2  to  10 
per  cent,  or  in  the  form  of  a  dusting  powder 
consisting  of  from  2  to  10  per  cent,  of  the 
drug  diluted  with  talc  or  powdered  starch. 

Potassium  sozoiodolate,  or  sozoiodol- 
potassium,  is  a  white,  odourless  powder  soluble 
in  50  parts  of  water,  insoluble  in  alcohol.  It 
is  used  as  an  antiseptic  dusting  powder,  pure 
or  diluted  with  from  3  to  10  times  its  weight 
of  talc  or  starch,  in  suppurating  wounds,  ulcers, 
etc.,  as  an  odourless  and  non-poisonous  substi- 
tute for  iodoform. 

Sodium  sozoiodolate,  or  sozoiodol-sodium, 
which  occurs  in  white  crystals,  is  soluble  in  14 
parts  of  water.     It  is  used  for  the  same  pur- 
poses as  the  potassium  compound.     Moreover, 
Dr.   S.    Sehwarz   ( Wiener   ktinische    Woclien- 
schrift,   1895,   No.  43;    Deutsche  Medizinal- 
Zeitung,   August  10,   1896)  recommends  the 
following  treatment,  which  he  considers  both 
prophylactic  and  curative  of  diphtheria :  In  , 
the  case  of  children  under  two  years  old  he 
insufflates  the  nasal  and  pharyngeal  cavities 
with  this  powder  every  four  hours : 
5  Finely  powdered  sodium  sozo- 
iodolate    45  grains ; 

Flowers  of  sulphur 90      " 

Saccharin 15      " 

M. 

For  children  from  two  to  four  years  old  he 
prescribes  equal  parts  of  sodium  sozoiodolate 
and  flowers  of  sulphur,  with  the  addition  of 
saccharin ;  for  those  over  four  years  old,  so- 
dium sozoiodolate  with  a  little  saccharin  with- 
out the  sulphur. 

Zinc  sozoiodolate,  or  sozoiodol-zinc,  a  white 
crystalline  powder  soluble  in  30  parts  of  water, 
is  used  like  the  potassium  salt. 


SOZOLIC  ACID 
SPINANTS 

SOZOIilC  ACID.— See  Aseptol. 
SPAHISH  FLIES.— See  Cantharides. 

SPARTEINE,  CsHsbNj,  is  an  alkaloid 
prepared  from  the  flowering  tops  of  Cytisus 
Scoparius,  or  the  common  broom-plant.  It  is 
a  colourless,  oily  liquid,  possessing  a  very  pene- 
trating odour,  and  has  a  bitter  taste.  It  is 
found  in  Asia  and  has  been  propagated  in  the 
United  States.  The  sulphate,  sparteinm  sul- 
phas (U.  S.  Ph.),  is  freely  soluble  in  water. 

The  physiological  action  of  sparteine  is  that 
of  a  stimulant  to  the  muscular  substance  of  the 
heart.  The  pulse  may  also  be  increased  in  fre- 
quency after  its  administration,  but  there  is 
rarely  deviation  in  the  arterial  tension.  Upon 
the  spinal  reflex  centres  it  is  sedative  ;  less 
so  to  the  circulatory  apparatus.  In  moderate 
doses  it  may  exert"  a  narcotic  influence.  As 
the  result  of  toxic  doses,  somnolence  appears, 
attended  with  extreme  frequency  of  the  pulse 
and  respiration  ;  intense  dyspnoea  with  feeble- 
ness of  the  heart's  action  comes  on  and  the 
cardiac  cycle  may  become  arrhythmical.  Nau- 
sea, vertigo,  and  vastly  diminished  reflex  ex- 
citability of  the  spinal  cord  follow,  and  death 
ensues,  sometimes  with  convulsions,  by  paraly- 
sis of  the  respiratory  centre  in  the  spinal  cord. 
In  conditions  of  health,  sparteine  is  not  a  diu- 
retic. 

The  therapeutic  uses  of  sparteine  are  as  a 
diuretic  and  cardiac  stimulant.  In  eases  of 
pronounced  anasarca,  where  this  condition  is 
not  due  to  renal  or  splenic  disease,  sparteine 
assists  in  the  removal  of  the  abnormal  fluid  by 
acting  upon  the  kidneys  and  as  a  hydragogue 
cathartic  upon  the  intestines.  It  is  inferior  in 
this  respect  to  other  diuretic  agents,  but  in 
their  absence  may  be  safely  employed,  usually 
with  good  results.  Sparteine  may  be  given,  in 
the  absence  of  digitalis,  in  eases  of  impaired 
heart  action  with  diminished  quantity  of  urine, 
sometimes  with  a  gratifying  sequel. 

[Dr.  Gilbert  G.  Cottam  {Therapeutic  Gazette, 
November,  1896  ;  New  York  Medical  Journal, 
November  28, 1896)  states  that  he  has  employed 
sparteine  sulphate  in  a  number  of  cases  as  a 
heart  stimulant  during  anaesthesia  with  very 
positive  results,  and  the  beneficial  effect  of  the 
drug  has  been  clearly  shown  in  nearly  every 
instance.  He  refers  to  Bevill  as  having  used 
it  in  doses  of  a  fifth  of  a  grain  by  the  mouth, 
given  thirty  minutes  before  the  administration 
of  chloroform.  He  describes  two  cases  in  which 
the  patients  did  well  throughout  prolonged 
antesthesia.  Langlois  and  Maurange  (Semaine 
medicate,  August,  1894),  he  says,  give  from  0-5 
to  0'6  of  a  grain  of  sparteine  sulphate  and  -^ 
of  a  grain  of  morphine  hypodevmically  fifteen 
minutes  before  the  administration  of  an  anjes- 
thetic.  They  have  done  this  a  hundred  and 
twenty  times  on  the  human  subject.  In  many 
of  the'  cases  the  patients  suffered  from  heart 
disease  or  had  to  undergo  prolonged  opera- 
tions, such  as  laparotomy,  kelotomy,  and  re- 
duction of  dislooaticms.  In  all  of  thom  the 
heart  beats  continued  full  and  perfectly  regu- 
lar. Dr.  Cottiim's  mode  of  procedure  is  to  in- 
ject hypodermically  iV  of  a  grain  of  sparteine 
sulphate  ten  minutes  before  the  anaesthesia  is 


216 


begun.  Then,  if  the  operation  is  protracted, 
-)V  of  a  grain  is  injected  during  its  progress. 
These  doses  have  been  found  ample  to  secure 
the  desired  efieot,  although  they  are  much 
smaller  than  is  generally  considered  necessary. 
Dr.  Cottam  gives  an  account  of  seven  cases  to 
illustrate  the  points  enumerated.  Sparteine 
sulphate  was  used  in  every  instance  in  the 
manner  described,  and  the  patients  themselves, 
from  various  causes,  were  such  as  would  be 
peculiarly  susceptible  to  the  depressing  influ- 
ence of  chloroform,  and  hence  admirably 
adapted  to  demonstrate  the  properties  of  spar- 
teine. A  study  of  these  cases  and  many  others 
of  a  minor  nature,  he  says,  has  caused  him  to 
form  these  conclusions:  1.  That  in  sparteine 
sulphate,  administered  hypodermically  before 
the  beginning  of  ansesthesia,  in  the  dose  of  t^ 
of  a  grain,  repeated  according  to  the  nature  of 
the  operation  and  the  condition  of  the  patient, 
we  have  a  safe,  efficient,  and  prompt  heart 
stimulant  in  chloroform  narcosis,  a.  That  it 
is  not  necessary  either  to  combine  it  with  mor- 
phine or  to  use  it  in  larger  doses  than  those 
specified.  3.  That,  other  things  being  equal, 
there  is  less  shook  and  there  is  prompter  reac- 
tion with  its  use.  ] 

The  action  of  the  drug  upon  the  heart  mus- 
cle— probably  through  the  cardiac  ganglia — is 
more  rapid  than  that  of  digitalis,  and  its  effect, 
in  moderate  dose,  lasts  for  from  four  to  six 
hours.  In  diseases  of  the  myocardium  or  of 
the  valves  of  the  heart,  when  prompt  action  is 
desired,  sparteine  answers  the  purpose.  See 
has  recommended  the  drug  highly  in  mitral 
and  aortic  regurgitation  and  in  stenosis  of  the 
mitral  valve.  He  reports  results  particularly 
gratifying  in  cases  in  which  the  insufficiency 
of  the  aortic  valve  was  accompanied  by  a  rapid- 
ly beating,  tumultuous  heart.  In  asthma  of 
cardiac  origin  the  drug  has  been  praised.  It 
is  said  that  the  vascular  symptoms  of  Graves's 
disease  may  be  alleviated  by  the  use  of  spar- 
teine. Jpnnctional  disturbances  of  the  heart 
seem  to  yield  to  the  influence  of  the  drug.  As 
an  antipyretic,  it  has  been  used  successfully 
by  Geley,  by  cutaneous  application,  in  the 
evening  rise  of  temperature  in  phthisis,  in 
measles,  and  in  scarlatina  (cited  in  New  York 
Medical  Journal,  February  23,  1896). 

Sparteine  may  be  administered  in  solution 
in  doses  of  from  -^g  to  J  of  a  grain.  As  the 
necessity  arises,  the  dose  may  be  increased 
to  2  grains.  For  rapid  stimulation  of  the 
heart,  the  sulphate  may  be  used.  Its  free 
solubility  in  water  renders  it  available  for  sub- 
cutaneous employment.  The  dose  of  sparteine 
sulphate  is  from  ^  to- -J  a  grain.  Tablets  of 
the  salt  for  hypodermic  use  are  in  the  market. 
Samuel  M.  Brickner. 

SPASMOTIN,    SPASMOTOXINE,    or 

sphacelotoxine.  or  sphacelinic  acid,  is  a  princi- 
ple obtained  from  ergot,  said  to  have  the  for- 
mula C20H21O9  and  to  exert  the  medicinal  actions 
of  ergot.  According  to  Dr.  C.  Jacobj,  of  the 
Pharmacological  Institute  in  Strassbu'rg  (cited 
in  the  Cincinnati  Lancet-Clinic,  August  4, 
1894),  it  has  been  used  satisfactorily  in  Freund's 
clinic,  in  doses  of  1 J  grain.    Too  little  is  as  yet 


217 


SOZOLIC  ACin 

SPINANTS, 


known  about  it,  however,  to  warrant  its  general 
employment. 

SPEARMINT.— See  Mentha  viridis. 

SPECIES. — These  preparations,  still  official 
in  several  European  phannacopoeias,  are  mix- 
tures of  dried  and  powdered  vegetable  sub- 
stances to  be  used  in  making  infusions, 
decoctions,  etc. 

The  species  aromaticce  (Ger.  Ph.)  consist  of 
2  parts  each  of  peppermint  leaves,  serpyllum, 
thyme,  and  lavender  flowers,  and  1  part  each 
of  cloves  and  cubeb. 

The  species  diureticce  (Ger.  Ph.)  are  equal 
parts  of  levisticura  root,  ononis  root,  licorice 
root,  and  juniper  berries. 

The  species  emollientes  (Ger.  Ph.)  consist  of 
equal  parts  of  coarsely  powdered  althaea  leaves, 
mallow  leaves,  melilotus,  chamomile,  and  flax- 
seed. 

The  species  laxantes  (Ger.  Ph.)  are  made  by 
moistening  with  a  little  water  16  parts  of 
senna  leaves  chopped  moderately  fine,  then 
sprinkling  over  them  as  evenly  as  possible  4 
parts  of  potassium  bitartrate  in  fine  powder, 
and,  when  the  mixture  has  become  dry,  adding 
10  parts  of  elder  flowers  and  5  parts  each  of 
fennel  and  anise. 

The  species  lignorum  (Ger.  Ph.)  consist  of 
50  parts  of  guaiac  wood,  10  each  of  sassafras 
wood  and  licorice  root,  and  30  of  the  root  of 
Ononis  spinosa. 

The  species  pectorales  (Ger.  Ph.)  contain  8 
parts  of  peeled  althasa  root,  4  parts  of  the  leaves 
of  Tussilago  Farfara,  3  parts  of  licorice  wood, 
2  parts  each  of  aniseed  and  mullein  flowersj 
and  1  part  of  orris  root. 

SPECIFICS. — Remedies  which  cure  certain 
diseases  in  some  way  not  indicated  by  their 
physiological  action  are  spoken  of  as  specifics. 
They  are  few  in  number,  the  most  notable  ex- 
amples being  mercury  for  the  cure  of  syphilis 
and  cinchona  for  the  cure  of  malarial  disease. 
It  is  now  considered  certain  that  cinchona  and 
its  alkaloids  prove  curative  in  malarial  affec- 
tions by  their  action  on  the  Plasmodium  ma- 
laria', and  it  is  probable  that  all  specifics, 
among  which  may  be  classed  the  antitoxines, 
act  by  destroying  the  energy  of  the  germ  or 
its  products  on  which  the  particular  disease 
depends. 

SPERMACETI,  the  eetaceum  of  the  phar- 
macopoeias, is  employed  in  making  cerates  and 
ointments,  for  which  its  freedom  from  irritat- 
ing properties  and  its  consistence  render  it 
peculiarly  valuable.  Spermaceti  ointment,  un- 
guentum  cetacei  (Br.  Ph.),  contains, in  addition 
to  spermaceti,  white  wax,  almond  oil,  and-  ben- 
zoin, and  is  rather  more  elegant  than  ordinary 
simple  ointment.  Spermaceti  cerate,  ceratum 
eetaceum  (U.  S.  Ph.),  is  essentially  the  same  as 
the  ointment  except  that  it  contains  no  ben- 
zoin.— Russell  H.  Nevins. 

SPEBMINE.— This  is  a  natural  alkaloid,  a 
leucomaine,  found  in  the  form  of  a  double  phos- 
phate of  spermine  and  calcium  in  the  testicle, 
in  the  ovary,  in  the  thyreoid  gland,  in  the 
thymus  gland,  in  the  lymphatic  glands,  in  the 
pancreas,  in  the  marrow  of  bone,  in  the  blood, 


in  the  yolk  of  egg,  etc.  The  spermine  now 
used  in  medicine  is  generally  in  the  form  of  a 
2-per-cent.  solution  of  the  hydrochloride,  of 
which  from  8  to  16  minims  are  administered 
by  subcutaneous  injection  once  a  day.  Dr. 
Al.exander  Poehl,  of  St.  Petersburg,  regards 
spermine  as  a  most  efficient  restorative  of 
vigour,  acting  as  an  antitoxine  in  cases  of  self- 
poisoning  hy  absorption  from  the  intestines 
and  by  increasing  the  oxidizing  powers  of  the 
blood  and  the  tissues.  Dr.  George  E.  Krieger, 
of  Chicago  {American  Therapist,  June,  1895), 
who  takes  the  same  view,  has  reported  the 
beneficial  action  of  spermine  in  asthma,  ance- 
mia,  dyspepsia,  chorea,  diabetes,  Bright's  dis- 
ease, neurasthenia,  neuralgia,  locomotor  ataxia, 
syphilis,  chronic  ulcers,  and  tuberculous  and 
other  infectious  diseases.  The  indications  for 
the  use  of  spermine  are  the  same  as  for  that  of 
testicle  juice  (see  vol.  i,  page  78). 

SPHACELOTOXINE.— See  Spasmotin. 

SPIGELIA  (U.  S.  Ph.),  ovpink  root,  is  the 
rhizome  and  sniall  roots  of  the  Spigelia  mari- 
landica,  an  American  plant  which  is  used  in 
medicine  to  cause  the  expulsion  of  the  Ascaris 
lumbricoides,  or  roundworm.  It  is  usually 
employed  in  the  form  of  the  fluid  extract,  ex- 
tractiim  spigelice  jluidum  (U.  S.  Ph.),  of  which 
the  dose  for  an  adult  is  from  1  to  2  fl.  drachms, 
although  the  powdered  drug  is  sometimes  used 
in  doses  of  from  1  to  2  drachms,  as  well  as  an 
infusion  of  ^  an  oz.  in  a  pint  of  water,  taken 
at  one  dose.  In  larger  doses  it  is  somewhat 
cathartic,  and  in  overdoses  gives  rise  to  vertigo, 
amblyopia,  dilatation  of  the  pupils,  twitching 
of  the  face,  and  sometimes  general  convulsions. 
Death  has  been  reported  to  have  followed  ex- 
cessive doses.  As  there  is  no  physiological 
antidote,  the  treatment  in  oases  of  poisoning 
must  be  conducted  upon  general  principles. 
The  preparatory  treatment  mentioned  under 
Anthblminthics  should  be  followed  in  all 
oases,  and  it  is  usual  to  administer  a  cathartic 
simultaneously,  senna  or  calomel  being  the  one 
usually  selected. 

Spigelia  anthelminthica  is  a  native  of  tropi- 
cal America,  where  it  is  employed  for  the  same 
purposes  as  Spigelia  marilandica,  but  it  is 
credited  with  being  rather  more  active  and 
more  dangerous  to  life. — Russell  H.  Kevins. 

SPINAIi-COBD  EMULSION.— See  un- 
der Animal  extracts  and  juices  (vol.  i,  page 
82) 

SPIN  ANTS. — This  "  barbarous  vernacu- 
lar," as  Stille  terms  it  {'J herapeiitics  and  Ma- 
teria Medica,  vol.  ii,  page  147),  has  been 
excluded  from  all  the  recent  medical  diction- 
aries and  works  on  materia  medica  and  thera- 
peutics. It  is  an  old  term  formerly  used  to 
designate  remedies  now  known  as  the  excito- 
motors,  including  principally  vegetable  sub- 
stances containing  the  alkaloids  strychnine 
and  brucine,  but  by  some  made  to  include  the 
oxytocics,  which  apparently  stimulate  the  mus- 
cular fibres  of  the  womb  by  their  action  on 
the  lower  portion  of  the  spinal  cord.  Proba- 
bly strychnine  is  the  only  substance  that  acts 
as  a  stimulant  to  the  entire  spinal  cord. 

Jeremiah  T.  Eskeidqe.    , 


SPIRITS 
SPRAYS 


218 


SFIBITS. — In  a  pharmaceutical  sense, 
these  are  alcoholic  solutions  of  volatile  sub- 
stances, the  latter  being  solids,  liquids,  or 
gases.  They  are  prepared  by  simple  solution,  or 
by  distillation,  or  by  a  combination  of  the  two. 

The  spirits  prepared  from  most  of  the  essen- 
tial oils  are  used  simply  for  flavouring.  Oth- 
ers, like  spirit  of  ammonia,  spirit  of  ether, 
compound  spirit  of  ether,  spirit  of  camphor, 
whisky,  brandy,  etc.,  are  used  chiefly  as  stimu- 
lants. The  most  important,  and  at  the  same 
time  the  most  variable  ones,  as  regards  strength, 
are  spirit  of  nitrous  ether  and  spirit  of  glonoin. 
The  strength  of  both  of  these  should  be  con- 
trolled by  assay,  and  it  should  be  borne  in  mind 
that  the  former  constantly  becomes  weaker  by 
age.  The  method  of  assay  is  given  in  the  U.  S. 
Ph.,  and  need  not,  therefore,  be  repeated  here. 
For  spirit  of  glonoin,  however,  no  reliable 
method  of  assay  was  known  when  the  last 
U.  S.  Ph.  was  published.  As  the  commercial 
article  varies  very  considerably  in  strength,  and 
as  uniformity  in  so  powerful  a  drug  is  highly 
desirable,  the  method  of  assay  devised  by  the 
writer  of  this  article  and  recently  published 
by  him  {Alumni  Journal,  New  York,  vol.  ii, 
page  183)  is  briefly  described  here  : 

Assay  of  Spirit  of  Glonoin. — Into  an  Er- 
lenmeyer  flask  introduce  30  c.  c.  of  a  normal 
solution  of  potassa  in  absolute  alcohol,  heat  it 
moderately,  and  then  add  to  it,  in  several  por- 
tions, 10  grammes  of  the  spirit  of  glonoin  to  be 
assayed,  finally  rinsing  the  vessel,  which  con- 
tained the  latter,  with  a  little  absolute  alcohol, 
and  adding  this  to  the  mixture.  Test  the 
liquid  with  litmus  paper  to  ascertain  whether 
it  is  still  alkaline.  If  it  is  not,  this  shows  that 
the  amount  of  alkali  was  insufficient  to  decom- 
pose all  the  nitroglycerin.  In  this  case  add 
another  portion  (10  c.  c.  or  more)  of  the  alco- 
holic potassa  solution,  carefully  measured  from 
a  burette,  and  consider  this  in  the  final  calcu- 
lation. Place  the  flask  on  a  water-bath  and 
heat  it  until  the  contents  begin  to  boil.  Then 
stop  it  and  set  it  aside  to  cool.  Now  pour  off 
the  clear,  pale-coloured  solution  from  the  col- 
oured crystalline  crust  adhering  to  the  bottom 
of  the  flask,  wash  the  latter  with  alcohol,  add 
the  washings  to  the  other  liquid,  then  a  little 
phenolphthalein  solution,  and  determine  the 
remaining  excess  of  alkali  with  normal  acid. 
Deduct  the  amount  of  this  excess  from  the 
total  volume  of  normal  alkali  employed  in  the 
assay,  and  multiply  the  remainder  by  0'0755. 
The  product  will  be  the  percentage,  by  weight, 
of  nitroglycerin  (glonoin)  present  in  the  spirit. 
Charles  Rice. 

SPIiEHIC  EXTRACT.— Dr.  W.  Cohn- 
stein,  of  Berlin  (AUgemeine  medicinische  Cen- 
tral-Zeitung,  1896,  No.  43;  Therapeutisehe 
Wochenschrift,  June  14,  1896),  having  found, 
like  Danilewsky,  that  the  use  of  a  watery  ex- 
tract of  the  ox's  spleen,  whether  given  by  the 
mouth  or  siibcutaneously,  gave  rise  to  a  nota- 
ble increase  in  the  number  of  the  red  blood- 
corpuscles  in  dogs  and  rabbits,  has  employed 
it  therapeutically.  He  reports  upon  its  use  by 
several  physicians  in  twenty-three  cases.  In 
one  of  them  the  disease  was  leuccemia;  the 


others  were  examples  of  avcemia  or  Morosis. 
In  the  case  of  leucsmia  there  was  only  a  tran- 
sitory effect  observed,  not  really  therapeutical. 
On  the  other  hand,  in  the  majority  of  the  cases 
of  antemia  and  chlorosis  the  action  of  the  ex- 
tract was  very  striking.  The  first  signs  of 
improvement  were  seen  in  the  subjective  symp- 
toms of  debility,  loss  of  appetite,  constipation, 
headache.,  and  dysmenorrhcRa.  Objectively,  the 
pallor  disappeared,  and  often  there  was  an  in- 
crease of  the  hfemoglobin  or  of  the  number  of 
the  red  blood-corpuscles.  In  many  cases  the 
patients  gained  flesh  notably.  In  many  others 
there  were  no  objective  signs  of  improvement. 
In  no  instance  was  any  unpleasant  effect  ob- 
served. 

The  splenic  extract  employed  by  the  author 
was  one  known  by  the  trade  name  of  euryihrol. 
It  is  a  watery  extract  to  which  salt  has  been 
added,  partly  to  preserve  it  and  partly  to  give 
it  a  better  flavour.  It  is  described  as  resem- 
bling Liebig's  beef  extract.  The  amount  to 
be  given  daily  is  from  one  to  two  teaspoonfuls, 
dissolved  in  hot  water. 

SPONGE,  as  it  occurs  in  the  shops,  is  rare- 
ly in  proper  condition  for  either  medical  or  sur- 
gical purposes,  containing  as  a  rule  more  or  less 
sand  and  calcareous  matter  and  being  of  an  ob- 
jectionable dark  colour.  Sponges  should  be 
soaked  for  a  day  or  two  in  a  3-per-cent.  solu- 
tion of  commercial  hydrochloric  acid,  to  re- 
move the  calcareous  matter,  and  subsequently 
washed  a  number  of  times  in  fresh  water.  To 
bleach  them,  the  method  is  to  soak  them  in  a 
1-per-cent.  solution  of  potassium  permanganate 
for  several  hours  and,  after  rinsing,  submit 
them  to  a  2-  or  3-per-cent.  solution  of  oxalic 
acid,  the  last  traces  of  Avhieh  must  be  removed 
by  repeated  washings.  Chlorine  or  a  dilute 
solution  of  sulphurous  acid  is  sometimes  used 
to  bleach  them,  but  the  texture  of  the  sponge 
is  more  apt  to  be  affected  than  when  the  above- 
described  method  is  employed.  To  render 
them  aseptic,  as  is  necessary  when  they  are  to 
be  used  as  absorbents  of  blood,  pus,  etc..  it  is 
necessary  to  soak  them  for  at  least  twenty-four 
hours  in  a  5-per-cent.  solution  of  carbolic  acid, 
and  after  their  removal  from  that  to  allow  them 
to  remain  in  water  sterilized  by  heat  for  two 
days,  and  then  to  immerse  them  in  a  carbolic- 
acid  solution  to  destroy  any  micro-organisms 
which  may  have  escaped  the  first  part  of  the 
process.  When  they  are  prepared  in  this  man- 
ner it  is  fairly  certain  that  they  are  free  from 
disease  germs  and  that  they  retain  their  ab- 
sorbent properties.  Heat,  either  dry  or  moist, 
injures  them  greatly,  as  do  also  all  the  com- 
monly employed  antiseptics,  such  as  corrosive 
sublimate.  It  is  a  common  practice  to  attempt 
to  disinfect  sponges  after  having  employed 
them  in  operations,  etc.,  but  it  is  much  wiser 
to  avoid  their  use  a  second  time,  as  it  is  almost 
impossible  to  render  them  entirely  aseptic. 
Sponges  of  the  cheaper  grades,  provided  they 
are  fairly  absorbent,  are  just  as  useful,  and  can 
be  destroyed  after  having  been  once  used,  or 
gauze  or  absorbent  cotton,  either  of  which  is 
easily  sterilized,  will  prove  reasonably  satis- 
factory. 


219 


SPIRITS 
SPRAYS 


Although  inferior  to  skin-grafting,  sponge- 
grafting,  or  the  application  of  rery  thin  sheets 
of  sterilized  sponge  upon  the  surface  of  un- 
healthy  granulating  sores  of  large  area,  will 
often  prove  useful  in  hastening  the  process  of 
repair  and  preventing  the  contraction  of  the 
cicatrices.  The  sponge  should  be  as  thin  as 
possible  and  held  in  place  by  light  pressure, 
and  antiseptic  dressings  should  be  applied.  It 
may  require  several  weeks  to  insure  success  in 
this  procedure,  but,  properly  performed,  it  is 
usually  successful. 

Sponge  tents  may  be  prepared  by  winding 
cord  tightly  around  small  pieces  of  dry  sponge, 
which  may  or  may  not  be  previously  impreg- 
nated with  mucilage  of  acacia.  Before  they 
are  to  be  used  the  cord  is  removed.  On  ac- 
count of  their  absorbent  properties  they  are 
decidedly  inferior  to  tents  of  laminaria  or  tu- 
pelo  wood,  except  when  they  are  to  be  impreg- 
nated with  some  medicinal  agent.  When  they 
are  employed  to  dilate  the  canal  of  the  cervix 
uteri  the  condition  of  the  patient  must  be 
watched  carefully,  as  decomposition  of  the 
mucus,  etc.,  absorbed  by  the  tent  has  often  oc- 
curred, with  a  resulting  septicemia.  By  some 
it  is  advised  that  when  they  are  used  in  that 
situation  it  is  proper  to  inclose  them  in  a  rub- 
ber condom.  For  tamponing  the  vagina  they 
are  not  so  suitable  as  absorbent  cotton,  but 
when  a  single  plug  is  used,  as  when  certain 
substances  are  to  be  retained  against  the  cer- 
vix, there  is  no  decided  objection  to  the  use  of 
a  sponge,  provided  it  is  not  allowed  to  remain 
in  position  for  longer  than  twelve  hours.  In 
post-partum  hmmorrhage  a  sponge  of  fair  size, 
impregnated  with  vinegar  sind  introduced  with- 
in the  uterus,  is  sometimes  effectual  in  check- 
ing the  flow  of  blood,  but  it  should  not  be 
permitted  to  remain  for  more  than  an  hour  or 
two,  lest  it  should  be  difficult  of  removal. 
Great  care  should  be  observed  that  the  sponge 
is  tough,  so  that  no  fragments  may  be  detached 
and  remain,  for  the  blood  absorbed  by  them 
would  almost  inevitably  decompose  and  give 
rise  to  \mpleasant  results. 

When  impregnated  with  a  minute  amount 
of  glycerin,  which  may  be  accomplished  by 
soaking  them  in  a  5-per-cent.  solution  of  that 
substance,  sponges  retain  their  elasticity  per- 
manently and  may  be  used  to  exert  moderate 
pressure  upon  varicose  veins,  enlarged  breasts, 
etc.,  being  held  in  position  by  appropriate  band- 
ages. (See  also  under  Antiseptics  in  surgery, 
vol.  i,  page  138.) — Russell  H.  Nevins. 

SPONGIOPILINE.  —  See  under  Poul- 
tices. 

SPRAYS. — A  spray  is  a  fluid,  which  may 
hold  in  solution  one  or  more  drugs,  reduced  to 
a  condition  of  minute  particles  by  the  force  of 
a  blast  of  air  or  steam.  This  condition  of  the 
fluid  is  known  as  atomization ;  the  instrument 
employed  to  produce  it,  as  an  atomizer. 

There  are  many  forms  of  atomizers  on  the 
market,  which  differ  in  size  and  shape  accord- 
ing to  the  purposes  for  which  they  are  intended 
to  be  used  or  the  blast  power  to  be  employed, 
but  in  all  used  at  the  present  time  the  fluid  is 
forced  through  a  tube  and  as  it  emerges  from 
58 


the  mouth  is  reduced  to  a  spray  by  a  blast  of 
air  or  steam.  The  first  attempt  to  use  a  spray 
was  made  with  a  syringe  which  forced  the 
fluid  through  numerous  minute  perforations  in 
a  plate  of  metal  that  closed  the  objective  end 
cf  the  barrel.  This  method  was  unsatisfactory, 
and  the  apparatus  devised  by  Sir  Benjamin 
Ward  Richardson  was  a  very  great  improve- 
ment. In  this  the  fluid  is  placed  in  a  recepta- 
cle sealed  with  a  stopper  which  contains  two 
tubes,  one  extending  beneath  the  surface,  the 
other  opening  above  the  surface  of  the  fluid 
and  also  at  the  mouth  of  the  first.  The  sec- 
ond tube  is  also  connected  with  the  blast  appa- 
ratus, usually  a  rubber  bulb  which  is  squeezed 
by  the  hand  of  the  operator.  When  air  is  thus 
driven  through  the  second  tube  into  the  res- 
ervoir the  pressure  forces  some  of  the  fluid 
through  the  first  tube  to  its  mouth,  where  it 
is  met  by  a  blast  of  air  from  the  second  tube 
which  reduces  it  to  spray. 

The  form  most  employed  at  the  present 
time,  and  the  most  generally  useful,  depends 
for  its  action  upon  a  different  principle.  Two 
tubes  with  very  fine  mouths  are  placed  at  right 
angles  to  each  other.  One  tube  leads  into  a 
receptacle  containing  the  fluid  which  it  is 
desired  to  atomize,  while  the  other  is  con- 
nected with  the  blast  apparatus.  The  air 
driven  through  the  latter  tube  across  the 
mouth  of  the  former  causes  a  rarefaction  of 
the  air  within  and  a  consequent  rise  of  fiuid 
in  the  tube  until  it  emerges  and  is  blown  into 
spray. 

The  blast  is  obtained  by  compression  of  a 
rubber  bulb,  by  the  liberation  of  compressed 
air,  or  by  steam.  The  hand-ball  atomizer  is 
used  for  many  purposes,  non-medical  as  well 
as  medical,  is  portable,  and  is  familiar  to  every 
one,  but  it  is  of  far  less  efficacy  in  most  cases 
where  the  use  of  the  spray  is  now  considered 
advantageous  than  an  atomizer  which  obtains 
its  power  from  compressed  air.  In  order  to 
obtain  a  continuous  spray  with  a  hand-ball 
atomizer  a  second  bulb  is  inserted  between  the 
hand  ball  and  the  rest  of  the  apparatus.  This 
second  bulb  dilates  as  the  first  is  compressed 
and  by  its  elasticity  maintains  a  steady  blast 
while  the  first  is  being  refilled  with  air.  A 
continuous  spray  of  this  nature  has  some  ad- 
vantage over  the  short,  spasmodic  action  of 
the  single-bulb  apparatus,  but  the  disadvantage 
of  inability  to  stop  the  spray  suddenly  is  very 
great  and  evident.  By  means  of  a  reservoir  of 
compressed  air,  a  connecting  tube,  and  a  cut-off, 
a  spray  may  be  made  continuous  as  long  as  is 
desired  and  stopped  in  an  instant.  Steam  is 
sometimes  used  for  the  blast.  It  has  the  ad- 
vantage of  warmth,  but  by  its  presence  causes 
great  "dilution  of  the  fluid,  a  fact  which  must 
always  be  borne  in  mind  when  a  solution  is 
being  prepared  for  atomization  by  this  means. 

Sprays  have  been  used  to  medicate  the  at- 
mosphere of  rooms,  to  produce  local  anmsthesia, 
to  be  inhaled  as  topical  remedies  for  the  mucous 
membrane  of  the  larynx,  trachea,  and  bronchi, 
to  cleanse  the  mucous  membrane  of  the  nose 
and  throat,  and  to  apply  remedial  agents  to 
the  same. 

In  the  early  days  of  antiseptic  surgery  rooms 


SPURGE 
STAPHISAGRIA 


220 


were  treated  with  continuous  sprays  of  car- 
bolic acid  from  steam  atomizers  before  and 
during  operations,  as  a  precaution  against 
sepsis.  Experience  and  a  better  knowledge  of 
the  principles  of  antisepsis  have  demonstrated 
this  precaution  to  be  unwise  and  useless,  so  it 
has  been  nearly,  if  not  quite,  totally  abandoned. 
Sometimes  the  air  of  a  room  is  medicated  in  a 
similar  manner  by  means  of  a  steam  spray, 
and  a  patient  is  caused  to  remain  there  a  cer- 
tain number  of  hours  in  order  that  the  drug 
may  become  absorbed  into  the  system  through 
the  skin  or  the  mucous  membrane  of  the 
respiratory  tract.  This  plan  is  said  to  have 
been  used  at  several  of  the  European  spas  and 
in  isolated  cases  elsewhere.  Very  often  great 
benefit  is  obtained  in  affections  of  the  larynx 
and  bronchi  by  the  use  of  a  steam  spray  in  the 
room  where  the  patient  is  confined.  In  these 
cases,  such  as  laryngeal  diphtheria,  the  dry 
form  of  chronic  bronchitis,  and  especially 
capillary  bronchitis,  the  steam  itself  is  a  valu- 
able therapeutic  agent,  to  which  the  added 
drugs  may  perhaps  be  considered  adjuvants. 
An  alkaline  spray  is  the  most  generally  useful, 
and  limewater  seems  to  be  the  most  commonly 
used.  Solutions  of  com  mon  salt,  of  bicarbonate 
of  sodium,  and  of  other  alkalies  are  also  em- 
ployed. A  disinfectant,  such  as  eucalyptus, 
turpentine,  thymol,  or  carbolic  acid,  is  often 
added,  but  the  latter  shoidd  be  used  very  care- 
fully, on  account  of  the  danger  of  poisoning  if 
it  is  used  for  any  great  length  of  time. 

Very  volatile  substances,  like  ether  or  rhigo- 
lene,  when  driven  in  the  form  of  a  spray  against 
the  skin,  evaporate  so  rapidly  as  to  quickly 
freeze  that  part  of  it,  deprive  it  temporarily  of 
sensation,  and  so  produce  a  condition  of  local 
anaesthesia.  This  means,  once  extensively  em- 
ployed, has  fallen  considerably  into  desuetude 
since  the  introduction  of  cocaine  as  a  local  an- 
assthetic. 

For  the  purpose  of  inhalation,  an  atomizer 
is  employed  which  reduces  the  fluid  to  a  very 
fine  spray  that  resembles  a  cloud.  As  the 
mouth  and  pharynx  are  filled  with  this  cloud 
the  patient  is  instructed  to  take  deep  inspira- 
tions, in  the  hope  that  a  suflicient  quantity 
of  the  dissolved  drug  may  be  inhaled  and  may 
remain  upon  the  diseased  mucous  membrane 
to  aid  it  to  regain  its  normal  condition.  Unless 
the  spray  is  very  fine,  very  little  indeed  can 
penetrate  into  the  larynx,  and,  though  reduced 
to  a  cloudlike  form,  little,  if  any,  penetrates  as 
far  as  the  bronchi ;  so  this  method  of  treatment 
is  usually  of  little  avail  except  to  the  mucous 
membrane  of  the  larynx  and  the  immediately 
adjacent  portion  of  the  trachea.  In  acute  and 
subacute  laryngitis  such  sprays  of  alkaline  so- 
lutions, resorcin,  cocaine,  and  listerine  are  of 
considerable  value.  Attempts  have  been  made, 
said  by  some  to  have  been  successful,  to  treat 
diseases  of  the  lungs  by  an  exceedingly  fine 
spray  through  the  larynx  and  down  the 
trachea. 

The  principal  use  of  the  spray  is  in  diseases 
of  the  nose  and  throat.  In  general  terms,  the 
objects  to  be  attained  are  to  cleanse  the  mucous 
membrane,  to  render  its  secretions  alkaline,  to 
interfere  with  the  development  of  pathogenic 


micro-organisms,  and  to  furnish  a  jJrotective 
coating  which  will  prevent  too  rapid  evapora- 
tion from  its  surface.  Alkaline  sprays  not  only 
render  the  secretions  of  the  mucous  membrane 
alkaline,  but  also  augment  their  amount,  and 
are  therefore  most  useful  for  the  purpose  of 
cleansing.  Probably  the  most  widely  known 
solution  used  for  this  purpose  is  that  known  as 
Dobeli's,  the  formula  of  which  is: 
5  Borax,  ) 

Sodium  bicarbon-  y  each 8  grains ; 

ate.  ) 

Carbolic  acid 4    '• 

Glycerin 2  fl.  drachms ; 

Distilled  water,  enough  to  make  4  fl.  oz. 
M. 

A  much  less  irritating  solution  for  the  same 
purpose  is  that  known  as  Seller's,  the  original 
formula  of  which  was  as  follows: 

3  Sodium  bicarbonate,  )       ,  o  j      ^ 

Borax,  '[-each...     8  drachms; 

Sodiun 

Sodium  salicylate. 


Sodium  benzoate,  )        ,  nn        ■ 

g  >  each 20  grains ; 


^i;tT''b^^ ''  " 

Menthol  5      " 

Oil  of  wintergreen 6  drops  ; 

Glycerin 8i  fl.  oz. ; 

Alcohol 2       " 

Water,  enough  to  make 16  pints. 


M, 

The  essential  ingredients  of  this  solution 
are  usually  dispensed  in  tablet  form,  on  ac- 
count of  the  much  greater  convenience,  but 
the  proportions  and  even  the  constituents  of 
the  tablets  which  are  sold  as  Seller's  vary  to 
such  a  degree  that  no  certain  formula  can  be 
given.  To  make  tablets  conforming  to  the 
formula  given  above,  omit  the  glycerin,  alcohol, 
and  water,  add  lOf  drachms  of  sodium  chloride, 
mix  thoroughly,  and  divide  into  128  tablets. 
One  tablet  is  dissolved  in  2  oz.  of  water  for  use 
as  a  spray. 

The  following  formula  of  a  Seller's  tablet  to 
be  found  on  the  market  shows  how  wide  a 
variance  exists : 

5  Borax,  )       ,  .        . 

Sodium  chloride,  [  ®*°"   ■■  ^  S™™^  ; 

Menthol,  J       ■  ,     ,  . 

Thymol,  \ ''''°° A  of  a  gram; 

Oil  of  eucalyptus -^  of  a  minim; 

Oil  of  wintergreen ^^^  "        " 

M.  ^ 

Frequently  after  cleansing  the  mucous  mem- 
brane with  this  solution  it  is  advisable  to  spray 
it  with  an  oily  solution  to  form  a  protective 
coating.  In  cases  where  stimulation  is  de- 
sirable, a  solution  of  eucalvptol,  thymol,  and 
menthol  in  a  pure  hydrocarbon  oil,  like  albo- 
lene,  is  very  useful.  In  acute  coryza  this  solu- 
tion, sprayed  into  the  nostril,  sometimes  acts 
like  a  charm  to  lessen  the  congestion  of  the 
mucous  membrane  and  relieve  the  feeling  of 
oppression.  It  is  also  useful  in  simple  chronic 
rhinitis.  In  atrophic  rhinitis  it  is  usually  a 
pleasant  application  for  the  patient  and  relieves 
niany  of  the  disagreeable  symptoms  for  a  time, 
though  it  can  hardly  be  said  to  be  curative. 


221 


SPURGE 
STAPHISAGRIA 


In  all  of  the  above-mentioned  solutions 
drugs  are  included  which  tend  to  repress  the 
development  of  pathogenic  micro-organisms, 
,  but  in  certain  diseases,  such  as  diphtheria  and 
croup,  sprays  of  peroxide  of  hydrogen  or  of 
bichloride  of  mercury  are  recommended.  In 
using  the  latter,  special  care  must  be  taken 
that  the  spray  is  fine,  because  a  coarse  spray  is 
of  less  use  and  sometimes  harmful  by  inducing 
absorption  of  a  too  great  quantity  of  the  drug 
when  it  is  used  for  some  time. 

As  a  prophylactic  against  diphtheria,  some 
authors  recommend  the  daily  use  of  the  follow- 
ing throat  spray,  particularly  for  persons  who 
are  suffering  from  nasal  catarrh  : 

5  Listerine 1  fl.  drachm ; 

Boric  acid 6  grains  ; 

Glycerin 1  fl.  drachm  ; 

"Water,  enough  to  make  1  fl.  oz. 
M. 

Matthias  Lanckton  Foster. 

SPTJE.GE. — See  Euphorbia  pilulifera,  un- 
der Euphorbia  (vol.  i,  page  401). 

SQUILL,  scilla  (U.  S.  Ph.,  Br.  Ph.),  hulhus 
scillm  (Ger.  Ph.),  is  the  bulb  of  Urginea 
(Scilla)  maritima,  a  liliaceous  plant.  It  is 
possessed  of  expectorant,  diuretic,  emetic,  and 
cathartic  properties,  but  is  used  only  when  the 
first  two  are  indicated.  As  an  expectorant,  it 
is  indicated  in  chronic  bronchitis,  when  the 
mucus  is  tough  and  viscid,  and  in  acute  bron- 
chitis, when  the  signs  of  congestion  of  the  mu- 
cous membrane  have  subsided.  '  When,  in  the 
last-named  affection,  the  expectoration  is 
scanty  it  is  desirable  to  combine  with  the 
squill  a  nauseant  expectorant,  such  as  ipecac, 
and,  on  the  other  hand,  when  it  is  profuse,  a 
stimulant  expectorant  is  useful.  Squill  has 
been  employed  to  some  extent  in  croup,  on  ac- 
count of  its  emetic  and  expectorant  properties, 
but  it  is  hardly  to  be  commended. 

As  a  diuretic,  it  is  contra-indicated  when- 
ever there  is  any  inflammatory  process  occur- 
ring in  the  kidneys,  and  it  would  be  safer  to 
restrict  its  employment  to  cases  of  cardiac 
dropsy.  It  is  usual  to  combine  with  it  one  or 
another  of  the  preparations  of  digitalis  when 
it  is  used  as  a  diuretic.  In  overdoses  it  purges 
actively,  and  paralysis  and  convulsions  may  en- 
sue. The  dose  of  the  drug  itself  is  from'  1  to 
2  grains ;  that  of  the  vinegar,  acetum  scillm 
(U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.),  from  15  to  40 
drops ;  that  of  the  fluid  extract,  extractum  scillcB 
fluidum  (U.  8.  Ph.),  2  to  3  minims;  and  of  the 
syrup,  syrupus  scillce  (U.  S.  Ph.,  Br.  Ph.),  from 
40  to  60  drops.  The  compound  syrup,  syrupus 
scillce  compositus  (IT.  S.  Ph.),  contains  about 
a  grain  of  tartar  emetic  in  the  ounce,  also 
senega,  and  is  a  very  useful  expectorant  mix- 
ture except  for  infants  and  persons  of  low  vi- 
tality. It  may  be  given  in  doses  of  from  10  to 
30  drops. 

[The  dose  of  the  tincture,  tinctura  scillce 
(U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.),  is  from  10  to  20 
minims;  that  of  the  oxyrael,  oxymel  scillce 
(Br.  Ph.,  Ger.  Ph.),  is  a  teaspoonful  for  adults 
(from  5  to  20  drops  for  infants)  as  an  expec- 
torant, and  a  teaspoonful,  given  in  fractional 
amounts  at  short  intervals,  as  an  emetic  for 


children.  The  dose  of  the  compound  squill 
pill,  pilula  scillce  composita  (Br.  Ph.),  is  from 
5  to  10  grains ;  for  the  pilula  ipecacuanha 
cum  scilla  (Br.  Ph.),  see  vol.  i,  page  543.] 

Russell  H.  Nevins. 
STANNUM.— See  Tin. 

STAPHISAGRIA  (U.  S.  Ph.),  stapMsa- 
grice  semina  (Br.  Ph.). — The  larkspur  is  a  ge- 
nus of  annual  or  biennial  flowering  herbs  of 
the  natural  order  Ranunculacece,  and  includes 
many  species.  The  one  most  used  in  medicine 
is  Delphinium  Staphisagria,  stavesacre,  indig- 
enous to  the  countries  bordering  on  the  Medi- 
terranean and  cultivated  in  many  parts  of 
southern  Europe.  Also  the  species  Delphi- 
nium ConsoUda,  that  is  common  in  central 
Europe  and  has  been  naturalized  in  tlie 
United  States,  is  sometimes  used  as  well  as 
Delphinium  exaltatum  and  Delphinium  Ajacis. 

The  seeds  of  Delphinium  Staphisagria, 
stavesacre,  are  most  commonly  employed.  In 
earlier  editions  of  the  U.  S.  Ph.  more  promi- 
nence was  given  to  the  seeds  of  Delphinium 
ConsoUda,  which  were  officinally  designated  as 
delphinium.  The  most  important  ingredient 
of  the  seeds  is  delphinine,  an  alkaloid  upon 
which  the  virtues  of  the  drug  are  supposed 
chiefly  to  depend.  It  is  insoluble  in  water; 
soluble  in  21  parts  of  alcohol,  in  11  of  ether, 
and  in  16  of  chloroform.  It  is  an  acrid  sub- 
stance, irritating  to  the  skin  and  mucous 
membranes.  The  seeds  contain  a  non-drying 
fixed  oil  in  the  proportion  of  from  25  to  30 
per  cent. 

Larkspur  seeds  have  been  used  in  the  form 
of  an  outward  "application  for  the  destruction 
of  vermin,  both  in  man  and  in  beasts,  from 
time  immemorial,  and  for  this  purpose  are  still 
somewhat  in  vogue,  though  largely  superseded 
by  more  modern  remedies.  For  such  applica- 
tions the  remedy  is  used  either  in  the  form  of 
a  lotion  or  that  of  an  ointment.  A  decoc- 
tion made  by  boiling  1  oz.  of  the  seeds  in  a 
pint  of  water  has  been  employed  both  for 
phtheiriasis  and  for  scabies.  A  lotion  recom- 
mended for  the  destruction  of  pediculi  capi- 
tis is  made  by  macerating  1  oz.  in  a  pint  of 
vinegar.  A  tinctu'e  in  the  same  proportions 
is  also  used,  as  well  as  a  solution  of  1  scruple 
of  delphinine  in  2  fl.  oz.  of  rectified  spirit. 
Another  effectual  preparation  is  the  expressed 
oil  sufiiciently  diluted  with  olive  oil.  Accord- 
ing to  Balmanno  Squire,  "a  cheap  way  of  pre- 
paring the  oil  for  application  is  to  digest  the 
seeds  in  melted  lard  and  strain  while  ^hot. 
The  flltrate  is  an  ointment  of  the  seeds  of 
stavesacre.  Two  drachms  of  the  bruised  seeds 
should  be  used  to  an  ounce  of  lard." 

Aside  from  these  uses,  larkspur,  more  par- 
ticularly Delphinium  ConsoUda.  has  been  rec- 
ommended as  a  vulnerary,  and  delphinine  has 
been  used  as  a  topical  remedy  for  the  relief 
of  neuralgia,  earache,  and  toothache.  The  al- 
kaloid delphinine  maybe  used  for  this  pur- 
pose either  in  alcohol  (from  16  to  30  grains  to 
the  ounce)  or  in  an  ointment  (10  to  40  grains 
to  the  ounce).  The  unguentum  staphisagrice 
of  the  Br.  Ph.  contains  about  10  per  cent,  of 
oil  of  stavesacre. 


STAR-ANISE 
STIMULANTS 


222 


Internally,  the  drug  is  seldom,  if  ever,  now 
employed,  though  formerly  it  was  used  in 
spasmodic  asthma,  in  dropsy,  in  gout,  and  in 
seasickness,  usually  in  the  form  of  a  tincture 
of  the  seeds.  The  dose  of  delphinine  is  said 
to  be  ^  a  grain,  repeated  at  intervals  of  three 
or  four  hours. — Edward  B.  Bbonson. 

STAB-ANISE.— See  Illicium. 

STARCH.— The  amylum  of  the  U.  S.  Ph- 
is starch  obtained  from  maize ;  that  of  the 
Br.  Ph.  includes  starch  from  wheat,  maize, 
and  rice ;  and  the  amylum  tritici  of  the  Ger. 
Ph.,  as  the  name  implies,  is  wheat  starch  only. 

For  the  use  of  starchy  substances  as  articles 
of  food,  see  the  article  on  Foods.  Starch  may  be 
administered  freely  by  the  stomach  as  an  anti- 
dote in  cases  of  poisoning  with  iodine ;  also, 
when  irritant  preparations  of  iodine,  such  as 
the  tincture,  have  accidentally  come  in  contact 
with  the  body  or  been  applied  too  copiously, 
their  irritating  action  may  be  cheeked  by  the 
immediate  application  of  starch.  Starch  was 
formerly  much  employed,  in  the  form  of  the 
starch  bandage,  for  encasing  a  limb  in  an  im- 
movable envelope  in  cases  of  fracture,  but  for 
this  purpose  it  has  now  been  almost  wholly 
superseded  by  plaster  of  Paris.  At  present 
starch  is  chiefly  used,  finely  powdered,  as  a 
topical  application  in  intertrigo  and  other 
forms  of  superficial  irritation  of  the  skin,  and 
to  reduce  the  strength  of  medicinal  powders 
used  locally  as  dusting  powders. 

Glycerite  of  starch,  gtyceritum  amyli  (U.  S. 
Ph.),  is  a  jellylike  mass  made  with  10  parts  of 
starch,  10  fluid  parts  of  water,  and  80  parts  of 
glycerin.  Glycerine  of  staroh,  glycerinum 
amyli  (Br.  Ph.),  is  also  a  jelly  made  with  1 
part  of  starch,  5  fluid  parts  of  glycerin,  and  3 
fluid  parts  of  distilled  water.  These  jellies 
are  used  as  lubricants,  as  bases  for  ointments, 
and  in  the  preparation  of  certain  suppositories. 
Mucilage  of  starch,  mucilago  amyli  (Br.  Ph.), 
is  employed  chiefly  as  a  vehicle  for  enemata. 
For  iodized  starch,  see  under  Iodine  (vol.  i, 
page  537). 

STAVESACBE.— See  Staphisagbia. 

STEAM. — The  employment  of  the  vapour 
of  water  by  inhalation  is  treated  of  in  the  ar- 
ticle on  Inhalants  (vol.  i,  page  528).  In  cases 
of  acne  with  decided  induration  of  the  lesions 
and  a  tendency  to  their  appearance  in  succes- 
sive crops,  also  in  those  of  chronic  eczema  with 
pronounced  infiltration,  the  daily  exposure  of 
the  affected  parts  to  the  action  of  steam,  as 
hot  as  it  can  comfortably  be  borne,  continued 
lor  from  fifteen  minutes  to  half  an  hour,  often 
proves  of  great  service.  Liberson  (3Iedecine 
moderne,  February  15,  1896;  Iledical  Record, 
March  38,  1896)  finds  that  it  not  only  aids  in 
the  absorption  of  superficial  and  deep  infiltra- 
tion, but  also  diminishes  or  arrests  purulent 
secretions,  removes  crusts,  checks  oozing,  and 
provokes  a  regeneration  of  healthy  tissues. 

Steam  has  been  employed  as  a  hccmostatic. 
In  a  series  of  lectures,  etc.,  published  under 
the  auspices  of  the  Imperial  IJniversity  of  Mos- 
cow (1894,  No.  4  [summarized  in  the  Central- 
Natt  fur  Oyn&lcologie  for  January  19,  1895, 
and  from  that  in  the  University  Medical  Maga- 


zine for  August,  1895]),  Dr.  Snegirjoff  advised 
its  use  for  controlling  hmmorrhage  during  op- 
erations, and  said  that  for  seven  years  he  had 
employed  it  after  dilatation  and  curetting  of 
the  uterine  cavity.  A  small  metal  cannula,  at- 
tached by  a  rubber  tirbe  to  a  kettle  containing 
water  at  the  boiling  point,  was  introduced  into 
the  cervical  canal.  The  steam  was  applied  for 
a  minute.  This  was  always  followed  imme- 
diately by  complete  hasmostasis  and  was  not 
associated  with  pain  or  other  symptoms.  When 
it  was  applied  in  carcinoma  of  the  uterus  the 
foetid  discharge  and  hjemorrhage  disappeared, 
and  the  pain  was  relieved.  When  it  was  ap- 
plied to  the  cavity  of  a  uterus  that  was  after- 
ward removed  the  endometrium  was  found  to 
be  cauterized  and  covered  with  a  thin  white 
membrane,  showing  that  the  steam  had  acted  as 
a  caustic  hcemostatic,  ancesthetic,  and  antiseptic. 
In  a  series  of  experiments  on  animals,  the  liver 
was  extirpated  with  the  loss  of  but  little  blood, 
and  the  animal  survived  ;  also  a  portion  of  the 
spleen,  lung,  kidney,  and  brain.  Haemorrhage 
from  bone  was  controlled,  and  a  new  growth 
of  bone  tissue  followed  the  operation.  A  horn 
of  the  uterus  of  a  dog  was  excised.  Bleeding 
from  a  longitudinal  or  transverse  incision  in 
the  femoral  artery  ceased  after  the  application. 
Muscular  and  cutaneous  haemorrhage  ceased 
immediately,  and  the  operation  was  always 
followed  by  primary  union.  In  1893  Dr.  Sneg- 
irjoff began  to  apply  the  method  in  a  series 
of  operations  at  the  Alxina  Hospital.  In  five 
cases  of  resection  of  the  knee  joint  the  oper- 
ation was  performed  without  the  use  of  an 
Esmarch  tube,  haemostatic  forceps,  or  ligature. 
In  amputation  of  the  breast  for  cancer,  and 
cancer,  lipoma,  and  cavernous  tumours  of  the 
skin,  in  amputation  of  the  cervix  uteri,  and  in 
hysterectomy  for  fibroid  tumours,  to  control 
hfemorrhage  from  the  stump,  the  application 
proved  effective.  After  the  incision  of  ab- 
scesses it  was  employed  as  a  method  of  disin- 
fection ;  in  hfemorrhagC  from  a  sinus  or  fistula, 
particularly  if  it  was  tuberculous,  haemorrhage 
was  controlled  entirely. 

The  writer  in  the  University  Medical  Maga- 
zine adds  an  abstract  of  a  subsequent  article 
on  the  subject  by  Dr.  Ludwig  Pincus,  of  Dant- 
zic  (Centralblatt  fUr  Gyndkologie,  March  16, 
1895).  Pincus  referred  to  Snegirjoff's  publica- 
tion and  reported  nine  cases  in  which  steam 
had  been  employed  in  controlling  haemorrhage 
from  the  uterine  cavity  and  in  treating  endo- 
metritis. In  a  case  of  carcinoma  of  the  fundus 
uteri,  with  severe  pain  in  the  pelvis,  ha^mor- 
rhage,  and  foetid  discharge,  the  application  had 
immediately  been  followed  by  a  discharge  of 
dark-coloured  fluid  containing  degenerated 
tissue,  and  the  haemorrhage  and  foetid  dis- 
charge had  disappeared  and  not  returned  until 
after  eleven  days.  The  treatment  was  con- 
tinued for  a  minute  and  a  half,  and  was  not 
associated  with  any  degree  of  pain. 

Steam  was  used  in  three  cases  of  uncompli- 
cated hyperplastic  endometritis,  with  severe 
menorrhagia.  In  one  case  three  applications 
were  made,  each  lasting  a  minute.  The  men- 
struation during  the  next  two  months  was 
regular  and  normal,  lasting  from  two  to  three 


223 


STAE-ANISR 
STIMULANTS 


days.  In  the  two  other  eases  which  he  had 
observed  but  two  and  three  weeks  respectively, 
the  haemorrhage  had  not  returned.  About  the 
third  day  after  each  application  there  had  been 
a  profuse  leucorrhoeal  discharge,  which  had 
completely  ceased  between  the  ninth  and  the 
twelfth  day.  In  one  of  these  last  cases  the 
treatment  had  been  followed  by  uterine  colic. 
Five  cases  of  cervical  endometntis  were  under 
treatment,  but  had  not  been  observed  long 
enough  for  any  definite  results  to  be  reported. 
Pincus  concludes  that  the  method  is  of  un- 
doubted value,  particularly  from  a  bacteri- 
ological standpoint,  and  that  it  should  be  of 
great  value  in  septic  puerperal  endometritis. 

Superheated  stea,m  has  been  used  as  a  caus- 
tic. Dr.  Paneoki,  of  Dantzic  (Therapeutische 
Monatshefte,  .January,  1896 ;  Deutsche  Iledizi- 
nal-Zeitung,  June  1,  1890;  New  York  Medical 
Journal,  June  20, 1896),  thinks  steam  preferable 
to  other  caustics  for  destroying  the  diseased 
endometrium.  The  caustic  action  of  steam  at 
the  temperature  of  its  generation,  he  says,  is 
superficial  if  it  is  used  for  a  brief  application 
only ;  if  it  is  applied  for  a  long  time  or  in  a 
superheated  state  (heated  to  248°  F.),  its  action 
extends  deeper,  lie  says  the  method  of  its  ap- 
plication is  very  easy  and  simple,  so  that  the 
physician  needs  no  assistant;  moreover,  it  is 
entirely  painless,  and  he  has  never  seen  it  do 
any  harm. 

STESCTJIilA. — Sterculia  (or  Cola)  acumi- 
nata is  a  tree  of  the  Malvales  indigenous  to 
western  Africa  and  cultivated  in  various  trop- 
ical countries.  The  seeds,  contained  in  a  cap- 
sule known  as  the  Icola  nut,  or  garu  nut,  contain 
caffeine,  a  small  amount  of  theobromine,  a  fixed 
oil,  and  a  volatile  oil.  Kola,  although  not  of- 
ficial, has  of  late  come  into  use  as  a  to7iic  and 
stimulant  to  the  nervous  system.  Like  coca,  it 
is  credited  with  marvellous  sustaining  powers 
that  enable  persons  to  endure  great  and  pro- 
tracted exertion,  either  bodily  or  mental,  or  dep- 
rivation of  food  without  suffering  from  fatigue 
or  hunger,  also  with  aphrodisiac  properties  and 
with  promoting  the  appetite  for  tood.  It  is  an 
efficient  and  acceptable  substitute  tor  tea  and 
eoflee.  It  seems  to  act  as  a  tonic  to  the  heart. 
It  is  said  that  by  chewing  from  20  to  40  grains 
of  the  fresh  seeds  a  person  may  often  overcome 
seasiclmess  in  about  three  quarters  of  an  hour. 
Kola  has  been  used  in  France  as  a  remedy  for 
diarrhoea.  Dr.  Albert  L.  Gihon,  of  the  United 
States  Navy  {Medical  Times,  April  17,  1886), 
was  among  the  first  in  this  country  to  use  kola 
therapeutically,  in  an  obstinate  case  of  neuras- 
thenia which  rapidly  yielded  to  its  use.  It  is 
probable  that  its  chief  virtue  will  be  shown  in 
such  cases.  There  are  many  preparations  of 
kola  on  the  market,  most  of  them  proprietary. 
Probably  the  fluid  extract  is  as  satisfactory  as 
any  of  the  others  ;  it  may  be  given  in  doses  of 
from  15  to  20  drops. 

STEBESOL. — This  is  an  antiseptic  varnish 
said  to  consist  of  135  parts  of  shellac,  5  of  ben- 
zoin, 25  of  tincture  of  Tolu,  3  of  oil  of  cinna- 
mon, 50  of  carbolic  acid,  and  enough  alcohol 
to  make  500  parts.  It  is  used  topically  in  diph- 
theria. 


STERNUTATOBIES,  or  remedies  or 
measures  which  excite  sneezing,  were  formerly 
employed  to  stimulate  the  secretion  of  the  mu- 
cous membrane  of  the  nose,  thus  relieving  the 
system  of  "  peccant  "  substances,  and  to  relieve 
vai'ious  morbid  conditions  by  repeated  acts  of 
sneezing.  At  the  present  time  they  hardly  en- 
ter into  medical  practice  and  are  only  employed 
when  it  is  desired  to  obtain  the  aid  of  sneezing 
to  expel  foreign  bodies  from  the  nose,  and  even 
then  they  may  be  dangerous,  causing  rupture 
of  weakened  blood-vessels.  Snuff  and  black  pep- 
per are  obtainable  almost  everywhere,  and  are 
as  suitable  as  any  other  sternutatory.  Occasion- 
ally it  will  be  found  that  small  objects  in  the 
eye,  such  as  particles  of  sand,  can  be  removed 
by  causing  the  person  to  close  the  affected  eye 
while  sneezing  is  excited.  The  rapid  passage 
of  air  through  the  nose  undoubtedly  causes  a 
partial  vacuum  in  the  tear  duct,  and  the  con- 
sequent sudden  gush  of  tears  from  the  eye  is 
very  apt  to  wash  out  the  foreign  body.  The 
same  effect  may  often  be  produced  by  closing 
the  nostril  of  the  same  side  as  the  affected  eye 
and  blowing  the  nose  with  considerable  force. 

liUSSELL  H.  NeVINS. 

STIBIUM.— See  Antimony. 

STILLINGIA,  or  queen's  root,  is  the  roof 
of  Stillingia  silvatica,  an  American  herbaceous 
plant  of  the  Euphorhiacece.  In  large  doses,  it 
is  emetic  and  cathartic  ;  in  the  doses  ordinarily 
employed,  it  is  credited  by  some  practitioners 
with  alterative  virtues  similar  to  those  ascribed 
to  sarsaparilla,  and  is  used  in  the  treatment  of 
syphilis,  scrofula,  and  other  dyscrasice.  The 
fluid  extract,  extractum  stillingice  fluidum 
(XT.  S.  Ph.),  may  be  given  in  doses  of  from  15 
to  45  minims. 

STIMULANTS.— These  may  be  defined  as 
agents  whose  influence  is  to  augment  the  vital 
activity  or  function  of  an  organ  or  to  increase 
the  vital  energy  of  the  entire  system.  By  the 
heightening  of  the  physiological  functions, 
stimulants  may,  at  the  same  time,  carry  a 
corrective  or  an  economical  effect  upon  sys- 
tems weakened  or  partly  disturbed  by  diseased 
conditions.  Many  of  the  substances  used  ther- 
apeutically as  stimulant  agents  evoke  an  in-  , 
tensifying  action  upon  normal  tissues  or 
systems  of  the  human  organism.  With  few 
exceptions,  however,  the  subject  will  be  dis- 
cussed in  this  article  from  its  therapeutical 
standpoint,  such  deviations  being  made  only 
for  the  sake  of  lucidity. 

Colloquially,  the  word  "  stimulants  "  is  used 
with  reference  to  alcoholic  liquors.  Aside  from 
the  fact  that  these  agents  are  of  undoubted  use 
in  the  treatment  of  disease,  their  ancient  usage 
demands  some  consideration.  Wine  is  referred 
to  by  Homer,  and  evidently  its  increased 
strength  acquired  by  age  was  known  to  the  an- 
cient Greeks,  since  the  poet  makes  mention  of 
wine  eleven  years  old.  The  Brahmans  used  the 
moon-plant  (Asclepias  acida)  as  a  sacrifice  for 
the  expiation  of  sin  ;  and  the  faithful  were  not 
allowed  to  touch  the  sacred  plant  except  for 
religious  purposes.  The  inhabitants  of  Egypt 
were  acquainted  with  the  intoxicating  powers 
of  grape  wine,  and  fermented  wine  formed  a 


STIMULANTS 


234 


conspicuous  part  in  the  religious  services  of  the 
ancient  Jews,  as  it  does  in  the  communion  ser- 
vices of  the  present  day.  Every  nation,  sav- 
age or  civilized,  possesses  some  characteristic 
stimulant,  from  the  coffee  of  the  Javanese  and 
the  tea  of  the  Chinese  to  the  kumyss  of  the 
Tartars  and  the  coca  leaves  of  the  South  Amer- 
ican Indians.  Stimulants  in  some  form  seem 
to  be  essential  to  the  carrying  out  of  routine 
duties ;  and  it  is  altogether  likely  that  the 
stimulant  required  by  the  savage  before  his 
entrance  into  battle  or  previous  to  the  under- 
taking of  a  Journey,  is  identical,  so  far  as  its 
purpose  is  concerned,  with  the  exhilarant  which 
the  man  of  higher  civilization  demands  in  his 
struggle  for  maintenance  and  advancement. 
Whatever  may  be  the  purpose  of  its  ingestion, 
it  is  true  that  every  race  and  tribe  is  possessed 
of  some  stimulant  in  its  armamentarium  of 
life.  The  moral  and  political  sides  of  the  ques- 
tion can  not  be  discussed  in  this  place. 

Broadly,  stimulants  may  be  grouped  into  two 
great  classes,  general  and  local.  By  general 
stimulants  are  meant  those  agents  which  pro- 
duce their  effect  simultaneously  upon  the 
entire  system.  Theoretically,  most  of  the 
stimulant  substances  would  come  under  this 
head,  since  vital  energy  or  the  increase  in  the 
vital  forces  is  recognised  chiefly  from  the  mani- 
festations of  the  circulatory  and  nervous  appa- 
ratus. And  yet  a  line  must  be  drawn,  for  many 
of  the  agents  under  consideration  induce  their 
manifestations  by  their  influence  upon  organs 
or  sets  of  organs.  Such  stimulants  are  known 
as  local  stimulants,  and  when  general  "effects 
are  produced  by  them  it  is  by  secondary  action 
or  by  the  ingestion  of  a  dose  larger  than  is 
necessary  to  call  forth  the  merely  local  influ- 
ence. Again,  not  all  stimulants  possess  alone 
a  vivifying  effect  upon  the  organism  or  a  part 
of  it.  Some  of  them,  like  opium,  for  instance, 
have  in  different  doses  a  sedative  influence ; 
while  others — for  example,  carbonate  of  ammo- 
nium— may  produce  irritation.  Yet  the  pri- 
mary effect  of  the  stimulants  is  stimulation,  and 
for  the  present  purpose  they  will  be  so  consid- 
ered. 

Before  reviewing  some  of  the  properties  of 
the  main  stimulants,  it  will  be  well  to  recog- 
nise the  general  principles  underlying  their  use 
and  the  indications  for  their  administration. 
The  personal  element  and  the  individual  tem- 
perament offer  bases  for  study.  A  man  ad- 
dicted to  the  use  of  coffee,  for  example,  will 
respond  but  poorly  in  emergency,  as  a  rule,  to 
the  alkaloid  of  the  bean.  Habit  plays  an  im- 
portant rSle  in  the  determination  of  the  effect 
desired  from  a  stimulant  agent.  A  patient  ex- 
hausted in  a  typhoid  fever  who  has  been  a 
heavy  user  of  alcohol  in  any  of  its  forms  will 
require  a  much  larger  proportion  of  this  stimu- 
lant to  secure  a  beneficial  action  than  one  whose 
system  is  not  permeated  with  it.  It  is  so  well 
known  that  drunkards  withstand  severe  disease 
poorly  that  it  has  become  an  established  prin- 
ciple that  such  patients,  especially  when  they 
suffer  from  grave  injuries  which  shock  the 
nervous  system,  shall  receive  copious  libations 
of  alcoholic  stimulants,  for  without  them  they 
will  most  certainly  succumb.    The  withdrawal 


of  any  accustomed  stimulant  evokes  a  shock 
which  is  often  more  to  be  feared  than  the  im- 
pending or  present  disease.  Exception  should 
be  made,  perhaps,  in  the  case  of  tobacco,  for 
many  users  of  the  weed  lose  their  taste  for 
smoking  or  chewing  during  an  acute  disease, 
sometimes  even  permanently.  The  individual 
temperament,  aside  from  habit,  must  be  taken 
under  consideration,  too.  Coffee  or  tea  may 
make  one  person  wakeful,  and  have  the  reverse 
effect  upon  another.  Tobacco  may  calm  one 
mind  and  distress  another  ;  it  may  arouse  the 
intellect  on  the  one  hand,  or  may  cloud  and 
obscure  its  workings  on  the  other.  Alcohol  in 
any  of  its  forms  presents  the  most  diverse  ef- 
fects upon  different  persons.  It  may  produce 
drowsiness  or  wakefulness ;  it  may  constipate 
or  cause  diarrhcea  ;  it  may  relieve  a  headache 
or  be  responsible  for  the  reverse  condition  ;  its 
use  may  cause  strength  in  one,  weakness  in 
another ;  from  one  intellect  it  may  call  forth 
brilliancy  and  it  may  blunt  another. 

Sex  has  an  important  bearing  upon  the  ad- 
ministration of  stimulants.  Women  yield  to 
them  much  more  easily  than  men,  and  require, 
therefore,  smaller  doses.  The  aged  require 
stimulation,  particularly  in  diseased  conditions, 
while  children,  in  health  at  least,  are  inde- 
pendent in  this  respect.  The  habitual  use  of 
some  stimulant  is  preferred  for  old  people  by 
many  authors  as  giving  tone  to  the  stomach, 
brain,  and  heart.  The  effects  of  stimulants 
vary  with  race  and  climate.  Savages  yield 
readily  to  the  influences  of  stimulant  agents 
to  which  they  are  not  accustomed,  and,  like 
diseases 'which  are  generally  innocuous  in  civ- 
ilization, such  agents  in  large  quantities  may 
prove  fatal.  Stimulants  can  be  used  with 
greater  freedom  and  less  danger  in  their  native 
places  than  elsewhere,  as  witness  the  prolonged 
and  harmless  chewing  of  coca  leaves  by  trav- 
ellers in  South  America.  The  effects  of  stimu- 
lants are  modified  by  disease.  Enormous  doses 
of  alcohol  can  be  given  in  typhoid  fever,  for 
example,  without  bringing  about  intoxication, 
and  in  cases  of  chronic  debility  immense  quan- 
tities of  alcoholic  liquors  may  be  taken  with 
impunity. 

All  agents  used  as  stimulants  depend  upon 
some  contained  active  principle  for  their  effect, 
which  is,  in  its  turn,  dependent  upon  the  quan- 
tity administered.  Within  certain  limits,  too, 
they  are  all  capable  of  replacing  ordinary  food 
for  the  sustenance  of  the  system.  In  the  case 
of  alcohol  this  is  probably  due  to  the  preven- 
tion of  tissue  waste  by  purely  chemical  means, 
since  carbon  and  hydrogen  are  offered  to  the 
oxygen  of  the  blood  in  place  of  the  elements 
in  the  tissues.  The  coca  leaves  offer,  on  cor- 
roborated evidence,  a  large  amount  of  suste- 
nance and  great  powers  of  endurance.  Coffee 
and  tea  have  sustaining  powers  to  a  marked 
degree,  and  in  the  case  of  perhaps  the  greatest 
proportion  of  civilized  nations  form  the  chief 
element  of  the  first  meal  of  the  day.  Some 
African  tribes,  when  preparing  for  long  jour- 
neys, take  with  them  only  coffee  and  butter  as 
articles  of  food. 

Alcoholic  stimulants  may  stand  as  a  type 
for  general  stimulants.    Under  this  head  may 


235 


STIMULANTS 


be  included  whisky,  bvaudy,  wines  of  all  kinds, 
ale,  beer,  porter,  and  stout.  Whisky  and 
brandy  may  be  regarded  as  representing  what 
are  known  as  diffusible  stimulants,  those  which 
are  quickly  absorbed  and  act  with  correspond- 
ing rapidity.  In  diseases  marked  by  the  so- 
called  typhoid  state — that  is,  in  adynamic 
conditions — the  alcoholic  medicines  are  pre- 
eminently indicated,  not  for  any  curative  in- 
fluence, indeed,  but  because  their  ingestion  at 
the  time  when  weakness  is  manifested  in  all 
the  organs,  and  mental  hebetude  supervenes, 
produces  a  purely  stimulant  effect  first,  and 
secondarily  acts  as  a  food  to  the  patient.  The 
dose  of  alcoholic  stimulants  in  such  phases  of 
disease  demands,  hovyever,  careful  considera- 
tion. Should  intoxication,  even  of  slight  de- 
gree, supervene,  the  succeeding  exhaustion  and 
depression  are  dangerous  in  the  extreme.  The 
amount  to  be  given  must  be  accurately  gauged 
and  can  be  determined  only  by  experiment. 
By  administering  these  stimulants  in  small 
doses  the  dose  for  each  individual  may  be  as- 
certained with  precision  and  the  further  ad- 
vantage may  be  gained  of  maintaining  the 
stimulant  action  for  a  considerable  time.  The 
different  degrees  of  susceptibility  and  their 
causes,  as  enumerated  above,  must  be  con- 
stantly in  mind. 

The  diffusible  stimulants  are  of  value  in 
other  conditions,  too,  than  the  mere  exhaus- 
tion of  disease.  In  the  beginning  of  the  milder 
infections,  such  as  an  acute  coryza  or  amygda- 
litis, a  hot  alcoholic  drink,  taken  during  or 
immediately  after  the  initiatory  chill  or  chilly 
feeling,  may  abort  the  attack.  Persons  ex- 
posed to  cold  and  wet  feel  an  immediate  re- 
newal of  warmth  after  the  ingestion  of  one  of 
the  diffusible  stimulants,  particularly  if  it  is 
accompanied  by  immersion  of  the  feet  in  hot 
water.  In  cases  of  temporary  weakness  of  the 
heart,  as  in  fainting,  a  warm  alcoholic  stimu- 
lant is  of  great  service.  In  all  instances  of 
cardiac  depression,  whether  from  poisoning, 
shock,  or  hfemorrhage,  alcohol  is  one  of  the 
best  means  at  our  disposal  for  stimulating  tlie 
heart  to  act,  and  temporarily  to  bridge  over  the 
crisis.  It  has  undoubtedly  saved  many  lives 
when  used  subcutaneously  in  large  doses  in 
impending  death  in  the  instances  mentioned. 

Whisky  and  brandy,  being  very  diffusible, 
are  to  be  preferred  for  rapid  stimulation.  The 
heavier  wines,  such  as  port,  burgundy,  sherry, 
and  claret,  are  of  greater  service  in  the  conva- 
lescent stages  of  prolonged  disease  ;  they  have 
a  more  agreeable  taste  and  are  tonic  as  well  as 
stimulating.  Champagne  is  an  excellent  stim- 
ulant after  severe  operations  and  tends  to  allay 
vomiting  and  nausea  when  given  very  cold  in 
frequent  small  doses. 

All  the  alcoholic  stimulants  have  the  s^me 
effect  upon  the  heart's  action  and  the  cerebral 
areas.  The  stimulation  by  these  agents  is 
evoked  by  an  increase  in  the  arterial  pressure 
and  by  a  reflex  conti'action  of  the  vessels.  The 
heart-beat  is  accelerated  and  becomes  more 
forcible  by  reason  of  reflex  action  from  the 
sensory  nerves  of  the  mouth,  oesophagus,  and 
stomach  when  the  fluid  is  taken  internally. 
It  is  quite  probable,  too,  that  there  ensues  a 


local  dilatation  of  the  cerebral  arteries  as  a 
consequence  of  the  ingestion  of  the  fluid,  which 
accounts  for  the  usual  accompanying  cerebral 
stimulation.  The  quantity  and  the  quality  of 
the  blood  sent  to  the  brain,  together  with  the 
varying  contraction  and  dilatation  of  the  blood- 
vessels and  the  force  of  the  cardiac  beat,  also  aid 
in  giving  rise  to  cerebral  stimulation.  Very 
small  amounts  of  the  other  general  stimulants, 
such  as  tea,  coffee,  betel  nut,  and  the  kola  nut, 
have  a  rapid  effect  when  taken  by  sipping. 
The  influence  is  much  more  pronounced,  and 
even  a  glass  of  cold  water,  slowly  sipped,  will 
produce  a  quick  increase  in  the  arterial  press- 
ure and  a  stimulation  of  the  circulation.  Sim- 
ilar results  may  be  obtained  by  stimulation  of 
the  nasal  mucous  membrane  by  the  odour  of 
volatile  salts,  such  as  carbonate  of  ammonium. 
The  use  of  smelling  salts  is  dependent  for  its 
restorative  effects  upon  this  principle. 

The  cold  lath  is  a  highly  valuable  respira- 
tory and  cardiac  stimulant  in  cafes  of  insola- 
tion, and  thus  induces  a  general  stimulating 
effect.  In  these  instances  it  exerts  a  tonic  ef- 
fect, too,  upon  the  peripheral  nervous  system, 
the  brain,  and  the  spinal  cord.  In  asthenic 
conditions  provoked  by  prolonged  fevers  or  by 
other  exhausting  causes,  the  cold  bath,  judi- 
ciously employed,  exerts  a  favourable  influence 
by  its  stimulation  of  the  vital  functions,  liest- 
lessness  is  quieted,  sleep  may  be  induced,  and 
delirium  and  prostration  may  be  lessened  by  its 
use.  The  respiration  and  the  circulation  feel 
the  influence  of  the  stimulative  process,  the 
former  being  deepened  and  amplified,  the  lat- 
ter receiving  a  renewal  of  tone.  In  this  in- 
stance stimulation  is  evoked  by  the  calming 
and  soothing  sequel  of  the  agent.  The  hot 
hath,  also,  by  its  sedative  action,  causes  stimu- 
lation of  the  cardiac  beat  in  a  reflex  way,  and 
thus  augments  the  energy  of  the  system.  Its 
good  results  are  seen  especially  in  atonic  con- 
ditions of  the  lungs  and  kidneys  and  in  some 
forms  of  heart  disease.  The  local  application 
of  water  in  the  form  of  sprays  and  douches 
and  sheet  baths  induces  a  general  stimulant 
effect  which  is  of  use  in  many  nervous  states. 
(For  the  indications  and  methods  see  under 
Htdriatics.) 

Dry  heat,  by  affording  a  dilatation  of  the 
cutaneous  and  subcutaneous  blood-vessels,  ex- 
erts the  influence  of  a  general  stimulant  upon 
the  organism.  In  cases  of  shock,  whether  or 
not  it  follows  an  operation,  the  application  of 
hot-water  bags,  of  heated  sand,  or  of  tin  cases 
containing  hot  water  to  the  sides  and  extremi- 
ties of  the  patient  aids  in  keeping  up  the  bal- 
ance of  the  circulation  and  in  restoring  the 
animal  heat.  In  the  algid  stage  of  cholera  and 
in  asphyxia  from  immersion  or  from  other 
causes,  dry  heat  is  valuable  as  a  restorative 
having  the  subsequent  effect  of  a  general  stim- 
ulant. In  the  treatment  of  all  cases  in  which 
the  temperature  has  fallen  below  the  normal, 
dry  heat  in  conjunction  with  two  of  the  car- 
diac stimulants,  atropine  and  digitalis,  is  pre- 
eminently indicated. 

In  some  manner  not  understood,  opium  may 
act  as  a  supporting  and  stimulant  agent  in 
some  forms  of  low  fever  and  in  conditions  of 


STIMULANTS 


226 


adynamia  from  any  cause.  When  there  is 
vomUing  and  not  enough  food  is  retained  to 
maintain  life,  opium  is  of  service  in  tiding 
over  the  patient  until  such  times  as  the  func- 
tions are  restored  to  the  normal  standard.  In 
such  cases,  administered  in  small  doses,  it  acts 
as  a  general  stimulant,  supporting  the  circula- 
tion, maintaining  the  heart  and  lungs,  and 
keeping  the  mind  clear. 

Electricity  must  be  regarded  as  a  general 
stimulant  when  its  influence  in  restoring  vital 
functions  after  deep  narcotism  or  asphyxia  is 
considered.  After  the  cessation,  or  apparent 
cessation,  of  respiration  in  chloroform  anaes- 
thesia, the  faradaic  current,  applied  to  the 
phrenic  nerve  at  the  root  of  the  neck,  may 
renew  respiratory  movements.  In  asphyxia 
neonatorum  and  in  impending  apncea  or  in 
orthopnma.  the  faradaic  current  may  evoke 
deeper  and  fuller  breathing.  Only  in  so  far 
as  electricity  is  of  aid  in  stimulating  the  vital 
functions,  however,  can  it  be  regarded  as  a 
general  stimulant. 

The  oxygen  of  the  inspired  air  is  one  of  the 
main  stimulants  which  the  body  receives.  It 
is  as  essential,  too,  as  it  is  constant  in  its  en- 
trance to  the  organism.  Inhaled  pure  or  as 
such,  oxygen  acts  as  a  stimulant  to  the  cardiac 
and  vascular  apparatus  and  produces  a  feeling 
of  energy  which  is  imparted  to  the  entire  sys- 
tem. The  effects  on  the  pulse  are  said  to  be 
transient,  but  the  general  exhilarating  influ- 
ence remains  as  long  as  the  oxygen  is  adminis- 
tered. In  dyspnoea  of  cardiac  or  pulmonary 
origin,  whether  the  mind  is  clear  or  obscured, 
oxygen,  given  by  inhalation,  may  help  to  take 
the  place  of  the  impaired  movements  of  the 
lungs,  furnishing  a  sufficient  supply  of  the  gas 
to  last  until  the  aetio'logical  difficulty  is  over- 
come. Frequently  it  may  arouse  a  patient 
from  a  light  coma  in  the  condition  specified. 

Strictly  speaking,  only  alcohol  in  its  various 
forms,  dry  heat,  and  electricity  should  be  in- 
cluded among  the  general  stimulants.  But  it 
is  very  difficult  to  draw  a  sharp  dividing  line 
between  those  agents  which  stimulate  the  en- 
tire system  and  those  whose  influence  extends 
indirectly  to  the  entire  organism  through  their 
action  upon  the  cerebro-spinal  axis  and  the 
vascular  apparatus.  Among  these  may  be 
mentioned  coca,  coffee  and  caffeine,  tea  and 
thebaine,  tobacco  and  nicotine,  chocolate,  wines 
of  all  kinds,  ammonia  and  many  of  the  salts  of 
ammonium,  ether  and  chloroform,  and  cam- 
phor. Many  of  these  are  cardiac  stimulants 
and    are  referred  to  under  Cardiac   stisiu- 

LANTS. 

It  is  of  value  in  cases  of  general  debility,  in 
depressed  conditions  of  the  spinal  cord,  and  in 
functional  viealcness  ot  some  of  the  internal 
organs  to  administer  spinal  stimulants.  Where 
an  inflammatory  condition  of  the  motor  cen- 
tres of  the  cord  exists,  however,  spinal  stimu- 
lants are  apt  to  do  more  harm  than  good. 
Little  benefit  can  be  expected  from  the  use  of 
these  agents  in  paralyses  of  organic  origin,  but 
when  a  hemiplegia  depends  upon  a  toxic  effect, 
as  in  lead  poisoning,  they  are  of  a  specially  use- 
ful nature.  The  excellent  results  obtained 
from  their  administration  in  nocturnal  enure- 


sis, in  atonic  retention  of  urine,  and  in  loss  of 
voluntary  motion  in  groups  of  muscles  are  well 
known.  When  prolonged  overwork  or  great 
excitement  has  caused  mental  and  physical  de- 
pression, some  of  the  spinal  stimulants  are 
serviceable.  All  the  spinal  stimulants  proba- 
bly act  by  increasing  the  excitability  of  the 
nerve  cells  in  the  spinal  cord  and  thei-eby  in- 
creasing the  rate  at  which  stimuli,  particularly 
reflex  impulses,  are  transmitted.  Their  influ- 
ence, like  that  of  the  general  stimulants,  ex- 
tends to  the  heart  and  circulation  and  in  some 
part  to  the  brain.  The  most  prominent  of  the 
spinal  stimulants  is  strychnine,  and  it  may 
stand  as  a  characteristic  type  of  the  group  as 
alcohol  does  for  the  general  stimulants.  'J'lie- 
baine  and  brucine  are  next  in  their  power  of 
action,  and  others,  of  less  impoi-tance,  are  ab- 
sinthe, ammonia,  gelsemine,  calabarine,  and 
nicotine.  In  very  large  doses,  also,  opium, 
morphine,  and  atropine  may  call  forth  convul- 
sions of  spinal  origin,  so  that  in  this  sense  they 
might  be  called  spinal  stimulants. 

One  of  the  most  important  groups  of  medi- 
cines in  all  departments  of  therapeutics  is  the 
class  known  as  cardiac  stimulants.  Their  use 
is  essential  and  is  indicated  in  many  conditions 
of  acute  and  chronic  disease.  In  the  treatment 
of  shock  from  any  cause,  where  there  is  weak- 
ness in  the  cardiac  beat  or  depression  of  the 
cardiac  ganglia  or  muscle,  cardiac  stimulants 
are  indicated.  In  the  prolonged  course  of  an 
acute  disease,  infectioiis  or  not,  where  asthenia 
or  adynamia  supervenes,  the  cardiac  stimulants 
are  of  use  to  support  the  patient  or  to  carry  him 
over  a  crisis.  Profound  collapse  with  depres- 
sion of  the  circulation  and  respiration,  instances 
of  threatened  death  from  sufocation  or  drown- 
ing, and  the  shocJc  from  an  ancesthetic  offer  le- 
gitimate opportunities  for  the  administration 
of  stimulants  for  the  heart.  In  the  crises  of 
pneumonia,  when  the  I'ight  heart  is  working 
against  tremendous  odds,  it  is  doubtful  if  we 
could  dispense  with  the  cardiac  stimulants. 
JSxhaustion  from  any  cause,  whether  from  dis- 
ease or  from  overwork,  from  great  excitement  or 
from  prolonged  emotional  strain,  demands  the 
efficient  and  intelligent  use  of  the  medicines 
under  consideration. 

There  are  two  conditions,  broadly  speaking, 
which  call  for  the  use  of  cardiac  stitimlants. 
The  first  is  convalescence  from  disease  in  which 
the  heart,  like  other  organs,  has  become  de- 
pressed and  weakened,  and  added  to  this  indi- 
cation might  legitimately  be  appended  certain 
forms  of  heart  disease  in  which  the  viscus  is 
not  properly  fulfilling  its  function,  and  the 
weakness  of  old  age.  The  second  indication  is. 
to  generalize,  any  sudden  failure  of  the  cardiac 
apparatus  or  any  group  of  symptoms  pointing 
to  an  impending  cessation  of  the  heart's  beat. 
The  symptoms  are  so  plain  and  so  easy  to  be 
recognised  that  it  is  not  necessary  in  this  place 
to  rehearse  them.  Suffice  it  to  say  that  it  does 
not  matter  what  the  aetiology  of  the  heart's 
poor  action  may  be,  the  use  of  stimulants  in 
the  conditions  enumerated  is  urgently  demand- 
ed. The  cardiac  stimulants  properly  included 
in  the  first  group  mentioned  should,  strictly 
speaking,  come  under  the  head  of  cardiac  ton- 


237 


STIMULANTS 


ios,  although  their  influence  is  first  a  stimu- 
lant, later  a  tonic  one.  They  will  therefore 
not  be  discussed  here.  (See  under  Cardiac 
TONICS,  vol.  i,  page  317.)  The  stimulants  of 
the  second  group,  however,  come  legitimately 
into  this  article. 

Alcohol  stands  foremost  as  a  rapid  and  safe 
cardiac  stimulant.  In  those  instances  in  which 
it  is  used  to  prevent  or  to  counteract  sudden 
failure  of  the  heart,  it  must  be  given  in  con- 
centrated form.  Its  most  diffusible  prepara- 
tions are  whisky  and  brandy  ;  and  to  perform 
their  work  most  quickly  these  should  be  ad- 
ministered subcutaneously.  In  cases  in  which 
the  patient  can  not  swallow  the  medicine,  the 
alcoholic  preparation  may  be  given  in  the  form 
of  an  enema  ;  but  it  is  apt  to  be  expelled  from 
the  rectum,  for  an  unconscious  or  partly  co- 
matose patient  has  little  or  no  control  over  his 
sphincter  muscles.  In  an  emergency,  alcohol 
is  best  given  in  small  doses  frequently  repeat- 
ed, since  its  stimulant  action  is  thus  longer 
maintained.  Its  effect  should  be  carefully 
noted,  too,  for  it  is  apt  to  prove  harmful  rather 
than  beneficial  if  it  docs  not  succeed  in  bring- 
ing the  pulse  nearer  the  normal  standard  in 
force  and  frequency.  Moreover,  it  is  clinically 
well  established  that  large  doses  of  alcohol  may 
paralyze  the  cardiac  muscle,  and  in  some  cases 
even  a  temporary  reduction  of  the  power  of  the 
heart  may  prove  fatal.  In  combination  with 
alcohol,  ether  forms  one  of  the  most  reliable  of 
heart  stimulants,  although  its  good  effects  in 
an  emergency  are  as  often  obtained  when  it  is 
used  alone  or  with  camphor.  Ether  must  be 
given  subcutaneously  when  it  is  given  for  its 
stimulant  effect ;  or,  rather,  the  injection  must 
be  made  deep  into  the  tissues.  It  is  very  prone 
to  produce  an  abscess  at  the  site  of  injection, 
but  even  this  sequel  would  hardly  be  a  formi- 
dable objection  in  the  face  of  impending  death. 
The  field  for  which  ether  is  particularly  adapt- 
ed is  that  of  the  unexpected  cardiac,  failure 
sometimes  seen  in  chloroform  ancesthesia  or 
even  in  ether  narcosis.  In  Germany  and  Aus- 
tria it  is  chiefly  depended  upon  as  a  cardiac 
stimulant,  to  the  almost  utter  exclusion  of 
other  similar  agents.  In  flagging  of  the  heart 
evoked  by  a  large  or  uncontrollable  hsemor- 
rhage,  neither  ether  nor  alcohol  can  be  substi- 
tuted for  an  intravenous  or  infra-arterial  saline 
infusion,  than  which  there  is  no  better  stim- 
■  ulant  for  the  heart.  Particularly  when  the 
infusion  is  combined  with  the  use  of  strych- 
nine is  its  effect  upon  the  cardiac  apparatus  a 
strikingly  stimulant  one.  A  saline  solution 
thrown  into  the  rectum,  if  of  the  physiological 
strength,  may  accomplish  beneficial  results  for 
the  heart  in  instances  of  shock  or  hasmorrhage. 
Even  the  injection  of  the  same  solution  into 
the  intercellular  spaces,  as  in  cases  of  suffoca- 
tion from  illuminating  gas,  evokes  a  powerful 
cardiac  stimulation.  (See  under  Tkansfusion.) 
Ammonia  has  long  been  recognised  as  an 
efficient  cardiac  stimulant  in  collapse  and  in 
intoxications  with  cardiac  depression.  It  may 
be  thrown  directly  into  a  vein,  or  its  vapour 
may  be  applied  to  the  nasal  mucous  membrane, 
or  it  may  be  given  subcutaneously,  alone  or  in 
combination  with  an  alcoholic    preparation. 


Ammonia,  like  alcohol,  is  reflex  in  its  action 
on  the  cardiac  apparatus,  and  accomplishes  its 
stimulation  not  only  by  its  influence  upon  the 
heart,  but  by  its  effect  upon  the  vaso-motor 
centres  also.  The  best  preparation  of  ammonia 
for  this  purpose  is  the  aqua  ammonicB  fortior 
(U.  S.  Ph.),  or  the  liquor  ammonia  (Br.  Ph.). 

Among  the  alkaloids  which  may  be  used  in 
sudden  cardiac  failure,  with  results  which  vary, 
are  atropine,  strychnine,  digitaline,  and  caf- 
feine. Of  these,  strychnine  gives  the  greatest 
tone  to  the  heart,  while  the  others  render  its 
beat  more  efficient.  The  nitrites  are  excellent 
cardiac  stimulants.  While  one  is  waiting  for 
an  effect  from  subcutaneous  instillations,  in- 
halations of  nitrite  of  amyl  will  prove  helpful 
in  rousing  a  heart  on  the  verge  of  collapse  or 
failure.  JSitroglycerin,  hypodermically  admin- 
istered, acts  like  nitrite  of  amyl  in  producing 
a  lessening  of  arterial  pressure  with  increase 
in  the  force  and  frequency  of  the  pulse. 

Among  agents  not  drugs  which  may  be  re- 
garded as  reliable  cardiac  stimulants,  heat,  dry 
or  moist,  occupies  a  prominent  position.  A 
poultice  or  hot-water  bag,  placed  over  the 
heart,  maybe  serviceable  in  time  of  emergency. 
The  use  of  large  quantities  of  hot  water  by 
the  rectum  or  by  the  mouth  will  prove  benefi- 
cial to  the  heart  in  hemorrhage  especially. 
The  impression  upon  a  flagging  or  collapsed 
heartof  counter-irritation,  particularly  the  fre- 
quently repeated  (sixty  to  seventy  times  a  min- 
ute) pressure  of  the  thumb  over  the  pra;cordia, 
is  to  awaken  its  muscles  and  ganglia  to  re- 
newed efforts,  and  it  may  be  satisfactorily  em- 
ployed in  sudden  cessation  of  the  heat  of  the 
heart  during  ancesthesia.  Some  of  the  volatile 
oils  also  have  a  reputation  as  cardiac  stimu- 
lants. 

Stimulation  of  a  heart  suddenly  weakened 
demands,  above  all,  rapidity.  Hence  the  meth- 
od of  evoking  the  stimulation  should  be, 
preferably,  by  subcutaneous  or  intravenous  in- 
jection ;  next,  the  rectum  is  to  be  chosen  ;  and 
lastly,  the  mouth. 

Vascular  stimulants,  although  closely  related 
in  their  action  to  cardiac  stimulants,  are  use- 
ful in  preventing  the  congestion  of  internal 
organs  by  equalizing  the  visceral  and  periph- 
eral circulations.  After  exposure  to  cold  and 
wet,  for  instance,  a  chill  may  be  aborted  and 
the  subsequent  congestion  prevented  by  the 
use  of  a  hot  alcoholic  drink  combined  with  pe- 
diluvia.  All  agents  which  dilate  the  peripheral 
vessels  may  be  regarded  as  vascular  stimulants 
when  they  increase  the  vigour  of  the  circula- 
tion in  these  vessels  simultaneously.  Such 
agents  are  the  nitrites,  ether,  alcohol,  dry  or 
moist  heat,  and  to,  a  less  degree  ammonia. 

Stimulating  expectorants  are  agents  which 
increase  the  tone  of  bronchial  mucous  mem- 
branes which  are  over-secreting,  and  by  so  do- 
ing diminish  the  amount  and  improve  the 
character  of  the  expectorated  material.  Some 
of  these  act  by  increasing  the  blood-pressure, 
others  by  a  direct  action  upon  the  mucous 
membrane.  In  this  group  should  be  included 
chloride  of  ammonium,  the  mineral  acids, 
strychnine,  benzoin,  the  balsams,  licorice,  sen- 
ega, terehene,  and  others  of  less  importance. 


STCECHAS 
STRONTIUM 


228 


When  the  low  pressure  under  which  bile  is 
secreted  is  interfered  with,  causing  an  ab- 
sorption of  the  biliary  fluid  or  its  partial  sus- 
pension of  secretion,  hepatic  stimulants  are 
indicated.  The  condition  of  "  biliousness  "  is 
so  well  known,  even  to  the  laity,  that  its  de- 
scription is  not  needed  here.  The  agents  most 
frequently  called  into  requisition  to  remedy 
this  state  are  the  mercurial  and  saline  cathar- 
tics, the  mineral  acids,  and  some  of  the  vege- 
table cathartics.  The  mere  ingestion  of  food 
of  the  proper  kind  is  frequently  sufficient  to 
call  forth  an  abundant  flow  of  bile. 

The  stimulant  diuretics  have  distinct  indi- 
cations. When  there  is  an  accumulation  of 
serous  fluid  in  the  tissues  or  cavities  of  the 
body,  when  the  blood  contains  harmful  toxic 
or  metabolic  products,  or  when  the  urine  be- 
comes too  concentrated,  these  agents  are  valu- 
able. If  the  excess  of  fluid  is  due  to  cardiac 
disease,  digitalis  and  strophanthus,  by  their 
diuretic  action,  are  of  value.  If  the  dropsy  is 
dependent  upon  renal  or  hepatic  influences, 
squill,  uva  ursi,  buchu,  or  the  potassium  salts 
may  be  added.  In  febrile  conditions,  in  which 
the  solid  elements  of  the  urine  are  usually 
deficient  and  their  retention  is  naturally 
harmful,  the  stimulant  diuretics  foster  their 
elimination.  For  this  purpose,  and  to  in- 
crease the  blandness  of  the  renal  secretion,  the 
potassium  salts,  turpentine,  caffeine,  and  ju- 
niper may  be  administered.  The  venous  con- 
gestion of  mitral  and  tricuspid  disease  and  of 
chronic  bronchitis  may  be  relieved  by  the  in- 
fluence of  digitalis  upon  diuresis.  For  the  de- 
tails as  to  all  the  agents  used  as  stimulants, 
reference  should  be  made  to  the  separate  arti- 
cles on  those  agents. — Samuel  M.  Brickner. 

STCECHAS.— See  Lavandula. 

STOMACHICS.— By  some  authors  sto- 
machics are  held  to  include  all  remedies  that 
promote  digestion,  such  as  the  digestive  fer- 
ments, etc.,  but  generally  the  name  is  restrict- 
ed to  the  aromatics  and  bitters  (q.  v.). 

STOKAX,  styrax  (U.  S.  Ph.),  styrax  prce- 
paratus  (Br.  Ph.),  styrax  liquidus  (Ger.  Ph.), 
balsamum  styracis.  liquid  storax,  is  a  balsam 
extracted  from  the  inner  bark  of  Liquidambar 
orientate  (sen  imberbe). 

The  tree  from  which  storax  is  obtained  re- 
sembles in  appearance  the  maple  or  plane  tree, 
is  bushy,  medium-sized,  with  smooth,  lobed, 
stipulate  leaves,  and  smooth,  purplish-gray 
bark.  It  is  indigenous  to  southwestern  dis- 
tricts of  Asia  Minor,  where  it  forms  forests. 
Its  range  is  a  limited  one,  not  extending  to  the 
north  or  to  the  islands  of  the  Levant. 

The  balsam  is  expressed  from  the  inner  bark 
which  is  scraped  off  with  a  sickle-shaped  knife 
after  the  outer  bark  has  been  removed.  The 
inner  bark  thus  obtained  is  boiled  in  water 
from  the  sea,  by  which  means  a  portion  of  the 
resinous  matter  is  melted  out  and  is  skimmed 
off  as  it  rises  to  the  surface  of  the  liquid.  The 
boiled  bark  is  next  subjected  to  pressure  in 
haircloth  bags,  with  the  addition  of  hot  water, 
and  a  still  further  portion  of  the  resin  is  ob- 
tained. The  storax  thus  extracted  is  a  soft, 
resinous  compound,  of  honey-like  consistence, 


and  has  a  peculiar,  balsamic,  agreeable  odour, 
and  a  pungent,  burning  taste.  It  is  of  a  gray- 
ish-brown colour  and  contains  a  considerable 
amount  of  water,  to  which  its  opacity  is  due. 
The  water  separates  after  long  standing  or  on 
heating,  leaving  a  heavier,  yellowish-brown 
substance  which  is  more  or  less  transparent. 
With  age  it  improves  in  odour  and  hardens, 
though  it  always  remains  sticky.  When  pure, 
storax  dissolves  in  alcohol,  in  ether,  in  chloro- 
form, and  in  most  of  the  volatile  oils.  Storax 
is  purified  by  melting  and  straining  or  by  dis- 
solving in  rectified  spirit,  filtering,  and  evap- 
orating the  solvent. 

Among  the  more  important  constituents  of 
storax  are  the  hydrocarbon  styrol,  or  cinna- 
mine,  CsHs,  a  thin,  colourless  liquid  of  fra- 
grant odour;  s<o?-esm,C36H6BOsi,  an  amorphous 
substance;  cinnamic  acid;  and  styracin,  or 
cinnamate  of  cinnamyl,  OsHiOjCuHs,  a  crys- 
tallizable  substance  with  an  agreeable  hya- 
cinthine  odour.  When  styracin  in  alcohol 
solution  is  treated  with  soda  it  is  converted 
into  cinnamate  of  sodium  and  cinnamalcohol, 
which  latter  is  also  known  as  styryl  alcohol,  or 
styrone,  CgHioO,  and  is  said  to  be  an  antiseptic 
and  deodorizer.  As  found  in  the  shops,  storax 
is  often  adulterated  with  turpentine. 

As  an  internal  remedy,  storax  is  now  but  lit- 
tle used  except  as  a  constituent  of  the  com- 
pound tinctui'e  of  benzoin.  It  has  been 
recommended,  however,  as  a  substitute  for  co- 
paiba, which  it  closely  resembles  in  its  action. 
It  is  said  to  be  a  useful  expectorant  in  bronchial 
troubles,  and  has  been  highly  spoken  of  as  a  rem- 
edy in  diphtheria  and  in  pseudo-membranous 
cro7ip.  In  gonorrhoea  and  also  in  leucorrhcea 
it  has  been  said  to  be  equally  efficacious  with 
copaiba  and  less  disagreeable  to  take.  The 
dose  is  from  10  to  30  grains,  two  or  three  times 
a  day. 

Storax  is  chiefly  employed  as  an  external 
remedy,  and  more  especially  in  the  treatment 
of  scabies.  Its  effects  are  very  similar  to  those 
of  balsam  of  Peru,  than  which,  however,  it  is 
said  to  be  somewhat  less  efficacious.  The  two 
drugs  may  with  some  advantage  be  combined. 
They  are  both  especially  suited  to  oases  in 
which  the  skin  is"  tender,  as  in  children,  or  is 
much  inflamed  and  such  strong  remedies  as 
siilphur,  naphthol,  and  the  like  are  too  severe. 
The  storax  is  usually  applied  in  the  form  of  a 
salve  made  with  lard  or  vaseline  or  as  a  lini- 
ment made  with  olive  oil.  Unna  used  it  with 
rape-seed  oil  as  in  the  following  formula  : 

B  Storax,  )       ,  ^r,       ^ 

Rape-seed  oil,  h*°^ 10  parts; 

Alcohol 1  part. 

M.  ^ 

The  storax  may  be  rubbed  in  pure  or  mixed 
with  a  small  proportion  of  oil.  It  is  but  slight- 
ly irritating  to  the  skin,  and  there  is  little  or 
no  danger  from  its  absorption  into  the  econ- 
orny.  Unna  reported  nine  cases  of  albuminous 
urine  out  of  124  cases  of  scabies  treated  with 
storax  inunctions,  but  it  is  not  improbable,  as 
has  been  intimated,  that  the  precipitate  thrown 
down  by  heat  and  nitric  acid  in  these  nine 
cases,  which  was  taken  for  albumin,  may  have 


229 


STCECHAS 
STRONTIUM 


been  only  a  resinous  deposit.  The  test  of  its 
solubility  in  alcohol  was  apparently  not  tried. 
In  the  treatment  of  scabies  the  inunctions 
should  be  preceded  by  a  soap  bath,  after  which 
the  skin  is  allowed  to  become  thoroughly  dry 
before  rubbing  in  the  storax  or  its  oily  solu- 
tion. In  simple  cases  two  inunctions  will 
usually  suffice  to  effect  a  cure,  and  seldom  are 
more  than  four  necessary — one  in  the  morning 
and  one  at  night,  for  two  days. 

Liquid  storax  is  said  to  be  a  useful  applica- 
tion in  frostbites  attended  with  ulceration. 
Edwaed  Bennet  Bronson. 

STRAMONIUM.— The  leaves  and  seeds 
of  Datura  stramonium,  or  the  thorn-apple,  are 
both  official.  The  official  leaves,  stramonii 
folia  (U.  S.  Ph.),  folia  stramonii  (Ger.  Ph.), 
are  the  dried  leaves  of  the  plant.  They  have 
a  heavy,  strong  narcotic  odour  and  an  unpleas- 
ant, bitter,  nauseous  taste.  The  dried  ripe 
seeds,  stramonii  semen  (U.  S.  Ph.,),  stramonii 
semina  (Br.  Ph.),  are  bitter  in  taste  and  of  an 
unpleasant  odour  when  crushed.  The  leaves 
contain  a  small  quantity  and  the  seeds  a  large 
quantity  of  daturine,  an  alkaloid  quite  identi- 
cal with  atropine.  In  the  seeds  there  is  also 
some  hyoscyamine. 

There  is  very  little  difference  in  action  be- 
tween stramonium  and  belladonna.  The  chief 
use  of  stramonium  is  as  an  antispasmodic  in 
convulsive  coughs  and  in  asthma.  It  has  been 
used  as  an  anodyne  in  a  few  painful  affections. 
In  asthma  it  is  taken  by  inhalation  of  the  fumes 
of  the  burning  leaves  or  ignited  powder.  Cig- 
arettes are  made  of  stramonium  for  the  use  of 
asthmatic  patients.  A  very  good  mixture  for 
igniting  and  inhaling  is  one  of  1  drachm  of 
nitrate  of  potassium,  ^  drachm  of  chlorate  of 
potassium,  1  drachm  of  stramonium,  and  20 
grains  of  ipecac.  The  leaves  of  Datura  tatula 
have  been  employed  as  a  substitute  for  those 
of  Datura  stramonium,  the  former  plant  con- 
taining the  same  alkaloid  as  the  latter. 

[The  dose  of  the  powdered  leaves  is  from  1 
to  3  grains ;  that  of  the  extract  of  the  seeds, 
extractum  stramonii  seminis  (U.  S.  Ph.),  ex- 
tractum  stramonii  (Br.  Ph.),  is  from  J  to  -J-  a 
grain  ;  that  of  the  tincture,  tinctnra  stramonii 
seminis  {U.  S.  Ph.),  tinctura  stramonii  {Br. 
Ph.),  is  from  10  to  30  minims  ;  and  that  of  the 
fluid  extract,  extractum  stramonii  seminis  flu- 
idum  (U.  S.  Ph.),  is  1  minim.  Stramonium 
ointment,  wnguentum  stramonii  (U.  S.  Ph.),  is 
serviceable  as  a  mild  anodyne  application  in 
itching  and  burning  affections  of  the  skin,  in 
painful  hamorrhoids,  in  boils,  in  irritable 
ulcers,  etc.] — Frederick  Peterson. 

STREPTOCOCCUS  SERUM.— See  under 
Serum  Treatment. 

STRONTIUM.— Three  of  the  compounds 
of  strontium,  the  bromide,  sfrontii  bromidum, 
the  iodide,  strontii  iodidum,  and  the  lactate, 
stronfii  lactas,  are  official  in  the  U.  S.  Ph. 

Strontium  bromide  and  strontiuia  io- 
dide are  used  for  the  same  purposes  as  the 
corresponding  salts  of  potassium,  sodium,  and 
ammonium ;  in  addition,  the  bromide  has 
been  observed  to  have  a  decided  effect  in  re- 
ducing the  amount  of  sugar  lost  in  the  urine 


in  diabetes,  and  Dr.  Carselli,  of  Palermo,  has 
found  it  remarkably  efficient  in  acute  gastritis 
in  doses  of  10  grains  three  times  a  day,  with 
or  after  the  meals.  It  is  said  to  stop  the 
vomiting  and  lessen  the  pain,  which  it  accom- 
plishes not  only  by  a  direct  action  on  the 
nervous  system,  but  also  by  acting  as  an  anti- 
septic, thus  arresting  fermentation  and  reduc- 
ing flatulence. 

Mr.  Anthony  Roche  {Lancet,  September  26, 
1896)  thinks  strontium  bromide  rather  supe- 
rior to  the  other  bromides  in  the  treatment  of 
epilepsy.  He  has  used  it,  alone  or  in  combina- 
tion with  other  bromides,  in  four  cases.  The 
patients  were  not  cured,  but  they  obtained 
much  relief.  In  all  the  cases  other  bromides 
had  been  employed  before,  and  the  addition  of 
the  strontium  salt  seemed  to  be  more  beneficial. 
It  has  long  been  noticed,  he  says,  that  a  com- 
bination of  bromides  acts  more  favourably  than 
any  one  of  them  alone.  It  should  be  impressed 
upon  the  patient  that  he  must  take  the  medi- 
cine for  a  long  period,  whether  it  has  at  first  a 
beneficial  effect  or  not.  Mr.  Roche  thinks  the 
bromide  of  strontium  well  entitled  to  further 
trial.  The  treatment  adopted  by  hira,  besides 
meeting  any  general  indications,  obtaining  the 
best  hygienic  surroundings  possible,  and  advis- 
ing a  strictly  vegetable  diet  with  milk,  is  to 
give  20  grains  of  the  bromide  of  strontium 
with  from  5  to  10  grains  of  the  bromide  of  am- 
monium or  sodium  night  and  morning,  largely 
diluted  with  water.  The  dose  of  strontium  is 
rapidly  increased  to  a  drachm  twice  a  day  if 
the  smaller  doses  do  not  control  the  attacks, 
and  if  the  patient  does  not  complain  of  it. 
The  majority  of  his  patients,  he  says,  took  the 
strontium  without  any  depression,  but  gener- 
ally with  the  producticm  of  an  acne  rash  on 
the  face.  Liquor  arsenicalis  added  to  the 
mixture  controlled  the  rash  and  increased  the 
appetite.  This  course  in  all  the  cases  mate- 
rially lessened  the  number  of  the  attacks.  The 
ordinary  dose  of  the  bromide  is  from  3  to  10 
grains ;  that  of  the  iodide  is  from  5  to  10 
grains. 

Strontium  carbonate  has  been  recom- 
mended by'Metral  {Bulletin  general  de  thera- 
peufigue,  October  PO,  1895 ;  Medical  News, 
November  30,  1895)  as  a  dentifrice.  He  gives 
the  following  formula  for  a  tooth  powder : 

B  Strontium  carbonate,  )    ^       -^ 

Flowers  of  sulphur,      )  ^        ' 

Essence  of  rose 6  drops. 

M. 

Strontium  lactate  has  been  used  as  an 
intestinal  antiseptic  and  for  the  purpose  of 
diminishing  albuminuria  in  parenchymatous 


Brouowski  {Wiener  medicinische  Presse, 
September  13,  1896;  British  Medical  Jour- 
nal, November  7,  1896)  gives  a  preliminary 
account  of  the  results  of  his  clinical  and  ex- 
perimental investigations  into  its  action  upon 
the  kidneys.  His  first  experiments  were  upon 
rabbits,  and  consisted  in  the  daily  subcutaneous 
injection  of  a  quantity  equal  to  double  the 
dose  in  proportion  to  the  animal's  weight. 
After  a  month  one  rabbit  had  gained  7  oz.  in 


STROPHANTHIDIN 
HTIiOPHANTHUS 


230 


weight,  and  the  second  10  oz.,  while  the  third 
had  not  altered.  They  were  perfectly  well  in 
every  way,  and  after  they  had  been  killed  the 
internal  organs  were  found  to  be  normal.  The 
drug  was  then  tried  in  ten  cases  of  kidney  dis- 
ease, three  of  which  were  acute  parenchymatous 
nephritis,  six  mixed  nephritis,  and  one  inter- 
stitial nephritis.  Six  doses  of  15  grains  were 
given  daily,  and  well  borne.  In  all  eases  the 
volume  of  "the  urine  increased,  and  its  specific 
gravity  fell.  This  effect  began  on  the  second 
or  third  day,  was  most  marked  on  the  sixth  or 
seventh,  and  persisted  two  or  three  days  after 
the  use  of  the  drug  had  been  discontinued. 
The  action  was  most  decided  in  acute  cases, 
and  was  much  slighter  in  the  chronic  forms; 
the  albumin  diminished  pari  passu  with  the 
increase  in  the  urine.  In  acute  cases  it  disap- 
peared entirely,  but  in  chronic  eases  no  dimi- 
nution was  observed.  The  ethereal  sulphates 
in  the  urine,  by  which  the  amount  of  intestinal 
putrefaction  may  be  estimated,  were  unaffected, 
and  there  was  no  constant  change  in  the  pulse 
or  blood-pressure.  The  antiseptic  properties 
of  lactate  of  strontium  were  tested  upon  a  pa- 
tient with  an  intestinal  fistula  in  the  cfecal 
region,  and  found  to  be  extremely  slight.  The 
author  concludes  that  strontium  lactate  is  a 
pure  diuretic,  and  is  more  valuable  than  any 
other  remedy  in  the  treatment  of  acute  inflam- 
matory conditions  of  the  kidney. 

Strontium  lactate  has  also  been  found  to  aid 
the  digestion  in  cases  of  dyspepsia  due  to  an 
excess  of  hydrochloric  acid  in  the  gastric  juice. 
It  is  essential  that  it  should  be  pure  and  free 
from  barium  oxide.  The  dose  is  from  5  to  10 
grains. 

Strontium  phospliate  has  been  recom- 
mended as  a  tonic  in  place  of  calcium  phos- 
phate, in  doses  of  from  10  to  30  grains. 

Strontium  salicylate,  according  to  Dr. 
Horatio  C.  Wood,  of  Philadelphia  (University 
Medical  Magazine,  .January,  1895),  tends  less  to 
lower  the  arterial  pressure  than  either  sodium 
or  ammonium  salicylate.  He  has  accordingly 
employed  it  in  a  large  number  of  cases  in 
amounts  ranging  from  15  to  120  grains  a  day. 
The  result  of  these  trials  shows  that  in  doses  of 
from  5  to  10  grains,  given  after  meals,  the 
salt  very  commonly  improves  digestion,  and 
the  dose  of  5  grains  an  hour  after  meals,  in 
flatulent  dyspepsia  and  in  various  conditions 
of  tendency  to  fermentative  changes  in  the 
alimentary  canal,  is  a  useful  intestinal  anti- 
septic, one  that  has  seemed  to  give  better  re- 
sults than  salol,  naphthol,  or  any  of  the  older 
intestinal  antiseptic  remedies.  Dr.  Wood  says 
that  it  does  not  give  rise  to  cinchonism  so  read- 
ily as  the  older  salicylates,  but  may  produce 
it  in  a  pronounced  degree.  He  has  not  tested 
it  in  acute  articular  rheumatism,  but  thinks  it 
would  be  less  efficacious  than  the  ammonium 
salicylate.  In  muscular  or  subacute  rheuma- 
tism, as  well  as  in  chronic  gouty  conditions 
with  a  tendency  to  digestive  disturbance,  Dr. 
Wood  has  found  it  to  be  a  very  valuable  rem- 
edy, exerting  the  action  of  the  salicylate  upon 
the  diathesis,  and  improving  instead  of  injur- 
ing the  digestion.  It  may  ba  given  in  solu- 
tion, but  it  is  best  administered  in  capsules ; 


a  5-grain  capsule  is  of  moderate  size,  and  of 
these  two  or  more  may  be  taken  at  once.  The 
taste  of  this  salt  is  similar  to  that  of  the  ordi- 
narv  salicylates,  but  distinctly  less  offensive, 
so  that,  if  "it  is  preferred,  it  may  be  given  in  a 
weak  solution. 
Strontium  and  caffeine  sulphonate. — 

See  SVMPHORAL. 

STROPHANTHIDIUr,  STKOPHAN- 
THIN. — See  under  Stkophanthus. 

STKOPHANTHXJS  (U.  S.  Ph.),  semen 
strophanthi  (Ger.  Ph.),  is  derived  from  the 
seeds  of  Strophanthus  hispidus,  a  tropical 
climbing  apocynaceous  plant.  Its  main  habi- 
tat is  Africa,  where  it  grows  more  abundantly 
in  the  heart  of  the  continent  than  along  the 
coast.  A  preparation  of  the  seeds  of  the  plant, 
known  as  ine  or  kombe,  is  used  by  the  natives 
as  an  arrow  poison,  producing  death  by  muscu- 
lar paralysis.  The  seeds  have  little  or  no  odour, 
but  an  exceedingly  bitter  taste.  The  U.  S.  Ph. 
recommends  this  test  for  the  purity  of  the  seed, 
and  it  is  of  some  importance  since  several  va- 
rieties appear  in  commerce  :  "  A  decoction  of 
1  part  of  the  seed  to  10  parts  of  water  is  of  a 
brownish  colour  and  is  not  changed  on  the  ad- 
dition of  a  solution  of  iodine,  of  ferric  chlo- 
ride, or  of  potassium  mercuric  iodide." 

In  1877  Gallois  and  Hardy  isolated  from  the 
seeds  a  principle,  probably  a  glucoside,  which 
they  called  strophanthin.  It  appears  as  white 
shining  crystals  ;  but  it  is  likely  that  this  is  a 
decomposition  product,  since  Fraser.  on  more 
careful  analysis,  separated  a  glucosidal  prin- 
ciple with  different  properties  which  he  termed 
strophanthidin.  This  active  principle  of  the 
seeds  is  imperfectly  crystalline,  is  neutral  in 
reaction,  and  has  a  very  bitter  taste.  It  is 
freely  soluble  in  water,  less  soluble  in  alcohol, 
and  insoluble  in  ether  and  in  chloroform. 

The  physiological  action  of  strophanthus 
and  its  active  principle  have  been  studied  by  a 
number  of  observers,  but  unanimity  of  con- 
clusion has  not  been  established  iii  all  par- 
ticulars. Upon  the  lower  grades  of  animals, 
ine  or  kombe  caused,  in  toxic  doses,  a  tonic 
contraction  of  the  heart  terminating  in  an  ar- 
rest of  the  beat,  with  death  by  syncope  accom- 
panied by  nausea  and  vomiting.  The  isolated 
heart  of  the  amphibian  is  as  susceptible  to  the 
drag  as  the  organ  of  the  uninjured  animal. 
When  the  drug  is  brought  into  immediate  con- 
tact with  muscular  tissue  it  acts  at  once  as 
a  muscular  poison,  and  its  influence  is  as 
marked  and  as  immediate  whether  the  muscle 
belongs  to  the  striated  or  to  the  unstriated 
variety.  A  peculiar  effect  upon  muscular  tis- 
sue wrought  by  the  drug  is  that  the  increase 
of  tone  which  appears  as  its  primarv  influence 
does  not  diminish  ;  but  on  the  death  of  a 
muscle  passes  at  once  into  a  state  of  post- 
mortem rigidity.  Since  the  reaction  of  the 
musoulai  tissue  is,  at  the  same  time,  acid,  it 
would  appear  as  if  this  state  were  due  to  the 
rapid  development  of  myosin.  The  paralysis 
evoked  by  the  contact  of  the  poison  with  vol- 
untary muscular  tissue  probably  extends  also 
to  the  cardiac  and  respiratory  m"usoles  when  it 
causes  death. 


231 


STROPHANTHIDIN 
STROPHANTHUS 


Observers  are  not  agreed  as  to  the  influence 
of  strophanthus  upon  the  circulation.  The 
statement  made  by  one  experimenter  that  it  in- 
creases the  blood-pressure  is  as  promptly  denied 
by  the  next  one.  The  bulk  of  evidence,  how- 
ever, seems  to  be  in  favour  of  the  proposition, 
and  it  is  likely  that  the  augmented  blood-pres- 
sure is  caused  by  the  action  of  the  drug  upon 
the  muscular  walls  of  the  arteries,  like  that 
which  it  exerts  upon  the  heart  muscle. 

The  question  of  the  diuretic  value  of  stro- 
phanthus is  as  unsettled  as  that  of  its  influ- 
ence upon  the  circulation.  Some  writers  have 
asserted  that  in  ascites  especially  the  drug  pro- 
duces marked  diuresis ;  others  contend  that 
this  influence  appears  only  when  there  is  ob- 
struction to  the  circulation  in  the  heart. 
Csatary  (review  in  the  Centralblatt  fiXr  die  ge- 
sammten  Therapie,  vol.  v,  1887),  after  careful 
experimentation,  afBrms  that  in  a  perfectly 
healthy  condition  there  is  no  diuretic  action  on 
the  part  of  strophanthus.  He  finds  that  the 
toxic  influence  of  the  drug  on  the  heart  increases 
the  force  and  frequency  of  the  cardiac  beat, 
and  says  this  is  the  influence  which  evokes  an 
elimination  of  fluids  from  the  body.  Purthei', 
he  states,  the  normal  or  diseased  condition  of 
the  kidneys  plays  no  role  in  this  diuresis. 
Cases  have  been  reported  of  dropsy  dependent 
upon  cardiac  disease  with  congestion  of  the 
kidneys  and  lungs  which  have  been  relieved 
by  the  administration  of  strophanthus. 

A  fall  in  the  number  of  beats  of  the  heart  is 
a  usual  result  of  the  administration  of  stro- 
phanthus. The  decrease  depends  upon  the 
dose.  Five  drops  of  the  tincture  are  said  to 
have  caused  a  fall  of  from  eight  to  twelve 
beats  a  minute ;  twenty  drops,  a  fall  of  thirty 
beats.  In  pneumonia  the  temperature  is  said 
to  fall,  sometimes  one  degree,  with  the  de- 
crease in  the  pulse-rate ;  but  the  respirations 
seem  not  to  be  similarly  affected. 

The  effect  of  strophanthus  is  quicker  than 
that  of  digitalis,  but  is  more  evanescent.  It 
seems  to  have  no  cumulative  action,  or  very 
little.  Its  influence  lasts  for  three  or  four 
hours,  occasionally  longer,  when  the  dose  must 
be  repeated  to  secure  a  further  effect.  Despite 
the  fact  that  its  cumulative  action  is  so  rare, 
the  tincture  has  produced  poisonous  symp- 
toms. In  one  reported  case  in  which  the  drug 
was  used  for  some  cardiac  disease,  cyanosis 
and  dyspnoea  with  pronounced  cardiac  dis- 
tress appeared  and  collapse  followed.  There 
was  no  pallor  or  vomiting,  however,  as  in  digi- 
talis poisoning.  Evans  {Medical  News,  June 
16, 1888)  reports  the  case  of  a  child  who  took  20 
drops  of  the  tincture.  The  face  became  flushed, 
the  skin  was  dry  and  hot,  and  the  pupils  con- 
tracted and  dilated  alternately  at  very  short 
intervals.  The  pulse-rate  was  140,  the  radial 
pulse  was  full,  and  the  heart-beat  was  vigor- 
ous. The  sensorium  was  undisturbed.  Uri- 
nary suppression  for  ten  hours  followed. 
Recovery  ensued. 

The  conclusions  to  be  derived  from  a  study 
of  the  writings  on  strophanthus  may  be 
summed  up  as  follows :  The  drug,  however 
administered,  invigorates  the  heart  muscle 
while  dilating  the  cardiac  cavities.    The  walls 


of  the  arteries  are  also  dilated  and  the  arterial, 
but  not  the  venous,  pressure  is  probably  in- 
creased by  its  use.  The  frequency  of  the  heart 
beat  and,  naturally,  of  the  pulse  is  reduced ;  the 
force  of  the  heart  is  probably  also  diminished. 
A  secondary  effect  is  the  regulation  of  the 
heart's  rhythm.  The  drug  is  probably  diu- 
retic, but  not  cumulative.  Sometimes  its  use 
occasions  nausea,  vomiting,  and  diarrhoea. 

From  a  consideration  of  its  physiological  ac- 
tion, the  indications  for  the  use  of  strophanthus 
will  be  seen  to  correspond  to  those  which  call 
for  the  administration  of  digitalis.  It  may  be 
given  to  tone  the  cardiac  muscle  in  ohstructive 
or  degenerative  valvular  lesions  of  the  heart 
when  compensation  is  lacking  or  has  not  been 
fully  established.  It  is  especially  useful  in  dis- 
ease, more  particularly  in  stenosis,  of  the  mitral 
valve  without  degeneration  of  the  cardiac  mus- 
cular fibre.  Praser,  who  has  studied  the  drug 
more  carefully  than  any  one  else,  has  asserted 
that  the  haemostatic  power  of  strophanthus  is 
much  inferior  to  that  of  digitalis,  and  that  its 
value  in  valvular  disease  of  the  heart  depends 
upon  the  soundness  of  the  muscular  tissue  ol 
that  organ.  When  the  heart  muscle  is  im- 
paired, he  says,  strophanthus  affords  no  more 
relief  to  the  weakly-acting  or  overworked  organ 
than  digitalis.  In  any  case  of  cardiac  weak- 
ness strophanthus  may  be  given  with  safety  and 
its  effect  looked  for  in  from  half  an  hour  to  an 
hour.  In  cases  of  shoch  with  impaired  heart 
action,  or  in  collapse  or  threatened  syncope,  it 
is  a  valuable  drug.  Given  subcutaneously,  the 
tincture  is  very  irritating  to  the  tissues,  but  its 
effect  is  rapid — more  rapid  than  that  of  digita- 
lis— and  in  an  emergency  it  may  be  so  used,  even 
if  an  abscess  subsequently  appears.  It  must 
not  be  forgotten  that  its  influence  does  not  last 
so  long  as  that  of  digitalis,  and  when  it  is  de- 
pended upon  for  cardiac  stimulation,  its  em- 
ployment must  be  repeated.  By  some  clinicians 
strophanthus  is  regarded  as  an  excellent  adju- 
vant to  digitalis,  although  as  a  substitute  for 
the  latter  it  is  not  in  high  favour.  It  may  re- 
place digitalis,  however,  in  those  cases  of  ex- 
cited heart  action  in  which  digitalis  fails  to 
evoke  a  sedative  action,  or  when  digitalis  hasi 
been  used  for  a  long  time  without  producing 
its  usual  effect  upon  the  heart  muscle.  Digi- 
talis causes  a  diminution  in  the  arterial  tension 
as  well  as  in  the  pulse-rate ;  strophanthus  is 
capable  of  calling  forth  the  latter  phenomenon 
only.  Strophanthus,  because  it  does  not  eon- 
strict  the  arteries  while  re-enforcing  the  energy 
of  the  cardiac  beat,  is  useful  in  cases  of  cardiac 
dropsy  when  there  is  simultaneous  congestion 
of  the  kidneys  and  lungs  or  of  either.  In  ir- 
regular or  insufficient  heart  action  leading  to 
oedema  of  the  lungs  the  drug  may  be  given 
subcutaneously  or  by  mouth  with  a  decidedly 
good  effect.  Its  diuretic  action  has  caused  its 
use  with  alleged  good  results  in  the  treatment 
of  renal  calculi.  In  many  forms  of  low  fever 
with  weak  heart  action  strophanthus  has  been 
recommended.  It  has  been  praised  as  well  in 
the  treatment  of  pneumonia,  pulmonary  tuher- 
culosiSf  asthma,  and  hemiplegic  conditions. 
In  the  urmmia  of  Bright's  disease  and  the  car- 
diac dyspnoea  attending  the  train  of  symptoms 


STRYCHNINE 
STYRONE 


232 


in  the  same  disease,  strophanthus  is  a  valuable 
remedy.  By  its  producing  diuresis  it  aids  in 
the  elimination  of  the  metabolic  products  cir- 
culating in  the  blood,  and  by  its  restoration  of 
energy  to  the  heart  muscle  it  frequently  suc- 
ceeds in  effectively  relieving  the  dyspnoea. 

Strophanthus  is  alleged  to  have  the  power  of 
aborting  the  so-called  urethral  chill  consequent 
upon  the  passage  of  a  sound ;  but  in  this  re- 
spect it  is  probably  inferior  to  quinine.  After 
the  administration  of  strophanthus  malarial 
chills  are  said  to  be  less  rigorous,  and  nervous 
chills  are  alleged  to  lose  much  of  their  force. 

Because  of  its  exceedingly  bitter  taste  stro- 
phanthus has  the  effect  of  a  simple  hitter  when 
taken  in  small  doses.  Since  it  has  no  cumula- 
tive action,  its  pronounced  influence  upon  the 
heart  need  not  be  feared  when  it  is  given  for 
this  purpose  ;  but  there  are  so  many  drugs  su- 
perior as  stomachics  to  the  one  under  consid- 
eration, that  this  tonic  influence  must  be 
regarded  as  purely  secondary  :  it  would  not  be 
well  to  give  a  medicine  so  intense  in  its  action 
for  purely  stomachic  effect.  The  tincture  of 
strophanthus  has  been  recorded  as  having 
cured  a  case  of  urticaria,  but  the  "  cure  "  was 
probably  a  coincidence. 

Success  has  been  alleged  for  the  drug  in  the 
treatment  of  exophthalmic  goitre.  For  this 
purpose  the  tincture  is  given  in  doses  of  3 
drops  every  six  hours,  and  the  dose  i»  gradu- 
ally increased  to  10  drops.  The  good  results 
reported  are  supposed  to  emanate  from  the  se- 
dation of  the  cardiac  action.  Though  one  can 
not  deny  the  reliability  of  these  reports,  since 
cases  have  been  recorded  in  America  and  Aus- 
tria, it  would  seem  that  the  relief  of  the  heart's 
tunmltuous  action  was  regarded  as  a  sign  of 
cure. 

Children  seem  to  be  able  to  take  strophan- 
thus in  proper  doses  witli  no  untoward  effect, 
and  some  clinicians  have  preferred  it  to  digi- 
talis when  either  was  indicated.  The  toxic  ac- 
tion of  strophanthus  is  much  more  rapidly 
evolved  than  that  of  digitalis,  however,  and 
caution  must  be  observed  when  it  is  adminis- 
tered to  children.  One  must  be  prepared  to 
combat  poisonous  symptoms,  as  evidenced  by 
cold  sweating  and  nausea,  by  appropriate  symp- 
tomatic, stimulant  treatment. 

The  dose  of  the  tincture,  ti7ictura  sirophan- 
thi  (U.  S.  Ph.,  Ger.  Ph.).  is,  for  an  adult,  from 
5  to  8  drops  three  or  four  times  daily.  For  a 
child  the  dose  is  1  drop  thrice  daily.  The 
tincture  is  best  given  diluted  or  flavoured  with 
some  syrup,  since  the  ingestion  of  the  pure 
tincture  is  apt  to  provoke  irritation  of  the  mu- 
cous membrane  of  the  mouth,  oesophagus,  or 
stomach.  It  is  well  to  begin  with  the  mini- 
mum dose  unless  one  is  acquainted  with  the 
preparation,  for  it  may  be  impure  or  of  too 
great  strength.  When  it  is  desired  to  obtain 
a  very  rapid  effect  of  the  drug,  the  tincture 
may  be  given  hypodermically,  although,  as  has 
been  mentioned  already,  it  may  cause  an  ab- 
scess when  so  administered.  There  is  an  un- 
official  extract  of  strophanthus. 

Strophanthin  has  been  so  little  experimented 
with  that  great  caution  should  be  exercised  in 
its  administration.    It  seems  dilEoult  to  obtain 


it  chemically  pure,  and  the  dose  has  been  vari- 
ously given  as  from  ^^^  to  -jV  of  a  grain.  Given 
hypodermically,  strophanthin  is  a  powerful  ir- 
ritant locally,  too  irritating  to  be  safely  given 
in  depressed  conditions.  When  it  is  adminis- 
tered by  the  mouth  it  seems  to  produce  the 
same  physiological  effects  as  strophanthus,  one 
part  to  six  million  having  caused  systolic  car- 
diac arrest  in  a  frog.  Locally  applied,  stro- 
phanthin is  a  more  powerful  ancBsthetic  than 
cocaine.  Three  or  four  drops  of  a  solution  of 
one  to  one  thousand  instilled  into  the  eye  will 
produce  complete  anesthesia  of  the  ocular  and 
palpebral  conjunctivae  that  will  last  for  several 
hours.  The  sensations  of  heat  and  cold  are  the 
last  to  disappear  and  the  first  to  return.  Al- 
though the  glucoside  does  not  appear  to  affect 
the  conjunctiva  unfavourably,  it  is  apt  to  cause 
a  cloudiness  or  even  an  ulcer  of  the  cornea, 
probably  by  a  hypereemia  induced  by  its  irri- 
tant action.  This,  naturally,  unfits  it  for  the 
production  of  ocular  anaesthesia.  Peterson 
(Medical  Record,  January  31,  1891)  has  recom- 
mended the  administration  of  strophanthin  per- 
cutaneously  by  means  of  cataphoresis.  For 
this  purpose  he  uses  the  anode  next  the  skin, 
moistened  in  a  solution  of  strophanthin  or  a 
tissue-paper  disc  containing  ^J-j-  of  a  grain  of 
the  glucoside,  with  a  current  of  from  5  to  8 
nn'Ihamperes.  No  irritant  action  is  evoked  by 
this  method  of  using  the  drug. 

[Dr.  W.  K.  Wadleigh,  of  Hopkinton,  New 
Hampshire  (Medical  News,  March  14,  1896),  has 
found  that  among  the  aged  strophanthus  gives 
much  better  results  in  almost  every  condition 
than  other  remedies  of  its  class.  In  old  age, 
he  says,  we  often  find  an  atheromatous  condi- 
tion of  the  arteries,  and,  although  digitalis 
may  not  be  positively  contra-indicated,  in  all 
such  cases  it  is  very  apt  to  do  little  good,  and 
sometimes  may  even  do  harm.  The  vertigo  of 
aged  people,  caused  by  cerebral  anmmia,  or  by 
a  lack  of  balance  between  the  different  parts 
of  the  circulation  of  the  brain,  is  a  condition 
in  which  he  has  been  able  to  do  much  good 
with  strophanthus.  His  experience  leads  him 
to  believe  that  strophanthus  will  produce  bene- 
fit in  a  larger  number  of  cases  of  angina  pec- 
toris than  any  other  single  remedy.  In  general 
anmmia  and  chlorosis,  when  accompanied  by 
weakness  of  the  heart,  it  not  only  gives  great 
relief  so  far  as  the  heart-  symptoms  are  con- 
cerned, but,  by  sending  more  blood  to  the  tis- 
sues, increases  their  nutrition.  It  is  often  an 
advantage  to  combine  it  with  nitroglycerin  in 
anasmia.  In  the  so-called  irritable  heart,  char- 
acterized by  palpitation  on  slight  exertion, 
more  or  less  pain  in  the  region  of  the  heart, 
often  quite  severe,  and  a  weak,  quick  pulse, 
sometimes  intermitting,  but  with  no  organic 
disease  of  the  heart  present,  says  Dr.  Wadleigh 
we  may  give  strophanthus  with  almost  an  ab- 
solute certainty  of  benefit  from  its  use,  and  it 
will  often  cure  the  patients.] 

Samuel  M.  Bbickner. 
STRYCHNINE.— See  under  Nux  tomica. 

STUPES  are  cloths,  sponges,  or  the  like, 
dipped  into  some  fluid  and  wrung  out  to  pre- 
vent dripping,  and  applied  to  some  portion  of 


233 


STRYCHNINE 
STYRONE 


the  body.  They  are  usually  employed  hot  and 
for  the  relief  of  pain,  to  abort  inflammatory 
processes,  and  in  all  conditions  when  poultices 
would  be  indicated,  but  are  inconvenient  to 
apply.  Flannel  is  the  most  convenient  fabric 
that  can  be  used,  and  it  may  be  of  any  shape 
that  is  most  suitable  for  the  part  on  which  it 
is  to  be  used.  It  should  be  dipped  in  as  hot 
water  as  can  be  had,  wi'unsf  out  so  as  not  to 
drip,  and  applied  immediately,  care  being 
taken  that  it  is  not  hot  enough  to  burn  sensi- 
tive parts.  It  should  then  be  covered  with  a 
dry  towel  or  cloth,  and  oiled  silk  or  rubber 
cloth  should  be  put  over  the  whole.  To  pre- 
vent scalding  of  the  hands  in  wringing  out, 
the  flannel  may  be  placed  in  a  towel,  the  too 
ends  of  which  are  to  be  twisted  in  opposite 
directions.  When  practicable,  a  hot-water  bag 
should  bo  placed  next  the  flannel,  so  that  the 
heat  may  be  retained  longer'  and  the  frequent 
renewal  of  the  stupe  avoided,  which  is  the 
most  serious  objection  to  its  employment. 
For  the  relief  of  all  neuralgias  of  the  head  and 
face  there  is  probably  no  simple  measure 
which  is  so  effectual.  In  all  conditions  such 
as  colic,  peritonitis,  etc.,  when  abdominal  pain 
is  severe,  relief  will  usually  be  afforded,  espe- 
cially if  a  few  drops  of  oil  of  turpentine  are 
sprinkled  upon  the  flannel  immediately  before 
its  application,  but  it  is  not  to  be  used  in  too 
large  amounts,  as  it  may  be  absorbed  and 
strangury  result.  Spirit  of  camphor  may  be 
substituted  for  the  turpentine,  and  with  bene- 
fit in  many  instances,  for  it  will  set  up  more 
or  less  irritation  of  the  skin,  as  the  plain  water 
will  if  its  use  is  continued  for  any  length  of 
time.  Laudanum  also  is  useful,  and  in  acute 
affections  of  the  air-passages  may  relieve  the 
strong  inclination  to  cough,  especially  when 
the  stupes  are  applied  over  the  front  of  tlie 
neck.  A  few  grains  of  red  pepper  may  be 
dusted  on  the  flannel  with  the  view  of  acting 
as  a  counter-irritant.  Chloroform  or  ether 
will  act  as  counter-irritants  and  also  have  a 
slight  local  ansesthetio  action.  Stupes  of  plain 
hot  water  may  be  useful  to  allay  the  pain  of 
sprains,  bruises,  etc.  They  should  not  be  em- 
ployed in  acute  affections  of  the  chest,  as  it  is 
necessary  to  renew  them  frequently,  and  the 
exposure  attendant  upon  their  removal  should 
be. avoided.  For  some  hours  after  their  use 
there  may  be  a  slight  erythema  of  the  skin. 
Russell  H.  Nevins. 

STYPTICIN. — This  is  the  trade  name  of 
cotarnine  hydrochloride,  CuHuNOs.HaO.HCl. 
Chemically,  says  Dr.  S.  Gottsohalk,  of  Berlin 
(Therapeutisclie  Monatshefte,  December,  1895; 
Therapeutische  Wochenschrift,  December  22, 
1895).  cotarnine,  which  in  combination  with 
opianic  acid  forms  the  narcotine  found  in 
opium,  is  very  closely  related  to  hydrastinine. 
Cotarnine  hydrochloride  is  comparatively  non- 
poisonous  and  a  very  efficient  hcemostatic  in 
gynaacological  practice.  It  is  described  as  an 
amorphous  powder,  almost  of  a  sulphur-yellow 
colour,  readily  soluble  in  water,  forming  a  solu- 
tion which  becomes  cloudy  on  exposure  to 
light. 

Dr.  Gottsohalk  has  given  the  drug  by  the 


mouth  in  doses  ranging  up  to  f  of  a  grain  five 
or  six  times  a  day.  Subcutaneously,  he  has 
employed  a  sterilized  10-per-cent.  watery  solu- 
tion, and  in  cases  of  profuse  metrorrhagia  in- 
jected 3  grains  (30  drops  of  the  solution)  deep 
into  the  gluteal  muscles  once  a  day.  With  a 
few  patients  who  did  not  bear  opium  well,  the 
drug  appeared  to  act  as  a  sedative  and  anal- 
getic, so  that  it  was  found  particularly  service- 
able in  cases  in  which,  together  with  uterine 
hiemorrhage,  there  was  dysmenorrhcea.  In 
this  respect  Gottsohalk  finds  cotarnine  superior 
to  ergot  and  hydrastis,  and  he  finds  it  also  a 
suitable  drug  for  protracted  use.  Cotarnine,  he 
says,  acts  promptly  in  haemorrhages  due  purely 
to  uterine  subinvolution  ;  if,  however,  there  are 
remnants  of  the  ovum  retained  in  the  uterus, 
ergot  and  its  preparations,  in  conjunction  with 
hot  irrigations,  work  better.  He  recommends 
cotarnine  in  hsemorrhages  due  to  fungous  en- 
dometritis, especially  if  they  are  of  ovarian 
origin,  but  only  as  a  palliative.  In  hcemor- 
rhages  due  to  fibroids  and  in  those  associated 
with  the  climacteric  cotarnine  is  of  service,  but 
in  those  that  are  secondary  to  parametric  exu- 
dations it  is  inferior  to  hydrastis  and  hydras- 
tinine. In  purely  congestive  menorrJiagia,  not 
dependent  on  organic  disease,  he  has  met  with 
good  results  from  the  concurrent  use  of  cotar- 
nine and  hydrastis  or  hydrastinine.  The  rem- 
edy is  powerless  against  hasmorrhages  that 
depend  on  the  presence  of  polypous  growths 
in  the  uterine  cavity,  no  matter  how  small  they 
may  be.  Cotarnine  is  contra-indicated  in  cases 
of  threatened  abortion,  also  in  uterine  haemor- 
rhages occurring  in  the  course  of  pregnancy. 
It  has  not  yet  been  definitively  ascertained 
whether  cotarnine  acts  on  the  walls  of  the 
blood-vessels  or  on  the  muscular  tissue  of  the 
uterus.  In  cases  of  menorrh.igia  Dr.  Gotts- 
ohalk thinks  the  hsemostatic  effect  of  cotarnine 
is  rendered  more  certain  by  giving  it  for  four 
or  five  days  before  the  flow  is  expected,  but  in 
reduced  doses  (not  more  than  0-035  of  a  grain), 
four  times  a  day.  As  soon  as  the  flow  begins 
the  doses  are  to  be  doubled.  At  the  height  of  a 
profuse  menstrual  flow  as  much  as  8  grains  may 
be  injected  into  the  gluteal  muscles,  and  this 
may  be  repeated  for  several  successive  days 
without  any  unpleasant  result.  For  internal 
use,  it  is  best  to  order  cotarnine  in  pills  or  in 
gelatin  capsules.  When  given  by  the  mouth 
it  acts  more  slowly  than  when  injected  into  the 
tissues. 

STYPTICS. — See  Haemostatics. 

STYRACOIi. — This  is  the  cinnamic  ether 

of  guaiacol,  g.H.CH  :cS.?o>0'  "^  -^'^^'^l- 
line  body.  It  is  a  powerful  antiseptic  and  has 
been  employed  to  some  extent  internally  in 
gonorrhoea  and  in  gastro-intestinal  catarrh, 
but  its  use  can  not  be  recommended  until 
further  reports  of  its  action  are  published. 

STYBAX.— See  Stobax. 

STYRONE. — This  is  a  compound  of  storax 
and  Peruvian  balsam,  a  yellow,  oily,  aromatic 
liquid.  Its  agreeable  odour  commends  it  as  an 
antiseptic  and  deodorizer.  Dr.  James  A.  Spald-- 


SUCCINIC  ACID 
SUGAR  OP  MILK 


234 


ing,  of  Portland,  Maine  (Archives  of  Otology, 
XX,  3),  recommends  its  use  particularly  in 
cases  of  perforation  of  ShrapneU's  membrane. 
Largely  diluted  with  alcohol,  so  that  the  solu- 
tion contains  from  1  to  5  per  cent,  of  styrone, 
it  may  be  used  for  syringing  the  auditory 
meatus.  It  reduces  the  amount  of  the  dis- 
charge and  overcomes  its  odour. 

STJCCINIC  ACID,  C.HoOi,  is  a  colourless 
crystalline  substance  obtained  by  the  distilla- 
tion o£  amber.  Ammonium  succinate  has  been 
used  in  medicine  (see  vol.  i,  page  58). 

SUCCINTJM.— See  Amber. 

SUCBOIi. — See  Duloin. 

STJDOBinCS.— See  DrAPHORETios. 

SUET. — Mutton  suet,  sevum  (U.  S.  Ph.), 
sevnm  prcBparatum  (Br.  Ph.),  purified  and  ren- 
dered almost  odourless  by  melting  and  strain- 
ing, is  employed  as  a  bland  application  (see 
Pats  and  Tallow). 

STJGAB.— The  carbohydrates  are  organic 
compounds  containing  in  the  molecule  six  or 
a  multiple  of  six  atoms  of  carbon  and  about 
twice  as  many  of  hydrogen.  They  are  divided 
into  three  general  groups:  saccharoses  (Cia 
HsjOii),  glucoses  (CbHijOs),  and  amyloses 
(CeHioOs).  These  groups  are  closely  allied 
chemically,  the  first  and  third  being  readily 
converted  into  the  second.  They  occur  very 
widely  distributed  throughout  the  vegetable 
kingdom.  The  term  sugar  is  applied  to  the 
saccharoses  and  glucoses,  and  in  a  more  re- 
stricted sense  to  the  saccharoses  alone. 

The  sugars  have  a  more  or  less  sweet  taste 
and  are  very  soluble  in  water.  Chemically, 
they  exhibit  the  properties  of  polyatomic  al- 
cohols. Sugars,  with  one  or  two  exceptions, 
possess  the  power  of  rotating  the  plane  of 
polarized  light.  When  this  plane  is  rotated  to 
the  right  they  are  known  as  dextrorotatory, 
and  are  represented  by  the  mark  +.  When 
the  plane  is  rotated  to  the  left  they  are  known 
as  liEvorotatory,  and  are  represented  by  the 
mark  — .  The  saccharoses  all  belong  to  the 
first  class.  Of  the  glucoses,  diastase  and 
galactose  are  dextrorotatory ;  levulose  and 
sorgose  are  la3vorotatory.  Bach  element  has  a 
specific  rotatory  power  peculiEr  to  itself  which 
is  measured  in  degrees.  By  taking  advantage 
of  these  properties  very  accurate  methods  of 
quantitative  analysis  have  been  devised. 

Saccharoses. — The  chief  saccharoses  are 
saccharose,  lactose,  and  maltose. 

Saccharose,  saccharum  (U.  S.  Ph.,  Ger.  Ph.), 
saccharum  purificatum  (Br.  Ph.),  or  cane 
sugar,  CijHjqOh,  is  the  substance  to  which  the 
term  sugar  is  most  commonly  applied.'  It  is 
found  in  the  juices  of  most  sweet  fruits,  in 
honey,  in  the  nectar  of  flowers,  and  in  the 
juices  of  many  plants.  It  is  derived  chiefly 
from  the  sugar  cane  {Saccharum  offieinarum), 
from  sorghum  (Sorgho  saccharatum),  from 
beet-root  (Beta  vulgaris),  and  from  the  red 
maple  (Acer  saccharinum).  The  juice  of  the 
sugar  cane  is  obtained  by  expressing  it  from 
the  stalk.  By  a  somewhat  intricate  process, 
the  crvstallizable  portions  are  removed.  These, 
being 'refined,  form  the  ordinary  sugar  of  com- 


merce. A  brown  liquid  containing  the  un- 
crystallizable  portions  is  left.  This  is  known 
as  molasses,  treacle,  or  syrup.  Cane  sugar 
crystallizes  in  large  transparent,  double  oblique 
prisms.  It  is  soluble  in  half  its  weight  of 
cold  water,  in  one  fifth  of  its  weight  of  boiling 
water,  and  in  175  parts  of  alcohol,  but  is  not 
soluble  in  ether.  It  melts  at  220°  P.  If  heated 
above  this  point  it  loses  its  water,  becomes 
dark  in  colour,  and  forms  a  brown  amorphous 
substance  of  a  slightly  bitter  taste  known  as 
caramel.  Strong  sulphuric  acid  chars  sugar 
and  leaves  a  blackened  mass.  Dilute  nitric 
acid  oxidizes  it  into  oxalic  acid.  Sugar  forms 
a  number  of  metallic  compounds  Imown  as 
saccharates.  By  fermentative  action  sugar 
yields  carbon  dioxide  and  alcohol.  In  the 
open  air  sugar  keeps  indefinitely,  and  for  long 
periods  of  time  in  concentrated  solutions.  It 
is  readily  decomposed,  however,  in  dilute  solu- 
tion by  the  action  of  several  fungi,  the  yeast 
plant  being  the  most  common.  It  may  also 
undergo  acetic,  lactic,  and  butyric  fermenta- 
tion on  the  addition  of  specific  germs. 

Sugar  has  very  slight  medicinal  properties, 
but  is  largely  used  in  pharmacy,  chiefly  in  the 
form  of  syrups.  Simple  syrup,  syrupus  (U.  S. 
Ph.,  Br.  Ph.),  is  a  6o-per-cent.  solution  of  sugar 
in  distilled  water.  The  numerous  medicinal 
syrups  are  made  either  directly  from  sugar  or 
from  simple  syrup.  They  are  used  for  a  double 
purpose — to  form  a  palatable  vehicle  and  to 
preserve  drugs  in  solution.  Sugar  enters  largely 
into  the  composition  of  the  various  elixirs,  a 
few  tinctures,  and  some  other  preparations.  ■ 
It  is  an  important  element  in  troches.  It  is 
largely  used  in  cough  syrups,  and  is  believed 
to  have  some  effect  in  relieving  cough.  Honey, 
met,  is  sometimes  used  for  the  same  purposes 
as  syrup.  It  contains  a  certain  amount  of 
glucose. 

As  an  article  of  food,  sugar  is  used  in 
enormous  and  steadily  increasing  quantities. 
It  is  largely  used  in  the  preservation  of  fruits 
and  some  other  forms  of  food.  Its  excessive 
use  is  the  cause  of  much  indigestion  and  dys- 
pepsia, particularly  among  children  and  young 
adults,  as  it  is  prone  to  undergo  acid  fermenta- 
tion in  the  stomach.  In  the  presence  of  sour 
milk  it  undergoes  lactic  fermentation  with  ex- 
treme rapidity.  The  addition  of  it  to  an  in- 
fant's food  may  therefore  do  much  to  render 
any  tendency  to  indigestion  difficult  of  control. 
In  diabetes  it  is  necessary  to  prohibit  its  use 
entirely,  although  it  is  not  the  form  of  sugar 
which  is  found  in  the  urine  of  these  patients. 

[Sugar,  either  dry  or  in  concentrated  solution, 
may  be  used  as  an  antiseptic  application  to 
wounds,  ulcers,  etc.,  in  an  emergency,  when 
more  energetic  agents  are  not  at  hand. 

Sugar  has  been  employed  as  an  oxr/tocie.  Dr. 
Bossi,  whose  account  of  his  experience  with  it 
is  summarized  in  the  Revue  internationale  de 
hibliographie  medicate,  pharmaceutique  et 
veterinaire  for  April  25,  1894,  found  that  it 
answered  the  purpose  well  and  was  free  from 
the  inconveniences  attending  the  action  ol 
ergot.  In  eleven  cases  of  uterine  inertia  dur- 
ing labour  an  ounce  of  sugar  dissolved  in  wa- 
ter was  given,  and  in  ten  of  them  it  had  a  most 


335 


SUCCINIC  ACID 
SUGAR  OP  MILK 


favourable  effect  on  the  pains.  The  eobolic 
action  of  sugar  is  said  to  be  apparent  in  from 
twenty-five  to  forty-five  minutes,  and  in  many 
cases  to  be  sufficiently  prolonged  to  accomplish 
the  expulsion  of  the  child.  In  some  of  Dr. 
Bossi's  eases  it  was  found  necessary  to  give  a 
second  dose  of  the  same  amount,  an  hour  after 
the  first  oue,  in  order  to  terminate  the  labour. 
The  contractions  excited  by  sugar  are  described 
as  always  perfectly  regular,  never  taking  on  a 
tetanic  character.     (See  under  Oxytocics.)] 

Lactose,  saccliarum  lacHs,  sugar  of  milk,  da 
HijOn.HiO,  is  the  saccharose  obtained  from 
whey.  It  is  used  largely  in  pharmacy  and  for 
the  feeding  of  infants.  For  a  more  complete 
description  see  Sugae  of  milk. 

Maltose,  malt  sugar,  CuHgjOu.HaO,  is 
formed  by  the  action  of  the  diastase  of  malt 
upon  starch.  It  is  the  chief  product  resulting 
from  the  action  of  saliva  and  pancreatic  juice 
upon  glycogen  and  starch  paste.  It  is  soluble 
in  water  and  in  alcohol,  but  crystallizes  with 
diificulty  in  fine  needles.  For  a  further  de- 
scription of  maltose,  see  under  Malt. 

Glucoses. — The  chief  glucoses  are  dextrose, 
levulose,  inosite,  galactose,  and  sorbinose. 

Dextrose,  or  grape  stigar,  CeHuOe,  usually 
passes  under  the  name  of  glucose.  It  is  widely 
diffused  throughout  the  vegetable  kingdom, 
and  is  found  in  the  greatest  amount  in  grapes, 
sprouting  grains,  honey,  and  sweet  fruits.  It 
is  often  found  in  the  liver  and  blood  of  mam- 
malia, in  the  yolk  of  eggs,  and  in  the  urine  of 
diabetics.  It  may  be  produced  artificially  by 
acting  upon  starch  with  dilute  sulphuric  acid. 
It  is  thus  manufactured  in  enormous  quanti- 
ties. Corn  starch  is  chiefly  used  for  this  pur- 
pose. It  is  boiled  with  dilute  sulphuric  acid, 
then  rendered  neutral  with  lime,  and  the  re- 
sulting liquid  is  drawn  off  and  evaporated 
down  to  a  syrup,  which  is  allowed  to  crystal- 
lize. It  crystallizes,  however,  with  more  diffi- 
culty than  cane  sugar  does,  and  does  not 
usually  present  the  same  crystalline  appear- 
ance. It  has  much  less  sweetening  power  than 
cane  sugar  has,  the  proportion  being  as  one  to 
two  and  a  half.  Glucose  readily  forms  com- 
pounds with  many  metallic  salts,  especially 
oxides,  and  is  therefore  considerably  used  as  a 
reagent.  It  undergoes  alcoholic  fermentation 
with  the  greatest  readiness,  and  is  largely  used 
in  beer-making  as  a  substitute  for  maltose. 

Glucose  has  no  medicinal  properties.  Its 
value  as  an  article  of  food  is  not  wholly  settled, 
but  it  is  not  regarded  by  the  best  authorities 
as  entirely  wholesome.  It  is  believed  that  it 
may,  if  used  in  large  quantities,  predispose  to 
diabetes.  It  is  largely  sold  under  the  name  of 
sugar,  but  fraudulently,  as  its  sweetening 
power  is  far  less  than  that  of  cane  sugar,  and 
in  wholesomeness  it  is  far  inferior,  ft  enters 
largely  into  the  composition  of  molasses  and 
syrups  designed  for  food  purposes,  and  is  used 
in  very  large  quantities  in  making  candy. 

Levulose  is  closely  allied  to  glucose.  It  dif- 
fers from  it  chiefly  in  being  less  fermentable, 
in  its  rotatory  power,  and  in  a  few  minor 
points.  Its  sweetening  power,  however,  is  less 
than  that  of  glucose.  When  pure  it  is  easily 
assimilated. 
59 


Inosite  is  a  rare  compound  which  has  been 
found  in  small  amounts  in  the  muscles  and  in 
diabetic  urine. 

Galactose  resembles  glucose  very  closely,  but 
ferments  less  easily  and  has  greater  rotatory 
power. 

Sorbinose  is  a  very  sweet  soluble  sugar  found 
in  mountain-ash  berries. 

Floyd  M.  Crandall. 

SUGAR  OF  KILK,  saccharum  ladis 
(U.  S.  Ph..  Br.  Ph.,  Ger.  Ph.),  or  lactose, 
CisHjsOii.HjO,  is  the  peculiar  sugar  derived 
from  milk.  It  occurs  in  white,  four-sided 
prisms,  has  a  sweetish  taste  and  gritty  feel,  and 
is  soluble  in  seven  parts  of  cold  water.  It  is 
insoluble  in  alcohol,  in  ether,  and  in  chloro- 
form. The  sugar  of  milk  of  commerce  is  ob- 
tained chiefly  from  cow's  milk  by  evaporating 
whey  and  crystallizing  out  the  sugar.  Cow's 
milk,  according  to  the  extensive  observations 
of  Leeds,  contains  from  3'5  to  55  per  cent, 
of  lactose,  the  average  being  4'43  per  cent. 
The  lactose  of  cow's  milk  is  usually  stated 
as  4-5  per  cent.  The  lactose  of  woman's 
milk,  according  to  Leeds,  varies  from  5'4 
to  79  per  cent.,  the  average  being  7  per 
cent.  The  lactose  at  the  two  milks  is  iden- 
tical chemically,  physiologically,  and  phys- 
ically. The  carbohydrates  in  the  food  of 
adults  are  represented  by  starches  and  the  va- 
rious forms  of  sugar.  In  milk  they  consist  of 
lactose  alone.  Lactose  in  its  chemical  proper- 
ties is  intermediate  between  cane  sugar  and 
starch.  It  occurs  in  lai;ger  quantity  than  any 
of  the  other  solid  constituents  of  human  milk, 
forming  more  than  half  the  total  solids.  As 
it  is  readily  soluble,  it  is  easily  assimilated  and 
requires  but  little  expenditure  of  energy  to  ef- 
fect its  transformation  preparatory  to  diges- 
tion. In  this  it  differs  materially  from  starch. 
This  is  clearly  a  wise  provision  of  Nature,  as 
the  infant  can  not  maintain  its  animal  heat  by 
locomotion. 

Milk  sugar  readily  undergoes  lactic-aeid  fer- 
mentation, at  least  ten  varieties  of  bacteria  be- 
ing known  to  produce  that  result.  Butyric 
fermentation  also  takes  place  quite  readily.  It 
does  not,  however,  ferment  readily  under  the 
action  of  yeast. 

Until  recently  it  was  difficult  to  obtain  per- 
fectly pure  sugar  of  milk,  but  the  largely  in- 
creased use  of  it  has  resulted  in  improvements 
in  the  method  of  its  manufacture.  It  can  now 
be  obtained  practically  pure  and  occurs  as  a  per- 
fectly white,  transparent,  crystalline  powder. 
Its  extreme  hardness  renders  it  admirably 
adapted  for  use  in  the  trituration  of  drugs.  It 
is  now  used  for  that  pui'pose  in  the  manufacture 
of  Dover's  powder  and  in  nearly  all  triturations 
as  well  as  the  tablet  triturates.  In  the  manu- 
facture of  these  tablets  the  medicinal  agent  is 
triturated  with  sugar  of  milk  until  a  thorough 
and  complete  division  and  complete  distribution 
of  it  have  been  made.  The  resulting  powder  is 
then  made  into  a  paste  with  varying  propor- 
tions of  alcohol  and  water  or  other  menstruum 
and  afterward  moulded  into  tablets.  This 
method  of  administering  medicine  has  become 
very  popular  during  recent  years.    The  medi- 


SUGGESTION 
SULPHONAL 


236 


cinal  agent  is  thoroughly  triturated  and  equal- 
ly divided,  with  a  consequent  perfect  accuracy 
of  dose.  Most  of  the  tablets  containing  drugs 
dissolve  readily  and  are  elegant  in  appearance. 
Sugar  of  milk  is  also  considerably  employed  in 
the  feeding  of  infants.  It  is  almost  universal- 
ly regarded  by  paediatric  specialists  as  more 
satisfactory  for  this  purpose  than  cane  sugar. 
For  further  information  see  Milk,  section  on 
Infant  feeding  (vol.  1,  page  633). 

Floyd  M.  Crandall. 

SUGGESTION.— See  under  Hypnotism. 

SULPHAMINOL  is  a  thioxydiphenyl- 
amiue  prepared  bv  B.  Merck  by  boiling  raetoxy- 
diphenylamine  with  soda  and  sulphur,  filtering, 
and  precipitating  with  ammonium   chloride. 

<  S,  XOH. 
Its  formula  is  given  as  |    I        I    I 
XNHX 
It  is  an  odourless  and  tasteless  yellow  powder, 
insoluble  in  water,  but  readily  soluble  in  alka- 
lies and  less  readily  in  their  carbonates.     Sul- 
pharainol  is  an  antiseptic  and  is  used  chiefly  as 
a  substitute  for  iodoform  in  the  topical  treat- 
ment of  wounds,  suppurating  surfaces,  tuber- 
culous deposits,  etc.     It  is  unirritating  and 
non-poisonous.    Taken  into  the  system,  it  splits 
up  into  sulphur  and  phenol.     It  has  been  used 
internally  in  cystitis  in  doses  of  3f  grains,  four 
times  a  day. 

Sulphaminol-creosote,  an  8-per  cent,  solution 
of  sulphaminol  in  creosote,  is  used  topically 
for  the  same  purposes  as  sulphaminol.  So  also 
are  sulphaminol-eucalyptol,  sulphaminol-guai- 
acol,  and  sulphaminol-menthol.  "  Sulphaminol 
salicylate,"  a  mixture  of  8  parts  of  sulphaminol 
and  92  of  salicylic  acid,  is  employed  topically 
like  sulphaminol  and  given  internally,  in  doses 
of  from  3  to  6  grains,  in  rheumatism. 

SULPHANILIC  ACID.— The  sulphanilic 
acid  used  in  medicine  is  one  of  three  isomeric 
compounds  of  aniline  made  by  heating  aniline 
with  fuming  sulphuric  acid.  It  forms  tabular, 
prismatic,  or  laminar  crystals  which  are  almost 
insoluble  in  cold  water,  in  alcohol,  or  in  ether, 
but  more  readily  soluble  in  hot  water.  Ehrlich 
has  proposed  the  use  of  sulphanilic  acid  as  a 
urinary  test  and  also  as  a  remedy  for  iodism. 
It  may  be  given  in  daily  amounts  of  90  grains, 
associated  with  sodium  bicarbonate  to  facili- 
tate its  solution  in  water. 

SULPHATES.  —  See    under    Sulphuric 

ACID. 

SULPHIDES.— See  under  Sulphur. 
SULPHIUriDE.- See  Saccharin. 
SULPHITES.  —  See    under    Sulphurous 

ACID. 

SULPHOCARBOL.— See  Aseptol. 

SULPHOCABBOLATES,  or  salts  of  sul- 
phocarbolic  acid,  a  combination  of  equal 
weights  of  carbolic  acid  and  strong  sulphuric 
acid,  are  assumed  to  possess  nearly  all  the 
medicinal  properties  of  carbolic  acid,  but  to 
exert  less  marked  constitutional  effects  than 
the  acid.  Sulphocarbolates  of  calcium,  mag- 
nesium, potassium,  zinc,  and  sodium,  sodii  sul- 


phocarlolas  (U.  S.  Ph.,  Br.  Ph.),  are  found  in  the 
shops.  With  the  exception  of  the  last  named, 
they  are  almost  always  used  in  solutions  of 
varying  strength  as  local  applications  in  diph- 
theria, the  sore  throat  of  scarlet  fever,  amygda- 
litis, gonorrhoea,  and  all  conditions  in  which  an 
astringent  and  feeble  antiseptic  is^  indicated. 
They  are  sometimes  employed  in  vaginal 
douches  in  the  puerperal  state,  and  with  good 
results.  The  zinc  salt  is  probably  the  most 
useful  in  any  of  the  conditions  mentioned,  as 
it  has  the  greatest  astringent  power. 

The  sodium  salt  is  employed  internally,  in 
doses  of  from  10  to  30  grains,  in  flatulent  dys- 
pepsia, in  the  vomiting  of  pregnancy,  and 
whenever  there  appear  to  be  fermentative 
changes  in  the  alimentary  canal,  but,  as  a  rule, 
it  has  not  proved  of  great  value. 

Russell  H.  Nevins. 

SULPHOCYANATES.— Martinotte  {Ri- 
forma  medica,  February  13,  1896;  British 
Medical  Journal,  April  11,  1896)  has  experi- 
mented with  potassium  sulphocyanate  as  a 
remedy  for  pulmonary  tuberculosis,  but  defi- 
nite results  have  not  yet  been  reported. 

SULPHONAL,  sulfonalum  (Ger.  Ph.),  or 
dional,  is  a  synthetical  product  which  was 
brought  into  notice  in  Germany  in  1886  by 
Baumann,  and  now  appears  in  the  market  as  a 
semi-proprietary  preparation.  It  is  obtained 
by  the  interaction  of  anhydrous  mercaptan 
and  anhydrous  acetone  in  the  presence  of  a 
stream  of  dry  hydrochloric-acid  gas.  The 
liquid  becomes  turbid  and  separates  into  two 
layers,  the  upper  one  of  which  is  mercaptol. 
This  is  separated,  washed,  and  oxidized  by 
means  of  permanganate  of  potassium  into  sul- 
phonal,  or.  in  chemical  language,  diethylsul- 
phondimethylmethane,  (CHs)jC(S02C2.H6)j.  It 
may  also  be  obtained  by  combining  the  chlo- 
ride or  the  bromide  of  ethyl  with  sodium  thio- 
sulphate,  treating  the  product  with  water  to 
make  ethyl  mercaptan,  which  in  the  presence 
of  alcoholic  hydrochloric-acid  solution  and 
acetone  is  condensed  to  mercaptol,  which  is 
oxidized  as  before.  It  occurs  in  heavy  colour- 
less, prismatic  crystals,  odourless  and  nearly 
or  quite  tasteless.  Regarding  its  solubility  in 
cold  water,  there  appears  to  be  considerable 
discrepancy  of  opinion,  as  various  writers  state 
that  it  may  be  dissolved  in  proportions  from 
one  to  fifty  to  one  to  four  hundred  and  fifty. 
It  is  certain  that  it  is  not  very  soluble  in  cold 
water,  but  dissolves  freely  in  hot  wnter  and 
also  in  alcohol.  It  is  a  very  stable  body,  not 
affected  by  concentrated  acids,  alkalies,  or  oxi- 
dizing agents  either  in  the  cold  or  when 
warm. 

The  physiological  action  of  sulphonal  is  by 
no  means  perfectly  understood  It  would 
seem  chiefly,  if  not  wholly,  to  affect  the  cere- 
bral centres,  and  a  large  number  of  the  symp- 
toms produced — such  as  somnolence,  stupor, 
disinclination  to  mental  or  physical"  effort, 
muscular  weakness,  inco-ordination  and  pare- 
sis, diplopia,  aphasia,  and  slow  and  weak  res- 
piration and  pulse — may  perhaps  be  explained 
by  the  theory  that  the  irritability  of  the  cen- 
tral nervous  system  is  obtunded  by  its  action. 


237 


SUGGESTION 
SULPHONAL 


But  this  alone  does  not  seem  competent  to 
explain  other  symptoms,  suoh  as  the  depres- 
sion of  reflex  activity,  disorders  of  the  digest- 
ive tract,  and  eruptions  on  the  skin.  Dr. 
Seliick,  of  Easton,  Pennsylvania,  has  investi- 
gated the  physiological  action  of  sulphonal  by 
means  of  experiments  on  frogs  and  rabbits, 
and  his  conclusions  may  be  quoted  as  the  best 
data,  on  the  whole,  in  our  possession  at  the 
present  time.  He  found'  that  moderate  doses 
produced  relaxation  of  the  muscles  and  a  stag- 
gering gait,  but  did  not  affect  the  irritability 
of  the  motor  or  sensory  nerve-fibres.  Reflex 
activity  was  usually  depressed,  but  was  some- 
times exalted.  In  large  doses  it  depressed  the 
respiration,  and  this  depression  was  not  af- 
fected by  section  of  the  pneumogastric  nerve. 
When  it  was  introduced  into  the  system 
through  the  stomach  very  little  if  any  effect 
was  produced  on  the  circulation,  and  spectro- 
scopic examination  failed  to  reveal  any  change 
in  the  blood,  but  when  it  was  injected  directly 
into  the  circulation  it  caused  a  slight  decrease, 
soon  followed  by  an  increase  in  the  arterial 
tension.  Possibly  this  may  be  explained  by 
the  fact  that  when  it  is  introduced  into  the 
stomach  it  acts  very  slowly  because  of  its  in- 
solubility or  of  its  slow  absorption,  but  when 
it  is  given  subcutaneously  in  a  warm  solu- 
tion its  effect  appears  much  more  promptly. 

The  method  of  the  elimination  of  sulphonal 
from  the  system  cannot  be  said  to  have  been 
satisfactorily  determined.  It  has  been  said  by 
some  writers  to  be  excreted  in  the  form  of 
combined  or  uncorabined  sulphuric  acid,  and 
it  has  been  said  that  a  certain  amount  of  un- 
changed sulphonal  could  be  found  in  the  urine. 
The -theory  latest  advanced  by  Smith,  of  Lon- 
don, based  upon  experiments  made  on  dogs, 
is  that  in  its  passage  through  the  system  sul- 
phonal is  broken  up  in  such  a  way  as  to  yield 
ethylsulphonic  acid,  and  that  this  is  eliminated 
in  the  urine.  The  same  experimenter  found 
that  moderate  doses  increased  the  amount  of 
urea  and  the  quantity  of  urine  excreted,  but 
to  so  slight  a  degree  that  it  does  not  appear 
that  in  such  doses  the  destruction  of  nitroge- 
nous tissue  is  materially  affected.  The  phos- 
phates in  the  urine  are  said  by  some  observers 
to  be  increased  by  small  and  decreased  by 
large  doses  qf  this  drug.  The  colour  of  the 
urine  is  apt  to  be  changed  to  a  reddish  brown 
by  the  presence  of  a  colouring  material  which 
is  closely  allied  to  and  has  generally  been  sup- 
posed to  be  identical  with  haematoporphyrin. 
JBy  almost  every  test  the  two  are  identical,  but 
an  examination  with  the  spectroscope  reveals 
a,  difference.  It  is  not  certain  whether  this 
substance  is  present  in  the  blood  or  is  formed 
during  or  after  the  process  of  excretion. 
Other  pigments  also  are  usually  present  in  the 
urine. 

The  effect  of  sulphonal  upon  the  blood-cor- 
puscles is  uncertain.  Some  observers  say  that 
they  are  reduced  in  number  during  the  use  of 
the  drug,  but  others  assert  that  this  is  an 
error.  An  occasional  annoying  result  of  its 
use  is  the  occurrence  of  a  rash  on  the  skin,  of 
pruritus,  or  of  both  combined. 

In  the  report  of  the  therapeutic  committee 


appointed  by  the  British  Medical  Association 
to  investigate  the  utility  of  various  hypnotics, 
the  disagreeable  after-effects  of  sulphonal  are 
thus  summarized  :  "In  six  out  of  ten  cases  in 
which  20  grains  had  been  given  disagreeable 
after-effects  were  noted  ;  drowsiness  next  day 
wag  noted  six  times,  giddiness  four  times, 
and  headache  and  inco-ordination  of  gait  each 
twice.  In  four  cases  where  10  grains  had 
been  given  drowsiness  was  noted  once;  in 
five  cases  with  15  grains  drowsiness  was 
noted  twice  and  giddiness  twice;  with  25 
grains  (four  cases)  drowsiness  was  noted 
twice,  giddiness  once,  and  headache  once.  In 
seven  cases  with  30  to  60  grains  drowsiness 
was  noted  four  times,  giddiness  twice,  inco- 
ordination of  gait  and  vomiting  each  once." 
Many  other  reports  corroborate  the  frequent 
appearance  of  these  symptoms,  which  may 
be  termed  mildly  toxic,  and  it  would  seem  as 
if  a  consideration  of  these  and  of  the  physio- 
logical action  of  sulphonal  would  cause  the 
physician  to  exercise  great  care  and  discj-etion 
in  its  use,  at  least  until  the  accumulated  evi- 
dence of  professional  experience  had  demon- 
strated its  action  to  be  without  danger.  But 
such  has  not  been  the  case.  It  has  been  loudly 
praised  and  highly  vaunted  as  an  absolutely 
safe  hypnotic,  and  is  still  advertised  as  such, 
although  there  are  numerous  cases  of  death  on 
record,  some  as  the  results  of  moderate  doses. 
The  most  striking  of  these,  perhaps,  is  reported 
by  Pettit.  A  woman,  twenty-eight  years  of 
age,  who  was  suffering  from  melancholia  with 
hysterical  manifestations,  but  was  not  known 
to  have  any  organic  lesion,  was  given  30  grains 
of  sulphonal  in  two  equal  doses  an  hour  and  a 
quarter  apart.  She  slept  for  twelve  hours  and 
then  could  be  roused  and  could  swallow,  but 
somnolence  increased  for  the  next  twelve  hours. 
The  pupils  began  to  contract  eighteen  hours 
after  the  last  dose.  At  the  end  of  forty  hours 
the  temperature  began  to  rise,  and  the  patient 
died  in  spite  of  active  treatment  such  as  is 
usually  instituted  in  cases  of  narcotic  poison- 
ing. iRehm  reports  a  case  in  which  the  patient 
narrowly  escaped  death  as  the  result  of  the  ad- 
ministration of  18  grains  for  three  successive 
days.  The  usual  symptoms  of  poisoning  ap- 
peared and  finally  resulted  in  a  state  of  collapse 
marked  by  pallor,  speech  reduced  so  as  to  be 
hardly  audible,  a  weak  and  rather  rapid  pulse, 
suppression  of  urine,  hypersesthesia,  diplopia, 
meiosis,  and  inability  to  move.  After  the 
lapse  of  two  weeks  the  patient  could  walk  with 
difiiculty.  A  very  serious  feature  in  most  of 
the  fatal  cases  of  poisoning  is  that  usually  the 
patients  have  been  under  treatment  for  some 
time  and  have  been  apparently  benefited  by 
the  drug  up  to  the  time  of  the  appearance  of 
the  toxic  symptoms.  Such  cases  demonstrate 
that  the  drug  is  not  so  harmless  as  it  has 
been  alleged  to  be,  even  though  it  is  not  what 
one  writer  asserts— the  most  dangerous  of  the 
hypnotics. 

The  symptoms  of  poisoning  are  numerous 
and  of  varying  degrees  of  severity,  and  may 
possibly  be  explained  as  due  to  the  action  of 
the  drug  upon  the  nervous  centres  which  main- 
tain a  controlling  influence  over  the  parts  of  the 


SULPEOSALICYLIC  ACID 
SULPHUR 


338 


body  affected.  They  may  be  thus  enumerated 
though  all  are  not  usually  present  in  one  case : 
Drowsiness,  stupor,  muscular  inco-ordination, 
incapacity  for  mental  or  physical  exertion,  tin- 
nitus aurium,  headache,  vertigo,  partial  loss  of 
the  reflexes,  nausea,  vomiting,  constipation, 
sometimes  diarrhoea,  ataxic  nervous  troubles, 
diplopia,  muscular  tremor  or  paresis,  ptosis, 
oedema  of  the  eyelids,  slow  and  weak  (possibly 
stertorous)  respiration,  slow  pulse,  elevation  of 
temperature,  general  anjEsthesia,  urine  changed 
in  colour  to  reddish  brown,  diminished  in  quan- 
tity or  suppressed,  aphasia,  and  cyanosis.  Death 
results  from  cessation  of  respiration.  In  sev- 
eral fatal  cases  motor  paralysis  appeared  to  be 
the  most  prominent  symptom.  Recovery  is 
usually  rapid  in  the  non-fatal  cases  of  poison- 
ing, if  the  patient  is  thoroughly  purged  and 
the  changes  in  the  urine  disappear  after  two 
or  three  days. 

There  is  no  agreement  in  the  observations 
made  after  death  from  sulphonal  poisoning  as 
to  the  lesion  produced  by  the  drug.  In  several 
cases  the  kidneys  have  been  pronounced  nor- 
mal. Stern  found  extensive  necrosis  of  the 
epithelium  of  the  convoluted  tubules  and  of 
the  ascending  limbs  of  Henle's  loops,  together 
with  minute  haemorrhages  in  the  kidneys  due 
to  toxic  nephritis.  Helweg  found  the  cells  of 
the  anterior  and  posterior  horns  of  the  spinal 
cord  degenerated  and  their  number  dimin- 
ished. 

[Schulz  (Neurologisches  Centralilatt,  Octo- 
ber, 1896 ;  British  Medical  Journal,  Novem- 
ber 28,  1896)  records  a  fatal  case  of  chronic 
sulphonal  poisoning.  The  patient,  a  woman, 
aged  fifty-nine,  had  been  under  treatment  some 
years  for  headaches,  constipation,  and  restless- 
ness, and  was  extremely  hysterical.  On  ac- 
count of  sleeplessness  she  had  recently  been 
taking  sulphonal  in  doses  of  15  grains,  and 
had  taken  altogether  about  half  an  ounce 
within  a  month.  When  she  was  admitted 
into  a  hospital  for  obstinate  constipation  with 
vomiting  there  was  a  smell  of  acetone  in  the 
breath,  the  tongue  was  dry  and  furred,  and 
there  was  great  thirst,  with  restlessness  and 
insomnia.  All  the  organs  otherwise  were  nor- 
mal ;  the  urine  was  normal.  The  next  evening 
25  grains  of  sulphonal  were  given,  and  on  the 
following  day  the  urine  was  scanty  and  brown- 
ish-red, but  free  from  albumin.  Pour  days 
later  the  gait  was  unsteady,  and  five  days  after 
this  there  were  weakness  of  the  limbs  and 
anaesthesia  of  the  legs  down  to  the  ankles ;  the 
knee-jerks,  previously  normal,  were  now  diffi- 
cult to  obtain.  Weakness  increased,  the  knee- 
jerks  disappeared,  incontinence  of  urine  and 
faeces  occurred,  and  two  days  later  the  patient 
died  suddenly.  The  urine,  after  the  single 
dose  of  sulphonal  mentioned,  had  continued 
brownish-red  with  no  albumin,  but  contained 
a  few  altered  red  blood-corpuscles.  The  colour 
was  found  to  be  due  to  haematoporphyrin. 
Schulz  considers  that  the  toxic  results  after 
only  one  dose  of  sulphonal  were  due  to  the  ob- 
stinate constipation  present,  causing  the  sul- 
phonal to  be  retained  in  the  body  longer  than 
usual.  Great  caution,  he  says,  should  there- 
fore be  exercised  in  ordering  sulphonal  for 


patients  who  are  constipated,  and  where  it  is 
ordered  a  careful  watch  should  be  kept  of  the 
urine  for  haematoporphyrin. 

Mr.  F.  P.  Hearder  {Lancet,  November  14, 
1896;  New  York  Medical  Jo^irnal,  December 
5,  1896)  reports  the  case  of  a  man,  forty-three 
years  of  age,  who.  four  months  previously  to 
his  admission,  on  May  2,  1896,  into  the  Wake- 
field Asylum,  had  hurt  the  back  of  his  head  in 
an  accident ;  he  had  suffered  much  from  shock, 
and  had  been  very  nervous  afterward.  Three 
weeks  before  his  admission  he  had  cut  his 
throat.  On  his  admission  the  pupils  were  un- 
equal, the  right  being  more  dilated  than  the 
left,  which  reacted  more  perfectly.  His  knee- 
jerks  were  exaggerated,  and  there  was  slight 
ankle  clonus.  His  superficial  arteries  were 
thickened  and  tortuous ;  the  heart's  action  was 
irritable  and  irregular,  and  the  sounds  were 
accentuated,  but  there  was  no  bruit.  In  the 
urine  there  was  a  copious  mucous  cloud ;  it 
was  acid,  of  the  specific  gravity  of  1-022,  and 
contained  no  albumin  or  sugar.  His  mental 
state  was  that  of  agitated  or  motor  melan- 
cholia. He  had  a  dejected  and  lacrymose 
expression,  and  he  had  aural  and  visual  hallu- 
cinations and  delusions  that  harm  (murder, 
etc.)  was  happening  to  his  mother  and  sister; 
he  cried  and  prayed  for  their  safety.  During 
the  next  few  days  he  continued  restless  and 
sleepless,  needed  forcible  feeding,  was  con- 
stantly attempting  to  tear  the  bandage  off  his 
throat,  and  required  continual  supervision.  A 
mixture  of  potassium  bromide  with  chloral 
hydrate  was  given  with  no  good  effect.  Sul- 
phonal was  then  tried  (15  grains  three  times  a 
day),  administered  in  a  warm  drink,  apparently 
with  very  good  effect,  as  he  took  his  food  bet- 
ter, slept  well  at  night,  and  was  less  restless 
during  the  day.  On  the  fourth  day  his  gait 
was  ataxic  and  his  expression  and  movements 
were  like  those  of  a  drunken  man.  On  the 
sixth  day  the  urine  was  noticed  to  be  becoming 
scanty  and  high-coloured.  The  use  of  sul- 
phonal was  at  once  stopped  and  the  urine  ex- 
amined. It  contained  no  blood  and  no  albumin. 
On  the  following  day  there  was  marked  oli- 
guria, about  5  ounces  of  urine  having  been 
passed  in  the  twenty-four  hours.  The  urine 
was- of  about  the  colour  of  porter  which  had 
been  shaken ;  there  was  no  deposit,  it  was 
acid,  and  of  the  specific  gravity  of  1-015.  The 
amount  of  albumin  was  exceedingly  copious, 
the  urine,  on  being  boiled,  becoming  almost 
solid.  The  patient  was  in  a  somewhat  soporose 
state ;  there  was  slight  oedema  ot  the  eyelids, 
but  no  swelling  of  the  legs  and  ankles.  The 
pulse  was  quiet  and  the  temperature  about 
normal.  He  was  kept  recumbent,  a  saline 
purge  was  administered,  and  a  diuretic  mix- 
ture containing  citrate  of  potassium  and  ace- 
tate of  potassium  was  given,  with  diluent 
drinks,  milk  and  soda-water,  and  barley-water. 
On  the  following  day  the  urine  was  still  some- 
what scanty,  high-coloured,  acid,  and  of  the 
specific  gravity  of  1-020,  but  it  contained  no 
blood  or  albumin.  The  patient  was  better  and 
took  food  (fluid  and  semifluid)  freely.  After 
that  he  made  considerable  physical  aiid  mental 
improvement,  but  continued  depressed.    Sev- 


339 


SULPHOSALICYLIO   ACID 
SULPH  UR 


eral  subsequent  examinations  of  his  urine  re- 
vealed nothing  abnormal.] 

Observers  disagree  in  regard  to  the  eifects 
produced  by  suddenly  stopping  the  use  of  the 
drug  after  it  has  been  employed  for  a  consid- 
erable length  of  time.  Some  assert  that  no 
ill  effects  are  thereby  produced,  while  others 
ascribe  to  its  sudden  withdrawal  a  condition 
which  resenibles  that  produced  by  the  abrupt 
withdrawal  of  morphine  in  morphinism,  marked 
by  general  weakness,  digestive  and  motor  dis- 
turbances, and  vertigo. 

Sulphonal  is  slow  in  its  action  atid  is  with- 
out doubt  cumulative  in  the  system.  Hence 
when  it  is  given  daily  for  some  time  there  is 
danger  that  it  may  cause  toxic  symptoms. 
This  should  be  guarded  against  as  far  as  pos- 
sible by  care  that  the  bowels  are  kept  open 
and  that  the  kidneys  act  normally  and  eflB- 
ciently  during  its  administration,  as  well  as  by 
its  prompt  discontinuance  on  the  appearance 
of  anorexia,  nausea,  gastric  pain,  or  other  dis- 
agreeable or  toxic  symptom. 

It  is  mainly  employed  as  a  hypnotic,  and  its 
use  appears  to  be  particularly  indicated  in  cases 
of  mental  excitement  or  distress,  over  which  it 
seems  to  exercise  a  distinct  sedative  action. 
Thus,  in  acute  mania,  melancholia,  and  de- 
lirium tremens,  as  well  as  in  the  milder  forms 
of  nervous  insomnia,  it  induces  sleep  by  night 
and  quiet  by  day,  a  condition  certainly  condu- 
cive to  the  restoration  of  the  mental  equilib- 
rium. It  is  not  an  anodyne  and  does  not  re- 
lieve sleeplessness  caused  by  pain. 

It  has  been  used  to  relieve  the  paroxysms  of 
asthma,  hiccough,  contyulsions  due  to  teething, 
and  trismus  neonatorum.  Good  results  are 
said  to  have  been  obtained  from  its  use  as  an 
adjuvant  to  other  treatment  in  cases  of  chorea 
and  epilepsy.  On  account  of  the  relaxation  of 
the  muscles  which  is  induced  as  one  of  its 
physiological  effects,  it  has  been  found  eflfieient 
to  arrest  spasm  of  the  muscles  of  broken  limhs 
and  to  relieve  muscular  cramps.  It  is  one  of 
the  numerous  remedies  recommended  as  a 
means  of  prophylaxis  against  seasickness  and 
the  similar  affection  sometimes  called  "  train- 
sickness." 

In  phthisis pulmonalis,  8  grains  of  sulphonal 
are  said  to  be  quite  as  competent  as  atropine 
to  prevent  night  sweats  equally  and  to  exert 
this  effect  for  a  longer  time.  In  diabetes  it 
has  been  found  to  cause  a  diminution  of  the 
amount  of  sugar  present  in  the  urine,  but  to 
produce  no  permanent  improvement,  as  the 
sugar  increases  to  its  former  amount  immedi- 
ately upon  the  withdrawal  of  the  drug.  Its 
use  in  typhoid  fever,  chronic  opium  poisoning, 
av.i  nocturnal  enuresis  has  not  been  sufficiently 
extensive  to  warrant  the  expression  of  any 
conclusion. 

Bad  results  have  been  reported  from  its  use 
in  angina  pectoris,  and  it  is  now  considered  to 
be  contra-indicated  in  this  disease. 

It  is  difficult  to  determine  the  proper  dose,  not 
only  because  this  differs  with  different  persons, 
but  also  because  it  may  vary  at  different  times 
with  the  same  person,  so  that  the  amount  which 
at  one  time  produced  quiet,  sound  sleep  from 
which  the  patient  awoke  refreshed  may  at 


another  time  be  followed  by  unpleasant  after- 
effects, or  the  expected  soporifie  effect  may  be 
replaced  by  mental  excitement,  headache,  and 
other  nervous  symptoms,  or  there  may  simply 
be  a  failure  on  the  part  of  the  drug  to  produce 
any  hypnotic  or  other  apparent  effect.  In  any 
given  case  the  amount  to  be  given  must  be  de- 
termined by  the  judgment  of  the  attending 
physician,  but  the  average  dose  may  be  stated 
as  from  15  to  30  grains  once  a  day  or  every 
alternate  day.  As  a  rule,  men  require  larger 
amounts  than  women. 

Sulphonal  is  best  administered  in  hot  liquids 
about  two  hours  before  it  is  desired  that  the 
patient  shall  sleep.  A  good  plan  is  to  dissolve 
it  in  boiling  water  and  to  give  it  as  soon  as  it 
has  cooled  sufficiently  to  be  potable,  flavoured, 
if  wished  with  a  liqueur  or  cordial.  Or  it  may 
be  given  in  hot  broth,  milk,  or  coffee,  and,  as 
it  is  practically  tasteless,  it  can  thus  be  ad- 
ministered without  the  knowledge  of  the 
patient.  In  some  cases  it  may  be  advanta-, 
geously  combined  with  small  doses  of  codeine 
or  morphine.  (See  also  under  Hypnotics  [vol. 
i,  page  509]). — Matthias  Lanckton  Fostek. 

SULPHOSALICYIilC  ACID,  or  salicyl- 
sulphuric  acid,  C6Hs(S0sH)(0H)C00H,  is  pre- 
pared, according  to  Professor  Coblentz,  by  the 
action  of  fuming  sulphuric  on  salicylic  acid, 
and  forms  white  crystals  which  are  soluble  in 
water  and  in  alcohol.  It  is  said  to  have  been 
employed  in  the  treatment  of  rhe^imatism. 

SULPHOTUMENOLIC      ACID.  —  See 

TUMENOL. 

SULPHUR  is  a  non-metallic  element.  It 
has  an  atomic  weight  of  31-98  and  is  variously 
bivalent,  quadrivalent,  and  sexvalent.  As  it 
occurs  in  nature,  it  forms  yellow,  transparent, 
rhombic  crystals.  It  is  insoluble  in  water, 
slightly  soluble  in  alcohol  and  in  ether,  but 
dissolves  freely  in  carbon  disulphide,  in  oil  of 
turpentine,  and  in  benzene.  It  gives  forth  a 
peculiar  odour  when  rubbed  and  has  a  very 
faint  taste.  In  nature  it  is  found  free  and  in 
combination  with  metals  in  the  form  of  the 
sulphides  in  many  ores,  especially  copper  and 
iron  pyrites.  It  is  very  widely  distributed,  al- 
though its  most  frequent  occurrence  is  in  vol- 
canic districts.  Sulphur  forms  one  of  the 
constituents  of  the  volatile  oils  of  garlic  and 
mustard  and  is  found  in  albumins  and  other 
proteids.  It  is  found  in  the  Western  United 
States,  in  Mexico,  and  in  the  West  Indies,  but 
the  chief  commercial  supply  comes  from  Italy 
and  Sicily.  Sulphur  is  popularly  known  as 
brimstone. 

The  sulphur  of  coranjerce  is  obtained  from 
the  native  ore  by  the  action  of  heat,  the  sul- 
phur becoming  volatilized.  When  this  vapour 
is  condensed,  the  sulphur  is  deposited  as  a  fine, 
greenish-yellow  powder  with  a  slight  charac- 
teristic alliaceous  odour  and  a  faintly  acid 
taste  from  the  presence  of  a  trace  of  sulphlir- 
ous  acid.  The  sulphurous  acid  is  formed  by  a 
slight  oxidation  of  the  sulj)hur.  This  form  of 
sulphur  is  known  as  sublimed  sulphur,  sul- 
phur sublimatum  (U.  S.  Ph.,  Br.  Ph.),  sulfur 
sublimatum  (Ger.  Ph.),  or  flowers  of  sulphur. 
It  is  slightly  soluble  in  oils  and  in  fats,  com- 


SULPHUR 


240 


pletely  soluble  in  carbon  disulphide,  and  insol- 
uble in  water.  When  ignited,  it  burns  with  a 
blue  flame  with  the  formation  of  sulphurous- 
acid  gas,  and  should  leave  no  ash. 

Washed  sulphur,  sulphur  lutum  (U.  S.  Ph.), 
sulfur  depuratum  (G-er.  Ph.),  is  obtained  by 
digesting  the  flowers  of  sulphur  with  dilute 
ammonia,  washing  thoroughly,  and  gently 
drying  and  passing  through  a  strainer.  Its 
characteristics  are  those  of  sulphur,  but  it  is 
inodorous.  The  U.  S.  Ph.  directs  that  on  the 
addition  of  water  blue  litmus  paper  must  not 
be  reddened  by  washed  sulphur. 

Precipitated  sulphur,  sulphur  prceeipitatum 
(U.  S.  Ph.,  Br.  Ph.),  sulfur  prceeipitatum  (Ger. 
Ph.),  is  also  known  as  lac  sulphuris,  or  milk  of 
sulphur.  It  is  obtained  by  boiling  sulphur  with 
slaked  lime  and  water,  by  which  process  cal- 
cium sulphide  and  calcium  hyposulphite  are 
formed.  The  addition  of  hydrochloric  acid 
decomposes  the  salts,  and  the  sulphur  is  pre- 
cipitated in  a  fine  powder.  To  be  official,  this 
sulphur  must  be  washed  until  it  is  tasteless, 
must  be  free  from  acid,  and  must  give  no  re- 
action with  oxalic  acid  for  carbonate  of  calcium 
and  water.  Because  of  its  extreme  fineness, 
precipitated  sulphur  is  white  instead  of  yellow. 
Its  other  properties  are  like  those  of  sulphur. 

The  antiseptic  and  antizymotic  action  of 
sulphur  has  been  known  for  a  long  time.  Ap- 
plied locally  in  powder,  it  has  the  power  of  de- 
stroying fungi  and  other  vegetable  parasites 
on  man  and  the  lower  animals.  When  ignited, 
it  gives  oflE  dense  fumes  of  sulphurous-acid  gas 
which  are  known  for  their  bactericidal  action. 
The  fumes  of  sulphur  dioxide  destroy  the  germs 
of  cholera,  typhoid  fever,  diphtheria,  glanders, 
and  tuberculosis.  The  disinfecting  qualities  of 
the  gas  evolved  by  the  burning  of  sulphur  have 
been  recognised  by  sanitary  authorities,  and  it 
is  the  common  practice  to  disinfect  rooms  that 
have  been  occupied  by  patients  suffering  from 
infectious  or  contagious  disease  by  this  means. 
The  laboratory  experiments  of  Squibb  and 
those  of  Dubie'f  and  Bruhl  (cited  in  New  York 
IJedieal  Journal,  August  17,  1889)  force  one  to 
.  the  conclusion  that  the  destructive  action  of 
gaseous  sulphurous  acid,  SOj,  depends  upon  the 
moisture  in  the  air  aside  from  its  own  manifest 
bactericidal  properties.  Prolonged  action  of 
the  pure  gas  may  destroy  germs  even  in  a  dry 
condition,  according  to  these  observers.  To 
provide  the  desirable  moisture  in  the  air,  a 
small  kettle  or  vessel  may  be  filled  with  water 
and  heated  previous  to  the  disinfecting  process, 
and  the  articles  of  furniture  and  the  walls  may 
be  moistened  with  water  or  some  disinfecting 
solution.  All  apertures  into  the  room  should 
be  closed  to  prevent  the  escape  of  pungent  gas ; 
if  necessary,  the  frames  of  the  windows  and 
doors  ftiay  be  stuffed  with  rags  or  cotton.  Not 
less  than  3  pounds  of  sulphur  to  each  1,000  feet 
of  space  must  be  burned.  The  powdered  sul- 
phur or  fragments  of  the  element  should  be 
laid  in  a  pan  which  rests  on  a  support  in  a  tub 
of  water  to  prevent  fire.  In  order  to  hasten 
the  combustion  of  the  sulphur  it  may  be  moist- 
ened with  alcohol.  This  is  the  method  in 
vogue  with  the  board  of  health  of  New  York 
city,  and  it  seems  to  meet  every  »pquirement 


after  the  occupancy  of  a  room  by  a  patient  sick 
with  an  infectious  disease.  Ships  which  have 
carried  passengers  suffeiing  from  cholera,  yel- 
low fever,  or  typhus  fever  may  be  disinfected 
in  the  same  way.  Koch  and  Sternberg  have 
shown  that  the  spores  of  the  anthrax  bacillus 
are  not  killed  by  fumigation  with  sulphur,  and 
that  it  can  not  be  used  successfully  for  the 
disinfection  of  clothing  or  bales  of  rags,  be- 
cause the  gas  is  lost  by  diffusion. 

Taken  internally  in  doses  of  from  20  to  40 
grains,  sulphur  produces  soft  stools.  The  fla- 
tus, after  such  a  dose,  smells  strongly  of  sul- 
phuretted hydrogen,  HjS.  If  the  dose  is 
repeated  several  times  at  short  intervals,  the 
odour  of  sulphur  is  given  off  by  the  breath 
and  by  the  skin.  Silver  articles  worn  next 
the  body  are  blackened,  and  the  linen  worn  by 
the  patient  becomes  yellow.  Sulphur  has  also 
been  found  in  the  urine  and  milk  after  its  ad- 
ministration. As  sulphur  is  a  constituent  ele- 
ment of  all  albuminous  bodies,  it  seems  to  be 
necessary  to  the  animal  economy  for  physiologi- 
cal purposes.  Taurocholic  acid  contains  the 
element,  and  it  is  believed  that  sulphur  stimu- 
lates the  bile-producing  function  of  the  liver. 

Poisonous  effects  have  been  observed  from 
the  ingestion  and  from  the  external  use  of  sul- 
phur. These  symptoms  have  manifested  them- 
selves in  nausea,  dysentery,  tonic  contractions 
of  the  muscles  of  the  extremities,  the  appear- 
ance of  fever,  and  painful  urination.  In  one 
case  there  were  extreme  prostration,  a  sulphu- 
rous breath,  clammy  perspiration,  vomiting 
and  purging,  and  intestinal  colic.  Sulphur  ap- 
plied as  an  ointment  is  easily  absorbed  from 
the  skin,  and  its  possible  poisonous  action  must 
be  guarded  against. 

Internally,  sulphur  may  be  given  as  a  sim- 
ple laxative  in  doses  of  ifrom  SO  to  60  grains. 
It  is  especially  valuable  after  pelvic  or  abdomi- 
nal operations,  because  of  its  depleting  yet 
gentle  action.  On  account  of  the  soft  stools 
it  produces,  it  is  useful  also  in  piles.  To  con- 
ceal its  taste,  which  is  disagreeable  to  some 
patients,  it  may  be  administered  in  syrup,  in 
milk,  in  molasses,  or  mixed  with  honey.  Small 
doses  of  sulphur  have  an  alterative  effect,  and 
in  cases  in  which  digestive  disturbances  are 
due  to  disordered  or  suspended  hepatic  func- 
tion sulphur  may  evoke  good  results.  As  an 
alterative  the  dose  is  from  5  to  30  grains.  In 
colic  due  to  impaction  of  a  gallstone,  or  of  any 
hepatic  origin,  daily  doses  of  5  grains  tend 
to  alleviate  the  symptoms.  In  cases  of  chlo- 
rosis, when  iron  is  not  well  borne  or  has  failed 
of  its  effpct,  sulphur  may  be  given  in  alterative 
doses.  As  a  stimulant  to  the  bronchial  mu- 
cous membrane  in  chronic  bronchitis,  sulphur 
has  some  reputation.  The  formula  of  Germain 
See  is  given  here : 

9  Precipitated  sulphur 50  grains ; 

Extract  of  belladonna  leaves. .    U  grain ; 

Powder  of  ipecac  and  opium .     5  grains ; 

Sugar 20     " 

M.  Make  10  capsules.  Use  from  2  to  10 
capsules  a  day. 

In  cystitis  and  in  pyelitis  of  tuberculous  or 
calculous  origin  sulphur  has  been  recommend- 


241 


SULPHUR 


ed  and  its  use  has  been  praised  in  the  treat- 
ment of  dercmgemenf.  of  the  menses.  It  has 
been  alleged  for  sulphur  that  it  relieves  the 
muscular  pains  in  gout  and  rheumatism.  Com- 
bined with  iodine,  the  iodides,  or  arsenic,  it 
seems  to  produce  beneficial  results  in  rheumat- 
ic arthritis.  The  natural  sulphur  baths  have 
long  been  reputed  to  be  of  benefit  in  rheuma- 
tism and  gout,  and  in  these  ailments  the  warm 
baths  seem  productive  of  most  good.  For  skin 
diseases  it  is  likely  that  partial  douching  of 
the  affected  parts  is  more  effectual  than  total 
immersion.  The  mineral  waters  containing 
sulphur  are  good  as  laxatives,  since  they  usu- 
ally contain  the  earthy  and  alkaline  sulphates. 
In  muscular  rheumatism  sulphur  has  had  some 
use,  but  it  is  of  doubtful  value.  What  is 
known  as  balsamum  pulmonum  is  a  solution 
of  sulphur  in  linseed  oil  to  aid  in  the  expec- 
toration of  a  chronic  or  acute  bronchitis  with 
profuse  sputum.  In  habitual  constipation, 
hcBmorrhoids,  and  rectal  hcemorrhages  Garrod 
advises  the  employment  of  a  lozenge  contain- 
ing 5  grains  of  precipitated  sulphur  and  1  grain 
of  cream  of  tartar.  In  skin  diseases  sulphur 
may  be  given  for  its  tonic  effect,  and  in  dis- 
eases of  the  nails  its  use  seems  to  be  indicated 
to  supply  the  element  to  those  organs. 

Externally  or  locally,  the  most  efficient  em- 
ployment of  sulphur  is  in  the  treatment  of 
scabies.  The  agent  destroys  the  path  of  the 
acarus  and,  as  a  sulphide,  probably  kills  the 
parasite  and  its  eggs.  In  the  treatment  of  this 
parasitic  disease  the  ordinary  ointment  of  sul- 
phur or  the  alkaline  ointment  may  be  used ; 
it  makes  no  difference  in  the  result  whether 
the  element  is  used  alone  or  in  combination 
with  alkalies,  the  main  thing  desired  being 
the  application  of  the  sulphur  to  the  diseased 
area.  Hebra's  perfected  formula  is  here  ap- 
pended : 

^  OUofTade  '"'^'"""'  [  ^^"'^  ■  •  •  •  6  02-  ; 
Grejnrp,    J  ^^„, ^  „,  ^ 

Chalk 4oz. 

M. 

Before  the  application  of  this  or  a  similar  oint- 
ment the  skin  must  be  washed  with  soap  and 
warm  water.  One  inunction  is  made  daily  for 
a  week,  the  clothing  next  to  the  body  remain- 
ing unchanged.  After  seven  days  the  patient 
should  take  a  full  bath  and  be  inspected.  Too 
vigorous  use  of  the  sulphur  ointment  may  pro- 
voke a  dermatitis  which  may  be  difficult  to 
cure.  An  ointment  containing  sulphur  has 
been  recommended  for  a  host  of  other  skin 
diseases,  among  them  acne,  alopecia  areata, 
sycosis,  psoriasis,  and  tinea  versicolor.  In  the 
first  and  last  of  these  a  treatment  combining 
the  application  of  an  ointment  and  the  use  of 
sulphur  baths  is  said  to  be  particularly  effica- 
cious. Tinea  tonsurans  is  said  to  be  amenable 
to  cure  by  the  use  of  a  sulphur  ointment  after 
the  clipping  of  the  hair.  The  fumes  of  burn- 
ing sulphur  are  reputed  to  be  beneficial  in  the 
treatment  of  inveterate  forms  of  eczema, psori- 
asis, impetigo,  and  prurigo.  For  this  method 
of  treatment  the  patient's  body,  except  his 


head,  is  inclosed  and  subjected  to   the  sul- 
phurous fumes. 

The  fumes  of  sulphur,  like  so  many  other 
agents,  have  been  alleged  to  relieve  the  parox- 
ysms of  whooping-cough.  Amenorrhcea  of 
functional  origin  and  rheumatic  and  scrofulous 
affections  have  been  known  to  yield  to  the  fumes 
of  burning  sulphur.  Care  must  be  taken  when 
the  agent  is  thus  employed  that  a  dermatitis 
does  not  arise. 

Applied  in  the  form  of  a  powder,  sulphur 
has  been  used  since  the  days  of  Pliny  as  a  rem- 
edy for  lumbago.  It  is  said  to  be  eflBcient  in 
the  treatment  of  sciatica  and  of  other  periph- 
eral nervous  disturbances.  Sulphur  ointment, 
spread  over  the  body  in  'cases  of  erysipelas, 
measles,  and  small-pox,  is  said  to  allay  the  heat 
of  the  skin  and  the  cutaneous  congestion  and, 
in  the  last  named  disease,  to  disinfect  the  pus- 
tules. 

Before  the  days  of  the  specific  treatment  of 
diphtheria  the  insufflation  of  powdered  sul- 
phur was  in  high  favour  in  the  treatment  of 
this  disease  and  of  croup.  Baumler,  of  Frei- 
burg (cited  in  Practitioner,  August,  1894),  says 
that  in  diphtheria,  judging  from  his  observa- 
tion in  a  large  number  of  cases,  sulphur  is 
better  as  a  local  application  than  any  of  the 
other  agents  he  has  used.  Sublimed  sulphur, 
applied  with  a  camel's-hair  brush  every  two  or 
three  hours  or  insufflated  an  equal  number  of 
times,  has  uniformly  given  good  results  in  his 
experience.  To  be  of  service  it  must  be  applied 
thick.  Even  in  cases  of  gangrene  of  the  uvula 
and  of  part  of  the  soft  palate  he  has  observed 
an  improvement  in  a  few  days.  He  adds  that 
this  method  of  treatment  is  best  when  the 
disease  is  confined  to  the  fauces,  but  urges  the 
insufflation  of  sulphur  in  cases  of  laryngeal 
diphtheria. 

In  the  treatment  of  tuberculous  joints  and 
of  tuberculous  osteomyelitis  sulphur  has  been 
used  with  excellent  effect,  applied  as  part  of 
the  dressing.  In  infectious  bone  processes, 
whether  of  tuberculous  astiology  or  not,  an 
emulsion  of  sulphur  and  glycerin  may  be 
injected  into  the  cavity  and  allowed  to  remain 
for  twenty-four  hours,  with  satisfactory  results. 
Ulcerative  stomatitis  yields  to  the  local  appli- 
cation of  sulphur.  At  a  meeting  of  the  Royal 
Medical  and  Chirurgical  Society  of  London 
Mr.  Lane  reported  the  results  of  a  year's  expe- 
rience with  the  use  of  sulphur  in  surgical  prac- 
tice (cited  in  Medical  News,  January  19,  1895). 
He  found  that  neither  sulphur  nor  its  by-prod- 
ucts had  a  deleterious  influence  upon  the  life 
or  health  of  a  patient.  Its  contact  with  re- 
cently incised  healthy  tissues  for  twenty-four 
hours  sufficed  to  render  the  parts  free  from 
organisms.  Advantageous  results  accrued 
from  the  local  application  of  sulphur  to  parts 
poorly  supplied  with  blood  or  already  in  a  state 
of  gangrene.  In  these  instances  the  sulphur 
may  be  left  on  for  a  longer  period  of  time. 
The  same  statement  applies  to  granulating  . 
surfaces.  Sulphur,  says  this  author,  destroys 
all  organisms,  whether  free  in  a  cavity  or  lying 
in  the  surrounding  tissues.  Finally,  the  action 
of  sulphur  is  painless,  says  this  surgeon.  An 
ointment,  unguentum  sulphuris,  is  prepared 


SULPHURIC   ACID 
SUPPOSITORIES 


243 


by  the  direction  of  the  U.  S.  and  Br.  Ph's,  the 
former  consisting  of  30  parts  of  sulphur  and  70 
of  benzoinated  lard,  that  of  the  latter  contain- 
ing 20  parts  of  sulphur  and  80  of  benzoinated 
lard.  The  Br.  Ph.  also  recognises  a  eonfectio 
sulphuris  containing  4  oz.  of  sublimed  sulphur, 
1  oz.  of  powdered  acid  potassium  tartrate,  4  fl. 
oz.  of  syrup  of  orange  peel,  and  18  grains  of 
powdered  tragaoanth. 

Sulphur  iodide,  sulphuris  iodidum  (U.  S. 
Ph.,  Br.  Ph.),  is  a  local  stimulant  and  caustic. 
It  is  sometimes  used  topically  in  the  treatment 
of  shin  diseases  accompanied  with  infiltration. 
The  Br.  Ph.  authorizes  an  ointment,  unguentum 
sulphuris  iodidi,  consisting  of  5  parts  of  sul- 
phur iodide,  15  of  solid  paraffin,  and  55  of 
vaseline.  Bousquet  (Presse  medicate,  July  15, 
1896)  suggests  its  employment  as  an  anti- 
septic. 

There  are  many  preparations  which  contain 
sulphur  or  its  derivatives.  Thus,  compound 
licorice  powder,  which  is  official,  contains  8 
per  cent,  of  washed  sulphur;  iohthyol  is  rich 
in  the  element  under  consideration. 

Potassa  sulphurata,  sulphurated  potassa,  is 
official  in  the  U.  S.  Ph.  It  is  prepared  by  the 
simultaneous  heating  of  carbonate  of  potassium 
and  sulphur.  It  is  brownish  in  colour  and  has 
a  most  disagreeable,  alkaline  taste.  Locally, 
potassa  sulphurata  is  a  powerful  irritant ;  taken 
internally,  it  produces  symptoms  of  irritation 
in  the  mucous  membranes  with  which  it  comes 
in  contact.  It  is  employed  in  stimulating 
ointments  in  shin  diseases  of  a  scaly  character 
and  may  be  used  to  make  sulphur  baths,  the 
strength  varying  from  1  to  3  oz.  of  the  prepara- 
tion in  15  gallons  of  water.  Employed  in  too 
great  strength,  the  baths  produce  dermatitis. 
The  baths  have  been  recommended  in  rheuma- 


Galx  sulphurata  (U.  S.  Ph.,  Br.  Ph.),  calcavia 
sulfurata  (Ger.  Ph.),  or  calcium  monosulphide, 
is  a  pale-gray  powder  with  a  nauseous  alkaline 
taste.  It  decomposes  on  exposure  to  the  air. 
It  is  sparingly  soluble  in  water.  The  drug  has 
had  a  wide  use,  based  on  reliable  clinical  re- 
ports, in  the  treatment  of  suppurative  diseases, 
of  boils  appearing  in  successive  crops,  and  of 
glandular  enlargements  due  to  tuberculous 
invasion.  The  dose  is  from  iV  to  |  of  a  grain, 
frequently  repeated.  This  preparation  is  some- 
times wrongly  called  "  calcium  sulphide." 

[The  action  of  the  sulphides  and  that  of  sul- 
phuretted hydrogen  are  essentially  that  of 
sulphur.] — Samuel  M.  Briokner. 

STJIiPHXTB.IC  ACID,  acidum  sulphuricum 
(U.S.  Ph.,  Br.  Ph.),  acidum  sulfuricum(GeT.  Ph.), 
is  a  highly  corrosive  liquid  of  an'  oily  appear- 
ance, employed  largely  in  the  arts  and  to  some 
extent  in  medicine. 

On  account  of  the  frequency  with  which  it 
is  met  with  it  is  often  the  cause  of  severe 
burns  of  the  surface  of  the  body  and  of  death 
when  accidentally  taken  internally.  The  symp- 
toms caused  by  it  do  not  differ  essentially  from 
those  due  to  other  corrosive  substances,  but,  as 
a  rule,  the  parts  with  which  it  has  come  in 
contact  are  blackened  and  charred.  Magnesia, 
lime,  and  soap  are  the  appropriate  chemical 


antidotes,  but  to  be  of  avail  must  be  adminis- 
tered promptly.  As  an  escharotic,  sulphuric 
acid  is.hardly  to  be  preferred  to  nitric  acid,  as 
by  itself  it  penetrates  deeply  and  is  not  easily 
controlled.  Combined  with  charcoal  (Ilicord's 
paste),  asbestos  (Jlichel's  paste),  saffron  (Vel- 
poau's  paste),  or  zinc  sulphate,  it  is  more  man- 
ageable and  may  be  used  in  the  treatment  of 
chancres  and  other  superficial  lesions  requiring 
cauterization.  A  liniment  containing  about  1 
part  of  the  acid  to  3  parts  of  olive  oil  is  a  de- 
cided counter-irritant. 

Diluted  sulphuric  acid,  acidum  sulphuricum 
dilutum  (U.  S.  Ph.,  Br.  Ph.),  acidum  sulfuricum 
dihitum(Gev.  Ph.),  and  aromatic  sulphuric  acid, 
acidum  sulphuricum  aromaticum  (U.  S.  Ph., 
Br.  Ph.),  are  practically  of  the  same  strength 
and  are  adapted  to  the  same  purposes,  the 
latter,  however,  being  rather  more  agreeable 
to  the  taste,  as  it  contains  small  amounts  of 
ginger  and  oil  of  cinnamon. 

When  the  action  of  a  mineral  acid  is  desired 
in  disturbances  of  digestion  it  is  not  advisable 
to  employ  sulphuric  acid,  as,  although  it  may 
afford  temporary  relief,  its  prolonged  use  is 
followed  by  interference  with  the  functions  of 
the  gastric  juice.  The  same  may  be  said  of 
its  employment  in  fevers.  In  such  conditions 
hydrochloric  or  uitrohydrochloric  acid  is  pref- 
erable. 

It  is,  however,  of  decided  value  in  the  treat- 
ment of  nearly  all  forms  of  diarrhosa,  provided 
the  dose  is  not  large,  especially  when  combined 
with  opium  or  carminatives,  and  it  is  particu- 
larly useful  in  Asiatic  cholera  and  the  diar- 
rhoeas prevalent  during  an  epidemic  of  cholera. 
In  the  latter  conditions  small  doses,  from  3  to 
5  drops,  of  the  diluted  varieties  may  be  given 
every  half  hour  until  a  beneficial  action  has 
been  observed.  As  a  prophylactic  against 
cholera,  it  is  usually  held  in  high  esteem.  Per- 
sons exposed  to  the  contagion  may  drink  freely 
of  a  1-  or  3-per-cent.  solution,  which  may  be 
sweetened  if  it  is  desired. 

In  the  treatment  of  colliquative  sweating 
sulphuric  acid  is  sometimes  employed  with 
good  results,  and  also  in  hcemorrhages  of  vari- 
ous kinds. 

The  cathartic  properties  of  magnesium  sul- 
phate are  increased  by  its  combination  with 
this  acid.  The  dose  of  either  the  aromatic  or 
the  plain  diluted  acid  is  from  10  to  30  drops, 
well  diluted. 

[A  somewhat  stronger  preparation  is  the 
modern  form  of  Haller's  acid  eli.rir.  The 
mixtura  sulfurica  acida  (Ger.  Ph.),  misturn 
sulphurica  acida  (N.  F.),  consists  of  1  part  of 
sulphuric  acid  and  3  parts  of  alcohol.  The 
dose  is  from  5  to  20  drops.] 

Sulphates,  or  combinations  of  siilphuric 
acid  and  bases,  are,  as  a  rule,  freely  soluble  in 
the  ordinary  menstrua,  and  are  generally  more 
or  less  astringent.  The  sulphates  of  the  or- 
ganic bases  are  usually  soluble  in  water,  and 
those  which  are  not  are  rendered  so  by  a  small 
amount  of  sulphuric  acid,  a  soluble  bisulphate 
usually  resulting.  The  alkaline  sulphates  are 
cathartic,  while  those  of  the  metallic  bases  de- 
pend upon  the  metal  for  their  therapeutic  ac 
tion.— Russell  H.  Nevins. 


243 


SULPHURIC  ACID 
SUPPOSITORIES 


STJLPHTJE.OTJS  ACID,  acidum  sulphuro- 
sum  (U.  S.  Ph.,  Br.  Ph.),  is  a  6'4-per-cent.  solu- 
tion of  sulphurous-acid  gas  (sulphur  dioxide) 
in  water.  It  is  a  colourless  liquid  having  the 
odour  of  burning  sulphur.  It  should  be  kept 
in  dark  amber-coloured,  glass-stoppered  bot- 
tles in  a  cool  place  and  away  from  the  lig:ht. 
It  is  an  energetic  antiseptic  and  germicide. 
It  is  chiefly  used  as  a  topical  application  in 
cases  of  tinea  versicolor.  The  undiluted  solu- 
tion may  be  rubbed  on  the  affected  skin  once 
or  twice  daily ;  if  it  is  to  be  applied  continu- 
ously, it  should  be  diluted  with  three  or  four 
times  its  bulk  of  water.  Internally,  the  acid 
has  been  used  to  some  extent  in  the  treatment 
ot  fermentative  dyspepsia  and  hay  fever.  The 
dose  is  from  ^J  to  1  fl.  drachm,  largely  diluted. 

The  sulphites  are  more  suitable  for  inter- 
nal use  than  the  acid,  since  they  give  oflE  the 
acid  in  a  nascent  state  in  the  stomach. '  They 
may  be  given,  dissolved  in  an  abundance  of 
water,  in  daily  amounts  of  15  grains.  The 
sodium  compounds,  sodii  sulphis  (U.  S.  Ph., 
Br.  Ph.)  and  sodii  hisulphis  (U.  S.  Ph.),  are 
most  commonly  used.  A  10-per-eent.  solution 
of  sodium  sulphite  has  been  employed  as  an 
antiseptic. 

SUMACH  BEBRIES.— See  Rhus  glabra. 

SUMACH,    SWEET.  — See    Rhus    aro- 

MATIOA. 

SUMBUL  (U.  S.  Ph.),  sumUa  radix  (Br.  Ph.), 
or  musk-root,  is  the  root  of  Ferula  Sumbul,  an 
umbelliferous  herb  indigenous  to  the  moun- 
tains between  Russian  Turkestan  and  Bu- 
charia.  Sumbul  is  a  stimulant  to  the  nervous 
system,  also  a  tonic.  It  has  been  used  in 
cholera,  in  asthenic  diarrhoea  and  dysentery, 
in  delirium  tremens,  in  hysteria,  in  neuras- 
thenia, and  in  chronic  bronchitis.  The  dose 
of  the  powder  is  from  3  to  8  grains ;  that  of 
the  tincture,  tinctura  sumbul  (U.  S.  Ph.,  Br.  Ph.), 
is  from  10  to  30  minims.  There  is  a  non-ofB- 
cial  extract,  the  dose  of  which  is  a  grain. 

SUPPOSITORIES.— These'are  solid  bodies 
intended  to  produce  a  local  action  by  the  grad- 
ual liberation  of  some  active  constituent  held 
in  solution  or  suspension  in  a  medium  which 
fuses  more  or  less  slowly  at  the  temperature  of 
the  body.  According  to  the  place  of  applica- 
tion, suppositories  are  of  various  shapes  and 
sizes.  Rectal  suppositories  are  usually  of  a 
conical  or  double-cone  shape  and  should  weigh 
about  15  grains.  Vaginal  suppositories  are 
globular,  and  shoiild  weigh  about  45  grains. 
tJrethral  suppositories  are  pencil-shaped,  and 
should  weigh  about  15  grains. 

Suppositories  are  usually  made  with  cacao 
butter  as  the  base.  Frequently,  also,  a  mixture 
of  gelatin  and  glycerin  is  used.  Suppositories 
may  either  be  rolled  by  hand,  cast  in  moulds, 
or  formed  by  pressure. 

Rolled  or  hand-made  suppositories  are  pre- 
pared by  grating  or  scraping  the  required 
quantity  of  cacao  butter  into  a  mortar,  then 
adding  the  prescribed  amount  of  medicinal 
substance,  either  in  fine  powder  or  in  the  form 
of  a  smooth  paste,  and  mixing  the  whole  thor- 
oughly to  a  sort  of  pill  mass,  which  is  then 
rolled  out  to  a  cylinder.    This  is  cut  into  the 


intended  number  of  pieces,  and  each  piece 
then  rolled  into  a  cone.  To  prevent  adhesion, 
particularly  in  warm  weather,  the  mass  must 
be  rolled  in  lyoopodium  or  some  other  neutral 
powder. 

Moulded  or  cast  suppositories  are  prepared 
by  melting  the  necessary  amount  of  cacao  but- 
ter and  incorporating  with  it  the  medicinal 
ingredient  either  in  powder  or  in  the  form  of 
paste,  or  in  solution  in  some  liquid  which  will 
mix  with  the  cacao  butter  (such  as  oleic  acid, 
olive  oil,  etc.).  The  moulds  having  been  pre- 
pared by  carefully  cleaning  and  wiping  them 
with  an  oily  cloth,  they  are  filled  with  the 
melted  mass,  which  must  be  not  too  far  from 
the  congealing  point.  It  is  best  to  fill  them  to 
overflowing,  as  the  mass  shrinks  a  little  in  the 
centre  of  the  base  on  cooling.  And  if  the 
medicinal  constituent  is  a  heavy  powder,  the 
mass  must  be  constantly  stirred  in  the  capsule 
from  which  it  is  poured.  The  moulds  are 
then  placed  on  ice  and,  when  the  suppositories 
are  sufficiently  set,  freed  from  the  excess  of 
adhering  mass,  whereupon  the  suppositories 
are  removed. 

Pressed  suppositories  are  prepared  in  special 
hand-machines.  The  mass  is  made  in  the  usual 
manner  and  introduced  into  the  apparatus, 
where  it  is  allowed  to  set.  By  means  of  cer- 
tain pistons  or  plungers  the  mass  is  then 
forced  into  moulds  by  pressure.  Various  ma- 
chines are  in  use  for  this  purpose,  but  they  all 
work  on  the  same  principle. 

In  warm  weather,  or  when  too  much  of  a 
soft  or  liquid  mass  is  to  be  incorporated  with 
a  given  amount  of  cacao  butter,  some  wax  or 
spermaceti  must  be  added  to  give  consistence 
to  the  mass.  This  addition,  however,  must  be 
carefully  adjusted  to  the  circumstances  of  the 
case.  The  melting  point  of  the  mass  should 
never  be  higher  than  95°  F. 

For  a  number  of  years  past  some  firms  have 
put  various  sizes  of  ready-made  hollow  sup- 
positories on  the  market,  which  are  intended 
to  be  filled  with  the  medicinal  mixture.  They 
are  very  convenient,  but  care  must  be  taken 
that  the  filling  is  of  the  proper  composition, 
so  that  when  the  outer  mantle  is  melted  off 
the  intended  action  upon  the  mucous  mem- 
brane may  take  place  in  the  manner  desired. 

For  urethral  suppositories,  or  bougies,  gela- 
tin is  usually  preferred,  as  it  is  not  so  likely 
to  break  or  crumble  while  being  introduced. 
Gelatin  of  the  best  quality  is  soaked  in  water 
until  it  has  been  softened,  and  the  excess  of 
water  is  poured  off.  For  every  12  parts  of 
soft  gelatin  5  parts  of  glycerin  are  added,  the 
mixture  is  melted  in  a  water-bath,  the  medic- 
inal substance  is  then  added,  and  the  mass  is 
poured  into  a  suitable  mould  or  into  glass 
tubes  the  interior  of  which  has  been  coated 
with  oil.  When  the  mass  has  been  thoroughly 
cooled  it  may  be  removed  from  the  glass  tubes 
by  means  of  an  oiled  glass  rod. 

The  U.  S.  Ph.  gives  only  one  working  for- 
mula for  a  special  kind  of  suppository,  but 
gives  general  directions  for  all  others.  Glyc- 
erin suppositories  are  directed  by  the  U.  S. 
Ph.  to  be  made  in  the  following  manner:  3 
grammes  of  sodium  bicarbonate  are  to  be  dis- 


SUPRARENAL  CAPSULE 


244 


solved  in  60  grammes  of  glycerin  in  a  capsule 
on  a  water-bath  ;  then  5  grammes  of  stearic  acid 
are  to  be  added,  and  the  whole  carefully  heated 
until  this  is  dissolved,  and  no  more  carbonic- 
acid  gas  escapes.  The  mass  is  then  to  be 
poured  into  suitable  moulds,  so  as  to  produce 
ten  suppositories.  When  they  are  set,  each 
should  be  wrapped  in  tin  foil  and  introduced 
into  a  glass  tube  to  be  corked  at  each  end. 

Dieterich  recommends  preparing  glycerin 
suppositories  by  mixing  90  grains  of  finely 
powdered  stearin  soap  with  3  oz,  of  glycerin, 
heating  until  solution  has  been  efEected,  mak- 
ing up  any  loss  by  evaporation  of  water,  and 
then  casting  in  moulds.  This  quantity  is  in- 
tended for  from  twenty-iive  to  fifty  supposi- 
tories.   (Cf.  Cacao  butter.) 

Charles  Rice. 

STTPRAIlEirAL  CAPSULE.— The  su- 
prarenal capsule  and  an  extract  prepared  from 
it  have  been  further  used  since  the  article  on 
Animal  extracts  and  juices  was  written,  and 
various  observers  have  published  accounts  of 
their  experience.  In  a  communication  pre- 
sented to  the  Physiological  Society,  of  London, 
on  March  16,  1893  {Journal  of  Physiology, 
April,  1895),  Dr.  G.  Oliver  and  Professor  B.  A. 
Schafer  referred  to  some  earlier  experiments 
showing  that  when  an  extract,  whether  pre- 
pared with  water,  alcohol,  or  glycerin,  of  the 
suprarenal  bodies  of  the  calf,  sheep,  or  dog 
was  injected — even  in  very  small  quantities — 
into  a  vein  in  a  dog  or  a  rabbit  the  following 
pronounced  physiological  effects  were  produced 
in  a  few  seconds:  1.  Extreme  contraction  of 
the  arteries,  which  was  shown  to  be  of  periph- 
eral origin.  2.  A  remarkable  and  rapid  rise 
of  the  arterial  blood-pressure,  which  took  place 
in  spite  of  powerful  cardiac  inhibition,  and  be- 
came further  augmented  when  the  vagi  were 
cut.  3.  Central  vagus  stimulation,  so  pro- 
nounced that  the  auricles  came  to  a  complete 
standstill  for  a  time,  although  the  ventricles 
continued  to  contract,  but  with  a  .slow,  inde- 
pendent rhythm.  4.  Great  acceleration  and 
augmentation  of  the  contraction  of  the  auricles 
and  ventricles  after  section  of  the  vagi,  the  au- 
ricular augmentation  being  especially  marked. 
5.  A  slight  change  in  the  respiration,  which 
became  shallower. 

A  large  number  of  subsequent  observations 
made  on  dogs,  cats,  and  rabbits  had  confirmed 
these  results.  As  in  their  earlier  experiments, 
watery  decoctions  of  the  glands  had  been  chiefly 
employed  by  them.  The  suprarenals  experi- 
mented with  were  derived  from  the  calf,  the 
sheep,  the  dog,  the  cat,  the  guinea-pig,  and 
man.  The  physiological  results  were  exactly 
the  same  whatever  the  source  of  the  glands, 
except  with  regard  to  two  which  were  taken 
from  subjects  of  Addison's  disease.  The  fol- 
lowing effects  are  given  by  the  authors :  1.  As 
a  rule,  when  the  intravenous  mode  of  adminis- 
tration was  adopted,  a  definite  small  quantity 
of  the  extract  representing  a  known  weight  of 
the  fresh  gland  was  injected.  In  exceptional 
instances,  however,  a  continuous  flow  of  a  5- 
per-cent.  solution  of  the  extract  was  employed. 
In  these  instances  the  physiological  effects  were 


maintained  during  the  entire  time  the  injec- 
tion lasted,  but  without  the  development  of 
other  apparent  symptoms  and  without  causing 
death.  In  this  way  large  doses  of  the  extract 
were  administered  to  the  dog,  thereby  produc- 
ing the  most  violent  cardio-vascular  disturb- 
ance without  causing  a  fatal  result.  2.  In  a 
former  communication  the  inference  as  to  the 
extreme  contraction  of  the  arteries  had  been 
derived  from  observations  on  the  blood-press- 
ure, from  the  use  of  the  limb  plethysmograph, 
and  from  the  arrest  of  the  flow  of  normal 
saline  solution  through  the  vessels  of  a  frog 
caused  by  the  addition  of  a  small  quantity  of 
suprarenal  extract.  Several  observations  with 
the  oncometer  had  confirmed  this  conclusion 
and  shown  that  it  might  be  extended  to  the 
vessels  of  the  kidneys,  for  the  tracings  showed 
a  well-pronounced  reduction  in  volume  of  that 
organ  during  the  suprarenal  effect  on  the  cir- 
culation. 3.  It  was  observed  that  stimulation 
of  the  depressor  nerve  did  not  produce  the 
usual  reduction  of  the  blood-pressure  while 
the  effects  of  the  suprarenal  injection  lasted  ; 
if  the  depressor  nerve  in  the  rabbit  was  stimu- 
lated at  the  height  of  the  pressure  caused  by 
intravenous  injection  of  suprarenal  extract,  the 
usual  fall  of  blood-pressure  was  not  produced, 
and  no  depressor  result  was'  to  be  obtained  un- 
til the  blood-pressure  had  again  become  nearly 
or  quite  normal.  The  depressor  result  reap- 
peared simultaneously  with  the  Traube-Hering 
curves,  if  these  were  seen  at  all  in  the  tracing.  4. 
It  was  invariably  found  that  the  heart's  action 
was  remarkably  accelerated  and  augmented  in 
the  dog,  the  cat,  and  the  rabbit  after  section 
of  the  vagi.  It  was  not  found  that  solutions 
of  less  than  1  per  cent,  of  suprarenal  extract 
in  Ringer's  circulating  fluid  would  affect  the 
frog's  ventricle  with  certainty,  recording  its 
pulsations  In  a  heart  plethysmograph.  The 
following  results,  however,  were  obtained  with 
this  and  with  stronger  solutions — up  to  5  per 
cent. :  1.  Reduction  of  diastole,  with  consequent 
acceleration.  2.  The  abolition  of  groups  of 
contractions  and  the  setting  up  of  continuous 
pulsation.  3.  The  arrest  of  the  ventricle  in 
systole.  As  this  extreme  effect  of  the  extract 
was  not  prevented  or  antagonized  by  potassium 
chloride,  the  conclusion  was  that  it  was  due  to 
calcium  salts  in  the  extract,  for  Ringer  had 
shown  that  the  calcium  effect  upon  the  con- 
traction of  the  frog's  ventricle  was  counter- 
acted by  potassium.  Moreover,  the  individual 
contractions  did  not  show  the  characteristic 
calcium  effect.  On  the  contrary,  each  individ- 
ual contraction  remained  normal,  although  the 
acceleration  produced  by  the  drug  might  ulti- 
mately be  sufficient  to  prevent  the  completion 
of  the  diastole,  and  the  contractions  might 
thereby  be  caused  to  run  together.  5.  The 
paralyzing  effect  of  the  subcutaneous  injection 
of  the  extract — about  1  or  2  grains — in  the 
frog  had  not  been  observed  in  other  animals 
experimented  on  in  this  way,  except  from  lethal 
doses  in  the  rabbit.  It  had  been  observed, 
however,  in  dogs  subjected  to  intravenous  in- 
jections of  the  extract,  that  when  the  muscles 
were  electrically  stimulated  through  the  nerve 
supplying  them,  a  modification  of  the  normal 


245 


SUPilARENAL  CAPSULE 


contraction  was  apparent,  the  relaxation  being 
delayed,  as  in  the  case  of  the  frog's  muscle. 
This  effect,  moreover,  not  only  was  observed 
while  the  suprarenal  rise  of  the  blood-pressure 
was  being  recorded,  but  was  traceable  for  some 
time  after  that  rise  had  passed  away.  It  was 
therefore  inferred  that  the  active  material  was 
probably  taken  up  by  the  muscular  tissues  and 
remained  for  a  time  stored  within  them.  6. 
No  definite  effect  upon  the  secretion  of  the 
submaxillary  gland  was  observed  as  the  result 
of  injecting  suprarenal  extract  into  the  blood. 
The  chorda  tympani  was  not  found  to  be  any 
less  active  in  promoting  the  secretion  of  the 
gland  in  an  animal  the  blood-vessels  of  which 
were  contracted  by  the  extract.  7.  It  was 
found  that  when  two  extracts  were  prepared 
of  equal  strength,  one  of  the  cortex  and  the 
other  of  the  medulla  of  the  perfectly  fresh 
gland,  the  intravenous  injection  of  the  former 
would  not  produce  the  characteristic  cardio- 
vascular disturbance,  while  that  of  the  latter 
in  the  same  dose  would  induce  it  in  a  marked 
degree.  It  is,  however,  the  authors  say,  some- 
what difficult  to  prepare  the  cortical  extract 
perfectly  free  from  a  trace  of  the  medulla,  so 
that  it  may  happen  that  a  comparatively  large 
dose  of  cortical  extract  may  produce  a  slight 
physiological  effect ;  but  not  more  than  that 
of  a  much  smaller  portion  of  the  medullary 
extract.  The  conclusion,  therefore,  is  that  the 
active  principle  of  the  extract  is  present  in  the 
medulla  only,  the  effects  obtained  from  the 
extract  of  cortex  being  small  and  inconstant 
and  probably  to  be  explained  by  accidental 
contamination  or  post-mortem  diffusion.  8. 
Experiments  were  made  with  suprarenals  from 
three  subjects — one  in  which  the  glands  were 
healthy,  and  two  others  in  which  they  were 
diseased  (cases  of  Addison's  disease).  The 
healthy  organs  yielded  an  extract  of  great 
physiological  activity,  whereas  the  diseased 
adrenals  afforded  one  which  gave  no  result.  9. 
In  regard  to  the  oral  administration  of  the  ex- 
tract as  a  remedy,  it  seemed  desirable  to  ascer- 
tain whether  peptic  digestion  impaired  its 
active  properties.  A  little  of  the  watery  ex- 
tract of  the  gland  was  added  to  artificial  gastric 
juice  (pepsin  +  O'S  per  cent,  of  hydrochloric 
acid)  and  exposed  to  a  temperature  of  104°  P. 
for  twenty-four  hours.  The  intravenous  injec- 
tion of  a  small  quantity  of  this  and  of  an  equal 
portion  of  the  same  extract  diluted  at  the  time 
to  the  same  extent  with  0-2  per  cent,  of  hydro- 
chloric acid  produced  identical  physiological 
effects.  The  injection  of  an  equivalent  amount 
of  acid  as  a  check  experiment  produced  no 
effects.  The  authors,  therefore,  do  not  think  it 
likely  that  gastric  digestion  will  seriously  lessen 
the  physiological  properties  of  the  extract. 
Experiments  were  made  with  the  view  of  as- 
certaining how  the  extract  was  eliminated  or 
disposed  of,  and  whether  the  active  principle 
was  destroyed  in  the  blood.  This  seemed  not 
improbable,  as  it  was  found  that  alkalies  and 
oxidation  destroyed  the  activity  of  the  extract. 
It  was  observed,  however,  that  when  allowed 
to  stand  in  freshly  drawn  blood  with  free  ex- 
posure to  the  air,  or  with  complete  exclusion 
of  air  for  twenty-two  hours,  the  extract  pos- 


sessed the  same  activity  as  when  preserved  in 
exactly  the  same  manner  in  normal  saline.  As 
an  altered  contraction  of  the  muscles  was  ob- 
served to  persist  after  the  subsidence  of  the 
cardio-vascular  disturbance  set  up  by  the  in- 
jection, it  seemed  probable  that  the  active 
principle  of  the  extract  passed  out  of  the  blood 
into  the  muscles,  and  remained  there  for  a 
time. 

The  authors  have  shown  that  in  Addison's 
disease  the  adrenals  may  become  totally  devoid 
of  the  physiologically  active  material.  If  these 
bodies  are  to  be  regarded  as  eliminators  of 
toxic  materials  rather  than  as  producers  of 
materials  which  are  of  definite  physiological 
value,  they  say  the  toxic  materials  they  should 
remove  or  destroy  might  be  expected,  in  cases 
in  which  their  function  is  in  abeyance,  to  pass 
out  by  the  kidneys.  They  have  found,  how- 
ever, that  an  extract  prepared  from  the  urine  in 
Addison's  disease  has  precisely  the  same  effect 
when  injected  into  a  vein  as  that  of  an  extract 
prepared  from  normal  urine.  In  fact,  all  the 
evidence  they  have  leads  them,  says  Dr.  Oliver, 
to  view  the  function  of  the  suprarenal  bodies — 
at  least  the  medulla — as  secretory  rather  than 
destructive,  and  the  secreted  product  as  being 
in  all  probability  of  great  physiological  impor- 
tance for  maintaining  the  tonicity  of  the  mus- 
cular tissues  in  general,  and  especially  that  of 
the  heart  and  arteries. 

Dr.  Richard  C.  Cabot,  of  Boston  (Medical 
News,  September  12,  1896),  has  collected  ac- 
counts of  twenty  cases  of  the  treatment  of 
Addison's  disease  with  suprarenal-capsule 
preparations.  In  nine  of  them  the  patients 
have  been  considerably  improved.  He  thinks 
that  the  various  fluid  extracts  are  very  inferior 
to  the  gland  itself,  dry  or  raw. 

Tonoli  (Gazzeita  medica  lombarda,  August 
17,  1896 ;  British  Medical  Journal,  October 
24,  1896)  reports  the  case  of  a  woman,  aged 
twenty,  who  had  suffered  from  Addison's  dis- 
ease for  some  fourteen  months.  "When  seen 
she  presented  all  the  classical  signs  and  symp- 
toms of  the  disease.  On  February  26th  20 
grains  of  the  powdered  suprarenal  capsule  were 
directed  to  be  given  daily  in  pills,  the  dose 
being  gradually  increased  to  2-J-  grains.  On 
March  6th  the  patient  already  felt  better ;  the 
pains  in  the  stomach  and  lower  limbs  had  dis- 
appeared. By  March  31st  the  pigmentation 
had  become  less  marked,  the  appetite  was 
better,  and  the  strength  had  increased.  On 
April  10th  she  walked  well,  and  her  strength 
was  much  greater.  The  menses  returned  after 
ten  months'  absence,  and  her  weight  increased. 
The  patient  then  went  out,  and  the  treatment 
was  suspended.  Meantime  the  temperature 
had  come  down  to  normal,  the  weight  had  in- 
creased decidedly,  the  black  patches  had  disap- 
peared from  the  mucous  membrane,  and  the 
slight  signs  which  had  first  been  noticed  at  the 
apices  of  the  lungs  had  disappeared.  The 
author  considers  this  was  a  case  of  cure  (so  far 
as  it  went),  and  not  a  mere  spontaneous  remis- 
sion in  the  course  of  the  disease. 

In  the  Journal  des  praticiens  for  April  18, 
1896,  M.  Huchard,  writing  on  the  use  of  the 
suprarenal  capsule  in  neurasthenia,  remarks 


SWEET   OTL 

SYMPTOMATIC  TREATMENT 


246 


that  Brown-Sequard's  experiments  and  the 
more  recent  ones  of  Abelous,  Langlois,  and 
Albanese  established  the  fact  that  the  physio- 
logical function  of  the  suprarenal  capsules  was 
to  transform  or  to  destroy  the  toxic  substances 
which  are  produced  in  the  organism  under  the 
influence  of  muscular  activity  and  of  the  nerv- 
ous system.  We  may  thenci  understand,  he 
says,  why  the  destruction  of  these  organs  ex- 
perimentally or  by  disease  is  capable  of  caus- 
ing in  the  organism  an  accumulation  of  toxic 
agents  which  is  the  principal  cause  of  the  seu- 
sation  of  extreme  fatigue  and  of  the  profound 
and  generalized  asthenia  experienced  by  pa- 
tients who  ,  suffer  with  Addison's  disease.  In 
neurasthenia,  then,  he  says,  patients  may  be 
benefited  by  this  treatment. 

Up  to  the  present  time,  says  M.  Huchard, 
the  observations  have  not  been  numerous 
enough  to  permit  of  absolute  conclusions  on 
the  results  obtained,  but  he  thinks  the  remedy 
is  worthy  of  attention.  He  thinks  that  the 
treatment  should  be  persevered  with,  not  only 
because  it  seems  to  be  indicated  by  pathological 
physiology,  but  because  it  has  not  yet  given 
rise  to  accidents  when  used  in  moderation. 
The  fresh  gland,  to  the  amount  of  from  1.5  to 
30  grains  a  day,  may  be  taken  by  the  mouth. 

Dr.  W.  H.  Bates,  of  New  York  {New  York 
Medical  Journal,  May  16,  1896),  has  employed 
an  aqueous  extract  of  the  suprarenal  capsule  of 
the  sheep  topically  in  various  diseases  of  the 
eye.  The  extract  used  by  him  is  prepared  by 
subjecting  the  dried  and  powdered  suprarenal 
capsule  of  the  sheep  to  the  action  of  cold  water 
for  a  few  minutes,  filtering  the  liquid,  and 
evaporating  it  to  dryness  at  a  temperature  be- 
low 105°  P.  It  requires  16  oz.  of  the  fresh 
glands  or  8  oz.  of  the  powdered  desiccated 
glands  to  make  an  ounce  of  the  aqueous  extract. 

The  active  principle  of  the  suprarenal  gland 
is  described  by  Dr.  Bates  as  very  soluble  in  wa- 
ter, 1  part  of  the  extract  dissolving  in  some- 
what less  than  3  parts  of  water.  It  is  insoluble 
in  strong  alcohol,  but  soluble  in  dilute  alcohol 
on  account  of  the  presence  of  water.  It  is  also 
insoluble  in  ether  or  chloroform.  The  dried  ex  • 
tract  has  remained  immersed  in  strong  alcohol, 
in  ether,  and  in  chloroform  for  several  months 
without  apparent  injury.  The  dried  aqueous 
extract  is  brown.  The  colour  depends  partly  on 
the  temperature  at  which  it  is  dried ;  the  higher 
the  temperature,  the  darker  the  colour.  It 
does  not  crystallize.  When  moist,  it  is  slight- 
ly sticky;  when  dry,  it  is  brittle.  It  has  a 
slight  odour  resembling  that  of  extract  of  beef. 
The  most  chafacteristic  chemical  property  is 
its  reaction  with  tincture  of  iron.  A  drop  of 
tincture  of  chloride  of  iron  added  to  a  neutral 
solution  of  the  aqueous  extract  produces  a 
green  colour  which  gradually  disappears.  A 
precipitate  is  formed,  and  the  addition  of  more 
of  the  iron  solution  may  produce  the  green 
colour  again,  with  the  formation  of  more  of 
the  precipitate.  The  supernatant  fluid  loses  its 
colour  at  the  same  time  that  the  precipitate  is 
formed.  Finally,  it  is  possible  to  add  sufficient 
tincture  of  iron  to  make  the  solution  of  the 
extract  clear,  and  the  addition  of  more  iron 
does  not  produce  the  green  colour.     The  pre- 


cipitate contains  the  extract  and  the  iron,  be- 
cause the  filtered  finid  evaporated  to  dryness 
leaves  no  residue  except  the  excess  of  iron. 
The  precipitate  is  black  and  Is  composed  in 
part  of  metallic  iron,  probably.  Dilute  hydro- 
chloric acid  dissolves  the  precipitate  and  the 
solution  becomes  reddish. 

Dr.  Bates's  explanation  of  these  phenomena 
is  that  the  extract  is  a  strong  reducing  agent. 
The  green  colour,  he  thinks,  is  due  to  the  fact 
that  the  red  perchloride  is  reduced  to  the  green 
sesquiohloride  by  the  extract.  It  changes  to 
the  black  of  metallic  iron  by  further  reduction 
with  the  extract.  What  becomes  of  the  ex- 
tract will  require  further  experiments  to  de- 
termine. The  reducing  action  of  the  extract 
he  regards  as  remarkable.  The  reaction  of 
tincture  of  iron  with  the  extract  is  very  deli- 
cate. A  solution  of  less  than  1  per  cent,  of  the 
extract  will  produce  the  green  colour  on  the 
addition  of  tincture  of  iron.  If  the  extract  is 
in  a  very  strong  solution,  it  may  reduce  the 
chloride  "of  iron  to  the  metallic  state  so  quick- 
ly that  the  green  colour  may  not  be  observed. 
'This  reaction,  says  Dr.  Bates,  does  not  occur 
with  solutions  of  the  thyreoid,  thymus,  testicle, 
or  pineal  gland. 

The  extract  does  not  keep  unless  it  is  steril- 
ized. It  is  incompatible  with  mercury  bichlo- 
ride, silver  nitrate,  copper  sulphate,  and  other 
astringents ;  indeed.  Dr.  Bates  declares  that  it 
"  does  not  act  well  when  combined  with  other 
substances."  When  he  used  it  in  solution  with 
cocaine,  he  found  that  the  eye  was  irritated 
and  not  anaesthetized,  and  he  thinks  that  in 
such  a  solution  the  medicinal  properties  of  both 
drugs  are  impaired. 

The  extract  employed  by  Dr.  Bates  may  be 
administered  by  the  mouth  in  considerable 
doses  without  harm  resulting,  but  large  doses, 
particularly  it  given  subcutaneously,  may  pro- 
duce alarming  results.  A  lady,  aged  eighty- 
seven  years,  had  a  pulse  of  forty,  which  was 
intermittent  and  irregular ;  after  the  extract 
had  been  used  in  the  eye  for  a  few  days  the 
pulse  became  regular,  increased  to  eighty,  and 
remained  so  during  a  period  of  six  months  that 
the  extract  was  used.  A  woman,  aged  thirty 
years,  swallowed  60  grains  at  one  dose.  She 
vomited  immediately,  but  felt  no  other  ill 
effects.  A  man,  aged  sixty  years,  after  taking 
2  grains  three  times  a  day  for  a  week,  was  sud- 
denly attacked  with  a  peculiar  eruption  on  his 
hands,  which  disappeared  in  ten  days  without 
treatment  after  stopping  the  use  of  the  extract. 
In  one  case  10  grains  given  subcutaneously 
produced  alarming  symptoms.  The  face  was 
livid;  there  was  great  pain  in  the  head  and 
chest,  with  a  feeling  of  throbbing.  Conscious- 
ness was  not  lost.  The  pulse  was  weak.  In  ten 
minutes  the  patient  felt  able  to  walk  home 
from  the  dispensary,  a  distance  of  more  than  a 
mile. 

Dr.  Bates  regards  the  extract  as  a  powerful 
astringent  and  hcemostatic.  When  it  is  in- 
stilled into  the  eye  the  conjunctiva  of  the  globe 
and  lids  is  whitened  in  a  few  minutes.  The 
effect  is  very  decided.  None  of  the  usual 
astringents,  including  cocaine,  he  says,  can 
produce  such  an  astringent  effect.    In  normal 


247 


SWEET   OIL 
SYMPTOMATIC  TBEATMENT 


eyes  the  extract  whitens  the  conjunctiva  and 
sclera  when  used  in  very  weali  solutions — less 
than  1  per  cent.  The  eflfeet  is  increased  by 
repeated  instillations  or  by  the  use  of  stronger 
solntions. 

He  mentions  the  following  diseases  of  the 
eye  in  which  the  extract  has  whitened  the  con- 
junctiva and  solera :  I'rachoma,  acute  catarrhal 
conjunctivitis,  chronic  conjunctivitis,  phlyc- 
tmnular  conjunctivitis  an  d  keratitis,  interstitial 
keratitis,  rheumatic  and  syphilitic  iritis,  epi- 
scleritis, irido-cyclitis,  sympathetic  ophthal- 
mia, atrophy  of  the  globe,  si^condary  glaucoma, 
traumatic  conjunctivitis,  traumatic  keratitis, 
traumatic  iritis,  traumatic  kerato-irifis,  lacry- 
mal  inflammations,  and  rheumatic  ophthalmia. 

The  extract  is  not  iiTitating.  It  generally 
produces  a  cooling  sensation  when  dropped  into 
the  eye.  It  does  not  dilate  or  contract  the  pu- 
pil, and  it  has  no  effect  on  the  accommodation. 
A  tolerance  was  not  established  in  two  oases 
in  which  the  extract  was  instilled  into  the  eye 
several  times  daily  for  more  than  three  months. 
A  third  patient  used  the  extract  daily  for  more 
than  twelve  months,  and  it  whitened  the  eye- 
ball and  palpebral  conjunctiva  as  well  at  the 
end  of  the  twelve  months  as  at  the  beginning. 
The  astringent  effect  of  the  extract  on  the  con- 
junctival vessels  is  temporary — usually  in  an 
hour  the  eye  looks  as  il  did  before  the  extract 
was  used.  There  is  no  congestion  after  the 
astringent  effect  has  passed  off. 

Dr.  Bates  is  not  positive  that  the  extract  is 
curative  in  any  form  of  conjunctivitis  ;  but  the 
immediate  effect  of  its  employment  is  very 
grateful  to  the  patients.  He  has  found  it  of 
material  benefit  by  reducing  congestion  in  in- 
terstitial keratitis,  glaucoma  secondary  to  cata- 
ract extraction,  and  iritis,  and  as  an  adjuvant 
to  cocaine.  "An  operation  on  some  nervous 
people  is  unsatisfactory,  because  cocaine  does 
not  produce  ansesthesia.  Such  cases  are  quite 
common.  A  woman  was  operated  upon  re- 
cently for  tenotomy  of  the  inferior  rectus. 
The  cocaine  did  not  whiten  the  ocular  conjunc- 
tiva, dilate  the  pupil,  or  produce  anaesthesia 
after  being  instilled  frequently  for  an  hour. 
A  few  drops  of  the  extract  whitened  the  ocular 
conjuneliva,  and  the  cocaine  in  five  minutes 
dilated  the  pupil  and  produced  anjesthesia. 
The  operation  caused  no  pain.  Traction  on 
the  tendon  of  the  muscle  with  the  hook  was 
not  painful.  There  was  very  little  ha;mor- 
rhage.  A  previous  operation  on  the  same  mus- 
cle, using  cocaine  alone,  was  painful,  and  there 
was  an  unusual  amount  of  haemorrhage.  The 
eye  was  bleeding  six  hours  later.  The  eye  was 
sore  for  two  days.  The  extract  in  this  case 
had  a  very  happy  effect  by  securing  a  painless 
operation  without  haemorrhage  and  without 
soreness  afterward." 

Dr.  Bates  adds  that  an  operation  which  re- 
quires more  than  a  few  minutes  becomes  pain- 
ful in  some  cases,  although  cocaine  may  be 
instilled  frequently.  Advancement  of  an  ocu- 
lar muscle,  he  remarks,  is  generally  so  painful 
that  many  operators  are  compelled  to  use  ether 
anajsthosia.  The  operation  may  begin  pain- 
lessly, but  subsequently  the  anaesthesia  wears 
off,  particularly  if  there  is  hcemorrhage.    The 


extract,  when  frequently  instilled,  prevents 
haemorrhage,  and  the  cocaine  angisthesia  is 
prolonged  indefinitely  for  this  reason.  As  soon 
as  bleeding  occurs,  one  notices  very  soon  the 
sensitiveness  of  the  eye  returning.  A  numlDer 
of  advancements  have  been  done  painlessly  and 
almost  bloodlessly  by  the  use  of  the  extract 
and  cocaine  together. 

The  extract  prevents  hjemorrhage,  says  Dr. 
Bates,  because  of  its  property  of  contracting 
the  small  arteries.  After  haemorrhage  be- 
gins it  IS  not  very  efficient.  It  is  possible  to 
perform  an  almost  bloodless  operation  on  the 
ocular  muscles  or  lacrymal  sac  by  instilling  the 
extract  frequently.  The  following  case  illus- 
trates its  ^alue  as  a  hfemostatic:  A  man  was 
operated  upon  four  times  during  three  months 
for  stricture  of  the  nasal  duct.  After  each 
operation  the  patient  lost  enough  blood  to 
saturate  two  towels  and  sometimes  more.  The 
hasmorrhage  was  unusually  copious,  and  the 
operations  were  very  painful.  A  fifth  opera- 
tion was  done  in  which  the  suprarenal  extract 
was  used  with  the  cocaine.  There  was  no  pain 
and  very  little  haemorrhage.  The  towel  used 
had  on  it  one  spot  of  blood  a  quarter  of  an 
inch  in  diameter. 

SWEET  OIL.— See  Olive  oil. 

SYMPHOROL.— The  symphorols  include 
sodium  sulphocaffeinate,  lithium  sulphocaffe- 
inate,  and  strontium  sulphocaffeinate,  but  the 
first-mentioned,  called  also  sodium  caffeine- 
sulphonate,  is  ordinarily  meant.  It  is  a  crys- 
talline, bitter,  non-poisonous  substance,  acting 
powerfully  as  a  diuretic.  The  dose  is  15  grains, 
to  be  given  from  three  to  six  times  a  day. 

SYMPTOMATIC  TREATMENT.— The 

symptomatic  treatment  of  disease  involves,  in 
a  certain  degree,  a  confession  of  ignorance  of 
cause  and  eliect,  since  it  is  an  acknowledgment 
that  the  ultimate  astiology  has  escaped  detec- 
tion, and  that  it  is  therefore  impossible  to 
attack  the  fountain  of  origin.  This  do  s  not 
imply  that  the  pathology  of  a  disease,  which 
we  are  forced  to  treat  as  its  symptoms  arise,  is 
ill  or  not  at  all  understood ;  for  although  the 
morbid  history  may  be  perfectly  clear,  the 
therapeutic  resources  at  our  command  may  not 
be  such  as  to  admit  of  our  applying  them  with 
invariably  successful  results.  In  consideration 
of  repeated  observation  and  of  manifold  expe- 
rience, certain  substances  which  relieve  certain 
symptoms,  increase  function,  or  limit  diseased 
processes  are  relied  upon  to  furnish  a  basis  for 
restoration  to  health  in  conditions  in  which  we 
lack  specific  remedies.  The  term  specific  must 
not  be  loosely  employed.  Every  drug,  at  least 
almost  every  remedy,  has  a  specific  action  upon 
some  portion  of  the  human  organism ;  but  it  can 
not  be  said  to  have  a  specific  influence  upon  a 
disease  as  an  entity  unless  by  its  innate  virtues, 
without  the  intervention  of  other  forces,  it 
succeeds  in  limiting  or  eliminating  the  morbid 
process.  Specific  treatment  is  unfortunately 
limited  at  present  to  a  few  diseases.  Quinine 
in  malarial  disease,  mercury  in  syphilis;  colchi- 
cum  in  gout,  and  antitoxine  in  diphtheria  are 
specific ;  possibly  the  results  of  the  administra- 
tion of  thyreoid  extract  in  myxoedema  and  of 


SYMPTOMATIC   TREATMENT 


348 


the  salicylates  in  rheumatism  may  be  regarded 
in  a  similar  light.  With  these  diseases  and 
with  these  remedies  the  specific  treatment  of 
the  present  day  comes  to  an  end,  unless  one 
wishes  to  include  in  the  category  the  homoeo- 
pathic system,  than  which  there  is  no  more 
exquisite  example  of  putative  specific  treat- 
ment founded  on  array  of  symptoms. 

In  the  treatment  of  disease  the  fight  against 
Nature  has  long  since  passed  into  deserved 
oblivion.  The  medical  profession  now  recog- 
nises the  force  of  the  old  Latin  proverb,  Medi- 
cus  curat,  natura  sanat  morbos,  and  directs 
its  efl'orts  toward  assisting  the  healing  power 
shown  by  Nature  in  diseases  least  influenced 
by  artificial  interference  and  in  those  which 
undergo  spontaneous  cure.  Aside  from  the 
few  exceptions  cited  above,  in  which  accident, 
coincidence,  or  deductive  inference  has  dis- 
covered a  specific  for  disease,  most  physicians 
are  obliged  to  treat  disease  from  the  sympto- 
matic point  of  view.  It  is  not  too  much  to 
hope,  in  the  light  of  recent  investigation  and 
experience,  that  within  a  few  years  the  treat- 
ment of  the  infectious  diseases,  at  least,  will 
be  placed  upon  a  specific  basis. 

There  is  another  sense,  a  broader  and  more 
generally  accepted  one,  in  which  the  phrase 
'•  symptomatic  treatment  "  may  be  regarded. 
This  refers  to  the  alleviation  of  symptoms 
arising  in  the  course  or  progress  of  a  disease, 
not  intended  to  be  curative  in  its  sequel,  but 
simply  and  solely  to  combat  threatening  or 
serious  manifestations  and  to  allay  disagreeable 
phenomena.  For  such  measures  to  be  thor- 
oughly and  conscientiously  pursued,  there 
must  be  a  clear  understanding  on  the  part  of 
the  physician  of  the  nature  of  the  illness  which 
is  present.  Thus,  few  men  would  be  willing 
to  risk  the  administration  of  chloral  hydrate 
for  the  purpose  of  inducing  sleep  in  pneumonia, 
or  in  any  pronounced  asthenic  condition  :  and 
it  would  be  a  poor  example  of  judgment  which 
would  allow  a  medical  attendant  to  give  strych- 
nine for  incontinence  of  urine  to  a  child  suf- 
fering from  chorea,  although  under  other 
condition  of  health  or  disease  both  of  the  drugs 
referred  to  might  be  legitimately  indicated. 

The  pursuit  of  symptomatic  treatment  may 
lead  into  error,  unless  followed  along  lines  of 
perfect  knowledge  of  the  processes  presenting 
themselves.  Sleeplessness,  for  example,  in 
pneumonia  may  be  due  to  disturbed  nutrition, 
to  high  fever,  to  an  embaixassed  circulation 
or  respiration,  or  even  to  pain.  And  success- 
fully to  combat  this  symptom,  the  physician 
must  determine,  as  accurately  as  his  skill  and 
experience  permit,  the  source  of  the  insomnia. 
If  it  is  due  to  continued  fever,  an  earnest  effort 
must  be  made  to  reduce  the  temperature,  with- 
out, however,  interfering  with,  embarrassing,  or 
obstructing  other  organs  or  functions.  If  car- 
diac weakness  is  responsible  for  the  distressing 
symptom,  or  if  impeded  respiration  is  the  fault, 
appropriate  remedies  acting  upon  the  organs 
concerned  must  be  chosen.  And  yet,  although 
the  patient  may  feel  restored  and  refreshed 
after  the  sleep  which  is  given  artificially,  it 
must  not  be  assumed  that  the  measure  is  cu- 
rative in  any  way  further  than  that  it  conserves 


the  patient's  strength,  and,  like  nourishing 
food,  aids  him  to  overcome  the  forces  which 
are  working  against  him. 

It  is  by  such  reasoning  that  we  find  the  pur- 
poses and  objects  of  the  symptomatic  treat- 
ment of  disease  justified  in  their  immediate 
and  remote  results.  No  physician  of  experi- 
ence presumes  to  assert  in  any  given  case  that 
a  cure  is  certain,  but  he  may,  judging  from  his 
results  in  large  numbers  of  cases,  hope  for  a 
restoration  to  health,  or  a  palliation  of  dis- 
tress in  many  diseases — frequently  fatal — by 
the  careful,  wise,  judicious  employment  of 
measures  which  will  allay  or  conquer  grave 
symptoms. 

There  can  be  no  more  searching  test  of  a 
physician's  acumen  and  knowledge  than  the 
proper  symptomatic  treatment  of  disease.  It 
involves  not  only  an  accurate  acquaintance 
with  the  pathological  and  physiological  pro- 
cesses at  work,  but  also  a  well-grounded  insight 
into  the  action,  in  health  and  in  disease,  of  the 
therapeutic  measures  called  into  play.  There 
must  reside  in  the  physician's  mind  an  under- 
standing of  the  constructive  and  destructive 
effects  of  disease  upon  nutrition,  its  infiuence 
upon  and  relation  to  the  blood,  the  normal 
balance  between  these  factors  and  the  great 
vital  functions  of  the  body;  excretion  and 
secretion  must  be  carefully  observed  and  as 
closely  watched,  and  the  sustaining  and  rest- 
producing  functions  of  the  organism  must  not 
escape  consideration.  In  short,  the  physiology 
of  disease  must  be  as  completely  in  the  eye  as 
the  physiology  of  health.  Nothing  can  super- 
sede the  knowledge  which  experience  brings 
in  the  proper  choice  of  remedies  to  meet  dis- 
turbed conditions,  The  differences  manifested 
by  the  action  of  drugs  in  health  and  in  diverse 
conditions  of  disease  are  of  very  wide  range, 
and  in  the  administration  of  any  medicine  for 
the  relief  of  symptoms  all  the  changes  and 
modifications  induced  by  personal  peculiarities, 
by  absorption,  and  by  influence  on  the  various 
organs  of  the  body  must  be  judged  of. 

Bearing  in  mind  that  the  purpose  of  the 
symptomatic  administration  of  drugs  depends 
upon  two  elements,  the  relief  of  immediate 
symptoms  and  through  this  the  conservation 
of  the  patient's  energy — in  other  words,  the 
amelioration  of  conditions — renders  the  subject 
easy  of  comprehension.  The  relief  of  symptoms 
which  threaten  life  or  cause  great  discomfort 
is,  all  things  considered,  the  first  imperative 
duty  of  the  physician,  no  matter  what  the 
causa  morbi  may  be.  Pain  must  be  mitigated, 
from  whatever  source  it  springs— a  pleurisy,  a 
brain  tumour,  or  an  enteritis.  By  its  depres- 
sion and  sapping  of  the  patient's  strength  it 
may  so  lower  the  vital  forces,  if  not  relieved, 
that  the  subsequent  struggle  against  the  de- 
structive agents  of  disease  may  be  rendered 
futile.  But  even  in  the  attempt  to  allay  this 
symptom  regard  must  be  had  for  the  effects 
of  the  chosen  drug  upon  the  organs  involved. 
Though  a  general  peritonitis— for  instance, 
with  paresis  of  peristalsis — may  give  rise  to 
great  pain,  opium  in  any  form  would  be  contra- 
iiidioated,  since  it  would  lead  only  to  further 
difficulty  in  securing  evacuation  of  the  bowels. 


249 


SYMPTOMATIC  TREATMENT 


In  an  ordinary  colic,  however,  brought  about 
by  an  abnormal  collection  of  intestinal  gases, 
a  simple  condition  only  must  be  met,  and, 
although  the  bowel  here,  too,  requires  empty- 
ing, the  contra-indication  to  the  use  of  opium 
is  by  no  means  so  urgent,  since  no  grave  dis- 
ease threatens  the  strength  of  the  sufferer. 
And  so,  in  the  treatment  of  the  symptom  pain, 
there  is  as  great  a  difference  in  the  degree  of 
this  "nerve  lightning"  in  almost  all  diseases 
and  their  complications  as  exists  in  the  two 
conditions  mentioned  as  examples.  The  highest 
judgment  must  be  called  upon  in  this  emer- 
gency as  in  the  planning  of  any  general  outline 
of  treatment. 

The  actual  subjugation  of  pain  would  con- 
stitute its  symptomatic  treatment,  and  yet  the 
determination  of  its  source  is  an  important 
preliminary  step.  When  this  can  be  ascertained 
and  directly  attacked,  it  is,  of  course,  unneces- 
sary to  administer  analgetic  remedies  unless 
ulterior  conditions  demand  their  employment. 
But  always,  in  the  attempt  to  obtund  pain,  the 
sequel  upon  the  disease  and  its  possible  com- 
plications must  be  duly  considered,  for  little  is 
gained  by  respite  from  this  or  any  other  symp- 
tom if  the  subsequent  result  jeopardizes  the 
life  of  a  patient  or  renders  a  recurrence  of  the 
symptom  more  likely. 

On  the  part  of  the  brain,  symptoms  should 
be  considered  and  treated  as  they  arise.  DeU- 
rium,  coma,  and  stupor  can  not,  however,  simply 
be  treated  as  entities.  Relief  from  the  cause 
of  the  first  must  be  sought  when  this  is  pos- 
sible, but  no  treatment  should  be  instituted  for 
this  phenomenon  which  is  apt,  in  the  course  of 
a  disease,  to  increase  a  subsequent  stupor  or 
comatose  condition.  Delirium  is  but  a  symp- 
tom, and  as  such  is  not  in  itself  to  be  feared. 
It  is  but  the  mark  of  some  process  whose  influ- 
ence may  lead  to  decrease  of  strength  or  of  vital 
force,  and  hence  must  be  fought  as  any  other 
danger  signal  would  be.  The  efforts,  as  in  the 
treatment  of  all  symptoms  of  a  grave  nature, 
must  be  directed  to  soothing  the  disturbed 
sensorium.  And  the  same  remedy  will  not 
always  be  efBcacious.  The  delirium  of  an 
acute  infectious  disease  or  of  agonizing  pain 
must  receive  essentially  diflferent  therapy  from 
that  of  alcoholic  intoxication  or  of  mania. 
Coma  and  stupor  arise  from  caused  so  mani- 
fold that  in  each  individual  case  we  must  exer- 
cise a  careful  consideration  of  the  remedies 
which  are  best  fitted  to  arouse  the  dormant  or 
flagging  forces.  Sleeplessness,  too,  may  de- 
pend upon  factors  so  varying  that,  when  it  is 
possible,  the  origin  must  be  sought  and  the 
appropriate  treatment  be  instituted.  There  is 
no  more  select  field  for  the  judicious  choice  of 
a  remedial  measure  than  in  this  very  domain : 
one  drug  is  contra-indicated  in  the  presence  of 
pain  ;  another,  in  the  face  of  delirium  ;  another, 
when  there  is  danger  of  a  cardiac  depression  ; 
and  the  next,  in  disturbed  gastric  function.  Yet 
insomnia  is  one  of  the  direst  symptoms  to 
encounter,  and,  no  matter  in  what  disease  or 
condition  it  appears,  it  must  be  satisfactorily 
met. 

The  heart  and  lungs  during  the  course  of 
diseases  of  other  organs,  or  when  they  them- 


selves are  affected,  give  origin  to  symptoms 
which  usually  require  therapeutic  notice.  Any 
embarrassment  of  the  respiration,  whether  of 
local  origin  in  the  trachea  or  of  cardiac  source 
in  an  impaired  heart,  or  local  again  in  a  con- 
solidated lung,  must  be  met  and  at  once. 
Even  when  a  dyspnoea  'depends  upon  some  in- 
curable disease,  such  as  a  malignant  growth  or 
an  aneurysm,  every  intelligent  efllort  should  be 
made  to  relieve  the  threatening  symptom. 
And  the  same  rule  holds  trug  for  any  serious 
manifestation  on  the  part  of  t^e  heart."  When 
weakened,  through  disease  or  innate  condi- 
tions, it  must  be  strengthened  by  appropriate 
means ;  when  overworked  or  pumping  against 
greater  odds  than  it  is  able  to  overcome,  suit- 
able measures  for  its  relief  must  be  inaugu- 
rated. The  conditions  which  are  able  to  cause 
sudden  cessation  of  the  heart's  beat  in  disease 
must  be  carefully  watched  for,  and  never,  if  it 
can  be  prevented,  allowed  to  gain  supremacy. 

Cough  is  a  symptom  which  may  or  may  not 
demand  therapeutic  consideration,  depending 
upon  whether  it  is  the  sole  symptom  or  one  of 
a  group  of  symptoms,  and  whether  its  presence 
is  annoying,  painful,  or  aggravating  to  the  pa- 
tient. If  its  source  can  jbe  attacked  and  de- 
stroyed without  damage  to  any  of  the  functions 
or  organs,  therapeutic  measures  may  be  prop- 
erly inaugurated.  If  it  springs  from  a  pleurisy, 
a  jjneumonia,  or  a  pulmonary  tuberculosis,  it 
matters  little  how  much  the  patient  may  cough 
if  the  distress  is  not  great;  but  if  a  bi'on- 
chitis,  or  a  chronic  pharyngitis,  or  a  long  uvula, 
or  disease  of  the  tonsils  is  the  origin  of  the 
cough,  that  disease  may  itself  be  treated.  In 
other  words,  if  a  cough  represents  the  effort 
of  Nature  to  assist  in  the  elimination  of  dele- 
terious material  and  does  not  cause  the  pa- 
tient too  much  effort  or  pain,  it  may  well  go 
untreated;  if,  on  the  other  hand, it  is  due  sim- 
ply to  an  irritation  of  the  bronchial  tract  or 
part  of  it,  the  cough  deserves  and  should  have 
directed  against  it  therapeutic  interference. 

Constipation  or  diarrhoea  and  defective  ab- 
sorption or  elimination  are  such  common  ac- 
companiments of  many  diseases  that  their 
symptomatic  treatment  is  almost  a  matter  of 
routine.  And  yet  even  these  every-day  mani- 
festations of  local  or  constitutional  disease  are 
frequently  wrongly  treated,  since  a  diarrhoea 
may  easily  yield  to  a  laxative  which  causes  the 
removal  of  offending  material,  and  a  constipa- 
tion be  cured  by  giving  the  intestines  a  much- 
needed  rest.  In  general,  vomiting  and  nausea 
and  the  conditions  already  mentioned  require 
deliberation  of  a  careful  kind,  and  usually  de- 
mand treatment  based  upon  a  recognition  of 
their  causes.  In  this  particular  field  of  thera- 
py, symptomatic  treatment  represents  espe- 
cially the  treatment  of  conditions,  since  it  is 
usually  difficult  to  attack  the  disturbing  ele- 
ment directly. 

The  limits  of  this  article  forbid  an  elabora- 
tion of  the  symptoms  which  may  be  CA'oked  by 
disease  in  the  several  organs  of  the  body.  The 
underlying  principles  of  the  "rational  empiri- 
cism "  known  as  symptomatic  treatment  have 
been  brought  out,  and  a  further  multiplication 
of  details  is  scarcely  necessary.    It  may,  how- 


SYNERGISTS 
SYRUPS 


250 


ever,  not  be  out  of  place  to  emphasize  the 
necessity,  in  this  connection,  of  a  careful 
watching  of  the  general  processes  of  the  body, 
which,  though  they  may  not  arouse  special 
symptoms  in  the  course  of  a  disease,  are  yet  so 
important  in  their  bearings  upon  the  causation 
of  symptoms  on  the  part  of  special  organs  that 
their  consideration  in  any  disease  is  part  and 
parcel  of  the  observation  of  the  case.  Refer- 
ence is  made,  of  coarse,  to  the  metabolic  pro- 
cesses ;  the  proper  exchange  of  gases  in  the 
blood  and  tissues ;  the  correct  elimination  of 
waste  and  toxic  products ;  the  normal  secre- 
tion and  excretion  of  physiological  fluids.  A 
departure  from  the  normal  might  not,  in  any 
given  case,  show  symptoms;  but  eventually, 
if  metabolism  is  impeded,  all  those  evidences 
of  a  disturbance  of  nutrition  so  well  known 
and  easily  recognised  may  make  their  ap- 
pearance. Emaciation,  glandular  enlargement, 
an  excess  of  urea  in  the  urine,  a  feeble  heart, 
diminished  secretion  of  bile,  and  the  number- 
less other  concomitants  of  malnutrition  would 
make  themselves  felt.  The  physician  should 
hold  himself  responsible  for  the  non-appear- 
ance of  this  condition  by  observing  closely  the 
catabolio  necessities  of  the  body  during  the 
entire  progress  of  an  illness.  In  this  direction 
symptomatic  treatment  becomes  prophylactic 
at  times,  and  than  this  there  can  be  no  higher 
aim  in  medicine. 

There  still  remain  a  few  points  toward  which 
attention  must  be  directed.  Those  conditions 
known  as  asthenic  or  adynamic,  which  may  be 
part  of  any  prolonged  disease,  acute  or  chronic, 
must  always  receive  symptomatic  treatment 
directed  to  the  organs  or  sets  of  organs  which 
are  the  principal  seats  of  weakness.  The  treat- 
ment can  not  be  specified,  but  must  be  general 
as  indicated.  If  the  heart  shows  signs  of  de- 
pression or  failure,  it  must  receive  stimulants ; 
if  the  intestines  are  weakened  in  their  func- 
tion, they  must  be  strengthened.  If  there  is 
exhaustion  of  the  nervous  system  or  of  the 
muscular  system  or  deterioration  of  the  blood, 
these  integers  must  be  given  the  benefit  of 
measures  which  will  restore  them  or  aid  in 
restoring  them  to  their  normal  condition.  But 
whatever  organ  is  thus  found  weakened  in  func- 
tion, the  therapeutic  measure  applied  must  be 
in  proportion  to  the  disturbance,  and  so  chosen 
as  to  inflict  no  further  injury  upon  the  dis- 
abled organ  or  upon  other  organs ;  and  this  is 
of  importance  secondary  only  to  that  of  the 
administration  of  some  remedial  agent.  The 
giving  of  nourishing  foods  in  the  conditions 
under  consideration  may  well  come  under  this 
heading.  No  therapeutic  agent  at  our  com- 
mand can  replace  the  nutriment  to  be  ob- 
tained from  proper  food-stuffs  which  contain, 
in  a  concentrated  and  easily  assimilable  form, 
the  essential,  elementary  physiological  requi- 
sites. Conditions  of  malnutrition  which  fre- 
quently follow  the  acute  diseases  commonly 
yield  in  a  remarkable  manner  to  judicious 
feeding ;  every  organ  and  system  of  organs 
seems  to  respond  almost  immediately  to  the 
ingestion  of  the  vital  principles  contained  in 
the  nourishment.  It  may  be  mentioned,  too, 
that  the  proper  nourishment  of  the  sick  during 


an  acute  illness  is  frequently,  in  more  senses 
than  one,  a  form  of  symptomatic  treatment  of 
higher  value  than  the  mere  fighting  of  ob- 
jective symptoms. 

It  has  been  considered  better,  in  the  course 
•of  this  article,  not  to  refer  to  groups  of  diseases 
or  the  individual  maladies ;  but,  by  pointing 
out  some  of  the  broad  principles  which  gov- 
ern symptomatic  treatment  in  general,  to  de- 
duce the  con<;lusions  reached.  To  summarize 
briefly,  it  may  be  repeated  that  symptomatic 
treatment  is  indicated  in  all  diseases  or  condi- 
tions whose  processes  give  rise  to  local  or  con- 
stitutional manifestations,  and  whose  seat  of 
origin  can  not  be  attacked,  or  when,  in  our 
ignorance,  we  do  not  know  how  to  attack  it ; 
or,  in  a  more  limited  sense,  when  symptoms  or 
conditions  arise  in  the  course  of  any  illness  the 
treatment  of  which  is  unable  to  overcome  the 
phenomena  of  local  or  general  origin.  Even 
when  a  cure  is  out  of  the  question,  the  judi- 
cious treatment  of  symptoms  may  provide 
comfort  and  prolong  life. 

Samuel  M.  Beickner. 

SYNERGISTS.  —  These  are  remedies 
which  in  some  manner  aid  or  intensify  each 
other's  actions.  The  synergistic  property  was 
formerly  held  to  be  of  great  importance,  and 
an  attempt  was  usually  made  to  modify  the 
complex  action  of  the  drug  chosen  as  the  prin- 
cipal reliance  and  known  as  the  base,  by  com- 
bining with  it  an  adjuvant  to  increase  the 
desired  effect,  and  a  corrigent  to  neutralize 
such  effects  as  were  undesirable.  To  succeed 
in  attaining  such  ideal  results  a  much  more 
accurate  knowledge  of  the  exact  action  of  each 
drug,  and  the  proportjionate  influence  exer- 
cised by  it  over  the  various  organs  of  the  body, 
as  well  as  a  genius  for  making  accurate  com- 
binations, would  be  necessary  to  a  degree  not 
yet  attained  in  the  human  race,  and  as  the  at- 
tempts made  were  usually  to  a  greater  or 
lesser  degree  failures  to  obtain  the  desired  re- 
sults, a  severe  simplicity  has  gradually  taken 
their  place  and  the  plain  drug,  uninfluenced 
by  adjuvant  or  corrigent  intentionally  intro- 
duced, is  the  rule  of  prescription-writing  at 
the  present  day.  Nevertheless,  the  advantage 
to  be  derived  from  the  employment  of  reme- 
dies which  are  of  assistance  to  each  other  is 
obvious. 

It  was  the  crude  attempt  to  use  the  knowl- 
edge that  most  drugs  produce  many  effects,  of 
which  some  are  beneficial  but  others  delete- 
rious in  any  given  case,  which  caused  those 
combinations  of  drugs  that  seem  strange  to  us ; 
but  it  is  of  great  advantage  to  remember  that 
many  drugs  produce  similar  even  if  not  iden- 
tical effects,  and  that  by  the  combination  of 
two,  each  of  which  produces  a  similar  or  iden- 
tical effect  upon  a  certain  organ,  a  better  re- 
sult can  be  obtained  than  from  either  singly, 
because,  as  a  smaller  amount  of  each  is  needed, 
the  other  effects,  whether  deleterious  or  not, 
are  produced  in  a  minimum  degree.  Thus 
opium  and  ipecacuanha  are  both  diaphoretics, 
while  one  is  a  narcotic  and  the  other  a  nau- 
seant.  By  combining  them  a  better  diapho- 
resis may  be  obtained  than  would  be  the  case 


251 


SYNERGISTS 
SYRUPS 


if  either  were  given  singly,  unless  in  sufficient- 
ly large  doses  to  produce  the  other  and  unde- 
sired  physiological  eflEects.  In  the  same  manner 
manganese  may  be  advantageously  combined 
with  iron  to  aid  it  in  producing  its  hsematinic 
effects.  Sometimes  the  combination  of  a 
stronger  and  a  weaker  agent  is  of  remarkable 
efficacy.  Although  cocaine  can  not  compare 
with  atropine  as  a  mydriatic,  still  a  more  pro- 
nounced mydriasis  may  be  obtained  from  their 
united  action  than  from  atropine  alone,  on  ac- 
count of  the  mechanical  expression  of  blood 
from  the  tissue  by  the  contraction  of  the 
blood-vessels  induced  by  the  cocaine. 

This  synergetic  action  of  various  drugs  may 
possibly  be  explained  in  some  cases  by  a  close 
alliance  in  chemical  composition,  as  is  the  case 
with  metallic  salts  and  with  the  members  of 
the  phenol  group,  or  by  the  presence  of  iden- 
tical or  closely  related  alkaloids  or  active  prin- 
ciples, such  as  that  of  berberine  in  calumba 
and  hydrastis.  But  such  a  relationship  is  not 
always  necessary  in  order  that  two  drugs  may 
enhance  each  other's  effect  upon  the  system,  as 
is  demonstrated  by  the  frequent  and  useful 
prescription  of  iron  with  bitter  tonics. 

The  employment  of  synergists  in  medicine 
should  not  be  considered  as  confined  to  the 
prescription  of  drugs,  which  by  their  physio- 
logical action  increase  each  other's  force,  but 
should  also  include  all  agencies  by  means  of 
which  the  system  is  aided  to  respond  to  the  in- 
fluence of  the  medicament  upon  which  reliance 
is  placed.  Thus  digestive  ferments  employed 
to  improve  the  digestion  and  so  contribute  to 
furnish  assimilable  material  for  the  support  of 
the  body  are  distinctly  synergistic  to  the 
means  used  to  combat  the  disease  from  which 
the  patient  is  suffering.  The  same  is  true  of 
tonics,  stimulants,  the  inhalation  of  oxygen, 
and  all  other  measures  which  aim  at  the  main- 
tenance of  the  patient's  strength  and  vitality. 
Water,  when  drank  in  large  quantities  as  a  di- 
luent, is  of  valuable  service  in  inflammation  of 
the  geni to-urinary  tract  by  flushing  the  emunc- 
tories  and  so  permitting  easier  and  better  ac- 
tion of  the  organs. 

Counter-irritation  may  frequently  act  syner- 
gistically  by  inducing  a  change  in  the  nervous 
or  oirculatsry  condition  of  an  organ,  as  when 
it  is  used  in  the  lumbar  region  in  eases  of 
nephritis,  that  it  may  assist  the  kidneys  to  re- 
spond to  the  diuretics  administered. 

The  regulation  of  other  organs  of  the  body 
than  those  primarily  diseased  is  an  important 
aid  to  the  restoration  of  functional  equilib- 
rium, hence  the  use  of  laxatives,  diaphoretics, 
and  other  eliminatives  is  frequently  indicated. 
Emetics,  cathartics,  and  general  depletion  fa- 
vour the  action  ot  depressant  remedies. 

The  synergistic  effect  of  electricity  in  the 
rapid  production  of  the  local  effects  of  cocaine, 
aconite,  and  other  drugs  has  been  mentioned 
and  classed  with  other  mechanical,  chemical, 
and  thermal  aids  to  absorption,  under  Sorbe- 

FACIENTS. 

Hygienic  measures  of  all  kinds,  pure  air, 

proper    food,   exercise,   massage,   the  various 

forms  of  baths,  are  most  valuable  synergists  to 

proper  medicinal  treatment,  not  including  sys- 

60 


temic  depressants,  and  when  properly  carried 
out  not  infrequently  become  the  principal  in- 
stead of  the  accessory  remedial  measures.  Un- 
favourable hygienic  conditions  increase  the 
activity  of  drugs  which  depress  the  bodily 
functions. 

Finally,  the  synergistic  effect  of  mental  emo- 
tion must  be  considered.  The  modvs  operandi 
here  is  difficult  to  explain,  but  it  is  universally 
acknowledged  that  a  cheerful  frame  of  mind 
is  of  much  assistance  to  the  action  of  restora- 
tive agents,  while  a  mournful  mood  increases 
the  force  of  depressant  remedies. 

Matthias  Lanckton  Foster. 

SYNOVIAL  EXTRACT.— Dr.  Samuel 
Hyde,  of  Buxton,  England,  writes  in  the  Brit- 
ish MedicalJournal  for  April  18,  1896,  that  he 
has  had  a  glycerin  extract  prepared  from  the 
fresh  synovial  membranes  and  articular  carti- 
lages of  healthy  animals,  and  is  using  it  as  a 
remedy  for  rheumatoid  arthritis  a,n6i  some  other 
forms  of  chronic  joint  disease.  He  gives  it  by 
the  mouth  in  doses  of  from  15  to  30  minims 
two  or  three  times  a  day.  He  reports  that  thus 
far  his  experience  with  it  is  encouraging. 

SYRUPS. — These  are  more  or  less  concen- 
trated solutions  of  sugar  in  water,  in  most 
cases  combined  with  some  flavouring  or  me- 
dicinal agent.  They  may  be  prepared  by  vari- 
ous methods.  When  heat  is  not  objectionable, 
they  are  most  expeditiously  made  by  this  agent. 
Otherwise  simple  agitation  or  percolation  must 
be  resorted  to. 

The  hot  process,  if  it  can  be  applied  to  all, 
not  only  is  the  most  expeditious,  but  produces 
the  most  stable  product,  as  it  destroys  the  vi- 
tality of  any  germs  which  may  set  up  fermen- 
tation, or  cause  the  formation  of  mould,  etc., 
in  the  product.  If  it  is  necessary  to  avoid 
actual  boiling  in  the  preparation  of  a  syrup, 
the  product  is  usually  not  so  clear  and  bright 
as  would  have  been  the  case  if  the  boiling  point 
had  been  attained,  because  in  the  latter  case 
the  suspended  matters  would  have  all  been 
carried  to  the  top,  where  they  could  have  been 
removed. 

In  the  preparation  of  syrups  containing  vola- 
tile or  easily  decomposable  medicinal  ingredi- 
ents, heat  must  be  avoided.  But  such  syrups, 
unless  kept  under  special  precautions,  are  very 
apt  to  deteriorate.  It  is  therefore  advisable 
never  to  prepare  more  of  a  stock  than  will  sup- 
ply the  demand  for  a  short  time  ahead. 

The  preservation  of  syrups  is  best  accom- 
plished by  keeping  them  in  completely  filled 
bottles,  each  holding  an  amount  sufficient  for 
a  few  days'  supply,  which  must  be  hermetically 
sealed  and  kept  in  a  cool  place.  If  the  syrup 
can  be  introduced  boiling  hot  into  the  bottles, 
previously  well  cleaned  and  immersed  in  hot 
water,  it  will  keep  so  much  the  better.  When 
it  is  necessary  to  clarify  a  syrup  which  is  tur- 
bid from  minute  suspended  matters,  this  may 
be  accomplished,  if  heat  is  not  objectionable, 
by  mixing  with  it,  while  cold,  an  aqueous  solu- 
tion of  white  of  egg  and'then  raising  it  to  boil- 
ing without  stirring.  As  the  albumen  contained 
throughout  the  solution  coagulates,  it  envelops 
the  suspended  matters  and  they  are  all  carried 


SYZYGIUM  JAMBOLANUM 
TABLETS 


252 


to  the  top  in  the  form  of  scum.  When  heat 
cannot  be  used,  the  clarification  is  best  effect- 
ed by  mixing  the  syrup  with  well-shredded 
and  moistened  paper-pulp,  thoroughly  agitat- 
ing it  during  some  time,  and  then  filtering 
through  paper  or  flannel.  The  first  portions 
of  the  liquid  may  be  returned  to  the  mixture 
until  it  runs  through  clear. 

In  come  cases  the  preservation  of  a  syrup  is 
secured  by  the  addition  of  an  acid,  or  of  alco- 
hol, or  of  glycerin. 

Fruit  syrups,  which  are  largely  used  as 
flavouring  agents  in  popular  beverages,  as  well 
as  in  medicinal  compounds,  are  usually  pre- 
pared with  the  aid  of  a  moderate  degree  of 
fermentation.  As  an  example  may  be  cited 
syrup  of  cherries,  which  is  best  prepared  in  the 
following  manner:  Crush  the  cherries,  with 
their  kernels,  and  let  the  mass  stand  in  a  cov- 
ered vessel  for  two  days  at  a  temperature  of 
from  60°  to  70°  P.,  stirring  it  occasionally. 
Then  express  the  juice,  add  for  every  100  parts 
of  the  latter  3  parts  of  sugar,  and,  when  this 
is  dissolved,  pour  the  juice  into  one  or  more 
narrow-mouthed  bottles  or  other  convenient 
vessels  of  such  a  nature  that  only  a  small  sur- 
face of  the  juice  is  exposed  to  the  air,  and  tie 
parchment  paper  over  the  orifice.  Fermenta- 
tion will  gradually  set  in,  its  rate  depending 
greatly  on  the  temperature,  which  should  be 
so  regulated  that  it  will  not  be  too  rapid.  The 
fermentation  produces  a  certain  amount  of  al- 
cohol, which  causes  the  gradual  coagulation  of 
the  mucilaginous  constituents.  As  soon  as  a 
small  sample,  say  4  c.  cm.,  of  a  filtered  portion 
of  the  juice  is  found  to  mix,  without  becoming 
turbid,  with  3  e.  cm.  of  90-per-cent.  alcohol, 
the  process  should  be  interrupted.  The  juice 
is  now  filtered  as  rapidly  as  possible,  the  filtrate 
is  transferred  to  a  suitable  vessel,  and  for  every 
350  parts  of  filtrate  650  parts  of  sugar  are  add- 
ed. The  mixture  is  slowly  raised  to  boiling 
and  kept  at  this  temperature  until  it  no  longer 
throws  up  a  scum,  which  must,  while  it  ap- 
pears, be  constantly  removed.  The  finished 
product  is  then,  while  still  hot,  strained  through 
flannel  and  immediately  transferred  to  suitable 
vessels,  which  must  be  filled  as  far  as  possible 
and  securely  stoppered. — Oharles  Rice. 

SYZYGITIM     JAMBOLANUM.  —  See 

Jambul. 


TABACTTM.— See  Tobacco. 

TABELLiSE,  TABLETS.— Tablets  are 
small  disc-like  masses  of  medicinal  powders 
the  basis  of  which  usually  consists  of  cane 
sugar  or  milk  sugar.  They  are  prepared  either 
in  moulds  or  by  compression. 

Moulded  tablets,  also  called  tablet  triturates 
(more  correct  would  be  triturate  tablets)  are 
prepared  by  triturating  an  active  substance 
with  a  sufficient  amount  of  milk  sugar  (or,  in 
some  cases,  other  soluble  medium),  so  that  when 
they  are  moulded  and  finished,  each  tablet  will 
contain  the  exact  intended  amount  of  the  me- 


dicinal constituent.  These  tablets  were  first 
suggested  and  introduced  by  Dr.  Robert  M. 
Puller,  of  New  York,  in  1878,  since  which  time 
their  use  and  manufacture  have  assumed  im- 
mense proportions. 

Since  the  tablets  are  usually  of  the  same 
size,  and  since  varying  quantities  of  medicinal 
constituents  occupy  varying  volumes,  the  maker 
has  to  devise  a  separate  formula  for  each  com- 
bination, so  that  a  finished  tablet  will  contain 
the  exact  dose  of  the  medicine  together  with 
enough  sugar  of  milk  to  make  up  the  bulk  of 
the  tablet.  The  formula  for  each  separate 
combination  is  arrived  at  in  the  following  way : 

The  mould  is  filled  with  powdered  sugar  of 
milk,  previously  made  into  a  pasty  mass  with 
alcohol.  The  mould  itself  consists  of  a  plate 
of  hard  rubber,  glass,  or  metal,  of  the  exact 
thickness  of  the  tablets  to  be  formed.  It  is 
pierced  by  a  number  of  parallel  rows  of  round 
holes  of  the  diameter  of  the  desired  tablets. 
On  either  side  are  two  additional  single  holes. 
The  plate  is  laid  on  a  flat  surface,  the  prepared 
mass  is  forced,  by  means  of  a  spatula,  into  the 
tablet  holes,  and  all  excess  of  the  mass  is  care- 
fully removed.  When  the  tablets  are  nearly 
set,  the  mould  is  brought  over  a  plate  contain- 
ing cylindrical  pegs  exactly  corresponding  to 
the  tablet  holes,  the  proper  guidance  of  the 
mould  being  accomplished  by  two  longer  pegs, 
one  on  each  side,  which  fit  into  the  lateral  holes 
of  the  mould. 

After  the  experimental  tablets  have  been  re- 
moved from  the  mould,  they  are  thoroughly 
dried  and  weighed.  They  generally  weigh  1'3 
grain  each,  though  this  weight  is  slightly  in- 
creased with  any  increase  in  the  solvent  action 
of  the  menstruum,  since  this  causes  more  sugar 
to  remain  in  a  compact  form  in  the  tablet. 
Next  it  becomes  necessary  to  ascertain  how 
much  milk  sugar  must  be  omitted  from  the 
ascertained  amount  to  make  room  for  the  de- 
sired quantity  of  the  medicinal  ingredient. 
For  this  purpose  130  grains  of  milk  sugar, 
corresponding  to  100  plain  tablets,  are  weighed 
off,  and  as  much  in  bulk  is  removed  from  this 
as  the  apparent  bulk  of  the  medicinal  sub- 
stance to  be  added.  The  amount  of  sugar  of 
milk  removed  is  ascertained  by  weighing.  The 
active  ingredient,  if  a  dry  solid,  is  now  mixed 
by  thorough  trituration  with  the  remaining 
sugar  of  milk.  In  the  case  of  solid  extracts, 
tinctures,  and  other  fluids,  these  are  mixed 
with  the  remaining  sugar  of  milk,  and  the 
whole  is  brought  to  a  solution  by  a  suitable 
menstruum,  to  insure  uniform  admixture.  The 
solution  is  then  evaporated  and  the  residue  re- 
duced to  powder. 

When  the  powder  or  triturate  is  ready,  it  is 
wet  with  a  suitable  menstruum  (see  below) 
and  moulded,  care  Ijeing  taken  that  the  wliole 
mixture  is  transferred  to  the  holes,  which  must 
all  be  filled,  while  none  of  the  mass  must  re- 
main over.  In  most  cases  this  is  only  an  ex- 
perimental step,  since,  if  there  is  either  too 
much  or  too  little  of  the  mass,  a  new  trial 
must  he  made,  until  there  is  just  enough.  But 
the  proportions  of  sugar  of  milk  and  of  me- 
dicinal ingredients  thus  ascertained  will  then 
hold  good  for  the  future,  and  it  is  only  neces- 


253 


SYZYGIUM  JAMBOLANUM 
TABLETS 


sary  to  keep  a  record  of  them  for  the  particular 
combination  in  question. 

If  at  this  trial  it  was  found  that  there  was 
not  enough  mass  to  fill  all  the  holes,  the  weight 
of  the  deficiency  is  ascertained  by  finding  the 
average  weight  of  the  finished  tablets  and  de- 
ducting the  calculated  weight  of  the  missing 
tablets  from  the  weight  of  the  bulk  of  sugar 
originally  removed  from  the  130  grains.  At 
the  next  trial  the  quantity  to  be  removed  should 
be  less  by  the  amount  represented  by  the  weight 
of  the  missing  tablets. 

It  is  important  that  all  the  ingredients,  as 
well  as  the  mixture  of  powders  ready  for 
moulding,  should  be  in  the  finest  possible  state 
of  subdivision. 

The  menstruum  selected  for  moistening  the 
mass  should  have  a  slightly  solvent  action  upon 
one  or  more  of  the  constituents,  but  the  latter 
should  not  be  too  freely  soluble,  since  the  mass 
is  then  moulded  with  difficulty,  and  the  tablets 
are  apt  to  be  uneven  or  become  too  hard.  The 
solvent  action  should  be  so  regulated  that  the 
resulting  tablets  will  not  crumble  when  shaken 
together  in  a  phial,  and  yet  will  readily  disinte- 
grate in  water,  either  at  once  or  at  least  after 
some  time. 

The  menstruum  generally  used  is  absolute 
alcohol,  alcohol  and  water,  or  chloroform. 
For  tablets  consisting  nearly  altogether  of 
sugar  of  milk,  a  menstruum  of  3  volumes  of 
alcohol  and  1  volume  of  water  is  the  most 
suitable.  The  larger  the  quantity  of  insoluble 
matters  which  is  present  in  the  mass,  the  more 
must  the  proportion  of  water  be  increased,  the 
object  being  to  dissolve  enough  of  the  sugar 
of  milk  to  hold  the  particles  together.  This 
is,  for  instance,  the  case  with  tablets  of  re- 
duced iron,  manganese  dioxide,  cerium  oxalate, 
bismuth  subnitrate,  and  similar  substances. 
For  tablets  of  codeine,  leptandrin,  aloin,  etc., 
and  bodies  very  soluble  in  alcohol,  it  is  best  to 
use  only  water. 

When  a  chemical  reaction  is  expected  to  take 
place,  so  as  to  produce  a  new  substance  which 
is  the  desired  active  ingredient,  the  menstruum 
selected  shoiild  not  dissolve  all  of  the  partici- 
pants in  the  reaction,  since  the  latter  is  ex- 
pected to  be  completed  in  the  stomach. 

When  the  powder  is  ready,  it  is  wet  to  a 
pasty  condition  by  the  most  suitable  men- 
struum, and  then  pressed  into  the  holes  of  the 
tablet  mould  lying  on  the  pill  tile  or  other  flat 
surface  by  means  of  a  horn  or  ivory  spatula 
which  is  drawn  over  the  mould.  Sometimes  it 
will  happen  that  the  mass  adheres  to  the  spat- 
ula and  is  thus  drawn  out  of  the  holes.  This 
may  be  avoided  or  remedied  by  dipping  the 
spatula  in  the  menstruum  used  for  moistening 
the  mass,  and  then  drawing  it  over  the  surface. 
The  mould  is  then  reversed  by  sliding  it  toward 
and  off  the  edge  of  the  tile,  and  the  spatula 
applied  to  the  other  side  in  the  same  manner 
as  before  described.  It  is  then  applied  to  the 
peg  plate  (or  pin  plate),  and  the  tablets  are 
pushed  out.  They  are  allowed  to  dry  for  a 
few  minutes  on  the  pegs,  then  removed  by 
striking  the  peg  plate  upon  the  counter  cov- 
ered with  a  sheet  of  paper  to  receive  the  tab- 
lets. 


If  the  tablets  are  to  be  finished  quickly,  a 
current  of  heated  air  is  allowed  to  pass  over 
the  side  which  is  to  rest  on  the  pegs. 

In  drying  tablets,  it  is  best  to  use  a  sieve  or 
wire  cage,  so  as  to  permit  of  uniform  drying  on 
all  sides.  This  is  particularly  necessary  in  the 
case  of  coloured  tablets. 

Hypodermic  Tablets. — These  may  be  pre- 
pared in  a  similar  manner  with  sugar  of  milk 
or  some  inert  mineral  salt  as  the  base. 

Compressed  Tahlets,or  Tabloids. — These  con- 
sist of  some  medicinal  substance  or  mixture, 
compressed  in  the  form  of  discs.  The  sub- 
stance in  this  case  should  not  be  in  fine  pow- 
der, but  in  a  granular  form,  being  brought  to 
this  condition,  if  necessary,  by  a  special  pro- 
cess. 

Of  course,  if  a  mixture  is  to  be  brought  into 
the  form  of  compressed  tablets,  the  ingredients 
must  first  be  mixed  most  thoroughly  by  tritu- 
ration to  a  fine  powder,  and  then  brought  into 
a  granular  form.  This  granulation  is  generally 
effected  by  mixing  the  powder  with  one  tenth 
of  its  weight  of  cane  sugar  and  one  twentieth 
of  powdered  gum  arable,  and  moistening  with 
water  until  the  mass  is  of  such  consistence 
that  it  can  readily  be  forced  through  a  No.  13 
sieve  without  sticking  to  it  or  clogging  it. 
When  it  has  thus  been  passed  through  the 
sieve  it  is  dried.  The  finished  granulation, 
which  must  be  perfectly  dry,  is  now  forced 
through  a  No.  20  sieve,  and  the  particles  which 
do  not  readily  pass  through  are  forced  through 
by  the  aid  of  a  flat  pestle.  In  moistening  the 
granulated  powder,  the  water  must  be  added 
uniformly  throughout,  best  in  the  form  of  a 
spray  and  in  small  portions  at  a  time. 

Substances  which  can  be  bought  already 
granulated,  or  may  be  brought  to  this  condi- 
tion by  grinding  and  sifting,  usually  require 
no  further  preparation,  and  may  be  compressed 
at  once — for  instance,  ammonium  chloride,  po- 
tassium bromide,  sodium  bromide,  potassium 
chlorate,  etc.  In  the  case  of  the  last-named  salt, 
if  it  is  to  be  combined  with  sugar,  its  danger- 
ously explosive  property  must  not  be  forgot- 
ten. No  trituration  or  forcible  compression 
of  a  dry  mixture  cf  the  salt  with  sugar  must 
be  attempted. 

Before  the  granulated  substance  is  com- 
pressed, some  lubricant  must  be  added.  The 
best  has  been  found  to  be  some  hydrocarbon 
oil,  which  must  be  absolutely  free  from  odour. 
A  very  small  quantity  is  sufiioient — about  10 
or  13  drops  for  each  pound  of  granulated 
mass.  It  is  best  added  in  the  form  of  a  fine 
spray  and  distributed  by  stirring  the  mixture. 
The  particles  thus  become  faintly  lubricated 
and  will  be  enabled  to  glide  upon  each  other 
freely,  easily  falling  into  the  mould  space,  feed- 
ing the  same  amount  each  time,  and  thus 
making  the  finished  tablets  equal  in  weight. 
The  aet  of  compression  forces  most  of  the  oil 
to  the  surface  of  the  tablet  and  lubricates  the 
latter  just  enough  to  prevent  it  from  sticking 
to  the  die.  Finely  powdered  French  chalk 
is  generally  used  as  an  additional  lubricant. 
It  is  added  in  small  quantity,  not  to  exceed  1 
ounce  for  every  3  pounds,  after  the  oil. 

Various  forms  of  compressed-tablet  moulds 


TABLOIDS 
TANNIC  ACID 


254 


have  been  devised  for  preparing  tablets  on  a 
small  scale  and  for  manufacturing  purposes. 

A  very  important  quality  which  compressed 
tablets  should  possess  is  that  of  rapid  disinte- 
gration or  solution,  except  in  the  case  of  those 
(for  instance,  of  potassium  chlorate)  which  are 
..intended  to  dissolve  slowly.  In  order  to  facili- 
tate their  rapid  disintegration,  the  mass  to  be 
granulated,  if  it  requires  it,  is  mi.xed  with  from 
one  twentieth  to  one  tenth  of  its  weight  of 
powdered  starch.  This  is  particularly  neces- 
sary in  the  case  of  such  substances  as  phenac- 
etine,  acetanilide,  sulphonal,  trional,  etc.,  as 
they  would  produce  scarcely  any  effect  at  all 
if  solution  had  to  proceed  gradually  from  the 
outside  of  a  solid  tablet.  Indeed,  without  this 
addition  such  tablets  would  be  likely  to  pass 
througli  the  whole  intestinal  canal  without 
losing  much  substance. — Charles  Rice. 

TABLOIDS. — This  is  a  synonym  used  in 
England  to  denote  compressed  tablets.     Con- 
cerning the  latter,  see  the  article  Tablets. 
Charles  Rice. 

TAKA-DIASTASE.— This  is  a  powerful 
amylolytic  ferment,  prepared  by  a  process  sim- 
ilar to  malting,  devised  by  Mr.  Jokichi  Taka- 
mine,  a  Japanese  chemist,  from  a  fungous 
•  growth  on  wheat  bram.  It  is  a  tasteless  and 
odourless  powder  capable  of  quickly  convert- 
ing a  hundred  times  its  weight  of  starch  into 
sugar,  mostly  maltose.  It  is  used  in  the  treat- 
ment of  so-called  amylaceous  dyspepsia,  and 
found  to  be  exceedingly  efficient.  It  may  be 
given  in  doses  of  2  grains,  after  eating.  Dr. 
George  Suttie,  of  Detroit  (Medical  Age,  Sep- 
tember 25,  1895),  has  reported  a  number  of 
cases  in  which  its  employment  proved  highly 
satisfactory. 

TALC. — What  is  generally  known  as  talc, 
talcum  (trer.  Ph.),  is,  properly  speaking,  steatite, 
or  more  probably  a  mixture  of  talc  and  stea- 
tite. As  used  in  medicine,  it  is  grayish-white 
in  colour  and  has  a  greasy  texture.  It  is  em- 
ployed as  a  dusting  powder,  either  by  itself 
or  combined  with  small  amounts  of  boric 
or  carbolic  acid,  as  a,  soothing  and  protective 
application  in  intertrigo,  eczema,  and  various 
other  irritated  conditions  of  the  skin,  and  is 
probably  the  best  agent  of  Its  class,  except 
when  it  is  to  be  applied  to  a  surface  secreting 
any  acid  fluid,  when  magnesia  or  magnesium 
carbonate  is  preferable,  on  account  of  its  alka- 
linity. It  is  especially  adapted  for  use  on 
parts  where  there  is  more  or  less  friction,  as 
its  unctuous  properties  allow  of  the  free  move- 
ments of  the  surfaces  upon  each  other.  Puri- 
fied talc,  talcum  purificatum  (N.  F.),  is  talc 
deprived  of  certain  of  its  impurities  by  hydro- 
chloric acid.  It  may  be  used  as  a  filtering 
agent,  and,  under  the  name  of  "  French  chalk," 
it  is  very  largely  employed  to  remove  grease 
from  fabrics,  being  powdered  and  applied  over 
the  spot  and  allowed  to  remain  for  an  hour  or 
two. — Russell  H.  Nevins. 

TALLOW. — Properly  speaking,  all  animal 
fats  that  are  solid  at  ordmary  temperatures 
are  grouped  under  this  head,  but  the  term  is 
usually  limited  to  the  solid  fats  obtained  from 
beeves  and  shSep.    (See  Suet.)     The  tallow 


obtained  from  the  internal  part  of  beeves  is 
hardly  suitable  for  medical  purposes,  as,  unless 
prepared  with  great  care,  it  contains  more  or 
less  water,  and  speedily  decomposes  with  the 
formation  of  various  fatty  acids  that  are  irri- 
tating to  the  skin.  That  prepared  from  the 
adipose  tissue  surrounding  the  kidneys,  thf. 
'■  short  fat "  of  commerce,  contains,  more 
stearin  than  the  other  varieties,  and  is  the 
least  objectionable. — Russell  H.  Nevins. 

TAMARIND,  tamarindus  (U.  S.  Ph.,  Br. 
Ph.),  pulpa  tamarindorum  cruda  and  pulpa 
tamarindorum  depurata  (Ger.  Ph.),  is  the  acid- 
ulous pulp  of  the  fruit  of  a  semitropical  and 
tropical  tree,  the  Tamarindus  indica,  which  is 
mildly  laxative.  It  is  often  combined  with 
other  laxatives,  and  enters  into  the  composi- 
tion of  confection  of  senna.  It  may  be  given 
in  doses  as  large  as  an  ounce  with  safety,  but 
larger  amounts  than  that  may  give  rise  to 
griping.  An  infusion  in  water  is  an  agreeable 
beverage  in  febrile  conditions,  when  the  stom- 
ach is  in  good  order.  Like  nearly  all  vegetable 
preparations  of  the  same  class,  it  is  moderately 
diuretic. — Russell  H.  Nevins. 

TANACETXTM:.— See  Tansy. 

TANNAL. — There  are  two  aluminum  salts 
known  under  this  name.  The  first,  which  is 
insoluble,  is  a  basic  aluminum  tannate,  Alj 
(OH)4(C,.Hb09)j  -I-  lOHjO,  a  brownish-yellow 
powder  formed,  according  to  Professor  Cob- 
lentz,  by  precipitating  a  solution  of  an  alumi- 
num salt  with  a  solution  of  tannic  acid  in  the 
presence  of  an  alkali.  The  second,  which  is 
soluble,  is  aluminum  tannic  tartrate,  AljfCjHe 
Oe)'}.(CnB-i,0,)i  +  6H2O,  obtained,  according  to 
the  same  author,  by  treating  insoluble  tannaJ 
with  tartaric.  Both  forms  are  astringent  and 
antiseptic.  The  insoluble  form  is  used  by  in- 
sufflation, and  the  soluble  form  in  solution  in 
nasal,  laryngeal,  and  pharyngeal  catarrh. 

TANNALBIN.— This  is  a  German  pro- 
prietary preparation.  Gottlieb  (Deutsche  medi- 
cinische  Wochenschrift,  March  12,  1896; 
Therapeutische  Wochenschrift,  March  29, 1896) 
describes  it  as  a  slightly  yellowish,  tasteless 
powder  containing  fifty  per  cent,  of  tannin, 
made  by  subjecting  a  compound  of  tannin  and 
albumin  to  a  heat  of  from  212°  to  248°  F.  for 
five  or  six  hours,  whereby  it  acquires  the  prop- 
erty of  resisting  gastric  digestion,  while  it  still 
remains  susceptible  to  the  slow  action  of  the 
intestinal  juices.  Yon  Engel  (ibid.)  has  found 
it  serviceable  in  all  diarrhceal  affections  in 
which  an  astringent  is  indicated,  especially 
chronic  intestinal  catarrh.  It  proved  efficient 
in  twenty-five  out  of  twenty-nine  subacute  or 
chronic  cases,  and  in  nine  out  of  ten  acute 
ones.  He  reports  that  he  has  observed  no 
harm  from  its  use.  The  dose  for  adults  is  15 
grains,  and  that  for  children  under  four  years 
old  half  that  amount  from  two  to  four  times  a 
day.  Vierordt  (Deutsche  medicinische  ^yoch- 
enschrift,  June  18, 1896 ;  British  Medical  Jour- 
nal, July  4,  1896)  has  used  tannalbin  in  some 
thirty  selected  cases,  mostly  of  subacute  or 
chronic  intestinal  catarrh,  including  ulcerative 
enteritis,  occurring  usually  in  young  subjects. 
Regulation  of  the  diet,  other  drugs  as  well  as 


255 


TABLOIPS 
TANNIC  ACID 


other  methods  of  treatment,  such  as  injections, 
etc.,  had  produced  no  good  effect.  The  astrin- 
gent action  of  the  drug  was  well  marked  in  the 
various  forms  of  diarrhoea,  even  including  cases 
of  suspected  tuberculous  ulceration  of  the  howel. 
Inthe  various  forms  of  enteritis  the  stools  be- 
came more  solid  and  the  mucus  diminished,  so 
that  the  dose  of  the  tannalbin  could  soon  be  les- 
sened and  its  use  discontinued.  In  four  cases 
in  which  cod-liver  oil  containing  either  creosote 
or  phosphorus  produced  diarrhoea,  the  stools 
became  solid  ana  less  frequent  when  tannalbin 
was  given  in  addition.  No  unpleasant  symp- 
toms were  produced  by  the  tannalbin.  The 
author  discusses  the  possibility  of  a  favourable 
action  being  exerted  on  internal  organs,  such 
as  the  kidneys,  etc.,  when  large  quantities  of 
tannin  can  thus  be  introduced  into  the  body 
without  inconvenience.  Of  five  cases  of  chronic 
renal  disease,  tannalbin  produced  good  effects 
in  three.  The  drug  does  not  produce  constipa- 
tion in  the  healthy  alimentary  canal.  The 
author  looks  upon  tannalbin  as  being  the  best 
tannie-acid  preparation  yet  introduced.  If  a 
favourable  action  is  not  soon  noted,  the  dose 
should  be  increased  rapidly,  the  limit  being  30 
grains  as  a  single  dose,  and  150  grains  in  the 
course  of  twenty-four  hours.  It.  may  be  given 
between  or  after  meals  in  water  or  milk. 

TANNIC  ACID.— This  is  an  organic  acid 
obtained  from  nutgall  (U.  S.  Ph.).  It  is  known 
officially  as  tannin,  acidum  tannicum  (U.  S. 
Ph.,  Br.  Ph.,  Ger.  Ph.),  gallotannic  acid,  and 
digallic  acid.  The  term  tannin,  however,  is 
usually  restricted  to  a  class  of  vegetable  prin- 
ciples which  have  many  differences  among 
themselves  in  other  respects,  but  are  alike  in 
causing  a  green  or  bluish-black  colour  or  pre- 
cipitates when  ferric  salts  are  added  to  their 
aqueous  solutions,  and  form  insoluble  com- 
pounds with  albuminous  or  gelatinous  solu- 
tions. The  tannin  derived  from  galls  differs 
from  that  from  other  sources  by  being  con- 
verted into  gallic  acid  on  exposure  to  atmos- 
pheric air  in  a  watery  solution.  Although 
tannic  acid  may  be  prepared  from  cinchona, 
tanacetum,  kino,  uva  ursi,  and  the  barks  and 
roots  of  many  other  plants,  the  official  product 
is  derived  from  the  nutgall.  It  is  prepared 
by  the  action  of  ether  upon  the  powdered  nut- 
gall  and  the  evaporation  of  the  product,  with- 
out, however,  being  an  ethereal  extract. 

Tannic  acid  may  be  derived  from  catechu 
and  kino  of  the  TJ.  S.  Ph.,  and  from  the  elm 
bark  of  the  Br.  Ph.  The  variety  of  tannic  acid 
obtained  from  these  sources  is  known  as  mimo- 
tannic  acid,  which  gives  a  greenish  precipitate 
with  neutral  solutions  of  ferric  salts.  Accord- 
ing to  some  chemists,  an  nnfermentable  sugar 
results  from  its  decomposition,  together  with 
an  acid  a  little  different  from  ordinary  gallic 
acid.  Bael  fruit,  oflRcial  in  the  Br.  Ph.,  is  said 
to  be  efficient  in  diarrhoeal  diseases  beekuse  of 
the  presence  of  tannic  acid.  The  leaves  of  the 
edible  Spanish  chestnut  contain  about  10  per 
cent,  of  tannin.  Among  the  other  substances 
which  contain  tannic  acid  are  the  rind  of  the 
fruit  of  the  pomegranate,  haematoxylon,  kra- 
meria,  larch  bark,  the  rhizome  of  geranium, 


sumach  (in  its  leaves,  stalks,  and  fruit),  the 
winterberry,  and  the  blackberry. 

Tannic  acid  is  a  yellowish  or  yellowish- 
white,  non-crystalline  powder  of  a  highly  as- 
tringent taste.  It  is  nearly  odourless,  or  has 
but  a  faint  odour  of  ether.  Its  formula  is 
CnHioOg.  The  acid  is  soluble  in  water,  less 
soluble  in  alcohol  and  in  ether ;  it  dissolves  in 
about  its  own  bulk  of  glycerin.  In  solution 
it  reddens  litmus  paper  and  it  forms  salts  with 
alkalies.  It  precipitates  albumin,  starch,  and 
gelatin,  and  furnishes,  on  the  addition  of  a 
ferric-chloride  test  solution,  a  bluish-black  pre- 
cipitate or  colour.  Tannic  acid  burns  with  a 
brilliant  flame  and,  heated  on  platinum  foil,  it 
leaves  little  ash. 

The  ready  union  of  tannic  acid  with  the 
vegetable  alkaloids  furnishes  a  test  for  the 
latter  which  is  largely  employed.  It  has  a 
striking  affinity  for  most  of  the  mineral  acids, 
forming  precipitates.  When  it  is  rubbed  with 
potassium  chlorate  an  explosion  of  consider- 
able violence  ensues. 

To  distinguish  tannic  from  gallic  acid,  the 
U.  S.  Ph.  recognises  two  tests.  One  consists 
in  adding  to  an  aqueous  solution  of  tannic  acid 
a  small  quantity  of  calcium-hydrate  test  solu- 
tion. The  production  of  a  pale  bluish-white 
precipitate,  which  is  not  dissolved  on  shaking, 
shows  a  distinction  from  gallic  acid.  The 
other  difference  lies  in  the  fact  that  tannic 
acid  causes  a  precipitate  with  most  alkaloids 
and  bitter  principles  and  with  solutions  of 
starch,  gelatin,  and  albumin. 

When  tannic  acid  is  applied  to  the  skin  or 
mucous  membrane,  in  powder  or  in  solution, 
it  exerts  a  decided  astringent  effect.  This  is 
probably  due  to  a  contraction  of  the  local 
blood-vessels,  and  the  dryness  of  mucous 
membranes  following  its  application  may  be 
attributed  to  the  same  influence.  The  astrin- 
gent action  is  persistent  for  some  time,  and  it 
may  be  that  this  influence  is  enhanced  by  the 
coagulation  of  the  mucus  and  to  the  constric- 
tion of  the  mouths  of  the  mucous  follicles. 
The  local  astringent  influence  of  tannic  acid 
takes  place  on  all  mucous  membranes,  whether 
it  is  actually  applied  cr  taken  internally. 
When  it  is  ingested,  it  probably  forms  an  in- 
soluble compound,  or  one  soluble  with  diffi- 
culty, with  the  acid  juices  of  the  stomach. 
These  compounds,  possibly  albuminates,_  are 
slowlv  acted  upon  by  the  intestinal  secretions, 
and  the  tannic  acid  may  undergo  changes 
which  result  in  the  production  of  gallic  acid. 
Aftei-  its  administration  tannic  acid  appears  in 
the  urine  in  the  form  of  gallic  acid,  and  one 
writer  has  recorded  the  finding  of  pyrogallic 
acid  in  the  renal  excretion  after  the  ingestion 
of  tannic  acid.  Locally,  tannic  acid  is  a  more 
powerful  astringent  than  gallic  acid,  and 
where  it  can  be  directly  applied  it  is  probably 
to  be  preferred,  since  the  bulk  of  opinion 
inclines  to  the  view  that  it  is  converted  into 
its  congener,  gallic  acid,  when  taken  inter- 
nally. 

Individual  susceptibility  differs  as  to  the 
effect  wrought  by  tannic  acid  when  ingested; 
but,  although  there  are  no  fatal  cases  of  poi- 
soning recorded,  there  are  a  number  of  pub- 


TANNIC  ACID 


256 


lished  instances  in  which  it  has  produced  pain 
in  the  stomach  and  abdomen  and,  in  a  few 
cases,  fever  and  a  constitutional  disturbance 
of  a  more  or  less  severe  nature.  It  can  not, 
however,  be  included  among  the  poisonous 
drugs,  although  large  doses  have  caused  a 
purulent  diarrhoea  lasting  for  some  weeks. 

Tannic  acid  is  taken  up  by  the  blood  as 
gallic  acid,  but  the  source  and  manner  of  its 
conversion  are  not  known.  For  this  reason, 
as  stated  before,  tannic  acid  may  be  preferred 
to  gallic  acid  when  it  can  be  directly  applied, 
as  to  the  skin,  to  the  intestines,  or  to  the  lungs 
or  throat  by  spray ;  but  for  general  internal 
use  gallic  acid  should  be  chosen. 

Tannin  is  the  chemical  antidote  of  anti- 
mony, and  where  there  has  been  poisoning  by 
tartar  emetic  it  should  be  given  as  promptly 
as  possible  in  a  strong  solution.  It  forms  a 
relatively  insoluble  precipitate  with  antimony, 
and  with  the  vegetable  poisonous  alkaloids; 
but  the  precipitates  are  slowly  dissolved  in  the 
intestines,  and  the  tannic  acid  administration 
must  therefore  be  accompanied  by  induced 
emeto-oatharsis. 

Locally,  tannin  has  been  recommended  in  a 
host  of  ailments.  As  a  local  astringent,  it 
may  be  used  whenever  any  drug  of  its  class  is 
indicated.  Trousseau  praised  its  use  in  the 
treatment  of  chronic  coryza,  in  the  form  of  a 
finely  pulverized  powder  used  as  a  snuff.  A 
snuff  containing  3  per  cent,  of  tannin  is  also 
said  to  abort  an  impending  coryza.  In  epis- 
taxis  its  astringent  action  may  control  the 
hsemorrhage.  Good  results  have  been  ob- 
tained in  the  treatment  of  sore  nipples  by  using 
a  1-per-oent.  solution.  Tannin  in  solution, 
in  varying  mild  strengths,  has  been  success- 
fully employed  in  excoriations  about  the  anus 
and  scrotum,  in  fissures  of  the  anus,  and  in 
hmmorrhoids.  Suppositories  of  tannin  are  of 
particular  value  in  the  last-named  ailment, 
especially  when  the  piles  are  irritated  or  in- 
flamed. They  become  reduced  in  size,  if  at  all 
susceptible  to  the  action  of  astringents,  and 
may  completely  disappear.  Prolapse  of  the 
rectum  has  been  treated  in  the  same  way  with 
good  results.  Tannin  as  part  of  a  gargle  has 
proved  valuable  in  cases  of  hypertrophy  or 
relaxation  of  the  uvula,  and  in  acute,  non-ex- 
udative inflammatory  conditions  of  the  phar- 
ynx. Hypertrophied  tonsils,  when  not  acutely 
inflamed,  may  be  reduced  in  size  in  a  similar 
manner  or  by  the  use  of  the  glyoerite  of  tannin, 
applied  with  a  brush  after  a  cleansing  of  the 
affected  mucous  membrane.  In  the  treatment 
of  chronic  or  acute  inflammation  of  the  eye- 
lids tannin  has  been  employed  with  alleged 
satisfaction.  Druitt  praised  its  use  in  the 
form  of  powder  or  the  glycerite  in  the  treat- 
ment of  aphthous  ulcers  of  the  mouth  and  of 
stomatitis  of  whatever  origin. 

[Dr.  M.  A.  Veeder,  of  Lyons,  N.  Y.  (Medical 
Record,  March  28,  1896),  reports  a  rebellious 
case  of  extensive  suppurating  sinuses  cured 
with  a  strong  solution  of  tannin  after  various 
other  applications  had  failed.  At  first  a  mod- 
erately strong  solution  was  tried  in  one  of  the 
sinuses  in  the  arm ;  it  acted  so  satisfactorily 
that  its  strength  was  increased  until  it  was 


nearly  a  saturated  solution  and  the  entire  tract 
of  the  cavity  was  filled  with  it.  The  immedi- 
ate effect  was  to  coagulate  the  pus  into  a  cheesy 
mass,  which,  when  the  parts  were  squeezed, 
came  out  of  the  various  openings  in  the  form 
of  long  worms.  All  this  material  was  simply 
washed  out  with  plain  water  and  there  was  no 
longer  any  purulent  secretion  whatever,  a  clear 
fluid  only  appearing,  and  the  sinuses  and  cavi- 
ties healed  very  kindly  and  with  great  rapid- 
ity. The  interior  of  the  abscess  cavity  and 
sinuses,  in  short,  says  Dr.  Veeder,  was  simply 
"  tanned."] 

Vesical  catarrh  is  said  to  have  yielded  to 
daily  injections  of  tannin,  of  a  strength  of 
3  per  cent.,  when  other  treatment  had  failed  to 
cure.  I  u  chronic  urethritis  in  men  and  in  ely Iri- 
tis of  gonorrhcsal  or  other  character,  injections 
and  douches'  have  resulted  in  cure.  For  the 
former,  the  glycerite  of  tannin  or  a  10-per- 
cent.' solution  has  been  used ;  for  the  latter,  a 
powder  containing  equal  parts  of  alum  and 
tannin  is  employed.  A  teaspoonful  of  this 
powder  dissolved  in  a  quart  of  water  and  used 
as  a  douche  is  equal  to  any  other  means  of 
treating  gonorrhoeal  elytritis,  when  combined 
with  the  other  necessary  hygienic  and  thera- 
peutic nieasures.  When  tannin  forms  a  part 
of  the  medicating  agent  of  a  douche  for  a 
pregnant  woman,  however,  its  percentage  must 
be  reduced,  because  of  the  possibility  of  evok- 
ing contractions  in  the  muscular  layers  of  the 
cervix.  Actual  abortion,  it  is  true,  has  prob- 
ably never  been  called  forth  by  the  drug ;  yet 
the  individual  susceptibility  of  gravid  women 
varies  so  greatly  that  due  caution  should  be 
observed.  In  ordering  a  douche  of  alum  and 
tannin  for  a  pregnant  woman  with  gonorrhoea, 
the  proportion  of  1  part  of  tannin  to  4  or  5 
parts  of  alum  is  a  safe  one  ;  or,  if  one's  fear  of 
cervical  contraction  should  have  a  clinical 
foundation,  the  tannin  may  be  omitted,  de- 
spite its  virtue  in  blennorrhagic  elytritis.  It 
is  doubtful  if  the  tannic-acid  treatment  of 
acute  gonorrhcsal  urethritis  in  men  should  be 
recommended.  Although  it  still  has  advo- 
cates, it  has  been  unquestionably  superseded. 

Before  plastic  surgery  on  the  genital  organs 
of  women  had  reached  its  present  develop- 
ment, prolapsus  uteri,  proctocele,  and  cystocele 
were  frequently  treated  by  means  of  tampons 
soaked  in  a  saturated  solution  of  tannic  acid, 
and  good  results  were  no  doubt  frequently 
obtained.  Very  often  in  these  cases  it  is  ad- 
visable to  try  douches  of  an  astringent  charac- 
ter before  resorting  to  surgical  measures,  for 
by  these  innocuous  means  the  symptoms  may 
sometimes  be  relieved  and  an  operation 
avoided. 

Tannin  has  been  praised  in  some  affections 
of  the  skin  in  which  a  local  astringent  action 
is  desired.  Ringer  advised  its  use,  in  the 
form  of  the  glycerites,  in  cases  of  eczema.  He 
asserts  that  a  specially  valuable  result  is  ob- 
tained in  the  early  stages  of  the  disease,  when 
the  skin  is  red  and  swollen  and  exudation  is 
free  {Practitioner,  i).  He  alleges  that  by  its 
use  the  itching  and  burning  are  subdued  and 
that  the  irritation  of  the  skin  by  scratching  is 
thus  avoided.     Impetigo   and    intertrigo   are 


257 


TANNIC  ACID 


said  to  have  yielded  to  the  use  of  tannic  acid 
in  an  ointment.  The  drug  is  usually  a  com- 
ponent in  preparations  intended  to  allay 
hyperidrosis  of  the  hands  and  feet,  and  it  has 
been  recommended,  in  a  1-per-cent.  solution, 
in  the  treatment  of  offensive  axillary  sweating. 
Tannin  has  been  used,  in  ointment  form,  for 
all  excoriations  and  abrasions  of  the  skin,  par- 
ticularly where  they  have  been  kept  up  by 
irritating  discharges  from  neighbouring  organs 
or  lesions.  It  has  also  been  recommended  in 
the  treatment  of  chilblains,  and  is  probably 
as  valuable  as  most  other  remedies  used  for 
the  purpose. 

Tannic  acid  has  been  used  in  the  treatment 
of  bii/rns  with  good  results,  it  is  alleged,  sub- 
duing pain  and  aiding  in  the  formation  of 
granulations.  A  solution  of  the  acid  in  a 
strength  of  1  to  4  in  tincture  of  benzoin  is  said 
to  prevent  the  formation  of  pustules  in  variola. 
As  a  vermifuge,  tannin  has  some  reputation  in 
the  treatment  of  threadworms  in  children. 
For  this  purpose  it  may  be  injected  into  the 
rectum  in  solution. 

As  a  styptic  by  internal  administration, 
tannic  acid  is  widely  known.  It  was  first 
used  as  a  haemostatic  agent  in  menorrhagia 
and  subsequently  in  all  forms  of  uterine 
hminorrhage  whether  of  functional  or  organic 
origin.  It  is  to  be  recommended  for  these 
conditions  only  when  they  are  not  otherwise 
controllable.  In  passive  haemorrhages  from 
the  stomach  and  intestines  its  constricting  and 
hsemostatic  properties  have  been  called  upon 
to  allay  bleeding.  Its  use  is  favourably  com- 
mented upon  in  cases  of  hematuria,  even  when 
this  condition  is  dependent  upon  organic 
change.  In  the  hmmoptysis  of  pulmonary 
tuberculosis  its  employment  in  a  spray  is  some- 
times of  benefit,  and  in  oases  of  hcemophilia 
tannin  may  be  used  when  other  hfemostatic 
agents  do  not  accomplish  the  desired  result. 

As  a  local  hcemostatic,  as  in  the  nose,  in  the 
rectum,  or  applied  to  bleeding  varicose  veins 
or  to  punctured  wounds  of  any  kind,  it  is  valu- 
able, though  probably  interior  to  some  other 
agents.  It  may  be  used  in  the.se  instances  in 
the  form  of  styptic  collodion  or  in  a  concen- 
trated aqueous  solution. 

[Dr.  Roswell  Park,  of  Buffalo  (Medical  News, 
November  16,  1895),  has  called  attention  to  a 
preparation  made  by  mixing  antipyrine  and 
tannic  acid  in  solution,  by  which  there  is  pre- 
cipitated an  intensely  agglutinative  and  co- 
hesive substance  which  is  the  best  styptic  for 
certain  purposes  that  he  knows  of.  This  com- 
bination he  first  resorted  to  in  a  case  of  appar- 
ently intractable  haemorrhage  after  the  removal 
of  adenoid  tissue  from  the  vault  of  the  phar- 
ynx, to  which  he  was  called  in  consultation. 
The  surgeon  in  attendance  happened  to  have 
?t  hand  a  bottle  of  alcoholic  solution  of  tannin, 
while  Dr.  Park  was  provided  with  antipyrine 
in  powder.  The  case  being  urgent,  he  sug- 
gested the  combination  of  the  two  styptics,  and 
added  the  dry  powder  to  the  solution.  To  the 
surprise  of  both  gentlemen,  there  was  formed 
at  once  a  gummy  mass,  at  first  fiocoulent, 
which  quickly  cohered,  the  result  being  a  com- 
bination the  adhesiveness  of  which  quite  aston- 


ished them.  A  small  sponge  dipped  into  the 
fiuid  containing  this  material  in  suspension 
was  inserted  into  the  post-nasal  space,  and  the 
hsemorrhage  was  instantly  checked,  not  to  re- 
cur. Dr.  Park  has  since  experimented  with 
these  materials,  and  has  found  that  they  may 
be  united  in  almost  any  proportion  with  the 
formation  of  the  gummy  mass.  He  suggests 
that  the  substances  be  mixed  in  proportion  to 
the  emergency  of  the  case  and  to  the  desire  for 
little  or  much  of  the  resulting  compound.  It 
is  possible,  he  says,  by  adding  strong  solutions, 
or  by  pouring  the  powder  of  one  into  the  solu- 
tion of  the  other,  to  precipitate  so  much  of  the 
agglutinative  compound  as  to  make  a  gum  that 
may  be  placed  about  the  margin  of  bleeding 
bone— for  instance,  in  operations  upon  the  cra- 
nium. Or  a  small  piece  of  sponge  or  cotton 
sopped  in  this  material  may  be  forced  into  a 
tooth-socket,  or  in  various  other  ways  its  use 
may  be  made  to  result  in  benefit  and  satisfac- 
tion. There  is  but  one  attendant  difficulty — 
it  is  so  remarkably  cohesive  that  when  the  time 
comes  for  detachment  or  separation  of  the  tam- 
pon it  is  difficult  to  remove  it.  It  may  be  even 
necessary  to  wait  a  sufficient  time  for  the  for- 
mation of  granulations  and  separation  by  nat- 
ural processes.] 

By  internal  administration,  tannin  is  said 
to  combat  successfully  cases  of  atonic  dyspep- 
sia. In  diarrhoeas  in  which  no  active  infiam- 
matory  condition  is  present  it  is  in  frequent 
use,  and  usually  is  an  element  in  the  diar- 
rhoea and  cholera  mixture  sold  in  the  shops. 
If  the  lesion  is  in  the  lower  part  of  the  intes- 
tinal tract,  enemata  of  tannin  are  efficient  in 
chronic  diarrhoeas  and  dysentery.  It  has  been 
given  internally  for  night  sweats,  bronchitis, 
and  p^^^ms,  although  in  the  last-named  dis- 
ease its  reputation  rests  purely  upon  theoreti- 
cal grounds.  The  allegation  once  made  for 
the  drug  that  it  diminished  the  albumin  in 
albuminuria  has  not  been  substantiated  by 
further  investigation. 

In  bacteriological  work,  tannin  mixed  with 
sulphate  of  iron  has  been  employed  by  Lofder 
for  the  staining  of  the  flagella  of  typhoid  fever 
and  cholera  bacilli.  In  the  arts,  as  is  well 
known,  it  is  used  to  convert  hide  into  leather. 

During  the  epidemic  of  cholera  in  Italy  in 
1884  Dr.  A.  Cantani  began  the  use  of  entero- 
clyses  of  tannin  in  the  treatment  of  this  dis- 
ease. His  procedure  was  to  inject  into  the 
intestinal  canal  of  all  patients,  severely  or 
mildly  ill,  from  2  to  4  pints  of  a  1-per-cent. 
solution  of  tannin  in  boiled  water.  The  tem- 
perature of  the  solution  was  from  100°  to  104° 
F.,  and  the  fluid  was  allowed  to  run  into  the 
intestine  gently  from  a  height  of  from  three 
to  six  feet.  This  procedure  was  repeated  sev- 
eral times  daily  with  results,  according  to  the 
statistics  of  Cantani  and  others,  that  were  de- 
cidedly encouraging.  The  enemata  were  begun, 
in  the  first  series  of  cases,  when  stubborn  vomit- 
ing which  could  not  be  controlled  by  opium 
had  set  in.  Subsequently  the  enteroclyses  were 
liegun  as  soon  as  any  symptoms  of  cholera 
manifested  themselves,  and  in  these  cases, 
sometimes  after  one  treatment,  the  diarrhoea 
and  the  vomiting  ceased. 


TANNIGEN 
TANNIGBNE 


258 


The  advantages  alleged  by  Cantani  were 
based  on  bacteriological  and  clinical  evidence. 
He  found,  in  conjunction  with  other  observers, 
that  the  exposure  of  pure  cultures  of  cholera 
bacilli  to  a  1-per-oent.  solution  of  tannin  at  a 
temperature  of  103°  P.  for  an  hour  and  a  half 
killed  the  bacilli  and  rendered  subsequent 
inoculations  of  gelatin  or  bouillon  from  the 
culture  experimented  with  sterile.  A  half-per- 
cent, solution  of  tannin  accomplished  the  same 
result  in  six  hours.  Since  tannin  is  innocuous 
to  man,  it  therefore  formed  the  most  valuable 
antiseptic  agent  for  use  against  the  cholera 
bacilli.  By  employing  the  solution  in  the 
manner  indicated,  Cantani  believes  that  fre- 
quently the  ileo-csecal  valve  is  forced  open  and 
the  diseased  small  intestine  directly  attacked.^ 
He  maintains  that  the  fluid  reaches  the  small 
intestine,  not  only  by  the  pressure  it  exerts, 
but  by  the  antiperistaltic  action  evoked  by  the 
column  of  water.  Farther,  he  argues,  the  con- 
striction of  the  mucous  membrane  determined 
by  the  tannin  diminishes  the  absorption  by  the 
intestine  of  ptomaines  and  the  other  biological 
poisonous  products  of  the  bacilli  present,  at  the 
same  time  emptying  the  intestine  of  its  noxious 
contents.  He  modestly  adds  that,  even  if  the 
enemata  do  not  prevent  the  accumulation  of 
toxic  materials,  at  least  they  do  not  foster  it. 
He  lays  stress,  finally,  upon  the  inability  of  the 
comma  bacillus  to  thrive  in  an  acid  medium 
and  gives  the  assurance  that  the  return  flow  of 
the  fluid  invariably  reddens  blue  litmus  paper. 
By  the  employment  of  this  method,  after  each 
defecation  or  diarrhoeal  stool,  Cantani  asserts, 
the  mortality  record  is  materially  lowered  ;  he 
adds  that  the  earlier  the  treatment  is  begun 
the  better  are  the  results,  that  the  heat  of  the 
solution  and  the  absorption  of  fluid  are  bene- 
ficial to  the  patient  in  stimulating  the  heart, 
the  lungs,  and  the  nervous  system,  and  that 
frequently  patients  so  treated  do  not  go  into 
the  algid  stage.  He  maintains  even  that  after 
the  dreaded  algidity  has  appeared  life  may  be 
saved  in  some  cases  by  the  employment  of  the 
tannin  enemata.  He  sometimes  adds  from  20  to 
30  drops  of  laudanum  to  the  solution  injected, 
which  may  be  made  with  inCasion  of  chamo- 
mile instead  of  water.  The  rectal  treatment 
should  be  accompanied  by  general  stimulation 
and,  when  necessary,  by  subcutaneous  or  intra- 
venous infusion  of  hot  sterilized  water  (100"  to 
103°  P.)  containing  in  solution  3  per  cent,  of  bi- 
carbonate of  sodium  and  4  per  cent,  of  chloride 
of  sodium.  Animal  experimentation  seems  to 
bear  out  Cantani's  belief  that  the  function  of 
the  tannin  is  to  form  insoluble  tannates  with 
the  toxic  materials  in  the  intestine.  {Die  Er- 
gebnisse  der  Gholera-Behandlung  mittelst  Hy- 
podermoclyse  und  Enteroclyae  wdhrend  der 
Epidemie  von  1884  *™  Italien,  von  A.  Cantani, 
Leipzig,  1886;  Die  Cholera-Behandlung,  von 
A.  Cantani,  Therapeutische  Monatshefte,  June, 
1888 ;  Berliner  klinische  Woehenschrift,  Sep- 
tember 13,  1893.) 

Von  Generisoh  does  not  believe  that  the 
good  results  of  Cantani's  treatment  resulted 
from  the  presence  of  tannic  acid  in  the  fluid 
used,  but  thinks  that,  with  sufficient  pressure, 
the  ileo-cajcal   valve  can  always  be  opened. 


He  therefore  proposes  a  modification  of  Can- 
tani's method  by  passing  into  the  rectum  a 
large  quantity  of  water  from  a  height  of  from  3 
to  4  feet.  He  asserts  that  after  allowing;  from 
15  to  30  pints  to  flow  into  the  rectum,  it  will 
appear  at  the  mouth,  thus  washing  out  the 
entire  alimentary  tract.  Although  this  process 
of  diaclysm  (or  diaclysis)  is  not  attractive,  the 
author  asserts  that  the  cleansing  process  is  the 
main  result  desired.  He  employs  tannin  in  a 
strength  of  1  or  3  parts  to  1.000,  but  believes 
that  a  salt  solution  or  any  indifferent  fluid 
would  be  equally  efficient  (Deutsche  medicin- 
ische  Woehenschrift,  1893,  No.  41). 

Tannin  may  be  administered  in  the  form  of 
pills,  capsules,  or  troches.  Its  dose  is  from  3 
to  10  grains.  When  given  for  hsemorrhage, 
it  is  best  administered  in  aqueous  solution, 
sweetened  and  flavoured,  or  in  an  emulsion. 
For  external  employment,  a  watery  solution  of 
from  3  to  10  grains  to  the  ounce  may  be  used. 
A  solution  containing  3  parts  of  tannin  and  1 
part  of  gallic  acid  is  more  astringent  than  one 
of  tannin  alone.  As  solutions  of  the  iron  (ferric) 
salts  are  precipitated  by  tannin,  they  must  not 
be  given  at  the  same  time. 

Tannin  bougies,  cereoH  cum  acido  tannieo, 
are  bougies  3^  inches  in  length,  containing  J  of 
a  grain  of  tannic  acid  made  up  with  syrup  and 
gum  arable. 

Collodium  stypticum  (U.  S.  Ph.,  Br.  Ph.) 
contains  30  parts  by  weight  of  tannic  acid,  5 
of  alcohol,  35  of  ether,  and  of  collodion  a  suf- 
ficient quantity  to  make  100.  This  is  a  modi- 
fication of  the  original  styptic  colloid  of  the  late 
Sir  Benjamin  Ward  Richardson,  of  London, 
which  did  not  contain  sufficient  tannin  for  the 
required  purposes.  Styptic  collodion  may  be 
applied  to  shaded  or  wounded  surfaces  to  pre- 
vent the  admission  of  air.  The  ether  and 
alcohol  evaporate,  leaving  a  stifE  coating  which, 
if  the  wound  is  aseptic,  forms  an  excellent  pro- 
tective dressing.  It  may  be  applied  with  a 
camel's-hair  brush  or  with  cotton  saturated 
with  the  solution.  For  special  purposes,  mor- 
phine, carbolic  acid,  or  other  antiseptic  agents 
may  be  incorporated  with  it.  For  small,  bleed- 
ing wounds  or  for  ulcerated  surfaces  it  forms 
a  most  efficient  coating.  It  must  be  kept  away 
from  a  flame,  since  the  vapour  of  ether  may 
take  fire. 

Glyeerite,  or  glycerine,  of  tannin,  glyceritum 
acidi  tannici  (U.  S.  Ph.),  glycerimim  acidi 
tannici  (Br.  Ph.),  contains  30  parts  of  tannin 
and  80  of  glycerin,  and  is  prepared  by  heating 
the  two  substances  over  a  water  bath.  It  is 
the  most  valuable  preparation  of  tannin  for 
external  use.  It  may  be  applied  with  benefit 
to  suppurating  surfaces  of  small  extent  and  is 
of  use  in  chronic  ozwna,  in  chronic  otitis  media, 
and  in  chronic  relaxation  of  the  pharyngeal 
vault.  It  makes  a  good  dressing  for  irntating 
cutaneous  eruptions^  and,  applied  to  the  nip- 
ples during  the  late  months  of  pregnancy,  will 
frequently  prevent  the  development  of  fissures 
of  the  nipples  during  the  nursing  period.  In- 
ternally, it  may  be  administered  for  any  of  the 
purposes  for  which  tannin  is  used,  in  doses  of 
from  10  to  40  minims. 

Suppositories  of  tannic  acid,  suppositoria 


259 


TANNIGBX 
TANNIGENE 


acidi  iannici  (Br.  Ph.),  contain  each  3  grains 
of  tannic  acid  and  12  grains  of  cacao  butter. 
The  suppositoria  acidi  tannici  cum  sapone  (Br. 
Ph.),  suppositories  of  tannic  acid  and  soap, 
contain  each  3  grains  of  tannic  acid,  10  of  glyo- 
erite  of  starch,  8  of  curd  soap  in  powder,  and 
7f  of  starch  powder.  Although  the  amount  of 
tannin  is  small  for  rectal  use  in  an  adult,  the 
suppositories  are  used  in  cases  oi  fissure  of  the 
anus  and  prolapse  of  the  rectum.  They  are 
useful  also  in  the  treatment  of  internal  hiem- 
orrhoids. 

Tannin  troches,  or  lozenges,  trochisei  acidi 
tannici  (U.  S.  Ph.,  Br.  Ph.),  are  used  in  relaxed 
conditions  of  the  mucous  memliranes  of  the 
mouth,  throat,  and  larynx,  and  to  allay  coughs 
arising  from  these  states.  In  mild  cases  of 
angina  they  may  be  employed,  allowing  them 
to  dissolve  slowly  in  the  mouth.  In  diarrhoeas, 
after  washing  out  of  the  rectum,  they  may  be 
administered  for  their  astringent  effect.  The 
U.  S.  troches  contain  each  about  1  grain  of  tan- 
nic acid,  the  British  each  |  grain.  The  troches 
of  the  two  pharmacopoeias  differ  also  in  the 
vehicles  and  sweetening  elements. 

Ointment  of  tannic  acid,  unguentum  acidi 
tannici  (U.  S.  Ph.)  contains  20  parts  of  tannin 
to  80  of  benzoinated  lard.  It  is  very  useful  for 
local  application  in  the  treatment  of  external 
or  prolapsed  hcemorrhoids,  sonetimes  produc- 
ing a  cure  by  causing  contraction  of  these 
varicosities.  Applied  to  indolent  ulcers,  it  some- 
times induces  granulations. 

Albuminate  of  tannin. — See  Tannalbin. 

Aluminum  tannate^  aluminii  tannas,  has 
been  recommended  for  its  efSoacy,  in  aqueous 
solution,  in  the  treatment  of  acute  gonorrhoea. 
The  drug  is  not  readily  soluble  in  water,  how- 
ever, and  cannot  be  i-ecommended. 

Bismuth  tannate,  bismuthi  tannas,  is  a 
light-yellow  powder,  insoluble  in  water  and 
tasteless.  It  contains  53  per  cent,  of  bismuth 
oxide  and  47  per  cent,  of  tannin.  It  is  astrin- 
gent in  its  effect  and  has  been  employed  in 
diarrhoeas,  gonorrhoea,  leucorrhoea,  and  puru- 
lent inflammations  of  the  conjunctiva. 

Cannabene  tannate  is  a  yellowish-brown 
powder,  insoluble  in  water  and  in  ether,  slightly 
soluble  in  alcohol.  It  has  an  odour  which  is 
not  entirely  unpleasant  and  a  bitter  taste.  It 
is  said  to  be  the  tannate  of  a  glucoside.  It  is 
hypnotic  in  its  effect,  though  not  reliable.  It 
is  said  to  be  devoid  of  the  exciting  effects  of 
the  extract  of  cannabis  indica.  The  dose  is 
from  4  to  20  grains. 

Iron  tannate,  ferri  tannas,  is  prepared  by 
precipitating  cold  solutions  of  ferric  salts  with 
tannin.  A  mixture  of  ferrous  salts  and  tannin, 
exposed  to  atmospheric  influences,  will  also 
deposit  ferric  tannate.  It  occurs  in  a  black  or 
bluish-black  powder  which  is  easily  decomposed 
by  the  mineral  and  the  stronger  organic  acids. 
It  has  been  used  in  chlorosis  and  ancemia  in 
amounts  of  from  8  to  30  grains  in  a  day  in  pill 
form.  Ink  is  a  watery  solution  of  ferric  gallo- 
tannate,  and  is  popularly  supposed  to  be  a 
remedy  for  ringworm. 

Mercury  tannate,  hydrarpyri  tannas,  is 
odourless  and  tasteless  and  is  insoluble  in 
ordinary  media.    Acted  upon  by  alcohol  or 


water,  however,  it  liberates  tannic  acid.  It 
may  be  prepared  by  precipitating  a  concen- 
trated solution  of  tannic  acid  and  oxygenated 
mercurous  nitrate,  or  by  rubbing  the  two  sub- 
stances together.  It  was  first  suggested  by 
Lustgarten  as  a  substitute  for  other  mercuric 
preparations  in  the  treatment  of  syphilis  (Cen- 
tratblatt  fur  die  gesammte  Therapie,  ii ;  New 
York  Medical  Journal,  March,  1892).  Although 
it  contains  50  per  cent,  of  metallic  mercury,  it 
is  alleged  for  it  that  its  special  advantage  is  that 
it  is  not  affected  by  the  acid  juices  of  the  stom- 
ach, but  remains  stable  until  it  comes  in  contact 
with  the  alkaline  secretions  of  the  small  intes- 
tine. Within  twenty-four  hours  it  appears  in 
the  urine  as  mercury  and  is  absorbed  from  the 
intestine  in  minute  globules  of  the  metal.  It 
does  not  salivate  or  cause  gastro-intestinal  dis- 
turbance. It  may  be  given  in  doses  of  3  grains 
thrice  daily  to  an  adult,  increasing  to  5  grains 
until  from  100  to  150  grains  are  being  taken. 

Potassium  tannate  has  been  proposed  as 
a  substitute  for  the  sodium  salt,  but  it  presents 
no  special  advantages  and  is  rarely  used. 

Quinine  tannate  contains  40  per  cent,  of 
quinine.  It  is  a  very  insoluble  salt  and  has 
but  from  i  to  J  the  power  of  the  sulphate.  It 
is  very  slowly  dissolved  in  the  stomach  and  has 
little  thermolytio  influence.  It  is  of  value  prin- 
cipally in  nervous  affections  or  as  a  substitute 
for  the -cinchona  bark.  Its  tastelessness,  or, 
rather,  lack  of  bitterness,  may  be  attributed  to 
its  difEculty  of  solution,  and  renders  it  suit- 
able for  administration  to  children  in  malarial 
diseases.  The  dose  is  three  times  that  of  the 
sulphate.  It  has  been  recommended  for  whoop- 
ing-cough. Tablets  made  up  with  chocolate, 
each  containing  1  grain  of  the  drug,  are  in  the 
market. 

Sodium  tannate,  sodii  tannas,  is  prepared 
by  dissolving  75  grains  of  tannic  acid  in  5 
oz.  of  water  and  saturating  the  solution  with 
bicarbonate  of  sodium.  It  has  been  used  in 
albuminuria  in  doses  of  -J  oz.  given  every  two 
hours ;  but  it  not  only  failed  to  relieve  the 
condition,  but  possibly  caused  death  from  urm- 
min  (Centralblatt  fiir  die  gesammte  Therapie,  i). 
Samuel  M.  Brickner. 

TANNIGEN,      TANNIGENE,     CHs 

(CHs. 00)209,  is  an  acetic-acid  ester  of  tannin  in 
which  two  molecules,  each,  of  three  hydroxyl 
groups  are  replaced  by  one  of  acetyl.  It  oc- 
curs in  the  form  of  a  yellowish-gray  powder, 
without  odour  or  taste.  It  is  insoluble  in  cold 
water  and  in  dilute  acids,  but  dissolves  freely 
in  cold  alcohol  and  in  dilute  alkaline  solution. 
The  experiments  of  Meyer,  who  first  produced 
the  drug,  show  that  its  influence  on  animals  is 
not  injurious.  It  produces  no  gastric  disturb- 
ances, and  is  well  tolerated  even  in  large  doses. 
Tannigene  passes  unchanged  into  the  small 
intestine,  where  it  is  .split  up  into  tannic  acid 
and  acetate  of  potassium.  It  has  been  found 
as  such  in  the  faeces,  so  it  is  probable  that  the 
alkaline  juicesof  the  intestines  do  not  break 
up  all  the  tannigene  ingested. 

Escherich  (Therapeutische  Woehenschrift, 
March  9, 1896)  finds  that  even  when  tannigene 
is  excreted  in  the  feces  some  astringent  effect  is 


TANNIN 
TAR 


260 


exerted  upon  the  intestinal  mucous  membrane. 
When  there  is  increased  secretion,  however, 
and  the  intestinal  juices  are  thoroughly  alka- 
line, Escherich  believes  that  tannigene  is  al- 
ways split  up  into  its  elements  and  exerts  an 
elective  influence  upon  those  places  where  the 
exudation  is  most  intense — that  is,  where  the 
disease  is  most  marlced.  He  finds  its  most  use- 
ful application  in  cases  where  the  lower  part 
of  the  intestinal  canal  is  affected  by  a  non- 
acute  inflammatory  process,  and  alleges  that 
nutrition  and  absorption  are  fostered  by  the 
diminished  secretion  of  mucus.  In  the  same 
article  the  author  lays  stress  upon  the  disin- 
fecting properties  of  tannigene  and  on  the  for- 
mation of  insoluble  compounds  with  alkaloids 
and  toxines,  as  lending  to  its  virtues. 

The  therapeutic  indications  for  the  use  of 
tannigene  include  the  summer  diarrhcea  of  chil- 
dren and  subacute  and  chronic  diarrhosasocoar- 
ring  in  the  ooavse  of  pulmonary  phthisis,  and 
dysentery.  Some  writers  have  professed  to  have 
treated  successfully  acute  enteritis  and  gastro- 
enteritis with  it,  but  the  weight  of  evidence 
seems  to  be  in  favour  of  its  employment  in 
subacute  and  chronic  intestinal  disturbances. 
Tannigene  is  said  to  exert  a  beneficial  influ- 
ence upon  the  stools  in  subacute  enteritis  as 
early  as  the  second  day  of  its  use;  and  in 
chronic  diarrhoeas,  although  it  is  not  so  rapidly 
effective,  the  faeces  become  formed  and  are  free 
from  mucus  early  in  the  treatment.  Dietetic 
instructions  must,  of  course,  be  simultaneously 
observed. 

The  good  results  from  the  use  of  tannigene 
do  not  seem  to  be  confined  to  the  intestinal 
mucous  membrane.  Cases  have  been  reported 
of  gastro-enteritis  in  which  tannigene  is  said 
to  have  stopped  the  vomiting  after  one  or  two 
doses.  The  drug  has  also  been  employed  in 
hay  fever  with  alleged  good  results.  It  is  said 
to  be  excellent,  used  as  a  snuff,  in  acute  and 
chronic  coryza.  Insufflations  of  tannigene 
have  been  used  in  acute  otitis  media,  and  the 
antiseptic  and  astringent  effect  of  the  drug 
relieved  the  existing  symptoms.  Good  re- 
sults have  been  reported  from  the  applica- 
tion of  a  3-per-cent.  solution  of  tannigene  in  a 
5-per-cent.  solution  of  phosphate  of  sodium  in 
the  treatment  of  acute  and  chronic  pharyngitis 
and  laryngitis.  It  is  said  that  a  disagreeable 
taste  has  followed  its  employment  in  these  in- 
stances. 

The  dose  of  tannigene  is  from  3  to  10  grains, 
given  from  three  to  six  times  daily,  the  dose 
varying  with  the  age  of  the  patient.  Escherich 
found  it  advantageous  to  give  a  large  initial 
dose— 15  grains  to  adults,  and  from  5  to  8  grains 
to  children.  It  may  be  administered  in  milk  or 
gruel,  or  taken  dry  on  the  tongue,  followed  by 
a  drink  of  water.  It  may  be  combined  with  a 
salt  of  bismuth  or  with  some  other  insoluble 
intestinal  antiseptic  if  thought  advisable.  (See 
also  AcETYLTANNiN.)— Samuel  M.  Bricknee. 

TANNIN.— See  Tannic  acid. 

TANNOFORM  is  a  condensation  product 
of  tannic  acid  and  formaldehyde,  of  the  for- 
mula CsbHioO.s.  It  is  a  light  reddish-white 
powder,  insoluble  in  water  and  in  acids,  but 


dissolves  in  dilute  alkalies.  It  is  tasteless  and 
odourless.  Advantages  have  been  alleged  for 
it  over  tannic  acid.  It  is  said  to  have  an  in- 
different action  upon  the  gastric  mucous  mem- 
brane and  to  cause  no  irritation  in  the  stomach, 
as  sometimes  happens  when  tannic  acid  is  ad- 
ministered. Since  acids  do  not  dissolve  tanno- 
form,  it  is  not  assimilated  by  the  stomach 
juices,  but  reaches  the  intestinal  canal  un- 
changed, where  it  can  exert  its  action,  which 
is  said  to  be  similar  to  that  of  tannic  acid.  Its 
advocates  allege  that  tannin,  on  the  contrary, 
is  of  harsh,  astringent  taste,  and  forms  insoluble 
precipitates  in  the  stomach  with  albumin,  pep- 
tone, and  gelatin,  thus  rendering  it  impossible 
for  it  to  reach  the  intestines  in  an  active  form. 
They  also  maintain,  what  is  not  strictly  true, 
that  small  doses  of  tannin  corrode  the  gastric 
mucous  membrane,  diminish  the  appetite,  and 
cause  a  sensation  of  weight  and  pain.  These 
disagreeable  effects  are  said  to  be  absent  after 
the  use  of  tannoform.  The  new  drug  may  be 
given  in  cases  of  diarrhoea  and  dysentery,  for 
an  astringent  effect,  in  doses  of  from  5  to  15 
grains  three  times  daily. 

Applied  locally,  tannoform,  it  is  alleged, 
checks  excessive  sweating,  and  it  has  been  used 
with  good  results  in  hyperidrosis  of  the  feet. 
In  this  affection  it  is  said  to  surpass  in  elBcacy 
both  tannic  and  salicylic  acids.  In  the  treat- 
ment of  old  wounds,  ulcers,  and  moist  erup- 
tions, it  may  be  used  pure  in  a  10-per-cent. 
ointment,  or  mixed  with  equal  parts  of  starch 
or  chalk. 

It  has  been  used  in  a  strength  of  1  part  to  4 
parts  of  starch  as  a  dusting  powder  for  soft 
chancres,  and  is  said  to  be  useful  in  the  treat- 
ment of  diabetic  pruritus  vuhw.  As  a  snuff 
in  ozcena,  .tannoform  has  also  been  recom- 
mended. (Therapeutische  Wochenschrift,  May 
10,  1896.)— Samuel  M.  Beickner. 

TANOSAL.— This  is  a  synthetical  tannic- 
acid  ester  of  creosote,  an  amorphous,  dark- 
brown,  very  hygroscopic  powder  having  a  faint 
odour  of  creosote.  On  account  of  its  prone- 
ness  to  deliquesce,  it  can  not  be  dispensed  as  a 
powder.  It  is  on  the  market  in  the  form  of  a 
watery  solution  of  a  definite  strength  and  in 
that  of  pills.  Each  pill  contains  about  5  grains 
of  tanosal,  equivalent  to  3  grains  of  creosote. 
On  account  of  the  ready  solubilitv  of  tanosal, 
it  is  easily  administered  in  water,  and  it  is  not 
irritating  to  sound  mucous  membranes;  yet, 
because  of  its  harsh  taste,  the  solution  should 
be  freely  diluted— a  tablespoonful  with  half  a 
glass  of  sweetened  water. 

Dr.  G.  Kestner,  of  the  civil  hospital  in  MQhl- 
hausen  (cited  in  the  Therapeutische  Wochen- 
schrift, November  22, 1896),  thinks  that  tanosal 
is  better  borne  by  the  digestive  organs  than 
any  other  preparation  of  creosote.  It  seems  to 
be  excreted,  he  says,  neither  unchanged  nor  in 
the  form  of  creosote.  He  has  used  it  in  more 
than  seventy-five  cases.  The  usual  dose  is  a 
tablespoonful  of  the  solution,  three  times  a 
day,  gradually  increased  in  some  cases  to 
double  that  amount.  There  have  been  in- 
stances, he  says,  in  which  patients  have  taken 
as  much  as  nine  tablespoonfuls  in  a  day  with- 


261 


TANNIN 
TAR 


out  any  inconvenience.  In  three  oases  of  tu- 
berculous intestinal  ulceration,  however,  the 
remedy  gave  rise  to  colic  and  diarrhoea,  even 
in  small  doses.  In  many  cases  it  became  dis- 
tasteful after  being  used  for  a  long  time,  but 
generally  the  distaste  was  overcome. 

Among  the  patients  there  were  thirty-three 
with  pulmonary  tuberculosis,  fifteen  with  acute 
bronchitis,  eleven  with  chronic  bronchitis,  one 
with  chronic  broncho-pneumonia,  five  with 
bronchitis  incidental  to  infectious  diseases, 
and  ten  with  simple  catarrh  of  the  throat  and 
bronchi,  and  it  was  in  the  last-mentioned  class 
of  cases  that  the  best  results  were  obtained. 
Reduction  of  the  bronchial  secretion  is  the 
chief  effect  of  tanosal,  and  to  accomplish  such 
reduction  Kestner  thinks  it  at  least  equal  to 
terpene.  Its  action  is  the  more  pronounced 
the  more  recent  the  case,  but  even  in  cases  of 
long  standing  it  diminishes  the  expectoration 
and  the  dyspnoea.  Children,  he  has  found,  re- 
spond to  it  more  readily  than  adults,  and  for 
them  the  amount  to  be  taken  daily  is  commonly 
a  teaspoonful  of  the  solution  for  each  year  of 
age.  In  phthisical  oases,  he  states,  it  acts  as 
well  as  any  other  preparation  of  creosote. 

TANSY,  Tanacetum  vulgare,  is  a  perennial 
herbaceous  plant  indigenous  to  Europe,  but 
naturalized  in  the  United  States.  The  parts 
used  in  medicine  are  the  leaves  and  flowering 
tops.  The  herb  grows  to  the  height  of  from 
two  to  three  feet.  The  leaves  have  a  peculiar 
fragrance,  and  a  bitter,  slightly  acrid,  and  aro- 
matic taste. 

Tansy  has  been  employed  in  the  treatment 
of  intermittent  fever,  as  a  diuretic  and  stimu- 
lant in  rheumatism  and  in  hysteria,  and  the 
seeds  are  recommended  as  a  powerful  anfhel- 
minthic.  The  oil  is. also  an  effective  vermifuge. 
The  drug  is  perhaps  best  known  from  its 
domestic  use  as  an  emmenagogue  and  an  aborti- 
faeient.  Its  action,  however,  either  as  a  stimu- 
lant to  the  menstrual  flow  or  as  an  ecbolic, 
is  extremely  uncertain,  and  grave  symptoms 
have  followed  its  administration.  Death  has 
resulted  even  from  the  ingestion  of  small 
doses — a  drachm — ■oi  the  oil,  yet  as  much  as 
four  drachms  have  been  taken  without  fatal 
effect.  A  case  is  reported  in  which  a  large 
quantity  of  the  infusion,  taken  internally,  pro- 
duced death.  The  toxic  effects  are  abdominal 
pain,  vomiting,  purging,  paralysis ,  of  the  mus- 
cles of  deglutition  and  respiration,  rapid  and 
full  pulse,  convulsions,  coma,  asphyxia,  and 
death. 

The  powder  is  given  in  doses  of  from  30  to 
60  grains.  The  dose  of  the  oil  as  an  emmena- 
gogue is  from  1  to  3  drops.  The  infusion  is 
made  by  steeping  an  ounce  of  the  tops  or  leaves 
in  a  pint  of  water,  and  is  given  in  quantities 
of  1  or  2  oz. — Charles  Jbwett. 

TAPIOCA  is  an  amylaceous  food  obtained 
from  Manihot  utilissima,  indigenous  to  Brazil, 
where  it  is  known  as  the  manioc  plant.  It  is 
cultivated  also  in  the  West  Indies,  where  it  is 
known  under  the  name  of  cassava.  It  is  culti- 
vated in  other  portions  of  tropical  America 
and  in  Africa  as  well.  It  is  perennial,  and 
grows  in  the  form  of  a  bush,  from  six  to  eight 


feet  in  height.  The  roots  are  tubers  of  great 
size,  sometimes  weighing  thirty  pounds.  Prom 
three  to  eight  of  these  tubers  grow  in  a  cluster. 
They  consist  largely  of  starch,  and  are  the 
edible  part  of  the  plant.  Most  varieties  con- 
tain a  bitter,  acrid  juice,  which  is  intensely 
poisonous,  owing  to  the  presence  of  prussio 
acid.  This  is  dissipated  by  washing,  drying, 
and  cooking.  The  starch  obtained  from  the 
tubers  is  ground  by  the  natives,  dried,  and 
again  pulverized  to  form  "  cassava  meal."  The 
tapioca  of  com^meree  is  made  by  heating  the 
meal  on  hot  plates  and  stirring  it  with  an  iron. 
As  the  starch  granules  burst,  a  portion  of  the 
starch  is  converted  into  dextrin,  and  the  whole 
conglomerates  into  small  irregular  masses.  The 
uncooked  starch  is  sometimes  imported  into 
this  country  under  the  name  of  Brazilian  arrow- 
root. Tapioca,  like  arrowroot,  sago,  and  other 
forms  of  simple  starch,  is  used  largely  as  a 
food,  and  is  well  adapted  to  the  needs  of  the 
sick.  Like  them,  it  has  no  medicinal  proper- 
ties.— Floyd  M.  Ckandall. 

TAR  is  a  highly  complex  product  of  the 
destructive  distillation  of  organic  substances 
and  bituminous  minerals,  more  particularly  of 
certain  woods  and  of  coal.  The  commonest 
variety  of  wood  tar,  pix  liguida  {q.  v.),  is  de- 
rived from  conifers,  especially  Pinus  palustris 
(in  this  country),  JPinus  silvestris,  and  Larix 
sibirica  (in  Europe).  It  is  a  thick,  dark-col- 
oured, viscid  liquid,  and  has  an  acid  reaction, 
a  peculiar  empyreumatic  odour,  and  a  bitter 
taste.  It  is  produced  by  distillation  per  de- 
scensum.  It  may  be  described  as  an  impure 
turpentine,  containing,  besides  turpentine,  as 
its  most  important  constituents,  various  sub- 
stances of  the  phenol  group  and  pyroligneous 
acid.  When  it  is  subjected  to  redistillation  in 
stills,  the  "  oil  of  tar "  is  separated  from  the 
pitch. 

Oil  of  tar,  oleum  picis  liguidee,  is  a  volatile, 
oily  liquid,  which  is  more  or  less  colourless  at 
first,  depending  upon  the  amount  of  impurities 
it  contains,  but  gradually  becomes  darker  with 
age,  from  oxidation.  It  has  a  complex  com- 
position, containing  oil  of  turpentine  and 
acetic  acid,  with  the  phenols  and  most  of  the 
empyreumatic  ingredients  of  crude  tar,  which 
it  resembles  in  odour  and  in  general  properties. 
Like  cnide  wood  tar,  the  oil  is  soluble  in  alco- 
hol, in  ether,  in  chloroform,  in  volatile  oils, 
and  in  solutions  of  caustic  alkalis. 

Oil  of  cade,  oleum  cadinum,  oleum  juniperi 
empyreumaticum,  is  an  empyreumatic  wood  tar, 
obtained  by  distillation  per  descensum  from  the 
wood  of  Juniperus  oxycedrus  (Linn.,  Ord.  Co- 
niferce),  a  tree  found  chiefly  in  lands  border- 
ing on  the  Mediterranean.  It  is  thinner  than 
common  wood  tar  (pix  liguida).  black  in  mass, 
but  brown  or  brownish  yellow  in  thin  layers. 
Its  odour  is  pleasanter  than  that  of  the  com- 
mon tar,  which,  however,  in  most  respects  it 
resembles.  Its  taste  is  acrid  and  bitter.  It 
contains  a  large  proportion  of  acetic  acid. 

Oleum  rusci  is  a  tar  obtained  from  the  bark 
or  other  woody  portions  of  Betula  alba,  chiefly 
in  Poland  and  in  adjacent  parts  of  Russia 
proper.    Birch  tar  has  also  been  known   as 


TAR 


262 


"Russian  oil,"  oleum  seu  betuUnum  musco- 
viticum.  The  origin  of  the  terra  oleum  rusci 
is  obscure.  It  has  been  suggested  by  MacEwan 
that  it  is  derived  from  the  Polish  brzoza  (birch), 
which  became  corrupted  and  Latinized  into 
Bniscus  and  Jiuscus. 

The  mode  of  obtaining  the  birch  tar  has 
varied.  At  present  it  is  said  to  be  produced 
by  distillation  per  descensum,  as  was  most  com- 
monly the  case  in  the  past.  All  that  is  now  in 
the  market  is  said  to  be  produced  in  this  way. 
Formerly  it  was  rectified  by  a  second  distilla- 
tion. The  rootlets  and  twigs  were  subjected 
to  dry  distillation  in  crude  olay  retorts  con- 
nected by  wooden  pipes  with  a  receiver  buried 
in  the  ground.  Such  a  rectified  product,  how- 
ever, is  rarely  if  ever  obtainable  at  the  present 
time. 

It  is  a  thick,  brownish-black  liquid,  having 
the  fragrant  odour  that  we  are  familiar  with 
in  Russia  leather.  It  is  said  to  contain  a  larger 
amount  of  pyrocatechia  than  oil  of  cade,  but 
less  pyroligneous  acid,  though  in  its  general 
properties  it  closely  resembles  oil  of  cade. 

Beech  tar,  oleum  fagi,  is  a  wood  tar  similar 
to  oleum  rusci  and  oil  of  cade,  and  is  the  prod- 
uct of  Fagus  silvatica,  or  Fagus  silvestris. 
It  has  been  one  of  the  chief  sources  of  creosote. 
Though  often  mentioned  by  medical  authorities 
abroad,  especially  German,  commercially  the 
name  is  said  to  have  little  significance,  except 
as  a  synonym  for  wood  tar,  or  as  another  name 
for  oleum  rusci.  It  is  stated  on  good  authority 
that  real  beech  tar  does  not  at  the  present  time 
exist  in  the  market.  A  beech  oil  obtained  by 
expression  from  the  fruit  of  the  tree  is  occa- 
sionally met  with,  and  is  also  known  as  oleum 
fagi.  '  It  is  a  bland  oil  of  a  yellow  colour,  has 
a  slight  odour  and  a  mild  taste,  and  resembles 
almond  oil. 

Coal  tar,  pixliquida  lithanthracis,  pix  liqui- 
da  e  liquo  fossili,  is  a  semi-liquid,  viscid  sub- 
stance, black  in  mass,  greenish-black  in  thin 
layers,  of  a  strong,  penetrating  odour,  and  but 
slightly  acid  or  alkaline  reaction.  It  is  one 
of  the  by-products  of  the  manufacture  of  illu- 
minating gas  from  bituminous  coal.  Its  com- 
position is  very  complex,  including  carbolic 
acid  in  large  quantity,  together  with  rosolic 
acid;  the  alkaline  bases  ammonia,  aniline, 
quinoline,  and  pyrrhol ;  the  neutral  hydrocar- 
bons benzol,  toluol,  oresol,  naphthol,  naphtha- 
line, chrysene,  anthracene,  cumene,  and  many 
others.  The  neutral  substances  constitute  the 
greater  portion  of  it. 

In  its  physiological  as  well  as  in  its  thera- 
peutical action,  tar  is  closely  allied  to  turpen- 
tine, though  certain  of  its  effects,  due  to  the 
large  amount  of  carbolic  acid  or  other  phenols 
which  it  contains,  are  peculiar  to  it.  To  in- 
sects and  other  low  forms  of  life  it  is  destruc- 
tive, and  in  large  doses  it  is  toxic  to  the  human 
organism.  In  moderate  doses  wood  tar  is  an 
excitant,  increasing  the  rapidity  of  the  pulse 
and  stimulating  the  secretions  of  the  lungs, 
kidneys,  and  skin.  If  it  is  given  in  larger  doses, 
the  appetite  is  impaired,  with  more  or  less 
serious  derangement  of  digestion,  headache, 
and  manifestations  of  general  intoxication. 
These  symptoms  have  been  observed  more  par- 


ticularly after  the  external  use  of  the  drug. 
When  it  is  freely  applied,  absorption  may  take 
place  in  sufficient  degree  to  give  rise  to  alarm- 
ing symptoms  that  correspond  to  those  of  car- 
bolic-acid poisoning.  Their  onset  may  be 
sudden,  and  occur  soon  after  the  beginning  of 
the  treatment,  sometimes  following  a  single 
application  when  the  surface  to  which  it  is 
made  is  extensive.  The  condition  is  charac- 
terized by  fever,  headache,  loaded  tongue, 
belching,  nausea,  vomiting  of  black  tarry  mat- 
ter, colic,  diarrhoea  with  tar-like  evacuations, 
strangury,  and  ischuria,  the  urine  becoming 
greenish,  and  finally  black,  emitting  the  char- 
acteristic odour  of  tar.  After  from  twenty- 
four  to  forty-eight  hours,  if  the  applications 
have  been  suspended,  the  symptoms  gradually 
abate,  with  copious  diaphoresis  and  some  diu- 
resis. First  the  urine  turns  from  black  to 
olive-green,  and  becomes  lighter  and  lighter 
in  colour  till  the  condition  finally  becomes 
normal.  It  is  said  that  if  the  use  of  the  remedy 
is  afterwards  resumed  the  patient  becomes  less 
intolerant  of  it,  and  no  further  trouble  is  ex- 
perienced. Children  and  young  persons  are 
most  susceptible. 

When  tar  in  a  concentrated  form  is  applied 
directly  to  a  sensitive  skin,  it  is  apt  to  cause 
irritation  with  an  eruption  of  a  spreading  ery- 
thema, or  of  inflammatory  papules,  which  may 
assume  a  peculiar  and  very  characteristic  ap- 
pearance. When  the  applications  of  tar  have 
been  extensive  a  follicular  inflammation  is  apt 
to  result,  with  occlusion  of  the  sebaceous  fol- 
licles by  comedo-like  plugs,  composed  of  par- 
ticles of  tar.  It  is  most  likely  to  occur  over  the 
exterior  surface  of  the  lower  extremities  where 
the  hairs  are  abundant.  Hard  and  more  or 
less  painful  papules  form,  varying  in  size  from 
that  of  a  pin  head  to  that  of  a  pea,  of  a  reddish- 
brown  colour,  with  a  black  point  showing  in 
the  centre  of  each.  They  may  be  accompanied 
with  the  formation  of  nodules  of  larger  size, 
or  with  furuncles.  The  afEection  is  known  as 
"  tar  acne,"  acne  picealis. 

Sometimes  the  internal  use  of  tar  is  attended 
with  the  production  of  a  cutaneous  rash, 
which  may  be  either  erythematous,  rubeolous, 
or  urticarial  in  character. 

In  common  with  all  balsaraics,  tar  has  a 
specific  action  on  mucous  tissue,  whereby  it 
becomes  an  effective  anticatarrhal  agent.  In 
health,  it  tends  to  increase  secretion,  but  where 
there  is  supersecretion  due  to  a  subacute  or 
chronic  inflammatory  congestion,  the  secretion 
is  diminished.  In  the  bronchorrhwa  of  phthisis 
and  other  pulmonary  affections  it  is  often  a 
useful  remedy,  and  also  in  chronic  or  subacute 
vesical,  urethral,  and  vaginal  catarrh.  The 
usual  dose  is  from  -J  a  drachm  to  ^  oz.  a  day. 
It  may  be  given  in  milk  or  beer,  or  in  the  form 
of  pills  or  capsules.  The  glycerite  is  also  a 
convenient  and  acceptable  form  of  administra- 
tion. Tar  water,  for  the  same  purposes,  may  be 
given  to  the  extent  of  from  1  to  2  pints  a  day. 

The  vapour  of  tar  is  used  for  inhalations  in 
pulmonary  troubles  with  excessive  secretions, 
and  also  for  deodorizing  and  purifying  vessels 
and  sick-rooms.  The  tar  having  "been  mixed 
with  carbonate  of  potassium  in  the  proportion 


263 


TAE 


of  1  to  24,  for  the  purpose  of  neutralizing  the 
pyroligneous  acid,  which  would  irritate  the 
lungs,  is  put  into  a  cup  which  is  placed  in  a 
small  water  bath  over  a  spirit  lamp.  In  this 
way  the  air  of  the  room  becomes  gradually 
charged  with  the  vapour.  For  the  purpose  ot 
inhalation,  the  same  effect  may  be  accomplished 
more  simply  by  letting  the  patient  inhale  the 
fumes  of  tar  water  or  wine  of  tar  by  means  of 
the  steam  atomizer. 

In  diseases  of  the  skin,  more  particularly  in 
those  in  which  the  mucous  layer  is  specially 
implicated,  tar  is  a  much  more  effective  remedy 
than  it  is  in  diseases  of  the  mucous  membrane 
proper.  In  eczema  and  psoriasis  tarry  appli- 
cations are  especially  efficacious.  Though 
some  (notably  Dr.  McCall  Anderson)  have  re- 
ported good  results  from  the  internal  use  of 
tar  in  these  affections,  all  are  agreed  that  the 
remedy  is  vastly  more  effective  when  applied 
directly  to  the  diseased  surface.  In  eczema, 
the  rule  is  generally  observed  to  await  the  de- 
cline of  active  inflammatory  manifestations 
before  beginning  tar  treatment.  If  it  is  begun 
earlier,  while  there  is  still  vesioulation,  surface 
exudation,  or  erosion,  it  is  apt  to  aggravate  the 
disease,  resembling  in  this  respect  the  treat- 
ment of  catarrhal  diseases  generally  by  bal- 
samics.  It  is  well  known,  for  example,  that  if 
the  use  of  copaiba  balsam,  sandal-wood  oil, 
and  the  like  is  begun  while  a  gonorrhoea  is 
in  the  acute  stage,  the,  effect  is  bad.  These 
remedies  are  not  appropriate  till,  with  the  de- 
cline of  inflammation,  the  purulent  discharge 
has  given  place  to  one  that  contains  a  consid- 
erable proportion  of  mucus.  In  eczema  where 
the  remedy  is  directly  applied  to  the  diseased 
.parts,  it  is  usually  necessary  to  defer  the  use 
of  tar  till  all  discharge  has  ceased.  Espe- 
cially in  eczema  of  an  impetiginous  character 
is  tar  obiectionable.  The  Indications  for  its 
use  is  generally  regarded  to  be  a  condition  of 
subacute  inflammation  manifested  by  a  dry 
scaling  surface  with  more  or  less  hypera3mia 
and  pruritus,  inflammatory  products  still  re- 
maining in  the  tissues.  Even  at  this  stage  it 
is  not  always  well  borne,  the  intolerance  in 
some  qases  being  apparently  due  to  idiosyn- 
crasy. It  is  therefore  advisable  to  begin  al- 
ways with  the  milder  preparations  or  with  the 
tar  in  a  diluted  form,  as  in  combination  with 
an  emollient  ointment  or  with  olive  oil,  or  in 
weaker  alcoholic  or  alkaline  solutions.  The 
weaker  solutions  ot  coal  tar,  made  either  from 
Diihring's  compound  tincture  or  from  liquor 
carbonis  detergens,  often  answer  well.  Later, 
stronger  applications  may  be  made.  Instead 
of  making  the  applications  continuous,  it  is 
sometimes  preferable  to  make  them  intermit- 
tent, as,  for  example,  by  means  ot  the  so-called 
"  tar  bath."  This  consists  in  first  smearing 
the  eczematous  surface  with  tar  or  some  of  its 
preparations,  afterward  immersing  the  parts 
in  a  warm  bath,  washing  off  the  tar  with 
soap,  and  finally  following  with  the  application 
of  some  soothing  and  desiccating  ointment 
like  Lasgar's  paste  (2  parts  each  of  zinc  oxide 
and  powdered  starch  and  4  parts  of  vaseline). 
This  method  of  using  tar  may  be  adopted  with 
advantage  even  at  an  early  stage  of  the  dis- 


ease and  before  the  surface  has  ceased  to  ex- 
ude. Lassar  first  recommended  it  for  such 
early  treatment.  After  the  daily  use  of  the 
tar  baths  for  a  few  days  an  exuding  surface 
often  becomes  dry,  yellowish,  and  scaly,  when 
it  is  possible  to  proceed  to  more  continuous 
and  energetic  applications. 

For  psoriasis  tar  was  formerly  used  much 
more  than  it  is  now.  Latterly  it  has  been 
largely  superseded  by  ohrysarobin.  As  em- 
ployed by  Hebra  and  others,  the  tar  treatment 
was  carried  out  very  vigorously,  and  on  this 
treatment  the  main  reliance  was  placed.  Two 
methods  were  employed — one  continuous,  the 
other  interrupted  or  intermittent.  In  the  for- 
mer the  patient  was  first  subjected  to  daily 
friction  with  green  soap  (see  under  Soap)  or 
prolonged  baths  till  the  scales  had  been  partly 
or  wholly  removed.  Wood  tar,  preferably  in 
the  form  of  olewm  cadini  or  oleum  rusci,  or 
some  tarry  preparation,  such  as  tinctura  rusci, 
was  then  well  rubbed  into  the  skin  and  allowed 
to  dry  on.  To  facilitate  the  drying,  the  patient 
was  clothed  in  woollen  or  wrapped  in  woollen 
blankets,  the  advantage  of  which  was  that  the 
wool  did  not  absorb  the  tar  as  linen  or  cotton 
would.  In  from  two  to  six  hours,  the  surface 
having  become  quite  dry,  the  patient  resumed 
the  usual  clothing.  The  tarry  inunctions  were 
repeated  once  or  twice  a  day,  at  each  inunc- 
tion the  tar  from  the  previous  application 
being  first  washed  off.  This  was  continued  till 
scales  ceased  to  form. 

For  intermittent  applications,  the  tar  bath 
was  used  in  the  manner  above  described,  ex- 
cept that  each  bath  was  preceded  by  green-soap 
frictions,  and  after  the  tar  had  been  rubbed  in 
the  patient  was  made  to  remain  in  the  bath  for 
at  least  six  hours.  The  tar  that  remained  on 
the  surface  was  then  washed  off  with  green 
soap,  and  finally  the  surface,  having  been  dried, 
was  dressed  with  a  soothing  ointment. 

Formerly  tar  was  much  used  as  a  remedy 
for  scabies.  Though  it  still  is  often  employed 
as  one  of  the  ingredients  of  various  "  itch 
ointments,"  it  is  rather  for  the  sake  of  its 
anticatarrhal  effect  than  for  the  purpose  of 
destroying  the  acarus. 

As  a  disinfectant  for  unclean  or  putrid  sores, 
the  tar  powders  with  gypsum  or  charcoal 
(more  especially  the  coal-tar  powder)  are  effica- 
cious. Coal-tar  powder  was  recommended  by 
Devergie  for  rupia,  ecthyma,  impetigo,  herpes, 
and  eczema.  An  objection  to  the  gypsum 
powders  is  their  tendency  to  adhere  and  cake 
on  the  parts  to  which  they  are  applied.  With 
the  recently  manufactured  disinfectant  pow- 
ders at  harid,  this  preparation  is  seldom  re- 
quired. 

Tar  has  a  definite  anticnesmatic  action,  chiefly 
owing  to  the  carbolic  acid  or  allied  phenols 
which  it  contains,  but  partly,  probably,  because 
of  its  effect  to  reduce  hypersemia.  This  action 
is  exhibited  even  in  watery  solutions.  For 
priclcly  heat  tar  water  is  an  excellent  applica- 
tion, and  also  for  itching  of  the  scalp.  The 
alkaline  and  alcoholic  solutions  as  well  as  the 
coal-tar  preparations  with  soap  bark  are  espe- 
cially serviceable  for  dry  eczematous  patches 
attended  with  itching. 


TARACANIN 
TEA 


264 


The  wood-tar  preparations  for  internal  use 
include  syrupus  picis  Hquidm,  of  which  the 
dose  is  from  -J-  to  1  fl.  oz. ;  glyceritum  picis 
liquidcB,  of  which  the  dose  is  from  -|  to  1  fl. 
drachm ;  and  infusum  picis  liguidce,,  aqua 
picis  (sen  picea),  tar  water,  of  which  the  dose 
is  from  3  to  4  fl.  oz. 

For  external  use,  the  prepartions  of  wood 
tar  most  commonly  employed  are  the  follow- 
ing :  Oleum  picis  liguidce  (U.  S.  Ph.),  unguen- 
tum  picis  liquidce  (U.  S.  Ph.),  and  unguentum 
picis  betulm  (8  parts  of  birch  tar  to  43  of  simple 
ointment). 

Tar  tinctures. — Tinctura  picis  betulce  may 
be  made  by  dissolving  1  part  of  birch  tar  m 
10  parts  of  alcohol,  and  afterward  filtering, 
The  formula  for  Hebra's  tinctura  rusci  is  the 
following: 
5  Birch  tar 50  parts ; 

Sulphuric  ether,  )ga^j^___  ^g      .. 

Alcohol,  ) 

Oil  of  lavender 3      " 

Mix  the  tar,  ether,  and  alcohol,  and  filter; 
then  add  the  oil  of  lavender. 

Tinctura  saponis  cum  pici  consists  of  equal 
parts  of  wood  tar,  green  soap,  and  alcohol. 

The  formula  for  Bulkley's  liquor  picis  alka- 
linus  is  as  follows : 

5  Tar 8  drachms ; 

Caustic  potash 1  drachm ; 

Water 5  drachms. 

The  potash  is  first  dissolved  in  the  water 
and  the  solutions  gradually  added  to  the  tar 
while  rubbing  in  a  mortar.  For  use  it  is  to 
be  diluted  at  first  with  8  parts  or  more  of 
water,  gradually  using  stronger  and  stronger 
solutions. 

For  tar  soaps  see  under  Soap. 

Wood-tar  powder  is  made  by  triturating  1 
part  of  wood  tar  with  7  parts  of  gypsum. 

The  preparations  of  coal  tar  are  suited  only 
to  external  use.  Because  of  its  irritating  qual- 
ities, this  tar  is  never  used  internally.  Its 
preparations  include  tinctures,  emulsions  with 
alkalies,  and  mixtures  in  the  form  of  powder. 
The  best  alcoholic  solutions  of  coal  tar  are 
made  with  tinctures  of  soap  bark.  The  tinc- 
ture of  elm  has  also  been  used.  The  coal-tar 
saponine  of  Lebceuf  is  made  as  follows : 

5  Coal  tar 100  parts  ; 

Tincture  of  qnillaia 3,400    " 

Mix  and  digest  for  six  days  in  a  closed  vessel 
at  a  temperature  of  from  95°  to  104°  F.  From 
time  to  time  agitate  the  mixture  and  finally 
filter.  Dilhring's  formula  {American  Jotirnal 
of  the  Medical  Sciences,  May,  1894)  is  the  fol- 
lowing : 

Digest  1  part  of  coal  tar  with  6  parts  of  soap- 
bark  tincture  (which  should  be  of  the  strength 
of  1  to  4,  and  made  with  95-per-cent.  alcohol), 
with  frequent  agitation,  for  not  less  than  eight 
days  and  preferably  for  a  longer  time,  and 
finally  filter.  "  It  is  a  brown-black,  clear  tinc- 
ture which  upon  the  addition  of  water  forms  a 
clearly  yellowish  emulsion,  the  colour  and  cer- 
tain other  characters  varying  with  the  kind  of 
coal  tar  employed."  This  preparation  is  called 
"  compound  tincture  of  coal  tar,"  and  is  said 


to  be  very  similar  in  its  composition  and  thera- 
peutic qualities  to  "  liquor  carbonis  deter- 
gens,"  a  proprietary  article  made  by  Wright  & 
Co.,  of  England,  which  is  much  used  in  Great 
Britain.  For  use  as  a  wash,  Duhring's  tinc- 
ture, as  well  as  his  liquor  carbonis  detergens, 
should  be  diluted  with  from  10  to  60  parts  of 
water. 

Emulsions  of  coal  tar  are  made  with  strong 
solutions  of  caustic  potash  and  soda  or  ammo- 
nia or  with  alcohol,  but  the  tar  separates  when 
water  is  added,  and  is  apt  to  cause  irritation. 
The  following  preparation,  in  which  alcohol 
and  glycerin  are  associated  with  the  alkali,  is 
recommended  by  Dr.  McCall  Anderson  : 

5  Coal  tar 3  drachms ; 

Alcohol 2  oz. ; 

Stronger  ammonia  water.  8  minims ; 

Glycerin 6  drachms ; 

Distilled  water,  enough  to  make  13  oz. 
Mix  the  tar  and  the  alcohol,  strain  the  mix- 
ture, and  add  the  other  ingredients.  It  forms 
an  opaque,  milky,  dirty-brownish  emulsion 
which  may  be  further  diluted  with  water  in 
all  proportions  without  precipitation. 

A  coal-tar  powder  (the  poudre  de  coal-tar  of 
the  French)  may  be  made  with  gypsum  in  the 
proportion  of  from  1  to  3  parts  of  the  tar  to 
100  of  gypsum.  The  tar  is  first  heated  till  it 
liquefies  in  a  pitch  kettle,  and  is  then  thor- 
oughly triturated  with  the  gypsum.  In  place 
of  the  gypsum,  powdered  wood  charcoal  has 
been  used. 

The  derivatives  of  coal  tar,  the  so-called 
"coal-tar  products,"  include  many  remedies 
of  great  value,  especially  among  those  of  com- 
paratively recent  adoption,  and  it  is  to  these 
that  this  tar  owes  its  chief  importance  in  medi- 
cine.— Edward  Bennet  Bronson. 

TARACANIN.— See  under  Blatta. 

TARAXACUM  (U.  S.  Ph.),  taraiaci  ra^ 
dix  (Br.  Ph.),  is  the  root  of  Taraxacum  offici- 
nale gathered  in  autumn.  It  is  the  ordinary 
dandelion  plant,  common  in  fields,  gardens, 
and  meadows.  Under  the  name  radix  tarax- 
aci  cum  herba,  the  Ger.  Ph.  recognises  both 
the  root  and  the  leaves.  It  is  required  to  be 
free  from  the  root  of  Chicorium  intybus,  or 
chicory,  which  it  greatly  resembles,  the  dif- 
ference being  that  the  chicory  root  is  usually 
paler  and  more  bitter,  and  has  the  milk  ves- 
sels in  radiating  lines.  The  root  of  the  plant 
is  the  most  efficacious  part.  A  sugar  is  fre- 
quently found  in  the  juices  of  the  roots  gath- 
ered in  the  spring,  iniilin  being  more  abundant 
when  the  plant  is  plucked  between  Septem- 
ber and  February. 

An  active  principle,  taraxacin,  was  isolated 
by  Pollex  in  1839.  It  is  an  amorphous,  bitter, 
crystallizable  mass  obtained  from  the  milk 
juice  of  the  plant.  It  is  somewhat  acrid,  fu- 
sible, and  scarcely  soluble  in  cold  water,  al- 
though very  soluble  in  boiling  water,  in  ether, 
and  in  alcohol.  Kromayer  obtained  not  only 
taraxacin,  but  also  taraxacerin,  CsHibO,  which 
is  insoluble  in  water,  but  is  dissolved  by  alco- 
hol. A  resin  and  a  fermentable  sugar  have 
also  been  found  in  the  juice  of  the  root. 

The  Arabs  were  the  first  to  employ  taraxa- 


265 


TARACANIN 
TEA 


cum,  using  it  as  a  deobstruent  and  blood  pu- 
rifier. During  the  eigliteentli  century  it  was 
widely  used  in  chronic  affections  of  the  abdom- 
inal viscera,  especially  those  of  the  liver.  It 
was  praised  in  the  treatment  of  renal  calcu- 
lus and  of  some  irritating  diseases.  Its  popu- 
lar reputation  as  a  diuretic  is  seen  in  the 
vulgar  English  and  French  names  of  the  plant. 
At  the  present  day  it  has  a  limited  employ- 
ment as  a  ionic  of  slight  power,  as  a  diuretic, 
and  as  an  aperient.  It  is  said  to  act  as  a 
stomachic  when  there  is  diminished  appetite, 
and  it  has  been  alleged  for  it  that  it  promotes 
digestion.  It  has  some  reputation  as  an  hepat- 
ic stimulant,  although  its  powers  in  this  di- 
rection are  probably  quite  feeble,  and  it  would 
require  its  prolonged  administration  to  secure 
an  increase  of  biliary  secretion  or  a  decrease 
of  hepatic  congestion.  It  has  been  used  in 
atonic  dyspepsia  combined  with  constipation 
with  reputed  benefit.  It  has  been  praised  even 
in  the  treatment  ot  pulmonary  phthisis  on  ac- 
count of  its  supposed  beneficial  action  on  the 
stomach,  liver,  and  intestines.  The  late  Dr. 
George  1$.  Wood,  of  Philadelphia,  employed  it 
with  confidence  in  the  treatment  of  chronic 
congestion  and  inflammation  of  the  liver  and 
spleen  when  there  was  no  irritation  or  inflam- 
matory condition  of  the  gastric  and  intestinal 
mucous  membranes.  The  dried  root  of  tarax- 
acum is  sometimes  mixed  with  ground  coffee 
to  be  used  in  making  a  drinlf,  and  has  some- 
times been  substituted  for  coffee  after  powder- 
ing and  roasting. 

Taraxacum,  to  be  of  any  service,  must  be 
given  continuously  for  several  weelcs,  and  will 
probably  be  of  value  only  in  cases  of  hepatic 
torpor  with  constipation.  It  may  be  adminis- 
tered in  decoction,  decoctum  taraxaci  (Br.  Ph.), 
the  dose  of  which  is  from  2  to  4  fl.  oz.,  though 
this  is  apt  to  ferment.  The  dose  of  the  extract, 
extractum  taraxaci  (U.  S.  Ph.,  Br.  Ph.,  Ger. 
Ph.),  is  from  20  to  60  grains  ;  that  of  the  fluid, 
or  liquid,  extract,  extractum  taraxaci  fluidum 
(U.  S.  Ph.),  extractum  taraxaci  liquidum  (Br. 
Ph.),  is  from  1  to  2  fl.  drachms ;  that  of  the 
fresh  juice,  succus  taraxaci  (Br.  Ph.),  is  from 
2  to  4  fl.  drachms. — Samuel  M.  Beickneb. 

TAKTAR,  CREAM  OF.— Potassium  bi- 
tartrate  (see  under  Potassium  tartrates). 

TABTAB.  EMETIC— Antimony  and  po- 
tassium tartrate  (see  under  Antimony). 

TARTARIC  ACID,  the  acidum  tartari- 
cum  of  the  pharmacopoeias,  belongs  to  the  same 
group  as  citric  acid,  has  essentially  the  same 
properties,  although  less  agreeable,  and  may 
be  substituted  for  it  with  entire  propriety 
when  the  question  of  economy  is  of  impor- 
tance. It  may  be  employed  in  making  a  sub- 
stitute for  lemonade,  but  is  by  itself  rather  flat 
and  insipid,  faults  which,  however,  may  be 
corrected  by  the  addition  of  a  few  drops  of  es- 
sence or  syrup  of  lemon,  or  of  any  fruit  syrup 
which  may  be  at  hand.  It  may  also  be  used 
in  preparing  extemporaneous  effervescing  mix- 
tures, about  3  parts  of  the  acid  neutralizing  4 
of  sodium  bicarbonate.  An  ordinary  dose  is 
120  grains,  although  double  that  quantity  can 
be  used  with  safety. 


The  tartrates  are  soluble,  as  a  rule,  and 
those  of  the  alkaline  bases  are  cathartic,  and 
generally  mildly  diuretic. 

Russell  H.  Nevins. 

TARTABLITHINE.— This  is  the  name  of 
an  American  proprietary  preparation  which  is 
furnished  in  the  form  of  effervescent  tablets. 
It  is  described  as  "  the  lithium  analogue  of 
cream  of  tartar ''  (Coblentz),  and  appears  to  be 
a  bitartrate  of  lithium.  It  is  used  in  gout,  also 
in  eczema  and  other  affections  attributed  to  an 
excess  of  uric  acid  in  the  blood,  in  doses  of 
from  5  to  10  grains  (one  or  two  tablets),  in 
water,  four  times  a  day.  Equal  parts  of  tar- 
tarlithine  and  sulphur,  also  in  the  form  of  5- 
grain  tablet  s,  to  be  taken  in  the  same  doses,  are 
employed  in  the  same  diseased  conditions,  and 
particularly  in  cases  associated  with  torpor  of 
the  liver. 

TARTARUS  BORAXATXJS  (Ger.  Ph.). 
— This  is  a  white  powder,  acid  to  the  taste  and 
in  reaction,  made  by  dissolving  2  parts  of 
borax  in  15  parts  of  water,  with  the  aid  of  a 
vapour  bath,  and  adding  5  parts  of  potassium 
bitartrate.  It  dissolves  in  its  own  weight  of 
water.  It  is  employed  as  a  laxative  in  doses 
of  from  1  to  2  oz.  It  has  been  supposed  to  be 
of  service  as  a  lithontripfic. 

TARTARUS  DEPURATUS  (Ger.  Ph.). 
— Potassium  bitartrate  (see  under  Potassium 
tartrates). 

TARTARUS  NATRONATUS  (Ger. 
Ph.). — Roohelle  salt  (see  Potassium  and  so- 
dium tartrate,  under  Potassium  tartrates). 

TARTARUS  STIBIATUS  (Ger.  Ph.).— 
Tartar  emetic  (see  Antimony). 

TEA. — The  plant  which  furnishes  tea  is 
the  Thea  chinensis,  or  Camellia  Thea,  an 
evergreen  shrub  which  belongs  to  the  natural 
order  Camelliacece,  indigenous  to  the  southern 
part  of  Asia.  It  is  extensively  cultivated  in 
China,  Japan,  and  India,  and  to  a  lesser  degree 
in  South  America,  the  United  States,  and  else- 
where within  40°  of  the  equator.  In  the  United 
States  its  cultivation  has  not  yet  been  attended 
by  any  marked  success,  possibly  on  account  of 
tile  soil  and  climate,  but  quite  as  probably  on 
account  of  lack  of  skill  in  the  preparation  of 
the  leaves.  The  plant  naturally  becomes  a) 
small  tree,  which  may  attain  to  a  height  of 
thirty  feet,  but  it  is  pruned  when  cultivated 
so  as  to  prevent  its  growth  upward  more  than 
from  four  to  eight  feet,  and  so  cause  it  to  be- 
come very  bushy  from  a  greater  abundance  of 
twigs  and  leaves.  It  was  formerly  described  as 
of  several  species,  but  these  are  now  considered 
to  be  varieties  which  have  been  produced  by 
long  cultivation,  each  of  which  possesses  cer- 
tain distinguishing  characteristics.  They  are 
called  Thea  bohea,  Thea.  viridis,  Thea  stricta, 
2^hea  assamica,  etc.  The  India,  Ceylon,  and 
other  teas  are  representatives  of  the  same  plant 
named  from  the  countries  in  which  they  are 
cultivated,  each  of  which  presents  certain 
characteristics  of  flavour,  dependent  mainly 
on  the  differences  of  soil  and  climate  and  pos- 
sibly on  variations  in  the  manner  of  prepara- 
tion.   The  most  important  division  of  tea  is 


TEA 


266 


into  green  and  black,  a  distinction  which  does 
not  depend  on  the  variety  of  the  plant  from 
which  the  leaves  are  taken,  but  chiefly,  if  not 
entirely,  on  the  method  of  their  preparation. 
For  example,  the  I'hea  viridis  may  be  the  va- 
riety cultivated  in  two  districts  of  China,  one 
of  which  produces  green  tea  and  the  other 
black.  At  the  same  time,  green  and  black 
teas  are  rarely  if  ever  produced  in  the  same 
district,  and  it  is  probable  that  different  ex- 
•posures,  soils,  and  cultivation  are  influential 
in  the  most  satisfactory  production  of  each. 
The  plants  are  propagated  from  seeds  planted 
at  certain  distances  from  one  another  in  rows. 
When  they  are  three  years  old  they  yield  the 
first  crop  of  leaves  for  collection,  and  increase 
yearly  in  value  until  they  are  eight  years  of 
age,  when  they  begin  to  deteriorate.  At  about 
this  time  they  are  frequently  cut  down,  so 
that  a  larger  product  of  leaves  may  be  ob- 
tained from  the  numerous  shoots  which  arise 
from  the  stump.  The  leaves  are  picked  by 
hand  during  the  rainy  season,  from  two  to 
four  pickings  usually  being  made  at  intervals 
of  about  six  weeks.  In  China  the  first  pic-k- 
ing is  made  when  the  earliest  buds  are  just 
opening  into  leaves.  This  first  crop  of  buds 
and  leaves  form  the  very  choicest  quality  of 
tea,  very  small  quantities  of  which  are  ever 
seen  in  this  country.  It  is  largely  purchased 
by  the  wealthy  Chinese  for  home  use,  and  it  is 
difficult  to  export,  because,  when  packed  in 
large  quantities,  as  in  the  great  tea  ships,  it  is 
quite  apt  to  ferment.  Considerable  quantities 
are  transported  in  small  packages  overland, 
principally  to  Eussia,  or  sent  with  great  care 
to  other  parts  of  the  world.  This  grade  of 
tea  scarcely  colours  the  water  in  which  it 
is  infused,  although  it  is  very  strong  to  the 
taste. 

The  warm  rains  soon  bring  out  more  young 
leaves  on  the  plants,  and  these  are  gathered 
during  the  second  picking.  At  this  time  the 
best  qualities  for  exportation  are  obtained,  as 
the  subsequent  pickings  supply  only  inferior 
grades  of  tea.  The  quality  of  the  leaves  de- 
pends upon  a  considerable  variety  of  deter- 
mining causes.  Other  things  being  equal,  the 
quality  varies  with  the  time  of  picking ;  of  the 
leaves  picked  from  a  plant  at  the  same  time, 
the  smaller  and  more  immature  are  of  better 
quality  than  the  larger,  while  the  soil,  situa- 
tion, climate,  attention  to  cultivation,  and  the 
character  of  the  individual  plant  contribute 
severally  toward  the  determination  of  the 
quality,'  and  all  unite  to  characterize  numer- 
ous commercial  varieties. 

The  descriptions  of  the  method  of  preparing 
and  drying  the  leaves  vary  a  great  deal  as 
given  by  different  writers,  and  it  is  probable 
that  the  details  of  the  procedure  are  not  the 
same  in  all  places,  but  the  following  may  per- 
haps be  considered  to  give  the  essential  differ- 
ences in  the  manufacture  of  green  and  black 
tea,  the  most  important  of  which  is  that  the 
leaves  intended  to  form  black  tea  are  allowed 
to  undergo  a  certain  amount  of  fermentation 
before  they  are  dried.  In  the  manufacture 
of  black  tea  the  leaves,  after  they  have  been 
plucked,  are  piled  in  heaps  and  left  for  several 


hours,  frequently  over  night.  They  are  then 
heated  for  a  few  minutes,  then  rolled  and 
heated  again.  This  alternate  heating  and 
rolling  is  repeated  several  times  until  the 
leaves  are  in  a  proper  condition,  and  then  they 
are  dried  slowly  over  a  fire.  The  odour  of 
these  leaves  is  "rather  slight,  and  numerous 
grades  are  flavoured  by  the  admixture  of  aro- 
matic fiowers  for  a  day  or  so,  after  which  they 
are  removed  by  sifting  or  otherwise.  In  this 
manner  the  so-called  English  breakfast  teas 
are  prepared.  When  green  tea  is  to  be  made, 
the  leaves  are  not  allowed  to  lie  and  ferment, 
but,  within  an  hour  or  so  after  they  have  been 
gathered,  are  placed  in  pans  and  heated  for 
four  or  five  minutes  over  a  brisk,  smokeless 
fire.  They  are  then  removed,  rolled  by  hand, 
and  again  placed  in  the  drying  pans  over  the 
fire,  where  they  are  kept  in  rapid  motion  for  an 
hour  or  two.  Colouring  matters  are  frequently 
added  to  the  leaves  intended  for  the  foreign 
market,  particularly  when  they  are  of  inferior 
quality.  The  principal  chemical  difference  be- 
tween green  and  black  tea  is  that  the  green 
contains  much  more  tannin,  but  the  exact  pro- 
portion is  uncertain,  as  it  varies  to  a  consider- 
able degree  according  to  the  analyses  reported 
by  different  chemists. 

The  chemical  constituents  of  tea  are  quite 
numerous,  but  the  three  most  important  ones 
are  an  alkaloid  theine  (see  Theine),  an  essential 
oil,  and  tannin.  The  essential  oil  is  that  which 
determines  the  flavour  of  the  tea  and  probably 
assists  materially  in  the  production  of  its 
physiological  effects.  It  is  citron  yellow,  light- 
er than  water,  is  solidified  by  cold  and  resini- 
fied  by  exposure  to  the  air,  and  yields  the 
characteristic  odour  of  tea.  It  is  not  present 
in  the  fresh  leaf,  but  develops  during  the  pro- 
cess of  roasting  and  drying. 

The  use  of  tea  as  a  beverage  has  been  com- 
mon among  the  Chinese  from  a  very  early 
period,  but  among  the  occidental  races  it  is 
essentially  modern.  It  was  introduced  into 
England  in  1657  at  Garraway's  coffee  house, 
where  it  was  received  with  great  favour.  At 
first  the  cost  was  excessive,  but  as  the  impor- 
tation increased  the  price  fell,  until  its  use  be- 
came general  and  supplanted  that  of  sage  tea, 
which  had  long  been  a  favourite  beverage.  At; 
the  present  time  enormous  quantities  are  con- 
sumed in  all  parts  of  the  world,  more  perhaps 
by  English-speaking  peoples  than  by  those  of 
other  European  origin. 

Writers  on  dietetics  are  accustomed  to  give 
explicit  directions  in  regard  to  the  preparation 
of  the  infusion,  but  it  is  to  be  feared  that  their 
rules  are  very  frequently  disregarded.  To  ob- 
tain the  greatest  benefit  and  enjoyment  from 
a  cup  of  tea,  boiling  water  should  be  poured 
upon  the  leaves,  allowed  to  stand  in  a  closed 
and  protected  vessel  for  from  three  to  eight 
minutes,  and  then  poured  off  to  be  drank. 
In  this  manner  the  volatile  oil,  which  deter- 
mines the  flavour  and  possesses  to  no  slight 
degree  stimulating  properties,  is  preserved, 
while  the  undesirable  extractive  matters  large- 
ly remain  in  the  leaf."  Prolonged  steeping  or 
boiling  causes  this  volatile  oil  to  be  dissipated, 
while  it  draws  out  the  tannin  and  other  ex- 


267 


TEA 


tractives  which  render  the  drink  less  palatable 
and  more  injurious  to  the  digestive  system. 
It  is  true  that  the  finest  young  leaves  contain 
proportionately  less  tannin  than  others  and 
that  on  that  account  it  is  less  objectionable  to 
boil  them,  but  no  advantage,  unless  it  may  be 
the  extraction  of  a  larger  amount  of  theine, 
can  be  obtained,  while  there  is  a  very  marked 
loss  in  the  dissipation  of  the  volatile  oil.  The 
inferior  grades  of  tea  are  the  ones  most  fre- 
quently boiled,  and  they  make  a  dark,  bitter, 
astringent  decoction. 

The  action  of  tea  upon  the  system  is  very 
complex.  Liebig  is  quoted  as  stating  that 
there  are  no  drinks  which,  in  their  complexity, 
have  more  resemblance  to  soup  than  tea  and 
coifee.  The  Chinese  are  said  to  consider  it 
"  cooling,  peptic,  exhilarating,  stimulating, 
both  laxative  and  astringent,  diuretic,  em- 
menagogue,  and,  in  large  concentrated  doses, 
emetic."  Some  years  ago  Mr.  E.  Smith  insti- 
tuted a  number  of  experiments  from  which  he 
determined  that  tea  caused  an  increase  in  the 
amount  of  carbon  dioxide  evolved  in  respira- 
tion as  well  as  in  the  depth  of  inspiration. 
This  would  seem  to  indicate  that  it  produces 
an  increase  in  the  waste  of  tissue,  but  the  sus- 
taining power  it  frequently  exhibits  would 
seem  to  denote  the  opposite  effect,  as  it  does 
not  furnish  any  nutriment  to  replace  the  waste. 
Smith  considers  that  it  promotes  assimilation 
and  the  transformation  of  foods.  This  may  be 
true,  although  it  retards  artificial  digestion. 
We  know  that  it  is  a  gentle  stimulant  to  the 
nervous  system,  that  it  is  refreshing,  that  it 
relieves  the  sensation  of  fatigue,  and  that  it 
permits  of  increased  exertion  without  food. 
The  latter  effect  is  so  marked  that  some  au- 
thorities, among  whom  is  Captain  Woodruff, 
of  the  United  States  Army,  highly  recommend 
tea  for  the  use  of  soldiers  on  a  march.  After 
a  considerable  experience  with  it  in  arctic  ex- 
ploration. Dr.  Hayes  also  warmly  commended 
its  sustaining  power. 

Other  effects  which  are  produced  by  tea  are 
the  promotion  of  cheerfulness  and  the  stimu- 
lation of  a  lively  flow  of  ideas,  as  well  as  the 
relief  of  migraine  and  headache  from  overwork 
or  worry,  and  the  production  of  insomnia.  It 
has  also  a  sedative  effect  upon  the  circulation 
and  promotes  the  action  of  the  skin.  Al- 
though it  is  difficult,  in  regard  to  the  latter 
effects,  to  distinguish  between  the  results  pro- 
duced by  the  tea  and  those  due  to  the  intro- 
duction of  the  hot  water  in  which  it  is  infused 
into  the  system,  we  may  with  confidence 
ascribe  a  certain  portion  of  the  effect  to  the 
tea  itself,  and  it  is  well  known  that  after 
drinking  a  cup  of  tea  the  skin  and  mucous 
membranes  are  rendered  moist,  the  perspira- 
tion is  increased,  and  the  temperature  of  the 
body  is  so  regulated  that  it  feels  cooler  in 
warm  weather  and  warmer  in  cold. 

In  large  quantities,  tea  precipitates  the  di- 
gestive ferments,  retards  digestion,  and  may 
occasion  irritability  and  catarrh  of  the  stom- 
ach. This  is  usually  associated  with  constipa- 
tion, but  sometimes  with  diarrhoea  with  more 
or  less  flatulence.  The  nervous  symptoms 
produced  are,  first,  restlessness  and  insomnia, 
CI 


then  muscular  tremors,  palpitation  of  the  heart, 
and  increased  nervous  worry. 

It  has  been  considered  doubtful  by  some 
writers  whether  such  a  condition  as  chronic 
tea  intoxication,  or  theism,  exists  or  not.  But 
these  writers  are  very  explicit  in  regard  to 
how  the  infusion  should  be  made  and  when 
drank,  and  if  those  rules  are  constantly  and 
habitually  violated,  if  large  quantities  of 
strong  and  boiled  tea  are  drank  at  all  times 
during  the  day,  it  is  not  a  matter  of  surprise 
that  the  physiological  effects  on  the  nervous 
and  digestive  systems  should  be  plainly  ap- 
parent. It  is  a  well-known  fact,  at  least  in 
the  city  of  New  York,  that  many  women  of  the 
poorer  classes  keep  a  teapot  on  the  stove  from 
morning  till  night,  and  drink  the  bitter  de- 
coction at  short  intervals,  adding  fresh  water 
to  the  stewed  leaves  from  time  to  time  and 
supplying  more  tea  leaves  as  the  strength 
begins  to  fail.  These  tea-drinkers  are  ill  nour- 
ished, ansemic,  dyspeptic,  and  morbidly  nerv- 
ous. Such  conditions  as  these  may  possibly 
not  be  due  entirely  to  the  action  of  the  tea, 
and  they  may  be  in  part  ascribed  to  the  starva- 
tion induced,  for  persons  who  drink  tea  in 
this  manner  usually  take  very  little  nourish- 
ment ;  but  the  tea  must  be  held  primarily 
responsible  for  a  large  share  of  the  toxic 
symptoms.  The  symptoms  which  have  been 
ascribed  to  such  an  abuse  of  tea  include  ano- 
rexia, flatulent  dyspepsia,  sometimes  nausea 
and  vomiting,  constipation,  muscular  tremor, 
irregular  and  feeble  cardiac  action,  dyspncea, 
nervousness,  hysteria,  headache,  neuralgia,  tin- 
nitus, mental  and  physical  exhaustion,  night- 
mare, and  hallucinations.  Delirium  is  said  to 
have  been  a  result  of  chewing  tea.  Spratling 
has  reported  a  very  marked  case  of  multiple 
neuritis  caused  by  and  dependent  upon  ex- 
cessive tea-drinking,  and  this  habit  has  been 
mentioned  by  some  authorities  as  a  contribut- 
ing factor  to  the  production  of  insanity.  The 
appearance  of  such  severe  nervous  manifesta- 
tions may  be  properly  ascribed  to  the  idiosyn^ 
crasy  of  the  individual,  but  their  occasional 
occurrence  furnishes  a  strong  evidence  that  the 
minor  nervous  troubles  commonly  attributed 
to  the  consumption  of  large  quantities  of  tea 
are  caused  by  the  tea  itself.  Professional  tea- 
tasters  are,  as  a  class,  very  nervous  and  are 
said  by  some  writers  to  be  abnormally  consti- 
pated and  to  have  a  diminished  excretion  of 
urea.  It  is  frequently  the  impression  that  be- 
cause tea-tasters  simply  rinse  the  mouth  with 
the  infusion  none  is  swallowed,  and  whatever 
effect  is  produced  upon  them  must  be  by  ab- 
sorption of  the  constituents  through  the  buc- 
cal mucous  membrane.  As  a  matter  of  fact, 
a  very  few  drops  remain  in  the  mouth  after 
each  taste  and  find  their  way  eventually  to  the 
stomach,  so  that  after  a  large  number  of 
tastings  quite  a  quantity  of  tea  has  been 
drank,  a  very  little  at  a  time,  and  physiologi- 
cal effects  may  be  expected.  Sometimes  the 
nervous  symptoms  which  are  induced  in  this 
manner  are  of  sufficient  severity  to  oblige  a  tea- 
taster  to  abandon  his  business,  but  so  marked 
an  effect  is  usually  referable  to  idiosyncrasy. 

The  use   of  tea  as  a  beverage  should  be 


TEABERRY 
TENTS 


268 


avoided  in  dyspepsia  and  in  all  irritable  con- 
ditions of  the  stomach,  as  well  as  when  there 
is  a  very  marked  tendency  to  constipation. 
But  it  is  very  useful  to  relieve  the  feeling  of 
oppression  which  follows  the  ingestion  of  a 
very  hearty  meal.  Persons  who  suffer  from 
nervousness  or  insomnia  should  never  drink 
tea,  because  it  tends  to  increase  these  troubles. 
It  is  very  frequently  harmful  when  given  to 
children. 

For  medicinal  purposes  a  hot  infusion  of 
tea  is  occasionally  useful  for  the  purpose  of 
causing  diaphoresis  at  the  commencement  of 
slight  attacks  of  muscular  rheumatism,  bron- 
chitis, amygilalifis,  or  pharyngitis.  It  will  also 
relieve  fatigue  and  muscular  soreness  after 
excessive  exertion,  and  so  predispose  to  rest. 
In  cases  of  poisoning  with  narcotics  or  with 
agents  which  cause  cardiac  depression,  tea  is 
a  good  antidote,  though  not  so  efficient  as  cof- 
fee. ■  In  these  cases  it  should  be  given  in  large 
qaantities  and  in  a  very  concentrated  form. 
It  has  been  used  as  an  injection  in  teucorrhcea, 
gonorrhoea,  and  gleet,  as  a  collyrium  in  con- 
junctivitis, and  as  a  gargle  in  pharyngitis  and 
amygdalitis,  but  in  all  these  affections  its  value 
depends  on  the  tannin  alone  and  not  upon  any 
of  the  constituents  peculiar  to  itself,  and  usu- 
ally more  satisfactory  solutions  of  tannin  can 
be  obtained  for  these  purposes.  One  use,  which 
is  only  too  common,  is  to  be  seriously  depre- 
cated— the  application  of  the  stewed  leaves  as 
a  poultice  to  an  inflamed  eye.  It  is  very,  very 
rarely  that  the  application  of  a  poultice  to  an 
eye  is  indicated,  and  much  harm  has  resulted 
sometimes  from  such  a  procedure;  moreover, 
when  it  is  needed  it  is  very  easy  to  find  ma- 
terials better  fitted  for  the  purpose  than  tea 
leaves. 

Lie  tea. — For  purposes  of  adulteration  of 
tea,  the  dust  and  sweepings  of  tea  warehouses 
are  gathered  together,  cemented  with  rice  water 
and  gum,  and  rolled  into  grains  which  are  col- 
oured green  and  black.  This  mixture  of  refuse 
is  very  appropriately  named  lie  tea,  and  can 
be  detected  on  infusion  when  true  tea  leaves 
become  unrolled,  but  the  lie  tea  separates  into 
its  constituent  parts. 

Brick  tea  is  another  mixture  of  refuse, 
broken  leaves,  twigs,  siftings,  and  sweepings, 
which  are  cemented  together  and  moulded  into 
forms.  When  it  is  to  be  used  a  piece  is  broken 
from  the  brick  and  infused  like  other  tea.  It 
is  used  to  some  extent  in  this  country,  and 
very  largely  by  the  Tartars,  who  reduce  it  to 
dust,  infuse  it,  whip  the  infusion,  powder  it 
into  a  cream,  and  drink  the  whole.  The  same 
method  of  drinking  powdered  tea  leaves  in  the 
infusion  made  from  them  is  practised  else- 
where, particularly  in  Asia. 

Matthias  Lanokton  Foster. 

TEABERRY.— See  Gaultheria. 

TEAS. — The  word  tea  is  in  common  use  to 
denote  infusions  of  certain  plants,  either  for 
beverages  or  for  medicinal  purposes.  It  is  not 
ordinarily  considered  to  denote  an  official  in- 
fusion or  decoction,  or  other  similar  drink,  as 
is  the  case  with  the  French  word  tisane,  but 
its  use  is  rather  restricted  to  infusions  which 


are  prepared  and  drank  in  the  domestic  rathei? 
than  the  professional  practice  of  medicine,  or 
as  substitutes  for  tea  and  coffee.  An  exhaust- 
ive enumeration  is  impracticable,  because 
most  of  these  herb  teas  enjoy  purely  local 
repute,  and  in  almost  every  locality  certain 
ones  are  found  in  high  esteem,  so  only  a  few 
examples  will  be  given. 

Teas  may  be  divided  into  two  classes,  those 
used  as  beverages  and  those  employed  solely  as 
medicines.  Those  of  the  first  class  have  been 
to  a  great  extent  supplanted  by  tea  and  coffee, 
but  the  use  of  quite  a  number  of  other  plants 
is  occasionally  met  with,  sometimes  for  pur- 
poses of  adulteration,  but  for  the  most  part 
upon  their  own  merits. 

First  in  importance  possibly  is  mate,  or  Para- 
guay tea,  which  is  made  from  the  dried  leaves 
of  Ilex  paraguaiensis,  or  Brazilian  holly,  a 
tree  fifteen  or  twenty  feet  high,  indigenous  to 
South  America.  Other  names  by  which  it  is 
known  are  St.  Bartholom,ew's  tea  and  Jesuit's 
tea,  the  latter  name  having  been  given  to  it 
because  it  is  said  that  the  early  Jesuit  mission- 
aries  in  Brazil  and  Paraguay  established  plan- 
tations for  the  cultivation  of  the  plant.  For 
the  the  des  Jesuites  of  the  Fr.  Cod.  see  the 
paragraph  on  Mexican  tea  (page  269).  The 
leaves  are  first  heated  to  develop  the  aromatic 
principle,  then  dried  over  a  fire,  and  finally 
powdered.  The  chief  constituents  are  an 
astringent  principle  analogous  to  tannic  acid, 
which  is  present  in  so  large  a  quantity  that 
the  leaves  are  in  demand  for  dyeing  purposes, 
a  volatile  oil  which  determines  the  flavour,  and 
an  alkaloid  isomeric  if  not  identical  with  theine. 
The  infusion  is  sudorific,  diuretic,  a  stomachic 
irritant,  and,  in  large  doses,  emetic  and  purga- 
tive. It  powerfully  influences  the  nutritive 
functions,  and  in  its  effects  shows  a  closer 
resemblance  to  coca  than  to  tea.  It  is  drank 
in  large  quantities  by  the  natives  of  those 
parts  of  South  America  where  the  plant 
abounds  and  is  much  prized  by  those  who 
have  learned  to  enjoy  its  peculiar  flavour. 
When  taken  in  excessive  quantities  it  is  said 
to  produce  a  kind  of  delirium  tremens. 

Brazilian  tea  is  almost  the  same  as  the  pre- 
ceding. It  is  made  from  the  leaves  of  Ilex 
gongonha  and  Ilex  thcezans.  The  preparation 
of  the  leaves  and  the  use  and  effect  of  the 
infusion  are  very  closely  similar  to  those  of 
Paraguay  tea. 

In  Sumatra  and  other  islands  of  the  East 
Indian  Archipelago  coffee  leaves  are  dried, 
powdered,  and  used  after  the  manner  of  tea. 
It  has,  indeed,  been  called  coffee  tea.  The 
leaves  possess  properties  analogous  to  those 
of  the  fruit,  and  were  found  by  Dr.  Stenhouse 
to  contain  a  larger  proportion  o'f  caffeine.  The 
infusion  resembles  in  taste  and  odour  one 
made  from  a  mixture  of  tea  and  coffee,  and  is 
said  to  approach  the  most  nearly  to  tea  of  any 
of  its  substitutes. 

Abyssinian  tea  is  made  from  the  dried  leaves 
of  Catha  edulis,  a  plant  which  is  cultivated  in 
northern  Africa.  The  use  of  the  infusion  is 
extensively  practised  as  a  beverage  in  Arabia 
as  well  as  in  Africa,  where  it  is  known  as 
"  chaat."    Dr.  Paul  failed  to  obtain  an  alkaloid 


269 


TEABERRY 

TENTS 


from  the  leaves,  and  their  composition  is  prac- 
tically unknown. 

BusJt.  lea  and  Ilonig  tea  are  made  from  the 
leaves  of  certain  species  of  Cyclopia,  and  are 
used  as  substitutes  for  tea  at  the  Cape  of  Good 
Hope.  The  leaves  are  said  to  contain  an  alka- 
loid called  cyclopine,  which  differs  from  theine. 

Neiv  Jersey  lea  is  made  from  the  dried  leaves 
of  Ceanothiis  americanus.  or  red  root,  a  shrub 
of  the  RhamnacecB.  It  has  been  pronounced 
"  a  good  substitute  for  indifferent  black  tea." 
During  the  American  Revolution,  and  also  in 
the  Southern  States  during  the  War  of  the 
Rebellion,  this  was  used  considerably  as  a 
substitute  for  tea  when  the  latter  was  not  to 
be  obtained.  Little  is  known  of  its  constitu- 
ents except  that  it  contains  tannin,  a  resin, 
and  a  volatile  oil.  It  has  some  repute  as  an 
alterative,  is  said  to  be  purgative,  and  has  been 
recommended  in  dysentery  and  as  a  local 
application  in  sore  throat. 

Labrador  tea  is  also  said  to  have  been  used 
as  a  substitute  for  tea  by  the  pati-iots  during 
the  American  Revolution.  It  is  made  from 
the  leaves  of  Ledum  lalifolium,  an  evergreen 
shrub  indigenous  to  the  northern  part  of  the 
United  States  and  to  Canada.  They  have  an 
agreeable  odour  and  taste,  while  the  infusion 
is  strong  in  astringent  and  narcotic  properties. 

Marsh  lea  is  made  from  Ledum  palustre,  a 
congener  of  the  preceding,  found  in  the  north- 
ern part  of  Europe,  Asia,  and  America.  The 
leaves  have  a  balsamic  odour  and  an  aromatic, 
bitter  taste,  and  are  said  to  have  been  substi- 
tuted for  hops  in  the  manufacture  of  beer  in 
Germany.  They  are  sometimes  used,  in  the 
form  of  a  decoction,  in  the  exanthemata,  in 
various  slcin  diseases,  and  to  allay  irritation  in 
whooping-cough. 

It  is  not  an  infrequent  occurrence  for  the 
same  name  to  be  applied  in  different  places  to 
two  or  more  substances  quite  distinct  in  their 
nature.  Mexican  tea  may  be  mentioned  as  an 
example,  as  this  name  is  applied  to  the  infu- 
sion of  the  dried  leaves  of  Psoralea  glandrtlosa, 
which  resembles  Paraguay  tea,  and  also  to  that 
made  from  Chenopodium  ambrosioides,  which 
is  an  anthelminthic  and  also  used  for  various 
nervous  derangements.  The  latter  is  known 
in  the  Pr.  Cod.  as  the  des  Jesuites,  and  as  t6 
de  Espafla  among  the  Spaniards,  and  will  serve 
here  to  introduce  the  second  class  of  teas,  the 
medicinal. 

Oswego  tea,  spearmint  tea,  and  peppermint  tea 
are  all  made  from  various  species  of  mint,  and 
are  much  esteemed  as  stimiaant  carminatives. 

Catnip  tea.  made  from  the  leaves  and  tops  of 
Nepeta  cataria.  bears  a  close  resemblance  to  the 
mint  teas,  but  has  the  reputation  of  being  also 
antispasmodic  and  emmenagogue.  Although  it 
is  not  used  to  any  great  extent  by  the  medical 
profession,  it  is  employed  as  a  domestic  remedy 
in  amenorrhoea,  chlorosis,  and  anccmia,  as  well 
as  for  its  carminative  action. 

Boneset,  or  thoroughwort,  tea  is  an  infusion 
of  the  leaves  and  tops  of  Eupatorium  perfolia- 
t'lm,  a  plant  indigenous  to  the  United  States. 
When  taken  warm,  it  is  a  popular  diaphoretic 
in  fevers  and  for  the  purpose  of  aborting  a  cold. 
In  the  form  of  a  warm,  strong  decoction  it  is 


an  efficient  emetic.  When  cold,  the  infusion  is 
used  with  advantage  in  dyspepsia,  general  de- 
bility, and  other  conditions  in  which  a  bitter 
tonic  is  indicated.  It  has  also  been  used  as  a 
tainiacide.  The  name  "boneset"  was  given 
to  this  tea  on  account  of  its  supposed  power 
to  relieve  the  bone  pains  in  dengue  or  "  break- 
bone  fever,"    (See  Eupatorium.) 

Saffron  tea  is  an  infusion  of  the  ilowers  of 
Carthamus  tinctorius  which  enjoys  some  re- 
pute as  a  diaphoretic  in  measles  and  other  ex- 
anthemata. 

Elderberry  tea  is  made  from  the  berries  of 
several  indigenous  species  of  Sambucus,  and 
is  used  as  an  aperient  and  diaphoretic. 

Tansy  tea  is  made  from  the  leaves  and  tops 
of  Tanacetum  vulgare,  a  perennial,  herbaceous 
plant  indigenous  to  Europe,  but  also  cultivated 
and  growing  wild  in  this  country.  It  is  very 
widely  known  as  an  emmenagogue,  a  diuretic, 
an  anthelminthic,  an  aromatic  bitter,  and  an 
irritant  narcotic.  Although  it  is  useful  in 
amenorrhoea,  it  has  no  rightful  title  to  its 
widespread  repute  as  an  abortifacient.  Death 
has  resulted  in  several  instances  when  very 
large  doses  have  been  taken  for  the  purpose 
of  causing  abortion,  without  this  effect  hav- 
ing been  produced. 

Linseed,  or  flaxseed,  tea  is  a  demulcent  drink 
made  by  the  infusion  of  the  whole  seeds  of 
Linum  usifatissimum  in  water  in  the  propor- 
tion of  half  an  ounce  to  a  pint.  The  mucilage 
present  is  thus  extracted  with  only  a  small 
quantity  of  the  oil,  and  thus  a  tea  is  made 
which  may  be  advantageously  employed  in 
inflammations  of  the  respiratory,  gastro-in- 
testinal,  and  urinary  mucous  membranes.  It 
is  useful  in  dysentery,  to  relieve  strangury,  cys- 
titis, and  renal  colic,  and  to  allay  cough.  When 
the  seeds  are  boiled,  more  of  the  oily  matter  is 
extracted  which  renders  the  decoction  less  fit 
to  be  given  by  the  mouth,  but  useful  as  a  laxa- 
tive enema. 

German  "  breast  tea,"  or  marshmallow  tea, 
is  another  demulcent  drink  which  is  made  from 
the  root  of  Althcea  officinalis,  and  is  official  in 
the  German  Pharmacopoeia  as  compound  althaea 
tea.  It  is  much  used  in  coughs,  colds,  and  bron- 
chial affections.  Occasionally  the  roots  of  other 
species  of  the  Jilalvacece  are  substituted  for  the 
marshmallow,  without  disadvantage,  as  they  all 
possess  similar  qualities. 

Worm  tea  is  a  popular  anthelminthic  for  the 
roundworm,  Ascaris  lumbricoides.  It  is  also 
known  as  the  compound  infusion  of  spigelia, 
and  is  composed  of  spigelia,  senna,  fennel, 
manna,  and  savine,  infused  in  water,  but  the 
proportions  in  which  these  drugs  are  used  is 
not  always  the  same. 

Oarfield  tea  and  Hamburg  tea  are  two 
proprietary  preparations  which  have  beeri 
widely  advertised,  but  hardly  deserve  notice. 
Garfield  tea  is  said  to  consist  chiefly  of  senna 
leaves  and  couch  grass  with  aromatios,  while 
Hamburg  tea  is  a  mixture  of  senna,  manna,' 
and  coriander. — Matthias  Lanckton  Poster. 

TEEL  OIL. — See  Sesame  oil. 

TENTS,  sometimes  employed  in  gyna;colog- 
ical  practice,  are  pencils  of  compressed  sponge 


TBREBBNB 
TBRPIN  HYDKATE 


370 


or  other  material  capable  of  expanding  on  the 
absorption  of  moisture.  They  were  formerly 
much  used  for  dilating  the  cervical  canal  of 
the  uterus.  Besides  sponge,  cornstalk,  slip- 
pery-elm bark,  the  stem  of  Laminaria  digitata, 
and  the  root  of  Nyssa  aquatica  (tupelo)  have 
been  utilized  for  making  tents.  Of  these  ma- 
terials, sponge,  laminaria,  and  tupelo  are  most 
epmloyed. 

Sponge  tents  are  made  from  fine  grained 
surgical  sponges  of  small  size.  These  are 
cleansed  and  disinfected,  and  are  then  sub- 
jected to  pressure,  either  by  winding  them  with 
twine  or  by  some  mechanical  device  until  they 
are  reduced  to  the  size  of  the  finger.  They  are 
allowed  to  dry  and  then  are  trimmed  to  the 
shape  of  a  slender  cylinder  or  cone  2-J-  inches 
long  and  -J-  inch  or  less  in  diameter.  Sponge 
tents  are  effectual  dilators,  but  are  particularly 
objectionable  from  the  standpoint  of  asepsis. 
Used  in  the  cervical  canal,  they  abrade  the  mu- 
cous surfaces,  soften  the  tissues,  and  sink  into 
the  cervical  folds.  On  the  removal  of  the  tent, 
fragments  of  the  sponge  are  liable  to  be  left 
behind.  Sometimes  the  tent  is  found  quite 
offensive  when  it  is  removed.  The  patient  is 
thus  exposed  to  septic  infection,  notwithstand- 
ing the  utmost  antiseptic  precaution.  Usually 
two  or  three  tents  have  to  be  used  in  succession 
to  effect  the  required  dilatation. 

Laminaria  tents  are  made  of  the  stalk  of 
Laminaria  digitata  turned  into  smooth  pencils. 
Their  dilating  power  is  little  inferior  to  that 
of  sponge,  but  they  are  apt  to  expand  unequally, 
leaving  a  constricted  zone  at  the  os  internum, 
and  are  therefore  withdrawn  with'  difficulty. 
The  point  of  constriction,  too,  where  the  dila- 
tation fails,  is  the  one  where  dilatation  is  most 
needed. 

riipeZoien^s  possess  great  and  equable  expan- 
sile power  and  dilate  more  gently  than  lami- 
naria. A  tupelo  tent  expands  to  two  or  three 
times  the  diameter  it  had  in  the  dry  state,  it  is 
smoother  than  sponge,  and  it  does  less  injury 
to  the  cervical  tissues.  Tupelo  is  therefore 
the  most  suitable  material  for  tents  if  they  are 
to  be  used  for  dilating  the  uterus. 

Both  laminaria  and  tupelo  are  open  to  the 
same  objections  that  obtain  in  the  case  of 
sponge,  though  in  less  degree.  It  is  practically 
impossible  to  maintain,  even  for  a  few  hours, 
an  aseptic  condition  of  the  cervical  canal,  even 
though  it  be  primarily  sterile  to  culture  tests. 
Dilatation  of  the  uterus  with  tents  is  always 
attended  with  danger,  and  the  plan  has  fallen 
into  disuse,  except  for  cases  in  which  the 
rigidity  of  the  cervical  tissues  is  so  great  as  to 
resist  the  action  of  the  steel  dilators. 

Tents,  if  used  at  all,  must  first  be  sterilized 
and  the  passages  prepared  as  carefully  as  for  a 
surgical  operation.  A  convenient  and  effectual 
method  of  sterilizing  the  tent  is  by  exposure 
for  several  hours  in  a  corked  phial  to  a  tem- 
perature of  about  302°  P.  The  vagina  and 
the  immediate  external  surroundings  are  to  be 
thoroughly  scrubbed  with  soap  and  hot  water. 
The  cervical  canal  is  cleansed  of  mucus  with  a 
curette  and  repeatedly  wiped  out  with  a  cotton- 
wrapped  probe  dipped  in  the  mercurial  solu- 
tion.   The  cervix  and  vagina  are  subjected 


to  a  prolonged  douching  with  a  l-to-2,000 
bichloride-of-meroury  solution,  the  parts  being 
scrubbed  with  a  swab  of  sterile  cheese  cloth 
during  the  irrigation.  The  cleansing  of  the 
cervical  canal  may  be  completed  by  introduc- 
ing for  a  few  moments  a  cotton-wrapped  pi-obe 
dipped  into  a  mixture  of  equal  parts  of  glycerin 
and  carbolic  acid  or  some  other  equally  power- 
ful antiseptic. 

To  introduce  the  tent,  the  patient  is  placed 
in  the  Sims  posture,  and  the  cervix  brought 
into  view  with  the  aid  of  a  Sims  speculum. 
The  cervix  is  drawn  gently  forward  and 
steadied  with  a  volsella  caught  in  the  anterior 
lip.  The  phial  containing  the  tent  is  now  un- 
corked, the  tent  seized  with  sterile  dressing 
forceps  and  passed  its  entire  length  into  the 
cervical  canal.  Sometimes  several  small  tents 
are  better  than  a  single  large  one.  As  an  ad- 
ditional precaution  against  sepsis,  the  tent, 
immediately  before  its  insertion,  may  be  wet 
with  the  antiseptic  solution  and  dipped  in 
sterilized  iodoform  powder  till  it  is  well  coated 
with  it.  The  tupelo  tent,  which  is  much  the 
best  of  the  varieties  mentioned,  is  apt  to  slip 
out  of  the  canal  if  left  unsupported.  A  vaginal 
tampon  of  iodoform  gauze  should  therefore  be 
placed  underneath  it.  A  tent  ought  not  be  left 
in  the  cervix  more  than  from  eight  to  twelve 
or  twenty  hours,  and  it  must  never  be  followed 
immediately  by  another.  The  rapidity  of  dila- 
tation is  greatly  increased  if  the  vagina  is 
douched  after  introducing  the  tent  into  the 
cervix  and  the  upper  portion  of  the  tamponade 
is  well  wet  with  the  antiseptic  solution.  The 
patient  must  remain  in  bed  until  the  tent  is 
removed. 

A  kind  of  tent  occasionally  employed  in 
general  surgical  practice  differs  somewhat 
from  the  foregoing.  These  tents  are  used 
merely  to  keep  wounds  or  fistulous  tracts  open. 
They  consist  of  small  masses  of  gauze,  wioking, 
or  similar  material  rolled  or  twisted  into  cylin- 
drical or  conical  shapes  and  inserted  into  the 
fistula  or  between  the  lips  of  the  wound.  The 
object  is  to  maintain  drainage. — Charles 
Jewett. 

TEREBENE,  terehenum  (U.  S.  Ph.),  is  a 
clear,  colourless  or  slightly  yellowish,  thin 
fiuid.  It  is  produced  by  the  action  of  sul- 
phuric acid  upon  the  oil  of  turpentine.  The 
acid  must  be  gradually  added  to  the  cooled  oil 
of  turpentine,  1  part  of  acid  to  20  parts  of  oil. 
The  mixture  is  boiled  after  twenty-four  hours' 
standing,  and,  upon  cooling,  the  oily  layer  is 
removed  after  freeing  it  from  acid,  and  is 
rectified.  Terebene  has  an  agreeable,  aromatic 
odour,  something  like  that  of  freshly  cut  pine, 
and  its  taste  is  very  similar  to  that  of  turpen- 
tine. It  is  isomeric  with  turpentine,  having 
the  formula  doHie.  It  dissolves  very  slightly 
in  water,  but  is  soluble  in  equal  volumes  of 
alcohol,  glacial  acetic  acid,  and  carbon  disul- 
phide.  It  boils  at  1.50°  to  160°  P.  Exposed 
to  the  light,  terebene  gradually  becomes  resin- 
ous and,  at  the  same  time,  acid.  The  U.  S. 
Ph.  requires  that  terebene  shall  not  redden 
blue  litmus  paper  and  shall  have  but  a  very 
slight  action  on  polarized  light.    On  evapora- 


271 


TEREBEKE 
TERPIN  HYDRATE 


tion,  it  should  not  leave  more  than  a  very 
slight  residue,  indicating  a  mere  trace  of  resin- 
ous matter.  Terebene  has  a  specific  gravity  of 
0-862  at  a  temperature  of  59°  P. 

Terebene  was  first  brought  to  the  attention 
of  tlie  profession  in  1873  by  Ribau,  of  Paris, 
but  it  was  many  years  before  it  received  gen- 
eral notice.  Even  since  it  came  into  quite 
common  use  its  physiological  properties  have 
been  but  little  investigated.  It  is  likely  that 
in  its  effects  upon  the  general  system  it  re- 
sembles its  isomer,  turpentine.  Occasionally 
its  continued  ingestion  has  been  known  to  give 
rise  to  pain  in  the  lumbar  region,  and  some- 
times diarrhoea  has  appeared  after  its  use. 
Wimmer  has  called  attention  to  an  occasional 
hsmaturia,  indicating  renal  congestion,  and 
to  an  apparent  diflficulty  in  passing  urine  after 
the  administration  of  terebene.  He  concludes 
therefore  that  it  is  contra-indicated  in  the  pres- 
ence of  kidney  disease.  All  the  symptoms 
enumerated  disappeared  upon  the  withdrawal 
of  the  drug  (New  York  Medical  Journal,  Feb- 
ruary 9,  1889).  No  records  of  poisoning  by 
terebene  are  to  be  found  in  literature,  and  it  is 
probable  that  only  in  exceptional  cases  in  which 
some  idiosyncrasy  exists  are  toxic  symptoms 
likely  to  be  evoked. 

Dr.  William  Murrell,  of  London,  was  the 
first  to  direct  attention  to  the  therapeutic  value 
of  terebene  {British  Medical  Journal,  December 
12, 1885).  He  recommended  it  for  the  so-called 
"  winter  cough  "  of  chronic  bronchitis,  and  re- 
ported in  his  first  paper  many  cures.  He 
praised  the  remedy  not  only  for  its  curative 
effects  but  because  of  its  advantages  also.  Its 
ease  of  administration,  its  agreeable  taste  and 
odour,  and  its  lack  of  bulk  appealed  to  him  as 
ideal  virtues  for  a  remedy.  He  employed  tere- 
bene— as  it  is  still  frequently  employed — in 
increasing  doses,  from  5  to  6  drops  every  four 
hours  to  20  drops  at  the  same  intervals,  taken 
on  a  lump  of  sugar  or  on  granulated  sugar. 
Murrell  had  great  success  with  this  therapeutic 
measure,  and  its  use  for  pulmonary  disturb- 
ances rapidly  became  general.  Murrell  further 
stated  that  terebene  possessed  little  or  no  toxic 
action,  but  remarked  that  its  use  endowed  the 
urine  with  a  peculiar  odour.  He  found  that 
terebene  acted  well  not  only  in  winter  cough, 
but  also  when  emphysema  complicated  the 
chronic  bronchitis.  He  alleged  that  in  phthisis, 
when  there  was  old  consolidation  with  no  acti  ve 
process  going  on.  its  employment  was  of  bene- 
fit, and  believed  that  it  might  prevent  the 
occurrence  of  a  Jicemoptysis.  Murrell  also 
found  that  when  there  were  flatulence  and 
hyperacidity  present  in  addition  to  the  cough, 
these  were  also  alleviated.  He  had  good  re- 
sults, too,  in  the  employment  of  terebene  as  a 
spray  in  the  mouth  and  nostrils.  He  con- 
cluded, as  is  now  generally  accepted,  that 
terebene  is  an  excellent  expectorant,  possessing 
at  the  same  time  considerable  stimulating 
power. 

Terebene  may  be  employed  in  acute  hron- 
chiiis  after  the  earlier  stages  have  been  passed, 
as  an  expectorant  and  stimulant.  It  is  effica- 
cious in  clearing  the  larynx  for  singing  and 
speaking.   It  has  been  recommended  in  asthma, 


emphysema,  phthisis,  pleurisy,  and  pleuro- 
pneumonia. In  cases  of  pleuritic  adhesions 
its  employment  is  said  to  hasten  the  absorption 
of  the  exudate.  In  fcetid  bronchitis  and  bron- 
chiectasis its  administration  is  said  to  be  as 
efficacious  as  that  of  turpentine.  Barton 
praised  its  use  in  small  doses  in  chronic 
rhinitis,  alleging  that  the  discharge  ceased, 
the  nasal  passages  became  clear,  and  the  head- 
ache disappeared.  Terebene  is  employed  with 
alleged  good  results  in  flatulence  and  in  sub- 
aciUe  inflammations  of  the  genito-urinary  tract. 
Its  alleged  diuretic  action  has  not  been  clinic- 
ally proved.  Murrell  has  found  that  tere- 
bene has  active  antiseptic  properties,  being 
able  to  check  the  action  of  the  yeast  plant 
in  a  solution  of  1  part  to  450,  and  in  a  solu- 
tion of  a  strength  of  1  to  500  to  hinder  the 
development  of  bacteria.  It  is  also  known 
that  the  activity  of  vaccine  virus  is  destroyed 
on  contact  with  terebene.  Practically,  this  anti- 
septic influence  has  been  made  use  of  by  sub- 
stituting terebene  for  carbolic  acid  in  the 
dressing  of  wounds,  ulcers,  and  burns,  and,  it 
is  stated,  with  success.  It  has  a  considerable 
deodorizing  power,  and  thus  destroys  the  odour 
of  secretions  while  protecting  the  surface  to 
which  it  is  applied  from  contact  with  atmos- 
pheric air.  Locally,  it  may  be  applied  pure  or 
in  a  strength  of  1  to  6  in  olive  oil.  Tampons 
soaked  in  terebene  have  been  applied  to  slough- 
ing carcinomata  of  the  cervix  uteri  for  anti- 
septic and  deodorizing  purposes.  "Whether  its 
activity  in  these  respects  is  due  to  a  certain 
amount  of  untransformed  turpentine,  as  is 
alleged  by  Bond  (British  Medical  Journal,  De- 
cember 19,  1885),  or  to  the  supposed  presence 
of  hydrogen  dioxide,  as  believed  by  Cammann 
{Transactions  of  the  American  Climatological 
Association,  1888,  p.  163),  has  not  been  deter- 
mined. 

Terebene  may  be  administered  on  sugar,  al- 
though it  is  likely  that  an  insoluble  mass  may 
result  from  this  method.  It  may  be  given  in 
emulsion  or  in  capsules  or  by  atomization,  as 
recommended  by  Murrell.  It  may  be  emulsi- 
fied by  adding  to  it  equal  parts  of  olive  oil  and 
emulsifying  with  acacia  or  tragaeanth.  A  good 
prescription  is  the  following  (Wimmer,  loc. 
cit.) : 

5  Terebene 10-15  minims  ; 

Spirit  of  chloroform. . .  10  drops  ; 
Mucilage  of  tragaeanth.     1  drachm ; 

Simple  syrup J  drachm  ; 

Distilled  water,  enough  to  make  1  oz. 

M.     S. :  For  one  dose. 

The  dose  of  terebene  is  from  3  to  15  minims, 
repeated  every  four  hours.  An  adult  may 
take  a  drachm  in  divided  doses  in  twenty-four 
hours. — Samuel  M.  Brickneb. 

TEE.EBI1TTHINA.— See  Turpentine. 

TEBPIN  HYDRATE,  terpini  hydras 
(U.  S.  Ph.),  terpinum  hydratum  (Ger.  Ph.),  is 
the  hydrate  of  the  diatomic  alcohol  terpin.  Its 
formula  is  C,oH,8(OH)j.HjO,  and  it  has  a 
molecular  weight  of  189'58.  It  occurs  in  col- 
ourless, rhombic,  quite  lustrous  prisms.  It  is 
almost  entirely  odourless,  and  has  a  slightly 
aromatic  yet  somewhat  bitter  taste.    It  is  per- 


TERPINOL 
THALLASOTHBRAPY 


273 


manent  in  the  air.  Terpin  hydrate  is  soluble 
in  about  250  parts  of  water  at  59°  P.  It  is 
dissolved  in  10  parts  of  alcohol  at  tlie  same 
temperature,  and  in  boiling  water  and  alcohol 
in  lesser  quantities.  Ether,  chloroform,  and 
boiling  glacial  acetic  acid  also  dissolve  terpin 
hydrate  In  the  respective  proportions  of  100, 
300,  and  1.  '-At  496-4°  F.  anhydrous  terpin 
distils  over  without  decomposition,  soon  solidi- 
fying to  a  crystalline,  hygroscopic  mass  which 
melts  at  315-6°  to  331°  P.  When  strongly 
heated  on  platinum,  it  burns  with  a  bright, 
smoky  flame,  leaving  no  residue.  .  .  .  Terpin 
hydrate  should  not  have  the  odour  of  turpen- 
tine, and  its  hot,  aqueous  solution  should  not 
redden  blue  litmus  paper  (absence  of  adhering 
acid)."  U.  S.  Ph. 

Lepine  first  investigated,  in  1883,  the  physi- 
ological action  of  terpin  hydrate  and  found 
that  its  influence  upon  the  mucous  membranes 
and  nervous  system  was  similar  to  that  of  tur- 
pentine. Because  of  its  action  on  the  kidneys 
he  recommended  its  employment  in  chronic 
nephritis;  and  because  of  its  sedative  and 
stimulating  influence  upon  the  bronchial  mu- 
cous membranes,  he  urged  its  use  in  chronic 
bronchitis.  These  observations  were  confirmed 
subsequently  by  clinicians,  and  terpin  hydrate 
is  much  used  to-day  in  these  disorders  and  in 
the  advanced  stages  of  acute  bronchitis,  espe- 
cially when  the  expectoration  and  secretion  are 
very  free.  It  has  been  employed  in  chronic 
cystitis  and  in  gonorrhoea  with  alleged  good 
results.  Terpin  hydrate  imparts  the  charac- 
teristic odour  of  turpentine  to  the  renal  secre- 
tion, and,  given  in  too  large  or  too  long 
continued  doses,  it  may  evoke  strangury,  albu- 
minuria, or  even  haematuria.  Its  influence, 
therefore,  may  be  very  irritating  to  mucous 
membranes  if  it  is  given  in  overdoses. 

Penzoldt  cordially  commends  the  employ- 
ment of  terpin  hydrate  in  chronic  disease  of 
the  heart  and  kidneys,  particularly  in  chronic 
diffuse  nephritis,  accompanied  by  degenerative 
changes  in  the  heart  muscle,  with  albuminuria 
and  widespread  oedema.  He  has  met  with 
congestion  of  the  kidneys,  however,  after  its 
use,  as  indicated  by  haamaturia,  and  cautions 
against  its  careless  or  promiscuous  employ- 
ment {Lehrbuch  der  klinische  Arzeneibehand- 
lung,  1889).  The  drug  has  also  been  praised  in 
the  treatment  of  whooping-cough  and  hay,  fever 
and  has  been  recommended  to  prevent  the  for- 
mation ot  flatus  and  assist  its  expulsion. 

Terpin  hydrate  may  be  given  in  doses  of 
from  1  to  3  grains,  from  four  to  six  times 
daily,  in  pill,  emulsion,  or  lozenge. 

Samuel  M.  Bbickner. 

TERPINOL  is  a  mixture  of  terpenes  with 
varying  properties  and  the  alcohol  terpineol, 
CioHnOH.  It  is  a  colourless,  oily  substance, 
and  is  prepared  by  boiling  terpin  with  diluted 
mineral  acids.  It  emits  an  odour  like  that  of 
hyacinths.  It  is  insoluble  in  water,  but  dis- 
solves readily  in  alcohol  and  in  ether. 

It  is  said  to  be  efficient  in  respiratory  dis- 
eases and  to  have  little  or  no  effect  upon  the 
kidneys  and  nervous  system,  being  eliminated 
almost  entirely  by  the  lungs.    It  is  employed 


in  chronic  bronchitis  as  an  expectorant  when 
the  cough  irritates  the  bronchial  mucous  mem- 
brane. 

Terpinol  may  be  given  in  doses  of  from  3  to 
5  grains,  from  four  to  six  times  a  day,  in  cap- 
sules or  in  pill  form. — Samuel  M.  BrIcknek. 

TESTA  PIl.ffiPAIlATA.— This  is  a  prep- 
aration made  by  freeing  oyster  shells  from  all 
extraneous  matter  and  reducing  them  to  a  fine 
powder.  It  is  used  as  an  antacid,  in  doses  of 
from  10  to  40  grains,  frequently  repeated,  in 
acid  dyspepsia  and  diarrhoea. 

TESTICLE  JTTICE,  TESTICULAR 
LIQUID. — See  under  Animal  extracts  and 
JUICES  (vol.  i,  page  73). 

TETANUS  ANTITOXINE.— See  under 
Animal  extracts  and  juices  (vol.  i,  page  84). 

TETRAETHYLAMMONIUM.    —   See 

Tetrethylammonium. 

TETRAHTDROBETANAPHTHYL- 

AMINE.— See  Thermine. 

TETRAHYDROPARAUUINANISOL. 

— See  Thalline. 

TETRAIODOPYRRHOL.— See  Iodol. 

TETRAIO  DPHENOLPHTHALEIN. 

— See  NosoPHENE. 

TETRETHYLAMMONIUM.— Hofmann 

{Annalen  der  Chemie,  Ixxviii)  obtained  this 
substance  by  decomposing  its  iodide  with  moist 
silver  nitrate  or  its  sulphate  with  baryta.  It 
occurs  in  deliquescent  hairlike  needles.  It  ab- 
sorbs carbon  dioxide  from  the  air.  It  is  strong- 
ly alkaline,  saponifying  fats.  Concentrated,  it 
burns  the  tongue.  It  is  as  bitter  as  quinine. 
It  has  a  caustic  action  upon  the  epidermis  and 
an  unctuous,  alkaline  feel  when  rubbed  be- 
tween the  fingers.  Its  formula,  or  rather  that 
of  its  hydroxide,  is  (CjH6)i]Sr.0H.  It  is  not 
decomposed  by  the  galvanic  current.  It  forms 
numerous  salts  (sulphate,  nitrate,  phosphate, 
carbonate,  hydrochloride,  hydrobromide,  io- 
dide, and  bromide),  and  beautiful  double  salts 
with  platinum,  gold,  mercury,  etc. 

The  drug  was  first  used  medicinally  by  the 
undersigned  (see  New  York  Jledical  Journal, 
September  16,  1893).  With  Mr.  Thomas  A. 
Edison  I  sought  the  best  solvent  for  uric  acid, 
in  order  to  make  use  of  it  with  electricity  (cata- 
phoretically)  in  gouty  and  rheumatic  joints. 
We  prepared  several  hundred  of  the  small 
glass  phials,  each  holding  about  two  cubic  cen- 
timetres of  different  liquid  solvents,  corked 
and  labelled.  Into  each  was  dropped  a  small 
quantity  of  powdered  uric  acid  as  obtained 
chemically  pure  from  Germany,  and  then  we 
filled  up  the  phials  each  with  one  solution. 
After  shaking  them  up  they  were  set  aside  for 
periodical  examination.  Only  two  of  these 
phials  showed  that  the  uric  acid  had  dissolved 
— ^that  is,  with  anything  like  readiness.  The 
two  effective  solutions  were  that  of  neurine 
and  that  of  tetrethylammonium.  On  repeti- 
tion, these  were  found  to  dissolve  uric  acid 
quite  freely.  I  compared  the  relative  values 
of  tetrethylammonium  and  piperazine,  and 
found  that  the  former  was  much  more  effective 
than  the  latter  as  a  solvent  for  urea,  uric  acid. 


273 


TEEPIXOL 
THALLASOTHBRAPY 


and  the  like.  I  employed  10-per-cent.  solu- 
tions of  each  for  the  experiments.  Urate  of 
sodium  removed  from  the  knee  of  a  patient 
dissolved  readily  in  both  neurine  and  tetrethyl- 
ammonium.  It  seems  that  both  nenrine  and 
tetrethylammonium  are  normal  constituents 
of  the  bodies  of  animals,  and  it  may  be  that 
the  diseases  in  which  urates  are  produced  and 
accumulate  in  the  system  are  due  to  a  defi- 
ciency of  what  seem  to  be  normal  elements  of 
our  structures. 

It  was  first  tried  on  rabbits,  to  establish  the 
dose,  and  then  in  some  cases  of  acute  and 
chronic  rheumatism.  In  these  patients  it  had 
beneficial  effects,  though  doubtless  its  chief 
use  would  be  in  cases  with  uric-acid  calculi 
and  allied  conditions.  It  is  important  to  bear 
in  mind  that  tetrame<%/animonium  is  poison- 
ous, giving  rise  to  symptoms  similar  to  those 
produced  by  curare,  whereas  tetrethylammoni- 
um may  be  employed  with  safety. 

The  doses  that  may  be  safely  used  by  the 
mouth  are  from  10  to  30  minims  of  a  10- 
per-cent.  solution  three  times  a  day.  Hypo- 
dermically,  it  would  be  better  to  have  a 
1-per-cent.  solution  and  to  inject  not  more 
than  10  minims  of  this  until  one  was  assured 
that  no  deleterious  effect  upon  the  tissues  was 
produced. 

It  may  prove  especially  useful  in  the  place 
of  solutions  of  lithium  salts  when  applied  on 
positive  galvanic  electrodes  about  gouty  joints 
or  rheumatic  tophi.  The  l-per-cent.  solution 
may  be  used  for  cataphoretic  purposes. 

Frederick  Peterson. 

TETBONAL  is  a  hypnotic  of  the  disul- 
phone  group,  the  difference  between  it  and 
trional  being  that  it  contains  four  ethyl  mole- 
cules, while  trional  contains  but  three.  Its 
formula  is  (CaH6)j.C(SOj03H6)j,diethylsulphon- 
diethylmethane.  It  is  produced  by  oxidiz- 
ing diethylketouemercaptol,  (CsH6)'i.C(SC2H6)2, 
with  potassium  permanganate  after  substitut- 
ing diethylketone,  (CjH6)aC0a,  for  acetone, 
(CsHaO),  during  the  manufacture  of  sulphonal. 
Tetronal  occurs  in  colourless,  shining  plates 
and  laminae.  It  is  soluble  in  450  parts  of  cold 
water,  in  alcohol,  and  in  ether,  and  has  a  neu- 
tral reaction.  Its  melting  point  is  193-3°  F. 
Its  solutions  are  odourless  and  tasteless. 

Although  tetronal  and  trional  are,  for  all 
practical  purposes,  interchangeable,  each  has 
slight  advantages  and  disadvantages.  Tetronal 
may  be  given  as  a  sedative  hypnotic  in  cases  of 
insomnia  due  to  nervousness  or  restlessness  de- 
pendent upon  organic  nervous  disease  or  func- 
tional disturbances.  It  has  no  great  value  as 
a  hypnotic  when  sleeplessness  is  due  to  pain, 
and  it  is  not  to  be  recommended  in  the  higher 
degrees  of  psychic  disturbance  or  when  de- 
lirium is  present.  It  does  not  seem  to  be  in- 
jurious when  administered  for  the  sleeplessness 
of  the  acute  infectious  diseases. 

Administered  in  doses  of  from  5  to  30  grains 
from  a  half  to  a  quarter  of  an  hour  before  bed- 
time, it  produces  a  quiet,  dreamless  sleep  of  a 
puration  varying  with  the  dose.  Its  effects  seem 
to  depend  upon  the  age,  sex,  constitution,  and 
disease  of  the  patient,  and  the  dose  must  be 


regulated  according  to  these  conditions.  It 
requires  from  fifteen  minutes  to  halt  an  hour 
for  tetronal  to  produce  its  effect,  which  is  usu- 
ally more  sedative  than  that  of  trional  and 
equally  hypnotic.  Renewed  too  frequently,  its 
hypnotic  influence  may  become  blunted,  and 
in  these  instances  trional  will  usually  exert 
the  desired  effect. 

After  the  ingestion  of  tetronal,  or  on  the 
day  following  its  administration,  there  may  be 
a  complaint  of  lassitude  and  drowsiness,  and, 
according  to  some  observers,  there  is  no  other 
ill  effect  from  its  use.  Other  wj-iters  have  re- 
ported pain  in  the  head,  anorexia,  nausea  and  . 
vomiting,  vertigo  and  ineo-ordination,  and  dis- 
turbances on  the  part  of  the  kidneys.  When 
these  symptoms  arise,  the  drug  must  be  at 
once  withdrawn  and  emeto-catharsis  and  diu- 
resis must  be  evoked. 

Tetronal  may  be  found  in  the  urine  as  such, 
not  being  decomposed  in  the  body,  as  might  be 
expected  from  its  composition.  If  not  ex- 
creted at  once,  it  may  subsequently  have  a 
delayed  or  postponed  action,  like  sulphonal. 
It  is  a  usual  practice,  therefore,  to  discontinue 
its  administration  after  it  has  been  given  for 
three  or  four  nights.  It  is  said  that  no  tetronal 
habit  is  formed. 

Tetronal  is  most  advantageously  given  in 
hot  milk.  The  average  dose  is  15  grains, 
which  may  be  repeated,  if  necessary,  in  an 
hour.    (See  Trional.)— Samuel  M.  Brickner. 

TEUCE.IN.— This  is  a  dark-brown  liquid, 
an  aqueous  extract  of  Teucrium  scordium. 
It  is  furnished  in  the  form  of  hermetically 
sealed  glass  tubes,  each  containing  about  45 
grains  of  the  liquid.  Professor  von  Mosetig- 
Moorhof  has  used  teucrin  extensively  in  the 
treatment  of  cold  abscesses,  tuberculous  ade- 
nitis, lupus  vulgaris,  and  actinomycosis.  The 
contents  of  a  tube  are  injected  subcutaneously. 
The  action  of  the  remedy  is  to  set  up  an  in- 
flammatory action  around  the  tuberculous  or 
other  deposit,  after  the  manner  of  tuberculin, 
and  so  bring  about  its  expulsion.  Some  ob- 
servers report  that  it  causes  a  rise  of  the  tem- 
perature, but  others  have  not  noticed  any  such 
effect.  According  to  Dr.  Cerna,  10  grains  of 
teucrm,  made  into  an  ointment  with  lanolin 
and  olive  oil  and  applied  to  hcemorrhoids  once 
a  day,  are  said  to  give  great  relief. 

TEXTCBITJliI.  —  Teucrium  scordium,  the 
garlic-germander,  or  water-germander,  of  Eu- 
rope, an  ajugeous  herb,  was  formerly  used  as 
an  anthelminthic,  diaphoretic,  and  tonic.  It 
has  lately  come  into  notice  again  as  the  source 
of  teucrin  (q.  v.). 

THAIiLASOTHERAPY  may  be  held  to 
include  sea  bathing,  residence  upon  the  sea- 
shore, with  such  occupations  as  fishing,  boat- 
ing, etc.,  and  sea  voyages.  There  are  few 
conditions  in  which  any  of  these  would  be 
contra-indicated,  and  they  are  those  in  which 
moist  air  has  an  injurious  effect  upon  the  mu- 
cous membranes  of  the  air-passages,  as  in  tu- 
berculosis, and  catarrhal  states  in  which  there 
is  a  tendency  to  relaxation  and  flabbiness  of 
the  mucous  surfaces  and  when  the  diminution 
of  the  amount  of  moisture  exhaled  by  the  skin 


THALLASOTHBRAPY 
THALLINE 


274 


and  through  the  lungs  would  be  injurious,  as 
in  Bright's  disease.  Also  acute  affections  of 
the  eyes  in  which  a  strong  light  is  irritating 
would  be  a  contra-indioation.  Moreover,  some 
persons  with  a  rheumatic  tendency  are  apt  to 
puffier  more  from  rheumatism  at  the  seaside  than 
in  the  interior.  Those  who  receive  the  greatest 
benefit  are  convalescents  from  acute  disease 
and  those  run  down  by  overwork,  mental  anx- 
iety, or  excesses  of  any  kind.  The  relief  some- 
times gained  by  the  victims  of  hay  fever  by 
residence  upon  an  arid  shore  is  hardly  to  be 
attributed  to  any  specific  element  in  the  air, 
but  rather  to  the  absence  of  the  exciting  cause, 
pollen. 

It  is  usual  for  removal  to  the  seashore,  even 
by  those  in  robust  health,  to  be  followed  by 
increased  appetite  and  great  capacity  for  sleep, 
which  is  usually  profound  and  refreshing,  al- 
though some,  especially  children,  are  made 
sleepless  for  a  while  by  the  noise  of  the  waves 
on  the  shore.  This,  however,  usually  wears  off 
in  a  day  or  two  and  is  only  one  of  the  minor  dis- 
advantages to  be  considered.  Constipation  or 
diarrhoea  sometimes  occurs  at  first,  but  either 
yields  to  the  simplest  treatment.  When  the 
question  of  bathing  is  of  little  importance,  the 
most  desirable  points  are  upon  the  coast  of 
Maine  and  the  British  provinces,  as  hot  days 
are  the  exception  and  cool  nights  the  rule. 
Many  other  points  upon  the  Atlantic  Ocean 
can  be  found,  such  as  along  the  Rhode  Island, 
New  Jersey,  and  Long  Island  shores,  where 
the  conditions  are  nearly  as  favourable  and 
are  as  a  rule  fairly  satisfactory.  It  is  desir- 
able that  some  locality  not  in  the  vicinity  of 
wooded  or  marshy  spots  should  be  selected,  as 
when  they  exist  mosquitoes  are  almost  sure  to 
be  found,  and,  while  they  may  not  be  very  an- 
noying to  persons  in  good  health,  they  are  a  se- 
rious complication  for  those  out  of  health.  In 
marshy  places  they  may  be  kept  down  to  a 
considerable  extent  by  pouring  small  amounts 
of  crude  petroleum  upon  the  surface  of  the 
water.  This  either  destroys  the  larvae  or  pre- 
vents their  escape,  and  the  procedure,  if  car- 
ried out  with  regularity,  will  undoubtedly 
diminish  the  number  in  a  very  marked  man- 
ner. 

The  coasts  of  tropical  and  seraitropical  lo- 
calities are  freely  visited  during  the  winter 
months,  but  caution  in  selecting  appropriate 
cases  must  be  exhibited,  as  the  humidity  is 
generally  greater  than  at  the  Northern  resorts, 
and  there  is  more  temptation  to  exposure.  For 
persons  in  good  health  there  are  no  particular 
objections  to  be  urged  against  them. 

It  is  safe  to  assume  that  malaria  is  absent 
from  the  large  majority  of  seaside  resorts  in 
the  northern  portion  of  the  United  States, 
but  in  the  warmer  portions  it  may  be  found 
where  the  soil  consists  largely  of  decomposed 
vegetable  matter,  or  where  extensive  marshes 
which  are  only  semi-ocoasionally  covered  by 
water  are  found.  Many  such  localities  exist 
along  the  shores  of  the  Gulf  of  Mexico,  and 
they  should  be  avoided  during  the  warmer 
months.  In  many  of  the  small  settlements 
made  up  of  cheaply  constructed  houses  crowd- 
ed closely  together  the  sanitary  arrangements 


are  very  bad  and  the  water  supply  is  apt  to  be 
contaminated  from  the  privy  vaults.  As  a  re- 
sult, numerous  cases  of  typhoid  fever  have  been 
directly  traced  to  them.  This  point  should 
therefore  be  carefully  looked  into  in  selecting 
a  locality.  It  is  also  unfortunate  that  in  too 
many  instances  the  food,  etc.,  are  poor,  and 
whatever  benefit  might  be  derived  from  the 
sea  air  is  overbalanced  by  the  lack  of  reason- 
able comforts. 

The  belief  that  exposure  to  the  night  air  of 
the  seashore  or  fogs  and  being  wet  by  salt 
water  are  less  apt  to  be  followed  by  "  catching 
cold"  than  like  occurrences  inland  is  wide- 
spread and  is  certainly  true  in  a  measure.  The 
fact  is  probably  due  to  the  better  general  con- 
dition of  the  person  and  to  the  moderate  stimu- 
lation of  the  cutaneous  circulation. 

The  effect  of  the  sun  is  an  element  not  to  be 
lost  sight  of  in  residence  upon  the  seacoast, 
and  the  practice  of  spending  hours  upon  the 
sand  in  the  scantiest  possible  bathing  suits  is 
to  be  encouraged,  especially  among  children, 
but  unless  they  are  very  strong  they  should 
not  be  allowed  to  dash  in  and  out  of  the  water, 
although  in  those  with  a  sluggish  circulation 
the  evaporating  of  the  salt  water  upon  the  sur- 
face of  the  body  and  the  stimulant  effects  of 
the  salts  left  may  be  beneficial.  When  con- 
siderable time  is  spent  upon  the  sand  it  is 
wise  to  protect  the  head  from  the  direct  rays 
of  the  sun  by  an  umbrella  or  something  of  the 
sort,  and  persons  with  skins  particularly  sus- 
ceptible to  the  action  of  the  sun  should  begin 
cautiously,  so  as  to  avoid  blistering. 

When  bathing  is  the  principal  attraction  to 
the  shore,  the  question  as  to  whether  still  wa- 
ter or  an  ocean  beach  should  be  selected  is  one 
which  will  depend  upon  the  physical  strength 
of  the  persons  concerned.  Surf  bathing,  even 
under  the  best  possible  conditions,  is  danger- 
ous and,  except  to  the  very  strong,  exhausting, 
and  it  is  safe  to  assume  that  its  advantages 
rarely  counterbalance  its  disadvantages.  Still- 
water bathing,  such  as  is  found  in  bays  and 
large  arms  of  the  sea,  is  much  to  be  preferred  ; 
yet  shallow  coves,  etc.,  where  the  water  becomes 
very  warm,  are  not  to  be  selected,  as  the  effect 
of  such  water  is  enervating  rather  than  stimu- 
lating, and.  moreover,  it  is  apt  to  be  dirty  and 
the  bottom  muddy.  Children,  however,  do 
not  appear  to  suffer  from  paddling  around  in 
such  places.  It  is  rather  curious  that  corns  are 
often  cured  by  wading  in  the  soft  warm  mud 
exposed  at  low  tide  in  such  localities.  Young 
children  in  many  instances  have  an  unreason- 
ing fear  of  the  water  and  should  not  be  forued 
to  enter  it.  If  they  are  allowed  to  "  paddle  " 
and  wade  around  the  margin  they  will  soon 
lose  their  fear  and  go  in  freely. 

The  popular  belief  is  that  before  breakfast  is 
the  proper  hour  for  bathing,  but  it  is  rare  that 
persons  are  found  who  are  benefited  by  taking 
baths  at  that  hour.  The  most  fitting"  time  is 
midway  between  two  meals,  when  the  system 
is  well  provided  with  food  and  the  processes  of 
digestion  are  completed.  Bathing  with  the 
stomach  full  of  food  is  apt  to  check  digestion, 
and  there  is  little  doubt  that  many  cases  of  the 
so-called  "  cramp  "  are  due  to  the  sudden  shock 


275 


THALLASOTHERA  PY 
THALLINE 


and  resultant  circulatory  changes.  On  the 
other  hand,  it  is  by  no  means  a  bad  plan  to  eat 
a  small  amount  of  light  food  soon  after  leaving 
the  water.  The  length  of  time  which  can  be 
spent  in  the  water  withoiit  disadvantage  will 
vary  greatly  in  accordance  with  the  general 
health  and  strength  of  the  person,  and  can 
be  ascertained  only  by  trial.  It  should  not, 
however,  reach  the  moment  when  the  exhila- 
rating and  stimulating  effects  cease,  as  when 
this  occurs  a  feeling  of  depression  follows 
which  may  continue  for  hours,  and  the  effect 
of  the  bath  be  bad  rather  than  good. 

For  persons  unaccustomed  to  sea  bathing, 
convalescents,  or  the  delicate,  it  is  wiser  to  be- 
gin with  a  single  dip  and  to  lengthen  the  time 
progressively.  As  a  rule,  it  is  rare  that  the 
duration  of  a  bath  should  be  prolonged  beyond 
fifteen  minutes,  and  under  all  circumstances 
chilliness,  blueness  of  the  lips,  or  a  fatigued 
feeling  Indicates  that  the  limit  of  beneiit  has 
been  exceeded.  Long  swims,  diving,  or  strug- 
gling against  a  heavy  surf  should  still  further 
cut  down  the  time,  as  exercise  renders  the  sys- 
tem less  resistant  to  the  depressing  effect  of  a 
bath.  When  diving,  it  is  best  to  place  small 
pieces  of  absorbent  cotton  in  the  ears  to  reduce 
the  danger  of  rupture  of  the  tympanic  mem- 
brane. Severe  exercise  immediately  after  bath- 
ing is  not  to  be  recommended.  The  person 
should  be  dried  as  quickly  as  possible  with 
rough  towels,  so  as  to  cause  a  healthful  glow 
upon  the  surface.  It  is  common  to  shower 
with  fresh  water  after  a  sea  bath,  but,  although 
it  is  rather  more  agreeable  to  do  so,  it  is  wiser 
to  omit  this  when  the  cutaneous  circulation  is 
sluggish,  as  the  small  amount  of  the  salts  left 
upon  the  skin  acts  as  a  stimulant  to  it. 

Often  large  numbers  of  medusw,  popularly 
known  as  "  jelly  fish,"  are  found  in  the  water, 
and  they  are  very  apt  to  give  rise  to  consider- 
able irritation  of  the  skin  if  they  come  in  con- 
tact with  it.  Usually  the  pain  and  redness 
subside  quickly,  and  some  relief  may  be  gained 
by  sponging  the  surface  with  a  weak  solution 
of  carbonate  or  bicarbonate  of  sodium.  Per- 
sons with  delicate  skins  will  do  well  to  keep 
out  of  the  water  when  the  medusae  are  numer- 
ous, as  sometimes  a  condition  approaching  der- 
matitis is  set  up  by  them. 

It  is  safe  to  assume  that  few  morbid  states 
contra-indicate  sea  bathing  for  those  accus- 
tomed to  it,  provided  the  person  does  not  be- 
come fatigued  or  chilled.  As  a  rule,  it  would 
be  hardly  advisable  to  allow  pregnant  women 
to  bathe  indiscriminately,  but  if  it  has  been 
customary,  there  would  be  little  objection  to  it 
up  to  the  eighth  month,  provided  the_ water 
was  calm.  During  menstruation  it  is  not 
often  proper,  except  when  the  process  lasts  but 
a  few  days  and  the  condition  of  the  pelvic  or- 
gans is  normal.  In  cases  of  chronic  diseases 
the  condition  of  the  individual  must  be  taken 
into  account. 

Bathing  and  prolonged  residence  upon  the 
seashore  are  held  in  high  esteem,  especially  by 
the  French,  in  the  treatment  of  the  conditions 
grouped  under  the  name  of  scrofula,  and  there 
is  little  doubt  that  they  are  of  great  value,  but 
the  appropriate  dietetic  and  medicinal  treat- 


ment should  not  be  neglected.  In  this  condi- 
tion it  is  probable  that  the  improved  appetite 
and  nutrition  are  rather  more  active  factors 
than  the  iodine  assumed  to  exist  in  sea  air. 
During  the  Jirst  dentition,  when  diarrhoea  ex- 
ists, it  is  rare  that  sea  air  does  not  produce  a 
rapid  change  for  the  better,  even  if  its  influ- 
ence is  exerted  for  a  few  hours  only. 

Sea  voyages  are  usually  of  great  benefit  to 
coiwalescents  or  the  broken  down,  as,  when 
they  are  taken  under  proper  conditions,  there 
is  absolute  freedom  from  worry  and  the  appe- 
tite is  better  and  the  sleep  sounder  and  more 
refreshing.  Of  course  there  are  some  unfortu- 
nate individuals  who  suffer  for  many  days 
with  seasickness,  and  often  to  such  an  extent 
as  to  threaten  life,  and  for  them  a  voyage 
would  be  entirely  inadmissible.  For  those 
who  are  not  so  unpleasantly  affected,  a  day  or 
two  of  seasickness  is  by  no  means  a  disadvan- 
tage, as  enforced  abstinence  from  food  is  usu- 
ally followed  by  an  improved  condition  of  the 
digestive  apparatus. 

It  is  usual  for  constipation  to  exist  during 
the  first  few  days  of  a  voyage,  but  it  may  be 
overcome  by  mild  laxatives  or  the  eating  of 
fruit  before  breakfast.  When  the  condition  of 
the  person  approaches  neurasthenia  it  is  much 
wiser  to  select  a  trip  longer  than  the  ordinary 
transatlantic  voyages,  and,  provided  a  com- 
fortable sailing  vessel  can  be  found,  it  is  much 
better  than  a  steamer.  At  almost  any  time 
vessels  can  be  found  about  to  make  voyages  of 
from  thirty  to  ninety  days,  and  usually  the 
ofBcers  enjoy  the  presence  of  passengers  and 
endeavour  to  make  them  comfortable.  The 
greatest  objection  to  sailing  vessels  is  that,  al- 
though the  accommodations  are  usually  better 
than  on  steamers,  the  food  is  apt  to  be  less  tempt- 
ing; but  this  is  generally  no  great  drawback, 
for  after  a  few  days  food  which  on  shore  would 
be  rejected  is  eaten  with  relish.  On  a  long 
voyage  of  this  kind  an  abundance  of  under- 
clothing must  be  taken,  as  there  is  little  op- 
portunity for  its  being  satisfactorily  washed 
and  ironed.— Russell  H.  Nevins. 

THAIiXiINE,  or  tetrahydroparamethyloxy- 
quinoline,  is  a  synthetical  product  first  pre- 
pared by  Skraup  in  1885.  Thorns  gives  the 
following  as  its  formula: 

H  HH 
I     \/ 
C     C 
^\  /\     H 
CH3O  — C    C    C<g 


-C     C      C<: 


H 

C     N 

I       I 

H  H 
By  heating  paraamidoanisol,  glycerin,  and  sul- 
phuric acid  in  the  presence  of  an  oxidizing 
agent,  paranitroanisol,  a  substance  is  obtained 
which  is  called  paraquinanisol.  When  this 
substance  is  treated  with  reducing  agents,  such 
as  tin  and  hydrochloric  acid,  it  is  caused  to 
take  up  four  atoms  of  hydrogen,  which  changes 
it  to  thalline,  so  called  because  oxidizing 
agents  produce  with  it  a  deep  emerald-green 
colour.     It  occurs  in  colourless  or  yellowish 


THAPSIA 
THERMINE 


276 


rhombic  crystals  which  melt  at  104°  F.  and  re- 
crystallize  on  cooling.  It  is  soluble  in  water, 
in" alcohol,  and  in  ether,  is  neutral  in  reaction, 
has  a  characteristic  aromatic  odour  which  re- 
sembles that  of  the  tonka  bean,  and  enters  into 
combination  with  acids  to  form  salts,  of  which 
the  sulphate,  thalUnum  sulfuricum  (Ger.  Ph.), 
and  the  tartrate  are  the  most  important. 
Thalline  itself  is  not  used  in  medicine,  but  is 
represented  bv  these  combinations. 

The  sulphate  is  a  whitish  or  yellowish  crys- 
talline powder,  with  the  characteristic  odour 
of  thalline  and  a  taste  described  as  acid,  saline, 
bitter,  and  spicy.  It  is  soluble  in  from  five  to 
seven  parts  of  cold  water,  freely  soluble  in  boil- 
ing water,  and  sparingly  soluble  in  alcohol. 
All  these  solutions  gradually  assume  a  brown- 
ish hue  on  exposure  to  light  and  air.  This  is 
the  more  frequently  employed  of  these  two 
salts,  and  is  therefore  the  more  important. 

The  tartrate  also  occurs  in  a  crystalline  pow- 
der which  closely  resembles  the  sulphate  in 
appearance,  odour,  and  action.  It  is  soluble  in 
ten  parts  of  water,  in  which  it  makes  an  acid 
solution.  It  is  very  sparingly  soluble  in  alco- 
hol. 

The  thalline  salts  are  antiseptic  and  antipy- 
retic. A  solution  of  from  4  to  5  per  cent, 
is  destructive  to  micro-organisms,  while  the 
internal  administi-ation  of  from  5  to  15  grains 
will  cause  a  fall  of  the  temperature  in  a  case 
of  hyperpyrexia  of  four  or  five  degrees  in 
two  hours,  but  this  drug  is  not  a  favourite 
remedy.  The  results  of  physiological  experi- 
ments indicate  that  these  salts  are  poisonous 
to  the  red  blood-cells  and  to  the  nervous  sys- 
tem, while  clinical  experience  has  demonstrated 
that  they  tend  to  lessen  the  cardiac  energy,  re- 
duce the  blood-pressure,  occasion  profuse  per- 
spiration, and  cause  extreme  prostration.  The 
administration  of  this  drug  has  been  followed 
also  by  chills,  cutaneous  eruptions,  cyanosis, 
vomiting,  diavrhcea,  and  albuminuria.  The 
duration  of  its  antipyretic  action  has  been 
stated  as  three  hours;  it  may  be  longer,  but 
it  is  usually  brief.  It  has  been  recommended 
particularly  in  typhoid  fever,  but  it  may  be  ob- 
jected to  its  use  that  if  does  not  exercise  any 
influence  over  the  disease  itself,  that  its  anti- 
pyretic action  is  more  transient,  less  effective, 
and  less  safe  than  that  of  some  other  remedies 
which  belong  to  the  same  class  as  thalline,  and 
finally  that  fatal  results  have  occurred  from  its 
use  in  this  disease. 

In  tuberculosis  thalline  causes  a  rapid  reduc- 
tion of  the  temperature,  but  it  has  been  found 
that  this  result  is  apt  to  be  accompanied  by 
alarming  prostration,  even  when  the  drug  has 
been  given  in  small  doses. 

It  should  bo  mentioned  that  Demme,  Grif- 
fiths, and  others  have  expressed  very  favourable 
opinions  of  the  action  of  thalline  in  reducing 
the  temperature  in  high  fevers  in  children. 

As  an  antiseptic,  the  use  of  thalline  has  been 
principally  confined  to  its  employment  as  an 
injection  in  gonorrhcea  and  gleet.  In  gonor- 
rhcea  the  use  of  a  solution  of  from  2  to  4 
per  cent,  in  strength  has  been  recommended, 
and  some  of  its  advocates  advise  that  at  the 
same  time  the  drug  shall  be  given  internally, 


about  3  grains  four  times  a  day.  For  gleet 
a  weaker  solution  is  considered  sufficiently 
powerful. 

When  given  internally,  thalline  is  eliminated 
mainly  by  the  kidneys  and  gives  the  urine  a 
dark,  brownish  colour. 

The  dose  of  the  thalline  salts  may  be  said  to 
vary  from  1  to  15  grains.  When  thalline  is 
used  as  an  antipyretic,  probably  the  best  results 
will  be  obtained  by  giving  from  i  to  1  grain 
every  hour  or  two,  and  carefully  watching  the 
effect. — Matthias  Lanokton  Foster. 

THAPSIA. — Thapsia  garganica,  an  um- 
belliferous plant  of  Algeria  and  southern 
Europe,  furnishes  a  very  irritating  resin,  which 
is  the  essential  ingredient  of  the  sparadrap  de 
thapsia  of  the  French,  a  plaster  that  is  used 
as  a  rubefacient  and  vesicant.  Great  care  is 
required  in  its  employment,  for  its  prolonged 
retention  in  place  is  apt  to  cause  ulceration. 

THEA.— See  Tea. 

THEINE,  or  trimethylxanthine,  is  an  alka- 
loid found  in  the  leaves  ol,Thea  chinensis,  or 
Camellia  Thea,  isomeric  with  caffeine  and 
guaranine,  and  is  the  chief  active  principle  in 
the  beverage  ordinarily  known  as  tea.  Its 
chemical  formula  is  C8H,oN40a-l-HsO.  It  oc- 
curs in  snow-white  needlelike  crystals,  solu- 
ble in  fifty  parts  of  cold  and  about  two  parts 
of  boiling  water,  odourless  and  of  a  feebly 
bitter  taste.  Applied  to  the  tongue,  it  causes 
a  slight  tingling  followed  by  a  temporary  local 
anaesthesia. 

Theine  was  discovered  by  Oudry  in  1827  and 
pronounced  identical  with  caffeine  and  gua- 
ranine by  Mulder  and  Jobst  in  1838.  Prom 
that  time  until  very  recently  the  identity  of 
these  alkaloids  was  considered  so  certain  that 
for  commercial  purposes  they  were  extracted 
indiscriminately  from  coffee,  tea,  kola,  mate, 
or  Paraguay  tea,  and  guarana,  and  labelled  to 
suit  the  demands  of  trade.  Most  of  them  were 
extracted  from  tea,  for  economical  reasons, 
whence  it  happens  that  many  of  the  investiga- 
tions made  with  regard  to  caffeine  were  unin- 
tentionally made  with  theine.  In  1868  Leven 
declared  that  these  two  alkaloids  were  not  iden- 
tical, because  he  found  that  theine  would  cause 
convulsions  in  frogs,  while  caffeine  would  not, 
and  that  the  lethal  dose  of  theine  was  the 
larger.  His  observations  were  not  confirmed 
by  other  investigators  and  were  forgotten 
until,  in  1885,  Dr.  Mays  obtained  some  genuine 
theine  and  caffeine  with  which  he  instituted  a 
series  of  experiments.  These  demonstrated 
certain  important  differences  between  the 
physiological  action  of  the  one  and  that  of  the 
other,  which  may  thus  be  briefly  stated  :  Theine 
affects  the  sensory,  caffeine  the  motor  system. 
Theine  causes  spasms,  convulsions,  and  an 
impairment  of  the  nasal  reflex  early  in  the 
course  of  poisoning,  while  caffeine  does  so  at  a 
late  stage  or  not  at  all.  Theine  induces  a  fall, 
caffeine  a  rise  in  the  bodily  temperature. 
Theine  is  also  a  powerful  local  ancBsthetic  and 
analgetic. 

In  other  respects  there  seems  to  be  a  general 
agreement  between  the  physiological  actions 
of  theine  and  caffeine.    Both  diminish  waste 


277 


THAPSIA 
THEKMINE 


of  tissue,  increase  the  rapidity  of  the  pulse  and 
the  strength  of  the  cardiac  action,  and  are 
antidotal  to  narcotic  poisons.  Br.  Castle  gives 
an  excellent  description  of  the  cerebral  intoxi- 
cation produced  by  the  injection  of  half  a  grain 
of  theine  into  his  own  general  circulation.  "  I 
was  excited  and  talkative,  and  so  rapidly  did 
I  talk  that  I  would  soon  exhaust  a  subject 
broached  by  others  and  endeavour  to  introduce 
some  natural  descendant  of  the  idea  as  a  topic 
of  conversation,  apparently  so  far  ahead  of  its 
proper  sequence  in  a  well-ordered  train  of 
thought  as  to  appear  like  an  interruption  with 
an  irrelevant  subject.  Alternating  with  states 
of  great  bodily  activity  were  spells  of  almost  a 
fainting  character.  These  were  seven  or  eight 
in  number,  and,  beginning  soon  after  the  in- 
jection, gradually  ceased  after  the  lapse  of  six 
or  seven  hours  " 

A  subcutaneous  injection  of  theine  causes  a 
profound  local  anaesthesia  at  and  below  the 
point  of  injection,  which  extends  outward 
along  the  nerve-trunk  toward  the  periphery, 
not  toward  the  centre.  According  to  Mays, 
this  ana'sthesia  appears  in  a  few  minutes  after 
the  injection  of  from  one  fifth  to  one  half  a 
grain,  and  is  much  more  marked  in  some  indi- 
viduals than  in  others.  It  is  associated  with 
a  feeling  of  coldness,  and  occasionally  with 
reduction  of  temperature  of  the  anassthetized 
part,  a  slight  reduction  in  the  pulse-rate,  but 
no  impairment  of  motion  or  symptoms  of  cer- 
ebral intoxication. 

The  therapeutic  uses  of  theine  are  largely 
the  same  as  those  of  caffeine,  but  for  one  pur- 
pose it  is  peculiarly  valuable,  that  of  relieving 
neuralgic  pain.  But  its  function  is  only  to 
relieve  the  pain,  and  its  use  should  be  accom- 
panied by  that  of  other  remedies  to  cure  the 
condition  upon  which  the  neuralgia  depends. 
It  has  thus  been  used  with  good  effect  in 
sciatica,  intercostal,  cervico-brachial,  and  other 
forms  of  neuralgia,  myalgia,  and  lumbago,  in- 
jected in  doses  of  \  of  a  grain  or  more  over  the 
course  of  the  affected  nerve.  Used  in  the 
same  way,  it  has  proved  serviceable  in  relieving 
the  pains  of  locomotor  ataxia,  but  the  dose  has 
to  be  large,  even  as  much  as  3  grains  ^having 
been  given.     (Cf.  Cai'feine.) 

Matthias  Lanckton  Foster. 

THEOBBOMA.— See  Cacao  buttek. 

THEOBROMINE.— This  alkaloid,  known 
also  as  dimetliylxantMne,  C7HeN402,  is  ob- 
tained from  the  fruit  of  Tlieobroma  Cacao. 
The  pure  alkaloid  is  a  white  powder  consisting 
of  microscopic  rhombic  needles.  It  is  odour- 
less and  has  at  first  very  little  taste,  but  a 
bitter  after-taste.  It  dissolves  in  about  1,600 
parts  of  cold  water,  in  about  150  parts  of  hot 
water,  in  about  4,300  parts  of  cold  alcohol,  in 
about  430  parts  of  hot  alcohol,  and  in  about 
105  parts  of  hot  chloroform.  It  dissolves 
readily  in  watery  solutions  of  the  fixed  alkalies. 
On  account  of  the  difficulty  of  dissolving  it  in 
ordinary  menstrua,  the  alkaloid  itself  is  little 
used  in  medicine,  but  several  of  its  salts  are 
employed. 

Dr.  Henri  Huchard  (Journal  des  praticiens, 
July  6, 1895 ;  American  Journal  of  the  Medical 


Sciences,  October,  1895)  classes  theobromine 
among  the  "  functional  epithelial  ■'  diuretics,  or 
those  which  act  upon  the  renal  epithelium 
without  altering  it,  comprising  milk,  lactose, 
glucose,  theobromine,  potassium  and  sodium 
nitrates,  asparagus,  couch-grass,  corn-silk,  and 
elder  bark.  The  "  irritant  epithelial "  diuretics, 
such  as  cantharides  and  juniper  berries,  pro- 
voke diuresis  by  causing  congestion  of  the  kid- 
ney. Experiments  with  theobromine,  he  says, 
have  shown  that  it  does  not  possess  any  action 
upon  the  nervous  system,  thus  differing  from 
caffeine,  which  is  a  cerebral  excitant.  It  is 
very  slightly  poisonous,  even  in  large  doses. 
It  has  a  diuretic  action  less  prolonged  than 
that  of  digitalis,  but  more  so  than  that  of 
caffeine.  This  diuresis  follows  very  rapidly  as 
a  urinary  downpour;  the  amount  of  urine  fre- 
quently becomes  3  or  4  pints.  Very  rarely 
it  produces  digestive  disturbances,  such  as 
nausea  and  vomiting,  which  may  be  avoided 
by  prescribing  the  drug  in  capsules  of  7  grains 
each.  It  has  no  action  upon  the  heart,  arteries, 
or  blood-pressure,  and  is  harmless  to  the  kid- 
neys. It  does  not  ofl'er  any  danger  of  habitua- 
tion or  of  accumulation,  and  it  is  eliminated 
unchanged  in  the  urine.  Finally,  it  is  indi- 
cated in  dropsies  of  cardiac  origin  and  in  the 
anasarca  of  Brighfs  disease.  If  it  is  pre- 
scribed in  the  dose  mentioned,  eight  capsules 
should  be  taken  on  the  first,  six  on  the  second 
and  third,  and  four  on  the  fourth  day.  Dr. 
Huchard  regards  theobromine  as  more  trust- 
worthy than  diuretin.  To  obtain  the  tonic 
effects  of  this  drug  it  is  employed  in  smaller 
doses,  associated  with  equal  parts  of  neutral 
sodium  phosphate,  for  several  weeks. 

A  combination  of  equal  molecules  of  the  so- 
dium compound  of  theobromine  and  sodium 
salicylate  is  a  German  proprietary  preparation 
called  diuretin  (see  Sodio-theobromine  salicy- 
late). Other  preparations  that  have  been  used 
therapeutically  are  the  hydrochloride,  the  ni- 
trate, the  salicylate,  the  tannate,  and  the  fol- 
lowing-named double  salts :  Theobromine  and 
lithium  benzoate  (Merck's  "  uropherine  '  B ' "), 
theobromine  and  lithium  salicylate  (Merck's 
"uropherine  "S"'),  theobromine  and  sodium 
benzoate,  and  theobromine  and  sodium  iodo- 
salicylate. 

THEKAPOL. — This  is  an  American  pro- 
prietary preparation  said  to  consist  of  a  bland 
vegetable  oil  containing  about  eight  per  cent, 
of  ozone  by  volume.     (See  Ozone.) 

THERIACA.— See  Treacle. 

THEBMirTJGIN.— This  is  the  trade 
name  of  methyltrihydroxyquinoline  carbonate 
of  sodium,  C9'H8(CHs).NCOONa,  a  yellowish- 
white  crystalline  powder  soluble  in  water.  It 
has  been  employed  to  some  extent  as  an  anti- 
pyretic, in  doses  of  from  1^  to  4  grains.  Ex- 
perience in  its  clinical  employment  has  not  yet 
been  sufficient  to  warrant  more  definite  state- 
ments concerning  it. 

THEBMINE,  or  tetrahydrobetanaphthyl- 
aTOine,CioHuNHj,isacolonrlessliquidobtained 
by  the  action  of  metallic  sodium  on  a  solution 
of  beta-naphthylamine  in  amyl  alcohol  (Cob- 
lentz).     Dissolved  in  water  in  the  proportion 


THBRMODINE 
THIOSINAMINE 


278 


of  from  1  to  5  per  cent.,  it  has  been  recom- 
mended as  a  mydriatic.  It  is  said  that  the 
hydrochloride  has  the  property  of  increasing 
the  heat  of  the  body. 

THEKMOBINE,     or     acetylparaethoxy- 
phenylurethane, 

/OCHs 
CoH./  (Cerna), 

\NCOCH3.COOC5H6 
is  a  colourless  crystalline  substance  sparingly 
soluble  in  water.  It  is  a  proprietary  prepara- 
tion introduced  as  an  antipyretic  and  analgetic 
devoid  of  unfavourable  efEeots,  but  the  accounts 
are  conflicting  as  to  its  innocence.  The  dose 
is  from  5  to  10  grains. 

CH3.CH.S 

THIALDIN,  NE       NCH.CH^,  is  a 

CHs.CH.S^" 
crystalline  derivative  of  paraldehyde.  It  is 
soluble  with  ditheulty  in  water,  but  dissolves 
readily  in  alcohol  and  in  ether.  It  is  said  to 
act  as  a  stimulant  to  the  heart,  but  enough  is 
not  known  of  it  to  warrant  its  use  in  practice 
at  present. 

THILANIN.— This  is  a  compound  of  3 
parts  of  sulphur  and  97  parts  of  lanolin.  It 
has  been  employed  topically  to  some  extent  in 
cases  of  eczema  and  other  skin  diseases  in  which 
sulphur  may  be  beneficial. 

THIOCAMPHOR.— This  name  has  been 
given  to  a  liquid  formed  by  the  action  of  sul- 
phurous-acid gas  on  camphor.  More  or  less 
diluted  with  water,  it  is  used  as  a  disinfectant. 

THIOFOBiM,  or  basic  bismuth  dithiosali- 
cylate,  has  been  proposed  as  a  substitute  for 
iodoform.  It  is  an  insoluble,  odourless  yellow 
powder.  According  to  De  Buck  (cited  in  the 
British  Medical  journal,  February  22,  1896, 
Epitome),  it  has  an  antiseptic  and  desiccative 
action,  and  forms  a  protective  insulating  layer 
for  the  parts  to  which  it  is  applied.  All  raw, 
■weeping,  or  ulcerated  surfaces  heal  rapidly 
under  it,  he  says,  whether  in  the  form  of  the 
pure  powder  or  mixed  with  equal  parts  of  levi- 
gated boric  acid.  It  is  indicated  in  all  ulcera- 
tive skin  affections,  and  where  epidermic  soft- 
ening exists.  Internally,  he  has  found  its 
constipating  and  disinfectant  qualities  manifest 
in  three  cases  of  acute  enterttis ;  in  a  fourth 
chronic  case  it  caused  gastric  irritation  and 
did  not  influence  the  muco-sanguinolent  stools. 
Daily  amounts  of  30  grains  for  an  adult,  or 
from  7  to  1(5  grains  for  a  child,  in  powder  or 
mucilage,  were  perfectly  well  borne  by  the 
stomach.  He  considers  the  drug  suited  for 
internal  use,  since  the  dithiosalicylates  are  less 
toxic  than  the  corresponding  salicylic  salts. 

Thioform  has  been  used  with  success  in 
purulent  otitis  media,  in  conjunctivitis,  in 
ulcer  of  the  cornea,  in  ulcers  of  the  leg,  and  in 
burns. 

THIOL  is  a  German  patented  sulphur 
derivative  of  various  mineral  oils.  It  occurs 
as  a  liquid  or  solid,  according  to  the  manner 


of  its  preparation.  Its  freedom  from  unpleas- 
ant odour  suggested  its  employment  instead 
of  ichthyol,  with  which  its  effects  are  iden- 
tical, and  it  is  used  for  the  same  purposes  and 
under  the  same  conditions.  Internally,  it  has 
been  given  in  the  treatment  of  rheumatism, 
but  with  no  brilliant  results.  The  dose  of  the 
fluid  variety  is  from  5  to  10  drops,  and  that  of 
the  dry  thiol  from  1  to  3  grains. 

[Solid  thiol,  prepared  by  evaporating  the 
liquid  form,  is  furnished  in  the  form  of  pow- 
der and  in  that  of  scales.  Both  solid  and 
liquid  thiol  have  been  found  very  useful  in 
the  treatment  of  burns.  Bidder  (Archiv  fUr 
Jclinische  Uhirurgie,  xliii,  1892 ;  University 
Medical  Magazine,  September,  1892)  says  of  it 
that,  when  applied  to  a  burned  surface,'  it  acts 
as  a  desiccant.  relieves  the  pain,  hardens  the 
skin,  and  hinders  the  growth  of  micro-organ- 
isms if  any  are  present. 

In  burns  of  the  first  or  second  degree,  where 
the  blebs  are  still  intact,  it  is  only  necessary 
to  brush  the  burned  area  with  equal  parts  of 
liquid  thiol  an  1  water,  and  cover  it  with  wool. 
By  this  method  of  treatment  the  pain  almost 
immediately  disappears.  At  the  end  of  eight 
days  the  dressing  should  be  changed,  and  re- 
applied if  the  blebs  have  not  healed.  If  the 
blebs  have  been  ruptured  and  the  eorium  is  ex- 
posed, all  loose  skin  should  be  cut  away  and 
the  burned  area  carefully  cleansed ;  it  should 
then  be  brushed  with  liquid  thiol,  powdered 
with  salicylic  or  boric  acid  and  then  with  pow- 
dered thiol,  and  the  whole  covered  with  vase- 
line and  cotton  wool,  and  bandaged.  As  a 
rule,  one  or  two  dressings  only  are  necessary 
before  the  burn  heals.  The  drug  is  of  special 
value  in  relieving  the  pain  of  large  granulat- 
ing surfaces  in  burns  of  the  third  or  fourth 
degree. 

It  is  chiefly  in  dermatological  practice  that 
thiol  has  been  used,  in  the  treatment  of  eczema, 
erythema,  erysipelas,  ulcers,  and  lupus;  it  is 
said,  however,  to  be  equal  to  ichthyol  in  sorJc- 
facient  virtues,  and  consequently  to  be  of  great 
efiicieney  in  the  treatment  of  inflammatory 
pelvic  exudates  and  other  inflammatory  de- 
posits. For  use  in  these  cases  a  10-per-cent. 
ointment  may  be  made  according  to  the  fol- 
lowing formula : 

5  Liquid  thiol. 1  part ; 

Vaseline 2  parts ; 

Lanolin 7     " 

M. 

Dry  thiol  dissolves  readily  in  collodion.] 
Russell  H.  Nevins. 

THIOLIN,  THIOLINIC  ACID,  accord- 
ing to  Professor  Coblentz,  is  a  dark-green 
mass  of  the  consistence  of  an  extract,  having 
a  peculiar  mustardlike  odour,  insoluble  in 
water,  but  soluble  in  alcohol.  It  is  formed  by 
the  action  of  warm  sulphuric  acid  on  sulphur- 
ated linseed  oil.  Its  medicinal  properties  are 
similar  to  those  of  ichthyol  and  thiol.  Sodium 
thiolinate  is  thought  to  be  preferable  to  thiolin 
for  medicinal  use. 

THIOOXYDIPHENYLAMINE.  -  See 

SULPHAMINOL. 


279 


THERMODINE 
THIOSINAMINE 


THIOPHENE.— This  is  an  organic  com- 
HC-CH 
pound,      H         1  ,  found   by  von   Meyer    in 
HC    CH. 

benzene  and  also  made  synthetically  from  coal 
tar.  It  is  a  colourless,  volatile  oil.  The  di- 
iodide,  in  the  form  of  powder,  has  been  used 
as  an  antiseptic,  especially  as  a  substitute  for 
iodoform.  The  tetrahromide,  a  substitution 
compound,  is  a  still  more  energetic  antiseptic. 
Thiophene  and  its  compounds  are  quite  ex- 
pensive. 

THIORESORCIN,  CeHi  (OS),,  is  a  yellow- 
ish-gray powder,  a  German  patented  prepara- 
tion, made  by  heating  resorcin  with  sulphur. 
It  is  insoluble  in  water.  It  has  been  recom- 
mended as  an  antiseptic,  especially  as  a  substi- 
tute for  iodoform,  but,  according  to  Professor 
Coblentz,  its  use  is  followed  by  unpleasant 
symptoms. 

THIOSALICYLIC  ACID.— See  Sulpho- 

SALICTLIG  ACID. 

THIOSAPOIi.— This  is  a  soda  soap  con- 
taining 10  per  cent,  of  sulphur,  used  topically 
in  skin  diseases  where  sulphur  is  indicated. 

THIOSIIT AMINE,  or  allylthinurea,  or 
allylsulphocarbamide,  NH(C3H6).CS.N'Ha,  is  a 
substance  deposited  in  the  form  of  colour- 
less crystals  of  a  faint  alliaceous  odour  and  a 
bitter  taste  when  a  mixture  of  1  part  each  of 
mustard  oil  and  alcohol  and  3  parts  of  am- 
monia water,  having  been  heated  to  122°  F.,  is 
allowed  to  cool.  It  is  soluble  in  water,  in  alco- 
hol, and  in  ether.  The  aqueous  solution  is 
said  to  be  prone  to  decomposition. 

Thiosinamine  is  a  diuretic.  In  addition,  it 
seems  to  have  a  peculiar  reducing  effect  on 
cicatricial  tissue  and  on  neoplasms.  It  was 
first  used  in  medicine  by  Dr.  Hans  Hebra,  of 
Vienna,  in  the  treatment  of  htpus.  Dr.  Sin- 
clair Tousey,  of  New  York,  who  has  made  a 
careful  study  of  the  use  of  thiosinamine  by 
others  and  employed  it  extensively  himself 
{New  York  Medical  Journal,  May  2, 1896),  says 
that  the  method  in  which  it  was  used  by 
Hebra  was  by  the  hypodermic  injection  of  a 
15-per-cent.  alcoholic  solution  deep  into  the 
muscular  tissue  between  the  shoulder  blades. 
A  fine  needle  was  used,  and  the  injection  was 
made  slowly.  The  beginning  dose  was  from 
■J  to  f  of  a  grain,  and  this  was  injected  twice 
a  week.  In  lupus  oases  the  dose  was  increased 
in  the  third  or  fourth  week  to  half  or  the 
whole  of  a  hypodermic  syringeful  of  a  15-per- 
cent, solution,  equivalent  to  from  1-J-  to  3 
grains  of  thiosinamine,  twice  a  week.  These 
doses  were  as  well  borne  as  so  much  distilled 
water,  but  Hebra  says  they  always  produced 
a  visible  curative  eifect.  In  a  few  cases  he 
went  as  high  as  one  and  a  half  or  two  syringe- 
fuls  with  no  bad  effect.  Keitel  and  Richter 
also  used  a  15-per-cent.  alcoholic  solution. 
Dr.  Tousey  used  a  10-per-cent.  alcoholic  solu- 
tion, and  Van  Hoorn,  on  the  recommendation 
of  Professor  Duclaux,  of  Paris,  used  a  10- 
per-cent.  solution  in  equal  parts  of  water  and 
glycerin.  This  he  found  just  as  active  and 
not  nearly  so  painful  as  the  alcoholic  solution. 


This  solution,  says  Dr.  Tousey,  has  the  further 
advantage  of  being  available  for  use  in  agar- 
agar  cultures  and  the  like,  where  the  presence 
of  alcohol  would  interfere. 

Hebra  rarely  used  as  much  as  3  grains,  and 
Dr.  Tousey  never  exceeded  1-J  grain,  but  the 
other  observers  cited  by  him  used  4^  grains  as 
a  regular  full  dose,  beginning,  of  course,  with 
smaller  ones.  Dr.  Tousey  finds  that  if  an 
alcoholic  solution  is  used  there  is  sharp  pain 
lasting  for  less  than  a  minute.  This  may  be 
somewhat  diminished  by  pressure  to  diffuse 
the  solution  through  the  tissues.  The  syringe 
has  to  be  washed  out  with  water  after  the  use 
of  an  alcoholic  solution,  otherwise  the  leather 
washers  on  the  piston  become  dried  and  loose. 

Like  Hebra,  Dr.  Tousey  has  found  it  desira- 
ble to  suspend  the  use  of  thiosinamine  for  ten 
days  every  six  weeks  or  two  months. 

Bacteriological  studies  of  thiosinamine,  says 
Dr.  Tousey,  have  been  reported  by  Hebra  and 
Van  Hoorn.  Hebra  at  first  found  that  rabbits 
were  apparently  made  proof  against  anthrax, 
but  in  a  second  series  of  experiments  all  the 
rabbits  died.  Van  Hoorn  found  that  the  pres- 
ence of  a  small  percentage  of  thiosinamine  in 
a  culture  medium  rendered  ineffectual  an  in- 
oculation with  certain  bacteria.  The  addition 
of  a  few  drops  of  a  10-per-cent.  solution  re- 
tarded or  rendered  the  further  growth  of  a 
culture  impossible  ;  but  even  flooding  it  with 
thiosinamine  for  twenty-four  hours  did  not 
kill  any  bacteria. 

The  physiological  effects  upon  animals  have 
been  studied  by  Hebra,  says  Dr.  Tousey.  He 
injected  3  grains  daily  for  a  month  into  a  dog 
weighing  twenty-two  pounds.  The  dog  re- 
mained perfectly  normal,  but  became  raven- 
ous, and  gained  nine  pounds  in  weight.  He 
further  injected  into  curarized  animals  doses 
ten  or  twenty  times  as  great  in  proportion  to 
their  weight  than  in  those  used  on  man.  The 
only  effect  was  a  slight  lowering  of  the  pulse 
curve,  and  this  was  evidently  due  to  the  alco- 
hol in  which  the  drug  was  dissolved. 

Its  physiological  effect  in  man,  says  Dr. 
Tousey,  is  in  a  general  way  that  of  a  very  mild 
tonic.  If  the  subject  is  perfectly  sound,  there 
are  no  symptoms  at  all  produced  by  the  injec- 
tions, and  if  there  is  a  lesion  present  the  re- 
action which  may  occur  is  local,  and  is  not 
accompanied  by  any  general  symptoms.  Espe- 
cially, there  is  never  any  febrile  movement. 
There  is  in  all  cases  a  tonic  effect  with  an  in- 
crease in  weight.  Hebra  states  that  absorption 
of  the  drug  is  very  rapid,  since  his  patients 
noticed  a  garlicky  taste  in  the  mouth  within  a 
few  minutes.  The  same  author  has  noted  an 
extraordinary  diuresis,  the  increase  in  the  daily 
amount  of  urine  being  two  hundred  or  five 
hundred  cubic  centimetres.  In  no  case  were 
there  renal  symptoms,  or  was  there  albumin 
or  any  other  pathological  product  in  the 
urine.  This  diuresis  ceases  after  a  number  of 
injections.  Hebra  thinks  it  is  a  therapeutic 
action  and  ceases  after  the  abnormal  fluids 
have  been  eliminated.  Van  Hoorn  and  Keitel, 
who  both  used  large  doses,  noted  after  several 
weeks'  treatment  the  onset  of  nausea,  head- 
ache, and  lassitude.    Hebra  used  smailer  doses 


THIOSINAMINE 
THOHOUGHWORT 


280 


and  Dr.  Tousey  still  smaller  ones,  and  they 
have  not  had  such  an  experience. 

Dr.  Tousey  cites  Richter  as  having  studied 
the  effect  of  thiosinamine  on  the  blood  in  a 
number  of  cases  of  lupus  vulgaris,  lupus  ery- 
thematosus, ulcer  of  the  leg,  and  cicatricial 
stricture  of  the  urethra.  He  noted  the  num- 
ber of  white  and  red  blood-cells,  the  amount 
of  hasmoglobin,  and  the  changes  in  the  mor- 
phology of  the  histological  elements  of  the 
blood.  Blood  examinations  were  made  just 
before  the  injection,  four  hours  later,  and 
again  twenty-four  hours  afterward.  In  some 
eases  examinations  were  made  half  an  hour 
afterward,  and  in  eight  of  these  cases  a  change 
in  the  number  of  leucocytes  had  already  taken 
place.  The  blood  was  always  obtained  by 
pricking  the  finger  tip  and  without  pressure, 
and  always  at  the  same  hour  of  the  day.  There 
was  uniformly  an  immediate  decrease  in  the 
number  of  leucocytes  to  one  third  of  the  nor- 
mal number — viz.,  from  about  fourteen  thou- 
sand down  to  four  thousand  to  the  cubic 
millimetre.  But  at  the  end  of  four  hours  the 
number  of  leucocytes  had  increased  to  normal 
or  beyond,  and  in  some  cases  there  was  well- 
marked  leucocytosis  which  persisted  for  forty- 
eight  hours.  There  were  no  uniform  changes 
in  the  number  of  red  cells.  The  amount  of 
hemoglobin  was  regularly  increased.  There 
was  no  special  effect  upon  the  number  of  eosin- 
ophile  cells,  but  there  was  a  uniform  increase 
in  the  number  of  multinuclear  leucocytes  or 
leucocytes  with  polymorphous  nuclei. 

Richter  states  that  in  its  action  on  the  blood 
thiosinamine  belongs  to  the  same  class  of  sub- 
stances as  hemialbumose,  peptone,  pepsin,  nu- 
clein,  pyocyanin,  tuberculin,  curare,  urea,  uric 
acid,  and  sodium  urate,  the  intravenous  injec- 
tion of  any  of  which  substances  causes  an  im- 
mediate leuoocytolysis  followed  by  leucocytosis. 
According  to  Dr.  Tousey,  there  has  been 
only  one  accident  reported  from  the  subcuta- 
neous use  of  thiosinamine.  It  consisted  in  the 
production  of  temporary  cutaneous  auEesthesia, 
and  was  observed  by  Keitel.  The  patient  was 
a  robust  youth  with  recurrent  psoriasis  of  a 
papular  type,  and  thiosinamine  was  used  with 
a  view  to  causing  absorption.  The  Injections 
were  made  at  various  points,  and  the  last  one 
into  the  muscles  of  the  extensor  aspect  of  the 
forearm.  This  was  followed  very  shortly  by 
complete  ansesthesia  of  the  skin  supplied  by 
the  cutaneous  branch  of  the  musculo-spiral 
nerve.  It  could  not  be  stated  positively  that 
the  nerve  had  been  wounded  by  the  needle, 
which  Dr.  Tousey  thinks  probable,  and  Keitel 
thought  the  effect  was  due  to  the  action  of  the 
drug  itself  upon  the  nerve.  In  one  of  Dr. 
Tousey's  cases  twenty-seven  hypodermics  of 
thiosinamine  were  administered  in  the  left  bi- 
ceps at  approximately  the  same  spot  without 
any  unfavourable  effect. 

The  effect  of  thiosinamine  upon  pathologi- 
cal conditions,  says  Dr.  Tousey,  is  that  of  a 
powerful  absorptive,  acting  probably  by  in- 
creasing the  activity  of  the  lymphatic  system. 
This  effect  is  seen  in  the  absorption  of  serous 
exudations,  which  is  accompanied  by  marked 
diuresis.  •  It  is  also  visible  in  its  effect  upon 


lupus,  corneal  opacities,  cicatrices,  glandular 
swellings,  and  neoplasms.  Hebra  used  it  in  a 
number  of  tuberculous  patients  who  had  had 
no  recent  pulmonary  symptoms,  and  observed 
a  return  of  fever  after  the  injections.  In  such 
cases  the  fever  is  perhaps  due.  Dr.  Tousey  sug- 
gests, to  the  absorption  of  encapsulated  pus. 
In  one  case  with  very  severe  night  sweats  there 
was  repeatedly  a  marked  amelioration  follow- 
ing the  injections.  This  was  verified  by  con- 
trol experiments.  This  same  absorptive  effect 
is  so  active  locally  that  in  some  classes  of  cases 
a  latent  process  may  be  fanned  into  an  active 
one.  This  is  especially  the  case  in  its  use  for 
clearing  up  opacities  of  the  cornea;  if  there  is 
the  slightest  inflammatory  condition  present  it 
will  be  very  much  aggravated,  and  treatment 
will  have  to  be  suspended.  In  some  cases,  says 
Dr.  Tousey,  this  local  inflammatory  reaction  is 
of  benefit.  Cases  have  been  reported  in  which 
an  apparently  cured  osteomyelitis  has  started 
up  again  after  the  injections — a  new  abscess 
has  formed,  a  sinus  has  opened,  and  an  old  se- 
questrum has  been  extruded.  This  has  been 
followed  by  definitive  healing,  and  the  entire 
process  could  only  be  regarded  as  having  been 
a  beneficent  one. 

The  results  obtained  by  Hebra,  Richter,  Van 
Hoorn,  and  Tousey  are  somewhat  at  variance. 
Hebra  and  Van  Hoorn  observed  in  practically 
every  case  a  local  reaction  which  they  describe 
as  beginning  in  two  or  three  hours  after  the 
injection.  The  diseased  part  became  red  and 
swollen,  sometimes  so  much  so  as  to  cause  fis- 
sures in  the  surface.  There  was  no  vesication 
and  there  was  little  if  any  serous  exudation. 
This  reaction  remained  undiminished  for  five 
or  six  hours,  but  at  the  end  of  twenty-four 
hours  had  entirely  disappeared.  Marked  des- 
quamation sometimes  follows.  There  was 
never  a  general  reaction,  and  especially  there 
was  no  fever.  There  was  a  sensation  of  heat 
and  tension  in  the  affected  part.  These  two 
authors,  says  Dr.  Tousey,  report  this  reaction 
to  have  occurred  in  practically  every  lupus 
case,  and  to  have  been  repeated  without  mate- 
rial increase  of  the  dose  after  each  injection. 
Dr.  Tousey's  own  lupus  cases  have  been  in  dis- 
pensary practice,  and  the  patients  have  not 
been  seen  until  forty-eight  hours  after  the  in- 
jection. So  far  as  the  patients'  statement  can 
be  credited,  they  have  not  shown  a  local  reac- 
tion. Richter  had  a  comparatively  large  num- 
ber of  cases  of  lupus  (eleven),  and  in  only  two 
was  there  any  reaction,  and  then  only  with  the 
first  two  or  three  inji^ctions.  His  cases  were 
under  constant  observation,  and  the  doses  used 
were  large. 

As  to  the  curative  action  upon  lupus,  says 
Dr.  Tousey,  Van  Hoorn  and  Hebra  observed  a 
very  great  effect  indeed  wherever  the  super- 
ficial area  of  disease  was  great.  Ulcerations 
healed,  and  the  thickened  and  nodular  edges 
flattened  out.  No  case  of  complete  cure  is  re- 
ported, and  where  the  area  involved  was  quite 
small — lupus  of  the  cheek  of  the  size  of  a  dime 
— it  was  hardly  influenced  at  all.  Richter  has 
seldom  seen  any  effect  at  all  upon  lupus.  In 
Dr.  Tousey's  own  cases  no  "  reaction  "  has  been 
noted,  but  he  has  uniformly  seen  a  diminished 


281 


THIOSINAMINE 
THOROUGHWORT 


■vascularity  and  a  softening  of  the  edges  with 
healing  of  the  ulcer.  He  agrees  with  the  other 
authors  cited  that  local  treatment  is  a  better 
means  of  handling  lupus  than  the  use  of  thio- 
sinamine. 

Its  therapeutic  application  in  clearing  up 
corneal  opacities,  he  remarks,  has  been  at- 
tended with  almost  perfect  success  in  the 
hands  of  all  the  investigators.  Hebra  had  a 
patient  who,  before  the  injections,  could  hard- 
ly avoid  collisions  with  people  on  the  street, 
and  afterward  the  acuteness  of  vision  had  so 
increased  as  to  enable  him  to  tell  the  direction 
of  the  wind  by  the  weather  vane  on  a  high 
tower.  He  and  Richter  report  a  number  of 
such  cases,  and  give  the  formula;  for  vision  be- 
fore and  after  treatment,  demonstrating  a  re- 
markable increase.  This  Dr.  Tousey  thinks  is 
of  the  greatest  possible  im  portance,  for  we  can 
promise  almost  all  these  patients  an  astonish- 
ing improvement  in  vision.  The  cases  for 
which  it  is  unsuitable  are  those  in  which 
a  vestige  of  inflammation  is  still  present 
and  might  be  started  up  into  fresh  phlyotEe- 
nulas. 

In  the  treatment  of  cicatricial  contractures, 
says  Dr.  Tousey,  thiosinamine  acts  by  causing 
absorption  of  the  fibrous  tissue,  whether  it  is 
situated  in  the  skin  or  in  deeper  parts,  such 
as  tendons  and  ligaments ;  and  all  the  authors 
cited  report  complete  cui'es  of  such  cases. 
Among  these  are  ectropion  following  Inpus  of 
the  cheek,  partial  ankylosis  of  the  knee  from 
lupus,  and  talipes  equinus  following  a  burn  of 
the  leg.  One  case  of  ectropion  was  so  marked 
that  the  eye  could  not  possibly  be  closed,  the 
tarsal  cartilage  was  so  rarefied  by  pressure  and 
traction  as  to  be  scarcely  perceptible,  and  even 
the  corner  of  the  mouth  was  drawn  up  toward 
the  eyelid.  This  patient  was  restored  to  a  nor- 
mal condition,  and  the  skin  of  the  cheek  be- 
came soft  and  freely  movable  on  the  subjaoent 
tissues.  In  another  case  of  Hebra's  tliere  was 
such  contracture  following  lupus  of  the  palm 
that  the  finger  nails  grew  into  the  flesh.  Com- 
plete extension  was  possible  after  about  twen- 
ty-five injections,  no  other  treatment  having 
been  employed.  Dr.  Tousey  says  it  was  this 
wonderful  absorptive  power  over  cicatricial 
tissues  which  suggested  to  him  its  use  in  keloid 
and  malignant  neoplasms. 

In  the  treatment  of  simple  ulcers  and  of 
stricture  of  the  urethra,  Riehter's  six  cases,  with 
an  average  of  eight  injections,  gave  negative 
results ;  but  Dr.  Tousey  would  not  regard  this 
as  final.  In  the  case  of  stricture  of  the  ure- 
thra or  rectum,  he  believes  tlie  use  of  thiosina- 
mine might  be  a  very  valuable  adjunct  to  local 
treatment. 

Dr.  Tousey  remarks  that  the  action  of  thio- 
sinamine upon  chronically  enlarged  glands  has 
been  observed  by  Hebra.  and  it  is  to  cause  a 
very  rapid  absorption.  In  syphilitic  cases,  on 
the  other  hand,  absorption  was  not  effected ; 
and  he  believes  that  this  may  in  some  cases  be 
of  diagnostic  value.  He  and  the  other  authors 
cited  have  not  used  it  in  the  treatment  of 
glandular  swellings  secondary  to  epithelioma 
or  carcinoma.  It  has  been  used  with  success 
for  uterine  myomata.    It  has  been  used  with 


negative  results  in  eczema,  psoriasis,  and  lupus 
erythematosus. 

Dr.  Tousey  records  a  case  of  keloid  in  which 
he  used  thiosinamine.  The  patient  was  a  man 
thirty-two  years  old.  In  September,  1893,  his 
left  arm  was  burned  from  shoulder  to  fingers. 
An  area  about  four  inches  and  a  half  in  diam- 
eter immediately  above  the  elbow  healed  by 
granulation,  but  the  rest  of  the  burn  was  more 
superficial.  About  four  months  after  the  ac- 
cident the  cicatrix  began  to  itch  and  burn, 
and  very  soon  a  hard,  prominent  mass  had 
formed  in  the  scar.  When  he  was  admitted 
into  St.  Bartholomew's  Clinic,  on  July  7,  1894, 
he  presented  a  typical  keloid,  consisting  of 
two  areas,  each  of  the  size  of  a  silver  dollar 
and  projecting  three  quarters  of  an  inch  above 
the  surface.  These  were  on  the  flexor  aspect 
of  the  arm  just  above  the  bend  of  the  elbow. 
The  treatment  consisted  in  injections  of  thio- 
sinamine into  the  left  biceps  twice  a  week. 
The  man  had  applied  for  treatment  because  of 
impaired  motion  at  the  elbow.  The  beginning 
dose  was  f  of  a  grain  of  thiosinamine,  in  10- 

Eer-cent.  solution  in  absolute  alcohol,  and  the 
ighest  dose  used  was  IJ  grain.  These  injec- 
tions produced  no  special  effect  except  on  the 
neoplasm.  After  one  or  two  injections  this 
became  very  much  paler,  and  after  twelve  one 
portion  had  lost  its  thickening  and  induration. 
This  part  was  then  visible  as  appai'ently  nor- 
mal skin,  but  a  little  paler  than  the  rest.  The 
other  area  gradually  changed  to  the  appear- 
ance of  normal  skin.  The  cure  was  complete 
after  twenty-seven  injections  had  been  given. 
Complete  use  of  the  arm  was  restored,  and 
there  was  no  thickening  or  adhesion  of  the 
skin,  though  the  cicatrices  were  still  recog- 
nisable. 

Dr.  Tousey  concludes  his  valuable  article  as 
follows :  "  We  have  in  thiosinamine  a  drug  pro- 
ducing, when  given  hypodermically,  no  gen- 
eral symptoms,  and  even  when  long  continued 
no  harmful  effects.  It  acts  specifically  upon 
certain  abnormal  tissues  to  cause  their  absorp- 
tion or  conversion  into  normal  tissues.  It  is 
of  doubtful  efficacy  in  lupus  and  a  variety  of 
skin  diseases.  But  it  is  of  the  greatest  possible 
value  in  the  removal  of  cicatricial  contractures 
following  lupus  or  any  other  cause  of  loss  of 
substance.  The  frightful  contractures  from 
burns  of  the  neck  would  yield  to  its  action,  as 
cases  of  ectropion  and  corneal  opacity  do.  My 
own  cases  have  shown  its  curative  effect  upon 
keloid,  and  its  palliative  and  probably  curative 
effect  on  malignant  tumours. 

THIOSTJLPHATES.  —  See      Hyposult 

PHITES. 

THITJE.ET.  CbHvNsSj,  an  oxidation  prod- 
uct of  phenyldithiobiuret,  is  a  white  crystalline 
powder  soluble  in  alcohol  and  in  ether,  but  not 
readily  in  water.  Its  salts,  the  salicylate,  the 
hydrobromide,  the  hydrochloride,  etc.,  are 
more  soluble  in  water.  Thiuret  and  its  salts 
are  antiseptic,  and  have  been  recommended  as 
substitutes  for  iodoform. 

THORN-APPLE.— See  Stramonium. 

THOROUGHWOBT.— See  Eupatoeium. 


THUJA 
THYMOL 


282 


THUJA,  or  arbor  vitce,  was  formerly  offi- 
cial in  the  TJ.  S.  Pharmacopoeia,  but  was 
dropped  in  the  last  revision  on  account  of  lack 
of  valuable  medicinal  properties.  The  leaves 
and  small  twigs  are  the  pai'ts  employed,  and  a 
fluid  extract  or  saturated  tincture  is  the  prep- 
aration most  commonly  used.  Either  of  these 
may  be  given  in  drachm  doses.  Thuja  has 
been  employed  in  malarial  fevers,  rheumatism, 
and  a  variety  of  diseases,  but  is  of  little  or  no 
value. — Russell  H.  Nevins. 

THUS  AMEE.ICANUM  (Br.  Ph.).— See 
Olibanum. 

THYMACETINE,  a  white  crystalline 
powder,  is  a  derivative  of  thymol,  having  the 

formula  CeH^-CHsCaH,  |  NHfc'H^O)-  ^*  ^^* 
first  obtained  by  Hofmann,  of  Leipsio. 

In  its  chemical  composition  it  bears  the 
same  relation  to  thymol  as  phenacetine  does  to 
phenol.  It  probably  combines  the  antiseptic 
properties  of  thymol  with  the  general  charac- 
teristics of  phenacetine.  Thymacetine  is  very 
slightly  soluble  in  water. 

The  most  exhaustive  physiological  study  of 
thymacetine  has  been  made  by  M.  Marandol  de 
Mentyel  {Bulletin  general  de  therapeutique, 
vol.  cxxiv),  although  Jolly  had  previously  re- 
ported upon  it  clinically  (Centralblatt  fiir  die 
f/esammte  Therapie.  February,  1892).  The  lat- 
ter found  that  in  doses  of  from  3  to  15  grains 
thymacetine  ameliorated  nervous  headaches, 
and  had  a  general  analgetic  effect  which  might 
be  compared  to  that  of  phenacetine.  Occasion- 
ally the  drug  exhibits  a  hypnotic  influence, 
which  is  not  so  permanent  or  reliable  as  that 
of  other  coal-tar  hypnotics.  As  disagreeable 
concomitant  actions.  Jolly  noted  occasionally 
cerebral  congestion  and  a  tendency  to  drowsi- 
ness. Although  his  physiological  experiments 
were  limited.  Jolly  found  that  doses  of  30 
grains  were  not  poisonous  to  dogs. 

De  Mentyel  (loc.  cit.)  finds  little  or  no  hyp- 
notic effect  from  doses  of  23  grains  of  thym- 
acetine. His  experiments  also  lead  him  to 
believe  that  the  drug  is  without  effect  upon 
the  intellect,  exciting  in  paralytics  and  de- 
mented insane  persons  neither  exaltation  nor 
depression.  Upon  the  vaso-motor  system,  the 
genital  tract,  the  secretions  in  general,  and  the 
gastro-intestinal  canal,  he  found  thymacetine 
without  effect.  Although  the  drug^  as  Jolly 
maintained,  sometimes  produces  cerebral  con- 
gestion, de  Mentyel  agrees  with  that  observer 
that  it  is  valuable  in  headaches  of  nervous  ori- 
gin. Whether  the  increase  of  muscular  force 
observed  after  the  ingestion  of  thymacetine  is 
due  to  an  increased  activity  of  the  nervous 
system  or  of  the  muscular  fibre  has  not  been 
determined ;  but  the  writer  inclines  to  the 
former  view,  since  he  has  frequently  observed 
a  rise  of  temperature  of  from  one  half  to  one 
degree  lasting  from  one  to  two  hours.  The  in- 
creased frequency  of  the  respiratory  move- 
ments— from  one  to  six  a  minute — noted  after 
the  administration  of  thymacetine  de  Mentyel 
is  also  convinced  should  be  attributed  to  the 
over-activity  of  the  nervous  system,  since  the 
emotional  condition  of  his  patients  can  not  ac- 


count for  the  phenomenon,  for  the  expcriment& 
were  repeated  several  times  with  a  uniform  re- 
sult. At  the  same  time,  an  acceleration  of  the 
pulse,  from  three  to  fifteen  beats  a  minute,  was 
noted,  and  a  decided  increase  in  the  arterial 
tension  was  observed.  This  combination  of 
phenomena  would  probably  account  for  the 
clinical  congestion  of  the  cerebrum  seen.  De 
Mentyel  noticed  no  diuretic  effect  of  the  drug. 

That  author,  in  his  resume,  says  that  the 
physiological  effects  are  independent  of  the 
size  of  the  dose.  The  following  phenomena 
were  observed  in  connection  with  the  experi- 
ments, which  also  proved  to  be  in  no  wise  de- 
pendent on  the  size  of  the  dose  given  :  There 
was  sometimes  a  pupillary  dilatation  with  no 
visual  disturbance ;  a  slight  headache  some- 
times supervened,  most  frequently  in  the  after- 
noon ;  the  force  of  the  cardiac  beat  was  not 
influenced,  despite  the  increase  of  arterial  ten- 
sion and  rapidity  of  the  pulse.  Occasionally 
lassitude  was  observed  without  severe  func- 
tional disturbance ;  a  coated  tongue,  slight 
anorexia,  and  epigastric  pain  occasionally  ap- 
peared ;  very  rarely  there  were  nausea  and 
vomiting,  which  promptly  disappeared  upon 
the  withdrawal  of  the  drug,  as  did  an  occa- 
sional uretero-vesical  spasm  and  dysuria.  In 
conclusion,  de  Mentyel  remarks  that  paralytics 
seem  most  susceptible  to  the  influences  of  the 
drug. 

The  dose  of  thymacetine  is  from  3  to  15 
grains,  repeated  three  or  four  times  daily. 
Owing  to  its  insolubility,  it  is  best  given  in 
capsules  or  wafers. — Samuel  M.  Brickner. 

THYME,  herba  thymi  (Ger.  Ph.),  is  the 
leaves  or  flowering  tops  of  Thymus  vulgaris. 
It  is  fragrant  and  stimulating  to  a  surface  to 
which  it  is  applied.  The  volatile  oil.  oleum 
thymi  (0.  S.  Ph..  Ger.  Ph.),  is  employed  as  a 
stimulant  and  antiseptic  application,  acting  by 
virtue  of  the  thymol  contained  in  it.  The 
herb  of  another  species.  Thymus  Serpyllum, 
herba  serpylli  (Ger.  Ph.),  also  furnishes  a  vola- 
tile oil  having  similar  properties  to  those  of 
the  oil  derived  from  Thymus  vulgaris.  Oil  of 
thyme  may  be  used  internally  as  a  carminative 
and  stimulant,  in  doses  of  from  1  to  3  drops 
on  sugar. 

THYMOL  (U.  S.  Ph.,  Br.  Ph.),  thymolum 
(Ger.  Ph.),  is  a  phenolic  stearoptene  known  in 
chemical  language  as  propylmethylphenol, 

CH3 

I 

C 

^  CH 


C,„Hi40= 


HC 
EC 


C-OH 


CaH, 

It  is  obtained  from  the  volatile  oils  oi  Thymus 
vulgaris.  Thymus  Serpyllum,  Monada  punc- 
tata, C'arum  puncfatum,  and  some  other  allied 
plants  in  one  of  three  ways — either  by  saponi- 
fication with  sodium  hydrate  and  then  treat- 
ing the  separated  soap  with  hydrochloric  acid, 


283 


THUJA 
THYMOL 


or  by  fractional  distillation  of  the  oils,  or  by 
means  of  prolonged  refrigeration  under  the  in- 
fluence of  which  it  crystallizes.  It  occurs,  ac- 
cording to  the  U.  S.  Pharmacopoeia,  in  large 
crystals  of  the  hexagonal  system,  nearly  or 
quite  colourless,  having  an  aromatic,  thyme- 
like odour,  a  pungent,  aromatic  taste,  with  a 
veiy  slight  caustic  effect  upon  the  lips,  and  a 
neutral  reaction.  Soluble  in  1,200  parts  of 
water  and  in  1  part  of  alcohol  at  15°  C.  (59° 
P.),  in  900  parts  of  boiling  water;  freely  solu- 
ble in  boiling  alcohol,  also  in  ether,  in  chloro- 
form, in  benzol,  in  benzin,  in  glacial  acetic 
acid,  and  in  the  fixed  and  volatile  oils.  It 
liquefies  with  camphor.  Its  specific  gravity  as 
a  solid  is  1'028:  after  fusion  it  is  lighter  than 
water.  It  melts  at  about  50°  C.  (133°  P.),  re- 
maining liquid  at  lower  temperatures,  and  boils 
at  about  ?30°  C.  (446°  P.).  The  crystals  when 
rubbed  develop  electricity  and  attract  small 
pieces  of  paper. 

In  its  physiological  action  thymol  bears  a 
resemblance  to  carbolic  acid,  and  also  to  oil  of 
turpentine.  It  is  said  to  interfere  more  pow- 
erfully than  carbolic  acid  with  the  develop- 
ment of  schizomycetes,  while  it  is  at  the  same 
time  much  less  caustic,  irritating,  or  poisonous. 
When  applied  to  the  skin  or  mucous  mem- 
branes, it  causes  paralysis  of  the  end-organs  of 
the  sensory  nerves  and  thus  induces  local  anaes- 
thesia, but  it  can  not  be  employed  for  this 
purpose  after  the  manner  of  cocaine,  because 
when  applied  in  a  sufficiently  concentrated 
form  to  produce  this  effect  it  is  also  a  strong 
local  irritant.  Large  doses  cause  a  sensation 
of  heat  in  the  epigastrium,  diaphoresis,  tinni- 
tus aurium,  deafness,  and  a  feeling  of  con- 
striction about  the  forehead.  Toxic  doses 
depress  the  nerve-centres  in  the  medulla  ob- 
longata and  spinal  cord,  lessen  reflex  action, 
reduce  the  temperature,  render  the  respiration 
slow,  lower  the  arterial  tension,  produce  mus- 
cular weakness,  and  may  cause  death  in  coma. 
Thymol  is  eliminated  by  the  respiratory  and 
urinary  organs,  which  show  a  decided  irritation 
during  its  excretion.  The  urine  is  increased 
in  quantity  and  becomes  of  an  olive-green  hue, 
as  in  carbolic-acid  poisoning. 

Thymol  is  not  very  frequently  used  in  inter- 
nal medication,  but  good  results  from  its  em- 
ployment in  a  number  of  diseases  have  been 
reported.  Por  this  purpose  it  may  be  given 
in  powder,  capsules,  or  emulsion,  which  are 
recommended  as  preferable  to  either  alcoholic, 
watery,  or  alkaline  solutions.  It  has  been  used 
in  acute  artieular  rheumatism,  but  has  not 
proved  so  effective  as  salicylic  acid.  Its  use 
as  an  antiseptic  to  restrain  abnormal  fermenta- 
tive processes  in  the  alimentary  tract  during 
acute  and  chronic  intestinal  disorders  in  both 
adults  and  children  has  some  warm  advocates. 
In  typhoid  fever  it  has  been  said  to  reduce  the 
temperature,  to  cause  the  stools  to  become  less 
frequent  and  less  offensive,  to  lessen  the  tym- 
panites, to  cause  the  tongue  to  become  clean 
and  moist,  to  diminish  the  excretion  of  urea, 
to  render  the  cerebral  symptoms  less  severe, 
and  to  increase  the  blood-pressure  without  in- 
jury to  the  heart.  Por  all  cases  of  intestinal 
derangement  thymol  may  be  given  in  doses  of 
03 


from  -J  to  3  grains  several  times  a  day.  The 
aggregate  may  amount  to,  but  should  not  ex- 
ceed, half  a  drachm  in  twenty-four  hours. 

Cases  of  chyluria  have  been  reported  in 
which  the  disappearance  of  the  fatty  matter 
and  of  the  filarise  appears  to  have  been  greatly 
expedited  by  the  ingestion  of  from  1  to  5 
grains  three  times  a  day.  Nugent  recommends 
it  to  be  given  in  combination  with  15  or  20 
grains  of  gallic  acid.  In  catarrh  of  the  blad- 
der it  is  of  advantage  to  supplement  the  inter- 
nal administration  of  the  drug  with  local 
treatment,  washing  out  the  organ  with  a  solu- 
tion of  from  1  to  3,000  to  1  to  1,500  in  strength. 
Good  results  have  been  obtained  from  its 
use  in  diabetes,  but  it  seems  to  produce  very 
slight  if  any  effect,  unless  the  patient  is  con- 
fined to  a  purely  nitrogenous  diet. 

Most  headaches,  with  the  exception  of  true 
migraine,  are  alleged  by  Jolly  to  be  as  amen- 
able to  thymol  in  average  doses  of  7J  grains 
as  to  phenacetine. 

In  diseases  of  the  respiratory  tract  thymol 
has  been  more  commonly  used,  principally  in 
combination  with  other  agents,  as  a  cleansing, 
deodorizing,  and  stimulating  local  application, 
also  as  an  inhalant,  and  less  frequently  as  an 
internal  remedy.  It  appears  to  exercise  a 
good  influence  in  some  eases  of  phthisis,  and 
is  useful  as  a  disinfectant  for  the  sputum.  In- 
halation of  thymol  is  not  infrequently  of  serv- 
ice in  diseases  of  the  upper  air-passages  as 
well  as  in  bronchitis  and  whooping-cough,  and 
it  is  said  to  excite  the  flow  of  blood  through 
the  lungs.  A  good  formula  is  the  following, 
suggested  by  Dr.  Clarence  Rice,  a  teaspoonful 
of  which  may  be  added  to  boiling  water  and 
the  steam  inhaled : 
^  Menthol,  ) 

Thymol,  [■  each 5  grains ; 

Carbolic  acid,  ) 

Oil  of  eucalyptus 2  fl.  oz. ; 

Oil  of  Pinus  silvestris 3  "    " 

M. 
This  may  also  be  inhaled  by  pouring  a  few 
drops  on  cotton  or  a  sponge  and  holding  it  to 
the  nostrils. 

In  atrophic  rhinitis,  the  purulent  rhinitis  of 
children,  and  other  diseases  of  the  nasal  cavity 
its  cleansing  and  deodorizing  properties  render 
it  very  useful  and  afford  a  certain  degree  of 
comfort  to  the  patient  and  his  friends,  but  in 
atrophic  rhinitis  at  least  it  can  not  be  said  to 
influence  to  any  great  degree  the  course  of  the 
disease.  The  following  is  a  solution  proposed 
by  Dr.  Douglas  for  this  purpose : 

5  Thymol 10  grains ; 

Eucalvptol 20      " 

Menthol 30      " 

Oil  of  cubeb 40      " 

Oil  of  rose a  sufficiency ; 

Benzoinol 4  oz. 

M. 
The  amounts  of  the  various  ingredients  may 
be  varied  as  a  stronger  or  weaker  effect  is  de- 
sired. In  the  treatment  of  diseases  of  the  na- 
sal cavity,  weak  solutions  of  thymol  may  be 
used  in  the  form  of  a  spray,  but  stronger  ones 
should  be  applied  by  means  of  a  cotton-car- 


THYMUS    EXTKACT 


284 


rier.  According  to  Seiss,  the  following  is  a 
preparation  of  minimum  strength  from  which 
a  therapeutic  efiect  can  be  expected : 

5  Thymol i  grain ; 

Alcohol i  drachm ; 

Glycerin li        " 

Water 1  oz. 

M. 

A  stronger  solution  than  one  of  5  grains  to  the 
ounce  is  seldom  if  ever  required. 

In  the  laryngitis  and  pharyngitis  of  the  ex- 
anthemata, especially  when  associated  with 
putrid  exhalations,  the  use  of  a  watery  solution 
from  1  to  3,000  to  1  to  1,000  in  strength  has 
been  recommended  as  a  gargle  or  spray.  Like- 
wise in  diphtheria  the  use  of  a  strong  solution 
as  a  lotion  or  spray  has  been  alleged  to  do 
some  good.  Its  fragrant  odour  renders  thymol 
a  very  pleasant  constituent  for  a  lotion  of  this 
nature  or  for  a  mouth  wash  for  use  in  ulcera- 
ted or  other  conditions  which  require  the  use 
of  an  antiseptic,  or  to  remove  the  smell  of 
tobacco  from  the  breath,  but  after  a  prolonged 
use  of  the  drug  this  odour  becomes  disagree- 
able to  many  people. 

It  has  been  strongly  recommended  as  a  ver- 
mifuge for  several  varieties  of  intestinal  para- 
sites, but  very  large  doses  are  necessary  to 
render  its.  use  effectual.  Some  writers  doubt 
its  ability  as  a  twniacide,  but  the  following 
procedure  is  said  to  be  effective.  During  the 
evening  previous  to  the  administration  of  the 
drug  the  patient  should  take  half  an  ounce  of 
castor  oil.  In  the  morning  60  grains  of  thy- 
mol are  to  be  given,  divided  into  twelve  doses 
at  intervals  of  fifteen  minutes,  and  twenty 
minutes  after  the  last  dose  half  an  ounce  more 
of  castor  oil  is  to  be  taken.  It  is  acknowl- 
edged that,  in  spite  of  free  stimulation  during 
this  treatment,  there  may  be  a  decided  fall  of 
the  respiration,  pulse,  and  temperature.  Sand- 
with  maintains  that  thymol  seems  to  have  a 
specific  action  as  an  anthelminthic  in  ankylo- 
stomiasis, and  gives  for  this  purpose  from  60  to 
90  grains  in  divided  doses  during  the  day,  re- 
peats this  in  a  week,  and  repeats  it  again  if 
necessary.  He  also  acknowledges  that  60 
grains  in  the  course  of  a  day  may  cause  symp- 
toms of  collapse.  While  it  may  possibly  be 
true,  as  has  been  alleged,  that  there  is  no  dan- 
ger of  fatal  poisoning  from  less  than  100 
grains  per  diem,  still  the  appearance  of  such 
toxic  symptoms  as  the  result  of  the  ingestion 
of  60  grains  demonstrates  that  such  doses  are 
risky,  although  apparently  necessary  to  secure 
anthelminthic  action. 

Gratifying  results  have  been  obtained  from 
the  use  of  solutions  as  vaginal  douches  in  leu- 
corrhma,  and  to  correct  offensive  lochia.  It 
has  been  used  dissolved  in  glycerin  to  the 
strength  of  from  1  to  3,000  to  1  to  1,000  on 
cotton  as  a  tampon  in  the  treatment  of  ero- 
sions of  the  OS  uteri. 

Thymol  is  said  to  be  able  to  arrest  dental 
caries,  and  Hartmann  has  found  it  useful  in 
inflammation  of  the  dental  pulp.  He  cleanses 
the  carious  cavity  and  inserts  a  bit  of  cotton 
which  has  been  powdered  with  thymol.  To 
hasten  its  solution  and  action,  he  advises  that 


the  mouth  be  washed  out  several  times  with 
lukewarm  water. 

As  an  antiseptic  lotion  a  solution  of  from  1  to 
3,000  to  1  to  1,000  has  been  used  to  some  extent 
for  wounds,  burns,  and  ulcers,  as  well  as  for 
cleansing  instruments  during  operations  and 
for  preserving  sponges  in  an  aseptic  condition. 
For  these  purposes  it  is  of  about  the  same  util- 
ity as  carbolic  acid,  and  presents  fewer  objec- 
tionable features,  but  will  probably  never 
become  popular,  because  it  furnishes  a  powerful 
attraction  for  flies.  Painted  on  the  skin  in 
pruritus,  it  gives  marked  relief.  A  solution 
which  has  been  recommended  to  be  kept  in 
stock  as  a  basis  from  which  to  prepare  any  de- 
sired solution  for  external  use  is  the  following  : 

]J  Thymol 15  grains  ; 

Alcohol 21  drachms ; 

Glycerin 5        " 

Water 1  pint. 

M. 

In  a  number  of  skin  diseases,  such  as  ring- 
worm of  the  scalp,  acne,  pityriasis,  psoriasis, 
and  eczema,  thymol  has  been  successfully  em- 
ployed, usually  in  the  form  of  ointments  which 
vary  in  strength  from  10  grains  to  the  ounce 
upward.  When  an  ointment  of  greater  strength 
than  20  grains  to  the  ounce  is  desired  the  thy- 
mol should  first  be  dissolved  in  alcohol,  a 
grain  to  a  minim.  Guladze  reports  excellent 
results  in  faviis  from  the  following  treatment : 
The  hair  is  cut  short  and  the  scalp  washed 
daily  with  green  soap  for  four  or  five  days. 
Then  an  ointment  of  1  part  of  thymol,  8  parts 
of  chloroform,  and  36  parts  of  olive  oil  is  ap- 
plied and  renewed  three  times  a  day.  As  soon 
as  the  crusts  begin  to  fall  the  hair  is  pulled 
out  and  the  ointment  applied  directly  to  the 
diseased  part.  He  says  that  recovery  takes 
place  in  from  three  to  four  weeks,  but  recom- 
mends the  application  for  a  week  longer  of  a 
mixture  of  2  parts  of  iodine  and  1  part  of  glyc- 
erin twice  a  day. 

Matthias  Lanokton  Poster. 

THYMUS  EXTRACT,  THYMUS 
FEEDING. — The  thymus  gland,  an  organ  of 
f cetal  and  early  infantile  life,  usually,  as  is  well 
known,  ceases  to  grow  soon  after  birth  and  at 
the  age  of  puberty  begins  to  undergo  fatty  de- 
generation and  atrophy.  Sometimes  a  "  revi- 
val "  of  the  gland — that  is,  its  renewed  growth, 
with  presumably  a  resumption  of  its  functional 
activity — takes  place  in  adult  life.  This  oc- 
currence has  been  observed  almost  exclusively 
in  persons  affected  with  exophthalmic  goitre, 
and  it  is  supposed  to  be  a  provision  of  Nature 
whereby  the  gland,  having  recovered  its  func- 
tional power,  produces  an  internal  secretion 
that  serves,  as  Mr.  David  Owen,  of  Manchester, 
England,  says,  to  neutralize  the  toxic  agents 
which  caused  the  disease.  At  the  annual  meet- 
ing of  the  British  Medical  Association  held  in 
1896  Mr.  Owen  read  a  paper  entitled  Thymus 
feeding  in  Exophthalmic  Goitre.  According 
to  an  abstract  of  Mr.  Owen's  paper  published 
in  the  Lancet  iov  August  22, 1896,  he  described 
three  cases  of  this  disease  under  his  care  that 
had  been  treated  with  thymus  gland.  The  first 
had  been  described  in  the  British  Medical 


285 


THYMUS  EXTRACT 


Journal  for  February  15,  1895.  Since  then 
Mikulicz,  Cunningham,  Bdes,  Solis-Cohen, 
Maude,  and  Todd  had  reported  on  the  same 
treatment  with  confirmatory  results.  All  three 
of  Mr.  Owen's  patients  had  been  restored  to 
health  by  the  treatment.  The  dose  of  the  raw 
gland  was  from  ^  to  1  oz.  three  or  four  times  a 
week.  The  relief  obtained  in  these  cases  must 
have  been  more  than  a  coincidence,  he  thought, 
as  in  one  of  his  cases  and  in  several  recorded 
by  others  discontinuance  of  the  use  of  the  gland 
had  been  followed  by  relapse,  but  on  resuming 
it  the  patients  had  again  improved.  Upon  one 
occasion  a  patient  of  his  who  always  had  been 
benefited  by  the  treatment  failed  to  respond  to 
the  glands.  This  was  found  to  be  due  to  their 
having  been  taken  from  full-grown  sheep.  On 
his  giving  calf's  thymus  most  urgent  symptoms 
were  at  once  relieved,  especially  dyftpncsa,  pal- 
pitation, and  tremors.  The  heart,  which  had 
been  irregular  and  rapid,  improved  greatly  in 
a  few  days.  Others  had  had  quite  as  striding 
results.  The  probability  of  the  theory  that 
hypertrophy  of  the  thymus  had  a  curative  ten- 
dency was  supported  by  the  fact  that  other 
lymphoid  structures,  including  the  spleen, 
were  also  found  enlarged,  and  it  was  well 
known  that  increased  lymphoid  activity  with 
consequent  leucocytosis  occurred  in  toxjemio 
conditions  and  served  an  antitoxic  purpose. 
Further  confirmation  of  this  theory  was  de- 
rived from  the  fact  that  pregnancy  often  re- 
lieved Graves's  disease,  and  this  might  be  due 
to  the  physiological  leucocytosis  which  existed 
then.  It  was  noteworthy  that  this  disease  was 
almost  unknown  in  infancy,  when  the  thymus 
gland  was  present.  The  fact  that  the  thyreoid 
gland  was  more  active  during  infancy  than 
later  would  render  the  infant  more  liable  to 
hyperthyreoidization  were  there  not  some 
counteracting  influence  which  the  thymus 
gland  possibly  supplied.  Mr.  Owen  thought 
there  was  evidence  of  antagonism  between  the 
thyreoid  and  thymus  glands.  Thyreoid  ex- 
tract increased  tissue  waste.  On  the  other 
hand,  the  thymus  gland  was  most  developed 
during  infancy  and  in  hibernating  animals  at 
each  period  of  hibernation,  which  pointed  to 
this  gland  exerting  an  inhibitory  influence 
over  waste.  This  theory  had  been  strength- 
ened by  the  results  of  experiments  and  by  the 
effects  produced  by  disease  of  the  thymus 
gland.  The  thyreoidal  secretion,  too,  had  a 
stimulating  influence  over  the  cerebral  func- 
tions, and  increased  activity  of  the  sexual 
organs  was  associated  with  enlargement  of  the 
thyreoid  gland.  On  the  contrary,  during  hi- 
bernation, when  the  thymus  gland  attained  its 
greatest  size,  the  cerebral  and  sexual  functions 
were  suspended  and  in  infancy  were  undevel- 
oped, but  underwent  rapid  development  at 
puberty,  when  the  thymus  gland  finally  dis- 
appeared. This  apparent  antagonism  supplied, 
in  Mr.  Owen's  opinion,  a  hypothetical  explana- 
tion of  the  mode  of  action  of  thymus  in  the 
treatment  of  exophthalmic  goitre — a  disease 
most  probably  due  to  excessive  activity  on  the 
part  of  the  thyreoid  gland. 

Reinbach  (Mittheilungen  aus  der  Grenzge- 
bieten  der  Medizin  und  Ghirurgie,  i,  1896 ; 


Gazette  hehdomadaire  de  medecine  et  de  chi- 
rurgie,  September  27, 1896)  reports  thirty  cases 
of  goitre  in  which  sheep's  thymus  was  used, 
sometimes  in  its  natural  state  and  sometimes 
in  the  form  of  pastilles  of  English  make.  The 
thymus  was  administered  in  the  form  of  hash 
spread  on  bread,  in  quantities  of  150  grains  for 
children  and  225  grains  for  adults,  three  times 
a  week.  Ijarger  quantities  did  not  seem  to  act 
more  energetically.  The  efl:ects  of  the  treat- 
ment were  ordinarily  manifested  at  the  end  of 
three  or  four  weeks,  and  the  results  remained 
the  same  when  the  treatment  was  continued 
for  a  longer  time.  Three  patients,  children 
ten  and  twelve  years  of  age,  were  completely 
cured  anatomically.  In  eighteen  cases  there 
was  considerable  amelioration,  with  diminu- 
tion in  the  size  of  the  tumour  and  in  the 
symptoms  provoked  by  it.  In  ten  cases  the 
treatment  failed  completely.  In  none  of  the 
cases  were  toxic  symptoms  analogous  to  those 
which  are  seen  in  the  thyreoid  treatment  ob- 
served, or  any  other  symptoms  of  a  toxic  na- 
ture. An  analysis  of  the  cases  observed  by  Dr. 
Reinbach  does  not  enable  us  to  say  in  which 
anatomical  variety  the  thyreoid  treatment  has 
greater  chance  of  success.  It  seems,  however, 
that  the  effects  of  the  medication  are  particu- 
larly appreciable  in  diffuse,  simple,  hyperplastic 
goitre.  On  the  whole,  he  says,  the  therapeutic 
results  of  the  thymus  treatment  are  very  nearly 
identical  with  those  of  the  thyreoid  treatment. 
The  former  has,  however,  the  advantage  of  not 
causing  toxic  symptoms,  and  for  this  reason  it 
may  be  preferred  to  the  latter  treatment,  and 
should  be  considered  as  the  preferable  method 
in  eases  in  which  the  thyreoid  treatment  has 
not  been  efficient.  Among  the  cases  reported 
by  Dr.  Reinbach  there  was  one  in  which  the 
thymus  treatment  led  to  a  successful  result 
after  the  thyreoid  treatment  had  completely 
failed. 

Typhoid  Thymus  Extract. — In  the 
Deutsche  medicinische  Wochenschrift  for  Octo- 
ber 12,  1893,  Dr.  Eugen  Fraenkel,  of  Hamburg, 
reported  that  ho  had  treated  fifty-seven  cases 
of  typhoid  fever  by  the  deep  subcutaneous  in- 
jection of  thymus  bouillon  in  which  the  typhoid 
bacillus  had  been  grown  and  then  killed.  In 
the  same  journal  Dr.  T.  Rumpf  reported  thirty 
cases  treated  by  the  dead  cultures  of  the 
Bacillus  pyocyaneus  grown  and  prepared  in 
the  same  manner  as  the  typhoid  cultures. 
These  authors  stated  that  half  a  cubic  centi- 
metre of  either  of  these  cultures,  injected  deep 
into  the  gluteal  region,  followed  by  the  injection 
of  one  cubic  centimetre  twenty-four  hours  later, 
was,  as  a  rule,  followed  by  a  slight  rise  of  tem- 
perature, with  or  without  a  chill,  on  the  third 
day  a  decided  fall  of  temperature,  not  to  be 
accounted  for  by  the  ordinary  course  of  the 
disease,  and  on  the  following  day  a  fall  still 
more  marked.  If  the  temperature  rose  again, 
under  a  continuance  of  the  injections  in  in- 
creasing doses  at  forty-eight-hour  intervals, 
the  patient  in  from  six  to  eight  days  would  be 
apyretic.  The  pulse  came  down  to  normal 
with  the  fall  of  temperature.  No  untoward 
symptoms  appeared  referable  to  the  heart's 
action  or  to  the  lungs  or  kidneys.    When  a 


THYMUS  EXTRACT 
THYREOID  TREATMENT 


286 


chill  accompanied  the  rise  after  the  injections 
the  heart's  action  did  not  increase  correspond- 
ingly wibh  the  rise  of  temperature.  Even 
when  the  fall  of  temperature  was  not  complete, 
the  fever  ohanpced  from  the  continuous  to  the 
remittent  type.  Still  more  marked  was  the 
change  in  the  general  condition  of  the  patient 
under  the  influence  of  the  injections.  The 
somnolence,  stupor,  and  delirium  disappeared  ; 
sleep  became  natural;  the  coated  tongue 
cleaned;  the  diarrhoea  disappeared,  and  the 
meteorism  improved.  The  patients'  appetite 
returned,  and  they  complained  of  hunger,  even 
though  the  successive  crops  of  roseola  contin- 
ued and  the  spleen  only  slowly  diminished  in 
size.  There  was  often  profuse  sweating  with 
decided  diuresis.  This  treatment,  however, 
did  not  prevent  complications  or  relapses,  but. 
when  relapses  did  occur  they  quickly  yielded 
to  further  injections.  In  some  cases,  however, 
the  treatment  was  without  effect.  The  earlier 
the  stage  of  the  disease  in  which  it  was  begun, 
the  better  were  the  results  obtained.  It  was 
effective  in  both  severe  and  mild  cases. 
Praenkel  makes  no  mention  of  his  death-rate  ; 
Rumpf  lost  two  patients  out  of  thirty — one  by 
intestinal  hiemorrhage,  the  other  by  pneumonia. 

The  foregoing  account  of  Praenkel  and 
Rumpf's  experience  is  given  by  Dr.  Alexander 
Lambert  {New  York  Medical  Journal,  April 
37,  1895),  who,  together  with  Dr.  John  Winters 
Brannan,  proceeded  to  try  the  treatment  in 
Bellevue  Hospital.  Dr.  Lambert  thus  de- 
scribes the  preparation :  The  thymus  glands  of 
calves  were  obtained  as  soon  after  death  as 
possible,  chopped  very  fine,  and  mixed  with 
distilled  water,  using  for  every  gramme  of  the 
chopped  glands  two  cubic  centimetres  of  the 
water.  This  was  allowed  to  stand  in  the  ice 
box  for  from  sixteen  to  eighteen  hours,  then 
strained  through  cheese  cloth  and  squeezed 
out  as  thoroughly  as  possible.  This  gave  a 
cloudy  mucilaginous  fluid,  which  was  alkalin- 
ized  with  potassium  hydroxide  until  not  quite 
neutral  to  the  phenolphthalein  test,  but  dis- 
tinctly alkaline  to  litmus.  The  fluid  was  then 
further  diluted  one  third  with  watei-,  and 
sterilized  for  half  an  hour  in  steam  at  100°  C. 
The  fluid  then  became  of  a  grayish-brown 
colour,  and  the  coarse  coagulated  flocks  were 
filtered  off  through  absorbent  cotton  after  the 
fluid  cooled.  The  resulting  fluid  was  of  a 
milky,  opalescent  colour,  and,  being  put  in 
small  flasks,  was  sterilized  in  steam  at  100°  C. 
for  two  successive  days.  These  flasks  were 
inoculated  from  a  broth-culture  of  a  typhoid 
bacillus  obtained  fresh  from  the  spleen  of  a 
patient  dead  from  typhoid  fever.  These  flasks 
were  then  out  into  the  thermostat  at  37'5°  C. 
and  the  cultures  allowed  to  grow  for  seventy- 
two  hours  ;  they  were  then  sterilized  by  heat- 
ing in  a  water  bath  at  63°  to  63°  C.  for  from 
twenty  to  thirty  minutes.  They  were  then 
tested  on  agar  plates,  and,  if  sterile,  were  ready 
for  use. 

Twenty-eight  cases  were  treated,  inchiding 
Dr.  Lambert's  and  Dr.  Brannan's  in  Bellevue 
Hospital,  Dr.  Northrup's  in  the  Presbyterian 
Hospital,  Dr.  Norrie's  in  St.  Luke's  Hospital, 
and  Dr.  Draper's  in  the  Roosevelt  Hospital. 


Of  these  twenty-eight  cases,  fifteen  showed 
more  or  less  improvement,  which  could,  Ur. 
Lambert  thought,  be  fairly  attributed  to  the 
injections.  Twelve  did  not  improve  under  the 
treatment,  and  one  death  occurred.  In  the 
fifteen  cases  showing  improvement  the  injec- 
tions were  begun  usually  about  the  tenth  day, 
ranging  from  the  sixth  to  the  fifteenth.  At 
first  in  two  cases  it  was  tried  as  Praenkel  had 
suggested,  by  injecting  half  a  cubic  centi- 
metre, and  on  the  following  day  one  cubic 
centimetre,  then,  at  the  expiration  of  forty- 
eight  hours,  if  the  temperature  did  not  show  a 
decided  fall,  two  cubic  centimetres;  and  then, 
if  the  temperature  still  remained  high,  repeat- 
ing the  injections  at  forty-eight-hour  intervals, 
increasing  the  amount  by  one  cubic  centimetre 
at  each  injection.  Under  this  plan  the  im- 
provement was  evident,  but  not  marked. 
Therefore  Dr.  Lambert  changed  the  plan  of 
treatment,  varying  it  somewhat  in  certain 
cases,  but,  as  a  rule,  injecting  increasing 
amounts  for  four  or  five  successive  days,  be- 
ginning with  a  half  or  one  cubic  centimetre ; 
then  giving,  at  twenty-four-hour  intervals, 
doses  of  two,  three,  or  four,  and  then  five  cubic 
centimetres,  as  the  case  demanded;  then  wait- 
ing forty-eight. hours,  and,  if  the  temperature 
rose  again  to  101°  P.  or  over,  repeating  the 
five  cubic  centimetres,  or  even  giving  six  or 
seven  cubic  centimetres.  This  gave  much 
better  results,  as  shown  both  in  the  tempera- 
ture curve  and  in  the  general  improvement  of 
the  patients. 

In  all  cases  the  injections  were  made  deep  in 
the  gluteal  region,  alternately  on  the  right  and 
left  sides.  In  only  one  or  two  eases  was  there 
any  local  reaction,  consisting  of  redness  and 
tenderness,  which  subsided  in  one  or  two  days. 
The  temperature  curve  followed  the  descrip- 
tion given  by  Praenkel.  Sometimes  there  was, 
within  from  thirty  minutes  to  two  hours  after 
the  injection,  a  rise  of  temperature  with  or 
without  distinct  chill,  and  at  times  this  rise 
or  this  chill  was  followed  by  profuse  sweating. 
In  two  cases  the  rise  of  temperature  was  ac- 
companied with  nausea  and  vomiting  and  head- 
ache. Asa  rule,  after  the  third  injection,  the 
temperature  curve  showed  a  lower  range,  fol- 
lowed after  the  fifth  injection  by  a  decided  fall 
of  several  degrees,  even  to  normal,  in  the  fol- 
lowing twenty-four  hours.  The  continuous 
type  of  fever  curve  often  changed  to  the  remit- 
tent type  while  falling.  At  times  no  abrupt 
fall  occurred,  but  the  fever  ranged  lower  and 
gradually  disappeared  by  a  long  lysis. 

The  pulse  showed  a  decided  improvement 
following  the  injections  both  in  its  frequency 
and  in  its  force  arid  tension.  With  the  chill 
and  rise  of  temperature  after  injections,  as  a 
rule,  the  pulse  did  not  show  a  proportional  in- 
crease in  frequency. 

The  general  condition  of  the  patient  showed 
the  greatest  improvement,  the  classical  picture 
of  the  third  week  of  typhoid  fever  bemg  en- 
tirely absent.  The  mental  condition  improved ; 
the  patients  lost  their  apathy  and  became  bright, 
the  sleep  became  more  natural,  the  delirium 
ceased,  and  the  diarrhoea  stopped.  When  con- 
stipation was  present  instead  of  diarrhoea,  the 


287 


THYMUS  EXTRACT 
THYREOID   TREATMENT 


injections  had  no  influence  whatever  upon  it. 
Marked  hunger  appeared  in  several  cases  co- 
incident with  the  fall  of  temperature.  The 
tongue  usually  cleaned  and  became  moist  be- 
fore the  use  of  the  injection  was  completed. 
In  one  case,  after  the  third  injection,  partial 
suppression  of  urine  occurred,  the  patient  pass- 
ing only  six  ounces  in  twenty-four  hours.  This 
symptom  disappeared  in  the  following  twenty- 
four  hours,  and  the  patient  showed  no  bad 
effects  from  it.  Five  cases  of  relapse  occurred 
in  the  sixteen  cases  favourably  affected  by  this 
treatment.  These  relapses  were  not  treated  in 
every  case  with  further  injections,  but  those 
so  treated  quickly  subsided.  The  roseola,  how- 
ever, was  not  affected,  and  the  swelling  of  the 
spleen  only  slowly  subsided. 

In  the  twelve  cases  that  showed  no  benefit 
from  the  treatment  the  injections  were  begun 
at  a  time  varying  from  the  ninth  to  the  twenty- 
second  day  of  the  disease,  averaging  on  the 
fifteenth  day.  This,  says  Dr.  Lambert,  is  five 
days  later  than  in  the  group  of  improved  cases, 
and  bears  out  Rampf's  statement  that  the  ear- 
lier in  the  disease  the  injections  are  begun  the 
more  chance  there  is  of  a  beneficial  action.  In 
three  cases  of  this  group  where  the  injections 
were  begun  on  the  twentieth  and  twenty-second 
days  of  the  disease  the  temperature  fell  rapid- 
ly after  the  injections,  but  it  was  so  late  in  the 
disease  that  one  can  not  be  sure  that  convales- 
cence would  not  have  begun  at  that  time  had 
the  injections  been  withheld.  In  the  eight 
other  oases  there  is  no  doubt.  Dr.  Lambert 
thinks,  that  the  injections  did  not  result  in 
any  benefit  to  the  patients.  On  the  other  hand, 
in  no  one  of  the  twenty-eight  cases  was  there 
any  harmful  effect  observed  due  to  the  injec- 
tions. The  case  that  proved  fatal  was  a  very 
severe  one,  the  patient  being  in  an  extremely 
poor  general  condition  when  the  injections 
were  begun.  On  the  eighth  day  but  three  in- 
jections were  given  of  one,  two,  and  three  cubic 
centimetres,  respectively ;  tub  baths  were  also 
given  during  and  after  the  injections  in  this 
case,  but  the  patient  died  from  the  severity  of 
the  disease  three  days  after  the  last  injection, 
and  on  the  fifteenth  day  of  the  disease.  The 
cases  recorded  by  Dr.  Lambert  were  taken  as 
they  came  to  the  hospitals,  and  were  mild, 
moderately  severe,  and  severe.  The  diagnosis 
was  purely  clinical. 

Dr.  Lambert  cites  von  .laksch,  of  Prague,  as 
having  used  the  original  thymus  bouillon  of 
Fraenkel  in  nine  cases  and  RnmpE's  prepara- 
tion in  eight.  In  one  severe  case  coming 
under  his  care  in  the  second  week,  with  a  tem- 
perature of  104°  to  105°  F.,  after  five  injections 
with  typhoid  thymus  bouillon  the  patient  was 
apyretic  and  the  temperature  did  not  rise  again. 
In  the  eight  remaining  eases  so  marked  a  result 
did  not  occur.  It  also  was  evident  that  with 
the  pyocyaneus  culture  a  continuous  can  be 
changed  t;o  a  remittent  fever,  but  in  severe  cases 
this  result  was  not  obtained.  He  did  not  ob- 
tain valuable  results  with  the  treatment,  as  he 
did  not  consider  that  he  had  so  modified  the 
typhoid  poison  that  it  proved  of  essential  bene- 
fit to  the  patient,  although  he  had  shortened 
the  duration  of  the  disease.    Moreover,  the  in- 


jections were  unpleasant  to  the  patients,  as 
they  often  caused  severe  pain.  In  one  severe 
case  which  came  to  autopsy,  sterile  pyocyaneus 
pus  was  found  in  the  injection  wound. 

Kraus  and  Buswell,  of  Vienna,  are  also  cited 
by  Dr.  Lambert  as  having  tried  the  pyocyaneus 
thymus  bouillon  in  twelve  cases.  They  in- 
jected into  the  thigh  and  observed  a  limited 
lyraphangeitis  follow  and  abscesses  in  two  cases. 
The  cases  were  severe  and  moderately  severe, 
without  complications,  but  with  two  deaths. 
The  stage  of  the  disease  was  the  second  or 
third  week,  so  far  as  the  history  could  show. 
Only  three  cases  showed  positive  results  on  the 
temperature.  In  four  or  five  further  cases  such 
a  supposition  was  fairly  possible,  in  the  rest  it 
was  quite  out  of  the  question.  There  was  no 
influence  on  the  curve  as  to  the  fever's  being 
continuous  or  remittent.  The  pulse  fell  with 
the  temperature;  the  diarrhoea  did  not  im- 
prove, the  roseola  persisted,  and  the  spleen 
continued  large.  Only  one  ease  showed  marked 
general  improvement,  though  it  showed  no 
marked  fall  of  temperature.  In  this  case  there 
was  distinct  increase  of  strength,  and  the  stu- 
por and  nightly  delirium  disappeared.  These 
authors  are  not  at  all  favourably  impressed  with 
the  treatment. 

In  summing  up  the  results  in  the  cases  re- 
corded by  hini.  Dr.  Lambert  says  he  certainly 
has  not  "obtained  the  brilliant  results  alleged 
by  Fraenkel  and  Rumpf.  The  treatment  seems 
to  him,  however,  to  have  been  of  benefit  in  a 
little  more  than  half  the  cases  tried,  and  where 
it  benefited  it  certainly  modified  the  severity, 
and  in  some  cases  shortened  the  duration  of  the 
disease. 

THYBADEN. —  This  preparation,  called 
also  extractum  ihyreoidem,  consists  of  a  dried 
extract  of  the  thyreoid  gland  triturated  with 
such  an  amount  of  sugar  of  milk  that  one  part 
of  the  product  is  equivalent  to  two  parts  of 
the  fresh  gland.  It  is  given  in  dr.ily  amounts 
of  from  15  to  25  grains  in  cases  in  which  thy- 
reoid medication  is  indicated. 

THYKEO  ANTITOXINE.— Dr.  Sigmund 
Prankel,  of  Vienna  {Medical  Record,  January 
11,  1896),  has  given  this  name  provisionally  to 
a  very  hygroscopic  crystalline  substance,  ap- 
parently an  alkaloid,  obtained  by  him  from  the 
thyreoid  gland  of  the  sheep  and  thought  by 
him  to  be  the  active  principle  of  the  ^land. 
So  far  as  has  been  reported  at  present,  it  has 
been  used  only  in  experiments  on  animals. 

THYREOID  EXTRACT,  THYREOID 
FEEDING,  THYREOID  GLAND,  THY- 
REOID MEDICATION,  THYREOID 
TREATMENT. — During  the  past  five  years 
the  attention  of  the  medical  profession  has 
been  strongly  called  to  the  therapeutic  value 
of  extracts  made  from  certain  animal  tissues, 
many  of  which  will  probably  soon  pass  into  ob- 
livion, while  others  will  almost  surely  obtain  a 
permanent  position  in  our  materia  mediea.  It 
is  by  no  means  the  first  time  in  the  history  of 
medicinethat  healing  virtues  have  been  attrib- 
uted to  extracts  made  from  animal  tissues,  for 
their  use  seems  to  have  been  known  in  a  crude 
way  among  the  ancient  peoples ;  references  are 


THYREOID  TREATMENT 


288 


made  to  them  as  well-known  therapeutic  agents 
in  the  Middle  Ages,  and  during  the  last  cen- 
tury a  number  were  dropped  from  the  London 
Pharmacopoeia.  But  no  such  antiquity  can  be 
ascribed  to  the  use  of  extract  of  the  thyreoid 
gland,  although  it  is  to-day  one  of  the  most 
prominent  of  this  class  of  drugs  whose  claim 
to  recognition"  is  based  upon  what  appears  to 
be  a  firm  foundation.  Its  employment  is  es- 
sentially modern  and  was  not  due  to  chance  or 
analogy,  but  was  the  result  of  careful  scientific 
observation  and  logical  deduction. 

The  history  of  its  origin  is  very  interesting. 
The  function  of  the  thyreoid  gland  had  been  a 
subject  of  curiosity  for  many  years  and  vari- 
ous theories  in  regard  to  this  function  were 
held  by  different  scientists,  while  some  even 
made  the  assertion  that  in  the  adult  human 
subject  it  performed  no  function  whatever  and 
was  of  no  value.  In  1873  the  disease  Imown  as 
myxosdema  was  first  described  by  Sir  William 
W.  Gull,  and  a  number  of  autopsies  have  re- 
vealed atrophy  of  the  thyreoid  gland  as  a  con- 
stant pathological  condition  in  that  disease. 
In  1883  Kocher  described  a  condition  called 
cachexia  strumipriva,  which  occurred  as  a  re- 
sult of  extirpation  of  the  thyreoid  gland,  and 
a  few  months  later  Simon  called  attention  to 
the  identity  of  the  symptoms  of  myxoedema 
and  those  of  cachexia  strumipriva.  These  char- 
acteristic symptoms  are  a  subnormal  tempera- 
ture, a  sensation  of  chilliness,  mental  and 
physical  torpor,  fibrillar  muscular  tremors, 
anaemiaa,  subcutaneous  deposit  of  mucin,  and 
a  thiclfened,  coarse,  dry,  and  harsh  slcin.  After 
removal  of  the  gland  the  subnormal  tempera- 
ture is  preceded  by  an  elevation  of  several 
degrees,  and  the  cachexia  appears  the  more 
quiclily  atler  the  operation  the  younger  the 
patient.  The  course  of  both  conditions  was 
marked  by  steady  progress  and  usually  resulted 
in  death.  A  series  of  experiments  upon  the 
lower  animals  demonstrated  that  a  similar  con- 
dition was  produced  in  them  by  the  extirpa- 
tion of  the  threoid  gland. 

It  was  next  learned  that  the  gland  could  be 
removed  from  the  neck  of  a  dog  and  trans- 
planted to  the  peritoneal  cavity,  and  that,  if  it 
became  vascularized  and  attached  in  the  place 
to  which  it  had  been  transplanted,  the  animal 
remained  free  from  the  symptoms  of  cachexia 
strumipriva  which  otherwise  invariably  super- 
vened. Attempts  to  transplant  the  thyreoid 
gland  of  a  sheep  into  the  tissues  of  patients 
suffering  with  myxoedema  followed  as  a  natu- 
ral sequence.  In  1890  Bettencourt  and  Serrano 
performed  this  operation  and  obtained  a  great 
improvement,  which  began  at  once,  before  the 
gland  had  had  time  to  resume  its  functions,  or 
indeed  to  become  vascularized.  This  demon- 
strated that  something  of  a  remedial  nature 
had  been  introduced  into  the  system  which  per 
se  had  caused  the  improvement,  and  the  most 
reasonable  explanation  appeared  to  be  that 
this  something  was  present  in  the  juice  of  the 
gland,  as  this  had  escaped  freely  into  the  tis- 
sues o£  the  patient  during  the  operation,  where 
it  could  readily  have  been  absorbed.  Further 
experiments  on  the  lower  animals  also  showed 
that  the  appearance  of  cachexia  strumipriva 


could  be  prevented  after  thyreoidectomy  by  the 
systematic  injection  of  the  fresh  juice  of  the 
thyreoid  gland.  Thus  all  other  theories  of  its 
function  were  done  away  with  and  it  was  evi- 
dent that  the  thyreoid  gland  produced  some- 
thing necessary  for  the  nutrition  of  the  body 
and  that  this  something  was  apparently  to  be 
found  as  a  secretion  in  the  juice  of  the  gland. 
These  questions  then  immediately  arose:  Could 
this  substance  be  isolated,  and  could  it  be  util- 
ized as  a  therapeutic  agent  ?  A  number  of  in- 
vestigators have  attempted  to  accomplish  the 
isolation  of  this  substance,  and  the  reports  thus 
far  published  seem  to  promise  some  definite  re- 
sult in  the  near  future,  although  at  the  present 
time  of  writing  we  have  little  or  no  knowledge 
of  its  chemical  nature  ;  but  the  second  ques- 
tion was  quickly  answered  in  the  affirmative. 

On  April  13, 1891,  G.  R.  Murray  gave  for  the 
first  time  a  hypodermic  injection  of  a  glycerin 
extract  of  a  sheep's  thyreoid  gland  to  a  patient 
suffering  from  myxoedema,  and  after  the  main- 
tenance of  this  treatment  for  a  reasonable 
length  of  time  was  gratified  to  observe  a  de- 
cided improvement.  In  the  early  part  of  1893 
several  successful  attempts  were  made  to  ad- 
minister the  thyreoid  gland  by  the  mouth,  in 
either  a  raw  or  a  cooked  condition  or  in  the 
form  of  an  extract,  which  demonstrated  that 
the  active  principle  secreted  by  the  gland  was 
not  destroyed  by  the  process  of  digestion,  and 
since  that  time  "it  has  been  employed  by  the 
profession  to  a  considerable  extent.  An  im- 
portant factor  doubtless  in  the  cordiality  of 
its  reception  is  the  fact  that  the  cases  for  which 
it  is  recommended  and  in  which  it  accom- 
plishes the  most  good  are  of  the  number  which 
before  were  acknowledged  to  be  hopeless  and 
incurable.  They  are  also  rare,  fortunately,  in 
this  country. 

Our  knowledge  of  the  physiological  action  of 
the  secretion  of  the  thyreoid  gland  is  very  lim- 
ited and  consists  only  of  what  has  been  ob- 
served of  the  symptoms  produced  by  its  absence 
and  those  produced  by  larger  doses  than  neces- 
sary given  to  patients  suffering  from  certain 
pathological  conditions.  The  symptoms  pro- 
duced by  its  absence  from  the  system  are  those 
of  myxoedema  and  of  cachexia  strumipriva, 
and  the  study  of  these  has  given  rise  to  theo- 
retical explanations  which  are  as  yet  attended 
with  so  much  uncertainty  that  the  only  defi- 
nite statement  which  can  be  made  is  that  the 
thyreoid  gland  performs  an  important  part  in 
the  nutrition  of  the  body.  The  usual  symp- 
toms which  have  been  noticed  after  the  admin- 
istration of  a  dose  too  large  for  the  patient  to 
tolerate  are  a  sharp  rise  of  the  temperature,  an 
increase  in  the  rapidity  of  the  pulse,  headache, 
nausea,  vomiting,  prostration,  and  profuse 
perspiration.  The  gastro-intestinal  disturb- 
ance is  apt  to  be  severe,  and  one  case  is  recoid- 
ed  which  terminated  in  coma  and  death.  A 
case  reported  by  Becloro  seems  to  be  particu- 
larly instructive  because  the  ingestion  of  a 
large  amount  of  thyreoid  gland  was  persisted 
in  for  several  days,  and  the  symptoms  which 
were  induced  bore  a  remarkable  resemblance  to 
those  present  in  exophthalmic  goitre.  The  pa- 
tient, who  was  suffering  with  myxoedema,  is 


289 


THYREOID  TREATMENT 


said  to  have  taken  nearly  three  ounces  (93 
grammes)  of  thyreoid  gland  in  eleven  days  and 
to  have  presented  the  following  symptoms  at 
the  end  of  that  time :  Rapid  pulse  and  respira- 
tion, elevation  ot  temperature,  restlessness,  in- 
somnia, the  presence  of  both  albumin  and 
glucose  in  the  urine,  which  was  greatly  in- 
creased in  quantity,  exophthalmia,  a  sensation 
of  heat,  profuse  perspiration,  partial  paraple- 
gia, and  temporary  tremor  of  the  arms.  Other 
authors  have  also  observed  symptoms  which 
occur  in  exophthalmic  goitre  occasioned  by  the 
prolonged  use  of  a  greater  or  less  excess  of 
thyreoid  extract  in  cases  of  myxcedema,  and 
this  has  occurred  to  such  an  extent  that  it  is 
alleged  that  with  the  exception  of  those  symp- 
toms referable  to  the  motility  of  the  upper  lid, 
von  Graefe's  and  Stellwag's  symptoms,  and 
those  due  to  swelling  of  the  thyreoid  gland,  all 
the  common  and  many  of  the  less  frequently 
observed  symptoms  of  exophthalmic  goitre 
have  been  thus  produced.  Swelling  of  the 
salivary  glands  has  also  been  reported  as  a  re- 
sult of  overdoses. 

For  medicinal  purposes  the  thyreoid  gland 
of  the  sheep  is  usually  employed,  but  that  of 
the  pig  or  of  the  cow  may  be  substituted  with 
equally  good  results.  The  animal  from  which 
the  gland  is  taken  must  be  in  perfect  health, 
and  that  this  is  the  condition  should  be  deter- 
mined by  a  thorough  and  careful  examination 
of  its  various  organs.  The  gland  should  be  re- 
moved with  complete  aseptic  precaution,  freed 
from  fat  and  connective  tissue,  and  then  placed 
in  a  sterilized  jar.  It  may  he  eaten  raw  or 
very  slightly  cooked,  but,  as  the  flavour  is  not 
pleasant,  it  is  advisable  to  give  it  in  glycerin  or 
some  other  vehicle  to  disguise  its  taste  when- 
ever this  method  of  administration  is  for  any 
reason  preferable. 

A  better  form  for  administration  is  the  liquid 
extract,  which  may  be  prepared  in  the  follow- 
ing manner  :  The  gland  is  finely  minced  and 
the  fragments,  together  with  the  fluid  which 
escapes  during  this  process,  are  placed  in  a 
mixture  of  equal  parts  of  boiled  water  and 
glycerin,  in  the  proportion  of  two  cubic  centi- 
metres of  the  mixture  to  each  lobe  of  the  gland, 
in  which  they  are  allowed  to  macerate  in  a  cool 
place  for  about  twenty-four  hours.  The  prep- 
aration is  then  flltered  under  pressure,  and 
usually  yields  about  a  drachm  and  a  half  of 
extract  obtained  from  one  entire  gland.  In 
the  earlier  preparations  a  0'5-per-cent.  solution 
of  carbolic  acid  was  used  instead  of  boiled  dis- 
tilled water,  but  this  is  not  necessary.  This 
extract  was  at  first  used  hypodermically  and 
may  still  be  so  given,  but  it  is  quite  apt  to 
cause  localized  inflammation  and  abscesses, 
and,  as  the  process  of  digestion  does  not  appear 
to  affect  the  active  principle,  it  is  preferable, 
unless  there  is  a  special  contra-indication,  to 
give  it  by  the  mouth.  When  given  hypoder- 
mically, it  must  he  injected  very  slowly  and  in 
much  smaller  doses  than  when  swallowed.  It 
deteriorates  after  a  few  days,  so  fresh  prepara- 
tions must  be  frequently  made. 

A  more  elegant  and  on  the  whole  more  satis- 
factory preparation  is  the  dry  extract,  which  is 
made  by  pulverizing  the  gland  or  the  expressed 


juice  after  it  has  been  dried,  or  from  precipi- 
tates  thrown  down  in  the  liquid  extract  by  al- 
cohol or  other  reagents.  This  dry  extract, 
mixed  with  proper  excipients,  is  on  the  market 
in  the  form  of  tablets  and  pills  which  are  stated 
by  the  manufacturers  not  to  be  liable  to  dete- 
riorate for  a  considerable  length  of  time,  and 
form  the  most  available  and  best  form  of  the 
drug  for  administration. 

ri)r.  S.  J.  Meltzer  {Mew  York  Medical  Jour- 
nal, May  25, 1895)  says  concerning  the  thyreoid 
preparations  :  "  We  can  hardly  speak  any  more 
of  thyreoid  extracts.  In  this  country  the  prep- 
arations of  three  firms  seem  to  be  in  vogue. — 
Parke,  Davis,  &  Co.,  Armour  &  Co.,  and  the 
London  firm  of  Burroughs,  Wellcome,  &  Co. 
The  latter  offer  the  thyreoid  exclusively  in  the 
convenient  form  of  tablets.  In  the  English 
and  German  literature  we  often  read  of  these 
tablets ;  in  this  country  also  they  are  preferred 
by  some.  My  own  experience  has  been  less 
favourable — the  effect  was  inconstant.  Of 
Parke,  Davis,  &  Co.'s  preparations,  I  have  em- 
ployed so  far  only  the  desiccated  powder.  In 
the  myxoedema  case  that  I  reported  to  you  (the 
members  of  the  German  Medical  Society  of 
New  York)  last  year  I  had  again  and  again  to 
return  to  the  powder  of  Parke,  Davis,  &  Co., 
which  always  brought  the  desired  effect.  Of 
Armour's  preparations,  I  have  used  both  the 
powder  and  the  tablets.  The  latter  have  not 
given  me  satisfactory  results.  The  tablet  form 
is  not  reliable,  anyhow ;  they  often  do  not  dis- 
solve, and  then  again  it  might  happen  that  an 
accumulated  large  number  would  accidentally 
dissolve  at  once  and  produce  a  dangerous  con- 
dition. The  powder  is  furthermore  preferable 
because  you  can  prescribe  different  quantities 
at  your  own  will,  while  fractions  of  the  small 
tablets  can  certainly  not  be  measured  exactly. 
The  powder  is  administered  in  wafers  or  in 
capsules,  if  it  is  simply  put  into  the  capsules 
without  being  previously  made  into  a  mass.  It 
should  be  borne  in  mind  that  the  weights  of 
the  preparations  of  the  different  firms  have  a 
different  meaning.  Parke,  Davis,  &  Co.  pre- 
pare fifteen  grains  of  powder  from  one  thy- 
reoid, while  Armour  &  Co.  prepare  only  six 
grains.  Thus  one  grain  of  Armour  &  Co.'s 
powder  is  equal  to  about  two  grains  and  a  half 
of  the  powder  of  Parke,  Davis,  &  Co.  For  the 
tablets  of  Burroughs,  Wellcome,  &  Co.  it  is 
maintained  that  they  represent  one  sixteenth 
of  a  thyreoid  and  contain  five  grains  of  the 
substance  of  the  gland.  Then  one  tablet  would 
be  about  equal  to  one  grain  of  the  powder  of 
Parke,  Davis,  &  Co.,  and  from  an  eighth  of 
such  a  tablet  Bramwell  has  seen  good  results  I " 
Dr.  Meltzer  adds  in  a  foot-note  that  tablets 
similar  to  those  of  Burroughs,  Wellcome,  & 
Co.  are  now  furnished  by  Fairchild  Brothers  & 
Foster.] 

The  indications  for  the  use  of  thyreoid  ex- 
tract may  be  briefly  stated  to  be  the  symptoms 
caused  by  the  absence  of  the  normal  secretion 
of  the  thyreoid  gland  from  the  system.  Its 
therapeutic  value  is  chiefly  exhibited  in  the 
treatment  of  myxcedema,  where  it  appears  to 
supply  a  substance  of  which  the  system  has 
been  (ieprived  by  the  functional  inactivity  of 


THYREOID  TREATMENT 


290 


the  organ  by  which  it  is  ncrmally  secreted. 
The  results  which  have  been  obtained  in  this 
heretofore  incurable  disease  have  been  pecul- 
iarly gratifying  whenever  the  treatment  has 
been  maintained  for  a  sufficient  length  of  time. 
Among  the  earliest  signs  of  improvement  are 
the  rise  of  the  temperature  to  normal  and  the 
disappearance  of  the  feeling  of  chilliness.  These 
are  apt  to  occur  during  the  first  week  of  treat- 
ment. The  swelling  then  begins  to  decrease, 
and  care  should  at  this  time  be  exercised  to 
prevent  a  too  rapid  diminution  in  weight,  as  this 
may  occasion  prostration.  The  skin  undergoes 
a  certain  amount  of  desquamation  and  then  be- 
gins to  regain  its  normal  condition.  At  first 
it  may  hang  loose  on  the  body,  because  it  has 
been  stretched  to  a  considerable  degree  by  the 
swelling,  but  it  gradually  regains  its  elasticity 
and  contracts,  while  at  the  same  time  it  loses 
its  harsh,  rough  appearance  and  becomes  soft 
and  moist.  After  several  months  of  treatment 
a  new  growth  of  hair  replaces  that  which  had 
fallen  out  and  the  nutrition  of  all  parts  of  the 
body  is  greatly  improved.  The  lessened  hebe- 
tude and  the  gradual  increase  of  physical  and 
mental  energy  are  among  the  early  symptoms 
of  improvement,  and  they  progress  about 
equally,  while  the  speech  improves  until  it  is 
fluent  and  distinct. 

The  treatment  of  myxoedema  is  divided  into 
two  stages,  the  first  to  remove  the  symptoms, 
the  second  to  prevent  their  recurrence.  The 
duration  of  the  first  stage  is  uncertain,  but 
may  be  said  to  be  several  months,  while  that 
of  the  second  will  probably  be  for  the  re- 
mainder of  the  patient's  lite.  The  dose  of  the 
extract  at  the  beginning  of  treatment  has  to 
be  determined  for  each  case  individually. 
Murray  says  with  regard  to  the  liquid  extract : 
"If  a  dose  of  five  minims  of  the  extract  is 
given  each  morning  two  or  three  hours  after 
breakfast  and  no  distinct  improvement  has 
taken  place  at  the  end  of  a  week  or  ten  days, 
and  the  pulse  has  not  been  accelerated,  the 
dose  should  be  increased  to  ten  minims  and 
later  to  fifteen  if  ten  is  not  found  to  be  suf- 
ficient. In  some  cases  it  is  necessary  to  give 
as  much  as  fifteen  minims  twice  a  day."  The 
pulse,  temperature,  and  digestive  organs  must 
be  watched  for  signs  of  intolerance.  An  in- 
crease of  the  pulse-rate  of  more  than  twenty 
beats  a  minute,  a  rise  of  temperature  to  a  de- 
gree above  normal,  or  any  gastro-intestinal 
disturbance  should  be  noted  as  an  indication 
that  the  dose  is  too  large  and  must  be  reduced. 
During  the  second  stage  the  object  is  to  fur- 
nish the  exact  amount  for  the  daily  need  of  the 
body,  and  this  likewise  can  be  determined  only 
by  experiment. 

[When  the  manifestations  of  myxoedema  have 
once  been  subdued  it  is  important  to  know 
when  to  resume  the  thyreoid  treatment.  On 
this  point  Dr.  Meltzer  {loc.  cit.)  remarks  that 
it  is  generally  stated  that  an  increase  in  weight 
is  an  indication  to  start  the  treatment  again, 
but  this  he  thinks  is  certainly  not  correct  for 
all  the  cases.  An  increase  in  weight  is  often 
observed  while  the  patient  is  still  continuing 
to  take  the  thyreoid  in  full  doses,  especially 
after  the  first  rapid  loss  in  weight;  the  im- 


proved health  is  the  cause  of  gaining  normal 
flesh.  He  has  seen  it  in  his  own  experience, 
and  similar  statements  are  made  by  others. 
He  would  rather  put  forward  the  complaint  of 
feeling  cold  as  a  sure  indication  of  the  begin- 
ning of  the  return  of  myxoedema.  He  has 
noticed  the  appearance  of  this  complaint 
sometimes  even  before  the  weight  has  shown 
an  increase,  and  a  few  small  doses  of  thyreoid 
were  sufficient  to  soon  do  away  with  the  chilli- 
ness. The  chilliness  is  an  important  symptom  in 
myxoedema,  and  is  independent  of  the  changes 
in  the  skin  or  the  subcutaneous  tissue.] 

Thyreoid  extract  is  an  efficacious  remedy  in 
creliniam,  which  seems  to  be  simply  a  variety 
of  myxoedema  that  appears  in  infancy  or 
early  childhood  and  is  in  like  manner  depend- 
ent on  a  faulty  development,  atrophy,  or 
functional  inactivity  of  the  thyreoid  gland. 
The  improvement  is  in  the  same  manner  and 
on  the  same  lines  as  in  myxoedema,  with  results 
which  are  equally  gratifying.  On  account  of 
the  arrest  in  their  development,  children  who 
suffer  from  cretinism  are  very  small,  and  a 
noticeable  effect  of  this  treatment  is  the 
rapidity  of  their  growth  after  they  have  come 
under  its  influence.  These  children  are  able 
to  take  much  larger  doses  of  thyreoid  extract 
in  proportion  to  their  size  than  rayxoedema- 
tous  adults,  but  too  large  doses  produce  the 
same  class  of  symptoms.  As  in  myxoedema, 
the  administration  of  the  remedy  must  be  pro- 
longed throughout  the  patient's  life,  and  it  has 
been  suggested  that  on  this  account  grafting 
of  a  thyreoid  gland  into  the  neck  may  prove 
the  preferable  method  of  treating  this  condi- 
tion. 

[In  Pcsdiatrics  for  May,  1896,  Dr.  Frederick 
Peterson  and  Dr.  Pearce  Bailey  report  a  case 
of  cretinism,  in  a  child  eighteen  months  old,  as 
probably  cured  by  thyreoid  treatment,  also  an- 
other, in  a  subject  fifteen  years  old,  as  greatly 
improved.  They  have  tabulated  the  cases  re- 
ported up  to  the  time  of  preparing  their  article, 
in  so  far  as  the  reports  were  sufficiently  specific 
to  be  of  statistical  value.  They  conclude  that 
under  thyreoid  treatment  the  symptoms  of 
myxoedema  disappear  from  the  child  quite  as 
readily  as  from  the  adult.  In  none  of  the 
cases  cited  by  them  did  the  general  oedema- 
tous  symptoms  fail  to  yield  to  the  remedy  when 
it  was  properly  and  sufficiently  applied.  The 
skin  became  soft,  the  swellings  disappeared, 
and  the  whole  appearance  of  the  patient  was 
completely  changed.  The  carrying  out  of  the 
treatment  of  myxoedema,  they  remark,  is  at- 
tended with  fewer  difficulties  "and  dangers  in 
children  than  in  adults.  Toxic  symptoms 
have  been  observed  in  a  few  cases  only,  ami 
but  two  patients  have  died  under  treatment. 
Of  these,  one  died  of  intercurrent  diphtheria 
and  one  of  bronchitis;  in  neither  of  these  two 
cases  was  the  treatment  regarded  as  a  causa- 
tive factor  of  the  fatal  symptoms. 

In  addition  to  the  disappearance  of  the 
symptoms  from  the  skin  and  subcutaneous 
tissues,  the  thyreoid  treatment  of  sporadic 
cretinism  has  in  some  cases  led  to  brilliant 
results  by  permitting  a  return  of  development 
and  growth  to  children  in  whom  these  func- 


291 


THYREOID  TREATMENT 


tions  had  been  limited  or  arrested  by  the  dis- 
ease. But  although  marked  changes  in  the 
mental  and  physical  condition  of  cretins  have 
occurred,  it  yet  remains  to  be  reported,  they 
add,  that  these  children  become  the  physical 
and  intellectual  equals  ot  children  who  have 
never  had  myxcedema.  Improvement  conse- 
quent upon  a  return  of  development  has  been 
more  constant  in  the  body  than  in  the  brain. 
In  a  large  number  of  the  reported  cases  the 
patients  have  grown  considerably  taller  and 
have  acquired  sufficient  power  and  control  of 
the  limbs  to  enable  them  to  walk,  which  had 
previously  been  impossible.  The  teeth,  which 
had  been  absent  or  defective,  began  to  appear 
normally. 

Intellectual  progress  has  been  neither  so 
constant  nor  so  rapid.  In  nearly  all  the  oases 
there  has  been  noted  some  mental  improve- 
ment, but  in  only  a  few  has  the  power  of 
speech  been  acquired  when  it  previously  had 
been  absent.  They  remark  that  the  occur- 
rence, in  the  formative  period  of  infancy  and 
childhood,  of  a  disease  which  attacks  nutrition, 
development,  and  growth  fundamentally  has 
much  more  disastrous  effects  than  when  its 
appearance  is  delayed  until  the  organism  has 
reached  maturity.  They  think  that,  while  it  is 
possible  that  the  removal  of  causes  inhibitory 
to  growth  may  result  in  a  gradual  return  of 
developmental  processes,  the  thyreoid  treat- 
ment of  infantile  myxcedema  has  in  no  case 
been  carried  out  for  a  sufficient  length  of  time 
to  permit  of  the  assertion  that  such  will  be  the 
case.  They  have  been  able  to  find  no  case  in 
which  treatment  is  reported  to  have  lasted 
more  than  a  year  and  a  half,  and  of  no  case 
is  it  said  that  the  patient  was  in  all  respects 
cured ;  but  from  the  fact  that  in  nearly  all  the 
cases  treatment  was  not  instituted  until  the 
child  was  several  years  of  age  and  had  de- 
veloped but  little  or  not  at  all  for  a  consider- 
able length  of  time,  several  years  would  be 
necessary,  by  the  natural  processes  of  develop- 
ment, for  the  complete  re-establishment  of 
normal  growth. 

Although  data  sufficient  to  justify  positive 
assertions  are  kicking,  it  seems  to  them  entirely 
within  the  range  of  possibility  that,  if  the 
treatment  of  sporadic  cretinism  is  begun  at  the 
outset  of  the  disease,  before  growth  is  seriously 
interfered  with,  it  will  permit  of  the  proper 
development  of  the  child,  without  myxcedema- 
tous  symptoms,  as  long  as  the  thyreoid  is  ad- 
ministered.] 

Insanity  is  not  a  rare  complication  of  myxce- 
dema. It  usually  occurs  in  the  form  of  acute 
or  chronic  mania,  melancholia,  or  dementia, 
and  is  quite  amenable  to  treatment  with  thy- 
reoid extract. 

[Thyreoid  treatment  has  been  employed 
successfully  in  some  cases  of  insanity  not  con- 
nected with  myxcedema.  Dr.  Lewis  C.  Bruce 
(Journal  of  Mental  Science,  January,  1895  ; 
Dublin  Journal  of  Medical  Science,  August, 
1895)  concludes  a  clinical  article  on  the  sub- 
ject as  follows : 

1.  By  the  internal  administration  of  thy- 
reoid-gland  substance  a  true  febrile  process  can 
be  induced,  and  the  resulting  reaction  is  bene- 


ficial to  the  patient.  2.  The  amount  of  the  drug 
necessary  to  induce  physiological  action  varies 
in  different  individuals,  but  it  is  seldom  neces- 
sary to  give  a  larger  dose  than  sixty  grains 
daily.  3.  Excessive  and  prolonged  adminis- 
tration of  thyreoid  extract  produces  gastric 
irritation.  4.  "The  use  of  thyreoid  extract  in 
the  treatment  of  the  insane  is  accompanied  by 
a  certain  amount  of  danger  from  induced  heart 
weakness.  This  danger  can  be  minimized  and 
almost  discounted  by  confining  the  patient  to 
the  bed  during  treatment  and  for  some  days 
afterward.  5.  The  administration  ot  thyreoid 
is  contra-indicated  in  cases  of  mania  where  the 
excitement  is  acute  and  the  loss  of  weight 
rapid,  and  where  there  is  danger  of  exhaustion 
from  malassimilation  of  food.  6.  Thyreoid 
treatment  appears  to  be  specially  useful  "in  the 
insanity  of  the  adolescent,  climacteric,  and 
puerperal  periods.  7.  It  is  especially  useful  in 
cases  where  recovery  is  protracted.  8.  In  cases 
of  long  standing,  where  there  is  a  tendency  to 
drift  into  dementia,  a  course  of  thyreoid  treat- 
ment sometimes  gives  the  necessary  fillip  which 
leads  to  ultimate  recovery.  9.  Patients  under 
this  treatment  should  be  kept  in  as  equable  a 
temperature  as  possible. 

The  use  of  thyreoids  in  the  various  forms  of 
mental  derangement  has  been  made  the  sub- 
ject of  special  investigation  in  three  of  the 
New  York  State  hospitals  for  the  insane,  says 
a  writer  in  the  International  3Iedical  Maga- 
zine for  May,  1896,  and  the  results  are  published 
in  the  State  Hospitals  Bulhtin  for  January, 
1896.  In  the  Middletown  State  Hospital 
(homoeopathic).  Dr.  Ales  Hrdlicka  has  used 
thyreoid  tablets  in  four  cases  ot  general  paresis, 
one  case  of  suicidal  melancholia,  one  of  pri- 
mary dementia,  one  of  dementia  follotving  acute 
melancholia,  one  of  puerperal  insanity,  one  of 
paranoia,  and  three  of  secondary  dementia. 
AH  these  patients  were  free  from  respiratory 
or  circulatory  disorder.  The  treatment  ex- 
tended over  two  months  and  was  begun  with 
the  administration  of  5  grains  daily,  and  the 
amount  was  gradually  augmented  to  25  or  30 
grains  daily.  Among  the  effects  of  the  drug 
the  following  are  recorded :  Both  the  pulse 
and  respiration  were  increased  in  frequency, 
but  this  increase  was  never  great.  There  was 
a  rise  in  temperature  of  one  or  two  degrees. 
The  appetite  improved.  The  bowels  were  reg- 
ulated, and  in  several  cases  diarrhcea  was  pro- 
duced. The  elimination  of  urea  was  increased. 
The  majority  of  patients  lost  weight  while 
under  treatment.  Regarding  the  mental 
symptoms,  there  was  noted,  under  moderate 
doses,  pronounced  general  psychical  improve- 
ment ;  the  mind  became  clearer  and  more 
active,  and  the  m.Tnner  livelier.  Sleep  was 
improved.  When  the  dose  was  immoderate, 
symptoms  of  irritation  appeared  as  a  rule. 
The  patient  with  puerperal  insanity  was  cured. 
In  the  case  of  suicidal  melancholia,  in  that  of 
dementia  following  melancholia,  and  in  two  ot 
the  cases  of  secondary  dementia  there  was 
temporary  improvement.  The  patient  with 
primary  dementia  grew  worse.  There  was 
some  temporary  amelioration  in  a  few  of  the 
cases  of  general  paresis. 


THYREOID  TREATMENT 


293 


Dr.  Warren  L.  Babcock  experimented  with 
desiccated  thyreoids  at  the  St.  Lawrence  State 
Hospital  with  three  main  objects  in  view: 
first,  to  definitely  ascertain  the  physiological 
action  of  thyreoid  ;  second,  to  determine  there- 
by in  just  what  classes  of  cases  it  might  be 
used  to  further  recovery ;  third,  to  apply  it 
therapeutically  to  those  cases  in  which  it  offered 
the  best  results.  This  observer  determined 
that  extracts  made  from  the  thyreoid  gland 
had  a  definite  physiological  action ;  that  an 
unvarying  strength  of  any  given  amount  could 
be  obtained  by  proper  preparation ;  and  that 
the  true  thyreoid  preparations  had  no  relation- 
ship with  the  so-called  animal  extracts.  The 
treatment  was  begun  by  the  administration  of 
5  grains  of  desiccated  thyreoid  extract,  and 
this  dose  was  increased  judiciously.  Fifteen 
grains  seemed  to  be  the  maximum  dose  that 
could  be  given  with  safety  for  any  length  of 
time,  and  tlien  only  in  patients  whose  physical 
health  was  impaired  in  a  slight  degree  if  at  all. 
The  physiological  action  of  the  drug  he  sums 
up  as  follows :  The  number  of  red  blood- 
corpuscles  to  the  cubic  millimetre  and  the  per- 
cenlage  of  haemoglobin  were  increased.  In  the 
majority  of  cases  arterial  tension  was  increased ; 
in  a  small  proportion  the  blood-pressure  was 
diminished.  Prfeoordial  oppression  occurred  in 
a  few  cases.  The  pulse  was  accelerated ;  the 
respirations  were  not  especially  influenced.  The 
temperature  in  the  majority  of  cases  was  ele- 
vated from  one  to  three  degrees.  In  one  case 
the  temperature  was  subnormal.  Myasthenia 
was  pronounced  in  the  majority  of  cases  at  an 
early  period  of  treatment ;  flaocidity,  tremor, 
and  general  weakness  characterized  these  cases. 
The  early  development  of  a  feeling  of  appre- 
hension, together  with  some  mental  and  much 
motor  restlessness,  was  noted,  usually  during 
the  third  day.  At  first  there  was  an  apparent 
sense  of  fatigue  with  great  mental  oppression, 
followed  by  a  gradual  clearing  up  of  the  cere- 
bral processes  and  improved  mental  co-ordina- 
tion. The  reflexes,  in  the  majority  of  cases, 
were  increased  and  exaggerated  from  an  early 
period  of  the  treatment.  In  nine  cases  pre- 
senting more  or  less  anjesthesia,  the  sensibility 
returned  to  normal  or  was  very  much  improved. 
Two  patients  became  hyperassthetic. .  Diuresis 
was  well  marked  in  many  cases,  and  perspira- 
tion was  decreased.  A  few  of  the  cases  pre- 
sented varying  degrees  of  gastric  symptoms.  An 
eruption  accompanied  by  severe  itching  like 
urticaria,  and  followed  by  scaling  and  des- 
quamation, was  observed  in  two  cases.  The 
elimination  of  the  products  of  retrograde 
metamorphosis  was  greatly  increased.  Dr. 
Babcock  thinks  that  the  thyreoid  treatment 
holds  out  a  prospect  of  recovery  or  improve- 
ment, first,  in  oases  of  post-melancholic  hebe- 
tude following  a  lengthy  period  of  depression  : 
second,  in  cases  of  stuporous  melancholia  of 
long  duration ;  third,  in  maniacal  cases  in 
which  the  attacks  have  been  unduly  prolonged  ; 
fourth,  in  cases  of  cerebral  exhaustion  follow- 
ing acute  delirium  or  stupor  in  which  the 
elimination  of  urea  and  other  nitrogenous 
compounds  is  greatly  reduced  :  fifth,  in  chronic 
"  disturbed  "  cases  ;   sixth,  in  doubtful  cases 


thyreoid  may  assist  in  distinguishing  between 
true  stupor  and  dementia  ;  in  delusional  cases 
it  will  show  whether  the  delusions  are  fixed 
or  temporary. 

Dr.  L.  Pierce  Clark,  of  -the  Craig  Colony  for 
Epileptics  (Medical  Record,  October  34,  1896), 
has  employed  thyreoid  treatment  in  epilepsy. 

The  cases  selected  were  those  in  which  many 
congenital  defects  were  noticeable,  and  in 
which  epilepsy  had  been  a  prominent  feature 
of  the  patient's  life  since  early  infancy.  An 
effort  was  also  made  to  select  cases  in  which 
defective  development  mentally  as  well  as 
physically  was  manifest.  The  treatment  was 
not  attended  with  very  good  results.  While 
all  the  patients  seemed  to  be  benefited  for  the 
time  being  in  some  ways.  Dr.  Clark  doubts  if 
there  will  be  any  permanent  improvement. 
On  the  whole,  he  says,  its  small  efl'ect  upon 
epileptic  seizures  in  these  trial  cases  would  not 
seem  to  justify  its  continued  use  in  epilepsy, 
and  its  further  administration  has  not  been 
attempted.] 

Attention  has  been  directed  to  the  use  of 
thyreoid  extract  in  sMn  diseases  by  Byrom 
Bramwell,  who  in  1893  reported  excellent  re- 
sults in  a  number  of  cases  of  psoriasis  treated 
in  this  manner,  and  since  then  it  has  been  tried 
rather  extensively  in  the  treatment  of  various 
cutaneous  diseases.  The  results  can  not  be 
said  to  have  been  marked  with  great  success, 
but  improvement  has  been  obtained  in  a  suf- 
ficiently large  number  of  cases  to  warrant 
further  investigation.  The  good  results  some- 
times obtained  from  the  use  of  thyreoid  ex- 
tract in  these  cases  suggest  the  question  of 
whether  it  is  not  possible  that  certain  forms  or 
cases  of  cutaneous  disease  are  dependent  upon 
some  irregularity  or  perversion  of  the  thyreoid 
secretion,  and  whether  the  artificial  ingestion 
of  its  active  principle  for  a  time  may  not  enable 
the  gland  to  regain  a  healthy  activity  and  cause 
the  symptomatic  cutaneous  eruption  to  dis- 
appear. At  present  a  distinction  can  not  be 
made  between  the  cases  which  will  and  those 
which  will  not  be  benefited  by  this  treatment. 

[In  the  New  York  Medical  Journal  for  May 
4,  1895,  Dr.  Leo  Stieglitz  repoi-ted  the  cases  of 
two  sisters  affected  with  deformity  of  the  nails 
that  he  had  treated  with  thyreoid  feeding.  In 
the  case  of  the  older  sister,  a  cook,  twenty-two 
years  old,  the  nails  in  which  the  disease  was 
most  advanced  were  of  a  brownish  hue,  "  as  if 
mortified " ;  they  were  rough,  irregular,  mis- 
shapen, short,  and  stunted,  as  if  retarded  in 
their  growth.  The  disease,  where  it  was  less 
pronounced,  involved  only  part  of  the  nail  in 
longitudinal  section,  the  diseased  part  being 
brown  and  occasionally  separated  from  the 
healthier  part  of  the  nail  by  a  longitudinal 
split.  The  nails  least  affected  were  rough, 
brittle,  and  mottled  in  appearance.  The  skin 
of  the  hands  was  rough  to  the  touch  and 
slightly  puffy.  The  growth  of  hair  on  the 
head  and  other  parts  of  the  body  w.as  abun- 
dant. The  skin  of  the  face  and  body  was  not 
abnormal  in  any  respect.  The  nails  of  the  toes 
showed  the  same  diseased  condition  as  those 
of  the  fingers.  A  careful  examination  of  the 
nervous  system  and  of  the  various  viscera  re- 


293 


THYREOID  TREATMENT 


vealed  no  disturbance  of  any  kind.  The  pa- 
tient was  put  upon  the  use  of  5  grains  of  Parke, 
Davis,  &  Co.'s  desiccated  thyreoids,  once  a  day 
the  first  week,  the  second  week  twice  a  day, 
and  subsequently  three  times  a  day.  At  no 
time  were  any  ill  effects  from  the  use  of  the 
drug  noticeable.  In  four  weeks  after  the  be- 
ginning of  the  treatment  the  patient  began  to 
shed  her  nails  and  some  of  her  hair.  In  two 
months  more  a  set  of  new,  well-developed, 
smooth,  and  shapely  nails  had  replaced  the  old 
diseased  ones.  The  skin  of  the  hands  became 
smooth  and  soft.  The  loss  of  hair  was  followed 
by  a  more  luxuriant  growth  than  had  been 
present  before.  The  patient  was  presented  in 
this  condition  to  the  New  York  Society  of 
German  Physicians  on  February  23,  1894. 
She  subsequently  stopped  taking  thyreoid  for 
a  few  weeks,  and  her  nails  began  to  show  signs 
of  returning  disease,  which  disappeared  when 
the  treatment  was  taken  up  again,  5  grains 
being  given  every  day  or  two. 

The  younger  girl,  seventeen  years  old,  had 
the  nail  of  her  right  thumb  affected  in  the 
same  way  that  her  sister's  nails  were ;  it  was 
brown,  rough,  thickened,  and  stunted  in  its 
growth.  The  girl  had  worked  for  a  year  and 
a  half  in  a  gold  factory,  where  she  often  had 
to  put  her  thumbs  into  a  solution  of  ammonia. 
For  six  months  she  had  not  been  working. 
She  had  noticed  the  change  in  her  right 
thumbnail  for  a  year ;  none  of  the  other  nails 
were  affected.  The  thyreoid  preparation  was 
administered  in  a  5-grain  dose  once  a  day,  but 
it  caused  so  much  nausea  that  the  patient 
stopped  the  treatment  after  a  few  days.  Dur- 
ing the  next  nine  months  the  condition  of  the 
nail  remained  unchanged,  the  nail  not  growing 
at  all,  according  to  the  patient's  statement. 
On  December  5th  she  began  taking  Burroughs, 
Wellcome,  &  Co.'s  5-grain  thyreoid  tabloids, 
one  a  day,  and  continued  to  do  so  up  to  the 
time  of  the  report,  the  tablets  creating  no  dis- 
turbance of  any  kind.  Within  a  few  days  the 
nail  began  to  grow,  and  on  December  23d  it 
was  already  half  renewed,  the  new  part  being 
somewhat  uneven,  but  of  proper  colour  and 
consistence, 

The  girl  was  shown  by  Dr.  Stieglitz  at  a 
meeting  of  the  Manhattan  Medical  and  Surgi- 
cal Society  on  December  29th.  and  it  was  seen 
that  the  contrast  between  the  healthy  and  dis- 
eased portion  of  the  nail  was  striking ;  whereas 
the  proximal  half  was  healthy  in  colour  and 
consistence,  though  uneven,  the  distal  half  was 
brown,  brittle,  and  stratified.  These  two  cases 
show,  says  Dr.  Stieglitz,  that  even  in  the  ab- 
sence of  myxcEdema  thyreoid  feeding  stimu- 
lates the  growth  of  the  nails  to  a  remarkable 
degree. 

In  the  same  article  Dr.  Stieglitz  reports  a 
case  of  circumscribed  sclerodermia  of  the  leg, 
in  a  woman  thirty-three  years  old,  in  which 
the  condition  was  much  improved  by  the  use 
of  5  grains  of  Parke,  Davis,  &  Oo.'s  desiccated 
thyreoid  gland  from  once  to  three  .times  a 
day,  but  he  does  not  maintain  that  thyreoid 
treatment  will  cure  sclerodermia. 

In  the  British  Medical  Journal  for  April 
18, 1896,  Dr.  William  Kushton  Parker  relates 


a  cure  of  eczema  with  thyreoid  extract  as  fol- 
lows: 

"Mrs.  K.,  aged  sixty-five,  mother  of  fifteen 
children,  had  been  hale  and  active  all  her  life. 
Between  1890  and  1895  she  became  very  much 
stouter,  and  a  very  conspicuous  bagginess  de- 
veloped under  the  chin.  During  the  summer 
of  1895  her  appetite  failed,  she  became  weak 
and  lazy,  and  lost  much  of  her  recent  accumu- 
lations of  fat.  In  October  eczema  appeared 
over  the  whole  surface,  so  that  by  November 
the  scalp  was  very  dry  and  scurfy,  the  hair 
lustreless  and  sparse  ;  the  trunk  dry  and  rough 
all  over,  swollen  and  erythematous  in  parts, 
and  much  torn  by  scratching ;  the  upper  limbs 
dry  and  harsh,  with  erythematous  patches  in 
the  bends  of  the  elbows ;  the  lower  limbs  red, 
greatly  swollen,  moist,  and  much  excoriated, 
worse  below  than  above  the  knees,  and  itching 
severely.  As  the  patient  always  felt  cold,  not- 
withstanding the  mildness  of  the  winter  and 
her  remaining  in  bed  near  a  blazing  fire  night 
and  day ;  and  as  she  had  this  baggy  myxoede- 
matoid  swelling  under  the  chin,  with  some 
suspicion  of  similar  masses  above  the  clavicles 
in  the  lower  part  of  the  posterior  triangles, 
and  as  the  entire  surface  had  by  the  middle  of 
December  become  dry  and  harsh  by  a  few 
weeks'  local  applications  to  the  legs,  she  was 
put  on  a  5-grain  thyreoid  tabloid  daily  for  two 
weeks,  and  two  tabloids  daily  in  January,  with 
the  result  that  the  chilliness  vanished,  the 
submental  bagginess  decreased,  and  the  entire 
skin  was  rapidly  losing  its  dryness,  roughness, 
and  itchiness,  and  becoming  quite  natural. 
She  then  discontinued  the  tabloids,  when  the 
eczema  returned  so  badly  as  to  be  very  little 
better  in  the  latter  half  of  January  than  in  the 
previous  November  or  early  half  of  December. 
During  February  she  was  put  on  three,  and 
afterward  four,  tabloids  daily,  when  the  chilli- 
ness again  disappeared,  the  submental  baggi- 
ness decreased,  and  the  whole  surface  rapidly 
lost  its  dryness,  harshness,  and  itchiness,  the 
skin  becoming  so  fine  and  soft  that  the  tab- 
loids were  discontinued  in  the  beginning  of 
March  without  any  recurrence  of  the  eczema 
during  the  six  subsequent  weeks  that  the  pa- 
tient was  under  observation. 

"There  was  no  suspicion  of  true  myxoederaa 
beyond  the  bagginess,  chilliness,  and  dry  skin  ; 
the  patient  was  garrulous,  and  her  mind  as 
clear  as  ever,  except  for  a  problematical  blunt- 
ing of  memory.  The  thyreoid  extract  was 
given  more  on  account  of  these  symptoms 
than  for  its  reputed  usefulness  in  psoriasis  and 
eczema;  and  the  total  disappearance  of  the 
eczema  under  its  administration  was  an  agree- 
able surprise.  It  should  be  added  that  the 
eczema  rubrum  of  the  legs  was  treated  with  lead 
lotions,  calamine  ointments,  and  bandaging; 
while  quinine,  strychnine,  iron,  and  arsenic 
were  given  for  the  loss  of  appetite,  weakness, 
and  malaise;  but  no  marked  difference  was 
observed  on  passing  from  one  to  another  tonic 
at  all  corresponding  to  the  obvious  changes 
which  kept  pace  with  the  variations  in  thyre- 
oid extract." 

Dr.  J.  Barclay  {British  Medical  Journal^ 
October  24, 1896 ;  New  York  Medical  Journal, 


THYREOID  TREATMENT 


294 


November  14,  1896)  calls  attention  to  the  re- 
sults obtained  by  him  in  the  treatment  of  lu- 
pus with  thyreoid  extract,  but  adds  that  the 
slight  extent  of  his  experience  does  not,  he 
thinks,  entitle  him  to  be  dogmatic  as  to  re- 
sults. He  relates  the  histories  of  four  eases. 
The  first  patient  was  an  unmarried  woman, 
aged  twenty-five  years,  who  had  been  the  sub- 
ject of  lupus  of  the  nose  and  both  cheeks  since 

1891.  Scraping  had  been  thoroughly  done  in 
1893,  and,  on  the  disease  returning,  scraping 
and  Paquelin's  cautery  were  employed  in  1893. 
Relapse  soon  followed,  and  in  January,  1895, 
thyreoid  tabloids,  one  three  times  a  day,  were 
given.  In  three  weeks  local  reaction  became 
apparent,  very  markedly  resembling  that  fol- 
lowing Koch's  tuberculin  in  this  disease. 
First  there  appeared  a  bright-red  ring  sur- 
rounding each  nodule,  with  swelling  of  the 
nodule  and  tenderness,  indicating  acute  in- 
flammation. The  dose  was  now  increased  to 
six  tabloids  daily,  and  after  a  couple  of  weeks 
nine  were  taken.  These  were  well  borne,  noth- 
ing worse  than  emaciation  being  observed 
during  the  months  of  the  treatment.  This 
condition  of  inflammation  persisted  for  several 
weeks,  at  the  end  of  which  the  nodules  began 
to  soften  and  break  down.  Complete  slough- 
ing followed,  and  a  deep  ulcer  took  the  place 
of  the  nodules.  At  this  stage  all  the  sur- 
rounding redness  had  disappeared.  After  all 
the  nodules  had  pursued  this  course  of  inflam- 
mation and  consequent  necrosis,  the  parts  pre- 
viously affected  presented  a  series  of  clean  and 
healthy-looking  sores,  from  which  a  thin  dis- 
charge exuded.  Healing  was  slow.  Yet  by 
merely  keeping  the  parts  clean  by  washing 
with  soap  and  water,  and  by  covering  them 
witli  vaseline  to  prevent  the  formation  of 
scabs,  healing  was  gradually  accomplished, 
and  there  remained  only  a  white,  flat,  and 
sound  scar.  No  other  external  application 
than  vaseline  was  employed.  Dr.  Barclay  re- 
grets that  the  discharge  from  the  ulcers  was 
not  examined  for  bacilli,  and  that  no  note  of 
the  temperature  during  the  stage  of  inflam- 
mation of  the  nodules  was  kept.  In  Septem- 
ber, 1895,  it  was  noted  that  the  face  was  nearly 
well,  and  in  January,  1896,  quite  well.  At 
the  date  of  the  report — July  16, 1896 — the  face 
remains  quite  well. 

In  another  case  the  patient  was  a  married 
woman,  aged  thirty-five  years.  She  had  been 
the  subject  of  extensive  lupus  of  the  face  since 
1889.  The  disease  included  a  large  patch  on 
the  right  cheek,  one  on  the  upper  lip,  and  the 
whole  of  the  nose  and  interior  of  the  nostrils. 
Various  attempts  at  destruction  of  the  malady 
had  lieen  made  before  the  author  saw  her, 
which  was  in  April,  1891.  At  that  time  a 
thorough  scraping  was  done,  but  the  disease 
returned  more  actively  than  before.  Cod-liver 
oil  was  taken  from  that  time  to  the  end  of 

1892,  but  without  apparent  benefit.  In  Feb- 
ruary, 1893,  scraping  and  Paquelin's  cautery 
were  followed  by  temporary  benefit,  but  after 
a  few  months  matters  were  as  bad  as  before. 
In  January,  1895,  thyreoid  tabloids  were  or- 
dered, but  were  taken  very  irregularly,  and 
sometimes  ceased  to  be  taken  altogether  for 


weeks  at  a  time  during  all  that  year.  On  all 
the  occasions  on  which  the  medicine  had  been 
continuously  taken  for  three  or  four  weeks, 
the  usual  local  reaction,  which  is  described  as 
having  occurred  in  the  preceding  case,  was  ob- 
served—namely, redness,  swelling,  and  pain; 
but  immediately  on  leaving  it  off  these  local 
signs  gradually  died  away,  and  no  necrosis  or 
sloughing  of  the  nodules  followed.  However, 
in  January.  1896,  the  patient  took  the  tabloids 
in  earnest,  first  three  daily,  after  a  fortnight 
six,  and  after  a  month  nine  a  day.  The  re- 
sult was  that  the  whole  of  the  nodules  on  the 
nose  sloughed  away,  the  deep  ulcers  left  have 
become  filled  up,  and  cicatrization  is  going 
on  steadily.  The  patch  on  the  right  cheek, 
which  had  somewhat  healed  over  before  the 
thyreoid  treatment  was  begun,  had  become 
inflamed,  but  no  necrosis  followed.  The 
nodules  on  the  upper  lip,  which  all  along 
had  been  larger  than  those  on  the  nose, 
seemed  to  have  been  more  slowly  affected  by 
the  thyreoid  than  the  others,  and  at  this 
time  all  had  not  softened  down  pari  passu 
with  their  neighbours.  At  the  time  of  the  re- 
port she  was  continuing  to  take  the  medicine 
steadily.  The  only  external  application  em- 
ployed was  vaseline. 

The  whole  process  of  the  local  reaction  fol- 
lowing thyreoid  treatment,  says  Dr.  Barclay, 
is  very  similar  to  that  which  we  were  accus- 
tomed to  observe  after  tuberculin  injection, 
with  this  difference,  that  the  thyreoid  reaction 
is  less  violent,  both  locally  and  constitution- 
ally, and  the  good  effects  will,  he  trusts,  be 
more  complete  and  more  permanent.  He  re- 
fers to  Mr.  Jonathan  Hutchinson  as  remark- 
ing, speaking  of  the  treatment  of  lupus  by 
Koch's  method :  "No  one  ventures  to  report 
an  instance  of  complete  cure.  Of  the  cases 
which  have  been  shown  to  me  as  the  most  sat- 
isfactory, I  am  bound  to  say  that  in  every  one 
there  has  been  evidence  at  some  part  of  the 
edge  of  the  remains  of  lupus  tissue  ready,  I 
do  not  doubt,  to  start  into  fresh  growth  on 
the  slightest  provocation."  Time  and  experi- 
ence, continues  Dr.  Barclay,  have  shown  the 
truth  of  thi?  statement.  Judging  from  these 
two  eases,  there  is  in  them  no  such  suspicious 
appearance  up  to  the  present  time.  As  to  the 
duration  of  the  treatment  necessary  to  insure 
a  permanent  cure,  even  with  full  doses  given 
regularly  and  continuously,  it  would  seem  as 
if  one  could  not  trust  to  a  complete  cure  being 
effected  in  a  shorter  time  than  a  year.  The 
dose  of  the  medicine  in  lupus,  as  in  psoriasis, 
requires  to  be  larger  than  what  is  found  suffi- 
cient for  myxojdema.  And,  as  regards  the  age 
of  the  patient,  the  older  he  or  she  may  be,  the 
more  cautious  ought  we  to  be  with  the  quan- 
tity prescribed.  Dr.  Barclay  states  that  he  has 
observed  no  serious  effect  in  youthful  patients, 
but  in  those  who  have  passed  fifty  years  of 
age  some  irregularity  of  the  heart's  action  has 
been  noticed,  which  is  controlled  easily,  how- 
ever, by  reducing  the  dose  and  giving  some  al- 
coholic stimulant.  Some  interesting  questions, 
he  thinks,  might  arise  in  the  course  of  this 
treatment.  For  instance,  he  asks,  would  it 
not  be  prudent  during  the  necrotic  stage  of 


295 


THYREOID  TREATMENT 


the  nodules  periodically  to  examine  the  dis- 
charge for  bacilli?  Valuable  information  as 
to  the  progress  of  the  treatment  might  there- 
by be  obtained.  Then  one  might  ask  what 
would  be  the  effect  of  a  similar  treatment  in 
tuberculous  glands  in  the  Tarious  situations  in 
which  these  are  found?  Would  it  be  analo- 
gous to  what  he  has  described  in  lupus?  And, 
lastly,  what  would  be  the  probable  effect  of 
this  treatment  in  tubercle  of  the  lungs'? 

Surgeon-Major  C.  B.  Maitland,  I.  M.  S. 
{Lancet,  October  31,  1896),  gives  an  account  of 
two  cases  of  leprosy  in  which  he  employed 
thyreoid  treatment.  One  of  the  patients  was 
a  Mussulman  and  the  other  a  Hindu.  He  re- 
marks that  the  thyreoid  gland  certainly  had  a 
beneficial  influence  on  these  two  men.  There 
was  obvious  improvement  in  the  skin,  as  shown 
by  the  effect  on  the  tubercles  and  the  ulcera- 
tion. There  were  no  symptoms  of  thyreoid  ism, 
although  the  Hindu  was  taking  two  glands 
daily  from  June  3d  to  September  15th.  The 
glands  were  pounded  up  raw  with  sugar  and 
water.  These  cases  are  interesting,  says  Mr. 
Maitland,  as  showing  that  the  thyreoid  gland 
certainly  has  some  effect  on  leprosy  even  when 
given  to  patients  who  continue  their  usual 
home  life  while  undergoing  treatment.] 

Our  knowledge  with  regard  to  the  efficiency 
of  thyreoid  extract  in  cases  of  obesity,  ancemia, 
acromegaly,  and  syphilis  is  very  slight.  In 
some  of  these  diseases  this  treatment  has  been 
suggested  on  purely  theoretical  grounds,  while 
of  others  a  few  cases  have  been  reported  ;  but 
more  extensive  investigations  should  be  made 
in  regard  to  all  before  any  conclusions  are 
drawn. 

[In  an  excellent  article  entitled  Thyreoid 
Therapy  (Medicine,  August,  1896),  Dr.  James 
B.  Herriok,  of  Chicago,  remarks  that  the  rapid 
loss  of  weight  that  occurs  in  myxoedema  when 
the  remedy  has  been  employed,  suggested  its 
use  in  obesity,  and  the  results  warrant  a  trial 
in  all  cases.  Kraus,  he  adds,  finds  thyreoidin 
of  greater  value  in  anaemic  obesity  than  in 
that  form  accompanied  by  rosy  lips,  ruddy 
cheeks,  good  appetite,  and  strong  muscles.  In 
all  cases  the  action  on  the  heart  is  to  be  watched. 
The  diet  may  or  may  not  be  altered.  Where 
great  tendency  to  weakness  is  shown,  a  full 
nourishing  diet  should  be  allowed  during  the 
treatment.  Relapses  are  common  unless  mod- 
erate doses  are  continued.  Among  those  cited 
by  Dr.  Herrick  as  giving  favourable  reports 
are  Davies,  Leichtenstern,  Wendelstadt,  Der- 
cum,  Barron,  and  Ewald.  Losses  in  weight, 
even  up  to  nearly  25  pounds  in  six  weeks,  are 
reported,  according  to  Dr.  Herrick.  Ewald, 
he  says,  has  found  that  thyreoiodinin  answers 
fully  as  well  in  promoting  reduction  of  weight 
as  the  entire  gland  does.  Just  why  some  cases 
are  refractory  and  others  amenable,  says  Dr. 
Herrick,  is  still  not  definitely  settled. 

The  following  account  of  an  interesting  case 
of  acromegaly  treated  with  thyreoid  extract, 
by  Dr.  G.  G.  Sears,  of  the  Boston  City  Hos- 
pital, was  published  in  the  Boston  Medical  and 
/Surgical  Journal  for  July  2,  1896  : 

"  Mrs.  C,  a  widow,  forty-live  years  old,  first 
presented  herself  for  treatment  at  the  Boston 


City  Hospital  in  January.  1895.  Her  maternal 
grandfather  died  insane ;  hei'  father  of  a '  com- 
plication of  diseases,'  probably  of  cardiac  ori- 
gin, at  the  age  of  fifty ;  her  mother  of  apoplexy 
at  seventy-one.  She  has  lost  two  brothers  from 
consumption,  while  one  brother,  when  last  seen 
several  years  ago,  had  a  brownish  discoloration 
of  the  skin  similar  to  that  of  the  patient  her- 
self, and  was  '  all  bloated  up.'  She  has  had 
three  children,  none  of  the  labours  being  note- 
worthy, one  of  whom  died  of  cholera  infantum  ; 
the  other  two  are  well  but  not  strong. 

"  Her  previous  medical  history  consists  of  an 
attack  of  varioloid  when  eight  years  old,  ery- 
sipelas when  eighteen,  and  pneumonia  when 
twenty.  Five  years  ago  she  had  an  attack  of 
grippe  accompanied  by  severe  pain  in  her  left 
ear.  She  has  had  occasional  attacks  of  cholera 
morbus,  and  has  been  under  treatment  for  re- 
troversion of  the  uterus  and  a  lacerated  cervix. 
She  reached  the  menopause  about  six  months 
ago,  but  had  been  irregular  for  about  a  year. 
Her  general  health  has  always  been  good,  but 
she  has  complained  all  her  life  of  drowsiness, 
which  in  recent  years  has  so  increased  that  now 
she  is  liable  to  drop  asleep  at  any  time.  With 
this  exception  she  dates  all  of  her  symptoms 
from  twelve  years  ago,  when  a  flat-iron  fell 
upon  her  left  side,  starting  up  a  brisk  uterine 
haemorrhage,  which  lasted,  however,  but  a 
short  time.  The  nervous  shook  was  much 
greater  than  the  physical  injury,  and  after  this 
she  passed  large  quantities  of  urine  and  had 
attacks  of  sudden  weakness,  in  which  she  fell 
but  yet  retained  consciousness.  She  began 
also  to  be  very  susceptible  to  cold,  so  that  she 
had  to  wear  extra  flannels  and  take  hot-water 
bottles  to  bed  with  her  even  in  summer.  Lately 
this  symptom  has  grown  decidedly  better,  and 
she  now  complains  chiefly  of  local  chilly  feel- 
ings with  the  appearance  of  'goose  flesh'  in 
spots  about  as  large  as  a  five-cent  piece.  Soon 
after  the  accident  she  noticed  that  her  hands 
and  feet  were  increasing  in  size,  so  that  while 
she  once  wore  a  3|-  shoe  she  now  requires  a 
broad  7,  and  instead  of  a  Gi  glove  she  now 
wears  a  7-J,  while  her  tongue  has  become  so  large 
that  it  is  frequently  bitten,  and  at  times '  feels  so 
big  that  she  wonders  whether  or  not  she  can 
thrust  it  out  of  her  mouth.'  Her  face  grew 
fuller,  her  nose  more  prominent,  and  her  hair 
coarser  and  drier,  but  it  has  never  fallen  out 
and  still  hangs  nearly  to  her  knees.  She  has 
suffered  intensely  at  times,  especially  at  night 
after  sweeping  or  washing,  from  a  feeling  of 
numbness  in  her  hands,  which  is  accompanied 
by  itching,  pain,  and  a  sensation  of  pins  and 
needles.  Her  body  also  has  at  times  felt  sore 
and  tender  all  over,  and  on  lying  down  her 
joints  become  so  rigid  that  she  "moves  with  dif- 
ficulty, while  on  rising  her  knees  are  so  stiff 
that  the  first  few  steps  are  hard  to  take.  She 
has  had  frequent  attacks  of  cardiac  palpitation 
as  well  as  very  distressing  hot  flashes  recurring 
every  ten  or  fifteen  minutes.  Sweating,  espe- 
cially at  night,  and  most  noticeably  over  the 
chest,  has  also  been  a  fairly  constant  symptom. 
Every  little  while  she  hears  a  '  puffing '  in  her 
ears  synchronous  with  the  heart  and  lasting 
for  a  longer  or  shorter  period,  but  which  for  a 


THYREOID  TREATMENT 


296 


day  at  a  time  may  be  nearly  constant.  About 
five  years  ago  she  lost  her  husband  after  a  very 
long  and  trying  illness,  and  after  this  she  no- 
ticed that  her  mental  processes  seemed  slow 
and  that  her  memory  was  greatly  impaired,  so 
that  she  would  often  begin  a  sentence  and  then 
forget  what  she  was  about  to  say.  She  also 
became  unusually  nervous  and  irritable  over 
trifles.  A  month  ago  her  nose  was  cleared  of 
mucous  polypi  by  Dr.  Leland,  but  they  have 
now  returned.  Her  appetite  has  been  raven- 
ous and  her  thirst  excessive. 

"  The  patient  is  a  rather  heavily-built  woman 
about  five  feet  five  inches  tall  and  weighing  one 
hundred  and  seventy-five  pounds.  She  stands 
fairly  erect,  without  the  marked  kyphosis  which 
has  been  noticed  in  many  of  these  cases.  Her 
face  appears  somewhat  lengthened,  and  the 
frontal  aspect  of  the  head  is  triangular  in 
shape  from  an  enlargement  of  the  jaws,  espe- 
cially the  lower,  the  under  teeth  closing  a  lit- 
tle outside  the  upper.  There  is  no  elevation 
of  the  eyebrows,  but  the  eyelids  appear  puflFy, 
and  the  skin  of  the  face  is  thickened  and 
masklike.  The  nose  is  noticeably  large,  the 
enlargement  being  in  both  the  soft  parts  and  the 
bones.  The  hair  of  the  head,  as  well  as  of  the 
pubes  and  axillae,  is  coarse  and  dry,  but  very 
abundant  and  only  slightly  streaked  with  gray. 
The  teeth  are  in  good  condition,  but  there  is 
some  retraction  of  the  gums.  The  tongue  is 
enlarged  to  at  least  a  halt  more  than  its  normal 
size.  Over  considerable  areas  on  the  neck  and 
face  the  skin,  which  is  everywhere  moist,  is 
brown  in  colour,  and  similar  patches  of  dis- 
coloration are  seen  over  the  trunk  and  limbs. 
Scattered  over  the  neck  and  trunk  are  very 
numerous  small  growths  varying  in  size  from 
the  head  of  a  pin  to  that  of  a  bean,  some  of 
which  are  deeply  pigmented.  A  few  are  pe- 
dunculated but  most  are  sessile.  There  is  no 
marked  fulness  above  the  clavicles.  The  clav- 
icles theniselves  are  not  noticeably  enlarged, 
but  the  manubrium  seems  heavier  and  thicker 
than  normal,  while  the  angle  at  its  juncture 
with  the  second  piece  of  the  sternum  is  more 
than  usually  acute.  Over  the  manubrium  the 
percussion  note  is  somewhat  dull,  the  prob- 
able result  of  the  increased  thickness  of  the 
bone. 

"  The  ribs  seem  heavier  and  are  somewhat 
closer  to  each  other  than  they  should  lie.  Owing 
to  the  thick  fat  layer,  it  is  difficult  to  determine 
changes  in  the  ilia,  but  they  seem  to  have  be- 
come thicker  and  heavier.  There  is  a  very 
marked  enlargement  of  the  hands,  especiallv 
in  their  breadth  and  thickness,  which  is  due 
less  to  changes  in  the  bones  than  in  the  soft 
part  covering  them.  The  fingers  are  thick  and 
stubby ;  the  nails  are  short,  broad,  and  marked 
with  longitudinal  striations.  The  crescent  is 
covered. 

"The  feet  show  similar  alterations,  but  in 
them  an  enlargement  of  the  bones  is  more 
readily  made  out,  the  toes  appearing  decid- 
edly longer  than  normal.  The  ankles  and 
lower  part  of  the  legs  are  pu£Ey  and  pit  deeply 
on  pressure.  The  chest  is  fairly  well  shaped 
and  measures  at  the  two  respiratory  extremes 
32  and  34|  inches.    Except  for  a  prolongation 


of  the  expiratory  sound,  which  can  be  accounted 
for  by  a  loss  of  elasticity  of  the  chest  walls,  ex- 
amination of  the  lungs  is  negative.  The  area 
of  cardiac  dulness  is  slightly  enlarged  lateral- 
ly, but,  except  for  their  rapidity  and  weakness, 
there  is  no  modification  of  the  sounds. 

"  The  voice  is  thick,  monotonous,  and  plain- 
tive, while  words  are  verj  slowly  enunciated. 
All  muscular  movements  are  slow  and  weak, 
while  the  tenderness  of  the  hands  is  so  great 
that  she  is  unable  to  grasp  the  dynamometer 
with  sufficient  force  to  move  the  index.  Pulse 
128.     Temperature  100°  P. 

"  The  following  measurements  of  the  head, 
hands,  and  feet  may  be  of  interest.  The  patient 
is  left-handed. 

Circumference  of  head 21|  inches. 

Circumference(ohin  to  vortex)...  26  " 

Circumference  of  right  palm 8J  " 

Circumference  of  left  palm 8%  " 

Length  of  right  middle  finger 4  " 

Length  of  left  middle  finger 3J  " 

Circumference  of  middle   finger 

(proximal  joint) 3  " 

Length  of  right  foot 9|  " 

Length  of  left  foot 9i  " 

Width  at  ball 3|  ' 

Length  of  great  toe 2^  " 

The  enlargement  of  the  hands  and  feet,  how- 
ever, is  more  conclusively  shown  by  the  larger 
sizes  of  gloves  and  shoes  which  she  now  re- 
quires than  by  these  measurements. 

"  For  the  examination  of  the  special  senses 
as  well  as  for  the  electrical  tests  I  am  indebted 
to  Dr.  P.  C.  Knapp,  who  went  over  the  case 
with  much  care.  Smell  is  nearly  lost,  there 
being  no  perception  of  camphor  or  menthol 
with  the  right  nostril  and  only  slight  with  the 
left,  a  condition  probably  explained  by  the 
presence  of  polypi.  Vision  is  practically  nor- 
mal, the  field  is  not  contracted,  and  the  colour 
sense  is  good.  Nothing  abnormal  was  seen  in 
the  fundus  oculi.  Hearing  in  the  right  ear  is 
normal,  but  with  the  left  ear  a  watch  can  not 
be  heard  more  than  six  inches  away.  Taste, 
cutaneous  sensibility,  and  the  muscle  sense  are 
unimpaired. 

"The  electrical  reactions  are  considerably 
diminished  quantitatively  to  galvanism  and 
slightly  to  faradism.  but  there  are  no  qualita- 
tive changes.  The  urine  had  a  specific  gravity 
of  1-018,  and  contained  neither  sugar  nor  albu- 
min ;  the  daily  amount  was  slightly  in  excess 
of  the  normal  quantity. 

"  She  was  put  on  general  tonics  and  on  the 
dried  extract  of  thyreoid  gland  in  gradually 
increasing  doses  until  12  grains  a  day  were 
taken,  while  galvanism  was  for  a  time  given 
by  Dr.  Knapp.  On  the  17th  of  April,  three 
months  after  her  first  visit,  she  reported  that 
she  was  feeling  very  much  better  and  took 
more  interest  in  current  events.  Her  memory 
had  improved,  and  she  spoke  and  moved  more 
rapidly.  Pain  in  the  hands  had  greatly  dimin- 
ished, so  that  she  slept  well  at  night,  but  her 
joints  still  felt  stiff.  Her  grasp  was  firm,  and 
she  was  able  to  do  her  own  washing  and  iron- 
ing, even  to  wringing  out  the  clothes  with  her 
hands.  The  'puffing'  in  her  ears  was  gone, 
and  the  palpitation  of  the  heart  better.  There 
was  much  less  puffiness  about  the  eyes  and  no 
pitting  over  the  ankles.     She  had  lost  over 


297 


THYREOID  TREATMENT 


twenty  pounds  in  weight,  but  felt  stronger 
than  for  many  months. 

"  From  this  time  to  the  present  her  general 
condition  has  remained  practically  the  same  or 
possibly  has  slightly  improved.  She  has  been 
able  to  do  all  her  own  housework,  even  to  the 
sewing,  and  has  also  gone  out  on  one  or  two 
occasions  in  the  capacity  of  monthly  nurse. 
Her  mental  condition  is  normal,  except  that 
she  complains  that  her  memory  is  still  some- 
what defective.  Her  weight  is  still  further 
reduced  so  that  she  now  tips  the  scales  at  one 
hundred  and  forty-six  pounds,  but  there  has 
been  no  change  in  the  measurements  of  her 
hands  or  feet.  The  longitudinal  furrows  on 
her  nails  are,  however,  less  marked,  and  her 
tongue  shows  a  considerable  diminution  in 
size.  The  mucous  growths  in  the  nose  have 
disappeared,  and  the  nasal  passages  are  unob- 
structed. During  last  June  she  suffered  for  a 
time  from  very  severe  vertical  headaches,  and 
she  has  had  occasional  attacks  of  palpitation 
and  vomiting,  which  were  apparently  due  to 
an  overdose  of  thyreoid  extract,  which  she  has 
taken  almost  continuously  in  daily  amounts 
varying  from  3  to  9  grains.  The  temperature, 
which  was  taken  only  at  infrequent  intervals, 
ranged  from  98'5°  to  99'2°,  more  commonly  the 
latter. 

"  The  history  of  the  case  and  the  marked 
physical  changes  leave  little  doubt  that  we 
were  dealing  with  a  case  of  acromegaly,  but 
certain  anomalous  symptoms — such  as  the  puffy 
conditions  of  the  eyelids,  which  may,  however, 
have  been  simply  the  result  of  anaemia,  though 
its  appearance  was  somewhat  different,  the  slow 
speech,  and  the  altered  mental  state — suggested 
that  her  condition  was  also  associated  with  a 
loss  of  function  of  the  thyreoid  gland,  which 
was  strengthened  by  the  fact  that  it  could  not 
be  felt  even  after  she  had  lost  considerable 
flesh,  and  the  decided  improvement  following 
the  administration  of  thyreoid  extract.  The 
direct  effects  of  treatment  were  seemingly 
apparent  in  the  loss  of  weight,  the  diminished 
trophic  disturbance  of  the  nails,  the  decreased 
size  of  the  tongue,  the  disappearance  of  the 
mucous  growths  in  the  nose,  and  perhaps  also, 
if  Sohaefer's  observation  is  correct,  that  the  thy- 
reoid secretion  dilates  the  blood-vessels,  in  the 
cessation  of  pain  in  the  hands  :  but  in  the  lat- 
ter case  it  is  somewhat  doubtful  how  far  this 
result  was  due  to  the  action  of  the  remedy,  and 
how  far  to  the  diminishing  influence  of  the 
climacteric  which  she  had  recently  passed,  and 
which  may  have  been  a  more  or  less  potent 
factor  in  causing  pain  from  the  vaso-motor 
disturbances  incidental  to  it.  The  other  treat- 
ment employed  consisted  of  tonics  and  the 
careful  regulation,  so  far  as  possible,  of  her  diet 
and  general  hygiene. 

"  Regarding  the  fetiology  of  the  case,  the 
condition  of  her  brother,  as  she  describes  it,  is 
interesting  as  showing  a  possible  family  taint, 
which  has  not  been  observed  in  any  of  the  re- 
ported instances  ;  but  the  facts  are  too  meagre 
on  which  to  base  even  a  probable  diagnosis, 
and  as  he  lives  many  miles  away  no  more  defi- 
nite information  could  be  obtained.  In  her 
own  history  no  adequate  cause  could  be  found. 


It  is  true  that  she  dates  her  symptoms  from 
the  time  when  she  was  struck  with  a  flat-iron, 
but  the  nervous  shock  which  this  produced 
simply  called  her  attention  to  a  condition 
which  had  imperceptibly  come  on,  as  a  photo- 
graph taken  some  months,  at  least,  before  the 
accident  shows  that  quite  marked  changes  had 
already  taken  place."] 

A  considerable  reduction  in  the  size  of  the 
thyreoid  gland  in  goitre  has  been  repeatedly 
obtained  by  the  use  of  thyreoid  extract,  and  a 
few  cures  have  been  reported.  Bruns  is  quoted 
by  Murray  as  having  treated  twelve  cases  of 
parenchymatous  goitre  in  young  persons  with 
raw  thyreoids,  with  the  result  that  four  were 
cured,  five  were  improved  and  the  goitres  less- 
ened in  size,  while  three  were  not  improved. 
This  ratio  of  cures  appears  to  be  unusually 
good,  and  the  thyreoid  treatment  has  certainly 
been  proved  worthy  of  trial  in  cases  of  this 
nature. 

[Professor  Kocher,  of  Bern,  says  the  Lancet 
for  July  20,  1895,  has  communicated  to  the 
Gorrespondemblatt  fur  schweizer  Aerzte  his  ex- 
perience of  the  treatment  of  goitre  by  means 
of  thyreoid  administration.  The  effect  is  un- 
mistakable, he  says,  the  swellings  becoming 
distinctly  smaller.  Symptoms  of  suffocation 
may  be  abolished  by  the  treatment  in  conse- 
quence of  the  diminution  in  size  of  the  goitre, 
but  in  no  case  did  the  swelling  entirely  disap- 
pear. Only  in  three  cases  was  the  treatment 
unsuccessful,  and  one  of  these  was  that  of  a 
large  cystic  goitre  in  which  success  could 
scarcely  be  looked  for ;  but.  In  spite  of  this  suc- 
cess. Professor  Kocher  utters  a  warning  against 
too  sanguine  views  as  to  the  success  of  thyreoid 
treatment  of  goitre,  and  expresses  the  opinion 
that  this  mode  of  treatment  is  not  more  efiBca- 
cious  than  that  by  iodine.  Success,  he  says,  is 
to  be  expected  only  if  the  treatment  is  under- 
taken at  the  right  time  and  is  carried  out  with 
energy  and  patience.] 

In  exophthalmic  goitre  the  weight  of  opin- 
ion inclines  to  the  view  that  thyreoid  extract 
is  contra-indicated.  Attention  has  already 
been  called  to  the  fact  that  excessive  doses  of 
the  extract,  given  in  myxa?dema,  create  symp- 
toms which  closely  resemble  those  of  exophthal- 
mic goitre,  and  it  may  also  be  noted  that  the 
view  at  present  generally  accepted  regarding 
the  pathological  condition  of  the  thyreoid 
gland  in  this  disease  is  that  it  is  "  a  true  hy- 
pertrophy of  the  glandular  elements  of  the 
gland  with  Increase  of  its  secretions  and  possi- 
bly some  change  in  the  character  of  that  secre- 
tion "  (Starr).  If  exophthalmic  goitre  is  a 
disease  dependent  upon  overactivity  of  the 
thyreoid  gland,  as  our  present  knowledge  seems 
to  indicate,  the  administration  of  thyreoid  ex- 
tract will  not  be  followed  by  improvement,  but 
rather  by  an  exaggeration  of  the  symptoms. 
The  reports  of  results  obtained  by  the  use  of 
the  extract  indicate  not  only  that  it  is  of  no 
service,  but  that  it  is  frequently  injurious. 
Only  once  has  great  improvement  been  re- 
ported, and  there  is  good  reason  to  believe 
that  another  tissue  was  substituted  for  the 
thyreoid  gland  in  this  case  and  that  thyreoid 
extract  was  not  given.    Thus  theory  and  ex- 


THYREOID  TREATMENT 


298 


perienoo  unite  to  discountenance  its  employ- 
ment in  this  disease. 

[Dr.  Ferdinand  Winkler  (Gentralblatt  fur  die 
gesammte  Therapie.  vii,  1895  ;  American  Jour- 
nal of  the  Iledical  Sciences,  October,  1895) 
states  that  Menzies  has  seen  great  beneiit 
from  the  thyreoid  treatment  in  six  cases^  of 
syphilitic  rupia,  and  Abraham  a  marked  im- 
provement in  two  patients  suffering  from 
leprosy. 

Jouin  {Mercredi  medical,  July  31,  1895; 
New  York  Medical  Journal,  August  31,  1895) 
has  employed  thyreoid  extract  for  patients 
suffering  with  fibrous  tumours  of  the  uterus. 
He  gave  from  four  to  eight  tablets  a  day,  each 
containing  3|-  grains  of  the  extract.  In  three 
cases  he  observed  a  diminution  of  the  haemor- 
rhage, and  in  two  cases  the  partial  disappear- 
ance of  the  tumour.  He  thinks  that  researches 
should  be  pursued  in  regard  to  this  method  of 
treatment,  although  our  present  knowledge  of 
the  physiology  of  the  thyreoid  gland  enables 
us  to  give  only  very  hypothetical  explanations 
in  regard  to  the  actioii  of  the  thyreoid  juice  in 
the  treatment  of  fibrous  tumours. 

Tetany  is  an  occasional  result  of  removal 
of  the  thyreoid  gland,  and  it  seems  susceptible 
of  cure  in  some  cases  by  means  of  thyreoid 
treatment  even  when  the  gland  is  present  and 
apparently  healthy.  Thus,  Dr.  Levi-Dorn 
(Therapeutische  Ilonatshefte,  February,  1896  ; 
Therapeutic  Gazette,  April,  1896)  relates  the 
case  of  a  tailoress,  twenty-one  years  old,  who, 
three  years  before  she  came  under  his  observa- 
tion, had  sought  to  relieve  herself  of  sweating 
fingers  by  cold  hand  baths.  She  had  after- 
wards at  times  spasms  in  both  hands — the 
fingers  would  become  so  tightly  clenched  that 
they  could  not  be  loosened  by  the  free  hand ; 
after  a  few  davs  the  hands  would  recover  their 
natural  flexibility.  On  July  7,  1894,  the 
spasms  occurred  in  connection  with  the  prema- 
ture birth  of  a  boy.  The  spasms  had  the  old 
form,  continuing  only  a  few  days,  always 
limited  to  the  upper  extremities.  Then  there 
set  in  frequently  a  feeling  of  itching  in  all  the 
limbs.  The  patient  experienced  great  weari- 
ness, drowsiness,  increasing  heat,  and  anxiety. 
The  weariness  was  greatest  on  rising  in  the 
morning.  A  tendency  to  profuse  perspiration 
was  of  long  standing.  The  disturbances  in- 
creased. The  patient's  father  had  worked  for 
twenty-five  years  in  metals,  especially  lead  and 
mercury,  but  showed  no  sign  of  poisoning. 
The  mother  herself  had  died  of  tuberculosis 
of  the  lungs.  Five  brothers  and  sisters  had 
died  at  an  early  age,  from  scrofula  or  weak- 
ness, or  both  (four  of  them  were  twins).  The 
patient  herself  presented  all  the  symptoms 
which  belong  to  tetany.  Pressure  upon  the 
internal  bicipital  sulcus  caused  parsesthesia  in 
the  affected  arm,  followed  by  the  typical  posi- 
tion. The  fingers  were  held  in  position  for 
holding  a  pen,  or  clasped  into  a  fist  with  the 
thumbs  turned  in.  The  mechanical  excitabil- 
ity of  the  nerves  was  much  increased.  The 
disease  seemed  to  have  been  started  by  the 
chilling  of  the  hands  and  to  have  been  aggra- 
vated by  the  premature  labour.  No  associa- 
tion with  any  infectious  disease  or  poisoning 


or  stomach  disease  could  be  established,  and 
no  disease  of  the  thyreoid  could  be  discovered. 
Tablets  of  thyreoidin  were  now  given,  one 
tablet  daily,  and  rapid  improvement  followed 
after  three  days.  The  spasm  ceased  after  the 
sixth  dose,  to  return  temporarily  fourteen  days 
later,  after  menstruation.  Apart  from  this, 
the  patient  remained  completely  cured  of  her 
tetany.  Her  general  condition  was  decidedly 
improved,  so  that  she  could  work  again.  Al- 
together, not  more  than  seventeen  tablets 
were  taken.  Each  tablet  contained  f  of  a 
grain  of  thyreoidin.  Her  health  had  persisted 
up  to  the  time  of  the  report,  a  period  of  four 
months  and  a  half,  without  medication. 

M.  Ijepiue  (cited  by  Meige,  Revue  Interna- 
tionale ae  medecine  et  de  chirurgie,  August  10, 
1896)  has  employed  the  thyreoid  treatment  in 
two  cases  of  myopathy  and  obtained  successful 
results.  To  one  patient,  forty-four  years  old, 
who  had  suffered  for  eight  years  with  the  dis- 
ease, 3  oz.  daily,  on  an  average,  were  admin- 
istered every  week  for  a  period  of  two  months. 
The  fresh  gland  was  mixed  with  powdered 
marsh  mallow.  Amelioration  took  place  in 
about  two  weeks  after  the  beginning  of  the 
treatment.  The  patient  felt  stronger  and  was 
able  to  walk  alone,  which  he  had  not  been  able 
to  do  for  some  time.  In  the  second  case  M.. 
Lepine  ascertained  that  if  the  thyreoid  treat- 
ment did  not  improve  the  atrophy,  it,  on  the 
other  hand,  considerably  ameliorated  the  con- 
dition of  the  muscles,  which  had  been  affected 
for  some  time. 

In  the  American  Journal  of  hisanity  for 
July,  1896,  Dr.  Joseph  G.  Rogers,  of  the 
Northern  Indiana  Hospital  for  the  Insane, 
gives  an  account  of  two  cases  of  catalepsy  of 
long  duration  in  which  prompt  beneficial 
effects  followed  thyreoid  medication  after  the 
complete  failure  of  other  methods  of  treatment. 
The  principal  points  in  the  more  remarkable 
case,  he  says,  are  as  follows :  In  the  autumn  of 
1890,  during  or  after  an  attack  of  malarial  fe- 
ver, the  patient  evinced  mental  aberration  for 
about  two  weeks,  with  hallucinations  and  de- 
lusions of  impending  personal  harm  and  legal 
involvement.  Subsequently  he  was  apparently 
well  until  the  middle  of  January,  1892,  when 
he  was  attacked  by  la  grippe,  speedily  compli- 
cated by  maniacal  symptoms ;  he  was  noisy, 
restless,  and  sleepless;  he  had  delusions  of 
dread,  which  were  occasionally  violent  (he 
once  fired  a  pistol  at  an  imaginary  enemy); 
he  was  very  hilarious  at  times,  laughing  and 
singing  without  provocation,  and  then  melan- 
choly and  dreamy.  He  was  admitted  into 
the  hospital  two  weeks  later,  on  February  2, 
1892,  in  a  fair  physical  condition,  and  showed 
no  salient  symptoms  of  mental  alienation 
in  conversation  or  conduct,  but  his  letters 
to  relatives,  shortly  after,  indicated  delusions 
of  conspiracy  and  revenge.  He  soon  became 
accustomed  to  his  surroundings,  took  part 
in  the  ward  work  and  amusements,  attended 
chapel  and  the  dances,  and  was  agreeable, 
cheerful,  contented,  well-behaved,  and  gen- 
tlemanly. On  June  9,  1893,  he  was  sent 
home,  apparently  in  a  fair  mental  condition, 
but  not  discharged.    On  October  14,  1892,  he 


299 


THYREOID  TREATMENT 


was  returned  to  the  hospital  in  a  state  of  great 
mental  depression,  which  had  existed  for  some 
time  previously.  For  some  weeks  following, 
at  times,  he  would  lie  for  hours  in  a  trance, 
neither  spealiing,  moving,  nor  giving  attention 
to  ordinary  external  impressions,  and,  if  forci- 
bly aroused,  would  at  once  become  violent  and 
strike  those  about  him.  Between  the  parox- 
ysms he  %as  melancholy  and  silent,  but  would 
take  some  exercise  and  a  suCficiency  of  food. 
The  trance  state,  however,  recurred  more  and 
more  frequently,  and  on  Christmas  day,  1892, 
it  became  continuous,  and  nasal  feeding  was 
begun,  because  food  placed  in  the  mouth  would 
remain  unswallowed.  Meantime,  however,  he 
had  been  fairly  well  nourished.  For  three 
years  continuously  but  little  change  in  the 
case  vras  manifested.  He  lay  during  all  this 
period  like  a  log,  to  all  appearances  wholly 
oblivious  to  external  impressions  or  internal 
sensations,  uttering  no  sound  and  making  no 
sign  indicative  of  mental  action,  unless  it  was 
an  occasional  secretion  of  tears  which  was 
often  noticed.  For  many  months  the  limbs 
could  be  readily  placed  in  any  position  without 
positive  resistance  and  would  remain  so  placed 
for  some  time,  however  grotesque  the  attitude  ; 
later  they  became  less  flexible  and  assumed  a 
fixed  position,  which  could  not  be  changed 
without  the  use  of  great  force,  which  was 
avoided.  Sensibility  to  touch  and  pain  seemed 
to  be  almost  annulled ;  the  faradaic  current 
produced  muscular  contraction,  but  was  not 
notably  noticed  by  the  patient.  This  condi- 
tion continued  without  material  change  until 
November  1,  1895.  During  the  first  months 
of  observation  tonics  of  various  sorts,  together 
with  faradaic  electricity,  massage,  and  baths, 
were  diligently  used,  but  they  were  of  no  avail, 
and  all  treatment  other  than  good  feeding, 
frequent  bathing,  and  careful  attention  to 
warmth  of  body  was  finally  stopped.  He  suf- 
fered no  intercurrent  ailment ;  assimilation 
and  excretion  were  suflScient  and  regular; 
there  seemed  to  be  no  hopeful  indication  for 
any  particular  method  of  treatment,  and  none 
was  attempted  for  many  months,  until  the 
author  determined  to  test  the  eflSoacy  of  thyre- 
oids, and  on  November  1,  1895,  the  treatment 
was  begun.  On  the  6th  active  movements  of 
the  fingers  were  noted,  on  the  24th  the  lips 
moved  slightly,  and  on  the  29th  the  patient 
extended'  his  left  arm  almost  straight.  The 
average  temperature  increased  a  degree  or 
more  and  became  normal,  while  the  pulse  rose 
to  90.  The  treatment  was  suspended  until 
December  16th,  when  it  was  resumed  and  con- 
tinued until  January  23d,  at  which  time  it  was 
stopped  on  account  of  the  rapid  action  of  the 
heart.  During  this  period  of  forty-one  days  of 
medication  the  temperature  and  respiration 
became  normal  and  for  a  few  days  were  some- 
what above  it;  the  pulse  remained  at  about  80 
for  two  weeks,  and  gradually  increased  until  it 
reached  140 ;  it  was  soft,  small,  and  regular. 
On  the  17th  of  January  the  patient  was  placed 
in  a  sitting  posture  and  was  able  to  take  a  cup 
of  eggnog  and  drink  it.  On  the  37th  the 
temperature  was  101°  F.  and  the  pulse  150; 
he  laughed  audibly  and  was  quite  restless. 
03 


An  attendant  offered  him  a  piece  of  paper  and 
a  pencil,  and  much  to  his  surprise  the  patient 
took  it  and  wrote  that  he  would  like  to  have 
his  mouth  washed  out  with  a  soft  cloth,  and 
that  he  would  like  a  little  cold  water  to  drink. 
In  the  course  of  the  evening  he  wrote  several 
sentences.  This  condition  lasted  until  Febru- 
ary, when  a  complete  relapse  took  place.  On 
the  7th  his  condition  was  unchanged,  on  the 
17th  he  was  able  to  take  soft  food,  and  on  the 
23d  he  was  able  to  speak.  On  the  29th  he  sat 
up  during  the  day  and  ate  well.  During  the 
month  of  March  no  thyreoids  were  given ;  the 
pulse  went  down  gradually  and  it  required 
two  weeks  to  reach  its  normal  state ;  the  respi- 
ration and  temperatum  became  slightly  sub- 
normal. The  relapse  toward  inactivity,  says 
Dr.  Rogers,  when  the  remedy  was  stopped  was 
not  so  complete  as  before,  but  still  very  not- 
able. For  a  time  mastication  was  difficult. 
On  March  9th  the  patient  got  up  and  walked 
with  some  assistance  to  another  room.  On  the 
12th  massage  was  begun,  and  on  the  28th  the 
use  of  the  thyreoids  was  again  resumed.  On 
April  7th  there  was  a  slight  improvement, 
which  gradually  increased  until  May  27th. 
On  that  date  the  patient  wrote  a  letter  to  his 
mother  and  was  able  to  walk  from  one  build- 
ing to  another.  From  that  time  up  to  that  of 
Dr.  Rogers's  writing  he  was  mentally  almost 
normal,  and,  although  physically  weak  from 
long  inactivity,  he  took  short  drives  and  walks, 
and  showed  general  evidence  of  having  reached 
permanently  a  plane  from  which  he  might  be 
reasonably  expected  to  pass  on  to  a  condition 
of  health. 

The  important  deductions  to  be  made  from 
the  histories  of  these  cases,  says  Dr.  Rogers,  are 
the  following:  1.  That  in  conditions  marked 
by  inhibition  of  sensory,  motor,  and  mental 
activity,  without  gross  organic  lesion,  such  as 
are  met  with  in  catatonia  and  in  certain  types 
of  stuporous  insanity  and  melancholia,  we  may 
expect  benefit  from  thyreoid  medication,  judi- 
ciously used.  2.  That  the  effects  of  thyreoids 
in  full  doses  bear  a  striking  resemblance  to 
many  of  the  symptoms  of  Graves's  disease — 
namely,  orbicular  weakness,  consecutive  con- 
junctivitis, skin  eruptions,  and  temporary 
bronzing,  withoilt  icterus  of  the  eyes,  profuse 
local  fcBtid  sweats,  subjective  sense  of  heat  and 
thirst,  excessive  metabolism,  decided  tachycar- 
dia, and  the  absence  of  any  fixed  relation  be- 
tween pulse-rate,  respiration,  and  temperature. 
3.  That  the  theory  of  MObius,  that  Graves's 
disease  is  due  to  overactivity  of  the  thyreoid 
gland,  is  strongly  supported. 

Thyreoid  feeding  has  been  employed  for 
the  novel  purpose  of  checking  the  growth 
of  the  foetus  in  utero,  so  as  to  admit  of  the 
birth  of  a  viable  child  in  cases  of  deformity  of 
the  pelvis.  At  a  meeting  of  the  Vienna  Ge- 
burtshilflieh-gynakologische  Gesellschaft  held 
on  March  3,  1896  (Centralhlatt  fur  Oynakolo- 
gie,  July  4,  1896;  New  York  Medical  Journal, 
August  1,  1896),  one  of  the  members  related 
the  case  of  a  woman  whom  he  had  attended 
in  labour  the  year  before.  She  had  an  infun- 
dibuliform  pelvis  on  which  the  spines  of  the 
isqhia  encroached  decidedly,  and  there  was  an 


THYREOIDIN 
THYREOIODININ 


300 


exostosis  on  the  right  ilio-pubic  tubercle.  The 
fcetus  was  very  large,  weighing  over  nine 
pounds.  After  repeated  attempts  at  extrac- 
tion by  the  high  forceps  operation,  the  reporter 
had  had  to  resort  to  craniotomy,  and  even  after 
that  had  been  performed  the  extraction  of  the 
child  had  been  very  difficult  owing  to  its  size. 
The  woman  had  since  come  under  his  care  in 
the  fourth  month  of  pregnancy.  In  pursuance 
of  Proohownik's  idea  of  restricting  the  growth 
of  the  foetus  by  dieting,  he  had,  from  the  be- 
ginning of  the  fifth  month,  employed  thyreoid 
feeding,  giving  one  tablet  a  day.  At  first  the 
woman  had  increased  in  weight,  but  in  the  later 
period  of  the  treatment  a  loss  of  weight  was 
observed  each  week.  It  was  judged  that  the 
growth  of  the  fcetus  was  well  under  control, 
and  the  pregnancy  was  allowed  to  go  to  term. 
When  labour  came  on,  the  head  was  driven 
into  the  pelvic  cavity,  but  its  further  advance 
was  impeded  by  the  projecting  spines  of  the 
isohia.  On  that  account  the  forceps  had  to  be 
applied,  the  head  having  rotated  normally, 
and  a  living  child  weighing  about  six  pounds 
and  a  quarter  was  easily  extracted.  The  re- 
porter admitted  that  it  was  very  questionable 
whether  this  difference  in  the  weight  of  the 
two  children  was  due  to  the  thyreoidin  treat- 
ment alone.  The  treatment  had  been  begun 
in  two  other  cases  of  pelvic  contraction  that 
had  since  come  under  observation  at  a  suffi- 
ciently early  stage  of  gestation,  and  from  the 
results  in  those  oases  some  opinion  might  be 
formed  as  to  whether  the  dwarfing  of  the  foetus 
in  the  case  related  had  been  post  hoc  ov propter 
hoc. 

Curiously  enough,  thyreoid  treatment,  which, 
as  we  have  just  seen,  lias  been  resorted  to  for 
the  purpose  of  checking  the  growth  of  the 
foetus,  has  been  employed  also  to  overcome 
stunting  of  the  growth.  But  this  is  to  some 
extent  explained  by  Dr.  J.  J.  Schmidt  (Thera- 
peutische  Wochenschrift,  November  15,  1896 ; 
iVew  York  Medical  Journal,  December  13, 
1896).  After  referring  to  Virchow's  observa- 
tion, in  1883,  on  the  relationship  of  rickets, 
cretinism,  and  dwarfing  without  any  disease  of 
the  thyreoid  gland  being  recognised  as  at  the 
bottom  of  the  relationship,  he  goes  on  to  say 
that  the  thyreoid  probably  plays  an  important 
part  in  simple  stunting  of  the  growth,  as  well 
as  in  cretinism  and  infantile  myxoedema.  He 
cites  a  number  of  recorded  examples  of  dwarf- 
ing associated  with  atrophy  of  the  thyreoid 
gland,  and  adds  that  experiments  on  animals 
corroborate  the  idea  of  a  direct  connection  be- 
tween the  two  conditions,  as  well  as  that  of 
the  feasibility  of  effecting  by  thyreoid  feeding 
the  restoration  of  normal  growth  checked  by 
thyreoidectomy.  Among  the  interesting  ob- 
servations cited  is  one  by  Lauz  of  a  hen  which, 
four  months  after  having  had  her  thyreoid 
gland  removed,  laid  an  egg  that  weighed  only 
about  a  tenth  of  what  an  average  hen's  egg 
weighs  and  had  a  shell  as  thin  as  paper.  Dr. 
Schmidt  gives  brief  notes  of  four  cases  in 
which  he  has  I'esorted  to  thyreoid  treatment  to 
overcome  dwarfing  in  children.  The  first  was 
that  of  a  girl,  thirteen  years  old,  but  of  the  size 
of  a  girl  of  ten,  whose  growth  was  restored  by 


thyreoid  feeding  for  a  period  of  eighteen 
months,  followed  by  a  five  months'  course  of  a 
daily  tablet  of  Baumann's  thyreoiodinin.  The 
second  was  that  of  a  girl,  fifteen  years  old,  in 
size  only  a  child  of  eleven,  who,  as  the  result 
of  ten  months'  treatment  with  thyreoiodinin, 
had  gained  in  weight  about  ten  pounds.  The 
third  was  that  of  a  boy,  sixteen  years  old,  but 
no  larger  than  an  ordinary  boy  six  years  of 
age,  who  after  a  six  months'  course  of  treat- 
ment with  English  thyreoid  tablets  had  grown 
more  than  two  inches  in  stature  and  gained 
over  ten  pounds  in  weight.  The  fourth  was 
that  of  a  seven-year-old  girl  so  small  that  her 
four-year-old  brother  exceeded  her  in  height. 
After  she  had  taken  a  Baumann's  thyreoiodinin 
tablet  daily  for  four  months  it  had  been  found 
that  she  had  grown  two  thirds  of  an  inch 
taller  and  was  more  than  two  pounds  heavier. 
This  was  not  quite  satisfactory  to  Dr.  Schmidt, 
and  he  ordered  two  of  Engelhardt's  thyreoid- 
gland  tablets  to  be  taken  daily.  Not  enough 
time  had  elapsed  since  his  making  this  change 
to  enable  him  to  report  on  the  resultj 

Matthias  Lanokton  Foster. 

THYEiEOIDIN.— This  substance,  which 
must  not  be  confounded  with  thyreoiodinin 
(thyreoiodine),  is  a  powdered  extract  of  the 
thyreoid  gland  of  the  sheep  or  the  ox.  It  may 
be  given  in  daily  amounts  of  from  5  to  10 
grains.     For  its  uses  in  therapeutics,  see  Thy- 

KEOID  treatment. 

THYREOIODINE,  THYREOIODI- 
NIN.— The  latter  of  these  two  name's  is  to  be 
preferred  as  being  a  closer  equivalent  than  the 
other  of  the  German  name  Thyreojodin  given 
to  the  substance  by  its  discoverer.  In  addition 
the  name  iodothyrein  has  recently  been  given 
to  it.  It  is  an  organic  iodine  compound  found 
by  Baumann  to  be  a  normal  constituent  of  the 
thyreoid  gland  and  thought  to  be  its  active 
principle.  It  is  an  amorphous  brown  powder 
readily  soluble  in  alcohol,  but  almost  insoluble 
in  water.  According  to  Professor  Ewald,  of 
Berlin  ( Wiener  medizinische  Blatter,  June  4, 
1896),  the  fresh  gland  contains  from  02  to  0-5 
per  cent,  of  thyreoiodinin,  about  one  tenth  of 
which  is  iodine.  The  therapeutical  action  of 
thyreoiodinin  is  in  most  respects  practically 
identical  with  that  of  the  thyreoid  gland  itself, 
but  it  is  thought  to  be  exerted  more  speedily. 

Baumann  {Munchener  medicinische  Wochen- 
schrift, April  7,  1896;  Centralblatt  fur  innere 
Medicin.  September  19,  1896)  describes  thy- 
reoiodinin as  containing  nitrogen  and  iodine 
in  very  stable  combination  and  as  being  al- 
most insoluble  in  cold  water  and  in  ether,  and 
as  having  a  remarkable  resemblance  in  some 
respects  to  an  iodine  compound  recently  pre- 
pared by  Drechsel  from  corals.  Only  a  small 
amount  of  free  thyreoiodinin  is  contained  in 
the  thyreoid  gland,  most  of  it  being  combined 
with  albumin  and  globulin,  but  by  repeated  ex- 
traction with  diluted  chloride-of-sodium  solu- 
tion all  the  iodine  compounds  may  be  removed 
from  well-ininoed  glands.  Since  an  effect  is 
often  seen  earlier  from  thyreoiodinin  than  from 
the  fresh  gland,  Baumann  assumes  that  thy- 
reoiodinin is  the  active  principle  of  the  gland. 


301 


THYREOIDIN 
THYREOIODININ 


A  curious  thing  mentioned  by  Baumann  is 
the  fact  that  numerous  observations  show  that 
in  Hamburg  and  Berlin  the  thyreoid  gland 
contains  much  more  iodine  than  in  Freiburg, 
as  a  rule,  and  that  this  is  particularly  the  case 
with  children,  in  whom  the  amount  is  rela- 
tively small.  The  quantity  of  iodine  con- 
tained in  the  gland  seems  to  be  but  little 
influenced  by  disease,  he  says,  but  to  be  notably 
increased  il  iodine  in  any  form  is  absorbed. 
Since  only  a  very  small  amount  of  iodine  is 
found  in  goitres,  and  since  the  amount  found 
in  the  gland  in  goitrous  regions  is  small,  says 
Baumann,  the  old  doctrine  of  the  influence  of 
the  quantity  of  iodine  present  in  a  locality — 
in  the  food,  in  the  air,  and  in  the  water — on 
the  development  of  goitre  receives  fresh  sup- 
port. Iodine  is  an  element  necessary  to  lite, 
and  if  no  marine  fish  are  consumed,  it  must 
enter  the  system  chiefly  in  the  vegetable  food. 

Baumann  has  recently  succeeded  in  flnding 
iodine  in  the  thymus  of  the  calf,  and  he  thinks 
it  probable  that  in  that  organ  also  it  exists  in 
the  form  of  thyreoiodinin.  In  most  instances, 
when  the  amount  of  thyreoiodinin  contained 
in  the  thyreoid  gland  has  once  been  increased 
by  the  ingestion  of  iodine  into  the  system  it 
remains  abnormally  large  for  a  long  time. 
Ordinarily,  therefore,  a  good  deal  of  thyreoio- 
dinin is  found  in  the  thyreoids  of  persons  who 
have  taken  iodine  for  a  lime.  This  is  true 
even  of  goitrous  individuals,  although  usually 
the  amount  of  iodine  contained  in  a  goitre  is 
smaller  than  that  contained  in  the  healthy 
gland. 

There  is  some  reason  to  think  that  thyreo- 
iodinin is  not  in  every  way  the  medicinal 
equivalent  of  the  thyreoid  gland.  Dr.  J.  A. 
Notkin  (Wiener  medizinische  Blatter,  October 
33,  1896 ;  New  York  Medical  Journal,  Novem- 
ber 14, 1896)  thinks  that  the  phenomena  caused 
by  extirpation  of  the  thyreoid  gland  are  divis- 
ible into  two  classes,  one  being  the  symptoms 
of  tetany  and  the  oi;her  those  of  myxoedema. 
He  thinks  it  probable  that  the  phenomena  of 
myxoedema  occur  only  when  there  is  left  some 
remnant  of  the  thyreoid  parenchyma  capable 
of  performing  its  functions,  also  that  myxcE- 
dema  is  caused  by  an  albuminous  principle, 
thyreoproteid,  whereas  tetany  depends  on 
poisoning  with  products  of  metabolism  which 
are  not  of  an  albuminous  nature.  Baumann's 
thyreoiodinin,  he  says,  will  cure  goitre  and 
myxoedema,  but  it  has  been  difficult  to  assume 
a  priori  that  it  would  also  cure  tetany.  It 
appears  from  data  furnished  by  Frankel, 
Kocher,  Jr.,  and  Gottlieb  that  besides  thy- 
reoiodinin the  thyreoid  gland  contains  other 
specifically  active  substances. 

Notkin  undertook  an  experimental  investi- 
gation as  to  the  truth  of  Baumann's  contention 
that  thyreoiodinin  would  cure  all  the  results  of 
removal  of  the  thyreoid  gland.  In  the  first 
experiment  the  entire  gland  was  removed 
from  a  dog.  Two  days  iater  there  were  fibril- 
lar and  occasionally  clonic  contractions  of  the 
muscles  of  the  limbs.  On  that  day  and  on  the 
following  day  45  and  60  grains  of  thyreoiodi- 
nin respectively  were  given  to  the  animal ; 
nevertheless,  the  most  pronounced  cachexia 


strumipriva  was  developed.  The  dog  was  now 
almost  dead,  when,  by  the  means  of  a  stomach- 
tube,  45  grains  of  Merck's  preparation  of  dried 
thyreoids  were  introduced  into  its  stomach. 
In  the  evening  the  convulsions  ceased,  and  on 
the  following  day  45  grains  more  of  the  Merck 
preparation  were  given.  On  this  day  and  the 
next  the  dog  was  lively  and  free  from  convul- 
sions. Now  in  the  course  of  two  days  180 
grains  of  thyreoiodinin  were  given  to  "it,  and 
again  fibrillar  contractions  showed  themselves, 
and  there  was  an  attack  of  tonic  and  clonic 
convulsions. 

In  the  second  experiment  thyreoiodinin  also 
proved  incapable  of  causing  the  subsidence  of 
the  tetanic  symptoms;  indeed,  they  became 
more  intense  under  its  employment,  and  even 
when  injected  subcutaneously  it  failed  to  aSeot 
them. 

In  the  third  experiment  the  animal  was 
treated  with  thyreoiodinin  beforehand.  In 
spite  of  this  and  of  the  large  doses  employed 
after  the  onset  of  the  convulsions,  the  dog 
could  not  be  saved  from  the  severest  symptoms 
of  the  cachexia.  The  urine  of  all  the  three 
dogs  was  albuminous. 

From  these  experiments  Notkin  concludes 
that  thyreoiodinin  is  incapable  of  overcoming 
the  phenomena  of  tetany ;  however,  he  did  not 
use  Baumann's  own  preparation,  and  this,  he 
says,  may  account  for  the  difference  between 
his  and  Baumann's  results. 

With  regard  to  the  action  of  thyreoid-gland 
preparations,  says  Ewald  (loc.  cit.),  we  have  to  dis- 
tinguish between  two  constituents ;  one  of  them 
gives  rise  to  objectively  recognisable  changes 
of  metabolism,  and  the  other  is  related  to  cer- 
tain subjective  symptoms  which  range  from 
slight  discomfort  to  pronounced  morbid  phe- 
nomena, constituting  tliyreoidism,.  Under  cer- 
tain circumstances  metabolism  may  be  notably 
heightened  by  thyreoid  preparations,  and  this 
heightening  can  not  fail  to  efl:ect  the  general 
condition,  as  is  shown  by  debility,  loss  of  ajjpe- 
tite,  nausea,  1  hirst,  sleeplessness,  depression, 
dizziness,  pains  in  the  back  and  in  the  loins, 
increased  frequency  of  the  pulse,  palpitation 
of  the  heart,  sensations  of  oppression,  and 
stenocardiac  attacks.  These  phenomena  are 
more  or  less  pronounced  in  all  cases  of  sudden 
alteration  of  metabolism  which  are  connected 
with  a  rapid  breaking  up  of  a  substance  con- 
taining albumin  and  with  a  heightened  com- 
bustion of  fat. 

The  employment  of  thyreoiodinin,  even  to 
the  amount  of  a  drachm  in  twenty-four  hours, 
says  Ewald,  has  no  material  influence  on  the 
pulse,  and  there  can  be  no  chance  of  iodine 
poisoning,  because  the  amount  of  iodine  con- 
tained, in  the  thyreoid  gland  and  its  prepara- 
tions is  very  small  (one  part  of  the  sheep's 
thyreoid  contains  O'OOOS  of  one  part  of  iodine) ; 
such  consequences,  however,  as  increased  fre- 
quency of  respiration,  headache,  pains  in  the 
limbs,  salivation,  urticaria,  palpitation,  and 
tremor  have  been  reported.  Often  enough,  on 
the  other  hand,  there  is  no  reaction,  in  spite  of 
the  employment  of  large  amounts  of  prepara- 
tions known  to  be  active.  Besides  the  toxic 
symptoms    mentioned,    albumin,    casts,    and 


THYREOPROTEIN 
TINCTURES 


302 


sugar  are  occasionally  found  in  the  urine  as  a 
result  of  thyreoid  treatment.  In  the  majority 
of  the  oases  of  glycosuria  the  excretion  of  sugar 
is  only  temporary,  but  in  one  observed  by 
Ewald,  that  of  a  woman,  after  having  first  oc- 
curred off  and  on,  it  settled  down  into  a  con- 
tinuous diabetes  from  which  the  patient  was 
still,  four  years  after  its  first  appearance,  suf- 
fering, or  rather  not  suffering,  for  beyond  the 
glycosuria  she  had  no.  subjective  or  objective 
symptoms  of  diabetes.  In  the  many  cases  in 
which  of  late  years  Ewald  has  employed  thy- 
reoid-gland  preparations  he  has  almost  in- 
variably examined  the  urine  for  sugar,  but  has 
never  found  glucose,  even  in  corpulent  patients. 
He  has  therefore  been  surprised  to  learn  that 
Noorden  has  observed  glycosuria  five  times  in 
seventeen  cases  of  thyreoid  feeding  in  the  cor- 
pulent, although  it  quickly  disappeared  on  dis- 
continuing the  treatment.  It  will  be  interesting 
to  observe,  he  says,  whether  this  phenomenon 
takes  place  also  in  the  thyreoiodinin  treatment, 
with  the  avoidance  of  all  sugar  in  the  prepara- 
tion ;  we  shall  then  know  whether  its  .occur- 
rence is  due  to  the  specific  action  inherent  in 
the  gland  or  is  a  toxic  by-effect. 

The  secretion  of  the  thyreoid  gland,  says 
Ewald,  is  continuously  being  carried  into  the 
circulation  in  minute  amounts,  where  its  office 
is  to  destroy  certain  poisonous  substances  of 
unknown  nature  whose  existence  is  inferred 
from  the  toxic  phenomena  which  follow  loss  of 
the  gland  or  of  its  function — athyreosis  or 
ecthyreosis.  That  these  phenomena  are  not 
merely  accidental  rests  as  well  on  their  nature, 
which  is  always  in  part  that  of  active  irrita- 
tion, as  on  the  results  of  replacing  the  defective 
secretion  or  of  artificial  increase  of  it — hyper- 
thyreoidism.  Moreover,  he  adds,  the  secretion 
acts  as  an  antidote  to  certain  toxines  which 
appear  as  by-products  of  metabolism.  If  the 
secretion  is  insuSicient,  these  toxines  accumu- 
late and  metabolism  is  reduced ;  if  it  is  secreted 
or  introduced  into  the  system  in  excess,  so  that 
the  point  of  neutralization  is  ovei'stepped,  and 
there  is  too  much  thyreoiodinin  in  the  organ- 
ism, the  specific  effects  of  this  substance  will 
show  themselves.  That  the  gland  bears  an 
essential  part  in  metabolism,  he  remarks,  is 
evident  from  the  facts  that  as  soon  as  an  ex- 
cessive amount  of  thyreoiodinin  gains  access 
to  the  circulation  an  acceleration  of  metabolism 
occurs,  even  to  the  point  of  a  morbid  increase, 
and  that,  conversely,  its  reduction  is  the  result; 
of  failure  or  deficiency  of  the  glandular  secre- 
tion. The  difference  between  the  normal  and 
the  pathological  state  is  one  of  degree  only, 
he  thinks,  and  in  this  matter  the  behaviour  of 
the  thyreoid  is  in  no  wise  different  from  that 
of  other  glands. 

In  regard  to  the  dose  of  thyreoiodinin,  says 
Ewald,  the  rule  has  been  promulgated  to  begin 
with  minute  doses,  to  increase  them  gradually, 
and  not  to  make  them  too  large  at  any  time. 
It  has  been  shown  that  the  employment  of 
very  large  quantities — the  equivalent  of  one 
or  two  glands — has  no  therapeutic  advantage, 
but  sometimes  does  harm  by  causing  a  sudden 
outbreak  of  thyrenidism.  The  daily  maximum 
allowable,  according  to  Ewald,  may  be  regarded 


as  ten  tablets,  corresponding  to  0'045  of  a  grain 
of  iodine. 

Unquestionably,  says  Ewald,  the  prime  indi- 
cation for  the  use  of  thyreoiodinin  is  found  in 
myxcBdema,  but  it  is  almost  as  much  indicated 
in  sporadic,  or  infantile,  cretinism.  The  idea 
of  using  the  thyreoid  preparations  in  skin  dis- 
eases, says  Ewaid,  was  founded  on  observations 
of  the  myxcedematous,  in  whom  a  striking  im- 
provement of  the  state  of  the  skin  and  of  the 
general  nutrition  had  been  seen  to  follow  their 
employment.  The  treatment  is  especially  use- 
ful in  psoriasis  vulgaris,  in  lupus,  in  ichthyosis, 
in  xerodermia,  and  in  sclerodermia.  It  seems 
to  Ewald  that  the  dermatologists,  at  least  in 
Germany,  are  still  rather  cold  toward  this 
treatment,  but  he  admits  that  the  greatest  re- 
serve is  justifiable,  especially  with  regard  to 
psoriasis,  in  which  spontaneous  and  utterly  un- 
expected recoveries  are  not  infrequent.  It  is 
different  with  the  treatment  of  corpulence,  he 
says,  which  must  make  an  impression  on  the 
observer  who  records  the  great  loss  of  weight 
by  the  myxcedematous.  A  loss  'of  weight  to 
the  extent  of  ten  kilogrammes  in  six  weeks — 
on  the  average,  of  from  four  to  five  kilogrammes 
— by  the  daily  use  of  from  three  to  five  tablets 
takes  place,  but  it  is  only  in  exceptional  cases 
that  the  reduction  of  flesh  proves  lasting. 

Since  it  may  be  considered  certain,  says 
Ewald,  that  metabolism  as  a  whole,  including 
the  destruction  of  albumin  and  the  combustion 
of  fat,  is  increased  by  the  thyreoid  treatment, 
independently  of  any  special  change  of  diet, 
the  loss  of  albumin  might  be  reduced  to  a  very 
small  one  by  increasing  the  ingestion  of  albu- 
min, and  so  an  ideal  treatment  of  obesity  be 
made  use  of — one  that  would  reduce  the  fat 
without  detriment  to  the  albuminous  constitu- 
ents of  the  body. 

Two  questions,  however,  Ewald  thinks,  are 
still  to  be  met :  1.  Why  is  it  that  many  cor- 
pulent persons  are  completely  refractory  to 
thyreoiodinin?  2.  Has  thyreoantitoxine  or 
thyreoiodinin  the  same  action  as  the  entire 
gland  ?  As  regards  their  behaviour  under  thy- 
reoid treatment,  he  says,  obese  pei'sons  can  not 
be  grouped  into  those  who  have  grown  corpu- 
lent in  consequence  of  improper  diet  and  those 
who  have  become  fat  in  spite  of  a  strict  regi- 
men ;  in  each  of  these  groups  there  are  those 
on  whom  this  treatment  acts  favourably  and 
those  on  whom  it  acts  unfavourably.  There 
are  certain  conditions  under  which  the  system 
clings  pertinaciously  to  its  fatty  elements. 
This  is  most  forcibly  shown  in  pernicious 
anasmia.  The  striking  obesity  of  persons  who 
die  of  this  disease  shows  how  obstinately  the 
organism  may  preserve  its  fat  in  spite  of  the 
ingestion  of  nutritious  material  being  reduced 
to  the  utmost,  and,  as  recent  investigations 
have  surely  shown,  in  spite  of  the  fact  that  the 
assumption  of  oxygen  and  the  loss  of  carbon 
dioxide  are  not  reduced.  The  second  question 
Evfald  answers  in  the  affirmative,  and  cites  in- 
stances of  a  rapid  and  decided  reduction  of 
obesity  as  the  result  of  treatment  with  thy- 
reoiodinin. 

Dr.  Qrawitz  {MUnchener  mediciniache  Woch- 
enschrift,  1896,  No.  14 ;  Deutsche  Medizinal- 


303 


THYEEOPROTEIN 
TINCTURES 


Zeitung,  June  15,  1896)  relates  the  cases  of  two 
women  who  were  treated  with  thyreoiodinin  for 
obesity.  In  one  of  them  the  use  of  the  remedy 
was  continued  for  only  three  days,  at  the  rate 
of  15  grains  a  day.  During  this  period  the 
patient  lost  three  kilogrammes  in  weight,  and 
this,  says  Grawitz,  was  all  the  more  remarkable 
from  the  fact  that  she  took  milk,  butter,  white 
bread,  and  eggs  freely,  although  restriction  in 
the  matter  of  these  articles  before  the  thyreo- 
iodinin was  used  had  brought  about  only  a 
very  trifling  loss  of  weight.  An  increased 
excretion  of  nitrogenous  matter  was  evident  in 
this  case — to  the  amount  of  about  an  ounce — 
so  that  a  decided  loss  of  weight  could  not  fail 
to  result.  There  was  however,  no  increase  of 
the  fluid  excretions,  and  the  urine  contained 
neither  albumin  nor  sugar.  The  other  patient 
took  15  grains  of  thyreoiodinin  daily  for  three 
weeks,  without  any  restriction  of  her  diet,  and 
she,  too,  lost  three  kilogrammes  in  weight. 
When  she  discontinued  the  use  of  the  remedy 
her  reduction  of  weight  persisted  for  a  short 
time,  but  she  soon  began  to  regain  her  flesh. 
Her  subjective  condition  was  not  affected,  and 
her  urine  was  free  from  both  albumin  and 
sugar.     Cf.  Thyreoid  treatment. 

THYBEOPROTEIN.— This  is  a  poison- 
ous albuminoid  isolated  by  Notkin  from  the 
thyreoid  gland.  It  is  thought  to  be  a  sub- 
stance which  it  is  one  of  the  functions  of  the 
gland  to  eliminate  from  the  organism. 

TIGLITTM.— See  Croton  oil. 

TIN  appears  to  be  physiologically  inert  and 
is  without  medical  uses  save  in  the  granulated 
or  powdered  form,  which  has  been  employed 
for  the  expulsion  of  tapeworms.  It  is  assumed 
to  act  mechanically.  It  may  be  given  in 
draohm  doses  every  morning  until  the  worm'is 
expelled.  It  is  an  unnecessarily  harsh  rem- 
edy, and  not  without  danger,  so  it  is  rapidly 
passing  out  of  use.  The  only  salt  of  tin 
which  is  of  interest  is  the  chloride,  which  is 
occasionally  found  in  carelessly  put  up  canned 
goods,  being  formed  by  the  action  of  the 
hydrochloric  acid,  employed  as  a  flux  in  the 
soldering  upon  the  tin.  It  has  been  stated 
that  enormous  doses  are  without  physiological 
effect,  but  it  is  probably  more  or  less  corrosive. 
In  cases  of  poisoning  caused  by  the  eating  of 
canned  food  the  effects  produced  are  rarely  if 
ever  due  to  this  salt,  but  rather  to  the  pto- 
maines derived  from  the  decomposed  food  and 
to  the  lead  in  the  solder.  The  symptoms  ob- 
served are  those  of  gastro-enteritis,  and  they 
occur  usually  after  the  eating  of  canned  fruits 
and  vegetables  which  are  naturally  acid  or  be- 
come so  in  the  cans.  As  tin  is  but  little  affected 
by  the  vegetable  adids,  the  lead  is  probably  the 
most  important  metallic  element  in  the  cases. 

Many  cases  of  lead  poisoning  have  occurred 
in  which  the  so-called  "  tin  foil "  (in  reality 
one  or  more  thin  sheets  of  lead  covered  with 
tin)  has  been  the  cause.  Little  of  the  tin  foil 
in  the  market  is  free  from  lead,  and  its  use  in 
pharmacy  and  to  envelop  foods  should  be  dis- 
couraged.— Russell  H.  Nevins. 

TINCTtTBES.— These  are  liquid  prepara- 
tions, consisting  mostly  of  solutions  in  alcohol, 


alcohol  and  water,  or  a  similar  solvent,  of  the 
soluble  constituents  of  crude  drugs  which  are 
not  entirely  soluble  in  the  menstruum.  For 
convenience'  sake,  a  few  preparations  not  ex- 
actly fitting  this  definition  are  usually  classed 
as  -tinctures — for  instance,  tincture  of  iodine, 
although  the  iodine  is  completely  soluble  in 
the  menstruum. 

Tinctures  may  be  prepared  either  by  mac- 
eration (or  solution)  or  by  percolation.  Mac- 
eration is  usually  resorted  to  when  the  drug 
to  be  extracted  is  of  such  a  nature  that  it 
would  cake  together  if  packed  in  a  percolator 
and  prevent  the  solvent  from  penetrating  it. 
This  is  the  case  particularly  with  resins,  gum 
resins,  and  drugs  containing  a  large  propor- 
tion of  soluble  matters.  These  are  always  best 
extracted  by  maceration.  But  maceration  is 
adapted  also  in  aU-  other  cases  without  excep- 
tion, and  is  in  some  countries  still  the  only 
process  recognised  oificially.  It  is,  however, 
rather  slow  and  tedious,  and  for  this  reason  is 
now  getting  to  be  more  and  more  replaced  by 
the  process  of  percolation.  There  is  a  radical 
difference  in  the  principles  underlying  the 
ratio  of  volume  or  weight  of  product  to  weight 
of  crude  drug  in  the  two  processes. 

Maceration,  if  conducted  properly,  is  carried 
on  in  the  following  manner :  A  definite  weight 
of  a  drug  of  known  quality  and  properly  com- 
minuted is  brought  in  contact  with  a  definite 
volume  or  weight  (usually  the  latter)  of  a 
menstruum  known  to  be  capable  of  dissolving 
the  useful  constituents.  The  mixture  is  set 
aside,  well  covered  to  prevent  evaporation,  but 
is  frequently  agitated  or  stirred  so  as  to  pro- 
mote the  action  of  the  solvent.  After  a  cer- 
tain time,  often  extending  to  some  weeks, 
when  it  may  be  judged  (or  may  be  known 
from  previous  experience)  that  all  soluble 
matters  have  gone  into  solution,  the  contents 
are  removed  and  the  liquid  is  separated  from 
the  undissolved  residue  by  straining.  Even 
assuming  that  none  of  the  liquid  was  lost  by 
evaporation,  the  whole  of  it  will  in  no  case  be 
recoverable,  since  the  residue  will  always  re- 
tain at  least  traces  of  it,  even  under  the  most 
powerful  pressure.  Hence  the  quantity  (weight) 
of  strained  liquid  obtained  is  likely  to  vary 
more  or  less  each  time  a  particular  tincture  is 
made.  But  this  variation  does  not  affect  its 
strength  or  medicinal  value.  If  the  liquid 
and  solid  have  been  kept  in  contact  for  a  suffi- 
cient time,  with  frequent  agitation,  the  process 
of  osmosis  will  have  gradually  brought  about 
a  uniform  condition  of  the  solution  both  out- 
side and  inside  of  the  particles  of  the  drug; 
and  it  will  then  be  merely  a  matter  of  me- 
chanical force  to  obtain  not  only  the  liquid 
surrounding  the  solid  particles,  but  also  as 
much  of  the  included  liquid  as  possible.  The 
person  who  can  apply  the  greatest  force  will 
simply  have  more  product  to  sell.  His  prod- 
uct need  not  be  supposed  to  be  better  than 
that  of  another  person  who  was  unable  to 
squeeze  as  much  of  the  liquid  from  the  solid 
particle  as  the  other.  Of  course,  the  liquid 
thus  obtained  by  straining  is,  in  most  cases, 
turbid  and  requires  to  be  filtered. 

Some  authorities  have  proposed  to    avoid 


TOBACCO 


304 


the  discrepancy  in  the  quantity  of  product, 
clue  to  the  variable  amount  of  liquid  retained 
by  the  drug,  by  treating  the  pressed  drug 
with  further  fresh  portions  of  the  men- 
struum, to  express  again,  and  to  add  the  prod- 
uct to  the  first  strainings,  until  a  definite 
weight  or  definite  volume  of  product  is  ob- 
tained. But  it  does  not  need  a  mathematical 
demonstration  to  prove  that  this  method  intro- 
duces serious  errors.  It  is  impossible  in  this 
way  to  dissolve  out  from  the  interior  of  the 
particles  all  the  soluble  matter ;  even  under 
the  most  favourable  conditions  some  of  it  must 
be  retained,  and  it  would  require  many  wash- 
ings, with  concomitant  maceration,  to  attain 
even  approximate  exhaustion.  If  the  process 
i.f  maceration  is  to  be -used  at  all,  no  washing 
of  the  residue  is  admissible. 

In  the  case  of  drugs  which  are  quite  readily 
extracted  or  almost  entirely  soluble  it  is  pref- 
erable to  suspend  them  in  a  cloth  or  other 
suitable  material  in  the  upper  part  of  the 
column  of  the  menstruum.  As  the  lattei'  dis- 
solves out  the  constituents,  the  dense  solution 
sinks  to  the  bottom,  causing  the  uncharged 
or  lighter-charged  portions  of  the  liquid  to  rise 
and  to  come  in  contact  with  the  drug.  This  is 
called  •'  superior  maceration." 

Percolation  is  suitable  for  all  substances  the 
constituents  of  which  are  only  partially  solu- 
ble, and  which  are  not  apt  to  agglutinate  in 
the  apparatus.  Such  are,  for  instance,  the 
drugs  of  a  fibrous  nature  derived  from  the 
vegetable  kingdom,  but  there  are  also  others. 
Percolation  is  used  to  efOeet  exhaustion  of  a 
drug  by  forcing  through  its  finely  comminuted 
particles  a  suitable  solvent  until  the  latter 
passes  practically  free  from  dissolved  matters. 
It  is  therefore  necessary  to  provide  for  such  a 
condition  that  the  liquid  in  its  downward  pas- 
sage will  not  find  an  easier  exit  by  the  chan- 
nels between  the  particles  than  through  the 
body  of  the  latter  themselves.  The  drug  must 
be  reduced  to  a  more  or  less  fine  powder — the 
finer,  the  stronger  in  alcohol  the  liquid  is.  It 
must  be  moistehed  with  the  liquid  and  allowed 
to  swell  as  far  as  it  will,  after  which  it  is  to 
be  packed  carefully  and  more  or  less  firmly — 
depending  on  the  nature  of  the  drug — into  the 
percolator,  which  is  a  cylindrical  or  conical 
vessel  provided  with  an" outlet  the  flow  from 
which  may  be  regulated,  and  it  is  then  covered 
by  a  sufficient  quantity  of  the  liquid  which  is 
to  be  passed  through  it.  The  percolator  is  now 
covered,  and  the  contents  are  allowed  to 
macerate,  the  lower  orifice  being  open,  until 
liquid  begins  to  drop  from  the  latter,  which  is 
a  sign  that  the  liquid  has  penetrated  the  mass. 
The  outlet  is  then  closed  and  the  contents  are 
allowed  further  to  macerate  for  such  a  length 
of  time  as  previous  experience  may  have  shown 
desirable.  Then  the  outlet  is  opened  and  the 
flow  of  percolate  so  regulated  that  a  slow  but 
steady  extraction  is  secured.  The  surface  of 
the  powder  must  never  be  without  liquid, 
otherwise  cracks  and  passages  would  form  in 
the  packed  powder,  which  would  permit  of  the 
passage  of  the  liquid  by  the  side  of  the  parti- 
cles. 
In  the  case  of  percolation  a  definite  volume 


or  weight  of  percolate  bearing  some  previonsly 
determined  relation  to  the  weight  of  the  drug 
is  the  object  aimed  at.  In  most  cases  the  ratio 
is  so  fixed  that  practical  exhaustion  of  the 
drug  is  secured  when  the  desired  volume  or 
weight  of  product  has  been  obtained.  Should 
this  not  be  the  case,  and  it  should  for  some 
reason  be  desired  to  carry  the  process  to  com- 
plete exhaustion,  while  yet  securing  a  definite 
quantity  of  product,  enough  liquid  may  be 
gradually  passed  through  the  drug  to  exhaust 
it  actually,  the  solution  concentrated  by  distil- 
lation or  evaporation,  and  the  residue  added 
to  the  first  percolate,  the  volume  or  weight  of 
which  may  then  be  adjusted  so  as  to  bear  the 
proper  ratio  to  that  of  the  drug. 

It  has  often  been  recommended  to  prepare 
tinctures  from  the  corresponding  fluid  extracts, 
and  most  manufacturers  of  the  latter  prepara- 
tions furnish  upon  their  labels  directions  for 
making  the  tinctures  from  the  latter.  This 
practice  will  no  doubt,  in  a  number  of  cases, 
result  in  the  production  of  tinctures  of  full 
medicinal  value  which  can  not  be  distinguished 
from  those  specially  prepared  by  percolation, 
but  in  many  other  cases  the  product  will  ma- 
terially differ  from  that  which  would  have 
been  obtained  by  the  legitimate  process.  When 
a  drug  contains  certain  useful  constituents 
which  are  alone  desirable  and  the  whole  of 
which  will  remain  in  solution  in  a  tincture 
made  from  the  corresponding  fluid  extract,  no 
harm  can  come  from  this  practice.  But  the 
knowledge  of  where  this  may  be  done  without 
detriment  is  not  possessed  by  many.  It  is 
therefore  always  advisable  to  adhere  to  the 
official  directions. — Charles  Rice. 

TOBACCO,  tabacum  (U.  S.  Ph.),  tabaci  folia 
(Br.  Ph.),  /ofi'a  nicotiance  (Ger.  Ph.),  has  power- 
ful emetic  and  nauseant  properties,  and  when 
taken  in  overdoses  acts  as  a  paralyzer  of  the 
respiratory  muscles  and  secondarily  depresses 
the  action  of  the  heart.  It  resembles  lobelia 
closely  in  its  general  effects.  Its  poisonous 
properties  depend  upon  a  crystalloid  body, 
nicotine,  which  is  obtained  by  distillation  or 
extraction  and  is  found  in  small  quantities  in 
the  fluid  which  collects  in  old  pipes.  Tannin, 
caustic  alkalies,  and  iodide  of  potassium  are 
chemical  incompatibles  which  may  be  used  in 
poisoning  with  tobacco  shortly  after  its  inges- 
tion, while  strychnine  is  the  physiological  an- 
tidote. The  depression,  etc.,  observed  should  be 
combated  with  stimulants,  ergot,  digitalis,  or 
belladonna. 

Tobacco  was  formerly  employed  as  a  depres- 
sant nauseant  in  croup  and  similar  conditions, 
but  its  action  is  so  uncertain  that  it  has  been 
abandoned  in  favour  of  less  dangerous  reme- 
dies. However,  in  cases  of  emergency  patients 
unaccustomed  to  its  use  may  be  made  to  inhale 
small  volumes  of  its  smoke,  but  it  is  hardly 
safe  to  allow  the  person  himself  to  smoke— it 
is  preferable  to  have  another  person  do  it,  the 
former  inhaling  the  smoke— as  a  number  of 
cases  of  fatal  poisoning  have  resulted  from  the 
use  of  a  foul  pipe  by  children. 

In  impaction  offices,  intussusception,  stran- 
gulated hernia,  and  painters'  colic  euemata  of 


305 


TOBACCO 


the  smoke  or  of  one  containing  not  over  15 
grains  of  tobacco  often  prove  of  great  value,  but 
if  lobelia  is  obtainable  it  is  much  to  be  preferred. 
In  tetanus  it  appears  to  be  of  decided  value, 
relieving  the  muscular  spasms  and  thus  pre- 
venting in  a  measure  the  exhaustion  of  the 
patient,  but  great  care  should  be  observed  lest 
its  poisonous  action  be  substituted  for  the  con- 
dition it  is  intended  to  cure.  Poisoning  by 
strychnine  has  been  successfully  treated  with 
it  or  its  active  principle,  nicotine,  of  which  ^'ij 
of  a  grain  is  a  sufBeient  dose,  and  in  all  condi- 
tions in  which  tobacco  is  indicated  nicotine  may 
be  substituted.  Being  capable  of  hypodermic 
use,  it  may  in  some  conditions  be  preferable. 
The  employment  of  tobacco  in  poultices,  etc.,  is 
inadmissible,  as  the  rapidity  of  its  absorption 
varies  greatly  and  a  lethal  amount  may  be  ab- 
sorbed almost  before  its  initial  effects  are  ob- 
served. 

In  amounts  smaller  than  those  necessary  to 
produce  its  marked  physiological  effects,  to- 
bacco, employed  in  the  usual  methods,  by 
smoking,  chewing,  snuffing,  or  dipping  (the 
rubbing  of  snuff  upon  the  gums),  may  be  re- 
garded as  an  accessory  food,  as  its  moderate 
use  is  accompanied  by  a  decreased  demand  for 
the  ordinary  articles  of  food  without  any  im- 
pairment of  the  strength,  etc.  It  also,  during 
periods  of  great  strain  or  deprivation  from 
food,  enables  those  who  use  it  to  endure  what 
would  otherwise  cause  a  "  break-down."  On  the 
other  hand,  when  used  to  excess,  it  may  cause 
impairment  of  the  digestion,  insomnia,  palpita- 
tion of  the  heart,  and  a  state  resembling  neu- 
rasthenia. Unfortunately,  the  amount  which 
can  be  used  without  disadvantage  can  not  be 
estimated,  as  it  differs  in  every  instance.  It  is 
pretty  certain,  however,  that  in  the  majority 
of  eases  it  is  abused  and  that  a  more  moderate 
indulgence  would  be  followed  by  slightly  im- 
proved physical  conditions ;  also  the  pleasure 
obtained  from  it  is  greater  when  its  use  is  re- 
stricted to  the  hours  of  leisure  and  those  im- 
mediately after  eating.  It  is  pretty  clearly 
established  that  smoking,  etc.,  should  be  dis- 
couraged among  those  who  have  not  yet  ac- 
quired their  growth  and  strength,  as  they 
are  undoubtedly  affected  unfavourably  by  it. 
Whether  there  are  any  marked  pathological 
effects  beyond  these  already  mentioned  must 
be  doubted,  as  among  the  Oriental  races,  where 
it  is  used  from  early  childhood,  there  are  no 
distinctive  widespread  diseases.  Atrophy  of 
the  optic  nerve  or  retina  has  been  often  at- 
tributed to  its  abuse,  but  it  seems  clear  that 
by  itself  it  is  without  effect  in  that  direction, 
but  when  there  is  a  confirmed  over-indulgence 
in  alcohol  and  tobacco  these  conditions  are  fre- 
quently observed.  As  a  rule,  in  these  cases  the 
abandonment  of  the  habit  is  followed  by  the 
cessation  of  the  atrophy. 

As  to  what  is  the  least  objectionable  method 
in  which  tobacco  may  be  employed  there  will 
always  be  more  or  less  discussion,  and  each  user 
must  settle  the  point  for  himself.  Cigarette- 
smoking  has  been  accused  of  being  at  the  bot- 
tom of  many  evils,  but  beyond  an  irritation  of 
the  mucous  membranes  of  the  air-passages, 
which  is  due  to  the  smoke  furnished  by  the 


paper  with  which  cigarettes  are  made,  it  is 
doubtful  if  there  is  anything  special  to  be 
urged  against  their  use  except  that  they  are 
rather  more  apt  to  induce  over-indulgence  on 
account  of  their  availability  when  there  would 
not  be  time  to  smoke  a  cigar. 

It  is  a  widely  spread  belief  that  cancer  in  the 
mouth  and  throat  may  be  directly  due  to  smok- 
ing, but  the  evidence  in  favour  of  such  a  theory 
is  very  slight,  although  there  is  abundant  evi- 
dence that  the  mechanical  irritation  of  a  pipe 
or  cigar  may  establish  a  focus  for  the  disease 
in  the  same  manner  as  a  broken  tooth  may. 
Chewing  tobacco  can  hardly  be  defended,  as  it 
is  a  filthy  habit,  causes  a  considerable  waste  of 
the  saliva,  which  is  probably  the  cause  of  the 
pyrosis  so  often  observed  in  chewers,  and  un- 
doubtedly increases  the  liability  to  denial  ca- 
ries. "Dipping"  is  rarely  practised  by  any 
except  the  lowest,  and  is  followed  by  irrita- 
tion of  the  gums  and  destruction  of  the  teeth. 

[Dr.  L.  Jankau,  in  an  article  summarized  in 
the  Medical  Record  for  February  8,  1896,  dis- 
cusses the  indications  and  eontra-indications  for 
the  use  of  tobacco  by  the  sick  and  the  convales- 
cent. I'he  employment  of  tobacco,  he  says,  is 
to  be  forbidden  in  all  surgical  operations  and 
in  long  convalescence  after  operations,  except 
those  practised  upon  the  eyes,  the  abdomen, 
and  the  bladder.  He  would  proscribe  tobacco 
also  in  affections  of  the  throat  and  pharynx, 
and,  with  certain  restrictions,  in  nasopharyn- 
geal catarrh.  As  regards  internal  maladies,  he 
says  one  should  never  forget  the  toxic  action 
of  tobacco,  and  in  acute  and  serious  diseases  it 
should  never  be  allowed.  Tobacco,  he  says, 
should  be  absolutely  forbidden  in  peritonitis, 
typhlitis,  and  perityphlitis.  Affections  of  the 
stomach  do  not  form  an  absolute  contra-indi- 
oation.  Subjects  affected  with  organic  disease 
of  the  heart  do  not  ordinarily  support  tobacco 
well ;  at  the  same  time,  habitual  smokers  can 
use  two  or  three  light  cigars  a  day.  As  to  pul- 
monary affections,  the  author  allows  his  anti- 
septic views  to  have  a  good  deal  of  weight  in 
guiding  his  judgment.  On  the  score  of  the 
proved  fact  that  tobacco  smoke  has  an  un- 
doubted influence  in  suppressing  the  develop- 
ment of  bacilli,  he  rather  advises  smoking  for 
persons  who  are  in  the  initial  stage  of  tubercu- 
losis. His  reasons  are  the  disinfecting  action 
of  tobacco  upon  the  mouth,  the  depression  ex- 
erted by  tobacco  upon  the  genital  functions, 
and  the  favourable  sedative  influence  of  this 
drug  upon  the  central  nervous  system.  Be- 
sides that,  he  thinks  that  it  tends  to  take  away 
the  attention  of  patients  from  themselves  and 
make  life  seem  more  agreeable  to  them.  Even 
slight  hsemoptyses  are  not  absolute  eontra-indi- 
cations for  the  use  of  tobacco.  In  syphilitics 
he  thinks  that  one  should  try  to  avoid  only 
the  abuse  of  tobacco,  both  as  to  quantity  and 
quality.  In  nervous  affections  he  would  sim- 
ply recommend  that  the  amount  of  smoking  be 
very  carefully  controlled,  the  number  of  cigars 
and  their  strength  being  rigorously  prescribed. 
In  cardiac  neuroses  particularly  the  greatest 
circumspection  is  to  be  employed.  In  gastric 
neuroses  tobacco  should  be  cut  off  entirely. 
Persons  who  are  subject  to  organic  affections 


TOBACCO 


306 


of  the  nervous  system  can  smoke  with  cau- 
tion. 

Some  years  ago  Dr.  J.  C.  Mulhall,  of  St. 
Louis,  published  in  the  St.  Louis  Courier  of 
Medicine  an  account  of  the  pleasures  and  the 
penalties  of  cigarette-smoking.  More  recently, 
in  a  paper  read  before  the  American  Laryngo- 
logical  Association  and  published  in  the  New 
York  Medical  Journal  for  November  30,  1895, 
he  returned  to  the  subject  as  one  speaking  with 
a  certain  amount  of  authority,  inasmuch  as  he 
had  smoked  cigarettes  for  twenty-five  years. 
There  is  a  reason  why  each  one  pursues  a  par- 
ticular plan  of  using  tobacco,  says  Dr.  Mul- 
hall. Early  associations  have  much  to  do  with 
the  selection  of  the  plan  ;  but,  apart  from  this, 
each  method  has  its  own  particular  pleasure. 
The  man  who  both  chews  and  smokes  derives 
a  different  kind  of  satisfaction  from  each  meth- 
od, and  he  would  derive  a  still  different  kind 
did  he  take  snuff.  Cigarette-smokers  may  be 
divided  into  those  who  inhale  the  smoke  and 
those  who  do  not.  The  latter  class  is  a  very 
small  one  and  the  pleasure  is  the  same,  in  a 
milder  degree,  as  that  of  the  cigar-smoker  and 
the  pipe-smoker,  who  make  a  smoke  chamber 
of  the  mouth.  But  all  real  devotees  of  the 
cigarette  inhale.  That  is,  with  a  quick  inspir- 
atory act  the  smoke  is  drawn  through  the 
larynx  into  the  trachea  and,  so  far  as  he  has 
been  able  by  different  experiments  to  learn, 
into  the  first  division  of  the  bronchial  tubes ; 
not,  as  the  public  believes,  into  the  lungs  prop- 
er. Inhalation  explains  the  pleasure  of  ciga- 
rette-smoking. If  the  cigarette-smoker  did  not 
feel  the  smoke  in  his  larynx  and  windpipe,  his 
pleasure  would  be  gone.  If  an  habitual  in- 
haler of  cigarette-smoke  perchance  smokes  a 
brand  of  cigarette  very  much  milder  than  that 
to  which  he  has  been  accustomed,  he  will  at 
once  reject  it,  simply  for  the  reason  that  his 
larynx  and  trachea  have  been  accustomed  to  a 
certain  degree  of  irritation ;  they  have,  so  to 
speak,  acquired  a  habit  which  rejects  any  un- 
usual departure.  For  the  same  reason  the  in- 
haler rejects  a  brand  of  cigarettes  much 
stronger  than  that  to  which  he  is  accustomed, 
and  he  will  not  inhale  the  smoke  of  a  cigar — 
vastly  more  irritating  than  that  of  any  ciga- 
rette. The  inhaler  may  change  his  cigarette 
for  one  more  pleasing  to  his  sense  of  flavour, 
provided  always,  however,  that  it  produces  his 
accustomed  degree  of  laryngeal  and  tracheal 
irritation. 

The  pleasure  in  cigarette-smoking,  therefore, 
as  compared  with  other  tobacco  habits,  says 
Dr.  Mulhall,  may  be  said  to  be  a  pleasurable 
irritation  of  the  laryngeal  and  tracheal  sensory 
branches  of  the  pneumogastric  nerve.  He  goes 
on  to  say  that  a  person  absorbs  nicotine  in  ac- 
cordance with  the  amount  of  absorbent  surface 
in  contact  with  the  column  of  smoke.  In  or- 
dinary smoking  the  mouth  alone  is  the  smoke- 
chamber  ;  but  when  one  inhales,  one  must  add 
to  the  mouth  the  mucous  membrane  of  the 
larynx,  windpipe,  and  larger  bronchi.  There 
is,  hence,  roughly  speaking,  three  times  as 
much  surface  for  the  absorption  of  nicotine ; 
and  consequently,  though  a  cigar  contains 
vastly  more  nicotine,  three  fourths  of  it  is 


wasted,  so  far  as  the  question  of  nicotine  in- 
toxication is  concerned,  as  compared  with  the 
cigarette.  Moreover,  the  cigarette-smoker  con- 
sumes two  or  three  while  the  cigar-smoker  con- 
sumes one.  The  puny  cigarette  is,  therefore, 
not  so  weak  as  it  appears,  and  with  this  ex- 
planation begins  to  appear  worthy  of  the  news- 
paper term  "  deadly."  Again,  the  cigar-smoker, 
as  compared  with  the  cigarette-smoker,  is  an 
infrequent  consumer.  We  know  that,  with 
most  drugs,  if  we  divide  an  ordinary  dose  into 
ten  equal  parts  and  give  one  part  every  ten 
minutes  until  the  ten  parts  are  taken,  a  more 
powerful  effect  is  produced  than  if  the  whole 
were  given  at  one  dose.  So  it  is  with  ciga- 
rettes. The  dose  of  nicotine  is  smaller,  but  the 
doses  are  much  more  frequently  repeated.  Dr. 
Mulhall  says  that  he  himself  can  smoke  one 
large,  strong  cigar  in  the  ordinary  manner 
without  evidence  of  nicotine  intoxication,  but 
he  can  not  smoke  three  cigarettes  in  succession 
and  inhale  the  smoke  without  nausea  or  ver- 
tigo or  a  rapid  pulse. 

Dr.  Mulhall  says  that  the  evil  effects  of  ciga- 
rette-smoking may  be  divided  into  the  local 
and  constitutional.  As  compared  with  other 
tobacco  habits,  if  the  cigarette  were  composed 
of  other  ingredients  than  tobacco  and  paper, 
we  should,  as  clinicians,  be  prepared  to  look  for 
different  signs  and  symptoms.  So  far  as  the 
constitutional  effects  are  concerned,  he  states, 
as  one  who  has  carefully  watched  this  question 
for  fifteen  years,  that  they  are  absolutely  the 
same  as  those  of  tobacco  used  in  any  other 
form.  The  evil  symptoms  are  always  those  of 
nicotine  poisoning — not  those  of  any  other 
drug.  The  only  chemist  of  high  standing  who, 
to  his  knowledge,  has  analyzed  cigarettes  is 
Dr.  Ledaux,  who  presented  to  a  section  of  the 
New  York  Academy  of  Medicine  a  report  of 
the  analysis  of  several  popular  brands  of  ciga- 
rettes. He  found  absolutely  no  evidence  of 
any  other  drug  but  nicotine  in  the  tobacco, 
and  in  the  paper  a  harmless  quantity  of  cellu- 
lose. 

The  attempt  has  been  made,  says  Dr.  Mul- 
hall, to  crush  the  cigarette  evil  by  asserting 
that  opium,  cannabis  indioa,  and  other  narcot- 
ics are  present  in  cigarettes.  Vice,  he  declares, 
can  not  be  cured  by  misrepresentation.  The 
only  narcotic  present  is  nicotine,  and  this  is  an 
evil  or  not  according  to  a  great  many  different 
circumstances.  The  chief  condition  in  which 
it  is  always  productive  of  great  harm  is  youth. 
Dr.  Mulhall  says  he  has  never  seen  a  child 
(meaning  one  that  had  not  reached  puberty) 
who  used  tobacco  habitually  whose  health  was 
not  in  some  manner  badly  impaired.  In  ado- 
lescence— and  practically  this  may  be  said  to 
be  from  puberty  to  the  age  of  eighteen  in  fe- 
males and  to  that  of  twenty-one  in  males — t  he 
evil  is  not  so  great,  he  thinks,  but  is  still  a 
great  one,  for,  though  the  nervous  crisis  of  pu- 
berty has  been  passed,  the  nervous  system  is 
still  rapidly  developing.  The  nerves  are  more 
resistant  than  in  childhood,  but,  on  the  other 
hand,  greater  demands  are  correspondingly 
made  upon  them,  either  by  the  higher  phases 
of  education  in  one  class  or  by  the  actual  daily 
struggle  for  existence  in  the  other.   At  seversu 


307 


TOBACCO 


of  our  great  universities,  says  Dr.  Mulhall,  it 
has  been  found  by  exact  and  scientific  investi- 
gation that  tiie  percentage  of  winners  in  intel- 
lectual and  athletic  contests  is  considerably 
higher  in  the  total  abstainers  from  tobacco. 
If  it  is  admitted,  he  continues,  that  the  use  of 
tobacco  is  a  great  evil  in  the  young,  it  follows 
as  a  self-evident  proposition  that  any  method 
which  encourages  its  use  must  be  more  repre- 
hensible than  a  method  which  discourages  it, 
and  the  cigarette  above  all  other  methods  pre- 
sents this  encouragement  to  the  use  of  tobacco. 
In  its  mildness  is  concealed  its  very  capacity 
for  doing  harm,  for  the  reason  that  it  teaches 
the  use  of  tobacco.  The  boy  at  first  uses  only 
the  mouth  as  a  smoke-chamber,  and  as  a  ciga- 
rette is  so  mild  he  absorbs  but  a  minute  quan- 
tity of  nicotine,  insufficient  to  produce  nausea. 
He  gradually  becomes  able  to  consume  more 
cigarettes,  and  quickly  acquires  nicotine  toler- 
ance. He  is  not  allowed  to  pursue  this  method 
long.  Invariably  some  other  boy  teaches  him 
to  inhale.  At  first  it  causes  violent  cough  and 
many  would  never  repeat  the  attempt,  but  the 
taunts  of  the  other  boy  are  heard,  and  with  the 
bravado  of  boyhood  he  perseveres.  The  larynx 
and  windpipe  soon  tolerate  the  smoke,  then  de- 
mand it,  and  the  boy  is  a  full-fledged  cigarette 
fiend. 

The  mildness  of  the  cigarette  explains  also 
its  fast-spreading  use  among  young  women,  es- 
pecially the  leisure-class  young  ladies.  As  a 
rule  they  do  not  inhale,  for  at  the  first  attempt 
the  violent  cough  ensuing  quenches  ambition 
in  this  direction,  and.  unlike  the  boy,  the  girl 
is  seldom  encouraged  to  persevere.  The  fear 
of  a  tobacco-tainted  breath  also  curbs  her  ha*)it. 
In  young  ladies  who  smoke  cigarettes  very  mod- 
erately and  who  do  not  inhale.  Dr.  Mulhall  has 
never  seen  evidences  of  nicotine  poisoning. 
The  immoderate  use  of  cigarettes,  even  without 
inhalation,  may,  of  course,  he  suggests,  afford 
sufficient  nicotine  to  disturb  the  health. 

The  great  evil  of  tobacco,  says  Dr.  Mulhall, 
is  its  constitutional  effect  on  the  nervous  sys- 
tem. The  much  lesser  evil  is  local — namely, 
on  the  upper  respiratory  organs.  His  experi- 
ence is,  like  that  of  the  late  Sir  Morell  Mac- 
kenzie, that,  provided  there  is  no  other  factor, 
the  use  of  tobacco  provokes  little  or  no  dis- 
turbance of  these  organs.  That  it  may  aggra- 
vate a  throat  or  nose  trouble  occasioned  by 
other  causes  he  admits,  and  that  by  its  consti- 
tutional depressing  effect  it  may  aggravate 
such  trouble ;  but,  excluding  all  other  causes 
and  loo'king  at  tobacco  purely  in  respect  to  its 
local  effect,  he  denies  that,  as  ordinarily  used, 
it  never  causes  throat  disea.se  worthy  of  the 
name.  There  are  a  few  exceptions,  he  adds, 
as  there  are  to  all  laws  in  medicine.  There 
are  idiosyncrasies  in  regard  to  the  use  of  tobac- 
co, with  reference  to  both  the  throat  and  the 
nervous  system,  but  they  are  rare  ;  tobacco,  in 
its  ordinary  use,  at  most  produces  a  slight 
hypersemia  or  insignificant  catarrh  in  the 
healthy  throat.  As  used  in  cigarettes — that  is, 
by  inhalation — the  smoke  comes  in  contact 
with  the  laryngeal,  tracheal,  and  bronchial 
mucous  membrane,  and  here  produces  in  many 
persons  the  same  trivial  hyperemia  and  secre- 


tion. This  latter  is  pearly  and  is  ejected  with 
a  single  gentle  cough.  He  has  occasionally 
heard  whistling  rales  in  the  bronchi  of  persons 
who  inhale  very  deep  and  were  immoderate 
smokers.  Hypersemia,  not  infiammation,  acute 
or  chronic,  he  says,  is  the  sole  disturbance. 
The  etfects  in  the  larynx  of  the  ordinary 
healthy  man  seem  almost  nil.  Mario,  the 
great  tenor,  inhaled  cigarette  smoke  between 
the  acts,  and  Dr.  Mulhall  says  that  he  himself 
experiences  no  vocal  difficulty  in  delivering 
lectures.  A  murderer  who  was  confined  in 
the  St.  Louis  jail  for  two  years  inhaled  an 
average  of  forty  cigarettes  a  day.  After  his 
execution  Dr.  Mulhall  examined  his  larynx 
and  trachea,  but  could  discover  no  evidence  of 
morbid  change  other  than  a  fracture  of  the 
hyoid  bone  caused  by  the  hangman's  rope. 

It  is  because  of  the  great  value  of  Dr.  Mul- 
hall's  communication,  owing  in  no  small  de- 
gree to  the  fact  of  his  being  at  the  same  time 
an  experienced  laryngologist  and  a  confirmed 
cigarette-smoker,  that  it  is  here  drawn  upon  at 
such  length.  The  remark  should  be  made, 
however,  that  not  alL  habitual  smokers  of 
cigarettes  inhale  the  smoke.  In  the  discussion 
that  followed  the  reading  of  Dr.  Mulhall's 
paper.  Dr.  S.  W.  Langmaid,  of  Boston,  said 
that,  from  a  large  experience  in  the  treatment 
of  prominent  singers,  he  had  found  that  smok- 
ing exercised  a  potent  influence  on  the  voice. 
In  his  own  ease  he  had  learned  that,  in  order 
to  be  in  good  voice,  he  must  not  smoke  during 
the  day  if  he  was  to  sing  that  evening.  Be- 
cause one  prominent  singer  could  smoke  and 
sing,  this  was  no  argument  that  others  could 
do  so.  The  best  singers  of  to-day  underwent 
a  great  deal  of  fatigue.  He  had  in  mind  one 
singer  with  a  magnificent  voice  in  whom  he 
felt  sure  he  could  detect  the  effect  of  cigarette- 
smoking.  He  had  known  another  singer,  an 
inveterate  smoker,  who  had  found  it  necessary 
to  abstain  as  long  as  three  weeks  at  a  time 
from  smoking,  in  order  that  he  might  be  at 
his  best  for  some  great  effort  in  singing.  He 
would  say  that  the  bad  effect  on  the  pharyn- 
geal mucous  membrane  was  much  less  from 
cigarette-smoking  than  from  pipe-smoking,  for 
the  reason  that  the  smoke  was  not  so  hot. 
What  he  objected  to  in.  cigarette-smoking  was 
its  destructive  effect  upon  consecutive  thought. 
The  cigar-smoker  did  not  want  to  be  narco- 
tized ;  the  cigarette-smoker  did  want  this.  Dr. 
W.  K.  Simpson,  of  New  York,  related  his  per- 
sonal experience  with  regard  to  smoking  and 
its  effect  upon  the  singing  voice.  At  one  time 
he  had  given  up  smoking  absolutely  for  eight 
years,  and  passed  through  what  seemed  to  be 
similar  to  the  experience  of  the  opium-smoker 
in  his  attempt  to  give  up  his  habit.  During 
this  period  when  he  was  not  smoking,  his 
throat  had  been  free  from  any  discharge  or 
uncomfortable  sensation,  and  he  had  been  able 
to  use  his  voice  with  remarkable  ease.  After 
he  had  resumed  smoking  he  had  found  it 
much  more  difficult  to  keep  the  singing  voice 
in  good  order.  A  barytone  did  not  suffer  so 
much  as  a  tenor  from  smoking.  He  felt  that 
he  could  detect  a  smoker  by  the  appeai'ance  of 
the  throat.    Dr.  James  E.  Newcomb,  of  New 


TODD  ALIA 
TONICS 


308 


York,  alluded  to  the  occasional  good  effect  of 
tobacco  in  eases  of  pharyngeal  mycosis  and 
mentioned  the  case  of  a  patient  of  his  whose 
decided  improvement,  after  but  little  benefit 
from  cauterization,  he  imputed  to  her  having 
taken  up  the  practice  of  smoking  cigarettes, 
but  without  inhaling  the  smoke.  Dr.  Lang- 
maid  said  that  he  had  once  tried  the  use  of 
a  solution  of  nicotine  in  a  case  of  this  kind, 
and  with  a  most  disastrous  result.  The  appli- 
cation had  been  followed  by  immediate  and 
severe  syncope.  He  wished  to  warn  against 
this  treatment,  although  it  had  been  recom- 
mended. Dr.  II.  L.  Swain,  of  New  Haven, 
said  that  an  interesting  fact  brought  out  by 
certain  measurements  taken  in  the  colleges 
relative  to  the  physical  development  of  the 
students  had  been  that  among  tobacco-smok- 
ers, as  a  class,  there  was  a  smaller  chest  expan- 
sion than  among  other  students.  Dr.  J.  H. 
Lowman,  of  Cleveland,  said  that  possibly  the 
irritation  observed  by  Dr.  Langmaid  in  singers 
might  have  been  due  to  many  of  the  slight 
causes  well  known  to  affect  the  throats  of 
singers.  Some  well-known  singers  could  not 
expose  themselves  to  the  air  while  riding — 
was  this  an  argument,  therefore,  in  favour  of 
giving  up  open-air  exercise?  Dr.  Mulhall  ad- 
mitted the  trutli  of  Dr.  Langmaid's  observa- 
tion as  to  the  local  effect  of  tobacco  on  the 
singer's  throat.  The  tenors  and  sopranos,  as 
compared  with  other  singers,  must  have  very 
perfect  throats  and  perfect  laryngeal  muscular 
control,  and  hence  not  only  the  local  effect  but 
the  indirect  effect  on  the  nervous  system  was 
of  iraport.ance  in  such  individuals.  Ordinarily, 
smoking  produced  only  a  very  transient  hyper- 
semia.  He  had  not  been  so  successful  as  Dr. 
Langmaid  in  detecting  a  smoker  by  the  ap- 
pearance of  the  throat.  He  had  never  seen 
pharyngeal  mycosis  in  smokers'  throats,  and  to 
this  extent  could  confirm  the  statements  gen- 
erally made  on  this  subject  by  writers.  A 
friend  of  his,  however,  had  told  him  that  he 
had  a  smoker  for  a  patient  who  was  affected 
with  this  disease.  He  could  not  understand 
how  tobacco  smoke  could  reach  sufficiently 
deep  to  affect  the  seat  of  this  affection.  He 
believed  he  had  been  the  first  to  call  attention 
to  the  fact  that  pharyngeal  mycosis  was  a  dis- 
ease which  would  sometimes  disappear  sponta- 
neously and  reappear. 

The  subject  of  smokers'  vertigo  was  under 
discussion  in  1895  before  the  French  Congress 
of  Learned  Societies  {Progres  medical,  May  4, 
1895;  Mew  York  Medical  Journal,  June  8, 
1895). 

M.  Kohos  said  that  vertigo  caused  by  nic- 
otine was  of  very  frequent  occurrence,  and 
that  it  manifested  itself  sometimes  under  the 
form  of  a  slight  acute  poisoning  accompanied 
with  pallor,  salivation,  cold  sweats,  headache, 
vertigo,  staggering,  etc.,  which  symptoms  were 
produced  in  those  who  smoked  for  the  first 
time ;  sometimes  the  poisoning  was  more  seri- 
ous, as,  for  instance,  in  the  case  of  a  man  who 
had  smoked  twenty-five  pipes  in  quick  succes- 
sion on  a  wager,  who  suffered  for  many  months 
with  vertigo.  The  vertigo  of  chronic  intoxica- 
tion from  tobacco,  he  says,  might  be  observed 


in  the  workmen  and  workwomen  in  tobacco 
factories,  as  well  as  in  smokers,  in  snuff-takers, 
and  in  those  who  chewed  tobacco.  The  action 
of  nicotine  varied  according  to  the  amount  ab- 
sorbed, and  the  disturbances  caused  in  the  life 
of  the  cells  in  consequence  of  their  contact  with 
the  poison  might  also  be  variable.  M.  Le  Roy 
de  Mericourt  remarked  that  he  had  never  ob- 
served smokers'  vertigo  in  Brittany  or  in  cer- 
tain other  countries  in  which  he  had  lived  for 
a  long  time,  but  he  had  observed  a  tendency 
to  syncope  dependent  upon  disturbances  of  the 
circulation  following  intoxication  with  the  or- 
dinary tobacco.] — Russell  H.  Nevins. 

TODBALIA. —  Toddalia  aeuleata,  a  ruta- 
ceous  plant  indigenous  to  southern  Asia,  has 
been  employed  as  a  tonic  in  general  dehility, 
chronic  diarrhcea,  and  convalescence  from  fe- 
vers. A  tincture  of  the  bark,  particularly  the 
root-bark,  known  as  "  Lopez  root,"  made  with 
1  part  of  the  bark  to  5  parts  of  alcohol,  may  be 
given  in  daily  amounts  of  from  90  to  300  grains. 

TOKAY. — This  expensive  Hungarian  wine 
is  credited  with  being  particularly  efficacious 
as  a  tonic  in  cases  of  the  debility  of  convales- 
cence, the  depression  of  influenza,  neurasthe- 
nia, etc.  An  excellent  wine,  having  nearly  the 
same  delicate  aroma  and  taste,  and  doubtless 
possessing  identical  medicinal  properties,  is 
produced  in  California,  and  costs  much  less 
than  the  imported  tokay.     (See  Wines.) 

TOLXJ  BALSAM,  halsamum  tolutanum 
(U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.),  or  balsam  of 
Tolu,  is  a  balsam  obtained  from  Toluifera 
Balsamum.  (U.  S.  Ph.)  or  from  the  exudation 
which  follows  incision  of  the  trunk  of  Myrox- 
ylon  Toluifera  (Br.  Ph.).  It  is  obtained  by 
making  V-shaped  cuts  in  the  trunk  of  the 
tree,  the  incisions  perforating  the  bark.  The 
exudation  is  caught  in  cups  which  are  after- 
ward emptied  into  flasks  of  rawhide,  and  is 
transported  in  earthen  jars  or  tin  or  glass 
vessels.  As  received  in  the  market,  balsam  of 
Tolu  is  soft  and  tenacious.  With  age  it  be- 
comes brittle  and  hard  like  resin.  It  is  shining 
and  translucent,  and  has  a  yellowish-brown  or 
reddish-brown  colour.  Its  odour  is  very  fra- 
grant and  it  has  a  pungent,  sweetish,  but  not 
disagreeable  taste.  It  melts  when  heated,  bums 
with  a  flame,  and,  while  being  consumed,  emits 
an  agreeable  odour.  The  volatile  oils  dissolve 
it  readily.  The  U.  S.  Ph.  gives  several  tests 
for  the  purity  of  the  drug ;  it  must  be  readily 
and  completely  soluble  in  alcohol,  the  solution 
being  acid  to  blue  litmus  paper;  it  must  be 
almost  completely  soluble  in  cliloroform  and  in 
solutions  of  the  fixed  alkalies ;  it  must  be  almost 
completely  soluble  in  ether,  but  nearly  insolu- 
ble in  water,  benzin,  or  carbon  disulphide. 
Carbon  disulphide,  aided  by  a  gentle  heat,  re- 
moves from  the  balsam  scarcely  anything  but 
its  cinnamic  and  benzoic  acids.  On  decanting 
and  evaporating  the  disulphide,  no  substance 
having  the  properties  of  a  resin  should  re- 
main. The  balsam  is  a  combination  of  volatile 
oil,  free  acid,  and  resin.  This  oil  is  principally 
tolene,  CioHu,  the  free  acids  being  benzoic  and 
cinnamic  acids. 

The  medicinal  properties  of  Tolu  balsam  are 


309 


TODDALIA 
TONICS 


very  similar  to  those  of  balsam  of  Peru.  Its 
taste,  however,  is  more  agreeable,  and  it  is 
therefore  much  employed  in  cough  mixtures, 
especially  as  a  vehicle.  It  has  long  been 
known  for  its  efficacy  in  chronic  bronchitis. 
In  chronic  mucous  fluxes  of  the  bronchi  and 
urinary  organs  it  has  been  widely  employed, 
and  has  been  used  with  reputed  good  results 
in  various  forms  of  chronic  diarrhoea  and  in 
chronic  dysentery.  Old  catarrhs  of  the  bron- 
chial apparatus  are  said  to  have  yielded  to 
inhalations  or  sprays  of  an  ethereal  solution  of 
Tolu  balsam.  Some  forms  of  skin  disease  in 
which  Peruvian  balsam  has  been  used  are  said 
to  have  been  equally  benefited  by  Tolu  balsam. 
It  has  been  applied  to  suppurating  or  inflamed 
areas,  mixed  with  equal  parts  of  castor  oil, 
with  alleged  success. 

In  doses  of  from  10  to  30  grains,  frequently 
repeated,  it  has  been  principally  employed  in 
the  bronchial  disorders  above  mentioned.  It 
forms  an  element  of  many  cough  mixtures,  its 
principal  use,  as  a  vehicle,  being  in  favour  not 
only  because  of  its  direct  beneficial  influence, 
but  also  on  account  of  its  agreeable  taste.  It 
may  be  given  in  the  form  of  emulsion  made  by 
rubbing  up  the  balsam  with  mucilage  and  sugar 
and  afterward  with  water. 

Syrup  of  Tolu,  syrupus  toJutanus  (U.  S.  Ph., 
Br.  Ph),  contains  3  fl.  oz.  of  tincture  of  Tolu, 
130  grains  of  carbonate  of  magnesium,  26  oz. 
of  refined  sugar,  in  coarse  powder,  and  a  pint  of 
water  (U.  S.  Ph.).  The  British  syrup  contains 
li  oz.  of  balsam  of  Tolu,  3  lbs.  of  refined  sugar, 
and  a  pint  of  distilled  water.  The  syrup  of 
Tolu  is  a  very  feeble  preparation  and  has  but 
little  of  the  therapeutic  virtues  of  the  balsam. 
It  is  used  principally  as  a  flavouring  element 
for  mixtures.  A  stronger  syrup  may  be  made 
by  adding  a  desired  amount  of  the  tincture  of 
Tolu.     The  dose  is  \  fl.  oz. 

Tincture  of  Tolu,  tinciura  tolutana  (IT.  S. 
Ph.,  Br.  Ph.),  is  made  of  the  balsam  of  Tolu  and 
alcohol  in  the  proportion  of  1  to  10.  It  possesses 
the  therapeutic  properties  of  the  balsam  and 
may  be  used  in  place  of  the  latter  whenever  it 
is  indicated.  It  is  frequently  employed  in 
chronic  bronchitis.  The  dose  is  from  1  to  3  fl. 
drachms.  It  may  be  used  as  a  flavouring 
medium.  The  tincture  becomes  decomposed 
on  the  addition  of  water. 

Samuel  M.  Briokner. 

TOLUENE,  TOLTJIDINE,  TOLXJOL,  or 

methylbenzene,  O7H8,  is  a  colourless  liquid  hav- 
ing the  odour  of  benzene.  It  is  obtained  by 
the  fractional  distillation  of  the  purified  light 
oils  of  coal  tar.  Besides  its  use  in  thermom- 
eter tubes  in  place  of  mercury,  over  which  it 
is  said  to  have  some  advantages  for  certain 
ranges  of  temperature,  it  has  been  employed  in 
medicine.  Professor  LOf&er.  of  Greifswald 
(cited  in  the  Ephemeris  of  Materia  Medica, 
etc.,  for  January,  1896),  has  found  that  it  kills 
the  micro-organism  of  diphtheria,  and  he  has 
treated  that  disease  by  topical  applications  of 
the  following  mixture  {American  Journal  of 
Pharmacy,  March,  1895),  in  which  the  menthol 
serves  to  deaden  the  pain  that  would  otherwise 
be  caused  : 


5  Menthol 10  grammes ; 

Toluol,  enough  to  make  36  c.  cm. ; 

Alcohol 60  c.  cm. ; 

Solution   of  ferric  chlo- 
ride (of  a  strength  not 

stated) 4  c.  cm. 

M. 

In  a  series  of  seventy-one  cases,  all  the  patients 
were  saved ;  in  another  of  twenty-six  cases, 
treated  after  the  second  day  of  the  disease, 
only  one  patient  was  lost. 

•TOLYLANTIPYRINE.  —  See       Toly- 

PYRINE. 

TOLYLHYPNAL.  —  Antipyrine  hydro- 
chloride (see  Antipyrine). 

TOLYPYRINE.— This  is  the  tolyl  analogue 

of  antipyrine,  CeH.CH3N<^^0^^ppjj^  (.^jj^q^_ 

tolyl  being  substituted  for  phenyl.  It  has  the 
same  medicinal  properties  as  antipyrine,  and  is 
used  in  the  same  doses.  It  has  the  advantage  of 
being  cheaper  than  antipyrine.    The  salicylate, 

or     tolysal,    CeH.CHsNX^^^^pp^^  ^.^jj^q^^ 

which  is  almost  insoluble  in  water,  but  readily 
soluble  in  alcohol,  has  been  used  to  some  ex- 
tent as  an  antipyretic  and  analgetic,  particu- 
larly in  rheumatism  and  rheumatic  neuralgia, 
in  doses  of  from  15  to  30  grains. 

TOLYSAL. — Tolypyrine  salicylate  (see 
under  Tolypyrine.) 

TONGA  is  a  somewhat  uncertain  prepara- 
tion of  barks  found  in  the  Fiji  Islands  which 
has  been  employed  to  some  extent  in  the  treat- 
ment of  neuralgia,  but  the  evidence  in  favour 
of  its  remedial  properties  is  not  very  great. 
It  is  used  in  the  shape  of  an  unoflicial  fluid 
extract  of  which  the  dose  is  from  -J  to  1  fl. 
drachm. — Russell  H.  Nevins. 

TONG ALINE. — This  is  an  American  pro- 
prietary preparation  said  to  be  made  from 
tonga,  cimicifuga,  sodium  salicylate,  pilocar- 
pine salicylate,  and  colchicine  salicylate.  It 
has  been  used  in  rheumatism,  neuralgia,  influ- 
enza, gout,  and  nervous  headache. 

TONGUE  TRACTION.— See  under  An- 
esthetics (vol.  i,  p.  64.) 

TONICS  are  measures  which  are  employed 
for  the  purpose  of  restoring  permanent  energy 
or  tone  to  weakened,  impaired,  or  diseased 
organs  or  systems  of  organs  or  the  organism 
at  large.  One  may  compare  the  action  of  tonic 
drugs  in  their  gradual  production  of  vital  force 
or  tension  in  a  weakened  or  degenerated  system 
to  the  strings  of  a  musical  instrument  which 
do  not  give  forth  their  proper  notes  unless  put 
upon  the  proper  stretch  or  under  proper  ten- 
sion. An  impaired  system  acted  upon  by  ap- 
propriate tonics  will,  if  it  still  has  the  power 
of  reaction,  gradually  begin  to  respond  to  "its 
natural  and  appropriate  stimuli."  The  great 
difference  between  tonics  and  stimulants  lies 
in  the  fundamental  notion  that  the  latter  are 
called  upon  for  sudden  and  temporary  excita- 
tion of  organs  which  require  some  measure  to 
tide  them  over  a  crisis,  or  to  excite  to  action 
some  organ  which  is  lagging  behind  physi- 


TONQUINOL 

Toxmas 


310 


ologioal  necessity,  or  to  repel  the  invasion 
and  triumph  of  some  grave  systemic  enemy. 
Stimulants  are  essentially  ephemeral  in  their 
results  and  are  administered  only  until  physi- 
ological demands  are  met  and  the  innate  forces 
of  the  vital  functions  are  capable  of  proceed- 
ing alone.  Tonics,  on  the  other  hand,  are  given 
in  emergencies  of  another  nature.  Their  pur- 
pose is  to  combat  debility  which  does  not 
threaten  life,  necessarily,  but  which  interferes 
with  the  normal  action  or  reaction  of  a  system 
of  the  body  or  of  the  entire  organism. 

An  organ  may  be  perfectly  developed  and 
healthy,  but  the  vital  force  necessary  for  it  to 
fulfil  its  physiological  purpose  may  be  de- 
ficient. This  force,  on  the  contrary,  may  be 
unimpaired,  it  may  even  be  greater  than  is  re- 
quired, but  the  organ  on  which  it  is  expended 
may  be  lacking  in  healthful  tone  or  may  not 
have  reached  its  necessary  development.  In 
either  case,  the  physiological  function  intended 
is  incapable  of  being  carried  out.  Again,  there 
may  be  debility  due  to  weakness  of  muscular  de- 
velopment or  lack, of  muscular  strength,  or  the 
system's  impairment  may  make  itself  manifest 
in  the  nervous  system.  These,  in  turn,  may 
find  the  source  of  degeneration  in  an  enfeebled 
or  languid  circulation  or  in  a  depreciated  con- 
dition of  the  blood.  But  these  vascular  faults, 
unless  they  are  essential,  may  have  their  origin 
in  deficient  nutrition,  which  may  spring  from 
improper  assimilation,  a  lack  of  appetite,  or 
disturbed  or  imperfect  digestion  of  food.  The 
development  of  toxines  in  the  circulating 
fluids,  originating  from  an  insufficient  excre- 
tion of  the  waste  products  of  metabolism,  may, 
on  its  part,  be  responsible  for  the  existing  de- 
bility. Finally,  disease  of  any  kind,  functional 
or  organic,  and  the  strain  involved  in  the  com- 
plexity of  modern  life,  may  rob  the  system,  or 
a  part  of  it.  of  its  "  tone."  The  source,  it  will 
be  seen,  must  be  the  seat  of  attack;  and  in 
every  case  in  which  debility  is  a  feature,  the 
origin,  whether  in  disturbed  nutrition  or  im- 
poverished blood,  must  be  the  point  toward 
which  therapeutic  measures  must  be  directed. 

Aside  from  the  strict  therapeutic  indications 
which  point  to  the  use  of  tonics,  they  should 
find  no  place  in  the  armamentarium  of  the 
physician,  for  it  is  a  peculiar  fact  that  fre- 
quently, when  improperly  administered  or  ad- 
ministered to  healthy  persons,  they  are  apt  to 
produce  symptoms  of  a  disagreeable  nature. 
This  is  particularly  trueof  the  class  of  drugs 
known  as  vegetable  bitters,  which  are  gastric 
tonics,  and  another  strong  contra-indication 
to  their  employment  is  a  febrile  condition,  be- 
cause, in  this  state,  they  easily  upset  the 
stomach  and  have  a  tendency  to  increase  the 
number  of  the  heart's  beats  without  lowering 
the  blood-pressure. 

Broadly  speaking,  tonics  may  be  regarded  as 
general  and  specific,  depending  upon  the  effect 
they  have  upon  the  entire  organism  or  an  in- 
dividual organ,  although  the  fact  must  always 
be  kept  in  mind  that  many  of  the  general 
tonics  are  specific  in  their  action,  and  vice 
versa.  The  specific  tonics,  again,  may  be 
grouped  under  several  heads,  such  as  cardiac 
tonics,  vascular  tonics,  gastric  tonics,  and  nerv- 


ous tonics,  including  spinal  and  cerebral  ex- 
citants. Each  of  these  specific  tonics  may  be 
general  in  its  remote  influence  after  having 
executed  its  specific  efl:ect,  but  it  must  not  be 
forgotten  that  the  toning-up  process  is  a  slow 
and  gradual  one  and  that  immediate  results 
must  not  be  expected. 

Among  the  general  tonics,  those  which  act 
upon  the  nervous  system  play  an  important 
part.  The  heavier  wines,  arsenic,  alone  or  in 
combination  with  strychnine  and  quinine  or 
strychnine  and  iron,  the  various  malt  extracts, 
and  beer  and  porter  take  high  rank.  But  some 
of  these  act  upon  the  stomach,  the  blood,  and 
the  heart  also,  and  the  difiiculty  of  laying 
down  strict  lines  of  distinction  will  be  at  once 
apparent.  Iron,  although  in  a  sense  a  vascular 
tonic,  is  a  general  tonic  in  that  it  makes  good 
the  lack  of  energy  and  vital  force  in  anmmia. 
Qtiinine,  again,  though  a  specific  tonic  in 
chronic  malarial  poisotiing  and  malarial  par- 
oxysmal diseases,  becomes  general  in  its  influ- 
ence by  depriving  the  system  of  a  source  of 
intermittent  or  persistent  poisoning.  Strych- 
?iifie  and  the  preparations  of  the  hypophosphites 
and  of  the  phosphates  are,  under  proper  indi- 
cations, reliable  and  valuable  general  tonics. 

Under  cardiac  tonics  are  included  all  those 
substances  which  increase  the  force  of  the 
heart's  beats  and  regulate  its  rhythm.  They 
may  be  called  for  in  organic  or  in  functional 
disturbance  of  the  heart's  action.  The  main 
ones  are  digitalis  and  its  derivatives,  conval- 
laria  maialis,  strophanthus,  adonis  vernalis, 
caffeine,  sparteine,  and  nux  vomica  and  its 
alkaloid,  strychnine.  (Compare  Cabdiac  stimu- 
lants, TONICS,  and  depressants.) 

The  vascular  tonics  are,  principally,  strych- 
nine, digitalis,  and  iron,  which  act  by  raising 
the  blood-pressure  through  the  augmented 
contraction  of  the  capillaries  and  arterioles 
which  they  produce.  Their  influence  upon 
metabolic  processes  rests  upon  the  change  in 
the  quantity  of  lymph  poured  into  the  tissues 
secondarily  to  their  effect  upon  the  smaller 
blood-vessels.  Under  the  group  of  gastric 
tonics  must  be  embraced  those  medicines  which 
make  for  an  increase  of  appetite  and  whose  in- 
fluence is  to  assist  gastric  digestion.  Many  of 
these  depend  for  their  activity  upon  the  bitter 
element  which  they  contain,  although  it  does 
not  seem  to  be  essential.  Among  them  may 
be  mentioned  quinine,  quassia,  gentian, 
cinnamon,  and  many  other  aromatic  drugs. 
Strychnine  represents  the  class  of  spinal 
tonics,  whose  function  is  described  in  their 
title.  In  the  employment  of  tonics  it  is  es- 
sential to  bear  in  mind  the  interdependence  of 
the  various  organs  and  the  relations  between 
metabolism  and  excretion. 

Samuel  M.  Brickner. 

TONairiNOL.— This  is  a  variety  of  arti- 
ficial musk  made  in  Leipsio.  .  It  is"  about  a 
third  cheaper  than  Baur's  artificial  musk.  It 
is  not  pretended  that  it  has  any  of  the  medici- 
nal virtues  of  musk. 

TOBMENTILLA.— The  root-stock  of  the 
European  rosaceous  plant  Tormentilla  silves- 
tris  is  astringent  and  was  formerly  known  as 


311 


TONQUINOL 
TOXINES 


German  rhatany.  It  has  been  used  in  dysen- 
tery  and  dysenteric  diarrhcea.  The  dose  of  the 
powder  is  from  ^  to  1  drachm. 

TOUCHWOOD.— Agaricus  chirurgorum. 
(See  under  Agaric.) 

TOXALBUMINS.— See  Tosines. 
TOXICODENDRON.— ie^Ms    Toxicoden- 
dron (see  vol.  ii,  page  131). 

TOXINES.— The  first  experiments  in  the 
toxine  treatment  of  malignant  tumours  were 
made  in  1893  by  Spronck,  of  Utrecht,  and  pub- 
lished in  the  Annales  de  Ulnstitut  Pasteur, 
October,  1893.  My  experiments  were  begun 
in  December,  1893,  and  were  the  gradual  out- 
come of  investigations  commenced  in  May, 
1891,  as  to  the  nature  and  effect  of  repeated 
inoculations  of  the  living  streptococcus  of  ery- 
sipelas upon  malignant  tumours.  The  idea  of 
combining  the  Bacillus  prodigiosus  with  the 
streptococcus  was  suggested  to  me  by  the  ex- 
periments of  Roger,  which  proved  that  the  Ba- 
cillus prodigiosus  had  the  power  of  intensifying 
the  virulence  of  the  streptococcus  of  erysipelas. 
This  combination  had  never  before  been  used 
or  suggested  with  reference  to  malignant  tu- 
mours. The  effect  of  combining  the  toxines 
was  to  greatly  intensify  the  reaction,  and  a 
large  number  of  experiments  proved  that  the 
antagonistic  and  curative  action  of  the  erysip- 
elas was  likewise  increased  by  the  addition  of 
the  Bacillus  prodigiosus. 

During  the  past  four  years  I  have  treated 
upward  of  a  hundred  and  sixty  oases  of  malig- 
nant tumours  by  this  method.  Several  changes 
have  been  made  in  the  technics  of  the  prepara- 
tion, but  the  following  method  of  preparing 
the  toxines  has  thus  far  proved  the  most  satis- 
factory : 

Method  of  Preparation  of  the  Toxines. — To 
make  the  toxines  of  erysipelas  and  of  the  Ba- 
cillus prodigiosus,  ordinary  peptonized  bou- 
illon is  put  into  small  flasks,  containing  50  to 
100  c,  cm.,  which,  after  proper  sterilization,  are 
inoculated  with  the  streptococci  of  erysipelas 
and  allowed  to  grow  for  three  weeks  at  a  tem- 
perature of  from  86°  to  95°  F.  The  flasks  are 
then  inoculated  with  the  Bacillus  prodigiosus 
and  the  cultures  allowed  to  grow  for  ten  or 
twelve  days  more  at  room  temperature.  At 
the  end  of  that  time,  after  being  well  shaken 
up,  the  cultures  are  poured  into  sterilized  glass- 
stoppered  half-ounce  bottles,  and  heated  to  a 
temperature  of  from  128°  to  140°  F.  for  an 
hour,  so  as  to  render  them  perfectly  sterile. 
After  they  have  cooled,  a  little  powdered  thy- 
mol is  added  as  a  preservative,  and  the  toxines 
are  ready  for  use.  The  toxines  when  prepared 
in  this  way  are  very  much  stronger  than  when 
filtered  through  a  Pasteur,  Chamberland,  or 
Kitasato  filter,  the  active  principles  contained 
in  the  germs  themselves  being  preserved.  If, 
as  is  sometimes  the  case,  the  preparation  is 
found  to  be  too  strong  to  use  with  safety,  it 
can  be  diluted  with  glycerin  or  sterilized  water. 

The  best  method  of  making  the  bouillon  is 
to  soak  a  pound  of  chopped  lean  meat  over 
night  in  water.  In  the  morning  strain  it 
through  a  cloth,  make  up  to  1,000  c.  cm.,  and 
boil  for  an  hour.    Then  filter  through  a  cloth, 


add  peptone  and  salt,  neutralize,  and  boil  again 
for  an  hour.  The  bouillon  will  then  pass 
through  filter-paper  perfectly  clear,  and  be 
ready  to  put  into  the  flasks.  It  is  not,  how- 
ever, necessary  to  neutralize  the  bouillon,  as  the 
streptococci  will  grow  even  more  readily  in 
acid  bouillon,  and  the  resulting-  preparation  is, 
if  anything,  stronger  than  when  neutralized 
bouillon  is  used. 

Results. — Of  the  cases  treated,  ninety-four 
were  sarcoma,  thirty-eight  were  carcinoma, 
twenty-three  were  epithelioma,  and  ten  other 
tumours  were  undoubtedly  malignant,  but  their 
exact  nature  had  not  been  determined  by  mi- 
croscopic examination. 

Of  the  sarcomas,  fourteen  were  spindle- 
celled,  fifty-two  round-celled,  seven  melanotic, 
and  the  others  mixed-celled.  In  nearly  half 
these  cases  more  or  less  improvement  was 
shown.  In  many  of  them  the  improvement 
was  very  striking,  in  others  slight  and  tempo- 
rary in  character.  The  variety  that  showed 
the  greatest  improvement  was  the  spindle- 
celled,  and  that  which  showed  the  least  was  the 
melanotic.  The  round-celled  type  of  sarcoma 
was  also  but  little  affected  by  the  toxines. 

The  effect  of  the  mixed  toxines  upon  carci- 
noma was  far  less  striking  than  it  was  upon 
sarcoma.  In  a  certain  small  proportion  of 
cases,  especially  in  epithelioma,  there  was  very 
great  improvement,  which  in  three  cases  re- 
sulted in  the  entire  disappearance  of  the  tu- 
mour. In  one  of  these  cases,  one  of  epitheli- 
oma of  the  chin,  the  lower  jaw,  and  the  floor  of 
the  mouth,  the  patient  is  now  well,  two  years 
after  treatment.  In  the  second  case,  one  of 
recurrent  carcinoma  of  the  face  involving  the 
lower  eyelid,  the  patient  remained  well  for  a 
year,  when  it  recurred ;  it  was  placed  under 
further  treatment  with  improvement.  The 
third  case  was  a  twice  recurrent  carcinoma  of 
the  breast.  In  this  instance  the  treatment  was 
continued  for  a  year  and  a  quarter  before  the 
disease  was  got  under  control.  The  patient  is 
well  at  present,  a  year  and  a  halt  from  the  be- 
ginning of  treatment.  But  in  all  these  cases 
of  carcinoma  the  time  has  been  manifestly  too 
short  to  make  it  possible  to  regard  them  in  any 
sense  as  cured.  These  cases,  together  with 
others,  however,  in  which  a  marked  temporary 
improvement  occurred,  are  sufficient  to  en- 
courage us  in  conducting  further  experiments. 
The  chief  value  of  the  toxines  in  carcinoma 
will  probably  be  found  to  lie  in  their  use  as  a 
prophylactic  measure  against  recurrence  after 
primary  operations.  Their  value  in  this  re- 
spect, however,  can  only  be  determined  by  years 
of  experimenting. 

Sufficient  time  has  elapsed  to  prove  that  the 
toxines  are  really  curative  in  a  certain  propor- 
tion of  cases  of  "  inoperable  "  sarcoma.  Four 
patients  have  now  remained  well  from  two  and 
a  half  to  upward  of  four  years  after  treatment. 
All  these  cases  were  entirely  beyond  operation, 
and  the  diagnosis  was  confirmed  clinically  and 
microscopically  by  leading  surgeons  and  pa- 
thologists. The  case  in  which  the  patient  has 
remained  well  for  more  than  four  years  can  not 
properly  be  classed  as  a  cure  from"  the  toxines, 
as  it  was  treated  by  repeated  injections  of  the 


TOXINES 


313 


living  germ  and  actual  erysipelas  was  pro- 
duced. Nearly  every  case  of  spindle-celled 
sarcoma  treated  was  either  cured  or  showed 
very  great  improvement.  In  one  case  of  mixed- 
celled  sarcoma,  recurrent,  the  patient  was  well 
three  years  and  a  quarter  after  treatment.  Re- 
currence in  this  case  occurred  three  years  and  a 
half  afterwards ;  in  one  case  of  spindle-celled 
sarcoma,  three  years  after  treatment ;  in 
another,  two  years  and  nine  months ;  and  in 
a  third,  two  years.  The  method  has  been  em- 
ployed only  in  "  inoperable  "  cases. 

The  value  of  the  toxines  depends  almost  en- 
tirely upon  the  virulence  of  the  cultures  from 
which  they  have  been  prepared.  Great  difS- 
culty  has  been  experienced  in  obtaining  suit- 
able cultures  and  keeping  them  sufficiently 
virulent.  Most  of  the  successful  oases  were 
treated  with  toxines  obtained  from  fatal  cases 
of  erysipelas.  The  cultures  rapidly  lose  their 
virulence  after  a  few  generations  unless  they 
are  frequently  passed  through  animals. 

The  toxines  are  very  powerful  bacteriolog- 
ical products  and  need  to  be  used  with  the 
utmost  care  to  be  free  from  danger.  I  have 
had  three  cases  in  which  death  was  caused  or 
undoubtedly  hastened  by  the  injections.  In 
all  these  cases,  however,  the  disease  was  so  far 
advanced  that  death  could  not  have  been  post- 
poned more  than  a  few  weeks  without  the 
treatment. 

In  the  early  cases  treated  with  the  toxines 
the  filtered  preparations  were  used.  Later  ex- 
periments showed  that  much  better  results 
were  obtained  by  using  both  the  soluble  and 
insoluble  products,  or,  in  other  words,  the  un- 
flltered  mixed  toxines  prepared  by  subjecting 
them  to  sufficient  heat  to  render  them  sterile. 
This  was  found  to  be  from  136-4°  to  140°  F. 
The  toxines  prepared  by  this  method  from 
virulent  cultures  are  extremely  powerful. 
Doses  of  from  -|  to  1  minim,  when  injected 
into  the  substance  of  the  tumour,  usually  pro- 
duce a  reaction  temperature  of  from  101°  to 
104°  F.  It  is  important  to  note  that  much 
larger  doses  can  be  safely  borne  when  injected 
subcutaneously,  remote  from  the  tumour,  the 
reason  probably  being  that  the  toxines  are 
more  quickly  absorbed  when  injected  into  the 
tumour  substance.  Individuals  vary  consider- 
ably in  their  susceptibility  to  the  action  of  the 
toxines.  Therefore  it  is  always  wise  to  begin 
with  the  minimum  dose  and  gradually  increase 
it,  the  temperature  reaction  being  the  chief 
guide  in  determining  the  dose.  If  no  im- 
provement has  been  noted  after  two  or  three 
weeks"  treatment  it  will  not  be  likely  to  occur 
at  all.  As  to  the  length  of  time  the  treat- 
ment should  be  continued  this  is  impossible  to 
state  definitely.  In  several  of  the  successful 
cases  a  cure  was  only  obtained  by  persistent 
and  long-continued  efforts ;  and  it  is  quite 
possible  that  in  some  of  the  cases  in  which  the 
sarcoma  disappeared  and  subsequently  re- 
curred a  permanent  cure  might  have  resulted 
had  the  treatment  been  continued  for  a  longer 
period  of  time. 

The  local  and  constitutional  effects  of  the 
toxines  are,  briefly,  as  follows:  The  introduc- 
tion of  the  fluid  into  the  tumour  causes  a 


burning  sensation  which  lasts  but  a  short  time. 
There  is  at  first  increased  hyperffimia  in  the 
neighbourhood  of  the  injections.  This,  how- 
ever, at  the  end  of  from  twelve  to  twenty-four 
hours  gives  place  to  well-marked  anasmia,  the 
tumour  resuming  a  characteristic  bluish  col- 
our. After  several  injections,  in  favourable 
cases,  the  circulation  of  the  tumour  becomes 
so  much  impaired  that  actual  necrobiosis  oc- 
curs and  the  degenerated  tissue  is  either  ab- 
sorbed or  breaks  down  and  comes  away  in  the 
form  of  a  slough.  In  the  spindle-celled  vari- 
ety, in  which  the  fibrous  elements  predominate 
over  the  cellular,  disappearance  by  absorption 
is  more  likely  to  occur,  while  in  the  round- 
celled  sarcomata  the  reverse  is  generally  the 
case. 

In  regard  to  the  constitutional  effects,  the 
reaction  depends  largely  upon  the  dose  admin- 
istered ;  slight  headache  and  malaise  are  the 
only  symptoms  noted  after  a  small  dose. 
Larger  doses  are  followed  by  a  chill  varying 
in  intensity  and  coming  on  within  from  fifteen 
minutes  to  two  hours  after  the  injection.  In 
some  few  instances  the  chill  may  not  set  in 
until  five  or  six  hours  after  the  injection,  but 
if  severe  in  chai'acter  it  is  likely  to  occur  with- 
in an  hour  from  the  time  of  injection.  The 
duration  of  the  chill  varies  from  ten  to  forty 
minutes,  according  to  its  severity.  The  tem- 
perature rapidly  rises  after  the  chill  has  sub- 
sided to  from  101°  to  105°  F. ;  in  some  few 
cases  it  has  reached  106°  and  upward.  The 
heart's  action  is  correspondingly  increased; 
the  pulse-rate  varies  from  120  to  160  ;  nausea, 
frequently  vomiting,  and  intense  headache 
usually  accompany  a  severe  reaction.  Profuse 
perspiration  soon  follows  and  the  temperature 
falls  rapidly  and,  as  a  rule,  will  have  returned 
to  normal  within  from  six  to  twelve  hours 
after  the  chill. 

The  effect  of  the  injections  upon  the  pain 
caused  by  the  tumour  is  in  many  cases  very 
striking,  making  it  possible  to  do  away  with 
morphine  entirely.  The  beneficial  influence 
of  the  toxines  upon  the  tumour  corresponds 
to  the  severity  of  the  reaction.  Experience 
has  proved,  however,  that  the  best  results  are 
more  likely  to  be  obtained  by  giving  doses 
sufficient  to  cause  but  moderate  reaction — for ' 
example,  a  temperature  of  from  101°  to  103° — 
and  then  repeating  them  frequei^tly  every  day 
or  every  other  day  according  to  the  physical 
condition  of  the  patient  and  the  way  in  which 
they  are  borne. 

In  regard  to  the  various  theories  that  have 
been  advanced  in  explanation  of  the  action  of 
the  toxines  upon  malignant  tumours,  I  will 
only  say  that  I  still  adhere  to  the  opinion  ex- 
pressed in  my  earlier  publications  that  the 
microparasitio  origin  of  malignant  tumours 
furnishes  the  most  rational  ground  for  ex- 
plaining the  action  of  the  toxines. 

A  number  of  successful  cases  of  sarcoma 
treated  by  this  method  have  been  reported 
by  other  surgeons.  The  more  important  of 
these  cases  will  be  found  in  my  most  recent 
paper,  in  the  Ammcan  Journal  of  the  Medi- 
cal Sciences  for  September  and  October, 
1896. 


313 


TOXINES 


TABLE  SHOWIKB  VARIETIES  OF  TUMOURS  SUC- 
CESSFULLY TREATED  BY  THE  TOXINES,  WITH 
FINAL   RESULT   (PERSONAL   CASES).  , 


Sarcoma,  spin- 
dle-celled. 

Sarcoma,  round- 
and  mixed- 
celled. 

Sarcoma,  round- 
celled. 

Chondro-sarco- 
ma. 

Osteo-sarcoma 
sacrum.* 

Epithelioma. 

Recurrent  carci- 
noma, breast. 


7  cases ;  1  re- 
curred 1  yr.,  1 
recurred  1^  yr. 

1  case. 


2  cases. 

1  case  ;  recurred 
8  mos. 

1  case. 

2  cases;    1    re- 
curred J  yr. 

1  case. 


Five  well  without 
recurrence  4,  3, 
2J,  2,  i  yrs. 

Well  3i  yrs. 


Well  1  and  2  yrs. 

Well  1  yr. 

One  well  2  yrs. 

Well  n  yr.  after 
beginning  of 
treatment  3  mos. 
after  end. 


[Dr.  Lewis  A.  Stimson,  Dr.  Arpad  G.  Gerster, 
and  Dr.  B.  Farquhar  Curtis,  constituting  a 
oomniittee  appointed  by  the  New  York  Sur- 
gical Society  to  investigate  and  report  upon 
the  erysipelas-toxine  treatment  of  malignant 
growths,  say  in  their  report  {Annals  of  Surgery, 
July,  1896):  "Both  before  and  since  our  ap- 
pointment as  a  committee,  we  have  been  able 
to  observe,  individually  and  together,  a  con- 
siderable number  of  cases  treated  by  this 
means,  and  in  no  case  have  we  found  any 
amelioration  which  held  out  a  prospect  of  ul- 
timate cure.  We  have,  on  the  contrary,  ob- 
served in  some  cases  that  the  rate  of  growth  of 
the  disease  was  much  more  rapid  during  the 
treatment.  The  treatment  also  imposes  a  very 
severe  tax  upon  the  strength  of  the  patient, 
and  apparently  hastens  the  cachexia  in  most 
cases. 

'•  We  believe  that  in  the  instances  of  ap- 
parent cure  or  marked  improvement  the  cor- 
rectness of  the  diagnosis  is  open  to  doubt. 

"  We  therefore  submit : 

"  1.  That  the  danger  to  the  patient  from  this 
treatment  is  great. 

"  2.  Moreover,  that  the  alleged  successes  are 
so  few  and  doubtful  in  character  that  the  most 
that  can  be  fairly  alleged  for  the  treatment  by 
toxines  is  that  it  may  offer  a  very  slight  chance 
of  amelioration. 

"  3.  That  valuable  time  has  often  been  lost 
in  operable  cases  by  postponing  operation  for 
the  sake  of  giving  the  method  of  treatment  a 
trial. 

"  4.  Finally,  and  most  important,  that  if  the 
method  is  to  be  resorted  to  at  all,  it  should 
be  confined  to  the  absolutely  inoperable  cases." 

The  committee's  views  are  properly  con- 
servative and  in  accord  with  the  spirit  in  which 
Dr.  Coley's  experiments  have  been  carried  on. 
As  he  himself  says,  only  a  large  experience  can 
determine  the  exact  value  of  the  toxine  treat- 
ment. Already  some  notable  reports  of  ob- 
servations by  capable  clinicians  have  been 
published,  as  the  following  examples  will 
show: 

Czerny  relates  his  experience  in  the  Munch- 
ener  meaicinische  Wochenschrift  for  September 
3,  1895,  and  his  account  is  summarized  in  the 
British  Medical  Journal  for  October  13,  1895. 


*  No  microscopical  examination  in  this  case. 


Although  he  has  often  seen  no  good  effect,  but 
even  a  more  rapid  development  of  tumours, 
after  a  casual  erysipelas,  yet  he  recollects  two 
cases  in  which  an  undoubted  beneficial  influ- 
ence was  exerted  upon  carcinoma.  He  has 
used  the  mixed  erysipelas  and  Bacillus-pro- 
digiosus  toxines  after  Coley's  method.  In  the 
case  of  a  woman  aged  thirty-five  a  sarcoma  of 
the  parotid  appeared  dui'ing  pregnancy,  and 
grew  at  first  slowly,  but  later  rapidly.  When 
she  presented  herself  there  was  a  mass  as  large 
as  the  fist  behind  the  ear,  the  parotid  wa.s 
hard,  and  a  mass  of  growth  was  present  in  the 
external  auditory  meatus.  The  facial  nerve 
was  paralyzed.  As  extirpation  offered  no 
hope,  the  toxine  treatment  was  begun,  and 
eighteen  injections  were  made.  The  growth 
became  greatly  lessened  in  size,  the  parotid 
gland  grew  soft,  and  the  facial  paralysis  dis- 
appeared except  from  the  frontal  branches  of 
that  nerve.  Czerny  says  that  a  marked  fa- 
vourable if  not  specific  action  upon  the  sar- 
coma was  noted  in  this  case.  It  is  to  be 
remembered,  says  the  writer,  that  tumours 
occurring  during  pregnancy  have  sometimes 
been  known  to  diminish  considerably  after- 
wards. Czerny  then  refers  to  three  cases  of 
recurrent  sarcoma  in  the  naso-pharyngeal 
space  in  which  he  used  the  same  treatment, 
but  the  number  of  injections  was  too  small  to 
produce  a  very  striking  effect.  He  has  also 
treated  four  cases  of  carcinoma  with  no 
very  real  benefit.  In  one  case  of  advanced 
carcinoma  of  the  upper  jaw  an  extensive 
softening  of  the  growth  with  subjective  im- 
provement occurred.  Putting  his  results 
alongside  Coley's  more  extensive  experiences, 
he  concludes  that  (1)  the  injection  of  these 
toxines  causes  fever,  etc.,  and  always  local  in- 
flammatory signs;  (2)  these  manifestations 
disappear  in  a  few  hours,  but  after  frequently 
repeated  injections  there  may  be  loss  of  appe-' 
tite,  wasting,  etc. ;  (3)  the  injections  exercise  a 
speciflc  action  upon  sarcomatous  growths,  and 
may  even  bring  about  a  cure  ;  (4)  as  the  results 
are  uncertain,  such  treatment  should  of  course 
never  take  the  place  of  an  operation,  but  should 
be  adopted  in  "  inoperable "  or  recurrent 
growths.  Perhaps  it  might  be  used  to  pre- 
vent recurrence  in  sarcoma ;  and  (5)  in  carci- 
noma at  most  a  retardation  of  growth  has  been 
noted,  but  no  cure. 

In  the  Wiener  medizinische  Blatter  for  Au- 
gust 27,  1896,  there  is  an  abstract  of  an  ac- 
count, originally  published  in  the  Gazette 
medicale  de  Liege,  of  observations  on  this 
treatment  by  Matagne,  of  Brussels.  He  has 
employed  it  in  fourteen  cases,  and  maintains 
that  in  one  of  them  a  complete  cure  was  ac- 
complished. The  patient  was  a  man,  sixty-four 
years  old,  who  in  January,  1895,  flrst  noticed 
something  abnormal  in  his  mouth.  In  Febru- 
ary he  consulted  a  physician,  who  diagnosti- 
cated epithelioma  and  advised  an  operation,  to 
which  the  patient  did  not  consent.  Many 
other  physicians  saw  the  patient,  and  they  all 
concurred  as  to  the  diagnosis  and  urged  the 
man  to  have  an  operation  performed.  Early 
in  June  the  patient  consulted  Dr.  Matagne. 
By  this  time  he  had  a  three-lobed  tumour 


TOXINES 


314 


which  occupied  the  floor  of  the  mouth.  The 
largest  lobe  was  as  large  as  a  nut ;  in  the  left 
submaxillary  region  there  was  a  gland  as  large 
as  a  small  nut — the  kind  of  nut  is  not  specified 
in  either  instance — and  under  the  chin  there 
were  two  other  glands  the  size  of  a  bean.  The 
tumour  was  hard  and  ulcerating,  but  without 
suppuration,  and  lancinating  pains  proceeded 
from  it  toward  the  left  ear.  In  a  short  time 
the  symptoms  were  so  marked  that  nobody 
who  saw  the  man  had  a  doubt  of  the  epitheli- 
omatous  nature  of  the  growth.  However,  no 
histological  examination  of  the  neoplasm  was 
made,  for  fear  of  opening  a  channel  for  sec- 
ondary infection. 

The  treatment  was  begun  on  the  10th  of 
June.  Five  centigrammes  of  the  toxine  were 
injected  beneath  the  skin  of  the  neck  below 
the  hyqid  bone.  In  two  hours  the  man's  tem- 
perature was  101'3°  F.  On  the  16th  of  June 
forty  centigrammes  were  injected  into  the  tu- 
mour, and  hard  swellings  made  their  appear- 
ance in  halt  an  hour;  the  tongue  remained 
quite  swollen  for  two  entire  days.  The  high- 
est temperature  reached  during  the  treatment 
was  105-8°  F.  During  the  whole  febrile  period 
the  tumour  diminished  in  size  very  decidedly, 
and  the  diminution  kept  on  after  the  subsi- 
dence of  the  fever,  so  that  by  the  beginning 
of  September  not  a  trace  of  the  growth  re- 
mained. 

Another  case  was  one  of  recurrent  sarcoma 
of  the  neck  in  a  woman  seventy-eight  years 
old.  The  tumour  was  as  large  as  an  egg  and 
situated  in  front  of  the  sterno-cleido-mastoid 
muscle.  Another  tumour,  of  the  size  of  a 
hazelnut,  was  seated  in  the  masseteric  region, 
and  two  small  but  very  hard  glands  were  to  be 
felt  under  the  chin.  After  a  course  of  treat- 
ment lasting  three  months  and  a  half,  the  in- 
jections being  given  every  second  day,  the 
large  tumour  had  wholly  disappeared  and  the 
one  in  the  masseteric  region  could  hardly  be 
felt,  but  the  enlarged  glands  had  not  under- 
gone complete  involution,  when  the  treatment 
was  accidentally  interrupted.  In  six  months 
after  its  discontinuance  there  was  a  moderate 
aggravation  of  the  disease,  and  the  patient 
was  advised  to  submit  to  the  injections  again. 
In  a  third  case,  one  of  recurrent  sarcoma  of 
the  neck  of  the  size  of  a  foetal  head,  the  pa- 
tient was  treated  with  the  toxines  for  three 
months,  and  the  tumour  had  then  shrunk  to 
two  thirds  of  its  original  size.  The  patient, 
out  of  patience  with  the  long  duration  of  the 
treatment,  decided  to  call  in  a  surgeon,  who 
operated  with  a  fatal  result.  In  a  case  of  re- 
current sarcoma  of  the  arm  the  injections 
checked  the  growth  of  the  tumour  only  tem- 
porarily. In  one  of  sarcoma  of  the  pharynx 
no  result  was  noted  other  than  a  brief  restraint 
of  the  growth. 

The  sixth  case  was  one  of  deeply  ulcerated 
sarcoma  of  the  neck  in  a  very  debilitated  man, 
sixty-four  years  old,  who  died  during  the  re- 
action following  an  injection  of  ten  cubic  cen- 
timetres of  the  toxines  after  the  treatment  had 
been  carried  on  for  five  weeks.  The  tumour 
had  diminished  in  volume  a  little.  The  seven 
other  cases  were  all  examples  of  epithelioma  or 


carcinoma,  and,  save  in  two  of  them,  the  re- 
sults were  but  very  slight.  In  one  of  these 
two,  a  recurrent  carcinoma  of  the  breast,  the 
injections  seemed  to  check  the  growth  of  the 
tumour,  for  it  remained  stationary  for  several 
months ;  in  the  other,  a  uterine  carcinoma, 
there  was  alleviation  of  the  pain  together  with 
reduction  of  the  size  of  the  tumour,  and  the 
improvement  lasted  for  four  months. 

Dr.  Henry  L.  Shively,  of  the  Presbyterian 
Hospital  Dispensary  (New  York  Medical  Jour- 
nal, December  13,  1896),  appends  to  a  report 
of  a  case  of  sarcoma  treated  by  him  with  the 
mixed  toxines  of  Streptococcus  erysipelatis  and 
Bacillus  prodigiosus  the  following  remarks: 
"  It  is  believed  that  an  impartial  survey  of  the 
facts  here  recorded  can  not  but  convince  one 
that  there  was  an  immediate  and  pronounced 
influence  of  the  toxines  in  causing  retrogres- 
sion and  absorption  of  the  tumour  mass,  and, 
although  a  cure  was  not  effected,  yet  the  pa- 
tient's urgent  and  distressing  symptoms  were 
relieved,  he  gained  for  a  time  in  flesh  and 
strength,  and  his  life  was  probably  prolonged. 
When  the  pitiable  hopelessness  of  his  condi- 
tion is  considered  then,  the  results  of  treatment 
can  not  be  deemed  an  entire  failure.  It  is  also 
apparent  from  the  symptoms  following  the  sec- 
ond infection  that  the  toxines  may,  act  as  a 
powerful  poison,  having  a  direct  paralyzing 
effect  upon  the  respiratory  centre.  Notwith- 
standing, however,  its  possible  dangers  and  the 
uncertainty  of  its  action,  the  toxine  treatment 
constitutes  at  present  our  only  therapeutic  re- 
source for  inoperable  malignant  disease  hav- 
ing well-authenticated  oases  of  recovery  to  its 
credit.  Should  not  the  patient  have  the  bene- 
fit of  its  trial  t " 

Dr.  Eu^n  Hirschfeld  {Australasian  Medical 
Gazette,  March  20,  1896 ;  New  York  Medical 
Journal,  May  23,  1896)  has  written  partly  con- 
cerning a  variation  of  the  toxine  treatment— 
namely,  the  use  of  the  serum  of  animals  in- 
fected with  erysipelas;  nevertheless,  all  that 
he  reports  has  a  direct  bearing  upon  the  Coley 
treatment.  He  first  refers  to  the  researches  of 
Emmerich  and  of  Scholl,  based  on  the  fact, 
established  by  repeated  observations,  that  ma- 
lignant tumours  had  been  found  to  disappear 
in  some  patients  who,  while  suffering  from  the 
tumours,  were  accidentally  infected  with  ery- 
sipelas. In  order  to  produce  by  treatment 
what  had  occurred  by  accident,  Neisser  and 
Pehleisen  inoculated  in  cases  of  hopeless  can- 
cer with  pure  cultivations  of  virulent  erysipelas 
cocci,  but  they  soon  gave  it  up  on  account  of 
the  many  untoward  accidents  connected  with 
the  method.  Professor  Bruns  reported  a  case 
of  melanosarcoma  of  the  mamma  of  the  most 
malignant  type  in  which  extirpation  was  done. 
The  disease  recurred  before  the  wound  healed, 
and  at  about  the  same  time  the  patient  became 
infected  with  a  serious  wandering  erysipelas, 
with  the  result  that  the  new  growth  disap- 
peared without  leaving  a  trace  behind.  Six 
years  later  Professor  Bruns  was  able  to  state 
that  the  patient  had  remained  cured.  In  look- 
ing over  the  literature  on  the  subject,  Professor 
Bruns,  says  Dr.  Hirschfeld,  found  three  cases 
of  undoubted  complete  and  permanent  cure  of 


315 


TOXINES 


sarcoma  by  natural  or  artificial  erysipelas,  but 
he  states  emphatically  that  there  was  no  case 
of  carcinoma  in  which  the  cure  had  been  es- 
tablished beyond  all  doubt.  Successful  obser- 
vations were  communicated  also  by  Biedert 
and  Bush ;  but  Emmerich  was  the  first  who 
undertook  to  put  the  matter  on  an  experi- 
mental basis,  as  early  as  in  1886.  He  obtained 
the  following  results : 

1.  Acute  cases  of  anthrax  in  animals  can  be 
cured  by  inoculation  with  erysipelas  cocci. 

3.  The  curative  power  of  the  erysipelas  cocci 
is  not  centred  in  the  cocci  themselves,  but  in 
certain  changes  brought  about  in  the  blood 
under  its  influence,  so  that  it  obtains  antibac- 
terial qualities. 

3.  The  blood  serum  of  animals  infected  with 
erysipelas  possesses  the  same  curative  powers 
as  the  erysipelas  coccus  itself. 

As  cancer  is  limited  to  the  human  species, 
says  Dr.  Hirschfeld,  it  was  impossible  to  carry 
out  similar  experiments  in  animals;  but,  as 
they  had  found  that  the  injection  of  blood 
serum  of  beasts  infected  with  erysipelas  was  as 
efficient  as  the  inoculation  with  the  erysipelas 
coccus  itself,  while  on  the  other  liand  it  was 
not  accompanied  by  the  same  serious  symp- 
toms as  the  inoculation,  they  concluded  to  try 
it  in  human  beings  in  such  cases  as  were  be- 
yond the  reach  of  operation. 

The  number  of  patients  suflEering  from  ma- 
lignant tumours  (carcinoma,  sarcoma,  and 
lymphoma  maiignum)  who  have  been  treated 
thus  far  with  the  erysipelas  serum  has  been 
comparatively  small,  and  the  results  obtained 
by  different  observers  extremely  contradictory. 
A  priori,  says  Hirschfeld,  we  must  remember 
that  the  time  that  has  elapsed  is  altogether  too 
short  to  allow  a  definite  opinion  to  be  formed 
on  the  subject.  The  beginning  of  the  serum 
treatment  of  cancer  dates  back  only  as  far  as 
the  beginning  of  the  year  1895.  Even  suppose 
all  the  patients  had  been  cured  by  the  injection 
of  the  serum,  he  says,  we  should  certainly  allow 
a  much  longer  time  to  elapse  before  we  could 
pronounce  them  completely  and  permanently 
cured.  In  two  successive  publications,  Em- 
merich, Scholl,  and  Zimmermann  report  alto- 
gether eleven  cases  with  partial  or  complete 
temporary  success.  It  is  very  much  to  be  re- 
gretted, Hirschfeld  thinks,  that  the  authors  do 
not  state  the  total  number  of  patients  who 
were  treated  by  the  new  method,  as  we  cer- 
tainly get  the  impression,  when  reading  their 
communications,  that  the  number  of  patients 
reported  is  very  small  in  proportion  to  the 
number  who  have  been  treated.  They  men- 
tion only  that  the  erysipelas  treatment  had 
been  without  effect  in  two  cases  of  far-ad- 
vanced carcinoma  in  which  secondary  infection 
was  accompanied  by  extensive  ulceration. 

Of  these  eleven  patients,  eight  were  suffering 
from  carcinoma — seven  of  which  were  located 
in  the  mamma — one  from  epithelioma,  one  from 
sarcoma  fusieellulare  of  the  thigh,  and  one 
from  sarcoma  of  the  face.  The  diagnosis  was 
established  by  microscopical  examination,  and 
most  of  the  patients  had  been  operated  upon 
repeatedly  without  any  success  by  leading 
German  surgeons,  and  had  been  handed  over 
C4 


to  Emmerich  for  the  serum  treatment  as 
hopeless. 

In  two  instances  the  original  tumour  disap- 
peared entirely,  while  in  all  a  great  diminution 
in  size  and  improvement  in  general  appearance, 
like  cicatrization,  were  observed.  The  very 
great  improvement  in  general  health,  says  Dr. 
Hirschfeld,  is  of  minor  value,  as  the  mental 
effect  alone  of  a  remedy  that  promises  cure  to 
a  hopeless  patient  would  be  sufficient  to  bring 
that  about. 

The  results  obtained  by  Professor  Bruns  in 
Tilbingen,  he  says,  are  very  much  less  satis- 
factory, although  he  used  serum  sent  by  Em- 
merich. He  subjected  six  patients  to  the 
treatment.  Pour  were  suffering  from  carci- 
noma, one  from  lymphoma  maiignum,  and  one 
from  sarcoma.  A  diminution  in  the  size  of 
the  tumour  did  not  take  place  in  any  single 
instance.  The  treatment  was  eventually  broken 
off  on  account  of  several  serious  symptoms  aris- 
ing from  it.  In  three  patients,  immediately 
after  the  injection,  attacks  of  dyspnoea,  cyano- 
sis of  the  face,  heart  palpitations,  and  vomiting 
supervened.  In  another  case  the  rise  of  tem- 
perature which  generally  follows  the  injection 
developed  into  fever  lasting  for  eight  days, 
with  severe  pains  in  the  joints.  The  appear- 
ance of  albuminuria  and  numerous  granulated 
cylinders  in  the  urine  compelled  Bruns  to  dis- 
continue the  treatment  in  the  fifth  patient. 

It  must  be  pointed  out,  however,  continues 
Dr.  Hirschfeld,  that  the  serious  complications 
mentioned  may  be  due  to  accidents  which  it 
should  be  possible  to  avoid.  The  continued 
high  fever  may  be  due  to  an  imperfect  sterili- 
zation of  the  serum.  The  sudden  attacks  of 
dyspnoea  were  caused,  as  Emmerich  suggests, 
by  the  accidental  insertion  of  the  injecting 
needle  into  a  vein,  thus  flooding  the  circula- 
tion at  once  with  the  whole  of  the  serum ;  he 
himself  met  with  the  mishap  but  once.  ■ 

Dr.  Hirschfeld  cites  several  cases  in  which 
the  erysipelas  treatment  was  employed  with 
varying  results.  He  has  endeavoured  to  col- 
lect all  the  material  that  is  available  in  the  lit- 
erature on  this  subject,  he  says,  and,  after  a 
review  of  the  whole  matter,  including  his  own 
observations,  he  comes  to  the  following  con- 
clusions : 

1.  The  injection  of  erysipelas  serum  into 
patients  suffering  from  malignant  new  growths 
produces  a  reaction  which  consists  in  a  rise  of 
temperature,  accompanied  by  a  corresponding 
increase  of  frequency  of  pulse,  which  generally 
returns  after  a  short  time  to  the  normal. 

3.  The  influence  upon  the  tumour  itself  is 
very  distinct.  The  serum  induces  a  change, 
the  principal  characteristic  of  which  is  retro- 
gressive metamorphosis,  which  begins  with  a 
fatty  degeneration  of  the  cellular  elements 
composing  the  tumour,  leading  to  melting 
down  and  afterward,  in  some  cases,  to  the  en- 
tire absorption  of  the  new  growth. 

3.  If  due  care  is  taken  in  its  preparation,  the 
injection  of  erysipelas  serum  is  not  followed 
by  the  appearance  of  erysipelas. 

4.  The  action  of  the  serum,  according  to  all 
observers,  is  more  powerful  in  sarcoma  than  in 
carcinoma.     Even  melanotic  sarcomata  of  the 


TRAGACANTH 

TRANSFUSION  AND  INFUSION 


316 


most  malignant  type  may  be  made  to  disap- 
pear under  the  influence  of  the  erysipelas 
toxine. 

5.  The  serum  signally  fails  in  some  cases  to 
benefit  the  patient,  although  the  injection  is 
followed  by  the  usual  reaction. 

6.  The  untoward  accidents  connected  with 
the  treatment  which  have  been  observed  so  far 
are — (a)  severe  rigour,  lasting  for  thirty-five 
minutes,  followed  by  rise  of  temperature  up  to 
104-4°  P. ;  (6)  severe  dyspnoea,  cyanosis,  vom- 
iting, and  palpitation  of  the  heart,  lasting  from 
ten  minutes  to  half  an  hour ;  (c)  the  appear- 
ance of  albumin  and  cylindrical  casts  in  the 
urine ;  (d)  continued  remittent  fever. 

7.  These  accidents  are  caused — (a)  by  the 
serum  not  being  in  a  sterile  condition ;  (b)  by 
the  insertion  of  the  injecting  needle  into  a 
iDlood-vessel ;  (c)  by  variation  of  different  kinds 
of  the  serum  not  explained  hitherto. 

8.  The  principal  points  of  interest  for  the 
general  practitioner  are,  whether  it  will  be  pos- 
sible to  avoid  these  accidents  in  future.  We 
can  easily  dismiss  the  second  point,  the  inser- 
tion of  the  injecting  needle  into  a  blood-vessel. 
If  attention  is  only  drawn  to  the  existence  of 
this  danger  we  shall  be  able  in  most  cases  to 
elude  it  by  ordinary  care. 

With  regard  to  the  serum  not  being  in  a 
sterile  condition  when  used,  says  Dr.  Hirseh- 
feld,  a  good  deal  of  bacteriological  experience 
is  required  in  the  operator  to  avoid  this  risk. 
Perhaps,  he  says,  it  would  be  possible  to  do 
away  with  it  altogether  by  adding  an  anti- 
septic (0'5  per  cent,  of  carbolic  acid)  to  the  se- 
rum, as  in  the  case  of  the  diphtheria  anlitoxine. 
A  further  concentration  of  the  serum  is  neces- 
sary, however,  if  this  plan  is  carried  out,  he 
adds,  or  otherwise  too  great  a  quantity  of  car- 
bolic acid  would  be  injected  at  the  same  time, 
which  by  its  chemical  action  might  possibly 
have  an  injurious  influence  and  interfere  with 
the  action  of  the  antitoxine. 

The  third  point,  the  apparently  unexplained 
variation  of  different  kinds  of  serum,  is  the 
most  serious,  and  one,  he  says,  that  most  of 
those  who  have  used  the  serum  have  expe- 
rienced. Emmerich  and  Seholl  mention  that 
the  difference  in  breed  of  the  sheep  used  for 
the  experiments  has  been  one  cause.  It  is  cer- 
tainly advisable.  Dr.  Hirschfeld  thinks,  to  get 
the  original  serum  from  Germany,  although 
the  difliculties  in  bringing  the  serum  to  the 
proper  standard  have  not  been  quite  overcome 
yet.  Besides,  it  is  not  at  all  certain  whether  it 
would  keep.  Professor  Bruns  experimented 
with  serum  which  he  had  received  from  Em- 
merich himself,  and  albuminous  deposits  which 
contained  micro-organisms  were  found  to  have 
formed  within  a  few  days.  The  addition  of  an 
antiseptic  might  overcome  this.  One  way  of 
lessening  the  danger  would  be  to  inject  a  cer- 
tain quantity  of  each  supply  into  an  animal, 
and  to  reject  it  altogether  if  an  abnormal  rise 
of  temperature  was  observed  to  follow. 

9.  The  efficiency  of  the  serum  treatment 
may  be  increased,  as  has  been  shown  by  Em- 
merich and  Zimmermann  in  their  last  commu- 
nication, by  following  it  up  with  the  inoculation 
of  the  erysipelas  coccus  itself.    The  previous 


injection  of  the  antitoxine  makes  the  subse- 
quent infection  run  a  more  benign  course. 
The  success  achieved  by  the  authors,  in  a  far- 
advanced  case  of  cancer  of  the  tongue,  with 
secondary  infiltration  of  the  submaxillary  and 
cervical  glands,  has  certainly  been  most  re- 
markable. 

The  method  of  the  treatment  of  malignant 
tumours  by  the  injection  of  erysipelas  serum, 
though  far  from  being  perfect,  says  Dr.  Hirsch- 
feld, has  been  successful  in  some  otherwise  ab- 
solutely hopeless  oases,  and  it  promises  to  do 
more,  and  has  done  more,  than  any  other 
treatment  at  our  disposal. 

Dr.  W.  A.  Thiele  (Annalen  der  russischen 
Chirurgie,  1896;  Centralblatt  fur  CMrurgie, 
October  3,  1896),  on  the  strength  of  four  cases 
of  his  own  and  a  case  of  Emmerich's  in  which 
Emmerich  and  SchoU's  erysipelas  serum  was 
used,  comes  to  the  following  conclusions:  1. 
Complete  cure  with  the  serum  has  not  been 
demonstrated.  2.  The  injections  are  free  from 
danger,  but  not  from  inconvenience,  for  they 
occasionally  give  rise  to  headache,  weakness, 
fever,  etc.  3.  The  cancerous  nodules  grow 
smaller  and  occasionally  disappear,  and  ul- 
ceration is  checked.  4.  Where  an  operation 
is  impracticable,  the  serum  should  be  used,  for 
it  mitigates  the  pain  and  thus  takes  the  place 
of  narcotics.  5.  It  is  very  desirable  that  the 
remedy  should  be  employed  systematically  in 
cases  of  incipient  malignant  tumours. 

Dr.  Robert  H.  Greene,  of  the  City  (Charity) 
Hospital  (Medical  News,  October  10,  1896),  has 
observed  temporary  benefit  from  the  employ- 
ment of  the  mixed  toxines  in  syphilis,  as  has 
been  known  to  follow  a  casual  attack  of  ery- 
sipelas.] William  B.  Coley. 

TBAGACAN'TH,  tragacantha  (U.  S.  Ph., 
Br.  Ph.,  Ger.  Ph.),  is  a  gummy  substance  ob- 
tained from  various  species  of  astragalus.  It 
is  soluble  with  difficulty  in  water.  It  is  used 
in  the  preparation  of  troches  and  similar 
bodies.  Its  solution  may  be  employed  in  the 
administration  of  insoluble  powders  which  are 
held  in  suspension  in  it.  Otherwise  it  is  not 
used  in  medicine,  except  occasionally  as  a  de- 
muleent.  The  official  mucilage,  mucilago  tra- 
gacanthcB  (U.  S.  Ph.,  Br.  Ph.),  is  employed 
chiefly  as  an  excipient  in  making  pills ;  so  is 
the  glycerinum,  tragacanthm  (Br.  Ph.),  which  is 
a  jellylike  mass.  The  compound  powder,  pul- 
vis  tragacanthm  compositus  (Br.  Ph.),  may  be 
given  in  doses  of  from  20  to  60  grains,  rubbed 
up  with  water. — Russell  H.  Nevins. 

TRANSFUSION  AND  INFTTSION.— 

The  history  of  transfusion  and  that  of  infusion 
are  inseparable.  Both  are  procedures  which 
have  for  their  intention  the  introduction  of 
foreign  material  into  the  blood  for  life-saving 
purposes ;  in  the  case  of  transfusion  it  is  the 
blood  of  another  individual,  in  the  instance  of 
infusion  it  is  a  fluid  with  therapeutic  qualities, 
nourishing  or  stimulating,  or  simply  intended 
to  fill  depleted  blood-vessels. 

The  widespread  belief  that  the  blood  is  the 
seat  of  the  soul  was  undoubtedly  the  incentive, 
during  ancient  times  and  the  Middle  Ages,  to 
improve  or  to  repair  the  condition  of  the  vas- 


317 


TRAGACANTH 
TRANSFUSION  AND  INFUSION 


cular  fluid.  Virgil  asserts  that  with  the  loss 
of  blood  the  soul  escapes.  In  Ovid's  Meta- 
morphoses the  ancient  legend  of  the  restora- 
tion of  ^son  from  age  to  youth  by  his 
daughter-in-law,  the  sorceress  Medea,  is  re- 
lated. This  change  was  accomplished  by  al- 
lowing his  blood  to  escape  through  a  wound 
in  the  neck  and  substituting  for  it  a  mixture 
containing  numerous  ingredients.  Part  of  this 
she  introduced  through  the  wound,  part  by  the 
mouth.  In  the  Odyssey  mention  is  made  of 
the  prevalent  belief  that  by  the  drinking  of 
freshly-drawn  blood  the  dead  might  be  made 
to  resume  their  mental  activities.  The  Bible 
contains  several  references  to  the  fact  that  the 
soul  is  in  the  blood,  and  Aristotle,  Bmpedo- 
cles,  Galen,  and  Lucretius  Carus  lend  their 
august  names  to  the  same  faith.  Even  if  we 
may  not  assume  that  an  actual  transfusion  or 
infusion  had  been  done  in  these  early  times, 
we  are  justified  in  believing  that  the  notion  of 
its  possibility  and  of  its  value  existed.  For 
centuries  the  myth  has  had  a  hold  upon  the 
people  that  the  drinking  of  blood  has  the 
power  of  eliminating  disease  and  of  impart- 
ing new  strength  and  power  to  the  body.  The 
imbibition  of  blood  was  an  agent  fcr  the  cure 
of  epilepsy  in  good  repute  up  to  almost  recent 
times,  and  most  of  the  old  works  on  therapeu- 
tics, even  to  the  beginning  of  the  present  cen- 
tury, mention  mixtures  for  the  cure  of  diseases 
of  every  kind  in  which  blood  is  an  important 
and  almost  ubiquitous  component  element. 

The  first  direct  transfusion  of  blood  is  prob- 
ably to  be  attributed  to  Cardanus,  in  1556. 
He  speaks  of  the  belief  being  prevalent  at  that 
time  that  age  could  be  made  to  assume  the 
character  of  youth  by  the  direct  transfer  of 
blood  from  the  younger  to  the  older  indi- 
vidual. Early  in  the  seventeenth  century  Li- 
bavius  wrote  scornfully  of  the  vaunted  virtues 
of  transfusion  as  a  panacea,  remarking  that 
"  by  this  means  virtue,  courage,  goodness  may 
be  transplanted  from  one  person  to  another 
without  any  disadvantage  to  the  giver."  In 
1638  the  attempt  was  made  to  pass  the  blood 
from  one  animal  to  another,  and  the  practice 
of  introducing  medicines  directly  into  the 
blood  was  suggested  by  the  great  Christopher 
Wren  in  1656.  Attempts  were  made  by  Clarke, 
Robert  Boyle,  Lower,  and  King  in  England  to 
transfuse  from  animals  to  men,  but  Denis  and 
Eramerez  in  Paris  first  succeeded  in  actually 
transfusing  lamb's  blood  into  the  blood-vessels 
of  a  human  being  on  June  15,  1667.  The  pa- 
tient was  a  man  suffering  from  some  severe 
abdominal  disease,  and  he  is  reported  to  have 
been  improved  by  the  operation.  The  pro- 
cedure fell  into  disrepute  a  year  or  two  later 
after  the  death  of  patients  in  Rome,  Paris,  and 
London  upon  whom  transfusions  had  been  per- 
formed. During  the  remainder  of  the  seven- 
teenth century  and  for  the  entire  eighteenth 
century  no  further  transfusions  were  per- 
formed on  human  beings,  but  experimental 
work  was  continued  in  England,  Germany, 
and  Italy  in  transfusion  and  infusion.  In 
1788  Rosa  announced  the  important  fact  that 
it  was  possible  to  augment  the  total  quantity 
of  an  animal's  blood  without  injury  to  the 


subject,  and  Biohat,  in  1805,  attempted  to  dis- 
cover the  different  effects  of  arterial  and  ve- 
nous blood  by  means  of  experiments  with 
transfusion.  He  succeeded  so  far  that  he  was 
able  to  say  that  venous  blood  stimulated  the 
heart  to  action,  while  it  exerted  a  depress- 
ing influence  upon  the  brain  and  peripheral 
nerves. 

The  publication  of  Leacock's  inaugural  es- 
say, in  Edinburgh,  induced  Blundell  to  renew 
the  efforts  in  behalf  of  transfusion  in  London. 
To  his  writings,  early  in  this  century,  may  be 
attributed  the  scientific  advance  of  this  pro- 
cedure and  its  establishment  upon  a  secure 
basis  {Medico-chirurgical  Transactions,  Lon- 
don, vol.  ix,  1818,  p.  53,  and  Researches, 
Physiological  and  Pathological,  on  Transfu- 
sion of  Blood,  London,  1824).  He  established 
several  very  important  facts  in  connection 
with  transfusion ;  among  them  that  infused 
arterial  blood  contained  the  same  life-giving 
elements  as  venous  blood  ;  that  a  much  smaller 
quantity  of  blood  was  required  to  maintain 
life,  after  a  hsemori-hage,  than  the  actual 
amount  lost;  that  dogs  from  which  the  blood 
had  been  withdrawn  could  live  temporarily 
after  an  infusion  of  human  blood.  He  also 
found  that  animals  which  had  been  starved 
lived  after  repeated  transfusions,  while  similar 
animals  which  were  not  subjected  to  this  pro- 
cedure died.  Blundell  also  perfected  a  syringe 
for  the  performance  of  the  operation.  In  sev- 
eral cases  of  post-partum  hEemorrhage  the 
patients  were  saved  by  transfusion  carried  out 
under  Dr.  Blundell's  direction,  and  the  opera- 
tion gained  thereby  enormously  {Lancet,  Sep- 
tember 17,  1835,  p.  343;  October  8,  1825,  p. 
Ill ;  November  19,  1825,  p.  395). 

Prevost  and  Dumas,  about  the  same  time, 
made  a  most  important  discovery  in  this  con- 
nection, deriving  their  information  from  ani- 
mal experimentation  and  removing,  at  the 
same  time,  one  of  the  chief  dangers  and  ob- 
jections from  the  operation  of  transfusion.  In 
the  main,  their  conclusions  were  that  defibrin- 
ated  blood  was  capable  of  completely  replac- 
ing normal  blood  lost  by  hismorrhage  and  of 
carrying  on  the  functions  of  the  latter;  that 
the  blood  of  different  species  was  not  well 
suited  to  the  purposes  of  transfusion,  for, 
although  it  might  maintain  a  life  that  was 
threatened  from  loss  of  blood  by  its  stimulant 
power,  the  red  cells  became  dissolved  in  their 
strange  medium  and  were  excreted  by  the  kid- 
neys and  the  intestines.  They  further  asserted 
that  for  human  beings  human  blood  only 
should  be  employed  in  transfusion,  and  that 
this  should  always  be  defibrinated.  Among 
their  minor  recommendations  may  be  men- 
tioned the  caution  against  a  too  rapid  filling 
of  the  blood-vessels,  lest  the  heart's  action  be 
impeded,  and  the  fact  that  defibrinated  blood 
which  has  been  preserved  by  cold  for  a  con- 
siderable time  may  be  used  with  safety  if 
previously  warmed  (Annales  de  chimie  et  de 
physique,  xviii,  Paris,  1821).  These  observa- 
tions have  been  confirmed  again  and  again, 
mainly  by  Dieflenbach  (Die  Transfusion  des 
Blutes,  Berlin,  1828),  Bischoff  (Beitrdge  zu  der 
Lehre  von  dem  Blute  und  der  Transfusion 


TRANSFUSION  AND  INFUSION 


318 


desselben.  MilUer's  ArcMv,  1835,  iv),  Pamim 
(Virchow's  Archiv,  xxvii,  1863,  pp.  240  and 
433),  and  Polli  (Annali  universali  di  medicina, 
cited  in  Schmidt's  Jahrbiichir,  Ixxv,  p.  88). 

Following  the  experiments  of  Panum  {loc. 
cit.},  the  indirect  transfusion  of  human  blood 
was  mainly  practised  in  emergencies  calling 
for  this  operation.  A  few  years  later,  how- 
ever, the  direct  transfusion  of  animal  blood 
came  into  vogue  for  a  short  time,  but,  after 
unfavourable  results  in  the  hands  of  various 
surgeons,  was  relegated  to  an  obscurity  from 
which  it  has  never  been  recalled.  In  various 
noteworthy  publications  Landois  showed,  as 
Prevost  and  Dumas  had  previously  demon- 
strated, that  the  blood  of  an  animal  of  a  dif- 
ferent species  was  not  suited  to  the  purposes 
of  transfusion,  since  a  dissolution  of  the  red 
blood-cells  resulted,  and  that  the  "  resistance  " 
of  blood-cells  of  different  species  varied  widely. 
He  pointed  out  that  the  haemooflobin  of  the 
dissolved  red  cells  appeared  in  the  urine  in  its 
own  form  and  as  albumin  within  a  few  hours 
of  the  operation.  He  proved  that  the  trans- 
fusion, in  large  quantities,  of  the  blood  of  dif- 
ferent species  frequently  produced  clots  in 
the  larger  blood-vessels,  which  often  led  to  sud- 
den death,  and  that  rouleaux  of  red  cells 
might  fill  and  occlude  the  pulmonary  capil- 
laries. He  finally  asserted  that  blood  of  a 
different  species  was  of  value  only  in  bringing 
oxygen  to  tissues  that  urgently  required  it, 
that  such  blood  could  under  no  circumstances 
replace  the  functions  of  normal  blood,  and  that 
it  mattered  little  whether  this  medium  was  de- 
fibrinated  or  introduced  into  the  circulation  of 
the  receiver  unchanged.  (See  mainly  Central- 
blatt  fur  die  medicinische  Wissenschaften,  xi, 
1873,  p.  56;  xii,  1874,  p.  37;  and  xiii,  1875,  p. 
1.)  Landois  further  contends  (Eulenburg's 
Real-Encyclopadie  der  gesammten  Heilkunde, 
XX,  Vienna  and  Leipsic,  1890,  p.  43)  that  the 
liberated  hsemoglobin  causes  the  dissolution 
of  many  white  blood-cells,  by  which  the 
fibrin-forming  elements  of  the  blood  are  set 
free.  Prom  these  considerations  it  will  eas- 
ily appear  that  signs  of  disturbances  in  the 
circulation  may  malse  themselves  manifest. 
The  skin  of  human  beings  who  have  undergone 
transfusion  with  lamb's  blood  may  assume  a 
dark  bluish-red  colour,  followed  by  circum- 
scribed areas  of  inflammation  and  of  urticarial 
eruptions.  The  occlusion  of  the  smaller  pul- 
monary vessels  may  determine  dyspnoea,  a 
laceration  of  the  capillaries  with  bloody  expec- 
toration, and  epistaxis.  Sudden  death  from  an 
embolus  may  even  supervene.  Increased  peris- 
talsis, with  bloody  stools  and  vomiting,  and 
involuntary  evacuations,  with  colic  and  flatu- 
lence, may  be  some  of  the  symptoms  on  the 
part  of  the  intestinal  tract.  As  Ponfiok  has 
shown,  there  may  be  casts  in  the  urine,  or  in- 
farcts may  appear  in  the  kindey,  as  Masing 
has  pointed  out.  The  heart,  the  peripheral 
nervous  system,  and  the  brain  may  show  the 
effects  of  a  disturbed  circulation.  In  fine,  all 
parts  of  the  organism  respond  in  some  meas- 
ure to  the  presence  of  an  alien  blood.  As  a 
rule,  after  such  a  transfusion,  within  a  short 
time  (from  half  an  hour  to  an  hour)  the  tem- 


perature rises,  sometimes  as  high  as  105°  F., 
but  it  may  subsequently  become  subnormal 
owing  to  the  diminished  metabolism  caused  by 
the  circulatory  disturbances  The  rise  of  tem- 
perature, it  should  be  remarked,  may  follow 
the  transfusion  of  allied  blood,  but  it  rarely 
reaches  as  high  a  figure  under  the  circum- 
stances above  mentioned. 

Ponfick  and  Panum  corroborated  this  valu- 
able work  of  Landois's,  adding  some  symptoms 
on  the  part  of  the  kidneys  and  liberated  hsemo- 
globin  that  are  significant.  The  exhaustive 
labours  of  these  observers  succeeded  in  putting 
an  end  to  the  transfusion  of  alien  blood,  con- 
vincing even  its  most  ardent  supporters.  Dur- 
ing the  discussion  concerning  the  value  of 
transfusion  from  animals  to  men  other  experi- 
menters were  labouring  with  details  of  the 
procedure.  Thus,  Worm-Miiller  showed  that 
even  after  a  slowly  induced  but  considerable 
increase  in  the  blood  quantity  by  transfusion — 
although  carried  to  more  than  one  hundred 
per  cent. — the  increase  in  blood-pressure  on 
the  part  of  the  recipient  of  the  blood  was  very 
insignificant  and  produced  no  disturbance 
of  well-being  {Transfusion  und  Plethora; 
eine  physiologische  Stvdie.  Univ.-Programm, 
Christiania,  1875).  He  also  proved  that,  al- 
though the  red  blood-cells  might  not  live  per- 
manently in  their  new  medium,  they  carried 
on  their  functions,  for  some  time  at  least,  and 
this  fact,  for  the  practical  purposes  of  transfu- 
sion, is  of  the  highest  importance. 

It  was  at  this  very  period  that  transfusion 
met  with  a  severe  blow,  from  which  it  has 
never  fully  recovered,  in  the  discovery  by 
Alexander  Schmidt  that  every  transfusion  with 
defibrinated  blood  might  contain  an  element 
of  vital  danger  by  the  production  of  what 
Kohler  calls  "  ferment-intoxication "  (Arnim 
Kohler,  Inaug.  Dissert.,  Dorpat,  1877).  In 
order  properly  to  understand  the  position 
which  Schmidt  and  his  pupils  assumed,  it 
will  be  necessary  to  refer  briefly  to  the  physi- 
ology of  coagulation.  It  was  Schmidt  who 
called  attention  to  the  fact  that  after  the  de- 
parture of  the  blood  from  the  blood-vessels 
its  clotting  was  due  to  the  action  of  a  ferment 
agent,  fibrin  ferment,  upon  the  precursors  or 
producers  of  fibrin — viz.,  fibrinogen  and  para- 
globulin.  He  showed,  as  well,  that  the  fibrin 
ferment  appeared  upon  the  rapid  destruction 
of  the  white  blood-cells  which  always  occurs 
and  which  he  estimated  in  the  horse  to  amount 
to  71'7  per  cent.  The  blood  withdrawn  from 
an  artery  or  vein  for  the  purpose  of  transfusion 
rapidly  produces  fibrin  ferment,  and  Schmidt 
ai'gues  that  as  the  fibrin  ferment  does  not  en- 
tirely exhaust  itself  by  the  production  of  the 
clot  and  is  in  part  retained  in  the  serum  even 
after  the  necessary  whipping  of  the  blood,  the 
injection  of  the  serum  may  be  productive  of 
coagulation  in  the  blood-vessels  of  the  re- 
ceiver ;  and  this  is  particularly  likely  to  occur 
if  flbrinoplastic  material  (paraglobulin)  is  also 
in  solution  in  the  injected  serum.  Serum  con- 
taining these  elements  became  known  as 
"ferment  blood,"  and  Kohler  succeeded  ex- 
perimentally in  causing  coagulations  of  the 
blood-vessels  of  an  animal  upon  its  injection. 


319 


TRANSFUSION  AND  INFUSION 


The  fibrin  ferment,  however,  did  not  exert  its 
full  influence,  the  interference  probably  being 
due  to  the  activity  of  the  erythrocytes. 

It  is  important,  however,  to  note  that  the 
theory  advanced  by  Schmidt's  school  was  vio- 
lently antagonized  by  those  who  had  succeeded 
in  satisfactorily  practising  the  transfusion  of 
defibrinated  blood.  Prominent  among  these 
was  Landois,  who  pointed  out  that  the  fibrin 
ferment  did  not  exist  in  blood  which  had  been 
thoroughly  defibrinated  by  suflScient  whipping. 
He  admits  (Eulenburg's  Keal-Encyclopadie  der 
gesammteii  Heilkunde,  1890,  xx,  p.  47)  that  if 
one  transfuses  serum  which  has  been  pressed 
out  of  clots  there  is  some  danger  of  toxic 
effect,  since  this  serum  is  rich  in  fibrin  fer- 
ment and  richer  still  in  leucocytes,  which,  upon 
their  introduction  into  the  circulation,  are  de- 
stroyed for  the  production  of  new  masses  of 
fibrin  producers.  But  Landois  insists  that  with 
sufficient  intelligent  care  a  thorough  whip- 
ping of  the  blood  withdrawn  for  transfusion 
purposes  will  produce  a  serum  free  from  fibrin 
ferment  and  flbrinoplastic  material.  He  fur- 
ther contends  that  the  body  is  capable  of  ren- 
dering a  small  proportion  of  fibrin  ferment 
harmless,  partly  by  excretion  through  the  kid- 
neys, as  other  ferments  are  excreted,  in  part 
by  the  deleterious  influence  upon  It  of  carbonic 
acid  which  is  constantly  forming  in  the  body 
as  the  result  of  metabolic  processes. 

The  symptoms  of  the  ferment  intoxication 
which  did  so  much  to  destroy  confidence  in  the 
practice  of  transfusion  here  follow  briefiy. 
A  considerable  quantity  of  "ferment  blood," 
injected  into  the  jugular  vein,  may  cause  the 
instant  death  of  an  animal  by  asphyxia,  and 
the  autopsy  discloses,  extensive  clots  in  the 
right  ventricle,  the  pulmonary  artery,  and  its 
branches.  The  transfusion  of  a  smaller  quan- 
tity into  the  peripheral  part  of  an  artery  may 
be  productive  of  restlessness,  convulsions,  pu- 
pillary dilatation,  severe  dyspnoea,  rapid  and 
irregular  heart  action,  vomiting,  and  diarrhoea, 
in  the  order  named.  The  animal  may  recover 
from  this  attack  or  it  may  remain  ill,  having 
fever,  severe  symptoms  on  the  part  of  the 
gastro-intestinal  tract,  and  pulmonary  and 
nervous  symptoms,  with  ultimate  death.  The 
mucous  and  serous  surfaces  usually  disclose 
hiEmorrhagic  areas,  and  ecchymoses  of  the 
mesenteric  and  bronchial  glands  are  not  in- 
frequently found.  The  coagulability  of  the 
blood  after  death  is  diminished,  probably  be- 
cause the  fibrin-forming  elements  have  been 
exhausted.  In  this  connection  it  is  interesting 
to  observe  that  the  transfusion  of  an  alien  fer- 
ment blood  evokes  the  deepest  ferment  intoxi- 
cation. Landois  believes  that  this  is  because 
the  presence  of  an  alien  blood  causes  a  destruc- 
tion of  red  blood-cells,  the  liberated  haemo- 
globin calling  forth  not  only  the  production  of 
fibrin  ferment,  but  the  destruction  of  leuco- 
cytes as  well,  which,  in  its  turn,  calls  into  being 
new  fibrin  ferment.  Von  Bergmann  agreed 
in  the  conclusions  reached  by  Kohler,  that,  in 
view  of  the  attendant  dangers,  transfusion  of 
defibrinated  blood  should  no  longer  be  prac- 
tised (Die  Sc.hicksale  der  Transfusion  im  letzten 
Vecennium,  Berlin,  1883).    Despite  the  pro- 


testations of  the  physiologists,  this  verdict  in- 
fluenced the  practice  of  transfusion  to  such  an 
extent  that,  although  it  is  still  done,  it  has 
not  met  with  the  universal  adoption  which  was 
expected  about  twenty  years  ago.  In  its  place 
saline  infusion  has  steadily  risen  in  favour  in 
the  profession  for  the  emergencies  which  the 
transfusion  of  blodd  was  expected  to  overcome. 
Landois  [loc.  ait.)  remarks :  "  It  is  further  as- 
serted that  transfusion  can  never  be  helpful ; 
it  can  but  be  harmful,  since  the  transfused 
blood  is  excreted  in  a  very  short  time,  as  soon 
as  it  has  become  disintegrated.  The  blood,  it  is 
said,  acts  only  by  filling  the  vessels,  and  there- 
fore the  infusion  of  a  solution  containing  so- 
dium chloride  is  to  be  preferred.  And  this  is 
urged  with  such  assurance  that  one  might 
believe  that  those  experimenters  who  had  es- 
tablished beyond  a  doubt  the  safety  of  the 
transfusion  of  defibrinated  blood  had  never 
given  the  subject  their  attention ;  and  I  refer 
to  those  who  have  proved  that  the  transfused 
defibrinated  blood  completely  assumes,  in  the 
circulation,  the  functions  of  the  respiratory 
exchange  of  gases,  of  nutrition,  and  of  metab- 
olism, in  the  same  manner  as  the  normal 
blood,  without  giving  any  evidence  that  its  red 
corpuscles  are  dissolved  or  are  destroyed  any 
sooner  or  any  more  extensively."  On  the  other 
hand,  William  Hunter,  in  his  lectures  before 
the  College  of  Surgeons,  London,  said  in  1889 : 
"  Any  advantages  that  the  transfusion  of  red 
corpuscles  may  have  over  simple  saline  injec- 
tions are  counterbalanced  by  the  danger  at- 
tending the  simultaneous  injection  of  white. 
In  the  case  of  defibrinated  blood,  the  latter  so 
predominate  that  transfusion  of  defibrinated 
blood  is  an  operation  not  only  dangerous  in 
itself,  but  one  whose  practical  value  by  no 
means  serves  to  compensate  the  additional  risks 
run  in  carrying  it  out."  In  the  same  series  of 
lectures  Hunter  points  out  the  generally  rec- 
ognised view  of  those  best  fitted  to  judge  as 
to  the  value  of  the  transfusion  of  defibrinated 
blood  (British  Medical  Journal,  August  10, 
1889.  p.  308).  He  concludes  that  defibrinated 
blood  possesses  no  nutritive  value,  that  its  in- 
fusion may  possibly  be  of  value  if  the  real 
need  of  the  body  is  for  red  corpuscles ;  that 
in  simple  anaemia,  when  the  absence  of  iron  is 
the  indication  to  be  met,  the  procedure  is 
valueless  ;  that  in  a  sudden  emergency  a  saline 
infusion  is  equally  good  if  not  better  in  its  re- 
sults. In  cases  calling  for  either  procedure  in 
an  emergency.  Hunter  observes,  there  is  a 
great  fall  in  blood-pressure  which  must  be  met, 
and  the  essential  thing,  therefore,  is  to  fill  the 
blood-vessels.  From  experimental  as  well  as 
clinical  evidence  Hunter  concludes  that  a  saline 
infusion  answers  the  necessary  indications  with- 
out embracing  the  dangers  of  the  transfusion 
of  defibrinated  blood.  It  is  safe  to  say  that  in 
this  country  and  England  this  is  the  view  of 
those  most  competent  to  judge. 

The  German  experimenters  were  not  able  to 
free  themselves  from  the  desire  to  transfuse 
blood,  either  directly  or  indirectly,  after  the 
admitted  brilliant  researches  of  Panum,  Pon- 
fick,  and  Landois,  already  referred  to.  When 
they  saw  the  tide  turning  in  favour  of  saline 


TRANSFUSION  AND  INFUSION 


320 


infusion — intravenous,  intraperitoneal,  or  intra- 
cellular— they  devised  methods  of  transfusion 
o£  blood  which  should  be  free  from  the  objec- 
tions urged  against  the  older  methods,  the  dan- 
gers of  capillary  thrombosis  and  of  intoxication 
by  fibrin  ferment.  Von  Ziemssen  was  particu- 
larly active  in  this  regard,  and  as  late  as  1893 
published  an  opinion  that  direct  transfusion 
was  free  from  the  danger  of  fibrin-ferment 
intoxication.  He  invented  a  method  of  per- 
forming direct  transfusion  of  blood  without 
opening  the  veins  of  either  giver  or  receiver, 
which  had  the  additional  advantage,  in  his 
opinion,  of  excluding  air  during  the  injection 
and  of  allowing  of  the  injection  of  as  great  a 
quantity  as  was  necessary  or  desirable.  A  de- 
scription of  the  procedure  will  be  given  further 
on.  Despite  the  gallant  fight  made  on  behalf 
of  transfusion,  it  steadily  sank  in  favour,  and, 
although  one  still  reads  accounts  of  occasional 
successful  cases,  the  injection  of  saline  liquids 
has  almost  altogether  superseded  it.  And  yet 
the  results  of  direct  transfusion  of  alien  blood 
were  not  so  serious  as  one  might  be  led  to  be- 
lieve. Many  cases  were  successful,  ending  in 
recovery  of  the  patient.  This  may  be  ex- 
plained by  the  facts  that  usually  a  limited 
quantity  was  transfused  and  that,  as  a  rule, 
the  body  was  able  to  eliminate  the  deleterious 
materials  which  had  entered  the  circulation. 
The  apparent  improvement  which  at  first  fol- 
lows every  transfusion  of  the  blood  of  an  animal 
of  different  species,  even  in  cases  ultimately 
fatal,  may  find  explanation  in  the  great  stimu- 
lation imparted  by  any  transfusion  to  the 
heart  and  lungs.  Nevertheless,  the  dangers  of 
capillary  thrombosis  in  the  lungs,  as  well  as  in 
the  periphery  of  the  body,  following  direct 
transfusion  of  alien  blood  are  real,  and  this 
procedure  has  met  a  deserved  fate  in  being 
consigned  to  oblivion.  Every  benefit  which 
may  be  derived  from  its  practice  may  be  ob- 
tained from  the  transfusion  of  human  blood 
and  from  a  saline  infusion. 

Before  dismissing  the  subject  of  the  direct 
and  indirect  transfusion  of  human  blood  it 
will  be  well  to  pass  rapidly  in  review  the  ar- 
guments for  and  against  its  practice.  Al- 
though, as  mentioned  in  detail  above,  there  is 
no  doubt  that  the  red  blood-cells  live  and  per- 
form their  function  in  a  new  medium  after  a 
direct  transfusion,  there  is  equally  no  question 
that  in  the  very  act  of  transfusion  the  danger 
of  clotting  in  the  apparatus  and  of  the  clot 
being  carried  into  the  circulation  offers  weighty 
objections  to  this  mode  of  procedure.  Further, 
the  fear  of  subsequent  coagulation  in  the  pul- 
monary or  peripheral  circulation,  against  which 
no  caution  can  be  observed,  is  sufficiently  de- 
terrent. The  fact,  too,  that  only  venous  blood, 
less  nutritious  and  less  stimulating  than  arte- 
rial, can  be  so  infused  is  an  argument  against 
the  measure.  If  it  were  possible  to  transfuse 
directly  from  an  artery  to  an  artery  through  a 
warmed  short  tube,  the  direct  transfusion  of 
human  blood  would  offer  a  greater  and  wider 
field  than  it  actually  does.  At  the  present  day 
it  is  rarely  if  ever  practised. 

The  transfusion  of  defibrinatcd  human  blood 
is  theoretically  ideal.     Practically,  however, 


the  dangers  attendant  upon  its  perforrnance 
render  it  unsafe.  The  indirect  ti'ansfnsion  of 
the  entire  blood  as  it  is  withdrawn  is,  of  course, 
out  of  the  question,  for  the  possibility  of  clot- 
ting after  its  introduction  is  even  greater  than 
that  of  directly  transfused  blood ;  but  even 
with  defibrinated  blood  the  bulk  of  opinion  is 
against  transfusion,  for,  even  though  the  blood 
withdrawn  may  be  thoroughly  defibrinated, 
may  be  actually  deprived  of  fibrin-forming 
elements,  the  danger  of  intoxication  from  the 
evolution  of  new  fibrin  ferment  stands  as  a 
bar  against  its  use.  It  will  be  remembered,  as 
was  pointed  out  above,  that  defibrinated  blood 
contains  many  leucocytes,  and  that  after  its 
introduction  into  the  blood-vessels  of  the  re- 
ceiver these  white  cells  are  disintegrated  and 
form  new  fibrin  ferment.  It  is  true  that  after 
many  transfusions  of  defibrinated  human  blood 
no  symptoms  of  ferment  intoxication  have  pre- 
sented themselves.  Yet  one  can  never  know 
when  this  frequently  fatal  condition  may  arise, 
and  still  the  deaths  in  many  lethal  cases  of  in- 
direct transfusion  have  not  been  assigned  to 
this  cause — eases  in  which  bloody  urine  and 
stools,  hEcraorrhagic  exudation  into  the  pleura 
and  peritonaeum,  and  a  sudden  death  from  as- 
phyxia have  marked  the  course  from  the  time 
of  "the  transfusion  until  the  end.  Other  symp- 
toms described  in  the  discussion  on  fibrin-fer- 
ment intoxication — such  as  pains  in  the  back 
and  htemoglobinuria — may  be  referred  to  an 
intoxication  or  to  the  destruction  of  the  red  as 
well  as  of  the  white  blood-cells,  evoked,  per- 
haps, by  the  high  temperature  following  trans- 
fusion.' Still,  many  transfusions  of  defibrinated 
human  blood  have  met  the  theoretical  pos- 
sibilities and  allow  the  statement  to  be  made 
in  all  truth  that  under  the  most  careful  intel- 
ligent supervision  a  transfusion  of  human  de- 
fibrinated blood  may  be  safe.  It  is  possible  to 
account  for  these  instances  on  two  grounds — 
first,  that  a  small  quantity  of  defibrinated 
blood  was  used  in  the  procedure :  second,  that, 
owing  to  the  small  quantity  injected,  the  red 
blood-cells  of  the  receiver  were  enabled  to 
overcome  the  pernicious  effects  of  the  fibrin 
ferment. 

These  considerations  naturally  suggest  the 
cautions  to  be  observed  in  the  event  of  a  trans- 
fusion of  defibrinated  blood  being  practised. 
Briefly  they  are  that  the  blood  to  be  transfused 
must  be  thoroughly  defibrinated.  This  implies 
an  active  beating  of  the  blood  for  a  period  of 
time  not  less  than  fifteen  or  twenty  minutes. 
The  blood  must  not  be  above  the  normal  tem- 
perature of  the  body,  since  a  transfusion  of 
blood  too  warm  may  cause  disintegration  of 
the  red  blood-cells  of  the  receiver,  as  shown  by 
Landois.  The  quantity  carried  into  the  re- 
ceiver's blood-vessels  at  one  time  must  be 
small  and  must  be  allowed  to  flow  at  a  slow 
rate  in  order  that  the  fibrin  ferment  trans- 
fused may  be  rendered  innocuous.  A  further 
advantage  of  allowing  the  fluid  to  flow  slowly 
lies  in  the  opportunity  provided  to  stop  the 
operation  if  at  any  moment  serious  or  disa- 
greeable phenomena  present  themselves.  A 
final  measure  of  caution,  not  for  the  operation 
of  transfusion  but  for  its  omission,  is  to  be  ob- 


331 


TRANSFUSION  AND   INFUSION 


served  in  those  conditions  of  poisoning  and 
intoxication  in  which  one  linows  that  there  is 
destruction  of  red  blood-cells  with  an  increase 
of  the  normal  fibrin  ferment.  Such  are,  for 
instance,  poisoning  by  carbonic  oxide,  ether, 
chloral,  potassium  chlorate,  and  phosphorus. 
In  cases  of  this  nature  the  danger  of  transfu- 
sion is  increased  by  the  almost  certain  coagu- 
lation of  the  blood  in  capillary  and  arterial 
areas. 

To  understand  properly  the  purpose  of  a 
saline  infusion  one  must  consider  the  cause  of 
death  after  severe  life-threatening  haemor- 
rhage. Goltz  believed  that  the  fatal  issue  was 
due  to  the  emptiness  of  the  vessels,  which  im- 
paired the  mechanical  equilibrium  of  the  cir- 
culatory process,  and  that  it  was  not  caused 
by  the  actual  withdrawal  of  blood  from  the 
body  which  deprived  the  vital  centres  of  the 
physiological  stimulus  imparted  to  them  by 
the  red  blood-cells.  With  this  belief  he  com- 
bined the  one  that  unless  the  blood-vessels  con- 
tained a  certain  quantity  of  fluid,  and  unless 
the  blood-pressure  retained  a  certain  height,  the 
circulation  could  not  remain  unbroken.  It  may 
be  mentioned  in  this  connection  that  he  pro- 
posed the  injection  of  an  artiiicial  serum  as  the 
best  means  of  filling  the  depleted  vessels.  Al- 
though Goltz's  opinions  were  violently  as- 
sailed by  many  physiologists,  the  excellent 
results  obtained  experimentally  and  clinically 
from  saline  infusions  in  cases  of  acute  anaemia 
have  led  many  reliable  observers  to  accept 
them.  The  discovery  of  the  fibrin-ferment  in- 
toxication gave  the  procedure  of  saline  infu- 
sion an  impetus  it  might  not  otherwise  have 
received,  for  immediately  upon  the  establish- 
ment of  the  proof  of  Schmidt's  and  KShler's 
conclusions  the  transfusion  of  defibrinated 
blood  received  a  sudden  quietus.  At  the  same 
time  experimenters  were  at  work  upon  the 
merits  of  different  fluids  to  be  used  in  intra- 
venous infusion  as  substitutes  for  defibrinated 
blood.  Maydl,  whose  experiments  convinced 
him  of  the  futility  of  injecting  a  saline  liquid, 
confessed  that  death  was  delayed  in  dogs 
which  had  been  deprived  of  two  thirds  of 
their  blood,  estimated  by  weight  ( Wiener  me- 
dicinische  Jahrbueher,  1884).  Kronecker  and 
Landerer  (Berliner  Minische  Wochenschrift, 
1879,  No.  53),  on  the  other  hand,  rescued  dogs 
which  had  lost  three  fourths  of  their  estimated 
blood  by  infusions  of  an  equal  quantity  of  neu- 
tral saline  solution  of  physiological  strength. 
It  was  Sehwarz,  in  1881,  who,  finding  that  the 
injections  as  made  by  Kronecker  not  only  were 
free  from  danger  but  actually  delayed  death 
and  rescued  from  it,  proposed  saline  infusion 
as  a  measure  for  averting  death  from  heemor- 
rhage.  In  the  meantime  experiments  made  in 
the  United  States  tended  to  show  that  any  in- 
different fluid  might  be  used  for  similar  pur- 
poses, and  fresh  cow's  milk  and  goat's  milk 
were  proposed  as  the  medium  to  be  infused. 
This  proposition  rapidly  fell  into  discredit, 
since  the  presence  of  milk  in  the  vessels  is  not 
only  dangerous,  but  serves  the  purpose  for 
which  it  is  intended  in  the  poorest  possible 
manner,  as  has  been  repeatedly  proved. 

There  is,  perhaps,  in  all  medical  literature 


no  discussion  fiercer  and  more  bitter  than  the 
one  waged  at  this  time  between  the  adherents 
of  the  transfusion  of  defibrinated  blood  and 
those  of  saline  infusion.  The  results  of  the 
experiments  of  each  were  perverted  to  suit  the 
individual  doctrine ;  but  the  latter  have  won 
the  fight — not,  however,  until  the  entire  sub- 
ject had  been  i;eviewed  anew  and  modern 
physiological  light  thrown  upon  it.  After 
numerous  experiments  Kronecker  (Deutsche 
medicinisehe  Wochenschrift,  1884,  p.  507)  con- 
cludes that  an  alkaline  solution  which  he  for- 
merly advocated  was  inferior  to  a  neutral 
saline  solution  for  purposes  of  infusion,  since 
the  red  blood-cells  behaved  better  in  contact 
with  a  neutral  than  with  an  alkaline  solution. 
Landerer  concluded  (Archiv  fur  Minische  Chi- 
rurgie,  xxxiv)  that  the  addition  of  one  part 
of  defibrinated  blood  to  a  three-  or  four-per- 
cent, alkaline-saline  solution  was  better  than 
either  an  alkaline-saline  solution  or  defibrin- 
ated blood  alone.  With  this  solution  he  suc- 
ceeded in  saving  animals  which  had  lost  five 
per  cent,  of  the  body  weight  of  blood.  He  also 
obtained  brilliant  results  experimentally  by 
adding  from  three  to  five  per  cent,  of  sugar  to 
the  solution.  This  was  done  in  the  belief  that 
the  restoration  to  the  blood  of  the  sugar  which 
was  lost  from  it  by  haemorrhage  was  essential. 
It  has  been  shown  since  then,  however,  that 
this  addition  is  unnecessary,  for  in  the  ma- 
jority of  the  cases  in  which  infusion  is  indi- 
cated an  ordinary  solution  of  sodium  chloride 
answers  the  purpose. 

The  term  "physiological  salt  solution "  re- 
quires mention.  In  the  serum  of  the  normal 
human  body  sodium  chloride  is  found  in  the 
proportion  of  0'6  per  cent.  This  has  been 
named  the  "  normal  "  or  "  physiological "  salt 
solution.  It  used  to  be  considered  necessary, 
when  employing  this  solution  for  intravenous 
injection,  to  render  it  alkaline,  because  of  the 
known  alkalinity  of  the  blood.  Thus  Hayem 
proposed  for  the  purpose  an  artificial  serum 
containing 

5  Sodium  hydrate 15|  grains ; 

Sodium  chloride 80        " 

Sodium  sulphate 39        " 

Boiled  water 3  fl.  oz. 

Little  proposed  a  solution  composed  as  follows : 

5  Sodium  chloride 50  grains; 

Potassium  chloride 2        " 

Water 1  pint. 

M. 
And  a  favourite  prescription  to  be  found  in 
many  text-books  of  surgery  is : 

5  Sodium  chloride 93  grains ; 

Liquor  sodae 20  drops ; 

Water 2  pints. 

M. 

Many  other  solutions  have  been  recommend- 
ed as  especially  valuable  for  saline  infusions, 
but  clinical  experience  has  taught,  as  above 
mentioned,  that  a  solution  containing  the  nor- 
mal proportion  of  sodium  chloride  fulfils  every 
demand. 

It  must  be  observed  that  even  the  most 
violent  antagonists  of   saline  infusion   have 


TRANSFUSION  AND  INFUSION 


322 


admitted  some  virtues  in  it.  Landois,  for  in- 
stance, wlio  fought  it  scornfully  and  bitterly 
and  who  has  rendered  good  service  to  the 
cause  of  transfusion  of  defibrinated  blood, 
says  that  the  most  that  a  saline  infusion  can 
accomplish  is  to  give  a  patient  suffering  from 
a  threatening  loss  of  blood  improved  condi- 
tions for  the  circulation  of  the  remaining 
blood.  He  insiststhat  it  can  not  replace  trans- 
fusion, but  concedes  that  it  is  valuable  as  a 
forerunner  of  transfusion.  In  one  respect  he 
is  correct,  when  he  asserts  that  in  cases  of  poi- 
soning in  which  the  blood  has  undergone  a 
change,  a  saline  infusion  can  not  take  the  place 
of  a  depletory  transfusion. 

Gartner  and  Beck  ( Wiener  Minische  Wochen- 
schrift,  1893,  No.  31,  p.  568)  have  shown  that 
after  an  intravenous  injection  of  a  highly  con- 
centrated saline  infusion  absorption  from  the 
intestines  and  serous  cavities  is  perceptibly 
hastened.  And,  although  their  experiments 
were  conducted  by  oversalting  the  blood,  they 
added  new  indications  for  the  practice  of  in- 
travenous saline  infusion  :  profuse  diarrhoeas 
and  cholera — which  had  long  before  been  men- 
tioned in  this  connection,  Sir  Spencer  Wells 
having  had  a  cholera  patient  recover,  in  1848, 
after  a  saline  infusion — and  the  more  problem- 
atical ones,  acute  hydrocephalus  and  pericar- 
ditis. 

Almost  all  conceivable  substances  have  been 
injected  into  the  veins  of  human  beings  for 
curative  purposes.  A  few  only  deserve  men- 
tion because  of  their  apparent  logical  use.  In 
the  Lancet  for  May  6, 1893,  p.  1095,  mention  is 
made  of  a  typhoid-fever  patient  into  whose 
veins  alcohol  was  injected  while  he  was  in  col- 
lapse. He  promptly  died.  Baccelli  {Wiener 
medizinische  Blatter,  1894,  No.  13,  p.  153)  de- 
scribes his  method  of  injecting  mercury  into 
the  veins  or  subcutaneous  tissue  in  constitu- 
tional syphilis.     His  formula  is  : 

5   Bichloride  of  mercury 45  grains ; 

Sodium  chloride 45  .    " 

Distilled  water  (sterilized)  .  32  fl.  oz. 

M. 

Although  salivation  is  sometimes  evoked,  Bac- 
celli urges  the  advantages  resulting  from  a 
small  quantity  of  the  drug,  the  rapid  combat- 
ing of  the  symptoms,  and  the  prompt  action 
upon  the  diseased  blood-vessels.  The  intra- 
venous method  has  not  been  generally  adopted. 
Hunter  {loc.  cit.),  among  many  others,  has  an- 
nounced the  futility  of  injecting  by  the  venous 
route  any  substances  other  than  a  normal  sa- 
line solution  where  a  strict  indication  exists ; 
and  it  will  not  be  necessary  further  to  empha- 
size this  point. 

In  considering  the  indications  for  the  per- 
formance of  transfusion,  both  transfusion,  di- 
rect and  indirect,  and  saline  infusion  will  be 
treated  together,  and,  unless  otherwise  speci- 
fied, infusion  will  be  understood.  First  and 
foremost  in  the  list  of  indications  stands  acute 
anmmia,  as  the  result  of  a  hcemorrhage  from 
traumatism,  from  surgical  interference,  or  in 
childbirth.  Those  who  have  witnessed  the 
deepened  respirations,  the  gradual  filling  and 
increasing  strength   of    a    previously  almost 


empty  pulse,  the  colour  slowly  returning  to 
the  face  and  body  after  the  previous  intense 
pallor — those  who  have  seen  these  phenomena 
when  a  patient  seemed  to  be  at  the  brink  of 
the  grave  will  feel  grateful  always  to  those 
who  have  persisted  in  the  elBcaey  of  this  life- 
saving  measure.  Not  that  it  is  always  suc- 
cessful ;  for  in  some  instances,  unfortunately, 
it  seems  to  be  undertaken  too  late,  or  its  good 
effects  seem  to  be  lacking.  In  the  writer's 
cases  only  fourteen  per  cent,  have  recovered ; 
but  they  were  all  eases  in  which  the  outlook 
was  worse  than  bad  when  the  operation  was 
begun.  But  the  writer  is  consoled  by  the  sta- 
tistics of  others,  which  are  in  many  instances 
better,  in  some  worse,  than  his  own.  Two 
striking  cases  are  recorded  by  Sternberger 
(Medical  Record,  January  7,  1893)  in  which 
the  high  virtue  of  an  intravenous  infusion  of  a 
normal  saline  infusion  is  made  plain.  Despite 
the  fact  that  many  persons  suffering  from 
severe  loss  of  blood  do  recover  after  a  saline 
infusion,  the  experiments  of  Mayl  and  of 
Landois  (loc.  cit.)  must  not  be  forgotten.  Both 
these  observers  maintain  that  after  complete 
prostration  from  haemorrhage,  in  which  the 
patient  passes  from  one  attack  of  syncope  into 
another,  a  saline  infusion  alone  can  not  save 
life.  It  is  well,  therefore,  to  keep  the  trans- 
fusion of  defibrinated  blood  in  mind  as  a  last 
resort  in  case  the  infusion  administered  does 
not  fulfil  the  necessities  of  the  case.  After  the 
performance  of  the  infusion,  preparations  may 
be  made  for  the  transfusion,  for,  after  all,  the 
danger  of  ferment  intoxication,  which  may 
sometimes  be  overcome,  is  not  so  great  or  so 
immediate  as  the  danger  to  life  from  the  loss 
of  blood.  In  an  acute  anfemia  the  operation 
must  be  undertaken  as  soon  as  threatening 
symptoms  manifest  themselves — general  pal- 
lor, coldness  of  the  extremities,  a  small, 
scarcely  perceptible  pulse,  shallow,  sighing 
respiration,  complaint  of  great  thirst,  and  at- 
tacks of  syncope.  If  vomiting  is  an  additional 
symptom,  so  that  one  is  persuaded  of  the  im- 
possibility of  giving  stimulants  by  the  mouth, 
the  operation  should  no  longer  be  delayed. 

Dr.  J.  H.  Glenn  (Transactions  of  the  Royal 
Academy  of  Medicine  in  Ireland,  vol.  xiii, 
1895,  p.  306)  reports  nine  cases  of  intravenous 
saline  infusion  for  severe  haemorrhage  with 
two  deaths,  one  in  a  case  already  septic.  The 
quantities  he  infused  at  the  Rotunda  Hospital 
were  remarkable,  from  five  to  seven  pints.  His 
patients  bore  these  large  amounts  well.  When 
it  is  considered  that  an  increase  in  the  volume 
of  blood  even  to  100  per  cent,  is  not  injurious 
to  animals,  there  seems  to  be  no  reason  why, 
when  necessary,  large  quantities  of  a  normal 
saline  solution  should  not  be  introduced 
through  a  vein. 

In  very  obstinate  simple  anmmia  without  a 
previous  direct  loss  of  blood,  and  in  chlorosis 
of  a  high  grade,  transfusion  or  infusion  may 
be  attempted.  Von  Ziemssen  (Gyclopoedia  of 
the  Practice  of  Medicine,  New  York,  1876) 
gives  for  the  former  a  percentage  of  46'9  of  re- 
covery after  the  performance  of  transEusion. 
Still,  anaemia  and  chlorosis  are  usually  curable 
diseases,  and  the  influence  of  a  transfusion  or 


323 


TRANSFUSION  AND  INFUSION 


infusion  is  but  transitory.  And  it  is  scarcely 
wise  to  advise  a  measure  which  has  always  in 
it  an  element  of  danger  for  the  cure  of  an 
afEection  which  usually  runs  its  course  to  a 
favourable  end.  Gusserow  recommends  a  trial 
of  transfusion  in  cases  of  pernicious  anmmia, 
and  Quincke  has  reported  two  cases  in  which 
he  alleged  a  cure  from  the  use  of  the  measure. 
Von  Ziemssen  (loc.  cit.)  urges  that  in  this  af- 
fection, if  benefit  is  expected,  the  procedure 
must  be  often  repeated.  It  is  at  best,  however, 
the  employment  of  a  last  resort,  and  the  dan- 
ger of  ferment  intoxication  is  increased  in  this 
and  in  similar  conditions  by  the  abnormal  in- 
crease of  leucocytes.  Scurvy,  purpura  hcemor- 
rhagica,  and  morius  maculosus  Werlhofii  must 
be  included  in  this  class  of  indications  for  in- 
fusion and  transfusion.  In  the  last-named 
disease  Jilrgensen  had  unfavourable  results, 
and  it  is  of  doubtful  value  in  any  of  this  class 
of  ailments. 

The  acute  infectious  diseases  have  been 
thought  to  offer  a  field  for  the  exercise  of  the 
benefits  of  infusion  and  transfusion.  In  a 
case  of  typhoid  fever  with  collapse  a  success- 
ful case  of  transfusion  with  lamb's  blood  has 
been  reported  (North  Carolina  Medical  Jour- 
nal, 1890,  p.  446).  In  small-pox  the  results 
have  not  been  sufficiently  striking,  either  for 
or  against  the  measure,  to  warrant  a  conclu- 
sion. In  yellow  fever  they  have  been  disap- 
pointing. In  cholera  the  results  may  justify 
the  hope  that  the  measure  may  prove  life-sav- 
ing, although  Stromeyer  and  Little  saw  little 
in  their  trials  to  encourage  them  in  transfus- 
ing ;  they  recommend  saline  infusion  (Clinical 
Lectures  and  Reports  of  the  London  Hospital, 
vol.  iv,  1867-'68,  p.  431).  Landois,  however, 
has  reported  three  cases  of  cholera  successfully 
treated  with  transfusion.  A  saline  infusion,  in 
cholera  particularly,  seems  rational,  since  it 
adds  fluid  to  the  circulating  blood.  In  septi- 
cmmia  and  pycemia,  which  must  be  reckoned 
among  the  infectious  diseases,  the  results  of 
the  measures  under  consideration  have  not 
been  encouraging.  It  does  not  seem  that  they 
are  indicated  in  this  class  of  diseases — except, 
perhaps,  cholera — for  the  addition  of  fresh 
material  to  the  blood,  and  through  this  medium 
to  the  tissues,  can  only  result  in  furnishing  a 
culture  medium  for  the  bacteria  to  thrive  upon, 
and  will  result  in  the  transfused  or  infused 
material  being  disorganized  by  these  organ- 
isms. As  a  consequence,  the  condition  of.  the 
patient,  instead  of  being  improved,  is  likely  to 
become  worse. 

Another  indication  for  saline  infusion  is 
found  in  the  systemic  poisoning  of  the  body  by 
carhonic  oxide.  In  this  form  of  poisoning,  as 
is  well  known,  the-  oxygen  of  the  blood  is 
gradually  replaced  by  carbonic  oxide,  and 
death  ensues  from  asphyxia.  It  was  this  fact 
which  gave  Landois  the  notion  of  what  he  has 
called  "depletory  transfusion,"  in  which  an 
artery  is  opened  for  the  escape  of  the  poisoned 
blood  and  normal  defibrinated  blood  is  admin- 
istered by  transfusion.  He  urges  the  early 
execution  of  the  process  in  order  that  the 
poison  may  not  too  deeply  injure  the  vital 
centres.    The  measure  has  been  advocated  in 


poisoning  with  carhonic  acid,  as  in  asphyxia  and 
in  asphyxia  neonatorum.  It  can  not  be  said  that 
the  results  have  justified  the  hopes  that  were 
inspired.  A  saline  infusion  promises  more, 
pai-ticularly  as  it  helps  to  allay  the  formation 
of  fibrin.  The  mitigation  of  the  toxic  efEeets 
of  chloral,  chloroform,  ether,  phosphorus,  mor- 
phine,anA  opium  has  been  sought  in  depletory 
transfusion  as  well ;  but  here,  too,  a  saline  in- 
fusion is  apt  to  prove  more  helpful,  for  ether, 
chloral,  phosphorus,  and  carbonic  oxide  tend, 
in  poisonous  doses,  to  increase  the  fibrin  fer- 
ment in  the  circulating  blood,  and  Landois 
himself  has  brought  about  clotting  in  the  ves- 
sels by  the  injection  of  ether.  A  transfusion 
has,  theoretically,  a  tendency  to  enhance  the 
danger  in  these  conditions ;  a  saline  infusion 
is  likely  to  be  of  real  benefit.  In  poisoning  by 
carbonic  oxide  (illuminating  gas)  a  saline  in- 
fusion into  the  cellular  tissue  may  be  rapidly 
performed  and  is  of  great  service.  The  theory 
of  a  saline  infusion  in  cases  of  poisoning  rests 
upon  the  belief  that  it  may  be  possible  to  fur- 
ther the  excretion  of  the  toxic  substance  by 
increasing  the  amount  of  fluid  in  the  blood- 
vessels. Nocher  saved  two  patients  with  severe 
iodoform  poisoning  by  a  saline  infusion  of  a 
pint  and  a  half  (Centralhlatt  fiXr  Chirurgie, 
1883,  Nos.  14  and  15). 

Attempts  have  been  made  to  cure  patients 
suffering  from  cholcemia  and  urcemia  by  de- 
pletory transfusion,  as  suggested  by  Landois. 
The  clinical  results  have  not  been  encouraging. 
Von  Belina,  however,  has  recorded  a  success- 
ful case  of  puerperal  eclampsia.  The  proposi- 
tion of  Ponfick  and  von  Lesser  to  carry  out 
transfusion  in  cases  of  severe  Mirns  rests  u  pon 
the  fact  that  after  such  accidents  the  red  blood- 
cells  are  destroyed  in  large  quantities,  induc- 
ing haemoglobiniEmia.  In  these  instances,  too, 
clinical  proof  of  the  value  of  the  measure  is 
lacking.  Hueter,  in  1873,  recommended  pe- 
ripheral transfusion  in  cases  of  freezing  of  the 
extremities,  in  order  to  put  into  circulation  the 
stagnant  blood  in  the  frozen  area.  The  litera- 
ture of  the  subject  contains  no  fui'ther  refer- 
ence to  this  proposition,  and  it  is  mentioned 
only  for  the  sake  of  completeness. 

In  conditions  of  extreme  inanition  and  ca- 
chexia transfusion  has  been  advised  for  the 
purpose  of  nutrition,  but  it  does  not  seem  ra- 
tional to  resort  to  such  a  violent  procedure 
when  better  nourishment  may  be  procured  by 
systematic  feeding.  If  such  a  measure  is  to  be 
considered,  a  saline  infusion  would  answer  the 
purpose  as  well,  since  it  has  not  been  shown 
that  transfused  blood  is  nourishing  to  the  g:en- 
eral  tissues.  A  few  only  of  the  host  of  indica- 
tions that  have  been  urged  as  legitimate  for 
the  practice  of  transfusion  and  infusion  will  be 
rapidly  passed  in  review.  In  severe  intestinal 
hemorrhage,  as  in  typhoid  fever  or  after  an 
injury,  infusion  is  advisable  since  it  is  likely  to 
have  the  same  influence  as  in  a  huemorrhage 
from  any  other  source.  The  same  may  be  said 
of  gastric  hemorrhage,  although  Leube  is  not 
enthusiastic  over  it,  fearing  another  haemor- 
rhage because  of  the  rise  in  blood-pressure ;  as 
already  pointed  out  in  this  article,  however, 
the  rise  of  pressure  is  nominal,  and  the  fear  is, 


TRANSFUSION  AND  INFUSION 


324 


therefore,  ill-founded.  In  cases  of  hmmophilia 
infusion  is  not  to  be  advised,  since  no  stimu- 
lant to  the  heart  should  be  given,  and  the 
presence  of  more  fluid  in  the  vessels  is  apt  to 
induce  a  fresh  hjemorrhage.  In  cerebral  an- 
csmia  infusion  may  be  done  as  a  last  resort. 
In  chronic  gastro-enteritis  in  children  Demme 
proposed  the  injection  of  defibrinated  blood  by 
means  of  a  hypodermic  syringe  into  an  un- 
opened vein,  when  diarrhoea  was  so  profuse  as 
to  impair  the  child's  strength.  Certainly  in 
this  instance  a  saline  infusion  is  more  rigidly 
indicated.  In  cases  of  severe  epistaxis,  in  leu- 
cfenti'rt,  for  example,  an  infusion  may  be  deemed 
necessary.  And  ihe  same  statement  holds  true 
for  haemorrhages  in  any  part  of  the  body. 

As  mentioned  above,  acute  hydrocephalus, 
acute  pericarditis,  and  large  collections  of  fluid 
in  any  of  the  serous  cavities  have  lately  been 
added  as  indications  for  a  saline  infusion,  ex- 
periments on  animals  showing  that  fluids  from 
serous  cavities  are  more  rapidly  absorbed  after 
infusion.  There  is  no  clinical  evidence  to  sub- 
stantiate these  experiments. 

As  a  final  but  important  indication  for  saline 
infusion  may  he  mentioned  shock.  Though  the 
exact  nature  of  this  phenomenon  has  thus  far 
eluded  detection,  the  facts  remain  that  warmth 
may  be  renewed  in  the  body,  the  heart  and 
respirations  may  be  quickened,  and  life  may 
frequently  be  maintained  by  the  timely  and 
judicious  employment  of  a  saline  infusion. 
The  subcutaneous  injection  of  strychnine  si- 
multaneously will  aid  the  heart  in  overcoming 
the  dilficulties  against  which  it  is  striving. 

According  to  the  manner  of  carrying  out  a 
transfusion,  it  is  recognised  by  different  names. 
The  term  hypodermic  transfusion  is  self-ex- 
planatory. The  defibrinated  blood  is  sucked 
up  into  a  large  hypodermic  syringe' and  is  in- 
jected either  directly  into  a  vein  or  into  the 
subcutaneous  tissue.  In  the  latter  case  it  is 
probable  that  the  red  cells  become  disinte- 
grated and  the  method  is  one  not  to  be  ad- 
vised. The  injection  into  a  vein,  though 
sometimes  difficult  of  execution,  may  be  car- 
ried out  repeatedly  by  leaving  the  needle  in 
its  position.  Von  Ziemssen  (Arbeiten  aus  der 
medioinischen  Klinik  der  Konig  Ludwig  Maxi- 
milians Universitdt,  iii,  1893),  who  has  always 
been  an  advocate  of  transfusion,  states  his  be- 
lief that  a  direct  transfusion  is  of  advantage  if 
it  can  be  accomplished  without  the  danger  of 
fibrin-ferment  intoxication.  He  suggests,  in 
cases  of  acute  anaamia  from  any  cause,  chlo- 
rosis, and  cachexia,  the  insertion  of  a  large 
aspirator  needle  into  the  median  basilic  vein 
of  the  giver,  and  another  into  the  median  ba- 
silic of  the  receiver.  Under  the  strictest  asep- 
sis, he  draws  the  blood  into  a  slightly  warmed 
glass  and  injects  it  into  the  needle  in  the  vein 
of  the  receiver.  The  syringe  used  must,  after 
each  injection,  be  washed  in  salt  water,  to  free 
it  from  traces  of  fibrin  ferment.  Von  Ziems- 
sen maintains,  after  many  trials,  that  there  was 
absence  of  hsemoglobinuria  and  phlebitis,  but 
occasionally  he  observed  chills,  fever,  and  albu- 
minuria. There  is  also  an  inci'ease  in  erythro- 
cytes and  in  haemoglobin.  The  advantages  are 
the  opportunity  of  repeated  transfusion  and 


the  lack  of  necessity  of  incising  the  vein  of 
either  giver  or  receiver.  In  1873  Karst  (Ber- 
liner klinische  Wochenschrift,  1873,  p.  587)  sug- 
gested the  injection  of  defibrinated  blood  into 
the  subcutaneous  cellular  tissue,  with  subse- 
quent massage.  This  was  carried  out  in  cases 
of  anaemia  of  many  kinds,  in  chlorosis,  and  in 
cachexia.  From  six  to  eight  fluid  ounces  may 
be  injected  at  a  time  by  means  of  a  large  hypo- 
dermic syringe,  and  immediately  after  the  in- 
jection massage  in  all  directions  is  begun  and 
kept  up  until  the  mass  of  blood  disappears. 
No  two  injections  should  be  made  in  the  same 
area.  As  the  massage  is  very  painful,  chloro- 
form must  be  administered  while  it  is  practised, 
and  the  measure  is  therefore  not  available  in 
eases  of  great  urgency  or  emergency.  Von 
Ziemssen  found  within  twenty-four  hours 
after  a  subcutaneous  injection  of  defibrinated 
blood  an  increase  in  haemoglobin  which  gradu- 
ally diminished. 

The  injection  of  an  isotonic  saline  solution 
into  the  axillary  cellular  tissue  has  been  suc- 
cessfully done  repeatedly.  Mr.  Arthur  Dodd 
{Lancet,  June  27,  1896 ;  New  York  Medical 
Journal,  July  18,  1896)  gives  a  detailed  ac- 
count of  the  performance  of  the  operation, 
citing  a  successful  employment  of  the  proced- 
ure in  a  case  of  partial  placenta  prcevia.  The 
results  of  intracellular  infusion  into  the  axilla 
are  similarly  striking  to  those  obtained  when 
an  infusion  is  made  into  other  cellular  spaces. 
The  instrument  used  is  a  slight  modification 
of  that  employed  for  intravenous  infusion, 
the  only  difference  being  that  a  sharp-pointed 
needle  of  a  little  stouter  make  is  required  in- 
stead of  the  usual  blunt  one.  The  needle,  tube, 
and  syringe  being  fitted  together,  the  syringe 
is  filled  with  the  saline  solution  at  a  tempera- 
ture of  100°  P.  The  point  of  the  needle  is  then 
forced  through  the  skin  of  the  axilla  deeply 
enough  to  move  freely  into  the  cellular  tissue, 
and  the  fluid  is  slowly  forced  through  it.  A  pint 
or  more  may  be  thus  satisfactorily  infused. 

At  a  meeting  of  the  Congres  franpais  de 
medeoine  interne,  M.  Vedel  presented  a  report 
of  experimental  work  with  saline  injections 
(Independance  medicate,  September  9,  1896 ; 
New  York  Medical  Journal,  September  26, 
1896).  Experimenting  on  dogs  which  he  had 
inoculated  intravenously  with  cultures  of  the 
Bacillus  coli  communis,  he  found  that  an  in- 
travenous saline  solution  immediately  after  in- 
oculation produced  a  slower  evolution  of  the 
disease  and  rendered  its  complications  less  pro- 
nounced. Several  successive  injections,  he  says, 
may  be  followed  by  recovery.  If  the  infection 
is  not  intense,  an  early  injection  may  even  pre- 
vent the  development  of  the  infectious  symp- 
toms. Slight  delay  in  performing  the  injection 
does  not  give  results  so  favourable,  although 
recovery  may  still  be  possible.  The  consecu- 
tive injections  are  a  great  aid  to  the  flrst  one. 
The  characteristic  hypothermia  and  cardiac 
weakness  are  not  benefited  by  tardy  injections, 
although  some  amelioration  of  the  pulse  may 
be  noted. 

M.  Vedel  had  some  success  with  large  sub- 
cutaneous injections  in  cholera,  in  pneumonia 
of  the  apex  in  an  alcoholic  subject,  and  in  two 


335 


TRANSFUSION  AND  INFUSION 


cases  of  sfaphylococcus  infection  with  dissemi- 
nated purulent  foci.  In  all  of  his  cases  the 
general  effects  were  about  the  same.  During 
the  injection  the  pulse  grew  more  energetic, 
intermittenoe  was  suppressed,  the  blood-pres- 
sure and  temperature  rose,  and  the  respiration 
was  better.  These  effects  lasted  for  from  thirty 
to  forty  minutes.  Then  the  critical  period  set 
in,  reached  by  a  violent  chill,  frequency  and 
unevenness  of  the  pulse,  and  accelerated  respi- 
ration. Convulsions  and  a  rapid  rise  of  tem- 
perature followed.  At  this  stage  the  cold  was 
followed  by  heat,  the  face  became  gaunt,  the 
conjunctiva3  were  injected,  respiration  was  pain- 
ful, the  pulse  was  accelerated,  and  the  tendon 
reflexes  were  exaggerated.  This  condition 
lasted  about  four  hours  and  was  accompanied 
by  diarrhtea,  sweating,  and  urination,  after 
which  improvement  set  in  and  the  patients 
recovered.  M.  Vedel  asserts  that  these  injec- 
tions are  indicated  early  in  any  infectious  dis- 
ease, the  indications  appearing  in  the  state  of 
the  pulse,  of  the  blood-pressure,  of  diuresis,  and 
of  the  general  condition.  Anuria  and  albumi- 
nuria, ne  says,  are  no  oontra-indications  to  the 
use  of  the  injections.  Large  doses,  however, 
are  not  tolerated  well  by  irremediably  affected 
kidneys;  and  if  pulmonary  cedema  is  present, 
the  injections  must  be  graduated  in  case  of  an 
affection  likely  to  cause  heemorrhages,  in  order 
not  to  favour  the  tendencies  of  the  infectious 
disorder. 

Similar  conclusions  are  reached  by  Bosc 
{Presse  medicale,  June  17,  1896).  The  critical 
stage  is  sooner  reached,  of  course,  when  the  in- 
fusion is  given  by  the  intravenous  route  than 
by  the  subcutaneous.  Boso  thinks  the  bene- 
ficial action  of  the  procedure  to  lie  in  the  fill- 
ing of  the  blood-vessels  and  in  hsemostasis  by 
the  contraction  of  the  torn  arterioles  (when  the 
haBmorrhage  springs  from  this  source),  and  by 
the  precipitation  of  hoematoblasts,  thus  favour- 
ing coagulation  of  the  blood.  The  good  results 
obtained  in  infectious  diseases  are  of  too  com- 
plex a  nature  to  be  as  yet  thoroughly  under- 
stood. Several  theories  have  been  advanced. 
It  seems  scarcely  probable  that  the  compara- 
tively small  quantity  of  fluid  infused  can  pro- 
duce a  destruction  of  the  toxines  or  a  sudden 
increase  of  resistance  on  the  part  of  the  body, 
as  suggested  by  Chorrin ;  it  is  more  likely  that 
the  physiological  resistance  becomes  renewed 
to  a  more  intense  activity.  It  is  possible,  too, 
that  the  profundity  of  infection  may  be  due  to 
a  diminished  phagocytosis  caused  byhypertox- 
icity  of  the  blood.  The  dilution  of  the  blood 
may  then  bring  about  a  renewed  activity  of 
the  leucocytes.  In  the  graver  infectious  con- 
ditions— puerperal  septiccemia.  tetanus,  pneu- 
monia, cholera,  acute  peritonitis,  septiccemia, 
and  pycBmia — a  subcutaneous  or  intravenous 
saline  infusion  may  be  life-saving  in  its  results. 
The  diuretic  effect  of  saline  infusions  has 
been  observed  by  many  writers.  F.  Dumarest 
(Province  medicale,  September  19,  1896 ;  New 
York  Medical  Journal,  October  17,  1896)  gives 
the  results  of  his  experience  with  intramuscu- 
lar injections  of  saline  solutions  in  cases  of 
albuminuria  and  urcemia.  After  the  injec- 
tions, two  orders  of  symptoms  were  observed. 


The  flrst  was  the  improvement  of  the  pulse,  of 
the  energy  of  the  heart,  and  of  the  mental  con- 
dition and  in  the  disappearance  of  the  so-called 
toxic  symptoms,  which  revealed  an  antitoxic 
influence  probably  connected  with  the  dilution 
of  the  poisons.  The  later  symptoms,  polyuria, 
diarrhoea,  and  sweating,  were  more  permanent 
and  exercised  an  eliminating  action.  The 
author  finds  no  contra-indication  to  the  em- 
ployment of  these  injections  in  morphological 
alterations  of  the  kidney.  His  experience,  on  the 
contrary,  has  been  that  they  exert  a  favourable 
influence  on  symptoms  due  to  these  changes. 
Anasarca  &nA  pulmonary  cedema  demand  their 
employment,  since  these  conditions  are  most 
serious  and  demand  heroic  treatment.  Com- 
bined with  phlebotomy,  intramuscular  injec- 
tions may  turn  the  tide  in  the  patient's  favour. 
He  believes  that  the  saline  injections  have  a 
double  influence ;  tonic  and  antitoxic  at  first, 
a  palliative  effect ;  diuretic  and  diaphoretic 
secondarily,)  a  curative  influence.  The  writer 
sees  no  reason  why  intramuscular  should  be  in 
any  way  superior  to  intracellular  or  intravenous 
injections,  both  of  which  can  be  accomplished 
almost  as  quickly.  Moreover,  the  intracellular 
spaces  unquestionably  offer  greater  areas  for 
absorption  than  the  minute,  though  numerous, 
lymph-spaces  of  the  intramuscular  tissues ;  and 
the  intravenous  route  affords  the  most  rapid 
opportunity  for  the  infused  fluid  to  enter  Vae 
circulation.  The  activity  recently  shown  in 
this  field  of  research  is  encouraging.  It  dem- 
onstrates not  only  the  generally  accepted  value 
of  saline  infusions,  but  an  extension  of  its  use- 
fulness which  opens  up  great  opportunities  for 
study  and  for  scientific,  clinical  application. 

Rectal  transfusion  of  defibrinaled  blood  was 
suggested  by  Dr.  A.  H.  Smith  (New  York  Medi- 
ccd  Journal,  April,  1879)  and  by  Sansom  (Lancet, 
February  9,  1881).  Ponfick  recommended  the 
injection  of  defibrinated  blood  into  the  perito- 
nceum,  to  promote  its  rapid  absorption  (Bres- 
lauer  drztlicke  Zeitschrift,  August  23,  1879). 
Despite  the  increase  of  red  blood-cells  that 
was  found  after  this  procedure,  the  attendant 
dangers  of  peritonitis,  and  a  death  in  Hosier's 
hands,  banished  the  operation.  It  may  be 
stated  in  this  connection  that  Afanajew  (Cen- 
tralblatt  fur  Chirurgie,  1884,  p.  670,  citing 
Vrateh,  1884,  No.  24)  suggested  the  intra- 
venous employment  of  peptone  blood,  as  it 
had  been  shown  that  this  remained  fluid  for 
twenty-four  hours  and  the  dangers  of  throm- 
bosis and  clotting  would  be  thus  avoided. 
But  even  the  experimental  work  showed  such 
profound  disturbances  in  the  animals  used 
that  it  was  never  tried  clinically. 

The  consideration  of  intraperitoneal  saline 
infusion  is  legitimately  in  place.  The  fact 
that  into  an  unopened  abdomen,  the  visceral 
and  peripheral  layers  of  peritonsum  lying  in 
close  apposition,  the  insertion  of  a  needle  or 
of  a  trocar  and  cannula  is  full  of  danger,  ren- 
ders the  operation  a  hazardous  one.  It  is  im- 
possible for  even  the  most  skilful  operator  to 
determine  accurately  and  beyond  peradventure 
whether  the  point  of  his  needle  lies  in  the 
intestine  or  in  the  free  peritoneal  cavity. 
Moreover,  injury  to  the  gut,  with  a  subse- 


TRANSFUSION  AND  INFUSION 


336 


quent,  perhaps  fatal,  peritonitis — even  if  the 
peritoneal  sac  were,  by  good  fortune,  entered 
— is  a  very  likely  and  very  possible  accident. 
One  must"  therefore  unhesitatingly  condemn 
this  procedure  as  reprehensible. 

The  peritonaeum,  however,  is  rapid  and  re- 
liable in  its  absorption  of  fluids.  Dr.  1.  Adler 
and  Dr.  S.  J.  Jleltzer  have  recently  shown, 
beyond  any  question,  that  the  peritonaeum  ab- 
sorbs isotonic  and  hypotonic  solutions  of  sodi- 
um chloride  rapidly  through  the  thoracic  duct 
(Journal  of  Experimental  Jledicine,  Septem- 
ber, 1896).  It  does  this,  moreover,  rapidly,  and 
such  solutions  of  sodium  chloride  thus  quick- 
ly find  their  way  into  the  circulating  blood. 
Their  further  announcement  that  similar  so- 
lutions are  absorbed  from  the  peritonasum  of 
dead  rabbits  makes  the  suggestion  about  to 
be  made  pregnant  with  significance,  for  it  is  in 
oases  in  which  all  the  conditions  of  intra-ab- 
dominal pressure  are  changed  that  saline  in- 
fusions of  any  kind  are  urgently  called  for ; 
not,  indeed,  the  changes  of  death,  but  those 
closely  allied  to  it.  The  suggestion  of  the 
writer  is  that  when  for  any  reason  an  intra- 
venous, or  an  intracellular  or  subcutaneous 
saline  infusion,  can  not  be  done,  or,  having 
been  done,  seems  not  to  exert  the  effect  expect- 
ed or  desired,  a  very  small  incision  be  made 
through  the  linea  alba  into  the  peritoneal 
cavity — an  incision  not  over  an  eighth  of  an 
inch  in  length — and  through  this  opening  as 
large  a  quantity  of  normal  or  isotonic  saline 
infusion  as  is  desired  be  injected  through  a 
blunt  cannula  or  tube.  The  bleeding  would 
be  most  insignificant,  the  shook  would  be 
minimal,  and  there  would  be  a  certainty  of  ab- 
sorption. The  writer  is  aware  of  the  risks  of 
making  even  a  small  incision  into  the  peri- 
tonaeum, especially  when  there  is  a  greatly 
lowered  vitality;  and  he  would  not  minimize 
the  possible  dangers  of  a  cceliotomy  even  to 
advance  a  plausible  theory.  And  yet.  under 
the  most  rigid  aseptic  and  antiseptic  prepara- 
tions and  in  the  face  of  impending  death,  he 
would  not  hesitate  to  resort  to  this  procedure 
if  the  other  usual  measures  failed  him. 

There  is  one  other  condition  in  which  an 
Intraperitoneal  saline  infusion  may  be  accom- 
plished. During  the  progress  of  a  laparotomy, 
when  the  indications  for  a  saline  infusion  arise, 
the  fluid  may  be  placed  directly  in  the  ab- 
dominal cavity  and  left  there  with  a  certainty 
of  absorption.  This  measure  does  not  pre- 
clude the  carrying  out  of  a  subsequent  rectal 
or  intravenous  or  intracellular  addition  to  the 
body's  totality  of  fluids,  and  may  of  itself  be 
sufficient  to  overcome  the  symptoms  arising 
from  a  severe  hmmorrhage.  For  this  purpose 
the  solution  should  be  of  the  normal  strength 
and  at  the  normal  temperature,  and  the  ra- 
pidity and  infallibility  of  its  absorption  allow 
the  employment  of  a  much  larger  quantity 
than  can  be  used  if  the  other  methods  are  re- 
sorted to. 

Transfusion  may  be  direct  or  indirect.  If 
direct  or  immediate,  the  blood  is  transferred 
from  artery  to  vein,  or  from  vein  to  vein,  or 
from  artery  to  artery,  the  choice  resting  with 
the  operator  and  according  to   the  circum- 


stances. Most  frequently,  when  done  at  all,  it 
is  accomplished  from  vein  to  vein.  There  are 
almost  innumerable  apparatuses  for  the  prac- 
tice of  direct  infusion.  Among  the  best  are 
Aveling's  and  Landois's  modification  of  it, 
Eoussel's,  Schliep's,  and  Albini's.  It  is  un- 
necessary to  describe  these  in  detail,  as  in 
many  particulars  they  resemble  each  other. 
The  essential  element  of  each  is  a  rubber  tube 
of  the  smallest  possible  length  which,  at  its 
middle,  is  enlarged  like  the  bulb  of  a  Davidson 
syringe.  Two  cannulae  are  necessary,  one  each 
for  the  vein  of  the  giver  and  that  of  the  re- 
ceiver. The  latter  cannula  may  be  of  glass  or 
silver,  must  be  slightly  curved,  and  should  be 
provided  with  an  oblique,  well-rounded  opening 
at  its  distal  end — the  end  that  enters  the  vein. 
It  should  be  two  inches  and  a  half  in  length 
and  should  have  a  small  collar  at  its  proximal 
end  to  hold  the  rubber  tubing  which  is  applied 
over  it  securely.  Further,  its  diameter  gradu- 
ally diminishes  as  it  approaches  the  distal  end. 
The  giver  of  the  blood  must  always  be  a  healthy 
individual,  free  from  acute  disease  or  constitu- 
tional taint.  After  the  vein — usually  the  me- 
dian cephalic  or  median  basilic  in  the  arm  or 
the  great  saphenous  vein  in  the  leg — is  selected, 
the  vessel  is  dissected  free  for  about  an  inch 
and  a  half.  It  is  then  incised  and  the  cannula 
attached  to  the  rubber  tubing  is  slipped  into 
it.  The  apparatus  has  previously  been  filled 
with  a  solution  of  salt  in  water.  As  the  blood 
enters  the  tubing,  the  dilatation  in  the  tub- 
ing is  squeezed  while  the  tubing  between  the 
dilatation  and  the  giver  is  compressed;  the 
tubing  between  the  -'syringe  "  and  the  receiver 
is  next  compressed,  the  syringe  again  fills  itself 
with  blood,  and  the  act  is  repeated  until  a 
suificient  quantity  has  been  transfused. 

If  the  transfusion  is  from  artery  to  vein — as 
the  old  transfusion  of  animal's  blood  was  usu- 
ally performed — it  may  be  done  by  means  of  a 
burette  or  by  the  same  iheans  as  has  been  de- 
scribed for  the  transfusion  from  vein  to  vein. 
In  the  transfusion  from  artery  to  artery — usu- 
ally from  the  central  end  of  the  radial  to  the 
peripheral  end  of  the  radial — the  arteries  are 
incised  on  the  side  after  that  of  the  giver  has 
been  tied  peripherally  and  that  of  the  receiver 
centrally.  The  cannulsB  are  inserted  according- 
ly, after  being  surrounded  by  a  ligature  each, 
and  the  blood  is  allowed  to  flow,  iDeing  aided 
by  the  apparatus  above  described.  Upon  the 
completion  of  the  operation,  both  vessels  are 
ligated  securely. 

The  direct  transfusion  of  blood  is  so  full  of 
danger  that  it  is  now  rarely  attempted.  The 
description  of  the  apparatus  already  given  will 
serve  in  describing  indirect  or  mediate  trans- 
fusion. In  this  procedure,  the  desired  quan- 
tity of  blood  is  drawn  from  the  giver  into  a 
bowl,  which  is  placed  in  another  vessel  con- 
taining water  at  the  temperature  of  the  body. 
The  blood  is  submitted  to  a  thorough  beating, 
of  not  less  than  fifteen  or  twenty  minutes'  dura- 
tion, with  a  glass  rod,  the  fibrin  depositing  it- 
self on  the  staff  being  removed  from  time  to 
time.  When  no  more  fibrin  is  observed  clinging 
to  the  rod,  the  beaten  blood  is  filtered  through 
linen  which  has  been  previously  washed,  to  free 


327 


TRANSFUSION  AND  INFUSION 


it  from  the  little  lumps  of  fibrin  which  float  in 
it.  In  the  mean  time  the  vein  or  artery  selected 
is  exposed.  The  cannula  above  described  is  in- 
serted into  it,  the  vein  below  being  ligatured, 
and  about  the  cannula  a  loose  ligature  is  ap- 
plied. A  tightly  fitting  rubber  tube  is  con- 
nected with  the  cannula  and  the  defibrinated 
blood  is  allowed  to  flow  in  slowly  by  its  own 
■weight  through  a  burette  or  flltei',  or  is  slowly, 
very  slowly,  pumped  in  with  a  syringe.  Upon 
the  completion  of  the  operation,  the  ligature 
about  the  cannula  is  tightened.  When  intra- 
venous transfusion  is  made,  the  veins  mentioned 
in  connection  with  direct  transfusion  are  usu- 
ally chosen.  Should  intra-arterial  transfusion 
be  chosen,  the  radial  or  the  posterior  tibial  artery 
may  be  used.  If  the  transfusion  is  centripetal, 
the  artery  below  the  point  of  transfusion  is  liga- 
tured ;  if  the  centrifugal  route  is  preferred — as 
it  is  by  some,  so  that  the  blood  may  undergo 
further  filtration  in  the  capillaries — ^^the  artery 
must  be  ligated  above  the  point  of  the  insertion 
of  the  cannula.  Centripetal  arterial  transfusion 
has  the  advantage  of  introducing  the  fresh  ma- 
terial directly  into  the  arterial  circulation  and 
of  more  quickly  restoring  the  lowered  blood- 
pressure.  In  acute  antemia  and  asphyxia  this 
is  of  importance.  It  is  sometimes  very  difficult 
of  accomplishment,  as  centrifugal  transfusion 
is,  because  of  the  great  pressure  that  must  be 
overcome. 

It  goes  without  saying  that  the  operation  of 
transfusion,  either  direct  or  indirect,  must  be 
carried  out  under  the  strictest  surgical  asepsis 
and  antisepsis ;  and  the  same  caution  applies 
to  saline  infusion  and  the  other  operation  herein 
to  be  described.  The  hands  of  the  operator,  the 
skin  of  the  giver  and  of  the  receiver,  and  all  in- 
struments employed  must  be  made  rigidly  asep- 
tic. Further,  care  must  be  taken  that  no  air 
enters  the  exposed  vessels,  and,  finally,  an  asep- 
tic dressing  must  be  applied  to  the  wound. 
The  quantity  of  blood  to  be  transfused  varies 
■with  the  conditions  and  age.  An  adult  may 
receive  from  one  to  two  pints,  if  given  for  acute 
anffimia;  if  administered  in  cases  of  poisoning, 
a  larger  quantity  may  be  transfused. 

The  phenomena  usually  manifested  after  a 
transfusion  of  defibrinated  blood  are,  in  their 
order,  a  subjective  and .  objective  sensation  of 
warmth,  deepened  respirations,  and  a  fuller  and 
more  frequent  pulse.  The  face  and  upper  part 
of  the  body  become  reddened  and  the  patient 
perspires.  The  pulse  and  respiration  gradually 
become  quieter  and  the  flushing  and  sweating 
disappear.  Sometimes,  within  a  period  vary- 
ing from  fifteen  to  twenty  minutes,  a  severe 
chill,  followed  by  a  rise  of  temperature,  may 
ensue,  accompanied  by  lumbar  pain  and  hiema- 
turia.  The  majority  of  observers  ascribe  this 
fever  to  fibrin-ferment  intoxication.  Severe 
occasional  symptoms  are  bloody  exudations 
into  the  serous  cavities  and  into  the  tissues, 
and  sudden  deaths  from  asphyxia  have  been 
observed.  The  hsemoglobinuria  has  already 
been  accounted  for  (see  above) ;  the  lumbar 
pains  have  been  ascribed  to  renal  infarcts. 

A  saline  infusion  requires  a  less  elaborate 
armamentarium  than  a  transfusion.  The  can- 
nula above  described,  a  large  glass  filter  or 


glass  jar,  and  instruments  for  exposing  and  li- 
gating  the  selected  vein  are  all  that  are  needed. 
A  saline  solution  containing  a  drachm  of  or- 
dinary table  salt  (sodium  chloride)  to  a  quart 
of  water  is  preferred  at  the  present  day.    The 
water  should  be  hot  when  infused,  at  a  tem- 
perature of  between  116°  and  118°,  cooled  down 
from  120°  F.     A  vein  in  the  arm,  the  median 
cephalic  or  median  basilic,  is  rapidly  exposed 
by  dissection  after  the  application  of  a  bandage 
tightly  rolled  about  the  arm  higher  up,  in  order 
to  make  the  vein  stand  out  distinctly,  for  it  must 
not  be  forgotten  that  in  the  conditions  for  the 
relief  of  which  an  infusion  is  usually  under- 
taken the  veins  are  apt  to  be  collapsed.     A 
small  opening  is  made  in  the  vein  with  a  pair 
of  scissors  and  the  vessel  is  ligatured  below. 
The  cannula  is  inserted  into  the  opening,  a 
loose  ligature  is  applied  about  it,  the  bandage 
is  removed,  no  longer  to  obstruct  the  circula- 
tion, and  the  fluid  is  allowed  to  flow  from  the 
jar  or  filter.     Care  must  be  taken  to  avoid  the 
entrance  of  air,  by  allowing  the  saline  solution 
to  flow  through  the  rubber  tube  and  cannula 
before  the  insertion  of  the  latter  into  the  vein. 
From  one  to  two  pints  may  be  thus  infused, 
the  solution  flowing  slowly  from  a  height  of 
three  or  four  feet.     Upon  the  completion  of 
the  operation,  the  ligature  about  the  cannula 
is  tightened  and  an  aseptic  dressing  applied. 
It  is  not  necessary  to  sew  the  cutaneous  woimd. 
[Dr.  Ely  Van  De  Warker,  of  Syracuse  (New 
York  Medical  Journal,  December   12,  1896), 
while  he  grants  that  subcutaneous  infusion 
and  saline  rectal  enemata  are  ordinarily  quite 
as  efficient  as  intravenous  infusion,  insists  that 
they  are  not  so  rapid  in  their  action  and  hence 
are   not  to  be   depended  upon  in   desperate 
cases.     He  describes  a  special  apparatus  which 
he  has  devised.     It  consists  of  a  glass  contain- 
er large  enough  to  hold  from  3  pints  to  2  quarts 
of  solution,  fitted  with  a  sufficient  length  of 
pure  gum  tubing  given  off  from  the  bottom  of 
the  container.     The  glass  has  a  scale  of  ounces 
etched  into  its  side,  so  that  the  quantity  of 
fluid  infused  at  any  stage  of  the  operation  may 
be  readily  ascertained.     The  second  part  of 
the  apparatus  consists  of  a  cannula,  a  trocar, 
and  a  .stopcock.     One  end  of  the  cock  is  corru- 
gated so  as  to  be  firmly  held  by  the  distal  end 
of  the  tubing.    The  other  end  of  the  cock  is 
slightly  tapered  so  as  to  slip  into  the  head  of 
the  cannula,  which  is  bevelled  to  correspond, 
so  that  when  it  is  connected  with  the  cannula 
an  airtight  taper  joint  is  formed.     The  trocar 
has  a  head  sufilciently  large  to  be  easily  grasped 
by  the  fingers  and  withdrawn  -when  the  can- 
nula is  inserted  into  the  vein.     The  operation 
is  done  by  the  use  of  this  apparatus  as  follows : 
After  the  vein  is  exposed  a  small  mouse-tooth 
forceps  is  used  to  pick  up  the  vessel,  but  any 
small  forceps  will  serve  the  purpose.    The  con- 
tainer having  been  filled,  the  stopcock  con- 
nected with  the  tubing  is  held  by  an  assistant. 
The  cannula  and  trocar  together  are  inserted 
into  the  vein,  which  is  held  up  by  the  forceps, 
so  as  to  offer  a  slight  shoulder  to  the  sharp 
point  of  the  trocar,  which  is  thrust  into  the 
lumen   of  the  vein,  care  being  taken  not  to 
transfix    the    vessel.    The    stopcock    is   no^w 


TRAUMATICIN 
TREPUSIA 


338 


opened,  and  the  solution  allowed  to  escape  un- 
til the  tubing  is  thoroughly  warmed  and  the 
solution  runs  out  at  a  proper  temperature. 
The  operator  is  now  ready  to  withdraw  the 
trocar  and  thus  open  the  cannula,  through 
which  the  blood  flows  more  or  less  freely. 
The  stopcock,  still  open  and  with  the  solution 
flowing,  is  at  once  connected  with  the  cannula 
by  the  taper  joint  simply  by  thrusting  the  two 
together.  Thus  the  two  currents,  one  of  blood 
from  the  cannula  and  the  other  of  saline  solu- 
tion through  the  eock,  are  joined  without  the 
possibility  of  the  entrance  of  air.  The  flow  of 
solution  is  regulated  by  the  eock  as  well  as  by 
the  height  at  which  the  container  is  held 
above  the  point  of  delivery.  In  the  case  of 
collapsed  veins,  says  Dr.  Van  De  Warker,  after 
a  very  exhausting  hasmorrhage  or  extreme 
shook,  no  blood  will  escape  from  the  cannula 
after  the  trocar  is  withdrawn.] 

Dawbarn  (Medical  Record,  January  2, 
1893)  suggests  intra-arterial  infusion  of  a  so- 
dium-chloride solution  of  the  physiological 
strength  in  cases  of  collapse  and  acute  ancemia. 
He  infuses  into  the  femoral  artery  through  a 
hypodermic  needle  connected  to  a  Davidson 
syringe  by  means  of  a  soft-rubber  catheter. 
By  combining  the  hypodermic  injection  of 
strychnine,  iV  of  a  grain  in  divided  doses,  and 
the  use  of  a  very  hot  solution,  Dawbarn  and 
others  have  obtained  excellent  results. 

Usually  after  a  hot,  intravenous  saline  infu- 
sion there  is  a  chill,  quite  severe  in  character, 
followed  by  a  moderate  rise  of  temperature  (to 
from  102°  to  103°  P.),  which  rapidly  descends 
to  normal.  The  chill  appears  in  from  fifteen 
to  thirty  minutes  after  the  completion  of  the 
operation,  and  may  be  accounted  for,  in  the 
writer's  opinion,  by  the  cooling  down  of  the 
blood  to  a  normal  temperature  after  the  addi- 
tion to  it  of  a  solution  of  a  temperature  of 
118°  P.  Within  a  few  minutes  after  the  infu- 
sion the  pulse  becomes  full  and  strong,  the 
patient  perspires  freely,  and  his  respirations 
are  amplified.  If  the  case  is  to  proceed  satis- 
factorily, the  pulse  usually  remains  full,  al- 
though not  so  bounding  as  at  first.  If  the 
infusion  has  not  been  sufficient  to  tide  the 
patient  over,  the  improvement  is  but  tempo- 
rary and  a  repetition  of  the  operation  may  be 
indicated.  The  flushing  of  the  face  observed 
after  transfusion  is  present,  too,  after  an  infu- 
sion, and  indicates  a  rise  in  blood-pressure 
and  an  augmentation  of  the  force  of  the  heart's 
beat. 

The  employment  of  a  saline  solution  in  the 
subcutaneous  cellular  tissue  was  sure  to  follow 
the  general  disuse  of  transfusion — subcutane- 
ous and  other.  Miinchmeyer  (Archiv  fur  Gy- 
niikologie,  xxxiv)  found  it  of  great  benefit  in 
ancemia  of  any  kind  and  in  shock.  As  above 
pointed  out,  it  is  a  valuable  procedure  in  acute 
ancemia  and  poisoning  by  illuminating  gas. 
It  is  of  value  if  the  circulation  is  not  too  feeble 
to  take  up  the  infused  solution ;  it  raises  the 
blood-pressure  and  thereby  increases  the  force 
of  the  cardiac  beat.  There  is  no  reaction,  ac- 
cording to  Miinchmeyer,  and,  when  done  under 
aseptic  conditions  and  followed  by  thorough 
massage,  it  is  a  harmless  procedure.    Miinch- 


meyer recommended  a  0'6-per-cent.  solution  of 
sodium  chloride  at  98°  P.,  and  the  injection  of 
two  pints.  He  found  it  particularly  useful  in 
the  brown  atrophy  of  the  heart  muscle  common 
in  fibroid  disease  of  the  uterus. 

Many  New  York  physicians  have  provided 
themselves  with  large  sterilized  hypodermic 
needles  (such  as  are  commonly  used  with 
aspirators),  attached  to  a  sterilized  rubber 
tube,  which  in  turn  can  be  connected  with  a 
syringe,  a  filter,  or  a  glass  jar — for  emergen- 
cies in  which  an  intracellular  infusion  may  be 
called  for.  The'  subscapular  spaces,  the  inter- 
scapular space,  the  inguinal  region,  and  the 
inner  side  of  the  thigh  offer  suitable  places 
for  the  practice  of  intracellular  infusion. 

At  the  Berlin  International  Congress  in  1891 
Lewaschev  proposed  the  replacement  of  pleu- 
ritic fluid  by  saline  solution.  In  the  Tkera- 
peutische  Wochenschrift  for  June  28,  1896,  he 
calls  attention  again  to  this  measure.  By  a 
thoracentesis  he  gradually  aspirates  the  pleu- 
ritic fluid  and  replaces  it  by  an  equal  quantity 
of  physiological  salt  solution.  This  prevents 
a  too  rapid  expansion  of  the  lungs  into  the 
empty  pleura,  while  the  solution  is  gradually 
absorbed.  Lewaschev  maintains  that  this  pro- 
cedure exerts  a  tonic  and  locally  aseptic  influ- 
ence. He  reports  fifty-two  cases  of  cure  by 
this  method. 

By  "  reciprocal  transfusion,"  a  term  pro- 
posed by  Lauder  Bninton,  is  meant  the  wash- 
ing out  of  leueomaines  from  the  blood-vessels 
of  fever  patients  with  a  normal  saline  solution. 
A  writer,  cited  in  the  New  York  Medical  Jour- 
nal for  August  17,  1889,  suggests  the  washing 
out  of  the  blood  with  the  blood  of  an  immu- 
nized person,  a  proceeding  the  value  of  which 
it  is  not  necessary  to  discuss  at  the  end  of  this 
article. 

The  term  "nervous  transfusion"  refers  to 
hypodermic  injections  of  extracts  made  from 
the  brain  or  spinal  cord. 

A  compendium  of  the  literature  of  transfu- 
sion and  infusion  up  to  1886  may  be  found  in 
volume  xviii  of  Deutsche  Chirurgie,  Stuttgart, 
1885. — Samuel  M.  Bmokneb. 

TRAXTMATICIIT  is  the  name  applied  to 
a  two-per-cent.  solution  of  gutta-percha  in 
chloroform,  introduced  by  Auspitz,  of  Vienna, 
as  an  improvement  upon  the  solution  of  gutta- 
percha which  was  official  at  that  time  in  the 
pharmacopoeias.  It  is  used  in  the  same  man- 
ner as  the  liquor  gutta-percha;  as  a  protective 
application  to  the  surface  in  slight  superficial 
injuries  or  inflammations,  and  is  in  many  re- 
spects superior  to  collodion  for  this  purpose. 
It  may  be  applied  with  a  small  brush,  a  glass 
rod,  or  the  finger  to  abrasions,  slight  excoria- 
tions, slight  superficial  wounds  after  bleeding 
has  ceased,  fissured  lips,  and  cutaneous  erup- 
tions, and  by  the  protection  it  affords  it  pro- 
motes rapid  healing.  Its  action  is  purely 
mechanical.  After  it  has  been  painted  over 
the  affected  part  the  chloroform  rapidly 
evaporates  and  leaves  a  thin,  almost  colourless 
film  of  gutta  percha  which  adheres  to  the  skin 
with  sufficient  tenacity  to  furnish  protection 
from  the  air,  friction,  or  most  other  sources  of 


339 


TRAUMATICIN 
TKEPUSIA 


irritation.  At  the  same  time  it  is  non-con- 
traotile,  soft,  flexible,  and  elastic,  so  that  it 
never  mechanically  causes  irritation  in  the 
manner  frequently  observed  after  the  use  of 
collodion.  As  this  coating  is  not  too  easily 
removed,  it  may  be  used  as  a  protection  when 
the  healthy  skin  is  about  to  be  exposed  to  in- 
fluences which  may  cause  infection,  irritation, 
or  abrasion. 

In  addition  to  its  use  as  a  protective  agent 
in  the  manner  just  described,  traumaticin  has 
been  highly  recommended  as  a  solvent  and 
vehicle  for  various  drugs  employed  in  the  treat- 
ment of  skin  diseases.  Thus,  it  is  maintained 
that  when  it  is  desired  to  apply  chrysarobin  in 
cases  of  psoriasis,  it  is  frequently  advantage- 
ous to  dissolve  this  drug  in  traumaticin  and 
paint  the  solution  over  the  diseased  area. 

In  the  treatment  of  erysipelas,  Eenoy  and 
Bolognesi  recommend  the  application  of  a 
mixture  of  ichthyol  and  traumaticin,  which 
they  state  to  be  abortive  in  sixty  per  cent,  of 
the  cases.  The  mixture  they  employ  is  com- 
posed of  three  parts  of  ichthyol  and  ten  parts 
of  traumaticin,  a  combination  which  makes  a 
dark-brown  liquid.  This  is  applied  with  a 
brush  over  the  inflamed  area  and  beyond  its 
border  for  at  least  three  quarters  of  an  inch. 

The  employment  in  cases  of  syphilis  of  a 
mixture  of  calomel  and  traumaticin  has  been 
suggested  by  Peroni,  and  very  favourable  re- 
sults obtained  in  this  manner  are  described  by 
Cauchard.  A  bath  is  given  to  the  patient  and 
then  traumaticin  containing  twenty-flve  per 
cent,  of  calomel  is  painted  over  the  skin 
wherever  syphilitic  manifestations  are  pres- 
ent, or,  when  these  are  absent,  the  mixture  is 
painted  on  the  patient's  back.  This  applica- 
tion is  made  three  times  a  week  until  the 
syphilitic  symptoms  have  disappeared.  This 
method  of  treatment  seems  to  be  most  effica- 
cious when  it  is  applied  to  sypMlides  of  either 
the  papular,  pustular,  or  squamous  variety,  as 
it  combines  the  advantages  of  both  local  and 
general  treatment,  but  it  is  said  to  be  also  of 
value  in  oases  of  syphilis  without  any  cutaneous 
eruption.  Cauchard  says  that  this  method  is 
particularly  indicated  in  cases  where  the  inter- 
nal administration  of  mercury  is  not  well  borne, 
in  children  suffering  from  hereditary  syphilis, 
and  in  persons  with  cutaneous  eruptions. 

This  is  certainly  a  very  neat  and  cleanly 
method  of  making  local  applications  of  such 
medicaments  as  those  mentioned,  and,  if  fur- 
ther experience  demonstrates  that  such  appli- 
cations are  equally  effective  as  those  made 
with  the  vehicles"  commonly  emjjloyed,  it 
should  supersede  the  methods  ordinarily  in 
use,  as  they,  in  spite  of  the  utmost  endeavour, 
can  hardly  avoid  the  charge  of  being  unclean- 
ly.— Matthias  Lanckton  Poster. 

TRAUBIATOL,  C■,'E^10,  an  iodocresol  ob- 
tained by  the  action  of  iodine  on  cresol,  is  a 
purplish-red  powder  said  to  be  antiseptic,  non- 
poisonous,  unirritating,  and  odourless.  It  has 
been  recommended  as  a  substitute  for  iodoform. 

Ladeire  (Allgemeine  Wiener  medicinische 
Zeitung,  September  1  and  8,  1896 ;  British 
Medical  Journal,  October  17,  1896)  records  a 


large  number  of  observations  made  by  himself 
and  others  upon  the  antiseptic  and  therapeu- 
tic properties  of  this  new  drug.  It  appears  to 
have  been  used  with  great  success  in  the  treat- 
ment of  varicose  ulcers,  eczema,  metritis,  vag- 
inal gonorrhoea,  soft  chancres,  and  wounds. 
Bacteriological  researches  also  prove  its  anti- 
septic power.  The  author  states  that  in  con- 
trast to  iodoform,  which  is  both  irritating  and 
poisonous,  traumalol  is  absolutely  harmless 
and  non-irritating,  both  locally  and  generally. 
Internally,  its  antiseptic  action  on  the  respi- 
ratory tract  is  as  potent  as  that  of  creosote 
or  iodoform.  Furthermore,  it  exerts  a  most 
favourable  influence  on  that  ordinarily  in- 
tractable complaint  tuberculous  diarrhoea. 

According  to  Floershein  (Journal  des  pra- 
ticiens,  September  26,  1896  ;  New  York  Medi- 
cal Journal,  October  17,  1896),  the  conditions 
in  which  traumatol  may  be  employed  are  those 
presenting  the  genei'al  indications  for  antisep- 
tics. Its  preparations  are  as  numerous  as 
those  of  iodoform  and  its  employment  is  as 
simple.  It  may  easily  be  incorporated  in  vase- 
line in  the  following  manner: 

5  Vaseline 75  grains ; 

Traumatol 15       " 

M. 

This  ointment  may  be  employed  in  cutane- 
ous affections  or  in  the  surgery  of  the  eye. 
Gauze  may  be  impregnated  with  traumatol  as 
easily  as  with  salol,  iodoform,  or  boric  acid. 
Traumatol  pencils  have  been  successfully  used 
in  fistulous  tracts  and  in  endometritis ;  their 
preparation  is  as  follows : 

5  Traumatol 150  grains ; 

Pulverized  gum 8       " 

M. 

This  is  to  be  mixed  with  a  sufficient  quan- 
tity of  water  and  glycerin.  Traumatol  may 
be  mixed  also  with  oil  and  collodion. 

TREACIiE,  or  molasses,  theriaca  (Br.  Ph.), 
is  sometimes  employed  in  the  diet  of  children 
on  account  of  its  slight  laxative  action,  but  its 
chief  uses  in  medicine  are  as  an  excipient  for 
pill  masses  and  to  flavour  the  official  imita- 
tions of  chlorodyne.  Dr.  William  Murrell 
(Manual  of  Pharmacology  and  Therapeutics, 
London  1896)  gives  the  following  formula  for 
making  treacle  whey,  which  he  says  is  "re- 
garded by  many  as  a  sovereign  remedy  for  a 
cold " :  Pour  two  or  three  tablespoonfuls  of 
treacle  into  a  pint  of  boiling  milk,  then  let  it 
boil  up  well  and  strain  it.  It  is  to  be  taken  as 
hot  as  it  can  be  borne,  after  going  to  bed. 

TBErXXSIA.— This  fanciful  name  has  been 
given  by  a  Neapolitan  pharmacist  to  a  prepa- 
ration consisting  of  dried  and  powdered  defl- 
brinated  blood.  It  is  termed  also  a  "natural 
iron  albuminate."  It  is  a  dark  reddish-brown 
powder  soluble  in  water,  said  by  Geissler  and 
Meller  to  have  the  following  composition : 

Serum,  paraglobulin,  and  globulin. .  89'73.3 

Extractives 2"475 

Inorganic  salts 6'295 

Iron  oxide 0-888 

98-885 
It  has  been  recommended  for  use  in  anmmia 
and  chlorosis. 


TRIBROMALDEHYDE 
TRIOxNAL 


330 


TRIBROMALDEHYDE.— See  Bbomal. 
TRIBEOMANILINE       HYDROBRO- 
MIDE. — See  Bromamidb. 

TRIBROMHYDRIN,  or  more  correctly 
allyl  tribromide,  is  a  colourless  or  faintly  yel- 
low liquid  at  ordinary  temperatures.  When 
cooled  down  below  50°  P.  it  solidifies  into  a 
mass  resembling  fat.  Its  chemical  formula  is 
CsHjBrs.  It  is  prepared  by  the  action  of  three 
parts  of  bromine  upon  two  parts  of  allyl  iodide. 
Its  specific  g:ravity  is  from  2'407  to  2-430.  The 
action  of  allyl  tribromide  is  closely  akin  to  that 
of  the  oil  of  garlic.  The  oil  of  garlic  contains 
an  organic  radicle,  allyl,  CsHb.  Its  exceeding- 
ly pu7igent  odour  and  acrid  taste  are  likewise 
imparted  to  the  tribromine  salt.  Both  irritate 
the  skin  when  locally  applied,  and  may  even 
cause  vesication. 

Allyl  tribromide,  when  given  internally,  im- 
parts the  characteristic  alliaceous  odour  to  the 
urine,,  the  perspiration,  and  the  breath.  It  has 
not  been  extensively  used  in  practice,  but,  in 
general,  its  effects  are  similar  to  those  of  the 
oil  of  garlic.  It  maybe  employed  in  spasmodic 
affections,  of  organic  or  functional  origin.  It 
has  been  praised  in  the  treatment  of  asthma, 
a'lgina  pectoris,  and  the  convulsions  of  in- 
fancy, and  is  said  to  relieve  the  symptoms  of 
hysteria.  It  has  probably  the  action  of  a  mild 
stimulant  upon  the  gastric  raucous  membrane. 
It  may  be  employed,  like  the  oil  of  garlic,  as  a 
stimulant  expectorant  in  chronic  bronchitis  and 
in  unyielding  acute  bronchitis. 

Allyl  tribromide  may  be  administered  in 
capsules  in  doses  of  5  drops.  For  hypodermic 
use,  it  may  be  given  in  doses  of  from  3  to  4 
drops,  when  immediate  action  is  desired,  dis- 
solved in  a  small  quantity  of  ether. 

Samuel  M.  Beickner. 

TRIBROMOMETHANE.— See     Beomo- 

FOEM. 

TRIBROMPHENOL.— See  Beomol. 

TRIBROMSALOL.— This  compound  of 
bromol  and  salicylic  acid,  CeHe.CrHjBrsOs,  has 
been  recommended  as  an  intestinal  antiseptic, 
but  has  not  come  sufficiently  into  use  to  war- 
rant any  definite  statement  as  to  its  value.  It 
is  said  to  be  a  very  unstable  compound. 

TRIBULXTS  liANTJGIlTOSUS.  —  This 
zygophyllaceous  plant,  indigenous  to  India  and 
Cochin-Chiiia,  has  been  credited  with  being 
emollient,  diuretic,  and  antispasmodic,  arid  has 
been  employed  in  the  treatment  of  dyspnoea, 
colic,  gonorrhoea,  spermatorrhoea,  and  urinary 
irritation.  According  to  M.  Bocquillon-Li- 
mousin  (Formulaire  de  medicaments  nouveaux 
pour  1896),  it  has  been  particularly  vaunted 
in  England  as  a  remedy  for  spermatorrhoea 
and  the  mental  troubles  that  may  accompany 
that ,  disorder.  A  fluid  extract,  made  with 
equal  parts  of  the  fruit  and  alcohol,  may  be 
given  in  doses  of  from  5  to  10  drops  three 
times  a  day. 

TRICHLORACETIC  ACID.— This  com- 
pound, CCIs.COOH,  is  generally  considered 
preferable  as  a  caustic  to  the  other  chloraoetic 
acids  (see  Chloeaoetio  acid).  As  an  astrin- 
gent application  to  enlarged  tonsils  and  to  the 


pharynx  in  cases  of  follicular  pharyngitis,  Ehr- 
mann (cited  by  Booquillon-Limousin)  has  found 
it  useful  when  employed  in  the  following  solu- 
tion : 

5  Trichloracetic  acid 5  grains; 

Iodine 3      " 

Potassium  iodide 3^    " 

Glycerin 1  fl.  oz. 

M. 

TRICHLORPHENOL,     a    three  -  atom 

chlorine    substitution    derivative  of   carbolic 

CI 
acid,  CbH2</-,A,  occurs  in  colourless  acicu- 

lar  crystals  having  the  odour  of  phenol.  It 
has  been  said  to  be  a  very  energetic  antisep- 
tic, far  exceeding  carbolic  acid,  but  on  this 
point  opinions  are  not  unanimous.  It  has 
been  found  highly  useful  as  a  topical  applica- 
tion in  erysipelas,  in  the  form  of  an  ointment 
containing  from  one  to  two  per  cent,  of  the 
drug.  A  solution-  of  the  same  strength  may 
be  employed  in  erysipelas,  also  as  a  wash  for 
foul  ulcers,  and  weaker  solutions,  of  from  half 
to  one  per  cent.,  as  a  vaginal  injection  in  leu- 
corrhcRa  or  for  injecting  into  the  rectum  in 
dysentery.  Triohlorphenol  forms  a  compound 
with  magnesium,  magnesium  trichlorphenate, 
which  has  been  used  in  a  two-per-cent.  solu- 
tion as  a  coUyrium  in  cases  of  purulent  oph- 
thalmia. 

TRICRESOL  is  a  combination  of  at  least 
three  members  of  the  cresol  group,  which  oc- 
curs as  a  colourless  oily  liquid  with  an  odour 
resembling  that  of  creosote  and  soluble  in 
about  forty  parts  of  water.  Contact  with  it 
does  not  benumb  the  hands,  as  in  the  case  of 
carbolic  acid,  and  it  is  apparently  without  ef- 
fect upon  metals.  It  is  about  as  poisonous  as 
carbolic  acid,  but,  inasmuch  as  solutions  of 
one  third  the  strength  of  those  of  that  sub- 
stance are  quite  as  active,  it  is  held  by  some  to 
be  preferable  as  an  antiseptic. 

Tricresolamine  consists  of  two  parts  each 
of  tricresol,  ethylenediamine,  and  water.  It  is 
slightly  less  irrftating  tha.n  tricresol  itself,  and 
is  employed  in  solutions  varying  in  strength 
from  one  tenth  to  one  per  cent. 

[Professor  Charteris  and  Dr.  John  IMorton,  of 
Glasgow  {Lancet,  March  31,  1894),  have  sub- 
jected tricresol  to  experimental  investigation, 
using  guinea-pigs  for  the  purpose  and  inject- 
ing subcutaneously  C  minims  of  the  drug 
mixed  with  25  minims  of  water,  also,  for  the 
sake  of  comparison,  a  solution  of  carbolic  acid 
of  the  same  strength.  They  found  that  this 
injection  of  tricresol  caused  in  seven  minutes 
a  backward  movement,  which  was  shortly  fol- 
lowed by  convulsions  of  the  hind  legs ;  after- 
ward the  whole  body  was  affected.  The 
convulsions  were  not,  however,  severe,  and  in 
forty  minutes  they  ceased,  leaving  the  guinea- 
pig  a  little  dull,  yet  when  touched  it  moved 
readily. 

Pure  phenol  injections  also  caused  convul- 
sions, which  commenced  in  the  same  manner 
and  extended  over  the  body.  They  were,  how- 
ever, somewhat  more  pronounced  than  those 
caused  by  the  tricresol  injection ;  in  the  course 
of  an  hour  the  guinea-pig  recovered. 


331 


TRIEROMALDEHYDE 
TRIONAL 


Neither  of  the  injections  was  followed  by  an 
open  sore,  but  in  the  course  of  three  days  a 
little  hardness  was  detected  at  the  sites  of 
the  punctures  in  the  cellular  tissue  of  the 
abdomen. 

They  found  that  a  12-minim  and  a  10-minim 
dose  of  tricresol  caused  immediately  severe 
convulsions,  which  became  continuous  and  in- 
volved the  whole  body.  Prom  other  experi- 
ments they  came  to  the  conclusion  that  a 
lethal  dose  of  tricresol  was  from  7  to  8  minims. 

Experiments  on  micro-organisms  instituted 
at  the  same  time  showed  that  tricresol  was  al- 
most, but  not  quite,  three  times  as  powerful  a 
germicide  as  pure  phenol.  An  exposure  of  the 
Staphylococcus  pyogenes  aureus  to  a  solution 
of  1  in  20  of  phenol  invariably  rendered  the 
organisms  sterile  in  two  minutes,  and  a  solu- 
tion of  1  in  60  of  tricresol  had  the  same  effect ; 
but  in  the  shorter  exposures  the  l-in-20  phenol 
solution  gave  a  greater  proportion  of  sterile 
cultures  than  tricresol. 

They  therefore  conclude  that  tricresol  is 
three  times  as  strong  a  germicide  as  pure  phe- 
nol, and  that  it  is  three  times  less  toxic-  Its 
advantages,  consequently,  for  surgical  pur- 
poses are  very  pronounced. 

Mr.  Robert  Lee,  of  West  Kensington,  having 
read  Charteris  and  Morton's  article,  had  the 
idea  of  ascertaining  if  a  solution  of  tricresol 
would,  like  one  of  carbolic  acid,  when  heated, 
give  off  a  vapour  constantly  of  its  own  strength. 
He  found  that  it  would,  and  he  consequently 
suggests  its  use  for  inhalation  in  diseased  con- 
ditions of  the  respiratory  passages  in  which 
carbolic  acid  has  been  found  useful.  In  his 
experiments  he  used  a  solution  of  a  drachm  of 
tricresol  in  a  pint  of  water,  but  he  remarks 
that  this  is  rather  strong  for  children,  with 
whom  a  weaker  one  may  be  employedj 

RnssELL  H.  Kevins. 

TRirOLITJM  FIBRINUM:,  or  Menyan- 
thes  trifoliata,  the  buck-bean,  is  a  gentianace- 
ous  herb  widely  distributed  over  temperate 
regions  of  Europe  and  America.  The  leaves, 
folia  trifolii  fibrini  (Ger.  Ph.),  are  tonic,  cathar- 
tic, and  in  large  doses  emetic.  They  are  now 
but  little  used  in  medicine.  The  dose  of  the 
powdered  leaves  as  a  tonic  is  20  grains,  three 
times  a  day;  that  of  the  extract,  extractum 
trifolii  fibrini  (Ger.  Ph.),  is  10  grains. 

TRIFOBMAL.— See  Formaldehyde. 

TBIFORMOIi.— This  is  a  trade  name  for 
trioxymethylene,  or  paraformaldehyde  (see 
Paeaform). 

TRIIODOMETACBESOL.  —  See  Loso- 
PHAsr. 

TRIKEESOL.— See  Tricresol. 

TRIMETHYLAMINE,  or  propylamine, 
(CHs)8N,  is  a  colourless  liquid  obtained  from  a 
large  number  of  albuminoids  which  have  un- 
dergone the  preparatory  stages  of  decomposi- 
tion, and  is  usually  employed  in  the  shape  of 
the  hydrochloride  or  chloride.  It  is  an  active 
irritant  of  the  alimentary  canal,  depresses  the 
action  of  the  heart,  and  lowers  the  tempera- 
ture, especially  in  acute  rheumatism,  in  the 
treatment  of  which  it  has  been  employed  to 
G5 


some  extent,  from  3  to  3  grains  being  given 
every  three  hours.  The  dose  of  the  chloride  is 
somewhat  larger— 5  grains.  Applied  locally, 
undiluted,  trimethylamine  acts  as  a  caustic; 
given  internally  in  full  doses,  it  is  apt  to  cause 
temporary  albuminuria. — Russell  H.  Netins. 

TRIMETHYLETHYLENE.— See  Pen- 

TAL. 

TBINITRIN.— See  Nitroglycerin. 
TRINITROCELLULOSE.— See  Photox- 

YLIN. 

TRINITROPHENOL.— See  Picric  acid. 

TRIOITAXi,  or  diethylsulphonemethylethyl- 
methane,  is  a  member  of  the  groups  of  sul- 
phones  to  which  sulphonal  and  tetronal  belong. 
Its  chemical  formula  is  CeHisSjOi,  and  it  dif- 
fers from  sulphonal  in  containing  one  atom 
more  of  carbon  and  one  fewer  of  hydrogen. 
Trional  occurs  in  white,  inodorous,  almost 
tasteless  crystals.  It  melts  at  about  258°  P. 
It  is  not  freely  soluble  in  cold  water,  more 
easily  so  in  boiling  water,  in  alcohol,  and  in 
milk.  It  burns  on  platinum  foil  without  resi- 
due. 

Administered  in  doses  of  from  15  to  30 
grains,  trional  induces  a  quiet,  usually  a  dream- 
less sleep,  which  lasts  for  from  six  to  eight 
hours.  If  it  is  given  at  bedtime,  this  hypnotic 
effect  is  manifested  in  from  fifteen  to  forty- 
five  minutes,  but  sometimes  not  before  an  hour. 
The  patient  can  usually  be  awakened  with  ease,, 
but  quickly  returns  to  sleep.  The  action  of 
trional  is.  as  a  rule,  not  cumulative,  as  that  of 
sulphonal  is.  It  is  easily  decomposed  by  the 
metabolic  processes  of  the  body.  After  the 
natural  awakening  at  the  end  of  the  induced 
sleep,  its  effect  upon  the  organism  disappears. 
Its  long-continued  use  is  said  to  have  caused 
the  presence  of  haematoporphyrin  in  the  urine  ; 
but,  although  this  may  appear  as  a  sign  of 
acute  or  chronic  intoxication  from  the  drug, 
it  is  doubtful  if  it  appears  readily,  owing  to  the 
easy  decomposition  of  trional  in  the  body. 

Occasionally  in  the  morning,  after  its  ad- 
ministration, lassitude  and  a  sense  of  pressure 
in  the  head  have  been  observed,  but  they  have 
disappeared  in  a  few  hours.  Very  rarely  a  post- 
poned action  of  trional  is  obtained  or  its  effect 
may  be  protracted.  This  is  valuable  in  so  far 
that  one  dose  can  thus  be  made  to  do  service 
for  several  successive  nights,  or  one  large  dose 
may  supplant  several  smaller  ones.  It  is  det- 
rimental, however,  in  this  respect,  that  the 
drowsy  feeling  oppresses  the  patient  during  the 
day.  Occasionally,  after  the  ingestion  of  tri- 
onal, patients  have  complained  of  loss  of  ap- 
petite, belching,  and  epigastric  pain ;  these 
symptoms  may  be  accompanied  by  nausea  and 
vomiting,  vertigo,  and  unsteadiness  of  gait. 
In  one  series  of  reported  cases  some  of  the  pa- 
tients complained  of  dizziness  and  inability  to 
stand,  and  felt  as  if  they  were  intoxicated. 
These  symptoms  soon  disappeared  and  sleep 
followed.  Others  have  observed  tinnitus  au- 
rium,  great  sensitiveness  to  sounds,  and  hy- 
perffisthesia. 

A  reduction  in  the  blood-pressure  and  a 
lowering  of  the  pulse  from  five  to  ten  beats 


TRIOXYBENZOI, 
TROPACOCAINE 


332 


a  minute  have  been  observed,  together  with 
palpitation.  Animal  experimentation  shows 
but  little  fall  in  the  blood-pressure;  at  first 
there  is  an  increase  in  the  number  of  respira- 
tions and  heart  beats,  with  death  from  respir- 
atory paralysis. 

The  writer  has  been  able  to  collect  six  cases 
of  acute  and  three  of  chronic  intoxication  by 
trional.  The  symptoms  of  acute  trional  poison- 
ing are  an  intensification  of  the  effects  of  physi- 
ological doses.  There  appear  severe  loss  of 
equilibrium,  vertigo  and  ataxia,  vomiting,  and 
diarrhoea.  The  temperature  falls  below  nor- 
mal. In  one  case  of  bronchitis  and  emphy- 
sema in  which  trional  had  been  given  but 
once  there  was  a  great  increase  in  the  rapid- 
ity of  the  pulse  and  respiration,  accompanied 
by  great  excitation  and  collapse.  Reinioke 
{Deutsche  medicinische  Wochenschrift,  March 
28,  1895)  describes  the  case  of  a  young  woman 
suffering  from  acute  hallucinatory  insanity  to 
whom  trional  had  been  given  for  fifteen  weeks. 
Her  bowels  were  regular.  In  one  hundred  and 
seven  days  she  received  600  grains  of  trional  in 
doses  of  15  grains  every  other  night.  She  be- 
came affected  with  headache,  vertigo,  muscse 
volitantes,  abdominal  pain,  and  slight  elevation 
of  temperature.  The  pulse  became  small  and 
rapid,  there  were  nausea  and  diarrhoea,  and  the 
urine  contained  blood  and  hyaline  and  granu- 
lar casts.  Recovery  ensued  under  appropriate 
treatment,  although  the  general  symptoms 
lasted  for  some  time.  Boudeau  (cited  in  the 
same  journal,  1895,  No.  45)  cautions  against 
the  too  prolonged  employment  of  trional,  since 
he  has  observed,  after  having  given  it  in  60- 
grain  doses  in  three  successive  nights,  somno- 
lence, hallucinations,  stertorous  breathing, 
cyanosis,  ataxia,  and  red  discoloration  of  the 
urine.  Sometimes  his  patients  complained  of 
dizziness,  headache,  and  tinnitus  aurium. 

Chronic  trional  intoxication  (Deutsche  medi- 
cinische Wochenschrift,  1894,  No.  17)  is  charac- 
terized by  anorexia,  vomiting  and  constipation, 
and  epigastric  pain.  Collapse  and  death  may 
ensue.  Haematoporphyrin  appears  in  the  urine, 
which  is  probably  due  to  some  disturbance  of 
hsemoglobin. 

The  hypnotic  effect  of  trional  is  probably 
due  to  a  direct  influence  upon  the  cerebral  cor- 
tex. This  may  be  inferred,  in  the  absence  of 
direct  experimental  evidence,  from  the  occa- 
sional cortical  symptoms  which  appear  after 
the  ingestion  of  the  drug.  "Although  Dr.  Rus- 
sell Bellamy,  of  Colorado  Springs  [New  York 
Medical  Journal,  July  21,  1894),  in  an  "  alco- 
holic service  "  in  Bellevue  Hospital,  New  York, 
found  the  drug  useful  in  delirium  tremens,  and 
although  Khmelewsky  (cited  in  the  New  York 
Medical  Journal,  April  20,  1895)  agrees  with 
him,  most  observers  are  not  of  the  same  opin- 
ion. 

[In  an  article  on  Insomnia  in  Surgery,  and 
its  Treatment  {New  York  Medical  Journal, 
March  2,  1895),  Dr.  George  Gr.  Van  Sohaick,  of 
the  French  Hospital,  New  York,  gives  a  brief 
account  of  the  case  of  a  woman,  thirty-five 
years  old,  in  which  trephining  and  the  removal 
of  a  large  portion  of  the  frontal  bone  were  re- 
quired by  a  depressed  fracture  of  the  frontal 


bone  of  six  years'  standing,  complicated  with 
extensive  necrosis.  The  patient  was  an  opium- 
eater,  and  was  also  addicted  to  the  use  of  alco- 
-hol  in  large  quantities.  The  operation,  though 
quite  extensive  and  prolonged,  was  well  borne 
by  the  patient,  who,  however,  in  a  few  days 
became  nearly  maniacal,  insulting  the  attend- 
ants and  nurses  and  being  somewhat  pugna- 
cious. Morphine  had  to  be  given  for  a  few 
days,  but  was  soon  replaced  by  trional.  The 
operation  succeeded  very  well  in  relieving  an 
intense  headache  localized  over  the  forehead. 
In  her  case  the  trional  appeared  to  have  re- 
placed the  morphine  quite  satisfactorily,  the 
opium  habit  seemed  to  disappear,  and  ttie  pa- 
tient, who  prior  to  the  operation  had  spent  her 
time  either  in  a  state  of  opium  narcosis  or  in 
howling  with  pain  and  excitement,  became  very 
quiet  and  comfortable.  Her  mode  of  life  and 
her  inability  to  obtain  proper  treatment  at 
home  or  in  an  institution,  however,  led  Dr.  Van 
Schaick  to  believe  that  she  would  soon  resume 
the  morphine  habit.] 

Khmelewsky  says  the  use  of  trional  is  indi- 
cated in  cases  in  which  no  psychical  disorders 
exist,  but  cautions  against  its  employment  in 
melancholia  and  hypochondriasis,  because  of 
the  depression  it  may  evoke.  He  has  never 
met  with  circulatory,  digestive,  or  respiratory 
disturbances  caiised  by  the  drug.  Other  writ- 
ers, the  majority,  have  not  observed  satisfac- 
tory hypnotic  effects  from  trional  in  the  face 
of  excitement  of  any  kind.  When  there  is  pain, 
trional  alone  is  scarcely  to  be  relied  upon,  but 
if  combined  with  morphine,  may  give  good  re- 
sults. It  is  contra-indicated  when  there  is  an 
annoying  cough  present  and  in  alcohol,  mor- 
phine, or  cocaine  intoxication. 

Trional  may  be  given,  as  a  reliable  and  safe 
hypnotic,  in  insomnia  resulting  from  organic 
brain  disease,  or  sleeplessness  in  the  different 
forms  of  neurasthenia  and  the  functional  psy- 
choses. In  ordinary  sleeplessness  from  worry, 
restlessness,  overfatigue,  or  excessive  brain  work, 
it  is  admirable.  It  may  be  administered  when 
sulphonal  has  failed  to  induce  sleep.  Its  value 
as  a  general  hypnotic  is  high,  except  in  the  in- 
stances above  mentioned.  As  a  sedative  it  is 
inferior  to  tetronal. 

[Trional  has  been  used  to  some  extent  in  the 
treatment  of  epilepsy.  Dr.  H.  P.  Boyer  ( Uni- 
versity Medical  Magazine,  March,  1896)  re- 
port^ his  observations  in  regard  to  this  use  of 
the  drug  by  Dr.  S.  Weir  Mitchell,  of  Philadel- 
phia. In  most  instances  where  trional  was 
used  the  patients  were  in  some  way  benefited. 
Either  the  number  of  attacks  was  diminished, 
their  severity  lessened,  or  the  general  physical 
condition  of  the  patient  improved.  The  results 
of  its  use  and  the  drawbacks  are  stated  in  an 
account  of  thirteen  oases.  Some  of  the  patients 
suffered  so  much  from  drowsiness  and  vertigo, 
and  derived  so  little  benefit  in  regard  to  the 
diminution  of  the  number  of  attacks,  that  the 
treatment  was  not  kept  up  for  more  than  two 
or  three  weeks.  Of  the  thirteen  cases  referred 
to,  in  ten  there  was  a  marked  decrease  in  the 
number  of  attacks  during  the  treatment,  and 
the  physical  symptoms  also  were  singularly 
improved.    In  five  of  the  cases  the  number'  of 


333 


TRIOXYBEXZOL 
TROPACOCAINE 


attacks  was  less  under  thetrional  treatment 
than  under  the  bromide  treatment :  in  two 
others,  however,  the  bromides  gave  more  satis- 
factory results.  Dr.  Mitchell  believes,  says  Dr. 
Boyer,  that  trional  may  often  prove  an  efficient 
substitute  for  the  bromides,  and  he  states  that 
he  has  seen  no  ill  effects  follow  its  continuous 
use  for  many  weeks.  It  is  well,  he  says,  at 
times  to  give  the  bromides  in  the  daytime  and 
trional  at  night.] 

Glaus  (Internationale  MiniscTie  Rundschau, 
1894,  No.  45  ;  American  Journal  of  the  Medi- 
cal Sciences,  April,  1895)  finds  trional  an  effi- 
cient and  safe  hypnotic  for  children.  He  has 
found  it  to  fail  only  when  pain  is  present,  sleep 
being  induced  when  the  drug  was  given  at 
bedtime  within  ten  or  fifteen  minutes.  He  has 
found  it  most  reliable  in  chorea,  pavor  noctur- 
nus,  and  the  insomnia  of  dentition  and  indi- 
gestion. No  untoward  effects  were  noted,  and 
a  habit  was  not  formed. 

The  advantages  of  trional  over  sulphonal 
are  summed  up  by  Vogt  (Nouveaux  remedes, 
1894,  No.  21).  Sleep  is  induced  more  prompt- 
ly, the  sleep  is  calm  and  natural,  the  awaken- 
ing is  normal  and  free  from  disorders,  and  a 
single  dose  suffices  for  the  purpose. 

The  dose  of  trional  for  adults  is  from  15 
to  30  grains  given  at  bedtime.  It  is  best  ad- 
ministered in  hot  water  or  milk,  as  it  is  then 
more  rapidly  absorbed  and  a  quicker  action  is 
obtained.  The  dose  for  children  varies  from  3 
to  20  grains,  depending  upon  the  age.  It  may 
be  given  as  early  asin  the  first  month  of  life. 

[According  to  Clans  {loc.  cit ),  the  daily 
amounts  of  trional  that  may  be  given  to  chil- 
dren of  various  ages  are  as  follows : 

Age.  Dose. 

1  month  to  1  year 3  to   6  p:aiiis. 

lto2years 6  "  12    " 

8"   6      "      18  "18    " 

6"  10      "      18  "23    " 

A  writer  in  the  Monatsschrift  fur  Oeburts- 
hiilfe  und  Qynakologie  for  April,  1896  {British 
Medical  Journal,  May  16,  1896),  gives  a  sum- 
mary of  recent  opinions  on  new  hypnotics  and 
narcotics.  In  respect  to  trional,  he  says,  the 
strength  of  the  dose  has  been  much  disputed. 
The  chief  importance  of  this  uncertainty,  as 
far  as  gynsecology  is,  concerned,  is  the  fact  that 
a  larger  dose  is  often  required  during  than  be- 
tween the  menstrual  periods.  Bad  results  have 
been  observed  only  when  very  large  doses  have 
been  given  or  when  the  use  of  the  drug  has 
been  continued  too  long.  When  trional  is 
given  for  dysmenorrhcea  or  any  other  painful 
condition,  its  use  must  never  be  continued  for 
weeks  or  months,  and  it  must  never  be  given 
in  larger  doses  than  30  grains.] 

If  the  drug  has  no  effect  after  two  or  three 
successive  nights,  it  is  wise  to  replace  it  by 
some  other  hypnotic.  Its  use  is  best  inter- 
rupted from  time  to  time  in  order  to  avoid 
possible  cumulative  effects.  The  constipation 
which  is  sometimes  seen  must  be  attacked  and 
tlie  extreme  acidity  of  the  urine  should  be  pro- 
vided against  by  the  administration  of  alkaline 
drinks. — Samuel  M.  Bricknee. 

TRIOXYBENZOL.— See   Gallacetophe- 

NONE. 


TRIOXYMETHYLENE.  —  See  Para- 
form. 

TBIPHENINE.— This  is  a  powder,  CH, 
C,HtO.NH(CHs.CH,CO),  homologous  with 
phenaeetine.  It  is  insoluble  in  ordinary  men- 
strua. It  has  been  used  as  an  antipyretic  and 
analgetic  in  doses  of  from  4  to  10  grains,  but 
it  has  not  been  tested  in  practice  sufficiently  to 
warrant  its  being  recommended. 

TRITICUM  (U.  S.  Ph.)  is  the  rhizome  of 
the  Agropyrum  repens,  or  couch  grass,  a  plant 
widely  disseniinated  through  the  Northern 
United  States.  It  is  a  demulcent  diuretic  and 
is  very  useful  in  all  conditions,  such  as  cystitis 
or  gonorrhoea,  in  which  it  is  desirable  to  ren- 
der the  urine  as  little  irritating  as  possible.  A 
decoction  of  almost  any  strength  may  be  em- 
ployed without  restriction  as  to  quantity,  but 
the  fluid  extract,  extractum  'tritici  fluidum 
(U.  S.  Ph.),  is  a  rather  more  convenient  form 
for  its  administration.  It  may  be  given  in 
doses  as  large  as  a  fl.  oz. 

[Triticum  must  not  be  confounded  with  the 
farina  tritici  of  the  British  Pharmacopoeia, 
which  is  wheaten  flour  (see  Flour).] 

Russell  H.  Nevins. 

TROCHES  (trochisci)  are  round,  oval,  or 
angular  tablets  or  lozenges  consisting  of  sugar, 
some  medicinal  ingredient,  and  some  binding 
material.  They  are  formed  while  in  a  moist 
or  plastic  condition,  and  without  much  pres- 
sure. They  are  sometimes  called  "  pastilles," 
but  in  this  work  the  term  "  pastille  "  will  be 
restricted  to  the  designation  of  compounds  in- 
tended to  be  burned  so  as  to  diffuse  a  pleasant 
odour. 

The  material  most  suitable  as  a  binding 
substance  for  troches  is  tragacanth,  either  in 
powder  or  in  the  form  of  mucilage.  All  in- 
gredients entering  into  troches  must  previous- 
ly be  reduced  to  the  finest  possible  powder  and 
thoroughly  mixed,  whereupon  the  mass  is  care- 
fully moistened  with  water  or  with  mucilage 
of  tragacanth  if  the  gum  is  not  already  pres- 
ent in  the  mixture,  and  worked  into  a  tough 
plastic  mass  which  will  not  "  run  "  or  flatten 
out  by  its  own  weight.  On  a  small  scale  the 
mass  is  then  rolled  out  either  on  a  pill  ma- 
chine or  on  a  board  with  adjustable  rims,  so  as 
to  permit  of  the  regulation  of  the  thickness  of 
the  troches,  and  by  means  of  a  cutter  pieces  of 
the  proper  shape  are  then  cut  out. 

On  a  large  scale  machinery  is  employed  both 
for  making  the  mass  and  for  forming  it.  Ma- 
chine-made troches  are  generally  preferred  to, 
hand-made  ones,  as  they  are  more  uniform  and 
handsome  in  appearance.  Still,  as  there  are 
some  combinations  which  are  only  occasionally 
called  for  and  which  the  wholesale  manufac- 
turer does  not  care  to  carry  in  stock,  the 
preparation  of  these  falls  upon  the  apothecary. 
Charles  Rice. 

TROPACOCAINE.— This  alkaloid,  CsH,, 
NO.(C6H6CO),called  also  benzoylpseudotropeine, 
is  obtained  from  the  leaves  of  a  Java  coca 

Elant.  It  is  employed  in  the  form  of  the 
ydrochloride  as  a  local  anmsthetic,  in  a  solu- 
tion of  the  strength  of  from  two  to  three  per 
cent.    According  to  some  writers  it  acts  more 


TRYPSIN 
TURPENTINE 


334 


rapidly  than  cocaine  ■&-a&  is  less  poisonous. 
Dr.  C.  A.  Veasey,  of  Philadelphia  {JVew  York 
Medical  Journal,  November  25,  1893),  has 
found  that  the  instillation  of  a  three-per-cent. 
solution  into  the  eye  causes  complete  anaesthe- 
sia in  about  two  minutes,  and  that  this  effect 
lasts  for  about  eight  minutes  and  may  be  pro- 
longed by  repeating  the  instillations.  In  his 
experience  the  pupil  was  rarely  affected,  al- 
though in  a  few  eases  it  was  slightly  dilated 
for  a  short  time,  and  in  those  oases  only  was 
there  sligkt  haziness  of  vision,  owing  to  the 
range  of  accommodation  being  changed  a  lit- 
tle, the  near  point  being  carried  farther  from 
the  eye.  The  palpebral  fissure  was  somewhat 
enlarged,  but  there  was  no  ptosis.  Dr.  Veasey 
considers  tropacocaine  superior  to  cocaine  in 
the  removal  of  foreign  bodies  from  the  eye,  in 
making  strong  astringent  or  caustic  applica- 
tions to  the  cornea  or  the  conjunctiva,  and  in 
eases  of  keratitis,  inasmuch  as  it  does  not  di- 
minish the  blood  supply  to  so  great  an  extent. 
For  other  purposes  he  has  not  found  it  supe- 
rior to  cocaine  hydrochloride.  According  to 
Dr.  Cerna,  large  amounts  of  tropacocaine  are 
apt  to  produce  slowing  of  the  pulse,  vertigo, 
and  intense  precordial  anxiety. 

TRYPSIN. — This  is  the  proteolytic  fer- 
ment of  the  pancreatic  juice.  It  occurs  as  a 
yellowish-white,  amorphous  powder  freely  solu- 
ble in  water  and  in  glycerin,  but  insoluble  in 
alcohol.  It  acts  upon  proteids  in  a  manner 
similar  to  that  of  pepsin.  Unlike  pepsin,  it 
does  not  act  in  an  acid  medium.  The  chief 
products  of  the  action  of  trypsin  are  tyrosine 
and  leucine.  As  a  digestive  agent  it  com- 
pletes the  digestion  of  the  proteids  already 
begun  in  the  stomach.  For  digestive  purposes 
the  extract  of  pancreas,  which  contains  all  the 
digestive  agents  of  the  pancreatic  juice,  is  com- 
monly employed.  Trypsin  has  been  especially 
used  as  a  solvent  for  diphtheritic  membrane 
and  in  certain  surgical  conditions.  In  solu- 
tion, it  is  unirritating  to  normal  tissue,  but 
has  the  property  of  digesting  the  fibrin  of 
false  membranes  with  great  rapidity.  That  it 
has  the  power  of  dissolving  diphtheritic  mem- 
branes to  a  decided  degree  can  not  be  doubted. 
It  was  at  one  time  very  largely  employed  for 
this  purpose.  It  is  much  less  used  at  present, 
and  by  most  practitioners  it  has  been  aban- 
doned for  this  purpose.  It  is  used  as  a  spray 
in  the  following  proportions :  Trypsin,  15 
grains;  bicarbonate  of  sodium,  5  grains;  wa- 
ter, 1  ounce.  It  is  sometimes  applied  to  the 
diphtheritic  membrane  by  insufflation,  four 
parts  of  trypsin  being  used  to  one  part  of 
soda.  This  mixture  is  sometimes  smeared  over 
a  dampened  brush  Snd  painted  upon  the  throat. 
It  has  also  been  used  for  the  purpose  of  dis- 
solving away  necrotic  or  seriously  contused 
tissues.  For  this  purpose  it  is  prepared  as  in 
diphtheria.— Floyd  M.  Cbandall. 

TUBERCTTLIN'. — See  under  Animal  ex- 
tracts and  juices  (vol.  i,  page  81). 

TtTBEROULOCIDIN.— This  is  a  modi- 
fied form  of  tuberculin  prepared  by  Klebs, 
said  to  cause  less  febrile  reaction  than  Koch's 


preparation.    It  has  not  come  into  use  to  any 
considerable  extent. 

TXJMENOL,  or  tumenolum,  or  sulphotu- 
menolic  acid,  is  a  non-ofl^oial  compound,  dis- 
covered by  Spiegel,  which  is  obtained  from 
mineral  oil  by  treating  the  unsaturated  hydro-, 
carbons  with  concentrated  or  fuming  sulphuric 
acid.  The  product  is  washed  free  of  all  excess 
of  the  acid  and  is  then  crude  or  commercial 
tumenol.  This  is  a  mixture  of  sulphones  and 
sulphonic  acids  which  occurs  as  a  dark-brown, 
acid,  syrupy  liquid.  Tumenol  oil  consists  of 
the  separated  sulphones,  and  occurs  as  a  dark- 
yellow,  thick  liquid  which  is  insoluble  in 
water,  but  readily  soluble  in  ether  and  in  ben- 
zene. Tumenolsulphonic  acid  can  also  be  sepa- 
rated as  a  dark-coloured  powder  which  has  a 
peculiar,  slightly  bitter  taste  and  is  soluble 
in  water.  Aqueous  solutions  of  tumenolsul- 
phonic acid  readily  take  up  tumenol  oil  when 
the  latter  is  added. 

Tumenol  was  originally  obtained  from  the 
bitumen  found  in  the  Messel  mine  near  Darm- 
stadt, and  derives  its  name  from  that  sub- 
stance. Very  little  is  known  of  its  therapeutic 
value  in  addition  to  the  statements  made  by  a 
Berlin  correspondent  in  the  Provincial  Medical 
Journal  for  January,  1893,  which  have  been  re- 
produced in  various  places.  It  appears  to  have 
been  introduced  into  medicine  by  Neisser  as  a 
partial  substitute  for  ichthyol,  to  which  it  is 
closely  related,  but  is  not  so  eflBeient,  because 
it  lacks  the  penetrating,  antiparasitic,  and  sor- 
befacient  properties  of  that  drug. 

It  is  said  that  compresses  soaked  in  a  two- 
to  five-per-cent.  solution  of  tumenolsulphonic 
acid  have  been  found  useful  in  the  treatment 
of  acute  recurrent  eczema  of  the  hands  and 
]face  ;  that  tumenol  oil,  in  the  form  of  a  paste 
from  five  to  ten  per  cent,  in  strength,  has 
proved  of  value  in  the  treatment  of  superficial 
ulcerations,  impetigo,  and  pemphigus ;  that  an 
ointment  of  similar  strength  of  tumenol  oil 
mingled  with  five  per  cent,  of  oxide  of  zinc 
and  nitrate  of  bismuth,  with  lard  as  a  base, 
has  been  employed  by  Neisser  in  similar  con- 
ditions with  success ;  and  that  the  itching  of 
eczema  and  prurigo  may  be  relieved  by  the  ap- 
plication of  a  ten-per-oent.  tincture  diluted 
with  equal  parts  of  ether,  alcohol,  glycerin,  or 
water.  The  undiluted  tumenol  oil  is  also  said 
to  have  been  painted  over  the  diseased  sur- 
faces. 

[The  sodium  salt  of  tumenolsulphonic  acid, 
a  soluble,  dark-coloured  powder,  may  be  used 
like  tumenol.] 

Matthias  Lanckton  Foster. 

TURMERIC,  TURMEROL.— See  under 

Curcuma. 

TURPENTINE,  terebinthina  (U.  S.  Ph., 
Ger.  Ph.),  is  an  oleoresin  obtained  from  the 
trunk  of  Pinus  palustris  (V.  S.  Ph.),  Pinus  aus- 
tralis  and  Pinus  tceda  (Br.  Ph.),  and  from  Pinus 
pinaster  a.\iA  Pinus  lands  (Ger.  Ph.).  Canada 
turpentine,  Canada  balsam,  Terebinthina  canor 
densis  (U.  S.  Ph.,  Br.  Ph.),  is  a  liquid  oleoresin 
derived  from  Abies  balsamea. 

Turpentine  is  a  term  usually  used  to  describe 
liquid  or  concrete  juices,  derived  from  certain 


335 


TRYPSIN 
TURPENTINE 


trees,  which  contain  a  resin  and  an  essential  oil, 
the  oil  of  turpentine.  Turpentine  is  generally 
obtained  from  species  of  fir,  larch,  or  pine  trees, 
each  species  giving  its  name  to  the  particular 
turpentine  derived  from  it.  The  various  tur- 
pentines are  similar  to  one  another  in  taste 
and  odour.  They  are  at  first  liquid,  gradually 
becoming  solid  on  exposure. 

The  most  important  turpentines  are  wldte 
turpentine,  common  European  turpentine,  Ven- 
ice turpentine,  Canada  turpentine,  and  Chian 
turpentine.  The  medical  properties  of  all  these 
varieties  depend  upon  the  presence  of  the  oil 
of  turpentine  for  their  virtues.  Chian  turpen- 
tine was  at  one  time  thought  to  have  been  used 
with  success,  locally  and  internally,  in  the 
treatment  of  cancer.  Its  odour  is  more  agree- 
able and  its  taste  less  offensive  and  less  bitter 
than  those  of  the  other  turpentines.  It  may  be 
given  in  emulsion  in  doses  of  5  grains,  gradu- 
ally increased  as  it  is  well  borne  by  the  patient. 

Canada  turpentine,  Canada  balsam,  or  bal- 
sam of  fir,  called  in  Europe  also  the  halm  of 
gilead,  is  widely  used  in  histological  work  for 
the  mounting  of  specimens  to  be  permanently 
preserved.  After  it  becomes  hard,  it  becomes 
and  remains  perfectly  clear  and  homogeneous. 

Turpentine  Oil, — The  oil,  or  "spirit,"  of 
turpentine,  oleum  terebinthincB  (U.  S.  Ph., 
Br.  Ph.,  Ger.  Ph.),  is  a  volatile  oil  distilled 
from  turpentine  (C  S.  Ph.)  or  from  the  oleo- 
resin  obtained  from  Pinus  palustris,  Pinus 
tceda,  or  Pinus  silvestris  (Br.  Ph.).  It  lias  the 
formula  CioHia,  is  very  highly  inflammable, 
and  is  colourless  or  faintly  yellow.  Its  specific 
gravity  is  0'86.  The  odour  of  turpentine  is 
strong  and  penetrating,  and  it  possesses  a  hot, 
pungent,  somewhat  bitter  taste.  Its  reaction 
is  neutral  or  faintly  acid.  Its  boiling  point  is 
about  300°  F.  The  oil  is  slightly  soluble  in 
water,  a  little  more  so  in  alcohol,  and  freely 
soluble  in  ether.  Artificial  camphor  may  be 
produced  by  bringing  oil  of  turpentine  into 
contact  with  hydrochloric  acid,  when  two  com- 
pounds will  be  formed,  a  red  liquid  and  a  white 
crystalline  substance  resembling  camphor. 
Turpentine  has  the  property  of  converting  the 
oxygen  which  it  absorbs  from  atmospheric  air 
into  ozone. 

Taken  internally,  in  moderate  doses,  the  oil 
of  turpentine  gives  the  sensation  of  warmth  in 
the  stomach.  The  circulation  becomes  acceler- 
ated and  the  warmth  of  the  skin  is  increased, 
but  no  cerebral  stimulation  appears,  although 
vertigo  and  intoxication  may  make  themselves 
manifest  if  the  dose  is  large  enough.  Fre- 
quently repeated  small  doses  stimulate  the 
kidneys,  and  may,  if  long  continued,  irritate 
the  genito-urinary  tract,  sometimes  even  caus- 
ing strangury.  The  urine  obtains  a  violaceous 
odour  and  may  contain  blood.  The  drug  is 
excreted  by  the  lungs  as  well  as  by  the  kidneys, 
and  finds  its  exit  from  the  body  through  these 
channels  even  when  it  is  inhaled.  In  large 
doses,  turpentine  induces  catharsis,  sometimes 
preceded  by  nausea  and  vomiting.  Occasion- 
ally an  erythematous  eruption  is  observed  after 
its  ingestion.  Experiments  show  that  the  co- 
agulability of  the  blood  is  increased  by  the 
administration  of  turpentine.    Some  cases  of 


death  from  taking  large  doses  of  the  oil  of  tur- 
pentine are  recorded,  but  the  exact  lethal  dose 
is  not  known.  It  probably  varies  with  indi- 
vidual idiosyncrasy,  but  the  amount  is  undoubt- 
edly a  large  one. 

Turpentine  is  rubefacient,  inducing  in  a  short 
time  an  intense  irritation  and  sometimes  in- 
flammation in  any  tissue  with  which  it  comes 
in  contact.  This  property  is  taken  advan- 
tage of  in  rheumatic  affections  and  in  some 
internal  and  subcutaneous  inflammatory  pro- 
cesses. Its  effect  upon  the  skin,  however,  is  so 
very  violent  that  its  local  external  use  can 
scarcely  be  commended.  In  the  form  of  a  lini- 
ment, it  has  been  found  useful  by  some  ob- 
servers in  burns,  as  well  as  in  erysipelas,  and 
as  a  dressing  for  local  gangrene.  Its  topical 
employment  has  been  recommended  in  eczema, 
the  lesion  being  changed  by  its  use  and  thus 
offering  a  better  opportunity  for  other  thera- 
peutic agents  to  act.  The  use  of  turpentine  in 
parasitic  diseases  of  the  scalp  has  also  been 
praised,  the  statement  being  made  that  it  de- 
stroys the  micro-organisms  and  prevents  the 
development  of  their  spores.  The  oil  of  tur- 
pentine has  extensive  employment  as  a  counter- 
irritant,  usually  in  the  form  of  stupes.  These 
may  be  prepared  by  dipping  pieces  of  flannel 
previously  soaked  in  hot  water  into  oil  of  tur- 
pentine which  has  been  warmed  by  placing  the 
vessel  containing  it  in  warm  water.  The  flan- 
nel may  then  be  applied  to  the  skin  and  al- 
lowed to  remain  on  as  long  as  it  can  be  borne. 
Turpentine  stupes  have  been  largely  used  in 
bronchitis  and  peritonitis  with  good  effect,  in 
the  latter  disease  frequently  reducing  the  me- 
teorism. 

As  an  element  in  enemata,  the  oil  of  turpen- 
tine often  aids  to  secure  an  evacuation  where 
other  substances  fail.  After  cceliotomy,  when 
cathartics  are  unable  to  induce  a  movement  of 
the  bowels,  or  when  the  colon  is  filled  with 
hard,  impacted  feeces,  the  oil  of  turpentine 
mixed  with  an  equal  quantity  of  olive  oil  will 
frequently  bring  about  the  desired  result  by 
its  local  stimulation  to  the  intestines.  Mixed 
with  an  equal  amount  of  the  milk  of  asafoetida, 
and  given  as  an  enema,  it  frees  the  intestines 
of  flatus  in  meteorism  from  functional  causes. 
An  equally  good  result  may  be  obtained  from 
the  combination  of  turpentine  with  ox-gall, 
in  cases  of  narcotic  poisoning,  the  stimulant 
effect  of  turpentine  may  be  employed  in  rectal 
injections  to  rouse  the  system. 

The  oil  of  turpentine  has  been  often  em- 
ployed internally  in  typhoid  fever  when  the 
tongue  is  dry  and  fissured  and  there  is  decided 
meteorism.  '  Under  its  use,  the  tongue  becomes 
moist  and  the  tympanites  diminishes.  In  the 
same  disease,  if  a  diarrhoea  during  convales- 
cence is  present,  indicating  a  slow  healing  of 
the  lesion  in  Peyer's  patches,  the  turpentine 
seems  to  foster  the  healing  of  the  ulcers.  In 
this  condition,  10  drops  of  the  oil  maybe  given 
every  two  hours.  Good  effects  have  also  been 
observed  in  ulcerative  processes  of  the  stomach 
and  intestines  from  the  use  of  the  oil  of  tur- 
pentine, when  it  probably  acts  as  a  stimulant  to 
the  diseased  areas.  The  drug  has  be_en  recom- 
mended as  being  efficient  as  a  stimulant  in  low 


TURPETH  MINERAL 
ULMUS 


336 


fevers  and  in  the  local  complications  of  typhoid 
fever,  such  as  pneumonia  and  bronchitis.  In 
the  latter  disease  it  may  be  employed  as  a 
counter-irritant  and  internally  at  the  same 
time.  In  puerperal  fever  its  local  and  internal 
use  has  been  praised.  The  use  of  the  oil  has 
been  extolled  in  the  various  neuralgias,  par- 
ticularly sciatica,  and  in  lumbago.  Although 
turpentine  is  rarely  used  as  a  diuretic,  its 
stimulant  action  upon  the  kidneys  may  be 
taken  advantage  of  in  cases  of  chronic  pyelitis 
and  cystitis ;  and  it  is  said  to  act  well  upon  a 
chronic  urethritis.  Its  use  is  praised  in  incon- 
tinence of  urine  depending  upon  weakness  of 
the  vesical  walls.  Whether  it  is  of  advantage 
in  whooping-cough,  spermatorrhoea,  amenor- 
rhma,  and  impotence  may  be  doubted. 

In  cases  of  tcenia  solium  and  ascarides  the 
internal  administration  of  the  oil  of  turpentine 
as  a  vermifuge  has  been  much  praised.  For 
the  same  purposes  it  may  be  given  in  the  form 
of  an  enema  with  an  equal  bulk  of  olive  oil. 
As  an  anthelminthic,  its  internal  dose  is  from  -J- 
to  1  fl.  oz.,  given  in  an  equal  amount  of  castor 
oil  or  followed  after  a  short  time  by  castor  oil. 

The  inhalation  of  the  vapour  of  the  oil  of 
turpentine  was  recommended  by  Skoda  in  gan- 
grene of  the  lungs  and  is  now  widely  used  for 
this  affection  and  for  fcetid  bronchitis  and 
asthma.  Baths  of  the  vapour  of  turpentine 
are  said  to  be  beneficial  to  persons  suffering 
from  chronic  rheumatism  ;  and  the  vapour  aris- 
ing from  turpentine  thrown  on  the  bedclothes 
is  said  to  cure  scabies.  Baths  containing  oil 
of  turpentine  are  said  to  give  good  results 
when  the  constitutional  effects  of  the  drug  are 
sought  for.  Prom  5  to  10  fl.  oz.  of  the  oil  may 
be  added  to  a  bath  for  this  purpose. 

The  antiseptic  properties  of  turpentine  are 
feeble,  although  the  oil  does  possess  some  bac- 
tericidal properties.  The  oil  of  turpentine  is 
an  antidote  to  phosphorus  and  in  cases  of  acute 
poisoning  may  be  given  in  a  mucilaginous 
mixture  in  a  dose  of  from  30  to  40  drops. 

The  dose  of  the  oil  of  turpentine  for  ordi- 
nary purposes  is  from  10  to  30  drops,  repeated 
every  two  or  three  or  four  hours  as  may  be 
demanded.  It  may  be  administered  on  sugar 
or  in  an  emulsion  with  glycerin  and  oil  of  gaul- 
theria,  or  with  some  aromatic  water,  to  dis- 
guise its  taste.  It  maybe  given  in  capsules  or 
it  may  form  part  of  a  pill  made  with  sugar,  oil 
of  lemon,  and  white  wax.  The  dose  of  the  oil  of 
turpentine  as  an  anthelminthic  is  ^fl.  oz.,  taken 
all  at  once  or  in  divided  doses  of  from  2  to  4 
fl.  drachms  for  two  or  three  doses.  In  an  ene- 
ma, it  may  be  used,  in  the  combinations  above 
described,  in  doses  of  from  -J  to  3  fl.  oz. 

Rectified  oil  of  turpentine,  oleum  terebin- 
thince.  rectificatum  (U.  S.  Ph.,  Ger.  Ph.),  is  the 
oil  of  turpentine  distilled  in  contact  with  lime- 
water.  It  is  free  from  the  disagreeable  taste 
and  odour  of  the  ordinary  oil  of  turpentine, 
and  the  U.  S,  Ph.  directs  that  it  should  always 
be  dispensed  for  internal  administration  for 
these  reasons.  Its  effects  and  its  properties  are 
those  of  the  oil  of  turpentine. 

Turpentine  liniment,  linimentum  terebin- 
ihinm  (U.  S.  Ph.,  Br.  Ph.),  contains  650  parts  of 
resin  cerate,  and  350  of  the  oil  of  turpentine 


(CJ.  S.  Ph.).  The  Br.  Ph.  directs  that  it  be  made 
from  soft  soap,  distilled  water,  camphor,  and  the 
oil  of  turpentine.  The  liniment  of  the  U.  S.  Ph. 
is  to  be  preferred,  since  it  is  more  stable.  This 
liniment  has  a  deservedly  widespread  employ- 
ment in  scalds  and  burns,  having  been  used  in 
the  eighteenth  century  by  factory  operatives 
in  England  and  being  later  (1797)  introduced 
to  the  profession  by  Dr.  Kentish,  of  England. 
It  should  be  applied  as  soon  as  possible  after 
the  emergency  calling  for  its  use.  The  best 
method  of  application  is  to  saturate  cotton  or 
gauze  with  the  liniment  and  lay  them  directly 
upon  the  burned  or  scalded  areas.  Care  must  be 
taken  to  avoid  uninjured  tissue  and  to  exclude 
the  air.  The  pain  of  a  burn  is  quickly  relieved 
by  the  liniment,  and  healing  of  the  burned 
surface  Is  promoted.  Dr.  Meigs,  of  Philadel- 
phia, recommended  the  use  of  turpentine  lini- 
ment in  erysipelas  of  traumatic  origin,  and  it 
has  been  employed  with  good  results  in  the 
local  treatment  of  furuncles  and  carbuncles. 

Liniment  of  turpentine  and  acetic  acid, 
linimentum  terebinthinm  aceticum  (Br.  Ph.), 
contains  glacial  acetic  acid,  liniment  of  cam- 
phor, and  oil  of  turpentine,  in  the  proportions, 
respectively,  of  one,  four,  and  four.  It  is  a  ru- 
befacient liniment  of  great  power,  and  its  uses 
are  the  same  as  those  of  the  turpentine  lini- 
ment. 

Confection  of  turpentine,  confectio  terebin- 
thincB  (Br.  Ph.),  is  made  by  rubbing  together 
1  fl.  part  of  oil  of  turpentine  and  1  part  of 
powdered  licorice  root,  and  adding  2  parts  of 
clarified  honey.  Its  nse  is  an  agreeable  method 
of  administering  turpentine  and  has  the  effects 
only  of  the  oil.  The  dose  is  from  1  to  2 
drachms. 

The  enema  of  turpentine,  enema  terebinthi- 
nce  (Br.  Ph.),  is  an  enema  containing  1  fl.  oz. 
of  the  oil  of  turpentine  and  15  fl.  oz.  of  muci- 
lage of  starch. 

[Turpentine  ointment,  unguentum  ierebin- 
th'tnce  (Br.  Ph.),  is  a  stimulating  ointment  con- 
taining 8  fl.  parts  of  oil  of  turpentine,  1  part 
of  resin  (rosin),  and  4  parts  each  of  yellow  wax 
and  prepared  lard.  The  German  official  prep- 
aration of  the  same  name  consists  of  equal 
parts  of  turpentine,  turpentine  oil,  and  yellow 
wax. 

Turpentine  oil  is  a  valuable  hcemostatic,  par- 
ticularly in  oases  of  hcemorrhage  following  the 
extraction  of  a  tooth.  According  to  Dr.  B.  H. 
Brodnax  {Times  and  Register,  June  29,  1895), 
a  bit  of  cotton  saturated  with  it  should  be 
pressed  into  the  cavity  and  kept  in  place  for 
about  five  minutes.  -  Dr.  N.  Mayne,  in  an  arti- 
cle attributed  to  the  Trained  Nurse  (cited  in 
the  New  Mngland  Medical  Monthly  for  May, 
1896),  says  that  for  some  years  he  has  used  oil 
of  turpentine  in  post-partum  haemorrhage,  and 
in  every  case  with  the  best  results."  He  satu- 
rates a  piece  of  lint  with  the  turpentine,  intro- 
duces it  in  his  hand  into  the  uterus,  and  holds 
it  against  the  walls.  Rapid  contraction  takes 
place,  and  all  haemorrhage  instantly  ceases.  In 
one  or  two  cases,  when  the  patient  was  almost 
pulseless,  it  seemed  to  act  as  a  stimulant.  On 
no  occasion  did  this  action  fail,  and  it  did  not 
cause  the  slightest  inconvenience  except  in  one 


337 


TURPETH  MINERAL 
ULMUS 


case  in  which  the  side  of  the  patient's  thigh 
was  slightly  blistered  by  some  of  the  oil  that 
came  in  contact  with  it.  He  considers  it  much 
quicker  and  surer  in  its  action  than  any  other 
remedy. 

Sasse  (Therapeutische  Monatshefte,  Febru- 
ary, 1895;  Practitioner,  May,  1895),  having 
observed  the  immediate  hEemostatic  action  of 
turpentine  oil  in  the  case  of  a  patient  who  had 
bled  for  several  hours  after  the  extraction  of  a 
tooth,  subsequently  used  it  in  a  case  of  scurvy, 
painting  the  gums  hourly  with  the  undiluted 
oil,  which  was  kept  in  the  mouth  for  a  short 
time,  and  giving  small  doses  internally.  The 
oral  hiemorrhage  and  the  hsematuria  gradually 
subsided,  and  the  patient's  general  health  im- 
proved.]— Samuel  M.  Bricknee. 

TUBPETH  MINEBAIi.— See  under 
Mercury  sulphates  (vol.  i,  page  638). 

TXJSSIIjAGO. — Tussilago  Farfara,  colt's- 
foot,  is  a  synantherous  herb  indigenous  to  the 
northern  temperate  zone.  The  leaves,  folia 
farfarce  (Ger.  Ph.),  are  demulcent  and  slightly 
bitter.  'They  are  used  mostly  in  domestic 
medicine  as  a  pectoral.  A  decoction  made 
with  an  ounce  of  the  leaves  and  a  pint  of 
water  may  be  taken  in  doses  of  4  fl.  oz.  three 
times  a  day. 

TUSSOIi.— This  fanciful  name  has  been 
given  to  a  salt  of  antipyrine  and  amygdalic 
'(phenylglycolic)  acid.  Dr.  Rehn,  of  Prank- 
fort  on  the  Main  ( Wiener  klinische  Wochen- 
schrift,  August  9,  1894),  has  used  the  drug  in 
a  number  of  cases  of  whooping-cough  in  chil- 
dren, and  has  found  it  useful  in  reducing  the 
frequency  of  the  paroxysms  and  mitigating 
their  intensity.  Its  action,  he  says,  is  different 
from  that  of  simple  antipyrine,  and  he  has  ob- 
served no  untoward  effects  from  its  use.  It  is 
soluble  in  water,  and  as  a  corrigent  raspberry 
syrup  is  better  than  milk.  The  minimum  doses 
for  children  are  as  follows :  Under  one  year  of 
age,  from  |  of  a  grain  to  1^  grain,  two  or  three 
times  a  day ;  from  one  to  two  years,  1^  grain, 
three  times  a  day;  from  two  to  four  years, 
from  3f  grains  to  6  grains,  three  or  four  times 
a  day ;  for  older  children,  7^  grains,  four  times 
a  day  or  oftener. 

Dr.  Rothschild  (Deutsche  medieinische 
Wochenschrift,  January  3,  1896;  Therapeu- 
tische Wochenschrift,  March  15,  1896)  gives  an 
account  of  an  epidemic  of  whooping-cough 
which  lasted  from  October,  1894,  until  the 
middle  of  February,  1895.  He  treated  sixty- 
one  cases,  which  he  divides  into  three  groups. 
In  the  first  group,  consisting  of  sixteen  cases, 
tussol  was  not  used.  The  disease  lasted  from 
six  to  ten  weeks  and  was  very  severe ;  two  of 
the  children,  about  six  months  old,  died.  The 
eighteen  patients  of  the  second  group  were 
treated  at  first  with  other  remedies,  and  then 
with  tussol.  During  the  first  period  of  their 
treatment  no  substantial  reduction  of  the 
number  or  the  severity  of  the  paroxysms  was 
achieved,  but  such  a  reduction  occurred  after 
four  days'  use  of  tussol.  In  the  twenty-seven 
patients  of  the  third  group  the  disease  was 
milder;  the  paroxysms  were  short,  infrequent, 
and  followed  by  far  less  weakness  than  in  the 


two  other  groups.  In  very  few  of  these  cases 
only  did  the  tussol  seem  to  have  no  effect,  and 
they  were  cases  in  which  it  was  doubtful  if  the 
remedy  was  given  regularly.  Rothschild  states 
it  as  a  certainty  that  in  patients  who  were 
treated  with  tussol  from  the  outset,  and  took 
their  doses  regularly,  the  duration  of  the  dis- 
ease was  notably  shortened  and  its  whole  course 
was  much  milder.  In  a  few  of  them  it  lasted 
not  longer  than  about  a  fortnight. 

TTJTTY.— See  under  Ziko. 

TYLOPHOBA.— The  leaves  of  Tylophora 
asthmatica,  or  East  Indian  ipecacuanha,  an 
asclepiadaoeous  plant  of  Asia,  Africa,  .and 
Australia,  are  used  in  India  as  a  diaphoretic 
and  expectorant  in  doses  of  3  or  4  grains,  and 
as  an  emetic  in  doses  of  from  30  to  30  grains. 
Like  ipecac,  it  has  been  employed  with  advan- 
tage in  the  treatment  of  dysentery.  The  leaves 
are  smoked  for  relief  from  the  paroxysms  of 
asthma.  Their  active  principle  is  an  alkaloid, 
tylophorine,  the  hydrochloride  and  nitrate  of 
which  are  soluble  in  water.  These  salts  have 
not  been  used  sufBciently  to  warrant  state- 
ments as  to  their  dose. 


TJLEXIITE,  CnHuNaO,  is  an  alkaloid  ex- 
tracted from  the  seeds  of  Ulex  europceus,  or 
gorse,  a  European  leguminous  shrub.  Ulexine 
has  been  thought  to  be  identical  with  cytisine 
(see  under  Cytisus  laburnum),  but  this  is 
questioned.  It  has  been  but  little  used  in  medi- 
cine, and  the  statements  concerning  it  to  be 
found  in  literature  are  contradictory.  For 
example,  a  writer  in  the  Lancet  for  February 
4,  1888,  summarizing  the  accounts  of  experi- 
mental studies  by  Bradford  (Journal  of  Physi- 
ology, viii,  3)  and  Pinet,  says  that  ulexine  seems 
to  have  a  special  action  on  the  respiration, 
paralyzing  the  vagus  somewhat  like  curare ;  on 
the  other  hand,  Bocquillon-Limousin  speaks 
of  it  as  producing  spasms,  and  yet  as  being 
antidotal  to  strychnine.  There  is  general 
agreement,  however,  that  it  is  a  diuretic  of  very 
prompt  action,  and  it  is  said  to  have  been  em- 
ployed with  decided  advantage  in  cases  of  car- 
diac dropsy.  The  diuretic  dose  of  the  nitrate 
is  from  ^  to  iV  of  a  grain. 

tTLMUS  (U.  S.  Ph.),  or  slippery-elm  bark, 
the  bark  of  Ulmus  fulva,  is  extensively  used 
as  a  demulcent  in  conditions  in  which  it  is 
proper  to  render  the  urine  as  mild  and  unirri- 
tating  as  possible,  and  to  a  certain  extent  in 
dysentery  and  diarrhoea,  but  is  of  little  or  no 
value  in  these  latter  states.  It  also  forms  the 
basis  of  a  useful  poultice,  as  it  retains  its 
warmth  and  inoisMire  for  a  considerable  time, 
more  especially  whpn  in  a  powdered  state. 
When  it  is  in  this  last  condition  a  mucilagin- 
ous decoction  may  be  made,  which,  if  sweetened 
and  flavoured  with  lemon-juice,  forms  an  agree- 
able demulcent  drink,  useful  to  allay  the  irri- 
tation of  the  throat  in  pharyngitis,  etc. 

The  mucilage,  mucilago  ulmi  (U.  S.  Ph.),  is 
made  with  about  6  parts  of  the  bark  and  100 


TILYPTOL 
URANIUM 


338 


of  water,  and  is  the  usual  form  in  which  this 
substance  is  administered.  It  is  sometimes 
used  externally  to  allay  the  irritation  of  various 
inflammatory  cutaneous  affections. 

Russell  H.  Nevins. 

XJIiYPTOL. — See  Eulyptol. 

■UNGrTJENTS. — See  Ointments. 

TJRAL,  CC13.CH:OH.NHCOj.C2Hb  =  CbHs 
OsNCla,  is  a  drug  with  reputed  hypnotic  power, 
made  by  mixing  urethane  and  chloral.  It 
occurs  in  white  crystals  or  prisms,  and  is  freely 
soluble  in  alcohol  and  ether,  very  sparingly 
soluble  in  water.  Its  melting  point  is  106°  P. 
Burned  on  platinum  foil,  it  leaves  no  ash.  It 
volatilizes  without  decomposition.  Boiled  with 
water,  it  decomposes  into  chloral  and  urethane. 
Ural  is  bitter  in  taste.  Its  effects  on  the  car- 
diac apparatus  and  on  the  blood-pressure  seem 
to  be  trifling,  and  but  one  case  of  poisoning  by 
the  drug  is  recorded.  In  general,  its  influence 
is  said  to  be  similar  to  that  of  somnal.  Ural 
has  been  used  chiefly  in  Italy,  and  since  its  in- 
troduction, in  1889,  it  seems  to  have  dropped 
out  of  use.  Since  1890  there  is  no  record  of 
it  in  literature.  Poppi,  who  experimented 
principally  with  ural,  came  to  the  conclusion 
that  its  use  was  indicated  principally  in  the 
insomnia  of  chronic  heart  disease,  in  that  of 
functional  and  organic  mental  disease,  and  in 
nervous  conditions  in  general.  The  drug  is 
probably  inferior  to  trional,and  seems  to  possess 
little  or  no  sedative  action  in  combination  with 
its  hypnotic  power. 

Adiministered  in  doses  of  from  |  to  1  drachm, 
it  induces  sleep  in  about  half  an  hour.     In  the 
case  of  poisoning  recorded  it  produced  symp- 
toms similar  to  those  of  chloral  depression. 
Samuel  M.  Briokner. 

XTBALINE,  URAIilUM,  TJRALTTM.— 

See  Ukal. 

URANITJM.— Professor  Kobert,of  Dorpat, 
states  that  all  the  soluble  and  absorbable  salts 
of  this  metal  are  violent  poisons,  more  danger- 
ous even  than  arsenic,  half  a  milligramme  of 
the  trioxide  to  each  kilogramme  of  an  animal's 
weight  being  surely  fatal.  Among  the  earliest 
symptoms  of  poisoning  is  glycosuria ;  then  fol- 
low' severe  gastroenteritis,  a  nephritis  not  un- 
like that  of  scarlet  fever,  and  haemorrhages 
into  the  heart  and  the  liver ;  finally,  in  ease 
death  is  escaped,  there  are  the  gravest  disturb- 
ances of  nutrition  and  excessive  emaciation. 
Kobert  sustains,  Woroschilsky's  statements 
that  uranium  must  be  regarded  as  poisonous 
to  protoplasm  and  destructive  to  every  living 
tissue,  even  destroying  the  vitality  of  the  blood. 
There  is  no  known  antagonist  to  uranium ; 
hence  its  use  as  a  medicine  should  be  under- 
taken and  carried  out  with  extreme  caution, 
for  the  symptoms  of  poisoning  are  insidious. 

In  theLancet  for  June  13, 1874, there  was  pub- 
lished a  brief  account  of  a  case  of  diabetes  melli- 
tus  treated  with  uranium  nitrate.  It  occurred 
in  Mr.  Kennedy's  service  at  the  West  Ham, 
Stratford,  and  Soiith  Essex  Dispensary,  and  the 
notes  were  furnished  by  the  house  surgeon, 
Mr.  R.  J.  Carey.  The  patient  was  a  girl, 
seventeen  years  old,  in  whom  the  disease  was 


well  marked.  For  a  fortnig;ht  she  was  treated 
with  tincture  of  chloride  of  iron :  and  then  for 
a  little  over  two  weeks  more  with  tincture  of 
opium.  She  lost  ground  all  this  time,  and 
uranium  nitrate  was  then  ordered,  at  first  ^  of 
a  grain,  gradually  increased  to  twice  that 
amount,  three  times  a  day.  In  a  week  she 
was  decidedly  improved,  and  seems  from  the 
report  to  have  been  cured  a  little  later.  The 
account  closes  as  follows :  "  Many  may  doubt 
if  the  nitrate  of  uranium  had  anything  to  do 
with  the  patient's  recovery,  but,  as  some  eases 
of  rapid  cure  and  many  of  permanent  pallia- 
tion of  this  disease  by  the  use  of  this  drug 
have  been  recorded,  it  is  to  be  hoped  that 
practitioners  of  large  experience  will  properly 
test  its  value  in  cases  of  diabetes  mellitus."  In 
spite  of  occasional  allusions  to  its  remedial 
action  in  diabetes,  however,  uranium  did  not 
receive  much  attention  until  its  use  as  a  remedy 
for  diabetes  mellitus  was  revived  by  Dr.  Samuel 
West, of  London,  who  called  to  mind  the  investi- 
gations of  uranium  in  its  physiological  and  toxi- 
cologieal  relations  by  Leoonte,  Chittenden, 
Lambert,  Woroschilsky,  and  others.  In  1895 
and  again  in  1896  Dr.  West  brought  the  subject 
before  the  British  Medical  Association.  In  his 
first  paper  {British  Medical  Journal,  August 
24,  1895)  he  credits  an  English  homceopathic 
physician.  Dr.  Hughes,  with  having  suggested 
the  use  of  uranium  in  diabetes  on  the  strength 
of  Ijeconte's  announcement,  in  1851,  that  the 
prolonged  administration  of  it  in  small  doses 
caused  glycosuria  in  dogs.  Chittenden  and 
Lambert's  experiments  showed,  said  Dr.  West, 
that  even  in  small  quantities  uranium  and  its 
salts  had  an  inhibitory  influence  on  amylolytic 
and  proteolytic  action,  so  that  a  few  drops  of 
a  one-per-cent.  solution  of  the  nitrate  prevented 
the  action  of  ptyalin,  and  a  rather  larger 
quantity  that  of  pepsin  and  trypsin.  The  ex- 
planation which  they  gave  of  this  action  was 
that  nitrate  of  uranium  formed  in  combination 
with  albumin  a  more  or  less  constant  and  indi- 
gestible compound.  When  administered  by 
the  mouth  the  drug  acted  slowly,  and  small 
doses  seemed  to  be  almost  as  efiRcacious  as 
large  doses.  For  instance,  they  obtained  the 
same  effect  with  ^  of  a  grain  as  with  a  grain. 

Dr.  West  states  that  in  the  uranium  treat- 
ment of  diabetes  he  at  first  administered  the 
drug  in  a  routine  sort  of  way  to  a  number  of 
diabetic  out-patients,  with  a  view  of  seeing  if 
any  obvious  action  could  be  traced.  He  gave 
small  doses  at  first  and  gradually  increased 
them,  not  knowing  how  much  a  patient  would 
be  able  to  stand.  He  found  after  the  drug 
had  been  administered  a  short  time  only  that 
all  the  patients  without  exception  stated  that 
their  thirst  was  greatly  relieved,  and  the  fre- 
quency of  micturition  and  the  quantity  of 
urine  passed  greatly  reduced.  This  result 
seemed  very  promising,  and  he  then  instituted 
a  careful  investigation  by  means  of  daily  ex- 
aminations of  the  urine  of  certain  patients 
whom  he  took  into  the  wards  for  that  purpose. 
The  first  patient  he  had  under  observation  for 
more  than  twelve  months,  and  during  that 
time  an  almost  daily  examination  of  the  urine 
was  made,  and  a  careful  record  kept  of  the 


339 


ULTPTOL 
URANIUM 


patient's  weight,  diet,  and  general  condition. 
The  second  case  had  also  been  under  observa- 
tion for  a  long  time,  though  not  under  the 
close  supervision  possible  with  a  hospital  pa- 
tient, the  lady  being  a  private  patient  and 
seen  by  him  from  time  to  time  in  consultation. 
In  all  cases  he  had  tried  to  place  the  patient 
under  constant  conditions,  so  that  the  only 
difference  should  be  the  administration  or 
withholding  of  the  drug. 

The  first  case  was  that  of  a  man,  aged 
twenty-one  years,  who  had  complained  of 
thirst,  loss  of  flesh,  and  frequent  micturition 
for  a  period  of  six  weeks.  The  urine  was 
found  to  be  of  high  specific  gravity  (1'036)  and 
to  be  loaded  with  sugar.  He  was  taken  into 
the  hospital,  kept  in  bed,  and  dieted.  The 
effect  of  this  change  in  his  habits  of  life  was 
shown  in  the  increase  for  the  next  few  days  in 
the  amount  of  sugar  and  the  amount  of  urine. 
The  diet  and  general  treatment  effected  a  con- 
siderable improvement  in  the  patient,  so  that 
the  percentage  of  sugar  was  reduced  to  six, 
having  been  on  the  man's  admission  more 
than  eight,  and  having  risen  on  one  occasion 
to  as  much  as  ten.  Five  pounds  in  weight  had 
been  gained,  and  the  patient  appeared  and  felt 
very  much  better. 

Uranium  nitrate  was  now  administered,  at 
first  in  small  quantities — 1  and  2  grains  three 
times  a  day— but  this  quantity  was  gradually 
increased  up  to  10  or  even  20  grains  three 
times  a  day,  when  it  was  found  that  it  could 
be  tolerated  by  the  stomach  without  disturb- 
ing the  digestion. 

The  first  effect  noticed  was  diminution  of 
the  amount  of  urine  and  of  the  thirst. 

The  percentage  of  sugar,  however,  did  not 
fall  materially  until  the  medicine  had  been 
taken  for  more  than  fourteen  days.  It  then 
fell  to  a  mean  of  four  per  cent.,  varying,  how- 
ever, from  day  to  day  considerably  between 
three  per  cent,  and  five  per  cent.  As  the  im- 
provement continued,  the  oscillation  became 
less,  and  the  tendency  toward  a  more  or  less 
fixed  percentage  became  marked. 

The  dose  of  uranium  was  gradually  increased 
up  to  15  grains,  and  in  six  weeks  there  had 
been  an  increase  in  weight  of  5  or  6  pounds. 
The  percentage  of  sugar  fell  further,  and  be- 
came more  or  less  constant,  about  3-5,  and 
there  was  a  further  decrease  in  the  amount  of 
urine,  the  quantity  averaging  between  2  and  3 
pints  daily,  and  the  total  daily  excretion  of 
sugar,  which  had  been  as  much  as  5  ounces, 
was  now  under  an  ounce.  The  dose  of  urani- 
um was  now  gradually  reduced,  and  about 
the  third  week  in  June  the  administration  was 
stopped.  For  a  time  no  change  occurred  in 
the  patient,  but  after  about  ten  days  the  per- 
centage of  sugar  again  rose,  and  in  the  course 
of  a  week  reached  to  between  five  and  six ;  the 
quantity  of  urine,  however,  was  not  materially 
altered. 

On  July  18th  the  administration  of  uranium 
was  again  begun,  but  this  time  not  in  the  form 
of  the  nitrate,  but  as  a  double  chloride  of  qui- 
nine and  uranium.  As  the  action  of  this  form 
of  the  drug  was  not  known,  its  administration 
was  begun  in  small  doses,  and  it  was  not  until 


July  30th  that  6  grains  had  been  reached,  given 
three  times  daily. 

The  smaller  doses  seemed  to  have  little  ef- 
fect, but  as  soon  as  one  of  6  grains  three  times 
a  day  was  reached,  a  sudden  drop  in  the 
amount  of  urine  and  the  percentage  of  sugar 
took  place,  the  percentage  falling  to  about 
three  and  the  quantity  to  about  55  ounces. 
The  dose  was  now  increased  to  10  grains,  and 
during  the  month  of  August  sometimes  the 
nitrate  and  sometimes  the  double  chloride  was 
administered.  In  the  course  of  September  a 
still  further  fall  gradually  took  place  in  the 
percentage  of  sugar,  until  it  reached  below  one, 
the  amount  of  urine  ranging  between  40  and 
50  ounces.  The  amount  of  uranium  given  was 
then  reduced  gradually  to  3  grains  three  times 
a  day,  and  its  use  was  continued  for  some  time 
longer;  and  during  the  months  of  October, 
November,  and  December  there  was  hardly 
more  than  a  trace  of  sugar  present,  oftentimes 
considerably  under  one  per  cent. 

In  the  middle  of  November  toast  was  per- 
mitted in  the  place  of  gluten  bread,  the  ura- 
nium being  still  given  in  the  same  doses. 
This,  however,  caused  no  change  in  the  condi- 
tion of  the  urine,  and  appeared  to  do  the  pa- 
tient no  harm,  so  that  he  was  allowed  to  have 
an  amount  of  6  oz.  of  toast  daily,  and  this  he 
had  till  Christmas  time.  He  now  had  gained 
about  14  pounds.  After  Christmas  time  he 
was  found  to  be  not  quite  so  well.  The  per- 
centage of  sugar  was  found  to  be  much  higher, 
fiuctuating  and  reaching  to  nearly  six  per 
cent.,  while  the  urine  was  also  increased  in 
quantity ;  the  patient  had  also  lost  2  pounds, 
and  looked  more  ill.  Presumably  this  relapse 
was  due  to  some  error  of  diet  during  the 
Christmas  festivities.  Ordinary  treatment 
having  no  obvious  effect,  and  the  percentage 
of  sugar  still  continuing  to  rise,  at  the  end  of 
a  fortnight  5  grains  of  uranium  were  given 
three  times  a  day.  This,  however,  had  no 
effect,  and  the  percentage  of  sugar  still  rose, 
till  in  the  middle  of  February  it  once  reached 
as  high  as  nearly  ten,  though  it  averaged  about 
eight.  The  dose  of  uranium  was  increased 
rapidly  to  15  grains,  but  it  was  not  until  this 
amount  had  been  taken  for  nearly  three  weeks 
that  its  effect  was  produced,  and  then — that  is 
to  say,  about  the  middle  of  March — the  per- 
centage fell  to  about  four,  and  the  fall  con- 
tinued until  at  the  end  of  March  the  urine 
contained  but  very  minute  traces  of  it,  a  great 
deal  below  one  per  cent.,  and  this  continued 
to  the  end  of  May,  the  dose  of  uranium  having 
some  time  previously  been  gradually  reduced 
to  5  grains  three  times  a  day,  which  amount 
the  patient  continued  to  take. 

At  the  end  of  May  and  during  the  early  part 
of  June  the  percentage  of  sugar  rose  again  to 
between  one  and  two,  and  finally,  when  the 
patient  left  the  hospital,  in  the  middle  of  June, 
the  percentage  was  about  two,  and  the  daily 
quantity  of  urine  about  50  ounces.  The  pa- 
tient presented  none  of  the  symptoms  of  dia- 
betes, and  he  did  not  look  ill.  He  said  he  felt 
well  and  strong,  and  left  the  hospital  with  the 
intention  of  going  to  work.  He  did  not  ap- 
pear again  until  October,  when  he  said  he  had 


URANIUM 


340 


been  harvesting,  living  a  good  deal  in  the  open 
air  and  under  rough  conditions.  He  came 
back  because  he  did  not  feel  so  well.  He  had 
been  for  about  three  months  without  any  of 
the  medicine.  From  October  12th  until  the 
25th  the  percentage  of  sugar  was  a  little  more 
than  six.  Doses  of  5  grains  of  uranium  were 
given,  and  subsequently  doses  of  10  grains.  By 
November  30th  the  percentage  of  sugar  had 
fallen  to  a  little  below  four.  At  Christmas 
time,  probably  again  in  consequence  of  the 
festivities  of  the  season,  the  percentage  was  as 
high  as  eight.  Doses  of  15  grains  of  uranium 
were  then  given  and  the  percentage  of  sugar 
fell  rapidly,  so  that  by  the  end  of  January  it 
was  constantly  under  two.  During:  the  whole 
time  the  patient  had  been  regulating  his  diet 
so  far  as  he  was  able  to  do  so. 

The  second  case  was  that  of  a  married 
woman,  forty-five  years  old,  who  had  been  in 
robust  health  until  about  six  months  before 
Dr.  West  saw  her,  at  which  time  she  began  to 
suffer  with  irritation  of  the  pudenda,  fre- 
quency of  micturition,  thirst,  and  loss  of  flesh. 
Mxaminatiou  of  the  urine  showed  that  she  was 
diabetic.  She  was  placed  upon  a  fixed  diet 
and  .treated  with  various  drugs.  She  weighed 
at  the  beginning  of  her  illness  129  pounds. 
Tlie  previous  treatment  had  caused  consider- 
able improvement  in  her  general  health,  and 
the  loss  of  weight  had  not  continued.  Before 
the  uranium  was  used,  analyses  of  the  urine 
were  made,  and  the  quantity  averaged  about 
1,625  cubic  centimetres,  the  specific  gravity 
1'034,  and  the  percentage  of  sugar  about  2-4. 
At  the  end  of  November  the  use  of  uranium 
nitrate  was  begun  in  small  doses.  One  grain 
was  given  at  first  twice  daily,  and  then,  a  little 
later,  three  times  a  day.  The  results  began  to 
be  manifest  in  the  beginning  of  December, 
first  upon  the  quantity  of  urine,  which  fell 
considerably,  and  as  the  dose  was  increased 
the  percentage  of  sugar  fell  also.  In  three 
weeks  from  the  beginning  of  the  treatment  the 
percentage  began  to  fall,  and  with  each  in- 
crease in  the  medicine  the  percentage  de- 
creased, until  after  she  had  been  taking  3 
grains  three  times  a  day  for  a  week  or  ten 
days  the  percentage  was  under  one.  Then  3^ 
grains  were  given  three  times  a  day,  and  the 
percentage  fell  one  half.  Pour  grains  were 
then  given,  and  on  January  22d  the  sugar  dis- 
appeared entirely  from  the  urine.  At  this 
time  the  average  amount  of  urine  was  1,300 
cubic  centimetres,  and  the  specific  gravity 
I'OIS.  Prom  this  date,  says  Dr.  West,  sugar 
was  entirely  absent  from  the  urine,  except  on 
four  odd  days,  until  the  end  of  April.  The 
highest  amount  of  sugar  present  on  these  odd 
days  was  0-37  per  cent.  During  May,  June, 
and  July  traces  were  present,  although  in 
most  of  the  examinations  no  sugar  was  found 
at  all;  but  even  when  a  small  amount  was 
found  it  was  usually  less  than  0-5  per  cent., 
and  the  highest  record  was  only  0'7  per  cent. 
During  all  this  time  3^  grains  of  uranium  ni- 
trate were  given  three  times  a  day.  In  Sep- 
tember, although  she  was  still  taking  the 
uranium,  the  percentage  of  sugar  rose,  the 
quantity  of  urine  was  also  increased  and  aver- 


aged about  1,500  cubic  centimetres,  and  the 
specific  gravity  was  about  1'020.  At  the  same 
time  considerable  fluctuations  were  noticed  in 
the  quantity  of  urine,  in  the  specific  gravity, 
and  in  the  percentage  of  sugar.  This  relapse, 
says  Dr.  West,  was  due  to  experiments  in  diet 
and  also  to  the  consequence  of  worry  in  regard 
to  household  afilairs.  If  he  had  seen  her  at 
that  time,  he  says,  he  would  have  increased 
the  dose  of  uranium  nitrate. 

The  chief  point  of  difference  between  this 
case  and  the  preceding  one,  says  Dr.  West,  is 
that  small  doses  of  uranium,  not  exceeding  4 
grains,  had  a  marked  effect,  though  in  the 
first  case  much  larger  doses  were  given,  and 
appeared  to  be  necessary.  Still,  it  is  quite  pos- 
sible, he  thinks,  that  when  the  effect  is  once 
produced  it  can  be  maintained  by  small  doses, 
and  he  is  inclined  to  think  that,  though  the 
drug  takes  longer  to  act  when  given  in  small 
quantities,  its  effect  does  not  depend  entirely 
upon  the  amount  administered  each  day,  but 
tliat  in  some  respects,  though  taking  longer  to 
act,  the  small  doses  may  have  almost  as  effi- 
cient an  action  as  the  larger  ones. 

Professor  Chittenden  observed  that  the  pro- 
longed administration  of  uranium  was  fpUowed 
by  the  presence  of  albumin  in  the  urine,  con- 
sequent upon  an  irritant  and  destructive  action 
on  the  renal  epithelium,  but  albumin  did  not 
appear  at  any  time  in  the  urine  in  either  of  Dr. 
West's  cases,  and  he  says  he  has  never  observed 
it  in  the  other  cases  he  has  treated  with  urani- 
um. Possibly  this  may  be  due,  he  says,  to  the 
gradual  administration  of  the  drug,  and  what 
he  has  observed  would  be  quite  in  accord  with 
Professor  Chittenden's  further  statements  that 
if  the  albuminuria  produced  by  a  certain  dose 
was  allowed  to  disappear  by  suspension  of  the 
drug,  the  driig  could  then  be  given  again,  and 
the  doses  increased  even  to  ten  times  the  orig- 
inal amount  before  albumin  again  appeared. 
This,  says  Dr.  West,  would  appear  to  point 
to  the  necessity  of  giving  the  drug  in  small 
amounts  at  first  and  increasing  them  gradu- 
ally. 

'These  cases,  taken  with  others,  says  Dr. 
West,  all  point  to  the  conclusion  that  we  have 
in  uranium  nitrate  a  drug  which  has  a  power- 
ful effect  upon  diabetes.  In  the  first  and 
second  cases  the  amount  of  sugar  was  greatly 
influenced  by  diet,  and  it  is  quite  possible,  he 
says,  that  this  drug  may  be  found  most  useful 
in  this  class  of  cases  on  account  of  its  physio- 
logical action  upon  digestion.  That  the  effect 
is  clearly  due  to  the  drug  is  shown  by  the  fact 
that  when  dieting  and  ordinary  treatment  have 
produced  all  the  improvement  that  is  possible, 
still  further  improvement  takes  place  after  the 
administration  of  the  drug.  As  to  its  mode  of 
action,  he  says,  we  can  do  nothing  but  specu- 
late. He  thinks  it  likely  that  its  action  is  due 
to  the  effect  it  has  in  checking  the  rapid  di- 
gestion of  starch  and  of  some  forms  of  albu- 
min, and  that  it  may  perhaps  be  especially 
useful  by  controlling  excessive  pancreatic  di- 
gestion. 

As  to  the  size  of  the  dose,  he  has  given  10, 
15,  and  20  grains  three  times  a  day  without 
gastro-intestinal    irritation    being    produced. 


341 


URANIUM 


Something  depends,  he  suggests,  upon  idio- 
syncrasy. At  the  same  time  he  thinks  it  pos- 
sible that  when  the  patient  has  once  come 
under  the  influence  of  the  drug  a  reduced 
dose  may  be  sufficient  to  keep  up  its  action. 
In  the  second  case  the  patient  attributed  her 
loss  of  flesh  to  the  action  of  the  drug.  This, 
says  Dr.  West,  is  doubtful,  and  certainly  the 
flrst  patient  continued  to  gain  in  weight  while 
taking  much  larger  doses. 

As  regards  the  salts  of  uranium,  he  has  used 
only  two — the  nitrate  and  the  double  chloride 
of  uranium  and  quinine.  So  far  as  he  can  see, 
there  is  no  difference  in  the  action  of  these 
two  salts ;  still,  he  suggests  that  the  uranous 
salts,  instead  of  the  uranic  which  he  has  been 
using,  may  have  a  different  effect.  The  ni- 
trate, he  thinks,  is  best  given  freely  diluted 
with  water  and  after  food,  beginning  with  a 
small  dose  of  1  or  3  grains  twice  daily  after 
the  chief  meals,  and  increasing  the  quantity 
slowly  at  intervals  of  a  few  days  until  its  effect 
is  produced.  So  given,  he  has  not  found  it  dis- 
turb digestion  or  cause  any  irritation  of  the 
stomach  or  bowels,  and  he  has  never  found 
its  prolonged  administration  produce  albumi- 
nuria. 

In  his  second  communication  (British  Medi- 
cal Journal,  September  19,  1896 ;  Therapeutic 
Gazette,  September,  1896)  Dr.  West  reported 
that  further  experience  had  confirmed  the 
general  statements  that  he  had  made  the  year 
before,  and  he  gave  brief  accounts  of  five  more 
oases.  The  first  one  was  an  instance  of  acute 
diabetes  in  a  woman  of  twenty-two  years.  On 
her  admission  she  was  passing  10  pints  of 
urine  containing  eight  per  cent,  of  sugar.  Af- 
ter she  had  been  dieted  for  three  weeks  in  the 
hospital  the  amount  of  urine  was  reduced  to 
4  pints  and  the  percentage  of  sugar  from  eight 
to  six;  but  during  all  this  time  there  were 
great  fiuctuations  in  the  amount  of  urine  and 
in  the  percentage  of  sugar,  such  as  were  usually 
seen  in  bad  cases  of  diabetes.  After  she  had 
been  placed  upon  the  use  of,  uranium  nitrate, 
the  doses  being  gradually  increased  to  5  grains 
three  times  a  day,  the  percentage  of  sugar  had 
been  reduced  to  four,  the  patient  had  greatly 
improved  and  gained  10  pounds  in  weight,  and 
the  irregular  fiuctuations  referred  to  had  en- 
tirely disappeared.  On  her  leaving  the  hos- 
pital a  short  time  afterward  the  percentage 
had  been  three  and  a  half  and  the  quantity  of 
urine  3^  pints.  She  had  gone  home  to  the 
anxieties  and  work  involved  in  the  care  of 
a  family  of  small  children,  had  been  unable 
to  continue  the  dieting,  and  had,  he  believed, 
died  not  long  after. 

In  the  second  case,  that  of  a  woman  of  forty- 
four,  the  patient  had  been  passing  7  pints  of 
urine  containing  seven  per  cent,  of  sugar,  with 
considerable  fluctuations  between  a  maximum 
of  0'3  per  cent,  and  a  minimum  of  6"5.  After 
her  being  dieted  in  the  usual  way,  the  percent- 
age had  fallen  to  6'8.  and  then  uranium  nitrate 
had  been  given,  with  the  result  that  the  per- 
centage fell  to  4'6.  She  had  greatly  impro'ved 
in  the  hospital,  and  had  continued  to  take  the 
drug  some  time  after  she  left. 

The  third  case  was  that  of  a  young  man. 


aged  twenty-five,  with  acute  diabetes  of  short 
duration.  He  was  passing,  on  admission,  7 
pints  of  urine,  with  a  percentage  of  between 
six  and  seven  of  sugar.  Ordinary  diet  pro- 
duced but  little  effect  upon  the  quantity  of 
urine  and  not  much  upon  the  percentage  of 
sugar.  Under  the  influence  of  the  drug  the 
percentage  fell  from  six  to  between  three  and 
four.  Ten  grains  of  the  drug  were  taken  three 
times  a  day  without  any  inconvenience,  the 
appetite  remaining  good  and  the  weight  in- 
creasing. Toward  the  end  of  his  time  he  was 
allowed  to  have  from  4  to  6  ounces  of  bread  or 
toast.  The  use  of  the  drug  was  continued,  but 
under  this  diet  the  percentage  rose  only  to  four 
and  a  half — not  so  much  as  might  have  been 
expected.  He  had  been  taking  the  drug  now 
for  a  long  time  as  an  out-patient,  was  consider- 
ably heavier  than  when  he  was  in  the  hospital, 
and  was  able  to  do  his  work  well;  and  al- 
though under  irregular  conditions  of  diet  the 
percentage  of  sugar  was  heavier,  still  he  be- 
lieved the  drug  was  a  necessity  to  him,  and  he 
was  much  better  and  abler  for  his  work  while 
taking  it. 

The  fourth  case  was  that  of  a  man  aged  fifty 
— a  bad  case  of  only  six  months'  duration. 
The  daily  amount  of  urine  was  about  5  pints, 
with  six  per  cent,  of  sugar.  He  was  dieted  as 
strictly  as  possible,  but  could  not  be  got  to  do 
without  bread.  The  dose  of  uranium  was  in- 
creased up  to  10  grains  three  times  a  day, 
which  he  took  without  any  inconvenience,  and 
he  gained  several  pounds  in  weight.  Under 
the  combined  action  of  the  drug  and  diet  the 
quantity  of  urine  was  reduced  about  a  pint, 
the  specific  gravity  remaining  much  the  same, 
and  the  percentage  of  sugar  fell  somewhat. 
The  most  marked  feature  about  this  case  was 
that  the  irregular  fluctuations,  which  had  been 
so  marked  soon  after  the  man's  admission  into 
the  hospital,  entirely  disappeared,  and  the  quan- 
tity of  urine  and  sugar  became  fairly  constant. 

The  last  case  was  that  of  a  private  patient, 
aged  forty-one,  who  had  been  the  subject  of 
diabetes  for  about  four  years.  In  this  case  the 
drug  had  not  proved  effioient.  The  patient 
had  never  been  able  to  take  more  than  about  3 
grains  three  times  a  day.  and  while  he  was  tak- 
ing the  drug  the  lowest  percentage  of  sugar 
reached  was  2'3.  As  long  as  he  was  under 
observation  the  percentage  averaged  about  three 
before  he  began  to  take  the  drug.  Before  he 
came  under  observation  the  analyses  had  been 
made  very  irregularly,  but  it  was  stated  that 
the  percentage  had  on  occasions  been  lower 
than  this  and  that  on  some  days  sugar  had 
been  entirely  absent.  These  statements,  how- 
ever, Dr.  West  could  not  vouch  for.  The  drug, 
in  the  doses  given,  seem  really  to  have  little  or 
no  effect,  and,  as  the  indigestion  became  some- 
'What  disturbed,  its  use  ultimately  had  to  be 
suspended.  The  failure  of  the  drug  in  this 
case  might  be  attributed,  he  thought,  in  some 
degree  to  the  idiosyncrasy  of  the  patient,  who 
was  unable  to  take  any  but  very  small  doses, 
and  even  those  for  only  a  brief  period. 

Dr.  West's  general  conclusions  were  the 
same  as  those  he  had  expressed  the  year  be- 
fore, viz.:  that  we  had  in  uranium  nitrate  a 


[JRETHANE 
UVA   URSl 


342 


drug  of  considerable  value  in  the  treatment  of 
diabetes  mellitus,  though,  like  all  other  drugs,  it 
could  not  be  relied  upon  to  produce  equally 
good  results  in  all  cases  indiscriminately. 

In  spite  of  the  fact  that  Dr.  West's  patients 
suffered  no  harm  from  the  doses  that  he 
thought  requisite,  it  does  not  seem  safe,  as  a 
rule,  to  begin  with  more  than  -^  oi  a.  grain,  to 
be  given  three  times  a  day. 

TJKETHANE,  or  ethylurethane,  or  ethyl 
carbamate,  C0(NH2)0C2H6,  is  a  synthetical 
product  which  is  formed  by  the  interaction  of 
ammonia  and  ethyl  carbonate  or  by  that  of 
nitrate  of  urea  and  ethyl  alcohol  at  from  130° 
to  130°  C.  It  is  alleged  by  Rademaker  to  be  a 
constituent  of  albuminous  urine,  from  which 
it  can  be  extracted,  though  never  present  in 
normal  urine,  and  it  has  been  suggested  by 
him  that  the  presence  of  this  substance  may 
occasion  certain  of  the  symptoms  which  are 
present  in  urasmic  poisoning.  It  occurs  in 
colourless  tabular  or  columnar  crystals,  which 
are  odourless  or  have  a  slight  ethereal  odour 
and  a  taste  which  resembles  that  of  nitrate  of 
potassium.  It  readily  forms  solutions,  which 
are  neutral  in  reaction,  with  water,  alcohol, 
and  many  other  media.  It  melts  at  from  47° 
to  50°  C,  and  boils  almost  without  decompo- 
sition between  170°  and  180°  C,  giving  off 
vapours  which  burn  with  a  blue  flame.  When 
an  aqueous  solution  of  urethane  is  treated  with 
nitric  or  oxalic  acid  or  with  nitrate  of  mercury, 
if  a  white  precipitate  is  formed,  urea  is  de- 
tected to  be  present. 

Experimental  investigations  on  the  lower 
animals  show  that  urethane  produces  a  short 
period  of  excitement  and  stimulation  of  the 
respiratory  and  cardiac  action,  which  is  fol- 
lowed by  profound  sleep  during  which  the 
respiration  again  becomes  slower.  A  fatal 
dose  causes  the  respiration  to  become  slower, 
the  temperature  lowered,  motion,  and  subse- 
quently sensation,  to  be  lost,  the  reflexes  to  be 
abolished,  the  unconsciousness  to  become  ab- 
solute, and  the  heart's  action  to  grow  feeble. 
Death  occurs  from  asphyxia.  In  small  animals 
it  is  said  to  be  an  eilectual  antagonist  to  the 
action  of  strychnine.  It  has  no  analgetic 
power.  A  careful  consideration  of  the  results 
of  these  experiments  does  not  yield  a  thor- 
oughly satisfactory  explanation  of  the  physi- 
ological action  of  urethane.  It  would  seem  to 
act  directly  upon  the  cerebrum  and  spinal 
cord,  and  possibly  upon  the  entire  nervous 
system.  Van  Amrep  demonstrated  that  large 
doses  of  the  drug  occasioned  a  loss  of  the 
faradaic  sensibility  in  the  cerebral  cortex. 
The  lessening  of  the  reflex  action  appears  to 
be  primarily  due  to  its  influence  on  the  spinal 
cord,  and  it  seems  to  be  probable  that  the  ex- 
citability of  the  motor  and  sensory  nerves  is 
reduced. 

Urethane  was  introduced  into  medicine  as  a 
hypnotic  in  1885  by  von  Jaksch.  It  is  quite 
mild  in  its  action,  and  seems  to  be  devoid  of 
the  dangerously  poisonous  qualities  which 
characterize  the  more  powerful  hypnotics. 
The  very  small  amount  which  has  recently  ap- 
peared in  literature  regarding  this  drug  may 


perhaps  indicate  that  the  conclusion  of  Dr. 
GrifiSth  and  Dr.  Kirby,  that  it  is  unreliable  and 
uncertain  in  its  action,  has  been  accepted  by 
the  profession  and  its  use  to  a  great  extent 
abandoned,  but  some  observers  commend  it 
very  highly  as  a  sedative  and  hypnotic,  not 
only  in  cases  of  insomnia  from  slight  causes, 
but  also  in  functional  disturbances  and  organic 
diseases  of  the  brain.  It  is  not  sufficiently 
powerful  to  take  the  place  of  sulphonal,  paral- 
dehyde, or  chloral  in  delirium  tremens  or  acute 
mania,  but  when  the  depressant  effect  of  the 
stronger  hypnotics  is  contra-indicated  from  any 
cause,  and  the  insomnia  does  not  depend  on 
such  grave  conditions,  urethane  is  particularly 
useful.  Demme  recommends  it  as  of  special 
value  in  children,  and  reports  a  number  of 
cases  thus  treated.  He  gives  4  grains  to  a 
child  a  year  old,  and  believes  that  larger  doses 
are  safe  even  when  the  children  are  weakly,  as 
he  has  never  seen  any  unpleasant  efEeots  from 
its  action. 

Cases  of  the  successful  treatment  of  tetanus 
with  urethane  are  recorded.  Abbott  has  re- 
ported a  patient  as  cured  in  two  days  by  the 
ingestion  of  9  grains  every  two  hours  and  30J 
grains  at  night. 

It  is  advisable  to  give  urethane  in  several 
small  doses,  frequently  repeated,  because  a 
single  large  dose  is  apt  to  induce  vomiting. 
In  this  manner  from  10  to  60  grains  may  be 
administered.  As  it  has  no  irritant  action,  it 
can  be  given  hypodermically  in  doses  of  from 
4  grains  upward. 

Matthias  Lanckton  Foster. 

TJBICEDIN. — This  is  a  German  proprietary 
preparation,  a  white,  granular  substance  freely 
soluble  in  water,  of  a  slightly  acid  reaction, 
said  to  consist  of  67  per  cent,  of  sodium 
citrate,  37'5  per  cent,  of  sodium  sulphate,  1-6 
per  cent,  of  sodium  chloride,  and  1-9  per  cent, 
of  lithium  citrate.  It  is  used  in  the  treatment 
of  gout  and  the  uric-acid  diathesis,  in  daily 
amounts  of  from  15  to  30  grains.  Large 
doses,  from  3  to  5  drachms,  may  cause  diar- 
rhoea. 

TJROPHEBINE.  —  This  is  lithio-theo- 
bromine  salicylate,  C7H,N"40aLi  -i-  CaH4{0II) 
COOLi,  being  an  analogue  of  diuretin,  which 
is  sodio-theobromine  salicylate  {q.  v.).  It  is  a 
white  powder  soluble  in  water.  It  is  used  as  a 
diuretic  in  doses  of  fifteen  grains. 

UBOTBOPINE.— Dr.  Arthur  Nicolaier,  of 
Gottingen,  has  given  this  name  to  hexamethyl- 
enetetrainine,  a  compound  formed  by  the  ac- 
tion of  formaldehyde  on  ammonia,  because  he 
has  observed  various  changes  in  the  urine  un- 
der its  use.  In  the  Deutsche  medieinische 
Wochenschrift  for  August  23,  1895  (New  York 
Medical  Journal,  October  19, 1895),  there  is  an 
article  by  him  on  the  therapeutical  use  of  uro- 
tropine.  He  says  that  under  the  influence  of 
the  remedy  diuresis  is  increased ;  that  uric 
acid  and  sedimentary  urates,  previously  pres- 
ent in  large  quantities,  no  longer  appear ;  and 
that  the  disappearance  of  these  deposits  is  not 
a  mere  consequence  of  the  increased  diuresis, 
but  is  due  to  the  direct  action  of  the  remedy 
on  the  uric  acid  and  its  salts.    These  experi- 


343 


URETHANE 
UVA   UUSI 


mental  results,  he  thinks,  hare  demonstrated 
that  urotropine  may  be  employed  not  only  as 
a  diuretic,  but  in  the  treatment  of  the  uric- 
acid  diathesis  and  the  various  morbid  condi- 
tions dependent  upon  it. 

His  further  experiments  show  that  the  rem- 
edy is  especially  adapted  to  the  treatment  of 
uric-acid  calculi,  for  after  the  ingestion  of 
urotropine  the  urine,  without  any  change  oc- 
curring in  its  acid  reaction,  gains  certain 
properties  that  make  it  a  uric-acid  solvent. 
Thus,  if  an  adult  whose  urine  does  not  dissolve 
uric-acid  concretions  even  after  several  days' 
retention  in  the  culture  oven  is  given  suffi- 
ciently large  doses  of  the  drug,  it  is  found  that 
within  twenty-four  hours  the  urine  begins  to 
dissolve  such  calculi  placed  in  it,  and  kept  at 
a  temperature  of  98'6°  P.,  and  that  this  goes 
on  until  after  several  days  only  the  organic 
albuminous  framework  of  the  stone  is  left. 
The  urine  loses  its  uric-acid  solvent  properties 
as  soon  as  the  urotropine  is  all  excreted. 

Further  researches  have  shown  that  the  in- 
creased diuresis  may  be  absent  in  certain  cases, 
also  that,  while  doses  of  120  and  even  150 
grains  may  be  borne  by  adults,  yet  in  certain 
cases,  for  some  unknown  reason,  the  continued 
use  for  lengthy  periods  of  time  of  daily  doses 
amounting  to  only  90  grains  occasionally  causes 
unpleasant  symptoms  which  call  for  a  decrease 
in  the  size  of  the  dose.  Several  patients  that 
had  taken  urotropine  in  large  doses  for  a  time 
began  to  complain  of  a  sensation  of  burning 
in  the  vesical  region,  generally  after  urinat- 
ing; these  pains  radiated  along  the  urethra, 
and  were  sometimes  accompanied  with  an  in- 
creased desire  to  micturate.  The  urinary  ex- 
amination in  these  eases  showed  only  a  mod- 
erate amount  of  transitional  epithelium  and 
no  other  abnormal  constituents.  If  in  spite 
of  these  symptoms  the  use  of  the  remedy  was 
persisted  in  in  the  same  doses,  the  trouble  in- 
creased in  severity,  and  occasionally  red  blood- 
corpuscles  appeared  in  the  sediment.  All  these 
troubles  disappeared,  however,  as  soon  as  the 
dose  of  urotropine  was  diminished  or  its  use 
was  discontinued  entirely,  and  the  urine  soon 
returned  to  its  normal  state.  Prom  daily 
doses  of  less  than  30  grains  the  author  has 
never  seen  any  ill  effects,  no  matter  how  long 
their  use  was  continued.  Occasionally,  how- 
ever, he  has  found  small  quantities  of  transi- 
tional epithelium  in  the  sediment  even  then. 
He  therefore  now  limits  the  doses  to  from  15 
to  22  grains  daily,  that  amount  being  taken  at 
once,  in  the  morning,  dissolved  in  water. 

Nicolaier  noticed  that  the  urine  of  patients 
that  were  taking  from  45  to  90  grains  of  uro- 
tropine remained  clear  and  retained  its  acid 
reaction  at  a  temperature  of  98-6°  P.,  even 
when  a  few  drops  of  urine  in  a  state  of  ammo- 
niacal  fermentation  were  added  to  it.  Several 
specimens  of  such  urine  he  has  kept  for  months 
in  the  oven,  without  ammoniacal  decomposi- 
tion setting  in.  Even  after  inoculation  with 
pure  cultures  of  the  Bacterium  coli  commune 
such  urine  remained  sterile  at  98'6'  P.  The 
same  thing  happened  with  the  urine  of  persons 
who  were  taking  daily  doses  of  15  or  even  7-i 
grains.     These  observations  have  convinced 


him  that  the  use  of  urotropine  hinders  the  de- 
velopment of  micro-organisms,  such  as  the 
bacteria  of  the  ammoniacal  decomposition  of 
urine  and  the  Bacterium  coli  commune,  which 
latter,  he  remarks,  is  a  factor  in  many  of  the 
bacterial  diseases  of  the  urinary  passages.  The 
results  of  his  experiments  in  this  direction 
show,  in  his  opinion,  that  the  drug  ought  to 
be  employed  in  these  morbid  conditions.  He 
has  used  urotropine  in  two  cases  of  cystitis  in 
which  the  urine  was  strongly  ammoniacal,  and 
found  it  quickly  efficacious.  In  cases  in  which 
the  urine  was  acid  he  has  not  found  it  ef- 
fective. 

Dr.  J.  A.  Plexner  (American  Practitioner  and 
News,  December  28,  1895)  says  that  alkaline 
and  putrid  urine  containing  mucus  in  excess, 
pus  and  pus  organisms,  uric  acid,  or  amor- 
phous urates,  are  rapidly  restored  by  it  to  a 
normal  appearance  and  an  acid  reaction.  The 
urine  is  sterilized  and  increased  in  quantity, 
and  calculi  and  deposits  are  dissolved.  He 
concludes  that  urotropine  is  a  most  valuable 
resource  in  suppurations  of  the  urinary  tract 
and  in  gouty  and  rheumatic  conditions  where 
an  active  eiiminant  of  uric  acid  and  its  salts 
is  indicated.  A  further  valuable  property  of 
urotropine,  he  thinks,  is  its  faculty  of  combin- 
ing readily  with  salicylic  acid  and  forming  a 
soluble  combination.  A  solution  containing 
from  10  to  15  grains  each  of  urotropine  and 
salicylic  acid  to  the  fluid  ounce  of  water  or 
other  suitable  vehicle  has  the  further  advan- 
tage over  the  salicylates  alone  that  its  taste  is 
not  disagreeable.  It  appears,  he  adds,  to  be 
far  less  irritant  to  the  gastric  mucous  mem- 
brane than  solutions  of  salicylic  acid  usually 
are,  and  he  thinks  the  combination  promises 
to  have  a  wide  range  of  therapeutic  usefulness. 

TTBrTICA. — The  common  stinging  nettle, 
TJrtica  dioica,  has  been  recommended  as  a 
diuretic  and  hcemostatic,  especially  for  check- 
ing uterine  hcemorrhage.  A  decoction  made  in 
the  proportion  of  1  part  of  the  herb  to  16  parts 
of  water  may  be  given  in  doses  of  4  fl.  oz.  three 
times  a  day.  There  is  a  non-official  fluid  ex- 
tract the  dose  of  which  is  -J  fl.  drachm. 

Urtica  (or  Pilea)  pumila,  the  bastard  nettle, 
has  been  found  efficacious  in  the  treatment  of 
rhus  poisoning  (see  vol.  ii,  page  132). 

trSTILAGO  MAIDIS.  — See  Ergot  of 
maize  (vol.  i,  page  389). 

TJViE. — Grapes.    See  Grape  cure. 

UVA  TIK.SI  (U.  S.  Ph.),  uvoi  ursi  folia  (Br. 
Ph.),  folia  uvcc  ursi  (Ger.  Ph). — The  leaves  of 
Arctotstaphylos  uva  ursi,  or  bearberry,  a  shrub 
widely  distributed  throughout  the  higher  parts 
of  the  temperate  zones,  are  astringent  and  di- 
uretic, resembling  buchu  in  their  action,  al- 
though inferior  to  it.  It  is  also  somewhat 
tonic  and  is  indicated  in  chronic  cystitis,  gleet, 
the  later  stages  of  diarrhoea,  and  pyelitis,  but 
is  hardly  active  enough  to  take  the  place  of 
other  diuretics  when  there  is  ascites.  Its  prop- 
erties are  believed  to  be  due  to  a  crystalline 
body,  arbutin,  which  maybe  substituted  for  the 
leaves  in  doses  of  from  5  to  10  grains.  The 
leaves  themselves  may  be  given  in  doses  of  from 
50  to  60  grains.    The  dose  of  the  infusion,  in- 


VACCINICTM 
VALERIAN 


344 


fusum  tiiw  ursi  (Br.  Ph.),  is  from  1  to  2  fl.  oz. 
An  unofficial  decoction  made  in  the  proportion 
of  1  part  of  the  leaves  to  16  parts  of  water  may 
be  employed  in  doses  as  large  as  3  fl.  oz.  The 
extract,  extractum  uvm  ursi  (U.  S.  Ph.),  and  the 
fluid  extract,  extractum  uvm  ursi  fluidum  (U. 
S.  Ph.),  may  be  given  respectively  in  doses  of 
from  20  to  60  grains  and  from  30  to  60  min- 
ims.—Russell  H.  Nevins. 


■VACCINITTM. — Several  species  of  this 
typical  genus  of  the  Vaeciniacem  have  been 
used  in  medicine.  The  berries  of  Vaccinium 
Arctostaphylos,  or  Oriental  whortleberry,  Vac- 
cinium corymbosum  (or  discomorphum),  or  the 
common  blueberry,  Vaccinium  frondosum,  or 
the  A  merican  blue  whortleberry,  and  Vaccinium 
Myrtillus  (or  nigrum),  or  the  English  whortle- 
berry, were  formerly  used  as  a  mild  astringent 
in  diarrhcsa  and  inflammatory  affections  of  the 
throat,  also  as  a  hemostatic.  Winternitz  (cited 
by  Hare,  Medical  Annual,  1893)  has  found 
those  of  Vaccinium  Myrtillus  efflcient  in  the 
treatment  ef  leucoplakia  iuccalis,  as  well  as  in 
various  other  affections  of  the  mouth,  chiefly 
in  the  form  of  a  concentrated  decoction. 

The  berries  of  Vaccinium  Oxycoccus,  or  the 
cranberry,  have  been  employed  as  an  astringent, 
detersive,  antiscorbutic,  and  refrigerant. 

The  leaves  of  Vaccinium  Vitis  idcea,  the  red 
whortleberry  or  red  bilberry,  have  long  been 
used  by  the  Russian  peasants,  who  call  the 
plant  brousinka,  as  a  remedy  for  rheumatism. 
Dr.  T.  T.  Hermann  (British  Medical  Journal, 
April  19,  1893)  has  used  it  in  the  form  of  a 
decoction  or  infusion  of  1  part  of  the  fresh 
herb,  with  the  roots,  to  8  parts  of  the  colature 
(from  3  to  3  tumblerfuls  being  given  daily)  in 
an  obstinate  case  of  chronic  articular  rheuma- 
tism, in  which  all  the  usual  methods  of  treat- 
ment had  failed.  A  striking  improvement 
followed  in  a  few  weeks,  and  in  two  months 
the  patient,  an  old  man,  was  practically  cured. 

S.  P.  Smirnoff,  of  Cronstadt  (Meditzinskia 
Prebai'lenia  K'MorsJcomii  SpornikiX,  Decem- 
ber, 1891  [cited  in  the  same  number  of  the 
British  Medical  Journal),  next  tried  the  sub- 
stance on  nine  patients,  sailors  and  soldiers  aged 
from  twenty-two  to  twenty-seven,  of  whom  six 
were  suffering  from  acute  and  three  from  chron- 
ic articular  rheumatism.  In  all  of  them  the 
treatment  was  begun  after  all  ordinary  means, 
including  the  use  of  salicylate  of  sodium, 
iodide  of  sodium  or  potassium,  hot  baths,  local 
applications  of  tincture  of  iodine,  turpentine 
oil.  belladonna,  mercurial  or  iodide-of-potas- 
siura  ointment,  etc.,  had  proved  quite  ineffica- 
cious. The  remedy  was  used  in  the  form  of  a 
decoction,  prepared  from  1  or  2  oz.  of  the  fresh 
stems,  with  the  leaves  and  roots,  in  6  oz.  of 
water,  and  this  amount  was  given  daily  iu 
divided  doses.  The  duration  of  the  treatment 
varied  from  a  week  to  three  months.  Of  the 
nine  patients,  seven  were  cured,  while  in  the  re- 
maining two  the  remedy  failed  (in  one  after  a 
week's  course,  in  the  other  after  three  months). 
In  all  the  cases  a  slight  increase  of  the  daily 


quantity  of  urine  was  observed,  and  in  the 
patients  in  whom  catarrhal  diarrhcEa  was 
present  that  complication  quickly  ceased  un- 
der the  influence  of  the  decoction.  Smirnoff 
sums  up  as  follows:  1.  The  results  obtained 
by  him  must  be  regarded  as  exceedingly 
favourable.  2.  The  red-bilberry  treatment 
deserves  a  further  extensive  trial.  3.  The 
method  is  extremely  simple,  convenient,  harm- 
less, and  cheap  (in  Russia  the  red  bilberry  is 
one  of  the  commonest  of  plants).  4.  It  is 
advisable  to  continue  the  use  of  the  decoction 
for  some  time  after  the  complete  disappearance 
of  all  symptoms,  since  in  one  case,  which  had 
been  cured  in  five  weeks,  a  relapse  occurred 
three  months  and  a  half  later.  5.  It  is  useful 
to  combine  the  internal  treatment  with  local 
applications  of  anodynes  and  counter-irritants. 
The  decoction  forms  a  cinnamon-brown,  some- 
what turbid  fluid,  with  a  slightly  bitter  and 
astringent  taste  and  a  neutral  reaction. 

As  the  author's  analysis  has  shown,  the 
decoction  contains  vaccinin,  tannic  acid,  ex- 
tractive, proteid,  and  mucoid  substances,  etc. 
Vaccinin,  discovered  by  Classen  in  1865,  is  a 
glucoside  occurring  in  the  form  of  white, 
minute,  acicular  crystals,  which  are  easily 
soluble  in  water  but  much  less  soluble  in  ether, 
and  almost  insoluble  in  alcohol.  The  glucoside 
is  not  identical  with  arbutin,  for  the  latter  is 
soluble  in  alcohol  and  gives  a  green  reaction 
with  perchloride  of  iron,  while  vaccinin,  when 
treated  with  the  salt,  assumes  a  cherry-red 
colour. 

VALERIAN,  Valeriana  (U.  S.  Ph.),  valeri- 
anm  rhizoma  (Br.  Ph.),  radix  valeriance  (Ger. 
Ph.),  consists  of  the  rhizome  and  rootlets  of 
Valeriana  officinalis,  an  herbaceous  perennial 
plant  indigenous  to  Europe  and  northern  Asia. 
It  is  cultivated  to  some  extent  in  this  country 
for  use  in  medicine,  but  it  is  said  that  the 
roots  of  the  cultivated  plants  contain  a  smaller 
proportion  of  the  volatile  oil  than  those  of  the 
wild  plants.  The  roots  which  grow  in  a  dry 
soil  are  smaller  but  contain  a  larger  proportion 
of  the  oil  than  those  from  damp  situations. 
When  freshly  gathered,  the  root  has  only  a 
slight  fragrance,  but  as  it  dries  it  develops  a 
peculiar  odour,  which  becomes  stronger  and 
more  unpleasant  with  the  lapse  of  time.  The 
taste  is  at  first  sweetish,  but  later  it  becomes 
unpleasant,  camphoraoeous,  and  somewhat 
bitter.  Its  colour  externally  is  yellowish  or 
brown,  internally  white,  and"  when  the  root  is 
reduced  to  a  powder  yellowish  gray.  Its  ac- 
tive princii  les  are  soluble  in  both  water  and 
alcohol. 

The  most  important  derivative  of  valerian 
is  its  volatile  or  essential  oil,  which  may  be 
obtained  in  proportions  that  vary  from  0'5  to 
3  per  cent,  'ihis  is  a  complex  substance  which, 
when  freshly  distilled,  is  light-greenish  or  yel- 
lowish in  colour  and  of  a  neutral  reaction. 
Changes  are  induced  by  age  and  exposure  to 
the  air  which  cause  it  to  become  of  a  browner 
or  more  deeply  yellow  colour,  and  to  acquire 
a  strong  odour  and  an  acid  reaction.  Tnese 
changes  are  due  to  oxidation,  which  results  in 
the  formation  of  certain  products,  the  chief  of 


345 


VACCINIUM 
VALERIAN 


which  are  a  hydrocarbon  or  terpene,  CioHu, 
called  valerin,  valeren,  or  valerene ;  a  camphor- 
aceous  substance  known  as  valerol,  CnHjoO  ; 
and  valerianic  acid,  CbHioOj.  A  serious  con- 
fusion of  terms  has  unfortunately  been  occa- 
sioned by  the  application  of  the  name  valerene 
to  two  other  hydrocarbons  as  well  as  to  that 
derived  from  oil  of  valerian.  One  of  these 
hydrocarbons,  known  also  as  amylene,  CsHio, 
is  formed  by  the  interaction  of  phosphoric 
oxide  and  amylic  alcohol ;  the  other,  CioHa,  is 
obtained  from  Borneo  camphor,  and  is  also 
called  borneene.  The  chemical  formulae  show 
that  these  are  not  identical  with  the  valerene 
obtained  from  oil  of  valerian,  which  is  a  ter- 
pene. 

Valerol  appears  to  be  composed  of  a  cam- 
phor, with  resin  and  water,  a  mixture  which 
readily  beomes  oxidized  on  exposure  to  the  air 
into  valerianic  acid. 

Valerianic  acid  is  a  colourless,  oily,  volatile 
fluid  with  a  very  strong  odour  and  a  sour, 
burning,  and  disagreeable  taste.  It  is  soluble 
in  30  parts  of  cold  water,  freely  soluble  in- 
alcohol,  ether,  or  strong  acetic  acid,  and  is  a 
solvent  for  camphor  and  some  resins.  It  was 
first  obtained  by  Ohevreul  from  the  oil  of  the 
dolphin,  and  received  at  that  time  the  name  of 
delphinic  acid.  This  name  was  afterward 
changed  to  the  one  it  now  bears  when  Pentz 
found  it  in  valerian.  It  has  also  been  obtained 
from  viburnum,  sambucus,  and  other  plants, 
as  well  as  from  organic  products  of  animal 
life.  But  it  is  largely  made  in  the  laboratory 
by  the  oxidation  of  amylic  alcohol.  This  last 
product  seems  to  be  chemically  identical  with 
the  natural  acid,  but  it  is  alleged  that  the 
valerianates  made  with  it  do  not  produce  the 
same  physiological  effects  as  those  made  from 
acid  obtained  from  valerian. 

Valerianic  acid  is  found  as  an  oxidation 
product  in  both  the  oil  and  the  root  of  valerian, 
the  amount  increasing  with  age  and  exposure. 
It  is  a  disagreeable  irritant,  and  does  not  pos- 
sess the  calmative  properties  of  the  oil  or  of 
the  fresh  root.  From  Beissner's  experiments 
we  learn  that  it  coagulates  albumin,  blood 
serum,  and  milk,  and  that  it  is  slightly  irritat- 
ing to  the  skin.  It  increases  the  rapidity  of 
the  heart's  action,  and  weakens  it  and  the 
respiration  as  well.  It  causes  weakness,  mus- 
cular paralysis,  convulsions,  and  death.  If 
death  is  quickly  produced,  the  gastric  mucous 
membrane  will  be  found  to  be  pale ;  but  if  the 
duration  of  the  intoxication  is  prolonged,  the 
mucous  membrane  of  the  whole  intestinal  tract 
will  be  found  to  be  inflamed,  the  kidneys  con- 
gested, the  urine  turbid  and  bloody.  The 
characteristic  odour  is  not  imparted  to  the 
urine  or  the  blood,  but  it  can  be  detected  in 
the  peritoneal  cavity.  The  acid  is  not  itself 
vised  in  medicine,  but  several  of  its  salts,  the 
valerianates,  are  in  use  and  will  be  described. 
In  addition  to  these  constituents  of  valerian, 
Waliszewski  has  isolated  two  alkaloids  which 
have  been  named  vaterine  and  chatinine. 

Valerian  seems  to  act  very  gently  as  a  gen- 
eral stimulant,  but  its  principal  action  is  as  a 
sedative  upon  the  nervous  system,  to  reduce  its 
irritability,  both  direct  and  reflex.    It  thus  acts 


as  an  antispasmodic  in  a  similar  manner  to 
that  of  asafcetida,  musk,  lavender,  and  other 
drugs  of  this  class.  It  does  not  produce  any 
narcotic  effects.  In  small  quantities  valerian 
excites  a  sensation  of  warmth  in  the  stomach, 
and  acts  as  a  tonic  by  improving  the  appetite 
and  digestion.  According  to  Bouchard,  the 
amount  of  urea  excreted  is  diminished.  The 
usual  medicinal  doses  may  irritate  the  digestive 
tract,  so  as  not  to  act  as  a  tonic  but  to  cause 
gastro-intestinal  disturbance.  The  pulse  is 
also  usually  accelerated.  Larger  but  yet  me- 
dicinal doses  increase  the  action  of  the  heart, 
raise  the  temperature,  and  in  many  persons 
produce  exhilaration,  sometimes  a  slight  men- 
tal disturbance,  with  formication  of  the  hands 
and  feet.  Very  large  doses  produce  dizziness, 
hallucinations,  diplopia,  and  active  delirium 
with  reduced  motility,  sensibility,  and  reflex 
excitability.  Such  quantities  also  cause  nau- 
sea, vomiting,  hiccough,  diarrhoea,  frequent 
micturition,  and  tenesmus,  together  with  an 
increased  flow  of  urine,  which  contains  an 
abnormally  large  quantity  of  urates  and  lith- 
ates.  The  blood-pressure,  as  well  as  the  pulse- 
rate,  is  lowered  by  the  paralyzing  effect  of  the 
drug  upon  the  nerve-centres.  When  used  for 
a  long  time  valerian  is  apt  to  cause  a  condition 
of  depression  and  melancholy.  It  is  excreted 
by  the  kidneys,  which  are  stimulated  by  it, 
and  also  by  the  lungs  and  skin.  It  may  cause 
death  in  small  animals,  but  is  not  sufficiently 
powerful  to  kill  a  man.  Cats  are  notably  very 
fond  of  valerian.  It  greatly  excites  their 
sexual  appetite,  and  finally  produces  in  them 
violent  convulsions. 

The  range  of  the  therapeusis  of  valerian  is 
quite  small,  as  it  is  confined  to  cases  of  irregu- 
lar nervous  action  which  do  not  depend  upon 
a  demonstrable  lesion  or  upon  inflammation. 
It  quiets  nervous  excitement,  and  is  a  valuable 
remedy  to  give  temporary  relief  in  all  forms  of 
hysteria.  In  hystero-epilepsy  it  is  sometimes 
of  great  benefit,  but  in  true  epilepsy  it  is  sel- 
dom, if  ever,  of  any  use,  unless  in  rare  cases  of 
petit  mal.  It  relieves  nervous  headache,  and 
acts  as  a  hypnotic  in  insomnia  of  hysterical 
origin.  It  is  rarely,  but  occasionally,  of  some 
benefit  in  chorea.  It  has  proved  a  valuable 
agent  to  relieve  the  nervous  disturbances  inci- 
dent to  the  menopause,  the  nervous  phenomena 
of  exophthalmic  goitre,  and  also  pruritus  of 
neurotic  origin.  It  has  been  successfully  em- 
ployed to  relieve  flatulence  in  infants,  as  well 
as  that  of  hysterical  and  hypochondriacal  sub- 
jects, and  is  useful  in  the  nervous  disorders 
depe7ident  upon  intestinal  parasites  in  chil- 
dren. It  has  proved  efficient  in  cough  of 
nervous  origin,  including  whooping-cough, 
especially  in  the  convulsions  and  other  neurotic 
troubles  which  result  from  them,  in  delirium 
with  depression,  and  in  the  coma  of  typhus 
fever.  It  has  been  recommended  in  diabetes 
mellitus  and  insipidus,  but  does  not  induce 
any  lasting  improvement.  In  its  action  va- 
lerian antagonizes  strychnine,  brucine,  and 
thebaine,  and  to  the  extent  of  its  power  is 
antidotal  to  those  poisons. 

The  infusion,  infusum  valeriance  (Br.  Ph.), 
may  be  given  in  doses  of  from  1  to  2  fl.  oz^ 


VALERIANIC  ACID 
VAPOURS 


346 


The  dose  of  the  tincture,  tinetura  valerianm 
(U.  S.  Ph.,  Br.  Ph.,  Ger.  Ph.),  is  from  1  to  2  fl. 
drachms ;  that  of  the  ammoniated  tincture, 
tinetura  valeriancB  amtnouiata  (U.  S.  Ph.,  Br. 
Ph.),  is  from  -J^  to  1  fl.  drachm ;  that  of  the 
ethereal  tincture,  tinetura  valerianm  CBtherea 
(Ger.  Ph.),  and  that  of  the  fluid  extract,  extrae- 
tum  valeriancB  fluidum  (U.  S.  Ph.).  are  the 
same.  The  best  preparation  to  employ  is  the 
oil,  which  may  be  given  in  doses  of  from  2  to 
5  minims  in  cinnamon  water  and  mucilage. 
The  nauseous  taste  of  the  tinctures  renders 
them  undesirable.  The  ammoniated  tincture 
is  more  useful  than  the  simple  tincture,  be- 
cause it  combines  with  the  antispasmodic 
action  of  valerian  the  stimulant  and  carmin- 
ative effects  of  ammonia. 

The  Valerianates. — The  salts  of  valerianic 
acid  are  used  in  medicine  to  a  slight  extent. 
As  a  rule,  their  therapeutic  value  is  not  great 
and  their  effects  correspond  with  those  of  the 
bases  rather  than  with  those  of  valerian. 

Ammonium  Valerianate. — This  is  the 
most  valuable  of  these  salts  and  the  only  one 
used  at  all  extensively.  It  occurs  in  colourless 
or  white  quadrangular  plates  which  emit  the 
odour  of  valerianic  acid  and  possess  a  sharp, 
sweetish  taste.  It  efSoresces  in  dry  and  deli- 
quesces in  damp  air.  It  readily  forms  solutions 
in  water,  in  alcohol,  and  in  ether  which  are 
neutral  in  reaction,  but  become  acid  from  the 
evaporation  of  ammonia.  When  the  solution 
is  dispensed  this  acidity,  if  present,  should  ba 
neutralized  by  the  addition  of  a  little  ammo- 
nia, which  is  also  useful  to  somewhat  mask 
the  disagreeable  odour  and  taste  of  the  vale- 
rianic acid. 

It  is  probable  that  small  doses  of  this  salt 
stimulate  the  functions  of  the  spinal  cprd  and 
that  large  ones  depress  them,  but  not  to  such 
a  degree  as  to  render  the  drug  dangerous.  It 
is  useful  in  the  same  class  of  cases  as  valerian — 
that  is,  in  mild,  functional  nervous  derange- 
ments, such  as  certain  forms  of  neuralgia, 
headache,  insomnia,  and  palpitation  of  the 
heart. 

Valerianate  of  ammonium  was  introduced 
as  a  therapeutic  agent  in  18.56  by  M.  Declat, 
who  used  a  preparation  known  as  Pierlot's 
solution,  made  by  dissolving  1  drachm  of  vale- 
rianic acid  in  32  drachms  of  distilled  water, 
saturating  the  solution  with  carbonate  of  am- 
monium and  adding  to  the  salt  thus  formed  40 
grains  of  an  alcoholic  extract  of  valerian  in 
order  to  prevent  its  rapid  decomposition.  This 
solution  is  neutral,  is  brown  in  colour,  and  has 
a  strong  valerianic  odour.  Prom  6  to  30 
drops  are  given,  in  water  or  on  a  lump  of 
sugar. 

The  dose  of  the  salt  as  prepared  at  the  pres- 
ent time  is  from  2  to  10  grains,  which  may  be 
given  in  a  pill  or  in  water.  The  most  elegant 
and  the  usual  mode  of  dispensing  it  is  in  the 
form  of  the  elixir  of  the  valerianate  of  ammo- 
nium, 1  drachm  of  which  contains  2  grains  of 
the  salt. 

Amyl  Valerianate. — See  vol.  i,  page  62. 

Bismuth.  Valerianate  is  a  non-official, 
white,  amorphous  powder,  insoluble  in  water 
or  alcohol,  and  with  a  strong  odour  of  vale- 


rianic acid.  Whatever  therapeutic  value  this 
salt  may  possess  is  probably  due  to  the  bismuth 
alone. 

Caffeine  Valerianate  was  tried  by  Paret 
in  187.5  in  hysteria.  It  appeared  to  act  as  a 
general  stimulant  and  was  sometimes  success- 
fully employed  to  moderate  nervous  vomiting 
and  to  mitigate  the  paroxysms  of  whooping- 
cough,  given  in  2-grain  pills  three  times  a  day. 

Antipyrine  Valerianate. — This  salt  has 
a  strong  valerianic  odour.  It  is  used  for  the 
same  purposes  and  in  the  same  doses  as  anti- 
pyrine. 

[Atropine  Valerianate. — See  vol.  i.  page 
157. 

Cerium  Valerianate. — This  is  a  yellowish- 
white  powder  which  has  been  employed  by 
Blondeau,  in  daily  amounts  of  1|  grain,  in  the 
treatment  of  the  vomiting  of  pregnancy,  in 
which  it  may  perhaps  have  some  advantage 
over  cerium  oxalate. 

Creosote  Valerianate. — Dr.  E.  Grawitz 
( Therapeutisehe  Monatshefte,  July,  1896 ;  Wien- 
er klinische  Rundschau,  August  23,  1896)  has 
found  this  preparation,  which  is  a  valerianic- 
aoid  ester  of  creosote,  advantageous  where 
creosote  is  indicated,  for  the  following  rea- 
sons :  1.  Being  odourless  and  tasteless,  it  is 
readily  taken.  2.  Adminstered  even  in  large 
doses,  it  seldom  gives  rise  to  digestive  dis- 
turbances. 3.  It  is  comparatively  cheap.  It 
comes  in  the  form  of  gelatin  capsules  each 
containing  about  3  grains.  One  capsule  a  day 
is  enough  to  begin  with,  but  the  number  may 
be  increased  until  from  six  to  nine  are  taken 
daily.] 

Iron  Valerianate  is  a  dark  brick-red 
amorphous  powder,  of  uncertain  chemical 
composition,  which  is  permanent  in  dry  air 
and  has  slightly  the  odour  and  taste  of  vale- 
rianic acid.  It  is  insoluble  in  water,  soluble 
in  alcohol.  It  should  be  kept  in  small,  well- 
stoppered  phials,  in  a  cool  and  dark  place. 

This  salt  was  originally  proposed  for  use  in 
a  class  of  eases  which  combined  a  condition  of 
chlorosis  or  ancemia  with  hysterical  symptoms, 
but  very  little  if  any  advantage  is  gained  by 
the  addition  of  the  valerianic  acid,  while  several 
other  preparations  of  iron  are  preferable  for 
administration.  The  usual  dose  is  1  or  2  grains 
several  times  a  day. 

Morphine  Valerianate  is  a  non-official 
salt  which  has  been  used  in  attempts  to  obtain 
the  desired  physiological  effects  of  morphine 
without  the  accompanying  disagreeable  effects, 
but  these  attempts  have  not  been  attended  with 
any  marked  success. 

Quinine  Valerianate. — This  salt  occurs  in 
white  or  nearly  white,  pearly,  lustrous,  tri- 
clinic  crystals  which  have  a  "slight  odour  of 
valerianic  acid,  a  bitter  taste,  and  a  neutral 
reaction.  It  is  soluble  in  100  parts  of  water 
and  5  of  alcohol  at  59°  P.,  in  40  parts  of  boil- 
ing water,  and  1  part  of  boiling  alcohol.  It  is 
also  slightly  soluble  in  ether.  It  should  be 
kept  in  well-stoppered  bottles.  The  aqueous  so- 
lution is  neutral  or  very  slightly  alkaline  and 
not  stable.  It  is  recommended  in  doses  of  1 
or  2  grains  three  or  more  times  a  day  in  cer- 
tain nervous  disorders,  but  it  is  not  so  efficient 


347 


VALERIANIC  ACID 
VAPOUES 


as  the  combination  of  the  sulphate  of  quinine 
with  oil  of  valerian  in  cases  in  which  quinine 
and  valerian  are  both  indicated. 

Goodell  has  recommended  for  certain  cases 
of  hysteria  and  nervoitsness  a  combination  of 
the  three  valerianates  of  ammonium,  iron,  and 
quinine,  1^  grain  of  each,  made  into  a  pill, 
three  times  a  day. 

Sodiiim  Valerianate  is  a  non -official  salt 
which  acts  in  a  very  similar  manner  to  the 
valerianate  of  ammonium,  but  much  less  effi- 
ciently. It  may  be  used  in  slight  functional 
derangements  of  the  nervous  system  in  doses  of 
from  1  to  5  grains. 

Zinc  Valerianate. — This  salt  occurs  in 
soft,  white,  pearly  scales,  not  deliquescent, 
with  a  slight  odour  of  valerianic  acid,  and  a 
sweet,  styptic  or  metallic  taste.  It  is  soluble 
in  about  100  parts  of  water  and  in  40  of  alco- 
hol, both  solutions  becoming  turbid  on  boiling. 

This  salt  was  introduced  into  medicine  with 
the  idea  of  combining  the  peculiar  virtues  of 
zinc  and  valerian  so  as  to  form  a  particularly 
valuable  remedy  for  various  nervous  disorders, 
but  it  has  failed  to  realize  the  expectations  it 
excited.  It  has  been  tried  in  quite  a  number 
of  diseases,  but  has  not  proved  very  effective 
in  any.  It  is  sometimes  of  use  in  doses  of 
from  •}  to  3  grains  in  mild  forms  of  neuralgia, 
and  it  is  said  to  give  relief  in  incontinence  of 
wine  from  a  neurotic  cause. 

[In  the  British  Medical  Journal  for  April 
18,  1896,  Dr.  Peter  H.  Abercrombie,  of  the 
Central  London  Throat,  Nose,  and  Ear  Hospi- 
tal, reported  a  case  of  well-marked  Jiay  fever 
in  which  the  administration  of  valerianate  of 
zinc  was  followed  by  a  cure,  to  all  intents  and 
purposes.  The  patient,  a  strong,  healthy  man, 
aged  thirty-two  years,  consulted  Dr.  Aber- 
crombie early  in  1893,  when  it  was  learned 
that  he  had  first  suffered  from  symptoms  of  the 
disease  when  he  was  sixteen  years  of  age,  and 
ever  since  had  suffered  regularly  every  sum 
mer,  with  greater  or  less  severity  according  to 
the  weather.  The  attacks  began  about  the 
middle  of  June  and  lasted  about  three  weeks 
or  a  month,  the  duration  of  the  seizures  de- 
pending on  the  dryness  of  the  summer.  Some- 
times the  attacks  were  so  severe  as  to  incapacitate 
him  for  business  and  to  require  confinement 
within  doors.  When  he  was  at  the  seaside  or 
in  town  there  were  never  any  symptoms  or 
signs  of  the  disease.  He  had  two  business 
offices,  one  in  a  large  commercial  city  in  Scot- 
land, and  the  other  in  a  large  town  some  seven 
miles  distant.  Between  these  two  places  he 
had  to  travel  at  least  twice  a  day.  The  coun- 
try through  which  the  railway  ran  consisted 
mainly  of  fields,  many  of  which  in  summer 
time  contained  hay,  grasses,  etc.  It  frequently 
happened  that  he  left  one  station  feeling  per- 
fectly well,  but  had  an  attack  in  the  train 
when  passing  the  fields,  which  disappeared  by 
the  time  he  reached  the  other  station.  Prior  to 
the  employment  of  the  treatment  suggested  by 
Dr.  Abercrombie,  the  only  remedies  used  had 
been  local.  These  had  sometimes  relieved  the 
symptoms,  but  only  for  a  very  short  time.  The 
patient  had  been  advised  to  go  to  the  seaside. 
There  was  a  history  of  nervous  affections  in 
66 


his  family,  and  the  patient  himself  was  dis- 
tinctly neurotic.  This  led  Dr.  Abercrombie  to 
prescribe  valerianate  of  zinc  as  a  nerve  tonic. 
Early  in  1893  he  prescribed :  1.  Three-grain  pills " 
of  zinc  valerianate,  one  to  be  taken  three  times 
a  day,  after  meals,  and  this  treatment  to  be 
begun  a  full  month  before  the  onset  of  the  at- 
tack was  expected  and  continued  for  at  least 
two  months.  3.  As  local  palliative  measures, 
if  required,  a  5-per-cent.  solution  of  cocaine 
hydrochloride  for  spraying  the  nose  and  throat, 
and  a  snuff  of  bismuth,  morphine,  etc.  The 
patient  went  to  the  seaside  that  summer,  but 
in  1894  and  1895  he  remained  inland,  followed 
the  treatment  laid  down  for  him,  and  escaped 
the  disease.] — Matthias  Lanckton  Poster. 

VALERIANIC  ACID.— See  under  Vale- 
rian and  Viburnum  Prunifolium. 

VAIiEROIi. — See  under  Valerian. 

VAIiZIN.— See  DuLom. 

VANIIiliA  (U.  S.  Ph.),  fructus  vanillce 
(Ger.  Ph.),  is  probably  destitute  of  any  medi- 
cinal properties  and  is  only  used  as  a  flavour- 
ing agent.  Cases  of  poisoning  have  been  as- 
cribed to  it,  but  it  is  probable  that  the  active 
agents  have  been  one  or  another  of  the  ptomaine 
group  derived  from  the  decomposition  of  the 
food  flavoured  with  it. 

Russell  H.  Nevins. 

VANILLIC  ALDEHYDE,  VANIL- 
LIN, CbHsOH.OCHs.CHO,  an  odorous  prin- 
ciple found  in  vanilla  pods,  is  a  colourless 
substance  soluble  in  8  parts  of  water.  It  is 
chiefly  used  as  a  flavouring  agent,  but  is  occa- 
sionally given  as  a  stomachic  in  dyspepsia,  in 
daily  amounts  of  from  |  to  3  grains. 

VAPOURS. — Vapours,  also  called  inhala- 
tions, are  fumes  more  or  less  charged  with 
medicinal  agents,  which  are  volatilized  by 
spontaneous  evaporation,  or  by  heat,  or  by  a 
current  of  gas  or  air.  They  may  be  divided 
into  dry  and  moist  vapours. 

Dry  Vapours. — These  are  derived  from  the 
evaporation  of  substances  readily  volatilizing 
at  the  ordinary  temperature.  Substances  of 
this  nature  are  acetic  ether,  ethyl  iodide,  amyl 
nitrite,  compound  spirit  of  ether,  ammoniaoal 
preparations,  ethereal  tinctures,  etc.  These 
are  inhaled  either  from  the  phials  in  which 
they  are  contained  or  from  gauze,  a  handker- 
chief, or  other  medium  to  which  portions  of 
them  are  applied.  Less  volatile  substances 
may  be  combined  with  more  volatile  ones. 
Thus,  camphor  may  be  dissolved  in  ether  or 
alcohol.  The  same  may  be  done  with  volatile 
oils,  iodine,  and  bromine.  Instead  of  ether  or 
alcohol,  some  other  volatile  liquid,  itself  pos- 
sessing desirable  medicinal  properties,  such  as 
chloroform,  bromoform,  etc.,  may  be  used.  If 
the  vapour  given  out  by  such  a  combination 
is  too  strong  for  the  air-passages,  the  prepara- 
tion may  be  suitably  diluted  or  the  vapour  may 
be  drawn  through  a  layer  of  cotton. 

Among  the  dry  vapours  may  also  be  classed 
the  inhalation  of  vapours  of  anaesthetic  agents, 
such  as  ether,  chloroform,  nitrous-oxide  gas, 
etc.  The  former  are  always  administered  so  that 
a  certain  amount  of  air  may  reach  the  lungs  of 


VARNISHES 
VASOGEN 


348 


the  patient.  Recently  a  new  method  of  ad- 
ministering these  agents  has  been  introduced, 
which  consists  in  passing  a  current  of  oxygen 
gas  through  the  liquids  and  making  the  patient 
inhale  the  gaseous  mixture  thus  produced. 

Moist  Vapours. — These  may  be  cold  or 
■warm  (even  hot).  Vapour  of  hot  water  alone 
is  often  beneficial.  Usually  the  medicinal  sub- 
stance, which  must  be  volatilizable  by  the 
vapour  of  water,  is  dissolved  in  or  added  to 
the  water  in  a  suitable  inhalation  apparatus, 
and  air  drawn  through  it  for  breathing.  In 
this  way  creosote,  eucalyptol,  fir-wood  oil,  and 
similar  agents  are  usually  administered.  Chlo- 
rine gas  is  generally  inhaled  from  a  mixture  of 
chlorinated  lime  with  a  suitable  quantity  of 
cold  water.  Inhalation  of  hydrocyanic  acid 
is  directed  by  the  Br.  Ph.  to  be  effected  from  a 
solution  of  from  10  to  15  minims  of  the  ofl- 
cial  2-per-cent.  acid  in  1  fl.  oz.  of  cold  water ;. 
inhalation  of  iodine,  according  to  the  same 
authority,  by  adding  1  fl.  oz.  of  tincture  of 
iodine  to  1  fi.  oz.  of  water,  gently  heating  it, 
and  drawing  air  through  it.  (See  also  Inhala- 
tion and  under  Insufflation  [vol.  i,  page 
533].) — Charles  Rice. 

VARNISHES. — These  are  preparations 
designed  for  topical  application  in  the  form  of 
liquids  which  dry  more  or  less  rapidly  and  so 
form  a  coating  over  the  part.  Apart  from 
collodion  and  solutions  of  gutta-percha,  celloi- 
din,  and  celluloid,  the  varnishes  now  in  use 
are  mostly  preparations  devised  by  Dr.  P.  G. 
Unna,  of  Hamburg,  consisting  chiefly  of  traga- 
canth.  Recently  Dr.  Unna  has  improved 
them  by  the  addition  of  gelatin,  forming  a 
mixture  which  he  calls  "  gelanth"  or  "  gelan- 
thum,"  "an  almost  ideal  watery  varnish."  Dr. 
Unna  {British  Medical  Journal,  October  17, 
1896)  says,  after  two  years'  experience  in  the 
use  of  gelanth,  that  he  had  long  known  that 
all  the  familiar  watery  varnishes  had  many 
disadvantages,  of  which  the  most  important 
were  want  of  activity  and  an  insufficient  distri- 
bution of  the  drugs  they  contained..  But  the 
simple  and  cleanly  application,  and  the  cheap- 
ness of  these  varnishes,  led  him  to  continue 
their  use  in  suitable  cases — namely,  for  slight 
superficial  erythema  and  eczema,  with  skins 
which  did  not  stand  fat  well,  and  with  patients 
who  objected  to  grease.  The  watery  varnishes 
were  a  necessary  evil,  he  says,  though  one 
could  not  prescribe  them  with  absolute  confi- 
dence in  serious  cases  of  skin  diseases.  The 
greatest  technical  defect  of  all  watery  var- 
nishes, and  especially  those  of  tragacanth,  is 
that  the  insoluble  drugs,  such  as  zinc  oxide, 
sulphur,  and  chrysarobin,  do  not  remain  sus- 
pended, but  are  deposited  on  the  surface  in  a 
gradually  hardening  layer.  But  if  one  so  in- 
creases the  amount  of  ti-agaoanth  that  the 
power  of  suspension  of  the  swollen  mass  is 
sufficient  to  keep  heavy  powders  in  permanent 
suspension,  we  get  a  porridgy,  lumpy  mass, 
which  can  not  be  evenly  mixed  with  medica- 
ments. These  are  indeed  better  suspended, 
but  they  are  badly  distributed. 

On  the  other  hand,  says  Unna,  there  is  in  a 
strong  gelatin  solution  an  ideal  power  of  sus- 


pension and  one  of  fine  distribution  of  the 
medicaments  at  the  same  time.  But  this, 
mixed  with  the  tragacanth,  would  give  to  the 
latter  the  undesirable  quality  of  being  capa- 
ble of  being  spread  only  when  warm.  If, 
however,  a  very  small  proportion  of  gelatin  is 
added,  up  to  3'5  per  cent.,  and  at  the  same 
time,  by  moderate  overheating,  the  gelatin  has 
its  power  of  gelatinizing  diminished,  a  mass  is 
obtained  which  bnly  feebly  gelatinizes,  but 
can  be  spread  in  a  very  thin,  uniform  layer 
upon  the  skin,  and  at  the  same  time  preserves 
its  quality  of  finest  distribution  of  the  drug. 
Certainly  it  does  not  possess  the  power  of  sus- 
pension of  the  stronger  solution  of  gelatin,  he 
adds,  but  this  is  supplied  by  the  other  con- 
stituent, tragacanth.  Equal  parts  of  each 
provide  a  vehicle  of  a  new  character,  in  which 
the  insoluble  medicaments  are  both  distributed 
as  finely  as  possible  and  permanently  sus- 
pended. By  the  admixture  of  gelatin  the 
tragacanth  gains  not  only  the  power  of  reduc- 
ing all  drugs  to  a  very  fine  distribution,  but 
also  a  second  advantage — namely,  the  rapid 
drying  to  an  absolutely  smooth  and  not  in  the 
least  sticky  covering.  This  quality  is  espe- 
cially important  for  the  incorporation  of  hy- 
groscopic material,  such  as  ichthyol,  in  watery 
varnishes. 

As  the  physical  properties  of  the  gelatin 
help  those  of  the  tragacanth,  says  Unna,  so  do 
those  of  the  tragacanth  aid  those  of  the  gela- 
tin. The  overheated  gelatin  would  alone  not 
provide  a  good  varnish,  for  it  would  have  be- 
come almost  fiuid.  The  drugs  suspended  in 
it,  though  evenly  mixed,  would  be  distributed 
irregularly  along  with  the  almost  fluid  gelatin. 
Like  the  ink  on  paper  and  the  artist's  colours 
on  canvas,  the  gelatin  which  is  to  be  spread  on 
the  skin  needs  something  to  give  it  body  re- 
sistance, and  this  is  supplied  in  an  excellent 
manner  by  the  swollen  tragacanth.  Although 
it  has  taken  up  a  considerable  amount  of  water, 
the  gum  still  has  the  resistance  of  a  stiff  paste, 
and  is  therefore  very  well  qualified  to  give  to 
the  gelatin  the  necessary  body.  By  the  addi- 
tion of  the  tragacanth  the  gelatin  gains  a  fur- 
ther advantage  not  so  readily  foreseen,  but  one 
which  has  proved  far  more  important  than  the 
former.  On  the  envelopment  of  every  particle 
of  gelatin  by  the  tragacanth  probably  depends, 
says  Dr.  Unna,  the  remarkable  compatibility 
and  the  indifference  of  the  gelanthum  to  large 
amounts  of  those  drugs  which  can  not  be  used 
with  a  simple  gelatin  solution,  such  as  salicylic 
acid,  resorcin,  corrosive  sublimate,  etc.  The 
power  of  incorporation  of  the  gelanthum  with 
the  most  varied  drugs,  which  it  owes  entirely 
to  the  tragacanth,  is  extreme.  It  may  be 
mixed  with  50  per  cent,  of  ichthyol,  40  per 
cent,  of  salicylic  acid,  resorcin,  and  pyrogallol, 
up  to  5  per  cent,  of  carbolic  acid  and  1  per 
cent,  of  corrosive  sublimate  without  influenc- 
ing its  value  as  a  varnish.  Two  incompatible 
bodies,  such  as  salicylic  acid  and  oxide  of  zinc, 
or  ichthyol  and  salts,  substances  which  com- 
bine in  a  watery  solution,  or  precipitate,  re- 
main in  gelanthum  without  any  mutual  action. 
Gelanthum  thus  lends  itself  to  the  use  of  sev- 
eral remedies  together.    To  this  possibility  of 


349 


VARNISHES 
VASOGBN 


combining  large  amounts  of  the  most  active 
medicaments  gelanthum  owes  also  a  degree  of 
activity  previously  unknown  in  watery  var- 
nishes. With  the  addition  of  from  10  to  20 
per  cent,  of  salicylic  acid  to  any  desired  medi- 
cine (chrysarobin,  pyrogallol,  resorcin,  or  tar), 
gelanthum  treatment,  says  L)r.  Unna,  may  be 
applied  with  all  its  advantages  of  cleanliness, 
circumscribed  action  on  the  diseased  areas 
only,  drying,  and  cheapness,  in  severe  cases  of 
psoriasis  and  dry  eczema  with  marlced  thick- 
ening of  the  epidermis.  Where  much  grease  is 
not  required,  as  in  many  eczemas  of  the  hand, 
excessively  dry  skin,  fissures,  etc.,  he  continues, 
one  can  replace  the  ointment  with  the  gelan- 
thum, which  naturally  to  most  patients  is  very 
much  pleasanter. 

The  mode  of  preparing  gelanthum  is  de- 
scribed by  Dr.  Unna  as  follows:  Pieces  of 
crude  tragacanth  are  emulsified  for  four  weeks 
in  the  cold,  with  twenty  times  their  volume  of 
water.  They  are  then  treated  with  steam  for 
one  day,  further  swollen,  and  finally  pressed 
through  muslin.  The  gelatin,  on  the  other 
hand,  is  swollen  up  cold,  and  then  filtered  in 
his  steam  filter,  after  long  exposure  to  steam 
pressure,  which  takes  from  it  part  of  its  power 
of  gelatinizing.  The  mixture  of  the  two  is  al- 
lowed to  swell  for  two  days  in  steam.  After 
being  pressed  once  more  through  muslin,  it  is 
mixed  with  5  per  cent,  of  glycerin,  some  rose 
water,  and  3  parts  to  10,000  of  thymol,  in 
order  to  prevent  the  growth  of  fungi.  Gelan- 
thum contains  about  3'5  percent,  of  gelatin 
and  tragacanth. 

Dr.  Unna  thus  sums  up  the  advantages  of 
gelanthum  as  compared  with  the  older  watery 
varnishes:  l._It  may  be  better  spread.  3.  It 
dries  more  rapidly  and  with  a  smoother  sur- 
face. 3.  It  feels  more  cooling,  on  account  of 
the  greater  amount  of  water  it  contains.  4. 
It  keeps  the  drugs  suspended  and  distributes 
them  more  evenly  on  the  skin.  5.  It  may  be 
combined  with  drugs,  either  singly  or  in  com- 
bination. 6.  It  permits  of  the  drying  of  hy- 
groscopic drugs  such  as  ichthyol.  7.  It  per- 
mits of  the  addition  of  grease.  8.  If  protected 
from  drying,  it  may  practically  be  kept  forever. 

An  antiseptic  varnish  known  as  adhcesol  is 
made,  according  to  Professor  Coblentz,  of  350 
parts  of  copal  resin,  30  of  benzoin,  30  of  balsam 
of  Tolu,  20  of  oil  of  thyme,  3  of  alpha-naphthol, 
and  1,000  of  ether. 

For  Unna's  carbolized  ichthyol  varnish,  see 
under  Ichthyol  (vol.  i,  page  523). 

VASCTJLAB,  SEDATIVES,  VASCTT- 
LAB.  STIMXIIiANTS. — See  Cardiac  stim- 
ulants, TONICS,  AND  depressants. 

VASEIilNE. — There  are  various  bland, 
tasteless,  and  odourless  fatty  products  of  the 
distillation  of  petroleum,  all  of  which  are 
characterized  by  not  becoming  rancid.  The 
three  chief  members  of  the  group,  those  that 
are  ofiicial,  are  distinguished  in  accordance 
with  their  consistence  at  ordinary  tempera- 
tures. Liquid  vaseline,  or  cosraoime,  petrolck- 
tum  liquidum  (U.  Si  Ph.),  paraffinum  hqiiidum 
(Ger.  Ph.),  is  a  colourless  or  slightly  yellowish 
oily  liquid.    It  is  employed  as  a  lubricant  and 


as  an  oily  vehicle  for  certain  drugs  to  be  ap- 
plied in  solution,  especially  in  the  form  of  a 
spray.  Soft  vaseline,  or  ordinary  vaseline, 
petrolatum  molle  (U.  S.  Vh.),  paraffinum  molle 
(Br.  Ph.),  is  a  whitish  or  yellowish  greasy  sub- 
stance of  about  the  consistence  of  lard.  Hard 
\ase\ine,  petrolatum  spissum  (U.  S.  Ph.),  paraf- 
finum durum  (Br.  Ph.),  paraffinum  solidum 
(Ger.  Ph.),  varies  somewhat  as  defined  in  the 
different  pharmacopoeias.  The  U.  S.  Ph.  de- 
scribes it  as  a  fatlike  mass  of  about  the  con- 
sistence of  a  cerate,  varving  from  white  to 
yellowish  or  yellow ;  the  feritish  and  German 
preparations  are  paraiEn  {q.  v.). 

Soft  vaseline  is  the  variety  almost  always 
meant  when  one  of  the  other  forms  is  not 
specified.  It  is  used  largely  as  a  base  for 
ointments  and  as  a  lubricant. 

Koster  (Therapeutische  Monatshefte,  June, 
1896 ;  Therapeutic  Gazette,  October,  1896)  treats 
erysipelas  by  applying  vaseline  to  the  affected 
and  surrounding  parts  twice  a  day;  linen  is 
laid  over  the  vaseline,  and  a  mask  is  made  if 
the  part  affected  is  the  face.  The  dressing  is 
held  in  place  with  gauze  bandages.  In  other 
respects  the  treatment  is  symptomatic — with 
acetanilide  or  antipyrine  for  severe  headache, 
and  the  same  remedies,  or  quinine,  when  the 
temperature  rises  above  100°  P.  Ice-bags  are 
applied  to  the  head,  and  laxatives,  chloral, 
digitalis,  and  alcoholics  used  as  indicated.  The 
advantages  of  this  method  are  said  to  be  the 
following :  It  can  be  used  even  upon  the  hairy 
scalp ;  smarting,  burning,  and  disagreeable 
odours  are  avoided ;  and  the  remedy  is  cheap. 

VASELOITE. — This  is  a  proprietary  oint- 
ment base  said  to  consist  of  a  solution  of 
stearone  and  margarone  in  a  neutral  mineral 
oil.  It  may  be  used  for  the  same  purposes  as 
vaseline. 

VASOGEN,  or  oxygenated  vaseline,  is  a 
new  German  ointment  base  said  to  be  vase- 
line treated  with  oxygen  to  such  an  extent  as 
to  contain  free  oxygen.  According  to  Pro- 
fessor Coblentz,  another  statement  is  that  it 
contains  about  25  per  cent,  of  olein  saponified 
with  anhydrous  ammonia,  mixed  with  vase- 
line, and  brought  to  a  suitable  consistence 
with  vaseline  oil.  As  it  mixes  readily  with 
many  drugs  that  have  important  topical  uses, 
such  as  iodoform,  creosote,  ichthyol,  menthol, 
pyrogallol,  chrysarobin,  creolin,  camphor,  etc., 
and  is  readily  absorbed,  it  is  likely  to  come 
into  extensive  use. 

Dr.  Leistikow  {Monatshefte  fUr  prahtische 
Dermatologie,  1895;  Annates  de  dermatologie 
et  de  syphiligraphie,  April,  1896)  has  em- 
ployed iodized  vasogen  containing  6  per  cent, 
of  iodine.  In  a  ease  of  recent  secondary  syphi- 
lis a  course  of  frictions  with  iodized  vasogen 
caused  the  symptoms  to  disappear  rapidly,  but 
the  patient  was  seized  with  violent  headache 
which  resisted  every  remedy,  even  iodine  given 
internally.  Daily  frictions  of  the  scalp  with 
75  grains  of  the  vasogen  preparation  caused  de- 
cided improvement  in  three  days  and  a  com- 
plete cure  in  three  weeks.  In  "a  woman  with 
extensive  nodes  of  the  tibia  which  had  been 
only  slightly  improved  by  frictions  the  appli- 


VENESECTION 
VBEATJRUM  VIRIDB 


350 


.Gi^iom  of  carbolized  mercurial  plaster,  and 
iodine  given  internally,  frietions  several  times 
.a  day  wilh  iodiaed  vasogen  caused  their  oom- 
(plete  disappearance  in  fourteen  days.  In  a 
■case  of  sciatica,  probably  of  syphilitic  origin, 
also  in  six  cases  of  ano-genital  mucous  patches, 
and  a  case  of  pigmentary  syphilide  of  the 
neck,  the  iodized  vasogen  proved  efficient.  In 
the  case  last  mentioned  other  treatment  had 
been  ineifeetual.  In  three  cases  of  lupus  vul- 
garis the  results  of  the  use  of  iodized  vasogen 
•were  absolutely  negative.  In  a  case  of  ulcer- 
ated gumma  cicatrization  tooli  place  more  rap- 
idly than  with  any  other  treatment.  Leistikow 
ascribes  the  superiority  of  iodized  vasogen  over 
other  topical  remedies  for  syphilis  to  the  fact 
that  the  absorption  of  iodine  is  very  rapid. 

VENESECTION.— See  Bloodletting. 

VERATBINE,  veratrina  (U.  S.  Ph.,  Br. 

Ph),  veratrinum  (G-er.  Ph.),  is  the  name  ap- 
plied to  a  mixture  of  alkaloids  obtained  from 
the  seeds  of  Asagrcea  officinalis,  a  bulbous 
plant  of  the  natural  order  Liliacem,  indige- 
nous to  Mexico  and  Central  America.  It  is  a 
white  or  grayish-white  amorphous  or  semi- 
erystalline  powder,  permanent  in  the  air, 
odourless,  but  causing  intense  irritation  and 
sneezing  when  even  a  minute  quantity  touches 
the  nasal  mucous  membrane,  with  an  acrid 
taste,  leaving  a  sensation  of  tingling  and 
numbness  on  the  tongue.  It  is  very  slightly 
soluble  in  cold  or  hot  water,  is  soluble  in  3 
parts  of  alcohol  at  59°  P.,  in  6  parts  of  ether, 
in  3  of  chloroform,  and  very  soluble  in  boiling 
alcohol. 

There  seems  to  be  considerable  doubt  in  re- 
gard to  the  exact  chemical  constituents  of  the 
seeds  of  the  plant,  and  the  name  veratrine  has 
been  applied  to  more  than  one  of  them.  The 
veratrine  of  Merck  appears  to  be  identical  with 
the  cevadine  of  Wright  and  Luff,  and  occurs 
in  anhydrous,  transparent  needles  or  compact 
crystals  which  effloresce  in  the  air  and  become 
opaque,  while  the  veratrine  of  Wright  and  Luff 
is  an  amorphous,  resinous  mass  obtained  from 
the  mother  liquor  of  the  preceding  by  extrac- 
tion with  ether.  On  account  of  this  uncertain- 
ty, no  further  description  will  be  attempted  of 
the  constituents  of  this  powder  or  of  the  vari- 
ous alkaloidal  substances  known  by  this  name. 

Experiments  on  the  lower  animals  indicate 
that  the  physiological  action  of  the  official 
veratrine  is  principally  upon  either  the  periph- 
eral nervous  system  or  upon  the  muscular  tis- 
sue'itself.  It  does  not  appear  to  affect  the 
brain,  but  it  excites  the  voluntary  muscles,  or 
possibly  their  controlling  centres  in  the  spinal 
cord,  so  as  to  give  rise  to  tonic  tetanic  convul- 
sions, which  in  some  respects  resemble  those 
induced  by  strychnine,  and  are  followed  by 
paralysis  and  loss  of  muscular  contractility. 
Death  results  from  the  general  paralysis  in 
which  the  muscles  of  respiration  as  well  as 
the  heart  are  involved.  The  heart  stops  in 
diastole.  After  death  the  muscles  are  found 
to  have  lost  their  ability  to  respond  to  elec- 
trical stimulation  to  a  very  great  extent  if  not 
entirely. 

The  ingestion  of  veratrine  in  man  is  apt  to 


be  provocative  of  severe  vomiting  and  diar- 
rhoea, sometimes  of  diuresis.  The  force  and 
frequency  of  the  heart's  action  are  reduced  in 
direct  proportion  as  the  size  of  the  dose  in- 
creases until  it  is  rapid,  irregular,  and  feeble. 
The  temperature  is  also  reduced.  No  fatal 
case  of  poisoning  is  on  record,  but  alarming 
symptoms  have  followed  the  ingestion  of  -jV  of 
a  grain.  In  an  experiment  upon  himself,  Esehe 
took  half  a  grain  of  the  acetate,  and  the  toxic 
symptoms  which  resulted  are  described  as  col- 
lapse, a  pale,  cold,  wet  skin,  pinched  features, 
a  rapid,  thready,  irregular  pulse,  with  violent 
vomiting,  and  marked  muscular  tremor. 

When  applied  to  the  skin,  veratrine  excites 
a  sensation  of  warmth  followed  by  tingling, 
and  may  cause  an  erythema  or,  less  often,  a 
pustular  or  petechial  eruption.  When  the 
epithelium  has  been  removed  it  is  a  very  pow- 
erful irritant.  Upon  the  mucous  membrane  it 
is  also  very  irritating  and  causes  sensations  of 
burning  and  numbness  in  addition  to  symp- 
toms characteristic  of  the  membrane  irritated, 
such  as  salivation  from  its  application  to  the 
mucous  membrane  of  the  mouth  or  sneezing 
when  applied  in  the  nose. 

Veratrine  has  been  used  internally  in  a  great 
variety  of  diseases,  in  doses  of  from  sV  to  tV  of 
a  grain,  but  it  has  proved  unreliable  and  dan- 
gerous, and  such  use  has  been  abandoned.  Its 
ability  to  reduce  the  pulse  and  temperature  led 
to  its  employment  in  pneumonia  and  other 
febrile  diseases,  but  no  advantage  was  gained 
from  its  use,  which  was  necessarily  confined  to 
sthenic  fevers  in  robust  patients.  Dysmenor- 
rhcea,  heart  disease,  chorioiditis,  hysteria,  and 
epilepsy  may  be  mentioned  as  a  few  examples 
of  the  diseases  for  which  this  drug  was  once 
prescribed. 

At  present  veratrine  is  employed  only  for 
external  use,  principally  as  a  counter-irritant 
or  as  an  antiparasitic.  As  a  counter-irritant 
it  has  been  used  in  superficial  neuralgias, 
pleurodynia,  chronic  pleurisy,  tic  douloureux, 
and  myalgia,  as  well  as  chronic  enlargement 
and  stiffness  of  the  joints,  but  it  does  not 
present  any  special  advantage  over  the  coun- 
ter-irritants more  commonly  in  use.  As  an 
antiparasitic,  it  has  proved  useful  in  phtheiri- 
asis,  alopecia  areata,  and  aspergillus  infec- 
tion. Two  other  purposes  for  which  veratrine 
is  said  to  have  been  used  are  to  promote  the 
nutrition  of  the  muscles  in  infantile  paralysis 
and,  by  dentists,  to  obtund  the  sensitiveness  of 
dentin. 

The  official  preparations  of  veratrine  are  the 
ointment  and  the  oleate.  The  ointment,  un- 
guentum  veratrincB  (U.  S.  Ph.,  Br.  Ph.),  is  com- 
posed, according  to  the  U.  S.  Ph.,  of  4  parts  of 
veratrine,  6  of  olive  oil,  and  90  of  benzoinated 
lard ;  the  Br.  Ph.  orders  1  part  of  veratrine,  14 
parts  of  hard  paraffin,  41  parts  of  soft  paraffin, 
and  7  parts  of  olive  oil.  This  ointment  is  the 
preparation  generally  employed,  but  frequent- 
ly requires  to  have  its  strength  reduced  before 
application.  It  should  never  be  applied  to  a 
raw  surface,  not  only  on  account  of  the  in- 
tense irritation  which  it  would  there  produce, 
but  also  because  of  the  danger  of  absorption 
of  the  drug  and  consequent  poisoning.    The 


351 


VENESECTION 
VERATRUM   VIRIDE 


oleate,  oleatum  veratrinw  (U.  S.  Ph.),  is  com- 
posed of  2  parts  of  veratrine  and  98  of  oleic 
acid.  This  was  intended  to  take  the  place 
of  the  ointment  when  inunction  rather  than 
counter-irritation  was  desired,  but  the  value 
of  the  drug,  except  as  a  counter-irritant  or 
antiparasitic,  is  at  best  very  doubtful.  When 
the  oleate  is  used  care  must  be  taken  to  avoid 
the  absorption  of  too  large  an  amount  of  the 
drug. 

Peugnet  recommends  for  the  treatment  of 
aspergillus  in  the  ear  a  solution  composed  of 
3  grains  of  veratrine,  10  minims  of  acetic  acid, 
and  i  oz.  each  of  rose  water  and  glycerin. 

Matthias  Lianckton  Foster. 

VERATROIDINE.  —  See    under   Veea- 

TRUM  VIRIDE. 

VERATROIi,  CeHioOj,  the  dimethyl  ether 
of  pyrocateehin,  a  colourless  oil,  of  an  agree- 
able aromatic  odour,  that  has  recently  been 
introduced  as  an  antiseptic.  According  to 
Surmont  and  Vermersoh  (Gazette  medicale  de 
Paris,  August  3,  1895),  the  bacillus  of  cholera, 
that  of  typhoid  fever,  and  that  of  diphtheria 
are  susceptible  to  its  action,  and  the  bacillus 
of  tuberculosis  in  human  beings  does  not 
seem  to  thrive  well  in  its  presence,  but  the 
Bacillus  pyogenes  cyaneus  and  the  Staphylo- 
eoccusp  yogenes  aureus  are  less  energetically 
influenced  by  it. 

VERATKUM  ALBTTM.— See  Helle- 
bore, White. 

VERATRUM  NIGRUM:.— See  Helle- 
bore, Black. 

VERATRUM  VIRIDE  (U.  S.  Ph.), 
veratri  viridis  rhizoma  (Br.  Ph). — This  is  the 
rhizome  and  roots  of  Veratrum  viride,  Ameri- 
can, or  swamp  hellebore,  Indian  poke,  or  poke 
root,  a  large  perennial  herb  which  belongs  to 
the  natural  order  Liliacece  and  is  indigenous  to 
the  Northern  United  States  and  Canada.  It  is 
found  in  marshy  places,  on  the  borders  of  damp 
thickets,  and  by  the  sides  of  small  streams 
as  far  south  as  Georgia.  The  roots  are  usu- 
ally collected  in  the  autumn,  after  the  leaves 
have  fallen,  but  some  doubt  has  been  expressed 
as  to  whether  they  are  not  equally  good  if  col- 
lected in  the  spring,  before  the  flowering  season. 
They  deteriorate  in  quality  by  the  lapse  of 
time  and  should  not  be  kept  more  than  a  year. 
The  root  is  of  a  bitter,  very  persistent  and  acrid 
taste,  and  of  a  disagreeable  odour  when  fresh, 
but  this  disappears  in  the  process  of  drying. 
The  powdered  root  is  irritating  to  the  skin  and 
raucous  membranes  and  causes  sneezing  when 
snuffed,  even  in  very  minute  quantity,  into  the 
nostrils. 

Historically,  there  is  little  to  be  said  in  re- 
gard to  this  drug.  We  know  that  the  aborigines 
were  acquainted  with  its  peculiar  intoxicating 
qualities,  and  some  tribes  are  said  to  have  used 
it  as  an  ordeal  or  test  of  strength  and  vigour. 
It  was  and  still  is  used  to  some  extent  by 
farmers  to  destroy  vermin  on  plants  and  bushes, 
as  well  as  to  intoxicate  birds  which  infest 
planted  fields,  so  as  to  render  them  easy  to  cap- 
ture. As  an  antiparasitic  and  counter-irritant 
it  has  yielded  place  to  more  satisfactory  agents. 
Its  introduction  into  medicine  as  a  cardiac  de- 


pressant may  be  said  to  date  from  the  publica- 
tion of  a  paper  by  Dr.  Osgood,  in  1835,  which 
was  followed  by  the  investigations  of  Dr.  Nor- 
wood. Since  then  the  drug  has  been  the  sub- 
ject of  considerable  study,  and  various  analyses 
of  it  have  been  made,  with  results  which  are 
very  confusing.  Probably  several  alkaloids  are 
present  which  are  not  easily  separated  from  the 
resin  associated  with  them,  and  the  most  satis- 
factory analysis  yet  made  is  that  by  Wright  and 
Luff,  who  found  the  plant  to  contain  jervine, 
pseudo-jervine,  cevadine,  a  very  little  rubijer- 
vine,  and  traces  of  veratrine  and  veratalbine. 
Some  authors  adhere  to  Bullock's  analysis,  who 
found  two  alkaloids,  jervine  and  veratroidine, 
and  in  the  principal  experiments  to  determine 
the  physiological  action  of  the  active  principles 
of  this  drug  these  have  been  employed.  These 
experiments  were  conducted  by  Dr.  H.  C. 
Wood,  and  the  following  descriptions  of  jervine 
and  veratroidine  are  largely  taken  from  his 
work : 

Jervine  is  present  in  larger  quantities  in  Ve- 
ratrum viride  than  any  other  alkaloid,  is  of  a 
bitter  taste,  and  forms  crystallizable  salts  with 
acids,  but  has  not  yet  been  employed  by  itself 
in  medicine.  The  first  symptom  produced  in 
one  of  the  lower  animals  by  a  dose  of  jervine 
is  a  disposition  to  be  quiet,  associated  with 
muscular  weakness.  Soon  rapidly  repeated 
thrills  run  through  the  muscles  and  cause  vio- 
lent trembling.  Finally,  the  animal  is  unable 
to  stand,  and  at  about  this  time  violent  epilep- 
toid  convulsions  occur — general  clonic  spasms 
without  rigidity.  These  convulsions  are  lack- 
ing in  force  even  when  most  violent,  and  they 
continue,  growing  less  severe  as  the  prostration 
increases  and  alternating  with  periods  of  re- 
laxation until  death.  Sensation  is  not  affected 
until  late  in  the  poisoning,  when  it  disappears. 
Consciousness  is  preserved  to  the  last.  The 
pupils  are  not  affected.  Salivation  is  profuse, 
but  no  vomiting  or  purging  is  induced. 

At  first,  while  the  animal  is  standing  quiet- 
ly the  frequency  of  the  pulse  is  lessened,  but 
the  convulsions  and  sometimes  the  violent 
trembling  which  precede  them  occasion  a 
change  to  great  rapidity.  This  effect  seems  to 
be  due  to  a  direct  action  of  the  drug  upon  the 
cardiac  muscle  or  ganglia,  as  well  as  upon  the 
vaso-motor  nerve-centres.  The  arterial  pres- 
sure is  greatly  lowered,  falling  progressively 
from  beginning  to  end  of  the  poisoning.  It 
is  not  certain  whether  the  convulsions  are  in- 
duced by  the  irritation  of  the  motor  centres  in 
the  brain  by  the  drug,  by  the  accumulation  of 
carbon  dioxide  in  the  blood,  or  by  the  cerebral 
anaemia  caused  by  the  depressed  circulation. 
Neither  the  pneumogastric  centre,  the  periph- 
eral motor  nerves,  nor  the  voluntary  muscles 
appear  to  be  affected.  Reflex  action  is  dimin- 
ished and  finally  abolished.  Death  results 
from  asphyxia  due  to  cessation  of  respiration. 

Very  little  more  is  known  of  the  action  of 
ruhijervine,  when  dissociated  from  the  resin 
with  which  it  is  combined  in  veratroidine,  than 
that  it  is  a  circulatory  depressant  and  that  it 
induces  vomiting  and  purging. 

Veratroidine  is  more  irritating  than  jervine, 
causes  muscular  twitchings  or  convulsions  of 


VERATRUM  VIRIDB 


353 


less  severity,  and  acts  in  a  similar  manner  upon 
the  spinal  cord.  It  is  a  very  powerful  respira- 
tory poison.  Its  action  upon  the  circulation 
and  upon  the  pneumogastrics  is  very  peculiar. 
Wood  says :  "  After  a  hypodermic  injection  of 
the  poison  the  rapidity  of  the  pulse  and  the  arte- 
rial pressure  are  at  first  decidedly  lessened. 
After  a  time,  the  pulse  still  remaining  very 
slow,  the  indi^'idual  heart-beats  become  en- 
dowed with  a  force  greatly  beyond  normal, 
and  the  arterial  pressure  becomes  normal ; 
then  suddenly  the  pulse-rate  becomes  very 
rapid,  the  individual  cardiac  beats  losing  much 
of  their  extraordinary  vigour,  but  the  arterial 
pressure  rising  nearly  50  per  cent,  beyond  its 
original  position."  These  effects  would  seem 
to  be  produced  by  the  primary  stimulation  of 
the  cardiac  inhibitory  apparatus — whether  of 
the  controlling  centre  or  not  is  uncertain — fol- 
lowed by  the  results  of  irritation  of  the  vaso- 
motor centres  by  the  accumulation  of  carbon 
dioxide  in  the  blood  induced  by  paralysis  of  the 
respiratory  centre.  The  latter  appears  to  be  the 
occasion  of  the  great  rise  of  blood-pressure,  as 
the  drug  does  not  seem  to  have  any  influence 
over  the  vaso-motor  nerves.  "  It  is  a  powerful 
respiratory  poison,  lessening  at  first  the  fre- 
quency of  the  cardiac  beat  by  stimulating  the 
pneumogastrics,  but  soon  losing  all  control 
over  the  heart,  owing  to  the  powerful  influ- 
ences which  the  induced  asphyxia  exerts." 
Small  doses  of  veratroidine  stimulate  the  car- 
diac inhibitory  apparatus,  while  larger  ones 
paralyze  it,  according  to  Professor  Wood's  ob- 
servations. 

The  resin  which  remains  after  the  extraction 
of  the  alkaloids  is  somewhat  irritating  to  the 
gastro-intestinal  tract. 

The  physiological  action  of  veratrum  viride 
is  that  of  a  powerful  spinal  and  circulatory  de- 
pressant. To  quote  Wood  once  more :  "  In  full 
therapeutic  doses  it  lowers  the  pulse-rate  both 
by  direct  action  on  the  muscle  (jervine),  and 
by  stimulating  the  inhibitory  nerves  (vera- 
troidine) :  it  diminishes  the  force  of  the  heart- 
beat by  a  direct  influence  on  the  cardiac  mus- 
cle (jervine)  and  produces  a  general  vaso-motor 
paralysis  (jervine)." 

When  small  doses  of  veratrum  viride  are 
given,  the  force  of  the  heart  is  lessened,  the 
rate  is  at  first  not  atEected,  but  later  becomes 
slow,  and  the  pulse  is  soft  and  moderately  full. 
This  condition  persists  while  the  body  remains 
perfectly  quiet,  but  the  slightest  exertion  is 
apt  to  cause  the  pulse  to  bedome  very  rapid, 
small,  and  even  imperceptible.  This  is  asso- 
ciated with  great  muscular  weakness,  lowered 
temperature,  nausea,  and  vomiting,  but  rarely 
with  catharsis.  In  this  respect  it  usually  ex- 
hibits a  marked  difference  from  its  near  rela- 
tive, veratrum  album.  Sometimes  it  occasions 
the  appearance  of  an  erythematous  or  pustular 
eruption  on  the  skin.  The  rapid  and  feeble 
condition  of  the  pulse  precedes  the  nausea, 
which  is  also  occasionally  absent,  and  is  there- 
fore not  dependent  on  the  gastric  disturbance. 
Larger  doses  induce  a  greater  intensity  of  the 
symptoms,  which  become  very  alarming.  The 
condition  now  is  one  of  collapse  characterized 
by  an  almost  imperceptible  pulse,  a  cold,  clam- 


my skin,  incessant  retching,  absolute  muscular 
prostration,  giddiness,  loss  of  vision,  mydriasis, 
and  semiconsciousness.  Reflex  action  is  im- 
paired, but  sensation  is  not  affected.  Excre- 
tion is  indirectly  increased  by  the  relaxation  of 
the  tissues,  but  there  is  probably  no  direct  in- 
terference with  this  function. 

In  spite  of  the  very  formidable  symptoms, 
death  very  rarely  occurs  from  poisoning  with 
veratrum  viride.  Recovery  after  the  ingestion 
of  an  ounce  of  the  tincture  has  been  reported, 
and  recently  Dr.  J.  B.  Tuttle  recorded  a  case  in 
which  four  teaspoonfuls  were  taken,  instead  of 
four  drops,  within  an  hour,  with  no  worse  re- 
sult than  severe  vomiting,  pallor,  and  prostrar 
tion.  The  prompt  emesis  and  the  consequent 
removal  of  the  unabsorbed  drug  probably  fur- 
nish the  correct  explanation  of  such  oases. 
Death  has  occurred  a  few  times.  In  cases  of 
poisoning  the  head  should,  if  possible,  be  placed 
on  a  lower  plane  than  the  rest  of  the  body,  and 
heat  should  be  applied  externally  while  strych- 
nine, atropine,  and  other  stimulants  are  ad- 
ministered internally. 

Opinions  differ  very  widely  in  regard  to  the 
therapeutic  value  of  this  drug.  One  author 
asserts  that  it  is  the  safest  and  best  circulatory 
depressant  which  we  have  for  adults,  while  an- 
other maintains  that  it  is  seldom  useful,  but 
almost  always  harmful.  The  beneficial  power 
which  it  exerts  has  been  ascribed  to  its  seda- 
tive action  on  the  nervous  system,  but  the 
weight  of  evidence  is  in  favour  of  the  view 
that  it  depends  upon  its  action  on  the  circula- 
tion. It  is  not  a  drug  to  be  recommended  or 
used  blindly  in  certain  pathological  or  inflam- 
matory conditions.  When  used  in  that  man- 
ner, it  is  apt  to  be  worse  than  useless,  but  when 
used  judiciously  in  the  proper  indicatory  con- 
ditions, veratrum  viride  is  of  great  value. 

It  is  frequently  of  good  service  during  the 
earliest  stage  of  many  parenchymatous  and 
serous  inflammations — i.  e.,  during  the  stage  of 
congestion  or  hypersemia — particularly  when 
they  occur  in  sthenic  subjects.  Thus,  its  em- 
ployment is  often  advantageous  in  pneumonia, 
pleurisy,  hepatitis,  and  other  acute  inflamma- 
tions of  the  viscera,  but  as  soon  as  this  early 
stage  is  passed  it  is  not  only  useless  but  con- 
tra-indicated. It  should  not  be  used  in  gastri- 
tis, peritonitis,  or  other  visceral  inflammation 
where  the  vomiting  it  is  apt  to  provoke  is  like- 
ly to  do  harm,  unless  it  is  combined  with  other 
drugs  which  will  correct  this  tendency  to  eme- 
sis. It  has  been  recommended  to  prevent  or 
ameliorate  the  severity  of  inflammations  which 
result  from  injuries  of  the  abdomen. 

Small  doses  frequently  repeated,  especially 
when  combined  with  morphine,  often  deter- 
mine resolution  in  amygdalitis.  Its  ability  to 
moderate  the  force  of  the  circulation  is  some- 
times made  use  of  to  aid  in  checking  hmmor- 
rhage  and  to  favour  the  formation  of  a  clot  in 
an  aneurysm.  In  the  latter  ease  the  patient 
must  be  kept  in  a  recumbent  posture  and  on  a 
proper  regimen,  while  the  dose  given  should 
be  small  and  its  effect  carefully  watched.  In 
the  abnormal  cardiac  tension  of  renal  disease 
and  in  acute  mania  veratrum  viride  is  often  of 
good  service.     In  puerperal  eclampsia  excel- 


353 


VERATRUM  VIRIDE 


lent  results  have  been  reported  from  the  use  of 
very  large  doses.  It  is  highly  esteemed  in 
hypertrophy  and  irritability  of  the  heart,  but 
it  must  never  be  used  when  there  are  valvular 
lesions,  dilatation,  or  a  weak  or  fatty  condition 
of  the  cardiac  muscle.  The  indications  for  its 
use  in  heart  diseases  nearly  correspond  to  the 
eontra-indications  for  digitalis.  Successful  re- 
sults have  been  reported  from  its  use  in  exoph- 
thalmic goitre.  Formerly  it  was  used  to  a 
considerable  extent  as  an  antipyretic  in  rheii- 
matism,  but  this  use  has  become  almost  if  not 
quite  obsolete. 

A  case  of  persistent  priapism  which  had  re- 
sisted treatment  with  a  large  number  of  other 
drugs,  but  finally  succumbed  to  veratrum  vi- 
ride,  is  reported  by  Walker. 

The  use  of  this  drug  is  contra-indicated  in 
all  conditions  which  are  characterized  by 
adynamia,  depression,  or  exhaustion.  Thus, 
its  use  is  inadmissible  in  typhoid  fever  and  in 
delirium  tremens,  although  in  some  cases  of 
cerebral  irritation  from  drink,  in  which  a 
strong  bounding  pulse  is  present,  it  may  per- 
haps be  of  service. 

The  ofSeial  preparations  are  the  tincture 
and  the  fluid  extract.  A  non-ofBoial  saturated 
tincture,  known  as  Norwood's,  is  sometimes 
used.  For  the  purpose  of  reducing  the  sever- 
ity of  an  incipient  inflammation  one  or  two 
drops  of  either  the  official  tincture,  tinctura 
veratri  viridis  (U.  S.  Ph.,  Br.  Ph.),  or  the  fluid 
extract,  extractum  veratri  viridis  fluidum 
(U.  S.  Ph.),  every  half  hour  for  two  or  three 
hours,  are  usually  about  the  requisite  doses. 
Its  use  should  be  maintained  only  until  the 
skin  is  moist  and  relaxed  and  the  pulse  slower, 
or  till  there  is  slight  nausea.  In  the  cardiac 
troubles  in  which  it  is  indicated  5  drops  three 
times  a  day  are  usually  sufficient.  In  puer- 
peral eclampsia  such  large  doses  have  been  rec- 
ommended as  half  a  drachm  every  flfteen 
minutes  till  vomiting  is  produced  or  the  con- 
vulsions cease. 

[To  combat  the  vascular  excitement  ot  puer- 
peral phlebitis,  the  late  Dr.  Pordyee  Barker 
preferred  veratrum  viride  to  all  other  drugs 
(Puerperal  Diseases,  New  York,  1874).  He 
says:  "I  meet  with  many  who  have  a  great 
fear  of  the  veratrum  viride,  because  it  some- 
times produces  the  appearance  of  dangerous 
collapse.  But  this  is  a  very  temporary  condi- 
tion, which,  so  far  as  I  have  heard,  has  never 
terminated  disastrously.  The  appearance  of 
one  who  has  taken  too  much  veratrum  viride 
is  almost  precisely  like  that  produced  by  to- 
bacco in  those  unaccustomed  to  its  use.  I 
have  often  seen  this,  but  now,  when  I  do,  it 
causes  no  alarm,  as  I  am  sure  that  the  effects 
will  soon  pass  off."  He  adds  that  there  is  no 
objection  to  assisting  reaction  in  such  cases  by 
carbonate  of  ammonium  or  small  quantities  of 
some  alcoholic  stimulant.  In  a  small  percent- 
age of  cases,  he  says,  it  is  quite  apt  to  cause 
nausea,  but  this  is  readily  counteracted  by 
giving  it  in  combination  with  tincture  of  gin- 
ger. As  to  its  positive  effects,  he  says  that 
one  can  by  it  absolutely  and  certainly  control 
the  frequency  of  the  pulse  of  inflammation 
and  of  irritation,  but  of  course  if  it  will  ac- 


complish this,  one  would  not  expect  to  reduce 
the  rapid  pulse  of  exhaustion,  as  found  in  the 
last  stages  of  phthisis  or  in  typhus  fever. 

Dr.  Barker  remarks  that  the  use  of  veratrum 
viride  is  not  incompatible  with  that  of  stimu- 
lants. He  alludes  to  a  case  in  which  the  vera- 
trum viride  did  not  seem  to  produce  any  effect 
on  the  pulse,  which  remained  constantly  above 
130,  until  the  condition  of  the  patient  was 
such  that  he  decided  to  give  brandy.  After 
the  first  ounce  had  been  given  the  pulse  fell 
to  108;  after  the  second,  to  86.  The  use  of 
brandy  was  continued  and  that  of  the  veratrum 
viride  was  suspended  for  a  few  hours,  and  the 
pulse  again  rose  to  130.  After  this,  if  the  use 
of  either  agent  was  suspended,  the  pulse  would 
rapidly  increase  in  frequency,  while  under  the 
combined  influence  of  the  two  it  was  kept  be- 
low 80.  Another  of  his  patients,  who  recov- 
ered, took  an  ounce  of  brandy  and  from  3  to 
10  drops  of  the  tincture  of  veratrum  viride 
every  hour  for  two  days,  the  quantity  of  the 
veratrum  viride  being  regulated  by  the  fre- 
quency of  the  pulse,  which  was  never  allowed 
to  rise  above  80,  although  it  sometimes  fell 
to  40. 

The  directions  which  he  generally  gave  to 
his  house  staff  in  Bellevue  Hospital  were,  to 
begin  the  use  of  the  veratrum  viride  at  once, 
and,  carefully  watching  its  effects,  bring  the 
pulse  down  to  80  and  hold  it  there.  After  the 
specific  effect  of  the  veratrum  is  once  produced, 
he  says,  it  can  be  kept  up  by  very  much  di- 
minished doses. 

In  puerperal  peritonitis  also  Dr.  Barker  re- 
lied on  veratrum  to  reduce  vascular  excitement. 
He  says :  "  I  regard  it  as  very  important  to  al- 
lay vascular  excitement,  as  this  necessarily  leads 
to  a  rapid  depression  of  the  vital  forces.  Our 
predecessors  resorted  to  venesection  to  accom- 
plish this,  but  the  general  experience  of  the 
profession  led  to  the  universal  abandonment  of 
this  practice,  as  it  was  found  that  in  this  dis- 
ease it  involved  absolute  loss  of  vital  power. 
But  in  the  veratrum  viride  we  have  an  agent 
which  reduces  vascular  excitement  without 
real  loss  of  vital  power.  There  is  a  positive 
distinction  between  depression  of  the  vital 
forces  and  absolute  loss  of  power."  In  con- 
junction with  the  use  of  morphine,  he  thought 
it  well  in  puerperal  peritonitis  to  gradually 
reduce  the  frequency  of  the  pulse  by  the  use 
of  tincture  of  veratrum  viride,  beginning  with 
5  drops  with  each  dose  of  morphine.  By  care- 
fully watching  the  effects,  and  graduating  the 
doses  short  of  provoking  vomiting,  one  may, 
he  says,  bring  the  pulse  down  to  70  or  80,  and 
then  one  should  endeavour  to  hold  it  there. 
Even  if  vomiting  does  come  on,  and,  for  a  time, 
the  patient  seems  almost  in  a  state  of  collapse, 
this  condition  need  excite'  no  alarm,  as  it  lasts 
but  a  short  time,  and  the  pulse  is  effectually 
reduced  in  frequency,  sometimes  to  30  or  40  a 
minute.  ,  He  has  seen  this  occur  a  hundred 
times  at  least,  he  says,  and  the  greatest  evil 
resulting  from  it  is  the  alarm  and  excitement 
which  it  causes  to  the  friends  and  attendants. 
It  is  therefore  desirable  to  avoid  this  explosion, 
so  to  speak,  of  the  action  of  veratrum  viride, 
if  possible.    If  the  pulse  has  once  been  reduced, 


-VERATRTTM  VIRIDB 


354 


according  to  Dr.  Barker,  3  drops,  3  drops,  or 
even  1  drop,  may  be  found  sufficient  to  con- 
trol it. 

Veratrum  viride  has  been  extensively  used 
in  the  United  States,  especially  in  the  South, 
in  the  treatment  of  puerperal  convulsions.  In 
the  Medical  Record  for  September  7, 1889,  Dr. 
Richard  Cole  Newton,  of  Montclair.  N.  J., 
says  that  twenty-eight  years  before.  Dr.  Cut- 
ler, of  Jersey  City,  stated  in  the  New  Jersey 
Academy  of  Medicine  that  he  had  been  in 
practice  twenty-five  years,  and  that  during 
that  time  he  had  seen  on  an  average  eight 
cases  of  puerperal  convulsions  a  year,  in  his 
own  practice  and  in  consultation,  that  he  had 
never  lost  a  case,  and  that  in  treating  this 
complaint  he  relied  upon  veratrum  viride. 
Dr.  Love,  who  was  present  and  heard  these 
remarks,  and  shortly  afterward  had  his  atten- 
tion called  by  the  late  Dr.  Isaac  Nichols,  of 
Newark,  to  the  use  of  benzoic  acid  in  the  treat- 
ment of  the  albuminuria  of  pregnancy,  put 
the  hints  dropped  by  these  men  together,  and 
concluded  to  treat  his  next  case  of  eclampsia 
with  veratrum  viride  and  benzoic  acid.  Dr. 
Love  has  had  in  all  twenty-three  cases,  and  he 
reports  twenty-three  recoveries. 

The  last  case  was  that  of  a  primipara  twen- 
ty-three years  of  age.  Her  urine  was  highly 
albuminous  on  April  30th.  In  spite  of  treat- 
ment, by  May  15th  her  water  had  diminished 
to  less  than  five  ounces  per  diem.  It  resembled 
pea  soup  in  appearance,  and  when  boiled  with 
nitric  acid  it  promptly  solidified.  She  then 
fell  into  convulsions  and  had  six  in  twenty- 
four  hours.  During  this  time  she  remained 
totally  unconscious.  As  it  was  difficult  to 
make  her  swallow,  and  as  the  veratrum  viride 
given  by  the  mouth  was  vomited,  8  minims  of 
Norwood's  tincture  were  given  hypodermically, 
but  this  also  produced  vomiting.  This  amount 
was,  however,  injected  under  the  skin  every 
hour  until  five  or  six  doses  had  been  given. 
The  benzoic  acid  was  also  given  every  four 
hours. 

Dr.  Love  says  that,  in  his  experience,  within 
twenty-one  days  after  the  first  spasm  labour 
will  come  on,  and  that  the  foetus  is  generally 
dead.  Only  two  children  in  his  twenty-three 
oases  survived.  His  plan  of  treatment,  says 
Dr.  Newton,  was  as  follows :  Give  3  drops  of 
Norwood's  tincture  (a  freshly  prepared  portion) 
and  repeat  it  in  an  hour ;  then  2  drops  every 
hour  or  two  until  the  patient  experiences  a 
cordlike  feeling  in  the  neck.  If  the  nurse  is 
not  sufficiently  intelligent  or  conscientious,  the 
physician  must  ^ive  the  veratrum  viride  him- 
self. The  benzoic  acid  is  given  in  the  follow- 
ing prescription,  which  is  taken  from  Ellis's 
Formulary  : 

B  Benzoic  acid 2  dr. ; 

Potassium  bicarbonate i  oz. ; 

Spirit  of  nitrous  ether 1  fl.  oz. ; 

Solution  of  ammonium  acetate. .  2  fl.  oz. ; 

Syrup  of  lemon,  enough  to  make  6  fl.  oz. 
M.  S. :  A  tablespoonful  every  four  hours. 

In  a  letter  published  in  the  New  York  Medi- 
cal Journal  for  December  14, 1895,  called  forth 
■by  a  discussion  to  be  mentioned  presently,  Dr. 


Newton  recurs  to  the  subject,  and  says  that,  if 
it  seems  to  be  indicated,  a  large  dose  of  calomel 
is  given  at  first,  and  its  action  may  be  aided  by 
large  warm  enemata.  If  the  bladder  is  full  and 
does  not  empty  itself  when  the  bowels  act,  the 
water  is  drawn.  The  point  upon  which  Dr. 
Love  strenuously  insists,  and  upon  which  he 
disagrees  with  the  weight  of  authority,  is  ab- 
solute non-interference  with  the  contents  of  the 
uterus,  so  far,  at  least,  as  the  convulsions  are 
concerned.  He  denies  that  emptying  the  uterus 
stops  the  convulsions,  and  affirms  that  where 
the  nervous  system  is  already  so  poisoned  that 
death  from  shock  is  imminent,  any  further 
strain  upon  the  thread  of  life,  already  stretched 
nearly  to  the  utmost,  is  an  unjustifiable  and 
needless  risk.  In  certain  eases  he  would  not 
hesitate  to  bleed,  but  considers  this,  as  a  rule, 
quite  unnecessary.  For  the  immediate  control 
of  the  spasms  he  would  use  chloroform  if  he 
thought  it  indicated. 

When  the  accoucheur  is  called  to  a  woman 
in  puerperal  convulsions,  says  Dr.  Newton,  he 
should  occupy  himself  entirely  with  the  control 
of  these  phenomena  and  with  the  elimination 
of  the  materies  morbi  so  far  as  practicable. 
There  is  no  need  to  bring  on  labour  or  to  take 
special  pains  to  accelerate  it.  If  the  nervous 
erethism  can  be  controlled  and  the  kidneys  and 
skin  made  to  act.  Nature  will  deliver  the  pa- 
tient sooner  or  later.  If  the  convulsions  come 
on  before  labour,  Dr.  Love  controls  them  and 
lets  the  uterus  and  its  contents  entirely  alone. 
Dr.  Newton  concurs  with  Dr.  Love  in  assert- 
ing that  there  is  no  use  whatever  in  emptying 
the  womb ;  the  procedure,  he  says,  adds  infi- 
nitely to  the  woman's  danger  and  does  not 
strike  at  the  root  of  the  evil.  The  convulsions 
may  be  a  concomitant  of  labour  or  they  may 
occur  long  before,  and  in  some  cases  have  ap- 
peared a  number  of  days  after  delivery.  They 
generally  occur  at  the  time  of  labour  because 
the  poisoned  and  weakened  nervous  system  is 
called  upon  for  a  great  expenditure  of  force, 
and  it  is  bad  practice  to  increase  the  strain 
upon  the  vital  powers  of  a  human  being  already 
almost  in  extremis. 

It  is  generally  admitted,  says  Dr.  Newton, 
that  pregnancy  is  a  serious  complication  of  the 
acute  infectious  diseases,  like  diphtheria  or 
typhoid  fever.  Yet  no  one  has  suggested  that 
this  element  of  danger  can  be  removed  by 
bringing  on  labour.  On  the  contrary,  if  labour 
does  come  on  the  case  at  once  assumes  a  more 
serious  aspect,  and  so  the  indication  is  to  do 
all  in  our  power  to  prevent  the  advent  of  la- 
bour. It  may  be  said  that,  inasmuch  as  the 
strain  of  labour  brings  on  the  convulsions,  if 
the  labour  can  be  concluded  the  exciting  cause 
of  the  eclampsia  will  be  removed.  This  is  un- 
questionably true.  But  the  acceleration  of  la- 
bour adds  immeasurably  to  the  risk,  whereas 
its  retardation  will  give  the  economy  more 
time,  with  the  aid  of  proper  remedies,  to  put 
itself  in  a  condition  to  safely  undergo  the 
strain  of  delivery. 

At  a  meeting  of  the  Society  of  Alumni  of 
Bellevue  Hospital  held  on  October  2,  1895 
{New  York  Medical  Journal,  November  23, 
1895),  Dr.  Charles  Clifford  Barrows  reported 


355 


VERATEUM   VIRIDB 


two  cases  of  puerperal  convulsions  in  which  he 
had  employed  veratrum  Tiride — in  one  case  in 
conjunction  with  Dfihrssen's  incisions  of  the 
cervix  uteri,  and  in  the  other  with  accouche- 
ment ford.  Each  of  the  patients  had  had  sev- 
eral convulsive  seizures  after  the  uterus  had 
been  emptied.  The  delivery  in  each  case  had 
not  been  followed  by  any  urinary  secretion 
until  after  the  administration  of  the  veratrum, 
when  it  had  become  very  copious,  and  the  pa- 
tient had  immediately  begun  to  improve.  Dr. 
Barrows  mentioned  another  case  of  eclampsia 
occurring  six  hours  after  delivery,  with  total 
suppression  of  urine.  The  usual  remedies,  in- 
cluding the  free  use  of  nitroglycerin,  had  been 
tried  without  success,  and  the  patient  had 
seemed  in  a  fair  way  to  die  at  the  time  he  had 
first  seen  her.  Under  the  hypodermic  use  of 
veratrum,  however,  the  kidneys  had  begun  to 
act  at  once,  and  the  patient  had  shortly 
become  conscious,  there  had  been  no  more 
convulsions,  and  she  had  made  an  excellent 
recovery. 

In  the  discussion  which  followed  (which 
called  forth  Dr.  Newton's  letter,  already  re- 
ferred to)  Dr.  J.  Clifton  Edgar  said  he  did  not 
believe  any  drug,  except  possibly  chloroform, 
was  of  as  much  value  as  veratrum  viride  in 
eclampsia.  He  had  not  dared  to  use  it  in  cases 
in  which  the  pulse  was  intermittent  or  soft, 
but  he  had  employed  it  freely  in  those  where 
the  pulse  had  been  tense  and  rapid.  The  ac- 
tion of  the  veratrum  viride  on  the  skin  should 
not  be  overlooked.  This  was  almost  as  prompt 
as  its  action  upon  the  heart  and  kidneys,  and 
by  the  free  excretion  through  the  skin  the  kid- 
neys were  greatly  relieved.  This,  in  his  opin- 
ion, was  much  better  than  exciting  the  skin  to 
action  by  using  the  hot-air  bath.  Dr.  Mann 
had  cited  before  the  American  G-ynsecological 
Society  a  case  in  which  a  teaspoonful  of  the 
plain  tincture  of  veratrum  viride  had  been 
given  by  mistake,  and  yet  the  woman  had  sur- 
vived. Dr.  Edgar  said  he  recalled  a  case  in 
which  he  firmly  believed  the  life  of  the  patient 
had  been  saved  solely  by  the  veratrum  viride. 
The  plain  tincture  had  been  given  hypoder- 
mically  in  10-minim  doses  until  the  pulse  had 
been  reduced  to  sixty,  and  this  had  been  con- 
tinned  until  the  pulse  had  shown  a  disposition 
to  remain  at  this  point  without  the  help  of  the 
drug. 

Dr.  W.  J.  Chandler,  of  South  Orange,  New 
Jersey,  said  that  the  use  of  veratrum  viride  in 
cases  of  puerperal  convulsions  had  many  years 
ago  been  a  common  treatment  in  the  Orange 
Memorial  Hospital.  At  one  time  a,  brother 
practitioner  had  told  him  that  he  was  treating 
cases  of  puerperal  eclampsia  with  teaspoonful 
doses  of  Norwood's  tincture,  and  that  all  the 
patients  recovered.  This  physician  had  also 
said  that  he  was  not  at  all  afraid  of  this  heroic 
treatment,  because  if  the  patient  received  too 
much  of  the  drug  it  would  at  once  be  rejected 
by  the  stomach.  Influenced  by  this  statement, 
Dr.  Chandler  had  decided  to  try  the  method. 
In  1879  he  had  been  called  to  see  a  woman  who 
had  had  convulsions  before  delivery.  When 
he  first  saw  her,  after  delivery,  the  convulsions 
were  present,  and  she  was  somewhat  maniacal. 


As  she  was  unable  to  swallow,  25  minims  of 
Norwood's  tincture  were  given  hypodermically. 
About  an  hour  afterward  he  was  hastily  sum- 
moned to  the  bedside,  and  found  the  respira- 
tions reduced  to  four  and  the  pulse  to  forty. 
As  the  drug  had  been  given  subcutaneously,  of 
course  no  relief  could  be  expected  from  vomit- 
ing, as  was  usually  the  case.  Under  stimula- 
tion and  appropriate  treatment  the  woman 
eventually  recovered.  In  this  case  the  excre- 
tion of  urine  had  been  increased,  and  the  skin 
had  been  bathed  in  perspiration.  This  action 
of  the  drug  he  had  noticed  in  all  these  cases. 
Since  this  time  he  had  often  used  the  drug 
very  freely  by  the  mouth„but  he  would  warn 
against  using  it  hypodermicallv. 

Dr.  F.  K.  Willis,  of  Watkins,  Kansas  {Medi- 
cal News,  March  28,  1896),  records  his  favour- 
able experience  in  the  treatment  of  puerperal 
convulsions  with  veratrum  viride.  He  says  it 
not  only  arrests  convulsions,  but  in  several 
cases  in  his  hands  it  has  prevented  them  when 
threatened.  No  patient,  he  says,  has  suffered 
eclamptic  convulsions  who  came  to  him  com- 
plaining of  headache  and  nervousness  and  pre- 
senting some  oedema,  a  full,  hard  pulse,  etc.  In 
this  class  of  cases,  5  minims  of  the  fluid  extract 
should  be  given  two  or  three  times  daily,  ac- 
cording to  the  urgency  of  the  case.  When 
paroxysms  occur,  he  always  administers  hypo- 
dermically 15  minims  at  once,  and  in  half 
an  hour  5  minims  more  if  necessary.  It  may 
be  necessary  to  continue  the  administration 
for  twenty-four  hours  or  longer  to  prevent 
recurrence.  Generally  speaking,  the  pulse 
should  be  held  at  50  or  60  for  a  day  or  two. 

In  conjunction  with  gelsemium,  veratrum 
viride  has  been  used  with  success  in  the  treat- 
ment of  traumatic  tetanus  by  Dr.  Fordyce  Grin- 
nell,  of  Pasadena,  California  (Medical  News, 
July  18,  1896).  ^  The  case  was  that  of  a  boy, 
six  years  old,  who,  while  barefoot,  cut  the  ball 
of  his  left  foot  on  a  piece  of  glass.  The  wound 
apparently  healed.  Some  nine  days  after  (on 
April  14th)  he  complained  of  stiff  jaws  and 
difficulty  in  swallowing.  These  symptoms  in- 
creased until,  on  the  night  of  the  16th,  tetanic 
spasms  began  to  manifest  themselves.  The 
cicatrix  of  the  wound  was  cleaned  and  scraped. 
It  seemed  somewhat  tender  on  pressure,  but 
no  foreign  body  was  discovered.  The  site  was 
scarified,  however,  and  turpentine  and  oil  were 
applied,  and  4-grain  doses  of  ammonium  bro- 
mide were  given  every  two  hours. 

As  no  perceptible  improvement  was  noted, 
on  the  17th  Norwood's  tincture  of  veratrum 
viride  was  given,  at  first  a  drop  every  hour, 
then  2  drops  every  hour.  As  this  did  not  seem 
to  prevent  the  return  of  the  spasms  from  time 
to  time,  fluid  extract  of  gelsemium  was  given, 
at  first  in  drop  doses  every  hour,  in  conjunc- 
tion with  the  veratrum,  then  in  2-drop  doses, 
and  finally  in  3-drop  doses.  The  dose  of  vera- 
trum was  also  increased  on  the  20th  to  3  drops 
every  hour,  so  that  the  child  was  taking  3 
drops  each  of  the  veratrum  viride  and  the  gel- 
semium every  hour,  and  it  seemed  to  require 
this  amount  to  control  the  spasms.  These 
doses  were  continued  for  forty-eight  hours. 
Only  once  during  this  time  didi  they  produce 


VERBASCUM 

VIBUKNUM  PRCTNIFOLIUM 


356 


active  vomiting  or  sufficient  nausea  to  require 
an  opiate  to  control  it.  When  this  relaxed 
condition  was  obtained,  the  drops  were  de- 
creased to  2  of  each  preparation  on  the  22d, 
and  on  the  25th  to  1  of  each,  which  was  con- 
tinued until  the  27th,  when  the  interval  was 
lengthened  to  two  hours,  and  gradually  there- 
after the  doses  were  discontinued. 

The  ammonium  bromide  was  given  in  3-  to  4- 
grain  doses  every  two  hours  during  this  entire 
period.  The  use  of  the  remedies  in  diminished 
doses  was  continued  to  the  30th  of  April,  when 
the  boy  could  open  his  mouth  without  diffi- 
culty, had  a  good  appetite,  and  was  playful, 
but  "more  boisterous  in  his  manner  than  usual, 
or,  as  his  mother  said,  "  more  nervous."  The 
instructions  had  been  to  decrease  the  amount 
and  frequency  of  the  doses  when  distinct  signs 
of  nausea  appeared  or  the  signs  of  convulsions 
abated.  Dr.  Grinnell  says  that  he  was  led  to 
try  veratrum  on  account  of  its  value  in  puer- 
peral and  other  convulsions,  and  gelsemium 
by  reason  of  its  action  in  causing  relaxation  of 
the  muscles  of  the  jaw.] 

Matthias  Lanckton  Fostee. 

VEBBASCUM. — Several  species  of  mul- 
lein have  been  used  in  medicine,  but  chiefly 
the  Verbascum  Thapsus.  Under  the  name  of 
flores  verhasci,  the  Ger.  Ph.  recognises  the 
flowers  of  Verbascum  phlomoides  and  Verbas- 
cum thapsiforme.  A  decoction  made  in  the 
proportion  of  an  ounce  of  the  flowers  to  a  pint 
of  water  may  be  talien  in  doses  of  from  3  to  5 
fl.  oz.  as  a  demulcent  and  astringent  in  diar- 
rhoea. The  leaves  are  occasionally  smoked  to 
allay  the  paroxysms  of  asthma. 

VERDIGKIS.— See  Cupric  acetate  (vol.  i, 
page  303). 

VERNONIA.  —  Several  species  of  this 
genus,  the  iron-weed,  have  been  used  to  some 
extent  in  medicine.  Ve7'non,ia  anthelminthica 
is  the  oil-plant,  or  kinka,  or  khatzum.'of  the 
East  Indies.  The  bitter  seeds  are  used  as  a 
stomachic,  and  the  fat  obtained  from  them  is 
said  to  be  a  powerful  anthelminthic.  Vernonia 
nigritiana,  a  species  found  in  western  Africa, 
is  said  to  act  upon  the  heart  like  digitalis,  but 
more  feebly.  Vernonia  has  not  come  suffi- 
ciently into  use  to  justify  positive  statements 
as  to  its  medicinal  value. 

VESICANTS,    VESICATOE.IES.— See 

Blisters. 

VIBXTBNTJM  OPTJLXTS  (U.  S.  Ph.).— 
This  caprifoliaceous  plant,  known  as  cramp 
bark,  is  a  large  shrub  which  is  found  through- 
out the  north  temperate  zone.  It  grows  on 
low  grounds. 

The  bark,  which  is  the  part  used  in  medi- 
cine, is  tough  and  has  a  bitter  and  slightly 
astringent  taste.  It  contains  a  volatile  oil, 
tannin,  an  acid,  and  a  bitter  principle,  vi- 
burnin. 

Cramp  bark  has  been  recommended  as  an 
antispasmodic  in  asthma,  and  has  been  used 
in  hysteria  and  in  puerperal  and  other  forms 
of  convulsions.  It  has  also  been  employed  in 
the  treatment  of  neuralgia  and  dysmenorrhoea. 
Its  medicinal  value  has  not  been  established, 


and  it  is  now  but  little  used  in  medicine.  The 
principal  preparation  is  the  fluid  extract,  ex- 
tractum  viburni  opuli  fluidum  (U.  S.  Ph.),  the 
dose  of  which  is  from  15  minims  to  a  fl. 
drachm.  The  berries  of  viburnum  opulus  are 
antiscorbutic. — Charles  Jewett. 

vibtjunum:  pruntfolium:  (U.  s. 

Ph.),  or  black  haw,  is  a  tall  shrub  indigenous  to 
the  middle  and  southern  portions  of  the  United 
States  east  of  the  Mississippi  River.  Closely 
allied  to  it  are  the  Vibtirnum  obovatum  of  the 
Southern  United  States  and  the  Viburnum 
Lantana  of  Europe.  The  bark,  which  is  the 
part  used  in  medicine,  has  a  bitter,  astringent 
taste,  but  no  odour.  It  contains  valerianic, 
tannic,  oxalic,  citric,  and  malic  acids,  a  brown- 
ish resinous  principle,  and  a  greenish-yellow 
resin,  viburnin. 

Viburnum  prunifolium  is  an  astringent, 
diuretic,  nervine,  and  antispasmodic.  In  the 
lower  animals,  toxic  doses  cause  progressive 
muscular  weakness  and  flnally  paralysis.  In 
warm-blooded  animals  it  is  a  vaso-motor  relax- 
ant, lowering  the  arterial  pressure. 

Viburnum  prunifolium  is  much  employed  as 
a  uterine  sedative.  It  appears  to  inhibit  uter- 
ine contractions  and  to  diminish  hypercemia 
of  the  pelvic  organs.  It  is  useful  therefore 
in  the  prophylaxis  of  abortion,  for  the  pallia- 
tive treatment  of  dysmenorrhcea,  especially  of 
the  spasmodic  variety,  and  in  menorrhagia  and 
metrorrhagia.  While  less  efHective  than  opium 
for  the  control  of  uterine  expulsive  efforts,  it 
has  the  advantage  of  freedom  from  the  un- 
pleasant after-effects  of  the  latter  drug.  It  is 
a  remedy  of  some  value  for  the  relief  of  after- 
pains.  In  dysmenorrhoeal  and  in  certain  forms 
of  intermenstrual  pain  it  is  frequently  com- 
bined with  Jamaica  dogwood  or  with  cannabis 
indica ;  in  menorrhagia,  with  golden  seal. 

[Dr.  Theodore  Shennan  {Edinburgh  Medical 
Journal.  November,  1876 ;  N'ew  York  Medical 
Journal,  November  21,  1896)  says  that  Dr. 
Phares,  of  Newtonia,  Mississippi,  has  the  credit 
of  initiating  the  use  of  viburnum  prunifolium. 
His  paper,  published  in  1866,  recommended  it 
as  astringent,  diuretic,  tonic,  and  antispas- 
modic, but  chiefly  as  a  remedy  for  dysmenor- 
rhoea  and  as  a  preventive  of  abortion.  Little 
more  was  heard  of  it  until  1876,  when  Dr. 
Jenks,  of  Detroit,  revived  its  use.  He  em- 
ployed it  in  menorrhagia,  metrorrhagia,  and 
dysmenorrhoea  with  menorrhagia.  He  attrib- 
uted a  great  deal  of  its  value  to  the  presence 
of  a  body  similar  to  valerianic  acid. 

Rockwell,  in  1879,  used  it  in  dysmenorrhoea. 
He  considered  it  was  indicated  in  delicate, 
nervous  women  in  whom  pain  was  due  to 
slight  anteflexion,  slight  endotrachelitis,  or 
partial  stenosis,  or  where  it  was  neuralgic  in 
character  He  classed  it  as  anodyne,  anti- 
spasmodic and  tonic.  The  last  term  is  very 
indefinite,  Dr.  Shennan  thinks,  though  in  one  of 
his  cases  he  noticed  a  relief  of  nausea  or  sick- 
ness which  followed  the  administration  of  vi- 
burnum. 

Abbot,  in  1879,  used  it  in  dysraenorrhcEa 
with  great  success,  as  also  Curtis  (1879)  and 
Lyman. 


357 


VERBASCUM 
VIBURNUM  PRUNIFOLIUM 


Chadwick,  in  1879,  found  it  gave  relief  in 
many  cases,  but  success  was  not  invariable,  or 
so  brilliant  as  previous  papers  had  led  him  to 
expect.  Its  action  was  similar  but  not  superior 
to  that  of  zinc  valerianate. 

Dr.  R.  L.  Payne  read  a  paper  on  Viburnum 
munifolium  before  the  Medical  Society  of 
North  Carolina  in  1888.  This,  says  Dr.  Shen- 
nan,  is  one  of  the  few  papers  which  treat  the 
subject  scientifically,  and  describe  experiments 
carried  out  on  the  lower  animals.  Dr.  Payne 
refers  to  the  literature  of  viburnum,  and  the 
want  of  definite  rules  for  its  use.  He  experi- 
mented with  the  ordinary  alcoholic  liquid  ex- 
tract ;  or  with  the  solid  extract  rubbed  up 
with  water,  with  the  view  of  getting  rid  of  the 
vitiating  effects  of  the  alcohol  contained  in  the 
fluid  extract.  He  found  that  both  had  a  simi- 
lar effect.  His  results  were  as  follows:  Pa- 
ralysis and  loss  of  reflex  motion,  both  with 
mechanical  and  with  chemical  stimuli.  He 
got  reactions  with  electrical  stimuli — whether 
faradaic  or  galvanic  is  not  stated — one  pole  to 
the  spine,  the  other  to  the  limb.  He  gave  as 
much  as  half  an  ounce  of  the  fluid  extract  to 
rabbits,  and  the  amount  of  alcohol  contained 
must  undoubtedly  have  had  an  effect  on  the  tra- 
cing. Dr.  Shennan  thinks  that  his  experi- 
ments on  rabbits  prove  this.  In  rabbits  (the 
solid  extract  being  used,  rubbed  up  with  water) 
the  blood -pressure  was  found  to  tall  very  rap- 
idly after  the  injection  of  a  syringeful  into  the 
jugular  vein.  Here,  Dr.  Shennan  thinks,  evi- 
dently no  care  had  been  taken  to  make  the 
fluid  neutral  or  slightly  alkaline,  and  the 
resins,  which  are  present  in  considerable  quan- 
tity, were  not  removed  before  injection.  Dr. 
Payne's  tracings  show  a  marked  effect  on  the 
blood-pressure,  but  at  parts  suggest,  by  the 
weakness  of  the  heart  curves,  that  there  may 
have  been  some  clotting  in  the  cannnlae. 
There  was  evidently  no  balancing  of  pressure 
in  the  vessels  by  use  of  a  column  of 'mercury, 
and,  as  the  blood  was  thus  allowed  to  pass  for 
some  distance  into  the  tube  leading  to  the  re- 
cording apparatus,  the  tendency  was  for  it  to 
clot.  Dr.  Shennan  states  that  he  has  found 
this  clotting  to  be  very  troublesome  in  his  own 
experiments. 

Dr.  Payne  concluded  that  there  was  no  effect 
on  sensibility.  The  chief  action  was  on  mo- 
tion, paralysis,  loss  of  voluntary  motion,  loss 
of  reflex  power,  the  extent  being  governed  en- 
tirely by  the  amount  of  the  driig  used.  The 
pupils  contracted  in  cold-blooded  animals  and 
did  not  change  in  warm-blooded  animals. 
Muscular  irritability  was  lost  after  lethal  doses, 
but  nerve  conduction  was  lost  before  muscular 
contractility.  Probably  the  action  was  chiefly 
on  the  spinal  cord  and  its  posterior  columns. 
The  heart  was  quick  and  feeble  in  its  action, 
and  the  blood-pressure  lowered  ;  in  lethal  doses 
the  heart  stopped  before  respiration. 

Dr.  Payne  recommended  the  use  of  vibur- 
num in  diseases  with  increased  excitability  of 
the  motor  centres — in  hysteria,  in  hystero-epi- 
lepsy,  in  petit  mat,  in  paralysis  agitans,  and 
in  the  dysmenorrhea  sometimes  designated  as 
ovarian  or  spasmodic.  He  asserted  that  it 
was  harmful  in  menorrhagia  due  to  congestion 


of  the  portal  circulation,  subinvolution  of  the 
uterus,  metritis,  erosions  of  the  cervix,  and 
fibroid  tumours.  It  was  preventive  of  abortion 
and  very  useful  in  habitual  abortion.  It  had 
a  paralyzing  action  on  the  uterus. 

Dr.  J.  Hinton,  of  Detroit,  in  1889,  applied  it 
for  the  control  of  false  pains,  and  even  of  labour 
pains.  He  has  never  observed  post-partum 
hsemorrhage  or  severe  after-pains  when  using 
this  drug. 

Joseph,  of  Landeck,  in  Silesia,  recommends 
viburnum  very  strongly  in  mrginal  dysmenor- 
rhoea.  He  used  it  in  two  cases  of  habitual 
abortion,  in  which  he  was  unsuccessful;  but 
he  does  not  consider  this  a  sufficient  trial.  Of 
the  forms  of  dysmenorrhcea,  according  to 
Joseph,  that  is  most  relieved  which  is  brought 
about  by  mechanical  obstruction — for  example, 
congenital  or  acquired  anteflexion,  as  opposed 
to  congestive  dysmenorrhcea,  which  is  more 
common  in  married  women.  The  amount  of 
the  flux  was  diminished,  and  sank  to  normal ; 
moreover,  the  remedy  changed  the  interrupted 
course  to  one  more  continuous.  He  recom- 
mends it  as  an  autispasmodic,  and  not  only  in 
uterine  or  intestinal  colic,  but  also  in  other 
conditions  of  cramp,  such  as  that  of  voluntary 
muscles. 

Dr.  Boal  prefers  viburnum  to  opium  in 
many  cases,  as  it  is  more  easily  borne  and  is 
readily  retained  by  the  stomach.  It  is  very 
beneficial  in  spasmodic  dysmenorrhcea,  and 
gives  relief  when  dysmenorrhcea  is  due  to 
flexion  or  to  stenosis.  It  relieves  pain  pre- 
ceding and  during  menstruation.  Even  if 
this  one  action  was  proved,  says  the  author, 
and  it  was  able  to  take  the  place  of  opium  or 
alcohol,  viburnum  would  be  very  serviceable. 

Blackerby  used  it  in  habitual  abortion,  and 
.cites  a  very  conclusive  case.  A  patient  of  his 
had  had  six  abortions.  Viburnum  was  admin- 
istered during  the  seventh  pregnancy,  which 
went  to  term  and  ended  in  the  birth  of  a  liv- 
ing child.  The  eighth  pregnancy  had  a  simi- 
lar result  under  the  same  treatment.  Many 
other  cas^,  says  Dr.  Shennan,  have  been  re- 
lated in  which  relief  was  obtained  in  threaten- 
ing abortion  after  overexertion. 

In  regard  to  the  indications  for  the  use  of 
this  drug,  says  Dr.  Shennan,  they  are  as  fol- 
lows :  1.  In  hahittial  abortion,  where  this  is 
not  caused  by  syphilitic  infection  or  by  fatty 
placenta,  good  results  undoubtedly  seem  to 
follow  its  use.  3.  In  threatening  abortion, 
however  caused,  and  at  any  period  of  gestation, 
if  the  patient  is  treated  soon  enough,  it  seems 
to  be  very'efiicient.  3.  In  dysmenorrhcea,  if 
functional,  spasmodic,  or  ovarian,  or  attended 
with  menorrhagia,  it  often  cures.  If  there  is 
flexion  or  stenosis,  it  gives  great  relief,  though, 
of  course,  it  can  not  cure.  4.  In  the  menor- 
rhagias  and  metrorrhagias  of  the  menopause 
and  in  the  nervous  disorders  of  that  time  it  is 
very  beneflcial.  5.  After-pains  are  so  readily 
relieved  by  it  that  some,  like  Auvard,  consider 
that  its  use  is  dangerous  unless  all  clots  are 
cleared  out  of  the  uterus  previously.  6.  It 
may  be  used  in  the  diagnosis  ot  false  pains,  as 
it  speedily  relieves  them.  7.  It  is  also  used  with 
success  in  colicky  diarrhoea  and  in  dysentery. 


VICHY 
VINEGAR 


358 


Some  even  maintain  that  it  has  a  curative 
effect  on  cramps  of  voluntary  muscles. 

Concerning  the  physiological  effects  on  ani- 
mals and  man,  Dr.  Shennan  has  undertaken 
some  experiments,  from  the  results  of  which  he 
draws  the  following  conclusions  :  In  mammals, 
warm-blooded  animals,  owing  to  the  difficulty 
of  giving  a  large  enough  dose  hypodermically, 
there  is  no  marked  effect,  except  drowsiness 
and  some  lessening  of  motor  power.  If  the 
substance  is  introduced  into  the  heart  directly, 
there  is  rapid  lowering  of  blood-pressure  to 
about  half  the  normal,  with  slow  return  to 
near  the  normal  as  the  drug  is  eliminated. 

Although  too  much  reliance  must  not  be 
placed  on  experimental  results  in  cold-blooded 
animals  as  applicable  to  warm-blooded  ani- 
mals, including  man,  we  may  be  allowed,  he 
says,  to  take  something  from  these  results  and 
use  them  as  probably  applicable. 

Thus,  there  are  probably  some  diminution 
of  reflex  irritability,  a  quieting  effect  on  invol- 
untary raascle,  and  possibly  some  lowering 
of  blood-pressure,  which,  even  though  small, 
might  afford  relief  in  congested  conditions. 
Then,  and  very  important,  there  is  the  effect 
of  the  valerianic  or  viburnio  acid  in  neurotic 
and  hysterical  conditions. 

In  the  Pharmacopeia  there  are  many  drugs 
capable  of  bringing  about  all  these  desired 
effects.  Why,  then,  he  asks,  use  Viburnum 
pranifolium  ?  Opium  is  one  of  our  sheet-an- 
chors, but  then  there  are  dangers  and  incon- 
veniences attending  its  use.  The  patient  may 
acquire  the  opium  habit,  the  constipation 
caused  by  it  is  very  troublesome,  and  it  is  very 
toxic.  Viburnum  h4s  similar  good  effects, 
though  not  so  strong.  It  is  a  good  form  in 
which  to  administer  valerianic  acid.  Its  effect 
upon  nnstriped  muscle,  though  not  so  strong 
as  that  of  opium,  gives  the  relief  necessary.  It 
has  scarcely  any  effect  in  causing  constipa- 
tion. 

Toxic  effects  have  been  noticed  only  with 
very  considerable  doses.  Herriok  has  seen  dis- 
turbance of  vision,  dryness  of  the  mouth,  and 
headaches ;  and  Wilson  has  observed  similar 
conditions,  but  these  were  with  doses  larger 
than  are  usually  administered  to  man.] 

The  dose  of  the  fluid  extract,  extractum  vi- 
burni  prunifolii  (U.  S.  Ph.),  is  from  -|  to  3  fl. 
drachms.  The  solid  extract,  which  is  not  offi- 
cial, does  not  appear  to  fully  represent  the 
drug,  but  in  pill  form  it  has  the  advantage  of 
being  less  unpleasant  than  the  former  prepa- 
ration. The  extract  may  be  given  in  doses  of 
from  3  to  10  grains.— Charles  Jewett. 

"VICHY  is  the  most  famous  of  the  French 
spas.  It  is  situated  in  the  Department  of  the 
Allien  It  is  one  of  the  most  universally  fre- 
quented resorts  in  Europe,  twenty  thousand 
people  being  accommodated  each  season.  The 
season  extends  from  early  in  May  to  late  in 
October.  The  springs  are  numerous,  and  the 
waters  are  used  both  externally  and  internally. 
The  temperature  of  the  springs  varies  froni 
57°  to  178°  P.  The  most  important  springs 
are  three  in  number,  the  Grande  Grille,  the 
Celestins,  and  the  Hopital.     In  the  second 


group  are  the  Lucas,  the  Source  du  Pare,  the 
Source  Lardy,  the  Puits-Caire,  and  the  De 
Mesdames.  The  water  from  these  springs  is 
exported  very  largely.  Artificial  Vichy  water 
is  much  used,  and  is  made  after  a  chemical 
formula  which  is  supposed  to  represent  the 
composition  of  the  water  of  the  springs.  The 
following  table,  showing  the  composition  of 
the  more  important  springs,  is  that  given  by 
Cyr: 


Grande 
Grille. 

CSleathu. 

H6pilal. 

4-883 
0  862 
0-303 
0-003 
0-434 
0-004 
trace 
0-291 
0-130 
0-002 
trace 
0-634 
0  070 

5-103 
0-31.T 
0-338 
0-005 
0-462 
0-004 
trace 
0-291 
0-091 
0-002 
trace 
0-534 
0-060 

5  029 

Potassium  bicarbonate 

Magrnesium  bicarbonate 

Strontium  bicarbonate 

Calcium  bicarbonate 

0  440 
0-200 
0-005 
0-570 

0-004 

Mangjanous  bicarbonate 

trace 
0-291 

Sodium  phosphate     

0046 

Sodium  arsenate 

0-002 

0-618 

Silica       

0  050 

T-006 

7  195 

7  155 

The  chief  ingredients  of  Vichy  water  are, 
therefore,  the  bicarbonates  of  sodium  and  of 
calcium  and  the  sulphate,  chloride,  and  phos- 
phate of  sodium.  It  is  abundantly  charged 
with  carbonic  acid.  It  is  properly  classed  as 
an  alkaline  water. 

Vichy  water  is  largely  prescribed  for  rheu- 
matism, gout,  dyspepsia,  lithmmia,  cystitis,  and 
diseases  of  the  liver.  Mild  but  persistent  forms 
of  enteritis  and  gastritis  are  especially  bene- 
fited by  a  course  of  Vichy  water.  Patients 
with  diabetes  also  improve  under  its  use  in  some 
instances.  The  most  positive  statements  are 
made  as  to  its  efficacy  in  icterus  and  recurring 
attacks  of  hepatic  colic.  It  is  a  most  valuable 
adjuvant  in  the  treatment  of  diseases  of  the 
gouty  and  rheumatic  group,  but  many  of  the 
favourable  results  are  undoubtedly  due  to  the 
large  amount  of  water  ingested. 

Floyd  M.  Crandall. 

VIEIRIC  ACID,  VIEIRIN.— This  is  a 
white,  amorphous  bitter  principle  obtained 
from  the  bark  of  Remijia  Vellozii,  a  ein- 
chonaceous  shrub  found  in  Brazil.  It  is  solu- 
ble in  alcohol  and  in  chloroform.  It  has  been 
recommended  as  a  substitute  for  quinine  as  a 
tonic  and  in  the  treatment  of  malarial  fevers. 
It  may  be  given  in  doses  of  from  1  to  4  grains. 

VTNCA. — Two  species  of  this  genus  of 
apocynaoeous  plants,  Vinca  major  and  Vinca 
minor,  the  large  and  the  small  periwinkle, 
have  been  used  to  some  extent  in  medicine. 
They  are  mildly  purgative,  diuretic,  and  dior- 
phoretic. 

VINBGAB,  aceium  (Br.  Ph.),  owes  its 
properties  to  the  presence  of  acetic  acid,  the 
proportion  of  which  varies  from  4  to  6  per 
cent.  It  may  be  dark  brown  in  colour  or  clear 
and  transparent,  the  former  indicating  its 
preparation  from  infusion  of  malt,  a  dark-col- 
oured wine,  or  cider,  and  the  latter  that  white 
wine  has  been  its  source.  The  variety  most 
commonly  employed  in  the  household  "in  the 
United  States  is  that  prepared  from  cider, 


359 


VICHY 
VINEGAE 


which  is  allowed  to  stand,  except  during  cold 
weathei',  in  the  open  air  in  casks,  in  each  head 
of  which  is  a  small  hole  to  allow  the  circula- 
tion of  air  and  with  a  bottle  inserted  into  the 
bunghole  with  the  view  of  permitting  the  en- 
trance of  light  and  at  the  same  time  prevent- 
ing the  entrance  of  insects.  It  usually  requires 
two  summers  to  complete  the  process,  at  the 
end  of  which  the  vinegar  should  be  of  a  clear 
brown  colour  and  a  slight  flavour  somewhat 
resembling  that  of  apples,  and  should  also  be 
free  of  any  woody  taste.  It  is  usual  to  rack 
ofl  the  clear  part  into  a  clean  cask  or,  what  is 
better,  into  glass  or  earthen  receptacles,  as,  if 
it  is  allowed  to  remain,  gelatinous  masses  con- 
sisting of  the  mycoderms  of  acetous  fermenta- 
tion are  formed,  which  under  some  conditions 
may  fill  the  casks.  This  substance  is  popu- 
larly known  as  the  "  mother  of  vinegar."  In 
small  amounts  it  will  cause  the  acetification  of 
almost  any  saccharine  solution,  and  in  many 
cases  when  it  is  found  in  partially  emptied 
vinegar  casks  it  is  customary  to  add  a  solution 
of  sugar  and  water.  In  this  way  a  fairly  satis- 
factory vinegar  is  made,  but  it  lacks  the  pecul- 
iar taste  and  odour  of  that  made  from  cider 
alone.  The  other  varieties  of  vinegar  are 
made  by  allowing  malt  infusions,  wines,  or 
solutions  of  alcohol  to  trickle  over  or  through 
pine  or  beech  shavings.  By  this  measure 
they  are  exposed  in  thin  layers  to  the  action 
of  the  air,  and  oxidization  of  the  alcohol  into 
acetic  acid  is  accomplished.  When  a  white 
wine  is  employed  the  product  is  known  as 
white  vinegar,  while  that  from  malt  is  dark. 
The  white  variety  is  usually  the  cheapest  and 
is  the  variety  oftenest  employed  in  the  com- 
mercial preparation  of  condiments  and  in  the 
household  where  there  is  a  real  or  fancied  ob- 
jection to  the  coloured.  There  is  no  differ- 
ence, however,  in  the  effects  of  the  different 
varieties,  and  a  selection  is  usually  dictated  by 
taste  or  convenience. 

Sulphuric  acid  is  the  commonest  adulterant 
of  vinegar,  but,  provided  it  does  not  exceed 
one  part  in  a  thousand,  is  without  much  effect. 
Lead  is  occasionally  found,  but  rarely  in  suf- 
ficient amounts  to  be  of  any  great  importance. 
Mustard  and  red  or  black  pepper  are  some- 
times used  to  add  to  the  pungency  of  vinegar 
which  contains  less  than  the  proper  amount  of 
acetic  acid. 

As  ordinarily  employed  as  a  condiment,  vin- 
egar is  reasonably  free  from  objection,  but  in 
undue  amounts  is  apt  to  cause  indigestion 
and  act  as  an  irritant  of  the  alimentary  canal. 
It  enjoys  some  reputation  among  the  laity  as 
an  agent  for  the  reduction  of  corpulency,  but 
in  suflBcient  quantities  to  have  the  desired 
effect  is  entirely  unsafe.  Sponging  with  solu- 
tions containing  10  per  cent,  of  vinegar  is  very 
grateful  in  all  febrile  conditions  and  after  se- 
vere exercise. 

For  .such  purposes  aromatic  vinegar,  which 
consists  of  acetic  acid,  water,  alcohol,  and  a 
number  of  the  essential  oils,  is  much  more 
agreeable,  but  is  rather  too  costly  for  general 
use. 

If  the  stronger  acids  are  not  available,  vine- 
gar may  be  employed  as  an  antidote  in  poison- 


ing with  alkalies.  Vinegars,  the  aceta  of  the 
pharmacopoeias,  are  solutions  of  various  drugs 
in  vinegar  or  acetic  acid,  more  particularly  the 
latter.  They  were  formerly  employed  to  a 
considerable  extent,  but  are  not  now  exten- 
sively used  on  account  of  their  ready  decom- 
position. 

[Carleton  (cited  in  the  Canadian  Prac- 
titioner for  May,  1896)  states  that  vinegar  is 
useful  in  ca/rholic-aeid  poisoning.  When  it  is 
applied  to  the  skin  or  to  a  mucous  membrane 
which  has  been  burned  by  the  acid,  it  causes  a 
rapid  disappearance  of  the  characteristic  white- 
ness, as  well  as  of  the  anjesthesia  produced  by 
carbolic  acid,  and  it  also  prevents  the  forma- 
tion of  a  slough.  Moreover,  it  neutralizes  any 
of  the  acid  that  may  have  been  introduced  in- 
to the  stomach.  The  first  thing,  therefore,  to 
do,  he  says,  in  cases  where  carbolic  acid  has 
been  swallowed  is  to  make  the  patient  drink 
some  vinegar  mixed  with  equal  parts  of  water, 
and  then  to  wash  out  the  stomach. 

M.  Lewin  {Revue  de  chirurgie,  September, 
1895  ;  New  York  Medical  Journal,  October  36, 
1895)  has  employed  vinegar  to  prevent  vomit- 
ing after  chloroform  ancesthesia  in  a  hundred 
and  seventy-four  cases.  In  a  hundred  and 
twenty-five  cases,  he  says,  he  has  obtained 
complete  success,  no  vomiting  of  any  kind 
having  been  produced.  In  forty-nine  cases 
there  was  vomiting,  but  it  was  generally  slight 
and  the  rejected  material  was  rather  viscous. 
The  method  should  be  very  cai'efully  carried 
out,  he  says,  in  order  to  insure  good  results. 
It  is  known,  he  remarks,  that  chloroform  is 
eliminated  almost  exclusively  through  the 
lungs,  partly  as  free  chloroform  and  partly  as 
formic  acid  and  chlorine.  It  is  evident,  he 
says,  that  the  chlorine  exercises  an  irritating 
action  on  the  larynx  and  on  the  trachea,  and 
that  this  is  one  of  the  principal  causes  of  the 
vomiting.  When  a  cloth  saturated  with  vine- 
gar is  held  over  the  nostrils,  the  chlorine  com- 
bines with  the  acetic  acid  as  fast  as  it  is  evolved, 
and  forms  trichloracetic  acid. 

It  is  very  dangerous  to  use  pure  chloroform, 
says  M.  Lewin,  and  all  medicinal  chloroform 
should  contain  a  certain  quantity  of  alcohol, 
which  renders  its  decomposition  during  nar- 
cosis more  difficult.  It  is  also  known,  he  con- 
tinues, that  chloroform  dehydrates  the  tissues, 
and  consequently  after  the  action  of  the  chlo- 
roform has  been  suspended  it  is  well  to  make 
the  patient  breathe  in  air  that  is  as  humid  as 
possible.  This  dehydrating  action,  he  says,  in- 
fluences also  the  endothelium  of  the  blood- 
vessels and  causes  coagulation  of  the  blood,  to 
which  the  slackening  of  the  circulatory  move- 
ment and  the  feeble  activity  of  the  chemico- 
biological  phenomena  in  the  capillaries  also 
contribute.  Cinder  such  circumstances,  he 
thinks,  acetic  acid  is  a  powerful  agent  in  re- 
storing to  the  blood  its  normal  fluidity,  owing 
to  a  property  that  it  derives  from  the  water  it 
contains,  and  to  its  energetic  power  of  destroy- 
ing the  fibrin.  Moreover,  acids  in  general  are 
stimulants  of  the  respiratory  tract.  The  fore- 
going considerations,  he  says,  seem  to  him  suf- 
ficient to  explain  the  phenomena  without 
bringing  forward  a  hypothetical  action  of  the 


VINUM 
WATER 


360 


vinegar,  or  of  acids  in  general,  on  the  vomit- 
ing centre  by  the  intervention  of  the  vaso- 
motor nerves. 

The  following  observations  were  made  in 
cases  where  this  treatment  was  employed  by 
M.  Lewin  :  Immediately  after  the  application 
of  the  vinegar  the  pulse  became  strong,  respi- 
ration grew  deeper,  the  face  regained  a  little 
colour,  and  the  corneal  conjunctiva  became 
bright.  The  appetite  returned  at  the  end  of  a 
short  time,  and  the  patients  occasionally  com- 
plained of  hunger  on  the  very  day  of  the  op- 
eration. Frequently  they  did  not  suffer  at  all 
from  the  general  uneasiness  which  nearly  al- 
ways follows  chloroform  ansEsthesia.  It  does 
not  follow  from  this,  says  M.  Lewin,  that  the 
application  of  the  vinegar  always  suppresses 
the  vomiting,  for,  in  some  cases  where  the  pa- 
tients are  very  nervous  or  are  suffering  from 
certain  affections  of  the  lungs  or  of  the  stom- 
ach, vomiting  may  occur  in  spite  of  the  treat- 
ment. 

The  method  of  application  is  as  follows :  A 
piece  of  linen  of  about  the  size  of  a  napkin  is 
saturated  with  vinegar  and  lightly  wrung  out ; 
it  is  then  placed  on  the  patient's  face,  over  the 
mask,  which  is  afterward  carefully  withdrawn, 
care  being  taken  not  to  allow  the  air  to  gain 
access  to  the  face  too  suddenly,  for  it  ought  to 
pass  through  the  linen  cloth  before  being  in- 
haled. This  cloth  must  be  kept  on  as  long  as 
possible,  for  three  hours  at  the  least,  and  it  is 
better  for  the  patient  if  the  application  is  pro- 
longed during  the  entire  day,  for  occasionally 
the  presence  of  chloroform  in  the  expired  air 
has  been  observed  for  more  than  two  days 
after  narcosis.  If  the  cloth  is  removed  too 
soon,  nausea  will  set  in.  If  the  linen  cloth 
dries  very  rapidly,  it  must  be  replaced  imme- 
diately with  a  fresh  one,  which  is  put  over  the 
first  cloth  before  the  latter  is  drawn  away,  in 
order  to  prevent  the  air  from  touching  the 
face.  If  the  wet  cloth  is  annoying  to  the  pa- 
tient, it  may  be  held  away  from  the  face  with 
a  mask.  It  is  of  the  greatest  importance  to 
conform  to  these  rules,  says  M.  Lewin,  for 
failure  to  observe  them  has  prevented  good  re- 
sults from  following  the  application  of  the 
vinegar.] — Russell  H.  Nevins. 

VINUM.— See  Wine. 

VIOLA  TRICOLOR.— This  plant  is  the 
pansy,  or  heart's-ease,  a  flowering  herb  of  the 
natural  order  ViolaceCB,'  a  native  of  Europe, 
extensively  cultivated  in  flower  gardens  in  this 
country  and  naturalized  from  Kentucky  south- 
ward. Its  medicinal  properties  depend  chiefly 
on  an  emetico-cathartic  active  principle  known 
as  moline,  on  viola-quercitrin,  and  on  salicylic 
acid. 

Violine  is  a  white  alkaloid,  soluble  in  alcohol, 
very  sparingly  soluble  in  water,  which  readily 
unites  with  various  acids  to  ^orm  salts.  In  the 
plant  it  is  found  in  the  form  of  the  malate  and 
can  be  extracted  in  a  pure  state  only  by  means 
of  a  complicated  process.  It  is  allied  to  eme- 
tine, the  alkaloid  of  ipecacuanha,  but  is  dis- 
tinctly different. 

Viola-quercitrin  is  a  glucoside  which  crys- 
tallizes in  the  form  of  fine  yellow  needles  and 


is  decomposed  when  boiled  with  a  dilute  acid 
into  queroitrin  and  a  fermentable  glucose. 
This  substance  was  discovered  by  Mandolin, 
who  also  detected  the  presence  of  salicylic  acid 
in  several  species  of  Viola. 

The  physiological  action  of  Viola  tricolor 
can  hardly  be  distinguished  from  that  of  the 
otlier  species  of  Viola,  nearly  if  not  quite  all 
of  which  are  possessed  of  similar  properties, 
and  very  little  has  been  written  on  the  subject 
of  the  physiological  action  of  the  violets.  But 
that  little  seems  to  show  a  noticeable  resem- 
blance in  their  action  to  that  of  salicylic  acid. 
Large  doses  are  said  to  cause  headaclie  asso- 
ciated with  a  feeling  of  confusion  and  dulness 
in  the  head  and  a  sensation  of  heat  over  the 
entire  body,  together  with  stimulation  and 
irritation  of  the  skin,  the  genito-urinary  tract, 
and  the  salivary  glands,  as  shown  by  cutaneous 
eruptions  with  intense  itching  and  profuse 
perspiration,  frequent  and  profuse  micturition 
of  foul-smelling,  turbid  urine,  with  tenesmus 
of  the  bladder,  and  a  profuse  secretion  of 
saliva.  In  smaller  doses  the  decoction  forms 
a  mucilaginous,  emollient,  and  slightly  laxa- 
tive drink. 

Viola  tricolor  was  first  introduced  into  med- 
icine as  a  remedy  for  crusta  lactea,  or  infantile 
eczema  of  the  head  and  face,  sometimes  known 
as  "  cradle  cap."  For  this  purpose  it  was  given 
in  the  form  of  a  decoction  of  the  fresh  herb  in 
milk,  while  a  poultice  of  the  leaves  was  applied 
locally.  Gradually  this  remedy  fell  into  dis- 
use, except  in  France,  where  it  continued  to  be 
employed,  and  lately  its  use  has  been  advocated 
by  Dr.  Piffard,  of  New  York,  as  efficacious  in 
cases  of  eczema.  Instead  of  a  decoction,  he 
uses  a  fluid  extract  and  gives  quite  full  direc- 
tions as  to  its  employment.  The  drug  should 
be  given  in  the  second  stage  of  the  disease, 
when  a  serous  or  sero-purulent  exudation  or 
crusting  is  present.  In  acute  eczema  full  doses 
induce  aggravation  and  extension  of  the  erup- 
tion, with  increased  local  heat  and  itching 
which  last  for  several  days.  In  order  to  avoid 
these  disagreeable  symptoms,  he  advises  that 
only  from  1  to  .5  drops  be  given  once  or  twice 
a  day  to  a  young  child  at  the  beginning  of 
treatment.  This  dose  may  be  increased  if 
neither  improvement  nor  aggravation  occurs 
after  a  few  days  of  treatment,  while  if  the 
trouble  is  aggravated  the  use  of  the  drug 
should  be  stopped  and  resumed  in  a  few  days 
with  a  smaller  dose.  In  subacute  and  chronic 
eczema  initial  doses  of  from  10  drops  to  2  fl. 
drachms  are  recommended,  in  a  small  quantity 
of  water,  about  half  an  hour  before  meals. 

The  syrup  of  violets  is  prepared  as  an  agree- 
able and  palatable  vehicle  for  other  medicines, 
and  has  been  used  in  bronchial  affections,  as  a 
demulcent  drink,  and  as  a  laxative  for  infants. 
It  may  also  be  used  as  a  test  for  the  presence 
of  acids  and  alkalies,  as  the  former  turn  the 
pale-violet  colour  of  the  syrup  into  red,  and 
the  latter  turn  it  into  green. 

The  Viola  cucullata,  or  common  wild  blue 
violet  of  America,  enjoys  a  local  reputation  in 
Pennsylvania  as  an  antidote  to  the  venom  of 
the  rattlesnaJce.  It  is  given  internally  in  the 
form  of  the  fresh,  raw  leaves  or  that  of  a  de- 


361 


VINUM 
WATER 


coction,  while  a  poultice  of  salt  and  indigo  is 
applied  to  the  wound. 

Matthias  Lanokton  Foster. 

VIOLETS. — See  under  Viola  teiooloe. 

VIRGINIA  SNAKEBOOT.— See  Ser- 
pent aria. 

VTROIi. — This  seems  to  be  an  English  pro- 
prietary preparation  of  bone-marrow,  intended 
originally  as  a  palatable  substitute  for  cod- 
liver  oil,  but  afterwards  recommended  as  a 
fatty  food  for  infants  and  young  children. 
{Indian,  Lancet,  August  16,  1896.) 

VIBTTSES. — See  under  Animal  extracts 
and  juices  (vol.  i,  page  82)  and  Toxines. 

VISCUM  ALBUM,  the  mistletoe,  is  a 
European  parasitic  shrub  which  grows  chiefly 
on  deciduous  trees,  notably  fruit  trees.  It 
forms  a  pendent  evergreen  bush  several  feet 
in  diameter.  The  American  mistletoe,  Vis- 
cum  flavescens  (Phoradendron  flavescens),  is 
similar  in  medicinal  properties  to  the  Euro- 
pean species.  In  addition  to  mucilage,  tannin^ 
resin,  and  a  fixed  oil,  mistletoe  contains  a  pe- 
culiar thick,  viscid,  and  tenacious  substance 
known  as  bird-lime  or  bird-glue.  The  latter 
ingredient  may  be  obtained  from  the  freshly 
bruised  mistletoe  bark  by  kneading  it  in  water. 
Pawlevsky  extracted  from  mistletoe  a  crystal- 
lizable  acid  nearly  insoluble  in  water  and  quite 
so  in  alcohol  and  in  ether.  The  fresh  bark 
and  leaves  emit  a  peculiar  unpleasant  odour, 
and  to  the  taste  are  slightly  acid,  bitter,  and 
somewhat  nauseous. 

Mistletoe  seems  to  act  upon  the  heart  like 
digitalis.  It  also  excites  vigorous  contractions 
of  the  uterine  muscular  fibres,  especially  during 
labour.  The  uterine  contractions,  unlike  those 
of  ergot,  are  not  tonic  but  clonic.  As  an  oxy- 
tocic, however,  mistletoe  is  less  powerful  than 
ergot.  It  has  been  employed  in  the  treatment 
of  menorrhagia  and  other  varieties  of  uterine 
hcBmorrhage  and  in  amenorrhcea.  It  was  for- 
merly used  to  some  extent  as  a  nervine. 

The  dose  as  an  oxytocic  is  from  -J  to  1  fl. 
drachm  of  the  fluid  extract  repeated  every 
thirty  to  sixty  minutes;  as  a  uterine  hasino- 
static,  a  drachm  may  be  given  every  four  to  six 
hours.  A  tincture  and  the  decoction  have  also 
been  employed.  Taken  in  large  quantities,  the 
preparations  of  mistletoe  produce  vomiting 
and  purging.     A  fatal  case  has  been  reported. 

The  drug  is  of  little  value  in  medicine  and 
has  practically  fallen  into  disuse. 

Charles  Jbwett. 

VITELLTJS.— Yolk  of  egg.    See  Eggs. 

VITIS  ID-SIA.— See  Vaccinium. 

VITRIOL,  BLUE.— See  Cupric 
under  Copper. 

VITRIOL,  GREEN.— See  Iron 
under  Iron  (vol.  i,  page  549). 

VITRIOL,  OIL  OP.— See  Sulphuric  acid. 

VITRIOL,  WHITE.— See  Zinc  sulphate, 
under  Zinc. 

VULNERARIES.— These  are  substances 
which,  applied  to  wounds,  bruises,  etc.,  are 
supposed  to  hasten  the  return  of  the  injured 
parts  to  their  natural  condition.    So  far  as 


open  wounds  are  concerned,  it  is  probable  that 
all  the  vulneraries  that  are  really  eflicient  act 
as  antiseptics  or  germicides ;  the  efiiects  of 
bruises  are  more  or  less  amenable  to  the  action 
of  sorbefacients. 


WAFERS.- These  consist  of  thin,  brittle 
sheets,  square  or  circular,  made  by  pouring  a 
mixture  of  water  and  fine  flour  upon  hot  plates. 
For  use,  a  suitable  piece  is  dipped  into  cold 
water  to  make  it  pliable.  It  is  then  laid  upon 
a  tablespoon,  the  powder  or  other  medicine 
placed  in  it,  and  the  edges  having  been  folded 
over,  the  closed  wafer  is  swallowed.  This 
method  was  formerly  much  in  use,  particularly 
in  domestic  practice  in  Europe,  for  administer- 
ing nauseous  medicines.  Limousin,  of  Paris, 
some  twenty  years  ago,  brought  this  form  of 
administering  medicines  again  into  vogue 
by  the  introduction  of  a  very  convenient  ap- 
paratus and  a  special  form  of  wafer.  The 
latter,  of  which  there  were  several  sizes,  are 
made  of  the  shape  of  small  concave  cups  with 
flat  rims.  One  of  these  wafer-cups  is  laid  in  a 
corresponding  cavity  of  a  frame,  the  requisite 
amount  of  the  substance  is  placed  in  the  wafer, 
and  another  wafer-cup,  the  edges  of  which  have 
just  been  moistened,  is  brought  down  over  the 
former  so  that  the  edges  of  the  two  meet  ex- 
actly, whereupon  they  are  gently  pressed  to- 
gether, thus  causing  the  two  wafers  to  cohere, 
enveloping  the  powder  between  them.  Li- 
mousin's first  apparatus  has  been  somewhat 
improved  upon,  both  by  himself  and  by  others, 
so  that  a  number  of  wafers  may  be  filled  and 
closed  in  one  operation.  When  a  wafer  capsule 
(as  it  maybe  called)  is  to  be  swallowed  it  should 
first  be  dipped  in  water  so  as  to  render  it  soft 
and  flexible. 

A  very  convenient  substitute  for  the  wafer 
is  the  Japanese  usego  paper,  consisting  of 
almost  pure  cellulose  and  having  remarkable 
tenacity.  The  medicinal  substance  is  envel- 
oped in  a  small  piece  of  the  paper  and  rolled 
into  a  sort  of  lozenge  or  elongated  bolus  which 
is  then  dipped  in  water  and  swallowed.  The 
paper  wrapper  is  readily  digested  in  the  stom- 
ach with  the  medicine. — Charles  Rice. 

WAHOO.— See  Euontmus. 

WASHES.— See  Lotions. 

WATER. — The  free  use  of  pure  water  as  a 
beverage  is  of  great  importance  in  therapeutics. 
It  may  even  constitute  the  chief  element  of 
treatment  in  certain  cases  of  disease.  Dr.  Hec- 
tor Maillart,  of  Geneva  (Revue  de  medecine, 
March,  1894),  says  that,  as  the  result  of  his 
study  of  the  subject,  he  feels  convinced  that 
the  treatment  of  typhoid  fever  with  copious 
drinks  may  be  recognised  as  a  deflnite  method. 
In  oi'der  that  the  treatment  may  be  eiBeacious, 
the  patient  should  drink  at  least  from  five  to 
six  quarts  of  water  daily  during  the  whole  fe- 
brile period.  There  is  no  contra-indication  to 
this  treatment ;  feebleness  of  the  heart,  far 
from  contra-indicating  the  drinks,  may  become 
a  special  indication  for  them.    The  results  are 


WATERS,  MINERAL 


362 


a  progressive  lowering  of  the  fever,  disappear- 
ance of  the  dryness  of  the  tongue  and  mouth, 
and  pronounced  sedation  of  all  the  alarming 
nervous,  circulatory,  and  renal  jjhenomena. 
These  results  are  due  to  the  oxidation  of  tox- 
ines  and  refuse  material,  which  are  rendered 
soluble  and  eliminated.  The  oxidation  is 
shown  by  the  formation  of  great  quantities  of 
urea,  and  the  elimination  takes  place  by  the 
skin  and  kidneys  in  the  form  of  profuse  sweat- 
ing and  abundant  diuresis.  This  diuresis  re- 
establishes the  integrity  of  the  renal  filter,  and 
that  results  in  the  rapid  disappearance  of  albu- 
minuria. This  method  of  treatment  has  no 
notable  influence  on  the  course  or  the  duration 
of  the  disease.  No  unpleasant  consequences 
have  been  observed  to  result  from  the  treat- 
ment, either  during  the  fever,  during  conva- 
lescence, or  after  recovery.  The  treatment, 
which  is  very  acceptable  to  the  patient,  is  easi- 
ly carried  out,  even  in  cases  in  which  the  nerv- 
ous disturbances  are  very  decided.  See  also 
under  Antiblennorrhaqics  (vol.  i,  page  105) 
and  the  articles  on  Waters,  Mineral  ;  Hydri- 
ATics,  Baths,  and  Douohes. 

WATERS,  MINERAIi. — Mineral  waters 
is  the  term  used  to  designate  natural  waters 
which  hold  in  solution  different  gaseous  or  min- 
eral substances,  the  proportion  of  these  latter 
constituents  being  such  that  the  waters  maybe 
employed  for  medicinal  purposes.  Such  waters 
may  be  administered  internally  as  beverages, 
or  externally  in  some  of  the  various  forms  of 
baths. 

An  absolutely  pure  water  cannot  be  obtained 
even  by  chemical  processes.  Almost  all  natu- 
ral waters  are  impregnated  with  extraneous 
substances.  Rain  water  contains  organic  mat- 
ter, carbonic  acid  or  other  gases,  and  salts 
which  it  absorbs  in  falling  through  the  atmos- 
phere. Spring  and  artesian-well  waters  are 
likely  to  contain  a  certain  amount  of  gases, 
such  as  carbonic-acid  gas  or  sulphuretted  hy- 
drogen produced  by  the  decomposition  of  or- 
ganic matter  in  the  soil,  as  well  as  a  certain 
amount  of  the  soluble  salts  dissolved  from  the 
strata  between  the  origin  and  source  of  the 
flow ;  it  is  to  be  recalled  that  gases  in  the  water 
will  facilitate  the  solution  of  otherwise  insolu- 
ble substances. 

The  constituents  of  mineral  waters  may  be 
gaseous,  inorganic,  or  organic.  The  following 
substances  have  been  found  in  mineral  waters : 


GASEons. 


Inorganic.  • 


Oxygen. 

Nitrogen. 

Carbonic  oxide. 

Sulphuretted  hydrogen. 

Methane. 

Air. 

'  Ammonium  crenate,  nitrate,  nitrite,  and 
sulphate. 

Aluminum  oxide,    phosphate,    silicate, 
and  sulphate. 

Antimony  teroxide. 

Arsenic,  arsenious  oxide. 

Barium  bicarbonate,  carbonate,  and  sul- 
phate. 

Bromine. 

Cadmium  sulphate. 

Calcium  bicarbonate,  bromide,  chloride, 
crenate.    carbonate,    fluoride,    phos- 
phate, silicate,  oxide,  sulphate,  and 
sulphide. 
,  Cobalt  carbonate  and  sulphate. 


INORQANIC. 


Acids, 

FREE   OR 
COMBINED. 


Copper  carbonate  and  sulphate. 

Fluorine. 

Iodine. 

Iron  bicarbonate,  bisulphate,  carbon- 
ate, crenate,  oxide,  phosphate,  sesqui- 
chloride,  sesquiearbonate,  sesquiox- 
ide,  sulphide,  and  sulphate. 

Lead  carbonate  and  sulphate. 

Lithium  carbonate,  chloride,  bicarbon- 
ate, and  sulphate. 

Magnesium  bicarbonate,  borate,  bro- 
mide, carbonate,  and  chloride. 

Manganese  carbonate,  bromide,  iodide, 
oxide,  and  sulphate. 

Nickel  bicarbonate,  carbonate,  and  sul- 
phate. 

Potassium  bromide,  chloride,  nitrate, 
and  sulphate. 

Phosphorus. 

Silica. 

Sodium  biborate,  bisulphide,  bromide, 
bicarbonate,  carbonate,  chloride,  io- 
dide, metasilicate,  hyposulphite,  ni- 
trate, phosphate,  silicate,  sulphate, 
and  sulphide. 

Strontium  bicarbonate,  carbonate,  and 
sulphate. 

Sulphur. 

Zinc  bicarbonate,  carbonate,  and  sul- 
1     phate. 

Boric. 

Hydrochloric. 

Hydrosulphuric. 

Nitric. 

Phosphoric. 

Silicic. 
_  Sulphuric. 

I  Acetic    acid. 
Butyric      " 
Fo?m?c       " 
Propionic  " 
Infusoria  and  vegetable  matter. 

An  inspection  of  this  list  of  active  or  inactive 
constituents  of  mineral  waters  will  indicate  the 
difficulty  of  classification.  Various  plans  have 
been  proposed  for  a  suitable  scheme  in  which 
to  group  these  watere,  based  on  their  geograph- 
ical distribution,  their  geological  origin,  their 
chemical  constituents,  their  thermal  character- 
istics, or  their  therapeutical  action,  each  of 
which  has  had  its  advocates.  As  the  physician 
is  interested  simply  in  their  remedial  proper- 
ties, the  most  satisfactory  method  for  his  use 
is  one  that  deals  with  the  temperature  and  the 
chemical  constituents  of  the  water.  The  latter 
method  has  its  disadvantages,  however,  as  may 
be  seen  if  we  take,  for  example.  Professor  J.  W. 
Mallet's  analysis  of  the  Rockbridge  Alum 
Springs,  in  which  some  twenty-five  constitu- 
ents are  found  in  the  water.  The  effects  of  the 
oxygen,  nitrogen,  and  carbon  dioxide  may  be 
accounted  for;  the  traces  of  organic  matter, 
calcium  fluoride,  and  cadmium  sulphate  may 
be  ignored  so  far  as  any  influence  they  are  like- 
ly to  exercise  is  concerned,  and  the  preponder- 
ance of  aluminum  sulphate  suggests  that  the 
water  will  possess  the  physiological  properties 
of  that  salt.  But  with  all  there  are  definite 
quantities  of  the  sulphates  of  sodium,  calcium, 
lithium,  magnesium,  potassium,  manganese, 
nickel,  cobalt,  copper,  zinc,  and  iron,  as  well  as 
of  sulphuric  acid,  that  combine  to  give  this 
spring  certain  definite  features,  and  that  may 
have  their  physiological  action,  moderate 
though  it  may  be.  It  is  not  possible  in  the 
case  of  the  Carlsbad  water  to  ignore  the  influ- 
ence of  the  bicarbonate  of  sodium,  which  almost 
equals  in  quantity  the  sulphate  of  sodium. 


363 


WATERS,  MINERAL 


There  are  waters  that  are  known  as  chalybeate 
in  which  the  percentage  of  iron  is  less  than  that 
of  many  of  the  other  ingredients,  yet  their  prin- 
cipal physiological  eflfect  is  due  to  the  iron  salt. 
Other  waters  contain  several  active  ingredi- 
ents, the  physiological  effects  of  each  being 
manifested  when  they  are  administered,  so  that 
they  might  be  included  in  several  classes. 

The  classification  adopted  by  the  better  Ger- 
man authors  on  balneology  has  for  its  purpose 
the  distinction  in  the  therapeutic  properties  of 
the  waters,  though  it  is  necessarily  difficult  to 
distinguish  these  properties,  as,  for  example, 
between  the  alkaline  and  the  alkaline-saline 
waters,  or  between  the  sulphuretted  and  the 
ferruginous  waters.  This  arrangement  in- 
cludes : 

r  1.  Simple  alkaline  waters. 
I.  Alkaline  J  2.  Alkaline  chlorinated  or  muriat- 
waters.    |  ed  waters. 

[  3.  Alkaline-saline  waters. 
II.  Saline  or  chlorinated  waters. 

III.  Sulphur  waters. 

IV,  Ferruginous  waters. 

V.  Earthy,  or  calcareous,  waters. 

VI.  Indifferent  thermal  waters 

The  alkaline  waters  are  those  that  contain 
potash  and  soda  ;  they  are  clear  and  colourless 
and  have  either  little  taste  or  a  salty  taste,  ac- 
cording to  the  quantity  of  salt  that  they  con- 
tain. The  most  important  constituents  of  the 
simple  alkaline  waters  are  sodium  carbonate 
and  carbonic  acid.  When  common  salt  is  pres- 
ent in  the  alkaline  water  in  decided  quantity, 
it  is  called  an  alkaline  chlorinated  water.  And 
if,  in  addition  to  the  alkali,  there  is  sodium  or 
magnesium  sulphate,  the  water  is  alkaline- 
saline.  Alkaline  carbonates,  chlorides,  and  sul- 
phates have  respectively  specific  effects  on  the 
biliary,  gastric,  intestinal,  and  urinary  secre- 
tions. For  example,  an  alkaline  carbonate  in- 
creases the  flow  of  bile,  neutralizes  the  gastric 
juice,  and  renders  the  urine  alkaline.  The 
sulphates  act  more  or  less  powerfully  on  the 
bowels,  and  increase  the  number  of  stools  as 
well  as  the  total  amount  of  faces  voided  in  a 
given  time. 

The  principal  ingredient  of  the  saline  waters 
is  sodium  chloride.  Such  waters  are  clear  and 
their  taste  depends  upon  the  quantity  of  salt 
present ;  if  it  is  below  2  per  cent,  the  water  is 
simply  saline,  but  if  there  is  a  large  quantity 
of  salt  the  water  is  a  brine  that  can  only  be 
used  therapeutically  as  a  bath.  In  some  chlo- 
rinated waters  there  are  definite  proportions  of 
salts  'of  iodine  or  bromine,  and  these  waters 
have  been  called  iodine  or  bromine  waters.  A 
chloride  acts  chiefly  in  increasing  the  quantity 
of  organic  and  inorganic  substances  eliminated 
by  the  kidneys. 

Sulphur  waters  are  those  that  contain  sul- 
phuretted hydrogen. 

Ferruginous,  or  chalybeate,  waters  are  those 
that  contain  definite  quantities  of  some  iron 
salt. 

Earthy,  or  calcareous,  waters  are  those  in 
which  calcium  carbonate  or  sulphate  and  mag- 
nesia are  the  predominant  chemical  ingredi- 
ents. 

Indifferent  thermal  waters  are  those  that 
contain  an  insignificant  quantity  of  mineral 
constituents. 
67 


The  French  balneologists  divided  mineral 
waters  into  the  following  classes : 


I.  Bicarbonated 
waters. 


II.  Chlorinated 
waters. 


in.  Sulphur 
waters. 


IV.  Sulphated 
waters. 


V.  Ferruginous 
waters. 


1.  Sodium  bicarbonate. 
3.  Calcium  bicarbonate. 
3.  Mixed  bicarbonates. 

1.  Sodium  chloride  alone. 

2.  Sodium    chloride   with   bicar- 

bonates. 

3.  Sulphuretted. 

Sulphuretted  hydrogen  with  sodi- 
um salts. 

Sulphuretted  hydrogen  with  cal- 
cium salts. 
Sodium  sulphate. 
Calcium  sulphate. 
Magnesium  sulphate. 
Mixed  sulphates. 
Bicarbonated. 
Sulphated. 
With  manganese  salts. 


The  disadvantage  of  such  a  chemical  classifi- 
cation is  apparent  in  the  association  of  waters 
that  contain  salts  which  act  so  dissimilarly  as 
in  class  IV,  which  includes  waters  that  contain 
sodium  sulphate  and  waters  that  contain  cal- 
cium sulphate. 

Mineral  waters  in  this  article  will  be  consid- 
ered as  hot,  or  thermal,  and  as  cold  waters. 
These  may  be  either  simple,  in  the  case  of 
thermal  waters  and  waters  which  contain  very 
small  percentages  of  mineral  substances;  gase- 
ous, in  consequence  of  the  presence  of  carbon 
dioxide,  or  carburetted.  or  sulphuretted  hydro- 
gen; chlorinated,  in  which  there  is  a  predomi- 
nance of  sodium  chloride  ;  alkaline ;  saline,  in 
which  there  is  sufficient  sodium  or  magnesium 
sulphate  to  produce  the  therapeutical  effect  of 
either  of  those  salts ;  chalybeate,  or  ferrugi- 
nous ;  and  earthy,  or  calcareous. 

In  the  simple  thermal  waters  saline  and 
gaseous  constituents  are  present  in  such  insig- 
nificant proportioiis  that  the  efficacy  of  the 
water  as  a  remedial  agent  is  evidently  due  to 
the  temperature,  which  may  range  from  85°  to 
more  than  110°  P.  The  most  familiar  ex- 
ample of  such  water  is  that  of  the  Hot  Springs 
of  Arkansas,  the  waters  of  which  contain  8'55 
grains  of  solids  to  the  gallon,  almost  4  grains 
of  which  is  calcium  carbonate:  the  tempera- 
ture of  the  water  varies  from  93°  to  157°  P., 
and  if  taken  internally  it  can  only  act,  as  is 
the  case  with  other  waters  of  this  class,  like 
simple  hot  water.  Drinking  the  water  from 
simple  thermal  mineral  springs  is  a  means  of 
effecting  gastric  lavage ;  the  secretion  of  saliva, 
gastric  juice,  bile,  pancreatic  juice,  and  urine 
is  increased,  with  the  consequent  stimulation 
of  metabolism  and  the  excretion  of  effete  prod- 
ucts from  the  tissues.  The  warm  water  is 
more  easily  absorbed  from  the  stomach  than 
cold  water  is,  because  the  temperature  of  the 
latter  must  be  raised  first  to  the  temperature 
of  the  body ;  and  such  water  gently  promotes 
the  peristaltic  action  of  the  bowels. 

The  use  of  warm  and  hot  water  in  baths  has 
been  described  elsewhere  in  this  work.  These 
thermal  waters  were  called  nerve-baths  by  Pro- 
fessor Romberg,  because  they  lessened  morbid 
irritability  of  the  cutaneous  nerves. 

The  internal  administration  of  simple  ther- 
mal water  is  more  useful  at  resorts  than  at 
home,  because  the  patients  who  visit  them  are 


WATERS,  MINERAL 


364 


more  careful  in  their  attention  "to  the  details 
of  the  treatment,  there  is  likely  to  be  less  in- 
fraction of  the  rules  which  are  laid  down  for 
dietetic  observance,  more  exercise  is  taken,  and 
there  are  the  associated  advantages  of  change 
of  air,  of  environment,  and  of  mental  impres- 
sions. 

In  prolonged  and  irritable  phases  of  chronic 
inflammation  of  the  throat,  the  stomach,  or  the 
intestines,  resort  to  such  a  spring  is  likely  to 
redound  to  the  patient's  advantage.  In  chronic 
constipation  associated  with  deficiency  of  the 
hepatic  or    intestinal    secretions,   in   chronic 


are  many  more  such  springs  in  which  the  wa- 
ters contain  a  larger  amount  of  solids;  but  it 
has  seemed  to  the  writer  that  this  class  should 
be  limited  to  springs  in  which  the  water  does 
not  contain  more  than  a  drachm  of  solids  in 
each  gallon,  and  that  to  include  waters  con- 
taining several  hundred  grains  of  solids  is  to 
ignore  the  possible  medicinal  effect  of  some  of 
the  constituent  substances.  For  some  of  the 
data  contained  in  this  table  and  in  subsequent 
lists,  the  writer  is  indebted  to  Leichtenstern's 
article  on  Balneotherapeutics  in  von  Ziemssen's 
Handbook  of  General  Therapeutics. 


Simple  Thermal  Speings. 


Monroe  Hot  Spring,  near  Prescott 

Eio  San  Francisco  Hot  Springs 

Hot  Springs 

Agua  Caliente,  San  Diego  Co 

Calistoga  Hot  Spring,  Napa  Co 

Hot  Spring,  Paoha  Island,  Mono  Lake 

Mono  Basin  Warm  Spring 

Paso  de  Robles  (suli)huretted),  San  Luis  Obispo  Co. . 

Caiion  City  Hot  Spring 

Bruneau  Hot  Springs,  Owyhee  Co 

Given's  Hot  Springs,  Owyhee  Co 

Emigrant  Gulch  Warm  Springs,  Gallatin  Co 

Helena  Hot  Spring,  Helena 

Livingston  Warm  Springs  

Matthew's  Warm  Springs 

Hot  Springs,  Churchill  Co 

Ward's  Hot  Springs,  Humboldt  Co 

Jemes  Hot  Springs,  Bernalillo  Co 

Warm  Springs 

Hot  Springs,  Bath  Co 


Gastein 

Johannisbad 

Neuhaus  (Styria) 

Romerbad 

Teplitz 

Tnirer 

Tobelbad 

Villach  (Styria) 

Bath 

PlombiSres  (Vosges) 

Mont  Dore  (Auvergne) 

Schlangenbad  (Nassau) 

Warmbrunn  (Silesia) 

Wildbad  (Black  Forest) 

Bormio 

Leuk  (Canton  Wallis) 

Pf asters  (Canton  St.  Gallien). , 


Solids,  p«r 
gallon. 


0-66 

8-55 

89-3 

87-50 

0-29 

2-08 

8 -07-1? -53 

0-40 


0-33 
0-62 
0-75 
0-69 
2-49 
1-19 
0-24 
83-87 
0-59-33-36 

11-35 
0-75 
1-03 
0-75 
2  ,32 
0-75 
1-95 

7-14 

0-92 
5-96 
1-01 
1-65 
8-08 
3.35 
6-95 
101 


Country  or  State. 


Arizona. 

Arizona. 
Arkansas. 
California. 
California. 
California. 
California. 
California. 
Colorado. 
Idaho. 
Idaho. 
Montana. 
Montana. 
Montana. 
Montana. 

Nevada. 

Nevada. 

New  Mexico. 

North  Carolina. 

"Virginia. 

Austria. 

Austria. 

Austria. 

Austria. 

Austria. 

Austria. 

Austria. 

Austria. 

England. 

France. 

France. 

Germany. 

Germany. 

Germany. 

Italy.      ' 

Switzerland. 

Switzerland. 


Elevatjon, 
in  feet. 


5,316 

6,666 

718 

735 

3:31 


6,730 
5,412 


4,396 
4,150 
4,485 


1,325 


3,490 

1,955 

1,200 

730 

700 

690 

1,070 

7,000 


1,400 
3,430 
925 
1,100 
1,323 
4,825 
4,356 
2,130 


Temperature  of 
spriogB,  Fahr. 


150-0°-I60-0° 

187-0°-130-0° 

93-0''-157-0'> 

100-4° 

100-0''-195-0° 

llOO" 

85-0°-  90-0° 

112-0°-122-0° 

104-0° 

105-0° 

98-0° 

103-0° 

122-0°-141-0° 

104-0° 

114-0°-123-0° 

168-0°-187-0° 

190-0°-300-0° 

94-0°-168-0° 

93-0°-llT0° 

60-0°-1100° 

95-0»-1.38-4° 
84-2° 
95-0° 


95-0°- 


118-4° 

-102-2° 

83-4° 

84-0° 

107-6°-116-6° 

66-0°-158-(l° 

107-6° 

82-0°-  92-0° 

96-8°-107-6° 

91-4°-  98-6° 

100-4° 

92-0°-123-0° 

98-6° 


rheumatism,  in  gout,  and  in  neurasthenia,  this 
treatment  will  prove  useful.  The  external 
and  internal  use  of  such  waters  will  benefit 
ulcers  of  the  skin  and  gunshot  wowids  that 
suppurate  chronically.  Old  cerebral,  spinal, 
and  peripheral  paralyses  are  often  benefited, 
if  only  by  the  improved  condition  of  the  pa- 
tient, while  paralysis  of  toxic  origin,  especially 
that  due  to  lead,  is  usually  rapidly  improved 
by  the  external  and  internal  use  of  thermal 
waters.  Hysteria,  insomnia,  neurasthenia, 
neuralgia,  and  peripheral  neuritis  may  be 
treated  beneficially  by  the  combined  use  of 
such  waters.  The  employment  of  these  waters 
in  the  earlier  stages  of  Bright's  disease,  in 
catarrh  of  the  pelvis  of  the  kidney,  and  in  cys- 
tic catarrh  will  aid  in  preventing  self-intoxica- 
tion and  be  likely  to  favourably  influence  the 
affected  tissues. 

The  accompanying  list  will  show  the  situa- 
tion of  a  number  of  thermal  springs.    There 


Carbonated  waters  are  those  that  contain 
carbonic  acid,  and  that  gas  is  nsually  associa- 
ted with  other  chemical  ingredients.  Admin- 
istered internally,  carbonic  acid  is  a  stimulant 
to  the  mucous  membrane  of  the  stomach  and 
intestines,  probably  in  consequence  of  excita- 
tion of  the  motor  nerves,  although  it  has  a 
sedative  effect  on  the  sensory  nerves  when  ad- 
ministered in  small  quantities.  It  also  causes 
increased  secretion  of  urine.  Large  quantities 
of  carbonated  water  have  produced  gastric 
distention,  eructations,  cardiac  irritability,  and 
pulmonary  and  cerebral  hyperjemia.  A  larger 
quantity  of  carbonic  acid  is  tolerated  if  the 
water  is  cold  than  if  it  is  warm.  In  gastric 
and  intestinal  atony  a  simple  carbonated 
water  will  frequently  afford  marked  relief.  In 
nausea  such  waters  are  applicable ;  and  in  the 
nausea  associated  with  malarial  and  other 
fevers  the  free  use  of  carbonated  waters  is  in- 
dicated.   Where  a  natural  water  is  inaccessible. 


365 


WATERS,   MINERAL 


the  separate  portions  of  a  sekllitz  powder  may 
be  dissolved  in  two  glasses,  and  a  tablespoon- 
lul  of  eaoli  solution  given  in  succession;  the 
small  quantity  of  carbonic-acid  gas  evolved  in 
the  stomach  is  very  agreeable  to  the  patient. 
In  certain  forms  of  vesical  or  prostatic  irrita- 
bility the  frequency  of  micturition  is  lessened 
by  using  these  waters.  [For  the  use  of  carbon- 
ated waters  in  the  Sohott  treatment  of  chronic 
heart  diseases,  see  Baths  (supplement)]. 

Chlorinated  waters,  which  are  also  known  as 
muriated  or  muriated  saline  waters,  are  those 
in  which  sodium  chloride  is  the  principal  solid 
constituent,  though  it  is  frequently  associated 
with  other  chloriae  salts  and  gases.  When  the 
chlorinated  waters  contain  iodine  or  bromine 
they  are  called  iodine  or  bromine  salt,  or 
chlorinated,  waters;  if  they  contain  such 
earthy  salts  as  calcium  or  magnesium  sulphate 
or  carbonate  they  are  termed  earthy  salt,  or 
chlorinated,  waters;  if  they  contain  sodium 
or  magnesium  sulphate  they  are  known  as 
saline  chlorinated  waters;  if  they  are  distin- 
guished by  the  presence  of  a  definite  quantity 
of  an  iron  salt  they  are  called  chalybeate  chlo- 
rinated waters :  and  if  there  is  a  large  volume 
of  carbonic  acid  they  are  called  acidulous 
chlorinated  waters. 

Sodium  chloride  plays  an  important  part  in 
the  animal  economy,  and  it  forms  the  greater 
portion  of  the  soluble  constituents  of  the  ash 
of  all  animal  substances.  The  gastric  juice  is 
normally  rich  in  sodium  chloride,  which  is  one 
of  the  sources  of  the  hydrochloric  acid  in  the 
stomach.  It  promotes  digestion  by  facilitating 
the  solution  of  albumin  and  casein,  and  plays 
an  important  role  in  furthering  the  processes 
of  absorption  and  secretion,  in  consequence  of 
its  stimulating  effect  on  the  gastric  and  intes- 
tinal glands. 

The  experiments  of  Braun,  Griitzner,  and 
Boas  have  shown  that  the  addition  of  sodium 
chloride  to  the  blood  increases  the  secretion  of 
gastric  juice,  and  whatever  quantity,  in  mod- 
eration, is  in  excess  of  the  needs  of  the  body  is 
excreted  chiefly  by  the  kidneys.  In  moderate 
quantities  it  is  quickly  absorbed  from  the 
stomach,  and  Buchheim  showed  that  within 
six  hours  it  was  excreted  in  the  urine.  As  it 
is  essential  for  the  formation  as  well  as  the 
disintegration  of  cells,  it  stimulates  not  only 
the  progressive,  but  also  the  retrogressive  tis- 
sue changes  of  the  animal  orgailism.  When  a 
moderate  quantity  of  sodium  chloride  is  intro- 
duced into  the  stomach  it  stimulates  the  secre- 
tion of  the  gastric  juice,  and  excites  increased 
peristaltic  action  in  that  viscus,  which  favours 
the  passage  of  the  gastric  contents  into  the  in- 
testinal canal.  The  peristaltic  action  of  the 
intestines  also  is  increased  by  the  salt. 

Bischoff,  Kaupp,  and  Volt  have  proved  that 
there  is  an  increased  excretion  of  urea  after 
the  administration  of  moderate  quantities  of 
sodium  chloride.  This  is  apparently  due  to 
the  improvement  in  metabolism,  the  serum 
seeming  to  carry  away  albuminates,  and  favour 
their  transformation  into  excretable  products. 

Externally,  chlorinated  waters  in  baths  in- 
crease the  excretion  of  urea  and  decrease  that 
of  uric  acid  and  that  of  phosphates.    There  is 


an  increased  consumption  of  oxygen  and  there 
is  increased  excretion  of  carbonic  acid.  The 
skin  is  macerated  and  cleansed,  its  functions 
are  stimulated  in  consequence  of  the  action  of 
the  sodium  chloride  and  the  usually  associated 
carbonic  acid  on  the  peripheral  nerves.  Such 
waters  are  more  eflBcacious  if  warm  than  if 
cold.  Various  theoretical  influences  have  been 
ascribed  to  the  use  of  baths  of  such  water,  but 
more  exact  observations  are  needed  to  deter- 
mine the  entire  scope  of  their  therapeutic 
efficacy. 

The  action  of  the  chlorinated  waters  is  in- 
creased if  either  carbonic  acid  or  sulphuretted- 
hydrogen  gas  is  present.  As  water  will  take 
up  its  own  volume  of  carbonic-acid  gas  under 
pressure,  the  amount  of  that  gas  in  natural 
mineral  water  differs  according  to  the  propor- 
tion of  that  gas  forced  into  the  source  whence 
the  water  comes;  the  gas  effervesces  when  the 
water  escapes  from  the  spring,  and  unless  the 
liquid  is  kept  in  firmly  closed  bottles  it  soon 
loses  its  natural  gas.  The  carbonated  waters 
are  usually  bright,  sparkling  liquids  which  pos- 
sess an  agreeable  aeidnlous  taste.  These  char- 
acteristics make  such  waters  refreshing  drinks 
in  febrile  and  other  diseases ;  the  sensitive 
nerves  of  the  stomach  seem  to  be  quieted  by 
the  influence  of  the  gas,  there  is  some  stimula- 
tion of  the  peristaltic  action  of  the  stomach 
and  intestines,  and  the  action  of  the  kidneys  is 
increased. 

The  presence  of  hydrogen  sulphide  increases 
the  palatability  as  well  as  the  therapeutic  use- 
fulness of  saline  waters,  as  is  shown  by  the 
Kentucky  Blue  Lick  water,  in  which  516  of  the 
660  grains  of  solids  in  each  gallon  are  sodium 
chloride. 

When  chlorinated  waters  are  warm  or  hot 
they  are  more  quickly  absorbed,  and  thus  may 
exercise  an  effect  that  is  not  obtained  by  the 
slow  and  imperfect  absorption  of  cold  water. 

Boas  observed  the  changes  in  the  secretion 
of  gastric  juice  during  the  administration  of 
warm  chlorinated  waters,  and  noticed  that 
after  from  three  to  four  weeks  of  this  treat- 
ment there  was  a  decided  improvement  in  the 
secretion  of  gastric  juice  and  a  coincident  ces- 
sation of  the  symptoms  in  chronic  gastritis. 
The  chlorinated  waters  are  indicated  in  all 
cases  of  gastric  catarrh  in  which  there  is  less- 
ening of  the  secretion,  either  with  or  without 
the  production  of  mucus.  Such  waters  are 
useful  for  patients  in  whom  there  is  a  defi- 
ciency of  the  gastric  and  intestinal  secretions. 
In  gouty  and  rheumatic  conditions  the  use  of 
such  waters,  by  improving  metabolism,  furthers 
the  excretion  of  effete  pi'oducts,  and  if  begun 
in  time  is  likely  to  delay  the  degenerative 
changes  incident  to  those  affections.  In  some 
forms  of  ancemia  in  which  there  is  rapid  de- 
crease in  the  proportion  of  red  blood-corpus- 
cles, marked  improvement  will  follow  tho 
external  and  internal  employment  of  thermal 
chlorinated  waters.  Hepatic  congestion  of  a 
chronic  type,  with  the  associated  aberration  in 
the  functions  of  the  liver  and  the  usually  at- 
tendant constipation,  is  benefited  by  this  treat- 
ment. In  certain  cases  of  neurasthenia  in 
which  there  is  self-intoxication  these  waters 


WATERS,  MINERAL 


366 


will  be  useful  and  are  to  be  preferred  to  the 
saline  waters  which  contain  the  sodium  and 
magnesium  salts ;  the  latter  are  slowly  ab- 
sorbed, are  likely  to  cause  gastric  distress,  and, 
by  saturatmg  the  blood  with  neutral  salts, 
which  are  improperly  or  slowly  excreted, 
further  involve  the  metabolic  functions  and 
thus  contribute  to  do  more  injury  to  the  nerv- 
ous system.  Hypertrophy  of  the  spleen,  due  to 
paludism,  may  be  reduced  by  the  use  of  this 
class  of  waters  in  conjunction  with  other  treat- 
ment. Bronchial  catarrh,  associated  with  gen- 
eral asthenia,  is  bettered,  if  not  cured,  by  a 
course  of  chlorinated  waters,  internally  and 
externally.  The  improvement  in  the  general 
nutrition  produced  by  such  waters  may  explain 
the  benefit  that  has  followed  their  administra- 
tion in  caries,  necrosis,  and  rhachitis. 

The  principal  springs  of  this  class  are  the 
following,  though  in  this  table  the  difficulty  of 
classification  has  been  encountered,  because  a 
number  of  the  chlorinated  waters  are  also  sul- 
phuretted and  owe  some  of  their  properties  to 
the  presence  of  hydrogen  sulphide : 


alkalies  in  small  or  moderate  doses  increases 
the  secretion  of  gastric  juice,  and  these  alkaline 
waters  may  be  administered  for  that  purpose ; 
large  doses  of  the  salt  impair  digestion  and 
diminish  appetite  and  nutrition. 

The  salt  does  decrease  the  proportion  of 
solids  and  increase  the  fluids  in  the  bile,  and 
it  makes  the  urine  distinctly  alkaline,  in  con- 
sequence of  the  neutralization  of  the  sodium 
phosphate.  The  best  effects  of  the  drug  may 
be  obtained  by  its  prolonged  administration  in 
small  doses,  rather  than  by  the  use  of  large 
doses.  Consequently  the  value  of  alkaline  wa- 
ters is  apparent,  because  they  are  not  likely  to 
be  taken  in  such  large  quantities  or  of  such 
strength  that  the  undesirable  effects  of  the 
sodium  salt  will  be  manifested.  In  the  case  of 
the  chlorinated  alkaline  waters  the  effects  of 
both  of  the  sodium  salts  are  obtained,  and  these 
waters  are  best  administered  when  it  is  neces- 
sary to  improve  the  blood  or  to  avoid  emacia- 
tion. 

The  alkaline  waters  are  used  in  the  treatment 
of  those  forms  of  dyspepsia  associated  with 


NAME  OF  SPRING. 


lola  Mineral  Well,  Alien  Co 

St.  Clair  Mineral  Spring 

Ballston  Spa,  Saratoga  Co 

Excelsior  Spring:,  Syracuse 

Saratoga  Springs,  Saratoga 

Aurora  Saline  Springs,  Marion  Co. 

Hall  (near  Steyer) 

laohl 

St.  Catharine's  Wells,  Ontario 

Bourbonne  les  Bains 

Neuhaus,  Bavaria 

Soden,  Nassau 

Kreuznach,  Valley  of  Nahe 

Kissingen,  Bavaria 

Nauheitn,  Wetterau 

Diirkheim,  Bavaria 

Miinster  am  Stein 

Pyrmont,  Hanover 

Connstadt,  Wiirtemberg 

Wiesbaden,  Nassau 

Salzbrunn,  Bavaria 

Baden-Baden 


Kansas. 

Michigan. 
New  York. 
New  York. 
New  York. 
Oregon. 

Austria. 

Austria. 

Canada. 

France. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 


ElevatioD, 
in  feet. 


310 
403 
S65 
21S 

1,064 

1,574 


T60 
1,200 
440 
3.30 
590 
450 
377 


400 
600 
323 
1,200 
616 


Teoipetature. 


49°- 

,52° 

4K° 

49°- 

51° 

57° 

■fifl' 

130°- 

150° 

05° 

K6° 

60°- 

85° 

fi9°- 

96° 

55°- 

H0° 

86° 

60°-  70° 

142°-166° 

46° 

140»-154° 


Solids,  In 
gallons. 


1,100-27 

628-37 

247-1,233 

668-24 

268-991 

861-62 

800-9 


2,951-68 
445-11 
757-2 
760 


56-8 


616 


Carbonated  ;  980-5   gr.   so 

dium  chloride.- 
405-53  gr.  sodium  chloride. 
Carbonated  ;  ferruginous. 
584-53  gr.  sodium  chloride. 
Carbonated ;  calcic. 


Carbonated  ;  iodine  and  bro- 
mine. 

Calcic. 


Carbonated. 

Carbonated. 
Carbonated. 
Carbonated. 

Carbonated. 
Carbonated. 


The  alkaline  waters  are  those  that  contain  a 
large  proportion  of  sodium  carbonate,  whicli  is 
usually  as.sociated  with  a  more  or  less  carbonic 
acid.  In  the  event  of  the  carbonic  acid  being 
present  in  a  fairly  large  percentage,  the  water 
is  known  as  acidulous  alkaline ;  when  the  so- 
dium carbonate  is  associated  with  sodium  chlo- 
ride it  is  called  a  chlorinated  alkaline  water ; 
and  when  sodium  or  magnesium  sulphate  is 
present  in  sufficient  quantity  to  produce  their 
characteristic  effects  the  water  is  known  as  an 
alkaline-saline  water. 

Gradeau  injected  large  quantities  of  sodium 
carbonate  into  the  blood-vessels  of  a  dog,  and 
Miinoh  has  administered  large  quantities  of 
that  salt  to  a  man,  but  in  each  series  of  experi- 
ments the  results  were  negative.  The  acids  of 
the  gastric  juice  decompose  sodium  carbonate, 
setting  carbonic  acid  free,  and  forming  sodium 
chloride,  and,  in  certain  fermentative  condi- 
tions, sodium  acetate,  butyrate,  and  lactate.. 
Experiments  have  shown  that  the  ingestion  of 


hyperacidity,  and  in  phases  of  gastric  catarrh 
in  which  large  quantities  of  mucus  are  secreted, 
and  the  ingestion  of  the  water  before  breakfast 
loosens  the  mucus  as  in  gastric  lavage.  In  all 
gastropathies  in  which  there  is  hyperacidity, 
and  in  gastric  dilatation,  alkaline  waters  are 
contra-indicated.  Cases  in  which  analysis  of 
the  gastric  juice  after  a  test  meal  shows  that 
there  is  a  large  quantity  of  acid  should  be 
treated  with  the  stronger  alkaline  waters;  if 
gastric  lavage  and  stimulation  are  desired,  the 
chlorinated  alkaline  waters  are  most  suitable ; 
and  where  gastric  and  hepatic  torpidity  are 
associated,  the  alkaline  saline  waters  are  most 
efficacious. 

As  sodium  bicarbonate  acts  more  rapidly  as 
a  diuretic  than  sodium  chloride,  and  in  small 
doses  it  seems  to  be  followed  by  a  greater  ex- 
cretion of  the  retrogressive  products  of  metab- 
olism of  the  uropoietic  apparatus,  alkaline 
waters  are  indicated  in  pyelitis,  ureteritis,  and 
cystitis.     The  urine  becomes  alkaline  and  is 


367 


WATERS,   MINERAL 


less  irritating,  the  catarrhal  exudation  becomes 
thinner  and  is  not  retained,  and  the  condition 
of  the  affected  mucous  membranes  is  improved. 

These  waters  are  useful  for  renal  or  eystic 
calculus  or  the  uric-acid  diathesis,  the  water 
and  its  salts  furthering  the  oxidation  of  uric 
acid  and  having  a  certain  solvent  influence  on 
formations  of  this  substance.  The  use  of  the 
water  in  cases  of  calculi  of  calcium  phosphate 
or  carbonate  is  not  justified  by  chemical  or 
physiological  facts. 

The  value  of  these  waters  in  gout  is  due  to 
-  the  effect  of  copious  draughts  of  water  with 
the  contained  salts  on  the  processes  of  metab- 
olism. In  such  conditions  they  are  rarely  so 
useful  as  the  saline  waters,  though  a  course  of 
the  latter  may  be  advantageously  followed  by 
a  course  of  alkaline  waters.  Headache  and 
other  conditions  associated  with  the  uric-acid 
diathesis  are  benefited  by  the  use  of  alkaline 
waters. 

Sir  William  Roberts  has  referred  to  the  fact 
that  a  considerable  number  of  the  springs  to 
which  gouty  patients  resort  are  strongly  im- 


is  either  to  provoke  a  downright  attack  of 
gout,  or  to  aggravate  the  .symptoms  under 
which  he  was  suffering.  This  has  been  a 
common  experience  at  spas,  and  the  patients 
have  been  comforted  with  the  assurance  that 
this  preliminary  storm  was  a  necessary  prelude 
to  the  amendment  that  was  to  follow.  In  all 
likelihood  the  gouty  exacerbation  is  due  to  the 
precipitation  of  the  urates  floating  in  the  blood 
and  lymph  into  the  structure  of  the  joint.  Dr. 
Roberts  advises  that  gouty  persons  should 
either  entirely  avoid  springs  that  owe  their 
activity  to  sodium  salts,  or  should  use  them 
very  sparingly:  he  considers  that  it  is  diflicult 
to  believe  that  they  can  do  any  direct  good, 
and  easy  to  believe  that  they  can  do  direct 
harm. 

Chlorinated  alkaline  waters  have  proved  to 
be  very  useful  in  bronchial  catarrh,  and  in 
acute  and  chronic  pharyngitis  and  laryngitis. 

The  following  table  gives  a  list  of  some  of 
the  more  important  alkaline  springs,  and  the 
proportion  in  a  thousand  of  the  more  impor- 
tant solid  and  gaseous  constituents  : 


NAME  OF  SPRING. 


Adams  Spring,  Lake  Co 

.SStna  Spring,  Napa  Co 

California  Seltzer  Spring 

Litton's  Seltzer  Spring 

Vichy  Springs,  New  Almaden. 

Geyser  Spa,  Sonoma  Co 

Highland  Springs,  Lake  Co. . . 

Manitou  Springs 

ApoUinaris  Spring,  Mill  Creek 

Eohitsoh  (Styria) 

Radein  (Styria)  —   

Giesshttbel  (Bohemia) 

Chaudes-Aigues 

Mont-d'Or 

Neris 

Vichy 

Vals 

Le  Boulou 

La  Bourboule 

Royat 

Vic-sur-cere 

Szczawnica 

Fachingen  (Nassau) 

Fellathalquellen  (lUyria) 

Bilin  (Bohemia) 

Obersalzbrunn  (Silesia) 

ApoUinaris 

Geilnau 

Ems 

Weilbach 

Selters 


California. 


California. 
California. 

California. 
California. 
California. 
California. 

Colorado. 

Montana. 

Austria. 
Austria. 
Austria. 
France. 
France. 
France. 
France. 
France. 
France. 
France. 

France. 

France. 

Gallicia. 
Germany. 

Germany. 
Germany. 
Germany. 
(Germany. 
Germany. 
Germany. 
Germany. 
Germany. 


Temperature. 


200-0° 

60-82° 

43°-60° 

40-0° 

55-4° 

53-6° 

60-0° 

68°-180° 

106°-108° 

114<'-12B° 

58-6°-100° 

56- 4° 

eo°-68° 

54°-125° 
66°-96° 


61-8° 
60  0° 

46-4° 
53-6° 
44-6° 
69-8° 
500° 
96°-116° 
53  6° 
60-8° 


]l-6 
80 

90 
31-0 
30 
10-8-( 
016-1-! 
0-98 


Sodium  bi- 
carbonate. 


8-6 

4-3 

1-2 
27-47 

0-5 
24 -.38 
40-5-0 

7-1 
141-75 

1-86 

1-3 

124-36 

8-4 
3  6 

4-2 
4-2 
2-4 
1-2 
1-0 
1-3-2-0 
1-3 
1-2 


Sodlnin 
chloride. 


0-6 


4-5 
2-5 


50 

1-5 
OOI-O-IO 
0-13-0-47 

0.37 

0-3 
0-6 


3-67 

0-3 
10.39 

0-5 

01 
49-55 

3-15 

1-7 

90.34 

4-6 
0-6 

0-2 
0-3 
0-1 
0-4 

6-9-i-6 

1-2 
2-2 


0-5 


019-0-51 
0-94 


0-2 
'2-60' 


Sodium 
Bulpbate. 


26-68 
0-8 
0-2 
Trace. 
0-30 

0-1 

41-58 


0-5 
0-8 
0-4 
0-3 


0-3 


carbonic 
acid. 


1,315 


251 
Abun- 
dant. 

180 


348 

879 

1,537 


460-5S2 
1,039 
360 
Abun- 
dant. 
379 


711 
945 

609 
1,337 

680 

1,600 

1.468 

653-59'; 

151 
1,149 


199-48  gr.  solids  to 
gal.  ;  carbonated 
(acidulous). 

136  gr.  per  gal. 

186  gr.  per  gal. 

228-69  gr,  per  gal. 
433-64  gr,  per  gal. 
67-12  gr,  per  gal, 
73-103  gr,  per  gal. 

14-43  gr.  per  gal. 


Chalybeate. 


Chalybeate. 

Arseniuretted, 

chlorinated. 
Arseniuretted, 

chlorinated. 
Arseniuretted, 

chlorinated,  cold. 
Chlorinated, 
301-6    gr,  to    gal. ; 

chalybeate. 
Chalybeate. 


Chlorinated. 
Lithia. 


pregnated  with  the  salts  of  sodium,  and  to  the 
fact  that  it  has  been  conclusively  demonstrated 
that  all  the  sodium  salts  act  adversely  on  the 
solubility  of  sodium  bi-urate,  and  hasten  its 
precipitation.  It  may  be  inferred  that  the  in- 
troduction of  these  salts  into  the  circulation 
must  tend  to  favour  the  occurrence  of  uratic 
depositions  in  the  body;  therefore  it  is  not 
surprising  to  learn  that  not  infrequently  the 
first  effect  of  these  waters  on  a  gouty  patient 


Sulphated,  or  bitter,  waters  are  those  saline 
waters  in  which  there  is  a  large  proportion  of 
sodium  or  of  magnesium  sulphate  or  of  both 
these  salts.  When  the  principal  constituents 
are  the  salts  mentioned  these  waters  have  been 
called  simple  sulphated,  or  bitter,  waters ;  when 
they  are  combined  with  sodium  carbonate,  so- 
dium chloride,  and  other  salts,  they  are  known  ' 
as  alkaline  sulphated  waters. 

Neither  magnesium  nor  sodium  sulphate  is 


WATERS,  MINERAL 


368 


a  normal  constituent  of  the  organism,  and, 
while  their  action  has  been  described  in  the 
sections  devoted  to  those  substances,  some  re- 
marlis  may  be  pertinent  here.  Altiiough  the 
nauseous  taste  of  sodium  sulphate  has  inter- 
fered with  the  general  employment  of  that 
drug,  it  is  less  irritating  than  magnesium  sul- 
phate, and  is  to  be  preferred  to  the  latter  salt 
in  many  instances.  Braun  is  authority  for  the 
statement  that  the  irritating  effect  of  mag- 
nesium sulphate  on  the  mucous  membrane  of 
the  stomach  is  about  fifty  per  cent,  greater 
than  that  of  sodium  sulphate. 

Buohheim's  investigations  have  shown  that 
in  the  intestinal  canal  the  potassium  salts  take 
a  certain  quantity  of  sulphuric  acid  from  these 
sulphates,  the  salts  being  reduced  to  sulphides, 
which  are  decomposed  by  the  acids  of  the  in- 
testinal canal,  with  the  generation  of  hydro- 
sulphuric  acid.  In  general,  these  sulphates 
act  by  increasing  the  fluids  of  the  intestinal 
canal. 

One  of  the  most  important  uses  of  the  waters 
of  this  class  is  for  the  treatment  of  the  various 
disorders  of  the  stomach.  The  researches  of 
Jaworski  on  the  effects  of  Carlsbad  water  have 
shown  that,  if  it  is  taken  in  small  quantities 
and  for  a  short  time,  it  stimulates  the  gastric 
secretion,  but,  if  administered  for  a  long  time, 
it  lessens  and  perhaps  stops  that  secretion. 
Boas  has  stated  that  its  prolonged  use  will 
cause  atrophy  of  the  glandular  parenchyma  of 
the  stomach.  Spitzer  found  that  these  waters 
increased  the  motor  power  of  the  stomach  and 
the  secretion  of  pepsin,  but  checked  an  excess- 
ive elimination  of  hydrochloric  acid. 

Ewald's  experience  has  been  that  the  alka- 
line sulphated  waters  have  such  a  high  per- 
centage of  alkali  that  they  act  as  antacids  in 
conditions  of  gastric  hyperacidity.  While  the 
simple  mechanical  action  of  gastric  lavage  is 
incidental  to  the  use  of  almost  all  mineral 
waters,  the  waters  under  consideration  have  a 
further  action  on  the  liver  and  intestines. 
Cordes  has  called  attention  to  the  fact  that 
such  waters,  when  given  to  nervous  or  anaemic 
persons,  may  cause  an  increase  in  the  irritation 
and  depression ;  and  Ewald  adds  an  emphatic 
protest  against  the  custom  of  sending  persons 
so  afflicted  to  springs  where  the  water  contains 
large  quantities  of  sodium  sulphate,  because 
the  waters  operate  badly  in  every  case.  Per- 
sons affected  with  pronounced  neuroses  should 
not  be  sent  to  such  spas  or  treated  with  such 
waters,  because  of  the  reflexes  that  proceed 
from  the  stomach  and  intestines. 

In  hyperacidity  or  increased  secretion  of 
gastric  juice  these  waters  are  likely  to  prove 
beneficial,  and  it  is  on  account  of  the  existence 
of  the  flrst-named  condition  with  gastric  ulcer 
that  these  waters  are  useful  in  the  treatment 
of  that  disease,  as  the  water  not  only  neutral- 
izes the  acidity  but  lessens  the  secretion  of  the 
gistric  juice.  The  sulphated  waters  are  indi- 
cated in  those  gastropathies  that  complicate 
and  are  due  to  disorders  of  the  liver  and  intes- 
tines. 

Simple  chronic  intestinal  catarrh  is  often 
benefited  by  the  use  of  a  sodium-sulphate  wa- 
ter, though  in  aiding  in  the  removal  of  effete 


matter  they  may  interfere  in  the  final  diges- 
tion of  nutritious  substances. 

In  hepatic  engorgement,  jaundice  due  to  ob- 
structions, and  hepatic  cirrhosis  the  waters 
containing  sodium  sulphate  are  very  useful. 
The  obstruction  to  the  circulation  in  the  por- 
tal vein  reacts  on  all  the  veins  of  the  intesti- 
nal tract,  and  the  engorged  capillaries  are 
relieved  by  the  exosmosis  induced  by  the  water. 
With  an  improvement  in  the  local  circulation 
there  is  improvement  in  the  general  nutrition 
of  the  affected  region.  Catarrh  of  the  duode- 
num and  of  the  gait  bladder  and  duct  are  bene- 
fited in  consequence  of  the  depletion  of  the 
engorged  intestinal  vessels  and  mucous  mem- 
brane and  the  removal  of  the  mucus.  Gall- 
stones are  passed  after  a  more  or  less  prolonged 
course  of  saline  waters. 

Corpulence  has  been  successfully  treated  with 
saline  waters,  but  no  small  part  of  the  benefit 
attending  their  use  is  due  to  the  rigorous  di- 
etary regimen,  including  the  abstinence  from 
starchy  and  fatty  foods  and  alcoholic  or  malt 
beverages.  Too  often  the  benefit  derived  from 
a  course  of  the  waters  is  lost  by  the  patient's 
resuming  the  habits  of  living  which  originally 
tended  to  produce  the  corpulence.  Duiing  the 
use  of  the  waters  there  is  an  increased  elimina- 
tion of  proteid  matters  and  fats  by  the  bowels, 
and  a  diminution  in  the  phosphoric  and  sul- 
phuric acids  and  the  chlorides  and  an  increase 
of  urea  in  the  urine.  In  such  conditions  the 
use  of  the  treatment  should  be  indicated  and 
supervised  by  a  physician. 

Diabetes  due  to  defective  metabolism  of  the 
carbohydrates  may  be  benefited  by  saline  wa- 
ters. 

The  depletion  of  the  intestinal  vessels  that 
follows  a  course  of  sulphated  waters  is  of  de- 
cided value  in  the  treatment  of  h(Emorrhoidal 
conditions,  which  so  often  occur  in  those  who 
may  be  considered  degenerative  assimilators. 
Here  also  the  improvement  in  metabolism  is 
the  cause  of  the  particular  improvement  in 
the  patient.  But  hsemorrhoidal  conditions  in 
thin  individuals  whose  physique  indicates  de- 
fective assimilation  are  aggravated  by  such 
waters. 

In  maladies  due  to  the  so-called  uric-acid 
diathesis,  as  well  as  in  gravel  and  stone  in  the 
kidney  or  bladder,  the  alkaline-saline  waters 
promote  the  solution  of  uric  acid. 

The  degree  of  intensity  of  purgative  action 
in  the  bitter  waters  varies  necessarily, with  the 
amount  of  sulphates  that  they  contain.  To  a 
greater  or  lesser  extent  all  of  them  increase 
the  quantity  of  solids  passed  from  the  bowels 
during  the  day,  because,  in  consequence  of 
the  purgative  effects  of  the  waters,  the  peri- 
staltic action  of  the  intestines  is  increased, 
the  food  passes  through  and  out  of  the 
digestive  canal  before  all  the  nutrient  ma- 
terial has  been  absorbed  from  it  by  the  lac- 
teals,  and,  as  the  late  Dr.  Qeorge  Harley  re- 
marked, more  feculent  matter  is  excreted  by 
the  bowels  than  would  have  been  the  case  had 
the  digestive  materials  sojourned  longer  in  the 
intestinal  canal  and  have  been  absorbed  to 
nourish  the  body. 
Another  fact  that  must  not  be  overlooked  is 


369 


WATERS,  MINEKAL 


that  the  thirst  produced  by  the  saline  constitu- 
ents of  these  waters  increases  the  quantity  of 
liquids  ingested,  and  the  more  liquids  that  are 
absorbed  the  greater  the  solution  of  solids  and 
the  greater  the  elimination  by  the  kidneys  of 
both  fluids  and  solids.  This  latter,  however, 
is  but  temporary,  as  the  continued  use  of  sul- 
phated  waters  decreases  the  time  during  which 
nutritive'  material  remains  in  the  digestive 
tract;  and  in  consequence  of  this  there  are 
lessened  absorption  by  the  laoteals  and  a 
smaller  excess  in  the  blood  to  be  excreted  in 
the  urine. 

The  following  table  includes  the  principal 
waters  of  this  class  : 


stimulates  the  appetite,  and  strengthens  diges- 
tion by  increasing  the  desire  for  food  and  the 
ability  to  dispose  of  it.  But  more  essential  in 
the  treatment  of  chlorosis  or  ancemia  at  a  spa 
is  the  change  in  the  mode  of  life — the  diet,  the 
life  in  the  open  air,  and  the  removal  of  dis- 
turbing local  influences  that  may  exist  at  the 
patient's  home.  The  quantity  of  iron,  varying 
from  half  a  grain  to  two  grains,  that  is  con- 
tained in  all  the  water  that  is  drank  in  a  day, 
seems  too  small  to  be  considered  as  the  sole 
factor  in  the  improvement  that  occurs  in  the 
diseases  mentioned. 

Ferruginous  waters  are  of  special  value  in 
those  forms  of  anwmia  due  to  haemorrhage, 


NAME  OF  SPRING. 


Situation. 

Magne- 

■ium 
sulphate. 

Sodium 
Bulphate. 

Magne- 
sium 
chloride. 

Sodium 
chloride. 

Per 

1,000    p 

arte      wat 

er 

Kentucky. 

007 

002 

0-01 

Kentucky. 

33-40 

1-5 

Pennsylvania. 

6-0 

01 

009 

Austria. 

17-43 

16-25 

1-32 

Austria. 

84-7 

831 

1-7 

Austria. 

16-0 

15-9 

1-3 

Austria. 

13-5 

0-3 

Austria. 

18-1 

16-1 

2-4 

Austria. 

10-9 

6-0 

0-2 

Austria. 

2-4 

18-4 

2-3 

Austria. 

40 

18-1 

14-4 

Austria. 

5-0 

2-0 

Austria. 

3-5 

1-1 

Austria. 

2-3 

1-0 

Austria. 

2-3 

10 

Austria. 

2-2 

0-9 

Austria. 

0-7 

France. 

0-60 

l-« 

1-94 

France. 

9-3 

50 

0-8 

Germany. 

5-4 

6-6 

161 

Germany. 

51 

60 

7-9 

3-9 

Germany. 

5-0 

5-8 

7-6 

38 

Germany. 

6-2 

0-8 

Germany. 

0-9 

0-4 

Spain. 

8-17 

93-23 

1-99 

Switzerland. 

21 

3-6 

Switzerland. 

82-0 

7-0 

Crab  Orchard  Springs 

Harrodsbur^  Springs 

Bedford  Springs 

Arpad  (Hungary) 

Kranz-tjosepn  Bitterquell 

Hunyadi  Janos  (Ofev) 

Sedlitz  (Bohemia) 

Piillna  (Bohemia) 

Saidschutz  (Bohemia) 

Ivanda  (Banat) 

Unter-Alap  (Hungary) 

Marienbad  (Bohemia) 

Franzensbad  (Bohemia) 

Karlsbad,  Miihlbrunnen 

Karlsbad,  Sprudel 

Karlsbad,  Schlossbrun 

Fuered  (Hungary) 

Brides-les-Bains 

Montmirail 

Mergentheim  (Wiirtemberg) 

Friedrichshall  (Saxe  Meiningen). 

Kissingen  (Bavaria) 

Elster  (Saxony) 

Bertrich  (Coblentz) 

Rublnat 

Tarasp  (Engadine) 

Birmensdorf 


Chalybeate. 


Alkaline. 
Alkaline. 
Alkaline,  126°  F. 
Alkaline,  158°  F. 
Alkaline,  182°  F. 
Alkaline. 
Carbonated,  95°  F. 


Alkaline. 


Ferruginous,  chalybeate,  or  iron  waters  are 
those  in  which  there  is  a  sufficient  amount  of 
some  iron  salt,  usually  the  carbonate,  chloride, 
or  sulphate,  to  give  the  water  a  characteristic 
styptic  taste  and  the  therapeutic  properties  of 
those  salts.  While  iron  is  contained  in  a  large 
number  of  mineral  waters,  the  quantity  is  usu- 
ally so  small  that  it  exercises  no  appreciable 
medicinal  efieot.  If  an  appreciable  quantity 
of  sodium  bicarbonate  is  associated  with  the 
iron,  the  water  is  called  an  alkaline  chalybeate 
water;  if  there  is  enojigh  sodium  sulphate  to 
produce  medicinal  effect,  the  water  is  called  a 
saline  chalybeate  water ;  if  sodium  chloride  is 
present  in  suflicient  quantity,  the  water  is 
termed  chlorinated,  or  muriatic-acidulous  cha- 
lybeate water ;  and  if  it  contains  calcium  car- 
bonate or  sulphate,  it  is  designated  as  earthy, 
or  calcic-acidulous,  chalybeate  water. 

The  iron  is  probably  absorbed  with  the  water 
from  the  stomach  and  intestinal  tract,  the  pro- 
cess of  absorption  being  furthered  if  there  is 
carbonic-acid  gas  in  the  water.  The  latter  is 
always  present  when  there  is  carbonate  of  iron, 
which  is  only  held  in  solution  by  an  excess  of 
acid. 

The  iron  increases  the  red  blood-corpuscles, 


suppuration,  or  protracted  acute  or  chronic 
diseases.  In  chlorosis,  in  the  cachexia  asso- 
ciated with  chronic  paludal  poisoning,  in  that 
consequent  on  ttie  prolonged  use  of  mercury  in 
syphilis,  in  chronic  lymphadenitis,  in  chorea, 
in  menstrual  derangements  of  hcBmic  origin,  in 
albuminuria,  and  in  neurasthenia  these  waters 
may  be  prescribed  with  advantage,  and  a  saline 
or  chlorinated  chalybeate  spring  is  preferable. 
Sometimes  the  administration  of  a  chalybeate 
water  causes  intestinal  torpidity,  and,  as  in 
chlorosis  there  is  often  self-intoxication  due  to 
constipation,  the  use  of  iron  water  must  be  dis- 
continued or  be  associated  with  that  of  a  saline 
water.  ,  Dyspepsia  or  diarrhoea  that  appears 
during  the  use  of  iron  waters  indicates  the  ne- 
cessity of  discontinuing  the  treatment,  unless 
warming  the  water  terminates  the  disorders 
mentioned. 

In  chronic  forms  of  paludal  poisoning  the 
iron  waters  that  contain  arsenic,  such  as  those 
of  Roncegno  and  Levico  in  the  Austrian  Ty- 
rol, are  especially  indicated.  Such  waters  are 
excellent  for  weak  and  delicate  persons  who 
are  affected  with  gastric  neuroses,  because 
their  use  may  be  continued  for  a  long  time. 
In  all  diseases  these  waters  should  be  adminis- 


WATERS,  MINERAL 


370 


tered  at  first  in  small  doses,  a  tablespoonful 
half  an  hour  after  luncheon  sufficing;  this 
dose  is  gradually  increased  up  to  two  or  three 
tablespoonfuls  three  times  a  day. 

Atony  of  the  stomach  is  improved  by  the  ad- 
ministration of  acidulated  (carbonated)  cha- 
lybeate waters. 

The  following  is  a. partial  list  of  chalybeate 
springs  of  the  United  States  and  of  Europe  : 


those  of  the  salts  with  which  it  is  associated. 
Sometimes  waters  that  contain  this  gas  will 
produce  a  sense  of  heat  in  the  stomach,  excite 
gastric  distress,  and  eventually  cause  unpleas- 
ant eructations  of  sulphuretted  hydrogen ; 
but  in  moderate  doses,  and  if  the  waters  con- 
tain also  sodium  chloride,  they  stimulate  the 
secretions  of  the  gastro-intestinal  canal.  Con- 
tinued for  some  time,  these  waters  impair  the 


NAME  OF  SPRING. 


Situation. 


Bailey  Springs,  Lauderdale  Co 

Cullum's  Springs,  Choctaw  Co 

Talladega  Spring,  Talladega  Co 

Fulton  Wells 

Linwood  Spring 

Angler's  Mineral  Spring 

Schuyler  County  Spring 

Benham''s  Carburetted  Saline  Well. 

Indian  Springs 

Ott's  Well 

Iowa  Acid  Spring 

Cherokee  Magnetic  Mineral  Spring . 

Owosso  Chalybeate  Spring 

Bratton  Spring 

Fairview  Mineral  Spring , 

Chittenango  Sprmgs 

Oak  Orchard  Acid  Spring 

Kittrell  Springs 

Iron  Spring  (Warm  Springs) 

Grerai  Mineral  Spring 

Stryker  Mineral  Well 

Payton  Mineral  Spring 

Cresson  Springs 

Kittanning  Mineral  Spring 

Guylych  and  Gay  lord's  Spring 

Blossburg  Springs 

Austin^'s  Spring 

Pate  Sour  Well 

Sour  Lake  Mineral  Springs 

Wootan  Wells 


Montebello  or  Newbury  Springs  . 

Bath  Alum  Springs  No.  2 

Bedford  Alum  and  Iron  Springs. 

Church  Hill  Alum  Spring 

Jordan  Alum  Springs 

Pulaski  Alum  Springs , 

Stribling  Springs 

Rock  Enon  Springs 

Walla  whatoola  Alum  Springs 

Sparta  Mineral  Wells 


Szliacs  (Hungary) 

Pyrawarth 

Frauzensbad  (Bohemia). . 

Spa 

Flltwick 

Harrogate 

Tunbridge  Wells 

Bussang 

La  Malou  (Herault) 

St.  Pardoux  (AUier) 

Charbonnidres 

Homburg 

Elster  (Saxony) 

Schwalbach  (Taunus) ...... 

Bocklet 

Driburg  (Westphalia) 

Pyrmont  (Waldeckj 

Alexisbad  (Black  Forest).. 

St.  Moritz  (Ehgadine)    

Tarasp 


Alabama. 

Alabama. 

Alabama. 

California. 

Florida. 

Georgia. 

Illinois. 

Indiana. 

Indiana. 

Indiana. 

Iowa. 

Iowa. 

Michigan. 

Missouri. 

Missouri. 

New  York. 

New  York. 

North  Carolina. 

North  Carolina. 

Ohio. 

Ohio. 

Oregon. 

Pennsylvania. 

Pennsylvania. 

Pennsylvania. 

Pennsylvania. 

Tennessee. 

Texas. 
Texas. 
Texas. 

Vermont. 

Virginia. 
Virginia. 
Virginia. 
Virginia. 
Virginia. 
Virginia. 
Virginia. 
Virginia. 
Wisconsin. 

Austria. 

Austria. 

Austria. 

Belgium. 

England. 

England. 

England. 

France. 

France. 

France. 

France. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Germany. 
Switzerland. 
Switzerland. 


Alkaline  chalybeate. 

9  "64  gr.  iron  bicarbonate  in  a  gal. 

8 '78  gr.  iron  carbonate  in  a  gal. 

13  gr.  iron  subcarbonate  in  a  gal.  ;  sulphuretted. 
^■&  gr.  iron  bicarbonate  in  a  gal.  ;  chlorinated. 
12 '5  gr.  iron  sesquioxide  in  a  gal.  ;  carbonated. 
69 '96  gr.  iron  protosulphate  in  a  gal.  ;  calcic. 
10-71  gr.  iron  carbonate  in  a  gal.  ;  saline. 

24'28  gr,  iron  sulphate  in  a  gal.  ;  calcic. 
1466  gr.  iron  carbonate  in  a  gal. ;  calcic. 
97 '3  gr.  iron  sulphate  in  a  gal.  ;  acidulated. 
11*26  gr.  iron  carbonate  in  a  gal.  ;  calcic. 
15"92  gr.  iron  bicarbonate  in  a  gal.  ;  calcic. 
36'74  gr.  iron  sulphate  in  a  gal. ;  calcic. 
18"73  gr.  iron  bicarbonate  in  a  gal.  ;  carbonated. 
20 '78  gr.  iron  carbonate  in  a  gal.  ;  acidulated. 

14  to  39  gr.  iron  sulphate  in  a  gal.  ;  acidulated. 
9"2  gr.  iron  carbonate  in  a  gal.  ;  acidulated. 
3r9  gr.  iron  in  a  gal. ;  acidulated. 

19'7  gr.  iron  carbonate  in  a  gal. ;  acidulated. 
9'93  gr.  iron  bicarbonate  in  a  gal.  ;  chlorinated. 
62  gr.  iron  carbonate  in  a  gal.  ;  chlorinated. 

23  to  33  gr.  iron  sulphate  in  a  gal.  ;  saline. 

24  gr.  iron  sulphate  in  a  gal.  ;  calcic. 
7306  gr.  iron  sulphate  in  a  gal. ;  calcic. 

31*33  gr.  iron  persulphate  in  a  gal.  ;  acidulated. 

J  6'4  gr.  iron  sulphate  J  j  , 

}  11-2  gr.  iron  oxide     f>Qagal. 

69-16  gr.  iron  sulphate  in  a  gal.  ;  saUne. 

7  to  17  gr.  iron  sulphate  in  a  gal. ;  acidulated. 
13'06  gr.  iron  sesquioxide  in  a  gal.  ;  acidulated. 
J  45 '04  gr.  iron  carbonate  (  ■  , 

1 13-2  gr.  iron  sulphate      f '°  ^  ^^l" 

26'7  gr.  iron  persulphate  in  a  gal.  ;  chlorinated. 

19 -26  gr.  iron  persulphate  in  a  gal. ;  carbonated. 

15879  gr.  iron  salts  in  a  gal. 

18-54  gr.  iron  sulphate  in  a  gal. 

108-75  gr.  iron  sulphate  in  a  gal. 

12  13  gr.  iron  sulphate  in  a  gal. 

14*25  gr.  iron  oxide  in  a  gal. 

23 '74  gr.  iron  persulphate  in  a  gal. 

14'34  gr.  iron  carbonate  in  a  gal. 

46  gr.  iron  bicarbonate  in  a  gal.  ;  carbonated. 
50  gr.  iron  bicarbonate  in  a  gal.  ;  carbonated. 

8  gr.  iron  bicarbonate  in  a  gal. ;  sahne. 
Iron  bicarbonate. 

Iron  sulphate. 

2*96  gr.  u-on  in  a  gal. 

6  grs.  iron  salts  in  a  gal. 
1*7  gr.  iron  bicarbonate  in  a  gal.; 
Iron  bicarbonate. 
Iron  bicarbonate. 
Irou  bicarbonate. 

7  gr.  iron  bicarbonate  in  a  gal. 
Iron  bicarbonate ;  saline. 
Carbonated. 

saline. 

alkaline. 

alkaline. 


carbonated. 


;  chlorinated. 


Iron  bicarbonate 
Iron  bicarbonate 
Iron  bicarbonate 
Iron  bicarbonate, 
Iron  bicarbonate 
Iron  bicarbonate 


alkaline, 
alkaline. 


Sulphur  waters  are  those  that  owe  their 
chief  characteristic  to  the  presence  of  sulphur- 
etted hydrogen,  either  as  a  free  gas  or  in  com- 
bination with  calcium,  magnesium,  potassium, 
or  sodium.  They  are  easily  recognised  by 
their  fcetid  smell,  resembling  the  odour  of  rot- 
ten eggs. 

It  is  difficult  to  distinguish  the  remedial 
effects  of    the  sulphuretted    hydrogen    from 


red  blood-corpuscles,  possibly  in  consequence 
of  the  action  of  sulphur  on  the  hemoglobin, 
and  aneemia,  debility,  and  wasting  result.  The 
sulphuretted  hydrogen  is  absorbed  by  the 
blood  of  the  capillaries  of  the  mucous  mem- 
brane of  the  intestinal  tract,  and  it  is  elimi- 
nated by  the  lungs  and  the  skin,  and  possibly 
a  small  quantity  is  excreted  by  the  urine. 
Rohrig  immersed  rabbits  in  water  saturated 


371 


WATERS,  MINERAL 


with  sulphuretted  hydrogen,  but  arranged  the 
animals  so  that  they  breathed  atmospheric  air ; 
death  ensued  in  eighteen  minutes  in  conse- 
quence of  the  absorption  of  the  gas.  This 
permeability  of  the  skin  by  sulphuretted  hy- 
drogen is  made  use  of  in  the  treatment  of 
certain  diseases,  especially  saturnism  and  mer- 
curialium,  by  baths. 

Braun  stated  that  he  had  personally  expe- 
rienced the  influence  of  sulphuretted  waters  in 
relieving  congestion  associated  with  enlarge- 
ment of  the  liver.  The  gas  is  transmitted  by 
the  blood  of  the  portal  vein,  and  it  combines 
in  the  liver  with  the  iron  of  degenerating 
blood-corpuscles,  forming  an  iron  sulphide, 
which  is  excreted  by  the  feeces.  Such  treat- 
ment is  particularly  indicated  for  patients  who 
can  not  use  the  saline  waters  because  of  intes- 
tinal catarrh. 

Hepatic  congestion  associated  with  bronchial 
catarrh,  hmmoptysis,  and  even  pulmonary  tu- 
berculosis, is  benefited  by  the  use  of  these  wa- 
ters. The  Bergeon  treatment  of  tuberculosis 
by  inhalations  and  rectal  insufflations  of  sul- 
phuretted hydrogen  that  Is  obtained  from 
some  strongly  impregnated  water  still  has  its 
advocates. 

Internally,  these  waters  may  be  used  as  a 
laxative  in  constipation  due  to  deficiency  of 
intestinal  secretion.  Hcemorrhoida  due  to  de- 
fective circulation  in  the  intestinal  vessels  are 
benefited  by  these  waters,  as  is  engorgement 
of  the  pelvic  viscera  in  women. 

Braun  suggested  that  the  fact  that  the  liver 
was  the  main  depot  for  retained  metallic  poi- 
sons afforded  an  explanation  of  the  benefit 
derived  from  the  administration  of  sulphur 
water  in  chronic  poisoning  by  lead  or  mer- 
cury. In  saturnism  and  merourialism  they 
may  be  given  as  draughts,  baths,  and  inhala- 
tions (nebulized). 

While  the  use  of  sulphur  waters  externally 
and  internally  has  had  great  vogue  in  the 
treatment  of  various  skin  diseases,  there  is  no 
good  evidence  to  prove  that  they  are  thera- 
peutically useful. 

The  use  of  baths  of  sulphur  water  or  of  sul- 
phur vapour,  as  in  the  case  of  Glenwood 
Springs,  Colorado,  has  relieved  certain  cases  of 
chronic  and  muscular  rheumatism  and  gout. 
The  influence  of  the  heat  and  moisture  and 
that  of  the  salts  contained  in  the  water  must 
not  be  overlooked. 

The  value  of  sulphuretted-water  baths  in  the 
various  forms  of  syphilis  and  in  paralysis  is  no 
greater  than  that  of  warm  water. 

Most  of  these  waters  owe  their  therapeutic 
value  to  the  salts  they  contain  rather  than  to 
the  sulphuretted  hydrogen  or  the  sulphides. 

The  waters  of  Aix-la-Chapelle,  or  Aachen, 
enjoy  a  general  European  reputation  for  their 
efficacy  in  the  treatment  of  rheumatism,  gout, 
and  syphilis.  Dr.  E.  P.  Philpots  (Bristol 
Medico-chirvirgicalJournal,  1885,  p.  104)  states 
that  after  a  person  with  syphilis  has  remained 
in  water  of  a  temperature  of  95°  P.  for  half 
an  hour,  he  is  dried  and  rubbed  with  about 
three  drachms  of  mercurial  ointment;  the 
solaei  muscles  being  rubbed  one  day,  the  thighs 
the  next,  then  the  abdomen,  thorax,  arm,  fore- 


arm, and  back,  and  then  the  solsei  receive  an 
inunction  again.  The  patient  is  given  a  mouth 
wash  of  potassium  chlorate,  and  if  salivation 
occurs  the  inunctions  are  discontinued  for  a 
day  or  so.  Prom  twenty  to  eighty  baths  and 
inunctions  are  given  in  each  course. 

Aix-les-Bains  is  frequented  by  the  English 
and  Prench  because  of  ics  proximity  to  London 
and  Paris.  Sir  Alfred  B.  Garrod  {Lancet,  1887, 
vol.  i,  p.  869)  said  he  had  known  a  patient  to 
leave  London  at  eleven  o'clock  one  morning 
and  finish  the  first  day's  treatment  by  the  same 
hour  the  following  day.  He  thought  the  best 
season  there  was  from  May  10th  to  June  10th, 
or  from  the  end  of  August  to  the  end  of  Sep- 
tember. The  hot  sulphur  mineral  douche, 
the  massage,  and  the  internal  administration 
of  the  sulphur  waters  relieve  rheumatoid  ar- 
thritis, muscular  rheumatism,  sciatica,  and 
other  neuralgic  affections,  and  cutaneous  af- 
fections associated  with  rheumatoid  arthritis 
and  gout. 

The  LTnited  States  is  particularly  rich  in 
springs  that  contain  this  gas,  and  in  the  list 
there  will  be  found  mention  of  such  waters. 
Of  the  European  spas  the  more  important  hot 
springs  are  those  of  Baden  (temperature  131° 
P.),  near  Vienna,  the  Herculesbad  (111-2°)  at 
Mehadia,  the  springs  at  Harkany  (143-6°), 
Gro.sswardein  (113°,  saline),  Pystjan  (173-7°, 
carbonated),  Trenchin-Teplitz  (104°,  calcic), 
and  Warasdin  (134-6°,  carbonated),  in  Hun- 
gary; Abano  and  Battaglia  (73-7°  to  160°, 
chlorinated),  in  Italy;  Bareges  (88°  to  111-2°, 
calcic),  Bagneres-de-Bigorre,  Bagneres-de-Lu- 
chon  (154°),  Amelie-les-Bains  (108°  to  141-8°, 
calcic),  Cauterets  (102-2°),  Eaiix-Bonnes  (89-6°), 
Saint-Sauveur  (93-56°),  and  Vernet,  in  the 
Prench  Pyrenees;  Aix-la-Chapelle  (131°,  sa- 
line), in  Germany;  Aix-les-Bains  (114-8°),  in 
Savoy;  Ponticosa  (77°  to  91-4°),  in  Spain; 
and  Baden  (114-8,  saline),  Lavey  (109-4°,  sa- 
line), and  Schinznach  (109-4°,  saline),  in  Swit- 
zerland. 

Among  the  cold  sulphur  springs  are  those  of 
Harrogate,  in  England ;  Lisdoonvarna,  in  Ire- 
land ;  Eilsen,  Neundorf  (calcic),  Weilbach 
(carbonated),  Meinberg  (carbonated),  Langen- 
briicken,  Hohenstedt,  Sebastiansweiler,  and 
Kreuth,  in  Germany;  Enghien,  in  Prance; 
Strathpeffer,  in  Scotland;  and  Alvenu,  in 
Switzerland. 

Certain  mineral  waters  which  contain  an 
appreciable  quantity  of  lithium  salts  are  re- 
ferred to  as  lithia  waters,  but  the  reports  in 
regard  to  their  therapeutic  virtues  are  com  moner 
in  the  secular  press  and  in  descriptive  circulars 
than  in  the  pages  of  medical  Journals.  The 
Londonderry  lithia  water,  from  Nashua,  New 
Hampshire,  the  Buffalo  lithia  water,  the  Parm- 
ville  lithia  water,  and  the  Bowden  lithia  water 
have  been  extolled  as  remedies  for  a  number 
of  diseases.  How  much  of  their  efficacy  is  due 
to  the  quantity  of  water  imbibed  and  how 
much  to  the  lithium  salt  is  a  matter  for  scien- 
tific research.  Sir  William  Roberts  (On  the 
Chemistry  and  Therapeutics  of  Uric-acid 
Oravel  and  Gout;  Croonian  Lectures,  1893) 
has  called  attention  to  the  fact  that,  because 
aolutions  of  lithium  carbonate  and  piperazino 


WATERS,   MINERAL 


373 


possess  a  high  solvent  power  for  free  uric  acid, 
it  has  been  inferred  from  this  fact  that  their 
administration  internally  might  exercise  a  fa- 
vouring influence  on  the  solubility  of  sodium 
bi-urate  in  the  bodily  fluids,  and  thereby  tend 
to  prevent  the  formation  of  uratio  deposits. 
This  inference,  however,  he  does  not  deem  jus- 
tifiable. He  found  experimentally  that  the 
addition  of  lithium  or  piperazine,  in  the  propor- 
tion of  01  per  cent,  and  0-2  per  cent.,  to  blood- 
serum  or  synovial  fluid  did  not  have  the 
slightest  effect  in  enhancing  the  solvent  power 
of  these  media  on  sodium  bi-urate  or  in  retarding 
its  precipitation  from  serum  and  synovia  arti- 
ficially impregnated  with  uric  acid.  Sir  William 
considered  that  if  the  remedies  mentioned  have 
any  effect  in  gout,  it  is  certainly  not  due,  as 
has  been  supposed,  to  their  solvent  action  on 
the  material  of  gouty  concretions. 

Dr.  J.  H.  Claiborne  (Virginia  Medical 
Monthly,  1889,  xvi,  p.  708)  says  he  has  pre- 
scribed Buffalo  lithia  water  for  a  number  of 
years  in  cases  of  Uihiasis,  urcBmia,  Bright's 
disease,  cystitis,  and  nepliriti6  colic  with  satis- 
factory results.  The  ingestion  of  large  quan- 
tities of  water,  from  half  a  gallon  to  a  gallon 
in  a  day,  often  causes  the  solution  of  gravel, 
and  it  is  passed  as  sabulous  matter.  Dr.  James 
Shelton  ( Virginia  Medical  Monthly,  1887,  xiv, 
p.  440)  has  found  that  the  water  from  spring 
No.  1  relieves  functional  neuroses,  arnenor- 
rhma,  dysmenorrhea,  menorrhagia,  the  ca- 
chexia and  sequelcB  of  paludal  fevers,  dyspepsia, 
scarlatinal  tiephritis,  diabetes  mellitus,  syphi- 
lis, gleet,  hepatic  engorgement,  eczema,  and  acne. 

[Dr.  George  Halsted  Boyland  {Mew  York 
Medical  Journal,  August  33,  1896),  who  was 
formerly  resident  physician  at  the  Buffalo 
Lithia  Springs,  says  he  is  satisfied  that  there 
is  no  other  mineral  water  either  in  America 
or  in  Europe  so  singularly  adapted  to  such 
a  large  number  and  variety  of  maladies.  He 
says:  "The  solvent  properties  of  all  three 
springs  on  grape  sugar  is  immediate  (as  can  be 
readily  proved  by  placing  10  or  30  grains  in  a 
test  tube  and  adding  half  an  ounce  of  water), 
and  their  great  value  in  the  treatment  of  dia- 
ietes  mellitus  is  attested  by  numerous  cases." 
He  has  found  the  waters  useful  also  in  jaun- 
dice, albuminuria,  and  those  cases  of  inflam- 
mation of  the  vermiform  appendix  that  are 
dependent  on  the  formation  of  phosphatic  de- 
posits in  the  appendix.] 

Earthy,  or  calcareous,  waters  are  those 
which  contain  such  earthy  substances  as  cal- 
cium carbonate  and  sulphate  and  magnesium 
carbonate  as  prominent  constituents.  The 
calcium  bicarbonate  in  mineral  waters  is  usu- 
ally first  reduced  in  the  stomach  to  a  carbo- 
nate before  it  can  be  changed  into  calcium 
chloride  or  lactate,  and  it  reappears  in  the 
f£Eces  as  calcium  carbonate  or  phosphate. 

Internally,  the  constituent  salts  of  these 
waters  have  some  action  as  antacids  and  act  as 
astringents.  The  acidity  of  the  urine  is  dimin- 
ished or  that  excretion  may  be  made  alkaline. 

The  alkaline  are  preferable  to  the  earthy 
waters  in  cases  of  gastric  catarrh  with  hyper- 
acidity. The  bactericidal  property  of  the 
calcium  salts  may  be  of  value  in  diarrhoea  ac- 


companied by  intestinal  catarrh.  There  is  no 
evidence  to  support  the  theory  that  these  wa- 
ters are  of  value  in  caries,  necrosis,  osteoma- 
lacia, or  other  bone  diseases,  and  they  do  not 
hasten  the  calcification  of  tubercles.  External- 
ly, these  waters  have  proved  useful  in  gouty  and 
rheumatic  affections  and  some  chronic  exanthe- 
mata, probably  because  of  the  presence  of  car- 
bonic acid  in  the  water.  While  these  waters 
have  been  used  in  the  treatment  of  bronchial 
catarrh,  cystitis,  hepatic  and  cystic  calculi,  and 
certain  skin  diseases,  there  is  no  good  evidence 
to  justify  the  belief  that  the  calcium  salts 
have  exercised  any  therapeutic  effect. 

These  springs — in  which  the  sum  of  mineral 
constituents  does  not  exceed  the  amount  pres- 
ent in  ordinary  potable  water,  in  which  there 
is  no  sodium,  or  only  a  small  trace  of  it,  and 
in  which  the  principal  ingredient  is  a  small 
percentage  of  calcium  carbonate  or  sulphate — 
are  likely  to  be  of  value  in  the  treatment  of 
gout.  Most  if  not  all  of  the  calcium  salt  proba- 
bly passes  out  in  the  faeces,  so  that  such 
springs  depend  upon  their  watery  constituents. 
As  the  waters  are  taken  freely  and  usually  on 
an  empty  stomach,  they  dilute  the  blood  tem- 
porarily and  lower  its  percentage  of  urates  and 
sodium  salts,  and  thus  retard  or  prevent  the 
precipitation  of  urates,  and  give  the  defective 
kidneys  more  time  for  the  task  of  eliminating 
uric  acid.  Among  the  springs  particularly  indi- 
cated in  gouty  conditions  are  those  of  Bath  and 
Buxton  in  England ;  of  Aix-les- Bains,  Bareges, 
Contrexeville,  and  Vittel  in  Prance;  and  of 
Gastein,  Pfaffers,  and  Wildbad  in  Germany. 

The  list  of  springs  in  the  various  States  makes 
mention  of  the  calcic  waters  in  the  United 
States.  In  Europe,  the  better  known  spas  are 
those  of  Bigorre,  Crausac,  Contrexeville,  St. 
Armand,  St.  Galmier,  and  Vittel,  in  Prance; 
Inselbad,  near  Paderborn,  Driburg  and  Lipp- 
spring,  in  Westphalia,  and  Wildungen  in  Wal- 
deek,  in  Germany;  and  Leuk,  in  Canton  Wallis, 
and  Weissenburg,  in  Canton  Bern,  in  Switzer- 
land. Calcium  sulphate  is  found  in  medium 
amounts  in  the  Pullna,  Sedlitz.  Saidschiitz, 
Iwanda,  and  Priedrickshall  saline  waters; 
in  the  Mergentheim,  Bourbonne,  Cannstadt, 
Sehmalkalden,  Rehme,  Wildegg,  and  Mondorf 
ehlorinated  waters ;  and  in  tlie  Neundorf, 
Schinznach,  Eilsen,  and  Luben  sulphur  waters. 
Carbonate  of  calcium  is  found  in  the  waters  of 
a  number  of  spas  as  an  associated  salt. 

Though  the  use  of  mineral  waters  is  indi- 
cated at  all  seasons  of  the  year,  there  are  cer- 
tain times  when  the  springs  in  this  country 
and  in  Europe  are  in  season.  At  a  number  of 
these  resorts  the  hotels  are  open  only  during 
certain  months  in  the  year,  and  at  other  times 
accommodations  are  likely  to  be  inferior.  The 
use  of  the  waters  at  home,  while  not  without 
advantage,  is  less  likely  to  be  followed  by  the 
improvement  that  occurs  when  they  are  taken 
at  the  springs,  where  the  change  of  air  and 
scene  add  their  influence  to  the  medicinal 
properties  of  the  water,  and  where  the  details 
of  diet  and  mode  of  life  are  more  punctiliously 
attended  to. 

The  season  at  most  of  the  resorts  extends 
from  May  to  October,  though  at  some  it  is 


373 


•WATERS,  MINERAL 


from  June  to  September,  while  some — like 
Glenwood  Springs,  Colorado,  Warm  Springs, 
North  Carolina,  or  Hot  Springs,  Arkansas — are 
open  all  the  year,  the  winter  and  spring  months 
being  most  popular  at  the  two  last-mentioned 
resorts.  Certain  resorts  in  Europe  are  not 
closed  at  any  season,  such  as  Aix-les-Bains, 
Aix-la-Chapelle,  Araelie-les-Bains,  Baden-Ba- 
den, Bath,  Dax,  and  Wiesbaden. 

The  possibility  of  more  outdoor  life  during 
a  sojourn  in  the  warm  months  of  the  year  is  a 
factor  that  should  be  considered  by  the  physi- 
cian in  selecting  a  resort,  especially  for  persons 
with  diseases  that  are  likely  to  be  affected 
by  variability  in  the  weather  or  by  confine- 
ment in  the  house. 

The  length  of  treatment  may  best  be  deter- 
mined by  the  resident  physician  at  the  springs. 
Power  of  recuperation,  as  well  as  impressibility, 
varies  in  different  individuals,  and  there  are 
instances  in  which  an  apparently  suitable  spa 
proves  to  be  disadvantageous  to  a  patient.  It 
is  therefore  inadvisable  for  the  physician  who 
recommends  a  course  of  treatment  to  lay  down 
any  specific  rule. 

If  the  resident  physician  at  such  a  resort  is 
a  competent  man,  he  can  best  report  on  the 
improvement,  and,  as  the  length  of  sojourn 
should  be  commensurate  with  the  advantages 
that  are  derived  from  it,  it  would  be  best  to 
direct  patients  to  follow  such  advice.  Obvi- 
ously, it  would  be  impossible  for  a  physician  at 
a  distance  to  know  of  the  features  of  the 
change  in  a  patient  affected  with  aneemia,  but 
the  resident  physician,  who  should  make  regu- 
lar observations  with  the  hsemoglobinometer 
and  h:ematocrite,  is  prepared  to  speak  with 
positiveness  on  the  benefit  afforded  by  the  re- 
sort. This  same  is  true  in  the  several  forms 
of  nephritis,  in  which  regular  urinary  analysis 
affords  positive  information  of  the  condition 
of  the  kidneys  and  of  the  influence  of  the 
water  on  their  action.  In  gastric  disorders 
the  examination  of  the  performance  of  stom- 
ach digestion  is  essential.  In  fact,  few  dis- 
eases should  be  treated  at  these  places  without 
the  regular  use  of  the  methods  of  precise  ex- 
amination rather  than  the  perfunctory  ques- 
tioning of  the  patient  and  advice  based  on 
interpretation  ot  his  statement  of  his  condi- 
tion. It  is  needless  to  say  that  there  are  very 
few  resorts  in  this  country  where  such  system- 
atic methods  are  in  vogue,  and  until  such  ad- 
vice can  be  secured  the  resorts  of  Europe  are 
likely  to  be  patronized  by  Americans  rather 
than  those  of  the  United  States.  The  empiri- 
cal administration  of  iron,  mercury,  potas- 
sium iodide,  or  quinine  is  likely  to  be  less 
advantageous  to  a  patient  than  the  use  of  any 


of  these  drugs  after  careful  consideration  of 
the  evidence  afforded  by  the  use  of  instru- 
ments of  precision.  The  writer  would  not 
overrate  tlie  value  ot  the  latter,  which  will 
prove  of  little  use  if  unassociated  with  good 
judgment  and  experience;  but  it  is  only  by 
the  aid  of  all  such  methods  that  physicians  can 
escape  the  old-time  reproach  that  they  were  a 
class  "  engaged  in  pouring  drugs  of  which  they 
knew  nothing  into  stomachs  of  which  they 
knew  less." 

The  question  in  regard  to  the  desirability  of 
a  person's  returning  home  immediately  after  a 
course  of  treatment,  or  of  going  to  some  other 
place  for  a  longer  or  shorter  time,  should 
be  decided  by  the  resident  physician  at  the 
springs.  In  many  instances,  especially  in  gas- 
tric, renal,  or  hepatic  affections,  it  is  essential 
for  the  patient  to  enhance  or  fortify  his  con- 
dition after  the  improvement  afforded  by  a 
course  of  mineral  waters,  and  some  weeks  at 
a  well-selected  place  will  insure  abstinence 
from  work  and  a  continued  attention  to  the 
details  of  diet. 

The  question  in  regard  to  the  choice  of  min- 
eral waters  and  their  applicability  to  different 
patients  is  as  unsettled  as  that  of  the  selection 
and  administration  ot  other  remedial  agents. 
Every  factor  that  plays  a  part  in  the  choice  of 
a  suitable  medicament  must  be  considered  as 
well  in  the  selection  of  a  mineral  water  that 
is  likely  to  benefit  a  patient.  But  in  choosing 
the  latter  it  is  necessary  to  con.sider  not  only 
the  character  of  the  disease,  the  degree  to 
which  the  organs  affected  are  involved,  the 
general  condition  of  the  patient,  and  the  analo- 
gous factors,  but  also  the  patient's  ability  to 
stand  the  journey  to  the  springs,  the  effects  of 
the  various  factors  besides  the  waters  that  ex- 
ist at  such  resorts,  and  the  season  of  the  year 
when  the  visit  shoidd  be  made. 

Dr.  Julius  Braun  has  very  truly  said  {On  the 
Curative  Effeds  of  Baths  and  Waters.  Trans- 
lated by  Hermann  Weber,  M.  D.) :  "  Cases  of 
sickness  of  very  different  kinds  are  cured  and 
improved  by  one  and  the  same  medicinal 
spring,  and  cases  of  similar  nature  are  cured  and 
improved  by  very  different  medicinal  springs." 

Dr.  A.  C.  Peale,  who  prepared  the  list  of  the 
mineral  springs  of  the  United  States  that  was 
published  in  Volume  V  of  the  Bulletins  of  the 
United  States  Geological  Survey,  collected 
data  that  must  serve  as  a  basis  for  all  future 
work  in  this  field. 

The  writer  would  acknowledge  his  obligation 
to  that  list,  which  has  materially  aided  his  per- 
sonal observations,  and  he  reproduces  herewith 
Dr.  Peale's  summary  of  the  springs  in  the  dif- 
ferent geographical  divisions  of  this  country : 


Northern  Atlantic  States 

Southern  Atlantic  States 

Southern  Central  States 

Northern  Central  States 

Western  States  and  Territories 

Total 


No.  of 
spring 


405 
371 
721 
601 
724 


2,822 


.Vo.  of 

Individual 

springe. 


667 
1,048 
1,911 
1,276 
3,951 


8,843 


No.  of 
eprlDgi) 
analyzed. 


165 
148 
137 
215 
132 


787 


No.  of 
springs 
nsed  as 
resorts. 


74 
1.52 
174 
122 
112 


631 


No.  of 
springs 
used  com- 
mercially. 


72 
42 


55 
18 


223 


Total 
Qamber  of 
analyses 
of  waters. 


187 
164 
146 
224 
138 


WATERS,  MINERAL 


374 


From  this  table  it  may  be  seen  that  less  than 
10  per  cent,  of  the  number  of  mineral  springs 
in.this  country  have  had  their  waters  analyzed, 
while  but  little  more  than  30  per  cent,  of  the 
places  where  mineral  waters  are  found  are 
used  as  resorts. 

Alabama  contains  a  number  of  mineral 
springs,  though  few  of  them  have  anything 
more  than  a  local  reputation,  and  the  waters 
of  but  few  have  been  analyzed.  Those  that  are 
used  as  resorts  have  much  to  be  desired  in  the 
matter  of  accommodation  for  visitors.  Bailey 
Springs,  in  Lauderdale  County,  Chandler's 
Springs,  in  Talladega  County,  and  Greene 
Springs,  in  Hale  County,  are  chalybeate  springs. 
Bladon  Springs,  in  Choctaw  County,  is  an  alka- 
line, carbonated,  and  sulphuretted  water,  simi- 
lar to  that  of  Aachen.  At  Blount  Springs 
there  are  five  saline  sulphuretted  springs,  and 
a  somewhat  similar  water  is  found  at  Cullum's 
Springs,  in  Choctaw  County.  There  are  sul- 
phuretted and  chalybeate  springs  at  Blue  Grass 
Sulphur  Springs,  near  Cornelia;  at  Coffee 
Springs,  in  Geneva  County;  at  Tallahatta 
Springs,  in  Clarke  County,  and  at  White  Sul- 
phur Springs,  in  Calhoun  County. 

Alaska  has  within  its  area  a  number  of  hot 
springs,  the  better  known  of  which  are  the  sa- 
line-sulphuretted springs  (temperature,  153° 
F.)  north  of  New  Archangel,  Sitka  Island. 
There  are  also  cold  springs  of  chalybeate,  sa- 
line, and  sulphuretted  waters,  no  analyses  of 
which  have  been  made. 

In  Arizona  there  are  hot  springs  (tempera- 
ture, 130°  P.)  above  the  mouth  of  the  San 
Francisco  River;  the  Monroe  Hot  Springs 
(temperature,  150°  to  160°  F.),  south  of  Prescott, 
are  used  for  bathing,  and  there  is  a  number  of 
carbonated,  sulphuretted,  alkaline,  and  saline 
springs,  none  of  which  is  used  as  a  resort. 

Arkansas  is  better  known  from  its  hot 
springs  than  from  any  other  feature  of  the 
State.  There  are  some  seventy  "springs  situ- 
ated in  a  picturesque  valley  that  is  easily  ac- 
cessible and  is  supplied  with  excellent  hotel 
accommodations — too  frequently  the  feature 
that  is  lacking  in  the  spas  in  the  United  States. 
There  is  no  characteristic  feature  in  either  the 
temperature  or  the  ingredients  of  this  watei'  to 
make  it  superior  to  many  other  thermal  springs 
in  this  country.  But  it  has  had  a  certain  popu- 
larity in  the  treatment  of  constitutional  syphi- 
lis and  chronic  rheumatism  and  gout,  and 
fashion  has  served  to  enhance  its  position 
among  such  resorts.  The  consensus  of  opinion 
of  expert  physicians  at  Hot  Springs  is  that 
the  therapeutic  value  of  these  waters  is  due 
more  to  physical  properties  than  to  chemical 
combination  (Dr.  T.  M.  Baird,  Hot  Springs 
Medical  Journal,  1894,  vol.  iii,  p.  3 ;  Dr.  W. 
H.  Barry,  ibid.,  1893,  vol.  i,  p.  103 ;  Dr.  G.  W. 
Galvin,  New  York  Medical  Journal,  1887,  vol. 
xlv,  p.  656 ;  Dr.  J.  T.  Jelks,  Atlanta  Medical 
Register,  1881,  vol.  i,  p.  513 ;  Dr.  .1.  M.  Keller, 
St.  Louis  Medical  and  Surgical  Journal,  1879, 
vol.  xxxvii,  p.  88 ;  Dr.  E.  R.  Lewis,  Journal  of 
the  National  Association  of  Railway  Surgeons, 
1889,  vol.  ii,  p.  6).  As  soon  as  this  water  is 
allowed  to  stand  or  to  flow  in  the  open  air  a 
large  amount  of  deposit  will  occur.     The  ex- 


ternal and  internal  use  of  these  waters  is  use- 
ful in  gout,  rheumatism,  neuralgia,  incipient 
BrighVs  disease,  cystitis,  functional  disease  of 
the  liver,  chronic  diarrhoea,  chronic  skin  dis- 
eases, especially  of  squamous  types,  and  ma- 
larial toxcemia. 

[An  editorial  writer  in  the  New  York  Med- 
ical Journal  for  December  1,  1894,  says : 

"If  we  were  to  base  our  judgment  on  chem- 
ical analyses  alone,  it  would  be  puzzling  to 
account  for  .the  cures  wrought  by  the  waters ; 
practically,  they  contain  nothing  but  silica. 
Nevertheless  they  do  bring  about  unquestion- 
ably the  recovery  of  many  an  invalid  doomed 
without  their  aid  to  years  of  drooping  health 
and  an  untimely  death.  How  do  they  do  it  ? 
The  local  physicians  say  that  it  is  by  virtue  of 
their  occasioning  a  marvellous  activity  of  the 
emunctories,  whereby  the  system  is  enabled  to 
tolerate  huge  doses  of  active  drugs,  while  at  the 
same  time  the  patient,  hoping  for  something 
akin  to  a  miracle,  subordinates  all  his-  thoughts 
to  the  effort  to  get  well  and  obeys  his  physi- 
cian's instructions  implicitly.  , 

"  Recognising  the  efficacy  of  a  sojourn  in 
the  romantic  city  of  Hot  Springs,  together 
with  a  systematic  use  of  its  thermal  waters, 
the  Government  has  established  on  its  reserva- 
tion there  a  general  hospital  for  the  benefit  of 
officers  and  enlisted  men  actually  in  the  serv- 
ice and  suffering  from  ailments  that  have  been 
contracted  in  the  line  of  duty  and  have  re- 
sisted treatment  at  other  military  or  naval 
hospitals.  .  ;  .  A  circular  issued  from  the  Ad- 
jutant-General's office  says : 

'• '  Relief  may  reasonably  be  expected  at  the 
Hot  Springs  in  the  following  conditions:  In 
the  various  forms  of  gout  and  rheumatism, 
after  the  acute  or  inflammatory  stage ;  neural- 
gia, especially  when  depending  upon  gout, 
rheumatism,  metallic  or  malarial  poisoning; 
paralysis,  not  of  organic  origin ;  the  earlier 
stages  of  locomotor  ataxia,  or  tabes ;  the  early 
stages,  only,  of  Bright s  disease;  diseases  of 
the  urinary  organs  ;  functional  diseases  of  the 
liver  ;  gastric  dyspepsia  not  of  organic  origin  ; 
chronic  diarrhoea ;  catarrhal  affections  of  the 
digestive  and  respiratory  tracts;  chronic  skin 
diseases,  especially  the  squamous  varieties; 
and  chronic  conditions  due  to  malarial  infec- 
tion. Speaking  generally,  treatment  by  the 
Hot  Springs  water  may  be  said  to  stimulate 
all  the  secretions  and  the  organic  functions,  to 
promote  digestion  and  assimilation,  and  to 
favour  tissue  metamorphosis  and  excretion, 
thereby  relieving  internal  congestions,  stimu- 
lating blood-mating,  increasing  the  appetite, 
and  favouring  new  and  healthy  tissues  at  the 
expense  of  the  old  and  inactive.  The  Hot 
Springs  water  is  contra-indicated  in  all  acute 
inflammatory  diseases,  tuberculosis,  organic 
disease  of  the  heart  or  brain,  cancer  and  other 
malignant  diseases,  aneurysm,  and  in  all  cases 
where  stimulation  of  the  circulation  is  to  be 
avoided.' "] 

Dr.  G.  Adams  has  published  an  account  of 
the  Arkansas  Lithia  Spring  (Therapeutic  Ga- 
zette, 1889,  V,  p.  13),  situated  near  Hope, 
Hampstead  County.  An  analysis  showed  that 
each  imperial  gallon  contained  75'86  grains, 


375 


WATERS,  MINERAL 


including  sodium  chloride,  24-16 ;  lithium 
chloride,  3-63 ;  magnesium  sulphate,  11'97;  and 
iron  oxide,  4-55  grains.  The  water  had  a  di- 
uretic and  laxative  effect.  There  was  no  ac- 
commodation for  patients. 

There  are  saline  springs  at  Blanchard  Springs, 
in  Union  County ;  saline  and  chalybeate  springs 
at  Blood  Spring,  in  Montgomery  County;  sul- 
phuretted saline  springs  near  Dardanelle ;  sul- 
phuretted springs  at  Gum  Springs,  in  Cleveland 
County,  at  Pennywits  Sulphur  Springs,  in 
Crawford  County,  and  at  White  Sulphur 
Springs,  near  Pine  Bluff.  There  are  chalybeate 
springs  at  Mount  Nebo  Sprin  ;s,  near  Darda- 
nelle. There  are  calcic  springs  at  Eureka 
Springs,  in  Carroll  County,  the  water  of  which 
contains  but  5'85  grains  of  solids,  including 
4'43  grains  of  calcium  bicarbonate  in  each  gal- 
lon, and  at  Mountain  Valley  Springs,  near  Hot 
Springs,  the  water  of  which  contains  31-82 
grains  of  solids,  12-66  grains  of  which  are  calci- 
um bicarbonate,  in  a  gallon.  Except  at  Eureka 
Springs,  the  accommodations  are  primitive. 

California  has  probably  a  larger  number  of 
mineral  springs,  more  of  which  are  improved 
as  resorts,  than  any  other  State.  As  is  the  case 
in  most  regions  where  there  are  evidences  of 


ter's  Springs,  in  Lake  County.  There  are  alka- 
line-sulphuretted springs  at  Castalian  Mineral 
Wells,  in  Inyo  County,  and  Pearson's  Springs, 
in  Lake  County.  The  alkaline  and  saline 
springs  are.Bartlett  Springs,  in  Lake  County. 
The  alkaline  springs  are  Geyser  Springs,  in 
Sonoma  County,  and  Highland  Springs,  in 
Lake  County.  There  are  sulphuretted  springs 
at  Fulton  Wells,  in  Los  Angeles  County  ;  Hot 
Mud  Springs,  in  Siskiyou  County ;  Monticello 
Hot  Springs,  Mountain  Glen  Springs,  and  Las 
Cruces  Hot  Springs,  in  Santa  Barbara  County ; 
Matilija  Hot  Springs,  in  Ventura  County ; 
Newsom's  Arroyo  Grande  Warm  Springs,  in 
San  Luis  Obispo  County;  Simmon's  Hot  Sul- 
phur Springs,  in  Colusa  County ;  Warner's 
Ranch  Springs,  in  San  Diego  County ;  St. 
Helena  Springs,  in  Napa  County ;  and  Wilbur 
Springs,  in  Colusa  County. 

Colorado  includes  within  its  territory  both 
warm  and  cold  springs,  the  waters  of  which 
are  rich  in  various  constituents.  Among  the 
most  celebrated  of  these  springs  are  the  six 
springs  at  Manitou,  a  beautifully  situated 
town  at  the  foot  of  Pike's  Peak.  An  analysis 
of  the  water  by  Oscar  Loew,  in  1875,  showed  the 
following  ingredients : 


MANITOU 

SPRINGS. 

CONSTrrUENTS. 

Iron  Ute 
Spring. 

Little  Chief 
Spring. 

Manitou 
Spring. 

Navajo 
Spring. 

Ulo  Soda 
Spring. 

Shoshone 
Spring. 

Parts  in 
100,000. 

59-34 
59-04 
14-56 
trace 

5-r8 
30-86 

TOl 
31 -59 

8-69 

ParU  in 
100,000. 

15-16 
7B-20 
13  01 
trace 

1-80 
51-88 

6-24 
47-97 

222 

Parts  In 
100,000. 
52-26 
111-00 
20-51 
0-21 
trace 
19-71 
13-35 
40-95 
201 

Parts  in 
100,000. 

124-69 

129-40 

31-66 

0-24 

'i8-42 

16-21 

39-78 

1-47 

Parts  in 
100,000. 

23-88 
40-00 

6-10 
trace 

1-40 
12-24 
trace 
13-93 
trace 

Parts  in 
100,000. 

88-80 

}■  108-50 
trace 

Lithium  carbonate 

Iron  carbonate     .        

37-08 

5-12 

42- )2 

Silica 

Total 

210-87 

218-48 

260-00 

361-87 

97-49 

281-62 

volcanic  action,  there  are  many  thermal  springs, 
some  of  which  are  popular  resorts.  There  are 
alkaline  carbonated  springs  at  Adams  Spring, 
in  Lake  County,  which  have  proved  of  value 
in  chronic  dyspepsia,  hepalic  congestion,  and 
rheumatism;  jEtna  Springs,  in  Napa  Coun- 
ty; Allen  Springs,  in  Lake  County;  Cali- 
fornia Seltzer  Spring,  in  Mendocino  County ; 
Pry's  Soda  Spring,  in  Siskiyou  County ;  Glen 
Alpine  Mineral  Springs,  in  El  Dorado  County ; 
Litton's  Seltzer  Spring,  in  Sonoma  County; 
Summit  Soda  Springs,  in  Alpine  County ; 
Tolenas  Spring,  in  Solano  County ;  and  Vichy 
Springs,  in  Santa  Clara  County.  There  are 
sulphuretted  -  saline  springs  at  Alum  Rock 
Springs,  in  Santa  Clara  County ;  Byron  Springs, 
in  Contra  Costa  County;  El  Paso  de  Robles 
Springs  (hot  and  cold),  in  San  Luis  Obispo 
County;  on  Pluton  Creek,  in  Sonoma  County; 
Harbin  Springs  and  Mill's  Mineral  Springs 
(hot),  in  Lake  County ;  and  Tuscan  or  Lick 
Springs,  in  Tehama  County.  There  are 
sulphuretted-chalybeate  springs  at  Bonanza 
Springs,  in  Lake  County ;  El  Paso  de  Robles 
Springs,  in  San  Luis  Obispo  County;  Mark 
West  Springs,  in  Sonoma  County ;  and  Wit- 


All  the  waters  contain  free  carbonic  acid  in 
large  quantities. 

Dr.  S.  Edwin  Solly  (Manitou,  Colorado, 
TJ.  S.  A.  Its  Mineral  Waters  and  Climate) 
recommends  the  administration  of  the  water 
of  the  Navajoe  spring  in  catarrhs,  hepatic  or 
renal  plethora,  gout,  gravel,  gastric  catarrh,  in- 
testinal catarrh,  pyrosis  associated  with  chronic 
dyspepsia,  and  gastric  irritability  in  incipient 
or  threatened  phthisis.  He  has  found  this 
water  useful  externally  in  skin  diseases  in 
which  pruritus  or  excoriation  of  the  epidermis 
is  a  prominent  feature,  and  as  an  injection  it 
relieves  intractable  leucorrhoea.  He  considers 
the  Shoshone  water  useful  in  gallstones,  ham- 
orrhoids,  jaundice,  and  dyspepsia  of  hepatic 
origin.  The  Little  Chief  water  is  advised  in 
those  diseases  in  which  the  administration  of 
iron  is  indicated.  The  Iron  Ute  spring  is  rec- 
ommended for  the  treatment  of  ancemia  caused 
by  parturition  or  prolonged  lactation,  in  amen- 
orrhcea  and  menorrhagia  of  hsemic  origin,  in 
gastric  and  intestinal  atony,  and  in  functional 
neuroses. 

At  Glenwood  there  is  the  Tampah  spring. 
An  analysis  of  the  water  by  Professor  Chandler 


WATERS,  MINERAL 


376 


showed   the  following   constituents   in   each 
gallon : 

Chloride  of  sodium 1089-8307  grains. 

Chloride  of  magnesium I3'0994      " 

Bromide  of  sodium 05635  grain. 

Iodide  of  sodium trace 

Fluoride  of  calcium " 

Sulphate  of  potassium 24-0434  grama. 

Sulphate  of  calcium 82-3861 

Bicarbonate  of  lithium 0-2209  grain. 

Bicarbonate  of  magnesium 13-6532  grams. 

Bicarbonate  of  calcium 24-3727      " 

Bicarbonate  of  iron trace 

Phosphate  of  sodium " 

Biborate  of  sodium ^| 

Alumina 

Silica l-9712grams. 

Organic  matter trace 

Total 1250-0411  grains. 

Dr.  J.  C.  Blickensderfer.  of  Denver,  has  found 
that  the  external  and  internal  use  of  these 
waters  is  of  value  in  Brighfa  disease,  rheuma- 
tism, hepatic  diseases,  syphilis,  and  various 
skin  diseases.  Dr.  Lewis  R.  Morris  {New  York 
Medical  Journal,  September  38,  1895)  states 
that  a  glass  or  more  of  the  water,  either  hot  ox 
cold,  taken  in  the  morning  before  breakfast, 
seems  to  increase  the  appetite  and  relieve  the 
nausea  in  dyspepsia  and  gastric  catarrh.  In 
chronic  catarrhal  gastro-enteritis,  in  const ijja- 
tion,  in  saturnism,  and  in  rheumatoid  arthritis 
Dr.  Morris  has  found  these  waters  useful.  The 
Siloani  springs,  in  Garfield  County,  have  an 
outflow  of  water  varying  in  temperature  from 
94°  to  104°  P.,  and  containing  616-5  grains  of 
salts,  principally  sodium  chloride  and  calcium 
sulphate,  in  each  gallon.  It  is  stated  that  the 
waters  act  like  those  of  Glenwood,  but  there 
are  no  such  luxurious  accommodations  as  exist 
at  the  latter  place. 

In  Gallon  City  there  are  several  springs  of 
therapeutic  value.  Dr.  F.  R.  Blake  {St.  Louis 
Courier  of  Medicine,  1881,  vol.  vi,  p.  178) 
states  that  the  waters  are  palatable,  though 
they  purge  if  taken  in  large  quantities.  They 
act  on  the  liver  and  kidneys,  and  he  has  found 
them  especially  useful  in  biliary  obstruction. 
The  hot  springs  are  used  for  baths.  Professor 
Loew  gives  an  analysis  of  the  waters  in  the 
following  table : 


ham  County ;  at  Oxford  and  North  Haven,  m 
New  Haven  County ;  and  at  Stafford  Springs, 
in  Tolland  County.  The  facilities  of  travel 
afford  the  residents  of  this  State  opportunity 
to  visit  springs  where  water  more  heavily  im- 
pregnated with  mineral  substances  may  be  ob- 
tained. 

There  are  no  mineral  springs  of  importance 
in  Delaware,  although  water  that  is  mildly 
chalybeate  is  found  in  several  parts  of  the 
State. 

Florida  is  rich  in  springs  that  contain  hydro- 
gen sulphide,  and  the  presence  of  that  gas  is  an 
objection  to  the  water  that  is  obtained  from 
the  artesian  wells.  As  a  rule,  the  waters  con- 
tain but  small  percentages  of  mineral  sub- 
stances. There  are  sulphuretted  springs  at 
Orange  City  and  Enterprise  (De  Barry  Springs), 
in  Volusia  County;  at  Clay  Spring,  near 
Apopka,  and  at  Hoosier  Spring,  near  Alta- 
monte  Station,  in  Orange  County ;  at  Tarpon 
Springs,  in  Hillsborough  County ;  and  at  White 
Springs,  in  Hamilton  County.  There  are  cha- 
lybeate springs  at  Newport  Sulphur  Springs, 
near  Saint  Mark's,  in  Wakulla  County,  and  at 
Wesson's  Iron  Springs,  in  Hamilton  County. 
The  accommodations  at  some  of  these  places 
are  primitive,  but  the  waters  may  be  employed 
as  adjuncts  to  the  mild  climate. 

Georgia  contains  a  number  of  mineral 
springs,  several  of  which  have  been  improved 
so  that  the  resorts  are  satisfactory.  There 
are  carburetted  chalybeate  springs  in  Fulton 
County,  near  Atlanta,  the  Angler's  Mineral 
Springs.  The  sulphuretted  chalybeate  springs 
are  Camp's  Spring,  near  Atlanta,  in  Fulton 
County;  Beall  Spring,  in  Warren  County; 
the  Chalybeate  Springs,  Warm  Springs,  and 
White  Sulphur  Springs,  in  Meriwether  County ; 
Magnolia  Spring,  in  Sumter  County ;  Powder 
Springs,  in  Cobb  County;  and  Watson's 
Springs,  in  Greene  County.  There  are  saline, 
calcic,  chalybeate,  and  sulphuretted  waters  at 
Catoosa  Springs,  in  Catoosa  County ;  at  Co- 
h-utta  Springs,  in  Murray  County;  at  Ferro- 
lithic  Springs,  in  Clarke  County;  at  Garnet 
Springs,  near  Toccoa,  in  Habersham  Coun- 
ty ;  at  Gordon  Springs,  in  Whitfield  County ; 


CONSTITCJKNTS. 


Sodium  carbonate  . . . . 
Calcium  carbonate. . . . 
Magnesium  carbonate 

Sodium  sulphate 

Sodium  chloride 

Total  


Parte  In 
100,000. 

12-67 
5-86 
2-49 
S-01 

13-72 

36-26 


caSon  city  springs. 


Iron  Duke.     Little  Duke. 


Parts  in 

100,000. 

12-66 
3-74 
2-34 
2-07 

19-66 


40-40 


Big  Ute.       Aqua  Vide.       "^g");""       "«'  Spring. 


Parts  in 
100,000. 
6-94 
7-32 
2-67 
2-80 
22-68 


41-22 


Peru  in 
100,000. 
12-58 
6-78 
3-02 
2-49 
20-7-0 


46-69 


Farts  in 
100,000. 

3-32 
4-82 
300 
3-10 
6-52 


20-63 


Parts  in 
100,000. 

1-19 
6-63 
2-11 
1-34 
3-01 


13-20 


There  are  no  mineral  springs  of  importance 
in  Connecticut,  although  some  weak  chalybeate 
and  sulphuretted  springs  possess  a  local  repu- 
tation, while  springs  once  used  as  resorts  are 
now  neglected.  There  are  sulphuretted  springs 
at  Lebanon,  in  New  London  County,  and  at 
SufEeld,  in  Hartford  County.  There  are  cha- 
lybeate springs  at  North  Woodstock,  in  Wind- 


and  at  Lawrence  Mineral  Springs,  in  Chat- 
tooga County.  There  is  a  small  sulphuretted- 
saline  spring  at  Indian  Springs,  in  Butts 
County.  Among  the  best  springs  in  the  State 
are  the  Bowden  Lithia  Springs,  in  Pulton 
County. 

These  springs  contain  the  following  constitu- 
ents: 


377 


WATERS,  MINERAL 


Bromine  Lithia 
Spiings. 

Lithia  Spring. 

Calcium  bicarbonate 

Grains  per  gal. 
17-24 

•2-87 

'4-44 
0  21 
121-78 
8-03 
1-46 
0-53 
1-22 
12-15 

'i'73 
1-26 

trace 

trace 
trace 
trace 
trace 

Grains  per  gal. 
1418 

Magnesium  bicarbonate 

Magnesium  sulphate 

10-33 
4-40 

Lithium  bicarbonate  .   . . 

2-84 

0-21 

Sodium  chloride ... 

133-70 

16-25 

Potassium  sulphate 

Aluminum  sulphate 

1-32 

102 

Calcium  phosphate  . 

0-63 

1-69 

Silicic  acid 

113 

Potassium  bicarbonate 

3-63 

Manganese.              

trace 

Phosphoric  acid          ...  . 

Total 

172-92 

191-31 

Dr.  T.  S.  Hopkins  (Climatologist,  1891,  vol. 
i,  p.  97)  says  that  these  -waters  are  useful  in  the 
treatment  of  lithiasis,  uriccBmia,  chronic  cys- 
titis, diabetes  melUtus,  cystitis,  prostatitis, 
gleet,  dyspepsia,  gout,  neurasthenia,  and  he- 
patic derangements. 

When  the  geological  formation  of  Idaho  is 
recalled,  the  presence  of  hot  springs  there 
would  be  expected.  While  many  of  the  hot 
springs  of  that  State  are  likely  to  be  used  for 
medicinal  purposes  in  the  future,  few  of  them 
are  improved  at  present.  In  Owyhee  County 
there  are  the  Bruneau  Hot  Spring,  in  Bruneau 
Valley,  and  Given's  Hot  Spring,  near  Reynolds. 
East  of  Boise  City,  in  Ada  County,  there  are 
■warm  and  hot  alkaline,  chalybeate,  and  sul- 
phuretted springs.  There  are  hot  sulphuretted 
springs  southwest  of  Idaho  City,  in  Boise 
County,  and  near  the  Snake  River,  in  Oneida 
County.  The  Soda  Springs,  at  the  bend  of 
Bear  River,  in  Oneida  County,  supply  car- 
bonated, calcareous,  and  chalybeate  waters. 

There  are  a  number  of  springs  in  Illinois 
that  contain  small  quantities  of  mineral  in- 
gredients, but  few  of  them  are  of  even  lo- 
cal importance.  There  are  carbonated  calcic 
springs  at  Alcyone  Springs,  in  Cook  County, 
which  contain  some  44  grains  of  solids,  prin- 
cipally calcium  and  magnesium  bicarbonates, 
to  the  gallon,  and  Zonian  Spring,  in  Kane 
County,  which  contains  15  grains  of  solids  to 
the  gallon.  The  Ganymede  Spring,  in  Ogle 
County,  contains  20  grains,  principally  cal- 
cium and  magnesium  carbonates,  of  salts  in 
each  gallon.  There  are  saline  and  chalyb- 
eate springs  at  Green  Lawn  Springs,  Mount 
Vernon,  in  Jefferson  County,  and  Perry  Springs, 
in  Pike  County.  The  waters  of  the  Glen  Flora 
Springs,  near  Waukegan,  in  Pike  County,  con- 
tain magnesium,  sodium,  and  calcium  bicar- 
bonates in  small  quantities,  the  total  salts  be- 
ing less  than  40  grains  to  the  gallon.  There 
is  a  chalybeate  spring  in  Schuyler  County  that 
contains  a  large  percentage  of  iron.  There  are 
a  number  of  sulphuretted  springs  in  various 
parts  of  the  State. 

Indiana  contains  within  its  borders  a  num- 


ber of  mineral  springs,  the  sulphuretted  and 
chalybeate  waters  beingmost  numerous.  There 
are  chalybeate  springs  at  Anderson  Spring, 
at  Hartsville  Spring,  and  near  Azalia,  in  Bar- 
tholomew County;  at  Anderson  Mound  Spring 
(carbonated),  in  Madison  County;  at  Central 
Springs,  near  Shoals,  in  Martin  County ;  at 
Milburn  Springs,  in  Pike  County;  and  at  Van 
Cleave  Springs,  in  Crawfordsville,  Montgom- 
ery County.  There  are  chalybeate  and  saline 
springs  at  be  Gonia  Springs,  in  Warren  County, 
the  water  of  which  is  carbonated  and  contains 
131  grains  of  solids,  principally  magnesium, 
potassium,  and  sodium  sulphates  and  calcium 
and  iron  carbonates,  in  each  gallon.  Hawkins's 
Chalybeate  Springs,  in  Richmond,  Wayne  Coun- 
ty, has  a  carbonated  water  that  contains  abovit 
thirty  grains  of  solids,  principally  calcium  bi- 
carbonate and  sulphate,  in  each  gallon.  The 
sulphnretted  saline  springs  are  Hosea  Saline 
Sulphur  Spring,  in  Clarke  County,  the  waters 
of  which  contain  897-29  grains  of  solids,  includ- 
ing sodium  sulphate  (393-76  grains),  calcium 
sulphate  (221-42  grains),  potassium  sulphate 
(lll-25grains),  calcium  carbonate (88-20 grains), 
and  sodium  chloride  (59-66  grains),  to  the  gal- 
lon ;  La  Payette  Artesian  Well,  in  Tippecanoe 
County,  a  carbonated  sulphnretted  water  con- 
taining 419-54  grains  of  solids,  principally 
sodium  chloride  (324'77  grains)  and  calcium 
sulphate  (56-01  grains),  to  the  gallon ;  Lodi 
Artesian  Well,  in  Fountain  County,  the  water 
of  which  contains  672-45  grains  of  solids,  prin- 
cipally sodium  chloride  (502-46  grains),  calcium 
sulphate  (55-56  grains),  and  magnesium  chloride 
(53-54  grains),  to  the  gallon ;  Trinity  Springs, 
in  Martin  County,  the  water  of  which  contains 
32"08  grains  of  solids  to  the  gallon  ;  Wyandotte 
Spring,  in  Crawford  County,  the  water  of  which 
contains  50  grains  of  solids  to  the  gallon  ;  and 
French  Lick  Springs,  in  Orange  County,  where 
the  waters  are  carbonated  and  sulphuretted 
and  average  between  250  and  350  grains  of 
solids  to  the  gallon,  the  principal  salts  being 
sodium  chloride,  calcium  and  magnesium  sul- 
phates, and  calcium,  magnesium,  and  sodium 
carbonates. 

Iowa  has  no  mineral  springs  of  special  im- 
portance. Chamberlain,  or  Storm  Lake,  Min- 
eral Springs,  in  Buena  Vista  County,  is  an 
acidulated  water  that  contains  some  50  grains 
of  solids,  principally  lime  and  magnesia,  in 
each  gallon ;  Colfax  Mineral  Springs,  in  jas- 
per County,  are  carbonated  saline  chalybeate 
waters  which  contain  some  140  grains  of  solids, 
principally  sodium,  magnesium,  and  calcium 
sulphates,  to  the  gallon.  The  Iowa  Acid  Spring, 
at  Bddyville,  in  Wapello  County,  contains 
408-99  grains  of  sulphuric  acid,  226-41  grains 
of  alumina,  97'3  grains  of  iron  sulphate,  44-65 
grains  of  calcium  sulphate,  and  small  amounts 
of  some  other  salts,  to  the  gallon.  There  is  a 
small  alkaline-saline  spring  at  Ottumwa,  in 
Wapello  County,  the  water  of  which  contains 
200  grains  of  sodium  sulphate  in  each  gallon. 

In  Kansas  there  are  some  wells  that  furnish 
ferruginous,  saline,  and  sulpho-saline  waters, 
several  of  which  enjoy  considerable  local  repu- 
tation. There  are  carbonated  saline-chalybeate 
springs  at  Arrington,  in   Atchison    County. 


WATERS,  MINERAL 


378 


There  are  chlorinated  springs  at  Geuda  Springs, 
in  Sumner  County ;  at  Cawker  City  (Great  Spirit 
Spring),  in  Mitchell  County;  at  Girard,  in 
Crawford  County;  and  at  lola,  in  Allen  Coun- 
ty. There  are  chalybeate  springs  at  Louisville, 
inPottawatomie  County,  and  at  BaxterSprings, 
in  Cherokee  County. 

Kentucky  is  well  known  on  account  of 
several  of  its  mineral  springs,  and  in  those 
counties  where  there  are  the  Silurian  and  Car- 
boniferous formations  it  is  impossible  to  bore 
an  artesian  well  without  striking  underground 
sources  of  some  kind  of  mineral  water.  The 
sulphuretted  springs  include  Allen  Springs,  in 
Warren  County ;  Buffalo  Springs,  in  Breckin- 
ridge County  ;  Fox  Springs,  in  Fleming  Coun- 
ty; Grayson  Springs,  in  Grayson  County; 
Hardin  Springs,  in  Hardin  County;  Salubrian 
Springs,  in  Christian  County;  and  Young's 
Springs,  in  Bath  County.  The  sulphuretted 
and  chlorinated  springs  include  Beachville 
Springs,  in  Metcalfe  County;  Big  Bone  Lick 
Springs,  in  Boone  County;  Blue  Lick  Spring 
in  Nicholas  County ;  Campbellsville  Sulphur 
Spring,  in  Taylor  County ;  Drennon  Springs, 
in  Henry  County;  EUiston's  Sulphur  Spring, 
in  Madison  County;  Estill  Springs,  in  Estill 
County;  Latonia  Springs,  in  Kenton  County; 
Olympian  Springs,  in  Bath  County;  Paroquet 
Springs,  in  Bullitt  County;  and  Sabree  Springs, 
in  Webster  County.  The  saline  springs  in- 
clude Bedford  Springs,  in  Trimble  County ;  the 
lower  Blue  Lick  Spring,  in  Nicholas  County ; 
Cerulean  Springs,  in  Trigg  County ;  Harrods- 
burg  Springs,  in  Mercer  County ;  Rochester 
Springs,  in  Boyle  County;  Tar  Springs,  in 
Breckinridge  County;  and  Yates  Mineral 
Spring,  in  Boyle  County.  The  principal  chalyb- 
eate springs  are  Bryant's  Springs,  in  Lincoln 
County;  Burgher's  Spring,  in  Logan  County; 
Davis  Spring,  in  Hopkins  County:  Dripping 
Springs,  in  Garrard  County;  Esculapia  Springs, 
in  Lewis  County;  Hickman's  Springs,  in  Daviess 
County;  Howell  Mineral  Springs,  in  Hardin 
County ;  and  Rockcastle  Springs,  in  Pulaski 
County. 

Lottisiana  has  no  mineral  springs  of  any 
particular  importance.  There  are  chalybeate 
springs  at  Abita  Spring  and  at  Claiborne 
Springs,  both  near  Covington,  in  Saint  Tam- 
many Parish  ;  they  were  popular  resorts  prior 
to  the  civil  war,  and  still  have  some  vogue 
with  the  residents  of  New  Orleans.  There  is  a 
sulphur  spring  at  White  Sulphur  Springs,  in 
Catahoula  Parish. 

Maine  contains  mineral  springs  that  supply 
waters  of  most  of  the  different  classes,  except 
the  thermal.  Pew  of  the  springs  are  strongly 
impregnated  with  salts  or  gases.  Alkaline, 
calcic  waters  are  supplied  by  the  Addison 
Mineral  Spring,  in  Washington  County ;  the 
American  Chalybeate  Spring  and  the  Auburn 
Mineral  Spring,  at  South  Auburn,  and  the  Lake 
Auburn  Mineral  Spring,  at  North  Auburn,  in 
Androscoggin  County ;  the  Poland  Spring,  at 
South  Poland,  in  Androscoggin  County ;  and 
the  Rosicrucian  Spring,  in  Lincoln  County. 
Sulphuretted  water  is  supplied  by  the  Bethel 
Spring,  in  Oxford  County ;  Boothbay  Medici- 
nal Mineral  Spring,  in  Lincoln  County;  and 


Katahdin  Mineral  Spring,  in  Piscataquis  Coun- 
ty. There  are  saline  springs  at  Hartford  Cold 
Springs,  in  Oxford  County ;  and  at  Lubec 
Saline  Springs,  in  Washington  County.  The 
Poland  Spring  is  the  best  known  of  the  Maine 
springs.  The  water  contains  about  3-75  grains 
of  solids  to  the  gallon,  principally  calcium 
carbonate  and  silica.  The  Paradise  Spring, 
near  Brunswick,  in  Cumberland  County,  is  a 
purer  water,  as  it  contains  less  than  a  grain  of 
salts  to  the  gallon,  sodium  carbonate  and  silica 
being  the  chief  constituents. 

Ilaryland  contains  a  number  of  springs  the 
waters  of  which  are  impregnated  with  small 
quantities  of  mineral  ingredients.  Noneof  them 
is  of  much  importance,  and  several  that  were 
formerly  used  as  resorts  have  been  virtually 
abandoned.  There  are  mild  chalybeate  springs 
at  Bentley's  Springs,  in  Baltimore  County ;  at 
River  Springs,  in  St.  Mary's  County ;  and  at 
Spa  Spring,  in  Prince  George's  County.  There 
is  an  alkaline,  calcic,  carbonated  spring,  the 
Strontia  Mineral  Spring,  at  Brooklandville,  in 
Baltimore  County.  The  water  contains  r86 
part  of  strontium  bicarbonate  in  100,000  parts. 

Massachusetts  has  no  mineral  springs  that 
possess  anything  more  than  local  importance ; 
the  waters  contain  but  small  proportions  of 
mineral  ingredients.  Alkaline  calcic  waters  are 
obtained  from  the  Allandale  Springs,  West  Rox- 
bury,  in  Suffolk  County;  Bethlehem  Spring, 
near  Braggville,  in  Worcester  County ;  and  the 
Commonwealth  Mineral  Spring,  Waltham,  in 
Midd  lesex  Con  nty.  Mild  chalybeate  waters  are 
supplied  by  the  Crystal  Mineral  Springs,  at 
Stoneham,  in  Middlesex  County;  Coldbrook 
Mineral  Springs,  in  Worcester  County;  and 
Hopkinton  Springs,  in  Middlesex  County. 

Michigan  contains  but  few  natural  mineral 
springs,  but  in  boring  artesian  wells  a  variety 
of  mineral  waters  has  been  obtained.  A  num- 
ber of  these  wells  have  been  referred  to  as 
magnetic;  in  no  instance,  it  is  credibly  stated, 
has  the  water  itself  any  magnetic  properties, 
the  magnetic  phenomena  being  manifested  in 
the  vicinity  of  the  springs.  Alkaline  calcic  wa- 
ters are  obtained  from  the  Eaton  Rapids  Mag- 
netic Springs  and  the  Grand  Ledge  Magnetic 
Wells,  in  Eaton  County ;  the  Leslie  Magnetic 
Wells,  in  Ingham  County ;  the  St.  Louis  Mag- 
netic Spring,  in  Gratiot  bounty;  theHubbard- 
ston  Magnetic  Spring,  in  loiiia  County;  the 
Shawnee  Mineral  Springs,  in  Monroe  County  ; 
and  Butterworth's  Magnetic  Spring,  at  Grand 
Rapids,  in  Kent  County.  Sulphuretted  water 
is  supplied  by  the  Alpena  Magnetic  Well,  in 
Alpena  County ;  Owen's  Mineral  Well,  at  Ypsi- 
lanti,  in  Washtenaw  County;  and  the  Wyan- 
dotte White  Sulphur  Spring,  in  Wayne  County. 
Saline  waters  are  supplied  by  the  Fruitport 
Artesian  and  Magnetic  Well,  in  Muskegon 
County ;  the  Lansing  Magnetic  Well,  in  Ing- 
ham County;  the  Midland  Magnetic  Well,  in 
Midland  County;  the  Spring  Lake  Magnetic 
Well,  in  Ottawa  County;  and  the  Ypsilanti 
Mineral  Well,  in  Washtenaw  County.  The 
principal  chlorinated  waters  are  those  of 
Mount  Clemens  Mineral  Springs  (sulphuretted), 
which  contain  from  9,000  to  11,000  grains  of 
salts,  principally  sodium  chloride,  in  each  gal- 


379 


WATERS,   MINERAL 


Ion ;  and  the  Saint  Clair  Mineral  Springs,  in 
Saint  Clair  County. 

Minnesota  mineral  springs  are  compara- 
tively unimportant.  There  are  aliialine  calcic 
springs  at  Inglewood  Springs,  near  Minneapo- 
lis, and  at  Owatonna  Mineral  Springs,  in 
Steele  County. 

Mississippi  contains  a  number  of  mineral 
springs  that  supply  almost  all  kinds  of  waters 
except  the  thermal.  There  are  chalybeate 
springs  near  Camden,  in  Madison  County ; 
near  Aberdeen,  in  Monroe  County;  near  Gra- 
nada, in  Granada  County  ;  near  Holly  Springs, 
in  Marshall  County ;  at  Ocean  Springs,  in 
Jackson  County  ;  and  near  Columbia,  in  Mari- 
on County.  The  water  of  Lauderdale  Spring, 
in  Lauderdale  County,  and  of  Castalian 
Springs,  in  Holmes  County,  is  chalybeate  and 
sulphuretted.  Saline  waters  are  supplied  by 
Cooper's  Well,  near  Raymond,  in  Hinds  Coun- 
ty, and  La  Fayette  Springs,  in  La  Payette 
County. 

An  analysis  by  J.  Lawrence  Smith  shows  that 
each  gallon  of  water  from  Cooper's  Well  con- 
tains— 

(Jrains, 

Sodium  sulphate 11  71 

Potassium  sulphate 0*61 

-Calcium  sulphate 33"13 

Aluminum  sulphate 6"33 

Magnesium  sulphate 28'28 

Sodium  chloride 8*36 

Calcium  chloride.^. 4*.32 

Magnesium  chloride 3'48 

Iron  peroxide 3'36 

Calcium  crenate 0*31 

Silicon  crenate 1*80 

Total 95-48 

The  late  Dr.  Joseph  Jones  (Times  and  Reg- 
ister, 1892,  vol.  XXV,  p.  395)  found  that  this 
water  was  purgative,  diuretic,  diaphoretic,  and 
alterative.  He  recommended  the  water  in  cases 
of  anasarca,  ascites,  whether  of  cardiac,  he- 
patic, or  renal  origin,  acute  and  chronic  alco- 
holism, Brighfs  disease,  uratic  or  oxalic 
calculus,  jaundice,  whether  due  to  portal  de- 
rangement or  to  paludism,  gout,  paludal  toxce- 
mia,  chronic  diarrhoea,  chronic  constipation, 
dyspepsia,  and  neurasthenia. 

Missouri  has  saline  springs  in  Milford,  in 
Barton  County :  in  Climax,  in  Camden  County ; 
in  Elk  Lick  Springs,  in  Pike  County :  near 
Crescent  Hill,  in  Bates  County ;  and  at  Reiger 
Spring,   in   Mercer  County.     There  are  sul- 

Eiiuretted  saline  springs  near  Marshall,  in 
aline  County,  and  at  Rocheport,  in  Boone 
County.  There  are  chlorinated  and  chalybeate 
springs  at  Aurora  Springs,  in  Miller  County ; 
at  Cedar  Springs,  in  Cedar  County:  at  Choteau 
Springs,  in  Cooper  County ;  and  at  Zodiac 
Springs,  in  Vernon  County.  There  are  saline 
and  chalybeate  springs  at  Bowsher  Mineral 
Springs,  in  Mercer  County;  at  Bratton  Spring, 
near  Columbia,  in  Boone  County ;  at  Lan- 
dreth's  Mineral  Well,  near  Knox  City,  in  Knox 
County ;  at  Paris  Chalybeate  Springs,  in  Law- 
rence County;  and  at  Spaulding  Springs,  in 
Ralls  County.  There  are  chalybeate  springs 
at  Cedar  Springs,  in  Cedar  County ;  at  Eldo- 
rado Springs,  in  Oregon  County  ;  at  Pairview 
Mineral  Springs,  in  Worth  County ;  and  at 
McAllister  Springs,  in  Saline  County.  There 
68 


are  chlorinated  springs  at  Boonesborough, 
in  Howard  County ;  at  Harriman's  Sulphur 
Springs,  in  Cooper  County  ;  at  Lewis  Springs, 
near  Glasgow,  in  Howard  County ;  and  at 
Sweet  Springs,  near  Huntsville,  in  Randolph 
County.  There  are  sulphuretted  and  chlorin- 
ated springs  at  Montesano  Springs,  in  Jeffer- 
son County,  and  at  Nevada  Mineral  Springs, 
in  Vernon  County.  There  are  alkaline  saline 
springs  at  Siloam  Springs,  in  Howell  County. 

Montana  contains  a  number  of  important 
springs,  but  very  few  of  them  have  been  im- 
proved. Probably  the  thermal  springs  will 
prove  important ;  those  now  used  are  the  Al- 
hambra  Springs,  at  Clancy,  in  JefEerson  County ; 
Allan's  Mineral  Springs,  in  Bitter  Root  Valley, 
in  Missoula  County ;  Big  Hole  Hot  Springs, 
in  Beaver  Head  County  ;  Boulder  Hot  Spring, 
in  Jefferson  County ;  Clark's  Warm  Springs 
and  Puller's  Springs,  in  Madison  County ; 
Helena  Hot  Springs,  in  Lewis  and  Clarke 
County ;  Hunter's  Hot  Springs  and  Mat- 
thews's  Warm  Springs,  in  Gallatin  County ; 
Ryan's  Hot  Springs,  in  Beaver  Head  County  ; 
and  White  Sulphur  Springs,  in  Meagher 
County.  All  of  these  waters  contain  mineral 
ingredients.  In  Yellowstone  Valley,  near  Mill 
Creek,  in  Gallatin  County,  there  is  the  ApoUi- 
naris  Spring  that  supplies  a  delightful  water, 
more  palatable  to  the  writer's  taste  than  the 
imported  ApoUinaris. 

Nebraska  has  no  mineral  springs  of  any  im- 
portance. The  waters  of  some  of  the  artesian 
wells  contain  saline  ingredients,  but  none  of 
them  is  of  medicinal  value. 

Nevada,  in  consequence  of  its  sparseness  of 
population,  has  had  but  little  improvement  of 
its  mineral  «prings,  which  include  hot  and 
cold  waters.  There  are  hot  springs  at  Elko,  in 
Elko  County ;  near  Carson  City,  in  Ormsby 
County  ;  at  Wellington,  in  Lyon  County  ;  at 
Steamboat,  in  Washoe  County :  at  Genoa,  in 
Douglas  County ;  and  in  Pine  Valley,  in  Eu- 
reka County.  There  are  sulphuretted  springs 
north  of  Columbus,  in  Esmeralda  County ; 
near  Mineral  Hill,  in  Eureka  County ;  and  at 
Golconda,  in  Humboldt  County.  It  is  likely 
that  within  a  few  years  several  other  springs 
in  this  State  will  be  improved  so  as  to  be  used 
as  resorts. 

Most  of  the  mineral  springs  of  New  Hamp- 
shire have  but  local  reputation,  and  their 
waters  contain  but  a  small  proportion  of  min- 
eral ingredients.  There  is  an  alkaline  spring 
at  Conway,  in  Carroll  County,  the  water  of 
which  contains  but  2  grains  of  solids  to  the 
gallon.  There  is  a  carbonated  chlorinated 
spring  at  Bradford,  in  Merrimack  County. 
There  is  a  calcic  spring  at  Birchdale  Springs, 
near  Concord,  in  Merrimack  County.  There 
are  chalybeate  springs  at  Charlestown  and  East 
Unity,  in  Sullivan  County ;  at  Milford,  Am- 
herst, and  Goffstown  Centre,  in  Hillsborough 
County ;  and  at  Moultonborough,  in  Carroll 
County.  There  is  also  the  Londonderry  lithia 
spring  at  Nashua,  in  Hillsborough  County. 

New  Jersey  has  no  mineral  spring  of  im- 
portance. At  Schooley's  Mountain,  in  Morris 
County,  there  is  a  chalybeate  spring,  the  water 
of  which  contains  a  little  more  than  half  a 


WATERS,  MINERAL 


380 


grain  of  iron  carbonate  in  each  gallon.  Sev- 
eral artesian  wells  in  the  State  supply  water 
that  contains  mineral  substances. 

New  Mexico  has  a  number  ot  mineral 
springs,  some  of  which  have  been  used  for 
medicinal  purposes  since  the  time  of  the  Span- 
ish occupation.  There  are  saline  chlorinated 
hot  springs  near  Las  Vegas,  in  San  Miguel 
County  ;  near  Barranca,  in  Taos  County ;  near 
Mimbres,  in  Grant  County ;  near  Jemes,  in 
Bernalillo  County ;  and  near  Rio  Pajarito,  in 
Taos  County.  The  Aztec  Spring,  near  Santa 
Pe,  supplies  a  pleasant  alkaline  water.  The 
Jemes  Hot  Springs,  in  Bernalillo  County,  yield 
alkaline  chlorinated  waters. 

New  York  State  has  been  noted  for  the  char- 
acter of  its  mineral  springs  for  more  than  a 
hundred  years,  the  famous  Saratoga  Springs 
having  been  a  resort  since  the  latter  portion  of 
the  eighteenth  century.  In  part,  the  notoriety 
of  the  various  springs  has  been  due  to  the  facts 
that  the  State  was  well  populated,  and  the  fa- 
cilities for  reaching  the  various  spas  were  bet- 
ter than  those  afforded  by  other  States  as  far 
as  local  springs  were  concerned.  There  are 
virtually  no  thermal  springs,  the  Lebanon 
springs  having  an  average  temperature  of 
75°  P.,  and  therefore  being  scarcely  eligible 
for  admission  to  the  list  of  such  springs. 

There  are  chalybeate  springs  at  Whitehall, 
in  Washington  County,  and  at  Lebanon 
Springs,  in  Columbia  County.  There  are 
chalybeate  and  sulphuretted  springs  near  Dry- 
den,  in  Tompkins  County,  and  at  Riohfleld 
Springs,  in  Otsego  County.  The  Oak  Orchard 
Acid  Springs,  at  Alabama,  in  Genesee  County, 
are  acid  and  chalybeate. 

Dr.  I.  Ott  has  made  a  careful  investigation 
of  the  physiological  action  of  Congress  water 
(Medical  Times,  1871,  vol.  i,  p.  353),  and  found 
that  when  that  water  is  ingested  the  excreta 
are  increased  and  the  intestinal  excretion  and 
insensible  perspiration  are  diminished,  while 
the  urinary  excretion  is  increased.  In  the  lat- 
ter the  amount  of  urea,  of  sodium  chloride,  and 


of  sulphuric  acid  is  increased,  and  the  amount 
of  uric  acid  lessened ;  the  amount  of  phos- 
phoric acid  is  little  altered,  but  more  of  it  is 
united  in  earthy  salts  than  when  this  water  is 
not  taken. 

The  carbonated  chlorinated  waters  are  those 
of  Ballston  Spa  Springs  at  Ballston,  in  Sara- 
toga County. 


BALLSTON  SPA  SPRINGS. 

CONSTITUENTS. 

Artesian 
Llthia 
Spring. 

Franklin 

Artesian 

Well. 

Washington 
Lithia  Well 
(Old  Conde 
Denton  ian). 

Grains  to 

Grains  to 

Grains  to 

Solids. 

the  gallon. 

the  gallon. 

the  gallon. 

Sodium  bicarbonate. . . 

11-93 

94-60 

34-40 

Calcium  bicarbonate. . 

238-16 

202-33 

173-48 

Magnesium    bicarbon- 

ate   

180-60 

177-87 

168-35 

Strontium  bicarbonate 

0-87 

trace 

019 

Lithium  bicarbonate. . 

7-75 

6-78 

15-51 

Iron  bicarbonate 

1-58 

1-61 

2-30 

Barium  bicarbonate. . . 

3-88 

1-23 

4-74 

Potassium  sulphate. . . 
Sodium  phosphate .... 

0-58 

0-76 

005 

0-01 

trace 

Sodium  biborate 

trace 

trace 

trace 

Sodium  chloride 

750  03 

659-34 

646-48 

Potassium  chloride. . . . 

33-S8 

33-93 

9-23 

Sodium  bromide 

3-64 

4-67 

2-37 

Calcium  fluoride 

trace 

trace 

trace 

0-12 

0-08 

0-76 

trace 

0-24 

0-26 

0-74 

trace 

0-22 

Alumina 

0-40 

SiUca 

103 

Organic  matter 

trace 

Total 

1,223-25 

1,184-87 

1,047-70 

GnseG. 

426-114 

460-066 

368-346 

The  foregoing  table  gives  the  analysis  of 
these  waters  made  by  Professor  C.  P.  Chand- 
ler. Next  to  those  of  Saratoga,  these  are  prob- 
ably the  most  popular  springs  in  the  State. 
There  is  a  carbonated  chlorinated  spring  at 
South  Argyle,  in  Washington  County,  that  is 
a  local  resort.  But  the  most  famous  of  the 
waters  of  this  class  are  those  of  the  Saratoga 
Springs,  Professor  Chandler's  analyses  of  some 
of  which  are  given  herewith  : 


CONSTITUENTS. 


Solids. 

Sodium  bicarbonate  — 
Calcium  bicarbonate. . . . 
Magnesium  bicarbonate 
Strontium  bicarbonate. . 

Lithium  bicarbonate 

Iron  bicarbonate 

Barium  bicarbonate  — 

Potassium  sulphate 

Sodium  phosphate 

Sodium  biborate 

Sodium  chloride 

Potassium  chloride 

Magnesium  sulphate  — 

Sodium  bromide 

Calcium  fluoride 

Sodium  iodide 

Alumina 

Silica, 

Organic  matter 

Total 

Gases. 

Carbonic  acid 


champion 
Spouting 
Springs. 


Congress 
Spring. 


Gr.  to 
the  gal, 

17-62 

227-07 

193-91 

008 

6-26 

0-65 

208 

0-25 

0-01 

trace 

702-24 

40-45 


3-68 
trace 
0-28 
0-46 
0-70 
trace 


1,195-68 


466-46 


Gr.  to 
the  gal. 

10-77 

143-40 

121-76 

trace 

4-76 

0-34 

0-93 

0-89 

0-02 

trace 

400-44 

805 


8-66 
trace 

0-14 
trace 

0-84 


Empire 
Spring. 


Gr.  to 

the  gal. 

902 

109-66 

42-96 

trace 

2 

0-79 

0-07 

2-77 

0-02 

trace 

506-63 

4-29 


0-27 

trace 

trace 

0-43 

1-46 

trace 


680-44 


344-67 


Flat 
Rock 
Spring. 


Geyser 
Spouting 
Spring. 


Gr.  to 
the  gal. 

910 

98-63 

29-47 

0-01 

3-23 

0-09 

0-10 

0-48 

0-04 

trace 

108-85 

7-99 

10-83 

0-32 


0-01 

0-04 

1-34 

trace 


270-53 


Gr.  to 
the  gal. 

71-23 

168-39 

149-34 

0-48 

900 

0-98 

201 

0.32 

trace 

trace 

662-08 

24-64 


2-21 
trace 

0-25 
trace 

0-66 
trace 


991-54 


thorn 
Spring. 


Gr.  to 

the  gal. 

4-29 

170-65 

176-46 

trace 

11-45 

1-13 

1-74 


trace 

trace 

509-97 

9  60 


1-53 
trace 
0-19 
0-13 
1-26 
trace 


888-40 


High 
Rock 
Spring. 


Spring. 


Gr.  to 
the  gal. 

34-89 
131-74 
64-92 
trace 


1-48 

trace 

1-61 


390-13 
8-60 


0-73 
trace 
008 
1-22 
2-26 
trace 


Gr.  to 

the  gal. 

2-76 

120  17 

76-87 

trace 

9-49 

2 -.57 

0-S8 

2-02 

trace 

trace 

459-90 

7 


0-99 
trace 
0-07 
0-33 
3- 16 
trace 


627-66,  687-28 


409-46   338-46 


Seltzer 
Spring. 


Gr.  to 
the  gnl. 
29-43 
89-87 
40-34 
trace 

0-90 

1-70 
trace 

0  56 
trace 
trace 
184-29 

1-34 


0-63 
trace 
003 
0-37 
2-56 
trace 


308-02 


.324-08 


United 
States 
Spring, 


Gr.  to 
the  gal. 

4-67 
93-12 
72-88 
002 
4-85 
0-97 
0-91 


0 
trace 
141-8- 


0-84 
trace 
005 
0-09 
0-19 
trace 


331-84 


246-73 


Vichy 
Spring. 


Gr.  to 

the  gal. 

82-.'-7 

95-62 

41 -.50 

trace 

1-76 

0-05 

0  59 

trace 

trace 

trace 

128-69 

14-11 


0-99 

trace 

trace 

0-48 

0-76 

trace 


367-32 


383-07 


381 


WATERS,  MINERAL 


The  most  prominent  chlorinated  alkaline 
springs  are  the  Sharon  Springs  in  Schoharie 
County.  Dr.  Gr.  A.  Williams  (Climatologist, 
1891,  vol.  i,  p.  119)  has  found  that  the  inhala- 
tion of  atomized  Sharon  Springs  water  benefits 
coryza,  chronic  nasal  catarrh,  bronckorrhma, 
acute  laryngitis,  chronic  catarrhal  laryngi- 
tis, laryngeal  phthisis,  laryngo-tracheitis,  and 
acute  bronchitis.  Dr.  G.  E.  Walton,  in  a  mon- 
ograph on  these  -waters,  commends  their  in- 
ternal and  external  use  for  rheumatism,  gout, 
hepatic  engorgement,  gallstones,  retial  conges- 
tion, cystic  catarrh,  chronic  metallic  poisoning, 
uterine  derangements,  and  skin  diseases.  J. 
G.  Pohle's  analysis  of  the  waters  gave  the  fol- 
lowing results : 


SHABON  SPRINGS. 

CONSTITUENTS. 

Red  Sulphur 
Spring. 

Gardner  Mag- 
nesia Spring. 

Solids. 

Sodium  bicarbonate 

Calcium  bicarbonate 

Magnesium  bicarbonate 

Grains  to 

the  gallon. 

0-49 

12-93 

0-69 

96  64 

18-96 

0-83 

0-73 

0-07 

0-89 
0-45 

Grains  to 

the  gallon. 

0-54 

9-70 

1-36 
93-50 

19-68 

Sodium  chloride 

1-23 

Magnesium  chloride 

0-44 

0-16 

0-63 

Silica 

0-40 

Total 

132-18 

127-64 

Gases. 

Sulphuretted  hydrogen 

Cuhic  inches. 
10-60 
4-58 
4-00 

Cubic  inches. 
6-00 
2-22 

3-00 

Sulphuretted  waters  are  obtained  at  Avon, 
in  Livingston  County  ;  at  Cairo,  in  Green 
County :  at  Chittenango,  in  Madison  County ; 
and  at  Clifton  Springs,  in  Ontario  County. 

There  is  an  alkaline  calcic  spring  at  Dans- 
ville,  in  Livingston  County. 

North  Carolina  contains  almost  all  varieties 
of  mineral  springs.  The  warm  springs  in 
Madison  County  have  a  plentiful  flow  of  a 
carbonated  calcic  water  that  has  a  tempera- 
ture which  varies  from  92°  to  117°  P. ;  there 
are  excellent  accommodations  at  the  place,  and 
it  is  a  deservedly  popular  resort.  There  are 
chalybeate  springs  at  Cowhead  Spring,  near 
Washington,  in  Beaufort  County ;  near  Hen- 
derson, in  Vance  County  :  at  Jackson  Springs 
and  at  Lemon  Springs,  in  Moore  County ;  and 
at  Piedmont  Springs,  in  Stokes  County.  Cha- 
lybeate and  sulphuretted  waters  are  obtained 
at  All-Healing  Springs,  in  Gaston  County  ;  at 
Alum  Spring,  in  Onslow  County :  at  Cleveland 
Mineral  Springs,  in  Cleveland  County ;  at 
Copal  Grove,  in  Stanley  County ;  and  at  Pied- 
mont Springs,  in  Burke  County.  There  are  a 
number  of  springs  that  supply  carbonated, 
calcic,  or  sulphuretted  waters ;  but  the  locali- 
ties are  virtually  unimproved,  and  accommoda- 
tions for  the  treatment  of  invalids  are  lacking. 

North  Dakota  has  within   its   territory  a 
number  of  mineral  springs,  but  all  are  virtu- 
ally unimproved. 
,  Ohio  contains  no  very  important  mineral 


springs.  There  are  calcic  springs  at  Bellbrook, 
in  Green  County;  at  Castalia,  in  Erie  County; 
at  Delaware,  in  Delaware  County  ;  and  at  Mag- 
netic Springs,  in  Union  County.  There  are 
chalybeate  springs  at  Mineral  Springs,  in 
Adams  County,  and  at  Wilberforce,  in  Green 
County.  There  are  chlorinated  alkaline  springs 
south  of  Cleveland,  in  Cuyahoga  County,  and 
at  Stryker  Mineral  Well,  in  Williams  County. 
Sulphuretted  waters  are  obtained  at  Howland 
Springs,  near  Warren,  in  Trumbull  County, 
and  near  Sandusky,  in  Wyandot  County. 

Oregon  contains  hot  and  cold  mineral  springs, 
but  very  few  of  them  have  been  improved  so  as 
to  make  suitable  resorts.  Among  the  thermal 
waters  are  Belknap  Hot  Springs  (184°  F.),  near 
McKinzie  Bridge,  in  Lane  County;  Canter's 
Blue  Sulphur  Springs  (200°  P.),  in  Baker 
County,  and  Des  Chutes  Hot  Springs  (143°  F.), 
in  Crook  County.  There  is  a  chlorinated  alka- 
line water  at  Wilhoit's  Soda  Springs,  in  Clacka- 
mas County.  There  is  a  number  of  sulphuretted 
and  carbonated  springs  that  have  not  been  im- 
proved. 

Pennsylvania  is  especially  rich  in  chalybeate 
springs.  Chalybeate  waters  are  obtained  at  Bed- 
ford Springs,  in  Bedford  County ;  at  Blossburg 
Springs,  in  Tioga  County ;  and  at  Cresson 
Springs,  in  Cambria  County.  Dr.  J.  D.  Mor- 
gan {Maryland  Medical  Journal,  1889,  vol.  xxi, 
p.  425)  says  that  the  Bedford  Spring  water  is 
useful  in  diseases  of  the  stomach,  liver,  kidney, 
and  bowels.  He  advises  that  one  or  two  glasses 
of  the  magnesia  water  should  be  taken  on  ris- 
ing in  the  morning,  and  a  brisk  walk  taken 
before  breakfast.  Just  before  breakfast,  din- 
ner, and  supper  a  small  glass  should  be  taken ; 
a  little  salt  may  be  added  to  increase  the  os- 
motic power  of  the  water,  which  acts  better  if 
heated.  Sulphuretted  and  chalybeate  waters 
are  obtained  at  Doubling  Gap,  in  Cumberland 
County ;  at  Minnequa  Springs,  in  Bradford 
County;  at  Three  Springs,  in  Huntingdon 
County;  and  at  Loretto,  in  Cambria  County. 
Gettysburg  water,  according  to  Dr.  I.  Ott 
{Medical  Times,  1871,  vol.  ii,  p.  143),  increases 
the  daily  excretion  of  urea  and  of  sulphuric 
acid,  and  decreases  that  of  uric  and  phosphoric 
acids  and  that  of  sodium  chloride.  Dr.  John 
Bell)  Medical  and  Surgical  Reporter,  1867, 
vol.  xvii,  p.  262)  reports  that  it  is  of  value  in 
the  treatment  of  gout,  rheumatism,  diabetes, 
dyspepsia,  and  constipation.  The  chief  con- 
stituents in  the  waters  of  the  principal  springs 
may  be  seen  from  the  table  at  the  top  of  page 
382'.     The  analyses  were  made  by  F.  A.  Genth. 

Rhode  Island  contains  no  mineral  springs 
that  are  of  any  importance  from  a  therapeutic 
standpoint. 

South  Carolina  has  no  mineral  springs  the 
waters  of  which  are  other  than  mediocre  in 
remedial  properties.  There  are  mild  chalyb- 
eate waters  at  Cherokee  Springs,  in  Spartan- 
burg County,  and  at  Seneca,  in  Oconee  County. 
There  are  sulphuretted  waters  at  Chick's 
Springs,  in  Greenville  County,  and  at  Glenn 
Springs,  in  Spartanburg  County. 

South  Dakota  contains  an  excellent  hot 
spring  at  Hot  Springs,  in  Pall  River  County. 
Mineral  waters  have  been  obtained  from  a  num- 


WATERS,  MINERAL 


382 


BEDFORD   SPRINGS. 

CRESSON 

SPRINGS. 

Gettysburg 

CONSTITUENTS. 

Sweet 

Mag'nesia 

Sulphur 

MagneBia 

Large 

Iron 

Alum 

Lithia 

Spring. 

Iron  Spring. 

Spring. 

Spring. 

Spring. 

Spring. 

Spring. 

Grains  to 

Grains  to 

Grains  to 

Grains  to 

Grains  to 

Grains  to 

Grains  to 

Grains  to 

the  galloD. 

the  gallon. 

the  gallon. 

the  gallon. 

the  gallon. 

the  gallon. 

the  gallon. 

the  gallon. 

Sodium  bicarbonate 

3  20 

0-53 

8-47 

10-21 

10-43 

7  09 

3-63 

Calcium  bicarbonate 

.    10-71 

Magnesium  carbonate 

0-14 

0-59 

100 

0-94 

i-88 

Magnesium  bicarbonate. . . 

6-31 

Manganese  carbonate 

trace 

trace 

trace 

trace 

trace 

005 

'6-61 
90-46 

0-08 

'6-.M 
7308 

004 

0-33 
99-83 

004 
6-68 

5-04 

'i-64 
48-93 

3-75 

'o-TO 
40-20 

0-03 

Calcium  sulphate 

0-48 

Potassium  sulphate 

0-30 

0-41 

0-18 

0-27 

0-32 

0-43 

0-15 

Strontium  sulphate 

001 

0-13 

008 

Magnesium  sulphate 

38-68 

33-40 

39-62 

0-29 

22-68 

27  TO 

3-36 

Iron  sulphate 

23-48 

49-64 

Calcium  phosphate 

Sodium  chloride 

002 

002 

0-01 

trace 

0-03 

trace 

0-53 

0-37 

0-46 

0-23 

0-04 

0-02 

0-28 

Aluminum  sulphate 

1-60 

21-20 

6-65 

trace 
0-17 
001 

trace 
0-54 
0-08 

trace 

0-77 

trace 

0-47 
trace 

1-21 

1-87 

Silica.                      

Hydrosulphuric  acid 

0-31 

1-87 

2-79 

0-56 

3-77 

1-78 

Total 

1-62 

141-17 

122-40 

153-30 

14-70 

108-39 

25-24 

ber  of  artesian  -wells  that  have  been  constructed. 
There  is  a  spring  at  Pierre  that  supplies  a  chlo- 
rinated alkaline  -water  the  composition  of  which 
resembles  that  of  the  waters  of  St.  Catherine,  in 
Canada. 

'Tennessee  contains  a  number  of  mineral 
springs,  especially  the  chalybeate  and  sulphu- 
rftted.  There  are  chalybeate  springs  at  Beer- 
sheba  Springs,  in  Grundy  County ;  at  Bon  Air 
Springs,  near  Sparta,  in  White  County ;  near 
Williamsburg,  in  McMinn  County ;  near  Elk- 
ton,  in  Griles  County;  near  Erwin,  in  Unicoi 
County ;  near  Mooresburg,  in  Hawkins  County ; 
at  Howard  Springs,  in  Cumberland  County ; 
near  Erie,  in  London  County ;  and  at  Robin- 
son Spring,  in  Van  Buren  County.  Chalybeate 
and  sulphuretted  waters  may  be  obtained  at 
Alleghany  and  Blount  Springs,  near  Mary- 
ville,  and  at  Montvale,  in  Blount  County ;  at 
Black  Water  Springs,  in  Granger  County ;  near 
Dandridge,  in  Jefferson  County ;  at  Blooming- 
ton,  in  Putnam  County ;  near  Bolivar,  in  Harde- 
man County;  at  Epperson  Springs,  in  Macon 
County ;  near  Rogersville,  in  Hawkins  County ; 
at  Kingston  Springs,  in  Cheatham  County ;  and 
at  Oliver  Springs,  in  Anderson  County.  There 
are  sulphuretted  waters  at  Avoca  Springs,  near 
Bristol,  in  Sullivan  County;  near  Dandridge, 
in  Jefferson  County ;  at  Beaver  Dam  Springs, 
in  Hickman  County ;  at  Clancy,  in  Robertson 
County ;  near  Bean's  Station,  in  Granger 
County;  and  near  Nashville,  in  Davidson 
County. 

Texas  contains  a  number  of  mineral  springs, 
but,  as  is  the  ease  in  most  of  the  Southern 
States,  few  of  them  are  improved  so  that  they 
may  be  used  as  resorts.  A  number  of  so-called 
mineral  springs  are  artesian  wells  in  which  the 
water  contains  mineral  ingredients.  Chalybeate 
waters  are  obtained  at  Dalby  Springs,  in  Bowie 
County ;  at  Hughes's  Spring,  m  Cass  County ; 
and  at  Hynson's  Iron  Mountain  Springs,  near 
Marshall,  in  Harrison  County.  Water  contain- 
ing sulphuric  acid  is  obtained  from  Sulphur 


Springs,  in  Hopkins  County,  and  from  the 
springs  near  Sour  Lake  and  Luling,  in  Cald- 
well County. 

Utah  has  a  number  of  mineral  springs,  but 
most  of  them  are  undeveloped,  especially  the 
hot  springs.  Near  Ogden  and  Salt  Lake  City 
there  are  hot  chlorinated  springs  that  are  used 
for  bathing.  There  are  saline,  chalybeate,  and 
calcic  springs  in  the  State  which  will  be  im- 
proved, in  all  likelihood,  within  a  few  years. 

Vermont  has  saline  sulphuretted  springs  at 
Alburgh  Springs,  in  Grand  Isle  County.  There 
are  sulphuretted,  springs  at  Barre  and  Plain- 
field,  in  Washington  County;  near  Hartland, 
in  Windsor  County ;  and  near  Berkshire,  in 
Franklin  County.  There  are  sulphuretted 
springs  at  Brunswick,  in  Essex  County,  and 
at  Newbury,  in  Orange  County.  There  are  car- 
bonated calcic  springs  at  Clarendon,  in  Rutland 
County. 

Virginia,  like  New  Fork,  includes  within  its 
borders  some  of  the  most  celebrated  spas  in  the 
United  States.  One  of  the  more  prominent  re- 
sorts is  at  Hot  Springs,  in  Bath  County,  the 
waters  of  which  have  a  temperature  of  from 
50°  to  110°  P.,  and  are  saline  and  calcic  in  com- 
position. The  Warm  Sulphur  Springs,  in  the 
same  county,  discharge  water  of  a  temperature 
of  from  96°  to  98°  P,  The  chalybeate  springs 
include  Bath  Alum  Springs,  in  Bath  County; 
the  Bedford  Alum  Springs,  in  Campbell  Coun- 
ty ;  the  Church  Hill  Alum  Springs,  in  Henrico 
County ;  the  Clifton  Springs,  in  Alleghany 
County;  Harrison's  Mineral  Spring,  in  Taze- 
well County ;  Jordan  Alum  Springs  and  Rock- 
bridge Alum  Springs,  in  Rockbridge  County ; 
Kern's  Springs  and  Shenandoah  Alum  Springs, 
in  Shenandoah  County ;  the  Alum  Springs  near 
Ballsville,  in  Powhatan  County ;  Pulaski  Alum 
Springs,  near  Dublin,  in  Pulaski  County ;  Raw- 
ley  Springs,  in  Rockingham  County;  Sharon 
Springs,  in  Bland  County;  Variety  Springs, 
in  Augusta  County;  Washington  Springs,  in 
Washington  County ;  and  Wytheville  Springs, 


383 


WATERS,  MINERAL 


in  Wythe  County.  Dr.  B.  Blackford  ( Virginia 
Medical  Monthly,  1877,  vol.  iv,  p.  778)  com- 
mends the  Bedford  Alura  Springs  water  in  the 
treatment  of  uterine  engorgement,  chronic  leu- 
corrhcea,  amenorrhoea,  dysmenorrhea,  and 
chronic  adenitis,  the  water  being  used  inter- 
nally and  as  a  douche.  This  use  of  these 
waters  has  been  commended  by  Dr.  J.  W.  Dil- 
lard  ( Virginia  Medical  Monthly,  vol.  v,  p.  718) 
in  chronic  diarrhoea.  Among  the  more  impor- 
tant chalybeate  and  sulphuretted  springs  are 
the  Buckingham  White  Sulphur  Springs,  in 
Buckingham  County ;  Hagan's  Springs,  in 
Scott  County;  Huguenot  Springs,  in  Powha- 
tan County ;  Jordan's  White  Sulphur  Springs, 
in  Frederick  County ;  Millborough  Springs,  in 
Bath  County ;  Mungel's  Springs,  in  Washing- 
ton County;  Roanoke  Red  Sulphur  Springs, 
in  Roanoke  County ;  Rock  Enon,  or  Capper's, 
Springs,  in  Frederick  County ;  and  Valley  view 
Springs,  in  Shenandoah  County.  The  sulphu- 
retted springs  include  Botetourt,  or  Johnson's, 
Springs,  in  Roanoke  County ;  Cedar  Bluff  Sul- 
phur Springs,  in  Tazewell  County ;  Coyner's 
Sulphur  Springs  and  Debrell  Spring,  in  Bote- 
tourt County ;  Crystal  Sulphur  Sprin,  in  Aug- 
gusta  County ;  Grayson's  Sulphur  Springs,  in 


Carroll  County;  Montgomery  White  Sulphur 
Springs,  in  Montgomery  County ;  and  Bggles- 
ton  Springs,  in  Giles  County.  The  saline  calcic 
springs  include  Alleghany  Springs  and  Yellow 
Sulphur  Springs,  in  Montgomery  County ;  Blue 
Ridge  Springs,  in  Botetourt  County ;  Healing 
Springs,  in  Bath  County ;  and  Sweet  Chalybeate 
Sprmgs,  in  Alleghany  County.  The  alkaline, 
calcic,  and  chalybeate  springs  include  the  Buf- 
falo Lithia  Springs,  in  Mecklenburg  County  ; 
the  Farmville  Lithia  Springs,  in  Prince  Edward 
County;  the  Orkney  Springs,  in  Shenandoah 
County;  and  Wolf  Trap  Lithia  Springs,  in 
Halifax  County. 

Washington  has  a  number  of  mineral  springs, 
but,  as  is  the  case  in  all  of  the  more  sparsely  set- 
tled States,  most  of  them  are  difficult  of  access 
and  there  are  no  accommodations  for  visitors. 
'The  Cascade  Warm  Mineral  Springs,  in  Ska- 
mania County,  supply  a  warm,  saline,  sulphu- 
retted water.  An  alkaline  chlorinated  water 
is  obtained  from  Medical  Lake,  in  Spokane 
County. 

West  Virginia,  like  its  mother  State,  Vir- 
ginia, contains  a  number  of  important  mineral 
springs.  There  are  alkaline  carbonated  springs 
at  Capon  Springs,  in  Hampshire  County;  and 


CONSTITUENTS. 


Solids. 

Calcium  bicarbonate 

Magnesium  carbonate. . . 
Magnesium  bicarbonate. 
Potassium  carbonate — 
Lithium  bicarbonate  — 

Barium  bicarbonate 

Iron  carbonate 

Iron  bicarbonate 

Sodium  sulphate 

Calcium  sulphate 

Lithium  sulphate 

Magnesium  sulphate  — 

Potassium  sulphate 

Aluminium  sulphate 

Manganese  sulphate 

Iron  protosulphate 

Iron  persulphate 

Nickel  sulphate 

Cobalt  sulphate 

Copper  sulphate 

Zinc  sulphate 

Magnesium  nitrate 

Ammonium  nitrate 

Calcium  phosphate 

Phosphates 

Sodium  silicate 

Sodium  chloride 

Calcium  chloride 

Calcium  fluoride 

Lithia 

Alumina 

Silica 

Iodine , 

Phosphoric  acid 

Sulphuric  acid 

Organic  matter 

Total 

GaeaB. 

Carbonic  acid 

Sulphuretted  hydrogen. . 

Oxygen 

Nitrogen 

Carbon  dioxide 


Bedford  Alum  and  Iron 
SpriugB. 

Farmville 
Lithia 
Springs. 

BUFPAl 

.0  LITHIA  SP 

RINGS. 

Spring  No.  1. 

Spring  No.  2. 

Spring  No.  3. 

Grains  to  tte 

Grains  to  the 

Grains  to  the 

Grains  to  tbe 

Grains  to  the 

Grains  to  the 

gallon.* 

gallon.-l- 

gallon.^ 

Imp.  gallon.§ 

Imp.  gallon. § 

imp.  gallon. 

1-33 

39-28 

14-96 

2-52 

4-49 

29-30 

i-85 

1-99 

1-48 

2-25 
1-75 

1-26 

o-so 

0-80 

3-77 

0-87 

8-B9 

4-99 

18-67 

1-81 

19-35 

83  07 

2-SS 

0-24 

12-58 

12-66 

1-53 

6-89 

0-lS 

0-71 

1016 

0-18 

0-46 

24-18 

7-24 

8-18 

9-07 

3-04 

0-19 

0-59 

23-46 

19-26 

0-04 

•  •  ■  ■ 

0-06 

.... 

0-06 

0-or 

0-27 

.... 

0-24 

0-30 

'6-23 

s-so 

'i-36 

■4-92 

6-22 

trace 

2-62 

trace 

1-69 

3-92 

1-72 

1-87 

0-57 

trace 

trace 

trace 

trace 

trace 

trace 

4-02 

19-98 

trace 

0-29 

, 

trace 

trace 

trace 

trace 

70-88 

92- 17 

26-39 

73-66 

98-38 

14-47 

Cublo  Inohes. 

Cubic  inches. 

Cuhlc  inches. 

74-2 

69-1 

592 

11-6 

B-9 

8-3 

3-4 

1-32 

.... 

3-33 

6-98 

•MB.  Hardin,  analyst  (1877). 
t  William  Gilham,  analyst. 


X  E.  T.  Fristoe,  analyst. 

§  W.  P.  Tonry,  analyst  (1874). 


WAX 
WINES 


384 


at  Mineral  Wells,  near  Parkersburg,  in  Wood 
County.  There  are  chlorinated  smine  -waters 
at  Hart  Well,  near  Willow  Island,  in  Pleasants 
County;  at  Blue  Sulphur  Springs,  in  Green- 
brier County ;  at  Borland  Mineral  Well,  in 
Pleasants  County;  and  at  Humphrey's  Spring, 
in  Monroe  County.  The  sulphuretted  -waters 
include  the  Floding,  or  Blue,  Sulphur  Springs, 
in  Cabell  County,  and  the  Gray  Sulphur  and 
Red  Sulphur  Springs,  in  Monroe  County.  There 
are  calcic,  sulphuretted,  and  chalybeate  waters 
at  Greenbrier  White  Sulphur  Springs,  in  Green- 
brier County,  which  have  been  used  medicinal- 
ly since  the  last  century.  There  are  chalybeate 
springs  at  Shannondale  Springs,  near  Charles- 
town,  in  Jefferson  County,  and  at  Spa  Springs, 
in  Morgan  County. 


chiefly  to  the  elimination  of  waste  products 
that  cause  intoxication.  The  internal  use  of 
the  water  produces  no  effect  on  the  circulatory 
organs,  though  the  pulse-rate  is  increased  by 
bathing  in  it  as  by  any  other  hot  baths.  The 
waters  cause  a  marked  increase  in  the  flow  of 
bile,  the  fffical  discharge,  the  quantity  of  urine 
and  the  proportion  of  urinary  solids,  and  the 
perspiration.  These  waters  are  useful  in  anCB- 
mia  and  debility  due  to  paludisra  or  self-in- 
toxication, and  in  diseases  due  to  a  defective 
action  of  the  eliminative  organs  or  to  impair- 
ment of  the  excretory  functions.  Included 
among  these  latter  are  gout,  rheumatism, 
chronic  paludal  poisoning,  chronic  duodenal 
catarrh,  catarrh  of  the  bile  ducts,  and  certain 
phases  of  Bright's  disease.     The  waters  are 


CONSTITUENTS. 

CAPON  SPRINGS. 

GREENBRIER 

WHITE  SULPHUR 

SPRINGS. 

Main  Spring. 

Bemty  Spring. 

Name  unknown. 

Solids. 

Sodium  carbonate 

Gr.  to  the  imp.  gal. 

0-59 

8-33 

1-44 
trace 
trace 

0  04 

6-59 

6*i7 
trace 
trace 
trace 

O'OG 

trace 
0'03 
0-70 
0-20 

Gr.  to  the  imp.  gal.* 
0-C3 
8-36 

1-27 
trace 
trace 

0-05 
trace 

0-41 

6-16 
trace 
trace 
trace 

o-os 

trace 

trace 
002 
0-67 
0-19 

Gr.  to  the  imp.  gaLf 

Calcium  carbonate .       ... 

707 

Magnesium  carbonate 

Copper  carbonate 

Calcium  sulphate .... 

78-35 

Nitrates 

Calcium  phosphate 

Silicates 

3-46 

Magnesium  chloride 

1-00 

Alumina .... 

Silica 

Organic  matter 

4-36 

Total 

12-14 

11-81 

129-66 

Gases. 

Cubic  inches. 

8-66 

i'76 
3-68 

Cubic  inches. 

7-76 

i-68 
3-68 

Cubic  inches. 
11-28 
0-24 
0-48 
4-64 

Sulphuretted  hydrogen 

Oxygen 

Nitrogen 

Total 

14-00 

13-12 

16-64 

*  J.  W.  Mallett,  analyst. 

Dr.  J.  L.  Le  Conte  {American  Journal  of 
the  Medical  Sciences,  1879,  vol.  i,  p.  148)  says 
that  the  waters  of  Capon  Spring  are  beneficial 
for  renal  calculi  composed  wholly  or  in  part 
of  uric  acid,  and  for  cystic  deposits  of  the 
same  substance ;  the  alkalies  of  the  water  tend 
to  disintegrate  the  agglutinating  material  of 
the  calculi.  Dyspepsia  caused  by  too  free  a 
secretion  of  acid  in  the  stomach,  or  due  to  a 
gouty  diathesis,  is  also  relieved.  Hepatic  con- 
gestion and  enlargement  due  to  derangement  of 
the  portal  circulation,  fwnctional  neuroses  due 
to  disorders  of  the  sexual  organs  in  women,  and 
chlorosis  are  benefited  by  a  course  at  this  spa. 

The  late  Dr.  W.  C.  Dabney  writes  in  regard 
to  the  Greenbrier  White  Sulphur  Springs  (Gail- 
lard's  Medical  Journal,  vol.  1,  1890,  p.  331) 
that  its  waters  have  little  or  no  effect  upon  the 
nervous  system  of  healthy  persons ;  the  relief 
from  neuralgia  obtained  from  their  use  is  due 


t  A.  A.  Hayes,  analyst. 

also  valuable  for  persons  who  have  no  actual 
disease,  but  in  whom  the  liver  and  bowels  are 
inactive  as  a  result  of  sedentary  habits  and 
over-indulgence  in  the  pleasures  of  the  table. 

Wisconsin  mineral  springs  have  acquired 
considerable  reputation  in  the  United  States. 
The  alkaline  calcic  waters  are  obtained  from 
the  Arctic  Springs,  at  Galesville,  in  Trempea- 
leau County;  the  Bethesda,  the  Glenn,  the 
Horeb,  the  Siloam,  the  Silurian,  and  the  White 
Rock  Springs,  at  Waukesha ;  the  Gihon  Springs, 
at  Delavan,  in  Walworth  County:  and  the  lodo 
Magnesian  Springs,  Beloit,  in  Rock  County. 
Alkaline-saline  waters  are  obtained  from  Bris- 
tol Soda  Springs  at  Woodworth.  in  Kenosha 
County,  and  the  Artesian  Mineral  Well  at 
Prairie  du  Chien,  in  Crawford  County.  Chalyb- 
eate waters  are  obtained  from  the  Black  Earth 
Mineral  Springs,  in  Dane  County;  the  New 
Saratoga  Springs  at  Star  Prairie,  in  St.  Croix 


385 


WAX 
WINES 


County;   and  the  Sparta  Mineral  Wells,  in 
Monroe  County. 

Wyoming  contains  within  its  territory  a 
number  of  mineral  springs,  few  of  which  are 
improved  as  resorts.  The  liot  springs  in  Yel- 
lowstone Park  are  not  used  for  therapeutic 
purposes,  but  there  is  a  hot  spring  at  Saratoga, 
in  Carbon  County,  that  is  a  resort. 

Samuel  T.  Aemstrong. 

"WAX  occurs  in  two  forms,  the  yellow- and 
white,  known  respectively  as  cera  flava  (U.  S. 
Ph..  Br.  Ph.,  Ger.  Ph.)  and  cera  alba  (U.  S. 
Ph.,  Br.  Ph.,  Ger.  Ph.).  The  latter  is  prepared 
from  the  former  by  its  exposure  in  thin  sheets 
to  the  sunlight  in  a  moist  atmosphere.  Their 
physical  properties  are  essentially  the  same, 
but  the  white  variety  is  preferable  on  account 
of  its  greater  freedom  from  impurities.  Hav- 
ing a  moderately  high  melting  point,  it  is  em- 
ployed to  impart  consistence  to  the  more  fluid 
oils  and  fats  in  the  preparation  of  ointments 
and  cerates.  It  is  also  used  in  the  preparation 
of  suppositories  and  medicated  bougies  in 
cases  where  their  slow  liquefaction  is  prefer- 
able to  the  more  rapid  melting  which  occurs 
when  cacao  butter  is  the  principal  excipieut. 
Waxed  cloth  is  prepared  by  saturating  cloth 
with  a  mixture  of  8  parts  of  white  wax,  4  parts 
of  olive  oil,  and  1  part  of  turpentine  oil.  It 
may  be  used  as  a  protective,  or  in  the  prepara- 
tion of  a  blistering  plaster. 

Internally,  wax  is  practically  inert  and 
harmless. 

Chinese  insect  wax,  or  Pe  la,  is  the  secretion 
of  a  species  of  coccus  upon  a  variety  of  ash. 
It  may  be  substituted  for  the  ofiicial  variety. 

Japanese  wax  is  obtained  from  the  fruits  of 
several  varieties  of  Rhus,  and  possesses  all  the 
properties  of  the  ordinary  kind,  but  is  apt  to 
become  rancid. 

Myrtle  wax  is  the  product  of  a  number  of 
species  of  Myrica.  The  popular  name  of  the 
common  United  States  species  is  bayberry. 
This  wax  is  obtained  by  subjecting  the  fruit 
to  the  action  of  hot  water.  It  is  greenish  in 
colour  and  of  an  agreeable  odour,  and  may  be 
substituted  for  the  common  variety. 

KussELL  H.  Nevins. 

WHEAT.— See  Triticum. 

WHEY  is  the  liquid  remaining  after  coag- 
ulating and  expressing  the  casein  from  milk. 
As  the  particles  of  fat  are  entangled  with  the 
casein  the  two  elements  are  removed  together. 
The  following  is  the  composition  of  ordinary 
whey,  the  figures  representing  percentages : 
Proteids,  0-83 ;  fat,  0-25 ;  sugar,  4-65 ;  ash.  0-65 ; 
water,  93'30.  The  principal  ingredient  is,  there- 
fore, sn  a;ar,  the  ash  being  practically  unchanged. 
Whey  is  prepared  by 'the  use  of  a  inilk-ourdling 
ferment,  essence  of  pepsin  of  liquid  rennet  be- 
ing commonly  used  for  this  purpose.  A  tea- 
spoonful  of  either  preparation  is  used  to  a  pint 
.  of  milk  which  is  kept  at  a  temperature  of  about 
100°  F.  until  coagulation  has  become  complete. 
The  coagulum  is  then  broken  up  and  the  whey 
strained  out.  P.or  the  uses  of  whey  and  the 
"  whey  cure  "  the  reader  is  referred  to  the  arti- 
cles on  Milk  and  Dietetic  treatment. 

Floyd  M.  Ceandall. 


WHISKY,  spiritus  frumenti  (U.  S.  Ph.).  is 
"  an  alcoholic  liquid  obtained  by  the  distilla- 
tion of  the  mash  of  fermented  grain  (usually 
of  mixtures  of  corn,  wheat,  and  rye),  and  at 
least  two  years  old  "  (U.  S.  Ph.).  Whisky  should 
be  of  an  amber  colour,  with  a  characteristic 
taste  and  odour  and  a  slightly  acid  reaction. 
The  pharmacopoeia  prescribes  that  its  specific 
gravity  shall  not  be  more  than  0'930  or  less 
than  0'914.  It  should  be  free  from  more  than 
mere  traces  of  fusel  oil,  added  sugar,  glycerin, 
and  aromatic  substances. 

Whisky  is  one  of  the  best  of  alcoholic  stimu- 
lants. It  is  ordinarily  preferred  to  brandy  in 
this  country,  because  of  its  usual  purity  and  its 
cheapness.  Its  tendency  to  constipate  is  less 
than  that  of  brandy.  It  may  be  employed  in 
any  sudden  collapse  of  cardiac  power  from  syn- 
cope, hcemorrhage,  or  any  other  cause.  When- 
ever a  cardiac  stimulant  is  indicated,  whisky 
may  be  given  by  the  mouth  if  possible,  hypoder- 
mioally,  or  in  an  enema.  In  the  first  and  last 
instances  it  is  best  given  hot.  In  adynamic 
fevers,  like  typhus  and  typhoid,  the  benefits  to 
be  derived  from  a  systematic  administration  of 
whisky  are  well  known  and  have  been  discussed 
in  another  article.  In  cases  of  poisoning  by 
substances  which  depress  the  heart,  alcohol  in 
the  form  of  whisky  is  indicated.  In  chronic 
pulmonary  tuberculosis  whisky  is  an  almost  in- 
dispensable medicinal  agent,  particularly  in  the 
last  stages  of  the  disease.  It  is  unnecessary  to 
enumerate  all  the  diseases  in  which  whisky  may 
be  employed  as  a  rational,  proper  therapeutic 
aid.  In  general  it  may  be  said  that  when  car- 
diac stimulation  is  required,  where  general  ady- 
namia prevails,  when  constitutional  weakness 
demands  a  rapid  general  stimulant,  whisky  is 
indicated. 

As  an  antiseptic  agent  whisky  possesses  some 
value,  but  in  its  employment  for  surgical  dress- 
ings it  has  long  been  superseded  by  other  sub- 
stances. 

As  to  its  administration,  whisky  may  be  given 
pure  or  in  combination  with  other  stimulants. 
In  an  emergency  it  may  be  administered  hypo- 
dermically — from  its  proneness  to  cause'  ab- 
scesses, the  injection  should  always  be  made 
deep — or  by  the  rectum.  When  given  in  fevers, 
the  quantity  must  vary  with  the  effects.  In 
the  form  of  eggnog  and  milk-punch  it  is  agree- 
able to  a  convalescent.  The  usual  dose  of  whis- 
ky for  an  adult  is  from  half  an  ounce  to  an 
ounce. — Samuel  M.  Beicknbr. 

WILLOW.— See  Salix. 

WINES.— The  history  of  the  use  of  wines 
begins  with  antiquity.  Throughout  the  Bible 
mention  is  made  of  the  employment  of  the 
juice  of  the  grape  in  religious  ceremonies  and 
in  social  entertainment.  The  drunkenness  of 
Noah  and  the  prophecy  made  by  Jacob  on  his 
deathbed,  in  which  there  is  a  reference  to  wine, 
show  the  great  antiquity  of  the  drink.  The 
Hebrews  of  antiquity  drank  fermented  wine 
and  an  artificial  wine  made  from  the  palm. 
Bzekiel  is  authority  for  the  statement  that  the 
drinking  of  wines  at  festive  gatherings  was  a 
rare  form  of  entertainment.  Moses  forbade  the 
priests  the  drinking  of  wine  or  of  any  intoxi- 


WINES 


386 


eating  liquor  previous  to  their  entrance  to  the 
temple.  Hosea  praised  the  peculiar  virtues  of 
the  wines  of  Lebanon,  although  they  were  not 
suited  for  transportation  for  long  distances. 
The  best  of  these  wines  is  known  in  Europe  at 
the  present  time  as  vin  cCor.  This  wine  is  not 
fermented  in  the  usual  way.  Fermentation  is 
induced  by  placing  the  grape-juice  in  clay  ves- 
sels in  the  sun.  It  is  said  of  the  vin  d'or  that 
a  few  glasses  drank  at  one  sitting  will  produce 
syncope.  The  vines  of  Palestine  are  still,  fa- 
mous for  the  size  and  sweetness  of  their  grapes. 
The  ancient  Jews  had  a  preference  for  red  wine. 
The  vintage,  which  lasted  from  September  to 
N'ovember,  was  celebrated  with  joyful  cere- 
monies. The  mechanism  of  their  wine  presses 
was  extremely  crude  ;  part  of  the  wine  was  fer- 
mented, part  of  it  drank  as  must. 

The  profane  writings  of  antiquity,  no  less 
than  the  sacred,  contain  multitudinous  refer- 
ences to  the  growth  of  grapevines,  the  drink- 
ing of  wine,  and  its  effects.  Despite  the 
testimony  of  Herodotus  to  the  contrary,  it 
seems  to'be  established  that  the  ancient  Egyp- 
tians cultivated  the  vine.  The  edge  of  the 
Nile  valley,  from  Thebes  to  Memphis,  contained 
soil  well  adapted  to  the  growth  of  the  grape. 
Sebennytus  is  celebrated  by  Pliny  as  having 
produced  very  fine  wine.  The  ripe  grapes  were 
gathered  in  baskets  or  hampers,  which  were  car- 
ried by  men  on  their  heads  or  by  yokes  upon 
their  shoulders  to  the  shed,  where  the  pressing 
of  the  grapes  was  accomplished  by  squeezing 
in  a  bag  or  by  treading.  According  to  Gene- 
sis (xl,  11),  the  juice  was  sometimes  drank  un- 
fermented :  "  I  took  the  grapes  and  pressed 
them  into  Pharaoh's  cup  and  I  gave  the  cup 
into  Pharaoh's  hand."  Usually,  however,  fer- 
mentation was  allowed  to  take  place  and  the 
wine  was  kept  in  hermetically  sealed  jars  of 
beautiful  forms.  The  light  wine  was  made  in 
Coptos ;  the  heavier  wines  of  good  repute  were 
derived  from  the  neighbourhood  of  Anthylla 
and  Lake  Marea. 

Drunkenness  among  the  Egyptians  was  by 
no  means  unknown.  Men  and  women  alike 
succumbed  to  the  influence  of  the  wine  pro- 
vided at  feasts.  On  the  authority  of  Herodotus, 
it  is  believed  by  Egyptologists  that  a  guest  in 
an  Egyptian  household  was  always  served  with 
wine,  although  it  is  fair  to  assume  that  it  was 
usually  drank  diluted  with  water.  Drunken- 
ness was  a  vice  in  early  Egyptian  history,  and 
to  it  must  be  ascribed  the  subjugation  of  the 
land  by  hardier  races — the  Assyrians,  the  Per- 
sians, and  the  Macedonian  Greeks. 

Among  the  Greeks  and  Romans  wine  was 
employed  as  a  drink  and  as  a  medicine.  Homer 
mentions  many  varieties  of  wine  which  were 
celebrated  for  peculiar  properties.  He  sings  of 
the  wines  of  Phrygia,  Epidaurus,  Arne,  and 
Thrace ;  and  the  products  of  Cyprus,  Ohio,  and 
Lesbos  were  equally  celebrated.  Horace  fre- 
quently alludes  to  the  virtues  of  Chian  wine. 
'The  Chians  are  said  to  have  first  known  the  art 
of  the  cultivation  of  the  vine,  taught  by  Qilno- 
pion,  the  son  of  Bacchus.  They  probably  made 
the  first  red  wine.  In  some  parts  of  Greece  the 
wine  of  Lesbos  was  preferred  to  all  others,  be- 
cause of  its  sweetness  and  its  delicious  flavour. 


The  wines  of  Naxos,  celebrated  as  being  the 
birthplace  of  Bacchus,  had  in  aweient  times, 
and  still  have,  high  repute.  Thasos  produced 
a  wine  which,  though  inferior  to  the  other 
wines,  was  compared  by  Pliny  to  nectar.  The 
Greeks  always  drank  their  wine  diluted,  in  the 
proportion  of  two  fifths  wine  and  three  fifths 
water.  The  mixing  bowl  usually  stood  near 
the  hearth,  often  on  a  tripod,  and  the  wine  was 
poured  from  this  into  drinking  cups.  Athe- 
njeus  quotes  from  a  poet  who  says  that  if  like 
parts  of  water  and  wine  are  used,  lunacy  fol- 
lows ;  if  the  wine  is  drank  pure,  paralysis  sure- 
ly results.  Herodotus,  too,  speaks  of  drinking 
pure  wine  as  "  filling  like  a  Scythian."  Homer 
records  several  kinds  of  wine — the  red,  the 
sparkling,  and  the  honey-sweet.  A  special 
wine  seems  to  have  been  reserved  in  honour  of 
elders  at  feasts  {■yepoiaiov). 

The  ancient  medical  writers  of  Greece  and 
Rome  "used  wine,  in  one  form  or  another,  in 
almost  all  diseases.  They  studied  carefully  the 
effects  of  different  kinds  of  wine  upon  the  sys- 
tem. Thus  they  recognised  that  new  wine  had 
a  tendency  to  upset  the  digestion,  to  promote 
diuresis,  and  to  interfere  with  calm  sleep.  They 
record  that  unfermented  wine  produces  colic, 
fiatulence,  and  diarrhoea.  The  appearance  of 
headaches  and  impaired  digestion  was  attrib- 
uted to  sweet  wines.  Hippocrates  recognised 
the  muscular  debility  which  follows  the  too 
habitual  use  of  wine,  and  pointed  out  the  dan- 
gers of  the  sudden  cessation  of  drinking.  As 
cited  by  Strumpf,  Hippocrates  also  recommend- 
ed wine  in  cases  of  poisoning  by  opium,  aco- 
nite, conium,  and  mushrooms,  or  whenever  a 
narcotic  poison  had  produced  depression.  He 
also  used  it  as  an  antidote  to  the  bites  of  ven- 
omous serpents,  and  praises  white  wine  as  a 
diuretic  in  calculous  disorders.  Wine  was  fre- 
quently used,  on  the  same  authority,  as  an  ap- 
plication to  wounds  and  ulcers.  As  a  stimulant 
it  was  used  in  the  algid  stages  of  fevers.  In 
hypercatharsis,  flatulence,  and  diarrhoea  it  was 
supposed  to  act  almost  as  a  specific.  Galen  de- 
scribes a  great  many  wines ;  but,  like  Pliny, 
gives  more  contra-indications  for  their  use  than 
reasons  for  thinking  that  their  employment 
would  be  beneficial. 

The  ancient  Arabs  possessed  wines  made  from 
the  grape,  raisins,  figs,  dates,  honey,  and  the 
juice  of  sweet  fruits,  as  well  as  from  the  cocoa 
and  pomegranate.  Rhazes  (cited  in  Stille's 
Therapeutics  and  Materia  Medica,  Philadel- 
phia, 1874),  speaking  of  the  advantages  of  wines 
used  moderately,  remarks  that  the  complexion 
and  nutrition  are  thereby  improved,  that  the 
excretions,  particularly  that  of  the  urine,  are 
promoted,  that  the  sleep  is  rendered  sound  and 
refreshing,  and  that  the  mental  faculties  are 
quickened.  He  says  wines  should  not  be  taken 
habitually,  but  only  at  intervals  of  several  days. 
Intoxication  he  paints  in  fearful  colours.  Its 
repetition,  he  says,  induces  disease,  headache, 
paralysis,  shaking  palsy,  and  acute  affections. 
Visceral  inflammation,  abscesses,  furuncles, 
mental  weakness,  apoplexy,  emaciation,  and 
palpitation  of  the  heart  are  some  of  the  dire 
things  this  Arabian  physician  predicts  for  the 
inebriate.    He  recommends  emetics  as  a  reme- 


387 


WINES 


dy  for  the  nausea  and  headache  following  a  de- 
bauch, and  advises  rest  with  the  use  of  acid 
syrups  diluted  with  water  or  barley  water. 

Probably  every  nation  or  tribe,  from  the  dawn 
of  history  and  before  that  time,  which  possessed 
any  fermentable  substance  made  s.om6  kind  of 
wine.  And  it  is  altogether  likely  that,  observ- 
ing the  stimulant  effect  of  wine  when  taken  in 
health,  they  all  used  it  for  medicinal  effect  when- 
ever it  was  deemed  wise  or  necessary.  Evidence 
is  not  lacking  on  this  point  in  the  writings 
quoted,  as  well  as  in  those  of  Strabo,  of  Galen, 
of  Paulus  -SJgineta,  and  of  Cicero.  Whether 
or  not  the  Egyptians  made  use  of  wines  medi- 
cinally is  not  definitely  known,  but  it  may  be 
surmised  that  such  was  the  case  from  their  con- 
tact with  nations  that  did.  Wine  and  oil  al- 
ways stood  as  representing  the  fertility  and 
the  wealth  of  a  country  in  ancient  times ;  and 
the  fact  that  "  a  land  flowing  with  milk  and 
honey "'  was  offered  as  an  inducement  to  the 
ancient  Jews  does  not  militate  against  their 
having  had  wine,  since  milk  and  honey,  on 
competent  authority,  represented  their  chief 
articles  of  diet.  The  religious  use  of  wine 
probably,  or  possibly,  began  in  a  sacrificial 
way,  the  fermented  juice  of  the  grape  being, 
rare  and  therefore  a  thing  worthy  of  sacrifice. 
Its  use  in  the  communion  service  is  a  heritage 
of  an  ancient  custom.  It  is  interesting  to  note 
that  among  the  ceremonial  usages  in  which 
wine  plays  a  part  is  its  administration,  in  the 
form  of  palm  wine,  to  a  mother  among  the 
negroes  of  Guiana  immediately  after  the  birth 
of  her  child.  In  Pranconian  Switzerland  the 
relatives  of  a  parturient  woman  take  turns  in 
bringing  her,  during  the  entire  puerperium,  a 
soup  of  peculiar  make  which  always  contains 
wine.  Among  the  Roman  medical  writers, 
Soranus  of  Ephesus  forbade  the  use  of  wine 
early  in  pregnancy,  because  he  feared  an  abor- 
tion. The  Jewish  women  of  ancient  times  were 
not  allowed  to  drink  wine  during  their  period 
of  pregnancy.  The  Chinese  seem  to  be  more 
liberal  in  this  respect,  permitting  their  preg- 
nant women  to  drink  anything  that  has  a  pleas- 
ant taste ;  but  they  must  not  drink  to  excess 
anything  that  is  intoxicating  or  heating  to 
the  blood.  The  Laplanders,  during  pregnancy, 
may  drink  Sarakka  wine ;  but  with  them  this 
is  a  religious  ceremony,  since  Sarakka  is  the 
goddess  who  presides  over  pregnancy  and  child- 
birth. The  German  women  of  five  centuries 
ago  were  advised  to  drink  any  strong  wine, 
especially  claret;  but  there  is  no  evidence  that 
similar  usages  prevail  to-dav  (Ploss,  Das  Weib, 
Leipsic,  1891,  vol.  ii,  pp.  331,  336,  513,  514). 
Finally,  it  may  be  mentioned  that  wine  is  used 
in  the  performance  of  some  ceremonies  of  a 
semi-religious,  semi-social  nature.  In  mar- 
riages and  engagements  the  drinking  of  wine 
is  customary  among  some  peoples,  being  essen- 
tial to  the  function.  The  rite  of  baptism  and 
that  of  circumcision  are  frequently  accom- 
panied by  the  drinking  of  wine,  a  white  wine 
being  usually  chosen  for  this  purpose. 

For  many  hundreds  of  years  the  wine  indus- 
try has  been  pursued  in  European  countries  par- 
ticularly, although  at  present  American  wmes 
are  forging  their  way  to  the  front,  and  the  cul- 


tivation of  the  vine  and  its  subsequent  treat- 
ment until  the  perfected  product  is  secured  are 
very  thoroughly  understood.  The  grapevine 
grows  luxuriantly  in  many  places,  especially  in 
ground  rich  in  the  salts  of  phosphorus  and  po- 
tassium. The  manure  used  is  of  importance 
as  well,  since  it  is  found  that  the  richer  the 
fertilizing  agent,  the  greater  is  the  effect  upon 
the  taste  of  the  grape-juice.  In  Germany  and 
Prance  the  dung  of  cattle  is  preferred  "to  all 
other  fertilizers,  since  it  is  very  rich  in  phos- 
phorus and  potassium.  The  finer  wines,  such 
as  Burgundy  and  Riesling,  show  a  difference 
in  taste  depending  upon  the  agent  used  for 
fertilizing. 

Hundreds  of  varieties  of  grapes  are  recog- 
nised by  viticulturists,  but  those  most  in  favour 
are  enumerated  here :  For  white  wines,  Sau- 
vignon  Vert,  Golden  Chasselas,  and  Bergher 
are  used  in  America ;  Riesling,  Rulander,  and 
white  Burgundy  are  chosen  in  Germany.  For 
the  medium  and  light  white  wines  of  Germany, 
Elbling,  Orleans,  and  Ortlioher  are  used.  For 
the  manufacture  of  red  wines,  Carbanet  Sau- 
vignon,  the  various  Burgundy  grapes,  Laska, 
Trollinger,  Mataro,  Carignau,  Zinfandel,  Le- 
noir, and  St.  Lawrence  grapes  are  the  princi- 
pal varieties.  Pedro  Ximenes,  Black  Burgundy, 
Trousseau,and  Old  Mission  grapes  are  employed 
for  the  production  of  ports  and  sherries.  IJn- 
less  otherwise  specified,  grape  wine  will  be  re- 
ferred to  in  this  article  when  wine  is  mentioned. 

Ripe  grapes  only  are  chosen  for  the  produc- 
tion of  wine.  The  expressed  juice  of  the  grape 
is  received  into  vats  and  is  known  as  must.  At 
the  ordinary  summer  temperature,  or  even  at  a 
temperature  of  60°  P.,  fermentation  begins  in 
the  clear  juice  of  the  grape  within  half  an  hour. 
The  juice  becomes  cloudy  and  thick  and  gives 
off  bubbles  of  carbonic-acid  gas  which  causes 
a  froth  to  form  at  the  surface  containing  the 
more  solid  parts.  This  is  called  the  head.  The 
grape-sugar  formerly  contained  in  the  juice  is 
now  being  converted  into  alcohol,  and  the  fluid 
loses  its  sweet  taste  and  becomes  vinous.  The 
fermentation  is  due,  according  to  the  best  au- 
thorities, to  the  presence  of  Saccha/romyces 
apiculatus  and  to  the  moulds  adhering  to  the 
grape-skins.  "Within  forty-eight  hours  after  the 
beginning  of  the  fermentation,  Saccha/romyces 
ellipsoideus  takes  the  place  of  the  ferment  above 
mentioned,  and  the  process  is  contiimed  for  an 
indefinite  period,  varying  with  the  ripeness  of 
the  grape,  its  previous  nourishment,  its  treat- 
ment, and  the  climate.  The  fermentation  ceases 
after  avarying  time  and  is  renewed  by  stirring 
the  contents  of  the  vat.  When  the  fluid  be- 
comes perfectly  clear  it  is  considered  wine  and 
is  placed  in  casks,  where  the  fermentation  is 
continued  for  from  six  to  eight  months.  This 
continued  fermentation  is  known  as  the  sec- 
ondary, in  contrast  to  that  which  first  occurs, 
the  primary.  It  is  essential  for  its  perfection 
that  air  should  be  excluded,  and  it  is  sometimes 
necessary  to  add  wine  to  it.  The  secondary  fer- 
mentation may  not  be  complete,  and  sometimes 
years  after  the  wine  is  pressed  from  the  grape 
fermentation  occurs,  a  sign  that  it  was  not  fin- 
ished as  it  should  have  been  when  placed  in  the 
cask.    During  the  entire  time  of  fermentation 


WINES 


388 


a  frothy  matter  is  formed  which,  with  the 
colouring  matters  and  tartar,  eventually  sinks 
to  the  bottom  of  the  cask,  when  it  is  called 
wine-lees.  The  shortest  time  for  wine  to  be 
ready  to  be  bottled  is  two  years.  Wines  very 
rich  in  sugar  may  undergo  occasional  fermen- 
tation for  years,  always  with  an  increase  of 
alcohol  and  a  decrease  in  the  acids,  the  tartar, 
and  th3  sugar.  It  is  during  the  secondary  fer- 
mentation that  the  bouquet  of  a  wine  is  devel- 
oped, as  the  lees  is  formed.  It  consists  of 
the  odorous  principles  contained  in  the  grape 
and  those  developed  by  the  fermenting  pro- 
cess. This  is  to  be  sharply  distinguished  from 
the  aroma  of  the  wine,  which  is  recognisable 
by  either  taste  or  smell. 

From  one  and  a  half  to  three  per  cent,  of  the 
wine  usually  evaporates  annually  through  the 
pores  of  the  containing  casks,  and  in  order  to 
avoid  the  germination  of  mould  and  the  conse- 
quent acetous  fermentation,  the  cask  must  be 
refilled.  The  longer  wine  is  allowed  to  remain 
sealed  in  casks,  secure  from  the  advent  of  air, 
the  finer  will  its  bouquet  become  and  the  greater 
its  percentage  of  alcohol.  Very  old  wine,  how- 
ever, is  found  to  lose  in  alcohol.  The  preser- 
vation of  wine  is  achieved  by  burning  pure 
sulphur  in  the  casks  in  which  it  is  to  be  per- 
manently stored.  This  process  frees  the  vat 
from  the  possibility  of  becoming  mouldy  and  is 
now  almost  universally  practised.  Filtering 
the  wine  or  the  adding  of  gelatin  or  albumin- 
ous substances  to  it  is  the  means  employed  to 
make  it  clear.  Red  wines  usually  lose  some  of 
their  colour  by  the  employment  of  these  pro- 
cedures, and  on  these  wines  it  is  practised  to  a 
very  small  extent. 

Among  the  agents  used  now  and  formerly 
for  the  preservation  of  wines  may  be  mentioned 
salicylic  acid,  boric  acid,  electricity,  plaster  of 
Paris,  peroxide  of  hydrogen,  and  phosphate  of 
calcium.  Plaster  of  Paris  is  commonly  used  in 
France  and  in  most  of  the  southern  countries. 

These  various  measures  for  preserving  or  im- 
proving wine  have  each  a  chemical  basis,  but 
the  processes  are  so  involved  that  they  have 
not  all  been  thoroughly  worked  out.  Salicylic 
acid  is  employed  to  preserve  wines  by  stopping 
the  fermentative  process.  Its  addition  to  food 
stuffs  is  prohibited  in  Germany,  and  Konig  is 
of  the  opinion  that  the  small  quantity  which  can 
be  added  without  giving  the  wine  a  disagreeable 
after-taste  is  ineffectual  as  a  preventive  of  fer- 
mentation. Boric  acid  has  been  employed  with 
the  same  intent,  and,  indeed,  boric  acid  in  mi- 
nute quantities  is  found  in  the  ash  of  the  wine ; 
but  its  effect  upon  the  organism  is  by  no  means 
indifferent,  and  its  employment  is  not  to  be 
recommended.  Some  Italian  chemists  have  of 
late  recommended  electricity  as  a  preservative 
of  wines.  The  statement  is  made  that  the  cur- 
rent aids  in  the  improvement  of  the  wine  and 
helps  to  render  it  aseptic.  But  these  results 
have  not  yet  been  confirmed.  Experiments 
with  hydrogen  peroxide  have  also  been  made 
with  a  view  to  clearing  the  wine  and  ripening 
it  quickly;  but  these,  too,  will  require  further 
elaboration  to  give  the  procedures  a  place 
among  those  regularly  practised . 

Of  all  the  measures  which  have  gained  a  wide 


prestige  for  the  preservation  of  wines,  the  ad- 
dition of  plaster  of  Paris  to  the  marc  is  the 
most  constantly  used.  As  mentioned  above, 
it  is  freely  practised  in  France,  particularly  in 
the  southern  portion,  but  it  is  generally  em- 
ployed in  southern  Italy,  Sicily,  Spain,  and 
Portugal.  Oxidized  and  non-oxidized  plaster 
of  Paris  are  both  employed,  and  the  statement 
is  made  that  by  this  means  fermentation  is 
hastened,  that  the  colour  of  the  wine  is  im- 
proved, and  that  its  permanence  is  increased. 
However,  platrage,  as  the  process  is  known  to 
the  French,  is  not  only  superfluous,  but  posi- 
tively injurious,  since  it  not  only  changes  the 
wine  chemically,  but  actually  produces  chem- 
ical bodies  which  may  be  injurious  to  the 
drinker.  One  of  the  dangers  consists  in  the 
liberation  of  free  phosphoric  acid  under  cer- 
tain circumstances.  The  chemical  changes  may 
be  briefly  stated  as  follows:  When  plaster  of 
Paris  is  added  to  soluble  salts  of  tartaric  acid, 
an  almost  insoluble  calcium  tartrate  and  the 
bisulphate  of  potassium  are  formed.  The  sul- 
phate of  potassium  may  disintegrate  some  of 
the  salts  of  phosphoric  acid  held  in  solution  in 
the  must,  and  free  phosphoric  acid  result  from 
this  reaction.  This  is  the  German  view.  The 
French  chemists  think  that  through  the  influ- 
ence of  the  calcium  sulphate  (plaster  of  Paris) 
the  stability  of  the  wine  and  its  acidity  are  in- 
creased by  the  introduction  into  the  wine  of 
the  potassium  bitartrate  which  is  in  the  grape, 
and,  on  account  of  its  insolubility,  usually  re- 
mains in  the  lees.  Chemists  do  not  agree  as  to 
the  changes  that  then  take  place.  But  it  is  safe 
to  assume  that  tartaric  acid,  sulphuric  acid,  and 
potassa  are  set  free  in  the  wine,  with  the  ulti- 
mate formation  of  potassium  bitartrate  and 
potassium  bisulphate,  the  latter  salt  contribut- 
ing to  the  increased  acidity  of  the  wine.  The 
gravest  danger  lying  in  plastered  wines  is  in 
the  deleterious  effects  of  the  potassium  sulphate 
upon  digestion,  upon  the  action  of  the  lieart, 
and  upon  the  blood.  It  tends  to  reduce  the 
alkalinity  of  the  blood,  as  has  been  proved  ex- 
perimentally by  Nencki,  Lichtheim.  and  Loch- 
singer  (Journal  fur  praMische  Chemie,  new 
series,  vol.  xxv,  1883,  p.  384).  These  observers 
gave  a  dog  for  eight  days,  with  its  usual  food, 
from  30  to  45  grains  of  acid  potassium  sul- 
phate, with  the  result  of  reducing  the  alkalin- 
ity of  its  blood  22  per  cent.  Concerning  the 
plastering  of  wines  they  reach  these  conclu- 
sions :  Wines  which  contain  less  than  15  grains 
of  plaster  of  Paris  to  a  quart  have  not  proved 
injurious ;  when  heavily  plastered  wines  are 
used  for  a  considerable  length  of  time,  the 
health  may,  however,  become  impaired;  the 
sale  of  plastered  wines  should  be  a  subject  of 
legislative  interference,  and  no  wine  which  con- 
tains more  than  15  grains  of  neutral  potassium 
sulphate  to  the  quart  should  be  sold  in  the 
market.  Considering  the  possible  dangers  to 
health,  it  seems  rational  to  discard  all  wines 
which  contain  more  than  5  grains  of  neutral 
potassium  sulphate  to  the  quart.  The  detec- 
tion of  the  plastering  of  wines  depends  upon 
the  demonstration  of  the  presence  of  the  acid 
potassium  bisulphate  or  of  the  neutral  potas- 
sium sulphate. 


389 


WINES 


Attempts  have  been  made  to  neutralize  the 
calcium  sulphate  of  the  plaster  of  Paris  by  cal- 
cium phosphate,  and  it  has  been  suggested  that 
the  potassium  bisiilphate  may  be  neutralized 
by  the  addition  of  strontium  tartrate  and  tar- 
taric acid ;  .but  it  has  been  found  that  these 
agents  do  not  entirely  remove  the  potassium 
salt,  that  equal  quantities  of  strontium  salts 
replace  it,  and  that  the  wine  is  even  more 
harmful  than  before.  Various  baryum  salts — 
the  nitrate,  the  chloride,  the  carbonate,  the 
acetate,  etc. — have  also  been  recommended  for 
the  neutralization  of  the  plaster  of  Paris,  but, 
on  account  of  their  direct  poisonous  effects, 
are  not  employed.  On  the  recommendation 
of  Hugounenq,  dicalcium  phosphate  may  be 
employed  for  the  preservation  of  wines  and  to 
promote  their  clearing.  This  process  is  called 
phosphatage,  and  is  said  to  have  all  the  vir- 
tues of  the  use  of  plaster  of  Paris  without  in- 
creasing the  sulphuric  acid  or  diminishing  the 
phosphoric  acid. 

The  following  table  shows  the  changes  that 
take  place  in  wines  which  have  undergone  pld- 
trage  (Bersch,  Die  Praxis  der  Weinbereitung, 
1889,  p.  417).  one  half  of  a  given  quantity  of 
wine  having  been  plastered,  the  other  half  not : 


Specific  gravity 

Alcohol 

Extractive  matters 

Total  acidity 

Volatile  acids 

Tartaric  acid 

Glycerin 

Tannic  acid  and  colour- 
ing matters 

Sulphurous  acids 

Potassium  sulphate 
(HKSO4) 

Ash 

The  ash  contains : 

Sulphurous  acid 

Phosphoric  acid 

Ferric  oxide  and  clay. . . 

Calcium 

Magnesia 

Potassium 


Plastered. 


0-9960 

10-99  vol.  p.  c. 
2-76p.  c.  wgt. 
6-6Q per  cent. 
0-71 
1-50 
8-20 

1-57        " 
1-52        " 

2-68 
4-38        " 

360         " 
8-9 
0-9 


Not  plastered. 


9955 

80  vol.  p.  C. 

50  p.  c.  wgt. 

00  per  cent. 

69 

60        " 

20 

68        " 


To  procure  a  diminished  acidity  of  wine,  cal- 
cium carbonate,  calcium  saccharate,  or  neutral 
potassium  tartrate  may  be  added.  The  wine 
takes  up  little  or  none  of  the  calcium  salt, 
and  it  is  therefore  scarcely  injurious.  Chaptal 
gave  the  name  to  the  process  by  which  sugar 
and  calcium  carbonate  are  added  to  must  which 
is  hyperacid.  An  increase  in  the  quantity  and 
sweetness  of  wine  may  be  obtained  by  the  pro- 
cess of  Gall.  After  the  better  grapes  are  se- 
lected from  the  poorer  ones,  the  poor  ones  are 
made  into  must,  and  to  that  is  added  at  once 
an  aqueous  solution  of  grape  sugar,  so  that  the 
must  shall  contain  a  proportion  of  sugar,  acids, 
and  water  equal  to  that  of  must  made  from  the 
best  of  grapes.  The  good  taste  of  poor  wine  is 
enhanced  by  this  process,  which  is  certainly  not 
an  honest  one. 

On  the  suggestion  of  Petiot,  some  inferior 
wines  are  made,  especially  in  France,  by  fer- 
menting the  marc  of  the  grapes,  from  which 
wine  has  already  been  prepared,  with  an  aque- 


ous solution  of  grape  sugar.  Some  excellent 
wines  may  be  manufactured  in  this  way  from 
grapes  of  superior  quality  ;  but  the  oftener  the 
marc  is  placed  in  the  solution  of  sugar,  the 
poorer  is  the  quality  of  the  wine.  As  a  rule, 
these  wines  have  an  agreeable  taste.  They  are 
frequently  adulterated  with  tannin,  glycerin, 
tartaric  acid,  etc. 

There  are  several  other  processes  in  vogue  in 
wine-making  countries  for  the  improvement, 
adulteration,  reduction  of  acidity,  and  increase 
of  quantity  of  wines,  but  the  main  ones  have  been 
here  mentioned,  and  the  others  are  scarcely  of 
sufficient  importance  to  warrant  their  descrip- 
tion in  this  article. 

All  wines  have  certain  common  properties. 
They  are  all  spirituous  liquors  obtained  by  fer- 
mentation from  fruit  or  grape  juices,  contain- 
ing a  certain  quantity  of  alcohol,  which  varies 
with  the  juice  and  its  subsequent  treatment. 
Even  wines  of  the  same  class  differ  materially 
in  their  amounts  of  alcohol.  The  following 
table  shows  the  average  percentages  of  alcohol 
in  the  principal  foreign  wines : 

Port  wine 19  to  23  per  cent. 

Sherry 15  to  25  " 

Madeira 18  to  32  '• 

Bordeaux 9  to  15  " 

Burgundy 7  to  13  " 

Rhine  wine 8  to  13  " 

Moselle  wine 8  to  11  " 

Tokay 9  to  13  " 

Champagne 5  to  15  " 

(Johnston's  Chemie  des  taglichen  Lelens,  Stutt- 
gart, 1887,  p.  267.) 

The  American  wines  contain  from  10  to  25 
per  cent,  of  alcohol,  according  to  their  quality 
and  variety. 

All  grape  wines  contain  a  certain  proportion 
of  grape-sugar,  to  which  the  sweetness  of  their 
taste  is  due  and  which  is  responsible  for  their 
fermentation.  They  all  contain  a  varying  quan- 
tity of  acid  which  is  responsible  for  the  more  or 
less  conspicuous  '•  vinosity  "  in  the  taste  of  the 
wine.  The  acids  of  wines  are  tartaric  acid  and 
acetic  acid,  the  latter,  as  pointed  out  above,  an 
impurity.  Malic  acid  is  found  in-  wines  which 
have  been  derived  from  unripe  grapes ;  but  it 
gradually  disappears  from  the  grape  as  it  ripens, 
and  its  presence  in  unripe  grapes  is  one  of  the 
reasons  for  choosing  the  ripe  fruit  of  the  vine 
for  wine-producing  purposes.  The  character- 
istic odour  of  wine  is  due  to  the  presence  of 
oenanthio  ether,  and  it  is  possessed  by  all  wines. 
This  ether  is  a  product  of  the  fermentation  of 
the  must,  and  is  said  by  Neubauer  to  contain 
as  its  principal  elements  caprylic  and  caprinic 
ethers.  It  is  probably  increased  with  the  age 
of  the  wine,  but  is  always  present  in  very  small 
comparative  quantities,  from  1  to  10,000  to  1 
to  40,000  parts  by  volume.  Aside  from  the 
general  characteristic  odour  of  wines  derived 
from  this  source,  each  wine  derives  an  aroma 
from  the  grape  from  which  it  is  made  which 
distinguishes  it  from  all  other  wines. 

The  proverbial  improvement  attained  by 
wines  with  age  springs  from  the  facts  already 
enunciated.  It  may  be  well  to  repeat  them 
briefly.    As  long  as  wine  contains  grape-sugar, 


WINES 


390 


fermentation  is  induced  which  increases  its 
percentage  of  alcohol.  Wines  that  contain 
but  little  sugar  do  not  improve  much  with  age 
unless  sugar-containing  wine  is  added  to  them 
from  time  to  time.  The  presence  of  cenanthic 
ether  is  fostered  by  the  prolonged  fermenta- 
tion, and  hence  the  wine  gets  a  stronger  odour. 
The  acids  of  the  wine  are  diminished  by  the 
separation  of  tartaric  acid,  which  increases  as 
time  passes.  Lastly,  the  clearness  and  the 
purity  of  the  taste  of  the  wine  are  increased 
by  the  removal  of  the  ferment. 

According  to  their  colour,  wines  are  divided 
into  red  and  white.  According  to  their  taste, 
they  are  known  as  npirituous,  siveet,  dry,  light, 
sparkling,  rough,  or  acidulous.  Red  wines  are 
made  from  the  must  of  black  grapes,  fermented 
with  the  marc — i.  e.,  their  skins  and  seeds.  White 
wines  are  derived  from  white  grapes  or  from 
black  grapes  freed  from  the  mare.  The  colour- 
ing matter  of  the  skin  of  the  grape  is  insoluble 
in  water,  but  is  dissolved  by  alcohol,  and  so  the 
juice  of  grapes  fermented  with  the  marc  be- 
comes red  as  fermentation  proceeds.  A  spiritu- 
ous wine  is  produced  from  the  Juice  of  a  grape 
that  is  very  saccharine,  in  which  fermentation 
is  easily  induced  and  proceeds  until  checked 
by  the  presence  of  a  certain  amount  of  alcohol. 
If  the  ferment  is  deficient  in  quantity  and  the 
sugar  superabundant,  a  sweet  wine  will  result. 
A  dry  wine  is  one  free  from  excess  of  sugar. 
The  grapes  that  contain  but  little  saccharine 
material  furnish  wines  having  a  comparatively 
smaller  proportion  of  alcohol,  which  are  known 
as  light  wines.  Sparkling  wines  are  those  which 
continue  to  undergo  fermentation  in  bottles 
with  a  production  of  carbonic-acid  gas.  The 
presence  of  tannic  acid  derived  from  the  marc 
of  the  grape  distinguishes  the  rough  or  astrin- 
gent wines,  while  the  acidulous  wines  are  char- 
acterized by  the  presence  of  tartar  or  carbonic 
acid.  Among  the  principal  sweet  wines  are 
sherrj',  Madeira,  port,  champagne,  muscat,  and 
Tokay.  The  principal  sparkling  wines  are  cham- 
pagne and  Moselle.  Madeira  wine  was  formerly 
much  in  use.  It  is  a  white  wine  with  a  rich, 
aromatic  flavour.  Its  frequent  adulteration 
renders  its  quality  uncertain.  Teneriffe  wine 
bears  a  close  resemblance  to  Madeira,  and  when 
pure  has  a  somewhat  acid  taste  and  a  delight- 
ful aromatic  odour.  Claret  is  the  most  widely 
used  French  wine.  It  is  a  red.  light  wine.  It 
is  somewhat  astringent  and  acid  in  taste,  with 
a  vinous  flavour.  The  brands  Chateau-Lafitte, 
Chateau-Latour,  Chdteau-Haut-Brion,  and  St. 
Julien  are  the  most  celebrated.  Sherry  wine, 
vinum  xerieum  {U.  S.  Ph.,  1870,  Br.  Ph.),  and 
port,  vinum  portense  (0.  S.  Ph.,  1870),  will  be 
described  under  the  official  wines. 

The  classification  of  wines  according  to  their 
source  is  convenient,  and  the  principal  ones 
will  be  here  mentioned : 

German  Wines. — 1.  Rhenish.  The  best  of 
these  are  the  white  wines.  The  wines  made 
from  Riesling  grapes  are  particularly  known 
for  their  delicate,  delicious,  refreshing  flavour 
and  their  characteristic  bouquet.  They  are 
sometimes  of  value  in  nervous  diseases.  The 
Orleans  wines  are  stronger  and  lack  the  aroma 
of  the  Eiesling  products.    The  best  known  of 


these  wines  are  Marcobrunner,  Johannisberger, 
Riidesheimer,  Hoehheimer,  and  Niersteiner.  2. 
Main  wines,  of  which  the  Steinwein  is  the  most 
celebrated.  3.  Pfalzeryixaes.  4.  Moselle  wines. 
5.  Aar  wines.  6.  Nechar  wines.  7.  Margrave 
wines.  8.  Baden  wines.  9.  Bohemian  wines. 
10.  Ilungarianv/ines:  white — CEdenberger;  red 
— Ofener,  Tokay,  Erlauer. 

French  Wines. — 1.  Champagnes  may  be 
either  red  or  white.  The  white  champagnes 
of  France  are  famous  and  are  consumed  in  all 
parts  of  the  world.  2.  The  Burgundy  wines 
are  noted  for  their  agreeable  and  delicate  fla- 
vour and  for  their  stimulating  properties.  The 
most  famous  white  varieties  are  Chablis  and 
Pouilly,  while  the  best-known  red  Burgundies 
are  Ohambertin,  St.-Georges,  Pommard,  and 
Blanue.  3.  The  Bordeatix  wines  are  known 
for  their  agreeable,  peculiar  perfume  and  their 
slight  astringenoy.  The  red  varieties  are  the 
clarets  above  mentioned.  The  best-known  white 
ones  are  Rions,  Sauberne,  and  Barsac. 

Of  Spanish  wines,  Malaga,  sherry,  and  Ali- 
cante are  widely  known  for  their  "  body."  The 
type  of  the  white  wines  of  Portugal  is  Bucellas ; 
of  the  red,  port. 

Many  of  the  Italian  wines  are  known  :  Al- 
bano,  AUiatico,  Marsala,  Orvietto.  The  African 
wines,  Madeira  and  TeneriflEe,  are  described 
above. 

American  wines  have  of  recent  years  attract- 
ed attention  for  their  increasing  purity  and 
strength.  The  first  attempts  to  grow  wines  in 
this  country  failed  early  in  the  century,  but  the 
value  of  the  Schuylkill  muscatel  grape  and  of 
the  North  Carolina  Catawba  grape  was  proved, 
and  these  varieties  were  subsequently  employed 
in  the  manufacture  of  wine.  It  is  only  within 
very  recent  years,  however,  that  the  quality  of 
American  wine  has  attracted  the  attention  of 
home  consumers.  Wines  of  great  diversity  of 
flavour,  acidity,  and  alcoholic  strength  are  now 
manufactured  in  America.  Although  most  of 
them  contain  alcohol  and  sugar  which  have 
been  added  for  preservation  or  improvement, 
American  wines  can  be  secured,  as  a  rule,  free 
from  harmful  adulteration  and  in  a  condition 
of  assured  purity.  Among  the  dry  red  wines 
made  in  this  country  are  Concord,  Clinton,  Cyn- 
thiana,  Sonoma,  Red  Mission,  Zinfandel,  and 
California  claret.  Well-known  dry  white  wines 
are  California  muscatel,  California  Sonoma 
hock.  Pleasant  Valley,  Catawba,  Sonoma  Ries- 
ling, and  white  Concord.  Sweet  wines  are  made 
in  many  parts  of  the  United  States.  Port  wines, 
sherry  wines,  and  sweet  Catawbas  appear  in  the 
market  in  several  varieties.  Many  American 
champagnes  have  attracted  notice  of  late  years 
and  will  undoubtedly  supersede  the  foreign 
product  in  time.  Prominent  among  these  wines 
are  "  grand  prize,"  medium  dry ;  "  eclipse,"  ex- 
tra dry ;  "  gold  seal,"  and  Cook's  imperial. 

Vines  for  the  product  of  their  grapes  are 
grown  in  California,  in  Texas,  in  western  New 
York,  and  in  southern  Ohio.  California  leads, 
her  output  in  1893  being  20,000,000  gallons  of 
wine.  While  this  can  not  be  compared  in 
point  of  quantity  to  the  product  of  some  of  the 
wine-making  countries  of  Europe,  the  produc- 
tion will  no  doubt  be  increased  as  the  merits 


391 


WINES 


of  American  wines  become  better  known  and 
the  demand  for  them  is  augmented. 

Besides  the  juice  of  the  grape,  there  are 
juices  of  several  other  fruits  that  undergo 
vinous  fermentation.  Cider  is  the  fermented 
juice  of  the  apple.  It  is  consumed  in  large 
quantities  in  southern  Germany,  Prance,  Eng- 
land, and  the  United  States.  The  expressed 
juice  of  the  apple  soon  undergoes  fermentation 
without  the  addition  of  a  ferment  agent.  It 
contains  a  large  percentage  of  grape-sugar, 
which  becomes  converted  into  alcohol  in  the 
manner  above  described.  The  taste  and  the 
quality  of  cider  depend  upon  the  variety  and 
ripeness  of  the  apples  from  which  it  is  made, 
the  climate,  the  soil,  and  the  care  of  the  trees. 
Cider  is  not  permanent  and  easily  undergoes 
acetous  fermentation.  Ferry  is  the  fermented 
juice  of  the  pear  and  resembles  cider  in  its 
properties. 

The  juice  of  all  varieties  of  palms  is  rich  in 
grape-sugar,  and  is  therefore  easily  ferment- 
able. Palm  wine  is  made  and  drank  in  the 
islands  of  the  Indian  Archipelago,  in  Sumatra, 
in  India,  and  in  the  Philippine  Islands.  The 
best  palm  wine  is  said  to  be  found  on  the 
western  coast  of  Africa.  In  the  oasis  of  Tosar, 
the  residents  of  which  are  Mohammedans,  palm 
wine  is  a  customary  drink  and  is  known  as 
"  lagmi."  The  drinkers  justify  themselves,  it 
is  reported,  by  saying :  "  Lagmi  is  not  a  wine ; 
the  edict  of  the  prophet  is  against  the  use  of 
wine  only."  The  wine  of  the  palm  is  produced 
in  Chile  and  in  most  tropical  countries.  In 
Africa  it  is  the  only  native  alcoholic  drink. 
In  Asia  it  is  consumed  in  enormous  quantities. 

A  wine  may  be  derived  from  the  sugar  ca7ie 
by  spontaneous  fermentation.  No  chemical 
analysis  has  ever  been  made  of  it,  although  it 
is  highly  prized  by  the  negroes  of  the  Southern 
United  States.  Pulque,  octli,  or  the  wine  of 
agave,  is  a  favourite  drink,  intoxicating  in 
character,  of  the  lower  classes  of  Mexico.  It 
is  obtained  by  the  fermentation  of  the  juice  of 
the  maguey,  or  Agave  americana.  The  juice 
has  a  sweetish  taste  and  soon  acquires  a  dis- 
agreeable odour.  It  undergoes  spontaneous 
fermentation,  and  when  mixed  with  other  juice 
from  the  same  species  which  has  already  begun 
to  ferment,  it  ferments  very  rapidly.  In  twenty- 
four  hours  the  pulque  has  its  pleasantest  taste 
and  effects.  It  acquires  the  peculiar  odour  of 
putrefying  or  gamy  meat,  and  is  therefore  not 
easily  partaken  of  by  those  not  accustomed  to 
drink  it.  It  is  very  refreshing  and  cooling  in 
its  effects,  but  even  a  small  quantity  may  be 
sufficient  to  produce  intoxication.  The  Mexi- 
cans maintain  that  pulque  possesses  many 
therapeutic  properties  of  value :  It  aids  diges- 
tion, promotes  sleep,  and  is  helpful  in  many 
gastric  diseases. 

The  juice  of  the  Mrch  provides  a  sweet, 
agreeable,  sparkling  wine.  The  wine  of  honey, 
or  mead,  was  formerly  popular  in  Germany, 
and  is  said  to  be  drank  at  the  present  day  in 
Russia.  The  best  known  of  the  berry  wines 
are  currant,  gooseberry,  strawberry,  blackberry, 
and  raspberry  wines.  They  are  all  agreeable 
drinks  and  are  commonly  drank  diluted  as 
refrigerants  in  summer.     Blackberry  wine  or 


brandy  has  some  reputation  as  a  remedy  in 
diarrhoea.  The  famous  wine  of  the  Tartars, 
Jcumyss,  or  koumyss,  is  the  fermented  milk  of 
the  ass.  It  is  now  prepared  in  most  civilized 
countries  by  the  artificial  fermentation  of  cow's 
milk,  and  possesses  some  nutritious  properties. 
It  is  easily  digested  and  assimilated,  and  is 
frequently  employed  as  a  substitute  for  milk 
in  conditions  in  which  the  stomach  can  not 
digest  the  raw  product.  For  such  usage  it  is  a 
valuable  adjuvant  in  the  treatment  of  asthenic 
conditions  and  as  a  food  in  the  vomiting  fol- 
lowing anmsthesia.  (See  Kumyss.)  The  lehan 
of  the  Arabs  and  the  yaurt  of  the  Turks  are 
wines  similar  to  kumyss.  In  some  parts  of 
Ireland  and  Scotland  and  in  the  Orkney  Islands 
buttermilk  is  sometimes  kept  nntil  fermenta- 
tion has  set  in.  It  then  acquires  intoxicating 
properties.  The  juice  of  the  orange  is  some- 
times allowed  to  ferment,  giving  rise  to  a 
typical  wine. 

An  infusion  of  malt  is  capable  of  undergoing 
fermentation,  giving  rise  to  the  malt  liquors — 
ale,  brown  stout,  porter,  and  lager  beer.  They 
are  practically  wines,  but  their  consideration 
does  not  properly  come  under  this  heading. 

Champagne  was  first  made  in  the  latter  half 
of  the  seventeenth  century  by  Perignon,  a 
priest  in  the  convent  of  St.  Peter  at  Haut- 
Villers,  althougb  the  crude  article  had  been 
known  and  prized  for  centuries.  Its  manufac- 
ture rapidly  spread,  and  to-day  good  qualities 
of  champagne  are  made  in  the  United  States, 
France,  Germany,  Austria,  and  Italy.  In  this 
country  French  champagne  is  the  favonrite, 
although  the  American  brands  '  are  making 
their  way  to  the  front.  Blue  grapes  make  the 
best  champagne,  and  those  containing  a  mini- 
mum quantity  of  colouring  matter  are  usually 
chosen.  Burgundy,  Rulander,  and  Riesling 
are  used  for  fine  champagnes.  For  the  infe- 
rior qualities  Ortlieber,  Steinschiller,  and  Gu- 
tedel  are  frequently  employed. 

The  preparation  of  champagne  has  been 
brought  to  a  state  of  perfection  in  France. 
The  selected  grapes  are  rapidly  pressed  and  the 
must  obtained  is  allowed  to  undergo  complete 
fermentation  in  order  that  all  traces  of  sugar 
may  be  removed.  After  this  wine  has  cleared 
itself  it  is  mixed  with  other  wines  of  chosen 
type  and  character  {coupage).  This  mixed 
wine,  which  is  the  basis  of  the  champagne,  is 
repeatedly  cleared  and  drawn  off,  and  in  the 
spring  of  the  year,  as  a  rule,  has  added  to  it 
from  1  to  2  per  cent,  of  sugar  for  the  produc- 
tion of  the  carbonic-acid  gas.  This  is  accom- 
plished by  adding  a  liqueur  which  contains 
ordinary  candy  sugar,  wine,  and  cognac  in  the 
proportions  of  150, 125,  and  10.  This  is  used 
for  the  better  champagnes;  beet-sugar  is  em- 
ployed for  the  cheaper  ones.  Sometimes  port, 
Madeira,  muscatel,  or  cherry-water  is  added  to 
the  liqueur  if  it  is  desired  to  produce  a  par- 
ticular flavour.  The  amount  of  liqueur  added 
depends  upon  the  pressure  it  is  intended  to 
secure  and  the  absorptive  ability  of  the  specific 
wine.  French  champagne  producers  distin- 
guish three  kinds  of  carbonated  wines:  Cre- 
mant,  which  has  a  carbonic-acid  gas  pressure 
of  about  four  atmospheres ;  mousseux,  with  a 


WINES 


392 


pressure  of  from  four  to  four  and  a  half  at- 
mospheres ;  and  grand  mousseux,  with  a  pres- 
sure as  high  as  six  atmospheres.  The  familiar 
form  of  champagne  bottle  is  employed  because 
it  enables  the  gas  to  remain  at  the  original 
pressure. 

The  bottles  are  now  carefully  corked,  leaving 
a  space  at  the  top  of  from  twelve  to  fifteen 
cubic  centimetres.  They  are  placed  horizon- 
tally in  the  fermentation  cellar,  which  has  a 
temperature  of  from  68°  to  75°  P.  As  the 
fermentation  proceeds,  the  position  of  the  bot- 
tle is  gradually  changed  every  few  days  until 
at  the  end  of  about  two  weeks  it  stands  ver- 
tically, cork  downward.  During  this  process 
a  precipitate  has  been,  formed  which  falls 
against  the  cork.  As  soon  as  the  workmen  are 
certain  that  precipitation  is  complete,  degorge- 
ment  is  practised.  This  consists  in  removing 
the  cork,  when  the  precipitate,  together  with  a 
small  quantity  of  tlie  wine,  is  hurled  from  the 
bottle  by  the  force  of  the  pressure  behind  it. 
The  bottle  is  again  filled  to  its  former  degree 
by  dosage  with  a  liqueur  which  varies  for  dif- 
ferent champagnes.  It  can  be  made  sweet  or 
dry,  mild  or  strong,  according  to  desire.  The 
bottle  is  then  so  handled  as  to  avoid  the  loss 
of  any  more  carbonic-acid  gas  than  is  neces- 
sary, it  is  corked,  the  cork  is  secured  with  cord 
and  wire,  and  all  this  is  covered  as  far  down  as 
the  empty  space  extends  with  tin-foil  or  seal- 
ing-wax. The  other  methods  of  making  cham- 
pagne are  inferior,  but  it  is  of  historic  interest 
to  note  that  the  older  method  consisted  in 
forcing  carbonic-acid  gas  into  bottles  contain- 
ing wine  already  "  dosed  "  by  means  of  a  force- 
pump. 

A  champagne  must  naturally,  to  be  pure, 
have  the  basis  of  an  aerated  water,  as  outlined 
above.  Chemically,  it  must  contain  no  im- 
purities injurious  to  health.  Saccharin,  oxalic 
acid,  and  salicylic  acid  are  used  in  France  to 
some  extent  as  adulterating  agents,  and  should 
be  tested  for  if  their  presence  is  suspected. 
After  champagne  has  been  poured  out  into 
glasses,  evidence  that  it  is  not  an  artificially 
aerated  water  may  be  adduced  by  stirring  it. 
If  it  foams  as  it  did  when  first  poured  out  it  is 
a  pure  or  at  least  a  natural  champagne.  If 
not,  it  is  to  be  condemned  as  artificial. 

The  medicinal  uses  of  champagne  are  those 
of  a  stimulant.  It  may  be  given  in  convales- 
cence from  any  adynamic  disease,  and  is  serv- 
iceable when  a  patient  is  suffering  from  the 
effects  of  severe  shock  or  collapse  and  when  he 
is  able  to  take  fluids  by  mouth.  It  is  of  real 
value  in  cases  of  vomiting  due  to  almost  any 
cause.  At  these  times,  when  the  stomach  re- 
fuses to  retain  anything  else,  cold  dry  cham- 
pagne in  small  doses  will  usually  be  retained 
and  may  frequently  stop  the  vomiting  alto- 
gether. It  is  of  special  use  in  the  vomiting 
following  ansesthesia  when  this  is  prolonged 
beyond  the  usual  time.  In  cases  of  anmmia 
and  chlorosis,  when  iron  is  not  well  borne  by 
the  stomach,  it  may  sometimes  be  found  use- 
ful to  give  It  with  small  doses  of  a  dry  cham- 
pagne. It  is  a  good  stimulant  after  fatigue  or 
overexertion,  but  a  too  long-continued  use  of 
this  wine  is  apt  to  produce  cirrhosis. 


The  effects  of  champagne  are  those  of  other 
diffusible  stimulants,  but  that  it  does  excite 
especially  the  intellectual  centres,  producing 
an  unusual  flow  of  wit  and  humour,  its  popu- 
larity at  dinners  and  among  postprandial 
speakers  testifies.  When  drank  as  other  fluids 
are,  two  or  three  glasses  of  champagne  will 
rarely  intoxicate  one  accustomed  to  any  alco- 
holic drink,  but  when  slowly  sipped  it  may 
give  rise  to  the  symptoms  of  acute  alcohol 
poisoning  after  half  a  glass  has  been  taken. 

Although  the  effect  of  wines  is  dependent,  to 
some  extent,  on  the  alcohol  they  contain,  the 
liquid  is  so  complex  that  much  of  its  influence 
upon  the  human  body  must  be  ascribed  to  the 
salts,  ethereal  bodies,  sugars,  and  acids  in  which 
it  abounds.  The  action  of  wine  is  mainly 
stimulant,  and  this  effect  is  derived  mainly,  it 
is  true,  from  its  alcohol.  It  is  probably,  how- 
ever, not  correct  to  state  that  an  equal  quantity 
of  water  containing  the  same  percentage  of 
alcohol  will  accomplish  the  same  result.  After 
drinking  wine,  the  whole  organism  responds 
to  it.  The  activity  of  the  nervous  system  is 
quickened,  the  special  senses  become  more 
susceptible  to  impressions,  and  the  intellectual 
faculties  are  more  active  and  alert.  The  pulse 
becomes  more  rapid,  and  the  cheeks  usually 
become  flushed  and  the  eyes  bright.  It  de- 
pends, of  course,  upon  the  variety  of  wine 
taken,  whether  these  effects  are  more  or  less 
pronounced.  The  sparkling  wines  produce 
them  rapidly  to  a  high  degree,  stimulating  the 
mental  faculties  particularly.  The  still  wines 
have  a  less  marked  stimulant  effect.  On  the 
other  hand,  the  sparkling  wines  have  a  ten- 
dency to  derange  gastric  digestion ;  the  still 
wines  have  little  influence  in  this  direction. 

In  a  physiological  study  of  the  influence  of 
alcoholic  drinks'  upon  the  chemical  processes 
of  digestion,  R.  H.  Chittenden  and  L.  B.  Men- 
del {American  Journal  of  the  Medical  Sciences, 
April,  1896)  conclude  that  wines  in  small 
amount  have  little  or  no  deleterious  action 
upon  the  chemical  processes  of  gastric  diges- 
tion. In  small  amount  they  may  even  increase 
the  rate  of  digestive  action.  In  larger  quanti- 
ties they  have  more  or  less  of  a  retarding  effect, 
which  is  dependent  more  upon  the  character 
and  amount  of  the  solid  matter  present  than 
upon  the  alcohol.  On  pancreatic  digestion, 
however,  they  find  that  wines  have  a  greater 
inhibitory  action  than  the  stronger  alcoholic 
liquors.  This  action  seems  to  be  entirely  inde- 
pendent of  the  amount  of  alcohol,  but  is  closely 
connected  with  the  acidity  of  the  fluid.  On 
salivary  digestion,  wines  as  a  class  show  a  very 
powerful  inhibitory  action,  due  almost  entirely 
to  their  acid  properties ;  for  when  the  acidity 
of  a  wine  was  experimentally  neutralized,  it 
lost  completely  its  inhibitory  effect  upon  sali- 
vary digestion. 

An  exaggeration  of  these  physiological  effects 
of  wine  is  found  in  the  condition  of  acute  alco- 
hol poisoning,  commonly  called  drunkenness 
or  intoxication.  A  condition  approaching  de- 
lirium appears  after  the  ingestion  of  more  wine 
than  can  be  tolerated  by  the  system.  Depend- 
ing upon  the  temperament  of  the  individual, 
he  may  be  joyful  or  morose,  combative  or 


393 


WINES 


peaceful,  erotic,  benumbed,  or  active.  These 
symptoms  gradually  subside,  the  speech  be- 
comes incoherent  and  thick,  the  head  whirls, 
and  \isioii  and  perception,  of  space  and  objects 
become  blunted.  It  is  a  curious  fact,  frequently 
observed  and  commented  upon,  that  those  fac- 
ulties most  constantly  employed  are  the  last  to 
succumb  to  intoxication.  An  educated  person 
will  continue  to  reason  long  after  he  has  lost 
the  support  of  his  limbs,  while  a  labourer, 
though  unable  to  talk,  finds  himself  able  to 
carry  on  his  work.  An  intoxication  ends  in 
two  ways :  Either  there  is  gastric  derange- 
ment, with  vomiting,  diarrhoea,  and  sometimes 
evacuation  of  the  bladder,  or  a  condition  of 
somnolence  supervenes,  characterized  by  an 
alcoholic  breath,  a  flushed  face,  dilated  pupils, 
a  slow,  full  pulse,  stertorous  breathing,  and 
sweating.  Recovery  is  the  rule,  although  a 
fatal  result  has  often  been  known. 

The  habitual  dietetic  use  of  wines  is  possibly 
harmless,  but  it  is  certainly  useless  in  health. 
Yet  it  is  an  established  fact  that,  in  the  wine- 
drinking  countries  of  Europe,  one  sees  little  of 
the  bad  effects  of  the  constant  use  of  the  bev- 
erage ;  and  in  Prance  and  Germany  it  is  used 
by  persons  of  all  ages  and  of  both  sexes.  It  is 
said  that  gout  and  calculous  disease  are  scarce- 
ly known  along  the  Rhine.  The  light  wines 
of  Germany  and  France,  diluted,  may  be  drank 
with  safety  for  many  years.  But  the  heavier 
wines,  such  as  sherry,  port,  and  Madeira,  are 
apt,  after  prolonged  use,  to  induce  diseases 
of  the  liver  (cirrhosis),  gout,  apoplexy,  and 
those  conditions  which  are  due  to  overstimu- 
lation. The  light  wines  are  refreshing  after 
exertion,  and  exert  a  protective  influence  when 
the  organism  is  subjected  to  a  severe  tax.  In 
one  of  the  hospitals  of  New  York  an  old  cus- 
tom prevails  of  giving  claret,  well  diluted,  to 
all  those  resident  in  the  building  during  an 
epidemic  of  cholera,  typhus,  or  small-pox.  It 
is  possible  that  wine  produces  a  deleterious 
effect  upon  the  complexion,  and  that  it  may 
prematurely  arouse  adult  passions  in  children 
who  drink  it  frequently.  The  habitual  use  of 
saccharine  wines  must  be  forbidden  to  persons 
who  have  gout  or  a  tendency  to  obesity  or  to 
the  gouty  diathesis. 

In  an  investigation  as  to  the  medical  prop- 
erties of  the  Bordeaux  and  Burgundy  wines, 
the  Lancet  commission  decided  that  the  white 
Bordeaux  wines  excited  the  appetite,  were  a 
direct  aid  to  gastric  digestion,  and  were  slight- 
ly aperient.  The  sauternes,  it  was  found,  were 
at  first  stimulating  and  later  had  a  sedative 
effect.  This  action  was  more  pronounced  upon 
nervous  and  easily  excitable  persons.  The 
white  Burgundy  wines  had  not,  as  had  been 
believed,  a  constipating  influence,  but  the  re- 
verse. The  clarets  were  found  to  have  neither 
a  stimulant  nor  a  sedative  influence,  which  the 
commission  attributed  to  the  combination  of 
tannin  with  a  small  percentage  of  alcohol. 
Taken  with  the  meals,  claret  was  found  to  have 
an  influence  beneficial  to  digestion.  The  red 
Burgundy  wines  are  not  so  helpful  to  digestion 
as  claret,  and  seem  to  show  a  tendency  to  cause 
obesity.  These  wines  are  not  well  suited  to  the 
gouty,  and  diabetics  can  not  take  them,  because 


of  the  sugar  they  contain.    {Lancet,  June  26, 
July  3,  July  24,  October  33,  1880.) 

As  to  the  sustaining  qualities  of  wine,  there 
can  be  little  difference  of  opinion.  Druitt 
(Medical  Times  and  Gazette,  1878,  vol.  ii,  p. 
364)  prints  his  correspondence  with  a  French 
army  surgeon  and  a  French  lady  who  wei'e  in 
Paris  during  the  siege.  Both  of  them  give 
high  testimony  to  the  worth  of  vin  ordinaire, 
at  a  time  when  it  was  impossible  to  obtain 
other  nourishment,  in  sustaining  the  vital 
powers.  The  surgeon  gives  evidence  as  to  how 
his  soldiers  withstood  severe  injuries  with  no 
other  food  than  the  wine  given  them.  This 
question  is  discussed  fully  in  the  article  Al- 
cohol. 

In  the  treatment  of  disease,  wine  is  used 
differently  from  the  more  ardent  spirits.  In 
an  acute  aniemia,  for  example,  dependent  upon 
a  severe  haemorrhage,  alcohol  in  a  more  rapidly 
assimilable  form  is  called  for,  such  as  whisky 
or  brandy ;  but  if  the  patient  recovers,  wine 
would  be  indicated  as  a  tonic  to  help  him  over 
his  debility.  In  eases  in  which  the  prolonged 
use  of  an  alcoholic  stimulant  is  demanded  and 
when  the  disease  is  of  a  mild  grade,  or  when 
the  stomach  can  not  tolerate  whisky  or  brandy, 
wine  is  pre-eminently  the  agent  to  use.  This 
is  not  the  place,  and  the  writer  has  not  the 
wish,  to  discuss  the  mooted  question  as  to  the 
wisdom  of  employing  wine  in  disease.  He  as- 
sumes that  the  intelligent  employment  of  some 
alcoholic  stimulant  is  to  be  taken  for  granted. 

When  wine  is  used  medicinally  it  is  essential 
that  a  genuine  wine  and  a  good  wine  be  em- 
ployed. Adulterated  wines  will  prove  injurious 
only,  deranging  the  digestion  and  impairing 
the  appetite,  if  not  inflicting  more  serious  in- 
jury. In  general,  it  may  be  said  that  sherry, 
containing  little  acid,  is  indicated  when  the 
stomach  is  weak  and  there  is  acid  dyscrasia. 
Port  is  to  be  preferred  in  cases  oi  pure  debility. 
Claret  is  useful  as  an  aperient  and  diuretic. 
Champagne  is  given  in  the  debility  of  old  age 
and  in  the  collapse  of  low  fevers.  Acidulous 
wines  are  not  to  be  given  to  gouty  subjects, 
nor  sweet  wines  to  diabetics. 

Young  infants  may  receive  marked  benefit 
from  the  judicious  administration  of  port  wine, 
given  at  hours  other  than  meal  times,  when 
suffering  from  marasmus  from  any  cause,  ca- 
tarrhal affections  of  long  standing,  tuberculosis, 
or  rhachitis.  The  appetite  and  nutrition  are 
improved  materially.  Sherry  promotes  sleep 
and  aids  digestion  in  senile  debility,  depending 
for  its  effects  not  only  upon  the  alcohol,  but 
upon  the  ethers  developed  in  it.  In  fevers  of 
all  kinds,  those  of  the  acute  infectious  diseases 
as  well  as  in  those  coming  from  acute  inflam- 
matory processes,  wine  fortifies  the  system  and 
helps  it  to  get  rid  of  the  deleterious  materials 
circulating  in  the  blood.  It  is  particularly 
valuable  when  there  is  high  delirium  or  great 
nervous  prostration,  with  a  rapid  dicrotic  pulse 
which  has  a  tendency  to  become  arrhythmical. 
In  typhoid  fever  and  in  typhus  fever  when  there 
is  absence  of  the  impulse  and  first  sound  of  the 
heart,  port  wine  is  a  valuable  agent,  adminis- 
tered in  large  doses.  In  the  pneumonia  and 
bronchitis  of  the  aged  it  is  a  helpful  remedy  as 


WINES 


394 


well.  In  the  exhaustion  of  fevers,  marked  by 
insomnia  and  feebleness  of  the  heart,  as  seen  in 
the  third  and  fourth  weeks  of  typhoid  fever, 
port  wine  is  good.  The  use  of  wine  is  indicated, 
too,  when  derangements  of  digestion  and  flerv- 
ous  prostration  appear,  entirely  out  of  propor- 
tion to  the  gravity  of  the  disease.  For  these 
purposes,  from  six  to  twelve  ounces  may  be 
given  daily  in  divided  doses  at  half-hourly 
intervals. 

In  threatening  cardiac  failure  in  the  acute 
delirium  of  some  form  of  insanity,  wine  is  a 
useful  remedy.  It  has  been  recommended  in 
catarrhal  inflammations  accompanying  epi- 
demic influenza,  in  the  intestinal  catarrhs  of 
summer  and  autumn,  and  as  a  stimulant  in 
amygdalitis.  In  purulent  inflammations  of 
long  standing  and  in  chronic  discharges  of 
blood,  pus,  or  mucus  from  the  uterus,  vagina, 
urethra,  intestines,  or  lungs,  or  from  fistula;  or 
ulcers,  claret  wines  are  highly  recommended. 
According  to  Binz,  the  alcohol  tends  to  check 
the  emigration  of  leucocytes  and,  on  the  au- 
thority of  Anstie,  it  helps  to  overcome  the 
excessive  metabolism  of  the  tissues.  In  addi- 
tion to  this,  it  is  no  mean  stimulant  and  sup- 
porting agent  to  one  whose  vitality  has  been 
drained  by  a  long-continued  discharge  of  pus. 

After  recovery  from  a  hemorrhage,  strong 
wines  may  be  given  for  their  tonic  eflfect 
upon  the  heart  and  peripheral  blood-vessels. 
Half  an  ounce,  from  five  to  six  times  daily,  is 
the  proper  dose.  In  the  a^ute  neuroses,  such 
as  infantile  convulsions  and  acute  chorea,  the 
patients  are  very  tolerant  of  wines,  and  the 
affections  are  sometimes  decidedly  relieved  by 
them.  In  acute  neuralgia  the  ethereal  wines 
occasionally  give  great  relief  from  pain.  Cham- 
pagne is  an  excellent  agent,  given  cold  in  small, 
often-repeated,  doses,  with  which  to  control 
the  vomiting  following  ancesthesia  and  the 
vomiting  of  seasickness  and  pregnancy.  In 
general  debility  which  has  its  origin  in  anorexia 
or  dyspepsia  a  Burgundy  or  a  red  Hungarian 
wine  is  of  good  service.  Anfemic  and  chlorotic 
patients  do  not  require  wine ;  but  a  progressive 
chlorosis  may  be  benefited  by  its  use. 

The  use  of  wine  in  pulmonary  tuberculosis 
has  been  fought  by  physicians  for  years.  It  is 
probably  correct  to  state  that,  when  the  wine 
chosen  for  the  purpose,  which  must  be  care- 
fully considered  in  every  case,  reduces  the  fever 
and  the  night-sweats  and  strengthens  the 
pulse,  it  is  an  eminently  fit  agent.  Anything 
which  will  favour  the  fortification  of  the  pa- 
tient's strength  is  a  legitimate  remedy  in  this 
disease,  and  wine  frequently  does. 

Wines — pure  wines — have  been  recommend- 
ed in  debility  arising  from  protracted  pain  or 
scurvy,  and  in  the  chronic  affections  of  the 
scalp  and  eyes  of  poorly  nourished  children. 
It  has  been  advised  to  give  it  by  enema  in 
cases  of  gastralgia  in  which  the  stomach  can 
not  tolerate  preparations  of  iron.  Tetanus  is 
said  to  have  been  cured  by  wine,  and  its  injec- 
tion has  been  recommended  in  chronic  dis- 
charges from  the  vagina  and  urethra  and  to 
lessen  the  discharge  from  fistulm.  Claret  has 
also  been  used  as  an  injecting  fluid  into  the 
tunica  vaginalis  for  the  cure  of  hydrocele.    The 


white  wines  of  Bordeaux  have  been  praised  as 
tonics  where  there  is  a  capricious  appetite  and 
for  the  decrease  of  corpulency,  and  they  have 
been  found  useful  in  cases  of  biliary  indiges- 
tion. Sauterne  wines  are  praised  for  their 
tonic  influence  in  pulmonary  cases  when  there 
are  insomnia  and  troublesome  cough.  The 
white  Burgundy  wines  have  been  found  of 
service  in  convalescence  from  any  prolonged 
disease.  Clarets  are  widely  used  as  tonics  to 
be  taken  with  the  meals ;  they  rarely  upset  the 
stomach,  and  are  agreeable  to  the  majority  of 
debilitated  patients.  In  ancemia  and  debility 
from  any  cause  and  in  atonic  gout  they  are 
useful.  Diluted,  they  are  excellent  refriger- 
ants in  the  course  of  a  febrile  disease.  In  mal- 
nutrition not  dependent  on  gastric  or  intestinal 
irritation,  and  as  a  tonic  for  convalescents,  the 
red  Burgundy  wines  are  widely  employed. 
Since  they  are  ultimately  sedative  in  their  ac- 
tion, their  use  may  preclude  the  administration 
of  any  narcotic  agent. 

The  quantity  of  wine  to  be  administered 
must  vary,  of  course,  with  the  disease  and 
the  patient.  In  low  fevers  sometimes  a  pint, 
frequently  a  quart,  may  be  given  in  twenty- 
four  hours.  It  may  be  administered  pure,  di- 
luted with  water  or  mineral  waters,  or  in  the 
form  of  wine  whey.  This  is  made  by  adding 
to  a  pint  of  boiling  milk  half  a  pint  of  some 
white  wine,  straining  through  a  cloth,  and 
adding  loaf-sugar  to  the  filtered  product. 

The  adulteration  of  wines  is  frequently  prac- 
tised oftener  in  this  country  and  France  than 
in  other  European  countries.  Although  at  the 
present  day  these  adulterations  are  not  directly 
poisonous,  they  usually  provoke  disturbances 
of  the  stomach,  and  are  reprehensible  for  this 
reason  not  only,  but  because  the  products  are 
sold  as  genuine  wines.  The  most  frequently 
adulterated  wines  are  port  and  Maderia,  al- 
though claret,  too,  is  frequently  imitated.  Lead 
is  frequently  found  in  minute  quantities.  This 
may  spring  from  the  shot  with  which  the  bot- 
tles are  cleansed  or  from  some  analogous  source. 
In  the  early  part  of  this  century  English  wine- 
dealers  were  in  the  habit  of  putting  large  quan- 
tities of  shot  into  the  barrels  containing  wine  to 
keep  it  from  turning  sour.  The  use  of  oxalic 
acid  was  suggested  if  the  lead  did  not  answer 
the  purpose.  (Citation  from  The  Wine  Dealer's 
Manual,  British  and  Foreign  Medical  and 
Chirurgical  Bevieiv,  April,  1858.)  Cider  or 
perry,  diluted  with  water,  may  be  palmed  off 
as  genuine  wine.  Frequently  inferior  wines 
may  be  made  more  easily  salable  by  the  addi- 
tion of  a  small  quantity  of  a  higher  grade  of 
wine.  Alcohol  is  added  to  thin  wines,  sour 
wines  are  sweetened  with  sugar,  honey,  or 
raisins,  and  pale  ones  are  coloured  with  burnt 
sugar.  Acetate  of  lead  may  be  added  to  wines 
to  give  them  arStringency,  and  acidulous  wines 
are  sometimes  neutralized  by  the  addition  of 
lime  or  alkalies.  Red  wines  are  often  made 
out  of  alcoholic  dilutions,  the  colouring  mat- 
ter being  beets,  litmus,  rhatany,  or  logwood, 
and  astringency  is  given  to  them  by  the  addi- 
tion of  alum,  tannin,  or  oak  or  willow  bark. 
Colouring  matter  is  employed  by  many  wine- 
dealers,  usually  made  of  alum  and  elder  berries. 


395 


WINES 


Free  sulphiirio  acid  can  not  be  detected  by 
barium,  since  all  wines  contain  some  soluble 
sulphates.  If  a  few  drops  of  the  suspected 
wine,  however,  are  dropped  on  a  piece  of 
glazed  paper  containing  starch,  the  texture  of 
the  paper  will  be  unaltered  and  the  spot,  when 
dry,  will  be  violet  if  the  wine  is  pure ;  but  if 
it  contains  only  a  trace  of  sulphuric  acid,  the 
spot  will  be  rose-red  and  the  paper  will  be 
friable.  Adulteration  has  been  known  from 
Pliny's  time,  and  this  historian  inveighs  bit- 
terly against  the  decadence  of  the  times  since 
"no  one  can  get  pure  wine  to  drink."  It  is 
known  at  the  present  day  in  Germany,  more 
in  Prance,  and  less  in  England,  but  most  of 
all  it  is  found  in  the  United  States. 

Wines  are  subject  to  a  number  of  disorders, 
which  will  be  briefly  considered  here.  One  of 
the  commonest  of  these  is  the  viscosity  of 
wine,  by  which  it  becomes  slimy,  thick,  and 
threadlike.  It  appears  more  frequently  in 
wines  poor  in  tannic  acid,  and  is  therefore 
more  commonly  found  tn  white  than  in  red 
wines.  In  acidulous  wines  this  disorder  some- 
times disappears  spontaneously,  particularly  if 
they  contain  a  considerable  percentage  of  al- 
cohol. It  may  be  cured  by  shaking  the  wine 
and  allowing  ithe  entrance  of  air,  or  by  adding 
grape-sugar  to  induce  a  new  fermentation. 

Acetous  fermentation  may  take  place  in 
wines  through  the  growth  of  the  fungus  Myco- 
derma  aceti.  It  is  the  most  dangerous  of  all 
the  disorders  of  wines,  since  it  may  make  the 
wine  unfit  to  drink  in  a  very  short  time.  This 
fermentation  occurs  chiefly  in  old  wines  with  a 
small  percentage  of  albuminous  matter,  in 
warm  cellars,  and  when  the  barrel  is  not  kept 
full.  When  a  wine  has  become  decidedly 
tainted  with  acetic  acid,  it  is  best  to  allow  it  to 
be  converted  entirely  into  vinegar.  Pasteur- 
ization (vid.  infra),  electrolysis,  and  the  pour- 
ing of  the  wine  into  another  cask  impregnated 
with  sulphur  have  been  suggested  as  cures. 

Lactic-acid  fermentation  may  be  caused  in 
wines  by  chain-forming  bacteria  which  are 
even  noticeable  to  the  naked  eye  as  masses. 
The  wine  attains  a  smell  and  a  taste  which 
render  it  unfit  for  drinking.  Other  bacteria 
affect  wines  differently.  It  may  become  pu- 
trid, developing  carbonic-acid  gas  and  becom- 
ing turbid.  The  colouring  matter  of  white  as 
well  as  of  red  wines  changes  to  brown,  and  a 
disagreeable  odour  and  taste  are  developed. 
This  change  occurs  chiefly  in  wines  poor  in 
alcohol  which  have  been  made  from  poor  or 
rotten  grapes. 

Through  the  action  of  a  ferment  not  yet  de- 
scribed, wines  may  become  bitter.  This  is  a 
peculiarity  of  red  wines,  and  was  first  noted 
by  Pasteur.  It  may  take  place  through  the 
action  of  ammonia  and  air  on  an  aldehyde 
which  sometimes  develops  in  the  wine.  There 
is  a  decided  lessening  of  the  colour  and  of  the 
iannic  acid  in  this  disease,  and  the  wine  is  not 
palatable.  Wines  may  become  mouldy.  This 
occurs  only  in  wines  deficient  in  alcohol,  and 
is  accomplished  by  the  growth  of  a  mould  on 
the  surface  of  the  urine. 

Red  wines  may  lose  their  colour  from  a  va- 
riety of  causes.  It  is  normal  for  all  red  wines 
69 


to  become  somewhat  lighter  in  colour  as  their 
age  advances.  But  the  wine  may  acquire  a 
pallor,  which  is  usually  due  to  the  cleaning'  of 
the  containing  casks  with  lime  or  with  water 
impregnated  with  lime  and  the  presence  of  too 
much  air  during  the  priiLary  fermentation. 
To  preserve  its  colour,  it  may  be  mixed  with  a 
proportionate  quantity  of  darker  -wine.  By 
chemical  action,  red  wines  may  become  black 
and  white  wines  green,  gray,  or  brown.  This 
condition  is  usually  cured  spontaneously  if  the 
wine  is  allowed  to  lie  for  a  period. 

Among  the  other  disorders  to  which  wines 
are  subject  may  be  mentioned  the  smell  of  sul- 
phur, which  is  usually  attributable  to  the  earth 
in  which  the  grape  has  grown  or  to  some  ex- 
ternal influence ;  a  mouldy  taste,  acquired  by 
the  wine  if  it  is  preserved  in  mouldy  vats ;  and 
the  taste  of  the  barrel  in  which  it  is  kept.  The 
same  holds  true  of  the  wood  from  which  the 
casks  are  made.  The  oak,  larch,  and  mulberry 
barrels,  for  instance,  give  the  wine  a  peculiar 
taste.  The  taste  acquired  by  the  wine  from  the 
ground  in  which  the  grape  was  grown,  which  is 
usually  very  characteristic,  may  be  diminished 
by  repeated  withdrawal  of  quantities  of  the 
wine  and  refilling  the  cask  with  fresh  wine  (Die 
menscMiche  Nahungs-  und  Oenussmittel,  von 
Dr.  J.  Konig,  Berlin,  1893;  Eandhuch  der 
chemischen  Technologie,  von  Dr.  F.  Fischer, 
Leipsic,  1893). 

Pasteur  suggested  a  method  of  ridding  wines 
of  most  of  the  disorders  to  which  they  are  sub- 
ject by  warming  them  to  a  temperature  of  140° 
F.  This  process  is  technically  known  as 
"  Pasteurization,"  and  may  be  easily  accom- 
plished by  the  apparatus  of  Ballo  (Fischer,  op. 
cit.). 

As  a  rule,  wines  clear  themselves;  but  to 
augment  or  hasten  the  process,  sweet  wines 
may  be  rendered  clear  by  clay  or  albuminous 
bodies,  which  gradually  cause  the  insoluble 
substances  to  sink  and  to  be  thus  easily  re- 
moved. The  colour  of  red  wines  is  said  to  be 
heightened  by  the  addition  of  plaster  of  Paris 
to  the  must. 

Vinum  album  (U.  S.  Ph.),  white  wine,  is 
"  made  by  fermenting  the  juice  of  fresh  grapes, 
the  fruit  of  Vitis  vinifera,  freed  from  seeds, 
stems,  and  skins."  When  a  white  wine  is  pre- 
scribed without  further  specification,  a  domes- 
tic dry  white  wine  is  recommended ;  such  are 
California  Riesling  and  Ohio  Catawba.  Pert 
wine  and  sherry  wine  were  formerly  ofBcial  in 
the  U.  S.  Ph.,  but  the  increasing  excellence  of 
domestic  wines  induced  the  committee  of  re- 
vision in  1880  to  return  to  the  old  nomencla- 
ture of  white  and  red  wines,  and  to  allow  any 
white  or  red  wine  to  be  used  which  was  of  the 
required  purity  and  alcoholic  strength.  Any 
German  or  other  white  wine  is  called  vinum 
album  (Ger.  Ph.). 

Vinum  album  fortius  (U.  S.  Ph.),  stronger 
white  wine,  is  a  mixture  of  white  wine  with 
one  seventh  as  much  of  alcohol  of  a  specific 
gravity  of  0'820.  It  must  contain  from  20  to 
25  per  cent,  by  weight  of  absolute  alcohol. 

Vinum  rubrum  (U.  S.  Ph.),  red  wine,  is 
"  made  by  fermenting  the  juice  of  fresh  col- 
oured grapes,  the  fruit  of  Vitis  vinifera,  in 


WINTERGREEN 
X   RAYS 


396 


presence  of  their  skins."  The  pharmacopoeia 
recommends,  when  no  speeiflcation  is  made, 
the  use  of  a  domestic  dry  red  wine,  or  a  native 
claret  or  Burgundy  ;  any  German  or  other  red 
wine  is  allowed  by  the  Ger.  Ph.  (For  the 
pharmacopoeial  requirements  of  vinum  album 
and  rubrum,  see  the  dispensatories  and  phar- 
macopoeias.) 

Vina  medicata,  medicated  wines,  possess  the 
advantage,  because  of  their  alcohol  and  acid, 
of  rendering  some  drugs  soluble  which  do  not 
easily  dissolve  in  water.  They  are  not  stable, 
and  few  are  at  present  in  use.  The  purest 
wines  should  always  be  chosen  when  they  are 
prescribed. — Samdel  M.  Briokner. 

"WINTERGREEN.— See  Gaultheria. 

WITCH-HAZEL.— See  Hamamelis. 

■WITHEBITE.— See  Barium  carbonate, 
under  Barium. 

WOOL- FAT.— See  Lanolin. 

WORMWOOD.— See  Absinthium. 

WBXG'KTIA.—  WrighHa  (or  Holarrhena) 
antidysenterica,  an  East  Indian  apocynaoeous 
tree,  has  a  bitter  bark  which  was  formerly  an 
article  of  European  commerce  under  the  names 
of  conessi  bark  and  TelUcherry  bark.  It  was 
used  in  diarrhcea  and  dysentery.  It  contains 
a  poisonous  alkaloid,  wrightine,  which  is  sup- 
posed to  be  the  active  principle,  but  has  not 
yet  been  sufficiently  studied  to  warrant  a  rec- 
ommendation of  its  use  in  medicine. 


XANTHOXYLXJM  (U.  S.  Ph.)  is  the  bark 
of  Xanthoxylum  americanum  and  of  Xanthox- 
ylum  Clava  Merculis.  Its  common  name  is 
prickly  ash.  The  former  species  grows  in  the 
Northern,  Middle,  and  Western  United  States, 
in  rocky  forests.  It  is  a  shrub  from  five  to  ten 
feet  in  height,  and  its  alternate  branches  are 
covered  with  strong  prickles,  whence  its  popu- 
lar name.  The  shrub  is  a  polygamous  plant, 
flowering  in  April  and  May  before  the  appear- 
ance of  the  foliage.  The  leaves  and  capsules 
possess  a  lemon-like  odour.  Xanthoxylum 
Clava  Herculia  is  indigenous  to  the  territory 
extending  from  the  Atlantic  coast  to  western 
Texas  and  from  Virginia  to  the  Gulf  of  Mexico. 
It  varies  in  size  from  a  large  shrub  to  a  small 
tree.  Its  bark  and  branches  are  also  covered 
with  sharp,  warty  prickles.  Both  varieties 
belong  to  the  natural  order  Rutacem. 

In  addition  to  the  official  shrubs  recognised, 
there  are  several  other  varieties  of  the  plant 
which  are  used  medicinally  in  the  localities  in 
which  they  grow.  In  the  Argentine  Republic 
Xanthoxylum  naranjillo  is  employed  as  a  diu- 
retic. a,nd  sudorific.  The  Brazilians  make  a 
decoction  of  Xanthoxylum  singuassiba  which 
is  alleged  to  have  powerful  sudorific  properties 
and  is  widely  used  as  a  gargle  in  inflammatory 
and  non-inflammatory  affections  of  the  throat. 
A  tincture  is  used  locally  for  severe  toothache, 
with  a  reported  analgetic  influence.  In  the 
bark  of  this  tree  an  alkaloid  similar  in  its 
properties  to  pilocarpine  has  been  found. 


Under  the  name  of  yellow  Hercules's  club 
and  yellow  thorn,  the  bark  of  Xanthoxylum 
caribcBum  has   made  its  appearance  in  com- 
merce.    This  is  the   satin-wood   of  southern 
Florida  and  the  West  Indies.     Its  baric  is  thin, 
with  a  bitter,  disagreeable  taste,  and   has  a 
canary-yellow  colour  which  is  imparted  to  the 
saliva  when  the  bark  is  chewed.     An  alkaloid 
derived  from  this  bark,  when  hypodermically 
injected   into  frogs,   rabbits,   or  guinea-pigs, 
produces  paralysis  and  subsequent  death.     In 
India  Xanthoxylum  alatum  is  used  as  an  an- 
thelminthic  and  sudorific.     The  Xanthoxylum 
nitidum  of  China  is  said  to  possess  febrifuge 
properties.     On  the  west  coast  of  Africa  IXan- 
thoxylum  senegalense  has  its  habitat.     Several 
alkaloids  have  been   isolated  from   its  bark, 
artarine  the  principal  one,  and  one  that  re- 
sembles cubebine  in  its  effects.     The  drug  ar- 
tar  root  is  said  to  be  derived  from  this  shrub." 
In  1829  Staples  isolated  from  Xanthoxylum 
americanum  a  crystalline  principle  which  he 
called  xanthoxylin.     The  same  result  was  ob- 
tained fifty  years  later  by  Lloyd.     MofEet,  in  a 
subsequent  analysis,  obtained  an  alkaloid  of 
yellow  crystals  which  were  soluble  in  alcohol 
and  in  chloroform,  insoluble  in  ether  and  in 
benzene.     Colton,  who  examined  Xanthoxylum 
Clava  Herculis,  isolated  crystals  which  formed 
colourless,  tasteless,  silky  needles,  soluble  in 
alcohol,  in  ether,  and  in  chloroform,  insoluble 
in   water  (American  Journal  of   Pharmacy, 
1880,  p.  191).     An  alkaloid  resembling  berber- 
ine  has  been  found    in  Xanthoxylum  Clava 
Herculis.    The  bark  of  Xanthoxylum  ameri- 
canum occurs  in  curved  or  quilled  fragments. 
The    bark  of  Xanthoxylum   Clava   Herculis 
resembles  it  but  is  thicker,  and  is  marked  by 
many  conical,  corky  projections  and  by  stout, 
brown  spines  rising  from  a  corky  base  (Bridges, 
Proceedings  of  the  American  Pharmaceutical 
Association,  1864).     The  bark  is  brittle,  very 
light,  and  almost  without  odour.     The  taste  is 
at  first  sweetish,  then   bitterish,  and  finally 
acrid. 

Xanthoxylum  is  said  to  resemble  guaiac  in 
its  remedial  action.  It  evokes  a  sense  of  heat 
in  the  stomach  when  ingested,  increases  the 
force  and  frequency  of  the  pulse,  and  produces 
to  some  extent  diaphoresis.  Upon  the  nervous 
system  it  is  stimulant  as  well.  On  account  of 
its  acridity,  it  has  been  employed  locally  as  a 
sialagogue.  An  infusion,  used  on  compresses, 
is  said  to  have  a  revulsive  action  which  is  taken 
adv.<intage  of  in  chronic  constitutional  syphilis. 
It  has  some  reputation  as  an  emmenagogue  and 
galactagogue.  Success  has  been  alleged  for  it 
in  the  treatment  of  chronic  rheumatism.  For 
diaphoretic  purposes,  for  expelling  flatus,  and 
for  the  allaying  of  rheumatic  pains,  xanthox- 
ylum has  been  employed.  As  a  counter-irri- 
tant, it  may  be  employed  in  inflammations 
affecting  the  serous  membranes.  In  this  waiV 
it  has  been  used  in  chronic  pelvic  disease  of 
women  in  the  form  of  a  hot  pack.  As  a  means 
of  relief  from  toothache,  the  bark  is  sometimes 
chewed. 

The  fluid  extract,  extractum  xanthoxyli  flu- 
idum  (U.  S.  Ph.),  may  be  given  in  doses  of 
from  i  to  1  fl.  drachm.    A  decoction  may  be 


397 


WINTERGREEN 
X  RAYS 


made  by  boiling  1  oz.  of  santhoxylum  in  3 
pints  of  water.  A  pint  may  be  given,  in  di- 
vided doses,  in  twenty-four  hours.  A  satura- 
ted tincture  may  be  administered  in  doses  of 
10  drops  three  or  four  times  daily.  A  powder 
is  prepared  from  the  bark,  the  dose  of  which 
is  from  10  grains  to  -J^  a  drachm  three  or  four 
times  daily. — Samuel  M.  Bbicknbr. 

XEROFORM:.— Dr.  E.  Heuss,  of  Zurich 
{2'herapeutische  Wochenschrift,  April  19, 1896; 
jVcm)  York  Medical  Journal,  May  9,  1896), 
remarks  that  xeroform,  or  bismuth  tribrom- 
phenol,  CoHa.BrsO-Bi-O,  was  recognised  as  an 
efficient  intestinal  antiseptic  in  the  last  cholera 
epidemic  in  Hamburg,  but  was  not  then  recog- 
nised as  a  surgical  antiseptic.  He  describes  it 
as  an  exceedingly  fine  yellow,  neutral,  insoluble 
powder,  stable  in  the  light,  having  a  faint 
odour  of  carbolic  acid,  almost  non-poisonous, 
and  unirritating  to  mucous  surfaces.  It  has 
but  little  effect  on  the  human  organism,  but  it 
is  so  highly  poisonous  to  the  comma  bacillus 
that  Hueppe  declared  it  almost  a  specific 
against  the  cholera  micro-organism.  The  au- 
thor's experiments,  published  in  the  Therapeu- 
tische  Monatshefte,  show  that  it  is  an  excellent 
surgical  antiseptic.  He  first  used  it  with  very 
good  results  in  the  treatment  of  chancroids ; 
if  they  were  not  complicated  with  buboes,  they 
healed  in  from  eight  to  fourteen  days.  In 
various  suppuratii'e  and  necrotic  affections, 
such  as  foul  ulcers,  buboes,  infected  wounds, 
paronychia,  etc.,  after  a  preliminary  cauteriza- 
tion with  pure  carbolic  acid,  it  promoted  the 
cessation  of  suppuration  and  led  to  prompt 
granulation  and  cicatrization,  and  never  gave 
rise  to  any  surrounding  inflammation.  In 
burns,  xeroform,  like  iodoform,  seemed  to  exert 
an  anodyne  action.  In  such  skin  diseases  as 
eczema  impefiginodes  and  eczema  madidans  a 
10-per-cent.  paste  of  xeroform  promptly  checked 
the  discharge,  and  cicatrization  speedily  en- 
sued. It  seemed  to  have  a  favourable  effect 
in  a  few  cases  of  localized  itching,  and  a  num- 
ber of  tuberculous  ulcers  and  glands  healed 
quickly  under  a  xeroform  dressing  applied 
after  curetting. 

Xeroform  seems  to  be  itself  inert,  but  on  its 
coming  in  contact  with  an  alkaline  liquid, 
such  as  the  tissue  juices,  the  tribromphenol  is 
gradually  set  free  and  exerts  its  action  on  the 
>bacteria,  while  the  bismuth  oxide  tends  to 
check  fermentation  and  acts  as  a  desiccant. 
Xeroform  is  inferior  to  iodoform  as  a  promoter 
of  granulation.  Its  antiseptic  power  seems  to 
be  somewhat  impaired  by  mixing  it  with  fatty 
substances ;  hence  it  is  better  to  use  paste  or  a 
gauze  impregnated  with  it.  Its  cost  is  about 
the  same  as  that  of  iodoform,  but  it  is  cheaper 
to  use  it,  because  only  about  half  the  amount 
is  required  that  would  have  to  be  employed  of 
iodoform. 

It  may  be  given  internally  in  doses  of  from 
7  to  15  grains,  three  times  a  day,  in  intestinal 
catarrh,  including  the  summer  diarrhoea  of 
children,  also  in  chronic  urticaria  and  in  cer- 
tain forms  of  eczema  in  children. 

X  RATS. — The  X  rays,  or  Rontgen  rays, 
are  chiefly  of  interest  to  tHe  medical  profession 


from  the  point  of  view  of  diagnosis,  but  they 
have  been  employed  therapeutically  also.  Our 
knowledge  of  them  has  been  so  recently  ac- 
quired that  some  account  of  their  nature  and 
the  processes  of  making  use  of  them  is  appro- 
priate. The  following,  therefore,  is  condensed 
from  a  paper  read  before  the  Medical  Society 
of  Victoria  in  August,  1896,  by  Dr.  F.  J.  Clen- 
dinnen,  of  Melbourne  {Intercolonial  Medical 
Journal  of  Australasia,  August  20, 1896) :  The 
labours  of  Hertz,  Lenard,  Crookes,  Hittorf,  and 
others  led  up  to  Rontgen's  discovery.  The  or- 
dinary Geissler  tube  was  the  first  step  in  the 
process,  then  came  the  Crookes  tube.  This  con- 
sists of  a  tube,  pear-shaped  or  otherwise  shaped, 
with  platinum  teiminals  fused  into  opposite 
ends,  and  exhausted  of  air.  When  a  high-ten- 
sion current  from  an  induction  coil  is  passed 
through,  a  violet  g^ow  is  seen  in  the  tube.  If 
the  tube  is  further  exhausted  the  glow  seems 
to  be  in  bands,  and  if  the  tube  is  still  further 
exhausted  the  glow  disappears,  and  then  the 
glass  of  the  tube  becomes  fluorescent,  and 
glows  with  a  bottle-green  colour,  provided  it  is 
made  of  soda  glass.  When  the  tube  is  in  this 
condition  the  X  rays  are  given  off  from  the 
cathode. 

The  late  Professor  Hertz  was  engaged  in  in- 
vestigating this  phenomenon  produced  in 
Crookes's  tube  just  before  his  death,  and  he 
instructed  his  assistant,  Lenard,  to  continue 
these  researches.  He  ascertained  that  the 
eathodic  rays  would  act  on  a  sensitive  plate, 
and  also  that  they  would  pass  through  wood, 
so  that  he  came  very  close  to  ROntgen's  dis- 
covery that  these  rays  would  pass  through  the 
tissues  of  the  human  body,  and  that  some  sub- 
stances were  more  easily  penetrated  by  them 
than  others — the  soft  tissues  of  the  body  more 
than  the  bones,  aluminum  more  than  other 
metals. 

What  these  rays  are  is  not  known ;  all  we 
know  is  that  they  travel  in  straight  lines,  can  . 
not  be  refracted  or  polarized,  cast  a  shadow, 
act  on  a  sensitive  plate,  pass  through  objects 
opaque  to  light,  and  cause  fluorescence.  It 
has  been  suggested  that  they  are  ultra-violet 
rays  of  the  spectrum,  with  which  they  agree  in 
some  respects,  though  their  wave  length  has 
not  been  determined.  In  this  connection,  says 
Dr.  Clendinnen,  some  observations  made  by 
himself  on  the  effect  produced  on  colour  may 
be  of  interest.  When  taking  a  photograph  by 
this  process  of  some  articles  inclosed  in  a  box 
painted  like  a  tartan  plaid,  he  found  that  the 
negative  was  striated,  and  comparing  the  strise 
with  the  colours  on  the  box,  he  found  that 
they  coiTesponded  with  the  red  colours,  and  it 
flashed  into  his  mind  that  these  X  rays  were 
absorbed  by  certain  colours  as  light  was.  He 
then  tried  to  take  a  photograph  of  a  picture 
painted  in  colours  on  a  half-inch  board,  and 
got  a  contrast  result.  This,  however,  was  not 
satisfactory,  as  the  opacity  might  have  been 
due  to  the  lead  in  the  paint,  and  the  surface 
was  uneven.  To  obviate  this  source  of  fallacy 
he  next  took  a  playing  card,  the  knave  of  dia- 
monds, and  the  red  colours  came  out  opaque, 
the  rest  transparent ;  then,  on  the  suggestion 
of  Professor  Lyle,  he  tried  aniline  colours, 


X  RAYS 


398 


soaking  blotting-paper  in  them,  and  found  that 
red  was  opaque,  blue  semi-transparent,  and 
white  transparent  to  the  X  rays.  He  then  cut 
pieces  of  coloured  tissue  paper  into  various 
shapes,  so  as  to  recognise  the  different  colours, 
pink  (as  he  had  no  I'ed),  orange,  yellow,  green, 
blue,  violet,  and  white.  On  passing  the  X  rays 
through  them,  he  found  pink  semi-transparent, 
yellow  and  orange  opaque,  green  opaque  (but 
not  so  opaque  as  the  former),  blue  and  violet 
more  transparent,  and  white  quite  transparent. 
These  experiments  seemed  to  show  that  the  X 
rays  obeyed  some  of  the  laws  of  ordinary  light 
in  that  red  and  yellow  are  non-actinic. 

There  are  three  things  required  for  produc- 
ing these  rays :  First,  power  or  current ;  this 
may  be  obtained  from  Grove,  Bunsen,  or  bi- 
chromate cells.  Grove's  and  Bunsen's  are  the 
best,  as  their  current  is  given  off  more  evenly 
and  lasts  longer,  but  the  fumes  that  arise  are 
too  pungent  for  comfort.  This  is  not  the  case 
with  bichromate  cells,  but  their  current  is  un- 
even. The  number  of  cells  to  use  must  be  in 
proportion  to  the  strength  or  sparking  of  the 
coil.  Accumulators  may  be  used — such  as 
Professor  Lyle  uses — a  dynamo,  the  main,  the 
Tesla  coil,  and  the  Wimshurst  machine  have 
all  been  used.  Second,  a  Ruhmkorffi  induc- 
tion coil  which  gives  a  spark  of  from  two 
to  six  inches ;  this  must  be  in  good  working 
order.  Third,  a  vacuum  tube.  The  positive 
and  negative  terminals  of  the  battery  are 
to  be  connected  to  the  coil,  and  the  termi- 
nals of  the  secondary  wire  of  the  coil  con- 
nected to  the  external  terminals  of  the  tube, 
which  is  supported  on  the  stand,  with  the  plate 
lying  underneath,  face  upward.  Owing  to  the 
capability  of  these  rays  of  penetrating  paper 
and  wood  with  such  ease,  we  may  photograph 
on  the  plate  inclosed  in  a  box. 

Although  these  rays  are  invisible  in  them- 
selves, tliey  stimulate  visible  fluorescence  in 
certain  salts  upon  which  they  are  allowed  to 
fall.  The  salts  which  have  been  found  to  fluo- 
resce best  are  barium  platinocyanide  and  calci- 
um tungstate.  The  fluorescent  screen  is  made 
by  painting  evenly  a  thick  piece  of  paper,  such 
as  drawing  paper,  with  a  mixture  of  gum  and 
glycerin,  and  then  dusting  over  it  before  it  is 
quite  dry  a  powder  of  the  salts  mentioned. 
Not  only  are  the  shadows  cast  on  this  screen, 
but  it  is  used  for  shortening  the  exposure. 

It  appears  from  certain  experiments  made 
by  Mr.  J.  A.  M'Clelland,  an  account  of  which 
is  given  by  Professor  J.  J.  Thomson  (Proceed- 
ings of  the  Royal  Society,  No.  360),  that  the  X 
rays  are  not  homogeneous,  but  that  some  of 
them  are  absorbed  by  one  set  of  substances  and 
others  by  other  sets.  This  lack  of  homogeneity 
is  the  more  pronounced  the  smaller  the  amount 
of  residual  air  in  the  Crookes's  tube.  Mr. 
M'Clelland  found  that  with  some  substances 
there  was  no  selective  absorption,  while  with 
others  it  was  very  marked.  Glass  gave  none, 
with  mica  and  paraffin  the  effect  was  small, 
and  with  fuchsine,  eosine,  fluorescine.  aesculin, 
and  barium  sulphide  the  effect  was  very  de- 
cided. With  several  fluorescent  screens  the 
effect  was  great.  Pure  water  also  gave  a  dis- 
tinct though  smaller  effect. 


When  the  X  rays  first  came  into  use  some 
physicians  expected  that  they  would  be  found 
to  have  some  physiological  action  that  could 
be  turned  to  account  therapeutically,  and  espe- 
cially that  they  would  prove  destructive  of 
morbific  germs.  It  seems,  however,  from  De 
Renzi's  experiments  {Qazzetta  degli  ospedale, 
August  30,  1896 ;  British  Medical  Journal, 
October  31,  1896)  that  they  have  no  such  effect, 
at  least  not  on  the  tubercle  bacillus,  the  bacillus 
of  Finkler,  or  the  cholera  spirillum. 

Dr.  P.  I5osc  (Nouveau  Montpellier  medical, 
April  25,  1896;  New  York  Medical  Journal, 
July  4, 1896),  having  seen  the  opinion  expressed 
in  print  that  the  curiosities  of  vision  observed 
in  the  hysterical  might  perhaps  be  due  to  their 
perceiving  these  rays,  examined  a  girl,  fifteen 
years  old,  who  was  affected  with  heraiancesthe- 
sia  and  astasia-abasia,  but  whose  vision  seemed 
normal.  Between  the  Crookes's  tube  and  the 
girl's  eye  he  placed  a  broad  screen  of  two 
thicknesses  of  black  paper.  The  light  was  ob- 
tained with  a  Holtz-Carre  static  machine. 
Under  these  conditions,  neither  he  himself  nor 
the  girl's  mother  could  see  anything.  The  pa- 
tient, on  the  contrary,  saw  very  clearly,  and 
with  each  °ye  separately,  a  light  which  she  said 
was  "like  a  lamp."  As  long  as  the  current 
was  passing  she  saw  distinctly ;  as  soon  as  it 
was  interrupted  she  could  see  nothing.  At  the 
time  of  making  the  interruption  Dr.  Boso  kept 
up  a  production  of  sparks,  so  that  the  girl  did 
not  know  that  he  had  stopped  the  current.  He 
remarks  that  it  was  curious  that  the  girl's  per- 
ception of  light  varied  with  the  luminous  inten- 
sity of  the  cathode  rays,  the  tube  being  the  same. 

Dr.  Frederick  S.  'Kolle,  of  Brooklyn  {New 
York  3Iedical  Journal,  January  16,  1897),  re- 
ports that  of  seven  persons  with  amaurosis, 
subjected  to  the  Rontgen  rays,  six  observed  a 
peculiar  shooting-star  light,  the  Sternschup- 
penlicht  of  the  Germans.  Four  of  the  patients 
could  count  the  individual  stars,  ranging  be- 
tween six  and  thirty-two  in  number. 

Cancer  is  one  of  the  diseases  in  which  the  X 
rays  have  been  expected  to  prove  remedial, 
and  possibly  they  may  yet  be  of  advantage  in 
the  treatment  of  some  forms  of  malignant 
growth. 

Dr.  V.  Despeignes  (Lyon  medical,  July  26 
and  August  9, 1896)  reports  a  case  in  which 
they  were  used  in  the  treatment  of  cancer  of 
the  stomach.  At  first  a  notable  amelioration 
was  observed,  but  unfortunately  it  did  not 
continue.  The  Rontgen  rays  did,  however, 
continue  to  diminish  the  size  of  the  tumour, 
and  at  the  time  of  the  patient's  death  it  was 
considerably  smaller. 

M.  Despeignes  says  that  the  treatment  con- 
siderably ameliorated  the  general  condition 
and  prolonged  the  patient's  life  for  fully  two 
weeks,  it  absolutely  suppressed  the  pain  near 
the  tumour,  and,  finally,  it  notably  diminished 
the  volume  of  the  growth.  He  adds,  however, 
that  he  thinks  the  amelioration  of  the  general 
condition  was  mainly  attributable  to  injections 
of  artificial  serum,  for  when  their  use  was  sus- 
pended at  the  patient's  request,  because  they 
were  painful,  the  general  condition  "became 
worse.    With  regard  to  the  cessation  of  the 


399 


X  RAYS 


pain,  when  morphine  injections  ceased  to  have 
any  further  action,  it  did  not  seem  warrant- 
able, he  says,  to  attribute  it  to  anything  but 
the  employment  of  the  Rontgen  rays,  for  from 
the  beginning  of  the  first  sitting  the  pain 
ceased  entirely.  Before  the  employment  of 
the  rays  the  patient  had  been  taking  daily 
doses  of  4^  oz.  of  chloroform  water,  and  very 
often  two  pills  containing  f  of  a  grain  of  ex- 
tract of  opium,  and  he  frequently  had  one  or 
two  injections  of  morphine.  After  the  em- 
ployment of  the  rays  the  use  of  the  opium  pills 
was  discontinued  and  only  very  small  quanti- 
ties of  chloroform  were  given  for  two  or  three 
days.  In  regard  to  the  diminution  of  the  size 
of  the  tumour,  says  M.  Despeignes,  the  action 
of  the  rays  was  still  more  distinct.  As  there 
was  no  sectio  cadaveris,  it  was  impossible  to 
say  what  part  of  the  tumour  was  influenced 
by  the  rays,  but  it  is  certain,  he  thinks,  that 
the  regression  did  not  take  place  on  the  sur- 
face alone,  but  that  the  action  of  the  rays  was 
felt  in  the  cancer ;  the  epigastric  region,  which 
had  been  very  much  swollen  on  the  4th  of 
July,  was  almost  flat  at  the  time  of  the  par 
tient's  death,  on  the  34th.  This  diminution 
extended  also  to  the  right  extremity  of  the 
stomach,  the  part  which  encircled  the  left  lobe 
of  the  liver.  When  death  occurred  it  was 
found  on  palpation  and  percussion  that  this 
lobe  of  the  liver  was  completely  free,  and  it 
seemed  as  if  the  cancer  had  entirely  disap- 
peared, on  that  side  at  least,  for,  M.  Despeignes 
argues,  if  the  regression  had  taken  place  in  the 
stomach  only,  it  is  probable  that  the  contrary 
wotild  have  been  the  case.  In  the  presence  of 
these  results,  and  although  the  termination 
was  fatal,  he  asks  if  there  may  not  be  hope,  if 
not  of  recovery,  at  least  of  a  considerable  pro- 
longation of  life  by  employing  this  treatment 
if  the  cancerous  affection  is  not  advanced  or 
not  progressing  rapidly. 

On  the  other  hand,  some  observers  have  put 
on  record  certain  pathological  phenomena  that, 
are  thought  to  have  been  produced  by  the  X 
rays.  In  the  New  York  Medical  Journal  for 
August  29,  1896,  an  editorial  writer  says :  "  So 
far  as  our  knowledge  goes  at  present,  these 
morbid  results  seem  to  affect  chiefly  if  not  ex- 
clusively the  skin  and  its  appendages.  Dr. 
Marouse  (Deutsche  medicinische  WocJien- 
schrift,  July  33,  1896 ;  British  Medical  Jmm-- 
nal,  August  15,  1896)  relates  the  case  of  a  lad, 
seventeen  years  old,  on  whom  he  experimented 
with  the  Rontgen  rays  once  or  twice  a  day  for 
a  period  of  four  weeks,  the  sittings  lasting 
from  five  to  ten  minutes,  and  longer  when  the 
chest  was  being  illuminated.  Hittorf's  tube 
was  sometimes  placed  close  to  the  body  and 
never  more  than  eight  or  ten  inches  away  from 
it.  The  heat  from  the  tube  is  said  to  have  been 
very  slight.  The  lad  was  completely  clothed 
when  his  head  was  undergoing  examination, 
and  wore  his  shirt  when  his  chest  was  sub- 
jected to  the  apparatus.  At  first  a  slight 
diffuse  redness  was  observed  in  one  half  of  the 
face,  especially  above  the  ear,  with  some  des- 
quamation. Subsequently  there  was  a  sharply 
defined  area  above  the  ear  where  the  hair  was 
very  thin.    The  hairs  could  be  plucked  out 


without  pain,  and  showed  signs  of  degenera- 
tion— in  short,  there  was  incipient  alopecia. 
There  was  pronounced  injection  of  the  con- 
junctiva of  the  eye  that  was  situated  on  that 
side  of  the  face  that  was  affected.  On  the 
back  there  was  a  space  '  as  large  as  a  plate ' 
over  which  the  epidermis  was  completely  sepa- 
rated, and  the  exposed  corium  showed  hemor- 
rhages and  exudation.  The  patch  was  quite 
tender,  but  there  had  been  no  pain  until 
shortly  before  the  lesions  were  noticed.  There 
were  similar  changes,  but  not  so  advanced, 
over  a  space  of  about  the  same  size  on  the 
front  of  the  chest.  The  dermatitis  resembled 
that  caused  by  a  burn.  Prom  other  sources 
we  hear  of  loss  of  the  nails  as  a  result  of  ex- 
posure to  the  X  rays." 

Dr.  A.  B.  Kibbe,  of  Seattle,  Washington 
(New  York  Medical  Journal,  January  16, 
1897),  reports  that  during  a  certain  week  he 
devoted  considerable  time  to  experimenting 
with  an  X-ray  apparatus.  In  general,  the  cur- 
rent strength  used  was  about  ten  amperes. 

He  found  that  the  most  convenient  manner 
of  testing  the  working  of  the  tube  was  by 
using  his  left  hand  in  front  of  the  fluoroscope, 
and  this  he  did  frequently ;  but  as  this  method 
gave  less  sharp  and  well-defined  pictures  than 
by  using  a  sensitive  plate  and  taking  pictures, 
the  fluoroscope  was  solely  used  to  test  the  ac- 
tivity of  the  tube  in  producing  the  radiations, 
and,  when  the  latter  were  satisfactory,  pictures 
of  the  hand,  wrist,  and  arm  were  taken  with 
exposures  varying  from  thirty  seconds  to  five 
minutes.  Just  how  often  the  hands  were  ex- 
posed he  is  unaible  to  say,  but  certainly  not 
fewer  than  twenty  times  for  the  left  with  the 
fluoroscope,  and  at  least  five  for  the  right, 
placed  on  the  plate  holder;  in  no  instance, 
however,  for  a  longer  period  than  five  minutes. 
In  order  to  obtain  a  picture  of  his  elbow  joint 
he  placed  it  about  four  inches  below  the  tube, 
which  was  of  the  ordinary  focus  pattern,  the 
cathode  a  cup-shaped  aluminum  disc,  the 
anode  a  plate  of  platinum  set  at  an  angle  of 
forty-five  degrees  to  the  long  axis  of  the  tube. 
The  focus  he  endeavoured  to  have  directly 
over  the  joint.  The  arm  was  partly  flexed 
and  resting  semipronated  on  the  plate  holder. 
A  second  exposure,  lasting  seven  minutes,  was 
tried  a  day  or  two  later,  and  a  third,  lasting 
ten  minutes,  on  the  evening  of  the  following 
day.  This  last  was  on  the  8th  of  September. 
At  the  time  a  slight  tingling  of  the  skin  was 
noticed,  so  slight,  however,  that  he  was  not 
certain  that  it  was  not  due  to  the  effects  of 
imagination,  as  during  the  "  sitting "  he  had 
been  going  over,  mentally,  Tesla's  arguments 
in  favour  of  the  assumption  that  the  so-called 
rays  are  really  due  to  minute  particles  thrown 
off  from  the  cathode.  In  each  instance  the 
arm  was  covered  with  his  usual  clothing,  con- 
sisting of  heavy  woollen  underclothing,  shirt 
and  coat  sleeve. 

A  day  or  two  later  his  attention  was  attracted 
to  the  appearance  of  the  dorsal  surfaces  of 
both  hands  by  a  slight  sensation  of  irritation 
and  itching.  At  first  sight  the  appearance 
suggested  sunburn,  but,  as  the  weather  had 
been  cloudy  for  a  number  of  days,  and  further, 


XYLENE 
ZINC 


400 


as  his  skin  had  always  been  more  than  ordi- 
narily free  from  any  of  the  common  afEections 
^eczema,  etc. — ho  half  jokingly  attributed 
it  to  the  X-rays.  On  September  18th  he  felt  a 
slight  itching  near  the  elbow  which  had  been 
exposed  to  the  rays,  and  that  night  he  found 
an  extensive  discoloration  of  the  skin,  ex- 
tending from  a  point  two  inches  above  the 
joint  to  a  distance  of  about  six  inches  down- 
ward toward  the  wrist,  and  including  about 
one  third  the  circumference  of  the  arm.  In 
colour  it  was  of  a  brownish  red,  punctated  at 
the  upper  and  lower  borders  and  ends  and 
more  confluent  at  the  centre.  Examination 
with  a  lens  showed  the  punctated  area  to  be 
due  to  an  apparently  greater  hypersemia  around 
the  hair  follicles.  No  vesicles  were  apparent, 
and  there  appeared  to  be  no  tendency  to  their 
formation.  Pressure  caused  the  redness  to 
disappear  to  a  great  extent,  but  not  entirely. 
There  was  no  sensitiveness,  but  the  tempera- 
ture was  decidedly  raised  above  that  of  the 
adjacent  healthy  skin.  Traction  on  the  hairs 
showed  no  loosening. 

On  September  20th,  the  affection  showing 
no  tendency  to  become  worse.  Dr.  Kibbe  cut 
out  a  piece  of  skin,  a  centimetre  square,  from 
the  most  deeply  discoloured  area,  without  using 
a  local  ansesthetic,  for  he  feared  to  interfere 
with  the  structures  by  injecting  cocaine.  The 
stratum  corneum  was  apparently  unchanged ; 
the  stratum  lucidum  was  not  clearly  visible, 
excepting  over  small  areas,  where  the  under- 
lying disturbance  was  seen  to  be  slight.  The 
outer  layers  of  the  cells  composing  the  rete 
mucosum  presented  the  most  striking  altera- 
tions, particularly  in  their  nuclei.  Taking  the 
stain  both  with  haematoxyiin  and  lithium  car- 
min  very  feebly,  the  nuclei  showed  in  addition 
a  peculiar  granular  change,  which  was  first 
indicated  in  those  retaining  a  more  normal 
reaction  to  the  stain  by  the  formation  of  a  fine 
nucleolus,  which  could  be  seen  here  and  there 
in  the  process  of  division.  Near  the  stratum 
granulosum  the  bodies  of  the  cells  were  appar- 
ently becoming  converted  into  keratohyalin  as 
a  first  step  to  the  increase  in  bulk,  as  it  were, 
of  the  stratum  granulosum  by  a  development 
in  their  interior  of  coarse  granules,  staining 
deeply  with  hsematoxylin,  and  also  with  carmin. 
With  the  former  they  appeared  like  blotches  of 
India  ink ;  in  some  places  giving  the  impres- 
sion as  though  the  cells  had  been  charred 
by  heat.  This  was  particularly  the  case  around 
the  hair  follicles.  The  corium  exhibited  the 
ordinary  changes  found  in  a  mild  dermatitis: 
capillary  dilatation,  with  collections  of  round 
cells  scattered  through  its  structure,  particu- 
larly around  the  hair  follicles.  No  extravasa- 
tions of  blood  were  noticed. 

On  October  3d  Dr.  Kibbe  noted  that  des- 
quamation of  the  entire  discoloured  area  on 
his  arm  was  going  on,  with  absolutely  no  pain, 
excepting  in  the  locality  from  which  the  skin 
had  been  exsected.  A  slight  itching  was  all 
that  now  annoyed  him.  Where  the  flakes  had 
been  detached  the  hairs  seemed  to  be  as  abun- 
dant and  as  firm  as  in  the  healthy  skin.  There 
appeared  to  have  been  no  interference  with 
the  healing  process  of  the  raw  surface  pro- 


duced by  the  exsection,  further  than  what 
might  have  been  expected  in  removing  a  piece 
of  skin  over  a  joint  where  every  movement 
would  tend  to  delay  cicatrization. 

He  suggests  that  the  few  reported  instances 
of  pathological  phenomena  pi-oduced  by  the  X- 
rays  are  to  be  regarded  as  due  to  individual 
susceptibility. 

XYLENE,  or  xylol,  or  dimethylbenzene, 
CeH4(CHs)2,  is  a  colourless  liquid  resembling 
benzene  in  general  properties.  Some  years  ago 
it  had  a  temporary  repute  in  the  treatment  of 
small-pox.  Given  internally,  in  quantities  not 
exceeding  45  minims  a  day  in  divided  doses,  it 
was  supposed  to  mitigate  the  severity  of  the 
disease  and  to  shorten  its  course.  It  is  reputed 
to  be  antiseptic. 

XTLENOL. — There  are  four  isomeric  xyle- 
nols,  three  of  which,  orthoxylenol,  metaxylenol, 
and  paraxyUnol,  are  used  in  medicine,  chiefly 
in  the  form  of  salicylates,  the  xylenolsalols,  in 
doses  of  from  3  to  6  grains.  The  indications 
for  their  employment  are  the  same  as  for  that 
of  salol  {g.  v.). 

XTLOL. — See  Xylene. 


YARROW.— See  Achillea. 

YEAST. — Beer  yeast,  or  brewer's  yeast, 
cerevisim  fermentum  (Br.  Ph.),  is  a  frothy, 
semifluid  substance  somewhat  resembling  soft 
soap  in  appearance,  having  a  peculiar  sourish 
odour  and  a  bitter  taste,  consisting  of  the  cells 
of  Saccharomyces  cerevisice. 

Brewer's  yeast  is  occasionally  used  in  medi- 
cine, in  doses  of  one  or  two  tablespoonfuls 
three  times  a  day.  Its  employment  in  this 
way  has  been  found  to  prevent  the  recurrence 
of  boils.  It  may  be  given  in  a  glass  of  beer  at 
meal  times. 

Dr.  Cassaet  (Semaine  midicale,  August  31, 
1895;  British  31edieal  Journal,  August  31, 
1895  ;  llierapeutic  Gazette,  December  16, 1895) 
reports  good  results  in  three  cases  of  diabetes 
from  the  administration  of  brewer's  yeast  in 
daily  amounts  of  an  ounce,  although  the  ad- 
ministration of  the  substance  could  not  be 
continued  long,  on  account  of  the  practical 
difficulty  in  summer  of  preventing  acetous  or 
putrid  fermentation.  It  was  taken  readily  by 
the  patients.  The  immediate  effect  was  the 
expulsion,  during  the  few  minutes  following 
its  absorption,  of  a  very  large  quantity  of  gas 
by  eructation  ;  then  in  the  course  of  the  first 
or  second  day  extremely  fcEtid  diarrhoea  with 
abundant  gas  occurred.  After  a  few  days  tol- 
erance was  established,  and  the  patient  felt 
better  than  he  had  felt  for  a  long  time ;  his 
general  state  improved,  his  appetite  returned, 
his  strength  inci'eased,  and  pain  diminished. 
The  weight  of  the  three  patients  on  whom  the 
treatment  was  tried  increased  three,  five,  and 
eight  pounds  respectively  after  the  yeast  had 
been  administered  for  a  fortnight.  The  gain 
in  weight  was  particularly  remarkable,  inas- 
much as  one  of  them  was  phthisical  as  well  as 
diabetic,  and  another  had  diabetes  of  the  grav- 


401 


XYLENE 
ZINC 


est  type.  On  discontinuing  the  treatment  loss 
ot  weight  was  soon  observed  again.  As  to  the 
strength  as  tested  by  the  dynamometer,  an  im- 
provement o£  from  twelve  to  twenty  kilo- 
grammes was  noted  in  the  right  hand  and  of 
Irom  seventeen  to  twenty-two  in  the  left.  The 
urea  remained  stationary  or  increased  and  the 
proportion  of  sugar  in  the  urine  diminished, 
in  one  case  by  three  fourths  and  in  another 
by  two  thirds  in  the  fortnight. 

Brewer's  yeast  is  used  externally  in  the  form 
of  a  poultice,  eataplasma  fermenti  (Br.  Ph.), 
made  by  mixing  6  fl.  oz.  of  the  yeast  with  its 
own  bulk  of  water  heated  to  100°  F.,  stirring 
in  14  oz.  of  wheaten  flour,  and  keeping  the 
mass  in  a  warm  place  until  it  rises.  This 
poultice  gives  offi  carbonic-acid  gas,  and  thus 
proves  stimulixnt  and  slightly  anodyne.  There 
are,  however,  other  and  better  means  of  accom- 
plishing all  that  it  can  effect. 

Balier's  yeast,  or  German  yeast,  yeast  freed 
from  water  and  pressed  into  cakes,  has  been 
used  in  the  treatment  of  enteroptosis  by  Dr.  A. 
Giinzburg  {Munchener  medicinische  Wochen- 
schrift.  July  7,  1896;  Presse  medicale,  August 
19,  1896)  in  a  large  number  of  cases,  with  suc- 
cessful results.  Every  day  a  quantity  of  about 
the  size  of  a  bean  was  given,  and  the  fermen- 
tation provoked  by  the  yeast  caused  a  certain 
degree  of  flatulence  which  held  and  immobi- 
lized the  intestine.  Occasionally  this  flatu- 
lence became  too  great  and  provoked  a  feeling 
of  distention ;  in  this  case  the  quantity  of 
yeast  had  to  be  diminished. 

In  a  general  manner,  says  Giinzburg,  this 
treatment  gives  the  patients  a  sensation  of 
comfort.  They  are  no  longer  inconvenienced 
with  flatus,  and  this  is  attributed  by  the  author 
to  the  peculiar  action  on  the  intestine  of  the 
carbonic  acid  which,  under  the  influence  of  the 
yeast,  is  developed  in  the  digestive  tract.  The 
stools  become  regular' and  abundant,  and  the 
distention  of  the  intestine  carries  the  aorta 
away  from  the  abdominal  wall  so  that  the  pa- 
tients do  not  feel  the  beating  of  this  vessel. 
Finally,  the  appetite  becomes  better  and  large 
quantities  of  food  can  be  taken  without  diffi- 
culty. 

Yeast  is  one  of  the  sources  of  nuclein  (q.  v.). 

YELLOW  ROOT.— See  Hydrastis. 

YERBA  SAGRADA.— See  Lantana. 

YERBA  SANTA,  eriodictyon  (U.  S.  Ph.), 
is  the  leaves  of  Eriodictyon  glutinosum  (or 
californicum),  or  Oalifornian  tar-bush,  a  hy- 
drophyllaoeous  plant.  Yerba  santa  has  some 
reputation  as  a  means  of  palliating  chronic 
pulmonary  inflammations.  The  dose  of  the 
fluid  extract,  extractum  eriodictyi  fluidum 
(U.  S.  Ph.),  is  from  20  minims  to  a  fl.  drachm. 
The  aromatic  syrup  of  yerba  santa,  syrupus 
eriodictyi  aromaticus  (Nat.  Form.),  is  em- 
ployed as  a  vehicle  to  mask  the  taste  of  qui- 
nine and  other  bitter  drugs. 


ZEA. — See  Corn-silk. 
ZlUC,  zincum  (TJ.  S.  Ph.,  Br.  Ph.).— This 
metal  is  not  itself  used  in  medicine,  but  is  ofiS.- 


cial  for  pharniaoeutical  purposes.  It  is  de- 
scribed as  "  a  bluish-white  metal  showing  a 
crystalline  fracture  and  having  a  specific  grav- 
ity ranging  from  6'9  when  oast  to  7'3  after  it 
is  rolled.  Soluble  in  dilute  sulphuric  or  hy- 
drochloric acid  with  evolution  of  hydrogen 
gas."  It  has  a  peculiar  taste  and  a  slight 
odour  when  rubbed.  It  is  to  be  found  in  the 
market  in  the  form  of  thin  sheets  or  of  irregu- 
lar, granular  pieces,  zincum  granulatum  (Br. 
Ph.),  or  in  a  fine  powder,  or  moulded  into 
pencils. 

For  therapeutical  purposes,  zinc  is  repre- 
sented by  several  oificial  and  a  large  number 
of  unotficial  salts  which  present  nearly  every 
phase  of  activity  in  direct  proportion  to  their 
solubility  and  power  of  diffusion,  a  variation 
which  causes  very  marked  differences  in  their 
physiological  action.  In  moderate  doses  the 
soluble  salts  determine  emesis  which,  though 
less  severe  than  that  induced  by  the  salts  of 
copper,  is  very  prompt  and  thorough,  while  the 
insoluble  salts  tend  to  allay  irritation  of  the 
gastro-intestinal  tract.  In  regard  to  the  lat- 
ter, however,  it  must  be  noted  that  large  doses 
often  cause  nausea  and  vomiting,  possibly  on 
account  of  the  conversion  of  a  portion  into  a 
more  soluble  salt  on  contact  with  the  contents 
of  the  stomach.  Almost  all  the  salts  are  as- 
tringent, and  the  soluble  ones  are  caustic  and 
corrosive  agents  which  in  large  doses  produce 
severe  gastro-enteritis  with  all  the  accompany- 
ing symptoms  of  irritant  poisoning.  When 
applied  externally,  the  insoluble  compounds 
form  soothing  and  protective  dressings  to  irri- 
tated surfaces,  while  the  soluble  ones  are  as- 
tringent, irritant,  and  even  caustic. 

In  medicinal  doses  the  zinc  salts  act  as  a 
tonic  upon  the  nervous  system  and  exert  a  cer- 
tain, not  very  powerful,  influence  to  ameliorate 
spasmodic  nervous  disorders,  such  as  chorea 
and  epilepsy.  It  is  probable  that  at  some  time 
between  the  moment  of  ingestion  and  that  of 
absorption  into  the  system  these  salts  are 
changed  into  the  form  of  an  albuminate,  and 
as  such  exist  and  are  carried  about  in  the  blood. 
Zinc  has  a  tendency  to  accumulation,  though 
to  a  lesser  degree  than  mercury,  lead,  or  cop- 
per, and  is  excreted  from  the  system  more 
rapidly  than  those  metals.  The  elimination  of 
the  drug  is  accomplished  principally  by  the 
liver  and  intestinal  glands,  but  it  has  been 
alleged  that  it  is  excreted  to  a  slight  degree  by 
the  kidneys. 

The  long-continued  ingestion  of  considerable 
quantities  of  zinc,  whether  given  for  medicinal 
purposes  or  inhaled  in  the  form  of  fumes  of 
the  molten  metal,  may  give  rise  to  disturb- 
ances of  the  nervous,  respiratory,  digestive, 
and  haematopoietic  systems,  characterized  by 
headache,  muscular  tremor,  feebleness,  paresis 
or  paralysis,  cough,  dyspnoea,  haemoptysis,  vom- 
iting, diarrhoea  or  constipation,  colic,  cramps, 
anfemia,  and  other  symptoms  of  interference 
with  the  nutrition  of  the  body.  The  treat- 
ment of  this  condition  of  chronic  zinc  poi- 
soning is  to  hasten  the  elimination  of  the 
metal  by  means  of  potassic  iodide,  laxatives, 
and  warm  baths. 

Dr.  Stephen  J.  Maher,  of  New  Haven,  de- 


ZINC 


403 


scribes  in  the  New  York  Medical  Journal  for 
December  21, 1895,  under  the  name  of  "  spelter 
shakes,"  attaolcs  of  severe  chills  followed  by 
fever  and  profuse  perspiration,  common  among 
workmen  in  brass-foundries,  and  attributed  by 
them  to  the  inhalation  of  the  fumes  of  molten 
zinc.  These  chills  are  said  not  to  be  associated 
with  headache,  nausea,  or  vomiting,  and  not 
to  exhibit  any  periodicity  or  tendency  to  re- 
currence except  on  renewed  exposure.  As  the 
workmen  know  that  the  attacks  are  of  brief 
duration  and  consider  them  without  danger, 
they  are  not  accustomed  to  summon  medi- 
cal assistance,  but  endeavour  to  obtain  sleep 
as  quickly  as  possible,  for  which  purpose  it 
is  customary  to  imbibe  considerable  whisky. 
After  a  few  hours  they  awake  exhausted,  but 
otherwise  recovered. 

Cases  of  acute  poisoning  by  the  soluble  zinc 
salts  exhibit  either  the  toxic  symptoms  refer- 
able to  the  acid  with  which  the  zinc  is  com- 
bined or  the  usual  characteristics  of  corrosive 
poisoning.  In  the  former  case  the  patient  is 
to  be  treated  for  poisoning  by  the  combined 
acid ;  in  the  latter  the  acute  symptoms  must 
be  relieved  by  washing  out  the  stomach  and 
the  administration  of  bicarbonate  of  sodium  or 
some  other  alkaline  carbonate,  as  the  best 
chemical  antidote,  followed  by  the  ingestion  of 
demulcents,  such  as  milk  or  flour  and  water, 
together  with  the  hypodermic  injection  of  mor- 
phine in  sufHcient  quantity  to  control  the  pain 
and  vomiting.  When  an  alkaline  carbonate 
can  not  otherwise  be  quickly  obtained,  it  is  a 
good  method  to  dissolve  soap  in  water  and 
cause  that  to  be  drank. 

Solutions  of  the  soluble  salts  are  useful  for 
purposes  of  disinfection  in  the  same  manner 
as  most  soluble  metallic  salts  and  are  preferred 
to  many  because  they  do  not  stain. 

The  therapeutic  applications  of  the  zinc 
salts  are  as  varied  as  might  be  inferred  from  a 
consideration  of  their  widely  dififerent  physio- 
logical actions.  In  suitable  doses  they  agree 
in  producing  a  beneficial  effect  upon  certain 
diseases  of  the  nervous  system  which  is  supe- 
rior to  that  induced  by  the  salts  of  any  other 
heavy  metal,  though  not  equal  to  that  of  the 
bromides,  which  have  superseded  them  in  the 
treatment  of  such  diseases.  Aside  from  this 
property,  there  is  but  little  agreement  in  their 
action,  and  each  salt  needs  a  separate  consid- 
eration. 

The  zinc  salts  which  are  official  in  the  United- 
States,  Great  Britain,  or  Germany  are  the 
acetate,  bromide,  carbonate,  chloride,  iodide, 
oxide,  phosphide,  sulphate,  and  valerianate. 
These  will  be  considered  first,  the  description 
of  each  taken  from  the  U.  S.  Ph.,  and  will  be 
followed  by  a  number  of  unofiicial  salts,  some 
of  which  are  but  little  used,  while  others  are 
employed  to  a  considerable  extent.  All  which 
are  not  permanent  in  the  air  should  be  kept  in 
small,  well-stoppered  bottles. 

Zinc  acetate,  zinci  acetas  (U.  S.  Ph.,  Br. 
Ph.),  zincum  aceticum  (Ger.  Ph.). — This  salt 
occurs  in  "soft,  white,  six-sided,  monoclinic 
plates  of  a  pearly  lustre,  having  a  faintly  ace- 
tous odour  and  an  astringent  metallic  taste. 
Exposed  to  the  air,  the  salt  gradually  efflo- 


resces and  loses  some  of  its  acid."  It  i3 
soluble  in  about  three  parts  of  water  and 
thirty-six  of  alcohol  at  ordinary  temperatures, 
in  about  one  and  a  half  part  of  boiling  water, 
and  in  three  parts  of  boiling  alcohol.  When 
subjected  to  protracted  boiling  in  watei-,  it  is 
rendered  less  soluble,  a  portion  of  the  acid  be- 
ing lost  and  a  basic  salt  formed. 

Zinc  acetate  is  seldom  employed  for  internal 
administration,  though  it  has  been  used  as  a 
nervine  and  to  check  diarrhoeas.  In  doses  of 
from  8  to  30  grains  it  is  an  efficient  emetic. 
Its  principal  use  is  as  a  local  astringent,  par- 
ticularly in  gonorrhoea,  leucorrhcea,  and  con- 
junctivitis, where  its  action  is  essentially  the 
same  as  that  of  the  sulphate,  though  somewhat 
less  irritating.  As  a  collyrium,  it  is  usually 
prescribed  in  the  strength  of  from  i  to  4  grains 
to  the  ounce  of  water,  a  drop  of  which  is  to  be 
instilled  into  the  eye  once  a  day  or  oftener. 
Like  all  astringent  coUyria,' this  should  be  used 
only  in  conjunctivitis,  and  will  do  harm  in 
certain  diseases  of  the  eye  which  are  frequent- 
ly distinguished  with  some  difficulty  from  that 
disease,  such  as  keratitis,  iritis,  or  scleritis. 

Solutions  of  about  the  same  strength  are 
used  as  injections  in  gonorrhcea,  after  the 
acute  symptoms  have  abated,  and  also  in  leu- 
corrhcea. Sir  Astley  Cooper  recommended  in 
gonorrhoea  a  solution  of  zinc  sulphate  and 
lead  acetate,  in  which  a  double  decomposition 
ensued  and  resulted  in  the  production  of  zinc 
acetate  and  lead  sulphate.  This  is  not  infre- 
quently useful,  as"  the  astringent  action  of  the 
zinc  salt  is  complemented  by  the  protection 
afforded  to  the  urethral  mucous  membrane  by 
a  coating  of  the  insoluble  lead  sulphate. 

An  ointment  containing  zinc  acetate  is  fre- 
quently useful  in  erythema  and  herpes.  The 
late  Dr.  Tilbury  Fox  recommended  as  an  as- 
tringent wash  in  erythema  and  eczema  the 
following :    . 

9  Zinc  acetate 2  grains ; 

Rose  water 1  fl.  oz. 

M. 

Zinc  'bromide,  zinci  bromidum  (U.  S.  Ph.), 
occurs  as  a  white  granular  powder,  odourless, 
and  having  a  sharp  saline  and  metallic  taste. 
It  is  very  deliquescent,  and  is  freely  soluble  in 
water  and  in  alcohol. 

This  salt  is  very  little  used.  It  was  prob- 
ably introduced  into  medicine  for  the  purpose 
of  combining  the  tonic  effect  of  zinc  upon  the 
nervous  system  with  the  sedative  action  of  the 
bromides,  but  it  has  not  proved  of  special  effi- 
cacy in  the  treatment  of  nervous  diseases.  It 
is  said  to  have  been  used  in  epilepsy  in  doses 
of  from  1  to  25  grains,  but  Gowers  appears  to 
have  voiced  the  general  opinion  when  he  stated 
that  it  seemed  of  small  value  and  to  be  badly 
borne.  The  dose  usually  recommended  is  from 
-i  to  3  grains. 

Zinc  carbonate. — This  salt  is  found  in  an 
impure  condition  in  Nature  as  a  mineral  which 
is  usually  amorphous,  but  sometimes  crystal- 
line, and  varies  in  colour  from  white  to  red  or 
green.  This  mineral,  when  powdered,  is  one 
of  the  oldest  local  remedies  we  possess,  com- 
monly known  as  calamine,  or  tutty,  and  forms 


403 


ZINC 


an  important  ingredient  of  calamine  ointment, 
which  was  formerly  a  favourite  dressing  for 
abrasions  and  superficial  cutaneous  inflamma- 
tions and  diseases. 

The  place  of  calamine  has  been  taken  in 
modern  therapeutics  by  the  precipitated  zinc 
carbonate,  zinci  carbonas  prcecipitatus  (U.  S. 
Ph.),  zinci  carbonas  (Br.  Ph.),  which  is  made 
by  the  interaction  of  zinc  sulphate  and  sodium 
carbonate.  It  is  "an  impalpable  white  pow- 
der of  somewhat  variable  chemical  composi- 
tion, without  odour  or  taste.  Permanent  in 
the  air.  Insoluble  in  water  or  alcohol ;  solu- 
ble in  diluted  acids  with  copious  efferves- 
cence." When  strongly  heated  it  loses  water 
and  carbon  dioxide,  leaving  a  residue  of  zinc 
oxide. 

Zinc  carbonate  may  be  given  in  small  doses 
to  allay  vomiting  and  irritation  of  the  gastro- 
intestinal tract,  but  is  seldom  used  for  this 
purpose.  It  is  slightly  astringent  and  is  use- 
ful as  a  surgical  dressing,  particularly  for 
superficial  infiammations  which  need  a  slight 
stimulation  in  addition  to  protection  from  the 
air.  For  this  purpose  it  may  be  used  as  a  dry 
powder,  in  a  lotion,  or  in  an  ointment.  The 
powder  is  also  used  to  dust  upon  cutaneous 
surfaces  which  are  in  apposition  with  each 
other,  as  a  prophylaxis  against  intertrigo, 

A  lotion  recommended  by  Crocker  in  acute 
inflammatory  conditions  of  the  skin  is : 

9  Precipitated  zinc  carbonate.  8  scruples; 

Zinc  oxide 4  drachms ; 

Glycerin 3  11.  drachms ; 

Eose  water,  enough  to  make  3  fl.  oz. 

M. 

A  good  ointment  for  most  purposes  is  this : 
B  Precipitated  zinc  carbonate.     3  drachms; 

Lard  ointment 10        " 

M. 

Zinc  chloride,  zinci  chloridum  (U.  S.  Ph., 
Br.  Ph.),  zirwum  chloratum  (Ger.  Ph.),  occurs 
as  a  white  granular  powder  or  in  porcelainlike 
masses,  irregular,  or  moulded  into  pencils, 
odourless,  of  such  intensely  caustic  properties 
as  to  make  tasting  dangerous,  unless  the  salt 
is  dissolved  in  much  water,  when  it  has  an  as- 
tringent, metallic  taste.  It  is  very  deliques- 
cent. It  is  soluble  in  0-3  part  of  water  at  15° 
C.  (59°  F.),  forming  a  clear  solution  which,  on 
protracted  boiling,  deposits  a  basic  salt.  It  is 
very  soluble  in  alcohol,  less  soluble  in  ether, 
and  has  an  acid  reaction. 

An  impure  zinc  chloride  was  obtained  and 
described  by  Glauber  in  1648,  and  another  im- 
pure form  was  described  as  "  butter  of  zinc ' 
by  Hellot  in  1735. 

When  applied  to  the  denuded  tissues  of  the 
body,  this  salt  exhibits  a  great  affinity  for  the 
water  there  present,  coagulates  the  albumin, 
shrivels  the  blood-vessels,  and  converts  the 
whole  into  a  dry,  grayish,  odourless  mass,  or 
eschar,  which  is  thrown  off  in  a  week  or  two 
by  the  living  tissue  beneath.  The  coagulation 
of  the  albumin  of  the  destroyed  tissue  serves 
to  form  a  barrier  which  limits  the  caustic  ac- 
tion of  the  salt  and  prevents  its  deeper  pene- 
tration. When  zinc  chloride  is  thus  applied 
to  living  tissue  it  causes  pain  for  from  six  to 


eight  hours,  which,  though  said  to  be  less  se- 
vere than  that  occasioned  by  arsenic  or  corro- 
sive sublimate,  is  sufficiently  intense. 

Internally,  the  action  of  zinc  chloride  in 
small  doses  is  that  of  a  weak  nerve  tonic,  but 
larger  quantities  produce  the  symptoms  of 
acute  irritant  poisoning,  the  treatment  for 
which  has  already  been  described.  It  is  not 
oftcTi  used  for  internal  medication,  but  when 
such  administration  is  desired  it  is  best  to 
dissolve  the  salt  in  spirit  of  ether,  in  the  pro- 
portion of  a  drachm  to  an  ounce.  Of  this 
solution  from  4  to  8  minims  may  be  given 
twice  a  day.  It  has  been  alleged  that  in  the 
early  stage  of  pulmonary  tuberculosis  hypo- 
dermic injections  of  a  solution  of  this  salt 
tend  to  promote  the  formation  of  fibrous  tis- 
sue and  check  the  progress  of  the  disease.  It 
is  recommended  to  be  given  in  doses  of  3 
minims  every  three  or  four  days,  for  five  or 
six  times,  and  it  is  slated  that  no  objection- 
able local  or  constitutional  effects  are  pro- 
duced by  such  administration. 

The  escharotic,  or  perhaps  it  might  better  be 
called  mummifying,  property  of  zinc  chloride 
has  been  made  use  of  for  the  removal  of  malig- 
nant and  other  morbid  growths,  such  as  n(si'i, 
warts,  and  condylomata,  to  destroy  "  inoper- 
able "  aneurysms,  to  open  abscesses  in  situa- 
tions where  puncture  or  incision  would  be 
dangerous,  and  to  cleanse  the  surfaces  of  gan- 
grenous  ulcers.  The  absence  of  .danger  of 
absorption  of  the  drug  and  the  natural  limita- 
tion of  its  caustic  action,  together  with  its 
power,  render  it  one  of  the  most  useful  agents 
which  we  possess  for  the  purpose  of  removing 
neoplasms,  but  the  advisability  of  using  any 
such  agent  for  the  removal  of  cancerous 
growths  when  extirpation  with  the  knife  is 
possible  is  very  questionable.  Although  the 
pain  caused  by  the  caustic  action  of  zinc 
chloride  is  considered  to  be  less  than  that  oc- 
casioned by  other  powerful  caustics,  it  is  never- 
theless far  greater  than  that  of  excision,  even 
when  performed  without  anassthesia,  and  it  is 
doubtful  if  the  statements  of  those  who  main- 
tain its  superior  efficacy  can  be  substantiated. 
It  has  no  selective  affinity  for  the  diseased 
rather  than  the  healthy  tissue,  but  destroys 
both  alike,  and  the  complete  extirpation  of  a 
cancerous  growth  certainly  appears  to  be  as 
likely  to  prove  curative  when  performed 
with  a  knife  as  when  done  by  the  chemical 
action  of  a  caustic.  Sometimes  and  for  vari- 
ous reasons  excisions  of  a  malignant  tumour  is 
impracticable,  and  then  in  a  certain  number 
of  cases  this  method  of  removal  is  valuable. 

A  certain  amount  of  danger,  albeit  very 
small,  attends  the  use  of  zinc  chloride  as  a 
caustic  for  the  purpose  of  removing  cancerous 
growths,  as  is  demonstrated  by  a  case  reported 
by  Dr.  Nichols  in  the  Boston  Medical  and 
iSurgioal  Journal.  An  epithelioma  of  the  lip 
was  first  washed  with  a  solution  of  caustic 
potash,  and  then  a  paste  containing  nearly 
25  per  cent,  of  zinc  chloride  was  applied. 
This  caused  great  pain  in  the  growth,  fol- 
lowed by  pain  in  the  region  of  the  stomach, 
and  then  succeeded  by  unconsciousness,  ster- 
torous breathing,  dilated  and  fixed  pupils,  a 


ZINC 


404 


small  and  weak  pulse  of  110,  flushed  face,  cold 
perspiration,  convulsions,  coma,  and  death  in 
about  eight  hours.  The  autopsy  failed  to  re- 
veal any  internal  lesions  which  could  account 
for  the  sudden  death. 

The  epithelium  acts  in  a  measure  as  a  pro- 
tection against  the  action  of  this  salt  upon  the 
subepithelial  structures,  so  when  zinc  chloride 
is  to  be  used  for  the  purpose  of  removing  mor- 
bid growths  the  cuticle,  it  present,  should  first 
be  removed  by  means  of  acid  nitrate  of  mer- 
cury or  by  a  blister,  and  the  preparation  should 
then  be  applied  to  the  raw  surface.  The  satu- 
rated solution  has  been  used  for  this  purpose, 
but  usually  the  salt  is  applied  in  the  form  of  a 
paste  of  a  strength  proportioned  to  the  situa- 
tion and  depth  of  the  growth  which  it  is  de- 
sired to  extirpate. 

The  oldest,  and  perhaps  best  known,  paste  is 
Canquoin's,  which  is  made  by  mixing  zinc 
chloride  with  wheaten  flour  in  proportions 
which  vary  from  one  to  two  to  one  to  five,  and 
adding  a  sufficient  quantity  of  water  to  make 
a  paste.  This  is  to  be  applied  to  the  denuded 
surface,  which  should  be  surrounded  by  some 
protective  covering  to  the  neighbouring  skin, 
such  as  a  thick  layer  of  simple  cerate  satu- 
rated with  chloroform,  which  serves  this  pur- 
pose very  well.  The  paste  is  applied  from  one 
twelfth  "to  one  third  of  an  inch  in  thickness 
and  allowed  to  remain  several  hours,  both  the 
thickness  and  the  length  of  time  to  be  deter- 
mined by  the  depth  to  which  it  is  desired  that 
the  caustic  action  should  penetrate.  After 
removal  of  the  eschar,  renewed  applications 
are  necessary  until  the  neoplasm  has  been  re- 
moved. The  paste  is  frequently  moulded  into 
pointed  pieces,  known  as  "caustic  arrows," 
which  are  plunged  into  the  substance  of  large 
tumours  to  secure  their  removal. 

Other  pastes  have  been  recommended  which 
differ  from  Canquoin's  in  that  they  contain 
various  admixtures  of  other  drugs  or  are  made 
with  other  diluents  than  flour,  such  as  an- 
hydrous sulphate  of  calcium,  gutta-percha, 
gluten,  and  zinc  oxide,  but  all  are  used  in  the 
same  manner,  and  with  the  same  precautions, 
to  accomplish  the  same  purpose  and  present 
very  few  practical  differences.  But  another 
method  of  applying  zinc  chloride  for  its  caus- 
tic action  is  that  of  Cooke,  in  which  lint  is 
saturated  with  the  deliquesced  salt,  cut  into 
pieces  of  the  size  required  and  applied  in  a 
similar  manner  as  the  paste. 

Zinc  chloride  is  a  very  active  antiseptic  and 
disinfectant.  A  5-per-cent.  sokition  is  sufB- 
cient  to  destroy  most  micro-organisms,  but  a 
SO-per-cent.  solution  is  necessary  for  the  de- 
struction of  anthrax  spores.  The  official  so- 
lution, liquor  zinci  chloridi  (Br.  Ph.),  contains 
about  50  per  cent,  of  the  salt  dissolved  in 
water,  and  is  a  clear,  colourless  liquid  of  a  very 
astringent,  sweetish  taste  and  acid  reaction. 
Burnett's  disinfecting  fluid  is  a  similar  but 
somewhat  stronger  preparation.  Both  are 
useful  as  disinfectants  and  deodorizers  for 
sinks,  water-closets,  drains,  and  other  places 
where  such  an  agent  is  needed.  They  are 
dangerous  poisons,  and  fatal  results  have  been 
occasioned  by  their  ingestion. 


Useful  antiseptic  lotions  for  suppurating 
wounds  and  putrid  ulcers  may  be  made  by  di- 
luting the  official  solution  to  the  strength  of 
from  2  to  10  minims  in  an  ounce  of  water. 
Such  a  lotion  serves  to  cleanse  the  surface,  and 
will  not  infrequently  stimulate  old  and  indo- 
lent ulcers  to  a  coudition  of  healthy  activity 
and  repair.  A  stronger  solution  is  useful  for 
the  irrigation  of  dissection  wounds. 

Small  cystic  tumours,  ganglia,  ranulm,  and 
nasal  polypi  have  been  injected  with  weak  so- 
lutions of  zinc  chloride  in  order  to  destroy 
them,  but  this  is  not  usually  so  satisfactory  a 
method  of  treatment  as  removal  by  the  ordi- 
nary surgical  procedures.  Polaillon  asserts 
that  he  has  obtained  as  good  results  in  the 
treatment  of  hydrocele  by  the  injection  of 
weak  solutions  of  zinc  chloride  as  from  the 
similar  use  of  tincture  of  iodine,  and  that  less 
pain  is  caused  by  the  former. 

[M.  Leon  Derville  (Journal  des  sciences 
medicates  de  Lille,  January  18,  1896 ;  JVew 
York  Medical  Journal,  February  22,  1896)  de- 
scribes a  mode  of  treating  lupus  when  it  is  in 
the  form  of  isolated  nodules  by  what  he  calls 
dilaceration  followed  by  applications  of  zinc 
chloride.  The  procedure  is  as  follows :  A 
scarificator  is  introduced  into  the  centre  of  the 
tubercle  and  pushed  until  it  is  arrested  by  the 
cicatricial  tissue  which  surrounds  the  lupous 
nodule ;  a  rotatory  movement  is  then  rapidly 
made  which  tears  the  tuberculous  tissue  and 
often  removes  fragments  at  the  same  time. 
Employed  in  this  manner,  says  the  author,  it 
not  only  dilacerates  the  diseased  tissue,  but  it 
removes  a  part  of  it  in  the  same  way  as  a  sharp 
curette  does. 

After  the  tubercle  has  been  torn  away,  a 
small  crystal  of  zinc  chloride  is  put  into  the 
little  cavity,  and  almost  immediately  the  bleed- 
ing stops.  A  small  black  patch  then  forms, 
and  this  is  surrounded  by  a  whitish  circle,  a 
small  eschar.  This  becomes  dry  and  forms  a 
crust  over  the  lesion,  and  under  it  cicatrization 
takes  place.  This  crust  usually  falls  off  be- 
tween the  tenth  and  the  fifteenth  day,  leaving 
only  a  reddish  mark. 

The  advantages  of  this  process,  says  M.  Der- 
ville, are  the  following:  1.  It  is  scarcely  pain- 
ful, and  consequently  is  well  borne  by  the 
patients.  2.  It  does  not  interfere  with  the 
patient's  occupation ;  it  leaves  a  few  crusts 
only  on  the  face,  and  does  not  require  any 
dressing.  3.  It  gives  rapid  results.  It  is  not 
rare  to  see  a  small  nodule  destroyed  at  the 
first  application  and  replaced  by  a  sclerotic 
tissue  which,  by  becoming  retracted,  can  have 
only  the  most  favourable  influence  on  the  sur- 
rounding tissue. 

The  disadvantages  are  that  zinc  chloride 
leaves  cicatrices,  often  irregular  and  promi- 
nent, but  this,  says  M.  Derville,  is  of  slight 
importance  if  they  are  on  the  body,  but  on  the 
face  they  become  deformities,  and  for  this 
reason  it  should  not  be  employed  on  the  latter. 
Another  disadvantage  is  the  sclerotic  action 
of  zinc  chloride  on  the  tissue,  which,  by  becom- 
ing shrivelled,  may  cause  a  shrinking  of  the 
natural  oriflces.  If  the  nodules  are  situated 
near  the  mouth  or  the  nostrils,  says  the  au- 


405 


ZINC 


thor,  other  procedures  are  preferable,  except 
in  cases  in  whicli  the  lupous  patches  are  very 
small. 

M.  Derville  says  that  he  does  not  maintain 
the  absolute  efBcacy  of  this  treatment,  for  re- 
covery after  a  single  application  can  not  be 
hoped  for  unless  the  tubercles  are  superficial 
and  not  very  extensive.  When  they  are,  the 
treatment  has  to  be  repeated  several  times. 
Usually  an  interval  of  tvpo  weeks  should  elapse 
between  the  applications ;  at  the  end  of  this 
time  the  crusts  fall  off  or  are  easily  detached, 
and  dilaceration  and  cauterization  may  be  re- 
sorted to  again.  This  procedure,  he  says,  if 
used  prudently  in  the  beginning,  may  be  of 
some  use  in  practice ;  it  may  cut  short  a  long 
and  tiresome  treatment,  and  also  rapidly  check 
a  relapse  in  the  same  region.] 

In  diphtheria  Wilhelmy  recommends  the 
local  application  of  a  20-per-cent.  solution 
on  pledgets  of  cotton  to  the  false  membrane 
on  the  tonsils  and  pharyngeal  walls.  This  se- 
cures the  removal  of  the  false  membrane  and, 
though  it  causes  severe  pain,  the  treatment  is 
said  to  be  remarkably  efBcacious. 

Solutions  of  from  15  to  60  grains  to  the 
ounce  are  useful  local  applications  in  cases  of 
chronic  pharyngitis,  or,  in  general  terras,  to 
mucous  membranes  which  have  undergone 
fibroid  degeneration  or  show  the  results  of 
chronic  inflammation.  In  chronic  laryngitis 
such  applications  have  occasionally  been  made 
to  the  vocal  cords  and  the  epiglottis.  A  solu- 
tion of  2  grains  to  the  ounce  is  sometimes  use- 
ful for  the  purpose  of  irrigation  in  cases  of 
empyema  of  the  accessory  nasal  sinuses,  as 
well  as  in  chronic  suppurative  otitis  media. 

Solutions  of  from  ^  to  2  grains  to  the  ounce 
of  water  have  been  used  in  chronic  conjuncti- 
vitis, and,  according  to  some  authors,  may  be 
advantageously  alternated  with  silver  nitrate 
in  the  treatment  of  trachoma.  Zinc  chloride 
has  also  been  used  in  gonorrhoea!  and  diphthe- 
ritic conjunctivitis,  but  if  used  at  all  in  con- 
junctival diseases,  it  should  be  with  great 
caution  and  in  very  weak  solutions.  The 
same  caution  should  be  observed  in  its  use  as 
an  injection  in  gonorrhoea  and  leucorrhoea,  for 
which  purpose  it  is  sometimes  employed. 

Zinc  iodide,  zinci  iodidum  (U.  S.  Ph.),  oc- 
curs as  a  white,  granular  powder,  odourless 
and  having  a  sharp  saline  and  metallic  taste. 
It  is  of  acid  reaction,  very  deliquescent,  and 
apt  to  absorb  oxygen  from  the  air  and  to  ac- 
quire the  colour  of  the  iodine  thus  liberated. 
It  is  readily  soluble  in  water,  alcohol,  or 
ether. 

Zino  iodide  has  not  become  a  popular  drug. 
It  has  been  given  internally  In  chorea  and  in 
scrofulous  diseases  of  the  skin  and  eyes,  but 
not  with  especially  brilliant  results.  For  this 
purpose  it  is  best  administered  dissolved  in 
syrup,  in  doses  of  from  -J-  grain  upward. 

It  possesses  caustic  properties  which,  though 
not  so  powerful,  closely  resemble  those  of  the 
chloride,  but  it  is  seldom,  if  ever,  used  as  a 
substitute  for  that  salt. 

In  the  form  of  a  10-per-cent.  ointment,  it 
has  been  used  as  a  substitute  for  potassic  iodide 
to  promote  the  resorption  of  tumours,  but  it 


does  not  appear  to  possess  any  advantage  over 
the  potassic  salt  as  a  sorbefacient. 

The  best  results  obtained  from  the  use  of 
zinc  iodide  have  been  in  the  treatment  of 
chronic  inflammations  of  the  mucous  mem- 
branes. Thus  a  3-per-cent.  solution  may  be 
used  as  a  lotion  in  post-nasal  catarrh,  and 
Lefferts  considers  that  a  nascent  zinc  iodide, 
made  by  the  addition  of  a  mixture  of  240 
grains  of  potassic  iodide,  480  grains  of  iodine, 
and  3  drachms  of  water,  drop  by  drop,  to  200 
grains  of  zinc  sulphate  and  140  minims  of  dis- 
tilled water,  forms  an  escharotio  well  adapted 
for  use  in  the  throat  and  nose.  Solutions  of 
zinc  iodide  have  been  successfully  used  to  re- 
duce the  size  of  chronically  enlarged  tonsils. 
In  1859  Lente  recommended  the  application  of 
a  solution  of  from  5  to  10  grains  to  the  ounce 
to  be  thrown  against  the  mucous  membrane  at 
the  mouth'of  the  Eustachian  tube,  in  cases  of 
its  catarrhal  swelling,  for  its  astringent  effect. 
He  says  that  it  is  as  efficacious  as  silver  nitrate, 
which  is  frequently  used  for  this  purpose,  and 
at  the  same  time  possesses  a  less  disagreeable 
and  persistent  taste. 

In  chronic  conjunctivitis  a  J-of-1-per-cent. 
solution  has  been  employed  as  a  collyrium. 

The  following  ointment  may  be  of  service  in 
acne  : 

5  Zinc  iodide 5  grains ; 

Vaseline 1  oz. 

M. 

The  ofiicial  zinc  oleate,  oleatum  zinci  (U.  S. 
Ph.,  Br.  Ph.),  is  composed  of  five  parts  of  zinc 
oxide  in  ninety-five  parts  of  oleic  acid,  and  con- 
sists of  a  fine  pearl-coloured  powder,  soft  and 
soaplike  to  the  touch.  This  preparation  is  use- 
ful in  cutaneous  diseases  where  ointments  are 
not  well  borne,  and  is  recommended  as  a  useful 
application  in  hromidrosis  and  in  hyperidro- 
sis,  particularly  of  the  axillie,  genitals,  and 
feet.  With  salicylic  acid  or  French  chalk  it 
has  been  used  in  the  treatment  of  comedo  and 
acute  vesicular  eczema.  In  the  combination 
of  one  part  of  zinc  oleate  to  two  parts  of  iodo- 
from,  it  has  been  recommended  for  erosions  of 
the  OS  uteri. 

[The  official  ointment  of  zinc  oleate,  un- 
guentum  zinci  oleati  (Br.  Ph.),  consists  of  equal 
parts  by  weight  of  zinc  oleate  and  soft  paraf- 
fin,] 

Zinc  oxide,  zinci  oxidum  (U.  S.  Ph.,  Br. 
Ph.),  zincum  oxydatum  (Ger.  Ph.),  is  an  amor- 
phous white  powder  without  odour  or  taste. 
It  gradually  absorbs  carbon  dioxide  from  the 
air.  It  is  insoluble  in  water  or  in  alcohol,  but 
soluble  without  effervescence  in  diluted  acids 
and  in  ammonia  water. 

This  salt  of  zinc  is  found  in  Nature  combined 
with  the  red  oxide  of  manganese  to  form  the 
mineral  zincite.  It  is  known  in  commerce  as 
zinc  white. 

Although  zinc  oxide  is  insoluble  in  the  ordi- 
nary solvents,  it  is  certain  that  some  portion 
does  enter  into  the  circulation  after  ingestion 
into  the  stomach,  and  it  is  probable  that  a 
chemical  change  takes  place  in  the  salt  on  con- 
tact with  the  contents  of  that  viscus.  which 
converts  a  portion  into  a  more  soluble  salt. 


ZINC 


406 


Possibly  this  conversion  is  into  the  albuminate, 
or  perhaps  into  the  lactate  or  chloride,  which 
may  be  in  turn  changed  into  the  albuminate. 
But  whatever  may  be  the  nature  of  the  chem- 
ical changes  which  take  place,  the  absorption 
of  zinc  into  the  system  after  ingestion  of  the 
oxide  is  proved  by  the  appearance  of  physio- 
logical symptoms  after  repeated  doses.  The 
experiments  of  D'Amore,  Falcone,  and  Mara- 
maldi  have  demonstrated  that  sufficiently  large 
doses,  steadily  repeated,  will  cause  intoxication 
and  death,  at  least  in  dogs.  They  gave  these 
animals  7f  grains  of  zinc  oxide  by  the  mouth 
daily,  and  noted  as  results  the  following  symp- 
toms :  Vomiting,  feebleness,  great  emaciation, 
partial  loss  of  sensation,  a  diminution  in  the 
number  of  the  red  blood-corpuscles,  and  a  less- 
ened excretion  of  urine,  which  was  found  to 
contain  albumin,  sugar,  zinc,  and  blood.  The 
dogs  lived  from  ten  to  fifteen  days,  and  the 
post-mortem  examination  revealed  extreme 
pallor  everywhere,  with  disseminated  areas  of 
fatty  degeneration  in  the  liver,  kidneys,  and 
pancreas,  surrounded  by  vascular  and  inter- 
stitial disturbances.  The  most  marked  lesions 
of  the  central  nervous  system  were  atrophy  of 
the  cells  of  the  anterior  cornua  of  the  spinal 
cord,  with  some  swelling  of  the  nuclei. 

In  medicinal  doses,  zinc  oxide  acts  as  a  mild 
intestinal  astringent  and  nerve  tonic.  In  com- 
bination with  bismuth  and  pepsin,  it  has  proved 
an  excellent  remedy  for  the  summer  diarrhoea 
of  children.  Combined  with  carminatives  and 
morphine,  it  is  efficacious  in  gastralgia.  It  has 
had  a  fair  trial  in  epilepsy  and  other  nervous 
diseases,  and,  while  it  is  as  good  as  any  zinc 
compound  and  better  than  a  salt  of  any  other 
metal,  it  is  really  of  little  value.  Bartholow 
considers  that  the  cases  of  epilepsy  in  which 
this  drug  is  most  efficient  are  those  in  which 
the  disease  is  the  result  of  peripheral  irrita- 
tion, having  its  origin  in  the  stomach.  The 
same  author  believes  zinc  oxide  to  be  of  pro- 
phylactic value  in  spasmodic  asthma.  Bene- 
fit is  said  to  have  been  obtained  from  its  use 
in  the  muscular  tremor  and  unsteadiness  of 
chronic  alcoholism  or  poisoning  with  mercury 
and  arsenic.  It  has  also  been  used  in  doses  of 
about  3  grains  to  check  the  night  sweats  of 
phthisis  and  the  profuse  secretion  of  bronchor- 
rhoea. 

Zinc  oxide  is  much  used  as  an  ingredient  in 
cosmetics,  but  when  so  employed  is  apt  to  in- 
jure the  skin. 

The  principal  medicinal  value  of  zinc  oxide 
is  as  a  protective,,  slightly  astringent  dressing 
for  cutaneous  affections,  such  as  abrasions, 
excoriations,  blisters,  burns,  fissures  of  the 
nipples,  lips,  and  other  parts  of  the  body,  in- 
tertrigo, herpes,  and  eczema.  For  this  purpose 
it  is  used  in  the  form  of  powders,  ointments, 
pastes,  and  lotions.  As  a  powder,  it  may  be 
used  pure,  but  in  certain  diseases,  such  as  ery- 
thematous and  Vesicular  eczema,  it  is  frequently 
too  astringent  and  needs  to  be  diluted  with 
some  inert  powder,  such  as  lycopodium,  kaolin, 
or  starch. 

Sometimes  in  eczematous  inflammation  of 
the  eyelids,  especially  when  due  to  irritating 
discharges  from  the  eyes,  as  in  the  scrofulous 


conjunctivitis  of  children,  a  powder  containing 
zinc  oxide  is  an  efficient  application.  Occa- 
sionally a  powder  20  per  cent,  in  strength  may 
be  applied  to  the  conjunctiva. 

The  following  has  been  pronounced  useful  in 
acute  eczema  of  the  auricle  and  also  as  an  ap- 
plication to  ulcers  of  the  sceptum  nasi  : 

5  Zinc  oxide 1  drachm ; 

taf-i^ 1- 

M. 

The  powdered  zinc  oxide  has  also  been  used, 
either  pure  or  mixed  with  alum  or  tannin,  for 
insufflation  into  the  larynx  in  cases  of  laryn- 
gitis. 

The  official  ointment,  unguentum  zinci 
oxidi  (U.  S.  Ph.),  unguentum  zinci  (Br.  Ph., 
Ger.  Ph.),  was  first  brought  into  use  by  Sir 
Erasmus  Wilson.  That  of  the  TJ.  S.  Ph.  is 
composed  of  20  parts  of  zinc  oxide  with  80  of 
benzoinated  lard ;  that  of  the  Br.  Ph.,  of  2 
parts  of  zinc  oxide  and  11  of  benzoated  lard ; 
and  that  of  the  Ger.  Ph.,  of  1  part  of  crude 
zinc  oxide,  zincum  oxydatum  crudum  (Ger. 
Ph.),  and  9  parts  of  lard.  This  has  long  been 
a  favourite  ointment  in  cutaneous  diseases,  and 
frequently  other  drugs,  such  as  carbolic  acid, 
tar,  and  oil  of  cade,  are  incorporated  with  it 
for  their  medicinal  effect.  Other  ointments 
than  the  official  may  be  made  by  varying  the 
proportion  of  the  lard,  or  by  using  some  other 
fatty  excipient,  such  as  vaseline  or  lanolin. 
When  a  non-fatty  excipient  is  chosen,  the 
preparation  may- be  known  as  a  paste,  and  is 
a  useful  substitute  for  the  ointment  in  hot 
weather  or  when  a  fatty  excipient  is  disagree- 
able. A  good  example  of  such  a  paste  is  the 
following : 

5  Zinc  oxide 50  parts ; 

Salicylic  acid,  )       ,  „      „ 

Carbolic  acid,  r^^'* " 

Mucilage  of  gum  J 

arabic,  [-each...  10      " 

Glycerin,  ) 

M. 

Neumann  recommends  in  seborrhcea  and 
pityriasis — 

E  Zinc  oxide,  )       -l.         i  j      i. 

Lead  carbonate,  \  ^^^^-  •  •   ^  '^™''^'° ' 

Spermaceti 1  oz. ; 

Olive  oil,  enough  to  make  a  soft  oint- 
ment. 

Another  which  has  been  recommended  for 
the  same  purpose  is — 

E  Zinc  oxide,  )       i,  o  i 

Honey,         h'"''' 3  scruples; 

Yellow  wax 2  drachms : 

Almond  oil 6  fl.  drachms. 

M. 

Before  either  of  these,  or  any  other  paste 
or  ointment  which  contains  zinc  oxide,  is  ap- 
plied to  the  scalp,  the  hair  should  be  cut 
short. 

In  the  form  of  a  lotion,  zinc  oxide  has  some- 
times been  used  as  a  collyrium  in  conjunctivitis, 
and  the  following  is  recommended  as  of  good 


407 


ZINC 


service  in  dermatitis,  irritable  acne,  and  other 
acute  inflammations  of  tlie  sliin : 

5  Zinc  oxide 2  drachms ; 

Glycerin 3  fl.  drachms ; 

Lead  water li  fl.  drachm ; 

Lime  water i  pint. 

M. 

For  use  in  gonorrhma,  it  has  been  suggested 
to  mix  the  salt  with  lanolin  or  some  other 
bland  oil,  and  to  allow  it  to  remain  for  some 
time  in  the  urethra. 

Zinc  oxide  has  also  been  recommended  as  a 
component  of  firm  surgical  dressings.  When 
it  is  mixed  with  the  chloride  and  made  into  a 
paste,  the  basic  oxychloride  is  formed,  which 
will  be  mentioned  later.  A  10-per-cent. 
paste  made  with  equal  parts  of  glycerin,  gela- 
tin, and  water  is  recommended  by  Unna  to  be 
rubbed  into  a  bandage  which  is  immediately 
applied.  As  the  mixture  dries,  it  hardens  and 
incases  the  limb  bandaged  in  a  stiff,  immov- 
able dressing. 

Zinc  phosphide,  zinci  phosphidum  (U.  S. 
Ph.),  is  a  gritty  powder  of  a  dark-gray  colour, 
or  crystalline  fragments  of  a  dark,  metallic 
lustre,  having  a  faint  odour  and  taste  of  phos- 
phorus. In  contact  with  the  air  it  slowly 
emits  phosphorus  vapour.  It  is  insoluble  in 
water  or  in  alcohol,  but  soluble  in  diluted  hy- 
drochloric or  sulphuric  acid,  with  the  evolu- 
tion of  hydrogen  phosphide. 

This  salt  has  been  recommended  by  Reclus 
as  very  satisfactory  in  some  cases  of  lymph- 
adenoma.  It  is  readily  decomposed  in  the 
stomach,  and  the  physiological  eflfeets  pro- 
duced by  its  administration  are  those  of  phos- 
phorus, of  which,  rather  than  of  zinc,  it  should 
be  considered  a  preparation. 

Zinc  sulphate,  zinci  sulphas  (U.  S.  Ph., 
Br.  Ph.),  zincum  sulfuricum  (Ger.  Ph.),  occurs 
in  colourless,  transparent  rhombic  crystals, 
without  odour  and  having  an  astringent  me- 
tallic taste.  It  effloresces  in  drv  air.  It  is 
soluble  in  0-6  part  of  water  at  15°  C.  (59°  P.) 
and  in  0-2  part  of  boiling  water,  also  in  about 
three  parts  of  glycerin.  It  is  insoluble  in 
alcohol. 

In  small  doses  given  internally,  this  salt  is  a 
tonic  and  astringent,  in  larger  quantities  an 
emetic,  and  in  still  larger  an  irritant  poison. 
As  a  tonic  it  may  be  used  in  the  same  class  of 
nervous  diseases  as  all  the  other  zinc  salts,  and 
as  an  astringent  it  is  sometimes,  especially 
when  combined  with  opium  and  ipecac,  of  good 
effect  in  diarrhoea  and  dysentery.  Occasion- 
ally it  is  useful  in  hronchorrhcea  and  in  dyspep- 
sia, but,  unless  benefit  is  soon  obtained,  the 
use  of  this  remedy  should  not  be  persisted  in. 
For  these  purposes  the  dose  is  from  i^j  to  2 
grains,  preferably  in  pill  form. 

Zinc  sulphate  is  a  systemic  emetic,  and  causes 
vomiting  when  injected  into  the  blood  as  well 
as  when  ingested  into  the  stomach.  As  it  is 
also  but  very  slightly  depressant,  it  is  a  valu- 
able emetic  for  use  in  narcotic  poisoning  as 
well  as  in  such  diseases  as  croup  and  whoop- 
ing-cough and  whenever  simple  evacuation  of 
the  stomach  is  desired.  To  produce  emesis 
it  is  usual  to  divide  from  3  to  15  grains  into 


several  portions  and  to  give  one  portion  every 
five  minutes  until  vomiting  occurs.  A  curious 
result  of  the  long-repeated  administration  of 
zinc  sulphate  is  that  the  stomach  becomes  re- 
markably tolerant  after  a  time,  so  that  enor- 
moiis  doses  may  be  taken  without  causing 
nausea,  but  the  course  of  treatment  necessary 
to  produce  this  tolerant  condition  may  result 
in  a  superficial  ulceration  of  the  mucous  mem- 
brane of  the  stomach. 

When  an  overdose  has  been  taken  the  symp- 
toms of  irritant  poisoning  appear  and  the 
treatment  already  described  should  be  insti- 
tuted. Very  few  cases  of  this  nature  with 
fatal  results  are  on  record. 

Solutions  of  zinc  sulphate  are  very  useful 
for  topical  applications  to  mucous  membranes, 
on  account  of  the  stimulant  and  astringent  ac- 
tion of  the  drug.  As  a  coUyrium  in  conjunc- 
tivitis it  is  very  popular,  although  rather  more 
irritating  than  the  acetate.  It  is  adapted  to 
chronic  rather  than  acute  cases,  and  should  be 
used  in  solutions  of  from  !■  to  4  grains  to  the 
ounce  of  water  once  a  day  or  oftener.  Care 
should  be  taken,  as  with  the  acetate,  not  to  use 
such  a  coUyrium  in  scleritis,  iritis,  or  kera- 
titis, conditions  which  are  frequently  distin- 
guished with  difficulty  from  acute  conjunctivitis. 

Solutions  of  about  the  same  strength  have 
been  applied  to  the  vocal  cords  to  relieve  vocal 
fatigue,  and  may  sometimes  be  of  service  in 
acute  coryza. 

Zinc  sulphate  is  an  efScient  hmmostatic 
when  applied  to  bleeding  surfaces,  and  is  of 
service  in  checking  epistaxis  when  applied  in 
the  form  of  a  powder  or  in  a  strong  solution. 
A  solution  of  40  grains  to  the  ounce  has 
been  employed  by  Dr.  Bean  to  arrest  laryngeal 
hcemorrhage. 

Weak  solutions  have  been  employed  to  irri- 
gate the  accessory  nasal  sinuses  in  cases  of 
empyema,  and  to  cleanse  the  nasal  mucous 
membrane  in  atrophic  rhinitis.  In  catarrhal 
inflammation  of  the  mucous  membrane  of  the 
Eustachian  tube  a  solution  of  1  to  2  grains  to 
the  ounce  may  be  applied  to  its  mouth,  and 
solutions  of  from  2  to  5  grains  to  the  ounce  are 
frequently  useful  in  acute  or  chronic  cases  of 
purulent  otitis  media.  In  inflammation  of  the 
external  ear  weak  solutions  of  from  J  of  a  grain 
to  the  ounce  upward  are  sometimes  of  service, 
but  when  furuncles  are  present  in  the  canal  the 
solution  needs  to  be  as  strong  as  from  30  to  60 
grains  to  the  ounce  in  order  to  be  useful. 

Many  practitioners  consider  zinc  sulphate 
one  of  the  best  remedies  for  gonorrhoea  which 
we  possess.  It  is  used  as  an  injection,  begin- 
ning with  a  weak  solution  and  increasing  the 
strength  as  the  urethra  becomes  more  toler- 
ant. 

When  dry  powdered  zinc  sulphate  is  sprinkled 
over  the  surface  of  an  epithelioma,  lupus,  or 
unhealthy  ulcer, a,  slough  is  cast  off,  but  as  this 
salt  has  not  the  same  power  of  penetration  as 
the  chloride,  it  is  not  as  efficient  for  the  re- 
moval of  malignant  neoplasms.  Sir  James  Y. 
Simpson  recommended  its  use  in  cancer  of  the 
uterus,  but  it  has  not  been  very  generally 
adopted.  It  is  useful  for  the  purpose  of  re- 
moving caruncles  of  the  female  urethra,  warts. 


ZINC 


408 


condylomata^  and  similar  small  neoplasms  or 
excresee?ices. 

Villate's  solution  has  been  successfully  em- 
ployed as  a  local  injection  for  the  cure  of  caries. 
It  consists  of — 

B  Copper  sulphate,  )  ^^^^  _  ^  ^     ^g 
Zinc  sulphate,       )  ^ 

Lead  water 30      "  . 

Vinegar 300      " 

M. 

The  sinuses  which  lead  to  the  carious  bone 
are  washed  out  with  this  solution  so  as  to  de- 
calcify and  bring  away  the  dead  portions.  It 
should  not  be  necessary  to  state  that  in  ne- 
crosis no  such  solution  can  be  expected  to  re- 
move a  sequestrum  unless  it  is  a  very  small 
one. 

Good  results  may  sometimes  be  obtained  in 
acne  by  bathing  tlie  surface  with  a  solution  of 
this  salt  with  equal  parts  of  potassium  sul- 
phate and  resorcin.  The  late  Dr.  Tilbury  Pox 
recommended  as  a  lotion  in  erythema,  intertri- 
go, and  eczema  the  following  : 

5  Zinc  sulphate 10  grains; 

Alum 30      " 

Glycerin 1  fl.  drachm  ; 

Rose  water 7-i  fl.  oz. 

M. 

In  dermatitis  venenata  a  solution  of  30  grains 
of  zinc  sulphate  to  the  ounce  of  water  is  said  to 
be  an  excellent  lotion. 

Zinc  valerianate,  zinei  valerianas  (IT.  S. 
Ph.,  Br.  Ph.),  has  already  been  considered  un- 
der Valerian. 

The  number  of  unofficial  salts  of  zinc  which 
are  used  in  medicine  is  very  great.  Most  of 
them  are  not  of  great  importance,  but  some 
have  won  prominence  and  are  quite  extensive- 
ly employed  at  the  present  time. 

Zinc  albuminate. — This  combination  is 
the  form  into  which  it  is  supposed  that  the 
various  other  salts  are  changed  in  the  digestive 
organs  before  they  enter  the  circulation,  and 
this  preparation  has  been  introduced  into  medi- 
cine with  the  hope  of  securing  a  readier  assimi- 
lation of  the  drug.  It  appears  in  the  form  of 
yellowish  scales  which  are  slightly  soluble  in 
water.  It  is  intended  for  internal  administra- 
tion in  those  diseases  in  which  the  use  of  zinc 
is  indicated. 

Zinc  arsenate  and  zinc  arsenite  are  two 
preparations  which  are  on  the  market,  but  are 
very  little  used.  Each  is  a  white  powder  solu- 
ble in  acids  and  in  sufficient  quantities  pro- 
duce the  symptoms  of  irritant  poisoning  when 
taken  internally. 

Zinc  borate,  or  tetraborate,  is  an  amor- 
phous white  powder  obtained  by  the  interac- 
tion of  zinc  sulphate  and  sodium  biborate  in  hot 
water. 

This  powder  has  beei^i.used  to  a  slight  extent 
in  surgical  practice,  dusted  over  the  surface  of 
wounds  for  its  antiseptic  action. 

Zinc  bromate  is  a  white,  deliquescent  pow- 
der, soluble  in  an  equal  part  of  water.  It  may 
be  used  in  the  same  manner  as  the  preced- 
ing, dusted  over  wounds  as  an  antiseptic  pow- 
der. 


Zinc  carbolate  is  a  white  powder,  slightly 
soluble  in  water  and  alcohol. 

This  salt  is  slightly  tonic  and  antiseptic  in 
its  action  when  given  internally  and  has  been 
used  in  cases  of  croup,  diphtheria,  and  foul 
stomach  in  doses  of  |  to  5  grains.  It  is  also 
recommended  as  an  antiseptic  for  surgical 
dressings  and  for  use  in  skin  diseases. 

Zinc  chrysophanate  is  a  brownish  red 
powder,  readily  soluble  in  slightly  alkaline  wa- 
ter and  in  the  alkaline  secretions  of  wounds. 
The  latter  quality  has  suggested  its  availability 
as  a  surgical  dressing. 

Zinc  citrate  is  an  amorphous  white  powder 
with  a  sharp  metallic  taste,  not  perfectly  solu- 
ble in  water,  which  has  been  very  slightly  used 
in  epilepsy  in  doses  of  from  3  to  13  grains. 
•-  Zinc  cyanide  is  a  snow-white  powder, 
odourless,  tasteless,  insoluble  in  water  or  alco- 
hol, soluble  in  diluted  acids  and  in  solutions  of 
the  cyanides  of  ammonium  and  jjotassium. 
After  a  while  it  decomposes  and  acquires  a 
sweetish,  metallic  taste. 

The  physiological  action  of  this  salt  is  very 
similar  to  that  of  hydrocyanic  acid  and  its 
alkaline  compounds,  sufficiently  so  that  it  is 
sometimes  used  therapeutically  as  a  substitute 
for  that  drug.  It  has  also  been  used  in  the 
same  category  of  nervous  diseases  as  the  other 
zinc  salts  with  about  the  same  effect.  It  is  fre- 
quently useful  in  neuralgia,  particularly  of  the 
trigeminus,  and  has  been  employed  to  relieve 
gastralgia,  dysmenorrhma,  and  certain  cardiac 
neuroses  characterized  by  pain,  palpitation,  and 
disordered  rhythm.  It  may  be  occasionally 
given  in  whooping-cough  with  good  effect,  but 
should  never  be  continuously  administered  in 
that  disease. 

Formerly  zinc  cyanide  was  used  in  acute 
articular  rheumatism,  but  it  has  been  super- 
seded by  other  remedies  because  benefit  is  un- 
certain and  its  administration  is  apt  to  be 
followed  by  headache.  The  drug  is  also  said 
to  be  anthelminthic. 

The  usual  dose  is  from  I  to  1-J  grain  repeat- 
ed as  frequently  as  every  hour  or  two,  because 
the  physiological  action  appears  to  be  tran- 
sient.    See  also  under  Cyancgen. 

Zinc  and  potassium  cyanide. — This  salt, 
which  is  obtained  by  dissolving  zinc  cyanide 
in  a  solution  of  potassium  cyanide,  occurs  in 
colourless  or  white  octahedrons  of  a  sweet  and 
metallic  taste.  It  is  permanent  in  the  air  and 
freely  soluble  in  water. 

The  physiological  action  of  this  salt  is  the 
same  as  that  of  zinc  cyanide,  to  which  it  is 
frequently  preferred  in  therapeutics  on  ac- 
count of  its  greater  solubility.  It  is  pre- 
scribed in  the  same  doses  and  may  be  given 
very  nicely  in  aromatic  sweetened  water,  but 
the  addition  of  a  small  quantity  of  acid  will 
precipitate  zinc  cyanide  from  the  solution. 

Zinc  ferrocyanide  is  a  white,  tasteless 
powder,  insoluble  in  water,  alcohol,  and  di- 
luted acids. 

The  medicinal  properties  of  this  salt  are  the 
same  as  those  of  the  cyanide,  and  it  is  used  in 
the  same  diseases.  The  usual  dose  is  given  as 
from  1  to  4  grains.  A  good  form  of  adminis- 
tration is — 


409 


ZINC 


B  Zinc  ferrocyanide 5  grains ; 

Magnesia 40      '■ 

Powdered  cinnamon. ...     1  drachm. 
M.    Divide  into  10  powders.     Sig. :  One  pow- 
der every  four  hours.    See  also  under  Cyano- 


Mercury  and  zinc  cyanide. — This  is  a 
white  powder  obtained  by  precipitation  from 
a  solution  of  potassium  and  mercury  cyanides 
by  means  of  zinc  sulphate,  and  is  probably  a 
mixture  rather  than  a  true  double  cyanide.  It 
was  proposed  in  1889  by  Sir  Joseph  Lister  as 
a  non-irritating,  antiseptic,  surgical  dressing, 
but  was  soon  declared  to  be  in  no  way  supe- 
rior to  the  dressings  previously  in  use.  Its 
germicidal  power  is  said  to  be  slight,  but  a 
l-to-1,200  solution  will  prevent  putrefaction  in 
animal  fluids.  A  ready  means  of  preparing  a 
dressing  with  mercury  and  zinc  cyanide  is  said 
to  be  to  dip  gauze  impregnated  with  zinc  cya- 
nide into  a  l-to-4,000  solution  of  mercury  bichlo- 
ride. This  cyanide  may  also  be  used  in  the 
form  of  an  ointment  in  the  treatment  of  ec- 
zema and  other  cutaneous  diseases,  taking  the 
place  of  the  oxide.     See  also  under  Cyanogen. 

Zinc  gynocardate  is  a  yellowish,  granular 
powder,  insoluble  in  water  and  dilute  acids, 
readily  soluble  in  alcohol,  ether,  and  chloro- 
form. 

This  salt  has  been  recommended  in  the  form 
of  an  ointment  for  the  treatment  of  syphilUic 
skin  diseases,  psoriasis,  prurigo,  leprosy,  and 
other  cutaneous  diseases  in  which  gynocardie 
acid  and  chaulmoogra  oil  have  been  used. 
(See  Chaulmoogra  oil.) 

Zinc  liydrochlorite. — A  solution  of  zinc 
hydrochlorite  is  recommended  as  possessing 
advantages  over  the  solution  of  chlorinated 
soda  as  an  antiseptic  in  that  it  is  not  allcaline 
and  is  astringent.  It  may  be  used  as  a  lotion 
or  as  a  gargle. 

Zinc  iodate  is  a  salt,  insoluble  in  water, 
produced  by  the  union  of  zinc  and  iodic  acid, 
which  has  been  used  to  no  great  extent  as  a 
topical  application  to  affections  of  the  mucous 
membranes. 

Zinc  lactate. — This  salt  occurs  in  short, 
quadrangular  crystals  of  an  acid  reaction  and 
an  acidulous  metallic  taste,  obtained  by  dis- 
placing the  carbon  dioxide  of  zinc  carbonate 
with  lactic  acid.  It  is  soluble  in  fifty-eight 
parts  of  cold  and  six  of  boiling  water,  nearly 
insoluble  in  alcohol. 

This  is  the  most  readily  tolerated  of  all  the 
zinc  salts,  and  is  therefoi-e  preferable  to  any 
other  for  internal  administration.  It  has  been 
used  with  good  results  in  hysterical  amblyopia, 
and  is  employed  in  the  same  class  of  nervous 
diseases  as  the  oxide.  The  usual  dose  is  from 
•J-  to  1  grain  several  times  a  day. 

Zinc  nitrate. — This  salt  occurs  in  striated, 
colourless,  pointed,  quadrilateral,  prismatic 
crystals,  is  very  deliquescent,  is  soluble  in 
water  and  alcohol,  and  very  caustic  in  its  ac- 
tion. Its  chief  if  not  its  only  use  is  as  a  caus- 
tic in  a  similar  manner  to  and  for  the  same 
purposes  as  the  chloride.  When  mixed  with 
flour  and  water  it  forms  a  paste  which  can  be 
easily  spread,  remains  soft,  and  does  not  con- 


tract or  spread  at  the  edge  through  absorption 
of  water.  It  may  also  be  made  into  pencils  in 
the  same  way  as  the  chloride,  but  they  must 
not  be  dried  by  means  of  heat,  as  that  will 
cause  some  decomposition  of  the  salt.  The 
late  Dr.  Tilbury  Fox  recommended  in  severe 
and  chronic  cases  of  lupus  erythematosus  the 
following : 

5  Zinc  nitrate 1^  drachm  ; 

Distilled  water,         ) 

Glycerite  of  starch,  [■  each  ...  1        " 

Flour,  ) 

M. 

This  is  formed  into  a  paste  and  applied  to 
the  surface  of  the  lupus.  When  the  paste  is 
withdrawn  a  poultice  is  applied  and  the  raw 
surface  left  by  the  removal  of  the  eschar  is 
dressed  with  an  ointment  like  diachylon  or 
zinc  oxide.  Eeapplication  may  be  needed,  and 
the  strength  of  the  paste  may  be  increased 
according  to  circumstances. 

Zinc  oleostearate. — This  is  a  semifluid, 
white,  oreamlike  product  of  the  combination 
of  zinc  stearate  with  benzoinated  liquid  albo- 
lene.  It  is  of  neutral  reaction,  almost  taste- 
less, with  the  odour  of  benzoin,  tenacious  to 
the  mucous  membrane,  to  which  it  is  non- 
irritant  and  acts  as  a  protective.  It  is  espe- 
cially intended  for  use  in  diseases  of  the 
naso-pharynx,  pharynx,  and  larynx,  to  which 
it  is  comparatively  easy  of  application,  and  as 
a  vehicle  for  the  application  of  other  drugs, 
many  of  which  may  be  combined  with  it,  to 
the  mucous  membranes  of  those  parts. 

[Dr.  Walter  F.  Chappell  {New  York  Medical 
Journal,  May  30,  1896)  says,  speaking  of  the 
use  of  zinc  oleo-stearate  in  conjunction  with 
other  drugs,  that  the  following  combinations 
have,  in  his  experience,  proved  most  valuable : 
Oleo-stearate  of  zinc  with  balsam  of  Peru,  in 
conditions  requiring  stimulation  and  healing ; 
with  liquor  plumbi  subacetatis,  in  acute  rhini- 
tis or  the  coryza  accompanying  a  common  cold  ; 
with  boric  and  carbolic  acids,  in  copious  wa- 
tery nasal  discharges  and  hypermmic  condi- 
tions ;  with  iodine,  in  dry  and  atrophic  rhinitis 
and  ozcena;  with  tannic  acid,  in  nosebleed,  and 
catarrhal  conditions  characterized  by  yellow 
discharges;  with  camphor  and  menthol,  it  is 
cooling,  and  therefore  available  in  hay  fever 
and  coryza;  with  acetanilide,  it  is  applied 
after  operations  as  an  antiseptic  and  protec- 
tive ;  with  antipyrine,  as  a  hfemostatic  in  re- 
curring epistaxis,  and  as  a  sedative  in  irritable 
conditions  of  the  raucous  membrane ;  with  ole- 
um pini  pumilionis  and  eucalyptol,  it  is  sooth- 
ing and  curative  as  an  intratracheal  injection, 
in  chronic  bronchitis  and  asthmatic  affections ; 
with  oleum  pini  pumilionis,  as  a  sedative 
in  irritable  conditions  of  the  nasal  mucous 
membrane  characterized  hy  excessive  S7ieezing  ; 
and  with  orthochlorphenol,  it  is  valuable  in 
syphilitic  ulcerations  and  ozcena.] 

Zinc  oxy chloride. — When  a  solution  of  zinc 
chloride  is  added  to  the  oxide  a  basic,  insoluble 
compound,  called  the  oxychloride,  is  formed, 
which  soon  dries  and  becomes  very  hard.  It 
is  used  by  dentists  for  temporary  and  some- 
times for  permanent   fillings    for  the  teeth. 


ZINC 


410 


The  characteristics  which  recommend  it  for 
this  purpose  are  that  after  it  has  hardened  in 
the  cavity  in  which  it  has  been  placed  it  neither 
expands  nor  contracts,  that  it  is  of  about  the 
same  density  as  dentin,  and  that  it  retains  its 
white  colour.  When  the  wet  mixture  of  zinc 
oxide  and  chloride  is  to  be  introduced  into  a 
dental  cavity  care  must  be  taken  that  the  pulp 
is  not  exposed  to  its  action,  because  in  that 
case  it  acts  immediately  as  a  painful  escharotio. 

The  hardness,  firmness,  and  insolubility  of 
this  salt  have  also  been  made  use  of  to  some 
extent  in  the  preparation  of  resistant  surgical 
dressings.  Zinc  oxide  mixed  with  one  tenth  as 
much  zinc  chloride  and  made  into  a  paste  with 
an  equal  weight  of  water  has  been  recommended 
as  an  air-tight,  firmly  adherent  and  non-irri- 
tating dressing  to  be  applied  to  sutured  wounds, 
particularly  when  they  are  in  situations  which 
render  them  liable  to  infection  from  the  bodily 
secretions.  Thus,  if  applied  after  an  operation 
for  harelip  the  nasal  secretions  pass  harmlessly 
over  its  surface,  and  the  wound  is  effectually 
protected.  After  an  operation  for  strangulated 
hernia  also  it  may  perhaps  be  of  service.  Such 
a  dressing  should  be  removed  by  the  fifth  or 
sixth  day.  It  will  very  likely  have  become 
somewhat  loosened  by  that  time,  but  when  it 
is  still  adherent  it  will  need  to  be  cut  away 
with  scissors. 

[Dr.  G.  Betton  Massey,  of  Philadelphia 
{Journal  of  the  American  Medical  Associa- 
tion, August  24,  1895),  finds  nascent  zinc  oxy- 
chloride  valuable  as  an  adjuvant  to  the  gal- 
vanic treatment  of  hcemorrhagic  endometritis 
and  incipient  malignant  conditions  of  the 
uterus.  The  positive  electrode,  made  of  zinc, 
is  inserted  into  the  uterine  cavity,  and  the 
passage  of  the  current  leads  to  the  formation 
of  the  oxychloride.  Owing  to  the  practical 
difBoulty  that  has,  'he  says,  at  times  resulted 
from  the  adhesion  of  the  electrode  to  the  sur- 
face after  a  prolonged  application,  and  also  on 
account  of  the  roughened  surface  rapidly  at- 
tained by  the  electrode,  he  has  been  led  to 
amalgamate  the  zinc  freely  with  mercury  be- 
fore using  it,  and  is  convinced  that  the  expe- 
dient is  a  valuable  one.  Not  only  does  this 
keep  the  zinc  surface  always  smooth,  lubri- 
cated, and  non-adhesive,  says  Dr.  Massey,  but 
a  new  value  is  attained  in  the  use  of  a  nascent 
oxychloride  of  mercury  in  addition  to  the  oxy- 
chloride of  zinc  and  a  far  more  efficient  altera- 
tive and  antiseptic  action  results.] 

Zinc  permanganate  occurs  in  crystals 
which  closely  resemble  those  of  potassium  per- 
manganate. It  is  hygroscopic,  soluble  in  water, 
and  unites  with  organic  substances  and  with 
alcohol  to  form  explosive  mixtures.  This  salt 
was  recommended  by  the  late  Mr.  Berkeley 
Hill  as  an  injection  in  acute  gonorrhoea.  For 
this  purpose  it  should  be  used  alone,  dissolved 
in  distilled  water,  in  the  strength  of  1  to  4,000, 
which  is  not  irritating  to  the  urethra. 

[Dr.  A.  S.  Hotaling,  resident  physician  to  the 
Bay  View  Hospital,  Baltimore  (Medical  I^ews, 
November  7,  1896),  reports  that  zinc  perman- 
ganate has  proved  more  satisfactory  in  his  hands 
than  any  other  remedy  in  both  acute  and  chronic 
cases  of  gonorrhoea.      Its  effect,  he  says,  is 


discernible  almost  immediately,  the  discharge 
in  the  majority  of  cases  becoming  greatly  re- 
duced after  a  few  injections.  After  the  stage 
of  acute  inflammation  has  subsided,  the  injec- 
tions are  made  four  or  five  times  a  day, 
after  urination,  with  an  ordinary  blunt-pointed 
hard-rubber  syringe,  with  a  capacity  of  from  3 
to  4  drachms.  His  rule  is  to  begin  with  a 
solution  of  half  a  grain  to  the  ounce  of  water, 
gradually  increasing  it  to  a  grain  and  a  half. 
An  alkaline  diuretic  is  given,  and  the  hygienic 
part  of  the  treatment  is  followed  closely  in 
every  case.  The  treatment  is  conducted  under 
his  personal  supervision,  instead  of  by  the 
patient. 

He  reports  fifty-eight  cases,  of  which  fifty 
were  permanently  cured.  In  thirty-three  cases 
it  was  the  first  attack  of  gonorrhoea.  The 
average  duration  of  urethritis  before  the  be- 
ginning of  the  treatment  was  about  three 
weeks.  The  average  time  that  elapsed  be- 
tween that  of  beginning  the  treatment  and 
that  of  the  cessation  of  the  discharge  was  nine 
days.  The  cure  was  pronounced  permanent 
in  an  average  of  twenty  days  after  the  treat- 
ment was  begun. 

Zinc  phospliate  is  a  white  powder,  insoluble 
in  water,  but  soluble  in  acids,  which  is  obtained 
by  the  interaction  of  zinc  sulphate  and  an  al- 
kaline phosphate.  It  may  occur  as  the  diphos- 
phate or  triphosphate,  the  former  of  which  is 
the  more  soluble.  This  salt  was  introduced  by 
Mr.  Barnes,  of  London,  who  thought  it  pos- 
sessed special  advantages  for  the  treatment  of 
certain  forms  of  nervous  diseases.  Hpilepsy 
attended  with  disorders  of  the  uterine  func- 
tions, and  the  nervous  disorders  which  occur 
in  enfeebled  persons,  especially  in  exhaustion 
from  over-excitemeiit,  seemed  much  benefited 
by  doses  of  from  2  to  5  grains,  especially  when 
combined  with  free  phosphoric  acid.  In  com- 
bination with  quinine  it  was  pronounced  valu- 
able in  oases  of  insanity  duriiig  convalescence 
from  fevers.  It  has  been  tried  with  but  little 
success  in  locomotor  ataxia  and  general  par 
ralysis. 

Zinc  salicylate  occurs  in  long,  colourless, 
satiny,  needlelike  crystals,  which  have  a  sweet, 
somewhat  bitter  and  styptic  taste,  are  soluble 
in  about  twenty-five  parts  of  cold  water,  freely 
in  boiling  water,  and  in  three  and  a  half  parts 
of  alcohol.  This  salt  is  used  solely  for  topical 
applications  as  an  astringent  and  antiseptic 
agent.  It  may  be  sprinkled  over  the  surfaces 
of  ulcerous  and  other  inflammatory  cutaneous 
diseases,  may  be  insufflated  into  the  nose  in 
the  treatment  of  nasal  catarrh,  and  may  be 
applied  as  acoUyrium  in  conjunctivitis  in  solu- 
tions of  from  one  half  to  one  per  cent,  in 
strength,  but  it  does  not  present  any  special 
advantages  over  other  better-known  prepara- 
tions. 

Zinc  sozoiodolate. — This  salt  occurs  in 
colourless,  needlelike  crystals,  which  are  solu- 
ble in  twenty  parts  of  water  and  in  alcohol. 
It  has  been  used  in  solutions  of  from  one  half 
to  one  per  cent,  in  strength  in  acute  and  chronic 
blennorrhoea  and  gonorrhoea,  usually  in  combi- 
nation with  other  drugs.  In  acute  gonorrhoea 
the  admixture  of  opium  to  the  solution  is  fre- 


411 


ZINC 


quently  advisable,  while  in  chronic  oases  the 
salicylate  of  bismuth  has  been  recommended 
as  a  useful  combination.  A  stronger  solution 
has  been  used  as  a  mouth  wash.  It  has  also 
been  used  mixed  with  some  inert  powder  to 
the  strength  of  from  5  to  20  per  cent,  in 
catarrhal  inflammation  of  the  nasal  and  pha- 
ryngeal mucous  membranes. 

Zinc  stearate  compound. — This  is  the  pro- 
prietary name  of  a  light  powder  obtained  by  the 
combination  of  a  soluble  zinc  salt  with  a  mix- 
ture of  stearic  and  other  fatty  acids.  It  is 
insoluble  in  water,  slightly  soluble  in  alcohol, 
and  soluble  in  oil  and  turpentine.  It  may  be 
used  as  a  toilet  powder,  or  as  a  protective  in 
intertrigo,  abrasions,  and  acute  cutaneous  dis- 
eases, but  is  intended  principally  as  a  vehicle 
for  the  local  application  of  drugs  used  in  the 
treatment  of  diseases  of  the  cutaneous  and 
mucous  surfaces. 

Zinc  subgallate. — This  is  an  odourless, 
non-toxic,  non-irritating,  greenish  gray  powder, 
of  neutral  reaction,  insoluble  in  water  or  alco- 
hol, containing  44  per  cent,  of  zinc  oxide  and 
56  per  cent,  of  gallic  acid.  Internally  it  has 
been  used  in  doses  of  from  ^  to  4  grains 
in  fermentative  dyspepsia  and  in  night  sweats. 
Its  chief'use  is  externally  as  an  antiseptic 
and  desiccant  dressing  in  the  treatment  of 
eczema,  fresh  and  septic  wounds,  and  hem- 
orrhoids, applied  pure  or  diluted  with  inert 
powders,  or  in  the  form  of  an  ointment.  It 
has  also  been  used  in  affections  of  the  nasal 
mucous  membrane,  in  chronic  purulent  otitis 
media,  and  in  gonorrhea.  For  the  latter  dis- 
ease it  is  used  suspended  in  the  proportion  of 
one  to  sixteen  in  mucilage  and  water  as  an  in- 
jection. 

Zinc  sulphide. — This  compound  occurs  in 
Nature  as  "  blende,"  but  as  prepared  for  med- 
ical use  is  in  the  form  of  an  impalpable  powder. 
It  was  recommended  by  Duhring  as  a  local  ap- 
plication in  subacute  forms  of  lupus  erythema- 
tosus and  in  seborrhea  of  the  face.  For  r.his 
purpose  the  following  lotion,  in  which  this  salt 
is  obtained  by  double  decomposition,  should  be 
applied  to  the  surface  and  the  sediment  allowed 
to  adhere : 

R  Zinc  Sulphate,  )  „„„i.         i  a   j,  . 

Potassium  sulphide,  \  ^^"^^  •  •  *  A-  ^r. ; 

Rose  water 3  fl.  oz. ; 

Alcohol 3  to  6  fl.  dr. 

M. 

Zinc  sulphite. — This  salt  is  obtained  by  the 
interaction  of  six  parts  of  zinc  sulphate  and  five 
and  a  quarter  parts  of  sodium  sulphite  in  solu- 
tion, a  reaction  which  takes  place  slowly,  but 
is  said  to  progress  gradually  to  completion.  It 
is  not  very  soluble  in  water,  but  is  soluble  in 
excess  of  sulphurous  acid,  and  is  recommended 
as  neither  poisonous  nor  irritating.  Tichborne 
says,  in  the  Medical  Press  and  Circular  for 
October  13,  1893,  that  he  introduced  this  salt 
many  years  ago  as  one  especially  adapted  for 
antiseptic  purposes.  Any  fabric  can  be  im- 
pregnated with  it  without  the  use  of  any  ad- 
hesive material  by  first  boiling  it  in  water  to 
cleanse  and  sterilize  it,  then  pouring  over  it  a 
boiling  solution  of  the  above-named  salts  and 
70 


allowing  the  whole  to  stand  for  twelve  hours. 
The  double  decomposition  leaves  the  sulphite 
entangled  in  a  semisoluble  condition  in  the 
meshes  of  the  fabric.  He  claims  that  this  salt 
exhibits  not  only  the  antiseptic  properties  of 
zinc  chloride,  but  also  the  special  action  of  the 
sulphites  and  combines  with  these  the  healing 
qualities  of  zinc  oxide.  He  also  states  that  this 
salt  is  sufficiently  soluble  to  maintain  a  germi- 
cidal condition  in  any  supernatant  fluid,  and 
ascribes  this  power  to  the  slow  absorption  of 
oxygen  by  the  sulphite  and  its  consequent 
change  into  the  more  soluble  sulphate.  This 
property  gives  it,  in  his  opinion,  a  peculiar  ad- 
vantage as  a  disinfectant  for  the  stools  of  pa- 
tients with  typhoid  fever  and  cholera. 

Zinc  sulphocarbolate,  zincisulphocarbolas 
(Br.  Ph.),  is  described  in  the  British  Pharma- 
copoeia as  occurring  in  "  colourless,  transparent, 
tubular,  efflorescent  crystals,  soluble  in  about 
twice  their  weight  of  rectified  spirit  or  of  water." 
The  appearance  of  the  crystals  varies  from  col- 
ourless to  reddish  according  to  the  process  of 
manufacture.  They  are  odourless,  of  acid  or 
neutral  reaction,  and  have  a  sfimewhat  bitter 
and  astringent  taste. 

During  the  past  few  years  zinc  sulphocarbo- 
late has  come  to  be  considerably  used  in  the 
treatment  of  intestinal  disorders,  particularly 
those  of  childhood,  and  appears  to  act  both  as 
an  astringent  and  as  an  intestinal  antiseptic. 
It  is  thus  indicated  in  all  cases  in  which  the  oc- 
currence of  foetid  stools  with  tympanites  shows 
the  presence  ot  fermentative  processes  in  thegas- 
tro-intestinal  tract,  and  excellent  results  have 
been  obtained  from  its  use  in  cholera  infantum, 
cholera  morbus,  and  typhoid  fever.  As  com- 
pared with  the  other  sulphocarbolates,  the  zinc 
salt  seems  to  have  the  better  effect  in  these 
diseases,  possibly  on  account  of  its  astringent 
and  nerve-tonic  action.  In  cholera  infantum 
it  may  be  given  in  doses  of  from  J^  to  1  grain 
as  often  as  necessary,  usually  every  two  hours, 
until  the  stools  reassume  their  normal  appear- 
ance and  lose  their  offensive  odour.  As  the 
symptoms  pass  away  the  intervals  between  the 
doses  should  be  lengthened.  In  cholera  mor- 
bus and  diarrhoea  of  adults  the  usual  dose  is 
2^  to  5  grains  every  two  hours  until  the  fer- 
mentative processes  in  the  stomach  and  intes- 
tines are  checked.  The  benefit  is  frequently 
quite  marked  and  rapid,  the  temperature  falls, 
vomiting,  tympanites,  and  diarrhoea  subside, 
and  then  the  drug  is  to  be  given  at  longer  in- 
tervals until  stopped.  When  the  first  doses  are 
rejected  by  the  stomach  they  may  be  repeated 
every  fifteen  minutes  until  one  is  retained. 
When  the  lower  bowel  is  involved  in  either 
children  or  adults  enemas  of  from  5  to  40 
grains  of  zinc  sulphocarbolate  to  the  pint  of 
warm  water  may  be  of  good  effect.  In  the 
treatment  of  these  diseases  it  may  often  be  of 
advantage  to  combine  with  this  drug  others 
which  are  indicated  in  these  conditions,  such 
as  bismuth  or  chalk.  In  typhoid  fever  this 
drug  has  done  good  service  in  controlling  the 
diarrhoea,  and  it  has  been  said  to  be  able  to 
abort  attacks  of  this  disease  if  given  during 
the  incipient  stage  in  doses  of  2  grains  every 
three  or  four  hours.    Good  results  have  also 


ZINC 


412 


been  reported  from  its  use  in  chronic  intes- 
tinal catari'h  and  heematemesis.  It  is  also  said 
to  have  been  of  service  in  the  vomiting  of  preg- 
nancy, given  in  combination  with  small  doses 
of  calomel,  and  to  have  been  beneficial  in 
scarlet  fever.  On  account  of  its  unpleasant 
taste  it  is  best  administered  in  the  form  of 
tablets. 

Externally,  zinc  sulphooarbolate  has  been 
used  in  solutions  of  from  1  to  5  per  cent,  as 
an  antiseptic  lotion,  and  as  such  is  less  apt  to 
cause  irritation  than  carbolic  acid.  The  same 
lotion  is  useful  in  balanitis,  and  a  solution 
from  0-5  to  3  per  cent,  in  strength  has  been 
recommended  for  irrigation  of  the  urethra 
in  gonorrhma.  In  syphilitic  and  catarrhal 
laryngitis  and  pharyngitis  a  spray  of  a  1-per- 
cent, solution  has  been  used  with  some  bene- 
fit. Similar  solutions  have  also  been  employed 
as  douches  for  chronic  purulent  otitis  media 
and  for  eczema  of  the  external  auditory  canal. 
This  drug  has  also  been  used  for  pityriasis 
capitis. 

Zinc  sulplioiclitliyolate,  or  ichthyol- 
sulphonate,  is  a  brownish-bla;ck,  tarlike  mass 
which  was  introduced  into  medicine  together 
with  the  other  compounds  of  sulphoichthyolic 
acid  for  the  purpose  of  facilitating  the  use  of 
iehthyol.  The  zinc  salt  is  not  so  good  as  the 
other  sulphoichthyolates  for  internal  adminis- 
tration and  is  seldom  used,  but  may  be  given 
in  doses  of  from  4  to  15  grains  in  cases  of 
chronic  rheumatism,  chronic  catarrhal  dis- 
eases of  the  stomach  and  lungs,  chronic  ca- 
tarrhal cystitis,  chronic  nephritis,  chronic 
gonorrhma,  and  diabetes.  Externally  it  may 
be  used  in  the  form  of  a  liniment,  incorpo- 
rated in  soap,  or  in  the  form  of  an  ointment, 
45  grains  to  the  ounce,  in  cases  of  acute  or 
chronic  rheumatism,  neuralgia,  sciatica,  lum- 
bago, intrapelvie  inflammatory  exudations, 
frostbites,  burns,  varicose  veins,  eczema,  pso- 
riasis, acne,  erysipelas,  and  favus. 


Zinc  sulphydrate. — This  is  a  white,  solid 
precipitate  which  decomposes  on  exposure  to 
the  air  and  must  therefore  be  kept  under  water. 
It  has  been  recommended  for  internal  use  in 
intestinal  troubles  dependent  on  bacterial  in- 
fection in  doses  of  from  0-5  to  2  grains,  given 
preferably  in  pill  form.  Externally,  it  is  useful 
in  the  treatment  of  chronic  eczema,  psoriasis, 
and  vegeto-parasific  shin  diseases,  applied  in 
a  10-per-cent.  ointment  with  lanolin  or  lard. 

Zinc  tannate  is  a  fine,  nearly  white  powder, 
insoluble  in  water,  alcohol,  or  ether,  obtained 
by  the  interaction  of  zinc  acetate  and  tannic 
acid.  It  has  been  used  to  a  slight  extent  in 
dyspepsia,  phthisis,  and  diarrhceal  affections 
and  rather  more  as  a  topical  application  to  the 
mucous  membranes. 

Bonnewyn  recommended  in  conjunctivitis 
with  a  muco-purulent  discharge — 

3  Zinc  tannate 30  grains ; 

Mucilage -J  fl.  oz. ; 

Distilled  water 6  oz. 

M. 

It  has  some  effect  as  an  astringent  when  ap- 
plied to  the  nasal  mucous  membrane,  and  has 
been  used  as  an  injection  in  gonorrhoea.  The 
dose  internally  is  given  as  from  1^  to  4J  grains. 

Zincohsemol  is  a  dark-brown  powder  which 
contains  about  1  per  cent,  of  zinc  in  hsemol. 
It  is  slightly  soluble  in  water  and  is  a  mild 
astringent  and  tonic  in  its  action.  It  has  been 
used  in  ancBmia,  chlorosis,  and  diarrhceal  affec- 
tions in  doses  of  from  4  to  8  grains  three  times 
a  day. 

Zymoidin  is  a  proprietary  article  which  is 
said  to  be  composed  of  the  oxides  of  zinc,  bis- 
muth, and  aluminum  with  iodine,  boric,  car- 
bolic, gallic,  and  salicylic  acids,  quinine,  and 
other  drugs.  It  has  been  placed  on  the  market 
for  use  as  an  antiseptic  in  the  form  of  powder, 
ointment,  solution,  or  bougie. 

Matthias  Lanokton  Foster. 


SUPPLEMENT. 


Much  has  been  added  to  our  knowledge  since  the  articles  contained  in  the  body  of  this  work 
were  prepared.  Thus  far,  most  of  the  literature  of  this  additional  knowledge  has  remained  scattered 
through  periodicals.  Besides  supplying  accidental  omissions,  it  is  the  function  of  this  Supplement  to 
give  the  substance  of  that  literature,  or  at  least  of  its  more  important  portions,  and  it  has  been  thought 
best  to  present  it  in  many  instances  in  almost  the  original  authors'  own  words. 

ABRASTOL 
AIK 


ABRASTOL.— See  Asapbol. 

ABB.IN. — See  under  Jequieity  (vol.  i,  page 
563). 

ACETONE. — This  substance  has  recently 
acquired  some  fresh  importance  in  medicine  as 
a  solvent  of  celluloid  (g.  v.,  in  Supplement). 

,  ACETYLENE.— See  under  Calcium  oar- 
bide. 

ACTOL. — See  Silver  lactate,  under  Silver. 

ADH.SSOL. — See  under  Varnishes. 

AIR,  CONDENSED  OR  RAREFIED. 

— The  use  of  the  pneumatic  cabinet  is  consid- 
ered by  Dr.  Chanes  E.  (Juimby  (New  York 
Medical  Journal,  August  1,  1896)  to  be  a  spe- 
cific and  practically  certain  remedy  for  pul- 
monary  hemorrhage.  The  flow  of  blood,  says 
Dr.  Quimby,  can  be  permanently  arrested  only 
by  the  formation  of  a  clot,  and  the  formation 
of  a  clot  is  determined  by  one  or  more  of  three 
causes :  (a)  Modification  of  the  blood  elements ; 
(6)  reduction  of  vascular  tension  with  slowing 
of  circulation ;  and  (c)  compression  of  the  bleed- 
ing vessels.  Upon  the  first  of  these  the  cabi- 
net lias  no  direct  influence.  For  effecting  the 
two  others  it  is,  facile  princeps,  our  most  pow- 
erful measure.  To  accomplish  this  we  employ 
continuous  respiration  under  negative  differ- 
entiation with  rarefactions  of  from  a  half  to 
three  quarters  of  an  inch  of  mercury — differ- 
ential respiration.  In  such  conditions,  a  pa- 
tient respires  with  the  pulmonary  circulation 
under  existing  barometric  pressure,  while  the 
entire  cutaneous  expansion  is  relieved  of  from 
a  quarter  to  half  a  pound  of  pressure  to  the 
square  inch.  The  result  is  capillary  dilatation 
with  lowering  of  the  systemic  vascular  tension, 
by  which  the  venous  system  is  filled  to  disten- 
tion, while  the  pulmonary  vessels  suffer  cor- 
responding depletion  and  slowing  of  their 
circulation  under  lowered  tension.  Should  the 
differentiation  obtained  by  the  cabinet  alone 
not  suffice,  says  Dr.  Quimby,  the  use  of  com-, 
pressed  air  for  inhalation  in  connection  with 
the  cabinet  must  certainly  cause  compression 
of  superficial  bleeding  vessels. 


413 


"  With  hsemorrhage  thus  arrested,"  he  con- 
tinues, "  we  have  to  consider  secondly  the  pre- 
vention of  its  recurrence.  For  our  present 
purposes  the  causes  of  pulmonary  haemorrhage 
may  be  condensed  into  two  :  Increased  vascu- 
lar tension  and  diminished  nutrition,  of  the 
vascular  walls,  resulting  in  weakening  and  di- 
minished resistance.  To  fully  appreciate  the 
beauties  of  the  cabinet  action  in  diminishing 
tension  and  increasing  nutrjtion,  if  is  neces- 
sary to  bear  in  mind  that  vascular  tension 
serves  solely  the  purpose  of  moving  the  blood 
through  the  vessels,  for,  if  I  mistake  not,  it  is 
now  generally  admitted  that  nutritive  inter- 
change depends  upon  cellular  action  and  not 
upon  mechanical  transudation.  It  is  certainly 
well  recognised  that  the  vessels  of  an  organ  in 
functional  activity  are  dilated,  while  vascular 
contraction  marks  those  parts  in  which  the  cir- 
culation is  relatively  diminished.  Tissue  nu- 
trition may  therefore  take  place  under  lowered 
tension,  provided  the  flow  of  blood  is  main- 
tained. The  evident  indications  in  the  condi- 
tion under  consideration,  then,  are  to  hasten 
pulmonary  circulation  as  a  means  of  augment- 
ing tissue  nutrition,  without  increased  and,  if 
possible,  with  decreased  vascular  tension.  It 
is  precisely  this  which  is  accomplished  by  the 
cabinet,  by  the  motion  termed  force  inspira- 
tion. When,  after  a  few  days',  possibly  a 
week's,  treatment  by  differential  respiration 
alone,  we  feel  sure  that  the  protective  clots  are 
firmly  established,  that  motion  is  replaced  by 
forced  inspiration.  At  first,  the  rarefaction 
employed  is  but  little  more  than  has  been  used 
for  differential  respiration.  But  day  by  day  it 
is  increased  until  the  maximum  that  is  deemed 
advisable  for  the  case  in  hand  is  reached.  This 
may  require  anywhere  from  two  to  ten  days. 
What  now  is  the  physics  of  this  motion  ?  Dur- 
ing inspiration  the  condition  is  that  just  de- 
scribed for  differential  respiration,  and  the 
action  that  of  a  general  cutaneous  cupping. 
With  the  higher  rarefaction  the  effect  is  greater, 
and  at  two  inches  of  mercury,  if  the  breath  is 
held  for  two  or  three  seconds  after  the  lungs 
have  reached  full  inflation,  the  capillary  hyper- 


AIROL 
ANESTHETICS 


414 


semia  of  the  skin  and  the  venous  distention  be- 
come very  evident.  At  this  point  the  breathing 
tube  is  dropped  from  the  patient's  mouth,  as 
the  controlling  valve  is  closed,  and  the  pul- 
monary pressure  instantly  drops  to  that  upon 
the  skin." 

AIKOIi. — This  is  a  German  patented  sub- 
stitute for  iodoform  as  an  antiseptic,  and  is  de- 
scribed as  an  iodine  substitution  compound  of 
basic  bismuth  gallate  (dermatol).  Professor 
Coblentz  gives  the  formula  as 
f— OH 

p  „  J  —OH 

^»ii^  i  -OH         ^j, 
[  — COO.Bi<^"- 

This  compound,  he  says,  possesses  the  absorb- 
ent properties  of  subgallate  of  bismuth  as  well 
as  the  antiseptic  properties  of  its  iodine  com- 
bination. It  is  a  greenish-gray,  fine,  inodorous, 
and  tasteless  powder.  Light  produces  no  effect 
on  it,  while  moist  air  causes  it  to  turn  red  with 
loss  of  iodine.  In  contact  with  water,  particu- 
larly when  heated,  the  powder  undergoes  slow 
decomposition,  becoming  red  with  loss  of  io- 
dine. Dilute  alkalies  and  acids  dissolve  it 
readily. 

Haegler  (Beitrage  zur  Mmische  Chirurgie, 
XV,  1 ;  Centralblatt  fur  Chirurgie,  January  18, 
1896)  has  made  comparative  trials  of  airol,  der- 
matol, and  iodoform,  and  has  satisfied  himself 
that  airol  is  less  poisonous  than  iodoform. 
Moreover,  he  says,  it  is  free  from  odour  and 
does  not  irritate  the  sound  skin.  Two  points 
of  its  superiority  to  iodoform  are  its  property 
of  parting  with  a  portion  of  its  iodine  in  the 
presence  of  the  warm  fluids  of  the  body  and 
the  fact  that,  by  reason  of  the  bismuth  con- 
tained in  it,  it  is  in  a  high  degree  desiccative. 
It  is  applied  for  the  most  part  with  a  powder 
blower ;  it  is  used  also  in  the  form  of  a  10- 
or  20-per-eent.  gauze,  in  that  of  a  10-per- 
cent, solution  in  collodion,  and,  for  tuberculous 
affections,  in  that  of  a  10-per-oent.  emulsion 
in  a  mixture  of  equal  parts  of  glycerin  and 
water.  In  the  course  of  a  year  Haegler  has 
used  airol  in  about  two  thousand  cases,  and  has 
observed  its  decided  effect  on  the  tuberculous 
process,  but  no  untoward  action.  He  regards 
it  as  a  useful  substitute  for  iodoform. 

De  Sanctis,  of  Rome  (Qazzetta  degli  ospedali, 
November  1,  1896 ;  British  Medical  Journal, 
December  36,  1896),  reports  having  used  airol 
with  results  which  he  characterizes  as  brilliant 
in  intertrigo,  both  of  the  secreting  and  of  the 
pruriginous  type.  Dusted  over  the  affected 
parts,  he  says,  it  gives  immediate  relief,  sooth- 
ing pain,  subduing  itching,  and  healing  exco- 
riations. He  gives  as  examples  of  its  use  two 
very  severe  cases.  One  of  these  was  that  of  an 
old  woman  who  had  intertrigo  of  the  whole 
hypogastric  region,  both  groins,  one  thigh,  and 
part  of  the  external  genitals ;  the  whole  sur- 
face was  reddened,  raised,  and  partially  cov- 
ered with  a  greasy,  grayish  layer,  and  in  some 
places  eroded  to  such  an  extent  that  the  slight- 
est touch  caused  bleeding.  Local  treatment  of 
various  kinds  had  been  tried  in  vain.  The  ap- 
plication of  airol  at  once  got  rid  of  the  burning 
feeling,  which  was  replaced  by  an  agreeable 


sense  of  freshness,  and  sleep  ceased  to  be  inter- 
rupted by  the  pain  and  itching.  The  powder 
was  applied  daily  and  kept  on  with  a  bandage. 
In  four  days  the  eroded  surface  was  completely 
healed ;  a  few  days  later  the  cure  was  com- 
plete, and  there  had  been  no  complaint  of  re- 
currence four  months  after  treatment.  De 
Sanctis  recommends  airol  as  one  of  the  best 
remedies  for  intertrigo  ;  it  is  non-toxic,  and  its 
use  is  not  attended  with  any  drawbacks. 

AKTOL. — See  Silver  lactate,  under  Silver. 

ALBOIiENE. — This  is  an  American  pro- 
prietary refined  product  of  petroleum  which  is 
employed  as  a  base  for  ointments  and  as  a  lu- 
bricant. It  is  odourless  and  does  not  become 
rancid. 

Liquid  Albolene,  which  is  very  readily  dif- 
fused in  the  form  of  spray,  is  a  suitable  solv- 
ent for  drugs  that  it  is  desired  to  apply  to  the 
nasopharyngeal  passages. 

ALLYL  STJLPHOCABBAMIDE,  AL- 
LTL  SULPHOUE.EA,  ALLYL  THIO- 
tJBiEA. — See  Thiosinamine. 

ALLYL  TRIBROMIDE,  CaHsBra,  is  de- 
scribed by  Professor  Coblentz  as  a  colourless  or 
slightly  yellowish  liquid  which  has  been  rec- 
ommended as  a  sedative  and  anodyne  to  be 
given  subcutaneously  in  doses  of  from  3  to  4 
drops,  dissolved  in  ether,  in  hysteria,  asthma, 
whooping-cough,  etc. 

ALXTMINUM     BOBOTANNICOTAR- 

TR.ATJ!.— This  is  made  by  dissolving  alumi- 
num borotannate  in  a  solution  of  tartaric  acid. 
It  is  called  also  cutal.  It  is  astringent  and  an- 
tiseptic, and  is  employed  topically,  pure  or  at- 
tenuated, in  catarrhal  states  of  the  skin  or 
mucous  membranes  attended  with  supersecre- 
tion.    Cf.  Tannal. 

AMBER.— Dr.  William  Murrell.  of  Lon- 
don (Clinical  Sketches.  February,  1896),  says 
that  for  some  years  he  has  used  oil  of  amber, 
both  internally  and  externally,  in  the  treat- 
ment of  whooping-cough.  He  has  not  kept 
notes  of  his  cases,  but  the  results  have  been  so 
satisfactory  that  the  custom  of  giving  it  has 
degenerated  into  a  routine.  He  has  found  it 
useful  also  in  chronic  bronchitis  and  winter 
cough.  In  whooping-cough  he  generally  orders 
a  teaspoonful  to  be  rubbed  in  along  the  course 
of  the  spine,  night  and  morning,  before  the  fire. 
For  rheumatism  he  finds  it  better  to  have  it 
made  into  a  liniment  with  equal  parts  of  aro- 
matic spirit  of  ammonia  and  spirit  of  camphor. 
For  internal  administration,  from  3  to  10 drops 
may  be  taken  every  four  hours,  on  a  piece  of 
sugar  or  on  a  crumb  of  bread,  but  this  mode  of 
administration  presents  some  difficulty  in  the 
case  of  children.  The  following  mixture.  Dr. 
Murrell  thinks,  is  preferable  : 

5  Oil  of  amber 10  minims ; 

Powdered  gum  acacia. . .     1  drachm  ; 

Syrup  of  orange  flowers.     3  drachms  ; 

Oil  of  anise 3  minims; 

Water,  to 1  oz. 

M. 

The  difficulty  is,  he  says,  in  covering  the 
somewhat  disagreeable  taste  of  the  amber  oil. 
He  has  made  some  experiments  with  the  view 


415 


AIROL 
ANJi:STflETlCS 


of  obtaining  a  tasteless  amber  oil,  but  the  re- 
sults have  been  unsatisfactory.  He  gives  the 
following  formula  for  a  liniment : 

g  Oil  of  amber 6  drachms ; 

Oil  of  rosemary,  Lach  . . .  1  drachm; 
Oil  of  origanum,  j  ' 

Oil  of  turpentine 1  oz. ; 

Linseed  oil,  to 4  oz. 

M. 

Dr.  Murrell  is  satisfied  that  more  extensive 
trials  will  show  that  oil  of  amber  is  a  useful 
therapeutic  agent. 

AMMONIUM  CHLOBIDE,  in  drachm 
doses,  has  been  used  successfully  in  one  case 
of  delirium  tremens  by  Dr.  Gilbert  G.  Cottam 
(Medicine,  November,  1896 ;  New  York  Medi- 
cal Journal,  November  31, 1896).  Having  some 
knowledge  of  the  patient  and  his  tolerance  of 
drugs.  Dr.  Cottam  began  by  administering  a 
grain  of  morphine  hypoderraically.  This  was 
without  the  slightest  effect.  Several  hours 
after  the  administration  of  the  morphine,  and 
after  the  symptoms  had  all  become  aggra- 
vated, he  gave  a  drachm  of  chloride  of  ammo- 
nium. This  was  promptly  vomited.  After  a 
short  time  another  was  given,  which  was  re- 
tained. It  acted  quickly  and  favourably.  In 
fifteen  minutes  the  hallucinations  of  snakes 
and  lizards  had  disajipeared,  and  the  patient 
had  become  quite  rational.  In  forty  minutes 
he  was  asleep,  and  it  was  not  thought  neces- 
sary to  continue  the  administration  of  the  drug. 

Dr.  W.  Bourne  Gossett,  of  Independence, 
Missouri  (New  York  Medical  Journal,  January 
23,  1897),  reports  the  case  of  a  lewd  woman 
who  had  been  "on  a  drunk"  for  eight  days, 
and  just  before  he  saw  her  had  had  the  usual 
"  reptile  hallucinations."  He  found  her  very 
restless,  moving  incessantly,  and  she  had  to 
be  forced  to  stay  in  bed.  At  once  he  sent  to  a 
neighbouring  apothecary's  for  a  drachm  of 
chloride  of  ammonium,  but  before  it  was 
brought  she  was  beginning  to  get  more  ex- 
cited and  seeing  "  snakes."  As  soon  as  he  got 
the  ammonium  he  at  once  gave  her  half  a 
drachm  in  a  large  quantity  of  water — four 
ounces — and  had  her  drink  it  in  one  or  two 
gulps.  In  fifteen  minutes  she  was  quieter,  and 
in  fifteen  minutes  more  he  gave  her  the  other 
half  drachm.  In  a  short  time  she  was  asleep 
and  slept  for  six  hours.  She  awoke  feeling 
much  better,  and  had  no  more  trouble.  Dr. 
Gossett  says  he  would  not  hesitate  to  give  a 
drachm  and  repeat  the  dose  in  half  an  hour  if 
the  patient  was  not  better. 

AMMONOIi.  —  Am  moniated  phenylacet- 
amide  ^see  under  Phenylaoetamide). 

AMYGDOPHENINE.  —  This     substitu- 
tion derivative  of  paramidophenol, 
/^OCOOCHs 
H  /  ^  H 


H 


H 
,H 


N< 


^COCHOHCeHj, 
has  been  employed  by  Dr.  B.  Stiive,  of  Prank- 
fort  on  the  Main,  in  the  treatment  of  rheu- 


matism (Centralblatt  fur  innere  Medicin, 
November  16,  1895),  and  found  to  be  very  ser- 
viceable. One  of  the  twenty  rheumatic  patients 
to  whom  he  gave  it  was  suffering  severely 
from  aortic  insufficiency,  and  this  patient  was 
cured  of  his  rheumatism  in  a  few  days.  In 
only  one  of  the  twenty  cases  did  the  remedy 
prove  of  no  benefit.  Dr.  Stiive  found  it  use- 
ful also  in  neuralgia.  He  gave  it  in  15  grains 
from  once  to  six  times  a  day,  in  the  form  of 
Engel's  compressed  tablets  or  in  powder,  and 
observed  no  unpleasant  effects,,  except  .in  the 
case  of  a  woman  who,  while  taking  75  grains  a 
day,  complained  of  slight  dizziness  on  the  sec- 
ond day. 

AMYL  NITRITE.— M.  Hayem  (Journal 
des  pratieiens,  1895 ;  Medical  Record,  January 
18,  1896)  says  this  drug  can  be  given  in  much 
larger  doses  than  is  usually  believed,  for  he  has 
more  than  once  given  from  50  to  100  drops  to 
be  inhaled  at  once,  without  meeting  with  any 
dangerous  symptoms.  The  following  is  his 
method  of  employing  the  remedy  in  pneu- 
monia (Medical  Press):  15  drops  were  poured 
on  a  compress  and  inhaled  in  the  recumbent 
posture  without  effort ;  a  few  seconds  after- 
ward the  same  dose  was  renewed,  and  yet  15 
drops  more  were  given,  so  that  in  the  space  of 
five  minutes  about  50  drops  were  inhaled. 
Redness  of  the  face,  acceleration  of  the  pulse, 
and  precipitation  of  the  respiratory  move- 
ments followed.  These  phenomena  soon  gave 
place  to  a  slight  cough,  a  thready  pulse,  dysp- 
noea, lividity  of  the  face,  and  cyanosis  of  the 
extremities  and  of  the  lips.  In  ordinary  cases 
only  one  series  of  inhalations  was  given  daily, 
while  two  (morning  and  evening)  were  ordered 
where  the  symptoms  were  grave.  It  did  not 
appear  to  M.  Hayem  that  the  treatment  had 
any  marked  effect  on  the  duration  of  the  dis- 
ease, or  on  the  thermic  cycle ;  the  effects 
seemed  to  be  entirely  local,  consisting  in  de- 
crease of  the  dyspncea,  modification  of  the 
expectoration,  and  attenuation  of  the  stetho- 
scopic  signs.  -The  drug  did  not  destroy  the 
virulence  of  the  pneumoeocci ;  its  chief  influ- 
ence was  on  the  pulmonary  circulation,  pro- 
ducing a  strong  flux  which  facilitated  the 
return  of  the  blood  into  the  alveoli  and  hast- 
ening the  absorption  of  the  exudation.  In  a 
period  of  two  years  he  had  treated  seventy- 
seven  cases  of  pneumonia,  with  sixteen  deaths, 
by  inhalations  of  the  nitrite.  Several  of  the 
fatal  cases  had  occurred  in  hard  drinkers. 

AMYLGEORM.— According  to  the  Wiener 
medizinisehe  Blatter  for  September  3,  1896, 
this  is  a  chemical  compound  of  formaldehyde 
and  starch,  made  by  a  patented  process  devised 
by  Professor  A.  Classen.  On  its  coming  in 
contact  with  living  tissue  or  with  the  secre- 
tions, formaldehyde  is  set  free.  It  is  thought 
to  be  an  excellent  antiseptic  and  deodorizer 
for  wounds,  far  more  energetic  than  iodoform, 
odourless,  unirritating,  and  harmless. 

ANiESTHETICS.— Dr.  P.  Hewitt  and  Mr. 
A.  M.  Sheild  (British  Medical  Journal,  October 
36,  1896)  have  called  attention  to  the  impor- 
tance of  the  patient's  posture  during  general 
anaesthesia.    They  think  that,  so  far  as  may 


AN^STILE 
APOMORPHINE 


416 


be  practicable,  the  head  should  be  kept  in  a 
Kne  with  the  long  axis  of  the  body  and  the 
face  turned  to  one  side  when  the  patient  is  in 
the  supine  posture  ;  that  the  lateral  posture  is 
of  advantage  in  most  major  operations  within 
or  about  the  mouth  and  nose ;  and  that,  pro- 
vided there  is  no  special  contra-indication,  the 
patient  should  be  turned  upon  his  side  at  onee 
when  the  operation  is  finished. 

The  Laborde  method  of  resuscitation  by 
rhythmical  tractions  on  the  tongue  has  been 
made  the  subject  of  laboratory  experiment  by 
Dr.  H.  A.  Haubold,  of  Bellevue  Hospital  Medi- 
cal College  (New  York  31edical  Journal,  Janu- 
ary 23,  1897).  His  observations  have  led  him 
to  conclude  that  the  Laborde  method  leaves 
much  to  be  desired,  and  he  thinlfs  it  should 
not  be  employed  to  the  exclusion  of  the  other 
methods  now  in  use. 

AN.a!STILE.^This  name  has  been  given 
to  a  mixture  of  ethyl  chloride  and  methyl 
chloride.  It  is  employed  as  a  local  anmsihetic. 
It  does  not  render  the  skin  so  hard  as  methyl 
chloride  alone  does.  (Dr.  W".  C.  Daish,  Aus- 
tralian Medical  Journal,  December  20,  1895.) 

ANETHOL,  or  anise  camphor,  a  camphor- 
like constituent  of  oil  of  anise,  has  been  em- 
ployed to  some  extent  as  an  antiseptic. 

ANHALONIXJM  LEWINII.— In  a  pa- 
per read  before  the  Association  of  American 
Physicians  in  May,  1896  {Medical  Record, 
August  23.  1896),  Dr.  D.  W.  Prentiss  and  Dr. 
Francis  P.  Morgan,  of  Washington,  gave  an 
account  of  their  investigation  of  the  medicinal 
properties  of  inescid,  or  muscate,  buttons,  which 
they  find  to  "  possess  properties  which  are  re- 
markable, the  exact  likeness  of  which  is  not 
found  in  any  other  known  drug,  and  also  that 
it  possesses  virtues  which,  when  applied  in  the 
treatment  of  certain  diseased  conditions,  may 
prove  the  drug  a  valuable  addition  to  our  pres- 
ent list  of  therapeutic  agents." 

Prentiss  and  Morgan  experimented  on  eight 
young  men,  and  found  that  the  most  remark- 
able visions  were  the  result,  the  beauty  and 
variety  of  which  were  much  enhanced  by 
drumming  or  otherwise  marking  regular  time, 
after  the  manner  of  the  Indians.  One  of 
the  young  men  described  his  experience  as 
follows : 

"  The  first  sensations  that  followed  my  tak- 
ing the  drug  came  upon  thoughtlessly  closing 
my  eyes.  Instantly  there  sprang  into  the  field 
of  view  a  host  of  little  tubes  of  shining  light, 
down  which  green  and  red  balls  the  size  of  peas 
were  constantly  rolling.  The  tubes  of  light 
bent  themselves  into  the  shape  of  letters,  but 
they  would  spell  nothing,  and  slowly  curving 
themselves  into  grotesque  shapes,  began  to  re- 
volve rapidly,  the  green  and  red  balls  going  in 
the  opposite  direction  with  even  greater  veloc- 
ity. All  the  field  of  view  between  these  silent 
wheels  was  filled  in  with  a  shifting  mass  of 
green.  The  colours  were  wonderful.  They 
were  the  colours  of  the  spectrum  intensified  as 
though  bathed  in  the  fiercest  sunlight.  No 
words  can  give  an  idea  of  their  intensity  or  of 
their  ceaseless  persistent  motion.  The  figures 
constantly  changed  in  form  and  colour,  but 


always  remained  a  series  of  fantastic  curves, 
revolving  rapidly  back  and  forth  upon  their 
own  axis.  The  forms  changed  through  rich 
arabesques,  Syrian-carpet  patterns,  and  plain 
geometric  figures,  and  with  each  new  form 
came  a  new  flush  of  colour,  every  shade  ap- 
pearing, from  pure  white  to  deepest  purple. 
When  the  eyes  opened  and  the  light  was 
turned  up,  the  visions  faded  like  stars  going 
out  in  daylight,  and  the  room,  tables,  chairs, 
and  all  surroundings  came  back  into  real  exist- 
ence and  within  reach  of  the  hands." 

In  some  cases  no  effect  whatever  was  pro- 
duced upon  the  reason  or  will  of  the  individ- 
ual. In  others  there  were  some  slowness  of 
thought  and  loss  of  power  of  expression,  and 
in  one  of  the  experiments  there  was  a  marked 
delusion.  Dilatation  of  the  pupil  was  well 
marked  in  every  case,  and  persisted  for  from 
twelve  to  twenty-four  hours  after  the  drug 
was  taken.  The  dilatation  was  accompanied 
by  a  slight  loss  of  the  power  of  accommoda- 
tion and  consequent  disturbance  of  vision. 
More  or  less  depression  of  the  muscular  sys- 
tem existed  in  every  case,  and  this  was  the  first 
effect  noticed  after  the  drug  was  taken.  It 
ranged  from  a  feeling  of  lazy  contentment  to 
decided  muscular  depression.  Partial  anses- 
thesia  of  the  skin  was  present  in  three  of  the 
cases,  appearing  when  the  effects  of  the  drug 
began  to  wear  oS.  The  heart's  action  was  at 
first  rendered  slower  and  stronger.  This  was 
followed  by  a  rise  to  the  normal  which  contin- 
ued during  the  period  of  greatest  activity  of 
the  drug.  In  the  cases  in  which  the  muscular 
depression  was  greatest,  slight,  if  any,  depres- 
sion of  the  heart  was  present.  The  respiration 
was  unaffected  in  all  eases  but  one.  In  this  it 
seemed  to  partake  slightly  of  the  general  mus- 
cular depression.  Upon  the  stomach  the  drug 
produced  an  effect  which  varied  from  a  feel- 
ing of  uneasiness  and  fulness  at  intervals  to 
nausea  and  vomiting.  Inability  to  sleep  for 
at  least  twelve  hours  after  the  infiuence  of  the 
drug  passed  off  was  a  uniform  effect.  Appre- 
ciation of  the  duration  of  time  was  lost  in  all 
cases — as  in  the  effect  of  cannabis  indica.  In 
one  case  a  snowstorm  appeared  to  last  an  hour, 
although  in  fact  the  vision  continued  not  more 
than  a  minute.  There  was  no  constant  effect 
upon  the  bowels,  skin,  temperature,  or  any 
secretion. 

Prentiss  and  Morgan  think  that  the  condi- 
tions in  which  it  seems  probable  that  the  use 
of  mescal  buttons  will  produce  beneficial  re- 
sults are  the  following  :  General  "  nervous- 
ness," nervous  'headache,  nervous  irritative 
cough,  colic,  hysterical  manifestations,  and 
other  similar  affections  in  which  an  antispas- 
modic is  indicated ;  that  they  will  be  found 
useful  as  a  cerebral  stimulant  in  neurasthenia 
and  in  depressed  conditions  of  the  mind — 
hypochondriasis,  melancholia,  and  allied  con- 
ditions—as a  substitute  for  opium  and  chloral 
in  conditions  of  great  nervous  irritahility  or 
restlessness,  in  active  delirium  and  mania,  and 
in  insomnia  caused  by  pain.  In  the  last  con- 
dition, they  remark,  it  acts  to  produce  sleep, 
not  as  a  hypnotic,  but  by  relieving  the  cause 
of  the  insomnia.     In  full  physiological  doses 


417 


AN^STILB 
APOMORPHINE 


it  produces  insomnia,  but  in  therapeutic  doses 
it  does  not  have  this  effect. 

Prentiss  and  Morgan  give  the  dose  of  an- 
halonium  in  substance  as  from  7  to  15  grains ; 
that  of  a  10-per-cent.  tincture  as  from  1  to  3 
teaspoonfuls;  and  that  of  a  fluid  extract  as 
from  7  to  15  drops. 

Dr.  D.  A.  Richardson,  of  Denver  {New  York 
Medical  Journal,  August  8,  1896).  reports  a 
case  of  occipital  and  frontal  cephalalgia  in 
which  the  attacks  were  kept  in  abeyance  by 
nightly  doses  of  4  drops  of  the  tincture.  In 
that  case  these  small  doses  seemed  to  Dr. 
Richardson  to  have  a  decided  diuretic  action, 
and  he  suggests  that  anhalonium  may  act  as  a 
solvent  of  uric  acid. 

One  of  the  alkaloids  of  anhalonium,  aiihalo- 
nine,  has  been  recommended  as  a  cardiac  and 
respiratory  stimulant  in  the  treatment  of  an- 
gina pectoris  and  asthma,  but  clinical  data  are 
thus  far  insufficient  to  warrant  its  use  in  prac- 
tice. Not  even  the  dose  is  stated  in  the  few 
publications  accessible  in  which  it  is  men- 
tioned. 

ANHYDBOGLTJCOCHLORAL.  —   See 

Chloralosb. 

ANTINOSINE.— This  is  a  compound  of 
sodium  and  nosophene,  used  for  the  same  pur- 
poses as  nosophene. 

ANTIPYKINE  MANDELATE,  AN- 
TIPYBINE     PHENYLGLYCOLATE.— 

See  Tdssol. 

ANTIPYBINE    SALICYLATE.  —  See 

Salipyeine. 

ANTISTREPTOCOCCIC  SEBUM,  AN- 
TISTEEPTOCOCCIN,  ANTISTREPTO- 
COCCTJS  SERUM. —  See  under  Serum 
TREATMENT  (vol.  ii,  page  178). 

ANTIVENENE.  —  See  under  Serum 
TREATMENT  (vol.  ii.  page  188). . 

APENTA  WATER.— This  is  a  Hunyadi 
water,  formerly  known  as  Rakoczy  water,  that 
has  recently  appeared  on  the  market.  It  is 
particularly  rich  in  magnesium  sulphate,  and 
is  a  valuable  purgative, 

APOLYSINE.— De  Nencki  and  de  Jawor- 
ski  (Presse  medicate,  October  26,  1895 ;  Jtfew 
York  Medical  Journal,  November  30,  1895) 
describe  this  as  a  yellowish-white  crystalline 
powder  of  a  sour  taste,  less  acid  than  citric 
acid,  and  of  a  specific  odour.  It  is  soluble  in 
cold  wa'.er  in  the  proportion  of  one  in  twenty- 
five,  and  quite  soluble  in  boiling  water.  It 
melts  at  a  temperature  of  161-3°  F.  It  is  easily 
dissolved  both  in  alcohol  and  in  cold  glycerin. 
In  its  origin  apolysine  may  be  compared  to 
phenacetine.  Both  compounds  spring  from 
paraphenetidine,  and  there  is  no  difference  be- 
tween them,  except  that  an  atom  of  hydrogen 
in  phenacetine,  in  the  amide  group  (NHa),  is 
replaced  by  the  element  of  acetic  acid,  while 
in  apolysine  the  same  atom  of  hydrogen  is 
replaced  by  the  citric-acid  nucleus.  On  com- 
paring the  chemical  formulas  of  these'  combi- 
nations, their  origin,  their  formation,  and  their 
difference  may  be  more  readily  understood. 
They  show  that  apolysine  is  very  closely  allied 
to  phenacetine. 


Apolysine,  according  to  the  authors,  pos- 
sesses remarkable  antipyretic  and  analgetic 
properties.  They  administered  the  drug  both 
as  an  antipyretic  and  analgetic  and  as  an  anti- 
pyretic only.  They  employed  it  in  many 
cases,  and  in  the  febrile  affections  a  lowering 
of  the  temperature  of  from  one  to  two  degrees 
was  observed,  which  was  maintained  tor  three 
or  four  hours  at  a  time.  In  painful  affections, 
such  as  neuralgia,  etc.,  the  pain  disappeared 
rapidly  after  the  administration  of  a  few 
doses,  which  varied  from  8  to  45  grains  once  a 
day.  The  authors  state  that  in  many  of  these 
cases  other  analgetics  had  been  used  previous- 
ly without  success. 

Their  clinical  observations  have  led  them  to 
the  following  conclusions :  1.  Apolysine  ad- 
ministered to  fever  patients  lowers  the  tem- 
perature and  at  the  same  time  prevents  a  series 
of  coexisting  symptoms,  particularly  pain.  3. 
Given  to  patients  suffering  from  neuralgia, 
etc.,  it  diminishes  the  violence  of  the  pain, 
allays  hypersesthesia,  shortens  the  duration  of 
the  attack,  and  often  completely  suppresses 
the  symptoms.  3.  Owing  to  its  chemical  prop- 
erties, it  acts  promptly  and  regularly,  and 
exercises  no  injurious  effect  on  the  organism. 
Its  employment  is  contra-indicated  during  fast- 
ing and  when  there  are  excessive  acid  secre- 
tions in  the  stomach.  4.  Finally,  apolysine  is 
more  soluble  than  other  drugs  in  the  same 
group,  and  consequently  more  promptly  and 
more  easily  absorbed. 

Dr.  David  Cerna,  of  Galveston  {Journal 
of  the  American  Medical  Association,  June 
20,  1896),  who  gives  the  following  formula  of 
apolysine : 

OCjHs 
C,H,<        H  OH 

N<  — C<         — CH,COOH, 

COCHj  COOH 

has  verified  some  of  de  Nencki  and  de  Jawor- 
ski's  statements  in  experiments  on  animals,  and 
has  found  apolysine  a  prompt  and  efficient 
remedy  in  a  case  of  lumbago,  and  in  one  of 
muscular  rheumatism.  The  dosb  for  an  adult 
is  from  15  to  30  grains.  Although  apolysine 
has  been  said  not  to  be  poisonous,  Dr.  Cerna 
has  known  it  to  kill  an  animal,  and  he  gives  a 
warning  against  its  routine  and  indiscriminate 
employment. 

APOMORPHINE.— Mr.  Edward  Balm,  of 
Hyderabad  {Indian  Medical  Record,  July  1, 
1895),  has  found  apomorphine  of  great  value 
as  an  antispasmodic.  He  says  that  in  the  Af- 
zulgunj  Hospital,  Hyderabad',  Dr.  Lawrie  used 
it  in  the  treatment  of  tetanus  on  the  sugges- 
tion of  Dr.  Bomford,  of  Calcutta,  in  doses  of 
from  tV  to  i  of  a  grain  hypodermically  twice 
or  three  times  a  day,  and  the  results  were  not 
disappointing.  When,  in  1894,  Mr.  Balm  took 
charge  of  the  hospital,  he  had  a  unique  and 
distressing  case  of  hiccough  in  a  man  fifty 
years  old.  He  had  suffered  from  it  for  about 
six  months,  and  the  acts  numbered  from  30  to 
40  a  minute.  He  had  been  a  well-built  man, 
but  was  reduced  to  a  skeleton,  and  the  sight 
of  food  was  most  loathsome  to  him.  He  had 
tried  a  lot  of  native  medicines  without  any  re- 


ARACHIS  HYPOG^A 
BATHS 


418 


lief,  and  Mr.  Balm's  predecessor  had  prescribed 
for  him  almost  all  the  drugs  of  the  pharmaco- 
poeia without  the  slightest  good.  Mr.  Balm 
subsequently  tried  atropine,  morphine  by  the 
mouth  and  subcutaneously,  bromide  of  potas- 
sium, camphor,  chloroform,  emetics,  a  mustard 
plaster  over  the  region  of  the  diaphragm,  and  a 
host  of  other  measures  without  the  least  good. 
He  then  gave  him  J  of  a  grain  of  apomorphine 
dissolved  in  107  parts  of  water  hypodermicaily. 
In  less  than  three  minutes  the  symptom  sub- 
sided, and  in  five  minutes  more  he  vomited. 
He  was  not  troubled  with  the  symptom  for 
two  days,  but  on  the  third  day  he  came  again 
to  the  hospital  with  it,  but  it  was  less  trouble- 
some than  before.  Mr.  Balm  gave  him  J  of  a 
grain  of  apomorphine  more,  hypodermicaily. 
The  symptom  subsided  in  about  the  same  time 
as  before  and  there  were  retching  and  vomit- 
ing for  the  whole  day,  but  the  hiccough  never 
recurred.  Mr.  Balm  has  also  tried  apomor- 
phine in  a  very  bad  case  of  hysteria,  in  a 
young  woman,  that  had  defied  every  other 
treatment,  also  in  cases  of  asthma,  and  in 
all  these  instances  it  afforded  temporary  re- 
lief. 

ARACHIS  HYPOG-ffiA.— Dr.  Heinrich 
Stern  (Food  and  Sanitation,  August  17,  1895 ; 
New  York  Medical  Journal,  September  14, 
1895)  has  employed  peanut  meal  as  the  chief 
constituent  of  a  bread  for  persons  with  dia- 
betes. Peanut  meal,  he  says,  is  the  residue 
left  after  the  oil  has  been  expressed.  He  has 
devised  the  following  method  for  preparing 
peanut  flour  in  the  household :  Tlie  peanut 
kernels,  including  their  inner  coating,  which 
is  also  nutritious  and  not  very  rich  in  car- 
bohydrates, are  put  into  a  tin  kettle  in  which 
small  holes  have  been  previously  made.  This 
is  kept  uncovered  and  placed  on  or  in  a  pan 
filled  with  water,  and  this  has  to  be  kept  boil- 
ing for  about  half  an  hour  to  allow  of  par- 
tial extraction  of  the  superfluous  oil.  After 
the  kernels  have  been  dried  they  are  pounded 
into  fine  particles  with  the  aid  of  a  rolling  pin. 
The  pounded  or  bruised  kernels  are  then 
placed  in  boiling  water  acidulated  to  some  de- 
gree with  tartaric  acid  or  vinegar,  preferably 
with  the  latter.  The  boiling  in  the  acidulated 
water  has  to  be  continued  for  some  time  for 
different  reasons :  For  the  extraction  of  sac- 
charine elements,  which  occur  to  some  amount 
in  nuts  of  American  growth  ;  to  overcome  the 
smell  and  taste  characteristic  of  the  peanut ; 
and  to  prevent  emulsifioation  of  the  remain- 
ing oil,  which,  to  some  degree,  is  essential  to  a 
rational  diabetic  food,  as  fats  must  supply  the 
deficiency  of  the  carbohydrate  elements.  It  is 
true,  says  Dr.  Stern,  that  a  partial  emulsifioa- 
tion of  the  oil  might  relieve  the  pancreatic 
juice  of  some  work,  and  this  might  be  espe- 
cially beneficial  in  grave  cases  of  diabetes  mel- 
litus  in  which  the  pancreas  seems  to  be 
involved,  but  he  leaves  it  to  future  investiga- 
tion to  determine  whether  the  oil  in  peanut 
flour  shall  be  introduced  in  its  natural  state 
into  the  alimentary  tract  or  in  the  form  of  a 
partial  or  complete  emulsion. 

Having  undergone  a  thorough  boiling  with 


acidulated  water,  the  ground  kernels  are  sub- 
jected to  dry  heat,  to  effect  complete  evapora- 
tion of  that  fluid ;  but  great  care  must  be 
exercised,  says  Dr.  Stern,  that  they  do  not  be- 
come browned  or  roasted.  An  additional 
treatment  with  the  rolling  pin,  he  says,  will 
produce  nearly  as  fine  a  fiour  as  the  common 
wheat  flour  of  commerce.  Prom  30  to  40 
per  cent,  of  the  oil,  he  says,  is  necessary 
for  a  complete  and  rational  diabetic  food. 
More  iiydrocarbons  are  not  required  and  would 
interfere  with  digestion.  It  is  not  possible  to 
control  the  amount  of  oil  expressed  by  the  do- 
mestic process  and  to  determine  its  percentage 
with  any  degree  of  certainty ;  if  the  flour  is 
manufactured  in  mills,  however,  this  could  be 
readily  controlled  and  ascertained. 

Dr.  Stern  has  made  use  of  the  flour  in  dif- 
ferent ways,  the  simplest  of  which  is  that  of 
giving  it  in  the  form  of  a  porridge,  some  milk 
being  added  to  it.  Bread  and  biscuits  can  also 
be  made  from  it,  but  the  most  agreeable  and 
most  easily  digestible  form  in  which  to  use  it 
is,  he  thinks,  the  German  pancake.  He  has 
used  this  flour  with  four  diabetics,  and  a  num- 
ber of  other  patients.  In  the  non-diabetic 
cases,  mostly  tuberculous  in  character,  he  ob- 
tained satisfactory  results,  inasmuch  as  diges- 
tion was  not  to  any  extent  taxed,  and  in  some 
cases  the  weight  of  the  patient  did  not  de- 
crease, while  in  one  instance  there  was  actual 
gain  in  weight  noticed.  With  the  first  dia- 
betic patient  to  whom  he  recommended  the 
fiour  its  use  was  a  complete  failure  at  first, 
as  the  digestion  became  very  much  impaired, 
thereby  aggravating  the  general  condition  of 
the  patient,  an  old  man.  A  more  careful  and 
rational  preparation  of  the  flour,  however,  and 
the  employment  of  smaller  quantities  when 
starting  with  it,  increased  its  digestibility,  and 
at  the  time  of  Dr.  Stern's  writing  this  patient 
enjoyed,  as  far  as  circumstances  permitted,  a 
comfortable  state  of  health.  The  three  other 
patients  were  also  thriving  well  on  this  flour, 
the  German  pancake  being  the  usual  form  in 
which  they  employed  it.  In  conjunction  with 
eatables  made  of  this  flour,  Dr.  Stern  allowed 
those  patients  only  such  food  stuffs  as  are  gen- 
erally recognised  as  permissible  in  diabetes 
mellitus.  He  has  done  this,  he  says,  not  be- 
cause he  is  a  believer  in  the  complete  exclusion 
of  carbohydrates  in  diabetes  (for  he  says  that 
fats  and  even  nitrogenous  substances  are  capable 
of  producing  glycogen),  but  to  investigate  the 
intrinsic  value  of  peanut  flour  as  a  food,  and 
its  ability  to  reduce  the  glycogenic  sugar  of 
the  urine. 

ABGONIN.— See  under  Silver  (vol.  ii, 
page  197). 

ASBESTOS.— A  Moscow  surgeon.  Dr.  Vo- 
lintzefi  (Gazette  des  hopitaux ;  Union  mSdi- 
cale,  July  18,  1896),  remarks  that  the  density 
of  this  material  is  much  greater  than  that  of 
cotton  or  of  tarlatan ;  it  is  less  porous  than 
either  of  them  and  less  hygroscopic.  The 
escape  of  vapours  takes  place  more  slowly 
under  a  dressing  of  asbestos  than  under  any 
other.  It  is  not  so  good  a  conductor  of  heat 
as  cotton  is,  but  on  this  point,  says  the  writer, 


419 


ARACHIS  HYPOG^A 
BATHS 


the  results  of  the  investigation  are  not  yet 
perfectly  satisfactory.  Asbestos,  he  says,  ab- 
sorbs the  albuminoid  secretions  better  than 
absorbent  cotton  or  tarlatan  does.  In  regard 
to  clinical  observations.  Dr.  Volintzeff  thinks 
they  are  yet  too  small  in  number  to  enable  him 
to  give  a  definitive  judgment.  Asbestos  is  not 
expensive,  he  remarks,  because  it  may  be  used 
several  times. 

Dr.  B.  O'N.  Kane,  of  Kane,  Pennsylvania 
(Medical  Record,  February  18,  1896),  recom- 
mends asbestos  as  a  useful  substance  for  sur- 
gical dressings.  These  dressings,  he  says,  may 
be  handled  by  dirty  hands  or  spattered  with 
blood  or  any  sort  of  filth,  and  yet  can  be 
rendered  absolutely  aseptic  in  less  than  two 
minutes  by  tossing  them  upon  the  coals  or 
into  the  blaze  of  an  ordinary  kitchen  stove. 
However,  repeated  burnings,  he  says,  seem  to 
injure  the  quality  of  the  material  some-what. 
The  form  of  asbestos  most  used  is  the  asbestos 
fibre  ;  it  is  as  soft  as  silk  floss,  and  its  absorbent 
qualities  are  greater  than  those  of  absorbent 
cotton.  Asbestos  wicking,  packing,  and  cord- 
ing are  adapted  for  drainage  tubes. 

ATBOFINE. — Aubert  (Lyon  medical,  Jan- 
uary 3,  1897;  New  York  Medical  Journal, 
January  33,  1897)  calls  attention  to  the  effi- 
ciency of  atropine  in  the  correction  of  several 
inconveniences  caused  by  quinine.  Among 
the  symptoms  which  are  produced  by  the  ad- 
ministration of  quinine,  even  in  doses  of  from 
C  to  8  grains,  the  most  frequent  are  buzzing 
and  ringing  in  the  ears,  a  sound  like  that  of 
rushing  water,  deafness,  vertigo,  and  head- 
ache. In  certain  eases  these  symptoms  are 
rather  accentuated,  and  the  patients  refuse  to 
continue  the  use  of  the  quinine. 

]\1.  Aubert  relates  the  histories  of  three  cases 
of  neuralgia  in  which  he  was  able  to  attenuate 
to  a  very  great  degree,  and  even  to  suppress, 
these  disagreeable  symptoms  by  the  addition 
of  a  small  dose  of  atropine  sulphate.  Prom  5 
to  7  grains  of  quinine  were  given  at  a  time, 
and  to  each  dose  the  author  added  0'007  of  a 
grain  of  atropine  sulphate.  In  one  case  this 
prevented  the  disagreeable  symptoms,  and  in 
the  two  others  greatly  moderated  them.  The 
periodical  pains  were  allayed,  and  no  appre- 
ciable symptom  of  atropinism  was  experienced. 
He  states  that  he  has  not  had  occasion  to  use 
larger  doses  of  quinine,  and  does  not  know 
what  the  results  would  be  with  larger  quanti- 
ties. He  is  not  aware  that  atropine  has  before 
been  employed  for  the  purpose  of  mitigating  the 
disagreeable  symptoms  provoked  by  quinine. 


BATHS.^Under  this  heading  it  is  proper 
to  class  what  is  known  as  the  Schott  treat- 
ment of  diseases  of  the  heart  practised  at  the 
baths  of  Nauheim,  at  the  foot  of  the  eastern 
end  of  the  Taunus  range  of  mountains.  An 
excellent  account  of  the  place  and  of  the  treat- 
ment has  been  given  by  Dr.  William  C.  Eives, 
lecturer  on  diseases  of  the  chest  and  on  gen- 
eral medicine  in  the  New  York  Polyclinic 
(New  York  Medical  Journal,  April  ll,'l896). 
The  hotels,  says  Dr.  Eives,  furnish  good  ac- 
commodation, and  are  most  of  them  provided 
with  lifts,  a  matter  of  much  importance  for 
heart  patients.  They  are  apt  to  be  very  full 
in  the  height  of  the  season,  and  it  is  almost 
impossible  to  obtain  rooms  at  the  Kaiserhof  in 
particular,  which  at  the  time  of  Dr.  Rives's 
writing  was  being  altered  and  enlarged,  with- 
out securing  them  weeks  or  even  months 
beforehand.  The  villas,  which  are  very  nu- 
merous and  usually  stand  in  the  midst  of  small 
grounds,  are  large,  spacious,  and  well  man- 
aged ;  the  food  and  cooking  are  essentially 
German  in  character.  Arranf;ements  should 
be  made  beforehand  as  to  whether  board  is  to 
be  provided  or  not,  as  many  will  prefer  to 
take  one  at  least  of  their  meals  at  one  of  the 
hotels.  Rolling  chairs  are  to  be  hired  by  the 
week  at  reasonable  prices,  as  well  as  attend- 
ants to  push  them. 

All  ordinary  articles  likely  to  be  needed  can 
be  obtained  in  the  town  ;  others  can  bo  quickly 
sent  from  Frankfort.  The  summer  climate  of 
Nauheim,  like  that  of  the  other  Taunus  re- 
sorts, is  somewhat  changeable,  often  cold  and 
rainy,  but  seldom  oppressively  hot.  The  soil 
is  good,  and  the  position  of  the  town  favour- 
able for  health. 

The  place  is  furnished  with  a  water  supply 
and  a  system  of  drainage  said  to  be  good,  but 
the  sanitary  conditions  are  probably  suscepti- 
ble of  some  further  improvement.  Although 
the  surrounding  country  is  less  attractive  than 
at  many  other  resorts,  there  are  walks,  drives, 
and  excursions  of  much  interest  for  those  who 
are  able  to  undertake  them.  The  Kurhaus  is 
large  and  handsome,  and  furnishes  the  usual 
means  of  recreation.  Subscriptions  have  been 
already  taken  for  an  English  church,  and  a 
piece  of  land  secured  upon  which  one  will 
probably  soon  be  built.  The  regular  season  at 
Nauheim  lasts  from  the  1st  of  May  to  the  end 
of  September,  but  the  bath  houses  are  open 
also  in  April  and  October. 

The  following  table,  showing  the  composi- 
tion of  the  waters,  is  taken  from  Eulenburg's 
Real-Encyclopddie  der  gesammten  Heilkunde : 


Kriedrich  Wil- 
helmsqaelle. 

Grosser  Sprudel. 

Cnrbrunnen. 

Cariabmnnen. 

Sodium  chloride                     ...          ....        .... 

Parts  In  1,000. 

89-894 
1-119 
3-324 
0-525 
0-035 
2-601 
0-048 

Farts  in  1,000. 
21-824 
0-497 
1-700 
0-440 
0-034 
8-354 
0-038 

Faits  in  1,000. 
15-421 
0-587 
1-034 
0-738 
0-083 
1-146 
0-026 

Parts  In  1,000. 
9  860 

0  078 

Calcium  chloride 

1-057 

Magnesium  chloride        

0-804 

0-227 

Calcium  carbonate 

0-951 

Iron  carbonate ....        ....                            

0-014 

Total  solids 

35-357 
578-93 
95  ST. 

86-353 
718-65 
88-8°  F. 

18-682 
995-22 
70-5'-  F. 

12-119 

720-93 

BATHS 


420 


In  the  midst  of  the  park,  near  the  banks  of 
the  little  river  Ursa,  says  Dr.  Rives,  burst 
forth  the  springs  that  supply  the  bath  houses 
on  which  the  fame  of  2Slauheira  depends. 
These  oome  from  a  great  depth  (five  hundred 
and  twenty-three  and  five  hundred  and  ninety 
feet),  and  were  found  by  means  of  borings 
made  at  difllerent  times  in  the  course  of  this 
century.  The  two  now  in  use — No.  7,  the 
Grosser  Sprudel,  and  No.  13,  the  Priedrich 
Wilhelmsquelle  (the  figures  being  used  to  des- 
ignate the  number  of  the  boring) — spout  forth 
as  white  foaming  liquids,  only  thirty-two  feet 
apart,  high  above  the  surface  of  the  ground, 
and  are  connected  with  five  bath  houses, 
four  in  the  immediate  neighbourhood,  and  a 
fifth  (bath  house  No.  4)  which  provides  only 
simple  saline  baths  from  spring  No.  7  out- 
side the  park  at  a  little  distance  from  the 
others. 

At  the  present  time  there  are  in  the  whole 
establishment  at  Nauheira  a  hundred  and 
ninety-six  bathrooms  with  two  hundred  and 
four  tubs.  The  tubs  are  of  wood,  painted, 
which  has  been  found  to  be  the  most  satisfac- 
tory material,  and  are  of  large  size,  so  that 
when  a  tub  is  filled  the  body  of  the  bather  is 
entireJy  immersed  up  to  the  neck,  and  the 
pressure  of  the  water  on  its  surface  is  very 
considerable.  Everything  connected  with  the 
baths,  which  are  under  government  control,  is 
admirably  systematized,  and  the  attendants 
are  well  fitted  by  long  experience  for  the  dis- 
charge of  their  duties. 

Drinking  the  waters,  says  Dr.  Rives,  plays 
but  a  secondary  part  at  Nauheim,  but  their 
internal  use  is  of  some  value  in  gouty  condi- 
tions and  disorders  of  the  liver,  and  the  Cur- 
brunnen  water,  diluted,  is  said  to  resemble 
that  of  the  Ragoczy  spring  of  Kissingen,  and 
the  Carlsbrunnen,  the  Elizabeth-Brunnen  of 
Homburg.  The  Ludwigsbrunnen  is  also  used 
as  a  table  water.  The  Schwalheim  spring,  two 
miles  distant,  yields  a  ferruginous  water  con- 
taining carbonic  acid. 

The  first  bath  house  at  Nauheim,  according 
to  Dr.  Rives,  was  opened  in  183o,  and  the 
baths  have  been  used  for  many  years  with  ad- 
vantage in  gotit,  rheumatism,  rickets,  and  so- 
called  scrofulous  diseases,  and  have  acquired 
a  well-merited  repute  in  the  treatment  of  lo- 
comotor ataxia  and  other  diseases  of  the  spinal 
cord.  Professor  F.  W".  Beneke,  of  Marburg, 
was  the  first  to  show,  contrary  to  the  views 
then  prevailing,  not  only  that  patients  with 
heart  disease,  more  especially  those  recovering 
from  acute  rheumatism,  could  bear  balneo- 
logical treatment,  but  that  they  were  actually 
benefited  by  such  a  course.  Beneke,  who  was 
physician  to  the  Nauheim  baths  from  18.57  to 
1866,  and  continued  to  visit  them  up  to  his 
death,  in  1883,  wrote  several  articles  upon  the 
effects  he  had  observed  there,  the  earliest  of 
which  appeared  in  1859.  After  the  publica- 
tion of  his  more  important  work,  Zur  Thera- 
pie  des  Oelcnkrheumatismus  und  der  ihm 
verbundenen  Merzkrankheiten,  in  1873,  patients 
with  heart  disease  began  to  frequent  Nauheira 
in  greater  numbers,  and,  on  the  lines  of  inves- 
tigation suggested   by  his   observations,   the 


baths  began  to  be  studied   more  closely  by 
other  physicians. 

In  1880  Dr.  August  Schott,  who  had  been 
making  independent  studies  since  1871,  pub- 
lished a  paper  (Berliner  klinische  Wochen- 
schrift,  1880,  No.  30)  by  far  the  most  important 
and  exhaustive  of  any  that  had  yet  appeared, 
and  the  first  to  do  full  justice  to  the  remark- 
able effect  of  the  baths  upon  the  heart.  Nu- 
merous articles  relating  to  the  same  and  allied 
subjects  have  since  been  written  by  himself 
and  his  brother.  Dr.  Theodor  Schott,  and  to 
their  joint  labours  the  present  celebrity  of 
Nauheim  is  largely  due. 

Within  the  last  ten  years  the  annual  num- 
ber of  visitors  during  the  season,  a  large  pro- 
portion of  whom  are  heart  patients,  has  more 
than  doubled,  amounting  to  over  twelve  thou- 
sand in  1895. 

The  foregoing  is  substantially  in  Dr.  Rives's 
own  words.  He  describes  the  effect  of  the 
baths  as  that  of  regulating  the  action  and 
strengthening  and  improving  the  nutrition 
of  the  diseased  heart,  whether  its  inability  to 
perform  its  functions  properly  depends  upon 
valvular  lesions  and  their  consequences  or  upon 
malnutrition  or  disease  of  the  cardiac  muscu- 
lar substance.  These  results,  he  says,  are 
chiefly  due  to  the  chloride  of  sodium,  to  the 
more  irritating  chloride  of  calcium,  and  to  the 
free  carbonic  acid  which  these  waters  are  said 
to  contain  in  larger  amount  than  almost  any 
other  baths  in  Germany.  They  contain,  more- 
over, a  considerable  percentage  of  iron,  to 
which  may  also  be  attributed  a  tonic  influence. 
The  most  powerful  though  more  temporary 
stimulation,  as  proved  experimentally,  is  caused 
by  the  carbonic  acid.  By  means  of  the  action 
of  these  saline  and  gaseous  contents  of  the 
bath  upon  the  terminal  branches  of  the  sen- 
sory nerves  of  the  skin  an  impression  is  made 
upon  the  cardiac  and  vaso-motor  centres  by 
which  the  heart  is  stimulated  in  a  reflex  way 
to  more  powerful  and  vigorous  contraction 
and  the  arteries  are  more  completely  filled,  and 
at  the  same  time  the  cutaneous  vessels  dilate, 
peripheral  resistance  is  lessened,  and  the  whole 
circulation  is  rendered  freer  and  more  active, 
while  metabolism  is  promoted  and  a  marked 
influence  exerted  upon  the  trophic  centres,  as 
must  be  inferred  from  the  striking  evidences 
of  improvement  in  the  bodily  nutrition  in 
general,  and  in  that  of  the  heart  in  carticular, 
and  the  persistence  and  even  increase  of  the 
good  effects  long  after  the  patient  has  com- 
pleted the  course. 

The  immediate  objective  results  of  the  baths 
are  stated  by  Dr.  Rives  as  follows:  "Exami- 
nation of  the  pulse,  confirmed  by  sphygmo- 
graphie  tracings  and  the  sphygmomanometer, 
shows  it  to  be  made  slower,"stronger,  and  of 
increased  volume,  the  cardiac  sounds  become 
more  distinct,  and  in  cases  of  dilatation  an 
unmistakable  contraction  of  the  heart,  demon- 
stra,ble  by  percussion  and  by  the  change  in  the 
position  of  the  apex  beat,  is  observed.  This 
contraction  is  most  noticeable  in  the  transverse 
diameter  of  the  heart,  and  takes  place  to  little 
or  no  extent  when  the  enlargement  is  solely 
compensatory,  as  in  many  cases  of  organic 


421 


BATHS 


mitral  and  aortic  regurgitation.  Dr.  Bezly 
Thoriie,  however,  affirms  that  there  is  a  diminu- 
tion in  the  area  of  cardiac  dulness,  as  measured 
in  the  oblique  transverse  diameter,  of  a  third 
to  about  half  an  inch  even  in  the  healthy 
heart.  The  respiration  becomes  easy,  and  is 
slower  and  deeper,  and  there  is  usually  in- 
creased action  of  the  kidneys.  Subjectively,  a 
sense  of  weight  and  oppression  on  the  chest, 
greater  than  in  an  ordinary  bath,  is  at  first  ex- 
perienced, which  quickly  passes  ofE ;  the  skin 
soon  becomes  warm,  and  tingling,  accompanied 
with  redness,  is  felt  in  its  more  sensitive  parts. 
Afterward,  the  patient  feels  invigorated,  and 
is  generally  conscious  of  a  sense  of  drowsiness." 

Dr.  Robert  H.  Baboock,  of  Chicago,  in  a 
paper  read  before  the  Mississippi  Valley  Medi- 
cal Association  (Journal  of  the  American  Medi- 
cal Association,  November  11,  1893),  says  that 
during  the  baths  there  is  a  slowing  of  the 
pulse  with  increased  volume  and  strength,  and 
irregularity,  if  any  exists,  is  lessened  or  disap- 
pears. The  cardiac  contractions  are  increased 
in  vigour  and  the  cavities  better  emptied,  thus 
permitting  of  a  diminution  in  the  size  of  a 
dilated  heart.  This  marked  and  beneficial 
effect  on  the  action  of  the  heart  does  not  ap- 
pear at  once,  but  persists  for  a  considerable 
time  subsequent  to  the  baths.  If  properly  ad- 
ministered, says  Dr.  Babcock,  the  baths  occa- 
sion a  gradual  and  perceptible  amelioration  of 
the  symptoms.  During  the  gymnastics  the 
rate  of  the  pulse  falls  and  the  volume  and 
strength  are  increased. 

While  Oertel's  method  is  limited  to  cases  of 
heart  disease  in  which  compensation  has  not 
been  lost,  the  Schott  method,  says  Dr.  Bab- 
cock, is  applicable  to  a  greater  variety  of  cases, 
and,  as  the  treatment  can  be  carried  out  in 
this  country  by  artificially  prepared  baths  and 
the  gymnastics,  it  seems  that  by  careful  selec- 
tion patients  subjected  to  this  treatment  may 
be  greatly  benefited. 

In  a  subsequent  communication,  read  before 
the  American  Climatological  Association  (New 
York  Medical  Journal,  December  8,  1894),  Dr. 
Babcock  says  that  the  baths  owe  their  elBcacy 
chiefly  to  free  carbonic  acid,  sodium  chloride, 
and  calcium  chloride,  for  the  other  saline  in- 
gredients are  present  in  amounts  too  small  to 
lend  more  than  feeble  aid  to  those  named. 
The  next  important  feature  of  the  baths,  he 
says,  is  their  temperature.  "Warm  baths  are 
debilitating,  and  exert  a  decided  weakening 
effect  on  the  heart  even  in  health ;  so  they 
are  recognised  as  inadmissible  in  the  treat- 
ment of  disease  of  the  heart.  The  tempera- 
ture of  the  Nauheim  baths  ranges  between  92° 
or  93°  P.  at  first  and  87°  or  a  little  lower 
toward  the  end  of  a  course  of  treatment.  At 
these  temperatures,  says  Dr.  Babcock,  baths 
are  cool,  and  even  at  93°  P.  they  impart  a  dis- 
tinct feeling  of  chilliness  to  the  patients  as 
they  enter  them. 

The  duration  of  each  bath  is  limited,  and  is 
increased  cautiously  with  the  progress  of  the 
treatment  and  improvement  of  the  patient's 
condition.  Prom  five  or  eight  minutes  as  the 
initial  limit,  the  baths  gradually  reach  a  dura- 
tion of  twenty  minutes. 


If  the  pulse  is  watched  during  the  bath,  it 
will  be  found  to  become  slower,  fuller,  and 
stronger,  and  if  it  was  irregular  in  rhythm  be- 
fore, it  is  likely  to  improve  even  to  the  extent 
of  attaining  perfect  regularity.  Efforts  on  the 
part  of  the  bather — such  as  speaking,  forced 
breathing,  moving  about,  etc. — generally  occa- 
sion temporary  irregularity  and  acceleration 
of  the  pulse.  The  respirations  are  generally 
slow  and  deep,  partly  in  consequence  of  a  feel- 
ing of  oppression  of  the  chest  experienced  by 
most  individuals.  This  sensation  of  weight  is 
not  complained  of  by  all  in  equal  degree,  how- 
ever, and  it  'is  usually  lost  after  a  iew  baths. 
The  improvement  in  the  rate  and  quality  of 
the  pulse  is  an  index  of  the  degree  of  benefit 
derived  by  the  patient.  If  not  counteracted 
by  exercise,  this  effect  on  the  pulse  will  persist 
for  an  hour  or  two  subsequently.  Changes  for 
the  better  in  the  size  of  the  area  of  cardiac 
dulness  and  in  the  sounds  may  be  noted  like-  ' 
wise.  This  has  been  demonstrated  repeatedly, 
says  Dr.  Babcock,  both  on  himself  by  a  com- 
petent Russian  physician  and  by  himself  on 
others.  Careful  percussion  immediately  before 
and  after  a  bath  of  from  eighteen  to  twenty 
minutes'  duration  showed  a  demonstrable  re- 
traction of  the  deep  limits  of  cardiac  dulness, 
and  the  heart  sounds  were  improved  in  strength, 
the  second  pulmonary  being  less  accentuated, 
the  second  aortic  stronger,  the  abnormal  differ- 
ence between  the  two  sounds  before  being  ap- 
preciably less  marked  after  the  bath.  Murmurs 
that  are  almost  inaudible  before  become  in- 
tensified ;  and,  conversely,  some  loud  bruits 
are  lessened  in  intensity. 

In  short,  so  far  as  can  be  determined  by 
physical  examination,  these  baths  appear  to 
lessen  the  rapidity  and  increase  the  force  of 
the  heart's  contractions,  thereby  occasioning  a 
better  filling  of  the  great  arterial  system  with 
corresponding  depletion  of  the  engorged  veins. 
This  is  borne  out  by  experiments  on  animals 
conducted  by  Dr.  August  Schott,  which  demon- 
strated, by  means  of  a  mercurial  manometer 
placed  in  the  trachea,  that  a  rise  of  arterial 
pressure  was  the  result  of  nearly  complete  im- 
mersion in  a  saline  solution.  In  this  respect, 
therefore,  the  effect  of  these  baths  is  similar 
to  that  following  the  administration  of  digi- 
talis :  both  lengthen  diastole  and  augment  the 
force  of  systole.  In  addition,  digitalis  exerts 
a  powerful  influence  as  a  vaso-motor  constric- 
tor, which  action  sometimes  offsets  its  bene- 
ficial effect  on  the  heart.  This  action  on  the 
vascular  system  is  felt  by  all  the  arteries  alike. 
Herein,  it  seems  to  Dr.  Babcock,  lies  the  differ- 
ence between  the  effect  produced  by  digitalis 
and  that  exerted  by  these  baths.  Experiments 
have  demonstrated  that  the  contraction  of 
cutaneous  vessels  effected  by  cold  baths  occa- 
sions at  first  increase  of  blood-pressure  and  of 
the  frequency  and  strength  of  the  heart's  con- 
tractions, hut  that  later  on  the  acceleration 
gives  place  to  a  retardation  of  the  rate.  The 
pulse,  therefore,  becomes  slower  and  stronger 
during  a  cold  bath,  provided  this  is  not  con- 
tinued until  vaso-motor  paresis  sets  in.  Thus 
far  a  cold  bath  of  moderate  duration  affects 
the  heart  in  its  contractions  in  the  same  way 


BATHS 


423 


as  digitalis,  although  the  mechanism  by  which 
this  result  is  accomplished  differs. 

On  the  other  hand,  says  Dr.  Baboock,  Schiller 
has  shown  that  the  application  of  cold  to  the 
abdomen — that  is,  contraction  of  the  cutaneous 
vessels  of  the  abdomen— is  followed  by  prompt 
dilatation  of  the  vessels  of  the  pia  mater; 
whereas  heat  applied  to  the  abdomen  is  suc- 
ceeded by  constriction  of  the  vessels  of  the 
pia  mater.  Prom  these  experiments  it  is 
probable  that  the  effect  of  a  cold  bath  is  not 
to  cause  contraction  of  internal  as  well  as  of 
cutaneous  vessels,  but  that  a  cold  bath  is  fol- 
lowed by  dilatation  of  internal  vessels.  In 
short,  during  and  after  a  cold  bath  of  moderate 
length,  the  heart  contracts  more  slowly  and 
forcibly.  Furthermore,  although  there  is  not 
a  consensus  of  opinion  as  to  the  balneological 
effect  of  mineral  waters,  whether  or  not  their 
saline  and  gaseous  constituents  serve  as  mild 
stimuli  to  the  sensory  nerves  of  the  integu- 
ment, it  is  probable,  as  remarked  by  Leiehten- 
stern,  that  they  act  as  vaso-motor  dilators, 
since  cutaneous  redness  follows  their  prolonged 
use  in  degrees  of  considerable  strength. 

From  the  foregoing  facts,  and  from  the  em- 
pirical knowledge  of  the  beneficial  effect  of  a 
balneological  treatment  of  many  cases  of  heart 
disease.  Dr.  Babcock  deduces  the  following  as 
the  modus  operandi  of  these  baths: 

Upon  the  patient's  entering  the  bath  there 
is  an  initial  or  primary  constriction  of  the  cuta- 
neous vessels  produced  by  the  cold.  This  is 
promptly  followed  by  a  dilatation  of  the  inter- 
nal vessels  and  stimulation  of  the  heart;  its  con- 
tractions, at  first  perhaps  accelerated,  become 
subsequently  reduced  in  rate  and  augmented  in 
force.  After  a  moment  or  two  the  sensation 
of  chilliness  gives  place  to  one  of  warmth,  when 
it  is  probable  the  contraction  of  the  cutaneous 
vessels  grows  less ;  the  gentle  stimulation  of 
the  sensory  cutaneous  nerves  produced  by  the 
salt  serves,  however,  to  maintain  the  increased 
energy  in  the  cardiac  contractions.  This  sec- 
ondary feeling  of  warmth  does  not  act  like  a 
primary  application  of  heat  to  the  surface  of 
the  body  by  causing  contraction  of  internal 
vessels ;  their  dilatation  persists.  Under  these 
conditions,  says  Dr.  Babcock,  the  heart  not 
only  has  less  labour  to  perform,  but  is  actually 
aided  in  the  accomplishment  of  its  decreased 
task.  Like  digitalis,  the  baths  slow  and 
strengthen  the  cardiac  contractions,  but,  un- 
like digitalis,  they  dilate  rather  than  contract 
the  arterial  system,  or,  in  other  words,  reduce 
rather  than  increase  peripheral  resistance. 

The  light  exercises,  or,  as  the  Schott  brothers 
choose  to  designate  this  part  of  their  cardiac 
therapeutics,  the  gymnastics,  says  Dr.  Babcock, 
are  an  extremely  simple  but  important  adjunct 
to  the  baths.  The  individuality  of  this  treat- 
ment lies  in  the  application  of  counter-resist- 
ance made  by  an  attendant  trained  for  that 
purpose.  He  must  see  to  it  that  the  move- 
ments are  performed  slowly  and  steadily,  that 
they  are  interrupted  by  short  periods  of  repose, 
and  that  the  effort  exerted  by  the  patient  is  not 
so  great  as  to  cause  embarrassment  of  respira- 
tion or  undue  acoelei'ation  of  the  pulse.  The 
attendant  must  watch  lest  the  patient  hold  his 


breath  and  thereby  overstrain  the  already  feeble 
right  ventricle,  and  must  at  once  call  a  halt 
upon  evidence  of  dyspnoea.  Finally,  he  must 
so  apply  his  counter-pressure  as  to  offer  resist- 
ance but  not  hinder  free  movement  of  the 
extremity.  This  requires  some  judgment  and 
skill,  yet  is  not  so  difficult  as  to  be  beyond  the 
acquirement  of  an  intelligent  friend  or  relative, 
who  can  then  help  the  patient  to  continue  his 
exercises  indefinitely  after  the  latter  has  passed 
from  the  physician's  daily  superintendence. 

These  exercises  exert  an  effect  on  the  heart 
and  circulation  similar  to  that  of  the  baths, 
and  therefore  supplement  and  re-enforce  the 
balneological  treatment.  If  the^  are  properly 
performed,  and  if  the  resistance  is  judiciously 
apportioned  to  the  patient's  endurance,  they 
slow  the  rate  and  augment  the  force  and  vol- 
ume of  the  pulse,  as  has  been  repeatedly  shown 
by  the  sphygmograph  and  sphygmomanometer. 
Percussion  and  auscultation  reveal  the  same 
improvement  in  the  size  of  the  dilated  heart 
and  in  the  character  of  its  sounds  as  after  a 
bath.  Patients  not  infrequently  comment  on 
their  feeling  of  euphoria  succeeding  this  form 
of  treatment ;  dull  precordial  pain,  discomfort, 
or  sense  of  oppression  gives  place  to  a  condi- 
tion of  ease  and  lightheartedness.  On  the 
other  hand,  if  too  great  resistance  is  applied, 
there  is  produced  a  sensation  of  cardiac  dis- 
tention with  a  variable  degree  of  dyspncea, 
while  the  pulse  grows  more  rapid  and  feebler. 
Improved  arterial  circulation  is  so  manifest  a 
result  of  these  exercises  that  Dr.  Schott  has 
known  them  to  lessen  the  frequency,  nay,  even 
the  severity  of  attacks  of  angina  pectoris  in  in- 
dividuals with  arteriosclerosis  who  had  been 
unable  to  indulge  in  even  very  moderate  phys- 
ical exercise  taken  in  the  ordinary  ways  of 
walking,  etc.  Permanent  amelioration  of  the 
sufferer's  condition  has  been  achieved  in  some 
of  these  cases. 

In  regard  to  contra-indications.  Dr.  Babcock 
thinks  there  can  be  no  doubt  of  the  dangers  of 
the  treatment  in  degenerative  changes  of  the 
blood-vessels  and  myocardium,  such  as  aneu- 
rysm and  advanced  arteriosclerosis,  acute  soft- 
ening, and  great  fatty  degeneration  of  the  heart. 
In  tliese  conditions  rupture  might  result  from 
heightened  intravascular  and  intracardiac  pres- 
sure. Furthermore,  the  query  has  been  made 
as  to  whether  chronic  interstitial  nephritis  is 
not  also  a  contra-indication  on  account  mainly 
of  the  danger  of  setting  up  acute  inflammation 
of  the  kidneys.  It  might  be  urged,  in  the  sec- 
ond place,  that  the  increased  vascular  tension 
produced  might  prove  disastrous  by  augment- 
ing the  heightened  arterial  tension  already  ex- 
isting. 

To  the  former  objection  Dr.  Babcock  replies 
that  when  Dr.  Schott  was  questioned  on  this 
point,  he  stated  that  he  did  not  consider  chronic 
interstitial  nephritis  a  contra-indication  to  the 
baths.  It  would  seem,  adds  Dr.  Babcock,  as  if 
the  stimulating  action  of  the  salts  and  carbonic 
acid  on  the  skin  rendered  the  effect  on  the  kid- 
neys different  from  that  of  a  bath  in  plain  water 
at  the  same  low  temperatures. 

As  regards  the  dangerous  augmentation  of 
existing  vascular  tension  to  the  extent  of  either 


433 


BATHS 


rupture  of  a  blood-vessel  or  of  stretching  the 
cavity  of  the  left  ventricle,  Dr.  Baboock  sug- 
gests that  such  baths  would  not  be  adminis- 
tered so  long  as  the  hypertrophied  heart  was 
adequate  to  the  peripheral  resistance  to  be  over- 
come. They  would  be  given  only  when  the 
cardiac  energy  was  threatening  to  fail  or  had 
actually  failed.  Under  such  circumstances  the 
only  thing  that  could  preserve  the  patient 
would  be  a  restoration  of  the  heart's  power. 
This  might  be  possible  if  the  heart's  walls 
were  not  too  degenerate  and  the  kidneys  not 
greatly  contracted.  Moreover,  if  the  baths  in 
question  brought  about  even  a  slight  degree  of 
dilatation  of  the  internal  vessels,  he  adds,  then 
the  peripheral  resistance  would  be  lessened 
rather  than  increased ;  and  if  the  circulation 
was  thereby  improved,  so  likewise  would  be  the 
action  of  the  kidneys. 

The  resisted  exercises,  the  Widp.rstandsgym- 
nastik  of  Ling,  are  fully  described  and  figured 
in  Dr.  W.  Bezly  Thome's  work  entitled  The 
Schott  Methods  of  the  Treatment  of  Chronic 
Diseases  of  the  Heart  (London,  1895).  Dr. 
Rives  (foe.  cit.)  gives  the  following  synopsis  of 
them: 

1.  Movements  of  the  extended  arms  in  three 
directions. 

(a)  From  the  ordinary  position  by  the  sides 
of  the  body  forward  and  upward  until  they 
reach  the  temples,  and  back  again. 

(6)  Prom  the  same  position  laterally  outward 
and  upward  to  the  temples^  and  back. 

(c)  From  the  horizontal  position,  with  the 
palms  of  the  hands  meeting  in  front  of  the 
body,  as  far  apart  as  possible,  and  back. 

Rotation  of  the  extended  arms  about  their 
axes  as  fully  as  possible,  causing  pronation  and 
supination. 

3.  For  the  elbow,  wrist,  and  finger  joints  the 
natural  flexions  and  extensions;  radial  and 
ulnar  abduction  and  adduction. 

3.  (a)  Flexion  of  the  trunk  forward,  from  a 
little  beyond  the  erect  position,  and  back. 

(6)  Lateral  flexions  of  the  trunk  to  right  and 
left,  and  back. 

(c)  Rotations  of  the  trunk  on  its  axis  to  right 
and  left,  and  back. 

4.  Movements  of  each  extended  leg  forward 
and  upward,  outward  and  upward,  backward 
and  upward,  and  back. 

5.  'Tlie  natural  flexions  and  extensions  of 
the  knee  and  ankle  joints. 

The  resistance,  says  Dr.  Rives,  is  always 
made  by  the  attendant  with  the  palm  of  "the 
hand  in  the  direction  exactly  opposite  to  that 
of  the  movement,  and  in  applying  it  to  the 
wrist  and  ankle  these  parts  are  placed  in  the 
fork  formed  by  separating  the  thumb  and  fin- 
gers ;  but  a  limb  is  never  actually  grasped,  lest 
support  rather  than  resistance  should  be  the 
result. 

The  degree  of  force  employed,  says  Dr. 
Rives,  should  be  as  much  as  the  patient  can 
overcome  without  the  slightest  discomfort, 
and  should  be  so  uniformly  applied  as  to  en- 
able him  to  perform  the  movements  slowly, 
evenly,  and  without  jerks.  He  must  be  able 
to  breathe  quietly,  and  the  mouth  and  alse 
nasi  must  be  watched  carefully,  so  that  at  the 


slightest  indication  of  loss  of  breath  a  pause 
may  be  made.  Some  of  the  movements  may 
be  omitted  according  to  circumstances;  the 
most  trying  to  the  patient  are  the  elevation  of 
the  arms  above  the  head  and  the  trunk  exer- 
cises. The  limbs  are  not  allowed  by  the  at- 
tendant to  fall  suddenly  after  the  completion 
of  a  movement ;  a  considerable  interval  of  time 
is  always  allowed  between  the  movements,  and 
this  is  prolonged  if  the  patient  seems  at  all 
fatigued.  The  clothing  should,  of  course,  be 
perfectly  loose  and  easy.  The  exercises  are 
usually  given  for  about  half  an  hour,  the 
series  being  gone  over  twice  in  that  time,  but 
they  are  often  employed  for  shorter  or  longer 
periods. 

Dr.  Rives  adds  that  Dr.  Schott  has  also  de- 
vised a  scheme  by  which  the  services  of  the 
attendant  may  sometimes  be  dispensed  with. 
In  carrying  out  these  self-resisted  exercises 
(Selbsthemmungsgymnastik),as  they  are  called, 
the  patient  endeavours,  as  it  were,  to  resist  his 
own  movements  by  partially  contracting  at  the 
same  time  the  antagonistic  muscles.  This  de- 
mands some  intelligence  on  his  part,  and  it 
would  often  be  unsafe  to  allow  its  employ- 
ment. 

The  action  of  these  exercises.  Dr.  Rives  re- 
marks, is  to  produce  an  effect  similar  in  many 
respects  to  that  caused  by  the  baths ;  the  cold 
extremities  become  warm,  the  sense  of  oppres- 
sion in  the  chest  is  relieved,  and  the  breathing 
is  deepened.  The  pulse  usually  becomes  fuller, 
stronger,  and  slower,  and  an  immediate  dimi- 
nution in  the  area  of  dulness  of  the  dilated 
heart,  not  due  to  increased  overlapping  by  the 
lung,  with  a  sim,ultaneous  lessening  of  the  di- 
mensions of  the  passively  congested  liver,  have 
been  frequently  demonstrated.  The  effect  is 
often  very  speedy  and  striking ;  according  to 
Dr.  August  Schott,  an  attack  of  cardiac  asthma 
which  would  otherwise  continue  for  hours  may 
be  charmed  away,  as  it  were,  in  a  few  minutes, 
and  an  extreme  dilatation  be  for  the  time  be- 
ing so  completely  dispelled  that  hardly  a  ves- 
tige remains. 

In  fresh  endocarditis  after  rheumatism,  says 
Dr.  Rives,  the  baths  promote  to  a  high  degree 
the  absorption  of  the  inflammatory  products 
and  offer  hopeful  prospects  of  a  more  or  less 
complete  cure.  In  chronic  valvular  disease, 
where  there  is  serious  damage  to  the  valve 
segments,  they  can  not  ordinarily  produce  the 
slightest  effect  upon  the  injured  valve  itself, 
and  those  murmurs  which  disappear  during  the 
course  are  due  to  relaxation  of  the  orifices  or 
want  of  tone  in  the  papillary  muscles.  Dr. 
Groedel,  of  Nauheim,  however,  states  that  he 
has  met  with  a  very  few  remarkable  cases  pre- 
senting evidences  of  fully  developed  valvular 
disease  which  have  been  cured  at  Nauheim, 
one  of  which  is  mentioned  in  Professor  Eich- 
horst's  Handbuch  der  speciellen  Pathologie 
und  Therapie,  fifth  edition,  vol.  i,  p.  56.  This 
patient  had  all  the  signs  of  pronounced  mitral 
insufficiency,  and  these  so  entirely  disappeared 
after  two  seasons  at  Nauheim  that  he  was  ac- 
cepted as  sound  by  a  very  strict  life-insurance 
company.  At  the  end  of  ten  years  there  was 
still  no  trace  of  the  disease.    Although  we 


BATHS 
BKLIjADONKA 


424 


can  not  expect,  says  Dr.  Rives,  that  seriously 
injured  valves  should  be  restored  to  their  nor- 
mal condition,  failure  of  compensation  result- 
ing therefrom  is  signally  benefited,  and  it  is 
in  those  cases  especially  in  which  digitalis  is 
not  tolerated  or  has  not  proved  useful  that  the 
results  are  so  astonishing.  It  is  v?ell  known 
that  in  aortic  regurgitation  digitalis  is  not  al- 
ways beneficial.  Good  results  are  secured  at 
Nauheim,  however  strange  it  may  at  first  ap- 
pear, in  lack  of  compensation  both  from  aortic 
and  from  mitral  disease,  as  well  as  in  cases  of 
combined  disease  of  both  valves  and  in  many 
instances  of  patent  foramen  ovale.  The  grad- 
ual influence  exerted  upon  the  nutrition  of  the 
heart,  without  the  other  accompanying  unde- 
sirable effects  which  are  often  a  cause  for  the 
failure  of  medicinal  treatment,  offers  an  im- 
mense advantage. 

In  weak  hearts  without  serious  organic  le- 
sion, from  ansemia,  chlorosis,  and  convales- 
cence-from  acute  diseases,  and  the  myocardial 
affections  resulting  from  influenza,  most  excel- 
lent results  are  obtained,  according  to  Dr. 
Rives,  particularly  in  young  subjects,  as  well 
as  in  cases  of  heart  strain  and  dilatation  due 
to  over-exertion.  In  the  chronic  sclerotic 
changes  (arteriosclerosis,  chronic  myocarditis) 
of  the  heart  and  vessels  and  fatty  degenera- 
tion, with  or  without  dilatation,  so  frequent  in 
persons  of  advancing  years,  of  which  the  ordi- 
nary treatment  is  usually  palliative,  the  bene- 
fit to  be  derived  is  naturally  more  uncertain 
and  generally  requires  long  and  persistent 
treatment.  Some  of  the  most  remarkable  re- 
sults of  the  Schott  methods,  howevei',  have 
been  obtained  in  apparently  hopeless  cases, 
and  even  patients  suffering  from  angina  pecto- 
ris have  been  practically  cured  at  Nauheim. 
While  many  cases  of  angina  pectoris  are  hope- 
less under  any  circumstances,  says  Dr.  Rives, 
yet  the  effect  of  the  Nauheim  baths  upon  the 
cardiac  nutrition  is  so  remarkable  that  where 
the  lesions  are  not  too  far  advanced  or  only 
incipient  the  results  of  the  treatraen  t  are  emi- 
nently gratifying.  He  cites  Balfour's  state- 
ment that  the  expression  pseudo-angina  is 
often  misleading,  and  should  not  be  applied 
to  cases  presenting  symptoms  identical  with 
those  of  true  angina,  merely  because  the  heart 
lesion  happens  to  be  curable.  Such  eases  it  is 
often  impossible  to  distinguish  from  the  in- 
curable ones,  and  Balfour  consequently  ex- 
presses himself  in  regard  to  the  prognosis  to 
the  effect  that  this  is  often  more  hopeful  than 
we  should  at  first  be  led  to  suppose. 

The  results  in  cases  of  heart  disease  depend- 
ent upon  or  complicated  with  disease  of  the 
kidney,  says  Dr.  Rives,  are  less  encouraging 
and  more  variable,  but  albuminuria  due  mere- 
ly to  secondary  renal  congestion  may  alto- 
gether disappear.  Cases  of  functional  nervous 
disturbance  of  the  heart  are  usually,  but  not 
always,  benefited. 

The  contra-indications  to  the  Nauheim  treat- 
ment are  stated  by  Dr.  Rives,  as  by  Dr.  Bab- 
cock,  to  be  advanced  arteriosclerosis  and  aortic 
aneurysm.  Patients  with  the  latter  affection, 
he  says,  have  used  the  baths  with  some  allevia- 
tion of  symptoms,  but  on  account  of  the  danger 


of  raising  the  blood  pressure  they  must  be  em- 
ployed with  the  greatest  caution.  Many  per- 
sons with  very  serious  heart  disease  come  to 
Nauheim,  he  remarks,  and,  as  is  only  to  be  ex- 
pected, some  deaths  occasionally  take  place 
during  the  season  ;  but  such  is  the  care  taken 
by  the  local  physicians,  who  write  their  orders 
with  exact  directions,  that  fatal  accidents  direct- 
ly attributable  to  the  baths  are  practically  un* 
known.  Groedel  states  that  during  a  practice 
of  many  years  at  Nauheim  he  has  never  had  a 
case  of  sudden  death  during  the  bath,  although 
he  has  known  of  two  cases  of  apoplexy  which 
occurred  during  the  exertion  of  dressing. 

As  to  the  exact  length  of  time  required  for  a 
cure,  it  is,  of  course,  says  Dr.  Rives,  impossible 
to  say  ;  improvement  is  usually  observed  after  a 
week  or  two,  and  some  patients  are  relieved  by 
a  single  course,  but  many  others  require  a 
much  longer  period,  and  there  are  compara- 
tively few  who  are  ill  enough  to  undertake  a 
long  journey  to  Nauheim  in  search  of  relief 
for  whom  it  is  not  advisable  that  they  should 
return  for  another  or  several  successive  sea- 
sons, while  in  some  desperate  cases  the  treat- 
ment will  necessarily  fail. 

In  an  excellent  article  on  this  method  of 
treating  heart  disease  {Lancet,  March  21  and 
28.  1896).  Dr.  R.  F.  C.  Leith,  of  Edinburgh, 
says:  "The  physiological  problems  raised  by 
'  the  system '  are  both  many  and  complex,  and 
there  must  be  much  still  hidden  from  us  which 
the  future  may  reveal,  and  which  may  bring 
about  a  more  perfect  understanding  of  its  ac- 
tions. So  far  as  they  are  at  present  known  to 
us,  it  is  readily  seen  that  its  scope  of  appli- 
cation is  far  wider  than  that  of  any  individ- 
ual drug;  but  to  assert  its  applicability  to  all 
classes  of  cardiac  derangements,  reserving  only 
advanced  arterio-capillary  sclerosis,  aneurysms, 
and  serious  rayocarditis,"is  surely  in  so  many 
words  to  proclaim  its  impotence.  It  is  but 
natural  that  it  should  fail.  Evil  habits  of 
nutrition  which  measure  their  existence  by 
months  or  years  are  not  to  be  got  rid  of  by 
one  or  even  two  courses  of  '  the  system '  of 
a  few  weeks'  duration  at  Nauheim  or  anywhere 
else.  I  have  already  met  with  failures  and  re- 
currences such  as  the  present  literature  of  the 
subject  makes  no  mention  of,  and  they  have 
but  served  to  increase  my  belief  in  its  value 
when  used  in  suitable  cases.  While  we  re- 
member that  it  is  also  capable  of  doing  much 
good  we  must  not  forget  that  it  is  also  capable 
of  doing  harm.  It  has  now  been  sufficiently 
proved  to  warrant  its  trial  in  suitable  cases, 
but  they  must  be  chosen  with  judgment.  To 
use  it  rashly,  and  with  too  great  expectations, 
is  certain  to  lead  to  disappointment  and  to  re- 
flect injuriously  upon  the  system  itself.  More- 
over, as  at  present  enunciated,  it  does  not 
seem  to  me  to  be  as  useful  as  it  might  be.  It 
is  at  once  too  wide  and  too  restricted ;  too 
wide  in  its  claims  and  too  restricted  in  its 
limitations.  Why,  for  instance,  should  we 
pause  at  86°  P.  ?  Why  not  go  further  in  suit- 
able eases  and  make  use  of  the  well-known 
effects  of  still  lower  temperatures,  inasmuch  as 
we  can  so  easily  regulate  their  influence  by  the 
duration  of  time  we  employ  them.    The  resist- 


435 


BATHS 
BELLADONNA 


ance  exercises  are  good  as  far  as  thejr  go,  but 
why  should  they  not  be  combined  with  mas- 
sage or  passive  or  active  exercises  ot  difiEerent 
kinds'?  Eccles,  Campbell,  and  others  have 
testified  to  their  value.  An  intelligent  use  of 
dumb-bells  and  other  gymnastic  appliances 
ought  to  prove  quite  as  effectual  as  the  resist- 
ance exercises  themselves,  and  they  have  done 
so  in  my  hands  in  the  opportunities  I  have  so 
far  had  of  putting  them  into  practice." 

Artificial  Nauheim  baths,  says  Dr.  Rives 
{loc.  cit.),  may  be  prepared  by  dissolving  the 
requisite  percentage  of  required  salts,  or,  as 
Dr.  John  Broadbent  points  out,  by  the  use  of 
sea  water,  which  contains  2'7  per  cent  of  chlo- 
ride of  sodium,  and  by  adding  for  the  pro- 
duction of  carbonic  acid  suitable  proportions 
of  commercial  muriatic  acid  and  bicarbonate 
of  sodium  or  chalk,  or,  as  has  been  suggested, 
a  mixture  of  the  bicarbonate  and  bisulphate 
of  sodium.  The  gas,  however,  when  thus 
evolved,  he  remarks,  escapes  more  rapidly 
than  it  does  from  the  natural  baths. 

Dr.  Rives  thinks  good  results  may  undoubt- 
edly be  obtained  in  this  way,  and  he  adds  that 
such  baths  have  been  employed  by  Dr.  Bezly 
Thorne  in  London  and  by  Dr.  Babeock  in 
Chicago,  as  well  as  in  the  Middlesex  Hospital, 
with  success ;  but  the  greater  freedom  from 
counteracting  injurious  conditions  to  be  had 
at  a  spa,  and  the  various  advantageous  mental 
and  hygienic  influences  to  which  the  patient 
is  there  subjected,  he  thinks,  are  sufficient  rea- 
sons, even  allowing  the  artificial  baths  to  be  as 
effective  as  the  natural  waters,  why  the  results 
obtained  at  Nauhei)n  are  more  striking  than 
those  reported  from  the  cities.  Mineral  springs 
in  the  country,  especially  when  possessing  a 
part  of  the  requirements,  offer  more  promising 
opportunities,  and  provision  has  been  or  is  be- 
ing made  at  Harrogate  and  various  places  in 
England  tor  carrying  out  the  treatment. 

In  administering  the  Nauheim  baths  to  pa- 
tients with  heart  disease,  says  Dr.  Rives,  sev- 
eral varieties  are  employed,  for  when  the  effect 
of  one  kind  of  bath  becomes  less  and  less 
marked,  owing  to  the  nervous  system  gradually 
becoming  habituated,  a  fresh  stimulus  is  im- 
parted by  changing  to  a  stronger  bath,  and 
thus  a  longer  course  can  be  taken  than  would 
otherwise  be  advantageous.  The  method  em- 
ployed by  Dr.  Theodor  Schott,  which  is  in 
the  main  practised  by  the  other  Nauheim 
physicians,  is  the  following  :  The  first  bath  or- 
dered (thermal  Soollad)  is  supplied  by  the 
water  taken  from  the  receiving  basins,  from 
which  by  exposure  to  the  air  a  large  part  of  the 
carbonic  acid  has  escaped,  and  a  considerable 
proportion  of  iron  and  salts  has  been  precipi- 
tated, so  that  it  is  of  a  muddy  colour  and  con- 
tains few  or  no  bubbles  of  gas.  No.  7  is  the 
spring  usually  first  employed,  as  it  contains 
the  smaller  proportion  of  salts,  3'18  per  cent, 
of  ohloride  of  sodium  and  0'17  of  chloride  of 
calcium.  Dr.  Schott  recommends  for  some 
cases,  at  the  beginning  of  treatment,  baths 
containing  only  1  per  cent,  of  chloride  of 
sodium  and  0-1  per  cent,  of  chloride  of  cal- 
cium. The  natural  temperature  is  88  8°  P., 
but  this  at  first  is  raised  to  one  varying  from 


92°  to  95°  P.  Temperatures  above  that  of  No. 
12  spring,  9.5'5°  P.,  are  not  suitable  for  heart 
patients.  The  duration  of  the  bath,  at  first  six 
to  eight  minutes,  is  gradually  lengthened  every 
few  days,  one  minute  at  a  time,  while  at  inter- 
vals the  temperature  is  lowered  about  one  de- 
gree (half  a  degree  centigrade). 

At  first  every  second  or  third  day,  afterward 
every  fourth  or  fifth,  the  bath  is  omitted.  The 
percentage  of  salts  is  now  gradually  increased, 
which  may  be  done  at  first  by  mixing  the 
waters  of  Nos.  7  and  12,  but  is  usually  accom- 
plished by  adding  a  quart  of  Nauheim  "  Mut- 
terlauge  "  (mother-lye) — the  unorystallizable 
liquid  left  behind  in  the  manufacture  of  salt — • 
which  is  subsequently  increased  to  two  and 
three  quarts,  or  occasionally  even  more.  The 
main  ingredient  of  this  is  chloride  of  calcium, 
which  may  be  raised  eventually  in  the  bath  to 
the  amount  of  0'5  per  cent.  When  the  pro- 
portion of  salts  is  thus  rendered  sufficiently 
large,  the  temperature  by  this  time  having 
been  lowered  several  degrees,  and  the  duration 
extended  to  not  more  than  twenty  minutes, 
the  patient  is  ready  to  continue  treatment  by 
a  course  of  Sprudel  baths  from  either  No.  7  or 
No.  12,  the  former  containing  the  greater 
amount  of  carbonic  acid,  the  latter  of  salts. 
These  differ  from  the  others  in  being  supplied 
with  water  direct  from  the  springs,  before  it 
has  undergone  the  action  of  the  air,  so  that  it 
appears  of  crystal  clearness  and  filled  with 
sparkling  bubbles  of  carbonic  acid,  which  it 
retains  in  undiminished  quantity.  They  are 
likewise  at  first  taken  warm,  usually  at  their 
natural  temperatures,  and  for  a  short  time — 
about  eight  minutes — and  as  they  are  con- 
tinued the  temperature  is  lowered  in  the  same 
cautious  way  and  the  duration  prolonged  in 
like  manner.  The  saline  contents  may  also  be 
increased  by  successive  additions  of  '•  Mutter- 
lauge."  In  consequence  of  the  powerful  exci- 
tation of  the  cutaneous  circulation  by  the 
carbonic  acid,  which  creates  an  agreeable  feel- 
ing of  warmth,  says  Dr.  Rives,  the  tempera- 
ture can  be  lowered  to  a  degree  which  could 
not  be  otherwise  tolerated,  but  is  seldom  if 
ever  reduced^  below  80°  P.  The  final,  most 
powerful  forni  of  stimulation  is  the  Sprudel- 
strombad,  in  which  the  supply  and  overflow 
pipes  of  the  bath  tub  are  left  open,  so  that 
in  addition  to  the  fresh  supplies  of  carbonic 
acid,  the  shock  of  the  running  water  against 
the  body  is  experienced. 

BEIiLADONNA.— Dr.  Douglass  W.  Mont- 
gomery, of  San  Prancisco  {Medical  News,  No- 
vember 16,  1895),  has  observed  decided  beneflt 
from  the  use  of  belladonna  in  the  form  of 
pemphigus  known  as  hereditary  inclination  to 
the  formation  of  blebs.  After  a  trial  of  arsenic 
and  then  of  potassium  iodide  (on  the  possibility 
that  the  trouble  was  syphilitic)  without  result, 
Dr.  Montgomery  prescribed  for  the  patient,  a 
boy  fifteen  years  old,  3  drops  of  tincture  of 
belladonna,  and  the  dose  was  increased  in  a 
few  days  to  4  drops.  Decided  improvement 
then  set  in  and  for  about  a  week  no  new  blebs 
formed.  A  few  new  blisters  then  appeared 
and  the  dose  of  belladonna  was  increased  up 


BENZONAPHTHOL 
CALCIUM  CHLOfllDB 


426 


to  6  drops  three  times  a  day,  but  without  en- 
tirely controlling  the  formation  of  the  blebs. 
The  patient  now  disappeared  for  a  number  of 
months,  and  on  his  return  Dr.  Montgomery 
hit  upon  the  probable  mode  of  action  of  the 
belladonna.  One  of  the  best-known  actions  of 
belladonna,  he  remarks,  is  its  power  of  con- 
trolling perspiration,  and  he  was  then  led  to 
think  that  if  this  was  the  only  action  of  the 
drug,  it  would  be  as  well  to  use  it  locally ;  a 
srhall  amount  was  applied  to  the  soles,  and 
with  satisfactory  results.  Blebs  formed,  but 
not  in  sufficient  numbers  to  especially  incom- 
mode the  boy,  and  the  disease  was  rendered 
tolerable. 

BENZONAPHTHOL.— Dr.  Jos^  A.  Clark 
(cited  in  the  Lancet  for  July  20,  1895)  reports 
having  employed  benzonaphthol  in  an  epidemic 
of  dysentery  which  occurred  in  Alquizar,  Cuba, 
during  which  he  had  one  hundred  and  thirty- 
seven  cases  of  the  disease  under  treatment,  of 
which  he  considered  twenty-three  as  serious 
and  a  hundred  and  fourteen  as  of  a  mild 
type.  The  mortality  among  those  treated 
with  ipecacuanha  and  calomel,  opium,  etc., 
amounted  to  9  per  cent.,  while  that  among  those 
treated  with  benzonaphthol  was  scarcely  more 
than  3  per  cent.  This  drug  had  the  great 
advantage  of  not  causing  vomiting,  salivation, 
or  depression  of  the  circulation,  and  it  also 
brought  patients  through  the  attack  more  rap- 
idly than  the  drugs  generally  used.  Forty-flve 
grains  per  diem  were  given  to  adults  and  but 
little  less  to  children. 

BENZOYLANILIDE. — See  Bbnzanilide. 

BENZOYL  -  BETA-  NAPHTHOL.— See 

Benzonaphthol. 

BISMUTH.— The  Deutsche  Aerzte-Zeitung 
for  February  1, 1896  {New  York  Medical  Jour- 
nal, February  23,  1896),  calls  attention  to  a 
soluble  ^Ao.sp/ia^e  of  bismuth,  "  bismutum  phos- 
phoricum  solubile,"  a  salt  that  contains  about 
30  per  cent,  of  oxide  of  bismuth.  Even 
concentrated  solutions  of  it  remain  clear  for 
some  hours,  and  a  solution  containing  from 
1  to  2  per  cent,  of  the  salt  will  remain  clear 
for  days,  but  it  is  rendered  turbid  by  boil- 
ing, also  by  the  addition  of  an  acid  or  of  an 
alkali.  The  reaction  of  such  a  solution  is  fee- 
bly alkaline,  and  its  taste  is  not  very  pro- 
nounced. Soluble  bismuth  phosphate  has  no 
effect  on  the  micro-organism  of  anthrax  or  on 
other  like  resistant  germs,  but  it  seems  capable 
of  arresting  the  development  of  the  Bacterium, 
coli.  Experiments  on  animals  have  shown  it 
to  be  harmless.  The  dose  necessary  in  its  ther- 
apeutical employment  is  much  smaller  than 
that  of  any  of  the  powdery  preparations  of  bis- 
muth ;  from  3  to  8  grains  are  to  be  given  three 
times  a  day.  It  has  been  used  as  a  remedy  for 
cholera  infantum  with  good  results. 

The  following  formula  is  attributed  to  DOrf- 
fler: 

B  Soluble  bismuth  phosphate .  1^  to  2  parts ; 

Distilled  water 90     " 

Syrup  of  marsh  mallow ....  8     " 

M.  A  child's  spoonful  to  be  given  every  hour 

In  most  cases  the  vomiting  ceased  after  the 


first  few  doses,  and  the  intense  odour  of  the 
stools  was  mitigated  as  soon  as  they  became 
black  in  appearance,  denoting  that  the  drug 
was  doing  its  work  in  the  intestine.  From 
profuse  diarrhoea,  the  intestinal  evacuations 
were  reduced  to  two  or  three  in  twenty-four 
hours.  No  milk  was  given.  In  the  majority 
of  cases  the  disease  was  at  an  end  in  the  course 
of  a  few  days.  The  writer  thinks  it  advisable 
to  continue  the  use  of  the  remedy  for  some 
days  after  the  diarrhoea  has  ceased. 

BLANCOLINE. — This  is  a  white,  odour- 
less substance  prepared  in  two  forms,  solid  and 
liquid.     It  is  used  like  vaseline. 

BLENNOSTASINE.— This  is  a  bromine 
derivative  of  cinchonidine,  CisIIaiNsOBrj.  Dr. 
Walter  F.  Chappell  (New  York  Medical  Jour- 
nal, December  5,  1896)  says  that  it  crystallizes 
from  dilute  solutions  in  large,  prismatic  crys- 
tals, or  from  concentrated  solutions  in  the 
form  of  small,  needle-shaped  crystals,  very 
soluble  in  water  and  quite  as  bitter  as  quinine. 
He  says  that  it  has  a  marked  contractile  effect 
on  the  vaso-motor  system  of  the  upper  respira- 
tory tract,  and,  being  non-toxic,  is  especially 
valuable  as  a  substitute  for  belladonna,  atro- 
pine, and  similar  drugs  in  hay  fever,  acute 
influenza,  rhinitis,  intermittent  rhinorrhma, 
laryngorrhcca,  and  bronchorrhcea,  has  a  power- 
ful sedative  influence  on  the  brain  and  spinal 
cord,  and  decidedly  diminishes  reilex  move- 
ments. 

Blennostasine  may  be  administered  in  cap- 
sule form,  when  combinations  are  required; 
but  for  many  reasons  Dr.  Chappell  thinks  one- 
grain  gelatin-coated  pills  are  preferable.  The 
dose  ranges  from  1  to  4  grains  or  more  every 
hour,  according  to  the  effect  desired. 

BOBOLYPTOL.— This  is  an  American 
proprietary  antiseptic  preparation,  presumably 
so  named  because  boric  acid  and  oil  of  euca- 
lyptus are  prominent  ingredients  of  it. 

BBOMATED  H.a:M:OL,  BIlOMH.a!- 
MOL. — This  is  a  derivative  of  haemogallol 
(g.  V.)  said  to  contain  2■^  per  cent,  of  bromine. 
It  has  been  recommended  in  the  treatment 
of  epilepsy. 


CAJEPTJT,  CAJUPTJT.— Mr.  Ram  Dhari 

Sinha,  L.  T.  M.  S.  (Indian  Medical  Gazette, 
December,  1896),  reports  having  used  cajuput 
oil  internally  as  an  expectorant  in  eighteen 
cases  of  pneumonia,  with  satisfaotorv  results. 
Ordinarily  he  gives  5  minims,  either  made  into 
an  emulsion  or  simply  shaken  with  water,  every 
four  or  five  hours.  In  all  the  eighteen  cases 
the  dyspnoea  and  cough  were  diminished  and 
expectoration  became  easier.  All  the  patients 
recovered. 

CALCIUM  CARBIDE.- This  compound, 
CaCj,  is  in  the  form  of  irregular  lumps  of  vari- 
ous shades  of  gray.  On  contact  with  water  it 
decomposes  and  acetylene  gas  is  generated. 
Some  of  the  French  surgeons  have  lately  em- 
ployed it  in  the  treatment  of  cancer  of  the 
uterus.  M.  Peyrot,  according  to  M.  Guinard 
{Gazette  medicate  de  Paris,  April  18, 1896),  has 


427 


BBNZONAPHTHOL 
CALCIUM  CHLORIDE 


employed  it  in  the  following  manner :  A  piece 
of  the  calcium  carbide  is  placed  directly  in  the 
vault  of  the  vagina,  where  it  very  soon  becomes 
decomposed  into  calcium  oxide  and  acetylene 
by  contact  with  the  moisture.  At  the  end  of 
several  days  the  oxide  is  removed  by  means 
of  irrigation  with  corrosive  sublimate.  This 
treatment  may  be  repeated  several  times.  The 
^results  are  very  appreciable,  says  M.  Guinard, 
^for  the  diseased  parts  assume  a  grayish  tint 
and  become  smooth,  and  the  hiemorrhages,  the 
fcetid  discharge,  and  the  pain  are  suppressed. 

With  regard  to  the  mode  of  action  of  calcium 
carbide,  says  M.  Guinard,  it  is  rather  complex. 
The  nascent  quicklime  acts,  he  thinks,  in  con- 
cert with  the  acetylene,  which  passes  into  the 
urine,  where  it  has  been  found.  Perhaps,  he 
says,  by  contact  with  the  cancerous  elements,, 
it  leads  to  a  sort  of  special  coagulation  of  the 
blood,  analogous  to  that  observed  in  persons 
poisoned  with  gas. 

M.  Livet  (These  de  Paris;  Revue  interna- 
tionale  de  medecine  et  de  chirurgie,  September 
25,  1896),  acting  on  M.  Guinard's  idea,  has  em- 
ployed calcium  carbide,  not  only  in  the  treat- 
ment of  uterine  cancer,  but  also  in  that  of 
other  ailections  accompanied  by  rebellions 
hcemorrhages,  pain,  and  fcetid  odours,  such  as 
certain  forms  of  fibroma  and  metritis.  He  re- 
ports eight  cases,  four  of  which  demonstrate 
that  the  treatment  with  calcium  carbide  is 
always  followed  by  an  amelioration,  whether 
in  cancer  of  the  breast,  metritis,  or  epithelioma 
of  the  uterus.  In  cases  of  cancer  of  the  neck 
of  the  uterus,  he  says,  the  vulva  and  the  vagina 
should  first  be  thoroughly  washed  and  disin- 
fected, and  then  pieces  of  calcium  carbide 
should  be  placed  in  the  inequalities  of  the 
tumour.  It  a  calcium-carbide  crayon  is  to  be 
introduced  into  the  cervical  cavity,  it  must  be 
done  very  rapidly,  for  when  it  comes  in  con- 
tact with  the  moist  mucous  membrane  it  pro- 
duces a  bubbling  and  nothing  more  is  seen  of 
it.  In  cancer  of  the  breast  the  cavities  are 
simply  filled  with  pieces  of  calcium  carbide. 

In  order  to  confine  the  acetylene,  an  ordinary 
dressing  is  used  on  the  breast  and  tamponing 
is  employed  in  the  vagina.  The  action  of  cal- 
cium carbide  is  very  rapid  ;  the  patient  feels  at 
once  a  burning  sensation  which  lasts  for  an 
hour  or  two,  and  at  the  end  of  that  time  the 
pain,  the  discharge,  and  the  fcetid  odour  have 
disappeared.  The  clot  which  is  formed  by  the 
coagulant  action  of  the  acetylene  presents  a 
temporary  barrier,  which  is  sometimes  defini- 
tive, to  the  haemorrhage,  and  when  the  foetid 
discharge  is  dried  up  the  nauseous  odour  dis- 
appears. When  the  tampon  of  iodoform  gauze 
which  confines  the  acetylene  is  removed  the 
vegetations  will  be  seen  to  be  diminished  in 
volume  and  covered  with  a  grayish  eschar 
which  is  easily  detached  with  a  blunt  curette. 
It  is  not  necessary  to  renew  the  applications 
of  the  carbide  oftener  than  every  four  or  five 
days,  unless  the  hiemorrhage  should  reappear 
on  the  day  following  the  first  application.  If 
it  is  necessary  to  use  the  nascent  lime  to  hasten 
the  destruction  of  the  neoplasm,  the  applica- 
tions of  the  carbide  may  be  more  frequent. 
In  all  cases  the  treatment,  being  purely  symp- 
71 


tomatic,  should  be  continued  until  the  fatal 
termination,  which  will  be  more  or  less  re- 
tarded. 

According  to  M.  Livet,  the  unpleasant  ef- 
fects of  this  treatment  are  few  ;  in  one  case  he 
observed  diarrhoea  and  in  another  burns  on 
the  vaginal  wall.  Unfortunately,  he  says,  the 
treatment  is  painful ;  the  burning  sensation  is 
very  intense  and  occasionally  persists  for  a 
long  time. 

CALCIUM  CHLOKISE,  according  to  Dr. 
Thomas  D.  Savill  (Lancet,  August  1,  1896; 
New  York  Medical  Journal,  August  32, 1896), 
is  a  very  efHcacioiis  remedy  for  the  itching  that 
accompanies  certain  skin  diseases. 

In  all  the  cases  which  have  come  under  his 
observation,  he  says,  the  itching  has  been  re- 
lieved, and  the  eruption,  if  anv  existed,  has 
disappeared  at  the  same  time.  He  states  fur- 
ther that  he  has  not  met  with  any  absolute 
failures  so  far,  although  sometimes  the  dose 
has  had  to  be  considerable  and  the  employment 
of  the  drug  continued  for  several  weeks.  The 
opportunity  of  trying  the  remedy  in  children 
for  the  itching  that  accompanies  urticaria,  he 
says,  has  not  presented  itself,  but  there  is  every 
reason  to  believe  that  it  would  be  equally  efS- 
cacious  in  such  cases. 

Dr.  Savill  says  that  the  doses  must  be  con- 
siderable, not  less  than  30  grains  three  times  a 
day,  and  they  should  be  gradually  increased. 
Thirty  and  even  40  grains  have  often  suc- 
ceeded where  smaller  doses  have  failed.  If  ad- 
ministered after  meals  and  in  a  wineglass  of 
water  it  is  surprising  how  little  these  large 
doses  upset  the  stomach,  and  he  states  that  he 
has  never  known  them  to  produce  vomiting. 
Patients  sometimes  complain,  he  says,  that  it 
makes  them  thirsty,  and  to  cover  the  salt  taste 
it  is  best  administered  with  a  drachm  of  tinc- 
ture of  orange  peel  and  an  ounce  of  chloroform 
water,  in  which  form  it  is  really  an  agreeable 
medicine  and  would  be  well  taken  by  children. 
It  is  important,  says  Dr.  Savill,  that  at  the 
same  time  the  diet  should  be  regulated,  no 
beer,  sugar,  or  sweets  being  allowed,  and  meat 
only  in  very  moderate  quantity.  It  is  also 
important  to  keep  the  bowels  acting  freely. 
Although  improvement  is  generally  noted  after 
the  first  dose,  he  says,  complete  recovery  is 
sometimes  not  obtained  until  the  blood  becomes 
saturated,  and  the  dose  must  be  increased  until 
this  is  accomplished.  In  long-standing  cases 
perseverance  is  necessary. 

When  recovery  is  oblained  the  dose  should 
be  gradually,  not  suddenly,  reduced,  and  it  is 
very  important  that  the  use  of  the  remedy 
should  be  continued  for  at  least  from  one  to 
three  weeks  after  all  symptoms  have  disap- 
peared. It  is  not  possible  yet,  he  thinks,  to 
indicate  precisely  which  cases  are  most  suit- 
able for  this  treatment,  but  it  is  worth  trying 
in  all  cases  where  itching  is  a  pronounced 
feature.  In  most  of  his  cases  an  actual  cure 
resulted,  but  in  a  few  of  very  long  duration 
relief  was  obtained  only  so  long  as  the  drug 
was  being  taken.  Nevertheless,  a  cure,  he 
thinks,  will  probably  result  with  perseverance 
even  in  these. 


CALCIUM  SULPHIDE 
CARBOLIC  ACID 


428 


Dr.  William  Huntly,  of  Kotah  (Indian 
Medical  Record,  May  1,  1894;  iVew  York 
Medical  Journal,  June  16,  1894),  speaks  highly 
of  calcium  chloride  as  a  hmmostatic.  In  a  case 
of  bleeding  after  the  extraction  of  a  tooth  the 
flow  was  arrested  by  the  administration  of 
opium,  but  returned  on  the  following  day, 
when  Dr.  Huntly  gave  the  patient  calcium 
chloride,  and  by  evening  the  bleeding  had 
stopped.  In  this  ease  the  use  of  calcium  chlo- 
ride was  continued  for  three  days.  In  ano,ther 
case  vomiting  of  blood  had  gone  on  all  night, 
and  every  native  remedy  had  been  tried  un- 
successfully. Dr.  Huntly  thought  it  clear  that 
the  hcematemesis  was  due  to  an  irritant  powder 
having  been  swallowed  by  mistake,  and  he  or- 
dered some  soap  pills  to  be  taken  at  once. 
After  the  use  of  calcium  chloride,  together 
with  other  measures,  there  was  no  recurrence 
of  the  bleeding.  In  a  case  of  severe  epistaxis 
the  same  measures  proved  effectual  without 
resort  to  plugging.  Dr.  Saundby,  says  Dr. 
Huntly,  has  obtained  good  results  in  a  case  of 
purpura  hcemorrhagica  from  6-grain  doses  of 
calcium  chloride  repeated  every  two  or  four 
hours.  Dr.  Huntly  thinks  better  results  are 
to  be  obtained  from  the  combination  of  opium 
and  calcium  chloride  than  from  either  drug 
alone,  although  opium  by  itself  has  often 
proved  successful,  as  nature  mends  the  broken 
surfaces  while  the  opium  is  exercising  its  re- 
straining influence ;  but  when  calcium  chloride 
is  added.  Nature's  efforts  are  supplemented. 
Opium,  he  continues,  acts  on  the  smaller  ar- 
terioles and  capillaries,  while  calcium  chloride 
acts  through  and  on  the  blood,  and  the  combi- 
nation is  all  the  more  valuable  because  their 
spheres  of  action  do  not  clash.  As  a  combina- 
tion, he  thinks  that  calcium  chloride  and  opium 
should  be  found  superior  to  lead  and  opium. 

CAIiCITJia:  SULPHIDE.— Dr.  J.  Sinclair 
Coghill  (British  MedicalJournal,  May  4, 1895  ; 
Therapeutic  Gazette,  September,  1895)  reports 
a  large  experience  in  the  use  of  calcium  sul- 
phide for  the  prevention  of  influenza.  He  gives 
it  in  pills,  each  containing  a  grain,  and  one 
pill  is  to  be  taken  daily.  During  the  first  epi- 
demic in  which  he  used  it  all  his  household 
took  it,  with  the  exception  of  two  servants, 
who,  for  some  reason  or  other,  did  not,  and 
the  result  was  that  all  escaped  except  the  two 
servants.  The  next  year,  when  the  epidemic 
again  broke  out,  the  writer  asked  the  authori- 
ties of  the  Isle  of  Wight  Railway  to  supply  all 
their  employees  with  the  pills,  and  all  who  took 
them  regularly  escaped.  The  manager  of  the 
Central  Railway  also  asked  Dr.  Coghill  to  sup- 
ply his  men  with  them,  and  he  afterward  in- 
formed him  that,  so  far  as  he  could  ascertain, 
none  of  the  men  who  had  taken  the  pills  regu- 
larly had  had  influenza.  During  the  next 
outbreak  the  pills  were  again  given,  with  like 
results ;  but  on  the  Isle  of  Wight  Railway  they 
were  not  given  out  to  each  workman  as  for- 
merly, consequently  but  few  took  them,  and 
the  result  was  that  a  large  number  of  influenza 
cases  occurred  among  those  who  had  not  used 
the  remedy. 

It  takes  about  three  days,  says  Dr.  Coghill, 


before  the  system  becomes  sufficiently  satu- 
rated with  the  drug  to  prevent  infection; 
therefore  it  is  rarely  of  use  to  those  who  have ' 
already  been  exposed  to  it,  though  even  then 
it  appears  to  modify  the  attack.  When  a  case 
appears  he  believes  the  5-grain  dose  of  quinine 
to  be  more  rapid  in  its  action  than  the  sulphide 
of  calcium,  and  therefore  safer  to  give,  but  he 
would  afterward  carry  on  the  efl^ect  with  the 
sulphide  of  calcium,  which  is  equally  efficacious 
and  much  easier  for  many  to  take,  as  it  never 
appears  to  disagree  in  any  way,  although  taken 
regularly  for  many  weeks.  Its  modus  operandi 
is  thought  to  be  that  of  rendering  the  blood 
unfit  to  receive  and  support  the  germ  of  the 
disease. 

CAMPHORIC  ACID.— Dr.  Ralph  Stock- 
man (Edinburgh  Medical  Journal,  January, 
1897 ;  New  York  Medical  Journal,  January  ]6, 
1897)  refers  to  the  early  experiments  made  by 
Gormanni  and  Brugnatelli,  the  results  of 
which  showed  that  this  drug  readily  destroyed 
the  tubercle  bacillus,  and  that  sputum  after 
treatment  with  it  failed  to  infect  rabbits. 
Piirbringer,  he  says,  used  it  as  an  intestinal 
antiseptic  in  typhoid  fever,  and  found  that  it 
greatly  diminished  the  number  of  organisms 
in  the  alvine  discharges,  but  had  no  effect  on 
the  duration  or  the  severity  of  the  fever.  In 
the  course  of  these  observations  it  was  noticed 
by  Piirbringer  that  it  checked  the  secretion  of 
sweat,  and  he  then  began  to  use  it  in  cases  of 
phthisical  sweating.  Other  trials,  says  Dr. 
Stockman,  by  Dreesmann,  Bohland,  Niesel, 
Combemale,  and  others  have  confirmed  this 
observation  ;  and  all  these  investigators  speak 
highly  of  its  action  and  place  it  in  the  very 
first  rank  as  an  anthidrotie. 

Dr.  Stockman  states  that  it  has  been  used 
only  to  a  comparatively  limited  extent,  and 
that,  although  it  is  said  to  act  more  power- 
fully than  either  atropine  or  agariein,  the  ex- 
perience on  which  this  opinion  is  founded  is 
not  very  extensive.  He  himself  began  to  use 
the  drug  four  years  ago,  and  since  then  he  has 
given  it  pretty  largely  in  phthisical  and  other 
cases  of  sweating.  One  ease  was  that  of  a 
lady  who  had  been  treated  by  electricity  for  a 
myoma  of  the  uterus.  She  suffered  greatly  at 
night  from  excessive  sweating,  and  occasion- 
ally also  during  the  day.  Dr.  Stockman  or- 
dered her  15  grains  of  camphoric  acid  at  night, 
and  this  completely  stopped  the  sweating. 
After  taking  it  for  two  weeks  she  found  that 
the  tendency  to  excessive  sweating  had  com- 
pletely disappeared,  and  since  then  it  has  not 
recurred.  Shortly  afterward  Dr.  Stockman 
again  used  it  successfully  in  a  patient  with  en- 
larged prostate,  who  suffered  from  profuse 
sweating  without  any  apparent  cause.  Tliis 
tendency  to  perspire  profusely  has  recurred  at 
intervals,  but  is  always  stopped  by  15  grains  of 
camphoric  acid  taken  once  or  twice  a  day,  and 
sometimes  one  dose  is  sufficient.  Dr.  Stock- 
man has  also  used  it  in  cases  of  hyperidrosis 
after  influenza  and  in  other  cases  in  which 
there  was  certainly  no  tubercle  present,  and  in 
all  of  them  doses  of  from  15  to  30  grains  have 
given  good  or  fairly  satisfactory  results. 


429 


CALCIUM  SULPHIDE 
CARBOLIC   ACID 


Dr.  Stockman  emphasizes  its  value  in  non- 
tuberculous  cases,  because  it  has  been  stated 
that  its  usefulness  is  confined  to  the  sweating 
of  phthisis,  in  which  its  value  is  quite  com- 
parable to  that  of  belladonna  or  atropine.  Ac- 
cording to  his  experience,  camphoric  acid  acts 
as  efficiently  as  atropine,  but  in  one  or  two  ob- 
stinate cases  it  has  not  shown  itself  so  power- 
ful an  anthidrotic  as  picrotoxin.  It  exercises, 
he  says,  no  specific  germicidal  action  on  tu- 
bercle bacilli  in  the  tissues,  and  it  does  not 
afi:ect  the  fever  or  local  lung  condition. 

With  regard  to  its  administration.  Dr. 
Stockman  thinks  that  the  best  plan  is  to  give 
30  grains  at  night  two  or  three  hours  before 
the  sweating  would  begin,  or  it  may  be  given 
in  two  doses  at  short  intervals.  It  is  best  ad- 
ministered in  powder  or  in  capsules  or  cachets, 
as  the  alcoholic  solution  is  very  bitter.  Owing 
to  its  insolubility,  he  says,  it  is  only  slowly  ab- 
sorbed from  the  intestinal  canal,  and  this  is 
the  reason  why  it  must  be  given  so  long  before 
the  time  of  sweating.  This  slowness  of  action 
is.  Dr.  Stockman  thinks,  undoubtedly  a  draw- 
back as  compared  with  that  of  atropine  or 
picrotoxin,  which  can  be  given  hypodermically 
and  act  rapidly.  Camphoric  acid  is  excreted 
in  the  urine  within  twelve  hours  after  its  ad- 
ministration by  the  mouth,  so  that  its  action 
is  usually  not  very  prolonged. 

The  only  unpleasant  effect  seen  by  Dr. 
Stockman  has  been  slight  irritation  of  the 
stomach  after  its  use.  It  is  said,  however,  to 
cause  renal  irritation,  and  in  one  case  it  was 
apparently  the  cause  of  a  skin  eruption.  It 
seems  to  be  non-poisonous,  he  says,  even  in 
large  doses,  and  in  this  respect  has  distinctly 
an  advantage  over  belladonna,  picrotoxin,  and 
agaracin.  Furbringer  has  given  as  much  as 
75  grains  a  day  in  typhoid  fever,  and  Niesel 
gave  750  grains  in  four  weeks  in  a  case  of  cys- 
titis, without  any  toxic  or  unpleasant  symp- 
toms being  produced.  He  adds  that  his  own 
experience  also  bears  this  out,  as  he  has  never 
noticed  any  depression  of  the  heart  or  nervous 
system,  and  Wagner  has  found  that  camphoric 
acid  has  much  the  same  effect  as  camphor  on 
the  circulation,  that  it  acts  as  a  stimulant  to 
the  heart  and  raises  the  blood-pressure. 

In  order  to  ascertain  its  mode  of  action,  Dr. 
Stockman  made  some  experiments  on  frogs 
and  on  sweat  secretion  in  cats.  The  experi- 
ments on  frogs  showed  that  it  was  not  very 
toxic  to  these  animals.  Doses  of  from  2  to  4 
grains  by  the  mouth  or  subeutaneously  caused 
slight  depression  which  lasted  for  some  hours 
and  was  then  succeeded  by  great  increase  in 
the  spinal  reflexes  which  lasted  for  several 
days.  Given  in  this  way,  it  scarcely  affected 
the  motor  nerves  and  muscles,  but  if  the  same 
dose  was  injected  directly  into  the  aorta  of 
pithed  frogs,  both  motor  nerves  and  muscles 
were  paralyzed.  Its  action  differs,  therefore, 
very  considerably  from  that  of  camphor. 
Doses  up  to  75  grains  had  very  little  effect  on 
rabbits  beyond  causing  slight  depression 
sometimes  followed  by  a  very  slight  increase 
of  reflexes.  The  toxicity  of  camphoric  acid  is 
therefore,  remarks  Dr.  Stockman,  very  slight 
in  animals  as  well  as  in  man. 


CANNABIS  INDICA.— The  Therapeut- 
ische  Woehenschrift  for  March  1,  1896  (New 
York  Medical  Journal,  March  21,  1896),  men- 
tions a  new  watery  fluid  extract  of  cannabis 
indica  termed  extractum  cannabis  indices 
aquosnm  fluidum,  and  states  that,  according 
to  R.  Cowan  Lees,  it  possesses  all  the  benefi- 
cial properties  of  the  plant,  but  does  not  give 
rise  to  that  state  of  intoxication,  bordering  on 
poisoning,  which  sometimes  follows  the  use  of 
even  meaium  doses  of  the  alcoholic  prepara- 
tions. It  has  no  efieet  on  the  secretion  of 
bronchial  mucus,  and  consequently  in  suitable 
cases  it  seems  more  efficient  than  opium,  and 
it  has  a  manifest  anodyne  and  hypnotic  effect 
in  pulmonary  affections.  Lees  has  observed 
the  best  results  from  its  use  in  tuberculous  dis- 
ease of  the  lungs,  in  which  it  materially  allevi- 
ates the  paroxysms  of  coughing,  while  at  the 
same  time  it  exerts  the  precious  stimulat- 
ing and  cheering  effects  of  cannabis  indica.  It 
is,  furthermore,  of  value  in  digestive  disturb- 
ances connected  with  constipation  and  as  a 
soporific  in  the  diseases  of  children.  The  me- 
dium dose  for  an  adult  is  from  30  to  60  drops  ; 
for  a  child  less  than  a  year  old,  from  0-15  to 
030  of  a  drop  for  each  month  of  age;  for 
older  children,  from  1^  to  3  drops  for  each 
year  of  age.  ' 

CABBAZOTIC  ACID.— See  Piceio  acid. 

CAKBOLIC  ACID.— In  the  Lancet  for 
January  16,  1897,  Mr.  Arthur  Eddowes,  of 
Loughborough,  reports  a  new  case  of  trau- 
matic tetanus  cured  by  the  subcutaneous  ad- 
ministration of  carbolic  acid.  A  man,  aged 
forty-one  years,  received  a  punctured  wound 
on  the  inner  side  of  the  ball  of  the  left  great 
toe  from  a  boot  nail  on  or  about  May  19th. 
Ijittle  notice  was  taken  of  the  wound  at  the 
time,  and  he  continued  his  work.  On  the  26th 
he  got  very  wet,  and  thought  he  had  contracted 
a  chill.  About  June  2d  the  wound  was  ob- 
served to  suppurate  slightly,  but  he  still  did 
his  work.  On  the  9th  he  felt  slight  stiffness 
of  the  lower  jaw  and  of  the  nape  of  the  neck  ; 
the  latter  sensation  was  described  "  as  if  some- 
thing was  constantly  pulling  his  head  back- 
ward." On  the  10th,  the  symptoms  being 
slightly  worse,  he  consulted  his  medical  man, 
who  prescribed  for  him.  He  visited  the  prac- 
titioner again  on  the  11th  and  12th,  but  he 
still  continued  his  work.  On  the  morning  of 
the  13th  he  was  advised  by  the  medical  man 
to  go  home  and  go  to  bed,  but  he  did  not  do 
so  till  6  p.  M.  During  these  days  the  symp- 
toms had  been  steadily  increasing  in  severity, 
and  by  the  13th  his  condition  was  as  follows : 
His  jaws  were  quite  closed,  so  that  slops  only 
could  be  taken.  The  muscles  of  the  back  were 
slightly  rigid,  sufficiently  so  to  make  move- 
ment difficult.  By  the  next  morning  (June 
14th)  there  was  fully  developed  trismus  with 
severe  aching  pains  in  the  muscles  around  the 
lower  jaw,  rigidity  and  arching  of  the  neck, 
rigidity  and  slight  arching  of  the  back,  and 
some  contraction  of  the  abdominal  walls ;  the 
lower  extremities  were  not  much  complained 
of  except  for  shooting  pains  round  the  knees ; 
the  upper  extremities  were  free.     The  urine 


CARBONIC  ACID 
COCAINE 


430 


passed  normally ;  the  bowels  were  acted  upon 
by  3  grains  of  calomel  given  the  previous  even- 
ing ;  the  surface  of  the  body  was  somewhat 
clammy.  The  pulse  was  66  and  of  good  vol- 
ume, and  the  temperature  was  98°  F.  His 
intellect  was  clear ;  the  power  of  swallowing 
was  not  perceptibly  affected,  the  pati«nt  being 
easily  fed  with  slops  owing  to  the  absence  of 
several  teeth. 

The  treatment  consisted  in  the  administra- 
tion of  chloral  hydrate  and  bromide  of  potas- 
sium every  four  hours  and  liquid  food.  On 
the  15th  the  arching  of  the  neck  and  trunls 
was  somewhat  more  extreme ;  the  trismus  was 
still  marked,  and  there  was  some  degree  of 
risus  sardonious  observable.  Also  there  was 
considerable  pain  complained  of,  beginning  in 
the  spiue  and  shooting  forward.  The  power 
of  the  extremities,  however,  remained  good; 
the  urine  passed  normally,  but;  the  bowels  were 
not  open.  The  pulse  and  temperature  were 
the  same  as  on  the  14th.  On  the  16th  his  con- 
dition remained  unchanged.  On  the  17th 
occasional  momentary  convulsive  movements 
of  the  trunk,  simulating  hiccough,  were  ob- 
served, the  arching  of  the  neck  and  trunk  was 
increased,  and  the  power  of  the  lower  extremi- 
ties was  slightly  lessened.  There  were  consid- 
erable pain  and'  some  tenderness  of  the  spinal 
column.  The  pulse  was  72  and  the  tempera- 
ture was  normal ;  the  urine  passed  normally, 
but  it  was  highly  concentrated  and  loaded 
with  urates;  the  bowels  were  opened  by  an 
aperient  and  an  enema.  On  the  18th  the  rigid- 
ity of  the  neck  was  less  extreme,  the  convulsive 
twitohings  were  more  frequent,  and  intense 
fcEtor  of  the  breath  was  noticed ;  otherwise  the 
condition  remained  the  same  as  on  the  17th. 
A  consultation  was  held,  and  the  following 
treatment  was  adopted:  Highly  nourishing 
diet  was  ordered,  consisting  of  eggs  with  milk 
and  brandy,  milk  with  soda  water,  jellies,  and 
cocoa,  frequently  administered  in  small  quan- 
tities. Ten  grains  each  of  chloral  hydrate  and 
bromide  of  potassium  were  administered  every 
two  hours.  Five  minims  of  carbolic  acid  (2- 
per-cent.  solution)  were  injected  hypodermically 
morning  and  evening.  The  chloral  aivd  bro- 
mide of  potassium  were  given  at  8  p.  M.,  and 
were  followed  by  intense  excitement  with 
numbness  in  the  extremities  half  an  hour  later, 
which  continued  during  the  greater  part  of  the 
night.  The  carbolic  acid  was  injected  at  10 
p.  M.,  and  no  after-effects  were  noticeable,  the 
pulse  being  102  and  the  temperature  100'8°. 
On  the  19th,  at  10-45  A.  m.,  the  pulse  was  96 
and  the  temperature  100'8°.  The  patient  had 
become  quieter,  the  convulsive  movements 
were  less  frequent  and  less  severe ;  he  took  his 
food  well ;  his  intellect  was  somewhat  clouded, 
but  he  was  conscious  of  his  surroundings. 
There  was  less  rigidity  of  the  back,  chest,  and 
abdomen,  and  there  was  more  power  in  the 
legs ;  there  was  no  change  in  the  degree  of  the 
trismus.  The  bowels  were  inactive,  and  an 
aperient  and  an  enema  had  to  be  resorted  to. 
On  the  20th  the  pulse  was  90  and  the  tempera- 
ture was  99-8°.  The  convulsive  movements 
were  very  slight  during  the  night,  but  the  pa- 
tient was  very  restless.    The  rigidity  of  the 


back,  chest,  and  abdomen  was  much  lessened, 
the  back  completely  resting  on  the  bed ;  there 
was  greater  power  in  the  lower  extremities,  but 
there  was  little  change  in  the  rigidity  of  the 
neck.  The  mouth  could  be  opened  slightly, 
but  not  sufficiently  to  allow  of  protrusion  of 
the  tongue.  The  bowels  were  still  inactive, 
and  an  enema  was  given.  The  patient's  con- 
dition had  considerably  improved  by  the  after- 
noon, and  the  treatment  was  slightly  changed, 
the  hypodermic  injection  of  carbolic  acid  being 
reduced  to  once  daily  and  the  chloral  and  bro- 
mide being  given  every  three  hours  instead  of 
every  two  hours  as  before.  On  the  21st  the 
pulse  was  72  and  the  temperature  normal.  The 
patient  had  had  a  restless  night,  but  less  so 
than  the  preceding  one.  The  rigidity  of  the 
muscles  was  lessening,  with  the  exception  of 
those  of  the  neck,  which  remained  firm.  The 
movement  of  the  jaw  was  more  complete,  and 
there  was  less  risus  sardonicus.  The  bowels, 
however,  had  not  been  opened,  in  spite  of  a 
dose  of  castor  oil.  The  use  of  the  hypodermic 
injections  was  discontinued,  and  15  grains  of 
chloral  hydrate  were  given  three  times  a  day. 
On  the  22d  the  pulse  was  78  and  the  tempera- 
ture 98'2°.  The  rigidity  had  almost  disap- 
peared except  in  the  neck  and  jaw.  The  patient 
was  still  restless,  evidently  from  being  confined 
to  bed,  and  the  bowels  were  still  inactive,  but 
the  patient's  condition  was  improving.  On 
the  23d  the  pulse  was  73  and  the  temperature 
normal.  He  had  had  a  good  night,  but  felt 
depressed.  There  were  no  paroxysms,  but  there 
was  some  pain  in  the  back.  The  rigidity  had 
considerably  dimmished,  and  the  lower  jaw 
was  slightly  more  movable.  As  the  bowels  re- 
mained inactive,  an  aperient  was  given.  Food 
was  well  taken.  A  tonic  was  prescribed. 
From  this  time  the  patient  made  a  steady  and 
uninterrupted  recovery,  and,  after  a  month  at 
Scarborough,  returned  in  perfect  health. 

CAE.BONIC  ACID.— This  gas  was  for- 
merly thought  to  have  a  remedial  action  when 
inhaled  in  cases  of  nasal  catarrh.  In  1864 
Herpin  said  of  it :  "  Douches  or  injections  of 
carbonic-acid  gas  have  been  successfully  used 
in  certain  affections  of  the  pituitary  mem- 
brane ;  in  cases  of  suppuration  it  corrects  and 
diminishes  the  bad  odour,  and  it  favours  and 
hastens  recovery."  Ml  Joal  {Revue  interna- 
tionale  de  rhinologie,  d'otologie,  et  de  laryn- 
gologie,  May,  1896),  who  quotes  this  passage 
from  Herpin,  reports  two  cases  of  anosmia 
cured  by  the  use  of  the  gas  in  the  form  of  a 
nasal  douche,  and  mentions  its  favourable  ac- 
tion in  hypertrophic  rhinitis  and  acute  coryza. 
He  describes  a  simple  device  for  the  inhalation. 
An  ordinary  "  siphon  "  of  carbonic-acid  water 
is  turned  upside  down  and  the  valve  pressed 
in  order  to  allow  that  portion  of  the  liquid 
which  is  above  the  extremitv  of  the  tube  to 
run  out.  On  the  tip  of  the  outlet  is  placed  a 
rubber  tube  about  six  inches  in  length,  on  the 
end  of  which  a  nasal  cannula  is  attached,  and 
the  apparatus  is  ready  for  use.  The  cannula 
is  introduced  into  the  nostril  and  the  valve 
pressed  gently,  and  the  carbonic  acid  pene- 
trates the  nasal  fossae;  or  the  valve  may  be 


431 


CAEBONIC   ACID 
COCAINE 


brought,  near  the  nostril  so  that  the  patient 
may  inhale  the  gas.  and  in  this  way  it  is 
drawn  through  the  respiratory  and  olfaccory 
parts  of  the  nasal  passages. 

CARDOL. — Under  this  name  two  oily  liq- 
uids are  on  the  market — one  obtained  from 
Anacardium  occidentale,  which  is  a  vesicant ; 
and  the  other  from  Anacardium  orientale, 
which  is  a  rubefacient. 

CABNIFERBIN.— According  to  Profes- 
sor Coblcntz,  this  German  meat  preparation 
contains  30  per  cent,  of  iron  in  combination 
with  phosphoric  acid.  It  is  said  to  be  taste- 
less. It  may  be  given  to  children  in  doses  of 
from  3  to  5  grains,  and  to  adults  in  doses  of  8 
grains,  as  a  tonic  and  nutrient. 

CELLOIDIN.— Dr.  R.  T.  Williamson  (Brit- 
ish Medical  Journal,  April  18,  1896)  thinks 
that  a  solution  of  celloidin  is  superior  to 
collodion  in  adhesive  power.  He  says  the 
strength  of  the  solution  he  has  employed  has 
been  the  same  as  that  used  in  microscopical 
work — namely,  2  parts  of  celloidin  dissolved 
in  a  mixture  of  15  parts  of  absolute  alcohol 
and  15  parts  of  pure  ether  (specific  gravity, 
0'720).  It  is  important,  he  says,  to  use  pure 
absolute  ether  of  this  specific  gravity,  and  not 
the  sulphuric  ether  which  has  a  specific  grav- 
ity of  0-735.  If  the  latter  is  used  the  celloidin 
does  not  adhere  to  the  skin  so  well. 

CEIiLTJLOID.— Professor  Landerer  and 
Dr.  E.  Kirsch  {Centralhlatt  fur  Chirurgie, 
July  18,  1896;  New  York  Medical  Journal, 
August  1,  1896).  after  mentioning  the  great 
drawbacks  of  plaster  of  Paris  as  a  splint  ma- 
terial— its  weight  and  its  proneness  to  become 
foul  by  absorbing  sweat,  urine,  etc. — say  that 
in  the  Medico-mechanical  Institute  of  Stutt- 
gart celluloid  has  been  found  an  excellent  sub- 
stitute free  from  these  disadvantages.  A 
wide-moiithed  bottle  is  packed  for  about  a 
quarter  of  its  height  with  celluloid  cut  into 
small  pieces,  and  then  it  is  filled  with  acetone. 
It  is  provided  with  an  air-tight  stopper  to 
guard  against  evaporation.  Prom  time  to 
time  it  is  opened,  and  the  contents  are  stirred 
with  a  stick.  The  celluloid  dissolves  in  course 
of  time.  A  plaster  cast  of  the  diseased  or  in- 
jured part  is  covered  with  a  moderately  thick 
layer  of  felt  or  flannel,  and  the  celluloid  solu- 
tion is  rubbed  into  this  covering  with  the 
hands,  which  are  to  be  protected  with  leather 
gloves.  This  process  should  be  repeated  from 
four  to  six  times.  The  advantages  of  the  cel- 
luloid splints  and  corsets  are  their  lightness, 
hardness,  stability,  elasticity,  and  cleanliness. 

CHELIDONITTiyr.— A  Russian  physician. 
Dr.  Denissenko  ( Vratch,  1896,  No.  30 :  Deutsche 
Medizinal-Zeitung,  September  34,  1896  ;  New 
York  Medical  Journal,  October  10.  1896),  has 
tested  the  action  of  the  juice  of  Chelidonium 
majus  on  cancer  in  the  municipal  hospital  in 
Brjansk.  In  his  early  experiments  he  used  the 
fresh  juice  of  the  herb,  but  since  February,  1895, 
he  has  been  using  the  extract  found  in  the  shops. 

His  method  of  employing  chelidonium  is  as 
follows :  He  directs  that  from  23  to  75  grains 
of  the  extract  be  taken  internally,  dissolved  in 


distilled  water  or  peppermint  water,  every  day 
throughout  the  treatment.  Into  the  substance 
of  the  tumour,  as  close  as  possible  to  the  boun- 
dary between  it  and  the  healthy  tissue,  he 
throws  a  number  of  injections  of  from  2  to  4 
drops  of  a  mixture  of  equal  weights  of  the  ex- 
tract, glycerin,  and  distilled  water,  not  exceed- 
ing a  Pravaz's  syringeful  in  all.  The  frequency 
with  which  these  injections  are  given  is  not 
stated.  If  the  tumour  is  ulcerated,  he  paints 
its  surface  twice  a  day  with  a  mixture  of  1  or 
3  parts  of  the  extract  and  1  part  of  glycerin. 
Iron,  quinine,  and  other  supporting  remedies 
are  employed  according  to  the  indications. 

Except  in  a  few  cases,  he  says,  the  internal 
use  of  the  drug  caused  no  disturbance  of  the 
stomach,  but  the  painting  of  the  ulcerated 
surfaces  gave  rise  to  a  slight  and  transitory 
burning.  It  was  different  with  the  parenchy- 
matous injections;  in  all  instances,  after  tlie 
injections,  especially  after  the  first  one,  there 
was  burning  pain  at  the  site  of  the  operation, 
the  patient  felt  weak,  there  was  a  more  or  less 
severe  chill,  and  then  the  temperature  rose  to 
between  100°  and  102°  P.  Although  these 
symptoms  disappeared  on  the  following  day. 
Dr.  Denissenko  saw  reason  to  exercise  a  certain 
amount  of  caution  in  the  use  of  the  injections. 

The  eifects  of  this  treatment  were  shown 
in  the  course  of  a  few  days.  They  were  the 
following :  1.  The  sallow  hue  of  the  skin  dis- 
appeared. 2.  Softening  of  the  tumour  set  in. 
3.  After  from  three  to  five  days  there  formed 
at  the  points  of  injection  fistulous  tracts  about 
which  the  softening  process  went  on  with 
special  rapidity.  4.  In  from  fifteen  to  twenty 
days  a  line  of  demarcation  could  be  distin- 
guished between  the  morbid  and  the  healthy 
tissues ;  the  one  seemed  to  be  forced  away  from 
the  other.  In  general,  the  tumour  diminished 
more  than  half  in  circumference,  and  the 
affected  lymphatic  glands  of  the  neighbour- 
hood underwent  involution. 

CHLORALIMIDE.— This  substance,  CCl, 
CH :  NH,  must  not  be  confounded  with  chlo- 
ralamide.  Chloralimide  is  a  crystalline  pow- 
der obtained  by  the  action  of  heat  on  chloral 
ammonium.  It  is  hypnotic  and  analgetic. 
The  dose  is  from  15  to  45  grains,  and  not 
more  than  90  grains  should  be  given  in  twen- 
ty-four hours.  Clinical  data  concerning  its 
use  are  still  so  defective  as  to  call  for  caution 
in  its  employment. 

CHLOBOSALOL.— See  under  Salicylic 
ACID  AND  THE  SALICYLATES  (Supplement). 

CHOCOLATE.— See  under  Cocoa. 

CITB,OPHEN,acompound  of  citric  acidand 
paraphenetidine,  CsHiOElf QQ''^rT  >CeH4Ja,  is 

closely  allied  to  apolysine  (q.  v.).  It  is  em- 
ployed as  an  antipyretic  and  analgetic  in 
doses  of  from  7  to  15  grains. 

COCAINE.— The  Therapeutische  Wochen- 
schrift  for  June  21,  1896,  contained  an  inter- 
esting summary  of  several  oases  of  poisoning 
with  cocame,  the  substance  of  which  is  given 
in  the  New  York  Medical  Journal  for  July  11, 
1896.  The  writer  first  remarks  upon  the  ex- 
traordinary  variability  of   the  symptoms  in 


CODEINE 

ERODIUM  CICUTARIUM 


433 


cases  of  cocaine  poisoning:.  There  may,  he 
says,  be  intellectual  torpor,  tonic  or  clonic 
convulsions,  or  maniacal  exaltation.  Respira- 
tory disturbances  are  particularly  intense ;  the 
breathing  is  shallow,  in  severe  cases  it  may  be 
of  the  Cheyne-Stokes  type,  and  death  may  oc- 
cur from  respiratory  paralysis.  Phenomena 
pertaining  to  the  circulation  are  less  pro- 
nounced. Poisoning  has  been  known  to  fol- 
low the  use  of  so  small  an  amount  of  cocaine 
as  0077  of  a  grain,  and  in  many  cases  that 
have  been  reported  there  has  been  no  reason 
to  suppose  that  the  preparation  was  impure  or 
that  the  recognised  maximum  dose  was  ex- 
ceeded ;  idiosyncrasy  must  therefore  be  as- 
sumed to  have  taken  a  part  in  giving  rise  to 
the  results. 

After  making  these  remarks,  the  writer  pro- 
ceeds to  give  condensed  accounts  of  four  cases 
of  cocaine  poisoning.  The  first  and  second 
eases  were  reported  by  Dr.  M.  Weiarieh  in  the 
Berliner  klinische  Wochenschrift.  In  one  of 
t.'iem  the  patient,  who  had  a  tumour  of  the 
bladder,  had  been  examined  with  the  cysto- 
scope  several  times  and  operated  upon  with 
the  aid  of  that  instrument  and  the  use  of  a 
one-to-fifteen  solution  of  cocaine.  On  the 
third  day  after  the  operation  the  same  solu- 
tion was  injected,  and  immediately  signs  of 
poisoning  showed  themselves — unconscious- 
ness, epileptoid  convulsions,  Cheyne-Stokes 
respiration,  and  slowing  of  the  pulse,  which 
was  imperceptible  in  the  wrist  and  hardly  to 
be  felt  in  the  thigh.  The  patient  was  saved 
by  means  of  prolonged  and  energetic  artificial 
respiration.  A  week  later  there  was  occasion 
to  use  an  injection  of  half  the  strength  of  the 
preceding  ones,  and  no  signs  of  poisoning 
showed  themselves.  Dr.  Weinrich's  other  pa- 
tient was  a  man  eighty  years  old.  Similar 
phenomena  of  poisoning  were  observed  after  a 
urethral  injection  of  a  one-to-fifteen  solution 

•  of  cocaine. 

The  first  case  is  remarkable,  says  the  Thera- 
peutische  Wochenschrift,  from  the  fact  that  the 
'Cocaine  had  been  used  six  times  without  any  ill 
■  effect,  and  then  on  the  seventh  occasion,  with- 

•  out  there  being  any  condition  especially  favour- 
able to  absorption,  severe  poisoning  resulted. 
It  seems  that  the  raucous  membrane  of  the 
■urethra  absorbs  drugs  more  readily  than  that 

•  of  the  bladder,  the  writer  goes  on  to  say,  but 
it  may  be  assumed  that  the  vesical  mucosa 
^absorbs  them  more  readily  when  it  is  diseased 
than  when  it  is  healthy,  on  account  of  losses  of 
epithelium,  etc. 

The  third  case  was  reported  by  Dr.  E. 
Pfister,  of  Cairo,  in  the  Berliner  klinische 
Wochenschrift,  1896,  No.  14.  The  man  had 
suffered  with  retention  of  urine  a  number  of 
times  in  consequence  of  vesical  calculi.  He 
received  an  injection  of  a  20-per-cent.  solution 
of  cocaine  into  the  bladder,  and  died  almost 
immediately.  A  Pravaz's  syringe,  the  writer 
remarks,  will  hold  four  times  the  amount  of 
such  a  solution  as  would  contain  the  maxi- 
mum dose  of  cocaine,  and  it  is  probable  that 
in  this  case  a  still  larger  syringe  was  used,  for 
only  thus,  he  says,  can  the  lightninglike  ra- 
pidity with  which  the  drug  acted  be  explained. 


The  fourth  case  was  observed  by  Dr.  Gr. 
Duchesne,  of  Orbec,  and  reported  in  the  Annee 
medicate  de  Caen  for  1896.  A  man  thirty- 
eight  years  old  had  two  injections  of  cocaine 
into  the  gum,  in  order  to  have  a  tooth  ex- 
tracted without  pain.  On  the  following  day 
he  had  oedema  of  the  lids  of  each  eye,  espe- 
cially of  the  upper  lid,  which  increased  for 
forty-eight  hours  and  then  subsided  entirely. 
Repeated  examinations  of  his  urine  showed  no 
trace  of  albumin.  In  this  case,  the  writer  in 
the  Therapeutische  Wochenschrift  thinks,  there 
was  probably  a  vaso-motor  paralysis  in  conse- 
quence of  the  action  of  the  drug  on  the  ter- 
minations of  the  inferior  dental  nerve,  which 
is  a  branch  of  the  inferior  maxillary,  or  of  a 
part  of  the  trigeminal,  which  by  its  ophthalmic 
branch  of  Willis  is  in  close  connection  with  the 
skin  and  the  mucous  membrane  of  the  lids. 

Great  caution  must  be  observed  in  the  use 
of  cocaine  within  the  urinary  passages,  says 
the  writer,  but  he  adds  that  the  capricious  ac- 
tion of  the  drug  is  as  difiicult  to  guard  against 
as  that  of  chloroform.  The  use  of  cocaine  is 
contra-indicated  in  anaemic  persons  and  in 
those  that  are  the  subjects  of  respiratory  or 
circulatory  disease.  When  cocaine  poisoning 
occurs,  amyl  nitrite  and  chloroform  should  be 
used,  also  opium  and  chloral  hydrate  for  the 
convulsions,  but  above  all  artificial  respiration 
and  injections  of  camphor  dissolved  in  ether. 

CODEINE.— According  to  Mr.  Joseph  W. 
England  (American  Journal  of  Pharmacy, 
July,  1894),  a  mixture  for  coughs,  known  as 
the  "C. — C."  cough  mixture,  is  very  largely 
used  in  the  Philadelphia  Hospital.  The  for- 
mula is  as  follows : 
5  Codeine  sulphate 1  grain  ; 

Diluted  hydrocyanic  acid. .  16  minims; 

Chloroform,  )        ,  c  a    -,      , 

Mucilage  of  acacia,  \  ^^"^^  ■     ^  ^-  drachms ; 

Syrup  of  wild  cherry  to 1  fl,  oz. 

M.     Dose,  a  teaspoonful. 

A  somewhat  similar  formula  is  given  on  page 
386  of  vol.  i. 

CODOii.— See  Rosinol. 

COPAIBA  has  been  recommended  by  Pro- 
fessor Monti,  of  Vienna,  in  the  treatment  of 
scabies  in  children.  Waring  [Manual  of  Prac- 
tical Therapeutics,  Philadelphia,  1886)  states 
that  Dr.  Monti  employed  the  balsam  in  twenty- 
seven  instances,  and  in  each  case  effected  a 
complete  cure.  Each  child  was  first  washed 
with  soap  and  water  and  then  rubbed  all  over 
twice  daily  with  the  balsam.  No  other  appli- 
cation was  used.  He  found  that  the  itch  insect 
could  not  live  in  the  balsam  beyond  two  or 
three  hours. 

COTARNINE  HYDROCHLORIDE.— 

See  Stypticin. 

COTTON  ROOT.-Dr.  George  A.  Blakeley, 
of  Albany,  Wisconsin  {3Iedical  News,  April  11, 
1896),  reports  a  case  of  poisoning  with  cotton 
root.  A  woman,  supposing  herself  to  be  preg- 
nant, took  4  oz.  of  the  fluid  extract  during  the 
interval  from  9  to  10  p.  m.  At  about  11  o'clock 
her  husband  arrived  home  and  found  her  un- 
conscious,    lie  summoned  Dr.  Blakeley,  who 


433 


CODEIKE 
ERODIUM   CICUTARIUM 


soon  reached  her  and  .found  her  in  a  state  of 
complete  muscular  relaxation.  The  pupils 
were  both  widely  dilated ;  the  respiration  was 
10,  sighing  and  shallow;  the  pulse  was  150, 
very  weak  and  compressible  ;  and  the  temper- 
ature was  95°  P.  in  the  axilla.  There  was  a 
faint,  peculiar  odour  to  the  breath,  but  there 
were  no  blisters  on  the  lips  or  tongue,  though 
the  latter  was  very  dark  coloured.  Dr.  Blake- 
ley  gave  i  of  a  grain  of  apomorphine  hypo- 
dermically  and  diluted  alcohol  by  the  same 
method.  Thorough  eraesis  occurred  in  five 
minutes,  and  the  vomited  matter  was  reddish- 
brown.  The  symptoms  showed  rapid  improve- 
ment, and  in  half  an  hour  she  could  swallow, 
when  the  stomach  was  thoroughly  washed  out, 
getting  rid  of  some  more  reddish-brown  ma- 
terial, which  appeared  like  extract  of  cotton- 
root  bark.  In  about  two  hours  she  was  able 
to  talk.  She  improved  rapidly  and  the  next 
morning  was  able  to  sit  up.  No  further  trouble 
occurred  except  that  she  was  quite  weak  for  a 
few  days.  It  turned  out  that  she  was  not 
pregnant. 

CREOSAL. — This  is  described  as  a  dark- 
brown  hygroscopic  powder,  readily  soluble  in 
water,  made  by  heating  beechwood  creosote 
with  tannic  acid  and  phosphorus  oxychloride. 
It  has  been  recommended  in  the  treatment  of 
catarrh  of  the  respiratory  organs,  in  doses  of 
15  grains  three  time  a  day. 

CE.EOSOL.— This  is  an  oily  liquid,  called 
also  homoguaiacol  and  homopvrocatechinmethyl 
ette.r,  CoHa.CH3(OCH3).(OH),' obtained  by  dis- 
tilling beechwood  tar  or  gum  guaiacum  (Merck). 
It  has  been  recommended  as  an  antiseptic. 

CREOSOTE.— Dr.  J.  P.  West,  of  Bellaire, 
Ohio  (Archives  of  Pmdiatrics,  May,  1896),  re- 
cords the  cases  of  two  children  with  enlarged 
bronchial  glands  in  which  the  beneficial  efEect 
of  creosote  was  very  prompt  and  decided. 

creosote-calcium:     chlorhy- 

DROPHOSPHATE.— This  is  described  as  a 
wh  te  syrupy  mass  consisting  of  creosote  car- 
bonate and  calcium  chlorhydrophosphate.  It 
has  been  recommended  in  the  treatment  of 
tuberculosis  and  scrofula  in  doses  of  from  3  to 
8  grains,  in  an  emulsion,  twice  a  day.  Pro- 
fessor Coblentz  gives  the  following  formula : 

5  Creosote-calcium  chlorhydro- 
phosphate    5  to  10  parts ; 

Mucilage  of  chondrus 15      " 

Oil  of  sweet  almonds,  )       ,  „_     „ 

Syrup  of  Tolu,              f  ®^°°-  '^'* 

Orange-flower  water 75      " 

M.     Dose,  a  teaspoonful  twice  a  day. 

CRESALOL,  CRESOL  SALICYLATE. 

— See  under  Salicylic  acid  and  the  sali- 
cylates (Supplement). 

CRYOSTASE.— This  is  the  name  of  an  an- 
tiseptic preparation  said  by  Professor  Coblentz 
to  be  a  mixture  of  equal  parts  of  carbolic  acid, 
camphor,  and  saponin,  with  traces  of  oil  of 
turpentine. 

CTJTAL. — See  Aluminum  bobotannicotab- 
TEATE  (Supplement). 


DERMATIN.  —  According  to  Professor 
Coblentz,  thisis  a  mixture  of  from  5  to  7  parts 
ot  salicylic  acid,  from  7  to  15  parts  of  starch, 
from  25  to  50  parts  of  talc,  from  30  to  60  parts 
of  silicic  acid,  and  from  3  to  9  parts  of  kaolin, 
used  as  a  protective  to  the  skin. 

DESOXYALIZARIN.— See    Anthrako- 

BIN. 

DEXTROSE. —See  under  Sugar  (vol.  ii, 
page  235). 

DIABETIN.— See  Levulose. 

BIACETAITILIDE.  —  This  compound, 
C6H6N(C2H302)a,  is  made  by  heating  acetani- 
lide  with  glacial  acetic  acid.  It  is  said  to  be 
similar  to  acetanilide  in  its  action,  but  more 
powerful. 

DIACETYLTANNIN.— See  Tannigen. 

DIETHYLENEDIAMINE.— See  Piper- 

AZINE. 

DIETHYLSULPHONEDIETHYLME- 

THANE.— See  Tetronal. 

DIETHYLSTJLPHONEDIMETHYL- 

METHANE.— See  Sulphonal. 

DIETHYLSTJLPHONEMETHYL- 
ETHYLMETHANE.— See  Trional. 

DIMETHYLETHYLCARBINOL.— See 

Amylene  hydrate. 

DIOXYANTHRANOL.  —  See  Anthea- 

EOBIN. 

DISPERMINE.— See  Pipeeazinb. 
DITHYMOL  IODIDE.— See  Aeistol. 
DITHYMOL   TRIIODIDE.— See  Anni- 

DALIN. 

DUOTAL. — Guaiacol  carbonate  (see  under 
Guaiacol). 


EMBELIC    ACID.— See  under  Bmbelia 

RiBES. 

ERODIUM  CICUTARIUM.— This  gera- 
niaceous  plant,  the  hemlock  stork's-bill,  wild 
mush,  or  pine  grass,  has  been  used  as  an 
astringent  and  diuretic.  Dr.  Komarovitch 
(Vratch,  February  29,  1896;  Cancel!,  April  4, 
1896)  states  that  he  has  made  considerable  use 
of  it  in  uterine  hwmorrhage  with  excellent  re- 
sults, often  after  better-known  drugs,  such  as 
ergot  and  hydfastis,  had  failed.  He  believes 
that  the  effect  of  the  erodium  is  to  increase 
the  elasticity  of  the  muscular  fibres  and  thus 
to  favour  their  contraction.  In  one  case  where 
a  polypus  was  the  cause  of  the  haemorrhage, 
after  a  fortnight's  treatment  the  tumour  was 
extruded  into  the  vagina,  which  had  never 
occurred  with  other  drugs  previously  tried. 
Twenty  of  the  cases  where  erodium  succeeded 
after  the  failure  of  ergot  and  hydrastis  were 
due  to  metritis,  but  others  were  dependent  on 
myoma  and  abortion.  The  preparation  used 
was  an  infusion  made  with  12  parts  of  water 
to  1  part  of  the  plant,  to  which  a  little  pepper- 
mint was  added  to  improve  the  taste.  Of  this 
a  tablespoonful  was  prescribed  every  two  hours. 
In  no  case  were  any  unpleasant  by-effects  pro- 
duced, though  sometimes  the  use  of  the  medi- 


ETHYL  CARBAMATE 

EUCASIN 


434 


cine  was  continued  for  some  weeks.    The  active 
principles  of  the  plant  are  stated  to  be  "  an 
ethereal  oil,  a  bitter  principle  called  geramin, 
and  tannic  acid." 
ETHYL     CAE.BAMATE.— See     Uke- 

TBANB. 

ETHYL  CHLOK.IDE.— In  addition  to  its 
use  as  an  anaesthetic,  ethyl  chloride  is  often  of 
service  as  an  analgetic.  The  spray  may  be 
applied  repeatedly  to  the  painful  part,  which 
it  may  not  be  necessary  to  freeze.  Dr.  W.  C. 
Daisch,  of  Melbourne  (Australian  Medical 
Journal,  December  30,  1895),  has  found  it  to 
give  great  relief  in  such  forms  of  pain  as  that 
of  migraine,  the  headache  of  influenza,  and 
toothache.  It  will  relieve  the  pain  of  iritis  or 
conjunctivitis  if  sprayed  round  the  orbit.  In 
epididymitis  it  relieves  and  reduces  inflamma- 
tion, and  it  has  been  used  in  meningitis  and 
sunstroke.  Itching,  pleurodynia,  and  the  pain 
of  shingles  may  be  relieved  by  its  use.  In 
spasmodic  dyspncea,  asthma,  and  hiccough  it 
should  be  sprayed  round  the  base  of  the  chest, 
says  Dr.  Daisch,  who  adds  that  it  will  stop  epi- 
staxis  if  applied  to  the  base  of  the  nose,  or 
sprayed  directly  into  the  nostrils,  and  might 
be  advantageously  used  in  persistent  bleeding 
after  tooth  extraction. 

According  to  Dr.  Daisch,  ethyl  chloride  is 
very  serviceable  as  a  dental  ancesthetic.  Before 
it  is  applied,  he  says,  the  gum  should  be  thor- 
oughly dried  and  smeared  with  vaseline,  and 
the  neighbouring  parts  protected  by  packing 
with  wool.  The  patient  is  instructed  to  breathe 
through  the  nose.  During  thawing,  care  must 
be  observed  in  the  use  of  hot  water ;  if  it  is 
used  too  hot  or  too  soon,  sloughing  may  result. 
For  the  extraction  of  a  tooth  the  gum  may  be 
frozen  on  each  side  of  the  tooth ;  it  checks 
Heeding  in  addition  to  its  action  as  an  anaes- 
thetic. It  is  said  not  to  be  necessary  to  spray 
into  the  mouth  at  all  to  prevent  pain  in  ex- 
tractions. If  the  jet  is  thrown  on  to  the  jaw 
outside,  near  the  entrance  of  the  dental  nerve 
in  front  o£  the  ear  for  the  upper,  behind  the 
ramus  of  the  inferior  maxilla  for  the  lower 
jaw,  anaesthesia  of  the  whole  jaw  on  one  side 
will  be  caused,  and  teeth  may  be  extracted 
painlessly,  says  Dr.  Daisch;  he  remarks  that 
this  is  useful  in  the  case  of  molars,  which  are 
not  so  accessible  to  the  spray  as  the  front 
teeth. 

ETHYLENE     PEBIODIDE.— See    Di- 

lODOFORH. 

ETHYLURETHANE.— See  Urethane. 

ETJCAINE,  CioHt^NO,,  is  the  methyl  ester 
of  a  benzoylated  oxypiperidinecarbonic  acid. 
The  hydrochloride  obtained  by  crystallization 
from  a  methyl-alcohol  solution  bears  the  for- 
mula CioHa,N04.HCl.H02.  Eucaine  is  insolu- 
ble in  water,  but  dissolves  freely  in  alcohol,  in 
ether,  in  chloroform,  and  in  benzene.  Evapo- 
rated from  its  ethereal  solution,  it  appears  in 
large,  brilliant,  colourless  crystals,  which  melt 
at  219°  F.  It  combines  with  mineral  acids  to 
form  more  or  less  freely  soluble  salts,  also 
crystalline  in  character.  Eucaine  hydrochlo- 
ride occurs  in  the  form  of  brilliant  platelets  or 


crystals  which  dissolre  readily  in  six  parts  of 
water  at  the  temperature  of  the  room.  There 
are  some  points  of  chemical  similarity  and 
difference  between  the  hydrochloride  of  cocaine 
and  that  of  eucaine.  Both,  in  solution,  change 
in  colour  to  yellow  aud  orange-red  when  boiled 
with  ferric  chloride.  The  addition  of  a  5-per- 
cent, solution  of  chromic  acid  to  a  solution  of 
eucaine  gives  rise  to  a  beautiful  yellow,  crys- 
talline precipitate.  With  cocaine  it  does  not. 
Again,  a  solution  of  the  eucaine  salt,  treated 
with  a  10-per-cent.  solution  of  potassium  iodide, 
presents  at  first  a  milky  turbidity,  and  gradu- 
ally deposits  fine  colourless  plates  after  stand- 
ing. In  this  respect  it  differs  from  cocaine. 
The  hydrochloride  of  eucaine  is  stable  in  the 
air,  and  it  does  not  undergo  decomposition  or 
change,  as  cocaine  does,  when  subjected  to  boil- 
ing. Cocaine,  as  is  well  known,  splits  up  into 
benzoylecgoniu  and  methyl  alcohol,  which  ren- 
ders its  subsequent  use  upon  mucous  mem- 
branes irritating.  Solutions  of  eucaine  salts 
remain  clear,  moreover,  and  require,  therefore, 
no  preservative  agent  to  be  added. 

Dr.  Gaetano  Vinci,  of  Messina,  as  a  result 
of  clinical  and  laboratory  experiments,  finds 
(Therapeutische  Monatshefte,  June,  1896)  that  a 
solution  of  eucaine  hydrochloride  of  a  strength 
of  from  2  to  5  per  cent,  induces  prompt  anass- 
thesiaof  the  conjunctiva  and  cornea  in  from  one 
to  three  minutes.  The  anassthesia  lasts  from 
twenty  to  thirty  minutes  and  may  be  prolonged 
by  the  further  application  of  the  solution.  The 
pupil  does  not  become  dilated,  and  during  the 
local  anaesthesia  reacts  normally  to  light.  Irri- 
tation of  the  conjunctiva  is  almost  always  ab- 
sent, but  the  observer  reports  an  occasional 
hyperaemia  following  the  use  of  cocaine. 

The  effect  of  large  or  medium  doses  upon 
animals  is  a  general  excitation  of  the  central 
nervous  system,  followed  ultimately  by  pa- 
ralysis. Severe  tonic  and  clonic  convulsions 
sometimes  appear,  which  are  succeeded  by 
paralysis.  Some  central  irritation  of  the  vagus 
nerve  diminishes  the  frequency  of  the  heart's 
beats,  and  because  of  the  irritation  of  the  vaso- 
motor system  of  nerves  the  blood-pressure  rises. 
In  Vinci's  experiments,  only  fatal  doses  suc- 
ceeded in  giving  rise  to  a  sudden  diminution 
of  the  blood-pressure.  When  doses  of  from 
^  to  i  of  a  grain  for  each  thirty-five  ounces  of 
the  animal's  weight  are  given,  coma,  dyspncea, 
and  opisthotonos,  with  paresis  of  the  posterior 
limbs,  supervene.  Fatal  doses  kill  by  respira- 
tory failure  after  a  preliminary  hastening  of 
the  respiration  with  marked  dyspnoea.  In  man, 
toxic  symptoms  have  never  been  evoked,  and  if 
it  is  given  in  therapeutic  doses — according  to 
Kiesel  as  much  as  30  grains — no  bad  effects 
upon  the  heart  or  respiration  are  likely  to 
follow. 

Vinci  points  out  the  similarity  of  the  physi- 
ological action  of  eucaine  and  that  of  cocaine, 
with  their  differences.  Eucaine  is  distinctly 
less  poisonous  to  man  than  cocaine,  and  of 
animals  injected  with  the  same  quantities  of 
both  drugs,  those  treated  with  eucaine  sur- 
vived, those  with  cocaine  died.  Eucaine  pro- 
duces a  primary  decrease  in  the  frequency  of 
the  heart  s  action ;  cocaine  an  acceleration.   So 


435 


ETHYL  CARBAMATE 
EUCASIN 


far  as  their  anmslhetic  properties  are  concerned, 
the  two  drugs  are  very  similar,  except  that 
eucaine  possesses  the  advantage  that  it  favours 
hyperaemia,  while  cocaine  induces  ischaeraia. 
Upon  the  eye,  eucaine  does  not  cause  mydriasis, 
and  it  does  not  interfere  with  the  reaction  of 
the  pupil  to  light,  an  advantage  of  importance 
in  ophthaimological  operations. 

Upon  the  mucous  membranes  of  the  nose 
and  throat  eucaine  produces  a  strong  ana3s- 
thetic  influence,  with  no  bad  effect  upon  the 
heart.  Kiesel  obtained  good  results  in  dental 
work  with  solutions  of  the  hydrochloride  of  a 
strength  of  from  1  to  5  per  cent.  Schleich  has 
found  that,  in  the  same  strength,  it  produces  a 
strong  anaesthetic  influence  when  subcutane- 
ously  administered ;  for  infiltration  anmsfhesia 
— as  first  advocated  by  Schleich — a  solution  of 
the  strength  of  from  1  to  3  per  cent,  is  suf- 
flciently  strong.  He  believes  that  eucaine  will 
replace  cocaine  in  instances  where  its  simple  ap- 
plication upon  mucous  membranes  is  required. 

In  ophthaimological  practice  many  other 
workers  have  substantiated  Vinci"s  work. 
Carter,  o£  London  {Lancet,  July  11,  1896), 
highly  recommends  eucaine  hydrochloride  as 
being  less  toxic  than  cocaine  and  as  having  no 
mydriatic  effect,  two  advantages  which  appeal 
to  him  strongly.  In  cases  in  which  a  contrac- 
tion of  the  smaller  vessels  is  desired,  however, 
cocaine  had  better  be  employed.  Vollert 
(iliinchener  medicinische  Wochenschrift,  1896, 
No.  22)  has  seen  occasional  hyperaemia  follow 
the  local  use  of  eucaine  in  the  eye,  as  was,  how- 
ever, stated  in  Vinci's  original  paper  {Deutsche 
Medizinal-Zeitung,  April  27, 1896).  Anaesthesia 
of  mucous  membranes  follows  the  instillation 
of  eucaine  h3'drochloride  in  from  one  to  three 
minutes,  and  lasts,  according  to  different  ob- 
servers, from  ten  to  thirty  minutes. 

Gorl  {Therapeutische  Monatshefte,  July, 
1896)  has  used  eucaine  as  an  anaesthetic  for 
eystoscopic  work,  and  says  that  patients  com- 
plain at  first  of  some  irritation  and  burning, 
but  that  the  anaesthesia  is  as  profound  as  that 
of  cocaine.  He  used  a  0'5-per-cent.  solution. 
Cystoscopy  is  succeeded  by  a  slight  bleeding, 
winch  he  attributes  to  a  hyperaemia  induced  by 
the  eucaine.  He  finds  that  eight  cubic  centi- 
metres of  the  same  solution  occasion  some 
burning  in  the  urethea,  but  this  is  followed  by 
an  anSBsthesia  sufficiently  strong  for  the  manip- 
ulation of  instruments.  Gorl  has  also  found 
the  agent  satisfactory  in  laryngological  work. 

It  has  been  suggested  that  in  order  to  avoid 
the  smarting  sometimes  incident  to  the  use  of 
eucaine  on  raucous  membranes,  a  1-per-cent. 
solution  should  be  first  instilled,  and  this  fol- 
lowed in  from  two  to  three  minutes  by  the 
instillation  of  a  2-per-cent.  solution.  In  order 
to  overcome  the  ischaemia  produced  by  cocaine, 
Berger  has  proposed  this  formula  for  the  pur- 
poses of  local  anaesthesia : 


]J  Eucaine  hydrochloride,  ) 
~ 'e,  \ 


each.      3  grains ; 


Cocaine  hydrochloride, 

Distilled  water 300  minims. 

M. 

For  the  other  requirements  of  local  anes- 
thesia, eucaine  seems  to  be  the  equal  of  cocaine 


in  rapidity,  in  intensity,  and  in  duration.  It 
may  be  employed  for  subcutaneous  ana'sthesia 
in  any  part  of  the  body  in  strengths  of  from  1 
to  6  or  7  per  cent,  for  the  opening  of  abscegsen, 
the  removal  of  small  tumours  or  growths  of 
any  kind,  or  for  the  general  purposes  of  minor 
surgery,  with  perfect  safety.  The  writer  has 
recently  used,  subcutaneously,  a  6-per-cent.  so- 
lution for  the  extirpation  of  a  very  large  wart, 
and  perfect  anaesthesia  was  procured.  It  lasted 
twenty  minutes  and  allowed  of  extensive  sutur- 
ing. An  additional  virtue  of  the  hydrochlo- 
ride of  eucaine  rests  upon  the  fact  that  it  is 
not  decomposed  by  repeated  boiling,  and  may 
thus  be  sterilized  as  often  as  desired. 

The  dose  of  eucaine  is  the  same  as  (hat  of 
cocaine.  As  mentioned  above,  Kiesel  {Zahn- 
drztliche  Rundschau,  April  5, 1896 ;  New  York 
Medical  Journal,  May  9,  1896)  says  that  30 
grains  may  be  employed  safely  by  subcuta- 
neous or  submucous  injection. 

Samuel  JM.  Beicknee. 

EUCALYPTUS.— In  the  British  Medical 
Journal  for  August  29,  1896,  there  is  an  ab- 
stract from  an  Italian  journal  of  an  article  by 
Dr.  Monfrida  Musmeci,  who,  while  studying  the 
action  of  eucalyptus,  found  that  a  decoction  of 
the  leaves  and  a  solution  of  a  salt  of  strychnine 
formed  a  flocoulent  precipitate  of  a  clear  col- 
our, while  there  remained  above  a  solution  of 
citron-yellow  tint,  the  strychnine  at  the  same 
time  losing  completely  its  characteristic  bitter 
taste.  On  this  account  the  author  raised  the 
questions  of  whether  the  strychnine  lost  its 
toxic  action,  and  if  accordingly  eucalyptus 
could  be  used  as  an  antidote.  To  ascertain,  he 
carried  out  a  series  of  experiments  On  frogs, 
rabbits,  and  dogs.  He  found  that  a  solution 
of  nitrate  of  strychnine,  1  per  cent.,  when 
injected  with  a  Pravaz  syringe,  would  kill  a 
frog  in  from  eight  to  ten  minutes  after  a  dose 
of  O'OOl  of  a  gramme,  while  a  dog  was  killed 
in  thirty-nine  minutes  by  a  dose  of  O'OOl  of  a 
gramme  for  each  kilogramme  of  its  weight. 
When  a  decoction  of  eucalyptus  was  adminis- 
tered at  the  same  time  the  animal  survived 
the  same  dose  used  for  the  check  experiment, 
and  even  became  tolerant  of  a  much  larger 
dose.  In  other  experiments  the  eucalyptus 
was  administered  after  convulsions  had  ap- 
peared, and  then  these  became  much  less 
marked  and  even  disappeared.  Prom  these 
experiments  Musmeci  believes  that  eucalyptus 
has  a  true  antidotal  action  in  strychnine  poi- 
soni7ig,  and  recommends  that  practiciil  appli- 
cation should  be  made  of  it  by  using  a  decoction 
for  washing  out  the  stomach  in  such  eases. 

EUCASIN.— This  is  a  German  nutrient 
preparation  made  by  subjecting  the  casein  of 
milk  to  the  action  of  ammonia.  Dr.  A.  Cohn 
{Centralblatt  fur  imiere  Medicin,  July  11, 
1896 ;  New  Fork  Medical  Jourjial,  August  1, 
1896)  describes  it  as  a  white  powder  of  a  some- 
what gritty  aspect,  without  any  special  taste, 
and  having  a  faint  odour  of  milk.  Mixed  with 
cold  water,  it  forms  a  gelatinous  mass.  On 
shaking  it  with  boiling  water,  a  uniform  clear- 
white  solution  is  formed.  This  tastes  like 
groats,  but  is  more  glutinous. 


EUDOXINE 
GEOSOTE 


436 


He  has  used  it  in  the  form  of  a  mush  of 
oatmeal  or  rice,  to  each  plateful  of  which  a 
teaspoonful  of  eucasin  has  been  added,  to- 
gether with  a  little  salt.  This  mixture  is  read- 
ily taken  two  or  three  times  a  day.  A  choco- 
late preparation  containing  20  per  cent,  of 
eucasin  has  been  put  on  the  market  by  Hart- 
wig  &  Vogel,  of  Dresden.  Dr.  Cohn  gives  brief 
accounts  of  several  eases  in  which  he  has 
found  eucasin  of  advantage,  including  cases 
of  pulmonary  and  laryngeal  tuberculous  dis- 
ease, armemia,  peritoneal  irritation,  typhlitis, 
parametritis,  and  perimetritis.  Particularly 
striking  were  the  effects  of  its  employment 
in  a  case  of  acute  anaemia  following  abor- 
tion. 


Dr.   E.   Salkowsky  (Deutsche 

Wochenschrift,  April  9,  1886 ; 

Wochenschrift,  April  19,  1896)  thinks  that  one 
of  the  advantages  of  eucasin  is  that  it  con- 
tains no  nuclein,  so  that  it  is  well  fitted  as  an 
article  of  diet  for  persons  of  the  uric-acid  di- 
athesis arid  predisposed  to  gout. 

ETJDOXINE.— This  is  a  uosophene  com- 
pound said  by  Professor  Coblentz  to  contain 
53-9  per  cent,  of  iodine  and  14'5  per  cent,  of 
bismuth.  It  is  described  as  a  reddish-brown 
powder,  odourless  and  tasteless,  employed  as 
a  gastric  and  intestirtal  antiseptic.  Prom  3 
to  6  grains  may  be  given  to  an  adult  three 
times  a  day  (Presse  medicale  ielge,  August  11, 
1895 ;  Revue  illustree  de  polyteehnique  medi- 
cate, October  31,  1895). 

EUaUININE.  —  This  substance  is  de- 
scribed by  von  Noorden  {Gentralblatt  fur 
innere  Medicin,  November  28,  1896 ;  New 
Fork  Medical  Journal,  January  2,  1897)  as 
the  ethylcarbonic-acid  ester  of  quinine,  having 

the  constitutional  formula  CO  <,^r^'  ti   xt  r> 

L'U2ona3J^J  aU 

It  occurs  in  white  needles  which  are  soluble 
with  difficulty  in  water,  but  readily  soluble  in 
alcohol,  in  ether,  and  in  chloroform.  It  has 
an  alkaline  reaction  and  forms  crystalline 
salts  with  acids.  The  chloride  is  readily  sol- 
uble in  water,  the  sulphate  dissolves  with 
some  difficulty,  and  the  tannate  is  almost  in- 
soluble. 

The  alkaloid  itself,  which  is  the  form  in 
which  von  Noorden  has  used  euquinine  most 
largely  is  entirely  tasteless  at  fii-st,  but  has  a 
slightly  bitter  after-taste,  reminding  one  of  the 
taste  of  a  very  weak  solution  of  quinine.  If  it 
is  taken  in  sherry,  milk,  soup,  cocoa,  or  the 
like,  he  says,  no  unpleasant  taste  is  perceived. 
Healthy  persons  can  take  15  grains,  and  in 
most  instances  twice  that  amount,  daily  with- 
out experiencing  any  unpleasant  feeling  in  the 
head.  Even  after  a  prolonged  use  of  these 
doses  there  were  no  disturbances  attributable 
to  them  in  any  of  von  Noorden's  patients. 

Euquinine  is  said  to  be  a  derivative  of  qui- 
nine, of  which  it  has  the  characteristic  reme- 
dial virtues  without  any  of  the  unpleasant 
properties  of  that  drug.  This  is  implied  in  its 
name.  It  may  be  used  in  all  cases  in  which 
guinine  is  indicated,  but  for  any  reason  is  ob- 
jectionable. 

ETTRYTHBOL.— See  Splenic  extract. 


EXEBCISE.— For  the  Schott  method  of 
treating  chronic  heart  disease,  see  under  Baths 
(Supplement). 


riLMOGEN'. — This  fanciful  name  has  been 
applied  to  an  English  preparation,  apparently- 
proprietary.  According  to  the  British  Medi- 
cal Journal  for  December  19, 1896,  it  consists 
of  a  solution  of  pyroxylin  in  acetone,  and  in 
order  to  render  flexible  the  film  of  nitrated 
cellulose  left  after  evaporation  of  the  acetone, 
a  small  quantity  of  oil  is  added.  The  solution 
possesses  considerable  solvent  powers  upon 
many  drugs  employed  in  dermatological  prac- 
tice, such  as  salicylic  acid,  resorcin,  iodoform, 
pyrogallic  acid,  mercury  bichloride,-  chrysaro- 
bin,  cocaine,  ichthyol,  and  carbolic  acid.  Its 
viscosity  permits  of  the  easy  suspension  of 
such  insoluble  substances  as  sulphur,  lead  ace- 
tate, zinc  oxide,  etc.  Eilmogen,  when  painted 
on  the  skin,  quickly  forms  a  film,  which  ad- 
heres firmly,  is  flexible,  and  is  unaffected  by 
washing  with  water;  the  film  can  be  removed 
easily  by  means  of  alcohol. 

FORMALDEHYDE.— Dr.  Elmer  Grant 
Horton,  of  the  laboratory  of  hygiene  of  the 
University  of  Pennsylvania  [Medical  News, 
August  8,  1896),  has  experimented  with  for- 
maldehyde as  a  means  of  disinfecting  books. 
His  conclusions  are  as  follows  : 

1.  Books  can  be  disinfected  in  a  closed  space 
simply  by  vapour  of  commercial  formalin  by 
using  1  cubic  centimetre  of  formalin  to  800 
cubic  centimetres,  or  less,  of  air.  2.  The  vapour 
of  formalin  is  rapid  in  its  disinfecting  action. 
The  effect  produced  in  the  flrst  fifteen  min- 
utes is  practically  equivalent  to  that  observed 
after  twenty-four  hours.  3.  An  increase  in 
the  amount  of  air  to  each  cubic  centimetre  of 
formalin  is  not  counterbalanced  by  an  increase 
in  the  length  of  time  of  exposure.  4.  In  case 
the  disinfection  has  been  incomplete,  the  vital- 
ity of  the  organisms  has  been  so  weakened 
that  they  survive  only  if  transferred  in  a  few 
hours  to  media  suitable  for  their  development. 
5.  The  use  of  vapour  of  formalin  has  not 
been  found  detrimental  to  the  books,  and  it  is 
not  objectionable  to  the  operator  beyond  caus- 
ing a  temporary  irritation  of  the  nose  and 
eyes,  somewhat  similar  to  that  produced  by 
ammonia. 

Dr.  J.  N.  Hurty,  of  Indianapolis  (Indiana 
Medical  Journal,  December,  1896),  speaks  of  a 
lamp  invented  by  Professor  F.  C.  Robinson,  of 
Bowdoin  Col  lege,  as  probably  the  best  formalde- 
hyde lamp  thus  far  devised. 

Dr.  W.  S.  Alexander,  of  Oxford,  Ohio  (New 
York  Medical  Joui-nal.  January  9,  1897),  re- 
ports having  cured  a  rebellious  case  of  pruri- 
tus vulvm  with  formaldehyde.  He  says  also 
that  cases  of  whooping-cough  are  treated  suc- 
cessfully by  spraying  with  an  atomizer  three 
times  daily  for  fifteen  minutes  at  a  time,  using 
a  1-per-cent.  solution.  He  speaks  of  formal- 
dehyde as  surpassing  all  other  remedies  in 
the  treatment  of  hay-fever — spraying  with  a 
half-per-cent.  solution'  and  directing"  the  pa- 


437 


EUDOXINE 
GEOSOTE 


tient  to  inhale  the  fumes  of  a  3-per-cent.  so- 
lution. 

FORMAIiOSE.— See  Formaldehyde. 

FORMOGELATIN  is  stated  {British,  Med- 
ical Journal,  December  19,  188())  to  be  a  com- 
pound of  formaldehyde  and  gelatin.  It  is  a 
gray,  somewhat  gritty,  mobile,  and  odourless 
powder,  intended  to  be  used  in  the  dressing  of 
wounds  as  a  substitute  for  iodoform.  It  is  said 
to  be  a  convenient  preparation  of  formaldehyde 
in  a  dry  form.     Cf.  Glutol. 

FORMYL    CHLORIDE.— See    Chloro- 

FORM. 

FORMYIi  TRIBROMIDE.— See  Beomo- 

FOEM. 

FORMYI,  TRIIODIDE.— See  Iodoform. 
FRAXININ.— See  under  Manna. 


GA.DXJOL.— See  Mobehuol. 
GALACTOSE.— See  under  Shgae  (vol.  ii, 
page  235)._ 

GALACTOTHERAPY.— See  under  Se- 
EUM  TREATMENT  (vol.  ii,  page  187). 

GARGLES. — In  a  paper  read  before  the 
British  Laryngological,  Khinological,  and  Oto- 
logical  Association,  Mr.  Lennox  Browne  (Jour- 
nal of  Laryngology,  Rhinology,  and  Otology, 
March,  1896;  New  York  Medical  Journal, 
March  21,  1896)  argued  in  favour  of  abolishing 
gargling  in  the  treatment  of  diseases  of  the 
throat  by  general  practitioners.  He  said  that 
for  the  purpose  of  laving  the  posterior  pillars 
and  wall  of  the  pharynx  von  Troltseh's  method 
must  be  used.  The  following  were  the  direc- 
tions :  "  Take  a  portion — say  a  tablespoonful 
— of  the  gargle  in  the  mouth,  hold  it  in  the 
back  of  the  throat  with  the  head  thrown  back  ; 
then,  closing  the  nose  with  the  finger  and 
thumb  to  prevent  entrance  of  air.  open  the 
mouth  and  make  the  movements  of  swallow- 
ing without  letting  the  liquid  go  down  the 
throat." 

But  this  process,  says  Mr.  Browne,  is  by  no 
means  easy  to  carry  out  efficiently,  and  is  im- 
possible when  any  acnte  inflammation  of  the 
throat  is  present,  on  account  of  the  pain  caused 
by  the  necessary  muscular  action.  The  mus- 
cular acts  required  for  ordinary  gargling  are 
entirely  irregular,  he  adds,  being  unlike  those 
called  for  in  the  exercise  of  the  normal  func- 
tions, such  as  breathing,  speaking,  swallowing, 
or  even  laughing.  In  all  cases,  therefore,  of 
acute  inflammatory  disease  of  the  throat  in 
which  the  act  of  swallowing  causes  severe 
pain,  and  even  movements  of  the  tongue  are 
attended  with  discomfort,  and  in  cases  (such 
as  those  of  amygdalitis)  in  which  the  mouth 
can  be  opened  but  very  slightly,  the  act  of 
gargling  by  any  method  can  not  but  tend  to 
increase  the  inflammation  and  the  patient's 
distress. 

Gargles  are  also  contra-indicated,  says  Mr. 
Browne,  in  cases  where  the  patient  requires  to 
be  kept  in  the  recumbent  posture  in  bed — 
notably  in  cases  of  diphtheria,  in  which  cardiac 


failure  has  to  be  especially  guarded  against — 
since  the  act  requires  him  to  rise  from  that 
position.  And  as,  according  to  the  well-known 
law,  paralytic  sequelae  attack  earliest  and  to 
the  greatest  extent  muscles  in  proportion  to 
the  constancy  of  their  use,  palatal  and  faucial 
paralyses,  early  and  frequent  as  they  always 
are,  can  not  but  be  accentuated  by  the  irreg- 
ular and  excessive  functional  exercise  involved 
in  the  act  of  gargling. 

Lastly,  gargles,  however  employed,  whether 
by  the  ordinary  method  or  by  von  TrOltsch's, 
lie  says,  can  not  be  safely  prescribed  unless 
the  ingredients  are  harmless  should  any  portion 
be  inadvertently  swallowed.  All  these  objec- 
tions to  gargles  in  the  adult  apply  with  still 
greater  force,  he  adds,  in  the  case  of  children, 
in  whom  the  act  of  gargling  is  in  the  majority 
of  cases  simply  impossible.  Gargles,  therefore, 
should  be  employed  only  as  emollient  and 
antiseptic  mouth  washes,  harmless  ingredients 
being  used.  As  a  substitute  Mr.  Browne  would 
recommend  the  more  general  use  of  mouth  ir- 
rigations, sprays,  lozenges,  and,  in  the  case  of 
children,  medicated  confections. 

In  the  discussion  that  followed.  Dr.  Dundas 
Grant  said  that  there  was  one  aspect  of  the 
gargling  question  which  he  thought  would 
come  up,  to  which  we  might  attach  at  least  a 
theoretical  and  also  a  practical  value,  which 
was  that,  in  practising  von  Troltseh's  method, 
it  was  not  altogether  useless  as  a  method  of 
massage,  and  there  was  a  school  in  which  mas- 
sage of  the  throat  was  given  a  prominence 
which  he  thought  was  quite  unnecessary,  but 
still  not  to  be  despised.  He  stated  that  he  had 
seen  some  advantage  from  the  employment  of 
massage  of  the  outside  of  the  pharynx ;  pos- 
sibly, also,  the  Eustachian  tubes  might  be  im- 
proved by  the  patient's  practising  von  Troltseh's 
method  of  gargling  at  the  same  time.  The 
swallowing  part  of  it  was,  he  said,  the  most 
essential  feature,  and  he  thought  that  in  sub- 
acute cases  where  a  degree  of  congestion  and 
thickening  remained  we  might  yet  find  it  of 
some  use,  although  it  might  be  limited. 

GELANTH,  GELANTHTJM.— See  under 

Varnishes. 

GEOSOTE.— This  substance  is  described 
by  Dr.  Rieck,  of  Bassum  (Deutsche  Medizinal- 
Zeitung,  December  24, 1896 ;  New  York  Medical 
Journal,  January  23,  1897),  as  the  valerianio- 
acid  ester  of  guaiacol,  a  yellowish,  oily  liquid 
of  the  specific  gravity  of  1-037,  but  slightly 
soluble  in  water,  but  readily  soluble  in  acid 
and  alkaline  liquids,  in  alcohol,  in  ether,  in 
benzene,  and  in  chloroform.  It  has  a  sweetish 
and  smoky  odour  and  a  sweetish  taste  passing 
into  a  slight  bitter,  unaccompanied  by  burn- 
ing and  not  persistent.  Applied  to  the  skin 
and  covered  with  gutta-percha  tissue,  it  is 
rapidly  absorbed  and  causes  no  irritation.  In- 
jected subcutaneously  in  amounts  of  from  15 
to  80  grains,  it  causes  transitory  burning  and 
does  not  give  rise  to  general  symptoms.  If 
the  injection  is  thrown  into  a  diseased  part, 
slight  oedema  with  a  sensation  of  heat  may  re- 
sult and  persist  for  a  few  days. 

Geosote  is  given  internally  in  3-grain  gelatin 


GLUCOSE 
GUAIACOL 


438 


Ccipsules.  It  is  said  not  to  disturb  the  stomach 
in  any  way  when  given  in  daily  amounts  of 
from  15  to  45  grains  and  used  continuously  for 
months,  and  not  to  give  rise  to  the  eructiitions 
occasioned  by  creosote — that  is.  Dr.  Rieck  has 
known  it  to  cause  eructations  in  only  one  in- 
stance, and  in  that  case  there  was  gaseous  dis- 
tention of  the  stomach  to  begin  with.  He 
says  he  has  given  as  much  as  75  grains  a  day 
without  giving  rise  to  any  unpleasant  effects. 
He  has  found  it  useful  iii  chlorosis,  acute  gas- 
tric and  intestinal  catarrh,  tuberculosis,  and 
articular  rheumatism. 

GLUCOSE.— See  under  Sugar  (vol.  ii,  page 
235). 

GLTJSIDE. — See  Saccharin. 

GIiTJTOIi.— This  is  a  German  proprietary 
preparation  consisting  of  gelatin  impregnated 
with  formaldehyde.  As  at  first  prepared,  it  was 
a  whitish  powder  insoluble  in  water;  it  is  now 
furnished  only  in  the  granular,  or  "grated" 
form,  which  i)r.  Schleich  considers  preferable 
to  the  powder.  It  is  highly  recommended  as 
an  antiseptic  application  ro  loounds,  ulcers, 
and  weeping  affections  of  the  skin  and  mucous 
memhrajies.  J)t.  C.  L.  Schleich,  of  Berlin,  who 
introduced  it  into  practice  (Therapeutische 
Monatshefte,  February,  1896),  says  that  when 
it  is  in  contact  with  living  animal  tissue  the 
action  of  the  cells  of  the  tissue  is  to  decompose 
the  compound  and  set  formaldehyde  free. 
Glutei  has  been  found  to  be  particularly  effi- 
cacious in  sealing  up  lacerated  wounds,  even 
those  communicating  with  a  fracture.  Prob- 
ably glutei  is  substantially  the  same  thing  as 
formogelatin  {q.  v). 

GLYCERIN. — This  familiar  substance  oc- 
casionally acts  as  a  mild  poison,  even  when 
used  in  small  amounts.  Antichievich  (Archiv 
fur  Kinderheilkunde,  xx;  Fortschritte  der 
Medicin,  August  1,  1896)  reports  an  instance 
of  acute  nephritis  produced  by  it  in  the  case 
of  a  boy  who  was  being  treated  with  injections 
of  a  solution  of  iodoform  in  glycerin.  The 
nephritis  disappeared  after  three  weeks'  use  of 
a  milk  diet.  In  another  case  hjemoglobinuria 
came  on  after  the  second  injection,  and  there 
was  polyuria  for  eight  days.  Olive  oil  was  sub- 
stituted for  the  glycerin,  and  the  injections 
were  then  well  borne. 

Glycerin  is  incompatible  with  potassium  per- 
manganate. 

GLYCEEOPHOSPHATES.— During  the 

past  two  years  a  few  articles  have  appeared  in 
the  Paris  medical  journals  with  regard  to  the 
use  of  the  glycerophosphates  of  calcium,  so- 
dium, potassium,  magnesium,  and  iron,  which 
were  first  brought  to  the  notice  of  the  profes- 
sion by  JI.  Robin,  in  the  Bulletin  de  I'Academie 
de  medecine  de  Paris,  April  24,  1894,  and  have 
since  then  been  recommended  by  him  as  of 
great  therapeutic  value. 

Comet  (Progres  medical,  August  11,  1894) 
gives  a  description  of  the  glycerophosphate  of 
calcium  and  of  the  method  of  its  preparation 
which  may  perhaps  be  taken  as  applying  to  the 
glycerophosphates  in  general.  It  is  a  white 
powder,  slightly  crystalline,  soluble  in  fifteen 


parts  of  cold  water,  almost  insoluble  m  boil- 
ing water,  and  insoluble  in  alcohol.  The  first 
step  in  its  preparation  is  the  manufacture  of 
glycerophosphoric  acid.  A  mixture  of  3,600 
grammes  of  pure  glycerin  and  3,000  grammes 
of  phosphoric  acid  is  maintained  at  a  temper- 
ature of  from  100°  to  110°  C.  for  six  days,  and 
thoroughly  shaken  three  or  four  times  each 
day.  It  gradually  becomes  darker  in  colour 
and  gives  off  a  vapour  until,  on  the  fifth  day, 
it  is  brown  and  the  vapour  ceases  to  rise. 
After  the  sixth  day  the  mixture  is  allowed  to 
cool.  It  then  becomes  clear  and  transparent, 
and  is  known  as  glycerophosphoric  acid.  A 
solution  of  500  grammes  of  calcium  carbonate 
in  2  litres  of  water  is  now  added  very  slowly  to 
the  acid  and  causes  copious  effervescence,  from 
the  formation  of  a  large  amount  of  carbon  di- 
oxide. This  process  is  continued  for  two  days, 
at  the  end  of  which  time  the  preparation  is 
filtered,  neutralized  with  a  weak  solution  of 
milk  of  lime,  and  precipitated  by  means  of 
alcohol.  This  precipitate  is  gray  in  colour 
and  resembles  glyoerole  of  starch.  It  is  poured 
out  at  the  end  of  an  hour,  redissolved  in  water, 
filtered,  and  evaporated  at  a  low  temperature. 

Robin  states  that  he  has  experimented  with 
the  salts  of  glycerophosphoric  acid  already 
mentioned,  both  singly  and  in  combination, 
since  1888.  He  was  induced  to  investigate 
their  therapeutic  action  by  the  observations 
that  a  relatively  large  quantity  of  phosphorus 
in  combination  with  organic  substances  could 
be  found  in  the  urine  of  certain  patients,  a 
condition  which  seemed  to  indicate  an  increased 
loss  of  the  lecithin  of  the  nervo^is  system,  and 
that  most  of  the  phosphorus  in  the  nervous 
system  was  to  be  found  in  the  form  of  glycero- 
phosphoric acid,  which  is  one  of  the  constitu- 
ents of  lecithin.  Another  consideration  which 
impelled  him  to  the  investigation  was  that 
drugs  which  contained  phosphorus  were  as- 
similated with  some  difficulty,  while  an  organic 
compound  which  resembled  in  form  that  pres- 
ent in  the  nervous  system  might  be  more  ac- 
ceptable and  productive  of  greater  benefit. 

The  physiological  action  of  the  glycerophos- 
phates is  said  by  Robin  to  be  to  accelerate 
metabolism  and  the  nitrogenous  exchanges,  to 
favour  the  assimilation  of  albuminoid  sub- 
stances, and  to  increase  the  excretion  of  nitro- 
gen, which  tends  to  lower  the  proportion  of 
uric  acid  to  urea,  though  it  does  not  influence 
the  formation  of  uric  acid  to  any  extent.  They 
increase  the  oxidation  of  broken-up  sulphur 
products  and  the  elimination  of  sodium  chlo- 
ride. Possibly  they  favour  the  assimilation  of 
the  phosphates  in  the  food,  and  so  afford  a 
protective  influence  to  the  combined  phosphor- 
us in  the  nervous  system. 

The  indication  for  the  use  of  the  glycero- 
phosphates is  a  condition  of  nutrition  fre- 
quently met  with  in  many  and  diverse  diseases, 
but  not  always  present.  This  is  a  diminution 
of  nitrogen  metabolism  or  oxidation  changes 
in  the  tissues,  evidence  of  which  may  be  found 
in  an  increased  amount  of  phosphoric  acid  as 
compared  with  the  urea  in  the  urine.  When 
this  is  absent,  and  particularly  when  the  oppo- 
site  condition,  that    of   increased  oxidation 


439 


GLUCOSE 
GUAIACOL 


changes,  is  present,  the  use  of  these  remedies 
is  contra-indicated.  Hence  one  patient  with  a 
certain  disease  may  be  benefited  and  another 
harmed  by  tiie  administration  of  these  drugs. 
The  best  results  are  said  to  be  obtained  in 
exhaustion  of  the  nervous  system,  as  in  con 
valescenee  from  acute  diseases,  some  forms  of 
neurasthenia,  and  muscular  atrophy.  They 
have  been  used  in  nervous  asthma  from  various 
causes — chlorosis,  gout,  diabetes,  phthisis  pul- 
monalis,  obesity,  chronic  nephritis,  Addison's 
disease,  the  uric-acid  diathesis,  phosphaturia, 
and  phosphaturic  albuminuria.  They  are  said 
to  be  adequate  to  relieve  the  pain  of  lumbago, 
sciatica,  and  trigeminal  neuralgia,  and  also  the 
lancinating  paitis  of  locomotor  ataxia.  Lafage 
is  inclined  to  think  them  of  some  efficacy  as 
galactagogues. 

The  glycerophosphates  may  all  be  adminis- 
tered by  the  mouth,  and  the  calcium,  sodium, 
and  magnesium  salts  may  also  be  given  hypo- 
dermically.  For  the  latter  purpose  Robin 
recommends  a  5-per-cent.  solution  of  the  cal- 
cium salt  and  a  30-per-eent.  solution  of  the 
sodium  salt.  Of  these,  3  or  4  minims  may  be 
injected  daily.  As  the  solutions  are  not  of 
themselves  antiseptic,  but  readily  become  con- 
taminated, they  should  be  freshly  prepared, 
and  the  injections  made  with  antiseptic  pre- 
ca.utions.  Then  they  usually  cause  no  local 
disturbance  beyond  some  pain  occasionally. 

For  the  administration  of  glycerophosphates 
by  the  stomach  Robin  gives  several  formulae, 
of  which  the  following  is  one : 

5  Glycerophosphate  of  calcium. .  90  grains; 
"      of  sodium,         ) 
"      of  potassium,    j-  each.  30      " 
"      of  magnesium,  ) 

"      of  iron 15      " 

Tincture  of  St.  Ignatius's  bean .  30  drops ; 

Pepsin 45  grains ; 

Maltine 15      " 

Tincture  of  kola 2-i  drachms ; 

Syrup  of  cherries,  sufficient  to  make  8  fl.  oz. 
M.  Sig. :   A  tablespoonful   at    breakfast    and 
dinner. 

This  syrup  should  be  cherry-red.  clear,  and 
without  deposit.  The  principal  objections  to 
it  are  that  it  is  difficult  to  prepare  and  that  it 
is  very  expensive.  Moreover,  M.  Robin  does 
not  consider  the  commercial  preparations  of 
the  glycerophosphates  satisfactory. 

[The  following  prescription  is  recommended 
by  M.  Delage  {Nouveaux  remedes,  April  24, 
1896),  who  frequently  substitutes  it  for  the 
syrup : 

g  Glycerophosphate  of  calcium ...  5  grains ; 
"  "  "  "  magnesium  1'75  grain; 

"  iron 0-9 

Powdered  ignatia 0-5       " 

Maltine 0-9 

Pepsin 2-9  grains. 

M.  This  quantity  is  for  one  capsule,  and  the 
dose  is  a  capsule  taken  at  breakfast  and  din- 
ner. 

M.  Delage  considers  glycerophosphate  of 
iron  the  best  chalybeate  that  can  be  employed 
in  the  treatment  of  chlorosis  and  in  anmmia 
with  insufficiency  of  the  oxidation  of  nitroge- 


nous food.  It  is  preferable,  he  says,  to  give 
it  in  the  form  of  pills,  as  in  the  following 
formula : 

g  Glycerophosphate  of  iron. . .  from  0'9  grain 

to  1-75  grain; 

Powdered  rhubarb 0'9  grain ; 

Extract  of  cinchona 2'9  grains. 

M.  This  is  for  one  pill ;  three  such  pills  are  to 

be  taken  during  the  day.  one  at  each  meal.] 
Matthias  Lanckton  Poster. 

GXJAIACOCAINE.— Dr.  W.  J.  Morton 
{Dental  Cosmos.  January,  1896)  has  given  this 
name  to  a  compound  of  12  parts  of  guaiacol' 
and  1  part  of  cocaine  hydrochloride,  which  he 
has  used  successfully  as  a  local  ancesihetic  by 
cataphoresis. 

GUAIACOL  has  been  praised  by  Tavitain 
in  the  treatment  of  swelled  testicle  (MMecine 
moderne,  March  18.  1896).  He  applies  it  either 
pure,  in  amounts  of  from  30  to  45  grains,  or 
in  the  form  of  an  ointment,  as  follows : 

5  Guaiacol 5  parts  ; 

Vaseline 30   " 

M. 
In  mild  cases,  he  asserts,  three  or  four  applica- 
tions will  suffice. 

Dr.  S.  Solis-Cohen  {Philadelphia  Polyclinic, 
1896,  No.  16)  says  that  guaiacol,  used  early  in 
diphtheria,  seems  to  have  a  germicidal  effect 
and  to  prevent  the  spreading  oif  the  false  mem- 
brane. Ten  parts  each  of  guaiacol  and  sterilized 
olive  oil  are  used,  with  one  part  of  menthol. 
In  examinations  of  cultures  after  the  applica- 
tion of  this  mixture  no  bacilli  are  met  with 
where  they  had  been  found  before.  Prophy- 
lactically  the  mixture  seems  to  be  efficacious. 
In  follicular  amygdaliiis  it  seems  to  cut  short 
the  course  of  the  disease  if  applied  early  ;  and 
in  parenchymatous  amygdalitis  it  is  said  to 
mitigate  the  severity  of  the  disease. 

Dr.  Maldaresco,  of  Bucharest,  has  used  gua- 
iacol in  pneumonia,  apparently  with  excellent 
results  (cited  in  Journal  des praticiens,  March 
28,  1896).  He  paints  the  drug  over  the  poste- 
rior surface  of  the  thorax  corresponding  to 
the  area  of  pneumonic  infiltration.  In  from 
six  to  seven  hours  the. temperature  sinks  and, 
if  the  process  is  repeated  three  or  four  times 
daily,  the  temperature  remains  down.  At  the 
same,  time  the  cough  diminishes,  the  tongue 
becomes  moist  and  soft,  the  expectoration  is 
more  easily  accomplished,  and  the  sjiutum  be- 
comes more  fluid.  The  temperature  usually 
falls  from  two  to  three  degrees,  and  some- 
times not  more  than  two  applications  are 
necessary  to  achieve  this  result.  The  author 
has  never  seen  a  relapse  and  has  used  no  other 
drugs  during  this  treatment.  Maldaresco  has 
obtained  equally  good  results  with  the  same 
procedure  m pulmonary  gangrene  and  broncho- 
pneumonia. Should  repeated  applications  ir- 
ritate the  skin,  they  may  be  made  to  the  sides 
or  to  the  anterior  aspect  of  the  thorax.  The 
author  uses  a  mixture  of  guaiacol  and  almond 
oil,  the  latter  constituting  4  per  cent,  of  the 
mixture.  By  this  method  of  treatment  he  has 
had  83  recoveries  and  18  deaths  out  of  101  pa- 
tients. 

The  contention  that  guaiacol  is  an  anms- 


'GUAIECETIN 
HYDROCHLORIC   ACID 


440 


thetic  is  not  a  new  one.  Laurens  _ 
maladies  de  roreille,  xxii,  1896)  has  found  that 
the  drug,  applied  to  the  nasal  and  pharyngeal 
mucous  membranes  and  to  the  ear  in  a  5-per- 
cent, solution  in  olive  oil,  produces  local  anies- 
thesia  sufficient  for  the  performance  of  minor 
operations.  He  applies  it  on  probes  armed 
with  cotton  and  rubs  the  nose  and  pharynx 
with  it  briskly.  Anesthesia  appears  in  from 
fifteen  to  twenty  minutes.  In  the  ear  he 
places  5  or  6  drops  of  the  same  solution 
warmed  slightly  and  allows  it  to  remain  about 
twenty  minutes,  when  it  is  withdrawn  by  ab- 
sorbent cotton.  Paracentesis,  says  Laurens, 
may  then  be  done  painlessly. 

Dr.  J.  Petrasko  reports  an  abortion  in  a 
woman  twenty-nine  years  of  age,  three  months 
pregnant,  who  received  i  of  a  grain  of  pure 
guaiacol  twice  daily  in  addition  to  an  infusion 
of  senega  (cited  in  'New  York  Medical  Journal, 
June  27,  1896).  The  patient  was  suffering 
from  an  infiltration  of  the  apex  of  the  left 
lung.  On  the  eighth  day,  after  she  had  re- 
ceived in  all  13  grains  of  guaiacol,  abortion 
took  place  which  could  not  be  accounted  for 
in  any  other  way  than  as  having  been  due  to 
the  influence  of  the  drug.  The  reporter  re- 
marks that  phenol  and  its  derivatives  exert  a 
paralyzing  action  on  the  vaso-motor  centres,  so 
that  they  may  cause  abortion  by  inducing  de- 
fective nutrition  of  the  foetus.  It  js  added 
that  the  patient  was  of  a  nervous  nature  and 
may  have  had  an  idiosyncrasy  for  guaiacol. 

[Dr.  E.  K.  Morris,  of  Sturgeon  Bay,  Wiscon- 
sin {Medical  News,  January  9,  1897),  reports 
having  used  guaiacol  for  rhus  poisoning  in  two 
cases.  The  first  patient  was  a  man,  forty-five 
years  old,  suffering  from  an  aggravated  form 
of  the  poisoning,  the  face  being  swollen  to 
such  an  extent  as  to  wholly  obliterate  the  fea- 
tures, and  the  eyes  being  entirely  closed.  Dr. 
Morris  made  an  application  of  zinc-oxide  oint- 
ment, and  ordered  applications  of  a  solution 
of  3  drachms  of  carbonate  of  sodium  in  3  oz. 
of  water,  on  absorbent  cotton.  The  result  was 
negative.  On  the  third  day  after  the  onset  he 
made  an  application  of  pure  guaiacol,  freely 
painting  it  over  the  inflamed  area  with  a  cam- 
el's-hair  brush,  and  then  covering  the  parts. 
On  the  next  day  there  was  marked  ameliora- 
tion of  the  trouble,  and  on  the  fourth  day 
after  beginning  the  guaiacol  treatment  the 
poisoning  and  its  resulting  inflammation  had 
entirely  disappeared. 

The  other  patient  was  a  boy  of  eleven  years 
with  the  same  trouble,  one  side  of  the  face  and 
neck  being  affected  to  about  the  same  extent 
as  in  the  previous  ease.  Dr.  Morris  used  gua- 
iacol, and  on  the  second  day  the  boy  was  out 
and  at  school,  the  trouble  having  entirely 
abated. 

G-uaiacol  cinnamate. — See  Sttbacol.] 

Guaiacol  phosphate,  PO(C6H40CHsO)a, 
occurs  in  hard,  colourless  tablets,  melting  at 
98°  C.  It  is  insoluble  in  water,  in  alcohol, 
and  in  ether,  but  is  easily  soluble  in  acetone 
and  in  chloroform.  The  dose  has  not  been 
determined. 

Guaiacol  succinate  is  an  ester  of  guaiacol. 
Its  formula  is  CiHi04(C6H40CHs)j.    Its  crys- 


tals are  silky  needles.  It  is  insoluble  in  water, 
slightly  soluble  in  ether  and  in  alcohol,  and 
freely  so  in  chloroform. 

Samuel  M.  Brickneb. 

GXTAIECETIN.  —  According  to  Dr.  J. 
Strauss  {Centralblatt  fUr  innere  Medicin,  June 
20,  1896;  New  York  Medical  Journal,  July 
111  1896),  who  has  experimented  with  this  sub- 
stance, which  is  a  pyrocatechin-monaoetie  acid, 

0^^,(9'!^'^^'^^,   obtained  by   introducing 

the  carboxyl  group  into  guaiacol,  it  is  a  taste- 
less powder.  He  gave  it  in  doses  of  7  grains, 
several  times  a  day.  On  the  whole,  he  thinks 
that  it  is  not  quite  so  apt  to  produce  unpleas- 
ant effects  as  either  creosote  or  guaiacol  car- 
bonate. 

GYMNASTICS.— For  the  Sohott  method 
of  treating  chronic  heart  diseases,  see  under 
Baths  (Supplement). 

GYMNEMA. — The  leaves  of  Oymnema 
silvestre,  ati  Bast  Indian  asclepiadaceous  shrub, 
when  chewed,  have  the  effect  of  temporarily 
destroying  the  sense  of  taste  for  sweet  and 
bitter  substances.  Their  active  principle,  gym- 
nemic  acid,  C3H66O12,  has  the  same  property, 
and  a  13-per-cent.  solution  of  the  acid  in  water 
containing  enough  alcohol  to  dissolve  it  has 
been  employed  as  a  mouth-wash  to  dissipate 
the  taste  of  bitter  medicines  (Coblentz,  op.  cii.). 


HEAT. — The  local  application  of  dry  hot 
air  in  the  treatment  of  rheumatism  has  lately 
been  attended  with  most  gratifying  results. 
It  is  essential  that  the  hot  air  should  be  as  dry 
as  possible ;  otherwise,  it  will  cause  pain. 
Special  appliances  have  been  devised  for  dry- 
ing and  heating  the  air,  and  for  restricting  its 
contact  with  the  body.  At  a  recent  meeting 
of  the  Harveian  Society  of  London  (British 
Medical  Journal,  November  21,  1896;  New 
York  Medical  Journal,  December  12, 1896)  Dr. 
Knowsley  Sibley  presented  a  woman,  twenty-six 
years  old,  who  had  been  a  complete  cripple  from 
rheumatism  for  nearly  three  years.  Her  mother 
and  her  mother's  grandfather  had  suffered 
from  the  same  complaint!  The  patient  had  had 
very  fair  health  up  to  three  years  before.  She 
had  never  been  laid  up  with  fever  and  there 
was  no  cardiac  lesion.  She  had  been  for  many 
months  under  treatment  at  Bath,  but  without 
getting  any  better.  She  was  sent  up  to  Lon- 
don for  treatment  on  September  30,  1896.  On 
her  admission,  the  following  note  was  made : 
"  The  patient  has  used  a  pair  of  crutches  for 
two  years,  and  can  just  manage  to  get  about 
on  the  level  with  the  aid  of  these ;  she  can  not 
get  up  or  down  stairs,  wash  or  dress  herself,  or 
do  her  hair.  She  feeds  herself  with  great  dif- 
ficulty, and  only  with  a  large  spoon  and  fork, 
as  she  can  not  get  either  hand  within  several 
inches  of  her  mouth.  She  can  not  rotate  the 
elbows,  which  are  nearly  fixed  at  right  angles. 
There  is  considerable  thickening  of  the  middle 
fingers  of  both  hands,  and  grating  and  limita- 
tion of  movements  at  the  shoulder  ioints. 
The  right  knee  is  ankylosed  nearly  at  a  right 


441 


GUAIECETIN 
HYDROCHLORIC   ACID 


angle ;  there  is  absolutely  no  movement  of  any 
kind  to  be  elicited ;  the  thigh  and  especially 
the  calf  muscles  of  this  leg  are  much  wasted  ; 
the  patient  can  just  touch  the  ground  with  the 
tip  of  the  toes,  but  is  unable  to  put  any  weight 
on  the  limb,  and  in  fact  can  not  raise  it  off 
the  bed  when  lying  on  her  back ;  there  is  con- 
stant pain  of  this  joint;  she  wears  a  gutta-per- 
cha splint  round  it  as  a  protection." 

The  localized  hot-air  treatment,  continues 
Dr.  Sibley,  was  begun  on  October  1st.  After  the 
second  application  it  was  possible  to  rotate  the 
left  elbow,  and  after  the  third  the  patient  was 
able  to  see  the  palms  of  both  hands,  which  she 
had  not  done  for  two  years.  After  the  sixth 
bath  she  was  able  to  do  her  front  hair,  and 
after  the  tenth  she  was  able  to  walk  a  few 
steps  without  her  crutches,  and  there  was  dis- 
tinctly some  movement  to  be  obtained  in  the 
knee  joint.  She  had  now  had  twenty-seven 
baths,  and  could  get  her  left  hand  all  over  her 
face,  head,  and  neck,  and  get  up  and  down 
stairs  with  ease.  There  was  also  a  fair  amount 
of  movement  in  the  right  knee  joint ;  the  pa- 
tient could  flex  and  extend  it  some  few  inches. 
All  these  results  had  been  obtained  without 
at  any  time  putting  her  under  an  ansesthetic 
and  breaking  down  the  adhesions,  as  was  origi- 
nally suggested ;  and  at  no  time  had  she  any 
pain  or  effusion  in  any  of  the  joints  under 
treatment.  Before  and  after  each  application 
of  the  dry  air,  which  was  heated  to  a  tempera- 
ture of  260°  P.,  the  limbs  were  gently  manipu- 
lated and  massaged.  She  had  been  taking 
some  syrup  of  iodide  of  iron,  and  the  bowels 
were  regulated  with  Condal  water. 

Dr.  Virgil  P.  Gibney  (Medical  Record,  Jan- 
uary 23,  1897)  reports  seven  eases  of  stiff  and 
painful  joints,  including  the  rheumatic,  the 
tuberculous,  and  the  traumatic,  also  a  case  of 
apparent  deformity  due  to  chronic  sciatica,  in 
which  he  has  applied  this  treatment  in  the 
Hospital  for  the  Ruptured  and  Crippled.  In 
all  these  cases  more  or  less  relief  from  pain 
and  stiffness  was  afforded,  and  in  several  of 
them  it  was  very  decided. 

HELIOTROPIN.— See  Pipeeonal. 

HOMOGrUAIACOL.— See  Ceeosol. 

HONEY.— Dr.  E.  Lerede  Chalke,  a  civil 
surgeon  of  Negapatam  (Indian  Medical  Rec- 
ord, May,  1896 ;  New  York  Medical  Journal, 
June  13,  1896),  says  that  he  has  had  hundreds 
of  oases  of  scorpion  stings  to  deal  with  and 
has  tried  various  remedies  to  relieve  the  sting- 
ing pain  and  burning  sensation  which  invari- 
ably are  the  chief  symptoms  for  which  relief 
is  sought,  and  he  finds  that  the  application  of 
honey  to  the  affected  part  acts  the  best,  pro- 
ducing almost  instant  relief.  The  stinging 
and  burning  sensations  vary  in  degree  accord- 
ing to  the  species  of  the  scorpion  which  causes 
the  sting.  He  has  seen  the  small,  pale,  red- 
dish-brown scorpions  in  the  ceded  districts 
evoke  unbearable  pain  in  the  part  stung,  while 
the  black,  huge  ones  so  common  in  the  Kur- 
nool  district  (about  six  inches  in  length,  with 
hair  on  the  back  and  claws  like  those  of  crabs) 
cause  great  agony  to  the  victim,  making  him 
simply  writhe  under  the  pain. 


He  recalls  the  case  of  a  delicate  middle-aged 
woman,  who  was  suffering  from  heart  disease, 
and  was  stung  by  one  of  the  black  kind,  a 
huge  monster  with  formidable  claws  and  a  big 
sting.  The  woman  was  carried  to  his  bunga- 
low in  great  agony,  cold  and  clammy,  and 
begged  of  him  to  relieve  her  of  the  intense 
pain  which,  she  said,  she  could  bear  no  longer. 
There  was  a  large  gathering  in  his  place  at 
the  time,  including  two  physicians.  He  im- 
mediately brought  the  honey,  which  he  applied 
gently  but  freely  over  the  affected  part.  The 
relief  was  almost  instantaneous,  to  the  aston- 
ishment of  the  patient  and  the  spectators,  par- 
ticularly the  physicians.  At  the  same  time  he 
gave  her  10  minims  of  chlorodyne  with  brandy, 
which  roused  her  spirits  within  a  short  time. 
He  applied  the  honey  again  after  an  interval 
of  five  minutes,  when  the  patient  expressed 
hei'self  nearly  rid  of  the  pain  and  comfortable. 

This,  he  says,  was  one  of  several  cases  he 
has  treated  with  honey,  and  he  has  always 
found  it  a  very  reliable  and  prompt  medica- 
ment. If  honey  is  not  procurable  at  the  time, 
a  sti'ong  solution  of  sugar  in  water  will  be 
found  a  very  effective  substitute.  He  has  also 
tried  over-ripe  plantains  squeezed  and  applied 
as  a  poultice  over  the  affected  part,  which  acts 
speedily  in  subduing  the  pain  and  burning 
sensation. 

HYDRIATICS.— For  the  Schott  method 
of  treating  chronic  heart  diseases,  see  under 
Baths  (Supplement). 

HYDROCHLOmC  ACID.— At  a  meet- 
ing of  the  American  Orthopsedio  Association 
held  in  IVIay,  1896  (New  York  Medical  Journal, 
August  8,  i896),  Dr.  Jerome  Hilton  Waterman 
reported  eight  cases  of  necrosis  of  hone  of  tu- 
berculous, origin  which  he  had  treated  by  the 
use  of  hydrochloric  acid  at  the  Hospital  for 
the  Ruptured  and  Crippled.  New  York,  eases 
some  of  which  had  not  done  well  under  the 
usual  methods  of  treatment.  In  some  of  these 
the  most  radical  operative  means  had  been  em- 
ployed, the  bone  being  thoroughly  curetted 
and  all  the  necrosed  tissue  supposed  to  have 
been  removed.  Sinuses  subsequently  formed, 
and  an  examination  under  anaesthesia  revealed 
the  fact  that  necrotic  bone  was  still  present. 
In  the  other  cases  of  the  series,  irrigation 
with  solutions  of  bichloride  of  mercury,  ap- 
plications of  hydrogen  peroxide,  packing  with 
various  kinds  of  gauze,  and  the  injection  of 
creosote  and  protonuclein  into  the  sinuses  had 
been  employed  for  many  months  without 
favourable  results,  either  in  decreasing  the 
amount  of  discharge  or  in  allaying  the  pro- 
gressive character  of  the  pathological  condi- 
tion. Confronted  with  these  unsatisfactory 
results.  Dr.  Waterman  resolved  to  try  the  ap- 
plication of  hydrochloric  acid.  The  theory 
was  that  the  action  of  the  acid  on  healthy 
bone  was  limited  to  the  decomposition  of  the 
mineral  constituents,  consisting  principally  of 
phosphates  and  carbonates  of  calcium,  together 
with  small  quantities  of  the  alkaline  salts,  not 
affecting  the  animal  matter,  and  that  in  ne- 
crosed bone  there  were  only  these  mineral  salts 
remaining,  to  which  the  chemical  action  of 


HYGIAMA 
ICHTHYOL 


443 


the  acid  was  more  particularly  confined,  dis- 
solving it  without  exerting  any  destructive 
influence  on  the  underlying  tissue.  In  this 
fact,  says  Dr.  Waterman,  lies  one  of  the  real 
merits  of  the  treatment,  for,  the  diseased  tissue 
being  removed,  the  process  of  repair  can  go  on 
unobstructed. 

The  acid  was  used  in  the  concentrated  form, 
whereas  before  for  the  most  part  dilute  so- 
lutions and  solutions  in  combination  with 
various  substances  had  been  used  by  other  sur- 
geons. The  number  ot  minims  injected  in 
each  individual  case  depended  on  the  amount 
of  bone  which  was  diseased  and  on  the  general 
condition  of  the  patient.  It  is  preferable,  says 
Dr.  Waterman,  not  to  use  the  acid  more  than 
twice  a  weeir,  owing  to  the  reaction  and  pain 
which  might  result.  However,  in  his  cases 
but  little  pain  was  experienced,  and  this  he 
attributes  in  part  to  the  fact  that  the  patients 
were  accustomed  to  more  or  less  manipulation, 
having  been  dressed  daily  for  several  months, 
and  also  to  the  anaesthetic  effect  of  the  acid. 
In  case  it  should  produce  undue  discomfort, 
he  says,  it  is  advisable  to  spray  the  tissues  with 
a  4-per-cent.  solution  of  cocaine  or  cocaine 
and  morphine  a  few  minutes  before  injecting 
the  acid,  or  else  employ  the  chloride-of-ethyl 
spray.  He  washed  out  the  sinus  thoroughly 
with  sterilized  water  in  order  to  remove  any 
pus  or  detritus,  and  thus  permit  the  acid  to 
penetrate  all  of  the  diseased  bony  tissue. 

An  ordinary  sterilized  glass  pipette  was 
found  convenient  for  the  application  of  the 
acid.  The  tube  was  introduced  to  the  bottom 
of  the  sinus  and  the  contents  were  deposited 
directly  upon  the  necrosed  structure.  After 
this  he  usually  allowed  a  minute  to  elapse, 
then  irrigated  the  sinus  with  a  saturated  solu- 
tion of  bicarbonate  of  sodium,  and  then  ap- 
plied a  wet  myrrh  dressing.  His  object  in 
using  the  latter  in  preference  to  dry  dressings, 
he  says,  was  because  of  the  marked  foetor  no- 
ticed in  many  instances  after  the  first  two  or 
three  injections,  which  is  accounted  for  by  the 
destruction  of  soft  tissue? ;  consequently  it  is 
more  pronounced  when  the  patient  moves  dur- 
ing the  application,  so  that  it  is  not  made 
directly  to  the  bone,  but  partly  on  the  sur- 
rounding tissues. 

In  certain  cases  of  the  series  it  was  neces- 
sary to  enlarge  the  opening  during  the  course 
of  treatment,  particularly  when  the  granula- 
tions were  so  exuberant  as  to  protrude  into  the 
lumen  ot  the  sinus,  but  in  the  majority  of  in- 
stances they  could  be  removed  by  the  intro- 
duction of  a  probe. 

Of  Dr.  \yaterman's  eight  cases  he  reports 
four  apparent  cures.  He  suggests  the  possi- 
bility that  in  two  of  the  others  either  the 
necrosed  area  was  larger  than  the  probe  indi- 
cated, so  that  not  sufficient  acid  had  as  yet 
been  applied  to  effect  the  solution,  or  another 
area  of  necrosis  existed  at  some  distant  point 
not  indicated  by  the  probe.  Should  these  con- 
ditions be  present,  he  says,  operative  methods 
are  necessary. 

For  the  use  of  dilute  hydrochloric  acid  in 
conjunction  with  pyrozone  in  suppurative  oti- 
tis media,  see  under  Pyeozone  (Supplement). 


HYGrlAMA. — This  is  the  name  of  a  pro- 
prietary food  made  of  condensed  milk  with  the 
addition  of  certain  cereals  specially  prepared 
and  of  cocoa  deprived  of  its  fat.  It  contains 
20'4  per  cent,  of  albuminous  matter,  10  per 
cent,  of  fat,  and  6'Si  per  cent,  of  carbohy- 
drates. According  to  von  Noorden,  it  is  par- 
ticularly useful  in  diseases  of  the  stomach  and 
intestines,  in  pulmonary  consumption,  in  the 
debility  of  convalescence,  in  typlioid  fever,  and 
in  weakly  children.  (Berliner  Minisctie  Woclh- 
ensctirifi,  1896,  No.  20 ;  Deutsche  Medizinal- 
Zeitung,  May  21,  1896.) 

HYOSCYAMINE.— Dr.  Chalmer  Pren- 
tice, of  Chicago  (New  York  Medical  Journal, 
January  2,  1897),  calls  attention  to  the  action 
of  hyoscyamine  in  paralysis  agitans,  and  re- 
ports three  cases.  The  first  was  that  of  a 
clergyman,  sixty-five  years  old,  first  seen  by 
Dr.  Prentice  in  January,  1891.  Shaking  of 
the  head  and  right  upper  and  lower  extremi- 
ties had  continued  for  a  period  of  four  years, 
gradually  increasing  in  severity.  Dr.  Prentice 
used  a  solution  of  hydrobromide  of  hyoscya- 
mine, 2  grains  to  the  ounce  of  water.  This 
was  dropped  into  each  eye.  In  twenty  min- 
utes the  shaking  of  the  upper  and  lower  ex- 
tremities and  head  had  entirely  ceased.  At 
the  end  of  three  quarters  of  an  hour  there  was 
such  a  general  relaxation  that  the  patient  was 
unable  to  rise  from  the  chair.  The  intelli- 
gence did  not  seem  to  be  disturbed,  but  the 
organs  of  speech  were  very  much  interfered 
with,  so  that  it  was  difficult  for  the  patient  to 
talk.  Dr.  Prentice  says  that  he  anxiously 
watched  the  patient,  sitting  and  talking  with 
him  for  a  period  of  two  hours,  at  the  end  of 
which  time  he  was  able  to  get  up  from  his 
chair  and  walk  again.  At  the  end  of  three 
hours  there  was  no  impediment  to  the  speech 
and  the  shaking  had  not  returned.  At  the 
end  of  about  six  hours  the  patient  said  the 
symptoms  had  gradually  begun  to  present 
themselves  again.  On  the  following  day  the 
strength  of  the  solution  was  reduced  to  1  grain 
to  the  ounce.  This  did  not  interfere  with  the 
locomotion  or  the  power  of  speech,  but  again 
put  the  shaking  in  abeyance.  Dr.  Prentice 
followed  this  case  up  for  a  month,  during 
which  time  the  paralysis  agitans  was  kept  un- 
der almost  complete  control  by  instilling  a 
drop  into  each  eye  morning  and  evening,  a  so- 
lution of  the  strength  of  a  grain  to  the  ounce 
being  used. 

The  second  case,  that  of  a  farmer,  sixty 
years  old,  was  seen  in  1892.  He  had  suffered 
with  paralysis  agitans  for  twenty  years.  No 
lesions  were  present  to  which  anvVeflex  action 
could  be  attributed.  In  this  case  Dr.  Pren- 
tice started  with  hyoscyamine,  a  grain  to  the 
ounce.  In  thirty  minutes  the  shaking  had  al- 
most entirely  ceased,  and  the  patient  renaained 
quiet  during  the  day.  A  return  of  the  symp- 
toms came  on  the  following  morning,  bnt"they 
were  not  so  severe  as  usual.  Dr.  Prentice  re- 
duced the  strength  of  the  solution  to  half  a 
grain  to  the  ounce,  and  advised  its  use  three 
times  daily.  By  following  this  treatment  this 
case  was  kept  entirely  under  control  for  a  pe- 


443 


HYGIAMA 
ICHTHYOL 


riod  of  about  two  montlis,  at  which  time  Dr. 
Prentice  lost  sight  of  the  patient. 

The  third  patient  was  an  unmarried  lady, 
aged  forty-five  years,  first  seen  in  May,  1893. 
In  this  case  there  were  some  strong  evidences 
of  tabes  dorsalis  with  slight  curvature  in  the 
dorsal  region  of  the  spine.  The  shaking  was 
general  and  most  torturing.  A  solution  of 
hyoscyamine  hydrobromide,  a  grain  to  the 
ounce,  reduced  the  shaking  to  a  minimum,  and 
gave  almost  perfect  relief.  In  this  case,  says 
Dr.  Prentice,  hyoscyamine  seems  to  have  been 
the  only  remedy  that  has  ever  affected  the  pa- 
tient, and  for  a  period  of  three  years  she  has 
depended  upon  it.  There  has  been  no  neces- 
sity to  increase  the  dose,  and  during  all  this 
time  there  has  been  no  period  in  which  she 
could  stop  using  the  hyoscyamine  without  a 
return  of  the  violent  shaking. 

Dr.  Prentice  says  he  hardly  believes  the  ef- 
fect can  be  due  to  the  action  of  the  drug  after 
it  has  been  absorbed  into  the  circulation,  for 
the  amount  so  taken  in  from  one  small  drop 
in  each  eye,  accounting  for  the  amount  washed 
away  by  lacrymation,  he  remarks,  would  not 
be  over  -jJiy  of  a  grain,  whereas  the  administra- 
tion of  ^5  of  a  grain  by  the  mouth  will  not 
produce  any  like  effect.  He  suggests  that  per- 
haps the  reason  for  the  marked  effect  of  such 
a  small  amount  of  hyoscyamine  in  the  eye  is 
the  fact  that  the  site  of  its  application  is  in 
close  proximity  to  the  cause  of  some  reflex  dis- 
turbance through  the  visual  and  other  allied 
centres. 


ICHTHYOL. — Guintsburg  {Medecine  mo- 
derne.  May  13,  1896  ;  Therapeutic  Gazette, 
September,  1896)  strongly  recommends  the  use 
of  iohthyol  in  intestinal  disorders,  particu- 
larly those  which  accompany  affections  of  the 
genito-urinary  tract  in  women.  The  dose  is  4 
or  5  grayis  a  day,  preferably  in  keratin-coated 
pills,  which  are  believed  to  pass  through  the 
stomach  undissolved  ;  thus  a  disagreeable  taste 
and  eructations  are  avoided.  The  medicine  is 
best  given  some  little  time  after  meals.  Good 
results  were  obtained  in  oases  of  diarrhoea  : 
the  appetite  improved,  the  abdominal  pains 
were  much  decreased,  and  the  patient  gained 
in  weight;  at  the  same  time,  if  there  was  a 
tendency  to  menorrhagia,  the  menstrual  func- 
tion became  more  nearly  normal.  The  best 
results  were  in  cases  of  rehellious  constipation. 
He  failed  to  meet  with  any  disagreeable  symp- 
toms such  as  are  recorded  by  Bouchonieff,  who 
found  that  in  persons  suffering  from  renal 
disease  or  from  chlorosis  iohthyol  was  apt  to 
produce  loss  of  appetite,  nausea,  and  vomiting. 
He  attributes  these  disagreeable  results  to  too 
large  doses. 

Dr.  Le  Tanneur  (Journal  de  medecine  de 
Paris,  August  9,  1896;  Journal  of  the  Ameri- 
can Medical  Association,  September  13,  1896) 
has  experimented  with  iohthyol  to  determine 
its  antiseptic  power  and  its  effects  in  pulmo- 
nary tuberculosis.  He  states  that  absolute 
sterility  is  secured  with  a  5-per-eent.  solution, 
although  the  shape  of  the  Koch  bacillus  is  al- 
72 


tered  and  its  development  much  retarded  with 
a  2-per-cent.  solution  and  even  a  weakei^  one. 
He  administered  it  to  his  patients  in  capsules 
(Chiron's)  which  contained  4  grains  each,  giv- 
ing from  four  to  twenty-four  a  day.  No  effect 
followed  the  administration  of  six  or  eight 
capsules.  M.  Le  Tanneur  began  with  two  cap- 
sules and  increased  the  number  to  twenty  a 
day,  taken  three  times  a  day,  during  the  meals. 
None  of  the  fifty  patients  treated  suffered  any 
inconvenieoce  from  its  use,  and  sevei'al  patients 
with  diarrhoea  and  gastric  disturbances  were 
cured  of  those  complications  by  it.  The  cough 
was  much  improved  owing  to  the  liquefaction 
of  the  sputa  produced  by  the  iohthyol,  which 
also  cured  the  congestion  of  the  bronchial 
tubes.  The  colour  of  the  expectoration  changed 
from  green  to  yellow,  then  to  gray,  and  finally 
to  the  ordinary  colour  of  mucous  secretions. 
The  dyspnoea  was  relieved  at  once  by  the  lique- 
faction of  the  sputa  and  the  decreased  con- 
gestion, which  rested  the  heart  and  raised  the 
general  tone  of  the  system.  Pain  in  the  inter- 
costal regions  was  also  much  relieved,  probably 
for  the  same  reason.  The  general  health  did 
not  show  improvement  so  soon  as  with  hypo- 
dermic injections  of  guaiacol,  but  it  arrived 
and  progressed  none  the  less  surely,  and  the 
patients  gained  flesh  much  more  than  with 
guaiacol.  Several  gained  from  seven  to  eight 
pounds  in  the  first  month,  others  gained  four 
pounds,  and  two  thirds  of  the  patients  showed 
a  marked  increase  in  weight.  The  sweats  also 
diminished,  but  apparently  only  as  the  general 
health  improved,  as  this  effect  was  not  noticed 
so  promptly  as  with  creosote  or  guaiacol.  The 
appetite  was  not  unfavourably  affected  as  is 
frequently  the  case  when  guaiacol  is  used,  but 
it  was  improved  and  restored  to  normal  in 
many  cases.  Le  Tanneur  concludes  that,  while 
ichthyol  is  by  no  means  the  long-sought  specific 
for  consumption,  yet  great  benefit  is  derived 
from  its  use  as  a  substitute  for  creosote  and 
guaiacol,  when,  as  often  happens,  the  system 
has  become  so  habituated  to  them  that  they 
fail  to  affect  it.  It  is  especially  indicated  in 
bronchial  tuberculosis,  which  it  most  promptly 
relieves.  Its  disagreeable  odour  renders  the 
use  of  the  capsule  imperative. 

Dr.  William  J.  Robinson  (New  York  Med- 
ical Journal,  November  14,  1896)  reports  a  re- 
markable case  of  lymphangeio- phlebitis  in 
which  ichthyol  proved  speedily  efficacious. 
The  patient  was  a  thin,  badly  nourished  man, 
fifty-three  years  old.  The  disease  affected  the 
left  lower  limb,  which  was  swollen  to  about 
double  its  normal  size,  of  an  erysipelatous  red, 
and  exquisitely  painful.  The  long  saphenous 
vein  was  felt  as  a  hard,  rigid  cord,  exceedingly 
sensitive  to  the  touch.  There  was  an  ulcer  on 
the  leg,  described  as  small,  superficial,  and 
altogether  insignificant.  The  man  had  two 
inguinal  hernise,  which  descended  through  the 
canals  at  the  least  strain.  On  the  back,  at  the 
point  of  pressure  of  the  truss,  there  was  slight 
ulceration.  He  had  intense  headache,  absolute 
loss  of  appetite,  constipation,  chills,  and  occa- 
sionally syncope.  His  temperature  was  101-8°, 
and  his  pulse  120,  small  and  compressible.  Dr. 
Robinson  prescribed  phenacetine  and  salol,  also 


IODOFORM 
MENTHOL 


444 


a  mixture  of  cardiac  stimulants,  and  ordered 
for  the  leg  continuous  hot  fomentations  of  a  3- 
per-oent.  solution  of  carbolic  acid  with  lead- 
and-opium  wash.     The  fomentations  relieved 
the  pain,  but  the  inflammation  did  not  abate. 
Dr.  Robinson  then  used  creolin,  a  l-to-1,000 
solution  of  corrosive  sublimate,  and  carbolic 
and  salicylio-acid  ointments  in  succession,  but 
without  being  able   to  check  the  continuous, 
uninterrupted  upward  progress  of  the  disease. 
Not  only  the  entire   limb  was  intensely  in- 
flamed and  oedematous,  but  the  left  side,  to 
about  the  level  of  the  umbilicus,  was  in  the 
same  condition.     The  scrotum  and  penis  at- 
tained enormous  proportions.     The  man  was 
unable  to  move,  and  his  sufferings  were  ex- 
treme.    In  about  a  month  Dr.  Robinson  was 
hastily  summoned  early  in  the  morning  and 
found  his  condition  such  as  to  give  rise  to  the 
gravest  apprehension.    The  pulse  was  thread- 
like, 140  a  minute ;  the  temperature  was  104° ; 
the  first  heart  sound  was  almost  inaudible. 
He  administered  a  hypodermic  injection  of 
digitalis,   strychnine,  and   nitroglycerin,    and 
ordered  a  25-per-cent.  solution  of  ichthyol  in 
glycerin.     He  enveloped  the  inflamed  parts  in 
lint  soaked  in  that  solution,  and  covered  it 
with  cotton  and  oiled  silk.     At  this  time  he 
entertained  little  hope  of  the  patient's  recovery, 
but  in  the  afternoon  of  that  day  the  picture 
had    completely  changed.     The  temperature 
was  100°,  the  pulse  was  96,  and  the  redness 
and  cedema  had  diminished  to  a  remarkable 
degree.     The  applications  were  repeated  three 
times  a  day.     On  the  next  day  the  svvelling 
had  completely  disappeared  from  the  le*  and 
genitals ;  on  the  back  it  persisted  for  two  days 
longer.     His  convalescence  from  that  day  on 
was  uninterrupted.     In  a  week  every  trace  of 
inflammation  had  disappeared,  but  he  felt  very 
weak.     The  man  afterward  had  an  attack  of 
phlebitis  in  the  right  leg.      The    symptoms 
were  practically  the  same  as  in  the  first  at- 
tack, though  not  quite  so  severe.     The  treat- 
ment   was    repeated,    but    in    addition    Dr. 
Robinson  ordered  very  large  doses  of  ichthyol 
internally — a  pill    of   4-J   grains  every  hour 
through  the  day  and  two  or  three  times  dur- 
ing the  night.    The  result  was  highly  satis- 
factory ;  in  three  days  the  man  was  quite  well. 
Hard  nodules  were  still  to  be  felt  in  the  course 
of  the  veins  at  the  time  of  the  report,  but  were 
disappearing  rapidly  under  the  internal  and  ex- 
ternal use  of  ichthyol.  For  external  use  Dr.  Rob- 
inson prescribed  ammonium  sulphiehthyolate, 
and  for  internal  use  sodium  sulphiehthyolate. 

Dr.  W.  Ottinger,  of  Exbrilcke  {Milnchener 
medicinische  Wochenschrift,  December  8, 1896 ; 
Wiener  medizinisehe  Blatter,  December  17, 
1896),  has  found  ichthyol  an  admirable  rem- 
edy in  numerous  cases  of  the  stings  of  flies, 
gnats,  bees,  and  wasps,  and  has  found  that  it 
quickly  and  surely  causes  the  phenomena  of 
inflammation  to  subside.  He  attributes  its 
effect  to  its  vaso-constrictor  action.  It  is  best 
to  apply  it  pure  in  a  pretty  thick  layer,  but  it 
may  be  used  in  the  form  of  an  ointment. 

lODOrOBM.— The  iodoform  treatment  of 
suppurating  bul>oes  has  of  late  come  into  ex- 


tensive use.  It  is  described  by  Dr.  William 
K.  Otis  (Journal  of  Cutaneous  and  Genito- 
urinary Diseases,  May,  1893)  as  follows : 

The  skin  for  some  eight  or  ten  inches  about 
the  affected  area  is  rendered  thoroughly  asep- 
tic by  scrubbing  with  green  soap  and  washed 
with  sulphuric  ether  and  then  with  bichloride- 
of-mercury  solution  (1  to  1,000).  A  narrow 
bistoury  is  then  inserted  into  the  abscess  cav- 
ity, the  contents  are  gently  but  thoroughly 
squeezed  out,  and  the  cavity  is  irrigated  with 
biohloride-of-meroury  solution  (1  to  1,000)  and 
immediately  filled  to  moderate  distention  with 
warm  iodoform  ointment  (10  per  cent,  iodo- 
form and  90  per  cent,  vaseline),  care  being 
taken  not  to  use  a  suflBoient  degree  of  heat  to 
liberate  iodine.  The  syringe  used  for  intro- 
ducing the  ointment  is  the  ordinary  cone- 
pointed  glass  syringe.  The  plunger  being 
removed,  the  barrel  is  warmed  in  the  flame  of 
an  alcohol  lamp  and  filled  with  ointment  by 
means  of  a  spatula.  On  finishing  the  injec- 
tion, at  the  instant  of  withdrawing  the  syringe 
from  the  wound,  a  compress  wet  with  cold  bi- 
chloride-of-mercury  solution  is  applied,  which 
instantly  solidifies  the  ointment  at  the  orifice 
and  prevents  the  escape  of  that  in  the  abscess 
cavity.  A  large  compress  of  sterilized  gauze 
is  then  applied  by  means  of  a  firm  spica.  The 
patient  is  told  to  return  in  four  days,  when,  if 
all  is  well,  the  dressing  is  reapplied,  but  if  any 
evidence  of  inflammatory  action  is  found  the 
wound  is  thoroughly  irrigated  and  cleansed 
and  the  injection  repeated.  Out  of  sixteen 
cases.  Dr.  Otis  reports  nine  cured  in  six  days, 
three  in  twelve  days,  one  in  fourteen  days,  and 
one  in  twenty-three  days.  He  alleges  the  fol- 
lowing advantages  for  this  method :  1.  It  is 
simple  and  safe.  2.  In  suitable  cases  the  cure, 
as  a  rule,  seems  more  rapid  than  by  any  other 
method.  3.  The  patient  is  not  prevented  from 
going  about  during  treatment.  4.  The  flrst 
gland  being  rendered  thoroughly  aseptic  makes 
it  less  likely  that  other  glands  in  the  chain 
will  become  infected.  5.  It  leaves  no  telltale 
soar.  6.  It  in  no  way  interferes  with  any  sub- 
sequent surgical  procedure,  should  such  be 
deemed  advisable.  Dr.  Otis  says  that  his  ex- 
perience has  demonstrated  that  this  method  is 
available  only  in  those  cases  of  infection  by 
the  staphylococcus  in  which  there  is  an  appre- 
ciable pus  cavity,  and  thus  a  storage  place  for 
ointment  until  absorption  can  take  place.  In 
diffuse  phlegmons,  in  which  no  pus  cavity  ex- 
ists, the  method  has  not  been  found  applicable. 
Dr.  Otis  gives  the  warning  that  there  is  a 
probability  of  failure  unless  two  cardinal  points 
are  observed:  1st,  absolute  cleansing  of  the 
cavity  of  all  traces  of  pus ;  and  2d,  the  injec- 
tion of  ointment  into  it  in  quantity  barely 
sufficient  to  produce  moderate  distention. 

ITROL. — See  Silver  citrate  (vol.  ii,  paee 
198).  ^  ^ 

JERVINE. — See  under  Veratrum  viride. 


KAOLIN. —See     Fuller's     earth,     under 
Earths  (vol.  i,  page  353). 


445 


IODOFORM 
MENTHOL 


KEirMMHOLZ    OIL.— See    under    Pine 
PEEPARATioNS  (vol.  ii,  page  88). 


LACTOSE. — See  Sugar  of  milk. 

LAB.D Dr.  George  Boody,  of  the  Iowa 

State  Hospital  {American  Journal  of  Insanity, 
July,  1896),  reports  the  results  of  experiments 
made  by  himself  with  leaf-lard  inunctions  in 
cases  of  malnutrition  with  emaciation.  The 
time  over  which  they  extended,  he  says,  was 
very  short  and  the  number  of  oases  few,  but 
they  were  carefully  carried  out  and  the  im- 
provement in  each  case  was  noted.  Pour 
oases  were  selected,  of  each  of  which  a  brief 
account  is  given,  with  the  following  conclu- 
sions: 1.  The  integument  plays  an  important 
role  as  an  organ  through  which  food  may  be 
taken,  carried  to  the  circulation,  and  assimi- 
lated, nutrition  improved,  and  wasted  tissue 
repaired.  3.  Inunction  with  lard  is  indicated 
in  every  case  of  extreme  emaciation  with  malnu- 
trition in  which  diet  and  tonic  treatment  with 
massage  fail  to  produce  the  expected  results. 
3.  It  is  the  author's  belief  that  if  the  condi- 
tions were  such  that  food  could  not  be  taken 
through  the  stomach,  nutrition  could  be  im- 
proved and  the  patient  made  to  gain  in  weight 
by  inunctions  of  leaf  lard,  olive  oil,  or  other 
fats,  twice  or  three  times  a  day. 

LEVTTLOSE,  or  fruit  sugar  (see  vol.  ii, 
page  235),  has  been  employed,  under  the  name 
of  diabetin,  as  a  sweetening  agent  for  persons 
aflected  with  diabetes. 


MAGNESIA. — Vergely  (Revue  medicate, 
February  16,  1696  ;  New  York  Medical  Jour- 
nal, March  14,  1896)  reports  favourable  results 
from  the  use  of  calcined  magnesia  in  the  treat- 
ment of  burns  of  moderate  severity.  The  af- 
fected parts  are  covered  with  a  thick  layer  of  a 
paste  which  is  prepared  by  mixing  the  calcined 
magnesia  with  a  certain  quantity  of  water. 
This  paste  is  allowed  to  dry  on  the  skin,  and 
when  it  becomes  detached  and  falls  oflE  it  is  re- 
placed by  a  fresh  application.  Very  soon  after 
the  paste  is  applied  the  pain  ceases,  and  under 
the  protective  covering  formed  by  the  magne- 
sia the  parts  recover  without  the  cutaneous 
pigmentation  which  is  often  observed  to  follow 
burns  that  have  been  allowed  to  remain  exposed 
to  the  air. 

MARROW.— Dr.  William  0.  Mann,  of  the 
Fergus  Falls  State  Hospital,  in  Minnesota 
(American  Journal  of  JnsoraiYy,  January,  1897), 
gives  his  experience  in  the  use  of  bone  marrow 
among  the  insane,  extending  over  a  period  of 
four  months.  Two  preparations  of  bone  mar- 
row were  used :  One  which  was  made  at  the 
hospital  by  finely  chopping  ribs  of  sheep  and 
adding  glycerin  in  the  proportion  of  a  pound 
to  twelve  ribs.  This  was  allowed  to  macerate 
four  days.  It  was  then  strained  through 
gauze  and  was  ready  for  use.  The  other 
preparation  was  that  manufactured  by  Armour 
&Co. 


Twenty-two  male  patients  were  selected, 
eleven  of  whom  took  one  form  of  the  extract, 
and  the  other  eleven  the  other  form.  Those 
patients  were  chosen  whose  general  appear- 
ance was  ansemic.  Extract  of  bone  marrow 
was  given  for  a  month,  a  drachm  three  times  a 
dav,  at  the  end  of  which  time  the  percentage 
of  hiBmoglobin  and  the  number  of  corpuscles 
were  again  ascertained,  the  same  time  of  day 
being  taken  as  at  first.  During  this  time  no 
medicine  was  administered  and  the  regular 
diet  was  given.  Fifteen  of  the  twenty-two 
cases  were  regarded  as  chronic,  and  the  seven 
remaining  were  acute  cases  in  which  improve- 
ment had  been  slow  and  had  reached  a  stand- 
still. 

Dr.  Mann  gives  tables  showing  that  in  some 
cases  the  number  of  red  corpuscles  was  nor- 
mal, while  the  leucocytes  were  increased  and 
the  percentage  of  haBmoglobin  was  diminished  ; 
also  that  the  ratio  of  the  percentage  of  haemo- 
globin to  the  number  of  red  blood-cells  was 
irregular.  The  average  increase  in  red  cor- 
puscles was  1,361,489,  and  those  that  took  the 
extract  made  at  the  hospital  gained  more  than 
the  others.  The  proportion  of  hasmoglobin  in- 
creased on  an  average  of  13'5  per  cent.  The 
leucocytes,  which  in  nearly  all  had  been  abnor- 
mal at  first,  decreased  in  number  at  the  end  of 
the  month.  The  general  appearance  in  the 
majority  of  the  cases  had  improved.  The  ap- 
petite was  better  and  the  action  of  the  bowels 
more  regular. 

In  only  one  case  was  there  a  tendency  to 
diarrhoea.  In  the  twenty-  two  cases  there  was 
an  aggregate  gain  of  forty-seven  pounds,  and 
on  discontinuing  the  use  of  the  marrow  those 
that  had  lost  immediately  began  to  gain,  and 
three  months  later  weighed  more  than  they 
ever  had  during  their  residence  in  the  hos- 
pital. One  man  especially,  that  had  weighed 
for  months  from  ninety-six  to  ninety-nine 
pounds,  now  weighed  a  hundred  and  twenty- 
eight. 

Dr.  Mann's  experiments  seem  to  have  been 
chiefly  directed  toward  ascertaining  the  ac- 
tion of  marrow  on  anaemia  rather  than  on  I'n- 
sanity,  but  he  says  that,  mentally,  one  patient 
began  to  improve  at  once  and  soon  went  home 
recovered.  Three  were  regarded  as  much  im- 
proved, and  four  others  were  brighter  and  had 
lost  a  great  deal  of  the  apathy  they  had  for- 
merly had.  In  the  fourteen  others  the  only 
improvement  noticed  was  in  their  physical 
condition.  Dr.  Mann  concludes  that  the  use 
of  bone  marrow  in  anseraia  results  in  an  in- 
crease in  the  red  corpuscles  of  the  blood,  and 
in  cases  of  insanity  associated  with  ansemia 
improvement  in  the  mental  condition  may  be 
expected  in  at  least  a  third  of  the  cases. 

MEDULLADEN.— This  is  the  fanciful 
name  of  an  extract  of  bone  marrow.  See  Mar- 
row. 

MEDULLARY  GLYCERIDE.— See  un- 
der Marrow  (vol.  ii,  page  599). 

MENTHOL.— Dr.  Sidney  A.  Bontor  (West 
London  Medical  Journal,  July,  1896 ;  New  York 
Medical  Journal,  August  1, 1896)  has  used  men- 
thol spray  in  forty  casesof  whooping-cough,  most 


MERCURY 
NAPHTHALAN 


446 


of  them  selected,  he  says,  on  aecotint  of  their 
severity,  and  the  result  has  been  most  satisfac- 
tory; in  thirty-nine  of  them  the  beneiit  was 
decided,  and  in  only  one  did  the  spray  seem  to 
have  no  effect ;  this  was  a  case  complicated  by 
acute  bronchitis.  One  patient  died,  a  weakly 
infant  of  only  seven  weeks,  the  immediate  cause 
of  death  being  convulsions  in  the  third  week 
of  illness ;  in  two  the  spray  was  not  persevered 
with,  although  the  paroxysms  were  relieved  by 
it.  because,  as  the  attacks  were  not  very  severe, 
the  parents  thought  the  little  smarting  of  the 
eyes  an  unnecessary  infliction. 

About  20  grains  of  menthol  were  dissolved 
in  an  ounce  of  liquid  vaseline  in  an  ordinary 
nasal  spray-producer ;  as  soon  as  the  paroxysm 
began,  or  preferably  as  soon  as  the  patient  felt 
that  one  was  impending,  a  fine  cloud  of  spray 
was  diffused  in  front  of  the  face,  the  spray- 
producer  being  held  about  two  feet  away ;  by 
this  means  the  air  in  front  of  the  nose  and 
mouth  was  saturated  with  the  oily  particles, 
and  at  each  inspiration  they  were  drawn  into 
the  air  passages;  this  was  quite  painless,  but 
occasionally  a  slight  spasm  of  the  glottis  oc- 
curred. The  effect  of  this  inhalation  is  quickly 
seen,  says  Dr.  Bontor,  for  the  mucus  is  rap- 
idly expectorated  and  the  paroxysm  is  soon 
over,  so  that  convulsions  are  less  frequent  and 
vomiting  is  rare,  with  the  result  that  the  pa- 
tient loses  his  dread  of  taking  food  and  eats 
with  a  better  appetite,  his  general  condition  be- 
ing thus  kept  at  a  much  higher  level.  Among 
the  forty  cases  there  were  none  of  prolonged 
debility,  none  followed  by  gastro-intestinal  ca- 
tarrh, and  none  at  the  time  of  the  report  with 
tuberculosis.  The  author  does  not,  however, 
maintain  that  this  result  is  wholly  attributable 
to  the  form  of  treatment,  because,  he  says,  he 
practises  in  a  healthy  country  district  where 
■the  tubercle  bacillus  does  not  flourish  and 
where  the  death-rate  is  naturally  low,  but  he 
adds  that  the  results  among  patients  in  the 
same  district  treated  by  other  methods  have 
not  been  so  satisfactory. 

MERCTJItT.  —  Rabinschek's  method  of 
treating  whooping-cough  with  mercury  bichlo- 
ride is  described  in.  the  BuUeiin  medical  de 
Paris  for  September  13,  1896  (Lyon  medical, 
October  11, 1896),  as  consisting  in  the  intro- 
duction into  the  back  of  the  mouth  of  a 
small  tampon  of  cotton  saturated  with  a  1-to- 
1,000  solution  of  corrosive  sublimate,  and  press- 
ing it  against  the  lower  part  of  the  tongue 
in  such  a  way  that  the  liquid  will  bathe  the 
epiglottis  and  the  neighbouring  mucous  mem- 
brane. The  method  has  been  applied  in  sev- 
enty-one cases  by  Dr.  Rocco  Gentile ;  thirty-five 
patients  were  cured  after  from  three  to  twelve 
applications,  thirteen  were  considerably  im- 
proved, and  the  others  interrupted  the  treat- 
ment or  had  complications  which  did  not 
depend  upon  the  whooping-cough.  One  of  the 
greatest  benefits  to  be  derived  from  this  treat- 
ment is  said  to  be  the  rapid  cessation  of  the 
vomiting  which  contributes  so  much  to  weaken 
the  patients.  Gentile  has  never  employed  more 
than  one  application  a  day.  In  a  very  small 
number  of  cases  he  has  observed  temporary 


disturbances,  such  as  haemorrhages  of  the  con- 
junctiva and  of  the  ear,  buccal  ulcerations,  and 
slight  fever;  but  he  says  these  complications 
are  not  serious. 

Surgeon-Major  Harold  Hendley,  of  the 
British  Indian  Medical  Service  (British  Medi- 
cal Journal,  January  16,  1897).  refers  to  Celli's 
successful  treatment  of  tetanus  with  subcutane- 
ous injections  of  corrosive  sublimate  (mentioned 
in  the  3Iedical  Annual  for  1896),  and  reports  a 
case  of  his  own.  A  Hindu  boy,  aged  nine,  son 
of  a  hillman  in  the  Kangra  District,  Punjab, 
was  first  seen  on  August  10,  1896,  when  it 
was  stated  by  the  father  that  he  had  been  suf- 
fering for  two  days  from  stiffness  of  the  neck 
and  difficulty  in  mastication,  associated  with  a 
considerable  amount  of  pain.  On  examination, 
marked  rigidity  of  the  muscles  connected  with 
the  lower  jaw,  the  neck,  and  the  right  arm  and 
thigh  was  discovered,  and  any  movement  of 
these  parts  was  attended  with  very  considerable 
pain.  The  temperature  was  101-2°  F.,  the  pulse 
was  96,  the  bowels  were  constipated.  On  the 
11th  his  temperature  was  99-8°  P.,  the  bowels  had 
been  moved  once ;  his  condition  was  about  the 
same.  On  the  12th  a  very  considerable  amount 
of  pain  was  complained  of  over  the  front  of 
the  chest,  more  especially  over  the  cardiac 
area,  and  a  slight  systolic  bruit  was  audible  at 
the  apex.  A  belladonna  plaster  applied  over 
the  area  of  greatest  pain  resulted  in  some  re- 
lief. On  the  13th  slight  spasms  became  evi- 
dent over  the  whole  body  at  intervals  of  from 
fifteen  to  twenty  minutes.  Two  grains  of 
chloral  hydrate  were  given  thrice  daily.  A 
fair  amount  of  sleep  was  obtained.  On  the 
16th  risus  sardonicus  and  opisthotonos  were 
well  marked  ;  theparoxjsms  became  very  fre- 
quent, occurring  at  times  every  two  or  three 
minutes,  and  any  movement  of  the  patient  in- 
creased their  frequency.  The.  bowels  were 
again  constipated,  the  temperature  was  100'2°, 
P.,  and  the  pulse  was  100,  small  and  weak.  Pain 
was  very  considerable ;  next  to  no  sleep  was 
obtained,  and,  in  spite  of  the  considerable 
amount  of  fluid  nourishment  taken  in  the 
shape  of  milk  and  soup,  the  patient  had  be- 
come considerably  emaciated.  Two  grains  of 
chloral  hydrate  were  now  given  every  hour, 
and  the  dose  of  calomel,  4  grains,  which  had 
been  given  on  his  admission,  was  repeated. 

From  the  17th  to  the  26th,  by  pushing  the 
chloral  hydrate  and  so  producing  sleep,  some 
control  over  the  paroxysms  was  obtained.  On 
the  latter  date,  however,  the  patient  became 
much  worse ;  the  paroxysms  increased  in  se- 
verity and  frequency,  and  a  fatal  ending 
seemed  not  far  off.  As  the  chloral  hydrate 
appeared  to  have  no  longer  any  effect  upon  the 
course  of  the  disease,  it  was  determined  to 
have  recourse  to  Celli's  treatment.  The  use  of 
chloral  hydrate  was  continued,  and  subcutane- 
ous injections  into  the  buttocks  of  corrosive 
sublimate  in  doses  of  about  0-09  of  a  grain 
were  given  twice  daily,  beginning  on  August 
27th.  After  the  first  two  injections  the  spasms 
decreased  decidedly  in  frequency  and  severity. 

On  September  2d — that  is,  after  eleven  in- 
jections— the  paroxysms  had  entirely  ceased, 
and  from  this  date,  when  the  injections  were 


447 


MERCURY 
KAPHTUALAN 


stopped,  recovery  was  sure,  and,  considering 
the  previous  state  of  the  patient,  fairly  rapid. 
Small  doses  of  chloral  hydrate  were  continued 
up  to  September  8th. 

It  is  noticeable,  remarlcs  Surgeon  -  Major 
Hendley,  that,  as  in  Oelli's  case,  very  marked 
amelioration  in  the  patient's  condition  occurred 
after  the  second  injection.  After  a  very  care- 
ful inquiry,  no  cause  for  the  occurrence  of  the 
disease  could  be  discovered.  The  early  symp- 
toms seemed  to  point  to  conditions  which 
might  admit  of  the  case  being  classified  as  one 
of  rheumatic  tetanus. 

METADIHYDROXYBENZEITE.—  See 

Kesorcin. 

miLK. — Lachmann's  so-called  "  vegetable 
milk,"  says  a  writer  in  Medecme  moderne  for 
September  9,  1896  {Lyon  medical,  October  4, 
1896),  when  made  with  almonds  and  sugar, 
does  not  contain  any  starchy  substances  and 
has  a  sufflciently  large  quantity  of  emulsified 
fat.     Its  composition  is  as  follows : 

Fat 24-60  per  cent. ; 

Vegetable  casein 7-50 

Cane  sugar 41-80 

Vegetable  dextrin 1-30 

Lime,  potassium,  etc. . . .     0-68 

"Water 24-13 

This  vegetable  milk  may  be  used  to  dilute 
cow's  milk  which  is  too  rich  in  albuminoids. 
For  this  purpose  it  is  superior  to  water,  as  it 
does  not  precipitate  the  casein  in  large  flakes, 
but  in  small  and  soft  ones.  Furthermore,  the 
addition  of  vegetable  milk  to  cow's  milk  in- 
creases the  fatty  substance  of  the  latter  and  ac- 
celerates its  digestion. 

MOBINGA. — The  Moringa  Fiery gosperma, 
the  Oriental  horse-radish  tree,  or  drumstick  tree, 
has  been  used  in  medicine.  Mr.  L.  B.  Dhar- 
galkar,  of  Bombay  (Indian  Lancet,  September 
1,  1896 ;  Neio  York  Medical  Journal,  October 
19,  1896),  has  used  the  root-bark  in  the  treat- 
ment of  jaundice.  He  says  the  root,  the  gum, 
the  leaves,  the  flowers,  and  the  fruit  are  all 
useful  in  medicine.  The  root  has  a  strong, 
pungent  odour  and  is  said  to  have  the  flavour 
of  horse-radish.  When  distilled  with  wafer,  it 
yields  an  essential  oil  which  is  very  pungent 
to  the  taste.  The  bark  is  rubefacient  and  is 
used  externally  by  the  poorer  classes  as  a  coun- 
ter-irritant in  chrome  rheumatism.  Some 
authors  state,  says  Mr.  Dhargalkar,  that  it  is 
supposed  to  act  as  an  emmenagogue  and  is  used 
to  produce  abortion.  The  stimulant  and  pun- 
gent properties  of  the  root-bark  have  been  de- 
scribed by  other  observers,  but  Mr.  Dhargalkar 
thinks  that  no  one  has  as  yet  mentioned  its 
usefulness  in  the  treatment  of  jaundice.  He 
himself  accidentally  found  that,  if  adminis- 
tered in  proper  doses,  it  was  useful  in  that  dis- 
ease, and  he  has  made  several  experiments 
with  it.  He  relates  the  histories  of  eight  cases 
in  which  he  obtained  satisfactory  results  with 
the  tincture  of  moringa,  the  action  of  which 
was  very  rapid. 

In  regard  to  the  toxic  effects  of  the  drug,  he 
states  that  he  has  had  no  opportunity  to  ob- 
serve them,  as    it  did  not  produce  any  un- 


favourable symptoms  in  any  of  the  patients 
treated  by  him.  In  order  to  try  its  effects  on 
the  healthy  system,  he  took  on  an  empty  stom- 
ach a  drachm  of  the  tincture  in  an  ounce  of 
water.  It  tasted,  he  says,  something  like  an 
infusion  of  bitter  almonds  and  produced  a  sen- 
sation of  warmth  at  the  pit  of  the  stomach  for 
two  or  three  minutes,  but  it  had  no  other  effect. 
The  physiological  action  of  the  drug  is,  he 
says,  still  unknown  to  him. 

MONOCHLORMETHANE.— Seeil/ei!%i 
chloride,  under  Methyl. 

MONOPHENETHYDEIN.— See  A  poly- 
sine. 

SETBROL. — This  name  has  been  given  to  a 
new  mydriatic  said  to  be  an  iodomethylate  of 
phenylpyrazol,  which  is  a  white,  odourless,  bit- 
ter powder  readily  soluble  in  water.  It  seems 
from  experiments  made  under  the  direction  of 
Professor  Albertoni,  of  Bologna  (Therapeu- 
tische  Wochenschrift,  December  6,  1896 ;  JVew 
York  Medical  Journal,  December  36,  1896), 
that  mydrol  dilates  the  pupil  in  animals  that 
have  a  round  pupil,  but  has  no  such  effect  on 
those  in  which  the  pupil  is  oblong.  Dr.  Cattaneo, 
of  Professor  Tartuferi's  clinic,  is  cited  as  hav- 
ing found  that,  by  reason  of  the  short  duration 
of  its  mydriatic  action,  when  employed  in  a 
solution  of  from  5  to  10  per  cent.,  and  its 
transitory  effect  on  the  accommodation  and 
especially  on  the  tonicity  of  the  eye,  its  diag- 
nostic use  is  of  advantage  in  cases  in  which 
there  is  reason  to  apprehend  harm  from  the  in- 
crease of  intra-ocular  pressure  caused  by  other 
mydriatics.  Albertoni  adds  that  it  is  absolute- 
ly unirritating  and  non-poisonous,  and  that  it 
excels  cocaine  in  diminishing  the  amount  of 
blood  not  only  in  the  vessels  of  the  conjunc- 
tiva, but  also  in  those  of  the  iris  and  most 
probably  in  those  of  the  deeper  structures. 
By  virtue  of  these  properties,  while  it  has  no 
actual  anaesthetic  action,  it  is  serviceable  in 
ciliary  and  supraciliary  pain,  blepharospasm, 
lacrymation,  and  many  diseases  of  the  iris,  the 
cornea,  the  sclera,  and  the  conjunctiva,  espe- 
cially that  of  the  globe.  Mydrol  is  said  to  be 
absorbed  rapidly  and  to  be  eliminated  un- 
changed in  the  urine. 

MYELOTHERAPY.— See  under  Seeum 
TEEATMEKT  (vol.  ii,  page  187). 

MYRTILLIIT.— A  thick  extract  of  the 
berries  of  Vaccinium  Myrtillus.  See  under 
Vaccinium  (Supplement). 


NAPHTHALAN.— This  is  described  by 
Dr,  Rudolf  Isaac,  of  Berlin  (Deutsche  medi- 
cinisehe  Wochenschrift,  December  24,  1896),  as 
an  ointment-like  mass  obtained  by  the  frac- 
tional distillation  of  crude  naphtha  from  the 
highlands  of  Armenia.  It  melts  at  about  158° 
F.  It  is  insoluble  in  water  and  in  glycerin, 
but  dissolves  readily  in  ether  and  in  chloro- 
form, and  mixes  easily  with  fats.  Naphthalan 
seems  to  have  been  first  employed,  early  in 
1896,  in  the  Michael  Hospital  in  Tiflis,  in  vari- 
ous skin  diseases.    Dr.  Isaac  reports  upon  its 


NITROUS  OXIDE 
NUX   VOMICA 


448 


use  in  about  fifty  eases  in  Dr.  Max  Joseph's 
Polilclinik  for  skin  diseases  in  Berlin.  ^  Most  of 
the  oases  were  chronic  eczema,  especially  the 
so-called  "  occupation  -  eczema  "  a  few  were 
acute  eczema,  and  the  remaining  ones  were 
single  cases  of  prurigo,  pruritus,  psoriasis 
mdgaris,  ichthyosis,  eczema  impetiginosum, 
eczema  occurring  as  a  sequel  of  scabies,  dia- 
betes, ulcer  of  the  leg,  etc.  The  results  were 
various.  In  several  cases  of  eczema  rapid  im- 
provement leading  to  a  cure  was  observed,  in 
others  the  good  effect  was  only  temporary,  and 
in  a  few  so  much  irritation  was  produced  that 
the  use  of  the  remedy  had  to  be  abandoned. 
There  was  no  noteworthy  effect  in  the  cases  of 
psoriasis. 

Naphthalan  is  absorbed  by  the  skin  very 
rapidly,  but  Dr.  Isaac  thinks  it  doubtful  on 
that  very  account  if  its  employment  as  a  con- 
stituent of  a  mercurial  ointment  for  the  in- 
unction treatment  of  syphilis  would  be  of 
advantage,  since  by  the  ordinary  method  time 
is  given  for  the  vaporization  of  the  mercury 
and  its  absorption  by  the  respiratory  mucous 
membrane.  Another  disadvantage  of  naph- 
thalan is  that  it  soils  the  linen,  but  the  stains 
are  readily  removed. 

NITROUS  OXIDE.— Dr.  Hobart  A.  Hare 
( Therapeutic  Gazette,  December,  1896 ;  Neiv 
York  Medical  Journal,  January  2, 1897)  reports 
a  case  of  death  after  the  inhalation  of  this  gas 
— not,  he  says,  as  one  of  death  due  to  the  direct 
influence  of  nitrous-oxide  gas,  but  as  an  in- 
stance of  the  fact  that  the  decided  rise  of 
arterial  pressure  which  is  produced  by  the  ad- 
ministration of  this  drug  during  the  period  of 
ansesthesia  may  cause  the  rupture  of  a  blood- 
vessel in  persons  who  have  a  tendency  to  apo- 
plexy. 

A  man  between  fifty  and  sixty  years  of  age, 
with  atheromatous  arteries,  visited  the  office  of 
a  well-known  dentist  who  makes  a  specialty  of 
extracting  teeth  under  the  influence  of  nitrous- 
oxide  gas,  in  order  that  he  might  have  removed 
one  or  two  molar  teeth  which  were  giving  him 
trouble.  He  had  often  taken  nitrous-oxide 
gas  in  the  same  dentist's  oflioe  on  previous 
occasions,  and  always  without  any  ill  effects 
whatever.  On  this  occasion  he  took  the  ordi- 
nary quantity,  his  teeth  were  extracted,  and  he 
returned  to  consciousness  with  the  usual  ra- 
pidity. -He  left  the  dentist's  chair,  walked  to 
a  washstand,  and  began  to  rinse  out  his  mouth 
with  water.  While  doing  this  he  stated  that 
his  right  hand  felt  numb,  then  complained  of 
the  extension  of  this  numbness  up  his  arm,  and 
rapidly  to  his  leg  and  side.  He  was  helped  to 
a  sofa,  where  in  the  course  of  a  very  few  min- 
utes he  became  partially  unconscious.  When 
Dr.  Hare  saw  him  the  attack  had  already 
lasted  about  twenty  minutes.  The  patient  was 
breathing  stertorously.  He  seemed  to  under- 
stand questions  put  to  him,  but  was  unable  to 
answer  them  clearly,  and  in  the  course  of  a 
very  few  minutes  passed  into  absolute  insensi- 
bility, which,  notwithstanding  the  use  of  vene- 
section and  other  measures,  deepened  into 
coma,  in  which  he  died  about  twelve  hours 
after  taking  the  ansesthetic. 


N'TJCLEIN'S.— Dr.  John  Ferguson,  of  To- 
ronto (Canadian  Medical  Review,  March,  1896 ; 
New  York  Medical  Journal,  June  6,  1896),  re- 
cords a  case  of  progressive  ancemia  in  which 
protonuolein  proved  curative  after  a  failure  of 
other  drugs.  Preparations  of  iron  and  arsenic 
had  been  tried  fairly,  but  could  not  be  toler- 
ated. The  patient  was  a  gentleman,  aged  fifty- 
four  years,  who  had  resided  in  India  for  several 
years.  His  health  had  not  been  good  for  about 
two  years.  During  this  period  he  had  suffered 
loss  of  flesh,  strength,  and  appetite.  In  April, 
1895,  the  symptoms  became  more  distressing, 
and  it  was  necessary  for  him  to  give  up  his 
work  as  a  tutor  and  rest.  He  became  a  patient 
of  Dr.  Ferguson's  about  the  end  of  September, 
1895.  At  this  date  he  was  a  pronounced  vic- 
tim to  insomnia.  His  digestion  was  extremely 
bad ;  he  had  much  pain  and  frequent  nausea 
after  taking  nourishment,  either  liquid  or  solid. 
There  was  an  excessive  amount  of  flatulence. 
The  bowels  were  very  torpid.  The  pulse  was 
weak,  and  usually  as  frequent  as  100  a  minute. 
There  was  always  some  elevation  of  tempera- 
ture, sometimes  as  high  as  102°  F.  Continu- 
ous headache  was  another  feature  of  the  case. 

The  lips  and  conjunctivae  were  almost  colour- 
less, and  the  tongue  was  exceedingly  pale. 
The  skin  had  a  pale  lemon  tint.  The  red 
blood-corpuscles  were  only  1,200,000  to  the 
cubic  millimetre.  The  urine  was  normal.  No 
organic  disease  could  be  discovered.  In  spite 
of  all  efforts  of  treatment  and  feeding,  he 
gradually  grew  worse. 

Dr.  J.  E.  Graham  saw  the  patient  in  consul- 
tation. No  other  disease  could  be  discovered 
than  progressive  anaemia.  It  was  agreed  to 
place  him  in  some  hospital  for  a  time.  He 
was  admitted  into  the  Toronto  Western  Hos- 
pital on  January  7,  1896.  Dr.  Ferguson  went 
with  him  in  the  coupe,  and  says  he  really 
feared  he  would  collapse  on  the  way.  When 
he  arrived  at  the  hospital  he  was  in  such  a 
state  of  exhaustion  as  to  be  unable  to  walk  up- 
stairs. On  being  taken  into  his  room  he  be- 
came unconscious,  and  in  this  condition  he 
was  hurriedly  undressed  and  put  to  bed  with 
hot  bags  around  him.  In  the  course  of  an 
hour  or  so  he  gradually  regained  conscious- 
ness. 

At  this  stage  of  his  disease  there  were  vary- 
ing elevation  and  a  subnormal  condition  of 
the  temperature.  He  had  intense  headache 
and  almost  continuous  insomnia.  'The  bowels 
were  constipated,  and  nearly  everything  in  the 
way  of  nourishment  was  vomited.  The  pa- 
tient was  in  a  state  of  extreme  emaciation  and 
asthenia.  There  were  frequently  low  delirium 
and  confusion  of  thought.  He  often  regarded 
himself  as  a  duality. 

On  his  admission  the  bowels  were  washed 
out  daily  with  a  large  enema  containing  some 
boric  acid.  Daily  he  was  given  a  sponge  bath. 
The  stomach  was  washed  out  every  day  except 
occasionally  when  he  felt  too  weak.  He  was 
fed  on  peptonized  milk,  egg  albumen,  and  beef 
juice.  The  headache  continued,  however,  in  a 
most  intense  degree,  and  there  was  no  improve- 
ment in  the  insomnia.  For  the  headache, 
aoetanilide,  phenaoetine,  salol,  and  other  agents 


449 


NITROUS  OXIDE 
NDX  VOMICA 


were  employed,  but  with  only  the  most  tem- 
porary relief.  Opium,  chloral,  paraldehyde, 
and  sulphonal  were  administered  from  time  to 
time  for  the  insomnia.  On  one  occasion  30 
grains  of  sulphonal  were  given,  with  the  result 
of  causing  only  a  few  hours'  imperfect  sleep, 
followed  the  day  after  by  much  vomiting, 
great  restlessness,  extreme  headache,  and  a 
feeble  pulse. 

He  had  been  in  the  hospital  a  little  over  two 
weeks,  and  all  the  appearances  pointed  to  an 
unfavourable  termination  of  the  case,  when  he 
was  now  placed  on  the  use  of  protonuclein 
(tablets),  as  prepared  by  Eeed  &  Carnrick. 
The  eneraata,  lavage  of  the  stomach,  and  the 
same  nourishment  were  continued.  Tablets 
were  given  every  three  hours.  By  the  third 
day  it  became  apparent  that  the  patient  was 
improving.  The  headache  was  the  first  symp- 
tom to  become  modified.  In  a  week  it  had 
almost  wholly  disappeared,  and  at  the  date  of 
the  report  was  entirely  gone. 

The  sleep  soon  became  better.  By  the  end 
of  the  first  week  of  the  use  of  protonuclein 
he  would  sleep  three  and  four  hours  at  a  time. 
At  the  time  of  the  report  he  could  sleep  from 
six  to  eight  hours,  and  woke  with  a  rested  and 
refreshed  feeling.  The  appetite  was  good  ;  he 
could  take  eggs,  meat,  toast,  porridge.. oysters, 
beef  juice,  bread  and  butter,  milk,  and  light 
puddings  without  the  slightest  discomfort. 
There  was  no  nausea  or  vomiting  ;  the  bowels 
were  quite  regular,  and  no  enemata  or  aperi- 
ents had  been  administered  for  at  least  ten 
days.  The  temperature  was  constantly  nor- 
mal. The  patient  was  gaining  in  flesh  and 
could  walk  about  the  ward  and  in  the  hall  for 
an  hour  and  experience  no  ill  effects.  The 
lips  and  nails  had  a  good  colour,  and  the 
tongue  had  lost  its  pallor.  The  abdominal 
walls,  which  had  been  extremely  retracted, 
were  now  filling  with  adipose  tissue.  The 
most  marked  change,  however,  was  to  be  found 
in  the  red  blood-globules.  When  the  proto- 
nuclein was  first  ordered  there  had  been  not 
quite  1,000,000  to  the  cubic  millimetre.  Now 
there  were  3,500,000.  The  progress  of  the  pa- 
tient had  been  one  of  daily  improvement.  He 
was  to  leave  the  hospital  in  two  or  three  days, 
when  the  same  line  of  treatment  would  be 
maintained,  with  the  addition  of  a  mild  course 
of  massage  to  assist  in  the  development  of  the 
muscles. 

NTJTROSE.— According  to  Dr.  R.  Stilve,' 
of  Prankfort-on-the-Main  {Berliner  klinische 
Wochenschrift,  1896,  No.  20 ;  Deutsche  Medi- 
zinal-Zeitung,  May  21, 1896),  nutrose  is  another 
name  for  a  certain  compound  of  casein  and 
sodium.  He  has  found  it  of  particular  value 
in  the  case  of  children  in  convalescence  from 
scarlet  fever,  measles,  diphtheria,  or  pneu- 
monia. Added  to  a  milk  or  soup  diet,  it  en- 
riches the  food  in  albumin,  and  thus  hastens 
recovery.  Its  taste  is  agreeable,  and  it  is 
utterly  unirritating  to  the  intestines,  from 
which  it  is  readily  absorbed. 

NUX  VOMICA.— Dr.  Thomas  J.  Mays,  of 
Philadelphia,  who  regards  the  state  of  the 
nervous  system  as  playing  an  important  part 


in  giving  rise  to  pulmonary  tuberculosis,  says 
(Journal  of  the  American  Medical  Association, 
October  10, 1896  ;  New  York  Medical  Journal, 
October  27,  1896)  that,  of  all  the  drugs  in  the 
materia  mediea,  there  is  none  that  compares 
favourably  with  strychnine  in  the  treatment  of 
this  disease.  'Aside  from  its  elective  affinity 
for  the  whole  nervous  system,  it  possesses  a 
special  influence  on  the  nerves  which  preside 
over  the  function  of  respiration.  There  is  rea- 
son for  believing  that  it  also  affects  the  periph- 
eral sensory  nerves.  In  small  doses  it  stimulates, 
in  medium  doses  it  tetanizes,  and  in  large  doses 
it  paralyzes  the  nervous  system.  The  dose  is 
a  relative  or  a  movable  quantity,  however,  he 
says,  for  that  which  produces  tetanus  or  pa- 
ralysis at  one  time  may  act  as  a  stimulus  at 
another. 

In  regard  to  the  action  of  strychnine  in  pul- 
monary consumption,  continues  Dr.  Mays,  if  it 
is  taken  for  granted  that  the  lung  disease  is 
merely  a  superficial  manifestation  of  disorder  of 
the  pulmonary  nerve  supply,  the  strychnine 
primarily  raises  the  tone  of  the  nervous  system 
as  a  whole  and  that  of  the  respiratory  nerves 
in  particular.  In  this  way  it  not  only  in- 
creases the  resistance  of  the  lung  to  disease, 
but  aids  digestion,  assimilation,  and  blood- 
building.  In  employing  strychnine  great  care 
must  be  taken  to  avoid  the  danger  point,  yet 
at  the  same  time  this  point  must  be  ap- 
proached as  closely  as  is  consistent  with  safety. 
The  best  way  to  bring  about  this  object,  says 
the  author,  is  to  begin  with  a  moderately  small 
dose  of  the  drug,  ^q-  of  a  grain  four  times  a 
day ;  give  this  for  a  week,  then  increase  it  to 
^  of  a  grain  for  another  week:  during  the 
next  give  ijV  of  a  grain,  the  following  week 
raise  the  dose  to  about  I'g  of  a  gi'ain,  and  so  on, 
making  a  slight  increase  every  week  until 
nervousness,  restlessness,  or  twitching  of  the 
muscles  is  observed,  the  signs  of  the  beginning 
of  strychnine  intoxication.  In  most  cases  these 
symptoms  do  not  develop  until  -jV  or  |  of  a 
grain  or  even  a  larger  dose  is  reached.  It 
must  be  understood  that  the  drug  is  to  be 
given  in  these  doses  four  or  even  five  times  a 
day.  The  object  is  to  impress  the  nervous 
system  with  the  full  stimulant  effect  of  this 
drug.  The  sooner  this  end  is  attained  the  bet- 
ter will  it  be  for  the  patient.  For  this  reason, 
begin  with  small  doses  and  work  upward  as 
rapidly  as  can  be  done  with  safety.  After  the 
desired  point  has  been  reached  the  question 
arises  whether  it  is  better  to  continue  the 
largest  dose  or  to  resume  the  original.  Dr. 
Mays  thinks  it  best  not  to  vary  from  this  line 
during  the  remainder  of  the  treatment,  in 
order  not  to  lose  what  has  been  accomplished. 
Keep  the  strychnine  treatment  up  to  the  high-  * 
est  level  of  safety,  he  says,  but  shun  the  point 
where  its  stimulus  extends  into  the  region  of 
tetanus  and  of  paralysis.  It  is  best,  however, 
to  reduce  the  dose  somewhat  at  this  point.  If, 
for  example,  it  is  found  that  ^  of  a  grain  is  a 
maximum  dose,  reduce  it  to  ^^^  of  a  grain,  then 
gradually  increase  the  dose  again  until  i  of  a 
grain  is  reached,  and  then  return  to  ^  or  to 
^  of  a  grain.  After  the  dose  has  been  in- 
creased and  decreased  several  times  it  will 


OPICTM 
OXYGEN 


450 


probably  be  found  that  ^  of  a  grain  no  longer 
prodiioes  any  dangerous  symptoms,  and  that  as 
much  as  ^  of  a  grain  can  be  given.  When  ad- 
ministered in  this  way  the  drug  may  be  given 
for  an  indefinite  period  to  the  majority  of 
phthisical  patients. 

The  remedial  effects  of  the  drug  show  them- 
selves in  various  ways.  The  nervousness, 
sleeplessness,  and  pain  in  the  chest  will  be 
ameliorated,  and  perhaps  entirely  disappear ; 
the  cough,  expectoration,  and  dyspnoea  will 
diminish ;  vomiting  will  abate ;  the  appetite 
improves ;  the  patient  gains  in  flesh  and  colour ; 
the  weak  and  rapid  acting  of  the  heart  will 
become  slower  and  stronger ;  the  red  corpuscles 
increase  in  number,  and  the  patient  becomes 
more  hopeful  and  brighter. 

Evenhoff  ( Vrateh  ;  Union  medicate,  July  11, 
1896)  has  experimented  with  strychnine  as  a 
remedy  for  cardiac  failure  during  chloroform 
ancBsthesia.  Tracheotomy  was  practised  on 
dogs,  and  a  tube  was  introduced  into  the 
larynx  and  put  in  communication  with  a  small 
bottle  which  contained  chloroform.  Artificial 
respiration  was  made  in  such  a  way  that  the 
air  passed  through  the  bottle,  and  it  could  be 
charged  or  not  with  chloroform.  Before 
ohloroformization  the  pressure  was  noted,  then 
the  air,  charged  with  chloroform,  was  injected 
and,  when  the  pressure  fell  to  0,  pure  air  was 
thrown  in  and  an  intravenous  injection  of  from 
2  to  3  milligrammes  of  strychnine  was  admin- 
istered. When  the  pressure  finally  became 
normal  the  animal  again  received  inhalations 
of  chloroform.  In  this  way  the  action  of  the 
chloroform  before  and  after  the  injection  of 
strychnine  was  ascertained.  The  results  of 
these  experiments  showed  that,  owing  to  these 
injections,  dogs,  which  usually  tolerate  chloro- 
form badly,  could  support  the  drug  without 
inconvenience  for  a  greater  length  of  time. 
The  favourable  action  of  strychnine  on  ohloro- 
formization was  thus  demonstrated.  Strych- 
nine, however,  has  two  inconveniences :  it  may 
possibly  provoke  a  tetanoid  attack,  and,  given 
in  the  dose  employed  by  Evenhoff,  it  increases 
parenchymatous  haemorrhage. 

Strychnine  is  often  particularly  valuable  in 
the  treatment  of  pneumonia.  Dr.  Hobart  A. 
Hare,  of  Philadelphia  {Therapeutic  Gazette, 
April,  1895),  says  that  the  three  sheet-anchors 
of  treatment  for  pneumonia  after  the  exudation 
has  taken  place  are  digitalis,  strychnine,  and 
belladonna.  Of  these,  strychnine  is  the  only 
one  which  we  can  use  alone  with  advantage. 
The  digitalis  nearly  always  fails  to  stimulate 
the  vaso-motor  system  sufficiently,  and  the 
belladoima  has  to  be  added  to  regulate  the 
blood-flow  by  its  vascular  action.  Often,  when 
digitalis  is  used  in  pneumonia,  the  pulse  is  full, 
but  soft  and  boggy,  if  such  a  term  may  be 
used  ;  and,  while  the  regularity  and  slowness, 
as  well  as  the  volume,  may  indicate  the  full 
action  of  digitalis,  the  patient  fails  to  receive 
beneflt  and  may  have  a  leaky  skin.  Under 
these  circumstances,  belladonna,  given  in  the 
dose  of  about  5  drops  of  the  tincture  every 
three  or  four  hours,  while  the  digitalis  is  given 
in  10-drop  doses  every  six  or  eight  hours,  will 
produce   marked  improvement.     The  strych- 


nine finds  its  great  value  as  a  whip  to  the  entire 
system — as  a  whip  which  will  pull  the  patient 
out  of  collapse  or  syncope,  or  overcome  the 
peculiar  torpor  which  is  so  dangerous  a  symp- 
tom in  this  disease,  indicating,  as  it  does,  that 
carbon  dioxide  is  accumulating  in  the  blood, 
or  that  the  poison  of  the  disease  is  obtundiug 
the  nerve-centres.  Particularly  are  strychnine 
and  belladonna  useful  about  the  time  of  crisis, 
when  the  rapid  fall  of  temperature  takes  away 
the  stimulating  effect  of  the  heat  and  produces 
collapse. 

Dr.  Hare  then  alludes  to  a  case  exemplifying 
most  strikingly  the  value  of  the  drugs  he  is 
speaking  of.  A  child  of  five  years,  having 
passed  through  the  earlier  stages  of  pneumonia 
rather  uneventfully,  arrived  at  the  period  for 
crisis.  On  the  day  that  crisis  occurred  it  sat 
up  in  bed  for  an  instant,  although  the  pulse 
was  already  weak  from  the  fall  in  fever,  and 
at  once  called  out,  "  Light  the  gas,  it's  getting 
dark,"  and  then  passed  into  profound  collapse. 
The  case  was  a  desperate  one,  and,  in  addition 
to  external  heat.  Dr.  Hare  gave  hypodermically 
^  of  a  grain  of  strychnine  and  '-^  of  a  grain 
of  atropine  every  fifteen  minutes  till  three  doses 
were  used,  when  the  child  showed  signs  of  re- 
newed vitality,  became  flushed  from  the  atro- 
pine, and  eventually  recovered  without  any 
further  symptoms  of  note. 

Dr.  Percy  Kidd,  of  London  (Practitioner, 
September,  1894),  says  he  has  used  strychnine 
in  the  treatment  of  croupous  pneumonia  ever 
since  he  read  an  article  published  in  St.  Bar- 
tholomew's Hospital  Reports,  in  the  volume  for 
1886,  by  Dr.  Herbert  Habershon,  who  reported  a 
series  of  cases  of  cardiac  failure  and  two  cases  of 
double  pneumonia  treated  with  the  drug.  The 
indications  for  the  use  of  strychnine,  says  Dr. 
Kidd,  are  mainly  derived  from  the  pulse.  If 
the  tension  begins  to  sink,  or  if  the  frequency 
of  the  beats  is  much  increased,  strychnine 
should  be  used  at  once,  and  by  subcutaneous 
injection,  as  Dr.  Habershon  rightly  insisted, 
for  in  cases  of  grave  disease  absorption  from 
the  stomach  is  slow  and  imperfect. 


OPIUM. — The  occasional  value  of  opium 
in  stopping  hcemorrhaqe  is  strikingly  shown 
by  a  case  reported  by  Dr.  William  Huntlv.  of 
Kotah  (Indian  Medicnl  Record,  May  1, 1894). 

A  man  came  to  him  on  the  morning  following 
the  extraction  of  a  lower  molar  tooth.  The 
bleeding  had  been  verv  severe,  and  blood  still 
flowed  from  the  gum.  Dr.  Huntly  stuffed  the 
cavity  with  lint  soaked  in  liquor  ferri  per- 
chloridi,  but  this  did  not  stop  the  bleeding. 
The  man  was  very  weak.  Kemembering  the 
effect  of  opium,  he  gave  him  a  full  dose  of  the 
tmcture,  and  in  less  than  a  minute  the  pupil 
contracted  and  the  bleeding  stopped.  The 
patient  was  then  ordered  to  take  30  grains  of 
calcmm  chloride  in  an  ounce  of  rain-water 
every  two  hours  until  he  had  taken  3  drachms. 
Ihe  bleedmg  never  recurred.  Dr.  Huntly's 
views  of  the  value  of  calcium  chloride  as  a 
hoimostatic  will  be  found  in  the  supplementary 
article  on  that  drug  (vol.  ii,  page  438). 


451 


OPIUM 
OXYGEN 


OPOTHERAPY.— This  term  is  occasion- 
ally applied  to  treatment  with  animal  juices 
and  extracts. 

OREXINE    HYDROCHLORIDE.— Dr. 

Hohn,  o£  Wiesbaden  {TherapeuHsche  Monat- 
shefte,  January,  1896 ;  Wiener  Hinische  Woeh- 
ensckrift,  April  30, 1896),  remarks  that  orexine 
chloride  should  always  be  given  in  wafers,  but 
that  the  uncombined  alkaloid  may  subse- 
quently be  administered  without  the  use  of 
wafers,  when  one  has  made  sure  that  it  does 
not  give  rise  to  a  sense  of  burning  in  the  mouth 
or  the  oesophagus.  Not  more  than  4  grains 
should  be  given  at  one  dose,  and  the  entire 
amount  given  in  the  course  of  twenty-four 
hours  should  not  exceed  8  grains.  A  dose 
should  be  taken  half  an  hour  before  the  mid- 
day meal,  and  perhaps  another  shortly  before 
the  evening  meal.  Hohn  has  used  orexine  in 
thirty-three  cases,  and  gives  the  histories  of 
ten,  including  three  of  miwmia,  one  of  gastric 
catarrh,  one  of  sequela  (loss  of  appetite,  pallor, 
debility,  etc.)  of  catarrh  of  the  large  intestine 
of  several  weeks'  duration,  two  of  supposed 
incipient  tuberculous  pulmonary  disease,  one 
of  such  disease  positively  recognised,  and  two 
of  vomiting  of  pregnancy.  In  twenty-three 
other  cases  there  was  loss  of  appetite  caused 
by  ansemia  in  eight,  gastric  catarrh  in  six,  and 
vomiting  of  pregnancy  in  one,  and  attendant 
upon  convalescence  in  three.  As  regards  the 
results,  in  five  of  the  thirty-three  cases  they 
are  not  siated  ;  in  nine  success  was  attained, 
according  to  the  patients'  accounts  ;  in  twelve, 
increase  of  the  appetite  was  noted ;  in  four, 
the  result  was  doubtful ;  and  in  two,  failure 
occurred  (one  was  that  of  a  phthisical  patient 
in  the  last  stages  of  the  disease,  and  the  other 
was  that  of  an  hysterical  woman). 

OROTHERAPY,  ORRHOTHERAPY. 

— See  Serum  treatment  and  The  whey  cure, 
under  Dietetic  treatment. 

OVARIAN  JXTIGE,  OVARIAN  STTB- 
STANCE,  OVARINE.— The  expressed  juice 
of  the  fresh  ovaries  of  healthy  young  animals, 
filtered  and  treated  by  the  method  described 
under  Animal  extracts  and  juices,  an  ex- 
tract, ovarine,  made  as  described  in  that  arti- 
cle, and  the  dried  substance  of  the  ovary,  have 
all  been  used  as  remedies.  The  Presse  medi- 
cate for  August  15,  1896  (New  York  Medical 
Journal,  September  12, 1896),  publishes  a  report 
of  a  meeting  of  the  Congres  fran5ais  de  medecine 
interne  at  which  M.  Spillmann  and  M.  Etienne 
presented  a  paper  on  the  treatment  of  chlorosis 
with  these  preparations.  They  thought  that  the 
morbid  symptoms  which  often  preceded  men- 
struation .might  be  considered  as  the  result  of 
an  intoxication  which  disappeared  after  this 
function  was  established.  If  chlorosis,  they 
said,  was  a  disease  of  the  ovaries,  their  func- 
tions were  changed  or  abolished,  and  with  the 
suppression  of  menstruation  chlorosis  appeared. 
And,  on  the  other  hand,  a  defective  general  con- 
dition interfered  with  and  impeded  recovery  of 
the  ovarian  gland.  If,  however,  the  ovarian 
internal  secretion  was  restored  to  the  organ- 
ism in  any  way,  it  was  possible,  perhaps,  to 
stop  the  intoxication,  to  influence  the  organ- 


ism in  general,  and  to  ailord  a  means  of  re- 
covery of  the  local  ovarian  aSeotion. 

The  authors  had  made  use  of  three  products  : 
The  fresh  ovaries  of  the  sheep,  dried  ovarian  sub- 
stance, and  ovarian  juice  prepared  by  the  Brown- 
Sequard-d'Arsonval  method.  These  remedies 
had  been  given  to  six  chlorotic  subjects,  with 
the  results  that  after  the  first  dose  very  sharp 
pains,  especially  in  the  abdominal  region,  had 
been  felt;  there  had  also  been  headache  and 
vague  muscular  pains.  In  two  of  the  patients 
the  temperature  had  risen  to  99'1°  and  100-2°  P., 
and  the  pulse  increased  from  76  to  100.  In  three 
of  the  patients  the  remote  results  had  been  dis- 
tinctly favourable  ;  the  general  condition  had 
been  rapidly  improved,  the  pallor  diminished, 
the  number  of  white  globules  increased,  and 
the  strength  restored.  In  amenorrhcea,  men- 
struation, which  had  been  suppressed  for  over 
three  months,  had  returned  in  one  case  in 
fifteen  days  after  the  beginning  of  the  treat- 
ment; in  another  ease  it  had  returned  at  the 
end  of  three  months.  The  authors  concluded 
that,  in  the  treatment  of  chlorosis,  ovarine  fa- 
voured the  elimination  of  the  toxines  and  intro- 
duced into  the  organism  an  antitoxic  principle, 
and  in  this  way  exerted  a  favourable  action  on 
the  general  condition,  on  the  formation  of  red 
globules,  and  on  menstruation. 

Dr.  Mond  (JHunchener  medicinische  Wochen- 
schrift,  1896,  No.  36 ;  Gazette  hebdomadaire  de 
medecine  et  de  chirurgie,  December  13,  1896) 
reports  twelve  cases  of  the  use  of  ovarine  in  the 
treatment  of  disturbances  following  oophorec- 
tomy and  the  menopause,  and  says  that  in  every 
case  the  effect  of  the  treatment  was  remarkable. 
There  was  progressive  attenuation  of  the  dis- 
turbances from  the  beginning  of  the  third  or 
fourth  day,  followed  by  their  complete  disap- 
pearance at  the  end  of  ten  or  twelve  days.  The 
quantity  employed  was  ten  tablets  a  day,  each 
containing  8  grains  of  fresh  ovarian  substance. 
He  advises  the  employment  of  large  doses  in 
the  beginning,  which  may  be  progressively  di- 
minished and  increased  again  if  the  dose  seems 
to  be  insufficient.  He  states  that  he  has  never 
seen  the  least  symptom  of  poisoning  in  any  case. 
In  several  cases  he  substituted  for  the  ovarine 
tablets  others  which  had  the  same  taste,  the 
same  colour,  and  the  same  appearance,  but 
contained  only  meat  extract  and  salt.  The 
administration  of  these  tablets  was  regularly 
followed  by  the  return  of  all  the  troubles,  so 
that  the  administration  of  the  real  ovarine 
tablets  evidently  did  not  act  by  suggestion. 

OXYGEN. — At  the  eighteenth  annual  meet- 
ing of  the  American  Laryngological  Associa- 
tion, that  of  the  year  1896  (JS/ew  York  Medical 
Journal,  August  29,  1896),  Dr.  George  Stoker, 
M.  R.  C.  P.  I.,  of  London,  presented  a  paper  in 
which  he  described  his  method  of  using  oxygen 
in  the  treatment  of  syphilitic  and  chlorotic 
ozmna  and  chronic  suppurative  otitis  media. 

The  oxygen  is  contained  in  a  wedge-shaped 
bag  made  of  mackintosh.  This  bag  is  placed 
between  two  boards,  such  as  are  used  with  the 
oxyhydrogen  light.  Prom  the  bag  leads  a  tube, 
which  terminates  in  a  nose  or  ear  piece.  There 
are  two  taps — a  large  one  on  the  bag,  lor  the 


PRLLOTINE 
PIPERIDINB 


452 


purpose  of  filling  it,  and  a  small  one  to  regu- 
late the  stream  of  oxygen  during  treatment. 
This  bag  contains  a  cubic  foot  of  gas,  or  of 
gas  and  purified  air  mixed  in  equal  quantities, 
and  this  amount  should  sutriee  for  six  hours' 
treatment.     In  the  great  majority  of  oases  he 
uses  equal  parts  of  oxygen  and  purified  air. 
This  latter  is  prepared  by  being  pumped  by 
means  of  a  bellows  or  hand  ball  through  two 
wash  bottles,  the  first  containing  some  water 
and  the  second  Oondy's  fluid.     The  bottles  are 
attached  to  the  bag  for  this  purpose,  and  when 
the  bag  is  half  full  it  is  detached  from  the  bot-. 
ties  and  filled  up  with  oxygen.     The  bag  being 
filled,  the  nose  piece  is  passed  into  onenostril,  the 
other  nostril  being  plugged  with  cotton  wool ; 
the  patient  is  directed  to  breathe  through  the 
mouth,  the  taps  are  turned  dh,  and  the  treat- 
ment is  begun.     In  ear  cases  the  only  differ- 
ence is  that  the  terminal  piece  is  placed  in  the 
external  auditory  meatus,  and  in  case  of  either 
ears  or  noses  it  is  desirable  to  have  several  dif- 
ferent-sized terminals  to  fit  different-sized  ori- 
fices.    The  oxygen  should  be  allowed  to  pass 
into  either  the  nose  or  ear  from  three  to  six 
hours  daily.     In  nose  oases  it  is  best  to  use  it 
about  half  an  hour  to  an  hour  at  a  time,  giv- 
ing intervals  of  rest  between  the  times.     If 
used  for  more  than  an  hour  in  nose  cases  it  is 
apt  to  cause  headache.     The  only  additional 
treatment  is  using  warm  water  to  cleanse  the 
parts  during  the  day.  never  less  than  twice  a  day. 
Dr.  Stoker  stated  that  of  late  he  had  been 
using  the  same  treatment  in  cases  of  purulent 
discharge  from  the  antrum  of  Mighmore.  the 
frontal  sinus,  or  the  ethmoidal  cells,  and  up 
to  that  time  the  results  had  been  satisfactory. 
Injections  of  oxygen  into  the  peritonieum 
have  been  recommended  by  M.  Potain  in  the 
treatment  of  ascites.     M.  Teissier  (Province 
medicate,  July  4,  1896;  New   York  Medical 
Journal,  August  1,  1896)  relates  the  case  of  a 
woman  with  ascites  and  general  oedema.     He 
punctured  the  abdomen  and  withdrew  about 
fourteen  pints  of  liquid,  but  the  liquid  collected 
again  in  six  days.    A  second  puncture  was  then 
made  and  followed  by  the  injection  of  1,300 
cubic  centimetres  of  oxygen.     The  operation 
was  very  well  borne,  and  it  did  not  provoke 
any  pain  or  local  reaction ;  there  was  also  com- 
plete absence  of  fever  during   the   following 
days.     The  circumference  of  the  abdomen  di- 
minished from  138  to  103  centimetres,  and  the 
oedema  of  the  lower  limbs   disappeared  very 
rapidly.     The  oxygen  was  easily  absorbed  by 
the  peritonasum.     For  a  few  days  there  was 
some  gurgling,  but  this  disappeared  at  the  end 
of  eight  or  ten  days.    At  the  time  of  the  report 
the  abdomen  still  measured  103  centimetres 
and  sonorousness  existed  everywhere,  even  in 
the  iliac  fossa  when  the  patient  lay  on  her  side. 
She  was  able  to  get  up  every  day  and  walk  in 
the  open  air.    These  results  had  been  obtained 
in  three  weeks. 


PELLOTINE.— This  is  an  alkaloid  ob- 
tained from  Anhalonium  Williamsii.  Dr. 
Jolly  (Deutsche  medicinische  Wochenschrift, 


1896,  No.  34 ;  British  Medical  Journal,  Octo- 
ber 84,  1890)  records  some  observations  on  the 
use  of  it  as  a  hypnotic.  It  may  be  adminis- 
tered by  the  mouth  or  subcutaneously.  The 
dose  is  from  ^  to  J  of  a  grain,  which  may  be 
repeated  if  necessary.  In  one  case  as  much  as 
11  grain  was  given  in  two  hours.  Dr.  Jolly 
has  used  pellotine  in  forty  cases,  and  the  re- 
sults have  been  satisfactory,  though  in  vary- 
ing degree.  In  no  Case  were  any  unpleasant 
after-effects  noticed.  He  considers  that  this 
drug  should  receive  further  trial. 

PHENETIDINE.— See  Phenacetine. 

PHENOL. — Dr.  Sbrana  (Riforma  medico,, 
March  16, 1896 ;  British  Medical  Journal,  May 
3,  1896)  reports  the  ease  of  an  Arab,  aged 
twenty-five,  who,  on  November  10th,  wounded 
his  left  big  toe  near  the  nail  by  striking  it 
against  a  stone.  The  wound  was  immediately 
dressed  with  cobwebs  full  of  earth.  Two  or 
three  days  later,  as  the  part  became  painful, 
the  wound  was  washed  with  urine,  then  cov- 
ered with  chalk,  and  over  this  a  sheep's  blad- 
der was  laid.  On  the  33d  there  was  some 
diificulty  in  masticating.  When  the  man  was 
seen,  on  the  35th,  there  was  well-marked 
tetanus,  the  temperature  was  101-3°  P.,  and 
there  were  risus  sardonicus,  complete  trismus, 
opisthotonos,  and  general  clonic  convulsions. 
A  hypodermic  injection  of  a  3-per-cent.  solu- 
tion of  phenol  was  given  in  the  foot  on  the 
evening  of  the  35th,  and  three  times  a  day 
afterward.  On  the  36th  the  necrosed  last 
phalanx  and  part  of  the  first  were  removed. 
On  the  30th,  the  inguinal  glands  were  en- 
larged and  painful.  On  December  4th  there 
was  smart  intestinal  haemorrhage,  also  a  copi- 
ous eruption  of  sudamina  on  various  parts  of 
the  body.  On  December  11th  the  patient  left 
his  room  quite  cured.     Of.  Carbolic  acid. 

PICRIC  ACID.— Jlr.  'William  Maclennan 
(British  Medical  Journal,  December  26,  1896 ; 
New  York  Medical  Journal.  January  16,  1897) 
says  that  the  admirable  results  which  he  has 
seen  follow  the  free  application  of  picric  acid 
in  solution  to  painful  and  extensive  burns  led 
him  to  try  its  effects  in  the  treatment  of  cer- 
tain skin  diseases.  He  has  employed  it  locally 
in  a  large  number  of  cases,  and  has  found  it 
more  efficacious  than  any  other  of  the  reme- 
dial agents  commonly  in  use,  and  he  thinks  it 
worthy  of  a  more  extensive  trial. 

Acute  eczema,  he  says,  is  rapidly  relieved 
under  the  influence  of  picric  acid,  and,  owing 
to  the  powerful  astringent  properties  which 
this  chemical  possesses,  it  forms,  when  applied 
over  a  discharging  or  denuded  surface,  a  pro- 
tective layer  of  coagulated  albumin  and  epi- 
thelial dilris  under  which  healing  rapidly 
proceeds;  and  as  a  potent  antiseptic,  by  in- 
hibiting the  action  of  the  microbes  on  which 
the  formation  of  pus  depends,  or  destroying 
them,  it  completely  prevents  suppuration. 

Applied  as  a  pigment  with  a  brush  or  piece 
of  absorbent  wool,  even  to  an  extensive  sur- 
face, it  is  quite  free  from  danger,  and  causes 
not  the  slightest  pain,  however  vascular  the 
surface  may  be.  Almost  immediately  itching 
and  smartmg  abate,  and  in  a  few  days,  when 


453 


PELLOTINE 
PIPEKIDINE 


the  protective  crust  is  removed  or  separates, 
the  undei'lying  skin  is  found  to  be  compara- 
tively dry,  free  from  redness,  and  covered  writh 
a  young  epidermis. 

Mr.  Maclennan  states  that  in  that  very 
troublesome  form  of  acute  eczema  occurring 
in  children  (eczema  capitis  et  faciale)  which  is 
usually  so  intractable  to  the  ordinary  methods 
of  treatment,  he  has  had  most  encouraging  re- 
sults from  the  use  of  picric  acid.  If  the  hair 
on  the  child's  head  happens  to  be  long  it 
should  be  cropped  short,  and  all  adherent 
crusts  removed  by  means  of  poulticing.  The 
raw  surface  should  then  be  freely  painted 
over,  morning  and  evening,  for  three  or  four 
days  in  succession  with  a  saturated  watery 
solution.  During  this  treatment  the  scalp 
and  the  face,  when  it  is  involved,  should  be 
protected  by  means  of  a  calico  mask.  After 
the  lapse  of  a  few  days  the  pellicle  which  has 
been  formed  by  the  action  of  the  picric  acid 
can  be  removed,  with  some  emollient  if  it  has 
not  previously  separated,  and,  it  any  undue 
redness  or  moisture  remains,  a  fresh  applica- 
tion may  be  made.  The  cessation  of  irritation 
Eermits  the  child  to  sleep,  and  its  general 
ealth  soon  improves.  When  the  disease  be- 
comes quiescent,  the  local  treatment  can  be 
combined  with,  or  followed  by,  the  internal 
administration  of  alteratives  like  arsenic  or 
gray  powder. 

Although  picric  acid  is  so  specially  valuable 
in  acute  discharging  eczemas,  says  the  author, 
it  will  be  found  an  eiHcient  remedy  in  almost 
any  superficial  inflammatory  affection.  Thus, 
in  three  cases  of  erysipelas  he  has  found  a 
saturated  solution  of  picric  acid  superior  to 
any  local  remedy  he  has  hitherto  tried.  It 
arrested  the  inflammation  and  prevented  the 
disease  from  spreading,  and  much  more  rap- 
idly diminished  local  discomfort  than  carbolic- 
acid  dusting  powder  or  ichthyol. 

Aspland,  he  says,  narrates  the  case  of  a 
soldier  suffering  from  diabetes  mellitus,  who 
contracted  ague.  He  was  treated  with  picric 
acid.  Under  its  influence  the  polyuria  rapidly 
disappeared  and  the  specific  gravity  fell  from 
1'03S  to  1"018,  and  in  a  few  weeks  sugar  was 
entirely  absent  from  the  urine. 

In  those  very  troublesome  cases  of  chronic 
simple  diarrhoea,  and  so-called  putrid  diar- 
rAoso,  with  very  offensive  stools,  Mr.  Maclennan 
has  employed  picric  acid  largely.  Often,  when 
opiates  and  other  astringents  have  failed, 
picric  acid  in  grain  doses  has  given  rapid  re- 
lief. The  powerful  astringent  and  antiseptic 
properties  of  picric  acid  diminish  secretion 
and  disinfect  the  intestinal  canal.  In  this  re- 
spect the  action  of  earbazotic  acid  resembles 
that  of  carbolic  acid,  to  which  it  is  constitu- 
tionally related. 

M.  P.  Broeq  {Revue  iniernationale  de  mede- 
cine  et  de.  chirurgie,  July  10,  1896)  employs 
the  following  formulae  in  the  treatment  of 
itching  of  the  scrotum  : 

(1)    9    Picric  acid 4i  grains ; 

yaseline.)       j^ 235      " 

Lanohn,  ( 
M.    S. :  For  external  use. 


(2) 


5    Picric  acid 15  grains ; 

y!fi,™'Uach 225     " 


Lanolin, 
M.     S. :  For  external  use. 


PIPERIDINE. — Piperidine  guaiaoolate  is 
described  by  Dr.  Arnold  Chaplin  and  Dr.  P.  W. 
Tunnicliffe  {British  Medical  Journal,  January 
16,  1897)  as  a  compound  formed  by  the  action 
of  piperidine  on  guaiacol  in  a  suitable  solvent, 
such  as  benzol  or  petrolic  ether,  having  the 
formula  CsHuNCyHsOj,  although  its  exact 
chemical  composition  is  still  under  investiga- 
tion. It  crystallizes  in  prismatic  needles  or 
plates.  It  is  soluble  to  the  extent  of  3'5  per 
cent,  in  water ;  it  is  also  easily  soluble  in  most 
organic  solvents.  It  is  decomposed  into  its 
constituents  by  mineral  acids  and  alkalies. 
The  chemical  property  which  from  a  pharma- 
ceutical standpoint  is  most  worthy  of  note  is 
its  relative  solubility.  When  the  insolubility 
of  the  carbonate  of  guaiacol  is  borne  in  mind 
this  becomes  emphasized.  The  solubility  is 
such  that  10  grains  may  be  administered  in  an 
ounce  draught  of  simple  water,  or  if  the  spe- 
cific gravity  of  the  medium  is  raised  by  the 
addition  of  a  little  glycerin  or  mucilage,  a 
dose  of  from  20  to  30  grains  may  be  given. 

The  salt  is  decomposed  into  guaiacol  and 
piperidine,  probably  not  in  the  acid  medium 
of  the  stomach,  but  in  the  alkaline  one  of  the 
duodenum.  The  reason  for  this  assumption  ia 
that  large  doses — a  drachm — can  be  given  with- 
out the  slightest  eructation  of  guaiacol.  The 
guaiacol  acts  in  the  intestine  as  an  antiseptic ;  in 
the  structures  through  which  it  is  excreted,  for 
example,  the  respiratory  mucous  membrane,  it 
acts  also  as  an  antiseptic.  As  to  the  piperidine, 
its  pharmacology  forms  in  part  the  subject  of 
a  research  to  be  published  by  Dr.  Tunnicliffe 
in  conjunction  with  Dr.  Lauder  Brunton.  For 
the  present,  Chaplin  and  Tunnicliffe  simply 
say  that  when  hydrochloride  of  piperidine, 
suitably  diluted,  is  injected  into  the  circula- 
tion in  doses  of  0'05  of  a  gramme  to  the  kilo- 
gramme of  weight,  the  heart  is  slowed  and  the 
vessels  are  contracted,  a  considerable  rise  of 
blood-pressure  taking  place.  When  it  is  in- 
jected under  the  skin  in  doses  of  from  1  to  2 
centigrammes  to  the  kilogramme,  an  increase 
in  reflex  excitability  occurs,  so  that  if  the  drug 
is  pushed  convulsions  may  develop.  Thus  in 
suitable  doses  piperidine  must  be  regarded  as 
a  cardio-vasoular  tonic  and  spinal  stimulant. 

For  three  months,  the  authors  say,  an  in- 
quiry as  to  the  value  of  piperidine  guaiacolate 
in  the  treatment  of  pulmonary  tnherculosis  has 
been  carried  out  at  the  City  of  London  Hos- 
pital for  Diseases  of  the  Chest.  The  patients 
to  whom  the  drug  was  given  were  subjected  to 
close  observation,  and  the  effects  of  the  medi- 
cine were  from  time  to  time  noted.  In  all, 
fourteen  cases  were  placed  under  observation, 
of  which  eight  were  in  out-patients  and  six  in 
in-patients.  The  duration  of  the  observations 
varied,  but  six  weeks  was  about  the  average. 
In  order  to  test  the  value  of  the  drug  effi- 
ciently, cases  were  chosen  more  or  less  at  hap- 
hazard, some  being  early  cases  in  which 
improvement  might  be  expected  under  appro- 


PYRAMIDONB 
SALICYLIC  ACID 


454 


priate  treatment,  others  being  more  advanced, 
while  yet  others  were  in  such  a  stage  as  to 
make  it  improbable  that  much  good  from  any 
form  of  treatment  would  accrue.  In  all  cases 
the  dose  to  begin  with  was  fixed  at  5  grains 
three  times  a  day,  and  this  was  gradually  in- 
creased until  30,  and  in  one  ease  35  grains, 
were  given  for  a  dose.  So  far  as  could  be 
gathered  from  questioning  the  patients  and 
from  personal  observation,  no  unpleasant  effects 
were  noticed.  All  of  them  stated  that  the 
medicine  had  agreed  with  them.  Pains  were 
taken  to  ascertain  if  the  drug  produced  any 
gastric  or  intestinal  irritation,  but  in  no  ease 
could  it  be  determined  that  the  processes  of 
digestion  were  in  any  way  interfered  with  by 
it.  The  authors  think  this  worthy  of  special 
stress,  because  experience  has  so  often  taught 
us  that  when  other  derivatives  of  creosote, 
such  as  crude  guaiacol,  are  given  over  a  length- 
ened period  their  use  has  to  be  discontinued 
from  time  to  time  owing  to  the  gastric  and  in- 
testinal disturbances  caused  by  them.  But  in 
these  cases  no  such  untoward  event  happened. 

With  regard  to  the  varied  symptoms  of 
phthisis,  it  is  difficult  to  say  with  certainty, 
they  remark,  that  the  guaiaoolate  of  piperidine 
had  any  distinct  effect  upon  them,  for  in  all 
cases  of  phthisis  it  is  so  frequently  foiind  that 
improved  hygienic  conditions  (good  food,  rest, 
and  attention),  such  as  a  residence  in  a  hos- 
pital affords,  plays  a  large  part  in  the  restora- 
tion of  the  patient's  health.  This  much, 
however,  they  think,  may  be  said,  that  in 
many  instances  the  cough  appreciably  im- 
proved while  the  treatment  was  in  progress. 
The  temperature  was  in  no  case  affected  ad- 
versely by  the  drug  ;  in  most  cases  it  receded 
to  normal.  The  appetite,  for  the  most  part, 
was  maintained,  and  very  often  patients  ex- 
pressed the  belief  that  the  medicine  improved 
it ;  indeed,  in  some  cases  it  seemed  that  it  had 
a  decidedly  good  effect  upon  the  appetite. 
Some  patients  gained  in  weight  while  the 
treatment  was  going  on,  and  in  two  instances 
it  was  thought  that  more  flesh  was  put  on 
than  would  have  been  the  case  had  ordinary 
remedies  been  tried.  The  expectoration  in 
most  eases  decreased  while  the  drug  was  being 
taken.  Among  the  out-patients  especially 
there  was  a  general  improvement  in  strength 
and  vitality.  In  the  case  of  out-patients  it 
must  be  remembered,  they  suggest,  that  im- 
proved hygienic  conditions  do  not  come  into 
operation  to  the  advantage  of  the  patient  as 
they  do  in  in-patient  practice. 

As  to  the  changes  noted  in  the  physical 
signs,  it  must  be  admitted,  they  say,  that  dis- 
cussion of  this  subject  is  full  of  difficulty,  for 
it  so  often  happens  that,  although  conside'rable 
improvement  takes  place  in  the  patient's  gen- 
eral condition,  yet  no  marked  change  occurs 
in  the  physical  signs.  Some  of  the  out-patients 
whose  condition  was  found  to  be  improving 
were  examined  week  by  week  to  see  if  any 
change  could  be  found  in  the  physical  signs. 
Consolidation  and  excavation  were  of  course 
unaffected,  but  in  not  a  few  instances  the  lungs 
were  noticed  to  become  drier  with  less  moist 
crepitant  rales.    This  change  was  attributed 


to  the  fact  that  the  area  of  simple  inflamma- 
tion around  the  tuberculous  infiltration  itself 
had  passed  from  an  active  to  a  more  quiescent 
condition.  The  same  improvement  in  physical 
signs  could  not  be  seen  in  most  of  the  persons 
under  treatment  as  in-patients.  Two  out-pa- 
tients considered  that  the  medicine  relieved 
their  dyspnoea,  and,  to  judge  from  the  lung 
signs,  which  were  under  the  treatment  improv- 
ing rapidly,  it  might  very  well  be  the  case. 

Dr.  Chaplin  and  Dr.  Tunnicliffe  conclude 
with  the  following  general  statements  : 

1.  Experience  has  shown  that  piperidine 
guaiacolate  is  a  perfectly  safe  drug  in  doses 
of  from  5  to  30  grains  three  times  a  day. 

2.  It  causes  no  unpleasant  efliects. 

3.  It  is  exceedingly  well  borne  by  the  stom- 
ach, and  in  this  respect  it  is  equal  to  any  other 
derivative  of  creosote. 

4.  Patients  while  under  its  influence  improve 
in  appetite  and  general  strength. 

PYBAMIDONE.— Professor  Filehne,  of 
Breslau  {Berliner  klinische  Wochenschrift, 
November  30,  1896 ;  ITierapeuHsche  Wochen- 
schrift, December  6,  1896),  describes  this  sub- 
stance as  a  substitution  compound  of  antipyrine 
in  which  an  atom  of  hydrogen  is  replaced  by 

the  group  Nprr"-     It  is  a  white  crystalline, 

tasteless  powder  soluble  in  ten  parts  of  water. 

The  effects  of  pyramidone  on  the  nervous 
system  are  analogous  to  those  of  antipyrine 
throughout,  and  the  mechanism  of  its  antipy- 
retic action  is  the  same — that  of  increasing  the 
dissipation  of  heat.  Thorough  observation, 
however,  discloses  certain  differences  of  effect. 
Pyramidone  acts  on  man  in  doses  only  a  third  as 
large  as  those  of  antipyrine ;  its  action  is  mani- 
fested more  gradually  and  subsides  more  slowly. 
Its  antipyretic  action  is  much  milder  and  lasts 
longer.  Animals  poisoned  with  very  large 
doses  of  pyramidone  show  no  material  altera- 
tion of  the  blood,  either  microscopically  or 
spectroscopically,  and  no  hiemorrhages,  throm- 
boses, or  organic  degenerations.  In  the  healthy 
human  subject,  doses  of  8  grains  produce 
neither  subjective  nor  objective  effects  ;  doses 
of  from  5  to  8  grains  were  given  to  patients 
three  times  a  day  with  advantage.  The  author 
has  always  found  it  promptly  efficacious  in  re- 
lieving pain  of  various  sorts,  such  as  febrile 
headache,  pain  in  the  lymph-glands  and  the 
spleen  in  pseudoleucmmia,  that  of  tuberculous 
peritonitis,  anmmia,  and  multiple  neuritis,  and 
intercostal  neuralgia  occurring  as  a  sequel  of 
influenza.  In  headache  it  is  sufficient  to  give 
6  grains. 

In  four  cases  of  nephritis  it  had  no  effect  on 
the  symptoms,  except  on  the  headache  in  one 
case  of  contracted  kidney.  Its  antipyretic  ac- 
tion was  proved  in  twelve  oases,  including 
those  of  tuberculosis,  typhus,  scarlet  fever, 
pseudoleucaemia,  influenzal  pneumonia,  etc. 
The  promptness  of  its  action  as  an  analgetic 
and  the  mildness  of  its  febrifuge  action,  the 
author  thinks,  entitle  it  to  further  trials. 

PYROZONE.— Dr.  William  Cheatham 
(Medical  Record,  September  13,  1896 ;  New 
York  Medical  Journal,  September  26,  1896) 


'455 


PYRAMIDONE 
SALICYLIC  ACID 


calls  attention  to  a  line  of  treatment  which,  he 
says,  has  rendered  him  the  best  service  in  two 
cases  of  suppurative  otitis  media.  In  both 
cases  the  curette,  chromic  acid,  pyrozone,  for- 
malin, boric  acid,  and  many  other  remedies 
were  employed,  but  no  permanent  relief  was 
obtained.  Finally  Dr.  Cheatham  directed  that 
10  drops  of  a  mixture  of  10  drops  of  dilute 
hydrochloric  acid  and  an  ounce  of  pyrozone 
should  be  put  into  the  ear  three  times  a  day 
after  cleansing  it ;  the  mixture  was  to  be  left 
in  for  five  minutes  after  having  been  forced  in 
deep  by  firm  pressure  upon  the  tragus.  In 
the  first  case  a  remarkable  change  was  noticed 
in  a  few  days ;  in  a  short  time  there  was  no 
secretion  from  the  cavity,  and  there  has  been 
no  return  of  it  for  several  months.  In  the 
second  case  the  patient  began  to  improve  rap- 
idly in  a  few  weeks,  and  recovery  set  in  with 
no  relapse. 

Dr.  Cheatham  states  that  he  has  treated  sev- 
eral similar  cases  with  but  one  failure,  and  that 
occurred  in  a  tuberculous  subject.  He  has 
treated  many  cases  of  lesser  severity  with  only 
an  occasional  failure,  and  he  has  not  seen  this 
treatment  fail  in  acute  cases.  Of  course  in 
the  primary  stage  of  acute  cases,  he  says,  such 
medication  is  contra-indicated,  but  after  pain, 
throbbing,  and  swelling  have  subsided,  and 
suppuration  continues,  notwithstanding  ordi- 
nary treatment,  the  acid  and  pyrozone  check 
it  very  promptly. 

As  to  drainage  in  these  cases,  he  says,  the 
iodoform  or  some  other  of  the  gauzes  cut  into 
narrow  strips  has  given  him  by  far  the  best 
results.  This  treatment  is  not  a  cure-all  by 
any  means,  continues  Dr.  Cheatham,  but  he 
hopes  his  brief  report  will  lead  others  to  try 
the  acid-and-pyrozone  combination.  Of  course, 
when  the  deeper  sinuses  are  involved,  surgery 
is  first  indicated,  then  the  pyrozone  and  acid. 
Under  its  use,  he  states,  he  finds  mastoid-cell 
involvement  much  less  frequent,  and  he  does 
not  believe  these  effervescing  preparations  in- 
crease such  dangers. 


Q.triN'INE. — ftuinine  arsenate  is  a  white 
crystalline  powder  obtained  by  dissolving  qui- 
nine in  a  hot  aqueous  solution  of  arsenous  acid. 
It  contains  about  69  per  cent,  of  quinine.  It 
is  soluble  in  hot  water,  slightly  so  in  cold  wa- 
ter. It  may  be  used  as  an  antiperiodic  in 
doses  of  from  -J  to  iV  of  a  grain. 

Cluinine  dihydrocliloride  carbamate  oc- 
curs in  colourless  crystals  easily  soluble  in 
water.  It  contains  70  per  cent,  of  quinine. 
Its  free  solubility  renders  it  especially  useful 
for  subcutaneous  employment. 

Quinine  ferrichloride  appears  in  the  mar- 
ket in  the  form  of  brown  scales  or  a  reddish- 
brown  powder  highly  hygroscopic.  It  is  freely 
soluble  in  alcohol  and  in  water.  It  has  been 
praised  as  a  hcemostatic,  used  as  a  dusting 
powder  to  be  applied  over  a  bleeding  area.  In 
a  2-per-cent.  solution,  its  employment  in  uterine 
hmmorrhaffe  is  alleged  to  have  been  successful. 

Quinine  hydrocliloTsulphate  is  obtained 
by  dissolving  the  hydrochloride  and  the  bisul- 


phate  of  quinine  in  warm  water  in  molecular 
proportions.  The  solution  is  evaporated,  and 
the  colourless  crystals  of  the  double  salt  ap- 
pear. It  is  soluble  in  an  equal  quantity  of 
water.  It  has  been  recommended  for  hypo- 
dermic use. 

Quinine  salicylate  occurs  in  fine  white 
crystals.  It  is  soluble  with  difliculty  in  water. 
As  an  antipyretic  it  has  been  recommended  in 
typhus  fever,  in  gout,  and  in  rheumatic  condi- 
tions. The  dose  is  from  1  to  8  grains,  three 
times  daily. — Samuel  M.  Bbickneb. 


RONTGEN  RAYS.— See  X-rays. 


SALICYLIC  ACID  AND  THE  SALI- 
CYLATES.— Thiersch's  solution  contains  1 
part  of  salicylic  acid  and  6  parts  of  boric 
acid,  dissolved  in  500  parts  of  hot  water.  It  is 
a  bland,  harmless  antiseptic,  and  may  be  freely 
used  on  surfaces  and  in  areas  where  more 
vigorous  antiseptic  fluids  might  be  absorbed 
and  produce  poisoning.  The  peritonseum  and 
pleura  are  especially  adapted  to  its  employ- 
ment. 

Aluminum  and  ammonium  salicylate, 
aluminum  salicylate. — See  Salumine. 

Bismuth  and  cerium  salicylate  is  an 
insoluble  pink  powder.  It  has  been  recom- 
mended in  acute  diseases  of  the  gastro-intesti- 
nal  tract  in  doses  of  from  15  to  30  grains. 

Caflfeine  and  sodium  salicylate,  or  caf- 
feine and  sodium  cinnamate,  is  a  freely  soluble 
double  salt,  well  adapted  for  hypodermic  use. 

Camphor  salicylate  is  a  crystalline  prepa- 
ration employed  in  the  treatment  of  lupus  anA 
parasitic  skin  diseases.  Internally,  it  has 
been  recommended  in  doses -of  from  3^  to  5 
grains  for  the  relief  of  chronic  dysentery  and 
chro7iic  diarrhoea. 

Chlorosalol  is  the  chlorophenylic  ether  of 
salicylic  acid.  Its  indications  and  dose  have 
not  yet  been  determined. 

Cresalol,  cresol  salicylate  is  the  cresalol 
analogue  of  betol  and  salol,  for  which  it  is 
sometimes  employed.  In  the  system  they  are 
split  up  into  cresol  and  salicylic  acid. 

Dithiochlorosalicylic  acid  appears  as  a 
reddish-yellow  powder.  It  is  reputed  to  have 
an  antiseptic  influence. 

ftiiinine  salicylate. — See  under  Quikikb 
(Supplement). 

Sodium  sulphosalicylate,  a  white  crys- 
talline powder,  with  no  special  advantages,  has 
been  proposed  as  a  substitute  for  sodium  sali- 
cylate. 

Sulphosalicylic  acid,  or  salicylsul- 
phuric  acid,  is  obtained  from  the  action  of 
fuming  sulphuric  acid  on  salicylic  acid. 
White  crystals,  soluble  in  water  and  in  alcohol, 
are  the  result.  Albumoses  and  peptones  will 
be  precipitated  on  the  addition  of  this  salt  to 
a  solutien  containing  them,  but  will  be  redis- 
solved  on  boiling,  while  albumins  and  globu- 
lins, if  present,  will  remain  precipitated.  The 
salt  is  therefore  a  valuable  testing  agent. 

Samuel  M.  Brickner. 


SALUBROL 
SILVER 


456 


SAIiTJBIlOL. — This  is  a  new  substitute  for 
iodoform  described  by  Dr.  M.  Silber,  of  Bres- 
lau  (Deutsche  medicinische  Wochenschrift, 
December  24,  1896 ;  Therapeutische  Wochen- 
schrijt,  January  3,  1897),  as  made  by  the  action 
of  bromine  on  a  compound  of  methylene  and 
antipyrine.  It  is  stable  under  ordinary  cir- 
cumstances, but  on  coming  in  contact  with 
organic  matter  it  gradually  gives  off  bromine. 
The  powder  applied  to  the  skin  sometimes 
gives  rise  to  a  burning  pain,  but  a  20-per-cent. 
gauze  has  no  irritating  action.  Salubrol  has 
been  given  to  animals  subcutaneously  in  daily 
amounts  of  150  grains  without  their  manifest- 
ing any  poisonous  action. 

SALXJFER,  according  to  Dr.  Squibb  {Sph- 
emeris,  January,  1897),  is  the  trade  name  given 
by  a  manufacturer  in  Leeds,  England,  to  po- 
tassium silicofluoride.  It  is  reported  to  be 
an  effieient  antiseptic  and  deodorizer,  but  the 
chief  applications  in  which  it  has  made  its. 
record  are  in  chronic  otorrhcea  and  as  a  uter- 
ine wash  in  puerperal  fever.  It  readily  dis- 
solves in  water,  and  a  saturated  solution  may 
be  made  in  boiling  water.  It  is  non-toxic,  but 
stains  instruments.  Often  the  best  effects  are 
to  be  obtained  from  the  saturated  solution. 

Mr.  F.  Faulder  White,  F.  E.  C.  S.,  of  Coven- 
try, England,  reports  having  even  freely  dusted 
very  foul  wounds  with  the  powder,  rapidly 
washing  it  off.  Recovery  takes  place  without 
local  inflammation  or  rise  of  temperature. 

Nothing  has  been  heard  of  it  in  America  as 
yet. 

SALVIA. — Krahn  (cited  in  Fortschritte 
der  Medicin,  November  15,  1896)  gives  a 
resume  of  the  literature  of  salvia,  and  says 
that  he  has  used  it  in  thirty-eight  cases  of 
profuse  sweating,  mostly  in  tuberculous  per- 
sons. He  employs  a  tincture  made  with  1  part 
of  the  leaves  and  10  parts  of  alcohol,  and  he 
has  convinced  himself  of  its  harmlessness  by 
taking  as  much  as  40  drops  of  it  twice  a  day 
for  six  weeks.  He  has  generally  given  his  pa- 
tients 30  drops  in  the  morning  and  from  80  to 
40  drops  in  the  evening.  For  dispensary 
patients  he  orders  an  infusion  made  with  a 
tablespoonful  of  the  leaves  and  a  pint  of 
water,  of  which  they  take  a  cupful  night  and 
morning.  In  all  but  two  of  the  thirty-eight 
cases  it  acted  favourably,  but  the  action  was 
not  sustained  when  it  was  given  for  weeks  at 
a  time.  Fever,  he  says,  is  not  a  contra-indica- 
tion,  and  he  has  observed  no  unpleasant 
effects. 

SENECIO.— Mr.  \V.  E.  Fothergill  {Medical 
Chronicle,  November,  1896 ;  New  York  Medi- 
cal Journal,  December  19,  1896)  has  sum- 
marized the  work  of  Dr.  William  Murrell,  Dr. 
Dalch6,  Dr.  Heim,  Dr.  Bardet,  and  Dr.  Bolog- 
nesi  bearing  on  the  therapeutic  value  of  the 
senecios,  and  their  conclusions,  substantially 
as  follows ; 

Murrell,  among  other  remarks,  says  he  has 
found  that  it  acts  admirably  in  those  oases  of 
amenorrhna  in  which  the  menstrual  function, 
having  been  established  and  performed  regu- 
larly for  some  months  or  even  years,  is  delayed 
or  suspended  as  the  result  of  exposure  to  cold 


or  some  similar  cause.  In  cases  in  which  the 
amenorrhoea  is  associated,  with  or  dependent 
on  anjEmia,  senecio  uniformly  failed  to  do  any 
good  until  the  anaemic  condition  had  been  re- 
moved with  iron.  In  cases  in  which  the  men- 
strual flow  had  never  been  established,  senecio 
was  frequently  most  useful,  and  in  four  cases 
of  vicarious  menstruation — the  blood  coming 
from  the  mouth  or  gums — nothing  could  have 
been  more  satisfactory.  He  is  satisfied  that 
senecio  not  only  anticipates  the  period,  but 
also  increases  the  quantity  of  the  flow.  In 
many  cases  of  dysmenorrhoea  it  promptly  re- 
lieves the  pain,  and  not  infrequently  the  men- 
strual headache  from  which  many  women 
suffer.    Senecio  is  apparently  not  an  ecbolic. 

Dalche  and  Heim  conclude  that  the  drug  re- 
lieves painful  menstruation  if  the  reproductive 
organs  are  healthy,  but  not  otherwise.  They 
remain  doubtful  whether  senecio  provokes  the 
menstrual  flow,  and  they  offer  no  hypothesis 
as  to  its  mode  of  action. 

Bardet  and  Bolognesi  conclude  that  senecio 
has  the  constant  property  of  provoking  men- 
struation, though  administered  in.  small  and 
harmless  doses.  They  hold  that  it  always 
tends  to  regulate  menstruation,  but  that  it 
does  not  relieve  pain  at  the  periods,  and  does 
not  increase  the  quantity  of  the  discharge. 
They  suggest  that  it  both  produces  congestion 
of  the  reproductive  organs  and  also  excites 
contraction  of  the  uterine  muscle. 

M.  Bardet  mentioned  one  of  the  cases  on 
which  the  latter  supposition  is  based  in  a  dis- 
cussion at  the  Societe  de  therapeutique.  A 
woman,  aged  thirty-eight  years,  suffered  from 
nausea  and  hypogastric  sensations  recalling  to 
the  mind  those  of  pregnancy,  on  three  occa- 
sions after  she  had  taken  senecio.  But  sub- 
jective phenomena  described  by  a  patient, 
says  the  writer,  are  very  slight  evidence  on 
which  to  base  a  statement,  as  M,  Bardet  does, 
to  the  effect  that  her  uterus  contracted. 

M.  Blondel  thinks  that  the  reports  on  the 
physiological  action  of  senecio  are  both  vague 
and  contradictory,  and  that  until  the  action  of 
a  drug  is  definitely  known  its  indications  and 
eontra-indioations  can  not  be  established. 
AmenorrhcEa,  he  says,  is  not  a  disease  but  a 
symptom ;  its  causes  must  be  discovered  before 
they  can  be  attacked,  and  the  treatment  should 
always  be  indirect,  on  account  of  the  risk  of 
causing  abortion.  The  drugs  which  act  di- 
rectly in  provoking  menstruation,  he  thinks, 
are  unreliable,  dangerous,  and  of  merely  tem- 
porary effect. 

Now,  these  remarks  of  M.  Blondel,  contin- 
ues Mr.  Fothergill,  though  likely  to  catch  the 
sympathy  of  the  superficial  reader,  are  not 
really  calculated  to  deter  any  one  from  giving 
respectful  study  to  the  work  of  these  authoi-s. 
For,  to  go  over  his  objections  in  reverse  order, 
granting  that  the  so-called  emmenagogues  in 
use  are  unsatisfactory,  there  is  no  reason  a 
priori  why  it  should  not  be  discovered  that 
one  or  other  of  the  active  principles  of  the 
senecios  is  a  true  emmenagogue,  reliable,  safe, 
and  perhaps  even  permanent  in  its  action. 
Next,  in  certain  cases,  amenorrhoea  is  not  a 
symptom  of  any  pre-existent  disease,  but  is 


457 


SALUBROL 
SILVER 


due  to  the  action  on  the  nervous  system  of 
various  external  and  temporary  causes.  Sec- 
ondary bad  effects,  both  mental  and  physical, 
follow  the  amenorrhcea,  which  in  such  cases  is 
a  primary  disorder,  and  is  certainly  one  suit- 
able for  direct  treatment.  Thus,  Edelheit 
mentions  four  cases  in  which  amenorrhcea  in- 
augurated a  primary  and  serious  affection, 
fatal  in  two  of  them,  recovery  in  the  other  two 
following  the  re-establishment  of  menstruation. 
Again,  the  difficulties  in  diagnosticating  early 
pregnancy,  if  great,  are  not  insuperable  to  all ; 
and  there  is  no  necessity  for  any  one  to  admin- 
ister a  possible  ecbolic  while  still  in  doubt  as 
to  the  diagnosis.  Lastly,  if  no  drug  may  be 
used  until  its  action  is  definitely  known  and 
its  indications  are  clearly  defined,  there  is  an 
end  to  the  introduction  of  new  therapeutic 
agents.  All  that  the  most  exacting  can  demand 
is  that  the  introducer  of  a  new  drug  shall 
give  a  working  hypothesis  according  to  which 
the  drug  may  reasonably  be  supposed  to  act. 

Menstruation,  he  continues,  expresses  an 
anabolic  surplus  produced  by  the  healthy  hu- 
man female  from  puberty  to  the  menopause, 
except  during  pregnancy  and  lactation,  the 
time  of  its  occurrence  probably  being  deter- 
mined by  the  activity  of  a  special  centre  in 
the  lumbar  part  of  the  cord.  In  the  light  of 
this  view  of  menstruation,  he  says,  substances 
like  iron,  which  affect  the  quality  or  quantity 
of  the  blood,  are  only  indirectly  emmena- 
gogues.  In  like  manner,  substances  which,  by 
causing  renal  or  gastro-intestinal  irritation,  pro- 
mote pelvic  congestion  and  uterine  heemorrhage, 
are  also  indirect  in  their  emmenagogue  action. 
To  be  a  direct  emmenagogue,  a  substance  must 
act  upon  the  nervous  mechanism  which  initi- 
ates the  discharge — namely,  the  hypothetical 
centre  for  menstruation.  Thus  an  emmena- 
gogue is  quite  distinct  from  an  ecbolic,  which 
is  supposed  to  cause  contraction  of  the  uterine 
muscle  by  acting  either  on  the  fibres  them- 
selves or  on  their  motor  nerves.  It  is  possi- 
ble, he  thinks,  that  senecio  may  be  found  to 
contain  an  active  principle  which  is  a  direct 
emmenagogue  in  the  proper  sense  of  the  word, 
and  it  does  not  follow  that  this  principle  must 
be  an  ecbolic. 

Several  kinds  of  amenorrhcea,  continues  Mr. 
Pothergill,  may  be  classified  according  to 
treatment,  and  the  indications  defined  by  the 
use  of  the  direct  emmenagogue  which  senecio 
may  prove  to  be.  Prom  the  reports  of  these 
authors,  it  does  not  seem  likely  that  the  drug 
will  be  of  much  use  in  dysmenorrhoea.  The 
following  is  his  classification  according  to 
treatment : 

No  Treatment. — Physiological  amenorrhcea 
• — i.  e.,  before  puberty,  during  pregnancy,  dur- 
ing lactation,  and  after  the  menopause.  Amen- 
orrhcea due  to  congenital  or  acquired  deficiency 
or  to  absence  of  essential  reproductive  organs. 

Surgical  and  other  Local  Treatment. — 
Amenorrhcea  due  to  local  defects,  such  as 
atresia  vaginae,  atresia  cervicis  uteri,  congeni- 
tal or  acquired  neoplasms,  etc. 

Indirect  Treatment. — Amenorrhcea  due  to 
general  disease  which  so  disturbs  metabolism 
that  there  is  no  anabolic  surplus — e.  g.,  anae- 


mia and  phthisis — where  menstruation  would 
be  an  unnecessary  drain  on  the  patient. 

Direct  Treatment  by  Emmenagogues. — 
Amenorrhcea  due  to  want  of  activity  of  the 
nervous  mechanism  initiating  menstruation, 
caused  by  nervous  disease,  shock  (mental  or 
physical),  fear  or  hope  of  pregnancy,  etc..  in- 
cluding those  cases  in  which  the  function  has 
never  been  established,  but  wliere  there  is  no 
local  defect  or  general  disease  sufRcient  to  ac- 
count for  its  absence. 

SILVER.— Dr.   E.  Abrahams,  of  the  Mt. 

Sinai  Hospital,  New  York  {Journal  of  the 
American  Medical  Association.  January  30, 
1897),  writes  in  praise  of  the  action  of  silver 
nitrate  in  a  number  of  morbid  conditions. 
One  of  these  is  the  epidermal  callosity  com- 
monly known  as  a  corn.  Soak  the  corn  in  hot 
soapy  water,  he  says,  then  shave  down  the 
horny  layers,  and  apply  a  30-per-cent.  solution 
of  silver  nitrate.  The  corn  will  never,  or  hardly 
ever,  recur  after  the  silver  has  been  applied  to  it. 

Certain  forms  of  Ivpus  vulgaris,  says  Dr. 
Abrahams,  are  eminently  aiiapted  to  the  local 
application  of  nitrate  of  silver.  The  first  in- 
dication is  found  in  the  small  lupus  papules 
which  characterize  the  beginning  of  the  de- 
structive disease.  By  effectively  cauterizing 
the  primary  lesions  the  disease  will  be  pre- 
vented from  taking  root.  The  second  indica- 
tion is  suggested  by  the  lupus  nodules  which 
are  formed  by  the  coalescence  of  the  initial  pap- 
ules. Lupus  in  both  these  forms,  he  says,  can 
be  radically  cured  by  the  thorough  application 
of  silver  caustic.  The  third  indication  is  the 
serpiginous  form  of  lupus.  Here  silver  is  used 
as  a  means  only  to  stop  the  downward  march 
of  destruction.  Kaposi  thus  speaks  of  silver 
in  the  treatment  of  lupus  vulgaris:  "Apart 
from  mechanical  treatment,  the  use  of  caustic 
is  important.  The  most  practicable  is  solid 
nitrate  of  silver.  It  has  sufficient  resistance 
to  penetrate  the  individual  lupus  nodules,  thus 
uniting  mechanical  and  caustic  action.  It 
also  possesses  the  advantage  that  it  does  not 
enter  healthy  tissues.  Large  nodules  of  lupus 
tumidus,  and  particularly  superficial  infiltra- 
tions, may  be  burned  out  as  thoroughly  as 
with  the  sharp  spoon.  Since  the  solid  stick 
not  only  destroys  the  vessels  of  the  border  and 
base  mechanically,  but  also  causes  thrombosis, 
the  cauterization  furnishes  all  the  require- 
ments for  effecting  a  cure."  In  the  face  of 
this  eminently  authoritative  statement,  says 
Dr.  Abrahams,  it  is  hai'd  to  see  why  some 
writers  of  distinction  fail  to  include  this  agent 
among  the  local  remedies  for  lupus. 

Lunar  caustic  finds  a  fitting  place  in  suita- 
ble cases  of  epillielioma  of  the  skin  and  mucous 
membranes,  says  Dr.  Abrahams.  Generally 
speaking,  he  says,  the  method  of  applying  the 
caustic  in  cutaneous  cancers  is  the  same  as 
in  lupus  or  in  the  other  growths  above  men- 
tioned, but  the  indications  are  fewer.  As  in 
lupus,  when  the  cancerous  nodule  or  ulcer  is 
small,  nitrate  of  silver  is  an  effective  and 
curative  remedy.  It  is  also  indicated  in  "in- 
operable" cases,  in  recurrent  nodules,  and  in 
the  serpiginous  forms  of  epithelioma. 


SODIUM  SULPHOSALICYLATB 
X  KAYS 


458 


SODIUM     SULPHOSALICYIiATE.— 

See  under  Samoylio  acid  and  the  salicylates 
(Supplement). 

STJGAB. — For  the  use  of  sugar  in  scorpion 
stings,  see  under  Honey  (Supplement). 


VACCINIUM.— Dr.  Karl  Ullmann  ( Wiener 
medizinische  Wochenschrift,  1895,  No.  41  ; 
Monatshefte  furpraktische  Dermatologie,  June, 
1896)  relates  his  experience  in  the  use  of  Win- 
ternitz's  myrtillm  (an  inspissated  extract  of 
Vaccinium  Myrtillus)  in  a  hundred  cases  of 
skin  diseases  in  Hans  Hebra's  clinic.  The  ex- 
tract is  applied  to  the  affected  skin  in  a  thick 
layer,  over  this  a  thin  coat  of  cotton  is  laid, 
arid  the  part  is  bandaged.  The  diseased  part 
is  cleansed  daily  with  a  l-to-200  solution  of 
sodium  chloride  and  with  alcohol  or  French 
brandy. 

Seventy  of  the  oases  were  of  eczema ;  the 
others  included  various  itching  affections,  hy- 
perkeratoses, psoriasis,  local  formations  of 
wheals,  and  burns  to  the  degree  of  rubefaction 
or  of  vesication.  The  cases  of  eczema  were 
chiefly  those  of  occupation-eczema,  the  next 
most  numerous  were  those  of  mycotic  eczema, 
and  finally  came  those  of  idiopathic  and  arti- 
ficial eczema.  In  the  matter  of  a  cure  the  re- 
sults were  not  so  good  as  had  been  expected. 

In  the  cases  of  occupation-eczema,  especially 
where  there  was  much  scaling,  there  was  tran- 
sient improvement,  but  in  the  weeping,  vesicu- 
lar, and  pustular  forms  there  was  not.  The 
effect  was  better,  however,  in  cases  of  eczema 
of  the  fingers  and  feet  characterized  by  the 
formation  of  wheals  and  rhagades. 

Mycotic  eczema  was  improved,  and  the  seal- 
ing seemed  to  subside,  but  in  no  instance  was 
there  an  actual  cure.  There  was  no  good  ef- 
fect in  cases  of  intertrigo  and  eczema  of  the 
scrotum.  In  cases  of  mycosis  flexurarum,  es- 
pecially if  there  was  much  scaling  and  thick- 
ening of  the  skin,  a  better  effect  was  produced. 
The  remedy  acted  well  in  seborrhceal  eczema 
of  the  face  in  children,  but  not  so  well  in  the 
seborrhoea  of  adults.  It  had  no  effect,  or  only 
the  most  transitory  one,  in  acute  idiopathic 
eczema,  acute  dermatitides,  so-called  trophic 
eczema,  and  psoriasis.  In  three  instances 
burns  to  the  degree  of  rubefaction  or  vesica- 
tion were  quickly  cured  with  it.  It  was  used 
in  the  following  compounds  : 

(1)  Purified  extract  of  the  ber- 

ries of  Vaccinium  Myr- 
tillus   50  parts ; 

Bpidermin 10  to  15      " 

(2)  Purified  extract  of  the  berries  of 

Vaccinium  Myrtillus 50  parts ; 

Myrrh 3      " 

The  author  comes  to  the  following  conclu- 
sions :  Extract  of  myrtillus  is  no  specific 
against  eczema.  It  is  of  advantage  only  in 
redness,  scaling,  and  wheallike  thickening  in 
consequence  of  chronic  eczema  affecting  the 
hairless  parts  of  the  body  and  in  the  sebor- 
rhceal eczema  of  children.    Mycotic  and  itch- 


ing affections  of  the  skin  are  hardly  influenced 
by  it  or  only  in  a  very  transitory  way.  Wheals 
and  chronic  ,  inflammatory  infiltrations  are 
softened  by  it.  In  burns  of  the  first  or  second 
degree  its  action  is  remarkably  quick  and  sat- 
isfactory. The  active  principle  of  the  extract 
is  probably  a  material  containing  tannic  acid, 
and  it  possesses  pronounced  antizymotic  prop- 
erties. The  extract  is  astringent  and  kerato- 
plastic.    It  is  in  no  wise  irritating  or  poisonous. 


X  RAYS.  —  M.  Rendu  (Progres  medical, 
January  30,  1897)  relates  the  case  of  a  lad, 
twenty  years  old,  who  presented  all  the  symp- 
toms of  infectious  pneumonia,  although  a 
bacteriologist  professed  to  have  found  Koch's 
bacilli  in  the  sputa.  The  patient's  father  asked 
that  the  Rontgen  rays  be  used  in  the  treatment. 
Daily  applications  of  fifty-five  minutes'  dura- 
tion were  begun,  and  after  the  third  applica- 
tion a  very  distinct  amelioration  was  manifest. 
The  fever  fell,  there  was  natural  perspira- 
tion, and  there  was  a  very  abundant  diuresis. 
After  the  first  application  there  was  produced 
on  the  skin  where  the  rays  had  penetrated  an 
intense  erythema  which  was  followed  by  blis- 
ters, then  an  eschar  which  did  not  heal  for 
several  weeks.  M.  Rendu  questions  whether 
recovery  was  the  result  of  the  acute  revulsion 
produced  by  the  erythema,  or  the  result  of  the 
action  of  the  X  rays  on  microbes.  He  thinks 
that  the  patient  was  not  tuberculous. 

The  idea  has  recently  been  entertained  that 
the  ROntgen  rays  may  be  of  service  in  tubercu- 
losis. In  the  Fortschritte  der  Medicin  for  Feb- 
ruary 1, 1897,  there  is  an  abstract  of  an  account, 
published  in  the  Semaine  midicale,  of  some 
experiments  undertaken  by  M.  Lortet  and  M. 
Genoud  nearly  a  year  before.  On  April  23, 
1896,  eight  Guinea-pigs  were  inoculated  in  the 
fold  of  the  right  groin  with  bouillon  that  had 
been  infected  with  a  Guinea-pig's  tuberculous 
spleen.  Two  days  later  three  of  the  animals 
were  stretched  out  on  a  board  and  the  inocu- 
lated region  was  exposed  to  the  influence  of 
the  Rontgen  rays.  This  was  done  daily  for 
about  an  hour  for  fifty-three  days.  On  the  9th 
of  June  the  five  check  animals  were  observed 
to  have  spontaneous  abscesses,  and  their  in- 
guinal glands  of  the  affected  side  were  sof- 
tened. On  the  other  hand,  the  three  that  were 
under  treatment  with  the  Rontgen  rays  had 
no  abscesses  and  their  inguinal  glands  were 
firm  and  sharply  defined.  Nine  days  later  the 
five  check  animals  showed  abundant  suppura- 
tion in  the  inguinal  fold  or  on  the  thigh,  and 
they  had  manifestly  grown  thin.  The  three 
that  were  under  treatment  were  in  good  con- 
dition and  had  gained  in  weight ;  their  ingui- 
nal glands  were  small,  having  gradually  shrunk, 
and  showed  no  tendency  to  suppuration.  'The 
Rontgen  rays,  therefore,  are  held  to  have  pre- 
vented the  acute  development  of  tuberculosis 
in  this  instance.  The  authors  suggest  the 
therapeutical  employment  of  them  in  cases  of 
tuberculous  disease  of  the  thoracic  and  ab- 
dominal organs,  especially  in  children. 


GENERAL   INDEX. 


A.  B.  C.  balsam,  i,  1. 

A.  B.  C.  ointment,  i,  1. 

Abelmoschus,  i,  1. 

Abies,"Xl- 

Abluents.    See  Detergents. 

Abortifacients,  abortives,  i,  1. 

Abrastol.    See  Asjvprol. 

Abrin.    See  under  Jequikity  (i,  563). 

Abrus  precatorius.     See  Jequirity. 

Absinthe,  i,  1. 

Absinthium,  i,  1. 

as  an  antispasmodic,  i,  1. 

in  the  treatment  of  taenia,  i,  101. 
Absorbents,  i,  1.     See  also  Sobbefacients. 
Abstergents,  abstersives.    See  Detergekts. 
Acacia,  i,  1. 
A.  C.  E.  mixture,  i,  1. 
Acetal,  i,  1. 

(as  a  hypnotic)  in  mental  disturbances,  i,  1. 
Acetaldehyde.    See  Aldehyde. 
Acetanilide,  i,  3. 

effects  of,  on  the  heart,  i,  3. 
"       "  on  the  kidneys,  i,  3. 
"       "  on  the  liver,  i,  2. 

(as  an  antispasmodic)  in  asthma,  i,  4. 
"  "  "  chorea,  i,  4, 

in  epidemic  influenza,  i,  3. 

"  epilepsy,  i,  4. 

"  epistaxis,  i,  4. 

"  facial  neuralgia,  i,  3. 

"  fever,  i,  3. 

"  gastralgia,  i,  3. 

"  grippe,  i,  3. 

"  headache,  i,  3. 

"  influenza,  i,  3. 

"  lobar  pneumonia,  i,  4. 

"  locomotor  ataxia  (lightning  pains),  i,  3. 

"  migraine,  i,  3. 

"  myalgia,  i,  3. 

"  neuralgia,  i,  3,  69. 

"  neuritis,  i,  3. 

"  optic  neuritis,  i,  3. 

"  pulmonary  phthisis,  i,  8. 

"  rheumatism,  i,  4, 135. 

"  sciatica,  i,  3. 

"  the  crises  of  tabes,  1,  3. 

"  tremors  associated  with  multiple  sclero- 
sis of  the  spinal  cord,  i,  4. 

"  tuberculosis,  i,  3. 

"  typhoid  fever,  i,  3. 

"  whooping-cough,  i,  4. 

"  zoster,  i,  3. 

poisoning  with,  i,  3. 
73 


Aoetbromanilide.    See  Beomacetanilide. 
Acetic  acid,  i,  4. 

(diluted),  as  an  antidote  to  poisoning  with 
the  caustic  alkalies,  i,  5. 

(glacial),  for  corns,  condylomata,  fungous 
growths,  and  warts,  i,  5. 

(by  inhalation),  in  colds  and  headache,  i,  5. 

(diluted),  in  pruritus,  i,  5. 

(externally),  in  rheumatism,  i,  5. 

in  shallow  or  venereal  ulcers,  i,  227. 

poisoning  with,  i,  4. 
Acetic  aldehyde.    See  Aldehyde. 
Acetic  ether,  i,  5. 

(by  inhalation)  in  collapse,  i,  5. 
"  "  faintness,  1,  5. 

Acetone,  i,  5 ;  ii,  413. 
Acetophenone,  i,  5, 

as  a  hypnotic,  i,  5. 
Acetphenetidine.    See  Phenacetinb. 
Acetum,  i.  5. 

"        pyrolignosum.     See     Ptroligneous 
aoid. 
Acetylaldehyde.    See  Aldehyde. 
Acetylamidobenzene.    See  Acetanilide. 
Acetylamidophenol,  i,  5. 

as  an  antipyretic,  i,  5. 
Aeetylamidosalol,  i,  5. 
Acetylene.    See  under  Calcium  carbide. 
Acetylmethyl.    See  Acetone. 
Acetylphenylhydrazine.    See  Hydracetin. 
Acetyltannin,  i,  5, 
Achillea,  i,  6. 
Acids,  i,  6. 

antidotes  for  poisoning  with,  i,  6. 

mineral,  i,  6. 

as  haemostatics,  i,  6. 

as  astringents,  i,  6. 

in  pruritus,  i,  6. 

"  the  treatment  of  taenia,  i,  101. 

"  vomiting,  i,  100. 

poisoning  with,  i,  6,  7,  230. 
Aconite,  i,  7. 

as  a  gastric  sedative  in  vomiting,  i,  100. 

effects  of  internal  administration  of,  i,  7. 

in  acute  articular  rheumatism,  1,  9. 

"      "     otitis,  i,  8. 

"      "      peritonitis,  i.  9. 

"      "     pleurisy,  i,  9. 

"      "     sthenic  inflammation,  i,  118. 

"  asthma  due  to  exposure,  i,  8. 

"  catarrhal  fever,  i,  8. 

"  chilblains,  i,  9. 

"  congestive  dysmenorrhoea,  i,  9. 


460 


GENERAL  INDEX. 


Aconite,  in  congestive  neuralgia,  i,  69. 

in  coryza,  i,  8. 

"  croup,  i,  8. 

"  dysmenorrhcea,  i,  9. 

"  epistaxis  (of  the  full-blooded),  i,  9. 

"  erysipelas,  i,  8. 

"  exophthalmic  goitre,  i,  9. 

"  fever  of  children,  i,  8. 

"      "     "  tuberculosis,  i,  9. 

"  gonorrhoea  (early  stages),  i,  9. 

"  gout  (for  its  anaesthetic  effect),  i,  9. 

"  measles,  i,  8. 

"  meningitis,  i,  9. 

"  neuralgia,  i,  9,  69. 

"  palpitation  from  nervousness,  i,  9. 

"  pericarditis,  i,  9. 

"  pneumonia,  i,  9. 

"  pruritus  (locally),  i,  9. 

"  quinsy,  i,  8. 

"  scarlatina,  i,  8. 

"  "  smoker's  heart,"  i,  9. 

"  tuberculosis,  i,  9. 

"  urethral  fever,  i,  9. 

"  vomiting  of  pregnancy,  i,  9. 
physiological  action  of,  i,  8. 
poisoning  with,  i,  7,  343. 
root,  tincture  of,  and  tincture  of  iodine  in 
toothache,  i,  186. 
Aconitine,  i,  10. 
in  chronic  rheumatism,  i,  11. 

"  congestive  neuralgia,  i,  69. 

"  gout,  i,  11. 

"  myalgia,  i,  11. 

"  neuralgia,  i,  11,  69. 

"  pneumonia,  i,  11. 

"  pruritus,  i,  11. 
poisoning  with,  i,  10. 
Acorns,  i,  11. 

Acorus  calamus.    See  Calamus. 
Actsea  raoemosa.    See  Cimioifuqa. 
Actinomeris  helianthoides,  i,  11. 
in  chronic  cystitis,  i,  11. 

"  dropsy,  i,  11. 

"  urinary  lithiasis,  i,  11. 
Active  principles,  i,  11. 
Actol.    See  Silver  lactate,  under  Silver. 
Adansonia,  i,  15. 

Adeps.    See  Pat,  Lard,  and  Lanolin. 
Adhaesol.    See'under  Varnishes. 
Adjuvants,  i,  15. 
Adonidin,  i,  15. 
Adonis,  i,  15. 
effects  of,  on  the  heart,  i,  15,  16. 
in  palpitation  of  the  heart,  i,  15,  16. 
Adrue.    See  Ctperus  aeticulatus. 
^gle  marmelos.     See  Bela  fruit. 
Aerotherapeutios.     See  Air,   compressed   or 

RAREFIED. 

Aerozol,  i,  16. 
.3ilrugo,  i,  16. 
jEsculin,  i,  16. 
^ther.    See  Ether. 
^ther  anaestheticus,  i,  16. 

"      chloroformiatus,  i,  16. 
jEtherolea,  i,  16. 
Aflfusion,  i,  16. 
cold,  Currie's  method  of,  in  fever,  i,  16. 

"    in  asphyxia,  i,  17. 

"     "  chorea,  i,  17. 

"     "  coma,  i,  17. 


Affusion,  cold,  in  frostbite,  i,  17. 
cold,  in  functional  disturbances,  i,  17. 
"     "  hysterical  manifestations,  i,  17. 
"     "  narcotism,  i,  17. 
"     ''  sunstroke,  i,  16. 
"     "  syncope,  i,  17. 
hot  and  cold,  in  chronic  inflammatory  thick- 
enings and  deposits,  i,  17. 
how  to  apply  the,  i,  17. 
Agaric,  i,  17. 
Agaricin,  i,  17. 
to  diminish  bronchial  secretions  and  to  stop 
the  flow  of  milk,  i,  17. 
Agaricus  albus,  i,  17. 

in  night-sweats  of  phthisis,  i,  17. 
Agaricus  chirurgorum,  i,  17. 

in  hEemorrhage,  i,  17. 
Agaricus  muscarius.    See  Muscarine. 
Agathin,  i,  17. 
in  neuralgia,  i,  17. 
"  rheumatism,  i,  17. 
Agglutinants,  i,  18. 
Agrimony,  i,  18. 

Agropyrum  repens.    See  Triticum  eepens. 
Aiiantus,  i,  18. 

Air,  absolute-pressure  method,  i,  19. 
apparatus  for  inspiration  of  condensed,  and 

expiration  into  rarefied,  i,  21,  22. 
bath,  condensed,  in  anaemia,  i,  28. 

"  "  "  bronchial  asthma,  i,  37. 

"  "  "  catarrh,  i,  27. 

"  "  "  catarrhal  deafness,  i,  37. 

"  "  "  chlorosis,  i,  28. 

"  "  "  convalescence  after  pleu- 

risy and  pneumonia,  i,  27. 
bath,  condensed,  in  hyperaemia  of  the  cutane- 
ous and  respiratory  surface,  i,  27. 
bath,  condensed,  in  obesity,  i,  28. 

"  "  "  pleuritic  effusions,  i,  27. 

"  "  "  pulmonary   emphysema, 

i,  27. 
bath,  condensed,  in  pulmonary  tuberculosis, 

i,  27. 
bath,  condensed,  in  whooping-cough,  i,  27. 
"  or    rarefied,   contra-indica- 

tions  for  use  of,  i,  27. 
compressed,  in  asthma,  i,  96. 
condensed  or  rarefied,  i,  18 ;  ii,  413. 

"        "         in  pulmonary  hasmor- 
rhage,  ii,  413. 
continuous  respiration  of  condensed,  i,  25. 
density  of,  i,  18. 

differential-pressure  method,  i,  20,  31. 
effect  of,  upon  pathological  conditions,  i,  24. 
effect  of,  on  respiration,  i,  24. 
"      "    "    the  circulation,  i,  24. 

"    "     "    respiration  and  circulation, 
i,  26. 
expiration  into  condensed,  i,  24. 

"  in  chronic  pulmo- 

nary catarrh,  i,  28. 
expiration  into  condensed,  in  consolidation 

after  pneumonia,  i,  28. 
expiration   into  condensed,  in  heart  affec- 
tions, i,  38. 
expiration    into   condensed,   in    pulmonaiT 

tuberculosis,  i,  29. 
expiration  into  rarefied,  i,  25,  28. 

"        in   asthma  depend- 
ent on  emphysema,  i,  39. 


GENERAL  INDEX, 


461 


Air,  expiration  into  rarefied,  in  bronehorrhcEa, 
i,  28. 
expiration  into  rarefied,  in  pulmonary  tuber- 
culosis, i,  28. 
inspiration  of  condensed,  i,  24. 

"  "  "         in  asthma,  i,  28. 

"  "  "         "  atelectasis,  i,  28. 

"  "  "         "  chlorosis,  i,  28. 

"  "  "         "  chronic  bronchi- 

tis, i,  28. 
inspiration  of  condensed,  in  chronic  broncho- 
pneumonia, 1,  28. 
inspiration  of  condensed,  in  chronic  pulmo- 
nary tuberculosis,  i,  28. 
inspiration  of  condensed,  in  convalescence 
from  croupous  or  catarrhal  pneumonia,  i, 
28. 
inspiration  of  condensed,  in  dyspnoea,  i,  28. 
"  "  "         "  lipocardiao  asth- 

ma, i,  28. 
inspiration  of  condensed,  in  mitral  insuffi- 
ciency, i,  28. 
inspiration  of  condensed,  in  pulmonary  con- 
gestion, i,  28. 
inspiration  of  condensed,  in  stenosis,  i,  28. 
"  "  "         "        "         and  in- 

sufficiency of  the  aortic  valves,  i,  28. 
inspiration   of  condensed,   with    expiration 

into  rarefied,  i,  25. 
inspiration  of  rarefied,  i,  25. 

"  "        "        for  strengthening  the 

muscles  of  inspiration,  i,  29. 
inspiration  of  rarefied,  with  expiration  into 

condensed,  i,  25. 
inspiration  of  rarefied,  with  expiration  into 

the  same  medium,  i,  35. 
localized  hot-,  treatment  in  rheumatism,  ii, 

440. 
phvsiological  and  therapeutical  action  of,  i, 

24. 
physiological  effects  of  the  method  of  abso- 
lute pressure,  i,  25. 
pneumatic  cabinet,  i,  19. 

"         chambers,  description  of,  i,  19,  20. 
rarefied,  i,  18. 

"        in  asthma,  by  exhaling  into,  i,  93. 
residual,  pump,  i,  33. 
respired,  i,  18. 

therapy  of  respiratory  differentiation,  i,  28. 
"        "  the  absolute  method,  i,  27. 
Airol,  ii,  414. 
as  an  antiseptic,  ii,  414. 
"  a  desiocative,  ii.  414, 
in  intertrigo,  ii,  414. 
"  tuberculous  affections,  ii,  414. 
Aiowan.     See  Ammi. 

Aktol.    See  Silver  lactate,  under  Silver. 
Alanin.    See  Amidopeopionio  acid. 
Albolene,  ii,  414. 
liquid,  ii,  414. 
Albumin,  i,  29. 
Albuminates,  i,  29. 
Alcohol,  i,  29. 
and  ether  as  heart  stimulants,  ii,  237. 
as  a  cardiac  stimulant,  ii,  227. 
"    cleansing  agent  for  the  skill,  i,  30. 
"    narcohypnotic,  i,  506. 
"    narcotic,  ii,  4. 
as  an  excitant,  ii,  4. 
"     intoxicant,  ii,  4. 


Alcohol,  as  a  stimulant,  i,  33. 
as  a  tonic,  i,  34. 

constitutional  effects  of,  in  health,  i,  31,  33. 
diagnosis  of  chronic  alcoholism,  i,  36,  37. 
effects  of,  on  the  digestive  apparatus,  i,  35. 
"        "    "    "    kidneys,  i,  36. 
"        "    "    "    nervous  system,  i,  35. 
"        "     "     "    vascular  system,  i,  136. 
external  uses  of,  i,  31. 
in  A.  C.  E.  mixture,  i,  1. 
(by  hypodermic  injection)  in  aconite  poison- 
ing, i.  7. 
in  anorexia,  i,  33. 
(externally)  in  aphthae  of  the  throat  and 

mouth,  i,  31. 
in  asthma,  i,  33. 
"  atonic  dyspepsia,  i,  33. 
"  erysipelas  (after  Behrend's  method),  i,  30. 
"  fevers,  i,  30,  33. 
inhalations  of,  in  collapse,  i,  31. 

"  "     "  extreme  asthenia,  i,  31. 

"     "  inanition,  i,  33. 
"     "  shock,  i,  31. 
(subcutaneously)  in  heart  failure  (sudden), 

ii,  227. 
injections  (interstitial)  of,  in  cancer  of  the 

uterus,  i,  31. 
in  infiammations,  i,  30. 
"  insect-poisoning,  i,  30. 
"  neiiralgia,  in  small  quantities  as  a  nerve 

stimulant,  i,  69. 
in  neurotic  affections,  i,  33. 
"  shock,  i,  34. 

internal  administration  of,  i,  31. 
in  toxic  conditions,  i,  33. 
"  treatment    of    contusions,   wounds,    and 

sprains,  i,  29,  30. 
(as  a  stimulant)  in  typhoid  fever,  ii,  325. 
(externally)  in  ulcers,  i,  31. 
medicinal  application  of,  i,  29. 
toxic  effects  of,  i,  34,  290. 
treatment  of  chronic  alcoholism,  i,  38. 
uses  of,  in  disease,  i,  32,  33. 
Aldehyde,  i,  39. 

Aldehydum  trichloratum.    See  Chloral. 
Alder.     See  Alnus. 
Alembroth.  i,  39. 
Aletris,  i,  39. 
Alexins,  i,  89. 

Alexipharmacs.    See  Antidotes. 
Alimentation,  i,  39. 

Debove's  powder  in  rectal,  i,  43. 

in  disease,  i,  41. 

"  health,  i,  40. 

meat  injections  in  rectal,  i,  43. 

peptonized  milk  in  rectal,  i,  43. 

"        •  suppositories  in,  i,  43. 
rectal,  i,  42. 

table  showing  daily  supply  of  food  necessary 
for  an  adult  doing  ordinary  work,  i,  4. 
Alisma,  i,  43. 
in  irritative  affections  of  the  urinary  pas- 
sages, i,  43. 
Alkalies,  i,  43. 
and  their  carbonates  as  antidotes  to  poison- 
ing by  acids,  i,  6. 
alkaline  baths  in  dry  and  scaly  eruptions,  i, 

45. 
alkaline  baths  in  the  itching  of  lichen,  i,  45. 


462 


GENERAL  INDEX. 


Alkalies,  as  germicides,  i,  447. 
in  asthma,  i,  96. 
"  atonic  dyspepsia,  i,  44. 
"  cirrhosis  of  the  liver,  i,  45. 
"  cystitis  without  decomposition,  i,  44. 
"  diarrhoeas    with    acid,    fluid,    irritating 

stools,  i,  44. 
"  eczema,  i,  44. 
"  gonorrhoea,  i,  44. 
"  hepatic  and  splenic  dropsy,  i,  45. 
"  hepatic  diabetes,  i,  45. 
"  jaundice,  i,  45. 
"  leucorrhoea,  i,  44. 
"  lithiasis,  i,  45. 

"  measles,  to  hasten  desquamation,  i,  44. 
"  rheumatism,  i,  45,  125. 
"  scarlet  fever,  to  hasten  desquamation,  i, 

44. 
"  sluggish  liver,  i,  45. 
"  strangury,  i,  44. 
"  the  moist  stage  of  eczema,  i,  44. 
"  undue  acidity  of  the  blood,  i,  44. 
Alkaloids,  i,  45. 

poisoning  with,  i,  333,  433. 
Alkanet,  i,  45. 
AUamanda  cathartica,  i,  45. 
Allspice.     See  Pimenta. 
Allyl,  i,  45. 
sulphocarbamide. 
sulphourea. 

thionrea.     See  Thiosinamine. 
tribromide,  ii,  414. 

"         as  an  anodyne  and  sedative,  ii,  414. 
"         in  asthma,  ii,  414. 
"  "  hysteria,  ii,  414. 

"  "  whooping-cough,  ii,  414. 

Almonds,  i,  45. 
Aloes,  i,  46. 
action  of,  on  the  intestines,  i,  47. 
as  a  laxative,  i,  48. 
as  an  anthelminthic,  i,  48. 
contra-indications  for  the  use  of,  i,  48. 
enema  of,  in  asoarides  vermiculares,  i,  103. 
in  ameuorrhoea,  i,  49. 
"  anaemia,  i,  48. 
"  atony  of  the  sexual  apparatus  in  women, 

i,  49. 
"  catarrhal  jaundice,  i,  49. 
"  constipation,  i,  48. 
"  gonorrhoea,  i,  49. 
"  hsemorrhoids,  i,  48. 
"  intestinal  indigestion,  i,  48. 
locally,  in  bedsores,  and  fissures  in  mucous 
membranes,  i,  49. 
Alpha-naphthol,  i,  49. 
Alphol,  i,  49. 
in  acute  articular  rheumatism,  1,  49. 
"  gonorrhoeal  cystitis,  i,  49. 
Alstonia,  i,  49. 
Alstonidine,  i,  49. 
Alstonine,  i,  49. 
Alterants,  i,  49. 
Alteratives,  i,  49. 
Althsea,     See  Marshmallow. 
Alum,  i,  50. 
as  a  styptic  in  haemorrhage  from   mucous 

membranes,  i,  50. 
burnt,  i,  50. 

curd  applications  in  chilblains,  i,  50. 
"  "  "  granulating  tissue,  i,  50. 


Alum,  dried,  for  destruction  of  flabby  and  un- 
healthy granulations,  i,  235. 
in  catarrhal  affections,  i,  50. 
"  diarrhoea,  i,  50. 
"  dysentery,  i,  50. 
"  enlarged  tonsils,  i,  50. 
"  granular  lids,  i,  50. 
"  lead  colic,  i,  50. 

"  vomiting  of  chronic  gastric  disease,  i,  50. 
poisoning  with,  i,  109. 
powder   (faucial    irrigation)  in    croup  and 

diphtheria,  i,  50. 
tannate  of,  in  gleet  and  gonorrhoea,  i,  50. 
water  in  colliquative  sweats  (by  sponging  the 

body),  i,  50. 
whey  in  diabetes,  i,  50. 
Aluminium  or  aluminum  and  its  salts,  i,  50. 
acetate  of,  as  a  surgical  dressing,  i,  51. 
as  an  antisepcic,  ii,  414. 
"   "  astringent,  ii,  414. 
benzoinated  solution  of,  in  foetid  leucorrhoea, 

i,  51. 
boroformate,  i,  50. 
borotannicotartrate,  ii,  414. 
chloride,  i,  51. 
in  catarrhal  states  of  the  skin  or  mucous 

membranes,  ii,  414. 
hydrate,  i,  51. 
sulphate,  i,  51. 

'•         In  solution  as  an  antiseptic  for  the 
nose,  throat,  and  vagina,  i,  51. 
sulphate,  in  weak  solution,  as  a  lotion  for 
ulcers  and  foetid  vaginal  discharges,  i,  51. 
sulphophenate  of,  and  potassium,  as  a  haemo- 
static and  disinfectant,  i,  51. 
tannate,  in  acute  gonorrhoea,  ii,  859. 
Alumnol,  i,  51. 
application  in  skin  diseases,  i,  51. 
as  a  dressing  for  venereal  sores,  i,  51. 
for  checking  lacrymation  and  epiphora,  i, 

51. 
for  the  irrigation  of  abscesses  and  wounds, 

i,  51. 
injections  in  gonorrhoea,  i,  51. 
Alveloz,  i,  51. 
as  an  application  to  cancerous  and  syphilitic 
ulcers,  i,  51. 
Amanita  niuscaria.    See  under  Agaric,  i,  53. 
Amanitine.    See  Muscarine. 
Amara.    See  Bitters. 
Amber,  i,  52 ;  ii,  414. 
oil  of,  in  chronic  bronchitis,  ii,  414. 
"    "    "  gout,  i,  53. 
"    "    "  infantile  diarrhoea,  i,  52. 
"    "    "  whooping-cough,  i,  53  ;  ii,  414. 
"    "    "  winter  cough,  ii,  414. 
Amblotics.    See  Abortifacients. 
Ambrosia,  i,  53. 
^  in  epistaxis,  i,  53. 
Ame,  i,  52. 

Amidobenzene.    See  Aniline. 
Amidopropionic  acid,  i,  52. 

(subcHtaneously)  in  syphilis,  i,  53. 
Ammi,  i,  52. 
Ammonia,  i,  53. 

externally,  as  a  counter-irritant,  i,  53. 
foetid  spirit  of,  in  gastro-neuroses,  i,  53. 

"        "       "    "  hysterical  conditions,  i,  58. 
in  aconite  poisoning,  i,  7. 
"  collapse,  ii,  337. 


GENERAL  INDEX. 


463 


Ammonia,  inhalation  of  the  vapour  of,  in  opium 
narcosis,  i,  53. 

inhalation  of  the  vapour  of,  in  cardiac  de- 
pression, i,  52. 

inhalation  of  the  vapour  of,  in  syncope,  i,  52. 

in  intoxication  v?ith  cardiac  depression,  ii, 
227. 

in  poisonous  insect  bites  and  stings,  i,  53. 

liniment,  in  neuralgia  and  rheumatism,  i,  53. 

physiological  action  of,  i,  52. 

solution  of,  in  collapse  (by  hypodermic  injec- 
tion),  i,  53. 

solution  of,  in  snake-bite  (by  hypodermic  in- 
jection), i,  53. 

spirit  of,  in  headache,  i,  53. 

"     "  in  post-febrile  asthenic  conditions, 
i,  53. 

water,  i,  52. 

"      as  an  antiseptic,  i,  53. 

"      for  emesis  in  acute  alcoholism,  i,  53. 

"      in  colic  and  flatulence  of  children,  i, 

54. 

water  in  gastric  fermentation,  i,  53. 
"      "       "       superacidity,  i,  53. 
Ammoniac,  i,  54. 

as  a  stimulating  expectorant,  i,  54. 
Ammoniated  mercury  ointment  in  the  treat- 
ment of  pediculi,  i,  116. 
Ammonium,  i,  54. 

acetate,  i,  54. 
"        as  a  lotion  in  bruises,  i,  54. 
"         "  "      "       "       glandular     enlarge- 
ments, i,  54. 

acetate  as  a  lotion  in  sprains,  i,  54. 

"        in  delirium  due  to  biliousness,  i,  54. 

"         "  exanthemata,  i,  54. 

"         "  fever,  i,  54. 

"         "  headache,  i,  54. 

"         "  infantile  coryza,  i,  54. 

"         "  influenza,  i,  54. 

"        locally,  in  porrigo,  i,  54. 

benzoate,  i,  177. 

for  phosphatic  calculi,  i,  177. 

in  incontinence  of  urine,  i,  177. 
"  irritability  of  the  bladder,  i,  177. 
Ammonium  biborate.    See  Ammonium  bokate. 

bicarbonate,  i,  54. 

as  an  antacid,  i,  55. 

in  cystic  catarrh,  i,  55. 

'•  intermittent  fever,  i,  55. 

"  malarial  disease,  i,  55. 

"  phthisis,  i,  55. 

"  renal  colic,  i,  55. 

carbazotate,  i.  55. 

carbonate,  i,  55. 

as  an  antacid,  i,  55. 

as  a  stimulant  expectorant  in  chronic  bron- 
chitis and  pneumonia,  i,  56. 

effect  of,  on  urea,  i.  55. 

in  asthma  associated  with  cardiac  disorders, 
i,  55. 

"  chorea,  i,  56. 

"  chronic  bronchitis,  i,  55. 

"  colic,  i,  55. 

"  cystinuria,  i,  56. 

"  diabetes  mellitus,  i,  56. 

"  epilepsy,  i,  56. 

"  erythema,  i,  56. 

"  fatty  liver,  i,  56. 

"  flatulence,  i,  55. 


Ammonium  carbonate,  in  hysteria,  i,  56. 

in  roseola,  i,  56. 

"  rubeola;  i,  56. 

"  scarlatina,  i,  56. 

"  typhoid  fever,  i,  56. 

"  urticaria,  i,  56. 

carbonicum  pyro-oleosum  in  hysterical  con- 
ditions, i,  56. 

chloride,  i,  56. 

in  amenorrhoea,  i,  57. 

"  amyloid  liver,  i,  57. 

"  bronchitis,  i,  56. 

"  chronic  bronchitis,  i,  418. 

"  chronic  nasal  catarrh,  i,  528. 

"  delirium  tremens,  ii,  415. 

"  dropsy,  i,  57. 

"  facial  neuralgia,  i,  57. 

"  functional  hepatic  derangement  associated 
with  lithsemia,  i.  56. 

"  gastric  catarrh,  i,  56. 

"  haemorrhages,  i,  57. 

"  headache,  i,  57. 

"  hepatic  abscess,  i,  57. 

"  hepatic  congestion,  i,  56. 

"  hepatic  inflammations,  i,  56. 

"  intercostal  neuralgia,  i,  57. 

"  intermittent  fever,  i,  56. 

"  intestinal  catarrh,  i,  56. 

"  laryngitis,  i,  57. 

"  myalgia,  i,  57. 

"  ovarian  neuralgia,  i,  57. 

"  pharyngitis,  i,  57. 

"  senile  gangrene,  i,  57. 

"  subacute  bronchitis,  i,  57. 

"  whooping-cough,  i,  57. 

vapour  inhalations  in  coryza,  i,  57. 

"  "  "  inflammations  of  the 

bronchi,  i,  57. 

vapour  inhalations  in  inflammations  of  the 
larynx,  i,  57. 

vapour  inhalations  in  inflammations  of  the 
pharynx,  i,  57. 

citrate,  i,  57. 

embellate,  i,  57. 

as  a  taeniafuge,  i,  57. 

in  diseases  of  the  bladder,  i,  57. 

fluoride,  i,  57. 

•'       liquor  ammonii  fluoridi  in  hyper- 
trophied  spleens,  i,  57. 

fluoride,  liquor  ammonii  fluoridi  inhalations 
in  phthisis,  i,  57. 

formate,  i,  57. 

in  muscular  paresis,  i,  57. 

"  reflex  paralysis,  i,  57. 

hydrosulphide,  i,  57. 

in  catarrh,  i,  57. 

"  diabetes,  i,  57. 

"  dysuria,  i,  57. 

"  rheumatic  diseases,  i,  57. 

nitrate,  i,  57. 

phosphate.    See  under  Phosphorus. 

physiological  action  of,  i,  54. 

picrate.    See  Ammonium  carbazotate. 

picronitricum,  i,  55. 

salicylate.    See  under  Salicylic  acid. 

succinate,  i,  57. 

in  delirium  tremens,  i,  58. 

(ethereal  solution  of)  in  the  convulsive  dis- 
orders of  children,  i,  58. 

solution  of,  in  asthma,  i,  58. 


464 


GENERAL  INDEX. 


Ammonium,  succinate,  in  convulsive  disorders, 
i,  58. 
in  hysterical  disorders,  i,  58. 
"  rheumatism,  i,  58. 
sulphate,  i,  58. 
as  a  stimulant,  i,  58. 
sulphichthyolate.     See  Iohthtol. 
sulphydrate.    See     Ammonium     hydeosdl- 

PHIDB. 

tetrethylate,  i,  58. 

in  acute  articular  rheumatism,  i,  58. 
"  gouty  deposits,  i,  58. 
urate,  i,  58. 
in  eczema,  i,  58. 
Ammonol,  ii,  415. 
Amplosia,  i,  58. 
Amygdala,  amygdalin,  amygdalus.     See  under 

Almonds. 
Amygdophenine,  ii,  415. 
in  aortic  insufficiency,  ii,  415. 
"  neuralgia,  ii,  415. 
"  rheumatism,  ii,  415. 
Amylasther  nitrosus.     See  Amyl  nitrite. 
Amyl  alcohol,  i,  58. 
chloride,  i,  58. 
as  an  an.-csthetic,  i,  58. 
hydride,  i,  59. 
as  an  anaasthetic,  i,  59. 
iodide,  i,  59. 
nitrite,  i,  59. 

as  an  antidote  in  cocaine  poisoning,  i,  62. 
doses  and  administration  of,  i,  60. 
effects  of,  on  the  circulation,  i,  59. 
"       "     "     "    nervous  system,  i,  59. 
"       "     "     "    temperature,  i,  60. 
"       "     "     "    urine,  i,  60. 
in  angeiospasm,  i,  60. 
"  angina  pectoris,  i,  60,  61,  538. 
"  asthma  (for  temporary  relief),  i,  95. 
"  bronchial  spasm  (by  inhalation),  i,  133. 
'•  cardiac  failure,  i,  528. 
"  cardiac,  pulmonary,  and  nervous   disor- 
ders, i,  60. 
"  cocaine  poisoning,  i,  62. 
inhalations  in  aortic  insufficiency,  i,  61. 
"  "  asthma,  i,  61. 

"  "  cardiac  dyspnoea,  i,  61. 

"  "  cardiac  failure,  i,  61. 

"  "  catalepsy,  i,  61. 

"  "  cerebral  anjemia,  i,  61. 

"  "  dyspnoBa  due  to  asthma  and 

bronchitis,  i,  61. 
inhalations  in  epilepsy,  i,  61. 

"  "  headache  due  to  auEemia  of 

the  brain,  i,  61. 
inhalations  in  heart  failure,  ii,  227. 
"  "  hystero-epilepsy,  i.  61. 

"  "  migraine  attended   with  an- 

geiospasm, i,  61. 
inhalations  in  strychnine  poisoning,  i,  63. 
"  "  syncope,  i,  61. 

"  "  tetanus,  i,  61. 

"  "  ursemio  dyspnoea,  i,  61. 

in  hay  asthma,  i,  529. 
"  increased  blood-pressure,  i,  60. 
"  neuralgia  as  a  nerve  stimulant,  i,  69. 
"  pneumonia,  ii,  415. 
"  Raynaud's  disease,  i,  63. 
"  reflex  vaso-motor  disturbances,  i,  61. 
"  seasickness,  i,  61,  99. 


Amyl  nitrite,  in  strychnine  poisoning,  1,  528. 

in  trigeminal  neuralgia,  i,  61. 

"  urEcmic  convulsions,  i,  538. 

symptoms  caused  by  inhaling,  i,  59. 

tertiary,  i,  61. 

tertiary,  inhalations  as  a  hypnotic,  i,  61. 
Araylamine  chloride,  i,  58. 
Amylene,  i,  58. 

as  an  anaesthetic,  i,  58. 
Amylene  hydrate,  i,  58. 

as  a  hypnotic,  i,  58,  507. 

as  an  anajsthetic,  i,  58. 
Amyloform,  ii,  415. 

as  an  antiseptic  and  deodorizer  for  wounds, 
ii,  415. 
Amylonitrous  ether.     See  Amyl  nitrite. 
Amylum.     See  Starch. 
Amyl  valerianate,  i,  63. 

as  an  antispasmodic,  i,  62. 

"  a  calmative,  i,  62. 

in  hepatic  colic,  i,  62. 

"  hysterical  paroxysms,  i,  63. 

"  migraine,  i,  63. 

"  muscular  rheumatism,  i,  63. 

"  nephritic  colic,  i,  62. 

"  neuralgia,  i,  62. 

"  spasmodic  dysmenorrhoea,  i,  63. 
Anacardium  occidentale.     See  Cashew  nut. 
Anacyclus.     See  Pyrethrum. 
Anesthesia,  i,  63. 

breathing  and  pulse  during,  i,  64. 

general,  i,  63. 

hypnotic.     See  under  Hypnotism. 

Laborde's  method  of  resuscitation  from,  i,  64 ; 
ii,  416.    . 

local,  i,  66,  397. 

mixed,  i,  66. 

primary,  i,  63. 

resuscitation  from,  i,  64,  65 ;  ii,  416. 

vomiting  during,  i,  63. 
Anesthetics,  i,  63. 

administration  of,  i,  63,  64. 
Anaestile,  ii,  416. 

as  a  local  auiBsthetic,  ii,  416. 
Anagallis,  i,  66. 

in  rabies,  i,  66. 
Anagyrine,  i,  66. 
Analeptics,  i,  66. 
Analgene,  i,  66. 

in  neuralgia,  i,  66. 

"  rheumatism,  i,  66. 

"  spasmodic  asthma,  i,  66. 
Analgesics.     See  Analgetics. 
Analgesine.     See  Antipyrine. 
Analgetics,  i,  66. 

Anaphrodisiacs.     See  Antaphrodisiacs. 
Anatriptics,  i,  69. 
Anda  oil,  i,  70. 
Andira,  i,  70. 

in  lumbricoid  worms,  i,  70. 
Andrographis  paniculata,  i,  70. 
Andropogon,  i,  70. 
Anemone  pratensis.  Anemone  Pulsatilla.     See 

Pulsatilla. 
Anemonin,  i,  70 ;  ii,  107. 

in  dysmenorrhoea,  i,  70. 
Anethol,  ii,  416. 

as  an  antiseptic,  ii,  416. 
Anethum  foeniculum.     See  Dill. 
Angeioneurosine.    See  Nitroglycerin. 


GENERAL  INDEX. 


465 


Angelica,  i,  70. 

Angine,  i,  70. 

Angostura,  Angustura.    See  Cusparia,  i,  70. 

Anhalonine,  i,  70;  ii,  417. 

as  a  cardiac  and   respiratory  stimulant  in 
angina  pectoris,  ii,  417. 

in  asthma,  ii,  417. 
Anhaloniuin  Lewiuii,  i,  70 ;  ii,  416. 

in  colic,  ii,  416. 

"  cough  (nervous),  ii,  416. 

"  delirium,  ii,  416. 

"  frontal  cephalalgia,  ii,  417. 

"  hypochondriasis,  ii,  416. 

"  hysteria,  ii,  416. 

"  insomnia  of  pain,  ii,  416. 

"  mania,  ii,  416. 

"  melancholia,  ii.  416. 
Anhydroglucochloral.    See  Chlokalose. 
Anhydrosuiphamenebenzoio    acid.     See    Sac- 
charin. 
Anidrotics.     See  Anthidrotics. 
Aniline,  i,  70. 
Aniline  caraphorate,  i,  70. 

in  chorea,  i,  70. 
,     "  epilepsy,  i,  70. 
Animal  extracts  and  iuices,  i,  70. 

hypodermic  method  of  administering,  i,  73. 

preparation  of,  for  hypodermic  administra- 
tion, i,  71. 
Anise,  Aniseed,  i,  85. 
Annidalin,  i,  85. 
Anodyne  colloid,  i,  393. 

in  lumbago,  i,  393. 

"  muscular  pains,  i,  393. 

"  neuralgia,  i,  293. 
Anodynes.     See  Akalgetios. 
Anodynine.     See  Antipyrine. 
Antacidine,  i,  85. 
Antacids,  1,  85. 

in  acid  diarrhcea,  i,  86. 

"  aphthous  sore  mouth,  i,  86. 

"  colic,  i,  86. 

"  pyrosis  with  acid  eructations,  i,  86. 
Antagonism,  physiological,  i,  86. 

toxicological,  i,  87. 
Antagonists,  i,  86. 

table  of,  i,  89. 

therapeutical,  i,  89. 
Antaphrodisiacs,  i,  90. 
Antarthritics,  i,  90. 
Antasthraatics,  i,  91. 
Antatrophics,  i,  97. 
Antemetios,  i,  97. 
Antennaria.    See  Gnaphalium. 
Antepileptics,  i,  100. 
Anterotics.    See  Antaphrodisiacs. 
Anthelminthics,  i,  101. 
Anthemis.    See  Chamomile. 
Anthemis  inhalation  in  catarrh  of  the  upper 

air-passages,  i,  331. 
Anthidrotics,  i,  103. 
Anthracite,  i,  103. 

powdered  coal  in  treatment  of  teenia,  i,  103. 
Anthrarobin,  i,  103. 

in  erythrasma,  i,  103. 

"  psoriasis,  i,  103. 

"  ringworm,  i,  103. 
Anthydropics,  i,  103. 

in  dropsical  effusions,  i,  103. 
Anthydropin.    See  under  Blatta. 


Anthysterics,  i,  103. 

Antiarin,  i,  104. 

Antiaris,  i,  103. 

Antibaoteria,  i,  104. 

Antibakterikon,  i,  104. 

Antiblennorrhagics,  i,  104. 

Anticnesmatics,  i,  106. 

Anticolics,  i,  107. 

Anticonvulsives.    See  Antispasmodics. 

Antideperditories,  i,  107. 

Antidiphtherine,  i,  107. 

application  of,  i,  107. 

in  diphtheria,  i,  107. 
Antidiphtheritics,  i,  107. 
Antidiphtheritic  serum.    See  under  Antitox- 

INES. 

Antidotes,  i,  86,  107. 

chemical,  i,  108. 

mechanical,  i,  108. 
Antidotum  arsenici,  i.  111, 
Antidyscratics,  i,  111. 
Antidysenterics,  i.  111. 
Antifebrine.     See  Acetanilide. 
Antifermentatives.     See  Antizymotics. 
Antifungin,  i.  111. 
Antigalactics,  i,  111. 

Antigonorrhoics.    See  Antiblennoeehaqics. 
Antihydropin.     See  Blatta, 
Antikamnia,  i.  111. 

in  influenza,  i,  113. 

"  melancholia,  i,  113. 

"  neuralgia,  i,  113. 
Antikol,  i,  112. 
Antilithics,  i,  113. 
Antiluetics.    See  Antisyphilitics. 
Antimiasmatics.     See  Antiperiodics. 
Antimonial  powder,  i,  114. 

wine,  i,  114. 
Antimony,  i,  112. 

acute  poisoning  with,  i,  113. 

chronic  poisoning  with,  i,  113. 

compound  pills  of,  in  cutaneous  disorders, 
i,  114. 

effects  of  small  doses  of,  i,  113. 

pills  of,  in  rheumatism,  i,  114. 

in  acute  indigestion  of  children,  i,  114. 

"  acute  sthenic  inflammations,  i,  118. 

"  asthma,  i,  114. 

"  catarrhal  disorders,  i,  114. 

"  dislocations,  i,  114. 

"  mammitis,  i,  114. 

"  mania,  i,  114. 

"  noisy  sthenic  delirium,  i,  114. 

"  orchitis,  i,  114. 

"  puerperal  fever,  i,  114. 

"  ri'gidity  of  the  os  uteri  during  labour,  i,  114. 

"  sthenic  fever,  i,  114. 

"  strangulated  hernia,  i,  114. 

"  treatment  of  poisoning  by,  i,  113, 113. 
Antinarcotics,  i,  115. 
Antinervin,  i,  115. 

Antineuralgics.    See  under  Analgetics. 
Antinosine,  ii,  417. 
Antiparasitics,  i,  115. 
Antiperiodics,  i,  117. 
Antiperiodio  tincture,  i,  118,  358. 
Antiphlogistics,  i,  118. 
Antiphtheirics,  Antiphthirics,  i,  119. 
Antiphthisin,  i,  119. 

in  fever,  i,  119. 


466 


GENERAL  INDEX. 


Antiphthisin,   in   pulmonary   tuberculosis,   i, 
119. 
in  tuberculous  ulcers,  i,  120. 
(hypoderraieally)     in      tuberculosis     (early 

stages),  i,  120. 
preparation  of,  i,  119. 

rectal  injections  of,  in  early  stages  of  tuber- 
culosis, i,  120. 
Antiplastics,  i,  120. 
Antipruritics.     See  Anticnesmatios. 
Antipyonine,  i,  120. 
for  prevention  of  suppuration  in  affections 

of  the  cornea  and  conjunctiva,  i,  120. 
(in  weak  solution)  in  conjunctivitis,  i,  120. 
in  corneal  ulcers,  i,  120. 
(in  weak  solution)  in  keratitis,  i,  120. 
in  panophthalmitis  (after  enucleation),  i,  130. 
"  pannus,  i,  120. 
"  purulent  conjunctivitis,  i,  120. 
Antipyretics,  i,  120. 

in  fever,  i,  130,  131. 
Antipyrine,  i,  133. 
(as  an  anodyne)  in  cystitis,  i,  124. 
in  bronchial  asthma,  i,  124. 
'■  cliorea,  i,  124. 
"  delirium,  i,  133. 
"  fever,  i,  123. 
"  locomotor  ataxia  (for  fulgurant    pains), 

i,  124. 
(solution)  in  haemorrhage,  i,  466. 
in  hectic  tuberculosis,  i,  123. 
"  hemicrania,  i,  134. 
"  measles,  i,  123. 
"  nervous  dysmenorrhcsa,  i,  34 
"  neuralgia,  i,  69. 
"  pneumonia,  i,  133. 
"  rheumatism,  i,  125. 
"  scarlatina,  i,  123. 
"  sciatica,  i,  124. 
"  typhoid  fever,  i,  123. 
"  whooping-cough,  i,  134. 
phenylglycolate.     See  TussoL. 
salicylate.     See  Salipyeine. 
table  of  doses  for  children,  i,  138. 
Antirrheumatics,  i,  134. 
Antirrheumatin,  i,  136. 
in  rheumatism,  i,  136. 
Antiscorbutics,  i,  136. 
Antisepsin,  i,  136. 
in  ulcers,  i,  136. 
"  wounds,  i,  126. 
Antiseptic  precautions   in  the  siok-chamber, 

i,  441. 
Antiseptics,  i,  126. 
in  obstetrics,  i,  130. 
"  surgery,  i,  136. 
"        "        dressings  in,  i,  139. 
"        "        the  operating  room,  i,  129. 
"       "        the  operation  before  and  after,  i, 

130. 
"  surgery,  the  personal   cleanliness  of  the 

operator  and  his  assistants,  i,  139. 
"  surgery,  the  preparation  of  instruments, 

i,  138. 
"  surgery,  preparation  of  the  genito-urinary 

passages  of  the  male,  i,  138. 
"  surgery,  preparation  of  the  nasal  and  oral 

cavities,  i,  137. 
"  surgery,  preparation  of  the  pelvic  organs 
in  the  female,  i,  128. 


Antiseptics,  in  surgery,  preparation  of  the  rec- 
tum and  anus,  i,  137. 

in  surgery,  preparation  of  the  skin  of  the 
head,  trunk,  and  extremities,  i,  137. 

"  surgery,  sutures  and  ligature  material,  i, 
138. 

internal  use  of,  i,  133. 
Antiseptol,  i,  133. 
Antispasmin,  i,  133. 

"  in  whooping-cough,  i,  133. 
Antispasmodics,  i,  133. 

Antistreptococcic     serum,    Antistreptocoeein, 
Antistreptococous      serum.      See     under 
Sebum  teeatment  (vol.  ii,  page  178). 
Antisudin,  i,  134. 

Antisudorifics.     See  Anthideotics. 
Antisudorin,  i,  134. 

in  local  hyperidrosis,  i,  134. 
Antisyphilitics,  i,  134. 
Antitsenia,  i,  134. 
Antitetanics,  i,  184. 
Antitetraizine,  i,  134. 

in  influenza,  i,  134. 

"  neuralgia,  i,  134. 

"  rheumatism,  i,  134. 
Antithermics.    See  Antipybetics. 
Antithermin,  i,  134. 

Antitoxine,  "  double  "  or  "  dual,"  ii,  175. 
Antitoxines,  i,  134. 
Antivenene.     See    under    Sekum    teeatment 

(vol.  ii,  page  188). 
Antizymotics,  i,  135. 
Antodontalgics,  i,  135. 
Anuretics,  i,  136. 
Aparine.    See  Galium. 
Apenta  water,  ii,  417. 

Aperients,  Aperitives.    See  under  Cathartics. 
Aphrodisiacs,  i,  136. 
Apiol,  i,  137. 

in  amenorrhoea,  i,  138. 

"  dysmenorrhoea,  i,  137. 

"  intermittent  fever,  i,  137. 

"  malarial  neuralgia,  i,  137. 

"  neuralgic  dysmenorrhoea,  i,  138. 
Apoeodeine,  i,  138. 
Apocynum,  i,  138. 

in  dropsy,  i,  138. 
Apolysine,  ii,  417. 

as  an  analgetic,  ii,  417. 

as  an  antipyretic,  ii,  417. 

in  lumbago,  ii,  417. 

"  muscular  rheumatism,  ii,  417. 

"  neuralgia,  ii,  417. 
Apomorphine,  i,  138 ;  ii,  417. 

as  an  antispasmodic,  ii,  417. 

effects  of  on  the  bronchial  secretion,  i,  189. 
"       "    "     "   circulation,  i,  139. 

hypodermic  use  of,  i,  139. 

in  asthma,  ii,  418. 

"  bronchial  catarrh  (as  an  expectorant),  i, 
loU. 

"  bronchorrhoea,  i,  189. 

"  chronic  bronchitis,  i,  139. 

"  hiccough,  ii,  417. 

"  hysteria,  ii,  418. 

"  pulmonary  emphysema,  i,  189. 

"  tetanus,  ii,  417. 

physiological  action  of,  i,  138. 
Apone,  i,  139. 

in  dyspepsia,  i,  139. 


GENERAL  INDEX. 


467 


Apone,  in  haemorrhoids,  i,  139. 

in  muscular  rheumatism,  i,  139. 

"  neuralgia,  i,  139. 
Apozemata,  i,  189. 
Apyonine,  i,  139. 
Aqua.    See  Water. 
Aquozone,  i,  140. 
Arachis  hypogaea,  i,  140 ;  ii,  418. 

in  constipation,  i,  140. 

"  diabetes  (as  a  bread),  ii,  418. 
Aranea,  i,  140.    . 

Araroba.    See  under  Chrysaeobin. 
Arbor  vitaj.    See  Thhja. 
Arbutin,  i,  140. 
Arbutus.     See  UvA  URSi. 
Archangelica.    See  Angelica. 
Arctium.    See  Lappa. 
Aretostaphylos,  i,  140. 
Arecane,  Arecoline,  Arekane,  i,  140. 
Areoa  nut,  in  treatment  of  tienia,  i,  103. 
Argentamine,  i,  140. 

in  gonorrhoea,  i,  140. 
Argentum.    See  Silver. 
Argonin.    See  under  Silver  (vol.  ii,  page  197). 

as  an  antiseptic,  ii,  197. 

in  catarrhal  conjunctivitis,  ii,  197. 

"  gonorrhoea,  ii,  197. 

"  purulent  conjunctivitis,  ii,  197. 
Aristol,  i,  140. 

for  vegetable  parasites,  i,  140. 

in  chronic  rhinitis,  i,  140. 

"  interstitial  keratitis,  i,  140. 

"  ozsena,  i,  140. 

"  psoriasis,  i,  140. 

"  suppurative  diseases  of  the  middle  ear,  i, 
140. 

"  syphilitic  ulceration,  i,  140. 

"  tuberculosis  (hypodermioally),  i,  140. 

"  ulcers,  i,  140. 

"  ulcers  of  the  leg,  i,  140. 
Aristolochia.    See  Serpentaria. 
Armoraeia.    See  Horseradish. 
Arnica,  i,  141. 

and  honey,  as  a  plaster  for  boils,  i,  141. 

jn  abrasions,  i,  141. 

"  bruises,  i,  141. 

(in  small  doses)  in  congestive  dysmenorrhcea, 
i,  141. 

in  cutaneous  eruptions,  i,  141. 

"  delirium  tremens  of  an  asthenic  type,  i, 
141. 

"  fevers,  i,  141. 

"  inflammation  of  pelvic  cellular  tissue,  i, 
141. 

"  inflammatory  conditions,  i,  141. 

"  melancholia  of  an  asthenic  type,  i,  141. 

"  rheumatic  gout,  i,  141. 

"  rheumatism,  i,  141. 

"  shock,  i,  141. 

"  sprains,  i,  141. 
Arnioin,  i,  141. 
Aromatics,  i,  141. 
Arrowroot,  i,  141. 
Arsenauro,  i,  143. 
Arsenic,  i,  143. 

after-treatment  of  poisoning  by,  i,  143. 

and  iron  in  neuralgia,  i,  68. 

as  a  stimulant,  i,  143. 

bromide  of,  in  asthma,  i,  97. 

chloride  of,  in  asthma,  i,  97. 


Arsenic,  effects  of  internal  doses  of,  i,  143,  143. 
effects  of  on  the  respiration  and  circulation 

i,  143. 
for  warts,  i,  144. 
in  acne,  i,  144. 
"  amenorrhoea,  i,  146. 
"  anaemia,  i,  145. 
"  angina  pectoris,  i,  146. 
"  asthma,  i.  96. 
"  cancer,  as  a  caustic,  i,  144. 
•'  cardiac  dyspnoea,  i,  146. 
"  cardiac  neuroses,  i,  146. 
"  chlorosis  (as  an  emmenagogue),  i,  374. 
"  chronic  bronchitis,  i,  146. 
"  chronic  gastric  catarrh,  i,  146. 
"  chronic  malarial  poisoning,  i,  145. 
."  chronic  oophoritis,  i,  146. 
"  chronic  rheumatism,  i,  145. 
"  chronic  urticaria,  i,  144. 
"  cirrhosis  of  the  liver,  i,  146. 
"  cystic  goitre,  i,  146. 
"  diabetes,  i,  145. 
"  diarrhoea,  i,  146. 
"  eczema,  i,  144. 
"  epithelioma,  i,  144. 
"  gastralgia,  i,  146. 
"  gastric  neuroses,  i,  146. 
"  gastrodynia.  ii,  146. 
"  hemorrhoids,  i,  146. 
"  Hodgkin's  disease,  i,  144. 
"  intermittency  of  the  pulse,  i.  146. 
"  intermittent  fever,  i,  117,  145. 
"  intestinal  indigestion,  i,  146. 
"  leucaemia,  i,  145. 
"  lichen  planus,  i,  144. 
"      "      ruber,  i,  144. 
"  lupus  erythematosus,  i,  144. 
"  lymphoma,  ii,  144. 
"  malarial  cachexia,  ii,  145. 
"  malarial  infection,  as  a  prophylactic,  i.  145. 
"  morning  vomiting  of  drunkards,  i,  l46. 
"  multiple  sarcoma,  i,  144. 
"  neuralgia,  i,  146. 
"  neurotic  asthma,  i,  146. 
"  pain  of  aortic  regurgitation,  i,  146. 
"  palpitation  of  the  heart,  i,  146. 
"  pelvic  peritonitis,  i,  146. 
"  pemphigus,  i,  144. 
"  psoriasis,  i,  144. 
"  pulmonary  emphysema,  i,  146. 
"  pulmonary  phthisis,  early  stages,  i,  146. 
"  regurgitation  of  food,  i,  146. 
"  rheumatic  gout,  i,  145. 
"  seborrhoea,  i,  144. 
"  secondary  syphilis,  i,  145. 
"  snake-bites,  i,  146. 

"  the  wasting  diseases  of  the  puerperal  pe- 
riod, i,  145. 
"  tremor  of  central  nervous  lesions,  i,  146. 
"  ulcer  of  the  stomach,  i,  146. 
"  uterine  congestion,  i,  146. 
"  vaginal  leueorrhoea,  i,  146. 
"  vomiting  due  to  gastric  irritation,  i,  99. 
"  vomiting  of  drunkards,  i,  146. 
"  vomiting  of  pregnancy,  i,  146. 
"  weak  heart  accompanied  by  pain,  i,  146. 
ointment  in  pediculosis,  i,  145. 

■     "        "    scabies,  i,  145. 
poisoning  with,  i,  143,  553,  591 ;  ii,  400. 
therapeutics  of,  i,  143. 


468 


GENERAL  INDEX. 


Arsenium.    See  Arsenic. 
Arsenous  acid  in  asthma,  i,  97. 
Arsenous  oxide,  i,  142. 
Arsenura.     See  Aksenic. 
Artemisia,  i,  147. 
Asafoetida,  i,  147. 

(as  a  stimulant  expectorant)  in  chronic  bron- 
chial and  laryngeal  affections,  i,  147. 
in  asthma,  i,  147. 
"  chorea  of  young  girls,  i,  147. 
"  constipation,  i,  147. 
"  flatulence,  i,  147. 
"  hypochondriacal  affections,  i,  147. 
"  hysterical  attacks,  i,  147. 
"  indigestion,  i,  147. 
"  nervous  irritability,  ii,  6. 
"  threatening  abortion,  i,  147. 
(enema)  in  tympanites  of  typhoid  fever,  i,  147. 
in  whooping-cough,  alter  the  acute  stage  has 
subsided,  i,  147. 
Asaprol,  i,  148. 
as  an  anodyne,  i,  68. 
in  fermentative  dyspepsia,  i,  148. 
"  influenza,  as  an  antipyretic,  i,  148. 
"  neuralgia,  for  immediate  relief,  i,  69. 
(as  an  antipyretic)  in  pneumonia,  i,  148. 
(as  an  antipyretic)  in  typhoid  fever,  i,  148. 
in  rheumatism,  i,  148. 
"  treatment  of  boils,  i,  148. 
Asarum,  i,  148. 
Asbestos,  ii,  419. 

as  a  surgical  dressing,  ii,  418. 
Asclepias  curassavica,  i,  148. 
Asolepias  tuberosa,  i,  148. 
in  acute  exanthemata,  i,  148. 
"  catarrh  of  the  respiratory  tract,  i,  148. 
"  fever,  i,  148. 
Asepsin.     See  Antisepsin. 
Aseptol,  i,  148. 
Asparagin,  i,  148. 

(by  hypodermic  injection)  in  syphilis,  i,  148. 
Asparagus,  i,  149. 
Asparamide.     See  Asparagin. 
Aspidium,  i,  149. 

in  the  treatment  of  taenia,  i,  102,  149. 
Aspidosamine,  Aspidosperma,   Aspidosperma- 

tine,  Aspidospermine,  i,  149. 
Aspiration,  i,  149. 

Dieulaloy's  rules  for,  in  empyema,  i,  151. 

in  absces.ses,  i,  153. 

"  ascites,  i,  152. 

"  chronic  congestive  hepatitis,  i,  151. 

"  chronic  hydrocephalus,  i,  150. 

"  cystic  tumours  of  the  ovaries  and  broad 

ligaments,  i,  152. , 
"  diagnosis  and  treatment  of  abscesses,  cysts, 

etc.,  i,  149. 
"  fluctuating  enlargements  of  the  joints,  i, 

152. 
"  haemothorax,  i,  151. 
"  hepatic  echinococcus,  i,  151. 
"  hernia,  i,  152. 
"  hydropericardium.  i,  151. 
"  hydrothorax,  i,  151. 
"  iliac  phlegmon,  i,  153. 
"  intestinal  occlusion,  i,  153. 
"  nephrydrosis,  i,  151. 
"  pericarditis,  i,  150. 
"  pericarditis  with  effusion,  i,  151. 
"  perityphlitic  abscess,  i,  152. 


Aspiration,  in  pleurisy  with  effusion,  i,  150. 

in  pneumonia,  i,  150. 

"  pneumothorax,  i,  151. 

"  retention  of  urine  due  to  stricture,  hy- 
pertrophied  prostate,  or  ruptured  urethra, 
i,  152. 

"  spina  bifida,  i,  150. 

"  suppurative  hepatitis,  i,  151. 

"  valvular  heart  disease,  i,  150. 

preparation  of  needles,  tube,  air-pump,  etc., 
before,  i,  149,  150. 
Asteracantha  longifolia,  i,  153. 
Astringents,  i,  152. 

in  checking  exudation,  i,  153. 

"  chronic  and  subacute  diarrhoeas,  i,  153. 

"  chronic  inflammations  of  mucous  mem- 
branes, i,  153. 

"  haemorrhage,  i,  153. 

"  subacute  inflammation,  i,  153. 

"  ulcerations,  i,  153. 
Atropa  belladonna.    See  Belladonna. 
Atropine,  i,  154. 

anaesthetic  effect  of,  i,  154. 

as  a  mydriatic,  i,  649. 

as  an  anthidrotic,  i,  103. 

effect  of  external  application  of,  i,  154. 

for  inflamed  and  swollen  parts  (externally), 
i,  154. 

hypodermically  for  its  general  and  systemic 
effects,  i,  156. 

hypodermically  for  local  and  constitutional 
effects,  i,  156. 

in  hepatic  colic,  i,  67. 

"  inflammation  of  the  sciatic  nerve,  i,  67. 

"  spasmodic  dysmenorrhcea,  i,  67. 

(by  hypodermic  injection)  in  aconite  poison- 
ing, i,  7. 

in  blepharitis,  i,  155. 

"  cancerous  tumors  (externally),  i,  154. 

"  cardiac  syncope,  i,  156. 

"  collapse  of  fevers,  sunstroke,  etc.,  i,  156. 

"  conjunctivitis  with  granulation,  i,  155. 

"  diseases  of  the  eye,  i,  155. 

"  earache,  i,  156. 

"  erysipelas,  i,  156. 

"  erythematous  dermatitis,  i,  156. 

"  glaucoma,  i,  154,  156. 

(externally)  in  infiltrations,  i,  154. 

in  neuralgia  of  the  trigeminus,  i,  156. 

(externally)  in  neuralgia,  i,  154. 

in  opium  poisoning,  i,  156. 

"  phlyctfenular  conditions  of  the  cornea,  i, 
155. 
.   "  photophobia  of  acute  conjunctivitis,  i,  155. 

"  poisoning  by  Calabar  bean,  i,  156. 

(locally)  in  sciatica,  i,  156. 

in  serious  collapse,  i,  156. 

"  swelling  of  the  mammary  glands,  i,  156. 

internal  application  of,  i,  157. 

in  ulcerations  of  the  cornea,  i,  155. 

"  vomiting,  i,  99. 

physiological  effect  of,  i,  154. 

poisoning  (see  under  IJelladonna,  vol.  i,  p. 
175). 

sulphate  (1-per-cent.  solution)  in  toothache, 
i,  136. 

small  doses,  as  a  corrective  of  the  unpleasant 
effect  of  quinine,  ii,  419. 

therapeutics  of,  i,  155. 
Auramine,  i,  157. 


GENERAL  INDEX. 


469 


Aurantium,  i,  157. 

juice  of.  in  scurvy,  i,  157. 
Aiirum.     See  Gold. 
Ava.    See  Kava. 
Avena.    See  Oatmeal. 
Axeromaticon,  i,  157. 

in  hyperidrosis,  i,  157. 
Axungia.    See  Laed. 
Aya-pana,  i,  157. 
Azederach,  i,  158. 

in  helminthiasis,  i,  158. 
Azote.    See  Nitrogen. 

Bacilli,  i,  158. 
Bacteriotherapy,  i,  158. 

treatment  of  tuberculosis  by,  i,  158,  159. 
Bael  fruit.     See  Bela. 
Baffine,  i,  159. 

Balneotherapeutics.    See  under  Baths. 
Balsamios,  Balsams,  i,  159. 

as  local  stimulants,  i,  159. 

in  asthma,  i,  160. 

"  atonic  catarrhal  inflammation,  i,  160. 

"  laryngeal  catarrh,  i,  529. 

"  pulmonary  catarrh,  i,  529. 

"  pulmonary  tuberculosis,  i,  529. 

"  whooping-cough,  i,  529. 
Balsam,  friar's,  i,  159. 
Balsaraura  pulmonum,  ii,  241. 

in  acute  and  chronic  bronchitis,  ii,  341. 
Bantingisra,  i,  160. 
Baptin,  i,  160. 
Baptisia  tinetoria,  i,  160. 
Baptisin,  i,  160. 
Baptitoxine,  i,  160. 
Bardana.    See  Lappa. 
Barium,  1,  160. 

bromide.    See  under  Bromine. 

carbonate,  i,  161. 

chloride,  i,  161. 

in  cardiac  disease,  i,  161. 

"  cutaneous  diseases,  1,  162. 

"  diffuse  and  multiple  cerebral  sclerosis,  i, 
161. 

"  dry  eczema,  i,  162. 

"  functional  cardiac  disorder,  i,  161. 

"  paralysis  agitans,  i,  162. 

"  tetanus,  i,  161. 

"  valvular  disease  of  the  heart,  i,  161. 

"  varicose  veins,  i,  162. 

"  white  swelling,  i,  161. 

dioxide,  i,  162. 

hyperoxide,  i,  163. 

iodide.    See  under  Iodine. 

oxide,  i,  162. 

peroxide,  i,  163. 

poisoning  with,  i,  161. 

salts,  effect  of,  on  the  ventricles  of  the  heart, 
i,  160. 

sulphide,  i,  163. 

sulphocarbolate,  i,  163. 

in  colliquative  diarrhoea,  i,  163. 

"  gastro-intestinal  disturbances,  i,  163. 
Barley.     See  Hordeum. 
Barley  water  in  febrile  conditions,  i,  351. 
Barosma.    See  Buchu. 
Baryta.    See  Barium  oxide,  under  Barium,  vol. 

"i,  page  162. 
Baryum.    See  Barium. 
Basilicon  ointment,  i,  162. 


Basilicon  ointment,  in  burns,  ii,  135. 

in  indolent  ulcers,  ii,  135. 
Baths,  i,  162 ;  ii,  419. 
acid,  i,  171. 
alkaline,  i,  170. 
in  chronic  rheumatism,  i,  171. 
"       "       vesicular  skin  diseases,  i,  171. 
"  functional  nervous  disorders,  i,  171. 
"  gout,  i,  171. 
"  ichthyosis,  i,  171. 
"  jaundice,  i,  171. 
"  prurigo,  i,  171. 
"  psoriasis,  i,  171. 
"  squamous  skin  diseases,  i,  171. 
"  urinary  lithiasis,  i,  171. 
alternating,  i,  166. 
aromatic,  i,  171. 

arsenical,  in  rheumatic  arthritis,  i,  171. 
artificial  Nauheim,  ii,  425. 
"        Plombieres.  i.  171. 
Vichy,  i,  171.' 
bromine,  in  syphilis  and  squamous  skin  dis- 
eases, i,  170. 
cold,  i,  165. 
"     action  of,  on  the  constitution,  i,  482, 
488, 484. 

"     effect  of,  on  the  red  blood-corpuscles, 
i,  164.       - 

"     effect  of,  on  the  respiration,  i,  164,  468. 
"      effects  of,  on  the  nervous  system,  1,  486. 
"      foot,  in  chilblains,  i,  170. 
"      "       "  bromidrosis,  i,  170. 
"      "       "  frostbite,  1,  170. 
"      "       "  menorrhagia,  i,  170. 
"      for  the  insane,  to  induce  sleep,  i,  488. 
"     in  acute  articular  rheumatism,  i,  488. 
"      "      "      infectious  diseases,  i,  486. 
"      "      "      hyperpyrexia,  i,  486. 
"      "  asphyxia  of  the  newborn,  ii,  128. 
"      "  cardiac  diseases,  i,  165. 
"      "  cerebro-spinal  meningitis,  i,  488. 
"      "  cholera  infantum,  i,  488. 
"     '"  diphtheria,  i,  488. 
"      "  epilepsy,  i,  488. 
"      "  erysipelas,  i,  488. 
"     (as  a  stimulant)  in  insolation,  ii,  335. 
"      manner  of  giving,  i,  165. 
"     in  neuralgia,  i,  165. 
"      "  neurasthenia,  i,  165,  488. 
"      "  pulmonary  diseases,  i,  165. 
"      "  quinsy,  i,  488. 
"      "  rheumatic  conditions,  i,  165. 
"      "  scarlatina,  i,  488. 
"      "  sepsis,  i,  488. 
"      "  small-pox,  i,  488. 
"      "  sunstroke,  i,  486. 
"     "  typhoid  fever,  i,  486. 
"      "  typhus  fever,  i,  488. 
"      (permanent  or  continuous  immersion) 
in  variola  and  pemphigus  vegetans,  i,  488. 
cold  sitz,  contra-indicated  in  heart  disease, 

i,  169. 
cold  sitz,  in  amenorrhoea,  i,  169. 
'     "      "  atony  of  the  bladder,  i,  169. 
'     "      "  cerebral  hyperaemia,  i,  169. 
'      "      "  chordee,  i,  489. 
'     "      "  chronic  diarrhoea,  i,  169. 
'      "      "       "        dysentery,  i,  169. 
'     "      "       "       engorgement  of  the  liver 
and  spleen,  i,  169. 


470 


GENERAL  INDEX. 


Baths,  cold  sitz,  in  chronic  posterior  urethritis, 
i,  489. 
cold  sitz,  in  dysmenorrhcea,  i,  169. 
"      "      "  external   and    internal    haemor- 
rhoids, i,  489. 
cold  sitz,  in  genito-urinary  affections,  i,  488. 
"      "      "  hemorrhoids,  i,  169. 
"      "      "  nocturnal  incontinence  of  urine 
in  children,  i,  169. 
cold  sitz,  in  obstinate  constipation,  i,  169. 
"      "      "  paresis  of  the  bladdei',  i,  169. 
"      "      "  passive  uterine  congestion,  i,  169. 
"      "      "  pregnancy,  i,  169. 
"      "      "  prostatorrhoea,  i,  169. 
"      "      "  pulmonary  hyperaemia,  i,  169. 
"      "      "  rectal  prolapse,  i,  169. 
"      "      "  spermatorrhoea,  i,  169. 
condensed  air,  i,  18,  36,  27. 
continuous,  i,  167. 

"  in  extensive  burns,  i,  167. 

"  "  pemphigus,  i,  167. 

"  "  psoriasis,  i,  167. 

"  variola,  i,  167. 
drip,  in  chronic  nervous  disease,  i,  490. 
elbow,  i,  171. 
emollient,  in  acute  arthritis,  i,  170. 

"  "  acute  inflammatory  skin    dis 

eases,  i,  172. 
emollient,  in  cold  abscess,  i,  171. 
"         "  lymphangeitis,  i,  171. 
"  phlebitis,"  i,  171. 
foot,  i,  169. 

gelatin,  in  skin  diseases,  i,  172. 
graduated,  i,  170. 

"         in  typhoid  fever,  i,  170. 
half,  i,  168. 
hand  (cold),  in  cerebral  hyperemia,  i,  170. 

"    in  epistaxis,  i,  170. 
hot-air,  i,  167. 

"      contra-indications  for  use  of,  i,  168. 
"      in  bronchial  irritation,  i,  168. 
"        "  chronic  articular  rheumatism,  i. 
168.  ' 

hot-air,  in  chronic  dropsies  of  serous  cavities 

i,  168. 
hot-air,  in  chronic  neuralgia,  i,  168. 

"        "  congestive  pulmonary  conditions, 
i,  168. 
hot-air,  in  diabetes,  i,  168. 

"        "  dryness  of  the  skin,  i,  168. 

"        "  gouty  conditions,  i,  168. 

"        "  hepatic  congestion,  i,  168. 

"        "  kidney  disease,  i,  468. 

"        "  lumbago,  i,  168. 

"       "  megrim,  i,  168. 

"        "  mercury  poisoning^  i,  168. 

"        "  obesity,  i,  168. 

"        "  opium  poisoning,  i,  168. 

"        "  paludal  cachexia,  i,  168. 

"        "  poisoning  by  illuminating  gas,  i, 

hot-air,  in  rheumatism,  i,  168. 

"       "  splenic  congestion,  i,  168. 
"        "  syphilis,  i,  168. 
"       "  urreimia,  i,  100,  468. 
"method  of  administering,  i,  167. 
hot,  in  articular  rheumatism,  i,  166. 
"     "  asphyxia  neonatorum,  i,  166. 
"     "  atony  of  the  lungs  and  kidneys,  ii,  225. 
"     "  chronic  muscular  rheumatism,  i,  160. 


Baths,  hot,  in  convulsions,  i,  166. 

hot,  in  cystitis,  i,  166. 

"  "  dropsy,  i,  489. 

"  "  dysmenorrhcea,  i,  166. 

"  "  erysipelas,  i,  166. 

"  "  heart  disease  (some  forms),  ii,  335. 

"  "  hysterical  mania,  i,  166. 

"  "  inflamed  wounds,  i,  166. 

"  "  inflammations,  i,  166. 

"  "  insomnia,  i,  166. 

"  "  lassitude,  i,  166. 

"  "  maniacal  excitement,  i,  166. 

"  "  metritis,  i,  166. 

"  "  metrorrhagia,  i,  166. 

"  "  muscular  fatigue,  i,  166. 

"  "  nervous    excitability   of    pregnancy, 

hot,  in  orchitis,  i,  166. 
"     "  pemphigus,  i,  166. 
"      "  phlebitis,  i,  166. 
'■    ,"  phlegmasia  alba  dolens,  i,  166. 
"      "  preliminary  pains  of  labour,  i,  166. 
"      "  psoriasis,  i,  166. 
"      "  rheumatism,  ii,  420. 
"      "  sexual  disorders,  i,  489. 
"      "  strangulated  hernia,  i,  166. 
"      "  urethritis,  i,  168. 
"      "  uterine  disorders  in  nursing  women, 
i,  166. 
hot,  in  variola,  i,  166. 
"     "  vesical  spasm,  i,  166. 
"    foot,  in  amenorrhcea,  i,  170. 
"       "     "  cerebral  congestion,  i,  170. 
"       "     "  plantar  anaesthesia,  i,  170. 
"       "     "  rheumatic  arthritis,  i,  170. 
"       "    "  sprains,  i,  170. 
"       "    "  tarsalgia,  i,  170. 
"    hip,  for  the  stimulation  of  the  menstrual 
flow,  i,  375. 
''^    mustard,  in  cholera  infantum,  i,  490. 

sitz,  in  acute  inflammation  of  the  pelvic 
organs,  i,  169. 
"    sitz,  in  acute  parametritis,  i,  489. 
"       "     "  amenorrhcea,  i,  169. 
"       "    "  anal  pruritus,  i,  169. 
"       "     "  dysmenorrhcea,  i,  169. 
''       "     "  hiemorrhoids,  i,  169. 
"       "     "  lochial  suppression,  i,  169. 

"    "  nervous  aid  circulatory  erethism 
of  the  pelvic  organs,  i,  169. 
"    sitz,  in  neuralgia  of  the  bladder,  i,  169. 
"       "     "  oophoritis,  i,  169. 
"       "    "  perimetritis,  i,  489. 
"       "     "  rectal  prolapse,  i,  169. 
"       "     "  retention  of  urine,  i,  169. 
"       "     "  spasmodic  conditions  of  the  blad- 
der and  urethra,  i,  169. 
"    sitz,  in  strangulated  hernia,  i,  489. 

"    "  subacute    inflammation    of   the 
pelvic  organs,  i,  169. 
iodated,  in  scrofula,  i,  172. 

"        "  squamous  skin  diseases,  i,  173. 
".       "  syphilis,  i,  173. 
leg,  1,  171. 
medicated,  i,  171. 

mercurial,  in  treatment  of  syphilides,  i,  173. 
moor.    See  Mud  BATHS, 
mud,  in  debility,  i,  172. 
"      "  neuralgia,  i,  172. 

"  rheumatic  conditions,  i,  173. 


GENERAL  INDEX. 


471 


Baths,  mud,  in  syphilis,  i,  172. 
mustard,  in  cholera,  i,  173. 

"         "  congestion  of  the  abdominal  vis- 
cera, i,  172. 
narcotic,  in  acute  inflammation  of  the  genito- 
urinary.organs,  i,  172. 
narcotic,  in  enteritis,  i,  172. 

"        "  external  hEemorrhoids,  i,  172. 
"        "  peritonitis,  i,  172. 
Nauheim,  ii,  419. 

"         in  angina  pectoris,  ii,  424. 
"         "  diseases  of    the   heart  (Schott 
treatment),  ii,  419. 
Nauheim,  in  endocarditis  after  rheumatism, 

ii,  428. 
Nauheim,  in  gout,  ii,  420. 

"         "  locomotor  ataxia,  ii,  420. 
"         "  rheumatism,  ii,  420. 
"         "  rickets,  ii,  420. 
"         "  scrofulous  diseases,  ii,  420. 
"         "  mitral  insuflSeieney,  ii,  423. 
"         "  valvular  disease,  ii,  423. 
"         "  weak  heart,  ii,  424. 
pine,  in  gout,  i,  172. 
"      "  paralysis,  i,  172. 
"      "  rheumatism,  i,  172. 
"      "  scrofula,  i,  172. 
"      "  skin  diseases,  i,  172. 
reducing,  i,  170. 

"        in  typhoid  fever,  i,  170. 
Roman,  i,  162. 
saline,  i,  172. 
sand,  in  chronic  rheumatism,  i,  172. 

"      "  paralysis,  i,  172. 
sea,  in  conditions  of  malassimilation,  i,  172. 
"      "  functional  nervous  disorders,  i,  172. 
"      "  scrofulous  diathesis,  i,  172. 
sedative,  in  hysteria,  i,  173. 

"         "  neurasthenia,  i,  178. 
sheet,  i,  169. 
"     in  anffimia,  i,  169,  490. 
"      "  chronic  nervous  diseases,  i,  490. 
"      "  fever,  i,  169,  490. 
"      "  metabolic  disturbances,  i,  490. 
"      "  neurasthenia,  i,  169,  490. 
"      "  nutritional  disorders,  i,  169. 
sitz,  i,  169. 

slime.    See  Mud  baths. 
sponge,  in  fever,  i,  491. 
stimulating,  i,  173. 
sulphurous,  i,  173. 

"         in  anaemia,  i,  178. 
,      "  "  catarrh,  i,  173. 

"  "  chlorosis,  i,  173. 

"  "  lead  palsy,  i,  173. 

"  "  scabies,  i,  173. 

"  "  scrofulous  diseases,  i,  173. 

"  "  treatment  of  syphilides,  i,  173. 

table  of  temperature  for,  i,  165. 
temperature  of,  i.  166. 
tepid,  in  bronchitis,  i,  489. 

"       "  multiple    sclerosis    of    the    spinal 
cord,  i,  489. 
tepid,  in  progressive  general  paralysis  of  the 

insane,  i,  489. 
Turkish,  i,  171. 
vapour,  i,  170. 

"      in  insomnia,  i,  171. 

"       "  nervous  irritability,  i,  171. 

"      "  trophic  cutaneous  diseases,  i,  171. 


Baths,  warm,  and  massage  in  paralysis  agitans 
and  paralysis  of  the  extremities,  i,  489. 
warm,  in  acute  neuritis,  i,  489. 
"      "  cardiac  disease,  i,  489. 
"       "  cerebral  hypersemia,  i,  489. 
"       "  chronic  myelitis,  i,  489. 
"      "  diseases  of  the  liver,  i,  489. 
"      "  pyelitis,  i,  489. 
"       "  suppression  of  urine,  i,  489. 
Bebeerine,  Beberine,  i,  173. 
Beef  juice,  i,  333. 
"    preparations.   See  under  Dietetic  treat- 
ment. 
"     tea,  i,  333. 
Bela  fruit,  i,  173. 

in  diarrhoea  and  dysentery,  i,  173. 
Belladonna,  i,  173 ;  ii,  425. 
and  alum  in  whooping-coug;h,  i,  174. 
"     morphine  in  inflamed  muscles  (by  in- 
jection), i,  67. 
and  morphine  in  inflamed  nerves  (by  injec- 
tion), i,  67. 
and  morphine  in  hepatic  colic,  i,  67. 
"  "         "  lead  colic,  i,  67. 

"  "         "  renal  colic,  i,  67. 

"  "         "  spasmodic   dysmenorrhoea, 

i,  67. 
applications  in  lymphatic  glandular  swell- 
ings, i,  174. 
applications  in  sprained  or  inflamed  joints, 

i,  174. 
as  an  anthidrotic,  i,  102. 
in  anal  spasm,  i,  133. 
"  cancer  of  the  rectum,  i,  175. 
"  epidemic    cerebro-spinal    meningitis    of 

children,  i,  175. 
"  hereditary  inclination  to  the  formation  of 

blebs,  ii.  435. 
(ointment)  in  inflammation  of  the  mammary 

glands,  i,  173. 
in  myelitis,  i,  175. 
"  neuralgia,  i,  69, 174. 
"  nocturnal  incontinence  of  urine,  i,  175. 
"  pemphigus,  ii,  425. 
"  spasmodic  asthma,  i,  174. 
"  "         contraction  of  the  rectum  (by 

the  mouth  or  in  a  suppository),  i,  175. 
"  spasmodic  coughs,  i,  175. 
(internally)  in  spasm  of  muscular  fibres  of 

the  intestines,  i,  68. 
in  spasm  of  the  urethra,  i,  133. 
"  tetanus,  i,  175. 

"  vesical  spasm,  in  a  suppository  or  in- 
ternally, i,  133. 
"  vomiting,  i,  99. 
"  whooping-cough,  i,  174. 
(ointment)   in  rigidity  of   the   os  uteri,  i, 
174. 
Benzanalgene,  i,  176. 
Benzanilide,  i,  176. 
Benzene,  i,  176. 

in  chronic  bronchitis,  i,  176. 
"  diphtheria,  i,  176. 
"  eczema,  i,  176. 
"  scabies,  i,  176. 
"  winter  cough,  i,  176. 
Benzeugenol,  i,  176. 

as  an  internal  antiseptic,  i,  176. 
Benzoic  acid  and  the  benzoates,  i.  176. 
as  an  intestinal  antiseptic,  i,  133. 


il-Z 


GENERAL  INDEX. 


Benzoic  acid  in  acute  septic  diseases,  i,  178. 
and  the  benzoates,  in  articular  rheumatism, 

i,  177. 
in  chronic  bronchitis,  i,  177. 
"  cystitis,  i,  177. 
"  diphtheria,  i,  178. 
"  erysipelas,  i,  178. 
"  gonorrhcea,  i,  177. 
"  infectious  diseases,  i,  178. 
"  lithfcmia,  i,  177. 
"  puerperal  fever,  i,  178. 
"  scarlktiua,  i,  178. 
"  septiciemia,  i,  178. 
"  whooping-cough,  i,  178. 
Benzoin,  i,  178. 
as  an  intestinal  antiseptic,  i,  159. 
compound  tincture  of  (externally),  in  abra- 
sions,   bedsores,   leech    bites,   and    small 
wounds,  i,  178. 
compound  tincture  of  (externally),  in  chapped 

and  fissured  hands  and  lips,  i,  178. 
compound  tincture  of  (externally),  in  chil- 
blains, i,  178. 
compound  tincture  of  (externally),  in  excori- 
ated and  fissured  nipples,  i,  178. 
compound  tincture  of  (externally),  in  eczema 

(as  an  anticnesmatie),  i,  179. 
compound  tincture  of  (externally),  in  frost- 
bite (as  an  anticnesmatie),  i,  179. 
compound  tincture  of  (externally),  in  granu- 
lating wounds,  i,  179. 
compound  tincture  of  (externally),  in  urti- 
caria (as  an  anticnesmatie),  i,  179. 
(by  inhalation)  in  acute  laryngitis,  i,  178. 
"  "  "  chronic  bronchitis,  i,  178. 

"  "  "  chronic  laryngitis,  i,  178. 

"  "  "  laryngeal  affections,  i,  178. 

Benzol.    See  Benzene. 
Benzonaphthol,  i,  179;  ii,  436. 
as  an  intestinal  antiseptic,  i,  179. 
in  dysentery,  ii,  426. 
Benzoparacresol,  i,  179. 
Benzophenoneid,  i,  179. 
in  phlyetjenular  ophthalmia,  i,  179. 
"  purulent  keratitis,  i,  179. 
"  ulcers  of  the  cornea,  i,  179. 
Benzophenoneide.     See  Aptonine. 
Benzosol,  i,  179. 
in  diabetes,  i,  179. 
"  intestinal  diseases,  i,  179. 
"  pulmonary  tuberculosis,  i,  179. 
Benzoylaconine.     See  Aconitine. 
Benzoylanilide.     See  Benzanilide. 
Benzoyl-beta-naphthol.    See  Benzonaphthol. 
Benzoylguaiacol.    See  Benzosol. 
Berberine,  i,  179. 

Betanaphthol.     See  under  Naphthol. 
Betanaphthol    salicylate    in    acute    articular 
rheumatism,  ii,  145. 
in  cystitis  with  animoniacal  fermentation, 
ii,  145. 
Betnl,  i,  179. 
in  articular  rheumatism,  i,  179. 
"  cystitis,  i,  179. 
"  fermentative  diarrhcsa,  i,  179. 
"  infectious  diarrhoea,  i,  179. 
Birch  tar.    See  under  Tar. 
Bismuth,  i,  179. 
and  carbolic  acid  in  vomiting  of  pregnancy, 
i,  180. 


Bismuth  and  cerium   oxalate  in  vomiting  of 
pregnancy,  i,  180. 
and  pepsin  in  typhoid  fever,  i,  181. 
benzoate,  i,  178. 

"         in  sluggish  ulceration,  i,  178. 
"  "  specific  sores,  i,  178. 

"  "  unhealthy  ulcerations,  i,  178. 

citrate,  i,  180. 

effects  of,  on  the  blood,  i,  180. 
in  acute  diarrhrea,  i,  180. 
"     "     indigestion,  i,  80. 
"  coeliao  disease  of  children,  i,  181. 
"  carcinoma,  i,  180. 
"  diarrhcEa  of  phthisis,  i,  181. 
"  gastric  pains,  i,  180. 
"       "       ulcer,  i,  180. 
"  summer  diarrhoea  of  infants,  i,  180. 
oleate,  i,  181. 

phosphate  in  cholera  infantum,  ii,  426. 
salicylate  as  an  antiseptic  dressing  for  ulcers, 

i,  182. 
salicylate  as  an  antiseptic  dressing  in  epi- 
thelioma, i,  182. 
salicylate  as  an  antiseptic  dressing  in  indo- 
lent sores,  i,  182. 
salicylate  in  cholera  infantum,  ii,  145. 

"         "  chronic    intestinal    catarrh,   ii, 
145. 
salicylate  in  gastro-intestinal  diseases,  i,  180. 
subbenzoate,  i,  181. 
subcarbonate,  i,  179. 
subgallate.     See  Deematol. 
subiodide,  i,  181. 
subnitrate,  i,  179. 

"  as  a  dusting  powder,  i,  181. 

"  "    snuff  in  acute  nasal  catarrh, 

i,  181. 
subnitrate  in   fissures  and  erosions  of  the 

rectum,  i,  181. 
subnitrate,  injections  of,  in  dysentery,  i,  181. 
"  "  "    "  urethritis,  i,  181. 

"  in  rectal  irritation,  i,  181. 

"  "  tenesmus,  i,  181. 

"  "  vomiting,  i,  180. 

"  "  "        due  to  gastric  irritr 

tion,  i,  99. 
tannate  in  diarrhoea,  ii,  259. 
"        "  gonorrhcea,  ii,  259. 
"        "  leucorrhoja,  ii,  259. 
"        "  purulent  inflammations  of   the 
conjunctiva,  ii,  259. 
Bistort,  i,  182. 
Bitters,  i,  182. 
action  of,  i,  183. 
aromatic,  i,  182. 

and  simple,  in  malaria,  i,  118. 
astringent,  i,  182. 
contra-indications  for  the  employment  of,  i, 

183. 
in  atonic  dyspepsia,  i,  183. 
"  cachexia,  i,  183. 

"  convalescence  from  acute  disease,  i,  183. 
"  debility,  i,  183. 

"  diarrhoea  (without  inflammation),  i,  183. 
"  digestive  atony,  i,  183. 
injections  of,  for  thread-worms,  i,  183. 
in  malarial  diseases,  i,  183. 
"  malnutrition,  i,  183. 
"  marasmus,  i,  183. 
"  morning  vomiting  of  drunkards,  i,  183. 


GENERAL  INDEX. 


473 


Bitters,  in  obstinate  vomiting,  i,  183. 
in  ttEnia,  i,  101. 

"  vomiting  of  drunkards,  i,  100. 
"  "  pregnancy,  i,  183. 

""  "  seasickness,  i,  183. 

simple,  i,  183. 
Blackberry.     See  RuBUS. 
Black  draught,  i,  183. 
Black  drop,  i,  184. 

Black  wash,  in  venereal  ulceration,  i,  635. 
Blancoline,  ii,  436. 
Blatta,  i,  184. 
decoction  of,  for  infantile  intestinal  disor- 
ders, i,  184. 
in  cirrhosis  of  the  liver,  i,  184. 
"  dropsy  due  to  Bright's  disease,  i,  184. 
"  heart  disease,  i,  184. 
Bleeding.    See  Bloodletting. 
Blennostasine,  ii,  436. 
in  acute  influenza,  ii,  436. 
"  bronchorrhoea,  ii,  436. 
"  hay  fever,  ii,  426. 
"  intermittent  rhinorrhcea,  ii,  436. 
"  laryngorrhcea,  ii,  426. 
"  rhinitis,  ii,  426. 
Blisters,  i,  184. 
application  of,  i,  185. 
flying,  i,  185. 

In  acute  articular  rheumatism,  i,  186. 
"      "      pleurisy,  i,  186. 
"      "      rheumatism,  i,  186. 
"  cerebral  meningitis,  i,  185. 
"  chronic  rheumatism,  i,  186. 
"  colic,  i,  186. 
"  collapse  and  coma,  i,  186. 
"  epilepsy,  i,  185. 
"  gastric  ulcer,  i,  186. 
"  heai' 

185. 

"  herpes  zoster,  i,  186. 
"  hysterical  paralysis,  i,  185. 
"  inflammation  of  the  mastoid  cells,  i,  185. 
"  intercostal  neuralgia,  i,  186. 
"  iritis,  i,  185. 
"  meningitis,  i,  185. 
"  motor  paralysis,  i,  185. 
"  neuralgia,  i,  184. 
"  oophoritis,  i,  185. 
"  otitis  media,  i,  185. 
"  peritonitis,  i,  185. 
"  persistent  nausea,  1, 186. 
"  pneumonia,  i,  186. 
"  sciatica,  i,  186. 
"  sensory  paralysis,  i,  185. 
"  spinal  meningitis,  i,  185. 
"  trigeminal  neuralgia,  i,  186. 
"  typhlitis,  i,  185. 
Blood,  i,  186. 
cooked,  i,  186. 

in  pernicious  anaemia,  i,  186. 
'•  pulmonary  phthisis,  i,  186. 
"  simple  anaemia,  i,  186. 
"  wasting  diseases,  i,  186. 
serum,  for  alimentation  by  the  rectum,  i, 
186. 
Bloodletting,  i,  187. 
general,  1,  187. 

in  acute  cerebral  congestion,  i,  188. 
"  bronchial  hsemorrhage  of  the  plethoric,  i, 
■    188. 


Bloodletting,  in  cerebral  apoplexy,  i,  189. 

in  cerebral  congestion,  i,  188. 

"  circulatory  excitement,  i,  187. 

"  convulsions  of  adults,  i,  188. 

"  insolation,  i,  188. 

"  ineningitis,  i,  188. 

"  peritonitis,  i,  188. 

"  pleurisy,  i,  188. 

"  pneumonia,  i,  188. 

"  poisoning  by  illuminating  gas,  i,  188. 

"  puerperal  convulsions,  i,  188. 

"  pulmonary  gangrene,  i,  188. 

"  pulmonary  haamorrhage  of  the  plethoric, 
i,  188. 

"  venous  engorgement,  i,  187. 

"        "       stasis,  i,  188. 

manner  of  performing  the  operation  of,  i, 
187. 
Boldine,  i,  189. 
Boldo,  i,  189. 
in  biliary  lithiasis,  i,  189. 

"  gonorrhcea,  i,  189. 
Boldoglucin,  i,  189. 
Boletus.    See  Agaric. 
Bonduc,  i,  189. 

in  malarial  disease,  i,  189. 
Bondncin,  i,  189. 
Bone  marrow.     See  Marrow. 
Boracic  acid.    See  Boric  acid. 
Borax,  i,  189. 

and  honey,  in  laryngitis,  i,  189. 

as  a  douche  for  leucorrhoeal  discharges,  i, 

glycerine  of,  i,  190. 

in  abrasions  oJE  mucous  surfaces,  i,  189. 

(in  solution)  in  conjunctivitis,  i,  189. 

"  cutaneous  disorders,  for  removal  of  scabs, 
i,  189. 

"  epilepsy,  i,  189. 

"  fissures  of  the  nipples,  i,  189. 

"  superficial  burns,  i,  189. 

"  ulcerative  stomatitis,  i,  189. 

"  uterine  haemorrhage,  i,  189. 

"  uric-acid  lithiasis,  i,  189. 
ointment  in  chilblains,  i,  189. 
with  honey  and    myrrh,  in    treatment   of 
spongy  gums,  i,  189. 
Boric  acid,  i,  190. 
as  a  gastric  antiseptic,  i,  133. 
(in  solution)  as  a  spray  in  coryza  of   hay 

fever,  i,  191. 
(in  solution)  as  a  spray  in  nasal  catarrh,  i, 

191. 
(in  solution)  as  a  spray  in  ozsena,  i,  191. 
(in   solution)  as  a  spray  in  pharyngitis,  i, 

191. 
for  irrigating  the  peritoniEum  after  laparot- 
omy, i,  190. 
in  ammoniacal  cystitis,  i,  190. 
"        "       decomposition  of  the  urine,  i,  190. 
"  conjunctivitis  (as  a  wash),  i,  191. 
"  contagious  ophthalmia,  i,  191. 
"  diarrhoea,  i,  190. 
"  flatulence,  i,  190. 
"  foetor  of  the  feet,  i,  191. 

"  granular  lids,  i,  190. 

"  inflammation  of  the  vagina,  i,  190. 

"  otorrhoea,  i,  190. 

"  powder,  for  bromidrosis,  i,  103. 

"  pulmonary  tuberculosis,  i,  191. 


474 


GENERAL  INDEX. 


Boric  acid  (in  solution)  in  pruritus,  i,  191. 

(in  solution)  in  tinea,  i,  191. 

in  treatment  of  ulcers,  i,  190. 

"  "         of  wounds,  i,  190. 

"  unhealthy  suppurating  surfaces,  i,  191. 

(in  solution)  in  urticaria,  i,  191. 
Borobenzoate,  ii,  204. 
Boro-borax,  i,  191. 
Boroglyceride,  i,  191. 
Borolyptol,  ii,  426. 
Boudin's  solution,  i,  146. 
Bougies.     See  under  Pencils. 
Boulton's  solution,  i,  310. 
Boussingaulthia  baselloides,  i,  191. 

in  uterine  haemorrhage  after  parturition,  i, 
191. 
Brain  and  spinal  cord  substance  in  epilepsy, 
i,  80. 

"      extract  in  neurasthenia,  i,  80. 

"  "      "    paralysis,  bulbar,  i,  80. 

"  "      '•    tabes  dorsalis,  i,  80. 

Bran,  i,  191. 

in  eczema,  i,  191. 
Brandy.    See  under  Alcohol. 
Brayera.     See  Cusso. 
Bread  and  milk  in  preparatory  treatment  of 

taenia,  i,  101,  102. 
Brein,  i,  197. 

Bromacetanilide.     See  Antisepsin. 
Bromal,  i,  191. 

hydrate,  i,  191. 

"        in  chorea,  i,  191. 
"         "  convulsive  diseases,  i,  191. 
"         "  epilepsy,  i,  191. 
"         "  lightning    pains     of    locomotor 
ataxia,  i,  191. 
Bromal  hydrate  in  neuralgia,  i,  191. 
Bromalin,  i,  191. 

in  epilepsy,  i,  191. 
Bromalum.    See  Bromal. 
Bromalura  hydratum,  i,  191. 
Bromamide,  i,  191. 

in  acute  articular  rheumatism,  i,  192. 

"      "      fibrinous  pneumonia,  i,  193. 

"  cardiac  dropsy,  i,  192. 

"  chronic  nephritis,  i,  193. 

"        "       rheumatic  arthritis,  i,  193. 

"  hepatic  dropsy,  i,  192. 

"  neuralgia,  i,  193. 

"  renal  dropsy,  i.  193. 

"  typhoid  fever,  i,  193. 
Bromated  hsemol,  ii,  486. 
Bromethyl.     See  Ethyl  bromide. 
Bromethylformin.    See  Bromalin. 
Bromhaemol,  ii,  426. 
Bromides,  i,  192. 

administration  and  dose  of,  i,  195. 

and  potassium  iodide  in  neuralgia  due  to 
lead,  i,  69. 

as  hypnotics,  i,  507. 

bromism  from,  i,  193. 

comparison  of  the  effects  of  the  different,  i, 
193. 

effects  of,   on    nutrition  and  temperature, 
i,  193. 

effects  of,  on  the  heart  and  circulation,  i, 
192. 

effects  of,  on  the  mental  faculties,  i,  193. 

effects  of,  on  the  motor  regions  of  the  brain 
and  spinal  cord  and  the  motor  nerves,  i,  193. 


Bromides,  effects  of,  on  the  muscular  system, 
i,  193. 

effects  of,  on  the  sensory  nerves,  i,  193. 
"       "     "     "    sexual  functions,  i,  193. 
"       "    "    "    vaso-motor  nerves,  i,  193. 

elimination  of,  i,  193. 

eruption  from,  i,  193. 

in  asthmatic  paroxysms,  i,  94,  95. 

"  cerebral  overwork,  ii,  6. 

"  cholera  infantum,  i,  194. 

"  congestive  neuralgia,  i,  69. 

"  delirium  tremens,  i,  194. 

influence    of,  on    the    alimentary  tract,  i, 
193. 

in  insomnia,  i,  507. 

"  maniacal  excitement,  i,  194. 

"  melancholic  frenzy,  i,  194 

"  menorrhagia  of  nervous  origin,  i,  194. 

"  migraine,  i,  194. 

"  nervous  excitement,  i,  194. 

"       "  "  of  the  heart,  i,  194. 

"       "        irritability,  i,  194. 

"  nervousness  from  irritation  of  the  sexual 
organs,  ii,  6. 

"  numbness,  i,  194. 

"  ovarian  pains,  i,  194. 

"  painful  flushings,  1,  194. 

"  prolonged  mental  strain,  ii,  6. 

"  seasickness,  i,  99. 

"  shooting  pains  (of  the  plethoric),  i,  194. 

"  spasm  due  to  cerebral  irritation,  i,  133. 

"      "       of  the  larynx,  i,  133. 

"  spasmodic  reflex  neuroses,  i,  194. 

"  tetanus,  i,  194. 

"  uterine  disorders,  i,  194. 

"  vomiting  due  to  cerebral  disease,  i,  99. 

"  vomiting  of  pregnancy,  i,  194. 

reflex  action  of,  i,  193. 

therapeutic  use  of,  i,  193. 
Bromidia,  i,  195. 
Bromine,  i,  195. 

as  a  germicide,  i,  445. 

in  cancer  of  the  uterus,  i,  195. 

"  erysipelas,  i,  445. 

"  parasitic  cutaneous  diseases,  i,  445. 

(locally)  in  hospital  gangrene,  i,  445. 

(locally)  in  putrid  sores,  i,  445. 

treatment  of  poisoning  by,  i,  109,  196. 

vapour  in  nasal  catarrh,  i,  196. 
Bromoform,  i,  196. 

dose  and  administration,  i,  196. 

in  asthma,  i,  196. 

"  laryngismus  stridulus,  i,  196. 

"  singultus,  i,  196. 

"  vertigo  from  reflex  causes,  i,  196. 

"  whooping-cough,  i,  196. 
Bromol,  i,  196. 

as  an   antiseptic  to   wounds  and  ulcers  in 
diphtheria,  i,  196. 

in  cholera  infantum,  i,  197. 

"  pulmonary  abscess,  i,  197. 

"  tapeworm,  i,  197. 

"  typhoid  fever,  i,  197. 
Bromum.  See  Bromine. 
Broth,  egg,  i.  356. 

mutton,  i,  333. 
Brousnika,  i,  197. 
Brucine,  i,  197 ;  ii,  26. 

in  chronic  pruritus,  ii,  29. 

"  inflammation  of  the  external  ear,  ii,  39. 


GENERAL  INDEX. 


475 


Bryonia,  i,  197. 

as  a  haemostatio  in  haemoptysis,  i,  197. 

in  haematoma,  i,  197. 

"  inflammation,  i,  197. 

"  "  of  the  serous  membranes, 

1,  197. 

"  post-partum  haemorrhage,  i,  197. 

"  rheumatism,  i,  197. 

"  whooping-cough,  i,  197. 
Bryonine,  i,  197. 
Buchu,  i,  197. 

in  chronic  and  subacute  catarrh  of  the  uri- 
nary mucous  membranes,  i,  197. 

"  chronic  vesical  irritation,  i,  197. 

"  dropsy,  i,  197. 

"  cystitis,  i,  197. 

"  pyelitis,  i,  197. 

"  urethritis,  i,  197. 
Buckthorn.     See  Rhamnus. 
Buena.     See  Oascarilla. 
Burdooli.    See  Lappa. 
Buttermilk  cure  for  gastric  disorders,  i,  333. 

lor  nephritis,  i,  338. 
Butternut.     See  Juglans. 
Butyl-chloral  hydrate,  i,  197. 

in  cough,  i,  197. 

"  dysmenorrhoea,  i,  197. 

"  facial  neuralgia,  i,  197. 

"  sciatica,  i,  197. 

"  trigeminal  neuralgia,  i,  69. 
Buxine,  i,  197. 

Caoao-butter,  i,  198. 

(by  inunction)  in  fever,  i,  198. 

rectal  medication  with,  i,  198. 

suppositories  of,  for  pelvic  pain,  i,  198. 
Cactine,  i,  199. 
Cactus    grandiilorus.     See    Cereus    grandi- 

FLORUS,  i,  199. 
Cadmium,  i,  199. 

bromide,  i,  199. 

"         in  epilepsy,  i,  199. 
Cadmium  poisoning,  i,  199. 
Cadmium  salicylate  in  gonorrhoea,  i,  200. 

in  keratitis,  i,  200. 

"  purulent  ophthalmia,  i,  200. 
Cadmium  sulphate  in  acute  ophthalmia,  i,  300. 

in  blennorrhoea,  i,  200. 

"  gleet,  i,  200. 

"  otorrhoea,  i,  200. 

"  ulcer  of  the  cornea,  i,  200. 
CsBsalpinia.    See  Bonduc. 
Cafeeine,  i,  200. 

and  antipyrine  in  migraine,  i,  201. 
"  "  "  nervous  headache,  i,  201. 

Caffeine  citrate,  i,  200. 

effervescent  citrated,  i,  200. 

in  chronic  nephritis,  i,  201. 

"  dropsy,  i,  201. 

"  headache,  i,  201. 

"  migraine,  i,  201. 

"  neuralgia,  i,  201. 

"  opium  poisoning  (as  a  stimulant  to  nerve 
activity),  i,  201. 

"  organic  disease  of  the  heart,  i,  201. 

"  spasmodic  asthma,  i,  201. 

physiological  action  of,  i,  200. 

poisoning  from,  i,  200. 
Cahinca,  i,  201. 
Cahinic  acid,  i,  201. 
74 


Cainca,  i,  201. 
Cajeput,  Cajuput,  i,  201. 

as  an  expectorant,  ii,  436. 

in  colic,  i,  301. 

"  cough,  ii,  426. 

"  dysmenorrhoea,  i,  201. 

"  dyspnoea,  ii,  426. 

"  neuralgia,  i,  301. 

"  pneumonia,  ii,  436. 

"  rheumatism,  i,  201. 
Calabar  bean.    See  Physostigma. 
Calamine,  i,  201. 
Calamus,  i,  201. 

in  atonic  dyspepsia,  i,  301. 

"  flatulence,  i,  301. 

"  flatulent  colic,  i,  201. 
Caloaria  chlorata,  i,  201, 

usta,  i,  201. 
Calcium,  i,  201. 

bromide  in  hysteria,  i,  203. 
"       "  insomnia,  i,  201. 
"       (as  a  sedative)  in  typhoid  fever,  i,  303. 

carbide,  ii,  426. 

in  cancer  of  the  breast,  ii,  437. 
"       "    "   uterus,  ii,  426. 

"  epithelioma  of  the  uterus,  ii,  437. 

"  fibroma,  ii',  437. 

"  foetid  odours,  ii,  437. 

"  metritis,  ii,  437. 

"  pain,  ii,  427. 

"  rebellious  hsemorrhages,  ii,  427. 

carbonate.     See  Chalk. 

chloride,  ii,  427. 

as  a  haemostatic  in  epistaxis  and  puerperal 
haemorrhage,  ii,  438. 

in  acne,  i,  202. 

"  acute  lobar  pneumonia,  i,  203. 

"  indurated  glands,  i,  202. 

"  furuncles,  i,  203. 

"  lupus,  i,  202. 

"  ovarian  and  uterine  tumours,  i,  202. 

"  rickets,  i,  303. 

"  strumous  cutaneous  affections,  i,  303. 

"  suppuration,  i,  202. 

"  tabes  mesenterica,  i,  203. 

"  tuberculous  deposits,  i,  202. 

glycerinophosphate,  i,  303. 

hydrate,  i,  303. 

hypophosphite,  i,  203, 

hyposulphite,  i,  302. 

iodide,  i,  203. 

oxide  as  a  germicide,  i,  447. 

phosphate,  i,  303. 

in  chronic  phthisis,  ii,  78. 

"  conditions  where  there  is  a  deficiency  of 
lime  and  phosphorus,  i,  202. 

"  debility  of  young  children,  ii,  78. 

"  dental  caries,  i,  302. 

"  fractures,  i,  302. 

"  mollities  ossium,  i,  303. 

"  rickets,  ii,  78. 

"  scrofulous  ulcerations,  i,  202. 

"  sinuses,  i,  202. 

"  syphilis,  ii,  78. 

"  tuberculous  tracts,  i,  202. 

salicylate  in  chancres,  ii,  145. 

'"'         "  diarrhoea  of  children,  ii,  145. 

in  syphilitic  ulcers,  ii,  145. 

sulphate.    See  Plaster  of  Paris, 

sulphide,  i,  303, 


476 


GENERAL  INDEX. 


Calcium  sulphide,  as  a  depilatory,  i,  303. 
baths  in  lead  poisoning,  i,  203. 

"      "  rheumatoid  arthritis,  i,  203. 
in  abscesses,  i,  203. 
"  acne,  i,  203. 
"  carbuncles,  i,  203. 
"  furuncles,  i,  203. 
'■  glandular  enlargements,  i,  308. 
"  prevention  of  influenza,  ii,  428. 
"  suppurative  cutaneous  disorders,  i,  303. 
Calendula,  i,  303. 

tincture  of,  in  bruises  and  sprains,  i,  303. 
Calisaya.     See  under  Cinchona. 
Calolactose,  i,  303. 
Calomel.     See  under  Mercury. 

(fractional  doses)  as  a  diuretic,  i,  624. 

as  an  antemetic,  i,  624. 

"    "  anthelminthio,  i,  634. 

compound  pills  of,  in  cutaneous  disorders,  i, 

114. 
compound  pills  of,  in  rheumatism,  i,  114. 
fumigation  in  laryngeal  diphtheria,  i,  530. 
"  "  croup  and  diphtheria,  i,  625. 

"  syphilis,  i,  624. 
in  Ascaris  vermicularis,  i,  102. 
•'  biliousness,  i,  624. 
"  cholera,  i,  634. 
"  constitutional  syphilis,  i,  634. 
(by  insufflation)  in  corneal  opacities,  i,  556. 
in  dysentery,  i,  634. 

"  functional  disturbances  of  the  liver,  i,  624. 
"  infantile  diarrhoea,  i,  624. 
"  jaundice,  i,  624. 
"  malarial  fever,  i,  634. 
(by  insufflation)  in  phlyctaenular  conjuncti- 
vitis, i,  556. 
in  pneumonia,  i,  634. 
"  venous  engorgement,  i,  345. 
"  vomiting  of  nervous  origin,  in  small  doses, 

i,  99. 
"  weak  cardiac  action,  i,  345. 
"  yellow  fever,  i,  624. 
ointment  in  eczema  of  the  chronic  type,  i, 

635. 
powder  as  a  dusting  powder  for  herpetic 

eruptions  and  venereal  ulceration,  i,  635. 
powder  (by  insufflation)  in  diphtheria,  i,  635. 
"         ■'  "  "   syphilitic  laryn- 

gitis, i,  635. 
Calotropis,  i,  203. 
in  dysentery,  i,  203. 
"  epilepsy,  i,  203. 
"  hectic  fever,  i,  203. 
"  intermittent  fever,  i,  203. 
"  leprosy,  i,  203. 
"  snake  bites,  i,  203. 
"  syphilis,  i,  203. 
Calumba,  Calumbae  radix,  i,  203. 
and  capsicum  in  vomiting  of  drunkards,  i, 

100. 
and  cinnamon  in  vomiting  of  drunkards,  i, 
100. 
.     and  ginger  in  vomiting  of  drunkards,  i,  100. 
Calx.    See  Lime. 
Cambogia.     See  Gamboge. 
Camomile.    See  Chamomile. 
Camphoid,  i,  303. 
Camphor,  i,  203. 
artificial,  ii,  335. 
as  a  sedative  in  dysmenorrhcea,  i,  305. 


Camphor,  by  hypodermic  injection,  as  a  stim- 
ulant in  aconite  poisoning,  i,  7. 

carbolate  in  small-pox,  ii,  73. 

cerate,  i,  205. 

elixir,  i,  206. 

for  sprains  and  enlarged  joints,  i,  204. 

in  adynamic  fever,  i,  205. 

"  angina  pectoris,  i,  305. 

"  atonic  ulcers,  i,  304. 

"  bronchitis,  i,  205. 

"  broncho-pneumonia,  i,  305. 

"  cholera,  i,  305. 

"  chorea,  i,  205. 

"  colic,  i,  205. 

"  coryza,  i,  204,  539. 

"  delirium  tremens,  i,  205. 

"  endometritis,  i,  204. 

"  erysipelas,  i,  204. 

"  fungous  ulcers,  i,  204. 

"  galactorrhcea,  i,  204. 

"  gastralgia,  i,  205. 

"  headaches,  ii,  6. 

"  hospital  gangrene,  i,  204 

"  hysterical  vomiting,  i,  205. 

"  idiopathic  gangrene,  i,  204. 

"  influenza,  i,  205. 

"  insanitv,  i,  205. 

(powdered)  in  intertrigo,  i,  304. 

in  low  fevers,  ii,  6. 

"  mastitis,  i,  204. 

"  migraine,  i,  205. 

"  myalgia,  i,  204. 

"  nervousness,  i,  205 ;  ii,  6. 

"  "  from  dysmenorrhcea,  ii,  6. 

"  pharyngo-laryngitis,  i,  205. 

"  pneumonia,  i,  205. 

"  restlessness,  i,  205. 

(as  an  ointment)  in  swellings  and  extravasa- 
tions from  bruises,  i,  304. 

in  toothache,  i,  204. 

"  uterine  endotrachelitis,  i,  304. 

monobromated,   in    nervous   excitement,   i, 
305. 

in  cholera  morbus,  i,  205. 

"  colic,  i,  205. 

powdered,  in  eczema,  i,  304. 

in  pruritus  ani,  i,  304. 

"  pruritus  pudendi,  i,  204. 

salioylated,  in  lupus,  i,  204. 

"  "  rodent  ulcer,  i,  204. 

sassafras,  in  neuralgia,  ii,  138. 

spirit  of,  applied  to  the  skin  for  bedsores,  i, 
204. 

in  boils,  i,  304. 

suppositories  in  rectal  spasm,  i,  304. 

"  "  urethral  spasm,  i,  304. 

"  "  vaginismus,  i,  304. 

"  "  vesical  spasm,  i,  304. 

Camphora.     See  Camphor. 
Camphorated  chalk,  i,  306. 

chloral  in  neuralgia,  i,  235. 

ether  in  cerebral  affections,  i,  204. 
"     "   peritonitis,  i,  304. 

oil  (hypodermically)  in  sudden  prostration, 
ii,  6. 

injections  in  fever  and  cough  of  tuberculosis, 
i,  205. 

salol,  ii,  150. 
vinegar,  i,  205. 
wine,  i,  305. 


GENERAL  INDEX. 


477 


Camphoric  acid.    See  under  Camphor,  i,  206. 

as  an  anthidrotic,  ii,  428. 

"    "  intestinal  antiseptic,  ii,  428. 

"  a  stimulant  (cardiac),  ii,  429. 

in  hyperidrosis  after  influenza,  ii,  428. 

"  phthisical  sweating,  i,  205 ;  ii,  428. 

"  typhoid  fever,  ii,  428. 

irrigations  in  cystitis,  i,  205. 
Canella.  i,  206. 

bark,  i,  206. 

in  congestive  dysmenorrhoea,  i,  206. 

"  convalescence,  i,  206. 

"  digestive  atony,  i,  206. 

"  flatulent  dyspepsia,  i,  206. 

"  menorrhagia,  i,  206. 

"  "  during  pregnancy,  i,  206. 

"  metrorrhagia  of  cancer,  i,206. 

"  "  of  chlorosis,  i,  206. 

"  persistent  bleeding  after  delivery,  i,  206. 
Cannabene  tannate,  ii,  259. 

as  a  hypnotic,  ii,  259. 
Cannabine,  i,  206. 
Cannabis  indica,  i,  206. 

as  a  hypnotic,  i,  507 ;  ii,  429. 

as  an  anodyne,  ii,  429. 

in  anorexia,  i,  207. 

"  constipation,  i,  207. 

"  dysmenorrhoea,  i,  307. 

"  hay  asthma,  i,  307. 

"  headache  in  the  neurasthenic,  i,  69. 

"  insomnia,  i,  207. 

"  nervous  headache,  i,  67. 

"  in  neuralgic  aflEections,  i,  207. 

"  ovarian  or  uterine  pain,  i,  67. 

"  pulmonary  affections,  ii,  429. 

"  sciatica,  i,  307. 

"  tetanus,  i,  207. 

"  tuberculous  disease  of  the  lungs,  ii,  429. 

physiological  effects  of,  i,  206. 

with  acetanilide,  in  neuralgia  hypodermic- 
ally,  i,  69. 
Cantharidates.    See  under  Cantharidic  acid. 
Cantharides,  i,  207. 

in  affections  of  the  bladder  and  urethra,  i, 
308. 

"  amenorrhoea.  i,  208. 

"  catarrhal  inflammations   of   the    genito- 
urinary tract,  i,  345. 

"  chronic  cystitis,  i,  208. 

"  in  chronic  desquamative  nephritis,  i,  308. 

"  diabetes  insipidus,  i,  308. 

"  dysuria,  i,  308. 

"  fissure  of  eczema,  i,  808. 

"  gleet,  i,  308. 

"  irritability  of  the  bladder  in  old  men,  i, 
308. 

"  irritability  of  the  bladder  in  women,  i, 
308. 

"  menorrhagia,  i,  308. 

"  prostatorrhoea,  i,  308. 

"  in  small  superficial  burns,  i,  308. 

"  spermatorrhcea,  i,  208. 

"  tuberculous  processes,  i,  308. 

poisoning  with,  1,  307. 
Cantharidic  acid,  i,  308. 

in  pulmonary  tuberculosis,  i,  208. 
Cantharidin,  i,  209. 
Cantharis.    See  Cantharides. 
Capraol,  i,  306. 
Capsicum,  i,  309. 


Capsicum  and  calumba  in  vomiting  of  drunk- 
ards, i,  100. 
and  gentian  in  vomiting  of  drunkards,  i,  100. 
"     serpentaria  in  vomiting  of   drunkards, 
i,  100. 
in  atonic  dyspepsia,  i,  209. 
"  chronic  affections  of  the  genito-urinary 

tract,  i,  209. 
"  collapse,  i,  209. 
"  delirium  tremens,  i,  309. 
"  diphtheria,  i,  309. 
'•  dipsomania,  i,  309. 
"  dyspepsia  of  hard  drinkers,  i,  209. 
"  flatulent  colic,  i,  309. 
"  haemorrhoids,  i,  809. 
"  intermittent  fever,  i,  809. 
"  seasickness,  i,  809. 
"  sore  throat  of  scarlet  fever,  i,  809. 
"  suppurating  surfaces,  i,  209. 
"  unhealthy  ulcers,  i,  209. 
plaster  for  painful  joints,  i,  209. 
"     in  chilblains,  i,  209. 
"      "  lumbago,  i,  809. 
"       "  neuralgia,  i,  809. 
Caraway.     See  Carum. 
Carbazotic  acid.    See  Picric  acid. 
Carbolate  of  camphor  in  sraall-pox,  ii,  73. 
Carbolic  acid,  i,  310. 
and  bismuth  in  cholera  infantum,  i,  812. 
in  cholera  morbus,  i,  212. 
"  diarrhcea,  i,  212. 
"  nausea  and  vomiting,  i,  218. 
and  tincture  of  iodine  in  malarial  cachexia, 

i,  212. 
as  a  caustic  for  the  destruction  of  morbid 

growths,  i,  213. 
as  a  gastric  sedative,  i,  99. 

"    germicide,  i,  448. 
(solution)  as  a  mouth-wash,  i,  441. 
(inhalation)  in  abscess  of  the  lung,  i,  213. 
(enema)  in  aScarides  vermicularis,  i,  102. 
in  chronic  inflammatory  processes,  i,  213. 
"  flatulent  dyspepsia,  i,  312. 
"  ganglion,  i,  813. 
"  gastric  fermentation,  i,  133. 
"  glands  which  threaten  suppuration,  i,  313. 
inhalation  for  gangrene  of  the  lung,  i,  813. 
"         in  chronic  bronchitis,  i,  313. 
"  "  phthisis,  i,  813. 

"  "  whooping-cough,  i,  213. 

in  hepatic  diabetes,  i,  212. 
injections  of  the  solution  of,  in  abscess,  fur- 
uncles, erysipelas,  lupus,  chancroid,   and 
buboes,  i,  213. 
injections  of  the  solution  of,  in  hasmorrhoids, 

i,  313. 
"  hydrocele,  i,  313. 
"  morbid  growths,  i,  313. 
"  na!vi,  i,  213. 
"  nasal  polypi,  i,  213. 
"  parasitic  skin  diseases,  i,  312. 
"  synovitis,  i,  213. 
"  tetanus,  i,  813. 
"  traumatic  tetanus,  ii,  439. 
"  treatment  of  pediculi,  i,  116. 
"  typhoid  fever,  i,  212. 
local  applications  of,  in  burns  and  scalds, 

i,  313. 
"  cutaneous  diseases,  i,  218. 
"  eczema,  i,  218. 


478 


GENERAL  INDEX. 


Carbolic  acid,  local  applications  of,  in  foul  ul- 
cers, i,  213. 

local  applications  of,  in  pseudo-membranous 
inflam  mations,  i,  313. 

"  skin  diseases,  i,  313. 

(as  a  spray)  solution  for  hay  asthma  and  nasal 
catarrh,  i,  213. 

(as  a  spray)  for  sore  throat,  i,  313. 

solution  for  stomatitis,  i,  313. 

1-per-cent.  solution,  in  toothache,  136. 

poisoning,  i,  311. 
Carbolized  gauze,  i,  310. 

oil,  i,  210. 
Carbon  and  its  gaseous  compounds,  i,  213. 

dioxide,  i,  213. 

in  pertussis,  i,  527. 

"  pulmonary  tuberculosis,  i,  527. 

(by  insuiHation)  in  pulmonary  tuberculosis, 
i,  583. 

in  spasmodic  asthma,  i,  527. 

monoxide,  i,  313. 
Carbonic-acid  gas  in  carbonated  waters,  as  an 
antemetic,  i,  98. 

in  acute  eoryza,  ii.  430. 

"  anosmia,  ii.  430. 

"  hypertrophic  rhinitis,  ii,  430. 

"  nasal  catarrh,  ii,  430. 

oxide,  i,  215. 

water,  i,  214. 

"     as  a  douche  in  uterine  troubles,  i,  314. 
Cardamom,  i,  215. 
Cardiac  sedatives,  i,  217. 

in  abnormally  forcible  action  of  the  heart,  i, 
316. 

stimulants  and  tonics,  i,  215. 
"  in  collapse,  i,  216. 

in    pericarditis,    peritonitis,    pleurisy,    and 
pneumonia,  i,  317. 

"  shock,  i,  216. 
Cardiac  tonics,  i.  317. 
Cardiiie,  i,  218. 

in  disease  of  the  heart,  i,  318. 
Cardol,  ii.  431. 

as  a  rubefacient  and  vesicant,  ii,  431. 
Carduus  benediotus.     See   Centaueea   bene- 

DICTA,  i,  217. 
Carica  papaya.     See  Papaw. 
Carminatives,  i,  318. 
Carniferrin,  ii,  431. 

as  a  nutrient  and  tonic,  ii,  431. 
Carpaine,  i,  318. 

in  aortic  stenosis,  i,  318. 

"  diseases  of  the  hearl,  i,  318. 

"  mitral  insufficiency,  i,  318. 
Carrageen.     See  CHONDnns. 
Carron  oil,  i,  219. 

as  a  dressing  to  the  face  in  small-pox,  i, 
582. 

in  burns  and  scalds,  i,  583. 

"  eczema,  i,  583. 
Carnm,  i,  318. 
Carvacrol,  i,  318. 

in  toothache,  i,  136. 
Caryophylli,  Caryophyllum,  Caryophyllus.    See 

Cloves. 
Cascara  amarga.     See  under  Rhamnus  pur- 

SHIANA. 

Cascara  sagrada.     See  Rhamxus  purshiana. 
Cascarilla,  i,  219. 
Cascarin.    See  Rhamnin. 


Cashew  nut,  i,  219. 

in  eczema,  i,  219. 

"  general  debility,  319. 

"  psoriasis,  i,  319. 
Cassia  acutifolia.  Cassia  aethiopica.  Cassia  alba, 
Cassia  angustifolia,  Cassia  elongata.     See 
Senna. 
Cassia  fistula,  i,  319. 
Cassia  lanceolata.  Cassia  marylandica,  Cassia 

obovata,  i,  319. 
Cassia  occidentalis,  i,  319. 

in  intermittent  fever,  i,  219. 

"  remittent  fever,  i,  219. 
Castanea,  i,  219. 

in  paroxysms  of  whooping-cough,  i,  819. 
Castoreum,  i.  219. 

in  hiccough,  i,  219. 

"  hysterical  manifestations,  i,  219. 

"  nervous  exhaustion,  i,  219. 

"  the  typhoid  state,  i,  319. 
Castor  oil,  i,  319. 

for  breaking  up  a  cold,  i,  320. 

in  cholera  infantum,  i,  230. 

"  constipation,  i,  330. 

"  diarrhoea,  i,  320. 

"  dysentery  of  a  mild  type,  i,  330. 

several  methods  of  taking,  i,  330. 
Cataphoresis.     See  under  Blectkioity,  and  cf. 
Coca  and  cocaine. 

in  local  pain,  i,  377. 
Cataplasms.    See  Poultices. 
Catechu,  i,  221. 

as  an  application  to  sore  and  chapped  nip- 
ples, i,  221. 

as  an  injection  in  gleet,  gonorrhoea,  and  leu- 
corrhoea,  i,  221. 

in  aphthas,  i,  231. 

"  gingivitis,  i,  221. 

"  haematemesis,  i,  221. 

"  hoarseness,  i,  331. 

"  ptyalism,  i,  331. 

"  relaxation  of  the  uvula,  i,  221. 

"  sore  throat,  i,  231. 

"  tickling  cough,  i,  221. 
Catgut,  dry  method  of  sterilization  of,  i,  139. 

wet  method  of  sterilization  of,  i,  129. 
Cathartics,  i.  321. 

drastic,  i,  333. 

hydragogue,  in  dropsical  effusions,  i,  334. 
"  "  inflammatory  effusions,  i,  334. 

in  pleurisy  with  effusion,  i,  234. 

"  acute  sthenic  inflammation,  i,  119. 

"  atonic  uterine  conditions,  i,  323. 

"  cerebral  congestion,  i,  224. 

"  relief  of  constipation,  i,  333. 

"      "      "  intestinal  colic,  i,  334. 

"  uraamia,  i,  324. 

saline,  in  vomiting,  i,  100. 
Cathartinic  acid,  i,  225. 

in  habitual  constipation,  i,  225. 
Catheretics,  i,  225. 
Catramine,  i,  226. 

in  lupus  and  tuberculosis,  i,  236. 
Caudle,"  i,  356. 
Caulophyllura,  i,  226. 
Caustics,  i,  226. 

arsenical,  in  lupus  vulgaris,  i,  144. 

in  contracting  cicatrices,  i,  826. 

"  internal  hfemorrhoids,  i,  237. 

"  non-malignant  growths,  i,  227. 


GENERAL  INDEX. 


479 


Caustics,  in  spinal  irritation,  i,  226. 

in  treatment  of  long-standing  neuralgias,  i, 
326. 

potential,  i,  227. 
Caviare,  i,  228. 
Cayaponine,  i,  228. 
C.  C.  cough  mixture,  ii,  432. 
Celandine.     See  Chblidonium. 
Celastrine.  i.  228. 
Celerv,  i,  338. 
Celluloid,  ii,  431. 

for  making  splints,  ii,  431. 
Centaurea  benedieta,  i,  328. 

in  intermittent  fever,  i,  229. 
Centaurium,  i,  239. 
Cephaelis.    See  Ipecacuanha. 
Cephalanthis,  Cephalanthus,  i,  229. 
Cera.    See  Wax. 
Cerasus.    See  Lauuocerasus. 
Cerates,  i,  339. 
Cerobrine,  i,  329. 
Cereus  grandiflorus,  i,  339. 

in  angina  pectoris,  i,  229. 

"  aortic  regurgitation,  i,  229. 

"  palpitation  of  the  heart,  i,  229. 

"  rheumatism,  i,  229.' 

"  sexual  exhaustion,  i,  239. 
Cerevisise  fermentum.    See  Yeast. 
Cerium,  i,  329. 

oxalate  in  chronic  diarrhoea,  i,  229. 

in  chorea,  i,  339. 

"  cough,  i,  329. 

"  diarrhoeal  conditions,  i,  339. 

"  epilepsy,  i,  229. 

"  gastralgia,  i,  339. 

"  vomiting  due  to  uterine  disease,  i,  329. 

"  "        of  pregnancy,  i,  339. 

Cerussa,  i,  330. 
Cetaoeum.    See  Spermaceti. 
Cetraria,  i,  380. 

in  constipation,  i,  230. 

"  diarrhcea,  i,  280. 

"  pulmonary  diseases,  i,  330. 
Cetrarin,  i,  330. 
Cevadilla.    See  Sabadilla. 
Chaat,  ii,  368. 
Chalk,  i,  230. 

as  a  dusting    powder    in    chafing,  ulcers, 
eczema,  etc.,  i,  230. 

as  an  antidote  in  poisoning  by  acids,  i,  330. 

camphorated,  i,  306. 

precipitated,  as  a  dentifrice,  i,  335. 

in  acid  eructations,  i,  230. 

"  cholera  infantum,  i,  230. 

"  diarrhoea,  i,  330. 

"  pyrosis,  i,  330. 
Chalyijeate  bread,  i,  551. 
Chalybeates.    See  Iron. 
Chamomile,  i,  330. 

compound  mixture  of,  in  neurasthenic  and 
hysterical  conditions,  i,  331. 

in  convalescence,  i,  231. 

"  digestive  atony,  i,  231. 

"  flatulent  colic  of  children,  i,  231. 

inhalations  of  the  vapour  of,  in  catarrh  of 
the  upper  air-passages,  i,  231. 

in  rheumatism,  i,  331. 

"  simple  fevers,  i,  331. 

poultice,  in  abdominal  distress,  i,  231. 

in  otalgia,  i,  231. 


Champagne,  i,  231. 
as  a  stimulant  after  severe  operations,  ii,  225. 
iced,  as  an  antemetic,  i,  99. 
in  pulmonary  troubles  of  the  aged,  i,  231. 
Charcoal,  i,  282. 
as  a  douche  for  ofEensive  leucorrhoeal  dis- 
charges, i,  232. 
as  a  germicide,  i,  440. 
in  cancer  of  the  stomach,  i,  233. 
"  choleraic  diarrhcea,  i,  332. 
"  dyspepsia,  i,  383. 
"  epidemic  dysentery,  i,  232. 
"  poisoning  with  alkaloids,  i,  233. 
"  pyrosis,  i,  333. 
"  ulcer  of  the  stomach,  i,  233. 
poultice,  in    foul-smelling    suppuration,  i, 

282. 
poultice,  in  gangrene,  i,  383. 
wood,  i,  85. 
Charpie.    See  Lint. 
Chartae,  Chartulae.    See  Powders. 
Chaulmoogra  oil,  i,  333. 
effects  of,  given  internally,  i,  233. 
in  bruises,  sprains,  and  stifE  joints,  i,  238. 
"  leprosy,  i,  338. 
"  neuralgia,  i,  233. 
"  phthisis,  i,  233. 
"  rheumatism,  i,  233. 
"  scabies,  i,  333. 
"  sciatica,  i.  233. 
"  scrofula,  i,  233. 
"  skin  diseases,  i,  333. 
"  syphilis,  i,  333. 
"  toothache,  i,  333. 
Chelidonium  majus,  i,  333. 
in  cancer,  ii,  481. 
"  corns  and  warts,  i,  233. 
Chemical  restraint,  i,  233. 
Chenopodium,  i,  234. 

in  lumbricoid  worms,  i,  234. 
oil  of,  in  Ascaris  lumbricoides,  i,  103. 
Cherry  laurel.    See  Laurocerasus. 

"      wild.    See  Prunus  virginiana. 
Chestnut  leaves.    See  Castanea. 
Chimaphila,  i.  334. 

in  treatment  of  dropsy,  i,  234. 
China.     See  Cinchona. 
Chininum.    See  Quinine. 
Chinoline.    See  Quinoline. 
Chionanthin,  i,  234. 
Chionanthus  virginica,  i,  334. 
as  a  cholagogue,  i,  234. 
"   diuretic,  i,  384. 
"   vulnerary,  i,  334. 
in  jaundice,  i,  334. 
"  portal  congestion,  i,  334. 
Chirata,  i,  334. 
as  a  tonic  in  exhaustion,  i,  334. 
in  acidity  of  the  stomach,  i,  234. 
"  dysentery,  i,  334. 
"  dyspepsia,  i,  334. 
"  flatulence,  i,  334. 
"  malarial  fever,  i,  234. 
Chiratin,  i,  234. 
Chloracetic  acid,  i,  234. 
in  nsBvi,  papillomata,  and  warts,  i,  284. 
"  ozaena,  i,  334. 
Chloral,  i,  334. 
camphorated,  in  neuralgia,  as  a  sedative  nar- 
cotic, i,  235, 


480 


GENERAL  INDEX. 


Chloral,  in  spasmodic  contraction  of  the  ar- 
teries, i,  133. 

alcoholate,  i,  335. 

ammonium,  in  nervous  insomnia,  i,  385. 

caffeine,  in  asthmatic  attaolis,  i,  835. 

in  neuralgia,  i,  335. 

cream,  i,  288. 

formamide.     See  Chlobalamide. 

hydrate,  i,  335. 

and  camphor,  in  toothache,  i,  136. 

as  a  hypnotic,  i,  507. 
"    narcotic,  ii,  4. 

contra-indications  to  the  use  of,  i,  337. 

in  after-pains,  i,  337. 

"  asthma,  i,  337. 

"  chorea,  i,  337. 

"  convulsions  of  childhood,  i,  237. 

"  "  "  strychnine  poisoning  and 

tetanus,  i,  337. 

"  delirium  of  fever,  i,  236. 

"         "        tremens,  i,  337. 

"  epilepsy,  i,  387. 

"  excitement  of  insanity,  i,  337. 

"  gonorrhoea,  i,  337. 

"  hiccough,  i,  337. 

"  insomnia,  i,  336. 

"  laryngismus  stridulus,  i,  337. 

"  nervous  insomnia,  i,  336. 

"  paralysis  agitans,  i,  337. 

"  puerperal  convulsions,  i,  337. 

"  restlessness,  i,  236. 

"  rigidity  of  the  os  uteri,  i,  337. 

"  scarlet  fever,  i,  237. 

"  seasickness,  i,  337. 

"  toothache,  i,  237. 

"  whooping-cough,  i,  237. 

local  action  of,  i,  235. 

locally  in  foul  ulceration,  i,  237. 

physiological  effects  of,  i,  235. 

poisoning  by,  i,  336. 

treatment  of  poisoning  by,  i,  236. 
Chloralamide,  i,  238  ;  ii,  431. 
as  a  hypnotic,  i,  507 ;  ii,  431. 

"  an  analgetic,  ii,  431. 
in  chorea,  i,  238. 

"  epilepsy,  i,  338. 

"  insomnia,  i,  338. 

"  neuralgia;  i,  288. 

"  seasickness,  i,  339. 

"  spasmodic  asthma,  i,  238. 
Chloralose,  i,  339. 
in  hysterical  chorea,  i,  239. 

headache,  i,  239. 

"  neurasthenia,  i,  239. 

"  psychical  troubles,  i,  239. 

"  sleeplessness,  i,  339. 

"  uterine  pains,  i,  239. 
Chloralum.     See  Chloral    and    also    under 

Aluminum  and  its  salts. 
Chloranodyne,  i,  239. 
Chloric  ether,  i,  339. 
Chlorinated  cotton,  i,  240. 
Chlorine,  i,  339. 
as  a  disinfectant,  i,  444,  537. 
inhalation  in  phthisis,  i,  340. 
in  treatment  of  gangrene,  i,  445. 

"  "         "  ulcers,  i,  445. 

Chlorine  water,  as  a  douche  in  septic  condi- 
tions after  childbirth,  i,  240. 
as  a  gargle  in  diphtheria,  i,  340. 


Chlorine  water,  in   ill   conditioned   and  foul- 
smelling  ulcerations,  i,  340. 
Chlorobrom,  i,  340. 
in  active  melancholia,  i,  240. 
"  seasickness,  i,  100,  340. 
"  simple  melancholia,  i,  340. 
Chlorodyne,  i,  340. 

in  acute  attacks  of  diarrhoea,  i,  340. 
Chloroform,  i,  340. 
anesthesia,  physiology  of,  i,  242. 

"  preparation  of  the  patient  for,  i, 

343. 
and  morphine  on  the  heart  and  respiration, 

i,  88. 
applied  locally,  in  chronic  rheumatism,  1, 

241. 
applied  locally,  in  lumbago,  i,  241. 
"  "        "   neuralgia,  i,  241. 

as  a  lotion  in  pruritus,  i,  241. 
"         "       "  urticaria,  i,  241. 
"  an  antemetic,  internally,  i,  99. 
"  a  solvent,  ii,  313. 

condition  during  full  ansesthesia  by,  i,  248. 
deaths  under,  i,  243. 
in  A.  C.  E.  mixture,  i,  1. 
"  acute  coryza.  i,  528. 
"  angina  pectoris,  i,  588. 
inhalation,  effects  of,  i,  341. 
in  coryza  of  iniluenza,  i,  528. 
"  flatulency  as  an  antispasmodic  and  seda- 
tive, i,  841. 
injections  of,  in  hydrocele,  i,  241. 

"  "   hypodermic,  in  sciatica,  i,  341. 

in  nausea,  i,  99. 
"  puerperal  eclampsia,  i,  538. 
"  rigid  perinasum  in  labour,  i,  341. 
"  strychnine  poisoning,  i,  528. 
"  tetanus,  i,  528. 
"  toothache,  i,  341. 
"  treatment  of  asthma,  i,  528. 
"  uraemia,  i,  528. 

"  vomiting,  as  an  antispasmodic  and  seda- 
tive, i,  341. 
method  of  administration  of,  i,  243. 
methods  of  resuscitation  from  overdose  of, 

i,  344. 
rhythmic  tractions   on    the   tongue  in  as- 
phyxia from,  i,  344. 
spirit,  in  asthmatic  paroxysm,  i,  94. 
"       "  intermittent  fever,  i,  241. 
"       "  persistent  hiccough,  i,  241. 
syncope  by  direct  action  of,  i,  344. 
vapour  inhalation,  in  biliary  colic,  i,  345. 
"  "  convulsions,  i,  245. 

"^  "  "  earache,  i,  533. 

"  "  "  hysterical  spasm  of  the 

larynx,  i,  345. 
vapour  inhalation,  in  the  second  stage  of 

labour,  i,  245. 
versus  ether,  i,  397. 
Chloral,  1,  245. 
Chloropercha,  i,  245. 
Chlorophenols,  Chlorphenols,  i,  245. 
in  solutions,  locally,  in  tuberculous  affections 
of  the  larynx,  i,  245. 
Chocolate.    See  under  Cocoa  (vol.  i,  page  285). 
Cholagogues,  i,  246. 
direct,  i,  346. 

in  bilious  conditions,  i,  347. 
indirect,  i,  347- 


GENERAL  INDEX. 


481 


Chlorosalol.     See  under  Salicylic  acid  and 

THE  salicylates  (Supplement). 
Chondrus,  i,  347. 
in  diarrhoea,  i,  247. 
"  dysentery,  i,  247. 
"  gastritis,  i,  247. 

"  irritated  conditions  of  the  urinary  tract, 
i,  247. 
Chromic  acid,  i,  247. 
as  an  anthidrotic,  i,  103. 
for  goitre,  i,  248. 
in  carcinoma,  i,  248. 
"  lupus,  i,  248. 
"  malignant  ulcers,  i,  248. 
"  naevi,  i,  248. 
"  uterine  cancer,  i,  248. 
paste,  in  condylomata,  i,  248. 
"       "  neoplasms    of    the  mucous  mem- 
branes, i,  248. 
paste,  in  neoplasms  of  the  skin,  i,  248. 
solution,  in  chronic  endometritis,  i,  248. 
"         "  intra-uterine  growths,  i,  248. 
"  "  laryngitis,  i,  248. 

"         "  pharyngitis,  i,  248. 
"         "  sycosis,  i,  248. 
"         "  syphilitic  glossitis,  i,  248. 
"         "  ulcerated  gums,  i,  248. 
in  warty  growths,  i,  248. 
Chrysarobin,  i,  248. 
for  Sarcina  lutea,  i,  249. 
"  Staphylococcus  pyogenes  aureus,  1,  249. 
in  eczema  seborrhoicum,  i,  116. 
"  psoriasis,  i,  249. 
"  ringworm,  i,  117. 
Chrysophanic  acid.    See  Chrysarobin. 
Cieatrizants.    See  Vulneraries. 
Cicuta,  i,  249. 
in  local  pains,  i,  250. 
"  migraine,  i,  250. 
"  nervous  headache,  i,  250. 
"  rheumatism,  i,  250. 
Cigarettes,  Cigars,  i,  250. 
Ciraicifuga,  i,  250. 
as  a  uterine  stimulant  in  labour,  ii,  55. 
in  acute  rheumatism,  i,  250. 
"  amenorrhoea,  i,  250. 
"  bronchial  catarrh,  i,  250. 
"  caseous  pneumonia,  i,  250. 
"  chorea,  i,  250. 
"  delirium  tremens,  i,  250. 
"  dysmenorrhoea,  i,  250. 
"  fatty  heart,  i,  250. 
"  fevers,  i,  250. 
"  headache,  i,  250. 
"  impotence,  i,  250. 
"  lumbago,  i,  250. 
"  nervousness,  i,  250. 
"  neuralgia  and  muscular  pains,  i,  250. 
"  pleurodynia,  i,  250. 
"  post-partum  hasmorrhage,  i,  250. 
"  rheumatic  taint,  i,  250. 
"  spermatoi-rhoea,  i,  250. 
"  wry-neck,  i,  250. 
Cinchona,  i,  2.50. 
in  locomotor  ataxia,  ii,  120. 
(in  powder)  in  ulcerations,  i,  253. 
"        "  "  unhealthy  wounds,  i,  253. 

physiological  action  of,  i,  252. 
Cinch  onidine  salicylate    in  chronic  articular 
rheumatism,  ii,  145. 


Cinchonidine  salicylate  in  subacute  articular 

rheumatism,  ii,  145. 
Cinchonine  iodosulphate.    See  Antiseptol. 
Cineraria,  i,  258. 

in  amenorrhcea,  i,  258. 
"  cataract,  i,  258. 
"  hysteria,  i,  258. 
Cinnabar,  i,  258. 
Cinnamic  acid  and  glycerin  in  tuberculosis  of 

joint  cavities,  i,  259. 
Cinnamon,  i,  259. 
and  calumba  in  vomiting  of  drunkards,  i, 

100. 
and  gentian  in  vomiting  of  drunkards,  i, 

100. 
and  serpentaria  in  vomiting  of  drunkards,  i, 

100. 
in  acute  dysentery,  i,  259. 
"  diarrhoea,  i,  259. 
"  flatulence,  i,  259. 
"  indigestion,  i,  259. 

injections  in  pulmonary  and  intestinal  tu- 
berculosis, i,  259. 
in  tuberculosis  of  joint  cavities,  i,  259. 
"  vesical  hjemorrhage,  i,  259. 
Cinnamyl-eugenol.    See  under  Cloves. 
Cissampelos.     See  Parbira. 
Citric  acid,  i,  259. 
in  Asiatic  cholera,  i,  260. 
solution,  as  a  gargle  in  diphtheria,  i,  260. 
Citrine  ointment.    See  under  Mercury. 
Citrophen,  ii,  481. 

as  an  analgetic  and  antipyretic,  ii,  431. 
CitruUus  colocynthis.    See  Colocynth. 
Clavethyl,  i,  260. 

Climatic  influence  in  asthma,  i,  96. 
treatment,  i,  260. 

"  in  chronic  bronchitis,  i,  271. 

"  of    consumption    or  phthisis,  i, 

270. 
treatment,  sea  voyages  in  chronic  empyema, 

i,  271. 
treatment,  sea  voyages  in  chronic  pleurisy, 

i,  271. 
treatment,  sea  voyages  in  chronic  hsemor- 

rhagic  phthisis,  i,  271. 
treatment,  sea  voyages  in  neuroses,  i,  271. 
"  sea  voyages  in  scrofulous  disease, 

i,  271. 
treatment,  sea  voyages  in  tuberculous  exca- 
vation, i,  271. 
treatment,  why  coolness  or  cold  is  preferable 

to  warmth  or  heat  in,  i,  263. 
treatment,  why  diathermancy  is  to  be  pre- 
ferred to  dense,  moist,  or  smoky  atmos- 
phere in,  i,  268. 
treatment,    why   dryness    is    preferable    to 

moisture  and  is  placed  first  in,  i,  262. 
treatment,  why   rarefaction  is  better   than 

sea-level  pressure  in,  i,  265. 
treatment,  why  sunshine  is  superior  to  cloud- 
iness in,  i,  267. 
treatment,  why  variability  can  be  substituted 
for  equability  in,  i,  267. 
Cloves,  i,  272. 
as  a  plaster  to  relieve  nausea  and  vomiting, 

i,  272. 
in  dental  caries,  i,  272. 

injections  of  the  tincture  of,  in  cold  abscesses, 
i.  272. 


482 


GENERAL  INDEX, 


Cloves,  oil  of,  in  toothache,  i,  136,  272. 

in  tuberculous  affections,  i,  372. 
Clysters.    See  Enemata. 
Cnious    benediotus.      See    Centaurea    bene- 

DICTA. 

Coal  tar,  i,  272. 
in  foul  ulcers  and  wounds,  i,  273. 
powder,  ii,  364. 

"      in  ecthyma,  eczema,  herpes  impetigo, 
and  rupia,  ii,  263. 
saponine,  i,  273. 
Cobalt,  i,  273. 
oxide,  in  rheumatism,  i,  273. 
poisoning  by,  i,  378. 
Cobweb.    See  Abanea. 
Coca  and  cocaine,  i,  374. 
Coca,  effects  on  the  organism  of,  1,  274. 
in  anaemia,  i,  374. 
"  neurasthenia,  i,  374. 
leaves  as  a  stimulant,  ii,  334. 
Cocaine,  action  of,  on  the  general  system,  i, 
384. 
application  of,  in  dental  surgery,  i,  375. 
"  "    gynfecology,  i,  275. 

"  "    to  the  eye,  i,  275. 

"  "        "      genito-urinary   tract 

i,  375. 
application  of,  to  the  mucous  surfaces,  i,  275. 
"  "       "      nose,     pharynx,     and 

larynx,  i,  275. 
application  of,  to  the  rectum,  i,  275. 

"      "       skin,  i,  276. 
as  a  mydriatic,  i,  649. 
cantharidate,  subeutaneously,  in  pulmonary 

tuberculosis,  i,  209. 
hydrochloride,  in  neuralgia,  hypodermically, 

i,  68. 
in  toothache,  i,  136. 

"  neuralgia,  by  the  mouth  and  hypodermic- 
ally,  i,  69. 
internally,  in  hysteria,  i,  284. 

"  "  melancholia,  i,  384. 

"  "  neurasthenia,  i,  384. 

introduction  of,  into  the  skin,  i,  276. 
in  vomiting,  in  small  doses,  i,  99. 
localization  of  the  action  of,  in  circumscribed 

nexiritis,  i,  280. 
localization  of  the  action  of,  on  the  brain,  i, 

283. 
local  medication  of  the  spinal  cord  with,  i, 

380. 
methods  of  perpetuating,  upon  the  peripheral 

nerves,  i,  377. 
poisoning,  ii,  431. 
solution,  irrigation  of  the  Cauda  equina  with, 

1,380. 
therapeutic  thrombosis,  or  the  localization 
and  prolongation  of  the  action  of,  i,  378. 
Coccus,  Cochineal,  1,  384. 
Cochlearia,  i,  384. 
CooillaiJa  bark,  i,  384. 
in  acute  bronchitis,  i,  385. 
"  bronchitis,  i,  285. 
"  bronchopneumonia,  i,  285. 
"  phthisis,  i,  385. 
"  subacute  bronchitis,  i,  385. 
Cocoa,  i,  285. 
Codeine,  i,  286. 
as  an  anodyne,  i,  67. 
in  asthma,  i,  93,  94. 


Codeine,  in  colic,  i,  886. 
in  cough,  ii,  433. 

"  irritable  and  nervous  cough,  i,  386. 
"  nervous  and  irritable  conditions,  i,  286. 
"      "         insomnia,  i,  386. 
"  the  cure  of  the  morphine  habit,  i,  286. 
"  saccharine  diabetes,  i,  386. 
"  whooping-cough,  i,  386. 
Cod-liver  oil,  i,  287. 
by  inunction  in  marasmus,  i,  288. 
"         "  "  perverted  nutrition,  i,  S88. 

in  cachexia,  i,  288. 
"  chorea,  i,  288. 

"  chronic  diarrhoea  of  young  children,  i,  388. 
"        "        eczema,  i,  288. 

"       laryngitis,  i,  388. 
"        "       rheumatism,  i,  288. 
"  conjunctivitis  of  children,  i,  288. 
"  dizziness,  i,  288. 
"  epilepsy,  i,  288. 
"  favus,  i,  288. 
"  functional  disturbances  of  the   nervous 

system,  i,  288. 
"  gout,  i,  288. 
"  impetigo,  i,  288. 
"  lupus,  i,  288. 
"  measles,  i,  388. 
"  neuralgia,  i,  288. 

"  "         from  impaired  nutrition,  1,  68. 

"  pharyngitis,  i,  288. 
"  phthisis,  i,  388. 
"  psoriasis,  i,  388. 
"  scarlet  fever,  i,  388. 
"  scleroderma,  i,  288. 
"  scrofula,  i,  288. 
"  strumous  enlargement  of  the  glands,  i, 

288. 
"  vertigo,  i,  288. 
Codol.     See  Rosinol. 
Coffee,  i,  289. 
effects  of,  as  a  beverage,  i,  389. 
in  alcoholic  poisoning,  i,  390. 
"  asthmatic  paroxysms,  i,  290. 
"  circulatory  enfeeblement,  i,  391. 
"  headache,  i,  290. 
"  malarial  disease,  i,  290. 
"  migraine,  i,  290. 
"  neuralgia,  i,  290. 
Cognac.    See  under  Alcohol. 
Colchicine,  i,  291. 
Colchicum,  i,  391. 
in  gout,  i,  391. 
"  recurrent  boils,  i,  391. 
poisoning,  i,  291. 
Coley's  treatment  of  sarcoma,  ii,  313. 
Collodion,  i,  292. 
as  a  protection   to   catarrhal    or    purulent 

ophthalmia,  i,  394. 
bichloride-of-mercury,  in  nasvi,  i,  392. 

"  "        "    in  venereal  warts,  i,  292. 

cantharidal,  i,  293. 

carbolic  acid.    See    under  Styptic    collo- 
dion. 
cocaine,  in  chilblains,  i,  393. 

"         "   pruritus,  i,  292. 
creosote,  in  carious  teeth,  i,  292. 
ferruginous,  in  erysipelas,  i.  293. 
flexible,  i,  293. 

"        as  a  protection  to  the  skin  in  small- 
pox, i,  294. 


GENERAL  INDEX. 


483 


Collodion,  flexible,  in  erysipelas,  i,  294. 

flexible,  for  relief  of  entropion,  i,  394. 

glyoerized,  i,  293. 

ichthyol,  in  skin  diseases,  i,  393. 

in  acute  orchitis,  i,  294. 

"  congenital  hydrocephalus,  i,  294. 

"  distichiasis,  i,  394. 
.    "  Assures  of  the  nipple,  i,  294. 

"  mammary  congestion,  i,  294. 

"  meningocele,  i,  394. 

"  spina  bifida,  i,  294. 

"  toothache,  i,  136. 

"  trichiasis,  i,  294. 

"  umbilical  hernia,  i,  394. 

iodine  or  iodized,  i,  393. 

iodoform,  in  orchitis,  i,  293. 

"  ■'  rheumatic  inflammations,  i,  393. 

"  "  venereal  sores,  i,  393. 

iodo-sulphural,  i,  293. 

salicylated,  in  inflamed  joints,  i,  393. 

salicylic-acid,  and  cannabis  indioa,  i,  393. 
"  "        "     zinc-chloride,  i,  293. 

"     and  lactic-acid,  i,  393. 

salol,  i,  293. 

saturnine,  in  aneurysms,  i,  394. 
"  "  condylomata,  i,  294. 

"  "  contusions  and  wounds,  i,  293. 

"  "  erysipelatous  inflammations,  i, 

293. 

saturnine,  in  varicose  veins,  i,  394. 

sedative,  in  painful  nerve  tracts,  i,  293. 

sinapis,  i,  393. 

styptic,  for  ruptured  perinaeum,  i,  393. 
in  fistula,  i,  293. 
"         "  harelip,  i,  393. 
"        "  scalp  wounds,  i,  293. 
"         "  superficial  burns,  i,  393. 

sulphurous,  in  skin  diseases,  i,  293. 

with  croton  oil,  i,  292. 
Collyria,  i,  394. 

in  gonorrhoeal  ophthalmia,  i,  295. 

"  ophthalmia  neonatorum,  i,  295. 
Coloeynth,  i,  395. 

in  cerebral  disorders,  i,  296. 

"  dropsy,  i,  396. 

"  fluid  effusions,  i,  396. 

"  occasional  constipation,  i,  396. 

poisoning  by,  i,  296. 
Cologne  water,  i,  297. 
Columbo.     See  Calumba. 
Condurango,  i,  397. 

in  cancer,  i,  397. 

"  syphilis,  i,  397. 

"  ulcer,  i,  397. 
Condy's  fluid,  ii.  70. 
Confections,  i,  397. 
Conine,  Coniine.  i,  297. 

in  hydrophobia,  i,  299. 

"  pleurisy,  i,  299. 

"  pneumonia,  i,  299. 

"  strychnine  poisoning,  i,  299. 

"  tetanus,  i,  299. 
Conium,  i,  397. 

as  a  motor  depressant,  i,  644. 

e£Eect  of  the  local  application  of,  i,  297. 

in  acute  laryngitis,  i,  399. 

'•  angina  pectoris,  i,  298. 

"  asthma,  i,  398. 

"  blepharospasm,  i,  298. 

"  cancer,  i,  398. 


Coniura,  in  chronic  glandular  enlargements,  i, 
398. 
in  delirium  tremens,  i,  299. 
diabetes,  i,  399. 
dysuria,  i,  398. 
■'  epilepsy,  i,  398. 
''  genito-urinarj'^  affections,  i,  398. 

hiccough,  i,  398. 
inhalation  of,  in  asthma,  i,  539. 
in  irritative  cough,  i,  399. 
laryngismus  stridulus,  i,  398. 
mania,  i,  299. 
melancholia,  i,  399. 
muscular  spasms,  i,  299. 
neuralgia,  i,  399. 
ovarian  monorrhagia,  i.  398. 
paralysis  agitans,  i,  298. 
spasm    from  irritative    lesions  of  nerve 
trunks,  i,  133. 

spasmodic  torticollis,  i,  398. 
spinal  sclerosis,  i,  398. 
tumours,  i,  298. 
ulcerations,  i,  298. 
whooping-cough,  i,  398. 
Contrayerva,  i,  899. 
Convallamarin,  i,  399. 
Convallaria,  i,  300. 
in  aberration  of  the  cardiac  rhythm,  i,  300. 
"  aortic  disease,  i,  300. 
"  cardiac  incompetency  resulting  from  over- 
strain, i,  300. 
"  chronic  phthisis,  i,  300. 
"  irregularities  of  the  circulation,  i,  300. 
"  mitral  regurgitation,  i,  300. 

"      stenosis,  i,  300. 
"  passive  congestion,  i,  300. 
physiological  action  of,  i,  300. 
in  pleuritic  effusions,  i,  300. 
"  pneumonia,  i,  300. 
"  valvular  disease,  i,  300. 
Convallarin,  i,  301. 
Convalvulin,  i,  301. 
Copaiba,  i,  301. 
in  cirrhosis  of  the  liver,  i,  302. 
"  gonorrhoea,  i,  301. 
"  psoriasis,  i,  303. 
"  scabies,  ii,  432. 
Copper,  i,  303. 
acetate  in  aphthae,  i,  303. 

"       "  conjunctivitis,  i,  303. 
"       "  gonorrhoea,  i,  303. 
aluminated,  in  granular  conjunctivitis,  i,  308. 
ammoniated,  in  chorea,  i,  303. 
"  "  epilepsy,  i,  303. 

"  "■  neuralgia,  i,  303. 

arsenite  as  an  enema  in  cholera,  i,  304. 

"  "         "        "  membranous  enteri- 

tis, i,  304. 
arsenite  as  a  spray,  for  asthma,  i,  303. 

"  "       "       in  acute  nasal  catarrh,  i, 

803. 
arsenite  in  aphthse,  i,  303. 
"  chlorosis,  i,  303. 
"        "  cholera,  i,  303,  305. 
"        "  chronic  catarrh,  i,  303. 
"  cystitis,  i,  304. 
"  diarrhoea,  i,  303. 
"         "  dysentery,  i,  303. 
"         "  enteritis,  i.  305. 
"        "  enterocolitis,  i,  303. 


484 


GENERAL  INDEX. 


Copper  arsenite  in  functional  anaemia,  i,  303. 
arsenite  in  gastritis,  i,  305. 
"         "  glanders,  i,  304. 
"        "  inflammations  of  the  mouth,  i, 
304. 
arsenite  in   inflammatory  derangements  of 

the  mucous  membranes,  i,  304. 
arsenite  in  intestinal  affections,  i,  305. 
"  iritis,  i,  305. 
"         '•  keratitis,  i,  305. 
'■        "  otitis  externa  diffusa,  i,  304. 
"         "  phlyctaenuliB,  i,  305. 
"         "  proctitis,  i,  304. 
"        "  rhinitis,  i,  304. 
arsenite  solution  in  amygdalitis,  i,  304. 
"  gleet,  i,  304. 
"  glossitis,  i,  304. 
"  "         ■'  gonorrhoea,  i,  304. 

"  "         "  chronic  gonorrhoea,  i,  304. 

"  "         "  hay  fever,  i,  304. 

"  "         "  influenza,  i,  304. 

"      -  "  intertrigo,  i,  304. 
"  "         "  leucorrhoea,  i.  304. 

"  "         "  oedema  of  the  glottis,  i, 

304. 
arsenite  solution  in  phthisis,  i,  304. 
"  "         "  prolapsus  ani,  i,  304. 

"  "         "  puerperal  fever,  i,  304. 

"  "         "  scurvy,  i,  304. 

"  "         "  sore  nipples,  i,  804. 

"  "         "  spongy  gums,  i,  304. 

"  stomatitis,  i,  304. 
"  "         "  the  form  of  a  spray  in 

incipient  tuberculous  affections,  i,  304. 
arsenite  solution  in  tympanites,  i,  304. 
"  "         "  yellow  fever,  i,  304. 

carbonate  in  phosphorus  poisoning,  i,  306. 
in  ganglionic  abscesses,  i,  303. 
"  tuberculous  arthritis,  i,  303. 
oleate  for  tinea  trichophytina,  i,  305. 
in  ringworm,  i,  117. 
"  warts,  corns,  etc.,  i,  305. 
ointment  in  indolent  ulcers,  i,  305. 
in  ringworm,  i,  305. 
sulphate  of,  as  a  germicide,  i,  448. 
in  acne  rosacea,  i,  306. 
Coriander,  i,  306. 
Corn  silk,  i,  306. 
in  albuminuria,  i,  306. 
"  chronic  nephritis,  i,  306. 
"  in  cystitis,  i,  300. 
"  enfeebled  heart,  i,  306. 
"  gonorrhoea,  i,  306. 
"  hfematuria,  i,  306. 
"  lithiasis,  i,  306. 
"  oedema,  i,  306. 
"  prostatitis,  i,  306. 
"  pyelitis,  i,  306. 
"  renal  colic,  i,  306. 
"      "     congestion,  i,  306. 
"  suppression  of  urine,  i,  806. 
"  vesical  irritability,  i,  306, 
smut.     See  Ergot  of  maize. 
Cornu  cervi.     See  under  Ammonium  carbon 

ATE. 

Cornus,  i,  307. 

in  malarial  disease,  i,  118,  307. 
Cornutine,  i,  307. 

in  haemorrhage,  i,  307. 

"  menorrhagia,  i,  307. 


Cornutine,  in  metrorrhagia,  i,  307. 
in  spermatorrhoea,  i,  307. 
"  uterine  inertia,  i,  307. 
Coronilla,  i,  307. 
Coronillin,  i,  307. 
Correctives,  Corrigents,  i,  307. 
Corrosive  sublimate.    See  IVEebcurt. 
Coryl,  i,  307. 
Cosmetics,  i,  307. 
Cosmoline.     See  Vaseline. 
Cotarnine  hydrochloride.     See  Stypticin. 
Coto  bark,  i,  309. 
in  atrophic  pharyngeal  catarrh,  i,  309. 
"  diarrhoea,  i,  309. 
Cotoin.     See  under  Coio  bark. 
Cotton,  i,  310. 
absorbent,  for  burns,  scalds,  and  blisters,  i, 

310. 
iodized,  in  ulceration  of  the  cervix  uteri,  i, 

310. 
root,  i,  311. 
"    poisoning  with,  ii,  432. 
Cotton-seed  oil,  i,  311. 

styptic,  in  superficial  haemorrhage,  i,  310. 
Coumarin,  i,  311. 
Counter-irritants,  i,  311. 
in  encephalitis,  i,  318. 
"  gastric  colic,  i,  313. 
"  pleuritic  effusion,  i,  312. 
where  to  apply,  i,  812. 
Counter-poisons.    See  Antagonists  and  anti- 
dotes. 
Cowhage.     See  Mucdna. 
Cream,  i,  636.    See  under  Milk. 
as  an  article  of  diet,  i,  636. 
in  constipation  of  young  children,  i,  222. 
Creasote.    See  Creosote. 
Creolin,  i,  312. 
as  a  germicide,  i,  448. 
in  chlorosis,  i,  313, 
"  cholera,  i,  313, 
"  infantile  diarrhoea,  i,  313. 
"  leprosy,  i,  313, 
"  scrofula,  i,  313. 
Creosal,  ii,  433, 
Creosol,  ii,  433. 

in  catarrh  of  the  respiratory  organs,  ii,  433. 
Creosotal,  i,  313. 
Creosote,  i,  313. 
administration  of,  in  different  -jvays,  i,  315. 
and  boric-acid  injections  in  gonorrhoea,  i,  314. 
applications  in  leucorrhoea,  i,  314. 
in  burns,  with  suppuration,  i,  314. 
"  chilblains,  i,  314. 
"  cholera  infantum,  i,  314. 
"        "       morbus,  i,  314. 
"  chronic  eczema,  i,  314. 
"  diabetes,  i,  314. 
"  dysentery,  i,  314. 
"  enlarged"  bronchial  glands,  ii,  433. 
"  erysipelas,  i,  314, 
"  fistula,  i,  314. 
"  foetid  otorrhcea,  i,  314. 
"  gangrenous  surfaces,  i,  314. 
"  gastric  fermentation,  i,  314, 
inhalation  in  abscess  and  gangrene  of  the 

lung,  i,  314, 
inhalation  in  bronchiectasis,  i,  314, 

"  chronic  bronchitis,  i,  314. 
"       laryngitis,  i,  814. 


GENERAL  INDEX. 


485 


Creosote  inhalations  in  pulmonary  tuberculosis, 
i,  314. 

in  intestinal  dyspepsia,  i,  314. 

"  laryngeal  tuberculosis,  i,  316. 

"  lienterie  diarrhoea,  i,  314. 

"  naevi,  as  a  caustic,  i,  314. 

"  psoriasis,  i,  314. 

"  puerperal  metritis,  i,  314. 

"  seasicliness,  i,  314. 

"  sloughing  ulcers,  i,  314. 

"  suppurating  surfaces,  i,  314. 

"  toothache,  i,  136,  314. 

"  tuberculous   laryngitis,   by   injections,  i, 
316. 

"  typhoid  fever,  i,  314. 

"  ulcers  of  the  larynx,  i,  314. 

"  vomiting,  i,  99,  314. 

of  hysteria,  i,  314. 

"  "         "  pregnancy,  i,  314. 

"  warts,  as  a  caustic,  i,  314. 

physiological  action  of,  i,  313. 

water  as  a  hasmostatic   in   bleeding  from 
leech  bites,  i,  314. 

water  as  a  haemostatic  to  uterine   hEemor- 
rhage,  i,  314. 
Creosote-calcium  chlorhydrophosphate,  ii,  433. 

in  scrofula,  ii,  433. 

"  tuberculosis,  ii,  433. 
Cre.salol,  Cresol  salicylate.     See  under  Salictl- 

10  ACID  AND  THE  SALICYLATES  (Supplement). 
Cresol,  Cresylic  acid,  Cresylol,  i,  318. 
Cresol  as  a  germicide  for  the  bacilli  of  tuber- 
culosis, i,  448. 
Creta.    See  Chalk. 
Cristalline,  i,  318. 
Crocus.    See  Saffron. 
Croton  chloral  as  a  hypnotic,  i,  508. 

in  neuralgia,  for  immediate  relief,  i,  69. 
Croton-ohloral  hydrate.     See  Butyl-chloral 

HYDRATE  and  under  Hypnotics. 
Croton  oil,  i,  318. 

by  inoculation,  for  nsevi,  i,  318. 

in  apoplexy,   for  rapid  evacuation  of  the 
bowels,  i,"318. 

"  chronic  bronchitis,  i,  318. 

"        "        inflammation  of  joints,  i,  318. 

"        "        headache,  by  application  to  the 
nape  of  the  neck,  i,  318. 

"  dropsy,  i,  318. 

"  dysmenorrhoea,  by  applications  to  the  ab- 
domen, i,  318. 

"  hydrocephalus,  i,  318. 

"  hysteria,  by  application  to  the  spine,  i,  318. 

"  obstinate  constipation,  i,  318. 

"  oophoralgia,  by  application  to  the  abdo- 
men, i,  318. 

"  paralyses  of  functional  origin,  by  applica- 
tion to  the  spine,  i,  318. 

"  phtiiisis,  i,  318. 

"  pleurisy,  i,  318. 

"  puerperal  convulsions,  i,  318. 

"  retention  of  urine,  i,  318. 

"  in  sciatica,  i,  318. 

"  tinea  tonsurans,  i,  318. 

"  tuberculous  meningitis,  by  application  to 

the  head,  i,  318. 
poisoning  by,  i,  318. 
Cryostase,  ii,  433. 
Cryptopine,  i,  318. 
Cu'beb,  i,  318. 


Cubeb  cigarettes  in  acute  coryza,  i,  430. 
cigarettes  in  acute  nasal  catarrh,  i,  319. 
"  "  bronchial  catarrh,  i,  430. 

"         "  subacute  bronchitis,  i,  430. 
in  affections  of  the  bladder,  i,  319. 
"    "   urethra,  i,  319. 
"  atonic  dyspepsia,  i,  319. 
"  chronic  iDronchitis,  i,  319. 
"       ■'       catarrh  of  the  rectum,  i,  319. 
"       "       cystitis,  i,  319. 
"  cystorrhoea,  i,  319. 
"  diphtheria,  i,  319. 
"  functional  irritability  of  the  bladder,  i, 

319. 
"  gonorrhoea,  i,  319. 
"  influenza,  i,  319. 
"  leucorrhcea,  i,  319. 
"  prostatorrhcea,  i,  319. 
"  pseudo-membranous  enteritis,  i,  319. 
troches,  in  chronic  irritability  of  the  air- 
passages,  fauces,  and  pharynx,  i,  319. 
Cubebin,  i,  318. 
Cucumber  ointment,  i,  319. 

for  cutaneous  irritation,  i,  319. 
Cucurbita.     See  Pepo. 
Cupping,  i',  319. 
for  bites  by  rabid  or  venomous  animals,  i, 

320. 
dry,  i,  319. 
"      in  acute  inflammation  of  the  kidneys,  i, 

320. 
"      in  congestion  of  the  kidneys,  i,  320. 
"      "  dyspnoea  due  to  cardiac  disease,  i, 

320. 
"      in  the  pain  and  cough  of  acute  pulmo- 
nary and  pleuritic  diseases,  i,  320. 
in  intracranial  congestion    and  inflamma- 
tions, i,  320. 
wet,  i,  320. 
Cupric  acetate  in  aphthse,  i,  303. 
in  conjunctivitis,  i,  303. 
■'  gonorrhoea,  i,  303. 
oxide  in  gingivitis,  i,  305. 
in  chronic  induration  of  the  lymph  glands, 

i,  305. 
"  taenia,  i,  305. 

phosphate  in  incipient  tuberculosis,  i,  305. 
sulphate  as  an  emetic  in  pseudo-membranous 

laryngitis,  i,  306. 
in  acne  rosacea,  i,  306. 
"  diarrhoea  and  dysentery,  i,  306. 
"  ecthyma,  i.  306. 
"  epilepsy,  i,  306. 
"  erythema,  i,  306. 
"  gangrenous  pharyngitis,  i,  306. 
"  gleet,  i,  306. 
"  gonorrhoea,  i,  306. 
"  haemorrhage,  i,  306. 
"  ichthyosis,  i,  307. 
"  indolent  ulcers,  i,  306. 
"  intermittent  fever,  i,  306. 
injections  in  buboes,  i,  306. 

"  "  hydrocele,  i,  306. 

"  malignant  sore  throat,  i,  306. 
"  mercurial  stomatitis,  i,  306. 
"  phosphorus  poisoning,  i,  110;  ii,  76. 
"  phthisis,  i,  306. 
"  psoriasis,  i,  306. 
"  scrofula,  i,  306. 
"  tinea  tarsi,  i,  306. 


486 


GENERAL   INDEX. 


Cupric  sulphate  in  trachoma,  ii,  314. 

in  typhoid  fever,  i,  306. 

"  ulcerative  colpitis,  i,  306. 

"  "        proctitis,  i,  306. 

"  venereal  ulcers,  i,  306. 
Cuprohsemol,  i,  320. 
Cuprum.     See  Copper. 
Curare,  i,  320. 

as  a  motor  depressant,  i,  644 

in  chorea,  i,  331. 

'•  epilepsy,  i,  331. 

"  grave  convulsive  conditions,  i,  331. 

"  hydrophobia,  i,  331. 

"  strychnine  poisoning,  i,  321. 

"  tetanus,  i,  321. 
Curarine,  i,  320. 
Curcuma,  i,  321. 

in  paludal  fever,  i,  333. 
Cure,  bichloride-of-gold,  for  inebriety,  i,  454. 

buttermilk,  for  diabetes,  i,  333. 

"  "    gastric  disorders,  i,  333, 

"  "    nephritis,  i,  333. 

grape,  i,  333,  455. 

whey,  for  acute  febrile  disease,  i,  333. 
"        "  irritability  of  the  stomach,  i,  383. 
Currant  shrub,  i,  352. 
Cusparia,  i,  323. 

in  diarrhoea,  i,  333. 

"  dysentery,  i,  333. 
Cusso,  i,  332. 

for  tapeworms,  i,  333. 
Cutal.    See  Aluminum  boeotannico-tartrate 

(Supplement). 
Cutin,  1,  322. 

Cyanides.    See  under  Cyanogen  and  cf.  Hy- 
drocyanic ACID. 
Cyanogen,  i,  333. 

Cyanurets.    See  under  Cyanogen. 
Cydonium,  i,  333. 

in  dysentery,  i,  333. 

"  poisoned  wounds,  i,  323. 

"  skin  diseases,  i,  333. 
Cyperus  articulatus,  i,  323. 
Cypripedium,  i,  323. 
Cytisus  laburnum,  i,  323. 

in  migraine,  i,  333. 

Damiana,  i,  333. 

in  cerebral  exhaustion,  i,  334. 

"  functional  impotence,  i,  334. 

"  general  atony  of  the  nervous  system,  i, 
334. 

"  migraine,  i,  324. 

"  nervous  dyspepsia,  i,  334. 

"  neuralgia,  i,  334. 
Datura.    See  Stramonium. 
Decoctions,  i,  324. 
Delphinine  in  earache,  ii,  231. 

(topically)  in  neuralgia,  ii,  321. 

"  toothache,  ii,  321. 
Delphinium.     See  Staphisagria. 
Demulcents,  i,  334. 
Dentifrices,  i,  334. 
Deodorizers,  i.  336. 
Depilatories,  i,  337. 
Depressants.    See  Cardiac  stimulants, 

Tonics,  and  Depressants. 
Derivatives,  i,  337. 
Dermatin,  ii,  4.33. 
Dermatol,  i,  339. 


Dermatol,  in  burns,  i,  339. 

"  eczema,  i,  329. 

"  excoriations,  i,  329. 

"  fermentative  dyspepsia,  i,  839. 

"  suppurating  surfaces,  i,  339. 
Desiccants,  i,  329. 

Desoxyalizarin.    See  Anthearobin. 
Detergents,  i,  329. 
De  Valangin's  solution,  i,  144. 
Dewees's  emraenagogue,  i,  875. 
Dextrose.    See  under  Sugar  (vol.  ii,  page  235). 
Diabetin.'    See  Levulose. 
Diacetanilide,  ii,  433. 
Diaoetyltannin.     See  Tanniqen. 
Diachylon,  i,  329. 
Dialyzed  preparations,  i,  330. 
Diaphoretics,  i,  331. 
Diaphtherin,  i,  333. 

in  otorrhcea,  i,  333. 

"  oziEna,  i,  883. 

"  ulcers,  i,  333. 

"  wounds,  i,  333. 
Diaphthol,  i,  833. 

in  gastro-intestinal  affections  accompanied 
by  fermentation,  i,  883. 

"  urinary  affections,  i,  333. 
Diastase,  i,  333. 

Dibromethane.    See  Ethylene  bromide. 
Dibromogallic  acid.     See  Gallobromol. 
Diohloracetic  acid,  i,  338. 
Dieleetrolysis.    See  under  Electricity  and  cf. 

Coca  and  Cocaine. 
Diet,  dry,  in  asthma,  i,  96. 

in  diabetes,  i,  333. 

"  dilatation  of  the  stomach,  i,  333. 

•'  dropsy,  i,  383. 

meat,  i,  333. 

skim-milk,  i,  833. 
Dietetic  treatment,  i,  333. 

in  acute  diarrhoea,  i,  336. 

"  cancer  of  the  stomach,  i,  336. 

"  chronic  diarrhoea,  i,  336. 

"  constipation,  i,  336. 

"  continued  fever,  i,  834. 

"  diabetes,  i,  337. 

"  fever,  i,  333,  334. 

"  functional  dyspepsia,  i,  885. 

"  gastritis,  acute  and  subacute,  i,  835. 

"  lithiemia  and  gout,  i,  338. 

"  nephritis,  i,  388. 

"  obesity,  i,  339. 

"  phthisis,  i.  838. 

"rickets,  i,  338. 

"  scurvy,  i,  337. 

"summer  diarrhoea  of  children,  i,  336. 

"  typhoid  fever,  i,  384. 

"  ulcer  of  the  stomach,  i,  335. 
Diethylacetal,  i,  1. 

Diethylenediamine.     See  Pipeeazine. 
Diethylsulphonediethylmethane.     See  Tetro- 

NAL. 

Diethylsulphonedimethylmethane.     See  Sul- 

PHONAL. 

Diethylsulphonemethylethylmethane.  See 

Trional. 
Digitalein,  Digitalin.    See  under  Digitalis. 
Digitalis,  i,  340. 

in  aconite  poisoning,  i,  7,  343. 

"  asthma,  i,  343. 

"  bronchial  congestions,  i,  843. 


GENERAL  INDEX. 


487 


Digitalis,  in  chronic  bronchitis  (as  a  diuretic), 
ii,  228. 

"  congestion  of  the  Itidneys,  i,  342. 

"  delirium  tremens,  i,  342. 

"  dilated  heart,  i,  341. 

"  diseases  of  the  mitral  and  tricuspid  valves 
of  the  heart,  i,  341. 

"  dyspnoea,  i,  343. 

"  epistaxis,  i,  342. 

"  erysipelas,  i,  343. 

"  exophthalmic  goitre,  i,  342. 

"  hsemorrhages,  i,  342. 

"  hsmorrhagio  diathesis,  i,  343. 

"  irritable  heart,  i,  343. 

"  local  inflammations,  i,  342. 

"  menorrhagia,  i,  342. 

"  migraine,  i,  342. 

"  mitral  insufficiency,  i,  341. 

"      "      stenosis,  i,  341. 

"  muscarine  poisoning,  i,  343. 

"  palpitation  of  the  heart,  i,  343. 

"  pericarditis,  i,  343. 

"  pneumonia,  i,  342. 

"  post-partum  haemorrhage,  i,  343. 

"  renal  dropsy,  i,  342. 

"  rheumatic  fever,  i,  342. 

"  scarlet  fever  (early  stages),  i,  342. 

"  spermatorrhoea,  i,  342. 

"  stenosis  of  the  tricuspid  oriflce,  i,  341. 

"  typhoid  fever,  i,  342. 

"  venous  congestion  of  mitral  and  tricuspid 
disease  (as  a  diuretic),  ii.  228. 

"  venous  en'gorgement,  i,  345. 

"  weak  cardiac  action,  i,  345. 
Digitin  i,  340. 

Digitonin,  Digitoxin.    See  under  Digitalis. 
Diiodoform,  i,  343. 

for    boils,    burns,    carbuncles,    wounds,    i, 
343. 

"  the  relief  of  pelvic  pains,  i,  343. 

in  neuropathic  hysteralgia,  i,  343. 
Diiodosalicylic  acid,  i,  343. 

in  articular  rheumatism,  i,  343. 
Diiodothiophene,  i,  343. 
Diisobutylorthocresol  iodide.    See  Burophene. 
Dill,  i,  344. 

in  flatulent  colic  of  infants,  i,  344. 
Diluents,  i,  344. 

Diraethylacetal.    See  under  Acetal. 
Dimethylethylcarbinol.       See   Amylenb    hy- 
drate. 
Dimethylketone.    See  Acetone. 
Dimethyloxyquinieine.     See  Antipyrine. 
Dimethylpiperazine  tartrate.     See  Lycetol. 
Dioleylleoithin.     See  Phosphoalbumin. 
Diosma.     See  Bdchu. 
Dioxyanthranol.     See  Anthbarobin. 
Diph'therin.    See  Oxyquinaseptol. 
Discutients.    See  Sorbefacients. 
Disinfectants.    See  Antiseptics. 
Disinfection  of  the  sick-room,  i,  443. 
Dispermine.     See  Pipeeazinb. 
Dita  bark.    See  Alstonia. 

in  malaria,  i,  118. 
Dithiosalicylic  acid,  i,  344. 

in  acute  articular  rheumatism,  i,  344. 
Dithymol  iodide.     See  Aristol. 

triiodide.    See  Annidalin. 
Diuretics,  i.  344. 

in  cystitis,  1,  346. 


Diuretics,  in  dropsy  due  to  cardiac  or  pul- 
monary disease,  i,  346. 

"  urethritis,  i,  346. 

stimulant,  ii,  228. 
Diuretin.     See   Sodio-theobromine   salicyl- 
ate. 
Djamboe,  i,  346. 

in  acute  gastro-enteritis,  i,  346. 

•'  dyspepsia,  i,  346. 

"  infantile  diarrhoea,  i,  346. 
DobelFs  solution,  i,  210. 
Dolichos.    See  Mucuna. 
Donovan's  solution,  i,  146,  627. 
Dorstenia.    See  Contbayerva. 
Doses,  i,  346. 

Dr.  Clarke's  method  for   determining,  ac- 
cording to  weight,  i,  347. 

Dr.    Cowling's    rules    for    determining,    i, 
347. 

Dr.  Young's  rule  for  determining,  i,  347. 

effect  of  habit  on,  i,  347. 

method  of  administration  of,  i,  348. 

time  for  administration  of,  i,  348. 
Douche,  ascending,  i,  349. 

aural,  i,  349. 

bell,  i,  349. 

cold  effects  of,  i,  348. 

in  chlorosis,  i,  491. 

"  chronic  gastric  disease,  i,  491. 

"  gout,  i,  491. 

"  rheumatism,  i,  491. 

"  simple  aniemia,  i,  491. 

columnar,  i,  349. 

compressed-air,  i,  349. 

concentric,  i,  349. 

descending,  i,  348. 

gas,  i,  349. 

horizontal,  i,  349. 

lumbar,  i,  349. 

nasal,  i,  349. 

ocular,  i,  349. 

rain,  i,  349. 

ring,  i,  349. 

sheet,  i,  349. 

splenic,  i,  349. 

steam,  i,  349. 

vapour,  i,  349. 

warm,  in    diseases  of  the    spinal    cord,  i, 
491. 
Douches,  i,  348. 
Drastics,  i,  349. 
Draughts,  i,  349. 
Dressings,  i,  129. 
Drinks,  i,  350. 

effects  of  cold  or  iced,  i,  350. 
Drops,  i,  352. 
Duboisine,  i,  352. 

as  a  mydriatic,  i,  649. 

in  acute  mania,  i,  353. 

"  cardiac  failure,  i,  353. 

"  insanity,  i,  353. 

"  morphine  poisoning,  i,  353. 

"  night  sweats  of  phthisis,  i,  358. 

"  paralysis  agitans,  i,  353. 

"  puerperal  mania,  i,  353. 

"  respiratory  neuroses,  i,  353. 
Dulcamara,  i,  353. 

in  bronchitis,  i,  353. 

"  chronic  catarrh,  i,  353. 

"  dropsy,  i,  353. 


488 


GENERAL  INDEX. 


Dulcamara,  in  gout,  i,  353. 

"  jaundioo,  i,  353. 

"  lepra,  i,  353. 

"  psoriasis,  i,  353. 

"  rheumatism,  i,  353. 
Buloin,  i,  353. 

in  diabetes,  i,  353. 
Ductal,  ii,  433. 

Earths,  i,  353. 

Ecballium.     See  Elaterium. 

Ecbolics.  See  Abortifacients  and  Oxytocics. 

Eeboline.    See  under  Eegot. 

Eoooprotics,  i,  354. 

Edulcorants.     See  Coerigents. 

Effervescing  preparations,  i,  355. 

Egg  broth,  i,  356. 

flip,  in  asthenic  conditions,  i,  355. 
Eggs,  i,  355. 

and  brandy  in  anaemia,  i,  355. 
"         "        "  cardiac  feebleness,  i,  355. 

and  coffee  in  malniitrition,  i,  354. 
"         "       "  nervous  exhaustion,  i,  355. 

and  liraewater  for  dandruff,  i,  356. 

white  of,  in  poisoning  with  corrosive  sub- 
limate, i,  355. 

yolk  of,  and  ginger,  for  dyspepsia,  i,  355.      , 
Elseomyenchysis,  i,  356. 
Elaeosacchara,  i,  857. 

Elastic  compression  of  the  chest  in  asthma,  i,  92. 
Elastica.    See  Rubber. 
Elaterin,  i,  357. 

in  dropsy,  i,  357. 
Elaterium,  i,  357. 

in  ascites,  i,  358. 

"  cerebral  affections  (as  a  revulsive  and  de- 
pleting agent),  i,  358. 

"  congestion  (as  a  revulsive  and  depleting 
agent),  i,  358. 

"  dropsy,  i,  358. 

"  pericarditis,  i,  358. 

"  pleurisy,  i,  358. 

"  uraemia,  i,  358. 
Electrical  stimulation  in  asthma,  i,  93. 
Electricity,  i,  358. 

alternating  sinusoidal  current,  i,  359. 

as  an  emmenagogue,  i,  375. 
"    oxytocic,  ii,  55. 

cataphoresis,  i,  361. 

condensed  list  of  nervous  disorders  and  the 
modes  of  application  of,  where  it  is  indi- 
cated, i,  366. 

destruction  of  aneurysms  by,  i,  361. 

frictional,  i,  359. 

(as  a  stimulant)  in  apncea,  ii,  326. 
"  "  "  asphyxia,  ii,  226. 

in  blepharospasm,  365. 

"  clonic  spasm,  i,  365. 

"  hypochondriasis,  i,  366. 

"  narcotism  (as  a  stimulant),  ii,  226. 

"  neuralgia  from  impaired  nutrition,  i,  68. 

"  neurasthenia,  i,  366. 

"  orthopnosa  (as  a  stimulant),  ii,  226. 

"  paralysis,  i,  365. 

"  railway  brain,  i,  366. 

"        "       spine,  i,  366. 

"  the  removal  of  superfluous  hairs,  i,  361. 

"  tic  convulsif,  i,  365. 

"  tonic  spasm,  i,  365. 

"  torticollis,  i,  365. 


Electricity,  in  writer's  cramp,  i,  365. 

methods  of  employing,  i,  365. 

physiological  effects  of,  i,  362. 

production  of  heat  and  light  by,  i,  361. 

refreshing  effects  of,  i,  368. 

resistance  of  the  human  body  to,  i,  361.  _ 

resuscitation  of  persons  apparently  killed 
by,  i,  369. 

static,  i,  359. 

testing  the  hearing  by,  i,  363. 
"     sight  by,  i,  363. 
"        "    smell  by,  i,  363. 
"        "    taste  by,  i,  363. 

tumours  treated  by,  i,  361. 

vaso-motor  effects  of,  i,  362. 
Electrolysis,  i,  361. 
Electro-magnet,  i,  360. 
Electrozone,  i,  369. 
Electuaries,  i,  369. 
Elerai,  i,  369. 

in  indolent  ulcers  (externally),  i,  369. 
Elixirs,  i,  369. 
EUer's  drops,  i,  58. 
Elm.     See  Umius. 
Embelia  ribes,  i,  370. 

in  tapeworm,  i,  370. 
Embelic  acid.    See  under  Embelia  kibes. 
Embrocations.    See  Liniments. 
Emetics,  i,  370. 

action  of,  i,  370. 

centric,  i,  371.. 

direct,  in  narcotic  poisoning,  371. 

in  bronchitis  of  children,  373. 

peripheral,  i,  371. 

systemic,  i,  371. 
Emetine.    See  Ipecacuanha. 
Emeto-oathartics,  i,  374. 
Emmenagogue,  Dewees's,  i,  875. 

Goodell's,  i,  375. 
Emmenagogues,  i,  374. 
Emol,  i,  876. 

for  the  removal  of  horny  growths,  i,  376. 

in  eczema  of  the  palm  and  sole,  i,  376. 

"  itching  of  urticaria,  i,  376. 

keratosis  of  the  soles  and  palms,  i,  376. 
Emollients,  i,  376. 
Emplastra.    See  Plasters. 
Emulsions,  i,  376. 
Endermic  medication,  i,  377. 
Enemata,  i,  377. 
Ephedra,  i,  385. 

antisyphilitica  in  gonorrhoea,  i,  385. 

in  acute  articular  rheumatism,  i,  385. 

"      "      muscular  rheumatism,  i,  385. 

"  chronic  articular  rheumatism,  i,  385. 

"        "       muscular  rheumatism,  i,  385. 

"  constipation,  i,  385. 

"  diarrhoea,  i,  385. 

"  gout,  i,  385. 

•'  rheumatic  osteomyelitis,  i,  385. 

"  sciatica,  i,  385. 

trifurcata  (as  a  styptic)  in  gonorrhoea,  i,  385. 

(.  ti        ((  '  -         -  — 

Ephedrine,  i,  385. 

homatropine.  i,  386. 
Epidermin,  i,  386. 

Epilation  in  favus  of  the  scalp,  i,  117. 
Epispastics.    See  Blisters. 
Epithems,  i,  886. 
Ergot,  i,  386. 


GENERAL  INDEX. 


489 


Ergot,  and  sodium  phosphate  in  algidity  of 
fevers  (first  stages),  i,  389. 
and    sodium    phosphate    in    cholera    (first 

stage),  i,  389. 
and  sodium  phosphate  in  neuroses  accom- 
panied by  mental  depression,  i,  389. 
and  sodium  phosphate  in  senile  exhaustion, 

i,  389. 
and  sodium  phosphate  in   tardy  convales- 
cence, i,  389. 
and  sodium  phosphate  in  tuberculosis,  i,  389. 
as  an  anthidrotic,  i.  103. 

"     oxytocic,  i,  387. 
for  after-pains,  i,  388. 
in  congestion  of  the  spinal  cord,  i,  388. 
"  deficient  tone  of  the  genital  organs,  i,  388. 
"  dysentery,  i,  388. 
"  enlarged  prostate,  i,  388. 
"  enuresis,  i,  388. 

"  epilepsy  (to  increase  the  action  of  bro- 
mides), 1,  388. 
"  epistaxis,  i,  388. 
"  galaotorrhcea,  i,  388. 
"  hsematuria,  i,  388. 
"  hsEmorrhaLje,  i,  388. 
"  hiemorrhoids,  i,  388. 
"  impotence  (hypodermically),  i,  388. 
"  metrostaxis,  1,  388. 
"  night  sweats,  i,  388. 
"  pulmonary  haemorrhage,  i,  388. 
"  spermatorrhoea,  i,  388. 
"  uterine  haemorrhage,  i,  388. 
"  varicose  veins,  i,  388. 
Ergotin,  Ergotine,  Ergotinine,  i,  389. 
Ergotinura,  i,  390. 
Ergot  of  maize,  i,  389. 

in  primary  uterine  atony,  i,  389. 
Ergotole,  i,  389. 
in  erysipelas  (locally),  i,  389. 
"  hyperaemia  (locally),  i,  389. 
"  phlegmonous  inflammation  (locally),  i,389, 
Erigeron,  i,  390. 
in  dropsy,  i,  390. 
oil  of,  in  diarrhoea,  i.  390. 
"      "  dysentery,  i,  390. 
"      "  epistaxis,  i,  390. 
"      "  gonorrhoea,  i,  390. 
"      "  haemoptysis,  i,  390. 
"      "  intestinal  haemorrhage,  i,  390. 
"      "  menorrhagia,  i,  390. 
"      "  metrorrhagia,  1,  390. 
"      "  uterine  haemorrhage,  i,  390. 
Eriodictyon.    See  Yeeba  santa. 
Erodium  cicutarium,  ii,  433. 
as  an  astringent  and  diuretic,  ii,  433. 

in  uterine  haemorrhage,  ii,  433. 
Errhines.     See  Steknutatories. 
Erysipelatous  inoculation.   See  under  Toxines. 
Erythrophloeine,  i,  390. 

(hypodermically)  in  locomotor  ataxia),  i,  390. 
"  "  sciatica,  i,  390. 

"  "  spinal  irritation,  i,  390. 

Erythroxylon.    See  Coca. 
Eseridine,  i,  391. 
Eserine,  i,  391. 
in  accommodative  asthenopia,  i,  392. 
"  cataract,  i.  392. 

(internal  administration)  in  chorea,  i,  393. 
in  episcleritis,  i,  392. 
"  glaucoma,  i,  391. 


Eserine,  in  gonorrhoea!  ophthalmia,  i,  393. 

in  mydriasis,  i,  392. 

"  neuralgia  of  the  eyeball,  i,  393. 

(internal  administration)  in  night-sweats  of 
phthisis,  i.  393. 

in  ophthalmia  neonatorum,  i,  393. 

"  paralytic  mydriasis  following  diphtheria, 

i,  393. 
"  phlyctaenular  keratitis,  i,  392. 
"  photophobia,  i,  392. 
"  ulcerative  keratitis,  i,  392. 

physiological  action  of,  i,  391. 

with  bromides,  in  strychnine  poisoning,  i,  392. 
Essences,  i,  393. 
Ether,  i,  393. 

and  alchohol,  as  a  heart  stimulant,  ii,  227. 

nitrous  oxide,  as  a  preliminary  measure  be- 
fore inhaling,  i,  3i34. 

and  oxygen,  as  an  angesthetic,  ii,  53. 

as  an  antemetic,  i,  99. 

as  a  sedative,  i,  538. 
"     solvent,  ii,  312. 

camphorated,  in  cerebral  affections,  i.  304. 
"  "  peritonitis,  i,  204. 

cardiac  failure  during  anjesthesia  by,  i,  396. 

cone,  i,  394. 

eflfect  of,  on  the  respiration,  i,  395. 

for  puerperal  eclampsia,  i,  397. 

(internally)  in  abdominal  colic,  i,  397. 

in  A.  C.  E.  mixture,  i,  1. 

(by  hypodermic  injection)  in  aconite  poison- 
ing, i,  7. 

(internally)  in  ascarides,  i,  397. 

(hypodermically)  in  cardiac  failure,  i,  397: 
"ii,  227. 

(subcutaneouslv)  in  chloroform  anaesthesia, 
ii,  227. 

(subcutaneouslv)  in  collapse,  i,  397. 

in  croup,  i,  528. 

(subcutaneously)  in  infantile  convulsions,  i, 
397. 

(subcutaneously)   in   intense   depression    of 
acute  infectious  diseases,  i,  397. 

(subcutaneously)  in  narcosis,  ii,  226. 

in  nausea,  i,  99. 

(internally)  in  nervous  headache,  i,  397. 

in  pathological  work,  i,  397. 

"  severe  pains  of  labour  i,  397. 

(internally)  in  spasmodic  vomiting  of  preg- 
nancy, i,  397. 

(internally)  in  tapeworm,  i,  397. 

manner  of  administering,  i,  395. 

position  of  patient  during  anaesthesia  by,  i, 
394. 

preparation  of  patient  for  anaesthesia  by,  i, 
394. 

spray  in  earache  i,  397. 

"       "  nervous  headache,  i,  397. 
"      "  neuralgic  affections,  i,  397. 
"      "  toothache,  i.  397. 

sulphuric,  in  neuralgia,  i,  69. 

treatment  of  shock  (3uring  anassthesia,  i,  396. 

versus  chloroform,  i,  397. 

vomiting  during  anaesthesia  by,  i,  396. 
Ethoxycaffeine,  i.  398. 

in  migraine,  i,  398. 
Ethylate  of  sodium  in  ringworm,  i,  117. 

bromide,  i,  398. 

(internally)  in  neuralgia,  i,  399. 
Ethyl  carbamate.    See  Urethane. 


490 


GENERAL  INDEX. 


Ethyl  chloride,  i,  399, 

as  a  dental  ansesthetic,  ii,  434. 
(spray)  as  an  analgetic,  ii,  434. 
"       in  asthma,  ii,  434. 
"        "  conjunctivitis  and  iritis,  ii,  434. 
"        "  epididymitis,  ii,  434. 
"       "  epistaxis,  ii,  434. 
"        "  hsemorrhage,  ii,  434. 
"        "  headache  of  influenza,  ii,  434. 
"        "  hiccough,  ii,  434. 
in  meningitis,  ii,  434. 
"  migraine,  ii,  434. 
"  pleurodynia,  ii,  434. 
"  pruritus,  ii,  434. 

"  shingles  (for  relief  of  pain),  ii,  434. 
"  spasmodic  dyspnoea,  ii,  434. 
"  in  sunstroke,  ii.  434. 
iodide,  i,  399. 

"      in  bronchitis,  i,  399. 
"      inhalations  in  hay  asthma,  i,  538. 
"  "  "  spasmodic  dyspnoea,  i, 

528. 
iodide  in  syphilitic  disease  of  the  air-pas- 
sages, i,  528. 
Ethylene  bromide,  i,  399. 
in  epilepsy,  i,  399. 
periodide.     See  DiroDOFORM. 
Ethylphenacetine.     See  under  Phenacetine. 
Ethylurethane.     See  Ueethane. 
Bueaine,  ii,  434. 
as  an  anaesthetic,  ii,  435. 
for  infiltration  ansesthesia,  ii,  435. 
for  subcutaneous  ansesthesia  for  the  opening 
of  abscesses  or  removal  of  tumours  or 
growths,  ii,  435. 
Eucalypteol,  i,  399,  400. 
in  acute  bronchitis,  i,  401. 
"  chronic  bronchitis,  i,  401. 
Euoalyptol.     See  under  Eucalyptus. 
in  acute  and  subacute  inflammations  of  the 

larynx,  i,  529. 
"  cholera,  i,  400. 
"  enteritis,  i,  400. 
"  gastric  catarrh,  i,  400. 
inhalation  in  amygdalitis,  i,  539. 
in  chronic  bronchitis,  i,  539. 
"  diphtheria,  i,  529. 
"  whooping-cough,  i,  529. 
"  tuberculosis,  i,  539. 
"  intestinal  catarrh,  i,  400. 
"  typhoid  fever,  i,  400. 
Eucalyptus,  i,  399. 
and  terebene,  oils  of,  in  headache  of  malarial 

disease  or  congestion,  i,  400. 
cigarettes  in  asthma,  i,  400. 
in  malarial  fevers,  i,  118. 
oil  of,  in  acute  bronchitis,  i,  400. 
in  acute  catarrh,  i,  400. 
"  chronic  bronchitis,  i,  400. 
"  enteritis,  i,  400. 
"  gastric  catarrh,  i,  400. 
"  headache,  i,  400. 
"  intestinal  catarih,  i,  400. 
(internally)  in  scarlet  fever,  i,  400, 
in  strychnine  poisoning,  ii,  435, 
"  typhoid  fever,  i,  400. 
"  ulcers,  i,  400. 
"  wounds,  i,  400. 
Eucasin,  ii,  435. 
in  anaemia,  ii,  436. 


Eucasin,  in  gout,  ii,  436. 
in  laryngeal  tuberculosis,  ii,  436. 
"  pararaet'  itis,  ii,  436. 
"  perimetritis,  ii,  436. 
"  pulmonary  tuberculosis,  ii,  436. 
"  typhlitis,  ii,  436. 
"  uric-acid  diathesis,  ii,  436. 
Eudoxine,  ii.  436. 

as  an  intestinal  antiseptic,  ii,  436. 
Buquinine,  ii,  436. 
Eugenic  acid,  i,  401. 
Eugenol,  i,  373,  401. 
acetamide,  i,  401. 
iodized,  i,  401. 
Eulachon  oil,  i,  401. 
Eulyptol,  i,  401. 

Euonymin  in  torpor  of  the  liver,  i,  401. 
Euonymus,  i,  401. 
Eupatorium,  i,  401. 
Euphorbia,  i,  401. 
chilensis,  i,  401. 
heterodoxa.     See  Alvbloz. 
hypericifolia,  i,  401. 

"  in  diarrhcea,  i,  401. 

'•  "  dysentery,  i,  401. 

"  "  leucorrhoea,  i,  401. 

"  "  menorrhagia,  i,  401. 

maculata.    See  Euphorbia  hypericifolia. 
ocellata,  i,  401. 

"        in  bites  of  poisonous  snakes,  i,  401. 
pilulifera,  i,  401. 

"         in  asthma,  i,  401. 
'■■  "  chronic  bronchitis,  i,  401. 

"  "  dyspnoea,  i,  401. 

prostata.    See  Euphorbia  ocellata. 
Euphorbium,  i,  401. 
in  indolent  ulcers,  i,  401. 
"  unhealthy  suppurating  surfaces,  i,  401. 
Euphorin,  i,  401. 
in  chronic  articular  rheumatism,  i,  402. 
"  fevers,  i,  402. 
"  migraine,  i,  403. 
"  muscular  rheumatism,  i,  402. 
"  rheumatic  fever,  i,  402. 
"  skin  diseases  of  parasitic  origin,  i,  402. 
"  surgical  fever,  i,  402. 
(as  a  local  disinfectant)  in  aphthous  stoma- 
titis, i,  402. 
(as  a  local  disinfectant)  in  burns,  i,  403. 
"  herpes,  i,  402. 
in  sciatica,  i,  403. 
(by  insufflation)  in  uterine  endotrachelitis,  i, 

402. 
in  venereal  ulcers,  i,  402. 
(in  powder  or  solution)  in  ulceration  of  the 
cervix  uteri,  i,  402. 
Europhene  (as  a  dressing)  for  burns,  i,  402. 
(by  insufflation)  in  catarrhal  conditions,  i, 

403. 
in  epistaxis,  1,  403. 
(by  insufflation)  in  ozaena,  i,  403. 
in  syphilitic  ulceration,  i,  403. 
in  powder  or  ointment  in  cliancre,  i,  402. 

"  chancroid,  i,  402. 
"        "        "         "  "  condvloma.  i,  402. 

"       "       "         "  "  lupus,  i,  403. 

"       "         "  "  scrofuloderma,     i, 

402. 
"  powder  or  ointment  in  ulcerations,  i,  402. 
Eurythrol.    See  Splenic  extract. 


GENERAL  INDEX. 


491 


Evaeuants,  i,  402. 
Exalgine,  i,  403. 

as  an  anodyne,  i,  68. 

in  angina,  i,  403. 

"  gouty  arthritis,  i,  403. 

"  headache  of  melancholia,  1,  403. 

"  hemicrania,  i,  403. 

"  insomnia  of  melancholia,  i,  403. 

"  lumbago,  i,  403. 

"  nervous  headache,  i,  403. 

"  neuralgia,  i,  69,  403. 

"  rheumatism,  i,  403. 

"  sciatica,  i,  403. 

"  simple  chorea,  i,  403. 

"  the  lightning  pains  of  tabes,  i,  403. 
Excitants,  i,  403. 
Exercise,  i,  404;  ii,  436. 

effect  and  importance  of,  i,  408. 

effects  of,  on  the  muscles,  i,  407. 

for  old  people,  i,  410. 

in  flat-foot,  i,  416. 

(vocal  and  respiratory)  in  laryngeal  disor- 
ders, i,  417.    . 

in  lateral  curvature  of  the  spine,  i,  416. 

"  the  development  and  culture  of  the  mind, 
i,  414. 

"  the  treatment  of  cardiac  and  circulatory 
affections,  i,  415. 

Ling's  system  of,  i,  413. 

proper  conditions  under  which,  should  be 
taken,  i,  409. 

Swedish  system  of,  i,  418. 

systemic   passive   respiratory,  in  Basedow's 
disease,  i,  415. 

therapeutics  of,  i,  411. 

treatment  of  the  insane  by,  i,  413. 
Exodyne,  i,  4:|.7. 
Expectant  treatment,  i,  417. 
Expectorants,  i,  417. 

stimulating,  ii,  227. 
Extracts,  i,  419. 

Faba  calabarica.     See  Physostigma. 

Pabiana  imbricata.     See  PioHi. 

Paradaism,  i,  359. 

Paradizatiou.     See  under  Electeicity. 

Parfara.    See  Tussilago. 

Pats,  i,  419. 

in  poisoning  with  carbolic  acid,  i,  109. 

"  "  "     corrosive  acids,  i,  109. 

"  "  "     metallic  oxides,  i,  109. 

"  "         by  metallic  salts,  i_,  i09. 

(by  inunction)  in  scarlet  fever,  i,  430. 
Pebrifuges,  i,  421. 
Febriline,  i,  421. 
Feeding,  forced.    See  under  Alimentation  and 

Gavage. 
Feeding.    See  Alimentation,  Dietetic  treat- 
ment. Foods,  and  Milk. 
Pel  bovinum.     See  Ox  gall. 
Fennel.    See  Fcenioulum. 
Fern,  male.     See  Aspidium. 
Ferratin,  i,  421. 

Perripyrine.     See  Fbreopyrine. 
Perrohjemol,  i,  422. 
Perropyrine,  i,  422. 

(by  injection)  in  blennorrhagia,  i,  422. 

in  nasal  hEemorrhage,  i,  422. 
Ferruginous  preparations.    See  Iron. 
Ferrum.    See  Iron. 
75 


Picus,  Pigs,  i,  422. 

Pilix  mas.    See  Aspidium. 

Filmogen,  ii,  436. 

Fir-wood  oil  in  rheumatism,  ii,  87. 

inhalation  in  chronic  laryngitis,  ii,  88. 
Fir  wool,  i,  422. 
Flaoourtia,  i,  423. 

in  diarrhoea,  i,  422. 

"  general  debility,  i,  422. 

"  hoarseness,  i,  423. 

"  nausea,  i,  422. 
Flag,  blue.    See  Iris. 

sweet.  See  Calamus. 
Flaxseed.  See  Linseed. 
Flaxseed  tea,  i,  351. 

in  dysentery,  i,  351. 

"  irritable  conditions  of  the  genito-urinary 
tract,  i,  351. 
Flour,  i,  423. 

baked,  as  a  food  in  infantile  diarrhoea,  i, 
423. 

boiled,  in  gastro-intestinal  indigestion,  i,  423. 

wheat,  in  burns,  i,  423. 

"       "  erythematous  eruptions,  i,  433. 
"       "  pruritic  eruptions,  i,  433. 
Fluorescein,  i,  433. 
Pluoral,  i,  423. 
Poeniculum,  i,  434. 
Fomentations,  i,  434. 

hot,  in  colic,  i,  469. 
Poods,  i,  424. 

animal,  i,  426. 

preservation  of,  i,  427. 

vegetable,  i,  425. 
Forced  feeding,  i,  43. 
Formaldehyde,  i,  427 ;  ii,  436. 

as  a  disinfectant,  ii,  436. 

in  acute  conjunctival  diseases,  i,  428. 
"  blennorrhagic  cystitis,  i,  428. 

"  "  urethritis,  i,  428. 

"  catarrhal  affections  of  the  vagina  and  cer- 
vix uteri,  i,  428. 
"  gonorrhoeal  affections,  i,  428. 
"  hay  fever,  ii,  436., 
"  pruritus  vulvae,  ii,  436. 
"  purulent  cystitis,  i,  428. 
"  tuberculous  cystitis,  i,  428. 
"  whooping-cough,  ii,  436. 
Formalin.    See  Formaldehyde. 
Formanilide,  i,  429. 
Pormalose.    See  Formaldehyde. 
Formic-acid  compounds,  i,  439. 

(in  powder)  for  ulcerated  surfaces,  i,  429. 

in  laryngeal  carcinoma,  i,  439. 

(in  spray)  in  laryngeal  tuberculosis,  i,  429. 
Formic    aldeliyde.  Formal.    See    Formalde- 
hyde. 
Pormogelatin,  ii,'437. 
Pormyl  chloride.    See  Chloroform. 

tribromide.    See  Bromoform. 

triiodide.    See  Iodoform. 
Foxglove.    See  Digitalis. 
Franciscea.    See  Manaca. 
Prangula,  i,  429. 

in  constipation,  i,  429. 
Fraxinin.    See  under  Manna. 
Friction.    See  Massage. 
Prigotherapy,  i,  439. 

in  dyspepsia,  i,  439. 
Fruit  syrups,  ii,  253. 


492 


aENBRAL  INDEX. 


Fuller's  earth.    See  under  Earths.^ 

in  undue  secretions  of  the  siiin,  i,  354. 
Fumigation,  i,  430. 
calomel,  in  cramp  and  diphtheria,  i,  625. 

"         "  in  syphilis,  i,  634. 
mercurial,  in  croup,  i,  430. 

"  "  laryngeal  diphtheria,  i,  430. 

"  •'  syphilis,  i,  430. 

stramonium,  in  spasmodic  asthma,  i,  430. 
sulphur,  in  chronic  skin  diseases,  i,  430. 
"         "  muscular  rheumatism,  i,  430. 
"         "  neuralgia,  i,  430. 
"         "  sciatica,  i,  430. 

Gaduol.    See  Mobrhuol. 
Galaotagogues,  i,  430. 

Galactose.    See  under  Sugar  (vol.  ii,  page  235), 
Galactotherapy.     See    under    Serum    treat- 
ment (vol.  ii,  page  187). 
Galangal,  i,  431. 
Galazyme,  i,  431. 
Galbanum,  i,  481. 
(internally)  in  amenorrhoea,  i,  432. 

"  "  chronic  bronchitis,  i,  432. 

"  chlorosis,  i,  433. 
"  "  chronic  rheumatism,  i,  432. 

"  hysteria,  i,  432. 
Galega,  i,  432. 
Galium,  i,  432. 
Galla.    See  Galls. 
Gallacetophenone,  i,  432. 

(externally)  in  psoriasis,  i,  432. 
Gallal,  i,  433. 
Gallanilide,  i,  432. 
(topically)  in  chronic  eczema,  i,  432. 
"  "  psoriasis,  i,  433. 

Gallanol,  i,  432. 
Gallic  acid,  i,  433. 
(internally)  in  haemoptysis,  i,  432. 

"  for  hasmorrhages,  i,  432. 

in  acute  nephritis,  i,  432. 
"  albuminuria,  i,  432. 
"  bronohorrhcea,  i,  432. 
"  colliquative  sweating,  i,  432. 
"  diabetes  insipidus,  i,  433. 
"  hsematuria,  i,  432. 
"  haemophilia,  i,  432. 
"  metrorrhagia,  i,  433. 
"  ulcers,  i,  432. 
Gallioin,  i,  432. 
in  conjunctivitis,  i,  432. 
"  keratitis,  i,  432. 
Gallobromol,  i,  433. 
(by  compress)  in  acute  eczema,  i,  433. 
(by  injection)  in  chordee,  i,  433. 
(internally)  in  chorea,  i,  433. 

"  "  epilepsy,  i,  433. 

(by  injection)  in  gonorrhcea,  i,  433. 
Gallol.    See  Gallanol. 
Galls,  i,  433. 
in  chronic  diarrhoea,  i,  433. 
"  painful  hsemorrhoids,  i,  433. 
"  poisoning  with  an  alkaloid,  i,  433. 
Galvanism.    See  Electricity. 
Gamboge,  i,  433. 
and  calomel  in  malarial  congestion  of  the 

liver,  i,  433. 
in  engorgement  of  the  portal  circulation,  i, 

433. 
"  flatulence,  i,  433. 


Gamboge  in  intestinal  indigestion,  i,  433. 
Gargles,  i,  433 ;  ii,  437. 
Garlic,  i,  434. 
Gaultheria,  i,  434. 
in  rheumatism,  i,  124,  135,  434. 
"  gastro-enteritis,  i,  435. 
Gavage,  i,  435. 
and  lavage  in  chronic  disorders  of  the  stom- 
ach, i,  436. 
for  infants  prematurely  born,  i,  436. 
in  anorexia,  i,  436. 
"  brain  disease,  i,  436. 
"  broncho-pneumonia,  i,  436. 
"  diphtheria,  i,  436. 
"  empyema,  i,  436. 

"  irritable  stomach  of  phthisis,  i,  436. 
"  phthisis,  i,  435. 
"  scarlet  fever,  i,  436. 
"  spasm  of  the  oesophagus,  i,  436. 
"  typhoid  fever,  i,  436. 
"  vomiting,  i,  436. 
Geissospermine,  i,  436. 
Geissospermum  laeve,  i,  436. 
Gelanth,  Gelanthum.    See  under  Varnishes. 
Gelanthum  (Unna's  treatment)  in  dry  eczema, 
ii,  349. 
in  eczema  of  the  hand,  ii,  349. 
"  excessively  dry  skin,  fissures,  etc.,  ii,  349. 
preparation  of,  ii,  349. 
Gelatin  in  poisoning  by  alum,  i,  109. 

in  poisoning  by  bromine,  i,  109. 
Gluten  in  poisoning  by  corrosive  sublimate,  i, 

109. 
Gelsemine,  i,  436. 
Gelsemium,  i,  436. 
as  a  motor  depressant,  i,  644. 
in  asthma,  i,  437. 
"  chorea,  i,  437. 
"  dysmenorrhcea,  i,  437. 
"  eczema,  i,  437. 
"  facial  spasm,  i,  437. 
"  fever,  i,  436. 

"  hacking  cough  of  phthisis,  i,  437. 
'•  inflammation,  i,  437. 
"  laryngismus  stridulus,  i,  437. 
"  malarial  disease,  i,  437. 
"  mania  with  motor  excitement  and  wake- 
fulness, i,  437. 
"  neuralgia,  i,  69,  437. 
"  ovarian  neuralgia,  i,  69. 
"  pleurisy,  i,  437. 
"  pneumonia,  i,  437. 
"  sciatica,  i,  437. 
"  spasmodic  conditions,  i,  437. 
"  trigeminal  neuralgia,  i,  69. 
"  whooping-cough,  i,  437. 
Gentian,  i,  437. 
and  capsicum  in  vomiting  of  drunkards,  i, 

100. 
and  ginger  in  vomiting  of  drunkards,  i,  100. 
Geoffraea.    See  Andira. 
Geosite,  ii,  437. 
in  acute  gastric  catarrh,  ii,  437. 
"  chlorosis,  ii,  437. 
"  rheumatism,  ii,  437. 
"  tuberculosis,  ii,  437. 
Geranium,  i,  437. 
in  diarrhoea,  i,  438. 
"  dysentery,  i,  438. 
by  injection  in  gonorrhoea,  1,  438. 


GENERAL  INDEX. 


493 


Geranium  in  haemorrhages,  i,  438. 
(topically)  in  indolent  ulcers,  i,  438. 

"  "  inflammatory  affections  of  the 

throat,  i,  438. 
in  leucorrhoea,  i,  438. 
Germander,  i,  438. 
Germicides,  i,  438. 
Gin,  i,  449. 

in  dysmenorrhoea,  i,  449. 
Ginger,  i,  449. 
and  oalumba  in  vomiting  of  drunkards,  i,  100. 
"    gentian  in  vomiting  of  drunkards,  i,  100. 
"   serpentaria  in  vomiting  of  drunkards,  i, 
100. 
troches  of,  in  catarrhal    aflections  of  the 
mouth  and  throat,  i,  449. 
Glacialin,  i,  449. 
Glonoin.    See  Nitroglycerin. 
Gluco-chloral.     See  Chloralose. 
Glucose.    See  under  Sugar  (vol.  ii,  page  235). 
Glucosides.    "See  under  Active  principles. 
Glue,  i,  449. 
suppositories  of,  in  habitual  constipation,  i, 
449. 
Gluside.     See  Saccharin. 
Gluten,  i,  449. 
bread  in  diabetes  mellitus,  i,  449. 
-peptone  sublimate,  i,  450. 
Glutei,  ii,  488. 
as  an  antiseptic,  ii,  438. 
in  ulcers  and  wounds,  ii,  438. 
"  weeping  affections  of  the  skin  and  mucous 
membranes,  ii,  438. 
GlyoelsBum,  i.  450. 

Glycerates,  Glycerides.     See  Gltceeites. 
Glycerin,  i,  450. 
and  carbolic  acid  in  acute  coryza,  i,  450. 
"         "  "     "  acute  pharyngitis,  i,  450. 

"         "  "     "  amygdalitis,  i,  450. 

"         "  "     "  hay  fever,  i,  450. 

as  a  laxative,  i,  450. 
"   solvent,  ii,  212. 
(internally)  for  flatulence,  i,  451. 
"  "   hEemorrhoids,  i,  451. 

"  "    heartburn,  i,  451. 

in  acne,  i,  450. 

enema  in  acute  diarrhoea,  i,  451. 
(intra-uterine    injections)  in  atony   of   the 

uterus,  i,  450. 
in  biliary  lithiasis,  i,  451. 
'•  chapping  of  the  hands  and  lips,  i,  450. 
"  eczema,  i,  450. 
"  fissures,  i,  450. 
"  hepatic  colic,  i,  451. 
injections  in  constipation,  i,  450. 
"  "  fsecal  impaction,  i,  451. 

"  "  haemorrhoids,  i,  450. 

"  (between   the  ovum  and  uterine 

wall)  in  labour,  ii,  55. 
injections  in  ulcer  of  the  rectum,  i,  450. 
(intra-uterine  injections)  in  placenta  praevia, 
_  i,  450. 

in  pruritus,  i,  450. 
'■  psoriasis,  i,  450. 
"  trichiniasis,  i,  451. 
"  tuberculosis,  i,  451. 
poisoning,  ii,  438. 

suppositories  in  dysmenorrhoea,  i,  450. 
"  "  endometritis,  i,  450. 

"  "  endotrachelitis,  i,  450. 


Glycerin  suppositories  in  pelvic  cellulitis,  i, 
450. 

suppositories  in  salpingitis,  i,  450. 

"  "  uterine  congestion,  i,  450. 

Glycerines,  Glycerites,  Glyceroles,  i,  451. 
Glycerophosphates,  ii,  438. 
in  Addison's  disease,  ii,  439. 

"  anaemia,  ii,  439. 

"  chlorosis,  ii,  439. 

"  chronic  nephritis,  ii,  439. 

"  convalescence  from  acute  disease,  ii,  439. 

"  diabetes,  ii,  439. 

"  gout,  ii,  439. 

"  cbesity,  ii,  439. 

''  phosphaturia,  ii,  439. 

"  pulmonary  phthisis,  ii,  439. 

"  sciatica,  ii,  439. 

"  trigeminal  neuralgia,  ii,  439. 

"  uric-acid  diathesis,  ii,  439. 
Glyceryl  nitrate.    See  Nitroglycerin. 
Glyconin,  i,  451. 
Glycozone,  i,  451. 
Glycyrrhiza.    See  Licorice. 
Glycyrrhizinum  ammoniatum,  i,  451. 
Gnaphalium,  i,  451. 

in  diarrhoea,  i,  451. 

"  dysentery,  i,  451. 
Goa  powder.     See  under  Chrtsarobin. 
Gold,  i,  451. 

and  arsenic  in  cancer,  i,  454. 
"  phthisis,  i,  454. 

and  sodium  chloride  in  sclerosis,  i,  454. 

bromide  for  inebriety,  i,  454. 
"        in  chorea,  i,  454. 
"         "  epilepsy,  i,  454. 
"         "  exophthalmic  goitre,  i,  454. 
"         "  hysteria,  i,  454. 

chloride  in  habitual  abortion,  i,  453. 
"         "  nervous  dyspepsia,  i,  454. 
"       (as  a  caustic)  in  ulceration  of  the 
cervix  uteri,  i,  453. 

cure  in  inebriety,  i,  454. 

cyanide  in  scrofula,  i,  322,  453. 
"        "  syphilis,  i,  322. 

in  amenorrhcea,  i,  453. 

"  anaemia,  i,  454. 

"  catarrh  of  the  duodenum  and  bile  ducts, 
i,  454. 

"  chlorosis,  i,  454. 

"  chronic  metritis,  i,  453. 

"  decline  of  the  sexual  power  in  men,  i,  453. 

"  dropsy,  i,  451,  453. 

"  hypertrophy  of  the  tongue,  i,  453. 

"  hypochondriasis,  i,  453. 

"  impotence,  i,  453. 

"  indurated  glands,  i,  453. 

"  jaundice,  i.  454. 

"  lupus,  i,  453,  454. 

"  ozaena,  i,  453. 

"  scrofulous  ulcers,  i,  453. 

"  squamous  skin  disease,  i,  453. 

"  sterility,  i,  453. 

"  suicidal  mania,  i,  453. 

physiological  action  of,  on  animals,  i,  452. 
"  "        "    "  man,  i,  452. 

therapeutics  of,  i,  453. 
Goodell's  emmenagogue,  i,  375. 
Gossypium.    See  Cotton. 
Goose  grease,  i,  454. 

(liniment)  in  affections  of  the  chest,  i,  454. 


494 


GENERAL  INDEX. 


Goose  grease  (liniment)  in  bronchitis,  i,  454. 

(internally)  in  influenza,  i,  454. 

(liniment)  in  muscular  rheumatism,  i,  455. 
Granatum.     See  Pelletierise. 
Grape  cure,  i,  455. 

in  chronic  diarrhoea,  i,  455. 

"  engorgement  of  the  portal  circulation,  i, 
455. 

'•  enlargement  of  the  spleen,  i,  455. 

"  functional  disorders  of  the  liver,  i,  455. 

"  haemorrhoids,  i,  455. 

"  intestinal  catarrh,  i,  455. 

"  phthisis,  i,  455. 

"  plethora,  i,  455. 

"  scrofula,  i,  455. 

"  tuberculosis,  i,  455. 
Green  soap.     See  under  Soap. 
Grindelia,  i,  455. 

as  a  dressing  for  blisters,  i,  456. 

for  the  dressing  of  burns,  i,  456. 

in  bronchitis,  i,  456. 

"  chronic  cystitis,  i,  456. 

"  dyspnoea,  i,  456. 

"  elytritis,  i,  456. 

"  hay  fever,  i,  456. 

"  herpes  zoster,  i,  456. 

"  spasmodic  asthma,  i,  456. 

"  "         coughs,  i,  456. 

"  uterine  catarrh,  i,  456. 
Grindeline  i,  455. 
Gruel,  flour,  i,  433. 

in  diarrhcea,  i,  423. 

•'  dysentery,  i,  433. 
Guaiac,  i,  456. 

in  chronic  skin  disease,  i,  456. 

■'       "        rheumatism,  i,  456. 

"  gout,  i,  456. 

"  pharyngeal  inflammation,  i,  456. 

"  syphilis,  i,  456. 
Guaiacooaine,  ii,  439. 

as  a  local  anaesthetic,  ii,  439. 
Guaiacol,  i  457. 

and  glycerin  in  gout,  i,  461. 

as  a  local  ansesthetic,  i,  461. 

carbonate  in  pulmonary  tuberculosis,  i,  461. 
"  typhoid  fever,  i,  461. 

cinnamate.    See  Styracol. 

effects  of,  administered  hypodermically,  i, 
458. 

effects  of,  on  the  temperature,  i,  459. 

in  acute  nephritis,  i,  458. 

"  amygdalitis,  i,  460 ;  ii,  439. 

"  arthritic  tuberculosis,  i,  457. 

"  bronchopneumonia,  ii,  439. 

"  chronic  catarrh  of  the  gastro-intestinal 
and  genito-urinary  tracts,  i,  457. 

"  chronic  nephritis,  i,  458. 

"  dental  surgery,  i,  461. 

"  dermatitis,  i,  461. 

"  diabetes  mellitus.  i,  458. 

"  diphtheria,  ii,  439. 

(external  application)  in  erysipelas,  i,  460. 

in  fever,  i,  457. 

"  foetid  bronchorrhoea,  ii,  459 

"  follicular  amygdalitis,  ii,  439. 

"  influenza,  i,  460. 

"  parenchymatous  amygdalitis,  ii,  439. 

(topical  application)  in  pleurisy  with  effusion, 
i,  460. 

in  pneumonia,  i,  460 ;  ii,  439. 


Guaiacol  in  pulmonary  gangrene,  ii,  439. 

iu  pulmonary  tuberculosis,  i,  457,  458,  459. 

"  pyaemia,  i,  460. 

(ointment)  in  blennorrhagie  epididymitis,  i, 
461. 

(ointment)  in  swelled  testicle,  ii,  439. 

(topical  applications)  in  typhoid  fever,  i,  459, 
460. 

phosphate,  ii,  440. 

salicylate,  ii,  145. 

succinate,  ii,  440. 
Guaiacum.    See  Guaiac  and  Guaiac  wood. 

as  an  emmenagogue  in  amenorrhoea  of  rheu- 
matism, i,  375. 
Guaiac  wood,  i,  457. 

in  chronic  gout,  i,  457. 

"        "       rheumatism,  i,  457. 

"        "       skin  diseases,  i,  457. 

"  scrofula,  i,  457. 

"  syphilis,  i,  457. 
Guaiecetin,  ii,  440. 
Guarana,  i,  461. 

in  convalescence,  i,  461. 

"  debility,  i,  461. 

"  migraine,  i,  461. 

"  sick  headache,  i,  461. 
Gum  arable.    See  Acacia. 

water  in  diarrhoea  of  infants,  i,  351. 
Gun  cotton.    See  Pyroxylin. 
Gurjun  balsam,  i,  461. 

as  an  expectorant,  i,  463. 

in  gonorrhoea,  i,  463. 

"  leprosy,  i,  462. 

"  vaginal  blennorrhagia,  i,  463. 
Gutta  percha,  i,  462. 

applied  to  fractures  or  injuries  of  the  jaw,  i, 

liquid,  for  abrasions,  excoriations,  etc.,  i,  463. 
Gutti.    See  Gamboge. 
Gymnastics.     See  under  Exekcise. 
Gymnema,  ii,  440. 
Gynocardia,    Gynoeardic    acid.      See    under 

Chaulmoobra  oil. 
Gypsum.    See  Plaster  of  Paris. 

Haemalbumin,  i,  463. 

in  anaemia,  i,  463. 

"  chlorosis,  i,  463. 

"  rickets,  i,  463. 

"  scrofula,  i,  463. 

"  ulcer  of  the  stomach,  i,  463. 
Hiematics,  i,  463. 
Haematin-albumin,  i,  463. 

in  aniemia.  i,  463. 
Haematinics.    See  under  HyEMATOPOlETlcs. 
Hoematopoietics,  i,  463. 
Hfematoxylon,  i,  464. 

in  diarrhoea,  i.  464. 
Hsemogallol,  i,  464. 

in  anaemia,  i,  464. 
Hiemoglobin,  i,  464. 

in  anemia,  i,  464. 
Hasmol.     See  H.smogallol. 
Hasmostatics,  i,  464. 
Hamaraelis,  i,  467. 

as  a  hismostatic,  i,  467. 

as  a  mouth  gargle  in  sore  throat,  i,  467. 

as  an  application  to  haemorrhoids,  i,  467. 

as  a  sedative,  i,  467. 

in  bruises,  i,  467. 


GENERAL  INDEX. 


495 


Hamamelis  (externally)  in  epistaxis,  i,  467. 
in  gastric  catarrii,  i,  467. 
"  hsemorrhage  from  the  mouth,  i,  467. 
(externally)  in  hasmorrhoids,  i,  467. 
in  pulmonary  hffimorrhages,  i,  407. 
'•  renal  haemorrhage,  i,  467. 
"  sprains,  i,  467. 
"  uterine  haemorrhage,  i,  467. 
Hartshorn.    See  under  Ammonium  carbonate. 
Headine,  i,  467. 
Heat,  i,  467. 
and  cold,  action  of,  on  the  system,  i,  163, 164. 
application  of,  in  drowning,  i,  468. 
■'  "    exhaustion,  i,  468. 

"  "     laryngismus    stridulus,    i, 

469. 
as  a  cardiac  stimulant,  i,  468. 
"   germicide,  i,  443. 
"    haemostatic,  i,  466. 
drv  (applications),  in  cholera  (algid  state), 

ii,  225. 
in  chronic  sciatica,  ii,  441. 
"  rheumatism,  ii,  440. 
dry  (applications),  in  shook,  ii,  225. 

"    in  toothache,  i,  136. 
in  hajmorrhagje  (algid  state),  i,  468. 
"  menorrhagia  and  metrorrhagia,  i,  469. 
"  pelvic  congestion,  i,  469. 
"  poisoning  by  aconite,  i,  7. 
"  rheumatism,  ii,  440. 
"  treatment  of  narcotic  poisoning,  i,  469. 
Hedeoraa,  i,  469. 
in  colic,  i,  469. 
"  nausea,  i,  469. 
Helenin,  Helenium.     See  under  Inula. 
in  leuoorrhoea  (as  an  antiseptic),  i,  534. 
"  tuberculosis  (as  an  antiseptic),  i,  534. 
Heliotropin.     See  Pipeeonal. 
Hellebore,  American.     See  Veeatrum  viride. 
black,  i,  469. 
"     in  sthenic  febrile  conditions,  i,  470. 
"      physiological  action  of,  i,  469. 
green.    See  Veratrum  viride. 
white,  i,  470. 

"     for  the  destruction  of  the  itch  mite, 
lice,  etc.,  i,  470. 
white,  in  acute  gastritis,  i,  470. 
"      "      "      pleurisy,  i,  470. 
"      "    croupous  pneumonia,  i,  470. 
"      "   pericarditis,  i,  470. 
Helleborein,   Helleborin.     See  under  Helle- 
bore, BLACK,  and  Hellebore,  white. 
Helleborus  albus.    See  Hellebore,  white. 
Helleborus  niger.    See  Helleborus,  black. 
Helmerich's  ointment,  i,  116. 
Hemidesmus,  i,  470. 
Hemlock.    See  Cicuta  and  Conium. 
Hemp.    See  Apooysum  and  Cannabis  indica. 
Henbane.     See  Hygsctamus. 
Hepatics,  i,  470. 

Hexamethylenetetramine.    See  LTrotropine. 
Hidrotics.    See  Diaphoretics. 
Hirudo.    See  Leeching. 
Hive  syrup.    See  under  Squill. 
Hoang-nan,  i,  471. 
in  leprosy,  i,  471. 
"  rabies,  i,  471. 
"  scrofula,  1,  471. 
Hoffmann's  anodyne  in  dyspnoea  of  asthma,  i, 
94. 


Homatropine,  i,  471. 

in  incipient  cataract,  i,  472. 

"  night  sweats  of  phthisis,  i,  471. 
Homoguaiacol.     See  Cbeosol. 
Honey,  i,  472. 

and  rye  meal  (paste)  in  abscess  of  the  ear,  i, 
473. 

in  scorpion  stings,  ii,  441. 
Hops.    See  Humulus  and  Lupulin. 
Hordeum,  i,  472. 


473. 


intestinal    inflammation,    i. 


decoction  of,  in  intestinal  irritation,  i,  473. 
Horehonnd,  i,  473. 
in  catarrhal  bronchitis,  i,  473. 
"  chronic  pulmonary  disorders,  i,  473. 
"  colds,  i,  473. 
"  sore  throat,  i,  473. 
Horseradish,  i,  473. 
dried  root  of,  chewed  for  toothache,  i,  473. 
in  atonic  dyspepsia,  i,  473. 
"  dropsy,  i,  473. 
"  flatulence,  i,  473. 
infusion  of,  for  hoarseness,  i,  473. 
Hot  applications  in  inflammatory  exudations, 
i,  469. 
in  itching,  i,  469. 
Humulus,  i,  473. 
for  breaking  off  the  opium  habit,  1,  474. 
in  chordee,  i,  474. 
"  delirium  tremens,  i,  474. 
"  diarrhoea,  i,  474. 
"  dyspepsia,  i,  473. 
"  incontinence  of  urine,  i,  473. 
"  irritable  bladder,  i,  474. 
"  irritation  of  the  genito-urinary  tract,  i, 

474. 
"  priapism,  i,  474. 
"  sexual  erethism,  i,  474. 
poultice  for  toothache  and  earache,  i,  475. 
Hunyadi  Janos,  i,  474. 
_  for  indigestion,  i,  474. 
"   disordered  liver,  i,  474. 
in  acute  congestion,  i,  474. 
"  chronic  congestion  of  the  pelvic  organs,  i, 

474. 
"  diarrhoea,  i,  474. 
"  dropsy,  i,  474. 
Hysenanehin,  i,  474. 
in  amblyopia,  i,  474. 
"  deafness,  i,  474. 
Hydracetin,  i,  474. 
Hydragogues,  i,  222, 475. 

indications  for  the  use  of,  i,  475. 
Hydrargyrum.     See  Mercury. 
Hydrastine,  Hydrastiuine.    See  under  Hydras- 
tis. 
in  acne,  i,  476. 
'■  bromidrosis,  i,  476. 
"  chronic  nephritis,  i,  476. 
"  dry  seborrhoea,  i,  476. 
(as  a  douche)  in  gonorrhoea,  i,  476. 
(internally  and  by  injection)  in  gonorrhoea, 

i,  476. 
in  granular  coniunctivitis,  i,  476. 
(as  a  lotion)  in  hyperidrosis,  i,  476. 
in  indolent  ulcers,  i,  476. 
"  intermittent  fever,  i,  476. 
"  paludal  cachexia,  i,  476. 


496 


GENERAL  INDEX. 


Hydrastine  (internally)   in  puerperal  haemor- 
rhage, i,  476. 
in  spermatorrhoea,  i,  476. 
"  ulcerating  carcinoma,  i,  476. 
(as  a  douche)  in  vaginal  leucorrhcea,  i,  476. 
Hydrastis,  i,  475. 
canadensis  as  an  eobolio.  ii,  55. 
in  catarrh  of  the  cystic  duet,  i,  476. 
gall  duets,  1,  476. 
(internally  and  topically)  in  catarrh  of  the 
vesical,  vaginal,  and  uterine  mucous  mem- 
branes, i,  476. 
in  chronic  enteritis,  i,  475. 
"        '■      gastric  catarrh,  i,  475. 
(local  applications)  in  follicular  amygdalitis, 

i,  476. 
.(local  application)  in  hemorrhage  from  the 

lower  bowel,  i,  476. 
:in  membranous  dysmenorrhcea,  i,  476. 
"  old  ulcers,  i,  476. 
"  otorrhoea,  i,  476. 
(local  applications)  in  pharyngitis,  i,  476. 

"  "  "  stomatitis,  i,  476. 

in  syphilitic  affections  of  the  throat  and 

nares,  i,  476. 
"  the  alcohol  habit,  i,  475. 
"  ulcers  of  the  rectum,  i,  476. 
Hydriatics,  Hydriatrics,  i,  476. 
Hydriodic  acid,  i,  492. 
in  acute  rheumatism,  i,  492. 
"  asthma,  i,  492. 

"  delayed  resolution  of  the  lungs  after  pneu- 
monia, i,  492. 
"  pleuritic  exudation,  i,  492. 
"  scrofulous  diathesis,  i,  492. 
ether.     See  Ethyl  iodide. 
Hydrobromic  acid,  i,  492. 
and  the  bromides  in  epOepsy,  i,  492. 
in  headache,  i,  492. 
"  nervous  cough,  i,  492. 
"  neuralgia,  i,  492. 
ether.    See  Ethyl  bromide,  i,  492. 
Hydrochloric  acid,  i,  492. 
as  a  disinfectant,  i,  446. 
in  acid  dyspepsia,  with  pyrosis,  i,  493. 
"  acute  rheumatism,  i,  493. 
"  anaemia, -i,  493. 
"  chlorosis,  i,  493. 
"  diarrhcea  of  typhoid  fever,  i,  493. 
"  fever,  i,  493. 
"  heart  disease  with  deficient  compensation, 

i,  493. 
"  indigestion,  i,  493. 
"  necrosis  of  bone  of  tuberculous  origin,  ii, 

441. 
"  neurasthenia,  i,  493. 
"  poisoning  with  silver  and  alkalies,  i,  493. 
(by  sponging)  in  pruritus  of  urticaria,  i,  493. 
(as  a  gargle)  in  scarlet  fever,  i,  493. 
in  superficial  cutaneous  growths,  i,  227. 
"  vomiting  due  to  alcoholic  overindulgence. 

i,  100.  ^ 

ether.    See  Ethyl  chloride. 
Hydrocotyle  asiatica,  i,  493. 
in  catarrhal  enterocolitis,  i,  493. 
"  fever,  i,  493. 
"  leprosy,  i,  493. 
"  lupus,  i,  493. 
"  scrofulodermata,  i,  493, 
"  syphilis,  i,  493. 


Hydrocyanic  acid,  i,  493. 
action  of,  i,  496. 

antidotes  for  poisoning  with,  i,  501. 
chronic  poisoning  with,  i,  498. 
in  heart  affections,  i,  495. 
(dilute)  in  vomiting  of  pregnancy,  i,  99. 
in  whooping-cough,  i,  495. 
poisoning  with,  i,  496. 
tests  for,  i,  499. 
uses  of,  i,  495. 
ether,  i,  323. 
Hydrofluoric  acid  in  pulmonary  tuberculosis, 

i,  527. 
Hydrogen  as  an  antipyretic,  i,  527. 
as  a  sedative,  i,  527. 
cyanide.     See  HyDEOCYANio  acid. 
dioxide,  i,  502. 

"        as  a  disinfectant,  i,  502. 
"        as  a  germicide,  i,  445. 
"        in  abscesses,  i,  502. 
.  "         "  amygdalitis,  i,  503. 
"        "  chancroid  and  chancre,  i,  503. 
"        "  diphtheria,  i,  503. 
"        injections  in  gonorrhoea,  i,  503,  531. 
"        in  scarlet  fever,  i,  503. 
"        "  superficial  ulcerations,  i,  503. 
"         "  unhealthy  suppurating  surfaces, 
i,  503. 
gas  in  abdominal  surgery,  i,  533. 
peroxide.    See  Hydrogen  dioxide. 
sulphide.     See  under  Sulphur,  i,  503. 
Hydronaphthol,  i,  503 ;  ii,  3. 
Hydroquinine,  i,  503. 
Hydroquinone,  i,  503. 
Hydrotherapeuties.     See  HvDRLiTios. 
Hydroxylamine  hydrochloride,  i,  503. 
in  lupus,  i,  503. 

"  parasitic  skin  disease,  i,  503. 
"  pityriasis,  i,  503.  , 
"  psoriasis,  i,  503. 
Hygiama,  ii,  442. 
in  debility  of  convalescence,  ii,  442. 
"  diseases  of  the  stomach  and  intestines,  ii, 
442.  '    ' 

"  pulmonary  consumption,  ii,  443. 
'■  typhoid  fever,  ii,  443. 
Hyosoine,  i,  503. 
effect  of,  on  the  insane,  i,  504. 
in  acute  mania,  i,  508. 
"  delirium  tremens,  i,  508. 
"  insomnia,  i,  508. 
"  paralysis  agitans,  i,  504. 
Hyoscyamine,  i,  504. 
as  a  mydriatic,  i,  649. 

"   sedative  to  the  nervous  system,  i,  504. 
in  insanity,  i,  504. 
"  paralysis  agitans,  ii,  443. 
"  spasms,  i,  504. 
"  vesical  pain,  i,  504. 
Hyoscyamus,  i,  504. 
as  a  sedative  to  the  nervous  system,  i,  504. 
in  griping  pains,  i,  504. 
"  insomnia,  i,  508. 
"  neuralgia,  i,  505. 
"  spasmodic  conditions,  i,  504 
"  vesical  pain,  i,  504. 
Ilypnal,  i,  505. 

in  insomnia  with  pain,  i,  505. 
Hypnone.  See  Aoetophenone. 
Hypnotic  measures,  i,  506. 


GENERAL  INDEX. 


497 


Hypnotics,  i,  505. 

indirect,  i,  505. 

medicinal,  i,  506. 

narco-,  i,  505. 

pure,  i,  505. 
Hypnotism,  i,  509. 

dangers  of,  i,  513. 

induction  of,  i,  510. 

in  functional  disorders  of  the  nervous  sys- 
tem, i,  514. 

"  functional  gastro-intestinal  disorders,  i, 
515. 

"  labour  pains,  i,  514. 

"  masturbation,  i,  515. 

"  menstrual  disorders,  i,  515. 

"  nocturnal  enuresis,  i,  515. 

"  onanism,  i,  515. 

"  organic  diseases,  i,  514. 

"  the  alcohol  and  drug  habit,  i,  515. 

precautions  necessary  in  the  therapeutic  use 
of,  i,  513. 

therapeutic  value  of,  i,  513. 
Hypodermic  medication,  i,  515. 

advantages  of,  i,  517. 

disadvantages  of,  i,  517. 

manner  of  performing,  i,  518. 

preparation  of  the  solution  for,  i,  516. 
Hypophosphites,  i,  518. 

in  bone  diseases,  i,  518. 

"  chronic  pulmonary  tuberculosis,  i,  518. 

"  disorders  of  the  nerve-centres,  i,  518. 

"  furuncles,  i,  518. 

"  scrofula,  i,  518. 

"  styes,  i,  518. 
Hypophosphorous  acid,  i,  519. 
Hyposulphites,  i,  519. 

(locally)  in  cutaneous  diseases  of  a  parasitic 
nature,  i,  519. 

in  gastric  fermentation,  i,  519. 

(locally)  in  pityriasis  versicolor,  i,  519. 

in  porrigo,  i,  519. 

(locally)  in  ringworm,  i,  519. 


Ice,  i,  519. 
applied  to  the  spine  in  amenorrhoea,  i,  530. 
"        "     "       "      "  scanty  menstruation, 
i,  520. 
applied  to  the  spine  in  seasickness,  i,  530. 
bag  in  bronchitis,  i,  530. 
"     "  encephalitis,  i,  520. 
"     "  epididymitis,  i,  530.       r 
"    "  inflammation  of  the  pelvic  organs,  i, 
520. 
bag  in  meningitis,  i,  520. 
"     "  myelitis,  i,  530. 
"    "  orchitis,  i,  530. 
"    "  pericarditis,  i,  530. 
"    "  peritonitis,  i,  520. 
"    "  pleurisy,  i,  530. 
"     "  pneumonia,  i,  530. 
cradling  in  pneumonia,  i,  530. 
(topically)  in  capillary  hsBmorrhage,  i,  530. 
"  "  inflammations,  i,  519. 

"  "  strangulated  hernia,  i,  519. 

"  "  superficial  congestions,  i,  519. 

to  the  spine  for  stimulation  of  the  menstrual 
flow,  i,  875. 
Iceland  moss.    See  Cetearia. 
Ichthyocolla.    See  Isinglass. 


Ichthyol,  i,  531. 

as  an  analgetic,  i,  533. 

"  a  sorbefaoient,  i,  523. 

in  acute  elytritis,  i,  533. 

"      "     perimetritis,  i,  533. 

"  bronchial  tuberculosis,  ii,  443. 

"  burns,  i,  533. 

"  chronic  constipation,  ii,  443. 
metritis,  i,  523. 

"        "   ^   parametritis,  i,  533. 

"  cicatricial  atrophy  of  the  vagina  and  cer- 
vix uteri,  i,  533. 

"  diarrhoea,  ii,  443. 

"  eczema,  i,  533. 

"        "       seborrhoicum,  i,  116. 

"  elephantiasis,  i,  533. 

"  endometritis,  i,  528. 

"  endotrachelitis,  i,  523. 

"  erysipelas,  i,  538. 

"  fissures  of  the  nipples,  i,  523. 

"  gastric  disturbances,  ii,  443. 

"  gout,  i,  538. 

"  gynaecological  practice,  i,  533. 

"  hyperemia,  i,  538. 

"  inflammation,  i,  533,  533. 

"  "  caused  by  the  stings  of  in- 

sects, ii,  444. 

injections  in  gonorrhoea,  i,  538. 

(salve  or  solution)  in  intertrigo,  i,  588. 

in  intestinal  disorders,  ii,  443. 

"  leprosy,  i,  522. 

"  lymphangeio-phlebitis,  ii,  443. 

"  nervous  eczema,  i,  523. 

"  parasitic  eczema,  i,  523. 

"  pruritus,  i,  523. 

"         "        of  the  vulva  and  of  the  anus,  i, 
534. 

"  pulmonary  tuberculosis,  ii,  443. 

"  rebellious  constipation,  ii,  443. 

(externally  and  internally)  in  rosacea,  i,  523. 

in  salpingo-oophoritis,  i,  533. 

"  scars  of  acne,  keloid,  and  variola,  i,  583. 

"  scleroderma,  i,  582. 

"  swollen  glands,  i,  522. 
Ignatia,  i,  524. 
Ignipuncture,  i,  524. 

in  chronic  articular  inflammation,  i,  534. 

"        "       hypertrophy  of  the  tonsils,  i,  524. 

"  fungous  arthritis,  i,  584. 

"  hypertrophy  of  the  nose,  i,  584. 

"  neuralgia,  i,  534. 

"  petit  mal,  i,  524. 

"  synovial  cysts,  i,  534. 
lUiciu'm,  i,  584. 
India  rubber.     See  Rubber. 
Indigo  in  dysmenorrhcEa,  i,  375. 
Infiltration  anaesthesia,  i,  534. 
Infusion.    See  under  Transfusion. 

and  the  subcutaneous  injeotion  of  strychnine 
in  shock,  ii,  324. 

in  acute  hydrocephalus,  ii,  824. 

"      "     pericarditis,  ii,  334. 

"  brown  atrophy  of  the  heart  muscle,  ii,  338. 

"  cerebral  anaemia,  ii,  884. 

"  cholera,  ii,  384. 

"  chronic  gastro-enteritis,  ii,  334.' 

"  collections  of  fluid  (in  the  serous  cavities), 
ii,  334. 

"  epistaxis,  ii,  334. 

"  gastric  hemorrhage,  ii,  824. 


498 


GENERAL  INDEX. 


Infusion  in  intestinal  hsemorrhage  of  typhoid 
fever,  ii,  323. 
in  iodoform  poisoning,  ii,  323. 
(of  an  isotonic  saline  solution)  in  placenta 

prsevia,  ii,  324. 
in  poisoning  with  carbonic  oxide,  ii,  333. 
"  "  "     chloral,  chloroform,  ether, 

morphine,  opium,  or  phosphorus,  ii,  323. 
"  poisoning  with  illuminating  gas,  ii,  328. 
"  puerperal  septicaemia,  ii,  324. 
"  septicaemia,  ii,  325. 
intra-arterial,  of  sodium  chloride  solution  in 

acute  anaemia  and  in  collapse,  ii,  328. 
intramuscular,  in  anasarca,  ii,  325. 

"   ■  "  albuminuria,  ii.  325. 

"  "  pulmonary  oedema,  ii,  325. 

"  "  urffimia,  ii,  325. 

intraperitoneal  saline,  ii,  325. 
intravenous  or  subcutaneous,  in  acute  peri- 
tonitis, ii,  825. 
intravenous  or  subcutaneous,  in  cholera,  ii, 

325. , 
intravenous  or  subcutaneous,  in  pneumonia, 

ii,  324,  325. 
intravenous  or  subcutaneous,  in   puerperal 

septicaemia,  ii,  325. 
intravenous  or  subcutaneous,  in  septicaemia, 

ii,  325. 
intravenous  or  subcutaneous,  in  tetanus,  ii, 
325. 
Infusions,  i,  525. 
Ingluvin,  i,  526. 
in  dyspepsia,  i,  536. 
"  vomiting  of  pregnancy,  i,  526. 
Inhalants,  Inhalation,  i,  526. 
Ink,  li,  259. 

in  ringworm,  ii,  259. 
Injection  Brou  in  gonorrhoea,  i,  531. 
Injections,  abortive,  i,  531. 

"         hypodermic.  See  Hypodermic  medi- 
cation. 
intravenous,  i,  580. 
rectal.     See  Enbmata. 
simple,  i,  531. 
urethral,  i,  580. 
Inoculation  against  rabies  by  the  method  of 
Tizzoni  and  Cenbanni,  i,  82. 
cholera,  i,  83. 
Instillation,  i,  532. 
Insufflation,  i,  583. 
of  hot  air  in  tuberculous  peritonitis,  i,  533. 
"  powders  in  deep  wounds,  cold  abscesses, 
affections  of  the  mouth,  nose,  etc.,  i,  533, 
534. 
Inula,  i,  534. 

as  a  tonic  in  amenorrhoea,  i,  534. 
Inunction,  i,  534. 
lodamylum,  i,  534. 
lodantipyrine,  i,  534. 

Iodide  of  ethyl  in  asthma,  inhalations  of,  i,  95. 
Iodides.     See  under  Iodine. 

in  chronic  lead  or  mercury  poisoning,  ii,  214. 
Iodine,  i,  534. 
as  a  germicide,  i,  445. 
bath,  for  constitutional  effects,  i,  537. 
enema  in  chronic  diarrhoea,  i,  536. 

"       "  dysentery,  i,  536. 
hypodermic  injection  of,  in  chronically  en- 
larged tonsils,  i,  536. 
hypodermic  injections  of,  in  goitre,  i,  536. 


Iodine,  hypodermic  injections  of,  in  hydatid 
cysts,  i,  536. 
hypodermic  injections  of,  in  hypertrophied 

prostate,  i,  536. 
hypodermic  injections  of,  in  hypertrophy  of 

lymphatic  glands,  i,  536. 
in  articular  involvements,  i,  535. 
(externally)  in  atrophic  rhinitis,  i,  536. 
in  chilblain,  i,  536. 
"  chloasma,  i,  536. 
(externally)  in  chronic  cystitis,  i,  536. 
in  chronic  glandular  enlargements,  i,  535. 
"       "        indurations  of  the  breast,  i,  536. 
"       "        phthisis,  i,  586. 
(externally)  in  enlarged  glands,  1,  536. 
in  enlargements  of  the  liver,  mammae,  testes, 

and  uterus,  i,  586. 
(externally)  in  erysipelas,  i,  536. 
(internally)   in  glandular  enlargements,  ii, 

214. 
(externally)  in  goitre,  i,  536. 
(internally)  in  goitre,  ii,  214. 
(externally)  in  inflammation  of  the  pharynx 

and  larynx,  i,  536. 
injection  in  ascites,  i,  536. 

"         "  cystic  bronchocele,  i,  536. 
"         "  dropsy  of  the  joints,  i,  536. 
"         "  hernia,  i,  536. 
"         "  hydrocephalus,  i,  536. 
(externally)  in  leucorrhoea,  i,  536. 
in  lupus,  i,  536. 

(externally)  in  muscular  rheumatism,  i,  536. 
(small  doses)  in  nausea,  i,  536. 
(externally)  in  ophthalmia,  i,  536. 
"  "  orchitis,  i,  536. 

"  "  ovarian  tumours,  i,  536. 

in  oziena.  i,  536. 

(externally)  in  pitting  of  small-pox,  i,  536. 
"  "  pityriasis,  i,  536. 

"  "  pleurisy,  i,  536. 

"  "  psoriasis,  i,  586. 

"  "  ringworm,  i,  536. 

in  scrofulous  diseases,  i,  535. 
"  tuberculosis,  i,  527. 
(as  an  intestinal  antiseptic)  in  typhoid  fever, 

i,  586. 
in  ulcers,  i,  536. 
(externally)  in  urethritis,  i,  536. 
(small  doses)  in  vomiting,  i,  536. 
salts  in  chronic  rheumatism,  i,  536. 
"     "        "        skin  disease,  i,  536. 
"     "        "        gout,  i,  536. 
"     "        "        lead  poisoning,  i,  536. 
"     "  tertiary  syphilis,  i,  536. 
terchloride  as  a  germicide,  i,  445. 
tincture  in  ringworm,  i,  117. 
vapour  in  chronic  bronchitis,  i,  586. 
"        "  pulmonary  tuberculosis,  i,  536. 
Iodoform,  i,  537. 
in  chronic  dysentery,  i,  537. 
"  cirrhosis  of  the  liver,  i,  537. 
(hypodermically)  in  cold  abscesses,  i,  538. 
in  diabetes,  i,  537. 
(hypodermically)  in  goitre,   hydrocele,  and 

tuberculous  affections,  i,  538. 
in  inflamed  mucous  membrane  of  the  genito- 
urinary organs,  i,  538. 
inhalation  in  bronchitis,  i,  540. 

"  "  coryza,  i,  540. 

in  suppurating  buboes,  i,  539 ;  ii,  444. 


GENERAL  INDEX. 


499 


Iodoform  injection  in  suppurating  inguinal 
buboes,  i,  539. 
in  meningitis,  i,  537. 
"  obesity,  i,  537. 
"  painful  septic  diseases   of   the    rectum, 

uterus,  and  vagina,  i,  538. 
"  phthisis,  i,  537. 
"  recent  wounds,  i,  538. 
"  ulcerated  throats,  i,  445. 
poisoning,  i,  539. 
powder  in  septic  wounds,  i,  538. 
lodoformin,  i,  540. 
lodol,  i,  540. 
in  balanitis,  i,  540. 
"  carbuncles,  i,  540. 
"  caseous  glands,  i,  540. 
(by  insufBation)  in  chronic  bronchial  catarrh, 

i,  540. 
(by  insufflation)  in  chronic  inflammation  of 

the  Eustachian  tube,  i,  540. 
(by  insufflation)  in  granular  pharyngitis,  i, 

540. 
(by  insufflation)  in  otitis  media,  i,  540. 
"  "  "  posterior  rhinitis,  i,  540. 

in  psoriasis,  i,  540. 
"  soft  chancre,  i,  540. 
"  suppurative  bubo,  i,  540. 
"  tinea  tonsurans,  i,  540. 
(by  insufflation)  in  trachoma,  i,  540. 
"  "  "  tuberculous  laryngitis,  i, 

540. 
in  ulcers,  i,  540. 
"  vaginal  catarrh,  i,  540. 
lodophenacetine,  lodophenine,  i,  540. 
lodopyrine.    See  Iodantipyrine. 
Ipecac,  Ipecacuanha,  i,  541. 
as  a  counter-irritant,  i,  543. 
"  an  emetic  in  croup,  i,  418. 
in  acute  bronchitis,  i,  373. 
"     dysentery,  i,  543. 
"     gastritis,  i,  543. 
"     laryngitis,  i,  543. 
"  asthma  (as  an  expectorant),  i,  95. 
(as  an  emetic)  in  bilious  attacks,  i,  543. 
in  bronchial  catarrh,  i,  543. 
"■  bronchitis,  i,  543. 

■  catarrhal  jaundice,  i,  543. 
'  chronic  bronchitis,  i,  548. 

"       dysentery,  i,  543. 
'  diarrhcEa  of  young  children,  i,  543. 
'  diarrhcEal  conditions,  i,  542. 
'  emphysema,  i,  542. 
'  epistaxis,  i,  543. 

■  hsemoptysis,  i,  543. 
'  hay  fever,  i,  543. 
'  laryngismus  stridulus,  i,  542. 

malarial  disease,  i,  542. 
membranous  croup,  i,  542. 
menorrhagia,  i,  543. 
migraine,  i,  542. 
narcotic  poisoning,  i,  541. 
pharyngitis,  i,  543. 
post-partum  haemorrhage,  i,  543. 
spasmodic    aifections  of  the  respiratory 
apparatus,  i,  373. 

■  spasmodic  croup,  i,  373. 
'  vomiting  of  gastric  atony,  i,  543. 
'        "  "  nervous  origin,  i,  543. 

(small  doses)  in  vomiting  of  pregnancy,  i,  99, 
541. 


Ipecac  in  whooping-cough,  i,  542. 
Ipomcea.    See  Jalap. 
Iridin,  i,  543. 
Iris,  i,  543. 

Irish  moss.    See  Chondrus. 
Irisin.    See  Iridin. 
Iron,  i,  543. 
acetate  in  chronic  nephritis,  i,  551. 
albuminate  in  chlorosis,  i,  553. 
ammoniochloride    in   amenorrhoea,   rickets, 

and  scrofula,  i,  549. 
and  arsenic  in  neuralgia,  i,  68. 
as  a  general  tonic,  i,  545. 

"     stomachic,  i,  545. 
bromide  in  chorea,  i,  553. 

"         "  scrofula,  i,  553. 
carbonate  in  anaemia,  i,  547. 
"  "  chlorosis,  i,  547. 

"         "  digestive  atony,  i,  547. 
"  "  menstrual  irregularities,  i,  547. 

chloride  (tinctuie)  in  albuminuria,  i,  548. 
"        (ethereal  tincture)  in  ansemia  and 
chlorosis,  i,  548. 
chloride  (in  solution)  in  aneurvsms  and  vari- 
ces, i,  547,  548. 
chloride  (tincture)  in  arsenic  poisoning,  i,  143. 
"        in  Bright's  disease,  i,  548. 
"        (tincture)  in  chronic  bronchitis,  i,  548. 
"  "        "  diphtheria,  i,  548. 

"  "        "  emphysema  (if  ansmia 

is  present),  i,  548. 
chloride  (tincture)  in  epistaxis,  i,  548. 
"  "  "  erysipelas,  i,  548. 

"  gleet,  i,  548. 
"        (solution)  in  haemorrhage,  i,  548. 
"        (tincture)  in  haemorrhages     of    the 
bowels,  Icidneys,  etc.,  i,  548. 
chloride  (tincture)  in  hysteria,  melancholia, 

and  mania,  i,  549. 
chloride  (tincture)  in  neuralgia  of  anaemia, 

i,  549. 
chloride  (tincture)  in  neurotic  disturbances, 

i,  549. 
chloride  (tincture)  in  passive  heemorrhage  (if 

aneemia  is  present),  i,  548. 
chloride  in  post-partum  haemorrhage,  i,  548. 
"        (tincture)  in  prostatorrhoea,  i,  548. 
"  "  "  pseudoleuciTmia,  i,  549. 

"  "  "  purpura,  i,  548. 

"  "  "  pysemia,  i,  549. 

"  "  "  rheumatism,  i.  548. 

"  "  "  scarlatina,  i,  549. 

"  "  "  septicaemia,  i,  549. 

"        in  soft  vegetations  and  growths,  i, 
548. 
chloride  (tincture)  in  spermatorrhoea,  i,  548. 
"  "  internally  and  externally 

in  sore  throat,  i,  549. 
chloride  (tincture)  injections  in  varicosities, 

i,  549. 
citrate  in  anffimia,  i,  550. 

"       "  malarial  disease,  i,  550. 
hydrate  as  an  antidote  in  arsenic  poisoning, 

i,  552. 
hydrate  in  myalgia,  i,  552. 
in  amygdalitis,  i,  546. 
"  anaemia,  i,  544 ;  ii,  310. 
"  chlorosis  as  an  emmenagogue,  i,  374. 
"  erysipelas,  i,  546. 
"  fatty  degeneration  of  the  heart,  i,  317. 


500 


GENERAL  INDEX, 


Iron  hydrate  in  pharyngitis,  i,  546. 
iodide  in  atony  of  mucous  surfaces  with  re- 
sultant discharges,  i,  551. 
iodide  in  atonic  amenorrhcea,  i,  551. 
"       "  chlorosis,  i,  551. 
"       "  nocturnal  enuresis   of   children,  i, 
551. 
iodide  in  scrofula,  i,  551. 
"       "  syphilis,  i,  551. 
lactate  in  chlorosis,  i,  551. 
malate,  i,  553. 

(Monsel's  solution)  in  acute  follicular  amyg- 
dalitis, i,  550. 
nitrate  in  chronic  diarrhoea,  i,  551. 
"        "  leucorrhcea,  i,  551. 
"        "  menorrhagia,  i,  551. 
oxalate,  i,  553. 
oxide  as  an  antidote  in  arsenic  poisoning,  i, 

553. 
oxide,  magnetic,  i,  553. 
phosphates  in  ansemia  with  cerebral  debility, 

i,  551. 
precipitated,  dialyzed,  in  arsenic  poisoning,  i, 

143. 
reduced,  in  anaemia,  i,  547. 

"         "  chronic  eczema,  i,  547. 
"         "  lepra,  i,  547. 
"         "  psoriasis,  i,  547. 
"         "  ulcerating  caroinomata,  i,  547. 
saccharated  oxide  of,  in  arsenic  poisoning,  i, 

143. 
succinate  in  jaundice,  i,  553. 
sulphate  (Monsel's  solution)  in  acute  follicu- 
lar amygdalitis,  i,  550. . 
sulphate  in  ansmia  accompanied  by  consti- 
pation, i,  549. 
sulphate  in  chronic  ophthalmia,  i,  549. 

"  debilitated  conditions  associated 
with  chronic  discharges,  i,  549. 
sulphate  (solution)  in  external  haemorrhages, 

i,  550. 
sulphate  in  gastric  atony  of  anaemia,  i,  549. 
"         "  gleet,  i,  549. 
"         "  ha3matemesis,  i,  550. 
"         "  haemoptysis,  i,  550. 
"         '■  hiemorrhoids,  i,  550. 
"         "  post-partum  haamorrhage,  i,  550. 
"         '■  syphilis,  i,  550. 
"         '•  uterine  hasmorrhage,  i,  550. 
tannate  in  anaemia,  ii,  359. 
"        "  chlorosis,  ii,  359. 
"        "   ringworm,  i,  553. 
tartrate,  i,  553. 
valerianate  in  anasmia,  i,  553. 

"  "        "        chlorosis,  ii,  348. , 

"  "  diabetes  insipidus,  i,  553. 

Irrigation,  i,  553. 
antiseptic,  of  joints,  i,  556. 
methods  of,  for  various  parts  of  the  body,  i, 

553. 
of  the  ear,  i,  553. 
"      eye,  i,  553. 
"       mouth,  i,  554, 
"      nose,  i,  554. 

"      rectum  and  colon  for  septic  colitis 
and  diarrhoea  of  children,  i,  554. 
of  the  rectum  and  colon  in  acute  dysentery, 

i,  491. 
of  the  stomach  for  intestinal  ob.struotion,  i, 
491. 


Irrigation  of  the  stomach  in  summer  diarrhoea 
of  infants,  i,  491. 
of  the  urethra  and  bladder,  i,  555. 
"       uterine  cavity,  i,  555. 
"      vagina,  i,  555. 
of  wounds,  i,  555,  556. 
Irritants,  i,  556. 
Isinglass,  i,  556. 
Isonaphthol.     See  Naphthol. 
Issue-peas,  i,  543. 

Itrol.    See  Silvee  citrate  (vol.  ii,  page  198). 
Izal,  i,  556. 
as  a  disinfectant  and  germicide,  i,  556. 

Jaborandi,  i,  558. 
as  a  diaphoretic,  i,  558. 
"    sialagogue,  i,  558. 
in   acute    congestive    conditions    following 

cold,  i,  559. 
(by  subcutaneous  injection  or  by  the  mouth) 

in  alopecia,  i,  560. 
in  ascites,  i,  559. 
"  asthma,  i,  559. 
"  bronchitis,  i,  559. 
"  diabetes  insipidus,  i,  559. 
"  diphtheria,  i,  559. 
"  dropsy,  i,  559. 
"  dry  skin  diseases,  i,  560. 
"  erysipelas,  i,  560. 
"  hydrothorax,  i,  559. 

(by  spraying)  in  laryngitis  with  scanty  secre- 
tion, i,  560. 
in  nephritis,  i,  559. 
"  pleurisy  with  effusion,  i,  558. 
"  poisoning  with  atropine,  i,  560. 
"  prurigo,  i,  560. 
"  pulmonary  oedema,  i,  559. 
"  urticaria,  i,  560. 
"  uraemia,  i,  559. 
Jalap,  i,  560. 
in  dropsical  affections,  i,  560. 
(resin)  in  malarial  disease,  i,  560. 
in  portal  congestion,  i,  560. 
Jambol.    See  Jambul. 
Jambul,  i,  561. 
as  an  astringent,  i,  561. 
as  a  stomachic,  i,  561. 
in  diabetes,  i,  561. 
Japanese  belladonna.     See  Scopoleine. 
Jasmine.     See  Gblsemium. 
Javelle  water,  i,  340. 

Jecoris  aselli,  oleum.    See  Cod-liver  oil. 
Jecjuirity,  i,  561. 
in  granulation  of  the  tyelids,  i,  563. 
"  pannus,  i,  563. 
Jervine.     See  under  Vekatruji  vieide. 
Juglans,  i,  563. 

in  constipation,  i,  563. 
Juice,  beef,  i,  333. 
Juices,  i,  563. 
Juniper,  i,  563. 
in  dropsy,  i,  563. 
"  impotence,  i,  137. 
Junket,  i,  43. 
Jute,  i,  563, 

Kairine,  1,  563. 

in  fever,  i,  563. 
Kalium.    See  Potassium. 
Kamala,  i,  563. 


GENERAL  INDEX. 


501 


Kamala  in  ascarides  vermiculares,  i,  103. 

in  intestinal  worms,  i,  563. 
Kaolin.    See  Puller's  earth  and  Earths. 
Kara,  Kava-kava,  i,  563. 
as  an  anaesthetic,  i,  563. 

"  a  motor  depressant,  i,  563. 

"  a  diuretic,  i,  563. 

"  a  sialagogue,  i,  563. 
in  cystitis,  i,  564. 

"  dropsy,  i,  564. 

"  elytritis,  i,  5t)4. 

"  gleet,  i,  564. 

"  gonorrhcEa,  i,  564. 

"  gout,  i,  564. 

"  incontinence  of  urine,  i,  564. 

"  retention  of  urine,  i,  564. 
Kefir,  i,  564. 

in  gastro-intestinal  nephritis,  i,  637. 
Keratin,  i,  564. 

Kermes  mineral.     See  under  Antimony  (vol.  i, 
page  14). 

as  an  emetic,  i,  114. 
Kerosene,  i,  565. 

in  atonic  and  indolent  ulcers,  i,  565. 

"  destruction  of  parasites,  i,  116. 
Kinetotherapy.  i,  565. 
Kino,  i,  565. 

in  diarrhoea,  i,  565. 

"  epistasis,  i,  565. 

"  indolent  ulcers,  i,  565. 

"  leueorrhoea,  i,  565. 

"  passive  hajmorrhage,  i,  565. 

"  polyuria,  i,  565. 

"  relaxed   conditions    of    the    mouth    and 
throat,  i,  565. 
Kochin,  i,  565. 
Kola.    See  Sterculia. 
Koumyss.    See  Kumyss. 
Kousso.     See  Cusso. 

in  treatment  of  taenia,  i,  103. 
Krameria,  i,  565. 

in  chronic  diarrhoea,  i,  566. 

"  dysentery,  i,  566. 

"  leueorrhoea,  i,  566. 

"  passive  bleeding  from  the  intestines,  i,  566. 

"  visceral  haemorrhage,  i,  566. 
Kresin,  i,  566. 

Kristaline.     See  Cristalline. 
Krummholz   oil.     See   under   Pine   prepara- 
tions (vol.  ii,  page  88). 
Kumyss,  i,  566. 

as  an  antemetic  food,  i,  98. 

in  acute  febrile  conditions,  i,  567. 

"  chronic  bronchitis,  i,  567. 

"  convalescence  of  acute  diseases,  i,  567. 

"  diseases  of  the  stomach  and  bowels,  i,  567. 

"  impaired  digestion,  i,  567. 

"  phthisis,  i,  567. 

Laburnum.    See  Cytisus  laburnum. 
Lac.    See  Milk. 
Lactic  acid,  i,  567. 

in  atonic  dyspepsia,  i,  567. 

"  corneal  ulcers,  i,  568. 

"  croup,  i,  567. 

"  diabetes,  i,  567. 

"  diarrhoea,  i,  567. 

"  diphtheria,  i,  567. 

"  epithelioma,  i,  568. 

"  gastric  superacidity,  i,  567. 


Lactic  acid  in  lingual  and  in  nasal  tubercu- 
losis, i,  568. 

in  papillomata,  i,  568. 

"  photophobia,  i,  568. 

"  tuberculous  laryngitis,  i,  567. 

"  "  ulceration,  i,  568. 

Lactol,  Lactonaphthol,  i,  568. 
Lactopeptine,  i,  568. 
Lactophenine,  i,  568. 

in  influenza,  i,  568. 

"  rheumatism,  i,  568. 

"  scarlet  fever,  i,  568. 

"  typhoid  fever,  i,  568. 
Lactose.    See  Sugar  of  milk. 
Laotuca,  i,  568. 
Lactucarium,  i,  568. 

in  nausea  following  the  use  of  opium  or 
morphine,  i,  568. 
Laotucin,  i,  568. 
Lamellae,  i,  568. 
Laminaria,  i,  568. 
Lanolin,  i,  569. 

(injection)  in  gonorrhoea,  i,  569. 
Lantana,  Lantanine,  i,  570. 
Lantanine  in  malarial  fevers,  i,  570. 
Lappa,  i,  570. 

in  hsemorrhoids,  i,  570. 

"  scrofula,  i,  570. 

"  syphilis,  i,  570. 
Larch.  See  Larix. 
Lard,  i,  570  ;  ii,  445. 

in  poisoning  by  acids  or  alkaloids,  i,  570. 

inunctions  in  malnutrition  with  emaciation, 
ii,  445. 
Larix,  i,  570. 

in  chronic  irritable  affections  of  the  genito- 
urinary tract,  i,  570. 
Larkspur.     See  Staphisaqria. 
Laudanum.     See  under  Opium. 
Laurel,  i,  571. 

in  acute  eczema  and  dermatitis,  i,  571. 

"  atonic  diarrhoea,  i,  571. 

(extract)  in  cerebro-spinal  meningitis,  i,  571. 

in  erythema,  i,  571. 

(extract)  in  megrim,  i,  571. 

in  rheumatism,  i,  571. 

"  tinea,  i,  571. 
Laurocerasus,  i,  571. 
Laurus.    See  Laurel. 
Lavage,  i,  571. 

in  acute  indigestion,  i,  578. 

"      "      vegetable  poisoning,  i,  491. 

"  chronic  gastritis,  i,  491,  573. 

"  dilatation  of  the  stomach,  i,  491,  573. 

"  gastralgia,  i,  578. 

"  intoxication,  i,  573. 

"  lead  poisoning,  i,  491. 

"  mercury  poisoning,  i,  491. 

"  motor  disturbances  of  the  stomach,  i,  573. 
Lavandula,  i,  573. 

in  digestive  atony,  i,  573. 
"  flatulence,  i,  573. 
"  headache,  i,  573. 
"  nervous  exhaustion,  i,  573. 
Lavements.     See  Bnemata. 
Lavender.    See  Lavandula. 
Laxatives,  i,  233 ;  i,  573. 
Lead,  i,  574. 

acetate  and  opium  in  diarrhcBa,  i,  577. 
"       in  diarrhoea,  i,  577. 


503 


GENERAL  INDEX. 


Lead  acetate  in  hsemorrhage  from  the  stomach, 
i,  577. 
acetate  in  hajmoptysis,  i,  577. 

"        "  intestinal  haemorrhage,  i,  577. 
and  opium  wash  in  erysipelas,  bruises,  and 

irritable  surfaces,  i,  577. 
and  opium  wash  in  rhus  poisoning,  i,  577 ; 

ii,  133. 
compound  suppositories  of,  in  dysentery  and 

ii-ritable  condition  of  the  rectum,  i,  577. 
Goulard's    extract  of,   in    sprains,  blisters, 

bruises,  etc.,  i,  577. 
iodide  ointtuent  in  enlarged  glands,  i,  578. 
"  "  "  hypertrophy  of  the  spleen, 

i,  578. 
liniment  in  burns  and  raw  surfaces,  i,  578. 
"  "  eczema  of  the  anus  and  genitals, 

i,  577. 
liniment  in  psoriasis,  i,  577. 
nitrate  in  fissured  nipples  and  chapping,  i,  578. 

"        "  onychia,  i,  578. 
oxide  ointment  in  eczema,  i,  578. 
"       plaster  in  raw  or  excoriated  surfaces, 
i,  578. 
poisoning,  i,  576. 
tannate  in  bedsores,  i,  578. 
Unna's,  paste,  ii,  64. 
Leeching,  i,  578. 
application  of  the  leech,  i,  579. 
for  local  depletion  in  children,  i,  578. 
"  conjunctivitis,  i,  579. 
"  meningitis,  i,  579. 
"  orchitis,  i,  579. 
"  otitis,  i,  579. 
Lemon,  i,  579. 

-juice  and  coffee  in  intermittent  fever,  i,  360. 
"      as  an  antidote  for  poisoning  from  the 
fumes  of  ammonia  water,  i,  53. 
-juice  (diluted,  as  a  gargle)  in  aphthous  af- 
fections, i,  360. 
-juice  in  corpulence,  i,  260. 

"      (diluted,  as  a  gargle)  in  gangrenous 
affections,  i,  360. 
-juice  in  jaundice,  i,  200. 

"      "  poisoning  by  Indian  hemp,  i,  580. 
"      "  post-partum  haemorrhage,  i,  360. 
"      (diluted)  in  pruritus,  i,  360. 
"      in  rheumatism,  i,  360. 
"      with  glycerin  lotion  in  sunburn,  i,  260. 
Leontodon.    See  Taraxacum. 
Leptandra,  i,  580. 
in  constipation,  i,  580. 
(as  a  tonic)  in  dyspepsia,  i,  580. 
Lettuce,  i,  580. 

Levisticum.     See  Lioustioum. 
Levulose,  ii,  445. 

in  diabetes,  ii,  445. 
Lichen.     See  Cetrakia. 
Licorice,  i,  580. 
and  flaxseed  in  diarrhoea,  i,  581. 
"         "         "  pharyngitis  and  laryngitis,  i, 
581. 
compound  powder  of,  in  constipation,  i,  581. 
in  bronchial  catarrh,  i,  580. 
"  bronchitis,  i,  580. 
Lignosulphite,  i,  581. 

in  pulmonary  tuberculosis,  i,  581. 
Ligusticum,  i,  581. 
in  amenorrhoea,  dropsy,  and  flatulent  dys- 
pepsia, i,  581. 


Lily  of  the  valley.    See  Convallaria. 
Lime,  i,  581. 
as  a  germicide,  i,  447. 
"  an  antidote  to  sulphuric-acid  poisoning, 

ii,  342. 
in  carbolic-acid  poisoning,  i,  583. 
incompatibility  and  toxicology  of,  i,  582. 
-juice  in  scurvy,  i,  360. 
physiological  action  of,  i,  583. 
syrup  of,  in  poisoning  by  carbolic  or  oxalic 

acid,  i,  582. 
vapour  of  slaked,  inhaled,  in  diphtheria,  i, 

582. 
-water  and  milk  in  nausea,  i,  98,  582. 

"      as  a  lotion  in  eczematous  surfaces,  i, 
582. 
-water  as  a  lotion  in  fissured  nipples,  i,  583. 
"        "     vaginal  wash  in  threadworms,  i, 
583. 
-water  as  a  wash  in  aphthae,  i,  583. 
"      in  acid  dyspepsia,  i,  582. 
"       "  mucous  enteritis,  i,  583. 
"      "  stone  in  the  bladder,  i,  583. 
"      "  typhoid  fever,  i,  582. 
Liniments,  i,  583. 
Linseed,  i,  583; 
infusion  of,  in  bronchial  inflammations,  i, 

584. 
infusion  of,  in  diarrhoea  and  dysentery,  i,  584. 
"  "    "  inflammation,  i,  584. 

"  "    "  irritation  and  infliammation  of 

the  urinary  organs,  i,  584. 
oil  as  a  nutrient  in  cachectic  conditions,  i, 
584. 
Lint,  i,  584. 

in  burns,  i,  584. 
Linum.    See  Linseed. 
Lipanin,  i,  585. 
Lippia  mexicana,  i,  585. 

in  asthma,  i,  585. 
Liquorice.     See  Licorice. 
Liriodendron  tulipifera  in  malarial  disease,  i, 

585. 
Listerine,  i,  585. 

Litharge.     See  Lead  oxide  under  Lead. 
Lithium,  i,  585. 
in  gout  and  lithiasis,  i,  585,  586. 
salicylate  in  acute  articular  rheumatism,  ii, 

145. 
salicylate  in  fever,  ii,  145. 
Lithontriptics,  i,  585. 
Lobelia,  i,  586. 
in  asthma,  i,  587. 
"        "       as  an  expectorant,  i,  95. 
"  bronchial  cough,  i,  587. 
"  chorea,  i,  587. 
"  convulsions,  i,  587. 
"  epilepsy,  i,  587. 
(enema)  in  fascal  impaction,  i,  587. 
infusion  of,  in  intestinal  intussusception,  i, 

587. 
infusion  of,  in  strangulated  hernia,  i,  587. 
in  habitual  constipation,  i,  587. 
"  spasmodic  croup,  i,  587. 
"  tetanus,  i,  587. 
"  whooping-cough,  i,  587 
Lobeline,  i,  587. 
Loco-weed,  i,  587. 
Logwood,  i,  588. 
London  paste,  ii,  303. 


GENERAL  INDEX. 


503 


Lorctin,  i,  588. 

in  cancer,  i,  588. 
Losophan,  i,  589. 

in  acne,  i,  589. 

"  clironic  eczema,  i,  589. 

"  prurigo,  i,  589. 

"  pruritus,  i,  589. 

"  rosacea,  i,  589. 

"  sycosis,  i,  589. 

"  tinea  tonsurans,  i,  589. 

"      "     versicolor,  i,  589. 
Lotions,  i,  589. 

yellow  mercurial,  in  chronic  ulcers  of  the 
skin  and  in  syphilis,  i,  589. 
Lovage.    See  Ligusticum. 
Jjozenges.    See  Troches. 
Lupulin,  i,  589. 

in  nervousness  from  irritation  of  the  blad- 
der, kidneys,  or  urethra,  ii,  6. 
Lupuline,  i,  474. 
Lupulus.     See  Humulus. 
Lycetol,  i,  589. 

in  gout  and  lithiasis,  i,  589. 
Lycopodium,  i,  589. 

in  flatulent  dyspepsia,  i,  590. 

powder  in  excoriated  surfaces,  i,  590. 

tincture  in  incontinence  of  urine,  i,  590. 
"        "  uric-acid  deposits,  i,  590. 
Lysol,  i,  590. 

(injection)  in  dysentery,  i,  590. 

in  dyspepsia,  i,  590. 

"  eczema,  i,  590. 

"  gonorrhoea,  i,  590. 

"  inflammatory  affections  of  the  throat,  i, 
590. 

"  leucorrhoea,  i,  590. 

"  lupus,  i,  590. 
Lytta.    See  Cantharides. 

Mace,  i,  590. 

Magendie's  solution  in  asthma,  i,  93. 
Magnesia  and  rhubarb  in  diarrhoea,  i,  591. 
and  the  salts  of  magnesium,  i,  590. 
as  an  antidote  in  sulphuric-acid  poisoning, 

ii,  243. 
fluid,  in  colic,  i,  591. 
in  arsenical  poisoning,  i,  591. 
"  burns,  ii,  445. 

"  headache  of  indigestion,  i,  591. 
"  phosphorus  poisoning,  ii,  76. 
"  poisoning  with  acids,  i,  591. 
Magnesium  borocitrate,  i,  591. 
carbonate  as  a  dentifrice,  i,  591. 
chloride,  i,  591. 

citrate  in  fever  of  children,  i,  591. 
hydrate   and  carbonate  in  poisoning  with 

arsenic,  i,  109. 
hydrate  and  carbonate  in   poisoning  with 

corrosive  sublimate,  i,  109. 
hydrate  and  carbonate  in  poisoning  with 

metallic  salts,  i,  109. 
hydrate  and   carbonate  in  poisoning  with 

phosphorus,  i,  109. 
salicylate  in  fevers,  i,  591. 
silicate,  i,  592. 

sulphate  in  early  stages  of  dysentery,  i,  592. 
Magnolia,  i,  592. 
in  colds,  i,  592. 
"  gout,  i,  592. 
"  intermittent  fever,  i,  593., 


Magnolia  in  malarial  disease,  i,  118. 

in  rheumatism,  i,  592. 
Malakin,  i,  593. 
in  croupous  pneumonia,  i,  593. 
"  neuralgia,  i,  593. 
"  rheumatic  fever,  i,  592. 
Male  fern.     See  Aspidium. 
Mallein,  i,  593. 

Mallow.    See  Marshmallow. 
Malt,  i,  594. 
extract  in  tuberculosis,  i,  595. 
"        "  wasting  diseases,  i,  595. 
Maltine.     See  under  Malt. 
Malto-carnis,  i,  595. 
Maltose.     See  under  Malt. 
Malva.    See  Marshmallow. 
Manaca,  i,  595. 
in  rheumatism,  i,  595. 
"  scrofula,  i,  595. 
"  syphilis,  i,  595. 
Manganese,  i,  595. 
and  iron  in  amenorrhcea  and  chlorosis,  i,  596. 
in  chlorosis  as  an  eminenagogue,  i,  374., 
dioxide,  in  amenorrhcea  or  anaemia,  i,  596. 
iodide,  in  aniemia,  i,  596. 
oxide,  in  gastrodynia,  i,  596. 
"        "  gastralgia,  i,  596. 
"        "  pyrosis,  i,  596. 
sulphate  (ointment)   in   glandular   indura- 
tions and  in  painful  joints,  i,  596. 
Mango,  i,  597. 
Manna,  i,  598. 
Mannitol  hexanitrate.    See  bracketed  section 

under  Nitric  acid. 
Maranta.    See  Arrowroot. 
Marrol,  i,  598. 
Marrow,  i,  598. 
in  ansemia,  i,  598,  599  ;  ii,  445. 
"  haemophilia,  i.  598. 
"  insanity,  ii.  445. 
Marrubium.     See  Hobehound. 
Marshmallow,  i,  599. 
in  chafed  or  excoriated  skin,  i,  599. 
"  inflammation  of  the  mucous  membranes, 

i,  599. 
"  renal  complications  of  children,  i,  600. 
Massage,  i,  600. 
abdominal,  i,  603. 

"        in  ascitic  accumulations,  i,  608. 
"  "  dilatation  of  the  stomach,  i,  608 

"  gallstones,  i,  608. 
"  "  intestinal  inertia,  i,  605,  608. 

"  "  jaundice,  i,  608. 

"  "  suppression  of  urine,  i,  608. 

k  friction  in  bruises,  in  lacerated  muscles  or 
ligaments,  and  in  traumatic  synovitis,  i, 
609. 
a  frictions,  i,  603. 
douche,  i,  603. 
effleurage,  i,  601. 
electro-,  i,  603. 
for  cataract,  i,  610. 

"    chronic  catarrh  of  the  middle  ear,  i,  610. 
general,  i,  603. 

"        in  functional  dyspepsia,  1,  608. 
hydraulic,  in  rheumatism  and  paralysis,  i, 

603. 
in  burns,  i,  609. 

"  chronic  inflammatory  processes  of  the  an- 
terior segment  of  the  eye,  i,  610. 


504 


GBNEEAL  INDEX. 


Massage  in  embolism  of  the  central  artery  of 
the  retina,  i,  610. 
in  fractures,  i,  609. 
(neck)  in  headache,  i,  608. 
in  health,  i,  607. 
(neck)  in  hemiorania,  i,  608. 
(Brandt's  method)  in  incontinence  of  urine, 
1,  609. 

in  insomnia,  i,  608. 

"  lateral  curvature  of  the  spine,  i,  610. 

"  locomotor  ataxia,  i,  608. 

"  lumbago,  i,  608. 

"  muscular  rheumatism,  i,  608. 

"  myositis,  i,  608. 

"  nervous  disorders,  i,  607. 

"  neuralgia,  i,  608. 

"         "  from  impaired  nutrition,  i.  68. 

"  palsy,  i,  608. 

"  pelvic  disorders  of  women,  i,  609. 

"  pianist's  cramp,  i,  608. 

"  prolapse  and   other  malpositions  of  the 
uterus,  i,  609. 

"  rheumatoid  arthritis,  i,  608. 

"  sciatica,  i,  608. 

"  spasmodic  affections,  i,  608. 

"  sprains,  i,  609. 

"  surgery,  i,  609. 

"  telegrapher's  cramp,  i,  608. 

(in  the  Brand  treatment)  in  typhoid  fever,  i, 
000. 

in  ulcers,  i,  609. 

"  vaso-motor  paresis,  i,  608. 

"  writer's  cramp,  i,  608. 

mechanical,  i,  603. 

of  the  ear  for  deafness,  i,  610. 

"    "      "     "    the    dislodgment     of    foreign 
bodies,  i,  610. 

of  the  eye  in  asthenopia,  i,  610. 

petrissage,  i,  601. 

physiological  effects  of,  i,  603. 

posture  during,  i,  600. 

tapotement,  i,  603. 

therapeutics  of,  i,  606. 
Mastic,  i,  610. 
Masticatories,  i,  610. 
Mate,  i,  611 ;  ii,  368. 
Matieo,  i,  611. 

in  acute  inflammation,  i,  611. 

"  cystitis,  i,  611. 

"  diarrhoea^  i,  611. 

"  dysentery,  i,  611. 

"  epistaxis,  i,  611. 

'■  gonorrhoea,  i,  611. 

"  hsematemesis,  i,  611. 

"  heematuria,  i,  611. 

"  hjemoptysis,  i,  611. 

"  leucorrhcBa,  i,  611. 

"  raenorrhagia,  i,  611. 
Matricaria,  i,  611. 
Matzol,  i,  611. 
Matzoon,  i,  611. 

as  an  antemetic  food,  i,  98. 
May-apple.    See  Pouophyllum. 
Meat  powder,  i,  333. 
Meconaroeine,  i,  611. 

in  broncho-pulmonary  affections  with  cough, 
i,  611. 

"  insomnia,  i,  611. 

"  neuralgia,  i,  611. 

"  the  morphine  habit,  i,  611. 


Mediate  treatment,  i,  611. 

in  syphilis,  i,  613. 
Medication,  rectal,  i,  198. 
Medulladen,  ii,  445. 
Medullary    glyceride.      See    under    Marrow 

(vol.  ii,  page  599). 
Meiotics,  i,  613. 
Mel.    See  Honey. 
Melilotus,  i,  613. 
Melissa,  i,  613.    ' 

as  a  diaphoretic  in  fever,  i,  613. 
Menispermum,  i,  613. 
Menthacetic  ether,  i,  613. 
Mentha  piperita,  i,  613. 
(oil)  externally  in  acute  rheumatism,  i,  613. 
"  "  "  arthralgia,  neuralgia,  etc., 

i,  613. 
in  abdominal  pain,  i,  613. 
"  colds,  i,  613. 

(infusion)  in  colic  and  flatulence,  i,  613. 
(poultice)  in  diarrhoea,  i,  613. 
(infusion)  in  dysmenorrhoea,  i,  613. 
inhalation  of  vapour  of,  in  pulmonary  tu- 
berculosis, i,  614. 
(poultice)  in  nausea,  i,  613. 
in  rheumatism,  i,  613. 
(oil)  in  toothache,  i,  613. 
to  promote  the  menstrual  flow,  i,  618. 
Mentha  viridis,  i,  614. 
Menthiodol.    See  under  Menthol. 
Menthol,  i,  614. 
as  a  local  amiesthetio,  i,  614. 
in  croup,  i,  529. 
"  diarrhoea,  i,  614. 
in  furuncle  of  the  external  auditory  meatus, 

i,  616. 
inhalation  in  chronic  nasal  catarrh,  i,  539. 
in  headache,  i,  614. 
"  nervous  dyspepsia,  i,  614. 
"  neuralgia,  i,  614. 
"  otitis  media,  i,  616. 
"  pruritus,  i,  614. 
"  toothache,  i,  136. 
. "  whooping-cough,  i,  539  ;  ii,  445. 
plaster  in  neuralgia  (mild  forms),  i,  614. 
solution  (by  injection)  in  dyspnoea  of  phthi- 
sis, i,  615. 
solution  (by  injection)  in  hay  fever  and  nasal 

catarrh,  i,  614. 
solution  (by  injection)  in  laryngeal  and  pul- 
monary affections,  i,  614. 
solution  (by  injection)  in  pulmonary  tuber- 
culosis, i,  614. 
solution  (by  injection)  in  ulceration  of  the 
larynx,  i,  614,  615. 
Mentho-phenol,  i,  616. 
in  abscess,  i,  616. 
"  facial  ervsipelas,  i,  616. 
"  otitis,  i,  616. 

"  phagedEenic  chancroid,  i,  616. 
"  syphilis,  i,  616. 
"  toothache,  i,  616. 
Mercauro,  i,  454. 

in  syphilis,  i,  454. 
Mercurial  purge  at  the  beginning  of  a  course 

of  quinine,  i,  117. 
Mercuric  cyanide  in  diphtheria,  i,  323. 
Mercury,  i,'617. 
ammoniated,  in  psoriasis,  i,  627. 

"  "  syphilitic  eruptions,  i,  627. 


GENERAL  INDEX. 


505 


Mercury,  ammoniated.  in  tinea,  i,  C27. 
ammoniated,  ointment  of,  in   treatment  of 

pedieuli,  i,  116. 
and  oantharidin  in  syphilis,  i,  621. 
"     potassium  iodide  in  neuralgia  caused  by 
syphilis,  i,  69. 

"    zino  cyanide,  i,  322 ;  ii,  409. 
as  a  cholagogue,  i,  618,  619. 
"     diuretic,  i,  618. 
as  an  alterative,  i,  617. 
bichloride,  as  a  germicide,  i,  447. 

"  as  an  antisyphilitic,  i,  626. 

"  as  a  parasitic,  i,  626. 

"  (small  doses)  as  a  systemic  tonic, 

i,  625. 
bichloride,  in  chronic  skin  disease,  i,  626. 
"  "   deficient  secretion  of   bile,   i, 

626. 
bichloride  (small  doses),  in  diphtheria,  i,  626; 

ii,  221. 
bichloride,  in  gastric  fermentation,  i,  626. 

"  (injections)  in  gonorrhoea,  i,  531. 

bichloride,  in  lentigo,  i,  626. 

"  "   malignant  onychia,  i,  626. 

"  "  "         pustule,  i,  626. 

"  "  naevi,  i,  636. 

"  "   ringworm,  i,  117. 

"  "  "  of  the  scalp,  i,  626. 

"  "   telangeiectases,  i,  626.  ' 

"  "   treatment  of  poisoning,  i,  625. 

"         (solution),    surgical   employment 
of,  i,  626. 
biniodide,  as  a  germicide,  i,  447. 
by  fumigation,  i,  621. 
"   intravenous  injection,  i,  621. 
"   inunction,  i,  621. 
chlorides,  i,  624. 

chronic  poisoning  with,  iodides  in,  ii,  214. 
compound  pill  of  subchloride  of,  in  chronic 

rheumatic  or  gouty  conditions,  i,  625. 
compound  pill  of  subchloride  of,  in  syphi- 
litic skin  diseases,  i,  625. 
fumes  of,  in  laryngeal  diphtheria,  i,  530. 
hypodermioally,  i,  621. 
in  angina  pectoris,  i,  620. 

sine  dolore,  i,  620. 
"  biliousness,  i,  619. 
"  diarrhoea,  i,  619. 
"  gout,  i,  619. 
"  heart  disease,  i,  620. 
"  inflammations   of   serous   membranes,   i, 

619. 
"  intestinal  dyspepsia,  i,  619. 
"  iritis,  i,  619. 
"  rheumatism,  i,  619. 
"  skin  diseases,  i,  619. 
"  syphilis,  i,  630,  621. 
"  whooping-cough  (Rabinschek's   method), 

ii,  446. 
(subcutaneous  injections)  in  tetanus,  ii,  446. 
iodide  and  arsenic  in  chronic  gout,  i,  627. 
"        "         "        "        "       rheumatism,  i, 
627. 
iodide  and  arsenic  in  lepra,  lupus,  psoriasis, 

and  venereal  eruptions,  1,  627. 
iodide  in  late  syphilis,  i,  637. 
liniment,  in  chronic  glandular  enlargemer.ts 

and  indurations,  i,  638. 
metallic,  i,  621. 
nitrate,  for  moles  and  njevi,  i,  638. 


Mercury,  nitrate,  in  phagedaenic  and  syphilitic 
ulcerations,  i,  638. 
nitrate,  in  ulcers  of  the  cervix  uteri,  i,  628. 
"       ointment  in   eczema,   psoriasis,  and 
ulcerative  conditions,  i,  628. 
ointment  in  acute  and  subacute  articular  in- 
flammation, i,  622. 
ointment  in  epididymitis,  i,  623. 

"         "  general  peritonitis,  i,  632. 
"  "  infantile  syphilis,  i,  632. 

"         (inunction)    in    local    indurations 
and  enlargements,  i,  622. 
ointment  (inunction)  in  enlargement  of  the 

lymph  glands,  i,  633. 
ointment  in  orchitis,  i,  632. 

"         (inunction)  in  syphilis,  i,  622. 
oleate,  i,  624. 
"       and  ether  in  treatment  of  pedieuli,  i, 
116. 
oleate,  in  ringworm,  i,  117. 

"        "  syphilis,  i,  624. 
oxides,  i,  623. 

oxide  (ointment)  in  acute  conjunctivitis,  i,  633. 
"  "  "  chronic  marginal  blepha- 

ritis, i,  623. 
oxide  (ointment)  in  chronic  rhinitis,  i,  633. 
"  "  "  eczema  of  the  lids,  i,  623. 

"  "  "  phlyctenular      ophthal- 

mia, i,  623. 
plaster  in  pitting  of  small-pox,  i,  623. 

"        "  syphilitic  nodes,  i,  623. 
red  iodide,  in  syphilitic  ulcers,  i,  637. 
"    oxide  (ointment)  in  parasitic  skin  dis- 
ease, i,  623. 
red  oxide   (ointment)  in  ringworm  of  the 

scalp,  i,  633. 
red  oxide  (ointment)  in  venereal  ulceration, 

i,  623. 
sozoiodolate  in  parasitic  skin  disease,  ii,  215. 
"  "   skin  disease,  ii,  215. 

"  "   syphilitic  ulcers,  ii,  215. 

subchloride   (ointment)  in  skin  diseases,  i, 

635. 
sulphates,  i,  628. 
tannate,  ii,  259. 

"         in  syphilis,  ii,  259. 
with  chalk  in  diarrhoea,  i,  623. 
"        "       "  intestinal  disorders,  i,  628. 
"        "       "  syphilis  of  children,  i,  622. 
Metadihydroxybenzene.     See  Resoroin. 
Metaldehyde,  i,  628. 
Methacetin,  i,  628. 
Methoxycaifeine,  i,  628. 
as  a  local  anEesthetio,  i,  688. 
in  migraine,  i,  628. 
"  neuralgia,  i,  628. 
Methyl,  i,  629. 
alcohol,  i,  638. 
chloride,  i,  638. 

"         in  lumbago,  i,  69. 
"  "  neuralgia,  trigeminal,  i,  69. 

"  "  sciatica,  i,  69. 

ether,  i,  628. 
iodide,  i,  629. 
nitrate.    See  under  Nitric  acid,  bracketed 

section, 
salicylate,  i,  639 ;  ii,  146. 
violet.    See  under  Pyootantnb. 
Methvlaeetanilide.    See  Exalgine. 
Methylal,  i,  629. 


506 


GENERAL  INDEX. 


Methylal  as  a  hypnotic,  i,  629. 
inhalation  in  asthma,  i,  629. 

"  "  neuralgia,  i,  629. 

in  insomnia,  i,  629. 

"  neuralgia  (by  the  mouth  and  hypodermic- 
ally),  i,  69. 
"  tetany,  i,  629. 
Methylene  blue,  i,  629. 
in  amoebic  dysentery,  i,  630. 
'•  beri-beri,  i,  630. 
"  chronic  cystitis,  i,  630. 
"  gonorrhosa,  i,  630. 
(by  the  stomach  or  hypodermioally)  in  gout, 

i,  629. 
in  malarial  disease,  i,  630. 
"  neuralgia,  i,  630. 
"  neuralgic  pains  of  chronic  malarial  origin, 

i,  68. 
"  posterior  spinal  sclerosis,  i,  630. 
(by  the  stomach  or  hypodermioally)  in  sci- 
atica, i,  629. 
(by  the  stomach  or  hypodermioally)  in  syno- 
vitis, i,  629. 
Methylpyrocatechin.     See  Guaiacol. 
Mezereon,  Mezereura,  i,  630. 
in  cutaneous  disorders,  i,  630. 
"  rheumatism,  i,  630. 
"  syphilis,  i,  630. 
Mica  panis,  i,  630. 
Miorocidine,  i,  630. 
Migrainin,  Migranin,  i,  631. 
in  headache  of  influenza,  i,  631. 
'■  migraine,  i,  631. 
Millc,  i,  631. 
adulteration,  i,  637. 
and  limewater  as  an  antemetic,  i,  98. 
as  a  food,  i,  426. 
condensed,  i,  633. 
cream,  i,  635. 
dietetic  uses  of,  i,  633. 
efEect  of  food  and  drugs  on  the,  i,  632. 
in  diabetes,  i,  337,  636. 
infant  feeding  with,  i,  633. 
in  parenchymatous  nephritis,  i,  637. 
"  poisoning  with  alkaline  salts,  i,  109. 
"        "  "     metallic  salts,  i,  109.   ' 

"  scarlet  fever,  i,  335. 
modified,  i,  635 ;  ii,  447. 
peptonized,  ii,  69. 

"  in  cancer  of  the    intestines,   i, 

836. 
peptonized,  in  nausea,  i,  98. 
pi'eservation  of,  i,  632. 
production  of  disease  through,  i,  632. 
Mineral  acids  in  treatment  of  taenia,  i,  101. 
in  vomiting,  i,  100. 
oils,  ii,  31. 

waters.    See  Waters,  Mineral. 
Mint.     See  Mentha  piperita  and   Mentha 

VIRIDIS. 

Mistletoe.    See  VisouM  album. 
Mixtures,  i,  643. 
MoUin,  i,  127,  643. 
Momordica.     See  Elateridm. 
Monobroraacetanilide.     See  Antisepsin. 
Monochloracetic  acid.    See  under  Chloracbtio 

ACID. 

Monoehlormethane.     See  Methyl  chloride,  un- 
der Methyl. 
Monochlorphenol.    See  under  CnLOROPHENOLS. 


Monophenethydrin.     See  Apolysine. 
Moringa,  ii,  447. 

as  a  counter-irritant,  ii,  447. 
'•  an  emmenagogue,  ii,  447. 

in  chronic  rheumatism,  ii,  447. 
"  jaundice,  ii,  447. 
Morphine.     See  under  Opium. 

and  atropine  in  hepatic  colic,  i,  67. 
'•  "         "  inflammation  of  the  sciatic 

nerve,  i,  67. 

and  atropine  in  lead  colic,  i,  67. 
"  "         "  renal  colic,  i,  67. 

"  "         "  spasmodic     dysmenorrhoea, 

i,  67. 

as  a  cardiac  stimulant,  ii,  38. 
"    hypnotic,  i,  508. 

as  an  adjuvant  to  expectorant  mixtures,  i, 
419. 

biraeconate  in  asthma,  i,  93., 

in  angina  pectoris,  i,  67 ;  ii,  36. 

"  asthma,  i,  93. 

"  Bright's  disease,  ii,  37. 

"  chronic  alcohol  poisoning,  ii,  87. 

"  delirium  of  nervous  exhaustion  in  acute 
fevers,  ii,  37. 

(small  doses)  in  diarrhceai  ii,  38. 

in  dysentery,  ii,  38. 

"  dyspnoea,  ii,  37. 

"  heart  disease,  ii,  36. 

"  hysterical  anorexia,  ii,  88. 

(subcutaneously)  in  mitral  insufficiency,  ii,  36. 
"  "      "      stenosis,  ii,  36. 

in  peritonitis,  ii,  38. 

"  ursemic  convulsions,  ii,  87. 

valerianate,  ii,  846. 
Morrhuol,  i,  643. 
Morns.    See  Mulberry. 
Mosohus.    See  Musk. 
Moss,  Iceland.    See  Cetraria. 

Irish.     See  Ohondrus. 
Motor  depressants,  i,  643. 
Moussena,  i,  645. 
Moussenine,  i,  645. 
Movement  cure.    See  under  Exercise,  (vol.  i, 

page  413). 
Mucilages.    See  Demulcents. 
Mucuna,  i,  645. 

in  Ascaris  lumbricoides,  i,  103. 

"  treatment  of  teenia,  i,  103. 
Mulberry,  i,  645. 
Mullein.     See  Verbascum. 
Miiller's  fluid,  ii,  95. 
Muriatic  acid.    See  Hydrochloric  acid. 

ether.    See  Ethyl  chloride. 
Muscale  buttons.     See  Anhalonium  Lewinii. 
Muscarine,  i,  645. 

as  a  meiotic,  i,  612. 

•'  an  anthidrotic,  i,  103. 

in  belladonna  poisoning,  i,  645. 

"  cholera  infantum,  i,  645. 

"  diabetes  insipidus,  i,  645. 

"  gout,  i,  645. 

"  hiccough,  i,  645. 

"  laryngismus  stridulus,  i,  645. 

"  meningitis,  i,  645. 

"  paralysis  of  respiration,  i,  645. 

"  pertussis,  i,  645. 

"  spasmodic  affections,  i,  645. 
cough,  i,  645. 
Muscle  extract  in  muscular  dystrophies,  i,  81. 


GENERAL  INDEX. 


507 


Musk,  i,  645. 

in  adynamic  pneumonia  of  drunkards,  i,  645. 

"  obstinate  hiccough,  ii,  6. 

"  sudden  nervous  depression,  ii,  6. 

"  typhoidal  disease,  i,  645. 

root.    See  Sumbul. 
Mussana,  Mussanine,  Mussena,  Mussenine.    See 

MOUSSENA. 

Mustard,  i,  646. 
and  molasses  in  dyspepsia  with  constipation, 

i,  646. 
as  a  counter-irritant,  i,  646. 

"   deodorizer,  i,  647. 
as  an  antiseptic,  i,  647. 

"     emetic,  i,  647. 
as  a  rubefacient,  i,  646. 
bath,  hot,  in  eruptive  fevers,  i,  647. 
foot  bath,  hot,  in  amenorrhoea,  i,  647. 
"       "       "      "  headache  due  to   indiges- 
tion, i,  647. 
plaster  (applied  to  chest  and  lungs)  in  bron- 
chitis, i,  647. 
plaster  (applied  to  the  abdomen)  in  diarrhoea, 

i,  647. 
plaster  (applied  to  the  stomach)  in  nausea,  i, 

98,  647. 
plaster  in  neuralgia,  i,  647. 
poisoning,  i,  648. 
Mutton  suet.    See  Suet, 
Mydriatics,  i,  649. 
effects  of,  i,  650. 
in  glaucoma,  i,  651. 
"  iritis,  i,  650. 
Mydrin,  i,  651. 
Mydrol,  ii,  447. 
as  a  mydriatic,  ii,  447. 
in  blepharospasm,  ii,  447. 
"  ciliary  and  supraciliary  pain,  ii,  447. 
"  lacrymation,  ii,  447. 
Myelotherapy.     See  under  Sekum  treatment 

(vol.  ii,  page  187). 
Myotics.    See  Meiotics. 
Myrcia,  i,  651. 
Myristica.     See  Nutmeg. 
Myronin,  i,  651. 
Myrrh,  i,  651. 
tincture  of  (internally),  in  amenorrhcea,  i,  651. 
"        "  (locally),  in  aphthous  inflamma- 
tion, i,  651. 
tincture  of  (internally),  in  catarrhal  gastritis, 

i,  651. 
tincture  of,  in  diphtheria,  i,  652. 
-    "         "    (internally),  in  gastralgia,  i,  651. 
"         "   (locally),  in  indolent  ulcers,  i,  651. 
"         "   in  leucorrhoea,  i,  651. 
"         "   (locally),  in  Riggs's  disease,  i,  651. 
"         "   (locally),  in  sore  throat,  i,  651. 
"         "   (locally),  in  spongy  gums,  i,  651. 
Myrrholin,  i,  652. 

in  laryngeal  and  pulmonary  phthisis,  i,  652. 
Myrtillin,  ii,  447. 
Myrtol,  i,  652. 
in  chronic  catarrh,  i,  653. 
"  bronchitis,  i,  653. 
"  weak  digestion,  i,  653. 

Napelline,  ii,  1. 
Naphthalan,  ii,  447. 
in  chronic  eczema,  ii,  448. 
"  diabetes,  ii,  448. 
76 


Naphthalan  in  eczema,  ii,  448. 
in  prurigo,  ii,  448. 
"  pruritus,  ii,  448. 
"  syphilis  (by  inunction),  ii,  448. 
"  ulcer  of  the  leg,  ii,  448. 
Naphthalene,  ii,  1. 
in  bronchorrhoea,  ii,  1. 
"  cystitis,  ii,  1. 
"  diarrhoea,  ii,  1. 
"  dysentery,  ii,  1. 
"  foetid  bronchitis,  ii,  1. 
"  pyelitis,  ii,  1. 
"  roundworms,  ii,  1. 
"  scabies,  ii,  1. 
"  seat  worms,  ii,  1. 
"  treatment  of  wounds,  ii,  1. 
"  typhoid  fever,  ii,  1. 
"  ulcers,  ii,  1. 
"  whooping-cough,  ii,  1. 
Naphthalol.    See  Betol. 
Naphthol,  ii,  3. 

as  an  antiseptic,  i,  448. 
camphorated,  ii,  3. 

"  in  ozsena,  ii,  3. 

"  "  tuberculosis,  ii,  2. 

"  "  tuberculous    ulceration    of 

the  tongue,  ii,  3. 
in  cholera,  ii,  2. 
(by  insufllation)  in  chronic  suppuration  of 

the  ear,  ii,  3. 
in  diarrhoea,  ii,  3. 
"  dilatation  of  the  stomach,  ii,  3. 
"  dysentery,  ii,  2. 
"  foul  ulcers,  ii,  2. 
"  gastric  fermentation,  ii,  3. 
(in  solution)  in  hyperidrosis,  ii,  3. 
in  influenza,  ii,  2. 
"  typhoid  fever,  ii,  1. 
Lassar's,  paste,  ii,  64. 
ointment  in  scabies,  ii,  3. 

"         "  tinea  ciroinata,  ii,  3. 
plaster  in  ringworm,  i,  117. 
salicylate.     See  Bbtol. 
Naphthosalol.     See  Betol. 
Narceine.    See  under  Opium. 
Narcotics,  ii,  3. 
Naregamia  alata,  ii,  5. 
in  catarrhal  affections,  in  indigestion,  and  in 
rheumatism,  ii,  5. 
Natrium.     See  Sodium. 
Neotandra.     See  under  Bebeerine. 
Nerium,  ii,  5. 
as  a  cardiac  tonic,  ii,  5. 
in  epilepsy,  ii,  5. 
Nervines,  ii,  5. 

Nervous  substance.     See  under  Animal  ex- 
tracts AND  JUICES, 
dose  and  administration,  i,  81.    ' 
in  epilepsy,  i,  80. 
"  functional  and  organic  nervous  disorder, 

i,  80. 
"  insomnia,  i,  80. 
"  neurasthenia,  i,  80. 
"  paralysis,  bulbar,  i,  80. 
"  tabes  dorsalis,  i,  80. 
Neurodin,  ii,  7. 
in  intestinal  pain,  ii,  7. 
"  neuralgia,  ii,  7. 

"         "         of  the  bladder  and  stomach, 
ii,  7. 


508 


GENERAL  INDEX. 


Neurodin  in  pains  in  the  arms  (from  spinal  ir- 
ritation), ii,  7. 

in  sciatica,  ii,  7. 
Niootiana,  Nicotine.    See  Tobacco. 
Nitrates.     See  under  Nitric  acid. 

effects  of,  in  cardiac  pain,  ii,  9. 

"       "   in  chronic  Bright's  disease,  ii,  10. 
Nitre.    See  Potassium  nitrate. 
Nitric  acid,  ii,  7. 

and  quinine  in  intermittent  fever  (with  he- 
patic engorgement),  ii,  8. 

as  a  germicide,  i,  446. 

in  cancrum  oris,  i,  227 ;  ii,  7. 

"  chancroids,  ii,  7. 

"  chronic  bronchitis,  ii,  8. 

"       "       cervical  endometritis,  ii,  7. 

"       "        cystitis,  ii,  7. 

"  cirrhosis  of  the  liver,  ii,  8. 

"  colliquative  diarrhoea,  ii,  8. 

"  condylomata,  i,  227. 

"  constitutional  syphilis,  ii,  8. 

"  dyspepsia  with  phosphatic  urine,  ii,  8. 

"  hsemorrhage,  ii,  7. 

"  haemorrhoids,  ii,  7. 

"  hospital  gangrene,  ii,  7. 

"  intra-uterine  granulations,  ii,  7. 

"  lithsemia,  ii,  8. 

"  oxaluria,  ii,  8. 

"  phagedaena,  i,  227. 

"  phagedaenio  ulcers,  ii,  7. 

"  small  fibroid  tumours,  ii,  7. 

"  summer  diarrhoea,  ii,  8. 

"  syphilis,  ii,  8. 

"  venereal  ulcerations,  i,  237. 

"  warts,  i,  337;  ii,  7.^ 

"  whooping-cough,  ii,  8. 
Nitrites,  ii,  11. 

dose  and  administration  of,  ii,  13. 

effects  of,  on  the  bowels  and  stomach,  ii,  12. 
"    "     "   kidneys,  ii,  12. 
"        "     "     "   nervous  system,  ii,  13. 
"        "     "     "   perspiration,  ii,  13. 
"        "    "     "   respiration,  ii,  12. 
"        "     "     "   temperature,  ii,  13. 

reduction  of  the  blood-pressure  by,  ii,  13. 

some  of  the,  compared,  ii,  13. 

therapeutic  uses  of  the,  ii,  13. 
Nitrobenzene,  ii,  13. 
Nitrogen,  ii,  14. 

inhalation  in  chronic  pneumonia,  ii,  14. 

monoxide  in  asthma,  i,  538. 

"  "  pulmonary  tuberculosis,  i,  528. 

"  "  spasmodic  affections,  i,  538. 

"  "  whooping-cough,  i,  528. 

Nitroglycerin,  ii,  14. 

dose  and  administration  of,  ii,  15. 

effects  of,  ii,  14,  15. 

in  anaamia,  ii,  15. 

"  angina  pectoris,  ii,  15. 

"  asthma,  i,  95. 

"  Bright's  disease,  ii,  15. 

"  cardiac  dyspnoea,  ii,  15. 

"  dyspnoea,  ii,  10. 

"  gastralgia,  ii,  15. 

"  headache  due  to  anaemia  of  the  brain,  ii, 
15. 

"  hepatic  colic,  ii,  15. 

"  hiccough,  ii,  15. 

"  intermittent  fever  (cold  stage),  ii,  15. 

"  laryngismus  stridulus,  ii,  15. 


Nitroglycerin  in  migraine,  ii,  15.  ,,    .    »„ 

in  neuralgia  (as  a  nerve  stimulant),  i,  o9 ; 

"  neuralgia  of  the  trigeminal  nerve,  ii,  15. 

"  Raynaud's  disease,  ii,  10. 

"  reflex  vomiting,  ii,  15. 

"  renal  colic,  ii,  15. 

"  sciatica,  ii,  15. 

"  seasickness,  i,  99  ;  ii,  15. 

"  spasmodic  asthma,  ii,  15. 

"         "  contraction  of  the  arteries,  i, 

133. 

"  tetanus,  ii,  15. 

"  whooping-cough,  ii,  15. 
Nitrohydrochlorie  acid,  ii,  16. 

as  an  escharotic,  ii,  16. 

in  acne,  ii,  16. 

(sponging)  in  cachexia  of  children,  ii,  16. 

in  constitutional  syphilis,  ii,  16. 

"  cutaneous  affections,  ii,  16. 

"  digestive  disorders,  ii,  16. 

"  diseases  of  the  liver,  ii,  16. 

"  dropsy,  ii,  16. 

"  dysentery,  ii,  16. 

(sponging)  in  jaundice,  11,  16. 

in  syphilis,  ii,  16. 

"  xanthelasma,  ii,  16. 
Nitrous  oxide,  ii,  16. 

administration  of,  ii,  18. 

death  from  inhalation  of,  ii,  448. 

in  extraction  of  teeth,  ii,  17. 

"  melancholia,  ii,  18. 

"  nervous  exhaustion,  ii,  18. 

"  labour,  ii,  18. 

"  minor  operations  of  short  duration,  ii,  18. 

physiological  action  of,  ii,  17. 

water,  ii,  18. 
Nosophene,  ii,  18. 

in  balanoposthitis,  ii,  19. 

"  dry  rhinitis,  ii,  19. 

"  nasal  diphtheria,  ii,  19. 

"  rhinitis  witli  excessive  secretion,  ii,  19. 

"  soft  chancre,  ii.  19. 

"  traumatic  weeping  eczema,  ii,  19. 
Nuclein,  spleen,  in  tuberculosis,  ii,  34. 

yeast,  in  amygdalitis,  ii.  24. 
"      "  indolent  ulcer,  ii,  34. 
"      "  pharyngitis,  ii,  24. 
"      "  tuberculosis,  ii,  24. 
Nuoleins,  ii,  19. 

dose  and  administration  of,  ii,  25. 

germicidal  properties  of  the,  ii,  23. 

"  value  of,  in  the  treatment  of  dis- 

ease, ii,  33. 

in  anasmia,  ii,  24. 

"  bronchitis,  ii,  24. 

"  chronic  Bright's  disease,  ii,  34. 

"        "       eczema,  ii,  34. 

"  diphtheria,  ii,  23,  35. 

"  general  debility,  ii,  24. 

"  hip-joint  disease,  ii,  34. 

"  influenza,  ii,  24. 

"  malarial  poisoning,  ii,  24. 

"  neurasthenia,  ii,  35. 

"  naso-pharyngeal  catarrh,  ii,  34. 

"  night  sweats,  ii,  34. 

"  pleurisy,  ii,  34. 

"  pneumonia,  ii,  34. 

(protonuclein)  in  progressive  anaemia,  ii,  448. 

in  scarlet  fever,  ii,  35. 


GENERAL  INDEX. 


509 


Nucleins  in  tuberculous  adenitis,  ii,  35. 

raanner  of  extracting,  ii,  20. 

prevention  of  disease  by  the  use  of,  ii,  23. 

therapeutics  of,  ii,  22. 
Nutgalls.    See  Galls. 
Nutmeg,  ii,  25. 

(oil)  as  a  rubefacient,  ii,  35. 

(powdered)  in  colic  of  infants,  ii,  25. 

in  enteritis,  ii,  35. 

"  gastralgia,  ii,  25. 

"  nausea,  ii,  25. 

(oil)  in  neuralgia  (as  a  rubefacient),  ii,  25. 
"     "  rheumatism  (as  a  rubefacient),  ii,  35. 
Nutrose,  ii,  449. 

in  convalescence  from  scarlet  fever,  diph- 
theria, measles,  or  pneumonia,  ii,  449. 
Nux  vomica,  ii,  20. 

in  amblyopia,  ii,  29. 

"  cardiac  failure,  ii,  28. 

"       "  "        during  chloroform  anaes- 

thesia, ii,  450. 

(tincture)  in  diarrhoea  (due  to  atony  of  the 
bowels),  ii,  28. 

in  flatulence,  ii,  28. 

"  flatulent  dyspepsia,  ii,  38. 

"  frontal  headache,  ii,  28. 

"  gastric  catarrh,  ii,  28. 

(extract)  in  habitual  constipation,  ii,  28. 

in  headache  of  gastric  origin,  ii,  28. 

(injections)  in  "insolation"  of  the  eyes,  ii,  39. 

in  morning  vomiting  of  drunkards,  ii,  38. 

"  nervous  cough,  ii,  38. 

"  neuralgia  from  impaired  nutrition,  i,  68. 

"  pneumonia,  ii,  450. 

"  pulmonary  tuberculosis,  ii,  449. 

"  pyrosis,  ii,  38. 

(small  doses)  in  vomiting  associated  with 
gastric  atony,  i,  99. 

in  vomiting  of  phthisis,  ii,  38. 

"        "  "  pregnancy,  ii,  28. 

physiological  action  of,  ii,  26. 

poisoning,  eucalyptus  in,  ii,  435. 

therapeutics  of,  ii,  38. 

Oak  bark,  ii,  30. 

in  diarrhcea,  ii,  31. 

"  flabby  ulceration,  ii,  31. 

(enema)  in  hseraorrhoids,  ii,  31. 

in  hyperidrosis,  ii,  31. 

(injections)  in  leucorrhcea,  ii,  31. 
Oatmeal,  ii,  31. 

in  chronic  constipation,  ii,  31. 
Odontine,  ii,  31. 
Odontol,  ii,  31. 

in  toothache,  ii,  31. 
Oils,  ii,  31. 

fixed,  ii,  33. 

in  poisoning  with  alkalies,  i,  109. 

"  "  "     corrosive  salts,  i,  109. 

"  "  "     carbolic  acid,  i,  109. 

"  "  "     metallic  salts,  i,  109. 

mineral,  ii,  31. 

volatile,  ii,  33. 
Ointment  mulls,  ii,  33. 
Ointments,  ii,  33. 
Oleander.     See  Nemum. 
Oleates.    See  under  Oleic  acid. 
Oleoresins,  ii,  34. 
Oleum  cadinum,  ii,  34. 
Olibanum,  ii,  34. 


Olibanum  in  bronchitis,  ii,  34. 

in  laryngitis,  ii,  34. 
Olive  oil,  ii,  34. 
as  an  enema,  ii,  33. 

for  the  protection  ot  raw  surfaces,  ii,  35. 
in  biliary  colic,  ii,  35. 
"  wasting  diseases,  ii,  35. 
Opium,  ii,  35. 
and  belladonna  in  uterine  pain,  i,  67. 
"    cannabis  indica  in  uterine  pain,  i,  67. 
"    its  derivatives,  i,  67. 
as  a  hypnotic,  i,  508. 

as  an  adjuvant  to  expectorant  mixtures,  i,  419. 
as  a  narcotic,  ii,  3. 
chronic  poisoning  with,  ii,  44,  45,  46. 
fumes  in  asthma,  i,  539. 
"       "  bronchitis,  i,  539. 
"       "  cardiac  pain,  i,  539. 
"       "  laryngitis,  i,  539. 
"       "  thoracic  pain,  1,  539. 
"       "  whooping-cough,  i,  539. 
by  hypodermic  injection,  in  the  early  stages 

of  meningitis,  i,  67. 
(as  a  stimulant)  in  adynamia,  ii,  226. 
(small  doses)  in  bronchitis,  ii,  37. 
in  collapse  from  cholera,  ii,  36. 
"  excessive  intestinal  peristalsis,  i,  67. 
"  diarrhoea  of  typhoid  fever,  ii,  36. 
'•  enfeeblement,  ii,  35. 
"  hfemoptysis,  ii,  35. 
"  haemorrhage,  ii,  450. 
"  haemorrhage  from  typhoid  ulcer,  ii,  36. 
"  hectic  fever  of  phthisis,  ii,  36. 
(small  doses)  in  inflammation  of  the  sciatic 

nerve,  i,  67. 
"  insomnia  due  to  cardiac  dyspnoea,  i,  508. 
"  intestinal  spasm,  i,  133. 
(as  a  stimulant)  in  low  fever,  ii,  225. 
in  nausea,  i,  99. 
"  neuralgia,  i,  69. 
"  pain,  ii,  37. 

"  pain  from  enteritis,  i,  67. 
"     "     from  rheumatism,  i,  125. 
(small  doses)  in  pleurisy,  ii,  37. 

"         "      "  pneumonia,  ii,  37. 
in  prostration  from  hsemorrhage,  ii,  35. 
in  tenesmus,  i,  67. 
"  vomiting,  i,  99. 
poisoning,  ii,  40,  41,  42,  43,  44. 
vinegar  of,  in  asthma,  i,  93. 
wine  of,  in  asthma,  i,  93. 
Opodeldoc,  ii,  46. 
Oranges.     See  Aueaktium. 
Orchitic  extract.    See  Animal  extracts  and 

juices. 
Orchitic  liquid,  i,  73. 
administration  and  dose,  i,  76. 
in  cancer,  i,  75. 
"  contractures,  i,  76. 
"  chorea,  i,  75. 
"  debility,  i,  76. 
"  diabetes  mellitus,  i,  75. 
"  epilepsy,  i,  76. 
"  hysteria,  i,  76. 
"  hystero-epilepsy,  i,  76. 
"  impotence,  i,  76. 
"  leprosy,  i,  75. 
"  locomotor  ataxia,  i,  74. 
"  neurasthenia,  i,  76. 
"  nocturnal  emissions,  1,  76. 


510 


GENEliAL  INDEX. 


Orohitio  liquid  in  nocturnal  incontinence  of 
children,  i,  76. 

in  senility,  premature,  i,  76. 

"  skin  diseases,  i,  75. 

"  tuberculosis,  i,  74. 
Orexine  hydrochloride,  ii,  46. 

in  anaemia,  ii,  451. 

"  anorexia,  ii,  46. 

"  gastric  catarrh,  ii,  451. 

"  incipient  phthisis,  ii,  451. 

"  vomiting  of  pregnancy,  ii,  451. 
Organic  extracts.  Organotherapy.    See  Animal 

EXTEAOTS  AND  JUICES. 

Origanum,  ii,  46. 
Orotherapy,  ii,  451. 
Orphol,  ii,  46. 

in  diarrhoea  (of  children),  ii,  46. 
Orrhotherapy,  ii,  451. 
Orris  root,  ii,  46. 
Orthine,  ii,  47. 
Orthochlorophenol.     See    under    Chloeophe- 

NOLS. 

Oryza  sativa.     See  Rice. 
Osmic  acid,  ii,  47. 

as  a  hardening  and  staining  agent,  ii,  47. 

injections  in  muscular  rheumatism,  ii,  47. 
"  "  intercostal  neuralgia,  ii,  47. 

"  "  sciatica,  ii,  47. 

therapeutics  of,  ii,  47. 
Osmium   hydroxide.   Osmium  tetroxide.     See 

Osmic  acid. 
■Ouabain,  ii,  48. 

in  whooping-cough,  ii,  48. 
'Ovarine,  ii,  48,  451, 

Ovarian  juice,  Ovarian  substance,  in  amenor- 
rhcea,   in  chlorosis,  and  in  disturbances 
following  the  menopause  and  oophorec- 
tomy, ii,  451. 
Ovi  albumen,  Ovi  vitellus.     See  under  Eggs. 
Oxalic  acid,  ii,  48. 

as  a  corrosive  poison,  ii,  48. 

as  an  emmenagogue,  i,  367 ;  ii,  49. 

in  dysmenorrhoea,  ii,  49. 

"  strangulated  hernia,  ii,  49. 

treatment  of  poisoning  with,  ii,  48. 
Oxalis,  ii,  49. 
■Ox-bile,  Ox-gall,  ii,  49. 
■Ox-bile  enema  in  ftecal  impaction,  ii,  49. 

in  habitual  constipation,  ii,  49. 

"  intestinal  dyspepsia,  ii,  ■49. 

"  malnutrition,  ii,  49. 
Oxygen,  ii,  49. 

and  ether  for  anaesthesia,  ii,  53. 

biological  relations  of,  ii,  49. 

ethereal,  ii,  50. 

in  acute  lobar  pneumonia,  ii,  53. 

"  anaemia,  ii,  52. 

I  (injections)  in  ascites,  ii,  453. 

in  asphyxia,  ii,  53. 

"  capillary  bronchitis  of  children,  ii,  53. 

■"  chlorosis,  ii,  52. 

"  chronic  suppurative  otitis  media,  ii,  451. 

"  collapse  due  to  acute  disease,  ii,  53. 

"  coma,  ii,  52. 

"  croup,  ii,  52. 

"  diabetes,  ii,  53. 

"  diphtheria,  ii,  53. 

(as  a  stimulant)  in  dyspnoea  of  cardiac  or 
pulmonary  origin,  ii,  336. 

in  gangrene,  ii,  51. 


Oxygen  in  gout,  ii,  53.  ^ 
in  hypochondriasis,  ii,  53. 
(as  a  stimulant)  in  indolent  ulcers,  ii,  51. 
in  infected  wounds,  ii,  51. 
"  insomnia  due  to  mental  fatigue,  ii,  53. 
"  leucaemia,  ii,  53. 
"  narcotic  poisoning,  i,  537. 
"  neurasthenia,  ii,  53. 
"  neurotic  dyspepsia,  ii,  53. 
"  ozaena,  ii,  ■451. 
"  pernicious  anaemia,  ii,  52. 
"  prostration  due  to  acute  disease,  ii,  53. 
"  pulmonary  tuberculosis,  ii,  52. 
"  purulent  discharges  from  the  antrum  of 
Highmore,  the  frontal  sinuses,  or  the 
■  ethmoid  cells,  ii,  452. 
"  rhachitis,  ii,  52. 
"  scrofulosis  (of  children),  ii,  52. 
"  sloughing,  ii,  51. 
"  surgical  anaesthesia,  ii,  53. 
"  syphilitic  rupia,  ii,  52. 
"  temporary  obstruction  of  the  air-passages, 

i,  527. 
"  toxic  narcoses,  ii,  53. 
"  tuberculosis,  ii,  53. 
"  tuberculous  ulcer,  ii,  53. 
medical  history  of,  ii,  50. 
physiological  effects  of,  ii,  51. 
preparation  and  administration  of,  ii,  50. 
therapeutics  of,  ii,  51. 
triatomio,  as  a  germicide,  i,  •445. 
Oxygenated  water  and  hydrogen-dioxide  solu- 
tion (by  inhalation)  in  chronic  gastric  ca- 
tarrh, ii,  52. 
(locally  through  the  stomach-tube)  in  gastro- 
intestinal catarrh,  ii,  53. 
Oxymels,  ii,  54. 
Oxynaphthoic  acid,  ii,  54. 
Oxyquinaseptol.     See  Diaphtherin. 
Oxysparteine,  ii,  54. 
Oxytocics,  ii,  54. 

Oyster  shell.    See  Testa  pe^paeata.  _ 
Ozone,  ii,  56. 
as  a  disinfectant,  i,  445. 
chemistry  of,  ii,  56. 
in  diabetes,  ii,  58. 
"  diphtheria,  i,  445. 
"  gout,  ii,  58. 

"  pernicious  anaemia,  ii,  58. 
inhalation  in  asthma,  ii,  58. 
"  "  bronchitis,  ii,  58. 

"  cholera,  ii,  58. 
"  diphtheria,  ii,  58. 
"  "  emphysema,  ii,  58. 

"  "  ozaena,  ii,  58. 

"  "  pulmonary  tuberculosis,  ii,  58 

"  "  whooping-cough,  ii,  58. 

preparation  and  properties  of,  ii,  56. 
physiological  effects  of,  ii,  57. 
therapeutics  of,  ii,  58. 

Pack,  wet,  in  cardiac  disorders,  i,  490. 

in  diabetes,  i,  490. 

"  gout,  i,  490. 

"  organic  cardiac  disease,  i,  490. 

"  rheumatism,  i,  490. 
Palmetto  wine,  ii,  58. 

as  a  tonic,  ii,  58. 

in  amygdalitis,  ii,  58. 

"  bronchitis,  ii,  58. 


GENERAL  INDEX. 


511 


Palmetto  wine  in  follicular  pharyngitis,  ii,  58. 
Painbotano,  ii,  58. 

as  a  stomachic  tonic,  ii,  58. 

in  fever  of  tuberculosis,  ii,  58. 

"  influenza,  ii,  58. 

"  malarial  disease,  ii,  58. 

"  typhoid  fever,  ii,  58. 
Pancreatic  emulsion,  ii,  59. 

in  tuberculosis,  ii,  59. 

extract.  See  IPancreatin  and  under  Ani- 
mal EXTRACTS  AND  JUICES. 

extract,  i,  80. 

extract  in  pancreatic  diabetes,  i,  80. 
Panoreatin,  ii,  59. 
Pansy.    See  Viola  trioolok. 
Papain,  Papaiva.    See  under  Papaw. 

and  sodium  bicarbonate  (as  a  dusting  pow- 
der) in  unhealthy  sores  and  sloughing  tis- 
sue, ii,  60. 

in  accumulation  of  cerumen  in  the  ear,  ii,  60. 

"  dilatation  of  the  stomach,  ii,  60. 
■    "  diphtheria,  ii,  60. 

"  dysentery,  ii,  60. 

"  gastric  catarrh,  ii,  60. 

"  roundworms,  ii,  60. 

"  ta;nia,  i,  103. 
Papaver.     See  Poppy. 
Papaw,  ii,  59. 

as  a  gastric  sedative,  ii,  60. 

in  fissure  of  the  tongue,  ii,  60. 

"  gastric  irritation,  ii,  60. 

■"  syphilitic  ulcerations  of  the  tongue,  ii,  60. 

"  ulcer  of  the  stomach,  ii,  60. 

"  warty  growths,  ii,  60. 
Para-acetphenetidine.     See  Phenaoetinb. 
Parabromaoetanilide.     See  Antisepsin. 
Parachlorophenol,  Pharachlorphenol.     See  un- 
der Chlorophenols. 
Paraohlorphenol,  topically,  in  lupus,  i,  246. 
Paracotoin,  Paracotoinic  acid.    See  under  Goto 

BARK. 

Paraeresalol,  Paracresol  salicylate,  ii,  60. 
Paracresalol  as  an  intestinal  antiseptic,  ii,  60. 
Paraffin,  ii,  60. 
Paraform,  ii,  61. 

as  an  intestinal  antiseptic,  ii,  60. 

in  cholera,  ii.  61. 

"  cholera  infantum,  ii,  61. 

"  typhoid  fever  (incipient  stage),  ii,  61. 

(diluted)  in  wounds  and  ulcers,  ii,  61. 
Paraldehyde,  ii,  61. 

as  a  hypnotic,  i,  509. 

dose  and  administration  of,  ii,  63. 

habit,  ii,  62. 

in  asthma,  ii,  62. 

"  broncho-pneumonia,  ii,  63. 

"  Cheyne-Stokes  respiration  associated  with 
broncho-pneumonia,  ii,  63. 

"  delirium  tremens  (early  stages),  ii,  63. 

"  hysteria,  i,  509. 

"  insanity,  ii,  62. 

"  insomnia  of  insanity,  ii,  62. 

"         "         "  mania,  i,  509. 

"  puerperal  convulsions,  ii,  63. 

poisoning  with,  ii,  61. 

therapeutics  of,  ii,  63. 
Parasiticides.     See  Antiparasitics  and  An- 

thelmiitthics.  _ 
Parataloid.    See  Tuberculin. 
Paregoric,  ii,  63. 


Paregoric  in  diarrhoea,  ii,  63. 
Pareira,  ii,  63. 

in  chronic  cystitis,  ii,  63. 
Parilla,  yellow.    See  Menispermum. 
Paris  green.    See  under  Arsenic. 
Parodyne.    See  Antipyrine. 
Parsley.    See  Petroselinum  and  Apiol. 
Parsley  camphor  in  dysmenorrhoea,  i,  137. 

in  intermittent  fever,  i,  137. 
Parthenicine,  ii,  63. 
Parthenine,  ii,  63. 
Paste,  Canquoin's,  ii,  64. 

Latour's,  ii,  64. 

Smith's,  in  cancer,  ii,  64. 

Vienna,  ii,  64. 
Pastes,  ii,  63. 
Pastilles,  Pastils,  ii,  64. 
Paullinia.    See  Guarana. 
Peanuts.     See  Arachis. 
Pearson's  solution,  i,  146. 
Peat,  ii,  65. 

(as  a  dusting  powder)  in  foul-smelling  ulcers, 
ii,  65. 

(as  a  dusting  powder)  in  gangrene,  ii,  65. 
Pectorals.    See  Expectorants. 
Pediluvium.    See  under  Baths  (vol.  i,  p.  169). 
Pelletierine,  ii,  65. 

in  paralysis  of  the  third  and  fourth  cranial 

nerves,  ii,  65. 
"  t»nia,  i,  103. 

"  worms,  ii,  65. 
Pellitory.     See  Ptrbthrum. 
Pellotine,  ii,  453. 
Pencils,  ii,  66. 

Pennyroyal.     See  Hbdeoma. 
Pental,  ii,  66. 

as  a  general  anaesthetic,  ii,  66. 
Pentane.     See  Amyl  hydride. 
Pepo,  ii,  68. 
Pepper,  black.     See  Piper  nigrum. 

cayenne.     See  Capsicum. 
Peppermint.    See  Mentha  piperita. 
Pepsin,  ii,  68. 

and  bismuth  in  diarrhcEa,  ii,  69. 
"    codeine  in  gastralgia,  ii,  09. 

for  eructations,  ii,  69. 

in  atonic  dyspepsia,  ii,  69. 
"  cancer  of  the  stomach,  ii,  69. 
"  dyspepsia,  ii,  69. 
"  indigestion  of  phthisis,  ii,  69. 
"  lienterie  diarrhoea,  ii,  69. 
"  mucous  gastritis,  ii,  69. 
"  treatment  of  tienia,  i,  101. 
"  ulcer  of  the  stomach,  ii,  69. 

"  vomiting  of  undigested  food,  ii,  69. 

solution  (by  spray)  in  diphtheria,  ii,  69. 
Peptomangan,  ii,  69. 

in  ansemia  of  rhachitis,  ii,  69. 

"  chlorosis,  ii,  69,  70. 

"  phthisis,  ii,  69. 
Peptonized  beef,  i,  43. 

gruel,  i,  43. 

milk.    See  under  Milk. 

milk  as  an  antemetic,  i,  98. 
"     in  nausea,  i,  98. 
"     punch,  i,  42. 
Peptonizing  tubes,  i,  43. 

process  for,  i,  43. 
Permanganate  of  potassium  in  bromidrosis,  i, 
103. 


513 


GENERAL  INDEX. 


Permanganate    of    potassium    in    unhealthy 
wounds,  i,  446. 
of  potassium  in  ulcers,  i,  446. 
Permanganates,  ii,  70. 
in  aniemia,  ii,  70. 

"  bites  of  poisonous  reptiles,  ii,  70. 
"  carbuncles,  ii,  70. 
"  delayed  menstruation,  ii,  70. 
(internally)  in  diphtheria,  ii,  70. 
in  flatulence,  ii,  70. 
"  hospital  gangrene,  ii,  70. 
(injections)  in  leucorrhcea,  ii,  70. 
in  obesity,  ii,  70. 
(injections)  in  otorrhoea,  ii,  70. 

"  "  ozaena,  ii,  70. 

(internally)  in  scarlet  fever,  ii,  70. 
in  ulcerating  surfaces,  ii,  70. 
Perosmic  acid.    See  OsMic  acid. 
Peroxide   of  hydrogen.      See   Hydeogen   di- 
oxide. 
Petrolatum.     See  Vaseline. 
Petroleum,  ii,  70. 
in  chilblains,  ii,  70. 
"  psoriasis,  ii,  71. 
"  pulmonary  affections,  ii,  70. 
"  rheumatism,  ii,  70. 
"  scabies,  ii,  71. 
"  tapeworm,  ii,  71. 
Petroselinum,  ii,  71. 
Phellandrium,  ii,  70. 

as  a  sedative  in  cough,  ii,  71. 
Phenacetine,  ii,  71. 
as  an  anodyne,  i,  68. 
in  exhaustion  from  overwork,  ii,  71. 
"  gastralgia,  ii,  71. 
"  headache,  ii,  71. 
"  influenza,  ii,  73. 

"  insomnia  of  diseases  of  the  uterus,  ii,  71. 
"  migraine,  ii,  71. 
"  neuralgia,  i,  69 ;  ii,  71. 
"  neuritis,  ii,  71. 
"  rheumatism,  for  temporary  relief  of  pain, 

i,  125. 
"  sciatica,  ii,  71. 
Phenates,  ii,  73. 
Phenazone.     See  Antipybine. 
Phenedine,  Phenetidine.    See  Phenacetine. 
Phenic  acid.    See  Carbolic  acid. 
Phenidine,  ii,  73. 
PhenocoU,  ii,  73. 
(as  an  analgetic)  in  acute  articular  rheuma- 
tism, ii,  72. 
in  fever  of  influenza,  ii,  72. 
"     "      "  phthisical  subjects,  ii,  72. 
"  malarial  fever,  ii,  72. 
"  neuralgia,  ii,  72. 
salicylate.    See  Salocoll. 
Phenol,  ii,  72. 
as  a  germicide,  i,  448. 
camphorated,  ii,  73. 
injections  in  tetanus,  ii,  452. 
iodized,  ii,  73. 
Phenol  sodique,  ii,  73. 

in  abrasions  and  wounds,  ii,  78. 
Pheriosalyl,  ii,  73. 
(internal  application)  in  septic  fever  due  to 
retained  portions  of  placenta,  ii,  73. 
Phenylaoetamide,  ii,  73. 
in  neuralgia,  ii,  73. 
"  rheumatism,  ii,  78. 


Phenylaoetamide  in  the  sequelae  of.  alcoholio 

excess,  ii,  73. 
Phenylamine.     See  Analine. 
Phenyl  formamide.     See  Poemanilide. 
Phenylhydrazine,  ii,  74. 

liBvulinate,  i,  134. 
Phenyl  hydride.    See  Benzene. 
Phenyl  salicylate.     See  Salol. 
Phenylio  alcohol.     See  Caebolio  acid. 
Phenylurethane.     See  Euphoeine. 
Phlebotomy,  ii,  74. 
Phloridzin,  ii,  74. 

as  an  antipyretic  in  malarial  fevers,  ii,  74. 
Phosphates.     See  Phosphokus. 
Phosphate  of  ammonium  in  rheumatism,  ii,  78. 

in  uric-acid  conditions,  ii,  78. 

"  osteomalacia,  ii,  78. 

"  rickets,  ii,  78. 

"  tuberculosis,  ii,  78. 
Phosphergot,  ii,  74. 

Phosphide  of  zinc  as  a  ^nic  in  anaemia,  i,  68. 
Phosphides,    Phosphites.      See    under    Phos- 

PHOEHS. 

Phospho-albumin,  ii,  74. 

in  anaamia,  ii,  74. 

"  circulatory  derangements  of  the  climac- 
teric, ii,  74. 

"  neurasthenia,  ii,  74. 

"  phthisis,  ii,  74. 
Phosphoric  acid  as  a  germicide,  i,  446. 

in  chronic  bone  diseases,  ii,  77. 

"        "       ulcers,  ii,  77. 

"  diabetes,  ii,  77. 

"  hysteria,  ii,  77. 

"  leucorrhcea,  ii,  77. 

"  phosphaturia,  ii,  77. 

"  sexual  debility,  ii,  77. 
Phosphorus,  ii,  74. 

as  a  germicide,  i,  440. 
"    nutrient,  ii,  75. 
"    tonic,  ii,  75. 

in  acne,  ii,  77. 

"  cerebral  atony,  ii,  76. 

"        "        endarteritis,  ii,  76. 

"        "        softening,  ii,  76. 

"  chronic  eczema,  ii,  77. 

"  impotence,  ii,  77. 

"  insomnia  of  cerebral  ansemia  and  malnu- 
trition, ii,  76. 

"  locomotor  ataxia,  ii,  76. 

"  lupus,  ii,  77. 

"  mania,  ii,  76. 

"  melancholia,  ii,  76. 

"  mental  enfeeblement,  ii,  76. 

"  neuralgia  of  the  asthenic  type,  ii,  76. 

"  osteomalacia,  ii,  77. 

"  paralysis  agitans,  ii,  76. 

"         "        of  cerebral  origin,  ii,  76. 

"  pernicious  anaemia,  ii,  77. 

"  pseudorleucasmia,  ii,  77. 

"  psoriasis,  ii,  77. 

"  rickets,  ii,  77. 

"  spinal  sclerosis,  ii,  76. 

poisoning  with,  ii,  75,  76. 

therapeutics  of,  ii,  76. 
Photoxvlin,  Photoxylon,  ii,  79. 
Phulluah,  ii,  79. 
in  frostbites  and  chilblains,  ii,  79. 

"  rheumatism,  ii,  79. 

"  sciatica,  ii,  79. 


GENERAL  INDEX. 


613 


Phulluah  in  sprains,  ii,  79. 
Physiological  action  of  drugs,  ii,  80. 

antagonism,  i,  86. 

salt  solution,  ii,  821. 
Physostigma,  ii,  81. 

as  a  meiotio,  i,  613. 
"   motor  depressant,  i,  644. 

in  haeraaturia,  ii,  81. 
Physostigmine,  ii,  81. 

salicylate  in  diarrhoea,  ii,  146. 
"         "  dysentery,  ii,  146. 
Phytolacca,  ii,  81. 

in  chronic  eczema,  ii,  81. 

"        "        rheumatism,  ii,  81. 

"  granular  conjunctivitis,  ii,  81. 

"  inilammation  of  the  lymphatic  glands,  ii, 
81. 

"  maramitis,  ii,  81. 

"  ulcers,  ii,  81. 
Pichi,  ii,  83. 

in  cancer  of  the  bladder,  ii,  83. 

"  cystitis,  ii,  83. 

"  hfematuria,  ii,  83. 

"  haemorrhage,  ii,  83. 

"  hepatic  diseases,  ii,  83. 

"  prostato-cystitis  following  gonorrhoea,  ii, 
82. 

"  renal  colic,  ii,  83. 

"  urinary  diseases,  ii,  83. 
Picraena  excelsa.    See  Quassia. 
Picric  acid,  ii,  82. 

as  a  test  for  albumin  in  the  urine,  ii,  83. 

in  burns,  ii,  83. 

"  chronic  diarrhoea,  ii,  453. 

"  diabetes  mellitus,  iii,  453. 

(locally)  in  eczema,  ii,  83,  453. 
"         "  erysipelas,  ii,  83,  453. 

in  fissured  nipples,  ii,  83. 

(locally)  in  fungous  endometritis,  ii,  83. 
"         "  itching  of  the  scrotum,  ii,  453. 
"         "  lymphangeitis,  ii,  83. 

in  malarial  disease,  ii,  83. 

"  putrid  diarrhoea,  ii,  453. 

"  trichiniasis,  ii,  83. 
Picrol,  ii,  83. 
Picrotoxin,  ii,  83. 

as  an  antiparasitic,  ii,  84. 

in  chorea,  ii,  84. 

"  colliquative  sweating,  ii,  84. 

"  epilepsy,  ii,  84. 

"  night  sweating  of  tuberculosis,  ii,  84. 

"  paralysis  agitans,  ii,  84. 
Pictet  liquid,  i,  527. 
Piliganine.    See  under  Lycopodium. 
Pilocarpine,  ii,  85. 

as  a  meiotic,  i,  613. 

in  asthma,  i,  95. 

"  broncho-pneumonia,  ii,  86. 

"  conjunctivitis,  ii,  86. 

"  croup,  ii,  85. 

"  croupous  pneumonia,  ii,  85. 

"  diphtheria,  ii,  85. 

"  influenza,  ii,  86. 

"  Meniere's  disease,  ii,  87. 

"  pneumonia  due  to  influenza,  ii,  86. 

"  rhinitis,  ii,  86. 
Pilocarpus.    See  Jaborandi  and  Pilocarpine. 
Pills,  ii,  84. 
Pimenta,  ii,  87. 

"        in  flatulence,  ii,  87. 


Pimpernel,  Pimpinella,  ii,  87. 

Pine  preparations,  ii,  87. 

Pinkroot.     See  Spigelia. 

Pinol.    See  under  Pine  preparations. 

Pinus  canadensis,  ii,  88. 

in  leucorrhcea,  ii,  88. 

pumilio,  oil  of,  in  catarrh,  ii,  88. 
"  "     "     "  rheumatism,  ii,  88. 

silvestris.    See  under  Pine  preparations. 

strobus,  ii,  88. 

"        as  an  expectorant,  ii,  88. 
Piper.    See  Piper  nigrum. 
Piperazidine,  Piperazine,  ii,  88. 
Piperazine  in  cystic  irritation,  ii,  89. 

in  diabetes,  ii,  89. 

"  gout,  ii,  89.    . 

"  gravel,  ii,  89. 

"  lumbago,  ii,  89. 

"  renal  colic,  ii,  89. 

"  rheumatism,  ii,  89. 

"  uric-acid  accumulation,  ii,  89. 

"     "       "    diathesis,  i,  586. 

poisoning  with,  ii,  89. 
Piperidine,  ii,  90. 

in  pulmonary  tuberculosis,  ii,  453,  454. 
Piperin,  Piperine,  ii,  90. 

in  malarial  disease,  ii,  90. 
Piper  nigrum,  ii,  90. 

as  a  carminative,  ii,  90. 
"   haemostatic  in  small  wounds,  ii,  90. 

in  malarial  disease,  ii,  90. 
Piperonal,  ii,  90. 
Pipsissewa.     See  Chimaphila. 
Piscidia,  ii,  90. 

(as  an  antispasmodic)  in  asthma,  ii,  91. 

in  bronchitis,  ii,  91. 

"  burns  and  scalds,  ii,  91. 

"  chorea,  ii,  91. 

(as  a  sedative)  in  cough,  ii,  91. 

in  haemorrhoids,  ii,  91. 

"  hysteria,  ii,  91. 

"  nervous  insomnia,  ii,  91. 

"        "        irritability,  ii,  91. 

"  neuralgia,  ii,  91. 

"  pains  of  abortion,  ii,  91. 

"  phthisis,  ii,  91. 

"  spasmodic  dysmenorrhoea,  ii,  91. 

"  toothache,  ii,  91. 

(as  an  antispasmodic)  in  whooping-cough,  ii, 
91. 
Pistacia  lentiscus,  ii,  91. 
Pitch.    See  Pix  burqundica,  Pix  canadensis, 

and  Tar. 
Pituitary-body  extract,  ii,  91. 

in  acromegaly,  i,  81. 
Pix  burgundiea,  ii,  91. 

as  a  rubefacient,  ii,  91. 

in  pulmonary  affections,  ii,  91. 

"  rheumatism,  ii,  91. 

canadensis,  ii,  91. 

liquida,  ii,  91. 

"       in  chronic  bronchitis,  ii,  91. 
"        "       "        cystitis,  ii,  92. 
"        "  pulmonary  affections,  ii,  91. 
Pixol,  ii,  93. 

in  acute  dermatitis,  ii,  93. 

"  psoriasis,  ii,  93. 

"  simple  chancre,  ii,  93. 

"  wounds,  ii,  93. 
Placebos,  ii,  93. 


514 


GENERAL  INDEX. 


Plaster  of  Paris,  ii,  93. 

Plasters,  ii,  92. 

Pleurisy  root.    See  Asclepias  tuberosa. 

Plumbum.    See  Lead. 

Pneumatic  cabinet,  i,  19,  20. 

resistance  valves,  i,  22,  23. 

tub.    See  under  Air,  Condensed  oe  rare- 
fied (vol.  i,  pages  18,  19,  20,  21). 
Podophyllin,  ii,  98. 

in  biliousness,  ii,  93. 

"  constipation,  ii,  93. 

"  functional  disturbances  of  the   liver,  ii, 
93. 

"  haemoptysis,  ii,  93. 

"  malarial  infection,  ii,  93. 

"  portal  congestion,  ii,  93. 

"  respiratory  catarrh,  ii,  93. 

"  vomiting,  i,  100. 
Podophyllotoxin,  ii,  94. 
Podophyllum,  ii,  94. 
Poisons,  ii,  94. 

list  of,  and  their  antidotes,  i,  110,  111. 

table  of  antagonistic,  i,  89. 
Pokeberry  root,  Pokeroot.    See  Phytolacca. 
Polygala.     See  Senega. 
Polygonum  bistorta,  ii,  94. 

hydropiper,  ii,  94. 

"  in  amenorrhoea,  ii,  94. 

Polyporus  fomentarius.     See  under  Agaric. 
Polysolves,  ii,  94. 

Pomegranate.     See  under  Pelletieeine. 
-.    root  in  tisuia,  i,  102. 
Pommades.     See  Ointments. 
Poplar.    See  Populus. 
Populin.    See  under  Populus. 

as  an  antipyretic,  ii,  94. 
Populus,  ii,  94. 

in  malarial  fevers,  ii,  94. 
Poppy,  ii,  94. 
Potash,  Potassa,  Potassa  eaustica,  ii,  94. 

as  a  germicide,  i,  447. 

in  acidity  of  the  stomach,  ii,  94. 

"  boils,  i,  328. 

"  cancer,  i,  228. 

"  carbuncles,  i,  228. 

"  cutaneous  aiiections,  ii,  95. 

"  deep-seated  or  indolent  abscesses,  i,  228. 

"  gout,  ii,  94. 

"  rheumatism,  ii,  94. 

"  uric-acid  diathesis,  ii,  94. 
Potassium  acetate,  ii,  94. 

as  a  laxative,  ii,  95. 

in  acute  rheumatism,  ii,  95. 

and  sodium  tartrate.    See  under  Potassium 

TARTRATES. 

and  sodium  tartrate  in  acute  rheumatism,  ii, 

100. 
bicarbonate.    See  under  Potassium  carbon- 
ates. 
bichromate,  ii,  95. 

"  in  corns,  warts,  etc.,  ii,  95. 

"  "  solution  for  the   destruction 

of  small  growths,  venereal   excrescences, 
and  mucous  patches,  i,  225. 
bisulphate.      See    under    Potassium    sul- 
phate. 
bitartrate.    See  under  Potassium  tartrates. 
bromide,  ii,  95. 

"         as  a  motor  depressant,  i,  644. 
"         in  asthmatic  paroxysms,  i,  94. 


Potassium  bromide  in  preparatory  treatment 
of  taenia,  i,  101. 
bromide  in  strychnine  poisoning,  i,  194. 

"        "  tetanus,  i,  194. 
cantharidate  as  a  hypodermic  in  early  stages 

of  pulmonary  tuberculosis,  i,  209. 
cantharidate  in  cough  of  tuberculosis,  i,  209. 
carbonate,  ii,  95. 

"  as  an  antilithic,  ii,  95. 

"  in  acute  rheumatism,  ii,  95. 

chlorate,  ii,  96. 

"         in  diphtheria,  ii,  96. 
"  "  hoarseness,  ii,  96. 

"  "  pharyngitis,  ii.  96.' 

"  "  salivation,  ii,  96. 

"  "  scarlet  fever,  ii,  96. 

"  "  sore  throat,  ii,  90. 

"  "  stomatitis,  ii.  96. 

"  "  tumours  of  the  gums  and  of  the 

tongue,  ii,  96. 
chlorochromate,  ii,  96. 
citrate  in  acute  rheumatism,  ii,  96. 
"       "  measles,  ii,  96. 
"       "  scarlet  fever,  ii,  96. 
"       "  uric-acid  diathesis,  ii,  96. 
Potassium  cobaltonitrite.     See  under  Cobalt 
(vol.  i,  page  273). 
cobaltonitrite,  i,  273. 

"  in  dyspnoea,  i,  273. 

"  "  high  arterial  pressure,  i,  273. 

"  "  ura3mia,  i,  273. 

cyanide,  i,  322 ;  ii,  97. 

"         in  pruritus  vulvae,  i,  323. 
"         "  severe  headache,  i,  323. 
"         "  skin  diseases,  i,  323. 
"  stains  of  the  conjunctiva,  i,  323. 
cyanides,  ii,  97. 

ferrocyanide  in  colliquative  sweating,  i,  323. 
"  "  poisoning    by    the    copper 

salts,  i,  110. 
hydrate.    See  Potassa. 
hypophosphite.    See  under  Phosphorus,  ii, 

97. 
iodide,  ii,  97. 

"       and  bromide  in  neuralgia  due  to  lead 
poisoning,  i,  69. 
iodide  and  mercury  in  neuralgia  caused  by 

syphilis,  i,  69. 
iodide  and  potassium  bromide  in  asthma,  i, 

97. 
iodide  as  a  sorbefacient,  ii,  99. 
"      in  actinomycosis,  ii,  99. 
"       "  acute  broncho-pneumonia,  ii,  98. 
"       "  aneurysm,  ii,  10. 
"       "  arterio-sclerosis,  ii,  98. 
"       "  asthma,  i,  97 :  ii,  99. 
"       "  Bright's  disease,  ii,  98. 
"       "  chronic  bronchitis,  ii,  98. 
"       "       "        copper  poisoning,  ii,  98. 
"       "        "        enlargements  of  the  lym- 
phatic glands,  ii,  Q9. 
iodide  in  chronic  lead  poisoning,  ii,  98. 
"       "        "        mercury  poisoning,  ii,  98. 
"       "        "        rheumatism,  ii,  98. 
"       "  hypertrophy  of  various  organs,  ii, 
98. 
iodide  in  inflammatory  exudates,  ii,  98. 
"       "  internal  aneurysm,  ii,  98. 
"       "  salicylic-acid  poisoning,  ii,  143. 
"       "  tertiary  syphilis,  ii,  97. 


GENERAL  INDEX. 


515 


Potassium  nitrate,  ii,  99. 
nitrate,  belladonna,  and  stramonium,  fumes 

of,  in  asthma,  i,  529. 
nitrate  fumes  in  asthma,  ii,  99. 

"       in  burns,  ii,  99. 
nitrite.    See  under  Nitrites. 
oxalates.    See  under  Oxalic  acid. 
permanganate,  ii,  99. 

"  as  a  gargle  in  diphtheria,  i, 

597. 
permanganate  as  a  germicide,  i,  446. 

"  as  an  antidote  to  morphine 

poisoning,  i,  596. 
permanganate  as  an  antidote  to  phosphorus 

poisoning,  i,  597 ;  ii,  76. 
permanganate  in  acute  articular   rheuma- 
tism, i,  596. 
permanganate  in  bromidrosis,  i,  103. 

"  "  caries  of  bones,  i,  597. 

"  "  diabetes,  i,  596. 

"  "  diphtheria,  i,  596. 

"  "  gangrene,  i,  597. 

"  injections  in  gonorrhoea,  i,  531. 

"  (as  a  spray)  in  oziena  and  pur- 

ulent otitis,  i,  597. 
permanganate     in     sloughing     malignant 

growths,  i,  597. 
permanganate  in  snake-bite  poisoning,  i,  597. 
"  ulcers,  i,  446,  596. 
"  "  unhealthy  wounds,  i,  446. 

"  solution  as    an  injection  in 

subacute  gonorrhoea,  i,  597. 
permanganate  solution  in  eczema,  i,  596. 
"  frostbite,  i,  596. 
"  "        "  hyperidrosis  of  the 

feet,  i,  597. 
permanganate  solution  in  leucorrhoea,  i,  597. 
phosphate,  ii,  99. 
salicylate,  ii,  146. 
salts  in  renal  dropsy,  i,  345. 
silicate,  ii,  99. 
sozoidolate  in  suppurating  wounds,  ulcers, 

etc.,  ii,  215. 
sulphates,  ii,  99. 
sulphite,  ii,  100. 
sulphocyanate,  ii,  100. 

"  in    pulmonary    tuberculosis, 

ii,  236. 
tannate,  ii,  257. 
tartrate  as  a  diuretic,  ii,  100. 

"        in  dropsy  due  to  acute  nephritis,  ii, 
100. 
tartrate  in  valvular  heart  disease,  ii,  100. 
tartrates,  ii,  100. 
tellurate,  ii,  100. 

"         in  night  sweats  of  phthisis,  ii,  100. 
Potio  Riveri,  ii,  100. 
Poultice,  iodide  of  starch,  ii,  103. 

jacket  in  pneumonia,  ii,  102. 
Poultices,  ii,  100. 
as  counter-irritants,  ii,  101. 
bran,  ii,  103. 
bread,  ii,  103. 

charcoal,  in  offensive  ulcers,  ii,  103. 
chlorine,  in  unhealthy  sores,  ii.  103. 
flaxseed,  in  eozematous  incrustations,  ii,  101. 
general  rules  for  the  employment  of,  11,  102. 
hot,  in  toothache,  i,  186. 
Indian  meal,  ii,  103. 
mustard,  in  deep  inflammation,  ii,  103. 


Poultices,  yeast,  ii,  103. 

Powders,  ii,  103. 

Prescriptions,  ii,  104. 

Propylamine.     See  Tkimethtlamine. 

Protonuclein.    See   under    Nucleins  (vol.  ii, 

page  21). 
Prunes,  ii,  105. 
Prunum.    See  Prunes. 
Prunus  virginiana,  ii,  105. 

in  cough,  ii,  105. 
Prussic  acid.    See  Hydrocyanic  acid. 
Pseudaconitine,  ii,  106. 
Pterocarpus.    See  Sandalwood. 
Ptisans.    See  Drinks.' 
Ptyalagogues.    See  Sialagogues. 
Ptyalin,  ii,  106. 

in  dyspepsia,  ii,  106. 
Ptvchotis  ajowan.    See  Ammi. 
Pulsatilla,  ii,  106. 

in  acute  catarrhal  affections,  ii,  107. 

"      "      cerebral  meningitis,  ii,  107. 

"      "      rheumatic  gout,  ii,  107. 

"      "     rheumatism,  ii,  107. 

"  asthma,  ii,  107. 

"  blepharophthalmia,  ii,  107. 

"  bronchitis,  ii,  107. 

"  catarrhal  deafness,  ii,  107. 

"  chronic  nasal  catarrh,  ii,  107. 

"  conjunctivitis,  ii,  107. 

"  delayed  menstruation,  ii,  107. 

"  dysmenorrhcea,  ii,  107. 

"  earache  (of  children),  ii,  107. 

"  eczema,  ii,  107. 

"  epididymitis,  ii,  107. 

"  functional  amenorrhoea,  ii,  107. 

"  gonorrhoeal  ophthalmia,  ii,  107. 

"  heart  disease,  ii,  106. 

"  indolent  ulcei-s,  ii,  107. 

"  inflammation  of  the  middle  ear,  ii,  107. 

"  irritative  cough,  ii,  108. 

"  mucous  leucorrhoea,  ii,  107. 

"  nervous  headache,  ii,  107. 

"  oophoritis,  ii,  107. 

"  orchitis,  ii,  107. 

"  purulent  ophthalmia,  ii,  107. 

"  rhinitis,  ii,  107. 

"  spinal  meningitis,  ii,  107. 

"  subacute  gastritis,  ii,  107. 

"  syphilides,  ii,  107. 

"  tapeworm,  ii,  108. 

therapeutics  of,  ii,  107. 
Pumiline.    See  under  Pine  preparations  (vol. 

ii,  page  88). 
Pump,  residual  air,  i,  22. 
Pumpkin  seeds.    See  Pepo. 

in  taenia,  i,  102. 
Punica,  Punioine.     See  Pelletierine. 
Punk.     See  under  Agaric. 
Purgatives.    See  Cathartics. 
Pustulants.    See  under  Counter-irritants. 
Pyoctanine,  ii,  108. 

(internally)  in  acute  nephritis,  ii,  109. 
"  adenitis,  ii,  109. 
"  "  chronic  nephritis,  ii,  109. 

in  chronic  ulcers,  ii,  108. 

"  conjunctivitis,  ii,  108. 

"  corneal  opacities,  ii,  108. 

"  dacryocystitis,  ii,  108. 

"  diphtheria,  ii,  108. 

(internally)  in  endometritis,  ii,  109. 


516 


GENERAL  INDEX. 


Pyoctanino  in  furuncles,  ii,  108. 

(internally)  in  gonorrhcea,  ii,  109. 

in  herpetic  ulcers  of  tlie  cornea,  ii,  108. 

"  idiopathic  ptyalism,  ii,  108. 

(internally)  in  malarial  fever,  ii,  109. 

(injections)  in  malignant  neoplasms,  ii,  108. 

in  otorrhoea,  ii,  108. 

"  pleurisy,  ii,  109. 

(injections)  in  pulmonary  phthisis,  ii,  109. 

in  suppurating  wounds,  ii,  108. 

"  trachoma,  ii,  108. 

(internally)  in  typhoid  fever,  ii,  109. 
Pyramidone,  ii,  454. 
Pyrantine,  ii,  109. 

in  acute  rheumatism,  ii,  109. 
Pyrazine,  Pyrazol,  Pyrazoline,  Pyrazolone,  ii, 

109. 
Pyrethrum,  ii,  109. 

as  an  insecticide,  ii,  109. 

in  headache,  ii,  109. 

"  paralysis  of  the  tongue,  ii,  109. 

"  toothache,  ii,  109. 
Pyretine,  ii,  110. 
Pyridine,  ii,  110. 

fumes  of,  in  angina  pectoris,  i,  530. 
"    "  asthma,  i,  530. 

in  angina  pectoris,  ii,  110. 

"  bronchial  asthma,  ii,  110. 

"  cardiac  enfeeblement,  ii,  110. 

injections  in  gonorrhcea,  ii,  10. 
Pyroaoetic  ether  or  spirit.     See  Acetone. 
Pyrodine.     See  Hydraoetin. 
Pyrogallic  acid,  Pyrogallol,  Pyrogallolum,  ii, 

110. 
Pyrogallic  acid  in  chancre,  ii.  111. 

in  eczema  marginatum,  ii.  111. 

"  epithelioma,  ii,  111. 

"  lupus,  ii.  111. 

"  phagedjena,  ii,  111. 

"  psoriasis,  ii.  111. 
Pyroglycerin.    See  Nitrooltcekin. 
Pyroligneous  acid,  ii,  111. 
Pyroxylin,  ii,  111. 
Pyrozone,  ii,  111,  454. 

in  pyorrhoea  alveolaris,  ii,  113. 

"  suppuration,  ii,  113. 

"  suppurative  otitis  media,  ii,  455. 

Quassia,  ii,  118. 

as  a  bitter  tonic,  ii,  113. 

in  anorexia,  ii,  113. 

"  ascarides,  ii,  113. 

(enema)  in  ascarides  vermicularls,  i,  103. 

in  atony  of  the  stomach,  ii,  113. 
Quebrachamine.    See  Quebracho. 
Quebrachine.     See  Quebracho. 
Quebracho,  ii,  113. 

in  asthma,  ii,  113. 

'■  dyspnoea,  ii,  113. 

"  emphysema,  ii,  113. 

"  mitral  insufficiency,  ii,  113. 
Querous.     See  Oak  bark  and  AcoRUS. 
Quicklime.     See  under  Lime  (vol.  i,  page  583). 
Quicksilver.    See  Mercury. 
Quillaia,  ii,  113. 

in  croupous  pneumonia,  ii,  113. 

"  interstitial  pneumonia  with  bronchiecta- 
sis, ii,  113. 

"  pleuropneumonia,  ii,  113. 

"  pulmonary  emphysema,  ii,  113. 


Quillaia  in  pulmonary  tuberculosis,  ii,  113. 

in  syphilitic  stenosis  of  the  bronchus,  ii,  113. 
Quillain.     See  Saponi>'. 
QuinaJgene.     See  Analgene  and  Benzanal- 

GENE. 

Quinaseptol.     See  Diaphthol. 
Quince  seed.     See  Cydonium. 
Quinetum,  ii,  113. 

in  malarial  affections,  ii,  118. 
Quinidine,  ii,  113. 
Quinine,  ii,  113. 

action  of,  on  the  cerebrum,  i,  353. 
"        "     "     "    uterus,  i,  853. 

antipyretic  power  of,  i,  853. 

arsenite,  ii,  455. 

as  an  oxytocic,  ii,  55. 

contra-indications  for  the  use  of,  ii,  131. 

dihydrochloride  carbamate,  ii,  455. 

ferrichloride,  ii,  455. 

hydroohlorsulphate,  ii,  455. 

hypodermically   in   pernicious  intermittent 
fever,  i,  117. 

in  acute  articular  rheumatism,  ii,  118. 

(as  a  spray  or  a  snuff)  in  acute  coryza,  ii, 
119. 

in  acute  glaucoma,  ii,  130. 
"  albuminuria  of  scarlatina,  ii,  119. 

(rectal  injections)  in  amcebic  dvsentery,  ii, 
130. 

in  antemia  (in  non-malarial  cases),  i,  68. 

"  asthma,  i,  356;  ii,  119. 

"  atonic  dyspepsia,  i,  354. 

"  blennorrhagic  ophthalmia,  ii,  130. 

"  cholera,  ii,  119,  131, 133. 

"  chorea,  ii,  130. 

"  chronic  bronchitis,  i,  356;  ii,  119. 

"        "       gastric  catarrh,  i,  354. 

(as  a  tonic)  in  chronic  phthisis,  ii,  119. 

in  convalescence,  i,  354. 

"  coryza,  i,  856. 

(injections)  in  cystitis,  ii,  130. 

in  debility,  i,  854. 

"  diarrhoea,  i,  355. 

"  diphtheria,  ii,  119. 

"  dysentery,  i,  355. 

"  dystocia,  ii,  116. 

"  early  stages  of  amygdalitis,  i,  356. 

"     "         "       "   meningitis,  i,  356. 

"      "         "       "  pleurisy,  i,  356. 

"      "         "       "   pneumonia,  i,  356. 

(injection)  in  empyema,  ii,  130. 

in  erysipelas,  i,  855  ;  ii,  119. 

"  gonorrhoea,  i,  854. 
"  hasmaturia,  i,  855. 

"  hay  fever,  i,  853. 

influence  of,  on  the  gravid  uterus,  ii,  116. 

in  follicular  amygdalitis,  ii,  119. 

(injections)  in  gonorrhoea,  ii,  180. 

(lotion)  in  gonorrhoeal  ophthalmia,  ii,  130. 

(injections)  in  growths  at  the  neck  of  the 
bladder,  ii.  130. 

in  hajmaturia,  ii,  130. 

"  haemorrhagic  malarial  fever,  ii,  118. 

(as  a  spray  or  a  snuff)  in  hay  fever,  ii,  119. 

in  hectic  fever  of  phthisis,  ii,  119. 

"  hydrops  articulorum  intermittens,  ii,  180. 

"  inflammations  of  the  serous  surfaces,  ii, 
119. 

(hypodermically)  in  insolation,  ii,  180. 

in  intermittent  fever,  i,  117 ;  ii,  117. 


GENERAL  INDEX. 


517 


Quinine,  in  intermittent  fever,  as  an  antipe- 
riodic,  i,  354. 

in  intermittent  neuralgia,  ii,  118. 

"  laryngismus  stridulus,  i,  356 ;  ii,  119. 

"  malarial  cachexia,  i.  355 ;  ii,  118. 
•    "         "       disease,  ii,  117,  118. 

"         "       neuralgia,  ii,  130. 

"         "       poisoning  and  malarial  paroxys- 
mal diseases,  ii,  310. 

"  masked  intermittent  fever,  ii,  118. 

"  Meniere's  disease,  ii,  130. 

"  migraine,  ii,  130. 

"  neuralgia,  ii,  118. 

"  neurasthenia,  ii,  130. 

"  paroxysms  of  intermittent  fever,  i,  117. 

"  pertussis,  ii,  119. 

"  phthisis,  i,  856. 

"  pityriasis,  ii,  130. 

"        "  versicolor,  i,  253. 

"  pneumonia,  ii,  119. 

"  prolonged  labour,  ii,  116. 

"         "  suppuration,  ii,  130. 

"         "         suppurative  processes,  i,  256. 

(topically)  in  pruritus  ani,  ii,  130. 

vulvffi,  ii,  120. 

in  puerperal  fever,  ii,  119. 

"  remittent  fever,  i,  355 ;  ii,  118. 

"  rheumatism,  i,  256. 

"  ringworm,  ii,  130. 

"  scarlatina,  i,  255 ;  ii,  119. 

"  sciatica,  ii,  130. 

"  septic  diseases,  i,  255. 

"  small-pox,  ii,  119. 

"  stenocardia,  ii,  120. 

"  surgical  fever,  i,  256. 

"  syphilis,  ii,  130. 

"  tinea  circinata,  i,  353. 

"  trigeminal  neuralgia,  ii,  130. 

"  typhoid  fever,  i,  355  ;  ii,  119. 

"  typhus  fever,  ii,  118. 

"  ulcers,  ii,  131. 

"  unhealthy  granulating  wounds,  ii,  120. 

"  urethral  fever,  i,  256 ;  ii,  120. 

"  uterine  inertia,  i,  356 ;  ii,  116,  130. 

"  whooping-cough,  i,  253. 

physiological  action  of,  ii,  114. 

salicylate,  ii,  455. 

tannate,  ii,  259. 

"        in  malarial  diseases,  ii,  359. 
"         "  nervous  affections,  ii,  359. 
"         "  whooping-cough,  ii,  259. 

valerianate,  ii,  346. 

with  antidiphtheritic  serum  in  malarial  fe- 
ver, ii,  174. 
Quinoidine.    See  Quinidine. 
Quinoline,  ii,  132. 
Quinosol,  ii,  123. 

irrigation  in  labour,  ii,  123. 
Quinquina.    See  Cinchona. 

Raspberry  vinegar,  i,  351. 
Ratanhia.     See  Kbameeia. 
Reconstituents,  ii,  123. 
Rectal  etherization,  i,  63. 

medication,  i,  198. 
Red  poppy.    See  Rhcbas. 

saunders.    See  Sandalwood, 
Refrigerants,  ii,  124. 
Relaxants,  ii,  125. 
Resina.    See  Rosin. 


Resinol.    See  RosiNOL. 
Resins,  ii,  135. 
Resol,  ii,  135. 

Resolvents.    See  Sokbefacients. 
Resorbin,  ii,  135. 
Resorcin,  ii,  125. 
and  ichthyol  in  chilblains,  ii,  136. 
as  a  gastric  sedative,  i,  100. 
"  an  intestinal  antiseptic,  i,  133. 
in  chancroids,  ii,  126. 
(topically)  in  diphtheria,  ii,  126. 
in  eczema,  ii,  126. 
"       "        seborrhoicum,  i,  116. 
"  erysipelas,  ii,  136. 
(antipyretic)  in  fever,  ii,  136. 
in  herpes,  ii,  136. 
"  lencopiakia,  ii,  136. 
"  leucorrhoea,  ii,  136. 
"  lupus  erythematosus,  ii,  136. 
"  psoriasis,  ii,  126. 
"  ulcerative  affections  of  the  mouth,  throat, 

ears,  etc.,  ii,  136. 
(by  spray)  in  whooping-cough,  ii,  126. 
Rest,  absolute,  in  anfemia,  i,  68. 
cure,  ii,  136.  . 
"     in  acute  mania,  ii,  137. 
"      "  anasmia,  i,  68. 
"      "  chorea,  ii,  127. 

"  epilepsy,  ii,  137. 
"       "  exophthalmic  goitre,  ii,  127. 
"       "  hysteria,  ii,  137. 
"       "  melancholia,  ii,  137. 
"       "  mental  or  nervous  exhaustion,  ii,  127. 
"       "  neurasthenia,  ii,  127. 
Restoratives,  ii,  138. 
Retinol.     See  Rosinol. 
Retroinjections.    See  under  Injections. 
Retrojeetions,  i,  531. 
Rhamnin,  ii,  128. 

Rhamnoxanthin.     See  under  Fkangula. 
Rhamus  purshiana,  ii,  138. 

in  chronic  constipation,  ii,  129. 
Rhatanhia,  Rhatany.     See  Krameria. 
Rhei  radix.  Rheum.     See  Rhubarb. 
Rheumin.     See  Chrtsophanio  acid. 
Rhigolene,  ii,  129. 
in  burns,  ii,  139. 
Rhceados  petala,  Rhoeas,  ii,  139. 
Rhubarb,  ii,  139. 
as  a  cholagogue,  ii,  130. 
in  atonic  dyspepsia,  ii,  130. 
"  constipation,  ii,  130. 
"  diarrhoea,  ii,  130. 

"  functional  disturbances  of  the  liver,  ii,  130. 
,   "  haemorrhage  from  the  rectum,  ii,  131. 
(topically)  in  unhealthy  ulcerations,  ii,  130. 
therapeutics  of,  ii,  130. 
Rhus,  if,  131. 
aromatica,  ii,  131. 

"  in    incontinence   of  urine  from 

vesical  atony,  ii,  131. 
aromatica  in  metrorrhagia  due  to  fibroid  tu- 
mours of  the  uterus,  ii,  131. 
aromatica  in  vesical  haematuria,  ii,  131. 
diversifolia,  ii,  131. 
glabra  in  sore  throat,  ii,  131. 
pumila,  ii,  131. 
radicans,  ii,  131. 
toxicodendron,  ii;  131. 

"         in  incontinence  of  urine,  ii,  133. 


518 


GENERAL  INDEX. 


Rhus  toxicodendron  in  hEemorrhoids,  ii,  133. 
toxicodendron  in  muscular  soreness  due  to 

hysterical  convulsions,  ii,  134.  ^ 
toxicodendron,  poisoning  with,  ii,  133. 
"  therapeutics  of,  ii,  133. 

"  treatment  of  poisoning  with, 

ii,  133,  133. 
venenata,  ii,  134. 
vernioifera,  ii,  134. 
Rice,  ii,  134. 
Ricinus,  ti,  134. 
Rontgen  rays.    See  X  rays. 
Rosa  eanina,  Rosa  centifolia,  Rosa  damascena, 

Rosa  gallica.     See  Rose. 
Rosaniline  hydrochloride,  Roseine.    See  PnCH- 

SINE. 

Rose,  ii,  134. 
Rosemary,  ii,  135. 

in  indolent  ulcers,  ii,  135. 
Rosin,  ii.  135. 
Rosinol,  ii,  135. 

in  foul  ulcers,  ii,  135. 

"  pruritus,  ii,  135. 

"  uterine  and  vaginal  catarrh,  ii,  135. 
Rosmarinus.     See  Rosemary. 
Rottlera.     See  Kamala. 
Rubber,  ii,  135. 

Rubefacients.    See  under  Counter-irritants, 
and  vol.  i,  page  313. 

iQ  colic,  i,  313. 

"  lumbago,  i,  313. 

"  neuralgia,  i,  313. 

"  pleurodynia,  i,  313. 

"  sciatica,  i,  313. 
Rubidium,  ii,  136. 

and  ammonium  in  epilepsy,  ii,  136. 

in  syphilis,  ii,  136. 
Rubijervine,  ii,  351. 
Rubus,  ii,  136. 

in  atonic  diarrhoea,  ii,  136. 
Eue,  ii,  137. 

in  araenorrhcea,  ii,  137. 

"  epilepsy,  ii,  137. 

"  hysteria,  ii,  137. 

"  ovarian  atony,  ii,  137. 

"  uterine  atony,  ii,  137. 
Rum,  ii,  137. 

pineapple,  ii,  137. 

shrub,  ii,  137. 
Rumex.  ii,  137. 

"  Rusma  of  the  Turks,"  i,  337. 
Ruta  graveolens.    See  Rue. 
Rye,  ii,  137. 

flour  in  acute  dry  eczema,  ii,  137. 
"      "  burns,,  ii,  137. 
"      "  erysipelas,  ii,  137. 

in  habitual  constipation,  ii,  137. 

Sabadilla,  ii,  137. 
Sabbatia,  ii,  137. 

as  an  appetizer,  ii,  137. 

in  malarial  fever,  ii,  137. 
Sabina.    See  Savine. 
Saccharin,  ii,  137. 

in  aphthous  sore  throat,  ii,  137. 

"  diabetes  raellitus,  ii,  138. 

"  indigestion,  ii,  138. 

"  obesity,  ii,  138. 

"  purulent  affections  of  the  ear,  ii,  137. 
Sacoharum.    See  Sugar. 


Saccharum  laotls.    See  Sugar  of  milk. 
Saffron,  ii,  138. 

tea  as  a  diaphoretic  in  measles  and  exan- 
themata, ii,  369. 
Safrol,  ii,  138. 
Sage.    See  Salvia. 
Sago,  ii,  138. 
Salaoetol,  ii,  138. 

in  acute  articular  rheumatism,  ii,  139. 

"  biliary  lithiasis,  ii,  139. 

"  chronic  rheumatism,  ii,  139. 

"  choleraic  diarrhoea,  ii,  139. 

"  muscular  rheumatism,  ii,  138. 
Salaotol,  ii,  139. 
Salazolon,  ii,  139. 
Salep,  ii,  139. 
Saleratus.    See  under  Potassium  carbonates 

and  Sodium  bicarbonate. 
Salicin,  ii,  139. 

in  acute  articular  rheumatism,  ii,  140. 

"      "      coryza,  ii,  140. 

"      "      inflammatory  processes,  ii,  140. 

"  catarrhal  jaundice,  ii,  140. 

"  chronic  articular  rheumatism,  ii;  140. 

"  diphtheria,  ii,  140. 

"  gout,  ii,  140. 

"  hay  fever,  ii,  140. 

"  lumbago,  ii,  140. 

"  neuralgia,  ii,  140. 

"  pneumonia,  ii,  140. 

"  rheumatism,  ii,  140. 
Salicylacetol.     See  Salacetol. 
Salieylaldehyde-methylphenylhydrazine.     See . 

Agathin. 
Salicylamide,  ii,  140. 

in  acute  amygdalitis,  ii,  141. 

"  neuralgia,  ii,  141. 

"  "        of  peripheral  nerves,  ii,  141. 

"  ovarian  neuralgia,  ii,  141. 

"  rheumatism,  ii,  141. 
Salicylates  in  gastric  fermentation,  i,  133. 

in  intestinal  fermentation,  i,  138. 
Salicylic  acid  and  the  salicylates,  ii,  141. 

applications  in  desquamative  eruptions,  ii, 
144. 

applications  in  pustular  acne,  ii,  144. 

as  an  analgetic,  ii,  143. 
"     antipyretic,  ii,  143. 
"     antiseptic,  ii,  142. 

chronic,  poisoning,  ii,  143. 

douche  in  chronic  ozaena,  ii,  143. 

enema  in  dysentery,  ii,  143. 

for  the  destruction  of  small  growths,  i,  225. 

in  acute  articular  rheumatism,  ii,  142. 

(on  tampons)  in  carcinoma  of  the  uterus,  ii, 
143. 

in  chronic  ui'ticaria,  ii,  143. 

"  corns  and  warts,  ii,  143. 

"  coryza,  ii,  143. 

"  dysidrosis,  ii,  144. 

"  eczema  seborrhoicum,  i,  116. 

"  erythema,  ii,  144. 

(ointment)  in  erythematous  eczema,  ii,  144. 

in  exophthalmic  goitre,  ii,  146. 

"  fever,  ii,  143. 

"  gastric  catarrh,  ii,  143. 

"        "      fermentation,  i,  132. 

"  gonorrhoeal  rheumatism,  ii,  142. 

"  gout,  ii,  143. 

"  hay  fever,  ii,  143. 


GENERAL  INDEX. 


519 


Salicylic  acid  and  the  salicylates  (for  pain)  in 
herpes  zoster,  ii,  143. 
in  hyperidrosis,  ii,  144. 
(locally)  in  hyperidrosis   of   the  feet    and 

hands,  ii,  143. 
in  impetigo  contagiosa,  ii,  145. 

"  intertrigo,  ii,  143. 

"  intestinal  flatulence,  ii,  143. 

"  lichen  asstivus,  ii,  145. 

"  lupus  erythematosus,  ii,  144. 

(on  tampons)  in  metrorrhagia,  ii,  143. 

in  nail  deformities,  ii,  145. 

"  neuralgia,  ii,  143. 

(ointment)  in  papular  eczema,  ii,  144. 

in  phthisis,  ii,  143. 

"  psoriasis,  ii,  143. 

"  "        guttata,  ii,  144. 

(for  swollen  joints)  in  purpura  haemorrha- 

giea,  ii,  143. 
in  relapsing  fever,  ii,  143. 

"  rheumatism,  i,  124. 

"  sciatica,  ii,  142. 

"  sclerotitis,  ii,  143. 

".  slight  haemorrhages,  ii,  143. 

"  squamous  eczema,  ii,  144. 

"  syphilitic  ulcerations,  ii,  145. 

"  urticaria,  ii,  145. 

inhalation  in  fcEtid  bronchitis,  ii,  143. 

in  gangrene  of  the  lung,  ii,  143. 

injections  in  cancer  of  the  uterus,  ii,  145. 

(ointment  and  solution)  in  inflammations  of 

the  sebaceous  glands,  ii,  144. 
ointment  in  eczema,  ii,  148,  144. 
in  eczema  rubrum,  ii,  144. 

"  epithelioma,  ii,  145. 

"  ichthyosis,  ii,  144. 

"  lentigo,  ii,  144. 

"  pityriasis,  ii,  144. 

"  pustular  eczema,  ii,  144. 

"  rhus  poisoning,  ii,  145. 

"  seborrhcea,  ii,  144. 

"  vesicular  eczema,  ii,  144. 

"  zoster,  ii,  143. 
Salicylidene  paraphenetidine.     See  Malakin. 
Saligenin,  ii,  147. 
in  acute  articular  inflammation,  ii,  147. 

"      "      rheumatism,  ii,  147. 

"  cholera,  ii,  147. 

"  dysentery,  ii,  147. 

"  influenza,  ii,  147. 

"  malarial  fevers,  ii,  147. 

"  typhoid  fever,  ii,  147. 
Salinaphthol.     See  Betol. 
Saline  cathartics  in  abdominal  haemorrhage,  ii, 
147. 
cathartics  in  vomiting,  i,  100. 
Salines,  ii,  147. 
in  abdominal  inflammations,  ii,  147. 

"  acute  inflammations,  ii,  147. 

"  appendicular  inflammation,  ii,  147. 

"  ascites  of  hepatic  cirrhosis,  ii,  147. 

"  congestive  conditions,  ii,  147. 

"  dropsical  conditions,  ii,  147. 

"  gout,  ii,  147. 

"  peritonitis,  ii,  147. 

"  rheumatism,  ii,  147. 

injections  for  increasing  red  corpuscles,  i,  464. 
solution  injections  in  haemorrhage,  i,  467. 
Salipyrine,  ii,  147. 
as  a  hypnotic,  ii,  148. 


Salipyrine  as  an  analgetic,  ii,  148. 

as  an  antipyretic,  ii,  148. 

in  acute  and  chronic  rheumatism,  ii,  148. 

"  facial  neuralgia,  ii,  148. 

"  headache,  ii,  148. 

"  intermittent  fever,  ii,  148. 

"  menorrhagia,  ii,  149. 

"  metrorrhagia,  ii,  149. 

"  myalgia,  ii,  148. 

"  neuralgia,  ii,  148. 

"  trigeminal  neuralgia,  ii,  148. 

"  typhoid  fever,  ii,  148. 
Salithymol,  ii,  149. 
Salivin.    See  Ptyalin. 
Salix,  ii,  149. 

as  a  sedative  to  the  sexual  organs,  ii,  149. 

in  dysmenorrhoea,  ii,  149. 

"  hypersesthesia,  ii,  149. 

"  prostatorrhcea,  ii,  149. 

"  spermatorrhoea,  ii,  149. 

"  uterine  neuralgia,  ii,  149. 
SalocoU,  ii,  149. 
Salol,  ii,  149. 

and  antipyrine  applications  in  fungous  en- 
dometritis, ii,  150. 

and  antipyrine  applications  in  uterine  haem- 
orrhage, ii,  150. 

as  an  analgetic,  ii,  150. 

"    "  antipyretic,  ii,  150. 

"   "  antiseptic  dressing  for  sores  and  ulcers, 
ii,  150. 

camphorated,  in  carbuncles  and  furuncles, 
ii,  150. 

in  catarrh  of  the  bile  ducts,  ii,  150. 

"  cystitis,  ii,  150. 

"  diarrhoea,  ii,  150. 

"  grippe,  ii,  150. 

"  hepatic  catarrh,  ii,  150. 

"  influenza,  ii,  150. 

"  intestinal  catarrh,  ii,  150. 

"         "         fermentation,  i,  132. 

"  jaundice,  ii,  150. 

"  migraine,  ii,  150. 

"  muscular  rheumatism,  ii,  150. 

"  neuralgia,  for  immediate  relief,  i,  69. 

"  neuritis,  ii,  150. 

"  pains  of  locomotor  ataxia,  ii,  150. 

"  pyelitis,  ii,  150. 

"  rheumatism,  ii,  125,  150. 

"  summer  diarrhoea  of  children,  ii,  150. 

"  urethritis,  ii,  150. 
Salophene,  ii,  151. 

as  an  intestinal  antiseptic,  ii,  151. 

in  acute  muscular  rheumatism,  ii,  151. 

"      "     rheumatism,  ii,  151. 

"  influenza,  ii,  151. 

"  migraine,  ii,  151. 
,   "  neuralgic  affections,  ii,  151. 

"  rheumatism,  i,  125;  ii,  151. 

"  subacute  gouty  arthritis,  i,  125. 

"  the  nervous  form  of  influenza,  ii,  152. 
Salt,  Carlsbad,  artificial,  ii,  152. 

"  in  hepatic  cirrhosis,  i,  224. 

common.    See  under  Sodium. 

"  enema  in  asoarides  vermiculares, 

i,  102. 

common,  in  poisoning  by  the  silver  salts,  i, 
110. 

Epsom.    See  Magnesium  sulphate  (vol.  i, 
page  592). 


520 


GENERAL  INDEX. 


Salt,  Monsell's,  ii,  153. 

Rochelle.     See  Potassuim  and  sodium  tar- 
tlrae,  under  Potassium  takteates. 
Saltpetre.    See  Potassium  nitrate. 
Salubrine,  ii,  152. 
in  bruises,  ii,  152. 

"  inflammatory  sicin  diseases,  ii,  152. 
"  muscular  rheumatism,  ii,  152. 
"  ozasna,  ii,  153. 
Salubrol,  ii,  456. 
Salufer,  ii,  456. 
Salumine,  ii,  152. 
(by  insufflation)  in  dry  catarrh  of  the  nose 
and  pharynx,  ii,  152. 
Salves.     See  Ointments. 
Salvia,  ii,  153. 
in  atonic  dyspepsia,  ii,  153. 
"  in  profuse  sweating,  ii,  456. 
Sal  volatile.     See  Ammonium  oaebonate. 
Sarabuous,  ii,  153. 
Sandal-wood,  ii,  153. 
oil  in  bronchitis,  ii,  153. 
"  "   diarrhoea,  ii,  153. 
"  "  gonorrhoea,  ii,  153. 
Sandarac,  ii,  1.53. 

Sanders-wood.    See  Sandal-wood. 
Sanguinal,  ii,  154. 
in  debility  with  nervous  symptoms,  ii,  154. 
"  nervousness,  ii,  154. 
"  neurasthenia,  ii,  154. 
Sanguinaria,  ii,  154. 
as  an  escharotic,  ii,  154. 
(externally)  as  a.  stimulant,  ii,  154. 
as  a  stimulant  expectorant,  ii,  154. 
for  unhealthy  surfaces,  ii,  154. 
in  asthma,  ii,  154. 
"  atonic  amenorrhoea,  ii,  154. 
"  chronic  nasal  catarrh,  ii,  154. 
"  gastro-duodenal  catarrh,  ii,  154. 
'■  impotence,  ii,  154. 
"  jaundice,  ii,  154. 
"  scrofula,  ii,  154. 
"  syphilis,  ii,  154. 
Sanguinariiie.     See  under  Sanguinaria. 
Sanguis.     See  Blood. 

Sanitary  wood  wool  as  an  absorbent  dressing, 
ii,  88.  ^ 

Sanoform,  ii.  154. 
in  buboes,  ii,  154. 
"  hard  chancre,  ii,  154. 
"  open  abscesses  (after-treatment),  ii,  154. 
"  paronychia,  ii,  154. 
"  phimosis,  ii,  154. 
"  soft  chancre,  ii,  154. 
"  wounds  from  excision  of  ulcers,  ii,  154. 
Santalura  rubrum,  Santal-wood.     See  Sandal- 
wood. 
Santonica,  ii,  155. 
Santonin.    See  under  Santonica. 
in  amenorrhcea,  ii,  155. 
"  "  of  chlorosis,  i,  375. 

"  ascarides  vermieulares,  i,  103. 
"  nocturnal  incontinence  of  urine  in  chil- 
dren, ii,  155. 
"  threadworms,  ii,  155. 
"  tobacco  amaurosis,  ii,  155. 
Santoninoxime,  ii,  155. 
Sapo.     See  Soap. 
Sapocarbol,  ii,  155. 
Sapolanolin,  ii,  155. 


Saponaria.  ii,  155. 
as  a  local  aniesthetic,  ii,  156. 
as  an  antipyretic,  ii,  156. 
Saponin,  ii,  156. 
Sapo  viridis.    See  under  Soap. 
Saprol,  ii,  156. 

as  a  disinfectant,  ii,  156. 
Sarraoenia  purpurea,  ii,  156. 
in  atonic  dyspepsia,  ii,  156. 
Sarsa.     See  Sarsapakilla. 
Sarsaparilla  as  a  blood  purifier,  ii,  156. 
Sassafras,  ii,  156. 
in  flatulent  colic,  ii,  156. 
mucilage  in  painful  affections  of  the  mouth 
and  throat,  ii,  156. 
Sassy-bark.     See  under  Erythrophlceine. 
Saunders.    See  Sandal-wood. 
Savine,  ii,  156. 
in  atonic  menorrhagia,  ii,  157. 
"  chronic  gout,  ii,  157. 
"  worms,  ii,  157. 
Saxol,  ii,  157. 
Saxoline.    See  Vaseline. 
Scammony,  ii,  157. 
in  dropsical  effusions,  ii,  157. 
"  fever,  ii,  157. 

"  obstinate  constipation,  ii,  157. 
Scarification,  ii,  158. 
in  conjunctivitis,  ii,  158. 
"  inflammation  of  the  tonsils,  ii,  158. 
"  local  congestion,  ii,  158. 
"  oedema  of  the  glottis,  ii,  158. 
"  subcutaneous  dropsy,  ii,  158. 
Scilla.    See  Squill. 
Scillain,  Scillin,  Scillipiorin,  Scillitin,  Scilli- 

toxin,  ii.  158. 
Scillain  (subcutaneously)  in  dropsy,  ii,  158. 
Sclerotic  acid,  ii,  158. 
Dragendorii's,  ii,  158. 
in  epilepsy,  ii,  158. 
"  internal  hjemorrhage,  ii,  158. 
Podwyssotzki's,  ii,  158. 
Scoparii  caonmina.    See  Scoparius. 
Scoparin,  ii,  158. 
Scoparius,  ii,  158. 

in  venous  engorgement,  i,  345. 
Scopolamine,  ii,  158. 
as  a  mydriatic,  ii,  159,  649. 
hydrobromide    in    plastic    iritis    (incipient 

stages),  ii,  159. 
in  inflammation  of  the  iris  and  cornea,  ii, 
159.  '     ' 

"  insomnia,  ii,  159. 
"  posterior  synechise,  ii,  159. 
Scopoleine,  Scopolenine,  ii,  159. 
Scurvy-grass.     See  Cochlearia. 
Scutellaria,  ii.  159. 
Sea-tangle.     See  Laminaeia. 
Sebum  ovile,  ii,  160. 
Seoale  in  deafness  from  quinine,  i,  389. 
in  deafness  from  salicylic  acid,  i,  389. 
"  fibroid  tumours,  i,  388. 
cereale.    See  Rye. 
cornutum.    See  Ergot. 
Sedatine.    See  Antipyrine. 
Sedatives,  ii,  160. 
circulatory,  ii,  161. 

"  in  sthenic  fevers,  ii,  161. 

gastric,  ii,  160. 
general,  ii,  160. 


GBNBEAL  INDEX. 


521 


Sedatives,  local,  ii,  160. 
pulmonary,  ii,  161. 
spinal,  ii,  160. 
urinary,  ii,  161. 
Seidlitz  powders,  ii,  161. 
in  constipation,  ii,  161. 
"  vomiting,  i,  100. 
Selenium,  ii,  161. 

in  skin  diseases,  ii,  161. 
Seneoin,  ii,  161. 
in  amenorrhoea,  ii,  161. 
"  dysmenorrhoea,  ii,  161. 
"  hiemoptysis,  ii,  161. 
"  jaundice,  ii,  161. 
Senecine,  ii,  161. 
Seneoio,  ii,  161. 
in  amenorrhoea,  ii,  163,  456. 
"  dysmenorrhcBa,  ii,  162,  456. 
"  epilepsy,  ii,  163. 
"  haemoptysis,  ii,  163. 
"  jaundice,  ii,  163. 
"  menstrual  headache,  ii,  456. 
"  pruritus,  ii,  163. 
"  vicarious  menstruation,  ii,  456. 
Senega,  ii,  162. 
in  bronchitis  (as  a  stimulating  expectorant), 

ii,  163. 
"  pneumonia,  ii,  162. 
Senegin.    See  Saponin. 
Seneka.    See  Senega. 
Senna,  ii,  162. 

in  constipation,  ii,  163. 
Septentrionaline,  ii,  162. 
in  rabies,  ii,  163. 
"  strychnine  poisoning,  ii,  163. 
"  tetanus,  ii,  162. 
Sequardine,  ii,  163. 
Sero-therapy.     See  Serum  therapy. 
Serpentaria,  ii,  163. 
and  capsicum  in  vomiting  of  drunkards,  i, 

100. 
and  cinnamon  in  vomiting  of  drunkards,  i, 

100. 
and  ginger  in  vomiting  of  drunkards,  i,  100. 
in  intermittent  fever,  ii,  163. 
Serpyllura,  ii,  162. 
Serum,  ii,  162. 
antidiphtheritic,  administered  by  the  mouth, 

ii,  174. 
antidiphtheritic,  in  malarial  fever,  ii.  174. 

"  "  scarlet  fever,  ii,  178. 

antistreptococcus.     See  under  Serum  treat- 
ment. 
antistreptococcus,  in  acute  hsemorrhagic  sep- 

ticffimia,  ii,  177. 
antistreptococcus,  in  erysipelas,  ii,  175. 
"  "  phlegmons,  ii,  175. 

"  "  puerperal  fever,  ii,  175. 

"  "       "   septicaemia,  ii,  175. 

"  "  ulcerative  endocarditis, 

ii,  178. 
artificial,  ii,  163. 

"         as  a  hfpmostatic,  ii,  164. 
"        in  acute  anjcmia  from  haemorrhage, 
ii,  163. 
artificial,  in  acute  pneumonia,  ii,  165. 

•'         (intravenous  injections)  in  anaemia, 
ii,  164. 
artificial,  in  ascites,  ii,  163. 

"         "  Asiatic  cholera,  ii,  164. 


Serum,  artificial,  in  asphyxia  due  to  inhalation 
of  oxide  of  carbon,  ii,  165. 
artificial,  in  exanthematous  typhus,  ii,  165. 
"  "  neurasthenia,  ii,  163,  164. 

"         (intravenous  injections)  in  septicae- 
mia after  operations,  ii,  164 
artificial  (intravenous  injections),  in  shock, 

ii,  164. 
cow's  (subcutaneous  injections),  in  summer 

diarrhoeas  of  children,  ii,  163. 
de  Dios  Carrasquilla's,  in  leprosy,  ii,  184. 
dose  of,  for  diphtheria,  ii,  170. 
horse  (subcutaneous  injections),  in  pulmo- 
nary tuberculosis,  ii,  163. 
(saline  solution)  in  scarlet  fever,  ii,  178. 
insmall-pox,  ii,  179. 
laotis.    See  Whev. 
Maragliano's,  in  tuberculosis,  ii,  182,  183, 

184. 
paste,  ii,  166. 
powder,  ii,  166. 
sublimate,  ii,  166. 
treatment,  ii,  166. 

"        of  anthrax,  i,  85. 
"         "  cancer,  ii,  185,  186. 
"  cholera,  i.  83 ;  ii,  187. 
"  diphtheria,  i,  83 ;  ii,  170,  171. 
"         "  diphtheritic  laryngitis,  ii,  173. 
"         "  hog  cholera,  ii,  188. 
"         "  hydrophobia,  i,  84. 
"         "  influenza,  i,  85. 
"         "  leprosy,  ii,  184. 
"        (Maragliano's)  of  lupus,  ii,  184. 
"        of  measles,  ii,  178. 
"         '■  pneumonia,  i,  85. 
"         "  scarlet  fever,  ii,  178. 
"         "  small-pox,  ii,  179. 
"         "  snake-bite,  ii,  188,  189. 
"         "  swine  plague,  ii,  188. 
"  syphilis,  i,  85 ;  ii,  186. 
"         "  tetanus,  i,  84. 

"  the  plague,  ii,  188. 
"         "  tuberculosis,    i,  85;    ii,  179,  180, 
181,  182,  183. 
treatment  of  typhoid  fever,  i,  84. 

"        Paquin's,  of  tuberculosis,  ii,  183. 
"        preparation  of  toxinefor,  ii,  167, 168. 
"        reports  of,  in  diphtheria,  ii,  173, 174. 
Sesame  oil,  ii,  190. 

in  chronic  intestinal  catarrh,  ii,  190. 
"  excessive  acidity,  ii,  190. 
"  febrile  pleurisy,  ii,  190. 
"  gastric  catarrh,  ii,  190. 
"  habitual  constipation,  ii,  190. 
"  phthisis  with  obstinate  diarrhoea,  ii,  190. 
"  septic  fever,  ii,  190. 
"  typhoid  fever,  ii,  190. 
"  ulcer  of  the  stomach,  ii,  190. 
Sevura,  Sevum  praeparatum.     See  Fats  and 

Tallow. 
Shikimol.    See  Safkol. 
Sialagogues,  ii,  190. 

general,  ii,  191. 
Silica,  ii,  191. 
(internally)  in  cancer  (for  relief  of  pain),  ii, 

191. 
in  ephelis,  ii,  191. 
hydrated,  in  buboes,  ii,  191. 
"  "  chancroids,  ii,  191. 

"  "  suppurating  surfaces,  ii,  191. 


532 


GENERAL  IXDBX. 


Silicates,  ii,  191. 
Silver,  ii,  191. 

and  sodium  hyposulphite  in  diseases  of  the 

throat,  ii,  197. 
and  sodium  hyposulphite  in  locomotor  ataxia, 

ii,  197. 
citrate  in  chronic  cystitis,  ii,  198. 

"       "  gonorrhoeal   inflammation  of  the 
Tulvo-vaginal  gland,  ii,  198. 
citrate  in  gonorrhoeal  urethritis  (in  women), 

ii,  198. 
iodide  in  dysmenorrhcsa,  ii,  197. 

"      "  epilepsy,  ii,  197. 

"      "  gastric  troubles,  ii,  197. 

"      "  trachoma,  ii,  197. 
lactate  in  erysipelas,  ii,  197. 
metallic,  as  an  antiseptic,  ii,  193. 
nitrate,  ii,  192. 

"       as  a  haemostatic,  ii,  193. 

"        "  an  astringent,  ii,  193. 

"        "  a  stimulant,  ii,  193. 

"        (as  a  oanstic)  for  warts,  and  mollus- 
cum  contagiosum,  ii,  196. 
nitrate  in  acute  coryza,  ii,  195. 

"       "      "      dysentery,  ii,  194. 

"       "  amygdalitis,  ii,  195. 

"       "  atrophic  rhinitis,  ii,  195. 

"       "  aural  polypi,  ii,  195. 

"       "  balanoposthitis,  ii,  196. 

"       "  bedsores,  ii,  196. 

"       "  blepharitis  marginalis,  ii,  195. 

"       (injections)  in  buboes,  ii,  196. 

"       in  catarrh  of  the  biliary  ducts,  ii,  194. 

"       "  cervical  endometritis,  ii,  196. 

"       "  cholera  infantum,  ii,  194. 

"       "  chronic  cystitis,  ii,  196. 

"       "  chronic  gastric  catarrh,  ii,  194. 

"       "  chronic  gastritis  (by  irrigating  the 
stomach),  ii,  194. 
nitrate  in  chronic  inflammation  of  the  intes- 
tines, ii,  194. 
nitrate  in  chronic  laryngitis,  ii,  196. 

"       "        "       pharyngitis,  ii,  195. 

"       "        "       purulent  inflammation  of 
the  middle  ear,  ii,  195. 
nitrate  in  corns,  ii,  457. 

"       (injections)  in  cysts,  ii,  196. 

"  "  "  dacryocystitis,  ii,  195. 

"      in  eczema,  ii,  196. 

"       "       "       of  the  external  ear,  ii,  195. 
"    "    eyelids,  ii,  195. 

"       "  epilepsy,  ii,  194. 

"       "  epistaxis,  ii,  195. 

"       "  erosions  of  the  os  uteri,  ii,  196. 

"       '■  erysipelas,  ii,  196. 

"       "  erythema,  ii,  196. 

"       "  external  otitis,  ii,  195. 

"       "  exuberant  granulations,  ii,  195. 

"       "  fissured  nipples,  ii,  196. 

"       "  fissures  of  the  lips  and  tongue,  ii, 

195. 
nitrate  in  gastric  ulcer,  ii,  194. 
"  gleet,  ii,  196. 

"       "  gonorrhoea,  ii,  196. 

"       "  hsematuria,  ii,  196. 

"       "  hydroceles,  ii,  196. 

"       "  indolent  sinuses,  ii,  196. 

"       "  infiammation  of  the  raucous  mem- 
brane of  the  Eustachian  tube,  ii,  195. 
nitrate  in  irritable  stomach,  ii,  194. 


Silver  nitrate  in  laryngeal  ulcers,  ii,  196,  457. 
nitrate  in  lichen,  ii,  196. 
"       "  lupus,  ii,  196. 
"       "  naso-pharyngitis,  ii,  195. 
"       "  ophthalmia  neonatorum,  ii,  194. 
"       "  ozaena,  ii,  195. 
"       "  persistent  vomiting,  ii,  194. 
"       "  prostatorrhoea,  ii,  196. 
"       "  prurigo,  ii,  196. 
"       "  pruritus  of  the  external  auditory 
meatus,  ii,  195. 
nitrate  in  psoriasis,  Ii,  196. 

"       "  purulent  conjunctivitis,  ii,  195. 
"       "  ringworms,  ii,  196. 
"       "  subacute  laryngitis,  ii,  196. 
"       "  tabes  dorsalis,  ii,  194. 
"      internal  uses  of,  ii,  193,  194. 
"      in  trachoma,  ii,  195,  214. 
"       "  ulcers  of  the  mouth,  ii,  195. 
"      (locally)  in  ulcers  of  the  rectum,  ii, 
194. 
nitrate  in  ulcers  of  the  nasal  sajptum,  ii,  195. 
"       "  vascular  granulations,  ii,  195. 
"       "  venereal  sores,  ii,  196. 
"       "  vomiting    (by    irrigation    of    the 
stomach),  ii,  194. 
nitrate  in  vomiting  of  chronic  gastric  dis- 
ease, i,  99. 
nitrate,  solid,  in  toothache,  i,  136. 

"        solution     in    whooping-cough    (by 
sponging  the  throat),  ii,  196. 
oxide  in  diarrhoea,  ii,  197. 
"      "  dysraenorrhoea,  ii,  197. 
"      "  gastric  hasmorrhage,  ii,  197. 
"      "  gastric  neuralgia,  ii,  197. 
"      "  gastritis,  ii,  197. 
"      "  gonorrhoea,  ii,  197. 
"      "  irritable  dyspepsia,  ii,  197. 
"      "  irritability  of  the  stomach,  ii,  197. 
"      "  profuse  sweating,  ii,  197. 
"      "  pulmonary  haemorrhage,  ii,  197. 
"      "  pyrosis,  ii,  197. 
"      "  venereal  sores,  ii,  197. 
"      "  vomiting,  ii,  197. 
Simulo,  ii,  198. 

in  epilepsy,  ii,  198. 
Sinapis,  Sinapisms.    See  Mustard. 
Skullcap.    See  Scutellaria. 
Slaked  lime.     See  under  Calx  and  Lime. 
Slippery  elm.     See  XJlmus. 
Smilacin,  ii,  198. 
Smilasin,  ii,  198. 
Smilax,  ii,  198. 

Snakeroot.     See  Serpentaria. 
Soap,  ii,  198. 
alkaline  fluid,  ii,  201. 

as  a  lubricant  for  the  fingers  in  making  vagi- 
nal and  rectal  examinations,  ii,  201. 
as  an  antidote  to  poisoning  by  acids,  i,  6. 
"    '■        "         "  sulphuric-acid  poisoning,  ii, 

242. 
Castile,  ii,  199. 
glycerin,  ii,  199. 
green,  ii,  199. 
"       in  eczema  rubrum  (of  the  leg),  ii,  200. 
"        "  inveterate  psoriasis,  ii,  300. 
in  acid  poisoning,  ii,  199. 
in  poisoning  with  zinc  salts,  i,  109. 
"         "  "     corrosive  sublimate,  i,  109. 

"  "     metallic  salts,  i,  109. 


GENERAL  INDEX. 


523 


Soap,  in  poisouina:  with  potassium  bichromate, 
1,  109. 
in  poisoning  with  salts  of  tin,  i,  109. 
liquid  glycerin,  ii,  199. 
marble,  ii,  201. 
marine,  ii,  199. 
Marseilles,  ii,  199. 
mercurial,  ii,  200.  \ 
neutral  fluid,  ii,  201. 
soft,  ii,  201. 
"     alkaline,  ii,  201. 
superfatted  fluid,  ii,  201. 
transparent,  ii,  199. 
Soapbark.    See  Quillaia. 
Soaps,  medicinal,  and  their  uses,  ii,  199. 
Soapsuds  as  a  laxative  enema,  ii.  199. 
Soapwort.     See  Saponaria  and  Saponine. 
Socaloin.     See  under  Aloin. 
Soda,  Soda  caustica,  ii,  201. 
Soda  as  a  germicide,  i,  447. 
tartarata,  ii,  202. 
water,  i,  214. 
Sodio-theobromine  salicylate,  ii,  203. 
for  arrhythmia,  ii,  202. 
in  acute  nephritis,  ii,  203. 
"      "  "        of  scarlatina,  ii,  203. 

"  aneurysm,  ii,  208. 
"  arteriosclerosis,  ii,  203. 
"  chronic  nephritis,  ii,  202. 
"  dropsy,  ii,  202. 
"       "     of  cardiac  origin,  ii,  203. 
"  heart  disease,  ii,  202. 
"  interstitial  nephritis,  ii,  203. 
"  mitral  insufficiency,  ii,  208. 
"  myocarditis,  ii,  203. 
"  nephritis,  ii,  203. 
"  in  pericarditis,  ii,  203. 
"  pleuritic  effusions,  ii,  303. 
"  serous  effusion,  ii,  202. 
"  valvular  heart  disease,  ii,  203. 
Sodium  acetate,  ii,  203. 

and  caffeine  sulphonate.     See  Stmphokol. 
"    magnesium  borocitrate,  ii,  203. 
"  "  "  in  urinary  lithi- 

asis,  ii,  203. 
and  magnesium  tartrate,  ii,  303. 
arsenate,  Sodium  arseniate,  ii,  204. 
auroohloride,  ii,  204. 
benzoate  in  lithaemia,  ii,  204. 

"         "  rheumatism,  ii,  204. 
biborate.     See  Boeax. 
bicarbonate,  ii,  204. 

"  in  acid  diarrhoea  of  children,  ii, 

304. 
bicarbonate  in  coryza,  ii,  205. 

"  "  deficiency  of  hydrochloric  acid 

in  the  gastric  juice,  ii,  304. 
bicarbonate  in  diabetes  (to  reduce  the  amount 

of  sugar),  ii,  304. 
bicarbonate  in  excess  of  hydrochloric  acid, 

ii,  304. 
bicarbonate  in  influenza,  ii,  205. 

"  (injections)  in  intestinal  intus- 

susception, ii,  204. 
bicarbonate  in  rheumatism,  i,  124. 

"  (locally)  in  stings  of  bees,  wasps, 

etc.,  ii,  204. 
bicarbonate  (locally)  in  superficial  bums,  ii, 

205. 
bisulphite.    See  under  Sulphurous  acid. 
V7 


Sodium  borate.    See  Borax. 
bromide.     See  under  Bromides. 

"        in  asthmatic  paroxysms,  i,  94. 
"         "  nervous  excitement,  i,  194. 
"         "        "        irritability,  i,  194. 
cantharidate  in  pulmonary  tuberculosis,  ii, 

300. 
carbolate,  ii,  206. 

"         in  diarrhoea  (as  an  intestinal  anti- 
septic), ii,  206. 
carbolate  in  dysentery  (as  an  intestinal  anti- 
septic), ii,  306. 
carbolate  in  typhoid  fever  (as  an  intestinal 

antiseptic),  ii,  306. 
carbonate,  ii,  206. 
cetrarate,  ii,  306. 
chlorate,  ii,  206. 

"       (for  palliative  treatment)  in  cancer 
of  the  uterus,  ii,  206. 
chloride,  ii,  206. 

"        in  capillary  hsemorrhages,  ii,  206. 
"         "  epistaxis,  ii,  306. 
"        injections  in  hydrocele,  ii,  163. 
"        in  intermittent  fever,  ii,  206. 
"        (as  a  gargle)  in  nasal  catarrh,  ii, 
206. 
chloride  in  nitrate-of-silver  poisoning,  ii,  193. 
"        (as  a  gargle)  in  pharyngitis,  ii,  207. 
"       in  poisoning  with  the  silver  salts,  i, 
110. 
oholeate,  ii,  207. 
citrate,  ii,  207. 
citro-tartrate,  ii,  207. 
diiodoparaphenolsulphonate.  See  Sodium  so- 

ZOIODOLATE. 

diiodosalicylate.    See  under  Diidosalictlic 

ACID. 

dithiosalicylate.    See  under  Dithiosaliotlic 

ACID. 

dithiosalicylate  in  rheumatism,  i,  125. 
ethylate,  ii,  207. 

"        in  psoriasis,  ii,  207. 
"  "  warts,  corns,  etc.,  ii,  207. 

ethylsulphate.    See  Sodium  sulphovinate. 
fluoride.    See  Fluoride. 
fluosilicate.    See  Sodium  silicofluoeide. 
formate,  ii,  207. 

"        in  tuberculous  diseases,  ii,  307. 
glycerinoborate,  ii,  207. 
hypophosphite.    See  under  Htpophosphites. 

(vol.  i,  page  519). 
hyposulphite  in  ringworm,  i,  117. 
iodide,  ii,  207. 

"        and  sodium  bromide  in  asthma,  i,  97. 
lactate,  ii,  207. 

"       in  insomnia,  ii,  207. 
nitrate,  ii,  207. 

"       in  dysentery,  ii,  207. 
nitrite.    See  under  Nitrites  (vol.  ii,  page  13). 
paraoresotate,  ii,  207. 

"  in    catarrhal    pneumonia,   ii, 

207. 
paracresotate  in  gastro-intestinal  disorders, 

ii,  207. 
paracresotate  in  rheumatism,  ii,  307. 

"  "  typhoid  fever,  ii,  307. 

phenolsulphonate,  ii,  307. 
phosphate,  ii,  207. 

"  as  a  cholagogue,  ii,  207. 

"  "    laxative,  ii,  207. 


524 


GENERAL  INDEX. 


Sodium  phosphate  in  biliary  calculi,  ii,  208. 
phosphate  in  biliary  inspissation,  ii,  79. 
"  "  boils  and  carbuncles,  ii,  208. 

"  "  catarrhal  jaundice,  ii,  79. 

"  "  diarrhoea,  ii,  79. 

"  "  epidemic     jaundice    of  warm 

climates,  ii,  208. 
phosphate  in  gastro-duodenal     catarrh,    ii, 

208. 
phosphate  (subcutaneous  injections)  in  hemi- 
plegia, ii,  208. 
phosphate  in  hepatic  torpor,  ii,  79. 

"  intestinal  dyspepsia,  ii,  79. 
"  jaundice,  ii,  208. 
"  lithasinia,  ii,  79,  208. 
"  malnutrition,  ii,  208. 
(subcutaneous  injections)  in  neu- 
rasthenia, ii,  208. 
phosphate  in  progressive  myopathic  paraly- 
sis, ii,  208. 
phosphate  in  sclerosis  of  the  liver,  ii,  208. 
"  sick  headache,  ii,  208. 
"  (subcutaneous  injections)  in  tabes 

dorsalis,  ii,  208. 
pyrophosphate.    See  under  Phosphorus  (vol. 

ii,  page  79). 
saccharinate.    See  under  Salicylic  acid. 
salicylate  in  acute  articular  rheumatism,  ii, 

146. 
salicylate  in  acute  follicular  amygdalitis,  ii, 

146. 
salicylate  in  acute  glaucoma,  ii,  146. 

"      "     infectious  diseases,  ii,  146. 
"  cholera  infantum,  ii,  146. 
"  diarrhoea,  ii,  146. 
"  dry  pleurisy,  ii,  146. 
"  dysmenorrhoea,  ii,  146. 
"  facial  neuralgia,  ii,  146. 
"  iritides  of  gonorrhcea,  ii,  146. 
"  migraine,  ii,  146. 
"  neuralgic  affections  of  peripher- 
al nerves,  ii,  146. 
salicylate  in  pertussis,  ii,  146. 

'•  "  pleurisy  with  effusion,  ii,  146. 

"  "  rheumatic  iritis,  ii,  146. 

"  "  rheumatism,  i,  125. 

santoninate.    See  under  Santonioa. 
silicates.    See  under  Silicates. 
silicofluoride,  ii,  208. 
sozoiodolate,  ii,  308. 

"  as  an  intestinal  antiseptic,  ii, 

208. 
sozoiodolate  in  diabetes,  ii,  208. 

"  "  nasal  catarrh,  ii,  208. 

"  "  syphilitic  ulcers,  ii,  208. 

"  "  whooping-cough,  ii,  208. 

sulphate  in  constipation,  ii,  208. 

"         "  sluggishness    of    the    liver,    ii, 
208. 
sulphite.    See  under  Sulphurods  acid. 
sulphobenzoate,  ii,  208. 
sulphocarbolate.    See  under  Sulphooarbo- 

lates. 
sulpholeate  (ointment)  in  skin  diseases,  ii, 

309. 
sulpholeate  as  a  base  for  ointments,  ii,  209. 
sulphomethylate,  ii.  209. 
sulphoricinate,  sulphoricinoleate.    See  under 

Sodium  sulpholeate. 
sulphovinate,  ii,  209. 


Sodium  tannate  in  albuminuria,  ii,  259. 

tartrate  in  fevers,  ii,  209. 
"         "  nausea,  ii,  309. 

taurocholate.    See  Sodium  choleate. 

tellurate,  ii,  209. 

"         in  night-sweats,  ii,  209. 

tetraborate,  ii,  209. 

thiophene-sulphonate  in  prurigo,  ii,  30&. 
"  "  "  skin  diseases,  ii,  309. 

thiosulphate,  ii,  209. 

tumenol  sulphonate.    See  under  Tumenol. 

valerianate,  ii,  209. 
Soja  hispida,  ii,  209. 

in  diabetes,  ii,  209. 
Solanin,  ii,  209. 

in  neuralgia,  ii,  209. 
Solanine.    See  under  Dulcamara. 
Solanum  carolinense,  ii,  209. 

in  chorea,  ii,  209. 

"  epilepsy,  ii,  209. 

"  puerperal  eclampsia,  ii,  209. 

"  tetanus,  ii,  809. 

dulcamara.    See  Dulcamara. 

paniculatum,  ii,  210. 

"  in  biliary  colic,  ii,  210. 

"  "  catarrh  of  the  bladder,  ii, 

310. 

paniculatum  in  chronic  dyspepsia,  ii,  210. 
"  "  diseases  of  the  liver  and  of 

the  spleen,  ii,  210. 
Solidago,  ii,  210. 

Solis-Cohen's  apparatus  for  inspiration  of  con- 
densed air  and  expiration  into  rarefied  air, 
i,  21,  22. 

pneumatic  resistance  valves,  i,  23,  23. 
Solphinol,  ii,  311. 

in  treatment  of  wounds,  ii,  311. 
Solution,  Boudin's,  i,  146. 

Boulton's,  i,  210. 

De  Valangin's,  i,  144. 

Dobell's,  i,  210. 

Donovan's,  i,  146. 

Fowler's,  i,  144,  146. 

Pearson's,  i,  146. 
Solutol,  ii,  211. 
Solvents,  ii.  211. 
Solveol,  ii,  212. 
Solvines.    See  Polysolves. 
Somatose,  ii,  212. 

in  agalactia,  ii,  213. 

"  anaemia,  ii,  212. 

"  cancer  of  the  stomach,  ii,  213. 

"  chlorosis,  ii,  213. 

"  gastro-enteritis,  ii,  313. 

"  irritation  of  the  gastro-intestinal  mucous 
membrane,  ii,  312. 

"  mercurial  cachexia,  ii,  312. 

"  pericarditis,  ii,  313. 

"  phthisis,  ii,  313. 

"  typhus  fever,  ii,  213. 

"  ulcer  of  the  stomach,  ii,  313. 
Somnal,  ii,  313. 

in  acute  melancholia,  ii,  313. 

"  insomnia,  ii,  313. 
Sophora  tinotoria.    See  Baptisia   tinctoria, 

i,  160. 
Soporifics.    See  Hypnotics. 
Sorbefacients,  ii,  313. 
Sorbinose.    See  under  Sugar, 
Sorrel.    See  Oxalis. 


GENERAL  INDEX. 


525 


Soy,  Soya  bean.    See  Soja  hispida. 
Sozal,  ii,  215. 

in  cystitis,  ii,  215. 

"  suppurating  surfaces,  ii,  215. 

"  tuberculous  abscesses,  ii,  215. 
Sozoiodol,  ii,  215. 

Sozoiodolate,  mercury,  in  parasitic  skin  dis- 
ease, ii,  215. 
Sozoiodolate,     potassium,     in      suppurating 

wounds,  ulcers,  etc.,  ii,  215. 
Sozolic  acid.    See  Asbptol. 
Spanish  flies.    See  Cantharides. 
Sparteine,  ii,  216. 

in  aortic  regurgitation,  ii,  216. 

as  a  heart  stimulant  in  anesthesia,  ii,  216, 

in  anasarca,  ii,  216. 

"  asthma  (of  cardiac  origin),  ii,  216. 

"  diseases  of  the  myocardium,  ii,  216. 

"  heart  disease,  ii,  216. 

"  measles,  ii,  216. 

"  mitral  regurgitations,  ii,  216. 

(subcutaneously)  in  phthisis,  ii,  216. 

in  scarlatina,  ii,  216. 

"  stenosis  of  the  mitral  valve,  ii,  216. 
Spas.    See  Waters,  mineral. 
Spasmotin,  Spasmotoxine,  ii,  216. 
Spearmint.    See  Mentha  viridis. 
Species,  ii,  217. 
Specifics,  ii.  217. 
Spermine,  ii,  317. 

in  anaemia,  asthma,  chorea,  chronic  ulcers, 
diabetes,  dyspepsia,  locomotor  ataxia,  neu- 
ralgia, neurasthenia,  ii,  217. 

in  self-poisoning  by  absorption  from  the  in- 
testines, ii,  217. 

"  syphilis,  ii,  217. 

"  tuberculous  disease,  ii,  217. 
Sphacelotoxine.    See  Spasmotin. 
Spigelia,  fluid  extract  of,  in  ascaris  lumbri- 
coides,  i,  102. 

in  roundworms,  ii,  217. 
Spinal-cord  emulsion.    See  under  Animal  ex- 
tracts AND  JUICES  (vol.  i,  page  82.) 

in  rabies,  i,  82. 
Spinants,  ii,  817. 
Spirits,  ii,  218. 

Spleen    extract,    Splenic    extract,    i,    81 ;    ii, 
218. 

in  constipation,  ii,  218. 

"  debility,  ii,  218. 

"  dysmenorrhcea,  ii,  218. 
.  (hypodermically)   in   Hodgkin's   disease,   i, 
81. 

(hypodermically)  in  enlarged  spleen,  i,  81. 

in  headache,  ii,  218. 

(hypodermically)  in  leucocythsemia,  i,  81. 

in  loss  of  appetite,  ii,  218. 
Sponge,  ii,  218. 

grafting  in  unhealthy  granulating  sores,  ii, 
219. 

tents,  ii,  219. 
"      (impregnated  with  vinegar)  in  post- 
partum haemorrhage,  ii,  219. 
Sponges  and  their  substitutes,  i,  128. 
Spongiopiline,  ii,  103,  and  see  under  Poul- 
tices. 
Sprays,  ii,  219. 

Springs.    See  Waters,  mineral. 
Springs,  Aachen,  ii,  371. 

Abano  and  Battaglia,  ii,  371. 


Springs,  Abita,  ii,  378. 
Adams,  ii,  375. 
Addison  Mineralj  ii,  378. 
^tna.  ii,  375. 

Aix-Jes-Bains,  ii,  371,  372,  373. 
Al  burgh,  ii,  383. 
Alcyone,  ii,  377. 
Alhambra,  ii,  879. 
AUandale,  ii,  378. 
Allan's  Mineral,  ii,  379. 
Alleghany  (Va.),  ii,  383. 
Alleghany,  ii,  382. 
Allen,  it;  375,  378. 
All-Healing,  ii,  381. 
Alpena  Magnetic  Well,  ii,  878. 
Alum,  ii,  381. 
Alum  Rock,  ii,  375. 
Alum  (Va.),  ii,  383. 
Alvenu,  ii,  371. 
Amelie-les-Bains,  ii,  873. 
American  Chalybeate,  ii,  878. 
Anderson,  ii,  377. 
Anderson's  Mound,  ii,  377. 
Angler's  Mineral,  ii,  376. 
Apenta,  ii.  417. 
ApoUinaris,  ii,  879. 
Arctic,  ii,  384. 
Arrington,  ii,  877. 
Artesian  Mineral  Well,  ii,  384. 
Auburn  Mineral,  ii,  378. 
Aurora,  ii,  379. 
Avoca,  ii,  383. 
Aztec,  ii,  380. 
Baden,  ii,  371. 
Baden  Baden,  ii,  378. 
Bagneres-de-Bigorre,  ii,  371. 
Bagneres-de-Luchon,  ii,  371. 
Bailey,  ii,  374. 
Ballston  Spa.  ii,  380. 
Bareges,  ii,  371,  373. 
Bartlett,  ii,  375. 
Bath,  ii,  373,  378. 
Bath  Alum,  ii,  382. 
Baxter,  ii,  378. 
Beachville,  ii,  378. 
Beali,  ii,  876. 
Bedford,  ii,  878,  381. 
Bedford  Alum,  ii,  382,  383. 
Beersheba,  ii,  883. 
Belknap  Hot,  ii,  381. 
Beloit,  ii,  384. 
Bentley,  ii,  378. 
Bethel,  ii,  378. 
Bethesda,  ii,  384. 
Bethlehem,  ii,  378. 
Big  Bone  Lick,  ii.  378. 
Big  Hole  Hot,  ii,  379. 
Bigorre,  ii,  372. 
Black  Earth  Mineral,  ii,  384 
Black  Water,  ii,  382. 
Bladon,  ii,  874. 
Blanohard,  ii,  375. 
Blood,  ii,  375. 
Blossburg,  ii,  381. 
Blount,  ii,  374,  882. 
Blue  Grass  Sulphur,  ii,  374 
Blue  Lick,  ii,  378. 
Blue  Ridge,  ii,  383. 
Blue  Sulphur,  ii,  384 
Bon  Air,  ii,  383. 


536 


GENERAL  INDEX. 


Springs,  Bonanza,  ii,  375. 
Boothbay  Medicinal  Mineral,  ii,  378. 
Borland  Mineral  Well,  ii,  384. 
Botetourt,  ii,  383. 
Boulder  Hot,  ii,  879. 
Bourbonne,  ii,  373. 
Bowden  Lithia,  ii,  376. 
Bowsher  Mineral,  ii,  379. 
Bratton,  ii,  879. 
Bristol  Soda,  ii,  384. 
Bruneau  Hot,  ii,  377. 
Bryant,  ii,  378. 

Buckingham  White  Sulphur,  ii,  383. 
Buffalo,  ii,  378. 
Buffalo  Lithia,  ii,  372. 
Buffalo  Lithia  (Va.),  ii,  383. 
Burgher's,  ii,  378. 
Butterworth's  Magnetic,  ii,  378. 
Byron,  ii,  375. 
California  Seltzer,  ii,  375. 
Campbellsville  Sulphur,  ii,  378. 
Camp's,  ii,  376. 
Cannstadt,  ii,  372. 
Canter's  Blue  Sulphur,  ii,  381. 
Canton  Bern,  ii,  373. 
Capon,  ii,  383. 

Cascade  Warm  Mineral,  ii,  383. 
Castalian,  ii,  879. 
Castalian  Mineral  Wells,  ii,  875. 
Catoosa,  ii,  376. 
Cauterets,  ii,  871. 
Cedar,  ii,  379. 

Cedar  BluflE  Sulphur,  ii,  388. 
Central,  ii,  377. 
Cerulean,  ii,  378. 
Chalybeate,  ii,  376. 
Chamberlain,  ii,  877. 
Chandler's,  ii,  874. 
Cherokee,  ii,  381. 
Choteau,  ii,  379. 
Church  Hill  Alum,  ii,  883. 
Claiborne,  ii,  878. 
Clark's  Warm,  ii,  379. 
Clay,  ii,  376. 

Cleveland  Mineral,  ii,  381. 
Clifton,  ii,  381,  383. 
Coffee,  ii,  374. 
Cohutta,  ii,  376. 
Coldbrook  Mineral,  ii,  378. 
Colfax  Mineral,  ii,  877. 
Colorado,  ii,  371,  873. 
Commonwealth  Mineral,  ii,  378. 
Congress,  ii,  380. 
Contrexeville,  ii,  372. 
Cooper's  Well,  ii,  879. 
Cowhead,  ii,  381. 
Coyner's  Sulphur,  ii,  383. 
Cresson,  ii,  381. 
Crusac,  ii,  372. 
Crystal  Mineral,  ii,  378. 
Crystal  Sulphur,  ii,  383. 
Cullum's,  ii,  374. 
Dalby,  ii,  383. 
Davis's,  ii,  378. 
Dax,  ii,  373. 
Debrell,  ii,  388. 
De  Barry,  ii,  376. 
De  Gonia,  ii,  877. 
Des  Chutes  Hot,  ii,  381. 
Doubling  Water  Lap,  ii,  381. 


Springs,  Drennon,  ii,  378. 
Driburg,  ii,  872. 
Dripping,  ii,  378. 
Eaton  Rapids  Magnetic,  ii,  378. 
Eaux-Bonnes,  ii,  371. 
Eggleston,  ii.  383. 
Eilsen,  ii,  37i,  372. 
Elk  Lick,  ii,  379. 
EUiston's  Sulphur,  ii,  378. 
El  Paso  de  Robles,  ii,  375. 
Enghien,  ii,  871. 
Epperson,  ii,  383. 
Esoulapia,  ii,  378. 
Estill,  ii,  878. 
Eureka,  ii,  375. 
Pairview  Mineral,  ii,  379. 
Parmville  Lithia,  ii,  388. 
Ferrolithic,  ii,  376. 
Fox,  ii,  378. 
French  Lick,  ii,  377. 
Priedrickshall,  ii,  373. 
Fruitport  Artesian  and  Magnetic,  ii,  378. 
Fry's  Soda,  ii,  375. 
Fulton  Wells,  ii,  375. 
Ganymede,  ii,  377. 
Garnet,  ii,  376. 
Gastein,  ii,  372. 
Geuda,  ii,  378. 
Geyser,  ii,  375. 
Gihon,  ii,  384. 
Given's  Hot,  ii,  877. 
Glen  Alpine  Mineral,  ii,  375. 
Glen  Flora,  ii,  377. 
Glenn,  ii,  884. 
Glenwood,  ii,  378. 
Gordon,  ii,  376. 

Grand  Ledge  Magnetic,  ii,  378. 
Grayson,  ii,  378. 
Grayson  Sulphur,  ii,  883. 
Gray  Sulphur,  ii,  384. 
Great  Spirit,  ii,  378. 
Greenbrier  White  Sulphur,  ii,  384. 
Greene,  ii,  374. 
Green  Lawn,  ii,  377. 
Grosswardien,  ii,  371. 
Gum,  ii,  875. 
Hagan's,  ii,  883. 
Harbin,  ii,  375. 
Hardin,  ii,  378. 
Harkany,  ii,  371. 
Harriman's  Sulphur,  ii,  379. 
Harrison's  Mineral,  ii,  383. 
Harrodsburg,  ii,  378. 
Harrogate,  ii,  371. 
Hartford  Cold,  ii,  378. 
Hartsville,  ii,  377. 
Hart  Well,  ii,  384. 
Hawkins's  Chalybeate,  ii,  377. 
Healing,  ii,  383. 
Helena  Hot,  ii,  379. 
Herculesbad,  ii,  371. 
Hickman,  ii,  878. 
Highland,  ii,  375. 
Hohenstedt,  ii,  371. 
Hoosier,  ii,  376. 
Hopkinton,  ii,  878. 
Horeb,  ii,  884. 

Hosea  Saline  Sulphur,  ii,  877, 
Hot,  ii,  381. 
Hot  Mud,  ii,  375. 


GENERAL  INDEX. 


527 


Springs,  Hot  (Va.),  ii,  383. 
Howard,  ii,  383. 
Howell  Mineral,  ii,  378. 
Howland,  ii,  881. 
Hubbard  Magnetic,  ii,  878. 
Huguenot,  ii,  383. 
Hughes,  ii,  382. 
Humphrey's,  ii,  384. 
Hunter's  Hot,  ii,  379. 
Hynson's  Iron  Mountain,  ii,  383. 
Indian,  ii,  876. 
Inglewood,  ii,  379. 
Inselbad,  ii,  372. 
lodo  Magnesium,  ii,  384. 
Iowa  Acid,  ii,  377. 
Iron  Ute,  ii,  375. 
Iwanda,  ii,  373. 
Jackson,  ii,  881. 
Jemes  Hot,  ii,  380. 
Johnson's,  ii,  383. 
Jordan  Alum,  ii,  383, 
Jordan's  White  Sulphur,  ii,  383. 
Katahdin,  ii,  378. 
Kern's,  ii,  883. 
Kingston,  ii,  383. 
Kreuth,  ii,  371. 
La  Fayette,  ii,  879. 
La  Fayette  Artesian  Well,  ii,  376. 
Lake  Auburn  Mineral,  ii,  878, 
Landreth's  Mineral  Well,  ii,  379. 
Langenbrucken,  ii,  371. 
Lansing  Magnetic  Well,  ii,  378. 
Las  Cruces  Hot,  ii,  375. 
Latonia,  ii,  878. 
Lauderdale,  ii,  379. 
Lawrence  Mineral,  ii,  876. 
Lebanon,  ii,  380. 
Lemon,  ii,  381, 

Leslie  Magnetic  Wells,  ii,  878. 
Leuk,  ii,  373, 
Levioo,  ii,  369. 
Lewis,  ii,  379. 
Lick,  ii,  375. 
Lippspring,  ii,  373. 
Lisdoonvarna,  ii,  371. 
Little  Chief,  ii,  375. 
Litton's  Seltzer,  ii,  375. 
Lodi  Artesian,  ii,  377, 
Londonderry  Lithia,  ii,  379. 
Loretto,  ii,  381, 
Lubec  Saline,  ii,  378. 
Luben,  ii,  372. 
Magnolia,  ii,  376. 
Manitou,  ii,  375. 
Mark  West,  ii,  875, 
Matilija  Hot,  ii,  375, 
Matthews's  Warm,  ii,  379. 
Magnetic,  ii,  381 , 
McAllister,  ii,  379, 
Medical  Lake,  ii,  383. 
Meinberg,  ii,  371. 
Midland  Magnetic  Well,  ii,  378. 
Milburn,  ii,  377. 
Millborough,  ii,  383, 
Mill's  Mineral,  ii,  375. 
Mineral  Wells,  ii,  384. 
Minnequa,  ii,  381. 
Mondorf,  ii,  373. 
Monroe  Hot,  ii,  374. 
Montesano,  ii,  379. 


Springs,  Montgomery  White  Sulphur,  ii,  383. 
Monticello  Hot,  ii,  375. 
Mountain  Grlen,  ii,  375, 
Mountain  Valley,  ii,  375, 
Mount  Clemens  Mineral,  ii,  378. 
Mount  Nebo,  ii,  375, 
Mungel's,  ii,  383. 
Nauheim,  ii,  419. 
Navajoe,  ii,  375, 
Nevada  Mineral,  ii,  379. 
Neundorf,  ii,  371,  373. 
Newport  Sulphur,  ii,  376. 
New  Saratoga  (Wisconsin),  ii,  384. 
Newsom's  Arroyo  Grande  Warm,  ii,  375. 
Oak  Orchard  Acid,  ii,  380. 
Oliver,  ii,  382. 
Olympian,,  ii,  378. 
Orkney,  ii,  383. 
Owalonna  Mineral,  ii,  379. 
Owen's  Mineral  Well,  ii,  378. 
Paris  Chalybeate,  ii,  379. 
Paroquet,  ii,  378.. 
Paradise,  ii,  378. 
Pearsons,  ii,  375. 
Pennywits  Sulphur,  ii,  375. 
Perry,  ii,  377, 
PfaSers,  ii,  372, 
Piedmont,  ii,  381. 
Poland,  ii,  378. 
Ponticosa,  ii,  871. 
Powder,  ii,  376. 
Pulaski  Alum,  ii,  383. 
Puller's,  ii,  379. 
PuUna,  ii,  369,  372. 
Pystjan,  ii,  371, 
Rawley,  ii,  383. 
Red  Sulphur  (W.  Va.),  ii,  384. 
Rehme,  ii,  372. 
Reiger,  ii,  379. 
RichBeld,  ii,  380. 
River,  ii,  378, 

Roanoke  Red  Sulphur,  ii,  383. 
Robinson,  ii,  382, 
Rochester,  ii,  378, 
Rockbridge  Alum,  ii,  362,  383. 
Rockcastle,  ii,  378. 
Rock  Bnon,  ii,  383. 
Roncegno,  ii,  369. 
Rosicruoian,  ii,  378. 
Ryan's  Hot,  ii,  379. 
Sabree,  ii,  378. 
Saidschutz,  ii,  373. 
St.  Armand,  ii,  373. 
St.  Galmier,  ii,  373, 
St.  Helena,  ii,  375, 
St,  Louis  Magnetic,  ii,  378. 
Saint  Clair  Mineral,  ii,  379. 
Saint-Sauveur,  ii,  371. 
Salubrian,  ii,  378. 
Saratoga,  ii,  380,  385. 
Schmalkalden,  ii,  372. 
Schurznach,  ii,  371,  372. 
Sebastianweiler,  ii,  371. 
Sedlitz,  ii,  372. 
Shannondale,  ii,  384. 
Sharon,  ii,  381,  882. 
Shawnee  Mineral,  ii,  378. 
Shenandoah  Alum,  ii,  383. 
Shoshone,  ii,  375. 
Siloam,  ii,  376,  379. 


528 


GENERAL  INDEX. 


Springs,  Silurian,  ii,  384. 

Simmons  Hot  Sulphur,  ii,  375. 

Soda,  ii,  377. 

Spa,  ii,  378,  384 

Sparta  Mineral,  ii,  885. 

Spaulding,  ii,  379. 

Spring  Lake  Magnetic  Well,  ii,  378. 

Stafford,  ii,  376. 

Storm  Lake,  ii,  377. 

Strathpeffer,  ii,  371. 

Stroutia  Mineral,  ii,  378. 

Stryker  Mineral  Well,  ii,  381. 

Sulphur,  ii,  383. 

Summit  Soda,  ii,  375. 

Sweet,  ii,  379. 

Sweet  Chalybeate,  ii,  383. 

Tallahatta,  ii,  374. 

Tar,  ii,  378. 

Tarpon,  ii,  376. 

Three,  ii,  381. 

Tolenas,  ii,  375. 

Trenchin-Teplitz,  ii,  371. 

Trinity,  ii,  377. 

Tuscan,  ii,  375. 

Valley  View,  ii,  383. 

Van  Cleave,  ii,  377. 

Variety,  ii,  383. 

Vemet,  ii,  371. 

Vichy,  ii,  375. 

Vittel,  ii,  373. 

Warasdin,  ii,  371. 

Warm,  ii,  373,  376. 

Warm  Sulphur  (Va.),  ii,  382. 

Warner's  Ranch,  ii,  375. 

Washington,  ii,  383. 

Watson's,  ii,  375. 

Weilbaoh,  ii,  371. 

Weissenburg,  ii,  373. 

Wesson  Iron,  ii,  376. 

White,  ii,  376. 

White  Rock,  ii,  384. 

White  Sulphur,  ii,  874,  375,  376,  378,  879. 

Wiesbaden,  ii,  373. 

Wilbur,  ii,  375. 

Wildbad,  ii,  373. 

Wildegg,  ii,  373. 

Wildungen,  ii,  873. 

Wilhoit*s  Soda,  ii,  381. 

Witter's,  ii,  375. 

Wolf  Trap  Lithia,  ii,  388. 

Wyandotte,  ii,  377. 

Wyandotte  White  Sulphur,  ii,  878. 

Wytheville,  ii,  883. 

Yampah,  ii,  375. 

Yates  Mineral,  ii,  378. 

Yellow  Sulphur,  ii,  383. 

Young's,  ii,  378. 

Ypsilanti  Mineral  Well,  ii,  878. 

Zodiac,  ii,  379. 

Zonian,  ii,  877. 
Spurge.    See  Euphorbia  piluUfera,  under  Eu- 
phorbia (toI.  i,  page  401). 
Squill,  ii,  331. 

as  a  stimulant  expectorant,  i,  418. 

in  acute  bronchitis,  ii,  331. 

"  asthma,  as  an  expectorant,  i,  95. 

"  cardiac  dropsy,  ii,  331. 

"  chronic  bronchitis,  ii,  331. 

"  croup,  ii,  331. 

"  venous  engorgement,  i,  845. 


Squill  in  weak  cardiac  action,  i,  345. 
Stannura.     See  Tin. 
Staphisagria,  ii,  331. 

as  a  vulnerary,  ii,  331. 

(decoction)  in  phtheiriasis,  ii,  331. 

in  scabies,  ii,  331. 

in  wounds,  ii,  231. 
Star-anise.     See  Illicium. 
Starch,  ii,  332. 

(powdered)  for  intertrigo,  ii,  333. 

in  poisoning  with  bromine,  i,  109. 

"         "  "    copper  sulphate,  i,  109. 

"         "  "    corrosive  sublimate,  i,  109. 

"    iodine,  i,  109 ;  ii,  323. 

"         "  "    zinc  sulphates,  i,  109. 

iodized,  in  lupus  erythematosus,  i,  537. 
"         "  scrofula,  i,  537. 
"        "  tuberculous  ulceration,  i,  537. 
Stavesacre.    See  Staphisaoeia. 
Steam,  ii,  333. 

in  acne,  ii,  323. 

"  acute  inflammations  of  the  air-passages, 
i,  528. 

"  carcinoma  of  the  uterus,  ii,  233. 

"  capillary  bronchitis  of  children,  i,  538;  ii, 
330. 

"  catarrhal  affections,  i,  418 

"  cervical  endometritis,  ii.  233. 

(spray)  in  chronic  bronchitis  (dry  form),  ii, 
320. 

in  chronic  eczema,  ii,  333. 

"  diphtheria,  i,  538. 

"  endometritis,  ii,  233. 

"  haemorrhage  (during  operations),  ii,  233. 

"  hyperplastic  endometritis,  ii,  333. 

"  inflammatory  conditions  of  the  throat,  i, 
469. 

"  laryngeal  croup,  1,  528. 

"  menorrhagia,  ii,  223. 

"  septic  puerperal  endometritis,  ii,  323. 

of  benzoin  and  paregoric  in  acute  laryngitis, 
i,  538. 

superheated,  as  a  caustic,  ii,  223. 
Sterculia,  ii,  333. 

as  a  heart  stimulant,  ii,  233. 
"    stimulant  to  the    nervous  system,  ii, 
228. 

in  neurasthenia,  ii,  223. 
Steresol,  ii,  333. 

in  diphtheria,  ii,  338. 
Sterilization  of  catgut  sutures,  dry  method  of, 
i,  138.' 

wet  method  of,  i,  139. 
Sternutatories,  ii,  223. 
Stibium.    See  Antimony. 
Stillingia,  ii,  223. 

in  scrofula,  ii,  333. 

"  syphilis,  ii,  333. 
Stimulant  diuretics,  ii,  228. 
Stimulants,  ii,  238. 

cardiac,  ii,  326. 

general,  ii,  234. 

hepatic,  ii,  238. 

local,  ii,  334. 

spinal,  ii,  326. 

vascular,  ii,  237. 
Stimulation,  electrical,  in  asthma,  i,  93, 
StoBchas.    See  Lavandula, 
Stomachics,  ii,  328. 
Storax,  ii,  338. 


GENERAL  INDEX. 


539 


Storax  (as  an  expectorant)  in  bronchial  troubles, 
ii,  228. 
in  diphtheria,  ii,  228. 
"  gonorrhcea,  ii,  228. 
"  leucorrhoea,  ii,  228. 
"  pseudo-membranous  croup,  ii,  328.' 
"  scabies,  ii,  228. 
liquid,  in  frostbites,  ii,  229. 
Stramonium,  ii,  229. 
and  belladonna  in  asthma,  i,  529 ;  ii,  229. 
fumigation  in  spasmodic  asthma,  i,  430. 
in  convulsive  coughs,  ii,  229. 
Streptococcus  serum.   See  under  Sekum  treat- 
ment. 
Strontium,  ii,  329. 
bromide  as  an  antemetio,  i,  99. 
"        in  acute  gastritis,  ii,  239. 
"        "  diabetes,  ii,  339. 
"        "  epilepsy,  ii,  229. 
"        "  vomiting  of  nervous  origin,  i,  99. 
carbonate  as  a  dentifrice,  ii,  229. 
iodide,  ii,  339. 

lactate  as  an  intestinal  antiseptic,  ii,  339. 
"      in  acute  parenchymatous  nephritis, 
ii,  330. 
lactate  in  albuminuria,  ii,  339. 

"       "  dyspepsia  due  to  an  excess  of  hy- 
drochloric acid  in  the  gastric  juice,  ii, 
330. 
lactate  in  interstitial  nephritis,  ii,  230. 
"       "  mixed  nephritis,  ii,  230. 

"  nephritis,  ii,  230. 
"       "  parenchymatous  nephritis,  ii,  329, 
230. 
phosphate,  ii,  230. 
salicylate,  ii,  147,  230. 

"        as  an  intestinal  antiseptic,  ii,  330. 
"        in    chronic  gouty  conditions,    ii, 
330. 
salicylate  in   fermentative  changes  in  the 

intestines,  ii,  147. 
salicylate  in  flatulent  dyspepsia,  ii,  147,  230. 
•'         "  muscular  rheumatism,  ii,   147, 
330. 
salicylate  in  subacute  rheumatism,  ii,  147, 
230. 
Strophanthidin,    Strophanthin.      See    under 

Strophanthus. 
Strophanthus,  ii,  330. 
(hypodermic  injection)  as   a  stimulant    in 

aconite  poisoning,  i,  7. 
diuretic  value  of,  ii,  331. 
in  angina  pectoris,  ii,  283. 
"  asthma,  ii.  231. 
"  cardiac  dropsy,  ii,  331. 
"        "       dyspnoea,  ii,  331. 
"        "       troubles,  ii,  331. 
"       "       weakness,  ii,  331. 
"  cerebral  anaemia,  ii,  233. 
"  chlorosis,  ii,  232. 
"  collapse,  ii,  331. 

"  congestion  of  the  kidneys,  ii,  331. 
"  "  "       lungs,  ii,  231. 

indications  for  the  use  of,  ii,  231. 
in  exophthalmic  goitre,  ii.  232. 
"  general  ansemia,  ii,  232. 
"  hemiplegia,  ii,  231. 
"  irritable  heart  when  no  organic  disease  of 

the  heart  is  present,  ii,  233. 
"  low  fever,  ii,  231. 


Strophanthus  in  malarial  chills,  ii,  232. 

in  oedema  of  the  lungs,  ii,  231. 

"  pneumonia,  ii,  231. 

"  pulmonary  tuberculosis,  ii,  231. 

"  renal  calculi,  ii,  281. 

"  shock,  ii,  231. 

"  stenosis,  ii,  231. 

"  threatened  syncope,  ii,  331. 

"  ursemia,  ii,  331. 

"  urethral  chills,  ii,  332. 

"  vertigo  (of  the  aged),  ii,  233. 

physiological  effects  of,  ii,  230. 
Strychnine.    See  under  Nux  vomica. 

(by  hypodermic  injection)  as  a  stimulant  in 
aconite  poisoning,  i,  7. 

in  abdominal  cramps,  i,  28. 

"  alcoholism,  acute  and  chronic,  ii,  29. 

"  bronchial  asthma,  ii,  28. 

"  chorea,  ii,  38. 

"  delirium  tremens,  ii,  7. 

"  diphtheritic  paralysis,  ii,  38. 

"  dysentery,  ii,  38. 

"  dyspnoea  of  pulmonary  affections,  ii,  38. 

"  epilepsy,  ii,  38. 

"  functional  anaesthesia,  ii,  28. 

"  heart  affections,  ii,  38. 

"  hemiplegia,  ii,  38. 

"  hypochondriasis,  ii,  38. 

(hypodermically)  in  hysterical  paralysis,  ii, 
29. 

in  idiopathic  tetanus,  ii,  28. 

(hypodermically)  in  local  paralysis,  ii,  28. 

in  nervousness,  ii,  7. 

"  neuralgia,  ii,  28. 

"  "         from  impaired  nutrition,  i,  68. 

"  paralysis  of  the  bladder  in  old  people,  ii, 
38.  _ 

"  prolapsus  ani,  ii,  38. 

"  snake  poisoning,  ii,  39. 

"  torpid  liver,  ii,  38. 

"  urinary  incontinence  of  children,  ii,  38. 

with  iron  and  quinine  in  ansemia,  ii,  38. 
"      "       "         "        "  chlorosis,  ii,  38. 
Stupes,  ii,  383. 
Styptiein,  ii,  233. 

and  hydrastis  in  congestive  menorrhagia,  ii, 
338. 

as  a  haemostatic,  ii,  233. 

in  dysmenorrhcEa,  ii,  233. 

"  fungous  endometritis,  ii,  233. 

"  haemorrhages  due  to  uterine  fibroids,  ii, 
333. 

"  haemorrhages  of  the  climacteric,  ii,  333. 

"  uterine  hjemorrhage,  ii,  333. 

"        "       subinvolution,  ii,  233. 
Styptics.    See  Haemostatics. 
Styracol,  ii,  333. 
Sty  rax.    See  Stoeax. 
Styrone,  ii,  233. 

in  perforation  of  Shrapnell's  membrane,  ii, 
234. 
Succinic  acid,  ii,  284. 
Succinum.    See  Amber. 
Sucrol.    See  Duloin. 
Sudorifics.    See  Diaphoretics. 
Suet,  ii,  284. 
Sugar,  ii,  234. 

as  an  antiseptic,  ii,  284. 
"     ecbolic,  ii,  55. 
"     oxytocic,  ii,  334. 


530 


GENERAL  INDEX. 


Sugar  in  ulcers  and  wounds,  ii,  234. 
in  uterine  inertia,  ii,  234. 
of  milk,  ii,  235. 
Suggestioji.     See  under  HrPNOTiSM. 
Salphaminol,  ii,  286. 
as  an  antiseptic,  ii,  236. 
creosote,  ii,  236. 
eucalyptol,  ii,  236. 
guaiacol,  ii,  236. 
in  suppurating  surfaces,  ii,  236. 
"  tuberculous  deposits,  ii,  236. 
"  wounds,  ii,  236. 
menthol,  ii,  236. 

salicylate  in  rheumatism,  ii,  236. 
Sulphanilio  acid,  ii,  236. 
Sulphates.     See  under  Sulphuric  acid. 
Sulphides.    See  under  Sulphue. 
Sulphinide.     See  Saccharin. 
Sulphites.     See  under  Sulphurous  acid. 
Sulphocarbol.     See  Aseptol. 
Sulphocarbolates,  ii,  236. 
in  amygdalitis,  ii,  286. 
.  "  diphtheria,  ii,  236. 
"  gonorrhcEa,  ii,  286. 
"  sore  throat  of  scarlet  fever,  ii,  236. 
Sulphocyanates,  ii,  236. 
Sulphonal,  ii,  236. 
as  a  hypnotic,  ii,  239. 
disagreeable  effects  of,  ii,  237. 
effects  of,  on  the  blood-corpuscles,  ii,  287. 
in  acute  mania,  ii,  289. 
"  asthma,  ii,  239. 
"  chorea,  ii,  239. 

"  chronic  opium  poisoning,  ii,  239. 
"  convulsions  due  to  teething,  ii,  239. 
"  delirium  tremens,  ii,  239. 
"  diabetes,  ii,  239. 
"  epilepsy,  ii,  239. 
"  hiccough,  ii,  289. 
"  insomnia,  i,  509. 
"  melancholia,  ii,  289. 
"  mental  distress,  ii,  239. 
"        "      excitement,  ii,  339. 
"  muscular  cramps,  ii,  239. 
"  nervous  insomnia,  ii,  339. 
"  night-sweats  of  plithisis,  ii,  239. 
"  nocturnal  enuresis,  ii,  239. 
"  pulmonary  phthisis,  ii,  239. 
(as  a  prophylactic)  in  seasickness,  ii,  339. 
in  spasm  of  the  muscles  of  broken  limbs,  ii, 

239. 
"  trismus  neonatorum,  ii,  339. 
"  typhoid  fever,  ii,  339. 
"  vomiting,  i,  99. 
poisoning,  ii,  337. 
Sulphosalicylic  acid,  ii,  239. 

in  rheumatism,  ii.  339. 
Sulphotumenolic  acid.    See  Tumbnol. 
Sulphur,  ii,  239. 
and  cream  of  tartar  in  habitual  constipation, 

ii,  241. 
and  cream  of  tartar  in  haemorrhoids,  ii,  241. 
"        "       "        "       "  rectal  hsemorrhages, 
ii,  241. 
and  glycerin  injections  in  infectious  bone 

processes,  ii,  341. 
and  milk  as  an  anthidrotic,  i,  103, 
as  a  laxative,  ii,  240. 
effects  of,  internally,  ii,  240. 
for  disordered  liver,  ii,  240. 


Sulphur  fumes  as  an  antiseptic,  ii,  240.  _ 
fumes  in  amenorrhoea  of  functional  origin,  ii, 

241. 
fumes  in  chronic  skin  disease,  i,  430. 
"      "  eczema,  i,  430 ;  ii,  241. 
"      "  impetigo,  ii,  241. 
"      "  neuralgia,  i,  430. 
"      "  prurigo,  ii,  241. 
"      "  psoriasis,  ii,  341. 
"      "  scabies,  i,  430. 
"      "  sciatica,  i,  430. 
"      "  scrofula,  ii,  341. 
"      "  whooping-cough,  ii,  241. 
in  chlorosis,  ii,  240. 

chronic  bronchitis,  ii,  240. 
''  colic  due  to  impaction  of  a  gallstone,  ii, 
240. 

cystitis,  ii,  240. 

derangement  of  the  menses,  ii,  241. 
diseases  of  the  nails,  ii,  241. 
eczema  seborrhoicum,  i,  116. 
gout,  ii,  241. 

muscular  rheumatism,  ii,  241. 
pyelitis,  ii,  241. 
rheumatism,  ii,  241. 
sciatica,  ii,  241. 
skin  disease,  ii,  241. 
tuberculous  joints,  ii,  241. 

"  osteomyelitis,  ii,  241. 

(locally)  in  ulcerative  stomatitis,  ii,  341. 
ointment  in  acne,  ii,  241. 

"         "  alopecia  areata,  ii,  241. 
"         "  erysipelas,  ii,  241. 
"         "  measles,  ii,  241. 
"         (with  sulphur  baths)  in  psoriasis, 
ii,  241. 
ointment  in  scabies,  ii,  241. 
"         "  small-pox,  ii,  241. 
"        (with  sulphur  baths)  in  sycosis,  ii, 
241. 
ointment  (with  sulphur  baths)  in  tinea  versi- 
color, ii,  241. 
powder  (by  insufaation)  in  croup,  ii,  241. 
"         "  "  "  diphtheria,  ii,  341. 

"       in  lumbago,  ii,  341. 
waters  in  gout,  i,  126. 

"       "  rheumatism,  i,  126. 
Sulphuric  acid,  ii,  242. 
and  asbestos  in  treatment  of  chancres,  ii,  242. 


charcoal  " 
"    saffron    "  "  "         " 

in  cholera,  ii,  242. 
"  colliquative  sweating,  ii,  243. 
"  diarrhoea,  ii,  342. 
"  haemorrhages,  ii,  243. 
Sulphurous  acid,  ii.  243. 
as  an  antiseptic,  ii,  243. 
"  a  germicide,  ii,  243. 
in  fermentative  dyspepsia,  ii,  243. 
"  hay  fever,  ii,  243. 
"  tinea  versicolor,  ii,  243. 
Sumach,  berries.    See  Rhus  glabra. 
Sumach,  sweet.    See  Rhus  aromatica. 
Surabul,  ii,  243. 
as  a  germicide,  i,  443. 
as  a  nervous  stimulant,  ii,  248. 
in  asthenia,  ii,  243. 
"  asthenic  diarrhcEa,  ii,  243. 
"  cholera,  ii,  243. 
"  chronic  bronchitis,  ii,  243. 


ii,241. 
ii,242. 


GENERAL  INDEX. 


531 


Sumbul  in  delirium  tremens,  ii,  7 ;  ii,  243. 

in  dysentery,  ii,  343. 
"  hysteria,  ii,  248. 
"  nerve  exhiaustion,  ii,  7. 

"  neurasthenia,  ii,  243. 
Suppositories,  ii,  243. 
Suprarenal  capsule,  ii,  244. 

as  a  hasmostatio,  ii,  246. 
"  an  astringent,  ii,  246. 

in  Addison's  disease,  ii,  245. 

"  conjunctivitis,  ii,  247. 

"  diseases  of  the  eye,  ii,  246,  247. 

"  glaucoma  (secondary  to  cataract  extrac- 
tion), ii,  247. 

"  hsemorrhage,  ii,  247. 

"  interstitial  keratitis,  ii,  246. 

"  iritis,  ii,  247. 

''  neurasthenia,  ii,  245. 

physiological  action  of,  ii,  244. 
Sweet  oil.    See  Olive  oil. 
Symphorol,  ii,  247. 

as  a  diuretic,  ii,  247. 
Symptomatic  treatment,  ii,  247. 
Synergists,  ii,  250. 
Synovial  extract,  ii,  251. 

in  rheumatoid  arthritis,  ii,  251. 
Syrups,  ii,  251. 

fruit,  ii,  252. 

of  cherries,  ii,  252. 

preservation  of,  ii,  251. 
Syzygium  Jambolanum.     See  Jambul. 

Tabaeum.     See  Tobaoco. 
TabellsB,  ii,  252. 

Table  of  antagonistic  poisons,  i,  89. 
Tablet  triturates,  ii,  252. 
Tablets,  ii,  252. 

compressed,  ii,  253. 

hypodermic,  ii,  253. 

moulded,  ii,  252. 
Tabloids,  ii,  254. 
Taka-diastase,  ii,  254. 

in  amylaceous  dyspepsia,  ii,  254. 
Talc,  ii,  54. 

powder  in  eczema,  ii,  254. 

in  intertrigo,  ii,  254. 
Tallow,  ii,  254. 
Tamarind,  ii,  254. 

as  a  laxative,  and  in  fever,  ii,  254. 
Tanacetum.    See  Tansy. 
Tannal,  ii,  254. 

in  laryngeal,  nasal,  and  pharyngeal  catarrh, 
ii,  254. 
Tannalbin,  ii,  254. 

in  chronic  intestinal  catarrh,  ii,  254. 

"        "     ■   renal  disease,  ii,  255. 

"  diarrhoea,  ii,  254. 

"  subacute  intestinal  catarrh,  ii,  254. 

"  tuberculous  ulceration  of  the  bowel,  ii,  255. 

"  ulcerative  enteritis,  ii,  254. 
Tannate,  basic  aluminum,  ii,  254. 
Tannic  acid,  ii,  255. 

and  antipyrine  in  hasmorrhages,  ii,  257. 

as  a  germicide,  i,  447. 
"    local  haemostatic,  ii,  257. 
"    styptic,  ii,  257. 

in  burns,  ii,  257. 

'•  hsematuria,  ii,  257. 

"  hyperidrosis  of  the  hands  and  feet,  ii,  257. 

"  menorrhagia,  ii,  357. 


Tannic  acid  in  offensive  axillary  sweating,  ii, 

257. 
in  passive  hsemorrhage    from  the  stomach 

and  intestines,  ii,  257. 
"  poisoning  with  digitalis,  i,  86, 108. 
"  uterine  haemorrhage,  ii,  257. 
ointment  in  abrasions  and  excoriations,  ii, 

257. 
ointment  in  corns,  ii,  257. 

"         "  external  or   prolapsed  hsemor- 

rhoids,  ii,  259. 
ointment  in  impetigo,  ii,  256. 

"        "  indolent  ulcers,  ii,  259. 
"        "  intertrigo,  ii,  856. 
solution  and  glycerin  in  diseases  of  the  ton- 
sillar follicles,  i,  446. 
sol  ation  in  diseases  of  the  nose  and  throat,  i, 

446. 
Tannigen,  Tannigene,  ii,  259. 
in  acute  eoryza,  ii,  260. 
"      enteritis,  ii,  260. 
"      otitis  media,  ii,  260. 

chronic  caryza,  ii,  260. 
"       diarrhoea,  ii,  260. 

dysentery,  ii,  260. 

gastro-enteritis,  ii,  260. 

hay  fever,  ii,  260. 

laryngitis,  ii,  260. 

pharyngitis,  ii,  260. 

subacute  diarrhoea,  ii,  257. 

summer  diarrhoea  (of  children),  ii,  360, 
Tannin.    See  Tannic  acid. 
albuminate.    See  Tannalbin. 
and  alum  douche  in  gonorrhoeal  elytritis,  ii, 

256. 
and  iodine  in  vegetable  poisoning,  i,  109. 
as  an  antidote  to  tartar-emetic  poisoning,  ii, 

256. 
glycerite  of,  in  hypertrophied  tonsils,  ii,  256. 
in  albuminuria,  ii,  357. 
(solution)  in  aphthous  ulcers,  ii,  356. 
in  atonic  dyspepsia,  ii,  357. 
"  bronchitis,  ii,  357. 
(Cantani's  treatment)  in  cholera,  ii,  257. 
in  chronic  eoryza,  ii,  256. 
"        "       diarrhoea,  ii,  257. 
"  diarrhoea,  ii,  257. 
"  eczema,  ii,  256. 
"  epistaxis,  ii,  256. 

(solution)  in  excoriations  of  the  anus,  ii,  256. 
"         "  "  "     "  scrotum,  ii, 

256. 
(solution)  in  fissures  of  the  anus,  ii,  257. 
in  haemophilia,  ii,  257. 
"  haemoptysis  of  pulmonary  tuberculosis,  ii, 

257. 
(solution)  in  inflammation  of  the  eyelids,  ii, 

256. 
injections  in  chronic  urethritis,  ii,  256. 

"         "  elytritis  (of  gonorrhoea),  ii,  256. 
"         "  gonorrhoea,  ii,  256. 
"         "  vesical  catarrh,  ii,  256. 
in  night  sweats,  ii,  257. 
"  phthisis,  ii,  257. 
(internally),  ii,  257. 
(solution)  in  sore  nipples,  ii,  256. 

"         "  stomatitis,  ii,  256. 
in  threadworms,  ii,  257. 
(locally),  ii.  256. 
suppositories  in  haemorrhoids,  ii,  256. 


533 


GENERAL  INDEX. 


Tannin  suppositories  in  prolapse  of  the  rec- 
tum, ii,  256. 

(strong  solution)  in  suppurating  sinuses,  ii, 
356. 

tampons  in  cystooele,  prolapsus  uteri,  and 
proctocele,  ii,  356. 
Tannoform,  ii,  260. 

in  diarrhoea  and  dysentery,  ii,  260. 

(locally)  in  excessive  sweating,  ii,  260. 

in  hyperidrosis  of  the  feet,  ii,  260. 

ointment  in  old  wounds,  ulcers,  and  moist 
eruptions,  ii,  260. 

powder  in  diabetic  pruritus  vulvK,  ii,  260. 

(as  a  snuff)  in  ozaena,  ii,  260. 

in  soft  chancre,  ii,  260. 
Tanosal,  ii,  260. 

in  catarrh  of  the  throat  and  bronchi,  ii,  361. 

"  chronic  broncliitis,  ii,  361. 

"        "       broncho-pneumonia,  ii,  361. 

"  tuberculosis,  ii,  261. 
Tansy,  ii,  261. 

as  a  vermifuge,  ii,  261. 

in  hysteria,  ii,  361. 

■'  intermittent  fever,  ii,  361. 

"  rheumatism,  ii,  261. 
Tapioca,  ii,  261. 
Tar,  ii,  261. 

beech,  ii,  262. 

camphor,  ii,  1. 

coal,  ii,  262. 

in  eczema  (scaly  forms),  ii,  93,  363. 

"  lupus,  ii,  92. 

"  psoriasis,  ii,  93. 

"  putrid  sores  (as  a  disinfectant),  ii,  363. 

inunctions  in  psoriasis,  ii,  363. 

in  scabies,  ii,  363. 

"  tinea  capitis,  ii,  93. 

Kussian,  ii,  363. 

tincture  of,  ii,  364 

vapour  in  chronic  inflammation  of  the  re- 
spiratory tract,  i,  529. 

vapour  in  pulmonary  troubles,  ii,  263. 

water  in  itching  of  the  scalp,  ii,  263. 
"      "  prickly  heat,  ii,  263. 

wood,  ii,  264. 

powder,  ii,  264. 
Taracanin.     See  under  Blatta. 
Taraxaoerin,  ii,  364. 
Taraxacin,  ii,  264. 
Taraxacum,  ii,  264. 

as  an  hepatic  stimulant,  ii,  365. 

in  atonic  dyspepsia,  ii,  265. 

"chronic  congestion  and  inflammation  of 
the  liver  and  spleen,  li,  265. 

"  constipation,  ii,  265. 

"  pulmonary  phthisis,  ii,  364. 
Tartar,  cream  of,  ii,  365. 

emetic,  ii,  265. 

"    (by  injections)  for  bodies  impacted  in 
the  oesophagus,  i,  112. 

ointment  as  a  counter-irritant,  i,  114. 
Tartaric  acid,  ii,  265. 
Tartarlithine,  ii.  365. 

in  eczema,  ii,  365. 

"  excess  of  uric  acid  in  the  blood,  ii,  265. 

"  gout,  ii,  265. 

"  torpor  of  the  liver,  ii,  365. 
Tartarus  boraxatns,  ii,  365. 

depuratus,  ii,  265. 

natronatus,  ii,  265. 


Tartarus  stibiatus,  ii,  365. 
Tartrate,  aluminum  tannic,  ii,  254, 
Tea,  ii,  265. 
Abyssinian,  ii,  268. 
action  of,  on  the  system,  ii,  269. 
as  a  beverage,  ii,  266, 267. 
boneset,  as  a  diaphoretic  in  colds  and  fevers, 

ii,  369. 
boneset,  cold,  in  dyspepsia,  general  debility, 

etc..  ii,  269. 
Brazilian,  ii,  268. 
brick,  ii,  268. 
Bush,  ii,  269. 

catnip,  in  amenorrhoea,  ii,  269. 
"       "  ansemia,  ii,  269. 
"       "  chlorosis,  ii,  369. 
chronic,  intoxication,  ii,  367. 
coffee,  ii,  268. 
elderberry,  ii,  269. 
Garfield,  ii,  369. 

German  breast,  in  coughs,  colds,  and  bron- 
chial affections,  ii,  369. 
Hamburg,  ii,  269. 
Honig,  ii,  269. 
hot,  as  a  diaphoretic  in  fevers,  rheumatism, 

bronchitis,  etc.,  ii,  368. 
hot,  for  relief  of  fatigue,  ii,  268. 
in  cardiac  depression,  ii,  268. 
•'  narcotic  poisoning,  ii,  268. 
Jesuit's,  ii,  268. 
Labrador,  ii,  269. 
lie,  ii,  268. 
linseed,  as  a  laxative  enema,  ii,  269. 

"  "    sedative  in  coughs,  ii,  269. 

"        in  cystitis,  ii,  269. 

"  dysentery,  ii,  269. 

"         "  inflammations  of  the  respiratory, 

gastro-intestinal,  and     urinary     mucous 

membranes,  ii,  269. 
linseed,  in  renal  colic,  ii,  269. 

"        "  strangury,  ii,  369. 
marsh,  ii,  369. 

"       in  skin  diseases,  ii,  269. 
marshmallow,  ii,  269. 
method  of  drying,  ii,  266. 
Mexican,  ii,  369. 
New  Jersey,  ii,  369. 
Oswego,  ii,  369. 
peppermint,  ii,  269. 
saffron,  as  a  diaphoretic  in  the  exanthemata, 

ii,  269. 
spearmint,  ii,  269. 
St.  Bartholomew's,  ii.  268. 
tansy,  as  an  anthelminthic,  ii,  269. 

"         "      emmenagogue,  ii,  269. 

"         "      irritant  narcotic,  ii,  269. 

"       in  amenorrhoea,  ii,  269. 
thoroughwort,  ii,  269. 
warm,  ii,  269. 

"       in  roundworms,  ii,  269. 
Teaberrv.     See  Gaulthebia. 
Teas,  ii,'268. 

Teel  oil.     See  Sesame  oil. 
Tents,  ii,  369. 
laminaria,  ii,  370. 
manner  of  introducing,  ii,  270. 
sponge,  ii,  270. 
sterilization  of,  ii,  270. 
tupelo,  ii,  270. 
Terebene,  ii,  270. 


GENERAL  INDEX. 


533 


Terebene  and  olive  oil  (locally)  in  sloughing 
carcinoma  of  the  cervix  uteri,  ii,  271. 

as  an  antiseptic,  i,  529. 
"     expectorant,  ii,  371. 

in  acute  bronchitis,  ii,  271. 

"  asthma,  i,  97 ;  ii,  271. 

"  bronchiectasis,  ii,  371. 

(as  a  dressing)  in  burns,  ulcers,  and  wounds, 
ii,  271. 

in  chronic  bronchitis,  ii,  271. 

"        "       rhinitis,  ii,  271. 

"  emphysema,  ii,  371. 

"  flatulence,  ii,  271. 

"  foetid  bronchitis,  ii,  271. 

"  haemoptysis,  ii,  371. 

"  phthisis,  ii,  371. 

"  pleurisy,  ii,  271. 

"  pleuritic  adhesions,  ii,  271. 

"  pleuro-pneumonia,  ii,  271. 

(inhalation)  in  pulmonary  tuberculosis,  i,  529. 

in  subacute  inflammations  of  the  genito-uri- 
nary  tract,  ii,  271. 

"  winter  cough  of  chronic  bronchitis,  ii,  371. 
Terebinthina.    See  Turpentine. 
Terpin  hydrate,  ii,  371. 

in  acute  bronchitis,  ii,  373. 

"  chronic  bronchitis,  ii,  273. 

"        "        cystitis,  ii.  373. 

"        "       diffuse  nephritis,  ii,  373. 

"        "       disease  of  the  heart  and  kidneys, 
ii,  373. 

"  chronic  nephritis,  ii,  272. 

"  flatulence,  ii,  272. 

"  gonorrhoea,  ii,  373. 

"  hay  fever,  ii,  272. 

"  whooping-cough,  ii,  373. 
Terpinol,  ii,  272. 

in  chronic  bronchitis,  ii,  378. 

"  respiratory  diseases,  ii,  372. 
Testa  prseparata,  ii,  273. 
Testicle  juice.  Testicular  liquid,  i,  73 ;  ii,  373. 
Testicular  liquid  in  cancer,  i,  75. 

in  chorea,  i,  75. 

"  diabetes  mellitus,  i,  75. 

"  epilepsy,  i,  76. 

"  leprosy,  i,  75. 

"  locomotor  ataxia,  i,  74. 

"  neurasthenia,  i,  76. 

"  skin  diseases,  i,  75. 

"  tuberculosis,  i,  74. 
Tetanus  antitoxine,  ii,  373. 
Tetrabromide.     See  under  Thiophene. 
Tetraethylammonium.     See  Tetbethtlammo- 

NIUM. 

Tetrahydrobetanaphthylamine.      See     Thee- 

MINE. 

Tetrahydroparaquinanisol.    See  Thalline. 
Tetraiodopyrrhol.     See  Iodol. 
Tetraiodphenolphthalein.     See  Nosopheije. 
Tetrethylammonium,  ii,  373. 

as  a  solvent  for  urea  and  uric  acid,  ii,  373. 

in  acute  and  chronic  rheumatism,  ii,  373. 

"  goutv  joints  or  rheumatic  tophi,  ii,  373. 
Tetronal,'ii,  278. 

(as  a  sedative  hypnotic)  in  insomnia  due  to 
nervousness  or  restlessness,  ii,  273. 

in  sleeplessness  of  the  acute  infectious  dis- 
eases, ii,  373. 
Teucrin,  ii,  373. 

in  actinomycosis,  ii,  273. 


Teucrin  in  cold  abscess,  ii,  373. 

in  lupus  vulgaris,  ii,  378. 

"  tuberculous  adenitis,  ii,  373. 
Teucrium,  ii,  873. 
Thallasotherapy,  ii,  873. 
Thalline,  ii,  375. 

in  hyperpyrexia,  ii,  876. 

injections  (as  an  antiseptic)  in  gleet  and 
gonorrhoea,  ii,  376. 

in  tuberculosis,  ii,  876. 

"  tvphoid  fever,  ii,  376. 
Thapsia,  ii,  876. 
Thea.    See  Tea. 
Theine,  ii.  376. 

as  an  analgetic  and  local  anassthetic,  ii,  376. 

(for  relief  of  pain)  in  locomotor  ataxia,  ii, 
377. 

in  lumbago,  ii,  277. 

"  myalgia,  ii,  277. 

"  neuralgia,  ii,  377. 

"  neuralgic  pain,  ii,  877. 

"  sciatica,  ii,  377. 
Theism,  ii,  867. 

Theobroma.    See  Cacao  buttee. 
Theobromine,  ii,  877. 

as  a  diuretic,  ii,  277. 

in  anasarca  of  Bright's  disease,  ii,  277. 

"  dropsy  of  cardiac  origin,  ii,  277. 
Therapol,  ii,  277. 
Theriaca.     See  Teeacle. 
Thermifugin,  ii,  377. 
Thermine,  ii,  377. 

as  a  mydriatic,  ii,  377. 
Thermodine,  ii,  878. 
Thialdin,  ii,  378. 

as  a  heart  stimulant,  ii,  378. 
Thilanin,  ii,  378. 
Thiocamphor,  ii,  878. 
Thioform,  ii,  878. 

(internallTr)  in  acute  enteritis,  ii,  278. 

in  burns,  ii,  278. 

"  conjunctivitis,  ii,  278. 

"  purulent  otitis  media,  ii,  378. 

"  ulcerated  surfaces,  ii,  378. 

"  ulcer  of  the  cornea,  ii,  878. 

"     "      "    "    leg,  ii,  878. 
Thiol,  ii,  378. 

ointment^  in  eczema,  erysipelas,  erythema, 
inflammatory  deposits,  lupus,  and  ulcers, 
ii,  878. 

solid,  in  treatment  of  burns,  ii,  378. 
Thiolin,  Thiolinic  acid,  ii,  378. 
Thiooxydiphenylamine.    See  Sdlphaminol. 
Thiophene,  ii,  379. 

diiodide  as  an  antiseptic,  ii,  279. 
Thioresorcin,  ii,  279. 

Thiosalicylic  acid.    See  Sulphosalicylic  acid. 
Thiosaprol,  ii,  379. 

in  skin  diseases,  ii,  379. 
Thiosinamine,  ii,  379. 

in  ankylosis  (of  the  knee),  ii,  381. 

"  cicatrices,  ii,  380,  381. 

"  corneal  opacities,  ii,  380,  881. 

"  ectropion,  ii,  881. 

"  glandular  swellings,  ii,  880. 

injections  in  keloid,  ii,  881. 

in  lupus,  ii,  379.  880. 

"      "      erythematosus,  ii,  880. 

"      "       vulgaris,  ii,  880. 

"  malignant  neoplasms,  ii,  381. 


534 


GENERAL  INDEX. 


Thiosinamine  in  neoplasms,  ii,  379,  280. 

in  serous  exudations,  ii,  280. 

"  stricture  of  the  uretiira  (cicatricial),  ii,  280. 

"  stricture  of  the  urethra  or  rectum,  ii,  281. 

"  talipes  equinus,  ii,  281. 

"  ulcer  of  the  leg,  ii,  280. 

"  uterine  myoraata,  ii,  281. 
Thiosulphates.    See  Hyposulphites. 
Thiuret,  ii,  281. 

Thorn  apple.     See  Stramonium. 
Thoroughwort.     See  Eupatomum. 
Thuja  in  malarial  fevers,  ii,  282. 

in  rheumatism,  ii,  282. 
Thus  Americanum.     See  Olibanum. 
Thymacetine,  ii,  382. 

as  a  hypnotic,  ii,  282. 

"  an  analgetic,  ii,  283. 

in  nervous  headaches,  ii,  383. 

physiological  effects  of,  ii,  383. 
Thyme,  ii,  383. 

as  a  carminative,  ii,  283. 
"    stimulant,  ii,  282. 
Thymol,  ii,  383. 

and  gallic  acid  in  ohyluria,  ii,  383. 

as  a  germicide,  i,  448. 
"    tseniacide,  ii,  384. 

in  abnormal  fermentative  processes  in  the 
alimentary  tract,  ii,  383. 

"  acne,  ii,  384. 

"  acute  articular  rheumatism,  ii,  283. 

"      "      intestinal  disorders,  ii,  383. 

(as  an  anthelminthio)  in  ankylostomiasis,  ii, 
384. 

in  atrophic  rhinitis,  ii,  383. 

"  chronic  intestinal  disorders,  ii,  383. 

"  diabetes,  ii,  383. 

"  eczema,  ii,  284. 

"  erosions  of  the  os  uteri,  ii,  284. 

"  favus,  ii,  284. 

"  inflammation  of  the  dental  pulp,  ii,  284. 
inhalation  in  bronchitis,  ii,  283. 

"  "  diseases  of  the  upper  air-pas- 

sages, ii,  383. 
in  headaches,  ii,  383. 

"  laryngitis,  ii,  384. 

"  leuoorrhcea,  ii,  384. 

"  offensive  lochia,  ii,  284. 

"  pharyngitis,  ii,  284. 

"  phthisis,  ii,  383. 

"  pityriasis,  ii,  384. 

"  pruritus,  ii,  384. 

"  psoriasis,  ii,  284. 

"  purulent  rhinitis  of  children,  ii,  383. 

"  ringworm  of  the  scalp,  ii,  284. 

"  tympanites,  ii,  383. 

"  typhoid  fever,  ii,  383. 

"  whooping-cough,  ii,  283. 
physiological  action  of,  ii,  383. 
Thymus  extract,  Thymus  feeding,  ii,  284. 

extract  in  dyspnoea,  ii,  285. 
in  palpitation,  ii,  285. 

"  tremors,  ii,  285. 

"  typhoid  fever,  ii,  285. 
Thyraden,  ii,  287. 
Thyreoantitoxine,  ii,  387. 
Thyreoid  extract.  Thyreoid  feeding.  Thyreoid 
gland,    Thyreoid     medication,    Thyreoid 
treatment,  i,  76  ;  ii,  287. 

extract,  dose  and  administration  of,  i,  80. 
"       in  dermatitis  exfoliativa,  i,  79. 


Thyreoid  extract  in  exophthalmic  goitre,  i,  78. 
extract  in  ichthyosis,  i,  79. 

"   insanity,  i,  79 ;  ii,  396. 
"   mvxoedema,  i,  76, 77,  78 ;  ii,  289. 
"        "  obesity,  i,  79 ;  ii,  295. 
"        "   psoriasis,  i,  79  ;  ii,  393. 
"        "   skin  diseases,  i,  79 ;  ii,  298. 

"  syphilis,  i,  79 ;  ii,  295. 
"        "  xeroderma,  i,  79. 
treatment,  administration  of  the,  ii,  289. 
"  for  checking  the  growth  of  the 

foetus  in  utero,  ii,  399. 
treatment,  history  of  the  origin  of,  ii,  288. 
"  in  acromegaly,  i,  80 ;  ii,  295. 

"  "  anaemia,  i,  80 ;  ii,  395. 

"  "        "       obesity,  ii,  395. 

"  "  catalepsy,  ii,  298. 

"  "  catatonia,  ii,  399. 

"  "  circumscribed  sclerodermia,  ii, 

293. 
treatment  in  cretinism,  i,  78 ;  ii,  290. 

"  "   deformity  of  the  nails,  ii,  292. 

"  "   eczema,  i,  79 ;  ii,  293. 

"  "  epilepsy,  ii,  293. 

"  "  fibrous  tumours  of  the  uterus, 

ii,  298. 
treatment  in  general  paresis,  ii,  291. 
"  "   goitre,  ii,  297. 

"  "  leprosy,  ii,  295. 

"   lupus,  ii,  394. 
"  "  melancholia,  ii,  399. 

"   myopathy,  ii,  298. 
"  "   primary  dementia,  ii,  291. 

"  "  puerperal  insanity,  ii,  291. 

"  "  secondary  dementia,  ii,  391. 

"  stunting  of  the  growth,  ii,  300. 
"  "   stuporous  insanity,  ii,  299. 

"  "   suicidal  melancholia,  ii,  391, 

"   tetany,  ii,  398. 
Thyreoiodine,  Thyreoiodinin,  ii,  300. 
in  cretinism,  ii,  302. 
"  ichthyosis,  ii,  302. 
"  infantile  cretinism,  ii,  303. 
"  lupus,  ii,  303. 
"  myxoedema,  ii.  303. 
"  psoriasis  vulgaris,  ii,  303. 
"  sclerodermia,  ii,  302. 
"  sporadic  cretinism,  ii,  302. 
"  xerodermia,  ii,  302. 
Thyreoprotein,  ii,  303. 
Tiglium.    See  Croton  oil. 
Tin,  ii,  303. 
Tinctures,  ii.  303. 
Tobacco,  ii,  304. 
enema  in  impaction  of  feeces,  ii,  804. 
in  intussusception,  ii,  305. 
"  painter's  colic,  ii,  305. 
"  strychnine  poisoning,  ii,  305. 
"  tetanus,  ii,  305. 
Toddalia,  ii,  308. 
in  chronic  diarrhoea,  ii,  308. 
"  convalescence  from  fevers,  ii,  308. 
(as  a  tonic)  in  general  debility,  ii,  808. 
Tokay,  ii,  308. 
(as  a  tonic)  in  debility  of  convalescence,  ii, 

308. 
in  influenza,  ii,  308. 
"  neurasthenia,  ii,  308. 
Tolu  balsam,  ii.  308. 
in  catarrh  of  the  bronchial  apparatus,  ii,  309. 


GENERAL  INDEX, 


535 


Tolii  balsam  in  chronic  bronchitis,  ii,  309. 

in  chronic  diarrhoea,  ii,  809. 

"        "       dysentery,  ii,  309. 

"        "       mucous  fluxes  of  the  bronchi,  ii, 
309. 

"  chronic  mucous  fluxes  of  the  urinary  or- 
gans, ii,  309. 

"  skin  diseases,  ii,  809. 

"  suppurating  and  inflamed  areas,  ii,  309. 
Toluene,  Toluidine,  Toluol,  ii,  309. 

in  diphtheria,  ii,  309. 
Tolylantipyrine.     See  Tolypyeine. 
Tolylhypnal,  ii,  309. 
Tolypyrine,  ii,  309. 

(as  an  analgetic  and  antipyretic)  in  rheuma- 
tism and  in  neuralgia  (rheumatic),  ii,  309. 
Tolysal,  ii,  309. 
Tonga,  ii,  309. 

in  neuralgia,  ii,  309. 
Tongaline,  ii,  309. 

in  gout,  influenza,  nervous  headache,  neu- 
ralgia, and  rheumatism,  ii,  309. 
Tongue  traction.    See  under  Anesthetics  (vol. 

i,  page  64). 
Tonics,  ii,  309. 

gastric,  ii,  310. 

general,  ii,  310. 

nervous,  ii,  310. 

specific,  ii,  310. 

vascular,  ii,  310. 
Tonquinol,  ii,  310. 
Tormentilla,  ii,  311. 

in  diarrhoea  and  dysentery,  ii,  311. 
Touchwood,  ii,  311. 
Toxalbnmins.     See  Toxines. 
Toxicodendron,  ii,  311. 
Toxieological  antagonism,  i,  87. 
Toxines,  ii,  311. 

in  anthrax,  ii,  315. 

"  cancer,  ii,  315. 

"  carcinoma,  ii,  313. 

"  erysipelas,  ii,  313. 

"  "  inoperable  "  sarcoma,  ii,  311. 

"  sarcoma,  ii,  312,  314. 

(mixed)  in  syphilis,  ii,  316. 

in  tumours,  ii,  313. 

local  and  constitutional  effects  of  the,  ii,  313. 

method  of  preparing,  ii,  311. 

result  of  cases  treated  by  Dr.  Coley  with,  ii, 
313. 
Tragacanth,  ii,  316. 
Transfusion  and  infusion,  ii,  316. 

depletory  (Landois's),  ii,  323. 
"  in  asphyxia,  ii,  323. 
"  "  neonatorum,  ii,  323. 

"  cholaemia,  ii,  323. 
"         "  puerperal  eclampsia,  ii,  323. 
"         "  urasmia,  ii,  323. 

direct  and  indirect,  ii,  318-320,  326,  337. 

hypodermic,  ii,  323. 

in  acute  anaemia,  ii,  322. 

"      "     infectious  diseases,  ii,  333. 

"  anaemia,  ii,  322. 

"  cachexia,  ii,  323. 

"  chlorosis,  ii,  322. 

"  cholera,  ii,  333. 

indications  for  performing,  ii,  333. 

in  haemorrhage  from  traumatism,  ii,  383. 

"  inanition,  ii,  333. 

"  pernicious  anaemia,  ii,  333. 


Transfusion  and  infusion  in  pysBmia,  ii,  323. 

in  septicffimia,  ii,  333. 

"  severe  burns,  ii,  333. 

"  small-pox,  ii,  323. 

(with  lamb's  blood)  in  typhoid  fever,  ii,  323. 

nervous,  ii,  328. 

(Baccelli's  method)  of  mercury  in  syphilis,  ii, 
322. 

peripheral,  in  freezing  of  the  extremities,  ii, 
323. 

reciprocal,  ii,  328. 

rectal,  ii,  325. 

(von  Ziemssen's  method),  ii,  320,  323. 
Traumaticin,  ii,  328. 

and  calomel  (locally)  in  syphilis,  ii,  329. 

as  a  solvent  for  drugs  employed  in  skin  dis- 
eases, ii,  329. 

in  abrasions  or  slight  excoriations,  ii,  328. 

"  cutaneous  eruptions  and  fissured  lips,  ii, 
328. 

(as  a  protective)  in  superficial  injuries  or  in- 
flammations, ii,  328. 
Traumatol,  ii,  339. 

as  an  antiseptic,  ii,  329. 

in  eczema,  ii,  339. 

"  endometritis,  ii,  339. 

"  metritis,  ii,  329. 

"  varicose  ulcers,  ii,  329. 

"  soft  chancres,  ii,  329. 

"  vaginal  gonorrhoea,  ii,  329. 

"  wounds,  ii,  329. 
Treacle,  ii,  339. 

whey  in  colds,  ii,  339. 
Trefusia,  ii,  329. 

in  anjemia  and  chlorosis,  ii,  339. 
Tribromaeetyl  oxide.     See  Beomal. 
Tribromaldehyde.     See  Beomal. 
Tribromaniline    hydrobromide.     See    Beoma- 

MIDE. 

Tribromhydrin,  ii,  330. 

as  a  stimulant  expectorant,  ii,  830. 

in  acute  bronchitis,  ii,  330. 

"  angina  pectoris,  ii,  330. 

"  asthma,  ii,  330. 

"  chronic  bronchitis,  ii,  330. 

"  convulsions  of  infancy,  ii,  330. 
Tribromomethane.     See  Beomofoem. 
Tribromphenol.     See  Bkomol. 
Tribromsalol,  ii,  330. 

as  an  intestinal  antiseptic,  ii,  880. 
Tribulus  lanuginosus,  ii,  330. 
in  colic,  ii,  330. 

"  gonorrhoea,  ii,  330. 

"  dyspnoea,  ii,  330. 

"  spermatorrhoea,  ii,  330. 

"  urinary  irritation,  ii,  330. 
Trichloracetic  acid,  ii,  330. 

in  enlarged  tonsils,  ii,  330, 
Triehlorphenol,  ii,  330. 

applications  in  erysipelas,  ii,  330. 

in  dysentery,  ii,  330. 

"  foul  ulcers,  ii,  380. 

"  leucorrhoea,  ii,  330. 
Tricresol,  ii,  330. 

inhalation   in  diseases  of   the   respiratory 
passages,  ii,  331. 
Tricresolamine,  ii,  330. 
Trifolium  fibrinum,  ii,  381. 
Triformal.    See  Poemaldehydb. 
Triformol,  ii,  331. 


536 


GENERAL  INDEX. 


Triiodometacresol.    See.  Losophan. 
Trikresol.    See  Tricresol. 
Trimethylamine,  ii,  331. 

in  acute  rheumatism,  ii,  331. 
Trimethylethylene.    See  Pental. 
Trinitrin.     See  Nitroolycerin. 
Triiiitrocellulose.     See  Photoxylin. 
Trinitrophenol.     See  Picric  acid. 
Trional,  ii,  331. 
as  a  hypnotic,  ii,  331. 
for  functional  psychoses,  ii,  332. 
in  chorea,  ii,  333. 
"  delirium,  i,  509. 
"  dysmenorrhoea,  ii,  333. 
"  insomnia,  i,  .509 ;  ii,  833. 
"  "         of  dentition  and  indigestion,  ii, 

333. 
(for  insomnia)  in  neurasthenia,  ii,  332. 
in  opiam  poisoning,  ii,  332. 
"  organic  brain  disease,  ii,  333. 
"  pavor  nocturnus,  ii,  333. 
poisoning  by,  ii,  333. 
Trioxybenzol.     See  Gallaoetophenone. 
Trioxymethylene.     See  Parafobm. 
Triphenine,  ii,  333. 
Triticum,  ii,  333. 
in  cystitis,  ii,  333. 
"  gonorrhoea,  ii,  333. 
Triturates,  tablet,  ii,  352. 
Troches,  ii,  333. 
Tropacooaine,  ii,  333. 
as  a  local  ansesthetic,  ii,  334. 
in  keratitis,  ii,  334. 
Trypsin,  ii,  334. 
applications  in  diphtheria,  ii,  334. 
(as  a  solvent)  in  diphtheritic  membrane,  ii, 
384. 
Tuberculin,  i,  81 ;  ii,  384. 
dose  of,  i,  83. 
in  lupus,  i,  81. 
"  tuberculosis,  i,  81. 
Tuberculocidin,  ii,  334. 
Tumenol,  ii,  334. 
oil  and  oxide  of  zinc  in  impetigo  pemphigus 

and  superficial  ulcerations,  ii,  334. 
-sul  phonic  acid  in  acute  recurrent  eczema  of 

the  hands  and  face,  ii,  834. 
tincture  in  itching  of  eczema  and  prurigo,  ii, 
334. 
Turmeric,  Turmerol.     See  under  Curcuma. 
Turpentine,  ii,  884. 
and  olive-oil  enema  after  coeliotomy,  ii,  335. 
"    milk  of  asafcetida  enema  in  meteorism 
from  functional  causes,  ii,  335. 
as  a  rubefacient,  ii,  335. 
Canada,  ii,  385. 
Chian  (locally  and  internally),  in  cancer,  ii, 

335. 
"  inflammatory  processes,  ii,  335. 
injections,  rectal,  in  narcotic  poisoning,  ii, 

335. 
in  parasitic  diseases  of  the  scalp,  ii,  335. 
"  rheumatism,  ii,  335. 
liniment  in  burns,  ii,  335. 

"        "       "      and  scalds,  ii,  336. 

"         "  carbuncles,  ii,  336. 

"         "  eczema,  ii,  335. 

"         "  erysipelas,  ii,  335. 

"         "  furuncles,  ii,  336. 

"         "  local  gangrene,  ii,  335. 


Turpentine  oil,  ii,  335. 

oil  as  a  hoemostatic,  ii,  336. 

"       "    vermifuge,  ii,  337. 

"    baths  of  the  vapour  of,  in  chronic  rheu- 
matism, ii,  336. 

"  in  amenorrhcea,  ii,  386. 

"    "  ascarides,  ii,  386. 

"  (internally)  in  bronchitis,  i,  418 ;  ii,  336. 

"  in  chronic  pyelitis,  ii,  336. 

"   "        "       urethritis,  ii,  336. 

'•   "  cystitis,  ii,  836. 

"    "  erysipelas  (of  traumatic  origin),  ii,  336. 

"   "  hemorrhage  following  the  extraction 
of  teeth,  ii,  336. 

"  in  impotence,  ii,  336. 

"    "  incontinence  of  urine,  ii,  336. 

"  (internally)  in  low  fevers,  ii,  885. 

"  in  lumbago,  ii,  386. 

"  (locally)  in  neuralgia,  ii,  336. 

"  in  phosphorus  poisoning,  ii,  336. 

"  (internally)  in  pneumonia,  ii,  336. 

"  in  post-partum  hfemorrhage,  ii,  336. 

"  (locally  and  internally)  in  puerperal  fever, 
ii,  386." 

"  (inhalation)  in  pulmonary  tuberculosis,  i, 
529. 

"  in  sciatica,  ii,  336. 

"   "  scurvy,  ii,  387. 

"    "  spermatorrhoea,  ii,  336. 

"    "  tEenia,  1,  102 ;  ii,  836. 

"  (internally)  in  typhoid  fever,  ii,  835. 

"  "      '     "  ulcerative  processes  of  the 

intestines  and  stomach,  ii,  335. 

"  in  whooping-cough,  ii.  336. 

"  vapour  of,  in  asthma,  ii,  386. 

"        "        '■    "  fcetid  bronchitis,  ii,  336. 

"        "        "    "  gangrene  of  the  lungs,  ii, 
336. 

"  vapour  of  (thrown  on  the  bedclothes),  in 
scabies,  ii,  336. 

stupes  as  a  counter-irritant,  ii,  885. 
"       in  bronchitis,  ii,  335. 
"        "  peritonitis,  i,  313 ;  ii,  335. 
Turpeth  mineral,  ii,  337. 
Tussilago,  ii,  387. 
Tussol,  ii,  337. 

in  whooping-cough,  ii,  337. 
Tntty.     See  under  Zinc. 
Tylophora,  ii,  837. 

as  a  diaphoretic,  emetic,  and  expectorant,  ii, 
337. 

in  asthma,  ii,  337. 

"  dysentery,  ii,  387. 
Tylophorine,  li,  387. 

Ulexine,  ii,  337. 
as  a  diuretic,  ii,  837. 
in  cardiac  dropsy,  ii,  337, 
TJlmus,  ii,  337. 
in  diarrhoea,  ii,  337. 
"  dysentery,  ii,  337. 

"  inflammatory  cutaneous  affections,  ii,  338. 
Ulyptol.     See  Eulyptol. 
Unguents.    See  Ointments. 
Ural,  ii,  838. 

•  in  functional  and  organic  mental  disease,  ii, 
338. 
"  insomnia  of  chronic  heart  disease,  ii,  338. 
"  nervous  conditions,  ii,  338. 
Uraline,  Uralium,  Uralum,  ii,  338. 


GENERAL  INDEX. 


537 


Uranium,  ii,  338. 
nitrate,  ii,  338. 

"       in  diabetes  mellitus,  ii,  338. 
"       "  treatment  of  diabetes,  ii,  338-343. 
Urethane,  ii,  343. 
as  a  hypnotic  and  sedative,  ii,  343. 
in  acute  mania,  ii,  342. 
"  delirium  tremens,  ii,  343. 
"  functional  disturbances  and  organic  dis- 
eases of  the  brain,  ii,  343. 
"  insomnia,  ii,  343. 
"  tetanus,  ii,  343. 
Uricedin,  ii,  343. 
in  gout,  ii.  343. 
"  uric-acid  diathesis,  ii,  343. 
Uropherine,  ii,  342. 

as  a  diuretic,  ii,  343. 
Urotropine,  ii,  342. 
as  a  diuretic,  ii,  343. 
in  cystitis,  ii,  343. 

"  gouty  and  rheumatic  conditions,  ii,  343. 
"  suppuration  of  the  urinary  tract,  ii,  343. 
"  uric-acid  calculi,  ii,  343. 
"         "        diathesis,  ii,  343. 
Urtica,  ii,  343. 
as  a  diuretic  and  haemostatic,  ii,  343. 
in  rhus  poisoning,  ii,  343. 
"  uterine  haemorrhage,  ii,  343. 
Ustilago  maidis.    See  Ergot  of  Maize  (vol.  i, 

page  389). 
Uva;,  ii,  343. 
Uva  ursi,  ii,  343. 
as  a  diuretic,  ii,  343. 
"  an  astringent,  ii,  343. 
"  a  tonic,  ii,  343. 
in  chronic  cystitis,  ii,  343. 
"  diarrhoea  (later  stages),  ii,  343. 
"  gleet,  ii,  343. 
"  pyelitis,  ii,  343. 

Vaccinin,  ii,  344. 
Vaccinium,  ii,  344. 
as  an    astringent,   antiscorbutic,  detersive, 

and  refrigerant,  ii,  344. 
in  acute  rheumatism,  ii,  344. 

"  chronic  articular  rheumatism,  ii,  344. 

"  eczema,  ii,  458. 

"  mycosis  flexurarum,  ii,  458. 

"  mycotic  eczema,  ii,  458. 

"  occupation  eczema,  ii,  458. 

"  rheumatism,  ii,  344. 

"  seborrhoeal  eczema  of  the  face  and  hands 
in  children,  ii,  458. 
Valerian,  ii,  344. 
as  a  general  stimulant,  ii,  345. 

"  an  antispasmodic,  ii,  345. 
"  a  sedative  to  the  nervous  system,  ii,  345. 
in  chorea,  ii,  345. 
"  coma  of  typlius  fever,  ii,  845. 
"  convulsions,  ii,  345. 
"  cough  of  nervous  origin,  ii,  345. 
"  delirium  with  depression,  ii,  345. 
"  flatulence  of  infants,  ii,  345. 
"  hysteria,  ii,  345. 
"  hystero-epilepsy,  ii,  345. 
"  insomnia  of  hysteria,  ii,  345. 
"  nervous  disorders  dependent  upon  intes- 
tinal parasites  in  children,  ii,  345. 
"  nervous  excitement,  ii.  345. 
"        "       headache,  ii,  345. 


Valerian  in  nervous  phenomena  of  exophthal- 
mic goitre,  ii,  345. 
in  nervousness  of  the  menopause,  ii,  345. 
"  petit  mal,  ii,  345. 
"  pruritus  of  neurotic  origin,  ii,  345. 
"  whooping-cough,  ii,  345. 
Valerianate,  ammonium,  in  headache,  insom- 
nia, neuralgia,  and  palpitation  of  the  heart, 
ii,  346. 
amyl.    See  vol.  i.  page  63. 
antipyrine,  ii,  346. 
atropine.    See  vol.  i,  page  157. 
bismuth,  ii,  346. 

caffeine,  as  a  general  stimulant,  ii,  346. 
"         in  hysteria,  ii,  346. 
"         "  nervous  vomiting,  ii,  346. 
"  "  whooping-cough,  ii,  346. 

cerium,  in  vomiting  of  pregnancy,  ii,  346. 
creosote,  ii,  346. 
iron,  ii,  346. 
"     in  anaemia,  ii,  346. 
"      "  chlorosis,  ii,  346. 
"      "  hysterical  symptoms,  ii,  346. 
morphine,  ii,  346. 
quinine,  ii,  346. 

"         in  hysteria  and  nervousness,  ii,  347. 
sodium,  in  functional  derangements  of  the 

nervous  system,  ii,  347. 
zinc,  in  hay  fever,  ii,  347. 
"     "  incontinence  of  urine  from  a  neurotic 
cause,  ii,  347. 
zinc,  in  neuralgia,  ii,  347. 
Valerianates,  ii,  346. 

Valerianic  acid.    See  under  Valerian  and  Vi- 
burnum PRUNIFOLIUM. 
Valerol.     See  under  Valerian. 
Valzin.    See  DuLciN. 
Vanilla,  ii,  347. 

Vanillic  aldehyde,  Vanillin,  ii,  847. 
Vapours,  ii,  347. 
moist,  ii,  348. 
Varnishes,  ii,  348. 

Vascular  sedatives,  Vascular  stimulants.     See 
Cardiac    stimulants.  Tonics,    and    De- 
pressants. 
Vaseline,  ii,  349. 
as  a  lubricant,  ii,  849, 
liquid,  ii,  349. 
oxygenated,  ii,  349. 
Vaselone,  ii,  349. 
Vasogen,  ii,  349. 
in  nodes,  ii,  349. 

iodized,  in  mucous  patches,  ii,  350. 
"       "  sciatica,  ii,  350. 
"       "  secondary  syphilis,  ii,  349. 
Venesection.    See  Bloodletting. 
Veratrine,  ii,  350. 
as  an  antiparasitic,  ii,  350. 
former  use  of,  internally,  ii,  350. 
in  alopecia  areata,  ii,  350. 
"  aspergillus  infection,  ii,  350. 
"         "         in  the  ear,  ii,  351. 
"  chronic  enlargement  and  stiffness  of  the 

Joints,  ii,  350. 
"  chronic  pleurisy,  ii,  350. 
"infantile  paralysis,  ii,  350. 
"  myalgia,  ii,  350. 
"  phtheiriasis,  ii,  350. 
"  pleurodynia,  ii,  350. 
"  superficial  neuralgias,  ii,  350. 


538 


GENERAL  INDEX. 


Veratrine  in  tic  douloureux,  ii,  350. 
Veratroidine.     See  under  Vekatrum  tieide. 
Veratrol,  ii,  351. 

Veratrum  album.    See  Hellebore,  White. 
nigrum.    See  Helleboee,  Black. 
viride,  ii,  351. 
and   gelsemium    in    traumatic    tetanus,   ii, 

355. 
as  a  cardiac  depressant,  ii,  351. 
in  abnormal  cardiac  tension  of  renal  disease, 

ii,  353. 
"  acute  mania,  ii,  352. 
"  amygdalitis,  ii,  353. 
"  aneurysm,  ii,  353. 

"  cerebral  irritation  from  drink,  ii,  353. 
"  exophthalmic  goitre,  ii,  353. 
"  hjemorrhage,  ii,  353. 
"  hepatitis,  ii,  353. 
"  hypertrophy  of  the  heart,  ii,  353. 
(iiuid  extract  or  the  tincture)  in  incipient 

inflammations,  ii,  353. 
in  irritability  of  the  heart,  ii,  353. 
"  parenchymatous  and  serous  inflammation, 

ii,  353. 
"  pleurisy,  ii,  353. 
"  pneumonia,  ii.  353. 
"  priapism,  ii,  353. 

(Norwood's  tincture)   in  puerperal  convul- 
sions, ii,  354. 
(large    doses)    in    puerperal    eclampsia,    ii, 

353. 
(to  reduce  vascular  excitement)  in  puerperal 

peritonitis,  ii,  353. 
in  puerperal  phlebitis,  ii.  353. 
physiological  action  of,  ii,  351. 
therapeutic  value  of,  ii,  353. 
treatment  of  puerperal  convulsions  with,  ii, 
354,  355. 
Verbascum,  ii,  356. 
decoction  of,  in  diarrhoea,  as  a  demulcent 
and  astringent,  ii,  356. 
Verdigris.      See    Cuprio    acid    (vol.   i,    page 

303). 
Vernonia,  ii,  356. 
as  an  anthelminthic,  ii,  356. 
"  a  stomachic,  ii,  356. 
Vesicants,  Vesicatories.    See  Blisters. 
Viburnum  opulus,  ii.  356. 
prunifolium,  ii,  356. 

"  as  a  diuretic,  ii,  356. 

"  as  an  antispasmodic,  ii,  356. 

"  "      astringent,  ii,  356. 

"  as  a  nervine,  ii,  356. 

"  "     uterine  sedative,  ii,  356. 

"  in  after-pains,  ii,  357. 

"  "  colicky  diarrhoea,  ii,  357. 

"  "  dysentery,  ii,  857. 

"  "  dysmenorrhcea,  ii,  356,  357. 

"  "  "  with  menor- 

rhagia,  ii,  356. 
prunifolium  in  false  pains,  ii,  357. . 

"  "  habitual  abortion,  ii,  357. 

"  "  hyperEemia  of  the  pelvic  or- 

gans, ii,  356. 
prunifolium  in  hysteria,  ii,  357. 

. "  "  hystero-epilepsy,  ii,  357. 

"  "  menorrhagia,  ii,  356. 

"  "  metrorrhagia,  ii,  356. 

"  "  paralysis  agitans,  ii,  357. 

"  "  petit  mal,  ii,  357. 


Viburnum   prunifolium  in  threatening  abor- 
tion, ii,  357. 
prunifolium   in  vaginal   dysmenorrhcea,  ii, 

357. 
prunifolium,  physiological  eflEect  of,  on  man, 
ii,  358. 
Vichy,  ii,  358. 
water  m  cystitis,  ii,  358. 
"      "  diabetes,  ii,  358. 
"      "  diseases  of  the  liver,  ii,  358. 
"      "  dyspepsia,  ii,  358. 
"      "  enteritis,  ii,  358. 
"      "  gastritis,  ii,  358. 
"      "  gout,  ii,  358. 
"      "  hepatic  colic,  ii,  358. 
"      "  icterus,  ii,  358. 
"      "  lithaimia,  ii,  358. 
"      "  rheumatism,  ii,  358. 
Vieirio  acid,  Vieirin,  ii,  358. 
in  malarial  fevers,  ii,  358. 
Vinca,  ii,  858. 
Vinegar,  ii,  358. 
in  poisoning  with  alkalies,  ii,  359. 
"         "  "     carbolic  acid,  ii,  359. 

"  vomiting  after  anaesthesia  with  chloro- 
form, ii,  359,  360. 
sponging  with  a  solution  of,  in  fevers,  ii, 
359. 
Vinum.    See  WiNB. 

Viola  cucuUata  in  rattlesnake  poisoning,  ii, 
360. 
-quercitrin,  ii,  360. 
tricolor,  ii,  360. 

"        (syrup)  in  bronchial  affections  as  a 
demulcent  and  laxative,  ii,  360. 
tricolor  in  crusta  lactea,  ii,  360. 
"       "  eczema,  ii.  360. 
"       "  infantile  eczema  of  the  head  and 
face,  ii,  860. 
Violets.    See  under  Viola  tricolor. 
Violine,  ii,  360. 

Virginia  snakeroot.     See  Serpentaria. 
Virol,  ii,  361. 
Viruses.    See  under  Animal  extracts    and 

JUICES  (vol.  i,  page  83)  and  Toxines. 
Viscum  album,  ii,  361. 
as  an  oxytocic,  ii,  361. 
in  amenorrhoea,  li,  361. 
"  menorrhagia,  ii,  361. 
"  uterine  hasmorrhage,  ii,  361. 
Vitellus,  ii,  361. 
Vitis  idsea.     See  Vaocintum. 
Vitriol,    blue.    See    Cupric   sulphate,    under 
Copper. 
green.     See  Iron  sulphate,  under  Iron  (vol. 

i,  page  549). 
oil  of.    See  Sulphuric  acid. 
white.     See  Zinc  sulphate,  under  Zinc. 
Vulneraries,  ii,  361. 

Wafers,  ii,  361. 
Wahoo.    See  Buonymus. 
Washes.     See  Lotions. 
Water,  ii,  361. 

as  a  lithontriptic,  i,  586. 
"    solvent,  li,  311. 

barley,  in  fevers,  i,  351. 

cold  (internally),  in  fevers,  i,  479. 

effects  of,  on  the  stomach  and  intestine,  i, 
477. 


GENERAL  INDEX. 


539 


Water,  enema  of  hot,  in  shook,  i,  491. 

general  effect  of,  on  the  interior  of  the  body, 

i,  476. 
hot,  applications  of,  in  plastic  iritis,  ii,  213. 
hot,  applications  of,  in  ulcer  of  the  cornea, 

ii,  213. 
hot,  douche  of,  in  catarrh  of  the  vagina  and 

cervix  uteri,  i,  480. 
hot,  douches  of,  in  neuralgic  conditions  of 

the  ovaries,  i,  480. 
hot,  douches  of,  in  parametritis,  ii,  213. 
hot  (by  the  mouth  or  rectum),  in   hiemor- 

rhage,  ii,  227. 
iced,  injections  of,  in  post-partum  hemor- 
rhage, i,  480. 
(rectal  applications)  in  acute  and  chronic 

dysentery,  i,  479. 
in  cancer  of  the  stomach,  i,  479. 
(rectal  applications)  in  chronic  haemorrhoids, 

i,  479. 
in  constipation,  i,  479. 
"  cystitis,  i,  346. 
(rectal  applications)  in  fsecal  impaction,  i, 

479. 
in  functional  disorders  of  the  stomach  and 

intestines,  i,  479. 
in  gastro-intestinal  catarrh,  i,  479. 
"  gouty  and  rheumatic  diatheses,  i,  350. 
"  lithBBmia,  i.  479. 

"  the  pelvic  diseases  of  women,  i,  480. 
"  ulcer  of  the  stomach,  i,  479. 
"  urethritis,  1,  346. 
Javelle,  i,  240. 
therapeutic  effects  of,  i,  479. 
warm,  as  an  emetic  for  cleansing  the  stomach 
in  continued  vomiting,  i,  372. 
Waters,  carbonated,  ii,  364. 
chlorinated,  ii,  365. 
mineral,  ii,  363. 

"        in  amenorrhoea,  ii,  375,  383. 
"         "  anjemia,  ii,  375,  384. 
"         "  anasarca,  ii,  379. 

"  ascites,  ii,  379. 
"         "  biliary  obstruction,  ii,  376. 

"  Bright's  disease,  ii,  364,  384. 
"        (Arkansas  Hot  Springs),  in  Bright's 
disease,  ii,  374,  879. 
mineral,  in  calculus,  ii,  379. 
"         "  catarrh,  ii,  375. 
"        (Arkansas  Hot  Springs),  in  catarrhal 
affections  of  the  digestive  tract,  ii,  374. 
mineral,  in  catarrh   of   the   bile  ducts,  ii, 
384. 

"         "  chlorosis,  ii,  384. 
"         "  chronic  adenitis,  ii,  383. 
"         "       "        alcoholism,  ii,  379. 
"  "       "       catarrhal  gastro-enteritis, 

ii,  376. 
mineral,  in  chronic  constipation,  ii,  379. 
"       "       cystitis,  ii.  377. 
"        (Arkansas  Hot  Springs),  in  chronic 
diarrhoea,  ii.  374,  379. 
mineral,   in   chronic    duodenal   catarrh,   ii, 

384. 
mineral,  in  chronic  inflammations  of  the  in- 
testines, stomach,  or  throat,  ii,  364. 
mineral,  in  chronic  leuoorrhcea,  ii,  383. 

"         "        "        metallic    poisoning,     ii, 
381. 
mineral,  in  chronic  paludal  poisoning,  ii,  384. 

78 


Waters,  mineral,   in  chronic  rheumatism,  ii, 
364. 
mineral  (Arkansas  Hot  Springs),  in  chronic 

skin  diseases,  ii,  374. 
mineral,  in  constipation,  ii,  876. 

"        (Arkansas  Hot  Springs),  in  constitu- 
tional syphilis,  ii,  374. 
mineral,  in  cystic  catarrh,  ii,  881. 

"       (Arkansas  Hot  Springs),  in  cvstitis, 
ii,  374. 
mineral,  in  debility,  ii,  384. 

"         "  diseases  of  the    stomach,  liver, 
kidney,  and  bowels,  ii,  381. 
mineral  (Arkansas  Hot  Springs),  in  diseases 

of  the  urinary  organs,  ii,  374. 
mineral,  in  disorders  of  the  sexual  organs  in 

women,  ii,  884. 
mineral,  in  dysmenorrhoea.  ii,  383. 

"  dyspepsia,  ii,  377,  379,  384. 
"         "  "         of  hepatic  origin,  ii, 

875. 
mineral,  in  excoriations  of  the  epidermis,  ii, 

875. 
mineral  (Arkansas  Hot  Springs),  in  function- 
al diseases  of  the  liver,  ii,  374. 
mineral,  in  functional  neuroses,  ii,  375,  884. 
"  gallstones,  ii,  375,  381. 
"         "  gastric  atony,  ii,  875. 
"         "  gastric  catarrh,  ii,  375,  376. 
"         "  gleet,  ii,  377. 

"  gout,  ii,  364,  374,  375,  877,  379, 
381. 
mineral  (Manitou  Springs),  in  gravel,  ii,  375. 
"        in  hfemorrhoids,  ii,  375. 
"         "  hepatic  congestion  and  enlarge- 
ment, ii,  384. 
mineral,  in  hepatic  derangements,  ii,  377. 
"         "        "       engorgement,  ii,  881. 
mineral  (externally  and  internally),  in  hyste- 
ria, ii,  364. 
mineral  (externally  and  internally),  in  insom- 
nia, ii,  364. 
mineral,  in  intestinal  atony,  ii,  875. 
"  jaundice,  ii,  375,  379. 
"         (injections),  in  leucorrhoea,  ii,  375. 
"         in  lithiasis,  ii,  377. 
"         (Arkansas  Hot  Springs),  in  locomo- 
tor ataxia,  ii,  375. 
mineral  (Arkansas  Hot  Springs),  in  malarial 

poisoning,  ii,  374. 
mineral,  in  menorrhagia,  ii,  875. 

"  neuralgia,  ii,  364.  374,  384. 
"  neurasthenia,  ii,  364,  377,  379. 
"         "  paludal  poisoning,  ii,  879. 
"         (Arkansas  Hot  Springs),  in  paraly- 
sis (inorganic),  ii,  374. 
mineral   (internally  and  externally),  in  pa- 
ralysis due  to  lead,  ii,  864. 
mineral,  in  peripheral  neuritis,  ii,  364. 

"         "  plethora,  hepatic  or  renal,  ii,  375. 
"         "  prostatitis,  ii,  377. 
"        (Manitou  Springs),  in  pyrosis  asso- 
ciated with  chronic  dyspepsia),  ii,  375. 
mineral,  in  renal  calculi,  ii,  384. 
"         "      "     congestion,  ii,  381. 
"  rheumatism,  ii,  881,  384. 
"         "  rheumatoid  arthritis,  ii,  376. 
"         "  saturnism,  ii,  376. 
"        (Manitou  Springs),  in  skin  diseases, 
ii,  375,  381. 


540 


GENERAL  INDEX. 


Waters,  mineral,  in  uricaemia,  ii,  377. 
mineral,  in  uterine  derangements,  ii,  381. 
"         "        "       engorgement,  ii,  383. 

alkaline,  ii,  363,  366. 
"  "         in  acute  laryngitis,  ii,  367. 

"  "         "   bronchial    catarrh,    ii, 

367. 
mineral,   alkaline    (carbonated),   in  chronic 
dyspepsia,  hepatic  congestion,  and  rheu- 
matism, ii,  375. 
mineral,  alkaline,  in  chronic  laryngitis,  ii, 
367.  .  .     .. 

mineral,  alkaline,  in  chronic  pharyngitis,  u, 

367.  ,      ,     ,. 

mineral,  alkaline,  in  cystic  and  renal  calculi, 

ii,  367. 
mineral,  alkaline,  in  cystitis,  ii,  366. 

'■  "         "  dyspepsia      (associated 

with  hyperacidity),  ii,  366. 
mineral,    alkaline,    in    gastric    catarrh,    ii, 

366. 
mineral,  alkaline,  in  gout,  ii,  367. 
"  "         "  pyelitis,  ii,  366. 

"  "         "  ureteritis,  ii,  366. 

"  "         "  urio-aoid    diathesis,    ii, 

367. 
mineral,  bitter,  ii,  367. 

"         Buffalo  lithia,  ii,  371. 
"  "  "      in  acne,  ii,  373. 

"  "  "      "  albuminuria,     ii, 

373. 
mineral,  Buffalo  lithia,  in  amenorrhcea,  ii, 

373. 
mineral,  Buffalo  lithia,  in  Bright's  disease,  ii, 

373. 
mineral,  Buffalo  lithia,  in  cachexia,  ii,  373. 
■'  "  "       "  cystitis,  ii,  373. 

"  "  "       "  diabetes   mellitus, 

ii,  373. 
mineral,  Buffalo  lithia,  in  dysmenorrhoea,  ii, 

373. 
mineral,    Buffalo    lithia,    in    dyspepsia,   ii, 

373. 
mineral,  Buffalo  lithia,  in  eczema,  ii,  373. 
"  gleet,  ii,  373. 
"  "  "        "  hepatic    engorge- 

ment, ii,,  373. 
mineral,  Buffalo  lithia,  in  inflammation  of 
the  vermiform  appendix  (from  phosphatic 
deposits),  ii,  373. 
mineral,    Buffalo    lithia,    in    jaundice,    ii, 

373. 
mineral,  Buffalo  lithia,  in  lithiasis,  ii,  373. 
"  "  "      "  menorrhagia,       ii, 

373. 
mineral,  Buffalo  lithia,  in  nephritic  colic,  ii, 

373. 
mineral,  Buffalo  lithia,  in  paludal  fever  (se- 
quela;), ii,  373. 
mineral,  Buffalo  lithia,  in  scarlatinal  nephri- 
tis, ii,  373. 
mineral,  Buffalo  lithia,  in  syphilis,  ii,  373. 
"  "  "      "  uraemia,  ii,  373. 

mineral,  carbonated,  ii,  364. 

"        carbonate,  in  gastric  atony,  ii,  364. 
mineral,  carbonated,  in  intestinal  atony,  ii, 

364. 
mineral,  carbonated,  in  nausea,  ii,  364. 

"  "  "  prostatic  or   vesical 

irritability,  ii,  365. 


Waters,  mineral,  chalybeate,  ii,  369,  381. 
mineral,  chlorinated,  ii,  365. 

"  "  (externally   and    inter- 

nally), in  anfemia,  ii,  365. 
mineral,  chlorinated,  in  bronchial  catarrh,  ii, 

366. 
mineral,  chlorinated,  in  caries,  ii,  366. 

"  "  (warm),  in  chronic  gas- 

tritis, ii,  365. 
mineral,  chlorinated,  in  gastric  catarrh,  ii, 

365. 
mineral,  chlorinated,  in  general  asthenia,  ii, 

366. 
mineral,  chlorinated,  in  gout,  ii,  365. 

"  "  (externally  and   inter- 

nally), in  hepatic  congestion  with  constipa- 
tion, ii,  365. 
mineral,  chlorinated,  in  hypertrophy  of  the 

spleen,  ii,  366. 
mineral,  chlorinated,  in  necrosis,  ii,  366. 
"  "  "  neurasthenia,  ii,  365. 

"  "  "  rhachitis,  ii,  366. 

"  "  "  rheumatism,  ii,  365. 

'■        ferruginous,  in  albuminuria,  ii,  369. 
"  "  "  anaemia,  ii,  369. 

"  "  "  atony  of  the    stom- 

ach, ii,  370. 
mineral,  ferruginous,  in  cachexia  associated 

with  chronic  paludal  poisoning,  ii,  369. 
mineral,  ferruginous,  in  chlorosis,  ii,  369. 
•'  "  "  chorea,  ii,  369. 

"  "  "  chronic     lymphade- 

nitis, ii,  369. 
mineral,  ferruginous,  in  gastric  neuroses,  ii, 

369. 
mineral,  ferruginous,  in  menstrual  derange- 
ments of  hsemic  origin,  ii,  369. 
mineral,   ferruginous,    in    neurasthenia,    ii, 

369. 
mineral,  ferruginous,  in  paludal  poisoning, 

ii,  369. 
mineral,  sulphated,  ii,  367. 

"  "  in  catarrh  of  the  duode- 

num, ii,  368. 
mineral,  sulphated,  in  catarrh   of  the  gall 

bladder  and  ducts,  ii,  368. 
mineral,    sulphated,  in    chronic    intestinal 

catarrh,  ii.  368. 
mineral,  sulphated,  in  diabetes,  ii,  368. 

"  "  "  disorders  of  the  stom- 

ach, ii,  368. 
mineral,  sulphated,  in  haemorrhoids,  ii,  368. 
"  "  "  hepatic     cirrhosis,    ii, 

368. 
mineral,  sulphated,  in  hepatic  engorgement, 

ii,  368. 
mineral,  sulphated,  in  jaundice  due  to  ob- 
structions, ii,  368. 
mineral,  sulphated,  in  uric-acid  diathesis,  ii, 

368. 
mineral,  sulphur,  ii,  370. 

"  "         in  saturnism,  ii,  371. 

"  "  "  mercurialism,  ii,  371. 

"  "  "  congestion       associated 

with  enlargement  of  tne  liver,  ii,  371. 
mineral,  sulphur,  in  hepatic  congestion,  ii, 

371. 
mineral,  sulphur,  in   bronchial   catarrh,  ii, 

371. 
mineral,  sulphur,  in  hemoptysis,  ii,  371. 


GENERAL  INDEX. 


541 


Waters,  mineral,  sulphur,  in  pulmonaiy  tuber- 
culosis (Bergeon  s  treatment),  ii,  371. 
mineral,  sulphur,  in  constipation  (due  to  de- 
ficiency of  intestinal  secretion),  ii,  371. 
mineral,  sulphur,  in  hsemorrhoids,  ii,  371. 
"  "  "  engorgement  of  the  pel- 

vic viscera  of  women,  ii,  371. 
mineral,  sulphur,  in  chronic  lead  poisoning, 

ii,  371. 
mineral,  vapour  of,  in  acute  bronchitis,  bron- 
chorrhoea,    chronic    catarrhal    laryngitis, 
chronic  nasal  catarrh,  coryza,  laryngeal 
phthisis,  and  laryngotracheitis,  ii,  381. 
Wax.  ii,  385. 
Chinese  insect,  ii,  385. 
Japanese,  ii,  385. 
myrtle,  ii,  385. 
Whe'at.    See  Tkiticum. 
Whey,  i,  43;  ii,  385,  394. 
cure  for  acute  febrile  disease,  i,  333. 
"      "  irritability  of  the  stomach,  i,  333. 
Whisky,  ii,  385. 

as  a  hypnotic,  i,  506. 
as  an  antiseptic,  ii,  385. 
in  adynamic  fevers,  ii,  385. 
"  chronic  pulmonary  tuberculosis,  ii,  385. 
"  hsemorrhage,  ii,  385. 
"  poisoning  (as  a  heart  stimulant),  ii,  385. 
"  sudden  cardiac  collapse,  ii,  385. 
"  syncope,  ii,  385. 
"  typhoid  fever,  ii,  385. 
"  typhus  fever,  ii,  385. 
Willow.    See  Salix. 
Wine,  blackberry,  in  diarrhoea,  ii,  391. 
claret,  ii,  390. 

"       in  ansemia,  ii,  394. 
"       "  atonic  gout,  ii,  394. 
"       "  chronic  discharges  of  blood,  pus,  or 
mucus,  ii,  394. 
claret,  in  debility,  ii,  394. 

"      (by  injection),  in  flstulse  (to  lessen  the 
discharge),  ii,  394. 
claret,  in  purulent  inflammations,  ii,  394. 
"       (injections  into  the  tunica  vaginalis) 
in  hydrocele,  ii,  394. 
Madeira,  ii,  390. 
palm,  ii,  391. 

port,  in  bronchitis  of  the  aged,  ii,  393. 
*'      "  catarrhal   afieotions  (of  young  in- 
fants), ii,  393. 
port,  in  debility,  ii,  393. 
"      "  marasmus  of  young  infants,  ii,  393. 
"      "  pneumonia,  ii,  393. 
"      "  tuberculosis  of  young  infants,  ii,  393. 
"      "  typhoid  fever,  li,  393. 
"      "  typhus  fever,  ii,  393. 
sauterne,    in    insomnia    and    troublesome 

cough,  ii,  394. 
sherry,  ii,  390. 

"       for  indigestion,  ii,  393. 
"       in  acute  inflammatory  processes,  ii, 
393. 
sherry,  in  fevers,  ii,  393. 

"  senile  debility,  ii,  393. 
whey,  ii,  394. 
Wines,  ii,  385. 
acidulous,  ii,  390. 
American,  ii,  390. 

(white,  of  Bordeaux)  as  a  tonic  for  a  capri- 
cious appetite,  ii,  394. 


Wines,  astringent,  ii,  390. 

champagne,  ii,  390,  391,  393. 

"  in  collapse  from  fever,  ii,  393. 

"  "  debility  of  old  age,  ii,  393. 

"  "  seasickness,  ii,  394. 

"  "  vomiting    of    pregnancy,  ii, 

394. 

dietetic  use  of,  ii,  393. 

dose  of,  ii,  394, 

dry,  ii,  390. 

effect  of,  ii,  393. 

French,  ii,  390. 

German,  ii,  390. 

"         in  nervous  diseases,  ii,  890. 

in  acute  chorea,  ii,  394. 

"      "     neuralgia,  ii,  394. 

"      "     neuroses,  ii,  394. 

(as  a  stimulant)  in  amygdalitis,  ii,  394. 

in  cardiac  failure,  ii,  394. 

"  epidemic  influenza,  ii,  394. 

"  eye  affections  (of  children),  ii,  394. 

(as  a  stimulant)  in  htemorrhages,  ii,  394. 

in  infantile  convulsions,  ii,  394. 

injections  of,  in  chronic  discharges  from  the 
vagina  and  urethra,  ii,  394. 

in  insomnia  of  typhoid  fever,  ii,  394. 

"  progressive  chlorosis,  ii,  394. 

"  pulmonary  tuberculosis,  ii,  394. 

"  rhachitis  of  young  infants,  ii,  393. 

"  scalp  affections  of  children,  ii,  394. 

"  tetanus,  ii,  394. 

"  the  treatment  of  diseases,  ii,  393. 

"  intestinal  catarrh,  ii,  395. 

"  weak  heart  of  typhoid  fever,  ii,  394. 

Italian,  ii,  390. 

light,  i,  390. 

medicated,  ii,  396. 

Orleans,  ii,  390. 

red,  ii,  390. 

Rhenish,  ii,  390. 

rough,  ii,  390. 

Spanish,  ii,  390. 

sparkling,  ii,  390.  / 

Teneriffe,  ii,  390. 

white,  ii,  390. 
Wintergreen.    See  Gaultheria. 
Witch-hazel.     See  Hamamelis. 
Witherite.     See    Barium    carbonate,    under 

Barium. 
Wood  charcoal,  i,  85. 
Wool-fat.    See  Lanolin. 
Wool,  sanitary  wood,  as  an  absorbent  dress- 
ing, ii,  88. 
Wormwood.    See  Absinthium. 
Wrightia,  ii,  396. 

in  diarrhoea  and  dysentery,  ii,  396. 

Xanthoxylum,  ii,  396. 
(as  a  gargle)  in  affections  of  the  throat,  ii, 

396. 
(infusion)  in  chronic  constitutional  syphilis, 

ii,  396. 
in  chronic  rheumatism,  ii,  396. 
(as  a  diaphoretic)  in   rheumatic  pains,  ii, 

396. 
(tincture)  in  toothache,  ii,  396. 
Xeroform,  ii,  397. 
as  an  intestinal    antiseptic  in   cholera,  ii, 

397. 
as  a  surgical  antiseptic,  ii,  397. 


543 


GENERAL  INDEX. 


Xeroform  in  buboes,  ii,  397. 

in  chronic  urticaria,  ii,  397. 

"  eczema  in  children,  ii,  397. 

"  foul  ulcers,  ii,  397. 

"  infected  wounds,  ii,  397. 

"  intestinal  catarrh,  ii,  397. 

"  necrotic  affections,  ii,  397. 

"  paronychia,  ii,  397. 

"  suppuration,  ii,  397. 
X  rays,  ii,  397. 

in  cancer,  ii,  398. 

"      "        of  the  stomach,  ii,  398. 
Xylene,  ii,  400. 

as  an  antiseptic,  ii,  400. 

internally  in  small-pox,  ii,  400. 
Xylenol,  ii,  400. 
Xylol.    See  Xylene. 

Yarrow.     See  Achillea. 
Yeast,  ii,  400. 

in  boils,  ii,  400. 
Yellow  root.    See  Hydrastis. 
Yerba  sagrada.     See  Lantana. 

santa,  ii,  401. 

Zea.     See  Coen-silk. 
Zinc,  ii,  401. 
acetate,  ii,  402. 

"        as  an  emetic,  ii,  403. 
"        as  a  nervine,  ii,  403. 
"        (as  a  local  astringent)  in  conjunc- 
tivitis, ii,  402. 
acetate  in  diarrhoea,  ii,  403. 

"       (as  a  local  astringent)  in  gonorrhoea, 
ii,  403. 
acetate  (as  a  local  astringent)  in  leucorrhcea, 

ii,  403. 
acetate  ointment  in  erythema,  ii,  403. 

"  "  "  herpes,  ii,  402. 

albuminate,  ii,  408. 
and  potassium  cyanide,  ii,  408. 
arsenate  and  zinc  arsenite,  ii,  408. 
borate,  ii,  408. 
bromate,  ii,  408. 
bromide,  ii,  402. 

"         in  epilepsy,  ii,  403. 
carbolate,  ii,  408. 
carbonate,  ii,  403. 

"  (as  a  prophylactic)  in  intertrigo, 

ii,  403. 
carbonate  (as  a  surgical  dressing)  in  super- 
ficial inflammation,  ii,  403. 
chloride,  ii,  403. 

"         as  an  antiseptic,  ii,  404. 
"  "    "  escharotic,  ii,  403. 

"         in  abscesses,  ii,  403. 
"         "  chronic  conjunctivitis,  ii.  405. 
"         "        "       laryngitis,  ii,  405. 
"         "        "       pharyngitis,  ii,  405. 
"         "        "       suppurative  otitis  media, 
ii,  405. 
chloride  in  condylomata,  ii,  403. 

"         "  diphtheritic     conjunctivitis,     ii, 
405. 
chloride  in  empyema  of  the  accessory  nasal 

sinuses,  ii,  405. 
chloride  in  ganglia,  ii,  404. 

"         "  gangrenous  ulcers,  ii,  403. 

"         "  gonorrhoea,  ii,  405. 

"         "  gonorrhoeal  conjunctivitis,  ii,  405. 


Zinc  chloride  in  hydrocele,  ii,  404. 

chloride  in  "  inoperable  "  aneurysms,  ii,  403. 
"         "  leueorrhoea,  ii,  405. 
"        (by  dilaceration,  JI.  Leon  Derville's 
method)  in  lupus,  ii,  404. 
chloride  in  malignant  growths,  ii  403. 
"         "  morbid  growths,  ii,  403. 

"  njEvi,  ii.  403. 
"         "  nasal  polypi,  ii,  404. 
"         "  pulmonary  tuberculosis,  ii,  403. 
"         "  ranula,  ii,  404. 
"         "  small  cystic  tumours,  ii,  404. 
chrysophanate,  ii,  408. 
citrate,  ii,  408. 
cyanide,  ii,  408. 

"        in  abdominal  pain,  i,  323. 
"         "  cardiac  neuroses,  i,  333 ;  ii,  408. 
"         "  chorea,  i,  833. 
"         "  dysraenorrhoea,  ii,  408. 
"         "  epilepsy,  i,  333. 
"         "  neuralgia,  i,  833  ;  ii,  408. 
"         "  whooping-cough,  ii,  408. 
ferrocyanide,  ii,  408. 
gynocardate,  ii,  409. 

"  in  leprosy,  ii,  409. 

"  "  prurigo,  ii,  409. 

"  "  psoriasis,  ii,  409. 

"  "  syphilitic   skin   diseases,  ii, 

409. 
hydrochlorate,  ii,  409. 

"  as  an  antiseptic,  ii,  409. 

iodate,  ii,  409. 
iodide  (internally)  in  chorea,  ii,  405. 

"      (locally)  in  chronically  enlarged  ton- 
sils, ii,  405. 
iodide  (as  a  collyrium)  in  chronic  conjunc- 
tivitis, ii,  405. 
iodide  (locally)  in  chronic  inflammation  of 

the  mucous  membranes,  ii,  405. 
iodide    llocally)    in    post-nasal    catarrh,   ii, 

405. 
iodide  (internally)  in  scrofulous  diseases  of 

the  skin  and  eyes,  ii,  405. 
iodide  (ointment)  in  tumours,  ii,  405. 
lactate,  ii,  409. 

"        in  hysterical  amblyopia,  ii,  409. 
nitrate,  ii,  409. 

"        in  lupus  erythematosus,  ii,  409. 
oleate  and  iodoform  in  erosions   of  the  os 

uteri,  ii,  405. 
oleate  (locally)  in  bromidrosis,  ii,  405. 
in  hyperidrosis,  ii,  405. 
"      (with  salicylic  acid  or  French  chalk) 
in  acute  vesicular  eczema  and  in  comedo, 
ii,  405. 
oleostearate,  ii,  409. 
oleostearate  and  a  solution  of  lead  subacetate 

in  acute  rhinitis  and  coryza,  ii,  409. 
oleostearate  and  boric   or  carbolic  acid  in 
nasal  discharges   and   hypersemic   condi- 
tions, ii,  409. 
oleostearate  with  acetanilide  as  an  antiseptic 

and  protective  after  operations,  ii,  409. 
oleostearate   with    antipyrine  in    recurring 

epistaxis,  ii,  409. 
oleostearate  with  balsam  of  Peru  as  a  stimu- 
lant and   healing  agent  to  the    mucous 
membranes,  ii.  409. 
oleostearate  with  camphor  and  menthol  in 
hay  fever  and  coryza,  ii,  409. 


GENERAL  INDEX. 


543 


Zinc  oleostearate  with  iodine  in  atrophic  and 
dry  rhinitis  and  ozsena,  ii,  409. 

oleostearate  with  oleum  pini  pumilionis  and 
eucalyptol  (intratracheal  injections)  in 
asthma  and  chronic  bronchitis,  ii,  409. 

oleostearate  with  orthoohlorphenol  in  ozsena 
and  syphilitic  ulcerations,  ii,  409. 

oleostearate  with  tannic  acid  in  catarrh  and 
nosebleed,  ii,  409. 

oxide,  ii,  405. 

"  applications  in  abrasions,  burns,  blis- 
ters, excoriations,  fissures,  etc.,  ii,  406. 

oxide  as  an  anthidrotic,  i,  103. 

"  in  acute  eczema  of  the  auricle,  ii, 
406. 

oxide  in  arsenic  poisoning,  ii,  406. 
"       "  bronchorrhoea,  ii,  406. 
"     (for  muscular  tremor)  in  chronic  alco- 
holism, ii,  406. 

oxide  in  conjunctivitis,  ii,  406. 
"      "  eczema,  ii,  406. 
"      "  epilepsy,  ii,  406. 
"      "  gonorrhoea,  ii,  407. 
"      "  mercury  poisoning,  ii,  406. 
"      "  night  sweats  of  phthisis,  ii,  406. 
"      "  scrofulous   conjunctivitis    of    chil- 
dren, ii,  406. 

oxide  (as  a  prophylactic)  in  spasmodic 
asthma,  ii,  406. 

oxide  insufflations  in  laryngitis,  ii,  406. 
•'    in  ulcers  of  the  sseptum  nasi,  ii,  406. 
"     with  bismuth  and  pepsin  in  summer 
diarrhcea  of  children,  ii,  406. 

oxide  with  carminatives  and  morphine  in 
gastralgia,  ii,  406. 

oxychloride,  ii,  409. 

"  as  a  surgical  dressing,  ii,  410. 

"  (as  an  adjuvant)  in  the  galvanic 

treatment  in  haemorrhagic  endometritis 
and  incipient  malignant  conditions  of  the 
uterus,  ii,  410. 

permanganate  in  gonorrhoea,  ii,  410. 

phosphate,  ii,  410. 

'■  in  epilepsy,  ii,  410. 

"  "  exhaustion    from    over-excite- 

ment, ii,  410. 

phosphate  in  insanity  during  convalescence 
from  fevers,  ii,  410. 

phosphide  as  a  tonic  in  ansemia,  i,  68. 
"  ill  lyraphadenoma,  ii,  407. 

salicylate  as  an  antiseptic,  ii,  410. 
"  as  an  astringent,  ii,  410. 

"  (as  a  collvrium)  in  conjunctivitis, 

ii,  410. 

salicylate  in  inflammatory  cutaneous  dis- 
eases, ii,  410. 

salicylate  in  nasal  catarrh,  ii,  410. 

sozoiodolate,  ii,  215. 

"  in  blennorrhcea  and  gonorrhoea, 

ii,  410. 

stearate,  compound,  ii,  411. 

subgallate,  ii,  411. 

"  as  a  dressing  in  eczema,  hsemor- 

rhoids,  and  wounds,  ii,  411. 

subgallate  in  chronic  purulent  otitis  media, 
ii,  411. 

subgallate  in  gonorrhoea,  ii,  411. 

sulphate,  ii,  407. 

"         and  corrosive  sublimate  in  onychia 
maligna,  i,  328. 


Zinc  sulphate  as  a  haemostatic,  ii,  407. 

sulphate  (internally,  in  small  doses)  as  an  as- 
tringent and  as  a  tonic,  ii,  407. 
sulphate  in  atrophic  rhinitis,  ii,  407. 
"        "  cancer  of  the  uterus,  ii,  407. 
"      (injections)  in  caries,  ii,  408. 
"      in  caruncle  of  the  female  urethra, 
ii,  407. 
sulphate  (weak   solutions)   in  catarrhal  in- 
flammation of  the  mucous  membrane  of 
the  Eustachian  tube,  ii,  407. 
sulphate  in  condylomata,  ii,  408. 

"      (as  a  collyrium)  in  conjunctivitis,  ii, 
407. 
sulphate  (as  an  emetic)  in  croup,  ii,  407. 
"      in  diarrhoea,  ii,  407. 
"       "  dysentery,  i.i,  407. 
"       "  eczema,  ii,  408. 
"       "  epistaxis,  ii,  407. 
"       "  epithelioma,  ii,  407. 
"       "  erythema,  ii,  408. 
"       "  gonorrhoea,  ii,  407. 
"      (weak  solutions)  in  inflammation  of 
the  external  ear,  ii,  407. 
sulphate  in  intertrigo,  ii,  408. 

"       "  laryngeal  haamorrhage,  ii,  407. 

"  lupus,  ii,  407. 
"      (as  an  emetic)  in  narcotic  poison- 
ing, ii,  407. 
sulphate  in  purulent  otitis  media,  ii,  407. 
"       "  small  neoplasms,  ii,  408. 

"  unhealthy  ulcers,  i,  228 ;  ii,  407. 
"       "  warts,  ii,  408. 
"       "  whooping-cough,  ii,  407. 
sulphichthyolate    (externally)    in   acute    or 

chronic  rheumatism,  ii,  412. 
sulphichthyolate  in  burns,  ii,  413. 

"  "  chronic    catarrhal    dis- 

eases of  the  stomach  and  lungs,  ii,  413. 
sulphichthyolate  in  chronic  gonorrhoea,  ii, 

413. 
sulphichthyolate    in    chronic    nephritis,   ii, 

413. 
sulphichthyolate  in  eczema,  ii,  413. 

"  "  erysipelas,  ii,  413. 

"  "  favus,  ii,  413. 

"  "  intrapelvic      inflamma- 

tory exudations,  ii,  413. 
sulphichthyolate  in  lumbago,  ii,  413. 
"  "  psoriasis,  ii,  412. 

"  '■  varicose  veins,  ii,  413. 

sulphide,  in  lupus  erythematosus,  ii,  411. 
"        "  seborrhcea  of  the  face,  ii,  411. 
sulphite,  ii,  411. 
sulphocarbolate,  ii,  411. 

"  as  an  antiseptic  in  intestinal 

disorders,  ii,  411. 
sulphocarbolate  (externally)  in  balanitis,  ii, 

412. 
sulphocarbolate  in  catarrhal  laryngitis,   ii, 

413. 
sulphocarbolate  in  cholera  infantum,  ii,  411. 
"  "        "      morbus,  ii,  411. 

"  (douches)  in  chronic  puru- 

lent otitis  media,  ii,  413. 
sulphocarbolate  in  eczema  of  the  external 

auditory  canal,  ii,  413. 
sulphocarbolate  in  pharyngitis,  ii,  413. 

"  "  pityriasis  capitis,  ii,  413. 

"  "  syphilis,  ii,413. 


544 


GENERAL  INDEX. 


Zinc  sulphoearbolate  in  vomiting  of  pregnancy, 
ii,  413. 
sulphydrate,  ii,  412. 

"  in  chronic  eczema,  ii,  412. 

"  "  psoriasis,  ii,  412. 

"  "  vegeto-parasitio  skin  diseases, 

ii,  413. 
tannate,  ii,  412. 

"        in  conjunctivitis,  ii,  412. 

"         "  diarrhoea,  ii,  413. 

"         "  dyspepsia,  ii,  413. 

"         "  phthisis,  ii,  413. 

"        injections  in  gonorrhoea,  ii,  413. 


Zinc  tetraborate,  ii,  408. 
valerianate,  ii,  408. 

"  in  hay  fever,  ii,  347. 

"  "  incontinence  of    urine   from 

nervousness,  ii,  347. 
valerianate  in  neuralgia,  as  a  sedative,  i,  68 ; 
ii,  347. 
Zincohaemol,  ii,  413. 
as  an  astringent  and  tonic,  ii,  413. 
in  anjemia,  ii,  412. 
"  chlorosis,  ii,  413. 
"  diarrhoea,  ii,  412. 
Zymoidin,  ii,  413. 


INDEX  OF  DISEASES  AND  REMEDIES. 


Abdominal  pain. 

See  Colic. 
Aberration  of  tlie  cardiac  rhythm. 

Convallaria,  i,  300. 
Abortion. 

Gold  chloride,  i.  453. 

Viburnum  prunifolium,  ii,  357. 
Abortion,  jpains  of. 

Piseidia,  li,  91. 
Abortion,  threatening'. 

Asafoetida,  i,  147. 
Abrasions. 

Arnica,  i,  141. 

Benzoin,  tincture  of,  i,  178. 

Chalk,  powdered,  i,  230. 

Gutta  pereha,  i,  463. 

Phenol  sodique,  ii,  73. 

Tannic-acid  ointment,  ii,  257. 

Traumaticin,  ii,  328. 

Zinc  oxide,  ii,  406. 
Abrasions  of  mucous  surfaces. 

Borax,  i,  189. 
Abscess. 

Alumnol  irrigations,  i,  51. 

Ammonium  chloride,  i,  57. 

Aspiration,  i,  153. 

Baths,  i,  171. 

Bromol,  i,  197. 

Calcium  sulphide,  i,  203. 

Carbolic  acid  (parenchymatous  injections), 
i,  213. 

Carbolic  acid  (solution)  inhalation,  i,  213. 

Chlorine  water,  i,  240. 

Cloves,  tincture  of,  i,  272. 

Iodoform,  i,  538. 

Mentho-phenol,  i,  616. 

Sanoform,  ii,  15. 

Sozal,  ii,  215. 
Abscess,  cold. 

Baths,  i,  171. 

Cloves,  tincture  of  (injections),  i,  272. 

Iodoform  (hvpodermically),  i,  538. 

Teucrin,  ii,  273. 
Abscess,  deep-seated. 
Vienna  paste,  i,  228. 
Abscess,  ganglionic. 
Copper  salts,  i,  303. 
Abscess,  hepatic. 

Ammonium  chloride,  i,  57. 
Abscess,  indolent. 

Vienna  paste,  i,  228. 
Abscess  of  the  ear. 
Honey  and  rye  meal,  i,  472. 


Abscess  of  the  lung. 

Carbolic  acid,  i,  213. 
Abscess,  open. 

Sanoform  (for  after-treatment),  ii,  154. 
Abscess,  perityphlitic. 

Aspiration,  i,  152. 
Abscess,  pulmonary. 

Bromol,  i.  197. 
Abscess,  tuberculous. 

Sozal,  ii,  215. 
Accumulation,  feecal. 

Aloes,  combined  with  strychnine,  i,  224. 
Acidity  of  the  stomach. 

See  Dyspepsia,  Acid. 
Acne. 
Alumnol  applications,  i,  51. 
Arsenic,  i,  144. 
Calcium  chloride,  i,  202. 
"       sulphide,  i,  203. 
Collodion,  i,  294. 
Cupric  sulphate,  i,  306. 
Hvdrastine,  i,  476. 
le'hthyol,  i,  522. 
Losophan,  i,  589. 
Nitrohydrochloric  acid,  ii,  16. 
Phosphorus,  ii,  77. 
Salicylic  acid,  ii,  144. 
Steam,  ii,  222. 
Sulphur  ointment,  ii,  241. 
Thymol,  ii,  284. 
Waters,  Buffalo  lithia,  ii,  372. 
Acne,  pustular. 

Salicylic  acid,  ii,  144. 
Acne  rosacea. 

Cupric-sulphate  solution,  i,  806. 
Acne  Tulgraris. 

Collodion,  i,  294. 
Acromegaly. 
Pituitary-body  extract  (hypodermically),  i,  81. 
Thyreoid  treatment,  ii,  295. 
Actinomycosis. 
Carbolic-acid  injections,  i,  213. 
Potassium  iodide,  ii,  99. 
Teucrin,  ii,  273. 
Adenitis. 
Belladonna,  i,  174. 
Cloves,  tincture  of,  i,  273,  273. 
Ichthyol,  i,  522. 
Iodine,  i,  536. 
Iodoform,  i,  538. 
Mercury  ointment,  i,  622. 
Nuclelns,  ii,  25. 
Plytolacca,  ii,  81. 


545 


546 


INDEX  OF   DISEASES  AND  EEMEDIES. 


Adenitis. 

Pyoctanine  (internally),  ii,  109. 
Teuorin,  li,  173. 
Adenitis,  clironic. 

Waters,  mineral,  ii,  383. 
Adenitis,  tuberculous. 

Cloves,  tincture  of  (injections),  i,  272,  273. 
Iodoform,  i,  538. 
Nucleins,  ii,  25. 
Teucrin,  ii,  173. 
Adynamia. 

Opium  (as  a  stimulant),  ii,  226. 
After-pains. 

Chloral  hydrate,  i,  237. 
Ergot,  i,  388. 

Viburnum  prunifolium,  ii,  357. 
Albuminuria. 
Asaprol,  i,  148. 
Corn  silk,  i,  306. 
Gallic  acid,  i,  432. 
Infusion,  intramuscular,  li,  325. 
Iron  chloride,  i,  548. 
Sodium  tannate,  ii,  259. 
Strontium  lactate,  ii,  229. 
Tannin,  ii,  2-57. 
Waters,  Buffalo  lithia,  ii,  372. 
"       ferruginous,  ii,  369. 
Albuminuria,  phosphatic. 
Olycerophosphates,  ii,  439. 
Alcohol  habit. 
Ammonia  water  (after  gastric  lavage),  i,  53. 
Bath,  half,  i,  169. 
Coffee,  i,  290. 
Cold  plunge,  i,  488. 
Gold  bromide,  i,  45. 
Hydrastis,  i,  475. 
Hypnotism,  i,  515. 
Mercauro,  i,  454. 
Nux  vomica,  ii,  29. 
Strychnine,  ii,  29. 
Waters,  mineral,  ii,  379. 
Alcohol  habit,  treatment  of  the  chronic, 

i,  38. 
Alopecia. 

Cantharides,  i,  208. 

Galvanism,  i,  368. 

Jaborandi  (subcutaneous  injections,  or  by 

the  mouth),  i,  560. 
Sulphur  ointment,  ii,  241. 
Veratrine,  ii,  350. 
Alopecia  areata. 
Sulphur  ointment,  ii,  241. 
Veratrine,  ii,  350. 
Amaurosis,  tobacco. 

Santonin,  ii,  155. 
Amblyopia. 
Hyaenanchin,  i,  474. 
Nux  vomica,  ii,  28. 
Zinc  lactate,  ii,  409. 
Amblyopia,  hysterical. 

Zinc  lactate,  ii,  409. 
Amenorrhcea. 
Aloes,  i,  49. 

Ammonium  chloride,  i,  57. 
Apiol,  i,  138. 
Arsenic,  i,  146. 
Baths,  i,  169,  170. 

"     hot  foot,  i,  170. 
Cantharides,  i,  208. 
Cimicifuga,  i,  250. 


Amenorrhcea. 

Cineraria,  i,  258. 

Galbanum  (internally),  i,  433. 

Gold,  i,  453. 

Ice  applied  to  the  spine,  i,  520. 

Inula  (as  a  tonic),  i,  534. 

Iron,  ammonio-ehloride  of,  i,  549. 
"     iodide,  i,  551. 

Ligustieum,  i,  581. 

Manganese  and  iron,  i,  596. 

Mustard  foot-bath,  hot,  i,  647. 

Myrrh,  tincture  of  (internally),  i,  651. 

Ovarine,  ii,  451. 

Pulsatilla,  ii,  107. 

Rue,  ii,  137. 

Santonin,  ii,  155. 

Seneoio,  ii,  162. 

Sulphur  fumes,  ii,  241. 

Tansy  tea,  ii,  269,  456. 

Turpentine,  ii,  336. 

Viscum  album,  ii,  361. 

Waters,  Buffalo  lithia,  ii,  373. 
"       mineral,  ii,  375,  388. 
Amenorrhcea,  atonic. 

Iron  iodide,  i,  551. 

Sanguinaria,  ii,  154. 
Amenorrhcea,  functional. 

Pulsatilla,  ii,  107. 

Sulphur  fumes,  ii,  241. 
Amygdalitis. 
Aconite,  i,  8. 
Baths,  cold,  i,  488. 

Cfipsicum  and  hot  water  (as  a  gargle),  i,  309. 
Cinchona,  i,  256. 
Copper-arsenite  solution,  i,  304. 
Eucalyptol  inhalation,  i,  529. 
Glycerin  and  carbolic  acid,  i,  450. 
Guaiacol,  ii,  439. 
Hydrastis,  i,  476. 
Hydrogen  dioxide,  i,  503. 
Iron  (Monsel's  solution),  i,  550. 
Xuclein,  yeast,  ii,  24. 
Palmetto  wine,  ii,  58. 
(early  hours  of).  Quinine,  ii,  256. 
Quinine,  ii,  119. 
Salieylamide,  ii,  141. 
Silver  nitrite,  ii,  195. 
Sodium  salicylate,  ii,  146. 
Veratrum  viride,  ii,  353. 
Wine  (as  a  stimulant),  ii,  394. 
Amygdalitis,  acute. 

Guaiacol,  i,  460. 
Amygdalitis,  acute  follicular. 
Iron  sulphate  (Monsel's  solution),  i,  550. 
Sodium  salicylate,  ii,  146. 
Amygdalitis,  "follicular. 
Guaiacol,  ii,  439. 

Hydrastis  (local  applications),  i,  476. 
Quinine,  ii,  119. 
Amygdalitis,  suppurative. 

Aconite,  i,  8. 
Anaemia. 
Air,  condensed,  inspiration  of,  i,  38. 
Aloes,  i,  48. 
Amyl  nitrite,  i,  61. 
Arsenic,  i,  145. 
Baths,  i,  173. 

"      condensed-air,  i,  38, 
"      sheet,  i,  169. 
"      sulphur,  i,  178. 


INDEX  OF  DISEASES  AND  REMEDIES. 


647 


Anaemia. 

Blood,  i,  186. 

Champagne,  ii,  393. 

Coca  (as  an  adjunct),  i,  274. 

Cold  douche,  i,  491. 

Copper  arsenlte,  i,  303. 

Euoasin,  ii,  436. 

Gold,  i,  454. 

HaBmalbumin,  i,  463. 

Haematin-albumin,  i,  463. 

Hsemoglobin,  i,  464. 

Hydrochloric  acid,  i,  493. 

Iniusion,  ii,  324,  328. 

Iron,  i,  544. 
"     carbonate,  i,  547. 

"     chloride  (ethereal  tincture),  1,  547,  548. 
"     citrate,  i,  550. 
"     sulphate,  i,  549. 
"     tannate,  ii,  259. 
"     valerianate,  i,  552 ;  ii,  346,  348. 

Manganese  dioxide,  i,  596. 

Marrow,  extract  of  bone,  i,  81, 598, 599 ;  ii,  445. 

Nitroglycerin,  ii,  15. 

Nucleins,  ii,  24. 

Orexine,  ii,  451. 

Oxygen,  ii,  52. 

Ozone,  ii,  58. 

Peptomangan,  ii,  69. 

Permanganates,  ii,  70. 

Phospho-albumin,  ii,  74. 

Protonuolein,  ii,  448. 

Pyramidone,  ii,  454. 

Serum,  artificial  (intravenous  injections),  ii, 
164. 

Somatose,  ii,  212. 

Spermine,  ii,  217. 

Splenic  douches,  i,  349. 

Strophanthus,  ii,  232. 

Strychnine  with  iron  and  quinine,  ii,  28. 

Thyreoid  treatment,  ii,  295. 

Transfusion  and  infusion,  ii,  322,  323. 

Trefusia,  ii,  329. 

Waters,   chlorinated   (externally  and  inter- 
nally), ii,  365. 

(due  to  hsemorrhage).  Waters,  ferruginous,  ii, 
369. 

Waters,  mineral,  ii,  375,  384. 

Zincohsemol,  ii,  412. 
Anaemia,  acute  (from  hemorrhage). 

Serum,  artificial,  ii,  163. 

Transfusion  and  infusion,  ii,  322. 
Anaemia,  cerebral. 

Amyl  nitrite,  i,  61. 

Copper  arsenite  (small  doses),  i,  303. 

Infusion,  ii,  324. 

Infusion,  intra-arterial,  of  sodium-chloride 
solution,  ii,  328. 

Stro[5hanthus,  ii,  232. 
Anaemia,  pernicious. 

Ozone,  ii,  58. 

Phosphorus,  ii,  77. 
Anaemia,  progressiye  pernicious. 

Arsenic,  i,  145. 

Protonuclein,  ii,  448. 
Anaemia,  rhachitic. 

Peptomangan,  ii,  69. 
Anaemia,  Tvitli  constipation. 

Iron  sulphate,  i,  549. 
Anaestliesia,  chloroform. 

Ether  (subcutaneously),  ii,  237. 


Anaestliesia,  chloroform. 

Paradaism,  i,  366. 
Anaesthesia,  plantar. 

Bath,  hot  foot,  i,  170. 
Anasarca. 

Infusion,  intramuscular,  ii,  325. 

Sparteine,  ii,  216. 

Waters,  mineral,  ii,  379. 
Anasarca  of  Briglit's  disease. 

Theobromine,  ii,  277. 
Aneurysms. 

Electricity,  i,  361. 

Potassium  iodide,  ii,  10. 

Sodio-theobromine  salicylate,  ii,  203, 

Veratrum  viride,  ii,  353. 

Zinc  chloride,  ii,  403. 
Aneurysms,  "  inoperable." 

Zinc  chloride,  ii,  403. 
Aneurysms,  internal. 

Potassium  iodide,  ii,  98. 
Angina  pectoris. 

Amyl  nitrite,  i,  60,  538. 

Anhalonine,  ii,  417. 

Arsenic,  i,  146. 

Baths,  Nauheira,  ii,  419. 

Camphor,  i,  205. 

Cereus  grandiflorus,  i,  229. 

Chloroform,  i,  528. 

Conium,  i,  298. 

Exalgine,  i,  408. 

Mercury,  i,  620. 

Morphine,  ii,  36. 

"        (hypodermic  injection),  i,  67. 

Nitroglycerin,  ii,  15. 

Pyridine,  ii,  110. 

fumes  of,  i,  530. 

Schott  treatment,  ii,  432. 

Strophanthus,  ii,  282. 

Tribromhydrin,  ii,  330. 
Ankylosis. 

Thiosinamine,  ii,  281. 
Ankylostomiasis. 

Thymol,  ii,  284. 
Anorexia. 

Alcohol,  i,  33. 

Cannabis  indica,  i,  207. 

Morphine,  ii,  38. 

Orexine  hydrochloride,  ii,  46. 

Quassia,  ii,  112. 

Splenic  extract,  ii,  318. 
Anorexia,  hysterical. 

Morphine,  ii,  88. 
Anthrax. 

Serum  treatment,  i,  85. 

Toxines,  ii,  315. 
Aortic  disease. 

Convallaria,  i,  300. 
Aortic  insufficiency. 

Air,  condensed,  inspiration  into,  i,  28. 

Amyl  nitrite,  i,  61. 
Aphonia,  hysterical. 

Paradaism,  i,  366. 
Aphthae. 

Alcohol  applications,  i,  31. 

Antacids,  i,  86. 

Bismuth  subnitrate,  i,  181. 

Borax,  i^  189. 

Catechu,  i,  231. 

"        infusion  or  tincture,  i,  331. 

Chlorine  water,  i,  240. 


548 


INDEX  OF  DISEASES  AND   REMEDIES. 


Aphthae. 

Citric  acid,  i,  2G0. 

Gopper-arsenite  solution  (locally  and  inter- 
nally), i,  303. 

Cupric  acetate  (topically),  i,  303. 

Lemon-juice  (diluted,  as  a  gargle),  i,  260. 
Apncea. 

See  Asphyxia. 
Apoplexy. 

Bloodletting,  i,  189. 

Croton    oil   (for  rapid    evacuation    of    the 
bowels),  i,  318. 

Paradaism,  i,  366. 

Sodium  phosphate,  ii,  208. 

Strophanthus,  ii,  231. 

Strychnine,  ii,  28. 
Arrhythmia. 

Sodio-theobromine  salicylate,  ii,  203. 
Arterial  tension,  lii^h. 

Potassium  cobaltonitrite,  i,  273. 
Arteriosclerosis. 

Sodio-theobromine  salicylate,  ii,  203. 
Arthralgia. 

Mentha  piperita  (oil),  i,  613. 
Arthritis,  fungous. 

Cloves,  tincture  of  (injections),  i,  372. 
Arthritis,  gonty. 

Exalgine,  i,  403. 
Arthritis,  rheumatoid. 

Baths,  hot  foot,  i,  170. 

Calcium  sulphide,  i,  203. 

Synovial  extract,  ii,  251. 
Arthritis,  tuberculous. 

Copper  salts,  i,  303. 
Articular  troubles. 

See  Rheumatism. 
Ascarides. 

Aloes,  i,  103. 

Bitters  (injections  of),  i,  183. 

Carbolic  acid,  i,  103. 

Ether  (internally),  i,  397. 

Limewater  (as  a  wash),  i,  583, 

Quassia,  ii,  112. 

Salt,  ii,  102. 

Santonin,  ii,  55. 

Tannin,  ii,  257. 

Turpentine  oil,  ii,  336. 
Ascites. 

Aspiration,  i,  152. 

Iodine  injection,  i,  536. 

Jaborandi,  i,  559. 

Massage,  abdominal,  i,  608. 

Salines,  ii,  147. 

Serum,  artificial,  ii,  163. 

Waters,  mineral,  ii,  379. 
Ascites  of  hepatic  cirrhosis. 

Salines,  ii,  147. 

Serum,  artificial,  ii,  163. 
Aspergillus  infection. 

Veratrine,  ii,  350. 
Asphyxia. 

Cold  affusions,  i,  17. 

Electricity,  ii,  226. 

Paradaism,  i,  366. 

Heat,  dry,  ii,  225. 

Oxygen,  ii,  52. 

Stimulants,  cardiac,  ii,  236. 

Transfusion,  depletory,  ii,  323. 
Asphyxia  from  oxide  of  carbon  inhalation. 

Serum,  artificial,  ii,  165. 


Asphyxia,  local. 

Amyl  nitrite,  i,  62. 

Nitroglycerin,  ii,  10. 
Asphyxia  neonatorum. 

Baths,  cold,  ii,  128. 
"      hot,  i,  166. 

Electricity,  ii,  226. 

Transfusion,  depletory,  ii,  323. 
Asthenia. 

See  Debility. 
Asthenopia. 

Massage  of  the  eye,  i,  610. 
Asthenopia,  accommodatire. 

Eserine,  i,  392. 
Asthma. 

Acetajiilide,  i,  4. 

Aconite,  i,  8. 

Air.  condensed,  inspiration  of,  i,  38. 

Alcohol,  i,  33. 

Alkalies,  i,  96. 

Allyl  tribromide,  ii,  414. 

Ammonium  succinate,  i,  58. 

Amyl  nitrite,  i,  95. 

Analgene,  i,  66. 

Anhalonine,  ii,  417. 

Antipyrine,  i,  124. 

Apomorphine,  ii,  418. 

Arsenic,  i,  96. 

Arsenious  solution,  i,  97. 

Asafoetida,  i,  147. 

Asaprol,  i.  148. 

Balsamic  fumes,  i,  529. 

Baths,  condensed-air,  i,  37. 

Bromide  of  ammonium,  i,  94. 
"         "  potassium,  i,  94. 
"         "  sodium,  i,  94. 

Bromoform,  i,  196. 

Caffeine,  i.  201. 

Cannabis  indica,  i,  207. 

Carbolic  acid,  i,  213. 

Chamomile,  i,  231. 

Chemical  means,  i,  93. 

Chloralamide,  i,  238. 

Chloral  caffeine,  i,  235. 

Chloral  hydrate,  i,  94,  237. 

Climatic  treatment,  i,  96. 

Conium,  i,  298. 

"         vapour  inhalations,  i,  299,  539. 

Copper-arsenite  solution  (spray),  i,  303. 

Diet,  careful,  i,  96. 

Digitalis,  i,  342. 

Elastic  compression  of  the  chest,  i,  93. 

Electrical  stimulation,  i,  93. 

Ether  (as  a  sedative),  i,  538. 

Ethyl,  iodide  of  (inhalations),  i,  95. 

Eucalyptus  cigarettes,  i,  400. 

Expiration  into  rarefied  air,  i,  28,  93. 

Fowler's  solution,  i,  97. 

Galvanism  of  the  neck,  i,  368. 

Gelsemium,  i,  437. 

Glycerophosphates,  ii,  439. 

Hoffmann's  anodyne,  i,  94. 

Hydriodic  acid,  i,  493. 

Inhalation  of  conium,  i,  529. 

Jaborandi,  i,  559. 

Lippia  mexicana,  i,  585. 

Lobelia,  i,  373,  587. 

Methylal  (by  inhalation),  1,  639. 

Morphine  (hypodermic  injection),  i,  93. 

Nitrogen  monoxide,  i,  538. 


INDEX  OP  DISEASES  AND  REMEDIES. 


549 


Asthma. 

Nitroglycerin,  i,  95 ;  ii,  15. 

Opium,  "fumes  of,  i,  529. 

Oxygen  inhalation,  i,  95. 

Ozone  inhalation,  ii,  58. 

Paraldehyde,  ii,  63. 

Pilocarpine,  nitrate   and    hydrochloride,  1, 
95. 

Pine  leaves,  oil  of,  i,  96. 

Piscidia  (as  an  antispasmodic),  ii,  91. 

Potassium  iodide,  i,  97 ;  ii,  99. 

"         nitrate,  belladonna,  and  stramo- 
nium, fumes  of,  i,  530. 

Potassium-nitrate  fumes,  ii,  99. 

Pulsatilla,  ii,  107. 

Pyridine,  fumes  of,  i,  530. 

Quebracho,  ii,  113. 

Quinine,  i,  356 ;  ii,  119. 

Sanguinaria,  ii,  154. 

Sodium  iodide,  i,  97. 

Spermine,  ii,  317. 

Stramonium,  ii,  339. 

"  and  belladonna,  i,  539. 

Strophanthus,  ii,  331. 

Strychnine,  ii,  38. 

Sulphonal,  ii,  239. 

(paroxysm),  Sulphuric  ether,  i,  94. 

Tartar  emetic,  i,  114. 

Terebene,  i,  97 ;  ii,  27. 

Tonics  (as  an  adjunct  to  other  treatment), 
i,  97. 

Tribromhydrin,  ii,  380. 

Turpentine  oil,  vapour  of,  ii,  336. 

Tylophora,  ii,  337. 

Zinc  oleostearate  with  oil  of  pine,  ii,  409. 
"     oxide,  ii,  406. 
Asthma,  bronchial. 

Antipyrine,  i,  124. 

Baths,  condensed-air,  i,  37. 

Pyridine,  ii,  110. 

Quebracho,  ii,  112. 

Strychnine,  ii,  38. 
Asthma,  cardiac. 

Sparteine,  ii,  316. 
Asthma,  ha^. 

Amyl  nitrite,  i,  528. 

Arsenic,  i,  146. 

Cannabis  indica,  i,  307. 

Carbolic-acid  solution  (by  spray),  i,  318. 

Ethyl-iodide  inhalation,  i,  538. 
Asthma,  lipocardiac. 

Air,  condensed,  inspiration  of,  i,  38. 
Asthma,  nervous. 

Amyl  nitrite,  i,  61. 

Glycerophosphates,  ii,  439. 
Asthma,  spasmodic. 

Analgene,  i,  66. 

Belladonna,  i,  173. 

Caffeine,  i,  201. 

Carbon  dioxide,  i,  527. 

Chamomile  oil,  i,  331. 

Chemical  means  of  combating,  i,  93. 

Chloralamide,  i.  238. 

Chloral  caffeine  (hypodermically),  i,  235. 

Grindelia,  i,  456. 

Nitroglycerin,  ii,  15. 

Physical  means  of  combating,  i,  93. 

Potassium  iodide,  ii,  99. 

Stramonium  fumigation,  i,  430. 

Zinc  oxide,  ii,  406. 


Atelectasis. 

Air,  condensed,  inspiration  of,  i,  38. 

Douches,  cold  rectal,  1,  349. 
Atony. 

Aloes,  i,  324. 

Bitters,  i,  183. 

Canella,  i.  306. 

Chamomile,  i,  231. 

Damiana,  i,  324. 

Electricity,  i,  368. 

Ergot  of  maize,  i,  389. 

Glycerin,'!,  450. 

Iron  carbonate,  i,  547. 
"    iodide,  i,  551. 

Lavandula,  i,  573. 

Phosphorus,  ii,  76. 

Quassia,  ii,  112. 

Rue,  ii,  137. 
Atony,  cerebral. 

Phosphorus,  ii,  76. 
Atony,  digestive. 

Bitters,  i,  183. 

Canella,  i,  206. 

Chamomile,  i.  231. 

Iron  carbonate,  i.  547. 

Lavandula,  i,  572. 
Atony,  gastric. 

Waters,  acidulated  (carbonated)  chalybeate, 
ii,  370. 

Waters,  carbonated,  ii,  364. 
"       mineral,  ii,  375. 
Atony,  general,  of  the  nervous  system. 

Damiana,  i,  334. 
Atony,  intestinal. 

Waters,  carbonated,  ii,  364. 
"       mineral,  ii,  375. 
Atony  of  anaemia. 

Iron  sulphate,  i,  549. 
Atony  of  tlie  bladder. 

Baths,  cold,  i,  169. 
Atony  of  the  lungs  and  kidneys. 

Baths,  hot,  ii,  235. 
Atony  of  the  nervous  system. 

Damiana.  i,  324. 
Atony  of  the  sexual  apparatus  in  women. 

Aloes,  i,  49. 
Atony  of  the  stomach. 

Electricity,  i,  368. 

Quassia,  ii,  113. 
Atony,  ovarian. 

Rue,  ii,  137. 
Atony,  uterine. 

Aloes  with  iron  and  with  myrrh,  i,  234, 

Ergot  of  maize,  i,  389. 

Glycerin  (intra-uterine  injections),  i,  450. 

Rue,  ii,  137. 
Atrophy,  brown,  of  the  heart. 

Saline  infusion,  ii,  338. 
Atrophy,  muscular. 

Glycerophosphates,  ii,  439. 
Atrophy  of  the  vagina  and  cervix  uteri. 

Ichthyol,  i,  523. 
Atrophy,  progressive  muscular. 

Galvanism,  i,  367. 

Balanitis. 

lodol,  i,  540. 

Zinc  sulphoearbolate,  ii,  413. 
Balanoposthitis. 
Nosophene,  ii,  19. 


550 


INDEX  OP  DISEASES  AND  REMEDIES. 


Balanoposthitis. 

Silver  nitrate,  ii,  196. 
Basedow's  disease. 

See  Goitre,  Exophthalmic. 
Bedsore. 

Benzoin  tincture,  i,  178. 

Copper-arsenite  solutions  (in  form  of  a  spray), 
i,  303. 

Lead-tannate  applications,  i,  578. 

Silver  nitrate,  ii,  196. 
Berl-beri. 

Methylene  blue,  i,  630. 
Biliary  lithiasis. 

See  Calculus,  Biliary. 
Biliousness. 

Calomel,  i,  634. 

Ipecac  (as  an  emetic),  i,  543. 

Mercury,  i,  619. 

Podophyllin,  ii,  93. 
Bites,  leecli. 

Benzoin  tincture,  i,  178. 
Bites,  snake. 

Alcohol,  i,  30. 

Ammonia  (hypodermically),  i,  53. 

Arsenic  and  opium,  i,  146. 

Calatropis,  i,  303. 

Honey,  ii,  441. 

Serum  treatment,  ii,  188,  189. 

Strychnine,  ii,  29. 
Bites,  venomous. 

Cupping,  i,  320. 

Honey,  ii,  441. 
Bladder,  alTections  of  tlie. 

Ammonium  citrate,  i,  57. 

Cantharides,  i,  208. 

Cubeb,  i,  319. 
Bladder,  irritable. 

Humulus,  i,  474. 
Blebs,  hereditary  inclination  to  the  for- 
mation of. 

Belladonna,  ii,  425. 
Bleeding. 

See  HvBmorrhagb. 
Blennorrhagia. 

See  GONORRHCEA. 

Blennorrhoea. 

Cadmium  sulphate  (solution)  injections,  i, 
200. 

Zinc  sozoiodolate,  ii,  410. 
Blepharitis. 

Atropine,  i,  155. 

Copper-arsenite  solution  (in  form  of  a  spray), 
i,  303. 

Silver  nitrate,  ii,  195. 
Blepharitis,  chronic  marginal. 

Mercury  oxide,  i,  633. 
Blepharitis  marginalis. 

Silver  nitrate,  ii,  195. 
Blepharophthalmia. 

Pulsatilla,  ii,  107. 
Blepharospasm. 

Conium,  i,  398. 

Electricity,  i,  365. 

Galvanization,  anodal,  i,  366. 

Mydrol,  ii,  447. 
Blisters. 

Cotton,  absorbent,  i,  810. 

Grindelia,  i,  456. 

Lead,  Goulard's  extract  of,  i,  577, 

Zinc  oxide,  ii,  406. 


Blood-poisoning. 

See  Septicemia. 
Boils. 
Alkalies  (poultice  of  hardwood  ashes),  i,  45. 
Arnica  plaster,  i,  141. 
Asaprol  (as  an  internal  antiseptic),  i,  148. 
Calcium  sulphide,  i,  203. 
Camphor,  spirit  of,  i,  304. 
Carbolic  acid  (parenchymatous),  i,  313. 
Colchicum,  i,  391 
Hypophosphites,  i,  518. 
Menthol,  i,  616. 
Pyoetanine,  ii,  108. 
Sodium  phosphate,  ii,  208. 
Turpentine  liniment,  ii,  336. 
(opening  of),  Vienna  paste,  i,  238. 
Yeast,  ii,  400. 
Boils  of  the  external  auditory  meatns. 

Menthol,  i,  616. 
Boils,  recurrent. 
Colchicum,  i,  391. 
Bone  diseases. 

See  Caries  and  Necrosis. 
Bowel  complaints,  fermentative. 

Bismuth  naphtholate,  i,  182. 
Brain  disease. 

See  Cerebral  affections. 
Bright's  disease. 
Diet  in,  i,  338. 
Iron  chloride,  i,  548. 
Nitroglycerin,  ii,  15. 
Nucleins,  ii,  34. 
Potassium  iodide,  ii,  98. 
Strontium  lactate,  ii,  230. 
Theobromine,  ii,  277. 
Waters,  Buffalo  lithia,  ii,  372. 

mineral,  ii,  374,  376,  379. 
"        thermal,  ii,  364. 
Bromidrosis. 
Boric  acid  (in  powder),  i,  103. 
Chromic  acid,  i,  103,  248. 
Diachylon  ointment,  i,  103. 
Hydrastine,  i,  476. 
Zinc  oleate,  ii,  405. 
Bronchial  affections. 
Asafcetida,  i,  147. 
Viola  tricolor  (synip),  ii,  360. 
Bronchial  congestion. 
Digitalis,  i,  342. 

Storax  (as  an  expectorant),  ii,  238. 
Bronchiectasis. 
Creosote  by  inhalation,  i,  314. 
Terebene,  ii,  271. 
Bronchitis. 
Air,  inspiration  of  condensed,  i,  28. 
Alum  whey,  i,  50. 
Ammonium  carbonate,  i,  55,  56. 
Ammonium  chloride,  i,  56,  418. 
Amyl  nitrite,  i,  61. 
Apomorphine,  i,  139. 
Arsenic,  i,  146. 
Benzene,  i,  176. 
Benzoic  acid,  i,  177. 
Benzoin  i,  178. 
Camphor  and  sweet  almond  oil  (internally), 

1,  *uo. 
Carbolic-acid  inhalations,  i,  213, 
CocillaBa  bark,  i,  285. 
Creosote  inhalations,  i,  314. 
Croton  oil,  i,  318. 


IKDEX  OP  DISEASES  AND  REMEDIES. 


551 


Bronchitis. 

Cubeb,  i,  319. 

Digitalis,  ii,  228. 

Dulcamara,  i,  353. 

Ethyl  iodide,  i,  399. 

Eucalyptol  inhalations,  i,  529. 

Eucalyptus,  i,  400. 

Galbanum,  i,  432. 

Goose-grease  liniment,  i,  454. 

Grindelia,  i,  456. 

Guaiacol,  i,  459. 

Ice  bag,  application  of  the,  i,  520. 

Iodine  vapour,  i,  536. 

Iodoform  inhalation,  i,  540. 

Ipecac,  i,  543. 

Jaborandi,  i.  559. 

Kurayss,  i,  567. 

Licorice,  i,  580. 

Mustard  plaster,  i,  647. 

Myrtol,  i,  652. 

Nitric  acid,  ii,  8. 

Nuclein,  ii,  34. 

Olibanum,  ii.  34. 

Opium  (small  doses),  ii,  37. 
"       fumes  of,  i,  539. 

Oxygen,  ii,  53. 

Ozone  inhalation,  ii,  58. 

Palmetto  wine,  ii,  58. 

Piseidia,  ii,  91. 

Pix  liquida,  ii,  91. 

Potassium  iodide,  ii,  98. 

Poultices,  ii,  101. 

Pulsatilla,  ii,  107. 

Quinine,  i,  526 ;  ii,  119. 

Sandal-wood  oil,  ii,  153. 

Sanguinaria,  ii,  154. 

Senega  (as  a  stimulating  expectorant),   ii, 
162. 

Squill,  ii,  331. 

Steam,  ii,  330. 

Sulphur,  ii,  340. 

Sumbul,  ii,  243. 

Tanosal,  ii,  361. 

Tepid  baths,  i,  489. 

Thymol  inhalation,  ii,  383. 

Tribromhydrin  (as  an  expectorant),  ii,  330. 

Turpentine  oil  (internally),  ii,  336. 
"  stupes,  ii,  335. 

Zinc  oleostearate  with  oil  of  pine,  ii,  409. 
Bronchitis,  acute. 

Balsaraum  pulmonum  (as  an  expectorant), 
ii,  241. 

Eucalyptus,  oil  of,  i,  400. 

Ipecac,  i,  373. 

Sanguinaria,  ii,  154. 

Squill,  ii,  221. 

Terebene,  ii,  371. 

Terpin  hydrate,  ii,  372. 

Tribromhydrin,  ii,  330. 

Waters,  chlorinated  alkaline,  ii,  381. 
Bronchitis,  capillary  (of  children). 

Oxygen,  ii,  53. 

Steam,  i,  538 ;  ii,  220. 
Bronchitis,  catarrhal. 

Horehound,  i,  473. 
Bronchitis,  chronic. 

Air,  inspiration  of  condensed,  i,  28. 

Alum  whey,  i,  50. 

Ammonium  carbonate  (as  an  expectorant),  i, 
55,  56. 


Bronchitis,  chronic. 

Ammonium  chloride,  i,  418. 

Apomorphine,  i,  139. 

Arsenic,  i,  146. 

Benzene,  i,  176. 

Benzoic  acid,  i,  177. 

Benzoin,  i,  178. 

Carbolic-acid  inhalation,  i,  313. 

Creosote  by  inhalation,  i,  314. 

Croton  oil,  i,  318. 

Cubeb,  i,  319. 

Digitalis  (as  a  diuretic),  ii,  238. 

Eucalyptol  inhalation,  i,  529. 

Eucalyptus,  oil  of,  i,  400. 

Galbanum  (internally),  i,  432. 

Guaiacol,  inhalations  of,  i,  459. 

Iodine  vapour,  i,  536. 

Ipecac,  i,  543. 

Iron  chloride  (tincture),  i,  548. 

Kumyss,  i,  567. 

Nitric  acid,  ii,  8. 

Opium,  i,  508. 

Pix  liquida,  ii,  91. 

Potassium  iodide,  ii,  98. 

Quinine,  i,  356  ;  ii,  119. 

Squill,  ii,  331. 

(dry  form).  Steam  spray,  ii,  380. 

Sulphur,  ii,  340. 

Sumbul,  ii.  243. 

Tanosal,  ii,  261. 

Terebene,  ii,  371. 

Terpin  hydrate,  ii,  373. 

Terpinol,  ii,  372. 
Bronchitis,  foetid. 

Naphthalene,  ii,  1. 

Salicylio-aoid  inhalation,  ii,  143. 

Terebene,  ii,  271. 

Turpentine  oil,  vapour  of,  ii,  336. 
Bronchitis  of  the  a^ed. 

Wine,  port,  ii,  393. 
Bronchitis,  subacute. 

Ammonium-chloride  troches,  i,  57. 

Cubeb  cigarettes,  i,  430. 
Bronchocele,  cystic. 

See  GoItre. 
Bronchopneumonia. 

Aconite  (as  a  sedative),  i,  9. 

Camphor  and  sweet-almond  oil  (internally), 
i,  305. 

CooillaHa  bark,  i,  385. 

Gavage,  i,  436. 

Guaiacol  applications,  ii,  437. 

Paraldehyde,  ii,  63. 

Pilocarpine,  ii,  86. 
Bronchopneumonia,  acute. 

Potassium  iodide,  ii,  98. 
Bronchopneumonia,  chronic. 

Tanosal,  ii,  261. 
Bronchorrhoea. 

Air,  condensed,  inspiration  of,  i,  28. 
"    rarefied,  expiration  into,  i,  28. 

Apomorphine,  i,  139. 

Blennostasine,  ii,  436. 

Gallic  acid,  i,  432. 

Naphthalene,  ii,  1. 

Waters,  chlorinated  alkaline,  ii,  381. 

Zinc  oxide,  ii,  406. 
"     sulphate,  ii,  407. 
Bronchorrhflea,  foetid. 

Guaiacol,  inhalation  of,  i,  459. 


552 


INDEX  OF  DISEASES  AND  REMEDIES. 


Bruises. 

Ammonium  acetate,  i,  54. 

Benzoin  tincture,  i,  178. 

Calendula,  i,  203. 

Chaulraoogra  oil,  i,  233. 

Hamamelis,  i,  467. 

Lead,  Goulard's  extract  of,  i,  577. 

Massage  h,  friction,  i,  609. 

Salubrine,  ii,  152. 

Stupes,  hot-water,  ii,  238.. 
Buboes. 

Carbolic  acid  (parenchymatous  injections), 
i,  213. 

Cupric  sulphate  solution  (injections),  i,  306. 

Sanoform,  ii,  154. 

Silica,  hydrated,  ii,  191. 

Silver  nitrate  (injections),  ii,  196. 

Xeroform,  ii,  397. 
Buboes,  suppurating. 

Iodoform  injection,  i,  539 ;  ii,  444. 

lodol,  i,  540. 
Burns. 

Aristol,  i,  140. 

Basilicon  ointment,  ii,  135. 

Borax,  i,  189. 

Cantharides  tincture  (topically),  i,  208. 

Carbolic  acid,  i,  213. 

Carron  oil,  i,  583. 

Chalk  powder,  i,  230. 

Chloral  hydrate,  i,  237. 

Collodion,  i,  293. 

Cotton,  absorbent,  i,  810. 

Creosote,  i,  314. 

Dermatol,  i,  329. 

Euphorin  (as  a  local  disinfectant),  i,  402. 

Europhene,  i,  402. 

Flour,  wheat,  i,  423. 

Ichthyol,  i,  522. 

Lead  liniment,  i,  578. 

Lint,  i,  584. 

Magnesia,  calcined,  ii,  445. 

Massage,  i,  609. 

Picric  acid,  ii,  88. 

Piscidia,  ii,  91. 

Potassium  nitrate,  ii,  99. 

Rhigolene,  ii,  129. 

Rye  flour,  ii,  137. 

Sodium  bicarbonate,  ii,  205. 

Tannic  acid,  ii,  257. 

Terebene,  ii,  271. 

Thioform,  ii,  278. 

Thiol  (solid),  ii,  278. 

Transfusion,  ii,  323. 

Turpentine  liniment,  ii,  335,  336. 

Xeroform,  ii,  397. 

Zinc  oxide,  ii,  406. 

Cachexia. 

Cod-liver  oil,  i,  288. 

Linseed  oil  (as  a  nutrient),  i,  584 

Transfusion,  ii,  323. 
Cachexia,  malarial. 

Arsenic,  i,  145. 

Carbolic  acid  and  iodine,  i,  213. 

Hydrastine,  i,  476. 

Quinine,  i,  255 :  ii,  118. 

Waters,  Buffalo  lithia,  ii,  873. 
"      ferruginous,  ii,  369. 
Cachexia,  mercurial. 

Somatose,  ii,  212. 


Cachexia  of  children. 

JJitrohydrochloric    acid    (for  sponging),  ii, 
16. 
Calculus. 

Waters,  mineral,  ii,  879. 
Calculus,  biliary. 
Boldo,  i,  189. 
Chloroform,  i,  245. 
Glycerin,  i,  451. 
Limewater,  i,  582. 
Massage,  abdominal,  i,  608. 
Olive  oil,  ii,  35. 
Salacetol,  ii,  89. 
Sodium  phosphate,  ii,  79,  208. 
Strophanthus,  ii,  231. 
Urotropine,  ii,  343. 
Waters,  chlorinated  alkaline,  ii,  381. 
mineral,  ii,  375,  876. 
Calculus,  cystic. 
Urotropine,  ii,  343. 
Waters,  alkaline,  ii,  867. 
Calculus,  renal. 
Strophanthus,  ii,  231. 
Waters,  alkaline,  ii,  367. 
"       mineral,  ii,  384. 
Calculus,  uric-acid. 
Urotropine,  ii,  343. 
Calculus,  resical. 

See  Calculus,  Cystic, 
Cancer. 
Alcohol,  i,  31. 
Alveloz,  i,  51. 
Arsenic  (as  a  caustic  and  in  superficial  forms), 

i,  144. 
Atropine  applications,  i,  154. 
Bismuth  and  morphine  (for  relief  of  pain),  i, 

180. 
Bromine,  i,  195. 
Calcium  carbide,  ii,  437. 
Carboriic  water,  i,  314. 
Chelidonium,  ii,  431. 
Chromic  acid,  i,  248. 
Condiirango,  i,  297. 
Conium,  i^  298. 

Formic-acid  compounds,  i,  429. 
Gold,  i,  454. 
Hydrastine,  i,  476. 
lo'dol,  i,  540. 
Iron,  reduced,  1,  547. 
Loretin,  i,  588. 
Orchitic  liquid,  i,  75. 
Pepsin,  ii,  69. 
Permanganates,  ii,  70. 
Potash,  i,  228. 
Salicylic  acid,  ii,  145. 
Salol,  camphorated,  ii,  150. 
Serum  treatment,  ii,  185,  186. 
"  "         (Richet    and    Hericourt's 

method),  ii,  185. 
Silica  (for  relief  of  pain),  ii,  191. 
Smith's  paste,  ii,  64. 
Sodium  chlorate,  ii,  206. 

"       phosphate,  ii,  208. 
Steam,  ii,  323. 

Terebene  and  olive  oil,  ii,  371. 
Testicle  juice,  i,  75. 
Toxines,  ii,  318,  315. 
X  rays,  ii,  398. 
Cancer,  larj'ngeal. 
Pormic-acid  compounds,  i,  429. 


INDEX  OF  DISEASES  AND  REMEDIES. 


553 


Cancer,  slongrhin^,  of  the  cerrlx  uteri. 

Terebene  and  olive  oil,  ii,  271. 

Turpentine,  Chian,  locally  and  internally,  ii, 
335. 

Vienna  paste,  i,  338. 
Cancer  or  the  bladder. 

Piohi,  ii,  82. 
Cancer  of  the  breast. 

Calcium  carbide,  ii,  437. 
Cancer  of  the  rectum. 

Belladonna,  i,  175. 
Cancer  of  the  stomach. 

Charcoal,  i,  333. 

Condurango,  i,  397. 

Pepsin,  ii,  69. 

Somatose,  ii,  313. 

Water,  i,  479. 

X  rays,  ii,  398. 
Cancer  of  the  uterus. 

Alcohol  (interstitial  injections),  i,  31. 

Bromine,  i,  195. 

Calcium  carbide,  ii,  426. 

Chromic  acid,  i,  248. 

Salicylic-acid  injections,  ii,  145. 

Sodium  chlorate  (for  palliative  treatment), 
ii,  306. 

Zinc  sulphate,  ii,  407. 
Cancer,  ulcerating. 

Conium  applications,  i,  398. 

Hydrastine,  i,  476. 
Cancrnm  oris. 

Copper-arsenite  solution  (in  form  of  a  spray), 
i,  803. 

Nitric  acid  (fuming),  i,  337. 
Carbuncle. 

Calcium  sulphide,  i,'203. 

Carbolic  acid  (parenchymatous  injections),  i, 
213 

Iodol,'i,  540. 

Permanganates,  ii,  70. 

Salol,  camphorated,  ii,  150. 

Sodium  phosphate,  ii,  208. 

Turpentine  liniment,  ii,  336, 

Vienna  paste,  i,  228. 
Carcinoma. 

See  Cancbe. 
Cardiac  depression. 

Tea,  ii,  265. 
Cardiac  disease. 

See  Heart  disease. 
Cardiac  excitement. 

Bromidia,  i,  195. 
Cardiac  failure. 

Amyl  nitrite,  i.  538. 

Duboisine,  i,  353. 

Ether  (hypodermically),  i,  397. 
Cardiac  feebleness. 

Egg  and  brandy,  i,  355. 
Cardiac  incompetency  from  overstrain. 

Convallaria,  i,  300. 
Cardiac  neuroses. 

Arsenic,  i,  146. 

Zinc  cyanide,  i,  333 ;  ii,  408. 
Cardiac  pain. 

See  Angina  pectoeis. 
Cardiac  tension,  abnormal,  of  renal  dis- 
ease. 

Veratrum  viride,  ii,  853. 
Caries. 

Calcium  chloride,  i,  303, 


Caries. 

Cod-liver  oil,  i,  388. 

Hydrochloric  acid,  ii,  441. 

Hypophosphites,  i,  518. 

Phosphoric  acid,  ii,  77. 

Potassium  permanganate,  i,  597. 

Waters,  chlorinated,  ii,  366. 
Caries,  dental. 

Collodion,  i,  293. 

(in  children),  Calcium  phosphate,  i,  203. 

Creosote  collodion,  i,  293. 

Silver  nitrate,  solid,  i,  136. 
Caruncles  of  the  female  urethra. 

Zinc  sulphate,  ii,  407. 
Caseous  glands. 

See  Glands,  Caseous. 
Catalepsy. 

Amyl  nitrite,  i,  61. 

Earadaism,  i,  366. 

Thyreoid  treatment,  ii,  398. 
Cataract. 

Cineraria,  i,  358. 

Bserine,  i,  392. 

Massage,  i,  610, 
Cataract,  incipient. 

Homatropine,  i,  472. 
Catarrh. 

Air,  condensed,  inspiration  of,  i,  28. 

Alum  (by  irrigation),  i,  50. 

Aluminum  borotannicotartrate,  ii,  414 

Ammonium  hydrosulphide,  i,  57. 

Anthemis  inhalations,  i,  331. 

Arsenic,  i,  146. 

Balsamic  fumes,  i,  259. 

Baths,  condensed-air,  i,  27. 
"       sulphur,  i,  173. 

Bismuth  powder,  i,  181. 

Boric  acid  (saturated  solution),  i,  191. 

Bromine  vapour,  i,  196. 

Cantharides,  i,  346. 

Carbonic-acid  inhalation,  ii,  430, 

Cimicifuga,  i,  250. 

Copaiba,  i,  445. 

Copper-arsenite  solution,  i,  303. 

Goto  bark,  i,  309, 

Cubeb,  i,  319. 

"      cigarettes,  i,  43. 

Eucalyptol,  i,  402. 

Europhene  (by  insufflation),  i,  402. 

Formaldehyde,  i,  438. 

Geosite,  ii,  438. 

Ginger  troches,  i,  449. 

Guaiacol,  i,  457. 

Hydrastis,  i,  475. 

Ipecac,  i,  542. 

Ijicoriee,  i,  580. 

Menthol  solution  (by  injection),  i,  614. 

Nucleins,  ii,  24. 

Orexine  hydrochloride,  ii,  457. 

Oxygenated  water  and  hydrogen-dioxide  so- 
lution (by  inhalation),  ii,  52. 

Pinus  purailio,  oil  of,  ii,  88. 

Pulsatilla,  ii,  107. 

Quinine,  i,  355. 

Salol,  ii,  150. 

Salumine,  ii,  153, 

Sanguinaria,  ii,  154. 

Sesame  oil,  ii,  190. 

Silver  nitrate,  ii,  194. 

Sodium  chloride,  ii,  306. 


554 


INDEX  OP  DISEASES  AND  REMEDIES. 


Catarrh. 

Sodium  sozoiodolate,  ii,  208. 

Solanum  panioulatum,  ii,  210. 

Steam,  i,  418. 

Tannal,  ii,  254. 

Tannalbin,  ii,  254. 

Tanosal,  ii,  261. 

Tartar  emetic,  i,  114. 

Turpentine,  i,  345. 

Water,  i,  479. 

Waters,  alkaline,  i,  45. 

"        mineral,  ii,  375,  384. 
"        sodium  sulphate,  ii,  368. 
"       thermal,  ii,  304. 

Wine,  ii,  394. 
"      port,  ii,  393. 

Xeroform  (internally),  ii,  397. 

Zino  salicylate,  ii,  410. 
"     sulphichthyolate,  ii,  412. 
Catarrh,  acute. 

Ammonium  acetate,  i,  54. 

Baths,  condensed-air,  i,  27. 

Pulsatilla,  ii,  107. 
Catarrh,  acute  nasal. 

Bismuth  powder  (used  as  a  snuff),  i,  181. 

Copper-arsenite  solution  (in  form  of  a  spray), 
i,  303. 

Cubeb,  i,  319. 
Catarrh,  apical. 

Air,  condensed,  inspiration  of,  i,  28. 
Catarrh,  atrophic  pharyngeal. 

Goto  bark,  i,  309. 
Catarrh,  bronchial. 

Apomorphine  (as  an  expectorant),  i,  139. 

Baths,  condensed-air,  i,  37. 

Cimicifuga,  i,  250. 

Cubeb  cigarettes,  i,  430. 

Ipecac,  i,  542. 

Licorice,  i,  580. 

(associated  with  general  asthenia).  Waters, 
chlorinated  (externally  and  internally),  ii, 
366,  867. 

Waters,  sulphuretted,  ii,  371. 
Catarrh,  chronic. 

Ammonium  chloride,  i,  528. 

Copper-arsenite  solution  (in  form  of  a  spray), 
i,  308. 

Dulcamara,  i,  353. 

Myrtol,  i,  652. 

Zinc  sulphichthyolate,  ii,  412. 
Catarrh,  chronic  bronchial. 

lodol  (by  insufflation),  i,  540. 
Catarrh,  chronic  duodenal. 

Waters,  mineral,  ii,  384. 
Catarrh,  chronic  gastric. 

Arsenic,  i,  146. 

Hydrastis,  i,  475. 

Oxygenated  water  and  hydrogen-dioxide  so- 
lution (by  inhalation),  ii,  52. 

Quinine,  i,  255. 

Silver  nitrate,  ii,  194. 
Catarrh,  chronic  gastroduodenal. 

Alkaline  mineral  waters,  i,  45. 
Catarrh,  chronic  intestinal. 

Ammonium  borate,  i,  55. 

Sesame  oil,  ii,  190. 

Tannalbin,  ii,  254. 

Waters,  sodium-sulphate,  ii,  368. 
Catarrh,  chronic  nasal. 

Ammonium  chloride,  i,  528. 


Catarrh,  chronic,  of  the  bladder. 

Pulsatilla,  ii,  107. 
Catarrh,  chronic,  of  the  gastrointestinal 
and  genito-urinary  tracts. 

Guaiacol,  i,  457. 
Catarrh,  chronic,  of  the  middle  ear. 

Massage,  i,  610. 
Catarrh,  chronic,  of  the  rectum. 

Cubeb,  i,  319. 

Menthol  inhalation,  i,  539. 

Ozone  inhalation,  ii,  58. 

Sanguinaria.  ii,  154. 

Waters,  chlorinated  allcaline,  ii,  381. 

■'  "  ",      (externally  and 

internally),  ii,  381. 

Waters,  thermal,  ii,  364. 
Catarrh,  dry,  of  tlie  nose  and  pharynx. 

Salumine  (by  insufflation),  ii,  152. 
Catarrh,  gastric. 

Eucalyptol,  i,  400. 

Hamamelis,  i,  467. 

Nux  vomica,  ii,  28. 

Papain,  ii,  60. 

Salicylic  acid,  ii,  148. 

Sesame  oil,  ii,  190. 

Waters,  chlorinated,  ii,  366. 
"      mineral,  ii,  875. 
Catarrh,  gastro-duodehal. 

Sanguinaria,  ii,  154. 

Sodium  phosphate,  ii,  308. 
Catarrh,  gastro-intestinal. 

Water,  i,  479. 
Catarrh,  hepatic. 

Salol,  ii,  150. 
Catarrh,  intestinal. 

Eucalyptol,  i,  400. 

Grape  cure,  i,  455. 

Oxygenated  water  and  hydrogen-dioxide  so- 
lution (locally  through  the  stomach-tube), 
ii,  53. 

Pulsatilla,  ii,  107. 

Salol,  ii,  150. 

Waters,  mineral,  ii,  375, 

Wine,  ii,  394. 

Xeroform  (internally),  ii,  897. 
Catarrh,  laryngeal. 

Balsamic  fumes,  i,  529. 

Baths,  condensed-air,  i,  27. 
Catarrh,  nasal. 

Boric  acid  (saturated  solution),  i,  191. 

Brcmine  vapour,  i,  196. 

Carbolic-acid  solution  (by  spray),  i,  218. 

Menthol  solution  (by  injection),  i,  614. 

Sodium  chloride  (as  a  gargle),  ii,  306. 
"       sozoiodolate,  ii,  308. 

Zinc  salicylate,  ii,  410. 
Catarrh,  naso-pharyngeal. 

Nucleins.  ii,  34. 
Catarrh  of  the  air-passages. 

Steam,  i,  418. 
Catarrh  of  tlie  bile  ducts. 

Salol,  ii,  150. 

Silver  nitrate,  ii,  194. 

Waters,  mineral,  ii,  384. 
Catarrh  of  the  bladder. 

Solanum  paniculatum,  ii,  210. 

Tannin  injections,  ii,  256. 
Catarrh  of  the  digestive  tract. 

Arsenic,  i,  146. 
Cubeb,  i,  819. 


INDEX  OF  DISEASES  AND  REMEDIES. 


555 


Catarrh  of  the  digestive  tract. 

Buoalyptol,  i,  400. 

G-eosite,  ii,  438. 
'  Guaiaool,  i,  457. 

Hydrastis,  i,  475. 

Orexine  hydrochloride,  ii,  451. 

Oxygenated  water  and  hydrogen-dioxide  so- 
lution (by  inhalation),  ii,  53. 

Quinine,  i,  255. 

Salol,  ii,  150. 

Sanguinaria,  ii,  154. 

Sesame  oil,  ii,- 190. 

Silver  nitrate,  ii,  194. 

Tannalbin,  ii,  254. 

Water,  i,  479. 

Waters,  alkaline,  i,  45. 
"       mineral,  ii,  384. 
"       sodium  sulphate,  ii,  368. 

Wine,  ii,  394. 

Xeroform,  ii,  397. 
Catarrh  of  the  gall  bladder  and  ducts. 

Waters,  sodium-sulphate,  ii,  368. 
Catarrh  of  the  genito-urinary  tract. 

Bismuth,  i,  181. 

Cantharides,  i,  345. 

Formaldehyde,  i,  428. 

Guaiaool,  i,  457. 

Pulsatilla,  ii,  107. 

Solanum  Pulsatilla,  ii,  210. 

Turpentine,  i,  345. 

Waters,  thermal,  ii,  364. 
Catarrh  of  the  respiratory  tract. 

Air,  condensed,  inspiration  of,  i,  28. 

Anthemis  inhalations,  i,  231. 

Apomorphine  (as  au  expectorant),  i,  139. 

Asolepias  tuberosa,  i,  148. 

Balsamic  fumes,  i,  259. 

Baths,  condensed-air,  i,  27. 

Bismuth  powder,  i,  181. 

Boric  acid  (saturated  solution),  i,  191. 

Bromine  vapour,  i,  196. 

Carbonic-acid  inhalation,  ii,  430. 

Ciraioifuga,  i,  250. 

Copper-arsenite  solution,  i,  303. 

Goto  bark,  i,  309. 

Cubeb  cigarettes,  i,  43. 

Ginger  troches,  i,  449. 

Ipecac,  1,  542. 

Licorice,  i,  580. 

Menthol  solution  (by  injection),  i,  614. 

Nucleins,  ii,  24. 

Salumine  (by  insufflation),  ii,  153. 

Sodium  chloride,  ii,  206. 
"       sozoiodolate,  ii,  308. 

Steam,  i,  418. 

Tanosal,  ii,  261. 

Tartar  emetic,  i,  114. 

Waters,  chlorinated,  ii,  366,  367. 

Zinc  salicylate,  ii,  410. 

"    sulphichthyolate,  ii,  412. 
Catarrli  of  the  throat  and  bronchi. 

Tanosal.  ii,  261. 
Catarrh  of  the  throat  and  mouth. 

Ginger,  troches  of,  i,  449. 
Catarrh  of  the  upper  air-passages. 

Anthemis  inhalation,  i,  231. 
Catarrh  of  the  urinary  mucous  membrane. 

Buchu,  i,  197. 
Catarrh  of  the  vagina  and  cervix  uteri. 

Formaldehyde,  i,  428. 

79 


Catarrh  of  the  vagina  and  cervix  uteri. 

lodol,  i,  540. 

Kosinal,  ii,  135. 
Catarrh,  pharyngeal. 

Baths,  condensed-air,  i,  27. 
Catarrh,  pulmonary. 

Balsamic  fumes,  i,  529. 
Catarrh,  respiratory. 

Chamomile,  i,  231. 

Podophyllin,  ii,  93. 
Catarrh,  subacute  intestinal. 

Tannalbin,  ii,  254. 
Catarrh,  subacute  nasal. 

Baths,  condensed-air,  i,  27. 
Catarrh,  uterine. 

Douche,  hot,  i,  480. 

Grindelia,  i,  456. 

Rosinal,  ii,  135. 
Catarrh,  vaginal. 

Formaldehyde,  i,  428. 

lodol,  i,  540. 

Rosinal,  ii,  185. 
Catarrh,  vesical. 

See  Catarrh  or  the  bladder. 
Catatonia. 

Thyreoid  treatment,- ii,  299. 
Cellulitis,  pelvic. 

Arnica,  fluid  extract  of  (internally),  i,  141. 

Baths,  hot  sitz,  i,  169. 

Electricity,  i,  368. 

Glycerin  suppositories,  ii,  450. 

Heat,  i,  468. 

Ice  applications,  i,  530. 

Ichthyol,  i,  528. 
Cephalalgia. 

See  Headache. 
Cerebral  affections. 

Bloodletting,  i,  188. 

Cathartics,  i,  234. 

Colooynth  (as  a  revulsive),  i,  296. 

Blaterium,  as    a    revulsive    and   depleting 
agent,  i,  858. 

Electricity,  i,  366. 

Gavage,  i,  436. 

Salicylated  camphor,  i,  204, 

Trional,  ii,  332. 

Urethane,  ii,  342. 
Cerebral  excitement. 

Cold  plunge,  i,  488. 
Cerebr.il  exhaustion. 

Damiana,  i,  824. 
Cerebral  exhaustion  from  overwork. 

Bromides,  ii,  6. 
Cerebral  irritation  from  drink. 

Veratrum  viride,  ii,  353. 
Chancres. 

Alumnol,  i,  51. 

Calcium  salicylate,  ii,  145. 

Bnrophene    (in    powder   or    ointment),    i, 
402. 

Hydrogen  dioxide,  i,  503. 

Iodoform  collodion,  i,  393. 

Nosophene,  ii,  19. 

Pixol,  ii,  93. 

Pyrogallic  acid,  ii.  111. 

Sanoform,  ii,  154,  360. 

Silver  nitrate,  ii,  196. 
"     oxide,  ii,  197. 

Sulphuric  acid  and  asbestos,  ii,  341. 
"  "      "    charcoal,  ii,  243. 


556 


INDEX  OF  DISEASES  AND  REMEDIES. 


Chancres. 

Sulphuric  acid  and  saffron,  ii,  242. 

Traumatol,  ii,  329. 
Chancroids. 

Alumnol,  i,  51. 

Carbolic  acid  (parenchymatous  injections),  i. 
313. 

Europhene  (in  powder  or  ointment),  i,  402. 

Hydrogen  dioxide,  i,  503. 

Iodoform  collodion,  i,  293. 

lodol,  i,  540. 

Mentho-phenol,  ii,  61. 

Nitric  acid,  ii,  7. 

Resorcin,  ii,  126. 

Silica,  hydrated,  ii,  191. 

Silver  nitrate,  ii,  196. 
"     oxide,  ii,  197. 

Xeroform,  ii,  897. 
Chapped  and  Assured  hands  and  lips. 

Benzoin  and  glycerin,  i,  178. 
Chilblains. 
Aconite,  i,  9. 

Alum  curd  (cataplasm),  i,  5a. 
Baths,  cold  foot,  i,  170. 
Capsicum  paper,  i,  209. 
Cocaine  collodion,  i,  292. 
Creosote,  i,  314. 
Iodine,  i,  536. 
Petroleum,  ii,  70. 
Phulluah,  ii,  79. 
Resorcin  and  ichthyol,  ii,  126. 
Chills,  malarial. 

See  Fever,  Malarial. 
Chills,  urethral. 
Quinine,  ii,  117. 
Strophanthus,  ii,  232. 
Chloasma. 

Iodine,  i,  536. 
Chlorosis. 
Air,  condensed,  inspiration  of,  i,  28. 
Arsenic,  i,  145. 

"        (as  an  emmenagogue),  i,  374. 
Baths,  sulphur,  i,  173. 

"       condensed-air,  i,  28. 
Champagne,  ii,  393. 
Cold  douche,  i,  491. 
Copper  arsenite,  i,  303. 
Creolin,  i,  313. 
Perratin,  i,  422. 
Galbanum  (internally),  i,  433. 
Geosite,  ii,  438. 
Glycerophosphates,  ii,  439. 
Gold,  i,  454. 
HEemalbumin,  i,  463. 
Hydrochloric  acid,  i,  493. 
Iron  (as  an  emmenagogue),  i,  374. 

"     albuminate,  i,  553. 

"     carbonate,  i,  547. 

"     chloride  (ethereal  tincture),  i,  548. 

"     iodide,  i,  551. 

"     lactate,  i,  551. 

"     tannate,  ii,  259. 

"     valerianate,  ii,  346,  848. 
Manganese  (as  an  emmenagogue),  i,  374. 

"         and  iron,  i,  596. 
Ovarine,  ii,  451. 
Oxygen,  ii,  52. 
Peptomangan,  ii,  69,  70, 
Somatose,  ii,  212. 
Strophanthus,  ii,  333. 


Chlorosis. 

Strychnine,  with  iron  and  quinine,  ii,  38. 
Sulphur,  ii,  240. 

Transfusion  and  infusion,  ii,  322. 
Trefusia,  ii,  329. 
Waters,  ferruginous,  ii,  369. 
Wines,  ii,  394. 
Zincohsemol,  ii,  412. 
Chlorosis,  progressive. 
Arsenic,  i,  145. 
Wines,  ii,  394. 
Cholsemla. 

Transfusion,  depletory,  ii,  333. 
Cholera. 
Acids,  mineral,  i,  6. 
Baths,  hot,  i,  160. 

(algid  state).  Baths,  mustard,  i,  173. 
Calomel,  i,  634. 
Camphor,  i,  306. 
Cantani's  treatment,  ii,  257. 
Carbolic  acid,  i,  212. 
(algid  state).  Chloral  hydrate  (hypodermical- 

ly),  i,  237. 
Copper  arsenite  (enema),  i,  304. 
Goto  bark  (injections),  i,  307. 
Creolin,  i,  313. 
Creosote,  i,  314. 
Eucalyptol,  i,  400. 
(algid  state),  Heat,  i,  468. 

"      dry,  ii,  235. 
Infusion,  intravenous  or  subcutaneous,  ii, 

324,  325. 
Naphthol,  ii,  2. 
Opium,  ii,  36. 
Paraform,  ii,  61. 
Quinine,  ii,  119. 
Saligenin,  ii,  147. 
Serum,  artificial,  ii,  164. 

"      treatment,  i,  83 ;  ii,  187. 
Sulphuric  acid,  ii,  242. 
Sumbul,  ii,  243. 

Tannin  (Cantani's  treatment),  ii,  257. 
Transfusion,  ii,  323. 
Cholera,  collapse  from. 

Opium,  ii,  36. 
Cholera,  hog. 

Serum  treatment,  ii,  188. 
Cholera  Infantum. 
Baths,  hot  mustard,  i,  490. 
Bismuth  phosphate,  ii,  436. 
"       salicylate,  ii,  145. 
Bromides,  i,  194. 
Bromol,  i,  197. 

Carbolic  acid  and  bismuth,  i,  212. 
Castor  oil,  i,  220. 
Chalk,  i,  230. 
Copper  arsenite,  i,  303,  305. 

"  "  (enema),  i,  304. 

Creosote,  i,  314. 
Muscarine,  i,  645. 
Paraform,  ii,  61. 
Serum,  cow's  (subcutaneous  injections),  ii, 

163. 
Silver  nitrate,  ii,  194. 
Sodium  salicylate,  ii,  146. 
Zinc  sulphocarbolate,  ii,  411, 
Cholera  morbus. 
Camphor,  oil  of,  i,  205. 
Carbolic  acid  and  bismuth,  i,  213, 
Copper  arsenite,  i,  303,  305. 


INDEX  OP  DISEASES  AND  REMEDIES. 


557 


Cholera  morbus. 

Copper  arsenite  (enema),  i,  304. 

Creosote,  i,  314. 

Zinc  sulphocarbolate,  ii,  411. 
Cholerine. 

Camphor,  i,  205. 
Chordee. 

Cold  sitz  baths,  i,  489. 

Gallobromol  (by  injection),  i,  433. 

Humulus,  i,  474. 

Ice,  applications  of,  i,  90. 

Veratrum  viride,  i,  90. 
Chorea. 

Acetanilide,  i,  4. 

Ammonium  carbonate,  i,  56. 

Antipyrine,  i.  124. 

Arsenic,  i,  145. 

Baths,  allcaline,  i,  171. 

Cerium  oxalate,  i,  229. 

Chloralamide,  i,  238. 

Chloral  hydrate,  i,  237. 

Chloralose,  i,  239. 

(of  uterine  trouble),  Cimicifuga,  i,  250. 

(of  rheumatic  taint),  Cimicifuga,  i,  250. 

Cod-liver  oil,  i,  288. 

Cold  affusions,  i,  17. 

Conium,  i,  298. 

Copper,  ammoniated,  i,  303. 

Curare,  i,  321. 

Eserine,  1,  892. 

Bxalgine,  i,  403. 

Paradaism,  i,  366. 

Gallobromol,  i,  433. 

Gelsemium,  i,  437. 

Gold  bromide,  i,  454. 

Heat,  i,  468. 

Iron  bromide,  i,  553. 

Lobelia,  i,  587. 

Orchitio  liquid,  i,  75. 

Picrotoxin,  ii,  84. 

Pisoidia,  ii,  91. 

Quinine,  ii,  120. 

Rest-cure,  ii,  127. 

Solanum  earolinense,  ii,  209. 

Spermine,  ii,  317. 

Strychnine,  ii,  28. 

Sulphonal,  ii,  239. 

Tartar  emetic,  i,  113. 

Testicle  juice,  i,  75. 

Trional,  ii,  333. 

Valerian,  ii,  345. 

Warm  pack,  i,  469. 

Waters,  ferruginous,  ii,  369. 

Wines,  ii,  894. 

Zinc  cyanide,  i,  323. 
"     iodide  (internally),  ii,  405. 
"     salts,  ii,  401. 
Chorea,  acute. 

Wines,  ii.  394. 
Chorea,  hysterical. 

Chloralose,  i,  239. 
Chylnria. 

Thymol  and  gallic  acid,  ii,  283. 
Cicatrices. 

Thiosinamine,  ii,  280,  281. 
Circulation,  engorgement  of  the  hepatic 
and  portal. 

Alkaline  mineral  waters,  i,  45. 
Circulation,  irregularities  of. 

Convallaria,  i,  300. 


Cirrhosis. 

Potassium  iodide,  ii,  98. 
Cirrhosis  of  the  liver. 

Alkaline  mineral  waters,  i,  45. 

Arsenic,  i,  146. 

Carlsbad  salts,  i,  224. 

Copaiba,  i,  303. 

Iodoform,  i,  537. 

Nitric  acid,  ii,  8. 

Waters,  sodium-sulphate,  ii,  368. 
Coecygodynia. 

Galvanization,  stabile  anodal,  i,  366. 
Coeliac  disease  (in  children). 

Bismuth  (in  large  doses),  i,  181. 
Colds. 

See  CoEYZA. 
Colic. 

Alcohol,  i.  33. 

Alum,  i,  50. 

Ammonia  water,  i,  54. 

Ammonium  borate,  i,  55. 

Amyl  valerianate,  i,  63. 

Anhalonium  Lewinii,  ii,  416. 

Antacids,  i,  86. 

Blisters,  small  flying  (to  the  abdomen),  i, 
186. 

Cajeput,  i,  301. 

Camphor,  i,  205. 

oil  of,  i,  205. 

Capsicum,  i,  209. 

Chamomile  poultice,  i,  281. 

Chloroform,  i,  345. 

Cinnamon,  i,  359. 

Codeine,  i,  386. 

Corn  silk,  i,  306. 

Ether  (internally),  i,  397. 

Glycerin,  i,  451. 

Linseed  tea,  ii,  269. 

Mustard  applications,  i,  312. 

Nitroglycerin,  ii,  15. 

Nutmeg,  ii.  25. 

Peppermint  infusion,  i,  613. 

Pichi,  ii,  82. 

Piperazine,  ii,  89. 

Sassafras,  ii,  156. 

Stupes,    hot,    with    oil    of    turpentine,    ii, 
233 

Sulphur,  ii,  240. 

Tribulus  lanuginosus,  ii,  330. 

Zinc  cyanide,  i,  328. 
Colic,  biliary. 

Chloroform  inhalation,  i,  345. 

Electricity,  i,  586. 

Glycerin,  i,  451. 

Nitroglycerin,  ii,  15. 

Olive  oil,  ii,  35. 

Solanum  paniculatum,  ii,  210. 

Sulphur,  ii,  340. 

Vichy  water,  ii,  358. 

Water,  i,  586. 
Colic,  Hatulent. 

Calamus,  i,  301. 

Capsicum,  i,  309. 

Chamomile,  i,  381. 

Sassafras,  ii,  156. 
Colic,  lead.  Colic,  painter's. 

Alum,  i,  50. 

Olive  oil,  ii,  Sn. 

Potassium  iodide,  ii,  98. 

Tobacco-smoke  enema,  ii,  304.. 


558 


INDEX  OF  DISEASES  AND   REMEDIES. 


Colic,  renal. 

Amyl  valerianate,  i,  G2. 

Chloroform  inhalation,  i,  245. 

Corn  silk,  i,  306. 

Linseed  tea,  ii,  269. 

Nitroglycerin,  ii,  15. 

Pichi,  ii,  82. 

Piperazine,  ii.  89. 
Colic,  saturnine. 

See  CJoLic,  Lead. 
Colic,  spasmodic. 

Alcohol,  i,  33. 

Waters,  Buflfalo  lithia,  ii,  372. 
Colitis. 

Bismuth  injections,  i,  181. 
Colitis,  chronic  catarrhal. 

Balsams,  i,  160. 
Colitis,  septic. 

Irrigation  of  the  rectum  and  colon,  i,  554. 
Collapse. 

Acetic  ether,  i,  5. 

Ammonia  (intravenously),  i,  53  ;  ii,  227. 

Atropine  (hypodermioally),  i,  156. 

Blisters,  i,  186. 

Camphorated  oil  (hypodermioally),  ii,  6. 

Capsicum  tincture,  i,  209. 

Champagne,  ii,  393. 

Ether  (subcutaneously),  i,  397. 

Heat,  application  of,  i,  468. 

Oxygen,  ii,  52. 

Strophanthus,  ii,  231. 
Collapse  from  cholera. 

Opium,  ii,  36. 
Collapse  of  fevers. 

Champagne,  ii.  393. 
Colpitis,  ulcerative. 

Cupric-sulphate  solution,  i,  306. 
Coma. 

Blisters,  1,  186. 

Cold  affusions,  i,  17. 

Oxygen,  ii,  52. 
Coma  of  typhus  fever. 

Opium  treatment  of,  ii,  128. 

Valerian,  ii,  345. 
Condylomata. 

Aeetic  acid,  i,  5. 

Chromic  acid,  i,  248. 

Europhene,  in  powder  or  ointment,  i,  403. 

Nitric  acid,  ii,  7. 

"     (fuming),  i,  227. 

Salicylic  acid  and  (glacial)  acetic  acid,  i,  225. 
Congestion  (hepatic  or  splenic). 

Baths,  hot-air,  i,  168. 

Elaterium,   as    a    revulsive    and   depleting 
agent,  i,  358. 
Congfestion,  acute. 

Hunyadi  Janos,  i,  474. 
Congestion,  acute  abdominal. 

Poultices,  ii,  101. 
Congestion,  acute  cerebral. 

Bloodletting,  i,  188. 
Congestion,  cephalic. 

Baths,  cold  foot,  i,  170. 
Congestion,  cerebral. 

See  Cerebral  affections. 
Congestion,  chronic. 

Taraxacum,  ii,  265. 
Congestion,   chronic,  of  the   Intestines, 
liver,  and  pelvic  organs. 

Hunyadi  Jinos,  i,  474. 


Congestion  from  cold, 
.    Jaborandi,  i,  559. 
Congestion,  hep.atic. 

Ammonium  chloride,  i,  56. 

Hepatic  douches,  i,  349. 

"Waters,  alkaline  carbonated,  ii,  375. 

"        chlorinated  (externally   and    inter- 
nally), ii,  365. 

Waters,  sulphuretted,  ii,  371. 
Congestion,  intracranial. 

Cupping  applied  to  the  nape  of  the  neck,  i, 
320. 
Congestion,  local. 

Scarification,  ii,  158. 
Congestion,  malarial,  of  the  liver. 

(Jamboge  and  calomel,  i,  433. 
Congestion,  mammary. 

Collodion  (applied  to  the  whole  breast),  i, 
294. 
Congestion  of  the  abdominal  viscera. 

Baths,  mustard,  i,  172. 
Congestion  of  the  kidneys. 

Digitalis,  i,  342. 

Strophanthus,  ii,  231. 
Congestion  of  the  lungs. 

Digitalis,  i,  342.^ 

Strophanthus,  ii,  231. 
Congestion  of  the  spinal  cord. 

Ergot,  i,  388. 
Congestion,  passive. 

Convallaria,  i,  300. 
Congestion,  passive  uterine. 

Baths,  i,  169. 
Cong:estion,  portal. 

Chionanthus  virginica,  i,  234. 

Jalap,  i,  560. 

Podophyllin,  ii,  93. 
Congestion,  prostatic. 

Rectal  douches,  i,  349. 
Congestion,  pulmonary. 

Air.  condensed,  inspiration  of,  i,  28. 

Baths,  cold  foot,  i,  170. 

Convallaria,  1,  300. 
Congestion,  renal. 

Corn  silk,  i,  306. 

Poultices,  ii,  102. 

Waters,  chlorinated  alkaline  (externally  and 
internally),  ii,  381. 
Congestion,"superflcial. 

Ice  (topically),  i,  519. 
Congestion,  uterine. 

Arsenic,  i,  146. 

Glycerin  suppositories,  i,  450. 
Congestion,  venous,  of  mitral  and  tricus- 
pid disease. 

Digitalis  (as  a  diuretic),  ii,  228. 
Conjunctivitis. 

Antipyonine  (weak  solutions),  i,  120. 

Argoriin,  ii,  197. 

Bismuth  tannate,  ii,  259. 

Borax  (5-per-cent.  solution),  1,  189. 

Boric  acid,  i,  191. 

Calomel  insufflation,  i,  556. 

Cod-liver  oil,  i,  288. 

Collodion,  i,  294. 

Copper  arsenite,  i,  305. 

Cupric  acetate  applications,  i.  303. 

sulphate  solution  (locally),  i,  306. 

Ethyl  chloride,  ii,  424. 

Formaldehyde,  i,  428. 


INDEX  OP  DISEASES  AND  REMEDIES. 


559 


ConjnnctiTitis. 

Gallicin,  i,  433. 

Hydrastine,  i,  476. 

Leeching,  i,  579. 

Mercury  oxide,  i,  623. 

Phytolacca,  ii,  81. 

Pilocarpine,  ii,  96. 

Pulsatilla,  ii,  107. 

Pyoctanine,  ii,  108. 

Scarification,  ii,  158. 

Silver  nitrate,  ii,  195. 

Suprarenal  capsule,  ii,  247. 

Thioform,  ii,  378. 

Zinc  acetate  (as  a  local  astringent),  ii,  403. 
"     oxide  (as  a  collyrium),  ii,  406. 
"     tannate,  ii,  412. 
Conjunctivitis,  acute. 

Copper  arsenite,  i,  305. 

Mercury  oxide  (ointment),  1,  633. 
Conjunctivitis,  aphtlious. 

Collodion,  i,  394. 
Conjunctivitis,  catarrlial. 

Argonin,  ii,  197. 
Conjunctivitis,  clironic. 

Zinc-chloride  applications,  ii,  405. 

Zinc  iodide  (as  a  collyrium),  ii,  405. 
Conjunctivitis,  diplitheritic. 

Zinc-chloride  applications  (with  caution),  ii, 
405. 
Conjunctivitis,  gonorrlioeal. 

Zinc-chloride  applications  (with  caution),  ii, 
405. 
Conjunctivitis,  granular. 

Copper,  aluminated,  applications,  i,  303. 

Hydrastine,  i,  476. 

Phytolacca,  ii,  81. 
Conjunctivitis,  phlyctscnular. 

Calomel  (by  insufflation),  i,  556. 
Conjunctivitis,  purulent. 

Antipyonine  (strong  solution),  i,  130. 

Argonin,  ii,  197. 

Silver  nitrate,  ii,  195. 
Conjunctivitis,  scrofulous,  of  childreu. 

Zinc-oxide  applications,  ii,  406. 
Conjunctivitis,  subacute. 

Copper  arsenite,  i,  305. 
Constipation. 

Aloes,  i,  48. 

Asatoetida,  i,  147. 

Baths,  coldj  i,  169. 

Cannabis  indica,  i,  207. 

Castor  oil,  i,  220. 

Cathartinic  acid,  i,  235. 

Cetrarin,  i,  230. 

Colocynth.  i,  296. 

Cream,  i,  222. 

Croton  oil,  i,  318. 

Electricity  applied  to  the  abdomen,  i,  368. 

Ephedra,  i,  385. 

Frangula,  i,  429. 

Glycerin  injections,  i,  450. 

Hunyadi  JAnos,  i,  474. 

Ichthyol,  ii,  443. 

Juglans,  i,  568. 

Leptandra,  i,  580. 

Licorice,  compound  powdered,  i,  581. 

Lobelia,  i,  587. 

Nux  vomica,  ii,  38. 

Oatmeal,  ii.  31. 

Olive  oil,  ii,  35. 


Constipation. 

Ox-gall,  ii,  49. 

Podophyllin,  ii,  93. 

Rhaninus  purshiana,  ii,  129. 

Rhubarb,  ii,  130. 

Rye,  ii,  137. 

Seammony,  ii,  157. 

Seidlitz  powders,  ii,  161. 

Senna,  ii,  163. 

Sesame  oil,  ii,  190. 

Sodium  sulphite,  ii.  208. 

Splenic  extract,  ii,  218. 

Sulphur  and  cream  of  tartar,  ii,  241. 

Taraxacum,  ii,  265. 

Water,  i,  333,  479. 

Waters,  chlorinated  (externally  and  inter- 
nally), ii,  365. 

Waters,  mineral,  ii,  376. 
Constipation,  chronic. 

Hunyadi  Janos,  i,  474. 

Nux  vomica  (extract),  ii,  28. 

Oatraeal,  ii,  31. 

Ox-bile,  ii,  49. 

Rhamnus  purshiana,  ii,  129. 

Rye,  ii,  137. 

Sesame  oil,  ii,  190. 

Sulphur  and  cream  of  tartar,  ii,  241. 

Waters,  mineral,  ii,  379. 

"        simple  thermal  (internally),  ii,  364. 
Constipation,  obstinate. 

Baths,  cold,  i,  169. 

Croton  oil,  i,  318. 

Ichthyol,  ii,  443. 

Seammony,  ii,  157. 
Consumption. 

See  TuBERcnLOSis.  Pulmonary. 
Contractions,  uterine,  Induction  of. 

Faradaism,  i,  366. 

Mammary  irritation,  ii,  56. 
Contusions. 

Alcohol,  i.  29. 

Collodion,  saturnine,  i,  393. 
Convalescence. 

Canella,  i.  306. 

Chamomile,  i,  231. 

Guarana,  i,  46l. 
Convalescence  from  fevers, 

Nutrose,  ii,  449. 
Convalescence  of  acute  disease. 

Kumyss,  i,  567. 
Convalescence  of  prolonged  disease. 

Wines,  ii,  325. 
Convalescence,  tardy. 

Ergot  and  sodium  phosphate,  i,  389. 
Convulsions. 

Ammonium  succinate,  1,  58. 

Amyl  nitrite,  i,  528. 

Baths,  hot,  i.  166. 

(of  adults),  Bloodletting,  i,  188. 

Chloral  hydrate,  i,  237. 

Chloroform  inhalation,  i,  245. 

Curare,  i,  331. 

Lobelia,  i,  587. 

(of  dentition),  Sulphonal,  ii,  389. 

Valerian,  ii,  345. 
Convulsions,  infantile. 

Amber,  oil  of  (applied  to  the  spine),  i,  58. 

Chloral  hydrate,  i,  237. 

Ether  (subcutaneously),  i,  897. 

Tribromhydrin,  ii,  330. 


560 


INDEX  OF  DISEASES  AND  REMEDIES. 


Convulsions,  infantile. 

Water  applied  to  the  head,  i,  349. 

Wines,  ii,  394. 
Convulsions  of  epilepsy. 

Chloral  hydrate,  i,  237. 
Convulsions,  puerperal. 

Bloodletting,  i,  188. 

Chloral  hydrate,  i,  237. 

Chloroform,  i,  528. 

Croton  oil,  i,  318. 

Paraldehyde,  ii,  62. 

Transfusion,  depletory,  ii,  323. 
Convulsions,  nrsemic. 

Amyl  nitrite,  i,  528. 

Chloroform,  i,  528. 

Morphine,  ii,  37. 

Warm  bath,  i,  166. 
Convulsive  diseases. 

Bromal  hydrate,  i,  191. 
Corneal  opacities. 

Calomel  (by  insufflation),  i,  556. 

Thiosinamine,  ii,  280,  381. 
Corns. 

Acetic  acid,  i,  5. 

Chelidonium,  i,  233. 

Collodion,  salieylie-acid  and  zino-chloride,  i, 
293. 

Copper  oleate,  i,  305. 

Potassium  bichromate,  ii,  95. 

Salicylic  acid,  ii,  143. 

Silver  nitrate,  ii,  457. 

Sodium  ethylate,  ii,  207. 

Tannic-acid  ointment,  ii,  257. 
Corpulence. 

See  Obesity. 
Coryza. 

Aconite,  i,  8. 

Ammonium-chloride  inhalations,  i,  57. 

Arsenic,  i.  146. 

Boric  acid,  i,  191. 

Camphor  (internally  and  by  inhalation),  i, 
205.  539. 

Carbonic-acid  inhalation,  ii,  430. 

Castor  oil,  i,  220. 

Chamomile,  i,  231. 

Chloroform,  i,  528. 

Glycerin  and  carbolic  acid,  i,  450. 

Horehound,  i,  473. 

Iodoform  inhalation,  i,  540. 

Magnolia,  i,  592. 

Quinine,  ii,  119. 

Salicylic  acid,  ii,  143. 

Sodium  bicarbonate,  ii,  205. 

Tannigene,  ii,  260. 

Tannin,  ii,  256. 

Waters,  chlorinated  alkaline,  ii,  381. 

Zinc  oleostearate  with  camphor  and  menthol, 
ii,  409. 
Coryza,  acute. 

Carbonic-acid  inhalation,  ii,  430. 

Chloroform,  i,  528. 

Cubeb  cigarettes,  i,  430. 

Glycerin  and  carbolic  acid,  i,  450. 

Quinine  (as  a  spray),  ii,  119. 

Salicin,  ii,  140. 

Silver  nitrate,  ii,  195. 

Tannigene,  ii,  360. 
Coryza,  chronic. 

Tannigene,  ii,  360. 

Tannin,  ii,  356. 


Coryza,  infantile. 

Ammonium  acetate,  i,  54. 
Coryza  of  liay  fever. 

Boric  acid  (saturated  solution),  i,  191. 
Coryza  of  influenza. 

Chloroform,  i,  528. 
Cough. 

Anhalonium  Lewinii,  ii,  416. 

Benzene,  i,  176. 

Bromides,  i,  194. 

Butyl  chloral  hydrate,  i,  197. 

Cajupnt,  ii,  426. 

Cannabis  indica,  i,  207. 

Catechu  lozenges,  i,  221. 

Cerium  oxalate,  i,  239. 

Codeine,  i.  286. 

Conium  vapour,  i,  299. 

Grindelia,  i,  456. 

Hydrobromic  acid,  i,  493. 

Linseed  tea,  ii,  369. 

Lobelia,  i,  587. 

Meconarceine.  i,  611. 

Muscarine,  i,  645. 

Nux  vomica,  ii,  28. 

Opium,  fumes  of,  i,  539. 

Phellandriura,  ii,  71. 

Prunus  virginiana.  ii,  105. 

Pulsatilla,  ii,  108. 

Stramonium,  ii,  329. 

Stupes,  hot,  to  the  front  of  the  neck,  ii,  333. 

Terebene,  ii,  271. 
Cough  and  pain  of  acute  pulmonary  and 
pleuritic  diseases. 

Dry  cupping  applied  to  the  back  and  chest, 
i,  320. 
Con^h,  bronchial. 

Lobelia,  i,  587. 
Cough,  broncho-pulmonary. 

Meconarceine,  i,  611. 
Cough,  convulsive. 

Stramonium,  ii,  229. 
Cough,  irritable. 

Codeine,  i,  286. 

Conium,  vapour  inhalations,  i,  399. 

Pulsatilla,  ii,  108. 
Cough,  nervous. 

Anhalonium  Lewinii,  ii,  416. 

Codeine,  i,  386. 

Hydrobromic  acid,  i,  493. 

Niix  vomica,  ii,  38. 

Valerian,  ii,  345. 
Cough,  reflex. 

Bromides,  i,  194. 

Chamomile  oil,  i,  331. 
Congh,  spasmodic. 

Grindelia,  i,  456. 

Muscarine,  i,  645. 
Cough,  tickling. 

Catechu  lozenges,  i,  331. 
Cough,  whooping-. 

See  Whooping-cough. 
Cough,  winter. 

Benzene,  i,  176. 
Cough,  winter,  of  bronchitis. 

Terebene,  ii,  271. 

See  also  Coeyza. 
Cramp,  abdominal. 

Strychnine,  ii,  28. 
Cramp,  pianist's. 

Paradaism  and  galvanism,  i,  367. 


INDEX  OP  DISEASES  AND  REMEDIES. 


561 


Cranip,  pianist's. 

Massage,  i,  608. 
Cramp,  telegrapher's. 

Massage,  i,  60^. 
Cramp,  writer's. 

Electricity,  i,  365. 

Massage,  i,  608. 
Crarjps,  muscular. 

Sulphonal,  ii,  231). 
Cretinism. 

Thyreoid  treatment,  i,  79 ;  ii,  290. 
Croup. 

Aconite,  i,  8. 

Alum  (by  insufflation  or  irrigation),  i,  50. 

Calomel  fumigation,  i,  625. 

Copper-arsenite  inhalation  (or  in  form  of  a 
spray),  i,  304. 

Ipecac,  i,  418. 

Lactic  acid,  i,  567. 

Menthol  inhalation,  i,  529. 

Mercurial  fumigation,  i,  430. 

Oxygen,  ii,  52. 

Pilocarpine,  ii,  85, 

Squill,  ii,  221. 

Steam,  i,  538. 

Storax,  ii,  228. 

Sulphur  powder  (by  insuf&ation),  ii,  241. 
Croup,  membranous. 

Ipecac,  i,  543. 

Steam,  i,  528. 

Storax,  ii,  328. 

Zinc  sulphate  (as  an  emetic),  ii,  407. 
Croup,  spasmodic. 

Belladonna,  i,  175. 

Ipecac,  i,  373. 

Lobelia,  i,  587. 
Crusta  lactea. 

Viola  tricolor,  ii,  360. 
Curvature,  lateral,  of  the  spine. 

Exercise,  i,  416. 

Massage,  i,  610. 
Cystic  irritation. 

Piperazine,  ii,  89. 
Cystinuria. 

Ammonium  carbonate,  i,  56. 
Cystitis. 

Alkalies,  i,  44. 

Alphol,  i,  49. 

Antipyrine  (as  a  local  anodyne),  i,  134. 

Baths,  hot,  i,  166. 

Benzoic  acid  and  the  benzoates,  i,  177. 

Beta-naphthol  salicylate,  ii,  145. 

Betol,  i,  179. 

Boric  acid,  i,  190. 

Buchu,  i,  197. 

Camphor  irrigations  of  the  bladder,  i,  205. 

Calcium  iodate  irrigations,  i,  201. 

Cantharides.  i,  208. 

Copper  arsenite,  i,  304. 

Corn  silk,  i,  306. 

Cubeb,  i,  319. 

Formaldehyde,  i,  428. 

Glycerin  and  carbolic-acid  applications,  i, 
450. 

Grindelia,  i,  456. 

Iodine,  i,  536. 

Kava,  i.  564. 

Linseed  tea,  ii,  269. 

Matico,  i,  611. 

Methylene  blue,  i,  630. 


Cystitis. 

Naphthalene,  ii,  1. 

Nitric  acid,  ii,  7. 

Pareira,  ii,  63. 

Pichi,  ii,  83. 

Pix  liquida,  ii,  93. 

Pyoctanine,  ii,  108. 

Quinine  injections,  ii,  130. 

Salol,  ii,  150. 

Sodium  bicarbonate,  ii,  366. 

Sozal,  ii,  215. 

Sulphur,  ii,  240. 

Terpin  hydrate,  ii,  373. 

Triticum,  ii,  333. 

Turpentine  oil,  ii,  336. 

Urotropine,  ii,  343. 

Uva  ursi,  ii,  343. 

Waters,  Buffalo  lithia,  ii,  873. 
"      mineral,  ii,  374,  377. 
Cystitis,  ammoniacal. 

Beta-naphthol  salicylate,  ii,  145. 

Boric  acid,  i,  190. 

Formaldehyde,  i,  438. 
Cystitis,  chronic. 

Glycerin  and  carbonic-acid  applications,  i, 
450. 

Grindelia,  i,  456. 

Iodine,  externally,  i,  536. 

Methylene  blue,  i,  630. 

Pareira,  ii,  63. 

Pix  liquida,  ii,  93. 

Silver  citrate,  ii,  198. 
"      nitrate,  ii,  196. 

Terpin  hydrate,  ii,  373. 

Uva  ursi,  ii,  343. 

Waters,  mineral,  ii,  377. 
Cystitis,  gonorrlioeal. 

Alphol,  i,  49. 

Cantharides,  i,  208. 
Cystitis,  prostato-,  following  gonorrhoea. 

Pichi,  ii,  83. 
Cystitis,  purulent. 

Formaldehyde,  i,  428. 
Cystitis,  tuberculous. 

Formaldehyde,  i,  428. 
Cystitis,  without  decomposition. 

Alkalies,  i,  44. 
Cystocele. 

Tannin  tampons,  ii,  256. 
Cystorrhcea. 

Cubeb,  i,  318. 
Cysts. 

Silver  nitrate  (injections),  ii,  196. 
Cysts,  hydatid. 

Iodine  (injections),  i,  536. 
Cysts,  ovarian. 

Iodine  injections,  i,  536. 

Dacryocystitis. 

Pyoctanine,  ii,  108. 

Silver  nitrate  (injections),  ii,  195. 
DandrnfT. 

Egg  and  limewater,  i,  356. 
Deafness. 

Baths,  condensed-air,  i,  27. 

Hyaenanchin,  i,  474. 

Massage  of  the  ear,  i,  610. 
Deafness,  catarrhal. 

Baths,  condensed-air,  i,  27. 

Pulsatilla,  ii,  107. 


563 


INDEX  OP  DISEASES  AND  REMEDIES. 


Deafness  from  qninine. 

Ergot,  i,  389. 
Deafness  from  salicylic  acid. 

Ergot,  i,  389. 
Debility. 
Alcohol,  i,  31. 
Baths,  mud,  i,  172. 
Calcium  phosphate,  ii,  78. 
Cashew  nut,  i,  319. 
Champagne,  ii,  393. 
Cold  plunge,  i,  481. 
Placourtia,  i,  422. 
Guarana,  1,  461. 
Hygiama,  ii,  442. 
Iron  sulphate,  i,  549. 
Niicleins,  ii,  24. 
Orohitic  liquid,  i,  76. 
Quinine,  i,  254. 
Splenic  extract,  ii,  218. 
Stimulants,  spinal,  ii,  226. 
Sumbul,  ii,  243. 
Testicle  juice,  i,  76. 
Waters,  mineral,  ii,  384. 
Wine,  Burgundy,  ii,  394. 
"       Hungarian  (red),  ii,  394. 
"      port,  ii,  393. 
"      sherry,  ii,  393. 
Debility,  cerebral. 

Iron  phosphates,  i,  551. 
Debility,  general. 
Cashew  nut,  i,  219. 
Placourtia,  i,  423. 
,       Nucleins,  ii,  34. 

Stimulants,  spinal,  ii,  826. 
(of  dyspepsia).  Wines,  Burgundy  or  red  Hun- 
garian, ii,  394. 
Debility  of  old  age. 
Champagne,  ii,  393. 
Debility  of  the  young. 

Calcium  phosphate,  ii,  78. 
Debility,  senile. 

Wine,  sherry,  ii,  393. 
Debility,  sexual. 

See  Impotence. 
Debility  with  nervous  symptoms. 

Sanguinal,  ii,  154. 
Decomposition,  ammoniacal,  of  the  urine. 

Boric  acid,  i,  190. 
Deflciencjr  of  hydrochloric  acid    in  the 
gastric  juice. 
Sodium  bicarbonate,  ii,  204. 
Deficiency  of  lime  and  phosphorus. 

Calcium  phosphate,  i,  203. 
Deformities,  nail. 
Salicylic  acid,  ii,  145. 
Thyreoid  treatment,  ii,  393. 
Delirium  (due  to  biliousness). 
Ammonium  acetate,  i,  54. 
Anhaloniura  Lewinii,  ii,  416. 
Antipyrine,  i,  133. 
Morphine,  ii,  37. 
Trional,  i,  509. 
Delirium  of  alcoholism. 
See  Delirium  tremens. 
Delirium  of  fever. 
Bath,  half,  i,  169. 
Chloral  hydrate,  i,  236. 
Delirium  of  nervous  exhaustion  of  acute 
fever. 
Morphine,  ii,  37. 


Delirium,  sthenic  noisy. 

Tartar  emetic  and  opium,  i,  114. 
Delirium  tremens. 
Ammonium  chloride,  ii,  415. 
"  succinate,  i,  58. 

(early  stages),  Bromides,  i,  194. 
Camphor,  i,  305. 
Capsicum,  i,  309. 
Chloral  hydrate,  i,  337. 
(tremors),  Cimicifuga,  i,  250. 
Cold  bath,  i,  488. 

"    plunge,  i,  488. 
Coniine,  i,  299. 
Digitalis,  i,  343. 
Humulus,  i,  474. 

(early  stages).  Paraldehyde,  ii,  07. 
Strychnine,  ii,  7. 
Sulphonal,  ii,  239. 
Sumbul,  ii,  7,  243. 
Urethane.  ii,  343. 
Delirium  with  depression. 

Valerian,  ii,  345. 
Dementia,  primary. 

Thyreoid  treatment,  ii,  291. 
Dementia,  secondary. 

Thyreoid  treatment,  ii,  391. 
Depression,  mental. 

1  aradization,  general,  i,  366. 
Depression,  mental  and  pliysical. 

Spinal  stimulants,  ii,  226. 
Depression,  sudden  nervous. 

Musk,  ii,  6. 
Depression,  simple. 

Cocaine,  i,  283. 
Dermatitis. 
Bismuth  subnitrate  (as  a  dusting  powder),  i, 

Pisol,  ii,  92. 
Dermatitis,  acute. 

Laurel,  i,  571. 
Dermatitis,  erythematous. 

Atropine,  i,  156. 
Dermatitis  exfoliativa. 

Thyreoid  feeding  (dry  powder),  i,  79. 
Dermatitis  venenata. 

Zinc  sulphate,  ii,  408. 
Desquamative  eruptions. 

Salicylic- acid  applications,  ii,  144. 
Diabetes. 

Alkaline  mineral  waters,  i,  45. 

Alum  whey,  i,  50. 

Ammonium  hydrosulphide,  i,  57. 

Arsenic,  i,  145. 

Baths,  hot-air,  i,  168. 

Codeine,  i,  386. 

Conium,  i,  399. 

Creosote,  i,  314. 

Dulcin,  i,  353. 

Ergot,  i,  389. 

Gluten  bread,  i,  449. 

Iodoform,  i,  537. 

Iron  valerianate,  i,  552. 

Jaborandi,  i,  559. 

Jambul,  i,  561. 

Lactic  acid,  i,  567. 

Lajvulose  (as  a  sweetening  agent),  ii.  445. 

Milk,  i,  636.  o    b      „    , 

Muscarine,  i,  645. 

Naphthalan,  ii,  448. 

Oxygen,  ii,  57. 


INDEX  OP  DISEASES  AND  REMEDIES. 


563 


Diabetes. 

Ozone,  ii,  58. 

Pancreatic  extract,  i,  80, 

Peanut  meal,  ii,  418. 

Phosphoric  acid,  ii,  77. 

Picric  acid,  ii,  453. 

Piperazine,  ii,  89. 

Potassinm  permanganate,  i,  596. 

Saccharin,  ii,  138. 

Sodium  bicarbonate,  ii,  204. 
"        sozoiodolate,  ii,  208. 

Soja  hispida,  ii,  209. 

Spermine,  ii,  217. 

Strontium  bromide,  ii,  239. 

Sulphonal,  ii,  239. 

Thymol,  ii,  288. 

Uranium  nitra,te,  ii,  838. 

Vichy  water,  ii,  358. 

Waters,  Buffalo  lithia,  ii,  372. 
"        saline,  ii.  3G8. 

Wet  pack,  i,  490. 

Yeast,  ii,  400. 

Zinc  sulphoiehthyolate,  ii,  412. 
Diabetes,  hepatic. 

Alkaline  mineral  waters,  i,  45. 

Carbolic  acid,  i,  212. 
Diabetes  insipidus. 

Ergot  (hypodermically),  i,  389. 

Iron  valerianate,  i,  552. 

Jaborandi,  i,  559. 

Muscarine,  i,  645. 
Diabetes  mellitus. 

Codeine,  i,  286. 

Gluten  bread  as  a  food,  i,  449. 

Morphine,  ii,  37. 

Picric  acid,  ii,  453. 

Saccharin,  ii,  138. 

Uranium  nitrate,  ii,  338. 

Waters,  Buffalo  lithia,  ii,  372. 
Diabetes,  pancreatic. 

Pancreatic  extract,  i,  80. 
Diarrlioea. 

Alkalies,  i,  44. 

Alum  (in  pills),  i,  50. 

Arsenic,  i,  146. 

Barium  sulphocarbolate,  i,  163, 

Bismuth,  i,  180. 

"         tannate,  ii,  259., 

Bitters,  i,  183. 

Boric  acid,  i,  190. 

(of  children).  Calcium  salicylate,  ii,  145. 

Calomel,  i,  634. 

Camphor  salicylate,  ii,  450. 

Carbolic  acid  and  bismuth,  i,  212. 

Castanea  leaves,  i,  219. 

Castor  oil,  i,  220. 

Cerium  oxalate,  i,  329. 

Cetraria,  i,  230. 

Chalk,  i,  330. 

Charcoal,  i,  233. 
.   Chloroform,  i,  341. 

Cinnamon,  i,  359. 

Copper  arsenite  (minute  doses),  i,  303. 

Coto  bark,  i,  309. 

Creolin,  i.  313. 

Creosote,  i,  814. 

Cnpric  sulphate,  i,  306. 

Diet,  i.  336. 

Ephedra,  i,  385. 

Erigeron,  oil  of,  i,  390, 


Diarrlioea. 

Placourtia,  i,  432. 

Flour  gruel,  i,  433. 

Galls,  i,  433. 

Geranium,  i,  438. 

Gnaphalium,  i,  451. 

Grape  cure,  i,  455. 

HEBmatoxylon,  i,  464. 

Humulus,  i,  474. 

Ichthyol,  ii,  443. 

Iodine  enema,  i,  536. 

Ipecac,  i,  543. 

Iron  nitrate,  i,  551. 

Irrigation,  i,  554. 

Kino,  i,  565. 

Krameria,  i,  566. 

Lactic  acid,  i,  567. 

Laurel,  i,  571. 

Lead  acetate  and  opium,  i,  577. 

Licorice  and  flaxseed,  i,  581. 

Linseed,  infusion  of,  i,  584. 

Magnesia  and  rhubarb,  i,  591. 

Matico,  i,  611. 

Menthol,  i,  614. 

Mercury,  i,  619. 

"  with  chalk,  i,  623. 

Morphine  (small  doses),  ii,  38. 
Moss,  Irish,  i,  347. 
Mustard  plaster  (applied  to  the  abdomen), 

i,  647. 
Naphthalene,  ii,  1. 
Naphthol,  ii,  3. 
Nitric  acid,  ii,  8. 
(due  to  atony  of  the  bowels),  Nux  vomica, 

ii,  38. 
Oak  bark,  ii,  31. 
Opium,  ii,  36. 

Peppermint  poultice,  i,  613. 
Paregoric,  ii,  68. 
Pepsin  and  bismuth,  ii,  69. 
Physostigmine  salicylate,  ii,  146. 
Picric  acid,  ii,  483. 
Quinine,  i,  355. 
Rhubarb,  ii,  130. 
Rubus,  ii,  136. 
Salaoetol,  ii,  189. 
Salol,  ii,  150. 
Sandal-wood  oil,  ii,  153. 
(of  dentition),  Sea  air,  ii,  275. 
Serum,  cow's,  ii.  168. 
Sesame  oil,  ii,  190. 
Silver  nitrate,  ii,  197. 

"      oxide,  ii,  197. 
Sodium  bicarbonate,  ii.  204. 

"       earbolate  (as  an  intestinal  antiseptic), 

ii,  306. 
Sodium  phosphate,  ii,  79. 
"       salicylate,  ii,  146. 
Sulphuric  acid,  ii,  342. 
Sumbul,  ii,  243. 
Tannalbin,  ii,  254. 
Tannigene,  ii.  260. 
Tannin,  ii,  257. 
Tannoform,  ii,  260. 
Toast  water,  i,  351. 
Tolu  balsam,  ii,  309. 
Ulmus,  ii,  337. 

Viburnum  prunifolium.  ii,  357. 
(late  stages),  Uva  ursi,  ii,  343. 
Waters,  mineral,  ii,  374,  379. 


664 


INDEX  OF  DISEASES  AND  REMEDIES. 


Diarrhoea. 

Zinc  acetate,  ii,  403. 
"     sulphate,  ii,  407. 
"     tannate,  ii,  412. 

Zincohasmol,  ii,  412. 
Diarrhoea,  acid. 

Antacids,  i,  86. 
Diarrhoea,  acid  (of  children). 

Sodium  bicarbonate,  ii,  204. 
Diarrhoea,  acute. 

Bismuth,  i,  180. 

Diet,  i,  336. 
Diarrlioea,  atonic. 

Laurel,  i,  571. 

Rubus,  ii,  136. 
Diarrhoea,  clioleraic. 

Charcoal,  i,  233. 

Salacetol,  ii,  139. 
Diarrhoea,  chronic. 

Baths,  cold,  i,  169. 

Bismuth,  i,  180. 

Camphor  salicylate,  ii,  455. 

Cerium  oxalate,  i,  229. 

Diet,  i.  336. 

Galls,  i,  433. 

Grape  cure,  i,  455. 

Iodine,  enema  of,  i,  536. 

Iron  nitrate,  i,  551. 

Picric  acid,  ii,  433. 

Tannigene,  ii,  260. 

Tannin,  ii,  257. 

Tolu  balsam,  ii,  309. 

Waters,  mineral,  ii,  374,  379. 
Diarrhoea,  colicliy. 

Viburnum  prunifolium,  ii,  357. 
Diarrhoea,  colliquative. 

Barium  sulphocarbolate,  i,  163. 

Nitric  acid,  ii,  8. 
Diarrlioea  from  undigested  food. 

Castor  oil,  i,  324. 
Diarrhoea,  infantile. 

Baked  flour  (as  a  food),  i,  423. 

Calomel,  i,  634. 

Creolin,  i,  313. 

Irrigation  of  the  rectum  and  colon,  i,  554. 

Toast  water,  i,  351. 
Diarrhoea,  infectious. 

Betol,  i.  179. 
Diarrhoea,  lienteric. 

Creosote,  i,  314. 

Pepsin,  ii,  69. 
Diarrhoea  of  phthisis. 

Sesame  oil,  ii,  190. 
Diarrhoea  of  typhoid  ferer. 

Alum  whey,  i,  50. 

Ilydroohloric  acid,  i,  493. 

Opium,  ii,  36. 
Diarrhoea,  putrid, 

Picric  acid,  ii,  453. 
Diari'hoea,  subacute. 

Rhubarb,  ii,  130. 

Tannigene,  ii,  257. 
Diarrhoea,  summer. 

Benzonaphthol  and  bismuth  salicylate,  ii,  3. 

Bismuth,  i,  180. 

Irrigation  of  the  stomach,  i,  491. 

Nitric  acid,  ii,  8. 

Salol,  ii,  150. 

Serum,  cow's,  intravenous  injections,  ii,  163. 

Tannigene,  ii,  260. 


Diarrhoea,  summer. 

Xeroform  (internally),  ii,  397. 
Zinc  oxide,  ii.  406. 
Diarrhoea  with  intestinal  catarrh. 

Calcium  salts,  ii,  372. 
Dilatation  of  the  stomach. 

Electricity,  i,  368. 

Lavage,  i,  491,  573. 

Massage,  abdominal,  i,  608. 

Naphthol,  ii,  2. 

Papain,  ii,  60. 
Dilatation  of  the  heart. 

See  under  Heart. 
Diphtlieria. 

Alum  (by  insufflation),  i,  50. 

Antidiphtherine,  i,  107. 

Benzene,  i,  176. 

Benzoic  acid,  i,  178. 

Bromal,  i,  197. 

Calomel  powder  (by  insufflation),  i,  635. 
"        fumigation,  i,  530. 

Capsicum  and  hot  water  (as  a  gargle),  i,  309. 

Chlorine  water,  1,  240. 

Cold  baths,  i,  488. 

Copper-arsenite  inhalation  (or  in  form  of  a 
spray),  i,  804. 

Creosote,  i,  314. 

Cubeb,  i,  319. 

Eucalyptol  inhalation,  i,  539. 

Gavage,  i,  436. 

Hydrogen  dioxide,  i,  503. 

Iron  chloride  (tincture),  i,  548. 

Jaborandi,  i,  559. 

Lactic  acid,  i,  567. 

Lime,  inhalation  of  the  vapour  of,  i,  583. 

Menthol  inhalations,  i,  529. 

Mercuric  cyanide,  i,  333. 

Mercury  bichloride  (in  spray),  i,  636 ;  ii,  321. 

Myrrh,  tincture  of,  i,  653. 

Nosophene,  ii,  19. 

Nucleins,  ii,  33,  35. 

Oxygen,  ii,  53. 

Ozone,  i,  445. 

"        inhalation,  ii,  58. 

Papain,  ii,  60. 

Pepsin  in  solution  (by  spray),  ii,  69. 

Peroxide  of  hydrogen,  ii,  331. 

Pilocarpine,  ii,  85. 

Potassium  chlorate,  ii.  96. 

"  permanganate,  i,  596  ;  ii,  70. 

"  "  (as  a  gargle),  i,  597. 

Pyootanine,  ii,  108. 

Quinine,  ii,  119. 

Resorcin  (topically),  ii,  136. 

Salicin,  ii,  140. 

Serum  treatment,  i,  83  ;  ii,  170,  171. 

Steam,  i,  330.  538. 

Steresol,  ii,  233. 

Storax,  ii,  228. 

Sulphur  powder  (by  insufflation),  ii,  341. 

Trypsin  (as  a  solvent  for  diphtheritic  mem- 
brane), ii,  334. 

Zinc  chloride  applications,  ii,  405. 
Diphtheria,  laryngeal. 

Calomel  fumigation,  i,  530. 

Mercurial  fumigation,  i,  430,  530. 

Steam  spray,  ii,  330, 
Diphtheria,  nasal. 
Myrrh,  i,  683. 

Nosophene,  ii,  19. 


INDEX  OP  DISEASES  AND  REMEDIES. 


565 


Dipsomania. 

See  Alcohol  habit. 
Bistichiasis. 

Collodion,  i,  294. 
Dizziness. 

See  Vertigo. 
Dropsy. 

Alkaline  carbonates,  i,  45. 

Aspiration,  i,  153. 

Baths,  hot,  i,  489. 

Caffeine,  i,  201. 

Cahinca,  i,  301. 

Chimaphila,  i,  234. 

Convallaria,  i,  300. 

Croton  oil,  i,  318. 

Digitalis,  i,  342. 
.  Dulcamara,  i,  353. 

Elaterin,  i,  357. 

Gold,  i,  451,  453. 

Horseradish,  i,  473. 

Hunyadi  Janos,  i,  474. 

Iodine  injections,  i,  536. 

Jaborandi,  i,  559. 

Jalap,  i,  560. 

Juniper,  i,  563. 

Kava,  i,  564. 

Ligusticum,  i,  581. 

Nitrohydrochloric  acid,  ii,  16. 

Potassium  salts,  i,  345. 

tartrates,  ii,  100. 

Salines,  ii,  147. 

Scamraony,  ii,  157. 

Scarification,  ii,  158. 

Soillain  (subcutaneously),  ii,  158. 

Squill,  ii,  321. 

Sodio-theobromine  salicylate,  ii,  203. 

Strophanthus,  ii,  331. 

Theobromine,  ii,  377. 

Ulexine,  ii,  337. 
Dropsy,  cardiac. 

Squill,  ii,  321. 

Strophanthus,  ii,  231. 

Theobromine,  ii,  377. 

Ulexine,  ii,  337. 
Dropsy,  due  to  acute  nephritis. 

Potassium  tartrates,  ii,  100. 
Dropsy,  hepatic. 

Alkaline  carbonates,  i,  45. 

Nitrohydrochloric  acid,  ii,  16. 
Dropsy  of  the  joints. 

Iodine  injection,  i,  536. 
Dropsy,  renal. 

Digitalis,  i,  342. 

Potassium  salts,  i,  345. 
Dropsy,  splenic. 

Alkaline  carbonates,  i,  45. 
Dropsy,  subcutaneous. 

Scarification,  ii,  158. 
Drowning. 

Heat,  i,  469. 

Stimulants,  heart,  ii,  226. 

Tongue  traction,  i,  64. 
Drunkenness. 

Treatment  of,  i,  34. 
Dysentery. 

Alum  (in  pills),  i,  50. 

Arsenic,  i.  146. 

Baths,  hot,  i,  166. 

Benzoiiaphthol,  ii,  426. 

(with  tenesmus),  Bismuth  injections,  i,  181. 


Dysentery. 

Calomel,  i,  624. 

Calotropis,  i,  308, 

Camphor  salicylate,  ii,  455. 

Carbonic-acid  gas,  i,  314. 

Castor  oil,  i,  221, 

Charcoal,  i,  333. 

Chirata,  i,  234. 

Cinnamon,  i,  259, 

Copper  arsenite,  i,  305. 

"  "        (niinute  doses),  i,  303. 

Creosote,  i,  314. 

Cupric  sulphate  (by  the  mouth  or  by  ene- 
mata),  i,  306. 

Cvdonium,  i,  323, 

Ergot,  i,  388. 

Erigeron,  oil  of,  i,  390. 

Flour  gruel,  i,  423. 

Geranium,  i,  438. 

Glycerin  enema,  i,  451. 

Gnaphalium,  i,  451, 

Iodine,  enema  of,  i,  536. 

Iodoform,  i,  537. 

Ipecac,  i,  543. 

Irrigation  of  the  rectum  and  colon,  i,  491. 

Krameria,  i,  566. 

Lead,  compound  suppositories,  i,  577. 

Linseed,  infusion  of,  i,  584 ;  ii,  369. 

Lysol  injections,  i,  690. 

(early  stages).  Magnesium  sulphate,  i,  593. 

Matico,  i,  611. 

Morphine,  ii,  38. 

Moss,  Irish,  i,  247, 

Naphthalene,  ii,  1. 

Naphthol,  ii,  2. 

Nitrohydrochloric  acid,  ii,  16. 

Papain,  ii,  60. 

Physostigmine  salicylate,  ii,  146. 

Quinine,  i,  355. 

Salioylic-aoid  enema,  ii,  148. 

Saligenin,  ii,  147. 

Silver  nitrate,  ii,  194. 

Sodium  nitrate,  ii,  307. 

Strychnine,  ii,  28. 

Sumbul,  ii,  243, 

Tannigene,  ii,  360. 

Tannoform.  ii,  260. 

Trichlorphenol,  ii,  330. 

Tylophora,  ii.  337. 

Ulmus,  ii,  337. 

Viburnum  prunifolium,  ii,  357. 

Water  (rectal  applications),  i,  479. 

Zinc  sulphate,  ii,  407. 
Dysentery,  acute. 

Cinnamon,  i,  259. 

Glycerin  enema,  i,  451. 

Ipecac,  i,  543. 

Irrigation  of  the  rectum  and  colon,  i,  491. 

Silver  nitrate,  ii,  194. 

Water  (rectal  applications),  i,  479. 
Dysentery,  amoebic. 

Methylene  blue,  i,  630. 

Quinine  injections,  rectal,  ii,  120. 
"       rectal  irrigation  with,  i,  254. 
Dysentery,  chronic. 

Baths,  cold,  i,  169. 

Camphor  salicylate,  ii,  455. 

Carbonic-acid  gas,  i,  214. 

Iodoform,  i,  537. 

Ipecac,  i,  542. 


566 


INDEX  OP  DISEASES  AND  REMEDIES. 


Dysentery,  chronic. 

Water  (rectal  applications),  i,  479. 
Dysentery,  epidemic. 

Charcoal,  i,  232. 
Dysidrosis. 

Salicylic  acid,  ii,  144. 
Dysmenorrhcea. 

Aconite,  i,  9. 

Amyl  valerianate,  i,  62. 

Anemonin,  i,  70. 

Antipyrine,  i,  124. 

Apiol,  i,  137. 

Arnica,  fluid  extract  of  (small  doses),  i,  141. 

Baths,  cold,  i,  169. 
"       hot,  i,  166. 
"       hot  hip,  i,  375. 

Belladonna  and  morphine,  i,  67. 

Butyl  chloral  hydrate,  i,  197. 

Cajeput,  i,  201. 

Camphor,  i,  205. 

Canella,  i,  206. 

Cannabis  indica,  i,  207. 

Cimioifuga,  i,  250. 

Croton  oil  (applications  to  the  abdomen),  i, 
318. 

Clipping  (applied  to  the  thighs),  i,  375. 

Douches,  hot  vaginal,  i,  375. 

Gelseminm,  i,  437. 

Gin,  i,  449. 

Glycerin  suppositories,  i,  450. 

Oxalic  acid,  ii,  49. 

Peppermint,  infusion  of,  i,  613. 

Pisoidia,  ii,  91. 

Pulsatilla,  ii,  107. 

Salix,  ii,  149. 

Senecin,  ii,  161. 

Senecio,  ii,  162,  456. 

Silver  Iodide,  ii,  197. 
"      oxide,  ii,  197. 

Sodium  salicylate,  ii,  146. 

Splenic  extract,  ii,  218. 

Stvpticin,  ii,  233. 

Trional,  ii,  383. 

Viburnum  prunifolium,  ii,  356,  357. 

Waters,  Buffalo  lithia,  ii,  372. 
"        mineral,  ii,  383. 

Zinc  cyanide,  ii,  408. 
Dysnienorrhoea,  congestiye. 

Aconite,  i,  9. 

Arnica,  fluid  extract  of  (in  small  doses),  i, 
141. 

Canella,  i,  206. 
Dysmenorrhoia,  nervous. 

Antipyrine,  i,  124. 
Dysmenorrlioea,  spasmodic. 

Amyl  valerianate,  i,  62. 

Belladonna  and  moi'phine,  i,  67. 

Pisoidia,  ii,  91. 
Dysmenorrlioea,  virginal. 

Viburnum  prunifolium,  ii,  357. 

(with  menorrhagia).  Viburnum  prunifolium, 
ii,  356. 
Dyspepsia. 

Acids,  mineral,  i,  6. 

Alcohol,  i,  33. 

Alkalies,  i,  44. 

Alkaline  waters,  i,  45. 

Ammonium  carbonate,  i,  55. 

Antizymotics,  1,  135. 

Apone,  1,  139. 


Dyspepsia. 

Asalcetida,  i,  147. 

Bitters,  i,  188. 

Charcoal,  i.  232. 

Chirata,  i,  234. 

Cinnamon,  i,  259. 

Cubeb,  i,  319. 

Prigotherapy,  i,  429. 

Glycerin  (internally),  i,  451. 

Horseradish,  i,  473. 

Humulus,  i,  473. 

Hunyadi  Janos  water,  i,  474. 

Hydrochloric  acid,  i,  492. 

Lactic  acid,  i,  567. 

Leptandra  (as  a  tonic),  i,  580. 

LycopodiuiQ,  i,  590. 

Lysol,  i,  590. 

(with  constipation).  Mustard  and  molasses, 

i,  646. 
Pepsin,  ii,  69. 
Ptvalin.  ii,  106. 
Pulsatilla,  ii.  107. 
Quinine,  i,  254. 
Rhubarb,  ii,  130. 
Saccharin,  ii,  138. 
Salvia,  ii,  152. 

Sarracenia  purpurea,  ii,  156. 
Spermine,  ii,  217. 
Strontium  lactate,  ii,  230. 
(with    hyperacidity).    Waters,    alkaline,    ii, 

866. 
Waters,  alkaline  carbonated,  ii,  375. 
Buffalo  lithia,  ii,  372. 
mineral,  ii,  376,  379,  384. 
Yolk  of  egg  and  tincture  of  ginger,  i,  355. 
Zinc  sulphate,  ii,  407. 
"     tannate,  ii,  412. 
Dyspepsia,  acid. 
Chirata,  i,  234. 
Hydrochloric  acid,  i,  498. 
Limewater,  i,  582. 
Potash,  ii,  94. 
Dyspepsia,  acute. 
Lavage,  i,  572. 
Tartar  emetic,  i,  114. 
Dyspepsia,  amylaceous. 

Taka-diastase,  ii,  254. 
Dyspepsia,  atonic. 
Alcohol,  i,  33. 

Alkalies  (before  eating),  i,  44. 
Alkaline  mineral  waters,  i,  45. 
Ammonium  carbonate,  i,  55. 
Bitters,  i,  183. 
Calamus,  i,  201.' 
Capsicum,  i,  209. 
Cubeb,  i,  319. 
Horseradish,  i,  478. 
Lactic  acid,  i,  567. 
Lumbar  douches,  i,  349. 
I'epsin,  ii,  69. 
Quinine,  i,  254. 
Rhubarb,  ii,  130. 
Salvia,  ii,  152. 

Sarracenia  purpurea,  ii,  156. 
Tannin,  ii,  257. 
Taraxacum,  ii,  265. 
Dyspepsia,  biliary. 

Wmes,  white,  ii.  394. 
Dyspepsia,  chronic. 
Solanum  panioulatum,  ii,  210. 


INDEX  OF  DISEASES  AND  HEMEDIES. 


567 


Dyspepsia,  fermentative. 

Asaprol,  i,  148. 

Dermatol,  i,  329. 

Sulphurous  acid,  ii,  243. 
Dyspepsia,  Hatulent. 

Canella,  i,  206. 

Carbolic  acid,  1,  313. 

Nux  vomica,  ii,  28. 

Strontium  salicylate,  ii,  147,  230. 
Dyspepsia,  functional. 

Diet,  i,  335. 

Massage,  general,  i,  608. 
Dyspepsia,  gastric. 

Waters,  alkaline  sulphuretted,  ii,  368. 
"       mineral,  ii,  374. 
Dyspepsia,  hepatic. 

Waters,  mineral,  ii,  375. 
Dyspepsia,  intestinal. 

Aloes,  i,  48. 

Arsenic,  i,  146. 

Creosote,  i,  814. 

Flour,  boiled,  i,  423. 

Gamboge,  i,  438. 

Mercury,  i,  619. 

Ox-bile,  ii.  49. 

Sodium  phosphate,  ii,  79. 
Dyspepsia,  irritable. 

Silver  oxide,  ii,  197. 
Dyspepsia,  nervous. 

Damiana,  i,  324. 

Faradaism,  i,  366. 

Gold  chloride,  i,  454. 

Menthol,  i,  614. 

Oxygen,  ii,  53. 
Dyspepsia  of  hard  drinkers. 

Capsicum,  i,  208. 
Dyspepsia,  with  acid  ernctations. 

Charcoal  and  bismuth,  i,  232. 
Dyspepsia  with  phosphatie  urine. 

Nitric  acid,  ii,  8. 
Dyspnoea. 

Air,  condensed,  inspiration  into,  i,  38.  . 

Amyl-nitrite  inhalation,  i,  61. 

Arsenic,  i,  146. 

Cajuput,  ii,  426. 

Cupping,  dry,  i,  330. 

Digitalis,  i,  842. 

Ethyl-iodide  inhalation,  i,  538. 

Grindelia,  i,  456. 

Morphine,  ii,  37. 

Nitroglycerin,  ii,  10. 

Oxygen  inhalation,  ii,  226. 

Potassium  cobaltonitrite,  i,  373. 

Quebracho,  ii,  112. 

Strophanthus,  ii,  331. 

Strychnine,  ii,  38. 

Thymus  extract,  ii,  385. 

Tribulus  lannginosus,  ii,  330. 
Dyspnoea,  cardiac. 

Amyl-nitrite  inhalation,  i,  61. 

Dry  cupping,  i,  330. 

Nitroglycerin,  ii,  15. 

Oxygen  inhalation,  ii,  326. 

Strophanthus,  ii,  281. 
Dyspnoea  of  asthma. 

Amyl  nitrite,  i,  61. 
Dyspnoea  of  phthisis. 

Menthol  solution  (by  injections),  i,  615. 
Dyspnoea,  pulmonary. 

Oxygen  inhalation,  ii,  226. 


Dyspnoea,  pulmonary. 

Strychnine,  ii,  38. 
Dyspnoea,  spasmodic. 

Ethyl  iodide  inhalation,  i,  538. 
Dyspnoea,  ursemic. 

Amyl  nitrite,  i,  61. 

Morphine,  ii,  87. 
Dystocia. 

Quinine,  ii,  55,  116. 

Thyreoid  treatment,  to  check  the  growth  of 
the  foetus,  ii,  399. 
Dystrophies,  muscular. 

Muscle  extract,  i,  81, 
Dysuria. 

Ammonium  hydrosulphide,'  i,  57. 

Cantharides,  i,  308. 

Conium,  i,  398. 

Earache. 

Chamomile  fomentations,  i,  331. 

Chloroform  vapour,  i,  533. 

Cloves,  oil  of,  i,  273. 

Delphinine,  ii,  321. 

Ether,  as  a  spray,  i,  897. 

Hop  poultice,  i,  474. 

Leeching,  i,  578. 

Pulsatilla,  ii,  107. 
Echinococcus,  hepatic. 

Aspiration,  i,  151. 
Eclampsia,  puerperal. 

See  Convulsions,  Puekperal. 
Ecthyma. 

Cod-liver  oil  and  iron,  i,  388. 

Cupric-sulphate  solution,  i,  306. 
Ectropion. 

Thiosinamine,  ii,  281. 
Eczema. 

Alumnol  applications,.!,  51. 

Arsenic,  i,  144. 

Barium  chloride,  i,  163. 

Benzene,  i,  176. 

Benzoin  (compound  tincture),  i,  179. 

Bran,  i,  191. 

Calomel  ointment,  i,  635. 

Camphor  powder  (with  starch),  or  ointment, 
i,  204. 

Can-on  oil,  i,  583. 

Cashew  nut  (topically),  i,  219. 

Chalk  powder,  i,  230. 

Chrysarobin,  i,  116. 

Cod-liver  oil,  i,  388. 

Creosote,  i,  314. 

Dermatol,  i,  839. 

Gallanilide,  i,  433. 

Gelanthum,  ii,  349. 

Gelsemiura,  i,  437. 

Ichthyol,  i,  522. 

Iron,  i,  547. 

Lead-oxide  ointment,  i,  578. 

Limewater  as  a  lotion,  i,  583. 

Losophan,  i,  589. 

Lysol,  i,  590. 

Mercury  nitrate  (ointment),  i,  628,  628. 

Nosophene,  ii,  19. 

Nuoleins,  ii,  24. 

Phosphorus,  ii,  77. 

Phytolacca,  ii,  81. 

Picric  acid,  ii,  83. 

Potassium  permanganate,  i,  596. 

Pulsatilla,  ii,  107. 


568 


IKDBX  OF  DISEASES  AND  REMEDIES. 


Eczema. 

Pyrogallic  acid,  ii,  111. 

Eesoroin,  ii,  126. 

Salicylic-acid  ointment,  ii,  143,  144. 

Silver  nitrate,  ii,  196. 

Soap,  green,  ii,  300. 

Steam,  ii,  322. 

Sulphur  fumes,  i,  4.30 ;  ii,  341. 

Talc  powder,  ii,  354. 

Tannin,  ii,  356. 

Tar,  ii,  93,  363. 

Tartarlithine,  ii,  265. 

Thiol  ointment,  ii,  278. 

Thymol,  ii,  384. 

Thyreoid  treatment,  ii,  393. 

Traumatol,  ii,  335. 

(itching  of),  Tumenol  tincture,  ii,  334. 

Tumenol  siilphonic  acid,  ii,  334. 

Turpentine  liniment,  ii,  335. 

Viola  tricolor,  ii,  360. 

Waters,  Buffalo  lithia,  ii,  373. 

Xeroform,  ii,  396. 

Zinc  oxide,  ii,  406. 
"     sulphate,  ii,  408. 

"    sulphichthyolate    (as   a    liniment),    ii, 
413. 
Eczema,  acute. 

Gallobvomol  (by  a  compress),  i,  433. 

Laurel,  i,  571. 

Picric  acid,  ii,  452. 
Eczema,  acute  dry. 

Rye  flour,  ii,  137. 
Eczema,  chronic. 

Calomel  ointment,  i,  625. 

Cod-liver  oil,  i,  288. 

Creosote,  i,  314. 

Gallanilide,  i,  433. 

Iron,  reduced,  i,  547. 

Naphthalan,  ii,  448. 

Nucleins,  ii,  34. 

Phosphorus,  ii,  77. 

Phytolacca,  ii,  81. 

Steam,  ii,  322. 

Thyreoid  feeding,  i,  79. 

Zinc  sulphydrate,  ii,  413. 
Eczema,  dry. 

Barium  chloride,  i,  163. 

Gelanthum  (Unna's  treatment),  ii,  349. 
Eczema,  erythematous. 

Salicylic-acid  ointment,  ii,  144. 
Eczema  impetiginodes. 

Xeroform,  ii,  397. 
Eczema  madidans. 

Xeroform,  ii,  397. 
Eczema  marginatum. 

Ichthyol,  i,  532. 

Pyrogallic  acid,  ii,  111. 
Eczema,  nervous. 

Ichthyol,  i,  533. 
Eczema  of  the  anus  and  genitals. 

Lead  liniment,  i,  577. 
Eczema  of  the  external  auditory  canal. 

Silver  nitrate,  ii,  195. 

Zinc  sulphocarbolate,  ii,  413. 
Eczema  of  the  eyelids. 

Silver  nitrate,  ii,  195. 
Eczema  of  the  hand  (in  very  dry  skin). 

Gelanthum  (Unna's  treatment),  ii,  349. 
Eczema  of  the  hands,  knees,  and  face. 

Tumenol-sulphonic  acid,  ii,  334. 


Eczema  of  the  lids. 

Mercury  oxide  (ointment),  i,  623. 
Eczema  of  the  nostrils. 

Myrrh,  i,  653. 
Eczema,  old. 

Ichthyol,  i,  533. 
Eczema,  papular. 

Salicylic  acid,  ii,  144. 
Eczema,  parasitic. 

Ichthyol,  i,  532. 
Eczema,  pustular. 

Salicylic-acid  ointment,  ii,  144. 
Eczema  rubrum. 

Salicylic-acid  ointment,  ii,  144. 
Eczema  rubrum  of  the  leg. 

Soap,  green,  ii,  200. 
Eczema  seborrhoicum. 

Chrysarobin,  i,  116. 

Ichthyol,  i,  116. 

Mercury  bichloride,  i,  116. 

Resorcin,  i,  116. 

Sulphur,  i,  116. 
Eczema,  squamous. 

Salicylic  acid,  ii,  144. 
Eczema,  traumatic  weeping. 

Nosophene,  ii,  19. 
Eczema,  vesicular. 

Salicylic-acid  ointment,  ii,  144. 
Effusion,  serous. 

Sodio-theobromine  salicylate,  ii,  303. 
Elephantiasis. 

Ichthyol,  i,  533. 
Elytritis. 

Bismuth,  i,  181. 

Boric  acid,  i,  180. 

Grindelia,  i,  456. 

Ichthyol,  i,  523. 

Kava,  i,  564. 

Tannin  and  alum  douche,  ii,  356. 
"       injections,  ii,  356. 

Vaginal  douches,  i,  349. 
Elytritis,  acute. 

Ichthyol,  i,  533. 
Elytritis,  gonorrhoeal. 

Tannin  and  alum  douche,  ii,  356. 
"       injections,  ii,  356. 
Emissions  (involuntary),  seminal. 

See  Spermatobehcea. 
Emphysema. 

Apomorphine,  i,  139. 

Arsenic,  i,  146. 

Baths,  condensed-air,  i,  37. 

Convallaria,  i,  300. 

Expiration  into  rarefied  air,  i,  28. 

Ipecac,  i,  543. 

Iron  chloride,  i,  548. 

Ozone  inhalation,  ii,  58. 

Quebracho,  ii,  112. 

Quillaia,  ii,  118. 

Terebene,  ii,  371. 
Emphysema,  pulmonary. 

Apomorphine,  i,  139. 

Arsenic,  i,  146. 

Baths,  condensed-air,  i,  37. 

Quillaia,  ii,  113. 
Emphysema  with  anaemia. 

Iron  chloride  (tincture),  i,  548. 
Empyema. 

Aspiration  (Dieulafoy's  method),  i,  151. 

Gavage,  i,  436. 


INDEX  OF  DISEASES  AND  REMEDIES. 


569 


Empyema. 

Quinine  injections,  ii,  120. 
Encephalitis. 

Blisters  to  the  back  of  the  neck,  i,  313. 

Cupping,  i,  320. 

Ice  iipplications,  i,  520. 
Endarteritis,  cerebral. 

Phosphorus,  ii,  76. 
Endocarditis  after  rhenmatism. 

Baths,  Nauheim,  ii,  438. 

Schott  treatment,  ii,  433. 

Serum,  anti^treptococous,  ii,  178. 
Endocarditis,  ulceratiye. 

Serum,  antistreptococcus,  ii,  178. 
Endometritis. 

Camphor,  i,  204. 

Chromic  acid,  i,  348. 

Euphorim,  i,  403. 

Glycerin  suppositories,  i,  450. 

Iclithyol,  i,  533. 

Nitric  acid,  ii,  7. 

Picric  acid,  ii,  83. 

Pyoctanine  (internally),  ii,  109. 

Salol  and  antipyrine,  ii,  150. 

Silver  nitrate,  ii,  196. 

Steam,  ii,  333. 

Stypticin,  ii,  333. 

Traumatol,  ii,  329. 

Zinc  oxyohloride,  ii,  410. 
Endometritis,  cervical. 

Camphor,  i,  304. 

Euphorin,  i,  403. 

Glycerin  suppositories,  1,  450. 
'      Ichthyol,  i,  523. 

Silver  nitrai  e,  ii,  196. 

Steam,  ii,  223. 
Endometritis,  chronic. 

Chromic-acid  applications,  i,  348. 
Endometritis,  chronic  ceryical. 

Nitric  acid,  ii,  7. 
Endometritis,  fnngrons. 

Picric  acid,  ii,  83. 

Salol  and  antipyrine,  ii,  150. 

Stypticin,  ii,  333. 
Endometritis,  haemorrhagic. 

Zinc  oxychloride,  ii,  410. 
Endometritis,  hyperplastic. 

Steam,  ii,  333. 
Endometritis,  septic  puerperal. 

Steam,  ii,  233. 
Endotrachelitis. 

See  Endometritis,  Cervical. 
Engorgement,  hepatic. 

Baths,  cold  sltz,  i,  169. 

Waters,  Buffalo  lithia,  ii,  373. 

"       chlorinated  alkaline  (externally  and 
internally),  ii,  371,  381. 

"Waters,  sodium-sulphate,  ii,  368. 
Engorgement  of  the  pelvic  viscera  (in 
women). 

Waters,  sulphuretted,  ii,  371. 
Engorgement  of  the  portal  circnlation. 

Gamboge,  i,  433. 

Grape  cure,  i,  455. 
Engorgement,  uterine. 

Waters,  mineral,  ii,  383. 
Engorgement,  venous. 

Bloodletting,  i,  187. 

Digitalis,  i,  345. 

Seoparius,  1,  345. 


Engorgement,  venous. 

Squill,  i,  345. 
Enlargements,  chronic,  and  stiffness  of 
the  joints. 

Veratrine,  ii,  350. 
Enlargements,  chronic,  of  the  lymphatic 

glands,  ii,  99. 
Enlargements,  fluctuating,  of  joints. 

Aspiration,  i,  153. 
Enlargements,  glandular. 

Cod-liver  oil,  i,  288. 

Iodine  {internally),  ii,  214. 
Enlargements,  glandular,  of  children. 

Calcium  sulphide,  i,  303. 

Thiosinamine,  ii,  380. 
Enteritis. 

Baths,  narcotic,  i,  173. 

Copper  arsenite,  i,  804,  805. 

Cubeb,  i,  319. 

Eucalyptol,  i,  400. 

Hydrastis,  i,  475. 

Limewater,  i,  583. 

Nutmeg,  ii,  35. 

Somatose,  ii,  312. 

Tannigene,  ii.  360. 

Thioform,  ii,  378. 

Vichy  water,  ii,  358. 
Enteritis,  acute. 

Tannigene,  ii,  360. 

Thioform,  ii,  278. 
Enteritis,  chronic. 

Hydrastis,  i,  475. 
Enteritis,  gastro-. 

Somatose,  ii,  213. 
Enteritis,  membranous. 

Copper-arsenite  enema,  i,  304. 
Enteritis,  mucous. 

Limewater,  i,  582. 
Enteritis,  pseudo-membranous. 

Cubeb,  i,  319. 
Enteritis,  ulcerative. 

Tannalbin,  ii,  354. 
Enterocolitis. 

Copper  arsenite,  i,  303. 

Hydroeotyle  asiatica,  i,  493. 
Enteroptosis. 

Yeast,  ii,  401. 
Entropion. 

Collodion,  i,  294. 
Enuresis. 

Belladonna,  i,  175. 

Ergot,  i,  388. 
Enuresis,  nocturnal. 

Belladonna,  i,  175. 

Faradization,  vesical,  i,  866. 

Hypnotism,  i,  515. 

Iron  iodide,  i,  551. 

Stimulants,  spinal,  ii,  226. 

Sulphonal,  ii,  239. 
Epididymitis. 

Ethyl  chloride,  ii,  434. 

Ice  applications,  i,  530. 

Mercury  iodide,  i,  633. 

Pulsatilla,  ii,  107. 
Epilepsy. 

Acetanilide,  i,  4. 

Ammonium  carbonate,  i,  56. 

Amyl  nitrite,  i,  61. 

Baths,  cold,  i,  488. 

Blisters  (to  abort  an  attack),  1,  185. 


670 


INDEX  OF  DISEASES  AND  REMEDIES. 


Epilepsy. 

Borax,  i,  189. 

Brain  and  spinal  cord  substance  (hypoder- 
mically),  i,  80. 

Bromalin,  i,  191. 

Bromated  hseinol,  ii,  426. 

BromhfEmol,  ii,  426. 

Calcium  bromide,  i,  202. 

Calotropis,  i,  203. 

Cannabis  indica,  i,  207. 

Cerium  oxalate,  i,  229. 

Cfiloralamide,  i,  238. 

Cod-liver  oil,  i,  288. 

Conium,  i,  298. 

Cupric  sulphate,  i,  306, 

Curare,  i,  321. 

Ergot  (to  increase  the  action  of  bromides),  i, 
388. 

Ethylene  bromide,  i,  399. 

Gallobromol  (internally),  i,  433. 

Gold  bromide,  i,  454. 

Hydrobromic  acid  and  tlie  bromides,  i,  493. 

Lobelia,  i,  587. 

Nerium,  ii,  5. 

Picrotoxin,  ii,  84. 

Rest-cure,  ii,  127. 

Rubidium  and  ammonium,  ii,  136. 

Rue,  ii,  137. 

Sclerotic  acid,  ii,  158. 

Senecio,  ii,  162. 

Silver  iodide,  ii,  197. 
"      nitrate,  ii,  194. 

Simulo,  ii,  198. 

Solanum  carolinense,  ii,  209. 

Strontium  bromide,  ii,  229. 

Strychnine,  ii,  28. 

Sulphonal,  ii,  239. 

Thyreoid  treatment,  ii,  293. 

Zinc  salts,  ii,  401. 
Epiphora. 

Alumnol  (in  solution),  i,  51. 
Episcleritis  (clironic  form). 

Eserine,  i,  392. 
Epistaxis. 

Aconite,  i,  9. 

Agaric  (for  plugging  the  nose),  i,  17. 

Ambrosia,  i,  52. 

Baths,  cold  hand,  i,  170. 

Digitalis,  i,  342. 

Ergot,  i,  388. 

Erigeron,  oil  of,  1,  390. 

Europhene,  i,  402. 

Hamamelis,  i,  467. 

Ipecac,  i,  543. 

Iron  chloride  (tincture),  i,  548. 

Kino,  i,  505. 

Matico,  i,  611. 

Silver  nitrate,  ii,  195. 

Sodium  chloride,  ii,  206. 

Tannin,  ii,  256. 
Zinc  sulphate,  ii,  407. 
Epittielioma. 
Arsenic,  i,  144. 
Bismuth  salicylate,  i,  183. 
Collodion,  salicylic-  and  lactic-acid,  i,  398. 
Lactic  acid,  i,  568. 
Pyrogallio  acid,  ii,  111. 
Salicylic-acid  and  zinc-chloride  collodion,  i, 

293. 
Salicylic-acid  ointment,  ii,  145. 


Epithelioma  of  the  serous  membranes. 

Silver-nitrate  applications,  ii,  457. 
Erethism,  nervous  and  circulatory,  of  the 
pelvic  organs. 

Baths,  hot  sitz,  i,  169. 
Erethism,  sexual. 

Humulus,  i,  474. 
Erosions  of  the  os  uteri. 

Silver  nitrate,  ii,  196. 

Thymol,  ii,  284. 

Zinc  oleate  and  iodoform,  ii,  405. 
Eructations,  acid. 

Chalk,  i,  230. 
Erysipelas. 

Aconite,  i,  8. 

Atropine,  i,  156. 

Bath,  hot,  i,  166. 

Benzoic  acid,  i,  178. 

Bromine,  i,  195,  445. 

Camphor,  i,  204. 

Carbolic  acid  (parenchymatous   injections), 

1,  ^lo. 

Chalk  and  lard  ointment,  i,  230. 
Cold  baths,  i,  488. 
Collodion,  ferruginous,  i,  293. 

flexible,  i,  294. 
Creosote,  i,  314. 

Brgotole  (local  applications),  i,  389. 
Guaiacol  (external  application),  i,  460. 
Ichthvol.  i,  533. 
Iodine,  i,  536. 
Iron,  i,  546. 

"      chloride  (tincture),  i,  548. 
Jaborandi,  i,  560. 
Lead-and-opium  wash,  i,  577. 
Mentho-phenol,  i,  616. 
Picric  acid,  ii,  83  ;  ii,  453. 
Quinine,  1,  355  ;  ii,  119. 
Resorcin,  ii,  136. 
Rye  flour,  ii,  137. 
Serum,  antistreptococcus,  ii,  175. 
Silver  lactate,  ii,  197. 
"      nitrate,  ii,  196. 
Sulphur  ointment,  ii,  341. 
Thiol  ointment,  ii,  378. 
Toxines,  ii,  313. 

Trichlorphenol  applications,  ii,  830. 
Turpentine  liniment,  ii,  335. 
(of  traumatic  origin).  Turpentine  oil,  ii,  336. 
Vaseline,  ii,  349. 
Zinc    sulphichthyolate   (as  a  liniment),    ii. 

Erythema. 

Bismuth  subnitrate  (as  a  dusting  powder),  i, 

Laurel,  i,  571. 

Salicylic  acid,  ii,  144. 

Silver  nitrate,  ii.  196. 

Thiol  ointment,  ii,  278. 

Zinc-acetate  ointment,  ii,  403, 

Zinc  sulphate,  ii,  408. 
Erythema,  clironic. 

Collodion,  i,  2&4. 
Erythrasma. 

Anthrarobin,  i,  103. 
Exanthemata. 

Ammonium  acetate,  i,  54. 

Saffron  tea  (as  a  diaphoretic),  ii,  369. 
Exanthemata,  acute. 

Asclepias  tuberosa,  i,  148. 


INDEX  OF  DISEASES  AND   REMEDIES. 


571 


Exanthemata,  chronic. 

Waters,  alkaline  (externally),  ii,  372. 
Excitement,  circulatory. 

Bloodletting,  i,  188. 
Excitement,  maniacal. 

Bath,  hot,  i,  166. 
Excitement,  mental. 

Sulphonal,  ii,  239. 
Excitement,  nervous. 

Valerian,  ii,  345. 
Excitement  of  insanity. 

Chloral  hydrate,  i,  237. 
Excitement,  sexual. 

Camphor,  i,  205. 

Humulus,  i,  474. 
Excoriations. 

Dernaatol,  i,  329. 

Lycopodium  powder,  i,  590. 

Tannio-aeid  ointment,  ii,  257. 

Waters,  mineral,  ii,  375. 
Excoriations  of  the  anus. 

Tannin  (solution),  ii,  256. 
Excoriations  of  the  scrotum. 

Tannin  (solution),  ii,  256. 
Exhaustion. 

Chirata,  i,  234. 

Stimulants,  cardiac,  ii,  226. 
Exliaustion,  cerebral. 

Damiana,  i,  324. 
Exhaustion  from  nervous  disease. 

Rest-cure,  ii,  127. 
Exhaustion  from  over-excitement. 

Zinc  phosphate,  ii,  410. 
Exhaustion  from  overwork. 

Phenacetine,  ii,  71. 
Exhaustion,  mental  or  nervous. 

Rest-cure,  ii,  127. 
Exhaustion,  nervous. 

Castor,  i,  219. 

Damiana,  i,  324. 

Glycerophosphates,  ii,  439. 

Lavandula,  i,  572. 

Nitrous-oxide  inhalation,  ii,  18. 

Sumbul,  ii,  7. 
Exhaustion,  senile. 

Ergot  and  sodium  phosphate,  i,  889. 
Exhaustion,  sexual. 

Cereus  grandiflorus,  i,  229. 
Exudates,  inflammatory. 

Potassium  iodide,  ii,  98. 
Exudations,  serous. 

Thiosinamine,  ii,  280. 

Fainting. 

See  Syncope. 
Fatigue,  muscular. 

Baths,  hot,  i,  166. 
Fatty  liver. 

See  LivEK,  Fatty. 
Favus. 

Alumnol  applications,  i,  51. 

Carbolic-acid  ointment,  i,  212. 

Cod-liver  oil,  i,  288. 
Felons. 

Alkalies  (poultice  of  hard-wood  ashes),  i,  45. 
Fermentation,  gastric. 

Ammonia  water,  i,  53. 

Creosote,  i,  314. 

Diaphthol,  i,  333. 

Hyposulphites,  i,  519. 
80 


Fermentation,  gastric. 

Naphthol,  ii,  2. 
Fermentative  changes  in  the  intestines. 

Strontium  salicylate,  ii,  147. 
Fever,  acute. 

Kumyss,  i,  567. 
Fever,  adynamic. 

Camphor,  i,  204. 
Fever,  algidity  of. 

Ergot  and  sodium  phosphate,  i,  389. 
Fever,  catarrhal. 

Aconite,  i,  8. 
Fever,  eruptive. 

Mustard  bath,  hot,  i,  647. 
Fever,  hay. 

See  Hay  fevee. 
Fever,  hectic. 

Calotropis,  i,  203. 
Fever,  hectic,  of  phthisis. 

Quinine,  ii,  49. 
Fever,  intermittent. 

See  Intermitiebt  fever. 
Fever,  low. 

Camphor,  ii,  6. 

Opium  (as  a  stimulant),  Ii,  225. 

Opium  (as  a    supporting  and  stimulating 
agent),  ii,  225. 

Strophanthus,  ii,  231. 

Turpentine  oil  (internally),  ii,  335. 
Fever,  malarial. 

Calomel,  i,  624. 

Chirata,  i,  234. 

Cinchona,  i,  254. 

Cornus,  i,  307. 

Curcuma,  i,  322. 

Pyoctanine  (internally),  ii,  109. 

Quinine,  i,  254 ;  ii,  174. 

Sabbatia,  ii,  137. 

Saligenin,  ii,  147. 

Serum,  antidiphtheritic,  and  quinine,  ii,  174. 

Thuja,  ii,  282. 

Vieiric  acid,  ii,  358. 
Fever  of  children. 

Aconite,  i,  8. 

Fats  by  inunction,  i,  420. 

Magnesium  citrate,  i,  591. 

Potassium  tartrates,  ii,  100. 
Fever  of  influenza. 

PhenocoU,  ii,  72. 
Fever  of  phthisis. 

Opium,  ii,  36. 

PhenocoU,  ii,  72. 
Fever  of  tuberculosis. 

Aconite,  i,  9. 
Fever,  paludal. 

See  Fever,  Malarial. 
Fever,  puerperal. 

Copper-arsenite  solution,  i,  304. 

Quinine,  ii,  119. 

Salufer,  ii,  456. 

Serum,  antistreptococcus,  ii,  175. 

Tartar  emetic,  i.  114. 

Turpentine  oil  (internally  and  locally),  ii,  336. 
Fever,  relapsing. 

Salicylic  acid,  ii,  143. 
Fever,  remittent. 

See  Remittent  fever. 
Fever,  rheumatic. 

Euphorin,  i,  402. 

Malakin,  i,  592. 


572 


INDEX  OF  DISEASES  AND  REMEDIES. 


Fever,  scarlet. 

See  SOAELET  FEVER. 

Fever,  septic. 

Sesame  oil,  ii,  190. 
Fever,  surgical. 

Euphorin,  i,  402. 
Quinine,  i,  256. 
Fever,  typhoid. 

See  Typhoid  fever. 
Fever,  typhus. 

See  Typhus  fevee. 
Fever,  urethral. 

Aconite,  i,  9. 
Quinine,  i,  256  ;  ii,  120. 
Fever,  yellow. 

See  Yellow  fever. 
Fevers. 

Acetanilide,  i,  2. 

Acetylamido  phenol,  i,  5. 

Aconite,  i,  8. 

Alcohol  (sponging  with),  i,  421. 

Antipyrine,  i,  123. 

Arnica,    fluid    extract    of    (internally),    i, 
141. 

Bath,  sheet,  i,  169. 

Baths,  cold,  i,  486. 

Calomel,  i,  624. 

Camphor,  ii,  6. 

Chamomile,  i,  231. 

Cimicifuga,  i,  250. 

Cinchona,  i,  255. 

Cold  affusions  (Currie's  method),  i,  16. 
"    water  (internally),  i,  479. 

Copper-arsenite  solution,  i,  304. 

Cornus,  i,  307. 

Curcuma,  i,  322. 

Ergot  and  sodium  phosphate,  i,  389. 

Euphorin,  i,  402. 

Gelsemium,  i,  436. 

Guaiacol,  i,  457. 

Hydrocotyle  asiatica,  i,  493. 

Injections  of  iced  water,  i,  480. 

Kairine,  i,  563. 

Kumyss,  i,  567. 

Lithium  salicylate,  ii,  145. 

Magnesia  citrate,  i,  591. 

Malakin,  i,  592. 

Nitre,  i,  421. 

Phosphergot,  i,  389. 

Pyoctanine,  ii,  109. 

Quinine,  i,  255;  ii,  174. 

Resorcin,  ii,  126. 

Salicylic  acid,  ii,  142. 

Sabbatia,  ii,  137. 

Scammony,  ii,  157. 

Serum  antistreptococcus,  ii,  175. 

Sesame  oil,  ii,  190. 

Sodium  tartrate,  ii,  209. 

Sponge  bath,  i,  491. 

Tartar  emetic,  i,  114. 

Thalline,  ii,  276. 

Turpentine  oil,  ii,  336. 

Vinegar  solution,  sponging  with,  ii,  359. 

Water,  rectal  enema  of,  i,  479. 

Wine,  sherry,  ii,  393. 
Fibroids,  uterine. 

Cimicifuga,  i,  250. 

Ergot,  i,  38,8. 

Galvanism,  i,  368. 

Nitric  acid,  ii,  7. 


Fissures. 

Gelanthum  (Unna's  treatment),  ii,  349. 

Iodoform,  i,  538. 

Zinc  oxide,  ii,  400. 
Fissures,  anal. 

Benzoin,  i,  178. 

Glycerin  injections,  i,  450. 

Tannin,  ii,  257. 
Fissures,  eczematous. 

Cantharides,  tincture  of  (topically),  i,  208. 
Fissures  of  the  lips  and  tongue. 

Silver  nitrate,  ii,  195. 
Fissures  of  the  nipples. 

Alcohol  applications,  i,  31. 

Borax,  i,  189. 

Collodion,  i,  294. 

Ichthyol,  i,  523. 

Lead  nitrate,  i,  578. 

Limewater  as  a  lotion,  i,  582. 

Picric  acid,  ii,  83. 
Fissures  of  the  rectum. 

Bismuth  injections,  i,  181. 

Iodoform,  i,  538. 
Fissures  of  the  tongue. 

Papain,  ii,  60. 
Fistula. 

Collodion,  i,  293. 

Creosote,  i,  314. 

Silver  nitrate,  ii,  195. 
Flat  foot. 

Exercise,  i,  416. 
Flatulence. 

Ammonia  water,  i,  54. 

Ammonium  carbonate,  i,  55. 

Asafoetida,  i,  147. 

Boric  acid,  i,  190. 

Calamus,  i,  201. 

Chirata,  i,  234. 

Chloroform,  i,  241. 

Cinnamon,  i,  259. 

Gamboge,  i,  433. 

Glycerin,  i,  451. 

Horseradish,  i,  473. 

Lavandula,  i,  572. 

Nux  vomica,  ii,  28. 

Peppermint  infusion,  i.  613. 

(eructations).  Pepsin,  ii,  69. 

Permanganates,  ii,  70. 

Pimenta,  ii,  87. 

Salicylic  acid,  ii,  143. 

Terebene,  ii,  271. 

Terpin  hydrate,  ii,  272. 
Flatulence  of  children. 

Asafcetida,  i,  147. 
Flatulence  of  infants. 

Valerian,  ii,  345. 
Flooding. 

See  HAEMORRHAGE. 

Flushing  of  the  face. 

Cimicifuga,  i,  250. 
Flnshiugs,  painful. 

Bromides,  i,  194. 
Foetor  of  the  feet. 

Boric  acid,  i,  191. 
Feetor  of  the  urine. 

Cinnamon,  oil  of,  i,  259. 
Fractures. 

Massage,  i,  609. 
Fractures  of  the  jaw. 

Gutta  percha,  i,  462. 


INDEX  OF  DISEASES  AND  REMEDIES. 


673 


Freckles. 

See  Lentigo. 
Freezing  of  the  extremities. 

Transfusion,  peripheral,  ii,  323. 
Frostbite. 

Baths,  cold  foot,  i,  170. 

Benzoin,  compound  tincture  of,  i,  179. 

Cold  affusions,  i,  17. 

Phulluah,  ii,  79. 

Potassium  permanganate,  i,  596. 

Storax,  liquid,  ii,  3S9. 
Fungous  growtlis. 

See  Growths. 
Fungus  hsematodes. 

Chromic  acid,  i,  248. 
Furuncles. 

See  Boils. 

Galactorrhoea. 

Camphorated  oil,  i,  204. 

Ergot,  i,  388. 
Gallstones. 

See  Calculus,  Biliary. 
(Janglion. 

Carbolic-acid  injections,  i,  213., 
Gangrene. 

Bromine,  i,  195,  227,  44o. 

Camphor,  i,  204. 

Carbolic-acid  inhalation,  i,  213. 

Charcoal  poultice,  i,  232. 

Chlorine,  i,  445. 

Citric  acid,  i.  260. 

Creosote,  i,  314. 

Guaiaool,  i,  459  ;  ii,  489. 

Lemon-juice,  i,  260. 
.  Nitric  acid,  ii,  7. 

Oxygen,  ii,  51. 

Permanganates,  ii,  70. 

Peat  (as  a  dusting  powder),  ii,  65. 

Potassium  permanganate,  i,  597. 
Gangrene,  hospital. 

Bromine,  1,  195,  227,  445. 

Nitric  acid,  ii,  7. 

Permanganates,  ii,  70. 

Salicylic  acid,  ii,  143. 

Turpentine  oil,  ii,  386. 
Gangrene,  idiopathic. 

Camphor,  i,  204. 
Gangrene,  local. 

Turpentine  liniment,  ii,  335. 
Gangrene  of  the  lung. 

Carbolic-acid  (solution)  inhalation,  i,  213. 

Creosote  (by  inhalation),  i,  314. 

Guaiacol,  i,  459 ;  ii,  489. 

Salicylic-acid  inhalation,  ii,  143. 

Turpentine  oil,  vapour  of,  ii,  336. 
Gastralgia. 

Acetanilide,  i,  3. 

Camphor,  1,  205. 

Cerium  oxalate,  i,  229. 

Gal  vanization,  anodal,  i,  366. 

Ijavage,  i,  572. 

Manganese  oxide,  i,  596. 

Myrrh,  tincture  of  (internally),  i,  651. 

Nitroglycerin,  ii,  15. 

Nutmeg,  ii,  35. 

Pepsin  and  codeine,  ii,  69. 

Phenaeetine,  ii,  71. 

Wines  (by  enema),  ii,  394 

Zinc  cyanide,  ii,  408. 


Gastric  disease,  chronic. 

Douche,  cold,  i,  491. 

Silver  iodide,  ii,  197. 
Gastric  pain. 

Bismuth,  i,  180. 
Gastritis. 

Copper  arsenite,  i,  305. 

Diet,  careful,  i,  335. 

Geosite,  ii,  438. 

Hellebore,  white,  i,  470. 

Ipecac,  i,  542. 

Lavage,  i,  491,  573. 

Moss,  Irish,  i,  247. 

Myrrh,  i,  651. 

Pepsin,  ii,  69. 

Silver-nitrate  irrigation,  ii,  194. 

Silver  oxide,  ii,  197. 

Strontium  bromide,  ii,  239. 

Vichy  water,  ii,  358. 

Waters,  chlorinated,  ii,  365. 
Gastritis,  acute. 

Copper  arsenite,  i,  305. 

Diet,  careful,  i,  335. 

Geosite,  ii,  438. 

Hellebore,  white,  i,  470. 

Ipecac,  i,  542. 

Strontium  bromide,  ii,  239. 
Gastritis,  catarrhal. 

Myrrh,  tincture  of,  i,  651. 
Gastritis,  chronic. 

Copper  arsenite,  i,  305. 

Lavage,  i,  491,  572. 

Silver  nitrate  (by  irrigation  of  the  stomach), 
ii,  194. 

Waters,  chlorinated,  ii,  365. 
Gastritis,  mucous. 

Pepsin,  ii,  69. 
Gastritis,  subacute. 

Copper  arsenite,  i,  305. 

Diet,  i,  335. 

Pulsatilla,  ii,  107. 
Gastrodynia. 

Manganese  oxide,  i,  596. 
Gastro-enteritis. 

Infusion,  ii,  324. 

Tannigene,  ii,  360. 

Waters,  mineral,  ii,  376. 
Gastro-enteritis,  chronic. 

Infusion,  ii,  324. 
Gastro-enteritis,  chronic  catarrhal. 

Waters,  mineral,  ii,  376. 
Gastro-neuroses. 

Ammonia,  foetid  spirit  of,  i,  53. 
Genital  neuroses  and  psychoses. 

Faradization,  general,  i,  366. 
Genito-urinary  irritation. 

Baths,  cold  sitz,  i,  488. 

Capsicum,  i,  309. 

Conium,  i,  298. 

Iodoform,  i,  538. 

Larix,  i,  570. 

Terebene,  ii,  371. 
Gingivitis. 

Catechu,  infusion  or  tincture,  i,  221. 

Cuprlc  oxide,  i,  305. 
Glanders. 

Copper  arsenite  (locally  and  internally),  i, 
304. 
Glands,  caseous. 

lodol,  i,  540. 


574 


INDEX  OF  DISEASES  AND  REMEDIES. 


Glands,  indurated. 

Gold,  i,  453. 

lehthyol,  i,  522. 

Iodine,  i,  536. 

Iodoform,  i,  535,  536. 
Glauconia. 

Eserine  (in  solution),  i,  391. 

Quinine,  ii,  120. 

Sodium  salicylate,  ii,  146. 

Suprarenal  capsule,  ii,  247. 
Glaucoma,  acute. 

Quinine,  ii,  130. 
Gleet. 

See  GoNOERHCEA,  Chronic. 
Glossitis. 

(/opper-arsenite  solution,  i,  304. 
Glossitis,  syphilitic. 

Chromic  acid  (as  a  wash),  i,  248. 
Goitre. 

Aconite,  i,  9. 

Arsenic,  i,  146. 

Chromic-aoid  injections,  i,  248. 

Digitalis,  i,  342. 

Exercise,  i,  415. 

Galvanization,  i,  366. 

Gold  bromide,  i,  454. 

Iodine,  i,  536. 

"       (externally),  i,  536. 

"       (hypodermic  injections),  i,  536. 

"       (internally),  ii,  214. 

Iodoform  (hypodermicaliy),  i,  538. 

Rest-cure,  ii,  137. 

Salicylic  acid,  ii,  146. 

Strophanthus,  ii,  232. 

Thyreoid  treatment,  i,  178 ;  ii,  297. 

Veratrum  viride,  ii,  353. 
Goitre,  cystic. 

Arsenic,  i,  146. 
Goitre,  exoplithalmie. 

Aconite  (tincture),  i,  9. 

Digitalis,  i,  343. 

Exercise,  systemic  passive  respiratory,  i,  415. 

Galvanization,  stabile,  i,  366. 

Gold  bromide,  i,  454. 

Rest-cure,  ii,  137. 

Salicylic  acid,  ii,  146. 

Strophanthus,  ii,  233. 

Thyreoid  feeding,  i,  78. 

Veratrum  viride,  ii,  353. 
Gonorrheea. 

Aconite  (tincture),  i,  9. 

Alkalies,  i,  44. 

Aloes,  i,  49. 

Aluminum  tannate,  ii,  259. 

Alumnol  injections,  i,  51. 

Argentamine,  i,  140. 

Argonin,  ii,  197. 

Baths,  hot.  i,  166. 

Benzoic  acid,  i,  177. 

Bismuth  injections,  i,  181. 
"        tannate,  ii,  259. 

Boric  acid  (2-per-cent.  solution),  i,  191. 

Buchu,  i,  197. 

Cadmium-salicylate  injections,  i,  200. 

Camphor,  i,  30.5. 

Catechu  injections,  i,  331. 

Chloral-hydrate  injection,  i,  237. 

Copaiba,  i,  301. 

Copper-arsenite  solution,  i,  304. 

Corn  silk,  i,  306. 


Gonorrhoea. 

Creosote  and  boric  acid  by  injection,  i,  314. 

Cubeb,  i,  319. 

Cupric  acetate  (topically),  i,  303. 

sulphate  solution  (injections),  i,  306. 
Ephedra  antisyphilitica,  i,  385. 

"        trifurcata  as  a  styptic,  i,  385. 
Erigeron,  oil  of,  i,  390. 
Perropyrine,  i,  423. 
Formaldehyde,  i,  438. 
Gallobromal  (by  injection),  i,  433. 
Geranium  (topically),  i,  438. 
Gurjun  balsam,  i,  462. 
Hydra.stine  (internally  and  by  injection),  i, 

476. 
Hydrogen-dioxide  injections,  i,  503,  531. 
lehthyol  injections,  i,  523. 
Iodine,  i,  536. 
Kava,  i,  564. 

Lafayette  mixture,  i,  301. 
Lanolin  injection,  i,  569. 
Lysol,  i,  590. 
Matico,  i,  611. 

Mercury  bichloride  (injections),  i,  531. 
Methylene  blue,  i,  630. 
Palmetto  wine,  ii,  58. 
Potassium  permanganate  (injections),  i,  531, 

597. 
Pyridine  injections,  ii,  110. 
Pyoctanine,  ii,  108. 

(internally),  ii,  109. 
Quinine  injections,  ii.  126. 

"        hvdrochloride  (locally),  i,  354. 
Salol,  ii,  150. 
Sandal-wood  oil,  ii,  153. 
Silver  citrate,  ii,  198. 
"      nitrate,  ii,  196. 
"      oxide,  ii,  197. 
Storax,  ii,  238. 
(in    pregnant  women).   Tannin    and   alum 

douche,  ii,  256. 
Tannin  injections,  ii,  356. 
Terpin  hydrate,  ii,  273. 
Thalline  injections,  ii,  376. 
Traumatol,  ii,  339. 
Tribulus  lanuginosus,  ii,  330. 
Triticum,  ii,  333. 
Turpentine  oil,  ii,  836. 
Water,  i,  105. 
Zinc  acetate  (as  a  local  astringent),  ii,  403. 

"     oxide,  ii,  407. 

"     permanganate,  ii,  410. 

"     sozoiodolate,  ii.  410. 

"     subgallate,  ii,  411. 

"     sulphate  injection,  ii,  407. 

"    siilphocarbolate,  ii,  412. 
Gonorrhoea,  acute. 

Aluminum  tannate,  ii,  359. 
Gonorrhoea,  chronic. 
Cadmium  sulphate,  i,  300. 
Cantharides,  i,  208. 
Catechu  injections,  i,  221. 
Copper  arsenite,  i,  304. 
Cuprio-sulphate  solution  (injections),  i,  806. 
Iron,  i,  549. 

"     chloride  (tincture),  i,  648. 
Kava,  i,  564. 
Silver  nitrate,  ii,  196. 
Tannin  injections,  ii,  256. 
Thalline  injections,  ii,  276. 


INDEX  OP  DISEASES  AND  REMEDIES. 


575 


Gonorrhoea,  chronic. 

Uva  ursi,  ii,  348. 

Waters,  Buffalo  lithia,  ii,  373. 
"        mineral,  ii,  377. 
Gonorrlioea,  subacute. 

?otassium-j)ermang:anate  injection,  i,  597. 
Gonorrhoea,  vaginal. 

Formaldehyde,  i,  428. 

Gurjun  balsam,  i.  462. 

Traumatol,  ii,  329. 
Gont. 

Aconite  (as  an  anaesthetic),  i,  9. 

Alkaline  mineral  waters,  i,  45. 

Amber,  oil  of,  i,  52. 

Baths,  Nauheim,  ii,  420. 
"      pine,  i,  172. 

Cod-liver  oil,  i,  288. 

Colohieum,  i,  291. 

Dulcamara,  i,  353. 

Ephedra,  i,  385, 

Glycerophosphates,  ii,  439. 

Guaiac,  i,  456. 

Guaiacol  and  glycerin,  i,  461. 

lehthyol,  i,  522. 

Kava,  i,  564. 

Lithium,  i,  586. 

Lycetol,  i,  589. 

Magnolia,  i,  592. 

Mercury,  i,  619. 

Methylene  blue,  i,  629. 

Muscarine,  i,  645. 

Oxygen,  ii,  52. 

Ozone,  ii,  58. 

Piperazine,  ii,  89. 

Potash,  ii,  94. 

Quinine  salicylate,  ii,  455. 

Salicin,  ii,  140. 

Salicylic  acid,  ii,  143. 

Salines,  ii,  147, 

Salophene,  i,  125. 

Strontium  lactate,  ii,  230. 

Sulphur,  ii,  241, 

Tartarlithine,  ii,  265,  _^ 

Tetrethylammonium,  ii,  273. 

Uricedin,  ii,  342. 

Drotropine,  ii,  343, 

Waters,  alkaline,  ii,  367,  372, 
"        chlorinated,  ii,  365, 

mineral,  ii,  374,  375,  377,  379, 
"        simple  thermal  (internally),  ii,  364. 
"        sulphur,  or  vapours,  ii,  371. 

Wet-pack,  i,  490. 
Gout,  acute  rheumatic. 

Pulsatilla,  ii,  107. 
Gout,  chronic. 

Guaiac  wood,  i,  457, 

Iodine  salts,  i,  536, 

Mercury  iodide  and  arsenic,  i,  627. 

Savine,  ii,  157, 
Gout,  rheumatic. 

Arsenic,  i,  145, 

Cod-liver  oil,  i,  288. 

Massage,  i,  608, 
Granular  lids. 

Atropine,  i,  155, 

Boric  acid,  i,  190, 
Granulating  sores. 

Sponge-grafting,  ii,  219, 
Granulation  of  the  eyelids, 

Jequirity,  i,  562. 


Granulations,  exuberant. 

Silver  nitrate,  ii,  195. 
Granulations,  intra-uterine. 

Nitric  acid,  ii,  7. 
Granulations,  vascular. 

Silver  nitrate,  ii,  195. 
Gravel. 

See  LiTHiASis. 
Grippe. 

See  Influenza. 
Growths,  intra-uterine. 

Chromic-acid  applications,  i,  248. 
Growths,  malignant. 

Zinc  chloride,  ii,  403. 
Growths,  naso-pharyngeal. 

Chromic-acid  applications,  i,  248. 
Growths,  sloughing  malignant. 

Potassium  permanganate,  i,  597. 
Growths,  sort. 

Iron  chloride,  i,  548. 
Growths,  superficial  cutaneous. 

Hydrochloric  acid,  i,  227. 
Gums,  spongy. 

Borax,  myrrh,  and  honey,  i,  189. 

Copper-arsenite  solution,  i,  304. 

Myrrh,  tincture  of,  i,  651. 

Hsematemesis. 

Calcium  chloride,  ii,  428. 

Catechu  lozenges,  i,  221. 

Iron  sulphate,  i,  550. 

Matioo,  i,  611. 
Hsematocele. 

Electricity,  i,  368. 
Hsematoma. 

Bryonia,  i,  197. 

Electricity,  i,  368. 
Hsematuria. 

Corn  silk,  i,  306. 

Ergot,  i,  388. 

Gallic  acid,  i,  433. 

Matico,  i,  611. 

Physostigma,  ii,  81. 

Pichi,  ii,  83, 

Quinine,  i,  255  ;  ii,  120. 

Rhus  aromatica,  ii,  131. 

Silver  nitrate,  ii,  196, 

Tannic  acid,  ii,  257. 
Haemophilia. 

Gallic  acid,  i,  432. 

Marrow,  i,  598. 

Tannin,  ii,  257. 
Haemoptysis. 

Air,  condensed,  inspiration  of,  i,  28. 

Bryonia,  i,  197. 

Cupric  sulphate  and  opium,  i,  306. 

Ergot,  i,  388. 

Erigeron.  oil  of,  i,  390. 

Gallic  acid,  i,  432. 

Ipecac,  i,  542. 

Iron  sulphate,  i,  550. 

Lead  acetate,  i,  577. 

Matico,  i,  611, 

Opium,  ii,  35, 

Podophyllin,  ii,  93. 

Senecin,  ii,  161. 

Senecio,  ii,  162. 

Tannin,  ii,  257. 

Terebene,  ii,  271. 

Waters,  sulphuretted,  ii,  371. 


576 


INDEX  OP  DISEASES  AND  REMEDIES. 


Haemorrhage,  passive. 

Iron  chloride  (tincture),  i,  548. 
Kino,  i,  565. 

(from  the  stomach  and  intestines),  Tannic 
acid,  ii,  257. 
Haemorrhage,  post-partum. 

Boussingaulthia  basselloides,  i,  191. 

Bryonia,  i,  197. 

Canella,  i,  200. 

Ciraicifuga,  i,  250. 

Ergot,  i,  388. 

Faradization,  i,  368. 

Hot  saline  solutions  (injections),  i,  467. 

Ioe,'i,  520. 

Injections  of  iced  water,  i,  480. 

Ipecac,  i,  548. 

Iron  chloride,  i,  548. 
"    sulphate,  i,  550. 

Lemon-juice,  i,  260. 

Sponge  tents  (impregnated  with  vinegar),  ii, 
219. 

Turpentine  oil,  ii,  336. 

Vinegar,  ii,  219. 
Haemorrhage,  pulmonary  (of  the  plethoric). 

Bloodletting,  i,  188. 

Ergot,  i,  388. 

Hamamelis,  i,  467. 

Pneumatic  cabinet,  ii,  413. 

Silver  oxide,  ii,  197. 
Haemorrliage,  rectal. 

See  H.EMOREHAGES  FROM  THE  RECTUM. 

Hfemorrhage,  renal. 

Hamamelis,  i,  467. 
Haemorrhage,  slight. 

Salicylic  acid,  ii,  143. 
Haemorrhage,  uterine. 

Boussingaulthia  baselloides,  i,  191. 
Creosote,  i,  314. 
Ergot,  i,  388. 
Erigeron,  oil  of,  i,  390. 
Erodinm  cicutarium,  ii,  433. 
Hamamelis,  i,  467. 
Ice,  i,  520. 

Quinine  feri-ichloride,  ii,  455. 
Saiol  and  antipyrine  applications,  ii,  150. 
Styptic!  n,  ii,  233. 
Tannic  acid,  ii,  257. 
Urtica,  ii,  343. 
Viscum  album,  ii,  361. 
Haemorrhages. 
Antipyrine,  i,  466. 

and  tannin,  ii,  257. 
Baths,  warm,  i,  489. 
Calcium  carbide,  ii,  426. 
chloride,  ii,  428. 
Cimioifuga,  i,  250. 
Cinnamon,  i,  359. 
Cornutine,  i,  307. 
Creosote,  i,  314. 

Cuprio-sulphate  solution  (locallv),  i,  306. 
Digitalis,  i,  343. 
Electricity,  i,  368. 
Ergot,  i,  388. 
Erigeron,  oil  of,  i,  390. 
Perropyrine,  i,  433. 
(from  tooth  extraction).  Ethyl  chloride,  ii, 

434. 
Gallic  acid  (internally),  i.  432. 
Geranium,  i,  438. 
Hamamelis,  i,  467. 


Haemorrhages. 

Heat,  i,  408. 

Hydrastine  (internally),  i,  476. 

Hydrastis,  i,  476. 

Ice,  i,  520. 

Infusion,  ii,  323. 

Injection  of  hot  saline  solution,  i,  467. 

Ipecac,  i,  543. 

Iron  chloride  (solution),  i,  548. 

"     sulphate,  i,  550. 
Kino,  i,  565. 
Lead  acetate,  i,  577. 
Ligation  of  arteries  in,  i,  465. 
Nitric  acid,  ii,  7. 
Opium,  ii,  36,  450. 
Pichi,  ii,  82. 

Pneumatic  cabinet,  ii,  413. 
Posture  in  the  arrest  of,  i,  465. 
Khubarb,  ii,  131. 

Saline  solution  (by  the  rectum),  ii,  237. 
Salt,  ii,  206. 
Sclerotic  acid,  ii,  158. 
Silver  oxide,  ii,  197. 
Sodium  chloride,  ii,  206. 
(during  operations).  Steam,  ii,  223. 
Stypticin,  ii,  230. 

Sulphur  and  cream  of  tartar,  ii,  241. 
Sulphuric  acid,  ii,  243. 
Suprarenal  capsule,  ii,  347. 
Surgical  means  for  arresting,  i,  464,  465. 
Tannic  acid  and  antipyrine,  ii,  257. 
Torsion  or  twisting  as  "a  means  of  arresting, 

i,  465. 
(from  traumatism).  Transfusion  and  infusion, 

ii,  323. 
Turpentine  oil.  ii,  336. 
Urtica,  ii,  343.' 
Veratrum  viride,  ii,  353. 
Vinegar,  i,  5 ;  ii,  219. 
Viscum  album,  ii,  361. 
Water,  hot  (by  the  mouth  or  the  rectum),  ii, 

337. 
Wines,  strong,  as  a  tonic,  ii,  894. 
Haemorrhages,  abdominal. 

Saline  cathartics,  ii,  147. 
Haemorrhages  after  labour. 

Ergot,  i,  388. 
Hasmorrhages,  bronchial  (of  the  plethoric). 

Bloodletting,  i,  188. 
Haemorrhages,  capillary. 
Ice  (topically),  i,  520. 
Sodium  chloride,  ii,  206. 
Haemorrhages,  cerebral. 

Baths,  warm,  i,  489. 
Haemorrhages,  climacteric. 

Stypticin,  ii,  333. 
Hemorrhages,  external. 

Iron  sulphate  (solution),  i,  550. 
HiBmorrhages  from  fibroids. 

Stypticin,  ii,  233. 
Haemorrhages  from  leecli  bites. 

Creosote,  i,  314. 
Hiiemorrhages  from  tlie  extraction  of  teeth. 

Turpentine  oil,  ii,  336. 
HajMiorrhages  from  tlie  rectum. 
1 1  ydrastis.  i,  476. 
Rhubarb,  ii,  131. 

Sulphur  and  cream  of  tartar,  ii,  341. 
Haemorrhages  from  the  stomach. 
Lead  acetate,  i,  577. 


INDEX  OF  DISEASES  AND  REMEDIES. 


577 


Haemorrhages  from  typhoid  ulcer. 

Opium,  ii,  36. 
Haemorrhages,  gastric. 

Infusion,  ii,  333. 

Silver  oxide,  ii,  197. 
Hsemorrhages,  internal. 

Sclerotic  acid,  ii,  158. 
Haemorrhages,  intestinal. 

Biigeron,  oil  of,  i,  390. 

Hydrastis,  i,  476. 

(of  typhoid  fever).  Infusion,  ii,  333. 

Krameria,  i,  566. 

Lead  acetate,  i,  577. 
Haemorrhages,  nasal. 

Ferropyrine,  i,  433. 
Haemorrhages  of  malarial  feyer. 

Quinine,  ii,  118. 
Haemorrhages  of  scurvy. 

Ergot,  i,  388. 
Haemorrhages,  vesical. 

Cinnamon,  i,  359. 

Krameria,  i,  560. 
Haemorrhoids. 

Apone,  i,  139. 

Arsenic,  i,  146. 

Baths,  cold,  i,  169. 
"      cold  sitz,  i,  489.   . 

(strangulated).  Baths,  hot  sitz,  i,  169. 

Baths,  narcotic,  i,  173. 

Carbolic-acid  injections,  i,  313. 

Chromic-acid  applications,  i,  348. 

Ergot,  i,  888. 

Galls,  i,  433. 

Glycerin  injections,  i,  450. 

Grape  cure,  i,  455. 

Ilamamelis,  i,  467. 

Iron  sulphate,  i,  550. 

Lappa,  i,  570. 

Nitric  acid,  ii,  7. 

Oak  bark  (enema),  ii,  31. 

Pisoidia,  ii,  91. 

Rhus  toxicodendron,  ii,  133. 

Sulphur  and  cream  of  tartar,  ii,  341. 

Tannio-acid  ointment,  ii,  356. 

Tannin  suppositories,  ii,  356. 

Water  (rectal  applications),  i,  479. 

"      in  form  of  an  ascending  douche,  i, 
349. 

Waters,  mineral,  ii,  371,  375. 

Zinc  subgallate,  ii,  411. 
Haemothorax. 

."Aspiration,  i,  151. 
Ilallneinations. 

Galvanism  and  Faradaism,  i,  366. 
Hay  fever. 

Blennostasine,  ii,  436. 

Copper-arsenite  solution,  i,  304. 

Poimaldehyde,  ii.  436. 

Glycerin  and  carbolic  acid,  i,  450. 

Grindelia,  i,  456. 

Ipecac,  i,  543. 

Menthol  solution  (by  injection),  i,  614. 

Quinine  hydrochloride  (either  by  spray  or 
painted  on  the  mucous  membrane),  i,  353 ; 
ii,  119. 

Salioin,  ii,  140. 

Salicylic  acid,  ii,  143. 

Sulphurous  acid,  ii,  343. 

Tannigene,  ii.  360. 

Terpin  hydrate,  ii,  373. 


Hay  fever. 

Zinc  valerianate,  ii,  347. 
Headache. 

Acetanilide,  i,  3. 

Acetic  acid  (by  inhalation),  i,  5. 

Alcohol,  i,  30. 

(of  anaamia),  Amyl  nitrite,  i,  61, 

Anhalonium  Lewinii,  ii,  417. 

Antipyrine,  i,  301. 

Blisters,  i,  185. 

Bromoform,  i,  196. 

Caffeine,  i,  301. 

Camphor,  ii,  6. 

Chloralose,  i,  339. 

Ciouta  maculata,  i,  350. 

Cocaine,  i,  383. 

Coffee,  i,  390. 

Croton  oil,  i,  318. 

Ether,  i,  397. 

Eucalyptus,  oil  of,  i,  400. 

Exalgine,  i,  403. 

(ilalvanization,  stabile,  i,  366. 

Guarana,  i,  461. 

Hydrobromic  acid,  i,  493. 

Lavandula,  i,  578, 

Magnesia,  i,  591. 

Massage  of  the  neck,  i,  608. 

Menthol,  i,  614. 

Migrainin,  i,  631. 

Mustard  foot-bath,  i,  647. 

Nitroglycerin,  ii,  15. 

Nux  vomica,  ii,  88. 

Phenacetine,  ii,  71. 

Potassium  cyanide,  i,  333. 

Pulsatilla,  ii,  107. 

Pyrethrum,  ii,  109. 

Salipyrine,  ii,  148. 

Splenic  extract,  ii,  318. 

Thymacetine,  ii,  383. 

Thymol,  ii,  383. 

Valerian,  ii,  345. 
Headache,  chronic. 

Croton  oil,  by  application  to  the  nape  of  the 
neck,  i,  318. 
Headache  due  to  anaemia  of  the  hrain. 

Nitroglycerin,  ii,  15. 
Headache  due  to  intra-cranial  lesions. 

Blisters,  i,  185. 
Headache,  febrile. 

Pyramidone,  ii,  454. 
Headache,  frontal. 

Anhalonium  Lewinii,  ii,  417. 

Cocaine,  i,  383. 

Galvanization,  stabile,  i,  366. 

Nux  vomica,  ii,  88.    ■ 
Headache,  liysterical. 

Chloralose,  i,  839. 
Headache,  menstrual. 

Senecio,  ii,  456. 
Headache,  nervous. 

Anhalonium  Lewinii,  ii,  416. 

Cannabis  indica,  i,  67. 

Caffeine  and  antipyrine,  i,  301. 

Cicuta  maculata,  i,  350. 

Ether,  as  a  spray,  i,  397. 
"       (internally),  i,  397. 

Exalgine,  i,  403. 

Pulsatilla,  ii,  107. 

Thymacetine,  ii,  383. 

Valerian,  ii,  345. 


578 


INDEX  OF  DISEASES  AND  REMEDIES. 


Headache,  occipital. 

Anhalonium  Lewinii,  ii,  417. 

Galvanization,  stabile,  i,  366. 
Headache  of  indigestion. 

Ammonia  water,  i,  53. 

Ammonium  valerianate,  ii,  346. 

Magnesia,  i,  591. 

Mustard  foot-bath,  i,  647. 
Headache  of  influenza. 

Ethyl  chloride,  ii,  434. 

Migrainin,  i,  631. 
Headache  of  melancholia. 

Exalgine,  i,  403. 
Headache,  sick. 

See  Migraine. 
Heart  aHections. 

Hydrocyanic  acid,  i,  495. 

Strychnine,  ii,  28. 
Heart,  dilatation  of  the. 

Air,  condensed,  expiration  into,  i,  28. 

Digitalis,  i,  341. 
Heart  disease. 

Adonis,  i,  16. 

Alcohol,  ii,  235,  227. 

Amyl  nitrite,  i,  60 ;  ii,  227. 

Aspiration,  i,  150. 

Baths,  hot,  Ii,  325. 
"      Nauheim,  ii,  419. 

Bromides,  i,  194. 

Caffeine,  i,  301.     , 

Cardine,  i,  218. 

Carpaine,  i,  218. 

Cereus  grandiflorus,  i,  339. 

Cimicifuga,  i,  350. 

Convallaria,  i,  300. 

Corn  silk,  i,  306. 

Digitalis,  i,  341. 

Hydrochloric  acid,  i,  493. 

Mercury,  i,  620. 

Morphine,  ii,  36. 

Nux  vomica,  ii,  28. 

Opium,  ii,  36. 

Pulsatilla  (as  a  sedative),  ii,  106. 

Saline  infusion,  ii,  227. 

Schott  treatment,  ii,  419. 

Sodio-theobromine  salicylate,  ii,  303. 

Sparteine,  ii,  216. 

Squill,  i,  345. 

Strophanthus,  ii,  333. 

Strychnine,  ii,  38. 

"  injections,  ii,  450. 

Veratrum  viride,  ii,  358. 
Heart  disease,  valvular. 

Aspiration,  i,  150. 

Barium  chloride,  i,  101. 
Heart  disease  with  deficient  compensa- 
tion 

Hydrochloric  acid,  i,  493. 
Heart  failure  (sudden). 

Alcohol  (subcutaneously),  ii,  237. 

Amyl  nitrite,  ii,  337. 

Ether  (subcutaneously),  i,  397. 

Nux  vomica,  ii,  38. 

(in  acute  delirium  of  some  forms  of  insanity), 
Wine,  ii,  394. 
Heart  failure  during  anaesthesia. 

Strychnine  injections,  ii,  450. 
Heart,  fatty. 

Cimicifuga,  i,  350. 

Iron,  i,  317. 


Heart,  flagging  of  the. 

Counter-irritation,  ii,  237. 

Saline     infusion,    intra-arterial     or    intra- 
venous,   combined    with    strychnine,    ii, 
337. 
Heart,  irregular. 

Sodium  salicylate,  ii,  146. 
Heart,  irritable. 

Digitalis,  i,  343. 

Strophanthus,  ii,  333. 

Veratrum  viride,  ii,  353. 
Heart,  nervous  excitement  of  the. 

Bromides,  i,  194. 
Heart,  organic  disease  of  the. 

Caffeine,  i,  201. 
Heart,  palpitation  of  the. 

See  Palpitation  of  the  heart. 
Heart,  smoker's. 

Aconite  (tincture),  i,  9. 
Heart,  weak. 

Alcoholic  stimulants,  ii,  325. 

Cimicifuga,  i,  250. 

Com  silk,  i,  306. 

Digitalis,  i,  345. 

Scoparius,  i,  345. 

Squill,  i,  345. 

Wine,  port,  ii,  394. 
Heartburn. 

See  Dyspepsia,  Acid. 
Hemicrania. 

See  MiGKAiKE. 
Hemiplegia. 

See  Apoplexy. 
Hepatitis. 

Veratrum  viride,  ii,  352. 
Hepatitis,  congestire. 

Aspiration,  i,  151. 
Hepatitis,  suppurative. 

Aspiration,  i,  151. 
Hernia. 

Aspiration,  i.  152. 

Iodine  injection,  i,  536. 
Hernia,  strangulated. 

Bath,  hot,  i,  166,  489. 

Collodion,  i,  394. 

Ice  (topically),  i,  519. 

Lobelia,  infusion  of,  i,  587. 

Oxalic  acid,  ii,  49. 

Tartar  emetic,  i,  114. 

Tobacco-smoke  enema,  i,  304. 
Hernia,  umbilical. 

Collodion,  i,  394. 
Herpes. 

Acetanilide,  i,  3. 

Baths,  sulphurous,  i,  173. 

Blisters,  i,  186. 

Collodion,  i,  294. 

(for  pain).  Ethyl  chloride,  ii,  434. 

Euphorin  (as  a  local  disinfectant),  i,  403. 

Grindelia,  i,  456. 

Resorcin,  ii,  126. 

Salicylic  acid,  ii,  143. 

Zinc-acetate  ointment,  ii,  402. 

Zinc  oxide,  ii,  406. 
Herpes  labialis. 

Collodion,  i,  394. 
Herpes  praBputialis. 

Collodion,  i,  394. 
Herpes  zoster. 

See  Zoster. 


INDEX   OF  DISEASES  AND   REMEDIES. 


579 


Hiccoiig:]!. 

Apomorphine,  ii,  417. 

Chloral  hydrate,  i,  287. 

CUiloroform,  spirit  of,  i,  241. 

Conium,  i,  298. 

Muscarine,  i,  645. 

Musk,  ii,  6. 

Nitroglycerin,  ii,  15. 

Sulphonal,  ii,  239. 
Hip-joint  disease. 

Nucleins,  ii,  24. 
Hives. 

See  Urtioaria. 
Hoarseness. 

Catechu  lozenges,  i,  221. 

Placourtia,  i,  422. 

Potassium  chlorate,  ii,  96. 
Hodglfin's  disease. 

Arsenic,  i,  144. 
Hydrocele. 

Chloroform  (iniection),  i,  241. 

Claret  (by  injection),  ii,  394. 

Electricity,  i,  368. 

Iodine  injections,  i,  536. 

Silver  nitrate,  ii,  196. 

Sodium  chloride,  ii,  163. 

Zinc-chloride  injections,  ii,  404. 
Hydrocephalus. 

Croton  oil,  i,  318. 

Iodine  injection,  i,  536. 
Hydrocephalus,  acute. 

Infusion,  ii,  324. 
Hydrocephalus,  clironic. 

Aspiration,  i,  150. 
Hydrocephalus,  congenital. 

Collodion,  i,  294. 
Hydropericardi  urn. 

Aspiration,  i,  151. 
Hydrophobia. 

Conium,  i,  229. 

Curare,  i,  321. 

Serum  treatment,  i,  84. 
Hydrops  articnlornm  intermittens. 

Quinine,  ii,  120. 
Hydrosalpinx. 

Electricity,  i,  368. 
Hydrothorax. 

Aspiration,  i,  151. 

Jaborandi,  i,  559. 
Hyperacidity,  gastric. 

See  Dyspepsia,  Gastric. 
Hyperseinia. 

^aths,  cold,  i,  169,  170. 
"      condensed-air,  i,  27. 
"      warm,  i,  489. 

Collodion,  i,  294. 

Ergotole  (local  application),  i.  389. 

Ichthyol,  i,  522. 

Viburnum  prunifolium,  ii,  356. 
Hypersemia,  cerebral. 

Baths,  cold,  i,  169,  170. 
"      warm,  i,  489. 
Hyperajmia,  ocular. 

Collodion,  i,  294. 
HyperiBmia  of  the  pelvic  organs. 

Viburnum  prunifolium,  ii,  356. 
Hyperaeniia,  pulmonary. 

Baths,  cold,  i,  169. 
Hvpersesthesia. 

Baths,  hot  sitz,  i,  1C9. 


HypersBSthesia. 

Electricity,  i,  368. 

Salix.  ii,  149. 
Hyperaisthesia,  ovarian. 

Electricity,  i,  368. 
Hyperidrosis. 

Belladonna,  i,  103. 

(after  influenza).  Camphoric  acid,  ii,  438. 

Goto  bark,  i,  309. 

Dover's  powder,  i,  103. 

Ergot,  i,  102. 

Gallic  acid,  i,  432. 

Hydrastine,  i,  476. 

Mineral  acids,  i,  103. 

Muscarine,  i,  103. 

Naphthol  (in  solution),  ii,  2. 

Nux  vomica,  i,  102. 

Oak  bark,  ii,  31. 

Picrotoxin,  i,  103. 

Salicylic  acid,  ii,  144. 

Salvia,  ii,  456. 

Silver  oxide,  i,  197. 

Strychnine,  i,  102. 

Sulphuric  acid,  ii,  242. 

Tannic  acid,  ii,  257. 

Tannoform,  ii,  260. 

Zinc  oleate.  ii,  405. 
"     oxide,  i,  102. 
Hyperidrosis  of  the  feet. 

Boric  acid,  i,  102. 

Potassium  permanganate,  i,  597. 

Tannic  acid,  ii,  257. 

Tannoform,  ii,  260. 
Hyperidrosis,  partial. 

Sulphur,  i,  103. 
Hyperityrexia. 

See  Fevers. 
Hypertrophy  of  the  heart. 

Veratrum  viride,  ii,  353. 
Hypertrophy  of  the  liver. 

Iodine  salts,  i,  536. 
Hypertrophy  of  the  lymphatic  glands. 

Iodine  injections,  i,  536. 
Hypertrophy  of  the  nose. 

[gnipuncture,  i,  534. 
Hypertrophy  of  the  prostate. 

Aspiration,  i,  152. 

Iodine  (injection),  i,  536. 
Hypertrophy  of  the  spleen. 

Ammonium  fluoride,  i,  57. 

Grape  cure,  i,  455. 

Lead-iodide  ointment,  i,  57. 

Waters,  mineral,  ii,  366. 
Hypertrophy  of  the  testicles. 

Guaiaeol  applications,  ii,  439. 

Iodine  salts,  i,  536. 
Hypertrophy  of  the  tongue. 

Gold,  i,  453. 
Hypertrophy  of  the  tonsils. 

Catechu,  infusion  or  tincture,  i,  221. 

Ignipuncture,  i,  524. 

Iodine  (injections),  i,  536. 

Tannin,  glycerite  of,  ii,  256. 

Trichloracetic  acid,  ii,  330. 
Hypertrophy,  uterine. 

Galvanism,  i,  368. 

Iodine  salts,  i,  536. 
Hypochondriasis. 

Anhalonium  Lewinii,  ii,  416. 

Electricity,  i,  366. 


580 


INDEX  OP   DISEASES  AND  REMEDIES. 


Hvpochondriasis. 

Faradization,  general,  i,  366. 

Gold,  i,  453. 

Oxygen,  ii,  53. 

Rest-cure,  ii,  127.  ' 

Strychnine,  ii,  38. 
Hysteria. 

AUyl  tribromide,  ii,  414. 

Ammonia,  fcetid  spirit  of,  i,  53. 

Ammonium  carbonate,  i,  56. 
"  succinate,  i,  .^8. 

Amy]  nitrite,  i,  61. 

Anlialoniura  Lewinii,  ii,  416. 

Apomorphine,  ii,  418. 

Asafcetida,  i,  147. 

Bromides,  i,  193. 

Caffeine  valerianate,  ii,  346. 

Camphorated  oil,  ii,  6. 

Castor,  i,  219. 

Chamomile,  i,  231. 

Cineraria,  i,  358. 

Cocaine  (internally),  i,  284. 

Cold  affusions,  i,  17. 

Creosote,  i,  314. 

Croton-oil  application  to  the  spine,  i,  318. 

Paradaism,  i,  367. 

Galbanum,  i,  433. 

Gold  bromide,  i,  454. 

Iron  chloride  (tincture),  i,  549. 
"    valerianate,  ii,  346. 

Orchitie  liquid,  i,  76. 

Paraldehyde,  i,  509. 

Phosphoric  acid,  ii,  77. 

Pisoidia,  ii,  91. 

Quinine  valerianate,  ii,  347. 

Rest-cure,  ii,  137. 

Rue,  ii,  137. 

Sumbul,  ii,  343. 

Tansy,  ii,  261. 

Valerian,  ii,  345. 

Viburnum  prunifolium,  ii,  357. 

Waters,  thermal  (externally  and  internally), 
ii,  384. 
Hysteria,  vomiting  of. 

See  Vomiting,  Hysterical. 
Hystero-epilepsy. 

Amyl  nitrite,  i,  61. 

Bromides,  i,  193. 

Orchitie  liquid,  i,  76. 

Valerian,  ii,  345. 

Viburnum  prunifolium,  ii,  357. 

Ichthyosis. 

Baths,  alkaline,  i,  171. 

Cuprio-sulphate  solution,  i,  306. 

Naphthalan,  ii,  448. 

Salicylic-acid  ointment,  ii,  144. 

Thyreoid  feeding,  i,  79. 
Icterus. 

See  Jaundice. 
Impaction,  faecal. 

Gflycerin  injections,  i,  451. 

Lobelia  (enema  of  the  infusion),  i,  587. 

Ox-bile  enema,  ii,  49. 

Tobacco-smoke  enema,  ii,  304. 

Water  (rectal  applications),  i,  479. 
Impetigo. 

Cod-liver  oil,  i,  288. 

Salicylic  acid,  ii,  241. 

Sulphur  fumes,  ii,  341. 


IiTipetigo. 

Tumenol  oil  nnd  oxide  of  zinc,  ii,  334 
Impetigo  contagiosa. 

Salicylic  acid,  ii,  145. 
Impotence. 

Apiol,  i,  137. 

Asafcetida,  i,  147. 

Cantharis,  i,  136. 

Carbonic-acid  gas.  i,  314. 

Carrot  seeds,  i.  137. 

Cashew  nut,  i,  219. 

Cimieifuga,  i,  137,  350. 

Damiana,  i,  334. 

Douches,  hot  and  cold,  i,  137. 

Electricity,  i,  137. 

Ergot,  i,  i37. 

Flagellation,  i,  137. 

Gold  chloride,  i,  137. 

Juniper,  oil  of,  i,  137. 

Lotions,  stimulating,  i,  137. 

Nux  vomica,  i,  137. 

Orchitie  liquid,  i,  76. 

Pepper  (black  and  red),  i,  136. 

Phosphorus,  i,  137 ;  ii,  77. 

Polygonum  hydropiperoides,  i,  137. 

Rue,  oil  of,  i,  137. 

Sanguinaria,  ii,  154. 

Savine,  oil  of,  i,  137. 

Strychnine,  i,  137. 

Testicle  juice,  i,  76. 

Turpentine,  i,  137 ;  ii,  336. 

Wines,  i,  137. 

Zinc  phosphide,  i,  137. 
Inanition. 

Transfusion,  ii,  333. 
Incontinence  of  urine. 

Ammonium  benzoate,  i,  177. 

Cantharides,  i,  308. 

(in  young  boys),  Collodion,  i,  394. 

Humulus,  i,  474. 

Kava,  i,  564. 

Lycopodium  tincture,  i,  590. 

Massage  (Brandt's  method),  i,  609. 

(from  vesical  atony),  Rhus  aromatica,  ii,  131. 

Rhus  toxicodendron,  ii,  133. 

Turpentine  oil,  ii,  336. 

(from  nervousness).  Zinc  valerianate,  ii,  347. 
Incontinence,  nocturnal,  of  urine  (in  chil- 
dren). 

Baths,  cold,  i,  169. 

Belladonna,  i,  175. 

Orchitie  liquid,  i,  76. 

Santonin,  ii,  155. 

Testicle  juice,  i,  76. 
Indigestion. 

See  Dyspepsia. 
Indurations,  glandular. 

Calcium  chloride,  i,  303. 

Cupric  oxide,  i,  305. 

Manganese  sulphate  (ointment),  i,  596. 
Inebriety. 

See  Alcohol  habit. 
Inertia,  intestinal. 

Massage,  abdominal,  i,  605,  608. 
Inertia,  uterine. 

Abdominal  binder,  ii,  56. 

Cold  applications,  ii,  56. 

Cimieifuga,  ii,  55. 

Cornutine,  i,  307. 

Cotton  root,  extract  of,  ii,  55. 


INDEX  OF  DISEASES  AND  REMEDIES. 


581 


Inertia,  uterine. 

J51ectricity,  ii,  55. 

Ergot,  i,  388. 

Glycerin  (intra-uterine   injections),   i,   450; 
ii,  55. 

Heat,  i,  468 ;  ii,  56. 

Hydrastis  canadensis,  ii,  55. 

Mammary  irritation,  ii,  56. 

Quinine,  i,  356;  ii,  116,  120. 

Rue,  ii,  137. 

Sugar,  ii,  234. 
Infiltrations. 

Atropine,  i,  154. 
Inflammation. 

Aconite,  i,  9,  118. 

Ammonium  cliloride,  i,  56. 

Arnica,  i,  141. 

Arsenic,  i,  146. 

Baths,  hot,  i,  166. 

Belladonna  and  morphine  injections,  i,  67. 
"  ointment,  i,  173. 

Bismuth,  i,  181. 

Boric  acid,  i,  196. 

Brucine,  ii,  29. 

Caffeine,  i,  201. 

Carbolic  acid,  i,  212. 

Collodion,  salioylated,  i,  293. 
"  saturnine,  i,  293. 

Copper  arseuite,  i,  805. 

Croton  oil,  i,  318. 

Cupping,  i,  320. 

Digitalis,  i,  342. 

(joose  grease,  i,  455. 

Ice  (topically),  i,  519. 

Iodoform  collodion,  1,  293. 

Linseed  tea,  ii,  269. 

Opium,  ii,  37. 

Phytolacca,  ii,  81. 

Poultices,  ii,  101. 

Pulsatilla,  ii,  107. 

Salines,  ii,  147. 

Scopolamine,  ii,  159. 

Silver  nitrate,  ii,  194,  195. 

Tannin,  ii,  255. 

Taraxacum,  ii,  265. 

Terebene,  ii,  271. 

Thymol,  ii,  284. 

Veratrum  viride.  i,  118;  ii,  352. 

Waters,  mineral,  ii,  372. 

Wines,  ii,  894. 

Xanthoxylum,  ii,  396. 

Yerba  santa,  ii,  401. 

Zinc  iodide,  ii,  405. 
Inflammation,  abdominal. 

Salines,  ii,  147. 
Inflammation,  acute,  of  tlie  serous  mem- 
branes. 

Aconite,  i,  9. 
Inflammation,  acute  stlienic. 

Aconite,  i,  118. 

Veratrum  viride,  i,  118. 
Inflammation,  clironic,  of  tlie  intestines. 

Silver  nitrate,  ii,  194. 
Inflammation,  clironic,  of  the  joints. 

Croton  oil,  i,  318. 
Inflammation,  clironic  pulmonary. 

Yerba  santa,  ii,  401. 
Inflammation,  chronic   purulent,  of  the 
middle  ear. 

Silver  nitrate,  ii,  195. 


Inflammation,  chronic  uterine. 

See  Metritis,  Chronic. 
Inflammation,  intracranial. 

See  Encephalitis  and  Meningitis. 
Inflammation,  local. 

Digitalis,  i,  342. 
Inflammation  of  joints. 

See  Rheumatism. 
Inflammation  of  muscles. 

See  Rheumatism. 
Inflammation  of  nerves. 

See  Neuritis. 
Inflammation  of  the  dental  pulp. 

Thymol,  ii,  284. 
Inflammation  of  the  external  ear. 

See  Otitis,  External. 
Inflammation  of  the  eyelids. 

See  Blepharitis. 
Inflammation  of  the  iris. 

See  Iritis. 
Inflammation  of  the  kidney. 

See  Nephritis. 
Inflammation  of  the  liver  and  spleen. 

Taraxacum,  ii,  265. 
Inflammation  of  the  lymphatic  glands. 

See  Adenitis. 
Inflammation  of  the  mammary  glands. 

See  Mastitis. 
Inflammation  of  tlie  middle  ear. 

See  Otitis  media. 
Inflammation  of  the  mouth. 

See  Stomatitis. 
Inflammation  of  the  mucous  membranes. 

Zinc  iodide,  ii,  405. 
Inflammation  of  the  mucous  membrane  of 
the  Eustachian  tube. 

Silver  nitrate,  ii,  195. 
Inflammation  of  the  pelvic  cellular  tissue. 

See  Cellulitis.  Pelvic. 
Inflammation  of  the  pharynx. 

See  Pharyngitis. 
Inflammation  of  tlie  respiratory,  gastro- 
intestinal, .ind  urinary  membranes. 

Linseed  tea,  ii,  269. 
Inflammation  of  the  serous  membranes. 

Quinine,  ii,  119. 

Xanthoxylum,  ii,  396. 
Inflammation  of  the  uterus. 

See  Metritis. 
Inflammation  of  the  vagina. 

See  Elytritis. 
Inflammation  of  the  vermiform  appendix. 

Waters,  Buffalo  lithia,  ii,  372. 
Inflammation,  parenchymatous. 

Veratrum  viride,  ii,  352. 
Inflammation,  perimetric. 

See  Perimetritis. 
Inflammation,  pseudo-membranous. 

Carbolic  acid,  i,  312. 
Inflammation,  purulent. 

Wines,  ii,  394. 
Inflammation,  rheumatic. 

See  Rheumatism. 
Inflammation,  serous. 

Veratrum  viride,  ii,  352. 
Inflammation,  subacute  rheumatic. 

Goose-grease  liniment,  i,  455. 
Inflammatory,  chronic,    thickening   and 
deposits. 

Cold  and  hot  affusions,  i,  17. 


583 


INDEX  OP  DISEASES  AND  EEMEDIES. 


Inflammatory  cutaneous  affections. 

Ulmus  (local  applications),  ii,  338. 
Inflammatory  deposits. 

Thiol  ointment,  ii,  378. 
Inflammatory  derang'ements  of  tlie  mucous 
membranes  of  tlie  body. 

Copper  arsenite,  i,  304. 
Inflammatory  processes. 

Turpentine,  ii,  335. 
Inflammatory  processes,  acute. 

Wine,  ii,  393. 
Inflammatory  throat  affections. 

Xanthoxylum  (as  a  gargle),  ii,  396. 
Influenza. 

Acetanilide,  i,  3. 

Ammonium  acetate,  i,  54. 

Antikamnia,  i,  112. 

Antitetraizine,  i,  134. 

Asaprol,  i,  148. 

Blennostasine,  ii,  426. 

Calcium  sulphide,  ii,  428. 

Camphor  and  sweet-almond  oil  (internally), 
i,  205. 

Cinnamon,  oil  of,  i,  259. 

Copper-arsenite  solution,  i,  304. 

Goose  grease  (internally),  i,  454. 

Guaiaool,  i,  460. 

Laotophenine,  i,  568. 

Naphthol,  ii,  2. 

Nucleins,  ii,  24. 

Pambotano,  ii,  58. 

Phenacetine.  ii,  73. 

Pilocarpine,  ii,  86. 

Saligenin,  ii,  147. 

Salol,  ii,  150. 

Salophene,  ii,  151. 

Scopolamine  hydrobromide,  ii,  159. 

Serum  therapy,  i,  85. 

Sodium  bicarbonate,  ii,  205. 

Wine,  ii,  394. 
Insanity. 

Baths,  cold,  i,  488. 

Camphor,  i,  205. 

Chemical  restraint,  i,  233. 

Exercise,  i,  413. 

Forced  feeding,  i,  43. 

Hyoscyamus,  i,  504. 

Marrow,  bone,  ii,  445. 

Paraldehyde,  ii,  62. 

Thyreoid  feeding,  i,  79  ;  ii,  296,  299. 

Zinc  phosphate,  ii,  410. 
Insanity     during     convalescence     from 
fevers. 

Zinc  phosphate,  ii,  410. 
Insanity,  puerperal. 

Thyreoid  treatment,  ii,  291. 
Insanity,  stuporous. 

Thyreoid  treatment,  ii,  299. 
Insolation. 

AflEusions,  cold,  i,  16. 

Atropine,  hypodermically,  i,  156. 

Baths,  cold,  i,  165.  486 ;  'ii,  225. 

Bloodletting,  i,  188. 

Ethyl  chloride,  ii,  434. 

Ice  applications,  i,  16. 

Quinine,  hypodermically,  ii,  126. 
Insolation  of  the  eyes. 

Nux  vomica  (injections),  ii,  39. 
Insomnia. 

Alcohol,  i,  506. 


Insomnia. 

Ammonium  valerianate,  ii,  346. 

Amylene  hydrate,  i,  507. 

Bath,  half,  i,  169. 
•'      hot,  i,  166. 

Baths,  vapour,  i,  171. 

Bromides,  i,  194,  507. 

Calcium  bromide,  i,  201. 

Cannabis  indica,  i,  207,  507. 

Chloralamide,  i,  238,  507. 

Chloral  ammonium,  i,  235. 
hydrate,  i,  236,  507. 

Chloralose,  i,  239. 

Chlorobrom,  i,  240. 

Codeine,  i,  286. 

Croton  chloral,  i,  508. 

Exalgine,  i,  403. 

Hyoscine,  i,  504,  508. 

Hyoscyamus,  i,  504,  508. 

Hypnone,  i,  5. 

Hypnotics,  i,  500. 

Massage,  i,  608. 

Meconarceine,  i,  611. 

Methylal,  i,  629. 

Morphine,  i,  508. 

Opium,  i,  508;  ii,  36. 

Oxygen,  ii,  53. 
Paraldehyde,  i,  409 ;  ii,  63. 
Phenacetine,  ii,  71. 
Phosphorus,  ii,  76. 
Piscidia,  i,  509 ;  ii,  91. 
Sodium  lactate,  ii,  207. 
Scopolamine  hydrobromide,  ii,  159. 
Somnal,  ii,  213. 
Sulphonal,  i,  509 ;  ii,  239. 
Tetronal,  ii,  278. 
Trional,  i,  509  ;  ii,  382. 
Urethane,  ii,  342. 
Waters,  thermal,  ii,  364. 
Whisky,  i,  506. 
Wine,  port,  ii,  394. 
Insomnia  from  pain. 

Anhalonium  Lewinii,  ii,  416. 
Insomnia,  nervous. 
Chl'.ral  hydrate,  i,  236. 
Codeine,  i,  286. 
Exalgine,  i,  403. 
Opium,  i,  508. 
Piscidia,  ii,  91. 
Sulphonal,  ii,  239. 
Tetronal,  ii,  273. 
Insomnia  of  acute  infectious  diseases. 

Tetronal  ii,  373. 
Insomnia  of  anajmia. 

Phosphorus,  ii,  76. 
Insomnia  of  chronic  heart  disease. 

Ural,  ii.  838. 
Insomnia  of  delirium  tremens. 

Opium,  i,  508. 
Insomnia  of  dentition  and  indigestion 

Trional,  ii,  333. 
Insomnia  of  diseases  of  the  uterus. 

Phenacetine,  ii,  71. 
Insomnia  of  hysteria. 

Valerian,  ii,  345. 
Insomnia  of  insanity. 
Paraldehyde,  i,  509  ;  ii,  62. 
Scopolamine  hydrobromide,  ii,  159. 
Insomnia  of  melancholia. 
Exalgine,  i,  403. 


INDEX  OP  DISEASES  AND  REMEDIES. 


583 


Inspissation,  biliary. 

Sodium  phosphate,  ii,  79. 
Intermittent  fever. 

Ammonium  carbazotate,  i,  55. 

Arsenic,  i,  117,  145. 

Calotropis,  i,  203. 

Capsicum  and  quinine,  i,  309. 

Carbolic  acid,  i,  212. 

Cassia  occidentalis,  i,  319. 

Chloroform,  i,  341. 

Cupric  sulphate,  i,  306. 

Hydrastine,  i,  476. 

Lemon-iuioe  and  salt,  or  coffee,  i,  260. 

Magnolia,  i,  592. 

(with  hepatic  engorgement),  Nitric  acid  and 
quinine,  ii,  8. 

(cold  stages).  Nitroglycerin,  ii,  15. 

Quinine,  i,  117. 

Salipyrine,  ii,  148. 

Serpentaria,  ii,  163. 

Sodium  chloride,  ii,  206. 

Tansy,  ii,  361. 
Intermittent  fever,  masked. 

Quinine,  ii,  118. 
Intermittent  fever,  pernicious. 

Quinine  (hypodermically),  i,  117. 
Intertrigo. 

Airol,  ii,  414. 

Bismuth  subnitrate  (as  a  dusting  powder),  i, 
181. 

Camphor  powder  (with  starch)  or  ointment, 
i,  304. 

Chalk  powder,  i,  330. 

Collodion,  i,  394. 

Copper-arsenite  solution,  i,  304. 

Ichthyol  (salve  or  solution),  i,  523. 

Salicylic  acid,  ii,  143. 

Starch,  powdered,  ii,  333. 

Talc  powder,  ii,  354. 

Tannic-acid  ointment,  ii,  356. 

Zinc  oxide,  ii,  406. 
Intestinal  disorders. 

Copper  arsenite,  i,  305. 

Ichthyol,  ii,  443. 

Irrigation  of  the  stomach,  i,  491. 

Mercury  and  chalk,  i,  632. 

Thymol,  ii,  383. 

Water,  i,  479. 

Zinc  sulphocarbolate,  ii,  411. 
Intussusception,  intestinal. 

Lobelia,  infusion  of,  i,  587. 

Sodium  bicarbonate  (injections),  ii,  304. 

Tobacco  smoke,  enemata  of,  ii,  304. 
Irido-chorioiditis,  rheumatic. 

Salicylic  acid,  ii,  143. 
Iritis. 

Atropine,  i,  155. 

Blisters  (on  the  temple),  i,  185. 

Ethyl  chloride,  ii,  434. 

Mercury,  i,  619. 

Scopolamine  hydrobromide,  ii,  159. 

Suprarenal  capsule,  ii,  347. 

Water,  hot  applications  of,  ii,  213. 
Iritis,  gonorrliaeal. 

Sodium  salicylate,  ii,  146. 
Iritis,  plastic. 

Scopolamine  hydrobromide,  ii.  159. 

Water,  hot  applications  of,  ii,  313. 
Iritis,  rlieumatic. 

Sodium  salicylate,  ii,  146. 


Irritability,  nervous. 

Asafoetida,  ii,  6. 
Irritability  of  the  bladder. 

See  Incontinence  op  urine. 
Irritability,  vesical. 

Corn  silk,  i,  306. 
Irritation,  chronic  vesical. 

Buchu,  i,  197. 
Irritation,  gastric. 

Papain,  ii,  60. 
Irritation,  rectal. 

Bismuth  injections,  i,  181. 
Irritation,  spinal. 

Baths,  halt,  i,  169. 

Cupping,  i,  320. 

Erythrophloiine,  i,  390. 

Paradaism,  i,  367. 

Ice,  i,  530. 

Neurodin,  ii,  7. 
Irritation,  urinary. 

Tribulus  lanilginosus,  ii,  330. 
Itching. 

See  Pbueitus. 

Jaundice. 

Acid  baths,  i,  171. 

Aloes,  i,  49. 

Calomel,  i,  634. 

Chelidonium  (as  a  purgative),  i,  233. 

Chionanthus  virginica,  i,  234. 

Dulcamara,  i,  353. 

Gold,  i,  454. 

Ipecac,  i,  543. 

Iron  succinate,  i,  553. 

Lemonade,  i,  360. 

Massage,  abdominal,  i,  608. 

Moringa,  ii,  447. 

Nitrohydrochloric  acid  (for  bathing),  ii,  16. 

Podophyllin,  ii,  93. 

Quinine,  i,  355. 

Salicin,  ii,  140. 

Salol,  ii,  150. 

Sanguinaria,  ii,  154. 

Senecin,  ii,  161. 

Senecio,  ii,  162. 

Sodium  phosphate,  ii,  79,  308. 

Viehv  water,  ii,  358. 

Waters,  Buffalo  lithia,  ii.  373. 
"        mineral,  ii,  375,  379. 
"       sodium-sulphate,  ii,  368. 
Jaundice,  catarrhal. 

Aloes,  i,  49. 

Ipecac,  i,  543. 

Podophyllin.  ii,  93. 

Salicin,  ii,  140. 

Sodium  phosphate,  ii,  79. 
Jaundice,  epidemic. 

Sodium  phosphate,  ii,  308. 

Keloid. 

Chromic  acid,  i,  348. 
Ichthyol,  i,  532._ 
Thiosinamine,  ii,  381. 
Keratitis. 
Antipvonine  i,  120. 
Aristdl,  i,  140. 
Benzophenoneid,  i,  179. 
Cadmium  saliovlate  injections,  i,  200. 
Collodion,  i.  394. 
Eserine,  i,  392. 


584 


INDEX  OP  DISEASES  AND  REMEDIES. 


Eeratitig. 

Gallicin,  i,  433. 

Suprarenal  capsule,  ii,  246. 

Tropacocaine,  ii,  334. 
Keratitis,  interstitial. 

Aristol,  i,  140. 

Suprarenal  capsule,  ii,  346. 
Keratitis,  phlyctaenular. 

Eserine,  i,  393. 
Keratitis,  ulceratiye. 

Eserine,  i,  393. 
Keratosis  of  the  soles  and  palms. 

Emol,  i,  376. 

Labour. 

Ctiloral  hydrate,  i,  337. 

(second  stage).  Chloroform  inhalation,  i,  345. 

Ergot,  ii,  55. 

Ether,  i,  397. 

Glycerin  (intra-uterine  injections),  i,  450. 

Hypnotism,  i,  514. 

Nitrous  oxide,  ii,  18. 

Quinine,  ii,  116. 

Quinosal  irrigation,  ii,  123. 
Labour,  difficult. 

See  Dystocia. 
Labour  pains. 

Chloroform,  i,  245. 

Glycerin  (intra-uterine  injections),  i,  450. 

Hot  douche,  ii.  55. 
Labour,  preliminary  pains  of. 

Baths,  hot,  i,  166. 
Labour,  prolonged. 

Quinine,  ii,  116. 
Lacrymation. 

Alumnol  (in  solution),  i,  51. 

Exercise,  vocal  and  respiratory,  i,  417. 

Mydrol,  ii,  447. 
Laryngismus  stridulus. 

Bromoform,  i,  196. 

Chloral  hydrate,  i,  337. 

Coniura,  i,  398. 

Gelsemium,  i,  437. 

Ipecac,  i,  543. 

Muscarine,  i,  645. 

Nitroglycerin,  ii,  15. 

Quinine,  i,  356  ;  ii,  119. 
Laryngitis. 

Ammonium-chloride  troches,  i,  57. 

Asafoetida,  i,  147. 

Benzoin,  i,  178. 

Borax  and  honey,  i,  189. 

Calomel  powder,  i,  635. 

Chromic  acid  (as  a  wash),  i,  348. 

Conium  vapour,  i,  399. 

Creosote,  i,  314. 

Cupric  sulphate,  i,  306. 

Fir-wool  oil,  ii,  88. 

Forinic-aoid  compounds,  i,  429. 

Ipecac,  i,  543. 

Jaborandi  (by  spray),  i,  560. 

Lactic  acid,  i,  507. 

Licorice  and  flaxseed,  i,  581. 

Olibanum,  ii,  34. 

Opium,  fumes  of,  i.  539. 

Palmetto  wine,  ii,  58. 

Serum  treatment,  ii,  173, 

Silver  nitrate,  ii.  196. 

Tannigene,  ii,  260. 

Thymol,  ii,  284. 


Laryngitis. 

Waters,  chlorinated  alkaline,  ii,  367. 
Zinc  chloride,  ii,  405. 
"     sulphocarbolate,  ii,  412. 
Laryngitis,  acute. 
Benzoin  and  paregoric  inhaled  from  steam- 
ing water,  i,  538. 
Benzoin  inhalation,  i,  178. 
Conium-vapour  inhalations,  i,  299. 
Ipecac,  i,  543. 

Waters,  chlorinated  alkaline,  ii,  381. 
Laryngitis,  catarrhal. 

Zinc  sulphocarbolate,  ii,  412. 
Laryngitis,  chronic. 

Benzoin  inhalation,  i,  178. 

Cod-liver  oil,  i,  388. 

Creosote  by  inhalation,  i,  314. 

Fir-wool  oil  inhalation,  ii,  88. 

Silver  nitrate,  ii,  196. 

Waters,  chlorinated  alkaline,  ii,  367. 

Zinc-chloride  applications,  ii,  405. 
Laryngitis,  diphtheritic. 

Serum  treatment,  ii,  172. 
Laryngitis,  pseudo-membranous. 

Cupric  sulphate  (as  an  emetic),  i,  306. 
Laryngitis,  subacute. 

Silver  nitrate,  ii,  196. 
Laryngitis,  sypliilitic. 

Calomel  powder  (by  insufflation),  i,  635. 

Zinc  sulphocarbolate,  ii,  412. 
Laryngitis,  tuberculous. 

Chlorophenols,  i,  245. 

Diaphthol,  i,  333. 

Formic-acid  compounds,  i,  429. 

lodol  (by  insufflation),  i,  540. 

Lactic  acid,  i,  567. 

Pichi,  ii,  82. 
Laryngorrhoea. 

Blennostasine,  ii,  426. 
Laryngo-tracheitis. 

Waters,  chlorinated  alkaline,  ii,  381. 
Lentigo. 

Borax  (in  5-per-cent.  solution),  i,  189. 

Mercury  bichloride,  i,  636. 

Salicylic-acid  ointment,  ii,  144. 
Lepra,  Leprosy. 

Calotropis.  i,  303. 

Chaulmoogra  oil,  i,  333. 

Creolin,  i.  312. 

Gurjun  balsam,  i,  462. 

Hoang-nan,  i,  471. 

Hydrocotyle  asiatioa,  i,  498. 

Ichthyol,  i,  533. 

Iron,  reduced,  i,  547. 

Mercury  iodide  and  arsenic,  i,  637. 

Orohitic  liquid,  i,  75. 

Serum,  de  Dios  Carrasquilla's,  ii,  184. 
"        treatment,  ii,  184. 

Testicle  juice,  i,  75. 

Thyreoid  treatment,  ii,  395. 

Zinc  gynooardate,  ii,  409. 
Lencatmla. 

Oxygen,  ii,  53. 
Leucoplakia. 

Resorcin,  ii,  126. 
Leucorrhoea. 

Arsenic,  i,  146. 

Bismuth  tannate,  ii,  259. 

Borax  and  hot  water  (douche),  i,  189. 

Carbonic  water  (douche),  i,  314. 


INDEX  OF  DISEASES  AND  REMEDIES. 


585 


Leucorrhoea. 

Catechu  injections,  i,  221. 

Charcoal  douche,  i,  232. 

Copper-arsenite  solution,  i,  304. 

Cubeb,  i,  319. 

Ephedra  trifurcata,  as  a  styptic,  i,  385. 

Geranium  (topically),  i,  438. 

Helenin  (as  an  antiseptic),  i,  534. 

Hydrastine,  i,  476. 

Iodine,  externally,  i,  536. 

Iron  nitrate,  i,  551. 

Kino,  i,  565. 

Krameria,  i,  566. 

Lysol,  i,  590. 

M'atico,  i,  611. 

Myrrh,  tincture  of,  i,  651. 

Oak  bark,  ii,  31. 

Potassium  permanganate,  i,  597. 

Potassium  permanganate  (injections),  ii,  70. 

Phosphoric  acid,  ii,  77. 

Pinus  canadensis,  ii,  88. 

Pulsatilla,  ii,  107. 

Resorcin,  ii,  126. 

Storax,  ii,  228. 

Thymol,  ii,  284. 

Trichlorphenol,  ii,  330. 

Waters,  mineral  (injections),  ii,  875,  383. 

Zinc  acetate  (as  a  local  astringent),  ii,  402. 
LencoiThoea,  chronic. 

Waters,  mineral,  ii,  383. 
Leucorrhcea,  chronic  vaginal. 

Arsenic,  i,  146. 
Leucorrhcea,  mucous. 

Pulsatilla,  ii,  107. 
Leucorrhoea,  vaginal. 

Arsenic,  i,  146. 

Hydrastine  (as  a  douche),  i,  476. 
Lice. 

See  Phtheiriasis  capitis. 
Lichen. 

Silver  nitrate,  ii,  196. 
Lichen  sestivus. 

Salicylic  acid,  ii,  145. 
Lichen,  itching  of. 

Alkaline  baths,  i,  45. 
Lichen  planus. 

Arsenic,  i,  144. 
Lichen  ruber. 

Arsenic,  i,  144. 
Lithsemia. 

Ammonium  chloride,  i,  56. 

Calcium  benzoate,  i,  201. 

Lithium  benzoate,  i,  177. 

Nitric  acid,  ii,  8. 

Nitrohydrochloric  acid,  ii,  16. 

Sodium  benzoate,  ii,  204. 
"       phosphate,  ii,  79,  208. 

Water,  flushing  the  alimentary  and  urinary 
tracts  with,  i,  479. 
Lithiasis. 

Actinomeris  helianthoides,  i,  11. 

Alisma,  i,  43. 

Alkalies,  i,  45. 

Alkaline  mineral  waters,  i,  45. 

Soldo,  i,  189. 

Corn  silk,  i,  306. 

Glycerin,  i,  451. 

Lithium,  i,  586. 

"        benzoate,  i,  585,  586. 
"        carbonate,  i,  586. 


Lithiasis. 

Lithium  citrate,  i,  586. 

Lycetol,  i,  589. 

Piperazine,  i,  586 ;  ii,  89. 

Water,  i,  586. 

"       Carlsbad,  i,  586. 

Waters,  Buffalo  lithia,  i,  586 ;  ii,  372. 

Waters,  mineral,  ii,  368,  377. 
Lithiasis,  biliary. 

See  Calculus,  Biliaey. 
Lithiasis,  urinary. 

Ammonium  benzoate,  i,  586. 
borate,  i,  55,  586. 

Hydrochloric  acid,  i,  493,  586. 

Lithium  benzoate,  i,  585,  586. 
"        carbonate,  i,  586. 
citrate,  i.  586. 
salts,  i,  585. 

Nitric  acid,  i.  586 ;  ii,  7. 

Pichi,  i,  586 ;  ii,  82. 

Piperazine,  i,  586;  ii,  89. 

Potassium  acetate,  i,  586 ;  ii,  95. 
"         bicarbonate,  i,  586. 

Sodium  and  magnesium  borooitrate,  ii,  303. 
"        bicarbonate,  i,  586. 
borate,  i,  189,  586. 

Sulphuric  acid,  i,  586. 

Triticum  ripens,  i,  586. 

Turpentine,  oil  of,  i,  586. 

Water,  i,  479. 
Liver,  amyloid. 

Ammonium  chloride,  i,  57. 
Liver,  chronic  engorgement  of  the,  and 
spleen. 

Baths,  cold,  i,  169. 
Liver,  cirrhosis  of  the. 

See  Cirrhosis  oi'  the  liver. 
Liver,  diseases  of  the. 

Baths,  acid,  i,  171. 

Colocynth,  i,  296. 

Mineral  acids,  ii,  228. 
"        cathartics,  ii,  238. 

Nitrohydrochloric  acid,  ii,  16. 

Saline  cathartics,  ii,  228. 

Solanum  paniculatum,  ii,  210. 

Vichy  water,  ii,  358. 
Liver,  disordered. 

Hunyadi  Janos,  i,  474. 

Sulphur,  ii,  240. 

Water,  i,  479. 

Waters,  mineral,  ii,  374. 
Liver,  fatty. 

Ammonium  carbonate,  i,  56. 
Liver,  functional  disorders  of  the. 

Grape  cure,  i,  455. 

Hepatic  douches,  i,  349. 

Podophyllin,  ii,  93. 
Liver,  torpid. 

Alkaline  carbonates,  i,  45. 

Ammonium  chloride,  i,  56. 

Calomel,  i,  624. 

Colocynth,  i,  296. 

Sodium  phosphate,  ii,  79. 
"       sulphate,  ii,  208. 

Strychnine,  ii,  28. 

Tartarlithine,  ii,  265. 
Lochia,  offensive. 

Thymol,  ii,  284. 
Locomotor  ataxia. 

Acetanilide,  i,  8. 


586- 


INDEX  OP  DISEASES  AND  REMEDIES. 


Locomotor  ataxia. 

Antipyrine,  i,  124. 

Baths,  Nauheira,  ii,  420. 

Cinchona,  ii,  120. 

Erythrophloeine  (hypodermically),  i,  390. 

Paradaism,  i,  367. 

(pains),  Glyceropliosphates,  ii,  439. 

Massage,  i,  608. 

Orohitic  liquid,  i,  74. 

Phosphorus,  ii,  76. 

Salicylic  acid  (for  the  pain),  ii,  142. 

Salol",  ii.  150. 

Silver  and  sodium  hyposulphite,  ii,  197. 

Spermine,  ii,  217. 

Testicle  juice,  i,  74. 

Theine  (for  the  relief  of  pain),  ii,  277. 

Waters,  mineral,  ii,  374. 
Locomotor  ataxia,  fulgurant,  or   liglit- 
ning;,  pains  of. 

Acetanilide,  i,  3. 

Antipyrine,  i,  124. 
Lumbago. 

Anodyne  colloid,  i,  292. 

Apolysine,  ii,  417. 

Capsicum  paper,  i,  209. 

Chloroform  liniment,  i,  241. 

Cimicifuga,  i,  250. 

Exalgine,  i,  403. 

Faradaism  and  galvanism,  i,  367. 

Glycerophosphates,  ii,  439. 

Massage,  i,  608. 

Piperazine,  ii,  89. 

Poultices,  ii,  101. 

Spice  bag,  application  of,  i,  209. 

Salicin,  ii,  140. 

Sulphur  powder,  ii,  241. 

Theine,  ii,  277. 

Turpentine  oil,  ii,  336. 
Lupus. 

Aristol,  i,  140. 

Arsenic,  i,  144. 

Calcium  chloride,  i,  202. 

Camphor  salicylate,  ii,  455. 

Carbolic  acid  (parenchymatous  injections), 
i,  213. 
'    Catramine,  i,  226. 

Chromic  acid,  i,  248. 

Cod-liver  oil  and  iron,  i,  288. 

Europhene,  in  powder  or  ointment,  1,  402. 

Gold,  i,  453,  454. 

Hydrocotyle  asiatica,  i,  493. 

Iodine,  i,  536. 

Lysol.  i,  590. 

Mercury  bichloride  (ointment),  i,  115. 
"        iodide  and  arsenic,  i,  627. 

Phosphorus,  ii,  77. 

Potassium  permanganate,  i,  115. 

Pyrogallio  acid,  ii.  111. 

Resorcin,  ii,  126. 

Salicylated  camphor,  i,  204. 

Salicylic  acid,  ii,  144. 

Serum  treatment,  Maragliano's,  ii,  184. 

Silver  nitrate,  ii,  196. 

Starch,  iodized,  i,  537. 

Tar,  ii,  92. 

Teucrin,  ii,  373. 

Thiol  ointment,  ii,  278. 

Thiosinamine,  ii,  279,  280. 

Thyreoid  treatment,  ii,  294. 

Tuberculin,  i,  81. 


Lupus. 

Zino-chloridc  applications,  ii,  404. 

Zinc  nitrate,  ii,  409.  457. 
"     sulphide,  ii,  411. 
Lupus  erytliematosus. 

Arsenic,  i,  144. 

Resorcin,  ii,  126. 

Salicylic  acid,  ii,  144. 

Starch,  iodized,  i,  537. 

Thiosinamine,  ii,  280. 

Zinc  nitrate,  ii,  409. 
"    sulphide,  ii,  411. 
Lupus  vulgaris. 

Arsenic  (arsenical  caustics),  i,  145, 

Silver  nitrate,  ii,  457. 

Teucrin,  ii,  273. 

Thiosinamine,  ii,  280. 
Lymphadenitis,  chronic. 

Waters,  ferruginous,  ii,  369. 
Lymphadenomn. 

Zinc  phosphide,  ii,  407. 
Lymphangeitis. 

Baths,  hot,  i,  160. 

Picric  acid,  ii,  83. 
Lymphangeio-phlebitis. 

Ichthyol,  ii,  443. 
Lymphoma. 

Arsenic,  i,  144. 

Malarial  cachexia. 

Quinine,  i,  255. 
Malarial  chills. 

Strophanthus,  ii,  233. 
Malarial  disease. 

Ammonium  carbazotate,  i,  55. 

Arsenic,  i,  145. 

Baths,  hot,  i,  166. 

Bitters,  i,  118. 

Calomel,  i,  624. 

Coffee,  black,  i,  290. 

Eucalyptus,  i,  118. 

Qelsemium.  i,  437. 

Ipecac,  i,  543. 

Iron  citrate,  i.  550. 

Jalap  (resin),  i,  560. 

Lantanine,  i,  570. 

Liriodendron  tulipifera,  i,  585. 

Methylene  blue,  i,  630. 

Nueleins,  ii,  24. 

Pambotano,  ii,  58. 

Phenocoll,  ii,  72. 

Phloridizin,  ii,  74. 

Picric  acid,  ii,  83. 

Piperin,  ii,  90. 

Piper  nigrum,  ii,  90. 

Podophyllin,  ii,  98. 

Quinetum,  ii,  113. 

Quinine,  i,  255;  ii,  117,  118. 

"       with     antidiphtheritic     serum,     ii, 
174. 

Saligenin,  ii.  147. 

Serum,  antidiphtheritic,  ii,  174. 

Waters,  mineral,  ii,  874. 
Malarial  fever. 

See  Pever,  Malaeial. 
Malnutrition. 

Alcohol,  i,  33. 

Baths,  i,  169. 

Bitters,  i,  183. 

Cod-liver  oil,  i,  388. 


INDEX  OF  DISEASES  AND  REMEDIES. 


587 


Malnntrition. 

Cream,  i,  636. 

Egg  and  coffee,  i,  355. 

Pats,  i,  420. 

Lard  inunctions,  ii,  445. 

Linseed,  i,  584. 

Maltose,  i,  595. 

Somatose,  i,  213. 
Mammitis. 

See  Mastitis. 
Mania. 

Anhalonium  Lewinii,  ii,  416. 

Baths,  hot,  i,  166. 

Coniine  (hypodermic  injections),  i,  299. 

Duboisine,  i,  353. 

Gelsemium,  i,  437. 

Gold,  i,  453. 

Hyoscine,  i.  508. 

Morphine,  ii,  37. 

Phosphorus,  ii,  76. 

Best-cure,  ii,  127. 

Sulphonal,  ii,  239. 

Urethane,  ii,  342. 

Veratrum  viride,  ii,  353. 
Mania,  acute. 

Duboisine,  i,  353. 

Hyoscine,  i,  508. 

Rest-cure,  ii.  127. 

Sulphonal,  ii,  239. 

Veratrum  viride.  ii,  353. 
Mania,  liysterical. 

Bath,  hot,  i,  166. 
Mania,  {tuerperal. 

Duboisine,  i,  353. 
Mania,  suicidal. 

Gold,  i,  453. 
Mania  witli  excitement. 

Gelsemium,  i,  437. 

Morphine  and  hvoscine  hydrobromide,   ii, 
37. 

Water  to  the  head  in  form  of  a  douche, 
i,  349. 
Marasmus  (of  children). 

Cod-liver-oil  inunctions,  i,  288. 
Marasmus  (of  young  infants). 

Wine,  port,  ii,  393. 
Mastitis. 

Belladonna  ointment,  i,  173. 

Camphorated  oil,  i,  204. 

Phytolacca,  ii,  81. 

Tartar  emetic,  i,  114. 
Mastodynia. 

Galvanization,  anodal,  i,  367. 
Masturbation. 

Antaphrodisiacs,  i,  90. 

Belladonna,  i,  90. 

Hypnotism,  i,  515. 

Lactuearium,  i,  90. 

Malt  liquors,  i,  90. 
Measles. 

Aconite,  i,  9. 

Alkaline  baths,  i,  44. 

Antipyrine,  i,  12.3. 

Cod-liver  oil,  i,  288. 

Saffron  tea  (as  a  diaphoretic),  ii,  269. 

Serum  treatment,  ii,  178. 

Sparteine,  ii,  316. 

Sulphur  ointment,  ii,  341. 
Megrim. 

See  Migraine. 
81 


Melancholia. 

Anhalonium  Lewinii,  ii,  416. 

Antikamnia,  i.  111. 

Chlorobrora,  i,  240. 

Cocaine  (internally),  i,  284. 

Coniine,  i,  299. 

Exalgine,  i,  403. 

Faradization,  i,  367. 

Iron  chloride  (tincture),  i,  549. 

Nitrous-oxide  inhalation,  ii,  18. 

Phosphorus,  ii,  76. 

Rest-cure,  ii,  127. 

Somnal,  ii,  313. 

Sulphonal,  ii,  239. 

Thyreoid  treatment,  i,  79 ;  ii,  299. 
Melanclioliii,  acute. 

Somnal,  ii,  213. 
Melancholia,  headache  of. 

Bxalgine,  i,  403. 
Melancholia,  simple. 

Chlorobrora,  i,  240. 
Melancholia,  stuporous. 

Faradization,  general,  i,  367. 
Melancholia,  suicidal. 

Thyreoid  treatment,  ii,  291. 
Meniere's  disease. 

Pilocarpine,  ii,  87. 

Quinine,  ii,  120. 
Meningitis. 

Aconite,  i,  9. 

Belladonna,  i,  175. 

Blisters,  i,  185. 

Bloodletting,  i,  189. 

Croton  oil,  i,  318. 

Cupping,  i,  320. 

Ethyl  chloride,  ii,  434. 

Ice  bag,  i,  520. 

Iodoform,  i,  537. 

Laurel,  i,  571. 

Leeching,  i,  579. 

Morphine  (hypodermically),  i,  67. 

Muscarine,  i,  645. 

Pulsatilla,  ii,  107. 

Quinine,  i,  256. 
Meningitis,  acute  cerebral. 

Pulsatilla,  ii,  107. 
Meningitis,  cerebral. 

Blisters  (over  the  mastoid  process),  i,  185. 

Cold  batli,  i,  488. 
Meningitis,  cerebro-spinal. 

Laurel  (extract),  i,  571. 

Belladonna,  i.  175. 

Blisters  (at  the  nape  of  the  neck),  i,  185. 

Pulsatilla,  ii,  107. 
Meningitis,  tuberculous. 

Croton  oil,  by  application  to  the  head,  i, 
318. 
Meningocele. 

Collodion,  i,  294. 
Menorrhagia. 

Aloes,  i,  49. 

Arsenic,  i,  146. 

Bromides,  i,  194. 

Canella,  i,  206. 

Cantharides,  i,  308. 

Conium  suppositories,  i,  398. 

Cornutine,  i,  307. 

Digitalis,  i,  343. 

Electricity,  i,  368. 

Erigeron,  oil  of,  i,  390. 


588 


INDEX  OF  DISEASES  AND  REMEDIES. 


Menorrhagia. 

Heat  applied  to  the  spine,  i,  469. 

Hydrastis,  i,  476. 

Ipecac,  i,  543. 

Iron  nitrate,  i,  551. 

Lemon-juice,  i,  360. 

Matioo,  i,  611. 

Salipyrine,  ii,  149. 

Savine,  ii,  157. 

Steam,  ii,  233. 

Styptiein  and  Hydrastis,  ii,  233. 

Tannic  acid,  ii,  357. 

Viburnum  prunifolium,  ii,  356. 

Visoum  album,  ii,  361. 

Waters,  Buffalo  lithia,  ii,  373. 
"       mineral,  ii,  375. 
Menorrhagia,  atonic. 

Savine,  ii,  157. 
Menorrhagia,  congestiye. 

Styptiein  and  hydrastis,  ii,  333. 
Menorrliagia    occurring     during    preg- 
nancy. 

Canella,  i,  306. 
Menorrhagia  of  nervous  origin. 

Bromides,  i,  194. 
Menorrhagia,  ovarian. 

Conium  suppositories,  i,  298. 
Menstrual  disorders. 

Hydrastis,  i,  476. 

Hypnotism,  i,  515. 

Iron  carbonate,  i,  547. 

Senecio,  ii,  163,  456. 
Mental  distress. 

Sulphonal,  ii,  239. 
Mental  hehctude. 

Cocaine,  i,  283. 
Mental  strain,  prolonged. 

Bromides,  ii,  6. 
Mercurialism. 

Waters,  sulphuretted,  ii,  371. 
Metritis. 

Arnica,  fluid  extract  of,  i,  141. 

Baths,  hot,  i,  166. 

Calcium  carbide,  ii,  427. 

Carbonic  water  (douche),  i,  214 

Electricity,  i,  368. 

Traumato"l,  ii,  329. 

Waters,  mineral,  ii,  381. 
Metritis,  chronic. 

Arsenic,  i,  146. 

Gold,  i,  453. 

Ichthyol,  i,  523. 
Metritis,  puerperal. 

Creosote,  i,  314. 
Metrorrhagia. 

Baths,  hot,  i,  166. 

Cornutine,  i,  307. 

Digitalis,  i,  342. 

Electricity,  i,  368. 

Ergot,  i,  388. 

Brigeron,  oil  of,  i,  390. 

Faradization,  i,  368. 

Gallic  acid,  i,  432. 

Heat  applied  to  the  spine,  i,  469. 

Hydrastis,  i,  476. 

(due  to  fibroid  tumours  of  the  uterus),  Rhus 
aromatica,  ii,  131. 

Salicylic  acid  (on  tampons),  ii,  143. 

Salipyrine,  ii,  149. 

Steam,  ii,  222. 


Metrorrhagia. 

Viburnum  prunifolium,  ii,  356. 
Metrorrhagia  of  chlorosis. 

Canella,  i,  206. 
Migraine. 

Aoetanilide,  i,  3. 

Amyl  nitrite,  i,  61. 
"      valerianate,  i,  63. 

Antikamnia,  i,  111. 

Antipyrine,  i,  124. 

(congestive  form),  Bromides,  i,  194. 

Caffeine,  i,  301. 

"         and  antipyrine,  i,  201. 

Camphor,  i,  205. 

Carbonic-acid  gas,  i,  214. 

Cicuta  maculata,  i,  250. 

Coffee,  i,  290. 

Cytisus  laburnum,  i,  333. 

Damiana,  i,  324. 

Digitalis,  i,  342. 

Ethoxycaffeine,  i,  398. 

Ethyl  chloride  (by  spray),  ii,  484. 

Euphorin,  i,  402. 

Bxalgine,  i,  403. 

Galvanism,  i,  367. 

Guarana,  i,  461. 

Ipecac,  i,  542. 

Laurel,  i,  571. 

Massage  of  the  neck,  608. 

Methoxyeaffeine,  i,.628. 

Migrainin,  i,  631. 

Nitroglycerin,  ii,  15. 

Phenacetine,  ii,  71. 

Pulsatilla,  ii,  107. 

Quinine,  ii,  120. 

Salol,  ii,  150. 

Salophene,  ii,  151. 

Sodium  salicylate,  ii,  146. 
Mitral  insufficiency. 

Air,  condensed,  expiration  into,  i,  38. 
"     inspiration  of  condensed,  i,  38. 

Digitalis,  i,  341. 

Morphine  (subcutaneously),  ii,  36. 

Quebracho,  ii,  113. 

Sodio-theobromine  salicylate,  ii,  203. 
Mollifies  ossium. 

Calcium  phosphate,  i,  803. 
MoUuscnm  contagiosum. 

Silver  nitrate,  ii,  196. 
Myalgia. 

Aoetanilide,  i,  3. 

Camphor  liniment,  i,  204. 

Iron  hydrate,  i,  552. 

Salipyrine,  ii,  148. 

Theine,  ii,  277. 

Veratrine,  ii,  350. 
Mydriasis. 

Eserine,  i,  392. 
Mydriasis  following  diphtheria. 

Eserine,  i,  392. 
Myelitis. 

Ice  bag,  i,  520. 

(acute  forms).  Belladonna,  i,  175. 

Galvanism,  i,  367. 
Myelitis,  chronic. 

Baths,  warm,  i,  489. 
Myocarditis. 

Sodio-theobromine  salicylate,  ii,  203. 
Myomata,  uterine. 

Thiosinamine,  ii,  281. 


INDEX  OP  DISEASES  AND  REMEDIES. 


589 


Myopathy. 

Thyreoid  treatment,  ii,  298. 
Myositis. 

Massage,  i,  608. 
Myxoedema. 

Thyreoid  treatment,  i,  78 ;  ii,  389. 

Nsevus. 

Arsenic,  i,  145. 

Bichloride-o£-meroury  collodion,  i,  392. 

Carbolic-acid  injections,  i,  313, 

Chromic  acid,  i,  848. 

Collodion,  salicylic-  and  lactic-aoid,  i,  393. 

Creosote  as  a  caustic,  i,  314. 

Mercury  bichloride,  i,  686. 

Monochloraoetic  acid,  i,  335. 

Trichloracetic  acid,  i,  885. 
Narcotism. 

Ammonia  inhalation,  i,  53. 

water    (after    gastric    lavage),    i, 
58. 

Cold  affusions,  i,  17. 

Electricity  (as  a  stimulant),  ii,  236. 

Ether  (subcutaneously),  ii,  337. 
Naso-pliaryngitis. 

Silver  nitrate,  ii,  195. 
Nausea. 

Apomorphine,  i.  98. 

Carbolic  acid  and  bismuth,  i,  313. 

Carbonic-acid  gas  in  carbonated  waters,  i, 
98. 

Champagne,  iced,  i,  99 ;  ii,  835. 

Chloroform  (internally),  i,  99. 

Copper  sulphate,  i,  98. 

Placourtia,  i,  483. 

Iodine,  i,  536. 

Ipecac,  i,  98. 

Kephir,  i,  98. 

Kumyss,  i,  98. 

Lactucariura,  i,  568. 

Limewater  and  milk,  i,  98. 

Matzoon,  i,  98. 

Milk  and  limewater,  i,  98. 
"      and  sodium  bicarbonate  with  cerium 
oxalate,  i,  98. 

Mustard  plaster  (applied  to  the  stomach),  i, 
647. 

Nutmeg,  ii,  35. 

Peppermint  poultice,  i,  618. 

Sodium  tartrate,  ii,  309. 

Zinc  sulphate,  i,  98. 
Nansea  of  drunkards. 

Hydrochloric  acid,  i,  100. 
Nausea,  persistent. 

Blisters,  small  flying  (to  the  abdomen),  i, 
186. 
Necrosis  of  bone. 

Calcium  chloride,  i,  303. 

Cod-liver  oil,  i,  388.  ; 

Hydrochloric  acid,  ii,  441. 

Hypophosphites,  i,  518. 

Waters,  chlorinated,  ii,  366. 

Xeroform,  ii,  397. 
Necrosis,  tuberculous. 

Hydrochloric  acid,  ii.  441. 
Neoplasms  of  tlie  skin. 

See  Keloid  and  Lupus. 
Nephritis. 

Baths,  hot,  i,  489. 
"      hot-air,  i,  468. 


Nephritis. 

Caffeine,  i,  301. 

Diet  in,  i,  338. 

Gallic  acid,  i,  433. 

Guaiacol,  i,  459. 

Iron,  i,  548,  551. 

Jaborandi,  i,  559. 

Milk,  i,  338,  637. 

Morphine,  ii,  87. 

Neurodin,  ii,  7. 

Nitrites,  ii,  13. 

Veratrum  viride,  ii,  353. 

Water,  i,  105,  586. 

Waters,  ii,  364,  374,  379. 

Buffalo  lithia,  ii,  373. 
Nephritis,  acute. 

Guaiacol,  i,  459. 

Pyoctanine  (internally),  ii,  109, 

Sodio-theobromine  salicylate,  ii,  303. 
Nephritis,  acute  parenchymatous. 

See  Beiqht's  disease. 
Nephritis,  chronic. 

Caffeine,  i,  801. 

Corn  silk,  i,  306. 

Glycerophosphates,  ii,  489. 

Guaiacol,  i,  459. 

Hydrastine,  i,  476. 

Iron,  i,  551. 

Pyoctanine,  ii,  109. 

Sodio-theobromine  salicylate,  ii,  303,  203. 

Terpin  hydrate,  ii,  378. 

Zinc  sulphoichthyolate,  ii,  418. 
Nephritis,  chronic  desquamative, 

Cantharides,  i,  808. 
Nephritis,  chronic  diffuse. 

See  Nephritis,  Interstitial. 
Nephritis,  gastro-intestinal. 

Kephir,  i,  687. 
Nephritis,  interstitial. 

Kephir,  i,  637. 

Milk,  i,  637. 

Strontium  lactate,  ii,  330. 

Terpin  hydrate,  ii,  330. 
Nephritis,  mixed. 

Strontium  lactate,  ii,  830. 
Nephritis,  parencliymatous. 

Milk,  i,  637. 

Strontium  lactate,  ii,  839,  380. 
Nephritis,  scarlatinal. 

Waters,  Buffalo  lithia,  ii,  372. 
Nephrydrosls. 

Aspiration,  i,  151. 
Nerve  tracts,  painful. 

Collodions,  sedative,  i,  393. 
Nervous    affections,  Nervous 'conditions, 
Nervous  disorders,  Nervousness. 

Aconite  tincture,  i,  9. 

Anhalonium  Lewinii,  ii,  416. 

Camphor,  i,  305 ;  ii,  6. 

Cimicifuga,  i,  350. 

Codeine,  i,  386. 

Hyoscyamine,  i,  504. 

Massage,  i,  607. 

Quinine  tannate,  ii,  359. 
"       valerianate,  ii,  347. 

Sanguinal,  ii,  154. 

Strychnine,  ii,  7. 

Valerian,  ii,  6, 
Nervousness  from  dysmenorrhoea. 

Camphor,  ii,  6. 


590 


INDEX  OP  DISEASES  AND  EEMEDIES. 


Nervousness  from  irritation  of  tlie  sexual 
organs. 

Bromides,  ii,  6. 
Nervousness  of  tlie  menopause. 

Valerian,  ii,  345. 
Neuralgia. 

Acetanilide,  i,  3,  69. 
Aconite,  i,  9. 
Aconitine,  i,  11. 
Agathin,  i,  17. 
Alcohol,  i,  33. 
Ammonia  (locally),  i,  53. 
Ammonium  valerianate,  ii,  346. 
Amydophenine,  ii,  415. 
Amyl  nitrite,  i,  69. 

"      valerianate,  i,  63. 
Analgene,  i,  66. 
Anodyne  colloid,  i,  293. 
Antikamnia,  i,  113. 
Antipyrine,  i,  69. 
Antitetraizine,  i,  134. 
Apolysine,  ii,  417. 
Apone,  i,  139. 
Arsenic,  i,  146. 

(of  ansemia).  Arsenic  and  iron,  i,  68. 
Asaprol,  i,  69,  148. 
Atropine,  i,  154. 
Baths,  hot-air,  i,  168. 

"      mud,  i,  172. 
Belladonna,  i,  69,  174. 
Blisters,  i,  186. 
Bromal  hydrate,  i,  191. 
Bromides,  i,  1C9. 
Caffeine,  i,  301. 
Cajepnt,  i,  301. 
Camphor  sassafras,  ii,  138. 
Camphorated  chloral  (locally),  i,  335. 
Canella,  i,  207. 
Cannabis  indica,  i,  307. 
Capsicum  paper,  i,  309. 
Carbolic  acid  (topically),  i,  313. 
Cautery,  actual,  i,  226. 
Chloralamide,  i,  238. 
Chloral  caffeine  (hypodermioally),  i,  335. 
Chloroform  liniment,  i,  241. 
Cimioifuga,  i,  250. 
Cocaine,  i,  69. 
Cod-liver  oil,  i,  68. 
(of  impaired  nutrition),  Cod-liver  oil,  i,  68, 

288. 
Coffee,  i,  390. 
Conium,  i,  399. 
Copper,  ammoniated,  i,  803. 
Croton  chloral,  i,  69. 
Damiana,  i,  324. 
Delphinine,  ii,  231. 
Electricity,  i,  68,  367. 
(of  impaired  nutrition).  Electricity,  i,  68. 
Bserine,  i,  392. 

Ethyl  bromide,  internally,  i,  399. 
Exalgine,  i,  403. 
Paradization,  i.  367. 
Gelsemium.  i,  437. 
Hydrobromic  acid,  i,  493. 
Hydrotherapy,  i,  68. 
(of   impaired'   nutrition),   Hydrotherapy,  i, 

68. 
Hyoscyamus,  i,  505. 
Ignipunctnre,  i,  534. 
Iron  chloride,  i,  549. 


Neuralgia. 

Iron  lactate,  i,  68. 
"     pyrophosphate,  i,  68. 

Malakin,  i,  593. 

Massage,  i,  68,  608. 

(of  impaired  nutrition).  Massage,  i,  68,  608. 

Meconarceine,  i,  611. 

Menthol,  i,  614. 

"        plaster,  i,  614. 

Methoxycaffeine,  i,  628. 

Methyl  chloride,  i,  69. 

Methylal  (inhalation  of),  i,  69,  629. 

Methylene  blue,  i,  680. 

Mustard  plaster,  i,  647. 

Neurodin,  ii,  7. 

Nitroglycerin,  i,  69. 

Nutmeg  oil  (as  a  rubefacient),  ii,  35. 

Nux  vomica,  i,  68. 

Opium,  i,  69. 

Osmic  acid,  ii,  47. 

Peppermint  oil,  i,  613. 

Phenacetine,  i,  69 ;  ii,  71. 

Phenocoll,  ii,  73. 

Phenylacetamide,  ii,  73. 

Phosphorus,  i,  68. 

Piscidia,  ii,  01. 

Potassium  cyanide,  i,  832. 

(due  to  lead).  Potassium  iodide  and  bromide, 
i,  69. 

Poultices,  ii,  101. 

(without  malaria).  Quinine,  i,  68  ;  ii,  118. 

Rest,  absolute,  i,  68. 

Saliein,  ii,  140. 

Salicylamide,  ii.  141. 

Salicylic  acid,  ii,  143. 

Salipyrine.  ii,  148. 

Salix,"  ii,  149. 

Salophene,  ii,  151. 

Silver  oxide,  ii,  197. 

Sodium  salicylate,  ii,  146. 

Solanin,  ii,  209. 

Spermine,  ii,  217. 

Strychnine,  i,  68. 

(of  impaired  nutrition).  Strychnine,  i,  68;  ii, 
28. 

Sulphur  fumigation,  i,  430. 

Theine,  ii,  277. 

Turpentine  oil  (locally),  ii,  336. 

Veratrine,  ii,  350. 

Waters,  sulphuretted  (externally  and  inter- 
nally), ii.  871. 

Wines',  ii,  894. 

Zinc  cyanide,  i,  333  ;  ii,  408. 
"     sulphichthyolate    (as    a    liniment),    ii, 
412. 

Zinc  valerianate,  i.  68  ;  ii,  347. 
Neuralgia,  abdominal. 

Galvanization,  i,  366.  368. 

stabile,  i,  366. 
Neuralgia,  acute. 

Wines,  ethereal,  ii,  394. 
Neuralgia,  astlienic. 

Phosphorus,  ii,  76. 
Neuralgia,  cervico-brachial. 

Galvanization,  stabile  anodal,  i,  360. 
Neuralgia,  chronic. 

Baths,  hot-air,  i,  168. 
Neuralgia,  congestive. 

Aconite,  i,  69. 

Bromides,  i,  69. 


INDEX  OP  DISEASES  AND  REMEDIES. 


591 


Neuralgia,  facial. 

Butyl-chloral  hydrate,  i,  197. 

Salipyrine,  ii,  148. 

Sodium  salicylate,  ii,  146. 
Neuralgia,  gastric. 

Silver  oxide,  ii,  197. 
Neuralgia,  intercostal. 

Osmic-aoid  injections,  ii,  47. 

(occurring  after  influenza),  Pyramidone,  ii, 
454. 
Neuralgia,  intermittent. 

Quinine,  ii,  118. 
Neuralgia,  malarial. 

Methylene  blue,  i,  68. 

Quinine,  ii,  120. 
Neuralgia  of  anaemia. 

Iron  chloride  (tincture),  i,  549. 
Neuralgia  of  the  bladder. 

Baths,  hot  sitz,  i,  169. 

Neurodin,  ii,  7. 
Neuralgia  of  the  eyeball. 

Eserine,  i,  393. 
Neuralgia  of  the  stomach. 

Neurodin,  ii,  7. 
Neuralgia,  ovarian. 

Bromides,  i,  194. 

Cannabis  indica,  i,  67. 

Croton-oil  applications  to  the  abdomen,  i,  318. 

Gelsemium,  i,  69. 

Douche,  hot,  i,  480. 

Salicylamide,  ii,  141. 
Neuralgia,  peripheral. 

Salicylamide,  ii,  141. 

Sodium  salicylate,  ii,  146. 
Neuralgia,  sacral. 

Galvanism,  i,  367. 
Neuralgia,  superficial. 

Veratrine,  ii,  850. 
Neuralgia,  syphilitic. 

Potassium  iodide  and  mercury,  i,  69. 
Neuralgia,  trigeminal. 

Amyl  nitrite,  i,  64. 

Butyl-chloral  hvdrate,  i,  69. 

Electricity,  i,  867. 

"  with  analgetic  agents,  i,  69. 

Gelsemium,  i,  69. 

Glycerophosphates,  ii,  439. 

Methyl  chloride,  i,  69. 

Nitroglycerin,  ii,  15. 

Quinine,  ii,  120. 

Salipyrine,  ii,  148. 
Neuralgia,  uterine. 

Arsenic,  i,  146. 

Belladonna  and  opium,  i,  67. 

Bromides,  i.  194. 

Salix,  ii,  149. 
Neurasthenia. 

Anhalonium  Lewinii,  ii,  416. 

Bath,  cold,  i,  165. 
"     half,  i,  168. 

Baths,  sheet,  i,  169,  490. 

Brain  extract,  i,  80. 

Cephalic  douches,  i,  349. 

Chamomile,  i,  231. 

Chloralose,  i,  239. 

Coca  (as  an  adjunct),  i,  274. 

Cocaine  (internally),  i,  284. 

Cold  baths,  i,  488. 

Electricity,  i,  366. 

Faradization,  general,  i,  367. 


Neurasthenia. 

Glycerophosphates,  ii,  439, 

Hydrochloric  acid,  i,  493. 

Nueleins,  ii,-  25. 

Orchitic  liquid,  i,  76. 

Oxygen,  ii,  52. 

Phospho-albumin,  ii,  74. 

Quinine,  ii,  130. 

Rest-cure,  ii,  137. 

Sanguinal,  ii,  154. 

Sea  air,  ii,  275. 

Serum,  artificial,  ii,  168,  164. 

Sodium  phosphate  (subcutaneous  injections), 
ii,  208. 

Spermine,  ii,  217. 

Sterculia,  ii,  233. 

Sumbul,  ii,  348. 

Suprarenal  capsule,  ii,  245. 

Testicle  juice,  i,  76. 

Trional  (for  insomnia),  ii,  883. 

Waters,  chlorinated,  ii,  365. 
"       ferruginous,  ii,  869. 
"      mineral,  ii,  364,  377,  879. 
Neuritis. 

Acetanilide,  i,  8. 

Belladonna  and  morphine  injections,  i,  67. 

Paradaism  and  galvanism,  i,  367. 

Phenacetine,  ii,  71. 

Salol.  ii,  150. 
Neuritis,  acute. 

Baths,  warm,  i,  489. 
Neuritis,  multiple. 

Pyramidone,  ii,  454. 
Neuritis,  peripheral. 

Salicylic  acid,  ii,  142. 

Waters,  thermal  (externally  and  internally), 
ii,  364. 
Neuroma. 

Cocaine  cataphoresis,  i,  367. 
Neuroses. 

Alcohol,  i,  33. 

Waters,  Buffalo  lithia.  ii,  372. 
"        mineral,  ii,  384. 

Wine,  ii,  894. 
Neuroses,  professional. 

Paradaism  and  galvanism,  i,  367. 

Duboisine,  i,  358. 
Neuroses  with  mental  depression. 

Ergot  and  sodium  phosphate,  i,  389. 
Night  sweats. 

See  Sweats,  Night. 
Night  terror  of  children. 

Trional,  ii,  332. 
Nipples,  retraction  of  the. 

Collodion,  i,  294. 
Nipples,  sore. 

Alcohol,  i,  31. 

Borax,  i,  189. 

Catechu,  i,  331. 

Copper  arsenite,  i,  304. 

lehthyol,  i,  523. 

Lead  nitrate,  i,  578. 
"     water,  i,  577. 

Silver  nitrate,  ii,  195. 

Tannin,  i,  256. 
Nodes. 

Mercury  plaster,  i,  633. 

Vasogen,  ii,  349. 
Nosebleed. 

See  Epistaxis. 


592 


INDEX  OF  DISEASES  AND  REMEDIES, 


Nutritional    disorders,    Nutrition,    per- 
verted (of  children). 
See  Malnutrition. 
Nymphomania. 

Treatment  of,  i,  90. 

Obesity. 

Bantmgism,  i,  160. 

Baths,  condensed-air,  i,  28. 
hot-air,  i,  168. 

Diet,  i,  338. 

Exercise,  i,  415. 

Glycerophosphates,  ii,  439. 

Iodoform,  i,  537. 

Permanganates,  ii,  70. 

Saccharin,  ii,  138. 

Thyreoid  treatment,  i,  79 ;  ii,  295. 
Obesity,  anaemic. 

Thyreoid  treatment,  ii,  295. 
Occlusion,  intestinal. 

Aspiration,  i,  153. 
(Edema  of  the  glottis. 

Copper-arsenite  solution,  i,  304. 

Scarification,  ii,  158. 
(Edema,  pulmonary. 

Infusion,  intramuscular,  ii,  325. 

Jaborandi,  i,  559. 

Strophanthus,  ii,  231. 
(Esophagitis. 

Copper  arsenite,  i,  305. 
Oligemia. 

Marrow,  extract  of  bone,  i,  81. 
Onanism. 

See  Masturbation. 
Onychia. 

Lead  nitrate,  i,  578. 
Onychia,  malignant. 

Mercury  bichloride,  i,  626. 

Zinc  sulphate  and  corrosive  sublimate,  i,  238. 
Oophoralgia. 

See  Neuralgia,  Ovarian. 
Oophoritis. 

Arsenic,  i,  146. 

Baths,  hot  sitz,  i,  169. 

Blisters,  i,  185. 

Electricity,  i,  368. 

Pulsatilla,  ii,  107. 
Ophthalmia. 

Iodine,  externally,  i,  536. 

Iron  sulphate,  i,  549. 
Ophthalmia,  acute. 

Cadmium  sulphate,  i,  300. 
Ophthalmia,  blennorrhagic. 

Quinine,  ii,  120, 
Ophthalmia,  chronic. 

Cadmium  sulphate,  i,  800. 
Ophthalmia,  gonorrhoeal. 

Bserine,  i,  393. 

Pulsatilla,  ii.  107. 

Quinine  (as  a  lotion),  ii,  130. 

Silver-nitrate  solutions,  i,  295. 
Ophthalmia  neonatorum. 

Copper  arsenite,  i,  305. 

Bserine,  i,  393. 

Silver  nitrate,  i,  295 ;  ii,  194. 
Ophthalmia,  phlyctainular. 

Benzophenoneid,  i,  179. 

Mercury  oxide  (ointment),  i,  683. 
Ophthalmia,  purulent. 

Cadmium  salicylate  injections,  i,  200. 


Ophthalmia,  purulent. 

Collodion,  i.  294. 

Pulsatilla,  ii,  107. 
Orchitis. 

Baths,  hot,  i,  166. 

Collodion,  i,  294. 

Ice  bag,  i,  520. 

Iodine,  externally,  i,  586. 

Leeching,  i,  579. 

Mercury  ointment,  i,  622. 

Pulsatilla,  ii,  107. 

Tartar  emetic,  i,  114. 
Orthopnoea. 

Electricity  (as  a  stimulant),  ii,  386. 
Osteomalacia. 

Phosphates,  ii,  78. 

Phosphorus,  ii,  77. 
Osteomyelitis,  rheumatic. 

Ephedra,  i,  385. 
Osteomyelitis,  tuberculous. 

Sulphur,  ii,  341. 
Otalgia. 

See  Earache. 
Otitis. 

Aconite,  i,  8. 

Blisters,  i,  185. 

Copper  arsenite,  i,  804. 

lodol,  i,  540. 

Menthol  oil,  i,  616. 

Leeching,  i,  579. 

Mentho-phenol,  i,  616. 

Potassium  permanganate,  1,  597. 
Otitis,  acute. 

Aconite,  i,  8. 
Otitis,  external. 

Brucine,  ii,  339. 

Silver  nitrate,  ii,  195. 
Otitis  externa  dilfnsa. 

Copper  arsenite,  i,  304. 
Otitis  media. 

Blisters,  i,  185. 

lodol  (by  insufflation),  i,  540. 

Menthol  oil,  i.  616. 

Pulsatilla,  ii,  107. 

Tannigene,  ii,  360. 
Otitis  media,  chronic  purulent. 

Oxygen,  ii,  451. 

Pyrozone,  ii,  455. 

Thioform,  ii,  378. 

Zinc-chloride  applications,  ii,  405. 

Zinc  subgallate,  ii,  411. 
"     snlphooarbolate,  ii,  413. 
Otitis,  purulent. 

Potassium    permanganate    (as   a  spray),   i, 
597. 
Otorrhoea. 

Boric  acid,  i,  190. 

Cadmium  sulphate,  i,  300. 

Creosote,  i.  314. 

Diaphtherin,  i,  382. 

Hydrastis,  i,  476. 

Permanganates  (injections),  ii,  70. 

Pyoctanine,  ii,  108. 

Salufer.  ii,  456. 
Otorrhoea,  chronic. 

Salufer,  ii,  456, 
Otorrhtea,  foetid. 

Creosote,  i,  314. 
Ovarian  pains. 
See  Neuralgia,  Ovarian. 


INDEX  OF  DISEASES  AND  REMEDIES. 


693 


OTaritis. 

See  Oophoritis. 
Oxaluria. 

Nitric  acid,  ii,  8. 
Oza)na. 

Boric  acid  (saturated  solution),  i,  191. 

Carbolic  acid,  i,  213. 

Chloracetic  acid,  i,  234. 

Diaphtherin,  i,  332. 

Europhene.  by  insufflation,  1,  403. 

Gold,  i,  453. 

Hydrastis,  i,  476. 

Iodine  (externally),  i,  536. 

Naphthol,  camphorated,  ii,  2. 

Oxygen,  ii,  451. 

Ozone  inhalation,  ii,  58. 

Permanganates  (injections),  ii,  70. 

Potassium    permanganate    (as   a   spray),  i, 
597. 

Salicylic  acid  (douche),  ii,  143. 

Salubrine,  ii,  152. 

Silver  nitrate,  ii,  195. 

Tannoform  powder,  ii,  260. 

Zinc  oleostearate,  ii,  409. 
Ozsena,  chlorotic. 

Oxygen,  ii,  451. 
Ozxna,  syphilitic. 

Carbolic  acid,  i,  213. 

Europhene,  i,  402. 

Hydrastis,  i,  476. 

Oxygen,  ii,  451. 

Zinc  oleostearate,  ii,  409. 

Pains,  preliminary,  of  labour. 

See  under  Labour. 
Pains,  uterine. 

Cannabis  indioa,  i,  67. 
Chloralose,  i,  239. 
Palpitation  of  the  heart. 

Aconite  (tincture),  i,  9. 

Ammonium  valerianate,  ii,  346. 

Cereus  grandiflorus,  i,  229. 

Digitalis,  i,  343. 

Thymus  extract,  ii,  385. 
Palsy. 

See  Paralysis. 
Fannus. 

Antipyonine,  i,  130. 

Jequirity,  i,  563. 
Panophthalmitis. 

Antipyonine  (strong  solution),  1,  130. 
Papillomnta. 

Acetic  acid,  i,  5. 

Alumnol,  i,  51. 

Arsenic,  i,  337. 

Carbolic  acid,  i,  213. 

Caustics,  i,  336,  337. 

Chloracetic  acid,  i,  334. 

Chromic  acid,  i.  348. 

Europhene,  in  powder  or  ointment,  i,  403. 

Lactic  acid,  i,  568. 

Nitric  acid,  i,  337 ;  ii,  7. 

Zinc  chloride,  ii,  403. 
Paralysis. 

Ammonium  formate,  i,  57. 

Baths,  pine,  i,  173. 
"       sand,  i,  173. 

Brain  extract,  i,  80. 

Croton-oil  applications,  i,  318. 

Electricity,  i,  365,  367. 


Paralysis. 

Massage,  i,  489,  608. 

hydraulic,  i,  603. 

Muscarine,  i,  645. 

Pelletierine,  ii,  65. 

Phosphorus,  ii,  76. 

Pyrethrum,  ii,  108. 

Sodium  phosphate,  ii,  308. 

Strychnine,  ii,  38,  39. 

Waters,  thermal,  ii,  364. 
Paralysis  agitans. 

Barium  chloride,  i,  163. 

Baths,  warm,  and  massage,  i,  489. 

Chloral  hydrate,  i,  237. 

Conium,  i,  898. 

Hyoscine,  i,  504. 

Hyoscyamine,  ii,  443. 

Phosphorus,  ii,  76. 

Picrotoxin,  ii,  84. 

Viburnum  prunifolium,  ii,  367. 
Paralysis,  bulbar. 

Brain  extract,  i,  80. 

Paradaism  or  galvanism,  i,  366. 
Paralysis,  cerebral. 

Phosphorus,  ii,  76. 

Waters,  thermal  (externally  and  internally), 
ii,  364. 
Paralysis,  deltoid  (circumflex  nerve). 

Faradaism,  i,  366. 
Paralysis,  diphtheritic. 

Faradaism  or  galvanism,  i,  366. 

Strychnine,  ii,  38. 
Paralysis,  Erb's. 

Faradization  or  galvanization,  i,  366. 
Paralysis,  facial. 

Faradization  or  galvanization,  i,  366. 
Paralysis,  functional. 

Croton-oil  applications  to  the  spine,  i,  318. 
Paralysis,  hysterical. 

Strychnine,  ii,  39. 
Paralysis,  infantile. 

Veratrine,  ii,  350. 
Paralysis,  lead. 

Baths,  sulphur,  i,  173. 

Electricity,  i,  577. 

Epsom  salts,  i,  577. 

Iodine,  i,  577. 

Potassium  iodide,  ii,  98. 

Waters,  mineral,  ii,  364. 
Paralysis,  local. 

Strychnine  (hypodermically),  ii,  28. 
Paralysis,  musculo-spiral. 

Faradization,  i,  367. 
Paralysis  of  respiration. 

Atropine,  i,  87. 
Paralysis  of  the  bladder. 

See  Paralysis,  Vesical. 
Paralysis  of  tlie  extremities.  . 

Baths,  warm,  and  massage,  i,  489. 
Paralysis  of  the  third  and  fourth  cranial 
nerves. 

Pelletierine,  ii,  65. 
Paralysis  of  the  tong'ue. 

Pyrethrum,  ii,  109. 
Paralysis  of  toxic  origin. 

Waters,  thermal  (externally  and  internally), 
ii,  864. 
Paralysis,  peripheral. 

Waters,  thermal  (externally  and  internally'), 
ii,364.  " 


594 


INDEX  OF  DISEASES  AND  REMEDIES. 


Paralysis,  progressive  general,  of  the  in- 
sane. 

Baths,  tepid,  i,  489. 
Paralysis,  progressive  myopathic. 

Sodium  phosphate,  ii,  208. 
Paralysis,  pseudohypertrophic. 

Galvanization,  local,  i,  367. 
Paralysis,  reflex. 

Ammonium  formate,  i,  57. 
Paralysis,  vesical. 

Faradization,  vesical,  i,  367. 

Strychnine,  ii,  38. 
Parametritis. 

Eucasin,  ii,  436. 

Water,  hot-,  douches,  ii,  313. 
Parametritis,  acute. 

Baths,  hot  sitz,  i,  489. 
Parametritis,  chronic. 

Ichthyol,  1,  523. 

Massage  (Brandt's  method),  i,  609. 
Paraplegia,  ataxic. 

Galvanism,  i,  366. 
Parasites. 

Bromide,  i,  445. 

Hydrogen  peroxide,  i,  115. 

Mercury  chloride,  i,  626. 

Picrotoxin,  ii,  84. 

Rectal  injections  of  water,  i,  480. 
Parasites,  sliin. 

Bromine  (locally),  i,  445. 

Camphor  salicylate,  ii,  455. 

Carbolic  acid,  i,  212. 

Chrysarobin,  i,  248. 

Mercury,  red  oxide  of  (ointment),  i,  628. 
"         sozoiodolate,  ii,  215. 

Sodium  diiodosalioylate,  ii,  146. 

Sfaphisagria,  ii,  221. 
Paresis,  general. 

Thyreoid  treatment,  ii,  391. 
Paresis,  muscular. 

Ammonium  formate,  i,  57. 
Paresis  of  the  bladder. 

Baths,  cold,  i,  169. 
Paresis  of  tlie  brain. 

Phosphorus,  ii,  76. 
Paresis,  vaso-motor. 

Massage,  i,  608. 
Paronychia. 

Sanoform,  ii,  154. 

Xeroform,  ii,  397. 
Pavor  nocturnus. 

See  Night  teerok  of  children. 
Pediculi  capitis. 

See  Phtheibiasis  capitis. 
Pediculi  pubis. 

See  Phtiieiriasis  pubis. 
Pediculosis. 

See  Phtheibiasis. 
Pediculus  corporis. 

See  Phtheibiasis  coeporis. 
Pemphigus. 

Arsenic,  i,  144. 

Bath,  hot,  i,  166. 

Belladonna,  ii,  425. 

Tumenol  oil  and  oxide  of  zinc,  ii,  334. 
Pemphigus  vegetans. 

Baths,  cold  (permanent  or  continuous  im- 
mersion), i,  488. 
Perforation  of  Shrapnell's  membrane. 

Styrone,  ii,  334. 


Pericarditis. 

Aspiration,  i,  150,  151. 

Digitalis,  i,  343. 

Hellebore,  white,  i,  470. 

Ice  applications,  i,  520. 

Poultices,  ii,  101. 

Sodio-theobromine  salicylate,  ii,  303. 

Somatose,  ii,  213. 
Pericarditis,  acute. 

Infusion,  ii,  324. 
Perimetritis. 

Baths,  hot  sitz,  i,  489. 

Douches,  hot-water,  ii,  213. 
"        uterine,  i,  349. 

Ichthyol,  i,  533. 
Peritonitis. 

Arsenic,  i,  147. 

Baths,  narcotic,  i,  173. 

Blisters,  i,  185. 

Bloodletting,  i,.  188. 

Ether,  camphorated,  i,  304. 

Ice  applications,  i,  520. 

Naphthol,  ii,  3. 

Opium,  ii,  38. 

Poultices,  ii,  101. 

Salicylated  camphor,  i,  304. 

Salines,  ii,  147. 

Stupes,  hot,  with  oil  of  turpentine  applied 
to  the  abdomen,  ii,  833. 

Turpentine  stupes,  i,  312;  ii,  335. 

Veratrum  viride,  ii,  353. 
Peritonitis,  acute. 

Aconite,  i,  9. 

Infusion,  intravenous  or   subcutaneous,  ii, 
335. 

Mercury  ointment,  i,  633. 

Opium,  ii,  87,  88. 

Salines,  ii,  147. 
Peritonitis,  pelvic. 

Arsenic,  i,  147. 

Baths,  hot  sitz,  i,  489. 

Douches,  hot-water,  ii,  313. 

Ichthyol,  i,  533. 
Peritonitis,  puerperal. 

Veratrum  viride  (to  reduce  vascular  excite- 
ment), ii,  353. 
Peritonitis,  tuberculous. 

Air,  hot  (by  insuflflation),  i,  533. 

Naphthol,  ii,  2. 

Pyramidone,  ii,  454. 
Pertussis. 

See  Whooping-cough. 
Petit  mal. 

Valerian,  ii,  345. 

Viburnum  prunifolium,  ii,  357. 
Phagedajna. 

Bromine,  i,  195,  337. 

Carbolic  acid,  i,  318. 

Europhene,  i,  402. 

Hydrogen  dioxide,  i,  508. 

Iodoform,  i,  536. 

Mentho-phenol,  i,  616. 

Mercury  nitrite,  i,  628. 

Nitric  acid  (fuming),  i,  227 ;  ii,  7. 

Pyrogallic  acid,  ii.  111. 

Resorcin,  ii,  126. 

Silica,  hydrated,  ii,  191. 

Xeroform,  ii,  397. 
Pharyngitis. 

Ammonium-chloride  troches,  i,  57. 


INDEX  OP  DISEASES  AND  REMEDIES. 


695 


Pharyngitis. 

Boric  acid  (saturated  solution),  i,  191. 

Chromic  acid,  i,  248. 

"  "      applications,  i,  348. 

Cod-liver  oil,  i,  388. 

Copper  arsenite,  i,  305. 

Ipecac,  i,  542. 

Iron,  i,  546. 

Licorice  and  flaxseed,  i,  581. 

Nuclein,  yeast,  ii,  34. 

Potassium  chlorate,  ii,  96. 

Resorcin,  i,  534. 

Sodium  bicarbonate,  i,  534. 

"       chloride  (as  a  gargle),  ii,  307. 
"       salicylate,  i,  534. 

Tannigene,  ii,  260. 

Thymol,  ii,  284. 

Zinc  sulphocarbolate,  ii,  412. 
Pharyngitis,  acute. 

Glycerin  and  carbolic  acid,  i,  450. 

Phosphate  of  sodium,  ii,  260. 

Tannigene,  ii,  26. 
Pharyngitis,  chronic. 

Silver  nitrate,  ii,  195. 

Sodium  phosphate,  ii,  360. 

Tannigene,  ii,  360. 

Waters,  chlorinated  alkaline,  ii,  367. 

Zinc-chloride  applications,  ii,  405. 
Pharyngitis,  follicular. 

Palmetto  wine,  ii,  58. 
Pharyngitis,  gangrenous. 

Cupric-sulphate  solution,  i,  306. 
Pharyngitis,  granular. 

lodol  (by  insufflation),  1,  540. 
Pharyngo-laryngitis. 

Camphor  and  sweet-almond  oil  (internally), 
i,  305. 
Phimosis. 

Sanofonn,  ii,  154. 
Phlebitis. 

Baths,  hot,  ii,  166. 
Phlebitis,  puerperal. 

Veratrum  viride,  ii,  353. 
Phlegmasia  alba  dolens. 

Baths,  hot,  i,  166. 
Phlegmons. 

Serum,  antistreptococcus,  ii,  175. 
Phlegmons,  iliac. 

Aspiration,  i,  153. 
Phosphaturia. 

Phosphoric  acid,  ii,  77. 
Photophobia. 

Atropine,  i,  155. 

Eserine,  i.  392. 

Lactic  acid,  i,  568. 
Phtheiriasis. 

Arsenic,  i,  145. 

Bromine,  i,  445. 

Carbolic  acid,  i,  116. 

Kerosene  oil,  i,  116. 

Larkspur,  i,  116  ;  ii,  331. 

Mercury  bichloride,  i,  116. 

Mercury  oleate,  i,  116. 

Naphthol,  i,  116. 

Staphisagria,  i,  116;  ii,  221. 

Vinegar,  i.  116. 
Phtheiriasis  capitis. 

Acetic  acid,  i,  116. 

Carbolic  acid  (alcoholic  solution),  i,  116. 

Cocculus  indicus  (decoction),  i,  116. 


Phtheiriasis  capitis. 

Kerosene  oil,  i,  116. 

Larkspur  (decoction  or  tincture),  i,  116. 

Mercury,  ammoniated,  ointment,  i,  110. 
"         oleate  and  ether,  i,  116. 
"         bichloride,  i,  116. 

Kaphthol  (5-per-eent.  solution  in  oil),  i,  117 

Staphisagria.  i,  116 ;  ii,  221. 

Steam,  i,  116. 

Veratrine,  ii,  350. 

Vinegar,  common,  i,  116. 
Phtheiriasis  corporis. 

Bromine,  i,  445. 

Carbolic  acid,  i,  212. 

Chrysarobin,  i,  116,  243. 

Mercury  chloride,  i,  626. 
"        red  oxide  of,  i,  623. 
"        sozoiodoiate,  ii,  215. 

Sodium  diiodosalicylate,  ii,  146. 
Phtheiriasis  pubis. 

Acetic  acid,  i,  116. 

Carbolic  acid,  i,  116. 

Kerosene  oil,  i,  116. 

Larkspur,  i,  116;  ii,  231. 

Mercury  bichloride,  i,  116. 
oleate,  i,  116. 

Naphthol,  i,  116. 

Staphisagria,  i,  116  ;  ii,  331. 

Vinegar,  i,  116. 
Phthisis. 

See  Tuberculosis. 
Pitting  of  small-pox. 

See  under  Sjiall-pox. 
Pityriasis. 

Acetic  acid,  i,  5. 

Iodine,  i,  536. 

Quinine,  ii,  120. 

Salicylic-acid  ointment,  ii,  144. 

Thymol,  ii,  284. 
Pityriasis  capitis. 

Zinc  sulphocarbolate,  ii,  412. 
Pityriasis  versicolor. 

Carbolic-acid  ointment,  i,  212. 

Hyposulphites,  i,  519. 

Quinine  applications,  i,  258. 
Plague  (bubonic). 

Serum  treatment  (Versin's),  ii,  188. 
Plague,  swine. 

Serum  treatment,  ii,  188. 
Plethora. 

Grape  cure,  i,  455. 
Plethora,  hepatic. 

Waters,  mineral,  ii,  375. 
Plethora,  renal. 

Waters,  mineral,  ii,  375. 
Pleurisy. 

Air,  condensed,  inspiration  of,  i,  28. 

Baths,  condensed-air,  i,  27. 

Blisters,  i,  186,  812. 

Bloodletting,  i,  188. 

Conium,  i,  299. 

Conrallaria,  i,  300. 

Croton  oil,  i,  318. 

Gelseniium,  i,  437. 

Guaiacol,  i,  460. 

Hellebore,  white,  i,  470. 

Ice  applications,  i,  520. 

Iodine,  i,  536. 

Jaborandi,  i,  588.    . 

Xuclein,  ii,  24. 


596 


INDEX  OP  DISEASES  AND  REMEDIES, 


Pleurisy. 

Opium  (small  doses),  ii,  37. 

Poultices,  ii,  101. 

Pyootanine  (internally),  ii,  109. 

Quinine,  i,  256. 

Sesame  oil,  ii,  190. 

Sodio-theobromine  salicylate,  ii,  203. 

Sodium  salicylate,  ii,  146. 

Terebene,  ii,  371. 

Veratrine,  ii,  350. 

Veratrum  viride,  ii,  352. 
Pleurisy,  acute. 

Blisters,  i,  186. 

Hellebore,  white,  i,  470. 
Pleurisy,  chronic  (with  effusion)._ 

Air,  condensed,  expiration  into,  i,  29. 

Veratrine,  ii,  350. 
Pleurisy,  dry. 

Sodium  salicylate,  ii,  146. 
Pleurisy,  febrile. 

Sesame  oil,  ii,  190. 
Pleurisy  witii  effusion. 

Aspiration,  i,  150. 

Blisters,  i,  312. 

Guaiacol  (application),  i,  460. 

Jaborandi,  i,  588. 

Sodium  salicylate,  ii,  146. 
Pleurodynia. 

Cimiciluga,  i,  250. 

Ethyl  chloride,  ii,  434. 

Galvanization,  stabile,  i,  367. 

Veratrine,  ii,  350. 
Pleuropneumonia. 

Quillaia,  ii,  113. 

Terebene,  ii,  371. 
Pneumonia. 

Acetanilide,  i,  4. 

Aconite,  i,  9. 

Aconitine,  digitaline,  and  strychnine  (com- 
bined), i,  11. 

Air,  condensed,  inspiration  of,  i,  38. 

Ammonium  carbonate,  i,  56. 

Amyl  nitrite,  ii,  415. 

Antipyrine,  i,  123. 

Asaprol,  i,  148. 

Baths,  condensed-air,  i,  27. 
"      hot,  i,  489. 

Bloodletting,  i.  188. 

Cajuput,  ii,  426. 

Calcium  chloride,  i,  202. 

Calomel,  i,  624. 

Camphor  and  sweet-almond  oil,  i,  205. 

Cimicifuga,  i.  350. 

Conium,  i,  299. 

Convallaria,  i,  300. 

Digitalis,  i,  342. 

Gelsemium,  i,  437. 

Guaiacol,  i,  460 ;  ii,  439. 

Hellebore,  white,  i,  470. 

Ice  cradling,  i,  530. 

Infusion,  intravenous  or  subcutaneous,   ii, 
325. 

Malakin,  i,  593. 

Musk,  i,  645. 

Nucleins,  ii,  34. 

Opium  (small  doses),  ii,  37. 

Oxygen,  ii,  52. 

Pilocarpine,  ii,  85. 

Poultice  JMcket,  ii,  103, 

Poultices,  ii,  101. 


Pneumonia. 

Quillaia,  ii,  113. 

Quinine,  i,  356;  ii,  119, 

liOntgen  rays,  ii,  458. 

Salicin,  ii,  140. 

Senega,  ii,  163. 

Serum,  artificial,  ii,  165. 
"      treatment,  i,  85. 

Sodium  paracresotate,  ii,  307. 

Stimulants,  cardiac,  ii,  226. 

Strophanthus,  ii,  231. 

Turpentine  oil  (internally),  ii,  336. 

Veratrum  viride,  ii.  353. 

Wine,  port,  ii,  393. 

X-rays,  ii,  458. 
Pneumonia,  .acute. 

Serum,  artificial,  ii,  165. 
Pneumonia,  acute  croupous, 

■  Hellebore,  white,  i,  470. 
Pneumonia,  acute  lobar. 

Calcium  chloride,  i,  202. 

Oxygen,  ii,  53. 
Pneumonia,  adynamic  (of  drunkards). 

Musk,  i,  645. 
Pneumonia,  caseous. 

Cimicifuga,  i,  250. 
Pneumonia,  catarrhal. 

Air,  condensed,  inspiration  of,  i,  28, 

Sodium  paracresotate,  ii,  207. 
Pneumonia,  chronic. 

Nitrogen  by  inhalation,  ii,  14. 
Pneumonia,'  chronic  interstitial. 

Air,  condensed,  inspiration  of,  i,  38. 
Pneumonia,  croupous. 

Malakin,  i,  593. 

Pilocarpine,  ii,  85. 

Quillaia,  ii,  113. 
Pneumonia  from  influenza. 

Pilocarpine,  ii,  86. 
Pneumonia,  lobar. 

Acetanilide,  i,  4. 

Aconite  (as  a  sedative),  i,  9. 

Bath,  cold,  i,  488. 
Pneumonia  of  the  apex. 

Infusion,  ii,  324. 
Pneumonia,  typhoid. 

Ammonium  carbonate,  i,  56. 
Pneumothorax. 

Aspiration,  i,  151.- 
Poliomyelitis. 

See  Myelitis. 
Polypi,  aural. 

Silver  nitrate,  ii,  195. 
Polyuria. 

Kino,  i,  565. 
Porrigo. 

Ammonium  acetate,  i,  54. 

Carbolic-acid  ointment,  i,  212. 

Hyposulphites,  i,  519. 
Pregnancy,  extra-uterine. 

Galvanism,  i,  368. 
Priapism. 

Baths,  cold  sitz,  i.  489. 

Humulus,  i,  474. 

Veratrum  viride,  ii,  353. 
Prickly  heat. 

Tar  water,  ii,  36. 
Proctitis. 

Copper  arsenite,  i,  304. 

Cuprio-sulphate  solution,  i,  806. 


INDEX  OP  DISEASES  AND  EEMBDIES. 


597 


Proctocele. 

Tannin  tampons,  ii,  256. 
Prolapse,  anal. 

Copper-arsenite  solution,  i,  304. 
Prolapse  of  the  uterus. 

Massage,  i,  609. 

Tannin  tampons,  ii,  356. 
Prolapse,  rectal. 

Baths,  cold,  i,  169. 

Tannin  suppositories,  ii,  356. 
Prostatitis. 

Carbonic-acid  gas,  ii,  314. 

Corn  silk,  i,  306. 

Waters,  mineral,  ii,  377. 
Prostato-cvstitis  (following  gonorrhoea). 

Piohi,  ii,  83. 
Prostatorrhoea. 

Baths,  cold,  i,  169. 

Cantharides,  i,  308. 

Cubeb,  i,  319. 

Iron  chloride  (tincture),  i,  548. 

Salix,  i,  149. 

Silver  nitrate,  ii,  196. 
Prurigo. 

Jaborandi,  i,  560. 

Losophan,  i,  589. 

Naphthalan,  ii,  448. 

Silver  nitrate,  ii,  196. 

Sodium  thiophene-sulphonate,  ii,  309. 

Sulphur  fumes,  ii,  241. 

Tumenol  tincture,  ii,  334. 

Zinc  gynocardate,  ii,  409. 
Pruritus. 

Aconite  (locally),  i,  9. 

Baths,  hot,  i,  169. 

Brucine,  ii,  29. 

Camphor  powder,  i,  204. 

Chloral  hydrate,  i,  237. 

Chloroform  (as  a  lotion),  i,  241. 

Cocaine  collodion,  i,  293. 

Formaldehyde,  ii,  436. 

Hydrochloric  acid,  i,  493. 

Ichthyol,  i,  533. 

Lemon-juice  (diluted),  i,  260. 

Losophan,  i,  589. 

Menthol  ointment,  i,  614. 

Naphthalan,  ii,  448. 

Picric  acid,  ii,  453. 

Potassium  cyanide,  i,  323. 

Quinine,  ii,  120. 

Eosinol,  ii,  135. 

Senecio,  ii,  162. 

Tannoform,  ii,  260. 

Thymol,  ii,  284. 

(of  neurotic  origin).  Valerian,  ii,  345. 

Water,  tar,  ii,  263. 

Waters,  mineral  (externally),  ii,  375. 

Xeroform,  ii,  397. 
Pruritus,  anal. 

Baths,  hot  sitz,  i,  169. 

Camphor  powder  (with  starch)  or  ointment, 
i,  204. 

Quinine  (topically),  ii,  120. 
Pruritus,  chronic. 

Brucine,  ii,  29. 
Pruritus  of  the  external  auditory  me- 
atus. 

Nitrate  of  silver,  solution  of,  ii,  195. 
Pruritus  of  urticaria. 

Hydrochloric  acid,  sponging  with,  i,  493. 


Pruritus  pudendi,  Pruritus,  Tulyar. 

Baths,  hot  sitz,  i,  169. 

Camphor  powder  (with  starch)  or  ointment, 
i,  204. 

Formaldehyde,  ii,  436. 

Potassium  cyanide,  i,  323. 

Quinine  (topically),  ii,  120. 

(of  diabetes),  Tannoform  powder,  ii,  260. 
Pseudoleuciemia. 

Iron  chloride  (tincture),  i,  549. 

Phosphorus,  ii,  77.  . 

(pain  of),  Pyramidone,  ii,  454, 
Psoriasis. 

Alumnol  applications,  i,  51. 

Anthrarobin,  i,  103. 

Aristol,  i,  140. 

Arsenic,  i,  144. 

Baths,  hot,  i,  166. 
"    alkaline,  i,  171. 

Cashew  nut  (topically),  i,  319. 

Chrysarobin,  i,  348. 

Cod-liver  oil  (internally),  i,  288. 

Copaiba  oil,  i,  302. 

Creosote,  i,  314. 

Cupric-sulphate  solution,  i,  306. 

Gallaoetophenone,  i,  432. 

Gallanilide,  i,  432. 

Iodine,  i,  536. 

lodol,  i,  540. 

Iron,  reduced,  i,  547. 

Lead  liniment,  i,  577. 

Mercury,  ammqniated,  i,  627. 

'•        iodide  and  arsenic,  i,  637. 
"         nitrate  (ointment),  i,  638. 

Petroleum,  ii,  71. 

Phosphorus,  ii,  77. 

Pixol,  ii,  93. 

Pyrogallic  acid,  ii,  lH, 

Resorcin,  ii,  136. 

Salicylic  acid,  ii,  143, 

Silver  nitrate,  ii,  196. 

Soap,  green,  ii,  200. 

Sodium  ethylate,  ii,  307. 

Sulphur  fumes,  ii,  341. 

"        ointment  and  sulphur  baths,  ii,  241. 

Tar,  ii,  92. 
"    inunctions,  ii,  263. 

Thymol,  ii,  284. 

Thyreoid  treatment,  i,  79 ;  ii,  393. 

Zinc  gynocardate,  ii,  409. 
"     sulphydrate,  ii,  412. 
Psoriasis  giittata. 

Salicylic  acid,  ii,  144. 
Psoriasis,  inveterate. 

Soap,  green,  ii,  300. 
Ptyalism. 

See  Salivation. 
Purpura. 

Iron  chloride  (tincture),  i,  548. 
Purpura  hainiorrhagica. 

Salicylic  acid  (for  swollen  joints),  ii,  143. 
Pustule,  malignant. 

Mercury  bichloride,  i,  636. 
Pyaemia. 

Guaiacol,  i,  460. 

Iron  chloride  (tincture),  i,  549. 

Transfusion,  ii,  333. 
Pyelitis. 

Baths,  hot  sitz,  i,  169. 
"      warm,  i,  489. 


598 


INDEX  OF  DISEASES  AND  REMEDIES. 


Pyelitis. 

Buohu,  i,  197. 

Corn  silk,  i,  306. 

Naphthalene,  ii,  1. 

Salol,  ii,  150. 

Sodium  bicarbonate,  ii,  366. 

Sulphur,  ii,  241. 

Turpentine  oil,  ii,  336. 

Uva  ursi,  ii,  343. 
Pyelitis,  chronic. 

Turpentine  oil,  ii,  336. 
Pyorrlitea  alreolaris. 

Mentho-phenol,  i,  616. 

Myrrh,  tincture  of,  i,  651. 

Pyrozone,  ii,  112. 
Pyrexia. 

See  Fever. 
Pyrosis  (with  acid  eructations). 

Antacids,  i,  86. 

Chalk,  i,  230. 

Charcoal,  i,  232. 

Manganese,  oxide  of,  i,  596. 

Silver  oxide,  ii,  197. 

Waters,  mineral,  ii,  375. 

Quinsy. 

See  Amygdalitis. 

Babies. 

Hoang-nan,  1,  471. 

Serpentrionaline,  ii,  162. 

Spinal-cord  emulsion,  i,  82. 
Railway  brain. 

Eleotrioity,  i,  366. 
Railway  spine. 

Electricity,  i,  366. 
Bannla. 

Chromic  acid,  i,  248. 
Raynaud's  disease. 

See  Asphyxia,  Local. 
Regurgitation,  aortic. 

Arsenic,  i,  146. 

Cereus  grandiflorus,  i,  229. 
Regurgitation,  mitral. 

Convallaria,  i,  300. 

Sparteine,  ii,  216. 
Regurgitation  of  food  (without  nausea). 

Arsenic,  i,  146. 
Relaxation  of  tlie  fauces  and  nrnla. 

Oak  bark  (as  a  gargle),  i,  31. 
Relaxation  of  the  uvula. 

Catechu,  i,  221. 
Remittent  fever. 

Cassia  occidentalis,  i,  219. 

Quinine,  i,  255 ;  ii,  118. 

Salicylic  acid,  ii,  143. 
Renal  disease. 

See  Nephritis. 
Restlessness. 

Chloral  hydrate,  i,  236. 
Retention  of  urine. 

See  Urine,  Retention  op, 
Rhachitis. 

See  Rickets. 
Rheumatism. 

Acetanilide,  i,  5. 

Aconite,  i,  9. 

Agathin,  i,  17. 

Alphol,  i,  49. 

Amber,  oil  of,  i,  52 ;  ii,  414 


Rheumatism. 

Ammonia  (locally),  i,  53. 
Ammonium  hydrosulphide,  i,  57. 
"  succinate,  i,  58. 

"  tetrethylate,  i,  58. 

Amygdophenine,  ii,  415. 
Amyl  valerianate,  i,  62. 
Analgene,  i,  66. 
Antirrheuinatin,  i,  126. 
Antitetraizine,  i,  134. 
Apolysine,  ii,  417. 
A  pone,  i,  139. 
Arnica,  i,  141. 
Arsenic,  i,  145. 
Asaprol,  i,  148. 
Baths,  hot-air,  i,  168. 
mud,  i,  173. 

"       Nauheim,  ii,  430. 

"       pine,  i,  172. 

"       sulphur,  i,  173. 
Belladonna  and  morphine  injections,  i,  67. 
Benzoic  acid,  i,  177. 
Beta-naphthol  salicylate,  ii,  145. 
Betol,  i,  179. 
Blisters,  i,  186. 
Bryonia,  i,  197. 
Cajeput,  i,  201. 
Calotropis,  i,  203. 
Cannabis  indiea,  i,  207. 
Cereus  grandiflorus,  i,  229. 
Chamomile,  i,  231. 
Chaulmoogra  oil.  i.  238. 
Chloroform  liniment,  i,  241. 
Cicuta  virosa,  i.  250. 
Cinehonidine  salicylate,  ii,  145. 
Cold  baths,  i,  488. 

"     douche,  i,  519. 
Douches   applied   to  the   dorsal    region,   i, 

349. 
Dulcamara,  i,  353. 
Electricity,  i,  368. 
Euphorin,  i,  402. 
Exalgine,  i,  403. 
Fir-wool  oil,  ii,  87. 
Galbanum,  i,  432. 

Gaultheria,  oil  of,  and  olive  oil,  i,  124. 
Geosite,  ii,  438. 
Goose  grease,  i,  455. 
Guaiac,  i,  456. 

"       wood,  i.  457. 
Guaiacol  and  glycerin,  i,  461. 
Heat,  dry,  ii,  440. 
Hot-water  stupes,  i,  124. 
Hydriodio  acid,  i.  492. 
Hydrochloric  acid,  i,  493. 
Hydrotherapeuties,  i,  126. 
Iodine  'Salts,  i,  536. 
Iodoform  collodion,  i,  293. 
Iron  chloride  (tincture),  1,  548. 
Laotophenine,  i,  568. 
Laurel,  i,  571. 
Lemon-juice,  i,  260. 
Lithium  salicylate,  ii,  145. 
Magnolia,  i,  592. 
Manaca,  i,  595. 


hydraulic,  i,  603. 
Mentha  piperita,  i,  613. 
Mercury,  i,  619. 

"        iodide  and  arsenic,  i,  627. 


INDEX  OF   DISEASES  AND   REMEDIES. 


599 


Rheumatism. 

Methylene  blue  (by  the  stomach  or  hypo- 

derraically),  i,  639. 
Mezereon,  i,  630. 
Moringa,  ii,  447. 

Morphine  and  belladonna  injections,  i,  67. 
Nutmeg  oil  (as  a  rubefacient),  ii,  35. 
Opium   (at   the  beginning  of  an  attack),  i, 

135. 
Osmic  acid,  ii,  47. 
Peppermint,  i,  613. 
Petroleum,  ii,  70. 
Phenocoll,  ii,  73. 
Phenylacetamide,  ii,  73. 
Phosphate,  ammonium,  ii,  78. 
PhuUuah,  ii,  79. 
Phytolacca,  ii,  81. 
Pinus  pumilio,  oil  of,  ii,  88. 
Piperazine,  ii,  89. 
Pix  burgundica,  ii,  91. 
Potash,  ii,  94. 
Potassium  acetate,  ii,  95. 

"  and  sodium  tartrate,  ii,  100. 

"  carbonates,  ii,  95. 

"  citrate,  ii,  96. 

"  permanganate,  i,  596. 

Pulsatilla,  ii,  107. 
Pyrantine,  ii,  109. 
Quinine,  i,  256. 

"        salicylate,  ii,  455. 
Rhus  toxicodendron  (internally  and  topic- 
ally), ii,  133. 
Salaoetol,  ii,  139. 
Salicin,  ii,  140. 
Salicylamide,  ii,  141. 
Salicylated  collodion,  i,  393. 
Salicylic-acid  compounds,  i,  134, 143. 
Salines,  ii,  147. 
Salipyrine,  ii,  148. 
Salol,  i,  135 ;  ii,  150. 
Salophene,  i,  125 ;  ii,  151. 
Salubrine,  ii,  153. 
Sodium  benzoate,  ii,  204.  - 

"        bicarbonate  (locally),  i,  124. 

"        dithiosalicylate,  i,  125. 

"        paracresotate,  ii,  307. 

"        salicylate,  ii.  146. 
Spice  bag,  application  of,  i,  309. 
Strontium  salicylate,  ii,  147,  380. 
Sulphaminol  salicylate,  ii.  236. 
Sulphosalicylic  acid,  ii,  239. 
Sulphur,  ii,  341. 

•'        fumigation,  i,  430. 
Tansy,  ii,  361. 

Tea,  hot  (as  a  diaphoretic),  ii,  368. 
Tetrethylammonium,  ii,  373. 
Thuja,  ii,  382. 
Thymol,  ii,  383. 
Trimethylamine,  ii,  344. 
Turpentine,  ii,  335,  336. 
Urotropine,  ii,  343. 
Vaccinium,  ii,  344. 

Waters,  alkaline  (externally),  ii,  373,  375. 
Buffalo  lithia,  ii,  373. 

"        chlorinated  alkaline  (externally  and 
inlernallv),  ii.  381. 
Waters,  mineral,  ii.  374,  384. 

"        sulphur,  ii,  371. 

"        thermal,  ii,  364. 
Wet-pack,  i,  490. 


Blienmatism. 

Wintergreen  oil,  i,  134. 
Xanthoxylum,  ii,  396. 
Zinc  sulphoichthyolate,  ii,  413. 
Rheumatism,  acute. 
Aconite,  i,  9. 
Alphol,  i,  49. 

Ammonium  tetrethylate,  i,  58. 
Baths,  hot,  i,  166. 

"      sulphur,  i,  173. 
Benzoic  acid,  i,  177. 
Beta  naphthol  salicylate,  ii,  145. 
Betol,  i,  179. 
Blisters,  i,  186. 
Cimicifuga,  i,  250. 
Cold  baths,  i,  488. 
Electricity,  i,  368. 
Ephedra,  i,  385. 
Geosite,  ii,  438. 
Hydriodic  acid,  i,  493. 
Hydrochloric  acid,  i,  493. 
Lemon-juice,  i,  260. 
Lithium  salicylate,  ii,  145. 
Mentha  piperita  (oil),  i,  613. 
Phenocoll  (as  an  analgetic),  ii,  73. 
Potassium  and  sodium  tartrate,  ii,  100. 

"  carbonates,  ii,  95. 

"  citrate,  ii,  90. 

"  permanganate,  i,  596. 

Pulsatilla,  ii,  107. 
Pyrantine,  ii,  109. 
Quinine,  ii,  118. 
Salacetol,  ii,  139. 
Salicin,  ii,  140. 
Salicylic  acid,  ii,  143. 
Saligenin,  ii,  147. 
Salipyrine,  ii,  148. 
Salophene,  ii,  151. 
Sodium  salicylate,  ii,  146. 
Tetrethylammonium,  ii,  273. 
Thymol,  ii,  283. 
Trimethylamine,  ii,  331. 
Vaccinium,  ii,  344. 
Rheumatism,  chronic. 
Aconite  (as  an  anaesthetic),  i,  9. 
Baths,  hot-air,  i,  168. 

"      sand,  i,  173. 
Blisters,  i,  186. 
Cannabis  indiea,  i,  207. 
Chloroform  liniment,  i,  241. 
Qinchonidine  salicylate,  ii,  145. 
Coohlearia,  i,  284. 
Cod-liver  oil,  i,  388. 
Ephedra,  i,  385. 
Euphorin,  i,  408. 

Pir-wool  (local  application),  i,  423. 
Galbanum  (internally),  i,  432. 
Guaiac,  i,  456. 

"      wood,  i,  457. 
Iodine  salts,  i.  536. 
Mercury  iodide  and  arsenic,  i,  627. 
Moringa' (as  a  counter-irritant),  ii,  447. 
Phytolaoea,  ii,  81. 
Potassium  iodide,  ii,  98. 
Salacetol,  ii,  139. 
Salicin,  ii,  140. 
Salipyrine,  ii,  148. 
Tetrethylammonium,  ii,  373. 
Turpentine  vapour  baths,  ii,  336. 
Vaccinium,  ii,  344. 


600 


INDEX  OP  DISEASP]S  AND  REMEDIES. 


Kheumatism,  chronic. 

Waters,  mineral,  ii,  374. 

"        simple  thermal  (internally),  ii,  304. 
"        sulphur,  or  vapours,  ii,  371. 

Zinc  sulphoiohthyolate,  ii,  412. 
Eheumatisin,  gonorrhoeal. 

Salicylic  acid,  ii,  143. 
Rheumatism,  muscular. 

Aconite,  i,  9. 

Amyl  valerianate,  i,  62. 

Apolysine,  ii,  417. 

A  pone,  i,  139. 

Baths,  hot-air,  i,  168. 

Euphorin,  i,  403. 

Goose  grease  (liniment),  i,  455. 

Iodine  (externally),  i,  536. 

Massage,  i,  608. 

Osmic-auid  injections  (solutions),  ii,  47. 

Salacetol,  ii,  138. 

Salol,  ii,  150. 

Salubrine,  ii,  152. 

Strontium  salicylate,  ii,  147,  230. 

Sulphur,  ii,  241. 

"        fumigation,  i,  430. 

Waters,  sulphur,  or  vapours,  ii,  371. 
Kheumatism,  subacute. 

Cinchonidine  salicylate,  ii,  145. 

Goose-grease  liniment,  i,  455. 

Strontium  salicylate,  ii,  147,  230. 
Rhinitis. 

Blennostasine,  ii,  426. 

Carbonic-acid  inhalation,  ii,  430. 

Chromic-acid  applications,  i,  248. 

Copper  arsenite,  1,  304.. 

Iodine,  i,  536. 

lodol,  i,  540. 

Mercury-oxide  ointment,  i,  633. 

Nosophene,  ii,  19. 

Pilocarpine,  ii,  96. 

Pulsatilla,  ii,  107. 

Thymol,  ii,  283. 

Zinc  oleostearate  and  iodine,  ii,  409. 
Rhinitis,  atrophic. 

Iodine  (externally),  i,  536. 

Silver  nitrate,  ii,  195. 

Terebene.  ii,  271. 

Thymol,  ii,  283. 

Zinc  sulphate,  i,  407. 
Rhinitis,  chronic. 

Mercury  oxide  (ointment),  i,  638. 

Terebene,  ii,  371. 
Rhinitis,  chronic  hypertrophic. 

Chromic-acid  applications,  i,  248. 
Rhinitis,  dry. 

Nosophene,  ii,  19. 
Rhinitis,  hypertrophic. 

Carbonic-acid  inhalations,  ii,  430. 
Rhinitis,  posterior. 

lodol  (by  insufflation),  i,  540. 
Rhinitis,  purulent  (of  children). 

Thymol,  ii,  383. 
Rhinorrhoea,  intermittent. 

Blennostasine,  ii,  436. 
Rieliets. 

Baths,  Nanheim,  ii,  430. 

Calcium  chloride,  i,  303. 

"        phosphates,  i,  303  ;  ii,  78. 

Cod-liver  oil,  i,  338. 

Diet  in,  i,  338. 

Hsemalbumin,  i,  468. 


Rickets. 

Iron,  ainmonio-chlonde  of,  i,  549. 

Oxygen,  ii,  52. 

Phosphates,  ii,  78. 

Phosphorus,  ii,  77. 

Waters,  chlorinated,  ii,  366. 

Wine,  port,  ii,  393. 
Rlgi?s's  disease. 

See  Pyorehcea,  Alveolae. 
Rigidity  of  the  os  uteri. 

Belladonna  ointment  (or  by  injection  into 
the  vagina),  i,  174. 

Tartar  emetic,  i,  114. 
Ringworm. 

Acetic  acid,  i,  5. 

Anthracite,  i,  108. 

Chrysarobin,  i,  248. 

"  (applied  in  flexible  collodion), 

i,  117. 

Copper  (10-per-cent.  solution),  i,  117. 

Croton  oil  (to  produce  suppuration),  i,  117. 

Hyposulphites  (locally),  i,  519. 

Ink,  ii,  259. 

Iodine,  i,  536. 

"       tincture  of,  i,  117. 

Iron  tannate,  i,  553. 

Laurel,  i,  571. 

Mercury,  ammoniated,  i,  637. 
"         bichloride,  i,  117. 
"         oleate,  i,  117. 

Naphthol  plaster,  i,  117. 

Quinine,  ii,  120. 

Salicylic-acid  ointment,  ii,  144. 

Salt,  common,  applications,  ii,  206. 

Silver  nitrate,  ii,  196. 

Sodium,  ethylate  of,  i,  117. 
"         hyposulphite  of,  i,  117. 

Sulphurous  acid,  i,  117. 

Thymol,  ii,  384. 
Ringworm  of  the  body. 

See  Tinea  trichophytina. 
Ringworm  of  the  scalp. 

See  Tinea  tonsurans. 
Rosacea. 

Ichthyol  (externally  and  internally),  i,  533. 

Losophan,  i,  589. 
Roundworms. 

See  WoEMS,  Lumbricoid. 

Salivation. 

Catechu,  i,  331. 

Creosote  solution,  i,  314. 

Potassium  chlorate,  ii,  96. 

Pyoctanine,  ii,  108. 
Salpingitis. 

Electricity,  i,  368. 

Glycerin  suppositories,  i,  450. 

Ichthyol,  i,  523. 

Iodoform,  i,  538. 
Salplngo-oophorltis. 

Ichthyol,  i,  533. 

Iodoform,  i,  538. 
Sarcoma. 

Arsenic,  i,  144. 

Thiosinamine,  ii,  381. 

Toxines,  ii,  312,  314. 
Sarcoma,  multiple. 

Arsenic,  i,  144. 
Saturnism. 

Baths,  hot-air,  i,  168. 


INDEX  OP  DISEASES  AND  REMEDIES. 


601 


Saturnism. 

Calcium  sulphide,  i,  203. 
Epsom  salts,  i,  536,  576. 
Iodine,  i,  576. 
Lavage,  i,  491. 
Magnesia,  i,  111. 
Magnesium  carbonate,  i,  109. 

"  hydrate,  i,  109. 

Milk,  i,  109,  111. 
Oils,  i,  109,  111. 
Potassium  bicarbonate,  i.  111. 

"         carbonate,  i,  111. 

"         iodide,  i,  69 ;  ii,  98. 
Waters,  mineral,  ii,  376. 

"       sulphuretted,  ii,  371    , 
Scabies. 
Arsenic  (externally),  i,  145. 
Balsam  of  copaiba,  ii,  432. 

"        "  Peru  (after  a  prolonged  bath),  i, 
116,  160. 
Baths,  sulphur,  i,  173. 
Benzene,  i,  176. 
Calcium   sulphide,  sublimed   sulphur,   lime 

and  water,  i,  203. 
Carbolic-acid  ointment,  i,  212. 
Chaulmoogra  oil,  i,  233. 
Hebra  ointment,  i.  116. 
Hyposulphites,  i,  519. 
Naphthalene,  ii,  1. 
Naphthol  ointment,  ii,  2. 
Petroleum,  ii,  71. 
Potassium  sulphide  bath,  i,  116. 
Staphisagria,  ii,  221. 
Storax,  liquid,  i,  116,  160 :  ii,  228. 
Sulphur  fumigation,  i,  430. 

"        ointment,  ii,  241. 
Tar,  ii,  263. 

Turpentine  oil,  vapour  of  (thrown  on  the  bed- 
clothes), ii,  336. 
Scalds. 

See  Burns. 
Scarlatina,  Scarlet  fever. 
Aconite,  i,  8. 
Affusion,  cold,  ii,  16. 
Ammonium  carbonate,  i,  56. 
Antipyrine,  i,  123. 
Baths,  alkaline,  i,  44. 
Baths,  cold,  i,  488. 
Benzoic  acid,  i,  178. 
Chloral  hydrate,  i,  237. 
Chlorine  water,  i.  240. 
Cod-liver  oil,  i,  288. 
Cold  bath,  i,  488. 
Copper-arsenite  solution,  i,  304. 
Digitalis,  i,  343. 

Eucalyptus,  oil  of  (internally),  i,  400. 
Pats  (by  inunction),  i,  420. 
Gavage;  i,  436. 

Hydrochloric  acid  (as  a  gargle),  i,  493. 
Hydrogen  dioxide,  i,  503. 
Iron  chloride  (tincture),  i,  549. 
Lactophenine,  i,  568. 
Nucleins,  ii,  25. 

(convalescence  from),  Nutrose,  ii,  449. 
Permanganates  (internally),  ii,  70. 
Potassium  chlorate,  ii,  96. 

"  citrate,  ii,  96. 

Quinine,  i,  255  ;  ii,  119. 
Serum,  antidiphtheritic,  ii,  178. 
"       treatment,  ii,  178. 


Scarlatina,  Scarlet  ferer. 

Sparteine,  ii,  216. 
Sciatica. 

Acetanilide,  i,  3. 

Antipyi'ine,  i,  124. 

Butyl  chloral  hydrate,  i,  197. 

Cannabis  indica,  i.  207. 

Chaulmoogra  oil,  i,  233. 

Chloroform  (hypodermic  injection),  i,  241. 

Croton  oil,  i,  318.    . 

Electricity,  i,  367. 

Ephedra,  'i,  385. 

Erythrophlceine  (hypodermically),  i,  390. 

Euphorin,  i,  402. 

Exalgine  in,  i,  403. 

Galvanism,  i,  367. 

Gelsemium,  i,  437. 

Glycerophosphates,  ii,  489. 

Heat,  dry,  ii,  441. 

Massage,  i,  608. 

Methylene  blue  (by.  the  stomach  or  hypoder- 
mically), i,  629. 

Neurodin,  ii,  7. 

Nitroglycerin,  ii,  15. 

(for  inflammation).  Opium,  i,  67. 

Osmic-aeid  injections  (in  solution),  ii,  47. 

Phenacetine,  ii,  71. 

Phulluah,  ii,  79. 

Quinine,  ii,  120. 

Salicylic  acid,  ii,  144. 

Spice  bag,  application  of,  i,  209. 

Sulphur,  ii,  241. 

"         fumigation,  i,  430. 

Theine,  ii,  277. 

Turpentine  oil,  ii,  336. 

Vasogen,  iodized,  ii,  350. 

(externally  and  internally).  Waters,  sulphur- 
etted, ii,  371. 

(as  a  liniment),  Zinc  sulphoichthyolate,  ii, 
412. 
Sciatica,  clironic. 

Heat,  dry,  ii,  441. 
Sclerodermia. 

Baths,  gelatin,  i,  172. 
"      stimulating,  i,  173. 

Cod-liver  oil  (internally),  i,  288. 

Ichthyol,  i,  523. 
Sclerodermia,  circumscribed. 

Thyreoid  treatment,  ii,  293. 
Sclerosis,  amyotrophic  lateral. 

Galvanism,  i,  366. 
Sclerosis,  arterio-. 

Potassium  iodide,  ii,  98. 
Sclerosis,  dilTiise  and  multiple. 

Barium  chloride,  i,  161. 
Sclerosis,  multiple  spinal. 

Acetanilide  (for  tremors),  i,  4. 

Galvanism,  i,  367. 
Sclerosis  of  the  liver. 

Sodium  phosphate,  ii,  208. 
Sclerosis,  posterior  spinal. 

Methylene  blue,  i,  630. 
Sclerosis,  spinal. 

Acetanilide,  i,  4. 

Barium  chloride,  i,  161. 

Baths,  tepid,  i,  489. 

Conium.  i,  298. 

Galvanism,  i,  367. 

Gold,  i,  454. 

Methylene  blue,  i,  630. 


603 


INDEX  OF  DISEASES  AND  REMEDIES. 


Sclerosis,  spinal. 

Phosphorus,  ii,  76. 

Potassium  iodide,  ii,  98. 

Tepid  baths,  i,  489. 
Sclerotitis. 

Salicylic  acid,  ii,  143. 
Scorbutus. 

See  SooRVT. 
Scrofula. 

Barium  chloride,  i,  161. 

Baths,  iodated,  i,  172. 
■'       Nauheim,  ii,  420. 

pine,  i,  173. 
"       sulphurous,  i,  173. 

Calcium  benzoate,  i,  301. 

Chaulmoogra  oil,  i,  333. 

Cod-liver  oil,  i,  383. 

Creolin,  i,  313. 

Cupric-sulphato  solution,  i,  306. 

Gold,  i,  453. 
"      cyanide,  i,  333. 

Grape  cure,  i,  455. 

Guaiac  wood,  i,  457. 

Hiemalbumin,  i,  463. 

Hoang-nau,  i,  471. 

Hydriodic  acid,  i,  493. 

Hypophosphites,  i,  518. 

Iodine,  i,  535. 

Iron,  ammonio-chloride  of,  i,  549. 
"      bromide,  i.  553. 
"     iodide,  i,  551. 

Lappa,  i,  570. 

Manaea,  i,  595. 

Oxygen,  ii,  53. 

Sanguinaria,  ii,  154. 

Sea  air,  sea  bathing,  ii,  375. 

Starch,  iodized,  i,  537. 

Stillingia,  ii,  333. 

Sulphur  lumes,  ii,  341. 

Thalassotherapy,  ii,  375. 
Scrofulodermata. 

Europhene,  in  powder  or  ointment,  i,  403. 

Hydrocotyle  asiatica,  i,  493. 
Scurvy. 

Citric  acid,  i,  136. 

Copper-arsenite  solution,  i,  304. 

Dietetic  treatment,  1,  333. 

Ergot,  i,  388. 

Fresh  fruits,  i,  136. 
"  milk,  i.  136. 
"      vegetables,  i,  136. 

Lemons,  i,  136. 

Lime-juice,  i,  136,  360. 

Orange-juice,  i,  157,  338. 

Raw  scraped  meat,  i,  136. 

Turpentine  oil,  ii,  337. 

Vinegar,  i,  136. 

Wines,  i,  136 ;  ii,  394. 
Scurvy,  haeinorrliage  of. 

Ergot,  i,  388. 
Seasickness. 

Bromides,  i,  99. 

Capsicum,  i,  309. 

Chloralamide,  i.  339. 

Chloral  hydrate,  i,  337. 

Chlorobrom,  i,  340. 

Creosote,  i,  314. 

Ether  (internally),  i,  397.^ 

Ice  applied  to  the  spine,  i,  530. 

Nitroglycerin,  ii,  15. 


Seasickness. 

Sulphonal,  ii,  339. 
Seasickness,  vertigo  of. 

See  under  Vertigo. 
Seborrlioea. 
Arsenic,  i,  144. 
Hydrastine,  i,  476. 
Salicylic-acid  ointment,  ii,  144. 
Zinc  sulphide,  ii,  411. 
Seborrhoea,  dry. 

Hydrastine,  i,  476. 
Seborrhoea  of  the  face. 

Zinc  sulphide,  ii,  411. 
Secretions,  gastric. 

Waters,  alkaline  sulphated,  ii,  368. 
Secretions,  undue,  of  the  skin. 

Fuller's  earth,  i,  354. 
Senility,  premature. 
Orchitic  liquid,  i,  76. 
Septicemia. 
Benzoic  acid,  i,  178. 
Cold  baths,  i,  488. 
Infusion,  intravenous  or   subcutaneous,   ii, 

335. 
Iron  chloride  (tincture),  i,  549. 
Quinine,  i,  355. 

Serum,  antistreptoooccus,  ii,  175. 
Sodium  benzoate,  i,  159. 
Transfusion,  ii,  333. 
Septicsemia,  acute  hasmorrhagic. 

Serum,  antistreptococcus.  ii,  177. 
Septicsemia  after  operations. 
Serum,  artificial  (intravenous  injections),  ii, 
164. 
SejpticBBmia,  puerperal. 
Chlorine  water  (as  a  douche),  i,  240. 
Infusion,   intravenous    or  subcutaneous,  ii, 

325. 
Serum,  antistreptococcus,  ii,  175. 
Shock. 
Alcohol,  i,  31,  34. 
Ammonia  inhalation,  i.  53. 
Arnica,  infusion  of,  i,  141. 
Champagne,  ii.  393. 
Enema  of  hot  water,  i,  491. 
Heat,  dry  applications  of,  ii,  335. 
Infusion  and  the  subcutaneous  injection  of 

strychnine,  ii,  334. 
Saline  infusion  (by  the  rectum),  ii,  227. 
Serum,  artificial  (intravenous  injections),  ii, 

164. 
Stimulants,  cardiac,  ii,  226. 
Stroplmnthus,  ii,  231. 
Singultus. 

Bromoform,  1,  196. 

Faradization  of  the  phrenic  nerve,  i,  367. 
Sinuses. 

Calcium-phosphate  solution,  i,  202. 
Sinuses,  indolent. 

Silver  nitrate,  ii,  196. 
Sinuses,  suppurating. 

Tannin  (strong  solution),  ii,  256. 
Sloughing. 
Bromine,  i,  195. 
Creosote,  i,  314. 
Iodoform,  i,  538. 
Oxygen,  ii,  51. 

Papain  and  sodium  bicarbonate,  ii,  60. 
Potassium  permanganate,  i,  597, 
Terebene  and  olive  oil,  ii,  271, 


INDEX  OP  DISEASES  AND  REMEDIES. 


603 


Sluggishness  of  the  liver. 

See  Liver,  Torpid. 
Small-pox. 

Carbolate  of  camphor,  ii,  73. 

Carron  oil  (as  a  dressing  for  the  face),  i 
583. 

Cold  baths,  i,  488. 

Collodion,  flexible,  i,  294. 

Iodine,  i,  536. 

Mercury  plaster,  i,  633. 

Quinine,  ii,  119. 

Serum  treatment,  ii,  179. 

Sulphur  ointment,  ii,  341. 

Transfusion,  ii,  838. 

Xylene,  ii,  400. 
Small-pox,  pitting  of. 

Iodine,  i,  586. 

Mercury  plaster,  i,  633. 
Snake  bite. 

See  under  Bites. 
SneeziJbg  (of  hay  fcTer). 

Copper-arsenite  solution,  i,  304. 
Sore  nipples. 

See  Nipples,  Sore. 
Sores. 

See  Ulcers. 
Sores,  bed. 

See  Bedsores. 
Sores,  chancroid. 

See  Chancroids. 
Sores,  indolent. 

See  Ulcers,  Indolent. 
Sores,  pntrid. 

See  Ulcers,  Putrid. 
Sores,  unhealthy. 

See  Ulcers,  Unhealthy. 
Sores,  venereal. 

See  Chancres  and  Chancroids. 
Sore  throat. 

Capsicum  and  hot-water  gargle,  i,  309. 

Carbolic-acid  solution,  i,  318. 

Catechu  lozenges,  i,  331. 

Cupric  sulphate,  i,  306. 

Horehound,  i,  473. 

Iron  chloride  (tincture),  internally  and  ex- 
ternally, i,  549. 

Myrrh,  tincture  of  (as  a  gargle),  i,  651. 

Potassium  chlorate,  ii,  96. 

Rhus  glabra,  ii,  181. 

Saccharin,  ii,  137. 
Sore  throat,  aphthous. 

Saccharin,  ii,  137. 
Sore  throat,  malignant. 

Cupric  sulphate,  i,  306. 
Sore  throat  of  scarlet  fever. 

Capsicum  and  hot  water  (as  a  gargle),  i,  309. 
Spasmodic  affections. 

Massage,  i,  608. 
Spasmodic  affections  of  the  respiratory 
apparatus. 

Ipecac,  i,  373. 
Spasmodic  conditions. 

Gelsemiura,  i,  437. 
Spasmodic  conditions  of  the  bladder  and 
urethra. 

Baths,  hot  sitz,  i,  169. 
Spasmodic  contraction  of  the  arteries. 

Amyl-nitrite  inhalation,  i,  138. 

Chloral,  i,  138. 
Nitroglycerin,  1,  133. 
82 


Spasmodic  contraction  of  the  rectum. 

Belladonna  (by  the  mouth  or  by  supposi- 
tory), i,  175. 
Spasmodic  reflex  neuroses. 

Bromides,  i,  194. 
Spasms. 
Amyl-nitrite  inhalation,  i,  183. 
Baths,  hot,  i,  166. 
Belladonna,  i,  68,  133. 
Bromides,  i,  133. 
Camphor,  i,  204. 
Chloroform,  inhalation,  i,  245. 
Coniine  and  morphine,  i,  399. 
Conium,  i,  133. 
BlEeomyenchysis,  i,  356. 
Electricity,  i,  367. 
Gelsemium,  i,  437. 
Hyosoyamine,  i,  504. 
Opium,  i,  138. 
Sulphonal,  ii,  239. 
Spasms,  anal. 

Belladonna,  i,  133. 
Spasms,  bronchial. 

See  Asthma. 
Spasms,  cerebral. 
Bromides,  i,  138. 
Spasms,  clonic. 

Electricity,  i,  365. 
Spasms,  facial. 

Gelsemium,  i,  437. 
Spasms  from  irritative  lesions  of  nerve 
trunks. 
Conium,  i,  133. 
Spasms,  hysterical,  of  the  larynx. 

Chloroform  inhalation,  i,  245. 
Spasms,  intestinal. 

Opium,  i,  133. 
Spasms,  muscular. 
Coniine  and  morphine  (hypodermic  injec- 
tions), i,  299. 
Spasms  of  the  larynx. 

Bromides,  i,  133. 
Spasms  of  the  muscles  (of  broken  limbs). 

Sulphonal,  ii,  239. 
Spasms  of  the  muscular  fibres  of  the  intes- 
tines. 
Belladonna,  i,  68. 
Spasms,  rectal. 

Camphor  suppositories,  1,  204. 
Spasms,  tonic. 

Electricity,  i,  365. 
Spasms,  urethral. 
Belladonna,  i,  133. 
Camphor  suppositories,  i,  304. 
Opium,  i,  133. 
Spasms,  vesical. 
Bath,  hot,  i,  166. 
Camphor  suppositories,  i,  304 
Spermatorrhoea. 
Baths,  cold,  i,  169. 
Cantharides,  i,  208. 
Cimicifuga,  i,  350. 
Cornutine,  i,  307. 
Digitalis,  i,  343. 
Douches,  rectal,  i,  349. 
Ergot,  i,  888. 
Humulus,  i,  474. 
Hydrastine,  i,  476. 
Iron  chloride  (tincture),  i,  548. 
Salix,  ii,  149. 


604: 


INDEX  OF  DISEASES  AND  EEMEDIBS; 


Spermatorrhoea. 

Spermatorrhoea  ring,  i,  90. 
Tribulus  lanuginosus,  ii,  330. 
Turpentine  oil,  ii,  336. 
Spina  bifida. 
Aspiration,  i,  150. 
Collodion,  i,  294. 
Iodine  injections,  i,  536. 
Spinal  irritation. 

See  Irkitation,  Spinal. 
Spongy  gums. 

See  Gums,  Spongy. 
Sprains. 
Alcohol,  i,  29. 
Ammonium  acetate,  i,  54. 
Arnica,  i,  141. 
Baths,  hot,  i,  170. 
Calendula,  i,  203. 
Chaulmoogra  oil,  i,  233. 
Hamamelis,  i,  467. 
Lead,  Goulard's  extract  of,  i,  577. 
Massage,  i,  609. 
Phulluah,  ii,  79. 
Salicylated  camphor,  i,  204. 
Stupes,  hot-water,  ii,  233. 
Stenocardia. 

See  Angina  pectoris. 
Stenosis,  aortic. 
Carpaine,  i,  218. 
Stenosis,  laryngeal. 
Air,  condensed,  inspiration  of,  1,  28. 
Morphine,  ii,  37. 
Stenosis,  mitral. 
Convallaria,  i,  300. 
Digitalis,  i,  341. 

Morphine  (subcutaneously),  ii,  36. 
Stenosis  of  the  mitral  orifice. 
Sparteine,  ii,  216. 
Strophanthus,  ii,  281. 
Stenosis  of  the  tricuspid  valve. 

Digitalis,  i,  341. 
Stenosis,  syphilitic,  of  the  bronchus. 

Quillaia,  ii,  113. 
Stenosis,  tracheal. 

Air,  condensed,  inspiration  of,  i,  38. 
Sterility. 

Gold,  i,  453. 
Stings  of  flies,  wasps,  etc. 
Arnica,  i,  141. 
Ichthyol,  ii,  444. 
Sodium  bicarbonate,  ii,  204. 
Stomatitis. 
Boric  acid  (saturated  solution),  i,  191. 
Carbolic-acid  solution,  i,  213. 
Copper-arsenite  solution,  i,  304. 
Copper-sulphate  solution,  i,  306. 
Euphorin,  i,  403. 

Hydrastis  (local  applications),  i,  476. 
Potassium  chlorate,  ii,  96. 
Sulphur,  ii,  241. 
Tannin  (solution),  ii,  356. 
Stomatitis,  aphthous. 

Euphorin  (as  a  local  disinfectant),  i,  403. 
Stomatitis,  mercurial. 

Cupric-sulphate  solution,  i,  306. 
Stomatitis,  ulcerative. 
Sulphur  (locally),  ii,  341. 
Strangury. 
Alkalies,  i,  44. 
Linseed  tea,  ii,  369. 


Stricture  of  the  urethra. 

Electricity,  i,  368. 
Thiosinamine,  ii,  380,  281. 
Styes. 

Hypophosphites,  i,  518. 
Subinvolution,  uterine. 
Cimicifuga,  i,  250. 
Stypticin,  ii.  253., 
Suffocation. 

See  Asphyxia. 
Sunstroke. 

See  Insolation. 
Suppuration. 
Antipyonine,  i,  120. 
Calcium  sulphide,  i,  303. 
Capsicum  tincture  (diluted),  i,  309. 
Carbolic  acid,  i,  213. 
Charcoal,  i,  213. 
Cinnamon  oil,  i,  259. 
Creosote,  i,  314. 
Dermatol,  i,  329. 
Euphorbium,  i,  401. 
Naphthol,  ii,  3. 

Potassium  sozoiodolate,  ii,  215. 
Pyoctanine,  ii,  108. 
Pyrozone,  ii,  112. 
Quinine,  i,  256 ;  ii,  120. 
Silica,  hydrated,  ii,  191. 
Sozal,  ii,"  215. 
Sulphaminol,  ii,  336. 
Urotropine,  ii,  343. 
Xeroform,  ii,  397. 
Suppuration,  chronic,  of  tlie  ear. 

Naphthol  (by  insufHation),  ii,  2. 
Suppuration,  foul-smelling. 

Charcoal,  i,  232. 
Siippuration  of  glands. 
Carbolic  acid  (parenchymatous  injections),  i, 
213. 
Siippuration  of  the  mucous  membranes. 

Cinnamon  oil,  i,  359. 
Suppuration  of  the  urinary  tract. 

Urotropine,  ii,  343. 
Suppuration,  prolonged. 

Quinine,  ii,  130. 
Sweating. 
Agaricin,  i,  103. 
Agaricus,  i,  103. 
Atropine,  i,  103, 156. 
Belladonna,  i,  103. 
Boric  acid  and  permanganate  of  potassium, 

i,103. 
Boric  acid  and  salicylic  acid,  1,  103. 
Camphor,  i,  205. 
Dover's  powder,  i,  103. 
Duboisine,  i,  353. 
Ergot,  i,  103.  338. 
Eserine,  i,  393. 
Homatropine,  i,  471. 
Mineral  acid,  i,  103. 
Muscarine,  i,  103. 
Nucleins,  ii,  34. 
Nux  vomica,  i,  103. 
Picrotoxin,  i,  103. 
Pilocarpine,  i.  103  ;  ii,  84. 
Potassium  tellurate,  ii,  100. 
Quinine,  i,  103. 
Strychnine,  i.  102. 
Sulphonal,  ii,  239. 
Tannin,  ii,  257. 


Index  of  diseases  and  ebmedies. 


605 


Sweating. 

Vinegar  (locally),  i,  103. 

Zinc  oxide,  i,  103. 
Sweating,  colliquatiTe. 

See  Hypebidrosis. 
Sweating,  profuse. 

See  Hypbrideosis. 
Sweats,  night. 

Ergot,  i,  388. 

Nucleins.  ii,  24. 

Tannin,  ii,  257. 
Sweats,  night,  of  plithisis. 

Agaricin,  i,  17. 

Camphor,  i,  205. 

Duboisine,  i,  353. 

Eserine  (internal  administration),  i,  393. 

Homatropine,  i,  471. 

Pierotoxin,  ii,  84. 

Potassium  tellurate,  ii,  100. 

Quinine,  i,  102. 

Sulphonal,  ii,  339. 

Tannin,  ii,  257. 

Zinc  oxide,  ii,  406. 
Swelling,  lymphatic  glandnlar. 

See  Adenitis. 
Swelling  of  glands. 

See  Adenitis. 
Swelling  of  the  breasts. 

See  Mastitis. 
Swelling,  white. 

Barium  chloride,  i,  161. 

Ignipuncture,  1,  534. 
Sycosis. 

Chromic-acid  applications,  i,  248. 

Ijosophan,  i,  589. 

Sulphur    ointment    and  sulphur  baths,   ii, 
241. 
Syncope. 

Ammonia  inhalation,  i,  53. 

Amyl  nitrite,  i,  61. 

Atropine,  i,  156. 

Cold  affusions,  i,  17. 

Paradaism,  i;  367. 

Whisky,  ii,  385. 
Syncope,  cardiac. 

Atropine  (hypodermically),  i,  156. 
Syncope,  threatened. 

Strophanthus,  ii,  331. 
Synechise,  posterior. 

Scopolamine,  ii,  159. 
Synovitis. 

Carbolic-acid  injections,  i,  313. 

Massage,  i,  609. 

Methylene  blue  (by  the  stomach  or  hypoder- 
mically), i,  629. 
Synovitis,  traumatic. 

Massage  a  friction,  i,  609. 
Syphilis. 

Amidopropionic  acid    (subcutaneous  injec- 
tions), i,  62. 

Antimony,  compound  pills  of,  i,  114. 

Arsenic,  i,  145. 

Asparagin  (hypodermic  injection),  i,  148. 

Baths,  iodated,  i,  172. 
"      mercury,  i,  173. 
"     mud,  i,  173. 
"     sulphur,  i,  173. 

Calcium  phosphate,  ii,  78. 

Calomel  fumigation,  i,  634. 

Calotropis,  i,  303. 


Syphilis. 

Condurango  (as  an  alterative),  i,  397. 
Europhene,  i,  403. 
Gold,  i,  451,  453. 

"     cyanide,  i,  333. 
Guaiac,  i,  456. 

"       wood,  i,  457. 
Hydroootyle  asiatica,  i,  493. 
Infusion  of  mercury  (Bacelli's  method),  ii, 

o3«. 
Iodine  salts,  i,  536. 
Iron  iodide,  i,  551. 

"    sulphate,  i,  550. 
Lappa,  i,  570. 
Manaca,  i,  595. 
Mentho-phenol,  i,  616. 
Mercurial  fumigation,  i,  430. 
Mercury,  i,  620,  631. 

"         ammoniated,  i,  637. 

"  and  oanthardin,  i,  621. 

"  and  chalk,  i,  622. 

"  cyanide,  i,  333. 

iodide,  i,  627, 

"         ointment  inunction,  i,  633. 
oleate  of,  i,  634. 

"         tannate,  ii,  359. 
Mezereon,  i,  630. 
Nitric  acid,  ii.  8. 
Nitrohydrochloric  acid,  ii,  16. 
Oxygen,  ii,  53. 
Potassium  iodide,  ii,  97,  98. 
Pulsatilla,  ii,  107. 
Quinine,  ii,  120. 
Rubidium,  ii,  136. 
Sanguinaria,  ii,  154. 
Sarsaparilla,  i,  324. 
Serum  treatment,  i,  85;  ii,  186. 
Spermine,  ii,  217. 
Stillingia,  ii,  223. 
Thyreoid  extract,  i,  79. 

"        treatment,  ii,  295. 
Toxines,  mixed,  ii,  316. 
Traumaticin  and  calomel  (locally),  ii,  329. 
Vasogen,  iodized,  ii,  349. 
Waters,  Buffalo  lithia,  ii,  373. 

"        mineral,  ii,  374. 

"        sulphuretted,  ii,  371. 
Xanthoxylura  (an  infusion  as  a  compress),  ii, 

396. 
Zinc  gynocardate,  ii,  409. 
Syphilitic  aifection  of  the  throat   and 
nares. 
Hydrastis,  i,  476i 
Syringomyelitis. 
Paradaism,  i,  367. 

Tabes.      - 

Brain  extract,  i,  80. 

Calcium  chloride,  i,  303. 

Exalgine,  i,  403. 

Galvanization,  i,  367. 

Silver  nitrate,  ii,  194. 

Sodium  phosphate,  ii,  308. 
Tabes,  crises  of. 

Acetanilide,  i,  3. 
Tabes  dorsalis. 

Brain  extract,  i.  80. 

Silver  nitrate,  ii,  194. 

Sodium  phosphate  (subcutaneous  injections), 
ii,  208. 


606 


INDEX  OP  DISEASES  AND  KEMEDIES. 


Tabes,  lightning  pains  of. 

Exalgine,  i,  403. 
Tabes  mesenterica. 

Calcium  chloride,  i,  202. 
Tsenia. 
Absinthium  (for  preparatory  treatment),  i, 

Ailantus,  i,  18. 

Aloes  (for  preparatory  treatment),  i,  102. 
Ammonium  chloride  (for  preparatory  treat- 
ment), i,  101. 
Anthracite  coal,  powdered,  i,  103. 
Areca  nut,  i,  102. 
Aspidium,  i,  101. 
Bitter  tonics  (for  preparatory  treatment),  i, 

Calomel,  i,  103. 

Carbolic  acid,  i,  102. 

Chenopodium,  oil  of,  i,  102. 

Cuprie  oxide,  i,  305. 

Gamboge,  i,  101. 

Hot  water  (to  the  abdomen  in  preparatory 

treatment),  i,  101. 
Kamala,  i,  103. 
Kousso,  i,  103. 
Mineral  acids,  i,  101. 
Mucuna,  i,  102. 
Papain,  i,  102. 
Papoid,  i,  103 ;  ii,  60. 
Pelletierine,  i,  102. 
Pepsin,  i,  101. 

Pumpkin  seed,  powdered,  i,  102. 
Quassia,  i,  103. 
Salt,  common  (in  preparatory  treatment),  i, 

Salted  meats  (in  preparatory  treatment),  i, 

Santonin,  i,  102. 

Spigelia,  fluid  extract  of,  i,  103. 

Tin,  powdered,  i,  103. 

Turpentine  oil,  i,  103 ;  ii,  836. 
Talipes  equinus. 

Thiosinamine,  ii,  281. 
Tapeworm. 

Aspidium,  i,  101. 

Embelia  ribes.  i,  370. 

Ether  (internally),  i,  397. 

Petroleum,  ii,  71. 

Pulsatilla,  ii,  108. 
Tarsalgia. 

Bath,  hot  foot,  i,  170. 
Teleangeiectasis. 

Mercury  bichloride,  i,  626. 
Tenesmus. 

Camphor,  i,  67. 

Opium,  i,  67. 
Tetanus. 

Amyl  nitrite,  i,  61. 

Apomorphine,  ii,  417. 

Atropine,  i,  175. 

Barium  chloride,  i,  161. 

Bromide  of  potassium,  i,  194. 

Cannabis  indica,  i,  207. 

Carbolic    acid    (hypodermic    injections),    i, 
312. 

(convulsions).  Chloral  hydrate,  i,  237. 

Chloroform,  i,  528. 

Conium,  i,  399. 

Corrosive-sublimate  injections,  ii,  446. 

Curare,  i,  331. 


Tetanus. 

Infusion,  intravenous  or  subcutaneous,  ii, 

335. 
Lobelia,  i,  587. 
Methylal,  i,  639. 
Nitroglycerin,  ii,  15. 
Phenol  injections,  ii,  453. 
Serpentrionaline,  ii,  163. 
Serum  treatment,  i,  84. 
Solanum  carolinense,  ii,  309. 
Tobacco,  ii,  306. 
Urethane,  ii,  342. 
Tetanus,  idiopatliie. 

Strychnine,  ii,  38. 
Tetanus,  traumatic. 
Carbolic  acid,  ii,  439. 
Conium,  i,  399. 

Veratrum  viride  and  gelsemium,  ii,  855. 
Tetany. 

Thyreoid  treatment,  ii,  398. 
Threadworms. 

See  AscAEiDES. 
Tic  convulsif. 

Electricity,  i,  866. 
Tic  douloureux. 
Paradaism,  i,  367. 
Veratrine,  ii,  350. 
Tinea  capitis. 

Tar,  ii,  93. 
Tinea  circinata. 
Carbblio-acid  ointment,  i,  313. 
Copper  oleate,  i,  305. 
lodol,  i,  540. 
Losophan,  i,  589. 
Naphthol  ointment,  ii,  2. 
Quinine  applications,  i,  253. 
Salicylic-acid  ointment,  ii,  344. 
Sulphur  ointment,  ii,  341. 
Sulphurous  acid,  ii,  343. 
Tinea  tarsi. 

Cupric-sulphate  solution  (injection),  i,  806. 
Tinea  tonsurans. 
Carbolic-acid  ointment,  i,  313. 
Croton  oil,  i,  818. 
lodol,  i,  540. 
Losophan,  i.  589. 
Mercury  bichloride,  i,  626. 

"        red  oxide  of  (ointment),  i,  633. 
Thymol,  ii,  284. 
Tinea  trichophytina. 
Copper  oleate,  i,  305. 
Iodine,  i,  117. 

Salicylic-acid  ointment,  ii,  244. 
Tinea  versicolor. 
Losophan,  i,  589. 

Sulphur  ointment  and  sulphur  baths,  ii,  241. 
Sulphurous  acid,  ii,  343. 
Toothache. 
Aconite,  i,  9. 

"        and  iodine  tinctures,  and  chloro- 
form, i,  136. 
Atropine  sulphate,  i,  136. 
Calotropis,  i,  208. 
Carbolic  acid,  i,  218. 
Carvacrol,  i,  186. 
Chaulmoogra  oil,  i,  333. 
Chloral  hydrate  (as  an  anaesthetic),  i,  387. 
."  "        and  camphor  (equal  parts). 

Chloroform,  i,  136. 


INDEX  OF  DISEASES  AND  REMEDIES. 


607 


Toothache. 

Cloves,  oil  of,  i,  136,  372. 

Cocaine  hydrochloride  (solution),  i,  136. 

Collodion  and  carbolic  acid,  i,  136. 

Creosote,  i,  136,  314. 

Delphinine,  ii,  231. 

Ethyl  chloride,  ii,  434. 

Heat,  dry,  i,  136. 

Hop  poultice,  i,  474. 

Horseradish,  dried  root,  chewed,  i,  473. 

Menthol,  i,  136. 

Odontine,  ii,  31. 

Odontol,  ii,  31. 

Peppermint  oil,  i,  613. 

Mentho-phenol,  i,  616. 

Piscidia,  ii,  91. 

Pyrethrum,  ii,  109. 
Torpor,  hepatic. 

See  Liver,  Tokpid. 
Torticollis. 

Capsicum  (infusion  of  the  pods),  i,  309. 

Cimicifuga,  i,  350. 

Conium,  i,  298. 

Elasomyenchysis,  i,  356. 

Electricity,  i,  365. 

Galvanization,  labile  anodal,  1,  867. 
Torticollis,  spasmodic. 

Conium,  i,  398. 

Elseomyenohysis,  i,  356. 
Trachoma. 

Copper  sulphate,  ii,  214. 

lodol  (by  insuflation),  i,  540. 

Pyootanine,  ii,  108. 

Silver  iodide,  ii,  197. 
"    nitrate,  ii,  195,  314. 
Tremors. 

Thymus  extract,  ii,  385. 

Zinc  oxide,  ii,  306. 
Tremors  of  central  neryous  lesions. 

Arsenic,  i,  146. 
Trichiasis. 

Collodion,  i,  394. 
Trichiniasis. 

Glycerin,  i,  451. 

Picric  acid,  ii,  83. 
Trismus  neonatorum. 

Sulphonal,  ii,  339. 
Tuberculosis. 

Acetanilide,  i,  3. 

Agaricin,  i,  17. 

Air,  expiration  into  condensed,  i,  39. 
"     rarefied,  i,  28. 
"     inspiration  of  condensed,  i,  38. 

Airol,  ii,  414. 

Ammonium  borate,  i,  55. 

Ammonium-fluoride  inhalation,  i,  57. 

Antiphthisin,  i,  130,  131. 

Aristol  (hypodermically),  i,  140. 

Arsenic,  i,  146. 

Balsamic  fumes,  i,  529. 

Baths,  condensed-air,  i,  37. 

Benzoic  acid  (internally  and  by  inhalation), 
i,  178. 

Benzosol,  i,  179. 

Bismuth,  i,  181. 

Boric  acid,  i,  191. 

Calcium  phosphate,  ii,  78. 

(cough  of),  Camphorated-oil  injections,  i,  305. 

Cannabis  indica,  ii,  429. 

Cantharides  injections,  i,  308. 


Tuberculosis. 

Cantharidic  acid,  i,  208. 

Carbolic-acid  (solution)  inhalation,  i,  213. 

Carbon  dioxide,  i,  527. 

(by  insufflation),  i,  533. 
Catramine,  i,  336. 
Cetraria,  i,  330. 
Chaulmoogra  oil,  i,  333. 
Cinnamio  acid  and  glycerin,  i,  259. 
Cloves,  tincture  of,  i,  273. 
Cocillafia  bark,  i,  285. 
Cod-liver  oil,  i,  388. 
Conium  and  cod-liver  oil,  i,  399. 
Copper-arsenite  solution,  i,  304. 
Copper  salts,  i,  303. 
Creosote  inhalation,  i,  314. 
Croton  oil,  i,  318. 
Cupric  sulphate,  i,  306. 
Diet  in,  i,  338. 

Ergot  and  sodium  phosphate,  i,  389. 
Ethyl  iodide,  i,  538. 
Eucalyptol  inhalation,  i,  529. 
Eucasin,  ii,  436. 
Exercise,  open-air,  i,  415. 
Gavage,  i,  435. 
Gelsemium,  i,  437. 
Geosite,  ii,  438. 
Glycerin,  i,  451. 
Glycerophosphates,  ii,  439. 
Gold  and  arsenic,  i,  454. 
Grape  cure,  i,  455. 
Guaiacol  carbonate,  i,  457,  461. 
Helenin  (as  an  antiseptic),  i,  534. 
Homatropine,  i,  47. 
Hydrofluoric  acid,  i,  527. 
Hydrogen,  i,  537. 
Hygiama,  ii,  443. 
Ichthyol,  ii,  443. 

Inhalations  and  rectal  insuf&ations  of  sul- 
phuretted hvdrogen  (Bergeon's  treatment), 
ii,  371. 
Iodine,  i,  527. 

"      vapour,  i,  536. 
Iodoform,  i,  537. 
Lignosulphite,  i,  581. 
Malt  extract,  i,  595. 
Menthol  solution  (by  injection),  i,  614. 
Monochlorophenol  (in  form  of  a  spray),  i,  24. 
Myrrholin,  i,  652. 
Naphthol,  camphorated,  ii,  2. 
Nitrogen  monoxide,  i,  528. 
Nucleins,  yeast,  and  spleen,  ii,  24. 
Nux  vomica,  ii,  28. 
Oxygen,  ii,  52. 
Ozone,  ii,  58. 

Pancreatic  emulsion,  ii,  59. 
Peppermint  inhalation,  i,  614. 
Pepsin,  ii,  69. 
Peptomangan,  ii,  69. 
Petroleum,  ii,  70. 
Phosphates,  ii,  78. 
Phospho-alburain,  ii,  74. 
Piperidine,  ii,  453. 
Piscidia,  ii,  91. 
Pix  burgundica,  ii.  91, 
Potassium  phosphate,  ii,  79. 

"  sulphocyanate,  ii,  236. 

Pyootanine  injections,  ii,  109. 
Quillaia,  ii,  113. 
Quinine,  i,  256 ;  ii,  119. 


608 


INDEX  OP  DISEASES  AND  REMEDIES. 


Tuberculosis. 

Kontgen  rays,  ii,  458. 

Salicylic  acid,  ii,  143. 

Serum,  horse   (subcutaneous  injections),  ii, 
163. 

Serum,  Maragliano's,  ii,  188,  184. 

treatment,  i,  85 ;  ii,  179,  183. 

Sesame  oil,  ii,  190. 

Sodium  cantharidate,  ii,  306. 
"       formate,  ii,  207. 

Somatose,  ii,  313. 

Sparteine  (outaneously),  ii,  216. 

Spermine,  ii,  217. 

Strophanthus,  ii,  331. 

Strychnine,  ii,  449. 

Sulphaminol,  ii,  336. 

Sulphonal,  ii,  239. 

Sulphuretted    hydrogen     (Bergeon's    treat- 
ment), ii,  371. 

Tannin,  ii,  257. 

Tanosal,  ii,  261. 

Tar,  ii,  91. 

Taraxacum,  ii,  364. 

Terebene,  creosote,  eucalyptol,  and  chloro- 
form, equal  parts,  inhalation  of,  i,  539. 

Thalline,  ii,  276. 

Thymol,  ii,  283. 

Tuberculin,  i,  81. 

Turpentine  oil,  inhalation  of  steam  from, 
i,  530. 

Waters,  chlorinated  alkaline,  ii,  381. 

Whisky,  ii,  385. 

(of  young  infants).  Wine,  port,  ii,  393. 

Wines,  ii,  394. 

X-rays,  ii,  458. 

Zinc   chloride   (hypodermic   injections),    ii, 
403. 

Zinc  tannate,  ii,  413. 
Tuberculosis,  arthritic. 

Guaiaool,  i,  457. 

Iodoform,  i,  538. 
Tuberculosis,  broucliial. 

Ichthyol,  ii,  443. 
Tuberculosis,  chronic  laryngeal. 

Chloroform,  i,  538. 
Tuberculosis,  chronic  pulmonary. 

Calcium  phosphates,  ii,  78. 

Hypophosphites,  i,  518. 

Iodine,  i,  536. 

Quinine  (as  a  tonic),  ii,  119. 
Tuberculosis,  fever  of. 

Aconite,  i,  9. 

Antipyrine,  i,  133. 

Pambotano,  ii,  58. 
Tuberculosis,  incipient. 

Copper  arsenite  (vapour  or  spray),  i,  304. 
Tuberculosis,  intestinal. 

Cinnamic-acid  injections,  i,  359. 
Tuberculosis,  laryngeal. 

Ethyl-iodide  inhalation,  i,  528. 

Eucasin,  ii,  436. 

Iodine,  i,  527. 

Myrrholin,  i,  052. 

Waters,  chlorinated  alkaline,  ii,  381. 
Tuberculosis,  lingual. 

Lactic  acid,  i,  568. 
Tuberculosis,  local. 

Cloves,  tincture  of  (injections),  i,  373. 

Iodoform,  i,  537,  538. 

Tuberculin,  i,  81. 


Tuberculosis,  miliary. 

Gold  and  arsenic,  i,  454. 
Tuberculosis,  nasal. 

Lactic  acid,  i,  568. 
Tuberculosis  of  joint  cavities. 

Cinnamio  acid  and  glycerin,  i,  359. 
Iodoform,  i,  537,  538. 
Tuberculosis,  pulmonary. 

Acetanilide,  i,  3. 

Air,  condensed,  expiration  into,  i,  89. 

"  •'  inspiration  of,  i,  28. 

"    rarefied,  expiration  into,  i,  28. 
Arsenic,  i,  140. 
Balsamic  fumes,  i,  539. 
Baths,  condensed-air,  i,  27. 
Benzosol,  i,  179. 
Boric  acid,  i,  191. 
Cannabis  indioa,  ii,  439. 
Cantharidio  acid,  i,  308. 
Carbon  dioxide,  i,  527. 

"  •'       (by  insufflation),  i,  533, 

Cinnamio  acid,  i,  259. 
Creosote,  by  inhalation,  i,  314. 

"         internally,  i,  315. 
Ergot  and  sodium  phosphate,  i,  889. 
Ethyl  iodide  inhalations,  i,  528. 
Guaiacol,  i,  457-^60. 
Hydrofluoric  acid,  i,  537. 
Hydrogen,  i,  527. 
Hygiama,  ii,  443. 
Ichthyol,  ii,  443. 
Iodine,  i,  537. 

"  vapour,  i,  536. 
Lignosulphite,  i,  581. 
Monochlorophenol  (in  form  of  a  spray),  i, 

246. 
Myrrholin,  i,  652. 
Nitrogen  monoxide,  i,  538. 
Oxygen  inhalation,  ii,  53. 
Ozone  inhalation,  ii,  58. 
Peppermint,  inhalation  of  the  vapour  of,  i, 

614. 
Phosphergot,  i,  889. 
Piperidine,  ii,  453. 
Potassium  sulphocyanate,  ii,  336. 
Pyoctanine  injections,  ii,  109. 
Quillaia,  ii,  118. 
Serum,   horse   (subcutaneous  injections),  ii, 

Sodium  cantharidate,  ii,  206. 

Strophanthus,  ii,  331. 

Strychnine,  ii,  449. 

Sulphonal.  ii,  339. 

Sulphuretted    hydrogen     (Bergeon's    treat- 
ment), ii,  371. 

Taraxacum,  ii,  364. 

Terebene,  creosote,  eucalyptol,   and  chloro- 
form, equal  parts,  inhalation  of,  i,  529. 

Tuberculin,  i,  81. 

Turpentine  oil,  inhalation  of  steam  from,  i. 
530. 

Whisky,  ii,  385. 

Wines,"  ii,  394. 

Zinc  chloride  (hypodermic  injections),  ii,  403. 
Tuberculous  deposits. 

Calcium  chloride,  i,  203. 

Sulphaminol,  ii,  386. 
Tuberculous  joints. 

Iodoform,  i,  538. 

Sulphur,  ii,  341. 


INDEX  OP  DISEASES  AND  REMEDIES. 


609 


Tuberculous  tracts. 

Calcium-phosphate    solution    (for    washing 
out),  i,  303. 
Tumours. 

Electricity,  i,  361. 

Toxines,  ii,  313. 

Vienna  paste,  i,  338. 
Tumours,  cancerous. 

See  Cancer. 
Tumours,  cystic,  of  the  ovaries. 

Aspiration,  i,  153. 
Tumours,  fibroid. 

See  Fibroids,  Uterine. 
Tumours  of  the  broad  ligament  of  the 
uterus. 

Aspiration,  i,  153. 
Tumours  of  the  gums  and  tongue. 

Potassium  chlorate,  ii,  96. 
Tumours,  orarian. 

Calcium  chloride,  i,  303. 

Iodine  (hypodermic  injection),  i,  586. 
Tumours,  uterine. 

Calcium  chloride,  i,  303. 

Thyreoid  treatment,  ii,  298. 
Tympanites. 

Copper-arsenite  solution,  i,  304. 

Thymol,  ii,  283. 
Typhlitis. 

Blisters,  i,  185. 

Eucasin,  ii,  436. 
Typhoid  icTer. 

Acetanilide,  i,  3. 

Alcohol,  as  a  stimulant,  ii,  335. 

Antipyrine,  i,  133. 

Asaprol,  i,  148. 

Bath,  half,  i,  168. 

"      reducing  or  graduated,  i,  170. 

Baths,  cold,  i,  600. 

Bismuth  and  pepsin,  i,  181. 

Brand  treatment,  i,  600. 

Broraol,  i,  197. 

Calcium  bromide,  i,  308. 

Camphoric  acid  (as  an  intestinal  antiseptic), 
ii,  438. 

Carbolic  acid  and  iodine,  i,  313. 

Castor,  i,  319. 

Cold  bath,  i,  486. 

Creosote,  i,  314. 

Cupric  sulphate,  i,  306. 

Digitalis,  i,  343. 

Euoalyptol,  i,  400. 

Gavage,  i,  436. 

Guaiacol  (topical  applications),  i,  459,  460. 
"         carbonate,  i,  461. 

Hydrochloric  acid,  i,  493. 

Hygiama,  ii,  448. 

Iodine  (as  an  intestinal  antiseptic),  i,  536. 

Lactophenine,  i,  568. 

Limewatcr,  i,  582. 

Massage  (Brand's  treatment),  i,  600. 

Naphthalene,  ii,  1. 

Naphthol,  ii,  1. 

Pambotano,  ii,  58. 

(incipient  stage),  Paraforra,  ii,  61. 

Pyootanine  (internally),  ii,  109. 

Quinine,  ii,  119. 

Saligenin,  ii,  147. 

Salipyrine,  ii,  148. 

Serum  treatment,  i,  84. 

Sesame  oil,  ii,  190. 


Typhoid  fever. 

Sodium  earbolate  (as  an  intestinal  antiseptic), 

ii,  306. 
Sodium  paraoresotate,  ii,  307. 
Sulphonal,  ii,  339. 
Thalline,  ii,  376. 
Thymol,  ii,  383. 
Thymus  extract,  ii,  385. 
Transfusion  (with  lamb's  blood),  ii,  323. 
Turpentine  oil  (internally),  ii,  335. 
Water  (copious  drinks),  ii,  361. 
Wine,  port,  ii,  393. 
Zinc  sulphocarbolate,  ii,  411. 
Typhus  fever. 
Cold  bath,  i,  488. 
Emetics,  i,  374. 
Quinine,  ii,  118. 

"        salicylate,  ii,  455. 
Serum,  artificial,  ii,  165. 
Somat6se,  ii,  313. 
Wine,  port,  ii,  393. 

Ulceration. 

See  Ulcers. 
Ulcer  of  the  rectum. 

Glycerin  injections,  i,  450. 

Hydrastis,  i,  476. 

Silver  nitrate  (locally),  ii,  194. 
Ulcer  of  the  stomach. 

Arsenic,  i,  146. 

Bismuth  and  morphine,  i,  180. 

Blisters,  small  flying,  i,  180. 

C^harooal,  i,  232. 

Diet  in,  i,  335. 

Hjemalbumin,  i,  463. 

Papain,  ii,  60. 

Pepsin,  ii,  69. 

Sesame  oil,  ii,  190. 

Silver  nitrate,  ii,  194. 

Somatose,  ii,  313. 

Water,  i,  479. 
Ulcer,  rodent. 

Salicylated  camphor,  i,  204. 
Ulcers. 

Alcohol,  i,  31. 

Alum,  i,  50. 

Alumnol  (as  a  dressing),  i,  51. 

Alveloz,  i,  52. 

Antiphthisin,  i,  130. 

Antipyonine,  i,  120. 

Aristol,  i,  140. 

Atropine,  i,  155. 

Benzophenoneid,  i,  179. 

Bismuth  salicylate,  i,  180,  182. 

Borax,  i,  189. 

Boric  acid,  i,  190. 

Calcium  phosphate,  i,  203. 

Carbolic  acid,  i,  313. 

Chalk  powder,  i,  330. 

Charcoal  poultices,  ii,  103. 

Chlorine,  i,  340,  445. 

Chromic  acid,  i,  348. 

Cinchona  powder,  i,  253. 

Condurango,  i,  397. 

Copper  oleate,  i,  305. 

Cupric-sulphate  solution  (locally),  i,  306. 

Diaphtherin,  i,  332. 

Elemi,  as  a  stimulant  application,  i,  369. 

Eucalyptus,  oil  of,  i,  400. 

Euphorbium,  i,  401. 


610 


INDEX  OF  DISEASES  AND  REMEDIES. 


Ulcers. 

G-allie  acid,  i,  432. 

Geranium,  i,  438. 

Glutol,  ii,  438. 

Hydrastine,  i,  476. 

Iodine,  i,  536. 

Iodoform  collodion,  i,  293. 

lodol,  i,  540. 

Kerosene,  i,  565. 

Kino,  i,  565. 

Massage,  i,  609. 

Monochloraoetio  acid,  i,  225. 

Myrrh,  tincture  of,  i,  657. 

Naphthalene,  ii,  1. 

Naphthol,  ii,  2. 

Nuclein,  yeast,  ii,  24. 

Oak  bark,  ii,  31. 

Oxygen  (as  a  stimulant),  ii,  51. 

Paraform  (diluted),  ii,  61. 

Peat,  ii,  65. 

Phosphoric  acid,  ii,  77. 

Phytolacca,  ii,  81. 

Potassium  permanganate,  i,  597. 
"  sozoiodolate,  ii,  215. 

Pulsatilla,  ii,  107. 

Pyoctanine,  ii,  108. 

Quinine,  ii,  121. 

Resorcin,  ii,  126. 

Rosemary,  ii,  135. 

Rosinol,  ii,  135. 

Salol  (as  a  dressing),  ii,  150. 

Sozoiodol-potassium,  ii,  215. 

Spermine,  ii,  217. 

Sugar,  ii,  234. 

Tannic-acid  ointment,  ii,  259. 

Tannin,  ii,  256. 

Tannoform  ointment,  ii,  260. 

Terebene  (as  a  dressing),  ii,  271. 

Thioform,  ii,  278. 

Thiol  ointment,  ii,  278. 

Trichloracetic  acid,  i,  225. 

Tumenol  and  zinc  oxide,  ii,  334. 

Turpentine  oil,  ii,  335. 

Waters,  mineral  (externally  and  internally), 
ii,  364. 

Xeroform,  ii,  397. 

Zinc  chloride,  ii,  403. 
"    sulphate,  i,  228. 
Ulcers,  aphthous. 

Potassium  chlorate,  ii,  QG. 

Tannin,  ii,  256. 
Ulcers,  atonic. 

Camphor  (externally),  i,  204. 

Kerosene,  i,  565. 
Ulcers,  cancerous. 

See  Cancer. 
Ulcers,  chronic. 

Phosphoric  acid,  ii,  77. 

Pyoctanine,  ii,  108. 

Spermine,  ii,  217. 
Ulcers,  corneal. 

Antipyonine,  i,  120. 

Atropine,  i,  155. 

Benzophenoneid,  i,  179. 

Cadmium  sulphate,  i,  200. 

Lactic  acid,  i,  568. 

Thioform,  ii,  278. 

Water,  hot,  applications  of,  i,  813, 
Ulcers,  foul. 

Trichlorphenol  applications,  ii,  330. 


Ulcers,  foul. 

Carbolic  acid,  i,  212. 

Charcoal  poultices,  ii,  103. 

Naphthol,  ii,  2. 

Rosinol,  ii,  135. 

Peat  (as  a  dusting  powder),  ii,  65. 
Ulcers,  fungous. 

Alum,  i,  50. 

Camphor,  i,  204. 
Ulcers,  gangrenous. 

Bromine,  i,  195. 

Zinc  chloride,  ii,  403. 
Ulcer,  gastric. 

See  Ulcer  of  the  stomach. 
Ulcers,  herpetic,  of  the  cornea. 

Pyoctanine,  ii,  108. 
Ulcers,  indolent. 

Basilicon  ointment,  ii,  135. 

Bismuth  salicylate,  i,  182. 

Cupric-sulphate  solution  (locally),  i,  306. 

Elemi,  as  a  stimulant  application,  i,  3G9. 

Euphorbium,  i,  401. 

Geranium,  i,  438. 

Hydrastine,  i,  476. 

Kerosene,  i,  565. 

Monochloracetic  acid,  i,  225. 

Myrrh,  tincture  of,  i,  657. 

Nuclein,  yeast,  ii,  24. 

Oxygen  (as  a  stimulant),  ii,  51. 

Pulsatilla,  ii,  107. 

Rosemary,  ii,  135. 

Tannic-acid  ointment,  ii,  259. 

Trichloracetic  acid,  i,  225. 
Ulcers,  laryngeal. 

Creosote,  i,  314. 

Menthol,  i,  614,  615. 

Silver  nitrate,  ii,  196. 
Ulcers,  malignant. 

See  Cancee. 
Ulcers  of  the  leg. 

Naphthalan,  ii,  448. 

Thioform,  ii,  278. 

Thiosinamine,  ii,  280. 
Ulcers  of  the  mouth. 

Silver  nitrate,  ii,  195. 
Ulcers  of  the  nasal  sseptnm. 

Silver  nitrate,  ii,  195. 
Ulcers  of  the  uterus. 

Carbolic  acid,  i,  213. 

Euphorin  (in  powder,  or  an  alcoholic  solu- 
tion), i,  402. 

Gold,  i,  453. 

Iodized  cotton  tampons,  i,  310. 

Mercury  nitrate,  i,  628. 
Ulcers,  phagedenic. 

Bromine,  i,  195. 

Mercury  nitrate,  i,  628. 

Nitric  acid,  ii,  7. 
Ulcers,  putrid. 

Bromine,  i,  445. 

Tar,  ii,  263. 
Ulcers,  scrofulous. 

Gold,  i,  453. 
Ulcers,  sloughing. 

Bromine,  i,  195. 

Creosote,  i,  314. 

Papain  and  sodium  bicarbonate,  ii,  60. 
Ulcers,  suppurating. 

Potassium  sozoiodolate,  ii,  215. 
"         permanganate,  i,  440. 


INDEX  OF   DISEASES  AND  REMEDIES. 


eix. 


Ulcers,  syphilitic. 

Alveloz,  i,  53. 

Aristol,  i,  140. 

Calcium  salicylate,  ii,  145. 

Europhene,  i,  402. 

Mercury  nitrate,  i,  628. 

red  iodide  of,  i,  627. 
"        sozoiodolate,  ii,  215. 

Papain,  ii,  60. 

Salicylic  acid,  ii,  145. 

Sodium  sozoiodolate,  ii,  208. 

Zinc  oleostearate,  ii,  409. 
Ulcers,  tuberculous. 

Antiphthisin,  i,  120. 

Lactic  acid,  i,  568. 

Naphthol,  camphorated,  ii,  2. 

Oxygen,  ii,  52. 

Starch,  iodized,  i,  537. 

Tannalbin,  ii,  255. 
Ulcers,  unhealthy. 

Benzoic  acid,  i,  178. 

Charcoal  poultices,  ii,  103. 

Chlorine  poultices,  ii,  103. 

Potassium  chlorate  (externally),  ii,  96. 

Rhubarb  powder,  ii,  130. 
Ulcers,  varicose. 

Traumatol,  ii,  329. 
Ulcers,  venereal. 

Black  wash,  i,  625. 

Cupric-sulphate  solution,  i,  306. 

Euphorin  (as  a  local  disinfectant),  i,  402. 

Mercuric  nitrate,  i,  228. 

Mercury,  red  oxide  of,  i,  623. 

Nitric  acid,  i,  227. 
Uraemia. 

Baths,  hot-air,  i,  100. 

Chloroform,  i,  528. 

Elaterium,  i,  358. 

Hot-air  bath,  i,  468. 

Infusion,  intramuscular,  ii,  325. 

Jaborandi,  i,  559. 

Potassium  cobaltonitrite,  i,  273. 

Strophanthus,  ii,  281. 

Transfusion,  depletory,  ii,  328. 

Waters,  Buffalo  lithia,  ii,  372. 
Ursemia,  vomitingr  of. 

Baths,  hot-air,  i,  100. 
Ureteritis. 

Sodium  bicarbonate,  ii,  366. 
Urethritis. 

See  GONOBRHCEA. 

Uric-acid  diathesis. 

Benzoic  acid,  i,  177. 

Glycerophosphates,  ii,  439. 

Lycopodium  tincture,  i,  590. 

Phosphates,  ammonium,  ii,  78. 

Piperazine,  i,  586 ;  ii,  89. 

Potash,  ii,  94. 

Potassium  citrate,  ii,  96. 

Tartarlithine,  ii,  265. 

Uricedin,  ii,  342. 

Urotropine,  ii,  348. 

Waters,  alkaline,  ii,  367,  368. 
Uricaemia. 

See  LiTH^MiA. 
Urine,  retention  of- 

Aspiration,  i,  152. 

Baths,  acid,  i,  171. 

Com  silk,  i,  306. 

Croton  oil,  i,  318. 


Urine,  retention  of. 

Kava-kava,  i,  564. 

Kidney  extract,  i,  181. 

Massage,  abdominal,  i,  608. 

Stimulants,  spinal,  ii,  226. 
Urticaria. 

Alumnol  applications,  i,  51. 

Benzoin,  compound  tincture  of,  i,  179. 

Calcium  chloride,  ii,  427. 

Chloroform  (as  a  lotion),  i,  241. 

Emol  in  itching  of,  i,  376. 

Jaborandi,  i,  560. 

Salicylic  acid,  ii,  145. 
Urticaria,  chronic. 

Arsenic,  i,  144. 

Salicylic  acid,  ii,  143. 

Taginismus. 

Belladonna,  i,  174. 

Camphor  suppositories,  i,  204. 

Electricity,  i,  365. 
Yaginitis. 

See  Elytritis. 
Varicosities. 

Iron-chloride  (tincture)  injections,  i,  549. 
Variola. 

See  Smallpox. 
Vegetations. 

Carbolic  acid,  i,  313. 

Catheretics,  i,  225. 

Iron  chloride,  i,  548. 
Veins,  varicose. 

Barium-chloride  ointment,  i,  162. 

Ergot,  i,  388. 
Vertigo. 

Bromoform,  i,  196. 
Vertigo  of  the  aged. 

Cod-liver  oil,  i,  288. 

Strophanthus,  ii,  332. 
Vertigo  of  seasicliness. 

Amyl  nitrite,  i,  61. 
Vomiting. 

Aconite,  i,  100. 

Amyl  nitrite,  i,  99. 

Arsenic  (Fowler's  solution),  i,  99,  146. 

Bismuth  subnitrate,  i,  180. 

Bitters,  i,  183. 

Bromides,  i,  99. 

Caffeine,  valerianate,  ii,  346. 

Calomel  (small  and  repeated  doses),  i,  99. 

Calumba,  i,  100. 

Camphor,  i,  205. 

Carbonated  waters,  i,  99. 

Carbonic-acid  gas,  i,  314. 

Champagne,  iced,  i,  99;  ii,  235,  392. 

Chlorobrom,  i,  100,  240. 

Chloroform,  i,  99,  241. 

Cocaine,  i,  99. 

Creosote,  i,  314. 

Emetics,  i,  98. 

Ether,  i,  99,  397. 

Gavage,  i,  436. 

Ice,  i,  520. 

Ingluvin,  i,  526. 

Iodine  (small  doses),  i,  536. 
"      tincture  of,  i,  99. 

Ipecac,  wine  of,  i,  543. 

Kephir,  i,  98. 

Kumyss,  i,  98. 

Limewater  and  milk,  i,  583. 


613 


INDEX  OF  DISEASES  AND   REMEDIES. 


Vomiting. 

Matzoon,  i,  98. 

Milk  and  limewater,  i,  98. 

'•      cerium  oxalate  and  sodium  bicarbon- 
ate, i,  98. 
Milk,  peptonized,  i,  98. 
Mustard  plasters  applied  to  the  epigastrium, 

i,  98. 
Nitrate  of  silver,  i,  99. 
Nitroglycerin,  i,  99. 
Nux  vomica,  ii,  23. 
Opium,  ii,  37. 
Pepsin,  ii,  69. 
Podophyllin,  i.  100. 
Salicylic  acid,  i,  100. 

Serpentaria.  i,  100.  ,    ,       ^         i,\ 

Silver  nitrate  (by  irrigation  of  the  stomacn;, 

ii,  194. 
Silver  oxide,  ii,  197. 
Sulphonal  in  milk,  i,  99. 
Vinegar  fumes,  ii,  359. 
Vomiting'  after  anaesthesia. 
Champagne,  ii,  ^94. 

(with  chloroform).  Vinegar  fumes,  ii,  359. 
Vomiting,  liysterical. 
Camphor,  i,  205. 
Creosote,  i,  314. 
Galvanization,  i,  867. 
Vomiting,  morning,  of  drunltards. 
Arsenic,  i,  146. 
Bitters,  i,  100,  183. 
Calumba,  i,  100. 
Gentian,  i,  100. 
Nux  vomica,  ii,  28. 
Serpentaria,  i,  100. 
Vomiting,  nervous. 
Caffeine  valerianate,  ii,  346. 
Galvanization,  i,  367. 
Ipecac,  i,  542. 
Vomiting,  obstinate. 
Bitters,  i,  183. 
Chlorobrom,  i,  240. 
Gavage,  i,  436. 
Opium,  ii.  37. 
Silver  nitrate,  ii,  194. 
Vomiting  of  cerebral  disease. 

Bromides,  i,  99. 
Vomiting  of  chronic  gastric  disease. 
Alum,  i,  99. 
Nitrate  of  silver,  i,  99. 
Vomiting  of  gastric  atony. 

Ipecac,  i,  542. 
Vomiting  of  indigestion. 

Pepsin,  ii,  69. 
Vomiting  of  pregnancy. 
Aconite,  i,  9. 
Arsenic,  i,  146. 
Bismuth,  i.  180. 
Bitters.  1,  i83. 
Bromides,  i,  194. 
Carbonic-acid  gas,  i,  214. 
Cerium  oxalate,  i,  229. 

"        valerianate,  ii,  346. 
Champagne,  ii,  394. 
Creosote,  i,  314. 
Ether  (internally),  i,  897. 
Ingluvin,  i,  526. 
Ipecac,  i,  542. 

"  wine  of  (in  small  doses),  i,  99. 

Nux  vomica,  ii,  28. 


Vomiting  of  seasicliness. 

Amyl  nitrite,  i,  99. 

Bitters,  i,  183. 

Champagne,  ii,  394. 

Chlorobrom,  i,  100,  240. 

Nitroglycerin,  i,  99. 
Vomiting  of  uraemia. 

Baths,  hot-air,  i,  100. 
Vomiting  of  uterine  disease. 

Cerium  oxalate,  i;  229. 
Vomiting,  reflex. 

Nitroglycerin,  ii,  15. 

Warts. 

Acetic  acid,  i,  5. 

Arsenic  (internally),  i,  144. 

Chelidonium,  i,  233. 

Chromic  acid,  i,  248. 

Collodion,  salicylic  acid,  and  zinc  chloride, 

i,  293. 
Copper  oleate,  i,  305. 
Creosote  as  a  caustic,  i,  314. 
Monochloracetic  acid,  i,  235. 
Nitric  acid,  i,  227 ;  ii,  7. 
Potassium  bichromate,  ii,  95. 
Salicylic  acid,  ii,  143. 
Silver  nitrate,  ii,  196. 
Sodium  ethylate,  ii,  207. 
Trichloracetic  acid,  i,  225. 
Zinc  sulphate,  ii,  407. 
Weakness  of  old  age. 

Stimulants,  cardiac,  ii,  227. 
Weakness,  seminal. 

See  Spekmatobrhcea. 
Whitlows. 

Alkalies  (poultice  of  hard-wood  ashes),  i,  45. 
Whooping  cough. 
Acetanilide,  i,  4. 
ADyl  tribroniide,  ii,  414. 
Amber,  oil  of,  i,  52 ;  ii,  414. 
Anemonin,  ii,  108. 
Antipyrine,  i,  124. 
Antispasmin,  i.  133. 
(paroxysms),  Asafoetida,  i,  147. 

Balsamic  fumes,  i,  529. 
Baths,  condensed-air,  i,  27. 

Belladonna,  i,  174. 

Benzoic  acid,  i,  178. 

Bromoform,  i.  196. 

Bryonia,  i,  197. 

Caffeine  valerianate,  ii,  846. 

Carbolic-acid  (solution)  inhalation,  i,  213. 

Carbonic-acid  gas.  i,  214. 

Castanea  leaves.  Chestnut  leaves,  i,  319. 

Chloral  hydrate,  i,  237. 

Coccus,  Cochineal,  i,  284. 

Codeine,  i,  386. 

Conium,  i,  298. 

Copper  dioxide,  i,  527. 

Eucalyptol  inhalation,  i,  529. 

Eucalyptus  and  terebene,  oils  of,  i,  400. 

Formaldehyde,  ii,  436. 

Gclsemium,  i,  437. 

Hydrocyanic  acid,  i,  495. 

Ipecac,  i,  543. 

Lobelia,  i,  587. 

Menthol  (by  spray),  ii,  445. 
"        inhalation,  i,  .539. 

Mercury-bichloride  applications,  ii,  446. 

Muscarine,  i,  645. 


INDEX  OF  DISEASES  AND  REMEDIES. 


613 


Wh«oping"COugrli. 

Naphthalene,  ii,  1. 

Nitric  acid,  ii,  8. 

Nitrogen  monoxide,  i,  538. 

Nitroglycerin,  ii,  15. 

Opium,  fumes  of,  i,  539. 

Ouabain,  ii,  48. 

Ozone  inhalation,  ii,  58. 

Piscidia  (as  an  antispasmodic),  ii,  91. 

Quinine,  ii,  119. 

"       insufflation,  i,  353. 
"      tannate,  ii,  359. 

Resorcin  (by  spray),  ii,  136. 

Silver-nitrate    solution    (by    sponging    the 
throat),  ii,  198. 

Sodium  salicylate,  ii,  146. 
"      sozoiodolate,  ii,  308. 

Sulphur  fumes,  ii,  341. 

Terpin  hydrate,  ii,  373. 

Thymol,  ii,  383. 

Turpentine  oil,  ii,  336. 

Tussol,  ii,  337. 

Valerian,  ii,  345. 

Zinc  cyanide,  ii,  408. 
"     sulphate  (as  an  emetic),  ii,  407. 
Worms,  intestinal. 

Aloes,  i,  103. 

Ammonium  embellate,  1,  57. 

Aspidium,  i,  108. 

Bitters  (injections),  i,  183. 

Carboiic-acid  injections,  i,  103. 

Kamala,  i,  568. 

Quassia,  i,  103. 

Savine,  ii,  157. 

Thymol,  ii,  284. 
Worms,  lumbricoid. 

Andira,  i,  70. 

Chenopodium,  i,  334. 

Ether,  i,  397. 

Naphthalene,  ii,  1. 

Papain,  ii,  60. 

Spigelia,  ii,  217. 

Quassia,  ii,  113. 

Tea.  worm,  ii,  269. 
Worms,  seat. 

See  AscAEiDES. 
Wounds. 

Alcohol,  i,  29. 

Alumnol  (irrigation),  i,  51. 

Amyloforni  (as  a  deodorizer),  ii,  415. 

Antiseptics,  i,  129. 

Benzoin,  i,  179. 

Boric  acid,  i,  196. 

Bromine,  i,  195. 

Bromol,  i,  190. 

Chloral  hydrate  (locally),  i,  337. 

Cinchona  powder,  i,  253. 

Cinnamon  oil  (as  a  dressing),  i,  259. 

Collodion,  saturnine,  i,  293. 

Cydonium,  i,  323. 

Diaphtherin,  i.  333. 

Diiodoform,  i,  343. 

Eucalyptus,  oil  of,  i,  400. 

Eucasin,  ii,  435. 

Formaldehyde,  ii,  436. 

Glutei  (as  an  antiseptic),  ii,  438. 

Hydrochloric  acid,  i,  493. 


Wounds. 

Hydrogen  dioxide,  i,  503. 

Insufflation,  i,  533. 

Iodine,  i,  537. 

Iodoform,  i,  538. 

Irrigation,  i,  555. 

Izal,  i,  556. 

Mentho-phenol  and  warm  water,  i,  016. 

Naphthalene,  ii,  1. 

Olive  oil,  ii,  35. 

Oxygen,  ii,  51. 

Phenol  sodique,  ii,  73. 

Piper  nigrum,  ii,  90. 

Pixel,  ii,  92. 

Potassium  permanganate,  i,  446. 

Sanoform,  ii,  154. 

Solphinol,  ii,  211. 

Sozoiodol-potassium.  ii,  315. 

Sugar,  ii,  334. 

Sulphaminol,  ii,  336. 

Tannoform,  ii.  154. 

"  ointment,  ii,  260. 

Terebene  (as  a  dressing),  ii,  371. 

Traumatol,  ii,  329. 

Xeroform,  i,  397. 

Zinc  oleastearate,  ii,  409. 
"    oxychloride,  ii,  410. 
"    subgallate,  ii.  411. 
Wounds,  gunshot,  chronic  suppurating'. 

Waters,  mineral  (externally  and  internally), 
ii,  364. 
Wounds,  infected. 

Antisejitics,  i,  129. 

Oxygen,  ii,  51. 

Xeroform,  ii,  397. 
Wounds,  poisoned. 

Alcohol,  i.  30. 

Cydonium,  i,  333. 
Wounds,  septic. 

Iodoform  powder,  i.  538. 

Zinc  subgallate,  ii.  411. 
Wounds,  suppurating. 

Iodoform,  i,  538. 

Potassium  sozoiodolate,  ii,  315. 
Wounds,  sutured. 

Zinc  oxychloride,  ii,  410. 
Wounds,  unhealthy. 

Cinchona  powder,  i,  353. 

Permanganate  of  potassium,  i,  446. 

Quinine,  ii,  120. 
Wryneclc. 

See  ToKTicoLLis. 

Xanthelasma. 

Nitrohydrochloric  acid,  ii,  16. 
Xerodermia. 

Thyreoid  feeding  (dry  powder),  i,  79. 

Yellow  ferer. 

Calomel,  i,  624. 
Copper-arsenite  solution,  i,  304. 

Zoster. 

Aoetanilide,  i,  3. 

Blisters,  i,  186. 

Grindelia,  i,  436. 

Salicylic  acid  (for  pain),  ii,  143. 


LIST  OF  AUTHORS  CITED. 


Abbe,  R.,  ii,  53. 

Abbott,  P.  C,  ii,  177. 

Aberororabie,  P.  H.,  ii,  347. 

Abernethy,  K.,  i,  592. 

Abrahams,  R.,  ii,  457. 

Abrajanoff,  ii,  39. 

Adams,  G.,  ii,  374. 

Agnew,  H.,  i,  195. 

Ahlfeld,  ii,  123. 

Albertoni,  ii,  447. 

Alexander,  W.  S.,  ii,  436. 

Allen,  A.  H.,  ii,  109. 

Allen,  B.  W.,  ii,  133. 

Allen,  C.  W.,  ii,  116. 

Anderson,  T.  P.,  1,  373. 

Anstey,  i,  395 

Anthoire.  i,  400. 

Arendt,  B.,  i,  609. 

Arnheitn,  A.,  ii,  154. 

Aronson,  H.,  ii,  61. 

Atkinson,  ii,  116. 

Attaeld,  ii,  140. 

Aubert,  ii,  419. 

Auerbach,  ii,  47. 

Aulde,  J.,  i,  303 ;  ii,  33, 24, 133, 

Babcoek,  R.,  ii,  431. 

Babcock,  W.  L.,  ii,  393. 

Babes,  i,  84. 

Bacoelli,  ii,  333. 

Bailey,  P.,  ii,  390. 

Baldwin,  E.  R.,  i,  614. 

Ballance,  C.  A.,  ii,  177. 

Balm,  B.,  ii,  417. 

Balz,  i,  309. 

Barber,  C.  F.,  ii.  309. 

Barbour,  J.  P..  ii.  60. 

Barcklay,  J.,  ii,  293. 

Bard,  ii,  185. 

Bardet,  i,  438;  ii,  456. 

Barker,  P..  ii,  353. 

Barr,  G.  W.,  ii,  38. 

Barrows,  0.  C,  ii,  354. 

Barth,  i,  394. 

Bartholow,  i,  386,  451 ;  ii,  15, 

98. 
Barton,  ii,  18. 
Baruch,  i,  448. 
Barwell,  ii,  39. 
Bassi,  ii,  165. 
Bales,  W.  H.,  ii,  346. 
Battey,  R.,  ii,  73. 
Baumann,  ii,  300. 


Baumler,  ii,  241. 

Beehtine,  P.,  i,  385. 

Beolere,  A.,  ii,  179. 

Beddell,  W.  M.  0.,  ii,  79. 

Behring,  i.  84. 

Bell,  J.,  ii.  381. 

Bellamy,  R.,  ii,  333. 

Berg,  H.  W.,  i,  625. 

Beringer,  G.  M.,  ii,  133. 

Barman,  ii,  150. 

Bicente,  ii,  98. 

Bidder,  ii.  378. 

Bigelow,  S.  L.,  i,  292. 

Biggs,  H.  M.,  i,  84. 

Billings,  J.  S.,  i,  599. 

Binz,  li,  120. 

Blackford,  B.,  ii,  383. 

Blackwell,  ii,  132. 

Blake,  P.  R.,  ii,  376. 

Blake,  J.  B.,  ii,  18. 

Blakely,  G.  A.,  ii,  433. 

Blano,  ii,  73. 

Bleyer,  J.  M.,  ii,  23. 

Bliokensderfer,  ii.  376. 

Blooh,  Dr.  0.,  i,  524. 

Blondel,  ii,  456. 

Blum,  i,  429. 

Boal,  ii,  357. 

Boas,  ii,  365. 

Bocquillou-Limousin,    i,   343; 

ii,  230. 
Boeck,  C,  i,  577 ;  ii,  126,  186. 
Bohland,  ii,  89. 
Bondurant.  ii,  209. 
Bontor,  S.  A.,  ii,  445. 
Boody,  G.,  ii,  445. 
Boso,  ii,  325,  398. 
Bossi,  ii,  334. 
Boucher,  ii.  206. 
Bowen,  J.  T.,  ii,  150. 
Boyer,  H.  P.,  ii,  332. 
Bradbury,  J.  B.,  ii,  8. 
Bramwell,  B.,  i,  79. 
Braun,  ii.  365,  371.  373. 
Brocq,  i,  291 ;  ii.  453. 
Brodie,  B.,  i,  586. 
Brodier,  i,  343 ;  ii.  165. 
Bronowsky,  i,  302. 
Brouowski,  ii,  329. 
Brown,  B.  IL,  i.  400. 
Browne,  L.,  ii,  487. 
Brown-Sequard,  i,  74;  ii,  163. 
Bruce,  L.  C,  ii,  290. 
614 


Brunton,  T.  L.,  i,  54,  341 ;  ii, 

80. 
Buchheim,  ii,  368. 
Buiza,  i,  570. 
Bnlkley,  L.  D.,  ii,  205. 
Bunge,  i,  545. 
Burcq,  i,  303. 
Buzzi.  ii,  301. 

Cabot,  R.  C,  ii,  245. 

Caille,  A.,  i,  191 ;  ii,  58. 

Calmette,  A.,  ii,  188. 

Cantani,  ii,  258. 

Cantrell.  J.  A.,  i,  302;  ii,  144. 

Cao,  i.  403. 

Garfield,  C.  A.,  ii,  131. 

Carleton.  ii,  359. 

Carpenter,  J.  S.,  i,  460. 

Carrasquilla,  J.  de  Dies,  ii,  184 

Carron.  i.  433. 

Carselli,  ii,  229. 

Carter,  ii,  23,  435. 

Carter,  B.  W.,  i,  459. 

Cassaet,  ii,  400. 

Castex,  i,  609. 

Cattaneo,  ii,  182. 

Cauchard.  ii.  339. 

Cautley,  B.,  i,  635. 

Cerna,  D.,  i,  563.  638,  645 ;  ii, 

60,  109.  208,  373,  417. 
Cesaris,  P.,  i,  403. 
Chadwiek,  ii,  357. 
Chalke,  E.  L.,  ii,  441. 
Championt  iere,  i,  461 ;  ii,  104. 
Chandler,  W.  J.,  ii,  355. 
Chanteraesse,  i,  84;  ii,  171. 
Chaplin,  A.,  ii.  453. 
Chappell,  W.  F.,  i,  316,  409, 

436. 
Charcot,  i,  491. 
Charteris,  ii.  330. 
Chaumier,  B.,  ii.  46. 
Cheatham,  W.,  ii,  454. 
Cheron,  ii,  83. 
Chilret,  ii,  146. 
Chittenden,  R.  H.,  ii,  392. 
Claiborne,  J.  H.,  ii,  372. 
Claisse,  A.,  ii,  165. 
Clapton,  i,  303. 
Clark,  A.,  1,  450. 
Clark,  H.  M.,  i,  55. 
Clark,  J.  A.,  ii,  426. 
Clark,  L.  P.,  ii,  292. 


LIST  OF  AUTHORS  CITED. 


615 


Claus,  ii,  47,  333. 
Olendinnen,  F.  J.,  ii,  397. 
Clouston,  ii,  63. 
Coblentz,  V.,  ii,  163,  166,  265, 

431,  433,  436. 
Coghill,  J.  S.,  ii,  428. 
Cohen,  (j.,  ii,  97. 
Colin,  A.,  ii,  435. 
Cohnstein,  W.,  ii,  318. 
Cole,  ii,  53. 
Coley,  F.  C,  i,  615. 
Colombini,  ii,  150. 
Combemale,  i,  629 ;  ii,  35,  108. 
Comstoclc,  A.  J.,  i,  590. 
Conway,  J.  R.,  i,  315. 
Cooif,  A.  B.,  ii,  63. 
Cooper,  A.,  ii,  402. 
Cornet,  ii,  438. 
Cottam,  Q.  G.,  ii,  316,  415. 
Courraont,  .1.,  ii,  85. 
Cozzolino,  i.  631. 
Cred6,  ii,  192, 197. 
Crespin,  ii,  58. 
Csatdry,  ii,  331. 
Cumston,  C.  G.,  i.  399. 
Cunningham,  R.  H.,  i,  427. 
Curgfinven,  J.  B.,  i,  400. 
Curtis,  B.  F.,  ii,  53,  313. 
Curtis,  C,  i,  402. 
Curtis,  H.  H.,  i,  417. 
Czerny,  ii,  313. 

Dabney,  W.  C,  ii,  384. 

Da  Costa,  i,  397,  459. 

Dahman,  M.,  i,  463. 

Daish,  W,  C,  ii,  416,  434. 

Dalche,  ii,  456. 

Dana,  i,  403. 

D'Arsonval,  i,  71. 

Darwin,  i,  645. 

Davies,  N.  W.,  i,  596. 

Dawbarn,  ii,  328. 

Day,  ii,  53. 

Debove,  i,  435. 

De  Bueck,  ii,  278. 

De  Hart,  I.  M.,  ii,  54. 

De  Jaworski,  ii,  417, 

Delage,  ii,  439. 

Delepine,  S.,  i,  556. 

Delshenkoft,  i,  568. 

De  Mentyel,  M.,  i,  403 ;  ii,  213, 

282. 
De  Minicis,  ii,  174. 
Demontporoelet,  ii,  161. 
De  Ifeneki,  ii,  417. 
Denissenko,  ii,  431. 
De  Renzi,  ii,  398. 
Derville,  L.,  ii,  404. 
De  Sanctis,  ii,  415. 
De  Schweinitz,  ii,  188. 
Desnos,  i,  630. 
Despeignes,  V.,  ii,  398. 
De  Weeker,  i,  562. 
Dhargalkar,  L.  B.,  ii,  447. 
Dillard,  J.  W.,  ii,  383. 
Dittrich,  J.  C,  ii,  58. 
Dobell,  H.,  ii,  59. 
Dodd,  A.,  ii,  324. 
Dori,  i,  553. 
Dornblath,  O.,  ii,  154. 


Doukalsljy,  ii,  92. 
Downie,  J.  W.,  i,  614. 
Drews,  R.,  ii,  152. 
Druitt,  ii,  393. 
Dubois,  ii,  38,  185. 
Duchesne,  G.,  ii,  432. 
Duclos,  i,  433. 
Duhring,  ii,  264. 
Duiardin-Beaumetz,     i,    335, 

487. 
Duniarest,  P.,  ii,  325. 
Dumontpallier,  ii,  96,  164. 
Dunwody,  J.  A.,  ii,  163. 

Ebstein,  L.,  ii,  143. 
Eddowes,  A.,  ii,  439. 
Edgar.  .1.  C,  ii,  355. 
Edson,  C,  i,  84. 
Bhrlioh.  P.,  i,  629. 
Elder,  T.  A.,  ii,  73. 
Elkins,  F.  A.,  ii,  62. 
Elliot.  R.  H.,  ii,  30. 
Bngelhardt,  i,  474. 
England,  J.  W.,  ii,  433. 
Esoherioh,  ii,  259. 
Etienne,  ii,  451. 
Evans,  B.  D.,  ii,  63. 
Evans,  H.,  ii,  231. 
Bvenhoff,  ii,  450. 
Ewald,  ii,  300,  368. 

Pafiourse,  ii,  145. 
Faulder,  P.,  ii,  456. 
Pawcett,  ii,  89. 
Penwick,  E.  H.,  i,  590. 
Penwiok,  W.  S.,  i,  520. 
Ferguson,  J.,  ii,  448. 
Perrand,  i,  451. 
Perreira,  C,  i,  630. 
Feulard,  i,  85. 
Pilehne,  ii,  454. 
Pinsen,  i,  463. 
Flemming,  C,  i,  239. 
Plexner,  J.  A.,  ii,  343. 
Flint,  A.,  i,  630. 
Flint,  W.  H.,  ii,  62. 
Floershein,  ii,  329. 
Flourens,  i,  395. 
Forlanini,  ii,  194. 
Pothergill,  W.  E.,  ii,  456. 
Pox,  G.  H.,  ii,  209. 
Pox,  T..  ii.  409. 
Fraenkel,  E.,  ii,  285. 
FranQois,  i,  629. 
Frangois-Franck,  i,  340. 
Prankel.  S..  ii,  387. 
Praser,  T.  R.,  i,  598. 
PuUerton,  B.  B.,  ii,  121. 
Pullington,  C.  P.,  i,  588. 
Furneaux,  J.,  i,  311. 

Gaethgens,  i,  496. 
Gahn,  i,  595. 
Gallois,  i,  637. 
Gambler,  P.,  i,  588. 
Garrod,  A.  B..  ii,  371. 
Gaucher,  i,  637. 
Gepner,  i,  428. 
Gerdes,  ii,  212. 
Gerster,  A.  G.,  ii,  313. 


Gibbs,  W.,  i,  273. 
Gibier,  P.,  i,  74;  ii,  175. 
Gibney,  V.  P.,  ii,  441. 
Gihon,  A.  L.,  ii,  223. 
Gillette,  i,  293. 
Giovanni,  ii,  81. 
Girdner,  J.  H.,  i,  567. 
Girtnert,  i,  458. 
Glass,  ii,  86. 
Glenn,  J.  H.,  ii,  333. 
Gompertz,  i,  616. 
Goodman,  ii,  81. 
Gordon,  J.,  i,  403. 
Gorl,  ii,  435. 
Gorman,  A.,  i,  588. 
Gossett,  W.  B.,  ii,  415. 
Gottlieb,  ii,  254. 
Gottsohalk,  S.,  ii,  333. 
Gowers,  ii,  15. 
Graoomeni,  i,  407. 
Gradeau,  ii,  366. 
Graham,  i,  610. 
Grant,  C.  G.,  i,  259. 
Grawitz,  ii,  303,  346. 
Greene,  R.  H.,  ii,  316. 
Gregg,  W.  H.,  i,  458. 
Grinnell,  P.,  ii,  355. 
Griswold,  G.,  i,  63. 
Gniening,  ii,  115. 
Grutzner,  ii,  365. 
Gruzdeff,  V.  S.,  i,  389. 
Guiuard,  ii,  436. 
Guintsburg,  ii,  443. 
Guladze,  ii,  384. 
Gull,  W.  W.,  ii,  388. 
Qilnzburg,  A.,  ii,  401. 
Guttmann,  P.,  i,  630 ;  ii,  151. 

Haegler,  ii,  414. 

Hagnos,  i,  597. 

Haig,  ii,  140. 

Hallopeau,  i,  343. 

Halsted,  G.,  ii,  372. 

Hamilton,  A.  McL.,  i,  599 ;  ii, 

18. 
Hammarsten,  ii,  20. 
Hammond,  L.  M..  i,  571. 
Hardwicke,  W.  W.,  i,  400. 
Hare,  H.  A.,  i,  384,  435;   ii, 

448, 450.     . 
Harold,  J.,  i,  422. 
Harrington,  i,  631. 
Harrison,  C.  H.  R.,  i,  50. 
Harrison,  R.,  ii,  82. 
Hartmann.  ii,  284. 
Haubold,  H.  A.,  ii,  416. 
Hayem,  ii,  415. 
Hearder,  P.  P.,  ii,  63,  338. 
Hederich,  i,  483. 
Hendley,  H.,  ii,  446. 
Hennig,  ii,  148. 
Hermann,  T.  T.,  ii,  344. 
Hern,  i,  275. 
Herriek.  J.  B.,  ii,  293. 
Hertz,  ii,  397. 
Heuss,  E.,  ii,  397. 
Hewitt,  P.,  ii,  415. 
Hiller,  i,  496. 
Hinton,  J.,  ii,  357. 
Hirschfeld,  E.,,ii,  314 


616 


LIST  OP  AUTHORS  CITED. 


Hitchoock,  C.  W.,  ii,  24. 
Hohn,  ii,  451. 
Hood,  ii,  146. 
Hopkins,  T.  S.,  ii,  377. 
Hoppe-Seyler,  i,  496. 
Horing,  ii,  108. 
Horton,  E.  G.,  ii,  436. 
Howell,  W.  H.,  ii,  4S. 
Hrdlicka,  A.,  i,  304;  ii,  291. 
Huchard,  i,  493 ;  ii,  245,  277. 
Humplirey,  ii,  63. 
Huntley,  W.,  ii,  438,  450. 
Hurty,  J.  W.,  ii,  436. 
Hutinel,  ii,  171. 

Ignatieff,  ii,  63. 
Isaac,  R.,  ii,  447. 

Jaoobi,  A.,  ii,  121. 
Jaoobi,  C,  ii,  216. 
Jacobsohn,  W.,  ii,  25. 
Jamieson,  W.  A.,  i,  376. 
Jankau,  L.,  ii,  305. 
Joal,  ii,  430. 
Jolly,  ii,  452. 
Joseph,  ii,  357,  448. 
Josias,  ii,  178. 
Jouin,  ii,  298. 

Kahn.  i,  652. 
KampHer,  i,  590. 
Kanasz,  J.,  i,  272. 
Kane,  E.  O'JST.,  ii,  419. 
Kappeler,  i,  395. 
Keay,  J.,  ii,  240. 
Kestner,  G.,  ii,  360. 
Ketchart,  i,  458. 
Keyes,  E.  L.,  ii,  98. 
Khmelewskv,  ii,  313. 
Kibbe,  A.  B.,  ii,  399. 
Kidd,  P.,  ii,  450. 
Kiesel,  ii,  435. 
Kirscli,  E.,  ii,  431. 
Kitasato,  i,  84 :  ii,  185. 
Kloman.  W.  C.  i,  389. 
Knapp,  ii,  115,  120. 
Knapp,  0.  P.,  ii,  25. 
Robert,  ii,  113. 
Koch,  i,  306. 
Kocher,  ii,  288,  397. 
Koenig,  i,  385,  631. 
Kohos,  ii,  308. 
Kolisko,  i.  398. 
KoUe,  R  S.,  ii,  398. 
Koller,  K.,  i,  375. 
Komarovitcli,  ii,  433. 
Korff,  i,  588. 
Kossmann,  R.,  ii,  123. 
Koster,  ii,  349. 
Krafft-Ebing.  ii,  63. 
Krahn,  ii.  456. 
Krauss,  W.  C,  ii,  16. 
Krieger,  G.  B.,  ii,  217. 
Krogius,  i,  279. 
KrOnig,  ii,  72. 

Labbe,  ii.  58. 
Labit,  ii,  87. 
Laborde,  i,  611. 
Ladeire,.ii,  329. 


Ladenburg,  A.,  i,  503. 
Lafout,  ii,  17. 
Laidley,  J.  B.,  ii,  133. 
Lamarque,  i,  428. 
Lambert,  A.,  ii,  286. 
Landerer,  ii,  431. 
Landois,  ii,  318,  323. 
Lane,  ii,  241. 
Langmaid,  S.  W.,  ii,  307. 
Lannois,  i,  459. 
Lashkevieh.  i,  55. 
Laubinger,  ii,  119. 
Le  Conte,  J.  L.,  ii,  384. 
Lederer,  ii,  140,  147. 
Leech,  D.  J.,  i,  59,  60,  373 ; 

11,  15,  62. 
Lee,  R.,  ii,  331. 
Leeds,  i,  631,  642. 
Lees,  R.  C,  ii,  439. 
Leiohtenstern,  ii,  364. 
Leistikow,  L.,  ii,  136,  349. 
Leith,  R.  P.  C,  ii,  434. 
Lepine,  ii,  205,  398. 
Leppmann,  A.,  i,  629. 
Lc  Tanneur,  ii,  443. 
Letzel,  i,  433. 
Levi-Dorn,  ii,  298. 
Leventlial,  G.,  i,  630. 
Lewin,  i,  390,  359. 
Lilienthal,  H.,  ii,  54. 
Linossier,  i,  459 ;  ii,  204. 
Livet,  ii,  437. 
Loderaan,  E.  G.,  ii,  133. 
LSffler,  ii.  309. 
Loomis,  H.  P.,  i,  339. 
Lourier,  A.,  ii,  187. 
Love,  ii,  354. 
Lowenthon,  v.,  i,  581. 
Lustgarten,  ii,  359. 
Luton,  A.,  i.  303,  389. 
Lydston,  G.  F.,  i,  454. 

Maealister,  C.  J.,  ii,  52. 
Maeallum,  A.  B.,  i,  545. 
Mackenzie,  H.  W.  G.,  i,  78. 
JMaoKenzie,  T.,  ii,  61. 
jMaclennan,  ii,  452. 
iVIacMunn,  J.,  i.  259. 
Maher,  S.  J.,  ii,  401. 
Maillart  H.,  ii,  361. 
Mai  ret,  i,  639. 
Maisoh,  A.,  i,  629. 
Maitland,  C.  B.,  ii,  295. 
Maldareseo,  ii,  439. 
Mann,  J.  D.,  i,  598. 
Mann,  W.  0.,  ii,  445. 
Manotti,  i,  272. 
Maragliano,  E.,  ii,  179. 
Marcuse,  ii,  399. 
Marinesco,  ii,  91. 
Markoe,  P.  H.,  ii,  18,  53. 
Marsden,  A.,  i,  145. 
Maslovsky,  ii,  113. 
Matagne.'ii,  318. 
Maurel,  i,  540. 
Maxwell,  A.,  ii,  209. 
Mayet,  i,  343. 
Mayne.  N.,  ii,  336. 
Mays,  T.  J.,  ii,  449. 
McCosh,  A.  J.,  ii,  54. 


MoKinlock,  J.,  ii,  89. 
Meisels,  i,  429. 
Mellinger,  i,  433. 
Meltzer,  S.  J.,  ii.  289,  326. 
Mendel.  L.  B.,  ii,  392. 
Mendelsohn,  i,  585. 
Mengus,  ii,  163. 
Menzies,  J.  D.,  i,  79. 
Metral,  ii,  229. 
Milkhalkine,  ii,  15. 
Miller,  R.  E.,  i,  383. 
Miloslawski,  i,  653. 
Mitchell,  €.  L.,  i,  470. 
Mitcliell,  S.  W.,  i,  607;  ii,  126. 
Mittra,  ii,  60. 
Moblev,  H.  A.,  ii,  183. 
Molliere,  H.,  ii,  86. 
Moncorvo,  i,  403 ;  ii,  126. 
Mond,  ii,  451. 

Montgomery,  D.  W..  ii,  425. 
Monti,  ii,  432. 
Moor,  W.,  i,  597. 
Moorman,  J.  W.,  ii,  132. 
Morgan,  P.  P.,  ii,  416. 
Morgan.  J.  D.,  ii,  381. 
Morris,  E.  K.,  ii,  440. 
Morris.  L.  R.,  ii,  876. 
Morton,  J.,  ii,  330. ' 
Morton,  T.  S.  K.,  ii,  53. 
Morton,  W.  J.,  ii,  56. 
Mueller,  A.,  ii,  29. 
Mulhall,  J.  C,  ii,  306. 
MilUer,  G.  J.,  i,  569. 
Murray,  W.,  i,  620 :  ii,  194,  288. 
Murreil,  W.,  ii,  15, 159, 270, 329, 

414. 
Musmeci,  M.,  ii,  435. 
Mya,  i,  630. 
Myers,  0.  M.,  i,  199. 

Nakawaga,  ii,  187. 
Kemann,  J.,  i,  051. 
Kesbitt,  ii,  140. 
Netter,  ii,  2,  99. 
Newconib,  J.  E.,  ii,  307. 
Newton,  R.  C,  ii,  354. 
Nicolaier,  i,  84 ;  ii,  342. 
Notkin,  J.  A.,  ii,  301. 
Noyes,  H.  D.,  i,  275. 

Oberlander,  ii.  200. 

Ochsner,  A.  J.,  i,  30. 

Olderogge,  W.  W.,  ii,  159. 

Oliver,  C.  A.,  ii,  159. 

Oliver,  G.,  ii.  244. 

Ormsby,  0.  B..  i,  587. 

Orthmann.  ii,  149. 

Osier,  W..  i,  487. 

Otis,  W.  K.,  i,  540  ;  ii,  444. 

Ott,  I.,  ii,  380. 

Ottinger,  W.,  ii,  444.  ■ 

Oudin,  ii,  58. 

Overlach,  M.,  i,  631. 

Owen,  D.,  ii,  284. 

Pander,  H.,  i,  247. 
Panecki,  ii,  223. 
Paquin,  P.,  ii,  183. 
Park,  R.,  i,  647  ;  ii,  457. 
Parker,  L.,  i,  480. 


LIST  OP  AUTHORS  CITED. 


617 


Parker,  W.  R.,  ii,  293. 

Parkes,  i,  440. 

Paul,  C,  i,  630. 

Pavesi,  i,  287. 

Payne,  R.  L.,  ii,  357. 

Peale,  A.  C,  ii,  373. 

Pearse,  H.  S.,  ii,  151. 

Pease,  C.  G.,  ii,  18. 

Pelzer,  i,  450. 

Penhallow,  D.  P.,  ii,  134. 

Penzoldt,  ii,  112,  272. 

Peroni,  ii,  329. 

Personal!,  i,  639. 

Peterson,  P.,  i,  277 ;  ii,  63, 233, 

290. 
Petrasko,  J.,  ii,  440. 
Petrone,  ii.  13. 
Pettit,  ii,  237. 
Peyrot,  ii,  436. 
Pfister,  E.,  ii,  433. 
Philpots,  E.  P.,ii,  371. 
Pliisalix,  ii,  189. 
Pictet,  R.,  i,  429. 
PifEard,  fl.,  ii,  191,  360. 
Pinard,  ii,  164. 
Pinous,  L.,  ii,  233. 
Poehl,  A.,  ii,  317. 
Poggi,  ii,  99. 
Poole,  i,  337. 
Poppi,  ii,  338. 
Porteous,  J.  L.,  ii,  23. 
Porter,  I.  W.,  ii,  58. 
Post,  S.  E.,  i,  409. 
Potter,  S.  0.  L.,  ii,  39. 
Pottevin,  i,  428. 
Potts,  C.  S.,  ii,  209. 
Poulet,  ii,  48,  86. 
Powell,  B.,  ii,  133. 
Power,  F.  B.,  i,  588. 
Pozzi,  ii,  164. 
Preisach,  i,  439. 
Prentice,  C.,  ii,  443. 
Prentiss,  D.  W.,  ii,  416. 
Preyer,  i,  496. 
Purdon,  H.  S.,  ii,  161. 
Purdy,  ii,  74. 

Qiiimby,  0.  B.,  ii,  413. 

Rabinsohek,  ii.  446, 
RadolifEe,  H.,  ii,  144. 
Raderaaker,  C.  J.,  ii,  94. 
Raymond,  ii,  47. 
Rehn,  ii,  337. 
Reichert,  1,  59,  493. 
Reich-HoUender,  G.,  ii,  130. 
Reilly,  F.  J.,  ii,  206. 
Reinach,  0.,  ii,  163. 
Reinbaoh,  ii,  285. 
Rekowski,  L.,  ii,  186. 
Rendu,  ii,  458. 
Rennie,  S.  J.,  ii,  189. 
Reynier,  ii,  150. 
Rhazes,  ii,  386. 
Rice,  C.  i,  283. 
Richardiere,  i,  459. 
Richardson,  B.  W.,  i,  376,  490 ; 

ii,  50,  53,  203. 
Richardson,  D.  A.,  ii,  417. 
Richet,  i,  610. 


Richter,  ii,  280. 
Rieck.  ii,  437. 
Ringer,  S.,  i,  636  ;  ii,  256. 
Rives,  W.  C,  ii,  419. 
Roberts,  i,  586. 
Roberts,  W.,  ii,  367,  371. 
Robertson,  W.,  i,  176. 
Robin,  ii,  438. 
Robinson,  W.  J.,  ii,  443, 
Rochard,  J.,  i,  593. 
Roche,  A.,  ii,  239. 
Roger,  ii,  178. 
Rogers,  J.  G.,  ii,  398. 
Rohrig,  ii,  370. 
Roosa,  D.  B.  St.  J.,  i,  650. 
Roosevelt.  J.  W.,  i,  373. 
Rose,  A.,  i,  314. 
Rotch,  i,  631. 
Rothschild,  ii,  337. 
Rougon,  ii,  49. 
Ruhrah,  J.,  ii,  186. 
Rullier,  i,  539. 
Rumpf,  T.,  ii,  285. 
Rusbv,  Henrv  H.,  ii,  82. 
Russell,  W.  ii.,  i,  401. 
Ruth,  ii,  67. 

Saalfeld,  i,  589. 

Sachs,  B.,  ii,  98. 

Sainsbury,  H.,  ii,  178. 

Salkowskv,  E.,  ii,  436. 

Sandwith",  ii,  284. 

Sapelier,  ii,  165. 

Sasse,  ii.  337. 

Sattler,  i,  563. 

Saundbv,  ii,  438. 

Savill,  T.  D.,  i,  403  ;  ii,  437. 

Sayre,  i,  588 

Sbrana,  ii.  452. 

Scarpa,  L.  G.,  i,  523. 

Schaefer,  E.  H.,  i,  616. 

Schaeter,  T.  W.,  i,  616. 

Schafer,  L.  A.,  ii,  244. 

Schapiro,  ii,  47. 

Sehepers,  i,  453. 

Schick,  ii,  237. 

Schirman,  A.,  i,  565. 

Schleieh,  C.  L.,  ii,  438,  524. 

Schmidt,  J.  J.,  ii,  300. 

Schraitz,  A.,  ii,  2. 

Schoenbein,  C.  F.,  i,  293. 

Schonbein,  i,  496. 

Schott,  A.,  ii,  420. 

Sohott,  T.,  ii,  425. 

Schroder,  C,  ii,  47. 

Schroff,  i,  375. 

Sohulz,  ii,  238. 

Schwarz.  i,  84  ;  ii,  315. 

Sears,  G.  G.,  ii,  295. 

See,  Germain,  i,  400,  422;  ii, 

143. 
Seifert,  ii,  19. 
Semmola,  i,  85. 
Sevestre,  ii,  171. 
Sewall,  H.,  ii,  24. 
Sharp,  G.,  i,  329  ;  ii,  89. 
Sheild,  A.  M.,  ii,  415. 
Shennan,  T.,  ii,  356. 
Sherwell,  S.,  i,  313.  584. 
Shively,  H.  L.,  ii,  314. 


Shurly,  E.  L.,  i,  439. 
Siblev,  K.,  ii,  440. 
Siebel,  ii,  151. 
Silber,  M.,  ii,  456. 
Simon,  C..E.,  i,  648. 
Simpson,  W.  K.,  ii,  307. 
Sinha,  R.  D.,  ii,  436. 
Skerritt,  E.  -M..  i,  301. 
Slaughter,  H.  P.,  ii,  89. 
Smirnoff,  S.  P.,  ii,  344. 
Smith,  A.  C,  i,  630. 
Smith,  A.  H.,  i,  338,  380;  ii, 

335 
Smith,  H.,  i.  503. 
Smith,  P.  B.,  i.  530. 
Smith,  S.,  ii,  64. 
Smith.  T.,  i,  502  :  ii,  188. 
Snegirjoff,  ii,  333. 
Snow,  H.,  i,  588. 
Solis-Cohen,  J.,  i,  433,  459. 
Solis-Cohen,  S.,  ii,  3,  47,  439. 
Solly,  S.  E.,  ii,  375. 
Soulier,  ii,  73. 
Sous,  ii,  29. 

Spalding,  J.  A.,  ii,  233. 
Spillman,  ii,  2,  451. 
Squibb,  i,  614  ;  ii,  456. 
Stallard,  P.,  ii,  67. 
Stern,  H.,  ii,  418. 
Sternberg,  i,  597. 
Stieglitz,  L.,  ii,  293. 
Stimson,  L.  A.,  ii,  313. 
Stockman,  R.,  ii,  438. 
Stockwell,  A.,  i,  70. 
Stoker,  ii,  52,  451. 
Stokes,  J.,  ii,  133. 
Storer,  M.,  i,  533. 
Stuart,  T.  P.  A.,  i,  373. 
Stucky,  R.  H.,  i,  454. 
Stuve,  R.,  ii,  190, 415,  449. 
Suker,  G.  P.,  i,  386. 
Summa,  H.,  ii,  70. 
Susewind,  ii,  213. 
Suttie,  G.,  ii,  254. 
Swain,  H.  L.,  ii.  308. 
Swayze.  B.  W.,  ii,  48. 
Swiatecki,  ii,  185. 
Szenes,  i,  455,  616. 
Sziklai,  ii,  85. 

Tarnier,  ii,  164. 
Tasano,  ii,  183. 
Taube,  H..  ii,  212. 
Tavitain,  ii,  439. 
Tavlor,  J.  R.,  ii,  134. 
Taylor,  R.  W.,  ii,  98. 
Tchervinsky,  ii,  63. 
Thaver,  i,  630. 
Thiele,  W.  A.,  ii,  316. 
Thomas,  i,  596. 
Thornton,  E.  Q.,  ii,  76. 
Thur.  U.  W.  E.,  i,  630. 
Tichborne,  ii,  411. 
Tizzoni,  i,  84. 
Tommasoli,  ii,  186. 
Tonoli,  ii,  245. 
Tournier,  ii,  20.5. 
Tourrier.  ii,  178. 
Tousev,  S.,  ii,  279. 
Treille,  A.,  ii,  174. 


618 


LIST  OP  AUTHORS  CITED. 


Trillat,  i,  428. 
Tunniolieee,  P.  W.,  ii,  453. 
Turnbull,  G.  L.,  ii,  16. 

Ullraann,  K.,  ii,  458. 
Ulrici,  ii,  63. 
,  Unna,  ii,  33,  300,  348. 

Vahle,  ii,  122. 

Van  Arsdale,  W.  W.,  ii,  54. 

Van  der  Warker,  E.,  ii,  337. 

Van  der  Willigen,  i.  534. 

Van  Hook,  W.,  i,  525. 

Van   Schaick,   G.  W.,  ii,   175, 

332. 
Vargas,  ii,  72. 
Vauglian,  V.  C,  ii,  19,  31,  33, 

34. 
Veasey,  C.  A.,  ii,  334. 
Vedel,  ii,  334. 
Veeder,  M.  A.,  ii,  256. 
Vergely,  ii,  445. 
Videll,  i,  84, 
Vierordt,  ii,  254. 
Vinci,  G.,  ii,  434. 
Vintras,  ii.  303. 
Vogl,  i,  487. 


Vogt,  ii,  333. 

Volintzeff,  ii,  418. 

Vollert,  ii,  435. 

Von  Engel,  ii,  254. 

Von  Generisch,  ii,  258. 

Von  Graefe,  ii,  115. 

Von  Mering,  J.,  ii,  7. 

Von  Mosetig-Moo'rhof,  ii,  373. 

Von   Noorden,  i,  544;   ii,  19, 

424,  436,  447. 
Von  Ruck,  ii,  69. 
Von  Ziemssen,  i,  490 ;  ii,  334. 
VuUiet,  i,  31. 

Wade,  J.  P.,  i,  340. 
Wade,  W.  C,  i,  51. 
Wadleigii,  W.  K.,  ii,  332. 
Wagner,  i,  276  ;  ii,  145. 
Warden,  i,  561. 
Waterhouse,  W.  D.,  i,  76. 
Waterman,  J.  H.,  ii,  441. 
Waters,  B.  H.,  ii,  151. 
Watson,  C,  i,  588. 
Weinrich,  M.,  ii,  433. 
Weir,  R.  P.,  i,  393. 
Weisbecker,  ii,  178. 
Welch,  E.  A.,  i,  189. 


Welch,  J.  W.,  ii,  134. 
Werler,  0.,  ii,  198. 
West.  S.,  ii,  338-343. 
Wheeler,  G.  A.,  i,  199. 
Whipple,  T.  S.,  i.  587. 
White,  W.  J.,  ii,  97. 
Whitehead,  J.  B.,  ii,  134. 
Whittaker.  J.  T.,  i,  403. 
Williams,  J.  D.,  ii,  175. 
Williamson,  R.  T.,  ii,  431. 
Willis,  P.  P.,  ii,  355. 
Wilson,  E.,  i,  394. 
Winkler,  P.,  ii,  398. 
Witte,  ii,  133. 
Wood,  H.  C.  i,  31,  56,  59,  194, 

311,430,435,486,597;  ii,  14, 

91,  330,  351. 
Wyss,  i,  458. 

Yeo,  i,  338  ;  ii,  14. 
Younger,  E.  6.,  i,  403. 

Zaeslein,  ii,  179,  180. 
Ziegenspeck,  R.,  i,  609. 
Ziegler,  i,  333. 
Zuhoff,  i,  597. 


END   OP  VOLUME  U. 


^SftSS 


''.>K>i:'S»i^"